February 18, 2017
Definition:
Episode of Care Reference Table
An Episode of Care consists of medical services addressing a specific condition or procedural
event within a defined time frame. The codes, units, and duration are based on best business
practices and are intended to meet the needs of the beneficiary, the provider, and the health plan.
How to use this table in completing the Diagnostic Information section of the Service Request form:
1. Identify the appropriate EOC using the description of EOC and the detailed CPT information found in the section below. Click on the EOC name to view associated CPT
codes.
2. Copy EOC name from table below to TRICARE Service Request/Notification form. Please note that you must copy the entire name of the EOC with correct spelling or your
request may be rejected.
3. The form requires either an EOC name or CPT codes for processing. You may also include additional CPT codes along with the EOC in the CPT code section of the form.
**Please note that this includes information for med/surg requests. Certain services listed below will still require clinical review. The selection of an EOC does not
override/eliminate the process associated with clinical review.
EOC Name (copy this exactly to the Referral Request Form)
Duration
180
Advanced Care Planning Services
Allergy
Arthro Hip
Arthro Knee
Arthro Shoulder
Arthro Wrist
365
180
180
180
180
180
AutismDemo ABA Sole Provider and Tiered
Description (See CPT code list associated with this EOC below)
Advance care planning including the explanation and discussion of advance directives such as
standard forms, by the physician or other qualified health care professional; first 30 minutes, faceto-face with the patient, family member(s), and/or surrogate. Also includes additional time needed
and outpatient clinic visit needed for assessment
Initial and follow up visits, allergy testing, allergen immumotherapy.
Hip Arthroscopy, with synovectomy
Knee arthroscopy including: synovial biopsy, lavage, lateral release, synovectomy,
debridement/shaving, meniscectomy, meniscus repair, ant cruciate ligament repair.
Arthroscopy, shoulder, surgical; with removal of loose body or foreign body, synovectomy,
debridement, lysis of adhesion, decompression.
Arthroscopy, wrist, surgical; for infection, lavage and drainage, synovectomy, endoscopy with
release of carpal ligament.
Includes assessment, observation, and adaptive behavior treatment with/without family for autistic
patient and caregiver(s). Also includes adaptive behavior treatment with/without family for autistic
patient and caregiver(s)
February 18, 2017
EOC Name (copy this exactly to the Referral Request Form)
AutismDemo: Initial ABA Asmnt/TP
Bariatric Lap Band Adjustment
BH Prescriber Interview
BH Therapist Interview
Breast Pump
Breast Pump Supplies
Cardiac Rehab
Cardio
Chronic Condition
Cochlear Implant Rehab
Duration
60
180
180
180
180
180
90
365
365
180
180
Colonoscopy Preventative
Dental Anesthesia 6 and Over
Dental Anesthesia Under 6
Dental Appliance for TMJ
Dental Eval OralMaxFace Surg Dentist
Dental Frenotomy/Frenulectomy
Dental Sleep Apnea Oral Appliance
Derm Acne
Derm Lesions
Derm MOHS
180
180
Anesthesia for intraoral procedures, including biopsy as well as deep sedation/general anesthesia
- each 15 minute increment. Not to be used for patients over 6 years of age
180
Includes xrays, arthrography, cephalogram, orthopantogaram, tomographic survey, oral
evaluation, 2D cephalometric imaging, occlusal of an orthotic device, and office visits
Includes TMJ arthrogram, cephalogram, orthopantogaram, tomographic survey, oral evaluation,
2D cephalometric imaging, and office visits
Frenoplasty and frenulectomy. Incision of labial and lingual frenum (frenotomy) and excision of
lingual frenum. Also includes problem focused oral evaluation.
Includes evaluation and prefabricated or custom oral appliance
Office visit and follow ups, includes incision & drainage of abscess, biopsy, urinalysis for
pregnancy
Office visits and follow ups, incision & drainage, biopsy, lesion excision and shaving, and flaps
and grafts.
Office visit and follow up; includes various MOHS codes.
EOC to be used for Developmental Pediatric evaluation requests issued to a developmental
pediatrician. Do not use for developmental PT, OT, or ST requests as these have separate EOC's
available
DXA one or more sites, axial and appendicular
3 Individual or group self management training sessions. For newly diagonsed diabetics or
gestational diabetics, not for obesity.
180
180
180
365
365
365
365
Dev Peds Eval
Dexa Scan
Diabetes Education
Description (See CPT code list associated with this EOC below)
Behavior identification assessment conducted by the physician or other qualified health care
professional, face to face with patient and caregiver(s)
Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline
Psychiatric diagnostic evaluation with medical services
Psychiatric diagnostic evaluation
Includes both manual and electric pump along with locking ring, adapter replacement and tubing
Includes breast pump supplies such as adapter, locking ring, and bottle replacement but does not
include pump
Outpatient cardiac rehab with or without ECG monitoring
Includes initial and follow up visits, imaging, ECG, stress tests, external cardiovascular telemetry,
Initial visit
and follow
up visitsrehabilitation
to enable specialist
to manage
chronic,implants.
long termThis
care.
Speech
therapy
and auditory
for patients
with Cochlear
EOC should
not be used for Speech Therapy or auditory rehabilitation if the patient has not received a
Cochlear Implant
Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or
washing (separate procedure), includes removal of tumors, removal of foreign body, and office
visit.
Anesthesia for intraoral procedures, including biopsy as well as deep sedation/general anesthesia
- each 15 minute increment. Not to be used for patients under 6 years of age
180
90
February 18, 2017
EOC Name (copy this exactly to the Referral Request Form)
Duration
365
Diabetic Foot Care
DME BiPAP
DME BiPAP Supply
DME CPAP
DME CPAP Supply
DME CPM
DME Insulin Pump
DME Protime
DME Wound Vac
ENT
Eval and Treat
Eval Only
Eye Strabismus
Eyes
FAI
Feeding Clinic Evaluation
180
180
180
180
180
365
180
30
180
180
90
180
180
180
180
180
Gastroenterology
GYN Tubal
Gynecology
Hearing Adult
Hearing Child
Home Health
Hospice
IUD
Lactation Counseling Outpatient
Mammogram/Breast Bx
MRI Brain
MRI Chest
MRI Lower Extremity
MRI Orbit Face
180
365
365
180
60
90
180
365
365
180
180
180
180
Description (See CPT code list associated with this EOC below)
Includes Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus), Trimming of
nondystrophic nails, Debridement of nail(s) by any method(s), Trimming of dystrophic nails, office
visits, and routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy.
Includes equipment associated with BiPAP
Battery, face mask, tubing and filter for BiPAP
Includes equipment associated with CPAP
Includes CPAP supplies
Continuous passive motion for knee and other than knee
external ambulatory infusion pump.
Includes lancets and provision of equipment for home INR monitoring
Negative Pressure Wound Therapy and associated equipment
Includes nasal endoscopy, stenger test, tympanogram visual reinforcement
Office visit and follow ups
Inititial office evaluation and one follow up
Includes various strabismus surgeries and release of extensive scar tissue
Includes ophthalmological and optometry services as well as office/outpatient visits
Arthroscopy of hip that includes femoroplasty, acetabuloplasty, and labral repair
Includes swallow study, office visit, psych evaluation, developmental testing, reporting, and OT
evaluation
Includes office visits, esophagoscopy, esophagogastroduodenoscopy, endoscopic retrograde
cholangiopancreatography (ERCP), small intestinal endoscopy, colonoscopy stoma dx,
proctosigmoidoscopy, sigmoidoscopy, colonoscopy. Please note that you must check procedure
list to ensure variation of service is included
Includes laparoscopy, surgical with and without device
Gynecology preventive and non- preventive services
Hearing tests only, no office visits. Includes tympanometry, air/bone audiometry, speech
audiometry, filtered speech
Hearing tests only, no office visits. Includes audiometry, nasopharyngoscopy, tympanometry, and
Bekesy eval.
Skilled nursing, clinical social worker, and PT/OT/ST in home setting
Hospice care provided in patient's home or other inpatient setting
Intrauterine device for birth control, insertion/removal and office visits
Outpatient lactation counseling services for mothers intending to nurse. Must be rendered by a
TRICARE authorized proivder in an outpatient hospital or clinic
Includes U/S, screening and diagnostic mammography, bilateral/unilateral mammography.
Please do not use for beneficiaries under 30 years of age.
Includes with and without contrast
Includes with and without contrast
Includes injections of hip, knee, ankle, evaluations of joint, hip, knee, ankle
Includes with and without contrast
February 18, 2017
EOC Name (copy this exactly to the Referral Request Form)
MRI Pelvis
MRI Spine
MRI Upper Extremity
Nebulizer
Neuro
OB High Risk Maternity & Perinatology
OB High Risk Provider Screening
OB Mat Ante and Delivery
Oncology
Duration
180
180
180
180
365
312
180
312
365
180
PEDS DEV Therapy OT
180
PEDS DEV Therapy PT
180
PEDs DEV Therapy ST
Podiatry
Pulmonary
Pulmonary Rehab
Sleep Study
TENS
Therapy OT
Therapy PT
Therapy ST
Ultrasound Abdominal
Ultrasound Extremity
Ultrasound Female Pelvic
Ultrasound Infant Hips
Urgent Care
180
365
90
180
180
180
180
180
90
90
90
90
10
Description (See CPT code list associated with this EOC below)
Includes with and without contrast
Includes MRI spinal canal and contents, cervical with/without contrast
Includes injection procedure shoulder, elbow, wrist, MRI, radiological interpretation
Includes neubulizer (with compressor), mask, filters, and administration set
Includes includes needle electromyography, nerve conduction studies (1 - 13 or more studies)
Includes office or outpatient visits, consultations with key components and includes OB US,
prenatal screening, amniocentesis, cordocentesis and includes delivery and post partum.
High Risk screening and eval only, no delivery codes
Routine global obstetric care including antepartum care, vaginal delivery (with or without
episiotomy, and/or forceps) and postpartum care, Rho(D).
Includes chemotherapy administration, administration of various medications (nausea meds,
steroids, etc.), IV hydration, and office visits
To be used for pediatric (ages 17 and under) beneficiaries for developmental delay or autism
diagnoses ONLY. If the request is for a pediatric beneficiary with no developmental delay or
autism diagnoses, see the Therapy OT EOC. Note that a separate request is required for each
requested therapy type (PT, OT, ST).
To be used for pediatric (ages 17 and under) beneficiaries for developmental delay or autism
diagnoses ONLY. If the request is for a pediatric beneficiary with no developmental delay or
autism diagnoses, see the Therapy PT EOC. Note that a separate request is required for each
requested therapy type (PT, OT, ST).
To be used for pediatric (ages 17 and under) beneficiaries for developmental delay or autism
diagnoses ONLY. If the request is for a pediatric beneficiary with no developmental delay or
autism diagnoses, see the Therapy ST EOC. Note that a separate request is required for each
requested therapy type (PT, OT, ST).
Includes injections, ultrasound, excision and/or destruction of nail, arthrocentesis and office or
outpatient visits
Includes office or outpatient visits for evaluations, follow up, spirometry and PFTs
Pulmonary rehab, includes therapeutic respiratory procedures/exercise
Includes polysomnography , sleep study with simultaneous recording of ventilation, respiratory,
O2 saturation
Includes unit, leads, and conductive garment
Includes traction, whirlpool, aquatic, direct one-on-one care, ADLs.
Includes hot/cold packs, diathermy, Hubbard tank, and therapeutic exercises.
Includes speech, swallow, and voice evaluations
Ultrasound, abdominal, real time with image documentation; Ultrasound, retroperitoneal
Ultrasound, extremity, nonvascular, real-time with image documentation
Ultrasound, pelvic (nonobstetric), real time with image documentation; Ultrasound, transvaginal
Ultrasound, infant hips, real time with imaging documentation
One office visit. For use by urgent care facilities only
February 18, 2017
EOC Name (copy this exactly to the Referral Request Form)
Urology
Vascular Surgery Eval
Vasectomy
Vestibular Testing
Videoflouroscopic Swallowing Study
Duration
180
180
180
180
180
Description (See CPT code list associated with this EOC below)
Includes office visit codes along with various procedures for common urological specialist visits
i.e. bladder irrigation, biopsy of prostate, removal of lesion, cystourethroscopy, etc.
Work-up/diagnostic screening for vascular surgery (not for the surgery itself). Includes the codes
Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen
examination(s). Also includes office visits
Includes various modes of vestibular testing as well as an office visit and basic vestibular eval
Swallow study and eval with cineradiography and videoradiography
February 18, 2017
EOC Name
Advanced Care Planning Services
CPT Code
Units
99497
2
99498
G0463
2
2
94010
3
94060
3
95004
100
95017
100
95018
100
95024
100
95027
100
95028
100
95044
95052
150
100
95115
70
95117
70
95120
70
95125
70
95130
70
Advanced Care Planning Services
Advanced Care Planning Services
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Description
Advance care planning including the explanation and discussion of advance directives
such as standard forms, by the physician or other qualified health care professional;
first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate
Advance care planning including the explanation and discussion of advance directives
such as standard forms, by the physician or other qualified health care professional;
each add'l 30 minutes (List separately in addition to code for primary procedure)
Hospital outpatient clinic visit for assessment and management of a patient
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate
measurement(s), with or without maximal voluntary ventilation
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator
administration
Percutaneous tests (scratch, puncture, prick) with allergenic extracts, immediate type
reaction, including test interpretation and report by a physician, specify number of tests
Allergy testing, any combination of percutaneous (scratch, puncture, prick) and
intracutaneous (intradermal), sequential and incremental, with venoms, immediate
type reaction, including test interpretation and report, specify number of tests
Allergy testing, any combination of percutaneous (scratch, puncture, prick) and
intracutaneous (intradermal), sequential and incremental, with drugs or biologicals,
immediate type reaction, including test interpretation and report, specify number of
tests
Intracutaneous (intradermal) tests with allergenic extracts, immediate type reaction,
including test interpretation and report by a physician, specify number of tests
Intracutaneous (intradermal) tests, sequential and incremental, with allergenic extracts
for airborne allergens, immediate type reaction, including test interpretation and report
by a physician, specify number of tests
Intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction,
including reading, specify number of tests
Patch or application test(s) (specify number of tests)
Photo patch test(s) (specify number of tests)
Professional services for allergen immunotherapy not including provision of allergenic
extracts; single injection
Professional services for allergen immunotherapy not including provision of allergenic
extracts; 2 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; 2 or more injections
Professional services for allergen immunotherapy in prescribing physicians office or
institution, including provision of allergenic extract; single stinging insect venom
February 18, 2017
EOC Name
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
CPT Code
Units
95131
70
95132
70
95133
70
95134
70
95144
70
95145
70
95146
70
95147
70
95148
70
95149
70
95165
70
95170
70
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Allergy
Description
Professional services for allergen immunotherapy in prescribing physicians office or
institution, including provision of allergenic extract; 2 stinging insect venoms
Professional services for allergen immunotherapy in prescribing physicians office or
institution, including provision of allergenic extract; 3 stinging insect venoms
Professional services for allergen immunotherapy in prescribing physicians office or
institution, including provision of allergenic extract; 4 stinging insect venoms
Professional services for allergen immunotherapy in prescribing physicians office or
institution, including provision of allergenic extract; 5 stinging insect venoms
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy, single dose vial(s) (specify number of vials)
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy (specify number of doses); single stinging insect venom
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy (specify number of doses); 2 single stinging insect venoms
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy (specify number of doses); 3 single stinging insect venoms
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy (specify number of doses); 4 single stinging insect venoms
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy (specify number of doses); 5 single stinging insect venoms
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy; single or multiple antigens (specify number of doses)
Professional services for the supervision of preparation and provision of antigens for
allergen immunotherapy; whole body extract of biting insect or other arthropod (specify
number of doses
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
February 18, 2017
EOC Name
Allergy
Allergy
Allergy
CPT Code
Units
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
99245
1
29861
29863
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
Allergy
Allergy
Allergy
Allergy
Allergy
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Arthroscopy, hip, surgical; with removal of loose body or foreign body
Arthroscopy, hip, surgical; with synovectomy
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99214
3
99215
3
99241
1
99242
1
99243
1
99244
1
99245
29870
29871
29873
1
1
1
1
29874
1
29875
1
29876
1
29877
1
29879
1
29880
1
29881
1
29882
29883
1
1
29884
1
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Hip
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
Arthroscopy, knee, surgical; for infection, lavage and drainage
Arthroscopy, knee, surgical; with lateral release
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, 2 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) including debridement/shaving of articular cartilage (chondroplasty),
same or separate compartment(s), when performed
Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any
meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty),
same or separate compartment(s), when performed
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)
February 18, 2017
EOC Name
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
CPT Code
Units
29885
1
29886
1
29887
1
29888
1
29889
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
99243
1
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Arthro Knee
Description
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
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
February 18, 2017
EOC Name
CPT Code
Units
99244
1
99245
1
29819
29820
29821
29822
29823
1
1
1
1
1
29824
1
29825
1
29826
29827
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
Arthro Knee
Arthro Knee
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Arthroscopy, shoulder, surgical; with removal of loose body or foreign body
Arthroscopy, shoulder, surgical; synovectomy, partial
Arthroscopy, shoulder, surgical; synovectomy, complete
Arthroscopy, shoulder, surgical; debridement, limited
Arthroscopy, shoulder, surgical; debridement, extensive
Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface
(Mumford procedure)
Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without
manipulation
Arthroscopy, shoulder, surgical; decompression of subacromial space with partial
acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List
separately in addition to code for primary procedure)
Arthroscopy, shoulder, surgical; with rotator cuff repair
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99241
1
99242
1
99243
1
99244
1
99245
29843
29844
29845
1
1
1
1
29846
1
29847
29848
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Shoulder
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Description
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Arthroscopy, wrist, surgical; for infection, lavage and drainage
Arthroscopy, wrist, surgical; synovectomy, partial
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
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
February 18, 2017
EOC Name
Arthro Wrist
CPT Code
Units
99215
3
99241
1
99242
1
99243
1
99244
1
99245
1
0360T
999
0361T
999
0364T
999
0365T
999
0368T
999
0369T
999
0370T
999
0359T
1
43770
1
99201
1
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
Arthro Wrist
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo ABA Sole Provider and Tiered
AutismDemo Initial ABA Asmnt/TP
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Observational behavioral follow-up assessment, includes physician or other qualified
health care professional, first 30 minutes
Observational behavioral follow-up assessment, includes physician or other qualified
health care professional, each additional 30 minutes
Adaptive behavior treatment by protocol, administered by technician, face to face with
one patient; first 30 minutes of technician time.
Adaptive behavior treatment by protocol, administered by technician, face to face with
one patient; each additional 30 minutes of technician time
Adaptive behavior treatment with protocol modification administered by physician or
other qualified health care professional with one patient; first 30 minutes of patient face
to face time.
Adaptive behavior treatment with protocol modification administered by physician or
other qualified health care professional with one patient; each additional 30 minutes of
patient face to face time
Family adaptive behavior treatment guidance and multiple-family group adaptive
behavior treatment guidance; with guardian and caregiver without the presence of the
patient.
Behavior identification assessment conducted by the physician or other qualified
health care professional, face to face with patient and caregiver(s).
Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric
restrictive device (eg, gastric band and subcutaneous port components)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
February 18, 2017
EOC Name
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
CPT Code
Units
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
99243
1
99244
1
99245
1
S2083
4
90792
90791
A4281
A4282
A4283
1
1
1
1
4
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
Bariatric Lap Band Adjustment
BH Prescriber Interview
BH Therapist Interview
Breast Pump
Breast Pump
Breast Pump
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of
saline
Psychiatric diagnostic evaluation with medical services
Psychiatric diagnostic evaluation
Tubing for breast pump, replacement
Adapter for breast pump, replacement
Cap for breast pump bottle, replacement
February 18, 2017
EOC Name
Breast Pump
Breast Pump
Breast Pump
Breast Pump
Breast Pump
Breast Pump
Breast Pump Supplies
Breast Pump Supplies
Breast Pump Supplies
Breast Pump Supplies
Breast Pump Supplies
Breast Pump Supplies
Breast Pump Supplies
CPT Code
A4284
A4285
A4286
Units
1
4
1
A9900
E0602
E0603
A4281
A4282
A4283
A4284
A4285
A4286
10
1
1
1
1
4
1
4
1
A9900
10
93797
36
93798
36
78472
1
78473
1
78481
1
78483
1
93000
7
93005
7
93010
7
93015
2
93016
2
Cardiac Rehab
Cardiac Rehab
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Description
Breast shield and splash protector for use with breast pump, replacement
Polycarbonate bottle for use with breast pump, replacement
Locking ring for breast pump, replacement
Miscellaneous DME supply, accessory, and/or service component of another HCPCS
code
Breast pump, manual, any type
Breast pump, electric (ac and/or dc), any type
Tubing for breast pump, replacement
Adapter for breast pump, replacement
Cap for breast pump bottle, replacement
Breast shield and splash protector for use with breast pump, replacement
Polycarbonate bottle for use with breast pump, replacement
Locking ring for breast pump, replacement
Miscellaneous DME supply, accessory, and/or service component of another HCPCS
code
Physician or other qualified health care professional services for outpatient cardiac
rehabilitation; without continuous ECG monitoring (per session)
Physician or other qualified health care professional services for outpatient cardiac
rehabilitation; with continuous ECG monitoring (per session)
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 (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
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
February 18, 2017
EOC Name
CPT Code
Units
93017
2
93018
2
93224
1
93225
1
93226
1
93227
1
93228
1
93229
1
93303
3
93304
3
93306
3
93307
3
93308
3
93320
3
93321
3
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Description
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
External electrocardiographic recording up to 48 hours by continuous rhythm recording
and storage; includes recording, scanning analysis with report, review and
interpretation by a physician or other qualified health care professional
External electrocardiographic recording up to 48 hours by continuous rhythm recording
and storage; recording (includes connection, recording, and disconnection)
External electrocardiographic recording up to 48 hours by continuous rhythm recording
and storage; scanning analysis with report
External electrocardiographic recording up to 48 hours by continuous rhythm recording
and storage; review and interpretation by a physician or other qualified health care
professional
External mobile cardiovascular telemetry with electrocardiographic recording,
concurrent computerized real time data analysis and greater than 24 hours of
accessible ECG data storage (retrievable with query) with ECG triggered and patient
select
External mobile cardiovascular telemetry with electrocardiographic recording,
concurrent computerized real time data analysis and greater than 24 hours of
accessible ECG data storage (retrievable with query) with ECG triggered and patient
select
Transthoracic echocardiography for congenital cardiac anomalies; complete
Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited
study
Echocardiography, transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, complete, with spectral Doppler echocardiography,
and with color flow Doppler echocardiography
Echocardiography, transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, complete, without spectral or color Doppler
echocardiography
Echocardiography, transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, follow-up or limited study
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)
February 18, 2017
EOC Name
Cardio
Cardio
CPT Code
Units
93325
3
93350
3
93351
3
93352
3
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Cardio
Description
Doppler echocardiography color flow velocity mapping (List separately in addition to
codes for echocardiography)
Echocardiography, transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed...with interpretation and repo
Echocardiography, transthoracic, real-time with image documentation (2D), includes Mmode recording, when performed, during rest and cardiovascular stress test...with
physician supervision
Use of echocardiographic contrast agent during stress echocardiography (List
separately in addition to code for primary procedure)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
February 18, 2017
EOC Name
CPT Code
Units
99244
1
99245
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
12
99212
12
99213
12
99214
12
99215
12
99241
1
99242
1
99243
1
99244
1
Cardio
Cardio
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Chronic Condition
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
February 18, 2017
EOC Name
CPT Code
Units
99245
1
92507
10
92508
10
92630
92633
44388
10
10
1
45300
45303
45305
45307
1
1
1
1
45308
1
45309
1
45315
1
45317
1
45320
1
45327
1
45330
45331
45332
1
1
1
45333
1
45334
45335
45337
1
1
1
45338
45346
1
1
Chronic Condition
Cochlear Implant Rehab
Cochlear Implant Rehab
Cochlear Implant Rehab
Cochlear Implant Rehab
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; individual
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; group, 2 or more individuals
Auditory rehabilitation; pre-lingual hearing loss
Auditory rehabilitation; post-lingual hearing loss
Colonoscopy stoma dx indudting colli spec spx
Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure)
Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie
Proctosigmoidoscopy, rigid; with biopsy, single or multiple
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 (eg, injection, bipolar cautery,
unipolar cautery, laser, heater probe, stapler, plasma coagulator)
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 transendoscopic stent placement (includes
predilation)
Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure)
Sigmoidoscopy, flexible; with biopsy, single or multiple
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 (eg, injection, bipolar cautery, unipolar
cautery, laser, heater probe, stapler, plasma coagulator)
Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
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 flx ablation tumor polyp/oth les
February 18, 2017
EOC Name
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
CPT Code
Units
45378
45379
45380
1
1
1
45381
1
45382
1
45384
1
45385
1
45386
45389
45390
1
1
1
45391
1
45392
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Description
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without 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
Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal
injection(s), any substance
Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg,
injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma
coagulator)
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
Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more
strictures
colonoscopy flx with endoscopic stent placement
Colonoscopy, flexible; with endoscopic mucosal resection
Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound
examination
Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound
guided intramural or transmural fine needle aspiration/biopsy(s)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
February 18, 2017
EOC Name
Colonoscopy Preventative
CPT Code
Units
99215
3
99241
1
99242
1
99243
1
99244
1
99245
00170
41899
D9223
00170
41899
D0140
D0160
D9223
21076
70328
70330
70332
70350
70355
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
99201
1
99202
1
99203
1
99204
1
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Colonoscopy Preventative
Dental Anesthesia 6 and Over
Dental Anesthesia 6 and Over
Dental Anesthesia 6 and Over
Dental Anesthesia Under 6
Dental Anesthesia Under 6
Dental Anesthesia Under 6
Dental Anesthesia Under 6
Dental Anesthesia Under 6
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Anesthesia for intraoral procedures, including biopsy; not otherwise specified
Unlisted procedure, dentoalveolar structures
Deep sedation/general anesthesia - each 15 minute increment
Anesthesia for intraoral procedures, including biopsy; not otherwise specified
Unlisted procedure, dentoalveolar structures
Limited oral evaluation - problem focused
Detailed and extensive oral evaluation - problem focused, by report
Deep sedation/general anesthesia - each 15 minute increment
Impression and custom preparation; surgical obturator prosthesis
Radiologic examination, temporomandibular joint, open and closed mouth; unilateral
Radiologic examination, temporomandibular joint, open and closed mouth; bilateral
Temporomandibular joint arthrography, radiological supervision and interpretation
Cephalogram, orthodontic
Orthopantogram (eg, panoramic x-ray)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
February 18, 2017
EOC Name
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
CPT Code
Units
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
99241
1
99242
1
99243
1
99244
1
99245
1
D0140
D0160
D0320
D0322
D0340
D7880
70350
70355
1
1
1
1
1
1
1
1
99201
1
99202
1
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Appliance for TMJ
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Limited oral evaluation - problem focused
Detailed and extensive oral evaluation - problem focused, by report
Temporomandibular joint arthrogram, including injection.
Tomographic survey
2D cephalometric radiographic image - acquisition, measurement and analysis
Occlusal orthotic device, by report
Cephalogram, orthodontic
Orthopantogram (eg, panoramic x-ray)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
February 18, 2017
EOC Name
Dental Eval OralMaxFace Surg Dentist
CPT Code
Units
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
D0140
D0160
D0320
D0322
D0340
1
1
1
1
1
1
D9310
41010
41115
41520
D0140
1
1
1
1
1
D7960
1
99201
1
99202
1
99203
1
99204
1
99205
1
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Eval OralMaxFace Surg Dentist
Dental Frenotomy/Frenulectomy
Dental Frenotomy/Frenulectomy
Dental Frenotomy/Frenulectomy
Dental Frenotomy/Frenulectomy
Dental Frenotomy/Frenulectomy
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Limited oral evaluation - problem focused
Detailed and extensive oral evaluation - problem focused, by report
Temporomandibular joint arthrogram, including injection.
Tomographic survey
2D cephalometric radiographic image - acquisition, measurement and analysis
Consultation-diagnostic service provided by dentist or physician other than requesting
dentist or physician
Incision of lingual frenum (frenotomy)
Excision of lingual frenum (frenectomy)
Frenoplasty (surgical revision of frenum, eg, with Z-plasty)
Limited oral evaluation - problem focused
Frenulectomy, also known as frenectomy or frenotomy, separate procedure not
incidental to another procedure
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
February 18, 2017
EOC Name
Dental Sleep Apnea Oral Appliance
CPT Code
Units
99211
1
99212
1
99213
1
99214
1
99215
1
99245
D0140
D0160
D0170
1
1
1
1
D9310
1
E0485
1
E0486
1
10060
2
10061
2
11100
6
11101
10
11900
11901
81025
95044
6
6
6
150
96372
6
99201
1
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Dental Sleep Apnea Oral Appliance
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Description
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Limited oral evaluation - problem focused
Detailed and extensive oral evaluation - problem focused, by report
Re-evaluation - limited, problem focused (Established patient; not post-operative visit)
Consultation-diagnostic service provided by dentist or physician other than requesting
dentist or physician
Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, prefabricated, includes fitting and adjustment
Oral device/appliance used to reduce upper airway collapsibility, adjustable or nonadjustable, custom fabricated, includes fitting and adjustment
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 multiple
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed; single lesion
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed; each separate/additional lesion (List separately in
addition to code for primary procedure)
Injection, intralesional; up to and including seven lesions
Injection, intralesional; more than seven lesions
Urine pregnancy test, by visual color comparison methods
Patch or application test(s) (specify number of tests)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
subcutaneous or intramuscular
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
99245
1
10060
2
10061
10120
2
1
11100
6
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Acne
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
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 multiple
Incision and removal of foreign body, subcutaneous
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed; single lesion
February 18, 2017
EOC Name
CPT Code
Units
11101
5
11300
2
11301
2
11302
2
11303
2
11305
2
11306
2
11307
2
11308
2
11310
2
11311
2
11312
2
11313
2
11400
2
11401
2
11402
2
11403
2
11404
2
11406
2
11420
2
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Biopsy of skin, subcutaneous tissue and/or mucous membrane (including simple
closure), unless otherwise listed; each separate/additional lesion (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
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 including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter 0.5 cm or less
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter 0.6 to 1.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter 1.1 to 2.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter 2.1 to 3.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter 3.1 to 4.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
trunk, arms or legs; excised diameter over 4.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
February 18, 2017
EOC Name
CPT Code
Units
11421
2
11422
2
11423
2
11424
2
11426
2
11440
2
11441
2
11442
2
11443
2
11444
2
11446
2
11600
3
11601
3
11602
3
11603
3
11604
3
11606
3
11620
3
11621
3
11622
3
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm
Excision, benign lesion including margins, except skin tag (unless listed elsewhere),
scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm
Excision, other benign lesion including margins (unless listed elsewhere), face, ears,
eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less
Excision, other benign lesion including margins (unless listed elsewhere), face, ears,
eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm
Excision, other benign lesion including margins (unless listed elsewhere), face, ears,
eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm
Excision, other benign lesion including margins (unless listed elsewhere), face, ears,
eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
0.5 cm or less
Excision, other benign lesion including margins (unless listed elsewhere), face, ears,
eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
0.5 cm or less
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
0.6 to 1.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
1.1 to 2.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
2.1 to 3.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
3.1 to 4.0 cm
Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter
over 4.0 cm
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter 0.5 cm or less
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter 0.6 to 1.0 cm
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter 1.1 to 2.0 cm
February 18, 2017
EOC Name
CPT Code
Units
11623
3
11624
3
11626
3
11640
3
11641
3
11642
3
11643
3
11644
3
11646
11755
11900
11901
3
1
6
6
12011
2
12013
2
12014
2
12015
2
12016
2
12017
2
12018
2
12031
2
12032
2
12034
2
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter 2.1 to 3.0 cm
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter 3.1 to 4.0 cm
Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia;
excised diameter over 4.0 cm
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter 0.5 cm or less
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter 0.6 to 1.0 cm
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter 1.1 to 2.0 cm
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter 2.1 to 3.0 cm
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter 3.1 to 4.0 cm
Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised
diameter over 4.0 cm
Biopsy of nail unit (eg plate, bed, matrix, hyponychium, proximal and lateral nail folds)
Injection, intralesional; up to and including seven lesions
Injection, intralesional; more than seven lesions
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; 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
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.5 cm or less
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.6 cm to 7.5 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 7.6 cm to 12.5 cm
February 18, 2017
EOC Name
CPT Code
Units
12035
2
12036
2
12037
2
12041
2
12042
2
12044
2
12045
2
12046
2
12047
2
12051
2
12052
2
12053
2
12054
2
12055
2
12056
2
12057
13100
13101
2
2
2
13102
13120
13121
2
2
2
13122
2
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 12.6 cm to 20.0 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 20.1 cm to 30.0 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); over 30.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or
less
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to
7.5 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to
12.5 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to
20.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to
30.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0
cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.5 cm or less
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.6 cm to 5.0 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 5.1 cm to 7.5 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 7.6 cm to 12.5 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 12.6 cm to 20.0 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 20.1 cm to 30.0 cm
Repair, intermediate, 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
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
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)
February 18, 2017
EOC Name
CPT Code
Units
13131
2
13132
2
13133
13151
13152
2
2
2
13153
14000
14001
14020
14021
14040
14041
14060
14061
14301
14302
2
4
4
4
4
4
4
4
4
4
4
15120
15200
15201
15220
15221
15240
15241
15260
15261
2
4
4
4
4
4
4
4
4
17000
6
17003
13
17004
4
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
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 primary
procedure)
Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
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)
Flaps
Flaps
Flaps
Flaps
Flaps
Flaps
Flaps
Flaps
Flaps
Flaps
Split thickness autograft, face, scal, eyelids, mouth, neck, ears, orbits, genitalia,
hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area on
infants and children
Grafts
Grafts
Grafts
Grafts
Grafts
Grafts
Grafts
Grafts
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), premalignant lesions (eg, actinic keratoses); first lesion
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions,
each (List separately in addition to code for first lesion)
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions
February 18, 2017
EOC Name
CPT Code
Units
17110
6
17111
6
17260
12
17261
17262
12
6
17263
10
17264
10
17266
6
17270
6
17271
6
17272
20
17273
10
17274
10
17276
6
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), of benign lesions other than skin tags or cutaneous vascular proliferative
lesions; up to 14 lesions
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), of benign lesions other than skin tags or cutaneous vascular proliferative
lesions; 15 or more lesions
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or
less
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0
cm
Destruction, malignant lesion lesion diameter 1.1 to 2.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0
cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0
cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter 0.5 cm or less
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter 0.6 to 1.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter 1.1 to 2.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter 2.1 to 3.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter 3.1 to 4.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion
diameter over 4.0 cm
February 18, 2017
EOC Name
CPT Code
Units
17280
6
17281
6
17282
6
17283
20
17284
18
17286
40490
40808
46900
46910
54050
54055
54056
54060
54100
56501
56605
56606
67810
69100
81025
2
2
3
6
6
6
6
6
6
3
6
6
6
1
1
6
87220
88304
6
3
88305
95044
12
150
96372
6
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Description
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 0.5 cm or less
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 0.6 to 1.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 1.1 to 2.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 2.1 to 3.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter 3.1 to 4.0 cm
Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous
membrane; lesion diameter over 4.0 cm
Biopsy of the lip
Biopsy of the mouth
Destruction of lesion on the anus
Destruction of lesion on the anus
Destruction of lesion on the penis
Destruction of lesion on the penis
Destruction of lesion on the penis
Destruction of lesion on the penis
Biopsy of penis
Destruction of lesion on vulva
Biopsy of vulva
Biopsy of vulva
Biopsy of the eye lid
Biopsy external ear
Urine pregnancy test, by visual color comparison methods
Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or
ectoparasite ova or mites (eg, scabies)
Level III-surgical pathology, gross and microscopic examination
Leval IV - Surgical, gross and microscopic examination… not requiring microscopic
evaluation or surgical margins
Patch or application test(s) (specify number of tests)
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
subcutaneous or intramuscular
February 18, 2017
EOC Name
CPT Code
Units
96910
42
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
99245
1
11300
2
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm Lesions
Derm MOHS
Description
Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and
ultraviolet B
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion
diameter 0.5 cm or less
February 18, 2017
EOC Name
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
CPT Code
Units
12011
2
12013
2
12014
2
12015
2
12016
2
12017
2
12018
2
12031
2
12032
2
12034
2
12035
2
12036
2
12037
2
12041
2
12042
2
12044
2
12045
2
12046
2
12047
2
12051
2
Description
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; 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
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.5 cm or less
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 2.6 cm to 7.5 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 7.6 cm to 12.5 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 12.6 cm to 20.0 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); 20.1 cm to 30.0 cm
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding
hands and feet); over 30.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or
less
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to
7.5 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to
12.5 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to
20.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to
30.0 cm
Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0
cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.5 cm or less
February 18, 2017
EOC Name
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
CPT Code
Units
12052
2
12053
2
12054
2
12055
2
12056
2
12057
2
13100
13101
2
2
13102
2
13120
13121
2
2
13122
2
13131
2
13132
2
13133
2
13151
13152
2
2
13153
2
14000
14001
4
4
14020
4
14021
4
14060
4
14061
4
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Description
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 2.6 cm to 5.0 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 5.1 cm to 7.5 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 7.6 cm to 12.5 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 12.6 cm to 20.0 cm
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous
membranes; 20.1 cm to 30.0 cm
Repair, intermediate, 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
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
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 primary
procedure)
Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm
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)
Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less
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, 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
February 18, 2017
EOC Name
Derm MOHS
Derm MOHS
CPT Code
14301
Units
2
14302
4
15002
4
15004
4
15200
4
15201
4
15220
4
15221
4
15240
4
15241
4
15260
4
15261
4
15731
2
15740
4
17311
2
17312
4
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Description
Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm
Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or
part thereof (List separately in addition to code for primary procedure)
Surgical preparation or creation of recipient site by excision of open wounds, burn
eschar, or scar (including subcutaneous tissues), or incisional release of scar
contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and
children
Surg prep or creation of recipient site by excision of open wounds,burn
eschar,scar(incl subcutaneous tiss.),incisional release of scar;
face,scalp,eyelids,mouth,neck,ears,orbits,genitalia,hand,feet and/or mult digits; 100 sq
cm or 1% of body, inf & child
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, or part thereof (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, or part thereof (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, or part
thereof (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, or part thereof (List separately in addition to
code for primary procedure)
Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian
forehead flap
Flap; island pedicle requiring identification and dissection of an anatomically named
axial vessel
Mohs micrographic technique, incl removal of all gross tumor, surgical excision of
tissue, mapping, color coding of specimens, microscopic examination of specimens by
the surgeon, head, neck, hands, feet, genitalia,first stage, up to 5 tissue blocks
Mohs micrographic technique, incl removal of all gross tumor, surgical excision of
tissue, mapping, color coding, microscopic examination of specimens by the surgeon,
head, neck, hands, feet, genitalia,each additional stage, up to 5 tissue blocks
February 18, 2017
EOC Name
CPT Code
Units
17313
2
17314
4
17315
15
96372
6
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Derm MOHS
Description
Mohs micrographic technique, including removal of all gross tumor, surgical excision of
tissue specimens, mapping, color coding of specimens, microscopic examination of
specimens by the surgeon, trunk, arms or legs, first stage, up to 5 tissue blocks
Mohs micrographic technique, incl removal of all gross tumor, surgical excision of
tissue, mapping, color coding of specimens, microscopic examination of specimens by
the surgeon, trunk, arms, or legs; each additional stage , up to 5 tissue blocks
Mohs micrographic technique, including removal of all gross tumor, surgical excision of
tissue specimens, mapping, color coding of specimens, microscopic examination of
specimens by the surgeon, each additional block after the first 5 tissue blocks
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
subcutaneous or intramuscular
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
February 18, 2017
EOC Name
CPT Code
Units
99244
1
99245
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
Derm MOHS
Derm MOHS
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
February 18, 2017
EOC Name
CPT Code
Units
99245
1
99354
99355
1
1
77080
1
77081
1
77085
1
77086
G0108
G0109
11055
1
3
3
4
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Prolonged service in the office or other outpatient setting required direct patient
contact beyond the usual service; first hour.
each additional 30 minutes
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial
skeleton (eg, hips, pelvis, spine
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites;
appendicular skeleton (peripheral) (eg, radius, wrist, heel)
Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial
skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment
VERTEBRAL FRACTURE ASSESSMENT VIA DXA
individual diabetic outpatient self-management training services
group session, diabetes outpatient self-management training services
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion
11056
4
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); two to four lesions
11057
4
11719
11720
11721
4
4
4
99201
1
99202
1
99203
1
99204
1
99205
1
99211
4
99212
4
99213
4
Dev Peds Eval
Dev Peds Eval
Dev Peds Eval
Dexa Scan
Dexa Scan
Dexa Scan
Dexa Scan
Diabetes Education
Diabetes Education
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than four
lesions
Trimming of nondystrophic nails, any number
Debridement of nail(s) by any method(s); 1 to 5
Debridement of nail(s) by any method(s); 6 or more
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
Diabetic Foot Care
Diabetic Foot Care
CPT Code
Units
99214
4
99215
4
99241
1
99242
1
99243
1
99244
1
99245
1
G0127
4
G0247
4
A4604
2
A7027
A7028
A7029
A7030
A7031
A7032
A7033
2
4
2
2
5
5
5
A7034
A7035
A7036
A7037
A7038
A7039
A7044
2
1
1
2
8
1
1
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
Diabetic Foot Care
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Trimming of dystrophic nails, any number
Routine foot care by a physician of a diabetic patient with diabetic sensory neuropathy
resulting in a loss of protective sensation (LOPS) to include if present, at least the
following: 1) local care of superficial
Tubing with integrated heating element for use with positive airway pressure device
Combination oral/nasal mask, used with continuous positive airway pressure device,
each
Oral cushion for combination oral/nasal mask, replacement only
Nasal pillows for combination oral/nasal mask, replacement only, pair
Full face mask used with positive airway pressure device, each
Face mask interface, replacement for full face mask, each
Cushion for use on nasal mask interface, replacement only, each
Pillow for use on nasal cannula type interface, replacement only, pair
Nasal interface (mask or cannula type) used with positive airway pressure device, with
or without head strap
Headgear used with positive airway pressure device
Chinstrap used with positive airway pressure device
Tubing used with positive airway pressure device
Filter, disposable, used with positive airway pressure device
Filter, nondisposable, used with positive airway pressure device
Oral interface used with positive airway pressure device, each
February 18, 2017
EOC Name
CPT Code
Units
A7045
1
A7046
1
E0470
1
E0471
1
E0472
E0561
E0562
A4604
1
1
1
2
A7027
2
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
A7028
A7029
A7030
A7031
A7032
A7033
4
2
2
5
5
5
A7034
2
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
A7035
A7036
A7037
A7038
A7039
A7044
1
1
2
8
1
1
A7045
1
A7046
1
A4604
2
A7027
A7028
A7029
2
4
2
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP
DME BiPAP Supply
DME BiPAP Supply
DME BiPAP Supply
DME CPAP
DME CPAP
DME CPAP
DME CPAP
Description
Exhalation port with or without swivel used with accessories for positive airway
devices, replacement only
Water chamber for humidifier, used with positive airway pressure device, replacement,
each
Respiratory assist device, bi-level pressure capability, without backup rate feature,
used with noninvasive interface, e.g., nasal or facial mask (intermittent assist device
with continuous positive airway pressure device)
Respiratory assist device, bi-level pressure capability, with back-up rate feature, used
with noninvasive interface, e.g., nasal or facial mask (intermittent assist device with
continuous positive airway pressure device)
Respiratory assist device, bi-level pressure capability, with backup rate feature, used
with invasive interface, e.g., tracheostomy tube (intermittent assist device with
continuous positive airway pressure device)
Humidifier, nonheated, used with positive airway pressure device
Humidifier, heated, used with positive airway pressure device
Tubing with integrated heating element for use with positive airway pressure device
Combination oral/nasal mask, used with continuous positive airway pressure device,
each
Oral cushion for combination oral/nasal mask, replacement only
Nasal pillows for combination oral/nasal mask, replacement only, pair
Full face mask used with positive airway pressure device, each
Face mask interface, replacement for full face mask, each
Cushion for use on nasal mask interface, replacement only, each
Pillow for use on nasal cannula type interface, replacement only, pair
Nasal interface (mask or cannula type) used with positive airway pressure device, with
or without head strap
Headgear used with positive airway pressure device
Chinstrap used with positive airway pressure device
Tubing used with positive airway pressure device
Filter, disposable, used with positive airway pressure device
Filter, nondisposable, used with positive airway pressure device
Oral interface used with positive airway pressure device, each
Exhalation port with or without swivel used with accessories for positive airway
devices, replacement only
Water chamber for humidifier, used with positive airway pressure device, replacement,
each
Tubing with integrated heating element for use with positive airway pressure device
Combination oral/nasal mask, used with continuous positive airway pressure device,
each
Oral cushion for combination oral/nasal mask, replacement only
Nasal pillows for combination oral/nasal mask, replacement only, pair
February 18, 2017
EOC Name
CPT Code
A7030
A7031
A7032
A7033
Units
2
5
5
5
A7034
A7035
A7036
A7037
A7038
A7039
A7044
2
1
1
2
8
1
1
A7045
1
A7046
E0561
E0562
E0601
A4604
1
1
1
1
2
A7027
2
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
A7028
A7029
A7030
A7031
A7032
A7033
4
2
2
5
5
5
A7034
2
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
A7035
A7036
A7037
A7038
A7039
A7044
1
1
2
8
1
1
A7045
1
A7046
1
E0935
1
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP
DME CPAP Supply
DME CPAP Supply
DME CPAP Supply
DME CPM
Description
Full face mask used with positive airway pressure device, each
Face mask interface, replacement for full face mask, each
Cushion for use on nasal mask interface, replacement only, each
Pillow for use on nasal cannula type interface, replacement only, pair
Nasal interface (mask or cannula type) used with positive airway pressure device, with
or without head strap
Headgear used with positive airway pressure device
Chinstrap used with positive airway pressure device
Tubing used with positive airway pressure device
Filter, disposable, used with positive airway pressure device
Filter, nondisposable, used with positive airway pressure device
Oral interface used with positive airway pressure device, each
Exhalation port with or without swivel used with accessories for positive airway
devices, replacement only
Water chamber for humidifier, used with positive airway pressure device, replacement,
each
Humidifier, nonheated, used with positive airway pressure device
Humidifier, heated, used with positive airway pressure device
Continuous airway pressure (CPAP) device
Tubing with integrated heating element for use with positive airway pressure device
Combination oral/nasal mask, used with continuous positive airway pressure device,
each
Oral cushion for combination oral/nasal mask, replacement only
Nasal pillows for combination oral/nasal mask, replacement only, pair
Full face mask used with positive airway pressure device, each
Face mask interface, replacement for full face mask, each
Cushion for use on nasal mask interface, replacement only, each
Pillow for use on nasal cannula type interface, replacement only, pair
Nasal interface (mask or cannula type) used with positive airway pressure device, with
or without head strap
Headgear used with positive airway pressure device
Chinstrap used with positive airway pressure device
Tubing used with positive airway pressure device
Filter, disposable, used with positive airway pressure device
Filter, nondisposable, used with positive airway pressure device
Oral interface used with positive airway pressure device, each
Exhalation port with or without swivel used with accessories for positive airway
devices, replacement only
Water chamber for humidifier, used with positive airway pressure device, replacement,
each
Continuous passive motion exercise device for use on knee only
February 18, 2017
EOC Name
DME CPM
DME Insulin Pump
DME Protime
DME Protime
DME Protime
CPT Code
E0936
E0784
A4258
A4259
Units
1
1
2
2
G0249
1
97605
1
97606
1
A6550
1
A7000
A7001
A7002
E2402
31231
31575
69210
92511
92550
92552
92553
92555
92556
1
1
1
1
1
1
1
1
1
1
1
1
1
92557
92561
92562
92563
92564
92565
92567
92568
1
1
1
1
1
1
1
1
92570
92571
92572
1
1
1
DME Wound Vac
DME Wound Vac
DME Wound Vac
DME Wound Vac
DME Wound Vac
DME Wound Vac
DME Wound Vac
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
Description
Continuous passive motion exercise device for use other than knee
External ambulatory infusion pump, insulin
Spring powered device for lancets
Lancets per box of 100
Provision of test materials and equipment for home INR monitoring of patient with
either mechanical heart valve(s), chronic atrial fibrillation, or venous thromboembolism
Negative pressure wound therapy (eg, vacuum assisted drainage collection), including
topical application(s), wound assessment, and instruction(s) for ongoing care, per
session; total wound(s) surface area less than or equal to 50 square centimeters
Negative pressure wound therapy (eg, vacuum assisted drainage collection), including
topical application(s), wound assessment, and instruction(s) for ongoing care, per
session; total wound(s) surface area greater than 50 square centimeters
Wound care set, for negative pressure wound therapy electrical pump, includes all
supplies and accessories
Canister, disposable, used with suction pump, each
Canister, nondisposable, used with suction pump, each
Tubing, used with suction pump, each
Negative pressure wound therapy electrical pump, stationary or portable
Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)
Laryngoscopy, flexible fiberoptic; diagnostic
Removal impacted cerumen requiring instrumentation, unilateral
Nasopharyngoscopy with endoscope (separate procedure)
Tympanometry and reflex threshold measurements
Pure tone audiometry (threshold); air only
Pure tone audiometry (threshold); air and bone
Speech audiometry threshold;
Speech audiometry threshold; with speech recognition
Comprehensive audiometry threshold evaluation and speech recognition (92553 and
92556 combined)
Bekesy audiometry; diagnostic
Loudness balance test, alternate binaural or monaural
Tone decay test
Short increment sensitivity index (SISI)
Stenger test, pure tone
Tympanogram
Acoustic reflex testing
Acoustic immittance testing, includes tympanometry (impedance testing), acoustic
reflex threshold testing, and acoustic reflex decay testing
Filtered speech test
Staggered spondaic word test
February 18, 2017
EOC Name
ENT
ENT
ENT
ENT
ENT
ENT
ENT
CPT Code
92575
92576
92577
92579
92582
92583
Units
1
1
1
1
1
1
92585
1
92586
1
92587
1
92588
92625
92626
1
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
ENT
Description
Sensorineural acuity level test
Synthetic sentence identification test
Stenger test, speech
Visual reinforcement audiometry (VRA)
Conditioning play audio (for children)
Select picture audiometry
Auditory evoked potentials for evoked response audiometry and/or testing of the
central nervous system; comprehensive
Auditory evoked potentials for evoked response audiometry and/or testing of the
central nervous system; limited
Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the
presence or absence of hearing disorder, 3-6 frequencies) or transient evoked
otoacoustic emissions, with interpretation and report
Distortion product evoked otoacoustic emissions; comprehensive diagnostic evaluation
(quantitative analysis of outer hair cell function by cochlear mapping, minimum of 12
frequencies), with interpretation and report
Assessment of tinnitus (includes pitch, loudness matching, and masking)
Evaluation of auditory rehabilitation status; first hour
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99241
1
99242
1
99243
1
99244
1
99245
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
ENT
ENT
ENT
ENT
ENT
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Description
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
February 18, 2017
EOC Name
CPT Code
Units
99242
1
99243
1
99244
1
99245
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
99241
1
99242
1
Eval and Treat
Eval and Treat
Eval and Treat
Eval and Treat
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Eval Only
Description
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
February 18, 2017
EOC Name
CPT Code
Units
99243
1
99244
1
99245
67311
67312
1
1
1
67314
1
67318
1
67320
1
67331
1
67332
1
67334
1
67335
1
67340
1
67343
1
99201
1
99202
1
99203
1
99204
1
99205
1
Eval Only
Eval Only
Eval Only
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Description
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Strabismus surgery, recession or resection procedure; 1 horizontal muscle
Strabismus surgery, recession or resection procedure; 2 horizontal muscles
Strabismus surgery, recession or resection procedure; 1 vertical muscle (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)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
February 18, 2017
EOC Name
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
CPT Code
Units
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
99243
1
99244
1
99245
1
76514
1
92002
1
92004
3
92012
3
92014
92015
92020
3
3
1
92060
1
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eye Strabismus
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Description
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Ophthalmic ultrasound, diagnostic; corneal pachymetry, unilateral or bilateral
(determination of corneal thickness)
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, 1 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,
1 or more visits
Determination of refractive state
Gonioscopy (separate procedure)
Sensorimotor examination with multiple measurements of ocular deviation (eg,
restrictive or paretic muscle with diplopia) with interpretation and report (separate
procedure
February 18, 2017
EOC Name
CPT Code
Units
92083
3
92132
2
92133
2
92134
2
92136
1
92225
3
92226
92235
92250
92270
92275
95930
3
3
1
1
1
1
99172
99173
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Description
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 30 degrees, or quantitative…
Scanning computerized ophthalmic diagnostic imaging, anterior segment, with
interpretation and report, unilateral or bilateral
Scanning computerized ophthalmic diagnostic imaging, posterior segment, with
interpretation and report, unilateral or bilateral; optic nerve
Scanning computerized ophthalmic diagnostic imaging, posterior segment, with
interpretation and report, unilateral or bilateral; retina
Ophthalmic biometry by partial coherence interferometry with intraocular lens power
calculation
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
Fluorescein angiography (includes multiframe imaging) with interpretation and report
Fundus photography with interpretation and report
Electro-oculography with interpretation and report
Electroretinography with interpretation and report
Visual evoked potential (VEP) testing central nervous system, checkerboard or flash
Visual function screening, automated or semi-automated bilateral quantitative
determination of visual acuity, ocular alignment, color vision by pseudoisochromatic
plates, and field of vision (may include all or some screening of the determination(s)
for contrast sensitivity, vision under glare)
Screening test of visual acuity, quantitative, bilateral
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
February 18, 2017
EOC Name
CPT Code
Units
99213
3
99214
3
99215
3
99241
1
99242
1
99243
1
99244
1
99245
29914
29915
29916
74230
90791
1
1
1
1
1
1
92523
92610
1
1
96111
97165
97166
97167
1
1
1
1
99205
1
43200
1
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
Eyes
FAI
FAI
FAI
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Feeding Clinic Evaluation
Gastroenterology
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)
Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)
Arthroscopy, hip, surgical; with labral repair
Swallowing function, with cineradiography/videoradiography
Psychiatric diagnostic evaluation
Evaluation of speech sound production (eg, articulation, phonological process,
apraxia, dysarthria); with evaluation of language comprehension and expression (eg,
receptive and expressive language)
Evaluation of oral and pharyngeal swallowing function
Developmental testing, (includes assessment of motor, language, social, adaptive,
and/or cognitive functioning by standardized developmental instruments) with
interretation and report
Occupational therapy eval low complex 30 minutes
Occupational therapy eval mod complex 45 minutes
Occupational therapy eval high complex 60 minutes
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by
brushing or washing, when performed (separate procedure)
February 18, 2017
EOC Name
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
CPT Code
Units
43235
1
43236
1
43239
1
43241
1
43255
1
43260
1
43261
1
43262
1
43265
1
43266
1
43274
1
43276
1
43277
1
44360
1
44361
1
44376
1
44388
1
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Description
Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of
specimen(s) by brushing or washing, when performed (separate procedure)
Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal
injection(s), any substance
Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple
Esophagogastroduodenoscopy, flexible, transoral; with insertion of intraluminal tube or
catheter
Esophagogastroduodenoscopy, flexible, transoral; with control of bleeding, any
method
Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including
collection of specimen(s) by brushing or washing, when performed (separate
procedure)
Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or
multiple
Endoscopic retrograde cholangiopancreatography (ERCP); with
sphincterotomy/papillotomy
Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi,
any method (eg, mechanical, electrohydraulic, lithotripsy)
Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent
(includes pre- and post-dilation and guide wire passage, when performed)
Endoscopic retrograde cholangiopancreatography (ERCP); with placement of
endoscopic stent into biliary or pancreatic duct, including pre- and post-dilation and
guide wire passage, when performed, including sphincterotomy, when performed,
each stent
Endoscopic retrograde cholangiopancreatography (ERCP); with removal and
exchange of stent(s), biliary or pancreatic duct, including pre- and post-dilation and
guide wire passage, when performed, including sphincterotomy and each stent
exchanged
Endoscopic retrograde cholangiopancreatography (ERCP); with trans-endoscopic
balloon dilation of biliary/pancreatic duct(s) or of ampulla (sphincteroplasty), including
sphincterotomy, when performed, each duct
Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not
including ileum; diagnostic, including collection of specimen(s) by brushing or washing,
when performed (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,
including ileum; diagnostic, with or without collection of specimen(s) by brushing or
washing (separate procedure)
Colonoscopy stoma dx indudting colli spec spx
February 18, 2017
EOC Name
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
CPT Code
Units
45300
1
45303
45305
45307
1
1
1
45308
1
45309
1
45315
1
45317
1
45320
1
45327
1
45330
1
45331
45332
1
1
45333
1
45334
1
45335
45337
1
1
45338
1
45346
1
45378
1
45379
45380
1
1
45381
1
45382
1
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Description
Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure)
Proctosigmoidoscopy, rigid; with dilation (eg, balloon, guide wire, bougie
Proctosigmoidoscopy, rigid; with biopsy, single or multiple
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 (eg, injection, bipolar cautery,
unipolar cautery, laser, heater probe, stapler, plasma coagulator)
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 transendoscopic stent placement (includes
predilation)
Sigmoidoscopy, flexible; diagnostic, with or without collection of specimen(s) by
brushing or washing (separate procedure)
Sigmoidoscopy, flexible; with biopsy, single or multiple
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 (eg, injection, bipolar cautery, unipolar
cautery, laser, heater probe, stapler, plasma coagulator)
Sigmoidoscopy, flexible; with directed submucosal injection(s), any substance
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 flx ablation tumor polyp/oth les
Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without 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
Colonoscopy, flexible, proximal to splenic flexure; with directed submucosal
injection(s), any substance
Colonoscopy, flexible, proximal to splenic flexure; with control of bleeding (eg,
injection, bipolar cautery, unipolar cautery, laser, heater probe, stapler, plasma
coagulator)
February 18, 2017
EOC Name
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
CPT Code
Units
45384
1
45385
1
45386
1
45389
45390
1
1
45391
1
45392
1
46600
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Gastroenterology
Description
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
Colonoscopy, flexible, proximal to splenic flexure; with dilation by balloon, 1 or more
strictures
colonoscopy flx with endoscopic stent placement
Colonoscopy, flexible; with endoscopic mucosal resection
Colonoscopy, flexible, proximal to splenic flexure; with endoscopic ultrasound
examination
Colonoscopy, flexible, proximal to splenic flexure; with transendoscopic ultrasound
guided intramural or transmural fine needle aspiration/biopsy(s)
Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing,
when performed (separate procedure)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
February 18, 2017
EOC Name
CPT Code
Units
99243
1
99244
1
99245
1
58670
1
58671
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
99241
1
99242
1
Gastroenterology
Gastroenterology
Gastroenterology
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
GYN Tubal
Description
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope
ring)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
February 18, 2017
EOC Name
CPT Code
Units
99243
1
99244
1
99245
56820
56821
57420
57421
57452
1
1
1
1
1
1
57454
1
57455
57456
1
1
57460
1
57461
1
57500
1
57505
57510
57511
57513
1
1
1
1
58100
1
88141
3
88142
3
88143
3
88147
3
88148
3
Screening by automated system with manual rescreening under physician supervision
88150
3
Cytopathology, slides, cervical or vaginal; manual screening under physician
supervision
GYN Tubal
GYN Tubal
GYN Tubal
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Description
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Colposcopy of the vulva;
Colposcopy of the vulva; with biopsy(s)
Colposcopy of the entire vagina, with cervix if present;
Colposcopy of the entire vagina, with cervix if present; with biopsy(s) of vagina/cervix
Colposcopy of the cervix including upper/adjacent vagina
Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix
and endocervical curettage
Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix
Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage
Colposcopy of the cervix including upper/adjacent vagina; with loop electrode
biopsy(s) of the cervix
Colposcopy of the cervix including upper/adjacent vagina; with loop electrode
conization of the cervix
Biopsy of cervix, 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)
Cautery of cervix; electro or thermal
Cautery of cervix; cryocautery, initial or repeat
Cautery of cervix; laser ablation
Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without
cervical dilation, any method (separate procedure)
Cytopathology, cervical or vaginal requiring interpretation by physician
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer
preparation; manual screening under physician supervision
With manual screening and rescreening under physician supervision.
Cytopathology smears, cervical or vaginal; screening by automated system under
physician supervision
February 18, 2017
EOC Name
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
CPT Code
Units
88152
3
88153
3
88154
3
88155
3
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Gynecology
Description
With manual screening and computer-assisted rescreening under physician
supervision
With manual screening and rescreening under physician supervision
With manual screening and computer-assisted rescreening using cell selection and
review under physician supervision
Cytopathology, slides, cervical or vaginal, definitive hormonal evaluation (eg,
maturatrion index, kyryopknotic index, estrogenic index)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
February 18, 2017
EOC Name
CPT Code
Units
99245
1
G0101
92550
92552
92553
92555
92556
1
1
1
1
1
1
92557
92561
92562
92563
92564
92565
92567
92568
1
1
1
1
1
1
1
1
92570
92571
92572
92575
92576
92577
92579
92588
92626
92511
92550
92552
92553
92555
92556
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
92557
1
92561
92567
92579
92582
92583
1
1
1
1
1
Gynecology
Gynecology
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Adult
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Hearing Child
Description
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Cervical or vaginal cancer screening; pelvic and clinical breast examination
Tympanometry and reflex threshold measurements
Pure tone audiometry (threshold); air only
Pure tone audiometry (threshold); air and bone
Speech audiometry threshold;
Speech audiometry threshold; with speech recognition
Comprehensive audiometry threshold evaluation and speech recognition (92553 and
92556 combined)
Bekesy audiometry; diagnostic
Loudness balance test, alternate binaural or monaural
Tone decay test
Short increment sensitivity index (SISI)
Stenger test, pure tone
Tympanometry (impedance testing)
Acoustic reflex testing, threshold
Acoustic immittance testing, includes tympanometry (impedance testing), acoustic
reflex threshold testing, and acoustic reflex decay testing
Filtered speech test
Staggered spondaic word test
Sensorineural acuity level test
Synthetic sentence identification test
Stenger test, speech
Visual reinforcement audiometry (VRA)
Distortion product evoked otoacoustic emissions: comprehensive
Evaluation of auditory rehabilitation status; first hour
Nasopharyngoscopy with endoscope (separate procedure)
Tympanometry and reflex threshold measurements
Pure tone audiometry (threshold); air only
Pure tone audiometry (threshold); air and bone
Speech audiometry threshold;
Speech audiometry threshold; with speech recognition
Comprehensive audiometry threshold evaluation and speech recognition (92553 and
92556 combined)
Bekesy audiometry; diagnostic
Tympanogram
Visual reinforcement audiometry
Conditioning play audiometry
Select picture audiometry
February 18, 2017
EOC Name
Hearing Child
Hearing Child
CPT Code
Units
92585
1
92586
1
92587
1
92588
92626
1
1
G0151
1
G0152
1
G0153
1
G0299
1
G0300
Q5001
Q5002
1
1
1
Q5003
1
Q5004
Q5005
Q5006
Q5007
Q5008
Q5009
58301
1
1
1
1
1
1
1
99201
1
99202
1
99203
1
99204
1
99205
1
Hearing Child
Hearing Child
Hearing Child
Home Health
Home Health
Home Health
Home Health
Home Health
Hospice
Hospice
Hospice
Hospice
Hospice
Hospice
Hospice
Hospice
Hospice
IUD
IUD
IUD
IUD
IUD
IUD
Description
Auditory evoked potentials for evoked response audiometry and/or testing of the
central nervous system; comprehensive
Auditory evoked potentials for evoked response audiometry and/or testing of the
central nervous system; limited
Distortion product evoked otoacoustic emissions; limited evaluation (to confirm the
presence or absence of hearing disorder, 3-6 frequencies) or transient evoked
otoacoustic emissions, with interpretation and report
Distortion product evoked otoacoustic emissions: comprehensive
Evaluation of auditory rehabilitation status; first hour
Services performed by a qualified physical therapist in the home health or hospice
setting, each 15 minutes
Services performed by a qualified occupational therapist in the home health or hospice
setting, each 15 minutes
Services performed by a qualified speech-language pathologist in the home health or
hospice setting, each 15 minutes
Direct skilled nursing services of a registered nurse (RN) in the home health or
hospice setting, each 15 minutes
Direct skilled nursing services of a license practical nurse (LPN) in the home health or
hospice setting, each 15 minutes
Hospice or home health care provided in patient's home/residence
Hospice or home health care provided in assisted living facility
Hospice care provided in nursing long-term care facility (LTC) or nonskilled nursing
facility (NF)
Hospice care provided in skilled nursing facility (SNF)
Hospice care provided in inpatient hospital
Hospice care provided in inpatient hospice facility
Hospice care provided in long-term care facility
Hospice care provided in inpatient psychiatric facility
Hospice or home health care provided in place not otherwise specified (NOS)
Removal of intrauterine device
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
February 18, 2017
EOC Name
CPT Code
Units
99211
2
99212
2
99213
2
99214
2
99215
J7297
J7298
J7300
J7301
2
1
1
1
1
99401
6
99402
6
99403
6
99404
6
10021
10022
19000
2
2
2
19001
2
19081
2
19082
2
19083
2
19084
2
IUD
IUD
IUD
IUD
IUD
IUD
IUD
IUD
IUD
Lactation Counseling Outpatient
Lactation Counseling Outpatient
Lactation Counseling Outpatient
Lactation Counseling Outpatient
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Description
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 3 year duration
Levonorgestrel-releasing intrauterine contraceptive system, 52 mg, 5 year duration
Intrauterine copper contraceptive
Levonorgestrel-releasing intrauterine contraceptive system
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to
an individual (separate procedure); approximately 15 minutes
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to
an individual (separate procedure); approximately 30 minutes
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to
an individual (separate procedure); approximately 45 minutes
Preventive medicine counseling and/or risk factor reduction intervention(s) provided to
an individual (separate procedure); approximately 60 minutes
Fine needle aspiration; without imaging guidance
Fine needle aspiration; with imaging guidance
Puncture aspiration of cyst of breast
Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to
code for primary procedure)
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; first lesion, including stereotactic guidance
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; each additional lesion, including stereotactic guidance (List separately
in addi
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; first lesion, including ultrasound guidance
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; each additional lesion, including ultrasound guidance (List separately in
additi
February 18, 2017
EOC Name
CPT Code
Units
19085
2
19086
2
19100
19101
76641
76642
2
2
1
1
76942
2
77002
77011
2
2
77012
2
77021
2
77065
1
77066
1
77067
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Description
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; first lesion, including magnetic resonance guidance
Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet),
when performed, and imaging of the biopsy specimen, when performed,
percutaneous; each additional lesion, including magnetic resonance guidance (List
separately i
Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate
procedure)
Biopsy of breast; open, incisional
us breast uni real time with image complete
us breast uni real time with image limited
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization
device), imaging supervision and interpretation
Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)
Computed tomography guidance for stereotactic localization
Computed tomography guidance for needle placement (eg, biopsy, aspiration,
injection, localization device), radiological supervision and interpretation
Magnetic resonance guidance for needle placement (eg, for biopsy, needle aspiration,
injection, or placement of localization device) radiological supervision and
interpretation
Diagnostic mammography, including computer-aided detection when performed;
unilateral
Diagnostic mammography, including computer-aided detection when performed;
bilateral
Screening mammography, bilateral (2-view study of each breast), including computeraided detection when performed
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
February 18, 2017
EOC Name
CPT Code
Units
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
99243
1
99244
1
99245
G0202
G0204
G0206
70544
1
1
1
1
1
70551
1
70552
1
70553
1
70554
1
71550
1
71551
1
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
Mammogram/Breast BX
MRI Brain
MRI Brain
MRI Brain
MRI Brain
MRI Brain
MRI Chest
MRI Chest
Description
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Screening mammography, producing direct digital image, bilateral, all views
Diagnostic mammography, producing direct 2D digital image, bilateral, all views
Diagnostic mammography, producing direct digital image, unilateral, all views
Magnetic resonance angiography, head; without contrast material(s)
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); without
contrast material, followed by contrast material(s) and further sequences
Magnetic resonance imaging, brain, functional MRI; including test selection and
administration of repetitive body part movement and/or visual stimulation, not requiring
physician or psychologist administration
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); with contrast material(s)
February 18, 2017
EOC Name
CPT Code
Units
71552
1
71555
27093
27095
1
1
1
27096
1
27370
27648
73525
1
1
1
Description
Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and
mediastinal lymphadenopathy); without contrast material(s), followed by contrast
material(s) and further sequences
Magnetic resonance angiography, chest (excluding myocardium), with or without
contrast material(s)
Injection procedure for hip arthrography; without anesthesia
Injection procedure for hip arthrography; with anesthesia
Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance
(fluoroscopy or CT) including arthrography when performed
Injection procedure for knee arthrography
Injection procedure for ankle arthrography
Radiologic examination, hip, arthrography, radiological supervision and interpretation
73580
1
Radiologic examination, knee, arthrography, radiological supervision and interpretation
73615
1
73718
1
73719
1
73720
1
73721
1
73722
1
73723
1
77002
1
77012
1
70540
1
70542
1
70543
72195
72196
1
1
1
MRI Chest
MRI Chest
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Lower Extremity
MRI Orbit Face
MRI Orbit Face
MRI Orbit Face
MRI Pelvis
MRI Pelvis
Radiologic examination, ankle, arthrography, radiological supervision and
interpretation
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without
contrast material(s)
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with
contrast material(s)
Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without
contrast material(s), followed by contrast material(s) and further sequences
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast
material
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast
material(s)
Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast
material(s), followed by contrast material(s) and further sequences
Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)
Computed tomography guidance for needle placement (eg, biopsy, aspiration,
injection, localization device), radiological supervision and interpretation
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast
material(s)
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast
material(s)
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast
material(s), followed by contrast material(s) and further sequences
Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s)
Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)
February 18, 2017
EOC Name
MRI Pelvis
CPT Code
Units
72197
1
72141
1
72142
1
72146
1
72147
1
72148
1
72149
1
72156
1
72157
1
72158
72195
1
1
23350
1
24220
25246
1
1
73040
1
73085
1
73115
1
73218
1
73219
1
73220
1
73221
1
73222
1
73223
1
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Spine
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
MRI Upper Extremity
Description
Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed
by contrast material(s) and further sequences
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, thoracic; without
contrast material
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; 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; 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, pelvis; without contrast material(s)
Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder
arthrography
Injection procedure for elbow arthrography
Injection procedure for wrist arthrography
Radiologic examination, shoulder, arthrography, radiological supervision and
interpretation
Radiologic examination, elbow, arthrography, radiological supervision and
interpretation
Radiologic examination, wrist, arthrography, radiological supervision and interpretation
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without
contrast material(s
Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with
contrast material(s)
Radiologic examination, hand; 2 views
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast
material(s)
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast
material(s)
Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast
material(s), followed by contrast material(s) and further sequences
February 18, 2017
EOC Name
MRI Upper Extremity
MRI Upper Extremity
Nebulizer
Nebulizer
Nebulizer
Nebulizer
Nebulizer
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
CPT Code
Units
77002
1
77012
1
A7003
A7005
A7013
A7015
E0570
95812
95816
95819
95860
95861
95863
95864
95867
95868
95869
6
1
6
3
1
1
1
1
3
3
3
3
3
3
3
95870
3
95872
3
95885
4
95886
2
95887
4
95907
95908
95909
95910
95911
95912
95913
3
3
3
3
3
3
3
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Description
Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection,
localization device)
Computed tomography guidance for needle placement (eg, biopsy, aspiration,
injection, localization device), radiological supervision and interpretation
Administration set, with small volume nonfiltered pneumatic nebulizer, disposable
Administration set, with small volume nonfiltered pneumatic nebulizer, non-disposable
Filter, disposable, used with aerosol compressor or ultrasonic generator
Aerosol mask, used with DME nebulizer
Nebulizer, with compressor
Electroencephalogram (EEG) extended monitoring; 41-60 minutes
Electroencephalogram (EEG); including recording awake and drowsy
Electroencephalogram (EEG); including recording awake and asleep
Needle electromyography; 1 extremity with or without related paraspinal areas
Needle electromyography; 2 extremities with or without related paraspinal areas
Needle electromyography; 3 extremities with or without related paraspinal areas
Needle electromyography; 4 extremities with or without related paraspinal areas
Needle electromyography; cranial nerve supplied muscle(s), unilateral
Needle electromyography; cranial nerve supplied muscles, bilateral
Needle electromyography; thoracic paraspinal muscles (excluding T1 or T12)
Needle electromyography; limited study of muscles in 1 extremity or non-limb (axial)
muscles (unilateral or bilateral), other than thoracic paraspinal, cranial nerve supplied
muscles, or sphincters
Needle electromyography using single fiber electrode, with quantitative measurement
of jitter, blocking and/or fiber density, any/all sites of each muscle studied
Needle electromyography, each extremity, with related paraspinal areas, when
performed, done with nerve conduction, amplitude and latency/velocity study; limited
(List separately in addition to code for primary procedure)
Needle electromyography, each extremity, with related paraspinal areas, when
performed, done with nerve conduction, amplitude and latency/velocity study;
complete, five or more muscles studied, innervated by three or more nerves or four or
more spinal levels
Needle electromyography, non-extremity (cranial nerve supplied or axial) muscle(s)
done with nerve conduction, amplitude and latency/velocity study (List separately in
addition to code for primary procedure)
Nerve conduction studies; 1-2 studies
Nerve conduction studies; 3-4 studies
Nerve conduction studies; 5-6 studies
Nerve conduction studies; 7-8 studies
Nerve conduction studies; 9-10 studies
Nerve conduction studies; 11-12 studies
Nerve conduction studies; 13 or more studies
February 18, 2017
EOC Name
Neuro
Neuro
Neuro
CPT Code
Units
95937
3
95957
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
99245
1
59000
59001
1
2
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
Neuro
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
Description
Neuromuscular junction testing (repetitive stimulation, paired stimuli), each nerve, any
1 method
Digital analysis of electroencephalogram (EEG) (eg, for epileptic spike analysis)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Amniocentesis; diagnostic
Amniocentesis; therapeutic amniotic fluid reduction (includes ultrasound guidance)
February 18, 2017
EOC Name
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
CPT Code
59012
59015
59020
59025
Units
1
1
1
24
59400
59409
1
1
59410
59425
59426
59430
1
3
6
1
59510
1
59610
1
59612
1
59614
76820
76821
1
4
2
76825
1
76826
1
76827
1
76828
76946
82105
82106
84163
84702
90384
90385
90386
1
1
1
1
1
2
2
2
3
96372
3
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
Description
Cordocentesis (intrauterine), any method
Chorionic villus sampling, any method
Fetal contraction stress test
Fetal non-stress test
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
Antepartum care only; 4-6 visits
Antepartum care only; 7 or more visits
Postpartum care only (separate procedure)
Routine obstetric care including antepartum care, cesarean delivery, and postpartum
care
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
Doppler velocimetry, fetal; umbilical artery
Doppler velocimetry, fetal; middle cerebral artery
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
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral
display; complete
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral
display; follow-up or repeat study
Ultrasonic guidance for amniocentesis, imaging supervision and interpretation
Alpha-fetoprotein (AFP); serum
Alpha-fetoprotein (AFP); amniotic fluid
Pregnancy-associated plasma protein-A
Gonadotropin, chorionic (hCG); quantitative
Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use
Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use
Rho(D) immune globulin (RhIgIV), human, for intravenous use
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
subcutaneous or intramuscular
February 18, 2017
EOC Name
OB High Risk Maternity and Perinatology
CPT Code
Units
99201
1
99202
1
99203
1
99204
1
99205
1
99211
16
99212
16
99213
16
99214
16
99215
16
99241
1
99242
1
99243
1
99244
1
99245
J2788
J2790
1
3
2
J2791
J2792
2
3
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
OB High Risk Maternity and Perinatology
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Injection, Rho(D) immune globulin, human, minidose, 50 mcg (250 i.u.)
Injection, Rho(D) immune globulin, human, full dose, 300 mcg (1500 i.u.)
Injection, Rho(D) immune globulin (human), (Rhophylac), intramuscular or
intravenous, 100 IU
Injection, Rho(D) immune globulin, intravenous, human, solvent detergent, 100 IU
February 18, 2017
EOC Name
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
CPT Code
59000
59015
59025
Units
2
2
5
76801
1
76802
1
76805
1
76810
1
76811
1
76812
1
76813
1
76814
1
76815
1
76816
1
76817
76818
76819
76820
1
3
3
1
76945
1
76946
1
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
Description
Amniocentesis; diagnostic
Chorionic villus sampling, any method
Fetal non-stress test
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, first trimester (<14 weeks0 days), transabdominal approach; single or first
gestation
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, first trimester (<14 weeks 0 days), transabdominal approach; each
additional gestation (List separately in addition to code for primary procedure)
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, after first trimester(> or + 14 weeks 0 days), transabdominal approach;
single or first gestation
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach;
each additional gestation (List separately in addition to code for primary procedure)
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation plus detailed fetal anatomic examination, transabdominal approach; single
or first gestation
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation plus detailed fetal anatomic examination, transabdominal approach; each
additional gestation (List separately in addition to code for primary procedure)
Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal
nuchal translucency measurement, transabdominal or transvaginal approach; single or
first gestation
Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal
nuchal translucency measurement, transabdominal or transvaginal approach; each
additional gestation (List separately in addition to code for primary procedure)
Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal
heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1
or more fetuses
Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, reevaluation of fetal size by measuring standard growth parameters and amniotic fluid
volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a
previous scan), transabdominal approach, per fetus
Ultrasound, pregnant uterus, real time with image documentation, transvaginal
Fetal biophysical profile; with non-stress testing
Fetal biophysical profile; without non-stress testing
Doppler velocimetry, fetal; umbilical artery
Ultrasonic guidance for chorionic villus sampling, imaging supervision and
interpretation
Ultrasonic guidance for amniocentesis, imaging supervision and interpretation
February 18, 2017
EOC Name
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
CPT Code
84163
84702
Units
1
2
99201
1
99202
1
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
99241
1
99242
1
99243
1
99244
1
99245
1
59025
4
59400
1
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB High Risk Provider Screening
OB Mat Ante and Delivery
OB Mat Ante and Delivery
Description
Pregnancy-associated plasma protein-A
Gonadotropin, chorionic (hCG); quantitative
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Fetal non-stress test
Routine obstetric care including antepartum care, vaginal delivery (with or without
episiotomy, and/or forceps) and postpartum care
February 18, 2017
EOC Name
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
CPT Code
59409
Units
1
59410
59412
59414
59425
59426
59430
1
1
1
3
1
1
59510
59515
1
1
59614
1
76805
1
76810
1
76825
1
76826
1
76827
1
76828
82105
82106
84163
84702
1
1
1
1
2
88142
1
88175
90384
90385
90386
1
3
3
3
99201
1
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
Description
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
Delivery of placenta (separate procedure)
Antepartum care only; 4-6 visits
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; including postpartum care
Vaginal delivery only, after previous cesarean delivery (with or without episiotomy
and/or forceps); including postpartum care
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, after first trimester(> or + 14 weeks 0 days), transabdominal approach;
single or first gestation
Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal
evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach;
each additional gestation (List separately in addition to code for primary procedure)
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
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral
display; complete
Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral
display; follow-up or repeat study
Alpha-fetoprotein (AFP); serum
Alpha-fetoprotein (AFP); amniotic fluid
Pregnancy-associated plasma protein-A
Gonadotropin, chorionic (hCG); quantitative
Cytopathology, cervical or vaginal, collected in preservative fluid, automated thin layer
preparation; manual screening under physician supervision
Cytopathology, cervical or vaginal (any reporting system), collected in preservative
fluid, automated thin layer preparation; with screening by automated system and
manual rescreening or review, under physician supervision
Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use
Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use
Rho(D) immune globulin (RhIgIV), human, for intravenous use
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
February 18, 2017
EOC Name
OB Mat Ante and Delivery
CPT Code
Units
99202
1
99203
1
99204
1
99205
1
99211
16
99212
16
99213
16
99214
16
99215
16
99241
1
99242
1
99243
1
99244
1
99245
J2788
J2790
1
3
3
J2791
J2792
3
3
96361
11
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
OB Mat Ante and Delivery
Oncology
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Injection, Rho(D) immune globulin, human, minidose, 50 mcg (250 i.u.)
Injection, Rho(D) immune globulin, human, full dose, 300 mcg (1500 i.u.)
Injection, Rho(D) immune globulin (human), (Rhophylac), intramuscular or
intravenous, 100 IU
Injection, Rho(D) immune globulin, intravenous, human, solvent detergent, 100 IU
Intravenous infusion, hydration; each additional hour (List separately in addition to
code for primary procedure) 11 units
February 18, 2017
EOC Name
Oncology
CPT Code
Units
96365
15
96366
25
96367
20
96368
12
96372
15
96375
20
96411
14
96413
30
96415
12
96416
12
96417
12
96521
24
99201
1
99202
1
99203
1
99204
1
99205
1
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Description
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or
drug); initial, up to 1 hour 15 units
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or
drug); each additional hour (List separately in addition to code for primary procedure)
25 units
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or
drug); additional sequential infusion of a new drug/substance, up to 1 hour (List
separately in addition to code for primary procedure) 20 units
Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or
drug); concurrent infusion (List separately in addition to code for primary procedure) 12
units
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug);
subcutaneous or intramuscular
Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each
additional sequential intravenous push of a new substance/drug (List separately in
addition to code for primary procedure) 20 units
Chemotherapy administration; intravenous, push technique, each additional
substance/drug (List separately in addition to code for primary procedure) 14 units
Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or
initial substance/drug 30 units
Chemotherapy administration, intravenous infusion technique; each additional hour
(List separately in addition to code for primary procedure) 12 units
Chemotherapy administration, intravenous infusion technique; initiation of prolonged
chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable
pump 12 units
Chemotherapy administration, intravenous infusion technique; each additional
sequential infusion (different substance/drug), up to 1 hour (List separately in addition
to code for primary procedure) 12 units
Refilling and maintenance of portable pump 24 units
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
February 18, 2017
EOC Name
Oncology
Oncology
Oncology
Oncology
Oncology
CPT Code
Units
99211
26
99212
26
99213
26
99214
26
99215
26
99241
1
99242
1
99243
1
99244
1
99245
1
J1100
J1200
J1442
J1453
J1626
J1720
J2353
J2405
J3480
J7030
97012
97016
97022
97024
60
30
52
52
150
50
200
200
200
52
26
26
26
12
97032
26
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
Oncology
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
Description
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Injection, dexamethosone sodium phosphate, 1 mg 60 units
Injection, diphenhydramine HCl, up to 50 mg 30 units
Injection, filgrastim (G-CSF), 1 microgram 52 units
Injection, fosaprepitant, 1 mg 52 units
Injection, granisetron hydrochloride, 100 mcg 150 units
Injection, hydrocortisone sodium succinate, up to 100 mg 50 units
Injection, octreotide, depot form for intramuscular injection, 1 mg 200 units
Injection, ondansetron HCl, per 1 mg 200 units
Injection, potassium chloride, per 2 mEq 200 units
Infusion, normal saline solution, 1,000 cc 52 units
Application of a modality to 1 or more areas; traction, mechanical
Application of a modality to 1 or more areas; vasopneumatic devices
Application of a modality to 1 or more areas; whirlpool
Application of a modality to 1 or more areas; diathermy (eg, microwave)
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15
minutes
February 18, 2017
EOC Name
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
CPT Code
97035
97036
Units
26
12
97110
52
97112
52
97113
26
97140
97150
97165
97166
97167
97168
26
26
1
1
1
4
97530
52
97535
97761
97012
97014
97016
97018
97022
97024
26
12
26
26
26
26
26
12
97032
26
97034
97035
97036
12
26
12
97110
52
97112
52
97113
52
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy OT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
Description
Application of a modality to 1 or more areas; ultrasound, each 15 minutes
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to
develop strength and endurance, range of motion and flexibility
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation
of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception
for sitting and/or standing activities
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with
therapeutic exercises
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic
drainage, manual traction), 1 or more regions, each 15 minutes
Therapeutic procedure(s), group (2 or more individuals)
Occupational therapy eval low complex 30 minutes
Occupational therapy eval mod complex 45 minutes
Occupational therapy eval high complex 60 minutes
Occupational therapy re-eval est plan care 30 minutes
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Prosthetic training, upper and/or lower extremity(s), each 15 minutes
Application of a modality to 1 or more areas; traction, mechanical
Application of a modality to 1 or more areas; electrical stimulation (unattended)
Application of a modality to 1 or more areas; vasopneumatic devices
Application of a modality to 1 or more areas; paraffin bath
Application of a modality to 1 or more areas; whirlpool
Application of a modality to 1 or more areas; diathermy (eg, microwave)
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15
minutes
Application of a modality to 1 or more areas; contrast baths, each 15 minutes
Application of a modality to 1 or more areas; ultrasound, each 15 minutes
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to
develop strength and endurance, range of motion and flexibility
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation
of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception
for sitting and/or standing activities
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with
therapeutic exercises
February 18, 2017
EOC Name
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
PEDS DEV Therapy PT
CPT Code
Units
97116
26
97140
26
97150
97161
97162
97163
97164
26
1
1
1
2
97530
52
97535
26
74230
2
92507
52
92508
92521
35
1
92522
1
92523
92524
92526
92610
1
1
15
1
97535
52
11750
1
17000
4
17110
4
17111
4
PEDS DEV Therapy PT
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
PEDS DEV Therapy ST
Podiatry
Podiatry
Podiatry
Podiatry
Description
Therapeutic procedure, one or more areas, each 15 minutes; gait training (includes
stair climbing)
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic
drainage, manual traction), 1 or more regions, each 15 minutes
Therapeutic procedure(s), group (2 or more individuals)
Physical Therapy Evaluation low complex 20 minutes
Physical Therapy Evaluation mod complex 30 minutes
Physical Therapy Evaluation high complex 45 minutes
Physical Therapy Re-eval est plan care
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Swallowing function, with cineradiography/videoradiography
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; individual
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; group, 2 or more individuals
Evaluation of speech fluency (eg, stuttering, cluttering)
Evaluation of speech sound production (eg, articulation, phonological process,
apraxia, dysarthria)
Evaluation of speech sound production (eg, articulation, phonological process,
apraxia, dysarthria); with evaluation of language comprehension and expression (eg,
receptive and expressive language)
Behavioral and qualitative analysis of voice and resonance
Treatment of swallowing dysfunction and/or oral function for feeding
Evaluation of oral and pharyngeal swallowing function
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Excision of nail and nail matrix, partial or complete, (eg, ingrown or deformed nail) for
permanent removal
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), premalignant lesions (eg, actinic keratoses); first lesion
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), of benign lesions other than skin tags or cutaneous vascular proliferative
lesions; up to 14 lesions
Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical
curettement), of benign lesions other than skin tags or cutaneous vascular proliferative
lesions; 15 or more lesions
February 18, 2017
EOC Name
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
CPT Code
20550
20551
20600
Units
1
1
1
20605
4
29540
4
64455
4
64632
73620
73630
76881
4
4
4
4
76882
4
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
99241
1
99242
1
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Podiatry
Description
Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")
Injection(s); single tendon origin/insertion
Arthrocentesis, aspiration and/or injection; small joint or bursa (eg, fingers, toes)
Arthrocentesis, aspiration and/or injection; intermediate joint or bursa (eg,
temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)
Strapping; ankle and/or foot
Injection(s), anesthetic agent and/or steroid, plantar common digital nerve(s) (eg,
Morton's neuroma)
Destruction by neurolytic agent; plantar common digital nerve
Radiologic examination, foot; 2 views
Radiologic examination, foot; complete, minimum of 3 views
Ultrasound, extremity, nonvascular, real-time with image documentation; complete
Ultrasound, extremity, nonvascular, real-time with image documentation; limited,
anatomic specific
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
February 18, 2017
EOC Name
CPT Code
Units
99243
1
99244
1
99245
1
71020
7
94010
7
94060
7
94070
94200
94250
94375
3
7
3
7
94620
3
94621
3
94640
3
94642
94660
94662
6
2
1
94664
94680
2
3
94681
94690
3
3
94726
94729
3
3
94750
3
Podiatry
Podiatry
Podiatry
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Description
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Radiologic examination, chest, 2 views, frontal and lateral
Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate
measurement(s), with or without maximal voluntary ventilation
Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator
administration
Bronchospasm provocation evaluation, multiple spirometric determinations as in
94010, with administered agents (eg, antigen[s], cold air, methacholine)
Maximum breathing capacity, maximal voluntary ventilation
Expired gas collection, quantitative, single procedure (separate procedure)
Respiratory flow volume loop
Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for
bronchospasm with pre- and post-spirometry and oximetry)
Pulmonary stress testing; complex (including measurements of CO2 production, O2
uptake, and electrocardiographic recordings)
Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for
sputum induction for diagnostic purposes (eg, with an aerosol generator, nebulizer,
metered dose inhaler or intermittent positive pressure breathing [IPPB] device)
Aerosol inhalation of pentamidine for pneumocystis carinii pneumonia treatment or
prophylaxis
Continuous positive airway pressure ventilation (CPAP), initiation and management
Continuous negative pressure ventilation (CNP), initiation and management
Demonstration and/or evaluation of patient utilization of an aerosol generator,
nebulizer, metered dose inhaler or IPPB device
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)
Plethysmography for determination of lung volumes and, when performed, airway
resistance
Diffusing capacity (eg, carbon monoxide, membrane)
Pulmonary compliance study (eg, plethysmography, volume and pressure
measurements
February 18, 2017
EOC Name
CPT Code
Units
99201
1
99202
1
99203
1
99204
1
99205
1
99211
6
99212
6
99213
6
99214
6
99215
6
99241
1
99242
1
99243
1
99244
1
99245
1
G0237
36
G0238
36
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary
Pulmonary Rehab
Pulmonary Rehab
Description
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Therapeutic procedures to increase strength or endurance of respiratory muscles, face
to face, one on one, each 15 minutes
Therapeutic procedures to improve respiratory function, other than described by
G0237, one on one, face to face, per 15 minutes
February 18, 2017
EOC Name
Pulmonary Rehab
Pulmonary Rehab
CPT Code
Units
G0239
36
G0424
36
95782
1
95783
1
95807
1
95808
1
95810
1
95811
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
A4557
A4595
3
12
6
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
Sleep Study
TENS
TENS
Description
Therapeutic procedures to improve respiratory function or increase strength or
endurance of respiratory muscles, two or more individuals (includes monitoring)
Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per
session, up to 2 sessions per day
Polysomnography; younger than 6 years, sleep staging with 4 or more additional
parameters of sleep, attended by a technologist
Polysomnography; younger than 6 years, sleep staging with 4 or more additional
parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist
Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart
rate, and oxygen saturation, attended by a technologist - Last Update
Polysomnography; any age, sleep staging with 1-3 additional parameters of sleep,
attended by a technologist
Polysomnography; age 6 years or older, sleep staging with 4 or more additional
parameters of sleep, attended by a technologist
Polysomnography; age 6 years or older, sleep staging with 4 or more additional
parameters of sleep, with initiation of continuous positive airway pressure therapy or
bilevel ventilation, attended by a technologist
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Lead wires (e.g., Apnea monitor), per pair
Electrical stimulator supplies, 2 lead, per month, (e.g. tens, nmes)
February 18, 2017
EOC Name
TENS
TENS
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
CPT Code
Units
E0720
1
E0730
1
97012
97016
97022
97024
20
12
20
20
97032
97035
97036
20
20
20
97110
20
97112
20
97113
20
97140
97150
97165
97166
97167
97168
20
20
1
1
1
2
97530
20
97535
97761
97012
97014
97016
97018
97022
97024
20
20
12
12
12
12
12
12
97032
12
97034
12
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy OT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Description
Transcutaneous electrical nerve stimulation (TENS) device, two lead, localized
stimulation
Transcutaneous electrical nerve stimulation (TENS) device, four or more leads, for
multiple nerve stimulation
Application of a modality to 1 or more areas; traction, mechanical
Application of a modality to 1 or more areas; vasopneumatic devices
Application of a modality to 1 or more areas; whirlpool
Application of a modality to 1 or more areas; diathermy (eg, microwave)
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15
minutes
Application of a modality to 1 or more areas; ultrasound, each 15 minutes
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to
develop strength and endurance, range of motion and flexibility
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation
of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception
for sitting and/or standing activities
Therapeutic procedure, 1 or more areas, each 15 minutes; aquatic therapy with
therapeutic exercises
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic
drainage, manual traction), 1 or more regions, each 15 minutes
Therapeutic procedure(s), group (2 or more individuals)
Occupational therapy eval low complex 30 minutes
Occupational therapy eval mod complex 45 minutes
Occupational therapy eval high complex 60 minutes
Occupational therapy re-eval est plan care 30 minutes
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Prosthetic training, upper and/or lower extremity(s), each 15 minutes
Application of a modality to 1 or more areas; traction, mechanical
Application of a modality to 1 or more areas; electrical stimulation (unattended)
Application of a modality to 1 or more areas; vasopneumatic devices
Application of a modality to 1 or more areas; paraffin bath
Application of a modality to 1 or more areas; whirlpool
Application of a modality to 1 or more areas; diathermy (eg, microwave)
Application of a modality to 1 or more areas; electrical stimulation (manual), each 15
minutes
Application of a modality to 1 or more areas; contrast baths, each 15 minutes
February 18, 2017
EOC Name
Therapy PT
Therapy PT
Therapy PT
CPT Code
97035
97036
Units
12
12
97110
12
97112
12
97113
12
97116
12
97140
12
97150
97161
97162
97163
97164
12
1
1
1
2
97530
12
97535
12
92507
20
92508
92521
20
1
92522
1
92523
92524
1
1
97535
76700
20
1
76705
1
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy PT
Therapy ST
Therapy ST
Therapy ST
Therapy ST
Therapy ST
Therapy ST
Therapy ST
Ultrasound Abdominal
Ultrasound Abdominal
Description
Application of a modality to 1 or more areas; ultrasound, each 15 minutes
Application of a modality to 1 or more areas; Hubbard tank, each 15 minutes
Therapeutic procedure, 1 or more areas, each 15 minutes; therapeutic exercises to
develop strength and endurance, range of motion and flexibility
Therapeutic procedure, 1 or more areas, each 15 minutes; neuromuscular reeducation
of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception
for sitting and/or standing activities
Therapeutic procedure, 1 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)
Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic
drainage, manual traction), 1 or more regions, each 15 minutes
Therapeutic procedure(s), group (2 or more individuals)
Physical Therapy Evaluation low complex 20 minutes
Physical Therapy Evaluation mod complex 30 minutes
Physical Therapy Evaluation high complex 45 minutes
Physical Therapy Re-eval est plan care
Therapeutic activities, direct (one-on-one) patient contact by the provider (use of
dynamic activities to improve functional performance), each 15 minutes
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; individual
Treatment of speech, language, voice, communication, and/or auditory processing
disorder; group, 2 or more individuals
Evaluation of speech fluency (eg, stuttering, cluttering)
Evaluation of speech sound production (eg, articulation, phonological process,
apraxia, dysarthria)
Evaluation of speech sound production (eg, articulation, phonological process,
apraxia, dysarthria); with evaluation of language comprehension and expression (eg,
receptive and expressive language)
Behavioral and qualitative analysis of voice and resonance
Self-care/home management training (eg, activities of daily living (ADL) and
compensatory training, meal preparation, safety procedures, and instructions in use of
assistive technology …
Ultrasound, abdominal, real time with image documentation; complete
Ultrasound, abdominal, real time with image documentation; limited (eg, single organ,
quadrant, follow-up)
February 18, 2017
EOC Name
Ultrasound Abdominal
Ultrasound Abdominal
Ultrasound Extremity
Ultrasound Extremity
Ultrasound Female Pelvic
Ultrasound Female Pelvic
Ultrasound Female Pelvic
CPT Code
Units
76770
1
76775
1
76881
1
76882
76830
76856
1
1
1
76857
1
76885
1
76886
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
51700
1
51701
51702
2
2
Ultrasound Infant Hips
Ultrasound Infant Hips
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urgent Care
Urology
Urology
Urology
Description
Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image
documentation; complete
Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image
documentation; limited
Ultrasound, extremity, nonvascular, real-time with image documentation; complete
Ultrasound, extremity, nonvascular, real-time with image documentation; limited,
anatomic specific
Ultrasound, transvaginal
Ultrasound, pelvic (nonobstetric), real time with image documentation; complete
Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or followup (eg, for follicles)
Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring
physician or other qualified health care professional manipulation)
Ultrasound, infant hips, real time with imaging documentation; limited, static (not
requiring physician or other qualified health care professional manipulation)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Bladder irrigation, simple, lavage and/or instillation
Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual
urine)
Insertion of temporary indwelling bladder catheter; simple (eg, Foley)
February 18, 2017
EOC Name
CPT Code
Units
51703
51705
2
2
51798
52000
1
1
52310
53600
53601
53660
53661
54056
55700
1
1
1
1
1
1
1
76942
2
99024
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Urology
Description
Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy,
fractured catheter/balloon)
Change of cystostomy tube; simple
Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, nonimaging
Cystourethroscopy (separate procedure)
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from
urethra or bladder (separate procedure); simple
Dilation of urethral stricture by passage of sound or urethral dilator, male; initial
Dilation of urethral stricture by passage of sound or urethral dilator, male; subsequent
Dilation of female urethra including suppository and/or instillation; initial
Dilation of female urethra including suppository and/or instillation; subsequent
Destruction of lesion on the penis
Biopsy, prostate; needle or punch, single or multiple, any approach
Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization
device), imaging supervision and interpretation
Postoperative follow-up visit, normally included in the surgical package, to indicate that
an evaluation and management service was performed during a postoperative period
for a reason(s) related to the original procedure
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99241
1
99242
1
99243
1
99244
1
99245
1
93970
1
93971
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
3
99212
3
99213
3
99214
3
99215
3
Urology
Urology
Urology
Urology
Urology
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Description
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
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
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
February 18, 2017
EOC Name
CPT Code
Units
99241
1
99242
1
99243
1
99244
1
99245
1
55250
1
99201
1
99202
1
99203
1
99204
1
99205
1
99211
1
99212
1
99213
1
99214
1
99215
1
99241
1
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vascular Surgery Eval
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Description
Office consultation for a new or established patient, which requires these 3 key
components: A problem focused history; A problem focused examination; and
Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen
examination(s)
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components: An expanded problem focused history; An
expanded problem focused examination
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components:
Office or other outpatient visit for the evaluation and management of a new patient,
which requires these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, that may not require the presence of a physician or other qualified health care
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Office consultation for a new or established patient, which requires these 3
components: A problem focused history, A problem focused examination, and a
Straightforward medical decision making
February 18, 2017
EOC Name
CPT Code
Units
99242
1
99243
1
99244
1
99245
1
92537
1
92540
1
92541
92542
1
1
92544
1
92546
92547
1
1
99213
1
74230
92610
1
1
Vasectomy
Vasectomy
Vasectomy
Vasectomy
Vestibular Testing
Vestibular Testing
Vestibular Testing
Vestibular Testing
Vestibular Testing
Vestibular Testing
Vestibular Testing
Vestibular Testing
Videoflouroscopic Swallowing Study
Videoflouroscopic Swallowing Study
Description
Office consultation for a new or established patient, which requires these 3 key
components: An expanded problem focused history; An expanded problem focused
examination; and Straightforward medical decision making.
Office consultation for a new or established patient, which requires these 3 key
components: A detailed history; A detailed examination; and Medical decision making
of low complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of moderate complexity.
Office consultation for a new or established patient, which requires these 3 key
components: A comprehensive history; A comprehensive examination; and Medical
decision making of high complexity.
Caloric vestibular test with recording, bilateral; bithermal (ie, one warm and one cool
irrigation in each ear for a total of four irrigations)
Basic vestibular eval, incl spontaneous nystagmus test w/eccentric gaze fix nystagmus
w/rec, nystagmus test, min 4 positions, w/rec, optokinetic nystagmus test, bidirectional
foveal & peripheral stimulation, w/rec & oscillating tracking test, w/rec
Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
Positional nystagmus test, minimum of 4 positions, with recording
Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, with
recording
Sinusoidal vertical axis rotational testing
Use of vertical electrodes (List separately in addition to code for primary procedure)
Office or other outpatient visit for the evaluation and management of an established
patient, which requires at least 2 of these 3 key components:
Swallowing function, with cineradiography/videoradiography
Evaluation of oral and pharyngeal swallowing function