CAYMAN
ISLANDS
GAZETTE
Extraordinary No.64/2013
Friday, 09 August 2013
Supplement
The following supplement is published with this issue of the Gazette. Further copies may be obtained from the
Clerk of the Legislative Assembly.
1. The Cayman National Cultural Foundation Law, 2013 (Commencement) Order, 2013. (80 cents)
COMMERCIAL
Liquidator and Creditor Notices
A copy of both forms and details for the
teleconferencing facilities can be obtained directly
from the Joint Official Liquidators.
Please note that both the proof of debt and
proxy form are to be submitted to the Joint
Official Liquidators by returning the completed
form(s) to the address detailed below or by
emailing the documents to the email address listed
below, prior to 12pm (Cayman Time) on 26
August 2013.
If you wish to attend, either in person or via
telephone conference, please contact Devina Patel
no later than 26 August 2013 to obtain further
information.
Dated this 6 day of August 2013
IAN STOKOE
Joint Official Liquidator & Chairman of the
Meeting
Contact for Enquiries:
Devina Patel
[email protected]
Telephone: (345) 914 8739
Facsimile: (345) 945 4237
Address for service:
PwC Corporate Finance & Recovery (Cayman)
Limited
PO Box 258
Strathvale House, North Church Street
George Town
Grand Cayman KY1-1104
RUBY REALTY CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 165726
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
SERENA OWNERSHIP LIMITED
(The “Company”)
(In Official Liquidation)
The Companies Law
Notice of Appointment and Notice of
Creditors’ Meeting
(Registered No. 120254)
Grand Court Cause No. FSD 92 of 2013 AJJ
TAKE NOTICE that by order of the Grand Court
made on 5 August 2013, Serena Ownership
Limited, registration number 120254, whose
registered office is situated at Maricorp Services
Limited, PO Box 2075 GT, # 31 The Strand, 46
Canal Point Road, West Bay Road, Grand
Cayman, Cayman Islands KY1-1105, was ordered
to be wound up in accordance with the
Companies Law (as amended).
AND FURTHER TAKE NOTICE that Ian
Stokoe and David Walker of PwC Corporate
Finance and Recovery (Cayman) Limited, PO
Box 258, Strathvale House, 90 North Church
Street, George Town, Grand Cayman, Cayman
Islands KY1-1104 have been appointed as Joint
Official Liquidators of the Company.
NOTICE IS HEREBY GIVEN, pursuant to
section 105(3) of the Companies Law (as
amended) that the Official Liquidators hereby
convene the first meeting of the creditors of the
Company on 29 August 2013 at 8.00am Cayman
Islands’ time (2.00pm UK time), for the purpose
of electing a liquidation committee in respect of
the Company and providing an update on the
conduct of the liquidation.
In order to attend and vote at the above
meeting, creditors are required to complete and
submit to the Joint Official Liquidators, in
advance of the meeting, a proof of debt form.
Any person who is entitled to attend and vote
at this meeting may appoint a proxy to attend in
his stead. A proxy form should be completed and
returned to the Joint Official Liquidators prior to
the meeting if you cannot attend and wish to be
represented. A proxy-holder need not be a
creditor.
Extraordinary No.63/2013
2
Friday, 02 August 2013
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
MUSASHI CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 208834
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
Extraordinary No.64/2013
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
KUROBE CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 215824
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
3
Friday, 09 August 2013
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
SAYAMA CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 188851
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
Extraordinary No.64/2013
DOTONBORI KAIHATSU CAYMAN CO.,
LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 194092
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
4
Friday, 09 August 2013
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
SHANGREN (TRADE FINANCE) LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 213083
TAKE NOTICE that the Company was put into
liquidation on 7 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Natasha Morgan of Maples
Liquidation Services (Cayman) Limited were
appointed joint voluntary liquidators with the
power to act jointly and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
KAIHIN CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 196377
TAKE NOTICE that the Company was put into
liquidation on 8 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
TSENGWEN INVESTMENTS LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 213524
TAKE NOTICE that the Company was put into
liquidation on 6 August 2013 by a written
resolution of the shareholder of the Company.
Extraordinary No.64/2013
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Friday, 09 August 2013
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 7 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
CREDIT SUISSE PATHFINDER FUND
(CAYMAN) LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 231359
TAKE NOTICE that the Company was put into
liquidation on 5 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Extraordinary No.64/2013
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
THORIUM COMMODITIES MASTER
FUND LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 239665
TAKE NOTICE that the Company was put into
liquidation on 5 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that
Mervin Solas and Marc Randall of Maples
Liquidation Services (Cayman) Limited were
appointed joint voluntary liquidators with the
power to act jointly and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 5 August 2013
MERVIN SOLAS
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
6
Friday, 09 August 2013
Contact for Enquiries:
[email protected]
BELAY GP LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 233828
TAKE NOTICE that the Company was put into
liquidation on 2 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that
Mervin Solas and Marc Randall of Maples
Liquidation Services (Cayman) Limited were
appointed joint voluntary liquidators with the
power to act jointly and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 5 August 2013
MERVIN SOLAS
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
Extraordinary No.64/2013
RELIGARE ALPHA FUND SPC
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 117175
TAKE NOTICE that the Company was put into
liquidation on 5 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
7
Friday, 09 August 2013
ABSOLUTE PARTNERS BLUE OCEAN
FUND LIMTED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 232418
TAKE NOTICE that the Company was put into
liquidation on 5 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
Extraordinary No.64/2013
MEC PROPERTY FUNDING
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Notice to Creditors from Liquidator
Registration No 108222
TAKE NOTICE that the Company was put into
liquidation on 5 August 2013 by a written
resolution of the shareholder of the Company.
AND FURTHER TAKE NOTICE that Marc
Randall and Mervin Solas of Maples Liquidation
Services (Cayman) Limited were appointed joint
voluntary liquidators with the power to act jointly
and severally.
AND FURTHER TAKE NOTICE that the
creditors of the Company are required on or
before 9 September 2013 to send in their names
and addresses and the particulars of their debts or
claims and the names and addresses of their
attorneys-at-law (if any) to the below contact and
if so required by notice in writing from the
liquidator either by their attorneys-at-law or
personally to come in and prove the said debts or
claims at such time and place as shall be specified
in such notice or in default thereof they will be
excluded from the benefit of any distribution
made before such debts are proved.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
8
Friday, 09 August 2013
Notices of Final Meeting of Shareholders
RUBY REALTY CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 165726
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:45 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
MUSASHI CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 208834
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:40 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
KUROBE CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 215824
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:35 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
Extraordinary No.64/2013
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
SAYAMA CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 188851
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:30 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
10
Friday, 09 August 2013
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
DOTONBORI KAIHATSU CAYMAN CO.,
LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 194092
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:25 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Extraordinary No.64/2013
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
KAIHIN CAYMAN CO., LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 196377
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:20 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
11
Friday, 09 August 2013
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
TSENGWEN INVESTMENTS LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 213524
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:15 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Extraordinary No.64/2013
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 8 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
SHANGREN (TRADE FINANCE) LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 213083
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 12 September
2013 at 10:10am.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
12
Friday, 09 August 2013
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 7 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
CREDIT SUISSE PATHFINDER FUND
(CAYMAN) LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 231359
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 12 September
2013 at 10:00am.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
Extraordinary No.64/2013
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
THORIUM COMMODITIES MASTER
FUND LTD.
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 239665
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 12 September
2013 at 1:40 PM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
13
Friday, 09 August 2013
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MERVIN SOLAS
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
BELAY GP LIMITED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 233828
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 12 September
2013 at 1:30 PM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
Extraordinary No.64/2013
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MERVIN SOLAS
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
[email protected]
RELIGARE ALPHA FUND SPC
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 117175
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:10 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
14
Friday, 09 August 2013
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
ABSOLUTE PARTNERS BLUE OCEAN
FUND LIMTED
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 232418
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:05 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
date of dissolution, after which they may be
destroyed.
Extraordinary No.64/2013
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
MEC PROPERTY FUNDING
(In Voluntary Liquidation)
(The "Company")
The Companies Law
Registration No: 108222
TAKE NOTICE that pursuant to section 127 of
the Companies Law (2012 revision) the final
general meeting of the Company will be held at
the offices of MaplesFS Limited, 4th Floor,
Boundary Hall, Cricket Square, Grand Cayman
KY1-1102, Cayman Islands, on 10 September
2013 at 9:00 AM.
Business:
1. To approve the Joint Voluntary Liquidators
final report and accounts of the winding up and
any explanation thereof.
2. To approve the Joint Voluntary Liquidators’
remuneration.
3. To resolve that the Joint Voluntary Liquidators
be authorised to retain the company’s books and
records for a period of six years following the
15
Friday, 09 August 2013
date of dissolution, after which they may be
destroyed.
4. To resolve that the Joint Voluntary Liquidators
be authorised to hold on trust the proceeds of any
uncleared dividend cheques which remain
uncleared for more than six months and, after
twelve months from the date of dissolution of the
Company, to transfer such proceeds to the
Financial Secretary in accordance with section
153(2) of the Companies Law (2012 Revision).
Proxies: Any person who is entitled to attend and
vote at this meeting may appoint a proxy to attend
and vote in his stead. A proxy need not be a
member or creditor. Please use below contact
details to confirm your attendance in person or by
proxy.
Date: 5 August 2013
MARC RANDALL
Joint Voluntary Liquidator
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
PO Box 1093, Boundary Hall
Grand Cayman KY1-1102
Cayman Islands
Contact for Enquiries:
Marc Randall
Email: [email protected]
Extraordinary No.64/2013
16
Friday, 09 August 2013
Partnership Notices
BORONIA INVESTMENT, L.P.
(In Voluntary Winding Up)
(The "Exempted Limited Partnership")
The Exempted Limited Partnership Law
Notice to Creditors from General Partner
Registration No: 32148
NOTICE IS HEREBY GIVEN pursuant to
section 15(4) of the Exempted Limited
Partnership Law (2012 Revision) that the winding
up and dissolution of the Exempted Limited
Partnership commenced on 2 August 2013 in
accordance with the terms of the partnership
agreement dated 26 February 2009 (the
"Partnership Agreement").
Boronia Investment GP, LLC in its capacity
as general partner shall wind up the Exempted
Limited Partnership in accordance with the terms
of the Partnership Agreement.
The creditors of the Exempted Limited
Partnership are required on or before 9 September
2013 to send in their names and addresses and the
particulars of their debts or claims to Boronia
Investment GP, LLC or in default thereof they
will be excluded from the benefit of any
distribution made before such debts are proved.
Date: 6 August 2013
BORONIA INVESTMENT GP, LLC
Address for service:
c/o Maples Liquidation Services (Cayman)
Limited
4th Floor, Boundary Hall
Cricket Square, George Town
Grand Cayman
Cayman Islands
Contact:
Marc Randall +1 345 814 5748
GOVERNMENT
Departmental Notice
THE CAYMAN ISLANDS
DEVELOPMENT & PLANNING LAW (2011 REVISION)
SECTION 3 (2) and (5)
NOTICE OF APPOINTMENT
CENTRAL PLANNING AUTHORITY
In accordance with Sections 3(2) and 3(5) of the Development and Planning Law (2011 Revision), the
Governor-in-Cabinet has appointed the following persons to the Central Planning Authority, who shall hold
office from 1 August 2013 until 31 July 2015:
NAME
POSITION
Mr. A. L. Thompson
Chairman (reappointment)
Mr. Robert Selkirk Watler, Jr.
Deputy Chairman
Mr. Fred Whittaker
Member
Mr. Ray Hydes
Member (reappointment)
Mr. Rex Miller
Member (reappointment)
Mr. Eldon Rankin
Member (reappointment)
Mr. Dalkieth Bothwell
Member
Mr. Ashton Bodden
Member, DCB
Mrs. Sharon Roulstone
Member
Mr. Trent McCoy
Member
Mr. Joseph Coe
Member
Mr. Selvin Richardson
Member
Mr. S. T. Bodden
Member
Director of Planning
Executive Secretary
Made in Cabinet this 6 day of August 2013
CARMENA H WATLER
Acting Clerk of the Cabinet
Departmental Notice
STANDARD HEALTH INSURANCE FEES
SHIC PLAN
CPT
10021
10022
10040
10060
10061
DESCRIPTION
FEE
Fine needle aspiration w/o imaging guidance
Fine needle aspiration with imaging guidance
Acne surgery (eg, marsupialization, opening or removal of multiple milia,
comedones, cysts, pustules)
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis,
cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single
Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis,
cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or
Extraordinary No.64/2013
18
196.46
215.09
122.40
134.44
358.05
Friday, 09 August 2013
multiple
10080
10081
Incision and drainage of pilonidal cyst; simple
Incision and drainage of pilonidal cyst; complicated
190.80
450.90
10120
10121
Incision and removal of foreign body, subcutaneous tissues; simple
Incision and removal of foreign body, subcutaneous tissues; complicated
149.67
413.45
10140
10160
Incision and drainage of hematoma, seroma or fluid collection
Puncture aspiration of abscess, hematoma, bulla, or cyst
183.32
125.34
10180
11000
560.32
105.86
11004
Incision and drainage, complex, postoperative wound infection
Debridement of extensive eczematous or infected skin; up to 10% of body surface
Debridement of extensive eczematous or infected skin; each additional 10% of the
body surface (List separately in addition to code for primary procedure)
Dbrdmt skn subq t/m/f necro infctj gent&pr
11005
11006
Dbrdmt skn subq t/m/f necro infctj abdl wall
Dbrdmt skn subq t/m/f necro infctj gent/abdl
1068.79
973.26
11008
Removal prosthetic matrl abdl wall for infection
Debridement including removal of foreign material associated with open
fracture(s) and/or dislocation(s); skin and subcutaneous tissues
Debridement including removal of foreign material associated with open
fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, and
muscle
Debridement including removal of foreign material associated with open
fracture(s) and/or dislocation(s); skin, subcutaneous tissue, muscle fascia, muscle,
and bone
Debridement; skin, and subcutaneous tissue
Debridement; skin, subcutaneous tissue, and muscle
437.12
Debridement; skin, subcutaneous tissue, muscle, and bone
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); two to four
lesions
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than
four lesions
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed (separate procedure); single lesion
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed (separate procedure); each separate/additional
lesion (List separately in addition to code for primary procedure)
Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including
15 lesions
Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten
lesions (List separately in addition to code for primary procedure)
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion
diameter 0.5 cm or less
846.90
53.90
11001
11010
11011
11012
11042
11043
11044
11055
11056
11057
11100
11101
11200
11201
11300
Extraordinary No.64/2013
19
112.50
756.94
1060.20
1257.30
1781.10
329.26
657.90
71.21
94.76
134.31
77.57
130.55
94.70
113.80
Friday, 09 August 2013
11301
11302
11303
11305
11306
11307
11308
11310
11311
11312
11313
11400
11401
11402
11403
11404
11406
11420
11421
11422
11423
11424
11426
11440
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion
diameter 0.6 to 1.0 cm
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion
diameter 1.1 to 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion
diameter over 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet,
genitalia; lesion diameter 0.5 cm or less
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet,
genitalia; lesion diameter 0.6 to 1.0 cm
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet,
genitalia; lesion diameter 1.1 to 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet,
genitalia; lesion diameter over 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips,
mucous membrane; lesion diameter 0.5 cm or less
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips,
mucous membrane; lesion diameter 0.6 to 1.0 cm
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips,
mucous membrane; lesion diameter 1.1 to 2.0 cm
Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips,
mucous membrane; lesion diameter over 2.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter 0.5 cm or less
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter 0.6 to 1.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter 1.1 to 2.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter 2.1 to 3.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter 3.1 to 4.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms or
legs; lesion diameter over 4.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter 0.5 cm or less
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter 0.6 to 1.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter 1.1 to 2.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter 2.1 to 3.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter 3.1 to 4.0 cm
Excision, benign lesion, except skin tag (unless listed elsewhere), scalp, neck,
hands, feet, genitalia; lesion diameter over 4.0 cm
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
Extraordinary No.64/2013
20
142.45
178.74
289.80
125.15
166.40
232.20
261.50
141.10
216.00
252.00
283.29
151.78
195.44
304.20
323.56
435.46
597.16
169.16
216.78
286.82
392.07
492.99
663.24
195.81
Friday, 09 August 2013
lips, mucous membrane; lesion diameter 0.5 cm or less
11600
11601
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
lips, mucous membrane; lesion diameter 0.6 to 1.0 cm
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
lips, mucous membrane; lesion diameter 1.1 to 2.0 cm
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
lips, mucous membrane; lesion diameter 2.1 to 3.0 cm
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
lips, mucous membrane; lesion diameter 3.1 to 4.0 cm
Excision, other benign lesion (unless listed elsewhere), face, ears, eyelids, nose,
lips, mucous membrane; lesion diameter over 4.0 cm
Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or
intermediate repair
Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex
repair
Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or
intermediate repair
Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex
repair
Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or
umbilical; with simple or intermediate repair
Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or
umbilical; with complex repair
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.5 cm or less
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 0.6 to 1.0 cm
11602
11603
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 1.1 to 2.0 cm
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 2.1 to 3.0 cm
344.99
438.13
11604
11606
Excision, malignant lesion, trunk, arms, or legs; lesion diameter 3.1 to 4.0 cm
Excision, malignant lesion, trunk, arms, or legs; lesion diameter over 4.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5
cm or less
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6
to 1.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1
to 2.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 2.1
to 3.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter 3.1
to 4.0 cm
Excision, malignant lesion, scalp, neck, hands, feet, genitalia; lesion diameter over
4.0 cm
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.5 cm or
less
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 0.6 to 1.0
cm
582.43
780.74
11441
11442
11443
11444
11446
11450
11451
11462
11463
11470
11471
11620
11621
11622
11623
11624
11626
11640
11641
Extraordinary No.64/2013
21
262.16
345.79
490.50
632.70
791.10
1283.40
1612.80
1218.60
1390.50
1282.38
1171.35
234.57
275.71
305.93
389.86
468.68
568.31
820.80
990.00
356.89
457.43
Friday, 09 August 2013
11642
11643
11644
11646
11719
11720
11721
11730
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 1.1 to 2.0
cm
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 2.1 to 3.0
cm
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter 3.1 to 4.0
cm
Excision, malignant lesion, face, ears, eyelids, nose, lips; lesion diameter over 4.0
cm
Trimming of nondystrophic nails, any number
Debridement of nail(s) by any method(s); one to five
584.34
850.50
1030.50
1174.50
39.46
87.30
122.40
109.04
11760
11762
Debridement of nail(s) by any method(s); six or more
Avulsion of nail plate, partial or complete, simple; single
Avulsion of nail plate, partial or complete, simple; each additional nail plate (List
separately in addition to code for primary procedure)
Evacuation of subungual hematoma
Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed
nail) for permanent removal;
Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed
nail) for permanent removal; with amputation of tuft of distal phalanx
Biopsy of nail unit, any method (eg, plate, bed, matrix, hyponychium, proximal
and lateral nail folds) (separate procedure)
Repair of nail bed
Reconstruction of nail bed with graft
11765
11770
Wedge excision of skin of nail fold (eg, for ingrown toenail)
Excision of pilonidal cyst or sinus; simple
226.39
669.18
11771
11772
Excision of pilonidal cyst or sinus; extensive
Excision of pilonidal cyst or sinus; complicated
1315.80
1673.10
11900
11901
Injection, intralesional; up to and including seven lesions
Injection, intralesional; more than seven lesions
Tattooing, intradermal introduction of insoluble opaque pigments to correct color
defects of skin, including micropigmentation; 6.0 sq cm or less
Tattooing, intradermal introduction of insoluble opaque pigments to correct color
defects of skin, including micropigmentation; 6.1 to 20.0 sq cm
Tattooing, intradermal introduction of insoluble opaque pigments to correct color
defects of skin, including micropigmentation; each additional 20.0 sq cm (List
separately in addition to code for primary procedure)
Subcutaneous injection of filling material (eg, collagen); 1 cc or less
Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc
68.38
103.02
Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc
Subcutaneous injection of filling material (eg, collagen); over 10.0 cc
Insertion of tissue expander(s) for other than breast, including subsequent
expansion
899.10
1215.90
11732
11740
11750
11752
11755
11920
11921
11922
11950
11951
11952
11954
11960
Extraordinary No.64/2013
22
101.70
117.00
341.38
748.80
426.60
494.10
720.90
741.60
1409.40
927.00
348.30
549.90
3000.60
Friday, 09 August 2013
11970
Replacement of tissue expander with permanent prosthesis
3060.90
11971
11975
Removal of tissue expander(s) without insertion of prosthesis
Insertion, implantable contraceptive capsules
1102.50
636.30
11976
11977
Removal, implantable contraceptive capsules
Removal with reinsertion, implantable contraceptive capsules
Subcutaneous hormone pellet implantation (implantation of estradiol and/or
testosterone pellets beneath the skin)
Insj non-biodegradable drug delivery implant
318.60
853.20
Removal non-biodegradable drug delivery implant
Rmvl w/rinsj non-biodegradable drug dlvr implt
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); 2.5 cm or less
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); 2.6 cm to 7.5 cm
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); 7.6 cm to 12.5 cm
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); 12.6 cm to 20.0 cm
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); 20.1 cm to 30.0 cm
Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk
and/or extremities (including hands and feet); over 30.0 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.5 cm or less
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.6 cm to 5.0 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 5.1 cm to 7.5 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 7.6 cm to 12.5 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 12.6 cm to 20.0 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 20.1 cm to 30.0 cm
Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; over 30.0 cm
Treatment of superficial wound dehiscence; simple closure
165.40
193.58
Treatment of superficial wound dehiscence; with packing
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.5 cm or less
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.6 cm to 7.5 cm
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 7.6 cm to 12.5 cm
369.00
11980
11981
11982
11983
12001
12002
12004
12005
12006
12007
12011
12013
12014
12015
12016
12017
12018
12020
12021
12031
12032
12034
Extraordinary No.64/2013
23
430.20
162.00
179.15
230.42
327.60
421.20
487.80
675.90
222.77
288.43
363.06
477.90
629.10
779.40
1124.10
388.79
255.60
343.80
423.00
Friday, 09 August 2013
12035
12036
12037
12041
12042
12044
12045
12046
12047
12051
12052
12053
12054
12055
12056
12057
13100
13101
13102
13120
13121
13122
13131
13132
13133
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 12.6 cm to 20.0 cm
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 20.1 cm to 30.0 cm
Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); over 30.0 cm
Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or
less
Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to
7.5 cm
Layer closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to
12.5 cm
Layer closure of wounds of neck, hands, feet and/or external genitalia; 12.6 cm to
20.0 cm
Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to
30.0 cm
Layer closure of wounds of neck, hands, feet and/or external genitalia; over 30.0
cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.5 cm or less
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.6 cm to 5.0 cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 5.1 cm to 7.5 cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 7.6 cm to 12.5 cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 12.6 cm to 20.0 cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 20.1 cm to 30.0 cm
Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; over 30.0 cm
Repair, complex, trunk; 1.1 cm to 2.5 cm
555.30
719.10
922.50
291.60
352.09
468.90
579.60
812.70
963.00
350.10
470.70
549.00
704.70
942.30
1141.20
1338.30
396.90
Repair, complex, trunk; 2.6 cm to 7.5 cm
Repair, complex, trunk; each additional 5 cm or less (List separately in addition to
code for primary procedure)
Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm
599.40
Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm
Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List
separately in addition to code for primary procedure)
Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands
and/or feet; 1.1 cm to 2.5 cm
Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands
and/or feet; 2.6 cm to 7.5 cm
Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands
and/or feet; each additional 5 cm or less (List separately in addition to code for
786.60
Extraordinary No.64/2013
24
264.60
506.70
304.20
538.80
991.80
277.20
Friday, 09 August 2013
primary procedure)
13150
13151
Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less
Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
590.40
720.90
13152
Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm
Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List
separately in addition to code for primary procedure)
Secondary closure of surgical wound or dehiscence, extensive or complicated
Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less
1269.00
1612.80
14301
Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm
or less
Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq
cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck,
axillae, genitalia, hands and/or feet; defect 10 sq cm or less
Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck,
axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10
sq cm or less
Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect
10.1 sq cm to 30.0 sq cm
Att/r any area defect 30.1-60sqcm
14302
14350
Att/r any area defect ea addl 30sqcm or part
Filleted finger or toe flap, including preparation of recipient site
480.88
1583.10
15002
15003
Prep site trunk/arm/leg 1st 100 sq cm/1pct
Prep site t/a/l addl 100 sq cm/1pct
700.87
165.33
15004
15005
Prep site f/s/n/h/f/g/m/d gt 1st 100 sq cm/1pct
Prep site f/s/n/h/f/g/m/d gt addl 100 sq cm/1pct
832.59
265.38
15040
563.25
15110
Harvest skin tissue cltr skin agrft 100 cm/<
Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal
open area (except on face), up to defect size 2 cm diameter
Split graft, trunk, arms, legs; first 100 sq cm or less, or one percent of body area of
infants and children (except 15050)
Split graft, trunk, arms, legs; each additional 100 sq cm, or each additional one
percent of body area of infants and children, or part thereof (List separately in
addition to code for primary procedure)
Epidrm agrft t/a/l 1st 100 cm/</1% bdy inft/chld
15111
15115
Epidrm agrft t/a/l ea 100 cm/ea 1% bdy inft/chld
Epidermal agrft f/s/n/h/f/g/m/d gt 1st 100 cm
294.39
1815.60
15116
Epidermal agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea
Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet
and/or multiple digits; first 100 sq cm or less, or one percent of body area of
402.77
13153
13160
14000
14001
14020
14021
14040
14041
14060
14061
15050
15100
15101
15120
Extraordinary No.64/2013
25
426.60
1059.69
1088.10
1434.60
1829.70
1531.29
2181.60
1995.30
3169.80
2113.30
855.00
1463.40
889.20
1887.78
1939.50
Friday, 09 August 2013
infants and children (except 15050)
15130
Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet
and/or multiple digits; each additional 100 sq cm, or each additional one percent of
body area of infants and children, or part thereof (List separately in addition to co
Dermal autograft trunk/arm/leg 1st 100 cm
15131
15135
Dermal autograft trunk/arm/leg ea 100 cm/ea
Dermal autograft f/s/n/h/f/g/m/d gt 1st 100
246.06
1861.86
15136
15150
Dermal agrft f/s/n/h/f/g/m/d gt ea 100 cm/ea
Cltr epidermal autograft t/a/l 1st 25 cm/<
227.31
1481.15
15151
15152
Cltr epidermal agrft t/a/l addl 1 cm-75 cm
Cltr epidrm agrft t/a/l ea 100 cm/ea 1 % bdy
297.75
391.91
15155
15156
Cltr epidrm agrft f/s/n/h/f/g/m/d gt 1st 25cm/<
Cltr epidrm agrft f/s/n/h/f/g/m/d gt addl 1-75cm
1472.04
424.98
15157
15170
Cltr epidrm agrft f/s/n/h/f/g/m/d gt ea 100 ea
Aclr drm rplcmt t/a/l 1st 100 cm/</1 % bdy
481.51
856.75
15171
15175
Aclr drm rplcmt t/a/l ea 100 cm/ea 1 % bdy
Aclr drm rplcmt f/s/n/h/f/g/m/d gt 1st 100 cm
214.67
1185.38
15176
345.22
15300
Aclr drm rplcmt f/s/n/h/f/g/m/d gt ea 100 cm/ea
Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or
less
Full thickness graft, free, including direct closure of donor site, trunk; each
additional 20 sq cm (List separately in addition to code for primary procedure)
Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or
legs; 20 sq cm or less
Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or
legs; each additional 20 sq cm (List separately in addition to code for primary
procedure)
Full thickness graft, free, including direct closure of donor site, forehead, cheeks,
chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less
Full thickness graft, free, including direct closure of donor site, forehead, cheeks,
chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm
(List separately in addition to code for primary procedure)
Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids,
and/or lips; 20 sq cm or less
Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids,
and/or lips; each additional 20 sq cm (List separately in addition to code for
primary procedure)
Algrft temporary closure t/a/l 1st 100 cm/</1
15301
15320
Algrft temporary closure t/a/l ea 100 cm/ea
Algrft temp closure f/s/n/h/f/g/m/d 1st 100cm
148.06
797.08
15321
15330
Algrft temp closure f/s/n/h/f/g/m/d ea 100cm
Aclr dermal allograft trunk/arm/leg 1st 100 cm
214.69
683.12
15121
15200
15201
15220
15221
15240
15241
15260
15261
Extraordinary No.64/2013
26
1542.60
1469.33
1299.60
762.30
1439.10
1093.50
1896.30
977.40
2362.50
1210.50
703.43
Friday, 09 August 2013
15331
Aclr dermal allograft trunk/arm/leg ea 100cm/ea
148.31
15335
15336
Aclr drm allograft f/s/n/h/f/g/m/d gt 1st 100cm
Aclr drm algrft f/s/n/h/f/g/m/d gt ea 100 cm/ea
754.31
205.26
15340
15341
Tissue cultured allogeneic skin 1st 25cm/<
Tiss cltr algc skn ea 25 cm
724.16
99.76
15360
15361
Tissue cltr algc drm trunk/arm/leg 1st 100 cm
Tissue cltr algc dermal t/a/l ea 100cm/ea 1 pct
779.20
163.37
15365
15366
Tiss cltr algc drm f/s/n/h/f/g/m/d 1st 100 cm
Tiss cltr algc drm f/s/n/h/f/g/m/d ea 100 cm
818.87
203.63
15400
735.30
15420
15421
Application of xenograft, skin; 100 sq cm or less
Application of xenograft, skin; each additional 100 sq cm (List separately in
addition to code for primary procedure)
Xenogrf temp closure f/s/n/h/f/g/m/d 1st 100cm
Xenograft temp closure f/s/n/h/f/g/m/d ea 100cm
15430
15570
Acellular xenograft implant 1st 100 cm/1 pct
Formation of direct or tubed pedicle, with or without transfer; trunk
1207.44
2601.00
15572
2704.50
15734
Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs
Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks,
chin, mouth, neck, axillae, genitalia, hands or feet
Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears,
lips, or intraoral
Delay of flap or sectioning of flap (division and inset); at trunk
Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legs
Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin,
neck, axillae, genitalia, hands, or feet
Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lips
Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, Walking tube),
any location
Forehead flap w/ preservation vascular pedicle
Muscle, myocutaneous, or fasciocutaneous flap; head and neck (eg, temporalis,
masseter, sternocleidomastoid, levator scapulae)
Muscle, myocutaneous, or fasciocutaneous flap; trunk
15736
15738
Muscle, myocutaneous, or fasciocutaneous flap; upper extremity
Muscle, myocutaneous, or fasciocutaneous flap; lower extremity
5150.70
5279.40
15740
15750
Flap; island pedicle
Flap; neurovascular pedicle
2682.00
2973.60
15756
15757
Free muscle flap with or without skin with microvascular anastomosis
Free skin flap with microvascular anastomosis
8005.50
8005.50
15758
Free fascial flap with microvascular anastomosis
7990.20
15401
15574
15576
15600
15610
15620
15630
15650
15731
15732
Extraordinary No.64/2013
27
128.70
901.78
264.22
3028.50
2987.10
1055.70
1318.50
1596.60
1637.10
1534.50
2785.60
4818.60
4878.90
Friday, 09 August 2013
15760
15770
15775
15776
Graft; composite (eg, full thickness of external ear or nasal ala), including primary
closure, donor area
Graft; derma-fat-fascia
Punch graft for hair transplant; 1 to 15 punch grafts
2485.80
1962.00
280.80
Punch graft for hair transplant; more than 15 punch grafts
Dermabrasion; total face (eg, for acne scarring, fine wrinkling, rhytids, general
keratosis)
Dermabrasion; segmental, face
Dermabrasion; regional, other than face
477.00
772.20
412.20
15788
15789
Dermabrasion; superficial, any site, (eg, tattoo removal)
Abrasion; single lesion (eg, keratosis, scar)
Abrasion; each additional four lesions or less (List separately in addition to code
for primary procedure)
Chemical peel, facial; epidermal
Chemical peel, facial; dermal
15792
15793
Chemical peel, nonfacial; epidermal
Chemical peel, nonfacial; dermal
544.50
849.60
15819
15820
Cervicoplasty
Blepharoplasty, lower eyelid;
2246.40
2253.60
15821
15822
Blepharoplasty, lower eyelid; with extensive herniated fat pad
Blepharoplasty, upper eyelid;
2111.40
2542.50
15823
15824
Blepharoplasty, upper eyelid; with excessive skin weighting down lid
Rhytidectomy; forehead
1815.30
2471.40
15825
15826
Rhytidectomy; neck with platysmal tightening (platysmal flap, P-flap)
Rhytidectomy; glabellar frown lines
3511.80
2010.60
15828
15829
Rhytidectomy; cheek, chin, and neck
Rhytidectomy; superficial musculoaponeurotic system (SMAS) flap
6599.70
4630.50
15830
15832
Excision skin abd infraumbilical panniculectomy
Excision, excessive skin and subcutaneous tissue (including lipectomy); thigh
1777.49
4589.10
15833
15834
Excision, excessive skin and subcutaneous tissue (including lipectomy); leg
Excision, excessive skin and subcutaneous tissue (including lipectomy); hip
4349.70
4292.10
15835
15836
Excision, excessive skin and subcutaneous tissue (including lipectomy); buttock
Excision, excessive skin and subcutaneous tissue (including lipectomy); arm
Excision, excessive skin and subcutaneous tissue (including lipectomy); forearm or
hand
Excision, excessive skin and subcutaneous tissue (including lipectomy); submental
fat pad
Excision, excessive skin and subcutaneous tissue (including lipectomy); other area
Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)
4674.60
2920.50
15780
15781
15782
15783
15786
15787
15837
15838
15839
15840
Extraordinary No.64/2013
28
2763.90
1148.40
772.20
207.90
1545.30
1901.70
2155.50
2379.60
2462.40
3744.00
Friday, 09 August 2013
15841
Graft for facial nerve paralysis; free muscle graft (including obtaining graft)
4275.00
15842
15845
Graft for facial nerve paralysis; free muscle flap by microsurgical technique
Graft for facial nerve paralysis; regional muscle transfer
6190.20
3721.50
15850
15851
Removal of sutures under anesthesia (other than local), same surgeon
Removal of sutures under anesthesia (other than local), other surgeon
215.03
259.49
15852
15860
Dressing change (for other than burns) under anesthesia (other than local)
Intravenous injection of agent (eg, fluorescein) to test blood flow in flap or graft
373.50
370.80
15920
15922
Excision, coccygeal pressure ulcer, with coccygectomy; with primary suture
Excision, coccygeal pressure ulcer, with coccygectomy; with flap closure
1419.30
1946.70
15931
15933
Excision, sacral pressure ulcer, with primary suture;
Excision, sacral pressure ulcer, with primary suture; with ostectomy
1540.80
2388.60
15934
15935
Excision, sacral pressure ulcer, with skin flap closure;
Excision, sacral pressure ulcer, with skin flap closure; with ostectomy
Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or
skin graft closure;
Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or
skin graft closure; with ostectomy
Excision, ischial pressure ulcer, with primary suture;
Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)
2937.60
3445.20
Excision, ischial pressure ulcer, with skin flap closure;
Excision, ischial pressure ulcer, with skin flap closure; with ostectomy
Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or
myocutaneous flap or skin graft closure
Excision, trochanteric pressure ulcer, with primary suture;
Excision, trochanteric pressure ulcer, with primary suture; with ostectomy
2574.90
3038.40
Excision, trochanteric pressure ulcer, with skin flap closure;
Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomy
Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous
flap or skin graft closure;
Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous
flap or skin graft closure; with ostectomy
Initial treatment, first degree burn, when no more than local treatment is required
Dressings and/or debridement, initial or subsequent; without anesthesia, office or
hospital, small
Dressings and/or debridement, initial or subsequent; without anesthesia, medium
(eg, whole face or whole extremity)
Dressings and/or debridement, initial or subsequent; without anesthesia, large (eg,
more than one extremity)
Escharotomy; initial incision
Escharotomy; each additional incision (List separately in addition to code for
primary procedure)
2276.10
2523.60
15936
15937
15940
15941
15944
15945
15946
15950
15951
15952
15953
15956
15958
16000
16020
16025
16030
16035
16036
Extraordinary No.64/2013
29
3236.40
4108.50
1647.90
2317.50
3663.00
1494.00
2214.90
3924.90
4222.80
104.40
115.89
217.86
363.34
874.80
291.60
Friday, 09 August 2013
17000
17003
17004
17106
17107
17108
17110
17111
17250
17260
17261
17262
17263
17264
17266
17270
17271
17272
17273
17274
17276
17280
Destruction by any method, including laser, with or without surgical curettement,
all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or
cutaneous vascular proliferative lesions, including local anesthesia; first lesion
Destruction by any method, including laser, with or without surgical curettement,
all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or
cutaneous vascular proliferative lesions, including local anesthesia; second through
14 le
Destruction by any method, including laser, with or without surgical curettement,
all benign or premalignant lesions (eg, actinic keratoses) other than skin tags or
cutaneous vascular proliferative lesions, including local anesthesia, 15 or more
lesions
Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less
than 10 sq cm
Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 50.0 sq cm
Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over
50.0 sq cm
Destruction by any method of flat warts, molluscum contagiosum, or milia; up to
14 lesions
Destruction by any method of flat warts, molluscum contagiosum, or milia; 15 or
more lesions
Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.5
cm or less
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 0.6
to 1.0 cm
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 1.1
to 2.0 cm
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 2.1
to 3.0 cm
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter 3.1
to 4.0 cm
Destruction, malignant lesion, any method, trunk, arms or legs; lesion diameter
over 4.0 cm
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter 0.5 cm or less
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter 0.6 to 1.0 cm
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter 1.1 to 2.0 cm
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter 2.1 to 3.0 cm
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter 3.1 to 4.0 cm
Destruction, malignant lesion, any method, scalp, neck, hands, feet, genitalia;
lesion diameter over 4.0 cm
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
Extraordinary No.64/2013
30
97.34
37.26
540.00
621.00
1326.60
2008.80
110.03
178.20
152.10
220.50
211.98
298.80
333.90
385.20
565.20
234.00
298.80
371.70
344.97
568.80
704.70
243.00
Friday, 09 August 2013
membrane; lesion diameter 0.5 cm or less
17311
17312
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 0.6 to 1.0 cm
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 1.1 to 2.0 cm
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 2.1 to 3.0 cm
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 3.1 to 4.0 cm
Destruction, malignant lesion, any method, face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter over 4.0 cm
Mohs micrographic h/n/h/f/g 1st stage 5 blocks
Mohs micrographic h/n/h/f/g each addl stage
17313
17314
Mohs trunk/arm/leg 1st stage 5 blocks
Mohs trunk/arm/leg ea stage after 1st stage
1056.66
651.22
17315
17340
Mohs trunk/arm/leg ea addl block any stage
Cryotherapy (CO2 slush, liquid N2) for acne
139.63
74.83
17360
17380
Chemical exfoliation for acne (eg, acne paste, acid)
Electrolysis epilation, each 1/2 hour
142.20
134.10
19000
Puncture aspiration of cyst of breast;
Puncture aspiration of cyst of breast; each additional cyst (List separately in
addition to code for primary procedure)
Mastotomy with exploration or drainage of abscess, deep
Injection procedure only for mammary ductogram or galactogram
Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate
procedure)
Biopsy of breast; open, incisional
Biopsy of breast; percutaneous, needle core, using imaging guidance
Biopsy of breast; percutaneous, automated vacuum assisted or rotating biopsy
device, using imaging guidance
Abltj cryosurgical w/ us gid ea fibroadenoma
Nipple exploration, with or without excision of a solitary lactiferous duct or a
papilloma lactiferous duct
Excision of lactiferous duct fistula
Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant
breast tissue, duct lesion, nipple or areolar lesion (except 19140), open, male or
female, one or more lesions
Excision of breast lesion identified by preoperative placement of radiological
marker, open; single lesion
Excision of breast lesion identified by preoperative placement of radiological
marker, open; each additional lesion separately identified by a preoperative
radiological marker (List separately in addition to code for primary procedure)
158.21
17281
17282
17283
17284
17286
19001
19020
19030
19100
19101
19102
19103
19105
19110
19112
19120
19125
19126
Extraordinary No.64/2013
31
279.83
442.80
521.10
677.70
932.40
1151.03
698.32
83.70
592.20
154.80
257.40
781.20
386.34
910.80
3171.04
1235.70
1004.40
1105.37
1289.70
832.50
Friday, 09 August 2013
19260
3146.40
19296
19297
Excision of chest wall tumor including ribs
Excision of chest wall tumor involving ribs, with plastic reconstruction; without
mediastinal lymphadenectomy
Excision of chest wall tumor involving ribs, with plastic reconstruction; with
mediastinal lymphadenectomy
Preoperative placement of needle localization wire, breast;
Preoperative placement of needle localization wire, breast; each additional lesion
(List separately in addition to code for primary procedure)
Image guided placement, metallic localization clip, percutaneous, during breast
biopsy (List separately in addition to code for primary procedure)
Plmt expandable cath brst following prtl mast
Plmt expandable cath brst concurrent prtl mast
19298
19300
Plmt radthx brachytx brst following prtl mast
Mastectomy gynecomastia
3605.44
1131.18
19301
19302
Mastectomy partial
Mastectomy partial w/axillary lymphadenectomy
933.84
1977.47
19303
19304
Mastectomy simple complete
Mastectomy subcutaneous
1597.79
1169.33
19305
19306
Mast rad w/pectoral muscles axillary lymph nodes
Mast rad w/pectoral musc ax int mam lymph nodes
2032.87
2299.98
19307
19316
Mast modf rad w/ax lymph nod w/wo pect/alis min
Mastopexy
2325.26
2891.70
19318
19324
Reduction mammaplasty
Mammaplasty, augmentation; without prosthetic implant
4137.80
1761.30
19325
19328
Mammaplasty, augmentation; with prosthetic implant
Removal of intact mammary implant
2711.70
1848.60
19330
Removal of mammary implant material
Immediate insertion of breast prosthesis following mastopexy, mastectomy or in
reconstruction
Delayed insertion of breast prosthesis following mastopexy, mastectomy or in
reconstruction
Nipple/areola reconstruction
3030.30
Correction of inverted nipples
Breast reconstruction, immediate or delayed, with tissue expander, including
subsequent expansion
Breast reconstruction with latissimus dorsi flap, with or without prosthetic implant
1622.70
Breast reconstruction with free flap
Breast reconstruction with other technique
Breast reconstruction with transverse rectus abdominis myocutaneous flap
(TRAM), single pedicle, including closure of donor site;
5675.40
5778.90
19271
19272
19290
19291
19295
19340
19342
19350
19355
19357
19361
19364
19366
19367
Extraordinary No.64/2013
32
4221.90
5622.30
270.00
143.10
140.40
9940.72
218.27
3031.20
2786.40
2317.50
4068.90
5408.10
8446.50
Friday, 09 August 2013
19368
Breast reconstruction tram 1 pedcl mvasc anast
6352.72
19369
19370
Breast reconstruction tram flap double pedicle
Open periprosthetic capsulotomy, breast
5552.58
2266.20
19371
19380
Periprosthetic capsulectomy, breast
Revision of reconstructed breast
2523.60
2884.50
19396
Preparation of moulage for custom breast implant
Incision of soft tissue abscess (eg, secondary to osteomyelitis); deep or
complicated
Exploration of penetrating wound (separate procedure); neck
Exploration of penetrating wound (separate procedure); chest
211.50
Exploration of penetrating wound (separate procedure); abdomen/flank/back
Exploration of penetrating wound (separate procedure); extremity
Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained
through same fascial incision
Biopsy, muscle; superficial
798.30
1134.00
617.40
272.70
20245
20250
Biopsy, muscle; deep
Biopsy, muscle, percutaneous needle
Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process,
ribs)
Biopsy, bone, trocar, or needle; deep (vertebral body, femur)
Biopsy, bone, excisional; superficial (eg, ilium, sternum, spinous process, ribs,
trochanter of femur)
Biopsy, bone, excisional; deep (eg, humerus, ischium, femur)
Biopsy, vertebral body, open; thoracic
20251
20500
Biopsy, vertebral body, open; lumbar or cervical
Injection of sinus tract; therapeutic (separate procedure)
2589.30
114.30
20501
20520
Injection of sinus tract; diagnostic (sinogram)
Removal of foreign body in muscle or tendon sheath; simple
147.60
307.46
20525
20526
Removal of foreign body in muscle or tendon sheath; deep or complicated
Injection therapeutic carpal tunnel
720.90
135.84
20550
20551
Injection, tendon sheath, ligament, trigger points or ganglion cyst
Injection single tendon origin/insertion
108.18
104.87
20552
20553
Injection single/mlt trigger point 1/2 muscles
Injection single/mlt trigger point 3/> muscles
103.78
121.48
20555
Placement needles muscle subsequent radioelement
Arthrocentesis, aspiration and/or injection; small joint, bursa or ganglion cyst (eg,
fingers, toes)
Arthrocentesis, aspiration and/or injection; intermediate joint, bursa or ganglion
cyst (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon
bursa)
582.66
20005
20100
20101
20102
20103
20150
20200
20205
20206
20220
20225
20240
20600
20605
Extraordinary No.64/2013
33
664.63
1610.10
675.00
2912.40
412.20
360.90
814.50
654.30
1028.70
3141.00
94.96
107.28
Friday, 09 August 2013
20610
20612
20615
20650
20660
20661
20662
20663
Arthrocentesis, aspiration and/or injection; major joint or bursa (eg, shoulder, hip,
knee joint, subacromial bursa)
Aspiration&/injection ganglion cyst any location
Aspiration and injection for treatment of bone cyst
Insertion of wire or pin with application of skeletal traction, including removal
(separate procedure)
Application of cranial tongs, caliper, or stereotactic frame, including removal
(separate procedure)
Application of halo, including removal; cranial
135.03
105.01
527.40
468.90
853.20
1326.60
Application of halo, including removal; pelvic
Application of halo, including removal; femoral
Application of halo, including removal, cranial, 6 or more pins placed, for thin
skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta),
requiring general anesthesia
Removal of tongs or halo applied by another physician
902.70
765.00
Removal of implant; superficial, (eg, buried wire, pin or rod) (separate procedure)
Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or
plate)
Application of a uniplane (pins or wires in one plane), unilateral, external fixation
system
Application of a multiplane (pins or wires in more than one plane), unilateral,
external fixation system (eg, Ilizarov, Monticelli type)
Adjustment or revision of external fixation system requiring anesthesia (eg, new
pin(s) or wire(s) and/or new ring(s) or bar(s))
Removal, under anesthesia, of external fixation system
463.50
1752.70
2193.99
20827
Xtrnl fixj w/stereotactic adjustment 1st&subq
Xtrnl fixj w/strtctc adjustment exchange strut
Replantation, arm (includes surgical neck of humerus through elbow joint),
complete amputation
Replantation, forearm (includes radius and ulna to radial carpal joint), complete
amputation
Replantation, hand (includes hand through metacarpophalangeal joints), complete
amputation
Replantation, digit, excluding thumb (includes metacarpophalangeal joint to
insertion of flexor sublimis tendon), complete amputation
Replantation, digit, excluding thumb (includes distal tip to sublimis tendon
insertion), complete amputation
Replantation, thumb (includes carpometacarpal joint to MP joint), complete
amputation
Replantation, thumb (includes distal tip to MP joint), complete amputation
20838
20900
Replantation, foot, complete amputation
Bone graft, any donor area; minor or small (eg, dowel or button)
9888.30
947.70
20902
Bone graft, any donor area; major or large
1587.60
20664
20665
20670
20680
20690
20692
20693
20694
20696
20697
20802
20805
20808
20816
20822
20824
Extraordinary No.64/2013
34
1032.30
234.90
857.90
1138.50
1752.30
908.10
824.40
9720.90
10085.40
11040.30
5793.30
5794.20
6571.80
5047.20
Friday, 09 August 2013
20910
Cartilage graft; costochondral
1491.30
20912
20920
Cartilage graft; nasal septum
Fascia lata graft; by stripper
1467.90
885.60
20922
20924
Fascia lata graft; by incision and area exposure, complex or sheet
Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)
1241.10
1360.80
20926
20930
Tissue grafts, other (eg, paratenon, fat, dermis)
Allograft for spine surgery only; morselized
1014.30
978.30
20931
Allograft for spine surgery only; structural
Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs,
spinous process, or laminar fragments) obtained from same incision
Autograft for spine surgery only (includes harvesting the graft); morselized
(through separate skin or fascial incision)
Autograft for spine surgery only (includes harvesting the graft); structural,
bicortical or tricortical (through separate skin or fascial incision)
Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick
catheter technique, needle manometer technique) in detection of muscle
compartment syndrome
Bone graft with microvascular anastomosis; fibula
Bone graft with microvascular anastomosis; iliac crest
618.30
8967.60
20970
20972
Bone graft with microvascular anastomosis; metatarsal
Bone graft with microvascular anastomosis; other than fibula, iliac crest, or
metatarsal
Free osteocutaneous flap with microvascular anastomosis; other than iliac crest,
metatarsal, or great toe
Free osteocutaneous flap with microvascular anastomosis; iliac crest
Free osteocutaneous flap with microvascular anastomosis; metatarsal
20973
20974
Free osteocutaneous flap with microvascular anastomosis; great toe with web space
Electrical stimulation to aid bone healing; noninvasive (nonoperative)
8745.30
915.30
20975
1344.60
20985
21010
Electrical stimulation to aid bone healing; invasive (operative)
Low intensity ultrasound stimulation to aid bone healing, noninvasive
(nonoperative)
Cptr-asst surgical navigation image-less
Arthrotomy, temporomandibular joint
21011
21012
Excision tumor soft tiss face/scalp subq < 2cm
Excision tumor soft tiss face/scalp subq 2+cm
441.95
465.84
21013
21014
Exc tumor soft tiss face&scalp subfascial < 2cm
Exc tumor soft tiss face&scalp subfascial 2+cm
767.09
813.32
21015
21016
Radical resection of tumor (eg, malignant neoplasm), soft tissue of face or scalp
Rad resection tumor soft tiss face/scalp 2+cm
1773.90
1706.33
21025
Excision of bone (eg, for osteomyelitis or bone abscess); mandible
1602.00
20936
20937
20938
20950
20955
20956
20957
20962
20969
20979
Extraordinary No.64/2013
35
1545.30
1235.70
1506.60
293.40
10791.90
8655.30
8168.40
7750.80
9907.20
8745.30
124.20
207.47
2836.80
Friday, 09 August 2013
21026
Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)
1498.50
21029
21030
Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)
Excision of benign tumor or cyst of facial bone other than mandible
1532.70
2193.30
21031
21032
Excision of torus mandibularis
Excision of maxillary torus palatinus
696.60
1056.60
21034
21040
Excision of malignant tumor of facial bone other than mandible
Excision of benign cyst or tumor of mandible; simple
3169.80
1246.50
21044
21045
Excision of malignant tumor of mandible;
Excision of malignant tumor of mandible; radical resection
2851.20
5918.40
21046
21047
Exc benign tumor/cyst mndbl intra-oral osteot
Exc b9 tum/cst mndbl xtr-oral osteot&prtl mndblc
1872.04
2304.17
21048
21049
Exc benign tumor/cyst maxl intra-oral osteot
Exc b9 tum/cst maxl xtr-oral osteot&prtl maxlct
1918.12
2210.72
21050
21060
Condylectomy, temporomandibular joint (separate procedure)
Meniscectomy, partial or complete, temporomandibular joint (separate procedure)
3355.20
3330.00
21070
21076
Coronoidectomy (separate procedure)
Impression&preparation surg obturator prosthesis
2724.30
1781.92
21077
21079
Impression & preparation orbital prosthesis
Impression&preparation interim obturator prosth
4473.18
2974.29
21080
21081
Impression&prepj definitive obturator prosthesis
Impression&prepj mandibular resection prosthesis
3342.10
3048.99
21082
21083
Impression&prepj palatal augmentation prosthesis
Impression&preparation palatal lift prosthesis
2792.30
2579.92
21084
21085
Impression&preparation speech aid prosthesis
Impression and custom preparation; oral surgical splint
3019.99
398.70
21086
21087
Impression&preparation auricular prosthesis
Impression&preparation nasal prosthesis
Application of halo type appliance for maxillofacial fixation, includes removal
(separate procedure)
Application of interdental fixation device for conditions other than fracture or
dislocation, includes removal
Injection procedure for temporomandibular joint arthrography
Genioplasty; augmentation (autograft, allograft, prosthetic material)
3303.10
3302.27
Genioplasty; sliding osteotomy, single piece
Genioplasty; sliding osteotomies, two or more osteotomies (eg, wedge excision or
bone wedge reversal for asymmetrical chin)
Genioplasty; sliding, augmentation with interpositional bone grafts (includes
obtaining autografts)
Augmentation, mandibular body or angle; prosthetic material
2574.90
21100
21110
21116
21120
21121
21122
21123
21125
Extraordinary No.64/2013
36
566.10
1364.40
178.20
2880.90
2385.00
2490.30
2394.90
Friday, 09 August 2013
21127
21137
21138
21139
21141
21142
21143
21145
21146
21147
21150
21151
21154
21155
21159
21160
21172
21175
21179
21180
21181
21182
Augmentation, mandibular body or angle; with bone graft, onlay or interpositional
(includes obtaining autograft)
Reduction forehead; contouring only
Reduction forehead; contouring and application of prosthetic material or bone graft
(includes obtaining autograft)
Rdctj fhd cntrg&setback ant frontal sinus wall
Reconstruction midface, LeFort I; single piece, segment movement in any direction
(eg, for Long Face Syndrome), without bone graft
Reconstruction midface, LeFort I; two pieces, segment movement in any direction,
without bone graft
Reconstruction midface, LeFort I; three or more pieces, segment movement in any
direction, without bone graft
Rcnstj midface lefort i 1 piece w/bone grafts
Reconstruction midface, LeFort I; two pieces, segment movement in any direction,
requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral
alveolar cleft)
Reconstruction midface, LeFort I; three or more pieces, segment movement in any
direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted
bilateral alveolar cleft or multiple osteotomies)
Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins
Syndrome)
Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes
obtaining autografts)
Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts
(includes obtaining autografts); without LeFort I
Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts
(includes obtaining autografts); with LeFort I
Reconstruction midface, LeFort III (extra and intracranial) with forehead
advancement (eg, mono bloc), requiring bone grafts (includes obtaining
autografts); without LeFort I
Reconstruction midface, LeFort III (extra and intracranial) with forehead
advancement (eg, mono bloc), requiring bone grafts (includes obtaining
autografts); with LeFort I
Reconstruction superior-lateral orbital rim and lower forehead, advancement or
alteration, with or without grafts (includes obtaining autografts)
Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead,
advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with
or without grafts (includes obtaining autografts)
Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts
(allograft or prosthetic material)
Reconstruction, entire or majority of forehead and/or supraorbital rims; with
autograft (includes obtaining grafts)
Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous
dysplasia), extracranial
Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following
intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous
Extraordinary No.64/2013
37
2266.20
2266.20
2652.30
3278.60
4120.20
4326.30
4428.90
4496.20
5983.20
6391.80
5568.30
6695.10
6677.10
6431.40
9682.20
10815.30
8767.80
9409.50
7056.00
6390.00
1539.90
6723.90
Friday, 09 August 2013
21198
dysplasia), with multiple autografts (includes obtaining grafts); total area of bone
grafting less
Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following
intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous
dysplasia), with multiple autografts (includes obtaining grafts); total area of bone
grafting grea
Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following
intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous
dysplasia), with multiple autografts (includes obtaining grafts); total area of bone
grafting grea
Reconstruction midface, osteotomies (other than LeFort type) and bone grafts
(includes obtaining autografts)
Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without
bone graft
Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with
bone graft (includes obtaining graft)
Reconstruction of mandibular rami and/or body, sagittal split; without internal
rigid fixation
Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid
fixation
Osteotomy, mandible, segmental;
21199
21206
Osteotomy, mandible, segmental; with genioglossus advancement
Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)
3879.00
4425.30
21208
21209
Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)
Osteoplasty, facial bones; reduction
2608.20
2713.50
21210
21215
Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)
Graft, bone; mandible (includes obtaining graft)
3510.00
3878.10
21230
21235
Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)
Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)
Arthroplasty, temporomandibular joint, with or without autograft (includes
obtaining graft)
Arthroplasty, temporomandibular joint, with allograft
4305.60
2547.90
Arthroplasty, temporomandibular joint, with prosthetic joint replacement
Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular
staple bone plate)
Reconstruction of mandible or maxilla, subperiosteal implant; partial
5049.90
Reconstruction of mandible or maxilla, subperiosteal implant; complete
Reconstruction of mandibular condyle with bone and cartilage autografts (includes
obtaining grafts) (eg, for hemifacial microsomia)
Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder);
partial
Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder);
complete
5781.60
21183
21184
21188
21193
21194
21195
21196
21240
21242
21243
21244
21245
21246
21247
21248
21249
Extraordinary No.64/2013
38
7144.20
7754.40
4563.00
4586.40
5648.40
4891.50
5547.60
3804.30
4120.20
3933.00
4204.80
3759.30
5665.50
3985.20
7416.00
Friday, 09 August 2013
21270
21275
Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage
(includes obtaining autografts)
Reconstruction of orbit with osteotomies (extracranial) and with bone grafts
(includes obtaining autografts) (eg, micro-ophthalmia)
Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial
approach
Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intraand extracranial approach
Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead
advancement
Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts;
extracranial approach
Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts;
combined intra- and extracranial approach
Malar augmentation, prosthetic material
Secondary revision of orbitocraniofacial reconstruction
21280
21282
Medial canthopexy (separate procedure)
Lateral canthopexy
2368.80
1957.50
21295
21296
Reduction masseter muscle&bone extraoral
Reduction masseter muscle&bone intraoral
2487.73
2095.08
21310
21315
Closed treatment of nasal bone fracture without manipulation
Closed treatment of nasal bone fracture; without stabilization
396.90
489.60
21320
21325
Closed treatment of nasal bone fracture; with stabilization
Open treatment of nasal fracture; uncomplicated
Open treatment of nasal fracture; complicated, with internal and/or external
skeletal fixation
Open treatment of nasal fracture; with concomitant open treatment of fractured
septum
Open treatment of nasal septal fracture, with or without stabilization
Closed treatment of nasal septal fracture, with or without stabilization
828.90
1708.20
Open treatment of nasoethmoid fracture; without external fixation
Open treatment of nasoethmoid fracture; with external fixation
Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or
headcap fixation, including repair of canthal ligaments and/or the nasolacrimal
apparatus
Open treatment of depressed frontal sinus fracture
Open treatment of complicated (eg, comminuted or involving posterior wall)
frontal sinus fracture, via coronal or multiple approaches
Closed treatment of nasomaxillary complex fracture (LeFort II type), with
interdental wire fixation or fixation of denture or splint
Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring
and/or local fixation
Open treatment of nasomaxillary complex fracture (LeFort II type); requiring
2750.40
3019.50
21255
21256
21260
21261
21263
21267
21268
21330
21335
21336
21337
21338
21339
21340
21343
21344
21345
21346
21347
Extraordinary No.64/2013
39
5665.50
5800.50
6687.00
8191.80
9275.40
6246.90
9558.90
4648.50
6386.40
2563.20
2959.20
1738.80
1325.70
3490.20
3550.50
3872.70
3108.60
3837.60
4275.00
Friday, 09 August 2013
multiple open approaches
21348
21355
21356
21360
21365
21366
21385
21386
21387
21390
21395
21400
21401
21406
21407
21408
21421
21422
21423
21431
21432
21433
21435
21436
Open treatment of nasomaxillary complex fracture (LeFort II type); with bone
grafting (includes obtaining graft)
Percutaneous treatment of fracture of malar area, including zygomatic arch and
malar tripod, with manipulation
Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)
Open treatment of depressed malar fracture, including zygomatic arch and malar
tripod
Open treatment of complicated (eg, comminuted or involving cranial nerve
foramina) fracture(s) of malar area, including zygomatic arch and malar tripod;
with internal fixation and multiple surgical approaches
Open treatment of complicated (eg, comminuted or involving cranial nerve
foramina) fracture(s) of malar area, including zygomatic arch and malar tripod;
with bone grafting (includes obtaining graft)
Open treatment of orbital floor blowout fracture; transantral approach (CaldwellLuc type operation)
Open treatment of orbital floor blowout fracture; periorbital approach
3829.50
2138.40
1796.40
2407.50
3566.70
3804.30
2743.20
2984.40
Open treatment of orbital floor blowout fracture; combined approach
Open treatment of orbital floor blowout fracture; periorbital approach, with
alloplastic or other implant
Open treatment of orbital floor blowout fracture; periorbital approach with bone
graft (includes obtaining graft)
Closed treatment of fracture of orbit, except blowout; without manipulation
Closed treatment of fracture of orbit, except blowout; with manipulation
3267.00
Open treatment of fracture of orbit, except blowout; without implant
Open treatment of fracture of orbit, except blowout; with implant
Open treatment of fracture of orbit, except blowout; with bone grafting (includes
obtaining graft)
Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental
wire fixation or fixation of denture or splint
Open treatment of palatal or maxillary fracture (LeFort I type);
Open treatment of palatal or maxillary fracture (LeFort I type); complicated
(comminuted or involving cranial nerve foramina), multiple approaches
Closed treatment of craniofacial separation (LeFort III type) using interdental wire
fixation of denture or splint
Open treatment of craniofacial separation (LeFort III type); with wiring and/or
internal fixation
Open treatment of craniofacial separation (LeFort III type); complicated (eg,
comminuted or involving cranial nerve foramina), multiple surgical approaches
Open treatment of craniofacial separation (LeFort III type); complicated, utilizing
internal and/or external fixation techniques (eg, head cap, halo device, and/or
intermaxillary fixation)
Open treatment of craniofacial separation (LeFort III type); complicated, multiple
surgical approaches, internal fixation, with bone grafting (includes obtaining graft)
2877.30
3400.20
Extraordinary No.64/2013
40
3502.80
3692.70
879.30
2475.90
3346.20
2632.50
3348.90
2865.60
2807.10
3594.60
5049.90
4278.60
5112.00
Friday, 09 August 2013
21450
Closed treatment of mandibular or maxillary alveolar ridge fracture (separate
procedure)
Open treatment of mandibular or maxillary alveolar ridge fracture (separate
procedure)
Closed treatment of mandibular fracture; without manipulation
21451
21452
Closed treatment of mandibular fracture; with manipulation
Percutaneous treatment of mandibular fracture, with external fixation
2193.30
1540.80
21453
21454
Closed treatment of mandibular fracture with interdental fixation
Open treatment of mandibular fracture with external fixation
2735.10
2820.60
21461
21462
Open treatment of mandibular fracture; without interdental fixation
Open treatment of mandibular fracture; with interdental fixation
2774.70
3288.60
21465
2871.00
21490
Open treatment of mandibular condylar fracture
Open treatment of complicated mandibular fracture by multiple surgical
approaches including internal fixation, interdental fixation, and/or wiring of
dentures or splints
Closed treatment of temporomandibular dislocation; initial or subsequent
Closed treatment of temporomandibular dislocation; complicated (eg, recurrent
requiring intermaxillary fixation or splinting), initial or subsequent
Open treatment of temporomandibular dislocation
21495
21497
Open treatment of hyoid fracture
Interdental wiring, for condition other than fracture
2726.10
2046.60
21501
779.40
21550
21552
Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;
Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;
with partial rib ostectomy
Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess),
thorax
Biopsy, soft tissue of neck or thorax
Exc tumor soft tissue neck/ant thorax subq 3+cm
21554
21555
Exc tumor soft tissue neck/thorax subfasc 5+cm
Excision tumor, soft tissue of neck or thorax; subcutaneous
1366.14
632.14
21556
21557
Excision tumor, soft tissue of neck or thorax; deep, subfascial, intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of neck or thorax
1127.30
3090.60
21558
21600
Rad resect tumor soft tiss neck/ant thorax 5+cm
Excision of rib, partial
2439.66
1256.40
21610
21615
Costotransversectomy (separate procedure)
Excision first and/or cervical rib;
3476.70
3032.10
21616
21620
Excision first and/or cervical rib; with sympathectomy
Ostectomy of sternum, partial
2896.20
3269.70
21627
21630
Sternal debridement
Radical resection of sternum;
1960.20
3826.80
21440
21445
21470
21480
21485
21502
21510
Extraordinary No.64/2013
41
1808.10
2088.00
812.70
4006.80
385.20
903.60
2578.50
946.80
1161.90
405.00
791.93
Friday, 09 August 2013
21632
Radical resection of sternum; with mediastinal lymphadenectomy
4892.40
21685
21700
Hyoid myotomy & suspension
Division of scalenus anticus; without resection of cervical rib
2168.29
1647.90
21705
2286.90
21740
Division of scalenus anticus; with resection of cervical rib
Division of sternocleidomastoid for torticollis, open operation; without cast
application
Division of sternocleidomastoid for torticollis, open operation; with cast
application
Reconstructive repair of pectus excavatum or carinatum
21750
21800
Closure of sternotomy separation with or without debridement (separate procedure)
Closed treatment of rib fracture, uncomplicated, each
2729.70
219.60
21805
21810
Open treatment of rib fracture without fixation, each
Treatment of rib fracture requiring external fixation (flail chest)
1426.50
3409.20
21820
21825
Closed treatment of sternum fracture
Open treatment of sternum fracture with or without skeletal fixation
456.30
1791.90
21920
21925
Biopsy, soft tissue of back or flank; superficial
Biopsy, soft tissue of back or flank; deep
466.20
796.50
21930
21931
Excision, tumor, soft tissue of back or flank
Excision tumor soft tissue back/flank subq 3+cm
1846.80
1124.11
21932
21933
Exc tumor soft tiss back/flank subfascial <5cm
Exc tumor soft tiss back/flank subfascial 5+cm
1469.92
1605.17
21935
21936
Radical resection of tumor (eg, malignant neoplasm), soft tissue of back or flank
Rad resection tumor soft tissue back/flank 5+cm
3547.80
3109.09
22010
22015
1829.44
1795.54
22116
I&d deep abscess pst spine crv thrc/cervicothrc
I&d deep abscess pst spine lumbar sac/lumbosac
Partial excision of posterior vertebral component (eg, spinous process, lamina or
facet) for intrinsic bony lesion, single vertebral segment; cervical
Partial excision of posterior vertebral component (eg, spinous process, lamina or
facet) for intrinsic bony lesion, single vertebral segment; thoracic
Partial excision of posterior vertebral component (eg, spinous process, lamina or
facet) for intrinsic bony lesion, single vertebral segment; lumbar
Prtl exc pst vrt intrnsc b1y les 1 vrt sgm ea
Partial excision of vertebral body, for intrinsic bony lesion, without decompression
of spinal cord or nerve root(s), single vertebral segment; cervical
Partial excision of vertebral body, for intrinsic bony lesion, without decompression
of spinal cord or nerve root(s), single vertebral segment; thoracic
Partial excision of vertebral body, for intrinsic bony lesion, without decompression
of spinal cord or nerve root(s), single vertebral segment; lumbar
Prtl exc vrt bdy b1y les w/o spi cord 1 sgm ea
22206
Osteotomy spine posterior 3 column thoracic
8139.79
21720
21725
22100
22101
22102
22103
22110
22112
22114
Extraordinary No.64/2013
42
1333.80
1486.80
3577.50
1579.50
1560.60
1827.00
421.75
2437.20
2290.50
1809.90
510.03
Friday, 09 August 2013
22207
Osteotomy spine posterior 3 column lumbar
7918.14
22208
Osteotomy spine posterior 3 column ea addl sgm
Osteotomy of spine, posterior or posterolateral approach, one vertebral segment;
cervical
Osteotomy of spine, posterior or posterolateral approach, one vertebral segment;
thoracic
Osteotomy of spine, posterior or posterolateral approach, one vertebral segment;
lumbar
Osteot spi pst/pstlat appr 1 vrt sgm ea vrt sgm
Osteotomy of spine, including diskectomy, anterior approach, single vertebral
segment; cervical
Osteotomy of spine, including diskectomy, anterior approach, single vertebral
segment; thoracic
Osteotomy of spine, including diskectomy, anterior approach, single vertebral
segment; lumbar
Osteot spi w/dskc ant appr 1 vrt sgm ea vrt sgm
2343.90
646.20
22505
22521
Closed treatment of vertebral process fracture(s)
Closed treatment of vertebral body fracture(s), without manipulation, requiring and
including casting or bracing
Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or
bracing, with and including casting and/or bracing, with or without anesthesia, by
manipulation or traction
Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s)
(including os odontoideum), anterior approach, including placement of internal
fixation; without grafting
Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s)
(including os odontoideum), anterior approach, including placement of internal
fixation; with grafting
Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s),
posterior approach, one fractured vertebrae or dislocated segment; lumbar
Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s),
posterior approach, one fractured vertebrae or dislocated segment; cervical
Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s),
posterior approach, one fractured vertebrae or dislocated segment; thoracic
Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s),
posterior approach, one fractured vertebrae or dislocated segment; each additional
fractured vertebrae or dislocated segment (List separately in addition to code for
primary p
Manipulation of spine requiring anesthesia, any region
Percutaneous vertebroplasty lumbar
22522
22523
Percutaneous vertebroplasty ea addl thrc/lmbr
Percutaneous vertebral augmentation thoracic
499.51
1477.34
22524
22525
Percutaneous vertebral augmentation lumbar
Perq vertebral augmentation ea addl thrc/lmbr
1382.74
716.85
22210
22212
22214
22216
22220
22222
22224
22226
22305
22310
22315
22318
22319
22325
22326
22327
22328
Extraordinary No.64/2013
43
5474.70
5826.60
5076.00
1650.31
5062.50
4892.40
4738.50
1576.45
1089.00
1676.70
4835.70
5462.10
3702.60
4303.80
3861.00
1339.20
594.00
4183.34
Friday, 09 August 2013
22526
Perq intrdscl electrothrm annuloplasty 1 lvl
3625.48
22527
22532
Perq intrdscl electrothrm annuloplasty addl lvl
Arthrodesis lateral extracavitary thoracic
2933.60
7248.19
22533
22534
Arthrodesis lateral extracavitary lumbar
Arthrodesis lat extracavitary ea addl thrc/lmbr
Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis),
with or without excision of odontoid process
Arthrd ant interbody decompress cervical belw c2
6841.56
1793.42
Arthrd ant interdy cervcl belw c2 ea addl ntrspc
Arthrodesis, anterior interbody technique, including minimal diskectomy to
prepare interspace (other than for decompression); cervical below C2
Arthrodesis, anterior interbody technique, including minimal diskectomy to
prepare interspace (other than for decompression); thoracic
Arthrodesis, anterior interbody technique, including minimal diskectomy to
prepare interspace (other than for decompression); lumbar
Arthrodesis, anterior interbody technique, including minimal diskectomy to
prepare interspace (other than for decompression); each additional interspace (List
separately in addition to code for primary procedure)
Arthrodesis, posterior technique, craniocervical (occiput-C2)
2029.38
Arthrodesis, posterior technique, atlas-axis (C1-C2)
Arthrodesis, posterior or posterolateral technique, single level; cervical below C2
segment
Arthrodesis, posterior or posterolateral technique, single level; thoracic (with or
without lateral transverse technique)
Arthrodesis, posterior or posterolateral technique, single level; lumbar (with or
without lateral transverse technique)
Arthrodesis, posterior or posterolateral technique, single level; each additional
vertebral segment (List separately in addition to code for primary procedure)
Arthrodesis, posterior interbody technique, including laminectomy and/or
diskectomy to prepare interspace (other than for decompression), single interspace;
lumbar
Arthrodesis, posterior interbody technique, including laminectomy and/or
diskectomy to prepare interspace (other than for decompression), single interspace;
each additional interspace (List separately in addition to code for primary
procedure)
Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral
segments
Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral
segments
Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more
vertebral segments
Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral
segments
Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral
segments
5839.20
22548
22551
22552
22554
22556
22558
22585
22590
22595
22600
22610
22612
22614
22630
22632
22800
22802
22804
22808
22810
Extraordinary No.64/2013
44
4671.90
7163.83
5047.20
5232.60
4895.10
2109.60
6695.10
4428.90
4143.60
4961.70
1858.50
4412.70
1555.20
4953.60
6030.00
6646.50
4555.80
4892.40
Friday, 09 August 2013
22845
22846
Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more
vertebral segments
Kyphectomy, circumferential exposure of spine and resection of vertebral
segment(s) (including body and posterior elements); single or 2 segments
Kyphectomy, circumferential exposure of spine and resection of vertebral
segment(s) (including body and posterior elements); 3 or more segments
Exploration of spinal fusion
Posterior non-segmental instrumentation (eg, Harrington rod technique), pedicle
fixation across one interspace, atlantoaxial transarticular screw fixation, sublaminar
wiring at C1, facet screw fixation
Internal spinal fixation by wiring of spinous processes
Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple
hooks and sublaminar wires); 3 to 6 vertebral segments
Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple
hooks and sublaminar wires); 7 to 12 vertebral segments
Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple
hooks and sublaminar wires); 13 or more vertebral segments
Anterior instrumentation; 2 to 3 vertebral segments
Anterior instrumentation; 4 to 7 vertebral segments
22847
22848
Anterior instrumentation 8/> vertebral segments
Pelvic fixation other than sacrum
4006.54
1716.14
22849
22850
3637.80
2196.90
22852
22855
Reinsertion of spinal fixation device
Removal of posterior nonsegmental instrumentation (eg, Harrington rod)
Application of intervertebral biomechanical device(s) (eg, synthetic cage(s),
threaded bone dowel(s), methylmethacrylate) to vertebral defect or interspace
Removal of posterior segmental instrumentation
Removal of anterior instrumentation
22856
22857
Tot disc arthrp art disc ant appro 1 ntrspc crv
Tot disc arthrp art disc ant appro 1 ntrspc lmbr
7409.11
7481.77
22861
22862
Revj rplcmt disc arthroplasty ant 1 ntrspc crv
Revj rplcmt disc arthroplasty ant 1 ntrspc lmbr
9122.80
8973.95
22864
22865
Rmvl disc arthroplasty ant 1 interspace cervical
Rmvl disc arthroplasty ant 1 interspace lumbar
8487.18
9570.92
22900
22901
Excision, abdominal wall tumor, subfascial (eg, desmoid)
Exc tumor soft tissue abdl wall subfascial 5+cm
1592.10
1370.05
22902
22903
Exc tumor soft tissue abdominal wall subq <3cm
Exc tumor soft tissue abdominal wall subq 3+cm
861.30
901.22
22904
22905
Rad resection tumor soft tissue abdl wall <5cm
Rad resection tumor soft tissue abdl wall 5+cm
2178.75
2821.24
23000
23020
Removal of subdeltoid (or intratendinous) calcareous deposits, any method
Capsular contracture release (eg, Sever type procedure)
1048.50
1676.70
22812
22818
22819
22830
22840
22841
22842
22843
22844
22851
Extraordinary No.64/2013
45
5985.90
6687.90
7163.10
4411.80
5926.50
3862.80
6488.10
2050.20
2503.80
6088.50
6129.00
2188.80
2578.50
3174.30
Friday, 09 August 2013
23030
Incision and drainage, shoulder area; deep abscess or hematoma
643.50
23031
23035
513.00
1620.00
23065
23066
Incision and drainage, shoulder area; infected bursa
Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder area
Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of
foreign body
Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration,
drainage, or removal of foreign body
Biopsy, soft tissue of shoulder area; superficial
Biopsy, soft tissue of shoulder area; deep
23071
23073
Excision tumor soft tissue shoulder subq 3+cm
Exc tumor soft tissue shoulder subfascial 5+cm
656.15
1601.52
23075
23076
Excision, soft tissue tumor, shoulder area; subcutaneous
Excision, soft tissue tumor, shoulder area; deep, subfascial, or intramuscular
690.30
972.00
23077
23078
Radical resection of tumor (eg, malignant neoplasm), soft tissue of shoulder area
Rad resection tumor soft tissue shoulder 5+cm
3457.80
3049.94
23100
Arthrotomy, glenohumeral joint, including biopsy
Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy
and/or excision of torn cartilage
Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsy
1900.80
Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsy
Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of
loose or foreign body
Claviculectomy; partial
Claviculectomy; total
Acromioplasty or acromionectomy, partial, with or without coracoacromial
ligament release
Excision or curettage of bone cyst or benign tumor of clavicle or scapula;
Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with
autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with
allograft
Excision or curettage of bone cyst or benign tumor of proximal humerus;
Excision or curettage of bone cyst or benign tumor of proximal humerus; with
autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of proximal humerus; with
allograft
Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicle
Sequestrectomy (eg, for osteomyelitis or bone abscess), scapula
Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical
neck
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), clavicle
1841.40
23040
23044
23101
23105
23106
23107
23120
23125
23130
23140
23145
23146
23150
23155
23156
23170
23172
23174
23180
Extraordinary No.64/2013
46
1976.40
1288.80
429.30
772.20
1510.20
2547.90
2521.80
1359.90
2212.20
1876.50
1152.90
1894.50
1276.20
1902.60
2513.70
2136.60
1133.10
1035.00
2029.50
1142.10
Friday, 09 August 2013
23190
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), scapula
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), proximal humerus
Ostectomy of scapula, partial (eg, superior medial angle)
23195
23200
Resection, humeral head
Radical resection for tumor; clavicle
2023.20
1987.20
23210
23220
Radical resection for tumor; scapula
Radical resection of bone tumor, proximal humerus;
2709.00
2718.90
23330
23331
Removal of foreign body, shoulder; subcutaneous
Removal of foreign body, shoulder; deep (eg, Neer hemiarthroplasty removal)
747.00
1851.30
23332
23350
Removal of foreign body, shoulder; complicated (eg, total shoulder)
Injection procedure for shoulder arthrography
3044.70
177.30
23395
23397
Muscle transfer, any type, shoulder or upper arm; single
Muscle transfer, any type, shoulder or upper arm; multiple
2472.30
2657.70
23400
23405
Scapulopexy (eg, Sprengels deformity or for paralysis)
Tenotomy, shoulder area; single tendon
2549.70
1497.60
23406
23410
Tenotomy, shoulder area; multiple tendons through same incision
Repair of ruptured musculotendinous cuff (eg, rotator cuff); acute
2154.60
2492.10
23412
23415
3027.60
1882.80
23430
23440
Repair of ruptured musculotendinous cuff (eg, rotator cuff); chronic
Coracoacromial ligament release, with or without acromioplasty
Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes
acromioplasty)
Tenodesis of long tendon of biceps
Resection or transplantation of long tendon of biceps
23450
23455
Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation
Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)
3331.80
3392.10
23460
23462
Capsulorrhaphy, anterior, any type; with bone block
Capsulorrhaphy, anterior, any type; with coracoid process transfer
3116.70
3337.20
23465
23466
Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block
Capsulorrhaphy, glenohumeral joint, any type multi-directional instability
2945.70
3508.20
23470
Arthroplasty, glenohumeral joint; hemiarthroplasty
Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral
replacement (eg, total shoulder))
Osteotomy, clavicle, with or without internal fixation;
Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion
or malunion (includes obtaining graft and/or necessary fixation)
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate; clavicle
3598.20
23182
23184
23420
23472
23480
23485
23490
Extraordinary No.64/2013
47
1146.60
1805.40
1415.70
3345.30
1865.70
1823.40
5374.80
1863.00
2413.80
2123.10
Friday, 09 August 2013
23500
23505
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate; proximal humerus
Closed treatment of clavicular fracture; without manipulation
Closed treatment of clavicular fracture; with manipulation
23515
23520
Open treatment of clavicular fracture, with or without internal or external fixation
Closed treatment of sternoclavicular dislocation; without manipulation
1595.70
387.90
23525
23530
Closed treatment of sternoclavicular dislocation; with manipulation
Open treatment of sternoclavicular dislocation, acute or chronic;
Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft
(includes obtaining graft)
Closed treatment of acromioclavicular dislocation; without manipulation
556.20
1455.30
Closed treatment of acromioclavicular dislocation; with manipulation
Open treatment of acromioclavicular dislocation, acute or chronic;
Open treatment of acromioclavicular dislocation, acute or chronic; with fascial
graft (includes obtaining graft)
Closed treatment of scapular fracture; without manipulation
Closed treatment of scapular fracture; with manipulation, with or without skeletal
traction (with or without shoulder joint involvement)
Open treatment of scapular fracture (body, glenoid or acromion) with or without
internal fixation
Closed treatment of proximal humeral (surgical or anatomical neck) fracture;
without manipulation
Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with
manipulation, with or without skeletal traction
Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or
without internal or external fixation, with or without repair of tuberosity(s);
Open treatment of proximal humeral (surgical or anatomical neck) fracture, with or
without internal or external fixation, with or without repair of tuberosity(s); with
proximal humeral prosthetic replacement
Closed treatment of greater humeral tuberosity fracture; without manipulation
565.20
1890.00
Closed treatment of greater humeral tuberosity fracture; with manipulation
Open treatment of greater humeral tuberosity fracture, with or without internal or
external fixation
Closed treatment of shoulder dislocation, with manipulation; without anesthesia
Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia
744.30
Open treatment of acute shoulder dislocation
Closed treatment of shoulder dislocation, with fracture of greater humeral
tuberosity, with manipulation
Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity,
with or without internal or external fixation
Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture,
with manipulation
Open treatment of shoulder dislocation, with surgical or anatomical neck fracture,
1996.20
23491
23532
23540
23545
23550
23552
23570
23575
23585
23600
23605
23615
23616
23620
23625
23630
23650
23655
23660
23665
23670
23675
23680
Extraordinary No.64/2013
48
2097.00
342.90
586.80
1701.90
418.50
2283.30
372.60
533.70
2152.80
537.30
871.20
2034.00
3965.40
471.60
1616.40
457.20
669.60
749.70
1975.50
888.30
2415.60
Friday, 09 August 2013
with or without internal or external fixation
23800
Manipulation under anesthesia, shoulder joint, including application of fixation
apparatus (dislocation excluded)
Arthrodesis, glenohumeral joint;
23802
23900
Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)
Interthoracoscapular amputation (forequarter)
3445.20
4063.50
23920
23921
Disarticulation of shoulder;
Disarticulation of shoulder; secondary closure or scar revision
3162.60
909.90
23930
23931
819.90
675.90
24065
24066
Incision and drainage, upper arm or elbow area; deep abscess or hematoma
Incision and drainage, upper arm or elbow area; bursa
Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess),
humerus or elbow
Arthrotomy, elbow, including exploration, drainage, or removal of foreign body
Arthrotomy of the elbow, with capsular excision for capsular release (separate
procedure)
Biopsy, soft tissue of upper arm or elbow area; superficial
Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)
24071
24073
Exc tumor soft tissue upper arm/elbow subq 3+cm
Exc tumor soft tiss upper arm/elbw subfasc 5+cm
972.78
1396.93
24075
24076
Excision, tumor, upper arm or elbow area; subcutaneous
Excision, tumor, upper arm or elbow area; deep, subfascial or intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of upper arm or
elbow area
Rad resect tumor soft tiss upper arm/elbow 5+cm
686.70
1179.00
Arthrotomy, elbow; with synovial biopsy only
Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without
removal of loose or foreign body
Arthrotomy, elbow; with synovectomy
Excision, olecranon bursa
1082.70
1581.30
24130
Excision or curettage of bone cyst or benign tumor, humerus;
Excision or curettage of bone cyst or benign tumor, humerus; with autograft
(includes obtaining graft)
Excision or curettage of bone cyst or benign tumor, humerus; with allograft
Excision or curettage of bone cyst or benign tumor of head or neck of radius or
olecranon process;
Excision or curettage of bone cyst or benign tumor of head or neck of radius or
olecranon process; with autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of head or neck of radius or
olecranon process; with allograft
Excision, radial head
24134
Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerus
1854.00
23700
23935
24000
24006
24077
24079
24100
24101
24102
24105
24110
24115
24116
24120
24125
24126
Extraordinary No.64/2013
49
625.50
3604.50
1374.30
1805.40
1784.70
385.20
707.89
2430.90
2604.12
1861.20
2224.80
898.20
1887.30
1841.40
1485.00
1740.60
1524.60
1459.80
Friday, 09 August 2013
24136
Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neck
1654.20
24138
1622.70
24150
24152
Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon process
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), humerus
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), radial head or neck
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis), olecranon process
Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with
contracture release (separate procedure)
Radical resection for tumor, shaft or distal humerus;
Radical resection for tumor, radial head or neck;
24155
24160
Resection of elbow joint (arthrectomy)
Implant removal; elbow joint
2199.60
1489.50
24164
24200
Implant removal; radial head
Removal of foreign body, upper arm or elbow area; subcutaneous
Removal of foreign body, upper arm or elbow area; deep (subfascial or
intramuscular)
Injection procedure for elbow arthrography
1359.90
368.10
Manipulation elbow under anesthesia
Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 2432024331)
Tendon lengthening, upper arm or elbow, each tendon
Tenotomy, open, elbow to shoulder, each tendon
Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder,
single (Seddon-Brookes type procedure)
Flexor-plasty, elbow (eg, Steindler type advancement);
Flexor-plasty, elbow (eg, Steindler type advancement); with extensor advancement
777.16
1181.38
1922.40
24343
24344
Tenolysis triceps
Tenodesis of biceps tendon at elbow (separate procedure)
Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or
secondary (excludes rotator cuff)
Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon
graft
Repair lateral collateral ligament elbow
Rcnstj lat coltrl ligm elbow w/tendon graft
24345
24346
Repair medial collateral ligament elbow
Rcnstj medial coltrl ligm elbw w/tdn grf
1857.96
2718.04
24357
24358
Tenotomy elbow lateral/medial percutaneous
Tnot elbow lateral/medial debride open
1115.21
1270.13
24359
Tnot elbow lateral/medial debride open tdn rpr
1520.03
24140
24145
24147
24149
24201
24220
24300
24301
24305
24310
24320
24330
24331
24332
24340
24341
24342
Extraordinary No.64/2013
50
2168.10
1442.70
1296.00
2652.30
2443.50
2158.20
962.10
177.30
1998.00
900.90
955.80
2311.20
2269.80
2086.20
1816.20
2416.50
1858.95
2485.31
Friday, 09 August 2013
24360
Arthroplasty, elbow; with membrane (eg, fascial)
3267.00
24361
24362
Arthroplasty, elbow; with distal humeral prosthetic replacement
Arthroplasty, elbow; with implant and fascia lata ligament reconstruction
Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic
replacement (eg, total elbow)
Arthroplasty, radial head;
2970.00
3446.10
Arthroplasty, radial head; with implant
Osteotomy, humerus, with or without internal fixation
Multiple osteotomies with realignment on intramedullary rod, humeral shaft
(Sofield type procedure)
Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)
Repair of nonunion or malunion, humerus; without graft (eg, compression
technique)
Repair of nonunion or malunion, humerus; with iliac or other autograft (includes
obtaining graft)
Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)
2054.70
2451.60
Decompression fasciotomy, forearm, with brachial artery exploration
Prophylactic treatment (nailing, pinning, plating or wiring), with or without
methylmethacrylate, humeral shaft
Closed treatment of humeral shaft fracture; without manipulation
Closed treatment of humeral shaft fracture; with manipulation, with or without
skeletal traction
Open treatment of humeral shaft fracture with plate/screws, with or without
cerclage
Open treatment of humeral shaft fracture, with insertion of intramedullary implant,
with or without cerclage and/or locking screws
Closed treatment of supracondylar or transcondylar humeral fracture, with or
without intercondylar extension; without manipulation
Closed treatment of supracondylar or transcondylar humeral fracture, with or
without intercondylar extension; with manipulation, with or without skin or
skeletal traction
Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture,
with or without intercondylar extension
Open treatment of humeral supracondylar or transcondylar fracture, with or
without internal or external fixation; without intercondylar extension
Open treatment of humeral supracondylar or transcondylar fracture, with or
without internal or external fixation; with intercondylar extension
Closed treatment of humeral epicondylar fracture, medial or lateral; without
manipulation
Closed treatment of humeral epicondylar fracture, medial or lateral; with
manipulation
Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral,
with manipulation
Open treatment of humeral epicondylar fracture, medial or lateral, with or without
2070.00
24363
24365
24366
24400
24410
24420
24430
24435
24470
24495
24498
24500
24505
24515
24516
24530
24535
24538
24545
24546
24560
24565
24566
24575
Extraordinary No.64/2013
51
4614.30
1601.10
2646.90
2397.60
2629.80
3298.50
1476.00
1984.50
503.10
1046.70
2314.80
2646.90
612.20
1064.70
1833.30
2343.60
2875.50
535.50
788.40
1277.10
1759.50
Friday, 09 August 2013
internal or external fixation
24576
24577
24579
24582
24586
24587
24600
24605
24615
Closed treatment of humeral condylar fracture, medial or lateral; without
manipulation
Closed treatment of humeral condylar fracture, medial or lateral; with manipulation
Open treatment of humeral condylar fracture, medial or lateral, with or without
internal or external fixation
Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with
manipulation
Open treatment of periarticular fracture and/or dislocation of the elbow (fracture
distal humerus and proximal ulna and/ or proximal radius);
Open treatment of periarticular fracture and/or dislocation of the elbow (fracture
distal humerus and proximal ulna and/ or proximal radius); with implant
arthroplasty
Treatment of closed elbow dislocation; without anesthesia
Treatment of closed elbow dislocation; requiring anesthesia
549.90
991.80
1859.40
1494.00
2680.20
3429.00
462.60
753.30
Open treatment of acute or chronic elbow dislocation
Closed treatment of Monteggia type of fracture dislocation at elbow (fracture
proximal end of ulna with dislocation of radial head), with manipulation
Open treatment of Monteggia type of fracture dislocation at elbow (fracture
proximal end of ulna with dislocation of radial head), with or without internal or
external fixation
Closed treatment of radial head subluxation in child, nursemaid elbow, with
manipulation
Closed treatment of radial head or neck fracture; without manipulation
1831.50
778.50
24800
24802
Closed treatment of radial head or neck fracture; with manipulation
Open treatment of radial head or neck fracture, with or without internal fixation or
radial head excision;
Open treatment of radial head or neck fracture, with or without internal fixation or
radial head excision; with radial head prosthetic replacement
Closed treatment of ulnar fracture, proximal end (olecranon process); without
manipulation
Closed treatment of ulnar fracture, proximal end (olecranon process); with
manipulation
Open treatment of ulnar fracture proximal end (olecranon process), with or without
internal or external fixation
Arthrodesis, elbow joint; local
Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)
24900
24920
Amputation, arm through humerus; with primary closure
Amputation, arm through humerus; open, circular (guillotine)
1834.20
1599.30
24925
24930
Amputation, arm through humerus; secondary closure or scar revision
Amputation, arm through humerus; re-amputation
774.90
1470.60
24931
24935
Amputation, arm through humerus; with implant
Stump elongation, upper extremity
1900.80
2499.30
24620
24635
24640
24650
24655
24665
24666
24670
24675
24685
Extraordinary No.64/2013
52
952.20
2043.00
280.80
413.10
1544.40
1931.40
478.80
801.00
1825.20
2271.60
2788.20
Friday, 09 August 2013
24940
Cineplasty, upper extremity, complete procedure
2632.50
25000
25001
Incision, extensor tendon sheath, wrist (eg, deQuervains disease)
Incision flexor tendon sheath wrist
1080.90
963.51
25020
Decompression fasciotomy, forearm and/or wrist; flexor or extensor compartment
Decompression fasciotomy, forearm and/or wrist; with debridement of nonviable
muscle and/or nerve
Dcmprn fasct f/arm&/wrst flxr&xtnsr w/o dbrdmt
Dcmprn fasct f/arm&/wrst flxr&xtnsr dbrdmt nv
1390.50
981.00
586.80
25065
Incision and drainage, forearm and/or wrist; deep abscess or hematoma
Incision and drainage, forearm and/or wrist; bursa
Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone
abscess)
Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal
of foreign body
Biopsy, soft tissue of forearm and/or wrist; superficial
25066
25071
Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)
Exc tumor soft tiss forearm and/wrist subq 3+cm
710.10
1308.04
25073
25075
Exc tumor sft tiss forearm&//wrist subfasc 3+cm
Excision, tumor, forearm and/or wrist area; subcutaneous
1806.54
650.70
25076
Excision, tumor, forearm and/or wrist area; deep, subfascial or intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of forearm and/or
wrist area
Rad rescj tum soft tissue forearm&/wrist 3+cm
Capsulotomy, wrist (eg, contracture)
1148.40
1330.20
25105
25107
Arthrotomy, wrist joint; with biopsy
Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or
without removal of loose or foreign body
Arthrotomy, wrist joint; with synovectomy
Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complex
25109
25110
Exc tendon forearm&/wrist flexor/extensor ea
Excision, lesion of tendon sheath, forearm and/or wrist
1481.65
801.00
25111
25112
Excision of ganglion, wrist (dorsal or volar); primary
Excision of ganglion, wrist (dorsal or volar); recurrent
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg,
tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors
Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg,
tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors,
with or without transposition of dorsal retinaculum
Synovectomy, extensor tendon sheath, wrist, single compartment;
Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of
distal ulna
943.10
1357.20
25023
25024
25025
25028
25031
25035
25040
25077
25078
25085
25100
25101
25115
25116
25118
25119
Extraordinary No.64/2013
53
1751.40
1555.24
2070.11
1416.60
1479.60
434.70
2590.20
3198.24
1601.10
1323.00
1722.60
1453.50
2098.80
2058.30
1926.00
1556.10
Friday, 09 August 2013
25120
25125
25126
25130
25135
25136
25145
Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding
head or neck of radius and olecranon process);
Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding
head or neck of radius and olecranon process); with autograft (includes obtaining
graft)
Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding
head or neck of radius and olecranon process); with allograft
Excision or curettage of bone cyst or benign tumor of carpal bones;
Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft
(includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of carpal bones; with allograft
1530.90
1812.60
1601.10
1552.50
1781.10
1669.50
1837.80
25170
25210
Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wrist
Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for
osteomyelitis); ulna
Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for
osteomyelitis); radius
Radical resection for tumor, radius or ulna
Carpectomy; one bone
25215
25230
Carpectomy; all bones of proximal row
Radial styloidectomy (separate procedure)
2278.80
1163.70
25240
25246
Excision distal ulna partial or complete (eg, Darrach type or matched resection)
Injection procedure for wrist arthrography
1516.50
223.20
25248
25250
Exploration with removal of deep foreign body, forearm or wrist
Removal of wrist prosthesis; (separate procedure)
1003.50
1647.90
25251
Removal of wrist prosthesis; complicated, including total wrist
Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each
tendon or muscle
Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each
tendon or muscle
Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft
(includes obtaining graft), each tendon or muscle
Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each
tendon or muscle
Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each
tendon or muscle
Repair, tendon or muscle, extensor, secondary, with tendon graft (includes
obtaining graft), forearm and/or wrist, each tendon or muscle
Rpr tendon sheath extensor f/arm&/wrst w/graft
Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist,
single, each tendon
Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each
tendon
Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon
2194.20
25150
25151
25260
25263
25265
25270
25272
25274
25275
25280
25290
25295
Extraordinary No.64/2013
54
1599.30
1522.80
2446.20
1483.20
1475.10
1476.00
1890.00
1206.90
1325.70
2003.40
1683.67
1415.70
943.20
1387.80
Friday, 09 August 2013
25300
Tenodesis at wrist; flexors of fingers
1893.60
25301
Tenodesis at wrist; extensors of fingers
Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single;
each tendon
Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single;
with tendon graft(s) (includes obtaining graft), each tendon
Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or
wrist;
Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or
wrist; with tendon(s) transfer
Capsulorrhaphy or reconstruction, wrist, any method (eg, capsulodesis, ligament
repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open
reduction) for carpal instability
Arthroplasty, wrist, with or without interposition, with or without external or
internal fixation
Centralization of wrist on ulna (eg, radial club hand)
Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint,
secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or
tenodesis) with or without open reduction of distal radioulnar joint
Osteotomy, radius; distal third
Osteotomy, radius; middle or proximal third
1581.30
1773.00
2209.50
25390
25391
Osteotomy; ulna
Osteotomy; radius AND ulna
Multiple osteotomies, with realignment on intramedullary rod (Sofield type
procedure); radius OR ulna
Multiple osteotomies, with realignment on intramedullary rod (Sofield type
procedure); radius AND ulna
Osteoplasty, radius OR ulna; shortening
Osteoplasty, radius OR ulna; lengthening with autograft
25392
25393
Osteoplasty, radius AND ulna; shortening (excluding 64876)
Osteoplasty, radius AND ulna; lengthening with autograft
2710.80
3029.40
25394
1709.09
25425
Osteoplasty carpal bone shortening
Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression
technique)
Repair of nonunion or malunion, radius OR ulna; with iliac or other autograft
(includes obtaining graft)
Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression
technique)
Repair of nonunion or malunion, radius AND ulna; with iliac or other autograft
(includes obtaining graft)
Repair of defect with autograft; radius OR ulna
25426
25431
Repair of defect with autograft; radius AND ulna
Repair nonunion carpal bone each bone
3141.00
2472.29
25310
25312
25315
25316
25320
25332
25335
25337
25350
25355
25360
25365
25370
25375
25400
25405
25415
25420
Extraordinary No.64/2013
55
1870.20
2202.30
2035.80
2677.50
3002.40
2537.10
3493.80
1961.10
1881.90
1962.90
2259.00
3060.90
2204.10
2938.50
1773.90
2500.20
2615.40
2688.30
2207.70
Friday, 09 August 2013
25441
25442
Repair of nonunion, scaphoid (navicular) bone, with or without radial
styloidectomy (includes obtaining graft and necessary fixation)
Arthroplasty with prosthetic replacement; distal radius
Arthroplasty with prosthetic replacement; distal ulna
25443
25444
Arthroplasty with prosthetic replacement; scaphoid (navicular)
Arthroplasty with prosthetic replacement; lunate
2010.60
2404.80
25445
Arthroplasty with prosthetic replacement; trapezium
Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus
(total wrist)
Arthroplasty, interposition, intercarpal or carpometacarpal joints
Revision of arthroplasty, including removal of implant, wrist joint
2321.10
Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulna
Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulna
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate; radius
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate; ulna
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate; radius AND ulna
Closed treatment of radial shaft fracture; without manipulation
Closed treatment of radial shaft fracture; with manipulation
1053.00
1548.00
1587.60
25530
25535
Open treatment of radial shaft fracture, with or without internal or external fixation
Closed treatment of radial shaft fracture, with dislocation of distal radio-ulnar joint
(Galeazzi fracture/dislocation)
Open treatment of radial shaft fracture, with internal and/ or external fixation and
closed treatment of dislocation of distal radio-ulnar joint (Galeazzi
fracture/dislocation), with or without percutaneous skeletal fixation
Open treatment of radial shaft fracture, with internal and/or external fixation and
open treatment, with or without internal or external fixation of distal radio-ulnar
joint (Galeazzi fracture/dislocation), includes repair of triangular cartilage
Closed treatment of ulnar shaft fracture; without manipulation
Closed treatment of ulnar shaft fracture; with manipulation
25545
25560
Open treatment of ulnar shaft fracture, with or without internal or external fixation
Closed treatment of radial and ulnar shaft fractures; without manipulation
1704.60
612.90
25565
Closed treatment of radial and ulnar shaft fractures; with manipulation
Open treatment of radial AND ulnar shaft fractures, with internal or external
fixation; of radius OR ulna
Open treatment of radial AND ulnar shaft fractures, with internal or external
fixation; of radius AND ulna
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal
separation, with or without fracture of ulnar styloid; without manipulation
Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal
1008.00
25440
25446
25447
25449
25450
25455
25490
25491
25492
25500
25505
25515
25520
25525
25526
25574
25575
25600
25605
Extraordinary No.64/2013
56
2318.40
2338.20
1840.50
3823.20
2806.20
1763.10
1586.70
1681.20
1881.90
513.00
775.80
1447.20
2566.80
2663.10
475.20
811.80
2353.50
2425.50
550.80
796.50
Friday, 09 August 2013
separation, with or without fracture of ulnar styloid; with manipulation
25606
25607
Perq skel fixj distal radial fx/epiphysl sep
Optx dstl radl x-artic fx/epiphysl sep
1524.64
1539.22
25608
25609
Optx dstl radl i-artic fx/epiphysl sep 2 frag
Optx dstl radl i-artic fx/epiphysl sep 3 frag
1895.26
2255.07
25622
25624
Closed treatment of carpal scaphoid (navicular) fracture; without manipulation
Closed treatment of carpal scaphoid (navicular) fracture; with manipulation
Open treatment of carpal scaphoid (navicular) fracture, with or without internal or
external fixation
Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular));
without manipulation, each bone
Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular));
with manipulation, each bone
Open treatment of carpal bone fracture (excluding carpal scaphoid (navicular)),
each bone
Closed treatment of ulnar styloid fracture
612.90
808.20
1006.20
1318.22
25670
Prq skeletal fixation ulnar styloid fracture
Open treatment ulnar styloid fracture
Closed treatment of radiocarpal or intercarpal dislocation, one or more bones, with
manipulation
Open treatment of radiocarpal or intercarpal dislocation, one or more bones
25671
25675
Prq skeletal fixj distal radioulnar dislocation
Closed treatment of distal radioulnar dislocation with manipulation
1128.99
776.70
25676
Open treatment of distal radioulnar dislocation, acute or chronic
Closed treatment of trans-scaphoperilunar type of fracture dislocation, with
manipulation
Open treatment of trans-scaphoperilunar type of fracture dislocation
Closed treatment of lunate dislocation, with manipulation
1699.20
1864.80
25805
Open treatment of lunate dislocation
Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or
intercarpal and/or carpometacarpal joints)
Arthrodesis, wrist; with sliding graft
25810
25820
Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)
Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)
3366.00
2223.00
25825
2680.20
25900
25905
Arthrodesis, wrist; with autograft (includes obtaining graft)
Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or
without bone graft (eg, Sauve-Kapandji procedure)
Amputation, forearm, through radius and ulna;
Amputation, forearm, through radius and ulna; open, circular (guillotine)
25907
Amputation, forearm, through radius and ulna; secondary closure or scar revision
837.00
25628
25630
25635
25645
25650
25651
25652
25660
25680
25685
25690
25695
25800
25830
Extraordinary No.64/2013
57
1751.40
506.70
699.30
1376.10
758.70
781.20
1624.50
1107.90
2005.20
1141.20
2785.50
2888.10
2169.90
1926.00
1746.00
Friday, 09 August 2013
25909
Amputation, forearm, through radius and ulna; re-amputation
1625.40
25915
25920
Krukenberg procedure
Disarticulation through wrist;
2570.40
1611.90
25922
25924
Disarticulation through wrist; secondary closure or scar revision
Disarticulation through wrist; re-amputation
945.90
1646.10
25927
25929
Transmetacarpal amputation;
Transmetacarpal amputation; secondary closure or scar revision
1952.10
870.30
25931
26010
Transmetacarpal amputation; re-amputation
Drainage of finger abscess; simple
1794.60
293.40
26011
26020
Drainage of finger abscess; complicated (eg, felon)
Drainage of tendon sheath, digit and/or palm, each
568.80
1313.10
26025
26030
Drainage of palmar bursa; single, bursa
Drainage of palmar bursa; multiple bursa
1323.90
1913.40
26034
26035
Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess)
Decompression fingers and/or hand, injection injury (eg, grease gun)
1782.00
2395.80
26037
26040
Decompressive fasciotomy, hand (excludes 26035)
Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneous
2175.30
1008.00
26045
26055
Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial
Tendon sheath incision (eg, for trigger finger)
1457.10
931.88
26060
499.50
26100
Tenotomy, percutaneous, single, each digit
Arthrotomy, with exploration, drainage, or removal of loose or foreign body;
carpometacarpal joint
Arthrotomy, with exploration, drainage, or removal of loose or foreign body;
metacarpophalangeal joint, each
Arthrotomy, with exploration, drainage, or removal of loose or foreign body;
interphalangeal joint, each
Arthrotomy with biopsy; carpometacarpal joint, each
26105
26110
Arthrotomy with biopsy; metacarpophalangeal joint, each
Arthrotomy with biopsy; interphalangeal joint, each
1050.30
842.40
26111
26113
Ex tum/vasc malf sft tiss hand/fngr subq 1.5+cm
Ex tum/vasc mal sft tis hand/fngr subfsc 1.5+cm
1075.54
1621.65
26115
Excision, tumor or vascular malformation, hand or finger; subcutaneous
Excision, tumor or vascular malformation, hand or finger; deep, subfascial,
intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of hand or finger
Rad rescj tum soft tissue hand/finger 3+cm
Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement,
or skin grafting (includes obtaining graft)
Fasciectomy, partial palmar with release of single digit including proximal
927.00
26070
26075
26080
26116
26117
26118
26121
26123
Extraordinary No.64/2013
58
841.50
1145.70
895.50
920.70
1284.30
2445.30
3201.59
2585.70
2606.40
Friday, 09 August 2013
26125
26130
26135
26140
26145
26160
26170
26180
26185
26200
interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or
skin grafting (includes obtaining graft);
Fasciectomy, partial palmar with release of single digit including proximal
interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or
skin grafting (includes obtaining graft); each additional digit (List separately in
addition
Synovectomy, carpometacarpal joint
Synovectomy, metacarpophalangeal joint including intrinsic release and extensor
hood reconstruction, each digit
Synovectomy, proximal interphalangeal joint, including extensor reconstruction,
each interphalangeal joint
Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm
and/or finger, each tendon
Excision of lesion of tendon sheath or capsule (eg, cyst, mucous cyst, or ganglion),
hand or finger
Excision of tendon, palm, flexor, single (separate procedure), each
Excision of tendon, finger, flexor (separate procedure), each tendon
2230.20
1566.00
1762.20
1708.20
1744.20
913.50
945.90
834.30
929.70
1137.60
26250
26260
Sesamoidectomy, thumb or finger (separate procedure)
Excision or curettage of bone cyst or benign tumor of metacarpal;
Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft
(includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal
phalanx of finger;
Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal
phalanx of finger; with autograft (includes obtaining graft)
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis); metacarpal
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis); proximal or middle phalanx of finger
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis); distal phalanx of finger
Radical resection, metacarpal; (eg, tumor)
Radical resection, proximal or middle phalanx of finger (eg, tumor);
26262
26320
Radical resection, distal phalanx of finger (eg, tumor)
Removal of implant from finger or hand
1568.70
956.70
26340
Manipulation finger joint under anes each joint
Repair or advancement, flexor tendon, not in digital flexor tendon sheath (eg, no
man's land); primary or secondary without free graft, each tendon
Repair or advancement, flexor tendon, not in digital flexor tendon sheath (eg, no
man's land); secondary with free graft (includes obtaining graft), each tendon
Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's
land); primary, each tendon
Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's
land); secondary, each tendon
841.74
26205
26210
26215
26230
26235
26236
26350
26352
26356
26357
Extraordinary No.64/2013
59
1695.60
1234.80
1538.10
1121.40
1081.80
931.50
1561.50
1692.00
2094.30
2346.30
2266.20
2317.50
Friday, 09 August 2013
26437
Repair or advancement, flexor tendon, in digital flexor tendon sheath (eg, no man's
land); secondary with free graft (includes obtaining graft), each tendon
Repair or advancement of profundus tendon, with intact superficialis tendon;
primary, each tendon
Repair or advancement of profundus tendon, with intact superficialis tendon;
secondary with free graft (includes obtaining graft), each tendon
Repair or advancement of profundus tendon, with intact superficialis tendon;
secondary without free graft, each tendon
Excision flexor tendon, implantation of prosthetic rod for delayed tendon graft,
hand or finger, each tendon
Removal of prosthetic rod and insertion of flexor tendon graft, hand or finger
(includes obtaining graft), each tendon
Repair, extensor tendon, hand, primary or secondary; without free graft, each
tendon
Repair, extensor tendon, hand, primary or secondary; with free graft (includes
obtaining graft), each tendon
Excision of extensor tendon, implantation of prosthetic rod for delayed tendon
graft, hand or finger
Removal of prosthetic rod and insertion of extensor tendon graft (includes
obtaining graft), hand or finger, each tendon
Repair, extensor tendon, finger, primary or secondary; without free graft, each
tendon
Repair, extensor tendon, finger, primary or secondary; with free graft (includes
obtaining graft) each tendon
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity);
using local tissue(s), including lateral band(s), each tendon
Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity);
with free graft (includes obtaining graft), each tendon
Closed treatment of distal extensor tendon insertion, with or without percutaneous
pinning (eg, mallet finger)
Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg,
mallet finger)
Repair of extensor tendon, distal insertion, primary or secondary; with free graft
(includes obtaining graft)
Realignment of extensor tendon, hand, each tendon
26440
26442
Tenolysis, flexor tendon; palm OR finger; each tendon
Tenolysis, flexor tendon; palm AND finger, each tendon
1247.40
1440.90
26445
26449
Tenolysis, extensor tendon, hand or finger; each tendon
Tenolysis, complex, extensor tendon, finger, including forearm, each tendon
1212.30
1699.20
26450
26455
Tenotomy, flexor, palm, open, each tendon
Tenotomy, flexor, finger, open, each tendon
733.50
847.80
26460
26471
Tenotomy, extensor, hand or finger, open, each tendon
Tenodesis; of proximal interphalangeal joint, each joint
849.60
1384.20
26474
Tenodesis; of distal joint, each joint
981.00
26358
26370
26372
26373
26390
26392
26410
26412
26415
26416
26418
26420
26426
26428
26432
26433
26434
Extraordinary No.64/2013
60
2396.70
1900.80
1975.50
1825.20
1753.20
2260.80
1064.70
1515.60
1444.50
1515.60
1251.90
1416.60
1654.20
1773.00
1139.40
1485.00
1368.00
1484.10
Friday, 09 August 2013
26476
Lengthening of tendon, extensor, hand or finger, each tendon
1012.50
26477
26478
Shortening of tendon, extensor, hand or finger, each tendon
Lengthening of tendon, flexor, hand or finger, each tendon
1078.20
1345.50
26479
1348.20
26490
26492
Shortening of tendon, flexor, hand or finger, each tendon
Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without
free graft, each tendon
Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free
tendon graft (includes obtaining graft), each tendon
Transfer or transplant of tendon, palmar; without free tendon graft, each tendon
Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining
graft), each tendon
Opponensplasty; superficialis tendon transfer type, each tendon
Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendon
26494
26496
Opponensplasty; hypothenar muscle transfer
Opponensplasty; other methods
2032.20
2317.50
26497
26498
Transfer of tendon to restore intrinsic function; ring and small finger
Transfer of tendon to restore intrinsic function; all four fingers
2201.40
2544.30
26499
2403.90
26508
Correction claw finger, other methods
Reconstruction of tendon pulley, each tendon; with local tissues (separate
procedure)
Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes
obtaining graft) (separate procedure)
Release of thenar muscle(s) (eg, thumb contracture)
26510
26516
Cross intrinsic transfer
Capsulodesis, metacarpophalangeal joint; single digit
1870.20
1593.90
26517
26518
Capsulodesis, metacarpophalangeal joint; two digits
Capsulodesis, metacarpophalangeal joint; three or four digits
1629.90
2031.30
26520
26525
Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint
Capsulectomy or capsulotomy; interphalangeal joint, each joint
1548.00
1649.70
26530
26531
Arthroplasty, metacarpophalangeal joint; each joint
Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint
1611.90
1847.70
26535
26536
Arthroplasty, interphalangeal joint; each joint
Arthroplasty, interphalangeal joint; with prosthetic implant, each joint
1657.80
1911.60
26540
Repair of collateral ligament, metacarpophalangeal or interphalangeal joint
Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon
or fascial graft (includes obtaining graft)
Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local
tissue (eg, adductor advancement)
Reconstruction, collateral ligament, interphalangeal joint, single, including graft,
each joint
1791.00
26480
26483
26485
26489
26500
26502
26541
26542
26545
Extraordinary No.64/2013
61
1838.70
2086.20
1926.90
2232.90
2045.70
2237.40
1257.30
1802.70
1460.70
2261.70
2025.00
1589.40
Friday, 09 August 2013
26553
Repair non-union, metacarpal or phalanx, (includes obtaining bone graft with or
without external or internal fixation)
Repair and reconstruction, finger, volar plate, interphalangeal joint
Pollicization of a digit
Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with
bone graft
Transfer, toe-to-hand with microvascular anastomosis; other than great toe, single
26554
26555
Transfer, toe-to-hand with microvascular anastomosis; other than great toe, double
Transfer, finger to another position without microvascular anastomosis
10847.70
2587.50
26556
26560
Transfer, free toe joint, with microvascular anastomosis
Repair of syndactyly (web finger) each web space; with skin flaps
9251.10
1658.70
26561
2214.90
26565
Repair of syndactyly (web finger) each web space; with skin flaps and grafts
Repair of syndactyly (web finger) each web space; complex (eg, involving bone,
nails)
Osteotomy; metacarpal, each
26567
26568
Osteotomy; phalanx of finger, each
Osteoplasty, lengthening, metacarpal or phalanx
1483.20
2240.10
26580
26587
Repair cleft hand
Reconstruction of supernumerary digit, soft tissue and bone
3350.70
1975.50
26590
26591
Repair macrodactylia
Repair, intrinsic muscles of hand, each muscle
2241.00
1861.20
26593
26596
Release, intrinsic muscles of hand, each muscle
Excision of constricting ring of finger, with multiple Z-plasties
1684.80
1884.60
26600
26605
Closed treatment of metacarpal fracture, single; without manipulation, each bone
Closed treatment of metacarpal fracture, single; with manipulation, each bone
Closed treatment of metacarpal fracture, with manipulation, with internal or
external fixation, each bone
Percutaneous skeletal fixation of metacarpal fracture, each bone
Open treatment of metacarpal fracture, single, with or without internal or external
fixation, each bone
Closed treatment of carpometacarpal dislocation, thumb, with manipulation
Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture),
with manipulation
Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb
(Bennett fracture), with manipulation, with or without external fixation
Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture),
with or without internal or external fixation
Closed treatment of carpometacarpal dislocation, other than thumb (Bennett
fracture), single, with manipulation; without anesthesia
Closed treatment of carpometacarpal dislocation, other than thumb (Bennett
fracture), single, with manipulation; requiring anesthesia
341.10
504.00
26546
26548
26550
26551
26562
26607
26608
26615
26641
26645
26650
26665
26670
26675
Extraordinary No.64/2013
62
1758.60
1946.70
3405.60
9160.20
9096.30
2721.60
1844.10
983.70
1079.10
1511.10
526.50
703.80
1207.80
1818.90
373.50
617.66
Friday, 09 August 2013
26820
Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb
(Bennett fracture), single, with manipulation
Open treatment of carpometacarpal dislocation, other than thumb (Bennett
fracture); single, with or without internal or external fixation
Open treatment of carpometacarpal dislocation, other than thumb (Bennett
fracture); complex, multiple or delayed reduction
Closed treatment of metacarpophalangeal dislocation, single, with manipulation;
without anesthesia
Closed treatment of metacarpophalangeal dislocation, single, with manipulation;
requiring anesthesia
Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with
manipulation
Open treatment of metacarpophalangeal dislocation, single, with or without
internal or external fixation
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger
or thumb; without manipulation, each
Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger
or thumb; with manipulation, with or without skin or skeletal traction, each
Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or
middle phalanx, finger or thumb, with manipulation, each
Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or
thumb, with or without internal or external fixation, each
Closed treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint; without manipulation, each
Closed treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint; with manipulation, each
Open treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint, with or without internal or external fixation, each
Closed treatment of distal phalangeal fracture, finger or thumb; without
manipulation, each
Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation,
each
Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each
Open treatment of distal phalangeal fracture, finger or thumb, with or without
internal or external fixation, each
Closed treatment of interphalangeal joint dislocation, single, with manipulation;
without anesthesia
Closed treatment of interphalangeal joint dislocation, single, with manipulation;
requiring anesthesia
Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with
manipulation
Open treatment of interphalangeal joint dislocation, with or without internal or
external fixation, single
Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)
26841
26842
Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;
Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with
26676
26685
26686
26700
26705
26706
26715
26720
26725
26727
26735
26740
26742
26746
26750
26755
26756
26765
26770
26775
26776
26785
Extraordinary No.64/2013
63
885.60
1269.00
1341.00
340.20
525.60
847.80
1225.80
278.10
462.60
967.50
1345.50
492.30
647.10
1380.60
227.70
368.40
751.50
889.20
244.56
448.20
712.80
990.90
1808.10
1699.20
1946.70
Friday, 09 August 2013
autograft (includes obtaining graft)
26843
1415.70
26990
26991
Arthrodesis, carpometacarpal joint, digits, other than thumb;
Arthrodesis, carpometacarpal joint, digits, other than thumb; with autograft
(includes obtaining graft)
Arthrodesis, metacarpophalangeal joint, with or without internal fixation;
Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with
autograft (includes obtaining graft)
Arthrodesis, interphalangeal joint, with or without internal fixation;
Arthrodesis, interphalangeal joint, with or without internal fixation; each additional
interphalangeal joint (List separately in addition to code for primary procedure)
Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft
(includes obtaining graft)
Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft
(includes obtaining graft), each additional joint (List separately in addition to code
for primary procedure)
Amputation, metacarpal, with finger or thumb (ray amputation), single, with or
without interosseous transfer
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single,
including neurectomies; with direct closure
Amputation, finger or thumb, primary or secondary, any joint or phalanx, single,
including neurectomies; with local advancement flaps (V-Y, hood)
Incision and drainage, pelvis or hip joint area; deep abscess or hematoma
Incision and drainage, pelvis or hip joint area; infected bursa
26992
27000
Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)
Tenotomy, adductor of hip, percutaneous (separate procedure)
1793.70
498.60
27001
27003
Tenotomy, adductor of hip, open
Tenotomy, adductor, subcutaneous, open, with obturator neurectomy
912.60
1064.70
27005
27006
Tenotomy, hip flexor(s), open (separate procedure)
Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure)
1452.60
1012.50
27025
27027
Fasciotomy, hip or thigh, any type
Decompression fasciotomy pelvic compartment uni
1698.30
1637.28
27030
27033
2173.50
2332.80
27040
Arthrotomy, hip, with drainage (eg, infection)
Arthrotomy, hip, including exploration or removal of loose or foreign body
Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic,
femoral, or obturator nerves
Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone,
with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor
fascia latae, rectus femoris, sartorius, iliopsoas)
Biopsy, soft tissue of pelvis and hip area; superficial
27041
27043
Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular
Excision tumor soft tissue pelvis&hip subq 3+cm
767.70
877.66
27045
Exc tumor soft tissue pelvis & hip subfasc 5+cm
1380.69
26844
26850
26852
26860
26861
26862
26863
26910
26951
26952
27035
27036
Extraordinary No.64/2013
64
1545.30
1919.70
1494.00
1250.10
540.90
1629.90
646.20
1870.20
910.80
1376.10
900.90
772.20
2578.50
2480.40
462.60
Friday, 09 August 2013
27047
Excision, tumor, pelvis and hip area; subcutaneous tissue
697.50
27048
1323.00
27050
27052
Excision, tumor, pelvis and hip area; deep, subfascial, intramuscular
Radical resection of tumor, soft tissue of pelvis and hip area (eg, malignant
neoplasm)
Arthrotomy, with biopsy; sacroiliac joint
Arthrotomy, with biopsy; hip joint
27054
27057
Arthrotomy with synovectomy, hip joint
Dcmprn fasciotomy pelvic cmprt dbrdmt muscle uni
2638.80
1660.89
27059
27060
Rad resection tumor soft tiss pelvis&hip 5+cm
Excision; ischial bursa
3359.14
999.90
27062
Excision; trochanteric bursa or calcification
Excision of bone cyst or benign tumor; superficial (wing of ilium, symphysis
pubis, or greater trochanter of femur) with or without autograft
Excision of bone cyst or benign tumor; deep, with or without autograft
Excision of bone cyst or benign tumor; with autograft requiring separate incision
Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess);
superficial (eg, wing of ilium, symphysis pubis, or greater trochanter of femur)
Partial excision (craterization, saucerization) (eg, osteomyelitis or bone abscess);
deep (subfascial or intramuscular)
Radical resection of tumor or infection; wing of ilium, one pubic or ischial ramus
or symphysis pubis
Radical resection of tumor or infection; ilium, including acetabulum, both pubic
rami, or ischium and acetabulum
Radical resection of tumor or infection; innominate bone, total
Radical resection of tumor or infection; ischial tuberosity and greater trochanter of
femur
Coccygectomy, primary
Removal of foreign body, pelvis or hip; subcutaneous tissue
904.50
1123.53
2482.20
27093
Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular)
Removal of hip prosthesis; (separate procedure)
Removal of hip prosthesis; complicated, including total hip prosthesis,
methylmethacrylate with or without insertion of spacer
Injection procedure for hip arthrography; without anesthesia
27095
27096
Injection procedure for hip arthrography; with anesthesia
Injection procedure for sacroiliac joint, arthrography and/or anesthetic/steroid
504.00
769.50
27097
27098
1754.10
2065.50
27105
Release or recession, hamstring, proximal
Transfer, adductor to ischium
Transfer external oblique muscle to greater trochanter including fascial or tendon
extension (graft)
Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)
27110
Transfer iliopsoas; to greater trochanter
2935.80
27049
27065
27066
27067
27070
27071
27075
27076
27077
27078
27080
27086
27087
27090
27091
27100
Extraordinary No.64/2013
65
3126.60
1007.10
2218.50
1318.50
1965.60
2286.90
1739.70
1902.60
3087.90
4360.50
5816.70
1979.10
1275.30
332.10
5319.90
275.40
2358.90
2504.70
Friday, 09 August 2013
27111
Transfer iliopsoas; to femoral neck
2898.90
27120
27122
Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)
Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)
3783.60
3681.00
27125
4079.70
27140
Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)
Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip
replacement), with or without autograft or allograft
Conversion of previous hip surgery to total hip replacement, with or without
autograft or allograft
Revision of total hip arthroplasty; both components, with or without autograft or
allograft
Revision of total hip arthroplasty; acetabular component only, with or without
autograft or allograft
Revision of total hip arthroplasty; femoral component only, with or without
allograft
Osteotomy and transfer of greater trochanter (separate procedure)
27146
27147
Osteotomy, iliac, acetabular or innominate bone;
Osteotomy, iliac, acetabular or innominate bone; with open reduction of hip
3255.30
3914.10
27151
Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy
Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with
open reduction of hip
Osteotomy, pelvis, bilateral (eg, congenital malformation)
Osteotomy, femoral neck (separate procedure)
Osteotomy, intertrochanteric or subtrochanteric including internal or external
fixation and/or cast
Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes
obtaining bone graft)
Treatment of slipped femoral epiphysis; by traction, without reduction
3619.80
Treatment of slipped femoral epiphysis; by single or multiple pinning, in situ
Open treatment of slipped femoral epiphysis; single or multiple pinning or bone
graft (includes obtaining graft)
Open treatment of slipped femoral epiphysis; closed manipulation with single or
multiple pinning
Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman
type procedure)
Open treatment of slipped femoral epiphysis; osteotomy and internal fixation
2770.20
Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate, femoral neck and proximal femur
Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation;
without manipulation
Closed treatment of pelvic ring fracture, dislocation, diastasis or subluxation; with
manipulation, requiring more than local anesthesia
Closed treatment of coccygeal fracture
1233.00
27130
27132
27134
27137
27138
27156
27158
27161
27165
27170
27175
27176
27177
27178
27179
27181
27185
27187
27193
27194
27200
Extraordinary No.64/2013
66
5616.90
6371.10
8532.18
5851.80
5899.50
2176.20
4401.00
3836.70
3132.00
3549.60
3708.00
1855.80
3270.60
3458.70
2672.10
3789.90
4241.70
1030.50
1568.70
441.90
Friday, 09 August 2013
27202
27215
27216
27217
27218
27220
27222
27226
27227
27228
27230
27232
27235
27236
27238
27240
27244
27245
27246
27248
27250
27252
27253
27254
Open treatment of coccygeal fracture
Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s) (eg,
pelvic fracture(s) which do not disrupt the pelvic ring), with internal fixation
Percutaneous skeletal fixation of posterior pelvic ring fracture and/or dislocation
(includes ilium, sacroiliac joint and/or sacrum)
Open treatment of anterior ring fracture and/or dislocation with internal fixation
(includes pubic symphysis and/or rami)
Open treatment of posterior ring fracture and/or dislocation with internal fixation
(includes ilium, sacroiliac joint and/or sacrum)
Closed treatment of acetabulum (hip socket) fracture(s); without manipulation
Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or
without skeletal traction
Open treatment of posterior or anterior acetabular wall fracture, with internal
fixation
Open treatment of acetabular fracture(s) involving anterior or posterior (one)
column, or a fracture running transversely across the acetabulum, with internal
fixation
Open treatment of acetabular fracture(s) involving anterior and posterior (two)
columns, includes T-fracture and both column fracture with complete articular
detachment, or single column or transverse fracture with associated acetabular wall
fracture, wit
Closed treatment of femoral fracture, proximal end, neck; without manipulation
Closed treatment of femoral fracture, proximal end, neck; with manipulation, with
or without skeletal traction
Percutaneous skeletal fixation of femoral fracture, proximal end, neck,
undisplaced, mildly displaced, or impacted fracture
Open treatment of femoral fracture, proximal end, neck, internal fixation or
prosthetic replacement
Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral
fracture; without manipulation
Closed treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral
fracture; with manipulation, with or without skin or skeletal traction
Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral
fracture; with plate/screw type implant, with or without cerclage
Open treatment of intertrochanteric, pertrochanteric, or subtrochanteric femoral
fracture; with intramedullary implant, with or without interlocking screws and/or
cerclage
Closed treatment of greater trochanteric fracture, without manipulation
Open treatment of greater trochanteric fracture, with or without internal or external
fixation
Closed treatment of hip dislocation, traumatic; without anesthesia
897.30
Closed treatment of hip dislocation, traumatic; requiring anesthesia
Open treatment of hip dislocation, traumatic, without internal fixation
Open treatment of hip dislocation, traumatic, with acetabular wall and femoral
head fracture, with or without internal or external fixation
1134.90
2451.60
Extraordinary No.64/2013
67
2472.30
2767.50
3654.90
4345.20
896.40
1599.30
3602.70
6057.90
6196.50
1077.30
1769.40
3135.60
3712.50
1142.10
2139.30
3339.00
3947.40
903.60
2221.20
764.10
3348.00
Friday, 09 August 2013
27267
27268
Treatment of spontaneous hip dislocation (developmental, including congenital or
pathological), by abduction, splint or traction; without anesthesia, without
manipulation
Treatment of spontaneous hip dislocation (developmental, including congenital or
pathological), by abduction, splint or traction; with manipulation, requiring
anesthesia
Open treatment of spontaneous hip dislocation (developmental, including
congenital or pathological), replacement of femoral head in acetabulum (including
tenotomy, etc);
Open treatment of spontaneous hip dislocation (developmental, including
congenital or pathological), replacement of femoral head in acetabulum (including
tenotomy, etc); with femoral shaft shortening
Closed treatment of post hip arthroplasty dislocation; without anesthesia
Closed treatment of post hip arthroplasty dislocation; requiring regional or general
anesthesia
Closed tx femoral fracture prox head w/o mnpj
Closed tx femoral fracture prox head w mnpj
27269
27275
Open tx femoral fracture proximal end head
Manipulation, hip joint, requiring general anesthesia
2878.69
505.80
27280
27282
Arthrodesis, sacroiliac joint (including obtaining graft)
Arthrodesis, symphysis pubis (including obtaining graft)
2464.20
2461.50
27284
27286
Arthrodesis, hip joint (including obtaining graft);
Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomy
4975.20
4097.70
27290
27295
Interpelviabdominal amputation (hindquarter amputation)
Disarticulation of hip
5978.70
4355.10
27301
832.94
27323
Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region
Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or
bone abscess)
Fasciotomy, iliotibial (tenotomy), open
Tenotomy, percutaneous, adductor or hamstring; single tendon (separate
procedure)
Tenotomy, percutaneous, adductor or hamstring; multiple tendons
Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg,
infection)
Biopsy, soft tissue of thigh or knee area; superficial
27324
27325
Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)
Neurectomy hamstring muscle
807.30
1757.66
27326
27327
Neurectomy popliteal
Excision, tumor, thigh or knee area; subcutaneous
1605.75
720.00
27328
Excision, tumor, thigh or knee area; deep, subfascial, or intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of thigh or knee
area
1256.40
27256
27257
27258
27259
27265
27266
27303
27305
27306
27307
27310
27329
Extraordinary No.64/2013
68
1652.40
1835.10
2468.70
2904.30
772.20
1535.40
864.17
1109.74
1818.00
1055.70
681.30
1024.20
1787.40
360.90
2625.30
Friday, 09 August 2013
27330
2022.30
27337
27339
Arthrotomy, knee; with synovial biopsy only
Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or
foreign bodies
Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR
lateral
Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial
AND lateral
Arthrotomy, with synovectomy, knee; anterior OR posterior
Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal
area
Excison tumor soft tissue thigh/knee subq 3+cm
Exc tumor soft tissue thigh/knee subfasc 5+cm
27340
27345
Excision, prepatellar bursa
Excision of synovial cyst of popliteal space (eg, Baker's cyst)
1103.40
1524.60
27347
27350
Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee
Patellectomy or hemipatellectomy
784.80
2124.00
27355
27356
1802.70
2199.60
27364
27365
Excision or curettage of bone cyst or benign tumor of femur;
Excision or curettage of bone cyst or benign tumor of femur; with allograft
Excision or curettage of bone cyst or benign tumor of femur; with autograft
(includes obtaining graft)
Excision or curettage of bone cyst or benign tumor of femur; with internal fixation
(List in addition to code for primary procedure)
Partial excision (craterization, saucerization, or diaphysectomy) bone, femur,
proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)
Rad resection tumor soft tissue thigh/knee 5+cm
Radical resection of tumor, bone, femur or knee
27370
27372
Injection procedure for knee arthrography
Removal of foreign body, deep, thigh region or knee area
197.10
955.80
27380
1602.00
27390
27391
Suture of infrapatellar tendon; primary
Suture of infrapatellar tendon; secondary reconstruction, including fascial or
tendon graft
Suture of quadriceps or hamstring muscle rupture; primary
Suture of quadriceps or hamstring muscle rupture; secondary reconstruction,
including fascial or tendon graft
Tenotomy, open, hamstring, knee to hip; single tendon
Tenotomy, open, hamstring, knee to hip; multiple tendons, one leg
27392
27393
Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateral
Lengthening of hamstring tendon; single tendon
2008.80
1071.00
27394
27395
Lengthening of hamstring tendon; multiple tendons, one leg
Lengthening of hamstring tendon; multiple tendons, bilateral
1632.60
2038.50
27396
Transplant, hamstring tendon to patella; single tendon
2131.20
27331
27332
27333
27334
27335
27357
27358
27360
27381
27385
27386
Extraordinary No.64/2013
69
1806.30
2399.40
3174.14
2421.00
2895.30
1376.91
2414.25
2436.30
2508.30
1926.90
4912.84
3127.50
2480.40
1827.90
2734.20
1061.10
1390.50
Friday, 09 August 2013
27397
Transplant, hamstring tendon to patella; multiple tendons
2707.20
27400
27403
Transfer, tendon or muscle, hamstrings to femur (eg, Egger's type procedure)
Arthrotomy with meniscus repair, knee
1980.00
2745.00
27405
27407
2272.50
3190.50
27412
Repair, primary, torn ligament and/or capsule, knee; collateral
Repair, primary, torn ligament and/or capsule, knee; cruciate
Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate
ligaments
Autologous chondrocyte implantation knee
27415
27416
Osteochondral allograft knee open
Osteochondral autograft knee open mosaicplasty
4366.31
2968.11
27418
27420
3002.40
2293.20
27424
Anterior tibial tubercleplasty (eg, Maquet type procedure)
Reconstruction of dislocating patella; (eg, Hauser type procedure)
Reconstruction of dislocating patella; with extensor realignment and/or muscle
advancement or release (eg, Campbell, Goldwaite type procedure)
Reconstruction of dislocating patella; with patellectomy
27425
27427
Lateral retinacular release (any method)
Ligamentous reconstruction (augmentation), knee; extra-articular
2367.00
3698.10
27428
3715.20
27430
Ligamentous reconstruction (augmentation), knee; intra-articular (open)
Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extraarticular
Quadricepsplasty (eg, Bennett or Thompson type)
27435
27437
Capsulotomy, posterior capsular release, knee
Arthroplasty, patella; without prosthesis
2236.50
2274.30
27438
27440
Arthroplasty, patella; with prosthesis
Arthroplasty, knee, tibial plateau;
2720.70
3292.20
27441
27442
Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy
Arthroplasty, femoral condyles or tibial plateau(s), knee;
Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and
partial synovectomy
Arthroplasty, knee, hinge prosthesis (eg, Walldius type)
3002.40
3510.00
Arthroplasty, knee, condyle and plateau; medial OR lateral compartment
Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or
without patella resurfacing (total knee replacement)
Osteotomy, femur, shaft or supracondylar; without fixation
Osteotomy, femur, shaft or supracondylar; with fixation
Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg,
Sofield type procedure)
Osteotomy, proximal tibia, including fibular excision or osteotomy (includes
correction of genu varus (bowleg) or genu valgus (knock-knee)); before epiphyseal
closure
4126.63
27409
27422
27429
27443
27445
27446
27447
27448
27450
27454
27455
Extraordinary No.64/2013
70
3634.20
5606.85
2475.00
2765.70
4960.80
2210.40
3554.10
4499.10
5226.12
2877.30
2826.90
3295.80
2394.90
Friday, 09 August 2013
27457
27465
27466
27468
27470
27472
27475
27477
27479
27485
27486
27487
27488
27495
27496
27497
27498
27499
27500
27501
27502
27503
27506
27507
27508
Osteotomy, proximal tibia, including fibular excision or osteotomy (includes
correction of genu varus (bowleg) or genu valgus (knock-knee)); after epiphyseal
closure
Osteoplasty, femur; shortening (excluding 64876)
Osteoplasty, femur; lengthening
Osteoplasty, femur; combined, lengthening and shortening with femoral segment
transfer
Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg,
compression technique)
Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other
autogenous bone graft (includes obtaining graft)
Arrest, epiphyseal, any method (eg, epiphydiodesis); distal femur
Arrest, epiphyseal, any method (eg, epiphydiodesis); tibia and fibula, proximal
Arrest, epiphyseal, any method (eg, epiphydiodesis); combined distal femur,
proximal tibia and fibula
Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or
valgus)
Revision of total knee arthroplasty, with or without allograft; one component
Revision of total knee arthroplasty, with or without allograft; femoral and entire
tibial component
Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or
without insertion of spacer, knee
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate, femur
Decompression fasciotomy, thigh and/or knee, one compartment (flexor or
extensor or adductor);
Decompression fasciotomy, thigh and/or knee, one compartment (flexor or
extensor or adductor); with debridement of nonviable muscle and/or nerve
Decompression fasciotomy, thigh and/or knee, multiple compartments;
Decompression fasciotomy, thigh and/or knee, multiple compartments; with
debridement of nonviable muscle and/or nerve
Closed treatment of femoral shaft fracture, without manipulation
Closed treatment of supracondylar or transcondylar femoral fracture with or
without intercondylar extension, without manipulation
Closed treatment of femoral shaft fracture, with manipulation, with or without skin
or skeletal traction
Closed treatment of supracondylar or transcondylar femoral fracture with or
without intercondylar extension, with manipulation, with or without skin or
skeletal traction
Open treatment of femoral shaft fracture, with or without external fixation, with
insertion of intramedullary implant, with or without cerclage and/or locking screws
Open treatment of femoral shaft fracture with plate/screws, with or without
cerclage
Closed treatment of femoral fracture, distal end, medial or lateral condyle, without
manipulation
Extraordinary No.64/2013
71
2886.30
3267.90
3707.10
4853.70
3579.30
4050.00
2453.40
2636.10
3160.80
1805.40
5175.90
6452.10
3144.60
3450.60
1184.40
1555.20
2394.90
2421.00
1207.80
1495.80
1648.80
2035.80
3828.60
3386.70
1017.00
Friday, 09 August 2013
27509
27510
27511
27513
27514
27516
27517
27519
27520
27524
27530
27532
27535
27536
27538
27540
27550
27552
27556
27557
27558
27560
27562
27566
27570
27580
Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral
condyle, or supracondylar or transcondylar, with or without intercondylar
extension, or distal femoral epiphyseal separation
Closed treatment of femoral fracture, distal end, medial or lateral condyle, with
manipulation
Open treatment of femoral supracondylar or transcondylar fracture without
intercondylar extension, with or without internal or external fixation
Open treatment of femoral supracondylar or transcondylar fracture with
intercondylar extension, with or without internal or external fixation
Open treatment of femoral fracture, distal end, medial or lateral condyle, with or
without internal or external fixation
Closed treatment of distal femoral epiphyseal separation; without manipulation
Closed treatment of distal femoral epiphyseal separation; with manipulation, with
or without skin or skeletal traction
Open treatment of distal femoral epiphyseal separation, with or without internal or
external fixation
Closed treatment of patellar fracture, without manipulation
Open treatment of patellar fracture, with internal fixation and/or partial or complete
patellectomy and soft tissue repair
Closed treatment of tibial fracture, proximal (plateau); without manipulation
Closed treatment of tibial fracture, proximal (plateau); with or without
manipulation, with skeletal traction
Open treatment of tibial fracture, proximal (plateau); unicondylar, with or without
internal or external fixation
Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without
internal fixation
Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee,
with or without manipulation
Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee,
with or without internal or external fixation
Closed treatment of knee dislocation; without anesthesia
1913.40
1447.20
3213.90
3411.90
3283.20
1274.40
1467.90
3119.40
578.70
2121.30
852.30
1169.10
2665.80
2615.40
950.40
2468.70
669.60
Closed treatment of knee dislocation; requiring anesthesia
Open treatment of knee dislocation, with or without internal or external fixation;
without primary ligamentous repair or augmentation/reconstruction
Open treatment of knee dislocation, with or without internal or external fixation;
with primary ligamentous repair
Open treatment of knee dislocation, with or without internal or external fixation;
with primary ligamentous repair, with augmentation/reconstruction
Closed treatment of patellar dislocation; without anesthesia
1050.30
Closed treatment of patellar dislocation; requiring anesthesia
Open treatment of patellar dislocation, with or without partial or total patellectomy
Manipulation of knee joint under general anesthesia (includes application of
traction or other fixation devices)
Arthrodesis, knee, any technique
789.30
2060.10
Extraordinary No.64/2013
72
2856.60
3537.90
3331.80
461.70
529.96
3822.30
Friday, 09 August 2013
27590
2446.20
27592
Amputation, thigh, through femur, any level;
Amputation, thigh, through femur, any level; immediate fitting technique including
first cast
Amputation, thigh, through femur, any level; open, circular (guillotine)
27594
27596
Amputation, thigh, through femur, any level; secondary closure or scar revision
Amputation, thigh, through femur, any level; re-amputation
1235.70
2379.60
27598
27600
Disarticulation at knee
Decompression fasciotomy, leg; anterior and/or lateral compartments only
2443.50
991.80
27601
1097.10
27603
27604
Decompression fasciotomy, leg; posterior compartment(s) only
Decompression fasciotomy, leg; anterior and/or lateral, and posterior
compartment(s)
Incision and drainage, leg or ankle; deep abscess or hematoma
Incision and drainage, leg or ankle; infected bursa
27605
27606
Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesia
Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia
489.60
918.90
27607
27610
Incision (eg, osteomyelitis or bone abscess), leg or ankle
Arthrotomy, ankle, including exploration, drainage, or removal of foreign body
Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon
lengthening
Biopsy, soft tissue of leg or ankle area; superficial
Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)
Radical resection of tumor (eg, malignant neoplasm), soft tissue of leg or ankle
area
Rad rescj tum soft tissue leg/ankle 5+cm
1390.50
1504.80
Excision, tumor, leg or ankle area; subcutaneous tissue
Excision, tumor, leg or ankle area; deep (subfascial or intramuscular)
Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without
removal of loose or foreign body
Arthrotomy, with synovectomy, ankle;
846.00
1333.80
Arthrotomy, with synovectomy, ankle; including tenosynovectomy
Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or
ankle
Excision tumor soft tissue leg/ankle subq 3+ cm
Exc tumor soft tissue leg/ankle subfasc 5+cm
2202.30
Excision or curettage of bone cyst or benign tumor, tibia or fibula;
Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft
(includes obtaining graft)
Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograft
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis or exostosis); tibia
1979.10
27591
27602
27612
27613
27614
27615
27616
27618
27619
27620
27625
27626
27630
27632
27634
27635
27637
27638
27640
Extraordinary No.64/2013
73
2583.00
2543.40
1403.10
799.29
529.20
1591.20
421.20
842.40
2870.10
3296.27
1577.70
2103.30
867.60
802.95
1801.95
2095.20
2301.30
2338.20
Friday, 09 August 2013
27645
27646
Partial excision (craterization, saucerization, or diaphysectomy) bone (eg,
osteomyelitis or exostosis); fibula
Radical resection of tumor, bone; tibia
Radical resection of tumor, bone; fibula
27647
27648
Radical resection of tumor, bone; talus or calcaneus
Injection procedure for ankle arthrography
2766.60
187.20
27650
1908.66
27654
27656
Repair, primary, open or percutaneous, ruptured Achilles tendon;
Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft
(includes obtaining graft)
Repair, secondary, Achilles tendon, with or without graft
Repair, fascial defect of leg
27658
27659
Repair, flexor tendon, leg; primary, without graft, each tendon
Repair, flexor tendon, leg; secondary, with or without graft, each tendon
1115.10
1606.50
27664
27665
Repair, extensor tendon, leg; primary, without graft, each tendon
Repair, extensor tendon, leg; secondary, with or without graft, each tendon
1085.40
1157.40
27675
27676
Repair, dislocating peroneal tendons; without fibular osteotomy
Repair, dislocating peroneal tendons; with fibular osteotomy
1295.10
1339.20
27680
Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendon
Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through
separate incision(s))
Lengthening or shortening of tendon, leg or ankle; single tendon (separate
procedure)
Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same
incision), each
Gastrocnemius recession (eg, Strayer procedure)
Transfer or transplant of single tendon (with muscle redirection or rerouting);
superficial (eg, anterior tibial extensors into midfoot)
Transfer or transplant of single tendon (with muscle redirection or rerouting); deep
(eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum
longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)
Transfer or transplant of single tendon (with muscle redirection or rerouting); each
additional tendon (List separately in addition to code for primary procedure)
Repair, primary, disrupted ligament, ankle; collateral
1331.10
2338.20
27700
27702
Repair, primary, disrupted ligament, ankle; both collateral ligaments
Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones
procedure)
Arthroplasty, ankle;
Arthroplasty, ankle; with implant (total ankle)
27703
27704
Arthroplasty, ankle; revision, total ankle
Removal of ankle implant
3919.50
2137.50
27705
Osteotomy; tibia
2241.00
27641
27652
27681
27685
27686
27687
27690
27691
27692
27695
27696
27698
Extraordinary No.64/2013
74
1883.70
2884.50
2287.80
2335.50
2672.10
1035.90
1042.20
1200.60
1363.50
1171.80
1647.90
1859.40
544.50
1703.70
2367.00
2807.10
4042.80
Friday, 09 August 2013
27707
Osteotomy; fibula
1283.40
27709
Osteotomy; tibia and fibula
Osteotomy; multiple, with realignment on intramedullary rod (eg, Sofield type
procedure)
Osteoplasty, tibia and fibula, lengthening or shortening
Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)
2755.80
3027.60
27725
27726
Repair of nonunion or malunion, tibia; with sliding graft
Repair of nonunion or malunion, tibia; with iliac or other autograft (includes
obtaining graft)
Repair of nonunion or malunion, tibia; by synostosis, with fibula, any method
Repair fibula nonunion/malunion w int fixation
27727
27730
Repair of congenital pseudarthrosis, tibia
Arrest, epiphyseal (epiphysiodesis), any method; distal tibia
2699.10
1624.50
27732
27734
Arrest, epiphyseal (epiphysiodesis), any method; distal fibula
Arrest, epiphyseal (epiphysiodesis), any method; distal tibia and fibula
Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal
tibia and fibula;
Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal
tibia and fibula; and distal femur
Prophylactic treatment (nailing, pinning, plating or wiring) with or without
methylmethacrylate, tibia
Closed treatment of tibial shaft fracture (with or without fibular fracture); without
manipulation
Closed treatment of tibial shaft fracture (with or without fibular fracture); with
manipulation, with or without skeletal traction
Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular
fracture) (eg, pins or screws)
Open treatment of tibial shaft fracture, (with or without fibular fracture) with
plate/screws, with or without cerclage
Open treatment of tibial shaft fracture (with or without fibular fracture) by
intramedullary implant, with or without interlocking screws and/or cerclage
Closed treatment of medial malleolus fracture; without manipulation
Closed treatment of medial malleolus fracture; with manipulation, with or without
skin or skeletal traction
Open treatment of medial malleolus fracture, with or without internal or external
fixation
Closed treatment pst malleolus fracture w mnpj
Open treatment posterior malleolus fracture
1235.70
1830.60
Closed treatment of proximal fibula or shaft fracture; without manipulation
Closed treatment of proximal fibula or shaft fracture; with manipulation
Open treatment of proximal fibula or shaft fracture, with or without internal or
external fixation
562.50
893.70
27712
27715
27720
27722
27724
27740
27742
27745
27750
27752
27756
27758
27759
27760
27762
27766
27768
27769
27780
27781
27784
Extraordinary No.64/2013
75
2601.00
3445.20
2987.10
3375.90
3711.60
2950.61
2415.60
3129.30
2493.00
702.97
1081.80
2086.20
2968.20
3328.20
503.10
824.40
1553.40
868.53
1707.43
1605.60
Friday, 09 August 2013
27786
Closed treatment of distal fibular fracture (lateral malleolus); without manipulation
463.50
27788
Closed treatment of distal fibular fracture (lateral malleolus); with manipulation
Open treatment of distal fibular fracture (lateral malleolus), with or without
internal or external fixation
Closed treatment of bimalleolar ankle fracture, (including Potts); without
manipulation
Closed treatment of bimalleolar ankle fracture, (including Potts); with
manipulation
Open treatment of bimalleolar ankle fracture, with or without internal or external
fixation
Closed treatment of trimalleolar ankle fracture; without manipulation
Closed treatment of trimalleolar ankle fracture; with manipulation
Open treatment of trimalleolar ankle fracture, with or without internal or external
fixation, medial and/or lateral malleolus; without fixation of posterior lip
Open treatment of trimalleolar ankle fracture, with or without internal or external
fixation, medial and/or lateral malleolus; with fixation of posterior lip
Closed treatment of fracture of weight bearing articular portion of distal tibia (eg,
pilon or tibial plafond), with or without anesthesia; without manipulation
Closed treatment of fracture of weight bearing articular portion of distal tibia (eg,
pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or
requiring manipulation
Open treatment of fracture of weight bearing articular surface/portion of distal tibia
(eg, pilon or tibial plafond), with internal or external fixation; of fibula only
Open treatment of fracture of weight bearing articular surface/portion of distal tibia
(eg, pilon or tibial plafond), with internal or external fixation; of tibia only
Open treatment of fracture of weight bearing articular surface/portion of distal tibia
(eg, pilon or tibial plafond), with internal or external fixation; of both tibia and
fibula
Open treatment of distal tibiofibular joint (syndesmosis) disruption, with or
without internal or external fixation
Closed treatment of proximal tibiofibular joint dislocation; without anesthesia
818.10
695.70
27870
Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesia
Open treatment of proximal tibiofibular joint dislocation, with or without internal
or external fixation, or with excision of proximal fibula
Closed treatment of ankle dislocation; without anesthesia
Closed treatment of ankle dislocation; requiring anesthesia, with or without
percutaneous skeletal fixation
Open treatment of ankle dislocation, with or without percutaneous skeletal
fixation; without repair or internal fixation
Open treatment of ankle dislocation, with or without percutaneous skeletal
fixation; with repair or internal or external fixation
Manipulation of ankle under general anesthesia (includes application of traction or
other fixation apparatus)
Arthrodesis, ankle, any method
27871
Arthrodesis, tibiofibular joint, proximal or distal
2174.40
27792
27808
27810
27814
27816
27818
27822
27823
27824
27825
27826
27827
27828
27829
27830
27831
27832
27840
27842
27846
27848
27860
Extraordinary No.64/2013
76
1539.90
643.50
1189.80
2196.90
842.40
1312.20
2358.90
2880.90
813.60
1673.10
2421.00
2786.40
3352.50
1629.90
607.50
1254.60
537.30
761.40
1946.70
2139.30
425.70
2708.10
Friday, 09 August 2013
27880
Amputation, leg, through tibia and fibula;
Amputation, leg, through tibia and fibula; with immediate fitting technique
including application of first cast
Amputation, leg, through tibia and fibula; open, circular (guillotine)
2462.40
Amputation, leg, through tibia and fibula; secondary closure or scar revision
Amputation, leg, through tibia and fibula; re-amputation
Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type
procedures), with plastic closure and resection of nerves
Ankle disarticulation
Decompression fasciotomy, leg; anterior and/or lateral compartments only, with
debridement of nonviable muscle and/or nerve
Decompression fasciotomy, leg; posterior compartment(s) only, with debridement
of nonviable muscle and/or nerve
Decompression fasciotomy, leg; anterior and/or lateral, and posterior
compartment(s), with debridement of nonviable muscle and/or nerve
Incision and drainage, bursa, foot
Incision and drainage below fascia, with or without tendon sheath involvement,
foot; single bursal space
Incision and drainage below fascia, with or without tendon sheath involvement,
foot; multiple areas
Incision, bone cortex (eg, osteomyelitis or bone abscess), foot
Fasciotomy, foot and/or toe
1488.60
2375.10
425.70
526.50
28035
28039
Tenotomy, percutaneous, toe; single tendon
Tenotomy, percutaneous, toe; multiple tendons
Arthrotomy, including exploration, drainage, or removal of loose or foreign body;
intertarsal or tarsometatarsal joint
Arthrotomy, including exploration, drainage, or removal of loose or foreign body;
metatarsophalangeal joint
Arthrotomy, including exploration, drainage, or removal of loose or foreign body;
interphalangeal joint
Release, tarsal tunnel (posterior tibial nerve decompression)
Excision tumor soft tissue foot/toe subq 1.5+cm
28041
28043
Exc tumor soft tissue foot/toe subfasc 1.5+cm
Excision, tumor, foot; subcutaneous tissue
941.09
525.60
28045
28046
Excision, tumor, foot; deep, subfascial, intramuscular
Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot
1077.30
1923.30
28047
28050
Rad resection tumor soft tissue foot/toe 3+cm
Arthrotomy with biopsy; intertarsal or tarsometatarsal joint
1845.03
1000.80
28052
28054
Arthrotomy with biopsy; metatarsophalangeal joint
Arthrotomy with biopsy; interphalangeal joint
690.30
588.60
28055
Neurectomy intrinsic musculature of foot
757.64
27881
27882
27884
27886
27888
27889
27892
27893
27894
28001
28002
28003
28005
28008
28010
28011
28020
28022
28024
Extraordinary No.64/2013
77
2837.70
2366.10
2007.90
1886.40
1674.00
1622.70
1946.70
412.20
779.40
973.80
991.80
700.20
1106.10
725.40
669.60
1653.30
805.26
Friday, 09 August 2013
28060
Fasciectomy, plantar fascia; partial (separate procedure)
1038.60
28062
28070
Fasciectomy, plantar fascia; radical (separate procedure)
Synovectomy; intertarsal or tarsometatarsal joint, each
1872.90
1097.10
28072
28080
Synovectomy; metatarsophalangeal joint, each
Excision, interdigital (Morton) neuroma, single, each
727.20
817.76
28086
28088
1244.70
873.90
28108
28110
Synovectomy, tendon sheath, foot; flexor
Synovectomy, tendon sheath, foot; extensor
Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg,
cyst or ganglion); foot
Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg,
cyst or ganglion); toe(s), each
Excision or curettage of bone cyst or benign tumor, talus or calcaneus;
Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or
other autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with
allograft
Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones,
except talus or calcaneus;
Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones,
except talus or calcaneus; with iliac or other autograft (includes obtaining graft)
Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal bones,
except talus or calcaneus; with allograft
Excision or curettage of bone cyst or benign tumor, phalanges of foot
Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
28111
28112
Ostectomy, complete excision; first metatarsal head
Ostectomy, complete excision; other metatarsal head (second, third or fourth)
1013.40
956.70
28113
Ostectomy, complete excision; fifth metatarsal head
Ostectomy, complete excision; all metatarsal heads, with partial proximal
phalangectomy, excluding first metatarsal (eg, Clayton type procedure)
Ostectomy, excision of tarsal coalition
Ostectomy, calcaneus;
973.80
1184.40
28126
Ostectomy, calcaneus; for spur, with or without plantar fascial release
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy)
bone (eg, osteomyelitis or bossing); talus or calcaneus
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy)
bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or
calcaneus
Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy)
bone (eg, osteomyelitis or bossing); phalanx of toe
Resection, partial or complete, phalangeal base, each toe
28130
28140
Talectomy (astragalectomy)
Metatarsectomy
1640.70
1133.10
28090
28092
28100
28102
28103
28104
28106
28107
28114
28116
28118
28119
28120
28122
28124
Extraordinary No.64/2013
78
762.08
675.00
1274.40
1674.00
1577.70
1057.50
1435.50
1215.90
862.20
828.90
2032.20
1553.40
1267.20
1287.90
1105.20
754.20
708.30
Friday, 09 August 2013
28150
Phalangectomy, toe, each toe
699.30
28153
751.50
28171
28173
Resection, condyle(s), distal end of phalanx, each toe
Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of
phalanx, each
Radical resection of tumor, bone; tarsal (except talus or calcaneus)
Radical resection of tumor, bone; metatarsal
28175
28190
Radical resection of tumor, bone; phalanx of toe
Removal of foreign body, foot; subcutaneous
999.00
346.50
28192
28193
Removal of foreign body, foot; deep
Removal of foreign body, foot; complicated
671.40
1028.70
28200
1134.00
28220
Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon
Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes
obtaining graft)
Repair, tendon, extensor, foot; primary or secondary, each tendon
Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes
obtaining graft)
Tenolysis, flexor, foot; single tendon
28222
28225
Tenolysis, flexor, foot; multiple tendons
Tenolysis, extensor, foot; single tendon
1048.50
580.50
28226
747.00
28240
Tenolysis, extensor, foot; multiple tendons
Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate
procedure)
Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)
Tenotomy, open, extensor, foot or toe, each tendon
Reconstruction (advancement), posterior tibial tendon with excision of accessory
navicular bone (eg, Kidner type procedure)
Tenotomy, lengthening, or release, abductor hallucis muscle
28250
28260
Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)
Capsulotomy, midfoot; medial release only (separate procedure)
1148.40
1608.30
28261
Capsulotomy, midfoot; with tendon lengthening
Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and
tendon(s) lengthening (eg, resistant clubfoot deformity)
Capsulotomy, midtarsal (eg, Heyman type procedure)
Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint
(separate procedure)
Capsulotomy; interphalangeal joint, each joint (separate procedure)
1545.30
Syndactylization, toes (eg, webbing or Kelikian type procedure)
Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)
Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type
procedure)
747.00
813.60
28160
28202
28208
28210
28230
28232
28234
28238
28262
28264
28270
28272
28280
28285
28286
Extraordinary No.64/2013
79
651.60
1622.70
1408.50
1766.70
967.50
1038.60
803.70
724.50
399.60
517.50
1545.30
711.90
2923.20
2145.60
712.80
654.30
875.70
Friday, 09 August 2013
28288
28289
28290
28292
28293
28294
28296
28297
28298
28299
28300
28302
28304
28305
28306
28307
28308
28309
28310
28312
28313
28315
28320
28322
28340
28341
Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal
head
Hallux rigidus correction with cheilectomy, debridement and capsular release of
the first metatarsophalangeal joint
Correction, hallux valgus (bunion), with or without sesamoidectomy; simple
exostectomy (eg, Silver type procedure)
Correction, hallux valgus (bunion), with or without sesamoidectomy; Keller,
McBride, or Mayo type procedure
Correction, hallux valgus (bunion), with or without sesamoidectomy; resection of
joint with implant
Correction, hallux valgus (bunion), with or without sesamoidectomy; with tendon
transplants (eg, Joplin type procedure)
Correction, hallux valgus (bunion), with or without sesamoidectomy; with
metatarsal osteotomy (eg, Mitchell, Chevron, or concentric type procedures)
Correction, hallux valgus (bunion), with or without sesamoidectomy; Lapidus type
procedure
Correction, hallux valgus (bunion), with or without sesamoidectomy; by phalanx
osteotomy
Correction, hallux valgus (bunion), with or without sesamoidectomy; by other
methods (eg, double osteotomy)
Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without
internal fixation
Osteotomy; talus
1009.80
896.40
1244.70
1545.30
1776.60
1939.50
1827.42
1831.50
1392.30
1931.40
1506.60
1606.50
Osteotomy, tarsal bones, other than calcaneus or talus;
Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes
obtaining graft) (eg, Fowler type)
Osteotomy, with or without lengthening, shortening or angular correction,
metatarsal; first metatarsal
Osteotomy, with or without lengthening, shortening or angular correction,
metatarsal; first metatarsal with autograft (other than first toe)
Osteotomy, with or without lengthening, shortening or angular correction,
metatarsal; other than first metatarsal, each
Osteotomy, with or without lengthening, shortening or angular correction,
metatarsal; multiple (eg, Swanson type cavus foot procedure)
Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe
(separate procedure)
Osteotomy, shortening, angular or rotational correction; other phalanges, any toe
Reconstruction, angular deformity of toe, soft tissue procedures only (eg,
overlapping second toe, fifth toe, curly toes)
Sesamoidectomy, first toe (separate procedure)
1385.10
Repair, nonunion or malunion; tarsal bones
Repair, nonunion or malunion; metatarsal, with or without bone graft (includes
obtaining graft)
Reconstruction, toe, macrodactyly; soft tissue resection
Reconstruction, toe, macrodactyly; requiring bone resection
1640.70
Extraordinary No.64/2013
80
1545.30
1287.90
1416.60
1104.30
1880.10
986.40
724.50
919.80
1097.10
1387.80
1427.40
1542.60
Friday, 09 August 2013
28344
Reconstruction, toe(s); polydactyly
1073.70
28345
28360
Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web
Reconstruction, cleft foot
1471.50
2493.00
28400
28405
Closed treatment of calcaneal fracture; without manipulation
Closed treatment of calcaneal fracture; with manipulation
621.90
1003.50
28406
28415
1278.00
2162.70
28430
Percutaneous skeletal fixation of calcaneal fracture, with manipulation
Open treatment of calcaneal fracture, with or without internal or external fixation;
Open treatment of calcaneal fracture, with or without internal or external fixation;
with primary iliac or other autogenous bone graft (includes obtaining graft)
Closed treatment of talus fracture; without manipulation
28435
28436
Closed treatment of talus fracture; with manipulation
Percutaneous skeletal fixation of talus fracture, with manipulation
768.60
918.00
28445
28446
Open treatment of talus fracture, with or without internal or external fixation
Open osteochondral autograft talus
Treatment of tarsal bone fracture (except talus and calcaneus); without
manipulation, each
Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation,
each
Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus),
with manipulation, each
Open treatment of tarsal bone fracture (except talus and calcaneus), with or without
internal or external fixation, each
Closed treatment of metatarsal fracture; without manipulation, each
1998.00
2581.39
Closed treatment of metatarsal fracture; with manipulation, each
Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each
Open treatment of metatarsal fracture, with or without internal or external fixation,
each
Closed treatment of fracture great toe, phalanx or phalanges; without manipulation
514.80
925.20
378.90
28530
28531
Closed treatment of fracture great toe, phalanx or phalanges; with manipulation
Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with
manipulation
Open treatment of fracture great toe, phalanx or phalanges, with or without internal
or external fixation
Closed treatment of fracture, phalanx or phalanges, other than great toe; without
manipulation, each
Closed treatment of fracture, phalanx or phalanges, other than great toe; with
manipulation, each
Open treatment of fracture, phalanx or phalanges, other than great toe, with or
without internal or external fixation, each
Closed treatment of sesamoid fracture
Open tx sesamoid fracture +-internal fixation
28540
Closed treatment of tarsal bone dislocation, other than talotarsal; without
410.40
28420
28450
28455
28456
28465
28470
28475
28476
28485
28490
28495
28496
28505
28510
28515
28525
Extraordinary No.64/2013
81
2753.10
514.80
496.80
643.50
710.10
1416.60
459.00
1177.20
266.40
576.90
783.90
208.80
297.00
744.30
348.30
880.47
Friday, 09 August 2013
anesthesia
28545
28546
28555
28570
28575
28576
Closed treatment of tarsal bone dislocation, other than talotarsal; requiring
anesthesia
Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with
manipulation
Open treatment of tarsal bone dislocation, with or without internal or external
fixation
Closed treatment of talotarsal joint dislocation; without anesthesia
Closed treatment of talotarsal joint dislocation; requiring anesthesia
564.30
690.30
1030.50
425.70
577.80
Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulation
Open treatment of talotarsal joint dislocation, with or without internal or external
fixation
Closed treatment of tarsometatarsal joint dislocation; without anesthesia
Closed treatment of tarsometatarsal joint dislocation; requiring anesthesia
Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with
manipulation
Open treatment of tarsometatarsal joint dislocation, with or without internal or
external fixation
Closed treatment of metatarsophalangeal joint dislocation; without anesthesia
Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesia
Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with
manipulation
Open treatment of metatarsophalangeal joint dislocation, with or without internal
or external fixation
Closed treatment of interphalangeal joint dislocation; without anesthesia
801.00
Closed treatment of interphalangeal joint dislocation; requiring anesthesia
Percutaneous skeletal fixation of interphalangeal joint dislocation, with
manipulation
Open treatment of interphalangeal joint dislocation, with or without internal or
external fixation
Arthrodesis; pantalar
Arthrodesis; triple
320.40
2137.50
2230.20
28740
28750
Arthrodesis; subtalar
Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;
Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy
(eg, flatfoot correction)
Arthrodesis, with tendon lengthening and advancement, midtarsal navicularcuneiform (eg, Miller type procedure)
Arthrodesis, midtarsal or tarsometatarsal, single joint
Arthrodesis, great toe; metatarsophalangeal joint
28755
28760
Arthrodesis, great toe; interphalangeal joint
Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great
1186.20
1071.90
28585
28600
28605
28606
28615
28630
28635
28636
28645
28660
28665
28666
28675
28705
28715
28725
28730
28735
28737
Extraordinary No.64/2013
82
1476.00
530.10
592.20
1009.80
1235.70
335.70
369.90
566.10
782.10
239.40
564.30
684.90
2897.10
3185.10
2173.50
1982.70
1674.00
1392.70
Friday, 09 August 2013
toe, interphalangeal joint (eg, Jones type procedure)
28800
28805
Amputation, foot; midtarsal (eg, Chopart type procedure)
Amputation, foot; transmetatarsal
1847.70
2238.30
28810
28820
Amputation, metatarsal, with toe, single
Amputation, toe; metatarsophalangeal joint
1152.90
875.70
28825
28890
Amputation, toe; interphalangeal joint
Eswt hi nrg pfrmd phys w/us gdn invg plntar fsca
782.10
905.09
29000
29010
Application of halo type body cast (see 20661-20663 for insertion)
Application of Risser jacket, localizer, body; only
608.40
492.30
29015
29020
Application of Risser jacket, localizer, body; including head
Application of turnbuckle jacket, body; only
670.50
534.60
29025
29035
Application of turnbuckle jacket, body; including head
Application of body cast, shoulder to hips;
578.70
475.20
29040
29044
Application of body cast, shoulder to hips; including head, Minerva type
Application of body cast, shoulder to hips; including one thigh
495.90
380.70
29046
29049
Application of body cast, shoulder to hips; including both thighs
Application; plaster figure-of-eight
469.80
194.40
29055
29058
Application; shoulder spica
Application; plaster Velpeau
389.70
198.90
29065
29075
Application; shoulder to hand (long arm)
Application; elbow to finger (short arm)
206.10
157.50
29085
29086
Application; hand and lower forearm (gauntlet)
Application cast finger
156.05
110.50
29105
29125
Application of long arm splint (shoulder to hand)
Application of short arm splint (forearm to hand); static
128.70
99.00
29126
29130
Application of short arm splint (forearm to hand); dynamic
Application of finger splint; static
134.10
82.80
29131
29200
Application of finger splint; dynamic
Strapping; thorax
134.10
81.00
29240
29260
Strapping; shoulder (eg, Velpeau)
Strapping; elbow or wrist
90.00
65.68
29280
29305
Strapping; hand or finger
Application of hip spica cast; one leg
86.40
540.90
29325
29345
Application of hip spica cast; one and one-half spica or both legs
Application of long leg cast (thigh to toes);
494.10
297.00
29355
29358
Application of long leg cast (thigh to toes); walker or ambulatory type
Application of long leg cast brace
270.90
451.80
Extraordinary No.64/2013
83
Friday, 09 August 2013
29365
Application of cylinder cast (thigh to ankle)
236.70
29405
29425
Application of short leg cast (below knee to toes);
Application of short leg cast (below knee to toes); walking or ambulatory type
215.17
237.60
29435
29440
Application of patellar tendon bearing (PTB) cast
Adding walker to previously applied cast
282.60
83.70
29445
29450
Application of rigid total contact leg cast
Application of clubfoot cast with molding or manipulation, long or short leg
339.30
173.70
29505
29515
Application of long leg splint (thigh to ankle or toes)
Application of short leg splint (calf to foot)
153.90
120.60
29520
29530
Strapping; hip
Strapping; knee
98.10
95.40
29540
29550
Strapping; ankle
Strapping; toes
73.52
66.60
29580
29581
Strapping; Unna boot
Appl mlt-layer venous wound compress below knee
96.09
132.61
29590
29700
Denis-Browne splint strapping
Removal or bivalving; gauntlet, boot or body cast
115.20
92.42
29705
29710
Removal or bivalving; full arm or full leg cast
Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.
90.31
186.30
29715
29720
Removal or bivalving; turnbuckle jacket
Repair of spica, body cast or jacket
124.20
87.30
29730
29740
Windowing of cast
Wedging of cast (except clubfoot casts)
85.50
136.80
29750
97.20
29804
29805
Wedging of clubfoot cast
Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy
(separate procedure)
Arthroscopy, temporomandibular joint, surgical
Arthroscopy shoulder dx +-synovial biopsy spx
29806
29807
Arthroscopy shoulder surgical capsulorrhaphy
Arthroscopy shoulder surgical repair slap lesion
2796.86
2663.48
29819
29820
Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
Arthroscopy, shoulder, surgical; synovectomy, partial
2304.90
2215.80
29821
29822
Arthroscopy, shoulder, surgical; synovectomy, complete
Arthroscopy, shoulder, surgical; debridement, limited
2396.70
2419.20
29823
29824
Arthroscopy, shoulder, surgical; debridement, extensive
Arthroscopy shoulder distal claviculectomy
Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or
without manipulation
2801.70
1813.74
29800
29825
Extraordinary No.64/2013
84
1545.30
2266.20
1129.02
2412.00
Friday, 09 August 2013
29834
Arthroscopy, shoulder, surgical; decompression of subacromial space with partial
acromioplasty, with or without coracoacromial release
Arthroscopy shoulder rotator cuff repair
Arthroscopy shoulder biceps tenodesis
Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate
procedure)
Arthroscopy, elbow, surgical; with removal of loose body or foreign body
29835
29836
Arthroscopy, elbow, surgical; synovectomy, partial
Arthroscopy, elbow, surgical; synovectomy, complete
2308.50
2322.90
29837
29838
Arthroscopy, elbow, surgical; debridement, limited
Arthroscopy, elbow, surgical; debridement, extensive
Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate
procedure)
Arthroscopy, wrist, surgical; for infection, lavage and drainage
Arthroscopy, wrist, surgical; synovectomy, partial
1981.80
2250.90
1916.10
29863
Arthroscopy, wrist, surgical; synovectomy, complete
Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage
and/or joint debridement
Arthroscopy, wrist, surgical; internal fixation for fracture or instability
Endoscopy, wrist, surgical, with release of transverse carpal ligament
Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity
fracture(s) of the knee, with or without manipulation; without internal or external
fixation (includes arthroscopy)
Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity
fracture(s) of the knee, with or without manipulation; with internal or external
fixation (includes arthroscopy)
Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar,
with or without internal or external fixation (includes arthroscopy)
Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar,
with or without internal or external fixation (includes arthroscopy)
Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)
Arthroscopy, hip, surgical; with removal of loose body or foreign body
Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage
(chondroplasty), abrasion arthroplasty, and/or resection of labrum
Arthroscopy, hip, surgical; with synovectomy
29866
29867
Arthroscopy knee osteochondral agrft mosaicplast
Arthroscopy knee osteochondral allograft
2666.26
4120.16
29868
5488.61
29871
Arthroscopy knee meniscal trnsplj med/lat
Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate
procedure)
Arthroscopy, knee, surgical; for infection, lavage and drainage
29873
Arthroscopy knee lateral release
1675.37
29826
29827
29828
29830
29840
29843
29844
29845
29846
29847
29848
29850
29851
29855
29856
29860
29861
29862
29870
Extraordinary No.64/2013
85
2722.75
2928.75
2558.94
1206.00
2052.00
1214.10
1751.40
1881.00
2266.20
2093.40
1758.60
2285.10
2887.20
2574.90
2907.90
1547.10
2295.90
2525.40
2306.70
1352.70
1984.50
Friday, 09 August 2013
29874
29875
29876
29877
29879
29880
29881
29882
29883
29884
29885
29886
29887
29888
29889
29891
29892
29893
29894
29895
29897
Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg,
osteochondritis dissecans fragmentation, chondral fragmentation)
Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection)
(separate procedure)
Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (eg,
medial or lateral)
Arthroscopy, knee, surgical; debridement/shaving of articular cartilage
(chondroplasty)
Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where
necessary) or multiple drilling or microfracture
Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including
any meniscal shaving)
Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any
meniscal shaving)
Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)
Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)
Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation
(separate procedure)
Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone
grafting, with or without internal fixation (including debridement of base of lesion)
Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion
Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion
with internal fixation
Arthroscopically aided anterior cruciate ligament repair/augmentation or
reconstruction
Arthroscopically aided posterior cruciate ligament repair/augmentation or
reconstruction
Arthroscopy, ankle, surgical; excision of osteochondral defect of talus and/or tibia,
including drilling of the defect
Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome
fracture, or tibial plafond fracture, with or without internal fixation (includes
arthroscopy)
Endoscopic plantar fasciotomy
Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of
loose body or foreign body
Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial
2348.10
2459.70
2733.79
2552.87
2652.30
3254.71
2787.13
2919.72
3747.60
2337.30
2697.30
2547.90
3380.40
4793.75
4867.20
2214.90
2223.90
1233.00
2206.80
2299.50
2115.00
29899
29900
Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited
Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement,
extensive
Arthroscopy ankle surgical w/ankle arthrodesis
Arthroscopy metacarpophalangeal synovial biopsy
29901
29902
Arthrs metacarpophalangeal joint debridement
Arthrs mtcarphlngl jt w/rdctj ur coltrl ligm
1598.44
1839.03
29904
Arthrs subtalar joint remove loose/foreign body
2032.59
29898
Extraordinary No.64/2013
86
2721.60
2665.75
1121.89
Friday, 09 August 2013
29905
Arthroscopy subtalar joint with synovectomy
2146.58
29906
29907
Arthroscopy subtalar joint with debridement
Arthroscopy subtalar joint subtalar arthrodesis
2078.55
2547.20
29914
29915
Arthroscopy hip w/femoroplasty
Arthroscopy hip w/acetabuloplasty
2638.07
2795.34
29916
30000
Arthroscopy hip w/labral repair
Drainage abscess or hematoma, nasal, internal approach
2795.34
329.40
30020
30100
Drainage abscess or hematoma, nasal septum
Biopsy, intranasal
311.40
187.20
30110
30115
385.20
992.70
30120
30124
Excision, nasal polyp(s), simple
Excision, nasal polyp(s), extensive
Excision or destruction, any method (including laser), intranasal lesion; internal
approach
Excision or destruction, any method (including laser), intranasal lesion; external
approach (lateral rhinotomy)
Excision or surgical planing of skin of nose for rhinophyma
Excision dermoid cyst, nose; simple, skin, subcutaneous
30125
30130
Excision dermoid cyst, nose; complex, under bone or cartilage
Excision turbinate, partial or complete, any method
1936.80
785.70
30140
30150
Submucous resection turbinate, partial or complete, any method
Rhinectomy; partial
1149.30
2242.80
30160
30200
Rhinectomy; total
Injection into turbinate(s), therapeutic
2889.00
129.60
30210
30220
Displacement therapy (Proetz type)
Insertion, nasal septal prosthesis (button)
211.50
401.40
30300
30310
Removal foreign body, intranasal; office type procedure
Removal foreign body, intranasal; requiring general anesthesia
134.21
567.90
30320
30400
Removal foreign body, intranasal; by lateral rhinotomy
Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip
Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and
alar cartilages, and/or elevation of nasal tip
Rhinoplasty, primary; including major septal repair
Rhinoplasty, secondary; minor revision (small amount of nasal tip work)
1482.30
3656.70
Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)
Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)
Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate,
including columellar lengthening; tip only
Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate,
including columellar lengthening; tip, septum, osteotomies
2531.70
4104.90
30117
30118
30410
30420
30430
30435
30450
30460
30462
Extraordinary No.64/2013
87
871.20
2187.00
2003.40
774.00
3969.90
4673.70
1877.40
2551.50
4778.10
Friday, 09 August 2013
30465
2367.57
30540
Repair nasal vestibular stenosis
Septoplasty or submucous resection, with or without cartilage scoring, contouring
or replacement with graft
Repair choanal atresia; intranasal
30545
30560
Repair choanal atresia; transpalatine
Lysis intranasal synechia
3063.60
240.30
30580
30600
Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)
Repair fistula; oronasal
1683.00
1819.80
30620
30630
2832.30
2162.70
30915
30920
Septal or other intranasal dermatoplasty (does not include obtaining graft)
Repair nasal septal perforations
Cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any
method, (separate procedure); superficial
Cauterization and/or ablation, mucosa of turbinates, unilateral or bilateral, any
method, (separate procedure); intramural
Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any
method
Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing)
any method
Control nasal hemorrhage, posterior, with posterior nasal packs and/or
cauterization, any method; initial
Control nasal hemorrhage, posterior, with posterior nasal packs and/or
cauterization, any method; subsequent
Ligation arteries; ethmoidal
Ligation arteries; internal maxillary artery, transantral
30930
31000
Fracture nasal turbinate(s), therapeutic
Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)
437.40
134.23
31002
31020
Lavage by cannulation; sphenoid sinus
Sinusotomy, maxillary (antrotomy); intranasal
Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of
antrochoanal polyps
Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of
antrochoanal polyps
Pterygomaxillary fossa surgery, any approach
Sinusotomy, sphenoid, with or without biopsy;
Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal
of polyp(s)
Sinusotomy frontal; external, simple (trephine operation)
Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type)
Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes
ablation)
Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision
(includes ablation)
291.60
822.60
30520
30801
30802
30901
30903
30905
30906
31030
31032
31040
31050
31051
31070
31075
31080
31081
Extraordinary No.64/2013
88
2891.27
2054.70
264.60
407.70
189.81
280.57
495.90
449.10
1781.10
2600.10
1966.50
2162.70
3172.50
1484.10
2057.40
1499.40
2574.00
3005.10
2971.80
Friday, 09 August 2013
31084
Sinusotomy frontal; obliterative, with osteoplastic flap, brow incision
3605.40
31085
31086
Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incision
Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incision
3885.30
3278.70
31087
3210.30
31200
31201
Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incision
Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary,
ethmoid, sphenoid)
Ethmoidectomy; intranasal, anterior
Ethmoidectomy; intranasal, total
31205
31225
Ethmoidectomy; extranasal, total
Maxillectomy; without orbital exenteration
2160.00
4426.20
31230
31231
5388.30
244.28
31238
31239
Maxillectomy; with orbital exenteration (en bloc)
Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy (via inferior meatus
or canine fossa puncture)
Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy (via puncture of
sphenoidal face or cannulation of ostium)
Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement
(separate procedure)
Nasal/sinus endoscopy, surgical; with control of epistaxis
Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy
31240
31254
Nasal/sinus endoscopy, surgical; with concha bullosa resection
Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior)
842.40
1690.20
31255
31256
Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior)
Nasal/sinus endoscopy, surgical, with maxillary antrostomy;
Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue
from maxillary sinus
Nasal/sinus endoscopy, surgical with frontal sinus exploration, with or without
removal of tissue from frontal sinus
Nasal/sinus endoscopy, surgical, with sphenoidotomy;
Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from
the sphenoid sinus
Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid
region
Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid
region
Nasal/sinus endoscopy, surgical; with medial or inferior orbital wall
decompression
Nasal/sinus endoscopy, surgical; with medial orbital wall and inferior orbital wall
decompression
Nasal/sinus endoscopy, surgical; with optic nerve decompression
Laryngotomy (thyrotomy, laryngofissure); with removal of tumor or laryngocele,
cordectomy
1789.35
1530.00
31090
31233
31235
31237
31267
31276
31287
31288
31290
31291
31292
31293
31294
31300
Extraordinary No.64/2013
89
4236.30
1301.40
2008.80
683.10
760.50
871.20
909.90
2768.40
1867.50
1931.40
1337.40
1647.90
3514.50
3903.30
3122.10
3414.60
3854.70
2842.20
Friday, 09 August 2013
31320
Laryngotomy (thyrotomy, laryngofissure); diagnostic
1349.10
31360
31365
Laryngectomy; total, without radical neck dissection
Laryngectomy; total, with radical neck dissection
3825.90
5740.20
31367
31368
Laryngectomy; subtotal supraglottic, without radical neck dissection
Laryngectomy; subtotal supraglottic, with radical neck dissection
4111.20
6336.00
31370
31375
Partial laryngectomy (hemilaryngectomy); horizontal
Partial laryngectomy (hemilaryngectomy); laterovertical
4670.10
3898.80
31380
31382
Partial laryngectomy (hemilaryngectomy); anterovertical
Partial laryngectomy (hemilaryngectomy); antero-latero-vertical
3970.80
4020.30
31390
31395
Pharyngolaryngectomy, with radical neck dissection; without reconstruction
Pharyngolaryngectomy, with radical neck dissection; with reconstruction
5854.50
6849.90
31400
31420
Arytenoidectomy or arytenoidopexy, external approach
Epiglottidectomy
2953.80
2694.60
31500
31502
Intubation, endotracheal, emergency procedure
Tracheotomy tube change prior to establishment of fistula tract
307.80
195.30
31505
31510
Laryngoscopy, indirect; diagnostic (separate procedure)
Laryngoscopy, indirect; with biopsy
217.68
306.90
31511
31512
Laryngoscopy, indirect; with removal of foreign body
Laryngoscopy, indirect; with removal of lesion
391.50
429.30
31513
31515
Laryngoscopy, indirect; with vocal cord injection
Laryngoscopy direct, with or without tracheoscopy; for aspiration
585.90
377.10
31520
31525
460.04
647.10
31527
Laryngoscopy direct, with or without tracheoscopy; diagnostic, newborn
Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn
Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating
microscope
Laryngoscopy direct, with or without tracheoscopy; with insertion of obturator
31528
31529
Laryngoscopy direct, with or without tracheoscopy; with dilatation, initial
Laryngoscopy direct, with or without tracheoscopy; with dilatation, subsequent
824.40
772.20
31530
896.40
31545
Laryngoscopy, direct, operative, with foreign body removal;
Laryngoscopy, direct, operative, with foreign body removal; with operating
microscope
Laryngoscopy, direct, operative, with biopsy;
Laryngoscopy, direct, operative, with biopsy; with operating microscope
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal
cords or epiglottis;
Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal
cords or epiglottis; with operating microscope
Largsc mcrscp/tlscp rmvl les vocal c/d flap
31546
Largsc mcrscp/tlscp rmvl les vocal c/d grf
1746.43
31526
31531
31535
31536
31540
31541
Extraordinary No.64/2013
90
978.30
1164.60
1302.30
903.60
1141.20
1155.60
1328.82
1137.51
Friday, 09 August 2013
31560
Laryngoscopy, direct, operative, with arytenoidectomy;
2224.80
31561
31570
2378.70
1323.90
31575
Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;
Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating
microscope
Laryngoscopy, flexible fiberoptic; diagnostic
31576
31577
Laryngoscopy, flexible fiberoptic; with biopsy
Laryngoscopy, flexible fiberoptic; with removal of foreign body
568.80
982.80
31578
31579
Laryngoscopy, flexible fiberoptic; with removal of lesion
Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy
1133.10
626.40
31580
3399.30
31590
31595
Laryngoplasty; for laryngeal web, two stage, with keel insertion and removal
Laryngoplasty; for laryngeal stenosis, with graft or core mold, including
tracheotomy
Laryngoplasty; with open reduction of fracture
Laryngoplasty, cricoid split
Laryngoplasty, not otherwise specified (eg, for burns, reconstruction after partial
laryngectomy)
Laryngeal reinnervation by neuromuscular pedicle
Section recurrent laryngeal nerve, therapeutic (separate procedure), unilateral
31600
31601
Tracheostomy, planned (separate procedure);
Tracheostomy, planned (separate procedure); under two years
1148.40
1423.80
31603
31605
Tracheostomy, emergency procedure; transtracheal
Tracheostomy, emergency procedure; cricothyroid membrane
1230.30
957.60
31610
1731.60
31612
31613
Tracheostomy, fenestration procedure with skin flaps
Construction of tracheoesophageal fistula and subsequent insertion of an
alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis)
Tracheal puncture, percutaneous with transtracheal aspiration and/or injection
Tracheostoma revision; simple, without flap rotation
31614
31615
Tracheostoma revision; complex, with flap rotation
Tracheobronchoscopy through established tracheostomy incision
1881.90
555.30
31620
798.23
31623
31624
Endobrncl us bronchoscopic dx/ther ivntj
Bronchoscopy (rigid or flexible); diagnostic, with or without cell washing (separate
procedure)
Bronchoscopy (rigid or flexible); with brushing or protected brushings
Bronchoscopy (rigid or flexible); with bronchial alveolar lavage
31625
31626
Bronchoscopy (rigid or flexible); with biopsy
Brnchsc w/plmt fiducial markers 1/mlt
822.60
823.11
31627
31628
Brnchsc w/cptr-asst image-guided navigation
Bronchoscopy (rigid or flexible); with transbronchial lung biopsy, with or without
948.86
915.30
31571
31582
31584
31587
31588
31611
31622
Extraordinary No.64/2013
91
1458.90
323.11
4155.30
3971.70
2544.30
3209.40
2811.60
2338.20
1748.70
232.20
767.70
715.50
686.70
693.00
Friday, 09 August 2013
fluoroscopic guidance
31629
922.50
31632
Bronchoscopy (rigid or flexible); with transbronchial needle aspiration biopsy
Bronchoscopy (rigid or flexible); with tracheal or bronchial dilation or closed
reduction of fracture
Bronchoscopy (rigid or flexible); with tracheal dilation and placement of tracheal
stent
Brnchsc w/transbrncl lung bx ea lobe
31633
31635
Brnchsc w/transbrncl ndl aspir bx ea lobe
Bronchoscopy (rigid or flexible); with removal of foreign body
302.61
992.70
31636
31637
Brnchsc w/placement brncl stent 1st bronchus
Brnchsc ea major bronchus stented
822.83
274.30
31638
31640
907.48
1161.00
31715
Brnchsc revj tracheal/brncl stent ins prev sess
Bronchoscopy (rigid or flexible); with excision of tumor
Bronchoscopy (rigid or flexible); with destruction of tumor or relief of stenosis by
any method other than excision (eg, laser)
Bronchoscopy (rigid or flexible); with placement of catheter(s) for intracavitary
radioelement application
Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial
tree, initial (eg, drainage of lung abscess)
Bronchoscopy (rigid or flexible); with therapeutic aspiration of tracheobronchial
tree, subsequent
Bronchoscopy (rigid or flexible); with injection of contrast material for segmental
bronchography (fiberscope only)
Transtracheal injection for bronchography
31717
31720
Catheterization with bronchial brush biopsy
Catheter aspiration (separate procedure); nasotracheal
230.40
169.20
31725
406.80
31750
31755
Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedside
Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling
tube for oxygen therapy
Tracheoplasty; cervical
Tracheoplasty; tracheopharyngeal fistulization, each stage
31760
31766
Tracheoplasty; intrathoracic
Carinal reconstruction
3681.00
4428.90
31770
31775
Bronchoplasty; graft repair
Bronchoplasty; excision stenosis and anastomosis
3687.30
4083.30
31780
31781
Excision tracheal stenosis and anastomosis; cervical
Excision tracheal stenosis and anastomosis; cervicothoracic
3804.30
4003.20
31785
31786
Excision of tracheal tumor or carcinoma; cervical
Excision of tracheal tumor or carcinoma; thoracic
3078.00
4113.90
31800
Suture of tracheal wound or injury; cervical
2929.50
31630
31631
31641
31643
31645
31646
31656
31730
Extraordinary No.64/2013
92
874.80
1018.80
221.90
1545.30
606.60
801.00
706.50
715.50
162.90
668.70
3236.40
3572.10
Friday, 09 August 2013
31805
Suture of tracheal wound or injury; intrathoracic
2932.20
31820
31825
Surgical closure tracheostomy or fistula; without plastic repair
Surgical closure tracheostomy or fistula; with plastic repair
899.10
1259.10
31830
32035
Revision of tracheostomy scar
Thoracostomy; with rib resection for empyema
927.00
1596.60
32036
32095
Thoracostomy; with open flap drainage for empyema
Thoracotomy, limited, for biopsy of lung or pleura
1944.00
1884.60
32100
Thoracotomy, major; with exploration and biopsy
Thoracotomy, major; with control of traumatic hemorrhage and/or repair of lung
tear
Thoracotomy, major; for postoperative complications
Thoracotomy, major; with open intrapleural pneumonolysis
2701.80
2574.90
32150
32151
Thoracotomy, major; with cyst(s) removal, with or without a pleural procedure
Thoracotomy, major; with excision-plication of bullae, with or without any pleural
procedure
Thoracotomy, major; with removal of intrapleural foreign body or fibrin deposit
Thoracotomy, major; with removal of intrapulmonary foreign body
32160
32200
Thoracotomy, major; with cardiac massage
Pneumonostomy; with open drainage of abscess or cyst
2646.00
2478.60
32201
32215
Pneumonostomy; with percutaneous drainage of abscess or cyst
Pleural scarification for repeat pneumothorax
760.50
2565.90
32220
32225
Decortication, pulmonary (separate procedure); total
Decortication, pulmonary (separate procedure); partial
3480.30
2477.70
32310
32320
Pleurectomy, parietal (separate procedure)
Decortication and parietal pleurectomy
3073.50
4303.80
32400
32402
Biopsy, pleura; percutaneous needle
Biopsy, pleura; open
387.90
1638.90
32405
32420
Biopsy, lung or mediastinum, percutaneous needle
Pneumonocentesis, puncture of lung for aspiration
518.40
435.60
32440
Removal of lung, total pneumonectomy;
Removal of lung, total pneumonectomy; with resection of segment of trachea
followed by broncho-tracheal anastomosis (sleeve pneumonectomy)
Removal of lung, total pneumonectomy; extrapleural
4605.30
Removal of lung, other than total pneumonectomy; single lobe (lobectomy)
Removal of lung, other than total pneumonectomy; two lobes (bilobectomy)
Removal of lung, other than total pneumonectomy; single segment
(segmentectomy)
Removal of lung, other than total pneumonectomy; with circumferential resection
of segment of bronchus followed by broncho-bronchial anastomosis (sleeve
4327.20
4661.10
32110
32120
32124
32140
32141
32442
32445
32480
32482
32484
32486
Extraordinary No.64/2013
93
3024.90
2522.70
2365.20
2962.80
2801.70
2255.40
4649.40
4839.30
4255.20
4365.00
Friday, 09 August 2013
lobectomy)
32501
Removal of lung, other than total pneumonectomy; all remaining lung following
previous removal of a portion of lung (completion pneumonectomy)
Rmvl lng oth/thn pnumec exc-plctj emphy lng
Removal of lung, other than total pneumonectomy; wedge resection, single or
multiple
Rescj&bronchoplasty pfrmd tm lobec/sgmectomy
32503
32504
Rescj apical lng tum w/o ch wall rcnstj
Rescj apical lng tum w/ch wall rcnstj
4016.73
4300.61
32540
32551
3656.70
397.73
32603
Extrapleural enucleation of empyema (empyemectomy)
Tube thoracostomy includes water seal
Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, without
biopsy
Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with
biopsy
Thoracoscopy, diagnostic (separate procedure); pericardial sac, without biopsy
32604
32605
Thoracoscopy, diagnostic (separate procedure); pericardial sac, with biopsy
Thoracoscopy, diagnostic (separate procedure); mediastinal space, without biopsy
1803.60
1153.80
32606
32650
Thoracoscopy, diagnostic (separate procedure); mediastinal space, with biopsy
Thoracoscopy, surgical; with pleurodesis, any method
1832.40
2230.20
32651
Thoracoscopy, surgical; with partial pulmonary decortication
Thoracoscopy, surgical; with total pulmonary decortication, including intrapleural
pneumonolysis
Thoracoscopy, surgical; with removal of intrapleural foreign body or fibrin deposit
Thoracoscopy, surgical; with control of traumatic hemorrhage
Thoracoscopy, surgical; with excision-plication of bullae, including any pleural
procedure
Thoracoscopy, surgical; with parietal pleurectomy
2722.50
3045.60
2766.60
32660
32661
Thoracoscopy, surgical; with wedge resection of lung, single or multiple
Thoracoscopy, surgical; with removal of clot or foreign body from pericardial sac
Thoracoscopy, surgical; with creation of pericardial window or partial resection of
pericardial sac for drainage
Thoracoscopy, surgical; with total pericardiectomy
Thoracoscopy, surgical; with excision of pericardial cyst, tumor, or mass
32662
32663
Thoracoscopy, surgical; with excision of mediastinal cyst, tumor, or mass
Thoracoscopy, surgical; with lobectomy, total or segmental
3102.30
3747.60
32664
32665
Thoracoscopy, surgical; with thoracic sympathectomy
Thoracoscopy, surgical; with esophagomyotomy (Heller type)
2699.10
3350.70
32800
32810
Repair lung hernia through chest wall
Closure of chest wall following open flap drainage for empyema (Clagett type
2565.00
2710.80
32488
32491
32500
32601
32602
32652
32653
32654
32655
32656
32657
32658
32659
Extraordinary No.64/2013
94
5346.00
3131.92
3652.20
529.40
1074.60
1354.50
1494.00
3548.70
2567.70
2729.70
2972.70
2995.20
2986.20
3834.90
3141.90
Friday, 09 August 2013
procedure)
32815
32820
Open closure of major bronchial fistula
Major reconstruction, chest wall (posttraumatic)
4140.90
3856.50
32900
32905
2188.80
2652.30
32940
Resection of ribs, extrapleural, all stages
Thoracoplasty, Schede type or extrapleural (all stages);
Thoracoplasty, Schede type or extrapleural (all stages); with closure of
bronchopleural fistula
Pneumonolysis, extraperiosteal, including filling or packing procedures
32960
32997
Pneumothorax, therapeutic, intrapleural injection of air
Total lung lavage (unilateral)
261.00
993.60
32998
33010
Ablation pulmonary tumor perq rf uni
Pericardiocentesis; initial
2369.98
483.30
33011
33015
Pericardiocentesis; subsequent
Tube pericardiostomy
407.70
1074.60
33020
33025
Pericardiotomy for removal of clot or foreign body (primary procedure)
Creation of pericardial window or partial resection for drainage
2667.60
3193.20
33030
33031
Pericardiectomy, subtotal or complete; without cardiopulmonary bypass
Pericardiectomy, subtotal or complete; with cardiopulmonary bypass
4041.00
5037.30
33050
33120
Excision of pericardial cyst or tumor
Excision of intracardiac tumor, resection with cardiopulmonary bypass
3219.30
6552.90
33130
33140
Resection of external cardiac tumor
Transmyocrd laser revsc thorcom spx
4139.10
3384.56
33141
33202
Transmyocrd laser revsc pfrmd tm oth opn car px
Insertion epicardial electrode open
1649.90
2051.82
33203
Insertion epicardial electrode endoscopic
Insertion or replacement of permanent pacemaker with transvenous electrode(s);
atrial
Insertion or replacement of permanent pacemaker with transvenous electrode(s);
ventricular
Insertion or replacement of permanent pacemaker with transvenous electrode(s);
atrial and ventricular
Insertion or replacement of temporary transvenous single chamber cardiac
electrode or pacemaker catheter (separate procedure)
Insertion or replacement of temporary transvenous dual chamber pacing electrodes
(separate procedure)
Insertion or replacement of pacemaker pulse generator only; single chamber, atrial
or ventricular
Insertion or replacement of pacemaker pulse generator only; dual chamber
Upgrade of implanted pacemaker system, conversion of single chamber system to
dual chamber system (includes removal of previously placed pulse generator,
testing of existing lead, insertion of new lead, insertion of new pulse generator)
2105.33
32906
33206
33207
33208
33210
33211
33212
33213
33214
Extraordinary No.64/2013
95
3554.10
2266.20
2232.90
2424.60
3028.50
874.80
1017.90
1445.40
1467.90
1986.30
Friday, 09 August 2013
33215
829.37
33222
33223
Rpsg prev implted pm/cvdfb r atr/r ventr eltrd
Insertion or repositioning of a transvenous electrode (15 days or more after initial
insertion); single chamber (one electrode) permanent pacemaker or single chamber
pacing cardioverter-defibrillator
Insertion or repositioning of a transvenous electrode (15 days or more after initial
insertion); dual chamber (two electrodes) permanent pacemaker or dual chamber
pacing cardioverter-defibrillator
Repair of single transvenous electrode for a single chamber, permanent pacemaker
or single chamber pacing cardioverter-defibrillator
Repair of two transvenous electrodes for a dual chamber permanent pacemaker or
dual chamber pacing cardioverter-defibrillator
Revision or relocation of skin pocket for pacemaker
Revision of skin pocket for single or dual chamber pacing cardioverter-defibrillator
33224
33225
Insj eltrd car ven sys attch pm/cvdfb pls gen
Insj eltrd car ven sys tm insj cvdfb/pm pls gen
1345.09
1199.61
33226
33233
1296.07
995.40
33254
33255
Rpsg prev implted car ven sys l ventr eltrd
Removal of permanent pacemaker pulse generator
Removal of transvenous pacemaker electrode(s); single lead system, atrial or
ventricular
Removal of transvenous pacemaker electrode(s); dual lead system
Removal of permanent epicardial pacemaker and electrodes by thoracotomy; single
lead system, atrial or ventricular
Removal of permanent epicardial pacemaker and electrodes by thoracotomy; dual
lead system
Removal of permanent transvenous electrode(s) by thoracotomy
Insertion of single or dual chamber pacing cardioverter-defibrillator pulse
generator
Subcutaneous removal of single or dual chamber pacing cardioverter-defibrillator
pulse generator
Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s);
by thoracotomy
Removal of single or dual chamber pacing cardioverter-defibrillator electrode(s);
by transvenous extraction
Insertion or repositioning of electrode lead(s) for single or dual chamber pacing
cardioverter-defibrillator and insertion of pulse generator
Operative ablation of supraventricular arrhythmogenic focus or pathway (eg,
Wolff-Parkinson-White, A-V node re-entry), tract(s) and/or focus (foci); without
cardiopulmonary bypass
Operative ablation of supraventricular arrhythmogenic focus or pathway (eg,
Wolff-Parkinson-White, A-V node re-entry), tract(s) and/or focus (foci); with
cardiopulmonary bypass
Ablation & rcnstj atria lmtd
Ablation & rcnstj atria x10sv w/o bypass
33256
Ablation & rcnstj atria x10sv w/bypass
4278.05
33216
33217
33218
33220
33234
33235
33236
33237
33238
33240
33241
33243
33244
33249
33250
33251
Extraordinary No.64/2013
96
1427.40
1512.90
1392.30
1192.50
1442.70
1238.40
1511.10
1649.70
1722.60
2735.10
2816.10
1513.80
1061.10
3192.30
2707.20
3577.50
3759.30
5150.70
2975.87
3580.01
Friday, 09 August 2013
33257
Atria ablate & rcnstj w other procedure limited
1362.89
33258
33259
1535.93
2004.34
33265
Atria abltj &rcnstj w other px extensive w/o byp
Atria ablate &rcnstj w other px extensive w byp
Operative ablation of ventricular arrhythmogenic focus with cardiopulmonary
bypass
Ndsc ablation & rcnstj atria lmtd w/o bypass
33266
33300
Ndsc ablation & rcnstj atria x10sv w/o bypass
Repair of cardiac wound; without bypass
4068.64
3836.70
33305
33310
5122.80
3654.90
33320
Repair of cardiac wound; with cardiopulmonary bypass
Cardiotomy, exploratory (includes removal of foreign body); without bypass
Cardiotomy, exploratory (includes removal of foreign body); with
cardiopulmonary bypass
Suture repair of aorta or great vessels; without shunt or cardiopulmonary bypass
33321
33322
Sutr rpr aorta/grt vsl w/shunt byp
Suture repair of aorta or great vessels; with cardiopulmonary bypass
3833.13
5744.70
33330
33332
Insertion of graft, aorta or great vessels; without shunt, or cardiopulmonary bypass
Insj grf aorta/grt vsl w/shunt byp
6261.30
5066.72
33335
33400
Insertion of graft, aorta or great vessels; with cardiopulmonary bypass
Valvuloplasty, aortic valve; open, with cardiopulmonary bypass
6984.00
5665.50
33401
Valvuloplasty, aortic valve; open, with inflow occlusion
Valvuloplasty, aortic valve; using transventricular dilation, with cardiopulmonary
bypass
Construction of apical-aortic conduit
Replacement, aortic valve, with cardiopulmonary bypass; with prosthetic valve
other than homograft or stentless valve
Replacement, aortic valve, with cardiopulmonary bypass; with homograft valve
(freehand)
Rplcmt a-valve stent< tiss valve
Replacement, aortic valve; with aortic annulus enlargement, noncoronary cusp
Replacement, aortic valve; with transventricular aortic annulus enlargement
(Konno procedure)
Replacement, aortic valve; by translocation of autologous pulmonary valve with
homograft replacement of pulmonary valve (Ross procedure)
Rpr ventr o/f trc obstrcj patch enlgment o/f trc
5706.90
6087.60
33417
33420
Resection or incision of subvalvular tissue for discrete subvalvular aortic stenosis
Ventriculomyotomy (-myectomy) for idiopathic hypertrophic subaortic stenosis
(eg, asymmetric septal hypertrophy)
Aortoplasty (gusset) for supravalvular stenosis
Valvotomy, mitral valve; closed heart
33422
Valvotomy, mitral valve; open heart, with cardiopulmonary bypass
6451.20
33261
33315
33403
33404
33405
33406
33410
33411
33412
33413
33414
33415
33416
Extraordinary No.64/2013
97
5135.40
2970.81
5318.10
4713.30
6159.60
6695.10
7717.50
7029.90
6661.86
7921.80
8019.00
7622.10
6825.57
6592.50
6952.50
5495.40
Friday, 09 August 2013
33425
Valvuloplasty, mitral valve, with cardiopulmonary bypass;
6628.50
33426
7905.60
33430
33460
Valvuloplasty, mitral valve, with cardiopulmonary bypass; with prosthetic ring
Valvuloplasty, mitral valve, with cardiopulmonary bypass; radical reconstruction,
with or without ring
Replacement, mitral valve, with cardiopulmonary bypass
Valvectomy, tricuspid valve, with cardiopulmonary bypass
33463
33464
Valvuloplasty, tricuspid valve; without ring insertion
Valvuloplasty, tricuspid valve; with ring insertion
7105.50
6801.30
33465
33468
Replacement, tricuspid valve, with cardiopulmonary bypass
Tricuspid valve repositioning and plication for Ebstein anomaly
6721.20
6988.50
33470
33471
Valvotomy, pulmonary valve, closed heart; transventricular
Valvotomy, pulmonary valve, closed heart; via pulmonary artery
5030.10
4708.80
33472
33474
Valvotomy, pulmonary valve, open heart; with inflow occlusion
Valvotomy, pulmonary valve, open heart; with cardiopulmonary bypass
4979.70
5535.90
33475
7105.50
33502
Replacement, pulmonary valve
Right ventricular resection for infundibular stenosis, with or without
commissurotomy
Outflow tract augmentation (gusset), with or without commissurotomy or
infundibular resection
Repair of non-structural prosthetic valve dysfunction with cardiopulmonary bypass
(separate procedure)
Repair of coronary arteriovenous or arteriocardiac chamber fistula; with
cardiopulmonary bypass
Repair of coronary arteriovenous or arteriocardiac chamber fistula; without
cardiopulmonary bypass
Repair of anomalous coronary artery; by ligation
33503
33504
Repair of anomalous coronary artery; by graft, without cardiopulmonary bypass
Repair of anomalous coronary artery; by graft, with cardiopulmonary bypass
4377.60
6170.40
33505
33506
Rpr anom c art w/constj intrap-art tunnel
Rpr anom c art from p-art to aorta
5183.04
5719.19
33507
33508
Rpr anom aortic origin c art unroofing/tlcj
Ndsc surg w/vid-asstd harvest vein cab
5300.00
260.39
33510
33511
Coronary artery bypass, vein only; single coronary venous graft
Coronary artery bypass, vein only; two coronary venous grafts
7254.00
7448.40
33512
33513
Coronary artery bypass, vein only; three coronary venous grafts
Coronary artery bypass, vein only; four coronary venous grafts
8284.50
9268.20
33514
33516
Coronary artery bypass, vein only; five coronary venous grafts
Coronary artery bypass, vein only; six or more coronary venous grafts
Coronary artery bypass, using venous graft(s) and arterial graft(s); single vein graft
(List separately in addition to code for arterial graft)
10083.60
10809.00
33427
33476
33478
33496
33500
33501
33517
Extraordinary No.64/2013
98
6978.60
7627.50
6223.50
5840.10
5840.10
5799.60
5355.90
4027.50
3878.10
1161.90
Friday, 09 August 2013
33533
Coronary artery bypass, using venous graft(s) and arterial graft(s); two venous
grafts (List separately in addition to code for arterial graft)
Coronary artery bypass, using venous graft(s) and arterial graft(s); three venous
grafts (List separately in addition to code for arterial graft)
Coronary artery bypass, using venous graft(s) and arterial graft(s); four venous
grafts (List separately in addition to code for arterial graft)
Coronary artery bypass, using venous graft(s) and arterial graft(s); five venous
grafts (List separately in addition to code for arterial graft)
Coronary artery bypass, using venous graft(s) and arterial graft(s); six or more
venous grafts (List separately in addition to code for arterial graft)
Reoperation, coronary artery bypass procedure or valve procedure, more than one
month after original operation (List separately in addition to code for primary
procedure)
Coronary artery bypass, using arterial graft(s); single arterial graft
33534
33535
Coronary artery bypass, using arterial graft(s); two coronary arterial grafts
Coronary artery bypass, using arterial graft(s); three coronary arterial grafts
7822.80
8479.80
33536
33542
Coronary artery bypass, using arterial graft(s); four or more coronary arterial grafts
Myocardial resection (eg, ventricular aneurysmectomy)
Repair of postinfarction ventricular septal defect, with or without myocardial
resection
Surg ventr rstrj px w/prostc patch pfrmd
Coronary endarterectomy, open, any method, of left anterior descending,
circumflex, or right coronary artery performed in conjunction with coronary artery
bypass graft procedure, each vessel (List separately in addition to primary
procedure)
Closure of atrioventricular valve (mitral or tricuspid) by suture or patch
Closure of semilunar valve (aortic or pulmonary) by suture or patch
8454.60
6769.80
Anastomosis of pulmonary artery to aorta (Damus-Kaye-Stansel procedure)
Repair of complex cardiac anomaly other than pulmonary atresia with ventricular
septal defect by construction or replacement of conduit from right or left ventricle
to pulmonary artery
Rpr car anomal surg enlgment ventr septl dfct
6581.70
6644.56
33620
Rpr 2 outlet r vntrc w/intraventr tunnel rpr
Repair of double outlet right ventricle with intraventricular tunnel repair; with
repair of right ventricular outflow tract obstruction
Repair of complex cardiac anomalies (eg, tricuspid atresia) by closure of atrial
septal defect and anastomosis of atria or vena cava to pulmonary artery (simple
Fontan procedure)
Rpr cplx car anomal modf fontan px
Repair of single ventricle with aortic outflow obstruction and aortic arch
hypoplasia (hypoplastic left heart syndrome) (eg, Norwood procedure)
Application right & left pulmonary artery bands
33621
Tthrc catheter insert for stent placement
2733.50
33518
33519
33521
33522
33523
33530
33545
33548
33572
33600
33602
33606
33608
33610
33611
33612
33615
33617
33619
Extraordinary No.64/2013
99
1747.80
2054.70
2816.10
3634.20
4606.20
2003.40
6878.70
7679.70
7924.63
1008.00
6489.00
6479.10
6643.80
6591.66
7416.00
7004.70
7584.08
8214.30
5156.44
Friday, 09 August 2013
33622
10660.54
33670
33675
Reconstruction complex cardiac anomaly
Repair atrial septal defect, secundum, with cardiopulmonary bypass, with or
without patch
Direct or patch closure, sinus venosus, with or without anomalous pulmonary
venous drainage
Repair of atrial septal defect and ventricular septal defect, with direct or patch
closure
Repair of incomplete or partial atrioventricular canal (ostium primum atrial septal
defect), with or without atrioventricular valve repair
Repair of intermediate or transitional atrioventricular canal, with or without
atrioventricular valve repair
Repair of complete atrioventricular canal, with or without prosthetic valve
Closure multiple ventricular septal defects
33676
33677
Closure multiple vsd w/resection
Closure multiple vsd w/removal artery band
6341.84
6334.62
33681
6144.30
33720
Closure of ventricular septal defect, with or without patch;
Closure of ventricular septal defect, with or without patch; with pulmonary
valvotomy or infundibular resection (acyanotic)
Closure of ventricular septal defect, with or without patch; with removal of
pulmonary artery band, with or without gusset
Banding of pulmonary artery
Complete repair tetralogy of Fallot without pulmonary atresia;
Complete repair tetralogy of Fallot without pulmonary atresia; with transannular
patch
Complete repair tetralogy of Fallot with pulmonary atresia including construction
of conduit from right ventricle to pulmonary artery and closure of ventricular septal
defect
Repair sinus of Valsalva fistula, with cardiopulmonary bypass;
Repair sinus of Valsalva fistula, with cardiopulmonary bypass; with repair of
ventricular septal defect
Repair sinus of Valsalva aneurysm, with cardiopulmonary bypass
33722
33724
Closure of aortico-left ventricular tunnel
Repair isolated partial pulm venous return
6437.70
5384.20
33726
6373.14
33735
33736
Repair pulmonary venous stenosis
Complete repair of anomalous venous return (supracardiac, intracardiac, or
infracardiac types)
Repair of cor triatriatum or supravalvular mitral ring by resection of left atrial
membrane
Atrial septectomy or septostomy; closed heart (Blalock-Hanlon type operation)
Atrial septectomy or septostomy; open heart with cardiopulmonary bypass
33737
33750
Atrial septectomy or septostomy; open heart, with inflow occlusion
Shunt; subclavian to pulmonary artery (Blalock-Taussig type operation)
4892.40
4233.60
33641
33645
33647
33660
33665
33684
33688
33690
33692
33694
33697
33702
33710
33730
33732
Extraordinary No.64/2013
100
5459.40
6368.40
7210.80
6916.50
7938.00
7625.70
6647.90
6494.40
6613.20
3090.60
6437.70
7090.20
7173.90
5951.70
7786.80
6746.40
6602.40
5942.70
4538.70
5480.10
Friday, 09 August 2013
33755
Shunt; ascending aorta to pulmonary artery (Waterston type operation)
4748.40
33762
33764
4645.80
4686.30
33782
Shunt; descending aorta to pulmonary artery (Potts-Smith type operation)
Shunt; central, with prosthetic graft
Shunt; superior vena cava to pulmonary artery for flow to one lung (classical
Glenn procedure)
Shunt; superior vena cava to pulmonary artery for flow to both lungs (bidirectional
Glenn procedure)
Anast cavopulm 2nd suprior v/c
Repair of transposition of the great arteries with ventricular septal defect and
subpulmonary stenosis; without surgical enlargement of ventricular septal defect
Rpr tga enlgmnt v-septl dfct
Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or
Senning type) with cardiopulmonary bypass;
Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or
Senning type) with cardiopulmonary bypass; with removal of pulmonary band
Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or
Senning type) with cardiopulmonary bypass; with closure of ventricular septal
defect
Repair of transposition of the great arteries, atrial baffle procedure (eg, Mustard or
Senning type) with cardiopulmonary bypass; with repair of subpulmonic
obstruction
Repair of transposition of the great arteries, aortic pulmonary artery reconstruction
(eg, Jatene type);
Repair of transposition of the great arteries, aortic pulmonary artery reconstruction
(eg, Jatene type); with removal of pulmonary band
Repair of transposition of the great arteries, aortic pulmonary artery reconstruction
(eg, Jatene type); with closure of ventricular septal defect
Repair of transposition of the great arteries, aortic pulmonary artery reconstruction
(eg, Jatene type); with repair of subpulmonic obstruction
A-root tlcj vsd pulm stns rpr w/o c ost rimpltj
33783
33786
A-root tlcj vsd pulm stns rpr w/ rimpltj c ostia
Total repair, truncus arteriosus (Rastelli type operation)
13932.80
7416.00
33788
5548.50
33802
33803
Reimplantation of an anomalous pulmonary artery
Aortic suspension (aortopexy) for tracheal decompression (eg, for tracheomalacia)
(separate procedure)
Division of aberrant vessel (vascular ring);
Division of aberrant vessel (vascular ring); with reanastomosis
33813
33814
Obliteration of aortopulmonary septal defect; without cardiopulmonary bypass
Obliteration of aortopulmonary septal defect; with cardiopulmonary bypass
4243.50
5994.90
33820
33822
Repair of patent ductus arteriosus; by ligation
Repair of patent ductus arteriosus; by division, under 18 years
3869.10
3641.40
33824
Repair of patent ductus arteriosus; by division, 18 years and older
4058.10
33766
33767
33768
33770
33771
33774
33775
33776
33777
33778
33779
33780
33781
33800
Extraordinary No.64/2013
101
4068.90
4686.30
1373.84
7014.60
7655.60
6746.40
6685.20
8601.30
8343.00
9038.70
8766.00
8766.00
8766.00
12843.24
2654.10
3554.10
3893.40
Friday, 09 August 2013
33840
33845
33851
33852
33853
33860
33863
33864
33870
33875
Excision of coarctation of aorta, with or without associated patent ductus
arteriosus; with direct anastomosis
Excision of coarctation of aorta, with or without associated patent ductus
arteriosus; with graft
Exc coarcj aorta w/l subcla art/prostc as gusset
Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic
material; without cardiopulmonary bypass
Repair of hypoplastic or interrupted aortic arch using autogenous or prosthetic
material; with cardiopulmonary bypass
Ascending aorta graft, with cardiopulmonary bypass, with or without valve
suspension;
Ascending aorta graft, with cardiopulmonary bypass, with or without valve
suspension; with aortic root replacement using composite prosthesis and coronary
reconstruction
Ascending aorta grf valve spare root remodel
Transverse arch graft, with cardiopulmonary bypass
4342.50
6087.60
5986.48
5514.30
6901.20
7323.30
7577.10
7601.41
9652.50
7810.20
33880
33881
Descending thoracic aorta graft, with or without bypass
Repair of thoracoabdominal aortic aneurysm with graft, with or without
cardiopulmonary bypass
Evasc rpr dta coverage art origin 1st endoprosth
Evasc rpr dta exp coverage w/o art origin
33883
33884
Plmt prox xtn prosth evasc rpr dta 1st xtn
Plmt prox xtn prosth evasc rpr dta ea prox xtn
3643.31
1385.57
33886
33889
Plmt dstl xtn prosth dlyd after evasc rpr dta
Opn subcla crtd art trpos nck inc ulat
3119.61
2690.56
33891
33910
Byp grf w/dta rpr nck inc
Pulmonary artery embolectomy; with cardiopulmonary bypass
3430.57
6566.40
33915
3965.40
33922
Pulmonary artery embolectomy; without cardiopulmonary bypass
Pulmonary endarterectomy, with or without embolectomy, with cardiopulmonary
bypass
Repair of pulmonary artery stenosis by reconstruction with patch or graft
Repair of pulmonary atresia with ventricular septal defect, by construction or
replacement of conduit from right or left ventricle to pulmonary artery
Transection of pulmonary artery with cardiopulmonary bypass
33924
33925
Lig&tkdn sysic-to-p-art shunt w/cgen hrt px
Rpr p-art arborizj anomal unifclizj w/o card byp
1096.26
6455.33
33926
33945
Rpr p-art arborizj anomal unifclizj w/card byp
Heart transplant, with or without recipient cardiectomy
Prolonged extracorporeal circulation for cardiopulmonary insufficiency; initial 24
hours
Prolonged extracorporeal circulation for cardiopulmonary insufficiency; each
additional 24 hours (List separately in addition to code for primary procedure)
8708.02
11331.00
33877
33916
33917
33920
33960
33961
Extraordinary No.64/2013
102
9241.20
5712.22
4930.62
4653.00
6633.90
6891.30
5562.00
2981.70
1626.30
Friday, 09 August 2013
33967
Insertion intra-aortic balloon assist dev prq
681.97
33968
98.27
33975
33976
Removal intra-aortic balloon assist device prq
Insertion of intra-aortic balloon assist device through the femoral artery, open
approach
Removal of intra-aortic balloon assist device including repair of femoral artery,
with or without graft
Insertion of intra-aortic balloon assist device through the ascending aorta
Removal of intra-aortic balloon assist device from the ascending aorta, including
repair of the ascending aorta, with or without graft
Implantation of ventricular assist device; single ventricle support
Implantation of ventricular assist device; biventricular support
33977
33978
Removal of ventricular assist device; single ventricle support
Removal of ventricular assist device; biventricular support
3388.50
3780.00
33979
33980
6113.20
9056.83
34501
Insj ventr assist dev impltable icorp 1 vntrc
Rmvl ventr assist dev impltable icorp 1 vntrc
Embolectomy or thrombectomy, with or without catheter; carotid, subclavian or
innominate artery, by neck incision
Embolectomy or thrombectomy, with or without catheter; innominate, subclavian
artery, by thoracic incision
Embolectomy or thrombectomy, with or without catheter; axillary, brachial,
innominate, subclavian artery, by arm incision
Embolectomy or thrombectomy, with or without catheter; radial or ulnar artery, by
arm incision
Embolectomy or thrombectomy, with or without catheter; renal, celiac, mesentery,
aortoiliac artery, by abdominal incision
Embolectomy or thrombectomy, with or without catheter; femoropopliteal,
aortoiliac artery, by leg incision
Embolectomy or thrombectomy, with or without catheter; popliteal-tibio-peroneal
artery, by leg incision
Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal
incision
Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by
leg incision
Thrombectomy, direct or with catheter; vena cava, iliac, femoropopliteal vein, by
abdominal and leg incision
Thrombectomy, direct or with catheter; subclavian vein, by neck incision
Thrombectomy, direct or with catheter; axillary and subclavian vein, by arm
incision
Valvuloplasty, femoral vein
34502
34510
Reconstruction of vena cava, any method
Venous valve transposition, any vein donor
5296.50
2574.90
34520
34530
Cross-over vein graft to venous system
Saphenopopliteal vein anastomosis
3444.30
2738.70
33970
33971
33973
33974
34001
34051
34101
34111
34151
34201
34203
34401
34421
34451
34471
34490
Extraordinary No.64/2013
103
2032.20
1911.60
2047.50
2317.50
4377.60
4364.10
2654.10
2909.70
2623.50
2964.60
3651.30
2886.30
2952.90
2884.50
2549.70
2923.20
2317.50
2148.30
2421.00
Friday, 09 August 2013
34800
34802
34803
34804
34805
34806
34808
34812
34813
34820
34825
34826
34830
34831
34832
34833
34834
35001
35002
35005
35011
35013
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using
aorto-aortic tube prosthesis
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using
modular bifurcated prosthesis (one docking limb)
Evasc rpr aaa w/mdlr bfrc prosth 2 limbs
Endovascular repair of infrarenal abdominal aortic aneurysm or dissection; using
unibody bifurcated prosthesis
Evasc rpr aaa aorto-uniiliac/aorto-unifem prosth
Tcat placement physiologic sensor aneurysmal sac
Endovascular placement of iliac artery occlusion device (List separately in addition
to code for primary procedure)
Open femoral artery exposure for delivery of aortic endovascular prosthesis, by
groin incision, unilateral
Placement of femoral-femoral prosthetic graft during endovascular aortic aneurysm
repair (List separately in addition to code for primary procedure)
Open iliac artery exposure for delivery of endovascular prosthesis or iliac
occlusion during endovascular therapy, by abdominal or retroperitoneal incision,
unilateral
Placement of proximal or distal extension prosthesis for endovascular repair of
infrarenal abdominal aortic aneurysm; initial vessel
Placement of proximal or distal extension prosthesis for endovascular repair of
infrarenal abdominal aortic aneurysm; each additional vessel (List separately in
addition to code for primary procedure)
Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated
arterial trauma, following unsuccessful endovascular repair; tube prosthesis
Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated
arterial trauma, following unsuccessful endovascular repair; aorto-bi-iliac
prosthesis
Open repair of infrarenal aortic aneurysm or dissection, plus repair of associated
arterial trauma, following unsuccessful endovascular repair; aorto-bifemoral
prosthesis
Iliac art expos w/crtj conduit uni
Brach art expos dplmnt aortic/iliac prosth uni
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm and associated occlusive
disease, carotid, subclavian artery, by neck incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, carotid, subclavian
artery, by neck incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, vertebral artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm and associated occlusive
disease, axillary-brachial artery, by arm incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
Extraordinary No.64/2013
104
3621.60
3996.90
4301.78
3996.90
3987.05
420.95
688.50
1125.90
800.10
1626.30
2162.70
688.50
5635.80
6093.00
6093.00
1682.17
965.20
3978.00
4092.30
3744.00
3550.50
3780.90
Friday, 09 August 2013
35021
35022
35045
35081
35082
35091
35092
35102
35103
35111
35112
35121
35122
35131
35132
insertion, with or without patch graft; for ruptured aneurysm, axillary-brachial
artery, by arm incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, innominate, subclavian artery, by thoracic incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, innominate,
subclavian artery, by thoracic incision
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, radial or ulnar artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, abdominal aorta
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, abdominal aorta involving visceral vessels (mesenteric, celiac,
ren
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta
involving visceral vessels (mesenteric, celiac, renal)
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, abdominal aorta involving iliac vessels (common, hypogastric,
exter
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, abdominal aorta
involving iliac vessels (common, hypogastric, external)
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, splenic artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, splenic artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, hepatic, celiac, renal, or mesenteric artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, hepatic, celiac, renal,
or mesenteric artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, iliac artery (common, hypogastric, external)
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, iliac artery (common,
hypogastric, external)
Extraordinary No.64/2013
105
4011.30
4035.60
3766.50
5967.00
7056.00
6876.00
7870.50
6484.50
6972.30
4826.70
3327.30
4541.40
4851.90
4762.80
4635.00
Friday, 09 August 2013
35180
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, common femoral artery (profunda femoris, superficial femoral)
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, common femoral
artery (profunda femoris, superficial femoral)
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for aneurysm, false aneurysm, and associated
occlusive disease, popliteal artery
Direct repair of aneurysm, false aneurysm, or excision (partial or total) and graft
insertion, with or without patch graft; for ruptured aneurysm, popliteal artery
Repair, congenital arteriovenous fistula; head and neck
35182
35184
Repair, congenital arteriovenous fistula; thorax and abdomen
Repair, congenital arteriovenous fistula; extremities
4532.40
3888.00
35188
35189
Repair, acquired or traumatic arteriovenous fistula; head and neck
Repair, acquired or traumatic arteriovenous fistula; thorax and abdomen
3234.60
4228.20
35190
35201
Repair, acquired or traumatic arteriovenous fistula; extremities
Repair blood vessel, direct; neck
3682.80
3811.50
35206
35207
Repair blood vessel, direct; upper extremity
Repair blood vessel, direct; hand, finger
3393.00
3836.70
35211
35216
Repair blood vessel, direct; intrathoracic, with bypass
Repair blood vessel, direct; intrathoracic, without bypass
4775.40
4719.60
35221
35226
Repair blood vessel, direct; intra-abdominal
Repair blood vessel, direct; lower extremity
4332.60
4322.70
35231
35236
Repair blood vessel with vein graft; neck
Repair blood vessel with vein graft; upper extremity
3770.10
5035.50
35241
35246
Repair blood vessel with vein graft; intrathoracic, with bypass
Repair blood vessel with vein graft; intrathoracic, without bypass
4771.80
4289.40
35251
35256
Repair blood vessel with vein graft; intra-abdominal
Repair blood vessel with vein graft; lower extremity
5365.80
4428.90
35261
35266
Repair blood vessel with graft other than vein; neck
Repair blood vessel with graft other than vein; upper extremity
3811.50
3907.80
35271
35276
Repair blood vessel with graft other than vein; intrathoracic, with bypass
Repair blood vessel with graft other than vein; intrathoracic, without bypass
5134.50
3682.80
35281
35286
Repair blood vessel with graft other than vein; intra-abdominal
Repair blood vessel with graft other than vein; lower extremity
Thromboendarterectomy, with or without patch graft; carotid, vertebral,
subclavian, by neck incision
Teaec w/graft superficial femoral art
Teaec w/graft popliteal art
4377.60
4189.50
35141
35142
35151
35152
35301
35302
35303
Extraordinary No.64/2013
106
4068.90
4619.70
4226.40
3790.80
3141.90
4066.20
3050.03
3211.06
Friday, 09 August 2013
35304
Teaec w/graft tibioperoneal trunk art
3248.55
35305
35306
3210.32
1331.62
35321
Teaec w/graft tibial/peroneal art 1st vessel
Teaec w/graft ea addl tibial/peroneal art
Thromboendarterectomy, with or without patch graft; subclavian, innominate, by
thoracic incision
Thromboendarterectomy, with or without patch graft; axillary-brachial
35331
35341
Thromboendarterectomy, with or without patch graft; abdominal aorta
Thromboendarterectomy, with or without patch graft; mesenteric, celiac, or renal
5119.20
4953.60
35351
35355
Thromboendarterectomy, with or without patch graft; iliac
Thromboendarterectomy, with or without patch graft; iliofemoral
4340.70
4176.00
35361
35363
Thromboendarterectomy, with or without patch graft; combined aortoiliac
Thromboendarterectomy, with or without patch graft; combined aortoiliofemoral
5794.20
4686.30
35371
35372
Thromboendarterectomy, with or without patch graft; common femoral
Thromboendarterectomy, with or without patch graft; deep (profunda) femoral
Reoperation, carotid, thromboendarterectomy, more than one month after original
operation (List separately in addition to code for primary procedure)
Angioscopy (non-coronary vessels or grafts) during therapeutic intervention (List
separately in addition to code for primary procedure)
Transluminal balloon angioplasty, open; renal or other visceral artery
3605.40
4039.20
Transluminal balloon angioplasty, open; aortic
Transluminal balloon angioplasty, open; brachiocephalic trunk or branches, each
vessel
Transluminal balloon angioplasty, open; venous
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
1345.50
2743.20
35476
35500
Transluminal balloon angioplasty, percutaneous; aortic
Transluminal balloon angioplasty, percutaneous; brachiocephalic trunk or
branches, each vessel
Transluminal balloon angioplasty, percutaneous; venous
Harvest uxtr vein 1 sgm lxtr/cab px
35501
35506
Bypass graft, with vein; carotid
Bypass graft, with vein; carotid-subclavian
3636.00
4938.30
35508
35509
Bypass graft, with vein; carotid-vertebral
Bypass graft, with vein; carotid-carotid
3759.30
3682.80
35510
35511
Byp w/vein crtd-brach
Bypass graft, with vein; subclavian-subclavian
3271.58
3365.10
35512
35515
Byp w/vein subcla-brach
Bypass graft, with vein; subclavian-vertebral
3264.42
3420.00
35516
35518
Bypass graft, with vein; subclavian-axillary
Bypass graft, with vein; axillary-axillary
3505.50
4264.20
35311
35390
35400
35450
35452
35458
35460
35471
35472
35475
Extraordinary No.64/2013
107
3872.70
3862.80
855.00
570.60
2514.60
2317.50
1596.60
2348.10
2426.40
1415.70
871.62
Friday, 09 August 2013
35521
Bypass graft, with vein; axillary-femoral
4596.30
35522
35523
Byp w/vein ax-brach
Bypass graft with vein brachial-ulnar/-radial
3209.65
3277.08
35525
35526
Byp w/vein brach-brach
Bypass graft, with vein; aortosubclavian or carotid
3187.18
4275.00
35531
35533
Bypass graft, with vein; aortoceliac or aortomesenteric
Bypass graft, with vein; axillary-femoral-femoral
4910.40
4089.60
35535
35536
Bypass graft with vein hepatorenal
Bypass graft, with vein; splenorenal
4060.85
4485.60
35537
35538
Byp w/vein aortoiliac
Byp w/vein aortobi-iliac
4523.50
5514.25
35539
35540
Byp w/vein aortofemoral
Byp w/vein aortobifemoral
5177.02
5915.40
35548
35549
Bypass graft, with vein; aortoiliofemoral, unilateral
Bypass graft, with vein; aortoiliofemoral, bilateral
3934.80
4995.90
35551
35556
Bypass graft, with vein; aortofemoral-popliteal
Bypass graft, with vein; femoral-popliteal
4731.30
4336.20
35558
35560
Bypass graft, with vein; femoral-femoral
Bypass graft, with vein; aortorenal
4312.80
4439.70
35563
35565
3582.90
4176.90
35570
Bypass graft, with vein; ilioiliac
Bypass graft, with vein; iliofemoral
Bypass graft, with vein; femoral-anterior tibial, posterior tibial, peroneal artery or
other distal vessels
Byp tibl-tibl/proneal-tibl/tibl/proneal trk-tibl
35571
35572
Bypass graft, with vein; popliteal-tibial, -peroneal artery or other distal vessels
Harvest fempop vein 1 sgm vasc rcnstj px
4784.40
878.05
35583
35585
In-situ vein bypass; femoral-popliteal
In-situ vein bypass; femoral-anterior tibial, posterior tibial, or peroneal artery
4646.70
5580.90
35587
5259.60
35601
35606
In-situ vein bypass; popliteal-tibial, peroneal
Harvest of upper extremity artery, one segment, for coronary artery bypass
procedure
Bypass graft, with other than vein; carotid
Bypass graft, with other than vein; carotid-subclavian
35612
35616
Bypass graft, with other than vein; subclavian-subclavian
Bypass graft, with other than vein; subclavian-axillary
4006.80
3502.80
35621
35623
Bypass graft, with other than vein; axillary-femoral
Bypass graft, with other than vein; axillary-popliteal or -tibial
4295.70
4099.50
35626
Bypass graft, with other than vein; aortosubclavian or carotid
5134.50
35566
35600
Extraordinary No.64/2013
108
5097.60
3570.22
922.50
3828.60
4417.20
Friday, 09 August 2013
35631
Bypass graft, with other than vein; aortoceliac, aortomesenteric, aortorenal
4752.00
35632
35633
Bypass graft w/other than vein ilio-celiac
Bypass graft w/other than vein ilio-mesenteric
3986.67
4261.60
35634
3929.70
35637
35638
Bypass graft w/other than vein iliorenal
Bypass graft, with other than vein; splenorenal (splenic to renal arterial
anastomosis)
Byp oth/thn vein aortoiliac
Byp oth/thn vein aortobi-iliac
35642
35645
Bypass graft, with other than vein; carotid-vertebral
Bypass graft, with other than vein; subclavian-vertebral
3672.00
3720.60
35646
35647
Bypass graft, with other than vein; aortofemoral or bifemoral
Byp oth/thn vein aortofem
5142.60
3664.37
35650
35651
Bypass graft, with other than vein; axillary-axillary
Bypass graft, with other than vein; aortofemoral-popliteal
4328.10
4350.60
35654
35656
Bypass graft, with other than vein; axillary-femoral-femoral
Bypass graft, with other than vein; femoral-popliteal
5381.10
4311.00
35661
35663
Bypass graft, with other than vein; femoral-femoral
Bypass graft, with other than vein; ilioiliac
4134.60
3662.10
35665
4484.70
35685
Bypass graft, with other than vein; iliofemoral
Bypass graft, with other than vein; femoral-anterior tibial, posterior tibial, or
peroneal artery
Bypass graft, with other than vein; popliteal-tibial or -peroneal artery
Bypass graft; composite, prosthetic and vein (List separately in addition to code for
primary procedure)
Bypass graft; autogenous composite, two segments of veins from two locations
(List separately in addition to code for primary procedure)
Bypass graft; autogenous composite, three or more segments of vein from two or
more locations (List separately in addition to code for primary procedure)
Plmt vein patch/cuff dstl anast byp conduit
35686
35691
Crtj dstl arven fstl lxtr byp surg non-hemo
Transposition and/or reimplantation; vertebral to carotid artery
858.30
3834.00
35693
35694
Transposition and/or reimplantation; vertebral to subclavian artery
Transposition and/or reimplantation; subclavian to carotid artery
3316.50
3399.30
35695
35697
Transposition and/or reimplantation; carotid to subclavian artery
Rimpltj visc art infrarnl aortic prosth ea art
Reoperation, femoral-popliteal or femoral (popliteal)-anterior tibial, posterior
tibial, peroneal artery or other distal vessels, more than one month after original
operation (List separately in addition to code for primary procedure)
Exploration (not followed by surgical repair), with or without lysis of artery;
carotid artery
3321.00
1617.23
35636
35666
35671
35681
35682
35683
35700
35701
Extraordinary No.64/2013
109
4275.00
3861.68
3898.02
4851.90
4197.60
3032.10
1248.30
1425.60
840.77
978.30
1827.90
Friday, 09 August 2013
35800
Exploration (not followed by surgical repair), with or without lysis of artery;
femoral artery
Exploration (not followed by surgical repair), with or without lysis of artery;
popliteal artery
Exploration (not followed by surgical repair), with or without lysis of artery; other
vessels
Exploration for postoperative hemorrhage, thrombosis or infection; neck
35820
35840
Exploration for postoperative hemorrhage, thrombosis or infection; chest
Exploration for postoperative hemorrhage, thrombosis or infection; abdomen
2691.90
2632.50
35860
35870
Exploration for postoperative hemorrhage, thrombosis or infection; extremity
Repair of graft-enteric fistula
1816.20
5026.50
35875
2820.60
35883
35884
Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);
Thrombectomy of arterial or venous graft (other than hemodialysis graft or fistula);
with revision of arterial or venous graft
Revision, lower extremity arterial bypass, without thrombectomy, open; with vein
patch angioplasty
Revision, lower extremity arterial bypass, without thrombectomy, open; with
segmental vein interposition
Revision femoral anast open nonautog graft
Revision femoral anast open w/autog graft
35901
35903
Excision of infected graft; neck
Excision of infected graft; extremity
2307.60
2663.10
35905
35907
Excision of infected graft; thorax
Excision of infected graft; abdomen
2797.20
3213.90
36000
36002
128.91
282.31
36013
Introduction of needle or intracatheter, vein
Njx px prq tx xtr pseudoarysm
Injection procedure for contrast venography (including introduction of needle or
intracatheter)
Introduction of catheter, superior or inferior vena cava
Selective catheter placement, venous system; first order branch (eg, renal vein,
jugular vein)
Selective catheter placement, venous system; second order, or more selective,
branch (eg, left adrenal vein, petrosal sinus)
Introduction of catheter, right heart or main pulmonary artery
36014
36015
Selective catheter placement, left or right pulmonary artery
Selective catheter placement, segmental or subsegmental pulmonary artery
591.30
628.20
36100
36120
Introduction of needle or intracatheter, carotid or vertebral artery
Introduction of needle or intracatheter; retrograde brachial artery
628.20
741.60
36140
36160
Introduction of needle or intracatheter; extremity artery
Introduction of needle or intracatheter, aortic, translumbar
503.10
650.70
36200
Introduction of catheter, aorta
624.60
35721
35741
35761
35876
35879
35881
36005
36010
36011
36012
Extraordinary No.64/2013
110
1711.80
1733.40
1645.20
1757.70
3186.90
3326.40
3647.70
3256.61
3453.76
186.30
647.10
510.30
679.50
789.30
Friday, 09 August 2013
36261
Selective catheter placement, arterial system; each first order thoracic or
brachiocephalic branch, within a vascular family
Selective catheter placement, arterial system; initial second order thoracic or
brachiocephalic branch, within a vascular family
Selective catheter placement, arterial system; initial third order or more selective
thoracic or brachiocephalic branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order,
and beyond, thoracic or brachiocephalic branch, within a vascular family (List in
addition to code for initial second or third order vessel as appropriate)
Selective catheter placement, arterial system; each first order abdominal, pelvic, or
lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; initial second order abdominal,
pelvic, or lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; initial third order or more selective
abdominal, pelvic, or lower extremity artery branch, within a vascular family
Selective catheter placement, arterial system; additional second order, third order,
and beyond, abdominal, pelvic, or lower extremity artery branch, within a vascular
family (List in addition to code for initial second or third order vessel as appropriat
Insertion of implantable intra-arterial infusion pump (eg, for chemotherapy of
liver)
Revision of implanted intra-arterial infusion pump
36262
36400
Removal of implanted intra-arterial infusion pump
Venipuncture, under age 3 years; femoral, jugular or sagittal sinus
849.60
57.60
36405
36406
87.30
93.20
36415
36420
Venipuncture, under age 3 years; scalp vein
Venipuncture, under age 3 years; other vein
Venipuncture, child over age 3 years or adult, necessitating physician's skill
(separate procedure), for diagnostic or therapeutic purposes. Not to be used for
routine venipuncture.
Routine venipuncture or finger/heel/ear stick for collection of specimen(s)
Venipuncture, cutdown; under age 1 year
36425
36430
Venipuncture, cutdown; age 1 or over
Transfusion, blood or blood components
236.70
122.40
36440
36450
Push transfusion, blood, 2 years or under
Exchange transfusion, blood; newborn
212.40
824.40
36455
36460
Exchange transfusion, blood; other than newborn
Transfusion, intrauterine, fetal
875.70
1153.80
36470
36471
Injection of sclerosing solution; single vein
Injection of sclerosing solution; multiple veins, same leg
152.52
246.87
36475
36476
Endoven abltj incmptnt vein xtr rf 1st vein
Endoven abltj incmptnt vein xtr rf 2nd+ veins
3072.75
1042.37
36478
36479
Endoven abltj incmptnt vein xtr laser 1st vein
Endoven abltj incmptnt vein xtr laser 2nd+ veins
2978.33
1045.01
36215
36216
36217
36218
36245
36246
36247
36248
36260
36410
Extraordinary No.64/2013
111
710.10
729.00
978.30
232.20
768.60
875.70
1114.20
236.70
2344.50
919.80
75.26
17.04
212.40
Friday, 09 August 2013
36481
Percutaneous portal vein catheterization by any method
1143.00
36500
36510
Venous catheterization for selective organ blood sampling
Catheterization of umbilical vein for diagnosis or therapy, newborn
475.20
265.50
36511
36512
Ther apheresis white bld cells
Ther apheresis red bld cells
274.52
273.39
36513
36514
Ther apheresis pltlts
Ther apheresis plsm pheresis
276.08
482.70
36522
36555
Photopheresis, extracorporeal
Insj non-tun ctr cvc under 5 yr
550.80
500.71
36556
36557
Insj non-tun ctr cvc age 5 yr/>
Insj tun ctr cvc w/o subq port/pmp under 5 yr
373.52
1519.07
36558
36560
Insj tun ctr cvc w/o subq port/pmp age 5 yr/>
Insj tun ctr ctr vad w/subq port under 5 yr
1287.53
1595.76
36561
36563
Insj tun ctr ctr vad w/subq port age 5 yr/>
Insj tun ctr ctr vad w/subq pmp
1280.08
1557.18
36565
36566
Insj tun vad req 2 cath 2 sits w/o subq port/pmp
Insj tun vad req 2 cath 2 sits w/subq port
1535.22
2580.53
36568
36569
Insj prph cvc w/o subq port/pmp under 5 yr
Insj prph cvc w/o subq port/pmp age 5 yr/>
548.20
459.11
36570
36571
Insj prph ctr vad w/subq port under 5 yr
Insj prph ctr vad w/subq port age 5 yr/>
1264.84
1302.40
36575
36576
Rpr tun/non-tun ctr vad cath w/o subq port/pmp
Rpr ctr vad w/subq port/pmp ctr/prph insj sit
294.90
671.12
36578
36580
Rplcmt cath ctr vad subq port/pmp
Rplcmt compl non-tun cvc w/o subq port/pmp
1052.89
402.39
36581
36582
Rplcmt compl tun cvc w/o subq port/pmp
Rplcmt compl tun ctr vad w/subq port
1347.18
1777.44
36583
36584
Rplcmt compl tun ctr vad w/subq pmp
Rplcmt compl prph cvc w/o subq port/pmp
1809.20
423.34
36585
36589
Rplcmt compl prph ctr vad w/subq port
Rmvl tun cvc w/o subq port/pmp
1778.45
388.65
36590
36591
Rmvl tun ctr vad w/subq port/pmp ctr/prph insj
Collect blood from implant venous access device
579.93
40.50
36592
36593
Collect blood from catheter venous nos
Declot by thrombolytic agent implant device/cath
52.78
146.47
36595
36596
Mchnl rmvl pricath obstr cv dev via ven access
Mchnl rmvl intral obstr cv dev thru dev lumen
1257.21
265.15
Extraordinary No.64/2013
112
Friday, 09 August 2013
36597
Rpsg previously placed cvc under fluor gdn
238.99
36598
36600
Cntrst njx rad eval ctr vad fluor img&reprt
Arterial puncture, withdrawal of blood for diagnosis
Arterial catheterization or cannulation for sampling, monitoring or transfusion
(separate procedure); percutaneous
Arterial catheterization or cannulation for sampling, monitoring or transfusion
(separate procedure); cutdown
Arterial catheterization for prolonged infusion therapy (chemotherapy), cutdown
Catheterization, umbilical artery, newborn, for diagnosis or therapy
282.77
91.80
Placement of needle for intraosseous infusion
Insertion of cannula for hemodialysis, other purpose (separate procedure); vein to
vein
Insertion of cannula for hemodialysis, other purpose (separate procedure);
arteriovenous, external (Scribner type)
Insertion of cannula for hemodialysis, other purpose (separate procedure);
arteriovenous, external revision, or closure
Arven anast opn upr arm cephalic vein trpos
256.50
4174.20
2132.80
36835
Arteriovenous anastomosis, open; by basilic vein transposition
Arven anast opn f/arm vein trpos
Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate
procedure)
Insertion of cannula(s) for prolonged extracorporeal circulation for
cardiopulmonary insufficiency (ECMO) (separate procedure)
Creation of arteriovenous fistula by other than direct arteriovenous anastomosis
(separate procedure); autogenous graft
Creation of arteriovenous fistula by other than direct arteriovenous anastomosis
(separate procedure); nonautogenous graft
Thrombectomy, open, arteriovenous fistula without revision, autogenous or
nonautogenous dialysis graft (separate procedure)
Revision, open, arteriovenous fistula; without thrombectomy, autogenous or
nonautogenous dialysis graft (separate procedure)
Revision, open, arteriovenous fistula; with thrombectomy, autogenous or
nonautogenous dialysis graft (separate procedure)
Insj thomas shunt spx
36838
36860
Dstl revsc&interval lig uxtr hemo access
External cannula declotting (separate procedure); without balloon catheter
3556.18
412.20
36861
891.00
37140
External cannula declotting (separate procedure); with balloon catheter
Thrombectomy, percutaneous, arteriovenous fistula, autogenous or nonautogenous
graft (includes mechanical thrombus extraction and intra-graft thrombolysis)
Venous anastomosis; portocaval
37145
37160
Venous anastomosis; renoportal
Venous anastomosis; caval-mesenteric
3990.60
5255.10
36620
36625
36640
36660
36680
36800
36810
36815
36818
36819
36820
36821
36822
36825
36830
36831
36832
36833
36870
Extraordinary No.64/2013
113
256.50
391.50
550.80
322.20
885.60
1357.20
1125.90
1990.48
2295.00
1916.10
3141.90
3022.20
1346.40
2439.90
1944.90
1480.23
3973.50
5608.80
Friday, 09 August 2013
37180
4969.80
37184
Venous anastomosis; splenorenal, proximal
Venous anastomosis; splenorenal, distal (selective decompression of
esophagogastric varices, any technique)
Prim prq trluml mchnl thrmbc 1st vsl
37185
37186
Prim prq trluml mchnl thrmbc sbsq vsl
Sec prq trluml thrmbc
872.39
1250.30
37187
37188
Prq trluml mchnl thrmbc vein
Prq trluml mchnl thrmbc vein repeat tx
1941.11
1473.77
37195
37200
Thrombolysis, cerebral, by intravenous infusion
Tcat bx
846.90
814.79
37201
1267.20
37209
Transcatheter therapy, infusion for thrombolysis other than coronary
Transcatheter therapy, infusion other than for thrombolysis, any type (eg,
spasmolytic, vasoconstrictive)
Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured
venous or arterial catheter)
Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve
hemostasis, to occlude a vascular malformation), percutaneous, any method, noncentral nervous system, non-head or neck
Transcatheter placement of an intravascular stent(s), (non-coronary vessel),
percutaneous; initial vessel
Transcatheter placement of an intravascular stent(s), (non-coronary vessel),
percutaneous; each additional vessel (List separately in addition to code for
primary procedure)
Transcatheter placement of an intravascular stent(s), (non-coronary vessel), open;
initial vessel
Transcatheter placement of an intravascular stent(s), (non-coronary vessel), open;
each additional vessel (List separately in addition to code for primary procedure)
Exchng prev placed iv cath thrombolytic ther
37210
37215
Uterine fibroid embolization perq w/rad gid
Tcat iv stent crv crtd art embolic protecj
2665.16
3812.78
37216
37250
Tcat iv stent crv crtd art w/o embolic protecj
Iv us non-c vsl dx eval&/ther ivntj 1st vsl
3498.17
408.08
37251
37500
Iv us non-c vsl dx eval&/ther ivntj ea vsl
Vasc ndsc seps
319.58
2240.80
37565
37600
Ligation, internal jugular vein
Ligation; external carotid artery
1462.50
1596.60
37605
Ligation; internal or common carotid artery
Ligation; internal or common carotid artery, with gradual occlusion, as with
Selverstone or Crutchfield clamp
Ligation or banding of angioaccess arteriovenous fistula
Ligation or biopsy, temporal artery
1402.20
37181
37202
37203
37204
37205
37206
37207
37208
37606
37607
37609
Extraordinary No.64/2013
114
5961.60
2214.84
973.80
917.10
2935.80
1905.30
867.60
2070.00
1061.10
408.31
1670.40
1293.30
689.40
Friday, 09 August 2013
37615
Ligation, major artery (eg, post-traumatic, rupture); neck
1608.30
37616
37617
Ligation, major artery (eg, post-traumatic, rupture); chest
Ligation, major artery (eg, post-traumatic, rupture); abdomen
2796.30
2619.00
37618
Ligation, major artery (eg, post-traumatic, rupture); extremity
Interruption, partial or complete, of inferior vena cava by suture, ligation, plication,
clip, extravascular, intravascular (umbrella device)
Ligation of femoral vein
Ligation of common iliac vein
Ligation and division of long saphenous vein at saphenofemoral junction, or distal
interruptions
Lig div&stripping short saphenous vein
1545.30
1208.89
37760
Lig div&strip long saph saphfem junct kne/belw
Ligation and division and complete stripping of long or short saphenous veins with
radical excision of ulcer and skin graft and/or interruption of communicating veins
of lower leg, with excision of deep fascia
Ligation of perforators, subfascial, radical (Linton type), with or without skin graft
37761
37765
Lig prfratr vein subfscal open incl us gid 1 leg
Stab phlebt varicose veins 1 xtr 10-20 stab incs
1390.71
1167.91
37766
Stab phlebt varicose veins 1 xtr > 20 incs
Ligation and division of short saphenous vein at saphenopopliteal junction
(separate procedure)
Ligation, division, and/or excision of recurrent or secondary varicose veins
(clusters), one leg
Pen revsc art +-vein grf
Pen ven occlusive px
1416.38
2660.40
2975.40
38115
Splenectomy; total (separate procedure)
Splenectomy; partial (separate procedure)
Splenectomy; total, en bloc for extensive disease, in conjunction with other
procedure (List in addition to code for primary procedure)
Repair of ruptured spleen (splenorrhaphy) with or without partial splenectomy
38120
38200
Laps surg splenc
Injection procedure for splenoportography
3954.23
351.00
38205
38206
Bld-drv hematop progen cell hrvg trnsplj algnc
Bld-drv hematop progen cell hrvg trnsplj autol
718.59
718.94
38207
38208
Trnspl prepj hematop progen cells cryoprsrv&strg
Trnspl prepj hematop progen thaw prev hrv
247.72
264.43
38209
38210
Trnspl prepj hematop progen thaw prev hrv washg
Trnspl prepj hematop progen deplj in hrv t-cell
229.55
266.46
38211
38212
Trnspl prepj hematop progen tum cell deplj
Trnspl prepj hematop progen red bld cell rmvl
264.72
258.62
37620
37650
37660
37700
37718
37722
37735
37780
37785
37788
37790
38100
38101
38102
Extraordinary No.64/2013
115
2597.40
1337.40
1606.50
998.10
1006.21
2844.00
2987.10
641.70
739.80
4092.33
1527.94
1835.10
2743.20
Friday, 09 August 2013
38213
Trnspl prepj hematop progen pltlt deplj
250.16
38214
38215
Trnspl prepj hematop progen plsm vol deplj
Trnspl prepj hematop progen concentration plsm
215.91
258.62
38220
38221
Marrow aspiration only
Marrow bx ndl/trocar
293.47
316.63
38230
38240
Bone marrow harvesting for transplantation
Marrow/bld-drv prph stem cell trnsplj allogeneic
1390.50
1089.69
38241
38242
Marrow/bld-drv prph stem cell trnsplj autol
Marrow/bld-drv prph stem cell trnsplj algc don
986.52
1082.79
38300
38305
Drainage of lymph node abscess or lymphadenitis; simple
Drainage of lymph node abscess or lymphadenitis; extensive
293.40
729.00
38308
38380
Lymphangiotomy or other operations on lymphatic channels
Suture and/or ligation of thoracic duct; cervical approach
884.70
1355.40
38381
38382
Suture and/or ligation of thoracic duct; thoracic approach
Suture and/or ligation of thoracic duct; abdominal approach
2421.00
2037.60
38500
Biopsy or excision of lymph node(s); open, superficial
Biopsy or excision of lymph node(s); by needle, superficial (eg, cervical, inguinal,
axillary)
Biopsy or excision of lymph node(s); open, deep cervical node(s)
Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision
scalene fat pad
Biopsy or excision of lymph node(s); open, deep axillary node(s)
Biopsy or excision of lymph node(s); open, internal mammary node(s)
587.77
1244.70
38700
38720
Dissection, deep jugular node(s)
Excision of cystic hygroma, axillary or cervical; without deep neurovascular
dissection
Excision of cystic hygroma, axillary or cervical; with deep neurovascular
dissection
Limited lymphadenectomy for staging (separate procedure); pelvic and para-aortic
Limited lymphadenectomy for staging (separate procedure); retroperitoneal (aortic
and/or splenic)
Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single
or multiple
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy
Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic
lymph node sampling (biopsy), single or multiple
Suprahyoid lymphadenectomy
Cervical lymphadenectomy (complete)
38724
38740
Cervical lymphadenectomy (modified radical neck dissection)
Axillary lymphadenectomy; superficial
3672.00
1797.30
38505
38510
38520
38525
38530
38542
38550
38555
38562
38564
38570
38571
38572
Extraordinary No.64/2013
116
399.60
850.50
918.90
1233.90
1210.50
1267.20
2374.20
2771.10
2665.80
2667.60
3213.90
3295.80
2449.80
3872.70
Friday, 09 August 2013
38745
Axillary lymphadenectomy; complete
Thoracic lymphadenectomy, regional, including mediastinal and peritracheal nodes
(List separately in addition to code for primary procedure)
Abdominal lymphadenectomy, regional, including celiac, gastric, portal,
peripancreatic, with or without para-aortic and vena caval nodes (List separately in
addition to code for primary procedure)
Inguinofemoral lymphadenectomy, superficial, including Cloquets node (separate
procedure)
Inguinofemoral lymphadenectomy, superficial, in continuity with pelvic
lymphadenectomy, including external iliac, hypogastric, and obturator nodes
(separate procedure)
Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator
nodes (separate procedure)
Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic,
aortic, and renal nodes (separate procedure)
Injection procedure; lymphangiography
Injection for identification of sentinel node
2779.20
1099.47
526.99
39200
Cannulation thrc dux
Intraop sentinel lymph id w/dye njx
Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy;
cervical approach
Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy;
transthoracic approach, including either transthoracic or median sternotomy
Excision of mediastinal cyst
39220
39400
Excision of mediastinal tumor
Mediastinoscopy, with or without biopsy
3410.10
1290.60
39501
2970.00
39560
39561
Repair, laceration of diaphragm, any approach
Repair, neonatal diaphragmatic hernia, with or without chest tube insertion and
with or without creation of ventral hernia
Repair, diaphragmatic hernia (other than neonatal), traumatic; acute
Repair, diaphragmatic hernia (other than neonatal), traumatic; chronic
Imbrication of diaphragm for eventration, transthoracic or transabdominal,
paralytic or nonparalytic
Rescj dphrm smpl rpr
Rescj dphrm cplx rpr
40490
40500
Biopsy of lip
Vermilionectomy (lip shave), with mucosal advancement
206.10
1545.30
40510
40520
Excision of lip; transverse wedge excision with primary closure
Excision of lip; V-excision with primary direct linear closure
1710.90
1390.50
40525
40527
Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan)
Excision of lip; full thickness, reconstruction with cross lip flap (Abbe-Estlander)
3300.30
3558.60
40530
Resection of lip, more than one-fourth, without reconstruction
1647.90
38746
38747
38760
38765
38770
38780
38790
38792
38794
38900
39000
39010
39503
39540
39541
39545
Extraordinary No.64/2013
117
846.00
1178.10
2240.10
3024.90
3276.00
4169.70
396.90
174.37
1619.10
2430.90
2801.70
3626.10
3577.50
3515.40
3464.10
3485.19
5241.89
Friday, 09 August 2013
40650
Repair lip, full thickness; vermilion only
1409.40
40652
40654
Repair lip, full thickness; up to half vertical height
Repair lip, full thickness; over one-half vertical height, or complex
1440.00
1681.20
40700
40701
Plastic repair of cleft lip/nasal deformity; primary, partial or complete, unilateral
Plastic repair of cleft lip/nasal deformity; primary bilateral, one stage procedure
2646.90
4107.60
40702
2590.20
40800
Plastic repair of cleft lip/nasal deformity; primary bilateral, one of two stages
Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and
reclosure
Plastic repair of cleft lip/nasal deformity; with cross lip pedicle flap (AbbeEstlander type), including sectioning and inserting of pedicle
Drainage of abscess, cyst, hematoma, vestibule of mouth; simple
40801
40804
Drainage of abscess, cyst, hematoma, vestibule of mouth; complicated
Removal of embedded foreign body, vestibule of mouth; simple
579.60
236.70
40805
40806
Removal of embedded foreign body, vestibule of mouth; complicated
Incision of labial frenum (frenotomy)
657.90
315.90
40808
40810
202.50
262.80
40830
Biopsy, vestibule of mouth
Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair
Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple
repair
Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex
repair
Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, with
excision of underlying muscle
Excision of mucosa of vestibule of mouth as donor graft
Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)
Destruction of lesion or scar of vestibule of mouth by physical methods (eg, laser,
thermal, cryo, chemical)
Closure of laceration, vestibule of mouth; 2.5 cm or less
40831
40840
Closure of laceration, vestibule of mouth; over 2.5 cm or complex
Vestibuloplasty; anterior
528.30
1712.70
40842
40843
Vestibuloplasty; posterior, unilateral
Vestibuloplasty; posterior, bilateral
1566.90
2436.30
40844
40845
Vestibuloplasty; entire arch
Vestibuloplasty; complex (including ridge extension, muscle repositioning)
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
mouth; lingual
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
mouth; sublingual, superficial
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
mouth; sublingual, deep, supramylohyoid
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
3133.80
3672.90
40720
40761
40812
40814
40816
40818
40819
40820
41000
41005
41006
41007
Extraordinary No.64/2013
118
2788.20
3038.40
201.60
398.70
870.30
1030.50
627.30
414.00
349.20
232.24
256.50
286.20
610.20
703.80
Friday, 09 August 2013
mouth; submental space
41019
41100
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
mouth; submandibular space
Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or floor of
mouth; masticator space
Incision of lingual frenum (frenotomy)
Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth;
sublingual
Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth;
submental
Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth;
submandibular
Extraoral incision and drainage of abscess, cyst, or hematoma of floor of mouth;
masticator space
Placement needle head/neck radioelement applicat
Biopsy of tongue; anterior two-thirds
41105
41108
Biopsy of tongue; posterior one-third
Biopsy of floor of mouth
309.60
239.40
41110
41112
Excision of lesion of tongue without closure
Excision of lesion of tongue with closure; anterior two-thirds
393.30
642.60
41113
41114
Excision of lesion of tongue with closure; posterior one-third
Excision of lesion of tongue with closure; with local tongue flap
954.00
2168.10
41115
41116
Excision of lingual frenum (frenectomy)
Excision, lesion of floor of mouth
426.60
715.50
41120
41130
Glossectomy; less than one-half tongue
Glossectomy; hemiglossectomy
1905.30
2204.10
41135
4789.80
41251
Glossectomy; partial, with unilateral radical neck dissection
Glossectomy; complete or total, with or without tracheostomy, without radical
neck dissection
Glossectomy; complete or total, with or without tracheostomy, with unilateral
radical neck dissection
Glossectomy; composite procedure with resection floor of mouth and mandibular
resection, without radical neck dissection
Glossectomy; composite procedure with resection floor of mouth, with suprahyoid
neck dissection
Glossectomy; composite procedure with resection floor of mouth, mandibular
resection, and radical neck dissection (Commando type)
Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of
tongue
Repair of laceration 2.5 cm or less; posterior one-third of tongue
41252
41500
Repair of laceration of tongue, floor of mouth, over 2.6 cm or complex
Fixation of tongue, mechanical, other than suture (eg, K-wire)
838.80
766.80
41008
41009
41010
41015
41016
41017
41018
41140
41145
41150
41153
41155
41250
Extraordinary No.64/2013
119
718.20
810.00
247.50
772.20
839.70
829.80
956.70
1028.05
261.00
4610.70
5366.70
4663.80
4880.70
6470.10
361.80
513.00
Friday, 09 August 2013
41510
Suture of tongue to lip for micrognathia (Douglas type procedure)
1354.50
41512
41520
Tongue base suspension permanent suture tq
Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
1094.85
647.10
41800
41805
Drainage of abscess, cyst, hematoma from dentoalveolar structures
Removal of embedded foreign body from dentoalveolar structures; soft tissues
229.50
298.80
41806
41820
Removal of embedded foreign body from dentoalveolar structures; bone
Gingivectomy, excision gingiva, each quadrant
493.20
622.80
41822
41823
429.30
705.60
41828
41830
Excision of fibrous tuberosities, dentoalveolar structures
Excision of osseous tuberosities, dentoalveolar structures
Excision of lesion or tumor (except listed above), dentoalveolar structures; without
repair
Excision of lesion or tumor (except listed above), dentoalveolar structures; with
simple repair
Excision of lesion or tumor (except listed above), dentoalveolar structures; with
complex repair
Excision of hyperplastic alveolar mucosa, each quadrant (specify)
Alveolectomy, including curettage of osteitis or sequestrectomy
41850
41870
Destruction of lesion (except excision), dentoalveolar structures
Periodontal mucosal grafting
180.00
726.30
41872
41874
Gingivoplasty, each quadrant (specify)
Alveoloplasty, each quadrant (specify)
669.60
756.90
42000
42100
Drainage of abscess of palate, uvula
Biopsy of palate, uvula
236.70
273.60
42104
42106
Excision, lesion of palate, uvula; without closure
Excision, lesion of palate, uvula; with simple primary closure
478.80
618.30
42107
42120
Excision, lesion of palate, uvula; with local flap closure
Resection of palate or extensive resection of lesion
1787.40
2958.30
42140
42145
Uvulectomy, excision of uvula
Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty)
470.70
2509.20
42160
42180
Destruction of lesion, palate or uvula (thermal, cryo or chemical)
Repair, laceration of palate; up to 2 cm
448.20
416.96
42182
42200
Repair, laceration of palate; over 2 cm or complex
Palatoplasty for cleft palate, soft and/or hard palate only
825.30
2801.70
42205
3186.00
42215
42220
Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only
Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to
alveolar ridge (includes obtaining graft)
Palatoplasty for cleft palate; major revision
Palatoplasty for cleft palate; secondary lengthening procedure
42225
Palatoplasty for cleft palate; attachment pharyngeal flap
2811.60
41825
41826
41827
42210
Extraordinary No.64/2013
120
369.00
546.30
849.60
726.30
849.60
4377.60
2664.90
2497.50
Friday, 09 August 2013
42226
Lengthening of palate, and pharyngeal flap
3475.80
42227
42235
Lengthening of palate, with island flap
Repair of anterior palate, including vomer flap
2935.80
2310.30
42260
42280
Repair of nasolabial fistula
Maxillary impression for palatal prosthesis
1653.30
309.60
42281
42300
Insertion of pin-retained palatal prosthesis
Drainage of abscess; parotid, simple
355.50
324.90
42305
42310
Drainage of abscess; parotid, complicated
Drainage of abscess; submaxillary or sublingual, intraoral
806.40
360.90
42320
597.60
42335
42340
Drainage of abscess; submaxillary, external
Sialolithotomy; submandibular (submaxillary), sublingual or parotid,
uncomplicated, intraoral
Sialolithotomy; submandibular (submaxillary), complicated, intraoral
Sialolithotomy; parotid, extraoral or complicated intraoral
42400
42405
Biopsy of salivary gland; needle
Biopsy of salivary gland; incisional
250.20
578.70
42408
42409
Excision of sublingual salivary cyst (ranula)
Marsupialization of sublingual salivary cyst (ranula)
1061.10
772.20
42410
2012.40
42440
42450
Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection
Excision of parotid tumor or parotid gland; lateral lobe, with dissection and
preservation of facial nerve
Excision of parotid tumor or parotid gland; total, with dissection and preservation
of facial nerve
Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of
facial nerve
Excision of parotid tumor or parotid gland; total, with unilateral radical neck
dissection
Excision of submandibular (submaxillary) gland
Excision of sublingual gland
42500
42505
Plastic repair of salivary duct, sialodochoplasty; primary or simple
Plastic repair of salivary duct, sialodochoplasty; secondary or complicated
1374.30
1757.70
42507
2302.20
42550
Parotid duct diversion, bilateral (Wilke type procedure);
Parotid duct diversion, bilateral (Wilke type procedure); with excision of one
submandibular gland
Parotid duct diversion, bilateral (Wilke type procedure); with excision of both
submandibular glands
Parotid duct diversion, bilateral (Wilke type procedure); with ligation of both
submandibular (Wharton's) ducts
Injection procedure for sialography
42600
Closure salivary fistula
1476.00
42330
42415
42420
42425
42426
42508
42509
42510
Extraordinary No.64/2013
121
415.95
789.30
1092.60
3630.60
4627.80
3363.30
6180.30
2312.10
1911.60
2601.00
3194.10
2726.10
193.50
Friday, 09 August 2013
42650
Dilation salivary duct
143.10
42660
42665
Dilation and catheterization of salivary duct, with or without injection
Ligation salivary duct, intraoral
215.10
456.30
42700
318.60
42800
Incision and drainage abscess; peritonsillar
Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral
approach
Incision and drainage abscess; retropharyngeal or parapharyngeal, external
approach
Biopsy; oropharynx
42802
42804
Biopsy; hypopharynx
Biopsy; nasopharynx, visible lesion, simple
342.90
308.70
42806
42808
Biopsy; nasopharynx, survey for unknown primary lesion
Excision or destruction of lesion of pharynx, any method
373.50
592.20
42809
42810
312.30
878.40
42820
42821
Removal of foreign body from pharynx
Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues
Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous
tissues and/or into pharynx
Tonsillectomy and adenoidectomy; under age 12
Tonsillectomy and adenoidectomy; age 12 or over
42825
42826
Tonsillectomy, primary or secondary; under age 12
Tonsillectomy, primary or secondary; age 12 or over
820.80
841.50
42830
42831
Adenoidectomy, primary; under age 12
Adenoidectomy, primary; age 12 or over
581.64
675.00
42835
42836
Adenoidectomy, secondary; under age 12
Adenoidectomy, secondary; age 12 or over
Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without
closure
Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with
local flap (eg, tongue, buccal)
Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; closure with
other flap
Excision of tonsil tags
536.40
669.60
844.20
2689.20
42894
42900
Excision or destruction lingual tonsil, any method (separate procedure)
Limited pharyngectomy
Resection of lateral pharyngeal wall or pyriform sinus, direct closure by
advancement of lateral and posterior pharyngeal walls
Resection of pharyngeal wall requiring closure with myocutaneous flap
Suture pharynx for wound or injury
42950
42953
Pharyngoplasty (plastic or reconstructive operation on pharynx)
Pharyngoesophageal repair
1989.90
2523.60
42720
42725
42815
42842
42844
42845
42860
42870
42890
42892
Extraordinary No.64/2013
122
688.50
1467.00
250.20
1880.10
816.61
1031.40
2421.00
3346.20
4507.20
570.60
3450.60
4776.30
977.40
Friday, 09 August 2013
42955
1579.50
43020
43030
Pharyngostomy (fistulization of pharynx, external for feeding)
Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy);
simple
Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy);
complicated, requiring hospitalization
Control oropharyngeal hemorrhage, primary or secondary (eg, post-tonsillectomy);
with secondary surgical intervention
Control of nasopharyngeal hemorrhage, primary or secondary (eg,
postadenoidectomy); simple, with posterior nasal packs, with or without anterior
packs and/or cauterization
Control of nasopharyngeal hemorrhage, primary or secondary (eg,
postadenoidectomy); complicated, requiring hospitalization
Control of nasopharyngeal hemorrhage, primary or secondary (eg,
postadenoidectomy); with secondary surgical intervention
Esophagotomy, cervical approach, with removal of foreign body
Cricopharyngeal myotomy
43045
43100
Esophagotomy, thoracic approach, with removal of foreign body
Excision of lesion, esophagus, with primary repair; cervical approach
3352.50
2568.60
43101
Excision of lesion, esophagus, with primary repair; thoracic or abdominal approach
Total or near total esophagectomy, without thoracotomy; with
pharyngogastrostomy or cervical esophagogastrostomy, with or without
pyloroplasty (transhiatal)
Total or near total esophagectomy, without thoracotomy; with colon interposition
or small bowel reconstruction, including bowel mobilization, preparation and
anastomosis(es)
Total or near total esophagectomy, with thoracotomy; with pharyngogastrostomy
or cervical esophagogastrostomy, with or without pyloroplasty
Tot esphg w/thorcom w/colon ntrpstj/int rcnstj
Prtl esphg crv w/fr intstinal grf
Partial esophagectomy, distal two-thirds, with thoracotomy and separate abdominal
incision, with or without proximal gastrectomy; with thoracic
esophagogastrostomy, with or without pyloroplasty (Ivor Lewis)
Prtl esphg dstl thorcom abdl inc ntrpstj/rcnstj
Partial esophagectomy, distal two-thirds, with thoracotomy only, with or without
proximal gastrectomy, with thoracic esophagogastrostomy, with or without
pyloroplasty
Partial esophagectomy, thoracoabdominal or abdominal approach, with or without
proximal gastrectomy; with esophagogastrostomy, with or without pyloroplasty
Partial esophagectomy, thoracoabdominal or abdominal approach, with or without
proximal gastrectomy; with colon interposition or small bowel reconstruction,
including bowel mobilization, preparation, and anastomosis(es)
Tot/prtl esphg w/o rcnstj w/crv esophagostomy
Diverticulectomy of hypopharynx or esophagus, with or without myotomy;
cervical approach
3299.40
42960
42961
42962
42970
42971
42972
43107
43108
43112
43113
43116
43117
43118
43121
43122
43123
43124
43130
Extraordinary No.64/2013
123
366.30
600.30
947.70
629.10
945.00
1179.00
1996.20
2510.10
5637.60
6282.90
6437.70
5426.85
6171.24
6574.50
5531.39
6251.40
5902.20
6437.70
4452.63
2642.40
Friday, 09 August 2013
43201
Diverticulectomy of hypopharynx or esophagus, with or without myotomy;
thoracic approach
Esophagoscopy, rigid or flexible; diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
Esphgsc rgd/flx dired sbmcsl njx any sbst
43202
43204
Esophagoscopy, rigid or flexible; with biopsy, single or multiple
Esophagoscopy, rigid or flexible; with injection sclerosis of esophageal varices
654.30
973.80
43205
43215
Esophagoscopy, rigid or flexible; with band ligation of esophageal varices
Esophagoscopy, rigid or flexible; with removal of foreign body
Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other
lesion(s) by hot biopsy forceps or bipolar cautery
Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other
lesion(s) by snare technique
Esophagoscopy, rigid or flexible; with insertion of plastic tube or stent
978.30
832.50
Esophagoscopy, rigid or flexible; with balloon dilation (less than 30 mm diameter)
Esophagoscopy, rigid or flexible; with insertion of guide wire followed by dilation
over guide wire
Esophagoscopy, rigid or flexible; with control of bleeding, any method
Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or other
lesion(s), not amenable to removal by hot biopsy forceps, bipolar cautery or snare
technique
Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination
Esophagoscopy, rigid or flexible; with transendoscopic ultrasound-guided
intramural or transmural fine needle aspiration/biopsy(s)
Upper gastrointestinal endoscopy, simple primary examination (eg, with small
diameter flexible endoscope) (separate procedure)
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; diagnostic, with or without collection of
specimen(s) by brushing or washing (separate procedure)
Stomach-intestine scope inject intestine wall
Upr gi ndsc ndsc us xm lmtd esoph
760.50
Upr gi ndsc tndsc us fine ndl aspir/bx esoph
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with biopsy, single or multiple
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with transmural drainage of pseudocyst
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with transendoscopic intraluminal tube
or catheter placement
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with transendoscopic ultrasound-guided
intramural or transmural fine needle aspiration/biopsy(s)
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with injection sclerosis of esophageal
712.37
43135
43200
43216
43217
43219
43220
43226
43227
43228
43231
43232
43234
43235
43236
43237
43238
43239
43240
43241
43242
43243
Extraordinary No.64/2013
124
3141.90
567.90
754.53
839.70
929.70
1022.40
681.30
1059.30
1025.10
762.30
782.57
618.30
575.48
833.87
605.29
645.72
1233.90
972.00
968.40
953.10
Friday, 09 August 2013
and/or gastric varices
43244
43245
43246
43247
43248
43249
43250
43251
43255
43256
43257
43258
43259
43260
43261
43262
43263
43264
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with band ligation of esophageal and/or
gastric varices
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with dilation of gastric outlet for
obstruction, any method
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with directed placement of percutaneous
gastrostomy tube
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with removal of foreign body
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with insertion of guide wire followed by
dilation of esophagus over guide wire
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with balloon dilation of esophagus (less
than 30 mm diameter)
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or
other lesion(s) by hot biopsy forceps or bipolar cautery
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with removal of tumor(s), polyp(s), or
other lesion(s) by snare technique
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with control of bleeding, any method
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with transendoscopic stent placement
(includes predilation)
Upr gi ndsc dlvr thermal nrg sphnctr/cardia
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with ablation of tumor(s), polyp(s), or
other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or
snare technique
Upper gastrointestinal endoscopy including esophagus, stomach, and either the
duodenum and/or jejunum as appropriate; with endoscopic ultrasound examination
Endoscopic retrograde cholangio-pancreatography (ERCP); diagnostic, with or
without collection of specimen(s) by brushing or washing (separate procedure)
Endoscopic retrograde cholangio-pancreatography (ERCP); with biopsy, single or
multiple
Endoscopic retrograde cholangio-pancreatography (ERCP); with
sphincterotomy/papillotomy
Endoscopic retrograde cholangio-pancreatography (ERCP); with pressure
measurement of sphincter of Oddi (pancreatic duct or common bile duct)
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde removal of stone(s) from biliary and/or pancreatic ducts
Extraordinary No.64/2013
125
978.30
822.60
1133.10
828.90
733.50
747.00
972.00
953.10
992.70
762.30
1070.28
929.70
844.20
1159.20
1349.10
1642.50
1542.60
1781.10
Friday, 09 August 2013
43265
43267
43268
43269
43271
43272
43273
43279
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde destruction, lithotripsy of stone(s), any method
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde insertion of nasobiliary or nasopancreatic drainage tube
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde insertion of tube or stent into bile or pancreatic duct
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde removal of foreign body and/or change of tube or stent
Endoscopic retrograde cholangio-pancreatography (ERCP); with endoscopic
retrograde balloon dilation of ampulla, biliary and/or pancreatic duct(s)
Endoscopic retrograde cholangio-pancreatography (ERCP); with ablation of
tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy
forceps, bipolar cautery or snare technique
Endoscopic papilla cannulation bile pancreatic
1833.30
1494.00
1681.20
1462.50
1741.50
1364.40
320.58
Laps esophagomyotomy w/fundoplasty if performed
Laparoscopy, surgical, esophagogastric fundoplasty (eg, Nissen, Toupet
procedures)
Laps rpr paraesphgl hrna incl fundplsty w/o mesh
Laps rpr paraesphgl hrna incl fundplsty w/mesh
2872.69
405.69
43325
43327
Laps esophageal lengthening addl
Esophagoplasty, (plastic repair or reconstruction), cervical approach; without
repair of tracheoesophageal fistula
Esophagoplasty, (plastic repair or reconstruction), cervical approach; with repair of
tracheoesophageal fistula
Esophagoplasty, (plastic repair or reconstruction), thoracic approach; without
repair of tracheoesophageal fistula
Esophagoplasty, (plastic repair or reconstruction), thoracic approach; with repair of
tracheoesophageal fistula
Esphgp cgen dfct thrc appr w/o rpr fstl
Esphgp cgen dfct thrc appr w/rpr fstl
Esophagogastrostomy (cardioplasty), with or without vagotomy and pyloroplasty,
transabdominal or transthoracic approach
Esophagogastric fundoplasty; with fundic patch (Thal-Nissen procedure)
Esopg/gstr fundoplasty w/lapt
43328
43330
Esopg/gstr fundoplasty w/thorcom
Esophagomyotomy (Heller type); abdominal approach
2706.08
2917.80
43331
43332
Esophagomyotomy (Heller type); thoracic approach
Rpr paraesoph hiatal hernia w/lapt w/o mesh
3198.60
2635.13
43333
43334
Lapt rpr paraesoph hiatal hernia w/ mesh
Rpr paraesoph hiatal hernia w/thorcom w/o mesh
2873.14
2906.96
43335
43336
Rpr paraesoph hiatal hernia w/thorcom w/mesh
Rpr paraesoph hiatal hernia thorcoabdom w/o mesh
3144.71
3422.52
43280
43281
43282
43283
43300
43305
43310
43312
43313
43314
43320
Extraordinary No.64/2013
126
3501.90
3859.31
4088.80
3110.40
3627.90
4030.20
4640.40
5873.36
6478.08
3590.10
3429.90
1847.23
Friday, 09 August 2013
43337
Rpr paraesoph hiatal hernia thorcoabdom w/mesh
3761.84
43338
43340
Esophagus lengthening
Esophagojejunostomy (without total gastrectomy); abdominal approach
307.64
3551.40
43341
43350
Esophagojejunostomy (without total gastrectomy); thoracic approach
Esophagostomy, fistulization of esophagus, external; abdominal approach
4228.20
2381.40
43351
43352
2477.70
2368.80
43410
Esophagostomy, fistulization of esophagus, external; thoracic approach
Esophagostomy, fistulization of esophagus, external; cervical approach
Gastrointestinal reconstruction for previous esophagectomy, for obstructing
esophageal lesion or fistula, or for previous esophageal exclusion; with stomach,
with or without pyloroplasty
Gastrointestinal reconstruction for previous esophagectomy, for obstructing
esophageal lesion or fistula, or for previous esophageal exclusion; with colon
interposition or small bowel reconstruction, including bowel mobilization,
preparation, and anastomo
Ligation, direct, esophageal varices
Transection of esophagus with repair, for esophageal varices
Ligation or stapling at gastroesophageal junction for pre-existing esophageal
perforation
Suture of esophageal wound or injury; cervical approach
43415
43420
Suture of esophageal wound or injury; transthoracic or transabdominal approach
Closure of esophagostomy or fistula; cervical approach
3114.00
1954.80
43425
43450
Closure of esophagostomy or fistula; transthoracic or transabdominal approach
Dilation of esophagus, by unguided sound or bougie, single or multiple passes
3115.80
285.30
43453
43456
Dilation of esophagus, over guide wire
Dilation of esophagus, by balloon or dilator, retrograde
414.90
739.80
43458
43460
Dilation of esophagus with balloon (30 mm diameter or larger) for achalasia
Esophagogastric tamponade, with balloon (Sengstaaken type)
520.20
697.50
43500
43501
1981.80
2765.70
43520
Gastrotomy; with exploration or foreign body removal
Gastrotomy; with suture repair of bleeding ulcer
Gastrotomy; with suture repair of pre-existing esophagogastric laceration (eg,
Mallory-Weiss)
Gastrotomy; with esophageal dilation and insertion of permanent intraluminal tube
(eg, Celestin or Mousseaux-Barbin)
Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation)
43605
43610
Biopsy of stomach; by laparotomy
Excision, local; ulcer or benign tumor of stomach
1977.30
2572.20
43611
43620
Excision, local; malignant tumor of stomach
Gastrectomy, total; with esophagoenterostomy
2837.70
4644.90
43621
43622
Gastrectomy, total; with Roux-en-Y reconstruction
Gastrectomy, total; with formation of intestinal pouch, any type
4995.90
5047.20
43360
43361
43400
43401
43405
43502
43510
Extraordinary No.64/2013
127
5664.60
6695.10
3172.50
3348.00
3349.80
2574.90
2601.00
2067.30
1850.40
Friday, 09 August 2013
43631
Gastrectomy, partial, distal; with gastroduodenostomy
3541.50
43632
43633
Gastrectomy, partial, distal; with gastrojejunostomy
Gastrectomy, partial, distal; with Roux-en-Y reconstruction
3864.60
3953.70
43634
4851.90
43644
43645
Gastrectomy, partial, distal; with formation of intestinal pouch
Vagotomy when performed with partial distal gastrectomy (List separately in
addition to code(s) for primary procedure)
Vagotomy including pyloroplasty, with or without gastrostomy; truncal or selective
Vagotomy including pyloroplasty, with or without gastrostomy; parietal cell
(highly selective)
Laps gstr rstcv px w/byp roux-en-y <150 cm
Laps gstr rstcv px w/byp&sm int rcnstj
43651
43652
Laps surg trnsxj vagus nrv truncal
Laps surg trnsxj vagus nrv slctv/hily slctv
2584.61
2984.62
43653
43752
Laps surg gastrostomy w/o constj gstr tube spx
Naso/oro-gastric tube plmt req phys&fluor gdn
1909.82
87.45
43753
43760
51.44
192.60
43770
43771
Gastric tube plmt w/aspir & lavage
Change of gastrostomy tube
Repositioning of the gastric feeding tube, any method, through the duodenum for
enteric nutrition
Laps gastric restrictive procedure place device
Laps gastric restrictive px revision device
43772
43773
Laps gastric restrictive px remove device
Laps gastric restrictive px remove&rplcmt device
2562.77
3259.75
43774
43775
Laps gastric restrictive px remove device &port
Laps gstrc rstrictiv px longitudinal gastrectomy
2594.55
3427.22
43800
43810
Pyloroplasty
Gastroduodenostomy
2172.60
2296.80
43820
43825
Gastrojejunostomy; without vagotomy
Gastrojejunostomy; with vagotomy, any type
Gastrostomy, open; without construction of gastric tube (eg, Stamm procedure)
(separate procedure)
Gastrostomy, open; neonatal, for feeding
2688.30
3096.00
Gastrostomy, open; with construction of gastric tube (eg, Janeway procedure)
Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or injury
Gastric restrictive procedure, without gastric bypass, for morbid obesity; verticalbanded gastroplasty
Gastric restrictive procedure, without gastric bypass, for morbid obesity; other than
vertical-banded gastroplasty
Gstr rstcv w/prtl gstrct 50-100 cm
2553.30
2344.50
43635
43640
43641
43761
43830
43831
43832
43840
43842
43843
43845
Extraordinary No.64/2013
128
1287.90
3064.50
2904.30
5644.84
6078.45
320.40
3192.15
2947.87
1784.70
1642.50
3656.70
3605.40
5446.89
Friday, 09 August 2013
43870
Gastric restrictive procedure, with gastric bypass for morbid obesity; with short
limb (less than 100 cm) Roux-en-Y gastroenterostomy
Gstr rstcv w/byp w/sm int rcnstj limit absrpj
Revision open gastric restrictive px not device
Revision of gastroduodenal anastomosis (gastroduodenostomy) with
reconstruction; without vagotomy
Revision of gastroduodenal anastomosis (gastroduodenostomy) with
reconstruction; with vagotomy
Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction,
with or without partial gastrectomy or bowel resection; without vagotomy
Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction,
with or without partial gastrectomy or bowel resection; with vagotomy
Closure of gastrostomy, surgical
43880
43886
Closure of gastrocolic fistula
Gstr rstcv px opn revj subq port component only
3295.80
925.03
43887
43888
Gstr rstcv px opn rmvl subq port component only
Gstr rstcv opn rmvl&rplcmt subq port
886.07
1353.63
44005
44010
2305.69
2306.70
44125
Enterolysis (freeing of intestinal adhesion) (separate procedure)
Duodenotomy, for exploration, biopsy(s), or foreign body removal
Tube or needle catheter jejunostomy for enteral alimentation, intraoperative, any
method (List separately in addition to primary procedure)
Enterotomy, small bowel, other than duodenum; for exploration, biopsy(s), or
foreign body removal
Enterotomy, small bowel, other than duodenum; for decompression (eg, Baker
tube)
Colotomy, for exploration, biopsy(s), or foreign body removal
Reduction of volvulus, intussusception, internal hernia, by laparotomy
Correction of malrotation by lysis of duodenal bands and/or reduction of midgut
volvulus (eg, Ladd procedure)
Biopsy of intestine by capsule, tube, peroral (one or more specimens)
Excision of one or more lesions of small or large bowel not requiring anastomosis,
exteriorization, or fistulization; single enterotomy
Excision of one or more lesions of small or large bowel not requiring anastomosis,
exteriorization, or fistulization; multiple enterotomies
Enterectomy, resection of small intestine; single resection and anastomosis
Enterectomy, resection of small intestine; each additional resection and
anastomosis (List separately in addition to code for primary procedure)
Enterectomy, resection of small intestine; with enterostomy
44126
44127
Entrc rescj atresia rescj&anast w/o tapring
Entrc rescj atresia rescj&anast sgm w/tapring
5370.66
5598.46
44128
44130
Entrc rescj atresia ea rescj&anast
Enteroenterostomy, anastomosis of intestine, with or without cutaneous
1016.67
2694.60
43846
43847
43848
43850
43855
43860
43865
44015
44020
44021
44025
44050
44055
44100
44110
44111
44120
44121
Extraordinary No.64/2013
129
4532.40
5096.43
5284.93
4078.80
4171.50
4131.90
3879.90
1687.50
1448.10
2232.00
2319.30
2389.50
2321.10
2601.00
485.10
2351.70
3157.20
2880.00
918.90
3114.00
Friday, 09 August 2013
enterostomy (separate procedure)
44139
44140
44141
Mobilization (take-down) of splenic flexure performed in conjunction with partial
colectomy (List separately in addition to primary procedure)
Colectomy, partial; with anastomosis
514.80
3340.80
3333.65
44151
44155
Colectomy, partial; with skin level cecostomy or colostomy
Colectomy, partial; with end colostomy and closure of distal segment (Hartmann
type procedure)
Colectomy, partial; with resection, with colostomy or ileostomy and creation of
mucofistula
Colectomy, partial; with coloproctostomy (low pelvic anastomosis)
Colectomy, partial; with coloproctostomy (low pelvic anastomosis), with
colostomy
Colectomy, partial; abdominal and transanal approach
Colectomy, total, abdominal, without proctectomy; with ileostomy or
ileoproctostomy
Colectomy, total, abdominal, without proctectomy; with continent ileostomy
Colectomy, total, abdominal, with proctectomy; with ileostomy
44156
44157
Colectomy, total, abdominal, with proctectomy; with continent ileostomy
Colct ttl abd w/prctect ileoanal anast
5768.10
4865.79
44158
44160
Colct ttl abd w/prctect ileoanal anast & rsvr
Colectomy with removal of terminal ileum and ileocolostomy
5014.80
4014.90
44180
44186
Laps enterolss fring intstinal adhesion spx
Laps jejunostomy
1859.50
1441.07
44187
44188
2229.44
2477.27
44203
Laps ileost/jejunostomy non-tube
Laps clst/skn lvl cecostomy
Laparoscopy, surgical; intestinal resection, with anastomosis (intra or
extracorporeal)
Laps ea sm int rescj&anast
44204
44205
Laps colct prtl w/anast
Laps colct prtl w/rmvl terminal ile
3237.04
3053.39
44206
44207
Laps colct prtl w/end clst&clsr dstl sgm
Laps colct prtl w/colopxtstmy lw anast
3562.31
3989.43
44208
44210
Laps colct prtl w/colopxtstmy lw anast w/clst
Laps colct tot w/o prctect w/ileost/ileopxts
4162.98
3925.87
44211
44212
Laps colct ttl abd w/prctect ileoanal anast&rsvr
Laps colct abdl w/prctect w/ileost
5320.26
4588.99
44213
44227
Laps moblj splenic flxr pfrmd w/prtl colct
Laps clsr ntrstm lg/sm int w/rescj&anast
Enterostomy or cecostomy, tube (eg, for decompression or feeding) (separate
procedure)
455.45
3432.69
44143
44144
44145
44146
44147
44150
44202
44300
Extraordinary No.64/2013
130
3331.80
3348.00
3887.10
4293.90
4626.90
4718.70
5408.10
5751.90
4013.10
742.32
2121.30
Friday, 09 August 2013
44310
Ileostomy or jejunostomy, non-tube (separate procedure)
2271.60
44312
44314
Revision of ileostomy; simple (release of superficial scar) (separate procedure)
Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure)
1269.00
2343.60
44316
44320
Continent ileostomy (Kock procedure) (separate procedure)
Colostomy or skin level cecostomy; (separate procedure)
Colostomy or skin level cecostomy; with multiple biopsies (eg, for Hirschsprung
disease) (separate procedure)
Revision of colostomy; simple (release of superficial scar) (separate procedure)
3295.80
2201.40
Revision of colostomy; complicated (reconstruction in-depth) (separate procedure)
Revision of colostomy; with repair of paracolostomy hernia (separate procedure)
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; diagnostic, with or without collection of specimen(s) by brushing
or washing (separate procedure)
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with biopsy, single or multiple
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with removal of foreign body
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by snare
technique
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with removal of tumor(s), polyp(s), or other lesion(s) by hot
biopsy forceps or bipolar cautery
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with control of bleeding, any method
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with ablation of tumor(s), polyp(s), or other lesion(s) not
amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with transendoscopic stent placement (includes predilation)
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with placement of percutaneous jejunostomy tube
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; with conversion of percutaneous gastrostomy tube to
percutaneous jejunostomy tube
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum,
including ileum; diagnostic, with or without collection of specimen(s) by brushing
or washing (separate procedure)
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum,
including ileum; with biopsy, single or multiple
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum,
including ileum; with control of bleeding, any method
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum,
including ileum; with transendoscopic stent placement (includes predilation)
Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by
2093.40
2365.20
44322
44340
44345
44346
44360
44361
44363
44364
44365
44366
44369
44370
44372
44373
44376
44377
44378
44379
44380
Extraordinary No.64/2013
131
2568.60
918.00
864.90
863.10
804.60
978.30
978.30
1076.40
1133.10
760.50
1199.70
904.50
1007.10
1061.10
1359.90
1137.60
546.30
Friday, 09 August 2013
brushing or washing (separate procedure)
44382
44383
Ileoscopy, through stoma; with biopsy, single or multiple
Ilesc thru stoma w/tndsc stent plmt
Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; diagnostic,
with or without collection of specimen(s) by brushing or washing (separate
procedure)
Endoscopic evaluation of small intestinal (abdominal or pelvic) pouch; with
biopsy, single or multiple
Colonoscopy through stoma; diagnostic, with or without collection of specimen(s)
by brushing or washing (separate procedure)
Colonoscopy through stoma; with biopsy, single or multiple
Colonoscopy through stoma; with removal of foreign body
681.30
917.99
1166.40
44640
Colonoscopy through stoma; with control of bleeding, any method
Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s)
by hot biopsy forceps or bipolar cautery
Colonoscopy through stoma; with ablation of tumor(s), polyp(s), or other lesion(s)
not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s)
by snare technique
Colonoscopy through stoma; with transendoscopic stent placement (includes
predilation)
Introduction of long gastrointestinal tube (eg, Miller-Abbott) (separate procedure)
Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture; single perforation
Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture; multiple perforations
Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture (single or multiple perforations); without colostomy
Suture of large intestine (colorrhaphy) for perforated ulcer, diverticulum, wound,
injury or rupture (single or multiple perforations); with colostomy
Intestinal stricturoplasty (enterotomy and enterorrhaphy) with or without dilation,
for intestinal obstruction
Closure of enterostomy, large or small intestine;
Closure of enterostomy, large or small intestine; with resection and anastomosis
other than colorectal
Closure of enterostomy, large or small intestine; with resection and colorectal
anastomosis (eg, closure of Hartmann type procedure)
Closure of intestinal cutaneous fistula
44650
44660
Closure of enteroenteric or enterocolic fistula
Closure of enterovesical fistula; without intestinal or bladder resection
3090.60
2729.70
44661
44680
Closure of enterovesical fistula; with bowel and/or bladder resection
Intestinal plication (separate procedure)
Exclusion of small bowel from pelvis by mesh or other prosthesis, or native tissue
(eg, bladder or omentum)
3927.60
2871.90
44385
44386
44388
44389
44390
44391
44392
44393
44394
44397
44500
44602
44603
44604
44605
44615
44620
44625
44626
44700
Extraordinary No.64/2013
132
715.50
741.60
739.80
796.50
841.50
1255.50
1321.20
1102.50
596.70
123.30
2248.20
2656.80
2258.45
2991.60
2626.20
1713.65
3033.90
3744.90
2372.40
2709.90
Friday, 09 August 2013
44701
Intraop colonic lvg
305.32
44800
44820
Excision of Meckel's diverticulum (diverticulectomy) or omphalomesenteric duct
Excision of lesion of mesentery (separate procedure)
1913.40
2034.00
44850
44900
Suture of mesentery (separate procedure)
Incision and drainage of appendiceal abscess; open
1802.70
1545.30
44901
44950
628.20
1537.19
44960
Incision and drainage of appendiceal abscess; percutaneous
Appendectomy;
Appendectomy; when done for indicated purpose at time of other major procedure
(not as separate procedure) (List separately in addition to code for primary
procedure)
Appendectomy; for ruptured appendix with abscess or generalized peritonitis
44970
45000
Laparoscopy, surgical, appendectomy
Transrectal drainage of pelvic abscess
2130.30
953.10
45005
45020
Incision and drainage of submucosal abscess, rectum
Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess
522.90
893.70
45100
45108
Biopsy of anorectal wall, anal approach (eg, congenital megacolon)
Anorectal myomectomy
767.70
1184.40
45110
45111
Proctectomy; complete, combined abdominoperineal, with colostomy
Proctectomy; partial resection of rectum, transabdominal approach
Proctectomy, combined abdominoperineal, pull-through procedure (eg, colo-anal
anastomosis)
Prctect prtl w/mucosec ileoanal anast rsvr
Proctectomy, partial, with anastomosis; abdominal and transsacral approach
4392.90
3498.30
3295.80
45130
Proctectomy, partial, with anastomosis; transsacral approach only (Kraske type)
Proctectomy, combined abdominoperineal pull-through procedure (eg, colo-anal
anastomosis), with creation of colonic reservoir (eg, J-pouch), with or without
proximal diverting ostomy
Proctectomy, complete (for congenital megacolon), abdominal and perineal
approach; with pull-through procedure and anastomosis (eg, Swenson, Duhamel, or
Soave type operation)
Proctectomy, complete (for congenital megacolon), abdominal and perineal
approach; with subtotal or total colectomy, with multiple biopsies
Proctectomy, partial, without anastomosis, perineal approach
Pelvic exenteration for colorectal malignancy, with proctectomy (with or without
colostomy), with removal of bladder and ureteral transplantations, and/or
hysterectomy, or cervicectomy, with or without removal of tube(s), with or without
removal of ovary(
Excision of rectal procidentia, with anastomosis; perineal approach
45135
45136
Excision of rectal procidentia, with anastomosis; abdominal and perineal approach
Exc ileoanal rsvr w/ileost
4033.80
4548.02
45150
Division of stricture of rectum
1278.00
44955
45112
45113
45114
45116
45119
45120
45121
45123
45126
Extraordinary No.64/2013
133
1133.10
2357.10
4645.80
4837.19
4489.20
4377.60
4650.30
4738.50
3149.10
6470.10
2864.70
Friday, 09 August 2013
45160
Excision of rectal tumor by proctotomy, transsacral or transcoccygeal approach
2827.80
45171
45172
Exc rct tum not incl muscularis propria
Exc rct tum incl muscularis propria
1349.29
1853.35
45190
Destruction of rectal tumor, any method (eg, electrodesiccation) transanal approach
Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s)
by brushing or washing (separate procedure)
Proctosigmoidoscopy, rigid; with dilation, any method
Proctosigmoidoscopy, rigid; with biopsy, single or multiple
1441.80
Proctosigmoidoscopy, rigid; with removal of foreign body
Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion
by hot biopsy forceps or bipolar cautery
Proctosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion
by snare technique
Proctosigmoidoscopy, rigid; with removal of multiple tumors, polyps, or other
lesions by hot biopsy forceps, bipolar cautery or snare technique
Proctosigmoidoscopy, rigid; with control of bleeding, any method
Proctosigmoidoscopy, rigid; with ablation of tumor(s), polyp(s), or other lesion(s)
not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
(eg, laser)
Proctosigmoidoscopy, rigid; with decompression of volvulus
Proctosgmdsc rgd tndsc stent plmt
Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure)
Sigmoidoscopy, flexible; with biopsy, single or multiple
386.10
Sigmoidoscopy, flexible; with removal of foreign body
Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by
hot biopsy forceps or bipolar cautery
Sigmoidoscopy, flexible; with control of bleeding, any method
Sgmdsc flx dired sbmcsl njx any sbst
449.10
Sigmoidoscopy, flexible; with decompression of volvulus, any method
Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by
snare technique
Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) not
amenable to removal by hot biopsy forceps, bipolar cautery or snare technique
Sgmdsc flx dilat balo 1/more strixs
Sigmoidoscopy, flexible; with endoscopic ultrasound examination
Sigmoidoscopy, flexible; with transendoscopic ultrasound guided intramural or
transmural fine needle aspiration/biopsy(s)
Sigmoidoscopy, flexible; with transendoscopic stent placement (includes
predilation)
Colonoscopy, rigid or flexible, transabdominal via colotomy, single or multiple
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without
772.20
45300
45303
45305
45307
45308
45309
45315
45317
45320
45321
45327
45330
45331
45332
45333
45334
45335
45337
45338
45339
45340
45341
45342
45345
45355
45378
Extraordinary No.64/2013
134
142.39
220.50
257.40
417.60
430.20
582.30
585.00
639.00
534.60
219.12
253.73
339.86
558.90
570.60
714.94
605.70
604.80
400.18
607.50
700.20
468.90
785.70
858.15
Friday, 09 August 2013
45379
45380
45381
collection of specimen(s) by brushing or washing, with or without colon
decompression (separate procedure)
Colonoscopy, flexible, proximal to splenic flexure; with removal of foreign body
Colonoscopy, flexible, proximal to splenic flexure; with biopsy, single or multiple
1099.80
961.77
975.00
45391
Colsc flx prox splenic flxr sbmcsl njx
Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding, any
method
Colonoscopy, flexible, proximal to splenic flexure; with ablation of tumor(s),
polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar
cautery or snare technique
Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s),
polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
Colonoscopy, flexible, proximal to splenic flexure; with removal of tumor(s),
polyp(s), or other lesion(s) by snare technique
Colsc flx prox splenic flxr dilat balo 1+ strixs
Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic stent
placement (includes predilation)
Colsc flx prox splenic flxr ndsc us xm
45392
45395
Colsc flx prox splenic flxr us gid ndl aspir/bx
Laps prctect compl cmbn abdominoprnl w/clst
718.20
3966.46
45397
45400
Laps prctect cmbn pull-thru crtj rsvr
Laps proctopexy for prolapse
4303.15
2322.57
45402
45500
Laps proctopexy for prolapse sigmoid rescj
Proctoplasty; for stenosis
3124.42
1570.50
45505
45520
Proctoplasty; for prolapse of mucous membrane
Perirectal injection of sclerosing solution for prolapse
1647.90
144.00
45540
45541
Proctopexy for prolapse; abdominal approach
Proctopexy for prolapse; perineal approach
3206.70
2523.60
45550
45560
Proctopexy combined with sigmoid resection, abdominal approach
Repair of rectocele (separate procedure)
3591.00
1494.00
45562
45563
Exploration, repair, and presacral drainage for rectal injury;
Exploration, repair, and presacral drainage for rectal injury; with colostomy
2657.70
3095.10
45800
45805
Closure of rectovesical fistula;
Closure of rectovesical fistula; with colostomy
3066.30
3103.20
45820
45825
Closure of rectourethral fistula;
Closure of rectourethral fistula; with colostomy
2729.70
3057.30
45900
45905
Reduction of procidentia (separate procedure) under anesthesia
Dilation of anal sphincter (separate procedure) under anesthesia other than local
497.70
360.90
45910
45915
Dilation of rectal stricture (separate procedure) under anesthesia other than local
Removal of fecal impaction or foreign body (separate procedure) under anesthesia
384.30
425.70
45382
45383
45384
45385
45386
45387
Extraordinary No.64/2013
135
1107.00
1203.49
1162.09
1287.91
958.72
950.40
568.04
Friday, 09 August 2013
45990
Anrct xm surg req anes general spi/edrl dx
219.72
46020
46030
Plmt seton
Removal of anal seton, other marker
230.01
293.40
46040
703.80
46070
46080
Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure)
Incision and drainage of intramural, intramuscular, or submucosal abscess,
transanal, under anesthesia
Incision and drainage, perianal abscess, superficial
Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or
fistulotomy, submuscular, with or without placement of seton
Incision, anal septum (infant)
Sphincterotomy, anal, division of sphincter (separate procedure)
46083
46200
Incision of thrombosed hemorrhoid, external
Fissurectomy, with or without sphincterotomy
214.20
867.60
46220
46221
Papillectomy or excision of single tag, anus (separate procedure)
Hemorrhoidectomy, by simple ligature (eg, rubber band)
343.80
391.50
46230
46250
Excision of external hemorrhoid tags and/or multiple papillae
Hemorrhoidectomy, external, complete
380.70
952.20
46255
46257
Hemorrhoidectomy, internal and external, simple;
Hemorrhoidectomy, internal and external, simple; with fissurectomy
Hemorrhoidectomy, internal and external, simple; with fistulectomy, with or
without fissurectomy
Hemorrhoidectomy, internal and external, complex or extensive;
Hemorrhoidectomy, internal and external, complex or extensive; with fissurectomy
Hemorrhoidectomy, internal and external, complex or extensive; with fistulectomy,
with or without fissurectomy
Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous
1133.02
1395.90
1426.50
46285
46288
Surgical treatment of anal fistula (fistulectomy/fistulotomy); submuscular
Surgical treatment of anal fistula (fistulectomy/fistulotomy); complex or multiple,
with or without placement of seton
Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage
Closure of anal fistula with rectal advancement flap
46320
46500
Enucleation or excision of external thrombotic hemorrhoid
Injection of sclerosing solution, hemorrhoids
252.07
104.40
46505
620.82
46604
46606
Chemodnrvtj int anal sphnctr
Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or
washing (separate procedure)
Anoscopy; with dilation, any method
Anoscopy; with biopsy, single or multiple
46608
Anoscopy; with removal of foreign body
236.70
46045
46050
46060
46258
46260
46261
46262
46270
46275
46280
46600
Extraordinary No.64/2013
136
775.80
282.60
1665.00
432.90
820.80
1494.90
1744.20
1469.73
1658.70
813.60
1668.60
578.70
1596.60
70.85
197.10
156.60
Friday, 09 August 2013
46700
Anoscopy; with removal of single tumor, polyp, or other lesion by hot biopsy
forceps or bipolar cautery
Anoscopy; with removal of single tumor, polyp, or other lesion by snare technique
Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy
forceps, bipolar cautery or snare technique
Anoscopy; with control of bleeding, any method
Anoscopy; with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to
removal by hot biopsy forceps, bipolar cautery or snare technique
Anoplasty, plastic operation for stricture; adult
46705
46706
Anoplasty, plastic operation for stricture; infant
Rpr anal fstl w/fibrin glue
1416.60
389.22
46707
46710
Repair anorectal fistula plug
Rpr ileoanal pouch fstl/pouch advmnt tprnl appr
1162.37
2534.97
46712
46715
4490.29
1563.30
46750
46751
Rpr ileoanal pouch fstl/pouch advmnt cmbn appr
Repair of low imperforate anus; with anoperineal fistula (cut-back procedure)
Repair of low imperforate anus; with transposition of anoperineal or anovestibular
fistula
Repair of high imperforate anus without fistula; perineal or sacroperineal approach
Repair of high imperforate anus without fistula; combined transabdominal and
sacroperineal approaches
Repair of high imperforate anus with rectourethral or rectovaginal fistula; perineal
or sacroperineal approach
Repair of high imperforate anus with rectourethral or rectovaginal fistula;
combined transabdominal and sacroperineal approaches
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty,
sacroperineal approach
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined
abdominal and sacroperineal approach;
Repair of cloacal anomaly by anorectovaginoplasty and urethroplasty, combined
abdominal and sacroperineal approach; with vaginal lengthening by intestinal graft
or pedicle flaps
Sphincteroplasty, anal, for incontinence or prolapse; adult
Sphincteroplasty, anal, for incontinence or prolapse; child
46753
46754
Graft (Thiersch operation) for rectal incontinence and/or prolapse
Removal of Thiersch wire or suture, anal canal
1352.70
287.10
46760
46761
Sphincteroplasty, anal, for incontinence, adult; muscle transplant
Sphnctrop anal levator musc imbrcj
1932.30
2142.41
46762
Sphnctrop anal impltj artif sphnctr
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), simple; chemical
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), simple; electrodesiccation
2033.00
46610
46611
46612
46614
46615
46716
46730
46735
46740
46742
46744
46746
46748
46900
46910
Extraordinary No.64/2013
137
277.20
283.50
343.80
407.70
414.00
1498.68
1954.80
3294.00
3994.20
4257.00
5047.20
5304.60
6437.70
7020.00
1944.72
1653.30
190.80
325.80
Friday, 09 August 2013
46916
46917
46922
46924
46940
46942
46945
46946
46947
47000
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), simple; cryosurgery
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), simple; laser surgery
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), simple; surgical excision
Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum,
herpetic vesicle), extensive, any method
Curettage or cauterization of anal fissure, including dilation of anal sphincter
(separate procedure); initial
Curettage or cauterization of anal fissure, including dilation of anal sphincter
(separate procedure); subsequent
Ligation of internal hemorrhoids; single procedure
Ligation of internal hemorrhoids; multiple procedures
330.30
570.60
441.90
861.30
342.90
241.20
319.50
372.60
578.58
378.90
47100
Hemorrhoidopexy stapling
Biopsy of liver, needle; percutaneous
Biopsy of liver, needle; when done for indicated purpose at time of other major
procedure (List separately in addition to code for primary procedure)
Hepatotomy; for open drainage of abscess or cyst, one or two stages
Hepatotomy; for percutaneous drainage of abscess or cyst, one or two stages
Laparotomy, with aspiration and/or injection of hepatic parasitic (eg, amoebic or
echinococcal) cyst(s) or abscess(es)
Biopsy of liver, wedge
47120
47122
Hepatectomy, resection of liver; partial lobectomy
Hepatectomy, resection of liver; trisegmentectomy
4094.10
5055.30
47125
47130
Hepatectomy, resection of liver; total left lobectomy
Hepatectomy, resection of liver; total right lobectomy
5123.70
5660.10
47300
47350
Marsupialization of cyst or abscess of liver
Management of liver hemorrhage; simple suture of liver wound or injury
Management of liver hemorrhage; complex suture of liver wound or injury, with or
without hepatic artery ligation
Management of liver hemorrhage; exploration of hepatic wound, extensive
debridement, coagulation and/or suture, with or without packing of liver
Management of liver hemorrhage; re-exploration of hepatic wound for removal of
packing
Hepaticotomy or hepaticostomy with exploration, drainage, or removal of calculus
Choledochotomy or choledochostomy with exploration, drainage, or removal of
calculus, with or without cholecystotomy; without transduodenal sphincterotomy
or sphincteroplasty
Choledochotomy or choledochostomy with exploration, drainage, or removal of
calculus, with or without cholecystotomy; with transduodenal sphincterotomy or
sphincteroplasty
Transduodenal sphincterotomy or sphincteroplasty, with or without transduodenal
2345.40
2863.80
47001
47010
47011
47015
47360
47361
47362
47400
47420
47425
47460
Extraordinary No.64/2013
138
362.70
2399.40
562.50
1859.40
1659.60
3404.70
5294.70
2229.30
2941.20
2731.50
3064.50
3170.70
Friday, 09 August 2013
extraction of calculus (separate procedure)
47480
47490
47500
Cholecystotomy or cholecystostomy with exploration, drainage, or removal of
calculus (separate procedure)
Percutaneous cholecystostomy
1964.70
947.70
Injection procedure for percutaneous transhepatic cholangiography
Injection procedure for cholangiography through an existing catheter (eg,
percutaneous transhepatic or T-tube)
Introduction of percutaneous transhepatic catheter for biliary drainage
Introduction of percutaneous transhepatic stent for internal and external biliary
drainage
Change of percutaneous biliary drainage catheter
501.30
613.80
47560
47561
Revision and/or reinsertion of transhepatic tube
Biliary endoscopy, intraoperative (choledochoscopy) (List separately in addition to
code for primary procedure)
Biliary endoscopy, percutaneous via T-tube or other tract; diagnostic, with or
without collection of specimen(s) by brushing and/or washing (separate procedure)
Biliary endoscopy, percutaneous via T-tube or other tract; with biopsy, single or
multiple
Biliary endoscopy, percutaneous via T-tube or other tract; with removal of stone(s)
Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary
duct stricture(s) without stent
Biliary endoscopy, percutaneous via T-tube or other tract; with dilation of biliary
duct stricture(s) with stent
Laps surg w/gid transhepatc cholangrph w/o bx
Laparoscopy, surgical; with guided transhepatic cholangiography with biopsy
47562
47563
Laparoscopy, surgical; cholecystectomy
Laparoscopy, surgical; cholecystectomy with cholangiography
2884.50
2978.08
47564
47570
Laparoscopy, surgical; cholecystectomy with exploration of common duct
Laparoscopy, surgical; cholecystoenterostomy
3501.90
2934.90
47600
47605
Cholecystectomy;
Cholecystectomy; with cholangiography
2425.73
2408.40
47610
47612
Cholecystectomy with exploration of common duct;
Cholecystectomy with exploration of common duct; with choledochoenterostomy
Cholecystectomy with exploration of common duct; with transduodenal
sphincterotomy or sphincteroplasty, with or without cholangiography
Biliary duct stone extraction, percutaneous via T-tube tract, basket, or snare (eg,
Burhenne technique)
Exploration for congenital atresia of bile ducts, without repair, with or without
liver biopsy, with or without cholangiography
Portoenterostomy (eg, Kasai procedure)
Excision of bile duct tumor, with or without primary repair of bile duct;
extrahepatic
3090.60
3743.10
47505
47510
47511
47525
47530
47550
47552
47553
47554
47555
47556
47620
47630
47700
47701
47711
Extraordinary No.64/2013
139
239.40
825.30
932.40
473.40
785.70
1030.50
978.30
1421.10
1138.50
1133.10
1510.58
1159.20
3605.40
1591.20
2565.00
3919.50
3893.40
Friday, 09 August 2013
47715
47720
Excision of bile duct tumor, with or without primary repair of bile duct;
intrahepatic
Excision of choledochal cyst
Cholecystoenterostomy; direct
47721
47740
Cholecystoenterostomy; with gastroenterostomy
Cholecystoenterostomy; Roux-en-Y
3141.90
3231.00
47741
47760
Cholecystoenterostomy; Roux-en-Y with gastroenterostomy
Anastomosis, of extrahepatic biliary ducts and gastrointestinal tract
3558.60
3577.50
47765
47780
Anastomosis, of intrahepatic ducts and gastrointestinal tract
Anastomosis, Roux-en-Y, of extrahepatic biliary ducts and gastrointestinal tract
3862.80
4051.80
47785
47800
Anastomosis, Roux-en-Y, of intrahepatic biliary ducts and gastrointestinal tract
Reconstruction, plastic, of extrahepatic biliary ducts with end-to-end anastomosis
4861.80
3579.30
47801
47802
Placement of choledochal stent
U-tube hepaticoenterostomy
2097.00
3399.30
47900
48000
Suture of extrahepatic biliary duct for pre-existing injury (separate procedure)
Placement of drains, peripancreatic, for acute pancreatitis;
Placement of drains, peripancreatic, for acute pancreatitis; with cholecystostomy,
gastrostomy, and jejunostomy
Removal of pancreatic calculus
Biopsy of pancreas, open, any method (eg, fine needle aspiration, needle core
biopsy, wedge biopsy)
Biopsy of pancreas, percutaneous needle
Resecj/dbrdmt pancreas necrotizing pancreatitis
3095.10
2626.20
Excision of lesion of pancreas (eg, cyst, adenoma)
Pancreatectomy, distal subtotal, with or without splenectomy; without
pancreaticojejunostomy
Pancreatectomy, distal subtotal, with or without splenectomy; with
pancreaticojejunostomy
Pancreatectomy, distal, near-total with preservation of duodenum (Child-type
procedure)
Excision of ampulla of Vater
Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy,
choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); with
pancreatojejunostomy
Pancreatectomy, proximal subtotal with total duodenectomy, partial gastrectomy,
choledochoenterostomy and gastrojejunostomy (Whipple-type procedure); without
pancreatojejunostomy
Pancreatectomy, proximal subtotal with near-total duodenectomy,
choledochoenterostomy and duodenojejunostomy (pylorus-sparing, Whipple-type
procedure); with pancreatojejunostomy
Pncrtect prox stot w/o pancreatojejunostomy
2574.90
47712
48001
48020
48100
48102
48105
48120
48140
48145
48146
48148
48150
48152
48153
48154
Extraordinary No.64/2013
140
4233.60
2894.40
2518.20
2832.30
2904.30
2138.40
634.50
5451.85
3533.40
3700.80
3965.40
3132.00
6010.20
5525.10
6282.90
5545.84
Friday, 09 August 2013
48155
5987.70
48500
Pancreatectomy, total
Injection procedure for intraoperative pancreatography (List separately in addition
to code for primary procedure)
Marsupialization of cyst of pancreas
48510
48511
External drainage, pseudocyst of pancreas; open
External drainage, pseudocyst of pancreas; percutaneous
3393.00
947.70
48520
48540
Internal anastomosis of pancreatic cyst to gastrointestinal tract; direct
Internal anastomosis of pancreatic cyst to gastrointestinal tract; Roux-en-Y
3391.20
3727.80
48545
48547
Pancreatorrhaphy for trauma
Duodenal exclusion with gastrojejunostomy for pancreatic trauma
2807.10
4583.70
48548
48554
Pancreaticojejunostomy side-to-side anast
Transplantation of pancreatic allograft
3894.97
5886.90
48556
2919.60
49040
Removal of transplanted pancreatic allograft
Exploratory laparotomy, exploratory celiotomy with or without biopsy(s) (separate
procedure)
Reopening of recent laparotomy
Exploration, retroperitoneal area with or without biopsy(s) (separate procedure)
Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal
abscess; open
Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal
abscess; percutaneous
Drainage of subdiaphragmatic or subphrenic abscess; open
49041
49060
Drainage of subdiaphragmatic or subphrenic abscess; percutaneous
Drainage of retroperitoneal abscess; open
760.50
1845.90
49061
49062
633.60
1874.70
49180
49203
Drainage of retroperitoneal abscess; percutaneous
Drainage of extraperitoneal lymphocele to peritoneal cavity, open
Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or
therapeutic); initial
Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or
therapeutic); subsequent
Biopsy, abdominal or retroperitoneal mass, percutaneous needle
Excision/destruction open abdominal tumors 5 cm
49204
49205
Exc/destruction open abdmnl tumors 5.1-10.0 cm
Exc/destruction open abdominal tumors >10.0 cm
3508.35
4192.01
49215
Excision of presacral or sacrococcygeal tumor
Staging celiotomy (laparotomy) for Hodgkins disease or lymphoma (includes
splenectomy, needle or open biopsies of both liver lobes, possibly also removal of
abdominal nodes, abdominal node and/or bone marrow biopsies, ovarian
repositioning)
Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)
3955.50
48400
49000
49002
49010
49020
49021
49080
49081
49220
49250
Extraordinary No.64/2013
141
278.10
2574.90
2088.85
1898.10
2083.50
1682.10
1387.80
1975.50
301.50
268.20
811.80
2801.62
3829.50
1416.60
Friday, 09 August 2013
49255
1802.70
49323
Omentectomy, epiploectomy, resection of omentum (separate procedure)
Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without
collection of specimen(s) by brushing or washing (separate procedure)
Laparoscopy, surgical; with biopsy (single or multiple)
Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or
multiple)
Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity
49324
49325
Laps insertion tunneled intraperitoneal catheter
Laps w/revision intraperitoneal catheter
943.82
950.46
49326
49327
Laps w/omentopexy
Laps w/insertion ntrstl dev w/img gid 1+
706.80
378.09
49400
49402
Injection of air or contrast into peritoneal cavity (separate procedure)
Removal peritoneal foreign body from cavity
233.10
1902.20
49411
49412
Interstitial dev plmt radiation therapy 1/mlt
Plmt intrstl dev opn w/img gid 1+
880.63
303.29
49419
49421
Insertion tunnel intraperitoneal cath subq port
Insertion of intraperitoneal cannula or catheter for drainage or dialysis; permanent
985.96
1449.00
49422
1191.60
49428
Removal of permanent intraperitoneal cannula or catheter
Exchange of previously placed abscess or cyst drainage catheter under radiological
guidance (separate procedure)
Contrast injection for assessment of abscess or cyst via previously placed catheter
(separate procedure)
Insertion of peritoneal-venous shunt
Revision of peritoneal-venous shunt
Injection procedure (eg, contrast media) for evaluation of previously placed
peritoneal-venous shunt
Lig prtl-ven shunt
49429
49435
Rmvl prtl-ven shunt
Insj subq extension intraperitoneal catheter
1148.24
343.46
49436
49491
Delayed creation exit site embedded catheter
Rpr 1st ingun hrna preterm inft rdc
485.16
1510.04
49492
Rpr 1st ingun hrna preterm inft ncrc8
Repair initial inguinal hernia, under age 6 months, with or without
hydrocelectomy; reducible
Repair initial inguinal hernia, under age 6 months, with or without
hydrocelectomy; incarcerated or strangulated
Repair initial inguinal hernia, age 6 months to under 5 years, with or without
hydrocelectomy; reducible
Repair initial inguinal hernia, age 6 months to under 5 years, with or without
hydrocelectomy; incarcerated or strangulated
Repair initial inguinal hernia, age 5 years or over; reducible
1735.71
49320
49321
49322
49423
49424
49425
49426
49427
49495
49496
49500
49501
49505
Extraordinary No.64/2013
142
1557.11
1716.30
1802.70
1908.90
277.20
144.00
2162.70
1984.50
216.00
953.79
1575.90
1755.00
1390.50
1555.20
1547.55
Friday, 09 August 2013
49507
Repair initial inguinal hernia, age 5 years or over; incarcerated or strangulated
1889.72
49520
49521
Repair recurrent inguinal hernia, any age; reducible
Repair recurrent inguinal hernia, any age; incarcerated or strangulated
2031.30
2214.90
49525
49540
Repair inguinal hernia, sliding, any age
Repair lumbar hernia
1647.90
1574.10
49550
49553
Repair initial femoral hernia, any age; reducible
Repair initial femoral hernia, any age; incarcerated or strangulated
1616.40
1931.40
49555
49557
Repair recurrent femoral hernia; reducible
Repair recurrent femoral hernia; incarcerated or strangulated
1916.10
2497.50
49560
49561
Repair initial incisional or ventral hernia; reducible
Repair initial incisional or ventral hernia; incarcerated or strangulated
1978.57
2116.80
49565
49566
2480.40
2693.70
49570
Repair recurrent incisional or ventral hernia; reducible
Repair recurrent incisional or ventral hernia; incarcerated or strangulated
Implantation of mesh or other prosthesis for incisional or ventral hernia repair (List
separately in addition to code for the incisional or ventral hernia repair)
Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure)
49572
49580
Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated
Repair umbilical hernia, under age 5 years; reducible
1670.40
1189.80
49582
49585
Repair umbilical hernia, under age 5 years; incarcerated or strangulated
Repair umbilical hernia, age 5 years or over; reducible
1545.30
1441.80
49587
49590
Repair umbilical hernia, age 5 years or over; incarcerated or strangulated
Repair spigelian hernia
1646.00
1654.20
49600
49605
1622.70
3263.40
49610
Repair of small omphalocele, with primary closure
Repair of large omphalocele or gastroschisis; with or without prosthesis
Repair of large omphalocele or gastroschisis; with removal of prosthesis, final
reduction and closure, in operating room
Repair of omphalocele (Gross type operation); first stage
49611
49650
Repair of omphalocele (Gross type operation); second stage
Laparoscopy, surgical; repair initial inguinal hernia
1946.70
1924.20
49651
49652
Laparoscopy, surgical; repair recurrent inguinal hernia
Laps repair hernia except incal/ingun reducible
2074.50
2109.14
49653
49654
Lap rpr hrna xcpt incal/ingun ncrc8/strangulated
Laparoscopy repair incisional hernia reducible
2603.68
2373.28
49655
49656
Laps rpr incisional hernia ncrc8/strangulated
Laps rpr recurrent incisional hernia reducible
2891.21
2400.68
49657
49900
Laps rpr recurrent incal hrna ncrc8/strangulated
Suture, secondary, of abdominal wall for evisceration or dehiscence
3469.04
1555.20
49904
Omental flap xtr-abdl
3010.88
49568
49606
Extraordinary No.64/2013
143
736.24
1421.10
2832.30
2008.80
Friday, 09 August 2013
50010
50020
Omental flap (eg, for reconstruction of sternal and chest wall defects) (List
separately in addition to code for primary procedure)
Renal exploration, not necessitating other specific procedures
Drainage of perirenal or renal abscess; open
50021
50040
Drainage of perirenal or renal abscess; percutaneous
Nephrostomy, nephrotomy with drainage
578.70
2388.60
50045
50060
Nephrotomy, with exploration
Nephrolithotomy; removal of calculus
2695.50
3464.10
50065
50070
Nephrolithotomy; secondary surgical operation for calculus
Nephrolithotomy; complicated by congenital kidney abnormality
Nephrolithotomy; removal of large staghorn calculus filling renal pelvis and
calyces (including anatrophic pyelolithotomy)
Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation,
endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm
Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation,
endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm
Transection or repositioning of aberrant renal vessels (separate procedure)
Pyelotomy; with exploration
3301.20
3739.50
Pyelotomy; with drainage, pyelostomy
Pyelotomy; with removal of calculus (pyelolithotomy, pelviolithotomy, including
coagulum pyelolithotomy)
Pyelotomy; complicated (eg, secondary operation, congenital kidney abnormality)
Renal biopsy; percutaneous, by trocar or needle
2860.20
1523.70
3236.40
50234
Renal biopsy; by surgical exposure of kidney
Nephrectomy, including partial ureterectomy, any approach including rib resection;
Nephrectomy, including partial ureterectomy, any approach including rib resection;
complicated because of previous surgery on same kidney
Nephrectomy, including partial ureterectomy, any approach including rib resection;
radical, with regional lymphadenectomy and/or vena caval thrombectomy
Nephrectomy with total ureterectomy and bladder cuff; through same incision
50236
50240
Nephrectomy with total ureterectomy and bladder cuff; through separate incision
Nephrectomy, partial
4327.20
3764.70
50250
50280
Open ablation renal mass cryosurg ultrasound
Excision or unroofing of cyst(s) of kidney
3098.95
2828.70
50290
Excision of perinephric cyst
Donor nephrectomy, open from living donor (excluding preparation and
maintenance of allograft)
Recipient nephrectomy (separate procedure)
Renal allotransplantation, implantation of graft; excluding donor and recipient
nephrectomy
Renal allotransplantation, implantation of graft; with recipient nephrectomy
2653.20
49905
50075
50080
50081
50100
50120
50125
50130
50135
50200
50205
50220
50225
50230
50320
50340
50360
50365
Extraordinary No.64/2013
144
1532.70
2369.70
2348.10
3556.80
3374.10
3953.70
2421.00
2788.20
3258.00
3535.20
563.40
3862.80
4735.80
4532.40
4686.30
2797.20
6304.50
7696.80
Friday, 09 August 2013
50370
Removal of transplanted renal allograft
2430.90
50380
50387
Renal autotransplantation, reimplantation of kidney
Rmvl&rplcmt xtrnlly accessible urtrl stent
4360.50
540.10
50389
50390
Rmvl nfros tube req fluor gid
Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous
344.26
465.30
50391
Instlj agt rnl pelvis&/urtr thru tube
Introduction of intracatheter or catheter into renal pelvis for drainage and/or
injection, percutaneous
Introduction of ureteral catheter or stent into ureter through renal pelvis for
drainage and/or injection, percutaneous
Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade
pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling
ureteral catheter
Introduction of guide into renal pelvis and/or ureter with dilation to establish
nephrostomy tract, percutaneous
Manometric studies through nephrostomy or pyelostomy tube, or indwelling
ureteral catheter
Change of nephrostomy or pyelostomy tube
Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or
without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or
ureteral splinting; simple
Pyeloplasty (Foley Y-pyeloplasty), plastic operation on renal pelvis, with or
without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or
ureteral splinting; complicated (congenital kidney abnormality, secondary
pyeloplasty, solitary kidn
Nephrorrhaphy, suture of kidney wound or injury
374.44
2853.00
50541
Closure of nephrocutaneous or pyelocutaneous fistula
Closure of nephrovisceral fistula (eg, renocolic), including visceral repair;
abdominal approach
Closure of nephrovisceral fistula (eg, renocolic), including visceral repair; thoracic
approach
Symphysiotomy for horseshoe kidney with or without pyeloplasty and/or other
plastic procedure, unilateral or bilateral (one operation)
Laparoscopy, surgical; ablation of renal cysts
50542
50543
Laps abltj rnl mass les w/intraop us
Laps prtl nfrct
2662.34
3268.75
50544
Laparoscopy, surgical; pyeloplasty
Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia
and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy)
Laparoscopy, surgical; nephrectomy, including partial ureterectomy
Laparoscopy, surgical; donor nephrectomy from living donor (excluding
preparation and maintenance of allograft)
Laparoscopy, surgical; nephrectomy with total ureterectomy
3692.70
50392
50393
50394
50395
50396
50398
50400
50405
50500
50520
50525
50526
50540
50545
50546
50547
50548
Extraordinary No.64/2013
145
666.00
703.80
221.40
870.30
164.70
257.40
3541.50
3802.50
3298.50
3438.00
3501.90
4071.60
2673.90
3990.60
3727.80
4762.80
5098.50
Friday, 09 August 2013
50590
50592
Renal endoscopy through established nephrostomy or pyelostomy, with or without
irrigation, instillation, or ureteropyelography, exclusive of radiologic service;
Renal endoscopy through established nephrostomy or pyelostomy, with or without
irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with
ureteral catheterization, with or without dilation of ureter
Renal endoscopy through established nephrostomy or pyelostomy, with or without
irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with
biopsy
Renal endoscopy through established nephrostomy or pyelostomy, with or without
irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with
fulguration and/or incision, with or without biopsy
Renal endoscopy through established nephrostomy or pyelostomy, with or without
irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with
removal of foreign body or calculus
Rnl ndsc nfros/pyelostomy rescj tum
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service;
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with ureteral
catheterization, with or without dilation of ureter
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with
endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral
pelvic junction, inci
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with fulguration
and/or incision, with or without biopsy
Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with removal of
foreign body or calculus
Lithotripsy, extracorporeal shock wave
Abltj 1+ rnl tum prq uni rf
50600
50605
Ureterotomy with exploration or drainage (separate procedure)
Ureterotomy for insertion of indwelling stent, all types
2530.80
2730.60
50610
50620
Ureterolithotomy; upper one-third of ureter
Ureterolithotomy; middle one-third of ureter
3156.30
3373.20
50630
50650
Ureterolithotomy; lower one-third of ureter
Ureterectomy, with bladder cuff (separate procedure)
Ureterectomy, total, ectopic ureter, combination abdominal, vaginal and/or perineal
approach
Injection procedure for ureterography or ureteropyelography through ureterostomy
or indwelling ureteral catheter
Manometric studies through ureterostomy or indwelling ureteral catheter
3577.50
3143.70
50551
50553
50555
50557
50561
50562
50570
50572
50574
50575
50576
50580
50660
50684
50686
Extraordinary No.64/2013
146
777.60
774.00
995.40
1017.90
1484.10
1158.89
1117.80
2024.10
2061.00
2292.30
1647.90
2277.00
3424.50
2900.54
3429.00
153.90
120.60
Friday, 09 August 2013
50688
Change of ureterostomy tube
Injection procedure for visualization of ileal conduit and/or ureteropyelography,
exclusive of radiologic service
Ureteroplasty, plastic operation on ureter (eg, stricture)
162.00
2781.00
2421.00
50740
50750
Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis
Ureterolysis for ovarian vein syndrome
Ureterolysis for retrocaval ureter, with reanastomosis of upper urinary tract or vena
cava
Revision of urinary-cutaneous anastomosis (any type urostomy);
Revision of urinary-cutaneous anastomosis (any type urostomy); with repair of
fascial defect and hernia
Ureteropyelostomy, anastomosis of ureter and renal pelvis
Ureterocalycostomy, anastomosis of ureter to renal calyx
50760
50770
Ureteroureterostomy
Transureteroureterostomy, anastomosis of ureter to contralateral ureter
3244.50
3445.20
50780
50782
Ureteroneocystostomy; anastomosis of single ureter to bladder
Ureteroneocystostomy; anastomosis of duplicated ureter to bladder
3356.10
3492.90
50783
50785
Ureteroneocystostomy; with extensive ureteral tailoring
Ureteroneocystostomy; with vesico-psoas hitch or bladder flap
3594.60
3877.20
50800
3301.20
50845
Ureteroenterostomy, direct anastomosis of ureter to intestine
Ureterosigmoidostomy, with creation of sigmoid bladder and establishment of
abdominal or perineal colostomy, including bowel anastomosis
Ureterocolon conduit, including bowel anastomosis
Ureteroileal conduit (ileal bladder), including bowel anastomosis (Bricker
operation)
Continent diversion, including bowel anastomosis using any segment of small
and/or large bowel (Kock pouch or Camey enterocystoplasty)
Urinary undiversion (eg, taking down of ureteroileal conduit,
ureterosigmoidostomy or ureteroenterostomy with ureteroureterostomy or
ureteroneocystostomy)
Replacement of all or part of ureter by bowel segment, including bowel
anastomosis
Cutaneous appendico-vesicostomy
50860
50900
Ureterostomy, transplantation of ureter to skin
Ureterorrhaphy, suture of ureter (separate procedure)
2807.10
2652.30
50920
50930
Closure of ureterocutaneous fistula
Closure of ureterovisceral fistula (including visceral repair)
2907.90
3404.70
50940
50945
Deligation of ureter
Laparoscopy, surgical; ureterolithotomy
Laparoscopy, surgical; ureteroneocystostomy with cystoscopy and ureteral stent
placement
2729.70
2889.90
50690
50700
50715
50722
50725
50727
50728
50810
50815
50820
50825
50830
50840
50947
Extraordinary No.64/2013
147
143.10
2943.00
3769.20
1869.30
2663.10
3374.10
3605.40
4635.00
4789.80
5985.00
5768.10
5469.30
3718.80
4222.80
4301.10
Friday, 09 August 2013
50948
50951
50953
50955
50957
50961
50970
50972
50974
50976
50980
51020
51030
51040
51045
51050
51060
51065
51080
51500
51520
51525
51530
51535
Laparoscopy, surgical; ureteroneocystostomy without cystoscopy and ureteral stent
placement
Ureteral endoscopy through established ureterostomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service;
Ureteral endoscopy through established ureterostomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with ureteral
catheterization, with or without dilation of ureter
Ureteral endoscopy through established ureterostomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with biopsy
Ureteral endoscopy through established ureterostomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with fulguration
and/or incision, with or without biopsy
Ureteral endoscopy through established ureterostomy, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with removal of
foreign body or calculus
Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service;
Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; with ureteral catheterization,
with or without dilation of ureter
Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; with biopsy
Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; with fulguration and/or
incision, with or without biopsy
Ureteral endoscopy through ureterotomy, with or without irrigation, instillation, or
ureteropyelography, exclusive of radiologic service; with removal of foreign body
or calculus
Cystotomy or cystostomy; with fulguration and/or insertion of radioactive material
Cystotomy or cystostomy; with cryosurgical destruction of intravesical lesion
3933.00
607.50
669.60
731.70
751.50
978.30
824.40
791.10
1133.10
1040.40
936.90
1968.30
1923.30
Cystostomy, cystotomy with drainage
Cystotomy, with insertion of ureteral catheter or stent (separate procedure)
Cystolithotomy, cystotomy with removal of calculus, without vesical neck
resection
Transvesical ureterolithotomy
Cystotomy, with stone basket extraction and/or ultrasonic or electrohydraulic
fragmentation of ureteral calculus
Drainage of perivesical or prevesical space abscess
1717.20
1909.80
Excision of urachal cyst or sinus, with or without umbilical hernia repair
Cystotomy; for simple excision of vesical neck (separate procedure)
Cystotomy; for excision of bladder diverticulum, single or multiple (separate
procedure)
Cystotomy; for excision of bladder tumor
Cystotomy for excision, incision, or repair of ureterocele
2151.00
2277.00
Extraordinary No.64/2013
148
2162.70
2581.20
2421.00
1701.90
2837.70
2457.00
2631.60
Friday, 09 August 2013
51550
2953.80
51610
Cystectomy, partial; simple
Cystectomy, partial; complicated (eg, postradiation, previous surgery, difficult
location)
Cystectomy, partial, with reimplantation of ureter(s) into bladder
(ureteroneocystostomy)
Cystectomy, complete; (separate procedure)
Cystectomy, complete; with bilateral pelvic lymphadenectomy, including external
iliac, hypogastric, and obturator nodes
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous
transplantations;
Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous
transplantations; with bilateral pelvic lymphadenectomy, including external iliac,
hypogastric, and obturator nodes
Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including
bowel anastomosis;
Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including
bowel anastomosis; with bilateral pelvic lymphadenectomy, including external
iliac, hypogastric, and obturator nodes
Cystectomy, complete, with continent diversion, any technique, using any segment
of small and/or large bowel to construct neobladder
Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with
removal of bladder and ureteral transplantations, with or without hysterectomy
and/or abdominoperineal resection of rectum and colon and colostomy, or any
combination there
Injection procedure for cystography or voiding urethrocystography
Injection procedure and placement of chain for contrast and/or chain
urethrocystography
Injection procedure for retrograde urethrocystography
51700
51701
Bladder irrigation, simple, lavage and/or instillation
Insj non-ndwellg bldr cath
116.10
119.17
51702
51703
Insj temp ndwellg bldr cath smpl
Insj temp ndwellg bldr cath comp
222.55
222.42
51705
51710
Change of cystostomy tube; simple
Change of cystostomy tube; complicated
Endoscopic injection of implant material into the submucosal tissues of the urethra
and/or bladder neck
Bladder instillation of anticarcinogenic agent (including detention time)
105.30
319.50
Simple cystometrogram (CMG) (eg, spinal manometer)
301.50
Simple cystometrogram (CMG) (eg, spinal manometer)
253.80
Complex cystometrogram (eg, calibrated electronic equipment)
369.00
Complex cystometrogram (eg, calibrated electronic equipment)
309.60
51555
51565
51570
51575
51580
51585
51590
51595
51596
51597
51600
51605
51715
51720
51725
5172526
51726
5172626
Extraordinary No.64/2013
149
3749.40
4053.60
5027.40
6365.70
5994.00
6684.30
7559.10
8475.30
8883.90
10661.40
147.60
128.70
185.40
925.20
173.70
Friday, 09 August 2013
51727
Complex cystometrogram urethral press profile
686.90
51727
51727
Complex cystometrogram urethral press profile
Complex cystometrogram urethral press profile
434.58
252.33
51728
51728
Complex cystometrogram voiding pressure studies
Complex cystometrogram voiding pressure studies
686.02
434.41
51728
51729
Complex cystometrogram voiding pressure studies
Complx cystometro w/void press&urethral profile
251.61
704.40
51729
51729
Complx cystometro w/void press&urethral profile
Complx cystometro w/void press&urethral profile
443.36
261.04
51736
5173626
51741
5174126
5177226
Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter)
157.50
Simple uroflowmetry (UFR) (eg, stop-watch flow rate, mechanical uroflowmeter)
131.40
Complex uroflowmetry (eg, calibrated electronic equipment)
159.30
Complex uroflowmetry (eg, calibrated electronic equipment)
134.10
51784
5178426
51785
5178526
51792
5179226
5179526
51797
5179726
51798
51800
51820
51840
51841
Urethral pressure profile studies (UPP) (urethral closure pressure profile), any
technique
Electromyography studies (EMG) of anal or urethral sphincter, other than needle,
any technique
Electromyography studies (EMG) of anal or urethral sphincter, other than needle,
any technique
Needle electromyography studies (EMG) of anal or urethral sphincter, any
technique
Needle electromyography studies (EMG) of anal or urethral sphincter, any
technique
Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency
time)
Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency
time)
Voiding pressure studies (VP); bladder voiding pressure, any technique
150
236.70
201.60
247.50
207.00
239.40
202.50
263.70
Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal,
gastric, intraperitoneal)
Voiding pressure studies (VP); intra-abdominal voiding pressure (AP) (rectal,
gastric, intraperitoneal)
Meas post-voiding residual urine&/bldr cap
Cystoplasty or cystourethroplasty, plastic operation on bladder and/or vesical neck
(anterior Y-plasty, vesical fundus resection), any procedure, with or without wedge
resection of posterior vesical neck
Cystourethroplasty with unilateral or bilateral ureteroneocystostomy
Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz,
Burch); simple
Anterior vesicourethropexy, or urethropexy (eg, Marshall-Marchetti-Krantz,
Burch); complicated (eg, secondary repair)
Extraordinary No.64/2013
236.70
247.50
207.00
51.15
2849.40
3780.00
2495.70
2781.00
Friday, 09 August 2013
51860
51865
Abdomino-vaginal vesical neck suspension, with or without endoscopic control
(eg, Stamey, Raz, modified Pereyra)
Cystorrhaphy, suture of bladder wound, injury or rupture; simple
Cystorrhaphy, suture of bladder wound, injury or rupture; complicated
51880
51900
Closure of cystostomy (separate procedure)
Closure of vesicovaginal fistula, abdominal approach
1339.20
3454.20
51920
51925
Closure of vesicouterine fistula;
Closure of vesicouterine fistula; with hysterectomy
2559.60
3301.20
51940
51960
Closure of bladder exstrophy
Enterocystoplasty, including bowel anastomosis
4738.50
4652.10
51980
51990
Cutaneous vesicostomy
Laparoscopy, surgical; urethral suspension for stress incontinence
Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or
synthetic)
Cystourethroscopy (separate procedure)
2439.00
2447.10
676.66
52265
52270
Csto w/irrg&evac mlt obstructing clots
Cystourethroscopy, with ureteral catheterization, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service;
Cystourethroscopy, with ureteral catheterization, with or without irrigation,
instillation, or ureteropyelography, exclusive of radiologic service; with brush
biopsy of ureter and/or renal pelvis
Cystourethroscopy, with ejaculatory duct catheterization, with or without
irrigation, instillation, or duct radiography, exclusive of radiologic service
Cystourethroscopy, with biopsy
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of
trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or
treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery)
and/or resection of; SMALL bladder tumor(s) (0.5 to 2.0 cm)
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery)
and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery)
and/or resection of; LARGE bladder tumor(s)
Cystourethroscopy with insertion of radioactive substance, with or without biopsy
or fulguration
Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or
conduction (spinal) anesthesia
Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia
Cystourethroscopy, with internal urethrotomy; female
52275
52276
Cystourethroscopy, with internal urethrotomy; male
Cystourethroscopy with direct vision internal urethrotomy
882.00
1261.80
51845
51992
52000
52001
52005
52007
52010
52204
52214
52224
52234
52235
52240
52250
52260
Extraordinary No.64/2013
151
2781.00
2200.50
2982.60
2637.00
405.34
579.60
640.80
576.00
595.75
769.50
747.00
1017.90
1761.30
2543.40
849.60
592.18
540.90
819.00
Friday, 09 August 2013
52277
52281
52282
52283
52285
52290
52300
52301
52305
52310
52315
52317
52318
52320
52325
52327
52330
52332
52334
52341
52342
52343
52344
52345
Cystourethroscopy, with resection of external sphincter (sphincterotomy)
Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis,
with or without meatotomy, with or without injection procedure for cystography,
male or female
Cystourethroscopy, with insertion of urethral stent
1206.90
Cystourethroscopy, with steroid injection into stricture
Cystourethroscopy for treatment of the female urethral syndrome with any or all of
the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of
urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration
Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral
Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s),
unilateral or bilateral
Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s),
unilateral or bilateral
Cystourethroscopy; with incision or resection of orifice of bladder diverticulum,
single or multiple
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from
urethra or bladder (separate procedure); simple
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from
urethra or bladder (separate procedure); complicated
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and
removal of fragments; simple or small (less than 2.5 cm)
Litholapaxy: crushing or fragmentation of calculus by any means in bladder and
removal of fragments; complicated or large (over 2.5 cm)
Cystourethroscopy (including ureteral catheterization); with removal of ureteral
calculus
Cystourethroscopy (including ureteral catheterization); with fragmentation of
ureteral calculus (eg, ultrasonic or electro-hydraulic technique)
Cystourethroscopy (including ureteral catheterization); with subureteric injection
of implant material
Cystourethroscopy (including ureteral catheterization); with manipulation, without
removal of ureteral calculus
Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or
double-J type)
Cystourethroscopy with insertion of ureteral guide wire through kidney to establish
a percutaneous nephrostomy, retrograde
Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser,
electrocautery, and incision)
Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon
dilation, laser, electrocautery, and incision)
Cystourethroscopy; with treatment of intra-renal stricture (eg, balloon dilation,
laser, electrocautery, and incision)
Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg,
balloon dilation, laser, electrocautery, and incision)
Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction
stricture (eg, balloon dilation, laser, electrocautery, and incision)
563.40
Extraordinary No.64/2013
152
580.93
1030.50
686.56
737.10
975.60
1035.00
1019.70
751.50
1328.40
1377.90
1948.50
1344.60
1559.70
1081.80
953.10
924.30
875.70
1350.00
1461.60
1619.10
1776.60
1845.00
Friday, 09 August 2013
52346
52351
52352
52353
Cystourethroscopy with ureteroscopy; with treatment of intra-renal stricture (eg,
balloon dilation, laser, electrocautery, and incision)
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic
Scope bladder & ureter remove or move stones
2074.50
1377.90
1629.42
Scope bladder & ureter break up kidney stone
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or
fulguration of lesion
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of tumor
Cystourethroscopy with incision, fulguration, or resection of congenital posterior
urethral valves, or congenital obstructive hypertrophic mucosal folds
Csto w/trurl rescj/inc ejaculatory duxs
2027.72
Transurethral incision of prostate
Transurethral resection of bladder neck (separate procedure)
Transurethral electrosurgical resection of prostate, including control of
postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy,
urethral calibration and/or dilation, and internal urethrotomy are included)
Transurethral resection; of regrowth of obstructive tissue longer than one year
postoperative
Transurethral resection; of postoperative bladder neck contracture
Non-contact laser coagulation of prostate, including control of postoperative
bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration
and/or dilation, and internal urethrotomy are included)
Contact laser vaporization with or without transurethral resection of prostate,
including control of postoperative bleeding, complete (vasectomy, meatotomy,
cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy
are included)
Laser enucleation prostate w morcellation
Transurethral drainage of prostatic abscess
1562.40
1719.90
414.90
53020
53025
Urethrotomy or urethrostomy, external (separate procedure); pendulous urethra
Urethrotomy or urethrostomy, external (separate procedure); perineal urethra,
external
Meatotomy, cutting of meatus (separate procedure); except infant
Meatotomy, cutting of meatus (separate procedure); infant
53040
53060
Drainage of deep periurethral abscess
Drainage of Skene's gland abscess or cyst
692.10
322.20
53080
53085
Drainage of perineal urinary extravasation; uncomplicated (separate procedure)
Drainage of perineal urinary extravasation; complicated
761.40
1825.20
53200
53210
Biopsy of urethra
Urethrectomy, total, including cystostomy; female
473.40
2104.20
53215
53220
Urethrectomy, total, including cystostomy; male
Excision or fulguration of carcinoma of urethra
2781.00
1617.30
52354
52355
52400
52402
52450
52500
52601
52630
52640
52647
52648
52649
52700
53000
53010
Extraordinary No.64/2013
153
1728.00
2030.40
2414.70
641.48
2701.80
2482.20
2140.20
2169.90
2472.30
2156.95
1305.00
914.40
583.86
236.70
Friday, 09 August 2013
53230
Excision of urethral diverticulum (separate procedure); female
2214.90
53235
53240
Excision of urethral diverticulum (separate procedure); male
Marsupialization of urethral diverticulum, male or female
2060.10
852.30
53250
53260
Excision of bulbourethral gland (Cowper's gland)
Excision or fulguration; urethral polyp(s), distal urethra
1313.10
520.20
53265
53270
Excision or fulguration; urethral caruncle
Excision or fulguration; Skene's glands
530.10
564.30
53275
53400
Excision or fulguration; urethral prolapse
Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type)
622.80
1926.90
53405
53410
Urethroplasty; second stage (formation of urethra), including urinary diversion
Urethroplasty, one-stage reconstruction of male anterior urethra
Urethroplasty, transpubic or perineal, one stage, for reconstruction or repair of
prostatic or membranous urethra
Urethroplasty, two-stage reconstruction or repair of prostatic or membranous
urethra; first stage
Urethroplasty, two-stage reconstruction or repair of prostatic or membranous
urethra; second stage
Urethroplasty, reconstruction of female urethra
Urtp w/tubularization post urt&/lwr bldr
Operation for correction of male urinary incontinence, with or without introduction
of prosthesis
Removal of perineal prosthesis introduced for continence
2250.90
2686.50
Insj tandem cuff
Operation for correction of urinary incontinence with placement of inflatable
urethral or bladder neck sphincter, including placement of pump and/or reservoir
Rmvl nfltbl urtl/bldr nck sphnctr
Removal, repair, or replacement of inflatable sphincter including pump and/or
reservoir and/or cuff
Rmvl&rplcmt nfltbl nck sphnctr thru infct fld
Surgical correction of hydraulic abnormality of inflatable sphincter device
2081.89
720.90
53500
Urethromeatoplasty, with mucosal advancement
Urethromeatoplasty, with partial excision of distal urethral segment (Richardson
type procedure)
Urethrolss trvg sec opn w/csto
53502
53505
Urethrorrhaphy, suture of urethral wound or injury, female
Urethrorrhaphy, suture of urethral wound or injury; penile
1486.80
1532.70
53510
53515
Urethrorrhaphy, suture of urethral wound or injury; perineal
Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous
1917.90
2654.10
53520
53600
Closure of urethrostomy or urethrocutaneous fistula, male (separate procedure)
Dilation of urethral stricture by passage of sound or urethral dilator, male; initial
1213.20
154.80
53415
53420
53425
53430
53431
53440
53442
53444
53445
53446
53447
53448
53449
53450
53460
Extraordinary No.64/2013
154
3239.10
2888.10
2995.20
2496.60
2797.78
2991.60
1171.80
5150.70
1825.77
2507.40
3364.59
1864.80
726.30
1914.08
Friday, 09 August 2013
53620
Dilation of urethral stricture by passage of sound or urethral dilator, male;
subsequent
Dilation of urethral stricture or vesical neck by passage of sound or urethral dilator,
male, general or conduction (spinal) anesthesia
Dilation of urethral stricture by passage of filiform and follower, male; initial
53621
53660
Dilation of urethral stricture by passage of filiform and follower, male; subsequent
Dilation of female urethra including suppository and/or instillation; initial
137.70
114.30
53661
53665
Dilation of female urethra including suppository and/or instillation; subsequent
Dilation of female urethra, general or conduction (spinal) anesthesia
120.60
215.10
53850
53852
Transurethral destruction of prostate tissue; by microwave thermotherapy
Transurethral destruction of prostate tissue; by radiofrequency thermotherapy
1637.10
1448.10
53855
54000
Insert temp prostatic ureth stent w/measurement
Slitting of prepuce, dorsal or lateral (separate procedure); newborn
1749.79
164.70
54001
54015
314.10
437.40
54100
54105
Slitting of prepuce, dorsal or lateral (separate procedure); except newborn
Incision and drainage of penis, deep
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), simple; chemical
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), simple; electrodesiccation
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), simple; cryosurgery
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), simple; laser surgery
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), simple; surgical excision
Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum
contagiosum, herpetic vesicle), extensive, any method
Biopsy of penis; (separate procedure)
Biopsy of penis; deep structures
54110
54111
Excision of penile plaque (Peyronie disease);
Excision of penile plaque (Peyronie disease); with graft to 5 cm in length
1395.90
2362.50
54112
54115
Excision of penile plaque (Peyronie disease); with graft greater than 5 cm in length
Removal foreign body from deep penile tissue (eg, plastic implant)
2682.90
1062.00
54120
54125
Amputation of penis; partial
Amputation of penis; complete
2043.00
2709.00
54130
3754.80
54150
54160
Amputation of penis, radical; with bilateral inguinofemoral lymphadenectomy
Amputation of penis, radical; in continuity with bilateral pelvic lymphadenectomy,
including external iliac, hypogastric and obturator nodes
Circumcision, using clamp or other device; newborn
Circumcision, surgical excision other than clamp, device or dorsal slit; newborn
54161
Circumcision, surgical excision other than clamp, device or dorsal slit; except
860.79
53601
53605
54050
54055
54056
54057
54060
54065
54135
Extraordinary No.64/2013
155
149.40
230.40
218.70
134.50
271.58
239.88
601.20
481.62
906.65
266.40
447.30
4963.50
272.00
403.94
Friday, 09 August 2013
newborn
54162
54163
Lss/exc pen post-circumcision ads
Rpr incompl circumcision
426.82
415.19
54164
54200
Frenulotomy pns
Injection procedure for Peyronie disease;
409.15
129.60
54205
54220
Injection procedure for Peyronie disease; with surgical exposure of plaque
Irrigation of corpora cavernosa for priapism
1035.00
500.40
54230
Injection procedure for corpora cavernosography
Dynamic cavernosometry, including intracavernosal injection of vasoactive drugs
(eg, papaverine, phentolamine)
Injection of corpora cavernosa with pharmacologic agent(s) (eg, papaverine,
phentolamine)
Penile plethysmography
298.80
Penile plethysmography
250.20
Nocturnal penile tumescence and/or rigidity test
354.60
Nocturnal penile tumescence and/or rigidity test
300.60
54231
54235
54240
5424026
54250
5425026
54300
54304
54308
54312
54316
54318
54322
54324
54326
54328
54332
54336
Plastic operation of penis for straightening of chordee (eg, hypospadias), with or
without mobilization of urethra
Plastic operation on penis for correction of chordee or for first stage hypospadias
repair with or without transplantation of prepuce and/or skin flaps
Urethroplasty for second stage hypospadias repair (including urinary diversion);
less than 3 cm
Urethroplasty for second stage hypospadias repair (including urinary diversion);
greater than 3 cm
Urethroplasty for second stage hypospadias repair (including urinary diversion)
with free skin graft obtained from site other than genitalia
Urethroplasty for third stage hypospadias repair to release penis from scrotum (eg,
third stage Cecil repair)
One stage distal hypospadias repair (with or without chordee or circumcision);
with simple meatal advancement (eg, Magpi, V-flap)
One stage distal hypospadias repair (with or without chordee or circumcision);
with urethroplasty by local skin flaps (eg, flip-flap, prepucial flap)
One stage distal hypospadias repair (with or without chordee or circumcision);
with urethroplasty by local skin flaps and mobilization of urethra
One stage distal hypospadias repair (with or without chordee or circumcision);
with extensive dissection to correct chordee and urethroplasty with local skin flaps,
skin graft patch, and/or island flap
One stage proximal penile or penoscrotal hypospadias repair requiring extensive
dissection to correct chordee and urethroplasty by use of skin graft tube and/or
island flap
One stage perineal hypospadias repair requiring extensive dissection to correct
chordee and urethroplasty by use of skin graft tube and/or island flap
Extraordinary No.64/2013
156
468.90
206.10
298.80
1865.70
2242.80
2268.00
2523.60
3016.80
1798.20
2155.50
2382.30
2894.40
3250.80
3355.20
3821.40
Friday, 09 August 2013
54340
54344
54348
54352
54360
54380
Repair of hypospadias complications (ie, fistula, stricture, diverticula); by closure,
incision, or excision, simple
Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring
mobilization of skin flaps and urethroplasty with flap or patch graft
Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring
extensive dissection and urethroplasty with flap, patch or tubed graft (includes
urinary diversion)
Repair of hypospadias cripple requiring extensive dissection and excision of
previously constructed structures including re-release of chordee and
reconstruction of urethra and penis by use of local skin as grafts and island flaps
and skin brought in as f
Plastic operation on penis to correct angulation
1658.70
2642.40
2793.60
4481.10
2171.70
1931.40
54406
Plastic operation on penis for epispadias distal to external sphincter;
Plastic operation on penis for epispadias distal to external sphincter; with
incontinence
Plastic operation on penis for epispadias distal to external sphincter; with
exstrophy of bladder
Insertion of penile prosthesis; non-inflatable (semi-rigid)
Insertion of penile prosthesis; inflatable (self-contained)
Insertion of inflatable (multi-component) penile prosthesis, including placement of
pump, cylinders, and/or reservoir
Rmvl nfltbl pen prosth w/o rplcmt prosth
54408
54410
Rpr component multi-component nfltbl pen prosth
Rmvl&rplcmt nfltbl pen prosth sm sess
1921.58
2100.99
54411
54415
Rmvl&rplcmt nfltbl pen prosth thru infct fld
Rmvl non-nfltbl/nfltbl pen prosth w/o rplcmt
2627.25
1371.75
54416
54417
1604.70
2244.96
54440
54450
Rmvl&rplcmt non-nfltbl/nfltbl prosth sm sess
Rmvl&rplcmt non-nfltbl/nfltbl pen infct sm sess
Corpora cavernosa-saphenous vein shunt (priapism operation), unilateral or
bilateral
Corpora cavernosa-corpus spongiosum shunt (priapism operation), unilateral or
bilateral
Corpora cavernosa-glans penis fistulization (eg, biopsy needle, Winter procedure,
rongeur, or punch) for priapism
Plastic operation of penis for injury
Foreskin manipulation including lysis of preputial adhesions and stretching
54500
54505
Biopsy of testis, needle (separate procedure)
Biopsy of testis, incisional (separate procedure)
216.90
644.40
54512
Excision of extraparenchymal lesion of testis
Orchiectomy, simple (including subcapsular), with or without testicular prosthesis,
scrotal or inguinal approach
Orchiectomy, partial
1581.30
54385
54390
54400
54401
54405
54420
54430
54435
54520
54522
Extraordinary No.64/2013
157
2791.80
3728.70
2731.50
3038.40
4616.10
1880.16
2497.50
2107.80
1043.10
2582.10
306.90
1175.40
1944.00
Friday, 09 August 2013
54530
Orchiectomy, radical, for tumor; inguinal approach
1833.30
54535
54550
Orchiectomy, radical, for tumor; with abdominal exploration
Exploration for undescended testis (inguinal or scrotal area)
2160.00
1594.80
54560
1918.80
54620
54640
Exploration for undescended testis with abdominal exploration
Reduction of torsion of testis, surgical, with or without fixation of contralateral
testis
Fixation of contralateral testis (separate procedure)
Orchiopexy, inguinal approach, with or without hernia repair
54650
54660
Orchiopexy, abdominal approach, for intra-abdominal testis (eg, Fowler-Stephens)
Insertion of testicular prosthesis (separate procedure)
2026.80
810.90
54670
54680
Suture or repair of testicular injury
Transplantation of testis(es) to thigh (because of scrotal destruction)
1364.40
1658.70
54690
54692
1737.90
1801.80
54800
Laparoscopy, surgical; orchiectomy
Laparoscopy, surgical; orchiopexy for intra-abdominal testis
Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or
hematoma)
Biopsy of epididymis, needle
54830
54840
Excision of local lesion of epididymis
Excision of spermatocele, with or without epididymectomy
927.90
1296.00
54860
54861
Epididymectomy; unilateral
Epididymectomy; bilateral
1228.50
1728.00
54865
54900
Exploration epididymis w/wo biopsy
Epididymovasostomy, anastomosis of epididymis to vas deferens; unilateral
355.87
2325.60
54901
3038.40
55040
Epididymovasostomy, anastomosis of epididymis to vas deferens; bilateral
Puncture aspiration of hydrocele, tunica vaginalis, with or without injection of
medication
Excision of hydrocele; unilateral
55041
55060
Excision of hydrocele; bilateral
Repair of tunica vaginalis hydrocele (Bottle type)
2132.10
1287.90
55100
55110
Drainage of scrotal wall abscess
Scrotal exploration
311.40
1147.50
55120
55150
Removal of foreign body in scrotum
Resection of scrotum
633.60
1387.80
55175
55180
Scrotoplasty; simple
Scrotoplasty; complicated
Vasotomy, cannulization with or without incision of vas, unilateral or bilateral
(separate procedure)
Vasectomy, unilateral or bilateral (separate procedure), including postoperative
semen examination(s)
1220.40
2162.70
54600
54700
55000
55200
55250
Extraordinary No.64/2013
158
1393.65
835.20
1790.10
458.10
265.50
195.30
1405.80
648.90
699.30
Friday, 09 August 2013
55300
55400
55450
55500
55520
Vasotomy for vasograms, seminal vesiculograms, or epididymograms, unilateral or
bilateral
Vasovasostomy, vasovasorrhaphy
Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure)
647.10
2832.30
628.20
1228.50
1085.40
55550
55600
Excision of hydrocele of spermatic cord, unilateral (separate procedure)
Excision of lesion of spermatic cord (separate procedure)
Excision of varicocele or ligation of spermatic veins for varicocele; (separate
procedure)
Excision of varicocele or ligation of spermatic veins for varicocele; abdominal
approach
Excision of varicocele or ligation of spermatic veins for varicocele; with hernia
repair
Laparoscopy, surgical, with ligation of spermatic veins for varicocele
Vesiculotomy;
55605
55650
Vesiculotomy; complicated
Vesiculectomy, any approach
1653.30
2868.30
55680
55700
Excision of Mullerian duct cyst
Biopsy, prostate; needle or punch, single or multiple, any approach
2533.50
395.58
55705
55706
Biopsy, prostate; incisional, any approach
Bx prostate strtctc saturation sampling img gid
1171.80
1380.90
55720
55725
Prostatotomy, external drainage of prostatic abscess, any approach; simple
Prostatotomy, external drainage of prostatic abscess, any approach; complicated
Prostatectomy, perineal, subtotal (including control of postoperative bleeding,
vasectomy, meatotomy, urethral calibration and/or dilation, and internal
urethrotomy)
Prostatectomy, perineal radical;
Prostatectomy, perineal radical; with lymph node biopsy(s) (limited pelvic
lymphadenectomy)
Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including
external iliac, hypogastric and obturator nodes
Prostatectomy (including control of postoperative bleeding, vasectomy,
meatotomy, urethral calibration and/or dilation, and internal urethrotomy);
suprapubic, subtotal, one or two stages
Prostatectomy (including control of postoperative bleeding, vasectomy,
meatotomy, urethral calibration and/or dilation, and internal urethrotomy);
retropubic, subtotal
Prostatectomy, retropubic radical, with or without nerve sparing;
Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node
biopsy(s) (limited pelvic lymphadenectomy)
Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral
pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
Exposure of prostate, any approach, for insertion of radioactive substance;
1424.70
1768.50
55530
55535
55540
55801
55810
55812
55815
55821
55831
55840
55842
55845
55860
Extraordinary No.64/2013
159
1527.30
1635.30
1801.80
1717.20
1231.20
2970.00
3842.10
4482.00
6071.40
3183.30
3345.30
3969.90
4228.20
5271.39
2182.50
Friday, 09 August 2013
55875
Exposure of prostate, any approach, for insertion of radioactive substance; with
lymph node biopsy(s) (limited pelvic lymphadenectomy)
Exposure of prostate, any approach, for insertion of radioactive substance; with
bilateral pelvic lymphadenectomy, including external iliac, hypogastric and
obturator nodes
Laps prstect retropubic rad w/nrv sparing robot
Electroejaculation
Cryosurgical ablation of the prostate (includes ultrasonic guidance for interstitial
cryosurgical probe placement)
Tprnl plmt ndl/caths into prst8 radj insj
55876
55920
Place interstitial dev radiation tx prostate 1+
Placement needle pelvic organ radioelement appl
323.66
1072.06
56405
56420
Incision and drainage of vulva or perineal abscess
Incision and drainage of Bartholin's gland abscess
259.20
243.90
56440
56441
Marsupialization of Bartholin's gland cyst
Lysis of labial adhesions
718.20
456.30
56442
56501
Hymenotomy simple incision
Destruction of lesion(s), vulva; simple, any method
126.23
259.47
56515
56605
850.10
199.48
56620
Destruction of lesion(s), vulva; extensive, any method
Biopsy of vulva or perineum (separate procedure); one lesion
Biopsy of vulva or perineum (separate procedure); each separate additional lesion
(List separately in addition to code for primary procedure)
Vulvectomy simple; partial
56625
56630
Vulvectomy simple; complete
Vulvectomy, radical, partial;
2652.30
3249.90
56631
56632
Vulvectomy, radical, partial; with unilateral inguinofemoral lymphadenectomy
Vulvectomy, radical, partial; with bilateral inguinofemoral lymphadenectomy
4042.80
4846.50
56633
56634
Vulvectomy, radical, complete;
Vulvectomy, radical, complete; with unilateral inguinofemoral lymphadenectomy
4097.70
4748.40
56637
5682.60
56700
Vulvectomy, radical, complete; with bilateral inguinofemoral lymphadenectomy
Vulvectomy, radical, complete, with inguinofemoral, iliac, and pelvic
lymphadenectomy
Partial hymenectomy or revision of hymenal ring
56740
56800
Excision of Bartholin's gland or cyst
Plastic repair of introitus
920.70
898.20
56805
56810
Clitoroplasty for intersex state
Perineoplasty, repair of perineum, nonobstetrical (separate procedure)
2296.80
1035.90
56820
56821
Colposcopy vulva
Colposcopy vulva w/bx
198.44
293.12
55862
55865
55866
55870
55873
56606
56640
Extraordinary No.64/2013
160
3091.50
3793.50
4611.87
236.70
2685.60
1796.65
102.60
2186.10
5745.60
637.20
Friday, 09 August 2013
57000
Colpotomy; with exploration
914.40
57010
57020
Colpotomy; with drainage of pelvic abscess
Colpocentesis (separate procedure)
1030.50
249.30
57022
398.70
57061
57065
Incision and drainage of vaginal hematoma; post-obstetrical
Incision and drainage of vaginal hematoma; non-obstetrical (eg, post-trauma,
spontaneous bleeding)
Destruction of vaginal lesion(s); simple, any method
Destruction of vaginal lesion(s); extensive, any method
57100
57105
Biopsy of vaginal mucosa; simple (separate procedure)
Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)
232.20
724.50
57106
Vaginectomy, partial removal of vaginal wall;
Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue
(radical vaginectomy)
Vaginectomy, partial removal of vaginal wall; with removal of paravaginal tissue
(radical vaginectomy) with bilateral total pelvic lymphadenectomy and para-aortic
lymph node sampling (biopsy)
Vaginectomy, complete removal of vaginal wall;
Vaginectomy, complete removal of vaginal wall; with removal of paravaginal
tissue (radical vaginectomy)
Vaginectomy, complete removal of vaginal wall; with removal of paravaginal
tissue (radical vaginectomy) with bilateral total pelvic lymphadenectomy and paraaortic lymph node sampling (biopsy)
Colpocleisis (Le Fort type)
Excision of vaginal septum
1195.20
Excision of vaginal cyst or tumor
Irrigation of vagina and/or application of medicament for treatment of bacterial,
parasitic, or fungoid disease
Insj uterine tandem&/vag ovoids
Fitting and insertion of pessary or other intravaginal support device
710.87
Diaphragm or cervical cap fitting with instructions
Introduction of any hemostatic agent or pack for spontaneous or traumatic
nonobstetrical vaginal hemorrhage (separate procedure)
Colporrhaphy, suture of injury of vagina (nonobstetrical)
99.00
1352.70
57230
57240
Colpoperineorrhaphy, suture of injury of vagina and/or perineum (nonobstetrical)
Plastic operation on urethral sphincter, vaginal approach (eg, Kelly urethral
plication)
Plastic repair of urethrocele
Anterior colporrhaphy, repair of cystocele with or without repair of urethrocele
57250
57260
Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy
Combined anteroposterior colporrhaphy;
1559.70
2090.70
57265
Combined anteroposterior colporrhaphy; with enterocele repair
2418.62
57023
57107
57109
57110
57111
57112
57120
57130
57135
57150
57155
57160
57170
57180
57200
57210
57220
Extraordinary No.64/2013
161
398.70
442.80
1008.47
3107.70
3578.40
2316.60
3666.60
3849.30
2274.30
940.50
100.80
1064.04
113.40
322.20
978.30
1349.10
1215.90
1586.70
Friday, 09 August 2013
57267
Insj mesh/prosth pel floor dfct ea sit
693.09
57268
57270
Repair of enterocele, vaginal approach (separate procedure)
Repair of enterocele, abdominal approach (separate procedure)
1725.30
2124.90
57280
57282
Colpopexy, abdominal approach
Sacrospinous ligament fixation for prolapse of vagina
2472.30
2729.70
57283
1612.15
57285
57287
Colpopexy vag intra-prtl appr
Paravaginal defect repair (including repair of cystocele, stress urinary incontinence,
and/or incomplete vaginal prolapse)
Paravaginal defect repair vaginal approach
Removal or revision of sling for stress incontinence (eg, fascia or synthetic)
57288
57289
Sling operation for stress incontinence (eg, fascia or synthetic)
Pereyra procedure, including anterior colporrhaphy
2816.10
2429.10
57291
57292
Construction of artificial vagina; without graft
Construction of artificial vagina; with graft
3295.80
3924.90
57295
57296
Revj rmvl prostc vag grf vag appr
Revj w/rmvl prosthetic vag grf abd appro
1167.58
2490.17
57300
57305
Closure of rectovaginal fistula; vaginal or transanal approach
Closure of rectovaginal fistula; abdominal approach
1933.20
2477.70
57307
2581.20
57310
57311
Closure of rectovaginal fistula; abdominal approach, with concomitant colostomy
Closure of rectovaginal fistula; transperineal approach, with perineal body
reconstruction, with or without levator plication
Closure of urethrovaginal fistula;
Closure of urethrovaginal fistula; with bulbocavernosus transplant
57320
57330
Closure of vesicovaginal fistula; vaginal approach
Closure of vesicovaginal fistula; transvesical and vaginal approach
2652.30
2680.20
57335
57400
Vaginoplasty for intersex state
Dilation of vagina under anesthesia
3069.90
370.80
57410
57415
Pelvic examination under anesthesia
Removal of impacted vaginal foreign body (separate procedure) under anesthesia
318.60
415.80
57420
57421
Colposcopy entire vag w/cervix if present
Colposcopy entire vag w/cervix bx
238.08
339.81
57423
57425
Paravaginal defect repair laparoscopic approach
Laps surg colpopexy ssp vag apex
2061.99
2099.02
57426
57452
Revision prosthetic vaginal graft laparoscopic
Colposcopy (vaginoscopy); (separate procedure)
Colposcopy (vaginoscopy); with biopsy(s) of the cervix and/or endocervical
curettage
Colposcopy cervix vag bx cervix
1885.00
242.93
57284
57308
57454
57455
Extraordinary No.64/2013
162
2523.60
1555.83
2081.70
2317.50
2374.20
2729.70
343.46
169.72
Friday, 09 August 2013
57456
Colposcopy cervix vag endocrv curtg
187.31
57460
57461
953.23
893.18
57505
Colposcopy (vaginoscopy); with loop electrode excision procedure of the cervix
Colposcopy cervix vag eltrd conization cervix
Biopsy, single or multiple, or local excision of lesion, with or without fulguration
(separate procedure)
Endocervical curettage (not done as part of a dilation and curettage)
57510
57511
Cauterization of cervix; electro or thermal
Cauterization of cervix; cryocautery, initial or repeat
308.03
287.10
57513
1030.50
57540
57545
Cauterization of cervix; laser ablation
Conization of cervix, with or without fulguration, with or without dilation and
curettage, with or without repair; cold knife or laser
Conization of cervix, with or without fulguration, with or without dilation and
curettage, with or without repair; loop electrode excision
Trachelectomy (cervicectomy), amputation of cervix (separate procedure)
Radical trachelectomy, with bilateral total pelvic lymphadenectomy and para-aortic
lymph node sampling biopsy, with or without removal of tube(s), with or without
removal of ovary(s)
Excision of cervical stump, abdominal approach;
Excision of cervical stump, abdominal approach; with pelvic floor repair
57550
57555
Excision of cervical stump, vaginal approach;
Excision of cervical stump, vaginal approach; with anterior and/or posterior repair
1606.50
2096.10
57556
57558
Excision of cervical stump, vaginal approach; with repair of enterocele
Dilation & curettage cervical stump
2295.90
286.85
57700
57720
Cerclage of uterine cervix, nonobstetrical
Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach
1133.10
1098.90
57800
Dilation of cervical canal, instrumental (separate procedure)
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy),
without cervical dilation, any method (separate procedure)
Endometrial bx conjunct w/colposcopy
262.80
Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)
Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate
procedure); abdominal approach
Myomectomy, excision of fibroid tumor of uterus, single or multiple (separate
procedure); vaginal approach
Myomectomy 5+ > 250 gm abdl
Total abdominal hysterectomy (corpus and cervix), with or without removal of
tube(s), with or without removal of ovary(s);
Total abdominal hysterectomy (corpus and cervix), with or without removal of
tube(s), with or without removal of ovary(s); with colpo-urethrocystopexy (eg,
Marshall-Marchetti-Krantz, Burch)
Supracervical abdominal hysterectomy (subtotal hysterectomy), with or without
removal of tube(s), with or without removal of ovary(s)
903.20
57500
57520
57522
57530
57531
58100
58110
58120
58140
58145
58146
58150
58152
58180
Extraordinary No.64/2013
163
251.05
221.40
1079.10
1080.48
979.20
4499.10
2022.30
2276.10
266.06
146.06
2851.59
2299.50
2845.00
3175.21
3904.20
3280.50
Friday, 09 August 2013
58270
Total abdominal hysterectomy, including partial vaginectomy, with para-aortic and
pelvic lymph node sampling, with or without removal of tube(s), with or without
removal of ovary(s)
Radical abdominal hysterectomy, with bilateral total pelvic lymphadenectomy and
para-aortic lymph node sampling (biopsy), with or without removal of tube(s), with
or without removal of ovary(s)
Pelvic exenteration for gynecologic malignancy, with total abdominal
hysterectomy or cervicectomy, with or without removal of tube(s), with or without
removal of ovary(s), with removal of bladder and ureteral transplantations, and/or
abdominoperineal rese
Vaginal hysterectomy;
Vaginal hysterectomy; with removal of tube(s), and/or ovary(s)
Vaginal hysterectomy; with removal of tube(s), and/or ovary(s), with repair of
enterocele
Vaginal hysterectomy; with colpo-urethrocystopexy (Marshall-Marchetti-Krantz
type, Pereyra type, with or without endoscopic control)
Vaginal hysterectomy; with repair of enterocele
58275
58280
Vaginal hysterectomy, with total or partial colpectomy;
Vaginal hysterectomy, with total or partial colpectomy; with repair of enterocele
3759.30
3493.80
58285
58290
Vaginal hysterectomy, radical (Schauta type operation)
Vaginal hysterectomy uterus > 250 gm
3948.30
3249.20
58291
58292
Vag hyst > 250 gm rmvl tube&/ovary
Vag hyst > 250 gm rmvl tube&/ovary w/rpr ntrcl
3588.32
3867.52
58293
58294
Vag hyst > 250 gm colpo-urtcstopexy +-ndsc ctrl
Vag hyst > 250 gm rpr ntrcl
4011.49
3502.18
58300
58301
Insertion of intrauterine device (IUD)
Removal of intrauterine device (IUD)
308.70
124.20
58321
58322
Artificial insemination; intra-cervical
Artificial insemination; intra-uterine
183.60
226.80
58323
Sperm washing for artificial insemination
Catheterization and introduction of saline or contrast material for
hysterosonography or hysterosalpingography
Transcervical introduction of fallopian tube catheter for diagnosis and/or reestablishing patency (any method), with or without hysterosalpingography
Insj heyman capsls clinical brachytx
Chromotubation of oviduct, including materials
200.70
Endometrial ablation, thermal, without hysteroscopic guidance
Uterine suspension, with or without shortening of round ligaments, with or without
shortening of sacrouterine ligaments; (separate procedure)
Uterine suspension, with or without shortening of round ligaments, with or without
shortening of sacrouterine ligaments; with presacral sympathectomy
Hysterorrhaphy, repair of ruptured uterus (nonobstetrical)
681.30
58200
58210
58240
58260
58262
58263
58267
58340
58345
58346
58350
58353
58400
58410
58520
Extraordinary No.64/2013
164
3940.20
6048.90
8435.70
3085.20
3554.10
3879.90
3544.20
3762.90
279.39
1163.70
1416.42
360.90
1903.50
2566.80
1658.70
Friday, 09 August 2013
58540
Hysteroplasty, repair of uterine anomaly (Strassman type)
2497.50
58541
58542
Laps supracrv hyst 250 g/<
Laps supracrv hyst 250 g/< rmvl tube/ovary
2275.20
2512.31
58543
58544
Laps supracrv hyst >250 g
Laps supracrv hyst >250 g rmvl tube/ovary
2546.70
2839.57
58545
58546
Laps myomectomy exc 1-4 250 gm/<
Laps myomectomy exc 5+ > 250 grams
2496.86
3009.13
58548
Laps w/rad hyst w/bilat lmphadec rmvl tube/ovary
Laparoscopy, surgical; with vaginal hysterectomy with or without removal of
tube(s), with or without removal of ovary(s) (laparoscopic assisted vaginal
hysterectomy)
Laps w/vag hyst 250 gm/< rmvl tube&/ovary
Laps w/vag hyst > 250 grams
4382.63
3357.56
857.70
58561
58562
Laps vag hyst > 250 gm rmvl tube&/ovary
Hysteroscopy, diagnostic (separate procedure)
Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or
polypectomy, with or without D & C
Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)
Hysteroscopy, surgical; with division or resection of intrauterine septum (any
method)
Hysteroscopy, surgical; with removal of leiomyomata
Hysteroscopy, surgical; with removal of impacted foreign body
58563
58565
Hysteroscopy, surgical; with endometrial ablation (any method)
Hystsc occlusion plmt prm
2528.26
4424.15
58570
58571
Laparoscopy w total hysterectomy uterus 250 g/<
Laps total hysterectomy 250 g/<w tube/ovary
2503.83
2801.61
58572
58573
Laparoscopy total hysterectomy uterus>250 g
Laparoscopy tot hysterectomy >250 g w tube/ovary
Ligation or transection of fallopian tube(s), abdominal or vaginal approach,
unilateral or bilateral
Ligation or transection of fallopian tube(s), abdominal or vaginal approach,
postpartum, unilateral or bilateral, during same hospitalization (separate procedure)
Ligation or transection of fallopian tube(s) when done at the time of cesarean
section or intra-abdominal surgery (not a separate procedure) (List separately in
addition to code for primary procedure)
Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or
suprapubic approach
Laparoscopy, surgical; with lysis of adhesions (salpingolysis, ovariolysis) (separate
procedure)
Laparoscopy, surgical; with removal of adnexal structures (partial or total
oophorectomy and/or salpingectomy)
3013.79
3509.08
58550
58552
58553
58554
58555
58558
58559
58560
58600
58605
58611
58615
58660
58661
Extraordinary No.64/2013
165
3277.49
2608.28
3010.69
1402.27
1555.20
1865.70
2065.50
1035.00
1508.40
1312.20
861.75
1441.80
2250.71
2277.00
Friday, 09 August 2013
58662
58670
58671
58672
58673
58700
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic
viscera, or peritoneal surface by any method
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or
Falope ring)
Laparoscopy, surgical; with fimbrioplasty
Laparoscopy, surgical; with salpingostomy (salpingoneostomy)
2523.37
1802.70
1802.70
2601.00
1854.00
2060.10
58740
Salpingectomy, complete or partial, unilateral or bilateral (separate procedure)
Salpingo-oophorectomy, complete or partial, unilateral or bilateral (separate
procedure)
Lysis of adhesions (salpingolysis, ovariolysis)
58750
58752
Tubotubal anastomosis
Tubouterine implantation
3936.60
3450.60
58760
58770
3038.40
3193.20
58825
Fimbrioplasty
Salpingostomy (salpingoneostomy)
Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); vaginal
approach
Drainage of ovarian cyst(s), unilateral or bilateral, (separate procedure); abdominal
approach
Drainage of ovarian abscess; vaginal approach, open
Drainage of ovarian abscess; abdominal approach
Drainage of pelvic abscess, transvaginal or transrectal approach, percutaneous (eg,
ovarian, pericolic)
Transposition, ovary(s)
58900
58920
Biopsy of ovary, unilateral or bilateral (separate procedure)
Wedge resection or bisection of ovary, unilateral or bilateral
1833.30
2329.20
58925
58940
Ovarian cystectomy, unilateral or bilateral
Oophorectomy, partial or total, unilateral or bilateral;
Oophorectomy, partial or total, unilateral or bilateral; for ovarian, tubal or primary
peritoneal malignancy, with para-aortic and pelvic lymph node biopsies, peritoneal
washings, peritoneal biopsies, diaphragmatic assessments, with or without
salpingecto
Resection of ovarian, tubal or primary peritoneal malignancy with bilateral
salpingo-oophorectomy and omentectomy;
Resection of ovarian, tubal or primary peritoneal malignancy with bilateral
salpingo-oophorectomy and omentectomy; with total abdominal hysterectomy,
pelvic and limited para-aortic lymphadenectomy
Resection of ovarian, tubal or primary peritoneal malignancy with bilateral
salpingo-oophorectomy and omentectomy; with radical dissection for debulking
(ie, radical excision or destruction, intra-abdominal or retroperitoneal tumors)
Bso w/omntc tah&rad dsj debulking
Bso w/omntc tah debulking w/lmphadec
2331.00
2069.10
58720
58800
58805
58820
58822
58823
58943
58950
58951
58952
58953
58954
Extraordinary No.64/2013
166
2178.51
2415.84
1184.40
1800.90
1287.90
1772.10
706.50
1837.80
3457.80
3549.60
4583.70
5935.50
7745.77
8407.75
Friday, 09 August 2013
58956
Bso tot omntc tah mal
5467.49
58957
58958
5807.52
6432.44
58970
58974
Resection recrt mal w/omentectomy
Resection recrt mal w/omentectomy pel lmphadec
Laparotomy, for staging or restaging of ovarian, tubal or primary peritoneal
malignancy (second look), with or without omentectomy, peritoneal washing,
biopsy of abdominal and pelvic peritoneum, diaphragmatic assessment with pelvic
and limited para-aortic
Follicle puncture for oocyte retrieval, any method
Embryo transfer, intrauterine
58976
59000
Gamete, zygote, or embryo intrafallopian transfer, any method
Amniocentesis, any method
1545.30
332.21
59001
59012
Amniocnts ther amniotic flu rdctj us gid
Cordocentesis (intrauterine), any method
440.43
669.60
59015
59020
Chorionic villus sampling, any method
Fetal contraction stress test
360.90
178.81
59025
59030
115.69
194.40
59051
Fetal non-stress test
Fetal scalp blood sampling
Fetal monitoring during labor by consulting physician (ie, non-attending physician)
with written report; supervision and interpretation
Ftl mntr labor phys wrttn reprt interpj only
59070
59072
Tabdl amnionfs us gid
Ftl umbilical cord occlusion w/us gid
959.77
1227.78
59074
59076
Ftl flu drg us gid
Ftl shunt plmt us gid
935.82
1204.41
59100
1908.00
59160
Hysterotomy, abdominal (eg, for hydatidiform mole, abortion)
Surgical treatment of ectopic pregnancy; tubal or ovarian, requiring salpingectomy
and/or oophorectomy, abdominal or vaginal approach
Surgical treatment of ectopic pregnancy; tubal or ovarian, without salpingectomy
and/or oophorectomy
Surgical treatment of ectopic pregnancy; abdominal pregnancy
Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy requiring
total hysterectomy
Surgical treatment of ectopic pregnancy; interstitial, uterine pregnancy with partial
resection of uterus
Surgical treatment of ectopic pregnancy; cervical, with evacuation
Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or
oophorectomy
Laparoscopic treatment of ectopic pregnancy; with salpingectomy and/or
oophorectomy
Curettage, postpartum
59200
Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure)
276.79
58960
59050
59120
59121
59130
59135
59136
59140
59150
59151
Extraordinary No.64/2013
167
3839.96
1406.70
537.30
285.30
109.29
2453.40
2041.20
2061.90
2800.80
2285.10
1562.40
2317.50
2414.78
765.00
Friday, 09 August 2013
59300
Episiotomy or vaginal repair, by other than attending physician
566.10
59320
59325
Cerclage of cervix, during pregnancy; vaginal
Cerclage of cervix, during pregnancy; abdominal
1122.47
1416.60
59350
Hysterorrhaphy of ruptured uterus
Routine obstetric care including antepartum care, vaginal delivery (with or without
episiotomy, and/or forceps) and postpartum care
Vaginal delivery only (with or without episiotomy and/or forceps);
Vaginal delivery only (with or without episiotomy and/or forceps); including
postpartum care
External cephalic version, with or without tocolysis (List in addition to code(s) for
delivery)
Delivery of placenta (separate procedure)
Antepartum care only; 4-6 visits
2176.20
Antepartum care only; 7 or more visits
Postpartum care only (separate procedure)
Routine obstetric care including antepartum care, cesarean delivery, and
postpartum care
Cesarean delivery only;
1168.00
240.30
2676.17
59812
59820
Cesarean delivery only; including postpartum care
Subtotal or total hysterectomy after cesarean delivery (List separately in addition to
code for primary procedure)
Routine obstetric care including antepartum care, vaginal delivery (with or without
episiotomy, and/or forceps) and postpartum care, after previous cesarean delivery
Vaginal delivery only, after previous cesarean delivery (with or without episiotomy
and/or forceps);
Vaginal delivery only, after previous cesarean delivery (with or without episiotomy
and/or forceps); including postpartum care
Routine obstetric care including antepartum care, cesarean delivery, and
postpartum care, following attempted vaginal delivery after previous cesarean
delivery
Cesarean delivery only, following attempted vaginal delivery after previous
cesarean delivery;
Cesarean delivery only, following attempted vaginal delivery after previous
cesarean delivery; including postpartum care
Treatment of incomplete abortion, any trimester, completed surgically
Treatment of missed abortion, completed surgically; first trimester
59821
59830
Treatment of missed abortion, completed surgically; second trimester
Treatment of septic abortion, completed surgically
1081.80
1153.80
59840
59841
Induced abortion, by dilation and curettage
Induced abortion, by dilation and evacuation
Induced abortion, by one or more intra-amniotic injections (amniocentesisinjections), including hospital admission and visits, delivery of fetus and
947.70
1118.90
59400
59409
59410
59412
59414
59425
59426
59430
59510
59514
59515
59525
59610
59612
59614
59618
59620
59622
59850
Extraordinary No.64/2013
168
2781.00
1588.98
1924.97
540.90
484.20
747.00
3450.60
2233.35
1751.40
3295.80
2271.60
2339.10
3965.40
2781.00
2632.19
800.34
815.24
1398.60
Friday, 09 August 2013
secundines;
59866
Induced abortion, by one or more intra-amniotic injections (amniocentesisinjections), including hospital admission and visits, delivery of fetus and
secundines; with dilation and curettage and/or evacuation
Induced abortion, by one or more intra-amniotic injections (amniocentesisinjections), including hospital admission and visits, delivery of fetus and
secundines; with hysterotomy (failed intra-amniotic injection)
Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or
without cervical dilation (eg, laminaria), including hospital admission and visits,
delivery of fetus and secundines;
Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or
without cervical dilation (eg, laminaria), including hospital admission and visits,
delivery of fetus and secundines; with dilation and curettage and/or evacuation
Induced abortion, by one or more vaginal suppositories (eg, prostaglandin) with or
without cervical dilation (eg, laminaria), including hospital admission and visits,
delivery of fetus and secundines; with hysterotomy (failed medical evacuation)
Multifetal pregnancy reduction(s) (MPR)
59870
59871
Uterine evacuation and curettage for hydatidiform mole
Removal of cerclage suture under anesthesia (other than local)
1081.80
444.60
60000
60100
Incision and drainage of thyroglossal cyst, infected
Biopsy thyroid, percutaneous core needle
305.10
279.00
60200
60210
Excision of cyst or adenoma of thyroid, or transection of isthmus
Partial thyroid lobectomy, unilateral; with or without isthmusectomy
Partial thyroid lobectomy, unilateral; with contralateral subtotal lobectomy,
including isthmusectomy
Total thyroid lobectomy, unilateral; with or without isthmusectomy
Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy,
including isthmusectomy
Thyroidectomy, total or complete
1590.30
2587.50
3743.10
5427.00
60271
Thyroidectomy, total or subtotal for malignancy; with limited neck dissection
Thyroidectomy, total or subtotal for malignancy; with radical neck dissection
Thyroidectomy, removal of all remaining thyroid tissue following previous
removal of a portion of thyroid
Thyroidectomy, including substernal thyroid gland; sternal split or transthoracic
approach
Thyroidectomy, including substernal thyroid gland; cervical approach
60280
60281
Excision of thyroglossal duct cyst or sinus;
Excision of thyroglossal duct cyst or sinus; recurrent
2004.30
2155.50
60500
60502
Parathyroidectomy or exploration of parathyroid(s);
Parathyroidectomy or exploration of parathyroid(s); re-exploration
Parathyroidectomy or exploration of parathyroid(s); with mediastinal exploration,
sternal split or transthoracic approach
3088.80
3404.70
59851
59852
59855
59856
59857
60212
60220
60225
60240
60252
60254
60260
60270
60505
Extraordinary No.64/2013
169
1555.20
1869.30
1235.70
1441.80
1810.80
796.50
3165.30
2613.60
3329.10
3250.80
2396.70
4066.20
3284.10
3624.30
Friday, 09 August 2013
60600
Parathyroid autotransplantation (List separately in addition to code for primary
procedure)
Thymectomy, partial or total; transcervical approach (separate procedure)
Thymectomy, partial or total; sternal split or transthoracic approach, without
radical mediastinal dissection (separate procedure)
Thymectomy, partial or total; sternal split or transthoracic approach, with radical
mediastinal dissection (separate procedure)
Adrenalectomy, partial or complete, or exploration of adrenal gland with or
without biopsy, transabdominal, lumbar or dorsal (separate procedure);
Adrenalectomy, partial or complete, or exploration of adrenal gland with or
without biopsy, transabdominal, lumbar or dorsal (separate procedure); with
excision of adjacent retroperitoneal tumor
Excision of carotid body tumor; without excision of carotid artery
60605
60650
Excision of carotid body tumor; with excision of carotid artery
Laps adrnlectomy prtl/compl tabdl
3828.60
2901.27
61000
Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; initial
Subdural tap through fontanelle, or suture, infant, unilateral or bilateral; subsequent
taps
Ventricular puncture through previous burr hole, fontanelle, suture, or implanted
ventricular catheter/reservoir; without injection
Ventricular puncture through previous burr hole, fontanelle, suture, or implanted
ventricular catheter/reservoir; with injection of drug or other substance for
diagnosis or treatment
Cisternal or lateral cervical (C1-C2) puncture; without injection (separate
procedure)
Cisternal or lateral cervical (C1-C2) puncture; with injection of drug or other
substance for diagnosis or treatment (eg, C1-C2)
Puncture of shunt tubing or reservoir for aspiration or injection procedure
Twist drill hole for subdural or ventricular puncture;
Twist drill hole for subdural or ventricular puncture; for implanting ventricular
catheter or pressure recording device
Twist drill hole for subdural or ventricular puncture; for evacuation and/or drainage
of subdural hematoma
Burr hole(s) for ventricular puncture (including injection of gas, contrast media,
dye, or radioactive material)
Burr hole(s) or trephine; with biopsy of brain or intracranial lesion
Burr hole(s) or trephine; with drainage of brain abscess or cyst
Burr hole(s) or trephine; with subsequent tapping (aspiration) of intracranial
abscess or cyst
Burr hole(s) with evacuation and/or drainage of hematoma, extradural or subdural
347.40
Burr hole(s); with aspiration of hematoma or cyst, intracerebral
Burr hole(s); for implanting ventricular catheter, reservoir, EEG electrode(s) or
pressure recording device (separate procedure)
Insertion of subcutaneous reservoir, pump or continuous infusion system for
3850.20
60512
60520
60521
60522
60540
60545
61001
61020
61026
61050
61055
61070
61105
61107
61108
61120
61140
61150
61151
61154
61156
61210
61215
Extraordinary No.64/2013
170
802.80
3260.70
3193.20
4230.00
3249.90
3646.80
3170.70
268.20
477.00
539.10
422.10
605.70
314.10
1647.90
2286.90
3141.90
1748.70
3785.40
3656.70
1149.30
4333.50
2266.20
2421.00
Friday, 09 August 2013
connection to ventricular catheter
61250
61253
Burr hole(s) or trephine, supratentorial, exploratory, not followed by other surgery
Burr hole(s) or trephine, infratentorial, unilateral or bilateral
2483.10
3609.90
61304
61305
5562.00
5964.30
61316
Craniectomy or craniotomy, exploratory; supratentorial
Craniectomy or craniotomy, exploratory; infratentorial (posterior fossa)
Craniectomy or craniotomy for evacuation of hematoma, supratentorial; extradural
or subdural
Craniectomy or craniotomy for evacuation of hematoma, supratentorial;
intracerebral
Craniectomy or craniotomy for evacuation of hematoma, infratentorial; extradural
or subdural
Craniectomy or craniotomy for evacuation of hematoma, infratentorial;
intracerebellar
Inc&subq plmt crnl b1 grf
61320
61321
Craniectomy or craniotomy, drainage of intracranial abscess; supratentorial
Craniectomy or craniotomy, drainage of intracranial abscess; infratentorial
6000.30
5699.70
61322
61323
Crnec/crx dcmprive w/o lobec
Crnec/crx dcmprive w/lobec
5756.79
6798.55
61330
61332
Decompression of orbit only, transcranial approach
Exploration of orbit (transcranial approach); with biopsy
4500.90
5355.00
61333
61334
Exploration of orbit (transcranial approach); with removal of lesion
Exploration of orbit (transcranial approach); with removal of foreign body
5422.50
5355.00
61340
Other cranial decompression (eg, subtemporal), supratentorial
Craniectomy, suboccipital with cervical laminectomy for decompression of
medulla and spinal cord, with or without dural graft (eg, Arnold-Chiari
malformation)
Other cranial decompression, posterior fossa
4254.30
3904.20
61458
61460
Craniotomy for section of tentorium cerebelli (separate procedure)
Craniectomy, subtemporal, for section, compression, or decompression of sensory
root of gasserian ganglion
Craniectomy, suboccipital; for exploration or decompression of cranial nerves
Craniectomy, suboccipital; for section of one or more cranial nerves
61470
61480
Craniectomy, suboccipital; for medullary tractotomy
Craniectomy, suboccipital; for mesencephalic tractotomy or pedunculotomy
5194.80
4833.00
61490
61500
Craniotomy for lobotomy, including cingulotomy
Craniectomy; with excision of tumor or other bone lesion of skull
3848.40
5799.60
61501
Craniectomy; for osteomyelitis
Craniectomy, trephination, bone flap craniotomy; for excision of brain tumor,
supratentorial, except meningioma
Craniectomy, trephination, bone flap craniotomy; for excision of meningioma,
supratentorial
5518.80
61312
61313
61314
61315
61343
61345
61440
61450
61510
61512
Extraordinary No.64/2013
171
6644.70
6731.10
6798.60
7305.30
1146.13
7812.00
3861.00
5769.00
6541.20
6573.60
7210.80
7498.80
Friday, 09 August 2013
61514
61516
61517
61518
61519
61520
61521
61522
61524
Craniectomy, trephination, bone flap craniotomy; for excision of brain abscess,
supratentorial
Craniectomy, trephination, bone flap craniotomy; for excision or fenestration of
cyst, supratentorial
Impltj brn intrcv chemotx agt
Craniectomy for excision of brain tumor, infratentorial or posterior fossa; except
meningioma, cerebellopontine angle tumor, or midline tumor at base of skull
Craniectomy for excision of brain tumor, infratentorial or posterior fossa;
meningioma
Craniectomy for excision of brain tumor, infratentorial or posterior fossa;
cerebellopontine angle tumor
Craniectomy for excision of brain tumor, infratentorial or posterior fossa; midline
tumor at base of skull
Craniectomy, infratentorial or posterior fossa; for excision of brain abscess
6441.30
6448.50
317.57
7177.50
7713.00
8054.10
8868.60
6534.00
6491.70
61540
Craniectomy, infratentorial or posterior fossa; for excision or fenestration of cyst
Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of
cerebellopontine angle tumor;
Craniectomy, bone flap craniotomy, transtemporal (mastoid) for excision of
cerebellopontine angle tumor; combined with middle/posterior fossa
craniotomy/craniectomy
Subdural implantation of strip electrodes through one or more burr or trephine
hole(s) for long term seizure monitoring
Craniotomy with elevation of bone flap; for subdural implantation of an electrode
array, for long term seizure monitoring
Craniotomy with elevation of bone flap; for excision of epileptogenic focus
without electrocorticography during surgery
Craniotomy with elevation of bone flap; for removal of epidural or subdural
electrode array, without excision of cerebral tissue (separate procedure)
Craniotomy with elevation of bone flap; for excision of cerebral epileptogenic
focus, with electrocorticography during surgery (includes removal of electrode
array)
Crx b1 flap temporal lobe w/o ecog
Craniotomy with elevation of bone flap; for lobectomy with electrocorticography
during surgery, temporal lobe
Craniotomy with elevation of bone flap; for lobectomy with electrocorticography
during surgery, other than temporal lobe, partial or total
Crx b1 flap lobec oth/thn temporal lobe w/o ecog
61541
61542
Craniotomy with elevation of bone flap; for transection of corpus callosum
Craniotomy with elevation of bone flap; for total hemispherectomy
7540.20
7416.00
61543
Craniotomy with elevation of bone flap; for partial or subtotal hemispherectomy
Craniotomy with elevation of bone flap; for excision or coagulation of choroid
plexus
Craniotomy with elevation of bone flap; for excision of craniopharyngioma
Craniotomy for hypophysectomy or excision of pituitary tumor, intracranial
approach
6798.60
61526
61530
61531
61533
61534
61535
61536
61537
61538
61539
61544
61545
61546
Extraordinary No.64/2013
172
7533.00
7915.50
4017.60
5459.40
5832.00
3613.50
6593.40
5691.54
7169.40
6920.10
6750.11
5931.00
9750.60
7222.50
Friday, 09 August 2013
61548
61550
61552
61556
61557
61558
61559
61563
61564
61566
61567
61570
61571
61575
61576
61580
61581
61582
61583
61584
61585
61586
61590
Hypophysectomy or excision of pituitary tumor, transnasal or transseptal approach,
nonstereotactic
Craniectomy for craniosynostosis; single cranial suture
Craniectomy for craniosynostosis; multiple cranial sutures
6168.60
3863.70
4626.90
Craniotomy for craniosynostosis; frontal or parietal bone flap
Craniotomy for craniosynostosis; bifrontal bone flap
Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf
skull); not requiring bone grafts
Extensive craniectomy for multiple cranial suture craniosynostosis (eg, cloverleaf
skull); recontouring with multiple osteotomies and bone autografts (eg, barrel-stave
procedure) (includes obtaining grafts)
Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous
dysplasia); without optic nerve decompression
Excision, intra and extracranial, benign tumor of cranial bone (eg, fibrous
dysplasia); with optic nerve decompression
Crx b1 flap slctv amygdalohippocampectomy
Crx b1 flap mlt subpial trnsxjs w/ecog
4708.80
5355.90
Craniectomy or craniotomy; with excision of foreign body from brain
Craniectomy or craniotomy; with treatment of penetrating wound of brain
Transoral approach to skull base, brain stem or upper spinal cord for biopsy,
decompression or excision of lesion;
Transoral approach to skull base, brain stem or upper spinal cord for biopsy,
decompression or excision of lesion; requiring splitting of tongue and/or mandible
(including tracheostomy)
Craniofacial approach to anterior cranial fossa; extradural, including lateral
rhinotomy, ethmoidectomy, sphenoidectomy, without maxillectomy or orbital
exenteration
Craniofacial approach to anterior cranial fossa; extradural, including lateral
rhinotomy, orbital exenteration, ethmoidectomy, sphenoidectomy and/or
maxillectomy
Craniofacial approach to anterior cranial fossa; extradural, including unilateral or
bifrontal craniotomy, elevation of frontal lobe(s), osteotomy of base of anterior
cranial fossa
Craniofacial approach to anterior cranial fossa; intradural, including unilateral or
bifrontal craniotomy, elevation or resection of frontal lobe, osteotomy of base of
anterior cranial fossa
Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital
ridge osteotomy and elevation of frontal and/or temporal lobe(s); without orbital
exenteration
Orbitocranial approach to anterior cranial fossa, extradural, including supraorbital
ridge osteotomy and elevation of frontal and/or temporal lobe(s); with orbital
exenteration
Bicoronal, transzygomatic and/or LeFort I osteotomy approach to anterior cranial
fossa with or without internal fixation, without bone graft
Infratemporal pre-auricular approach to middle cranial fossa (parapharyngeal
6655.50
7112.70
Extraordinary No.64/2013
173
6180.30
7004.70
5598.00
7004.70
6648.74
7585.18
5925.60
6066.00
5279.40
6869.70
6235.20
6881.40
6746.40
7112.70
4247.10
8847.90
Friday, 09 August 2013
61591
61592
61595
61596
61597
61598
61600
61601
61605
61606
61607
61608
61609
61610
61611
61612
61613
61615
space, infratemporal and midline skull base, nasopharynx), with or without
disarticulation of the mandible, including parotidectomy, craniotomy,
decompression and/or mobilization
Infratemporal post-auricular approach to middle cranial fossa (internal auditory
meatus, petrous apex, tentorium, cavernous sinus, parasellar area, infratemporal
fossa) including mastoidectomy, resection of sigmoid sinus, with or without
decompression and
Orbitocranial zygomatic approach to middle cranial fossa (cavernous sinus and
carotid artery, clivus, basilar artery or petrous apex) including osteotomy of
zygoma, craniotomy, extra- or intradural elevation of temporal lobe
Transtemporal approach to posterior cranial fossa, jugular foramen or midline skull
base, including mastoidectomy, decompression of sigmoid sinus and/or facial
nerve, with or without mobilization
Transcochlear approach to posterior cranial fossa, jugular foramen or midline skull
base, including labyrinthectomy, decompression, with or without mobilization of
facial nerve and/or petrous carotid artery
Transcondylar (far lateral) approach to posterior cranial fossa, jugular foramen or
midline skull base, including occipital condylectomy, mastoidectomy, resection of
C1-C3 vertebral body(s), decompression of vertebral artery, with or without
mobilization
Transpetrosal approach to posterior cranial fossa, clivus or foramen magnum,
including ligation of superior petrosal sinus and/or sigmoid sinus
Resection or excision of neoplastic, vascular or infectious lesion of base of anterior
cranial fossa; extradural
Resection or excision of neoplastic, vascular or infectious lesion of base of anterior
cranial fossa; intradural, including dural repair, with or without graft
Resection or excision of neoplastic, vascular or infectious lesion of infratemporal
fossa, parapharyngeal space, petrous apex; extradural
Resection or excision of neoplastic, vascular or infectious lesion of infratemporal
fossa, parapharyngeal space, petrous apex; intradural, including dural repair, with
or without graft
Resection or excision of neoplastic, vascular or infectious lesion of parasellar area,
cavernous sinus, clivus or midline skull base; extradural
Resection or excision of neoplastic, vascular or infectious lesion of parasellar area,
cavernous sinus, clivus or midline skull base; intradural, including dural repair,
with or without graft
Transection or ligation, carotid artery in cavernous sinus; without repair (List
separately in addition to code for primary procedure)
Transection or ligation, carotid artery in cavernous sinus; with repair by
anastomosis or graft (List separately in addition to code for primary procedure)
Transection or ligation, carotid artery in petrous canal; without repair (List
separately in addition to code for primary procedure)
Transection or ligation, carotid artery in petrous canal; with repair by anastomosis
or graft (List separately in addition to code for primary procedure)
Obliteration of carotid aneurysm, arteriovenous malformation, or carotid-cavernous
fistula by dissection within cavernous sinus
Resection or excision of neoplastic, vascular or infectious lesion of base of
Extraordinary No.64/2013
174
9154.80
7725.60
6030.00
6489.00
7729.20
6545.70
5345.10
6008.40
5562.90
7875.00
7877.70
8641.80
2159.10
5758.20
1481.40
5562.00
8973.90
6874.20
Friday, 09 August 2013
61630
61635
posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral
bodies; extradural
Resection or excision of neoplastic, vascular or infectious lesion of base of
posterior cranial fossa, jugular foramen, foramen magnum, or C1-C3 vertebral
bodies; intradural, including dural repair, with or without graft
Secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa
following surgery of the skull base; by free tissue graft (eg, pericranium, fascia,
tensor fascia lata, adipose tissue, homologous or synthetic grafts)
Secondary repair of dura for CSF leak, anterior, middle or posterior cranial fossa
following surgery of the skull base; by local or regionalized vascularized pedicle
flap or myocutaneous flap (including galea, temporalis, frontalis or occipitalis
muscle)
Evasc temp balo artl occlusion
Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve
hemostasis, to occlude a vascular malformation), percutaneous, any method;
central nervous system (intracranial, spinal cord)
Transcatheter occlusion or embolization (eg, for tumor destruction, to achieve
hemostasis, to occlude a vascular malformation), percutaneous, any method; noncentral nervous system, head or neck (extracranial, brachiocephalic branch)
Balo angiop icra prq
Tcat plmt iv stent icra w/balo angiop if pfrmd
61640
61641
Balo dilat icra prq 1st vsl
Balo dilat icra prq ea vsl sm vasc fam
3692.54
1825.26
61642
61680
Balo dilat icra prq ea vsl diff vasc fam
Surgery of intracranial arteriovenous malformation; supratentorial, simple
1874.98
7841.70
61682
61684
Surgery of intracranial arteriovenous malformation; supratentorial, complex
Surgery of intracranial arteriovenous malformation; infratentorial, simple
9553.50
8433.00
61686
61690
Surgery of intracranial arteriovenous malformation; infratentorial, complex
Surgery of intracranial arteriovenous malformation; dural, simple
10935.90
7769.70
61692
Surgery of intracranial arteriovenous malformation; dural, complex
Surgery of complex intracranial aneurysm, intracranial approach; carotid
circulation
Surgery of complex intracranial aneurysm, intracranial approach; vertebrobasilar
circulation
Surgery of simple intracranial aneurysm, intracranial approach; carotid circulation
Surgery of simple intracranial aneurysm, intracranial approach; vertebrobasilar
circulation
Surgery of intracranial aneurysm, cervical approach by application of occluding
clamp to cervical carotid artery (Selverstone-Crutchfield type)
Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by
intracranial and cervical occlusion of carotid artery
Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by
intracranial electrothrombosis
8279.10
61616
61618
61619
61623
61624
61626
61697
61698
61700
61702
61703
61705
61708
Extraordinary No.64/2013
175
8987.40
3795.30
6327.00
2587.65
4705.20
3346.20
4445.59
5059.80
8145.00
7839.00
8034.30
7725.60
3445.20
8181.00
6218.10
Friday, 09 August 2013
61710
61711
61720
61735
61750
61751
61760
61770
61781
61782
61783
Surgery of aneurysm, vascular malformation or carotid-cavernous fistula; by intraarterial embolization, injection procedure, or balloon catheter
Anastomosis, arterial, extracranial-intracranial (eg, middle cerebral/cortical)
arteries
Creation of lesion by stereotactic method, including burr hole(s) and localizing and
recording techniques, single or multiple stages; globus pallidus or thalamus
Creation of lesion by stereotactic method, including burr hole(s) and localizing and
recording techniques, single or multiple stages; subcortical structure(s) other than
globus pallidus or thalamus
Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial
lesion;
Stereotactic biopsy, aspiration, or excision, including burr hole(s), for intracranial
lesion; with computerized axial tomography and/or magnetic resonance guidance
Stereotactic implantation of depth electrodes into the cerebrum for long term
seizure monitoring
Stereotactic localization, including burr hole(s), with insertion of catheter(s) or
probe(s) for placement of radiation source
Strtctc cptr asstd px idrl crnl
Strtctc cptr asstd px xdrl crnl
5119.20
6508.80
4897.80
5054.40
5047.20
5544.00
5960.70
5312.70
946.82
758.02
798.88
61796
Strtctc cptr asstd px spinal
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg,
alcohol, thermal, electrical, radiofrequency); gasserian ganglion
Creation of lesion by stereotactic method, percutaneous, by neurolytic agent (eg,
alcohol, thermal, electrical, radiofrequency); trigeminal medullary tract
Stereotactic radiosurgery 1 simple cranial les
61797
61798
Strtctc radiosurgery ea addl cranial les simple
Stereotactic radiosurgery 1 complex cranial les
1148.15
4339.38
61799
61800
Strtctc radiosurgery ea addl cranial les complex
Appl strtctc headframe stereotactic radiosurgery
1612.19
806.16
61850
3304.80
61863
61864
Twist drill or burr hole(s) for implantation of neurostimulator electrodes, cortical
Craniectomy or craniotomy for implantation of neurostimulator electrodes,
cerebral, cortical
Strtctc impltj nstim eltrd w/o mer 1st ra
Strtctc impltj nstim eltrd w/o mer ea ra
61867
61868
Strtctc impltj nstim eltrd w/mer 1st ra
Strtctc impltj nstim eltrdw/mer ea ra
5176.91
2433.01
61870
61875
Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical
Craniectomy for implantation of neurostimulator electrodes, cerebellar; subcortical
3723.30
3501.90
61880
Revision or removal of intracranial neurostimulator electrodes
Incision and subcutaneous placement of cranial neurostimulator pulse generator or
receiver, direct or inductive coupling; with connection to a single electrode array
Incision and subcutaneous placement of cranial neurostimulator pulse generator or
receiver, direct or inductive coupling; with connection to two or more electrode
2471.40
61790
61791
61860
61885
61886
Extraordinary No.64/2013
176
4118.40
3960.90
4260.08
4075.20
3473.61
1609.63
943.20
1390.50
Friday, 09 August 2013
arrays
61888
62000
Revision or removal of cranial neurostimulator pulse generator or receiver
Elevation of depressed skull fracture; simple, extradural
1009.80
3420.00
62005
4185.00
62120
62121
Elevation of depressed skull fracture; compound or comminuted, extradural
Elevation of depressed skull fracture; with repair of dura and/or debridement of
brain
Craniotomy for repair of dural/CSF leak, including surgery for rhinorrhea/otorrhea
Reduction of craniomegalic skull (eg, treated hydrocephalus); requiring craniotomy
and reconstruction with or without bone graft (includes obtaining grafts)
Repair of encephalocele, skull vault, including cranioplasty
Craniotomy for repair of encephalocele, skull base
62140
62141
Cranioplasty for skull defect; up to 5 cm diameter
Cranioplasty for skull defect; larger than 5 cm diameter
4598.10
4816.80
62142
62143
Removal of bone flap or prosthetic plate of skull
Replacement of bone flap or prosthetic plate of skull
3197.70
3862.80
62145
62146
4948.20
4377.60
62148
62161
Cranioplasty for skull defect with reparative brain surgery
Cranioplasty with autograft (includes obtaining bone grafts); up to 5 cm diameter
Cranioplasty with autograft (includes obtaining bone grafts); larger than 5 cm
diameter
Incise&retrieval subq cranioplasty bone graft
Nundsc icra dsj ads fenestration septum csts
62162
62163
Nundsc icra fenestration/exc cst plmt cath drg
Nundsc icra w/retrieval fb
6085.95
6926.90
62164
62165
Nundsc icra exc tum plmt cath drg
Nundsc icra exc pituitary tum
7165.41
6442.36
62180
62190
Ventriculocisternostomy (Torkildsen type operation)
Creation of shunt; subarachnoid/subdural-atrial, -jugular, -auricular
4006.80
3469.50
62192
62194
Creation of shunt; subarachnoid/subdural-peritoneal, -pleural, other terminus
Replacement or irrigation, subarachnoid/subdural catheter
3523.50
1296.90
62200
62201
Ventriculocisternostomy, third ventricle;
Ventriculocisternostomy 3rd vntrc neurondsc
4726.80
4996.62
62220
62223
Creation of shunt; ventriculo-atrial, -jugular, -auricular
Creation of shunt; ventriculo-peritoneal, -pleural, other terminus
4307.40
4331.70
62225
1852.20
62252
62256
Replacement or irrigation, ventricular catheter
Replacement or revision of CSF shunt, obstructed valve, or distal catheter in shunt
system
Reprogramming of programmable CSF shunt
Removal of complete CSF shunt system; without replacement
62258
Removal of complete CSF shunt system; with replacement by similar or other
4531.50
62010
62100
62117
62147
62230
Extraordinary No.64/2013
177
5310.00
5804.10
4892.40
4874.40
4878.00
4841.10
445.59
5992.94
3162.60
236.70
1863.00
Friday, 09 August 2013
shunt at same operation
62264
Percutaneous lysis of epidural adhesions using solution injection (eg, hypertonic
saline, enzyme) or mechanical means (eg, spring-wound catheter) including
radiologic localization (includes contrast when administered)
Prq lss edrl ads sln njx/mchnl loclzj 1 d
62268
62269
Percutaneous aspiration, spinal cord cyst or syrinx
Biopsy of spinal cord, percutaneous needle
1906.20
1579.50
62270
62272
Spinal puncture, lumbar, diagnostic
Spinal puncture, therapeutic, for drainage of spinal fluid (by needle or catheter)
215.10
283.50
62273
Injection, epidural, of blood or clot patch
Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
solutions), with or without other therapeutic substance; subarachnoid
Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
solutions), with or without other therapeutic substance; epidural, cervical or
thoracic
Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline
solutions), with or without other therapeutic substance; epidural, lumbar, sacral
(caudal)
Injection procedure for myelography and/or computerized axial tomography, spinal
(other than C1-C2 and posterior fossa)
Aspiration or decompression procedure, percutaneous, of nucleus pulposus of
intervertebral disk, any method, single or multiple levels, lumbar (eg, manual or
automated percutaneous diskectomy, percutaneous laser diskectomy)
Injection procedure for diskography, each level; lumbar
512.10
Injection procedure for diskography, each level; cervical or thoracic
Injection procedure for chemonucleolysis, including diskography, intervertebral
disk, single or multiple levels, lumbar
Injection procedure, arterial, for occlusion of arteriovenous malformation, spinal
Injection, single (not via indwelling catheter), not including neurolytic substances,
with or without contrast (for either localization or epidurography), of diagnostic or
therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, oth
Injection, single (not via indwelling catheter), not including neurolytic substances,
with or without contrast (for either localization or epidurography), of diagnostic or
therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, oth
Injection, including catheter placement, continuous infusion or intermittent bolus,
not including neurolytic substances, with or without contrast (for either localization
or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic,
Injection, including catheter placement, continuous infusion or intermittent bolus,
not including neurolytic substances, with or without contrast (for either localization
or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic,
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter,
for long-term medication administration via an external pump or implantable
reservoir/infusion pump; without laminectomy
Implantation, revision or repositioning of tunneled intrathecal or epidural catheter,
for long-term medication administration via an external pump or implantable
524.70
62263
62280
62281
62282
62284
62287
62290
62291
62292
62294
62310
62311
62318
62319
62350
62351
Extraordinary No.64/2013
178
1090.80
1042.86
483.30
566.10
636.30
522.90
3543.30
551.70
2452.50
1232.10
875.70
933.30
968.40
942.30
1545.30
2763.90
Friday, 09 August 2013
reservoir/infusion pump; with laminectomy
62355
62360
62361
62362
62365
63001
63003
63005
63011
63012
63015
63016
63017
63020
63030
63035
63040
Removal of previously implanted intrathecal or epidural catheter
Implantation or replacement of device for intrathecal or epidural drug infusion;
subcutaneous reservoir
Impltj/rplcmt ithcl/edrl nfs non-prgrbl pmp
Implantation or replacement of device for intrathecal or epidural drug infusion;
programmable pump, including preparation of pump, with or without programming
Removal of subcutaneous reservoir or pump, previously implanted for intrathecal
or epidural infusion
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
one or two vertebral segments; cervical
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
one or two vertebral segments; thoracic
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
one or two vertebral segments; lumbar, except for spondylolisthesis
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
one or two vertebral segments; sacral
Laminectomy with removal of abnormal facets and/or pars inter-articularis with
decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill
type procedure)
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
more than 2 vertebral segments; cervical
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
more than 2 vertebral segments; thoracic
Laminectomy with exploration and/or decompression of spinal cord and/or cauda
equina, without facetectomy, foraminotomy or diskectomy, (eg, spinal stenosis),
more than 2 vertebral segments; lumbar
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk;
one interspace, cervical
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk;
one interspace, lumbar (including open or endoscopically-assisted approach)
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk;
each additional interspace, cervical or lumbar (List separately in addition to code
for primar
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk,
reexploration, single interspace; cervical
Extraordinary No.64/2013
179
1368.00
566.10
1849.28
1653.30
1313.10
4944.60
5364.90
4862.70
4583.70
4892.40
6095.70
5768.10
5402.70
4932.00
5275.80
1433.70
5602.50
Friday, 09 August 2013
63042
63045
63046
63047
63048
63050
63051
63055
63056
63057
63064
63066
63075
63076
63077
63078
63081
63082
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including
partial facetectomy, foraminotomy and/or excision of herniated intervertebral disk,
reexploration, single interspace; lumbar
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or
lateral recess stenosis)), single vertebral segment; cervical
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or
lateral recess stenosis)), single vertebral segment; thoracic
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or
lateral recess stenosis)), single vertebral segment; lumbar
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with
decompression of spinal cord, cauda equina and/or nerve root(s), (eg, spinal or
lateral recess stenosis)), single vertebral segment; each additional segment,
cervical, thoracic, or lu
Lamop crv w/dcmprn spi cord 2/more vrt seg
Lamop crv dcmprn spi cord 2+ seg rcnstj b1
Transpedicular approach with decompression of spinal cord, equina and/or nerve
root(s) (eg, herniated intervertebral disk), single segment; thoracic
Transpedicular approach with decompression of spinal cord, equina and/or nerve
root(s) (eg, herniated intervertebral disk), single segment; lumbar (including
transfacet, or lateral extraforaminal approach) (eg, far lateral herniated
intervertebral disk)
Transpedicular approach with decompression of spinal cord, equina and/or nerve
root(s) (eg, herniated intervertebral disk), single segment; each additional segment,
thoracic or lumbar (List separately in addition to code for primary procedure)
Costovertebral approach with decompression of spinal cord or nerve root(s), (eg,
herniated intervertebral disk), thoracic; single segment
Costovertebral approach with decompression of spinal cord or nerve root(s), (eg,
herniated intervertebral disk), thoracic; each additional segment (List separately in
addition to code for primary procedure)
Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),
including osteophytectomy; cervical, single interspace
Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),
including osteophytectomy; cervical, each additional interspace (List separately in
addition to code for primary procedure)
Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),
including osteophytectomy; thoracic, single interspace
Diskectomy, anterior, with decompression of spinal cord and/or nerve root(s),
including osteophytectomy; thoracic, each additional interspace (List separately in
addition to code for primary procedure)
Vertebral corpectomy (vertebral body resection), partial or complete, anterior
approach with decompression of spinal cord and/or nerve root(s); cervical, single
segment
Vertebral corpectomy (vertebral body resection), partial or complete, anterior
approach with decompression of spinal cord and/or nerve root(s); cervical, each
Extraordinary No.64/2013
180
6077.70
5896.80
5850.90
6197.40
2574.90
5247.21
5950.77
6694.20
5550.30
1699.20
5833.80
1287.90
5081.40
1952.10
4871.70
1342.80
6626.70
1591.20
Friday, 09 August 2013
additional segment (List separately in addition to code for primary procedure)
63085
63086
63087
63088
63090
63091
63101
63102
63103
63170
63172
63173
63180
63182
63185
63190
63191
63194
63195
63196
63197
63198
Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic
approach with decompression of spinal cord and/or nerve root(s); thoracic, single
segment
Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic
approach with decompression of spinal cord and/or nerve root(s); thoracic, each
additional segment (List separately in addition to code for primary procedure)
Vertebral corpectomy (vertebral body resection), partial or complete, combined
thoracolumbar approach with decompression of spinal cord, cauda equina or nerve
root(s), lower thoracic or lumbar; single segment
Vertebral corpectomy (vertebral body resection), partial or complete, combined
thoracolumbar approach with decompression of spinal cord, cauda equina or nerve
root(s), lower thoracic or lumbar; each additional segment (List separately in
addition to code
Vertebral corpectomy (vertebral body resection), partial or complete,
transperitoneal or retroperitoneal approach with decompression of spinal cord,
cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment
Vertebral corpectomy (vertebral body resection), partial or complete,
transperitoneal or retroperitoneal approach with decompression of spinal cord,
cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional
segment (List separately
Vcrpec lat xtrcavitary dcmprn thrc 1 sgm
7022.70
1986.30
6282.90
1699.20
6551.10
1787.40
6101.26
Vcrpec lat xtrcavitary dcmprn lmbr 1 sgm
Vcrpec lat xtrcavitary dcmprn thrc/lmbr ea sgm
Laminectomy with myelotomy (eg, Bischof or DREZ type), cervical, thoracic, or
thoracolumbar
Laminectomy with drainage of intramedullary cyst/syrinx; to subarachnoid space
Laminectomy with drainage of intramedullary cyst/syrinx; to peritoneal space
Laminectomy and section of dentate ligaments, with or without dural graft,
cervical; one or two segments
Laminectomy and section of dentate ligaments, with or without dural graft,
cervical; more than two segments
Laminectomy with rhizotomy; one or two segments
Laminectomy with rhizotomy; more than two segments
6074.85
1901.26
Laminectomy with section of spinal accessory nerve
Laminectomy with cordotomy, with section of one spinothalamic tract, one stage;
cervical
Laminectomy with cordotomy, with section of one spinothalamic tract, one stage;
thoracic
Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage;
cervical
Laminectomy with cordotomy, with section of both spinothalamic tracts, one stage;
thoracic
Laminectomy with cordotomy with section of both spinothalamic tracts, two stages
within 14 days; cervical
3994.20
Extraordinary No.64/2013
181
5840.10
5694.30
5922.90
5348.70
5603.40
4599.00
5452.20
4356.90
4849.20
4980.60
5346.00
5892.30
Friday, 09 August 2013
63275
Laminectomy with cordotomy with section of both spinothalamic tracts, two stages
within 14 days; thoracic
Laminectomy, with release of tethered spinal cord, lumbar
Laminectomy for excision or occlusion of arteriovenous malformation of spinal
cord; cervical
Laminectomy for excision or occlusion of arteriovenous malformation of spinal
cord; thoracic
Laminectomy for excision or occlusion of arteriovenous malformation of spinal
cord; thoracolumbar
Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm,
extradural; cervical
Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm,
extradural; thoracic
Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm,
extradural; lumbar
Laminectomy for excision or evacuation of intraspinal lesion other than neoplasm,
extradural; sacral
Laminectomy for excision of intraspinal lesion other than neoplasm, intradural;
cervical
Laminectomy for excision of intraspinal lesion other than neoplasm, intradural;
thoracic
Laminectomy for excision of intraspinal lesion other than neoplasm, intradural;
lumbar
Laminectomy for excision of intraspinal lesion other than neoplasm, intradural;
sacral
Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, cervical
63276
63277
Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, thoracic
Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, lumbar
6246.90
5616.90
63278
Laminectomy for biopsy/excision of intraspinal neoplasm; extradural, sacral
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
extramedullary, cervical
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
extramedullary, thoracic
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
extramedullary, lumbar
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural, sacral
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
intramedullary, cervical
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
intramedullary, thoracic
Laminectomy for biopsy/excision of intraspinal neoplasm; intradural,
intramedullary, thoracolumbar
Laminectomy for biopsy/excision of intraspinal neoplasm; combined extraduralintradural lesion, any level
Ostpl rcnstj dorsal spi elmnts flwg ispi px
5306.40
63199
63200
63250
63251
63252
63265
63266
63267
63268
63270
63271
63272
63273
63280
63281
63282
63283
63285
63286
63287
63290
63295
Extraordinary No.64/2013
182
5892.30
4874.40
6437.70
6669.90
7471.80
5824.80
6412.50
5632.20
4805.10
5739.30
5804.10
5796.00
5023.80
6346.80
6412.50
6556.50
6702.30
5282.10
6808.50
7128.00
7533.00
7120.80
876.68
Friday, 09 August 2013
63615
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; extradural, cervical
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; extradural, thoracic by transthoracic approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; extradural, thoracic by thoracolumbar
approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; extradural, lumbar or sacral by transperitoneal
or retroperitoneal approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; intradural, cervical
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; intradural, thoracic by transthoracic approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; intradural, thoracic by thoracolumbar
approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; intradural, lumbar or sacral by transperitoneal
or retroperitoneal approach
Vertebral corpectomy (vertebral body resection), partial or complete, for excision
of intraspinal lesion, single segment; each additional segment (List separately in
addition to codes for single segment)
Creation of lesion of spinal cord by stereotactic method, percutaneous, any
modality (including stimulation and/or recording)
Stereotactic stimulation of spinal cord, percutaneous, separate procedure not
followed by other surgery
Stereotactic biopsy, aspiration, or excision of lesion, spinal cord
63620
63621
Stereotactic radiosurgery 1 spinal lesion
Stereotactic radiosurgery ea addl spinal lesion
1894.72
590.80
63650
63655
Percutaneous implantation of neurostimulator electrode array, epidural
Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural
3397.50
4462.20
63662
63664
3176.79
3472.26
63700
Rmvl spinal nstim eltrd plate/paddle incl fluor
Revj incl rplcmt nstim eltrd plt/pdle incl fluor
Incision and subcutaneous placement of spinal neurostimulator pulse generator or
receiver, direct or inductive coupling
Revision or removal of implanted spinal neurostimulator pulse generator or
receiver
Repair of meningocele; less than 5 cm diameter
63702
63704
Repair of meningocele; larger than 5 cm diameter
Repair of myelomeningocele; less than 5 cm diameter
3716.10
4053.60
63706
63707
Repair of myelomeningocele; larger than 5 cm diameter
Repair of dural/CSF leak, not requiring laminectomy
4401.00
4411.80
63709
Repair of dural/CSF leak or pseudomeningocele, with laminectomy
5055.30
63300
63301
63302
63303
63304
63305
63306
63307
63308
63600
63610
63685
63688
Extraordinary No.64/2013
183
6033.60
6150.60
6551.10
6489.00
6502.50
6653.70
6643.80
7065.90
1661.40
3244.50
2502.90
3785.40
2304.90
1452.60
3715.20
Friday, 09 August 2013
63710
4424.40
63744
63746
Dural graft, spinal
Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other; including
laminectomy
Creation of shunt, lumbar, subarachnoid-peritoneal, -pleural, or other;
percutaneous, not requiring laminectomy
Replacement, irrigation or revision of lumbosubarachnoid shunt
Removal of entire lumbosubarachnoid shunt system without replacement
64400
64402
Injection, anesthetic agent; trigeminal nerve, any division or branch
Injection, anesthetic agent; facial nerve
369.00
243.90
64405
64408
Injection, anesthetic agent; greater occipital nerve
Injection, anesthetic agent; vagus nerve
242.10
284.40
64410
64412
Injection, anesthetic agent; phrenic nerve
Injection, anesthetic agent; spinal accessory nerve
250.20
242.10
64413
64415
Injection, anesthetic agent; cervical plexus
Injection, anesthetic agent; brachial plexus
299.70
268.20
64416
64417
Injection anes brachial plexus cont nfs cath
Injection, anesthetic agent; axillary nerve
305.64
250.20
64418
64420
Injection, anesthetic agent; suprascapular nerve
Injection, anesthetic agent; intercostal nerve, single
274.07
261.90
64421
64425
Injection, anesthetic agent; intercostal nerves, multiple, regional block
Injection, anesthetic agent; ilioinguinal, iliohypogastric nerves
486.90
257.40
64430
64435
Injection, anesthetic agent; pudendal nerve
Injection, anesthetic agent; paracervical (uterine) nerve
261.00
234.90
64445
64446
Injection, anesthetic agent; sciatic nerve
Injection anes sciatic nerve cont infusion cath
326.70
305.97
64447
64448
Njx anes fem nrv 1
Injection anes femoral nerve cont infusion cath
228.81
275.13
64449
64450
Injection anes lumbar plexus post cont nfs cath
Injection, anesthetic agent; other peripheral nerve or branch
Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, single level
Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or
thoracic, each additional level (List separately in addition to code for primary
procedure)
Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral,
single level
Injection, anesthetic agent and/or steroid, transforaminal epidural; lumbar or sacral,
each additional level (List separately in addition to code for primary procedure)
Injection, anesthetic agent; sphenopalatine ganglion
Injection, anesthetic agent; carotid sinus (separate procedure)
306.30
185.40
63740
63741
64479
64480
64483
64484
64505
64508
Extraordinary No.64/2013
184
4424.40
2841.30
2214.90
1661.40
485.10
436.50
398.11
447.30
244.80
262.80
Friday, 09 August 2013
64510
Injection, anesthetic agent; stellate ganglion (cervical sympathetic)
295.20
64517
64520
Njx anes suprior hypogstr plexus
Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic)
385.18
490.41
64530
64550
Injection, anesthetic agent; celiac plexus, with or without radiologic monitoring
Application of surface (transcutaneous) neurostimulator
540.90
123.54
64553
64555
Percutaneous implantation of neurostimulator electrodes; cranial nerve
Percutaneous implantation of neurostimulator electrodes; peripheral nerve
360.90
309.60
64560
64561
Percutaneous implantation of neurostimulator electrodes; autonomic nerve
Prq impltj nstim eltrds sac nrv
391.50
1611.28
64565
64568
Percutaneous implantation of neurostimulator electrodes; neuromuscular
Inc impltj crnl nrv nstim eltrds & pulse gener
293.40
1127.59
64569
64570
Revision/replmt nstim crnl eltrds
Removal crnl nrv nstim eltrds & pulse generator
1130.12
999.18
64575
64577
Incision for implantation of neurostimulator electrodes; peripheral nerve
Incision for implantation of neurostimulator electrodes; autonomic nerve
963.90
963.90
64580
64581
Incision for implantation of neurostimulator electrodes; neuromuscular
Inc impltj nstim eltrds sac nrv
793.80
1141.09
64585
Revision or removal of peripheral neurostimulator electrodes
Incision and subcutaneous placement of peripheral neurostimulator pulse generator
or receiver, direct or inductive coupling
Revision or removal of peripheral neurostimulator pulse generator or receiver
Destruction by neurolytic agent, trigeminal nerve; supraorbital, infraorbital,
mental, or inferior alveolar branch
Destruction by neurolytic agent, trigeminal nerve; second and third division
branches at foramen ovale
Destruction by neurolytic agent, trigeminal nerve; second and third division
branches at foramen ovale under radiologic monitoring
Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (eg, for
blepharospasm, hemifacial spasm)
Chemodenervation of muscle(s); cervical spinal muscle(s) (eg, for spasmodic
torticollis)
Chemodenervation of muscle(s); extremity(s) and/or trunk muscle(s) (eg, for
dystonia, cerebral palsy, multiple sclerosis)
Destruction by neurolytic agent, intercostal nerve
Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral,
single level
Destruction by neurolytic agent, paravertebral facet joint nerve; lumbar or sacral,
each additional level (List separately in addition to code for primary procedure)
Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or
thoracic, single level
Destruction by neurolytic agent, paravertebral facet joint nerve; cervical or
thoracic, each additional level (List separately in addition to code for primary
678.60
64590
64595
64600
64605
64610
64612
64613
64614
64620
64622
64623
64626
64627
Extraordinary No.64/2013
185
738.90
530.10
540.90
669.60
1837.80
377.10
406.80
459.00
417.60
470.70
258.30
558.00
333.00
Friday, 09 August 2013
procedure)
64630
64640
Destruction by neurolytic agent; pudendal nerve
Destruction by neurolytic agent; other peripheral nerve or branch
391.50
394.20
64650
64653
106.28
139.04
64681
Chemodnrvtj eccrine glnds bth ax
Chemodnrvtj eccrine glnds oth area pr d
Destruction by neurolytic agent, celiac plexus, with or without radiologic
monitoring
Dstrj nulyt +-rad mntr suprior hypogstr plexus
64702
64704
Neuroplasty; digital, one or both, same digit
Neuroplasty; nerve of hand or foot
1325.70
1467.90
64708
64712
Neuroplasty, major peripheral nerve, arm or leg; other than specified
Neuroplasty, major peripheral nerve, arm or leg; sciatic nerve
1944.90
2121.30
64713
64714
Neuroplasty, major peripheral nerve, arm or leg; brachial plexus
Neuroplasty, major peripheral nerve, arm or leg; lumbar plexus
2725.20
2422.80
64716
64718
Neuroplasty and/or transposition; cranial nerve (specify)
Neuroplasty and/or transposition; ulnar nerve at elbow
2464.20
2523.60
64719
64721
Neuroplasty and/or transposition; ulnar nerve at wrist
Neuroplasty and/or transposition; median nerve at carpal tunnel
1989.90
1854.00
64722
64726
2050.20
751.50
64732
Decompression; unspecified nerve(s) (specify)
Decompression; plantar digital nerve
Internal neurolysis, requiring use of operating microscope (List separately in
addition to code for neuroplasty) (Neuroplasty includes external neurolysis)
Transection or avulsion of; supraorbital nerve
64734
64736
Transection or avulsion of; infraorbital nerve
Transection or avulsion of; mental nerve
1476.00
1255.50
64738
64740
Transection or avulsion of; inferior alveolar nerve by osteotomy
Transection or avulsion of; lingual nerve
1447.20
1586.70
64742
64744
Transection or avulsion of; facial nerve, differential or complete
Transection or avulsion of; greater occipital nerve
1668.60
1597.50
64746
64752
Transection or avulsion of; phrenic nerve
Transection or avulsion of; vagus nerve (vagotomy), transthoracic
Transection or avulsion of; vagi limited to proximal stomach (selective proximal
vagotomy, proximal gastric vagotomy, parietal cell vagotomy, supra- or highly
selective vagotomy)
Transection or avulsion of; vagus nerve (vagotomy), abdominal
Transection or avulsion of; pudendal nerve
Transection or avulsion of obturator nerve, extrapelvic, with or without adductor
tenotomy
Transection or avulsion of obturator nerve, intrapelvic, with or without adductor
803.70
2326.50
64680
64727
64755
64760
64761
64763
64766
Extraordinary No.64/2013
186
685.80
734.56
2111.40
1287.90
3316.50
1964.70
855.00
1021.50
1606.50
Friday, 09 August 2013
tenotomy
64771
64772
Transection or avulsion of other cranial nerve, extradural
Transection or avulsion of other spinal nerve, extradural
1647.90
2052.90
64774
64776
Excision of neuroma; cutaneous nerve, surgically identifiable
Excision of neuroma; digital nerve, one or both, same digit
Excision of neuroma; digital nerve, each additional digit (List separately in
addition to code for primary procedure)
Excision of neuroma; hand or foot, except digital nerve
Excision of neuroma; hand or foot, each additional nerve, except same digit (List
separately in addition to code for primary procedure)
Excision of neuroma; major peripheral nerve, except sciatic
922.50
1074.60
2403.00
64788
Excision of neuroma; sciatic nerve
Implantation of nerve end into bone or muscle (List separately in addition to
neuroma excision)
Excision of neurofibroma or neurolemmoma; cutaneous nerve
64790
64792
Excision of neurofibroma or neurolemmoma; major peripheral nerve
Excision of neurofibroma or neurolemmoma; extensive (including malignant type)
2151.90
2224.80
64795
64802
Biopsy of nerve
Sympathectomy, cervical
914.40
2657.70
64804
64809
Sympathectomy, cervicothoracic
Sympathectomy, thoracolumbar
3587.40
2945.70
64818
64820
Sympathectomy, lumbar
Sympth dgtal arts ea dgt
2699.10
1219.55
64821
64822
Sympth rdl art
Sympth ur art
1203.16
1201.92
64823
64831
Sympth supfc plmr arch
Suture of digital nerve, hand or foot; one nerve
Suture of digital nerve, hand or foot; each additional digital nerve (List separately
in addition to code for primary procedure)
Suture of one nerve, hand or foot; common sensory nerve
1223.47
1704.60
1967.40
2360.70
64840
Suture of one nerve, hand or foot; median motor thenar
Suture of one nerve, hand or foot; ulnar motor
Suture of each additional nerve, hand or foot (List separately in addition to code
for primary procedure)
Suture of posterior tibial nerve
64856
64857
Suture of major peripheral nerve, arm or leg, except sciatic; including transposition
Suture of major peripheral nerve, arm or leg, except sciatic; without transposition
2831.40
2518.20
64858
64859
Suture of sciatic nerve
Suture of each additional major peripheral nerve (List separately in addition to
2503.80
1147.50
64778
64782
64783
64784
64786
64787
64832
64834
64835
64836
64837
Extraordinary No.64/2013
187
461.70
1261.80
669.60
1841.40
1390.50
1159.20
927.90
1899.00
1134.90
2778.30
Friday, 09 August 2013
code for primary procedure)
64861
64862
Suture of; brachial plexus
Suture of; lumbar plexus
2703.60
3292.20
64864
64865
Suture of facial nerve; extracranial
Suture of facial nerve; infratemporal, with or without grafting
2355.30
3441.60
64866
64868
Anastomosis; facial-spinal accessory
Anastomosis; facial-hypoglossal
3690.90
4108.50
64870
Anastomosis; facial-phrenic
Suture of nerve; requiring secondary or delayed suture (List separately in addition
to code for primary neurorrhaphy)
Suture of nerve; requiring extensive mobilization, or transposition of nerve (List
separately in addition to code for nerve suture)
Nerve graft (includes obtaining graft), head or neck; up to 4 cm in length
3644.10
3234.60
64905
64907
Nerve graft (includes obtaining graft), head or neck; more than 4 cm length
Nerve graft (includes obtaining graft), single strand, hand or foot; up to 4 cm
length
Nerve graft (includes obtaining graft), single strand, hand or foot; more than 4 cm
length
Nerve graft (includes obtaining graft), single strand, arm or leg; up to 4 cm length
Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm
length
Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; up to
4 cm length
Nerve graft (includes obtaining graft), multiple strands (cable), hand or foot; more
than 4 cm length
Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; up to 4
cm length
Nerve graft (includes obtaining graft), multiple strands (cable), arm or leg; more
than 4 cm length
Nerve graft, each additional nerve; single strand (List separately in addition to code
for primary procedure)
Nerve graft, each additional nerve; multiple strands (cable) (List separately in
addition to code for primary procedure)
Nerve pedicle transfer; first stage
Nerve pedicle transfer; second stage
64910
64911
Nerve repair w/conduit ea nerve
Nerve repair w/autogenous vein graft ea nerve
1599.15
1901.18
65091
65093
Evisceration of ocular contents; without implant
Evisceration of ocular contents; with implant
1363.50
1705.50
65101
65103
Enucleation of eye; without implant
Enucleation of eye; with implant, muscles not attached to implant
2083.44
1895.40
65105
Enucleation of eye; with implant, muscles attached to implant
2379.60
64872
64874
64885
64886
64890
64891
64892
64893
64895
64896
64897
64898
64901
64902
Extraordinary No.64/2013
188
1768.50
2524.50
3759.30
3495.60
2845.80
2796.30
3074.40
3388.50
3841.20
3540.60
3940.20
2362.50
2455.20
2021.40
2226.60
Friday, 09 August 2013
65110
65112
65114
65125
65130
65135
65140
65150
65155
65175
65205
65210
65220
65222
65235
Exenteration of orbit (does not include skin graft), removal of orbital contents;
only
Exenteration of orbit (does not include skin graft), removal of orbital contents;
with therapeutic removal of bone
Exenteration of orbit (does not include skin graft), removal of orbital contents;
with muscle or myocutaneous flap
Modification of ocular implant with placement or replacement of pegs (eg, drilling
receptacle for prosthesis appendage) (separate procedure)
Insertion of ocular implant secondary; after evisceration, in scleral shell
Insertion of ocular implant secondary; after enucleation, muscles not attached to
implant
Insertion of ocular implant secondary; after enucleation, muscles attached to
implant
Reinsertion of ocular implant; with or without conjunctival graft
Reinsertion of ocular implant; with use of foreign material for reinforcement and/or
attachment of muscles to implant
Removal of ocular implant
Removal of foreign body, external eye; conjunctival superficial
Removal of foreign body, external eye; conjunctival embedded (includes
concretions), subconjunctival, or scleral nonperforating
Removal of foreign body, external eye; corneal, without slit lamp
3046.50
3127.50
3379.50
772.20
1467.90
1566.00
2068.20
1441.80
1653.30
1166.40
116.74
131.60
112.50
Removal of foreign body, external eye; corneal, with slit lamp
Removal of foreign body, intraocular; from anterior chamber or lens
Removal of foreign body, intraocular; from posterior segment, magnetic extraction,
anterior or posterior route
Removal of foreign body, intraocular; from posterior segment, nonmagnetic
extraction
Repair of laceration; conjunctiva, with or without nonperforating laceration sclera,
direct closure
Repair of laceration; conjunctiva, by mobilization and rearrangement, without
hospitalization
Repair of laceration; conjunctiva, by mobilization and rearrangement, with
hospitalization
Repair of laceration; cornea, nonperforating, with or without removal foreign body
163.91
1715.40
2082.60
65286
65290
Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue
Repair of laceration; cornea and/or sclera, perforating, with reposition or resection
of uveal tissue
Repair of laceration; application of tissue glue, wounds of cornea and/or sclera
Repair of wound, extraocular muscle, tendon and/or Tenon's capsule
65400
65410
Excision of lesion, cornea (keratectomy, lamellar, partial), except pterygium
Biopsy of cornea
1133.10
466.20
65420
65426
Excision or transposition of pterygium; without graft
Excision or transposition of pterygium; with graft
944.78
1369.33
65260
65265
65270
65272
65273
65275
65280
65285
Extraordinary No.64/2013
189
1864.80
2199.60
275.02
494.10
726.30
821.70
3026.69
927.00
1153.80
Friday, 09 August 2013
65430
122.40
65600
Scraping of cornea, diagnostic, for smear and/or culture
Removal of corneal epithelium; with or without chemocauterization (abrasion,
curettage)
Removal of corneal epithelium; with application of chelating agent (eg, EDTA)
Destruction of lesion of cornea by cryotherapy, photocoagulation or
thermocauterization
Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo)
65710
65730
Keratoplasty (corneal transplant); lamellar
Keratoplasty (corneal transplant); penetrating (except in aphakia)
3068.10
3759.30
65750
65755
Keratoplasty (corneal transplant); penetrating (in aphakia)
Keratoplasty (corneal transplant); penetrating (in pseudophakia)
3811.50
3698.10
65756
65760
Keratoplasty endothelial
Keratomileusis
2478.45
3709.80
65765
65767
Keratophakia
Epikeratoplasty
3844.80
3079.80
65770
65771
Keratoprosthesis
Radial keratotomy
3605.40
1617.30
65772
65775
Corneal relaxing incision for correction of surgically induced astigmatism
Corneal wedge resection for correction of surgically induced astigmatism
1199.70
1380.60
65780
65781
Ocular surface reconstruction amniotic membrane
Ocular surface reconstruction limbal allograft
1555.66
2458.31
65782
1989.88
65820
Occular surface reconstruction limbal autograft
Paracentesis of anterior chamber of eye (separate procedure); with diagnostic
aspiration of aqueous
Paracentesis of anterior chamber of eye (separate procedure); with therapeutic
release of aqueous
Paracentesis of anterior chamber of eye (separate procedure); with removal of
vitreous and/or discission of anterior hyaloid membrane, with or without air
injection
Paracentesis of anterior chamber of eye (separate procedure); with removal of
blood, with or without irrigation and/or air injection
Goniotomy
65850
65855
Trabeculotomy ab externo
Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)
2154.60
1647.90
65860
Severing adhesions of anterior segment, laser technique (separate procedure)
Severing adhesions of anterior segment of eye, incisional technique (with or
without injection of air or liquid) (separate procedure); goniosynechiae
Severing adhesions of anterior segment of eye, incisional technique (with or
without injection of air or liquid) (separate procedure); anterior synechiae, except
goniosynechiae
Severing adhesions of anterior segment of eye, incisional technique (with or
1277.10
65435
65436
65450
65800
65805
65810
65815
65865
65870
65875
Extraordinary No.64/2013
190
157.50
463.50
483.30
817.20
360.90
378.90
1247.40
1110.60
1758.60
1256.40
1376.10
1417.50
Friday, 09 August 2013
without injection of air or liquid) (separate procedure); posterior synechiae
65900
Severing adhesions of anterior segment of eye, incisional technique (with or
without injection of air or liquid) (separate procedure); corneovitreal adhesions
Removal of epithelial downgrowth, anterior chamber eye
65920
65930
Removal of implanted material, anterior segment eye
Removal of blood clot, anterior segment eye
1873.17
1298.70
66020
66030
Injection, anterior chamber (separate procedure); air or liquid
Injection, anterior chamber (separate procedure); medication
360.90
232.20
66130
66150
Excision of lesion, sclera
Fistulization of sclera for glaucoma; trephination with iridectomy
1153.80
1913.40
66155
1854.00
66174
66175
Fistulization of sclera for glaucoma; thermocauterization with iridectomy
Fistulization of sclera for glaucoma; sclerectomy with punch or scissors, with
iridectomy
Fistulization of sclera for glaucoma; iridencleisis or iridotasis
Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of
previous surgery
Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from
previous ocular surgery or trauma (includes injection of antifibrotic agents)
Trluml dilat aqueous canal w/o dev/stnt
Trluml dilat aqueous canal w/dev/stnt
66180
66185
Aqueous shunt to extraocular reservoir (eg, Molteno, Schocket, Denver-Krupin)
Revision of aqueous shunt to extraocular reservoir
2621.70
1754.10
66220
66225
2317.50
3115.80
66500
Repair of scleral staphyloma; without graft
Repair of scleral staphyloma; with graft
Revision or repair of operative wound of anterior segment, any type, early or late,
major or minor procedure
Iridotomy by stab incision (separate procedure); except transfixion
66505
66600
Iridotomy by stab incision (separate procedure); with transfixion as for iris bombe
Iridectomy, with corneoscleral or corneal section; for removal of lesion
844.20
1434.60
66605
2086.20
66700
Iridectomy, with corneoscleral or corneal section; with cyclectomy
Iridectomy, with corneoscleral or corneal section; peripheral for glaucoma
(separate procedure)
Iridectomy, with corneoscleral or corneal section; sector for glaucoma (separate
procedure)
Iridectomy, with corneoscleral or corneal section; optical (separate procedure)
Repair of iris, ciliary body (as for iridodialysis)
Suture of iris, ciliary body (separate procedure) with retrieval of suture through
small incision (eg, McCannel suture)
Ciliary body destruction; diathermy
66710
Ciliary body destruction; cyclophotocoagulation
1313.10
65880
66160
66165
66170
66172
66250
66625
66630
66635
66680
66682
Extraordinary No.64/2013
191
1403.10
1668.60
1874.70
1788.30
2064.60
2304.00
1664.54
1755.21
1555.20
891.00
1401.30
1356.30
1356.30
1522.80
1645.20
1231.20
Friday, 09 August 2013
66711
Ciliary bdy dstrj cyclopc ndsc
1283.69
66720
66740
Ciliary body destruction; cryotherapy
Ciliary body destruction; cyclodialysis
1313.10
1275.30
66761
1380.60
66852
Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (one or more sessions)
Iridoplasty by photocoagulation (one or more sessions) (eg, for improvement of
vision, for widening of anterior chamber angle)
Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure)
Discission of secondary membranous cataract (opacified posterior lens capsule
and/or anterior hyaloid); stab incision technique (Ziegler or Wheeler knife)
Discission of secondary membranous cataract (opacified posterior lens capsule
and/or anterior hyaloid); laser surgery (eg, YAG laser) (one or more stages)
Repositioning of intraocular lens prosthesis, requiring an incision (separate
procedure)
Removal of secondary membranous cataract (opacified posterior lens capsule
and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy
(iridocapsulotomy, iridocapsulectomy)
Removal of lens material; aspiration technique, one or more stages
Removal of lens material; phacofragmentation technique (mechanical or
ultrasonic) (eg, phacoemulsification), with aspiration
Removal of lens material; pars plana approach, with or without vitrectomy
66920
66930
Removal of lens material; intracapsular
Removal of lens material; intracapsular, for dislocated lens
2442.60
2337.30
66940
Removal of lens material; extracapsular (other than 66840, 66850, 66852)
Extracapsular cataract removal with insertion of intraocular lens prosthesis (one
stage procedure), manual or mechanical technique (eg, irrigation and aspiration or
phacoemulsification), complex, requiring devices or techniques not generally used
in routi
Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one
stage procedure)
Extracapsular cataract removal with insertion of intraocular lens prosthesis (one
stage procedure), manual or mechanical technique (eg, irrigation and aspiration or
phacoemulsification)
Insertion of intraocular lens prosthesis (secondary implant), not associated with
concurrent cataract removal
Exchange of intraocular lens
Removal of vitreous, anterior approach (open sky technique or limbal incision);
partial removal
Removal of vitreous, anterior approach (open sky technique or limbal incision);
subtotal removal with mechanical vitrectomy
Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach
(posterior sclerotomy)
Injection of vitreous substitute, pars plana or limbal approach, (fluid-gas
exchange), with or without aspiration (separate procedure)
Implantation of intravitreal drug delivery system (eg, ganciclovir implant),
2358.90
66762
66770
66820
66821
66825
66830
66840
66850
66982
66983
66984
66985
66986
67005
67010
67015
67025
67027
Extraordinary No.64/2013
192
1241.10
1347.30
1007.10
1117.54
1701.90
1787.40
2086.20
2266.20
2191.50
2692.80
2913.30
2961.00
2276.10
2513.70
2368.80
3078.00
1328.40
1447.20
2884.50
Friday, 09 August 2013
includes concomitant removal of vitreous
67028
67030
Intravitreal injection of a pharmacologic agent (separate procedure)
Discission of vitreous strands (without removal), pars plana approach
Severing of vitreous strands, vitreous face adhesions, sheets, membranes or
opacities, laser surgery (one or more stages)
Vitrectomy, mechanical, pars plana approach;
Vitrectomy, mechanical, pars plana approach; with focal endolaser
photocoagulation
Vitrectomy, mechanical, pars plana approach; with endolaser panretinal
photocoagulation
Vitrectomy pars plana remove preretinal membrane
677.70
1555.20
4430.03
4581.88
67113
Vitrectomy pars plana remove int memb retina
Vitrectomy pars plana remove subretinal membrane
Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with
or without drainage of subretinal fluid
Repair of retinal detachment, one or more sessions; photocoagulation, with or
without drainage of subretinal fluid
Repair of retinal detachment; scleral buckling (such as lamellar scleral dissection,
imbrication or encircling procedure), with or without implant, with or without
cryotherapy, photocoagulation, and drainage of subretinal fluid
Repair of retinal detachment; with vitrectomy, any method, with or without air or
gas tamponade, focal endolaser photocoagulation, cryotherapy, drainage of
subretinal fluid, scleral buckling, and/or removal of lens by same technique
Repair of retinal detachment; by injection of air or other gas (eg, pneumatic
retinopexy)
Repair of retinal detachment; by scleral buckling or vitrectomy, on patient having
previous ipsilateral retinal detachment repair(s) using scleral buckling or
vitrectomy techniques
Rpr complex retina detach vitrectomy & memb peel
67115
67120
Release of encircling material (posterior segment)
Removal of implanted material, posterior segment; extraocular
1184.40
1269.90
67121
Removal of implanted material, posterior segment; intraocular
Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without
drainage, one or more sessions; cryotherapy, diathermy
Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without
drainage, one or more sessions; photocoagulation (laser or xenon arc)
Destruction of localized lesion of retina (eg, macular edema, tumors), one or more
sessions; cryotherapy, diathermy
Destruction of localized lesion of retina (eg, macular edema, tumors), one or more
sessions; photocoagulation
Destruction of localized lesion of retina (eg, macular edema, tumors), one or more
sessions; radiation by implantation of source (includes removal of source)
Destruction of localized lesion of choroid (eg, choroidal neovascularization);
photocoagulation (eg, laser), one or more sessions
1663.20
67031
67036
67039
67040
67041
67042
67043
67101
67105
67107
67108
67110
67112
67141
67145
67208
67210
67218
67220
Extraordinary No.64/2013
193
1725.30
3816.00
4336.20
4686.30
3643.85
2293.20
2421.00
3351.60
4954.50
2899.80
3100.50
4729.72
1359.90
1518.03
1661.40
1524.43
2276.10
1760.40
Friday, 09 August 2013
67229
67250
Destruction of localized lesion of choroid (eg, choroidal neovascularization);
photodynamic therapy (includes intravenous infusion)
Dstrj les choroid pdt 2nd eye 1 sess
Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one
or more sessions; cryotherapy, diathermy
Destruction of extensive or progressive retinopathy (eg, diabetic retinopathy), one
or more sessions; photocoagulation (laser or xenon arc)
Extensive retinopathy 1+ sess preterm infant
Scleral reinforcement (separate procedure); without graft
67255
67311
Scleral reinforcement (separate procedure); with graft
Strabismus surgery, recession or resection procedure; one horizontal muscle
2400.30
1532.70
67312
Strabismus surgery, recession or resection procedure; two horizontal muscles
Strabismus surgery, recession or resection procedure; one vertical muscle
(excluding superior oblique)
Strabismus surgery, recession or resection procedure; two or more vertical muscles
(excluding superior oblique)
Strabismus surgery, any procedure, superior oblique muscle
Transposition procedure (eg, for paretic extraocular muscle), any extraocular
muscle (specify) (List separately in addition to code for primary procedure)
Strabismus surgery on patient with previous eye surgery or injury that did not
involve the extraocular muscles (List separately in addition to code for primary
procedure)
Strabismus surgery on patient with scarring of extraocular muscles (eg, prior ocular
injury, strabismus or retinal detachment surgery) or restrictive myopathy (eg,
dysthyroid ophthalmopathy) (List separately in addition to code for primary
procedure)
Strabismus surgery by posterior fixation suture technique, with or without muscle
recession (List separately in addition to code for primary procedure)
Placement of adjustable suture(s) during strabismus surgery, including
postoperative adjustment(s) of suture(s) (List separately in addition to code for
specific strabismus surgery)
Strabismus surgery involving exploration and/or repair of detached extraocular
muscle(s) (List separately in addition to code for primary procedure)
Release of extensive scar tissue without detaching extraocular muscle (separate
procedure)
Chemodenervation of extraocular muscle
2008.80
Biopsy extraocular muscle
Orbitotomy without bone flap (frontal or transconjunctival approach); for
exploration, with or without biopsy
Orbitotomy without bone flap (frontal or transconjunctival approach); with
drainage only
Orbitotomy without bone flap (frontal or transconjunctival approach); with
removal of lesion
Orbitotomy without bone flap (frontal or transconjunctival approach); with
removal of foreign body
544.18
67221
67225
67227
67228
67314
67316
67318
67320
67331
67332
67334
67335
67340
67343
67345
67346
67400
67405
67412
67413
Extraordinary No.64/2013
194
1009.80
424.48
1713.60
1702.39
1631.69
1955.70
1854.00
2276.10
2106.90
2286.90
1467.90
2152.80
1441.80
720.90
1802.70
1390.50
539.10
2160.00
1980.90
2352.60
2716.20
Friday, 09 August 2013
67505
Orbitotomy without bone flap (frontal or transconjunctival approach); with
removal of bone for decompression
Fine needle aspiration of orbital contents
Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with
removal of lesion
Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with
removal of foreign body
Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with
drainage
Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); with
removal of bone for decompression
Orbitotomy with bone flap or window, lateral approach (eg, Kroenlein); for
exploration, with or without biopsy
Retrobulbar injection; medication (separate procedure, does not include supply of
medication)
Retrobulbar injection; alcohol
67515
67550
Injection of therapeutic agent into Tenon's capsule
Orbital implant (implant outside muscle cone); insertion
139.50
1802.70
67560
67570
Orbital implant (implant outside muscle cone); removal or revision
Optic nerve decompression (eg, incision or fenestration of optic nerve sheath)
1784.70
2440.80
67700
67710
Blepharotomy, drainage of abscess, eyelid
Severing of tarsorrhaphy
184.47
311.40
67715
67800
Canthotomy (separate procedure)
Excision of chalazion; single
366.30
218.88
67801
67805
Excision of chalazion; multiple, same lid
Excision of chalazion; multiple, different lids
Excision of chalazion; under general anesthesia and/or requiring hospitalization,
single or multiple
Biopsy of eyelid
304.59
356.44
Correction of trichiasis; epilation, by forceps only
Correction of trichiasis; epilation by other than forceps (eg, by electrosurgery,
cryotherapy, laser surgery)
Correction of trichiasis; incision of lid margin
Correction of trichiasis; incision of lid margin, with free mucous membrane graft
Excision of lesion of eyelid (except chalazion) without closure or with simple
direct closure
Destruction of lesion of lid margin (up to 1 cm)
Temporary closure of eyelids by suture (eg, Frost suture)
94.99
Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy;
Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy;
with transposition of tarsal plate
Repair of brow ptosis (supraciliary, mid-forehead or coronal approach)
864.00
67414
67415
67420
67430
67440
67445
67450
67500
67808
67810
67820
67825
67830
67835
67840
67850
67875
67880
67882
67900
Extraordinary No.64/2013
195
2228.40
437.40
3352.50
2887.20
3031.20
2722.50
2966.40
175.50
280.80
565.20
250.20
178.20
503.10
1691.10
353.47
252.00
442.80
1364.40
1399.50
Friday, 09 August 2013
67901
2169.00
67909
67911
Repair of blepharoptosis; frontalis muscle technique with suture or other material
Repair of blepharoptosis; frontalis muscle technique with fascial sling (includes
obtaining fascia)
Repair of blepharoptosis; (tarso) levator resection or advancement, internal
approach
Repair of blepharoptosis; (tarso) levator resection or advancement, external
approach
Repair of blepharoptosis; superior rectus technique with fascial sling (includes
obtaining fascia)
Repair of blepharoptosis; conjunctivo-tarso-Muller's muscle-levator resection (eg,
Fasanella-Servat type)
Reduction of overcorrection of ptosis
Correction of lid retraction
67912
67914
Corrj lagophthalmos impltj upr eyelid lid load
Repair of ectropion; suture
2145.90
977.40
67915
67916
483.30
1341.90
67921
Repair of ectropion; thermocauterization
Repair of ectropion; blepharoplasty, excision tarsal wedge
Repair of ectropion; blepharoplasty, extensive (eg, Kuhnt-Szymanowski or tarsal
strip operations)
Repair of entropion; suture
67922
67923
Repair of entropion; thermocauterization
Repair of entropion; blepharoplasty, excision tarsal wedge
378.90
1467.90
67924
Repair of entropion; blepharoplasty, extensive (eg, Wheeler operation)
Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral
conjunctiva direct closure; partial thickness
Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral
conjunctiva direct closure; full thickness
Removal of embedded foreign body, eyelid
Canthoplasty (reconstruction of canthus)
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or
full thickness, may include preparation for skin graft or pedicle flap with adjacent
tissue transfer or rearrangement; up to one-fourth of lid margin
Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or
full thickness, may include preparation for skin graft or pedicle flap with adjacent
tissue transfer or rearrangement; over one-fourth of lid margin
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from
opposing eyelid; up to two-thirds of eyelid, one stage or first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from
opposing eyelid; total eyelid, lower, one stage or first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from
opposing eyelid; total eyelid, upper, one stage or first stage
Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from
opposing eyelid; second stage
1857.60
67902
67903
67904
67906
67908
67917
67930
67935
67938
67950
67961
67966
67971
67973
67974
67975
Extraordinary No.64/2013
196
2372.40
2374.20
2879.10
2122.20
1909.80
1689.30
2162.70
1854.00
769.50
949.50
1545.30
222.30
1822.50
2062.80
2368.80
2272.50
3181.50
3420.90
1535.40
Friday, 09 August 2013
68020
Incision of conjunctiva, drainage of cyst
166.30
68040
68100
Expression of conjunctival follicles (eg, for trachoma)
Biopsy of conjunctiva
128.70
187.20
68110
68115
Excision of lesion, conjunctiva; up to 1 cm
Excision of lesion, conjunctiva; over 1 cm
365.72
454.50
68130
68135
Excision of lesion, conjunctiva; with adjacent sclera
Destruction of lesion, conjunctiva
813.60
247.50
68200
68320
Subconjunctival injection
Conjunctivoplasty; with conjunctival graft or extensive rearrangement
178.20
1654.20
68325
2090.70
68360
Conjunctivoplasty; with buccal mucous membrane graft (includes obtaining graft)
Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive
rearrangement
Conjunctivoplasty, reconstruction cul-de-sac; with buccal mucous membrane graft
(includes obtaining graft)
Repair of symblepharon; conjunctivoplasty, without graft
Repair of symblepharon; with free graft conjunctiva or buccal mucous membrane
(includes obtaining graft)
Repair of symblepharon; division of symblepharon, with or without insertion of
conformer or contact lens
Conjunctival flap; bridge or partial (separate procedure)
68362
68371
Conjunctival flap; total (such as Gunderson thin flap or purse string flap)
Hrvg cjncl algrft liv don
1544.40
817.41
68400
68420
Incision, drainage of lacrimal gland
Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy)
301.50
362.70
68440
68500
Snip incision of lacrimal punctum
Excision of lacrimal gland (dacryoadenectomy), except for tumor; total
276.30
1859.40
68505
68510
Excision of lacrimal gland (dacryoadenectomy), except for tumor; partial
Biopsy of lacrimal gland
1574.10
674.10
68520
68525
Excision of lacrimal sac (dacryocystectomy)
Biopsy of lacrimal sac
1632.60
518.40
68530
68540
Removal of foreign body or dacryolith, lacrimal passages
Excision of lacrimal gland tumor; frontal approach
947.70
2062.80
68550
68700
Excision of lacrimal gland tumor; involving osteotomy
Plastic repair of canaliculi
2482.20
1694.70
68705
68720
Correction of everted punctum, cautery
Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity)
265.50
2123.10
68745
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); without tube
Conjunctivorhinostomy (fistulization of conjunctiva to nasal cavity); with insertion
of tube or stent
2060.10
68326
68328
68330
68335
68340
68750
Extraordinary No.64/2013
197
2130.30
2104.20
1292.40
1466.10
1123.20
978.30
2332.80
Friday, 09 August 2013
68760
Closure of the lacrimal punctum; by thermocauterization, ligation, or laser surgery
283.50
68761
68770
Closure of the lacrimal punctum; by plug, each
Closure of lacrimal fistula (separate procedure)
256.50
925.20
68801
68810
136.80
195.30
68840
68850
Dilation of lacrimal punctum, with or without irrigation
Probing of nasolacrimal duct, with or without irrigation;
Probing of nasolacrimal duct, with or without irrigation; requiring general
anesthesia
Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or
stent
Probing of lacrimal canaliculi, with or without irrigation
Injection of contrast medium for dacryocystography
69000
69005
Drainage external ear, abscess or hematoma; simple
Drainage external ear, abscess or hematoma; complicated
190.80
526.50
69020
69090
Drainage external auditory canal, abscess
Ear piercing
200.70
105.30
69100
69105
Biopsy external ear
Biopsy external auditory canal
164.70
234.90
69110
69120
Excision external ear; partial, simple repair
Excision external ear; complete amputation
848.70
1729.80
69140
69145
Excision exostosis(es), external auditory canal
Excision soft tissue lesion, external auditory canal
1996.20
643.50
69150
69155
Radical excision external auditory canal lesion; without neck dissection
Radical excision external auditory canal lesion; with neck dissection
2611.80
4492.80
69200
69205
Removal foreign body from external auditory canal; without general anesthesia
Removal foreign body from external auditory canal; with general anesthesia
128.70
525.89
69210
69220
64.34
104.73
69320
69400
Removal impacted cerumen (separate procedure), one or both ears
Debridement, mastoidectomy cavity, simple (eg, routine cleaning)
Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than
routine cleaning)
Otoplasty, protruding ear, with or without size reduction
Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to
trauma, infection) (separate procedure)
Reconstruction external auditory canal for congenital atresia, single stage
Eustachian tube inflation, transnasal; with catheterization
69401
69405
Eustachian tube inflation, transnasal; without catheterization
Eustachian tube catheterization, transtympanic
108.90
154.80
69420
Myringotomy including aspiration and/or eustachian tube inflation
Myringotomy including aspiration and/or eustachian tube inflation requiring
general anesthesia
268.20
68811
68815
69222
69300
69310
69421
Extraordinary No.64/2013
198
422.10
532.80
178.20
170.10
315.90
2126.70
3252.60
3473.10
144.90
380.70
Friday, 09 August 2013
69424
Ventilating tube removal when originally inserted by another physician
226.80
69433
69436
Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia
Tympanostomy (requiring insertion of ventilating tube), general anesthesia
426.42
621.90
69440
69450
Middle ear exploration through postauricular or ear canal incision
Tympanolysis, transcanal
2028.60
2083.50
69501
69502
Transmastoid antrotomy (simple mastoidectomy)
Mastoidectomy; complete
2442.60
3323.70
69505
69511
Mastoidectomy; modified radical
Mastoidectomy; radical
3462.30
3429.00
69530
69535
Petrous apicectomy including radical mastoidectomy
Resection temporal bone, external approach
4139.10
6341.40
69540
69550
Excision aural polyp
Excision aural glomus tumor; transcanal
322.20
3636.90
69552
69554
Excision aural glomus tumor; transmastoid
Excision aural glomus tumor; extended (extratemporal)
4195.80
5842.80
69601
69602
Revision mastoidectomy; resulting in complete mastoidectomy
Revision mastoidectomy; resulting in modified radical mastoidectomy
3073.50
3607.20
69603
69604
Revision mastoidectomy; resulting in radical mastoidectomy
Revision mastoidectomy; resulting in tympanoplasty
3481.20
3876.30
69605
Revision mastoidectomy; with apicectomy
Tympanic membrane repair, with or without site preparation or perforation for
closure, with or without patch
Myringoplasty (surgery confined to drumhead and donor area)
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or
middle ear surgery), initial or revision; without ossicular chain reconstruction
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or
middle ear surgery), initial or revision; with ossicular chain reconstruction (eg,
postfenestration)
Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or
middle ear surgery), initial or revision; with ossicular chain reconstruction and
synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total
ossicular repl
Tympanoplasty with antrotomy or mastoidotomy (including canalplasty,
atticotomy, middle ear surgery, and/or tympanic membrane repair); without
ossicular chain reconstruction
Tympanoplasty with antrotomy or mastoidotomy (including canalplasty,
atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular
chain reconstruction
Tympanoplasty with antrotomy or mastoidotomy (including canalplasty,
atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular
chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement
3746.70
69610
69620
69631
69632
69633
69635
69636
69637
Extraordinary No.64/2013
199
432.90
2461.50
3134.70
3681.00
3594.60
3904.20
4133.70
4131.90
Friday, 09 August 2013
prosthesis (PORP), total
69662
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); without ossicular chain reconstruction
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); with ossicular chain reconstruction
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); with intact or reconstructed wall, without ossicular
chain reconstruction
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); with intact or reconstructed canal wall, with ossicular
chain reconstruction
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); radical or complete, without ossicular chain
reconstruction
Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery,
tympanic membrane repair); radical or complete, with ossicular chain
reconstruction
Stapes mobilization
Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or
without use of foreign material;
Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or
without use of foreign material; with footplate drill out
Revision of stapedectomy or stapedotomy
69666
69667
Repair oval window fistula
Repair round window fistula
3217.50
3156.30
69670
69676
Mastoid obliteration (separate procedure)
Tympanic neurectomy
3295.80
2268.90
69700
1625.40
69714
69715
Closure postauricular fistula, mastoid (separate procedure)
Removal or repair of electromagnetic bone conduction hearing device in temporal
bone
Impltj oi implt b1 w/o mstdc
Impltj oi implt b1 mstdc
69717
69718
Rplcmt oi implt b1 w/o mstdc
Rplcmt oi implt b1 mstdc
3079.84
3691.07
69720
69725
Decompression facial nerve, intratemporal; lateral to geniculate ganglion
Decompression facial nerve, intratemporal; including medial to geniculate ganglion
Suture facial nerve, intratemporal, with or without graft or decompression; lateral
to geniculate ganglion
Suture facial nerve, intratemporal, with or without graft or decompression;
including medial to geniculate ganglion
Labyrinthotomy, with or without cryosurgery including other nonexcisional
destructive procedures or perfusion of vestibuloactive drugs (single or multiple
perfusions); transcanal
3883.50
5624.10
69641
69642
69643
69644
69645
69646
69650
69660
69661
69711
69740
69745
69801
Extraordinary No.64/2013
200
3818.70
4161.60
4333.50
4814.10
4619.70
5045.40
2429.10
3344.40
3737.70
4239.90
1287.90
2985.05
3580.56
4449.60
5244.30
3175.20
Friday, 09 August 2013
69805
69806
Labyrinthotomy, with or without cryosurgery including other nonexcisional
destructive procedures or perfusion of vestibuloactive drugs (single or multiple
perfusions); with mastoidectomy
Endolymphatic sac operation; without shunt
Endolymphatic sac operation; with shunt
69820
69840
Fenestration semicircular canal
Revision fenestration operation
3438.00
2353.50
69905
69910
Labyrinthectomy; transcanal
Labyrinthectomy; with mastoidectomy
3857.40
4439.70
69915
69930
Vestibular nerve section, translabyrinthine approach
Cochlear device implantation, with or without mastoidectomy
5052.60
5318.10
69950
69955
Vestibular nerve section, transcranial approach
Total facial nerve decompression and/or repair (may include graft)
5448.60
5846.40
69960
69970
Decompression internal auditory canal
Removal of tumor, temporal bone
Use of operating microscope (List separately in addition to code for primary
procedure)
Myelography, posterior fossa, radiological supervision and interpretation
5529.60
6309.00
Myelography, posterior fossa, radiological supervision and interpretation
129.60
Cisternography, positive contrast, radiological supervision and interpretation
340.20
Cisternography, positive contrast, radiological supervision and interpretation
204.30
Radiologic examination, eye, for detection of foreign body
94.50
Radiologic examination, eye, for detection of foreign body
37.80
Radiologic examination, mandible; partial, less than four views
85.50
Radiologic examination, mandible; partial, less than four views
34.20
Radiologic examination, mandible; complete, minimum of four views
121.50
Radiologic examination, mandible; complete, minimum of four views
48.60
Radiologic examination, mastoids; less than three views per side
77.40
Radiologic examination, mastoids; less than three views per side
30.60
Radiologic examination, mastoids; complete, minimum of three views per side
134.10
Radiologic examination, mastoids; complete, minimum of three views per side
54.00
Radiologic examination, internal auditory meati, complete
133.20
Radiologic examination, internal auditory meati, complete
54.00
69802
69990
70010
7001026
70015
7001526
70030
7003026
70100
7010026
70110
7011026
70120
7012026
70130
7013026
70134
7013426
Extraordinary No.64/2013
201
3568.50
3862.80
4377.60
834.30
432.90
Friday, 09 August 2013
70140
Radiologic examination, facial bones; less than three views
109.49
70150
7015026
70160
70170
7017026
70190
7019026
70200
7020026
70210
7021026
70220
7022026
70240
7024026
70250
7025026
Radiologic examination, facial bones; complete, minimum of three views
116.10
Radiologic examination, facial bones; complete, minimum of three views
136.31
Radiologic examination, nasal bones, complete, minimum of three views
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation
88.51
128.70
Dacryocystography, nasolacrimal duct, radiological supervision and interpretation
45.00
Radiologic examination; optic foramina
112.55
Radiologic examination; optic foramina
40.50
Radiologic examination; orbits, complete, minimum of four views
144.04
Radiologic examination; orbits, complete, minimum of four views
51.30
Radiologic examination, sinuses, paranasal, less than three views
97.90
Radiologic examination, sinuses, paranasal, less than three views
35.10
Radiologic examination, sinuses, paranasal, complete, minimum of three views
149.69
Radiologic examination, sinuses, paranasal, complete, minimum of three views
49.50
Radiologic examination, sella turcica
85.50
Radiologic examination, sella turcica
34.20
Radiologic examination, skull; less than four views, with or without stereo
112.19
Radiologic examination, skull; less than four views, with or without stereo
38.70
70260
7026026
70300
7030026
70310
7031026
70320
7032026
70328
7032826
Radiologic examination, skull; complete, minimum of four views, with or without
stereo
Radiologic examination, skull; complete, minimum of four views, with or without
stereo
Radiologic examination, teeth; single view
156.89
55.80
30.60
Radiologic examination, teeth; single view
12.60
Radiologic examination, teeth; partial examination, less than full mouth
48.60
Radiologic examination, teeth; partial examination, less than full mouth
19.80
Radiologic examination, teeth; complete, full mouth
92.70
Radiologic examination, teeth; complete, full mouth
36.90
Radiologic examination, temporomandibular joint, open and closed mouth;
unilateral
Radiologic examination, temporomandibular joint, open and closed mouth;
unilateral
Extraordinary No.64/2013
202
118.80
47.70
Friday, 09 August 2013
70330
7033026
70332
7033226
70336
7033626
70350
7035026
70355
7035526
70360
7036026
Radiologic examination, temporomandibular joint, open and closed mouth;
bilateral
Radiologic examination, temporomandibular joint, open and closed mouth;
bilateral
Temporomandibular joint arthrography, radiological supervision and interpretation
139.50
55.80
226.80
Temporomandibular joint arthrography, radiological supervision and interpretation
79.20
Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)
1227.60
Magnetic resonance (eg, proton) imaging, temporomandibular joint(s)
244.80
Cephalogram, orthodontic
77.40
Cephalogram, orthodontic
30.60
Orthopantogram
92.70
Orthopantogram
36.90
Radiologic examination; neck, soft tissue
99.35
Radiologic examination; neck, soft tissue
30.60
7037026
70371
Radiologic examination; pharynx or larynx, including fluoroscopy and/or
magnification technique
Radiologic examination; pharynx or larynx, including fluoroscopy and/or
magnification technique
Cplx dynamic pharyngeal&sp eval c/v rec
70371
70371
Cplx dynamic pharyngeal&sp eval c/v rec
Cplx dynamic pharyngeal&sp eval c/v rec
222.06
116.96
70373
7037326
70380
7038026
70390
7039026
70450
7045026
70460
7046026
Laryngography, contrast, radiological supervision and interpretation
242.10
Laryngography, contrast, radiological supervision and interpretation
72.00
Radiologic examination, salivary gland for calculus
98.10
Radiologic examination, salivary gland for calculus
28.80
Sialography, radiological supervision and interpretation
237.60
Sialography, radiological supervision and interpretation
83.70
Computerized axial tomography, head or brain; without contrast material
758.16
Computerized axial tomography, head or brain; without contrast material
212.40
Computerized axial tomography, head or brain; with contrast material(s)
848.86
Computerized axial tomography, head or brain; with contrast material(s)
228.60
Computerized axial tomography, head or brain; without contrast material, followed
by contrast material(s) and further sections
1034.56
70370
70470
Extraordinary No.64/2013
203
206.10
62.10
339.02
Friday, 09 August 2013
7047026
70480
7048026
70481
7048126
70482
7048226
70486
7048626
70487
7048726
70488
7048826
70490
7049026
70491
7049126
70492
7049226
70496
70498
70540
7054026
70542
Computerized axial tomography, head or brain; without contrast material, followed
by contrast material(s) and further sections
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; without contrast material
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; without contrast material
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; with contrast material(s)
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; with contrast material(s)
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; without contrast material, followed by contrast material(s) and further
sections
Computerized axial tomography, orbit, sella, or posterior fossa or outer, middle, or
inner ear; without contrast material, followed by contrast material(s) and further
sections
Computerized axial tomography, maxillofacial area; without contrast material
284.40
773.58
200.70
844.20
254.70
1072.55
278.10
731.70
Computerized axial tomography, maxillofacial area; without contrast material
220.50
Computerized axial tomography, maxillofacial area; with contrast material(s)
772.20
Computerized axial tomography, maxillofacial area; with contrast material(s)
232.20
Computerized axial tomography, maxillofacial area; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, maxillofacial area; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, soft tissue neck; without contrast material
978.30
293.40
772.20
Computerized axial tomography, soft tissue neck; without contrast material
232.20
Computerized axial tomography, soft tissue neck; with contrast material(s)
762.30
Computerized axial tomography, soft tissue neck; with contrast material(s)
228.60
Computerized axial tomography, soft tissue neck; without contrast material
followed by contrast material(s) and further sections
Computerized axial tomography, soft tissue neck; without contrast material
followed by contrast material(s) and further sections
Computed tomographic angiography, head, without contrast material(s), followed
by contrast material(s) and further sections, including image post-processing
Computed tomographic angiography, neck, without contrast material(s), followed
by contrast material(s) and further sections, including image post-processing
Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast
material(s)
Magnetic resonance (eg, proton) imaging, orbit, face, and neck; without contrast
material(s)
Mri orbit face&nck c+ matrl
Extraordinary No.64/2013
204
1050.30
315.90
1133.10
1133.10
1377.90
275.40
2211.94
Friday, 09 August 2013
70542
Mri orbit face&nck c+ matrl
1903.00
70542
70543
Mri orbit face&nck c+ matrl
Mri orbit face&nck c-/c+
308.94
2662.89
70543
70543
Mri orbit face&nck c-/c+
Mri orbit face&nck c-/c+
2389.78
273.12
70544
70544
Mra head c-matrl
Mra head c-matrl
1705.17
1503.06
70544
70545
Mra head c-matrl
Mra head c+ matrl
202.12
1878.16
70545
70545
Mra head c+ matrl
Mra head c+ matrl
1655.18
222.98
70546
70546
Mra head c-/c+
Mra head c-/c+
2427.25
2184.92
70546
70547
Mra head c-/c+
Mra nck c-matrl
242.33
1680.70
70547
70547
Mra nck c-matrl
Mra nck c-matrl
1481.49
199.21
70548
70548
Mra nck c+ matrl
Mra nck c+ matrl
1907.79
1682.17
70548
70549
Mra nck c+ matrl
Mra nck c-/c+
225.62
2427.31
70549
70549
2185.10
242.21
7055326
70554
Mra nck c-/c+
Mra nck c-/c+
Magnetic resonance (eg, proton) imaging, brain (including brain stem); without
contrast material
Magnetic resonance (eg, proton) imaging, brain (including brain stem); without
contrast material
Magnetic resonance (eg, proton) imaging, brain (including brain stem); with
contrast material(s)
Magnetic resonance (eg, proton) imaging, brain (including brain stem); with
contrast material(s)
Magnetic resonance (eg, proton) imaging, brain (including brain stem); without
contrast material, followed by contrast material(s) and further sequences
Magnetic resonance (eg, proton) imaging, brain (including brain stem); without
contrast material, followed by contrast material(s) and further sequences
Mri brain functional w/o physician admnistration
70554
70554
Mri brain functional w/o physician admnistration
Mri brain functional w/o physician admnistration
1722.37
353.42
71010
Radiologic examination, chest; single view, frontal
77.84
70551
7055126
70552
7055226
70553
Extraordinary No.64/2013
205
1380.60
276.30
1575.90
315.00
1899.00
379.80
2075.79
Friday, 09 August 2013
7101026
71015
7101526
71020
7102026
71021
7102126
71022
7102226
71023
7102326
71030
7103026
71034
7103426
71035
7103526
71040
7104026
71060
7106026
71090
7109026
71100
7110026
71101
71101-
Radiologic examination, chest; single view, frontal
28.80
Radiologic examination, chest; stereo, frontal
85.50
Radiologic examination, chest; stereo, frontal
34.20
Radiologic examination, chest, two views, frontal and lateral;
97.87
Radiologic examination, chest, two views, frontal and lateral;
36.90
Radiologic examination, chest, two views, frontal and lateral; with apical lordotic
procedure
Radiologic examination, chest, two views, frontal and lateral; with apical lordotic
procedure
Radiologic examination, chest, two views, frontal and lateral; with oblique
projections
Radiologic examination, chest, two views, frontal and lateral; with oblique
projections
Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy
118.80
47.70
126.00
50.40
144.90
Radiologic examination, chest, two views, frontal and lateral; with fluoroscopy
57.60
Radiologic examination, chest, complete, minimum of four views;
143.52
Radiologic examination, chest, complete, minimum of four views;
50.40
Radiologic examination, chest, complete, minimum of four views; with
fluoroscopy
Radiologic examination, chest, complete, minimum of four views; with
fluoroscopy
Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)
199.80
80.10
87.30
Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies)
35.10
Bronchography, unilateral, radiological supervision and interpretation
227.70
Bronchography, unilateral, radiological supervision and interpretation
91.80
Bronchography, bilateral, radiological supervision and interpretation
329.40
Bronchography, bilateral, radiological supervision and interpretation
131.40
Insertion pacemaker, fluoroscopy and radiography, radiological supervision and
interpretation
Insertion pacemaker, fluoroscopy and radiography, radiological supervision and
interpretation
Radiologic examination, ribs, unilateral; two views
Radiologic examination, ribs, unilateral; two views
206
105.30
106.92
41.40
Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum
of three views
Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum
Extraordinary No.64/2013
262.80
119.70
47.70
Friday, 09 August 2013
26
of three views
71110
7111026
Radiologic examination, ribs, bilateral; three views
132.67
Radiologic examination, ribs, bilateral; three views
52.20
71111
7111126
71120
7112026
71130
7113026
71250
7125026
71260
7126026
71270
7127026
71275
71275
71275
Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum
of four views
Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum
of four views
Radiologic examination; sternum, minimum of two views
162.90
64.80
98.10
Radiologic examination; sternum, minimum of two views
38.70
Radiologic examination; sternoclavicular joint or joints, minimum of three views
109.80
Radiologic examination; sternoclavicular joint or joints, minimum of three views
44.10
Computerized axial tomography, thorax; without contrast material
762.30
Computerized axial tomography, thorax; without contrast material
190.80
Computerized axial tomography, thorax; with contrast material(s)
879.30
Computerized axial tomography, thorax; with contrast material(s)
175.50
Computerized axial tomography, thorax; without contrast material, followed by
contrast material(s) and further sections
Computerized axial tomography, thorax; without contrast material, followed by
contrast material(s) and further sections
Ct angiography chest w/contrast/noncontrast
Ct angiography chest w/contrast/noncontrast
1165.08
215.10
1529.25
1266.90
262.35
7155026
71551
71551
Ct angiography chest w/contrast/noncontrast
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and
mediastinal lymphadenopathy); without contrast material(s)
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and
mediastinal lymphadenopathy); without contrast material(s)
Mri ch c+ matrl
Mri ch c+ matrl
71551
71552
Mri ch c+ matrl
Mri ch c-/c+
297.91
2678.97
71552
71552
Mri ch c-/c+
Mri ch c-/c+
Magnetic resonance angiography, chest (excluding myocardium), with or without
contrast material(s)
Magnetic resonance angiography, chest (excluding myocardium), with or without
contrast material(s)
Radiologic examination, spine, entire, survey study, anteroposterior and lateral
2381.02
297.95
71550
71555
7155526
72010
Extraordinary No.64/2013
207
1642.50
328.50
2011.20
1713.29
1369.80
273.60
234.15
Friday, 09 August 2013
7201026
72020
7202026
72040
7204026
72050
7205026
72052
7205226
72069
7206926
72070
7207026
72072
7207226
72074
7207426
72080
7208026
72090
7209026
72100
7210026
72110
7211026
72114
7211426
72120
Radiologic examination, spine, entire, survey study, anteroposterior and lateral
94.50
Radiologic examination, spine, single view, specify level
81.12
Radiologic examination, spine, single view, specify level
30.60
Radiologic examination, spine, cervical; two or three views
111.06
Radiologic examination, spine, cervical; two or three views
40.50
Radiologic examination, spine, cervical; minimum of four views
151.90
Radiologic examination, spine, cervical; minimum of four views
59.40
Radiologic examination, spine, cervical; complete, including oblique and flexion
and/or extension studies
Radiologic examination, spine, cervical; complete, including oblique and flexion
and/or extension studies
Radiologic examination, spine, thoracolumbar, standing (scoliosis)
192.87
80.10
105.30
Radiologic examination, spine, thoracolumbar, standing (scoliosis)
42.30
Radiologic examination, spine; thoracic, two views
112.53
Radiologic examination, spine; thoracic, two views
43.20
Radiologic examination, spine; thoracic, three views
129.38
Radiologic examination, spine; thoracic, three views
46.80
Radiologic examination, spine; thoracic, minimum of four views
168.30
Radiologic examination, spine; thoracic, minimum of four views
58.50
Radiologic examination, spine; thoracolumbar, two views
112.50
Radiologic examination, spine; thoracolumbar, two views
45.00
Radiologic examination, spine; scoliosis study, including supine and erect studies
130.50
Radiologic examination, spine; scoliosis study, including supine and erect studies
52.20
Radiologic examination, spine, lumbosacral; two or three views
110.02
Radiologic examination, spine, lumbosacral; two or three views
42.30
Radiologic examination, spine, lumbosacral; minimum of four views
159.34
Radiologic examination, spine, lumbosacral; minimum of four views
63.00
Radiologic examination, spine, lumbosacral; complete, including bending views
214.75
Radiologic examination, spine, lumbosacral; complete, including bending views
90.90
Radiologic examination, spine, lumbosacral, bending views only, minimum of four
views
168.30
Extraordinary No.64/2013
208
Friday, 09 August 2013
7212026
72125
7212526
72126
7212626
72127
7212726
72128
7212826
72129
7212926
72130
7213026
72131
7213126
72132
7213226
72133
7213326
72141
7214126
72142
7214226
72146
7214626
72147
Radiologic examination, spine, lumbosacral, bending views only, minimum of four
views
Computerized axial tomography, cervical spine; without contrast material
50.40
769.50
Computerized axial tomography, cervical spine; without contrast material
192.60
Computerized axial tomography, cervical spine; with contrast material
876.60
Computerized axial tomography, cervical spine; with contrast material
175.50
Computerized axial tomography, cervical spine; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, cervical spine; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, thoracic spine; without contrast material
1062.00
212.40
751.50
Computerized axial tomography, thoracic spine; without contrast material
187.20
Computerized axial tomography, thoracic spine; with contrast material
876.60
Computerized axial tomography, thoracic spine; with contrast material
175.50
Computerized axial tomography, thoracic spine; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, thoracic spine; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, lumbar spine; without contrast material
1062.00
212.40
865.78
Computerized axial tomography, lumbar spine; without contrast material
191.70
Computerized axial tomography, lumbar spine; with contrast material
992.07
Computerized axial tomography, lumbar spine; with contrast material
175.50
Computerized axial tomography, lumbar spine; without contrast material, followed
by contrast material(s) and further sections
Computerized axial tomography, lumbar spine; without contrast material, followed
by contrast material(s) and further sections
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with
Extraordinary No.64/2013
209
1062.00
212.40
1344.60
269.10
1611.90
322.20
1468.80
293.40
1611.90
Friday, 09 August 2013
contrast material(s)
7214726
72148
7214826
72149
7214926
72156
7215626
72157
7215726
72158
7215826
72159
7215926
72170
7217026
72190
7219026
72191
Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar;
without contrast material
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; cervical
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; cervical
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; thoracic
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; thoracic
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; lumbar
Magnetic resonance (eg, proton) imaging, spinal canal and contents, without
contrast material, followed by contrast material(s) and further sequences; lumbar
Magnetic resonance angiography, spinal canal and contents, with or without
contrast material(s)
Magnetic resonance angiography, spinal canal and contents, with or without
contrast material(s)
Radiologic examination, pelvis; one or two views
322.20
1451.70
290.70
1593.90
318.60
2248.20
449.10
2253.60
450.90
2196.00
439.20
1488.60
297.90
100.07
Radiologic examination, pelvis; one or two views
35.10
Radiologic examination, pelvis; complete, minimum of three views
138.89
Radiologic examination, pelvis; complete, minimum of three views
54.00
Ct angiography pelvis w/contrast/noncontrast
1421.72
72191
72191
Ct angiography pelvis w/contrast/noncontrast
Ct angiography pelvis w/contrast/noncontrast
1177.96
243.76
72192
7219226
72193
7219326
Computerized axial tomography, pelvis; without contrast material
658.80
Computerized axial tomography, pelvis; without contrast material
164.70
Computerized axial tomography, pelvis; with contrast material(s)
767.70
Computerized axial tomography, pelvis; with contrast material(s)
153.90
72194
72194-
Computerized axial tomography, pelvis; without contrast material, followed by
contrast material(s) and further sections
Computerized axial tomography, pelvis; without contrast material, followed by
Extraordinary No.64/2013
210
1009.01
180.90
Friday, 09 August 2013
26
contrast material(s) and further sections
72195
72195
Mri pelvis c-matrl
Mri pelvis c-matrl
1640.10
1396.14
72195
72196
7219626
72197
Mri pelvis c-matrl
Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)
243.96
1344.60
Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)
269.10
Mri pelvis c-/c+
2310.35
72197
72197
Mri pelvis c-/c+
Mri pelvis c-/c+
2050.35
260.00
72198
7219826
72200
7220026
72202
7220226
72220
7222026
72240
7224026
72255
7225526
72265
7226526
72270
7227026
72275
72275
Magnetic resonance angiography, pelvis, with or without contrast material(s)
1368.90
Magnetic resonance angiography, pelvis, with or without contrast material(s)
273.60
Radiologic examination, sacroiliac joints; less than three views
112.07
Radiologic examination, sacroiliac joints; less than three views
41.40
Radiologic examination, sacroiliac joints; three or more views
123.04
Radiologic examination, sacroiliac joints; three or more views
41.40
Radiologic examination, sacrum and coccyx, minimum of two views
109.91
Radiologic examination, sacrum and coccyx, minimum of two views
38.70
Myelography, cervical, radiological supervision and interpretation
627.30
Myelography, cervical, radiological supervision and interpretation
187.20
Myelography, thoracic, radiological supervision and interpretation
528.30
Myelography, thoracic, radiological supervision and interpretation
158.40
Myelography, lumbosacral, radiological supervision and interpretation
540.90
Myelography, lumbosacral, radiological supervision and interpretation
162.90
Myelography, entire spinal canal, radiological supervision and interpretation
795.60
Myelography, entire spinal canal, radiological supervision and interpretation
239.40
Epidurograpy rs&i
Epidurograpy rs&i
659.11
460.76
72275
72285
7228526
72295
Epidurograpy rs&i
Diskography, cervical or thoracic, radiological supervision and interpretation
198.36
902.70
Diskography, cervical or thoracic, radiological supervision and interpretation
225.90
Diskography, lumbar, radiological supervision and interpretation
854.10
Extraordinary No.64/2013
211
Friday, 09 August 2013
7229526
73000
7300026
73010
7301026
73020
7302026
73030
7303026
73040
7304026
73050
7305026
73060
7306026
73070
7307026
73080
7308026
73085
7308526
73090
7309026
73092
7309226
73100
7310026
Diskography, lumbar, radiological supervision and interpretation
214.20
Radiologic examination; clavicle, complete
91.46
Radiologic examination; clavicle, complete
29.70
Radiologic examination; scapula, complete
98.83
Radiologic examination; scapula, complete
36.90
Radiologic examination, shoulder; one view
80.86
Radiologic examination, shoulder; one view
28.80
Radiologic examination, shoulder; complete, minimum of two views
95.62
Radiologic examination, shoulder; complete, minimum of two views
38.70
Radiologic examination, shoulder, arthrography, radiological supervision and
interpretation
Radiologic examination, shoulder, arthrography, radiological supervision and
interpretation
Radiologic examination; acromioclavicular joints, bilateral, with or without
weighted distraction
Radiologic examination; acromioclavicular joints, bilateral, with or without
weighted distraction
Radiologic examination; humerus, minimum of two views
253.80
90.00
99.90
35.10
93.18
Radiologic examination; humerus, minimum of two views
33.30
Radiologic examination, elbow; two views
81.13
Radiologic examination, elbow; two views
27.90
Radiologic examination, elbow; complete, minimum of three views
97.23
Radiologic examination, elbow; complete, minimum of three views
35.10
Radiologic examination, elbow, arthrography, radiological supervision and
interpretation
Radiologic examination, elbow, arthrography, radiological supervision and
interpretation
Radiologic examination; forearm, two views
285.30
99.90
80.87
Radiologic examination; forearm, two views
33.30
Radiologic examination; upper extremity, infant, minimum of two views
90.90
Radiologic examination; upper extremity, infant, minimum of two views
36.00
Radiologic examination, wrist; two views
76.29
Radiologic examination, wrist; two views
30.60
Extraordinary No.64/2013
212
Friday, 09 August 2013
73110
7311026
73115
7311526
73120
7312026
73130
7313026
73140
7314026
73200
7320026
73201
7320126
Radiologic examination, wrist; complete, minimum of three views
88.33
Radiologic examination, wrist; complete, minimum of three views
36.90
Radiologic examination, wrist, arthrography, radiological supervision and
interpretation
Radiologic examination, wrist, arthrography, radiological supervision and
interpretation
Radiologic examination, hand; two views
229.50
91.80
73.95
Radiologic examination, hand; two views
28.80
Radiologic examination, hand; minimum of three views
87.88
Radiologic examination, hand; minimum of three views
36.90
Radiologic examination, finger(s), minimum of two views
67.89
Radiologic examination, finger(s), minimum of two views
28.80
Computerized axial tomography, upper extremity; without contrast material
721.80
Computerized axial tomography, upper extremity; without contrast material
216.00
Computerized axial tomography, upper extremity; with contrast material(s)
751.50
Computerized axial tomography, upper extremity; with contrast material(s)
225.90
7320226
73206
73206
Computerized axial tomography, upper extremity; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, upper extremity; without contrast material,
followed by contrast material(s) and further sections
Ct angiography upper extremity
Ct angiography upper extremity
73206
73218
Ct angiography upper extremity
Mri uxtr oth/thn jt c-matrl
200.46
1120.22
73218
73218
Mri uxtr oth/thn jt c-matrl
Mri uxtr oth/thn jt c-matrl
965.93
154.29
73219
73219
Mri uxtr oth/thn jt c+ matrl
Mri uxtr oth/thn jt c+ matrl
1320.16
1136.01
73219
73220
7322026
Mri uxtr oth/thn jt c+ matrl
without contrast material(s), followed by contrast material(s) and further sequences
184.15
1757.70
without contrast material(s), followed by contrast material(s) and further sequences
351.00
73202
73221
7322126
917.10
183.60
1105.19
904.73
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without
contrast material(s)
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without
contrast material(s)
Extraordinary No.64/2013
213
1349.10
270.00
Friday, 09 August 2013
73222
Mri any jt uxtr c+ matrl
1431.78
73222
73222
Mri any jt uxtr c+ matrl
Mri any jt uxtr c+ matrl
1230.96
200.81
73223
73223
Mri any jt uxtr c-/c+
Mri any jt uxtr c-/c+
1773.84
1588.79
73223
73225
Mri any jt uxtr c-/c+
Mra uxtr c+-matrl
185.05
1324.05
73225
73225
Mra uxtr c+-matrl
Mra uxtr c+-matrl
1092.90
231.15
73500
7350026
73510
7351026
Radiologic examination, hip, unilateral; one view
73.92
Radiologic examination, hip, unilateral; one view
31.50
Radiologic examination, hip, unilateral; complete, minimum of two views
92.40
Radiologic examination, hip, unilateral; complete, minimum of two views
41.40
73520
7352026
73525
7352526
73530
7353026
73540
7354026
73542
7354226
73550
7355026
73560
7356026
73562
7356226
Radiologic examination, hips, bilateral, minimum of two views of each hip,
including anteroposterior view of pelvis
Radiologic examination, hips, bilateral, minimum of two views of each hip,
including anteroposterior view of pelvis
Radiologic examination, hip, arthrography, radiological supervision and
interpretation
Radiologic examination, hip, arthrography, radiological supervision and
interpretation
Radiologic examination, hip, during operative procedure
119.00
51.30
257.40
90.90
144.00
Radiologic examination, hip, during operative procedure
57.60
Radiologic examination, pelvis and hips, infant or child, minimum of two views
101.70
Radiologic examination, pelvis and hips, infant or child, minimum of two views
40.50
Radiological examination, sacroiliac joint arthrography, radiological supervision
and interpretation
Radiological examination, sacroiliac joint arthrography, radiological supervision
and interpretation
Radiologic examination, femur, two views
328.50
115.20
87.00
Radiologic examination, femur, two views
36.90
Radiologic examination, knee; one or two views
83.40
Radiologic examination, knee; one or two views
36.00
Radiologic examination, knee; three views
95.34
Radiologic examination, knee; three views
41.40
Extraordinary No.64/2013
214
Friday, 09 August 2013
73564
7356426
73565
7356526
73580
7358026
73590
7359026
73592
7359226
73600
7360026
73610
7361026
73615
7361526
73620
7362026
73630
7363026
73650
7365026
73660
7366026
73700
7370026
73701
7370126
Radiologic examination, knee; complete, four or more views
115.16
Radiologic examination, knee; complete, four or more views
52.20
Radiologic examination, knee; both knees, standing, anteroposterior
95.31
Radiologic examination, knee; both knees, standing, anteroposterior
46.80
Radiologic examination, knee, arthrography, radiological supervision and
interpretation
Radiologic examination, knee, arthrography, radiological supervision and
interpretation
Radiologic examination; tibia and fibula, two views
327.60
115.20
84.75
Radiologic examination; tibia and fibula, two views
36.00
Radiologic examination; lower extremity, infant, minimum of two views
80.70
Radiologic examination; lower extremity, infant, minimum of two views
31.50
Radiologic examination, ankle; two views
77.08
Radiologic examination, ankle; two views
31.50
Radiologic examination, ankle; complete, minimum of three views
94.72
Radiologic examination, ankle; complete, minimum of three views
38.70
Radiologic examination, ankle, arthrography, radiological supervision and
interpretation
Radiologic examination, ankle, arthrography, radiological supervision and
interpretation
Radiologic examination, foot; two views
261.90
79.20
79.34
Radiologic examination, foot; two views
31.50
Radiologic examination, foot; complete, minimum of three views
88.02
Radiologic examination, foot; complete, minimum of three views
38.70
Radiologic examination; calcaneus, minimum of two views
73.47
Radiologic examination; calcaneus, minimum of two views
31.50
Radiologic examination; toe(s), minimum of two views
64.91
Radiologic examination; toe(s), minimum of two views
27.90
Computerized axial tomography, lower extremity; without contrast material
712.03
Computerized axial tomography, lower extremity; without contrast material
237.60
Computerized axial tomography, lower extremity; with contrast material(s)
786.89
Computerized axial tomography, lower extremity; with contrast material(s)
254.70
Extraordinary No.64/2013
215
Friday, 09 August 2013
7370226
73706
Computerized axial tomography, lower extremity; without contrast material,
followed by contrast material(s) and further sections
Computerized axial tomography, lower extremity; without contrast material,
followed by contrast material(s) and further sections
Ct angiography lower extremity
73706
73706
Ct angiography lower extremity
Ct angiography lower extremity
1069.39
250.57
73718
73718
Mri lxtr oth/thn jt c-matrl
Mri lxtr oth/thn jt c-matrl
1277.59
1100.84
73718
73719
Mri lxtr oth/thn jt c-matrl
Mri img lxtr oth/thn jt c+ matrl
176.75
1448.72
73719
73719
Mri img lxtr oth/thn jt c+ matrl
Mri img lxtr oth/thn jt c+ matrl
1246.57
202.15
73720
7372026
without contrast material(s), followed by contrast material(s) and further sequences
1755.90
without contrast material(s), followed by contrast material(s) and further sequences
350.10
73702
927.00
185.40
1319.96
7372126
73722
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without
contrast material
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without
contrast material
Mri any jt lxtr c+ matrl
73722
73722
Mri any jt lxtr c+ matrl
Mri any jt lxtr c+ matrl
1229.76
200.52
73723
73723
Mri any jt lxtr c-/c+
Mri any jt lxtr c-/c+
1732.45
1551.48
73723
Mri any jt lxtr c-/c+
Magnetic resonance angiography, lower extremity, with or without contrast
material(s)
Magnetic resonance angiography, lower extremity, with or without contrast
material(s)
Radiologic examination, abdomen; single anteroposterior view
180.97
Radiologic examination, abdomen; single anteroposterior view
33.30
73721
73725
7372526
74000
7400026
74010
7401026
74020
7402026
74022
216
293.40
1430.28
1534.50
307.80
83.17
Radiologic examination, abdomen; anteroposterior and additional oblique and cone
views
Radiologic examination, abdomen; anteroposterior and additional oblique and cone
views
Radiologic examination, abdomen; complete, including decubitus and/or erect
views
Radiologic examination, abdomen; complete, including decubitus and/or erect
views
Radiologic examination, abdomen; complete acute abdomen series, including
Extraordinary No.64/2013
1381.27
101.70
41.40
121.37
44.10
159.47
Friday, 09 August 2013
supine, erect, and/or decubitus views, upright PA chest
7402226
74150
7415026
74160
7416026
Radiologic examination, abdomen; complete acute abdomen series, including
supine, erect, and/or decubitus views, upright PA chest
Computerized axial tomography, abdomen; without contrast material
54.90
829.56
Computerized axial tomography, abdomen; without contrast material
183.60
Computerized axial tomography, abdomen; with contrast material(s)
1028.92
Computerized axial tomography, abdomen; with contrast material(s)
215.10
7417026
74175
74175
Computerized axial tomography, abdomen; without contrast material, followed by
contrast material(s) and further sections
Computerized axial tomography, abdomen; without contrast material, followed by
contrast material(s) and further sections
Ct angiography abdomen w/contrast/noncontrast
Ct angiography abdomen w/contrast/noncontrast
74175
74176
Ct angiography abdomen w/contrast/noncontrast
Ct abd & pelvis w/o contrast
281.04
646.96
74176
74176
Ct abd & pelvis w/o contrast
Ct abd & pelvis w/o contrast
395.57
251.39
74177
74177
Ct abd & pelvis w/contrast
Ct abd & pelvis w/contrast
994.23
736.97
74177
74178
Ct abd & pelvis w/contrast
Ct abd & pelvis w/o contrst 1+ body regns
257.26
1294.62
74178
74178
Ct abd & pelvis w/o contrst 1+ body regns
Ct abd & pelvis w/o contrst 1+ body regns
998.47
296.15
74181
7418126
74182
74182
Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)
1344.60
Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s)
269.10
Mri abd c+ matrl
Mri abd c+ matrl
1925.46
1657.45
74182
74183
Mri abd c+ matrl
Mri abd c-/c+
268.02
2299.20
74183
74183
Mri abd c-/c+
Mri abd c-/c+
1955.96
343.24
74185
7418526
Magnetic resonance angiography, abdomen, with or without contrast material(s)
1674.00
Magnetic resonance angiography, abdomen, with or without contrast material(s)
333.90
74170
74190
7419026
Peritoneogram (eg, after injection of air or contrast), radiological supervision and
interpretation
Peritoneogram (eg, after injection of air or contrast), radiological supervision and
interpretation
Extraordinary No.64/2013
217
1162.71
261.00
1414.10
1133.06
175.50
70.20
Friday, 09 August 2013
74210
7421026
74220
7422026
Radiologic examination; pharynx and/or cervical esophagus
180.23
Radiologic examination; pharynx and/or cervical esophagus
66.60
Radiologic examination; esophagus
185.40
Radiologic examination; esophagus
73.80
74250
Swallowing function, pharynx and/or esophagus, with cineradiography and/or
video
Swallowing function, pharynx and/or esophagus, with cineradiography and/or
video
Removal of foreign body(s), esophageal, with use of balloon catheter, radiological
supervision and interpretation
Removal of foreign body(s), esophageal, with use of balloon catheter, radiological
supervision and interpretation
Radiologic examination, gastrointestinal tract, upper; with or without delayed
films, without KUB
Radiologic examination, gastrointestinal tract, upper; with or without delayed
films, without KUB
Radiologic examination, gastrointestinal tract, upper; with or without delayed
films, with KUB
Radiologic examination, gastrointestinal tract, upper; with or without delayed
films, with KUB
Radiologic examination, gastrointestinal tract, upper; with small bowel, includes
multiple serial films
Radiologic examination, gastrointestinal tract, upper; with small bowel, includes
multiple serial films
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with or without
delayed films, without KUB
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with or without
delayed films, without KUB
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with or without
delayed films, with KUB
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with or without
delayed films, with KUB
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with small
bowel follow-through
Radiological examination, gastrointestinal tract, upper, air contrast, with specific
high density barium, effervescent agent, with or without glucagon; with small
bowel follow-through
Radiologic examination, small bowel, includes multiple serial films;
74250-
Radiologic examination, small bowel, includes multiple serial films;
74230
7423026
74235
7423526
74240
7424026
74241
7424126
74245
7424526
74246
7424626
74247
7424726
74249
7424926
Extraordinary No.64/2013
218
233.10
93.60
463.50
185.40
264.87
105.30
271.25
108.90
365.40
146.70
261.90
104.40
272.70
108.90
384.30
153.90
215.55
83.70
Friday, 09 August 2013
26
74251
7425126
74260
7426026
74261
Radiologic examination, small bowel, includes multiple serial films; via
enteroclysis tube
Radiologic examination, small bowel, includes multiple serial films; via
enteroclysis tube
Duodenography, hypotonic
264.60
107.10
218.70
Duodenography, hypotonic
87.30
Ct colonogrphy dx image postprocess no contrast
1384.23
74261
74261
Ct colonogrphy dx image postprocess no contrast
Ct colonogrphy dx image postprocess no contrast
1131.01
253.22
74262
74262
Ct colonogrphy dx image postprocess w/contrast
Ct colonogrphy dx image postprocess w/contrast
1555.63
1272.86
74262
74263
Ct colonogrphy dx image postprocess w/contrast
Ct colonography screening image postprocessing
282.77
1656.89
74263
74263
Ct colonography screening image postprocessing
Ct colonography screening image postprocessing
1395.31
261.58
74270
7427026
Radiologic examination, colon; barium enema, with or without KUB
291.32
Radiologic examination, colon; barium enema, with or without KUB
107.10
74280
7428026
74283
7428326
74290
7429026
74291
7429126
74300
74301
74305
7430526
Radiologic examination, colon; air contrast with specific high density barium, with
or without glucagon
Radiologic examination, colon; air contrast with specific high density barium, with
or without glucagon
Therapeutic enema, contrast or air, for reduction of intussusception or other
intraluminal obstruction (eg, meconium ileus)
Therapeutic enema, contrast or air, for reduction of intussusception or other
intraluminal obstruction (eg, meconium ileus)
Cholecystography, oral contrast;
Cholecystography, oral contrast;
144.90
495.90
198.90
137.70
55.80
Cholecystography, oral contrast; additional or repeat examination or multiple day
examination
Cholecystography, oral contrast; additional or repeat examination or multiple day
examination
Cholangiography and/or pancreatography; intraoperative, radiological supervision
and interpretation
Cholangiography and/or pancreatography; additional set intraoperative,
radiological supervision and interpretation (List separately in addition to code for
primary procedure)
Cholangiography and/or pancreatography; postoperative, radiological supervision
and interpretation
Cholangiography and/or pancreatography; postoperative, radiological supervision
and interpretation
Extraordinary No.64/2013
386.64
219
94.50
37.80
206.10
128.70
139.50
70.20
Friday, 09 August 2013
74320
7432026
74327
7432726
74328
7432826
74329
7432926
74330
7433026
74340
7434026
7435026
74355
7435526
74400
7440026
74410
7441026
74415
7441526
74420
7442026
74425
Cholangiography, percutaneous, transhepatic, radiological supervision and
interpretation
Cholangiography, percutaneous, transhepatic, radiological supervision and
interpretation
Postoperative biliary duct stone removal, percutaneous via T-tube tract, basket, or
snare (eg, Burhenne technique), radiological supervision and interpretation
Postoperative biliary duct stone removal, percutaneous via T-tube tract, basket, or
snare (eg, Burhenne technique), radiological supervision and interpretation
Endoscopic catheterization of the biliary ductal system, radiological supervision
and interpretation
Endoscopic catheterization of the biliary ductal system, radiological supervision
and interpretation
Endoscopic catheterization of the pancreatic ductal system, radiological
supervision and interpretation
Endoscopic catheterization of the pancreatic ductal system, radiological
supervision and interpretation
Combined endoscopic catheterization of the biliary and pancreatic ductal systems,
radiological supervision and interpretation
Combined endoscopic catheterization of the biliary and pancreatic ductal systems,
radiological supervision and interpretation
Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple
fluoroscopies and films, radiological supervision and interpretation
Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple
fluoroscopies and films, radiological supervision and interpretation
Percutaneous placement of gastrostomy tube, radiological supervision and
interpretation
Percutaneous placement of enteroclysis tube, radiological supervision and
interpretation
Percutaneous placement of enteroclysis tube, radiological supervision and
interpretation
Urography (pyelography), intravenous, with or without KUB, with or without
tomography
Urography (pyelography), intravenous, with or without KUB, with or without
tomography
Urography, infusion, drip technique and/or bolus technique;
Urography, infusion, drip technique and/or bolus technique;
369.90
91.80
417.60
166.50
413.10
124.20
413.10
124.20
432.90
129.60
334.80
100.80
126.90
349.20
105.30
242.95
76.50
262.80
78.30
Urography, infusion, drip technique and/or bolus technique; with
nephrotomography
Urography, infusion, drip technique and/or bolus technique; with
nephrotomography
Urography, retrograde, with or without KUB
284.40
84.60
314.10
Urography, retrograde, with or without KUB
63.00
Urography, antegrade, (pyelostogram, nephrostogram, loopogram), radiological
supervision and interpretation
207.12
Extraordinary No.64/2013
220
Friday, 09 August 2013
7442526
74430
7443026
74440
74440
Urography, antegrade, (pyelostogram, nephrostogram, loopogram), radiological
supervision and interpretation
Cystography, minimum of three views, radiological supervision and interpretation
74440
74445
7444526
74450
7445026
74455
7445526
83.70
177.30
Cystography, minimum of three views, radiological supervision and interpretation
63.00
Vasograpy vesiculograpy/epididymograpy rs&i
Vasograpy vesiculograpy/epididymograpy rs&i
239.72
169.77
Vasograpy vesiculograpy/epididymograpy rs&i
Corpora cavernosography, radiological supervision and interpretation
69.94
246.60
Corpora cavernosography, radiological supervision and interpretation
147.60
Urethrocystography, retrograde, radiological supervision and interpretation
180.90
Urethrocystography, retrograde, radiological supervision and interpretation
63.00
Urethrocystography, voiding, radiological supervision and interpretation
223.20
Urethrocystography, voiding, radiological supervision and interpretation
78.30
7447026
74475
Radiologic examination, renal cyst study, translumbar, contrast visualization,
radiological supervision and interpretation
Radiologic examination, renal cyst study, translumbar, contrast visualization,
radiological supervision and interpretation
Intro cath in rnl pelvis drg&/njx prq rs&i
74475
74475
Intro cath in rnl pelvis drg&/njx prq rs&i
Intro cath in rnl pelvis drg&/njx prq rs&i
625.86
113.11
74480
74480
Intro urtrl cath/stent prq rs&i
Intro urtrl cath/stent prq rs&i
727.96
616.52
74480
74485
Intro urtrl cath/stent prq rs&i
Dilat nfros urtrs/urt rs&i
111.45
516.61
74485
74485
Dilat nfros urtrs/urt rs&i
Dilat nfros urtrs/urt rs&i
422.18
94.43
74710
7471026
74740
7474026
74775
7477526
7555226
75553-
Pelvimetry, with or without placental localization
153.90
Pelvimetry, with or without placental localization
62.10
Hysterosalpingography, radiological supervision and interpretation
211.01
Hysterosalpingography, radiological supervision and interpretation
70.20
Perineogram (eg, vaginogram, for sex determination or extent of anomalies)
247.50
Perineogram (eg, vaginogram, for sex determination or extent of anomalies)
99.00
Cardiac magnetic resonance imaging for morphology; without contrast material
312.30
Cardiac magnetic resonance imaging for morphology; with contrast material
339.30
74470
Extraordinary No.64/2013
221
235.80
83.70
738.97
Friday, 09 August 2013
26
7555426
7555526
75557
75557
Cardiac magnetic resonance imaging for function, with or without morphology;
complete study
Cardiac magnetic resonance imaging for function, with or without morphology;
limited study
Cardiac mri morphology & function w/o contrast
Cardiac mri morphology & function w/o contrast
75557
75559
Cardiac mri morphology & function w/o contrast
Cardiac mri w/o contrast w stress imaging
445.94
2492.69
75559
75559
Cardiac mri w/o contrast w stress imaging
Cardiac mri w/o contrast w stress imaging
1897.73
594.96
75561
75561
Cardiac mri w/w/o contrast & further seq
Cardiac mri w/w/o contrast & further seq
2389.24
1866.12
75561
75563
Cardiac mri w/w/o contrast & further seq
Cardiac mri w/w/o contrast w stress
523.12
3028.15
75563
75563
Cardiac mri w/w/o contrast w stress
Cardiac mri w/w/o contrast w stress
2366.29
661.87
75565
75565
Cardiac mri for velocity flow mapping
Cardiac mri for velocity flow mapping
307.65
264.25
75565
75571
Cardiac mri for velocity flow mapping
Ct heart no contrast quant eval coronry calcium
43.41
399.50
75571
75571
Ct heart no contrast quant eval coronry calcium
Ct heart no contrast quant eval coronry calcium
307.37
92.13
75572
75572
Ct heart contrast eval cardiac structure&morph
Ct heart contrast eval cardiac structure&morph
502.21
216.79
75572
75573
Ct heart contrast eval cardiac structure&morph
Ct hrt contrst cardiac struct&morph cong hrt dx
285.42
677.66
75573
75573
Ct hrt contrst cardiac struct&morph cong hrt dx
Ct hrt contrst cardiac struct&morph cong hrt dx
267.50
410.16
75574
75574
Cta hrt cornry art/bypass grfts contrst 3d post
Cta hrt cornry art/bypass grfts contrst 3d post
1934.02
1542.37
75574
Cta hrt cornry art/bypass grfts contrst 3d post
Aortography, thoracic, without serialography, radiological supervision and
interpretation
Aortograpy thrc srlograpy rs&i
391.64
Aortograpy thrc srlograpy rs&i
Aortograpy thrc srlograpy rs&i
Aortography, abdominal, by serialography, radiological supervision and
interpretation
1135.81
222.53
75600
75605
75605
75605
75625
Extraordinary No.64/2013
222
333.90
320.40
1929.44
1483.50
179.10
1358.34
236.70
Friday, 09 August 2013
75630
75635
75635
75635
75650
75658
75660
75662
75665
75671
75676
75680
75685
75705
75710
75716
75722
75724
75726
75731
75733
75736
75741
75743
75746
75756
75774
Aortography, abdominal plus bilateral iliofemoral lower extremity, catheter, by
serialography, radiological supervision and interpretation
Cta aa&bi iliofem lxtr rs&i c-/c+ post-pxessing
Cta aa&bi iliofem lxtr rs&i c-/c+ post-pxessing
285.30
2186.77
1768.78
Cta aa&bi iliofem lxtr rs&i c-/c+ post-pxessing
Angiography, cervicocerebral, catheter, including vessel origin, radiological
supervision and interpretation
Angiography, brachial, retrograde, radiological supervision and interpretation
Angiography, external carotid, unilateral, selective, radiological supervision and
interpretation
Angiography, external carotid, bilateral, selective, radiological supervision and
interpretation
Angiography, carotid, cerebral, unilateral, radiological supervision and
interpretation
Angiography, carotid, cerebral, bilateral, radiological supervision and
interpretation
Angiography, carotid, cervical, unilateral, radiological supervision and
interpretation
Angiography, carotid, cervical, bilateral, radiological supervision and interpretation
Angiography, vertebral, cervical, and/or intracranial, radiological supervision and
interpretation
Angiography, spinal, selective, radiological supervision and interpretation
Angiography, extremity, unilateral, radiological supervision and interpretation
417.99
Angiography, extremity, bilateral, radiological supervision and interpretation
Angiography, renal, unilateral, selective (including flush aortogram), radiological
supervision and interpretation
Angiography, renal, bilateral, selective (including flush aortogram), radiological
supervision and interpretation
Angiography, visceral, selective or supraselective, (with or without flush
aortogram), radiological supervision and interpretation
Angiography, adrenal, unilateral, selective, radiological supervision and
interpretation
Angiography, adrenal, bilateral, selective, radiological supervision and
interpretation
Angiography, pelvic, selective or supraselective, radiological supervision and
interpretation
Angiography, pulmonary, unilateral, selective, radiological supervision and
interpretation
Angiography, pulmonary, bilateral, selective, radiological supervision and
interpretation
Angiography, pulmonary, by nonselective catheter or venous injection,
radiological supervision and interpretation
Angiography, internal mammary, radiological supervision and interpretation
Angiography, selective, each additional vessel studied after basic examination,
radiological supervision and interpretation (List separately in addition to code for
308.70
Extraordinary No.64/2013
223
298.80
257.40
265.50
341.10
261.00
360.90
293.40
350.10
257.40
283.50
250.20
226.80
327.60
288.00
257.40
268.20
247.50
265.50
318.60
216.00
236.70
157.50
Friday, 09 August 2013
primary procedure)
75791
75791
Angiogrphy av shunt complete eval fluor s&i
Angiogrphy av shunt complete eval fluor s&i
1479.93
1083.03
75791
Angiogrphy av shunt complete eval fluor s&i
Lymphangiography, extremity only, unilateral, radiological supervision and
interpretation
Lymphangiography, extremity only, bilateral, radiological supervision and
interpretation
Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and
interpretation
Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and
interpretation
Shuntogram for investigation of previously placed indwelling nonvascular shunt
(eg, LeVeen shunt, ventriculoperitoneal shunt, indwelling infusion pump),
radiological supervision and interpretation
Splenoportography, radiological supervision and interpretation
Venography, extremity, unilateral, radiological supervision and interpretation
396.90
Venography, extremity, bilateral, radiological supervision and interpretation
Venography, caval, inferior, with serialography, radiological supervision and
interpretation
Venography, caval, superior, with serialography, radiological supervision and
interpretation
Venography, renal, unilateral, selective, radiological supervision and interpretation
215.10
Venography, renal, bilateral, selective, radiological supervision and interpretation
Venography, adrenal, unilateral, selective, radiological supervision and
interpretation
Venography, adrenal, bilateral, selective, radiological supervision and
interpretation
Venography, sinus or jugular, catheter, radiological supervision and interpretation
Venography, superior sagittal sinus, radiological supervision and interpretation
312.30
Venography, epidural, radiological supervision and interpretation
Venography, orbital, radiological supervision and interpretation
Percutaneous transhepatic portography with hemodynamic evaluation, radiological
supervision and interpretation
Percutaneous transhepatic portography without hemodynamic evaluation,
radiological supervision and interpretation
Hepatic venography, wedged or free, with hemodynamic evaluation, radiological
supervision and interpretation
Hepatic venography, wedged or free, without hemodynamic evaluation,
radiological supervision and interpretation
Venous sampling through catheter, with or without angiography (eg, for
parathyroid hormone, renin), radiological supervision and interpretation
Transcatheter therapy, embolization, any method, radiological supervision and
interpretation
211.50
139.50
75801
75803
75805
75807
75809
75810
75820
75822
75825
75827
75831
75833
75840
75842
75860
75870
75872
75880
75885
75887
75889
75891
75893
75894
Extraordinary No.64/2013
224
136.80
194.40
149.40
212.40
84.60
214.20
153.90
221.40
232.20
236.70
257.40
314.10
211.50
211.50
273.60
247.50
226.80
216.00
195.30
298.80
Friday, 09 August 2013
75901
Transcatheter therapy, infusion, any method (eg, thrombolysis other than
coronary), radiological supervision and interpretation
Angiogram through existing catheter for follow-up study for transcatheter therapy,
embolization or infusion
Exchange of a previously placed arterial catheter during thrombolytic therapy with
contrast monitoring, radiological supervision and interpretation
Mchnl rmvl pricath obstr matrl rs&i
75901
75901
Mchnl rmvl pricath obstr matrl rs&i
Mchnl rmvl pricath obstr matrl rs&i
306.62
90.97
75902
75902
Mchnl rmvl intral obstr matrl rs&i
Mchnl rmvl intral obstr matrl rs&i
321.61
256.44
75902
75940
Mchnl rmvl intral obstr matrl rs&i
Percutaneous placement of IVC filter, radiological supervision and interpretation
Transcatheter introduction of intravascular stent(s), (non-coronary vessel),
percutaneous and/or open, radiological supervision and interpretation, each vessel
Transcatheter retrieval, percutaneous, of intravascular foreign body (eg, fractured
venous or arterial catheter), radiological supervision and interpretation
Transluminal balloon angioplasty, peripheral artery, radiological supervision and
interpretation
Transluminal balloon angioplasty, each additional peripheral artery, radiological
supervision and interpretation (List separately in addition to code for primary
procedure)
Transluminal balloon angioplasty, renal or other visceral artery, radiological
supervision and interpretation
Transluminal balloon angioplasty, each additional visceral artery, radiological
supervision and interpretation (List separately in addition to code for primary
procedure)
Transcatheter biopsy, radiological supervision and interpretation
Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological
supervision and interpretation
Percutaneous transhepatic biliary drainage with contrast monitoring, radiological
supervision and interpretation
Percutaneous placement of drainage catheter for combined internal and external
biliary drainage or of a drainage stent for internal biliary drainage in patients with
an inoperable mechanical biliary obstruction, radiological supervision and
interpretation
Change of percutaneous tube or drainage catheter with contrast monitoring (eg,
gastrointestinal system, genitourinary system, abscess), radiological supervision
and interpretation
Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography) for
percutaneous drainage (eg, abscess, specimen collection), with placement of
catheter, radiological supervision and interpretation
Fluoroscopy (separate procedure), up to one hour physician time, other than 71023
or 71034 (eg, cardiac fluoroscopy)
Fluoroscopy (separate procedure), up to one hour physician time, other than 71023
65.17
175.50
75896
75898
75900
75960
75961
75962
75964
75966
75968
75970
75978
75980
75982
75984
75989
76000
76000-
Extraordinary No.64/2013
225
283.50
319.50
83.70
397.59
216.00
463.50
236.70
134.10
283.50
141.30
134.10
211.50
261.90
282.60
144.00
236.70
201.24
38.70
Friday, 09 August 2013
26
or 71034 (eg, cardiac fluoroscopy)
7600326
76010
7601026
7604026
7606126
7606226
7606526
7606626
7607026
7607526
Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)
Radiologic examination from nose to rectum for foreign body, single view, child
76080
7608026
7608626
7608826
7609026
7609126
7609326
7609426
7609526
7609626
76098
7609826
76100
98.10
72.00
Radiologic examination from nose to rectum for foreign body, single view, child
28.80
Bone length studies (orthoroentgenogram, scanogram)
47.70
Radiologic examination, osseous survey; limited (eg, for metastases)
81.00
Radiologic examination, osseous survey; complete (axial and appendicular
skeleton)
102.60
Radiologic examination, osseous survey, infant
59.40
Joint survey, single view, one or more joints (specify)
54.90
Computerized tomography bone mineral density study, one or more sites
78.30
Dual energy x-ray absorptiometry (DEXA), bone density study, one or more sites;
axial skeleton (eg, hips, pelvis, spine)
Radiologic examination, abscess, fistula or sinus tract study, radiological
supervision and interpretation
Radiologic examination, abscess, fistula or sinus tract study, radiological
supervision and interpretation
Mammary ductogram or galactogram, single duct, radiological supervision and
interpretation
Mammary ductogram or galactogram, multiple ducts, radiological supervision and
interpretation
69.30
173.70
87.30
63.90
82.80
Mammography; unilateral
58.50
Mammography; bilateral
72.00
Magnetic resonance imaging, breast, without and/or with contrast material(s);
unilateral
Magnetic resonance imaging, breast, without and/or with contrast material(s);
bilateral
Stereotactic localization guidance for breast biopsy or needle placement (eg, for
wire localization or for injection), each lesion, radiological supervision and
interpretation
Mammographic guidance for needle placement, breast (eg, for wire localization or
for injection), each lesion, radiological supervision and interpretation
Radiological examination, surgical specimen
342.00
450.90
247.50
99.90
79.20
Radiological examination, surgical specimen
31.50
Radiologic examination, single plane body section (eg, tomography), other than
with urography
216.00
Extraordinary No.64/2013
226
Friday, 09 August 2013
7610026
76101
7610126
76102
7610226
76120
76125
7635526
7636026
7637026
76376
Radiologic examination, single plane body section (eg, tomography), other than
with urography
Radiologic examination, complex motion (ie, hypercycloidal) body section (eg,
mastoid polytomography), other than with urography; unilateral
Radiologic examination, complex motion (ie, hypercycloidal) body section (eg,
mastoid polytomography), other than with urography; unilateral
Radiologic examination, complex motion (ie, hypercycloidal) body section (eg,
mastoid polytomography), other than with urography; bilateral
Radiologic examination, complex motion (ie, hypercycloidal) body section (eg,
mastoid polytomography), other than with urography; bilateral
Cineradiography, except where specifically included
Cineradiography to complement routine examination (List separately in addition to
code for primary procedure)
98.10
257.40
102.60
314.10
126.00
185.40
147.60
Computerized tomography guidance for stereotactic localization
171.00
Computerized tomography guidance for needle placement (eg, biopsy, aspiration,
injection, localization device), radiological supervision and interpretation
197.10
Computerized tomography guidance for placement of radiation therapy fields
144.00
3d rndr i&r ct mri us/oth x req postpcx
361.98
76376
76376
3d rndr i&r ct mri us/oth x req postpcx
3d rndr i&r ct mri us/oth x req postpcx
332.02
29.96
76377
76377
3d rndr i&r ct mri us/oth req postpcx
3d rndr i&r ct mri us/oth req postpcx
448.98
341.68
76377
76380
3d rndr i&r ct mri us/oth req postpcx
Computerized tomography, limited or localized follow-up study
107.30
443.70
76390
7639026
7640026
Magnetic resonance spectroscopy
1275.30
Magnetic resonance spectroscopy
191.70
Magnetic resonance (eg, proton) imaging, bone marrow blood supply
254.70
76506
7650626
76510
76510
76510
76511
Echoencephalography, B-scan and/or real time with image documentation (gray
scale) (for determination of ventricular size, delineation of cerebral contents and
detection of fluid masses or other intracranial abnormalities), including A-mode
encephalograph
Echoencephalography, B-scan and/or real time with image documentation (gray
scale) (for determination of ventricular size, delineation of cerebral contents and
detection of fluid masses or other intracranial abnormalities), including A-mode
encephalograph
Oph us dx b-scan&quan a-scan sm pt enctr
Oph us dx b-scan&quan a-scan sm pt enctr
Oph us dx b-scan&quan a-scan sm pt enctr
Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude
quantification
Extraordinary No.64/2013
227
298.80
119.70
401.87
198.88
202.99
283.50
Friday, 09 August 2013
7651126
7651326
76514
Ophthalmic ultrasound, echography, diagnostic; A-scan only, with amplitude
quantification
Ophthalmic ultrasound, echography, diagnostic; contact B-scan (with or without
simultaneous A-scan)
Ophthalmic ultrasound, echography, diagnostic; contact B-scan (with or without
simultaneous A-scan)
Ophthalmic ultrasound, echography, diagnostic; anterior segment ultrasound,
immersion (water bath) B-scan or high resolution biomicroscopy
Ophthalmic ultrasound, echography, diagnostic; anterior segment ultrasound,
immersion (water bath) B-scan or high resolution biomicroscopy
Oph us dx crnl pachymetry uni/bi
76514
76514
Oph us dx crnl pachymetry uni/bi
Oph us dx crnl pachymetry uni/bi
8.13
31.94
76516
7651626
Ophthalmic biometry by ultrasound echography, A-scan;
227.70
Ophthalmic biometry by ultrasound echography, A-scan;
91.80
76512
7651226
76513
76519
7651926
76529
7652926
76536
7653626
76604
7660426
76645
7664526
76700
7670026
76705
7670526
76770
Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens
power calculation
Ophthalmic biometry by ultrasound echography, A-scan; with intraocular lens
power calculation
Ophthalmic ultrasonic foreign body localization
Ophthalmic ultrasonic foreign body localization
228
302.40
120.60
302.40
120.60
40.07
248.40
99.00
264.60
106.20
Echography, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), Bscan and/or real time with image documentation
Echography, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), Bscan and/or real time with image documentation
Echography, chest, B-scan (includes mediastinum) and/or real time with image
documentation
Echography, chest, B-scan (includes mediastinum) and/or real time with image
documentation
Echography, breast(s) (unilateral or bilateral), B-scan and/or real time with image
documentation
Echography, breast(s) (unilateral or bilateral), B-scan and/or real time with image
documentation
Echography, abdominal, B-scan and/or real time with image documentation;
complete
Echography, abdominal, B-scan and/or real time with image documentation;
complete
Echography, abdominal, B-scan and/or real time with image documentation;
limited (eg, single organ, quadrant, follow-up)
Echography, abdominal, B-scan and/or real time with image documentation;
limited (eg, single organ, quadrant, follow-up)
Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with
image documentation; complete
Extraordinary No.64/2013
142.20
257.72
108.00
257.40
102.60
251.93
113.40
320.01
126.90
246.20
99.90
318.12
Friday, 09 August 2013
7677026
76775
7677526
76776
Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with
image documentation; complete
Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with
image documentation; limited
Echography, retroperitoneal (eg, renal, aorta, nodes), B-scan and/or real time with
image documentation; limited
Us trnspl kdn r-t img +- duplex dop std
130.50
214.87
92.70
324.32
76776
76776
7677826
76800
7680026
76801
Us trnspl kdn r-t img +- duplex dop std
Us trnspl kdn r-t img +- duplex dop std
Echography of transplanted kidney, B-scan and/or real time with image
documentation, with or without duplex Doppler studies
Echography, spinal canal and contents
229.57
94.76
Echography, spinal canal and contents
163.80
Us pg uter img f&mat 14 wk tabdl 1/1st gestation
318.00
76801
76801
Us pg uter img f&mat 14 wk tabdl 1/1st gestation
Us pg uter img f&mat 14 wk tabdl 1/1st gestation
197.99
120.01
76802
76802
Us pg uter f&mat 14 wk tabdl ea gestation
Us pg uter f&mat 14 wk tabdl ea gestation
178.50
88.13
76802
90.37
76811
Us pg uter f&mat 14 wk tabdl ea gestation
Echography, pregnant uterus, B-scan and/or real time with image documentation;
complete (complete fetal and maternal evaluation)
Echography, pregnant uterus, B-scan and/or real time with image documentation;
complete (complete fetal and maternal evaluation)
Echography, pregnant uterus, B-scan and/or real time with image documentation;
complete (complete fetal and maternal evaluation), multiple gestation, after the
first trimester
Echography, pregnant uterus, B-scan and/or real time with image documentation;
complete (complete fetal and maternal evaluation), multiple gestation, after the
first trimester
Us pg uter f&mat detailed ftl xm 1st gestation
76811
76811
Us pg uter f&mat detailed ftl xm 1st gestation
Us pg uter f&mat detailed ftl xm 1st gestation
315.97
215.59
76812
76812
Us pg uter f&mat detailed ftl antmc xm ea
Us pg uter f&mat detailed ftl antmc xm ea
357.40
143.71
76812
76813
Us pg uter f&mat detailed ftl antmc xm ea
Us fetal nuchal translucency 1st gestation
213.69
297.61
76813
76813
Us fetal nuchal translucency 1st gestation
Us fetal nuchal translucency 1st gestation
164.15
133.46
76814
76814
Us fetal nuchal translucency ea addl gestation
Us fetal nuchal translucency ea addl gestation
197.24
84.68
76805
7680526
76810
7681026
Extraordinary No.64/2013
229
144.90
327.60
275.25
126.90
520.20
207.90
531.56
Friday, 09 August 2013
76814
Us fetal nuchal translucency ea addl gestation
Echography, pregnant uterus, B-scan and/or real time with image documentation;
limited (fetal size, heart beat, placental location, fetal position, or emergency in the
delivery room)
Echography, pregnant uterus, B-scan and/or real time with image documentation;
limited (fetal size, heart beat, placental location, fetal position, or emergency in the
delivery room)
Echography, pregnant uterus, B-scan and/or real time with image documentation;
follow-up or repeat
Echography, pregnant uterus, B-scan and/or real time with image documentation;
follow-up or repeat
Us pg uter r-t img trvg
Us pg uter r-t img trvg
112.56
76817
76818
7681826
76819
Us pg uter r-t img trvg
Fetal biophysical profile; with non-stress testing
105.50
284.12
Fetal biophysical profile; with non-stress testing
136.80
Ftl biophysical profile w/o non-strs tstg
297.07
76819
76819
Ftl biophysical profile w/o non-strs tstg
Ftl biophysical profile w/o non-strs tstg
181.10
115.96
76820
76820
Dop velocimetry ftl umbilical art
Dop velocimetry ftl umbilical art
221.10
154.56
76820
76821
Dop velocimetry ftl umbilical art
Dop velocimetry ftl middle cere art
66.54
282.43
76821
76821
Dop velocimetry ftl middle cere art
Dop velocimetry ftl middle cere art
Echocardiography, fetal, cardiovascular system, real time with image
documentation (2D), with or without M-mode recording;
Echocardiography, fetal, cardiovascular system, real time with image
documentation (2D), with or without M-mode recording;
Echocardiography, fetal, cardiovascular system, real time with image
documentation (2D), with or without M-mode recording; follow-up or repeat study
Echocardiography, fetal, cardiovascular system, real time with image
documentation (2D), with or without M-mode recording; follow-up or repeat study
Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or
continuous wave with spectral display; complete
Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or
continuous wave with spectral display; complete
Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or
continuous wave with spectral display; follow-up or repeat study
Doppler echocardiography, fetal, cardiovascular system, pulsed wave and/or
continuous wave with spectral display; follow-up or repeat study
Echography, transvaginal
178.69
103.74
76815
7681526
76816
7681626
76817
76817
76825
7682526
76826
7682626
76827
7682726
76828
7682826
76830
Extraordinary No.64/2013
230
199.06
85.50
192.60
86.40
267.84
162.34
345.33
180.00
236.70
166.50
268.20
107.10
171.00
86.40
271.17
Friday, 09 August 2013
7683026
76831
76856
7685626
76857
7685726
76870
7687026
76872
7687226
Echography, transvaginal
119.70
Hysterosonography, with or without color flow Doppler
Echography, pelvic (nonobstetric), B-scan and/or real time with image
documentation; complete
Echography, pelvic (nonobstetric), B-scan and/or real time with image
documentation; complete
Echography, pelvic (nonobstetric), B-scan and/or real time with image
documentation; limited or follow-up (eg, for follicles)
Echography, pelvic (nonobstetric), B-scan and/or real time with image
documentation; limited or follow-up (eg, for follicles)
Echography, scrotum and contents
285.80
Echography, scrotum and contents
109.80
Echography, transrectal;
343.53
Echography, transrectal;
153.90
262.16
106.20
210.38
78.30
244.26
7687326
7688026
76881
Echography, transrectal; prostate volume study for brachytherapy treatment
planning (separate procedure)
Echography, transrectal; prostate volume study for brachytherapy treatment
planning (separate procedure)
Echography, extremity, non-vascular, B-scan and/or real time with image
documentation
Us extremity non-vasc real-time img compl
76881
76881
Us extremity non-vasc real-time img compl
Us extremity non-vasc real-time img compl
264.39
87.64
76882
76882
Us extremity non-vasc real-time img lmtd
Us extremity non-vasc real-time img lmtd
99.72
34.02
76882
Us extremity non-vasc real-time img lmtd
Echography of infant hips, real time with imaging documentation; dynamic (eg,
requiring manipulation)
Echography of infant hips, real time with imaging documentation; limited, static
(eg, not requiring manipulation)
Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation
65.70
Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation
105.30
76873
76885
76886
76930
7693026
76932
7693226
76936
76936-
525.60
262.80
108.00
352.03
Ultrasonic guidance for endomyocardial biopsy, imaging supervision and
interpretation
Ultrasonic guidance for endomyocardial biopsy, imaging supervision and
interpretation
Ultrasound guided compression repair of arterial pseudo-aneurysm or
arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of
lesion and imaging)
Ultrasound guided compression repair of arterial pseudo-aneurysm or
Extraordinary No.64/2013
231
309.60
278.10
262.80
319.50
127.80
932.40
372.60
Friday, 09 August 2013
26
76937
76937
76937
arteriovenous fistulae (includes diagnostic ultrasound evaluation, compression of
lesion and imaging)
Us vasc access sits vsl patency ndl entry
Us vasc access sits vsl patency ndl entry
95.77
51.19
Us vasc access sits vsl patency ndl entry
Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging
supervision and interpretation
Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging
supervision and interpretation
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device), imaging supervision and interpretation
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device), imaging supervision and interpretation
Ultrasonic guidance for chorionic villus sampling, imaging supervision and
interpretation
Ultrasonic guidance for chorionic villus sampling, imaging supervision and
interpretation
Ultrasonic guidance for amniocentesis, imaging supervision and interpretation
44.58
Ultrasonic guidance for amniocentesis, imaging supervision and interpretation
63.90
Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation
285.30
Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation
85.50
Ultrasonic guidance for placement of radiation therapy fields
246.60
Ultrasonic guidance for placement of radiation therapy fields
99.00
Ultrasonic guidance for interstitial radioelement application
697.50
Ultrasonic guidance for interstitial radioelement application
279.00
Ultrasound study follow-up (specify)
183.60
Ultrasound study follow-up (specify)
72.90
Gastrointestinal endoscopic ultrasound, supervision and interpretation
263.70
Gastrointestinal endoscopic ultrasound, supervision and interpretation
118.80
Ultrasound bone density measurement and interpretation, peripheral site(s), any
method
179.53
Ultrasonic guidance, intraoperative
288.00
Fluor gid ctr vad plmt rplcmt/rmvl
260.72
77001
77001
Fluor gid ctr vad plmt rplcmt/rmvl
Fluor gid ctr vad plmt rplcmt/rmvl
205.15
55.57
77002
Fluoroscopic guidance needle placement
227.71
76941
7694126
76942
7694226
76945
7694526
76946
7694626
76948
7694826
76950
7695026
76965
7696526
76970
7697026
76975
7697526
76977
7698626
77001
Extraordinary No.64/2013
232
283.50
142.20
308.70
123.30
257.40
129.60
296.44
Friday, 09 August 2013
77002
Fluoroscopic guidance needle placement
150.18
77002
77003
Fluoroscopic guidance needle placement
Fluor gid & loclzj ndl/cath spi dx/ther njx
77.53
218.53
77003
77003
Fluor gid & loclzj ndl/cath spi dx/ther njx
Fluor gid & loclzj ndl/cath spi dx/ther njx
134.36
84.18
77011
77011
Ct guidance stereotactic localization
Ct guidance stereotactic localization
1109.83
937.57
77011
77012
Ct guidance stereotactic localization
Ct guidance needle placement
172.26
1017.89
77012
77012
Ct guidance needle placement
Ct guidance needle placement
857.81
160.08
77014
77014
Ct guidance radiation therapy flds placement
Ct guidance radiation therapy flds placement
522.89
384.74
77014
77021
Ct guidance radiation therapy flds placement
Mr guidance needle placement
138.15
1609.20
77021
77021
Mr guidance needle placement
Mr guidance needle placement
1351.09
258.11
77031
77031
Strtctc loclzj gid breast bx/needle placement
Strtctc loclzj gid breast bx/needle placement
896.06
679.99
77031
77032
Strtctc loclzj gid breast bx/needle placement
Mammographic gid needle placementt breast
216.08
227.89
77032
77032
Mammographic gid needle placementt breast
Mammographic gid needle placementt breast
144.22
83.67
77051
77051
Computer-aided detection dx mammography
Computer-aided detection dx mammography
56.04
46.26
77051
77052
Computer-aided detection dx mammography
Computer-aided detection screening mammography
9.78
54.33
77052
77052
Computer-aided detection screening mammography
Computer-aided detection screening mammography
44.84
9.49
77053
77053
Mammary ductogram or galactogram single
Mammary ductogram or galactogram single
302.99
255.93
77053
77054
Mammary ductogram or galactogram single
Mammary ductogram or galactogram multiple
47.05
348.54
77054
77054
Mammary ductogram or galactogram multiple
Mammary ductogram or galactogram multiple
297.57
50.96
77055
77055
Mammography unilateral
Mammography unilateral
165.49
90.98
Extraordinary No.64/2013
233
Friday, 09 August 2013
77055
Mammography unilateral
74.51
77056
77056
Mammography bilateral
Mammography bilateral
216.05
119.03
77056
77057
Mammography bilateral
Screening mammography bilateral
97.02
165.80
77057
77057
Screening mammography bilateral
Screening mammography bilateral
96.33
69.47
77058
77058
Mri breast unilateral
Mri breast unilateral
2273.48
2024.95
77058
77059
Mri breast unilateral
Mri breast bilateral
248.53
2939.71
77059
77059
Mri breast bilateral
Mri breast bilateral
2701.01
238.70
77071
77072
Manual appl stress pfrmd phys joint radiography
Bone age studies
68.11
79.09
77072
77072
Bone age studies
Bone age studies
53.43
25.66
77073
77073
Bone length studies
Bone length studies
111.25
76.19
77073
77074
Bone length studies
Radiologic examination osseous survey limited
35.07
129.11
77074
77074
Radiologic examination osseous survey limited
Radiologic examination osseous survey limited
82.44
46.67
77075
77075
Radiologic examination osseous survey compl
Radiologic examination osseous survey compl
206.10
140.29
77075
77076
Radiologic examination osseous survey compl
Radiologic examination osseous survey infant
65.81
137.87
77076
77076
Radiologic examination osseous survey infant
Radiologic examination osseous survey infant
67.80
70.08
77077
77077
Joint survey single view 2 or more joints
Joint survey single view 2 or more joints
115.37
83.04
77077
77078
Joint survey single view 2 or more joints
Ct bone mineral density study 1+ sits axial skel
32.33
310.42
77078
77078
Ct bone mineral density study 1+ sits axial skel
Ct bone mineral density study 1+ sits axial skel
280.54
29.88
77079
77079
Ct bone mineral density study 1+ sits appnd
Ct bone mineral density study 1+ sits appnd
280.61
251.27
Extraordinary No.64/2013
234
Friday, 09 August 2013
77079
Ct bone mineral density study 1+ sits appnd
29.34
77080
77080
Dxa bone density study 1+ sits axial skel
Dxa bone density study 1+ sits axial skel
311.04
277.02
77080
77081
Dxa bone density study 1+ sits axial skel
Dxa bone density study 1+ sits appendicular skel
34.02
97.24
77081
77081
Dxa bone density study 1+ sits appendicular skel
Dxa bone density study 1+ sits appendicular skel
69.71
27.53
77082
77082
Dxa bone density study vertebral fracture
Dxa bone density study vertebral fracture
84.82
65.41
77082
77083
Dxa bone density study vertebral fracture
Radiographic absorptiometry 1+ sits
19.41
85.05
77083
77083
Radiographic absorptiometry 1+ sits
Radiographic absorptiometry 1+ sits
62.23
22.83
77084
77084
Bone marrow blood supply
Bone marrow blood supply
253.26
186.69
77084
77261
Bone marrow blood supply
Therapeutic radiology treatment planning; simple
66.56
340.20
77262
77263
Therapeutic radiology treatment planning; intermediate
Therapeutic radiology treatment planning; complex
496.80
622.80
77280
7728026
77285
7728526
77290
7729026
77295
7729526
Therapeutic radiology simulation-aided field setting; simple
453.60
Therapeutic radiology simulation-aided field setting; simple
136.80
Therapeutic radiology simulation-aided field setting; intermediate
640.80
Therapeutic radiology simulation-aided field setting; intermediate
192.60
Therapeutic radiology simulation-aided field setting; complex
869.40
Therapeutic radiology simulation-aided field setting; complex
261.00
Therapeutic radiology simulation-aided field setting; three-dimensional
3429.00
Therapeutic radiology simulation-aided field setting; three-dimensional
857.70
77301
77301
Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap
calculation, off axis factor, tissue inhomogeneity factors, as required during course
of treatment, only when prescribed by the treating physician
Basic radiation dosimetry calculation, central axis depth dose, TDF, NSD, gap
calculation, off axis factor, tissue inhomogeneity factors, as required during course
of treatment, only when prescribed by the treating physician
Ntsty modul radthx pln dose-vol histos
Ntsty modul radthx pln dose-vol histos
77301
Ntsty modul radthx pln dose-vol histos
77300
7730026
Extraordinary No.64/2013
269.10
121.50
4104.56
3044.07
1060.49
235
Friday, 09 August 2013
77305
7730526
77310
7731026
77315
7731526
77321
7732126
77326
7732626
77327
7732726
77328
7732826
77331
7733126
77332
7733226
77333
7733326
Teletherapy, isodose plan (whether hand or computer calculated); simple (one or
two parallel opposed unmodified ports directed to a single area of interest)
Teletherapy, isodose plan (whether hand or computer calculated); simple (one or
two parallel opposed unmodified ports directed to a single area of interest)
Teletherapy, isodose plan (whether hand or computer calculated); intermediate
(three or more treatment ports directed to a single area of interest)
Teletherapy, isodose plan (whether hand or computer calculated); intermediate
(three or more treatment ports directed to a single area of interest)
Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle
or inverted Y, tangential ports, the use of wedges, compensators, complex
blocking, rotational beam, or special beam considerations)
Teletherapy, isodose plan (whether hand or computer calculated); complex (mantle
or inverted Y, tangential ports, the use of wedges, compensators, complex
blocking, rotational beam, or special beam considerations)
Special teletherapy port plan, particles, hemibody, total body
Special teletherapy port plan, particles, hemibody, total body
Treatment devices, design and construction; simple (simple block, simple bolus)
Treatment devices, design and construction; intermediate (multiple blocks, stents,
bite blocks, special bolus)
Treatment devices, design and construction; intermediate (multiple blocks, stents,
bite blocks, special bolus)
236
156.60
462.60
207.90
590.40
295.20
536.40
162.00
Brachytherapy isodose calculation; simple (calculation made from single plane,
one to four sources/ribbon application, remote afterloading brachytherapy, 1 to 8
sources)
Brachytherapy isodose calculation; simple (calculation made from single plane,
one to four sources/ribbon application, remote afterloading brachytherapy, 1 to 8
sources)
Brachytherapy isodose calculation; intermediate (multiplane dosage calculations,
application involving 5 to 10 sources/ribbons, remote afterloading brachytherapy, 9
to 12 sources)
Brachytherapy isodose calculation; intermediate (multiplane dosage calculations,
application involving 5 to 10 sources/ribbons, remote afterloading brachytherapy, 9
to 12 sources)
Brachytherapy isodose calculation; complex (multiplane isodose plan, volume
implant calculations, over 10 sources/ribbons used, special spatial reconstruction,
remote afterloading brachytherapy, over 12 sources)
Brachytherapy isodose calculation; complex (multiplane isodose plan, volume
implant calculations, over 10 sources/ribbons used, special spatial reconstruction,
remote afterloading brachytherapy, over 12 sources)
Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by
the treating physician
Special dosimetry (eg, TLD, microdosimetry) (specify), only when prescribed by
the treating physician
Treatment devices, design and construction; simple (simple block, simple bolus)
Extraordinary No.64/2013
347.40
366.30
146.70
540.00
215.10
784.80
314.10
207.90
166.50
279.00
112.50
375.30
149.40
Friday, 09 August 2013
77338
Treatment devices, design and construction; complex (irregular blocks, special
shields, compensators, wedges, molds or casts)
Treatment devices, design and construction; complex (irregular blocks, special
shields, compensators, wedges, molds or casts)
Continuing medical physics consultation, including assessment of treatment
parameters, quality assurance of dose delivery, and review of patient treatment
documentation in support of the radiation oncologist, reported per week of therapy
Mlc imrt design & construction per imrt plan
77338
77338
Mlc imrt design & construction per imrt plan
Mlc imrt design & construction per imrt plan
659.38
576.91
77370
77372
Special medical radiation physics consultation
Radiation delivery stereotactic cranial linear
301.50
3063.96
77373
77401
5714.33
163.80
77417
Stereotactic body radiation delivery
Radiation treatment delivery, superficial and/or ortho voltage
Radiation treatment delivery, single treatment area, single port or parallel opposed
ports, simple blocks or no blocks; up to 5 MeV
Radiation treatment delivery, single treatment area, single port or parallel opposed
ports, simple blocks or no blocks; 6-10 MeV
Radiation treatment delivery, single treatment area, single port or parallel opposed
ports, simple blocks or no blocks; 11-19 MeV
Radj dlvr 1 area 1/prll opsd ports smpl 20mev/<
Radiation treatment delivery, two separate treatment areas, three or more ports on a
single treatment area, use of multiple blocks; up to 5 MeV
Radiation treatment delivery, two separate treatment areas, three or more ports on a
single treatment area, use of multiple blocks; 6-10 MeV
Radiation treatment delivery, two separate treatment areas, three or more ports on a
single treatment area, use of multiple blocks; 11-19 MeV
Radiation treatment delivery, two separate treatment areas, three or more ports on a
single treatment area, use of multiple blocks; 20 MeV or greater
Radiation treatment delivery, three or more separate treatment areas, custom
blocking, tangential ports, wedges, rotational beam, compensators, special particle
beam (eg, electron or neutrons); up to 5 MeV
Radiation treatment delivery, three or more separate treatment areas, custom
blocking, tangential ports, wedges, rotational beam, compensators, special particle
beam (eg, electron or neutrons); 6-10 MeV
Radiation treatment delivery, three or more separate treatment areas, custom
blocking, tangential ports, wedges, rotational beam, compensators, special particle
beam (eg, electron or neutrons); 11-19 MeV
Radiation treatment delivery, three or more separate treatment areas, custom
blocking, tangential ports, wedges, rotational beam, compensators, special particle
beam (eg, electron or neutrons); 20 MeV or greater
Therapeutic radiology port film(s)
77418
77421
Ntsty modul dlvr 1/mlt flds/arcs pr tx session
Strsc x-ray gdn loclzj target vol dlvr radj ther
2378.84
474.62
77334
7733426
77336
77402
77403
77404
77406
77407
77408
77409
77411
77412
77413
77414
77416
Extraordinary No.64/2013
237
606.60
243.00
249.30
1236.29
163.80
163.80
163.80
237.77
192.60
192.60
192.60
192.60
214.20
214.20
214.20
214.20
77.40
Friday, 09 August 2013
77421
Strsc x-ray gdn loclzj target vol dlvr radj ther
403.04
77421
77422
Strsc x-ray gdn loclzj target vol dlvr radj ther
Hi nrg neutron radj tx dlvr 1 tx area
71.58
248.82
77423
77427
Hi nrg neutron radj tx dlvr 1/> isocenter
Radiation treatment management, five treatments
Radiation therapy management with complete course of therapy consisting of one
or two fractions only
Stereotactic radiation treatment management of cerebral lesion(s) (complete course
of treatment consisting of one session)
Stereotactic body radiation management
Special treatment procedure (eg, total body irradiation, hemibody radiation, per
oral, endocavitary or intraoperative cone irradiation)
Special treatment procedure (eg, total body irradiation, hemibody radiation, per
oral, endocavitary or intraoperative cone irradiation)
Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or
less)
Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or
less)
Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)
361.47
428.40
Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm)
425.70
Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators
637.20
Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators
319.50
Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators
849.60
Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators
425.70
Hyperthermia generated by intracavitary probe(s)
639.00
Hyperthermia generated by intracavitary probe(s)
320.40
Infusion or instillation of radioelement solution
973.80
Infusion or instillation of radioelement solution
876.60
Intracavitary radiation source application; simple
765.00
Intracavitary radiation source application; simple
573.30
Intracavitary radiation source application; intermediate
1133.10
Intracavitary radiation source application; intermediate
849.60
Intracavitary radiation source application; complex
1473.30
Intracavitary radiation source application; complex
1178.10
Interstitial radiation source application; simple
978.30
77431
77432
77435
77470
7747026
77600
7760026
77605
7760526
77610
7761026
77615
7761526
77620
7762026
77750
7775026
77761
7776126
77762
7776226
77763
7776326
77776
Extraordinary No.64/2013
238
268.20
1313.10
2444.40
1327.50
428.40
669.60
334.80
849.60
Friday, 09 August 2013
7777626
77777
7777726
77778
7777826
7778126
7778226
7778326
7778426
77785
77785
Interstitial radiation source application; simple
783.00
Interstitial radiation source application; intermediate
1471.50
Interstitial radiation source application; intermediate
1178.10
Interstitial radiation source application; complex
2271.60
Interstitial radiation source application; complex
1817.10
Remote afterloading high intensity brachytherapy; 1-4 source positions or catheters
218.70
Remote afterloading high intensity brachytherapy; 5-8 source positions or catheters
459.00
Remote afterloading high intensity brachytherapy; 9-12 source positions or
catheters
Remote afterloading high intensity brachytherapy; over 12 source positions or
catheters
Remote aftld radionuclide brachytx 1 channel
Remote aftld radionuclide brachytx 1 channel
738.90
738.90
471.94
296.61
77785
77786
Remote aftld radionuclide brachytx 1 channel
Remote aftld radionuclide brachytx 2-12 channel
175.33
1393.84
77786
77786
Remote aftld radionuclide brachytx 2-12 channel
Remote aftld radionuclide brachytx 2-12 channel
992.82
401.03
77787
77787
Remote aftld radionuclide brachytx > 12 channel
Remote aftld radionuclide brachytx > 12 channel
2088.30
1471.58
77787
77789
7778926
77790
7779026
78000
7800026
78001
7800126
Remote aftld radionuclide brachytx > 12 channel
Surface application of radiation source
616.72
185.40
Surface application of radiation source
148.50
Supervision, handling, loading of radiation source
226.80
Supervision, handling, loading of radiation source
180.90
Thyroid uptake; single determination
124.20
Thyroid uptake; single determination
37.80
Thyroid uptake; multiple determinations
180.00
Thyroid uptake; multiple determinations
54.90
78003
7800326
78006
Thyroid uptake; stimulation, suppression or discharge (not including initial uptake
studies)
Thyroid uptake; stimulation, suppression or discharge (not including initial uptake
studies)
Thyroid imaging, with uptake; single determination
Extraordinary No.64/2013
239
186.01
76.50
314.10
Friday, 09 August 2013
7800626
78007
7800726
78010
7801026
78011
7801126
78015
7801526
78016
7801626
78018
7801826
78020
78070
7807026
78075
7807526
78102
7810226
78103
7810326
78104
7810426
78110
7811026
78111
Thyroid imaging, with uptake; single determination
94.50
Thyroid imaging, with uptake; multiple determinations
392.27
Thyroid imaging, with uptake; multiple determinations
121.50
Thyroid imaging; only
247.50
Thyroid imaging; only
73.80
Thyroid imaging; with vascular flow
304.20
Thyroid imaging; with vascular flow
91.80
Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)
442.80
Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only)
133.20
Thyroid carcinoma metastases imaging; with additional studies (eg, urinary
recovery)
Thyroid carcinoma metastases imaging; with additional studies (eg, urinary
recovery)
Thyroid carcinoma metastases imaging; whole body
Thyroid carcinoma metastases imaging; whole body
Thyroid carcinoma metastases uptake (List separately in addition to code for
primary procedure)
Parathyroid imaging
493.20
148.50
668.70
166.50
111.60
216.00
Parathyroid imaging
86.40
Adrenal imaging, cortex and/or medulla
486.90
Adrenal imaging, cortex and/or medulla
98.10
Bone marrow imaging; limited area
273.60
Bone marrow imaging; limited area
82.80
Bone marrow imaging; multiple areas
407.70
Bone marrow imaging; multiple areas
121.50
Bone marrow imaging; whole body
501.30
Bone marrow imaging; whole body
150.30
Plasma volume, radiopharmaceutical volume-dilution technique (separate
procedure); single sampling
Plasma volume, radiopharmaceutical volume-dilution technique (separate
procedure); single sampling
Plasma volume, radiopharmaceutical volume-dilution technique (separate
procedure); multiple samplings
Extraordinary No.64/2013
240
144.00
43.20
304.20
Friday, 09 August 2013
7811126
78120
7812026
78121
7812126
78122
7812226
78130
7813026
78135
7813526
78140
7814026
7816026
7816226
7817026
78185
7818526
78190
7819026
78191
7819126
78195
7819526
78201
7820126
78202
Plasma volume, radiopharmaceutical volume-dilution technique (separate
procedure); multiple samplings
Red cell volume determination (separate procedure); single sampling
61.20
189.90
Red cell volume determination (separate procedure); single sampling
37.80
Red cell volume determination (separate procedure); multiple samplings
306.90
Red cell volume determination (separate procedure); multiple samplings
62.10
Whole blood volume determination, including separate measurement of plasma
volume and red cell volume (radiopharmaceutical volume-dilution technique)
Whole blood volume determination, including separate measurement of plasma
volume and red cell volume (radiopharmaceutical volume-dilution technique)
Red cell survival study;
Red cell survival study;
478.80
95.40
339.30
101.70
Red cell survival study; differential organ/tissue kinetics, (eg, splenic and/or
hepatic sequestration)
Red cell survival study; differential organ/tissue kinetics, (eg, splenic and/or
hepatic sequestration)
Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or hepatic)
527.40
105.30
437.40
Labeled red cell sequestration, differential organ/tissue, (eg, splenic and/or hepatic)
108.90
Plasma radioiron disappearance (turnover) rate
76.50
Radioiron oral absorption
70.20
Radioiron red cell utilization
108.00
Spleen imaging only, with or without vascular flow
347.40
Spleen imaging only, with or without vascular flow
86.40
Kinetics, study of platelet survival, with or without differential organ/tissue
localization
Kinetics, study of platelet survival, with or without differential organ/tissue
localization
Platelet survival study
661.50
165.60
704.70
Platelet survival study
141.30
Lymphatics and lymph glands imaging
519.30
Lymphatics and lymph glands imaging
155.70
Liver imaging; static only
363.60
Liver imaging; static only
108.90
Liver imaging; with vascular flow
440.10
Extraordinary No.64/2013
241
Friday, 09 August 2013
7820226
78205
7820526
78206
78215
7821526
78216
7821626
78220
7822026
78223
7822326
78230
7823026
78231
7823126
78232
7823226
78258
7825826
78261
7826126
78262
7826226
78264
7826426
78270
Liver imaging; with vascular flow
131.40
Liver imaging (SPECT);
810.90
Liver imaging (SPECT);
204.30
Liver imaging (SPECT); with vascular flow
Liver and spleen imaging; static only
603.00
459.00
Liver and spleen imaging; static only
115.20
Liver and spleen imaging; with vascular flow
494.10
Liver and spleen imaging; with vascular flow
124.20
Liver function study with hepatobiliary agents, with serial images
484.20
Liver function study with hepatobiliary agents, with serial images
121.50
Hepatobiliary ductal system imaging, including gallbladder, with or without
pharmacologic intervention, with or without quantitative measurement of
gallbladder function
Hepatobiliary ductal system imaging, including gallbladder, with or without
pharmacologic intervention, with or without quantitative measurement of
gallbladder function
Salivary gland imaging;
457.20
137.70
342.90
Salivary gland imaging;
102.60
Salivary gland imaging; with serial images
369.00
Salivary gland imaging; with serial images
92.70
Salivary gland function study
376.20
Salivary gland function study
94.50
Esophageal motility
392.40
Esophageal motility
117.00
Gastric mucosa imaging
480.60
Gastric mucosa imaging
120.60
Gastroesophageal reflux study
493.20
Gastroesophageal reflux study
123.30
Gastric emptying study
504.90
Gastric emptying study
151.20
Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor
170.10
Extraordinary No.64/2013
242
Friday, 09 August 2013
7827026
78271
7827126
78272
7827226
78278
7827826
78290
7829026
78291
7829126
78300
7830026
78305
7830526
78306
7830626
78315
7831526
78320
7832026
78350
7835026
78351
78428
7842826
78445
7844526
Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor
34.20
Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor
204.30
Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor
41.40
Vitamin B-12 absorption studies combined, with and without intrinsic factor
271.80
Vitamin B-12 absorption studies combined, with and without intrinsic factor
54.90
Acute gastrointestinal blood loss imaging
626.40
Acute gastrointestinal blood loss imaging
188.10
Bowel imaging (eg, ectopic gastric mucosa, Meckels localization, volvulus)
369.00
Bowel imaging (eg, ectopic gastric mucosa, Meckels localization, volvulus)
109.80
Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)
392.40
Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt)
117.00
Bone and/or joint imaging; limited area
406.80
Bone and/or joint imaging; limited area
122.40
Bone and/or joint imaging; multiple areas
483.30
Bone and/or joint imaging; multiple areas
144.00
Bone and/or joint imaging; whole body
548.10
Bone and/or joint imaging; whole body
164.70
Bone and/or joint imaging; three phase study
619.20
Bone and/or joint imaging; three phase study
185.40
Bone and/or joint imaging; tomographic (SPECT)
792.90
Bone and/or joint imaging; tomographic (SPECT)
198.90
Bone density (bone mineral content) study, one or more sites; single photon
absorptiometry
Bone density (bone mineral content) study, one or more sites; single photon
absorptiometry
B1 dns std 1+ sits dual phtn absrptm 1+ sits
Cardiac shunt detection
216.00
64.80
233.90
335.70
Cardiac shunt detection
134.10
Non-cardiac vascular flow imaging (ie, angiography, venography)
370.80
Non-cardiac vascular flow imaging (ie, angiography, venography)
112.50
Extraordinary No.64/2013
243
Friday, 09 August 2013
78451
Myocardial spect single study at rest or stress
600.93
78451
78451
Myocardial spect single study at rest or stress
Myocardial spect single study at rest or stress
431.03
169.90
78452
78452
Myocardial spect multiple studies
Myocardial spect multiple studies
968.65
772.38
78452
78453
Myocardial spect multiple studies
Myocardial perfusion planar 1 study rest/stress
196.26
513.38
78453
78453
Myocardial perfusion planar 1 study rest/stress
Myocardial perfusion planar 1 study rest/stress
392.20
121.18
78454
78454
Myocardial perfusion planar multiple studies
Myocardial perfusion planar multiple studies
539.02
377.27
78454
7845526
78456
78456
Myocardial perfusion planar multiple studies
161.76
Venous thrombosis study (eg, radioactive fibrinogen)
133.20
Aqt ven thrombosis img peptide
Aqt ven thrombosis img peptide
823.92
694.47
78456
78457
7845726
78458
7845826
7846026
Aqt ven thrombosis img peptide
Venous thrombosis imaging, venogram; unilateral
129.45
342.00
Venous thrombosis imaging, venogram; unilateral
101.70
Venous thrombosis imaging, venogram; bilateral
527.40
Venous thrombosis imaging, venogram; bilateral
158.40
7846126
7846426
7846526
78466
7846626
78468
7846826
78469
Myocardial perfusion imaging; (planar) single study, at rest or stress (exercise
and/or pharmacologic), with or without quantification
Myocardial perfusion imaging; multiple studies, (planar) at rest and/or stress
(exercise and/or pharmacologic), and redistribution and/or rest injection, with or
without quantification
Myocardial perfusion imaging; tomographic (SPECT), single study at rest or stress
(exercise and/or pharmacologic), with or without quantification
Myocardial perfusion imaging; tomographic (SPECT), multiple studies, at rest
and/or stress (exercise and/or pharmacologic) and redistribution and/or rest
injection, with or without quantification
Myocardial imaging, infarct avid, planar; qualitative or quantitative
Myocardial imaging, infarct avid, planar; qualitative or quantitative
244
236.70
171.90
252.00
441.00
131.40
Myocardial imaging, infarct avid, planar; with ejection fraction by first pass
technique
Myocardial imaging, infarct avid, planar; with ejection fraction by first pass
technique
Myocardial imaging, infarct avid, planar; tomographic SPECT with or without
quantification
Extraordinary No.64/2013
175.50
477.90
144.00
689.40
Friday, 09 August 2013
7846926
78472
7847226
78473
7847326
7847826
7848026
78481
7848126
78483
7848326
78494
78496
78580
7858026
78584
7858426
78585
7858526
78586
Myocardial imaging, infarct avid, planar; tomographic SPECT with or without
quantification
Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress
(exercise and/or pharmacologic), wall motion study plus ejection fraction, with or
without additional quantitative processing
Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress
(exercise and/or pharmacologic), wall motion study plus ejection fraction, with or
without additional quantitative processing
Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study
plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or
without additional quantification
Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study
plus ejection fraction, at rest and stress (exercise and/or pharmacologic), with or
without additional quantification
Myocardial perfusion study with wall motion, qualitative or quantitative study
(List separately in addition to code for primary procedure)
Myocardial perfusion study with ejection fraction (List separately in addition to
code for primary procedure)
Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or
with stress (exercise and/or pharmacologic), wall motion study plus ejection
fraction, with or without quantification
Cardiac blood pool imaging, (planar), first pass technique; single study, at rest or
with stress (exercise and/or pharmacologic), wall motion study plus ejection
fraction, with or without quantification
Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest
and with stress (exercise and/ or pharmacologic), wall motion study plus ejection
fraction, with or without quantification
Cardiac blood pool imaging, (planar), first pass technique; multiple studies, at rest
and with stress (exercise and/ or pharmacologic), wall motion study plus ejection
fraction, with or without quantification
Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study
plus ejection fraction, with or without quantitative processing
Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right
ventricular ejection fraction by first pass technique (List separately in addition to
code for primary procedure)
Pulmonary perfusion imaging, particulate
171.90
651.60
195.30
997.20
299.70
94.50
92.70
669.60
201.60
940.50
187.20
736.20
229.50
408.60
Pulmonary perfusion imaging, particulate
122.40
Pulmonary perfusion imaging, particulate, with ventilation; single breath
417.60
Pulmonary perfusion imaging, particulate, with ventilation; single breath
166.50
Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and
washout, with or without single breath
Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and
washout, with or without single breath
Pulmonary ventilation imaging, aerosol; single projection
Extraordinary No.64/2013
245
653.40
195.30
289.80
Friday, 09 August 2013
7858626
Pulmonary ventilation imaging, aerosol; single projection
72.00
7858726
78588
Pulmonary ventilation imaging, aerosol; multiple projections (eg, anterior,
posterior, lateral views)
Pulmonary ventilation imaging, aerosol; multiple projections (eg, anterior,
posterior, lateral views)
Pulm pi part vntj img aersl 1/mlt prjcj
78588
78588
Pulm pi part vntj img aersl 1/mlt prjcj
Pulm pi part vntj img aersl 1/mlt prjcj
624.90
150.37
78591
7859126
Pulmonary ventilation imaging, gaseous, single breath, single projection
404.10
Pulmonary ventilation imaging, gaseous, single breath, single projection
100.80
78587
78593
7859326
78594
7859426
78596
7859626
78600
7860026
78601
7860126
78605
7860526
78606
7860626
78607
7860726
78609
78609
78610
7861026
369.00
91.80
775.27
Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or
without single breath; single projection
Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or
without single breath; single projection
Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or
without single breath; multiple projections (eg, anterior, posterior, lateral views)
Pulmonary ventilation imaging, gaseous, with rebreathing and washout with or
without single breath; multiple projections (eg, anterior, posterior, lateral views)
Pulmonary quantitative differential function (ventilation/perfusion) study
395.10
99.90
553.50
137.70
760.50
Pulmonary quantitative differential function (ventilation/perfusion) study
228.60
Brain imaging, limited procedure; static
414.00
Brain imaging, limited procedure; static
104.40
Brain imaging, limited procedure; with vascular flow
487.80
Brain imaging, limited procedure; with vascular flow
122.40
Brain imaging, complete study; static
491.40
Brain imaging, complete study; static
123.30
Brain imaging, complete study; with vascular flow
513.90
Brain imaging, complete study; with vascular flow
129.60
Brain imaging, complete study; tomographic (SPECT)
827.10
Brain imaging, complete study; tomographic (SPECT)
207.00
Brn img p+ emij tomog prfuj eval
1322.05
Brn img p+ emij tomog prfuj eval
Brain imaging, vascular flow only
174.63
246.60
Brain imaging, vascular flow only
73.80
Extraordinary No.64/2013
246
Friday, 09 August 2013
7861526
78630
7863026
78635
7863526
78645
7864526
78647
7864726
78650
7865026
78660
7866026
78700
7870026
78701
7870126
7870426
78707
7870726
78708
7870826
78709
78709-
Cerebral blood flow
108.00
Cerebrospinal fluid flow, imaging (not including introduction of material);
cisternography
Cerebrospinal fluid flow, imaging (not including introduction of material);
cisternography
Cerebrospinal fluid flow, imaging (not including introduction of material);
ventriculography
Cerebrospinal fluid flow, imaging (not including introduction of material);
ventriculography
Cerebrospinal fluid flow, imaging (not including introduction of material); shunt
evaluation
Cerebrospinal fluid flow, imaging (not including introduction of material); shunt
evaluation
Cerebrospinal fluid flow, imaging (not including introduction of material);
tomographic (SPECT)
Cerebrospinal fluid flow, imaging (not including introduction of material);
tomographic (SPECT)
CSF leakage detection and localization
636.68
144.00
350.10
105.30
493.20
123.30
878.40
176.40
671.40
CSF leakage detection and localization
168.30
Radiopharmaceutical dacryocystography
350.10
Radiopharmaceutical dacryocystography
105.30
Kidney imaging; static only
449.10
Kidney imaging; static only
112.50
Kidney imaging; with vascular flow
412.20
Kidney imaging; with vascular flow
102.60
Kidney imaging; with function study (ie, imaging renogram)
144.00
Kidney imaging with vascular flow and function; single study without
pharmacological intervention
Kidney imaging with vascular flow and function; single study without
pharmacological intervention
Kidney imaging with vascular flow and function; single study, with
pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or
diuretic)
Kidney imaging with vascular flow and function; single study, with
pharmacological intervention (eg, angiotensin converting enzyme inhibitor and/or
diuretic)
Kidney imaging with vascular flow and function; multiple studies, with and
without pharmacological intervention (eg, angiotensin converting enzyme inhibitor
and/or diuretic)
Kidney imaging with vascular flow and function; multiple studies, with and
Extraordinary No.64/2013
247
561.60
169.20
592.20
178.20
617.40
185.40
Friday, 09 August 2013
26
without pharmacological intervention (eg, angiotensin converting enzyme inhibitor
and/or diuretic)
Kidney imaging, tomographic (SPECT)
685.80
Kidney imaging, tomographic (SPECT)
171.00
Kidney vascular flow only
59.40
Kidney function study, non-imaging radioisotopic study
270.00
Kidney function study, non-imaging radioisotopic study
82.80
Urinary bladder residual study
197.10
Urinary bladder residual study
58.50
Ureteral reflux study (radiopharmaceutical voiding cystogram)
350.10
Ureteral reflux study (radiopharmaceutical voiding cystogram)
105.30
Testicular imaging;
108.00
Testicular imaging; with vascular flow
463.50
Testicular imaging; with vascular flow
139.50
Radiopharmaceutical localization of tumor; limited area
408.60
Radiopharmaceutical localization of tumor; limited area
122.40
Radiopharmaceutical localization of tumor; multiple areas
504.00
Radiopharmaceutical localization of tumor; multiple areas
151.20
Radiopharmaceutical localization of tumor; whole body
639.00
Radiopharmaceutical localization of tumor; whole body
161.10
Radiopharmaceutical localization of tumor; tomographic (SPECT)
738.90
Radiopharmaceutical localization of tumor; tomographic (SPECT)
185.40
Rp loclzj tum/dstrbj agt whbdy req 2/> d img
1723.26
78804
78804
Rp loclzj tum/dstrbj agt whbdy req 2/> d img
Rp loclzj tum/dstrbj agt whbdy req 2/> d img
1537.58
185.68
78805
7880526
78806
7880626
78807
Radiopharmaceutical localization of inflammatory process; limited area
428.40
Radiopharmaceutical localization of inflammatory process; limited area
128.70
Radiopharmaceutical localization of inflammatory process; whole body
738.90
Radiopharmaceutical localization of inflammatory process; whole body
185.40
Radiopharmaceutical localization of inflammatory process; tomographic (SPECT)
738.90
78710
7871026
7871526
78725
7872526
78730
7873026
78740
7874026
7876026
78761
7876126
78800
7880026
78801
7880126
78802
7880226
78803
7880326
78804
Extraordinary No.64/2013
248
Friday, 09 August 2013
7880726
78808
Radiopharmaceutical localization of inflammatory process; tomographic (SPECT)
184.50
Njx rp loclzj non-img probe study intravenous
Generation of automated data: interactive process involving nuclear physician
and/or allied health professional personnel; simple manipulations and
interpretation, not to exceed 30 minutes
Generation of automated data: interactive process involving nuclear physician
and/or allied health professional personnel; complex manipulations and
interpretation, exceeding 30 minutes
185.07
Radiopharmaceutical therapy, hyper-thyroidism; subsequent, each therapy
200.70
Rp ther oral admn
Rp ther oral admn
757.99
361.14
79005
7902026
7903026
7903526
7910026
79101
79101
Rp ther oral admn
Radiopharmaceutical therapy, thyroid suppression (euthyroid cardiac disease),
including evaluation of patient
396.85
Radiopharmaceutical ablation of gland for thyroid carcinoma
405.90
Radiopharmaceutical therapy for metastases of thyroid carcinoma
449.10
Radiopharmaceutical therapy, polycythemia vera, chronic leukemia, each treatment
216.90
Rp ther iv admn
Rp ther iv admn
781.38
356.56
79101
79200
7920026
7940026
79403
Rp ther iv admn
Intracavitary radioactive colloid therapy
424.82
521.10
Intracavitary radioactive colloid therapy
313.20
Radiopharmaceutical therapy, nonthyroid, nonhematologic
321.30
Rp ther radiolbld monoclonal antb iv nfs
1097.46
79403
79403
Rp ther radiolbld monoclonal antb iv nfs
Rp ther radiolbld monoclonal antb iv nfs
589.16
508.30
79440
7944026
Intra-articular radiopharmaceutical therapy
658.80
Intra-articular radiopharmaceutical therapy
395.10
7889026
7889126
7900126
79005
79005
80048
80050
80051
Basic metabolic panel This panel must include the following: Calcium (82310)
Carbon dioxide (82374) Chloride (82435) Creatinine (82565) Glucose (82947)
Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520)
General health panel This panel must include the following: Comprehensive
metabolic panel (80053) Hemogram, automated, and manual differential WBC
count (CBC) (85022) OR Hemogram and platelet count, automated, and automated
complete differential WBC count
Electrolyte panel This panel must include the following: Carbon dioxide (82374)
Extraordinary No.64/2013
249
14.40
27.90
376.20
35.13
92.38
32.38
Friday, 09 August 2013
Chloride (82435) Potassium (84132) Sodium (84295)
80102
Comprehensive metabolic panel This panel must include the following: Albumin
(82040) Bilirubin, total (82247) Calcium (82310) Carbon dioxide (bicarbonate)
(82374) Chloride (82435) Creatinine (82565) Glucose (82947) Phosphatase,
alkaline (84075) Potassium
Obstetric panel This panel must include the following: Hemogram, automated, and
manual differential WBC count (CBC) (85022) OR Hemogram and platelet count,
automated, and automated complete differential WBC count (CBC) (85025)
Hepatitis B surface antigen
Lipid panel This panel must include the following: Cholesterol, serum, total
(82465) Lipoprotein, direct measurement, high density cholesterol (HDL
cholesterol) (83718) Triglycerides (84478)
Renal function panel This panel must include the following: Albumin (82040)
Calcium (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435)
Creatinine (82565) Glucose (82947) Phosphorus inorganic (phosphate) (84100)
Potassium (84132) Sodium (84295)
Acute hepatitis panel This panel must include the following: Hepatitis A antibody
(HAAb), IgM antibody (86709) Hepatitis B core antibody (HbcAb), IgM antibody
(86705) Hepatitis B surface antigen (HbsAg) (87340) Hepatitis C antibody (86803)
Hepatic function panel This panel must include the following: Albumin (82040)
Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075)
Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460)
Transferase, aspartate am
Drug screen, qualitative; multiple drug classes chromatographic method, each
procedure
Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme
assay), each drug class
Drug confirmation, each procedure
80150
80152
Amikacin
Amitriptyline
80.10
87.30
80154
80156
Benzodiazepines
Carbamazepine; total
87.30
64.80
80158
80160
Cyclosporine
Desipramine
85.06
93.60
80162
80164
Digoxin
Dipropylacetic acid (valproic acid)
45.49
46.96
80166
80168
Doxepin
Ethosuximide
81.00
73.80
80170
80172
Gentamicin
Gold
76.50
86.40
80173
80174
Haloperidol
Imipramine
78.30
87.30
80176
Lidocaine
78.30
80053
80055
80061
80069
80074
80076
80100
80101
Extraordinary No.64/2013
250
44.50
89.34
59.76
35.68
137.37
45.97
45.40
73.80
98.10
Friday, 09 August 2013
80178
Lithium
29.96
80182
80184
Nortriptyline
Phenobarbital
86.40
69.30
80185
80186
Phenytoin; total
Phenytoin; free
62.10
83.70
80188
80190
Primidone
Procainamide;
72.90
72.90
80192
80194
Procainamide; with metabolites (eg, n-acetyl procainamide)
Quinidine
79.20
73.80
80196
80197
Salicylate
Tacrolimus
50.40
104.40
80198
80200
Theophylline
Tobramycin
61.20
99.00
80201
80202
69.30
72.00
81005
81007
Topiramate
Vancomycin
ACTH stimulation panel; for adrenal insufficiency This panel must include the
following: Cortisol (82533 x 2)
ACTH stimulation panel; for 21 hydroxylase deficiency This panel must include
the following: Cortisol (82533 x 2) 17 hydroxyprogesterone (83498 x 2)
ACTH stimulation panel; for 3 beta-hydroxydehydrogenase deficiency This panel
must include the following: Cortisol (82533 x 2) 17 hydroxypregnenolone (84143
x 2)
Clinical pathology consultation; limited, without review of patient's history and
medical records
Clinical pathology consultation; comprehensive, for a complex diagnostic problem,
with review of patient's history and medical records
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,
ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number
of these constituents; non-automated, with microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,
ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number
of these constituents; automated, with microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,
ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number
of these constituents; non-automated, without microscopy
Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin,
ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number
of these constituents; automated, without microscopy
Urinalysis; qualitative or semiquantitative, except immunoassays
Urinalysis; bacteriuria screen, except by culture or dipstick
81015
81020
Urinalysis; microscopic only
Urinalysis; two or three glass test
14.05
15.82
80400
80402
80406
80500
80502
81000
81001
81002
81003
Extraordinary No.64/2013
251
123.30
257.40
252.00
59.40
140.40
17.96
16.53
15.26
15.04
16.54
23.40
Friday, 09 August 2013
81025
Urine pregnancy test, by visual color comparison methods
25.64
81050
82000
Volume measurement for timed collection, each
Acetaldehyde, blood
22.50
56.13
82003
82009
Acetaminophen
Acetone or other ketone bodies, serum; qualitative
77.40
27.00
82010
82013
Acetone or other ketone bodies, serum; quantitative
Acetylcholinesterase
64.80
63.00
82016
82017
Acylcarnitines; qualitative, each specimen
Acylcarnitines; quantitative, each specimen
84.60
90.90
82024
82030
Adrenocorticotropic hormone (ACTH)
Adenosine, 5-monophosphate, cyclic (cyclic AMP)
162.90
113.40
82040
82042
Albumin; serum
Albumin; urine or other source, quantitative, each specimen
19.50
36.00
82043
82044
Albumin; urine, microalbumin, quantitative
Albumin; urine, microalbumin, semiquantitative (eg, reagent strip assay)
64.80
23.33
82055
82075
Alcohol (ethanol); any specimen except breath
Alcohol (ethanol); breath
61.20
40.50
82085
82088
Aldolase
Aldosterone
50.40
158.40
82101
82103
Alkaloids, urine, quantitative
Alpha-1-antitrypsin; total
115.20
65.75
82104
82105
Alpha-1-antitrypsin; phenotype
Alpha-fetoprotein; serum
76.35
60.23
82106
82108
Alpha-fetoprotein; amniotic fluid
Aluminum
63.83
108.00
82127
82128
Amino acids; single, qualitative, each specimen
Amino acids; multiple, qualitative, each specimen
63.90
48.60
82131
82135
Amino acids; single, quantitative, each specimen
Aminolevulinic acid, delta (ALA)
165.60
72.00
82136
82139
Amino acids, 2 to 5 amino acids, quantitative, each specimen
Amino acids, 6 or more amino acids, quantitative, each specimen
102.60
102.60
82140
82143
Ammonia
Amniotic fluid scan (spectrophotometric)
81.00
69.30
82145
82150
Amphetamine or methamphetamine
Amylase
82.80
24.59
82154
82157
Androstanediol glucuronide
Androstenedione
116.10
129.60
Extraordinary No.64/2013
252
Friday, 09 August 2013
82160
Androsterone
99.31
82163
82164
Angiotensin II
Angiotensin I - converting enzyme (ACE)
111.60
76.50
82172
82175
Apolipoprotein, each
Arsenic
77.40
87.30
82180
82190
Ascorbic acid (Vitamin C), blood
Atomic absorption spectroscopy, each analyte
54.00
80.10
82205
82232
Barbiturates, not elsewhere specified
Beta-2 microglobulin
62.10
74.55
82239
82240
Bile acids; total
Bile acids; cholylglycine
78.30
123.30
82247
82248
Bilirubin; total
Bilirubin; direct
19.50
20.85
82252
82261
16.20
65.70
82286
Bilirubin; feces, qualitative
Biotinidase, each specimen
Blood, occult, by peroxidase activity (eg, guaiac); feces, 1-3 simultaneous
determinations
Bradykinin
82300
82306
Cadmium
Calcifediol (25-OH Vitamin D-3)
80.10
144.00
82308
82310
Calcitonin
Calcium; total
144.90
18.83
82330
82331
Calcium; ionized
Calcium; after calcium infusion test
64.80
35.10
82340
82355
Calcium; urine quantitative, timed specimen
Calculus (stone); qualitative analysis
41.40
65.70
82360
82365
Calculus (stone); quantitative analysis, chemical
Calculus (stone); infrared spectroscopy
66.60
66.60
82370
82373
Calculus (stone); x-ray diffraction
Carbohydrate deficient transferrin
63.90
38.70
82374
82375
Carbon dioxide (bicarbonate)
Carbon monoxide, (carboxyhemoglobin); quantitative
26.10
64.80
82376
82378
Carbon monoxide, (carboxyhemoglobin); qualitative
Carcinoembryonic antigen (CEA)
21.60
69.48
82379
82380
Carnitine (total and free), quantitative, each specimen
Carotene
90.90
56.70
82382
Catecholamines; total urine
111.60
82270
Extraordinary No.64/2013
253
15.14
128.70
Friday, 09 August 2013
82383
Catecholamines; blood
152.10
82384
82387
Catecholamines; fractionated
Cathepsin-D
133.20
111.60
82390
82397
Ceruloplasmin
Chemiluminescent assay
47.50
65.70
82415
82435
Chloramphenicol
Chloride; blood
77.40
21.60
82436
82438
Chloride; urine
Chloride; other source
35.10
26.10
82441
82465
Chlorinated hydrocarbons, screen
Cholesterol, serum or whole blood, total
30.60
19.73
82480
82482
Cholinesterase; serum
Cholinesterase; RBC
50.40
63.90
82485
113.40
82495
82507
Chondroitin B sulfate, quantitative
Chromatography, qualitative; column (eg, gas liquid or HPLC), analyte not
elsewhere specified
Chromatography, qualitative; paper, 1-dimensional, analyte not elsewhere
specified
Chromatography, qualitative; paper, 2-dimensional, analyte not elsewhere
specified
Chromatography, qualitative; thin layer, analyte not elsewhere specified
Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not
elsewhere specified, single stationary and mobile phase
Chromatography, quantitative, column (eg, gas liquid or HPLC); multiple analytes,
single stationary and mobile phase
Chromium
Citrate
82520
82523
Cocaine or metabolite
Collagen cross links, any method
82.80
100.80
82525
82528
Copper
Corticosterone
49.36
102.60
82530
82533
Cortisol; free
Cortisol; total
112.50
60.16
82540
Creatine
Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte
not elsewhere specified; qualitative, single stationary and mobile phase
Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte
not elsewhere specified; quantitative, single stationary and mobile phase
Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte
not elsewhere specified; stable isotope dilution, single analyte, quantitative, single
stationary and mobile phase
25.45
82486
82487
82488
82489
82491
82492
82541
82542
82543
Extraordinary No.64/2013
254
108.90
86.40
115.20
77.40
87.30
67.10
108.90
150.30
82.80
82.80
82.80
Friday, 09 August 2013
82550
82552
Column chromatography/mass spectrometry (eg, GC/MS, or HPLC/MS), analyte
not elsewhere specified; stable isotope dilution, multiple analytes, quantitative,
single stationary and mobile phase
Creatine kinase (CK), (CPK); total
Creatine kinase (CK), (CPK); isoenzymes
82553
82554
Creatine kinase (CK), (CPK); MB fraction only
Creatine kinase (CK), (CPK); isoforms
37.86
55.80
82565
82570
Creatinine; blood
Creatinine; other source
20.63
30.60
82575
82585
Creatinine; clearance
Cryofibrinogen
39.21
36.00
82595
82600
Cryoglobulin, qualitative or semi-quantitative (eg, cryocrit)
Cyanide
36.90
77.40
82607
82608
Cyanocobalamin (Vitamin B-12);
Cyanocobalamin (Vitamin B-12); unsaturated binding capacity
58.36
76.50
82615
82626
Cystine and homocystine, urine, qualitative
Dehydroepiandrosterone (DHEA)
52.20
122.40
82627
82633
Dehydroepiandrosterone-sulfate (DHEA-S)
Desoxycorticosterone, 11-
122.40
154.80
82634
82638
Deoxycortisol, 11Dibucaine number
147.60
48.60
82646
82649
Dihydrocodeinone
Dihydromorphinone
94.50
99.00
82651
82652
Dihydrotestosterone (DHT)
Dihydroxyvitamin D, 1,25-
108.00
162.00
82654
91.80
82664
Dimethadione
Enzyme activity in blood cells, cultured cells, or tissue, not elsewhere specified;
radioactive substrate, each specimen
Electrophoretic technique, not elsewhere specified
82666
82668
Epiandrosterone
Erythropoietin
99.00
87.86
82670
82671
Estradiol
Estrogens; fractionated
75.69
118.17
82672
82677
Estrogens; total
Estriol
94.88
75.19
82679
82690
Estrone
Ethchlorvynol
166.50
92.70
82693
Ethylene glycol
80.10
82544
82658
Extraordinary No.64/2013
255
82.80
26.93
51.61
82.80
102.60
Friday, 09 August 2013
82696
Etiocholanolone
127.80
82705
82710
Fat or lipids, feces; qualitative
Fat or lipids, feces; quantitative
34.20
107.10
82715
82725
Fat differential, feces, quantitative
Fatty acids, nonesterified
64.80
61.20
82728
82735
Ferritin
Fluoride
53.27
86.40
82742
82746
Flurazepam
Folic acid; serum
90.90
60.53
82747
82757
Folic acid; RBC
Fructose, semen
88.20
47.70
82759
82760
Galactokinase, RBC
Galactose
54.00
54.00
82775
82776
Galactose-1-phosphate uridyl transferase; quantitative
Galactose-1-phosphate uridyl transferase; screen
71.10
27.00
82784
82785
Gammaglobulin; IgA, IgD, IgG, IgM, each
Gammaglobulin; IgE
61.20
67.09
82787
82800
180.00
38.70
82810
Gammaglobulin; immunoglobulin subclasses, (IgG1, 2, 3, or 4), each
Gases, blood, pH only
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including
calculated O2 saturation);
Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including
calculated O2 saturation); with O2 saturation, by direct measurement, except pulse
oximetry
Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry
82820
82938
Hemoglobin-oxygen affinity (pO2 for 50% hemoglobin saturation with oxygen)
Gastrin after secretin stimulation
62.10
86.40
82941
82943
Gastrin
Glucagon
80.10
94.50
82945
82946
Glucose, body fluid, other than blood
Glucagon tolerance test
35.14
59.40
82947
82948
Glucose; quantitative, blood (except reagent strip)
Glucose; blood, reagent strip
16.94
13.86
82950
82951
Glucose; post glucose dose (includes glucose)
Glucose; tolerance test (GTT), three specimens (includes glucose)
26.45
54.62
82952
82953
Glucose; tolerance test, each additional beyond three specimens
Glucose; tolbutamide tolerance test
27.36
72.90
82955
Glucose-6-phosphate dehydrogenase (G6PD); quantitative
71.10
82803
82805
Extraordinary No.64/2013
256
80.10
90.90
47.70
Friday, 09 August 2013
82960
28.63
82963
Glucose-6-phosphate dehydrogenase (G6PD); screen
Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically
for home use
Glucosidase, beta
82965
82975
Glutamate dehydrogenase
Glutamine (glutamic acid amide)
28.80
59.40
82977
82978
Glutamyltransferase, gamma (GGT)
Glutathione
22.79
59.40
82979
82980
Glutathione reductase, RBC
Glutethimide
46.80
84.60
82985
83001
Glycated protein
Gonadotropin; follicle stimulating hormone (FSH)
40.90
67.52
83002
83003
Gonadotropin; luteinizing hormone (LH)
Growth hormone, human (HGH) (somatotropin)
69.32
90.00
83008
83010
Guanosine monophosphate (GMP), cyclic
Haptoglobin; quantitative
90.90
71.10
83012
83015
82.80
129.60
83026
83030
Haptoglobin; phenotypes
Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury); screen
Heavy metal (arsenic, barium, beryllium, bismuth, antimony, mercury);
quantitative, each
Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)
Hemoglobin fractionation and quantitation; chromatography (eg, A2, S, C, and/or
F)
Hemoglobin; by copper sulfate method, non-automated
Hemoglobin; F (fetal), chemical
83033
83036
Hemoglobin; F (fetal), qualitative
Hemoglobin; glycated
27.00
38.57
83045
83050
Hemoglobin; methemoglobin, qualitative
Hemoglobin; methemoglobin, quantitative
22.50
27.90
83051
83055
Hemoglobin; plasma
Hemoglobin; sulfhemoglobin, qualitative
33.30
27.00
83060
83065
Hemoglobin; sulfhemoglobin, quantitative
Hemoglobin; thermolabile
43.20
37.80
83068
83069
Hemoglobin; unstable, screen
Hemoglobin; urine
38.70
22.50
83070
83071
Hemosiderin; qualitative
Hemosiderin; quantitative
26.10
30.60
83080
b-Hexosaminidase, each assay
65.70
82962
83018
83020
83021
Extraordinary No.64/2013
257
17.01
82.80
117.00
56.48
69.91
14.40
45.00
Friday, 09 August 2013
83088
Histamine
127.80
83090
83150
Homocystine
Homovanillic acid (HVA)
78.30
90.90
83491
83497
Hydroxycorticosteroids, 17- (17-OHCS)
Hydroxyindolacetic acid, 5-(HIAA)
90.00
72.90
83498
83499
Hydroxyprogesterone, 17-d
Hydroxyprogesterone, 20-
120.60
105.30
83500
83505
98.10
121.50
83519
83520
Hydroxyproline; free
Hydroxyproline; total
Immunoassay for analyte other than infectious agent antibody or infectious agent
antigen, qualitative or semiquantitative; multiple step method
Immunoassay for analyte other than infectious agent antibody or infectious agent
antigen, qualitative or semiquantitative; single step method (eg, reagent strip)
Immunoassay, analyte, quantitative; by radiopharmaceutical technique (eg, RIA)
Immunoassay, analyte, quantitative; not otherwise specified
83525
83527
Insulin; total
Insulin; free
66.60
70.20
83528
83540
Intrinsic factor
Iron
86.40
23.16
83550
83570
Iron binding capacity
Isocitric dehydrogenase (IDH)
33.38
47.70
83582
83586
Ketogenic steroids, fractionation
Ketosteroids, 17- (17-KS); total
76.50
79.20
83593
83605
Ketosteroids, 17- (17-KS); fractionation
Lactate (lactic acid)
142.20
49.50
83615
83625
Lactate dehydrogenase (LD), (LDH);
Lactate dehydrogenase (LD), (LDH); isoenzymes, separation and quantitation
20.46
71.10
83632
83633
Lactogen, human placental (HPL) human chorionic somatomammotropin
Lactose, urine; qualitative
108.90
33.30
83634
83655
Lactose, urine; quantitative
Lead
50.40
51.30
83661
83662
Fetal lung maturity assessment; lecithin sphingomyelin (L/S) ratio
Fetal lung maturity assessment; foam stability test
123.30
72.00
83663
83664
Fetal lung maturity assessment; fluorescence polarization
Fetal lung maturity assessment; lamellar body density
43.20
24.30
83670
83690
Leucine aminopeptidase (LAP)
Lipase
43.20
38.70
83718
Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol)
29.28
83516
83518
Extraordinary No.64/2013
258
54.24
77.40
85.50
72.72
Friday, 09 August 2013
83719
Lipoprotein, direct measurement; direct measurement, VLDL cholesterol
47.70
83721
83727
Lipoprotein, direct measurement; direct measurement, LDL cholesterol
Luteinizing releasing factor (LRH)
36.90
92.70
83735
83775
Magnesium
Malate dehydrogenase
25.04
38.70
83785
113.40
83805
Manganese
Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not
elsewhere specified; qualitative, each specimen
Mass spectrometry and tandem mass spectrometry (MS, MS/MS), analyte not
elsewhere specified; quantitative, each specimen
Meprobamate
83825
83835
Mercury, quantitative
Metanephrines
90.00
102.60
83840
83857
Methadone
Methemalbumin
87.30
57.60
83858
83864
Methsuximide
Mucopolysaccharides, acid; quantitative
91.80
40.61
83866
83872
Mucopolysaccharides, acid; screen
Mucin, synovial fluid (Ropes test)
38.70
27.00
83873
83874
Myelin basic protein, CSF
Myoglobin
94.50
58.45
83883
83885
Nephelometry, each analyte not elsewhere specified
Nickel
62.10
98.10
83887
83890
Nicotine
Molecular diagnostics; molecular isolation or extraction
90.90
49.50
83891
83892
Molecular diagnostics; isolation or extraction of highly purified nucleic acid
Molecular diagnostics; enzymatic digestion
46.80
36.00
83893
38.70
83912
83915
Molecular diagnostics; dot/slot blot production
Molecular diagnostics; separation by gel electrophoresis (eg, agarose,
polyacrylamide)
Molecular diagnostics; nucleic acid probe, each
Molecular diagnostics; amplification of patient nucleic acid (eg, PCR, LCR), single
primer pair, each primer pair
Molecular diagnostics; amplification of patient nucleic acid, multiplex, each
multiplex reaction
Molecular diagnostics; interpretation and report
Nucleotidase 5-
83916
83918
Oligoclonal immunoglobulin (oligoclonal bands)
Organic acids; total, quantitative, each specimen
93.60
92.70
83788
83789
83894
83896
83898
83901
Extraordinary No.64/2013
259
82.80
82.80
82.80
46.80
56.70
130.50
102.60
62.10
45.00
Friday, 09 August 2013
83925
Opiates, (eg, morphine, meperidine)
66.60
83930
83935
Osmolality; blood
Osmolality; urine
42.30
58.50
83937
83945
Osteocalcin (bone g1a protein)
Oxalate
115.20
72.90
83970
83986
Parathormone (parathyroid hormone)
pH, body fluid, except blood
124.20
20.70
83992
84022
Phencyclidine (PCP)
Phenothiazine
72.00
68.40
84030
84035
Phenylalanine (PKU), blood
Phenylketones, qualitative
19.19
20.70
84060
84061
Phosphatase, acid; total
Phosphatase, acid; forensic examination
41.57
43.20
84066
84075
Phosphatase, acid; prostatic
Phosphatase, alkaline;
57.60
19.20
84078
84080
Phosphatase, alkaline; heat stable (total not included)
Phosphatase, alkaline; isoenzymes
46.80
77.40
84081
84085
Phosphatidylglycerol
Phosphogluconate, 6-, dehydrogenase, RBC
95.40
38.70
84087
84100
Phosphohexose isomerase
Phosphorus inorganic (phosphate);
47.70
17.40
84105
84106
Phosphorus inorganic (phosphate); urine
Porphobilinogen, urine; qualitative
31.50
33.30
84110
84119
Porphobilinogen, urine; quantitative
Porphyrins, urine; qualitative
48.60
44.10
84120
84126
Porphyrins, urine; quantitation and fractionation
Porphyrins, feces; quantitative
78.30
78.30
84127
84132
Porphyrins, feces; qualitative
Potassium; serum
45.00
18.75
84133
84134
Potassium; urine
Prealbumin
36.00
55.80
84135
84138
Pregnanediol
Pregnanetriol
88.20
86.40
84140
84143
Pregnenolone
17-hydroxypregnenolone
94.50
78.97
84144
84146
Progesterone
Prolactin
66.04
65.14
Extraordinary No.64/2013
260
Friday, 09 August 2013
84150
Prostaglandin, each
97.20
84152
84153
Prostate specific antigen (PSA); complexed (direct measurement)
Prostate specific antigen (PSA); total
64.24
58.72
84154
84155
Prostate specific antigen (PSA); free
Protein; total, except refractometry
84.60
21.00
84160
84165
Protein; refractometric
Protein; electrophoretic fractionation and quantitation
17.10
47.29
84181
91.80
84202
84203
Protein; Western Blot, with interpretation and report, blood or other body fluid
Protein; Western Blot, with interpretation and report, blood or other body fluid,
immunological probe for band identification, each
Protoporphyrin, RBC; quantitative
Protoporphyrin, RBC; screen
84206
84207
Proinsulin
Pyridoxal phosphate (Vitamin B-6)
97.20
129.60
84210
84220
Pyruvate
Pyruvate kinase
66.60
57.60
84228
84233
Quinine
Receptor assay; estrogen
63.90
192.60
84234
84235
Receptor assay; progesterone
Receptor assay; endocrine, other than estrogen or progesterone (specify hormone)
192.60
236.70
84238
84244
Receptor assay; non-endocrine (eg, acetylcholine) (specify receptor)
Renin
191.70
105.30
84252
84255
Riboflavin (Vitamin B-2)
Selenium
82.80
87.30
84260
84270
Serotonin
Sex hormone binding globulin (SHBG)
156.60
100.80
84275
84285
Sialic acid
Silica
78.30
127.80
84295
84300
Sodium; serum
Sodium; urine
24.30
24.30
84305
84307
Somatomedin
Somatostatin
123.30
99.00
84311
84315
Spectrophotometry, analyte not elsewhere specified
Specific gravity (except urine)
36.90
14.40
84375
84402
Sugars, chromatographic, TLC or paper chromatography
Testosterone; free
49.50
101.52
84403
Testosterone; total
79.82
84182
Extraordinary No.64/2013
261
134.10
71.10
27.90
Friday, 09 August 2013
84425
Thiamine (Vitamin B-1)
111.60
84430
84432
Thiocyanate
Thyroglobulin
66.60
100.80
84436
84437
Thyroxine; total
Thyroxine; requiring elution (eg, neonatal)
26.37
35.10
84439
84442
Thyroxine; free
Thyroxine binding globulin (TBG)
45.91
65.70
84443
84445
Thyroid stimulating hormone (TSH)
Thyroid stimulating immunoglobulins (TSI)
61.92
230.40
84446
84449
Tocopherol alpha (Vitamin E)
Transcortin (cortisol binding globulin)
66.60
82.80
84450
84460
Transferase; aspartate amino (AST) (SGOT)
Transferase; alanine amino (ALT) (SGPT)
21.04
22.42
84466
84478
Transferrin
Triglycerides
43.98
20.19
84479
84480
Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR)
Triiodothyronine T3; total (TT-3)
31.94
57.98
84481
84482
Triiodothyronine T3; free
Triiodothyronine T3; reverse
75.47
78.73
84485
84488
Trypsin; duodenal fluid
Trypsin; feces, qualitative
36.00
28.80
84490
84510
Trypsin; feces, quantitative, 24-hour collection
Tyrosine
24.30
44.10
84520
84525
Urea nitrogen; quantitative
Urea nitrogen; semiquantitative (eg, reagent strip test)
20.19
13.59
84540
84545
Urea nitrogen, urine
Urea nitrogen, clearance
25.89
36.00
84550
84560
Uric acid; blood
Uric acid; other source
20.19
33.30
84577
84578
Urobilinogen, feces, quantitative
Urobilinogen, urine; qualitative
57.60
15.30
84580
84583
Urobilinogen, urine; quantitative, timed specimen
Urobilinogen, urine; semiquantitative
36.00
17.10
84585
84588
Vanillylmandelic acid (VMA), urine
Vasopressin (antidiuretic hormone, ADH)
69.30
140.40
84590
84591
Vitamin A
Vitamin, not otherwise specified
83.70
62.10
Extraordinary No.64/2013
262
Friday, 09 August 2013
84597
87.30
84620
Vitamin K
Volatiles (eg, acetic anhydride, carbon tetrachloride, dichloroethane,
dichloromethane, diethylether, isopropyl alcohol, methanol)
Xylose absorption test, blood and/or urine
84630
84681
Zinc
C-peptide
59.40
99.00
84702
84703
60.68
31.99
85008
85009
Gonadotropin, chorionic (hCG); quantitative
Gonadotropin, chorionic (hCG); qualitative
Ovulation tests, by visual color comparison methods for human luteinizing
hormone
Bleeding time
Blood count; manual differential WBC count (includes RBC morphology and
platelet estimation)
Blood count; manual blood smear examination without differential parameters
Blood count; differential WBC count, buffy coat
85013
85014
Blood count; spun microhematocrit
Blood count; other than spun hematocrit
15.30
15.30
85018
14.24
85027
85041
Blood count; hemoglobin
Blood count; hemogram and platelet count, automated, and automated complete
differential WBC count (CBC)
Blood count; hemogram and platelet count, automated
Blood count; red blood cell (RBC) only
85044
85045
Blood count; reticulocyte count, manual
Blood count; reticulocyte count, flow cytometry
20.74
20.68
85048
85060
Blood count; white blood cell (WBC)
Blood smear, peripheral, interpretation by physician with written report
18.90
56.70
85097
85130
Bone marrow; smear interpretation only, with or without differential cell count
Chromogenic substrate assay
139.50
55.80
85170
85175
Clot retraction
Clot lysis time, whole blood dilution
22.50
36.00
85210
85220
Clotting; factor II, prothrombin, specific
Clotting; factor V (AcG or proaccelerin), labile factor
54.00
100.80
85230
85240
Clotting; factor VII (proconvertin, stable factor)
Clotting; factor VIII (AHG), one stage
116.10
102.60
85244
85245
Clotting; factor VIII related antigen
Clotting; factor VIII, VW factor, ristocetin cofactor
126.00
105.30
85246
85247
Clotting; factor VIII, VW factor antigen
Clotting; factor VIII, von Willebrand factor, multimetric analysis
105.30
105.30
85250
Clotting; factor IX (PTC or Christmas)
117.00
84600
84830
85002
85007
85025
Extraordinary No.64/2013
263
57.60
68.40
54.00
25.61
17.85
15.30
20.70
26.32
24.27
14.83
Friday, 09 August 2013
85260
Clotting; factor X (Stuart-Prower)
97.20
85270
85280
Clotting; factor XI (PTA)
Clotting; factor XII (Hageman)
97.20
97.20
85290
85291
Clotting; factor XIII (fibrin stabilizing)
Clotting; factor XIII (fibrin stabilizing), screen solubility
100.80
56.70
85292
85293
Clotting; prekallikrein assay (Fletcher factor assay)
Clotting; high molecular weight kininogen assay (Fitzgerald factor assay)
102.60
102.60
85300
85301
Clotting inhibitors or anticoagulants; antithrombin III, activity
Clotting inhibitors or anticoagulants; antithrombin III, antigen assay
62.80
55.24
85302
85303
Clotting inhibitors or anticoagulants; protein C, antigen
Clotting inhibitors or anticoagulants; protein C, activity
133.20
72.77
85305
85306
Clotting inhibitors or anticoagulants; protein S, total
Clotting inhibitors or anticoagulants; protein S, free
128.70
76.81
85307
85335
Activated Protein C (APC) resistance assay
Factor inhibitor test
107.10
59.40
85337
85345
Thrombomodulin
Coagulation time; Lee and White
55.80
13.93
85347
85348
Coagulation time; activated
Coagulation time; other methods
21.60
28.80
85360
46.80
85366
85370
Euglobulin lysis
Fibrin(ogen) degradation (split) products (FDP)(FSP); agglutination slide,
semiquantitative
Fibrin(ogen) degradation (split) products (FDP)(FSP); paracoagulation
Fibrin(ogen) degradation (split) products (FDP)(FSP); quantitative
85378
85379
Fibrin degradation products, D-dimer; semiquantitative
Fibrin degradation products, D-dimer; quantitative
27.67
56.70
85384
85385
Fibrinogen; activity
Fibrinogen; antigen
44.10
45.00
85390
85396
Fibrinolysins or coagulopathy screen, interpretation and report
Coagj/fbrnlys assay whl bld use additive pr d
46.80
41.59
85400
85410
Fibrinolytic factors and inhibitors; plasmin
Fibrinolytic factors and inhibitors; alpha-2 antiplasmin
47.70
47.70
85415
85420
Fibrinolytic factors and inhibitors; plasminogen activator
Fibrinolytic factors and inhibitors; plasminogen, except antigenic assay
65.70
51.30
85421
85441
Fibrinolytic factors and inhibitors; plasminogen, antigenic assay
Heinz bodies; direct
98.10
15.30
85445
Heinz bodies; induced, acetyl phenylhydrazine
28.80
85362
Extraordinary No.64/2013
264
42.30
47.70
62.10
Friday, 09 August 2013
85461
85475
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; differential lysis
(Kleihauer-Betke)
Hemoglobin or RBCs, fetal, for fetomaternal hemorrhage; rosette
Hemolysin, acid
85520
85525
Heparin assay
Heparin neutralization
70.20
63.90
85530
85536
Heparin-protamine tolerance test
Iron stain, peripheral blood
76.50
38.70
85540
85547
Leukocyte alkaline phosphatase with count
Mechanical fragility, RBC
50.40
48.60
85549
85555
Muramidase
Osmotic fragility, RBC; unincubated
92.70
44.10
85557
85576
Osmotic fragility, RBC; incubated
Platelet; aggregation (in vitro), each agent
83.70
82.80
85597
85610
Platelet neutralization
Prothrombin time;
72.00
16.09
85611
85612
Prothrombin time; substitution, plasma fractions, each
Russell viper venom time (includes venom); undiluted
26.10
47.70
85613
85635
Russell viper venom time (includes venom); diluted
Reptilase test
56.70
45.00
85651
85652
Sedimentation rate, erythrocyte; non-automated
Sedimentation rate, erythrocyte; automated
14.60
13.25
85660
85670
Sickling of RBC, reduction
Thrombin time; plasma
16.80
36.00
85675
85705
Thrombin time; titer
Thromboplastin inhibition; tissue
36.00
64.80
85730
85732
Thromboplastin time, partial (PTT); plasma or whole blood
Thromboplastin time, partial (PTT); substitution, plasma fractions, each
20.30
34.20
85810
46.80
86001
86003
Viscosity
Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky
Mountain spotted fever, scrub typhus), each antigen
Allergen specific IgG quantitative or semiquantitative, each allergen
Allergen specific IgE; quantitative or semiquantitative, each allergen
86005
86021
Allergen specific IgE; qualitative, multiallergen screen (dipstick, paddle or disk)
Antibody identification; leukocyte antibodies
46.80
113.40
86022
86023
Antibody identification; platelet antibodies
Antibody identification; platelet associated immunoglobulin assay
164.70
84.60
86038
Antinuclear antibodies (ANA);
46.54
85460
86000
Extraordinary No.64/2013
265
41.40
44.10
55.80
59.40
18.90
18.39
Friday, 09 August 2013
86039
Antinuclear antibodies (ANA); titer
65.70
86060
86063
30.28
26.20
86140
86146
Antistreptolysin 0; titer
Antistreptolysin 0; screen
Blood bank physician services; difficult cross match and/or evaluation of irregular
antibody(s), interpretation and written report
Blood bank physician services; investigation of transfusion reaction including
suspicion of transmissible disease, interpretation and written report
Blood bank physician services; authorization for deviation from standard blood
banking procedures (eg, use of outdated blood, transfusion of Rh incompatible
units), with written report
C-reactive protein
Beta 2 Glycoprotein I antibody, each
86147
86155
Cardiolipin (phospholipid) antibody, each Ig class
Chemotaxis assay, specify method
93.97
51.30
86156
86157
Cold agglutinin; screen
Cold agglutinin; titer
31.50
36.90
86160
86161
Complement; antigen, each component
Complement; functional activity, each component
59.64
59.64
86162
86171
Complement; total hemolytic (CH50)
Complement fixation tests, each antigen
118.80
79.20
86185
86215
Counterimmunoelectrophoresis, each antigen
Deoxyribonuclease, antibody
49.50
66.60
86225
86226
59.18
66.60
86243
Deoxyribonucleic acid (DNA) antibody; native or double stranded
Deoxyribonucleic acid (DNA) antibody; single stranded
Extractable nuclear antigen, antibody to, any method (eg, nRNP, SS-A, SS-B, Sm,
RNP, Sc170, J01), each antibody
Fc receptor
86255
86256
Fluorescent noninfectious agent antibody; screen, each antibody
Fluorescent noninfectious agent antibody; titer, each antibody
50.59
79.20
86277
86280
Growth hormone, human (HGH), antibody
Hemagglutination inhibition test (HAI)
72.00
49.50
86300
86301
Immunoassay for tumor antigen, quantitative; CA 15-3 (27.29)
Immunoassay for tumor antigen, quantitative; CA 19-9
73.32
97.20
86304
86308
Immunoassay for tumor antigen, quantitative; CA 125
Heterophile antibodies; screening
73.32
21.58
86309
86310
Heterophile antibodies; titer
Heterophile antibodies; titers after absorption with beef cells and guinea pig kidney
Immunoassay for tumor antigen; other antigen, quantitative (eg, CA 50, 72-4, 549),
each
42.30
42.30
86077
86078
86079
86235
86316
Extraordinary No.64/2013
266
123.30
124.20
113.40
26.20
137.70
65.00
90.00
71.97
Friday, 09 August 2013
86317
78.30
86320
Immunoassay for infectious agent antibody, quantitative, not otherwise specified
Immunoassay for infectious agent antibody, qualitative or semiquantitative, single
step method (eg, reagent strip)
Immunoelectrophoresis; serum
86325
86327
Immunoelectrophoresis; other fluids (eg, urine, CSF) with concentration
Immunoelectrophoresis; crossed (2-dimensional assay)
129.60
86.40
86329
72.00
86332
86334
Immunodiffusion; not elsewhere specified
Immunodiffusion; gel diffusion, qualitative (Ouchterlony), each antigen or
antibody
Immune complex assay
Immunofixation electrophoresis
86337
86340
Insulin antibodies
Intrinsic factor antibodies
86.64
80.10
86341
86343
Islet cell antibody
Leukocyte histamine release test (LHR)
66.60
68.40
86344
43.20
86359
Leukocyte phagocytosis
Lymphocyte transformation, mitogen (phytomitogen) or antigen induced
blastogenesis
T cells; total count
86361
86376
T cells; absolute CD4 count
Microsomal antibodies (eg, thyroid or liver-kidney), each
123.30
88.20
86378
86382
Migration inhibitory factor test (MIF)
Neutralization test, viral
90.90
90.90
86384
86403
Nitroblue tetrazolium dye test (NTD)
Particle agglutination; screen, each antibody
54.00
32.04
86406
86430
Particle agglutination; titer, each antibody
Rheumatoid factor; qualitative
38.70
33.77
86431
86485
Rheumatoid factor; quantitative
Skin test; candida
37.80
26.10
86486
86490
Skin test unlisted antigen each
Skin test; coccidioidomycosis
15.85
29.70
86510
86580
Skin test; histoplasmosis
Skin test; tuberculosis, intradermal
27.90
20.70
86590
86592
Streptokinase, antibody
Syphilis test; qualitative (eg, VDRL, RPR, ART)
34.20
25.81
86593
86602
Syphilis test; quantitative
Antibody; actinomyces
27.58
59.40
86603
Antibody; adenovirus
57.87
86318
86331
86353
Extraordinary No.64/2013
267
53.71
89.34
60.09
113.40
80.56
200.70
144.00
Friday, 09 August 2013
86606
Antibody; Aspergillus
79.20
86609
86611
Antibody; bacterium, not elsewhere specified
Antibody; Bartonella
108.00
55.80
86612
86615
70.20
67.95
86618
Antibody; Blastomyces
Antibody; Bordetella
Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western blot
or immunoblot)
Antibody; Borrelia burgdorferi (Lyme disease)
86619
86622
Antibody; Borrelia (relapsing fever)
Antibody; Brucella
72.90
44.10
86625
86628
Antibody; Campylobacter
Antibody; Candida
92.70
82.80
86631
86632
Antibody; Chlamydia
Antibody; Chlamydia, IgM
55.53
66.60
86635
86638
Antibody; Coccidioides
Antibody; Coxiella Brunetii (Q fever)
80.10
73.80
86641
86644
Antibody; Cryptococcus
Antibody; cytomegalovirus (CMV)
56.70
71.11
86645
86648
Antibody; cytomegalovirus (CMV), IgM
Antibody; Diphtheria
73.90
82.80
86651
86652
Antibody; encephalitis, California (La Crosse)
Antibody; encephalitis, Eastern equine
70.20
70.20
86653
86654
Antibody; encephalitis, St. Louis
Antibody; encephalitis, Western equine
70.20
70.20
86658
86663
Antibody; enterovirus (eg, coxsackie, echo, polio)
Antibody; Epstein-Barr (EB) virus, early antigen (EA)
90.90
77.18
86664
86665
Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)
Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)
82.80
87.30
86666
86668
Antibody; Ehrlichia
Antibody; Francisella Tularensis
55.80
52.20
86671
86674
Antibody; fungus, not elsewhere specified
Antibody; Giardia Lamblia
94.50
75.60
86677
86682
Antibody; Helicobacter pylori
Antibody; helminth, not elsewhere specified
80.08
94.50
86684
86687
Antibody; Hemophilus influenza
Antibody; HTLV-I
84.60
58.77
86688
Antibody; HTLV-II
54.50
86617
Extraordinary No.64/2013
268
100.80
98.10
Friday, 09 August 2013
86689
Antibody; HTLV or HIV antibody, confirmatory test (eg, Western Blot)
93.92
86692
86694
Antibody; hepatitis, delta agent
Antibody; herpes simplex, non-specific type test
91.80
70.00
86695
86696
Antibody; herpes simplex, type I
Antibody; herpes simplex, type 2
69.55
68.65
86698
86701
Antibody; histoplasma
Antibody; HIV-1
71.10
58.12
86702
86703
Antibody; HIV-2
Antibody; HIV-1 and HIV-2, single assay
67.50
54.52
86704
86705
Hepatitis B core antibody (HBcAb); total
Hepatitis B core antibody (HBcAb); IgM antibody
51.93
76.50
86706
86707
Hepatitis B surface antibody (HBsAb)
Hepatitis Be antibody (HBeAb)
44.30
53.62
86708
86709
Hepatitis A antibody (HAAb); total
Hepatitis A antibody (HAAb); IgM antibody
53.94
66.60
86710
86713
Antibody; influenza virus
Antibody; Legionella
66.60
84.60
86717
86720
Antibody; Leishmania
Antibody; Leptospira
65.70
70.20
86723
86727
Antibody; Listeria monocytogenes
Antibody; lymphocytic choriomeningitis
70.20
70.20
86729
86732
Antibody; Lymphogranuloma Venereum
Antibody; mucormycosis
72.00
70.20
86735
86738
Antibody; mumps
Antibody; Mycoplasma
80.10
84.60
86741
86744
Antibody; Neisseria meningitidis
Antibody; Nocardia
70.20
70.20
86747
86750
Antibody; parvovirus
Antibody; Plasmodium (malaria)
83.70
70.20
86753
86756
Antibody; protozoa, not elsewhere specified
Antibody; respiratory syncytial virus
65.70
70.20
86757
86759
Antibody; Rickettsia
Antibody; rotavirus
105.30
75.60
86762
86765
Antibody; rubella
Antibody; rubeola
34.88
90.90
86768
86771
Antibody; Salmonella
Antibody; Shigella
72.00
70.20
Extraordinary No.64/2013
269
Friday, 09 August 2013
86774
Antibody; tetanus
87.30
86777
86778
Antibody; Toxoplasma
Antibody; Toxoplasma, IgM
69.30
90.00
86784
86787
Antibody; trichinella
Antibody; varicella-zoster
78.30
77.40
86790
86793
Antibody; virus, not elsewhere specified
Antibody; Yersinia
87.39
72.00
86800
86803
Thyroglobulin antibody
Hepatitis C antibody;
84.60
71.44
86804
86805
Hepatitis C antibody; confirmatory test (eg, immunoblot)
Lymphocytotoxicity assay, visual crossmatch; with titration
113.40
241.20
86806
86807
Lymphocytotoxicity assay, visual crossmatch; without titration
Serum screening for cytotoxic percent reactive antibody (PRA); standard method
183.60
144.00
86808
86812
Serum screening for cytotoxic percent reactive antibody (PRA); quick method
HLA typing; A, B, or C (eg, A10, B7, B27), single antigen
112.50
111.05
86813
86816
HLA typing; A, B, or C, multiple antigens
HLA typing; DR/DQ, single antigen
164.70
175.50
86817
86821
HLA typing; DR/DQ, multiple antigens
HLA typing; lymphocyte culture, mixed (MLC)
406.80
391.50
86822
86850
HLA typing; lymphocyte culture, primed (PLC)
Antibody screen, RBC, each serum technique
140.40
24.26
86870
86880
Antibody identification, RBC antibodies, each panel for each serum technique
Antihuman globulin test (Coombs test); direct, each antiserum
61.20
19.93
86885
86886
Antihuman globulin test (Coombs test); indirect, qualitative, each antiserum
Antihuman globulin test (Coombs test); indirect, titer, each antiserum
20.62
28.90
86890
86900
Autologous blood or component, collection processing and storage; predeposited
Blood typing; ABO
117.00
17.23
86901
18.20
86905
86906
Blood typing; Rh (D)
Blood typing; antigen screening for compatible unit using patient serum, per unit
screened
Blood typing; RBC antigens, other than ABO or Rh (D), each
Blood typing; Rh phenotyping, complete
86940
86941
Hemolysins and agglutinins; auto, screen, each
Hemolysins and agglutinins; incubated
37.80
47.70
87001
87003
Animal inoculation, small animal; with observation
Animal inoculation, small animal; with observation and dissection
62.10
78.30
87015
Concentration (any type), for infectious agents
38.70
86904
Extraordinary No.64/2013
270
20.56
20.70
29.70
Friday, 09 August 2013
87040
87045
87070
87075
87076
87081
87084
87086
87088
Culture, bacterial; blood, with isolation and presumptive identification of isolates
(includes anaerobic culture, if appropriate)
Culture, bacterial; stool, with isolation and preliminary examination (eg, KIA,
LIA), Salmonella and Shigella species
Culture, bacterial; any other source except urine, blood or stool, with isolation and
presumptive identification of isolates
Culture, bacterial; any source, anaerobic with isolation and presumptive
identification of isolates
Culture, bacterial; anaerobic isolate, additional methods required for definitive
identification, each isolate
Culture, presumptive, pathogenic organisms, screening only;
Culture, presumptive, pathogenic organisms, screening only; with colony
estimation from density chart
Culture, bacterial; quantitative colony count, urine
34.47
36.27
32.27
34.92
56.70
24.66
34.20
27.74
26.52
87106
Culture, bacterial; with isolation and presumptive identification of isolates, urine
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates;
skin, hair, or nail
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates;
other source (except blood)
Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates;
blood
Culture, fungi, definitive identification, each organism; yeast
87107
87109
Culture, fungi, definitive identification, each organism; mold
Culture, mycoplasma, any source
47.70
60.84
87110
Culture, chlamydia, any source
Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source,
with isolation and presumptive identification of isolates
Culture, mycobacterial, definitive identification, each isolate
52.46
Culture, typing; immunofluorescent method, each antiserum
Culture, typing; gas liquid chromatography (GLC) or high pressure liquid
chromatography (HPLC) method
Culture, typing; immunologic method, other than immunofluoresence (eg,
agglutination grouping), per antiserum
Culture, typing; identification by nucleic acid probe
36.00
Culture, typing; identification by pulse field gel typing
Culture, typing; other methods
Dark field examination, any source (eg, penile, vaginal, oral, skin); includes
specimen collection
Homogenization, tissue, for culture
Ova and parasites, direct smears, concentration and identification
Susceptibility studies, antimicrobial agent; agar dilution method, per agent (eg,
antibiotic gradient strip)
Susceptibility studies, antimicrobial agent; disk method, per plate (12 or fewer
24.30
24.30
87101
87102
87103
87116
87118
87140
87143
87147
87149
87152
87158
87164
87176
87177
87181
87184
Extraordinary No.64/2013
271
26.98
32.07
56.70
27.42
62.10
58.50
68.40
24.30
76.50
62.10
33.30
41.02
28.80
28.40
Friday, 09 August 2013
agents)
87186
87187
87188
87190
87197
87205
87206
87207
87210
87220
87230
87250
87252
87253
87260
87265
87270
87272
87273
87274
87275
87276
87277
Susceptibility studies, antimicrobial agent; microdilution or agar dilution
(minimum inhibitory concentration (MIC) or breakpoint), each multiantimicrobial, per plate
Susceptibility studies, antimicrobial agent; microdilution or agar dilution,
minimum lethal concentration (MLC), each plate (List separately in addition to
code for primary procedure)
Susceptibility studies, antimicrobial agent; macrobroth dilution method, each agent
Susceptibility studies, antimicrobial agent; mycobacteria, proportion method, each
agent
Serum bactericidal titer (Schlicter test)
Smear, primary source with interpretation; Gram or Giemsa stain for bacteria,
fungi, or cell types
Smear, primary source with interpretation; fluorescent and/or acid fast stain for
bacteria, fungi, parasites, viruses or cell types
Smear, primary source with interpretation; special stain for inclusion bodies or
intracellular parasites (eg, malaria, coccidia, microsporidia, cytomegalovirus,
herpes viruses)
Smear, primary source with interpretation; wet mount for infectious agents (eg,
saline, India ink, KOH preps)
Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or
ectoparasite ova or mites (eg, scabies)
Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin)
Virus isolation; inoculation of embryonated eggs, or small animal, includes
observation and dissection
Virus isolation; tissue culture inoculation, observation, and presumptive
identification by cytopathic effect
Virus isolation; tissue culture, additional studies or definitive identification (eg,
hemabsorption, neutralization, immunofluoresence stain), each isolate
Infectious agent antigen detection by immunofluorescent technique; adenovirus
Infectious agent antigen detection by immunofluorescent technique; Bordetella
pertussis/parapertussis
Infectious agent antigen detection by immunofluorescent technique; Chlamydia
trachomatis
Infectious agent antigen detection by immunofluorescent technique;
cryptosporidium/giardia
Infectious agent antigen detection by immunofluorescent technique; Herpes
simplex virus type 2
Infectious agent antigen detection by immunofluorescent technique; Herpes
simplex virus type 1
Infectious agent antigen detection by immunofluorescent technique; Influenza B
virus
Infectious agent antigen detection by immunofluorescent technique; influenza A
virus
Infectious agent antigen detection by immunofluorescent technique; Legionella
micdadei
Extraordinary No.64/2013
272
34.20
36.90
30.60
26.10
56.70
21.27
48.60
37.58
20.64
26.10
85.50
95.40
92.70
75.60
63.90
63.90
52.69
52.69
63.90
51.79
62.10
62.10
62.10
Friday, 09 August 2013
87278
87279
87280
87281
87283
87285
87290
87299
87300
87301
87320
87324
87327
87328
87332
87335
87336
87337
87339
87340
87341
87350
87380
87385
Infectious agent antigen detection by immunofluorescent technique; Legionella
pneumophila
Infectious agent antigen detection by immunofluorescent technique; Parainfluenza
virus, each type
Infectious agent antigen detection by immunofluorescent technique; respiratory
syncytial virus
Infectious agent antigen detection by immunofluorescent technique; Pneumocystis
carinii
Infectious agent antigen detection by immunofluorescent technique; Rubeola
Infectious agent antigen detection by immunofluorescent technique; Treponema
pallidum
Infectious agent antigen detection by immunofluorescent technique; Varicella
zoster virus
Infectious agent antigen detection by immunofluorescent technique; not otherwise
specified, each organism
Infectious agent antigen detection by immunofluorescent technique, polyvalent for
multiple organisms, each polyvalent antiserum
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; adenovirus enteric types 40/41
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Chlamydia trachomatis
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Clostridium difficile toxin(s)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Cryptococcus neoformans
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; cryptosporidium/giardia
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; cytomegalovirus
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Escherichia coli 0157
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Entamoeba histolytica dispar group
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Entamoeba histolytica group
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Helicobacter pylori
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; hepatitis B surface antigen (HBsAg)
neutralization
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; hepatitis Be antigen (HBeAg)
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; hepatitis, delta agent
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
Extraordinary No.64/2013
273
62.10
62.10
62.10
62.10
62.10
62.10
62.10
51.79
27.00
62.10
42.46
62.10
62.10
62.10
62.10
62.10
62.10
62.10
55.80
42.94
55.80
56.70
66.60
55.80
Friday, 09 August 2013
or semiquantitative, multiple step method; Histoplasma capsulatum
87390
87391
87400
87420
87425
87427
87430
87449
87450
87451
87470
87471
87472
87475
87476
87477
87480
87481
87482
87485
87486
87487
87490
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; HIV-1
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; HIV-2
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Influenza, A or B, each
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; respiratory syncytial virus
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; rotavirus
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Shiga-like toxin
Infectious agent antigen detection by enzyme immunoassay technique, qualitative
or semiquantitative, multiple step method; Streptococcus, group A
Infectious agent antigen detection by enzyme immunoassay technique qualitative
or semiquantitative; multiple step method, not otherwise specified, each organism
Infectious agent antigen detection by enzyme immunoassay technique qualitative
or semiquantitative; single step method, not otherwise specified, each organism
Infectious agent antigen detection by enzyme immunoassay technique qualitative
or semiquantitative; multiple step method, polyvalent for multiple organisms, each
polyvalent antiserum
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and
Bartonella quintana, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and
Bartonella quintana, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Bartonella henselae and
Bartonella quintana, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Borrelia burgdorferi,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Candida species, direct
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Candida species,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Candida species,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia
pneumoniae, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia
pneumoniae, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia
pneumoniae, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis,
Extraordinary No.64/2013
274
65.77
65.77
27.00
55.80
55.80
55.80
39.31
62.10
43.20
43.20
76.50
135.90
164.70
76.50
135.90
164.70
76.50
135.90
161.10
76.50
135.90
164.70
71.10
Friday, 09 August 2013
direct probe technique
87491
87492
87495
87496
87497
87510
87511
87512
87515
87516
87517
87520
87521
87522
87525
87526
87527
87528
87529
87530
87531
87532
87533
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus, direct
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); cytomegalovirus,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Gardnerella vaginalis,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus, direct
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis B virus,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, direct probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, amplified
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, direct probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G, amplified
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); hepatitis G,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6, direct
probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Herpes virus-6,
quantification
Extraordinary No.64/2013
275
135.90
134.10
76.50
135.90
164.70
76.50
135.90
161.10
58.99
135.90
164.70
58.99
118.80
198.00
76.50
135.90
161.10
80.10
135.90
124.08
76.50
135.90
161.10
Friday, 09 August 2013
87534
87535
87536
87537
87538
87539
87540
87541
87542
87550
87551
87552
87555
87556
87557
87560
87561
87562
87580
87581
87582
87590
87591
87592
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, direct probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, amplified probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); HIV-1, quantification
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, direct probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, amplified probe
technique
Infectious agent detection by nucleic acid (DNA or RNA); HIV-2, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Legionella
pneumophila, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Legionella
pneumophila, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Legionella
pneumophila, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria species,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria
tuberculosis, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria
tuberculosis, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria
tuberculosis, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria aviumintracellulare, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria aviumintracellulare, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycobacteria aviumintracellulare, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma
pneumoniae, direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma
pneumoniae, amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Mycoplasma
pneumoniae, quantification
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae,
quantification
Extraordinary No.64/2013
276
76.50
135.90
257.40
80.10
135.90
164.70
76.50
135.90
161.10
76.50
135.90
164.70
76.50
135.90
124.08
76.50
135.90
164.70
76.50
135.90
161.10
80.10
135.90
164.70
Friday, 09 August 2013
88000
88005
Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human,
quantification
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A,
direct probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A,
amplified probe technique
Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A,
quantification
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified;
direct probe technique, each organism
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified;
amplified probe technique, each organism
Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified;
quantification, each organism
Infectious agent detection by immunoassay with direct optical observation;
Chlamydia trachomatis
Infectious agent detection by immunoassay with direct optical observation;
Neisseria gonorrhoeae
Infectious agent detection by immunoassay with direct optical observation;
Streptococcus, group A
Infectious agent detection by immunoassay with direct optical observation; not
otherwise specified
Necropsy (autopsy), gross examination only; without CNS
Necropsy (autopsy), gross examination only; with brain
88007
88012
Necropsy (autopsy), gross examination only; with brain and spinal cord
Necropsy (autopsy), gross examination only; infant with brain
1176.30
1008.00
88014
88016
Necropsy (autopsy), gross examination only; stillborn or newborn with brain
Necropsy (autopsy), gross examination only; macerated stillborn
998.10
891.00
88020
88025
Necropsy (autopsy), gross and microscopic; without CNS
Necropsy (autopsy), gross and microscopic; with brain
1176.30
1313.10
88027
88028
Necropsy (autopsy), gross and microscopic; with brain and spinal cord
Necropsy (autopsy), gross and microscopic; infant with brain
1391.40
1161.00
88029
88036
Necropsy (autopsy), gross and microscopic; stillborn or newborn with brain
Necropsy (autopsy), limited, gross and/or microscopic; regional
1161.00
939.60
88037
88040
Necropsy (autopsy), limited, gross and/or microscopic; single organ
Necropsy (autopsy); forensic examination
Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears
with interpretation
Cytopathology, fluids, washings or brushings, except cervical or vaginal; filter
756.00
2889.00
87620
87621
87622
87650
87651
87652
87797
87798
87799
87810
87850
87880
87899
88104
88106
Extraordinary No.64/2013
277
58.99
109.43
161.10
76.50
135.90
161.10
76.50
135.90
164.70
55.80
55.80
55.80
46.05
891.00
1113.30
94.44
81.51
Friday, 09 August 2013
method only with interpretation
88112
88112
Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears
and filter preparation with interpretation
Cytopathology, concentration technique, smears and interpretation (eg,
Saccomanno technique)
Cytp slctv cell enhancement interpj xcpt c/v
Cytp slctv cell enhancement interpj xcpt c/v
88112
88120
Cytp slctv cell enhancement interpj xcpt c/v
Cytp insitu hybrid urine spec 3-5 probes ea mnl
168.70
1335.40
88120
88120
Cytp insitu hybrid urine spec 3-5 probes ea mnl
Cytp insitu hybrid urine spec 3-5 probes ea mnl
1189.03
146.37
88121
88121
Cytp insitu hybrid urne spec 3-5 probes cptr ea
Cytp insitu hybrid urne spec 3-5 probes cptr ea
1138.87
1003.01
88121
88125
Cytp insitu hybrid urne spec 3-5 probes cptr ea
Cytp forensic
135.86
64.93
88125
88125
Cytp forensic
Cytp forensic
26.10
38.83
88130
Sex chromatin identification; Barr bodies
Sex chromatin identification; peripheral blood smear, polymorphonuclear
drumsticks
Cytopathology, cervical or vaginal (any reporting system); requiring interpretation
by physician (List separately in addition to code for technical service)
Cytopathology, cervical or vaginal (any reporting system), collected in preservative
fluid, automated thin layer preparation; manual screening under physician
supervision
Cytopathology, slides, cervical or vaginal; manual screening under physician
supervision
Cytopathology, slides, cervical or vaginal; with manual screening and computerassisted rescreening under physician supervision
Cytopathology, slides, cervical or vaginal; with manual screening and rescreening
under physician supervision
Cytopathology, slides, cervical or vaginal; with manual screening and computerassisted rescreening using cell selection and review under physician supervision
Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg,
maturation index, karyopyknotic index, estrogenic index) (List separately in
addition to code(s) for other technical and interpretation services)
Cytopathology, smears, any other source; screening and interpretation
56.70
Cytopathology, smears, any other source; preparation, screening and interpretation
Cytopathology, smears, any other source; extended study involving over 5 slides
and/or multiple stains
Cytopathology, slides, cervical or vaginal (the Bethesda System); manual
screening under physician supervision
70.20
88107
88108
88140
88141
88142
88150
88152
88153
88154
88155
88160
88161
88162
88164
Extraordinary No.64/2013
278
122.40
105.30
307.74
139.04
36.07
41.51
54.42
31.62
34.20
30.60
30.60
36.90
66.38
133.20
33.30
Friday, 09 August 2013
88173
88177
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual
screening and rescreening under physician supervision
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual
screening and computer-assisted rescreening under physician supervision
Cytopathology, slides, cervical or vaginal (the Bethesda System); with manual
screening and computer-assisted rescreening using cell selection and review under
physician supervision
Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study
to determine adequacy of specimen(s)
Cytopathology, evaluation of fine needle aspirate; interpretation and report
Cytp c/v auto thin lyr prepj adequacy ea eval
88177
88177
Cytp c/v auto thin lyr prepj adequacy ea eval
Cytp c/v auto thin lyr prepj adequacy ea eval
11.27
37.13
88182
88182
Flo cytometry cell cycle/dna alys
Flo cytometry cell cycle/dna alys
368.04
223.10
88182
88184
Flo cytometry cell cycle/dna alys
Flo cytometry cell surf marker techl only 1st
144.95
182.21
88185
88187
Flo cytometry cell surf marker techl only ea
Flo cytometry interpj 2-8 markers
134.89
254.03
88188
88189
Flo cytometry interpj 9-15 markers
Flo cytometry interpj 16/> markers
317.39
416.98
88230
88233
Tissue culture for non-neoplastic disorders; lymphocyte
Tissue culture for non-neoplastic disorders; skin or other solid tissue biopsy
237.36
463.50
88235
88237
Tissue culture for non-neoplastic disorders; amniotic fluid or chorionic villus cells
Tissue culture for neoplastic disorders; bone marrow, blood cells
357.89
386.10
88239
Tissue culture for neoplastic disorders; solid tumor
Chromosome analysis for breakage syndromes; baseline Sister Chromatid
Exchange (SCE), 20-25 cells
Chromosome analysis for breakage syndromes; baseline breakage, score 50-100
cells, count 20 cells, 2 karyotypes (eg, for ataxia telangiectasia, Fanconi anemia,
fragile X)
Chromosome analysis; count 5 cells, 1 karyotype, with banding
Chromosome analysis; count 15-20 cells, 2 karyotypes, with banding
473.40
Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding
Chromosome analysis, amniotic fluid or chorionic villus, count 15 cells, 1
karyotype, with banding
Chromosome analysis, in situ for amniotic fluid cells, count cells from 6-12
colonies, 1 karyotype, with banding
Chromosome analysis; additional karyotypes, each study
Chromosome analysis; additional specialized banding technique (eg, NOR, Cbanding)
607.50
88165
88166
88167
88172
88245
88248
88261
88262
88263
88267
88269
88280
88283
Extraordinary No.64/2013
279
30.60
30.60
30.60
144.00
175.50
48.41
437.40
432.90
546.30
464.78
669.60
468.15
122.22
185.40
Friday, 09 August 2013
88285
Chromosome analysis; additional cells counted, each study
58.50
88289
88291
Chromosome analysis; additional high resolution study
Cytogenetics&molec cytogenetics i&r
130.50
155.70
88300
88302
Level I - Surgical pathology, gross examination only
Level II - Surgical pathology, gross and microscopic examination
56.70
86.17
88304
88305
Level III - Surgical pathology, gross and microscopic examination
Level IV - Surgical pathology, gross and microscopic examination
108.82
144.84
88307
88309
230.25
363.71
88333
Level V - Surgical pathology, gross and microscopic examination
Level VI - Surgical pathology, gross and microscopic examination
Decalcification procedure (List separately in addition to code for surgical
pathology examination)
Special stains (List separately in addition to code for surgical pathology
examination); Group I for microorganisms (eg, Gridley, acid fast, methenamine
silver), each
Special stains (List separately in addition to code for surgical pathology
examination); Group II, all other, (eg, iron, trichrome), except
immunocytochemistry and immunoperoxidase stains, each
Special stains (List separately in addition to code for surgical pathology
examination); histochemical staining with frozen section(s)
Determinative histochemistry to identify chemical components (eg, copper, zinc)
Determinative histochemistry or cytochemistry to identify enzyme constituents,
each
Consultation and report on referred slides prepared elsewhere
Consultation and report on referred material requiring preparation of slides
Consultation, comprehensive, with review of records and specimens, with report
on referred material
Pathology consultation during surgery;
Pathology consultation during surgery; first tissue block, with frozen section(s),
single specimen
Pathology consultation during surgery; each additional tissue block with frozen
section(s)
Path consltj surg cytologic xm 1st sit
88333
88333
Path consltj surg cytologic xm 1st sit
Path consltj surg cytologic xm 1st sit
48.80
133.51
88334
88334
Path consltj surg cytol xm ea addl
Path consltj surg cytol xm ea addl
113.82
34.54
88334
88342
Path consltj surg cytol xm ea addl
Immunocytochemistry (including tissue immunoperoxidase), each antibody
79.28
154.80
88346
88347
Immunofluorescent study, each antibody; direct method
Immunofluorescent study, each antibody; indirect method
128.70
118.80
88348
Electron microscopy; diagnostic
490.50
88311
88312
88313
88314
88318
88319
88321
88323
88325
88329
88331
88332
Extraordinary No.64/2013
280
51.30
59.40
46.80
72.00
73.80
80.10
140.40
149.40
193.50
116.10
183.60
98.10
182.31
Friday, 09 August 2013
88349
Electron mic scanning
495.33
88349
88349
Electron mic scanning
Electron mic scanning
385.22
110.11
88355
88356
Morphometric analysis; skeletal muscle
Morphometric analysis; nerve
360.90
408.60
88358
88360
Morphometric analysis; tumor
M/phmtrc alys tum imhchem ea antb mnl
325.80
265.15
88360
88360
M/phmtrc alys tum imhchem ea antb mnl
M/phmtrc alys tum imhchem ea antb mnl
140.25
124.91
88361
88361
M/phmtrc alys tum imhchem ea antb cptr
M/phmtrc alys tum imhchem ea antb cptr
355.82
225.02
88361
88362
M/phmtrc alys tum imhchem ea antb cptr
Nerve teasing preparations
130.81
329.40
88365
88367
Tissue in situ hybridization, interpretation and report
M/phmtrc alys ish ea prb cptr-asst technology
154.80
462.18
88367
88367
M/phmtrc alys ish ea prb cptr-asst technology
M/phmtrc alys ish ea prb cptr-asst technology
308.67
153.51
88368
88368
M/phmtrc alys ish ea prb mnl
M/phmtrc alys ish ea prb mnl
371.20
204.94
88368
88371
166.25
66.60
88380
M/phmtrc alys ish ea prb mnl
Protein analysis of tissue by Western Blot, with interpretation and report;
Protein analysis of tissue by Western Blot, with interpretation and report;
immunological probe for band identification, each
Microdissection prep identified target laser
88380
88380
Microdissection prep identified target laser
Microdissection prep identified target laser
193.37
128.33
88381
88381
Microdissection prep identified target manual
Microdissection prep identified target manual
403.93
287.68
88381
88385
Microdissection prep identified target manual
Ra-based eval mlt molec prbs 51 thru 250 prbs
116.25
673.13
88385
88385
Ra-based eval mlt molec prbs 51 thru 250 prbs
Ra-based eval mlt molec prbs 51 thru 250 prbs
599.90
73.24
88386
88386
Ra-based eval mlt molec prbs 251 thru 500 prbs
Ra-based eval mlt molec prbs 251 thru 500 prbs
739.49
632.76
88386
88387
Ra-based eval mlt molec prbs 251 thru 500 prbs
Macro exam dissect&prep tiss nonmicro std ea
106.73
73.38
88387
Macro exam dissect&prep tiss nonmicro std ea
15.04
88372
Extraordinary No.64/2013
281
86.40
321.70
Friday, 09 August 2013
88387
Macro exam dissect&prep tiss nonmicro std ea
58.34
88388
88388
Macr exm diss&prp nonmicr imprnt/conslt/frz sec
Macr exm diss&prp nonmicr imprnt/conslt/frz sec
45.35
7.93
88388
89049
Macr exm diss&prp nonmicr imprnt/conslt/frz sec
Caffeine halothane contrcure
37.42
250.65
89050
23.46
89125
Cell count, miscellaneous body fluids (eg, CSF, joint fluid), except blood;
Cell count, miscellaneous body fluids (eg, CSF, joint fluid), except blood; with
differential count
Crystal identification by light microscopy with or without polarizing lens analysis,
any body fluid (except urine)
Fat stain, feces, urine, or respiratory secretions
89160
89190
Meat fibers, feces
Nasal smear for eosinophils
18.90
24.30
89220
89230
Sptm obtg spec aersl induced spx
Sweat collj iontophoresis
Semen analysis; presence and/or motility of sperm including Huhner test (post
coital)
Semen analysis; motility and count
Semen analysis; complete (volume, count, motility, and differential)
36.20
69.49
Sperm antibodies
Sperm evaluation; hamster penetration test
Sperm evaluation; cervical mucus penetration test, with or without spinnbarkeit
test
Sweat collection by iontophoresis
152.10
365.40
Imadm through 18yr any route 1st vac/toxoid
Imadm through 18yr any route ea addl vac/toxoid
Immunization administration (includes percutaneous, intradermal, subcutaneous,
intramuscular and jet injections and/or intranasal or oral administration); one
vaccine (single or combination vaccine/toxoid)
Immunization administration (includes percutaneous, intradermal, subcutaneous,
intramuscular and jet injections and/or intranasal or oral administration); each
additional vaccine (single or combination vaccine/toxoid) (List separately in
addition to code
Imadm intransl/oral 1 vacc
Imadm intransl/oral ea vacc
29.43
17.03
Hepatitis A vaccine, adult dosage, for intramuscular use
Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for
intramuscular use
Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only,
intramuscular use
Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for
90.96
89051
89060
89300
89310
89320
89325
89329
89330
89360
90460
90461
90471
90472
90473
90474
90632
90645
90646
90648
Extraordinary No.64/2013
282
38.70
48.60
22.03
66.60
56.70
70.57
87.30
62.10
21.07
24.81
21.56
17.03
38.54
41.40
38.70
Friday, 09 August 2013
intramuscular use
90657
90658
90669
90680
90700
90701
90702
90703
90704
90705
90706
90707
90710
90713
90716
90717
90718
90732
90733
90735
90744
90746
90748
90801
90802
90804
90805
Influenza virus vaccine, split virus, 6-35 months dosage, for intramuscular or jet
injection use
Influenza virus vaccine, split virus, 3 years and above dosage, for intramuscular or
jet injection use
Pneumococcal conjugate vaccine, polyvalent, for children under five years, for
intramuscular use
Rotavirus vaccine, tetravalent, live, for oral use
Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), for
intramuscular use
Diphtheria, tetanus toxoids, and whole cell pertussis vaccine (DTP), for
intramuscular use
Diphtheria and tetanus toxoids (DT) adsorbed for use in individuals younger than
seven years, for intramuscular use
Tetanus toxoid adsorbed, for intramuscular or jet injection use
Mumps virus vaccine, live, for subcutaneous or jet injection use
15.93
19.80
84.31
76.50
43.36
38.70
18.62
19.30
45.00
Measles virus vaccine, live, for subcutaneous or jet injection use
Rubella virus vaccine, live, for subcutaneous or jet injection use
Measles, mumps and rubella virus vaccine (MMR), live, for subcutaneous or jet
injection use
Measles, mumps, rubella, and varicella vaccine (MMRV), live, for subcutaneous
use
Poliovirus vaccine, inactivated, (IPV), for subcutaneous use
41.40
47.70
Varicella virus vaccine, live, for subcutaneous use
Yellow fever vaccine, live, for subcutaneous use
Tetanus and diphtheria toxoids (Td) adsorbed for use in individuals seven years or
older, for intramuscular or jet injection
Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed
patient dosage, for subcutaneous or intramuscular use
Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous or jet
injection use
Japanese encephalitis virus vaccine, for subcutaneous use
Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for
intramuscular use
Hepatitis B vaccine, adult dosage, for intramuscular use
Hepatitis B and Hemophilus influenza b vaccine (HepB-Hib), for intramuscular
use
Psychiatric diagnostic interview examination
Interactive psychiatric diagnostic interview examination using play equipment,
physical devices, language interpreter, or other mechanisms of communication
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with
the patient;
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
86.68
83.30
Extraordinary No.64/2013
283
58.15
58.50
41.23
26.10
31.50
90.24
100.80
61.37
90.51
78.66
200.82
225.90
110.38
126.86
Friday, 09 August 2013
90806
90807
90808
90809
90810
90811
90812
90813
90814
90815
90816
90817
90818
in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with
the patient; with medical evaluation and management services
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with
the patient;
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with
the patient; with medical evaluation and management services
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with
the patient;
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with
the patient; with medical evaluation and management services
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 20 to 30 minutes face-to-face with the
patient;
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 20 to 30 minutes face-to-face with the
patient; with m
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 45 to 50 minutes face-to-face with the
patient;
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 45 to 50 minutes face-to-face with the
patient; with m
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 75 to 80 minutes face-to-face with the
patient;
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
office or outpatient facility, approximately 75 to 80 minutes face-to-face with the
patient; with m
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
20 to 30 minutes face-to-face with the patient;
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
20 to 30 minutes face-to-face with the patient; with medical evaluation and
management
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
45 to 50 minutes face-to-face with the patient;
Extraordinary No.64/2013
284
148.09
173.07
226.03
301.50
134.10
156.60
160.48
207.00
270.00
264.14
133.20
154.80
186.30
Friday, 09 August 2013
90845
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
45 to 50 minutes face-to-face with the patient; with medical evaluation and
management
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
75 to 80 minutes face-to-face with the patient;
Individual psychotherapy, insight oriented, behavior modifying and/or supportive,
in an inpatient hospital, partial hospital or residential care setting, approximately
75 to 80 minutes face-to-face with the patient; with medical evaluation and
management
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 20 to
30 minutes fa
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 20 to
30 minutes fa
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 45 to
50 minutes fa
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 45 to
50 minutes fa
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 75 to
80 minutes fa
Individual psychotherapy, interactive, using play equipment, physical devices,
language interpreter, or other mechanisms of non-verbal communication, in an
inpatient hospital, partial hospital or residential care setting, approximately 75 to
80 minutes fa
Psychoanalysis
90846
90847
Family psychotherapy (without the patient present)
Family psychotherapy (conjoint psychotherapy) (with patient present)
159.30
151.62
90849
90853
Multiple-family group psychotherapy
Group psychotherapy (other than of a multiple-family group)
129.60
87.30
90857
Interactive group psychotherapy
Pharmacologic management, including prescription, use, and review of medication
with no more than minimal medical psychotherapy
Narcosynthesis for psychiatric diagnostic and therapeutic purposes (eg, sodium
amobarbital (Amytal) interview)
Electroconvulsive therapy (includes necessary monitoring); single seizure
82.80
90819
90821
90822
90823
90824
90826
90827
90828
90829
90862
90865
90870
Extraordinary No.64/2013
285
212.40
294.30
326.70
139.50
171.90
177.58
225.00
314.10
323.10
166.50
93.77
271.80
209.70
Friday, 09 August 2013
90951
Individual psychophysiological therapy incorporating biofeedback training by any
modality (face-to-face with the patient), with psychotherapy (eg, insight oriented,
behavior modifying or supportive psychotherapy); approximately 20-30 minutes
Individual psychophysiological therapy incorporating biofeedback training by any
modality (face-to-face with the patient), with psychotherapy (eg, insight oriented,
behavior modifying or supportive psychotherapy); approximately 45-50 minutes
Hypnotherapy
Environmental intervention for medical management purposes on a psychiatric
patient's behalf with agencies, employers, or institutions
Psyc eval hosp records dx purposes
Interpretation or explanation of results of psychiatric, other medical examinations
and procedures, or other accumulated data to family or other responsible persons,
or advising them how to assist patient
Preparation of report of patient's psychiatric status, history, treatment, or progress
(other than for legal or consultative purposes) for other physicians, agencies, or
insurance carriers
Biofeedback training by any modality
Biofeedback training, perineal muscles, anorectal or urethral sphincter, including
EMG and/or manometry
Hemodialysis procedure with single physician evaluation
Hemodialysis procedure requiring repeated evaluation(s) with or without
substantial revision of dialysis prescription
Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration,
or other continuous renal replacement therapies), with single physician evaluation
Dialysis procedure other than hemodialysis (eg, peritoneal dialysis, hemofiltration,
or other continuous renal replacement therapies) requiring repeated physician
evaluations, with or without substantial revision of dialysis prescription
Esrd related svc monthly <2 yr old 4/>visits
90954
90955
Esrd related svc monthly 2-11 yr old 4/>visits
Esrd related svc monthly 2-11 yr old 2/3 visits
1325.75
742.53
90956
90957
Esrd related svc monthly 2-11 yr old 1 visit
Esrd related svc monthly 12-19 yr old 4/>visits
521.08
1046.60
90958
90959
Esrd related svc monthly 12-19 yr old 2/3 visits
Esrd related svc monthly 12-19 yr old 1 visit
702.47
462.30
90960
90961
Esrd related svc monthly 20&> yr old 4/> visits
Esrd related svc monthly 20&> yr old 2/3 visits
515.18
413.70
90962
90963
Esrd related svc monthly 20&> yr old 1 visit
Esrd svc home dialysis full month <2yr old
301.29
898.85
90964
90965
Esrd svc home dialysis full month 2-11 yr old
Esrd svc home dialysis full month 12-19 yr old
750.40
704.13
90966
90967
Esrd svc home dialysis full month 20 yr old
Esrd related svc <full month < 2 yr old
368.71
33.03
90875
90876
90880
90882
90885
90887
90889
90901
90911
90935
90937
90945
90947
Extraordinary No.64/2013
286
117.06
226.80
183.60
118.80
120.97
159.30
171.00
123.30
180.00
249.80
566.10
300.60
482.40
1568.42
Friday, 09 August 2013
90968
Esrd related svc <full month 2-11 yr old
26.85
90969
90970
19.63
13.50
91013
Esrd related svc <full month 12-19 yr old
Esrd related svc <full month 20&> yr old
Dialysis training, patient, including helper where applicable, any mode, completed
course
Dialysis training, patient, including helper where applicable, any mode, course not
completed, per training session
Hemoperfusion (eg, with activated charcoal or resin)
Esophageal motility (manometric study of the esophagus and/or gastroesophageal
junction) study;
Esophgl motility std w/i&r stim/perfusion
91013
91013
Esophgl motility std w/i&r stim/perfusion
Esophgl motility std w/i&r stim/perfusion
39.13
29.29
91020
91022
Gastric motility (manometric) studies
Duol motility std
255.60
497.91
91022
91022
Duol motility std
Duol motility std
284.78
213.12
91030
91034
Esophagus, acid perfusion (Bernstein) test for esophagitis
Esoph g-esop rflx ncath eltrd plmt
158.40
658.66
91034
91034
Esoph g-esop rflx ncath eltrd plmt
Esoph g-esop rflx ncath eltrd plmt
488.07
170.59
91035
91035
Esoph g-esop rflx tlmtr eltrd plmt
Esoph g-esop rflx tlmtr eltrd plmt
1202.01
965.94
91035
91037
Esoph g-esop rflx tlmtr eltrd plmt
Esophgl funcj g-esop rflx impd eltrd plmt
236.07
451.78
91037
91037
Esophgl funcj g-esop rflx impd eltrd plmt
Esophgl funcj g-esop rflx impd eltrd plmt
303.43
148.35
91038
91038
Esophgl funcj g-esop rflx impd eltrd prolng
Esophgl funcj g-esop rflx impd eltrd prolng
441.22
277.23
91038
91040
Esophgl funcj g-esop rflx impd eltrd prolng
Esophgl balo distension provocation std
163.99
956.84
91040
91040
Esophgl balo distension provocation std
Esophgl balo distension provocation std
814.55
142.29
91065
91110
Breath hydrogen test (eg, for detection of lactase deficiency)
Gi trc img intral esoph thru ile phys i&r
166.50
2494.19
91110
91110
Gi trc img intral esoph thru ile phys i&r
Gi trc img intral esoph thru ile phys i&r
1972.12
522.07
91111
Gastrointestinal tract imaging esophagus
1753.90
90989
90993
90997
91010
Extraordinary No.64/2013
287
653.40
135.90
597.60
293.40
68.42
Friday, 09 August 2013
91111
Gastrointestinal tract imaging esophagus
1631.24
91111
91120
Gastrointestinal tract imaging esophagus
Rct sensation tone&compliance
122.66
1002.67
91120
91120
Rct sensation tone&compliance
Rct sensation tone&compliance
873.02
129.65
91122
91132
Anorectal manometry
Egg dx tc
357.30
140.33
91132
91132
Egg dx tc
Egg dx tc
65.72
74.61
91133
91133
Egg dx tc provocative tstg
Egg dx tc provocative tstg
200.44
89.94
91133
110.50
92020
Egg dx tc provocative tstg
Ophthalmological services: medical examination and evaluation with initiation of
diagnostic and treatment program; intermediate, new patient
Ophthalmological services: medical examination and evaluation with initiation of
diagnostic and treatment program; comprehensive, new patient, one or more visits
Ophthalmological services: medical examination and evaluation, with initiation or
continuation of diagnostic and treatment program; intermediate, established patient
Ophthalmological services: medical examination and evaluation, with initiation or
continuation of diagnostic and treatment program; comprehensive, established
patient, one or more visits
Determination of refractive state
Ophthalmological examination and evaluation, under general anesthesia, with or
without manipulation of globe for passive range of motion or other manipulation to
facilitate diagnostic examination; complete
Ophthalmological examination and evaluation, under general anesthesia, with or
without manipulation of globe for passive range of motion or other manipulation to
facilitate diagnostic examination; limited
Gonioscopy (separate procedure)
92025
92025
Computerized corneal topography uni/bi
Computerized corneal topography uni/bi
53.37
24.70
92025
Computerized corneal topography uni/bi
Sensorimotor examination with multiple measurements of ocular deviation (eg,
restrictive or paretic muscle with diplopia) with interpretation and report (separate
procedure)
Orthoptic and/or pleoptic training, with continuing medical direction and
evaluation
Fitting of contact lens for treatment of disease, including supply of lens
Visual field examination, unilateral or bilateral, with interpretation and report;
limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus
level automated test, such as Octopus 3 or 7 equivalent)
Visual field examination, unilateral or bilateral, with interpretation and report;
28.67
92002
92004
92012
92014
92015
92018
92019
92060
92065
92070
92081
92082
Extraordinary No.64/2013
288
87.67
103.19
62.82
87.18
28.58
246.60
153.90
53.27
66.59
56.70
206.10
46.80
81.78
Friday, 09 August 2013
92130
92132
intermediate examination (eg, at least 2 isopters on Goldmann perimeter, or
semiquantitative, automated suprathreshold screening program, Humphrey
suprathreshold automatic
Visual field examination, unilateral or bilateral, with interpretation and report;
extended examination (eg, Goldmann visual fields with at least 3 isopters plotted
and static determination within the central 30degree, or quantitative, automated
threshold
Serial tonometry (separate procedure) with multiple measurements of intraocular
pressure over an extended time period with interpretation and report, same day (eg,
diurnal curve or medical treatment of acute elevation of intraocular pressure)
Tonography with interpretation and report, recording indentation tonometer
method or perilimbal suction method
Tonography with water provocation
Cmptr ophthalmic dx img ant segmt w/i&r uni/bi
92132
92132
Cmptr ophthalmic dx img ant segmt w/i&r uni/bi
Cmptr ophthalmic dx img ant segmt w/i&r uni/bi
24.18
33.05
92133
92133
Computerized ophthalmic imaging optic nerve
Computerized ophthalmic imaging optic nerve
69.48
23.84
92133
92134
Computerized ophthalmic imaging optic nerve
Computerized ophthalmic imaging retina
45.63
69.48
92134
92134
Computerized ophthalmic imaging retina
Computerized ophthalmic imaging retina
23.84
45.63
92136
92136
Oph bmtry prtl coher intrfrmtry io lens pwr cal
Oph bmtry prtl coher intrfrmtry io lens pwr cal
123.93
79.77
92136
92140
Oph bmtry prtl coher intrfrmtry io lens pwr cal
Provocative tests for glaucoma, with interpretation and report, without tonography
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment,
melanoma), with interpretation and report; initial
Ophthalmoscopy, extended, with retinal drawing (eg, for retinal detachment,
melanoma), with interpretation and report; subsequent
Remote img dx retinl dis w/alys & report uni/bi
Remote img mgt retinl dis w/i&r uni/bi
44.16
57.90
Fluorescein angioscopy with interpretation and report
Fluorescein angiography (includes multiframe imaging) with interpretation and
report
Indocyanine-green angiography (includes multiframe imaging) with interpretation
and report
Fundus photography with interpretation and report
Ophthalmodynamometry
Needle oculoelectromyography, one or more extraocular muscles, one or both eyes,
with interpretation and report
Electro-oculography with interpretation and report
126.90
92083
92100
92120
92225
92226
92227
92228
92230
92235
92240
92250
92260
92265
92270
Extraordinary No.64/2013
289
125.94
52.70
57.03
81.00
57.24
79.44
70.28
28.24
61.25
247.50
225.00
79.20
66.60
128.70
128.70
Friday, 09 August 2013
92275
Electroretinography with interpretation and report
162.90
92283
92284
56.70
113.40
92313
92314
Color vision examination, extended, eg, anomaloscope or equivalent
Dark adaptation examination with interpretation and report
External ocular photography with interpretation and report for documentation of
medical progress (eg, close-up photography, slit lamp photography,
goniophotography, stereo-photography)
Special anterior segment photography with interpretation and report; with specular
endothelial microscopy and cell count
Special anterior segment photography with interpretation and report; with
fluorescein angiography
Prescription of optical and physical characteristics of and fitting of contact lens,
with medical supervision of adaptation; corneal lens, both eyes, except for aphakia
Prescription of optical and physical characteristics of and fitting of contact lens,
with medical supervision of adaptation; corneal lens for aphakia, one eye
Prescription of optical and physical characteristics of and fitting of contact lens,
with medical supervision of adaptation; corneal lens for aphakia, both eyes
Rx&fitg c-lens supvj crnlsclrl lens
Rx c-lens supvj&dirion fitg tech ou xcpt aphk
92315
92316
Rx c-lens supvj fitg tech crnl aphk 1o
Rx c-lens supvj fitg tech crnl aphk ou
63.02
98.58
92317
66.07
92326
92340
Rx c-lens supvj fitg tech crnlsclrl
Modification of contact lens (separate procedure), with medical supervision of
adaptation
Replacement of contact lens
Fitting of spectacles, except for aphakia; monofocal
92341
92342
Fitg spectls xcpt aphk bifocal
Fitg spectls xcpt aphk mltfcl
40.23
52.41
92352
92353
Fitg spectl prosth aphk monofocal
Fitting of spectacle prosthesis for aphakia; multifocal
22.45
51.30
92370
92371
Rpr&refitg spectls xcpt aphk
Rpr&refitg spectls spectl prosth aphk
48.20
70.29
92502
92504
Otolaryngologic examination under general anesthesia
Binocular microscopy (separate diagnostic procedure)
Evaluation of speech, language, voice, communication, auditory processing, and/or
aural rehabilitation status
Treatment of speech, language, voice, communication, and/or auditory processing
disorder (includes aural rehabilitation); individual
Treatment of speech, language, voice, communication, and/or auditory processing
disorder (includes aural rehabilitation); group, two or more individuals
Nasopharyngoscopy with endoscope (separate procedure)
Nasal function studies (eg, rhinomanometry)
297.00
61.25
92285
92286
92287
92310
92311
92312
92325
92506
92507
92508
92511
92512
Extraordinary No.64/2013
290
59.40
235.92
180.00
268.20
180.90
247.50
91.51
67.48
43.20
118.80
56.70
140.40
60.61
47.70
229.50
144.00
Friday, 09 August 2013
92516
Facial nerve function studies (eg, electroneuronography)
123.30
92520
92526
Laryngeal function studies
Treatment of swallowing dysfunction and/or oral function for feeding
257.40
123.30
92531
92532
54.00
62.10
92534
Spontaneous nystagmus, including gaze
Positional nystagmus
Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes
four tests)
Optokinetic nystagmus
92540
92540
Vstblr funcj nystag fovl&perph stimj oscil trkg
Vstblr funcj nystag fovl&perph stimj oscil trkg
151.13
26.55
92540
124.58
92548
Vstblr funcj nystag fovl&perph stimj oscil trkg
Spontaneous nystagmus test, including gaze and fixation nystagmus, with
recording
Positional nystagmus test, minimum of 4 positions, with recording
Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes
four tests), with recording
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with
recording
Oscillating tracking test, with recording
Sinusoidal vertical axis rotational testing
Use of vertical electrodes (List separately in addition to code for primary
procedure)
Computerized dynamic posturography
92550
92551
Tympanometry and reflex threshold measurements
Screening test, pure tone, air only
38.60
34.20
92552
92553
Pure tone audiometry (threshold); air only
Pure tone audiometry (threshold); air and bone
40.77
61.69
92555
92556
36.90
54.76
92559
Speech audiometry threshold;
Speech audiometry threshold; with speech recognition
Comprehensive audiometry threshold evaluation and speech recognition (92553
and 92556 combined)
Audiometric testing of groups
92560
92561
Bekesy audiometry; screening
Bekesy audiometry; diagnostic
66.60
83.70
92562
92563
Loudness balance test, alternate binaural or monaural
Tone decay test
40.50
45.00
92564
92565
Short increment sensitivity index (SISI)
Stenger test, pure tone
41.40
50.40
92567
Tympanometry (impedance testing)
43.18
92533
92541
92542
92543
92544
92545
92546
92547
92557
Extraordinary No.64/2013
291
76.50
63.00
121.50
114.30
128.70
77.40
77.40
101.70
72.00
216.00
92.70
41.40
Friday, 09 August 2013
92568
Acoustic reflex testing
41.40
92570
92571
Acoustic immit test tympanom/acoust reflx/decay
Filtered speech test
58.15
38.70
92572
92575
Staggered spondaic word test
Sensorineural acuity level test
42.30
36.00
92576
92577
Synthetic sentence identification test
Stenger test, speech
38.70
51.30
92579
92582
Visual reinforcement audiometry (VRA)
Conditioning play audiometry
102.60
65.70
92583
92584
72.00
252.00
92590
Select picture audiometry
Electrocochleography
Auditory evoked potentials for evoked response audiometry and/or testing of the
central nervous system; comprehensive
Aep era&/tstg cns lmtd
Evoked otoacoustic emissions; limited (single stimulus level, either transient or
distortion products)
Evoked otoacoustic emissions; comprehensive or diagnostic evaluation
(comparison of transient and/or distortion product otoacoustic emissions at
multiple levels and frequencies)
Hearing aid examination and selection; monaural
92591
92592
Hearing aid examination and selection; binaural
Hearing aid check; monaural
146.70
40.50
92593
92594
Hearing aid check; binaural
Electroacoustic evaluation for hearing aid; monaural
57.60
36.00
92595
92596
38.70
51.30
92601
Electroacoustic evaluation for hearing aid; binaural
Ear protector attenuation measurements
Evaluation for use and/or fitting of voice prosthetic or augmentative/alternative
communication device to supplement oral speech
Alys cochlear implt pt <7 yr prgrmg
92602
92603
Alys cochlear implt pt <7 yr sbsq reprgrmg
Alys cochlear implt 7 yr/> prgrmg
200.79
187.38
92604
92607
Alys cochlear implt 7 yr/> sbsq reprgrmg
Rx sp-genratj augmnt&comunicaj dev 1st hr
124.41
259.20
92608
92609
Rx sp-genratj augmnt&comunicaj dev ea 30 min
Ther sp-genratj dev prgrmg&modificaj
57.16
139.99
92610
92611
Eval oral&pharyngeal swlng funcj
Motion fluor eval swlng funcj c/v rec
270.34
264.89
92612
92613
Flx fibopt ndsc eval swlng c/v rec
Flx fibopt ndsc eval swlng c/v rec phys i&r
336.75
86.41
92585
92586
92587
92588
92597
Extraordinary No.64/2013
292
353.70
151.11
124.20
141.30
113.40
188.10
279.88
Friday, 09 August 2013
92614
Flx fibopt ndsc eval laryn sens c/v rec
296.87
92615
92616
Flx fibopt ndsc eval laryn sens phys i&r
Flx fibopt ndsc eval swlng&laryn sens c/v rec
78.45
438.23
92617
92620
Flx fibopt ndsc eval swlng&laryn sens phys i&r
Eval ctr aud funcj w/reprt 1st 60 min
103.33
99.31
92621
92625
Eval ctr aud funcj w/reprt ea 15 min
Assmt tinnitus
25.94
93.11
92626
92627
Eval aud rhab status 1st hr
Eval aud rhab status ea 15 min
174.65
43.12
92640
92950
Analysis w/prgrmg aud brainstem implant pr hr
Cardiopulmonary resuscitation (eg, in cardiac arrest)
122.67
482.59
92953
92960
Temporary transcutaneous pacing
Cardioversion, elective, electrical conversion of arrhythmia; external
329.40
425.70
92961
92970
Cardioversion elective arrhyt int spx
Cardioassist-method of circulatory assist; internal
945.23
684.90
92971
92973
Cardioassist-method of circulatory assist; external
Prq trluml c thrmbc
275.40
1041.07
92974
Tcat plmt radj dlvr dev sbsq c iv brachytx
Thrombolysis, coronary; by intracoronary infusion, including selective coronary
angiography
Thrombolysis, coronary; by intravenous infusion
Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation
and/or therapeutic intervention including imaging supervision, interpretation and
report; initial vessel (List separately in addition to code for primary procedure)
Intravascular ultrasound (coronary vessel or graft) during diagnostic evaluation
and/or therapeutic intervention including imaging supervision, interpretation and
report; each additional vessel (List separately in addition to code for primary
procedure)
Transcatheter placement of an intracoronary stent(s), percutaneous, with or without
other therapeutic intervention, any method; single vessel
Transcatheter placement of an intracoronary stent(s), percutaneous, with or without
other therapeutic intervention, any method; each additional vessel (List separately
in addition to code for primary procedure)
Percutaneous transluminal coronary balloon angioplasty; single vessel
Percutaneous transluminal coronary balloon angioplasty; each additional vessel
(List separately in addition to code for primary procedure)
Percutaneous balloon valvuloplasty; aortic valve
Prq balo vlvp mitral valve
801.14
Percutaneous balloon valvuloplasty; pulmonary valve
Atrial septectomy or septostomy; blade method (Park septostomy) (includes
cardiac catheterization)
2477.70
92975
92977
92978
92979
92980
92981
92982
92984
92986
92987
92990
92993
Extraordinary No.64/2013
293
1488.60
753.30
613.80
378.90
3399.30
1235.70
3095.10
1235.70
3656.70
3403.45
4408.20
Friday, 09 August 2013
93024
Percutaneous transluminal coronary atherectomy, by mechanical or other method,
with or without balloon angioplasty; single vessel
Percutaneous transluminal coronary atherectomy, by mechanical or other method,
with or without balloon angioplasty; each additional vessel (List separately in
addition to code for primary procedure)
Percutaneous transluminal pulmonary artery balloon angioplasty; single vessel
Percutaneous transluminal pulmonary artery balloon angioplasty; each additional
vessel (List separately in addition to code for primary procedure)
Electrocardiogram, routine ECG with at least 12 leads; with interpretation and
report
Electrocardiogram, routine ECG with at least 12 leads; tracing only, without
interpretation and report
Electrocardiogram, routine ECG with at least 12 leads; interpretation and report
only
Cardiovascular stress test using maximal or submaximal treadmill or bicycle
exercise, continuous electrocardiographic monitoring, and/or pharmacological
stress; with physician supervision, with interpretation and report
Cardiovascular stress test using maximal or submaximal treadmill or bicycle
exercise, continuous electrocardiographic monitoring, and/or pharmacological
stress; physician supervision only, without interpretation and report
Cardiovascular stress test using maximal or submaximal treadmill or bicycle
exercise, continuous electrocardiographic monitoring, and/or pharmacological
stress; tracing only, without interpretation and report
Cardiovascular stress test using maximal or submaximal treadmill or bicycle
exercise, continuous electrocardiographic monitoring, and/or pharmacological
stress; interpretation and report only
Ergonovine provocation test
93025
93025
Microvolt t-wave assess ventricular arrhythmias
Microvolt t-wave assess ventricular arrhythmias
626.33
507.27
93025
93040
Microvolt t-wave assess ventricular arrhythmias
Rhythm ECG, one to three leads; with interpretation and report
119.07
49.49
93041
93042
Rhythm ECG, one to three leads; tracing only without interpretation and report
Rhythm ECG, one to three leads; interpretation and report only
Electrocardiographic monitoring for 24 hours by continuous original ECG
waveform recording and storage, with visual superimposition scanning; includes
recording, scanning analysis with report, physician review and interpretation
Electrocardiographic monitoring for 24 hours by continuous original ECG
waveform recording and storage, with visual superimposition scanning; recording
(includes hook-up, recording, and disconnection)
Electrocardiographic monitoring for 24 hours by continuous original ECG
waveform recording and storage, with visual superimposition scanning; scanning
analysis with report
Electrocardiographic monitoring for 24 hours by continuous original ECG
waveform recording and storage, with visual superimposition scanning; physician
review and interpretation
44.10
36.00
92995
92996
92997
92998
93000
93005
93010
93015
93016
93017
93018
93224
93225
93226
93227
Extraordinary No.64/2013
294
3476.70
949.50
2449.80
949.50
71.00
56.70
51.30
338.10
100.80
164.70
170.10
380.70
481.75
162.00
175.50
173.70
Friday, 09 August 2013
93228
71.24
93278
93279
Xtrnl mobile cv telemetry w/phys r&i w/report
Patient demand single or multiple event recording with presymptom memory loop,
per 30 day period of time; includes transmission, physician review and
interpretation
Patient demand single or multiple event recording with presymptom memory loop,
per 30 day period of time; recording (includes hook-up, recording, and
disconnection)
Patient demand single or multiple event recording with presymptom memory loop,
per 30 day period of time; monitoring, receipt of transmissions, and analysis
Patient demand single or multiple event recording with presymptom memory loop,
per 30 day period of time; physician review and interpretation only
Signal-averaged electrocardiography (SAECG), with or without ECG
Program eval implantable in prsn 1 ld pacemaker
93279
93279
Program eval implantable in prsn 1 ld pacemaker
Program eval implantable in prsn 1 ld pacemaker
44.73
82.45
93280
93280
Program eval implantable in persn dual ld pacer
Program eval implantable in persn dual ld pacer
149.93
51.32
93280
93281
Program eval implantable in persn dual ld pacer
Program eval implantable in prsn multi ld pacer
98.60
176.45
93281
93281
Program eval implantable in prsn multi ld pacer
Program eval implantable in prsn multi ld pacer
61.96
114.49
93282
93282
Program eval implantable in persn 1 ld card/dfb
Program eval implantable in persn 1 ld card/dfb
163.00
55.59
93282
93283
Program eval implantable in persn 1 ld card/dfb
Progrm eval implantable in prsn dual l card/dfb
107.41
198.77
93283
93283
Progrm eval implantable in prsn dual l card/dfb
Progrm eval implantable in prsn dual l card/dfb
63.55
135.22
93284
93284
Progrm eval implantable in prsn mlt ld card/dfb
Progrm eval implantable in prsn mlt ld card/dfb
245.58
74.19
93284
93285
Progrm eval implantable in prsn mlt ld card/dfb
Program eval implantable dev in prsn ilr system
171.39
110.64
93285
93285
Program eval implantable dev in prsn ilr system
Program eval implantable dev in prsn ilr system
43.33
67.31
93286
93286
Peri-px eval&program in prsn pacemaker system
Peri-px eval&program in prsn pacemaker system
58.25
26.36
93286
93287
Peri-px eval&program in prsn pacemaker system
Peri-px eval&program cardioverter/defibrillator
31.89
92.64
93287
93287
Peri-px eval&program cardioverter/defibrillator
Peri-px eval&program cardioverter/defibrillator
36.18
56.46
93268
93270
93271
93272
Extraordinary No.64/2013
295
382.17
136.80
215.10
91.80
211.50
127.18
Friday, 09 August 2013
93288
Interrogation eval in person 1/dual/mlt lead pm
98.78
93288
93288
Interrogation eval in person 1/dual/mlt lead pm
Interrogation eval in person 1/dual/mlt lead pm
43.64
55.14
93289
93289
Interrogation eval f2f 1/dual/mlt leads cvdfb
Interrogation eval f2f 1/dual/mlt leads cvdfb
152.54
51.74
93289
93290
Interrogation eval f2f 1/dual/mlt leads cvdfb
Interrogation eval f2f implantable cv mntr sys
100.80
79.59
93290
93290
Interrogation eval f2f implantable cv mntr sys
Interrogation eval f2f implantable cv mntr sys
27.10
52.49
93291
93291
Interrogation evaluation in person ilr system
Interrogation evaluation in person ilr system
94.74
39.06
93291
93292
Interrogation evaluation in person ilr system
Interrogation eval in person wr defibrillator
55.68
96.18
93292
93292
Interrogation eval in person wr defibrillator
Interrogation eval in person wr defibrillator
34.69
61.49
93293
93293
Transtelephonic rhythm strip pacemaker eval
Transtelephonic rhythm strip pacemaker eval
136.76
98.63
93293
93294
Transtelephonic rhythm strip pacemaker eval
Interrogation eval remote </90 d 1/2/mlt lead pm
38.13
94.89
93295
93296
Interrogation eval remote </90 d 1/2/> ld cvdfb
Interrogation remote </90 d technician review
152.27
93.78
93297
93298
Interrogation eval remote </30 d cv mntr sys
Interrogation evaluation remote </30 d ilr sys
56.66
75.22
93303
Transthoracic echocardiography for congenital cardiac anomalies; complete
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or
limited study
Echo tthrc r-t 2d -+m-mode compl spec&color dop
Echo tthrc r-t 2d -+m-mode compl spec&color dop
513.90
Echo tthrc r-t 2d -+m-mode compl spec&color dop
Echocardiography, transthoracic, real-time with image documentation (2D) with or
without M-mode recording; complete
Echocardiography, transthoracic, real-time with image documentation (2D) with or
without M-mode recording; follow-up or limited study
Echocardiography, transesophageal, real time with image documentation (2D)
(with or without M-mode recording); including probe placement, image
acquisition, interpretation and report
Echocardiography, transesophageal, real time with image documentation (2D)
(with or without M-mode recording); placement of transesophageal probe only
Echocardiography, transesophageal, real time with image documentation (2D)
(with or without M-mode recording); image acquisition, interpretation and report
230.29
93304
93306
93306
93306
93307
93308
93312
93313
93314
Extraordinary No.64/2013
296
280.80
851.82
621.52
499.03
252.00
665.35
257.40
424.80
Friday, 09 August 2013
only
93351
Transesophageal echocardiography for congenital cardiac anomalies; including
probe placement, image acquisition, interpretation and report
Transesophageal echocardiography for congenital cardiac anomalies; placement of
transesophageal probe only
Transesophageal echocardiography for congenital cardiac anomalies; image
acquisition, interpretation and report only
Doppler echocardiography, pulsed wave and/or continuous wave with spectral
display (List separately in addition to codes for echocardiographic imaging);
complete
Doppler echocardiography, pulsed wave and/or continuous wave with spectral
display (List separately in addition to codes for echocardiographic imaging);
follow-up or limited study (List separately in addition to codes for
echocardiographic imaging)
Doppler echocardiography color flow velocity mapping (List separately in addition
to codes for echocardiography)
Echocardiography, transthoracic, real-time with image documentation (2D), with
or without M-mode recording, during rest and cardiovascular stress test using
treadmill, bicycle exercise and/or pharmacologically induced stress, with
interpretation and repor
Echo tthrc r-t 2d -+m-mode rest&strs cont ecg
93352
93451
Use of echo contrast agent during stress echo
Right heart cath o2 saturation & cardiac output
113.06
2852.54
93451
93451
Right heart cath o2 saturation & cardiac output
Right heart cath o2 saturation & cardiac output
2310.41
542.12
93452
93452
L hrt cath w/njx l ventriculography img s&i
L hrt cath w/njx l ventriculography img s&i
3168.34
2187.75
93452
93453
L hrt cath w/njx l ventriculography img s&i
R & l hrt cath w/njx l ventriculog img s&i
980.59
4148.15
93453
93453
R & l hrt cath w/njx l ventriculog img s&i
R & l hrt cath w/njx l ventriculog img s&i
2864.24
1283.91
93454
93454
Cath plmt & njx coronary art angio img s&i
Cath plmt & njx coronary art angio img s&i
3175.12
2223.68
93454
93455
Cath plmt & njx coronary art angio img s&i
Cath plmt & njx coronary art/grft angio img s&i
951.44
3801.70
93455
93455
Cath plmt & njx coronary art/grft angio img s&i
Cath plmt & njx coronary art/grft angio img s&i
2663.36
1138.35
93456
93456
Cath plmt r hrt & arts w/njx & angio img s&i
Cath plmt r hrt & arts w/njx & angio img s&i
4095.86
2828.37
93456
93457
Cath plmt r hrt & arts w/njx & angio img s&i
Cath plmt r hrt/arts/grfts w/njx&angio img s&i
1267.49
4567.94
93315
93316
93317
93320
93321
93325
93350
Extraordinary No.64/2013
297
663.30
135.90
526.50
307.08
187.20
247.27
853.56
817.51
Friday, 09 August 2013
93457
Cath plmt r hrt/arts/grfts w/njx&angio img s&i
3198.04
93457
93458
Cath plmt r hrt/arts/grfts w/njx&angio img s&i
Cath plmt l hrt & arts w/njx & angio img s&i
1369.90
3926.59
93458
93458
Cath plmt l hrt & arts w/njx & angio img s&i
Cath plmt l hrt & arts w/njx & angio img s&i
2749.06
1177.53
93459
93459
Cath plmt l hrt/arts/grfts wnjx & angio img s&i
Cath plmt l hrt/arts/grfts wnjx & angio img s&i
4355.53
3007.00
93459
93460
Cath plmt l hrt/arts/grfts wnjx & angio img s&i
R & l hrt cath winjx hrt art& l ventr img s&i
1348.53
4666.19
93460
93460
R & l hrt cath winjx hrt art& l ventr img s&i
R & l hrt cath winjx hrt art& l ventr img s&i
3174.18
1492.01
93461
93461
R&l hrt cath w/injec hrt art/grft&l vent img s&i
R&l hrt cath w/injec hrt art/grft&l vent img s&i
5335.97
3683.58
93461
93462
R&l hrt cath w/injec hrt art/grft&l vent img s&i
Left heart cath by transeptal puncture
1652.40
756.48
93463
93464
Medication admin & hemodynamic measurment
Physiologic exercise study & hemodynamic measure
398.95
938.52
93464
93464
582.53
356.00
93505
Physiologic exercise study & hemodynamic measure
Physiologic exercise study & hemodynamic measure
Insertion and placement of flow directed catheter (eg, Swan-Ganz) for monitoring
purposes
Endomyocardial biopsy
93563
93564
Njx sel hrt art congenital hrt cath w/s&i
Njx sel hrt art/grft congenital hrt cath w/s&i
206.77
207.05
93565
160.18
93580
Njx sel l vent/atrial angio hrt cath w/s&i
Intravascular doppler velocity and/or pressure derived coronary flow reserve
measurement (coronary vessel or graft) during coronary angiography including
pharmacologically induced stress; initial vessel (List separately in addition to code
for primary pro
Intravascular doppler velocity and/or pressure derived coronary flow reserve
measurement (coronary vessel or graft) during coronary angiography including
pharmacologically induced stress; each additional vessel (List separately in
addition to code for pri
Prq tcat clsr cgen intratrl comunicaj w/implt
93581
93600
Prq tcat clsr cgen ventr septal dfct w/implt
Bundle of His recording
13877.29
772.20
93602
93603
Intra-atrial recording
Right ventricular recording
510.30
605.70
93609
Intraventricular and/or intra-atrial mapping of tachycardia site(s) with catheter
1494.00
93503
93571
93572
Extraordinary No.64/2013
298
725.40
1007.10
693.90
637.20
10167.89
Friday, 09 August 2013
manipulation to record from multiple sites to identify origin of tachycardia
93610
93612
Intra-atrial pacing
Intraventricular pacing
592.20
568.80
93613
Icar ephys 3-dimensional mapg
Esophageal recording of atrial electrogram with or without ventricular
electrogram(s);
Esophageal recording of atrial electrogram with or without ventricular
electrogram(s); with pacing
Induction of arrhythmia by electrical pacing
Comprehensive electrophysiologic evaluation with right atrial pacing and
recording, right ventricular pacing and recording, His bundle recording, including
insertion and repositioning of multiple electrode catheters; without induction or
attempted inducti
Comprehensive electrophysiologic evaluation with right atrial pacing and
recording, right ventricular pacing and recording, His bundle recording, including
insertion and repositioning of multiple electrode catheters; with induction or
attempted induction
Comprehensive electrophysiologic evaluation with right atrial pacing and
recording, right ventricular pacing and recording, His bundle recording, including
insertion and repositioning of multiple electrode catheters; with left atrial
recordings from coron
Programmed stimulation and pacing after intravenous drug infusion (List
separately in addition to code for primary procedure)
Electrophysiologic follow-up study with pacing and recording to test effectiveness
of therapy, including induction or attempted induction of arrhythmia
Intra-operative epicardial and endocardial pacing and mapping to localize the site
of tachycardia or zone of slow conduction for surgical correction
Electrophysiologic evaluation of single or dual chamber pacing cardioverterdefibrillator leads including defibrillation threshold evaluation (induction of
arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of
initial implant
Electrophysiologic evaluation of single or dual chamber pacing cardioverterdefibrillator leads including defibrillation threshold evaluation (induction of
arrhythmia, evaluation of sensing and pacing for arrhythmia termination) at time of
initial implant
Ephys eval pacg cvdfb prgrmg/reprgrmg parameters
1153.65
Ephys eval pacg cvdfb prgrmg/reprgrmg parameters
Ephys eval pacg cvdfb prgrmg/reprgrmg parameters
Intracardiac catheter ablation of atrioventricular node function, atrioventricular
conduction for creation of complete heart block, with or without temporary
pacemaker placement
Intracardiac catheter ablation of arrhythmogenic focus; for treatment of
supraventricular tachycardia by ablation of fast or slow atrioventricular pathways,
accessory atrioventricular connections or other atrial foci, singly or in combination
Intracardiac catheter ablation of arrhythmogenic focus; for treatment of ventricular
856.44
841.38
93615
93616
93618
93619
93620
93621
93623
93624
93631
93640
93641
93642
93642
93642
93650
93651
93652
Extraordinary No.64/2013
299
134.10
358.20
1287.90
2567.70
3511.80
3800.70
625.50
1545.30
2189.70
1735.20
1702.80
1697.82
3193.20
3605.40
3685.50
Friday, 09 August 2013
tachycardia
93668
Evaluation of cardiovascular function with tilt table evaluation, with continuous
ECG monitoring and intermittent blood pressure monitoring, with or without
pharmacological intervention
Prph artl disease rhab pr sess
93701
93720
Biompedance-derived physiologic cv analysis
Plethysmograpy tot bdy w/i&r
86.57
103.13
93721
93722
Plethysmograpy tot bdy trcg only w/o i&r
Plethysmograpy tot bdy i&r only
73.01
33.79
93724
93724
Elec alys antitachycardia pm system
Elec alys antitachycardia pm system
715.67
140.53
93724
93740
Elec alys antitachycardia pm system
Temperature gradient studies
575.15
108.00
93770
Determination of venous pressure
Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape
and/or computer disk, for 24 hours or longer; including recording, scanning
analysis, interpretation and report
Ambl bld press w/tape&/disk 24+ hr + rec only
30.60
137.83
65.76
93880
93882
Ambl bld press w/tape/disk 24+ hr alys w/reprt
Ambl bld press tape&/disk 24+ hr phys rev w/i&r
Physician services for outpatient cardiac rehabilitation; without continuous ECG
monitoring (per session)
Outpatient cardiac rehab w/cont ecg monitoring
Non-invasive physiologic studies of extracranial arteries, complete bilateral study
(eg, periorbital flow direction with arterial compression, ocular
pneumoplethysmography, Doppler ultrasound spectral analysis)
Duplex scan of extracranial arteries; complete bilateral study
Duplex scan of extracranial arteries; unilateral or limited study
93886
93888
Transcranial Doppler study of the intracranial arteries; complete study
Transcranial Doppler study of the intracranial arteries; limited study
461.70
339.30
93890
93890
Tcd std icra art vasoreactv std
Tcd std icra art vasoreactv std
545.02
423.82
93890
93892
Tcd std icra art vasoreactv std
Tcd std icra art emboli detcj w/o iv mbubb njx
121.20
581.23
93892
93892
Tcd std icra art emboli detcj w/o iv mbubb njx
Tcd std icra art emboli detcj w/o iv mbubb njx
442.64
138.59
93893
93893
Tcd std icra art emboli detcj w/iv mbubb njx
Tcd std icra art emboli detcj w/iv mbubb njx
575.75
439.36
93893
Tcd std icra art emboli detcj w/iv mbubb njx
136.38
93660
93784
93786
93788
93790
93797
93798
93875
Extraordinary No.64/2013
300
639.00
142.65
369.90
65.66
46.80
68.76
297.90
431.58
407.70
Friday, 09 August 2013
93922
93923
93924
93925
93926
93930
93931
93965
93970
93971
93975
93976
93978
93979
93980
93981
93982
93990
94002
94003
94004
94005
94010
94011
Non-invasive physiologic studies of upper or lower extremity arteries, single level,
bilateral (eg, ankle/brachial indices, Doppler waveform analysis, volume
plethysmography, transcutaneous oxygen tension measurement)
Non-invasive physiologic studies of upper or lower extremity arteries, multiple
levels or with provocative functional maneuvers, complete bilateral study (eg,
segmental blood pressure measurements, segmental Doppler waveform analysis,
segmental volume ple
Non-invasive physiologic studies of lower extremity arteries, at rest and following
treadmill stress testing, complete bilateral study
Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral
study
Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or
limited study
Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral
study
Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or
limited study
Non-invasive physiologic studies of extremity veins, complete bilateral study (eg,
Doppler waveform analysis with responses to compression and other maneuvers,
phleborheography, impedance plethysmography)
Duplex scan of extremity veins including responses to compression and other
maneuvers; complete bilateral study
Duplex scan of extremity veins including responses to compression and other
maneuvers; unilateral or limited study
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal
contents and/or retroperitoneal organs; complete study
Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal
contents and/or retroperitoneal organs; limited study
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts;
complete study
Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts;
unilateral or limited study
Duplex scan of arterial inflow and venous outflow of penile vessels; complete
study
Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or
limited study
Implant wireless press sensor study aneurysm sac
Duplex scan of hemodialysis access (including arterial inflow, body of access and
venous outflow)
Ventilation assist & mgmt inpatient 1st day
Ventilation assist & mgmt inpatient ea sbsq day
Ventilation assist & mgmt nursing fac pr day
Home ventilator mgmt care oversight 30 min/>
Spirometry, including graphic record, total and timed vital capacity, expiratory
flow rate measurement(s), with or without maximal voluntary ventilation
Meas spiromtrc forcd expiratory flo infant-2 yr
Extraordinary No.64/2013
301
228.60
364.50
369.00
398.17
245.96
432.90
270.90
243.31
382.93
237.86
387.90
422.10
364.50
268.20
514.80
360.90
101.76
297.00
218.34
157.25
114.51
203.72
92.70
216.23
Friday, 09 August 2013
94012
Meas spiro forcd exp flo pre&post bronch inf-2y
352.90
94013
Meas lung volumes infant or child thru 2 yrs
Patient-initiated spirometric recording per 30-day period of time; includes
reinforced education, transmission of spirometric tracing, data capture, analysis of
transmitted data, periodic recalibration and physician review and interpretation
Patient-initiated spirometric recording
Patient-initiated spirometric recording per 30-day period of time; physician review
and interpretation only
Bronchospasm evaluation: spirometry as in 94010, before and after bronchodilator
(aerosol or parenteral)
Prolonged postexposure evaluation of bronchospasm with multiple spirometric
determinations after antigen, cold air, methacholine or other chemical agent, with
subsequent spirometrics
Vital capacity, total (separate procedure)
Maximum breathing capacity, maximal voluntary ventilation
Functional residual capacity or residual volume: helium method, nitrogen open
circuit method, or other method
Expired gas collection, quantitative, single procedure (separate procedure)
76.21
98.10
94360
94370
Thoracic gas volume
Determination of maldistribution of inspired gas: multiple breath nitrogen washout
curve including alveolar nitrogen or helium equilibration time
Determination of resistance to airflow, oscillatory or plethysmographic methods
Determination of airway closing volume, single breath tests
94375
94400
Respiratory flow volume loop
Breathing response to CO2 (CO2 response curve)
99.00
134.10
94450
94452
Breathing response to hypoxia (hypoxia response curve)
Hast w/phys i&r
95.40
124.52
94452
94452
Hast w/phys i&r
Hast w/phys i&r
87.06
37.46
94453
94453
Hast w/phys i&r w/suppl o2 titrj
Hast w/phys i&r w/suppl o2 titrj
177.79
129.13
94453
94610
Hast w/phys i&r w/suppl o2 titrj
Intrapulmonary surfactant administration
Pulmonary stress testing; simple (eg, prolonged exercise test for bronchospasm
with pre- and post-spirometry)
Pulmonary stress testing; complex (including measurements of CO2 production,
O2 uptake, and electrocardiographic recordings)
Nonpressurized inhalation treatment for acute airway obstruction
Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment
or prophylaxis
Continuous inhalation treatment 1st hr
48.67
157.18
94014
94015
94016
94060
94070
94150
94200
94240
94250
94260
94350
94620
94621
94640
94642
94644
Extraordinary No.64/2013
302
91.80
54.46
58.50
128.70
212.40
40.50
56.70
99.00
33.30
84.60
82.80
66.60
254.70
212.40
41.40
47.70
85.99
Friday, 09 August 2013
94645
32.68
94690
94720
Continuous inhalation treatment ea addl hr
Continuous positive airway pressure ventilation (CPAP), initiation and
management
Continuous negative pressure ventilation (CNP), initiation and management
Aerosol or vapor inhalations for sputum mobilization, bronchodilation, or sputum
induction for diagnostic purposes; initial demonstration and/or evaluation
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate
lung function; initial demonstration and/or evaluation
Manipulation chest wall, such as cupping, percussing, and vibration to facilitate
lung function; subsequent
Oxygen uptake, expired gas analysis; rest and exercise, direct, simple
Oxygen uptake, expired gas analysis; including CO2 output, percentage oxygen
extracted
Oxygen uptake, expired gas analysis; rest, indirect (separate procedure)
Carbon monoxide diffusing capacity, any method
94725
94750
Membrane diffusion capacity
Pulmonary compliance study, any method
162.90
98.10
94760
34.98
95044
Noninvasive ear or pulse oximetry for oxygen saturation; single determination
Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations
(eg, during exercise)
Noninvasive ear or pulse oximetry for oxygen saturation; by continuous overnight
monitoring (separate procedure)
Carbon dioxide, expired gas determination by infrared analyzer
Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate
type reaction, specify number of tests
Percutaneous tests (scratch, puncture, prick) sequential and incremental, with
drugs, biologicals or venoms, immediate type reaction, specify number of tests
Nitric oxide expired gas determination
Intracutaneous (intradermal) tests, sequential and incremental, with drugs,
biologicals, or venoms, immediate type reaction, specify number of tests
Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction,
specify number of tests
Skin end point titration
Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction,
including reading, specify number of tests
Patch or application test(s) (specify number of tests)
95052
95056
Photo patch test(s) (specify number of tests)
Photo tests
13.50
12.60
95060
95065
Ophthalmic mucous membrane tests
Direct nasal mucous membrane test
Inhalation bronchial challenge testing (not including necessary pulmonary function
tests); with histamine, methacholine, or similar compounds
23.40
20.70
94660
94662
94664
94667
94668
94680
94681
94761
94762
94770
95004
95010
95012
95015
95024
95027
95028
95070
Extraordinary No.64/2013
303
180.90
118.80
49.61
63.00
54.90
140.40
169.20
56.70
106.20
72.00
106.20
62.10
7.55
27.00
56.16
27.90
14.40
12.83
20.70
19.08
175.50
Friday, 09 August 2013
95180
Inhalation bronchial challenge testing (not including necessary pulmonary function
tests); with antigens or gases, specify
Ingestion challenge test (sequential and incremental ingestion of test items, eg,
food, drug or other substance such as metabisulfite)
Professional services for allergen immunotherapy not including provision of
allergenic extracts; single injection
Professional services for allergen immunotherapy not including provision of
allergenic extracts; two or more injections
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; single injection
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; two or more injections
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; single stinging insect
venom
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; two stinging insect venoms
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; three stinging insect
venoms
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; four stinging insect venoms
Professional services for allergen immunotherapy in prescribing physicians office
or institution, including provision of allergenic extract; five stinging insect venoms
Professional services for the supervision and provision of antigens for allergen
immunotherapy, single or multiple antigens, single dose vials (specify number of
vials)
Professional services for the supervision and provision of antigens for allergen
immunotherapy (specify number of doses); single stinging insect venom
Professional services for the supervision and provision of antigens for allergen
immunotherapy (specify number of doses); two single stinging insect venoms
Professional services for the supervision and provision of antigens for allergen
immunotherapy (specify number of doses); three single stinging insect venoms
Professional services for the supervision and provision of antigens for allergen
immunotherapy (specify number of doses); four single stinging insect venoms
Professional services for the supervision and provision of antigens for allergen
immunotherapy (specify number of doses); five single stinging insect venoms
Professional services for the supervision and provision of antigens for allergen
immunotherapy; single or multiple antigens (specify number of doses)
Professional services for the supervision and provision of antigens for allergen
immunotherapy; whole body extract of biting insect or other arthropod (specify
number of doses)
Rapid desensitization procedure, each hour (eg, insulin, penicillin, horse serum)
95250
95251
Gluc mntr cont rec from interstitial tiss fluid
Gluc mntr cont rec from ntrstl tiss flu i&r
265.16
62.92
95800
Slp stdy unatnd w/hrt rate/o2 sat/resp/slp time
3262.03
95071
95075
95115
95117
95120
95125
95130
95131
95132
95133
95134
95144
95145
95146
95147
95148
95149
95165
95170
Extraordinary No.64/2013
304
204.30
198.90
17.96
23.11
26.10
28.80
34.20
47.70
62.10
63.90
65.70
33.49
36.00
46.80
64.80
65.70
81.00
15.30
33.30
207.00
Friday, 09 August 2013
95800
Slp stdy unatnd w/hrt rate/o2 sat/resp/slp time
3119.72
95800
95801
Slp stdy unatnd w/hrt rate/o2 sat/resp/slp time
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal
142.31
5454.71
95801
95801
5333.99
120.72
95811
95811
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal
Slp stdy unatnd w/min hrt rate/o2 sat/resp anal
Multiple sleep latency or maintenance of wakefulness testing, recording, analysis
and interpretation of physiological measurements of sleep during multiple trials to
assess sleepiness
Sleep std airflow hrt rate&o2 sat effort unattn
Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart
rate, and oxygen saturation, attended by a technologist
Polysomnography; sleep staging with 1-3 additional parameters of sleep, attended
by a technologist
Polysomnography; sleep staging with 4 or more additional parameters of sleep,
attended by a technologist
Polysm sleep staging 4/> addl param w/cpap tx
Polysm sleep staging 4/> addl param w/cpap tx
95811
95812
Polysm sleep staging 4/> addl param w/cpap tx
Eeg extnd mntr 41-60 min
455.02
619.00
95812
95812
Eeg extnd mntr 41-60 min
Eeg extnd mntr 41-60 min
444.52
174.48
95813
95813
Eeg extnd mntr > 1 hr
Eeg extnd mntr > 1 hr
649.47
427.50
95813
Eeg extnd mntr > 1 hr
Electroencephalogram (EEG) including recording awake and drowsy (including
hyperventilation and/or photic stimulation when appropriate)
Electroencephalogram (EEG) including recording awake and asleep (including
hyperventilation and/or photic stimulation when appropriate)
Electroencephalogram (EEG); sleep only
Electroencephalogram (EEG); cerebral death evaluation only
221.97
Electroencephalogram (EEG); all night sleep only
Electrocorticogram at surgery (separate procedure)
Insertion by physician of sphenoidal electrodes for electroencephalographic (EEG)
recording
Muscle testing, manual (separate procedure) with report; extremity (excluding
hand) or trunk
Muscle testing, manual (separate procedure) with report; hand, with or without
comparison with normal side
Muscle testing, manual (separate procedure) with report; total evaluation of body,
excluding hands
Muscle testing, manual (separate procedure) with report; total evaluation of body,
including hands
343.80
533.70
95805
95806
95807
95808
95810
95816
95819
95822
95824
95827
95829
95830
95831
95832
95833
95834
Extraordinary No.64/2013
305
566.10
213.46
713.70
756.90
747.00
2117.10
1662.09
266.90
215.10
270.90
177.30
241.20
105.30
72.90
113.40
139.50
Friday, 09 August 2013
95851
95852
95857
95860
95861
Range of motion measurements and report (separate procedure); each extremity
(excluding hand) or each trunk section (spine)
Range of motion measurements and report (separate procedure); hand, with or
without comparison with normal side
Tensilon test for myasthenia gravis;
87.30
72.00
122.40
216.72
282.23
95864
95865
Needle electromyography, one extremity with or without related paraspinal areas
Needle electromyography, two extremities with or without related paraspinal areas
Needle electromyography, three extremities with or without related paraspinal
areas
Needle electromyography, four extremities with or without related paraspinal areas
Ndl emg larx
95865
95865
Ndl emg larx
Ndl emg larx
64.22
201.02
95866
95866
Ndl emg hemidphrm
Ndl emg hemidphrm
181.64
27.47
95866
95867
Ndl emg hemidphrm
Needle electromyography, cranial nerve supplied muscles, unilateral
154.18
211.50
95868
95869
Needle electromyography, cranial nerve supplied muscles, bilateral
Needle electromyography; thoracic paraspinal muscles
257.40
162.34
95870
95870
Ndl emg lmtd std musc 1 xtr/non-limb uni/bi
Ndl emg lmtd std musc 1 xtr/non-limb uni/bi
99.09
34.50
95870
64.59
95873
95873
Ndl emg lmtd std musc 1 xtr/non-limb uni/bi
Needle electromyography using single fiber electrode, with quantitative
measurement of jitter, blocking and/or fiber density, any/all sites of each muscle
studied
Estim gdn conjunct chemodnrvtj
Estim gdn conjunct chemodnrvtj
95873
95874
Estim gdn conjunct chemodnrvtj
Ndl emg gdn conjunct chemodnrvtj
55.40
86.55
95874
95874
Ndl emg gdn conjunct chemodnrvtj
Ndl emg gdn conjunct chemodnrvtj
Ischemic limb exercise with needle electromyography, with lactic acid
determination
Nerve conduction, amplitude and latency/velocity study, each nerve; motor,
without F-wave study
Nerve conduction, amplitude and latency/velocity study, each nerve; motor, with
F-wave study
Nerve conduction, amplitude and latency/velocity study, each nerve; sensory or
mixed
Motor &/sens nrv cndj preconf eltrd array limb
Motor &/sens nrv cndj preconf eltrd array limb
29.75
56.80
95863
95872
95875
95900
95903
95904
95905
95905
Extraordinary No.64/2013
306
473.40
618.30
265.24
257.40
86.04
30.64
144.00
125.91
166.50
142.56
197.22
189.44
Friday, 09 August 2013
95905
7.78
95928
95928
Motor &/sens nrv cndj preconf eltrd array limb
Intraoperative neurophysiology testing, per hour (List separately in addition to
code for primary procedure)
Testing of autonomic nervous system function; cardiovagal innervation
(parasympathetic function), including two or more of the following: heart rate
response to deep breathing with recorded R-R interval, Valsalva ratio, and 30:15
ratio
Testing of autonomic nervous system function; vasomotor adrenergic innervation
(sympathetic adrenergic function), including beat-to-beat blood pressure and R-R
interval changes during Valsalva maneuver and at least five minutes of passive tilt
Testing of autonomic nervous system function; sudomotor, including one or more
of the following: quantitative sudomotor axon reflex test (QSART), silastic sweat
imprint, thermoregulatory sweat test, and changes in sympathetic skin potential
Short-latency somatosensory evoked potential study, stimulation of any/all
peripheral nerves or skin sites, recording from the central nervous system; in upper
limbs
Short-latency somatosensory evoked potential study, stimulation of any/all
peripheral nerves or skin sites, recording from the central nervous system; in lower
limbs
Short-latency somatosensory evoked potential study, stimulation of any/all
peripheral nerves or skin sites, recording from the central nervous system; in the
trunk or head
Ctr motor ep std transcrnl motor stimj upr limbs
Ctr motor ep std transcrnl motor stimj upr limbs
95928
95929
Ctr motor ep std transcrnl motor stimj upr limbs
Ctr motor ep std transcrnl motor stimj lwr limbs
285.32
633.74
95929
95929
Ctr motor ep std transcrnl motor stimj lwr limbs
Ctr motor ep std transcrnl motor stimj lwr limbs
Visual evoked potential (VEP) testing central nervous system, checkerboard or
flash
Orbicularis oculi (blink) reflex, by electrodiagnostic testing
352.77
280.97
H-reflex, amplitude and latency study; record gastrocnemius/soleus muscle
H-reflex, amplitude and latency study; record muscle other than
gastrocnemius/soleus muscle
Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve,
any one method
Monitoring for identification and lateralization of cerebral seizure focus,
electroencephalographic (eg, 8 channel EEG) recording and interpretation, each 24
hours
Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more
channel telemetry, combined electroencephalographic (EEG) and video recording
and interpretation (eg, for presurgical localization), each 24 hours
Monitoring for localization of cerebral seizure focus by computerized portable 16
or more channel EEG, electroencephalographic (EEG) recording and
interpretation, each 24 hours
127.94
95920
95921
95922
95923
95925
95926
95927
95930
95933
95934
95936
95937
95950
95951
95953
Extraordinary No.64/2013
307
414.90
104.40
108.90
100.80
369.00
298.80
298.80
615.63
330.30
339.30
175.50
134.10
180.00
655.20
906.30
763.20
Friday, 09 August 2013
95954
95955
95956
95957
95957
95957
Pharmacological or physical activation requiring physician attendance during EEG
recording of activation phase (eg, thiopental activation test)
Electroencephalogram (EEG) during nonintracranial surgery (eg, carotid surgery)
Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more
channel telemetry, electroencephalographic (EEG) recording and interpretation,
each 24 hours
Dgtal alys eeg
355.50
340.20
779.40
315.45
148.91
166.54
95978
Dgtal alys eeg
Dgtal alys eeg
Wada activation test for hemispheric function, including electroencephalographic
(EEG) monitoring
Functional cortical and subcortical mapping by stimulation and/or recording of
electrodes on brain surface, or of depth electrodes, to provoke seizures or identify
vital brain structures; initial hour of physician attendance
Functional cortical and subcortical mapping by stimulation and/or recording of
electrodes on brain surface, or of depth electrodes, to provoke seizures or identify
vital brain structures; each additional hour of physician attendance (List separately
in ad
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Electronic analysis of implanted neurostimulator pulse generator system (eg, rate,
pulse amplitude and duration, configuration of wave form, battery status, electrode
selectability, output modulation, cycling, impedance and patient compliance
measurements
Elec alys nstim pls gen cplx dp brn 1st hr
95979
95980
Elec alys nstim pls gen cplx dp brn ea 30 min
Elec alys nstim pls gen gastric intraop w/prgrmg
253.83
114.21
95958
95961
95962
95970
95971
95972
95973
95974
95975
Extraordinary No.64/2013
308
654.30
429.30
448.20
47.70
78.30
143.10
90.90
292.50
173.70
527.16
Friday, 09 August 2013
95990
Refill&maintenance pump drug dlvr spinal/brain
122.42
95991
96101
Rfl&main implt pmp/rsvr rx dlvr spi/brn by phys
Psychological testing pr hr f2f time w/pt
135.39
191.25
96102
96103
Psycl tstg pr hr admn by tech pr hr
Psycl tstg pr hr admn by cptr w/prof i&r
93.33
87.96
96105
96110
Assmt aphasia w/i&r pr hr
Developmental tstg lmtd w/i&r
170.98
41.77
96111
96116
Developmental tstg extnd w/i&r
Nubhvl status xm pr hr f2f w/pt interpj&prepj
175.28
226.49
96118
96119
Nuropsyc testing pr hr f2f w/pt + interpj time
Nuropsyc tstg wprof i&r admn by tech pr hr
234.56
156.24
96120
96125
Nuropsyc tstg admn by cptr w/prof i&r
Standardized cognitive performance testing
115.84
208.77
96150
96151
Hlth&behavior assmt ea 15 min f2f w/pt 1st assmt
Hlth&behavior assmt ea 15 min f2f w/pt re-assmt
51.14
27.87
96152
96153
Hlth&behavior ivntj ea 15 min f2f indiv
Hlth&behavior ivntj ea 15 min f2f grp 2/> pts
27.63
34.17
96154
96155
Hlth&behavior ivntj ea 15 min f2f fam w/pt
Hlth&behavior ivntj ea 15 min f2f fam w/o pt
37.46
38.51
96360
96361
Iv infusion hydration initial 31 min-1 hour
Iv infusion hydration each additional hour
115.16
46.20
96365
96366
Iv infusion therapy/prophylaxis /dx 1st to 1 hr
Iv infusion therapy prophylaxis/dx ea hour
132.82
58.35
96367
96368
Iv infusion ther proph addl sequential to 1 hr
Iv nfs therapy prophylaxis/dx concurrent nfs
84.16
48.93
96369
96370
Subcutaneous infusion initial 1 hr w/pump set-up
Subcutaneous infusion each additional hour
299.67
33.76
96371
96372
Subq infusion additional pump infusion site
Therapeutic prophylactic/dx injection subq/im
126.53
34.73
96373
96374
Therapeutic prophylactic/dx njx intra-arterial
Ther proph/dx njx iv push single/1st sbst/drug
31.87
97.45
96375
96401
Therapeutic injection iv push each new drug
Chemotx admn subq/im non-hormonal anti-neo
56.42
153.81
96402
96405
Chemotx admn subq/im hormonal anti-neo
Chemotherapy administration, intralesional; up to and including 7 lesions
82.57
93.60
96406
96409
Chemotherapy administration, intralesional; more than 7 lesions
Chemotx admn iv push tq 1/1st sbst/drug
126.00
278.82
Extraordinary No.64/2013
309
Friday, 09 August 2013
96411
Chemotx admn iv push tq ea sbst/drug
159.52
96413
96415
Chemotx admn iv nfs tq up 1 hr 1/1st sbst/drug
Chemotherapy admn iv infusion tq ea hr
398.03
89.79
96416
96417
Chemotx admn tq init prolng chemotx nfus pmp
Chemotx admn iv nfs tq ea seql nfs to 1 hr
426.61
190.54
96420
96422
Chemotherapy administration, intra-arterial; push technique
Chemotherapy administration, intra-arterial; infusion technique, up to one hour
Chemotherapy administration, intra-arterial; infusion technique, one to 8 hours,
each additional hour (List separately in addition to code for primary procedure)
Chemotherapy administration, intra-arterial; infusion technique, initiation of
prolonged infusion (more than 8 hours), requiring the use of a portable or
implantable pump
Chemotherapy administration into pleural cavity, requiring and including
thoracentesis
Chemotherapy administration, into CNS (eg, intrathecal), requiring and including
lumbar puncture
Rfl/main portable pmp
146.70
159.30
Refill&maintenance pump drug dlvr systemic
Irrigation implanted vad for drug dlvr
Chemotherapy injection, subarachnoid or intraventricular via subcutaneous
reservoir, single or multiple agents
Pdt xtrnl appl light dstr les skn by activj rx
Pdt ndsc abl abnor tiss via activj rx 30 min
255.97
79.65
163.85
34.20
96920
96921
Pdt ndsc abl abnor tiss via activj rx a 15 min
Actinotherapy (ultraviolet light)
Microscopic examination of hairs plucked or clipped by the examiner (excluding
hair collected by the patient) to determine telogen and anagen counts, or structural
hair shaft abnormality
Whole body integumentary photography
Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum
and ultraviolet B
Photochemotherapy; psoralens and ultraviolet A (PUVA)
Photochemotherapy (Goeckerman and/or PUVA) for severe photoresponsive
dermatoses requiring at least four to eight hours of care under direct supervision of
the physician (includes application of medication and dressings)
Laser skin disease psoriasis tot area <250 sq cm
Laser skin disease psoriasis 250-500 sq cm
96922
97001
Laser skin disease psoriasis >500 sq cm
Physical therapy evaluation
620.53
88.97
97002
97003
Physical therapy re-evaluation
Occupational therapy evaluation
43.47
73.80
96423
96425
96440
96450
96521
96522
96523
96542
96567
96570
96571
96900
96902
96904
96910
96912
96913
Extraordinary No.64/2013
310
63.90
108.00
268.20
228.60
338.81
195.30
663.01
329.38
55.80
200.24
45.00
51.30
195.30
398.75
408.97
Friday, 09 August 2013
97004
Occupational therapy re-evaluation
36.00
97010
97012
Application of a modality to one or more areas; hot or cold packs
Application of a modality to one or more areas; traction, mechanical
32.94
39.16
97014
97016
Application of a modality to one or more areas; electrical stimulation (unattended)
Application of a modality to one or more areas; vasopneumatic devices
35.31
58.50
97018
97022
Application of a modality to one or more areas; paraffin bath
Application of a modality to one or more areas; whirlpool
43.20
41.40
97024
97026
Application of a modality to one or more areas; diathermy
Application of a modality to one or more areas; infrared
37.81
22.50
97028
Application of a modality to one or more areas; ultraviolet
Application of a modality to one or more areas; electrical stimulation (manual),
each 15 minutes
Application of a modality to one or more areas; iontophoresis, each 15 minutes
Application of a modality to one or more areas; contrast baths, each 15 minutes
33.30
Application of a modality to one or more areas; ultrasound, each 15 minutes
Application of a modality to one or more areas; Hubbard tank, each 15 minutes
Therapeutic procedure, one or more areas, each 15 minutes; therapeutic exercises
to develop strength and endurance, range of motion and flexibility
Therapeutic procedure, one or more areas, each 15 minutes; neuromuscular
reeducation of movement, balance, coordination, kinesthetic sense, posture, and
proprioception
Therapeutic procedure, one or more areas, each 15 minutes; aquatic therapy with
therapeutic exercises
Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes
stair climbing)
Therapeutic procedure, one or more areas, each 15 minutes; massage, including
effleurage, petrissage and/or tapotement (stroking, compression, percussion)
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic
drainage, manual traction), one or more regions, each 15 minutes
Ther px grp 2/> indivs
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
Development of cognitive skills ea 15 min
37.77
47.70
Sensory integrative tqs ea 15 min
Self care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use
of adaptive equipment) direct one-on-one contact by provider, each 15 minutes
Community/work reintegration trainj ea 15 min
Wheelchair mgmt ea 15 min
38.27
Work hardening/conditioning; initial 2 hours
Work hardening/conditioning; each additional hour (List separately in addition to
code for primary procedure)
190.80
97032
97033
97034
97035
97036
97110
97112
97113
97116
97124
97140
97150
97530
97532
97533
97535
97537
97542
97545
97546
Extraordinary No.64/2013
311
44.42
54.90
33.30
46.60
43.21
52.59
43.91
41.79
48.65
27.21
56.70
36.03
56.70
39.24
29.60
99.90
Friday, 09 August 2013
97597
Debridement open wound 20 sq cm<
104.34
97598
97605
Debridement open wound addl 20 sq cm
Neg press wnd ther </equal 50 sq cm
114.89
68.79
97606
112.59
97755
97760
Neg press wnd ther > 50 sq cm
Physical performance test or measurement (eg, musculoskeletal, functional
capacity), with written report, each 15 minutes
Asstv techn assmt dir cntct w/reprt 15 min
Orthotic mgmt&trainj uxtr lxtr&/trnk ea 15 min
97761
97762
Prostc trainj upr&/lxtr ea 15 min
Checkout orthotic/prosthetic use
57.46
57.79
97802
97803
Med nutr ther 1st assmt&ivntj indiv ea 15 min
Med nutr ther re-assmt&ivntj indiv ea 15 min
32.69
31.73
97804
97810
Med nutr ther grp2/> indiv ea 30 min
Acup 1/> ndls w/o elec stimj 1st 15 min
12.42
60.96
97811
97813
Acup 1/> ndls w/o elec stimj ea 15 min
Acup 1/> ndls w/elec stimj 1st 15 min
51.38
66.59
97814
98925
Acup 1/> ndls w/elec stimj ea 15 min w/re-insj
Osteopathic manipulative treatment (OMT); one to two body regions involved
57.30
53.46
98926
98927
Osteopathic manipulative treatment (OMT); three to four body regions involved
Osteopathic manipulative treatment (OMT); five to six body regions involved
83.70
100.80
98928
98929
Osteopathic manipulative treatment (OMT); seven to eight body regions involved
Osteopathic manipulative treatment (OMT); nine to ten body regions involved
115.20
135.00
98940
98941
Chiropractic manipulative treatment (CMT); spinal, one to two regions
Chiropractic manipulative treatment (CMT); spinal, three to four regions
48.32
63.55
98942
98943
Chiropractic manipulative treatment (CMT); spinal, five regions
Chiropractic manipulative treatment (CMT); extraspinal, one or more regions
91.80
49.50
98960
98961
Education&training self-mgmt nonphys 1 pt
Education&training self-mgmt nonphys 2-4 pts
63.65
49.81
98962
Education&training self-mgmt nonphys 5-8 pts
Handling and/or conveyance of specimen for transfer from the physician's office to
a laboratory
Handling and/or conveyance of specimen for transfer from the patient in other than
a physician's office to a laboratory (distance may be indicated)
Handling, conveyance, and/or any other service in connection with the
implementation of an order involving devices (eg, designing, fitting, packaging,
handling, delivery or mailing) when devices such as orthotics, protectives,
prosthetics are fabricated b
Services requested after office hours in addition to basic service
Services provided at request of patient in a location other than physician's office
36.96
97750
99000
99001
99002
99050
99056
Extraordinary No.64/2013
312
79.20
69.48
63.04
23.40
26.10
27.00
81.00
101.70
Friday, 09 August 2013
which are normally provided in the office
99058
99170
Office services provided on an emergency basis
Collj/int physio data dig strd/trans minim 30min
96.58
363.95
99173
99174
Screening
Ocular photoscreening interpretation bilateral
Ipecac or similar administration for individual emesis and continued observation
until stomach adequately emptied of poison
Physician attendance and supervision of hyperbaric oxygen therapy, per session
29.89
39.61
Phlebotomy, therapeutic (separate procedure)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a problem focused history; a problem
focused examination; and straightforward medical decision making. Counseling
and/or coordi
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: an expanded problem focused history;
an expanded problem focused examination; and straightforward medical decision
making. Coun
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a detailed history; a detailed
examination; and medical decision making of low complexity. Counseling and/or
coordination of ca
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of moderate
complexity. Counseling and/or coo
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of high complexity.
Counseling and/or coordin
Office or other outpatient visit for the evaluation and management of an
established patient, that may not require the presence of a physician. Usually, the
presenting problem(s) are minimal. Typically, 5 minutes are spent performing or
supervising these
Office or other outpatient visit for the evaluation and management of an
established patient, which requires at least two of these three key components: a
problem focused history; a problem focused examination; straightforward medical
decision making. Cou
Office or other outpatient visit for the evaluation and management of an
established patient, which requires at least two of these three key components: an
expanded problem focused history; an expanded problem focused examination;
medical decision making
Office or other outpatient visit for the evaluation and management of an
established patient, which requires at least two of these three key components: a
detailed history; a detailed examination; medical decision making of moderate
complexity. Counseling
69.30
99175
99183
99195
99201
99202
99203
99204
99205
99211
99212
99213
99214
Extraordinary No.64/2013
313
106.20
271.80
75.03
86.93
119.33
157.94
207.38
36.97
56.87
74.01
101.53
Friday, 09 August 2013
99215
99217
99218
99219
99220
99221
99222
99223
99224
99225
99226
99231
99232
99233
99234
99235
Office or other outpatient visit for the evaluation and management of an
established patient, which requires at least two of these three key components: a
comprehensive history; a comprehensive examination; medical decision making of
high complexity. Coun
Obs care dschrg d mgmt
Initial observation care, per day, for the evaluation and management of a patient
which requires these three key components: a detailed or comprehensive history; a
detailed or comprehensive examination; and medical decision making that is
straightforward
Initial observation care, per day, for the evaluation and management of a patient,
which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of moderate
complexity. Counseling and/or coord
1st obs care pr d high severity
Initial hospital care, per day, for the evaluation and management of a patient which
requires these three key components: a detailed or comprehensive history; a
detailed or comprehensive examination; and medical decision making that is
straightforward or
Initial hospital care, per day, for the evaluation and management of a patient,
which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of moderate
complexity. Counseling and/or coordina
Initial hospital care, per day, for the evaluation and management of a patient,
which requires these three key components: a comprehensive history; a
comprehensive examination; and medical decision making of high complexity.
Counseling and/or coordination
Sbsq obs care pr d low severity
Sbsq obs care pr d moderate severity
Sbsq obs care pr d high severity
Subsequent hospital care, per day, for the evaluation and management of a patient,
which requires at least two of these three key components: a problem focused
interval history; a problem focused examination; medical decision making that is
straightforwar
Subsequent hospital care, per day, for the evaluation and management of a patient,
which requires at least two of these three key components: an expanded problem
focused interval history; an expanded problem focused examination; medical
decision making of
Subsequent hospital care, per day, for the evaluation and management of a patient,
which requires at least two of these three key components: a detailed interval
history; a detailed examination; medical decision making of high complexity.
Counseling and/o
Observation or inpatient hospital care, for the evaluation and management of a
patient including admission and discharge on the same date which requires these
three key components: a detailed or comprehensive history; a detailed or
comprehensive examinati
Observation or inpatient hospital care, for the evaluation and management of a
Extraordinary No.64/2013
314
156.37
123.12
134.10
185.40
263.08
146.86
215.43
242.77
46.14
90.63
127.71
76.73
99.73
152.75
174.35
238.54
Friday, 09 August 2013
99236
99238
99239
99241
99242
99243
99244
99245
99251
99252
99253
99254
99255
99281
patient including admission and discharge on the same date which requires these
three key components: a comprehensive history; a comprehensive examination;
and medical decision
Obs/i/p hosp care high severity
Hospital discharge day management; 30 minutes or less
Hospital discharge day management; more than 30 minutes
Office consultation for a new or established patient, which requires these three key
components: a problem focused history; a problem focused examination; and
straightforward medical decision making. Counseling and/or coordination of care
with other provi
Office consultation for a new or established patient, which requires these three key
components: an expanded problem focused history; an expanded problem focused
examination; and straightforward medical decision making. Counseling and/or
coordination of c
Office consultation for a new or established patient, which requires these three key
components: a detailed history; a detailed examination; and medical decision
making of low complexity. Counseling and/or coordination of care with other
providers or agen
Office consultation for a new or established patient, which requires these three key
components: a comprehensive history; a comprehensive examination; and medical
decision making of moderate complexity. Counseling and/or coordination of care
with other pr
Office consultation for a new or established patient, which requires these three key
components: a comprehensive history; a comprehensive examination; and medical
decision making of high complexity. Counseling and/or coordination of care with
other provid
Initial inpatient consultation for a new or established patient, which requires these
three key components: a problem focused history; a problem focused examination;
and straightforward medical decision making. Counseling and/or coordination of
care with
1st inpt consltj 40 min
Initial inpatient consultation for a new or established patient, which requires these
three key components: a detailed history; a detailed examination; and medical
decision making of low complexity. Counseling and/or coordination of care with
other provid
Initial inpatient consultation for a new or established patient, which requires three
key components: a comprehensive history; a comprehensive examination; and
medical decision making of moderate complexity. Counseling and/or coordination
of care with oth
Initial inpatient consultation for a new or established patient, which requires these
three key components: a comprehensive history; a comprehensive examination;
and medical decision making of high complexity. Counseling and/or coordination
of care with o
Emergency department visit for the evaluation and management of a patient, which
requires these three key components: a problem focused history; a problem focused
examination; and straightforward medical decision making. Counseling and/or
Extraordinary No.64/2013
315
384.38
133.05
172.27
105.67
143.19
182.41
234.86
298.54
122.67
182.33
198.36
242.77
314.79
91.71
Friday, 09 August 2013
coordination of
99304
99305
Emergency department visit for the evaluation and management of a patient, which
requires these three key components: an expanded problem focused history; an
expanded problem focused examination; and medical decision making of low
complexity. Counseling a
Emergency department visit for the evaluation and management of a patient, which
requires these three key components: an expanded problem focused history; an
expanded problem focused examination; and medical decision making of moderate
complexity. Counsel
Emergency department visit for the evaluation and management of a patient, which
requires these three key components: a detailed history; a detailed examination;
and medical decision making of moderate complexity. Counseling and/or
coordination of care wi
Emergency department visit for the evaluation and management of a patient, which
requires these three key components within the constraints imposed by the urgency
of the patient's clinical condition and/or mental status: a comprehensive history; a
compreh
Critical care, evaluation and management of the critically ill or critically injured
patient; first 30-74 minutes
Critical care, evaluation and management of the critically ill or critically injured
patient; each additional 30 minutes (List separately in addition to code for primary
service)
1st nf care pr d e/m lw severity
1st nf care pr d e/m mod severity
99306
99307
1st nf care pr d e/m hi severity
Sbsq nf care pr d e/m stable
157.46
49.66
99308
99309
Sbsq nf care pr d e/m minor complctj
Sbsq nf care pr d e/m new problem
69.18
98.10
99310
99315
Sbsq nf care pr d e/m unstable/new problem
Nf dschrg d mgmt 30 min/<
136.08
88.44
99316
99318
Nf dschrg d mgmt > 30 min
E/m pt invg annual nf assmt
111.15
99.15
99324
99325
Dom/r-home lw severity
Dom/r-home e/m new pt mod severity
82.70
111.12
99326
99327
Dom/r-home e/m new pt mod hi severity
Dom/r-home e/m new pt hi severity
147.93
204.83
99328
99334
Dom/r-home e/m new pt significant new problem
Dom/r-home e/m est pt self-lmtd/minor
261.61
63.42
99335
99336
Dom/r-home e/m est pt lw mod severity
Dom/r-home e/m est pt mod hi severity
92.06
136.21
99337
99339
Dom/r-home e/m est pt significant new problem
Indiv phys supvj home/dom/r-home mo 15-29 min
191.90
74.71
99282
99283
99284
99285
99291
99292
Extraordinary No.64/2013
316
120.82
183.70
260.67
355.91
370.17
187.78
91.71
128.46
Friday, 09 August 2013
99342
Home visit for the evaluation and management of a new patient, which requires
these three key components: a problem focused history; a problem focused
examination; and straightforward medical decision making. Counseling and/or
coordination of care with ot
Home vst new pt mod severity
99343
99344
Home vst new pt mod to hi severity
Home vst new pt hi severity
135.42
189.85
99345
99347
Home vst new pt unstable/significant new problem
Home vst est pt self limited/minor
250.72
63.21
99348
99349
Home vst est pt low to mod severity
Home vst est pt mod to hi severity
83.81
122.05
99350
189.52
99363
Home vst est pt unstable/significant new problem
Prolonged physician service in the office or other outpatient setting requiring direct
(face-to-face) patient contact beyond the usual service (eg, prolonged care and
treatment of an acute asthmatic patient in an outpatient setting); first hour (List
sepa
Prolng phys svc office o/p dir contact ea 30 min
Prolonged physician service in the inpatient setting, requiring direct (face-to-face)
patient contact beyond the usual service (eg, maternal fetal monitoring for high risk
delivery or other physiological monitoring, prolonged care of an acutely ill inpati
Prolonged physician service in the inpatient setting, requiring direct (face-to-face)
patient contact beyond the usual service (eg, maternal fetal monitoring for high risk
delivery or other physiological monitoring, prolonged care of an acutely ill inpati
Prolonged evaluation and management service before and/or after direct (face-toface) patient care (eg, review of extensive records and tests, communication with
other professionals and/or the patient/family); first hour (List separately in addition
to co
Prolng e/m before&/after dir care ea 30 min
Physician standby service, requiring prolonged physician attendance, each 30
minutes (eg, operative standby, standby for frozen section, for cesarean/high risk
delivery, for monitoring EEG)
Anticoagulant mgmt outpatient 1st 90 days
99364
99366
Anticoagulant mgmt outpatient ea sbsq 90 days
Team conference face-to-face nonphysician
56.96
48.20
99367
99368
Team conference non-face-to-face physician
Team conference non-face-to-face nonphysician
64.15
41.06
99374
99375
Phys supvj pt home hlth agency mo 15-29 minutes
Phys supvj pt home hlth agency mo 30 min/>
70.15
124.52
99377
99378
Phys supvj hospice pt mo 15-29 min
Phys supvj hospice pt mo 30 min/>
80.18
139.34
99379
99380
Phys supvj nf pt mo 15-29 min
Phys supvj nf pt mo 30 min/>
73.02
113.75
99341
99354
99355
99356
99357
99358
99359
99360
Extraordinary No.64/2013
317
88.12
99.69
186.25
90.80
224.06
142.40
202.71
96.23
186.05
128.97
Friday, 09 August 2013
99381
1st preventive medicine new patient < 1yr
112.83
99382
99383
1st preventive medicine new patient age 1-4 yrs
1st preventive medicine new patient age 5-11 yrs
121.55
128.47
99384
1st preventive medicine new patient age 12-17 yr
Initial preventive medicine evaluation and management of an individual including
a comprehensive history, a comprehensive examination, counseling/anticipatory
guidance/risk factor reduction interventions, and the ordering of appropriate
laboratory/diagnos
1st preventive medicine new patient age 40-64yrs
137.51
219.39
99397
1st preventive medicine new patient age 65yrs&>
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive medicine reevaluation and management of an individual
including a comprehensive history, comprehensive examination,
counseling/anticipatory guidance/risk factor reduction interventions, and the
ordering of appropriate laboratory/diagno
Periodic preventive med est patient age 65yrs&>
99401
99402
Prev med cnsl indiv spx 15 min
Prev med cnsl indiv spx 30 min
48.03
91.34
99403
99404
Prev med cnsl indiv spx 45 min
Prev med cnsl indiv spx 60 min
136.56
177.16
99406
99407
Tobacco use cessation intermediate 3-10 minutes
Tobacco use cessation intensive >10 minutes
26.43
52.70
99408
99409
Alcohol/substance screen & interven 15-30 min
Alcohol/substance screen & interven >30 min
63.89
124.96
99385
99386
99387
99391
99392
99393
99394
99395
99396
Extraordinary No.64/2013
318
142.18
195.28
82.75
86.88
89.13
105.22
115.76
135.29
183.69
Friday, 09 August 2013
99411
Prev med cnsl grp spx 30 min
45.69
99412
99460
Prev med cnsl grp spx 60 min
1st hosp/birthing center care per day nml nb
74.76
144.33
99462
99463
Subq hospital care per day e/m normal newborn
1st hosp/birthing center nb admit&dschg sm date
68.89
157.01
99464
99465
Attn at delivery& 1st stabilization of newborn
Delivery/birthing room resuscitation
155.16
278.60
Extraordinary No.64/2013
319
Friday, 09 August 2013