[Federal Register: September 8, 1998 (Volume 63, Number 173)] [Proposed Rules] [Page 47801-47850] From the Federal Register Online via GPO Access [wais.access.gpo.gov] [DOCID:fr08se98-39] [[pp. 47801-47850]] Medicare Program; Prospective Payment System for Hospital Outpatient Services [[Continued from page 47800]] [[Page 47800]] 470.. 49999 UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM 470.. 50688 CHANGE OF URETEROSTOMY TUBE 470.. 51705 CHANGE OF CYSTOSTOMY TUBE; SIMPLE 470.. 51710 CHANGE OF CYSTOSTOMY TUBE; COMPLICATED 521.. Level I Cystourethroscopy and T 5.06 $256.39 $112.10 $51.28 other Genitourinary Procedures 521.. 50398 CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE 521.. 52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE) 521.. 52265 CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; LOCAL ANESTHESIA 522.. Level II Cystourethroscopy and T 10.46 $530.00 $262.39 $106.00 other Genitourinary Procedures 522.. 50551 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; 522.. 50553 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL CATHETERIZATION, WITH OR WITHOUT DILATION OF URETER 522.. 50555 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY 522.. 50557 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR INCISION, WITH OR WITHOUT BIOPSY 522.. 50559 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF RADIOACTIVE SUBSTANCE WITH OR WITHOUT BIOPSY AND/OR FULGURATION 522.. 50561 RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY OR PYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS 522.. 52005 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; 522.. 52007 CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BRUSH BIOPSY OF URETER AND/OR RENAL PELVIS 522.. 52010 CYSTOURETHROSCOPY, WITH EJACULATORY DUCT CATHETERIZATION, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR DUCT RADIOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE 522.. 52204 CYSTOURETHROSCOPY, WITH BIOPSY 522.. 52214 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OF TRIGONE, BLADDER NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS 522.. 52224 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT OF MINOR (LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY 522.. 52260 CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (SPINAL) ANESTHESIA 522.. 52270 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE 522.. 52275 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE 522.. 52276 CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY 522.. 52281 CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OF URETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR FEMALE 522.. 52283 CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE 522.. 52285 CYSTOURETHROSCOPY FOR TREATMENT OF THE FEMALE URETHRAL SYNDROME WITH ANY OR ALL OF THE FOLLOWING: URETHRAL MEATOTOMY, URETHRAL DILATION, INTERNAL URETHROTOMY, LYSIS OF URETHROVAGINAL SEPTAL FIBROSIS, LATERAL INCISIONS OF THE BLADDER NECK, AND FULGURATION 522.. 52290 CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL OR BILATERAL 522.. 52300 CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL 522.. 52301 CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL 522.. 52305 CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE 522.. 52310 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE 522.. 52315 CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS, OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED 522.. 52327 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH SUBURETERIC INJECTION OF IMPLANT MATERIAL 522.. 52510 TRANSURETHRAL BALLOON DILATION OF THE PROSTATIC URETHRA, ANY METHOD 522.. 53605 DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA 523.. Level III Cystourethroscopy T 16.87 $854.79 $447.03 $170.96 and other Genitourinary Procedures 523.. 50951 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; 523.. 50953 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH URETERAL CATHETERIZATION, WITH OR WITHOUT DILATION OF URETER 523.. 50955 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BIOPSY 523.. 50957 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH FULGURATION AND/OR INCISION, WITH OR WITHOUT BIOPSY 523.. 50959 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY AND/OR FULGURATION (NOT INCLUDING PROVIS) 523.. 50961 URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH REMOVAL OF FOREIGN BODY OR CALCULUS 523.. 51020 CYSTOTOMY OR CYSTOSTOMY; WITH FULGURATION AND/OR INSERTION OF RADIOACTIVE MATERIAL 523.. 51030 CYSTOTOMY OR CYSTOSTOMY; WITH CRYOSURGICAL DESTRUCTION OF INTRAVESICAL LESION [[Page 47801]] 523.. 51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE 523.. 51045 CYSTOTOMY, WITH INSERTION OF URETERAL CATHETER OR STENT (SEPARATE PROCEDURE) 523.. 51050 CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION 523.. 51065 CYSTOTOMY, WITH STONE BASKET EXTRACTION AND/OR ULTRASONIC OR ELECTROHYDRAULIC FRAGMENTATION OF URETERAL CALCULUS 523.. 51520 CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATE PROCEDURE) 523.. 51880 CLOSURE OF CYSTOSTOMY (SEPARATE PROCEDURE) 523.. 52234 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 TO 2.0 CM) 523.. 52235 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM) 523.. 52240 CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S) 523.. 52250 CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, WITH OR WITHOUT BIOPSY OR FULGURATION 523.. 52277 CYSTOURETHROSCOPY, WITH RESECTION OF EXTERNAL SPHINCTER (SPHINCTEROTOMY) 523.. 52282 CYSTOURETHROSCOPY, WITH INSERTION OF URETHRAL STENT 523.. 52317 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM) 523.. 52318 LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUS BY ANY MEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM) 523.. 52320 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS 523.. 52325 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH FRAGMENTATION OF URETERAL CALCULUS (EG, ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE) 523.. 52330 CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS 523.. 52332 CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL STENT (EG, GIBBONS OR DOUBLE-J TYPE) 523.. 52334 CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS NEPHROSTOMY, RETROGRADE 523.. 52335 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR PYELOURETERAL JUNCTION BY ANY METHOD); 523.. 52336 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR PYELOURETERAL JUNCTION BY ANY METHOD); WITH REMOVAL OR MANIPULATION OF CALCULUS (URETERAL CATHETERIZATION IS INCLUDED) 523.. 52338 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR PYELOURETERAL JUNCTION BY ANY METHOD); WITH BIOPSY AND/OR FULGURATION OF LESION 523.. 52339 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR PYELOURETERAL JUNCTION BY ANY METHOD); WITH RESECTION OF TUMOR 523.. 52340 CYSTOURETHROSCOPY WITH INCISION, FULGURATION, OR RESECTION OF CONGENITAL POSTERIOR URETHRAL VALVES, OR CONGENITAL OBSTRUCTIVE HYPERTROPHIC MUCOSAL FOLDS 523.. 52450 TRANSURETHRAL INCISION OF PROSTATE 523.. 52500 TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE) 523.. 52606 TRANSURETHRAL FULGURATION FOR POSTOPERATIVE BLEEDING OCCURRING AFTER THE USUAL FOLLOW-UP TIME 523.. 52640 TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK CONTRACTURE 523.. 52700 TRANSURETHRAL DRAINAGE OF PROSTATIC ABSCESS 523.. 55720 PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; SIMPLE 523.. 55725 PROSTATOTOMY, EXTERNAL DRAINAGE OF PROSTATIC ABSCESS, ANY APPROACH; COMPLICATED 523.. 55859 TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT APPLICATION, WITH OR WITHOUT CYSTOSCOPY 524.. Level IV Cystourethroscopy and T 28.89 $1,463.84 $833.38 $292.77 other Genitourinary Procedures 524.. 52337 CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY (INCLUDES DILATION OF THE URETER AND/OR PYELOURETERAL JUNCTION BY ANY METHOD); WITH LITHOTRIPSY (URETERAL CATHETERIZATION IS INCLUDED) 524.. 52601 TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED) 524.. 52612 TRANSURETHRAL RESECTION OF PROSTATE; FIRST STAGE OF TWO-STAGE RESECTION (PARTIAL RESECTION) 524.. 52614 TRANSURETHRAL RESECTION OF PROSTATE; SECOND STAGE OF TWO-STAGE RESECTION (RESECTION COMPLETED) 524.. 52620 TRANSURETHRAL RESECTION; OF RESIDUAL OBSTRUCTIVE TISSUE AFTER 90 DAYS POSTOPERATIVE 524.. 52630 TRANSURETHRAL RESECTION; OF REGROWTH OF OBSTRUCTIVE TISSUE LONGER THAN ONE YEAR POSTOPERATIVE 524.. 52647 NON-CONTACT LASER COAGULATION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED) 524.. 52648 CONTACT LASER VAPORIZATION WITH OR WITHOUT TRANSURETHRAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED) 524.. 53850 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY MICROWAVE THERMOTHERAPY 524.. 53852 TRANSURETHRAL DESTRUCTION OF PROSTATE TISSUE; BY RADIOFREQUENCY THERMOTHERAPY 527.. Lithotripsy T 51.56 $2,612.52 $1,372.95 $522.5 527.. 50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE 529.. Simple Urinary Studies and T 2.5 $126.67 $63.05 $25.33 Procedures 529.. 50396 MANOMETRIC STUDIES THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL CATHETER 529.. 50686 MANOMETRIC STUDIES THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER 529.. 51725 SIMPLE CYSTOMETROGRAM (CMG) (EG, SPINAL MANOMETER) 529.. 51726 COMPLEX CYSTOMETROGRAM (EG, CALIBRATED ELECTRONIC EQUIPMENT) 529.. 51736 SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE, MECHANICAL UROFLOWMETER) [[Page 47802]] 529.. 51741 COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT) 529.. 51772 URETHRAL PRESSURE PROFILE STUDIES (UPP) (URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE 529.. 51784 ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQUE 529.. 51785 NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRAL SPHINCTER, ANY TECHNIQUE 529.. 51792 STIMULUS EVOKED RESPONSE (EG, MEASUREMENT OF BULBOCAVERNOSUS REFLEX LATENCY TIME) 529.. 51795 VOIDING PRESSURE STUDIES (VP); BLADDER VOIDING PRESSURE, ANY TECHNIQUE 529.. 51797 VOIDING PRESSURE STUDIES (VP); INTRA-ABDOMINAL VOIDING PRESSURE (AP) (RECTAL, GASTRIC, INTRAPERITONEAL) 529.. 54240 PENILE PLETHYSMOGRAPHY 529.. 54250 NOCTURNAL PENILE TUMESCENCE AND/OR RIGIDITY TEST 530.. Genitourinary Procedures T 2.52 $127.69 $54.69 $25.54 530.. 51000 ASPIRATION OF BLADDER BY NEEDLE 530.. 51005 ASPIRATION OF BLADDER; BY TROCAR OR INTRACATHETER 530.. 51010 ASPIRATION OF BLADDER; WITH INSERTION OF SUPRAPUBIC CATHETER 530.. 51700 BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION 530.. 51720 BLADDER INSTILLATION OF ANTICARCINOGENIC AGENT (INCLUDING DETENTION TIME) 530.. 53600 DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; INITIAL 530.. 53601 DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR URETHRAL DILATOR, MALE; SUBSEQUENT 530.. 53620 DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; INITIAL 530.. 53621 DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND FOLLOWER, MALE; SUBSEQUENT 530.. 53660 DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; INITIAL 530.. 53661 DILATION OF FEMALE URETHRA INCLUDING SUPPOSITORY AND/OR INSTILLATION; SUBSEQUENT 530.. 53675 CATHETERIZATION, URETHRA; COMPLICATED (MAY INCLUDE DIFFICULT REMOVAL OF BALLOON CATHETER) 530.. 53899 UNLISTED PROCEDURE, URINARY SYSTEM 530.. 54200 INJECTION PROCEDURE FOR PEYRONIE DISEASE; 530.. 54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM 530.. 54231 DYNAMIC CAVERNOSOMETRY, INCLUDING INTRACAVERNOSAL INJECTION OF VASOACTIVE DRUGS (EG, PAPAVERINE, PHENTOLAMINE) 530.. 54235 INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S) (EG, PAPAVERINE, PHENTOLAMINE) 530.. 54450 FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIAL ADHESIONS AND STRETCHING 530.. 55899 UNLISTED PROCEDURE, MALE GENITAL SYSTEM 531.. Level I Urethral Procedures T 18.94 $959.68 $527.26 $191.94 531.. 51715 ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK 531.. 53000 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PENDULOUS URETHRA 531.. 53010 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA, EXTERNAL 531.. 53020 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); EXCEPT INFANT 531.. 53025 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE); INFANT 531.. 53040 DRAINAGE OF DEEP PERIURETHRAL ABSCESS 531.. 53060 DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST 531.. 53080 DRAINAGE OF PERINEAL URINARY EXTRAVASATION; UNCOMPLICATED (SEPARATE PROCEDURE) 531.. 53200 BIOPSY OF URETHRA 531.. 53250 EXCISION OF BULBOURETHRAL GLAND (COWPER'S GLAND) 531.. 53260 EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTAL URETHRA 531.. 53265 EXCISION OR FULGURATION; URETHRAL CARUNCLE 531.. 53270 EXCISION OR FULGURATION; SKENE'S GLANDS 531.. 53275 EXCISION OR FULGURATION; URETHRAL PROLAPSE 531.. 53442 REMOVAL OF PERINEAL PROSTHESIS INTRODUCED FOR CONTINENCE 531.. 53502 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE 531.. 53505 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE 531.. 53510 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PERINEAL 531.. 53665 DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) ANESTHESIA 531.. 54000 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); NEWBORN 531.. 54001 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE); EXCEPT NEWBORN 532.. Level II Urethral Procedures T 25.5 $1,292.07 $602.18 $258.41 532.. 53210 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE 532.. 53215 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; MALE 532.. 53220 EXCISION OR FULGURATION OF CARCINOMA OF URETHRA 532.. 53230 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); FEMALE 532.. 53235 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE); MALE 532.. 53240 MARSUPIALIZATION OF URETHRAL DIVERTICULUM, MALE OR FEMALE 532.. 53400 URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, OR STRICTURE (EG, JOHANNSEN TYPE) 532.. 53405 URETHROPLASTY; SECOND STAGE (FORMATION OF URETHRA), INCLUDING URINARY DIVERSION 532.. 53410 URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIOR URETHRA 532.. 53420 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; FIRST STAGE 532.. 53425 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OF PROSTATIC OR MEMBRANOUS URETHRA; SECOND STAGE 532.. 53430 URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA 532.. 53447 REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE SPHINCTER INCLUDING PUMP AND/OR RESERVOIR AND/OR CUFF 532.. 53449 SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE SPHINCTER DEVICE 532.. 53450 URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT 532.. 53460 URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRAL SEGMENT (RICHARDSON TYPE PROCEDURE) 532.. 53515 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PROSTATOMEMBRANOUS 532.. 53520 CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE (SEPARATE PROCEDURE) 536.. Circumcision T 13.17 $667.32 $326.57 $133.46 536.. 54150 CIRCUMCISION, USING CLAMP OR OTHER DEVICE; NEWBORN [[Page 47803]] 536.. 54152 CIRCUMCISION, USING CLAMP OR OTHER DEVICE; EXCEPT NEWBORN 536.. 54160 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; NEWBORN 536.. 54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; EXCEPT NEWBORN 537.. Penile Procedures T 28.72 $1,455.23 $864.34 $291.05 537.. 37790 PENILE VENOUS OCCLUSIVE PROCEDURE 537.. 54110 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); 537.. 54111 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT TO 5 CM IN LENGTH 537.. 54112 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT GREATER THAN 5 CM IN LENGTH 537.. 54120 AMPUTATION OF PENIS; PARTIAL 537.. 54205 INJECTION PROCEDURE FOR PEYRONIE DISEASE; WITH SURGICAL EXPOSURE OF PLAQUE 537.. 54300 PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG, HYPOSPADIAS), WITH OR WITHOUT MOBILIZATION OF URETHRA 537.. 54304 PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH OR WITHOUT TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS 537.. 54308 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); LESS THAN 3 CM 537.. 54312 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION); GREATER THAN 3 CM 537.. 54316 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDING URINARY DIVERSION) WITH FREE SKIN GRAFT OBTAINED FROM SITE OTHER THAN GENITALIA 537.. 54318 URETHROPLASTY FOR THIRD STAGE HYPOSPADIAS REPAIR TO RELEASE PENIS FROM SCROTUM (EG, THIRD STAGE CECIL 537.. 54322 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVANCEMENT (EG, MAGPI, V-FLAP) 537.. 54324 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP) 537.. 54326 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY LOCAL SKIN FLAPS AND MOBILIZATION OF URETHRA 537.. 54328 ONE STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUT CHORDEE OR CIRCUMCISION); WITH EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY WITH LOCAL SKIN FLAPS, SKIN GRAFT PATCH, AND/ OR ISLAND FLAP 537.. 54340 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); BY CLOSURE, INCISION, OR EXCISION, 537.. 54344 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING MOBILIZATION OF SKIN FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT 537.. 54348 REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE, DIVERTICULA); REQUIRING EXTENSIVE DISSECTION AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT (INCLUDES URINARY DIVERSION) 537.. 54352 REPAIR OF HYPOSPADIAS CRIPPLE REQUIRING EXTENSIVE DISSECTION AND EXCISION OF PREVIOUSLY CONSTRUCTED STRUCTURES INCLUDING RE-RELEASE OF CHORDEE AND RECONSTRUCTION OF URETHRA AND PENIS BY USE OF LOCAL SKIN AS GRAFTS AND ISLAND FLAPS AND SKIN BROUGHT IN AS F 537.. 54360 PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION 537.. 54380 PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; 537.. 54385 PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNAL SPHINCTER; WITH INCONTINENCE 537.. 54402 REMOVAL OR REPLACEMENT OF NON-INFLATABLE (SEMI-RIGID) OR INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS 537.. 54407 REMOVAL, REPAIR, OR REPLACEMENT OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING PUMP AND/OR RESERVOIR AND/OR CYLINDERS 537.. 54409 SURGICAL CORRECTION OF HYDRAULIC ABNORMALITY OF INFLATABLE (MULTI-COMPONENT) PROSTHESIS INCLUDING PUMP AND/OR RESERVOIR AND/OR CYLINDERS 537.. 54420 CORPORA CAVERNOSA-SAPHENOUS VEIN SHUNT (PRIAPISM OPERATION), UNILATERAL OR BILATERAL 537.. 54435 CORPORA CAVERNOSA-GLANS PENIS FISTULIZATION (EG, BIOPSY NEEDLE, WINTER PROCEDURE, RONGEUR, OR PUNCH) FOR PRIAPISM 537.. 54440 PLASTIC OPERATION OF PENIS FOR INJURY 538.. Insertion of Penile Prosthesis T 45.59 $2,310.02 $1,540.64 $462.00 538.. 53440 OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH OR WITHOUT INTRODUCTION OF PROSTHESIS 538.. 53445 OPERATION FOR CORRECTION OF URINARY INCONTINENCE WITH PLACEMENT OF INFLATABLE URETHRAL OR BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP AND/OR RESERVOIR 538.. 54400 INSERTION OF PENILE PROSTHESIS; NON-INFLATABLE (SEMI-RIGID) 538.. 54401 INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-CONTAINED) 538.. 54405 INSERTION OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS, INCLUDING PLACEMENT OF PUMP, CYLINDERS, AND/OR RESERVOIR 546.. Testes/Epididymis Procedures T 17.14 $868.47 $453.81 $173.69 546.. 54505 BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE) 546.. 54510 EXCISION OF LOCAL LESION OF TESTIS 546.. 54520 ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUT TESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH 546.. 54530 ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH 546.. 54550 EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTAL AREA) 546.. 54600 REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUT FIXATION OF CONTRALATERAL TESTIS 546.. 54620 FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE) 546.. 54640 ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR 546.. 54660 INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE) 546.. 54670 SUTURE OR REPAIR OF TESTICULAR INJURY 546.. 54680 TRANSPLANTATION OF TESTIS(ES) TO THIGH (BECAUSE OF SCROTAL DESTRUCTION) 546.. 54700 INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/OR SCROTAL SPACE (EG, ABSCESS OR HEMATOMA) 546.. 54820 EXPLORATION OF EPIDIDYMIS, WITH OR WITHOUT BIOPSY 546.. 54830 EXCISION OF LOCAL LESION OF EPIDIDYMIS 546.. 54840 EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY 546.. 54860 EPIDIDYMECTOMY; UNILATERAL 546.. 54861 EPIDIDYMECTOMY; BILATERAL [[Page 47804]] 546.. 54900 EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; UNILATERAL 546.. 54901 EPIDIDYMOVASOSTOMY, ANASTOMOSIS OF EPIDIDYMIS TO VAS DEFERENS; BILATERAL 546.. 55060 REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE) 546.. 55110 SCROTAL EXPLORATION 546.. 55120 REMOVAL OF FOREIGN BODY IN SCROTUM 546.. 55150 RESECTION OF SCROTUM 546.. 55175 SCROTOPLASTY; SIMPLE 546.. 55180 SCROTOPLASTY; COMPLICATED 546.. 55200 VASOTOMY, CANNULIZATION WITH OR WITHOUT INCISION OF VAS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) 546.. 55250 VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE), INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) 546.. 55400 VASOVASOSTOMY, VASOVASORRHAPHY 546.. 55450 LIGATION (PERCUTANEOUS) OF VAS DEFERENS, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) 546.. 55500 EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL (SEPARATE PROCEDURE) 546.. 55520 EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE) 546.. 55530 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; (SEPARATE PROCEDURE) 546.. 55535 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; ABDOMINAL APPROACH 546.. 55540 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FOR VARICOCELE; WITH HERNIA REPAIR 546.. 55680 EXCISION OF MULLERIAN DUCT CYST 547.. Prostate Biopsy T 4.39 $222.44 $125.2 $44.49 547.. 55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANY APPROACH 547.. 55705 BIOPSY, PROSTATE; INCISIONAL, ANY APPROACH 550.. Surgical Hysteroscopy T 16.89 $855.81 $447.93 $171.16 550.. 56351 HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C 550.. 56352 HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINE ADHESIONS (ANY METHOD) 550.. 56353 HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTION OF INTRAUTERINE SEPTUM (ANY METHOD) 550.. 56354 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA 550.. 56355 HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY 550.. 56356 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION (ANY METHOD) 551.. Level I Laparoscopy T 24.78 $1,255.59 $711.67 $251.12 551.. 56300 LAPAROSCOPY (PERITONEOSCOPY), DIAGNOSTIC; (SEPARATE PROCEDURE) 551.. 56301 LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION) 551.. 56302 LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG, BAND, CLIP, OR FALOPE RING) 551.. 56303 LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD 551.. 56304 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE) 551.. 56305 LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE) 551.. 56306 LAPAROSCOPY, SURGICAL; WITH ASPIRATION (SINGLE OR MULTIPLE) 551.. 56346 LAPAROSCOPY, SURGICAL; GASTROSTOMY, TEMPORARY (TUBE OR RUBBER OR PLASTIC) (SEPARATE PROCEDURE) 552.. Level II Laparoscopy T 37.71 $1,910.75 $1,053.16 $382.15 552.. 56307 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY) 552.. 56309 LAPAROSCOPY, SURGICAL; WITH REMOVAL OF LEIOMYOMATA (SINGLE OR MULTIPLE) 552.. 56311 LAPAROSCOPY, SURGICAL; WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE 552.. 56312 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY 552.. 56313 LAPAROSCOPY, SURGICAL; WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE 552.. 56316 LAPAROSCOPY, SURGICAL; REPAIR OF INITIAL INGUINAL HERNIA 552.. 56317 LAPAROSCOPY, SURGICAL; REPAIR OF RECURRENT INGUINAL HERNIA 552.. 56318 LAPAROSCOPY, SURGICAL; ORCHIECTOMY 552.. 56320 LAPAROSCOPY, SURGICAL; WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE 552.. 56343 LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY) 552.. 56344 LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY 552.. 56362 LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITHOUT BIOPSY 552.. 56363 LAPAROSCOPY WITH GUIDED TRANSHEPATIC CHOLANGIOGRAPHY; WITH BIOPSY 561.. Level I Female Reproductive T 1.52 $77.02 $24.63 $15.4 Procedures 561.. 56405 INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS 561.. 56420 INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS 561.. 56441 LYSIS OF LABIAL ADHESIONS 561.. 57061 DESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY METHOD 561.. 57100 BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE) 561.. 57150 IRRIGATION OF VAGINA AND/OR APPLICATION OF MEDICAMENT FOR TREATMENT OF BACTERIAL, PARASITIC, OR FUNGOID DISEASE 561.. 57160 FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINAL SUPPORT DEVICE 561.. 57170 DIAPHRAGM OR CERVICAL CAP FITTING WITH INSTRUCTIONS 561.. 57180 INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUS OR TRAUMATIC NONOBSTETRICAL VAGINAL HEMORRHAGE (SEPARATE PROCEDURE) 561.. 57452 COLPOSCOPY (VAGINOSCOPY); (SEPARATE PROCEDURE) 561.. 57454 COLPOSCOPY (VAGINOSCOPY); WITH BIOPSY(S) OF THE CERVIX AND/OR ENDOCERVICAL CURETTAGE 561.. 57500 BIOPSY, SINGLE OR MULTIPLE, OR LOCAL EXCISION OF LESION, WITH OR WITHOUT FULGURATION (SEPARATE PROCEDURE) 561.. 57505 ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION AND CURETTAGE) 561.. 57510 CAUTERIZATION OF CERVIX; ELECTRO OR THERMAL 561.. 57511 CAUTERIZATION OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT 561.. 57513 CAUTERIZATION OF CERVIX; LASER ABLATION [[Page 47805]] 561.. 57800 DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATE PROCEDURE) 561.. 58100 ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE) 561.. 58301 REMOVAL OF INTRAUTERINE DEVICE (IUD) 561.. 59200 INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN) (SEPARATE PROCEDURE) 562.. Level II Female Reproductive T 12.76 $646.54 $330.75 $129.31 Procedures 562.. 56350 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE) 562.. 56399 UNLISTED PROCEDURE, LAPAROSCOPY, HYSTEROSCOPY 562.. 56440 MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST 562.. 56700 PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING 562.. 56720 HYMENOTOMY, SIMPLE INCISION 562.. 56740 EXCISION OF BARTHOLIN'S GLAND OR CYST 562.. 56800 PLASTIC REPAIR OF INTROITUS 562.. 56810 PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL (SEPARATE PROCEDURE) 562.. 57000 COLPOTOMY; WITH EXPLORATION 562.. 57010 COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS 562.. 57020 COLPOCENTESIS (SEPARATE PROCEDURE) 562.. 57065 DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY METHOD 562.. 57105 BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE (INCLUDING CYSTS) 562.. 57130 EXCISION OF VAGINAL SEPTUM 562.. 57135 EXCISION OF VAGINAL CYST OR TUMOR 562.. 57200 COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL) 562.. 57210 COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR PERINEUM (NONOBSTETRICAL) 562.. 57230 PLASTIC REPAIR OF URETHROCELE 562.. 57400 DILATION OF VAGINA UNDER ANESTHESIA 562.. 57410 PELVIC EXAMINATION UNDER ANESTHESIA 562.. 57415 REMOVAL OF IMPACTED VAGINAL FOREIGN BODY (SEPARATE PROCEDURE) UNDER ANESTHESIA 562.. 57460 COLPOSCOPY (VAGINOSCOPY); WITH LOOP ELECTRODE EXCISION PROCEDURE OF THE CERVIX 562.. 57700 CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL 562.. 57720 TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX, VAGINAL APPROACH 562.. 58345 TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FOR DIAGNOSIS AND/OR RE-ESTABLISHING PATENCY (ANY METHOD), WITH OR WITHOUT HYSTEROSALPINGOGRAPHY 562.. 58350 CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS 562.. 58970 FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD 562.. 59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING PHYSICIAN 562.. 59320 CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL 562.. 59871 REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHER THAN LOCAL) 563.. Level III Female Reproductive T 16.90 $856.31 $464.88 $171.26 Procedures 563.. 56620 VULVECTOMY SIMPLE; PARTIAL 563.. 56625 VULVECTOMY SIMPLE; COMPLETE 563.. 57220 PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH (EG, KELLY URETHRAL PLICATION) 563.. 57240 ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH OR WITHOUT REPAIR OF URETHROCELE 563.. 57250 POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY 563.. 57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; 563.. 57265 COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELE REPAIR 563.. 57268 REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE) 563.. 57284 PARAVAGINAL DEFECT REPAIR (INCLUDING REPAIR OF CYSTOCELE, STRESS URINARY INCONTINENCE, AND/OR INCOMPLETE VAGINAL PROLAPSE) 563.. 57288 SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) 563.. 57289 PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY 563.. 57291 CONSTRUCTION OF ARTIFICIAL VAGINA; WITHOUT GRAFT 563.. 57300 CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANAL APPROACH 563.. 57520 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; COLD KNIFE OR LASER 563.. 57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION, WITH OR WITHOUT DILATION AND CURETTAGE, WITH OR WITHOUT REPAIR; LOOP ELECTRODE EXCISION 563.. 57530 TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX (SEPARATE PROCEDURE) 563.. 57550 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; 563.. 57555 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH ANTERIOR AND/OR POSTERIOR REPAIR 563.. 57556 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITH REPAIR OF ENTEROCELE 563.. 58145 MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS, SINGLE OR MULTIPLE (SEPARATE PROCEDURE); VAGINAL APPROACH 563.. 58800 DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL, (SEPARATE PROCEDURE); VAGINAL APPROACH 563.. 58820 DRAINAGE OF OVARIAN ABSCESS; VAGINAL APPROACH, OPEN 567.. D & C T 13.61 $689.61 $364.09 $137.92 567.. 57820 DILATION AND CURETTAGE OF CERVICAL STUMP 567.. 58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL) 567.. 59160 CURRETTAGE, POSTPARTUM 568.. Infertility Procedures T 2.49 $126.17 $49.49 $25.23 568.. 55870 ELECTROEJACULATION 568.. 58321 ARTIFICIAL INSEMINATION; INTRA-CERVICAL 568.. 58322 ARTIFICIAL INSEMINATION; INTRA-UTERINE 568.. 58323 SPERM WASHING FOR ARTIFICIAL INSEMINATION 568.. 58974 EMBRYO TRANSFER, INTRAUTERINE [[Page 47806]] 568.. 58976 GAMETE, ZYGOTE, OR EMBRYO INTRAFALLOPIAN TRANSFER, ANY METHOD 578.. Pregnancy and Neonatal Care T 1.26 $63.84 $33.9 $12.77 Procedures 578.. 59000 AMNIOCENTESIS, ANY METHOD 578.. 59012 CORDOCENTESIS (INTRAUTERINE), ANY METHOD 578.. 59015 CHORIONIC VILLUS SAMPLING, ANY METHOD 578.. 59020 FETAL CONTRACTION STRESS TEST 578.. 59025 FETAL NON-STRESS TEST 578.. 59030 FETAL SCALP BLOOD SAMPLING 578.. 59050 FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE, NON-ATTENDING PHYSICIAN) WITH WRITTEN REPORT; SUPERVISION AND INTERPRETATION 578.. 59899 UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY 580.. Vaginal Delivery T 4.59 $232.57 $146.34 $46.51 580.. 59409 VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); 580.. 59412 EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS (LIST IN ADDITION TO CODE(S) FOR DELIVERY) 580.. 59414 DELIVERY OF PLACENTA (SEPARATE PROCEDURE) 580.. 59612 VAGINAL DELIVERY ONLY, AFTER PREVIOUS CESAREAN DELIVERY (WITH OR WITHOUT EPISIOTOMY AND/OR FORCEPS); 586.. Therapeutic Abortion T 12.5 $633.37 $431.89 $126.67 586.. 59840 INDUCED ABORTION, BY DILATION AND CURETTAGE 586.. 59841 INDUCED ABORTION, BY DILATION AND EVACUATION 587.. Spontaneous Abortion T 13.25 $671.37 $347.02 $134.27 587.. 59812 TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETED SURGICALLY 587.. 59820 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST TRIMESTER 587.. 59821 TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND TRIMESTER 587.. 59870 UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE 600.. Spinal Tap T 2.63 $133.26 $61.47 $26.65 600.. 62270 SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC 600.. 62272 SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL FLUID (BY NEEDLE OR CATHETER) 601.. Level I Nervous System T 3.11 $157.58 $74.13 $31.52 Injections 601.. 64400 INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISION OR BRANCH 601.. 64402 INJECTION, ANESTHETIC AGENT; FACIAL NERVE 601.. 64405 INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE 601.. 64408 INJECTION, ANESTHETIC AGENT; VAGUS NERVE 601.. 64410 INJECTION, ANESTHETIC AGENT; PHRENIC NERVE 601.. 64412 INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE 601.. 64413 INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS 601.. 64415 INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS 601.. 64417 INJECTION, ANESTHETIC AGENT; AXILLARY NERVE 601.. 64418 INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE 601.. 64420 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE 601.. 64421 INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK 601.. 64425 INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES 601.. 64430 INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE 601.. 64435 INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE 601.. 64440 INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL NERVE (THORACIC, LUMBAR, SACRAL, COCCYGEAL), SINGLE VERTEBRAL LEVEL 601.. 64441 INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL NERVES, MULTIPLE LEVELS (EG, REGIONAL BLOCK) 601.. 64442 INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, SINGLE LEVEL 601.. 64443 INJECTION, ANESTHETIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, EACH ADDITIONAL LEVEL 601.. 64445 INJECTION, ANESTHETIC AGENT; SCIATIC NERVE 601.. 64450 INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 601.. 64505 INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION 601.. 64508 INJECTION, ANESTHETIC AGENT; CAROTID SINUS (SEPARATE PROCEDURE) 601.. 64510 INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC) 601.. 64520 INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC) 601.. 64530 INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING 601.. 64600 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SUPRAORBITAL, INFRAORBITAL, MENTAL, OR INFERIOR ALVEOLAR BRANCH 601.. 64605 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT FORAMEN OVALE 601.. 64610 DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE; SECOND AND THIRD DIVISION BRANCHES AT FORAMEN OVALE UNDER RADIOLOGIC MONITORING 601.. 64612 DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); MUSCLES ENERVATED BY FACIAL NERVE (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM) 601.. 64613 DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); CERVICAL SPINAL MUSCLES (EG, FOR SPASMODIC TORTICOLLIS) 601.. 64620 DESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE 601.. 64622 DESTRUCTION BY NEUROLYTIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, SINGLE LEVEL 601.. 64623 DESTRUCTION BY NEUROLYTIC AGENT; PARAVERTEBRAL FACET JOINT NERVE, LUMBAR, EACH ADDITIONAL LEVEL 601.. 64630 DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE 601.. 64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE OR BRANCH 601.. 64680 DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH OR WITHOUT RADIOLOGIC MONITORING 601.. 64999 UNLISTED PROCEDURE, NERVOUS SYSTEM 602.. Level II Nervous System T 3.33 $168.73 $87.69 $33.75 Injections [[Page 47807]] 602.. 61000 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; INITIAL 602.. 61001 SUBDURAL TAP THROUGH FONTANELLE, OR SUTURE, INFANT, UNILATERAL OR BILATERAL; SUBSEQUENT TAPS 602.. 61020 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITHOUT INJECTION 602.. 61026 VENTRICULAR PUNCTURE THROUGH PREVIOUS BURR HOLE, FONTANELLE, SUTURE, OR IMPLANTED VENTRICULAR CATHETER/RESERVOIR; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT 602.. 61050 CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHOUT INJECTION (SEPARATE PROCEDURE) 602.. 61055 CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITH INJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT (EG, C1-C2) 602.. 61070 PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR INJECTION PROCEDURE 602.. 62194 REPLACEMENT OR IRRIGATION, SUBARACHNOID/SUBDURAL CATHETER 602.. 62225 REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER 602.. 62268 PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX 602.. 62273 INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH 602.. 62274 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); SUBARACHNOID OR SUBDURAL, SINGLE 602.. 62275 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, CERVICAL OR THORACIC, SINGLE 602.. 62276 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); SUBARACHNOID OR SUBDURAL, DIFFERENTIAL 602.. 62277 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); SUBARACHNOID OR SUBDURAL, CONTINUOUS 602.. 62278 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, SINGLE 602.. 62279 INJECTION OF DIAGNOSTIC OR THERAPEUTIC ANESTHETIC OR ANTISPASMODIC SUBSTANCE (INCLUDING NARCOTICS); EPIDURAL, LUMBAR OR CAUDAL, CONTINUOUS 602.. 62280 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); SUBARACHNOID 602.. 62281 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL, CERVICAL OR THORACIC 602.. 62282 INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS); EPIDURAL, LUMBAR OR CAUDAL 602.. 62288 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS; SUBARACHNOID (SEPARATE PROCEDURE) 602.. 62289 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, ANTISPASMODIC, CONTRAST, OR NEUROLYTIC SOLUTIONS; LUMBAR OR CAUDAL EPIDURAL (SEPARATE PROCEDURE) 602.. 62292 INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISKOGRAPHY, INTERVERTEBRAL DISK, SINGLE OR MULTIPLE LEVELS, LUMBAR 602.. 62294 INJECTION PROCEDURE, ARTERIAL, FOR OCCLUSION OF ARTERIOVENOUS MALFORMATION, SPINAL 602.. 62298 INJECTION OF SUBSTANCE OTHER THAN ANESTHETIC, CONTRAST, OR NEUROLYTIC SOLUTIONS, EPIDURAL, CERVICAL OR THORACIC (SEPARATE PROCEDURE) 616.. Implantation of T 14.43 $731.16 $366.57 $146.23 Neurostimulator Electrodes 616.. 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; EPIDURAL 616.. 64553 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE 616.. 64555 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE 616.. 64560 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE 616.. 64565 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR 616.. 64573 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; CRANIAL NERVE 616.. 64575 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; PERIPHERAL NERVE 616.. 64577 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; AUTONOMIC NERVE 616.. 64580 INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES; NEUROMUSCULAR 617.. Revision/Removal Neurological T 11.56 $585.74 $287.59 $117.15 Device 617.. 62230 REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR DISTAL CATHETER IN SHUNT SYSTEM 617.. 62350 IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OR EPIDURAL CATHETER, FOR IMPLANTABLE RESERVOIR OR IMPLANTABLE INFUSION PUMP; WITHOUT LAMINECTOMY 617.. 62355 REMOVAL OF PREVIOUSLY IMPLANTED INTRATHECAL OR EPIDURAL CATHETER 617.. 62365 REMOVAL OF SUBCUTANEOUS RESERVOIR OR PUMP, PREVIOUSLY IMPLANTED FOR INTRATHECAL OR EPIDURAL INFUSION 617.. 63660 REVISION OR REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODES 617.. 63688 REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER 617.. 63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOID SHUNT 617.. 63746 REMOVAL OF ENTIRE LUMBOSUBARACHNOID SHUNT SYSTEM WITHOUT REPLACEMENT 617.. 64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODES 617.. 64595 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER 618.. Implantation of Neurological T 25.56 $1,295.11 $780.49 $259.02 Device 618.. 61215 INSERTION OF SUBCUTANEOUS RESERVOIR, PUMP OR CONTINUOUS INFUSION SYSTEM FOR CONNECTION TO VENTRICULAR CATHETER 618.. 61885 INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING 618.. 62360 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS RESERVOIR 618.. 62361 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; NON- PROGRAMMABLE PUMP 618.. 62362 IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING 618.. 63685 INCISION AND SUBCUTANEOUS PLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING 618.. 64590 INCISION AND SUBCUTANEOUS PLACEMENT OF PERIPHERAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING [[Page 47808]] 631.. Level I Nerve Procedures T 12.98 $657.69 $333.8 $131.54 631.. 27315 NEURECTOMY, HAMSTRING MUSCLE 631.. 27320 NEURECTOMY, POPLITEAL (GASTROCNEMIUS) 631.. 28030 NEURECTOMY OF INTRINSIC MUSCULATURE OF FOOT 631.. 28035 TARSAL TUNNEL RELEASE (POSTERIOR TIBIAL NERVE DECOMPRESSION) 631.. 61790 CREATION OF LESION BY STEREOTACTIC METHOD, PERCUTANEOUS, BY NEUROLYTIC AGENT (EG, ALCOHOL, THERMAL, ELECTRICAL, RADIOFREQUENCY); GASSERIAN GANGLION 631.. 62287 ASPIRATION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISK, ANY METHOD, SINGLE OR MULTIPLE LEVELS, LUMBAR 631.. 63600 CREATION OF LESION OF SPINAL CORD BY STEREOTACTIC METHOD, PERCUTANEOUS, ANY MODALITY (INCLUDING STIMULATION AND/OR RECORDING) 631.. 63610 STEREOTACTIC STIMULATION OF SPINAL CORD, PERCUTANEOUS, SEPARATE PROCEDURE NOT FOLLOWED BY OTHER SURGERY 631.. 63615 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION OF LESION, SPINAL CORD 631.. 64702 NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT 631.. 64704 NEUROPLASTY; NERVE OF HAND OR FOOT 631.. 64708 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; OTHER THAN SPECIFIED 631.. 64712 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; SCIATIC NERVE 631.. 64713 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; BRACHIAL PLEXUS 631.. 64714 NEUROPLASTY, MAJOR PERIPHERAL NERVE, ARM OR LEG; LUMBAR PLEXUS 631.. 64716 NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY) 631.. 64718 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW 631.. 64719 NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST 631.. 64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPAL TUNNEL 631.. 64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY) 631.. 64726 DECOMPRESSION; PLANTAR DIGITAL NERVE 631.. 64727 INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS) 631.. 64732 TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE 631.. 64734 TRANSECTION OR AVULSION OF; INFRAORBITAL NERVE 631.. 64736 TRANSECTION OR AVULSION OF; MENTAL NERVE 631.. 64738 TRANSECTION OR AVULSION OF; INFERIOR ALVEOLAR NERVE BY OSTEOTOMY 631.. 64740 TRANSECTION OR AVULSION OF; LINGUAL NERVE 631.. 64742 TRANSECTION OR AVULSION OF; FACIAL NERVE, DIFFERENTIAL OR COMPLETE 631.. 64744 TRANSECTION OR AVULSION OF; GREATER OCCIPITAL NERVE 631.. 64746 TRANSECTION OR AVULSION OF; PHRENIC NERVE 631.. 64761 TRANSECTION OR AVULSION OF; PUDENDAL NERVE 631.. 64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL 631.. 64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL 631.. 64774 EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLY IDENTIFIABLE 631.. 64776 EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT 631.. 64778 EXCISION OF NEUROMA; DIGITAL NERVE, EACH ADDITIONAL DIGIT (LIST SEPARATELY BY THIS NUMBER) 631.. 64782 EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE 631.. 64783 EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONAL NERVE, EXCEPT SAME DIGIT (LIST SEPARATELY BY THIS NUMBER) 631.. 64784 EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC 631.. 64787 IMPLANTATION OF NERVE END INTO BONE OR MUSCLE (LIST SEPARATELY IN ADDITION TO NEUROMA EXCISION) 631.. 64788 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE 631.. 64790 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL NERVE 631.. 64795 BIOPSY OF NERVE 631.. 64830 MICRODISSECTION AND/OR MICROREPAIR OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE REPAIR) 632.. Level II Nerve Procedures T 18.13 $918.64 $461.04 $183.73 632.. 64786 EXCISION OF NEUROMA; SCIATIC NERVE 632.. 64792 EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; EXTENSIVE (INCLUDING MALIGNANT TYPE) 632.. 64831 SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE 632.. 64832 SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONAL DIGITAL NERVE 632.. 64834 SUTURE OF ONE NERVE, HAND OR FOOT; COMMON SENSORY NERVE 632.. 64835 SUTURE OF ONE NERVE, HAND OR FOOT; MEDIAN MOTOR THENAR 632.. 64836 SUTURE OF ONE NERVE, HAND OR FOOT; ULNAR MOTOR 632.. 64837 SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT 632.. 64840 SUTURE OF POSTERIOR TIBIAL NERVE 632.. 64856 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; INCLUDING TRANSPOSITION 632.. 64857 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPT SCIATIC; WITHOUT TRANSPOSITION 632.. 64858 SUTURE OF SCIATIC NERVE 632.. 64859 SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE 632.. 64861 SUTURE OF; BRACHIAL PLEXUS 632.. 64862 SUTURE OF; LUMBAR PLEXUS 632.. 64864 SUTURE OF FACIAL NERVE; EXTRACRANIAL 632.. 64865 SUTURE OF FACIAL NERVE; INFRATEMPORAL, WITH OR WITHOUT GRAFTING 632.. 64870 ANASTOMOSIS; FACIAL-PHRENIC 632.. 64872 SUTURE OF NERVE; REQUIRING SECONDARY OR DELAYED SUTURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY NEURORRHAPHY) 632.. 64874 SUTURE OF NERVE; REQUIRING EXTENSIVE MOBILIZATION, OR TRANSPOSITION OF NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) 632.. 64876 SUTURE OF NERVE; REQUIRING SHORTENING OF BONE OF EXTREMITY (LIST SEPARATELY IN ADDITION TO CODE FOR NERVE SUTURE) 632.. 64885 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH [[Page 47809]] 632.. 64886 NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE THAN 4 CM LENGTH 632.. 64890 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; UP TO 4 CM LENGTH 632.. 64891 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, HAND OR FOOT; MORE THAN 4 CM LENGTH 632.. 64892 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; UP TO 4 CM LENGTH 632.. 64893 NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM OR LEG; MORE THAN 4 CM LENGTH 632.. 64895 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; UP TO 4 CM LENGTH 632.. 64896 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), HAND OR FOOT; MORE THAN 4 CM LENGTH 632.. 64897 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; UP TO 4 CM LENGTH 632.. 64898 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS (CABLE), ARM OR LEG; MORE THAN 4 CM LENGTH 632.. 64901 NERVE GRAFT, EACH ADDITIONAL NERVE; SINGLE STRAND 632.. 64902 NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE) 632.. 64905 NERVE PEDICLE TRANSFER; FIRST STAGE 632.. 64907 NERVE PEDICLE TRANSFER; SECOND STAGE 648.. Laser Retinal Procedures T 3.94 $199.64 $95.15 $39.93 648.. 67105 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; PHOTOCOAGULATION, WITH OR WITHOUT DRAINAGE OF SUBRETINAL FLUID 648.. 67145 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC) 648.. 67210 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC) 648.. 67228 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC) 649.. Laser Eye Procedures except T 4.44 $224.97 $111.64 $44.99 Retinal 649.. 65855 TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS (DEFINED TREATMENT SERIES) 649.. 65860 SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER TECHNIQUE (SEPARATE PROCEDURE) 649.. 66761 IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (EG, FOR GLAUCOMA) (ONE OR MORE SESSIONS) 649.. 66762 IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR WIDENING OF ANTERIOR CHAMBER ANGLE) 649.. 66770 DESTRUCTION OF CYST OR LESION IRIS OR CILIARY BODY (NONEXCISIONAL PROCEDURE) 649.. 66821 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES) 649.. 66999 UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE 649.. 67031 SEVERING OF VITREOUS STRANDS, VITREOUS FACE ADHESIONS, SHEETS, MEMBRANES OR OPACITIES, LASER SURGERY (ONE OR MORE STAGES) 649.. 67299 UNLISTED PROCEDURE, POSTERIOR SEGMENT 651.. Level I Anterior Segment Eye T 7.24 $366.85 $174.7 $73.37 Procedures 651.. 65272 REPAIR OF LACERATION; CONJUNCTIVA, BY MOBILIZATION AND REARRANGEMENT, WITHOUT HOSPITALIZATION 651.. 65275 REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITH OR WITHOUT REMOVAL FOREIGN BODY 651.. 65286 REPAIR OF LACERATION; APPLICATION OF TISSUE GLUE, WOUNDS OF CORNEA AND/OR SCLERA 651.. 65420 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT 651.. 65436 REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OF CHELATING AGENT (EG, EDTA) 651.. 65450 DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY, PHOTOCOAGULATION OR THERMOCAUTERIZATION 651.. 65772 CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM 651.. 65810 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF VITREOUS AND/OR DISCISSION OF ANTERIOR HYALOID MEMBRANE, WITH OR WITHOUT AIR INJECTION 651.. 65815 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF BLOOD, WITH OR WITHOUT IRRIGATION AND/OR AIR INJECTION 651.. 65820 GONIOTOMY 651.. 66130 EXCISION OF LESION, SCLERA 651.. 66500 IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPT TRANSFIXION 651.. 66505 IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); WITH TRANSFIXION AS FOR IRIS BOMBE 651.. 66600 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION 651.. 66625 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE) 651.. 66630 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; SECTOR FOR GLAUCOMA (SEPARATE PROCEDURE) 651.. 66700 CILIARY BODY DESTRUCTION; DIATHERMY 651.. 66710 CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION 651.. 66720 CILIARY BODY DESTRUCTION; CRYOTHERAPY 651.. 66820 DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); STAB INCISION TECHNIQUE (ZIEGLER OR WHEELER KNIFE) 651.. 66825 REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE) 652.. Level II Anterior Segment Eye T 16.48 $835.03 $433.69 $167.01 Procedures 652.. 65235 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OR LENS 652.. 65280 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOT INVOLVING UVEAL TISSUE 652.. 65285 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, WITH REPOSITION OR RESECTION OF UVEAL TISSUE 652.. 65400 EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR, PARTIAL), EXCEPT PTERYGIUM 652.. 65426 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT 652.. 65770 KERATOPROSTHESIS 652.. 65775 CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCED ASTIGMATISM 652.. 65850 TRABECULOTOMY AB EXTERNO 652.. 65865 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); GONIOSYNECHIAE 652.. 65870 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECHIAE, EXCEPT GONIOSYNECHIAE [[Page 47810]] 652.. 65875 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNECHIAE 652.. 65880 SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONAL TECHNIQUE (WITH OR WITHOUT INJECTION OF AIR OR LIQUID) (SEPARATE PROCEDURE); CORNEOVITREAL ADHESIONS 652.. 65900 REMOVAL OF EPITHELIAL DOWNGROWTH, ANTERIOR CHAMBER EYE 652.. 65920 REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT EYE 652.. 65930 REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT EYE 652.. 66150 FISTULIZATION OF SCLERA FOR GLAUCOMA; TREPHINATION WITH IRIDECTOMY 652.. 66155 FISTULIZATION OF SCLERA FOR GLAUCOMA; THERMOCAUTERIZATION WITH IRIDECTOMY 652.. 66160 FISTULIZATION OF SCLERA FOR GLAUCOMA; SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IRIDECTOMY 652.. 66165 FISTULIZATION OF SCLERA FOR GLAUCOMA; IRIDENCLEISIS OR IRIDOTASIS 652.. 66170 FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO IN ABSENCE OF PREVIOUS SURGERY 652.. 66172 FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY AB EXTERNO WITH SCARRING FROM PREVIOUS OCULAR SURGERY OR TRAUMA (INCLUDES INJECTION OF ANTIFIBROTIC AGENTS) 652.. 66180 AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR (EG, MOLTENO, SCHOCKET, DENVER-KRUPIN) 652.. 66185 REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR 652.. 66225 REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT 652.. 66250 REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT, ANY TYPE, EARLY OR LATE, MAJOR OR MINOR PROCEDURE 652.. 66605 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; WITH CYCLECTOMY 652.. 66635 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; OPTICAL (SEPARATE PROCEDURE) 652.. 66680 REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS) 652.. 66682 SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITH RETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG, MCCANNEL SUTURE) 652.. 66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS 652.. 66830 REMOVAL OF SECONDARY MEMBRANOUS CATARACT (OPACIFIED POSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID) WITH CORNEO-SCLERAL SECTION, WITH OR WITHOUT IRIDECTOMY (IRIDOCAPSULOTOMY, IRIDOCAPSULECTOMY) 652.. 68130 EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA 652.. 68330 REPAIR OF SYMBLEPHARON; CONJUNCTIVOPLASTY, WITHOUT GRAFT 652.. 68360 CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE) 652.. 68362 CONJUNCTIVAL FLAP; TOTAL (SUCH AS GUNDERSON THIN FLAP OR PURSE STRING FLAP) 667.. Cataract Procedures T 15.33 $776.40 $521.72 $155.28 667.. 66840 REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES 667.. 66850 REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE (MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION 667.. 66852 REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH OR WITHOUT VITRECTOMY 667.. 66920 REMOVAL OF LENS MATERIAL; INTRACAPSULAR 667.. 66930 REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS 667.. 66940 REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840, 66850, 66852) 668.. Cataract Procedures with IOL T 19.28 $976.91 $530.87 $195.38 Insert 668.. 66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE) 668.. 66984 EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) 668.. 66985 INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARY IMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL 668.. 66986 EXCHANGE OF INTRAOCULAR LENS 670.. Corneal Transplant T 29.23 $1,481.07 $847.5 $296.21 670.. 65710 KERATOPLASTY (CORNEAL TRANSPLANT); LAMELLAR 670.. 65730 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (EXCEPT IN APHAKIA) 670.. 65750 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN APHAKIA) 670.. 65755 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (IN PSEUDOPHAKIA) 676.. Posterior Segment Eye T 6.3 $319.22 $140.35 $63.84 Procedures 676.. 65260 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, MAGNETIC EXTRACTION, ANTERIOR OR POSTERIOR ROUTE 676.. 65265 REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM POSTERIOR SEGMENT, NONMAGNETIC EXTRACTION 676.. 66220 REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT 676.. 67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); PARTIAL REMOVAL 676.. 67010 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUE OR LIMBAL INCISION); SUBTOTAL REMOVAL WITH MECHANICAL VITRECTOMY 676.. 67015 ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDAL FLUID, PARS PLANA APPROACH (POSTERIOR SCLEROTOMY) 676.. 67030 DISCISSION OF VITREOUS STRANDS (WITHOUT REMOVAL), PARS PLANA APPROACH 676.. 67101 REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS; CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT DRAINAGE OF SUBRETINAL FLUID 676.. 67110 REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHER GAS (EG, PNEUMATIC RETINOPEXY) 676.. 67115 RELEASE OF ENCIRCLING MATERIAL (POSTERIOR SEGMENT) 676.. 67120 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; EXTRAOCULAR 676.. 67121 REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; INTRAOCULAR 676.. 67141 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK, LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY 676.. 67208 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY 676.. 67218 DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULOPATHY, CHOROIDOPATHY, SMALL TUMORS), ONE OR MORE SESSIONS; RADIATION BY IMPLANTATION OF SOURCE (INCLUDES REMOVAL OF SOURCE) [[Page 47811]] 676.. 67227 DESTRUCTION OF EXTENSIVE OR PROGRESSIVE RETINOPATHY (EG, DIABETIC RETINOPATHY), ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY 676.. 92018 OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT MANIPULATION OF GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE DIAGNOSTIC EXAMINATION; COMPLETE 676.. 92019 OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDER GENERAL ANESTHESIA, WITH OR WITHOUT MANIPULATION OF GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE DIAGNOSTIC EXAMINATION; LIMITED 677.. Strabismus/Muscle Procedures T 16.26 $823.89 $436.63 $164.78 677.. 65290 REPAIR OF WOUND, EXTRAOCULAR MUSCLE, TENDON AND/OR TENON'S CAPSULE 677.. 67311 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE HORIZONTAL MUSCLE 677.. 67312 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO HORIZONTAL MUSCLES 677.. 67314 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); ONE VERTICAL MUSCLE (EXCLUDING SUPERIOR OBLIQUE) 677.. 67316 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON); TWO OR MORE VERTICAL MUSCLES (EXCLUDING SUPERIOR OBLIQUE) 677.. 67318 STRABISMUS SURGERY, ANY PROCEDURE (PATIENT NOT PREVIOUSLY OPERATED ON), SUPERIOR OBLIQUE MUSCLE 677.. 67320 TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULAR MUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY) 677.. 67331 STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY OR INJURY THAT DID NOT INVOLVE THE EXTRAOCULAR MUSCLES 677.. 67332 STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULAR MUSCLES (EG, PRIOR OCULAR INJURY, STRABISMUS OR RETINAL DETACHMENT SURGERY) OR RESTRICTIVE MYOPATHY (EG, DYSTHYROID OPHTHALMOPATHY) 677.. 67334 STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE, WITH OR WITHOUT MUSCLE RECESSION 677.. 67335 PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY, INCLUDING POSTOPERATIVE ADJUSTMENT(S) OF SUTURE(S) (REPORT IN ADDITION TO CODE FOR SPECIFIC STRABISMUS SURGERY) 677.. 67340 STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OF DETACHED EXTRAOCULAR MUSCLE(S) 677.. 67343 RELEASE OF EXTENSIVE SCAR TISSUE WITHOUT DETACHING EXTRAOCULAR MUSCLE (SEPARATE PROCEDURE) 681.. Level I Eye Procedures T 1.67 $84.62 $30.51 $16.92 681.. 65125 MODIFICATION OF OCULAR IMPLANT WITH PLACEMENT OR REPLACEMENT OF PEGS (EG, DRILLING RECEPTACLE FOR PROSTHESIS APPENDAGE) (SEPARATE PROCEDURE) 681.. 65205 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL SUPERFICIAL 681.. 65210 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL EMBEDDED (INCLUDES CONCRETIONS), SUBCONJUNCTIVAL, OR SCLERAL NONPERFORATING 681.. 65220 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT SLIT LAMP 681.. 65222 REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT LAMP 681.. 65430 SCRAPING OF CORNEA, DIAGNOSTIC, FOR SMEAR AND/OR CULTURE 681.. 65435 REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUT CHEMOCAUTERIZATION (ABRASION, CURETTAGE) 681.. 65600 MULTIPLE PUNCTURES OF ANTERIOR CORNEA (EG, FOR CORNEAL EROSION, TATTOO) 681.. 67345 CHEMODENERVATION OF EXTRAOCULAR MUSCLE 681.. 67500 RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION) 681.. 67505 RETROBULBAR INJECTION; ALCOHOL 681.. 67515 INJECTION OF THERAPEUTIC AGENT INTO TENON'S CAPSULE 681.. 67599 UNLISTED PROCEDURE, ORBIT 681.. 68200 SUBCONJUNCTIVAL INJECTION 681.. 68761 CLOSURE OF THE LACRIMAL PUNCTUM; BY PLUG, EACH 681.. 68899 UNLISTED PROCEDURE, LACRIMAL SYSTEM 682.. Level II Eye Procedures T 3.54 $179.37 $81.36 $35.87 682.. 67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) 682.. 67700 BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID 682.. 67710 SEVERING OF TARSORRHAPHY 682.. 67800 EXCISION OF CHALAZION; SINGLE 682.. 67801 EXCISION OF CHALAZION; MULTIPLE, SAME LID 682.. 67805 EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS 682.. 67810 BIOPSY OF EYELID 682.. 67820 CORRECTION OF TRICHIASIS; EPILATION, BY FORCEPS ONLY 682.. 67825 CORRECTION OF TRICHIASIS; EPILATION BY OTHER THAN FORCEPS (EG, BY ELECTROSURGERY, CRYOTHERAPY, LASER SURGERY 682.. 67840 EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUT CLOSURE OR WITH SIMPLE DIRECT CLOSURE 682.. 67850 DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM) 682.. 67875 TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE) 682.. 67915 REPAIR OF ECTROPION; THERMOCAUTERIZATION 682.. 67922 REPAIR OF ENTROPION; THERMOCAUTERIZATION 682.. 67930 SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT CLOSURE; PARTIAL THICKNESS 682.. 67938 REMOVAL OF EMBEDDED FOREIGN BODY, EYELID 682.. 67999 UNLISTED PROCEDURE, EYELIDS 682.. 68020 INCISION OF CONJUNCTIVA, DRAINAGE OF CYST 682.. 68040 EXPRESSION OF CONJUNCTIVAL FOLLICLES (EG, FOR TRACHOMA) 682.. 68400 INCISION, DRAINAGE OF LACRIMAL GLAND 682.. 68420 INCISION, DRAINAGE OF LACRIMAL SAC (DACRYOCYSTOTOMY OR DACRYOCYSTOSTOMY) 682.. 68440 SNIP INCISION OF LACRIMAL PUNCTUM 682.. 68530 REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES 682.. 68705 CORRECTION OF EVERTED PUNCTUM, CAUTERY 682.. 68760 CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION, LIGATION, OR LASER SURGERY 682.. 68801 DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION [[Page 47812]] 682.. 68840 PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION 683.. Level III Eye Procedures T 10.19 $516.32 $257.87 $103.26 683.. 65175 REMOVAL OF OCULAR IMPLANT 683.. 65410 BIOPSY OF CORNEA 683.. 65800 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH DIAGNOSTIC ASPIRATION OF AQUEOUS 683.. 65805 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH THERAPEUTIC RELEASE OF AQUEOUS 683.. 66020 INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); AIR OR LIQUID 683.. 66030 INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); MEDICATION 683.. 67025 INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBAL APPROACH, (FLUID-GAS EXCHANGE), WITH OR WITHOUT ASPIRATION (SEPARATE PROCEDURE) 683.. 67715 CANTHOTOMY (SEPARATE PROCEDURE) 683.. 67830 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN 683.. 67880 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY 683.. 67935 SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN, TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT CLOSURE; FULL THICKNESS 683.. 68510 BIOPSY OF LACRIMAL GLAND 683.. 68525 BIOPSY OF LACRIMAL SAC 683.. 68810 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; 684.. Level IV Eye Procedures T 13.48 $683.02 $348.94 $136.6 684.. 65091 EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT 684.. 65093 EVISCERATION OF OCULAR CONTENTS; WITH IMPLANT 684.. 65101 ENUCLEATION OF EYE; WITHOUT IMPLANT 684.. 65103 ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES NOT ATTACHED TO IMPLANT 684.. 65105 ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHED TO IMPLANT 684.. 65130 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER EVISCERATION, IN SCLERAL SHELL 684.. 65135 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES NOT ATTACHED TO IMPLANT 684.. 65140 INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT 684.. 65150 REINSERTION OF OCULAR IMPLANT; WITH OR WITHOUT CONJUNCTIVAL GRAFT 684.. 65155 REINSERTION OF OCULAR IMPLANT; WITH USE OF FOREIGN MATERIAL FOR REINFORCEMENT AND/OR ATTACHMENT OF MUSCLES TO IMPLANT 684.. 67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT 684.. 67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT 684.. 67400 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); FOR EXPLORATION, WITH OR WITHOUT BIOPSY 684.. 67405 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH DRAINAGE ONLY 684.. 67412 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF LESION 684.. 67413 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL APPROACH); WITH REMOVAL OF FOREIGN BODY 684.. 67550 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION 684.. 67560 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL OR REVISION 684.. 67808 EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/OR REQUIRING HOSPITALIZATION, SINGLE OR MULTIPLE 684.. 67835 CORRECTION OF TRICHIASIS; INCISION OF LID MARGIN, WITH FREE MUCOUS MEMBRANE GRAFT 684.. 67882 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIAN TARSORRHAPHY, OR CANTHORRHAPHY; WITH TRANSPOSITION OF TARSAL PLATE 684.. 67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONAL APPROACH) 684.. 67901 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL 684.. 67902 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASCIA) 684.. 67903 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, INTERNAL APPROACH 684.. 67904 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROACH 684.. 67906 REPAIR OF BLEPHAROPTOSIS; SUPERIOR RECTUS TECHNIQUE WITH FASCIAL SLING (INCLUDES OBTAINING FASCIA) 684.. 67908 REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'S MUSCLE-LEVATOR RESECTION (EG, FASANELLA- SERVAT TYPE) 684.. 67909 REDUCTION OF OVERCORRECTION OF PTOSIS 684.. 67911 CORRECTION OF LID RETRACTION 684.. 67914 REPAIR OF ECTROPION; SUTURE 684.. 67916 REPAIR OF ECTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE 684.. 67917 REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, KUHNT-SZYMANOWSKI OR TARSAL STRIP OPERATIONS) 684.. 67921 REPAIR OF ENTROPION; SUTURE 684.. 67923 REPAIR OF ENTROPION; BLEPHAROPLASTY, EXCISION TARSAL WEDGE 684.. 67924 REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, WHEELER OPERATION) 684.. 67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) 684.. 67961 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNESS, MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE TRANSFER OR REARRANGEMENT; UP TO ONE-FOURTH OF LID MARGIN 684.. 67966 EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS, CONJUNCTIVA, CANTHUS, OR FULL THICKNESS, MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICLE FLAP WITH ADJACENT TISSUE TRANSFER OR REARRANGEMENT; OVER ONE-FOURTH OF LID MARGIN 684.. 67971 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; UP TO TWO-THIRDS OF EYELID, ONE STAGE OR FIRST STAGE 684.. 67973 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; TOTAL EYELID, LOWER, ONE STAGE OR FIRST STAGE 684.. 67974 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; TOTAL EYELID, UPPER, ONE STAGE OR FIRST STAGE 684.. 67975 RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OF TARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; SECOND STAGE 684.. 68320 CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT [[Page 47813]] 684.. 68325 CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT) 684.. 68326 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH CONJUNCTIVAL GRAFT OR EXTENSIVE REARRANGEMENT 684.. 68328 CONJUNCTIVOPLASTY, RECONSTRUCTION CUL-DE-SAC; WITH BUCCAL MUCOUS MEMBRANE GRAFT (INCLUDES OBTAINING GRAFT) 684.. 68335 REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA OR BUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING GRAFT) 684.. 68340 REPAIR OF SYMBLEPHARON; DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OR CONTACT LENS 684.. 68500 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; TOTAL 684.. 68505 EXCISION OF LACRIMAL GLAND (DACRYOADENECTOMY), EXCEPT FOR TUMOR; PARTIAL 684.. 68520 EXCISION OF LACRIMAL SAC (DACRYOCYSTECTOMY) 684.. 68540 EXCISION OF LACRIMAL GLAND TUMOR; FRONTAL APPROACH 684.. 68550 EXCISION OF LACRIMAL GLAND TUMOR; INVOLVING OSTEOTOMY 684.. 68700 PLASTIC REPAIR OF CANALICULI 684.. 68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TO NASAL CAVITY) 684.. 68745 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITHOUT TUBE 684.. 68750 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASAL CAVITY); WITH INSERTION OF TUBE OR STENT 684.. 68770 CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE) 684.. 68811 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; REQUIRING GENERAL ANESTHESIA 684.. 68815 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; WITH INSERTION OF TUBE OR STENT 690.. Vitrectomy T 30.54 $1,547.45 $852.02 $309.49 690.. 67027 IMPLANTATION OR REPLACEMENT OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG, GANCICLOVIR IMPLANT), INCLUDES CONCOMITANT REMOVAL OF VITREOUS 690.. 67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; 690.. 67038 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH EPIRETINAL MEMBRANE STRIPPING 690.. 67039 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCAL ENDOLASER PHOTOCOAGULATION 690.. 67040 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION 690.. 67107 REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH AS LAMELLAR SCLERAL DISSECTION, IMBRICATION OR ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH OR WITHOUT CRYOTHERAPY, PHOTOCOAGULATION, AND DRAINAGE OF SUBRETINAL FLUID 690.. 67108 REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANY METHOD, WITH OR WITHOUT AIR OR GAS TAMPONADE, FOCAL ENDOLASER PHOTOCOAGULATION, CRYOTHERAPY, DRAINAGE OF SUBRETINAL FLUID, SCLERAL BUCKLING, AND/OR REMOVAL OF LENS BY SAME TECHNIQUE 690.. 67112 REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING PREVIOUS IPSILATERAL RETINAL DETACHMENT REPAIR(S) USING SCLERAL BUCKLING OR VITRECTOMY TECHNIQUES 700.. Plain Film X 0.78 $39.52 $22.37 $7.90 700.. 70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY 700.. 70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOUR VIEWS 700.. 70110 RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS 700.. 70120 RADIOLOGIC EXAMINATION, MASTOIDS; LESS THAN THREE VIEWS PER SIDE 700.. 70130 RADIOLOGIC EXAMINATION, MASTOIDS; COMPLETE, MINIMUM OF THREE VIEWS PER SIDE 700.. 70134 RADIOLOGIC EXAMINATION, INTERNAL AUDITORY MEATI, COMPLETE 700.. 70140 RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS 700.. 70150 RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF THREE VIEWS 700.. 70160 RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF THREE VIEWS 700.. 70190 RADIOLOGIC EXAMINATION; OPTIC FORAMINA 700.. 70200 RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOUR VIEWS 700.. 70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS 700.. 70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE, MINIMUM OF THREE VIEWS 700.. 70240 RADIOLOGIC EXAMINATION, SELLA TURCICA 700.. 70250 RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS, WITH OR WITHOUT STEREO 700.. 70260 RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR VIEWS, WITH OR WITHOUT STEREO 700.. 70300 RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW 700.. 70310 RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS THAN FULL MOUTH 700.. 70320 RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH 700.. 70328 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; UNILATERAL 700.. 70330 RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND CLOSED MOUTH; BILATERAL 700.. 70350 CEPHALOGRAM, ORTHODONTIC 700.. 70355 ORTHOPANTOGRAM 700.. 70360 RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE 700.. 70380 RADIOLOGIC EXAMINATION, SALIVARY GLAND FOR CALCULUS 700.. 71010 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL 700.. 71015 RADIOLOGIC EXAMINATION, CHEST; STEREO, FRONTAL 700.. 71020 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; 700.. 71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH APICAL LORDOTIC PROCEDURE 700.. 71022 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH OBLIQUE PROJECTIONS 700.. 71030 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; 700.. 71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERAL DECUBITUS, BUCKY STUDIES) 700.. 71100 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS 700.. 71101 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF THREE VIEWS 700.. 71110 RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS 700.. 71111 RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDING POSTEROANTERIOR CHEST, MINIMUM OF FOUR VIEWS 700.. 71120 RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS 700.. 71130 RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS, MINIMUM OF THREE VIEWS 700.. 72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY, ANTEROPOSTERIOR AND LATERAL 700.. 72020 RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL 700.. 72040 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; ANTEROPOSTERIOR AND LATERAL [[Page 47814]] 700.. 72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; MINIMUM OF FOUR VIEWS 700.. 72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; COMPLETE, INCLUDING OBLIQUE AND FLEXION AND/OR EXTENSION STUDIES 700.. 72069 RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING (SCOLIOSIS) 700.. 72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR AND LATERAL 700.. 72072 RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR AND LATERAL, INCLUDING SWIMMER'S VIEW OF THE CERVICOTHORACIC JUNCTION 700.. 72074 RADIOLOGIC EXAMINATION, SPINE; THORACIC, COMPLETE, INCLUDING OBLIQUES, MINIMUM OF FOUR VIEWS 700.. 72080 RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR, ANTEROPOSTERIOR AND LATERAL 700.. 72090 RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDING SUPINE AND ERECT STUDIES 700.. 72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; ANTEROPOSTERIOR AND LATERAL 700.. 72110 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, WITH OBLIQUE VIEWS 700.. 72114 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS 700.. 72120 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL, BENDING VIEWS ONLY, MINIMUM OF FOUR VIEWS 700.. 72170 RADIOLOGIC EXAMINATION, PELVIS; ANTEROPOSTERIOR ONLY 700.. 72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREE VIEWS 700.. 72200 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREE VIEWS 700.. 72202 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MORE VIEWS 700.. 72220 RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUM OF TWO VIEWS 700.. 73000 RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE 700.. 73010 RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE 700.. 73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW 700.. 73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWO VIEWS 700.. 73050 RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL, WITH OR WITHOUT WEIGHTED DISTRACTION 700.. 73060 RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS 700.. 73070 RADIOLOGIC EXAMINATION, ELBOW; ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73080 RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREE VIEWS 700.. 73090 RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73092 RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS 700.. 73100 RADIOLOGIC EXAMINATION, WRIST; ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73110 RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREE VIEWS 700.. 73120 RADIOLOGIC EXAMINATION, HAND; TWO VIEWS 700.. 73130 RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS 700.. 73140 RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS 700.. 73500 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; ONE VIEW 700.. 73510 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE, MINIMUM OF TWO VIEWS 700.. 73520 RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWO VIEWS OF EACH HIP, INCLUDING ANTEROPOSTERIOR VIEW OF PELVIS 700.. 73530 RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE 700.. 73540 RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT OR CHILD, MINIMUM OF TWO VIEWS 700.. 73550 RADIOLOGIC EXAMINATION, FEMUR, ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73560 RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73562 RADIOLOGIC EXAMINATION, KNEE; ANTEROPOSTERIOR AND LATERAL, WITH OBLIQUE(S), MINIMUM OF THREE VIEWS 700.. 73564 RADIOLOGIC EXAMINATION, KNEE; COMPLETE, INCLUDING OBLIQUE(S), AND TUNNEL, AND/OR PATELLAR AND/ OR STANDING VIEWS 700.. 73565 RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING, ANTEROPOSTERIOR 700.. 73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73592 RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS 700.. 73600 RADIOLOGIC EXAMINATION, ANKLE; ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73610 RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREE VIEWS 700.. 73620 RADIOLOGIC EXAMINATION, FOOT; ANTEROPOSTERIOR AND LATERAL VIEWS 700.. 73630 RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OF THREE VIEWS 700.. 73650 RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS 700.. 73660 RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS 700.. 74000 RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW 700.. 74010 RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR AND ADDITIONAL OBLIQUE AND CONE VIEWS 700.. 74020 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDING DECUBITUS AND/OR ERECT VIEWS 700.. 74022 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMEN SERIES, INCLUDING SUPINE, ERECT, AND/ OR DECUBITUS VIEWS, UPRIGHT PA CHEST 700.. 74710 PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION 700.. 76010 RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY, SINGLE FILM, CHILD 700.. 76020 BONE AGE STUDIES 700.. 76040 BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, SCANOGRAM) 700.. 76061 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES) 700.. 76062 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON) 700.. 76065 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT 700.. 76066 JOINT SURVEY, SINGLE VIEW, ONE OR MORE JOINTS (SPECIFY) 700.. 76076 DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) 700.. 76078 RADIOGRAPHIC ABSORPTIOMETRY (PHOTODENSITOMETRY), ONE OR MORE SITES 700.. 76098 RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN 700.. 76100 RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG, TOMOGRAPHY), OTHER THAN WITH UROGRAPHY 700.. 76120 CINERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED 700.. 76125 CINERADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION 700.. 76150 XERORADIOGRAPHY 700.. 76499 UNLISTED DIAGNOSTIC RADIOLOGIC PROCEDURE 700.. 77417 THERAPEUTIC RADIOLOGY PORT FILM(S) 700.. 78350 BONE DENSITY (BONE MINERAL CONTENT) STUDY, ONE OR MORE SITES; SINGLE PHOTON ABSORPTIOMETRY [[Page 47815]] 706.. Miscellaneous Radiological X 1.96 $99.31 $57.63 $19.86 Procedures 706.. 70170 DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 70373 LARYNGOGRAPHY, CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 70390 SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 71040 BRONCHOGRAPHY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 71060 BRONCHOGRAPHY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74190 PERITONEOGRAM (EG, AFTER INJECTION OF AIR OR CONTRAST), RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74305 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; POSTOPERATIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74320 CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74328 ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74329 ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74330 COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARY AND PANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74350 PERCUTANEOUS PLACEMENT OF GASTROSTOMY TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74355 PERCUTANEOUS PLACEMENT OF ENTEROCLYSIS TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74470 RADIOLOGIC EXAMINATION, RENAL CYST STUDY, TRANSLUMBAR, CONTRAST VISUALIZATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74740 HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 74742 TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75801 LYMPHANGIOGRAPHY, EXTREMITY ONLY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75803 LYMPHANGIOGRAPHY, EXTREMITY ONLY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75805 LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75807 LYMPHANGIOGRAPHY, PELVIC/ABDOMINAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75809 SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING NONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 75898 ANGIOGRAM THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION OR INFUSION 706.. 76075 DUAL ENERGY X-RAY ABSORPTIOMETRY (DEXA), BONE DENSITY STUDY, ONE OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE) 706.. 76080 RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACT STUDY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 76086 MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 76088 MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 76095 STEREOTACTIC LOCALIZATION FOR BREAST BIOPSY, EACH LESION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 76096 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION 706.. 76101 RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; UNILATERAL 706.. 76102 RADIOLOGIC EXAMINATION, COMPLEX MOTION (IE, HYPERCYCLOIDAL) BODY SECTION (EG, MASTOID POLYTOMOGRAPHY), OTHER THAN WITH UROGRAPHY; BILATERAL 710.. Computerized Axial Tomography S 5.06 $256.39 $176.28 $51.28 710.. 70450 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL 710.. 70460 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITH CONTRAST MATERIAL(S) 710.. 70470 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 70480 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL 710.. 70481 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITH CONTRAST MATERIAL(S) 710.. 70482 COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIOR FOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 70486 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL 710.. 70487 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITH CONTRAST MATERIAL(S) 710.. 70488 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 70490 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL 710.. 70491 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITH CONTRAST MATERIAL(S) 710.. 70492 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUT CONTRAST MATERIAL FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 71250 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL 710.. 71260 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITH CONTRAST MATERIAL(S) 710.. 71270 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 72125 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL 710.. 72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRAST MATERIAL 710.. 72127 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 72128 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL 710.. 72129 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITH CONTRAST MATERIAL 710.. 72130 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 72131 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL 710.. 72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRAST MATERIAL 710.. 72133 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 72192 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL 710.. 72193 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITH CONTRAST MATERIAL(S) [[Page 47816]] 710.. 72194 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 73200 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL 710.. 73201 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) 710.. 73202 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 73700 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL 710.. 73701 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) 710.. 73702 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 74150 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL 710.. 74160 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITH CONTRAST MATERIAL(S) 710.. 74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS 710.. 76355 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION 710.. 76360 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR NEEDLE BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 710.. 76365 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR CYST ASPIRATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 710.. 76370 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS 710.. 76375 CORONAL, SAGITTAL, MULTIPLANAR, OBLIQUE, 3-DIMENSIONAL AND/OR HOLOGRAPHIC RECONSTRUCTION OF COMPUTERIZED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, OR OTHER TOMOGRAPHIC MODALITY 710.. 76380 COMPUTERIZED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UP STUDY 716.. Fluoroscopy X 1.59 $80.56 $47.91 $16.11 716.. 70370 RADIOLOGIC EXAMINATION; PHARYNX OR LARYNX, INCLUDING FLUOROSCOPY AND/OR MAGNIFICATION TECHNIQUE 716.. 70371 COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY CINE OR VIDEO RECORDING 716.. 71023 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL AND LATERAL; WITH FLUOROSCOPY 716.. 71034 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOUR VIEWS; WITH FLUOROSCOPY 716.. 71036 NEEDLE BIOPSY OF INTRATHORACIC LESION, INCLUDING FOLLOW-UP FILMS, FLUOROSCOPIC LOCALIZATION ONLY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 716.. 71038 FLUOROSCOPIC LOCALIZATION FOR TRANSBRONCHIAL BIOPSY OR BRUSHING 716.. 71090 INSERTION PACEMAKER, FLUOROSCOPY AND RADIOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 716.. 74340 INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG, MILLER-ABBOTT), INCLUDING MULTIPLE FLUOROSCOPIES AND FILMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 716.. 75989 RADIOLOGICAL GUIDANCE FOR PERCUTANEOUS DRAINAGE OF ABSCESS, OR SPECIMEN COLLECTION (IE, FLUOROSCOPY, ULTRASOUND, OR COMPUTED TOMOGRAPHY), WITH PLACEMENT OF INDWELLING CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION 716.. 76000 FLUOROSCOPY (SEPARATE PROCEDURE), UP TO ONE HOUR PHYSICIAN TIME, OTHER THAN 71023 OR 71034 (EG, CARDIAC FLUOROSCOPY) 716.. 76001 FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A NON-RADIOLOGIC PHYSICIAN (EG, NEPHROSTOLITHOTOMY, ERCP, BRONCHOSCOPY, TRANSBRONCHIAL BIOPSY) 716.. 76003 FLUOROSCOPIC LOCALIZATION FOR NEEDLE BIOPSY OR FINE NEEDLE ASPIRATION 720.. Magnetic Resonance Angiography S 6.34 $321.24 206.11 $64.25 720.. 70541 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD AND/OR NECK, WITH OR WITHOUT CONTRAST MATERIAL(S) 726.. Magnetic Resonance Imaging S 7.96 $403.33 $258.09 $80.67 726.. 70336 MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULAR JOINT 726.. 70540 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ORBIT, FACE, AND NECK 726.. 70551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL 726.. 70552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITH CONTRAST MATERIAL(S) 726.. 70553 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDING BRAIN STEM); WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES 726.. 71550 MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY) 726.. 72141 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL 726.. 72142 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, CERVICAL; WITH CONTRAST MATERIAL(S) 726.. 72146 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL 726.. 72147 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, THORACIC; WITH CONTRAST MATERIAL(S) 726.. 72148 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL 726.. 72149 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, LUMBAR; WITH CONTRAST MATERIAL(S) 726.. 72156 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL 726.. 72157 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC 726.. 72158 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL AND CONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR 726.. 72196 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS 726.. 73220 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY, OTHER THAN JOINT 726.. 73221 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF UPPER EXTREMITY 726.. 73720 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY, OTHER THAN JOINT 726.. 73721 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINT OF LOWER EXTREMITY 726.. 74181 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN 726.. 75552 CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITHOUT CONTRAST MATERIAL 726.. 75553 CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY; WITH CONTRAST MATERIAL 726.. 75554 CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; COMPLETE STUDY 726.. 75555 CARDIAC MAGNETIC RESONANCE IMAGING FOR FUNCTION, WITH OR WITHOUT MORPHOLOGY; LIMITED STUDY 726.. 76093 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); UNILATERAL 726.. 76094 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONTRAST MATERIAL(S); BILATERAL [[Page 47817]] 726.. 76390 MAGNETIC RESONANCE SPECTROSCOPY 726.. 76400 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BONE MARROW BLOOD SUPPLY 728.. Myelography S 4.07 $206.22 $113.23 $41.24 728.. 70010 MYELOGRAPHY, POSTERIOR FOSSA, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72240 MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72255 MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72265 MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72270 MYELOGRAPHY, ENTIRE SPINAL CANAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72285 DISKOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 728.. 72295 DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. Arthography S 2.48 $125.66 $72.09 $25.13 730.. 70332 TEMPOROMANDIBULAR JOINT ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73040 RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73085 RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73115 RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73525 RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73580 RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 730.. 73615 RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 736.. Digestive Radiology S 1.85 $93.74 $54.24 $18.75 736.. 74210 RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS 736.. 74220 RADIOLOGIC EXAMINATION; ESOPHAGUS 736.. 74230 SWALLOWING FUNCTION, PHARYNX AND/OR ESOPHAGUS, WITH CINERADIOGRAPHY AND/OR VIDEO 736.. 74240 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB 736.. 74241 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB 736.. 74245 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS 736.. 74246 RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB 736.. 74247 RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED FILMS, WITH KUB 736.. 74249 RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIR CONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL BOWEL FOLLOW-THROUGH 736.. 74250 RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS; 736.. 74251 RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS; VIA ENTEROCLYSIS TUBE 736.. 74260 DUODENOGRAPHY, HYPOTONIC 736.. 74270 RADIOLOGIC EXAMINATION, COLON; BARIUM ENEMA, WITH OR WITHOUT KUB 736.. 74280 RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFIC HIGH DENSITY BARIUM, WITH OR WITHOUT GLUCAGON 736.. 74283 THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OF INTUSSUSCEPTION OR OTHER INTRALUMINAL OBSTRUCTION (EG, MECONIUM ILEUS) 736.. 74290 CHOLECYSTOGRAPHY, ORAL CONTRAST; 736.. 74291 CHOLECYSTOGRAPHY, ORAL CONTRAST; ADDITIONAL OR REPEAT EXAMINATION OR MULTIPLE DAY EXAMINATION 736.. G0106 Colorectal Ca screening 736.. G0120 Colorectal Ca screening 737.. Diagnostic Urography S 2.81 $142.38 $86.56 $28.48 737.. 74400 UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY; 737.. 74405 UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, WITH OR WITHOUT TOMOGRAPHY; WITH SPECIAL HYPERTENSIVE CONTRAST CONCENTRATION AND/OR CLEARANCE STUDIES 737.. 74410 UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; 737.. 74415 UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY 737.. 74420 UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB 737.. 74425 UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM, LOOPOGRAM), RADIOLOGICAL SUPERVISION AND 737.. 74430 CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 737.. 74440 VASOGRAPHY, VESICULOGRAPHY, OR EPIDIDYMOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 737.. 74445 CORPORA CAVERNOSOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 737.. 74450 URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 737.. 74455 URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION AND INTERPRETATION 737.. 74775 PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATION OR EXTENT OF ANOMALIES) 738.. Therapeutic Radiologic S 4.48 $227.00 $133.23 $45.4 Procedures 738.. 74235 REMOVAL OF FOREIGN BODY(S), ESOPHAGEAL, WITH USE OF BALLOON CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74327 POSTOPERATIVE BILIARY DUCT STONE REMOVAL, PERCUTANEOUS VIA T-TUBE TRACT, BASKET, OR SNARE (EG, BURHENNE TECHNIQUE), RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74360 INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG, ESOPHAGUS), RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74363 PERCUTANEOUS TRANSHEPATIC DILATATION OF BILIARY DUCT STRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74475 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74480 INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETER THROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 74485 DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 75980 PERCUTANEOUS TRANSHEPATIC BILIARY DRAINAGE WITH CONTRAST MONITORING, RADIOLOGICAL SUPERVISION AND INTERPRETATION [[Page 47818]] 738.. 75982 PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR COMBINED INTERNAL AND EXTERNAL BILIARY DRAINAGE OR OF A DRAINAGE STENT FOR INTERNAL BILIARY DRAINAGE IN PATIENTS WITH AN INOPERABLE MECHANICAL BILIARY OBSTRUCTION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 738.. 75984 CHANGE OF PERCUTANEOUS TUBE OR DRAINAGE CATHETER WITH CONTRAST MONITORING (EG, GASTROINTESTINAL SYSTEM, GENITOURINARY SYSTEM, ABSCESS), RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. Diagnostic Angiography and S 5.83 $295.40 $168.71 $59.08 Venography 739.. 75600 AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75605 AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75625 AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75630 AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWER EXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75650 ANGIOGRAPHY, CERVICOCEREBRAL, CATHETER, INCLUDING VESSEL ORIGIN, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75658 ANGIOGRAPHY, BRACHIAL, RETROGRADE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75660 ANGIOGRAPHY, EXTERNAL CAROTID, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75662 ANGIOGRAPHY, EXTERNAL CAROTID, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75665 ANGIOGRAPHY, CAROTID, CEREBRAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75671 ANGIOGRAPHY, CAROTID, CEREBRAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75676 ANGIOGRAPHY, CAROTID, CERVICAL, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75680 ANGIOGRAPHY, CAROTID, CERVICAL, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75685 ANGIOGRAPHY, VERTEBRAL, CERVICAL, AND/OR INTRACRANIAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75705 ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75710 ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75716 ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75722 ANGIOGRAPHY, RENAL, UNILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75724 ANGIOGRAPHY, RENAL, BILATERAL, SELECTIVE (INCLUDING FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75726 ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH OR WITHOUT FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75731 ANGIOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75733 ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75736 ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75741 ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75743 ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75746 ANGIOGRAPHY, PULMONARY, BY NONSELECTIVE CATHETER OR VENOUS INJECTION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75756 ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75774 ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTER BASIC EXAMINATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75790 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT), RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75810 SPLENOPORTOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75820 VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75822 VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75825 VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75827 VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75831 VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75833 VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75840 VENOGRAPHY, ADRENAL, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75842 VENOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75860 VENOGRAPHY, SINUS OR JUGULAR, CATHETER, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75870 VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75872 VENOGRAPHY, EPIDURAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75880 VENOGRAPHY, ORBITAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75885 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75887 PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75889 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 739.. 75891 HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMIC EVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 746.. Mammography S 0.69 $34.96 $19.44 $6.99 746.. 76090 MAMMOGRAPHY; UNILATERAL 746.. 76091 MAMMOGRAPHY; BILATERAL 747.. Diagnostic Ultrasound Except S 1.65 $83.60 $54.69 $16.72 Vascular 747.. 76506 ECHOENCEPHALOGRAPHY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION (GRAY SCALE) (FOR DETERMINATION OF VENTRICULAR SIZE, DELINEATION OF CEREBRAL CONTENTS AND DETECTION OF FLUID MASSES OR OTHER INTRACRANIAL ABNORMALITIES), INCLUDING A-MODE ENCEPHALOGRAPH 747.. 76511 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; A-SCAN ONLY, WITH AMPLITUDE QUANTIFICATION 747.. 76512 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CONTACT B-SCAN (WITH OR WITHOUT SIMULTANEOUS A- SCAN) 747.. 76513 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; IMMERSION (WATER BATH) B-SCAN 747.. 76516 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; 747.. 76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITH INTRAOCULAR LENS POWER CALCULATION 747.. 76529 OPHTHALMIC ULTRASONIC FOREIGN BODY LOCALIZATION [[Page 47819]] 747.. 76536 ECHOGRAPHY, SOFT TISSUES OF HEAD AND NECK (EG, THYROID, PARATHYROID, PAROTID), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION 747.. 76604 ECHOGRAPHY, CHEST, B-SCAN (INCLUDES MEDIASTINUM) AND/OR REAL TIME WITH IMAGE DOCUMENTATION 747.. 76645 ECHOGRAPHY, BREAST(S) (UNILATERAL OR BILATERAL), B-SCAN AND/ OR REAL TIME WITH IMAGE DOCUMENTATION 747.. 76700 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE 747.. 76705 ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLLOW-UP) 747.. 76770 ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE 747.. 76775 ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED 747.. 76778 ECHOGRAPHY OF TRANSPLANTED KIDNEY, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION, WITH OR WITHOUT DUPLEX DOPPLER STUDIES 747.. 76800 ECHOGRAPHY, SPINAL CANAL AND CONTENTS 747.. 76805 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL AND MATERNAL EVALUATION) 747.. 76810 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL AND MATERNAL EVALUATION), MULTIPLE GESTATION, AFTER THE FIRST TRIMESTER 747.. 76815 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED (FETAL SIZE, HEART BEAT, PLACENTAL LOCATION, FETAL POSITION, OR EMERGENCY IN THE DELIVERY ROOM) 747.. 76816 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; FOLLOW-UP OR REPEAT 747.. 76818 FETAL BIOPHYSICAL PROFILE 747.. 76830 ECHOGRAPHY, TRANSVAGINAL 747.. 76831 HYSTEROSONOGRAPHY, WITH OR WITHOUT COLOR FLOW DOPPLER 747.. 76856 ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; COMPLETE 747.. 76857 ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED OR FOLLOW-UP (EG, FOR FOLLICLES) 747.. 76870 ECHOGRAPHY, SCROTUM AND CONTENTS 747.. 76872 ECHOGRAPHY, TRANSRECTAL 747.. 76880 ECHOGRAPHY, EXTREMITY, NON-VASCULAR, B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION 747.. 76885 ECHOGRAPHY OF INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC (EG, REQUIRING MANIPULATION) 747.. 76886 ECHOGRAPHY OF INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC (EG, NOT REQUIRING MANIPULATION 747.. 76970 ULTRASOUND STUDY FOLLOW-UP (SPECIFY) 747.. 76975 GASTROINTESTINAL ENDOSCOPIC ULTRASOUND, RADIOLOGICAL SUPERVISION AND INTERPRETATION 747.. 76986 ECHOGRAPHY, INTRAOPERATIVE 747.. 76999 UNLISTED ULTRASOUND PROCEDURE 747.. G0050 POST-VOIDAL RESIDUAL URINE/BLADDER CAPACITY 749.. Guidance under Ultrasound X 2.44 $123.63 $76.16 $24.73 749.. 76930 ULTRASONIC GUIDANCE FOR PERICARDIOCENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76932 ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76934 ULTRASONIC GUIDANCE FOR THORACENTESIS OR ABDOMINAL PARACENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76936 ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIAL PSEUDO-ANEURYSM OR ARTERIOVENOUS FISTULAE (INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION AND IMAGING) 749.. 76938 ULTRASONIC GUIDANCE FOR CYST (ANY LOCATION) OR RENAL PELVIS ASPIRATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76941 ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION OR CORDOCENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76942 ULTRASONIC GUIDANCE FOR NEEDLE BIOPSY, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76945 ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76946 ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76948 ULTRASONIC GUIDANCE FOR ASPIRATION OF OVA, RADIOLOGICAL SUPERVISION AND INTERPRETATION 749.. 76950 ECHOGRAPHY FOR PLACEMENT OF RADIATION THERAPY FIELDS, B-SCAN 749.. 76960 ULTRASONIC GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS, EXCEPT FOR B-SCAN ECHOGRAPHY 749.. 76965 ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT APPLICATION 750.. Therapeutic Radiation X 0.91 $46.11 $25.54 $9.22 Treatment Planning 750.. 77261 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; SIMPLE 750.. 77262 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; INTERMEDIATE 750.. 77263 THERAPEUTIC RADIOLOGY TREATMENT PLANNING; COMPLEX 750.. 77336 CONTINUING MEDICAL RADIATION PHYSICS CONSULTATION IN SUPPORT OF THERAPEUTIC RADIOLOGIST INCLUDING CONTINUING QUALITY ASSURANCE REPORTED PER WEEK OF THERAPY 750.. 77370 SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION 750.. 77399 UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY AND TREATMENT DEVICES 750.. 77431 RADIATION THERAPY MANAGEMENT WITH COMPLETE COURSE OF THERAPY CONSISTING OF ONE OR TWO FRACTIONS ONLY 750.. 77432 STEREOTACTIC RADIATION TREATMENT MANAGEMENT OF CEREBRAL LESION(S) (COMPLETE COURSE OF TREATMENT CONSISTING OF ONE SESSION) 751.. Level I Therapeutic Radiation X 1.15 $58.27 $33.22 $11.65 Treatment Preparation 751.. 77299 UNLISTED PROCEDURE, THERAPEUTIC RADIOLOGY CLINICAL TREATMENT PLANNING 751.. 77300 BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTH DOSE, TDF, NSD, GAP CALCULATION, OFF AXIS FACTOR, TISSUE INHOMOGENEITY FACTORS, AS REQUIRED DURING COURSE OF TREATMENT, ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN 751.. 77305 TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); SIMPLE (ONE OR TWO PARALLEL OPPOSED UNMODIFIED PORTS DIRECTED TO A SINGLE AREA OF INTEREST) [[Page 47820]] 751.. 77310 TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); INTERMEDIATE (THREE OR MORE TREATMENT PORTS DIRECTED TO A SINGLE AREA OF INTEREST) 751.. 77315 TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTER CALCULATED); COMPLEX (MANTLE OR INVERTED Y, TANGENTIAL PORTS, THE USE OF WEDGES, COMPENSATORS, COMPLEX BLOCKING, ROTATIONAL BEAM, OR SPECIAL BEAM CONSIDERATIONS) 751.. 77321 SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMIBODY, TOTAL BODY 751.. 77326 BRACHYTHERAPY ISODOSE CALCULATION; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR SOURCES/ RIBBON APPLICATION, REMOTE AFTERLOADING BRACHYTHERAPY, 1 TO 8 SOURCES) 751.. 77327 BRACHYTHERAPY ISODOSE CALCULATION; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS, APPLICATION INVOLVING 5 TO 10 SOURCES/RIBBONS, REMOTE AFTERLOADING BRACHYTHERAPY, 9 TO 12 SOURCES) 751.. 77328 BRACHYTHERAPY ISODOSE CALCULATION; COMPLEX (MULTIPLANE ISODOSE PLAN, VOLUME IMPLANT CALCULATIONS, OVER 10 SOURCES/RIBBONS USED, SPECIAL SPATIAL RECONSTRUCTION, REMOTE AFTERLOADING BRACHYTHERAPY, OVER 12 SOURCES) 751.. 77331 SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN 751.. 77332 TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE (SIMPLE BLOCK, SIMPLE BOLUS) 751.. 77333 TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE (MULTIPLE BLOCKS, STENTS, BITE BLOCKS, SPECIAL BOLUS) 751.. 77334 TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX (IRREGULAR BLOCKS, SPECIAL SHIELDS, COMPENSATORS, WEDGES, MOLDS OR CASTS) 752.. Level II Therapeutic Radiation X 3.54 $179.37 $88.82 $35.87 Treatment 752.. 77280 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE 752.. 77285 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; INTERMEDIATE 752.. 77290 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; COMPLEX 752.. 77295 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; THREE-DIMENSIONAL 757.. Radiation Therapy S 2.30 $116.54 $52.43 $23.31 757.. 61793 STEREOTACTIC RADIOSURGERY (PARTICLE BEAM, GAMMA RAY OR LINEAR ACCELERATOR), ONE OR MORE SESSIONS 757.. 77401 RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHO VOLTAGE 757.. 77402 RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; UP TO 5 MEV 757.. 77403 RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; 6-10 MEV 757.. 77404 RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; 11-19 MEV 757.. 77406 RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; 20 MEV OR GREATER 757.. 77407 RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; UP TO 5 MEV 757.. 77408 RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 6-10 MEV 757.. 77409 RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 11-19 MEV 757.. 77411 RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 20 MEV OR GREATER 757.. 77412 RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON OR NEUTRONS); UP TO 5 MEV 757.. 77413 RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON OR NEUTRONS); 6-10 MEV 757.. 77414 RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON OR NEUTRONS); 11-19 MEV 757.. 77416 RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATE TREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, ELECTRON OR NEUTRONS); 20 MEV OR GREATER 757.. 77470 SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY IRRADIATION, HEMIBODY IRRADIATION, PER ORAL, VAGINAL CONE IRRADIATION 758.. Hyperthermic Therapies S 3.41 $172.78 $76.84 $34.56 758.. 77600 HYPERTHERMIA, EXTERNALLY GENERATED; SUPERFICIAL (IE, HEATING TO A DEPTH OF 4 CM OR LESS) 758.. 77605 HYPERTHERMIA, EXTERNALLY GENERATED; DEEP (IE, HEATING TO DEPTHS GREATER THAN 4 CM) 758.. 77610 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); 5 OR FEWER INTERSTITIAL APPLICATORS 758.. 77615 HYPERTHERMIA GENERATED BY INTERSTITIAL PROBE(S); MORE THAN 5 INTERSTITIAL APPLICATORS 758.. 77620 HYPERTHERMIA GENERATED BY INTRACAVITARY PROBE(S) 759.. Brachytherapy and Complex S 7.98 $404.34 $160.01 $80.87 Radioelement Applications 759.. 77750 INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION 759.. 77761 INTRACAVITARY RADIOELEMENT APPLICATION; SIMPLE 759.. 77762 INTRACAVITARY RADIOELEMENT APPLICATION; INTERMEDIATE 759.. 77763 INTRACAVITARY RADIOELEMENT APPLICATION; COMPLEX 759.. 77776 INTERSTITIAL RADIOELEMENT APPLICATION; SIMPLE 759.. 77777 INTERSTITIAL RADIOELEMENT APPLICATION; INTERMEDIATE 759.. 77778 INTERSTITIAL RADIOELEMENT APPLICATION; COMPLEX 759.. 77781 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 1-4 SOURCE POSITIONS OR CATHETERS 759.. 77782 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 5-8 SOURCE POSITIONS OR CATHETERS 759.. 77783 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; 9-12 SOURCE POSITIONS OR CATHETERS 759.. 77784 REMOTE AFTERLOADING HIGH INTENSITY BRACHYTHERAPY; OVER 12 SOURCE POSITIONS OR CATHETERS 759.. 77789 SURFACE APPLICATION OF RADIOELEMENT 759.. 77799 UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY 760.. PET Scans S 17.26 $874.55 $419.46 $174.91 760.. 78459 MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION [[Page 47821]] 760.. 78608 BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); METABOLIC EVALUATION 760.. 78609 BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); PERFUSION EVALUATION 760.. 78810 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC EVALUATION 760.. G0030 PET imaging prev PET single 760.. G0031 PET imaging prev PET multple 760.. G0032 PET follow SPECT 78464 singl 760.. G0033 PET follow SPECT 78464 mult 760.. G0034 PET follow SPECT 76865 singl 760.. G0035 PET follow SPECT 78465 mult 760.. G0036 PET follow cornry angio sing 760.. G0037 PET follow cornry angio mult 760.. G0038 PET follow myocard perf sing 760.. G0039 PET follow myocard perf mult 760.. G0040 PET follow stress echo singl 760.. G0041 PET follow stress echo mult 760.. G0042 PET follow ventriculogm sing 760.. G0043 PET follow ventriculogm mult 760.. G0044 PET following rest ECG singl 760.. G0045 PET following rest ECG mult 760.. G0046 PET follow stress ECG singl 760.. G0047 PET follow stress ECG mult 761.. Standard Non-Imaging Nuclear S 2.04 $103.37 $61.47 $20.67 Medicine 761.. 78000 THYROID UPTAKE; SINGLE DETERMINATION 761.. 78099 UNLISTED ENDOCRINE PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 761.. 78110 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); SINGLE SAMPLING 761.. 78111 PLASMA VOLUME, RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS 761.. 78120 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); SINGLE SAMPLING 761.. 78199 UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 761.. 78270 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITHOUT INTRINSIC FACTOR 761.. 78271 VITAMIN B-12 ABSORPTION STUDY (EG, SCHILLING TEST); WITH INTRINSIC FACTOR 761.. 78272 VITAMIN B-12 ABSORPTION STUDIES COMBINED, WITH AND WITHOUT INTRINSIC FACTOR 761.. 78282 GASTROINTESTINAL PROTEIN LOSS 761.. 78299 UNLISTED GASTROINTESTINAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 761.. 78725 KIDNEY FUNCTION STUDY WITHOUT PHARMACOLOGIC INTERVENTION 761.. 78999 UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 762.. Complex Non-Imaging Nuclear S 1.78 $90.19 $51.53 $18.04 Medicine 762.. 78001 THYROID UPTAKE; MULTIPLE DETERMINATIONS 762.. 78003 THYROID UPTAKE; STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INITIAL UPTAKE STUDIES) 762.. 78121 RED CELL VOLUME DETERMINATION (SEPARATE PROCEDURE); MULTIPLE SAMPLINGS 762.. 78122 WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATE MEASUREMENT OF PLASMA VOLUME AND RED CELL VOLUME (RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE) 762.. 78130 RED CELL SURVIVAL STUDY; 762.. 78135 RED CELL SURVIVAL STUDY; DIFFERENTIAL ORGAN/TISSUE KINETICS, (EG, SPLENIC AND/OR HEPATIC SEQUESTRATION) 762.. 78140 LABELED RED CELL SEQUESTRATION, DIFFERENTIAL ORGAN/TISSUE, (EG, SPLENIC AND/OR HEPATIC) 762.. 78160 PLASMA RADIOIRON DISAPPEARANCE (TURNOVER) RATE 762.. 78162 RADIOIRON ORAL ABSORPTION 762.. 78170 RADIOIRON RED CELL UTILIZATION 762.. 78172 CHELATABLE IRON FOR ESTIMATION OF TOTAL BODY IRON 762.. 78190 KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFERENTIAL ORGAN/TISSUE LOCALIZATION 762.. 78191 PLATELET SURVIVAL STUDY 762.. 78414 DETERMINATION OF CENTRAL C-V HEMODYNAMICS (NON-IMAGING) (EG, EJECTION FRACTION WITH PROBE TECHNIQUE) WITH OR WITHOUT PHARMACOLOGIC INTERVENTION OR EXERCISE, SINGLE OR MULTIPLE DETERMINATIONS 762.. 78455 VENOUS THROMBOSIS STUDY (EG, RADIOACTIVE FIBRINOGEN) 762.. 78499 UNLISTED CARDIOVASCULAR PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 771.. Standard Planar Nuclear S 3.78 $191.53 $116.84 $38.31 Medicine 771.. 78006 THYROID IMAGING, WITH UPTAKE; SINGLE DETERMINATION 771.. 78010 THYROID IMAGING; ONLY 771.. 78011 THYROID IMAGING; WITH VASCULAR FLOW 771.. 78015 THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA (EG, NECK AND CHEST ONLY) 771.. 78102 BONE MARROW IMAGING; LIMITED AREA 771.. 78103 BONE MARROW IMAGING; MULTIPLE AREAS 771.. 78104 BONE MARROW IMAGING; WHOLE BODY 771.. 78185 SPLEEN IMAGING ONLY, WITH OR WITHOUT VASCULAR FLOW 771.. 78201 LIVER IMAGING; STATIC ONLY 771.. 78202 LIVER IMAGING; WITH VASCULAR FLOW 771.. 78215 LIVER AND SPLEEN IMAGING; STATIC ONLY 771.. 78216 LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW 771.. 78230 SALIVARY GLAND IMAGING; 771.. 78231 SALIVARY GLAND IMAGING; WITH SERIAL IMAGES 771.. 78261 GASTRIC MUCOSA IMAGING 771.. 78290 BOWEL IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKEL'S LOCALIZATION, VOLVULUS) 771.. 78300 BONE AND/OR JOINT IMAGING; LIMITED AREA 771.. 78305 BONE AND/OR JOINT IMAGING; MULTIPLE AREAS 771.. 78306 BONE AND/OR JOINT IMAGING; WHOLE BODY [[Page 47822]] 771.. 78399 UNLISTED MUSCULOSKELETAL PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 771.. 78428 CARDIAC SHUNT DETECTION 771.. 78445 NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY, VENOGRAPHY) 771.. 78457 VENOUS THROMBOSIS IMAGING (EG, VENOGRAM); UNILATERAL 771.. 78458 VENOUS THROMBOSIS IMAGING (EG, VENOGRAM); BILATERAL 771.. 78460 MYOCARDIAL PERFUSION IMAGING; (PLANAR) SINGLE STUDY, AT REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION 771.. 78466 MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; QUALITATIVE OR QUANTITATIVE 771.. 78478 MYOCARDIAL PERFUSION STUDY WITH WALL MOTION, QUALITATIVE OR QUANTITATIVE STUDY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) (USE ONLY FOR CODES 78460, 78461, 78464, 78465) 771.. 78480 MYOCARDIAL PERFUSION STUDY WITH EJECTION FRACTION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) (USE ONLY FOR CODES 78460, 78461, 78464, 78465) 771.. 78481 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 771.. 78580 PULMONARY PERFUSION IMAGING, PARTICULATE 771.. 78586 PULMONARY VENTILATION IMAGING, AEROSOL; SINGLE PROJECTION 771.. 78587 PULMONARY VENTILATION IMAGING, AEROSOL; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) 771.. 78591 PULMONARY VENTILATION IMAGING, GASEOUS, SINGLE BREATH, SINGLE PROJECTION 771.. 78593 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; SINGLE PROJECTION 771.. 78599 UNLISTED RESPIRATORY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 771.. 78600 BRAIN IMAGING, LIMITED PROCEDURE; STATIC 771.. 78601 BRAIN IMAGING, LIMITED PROCEDURE; WITH VASCULAR FLOW 771.. 78605 BRAIN IMAGING, COMPLETE STUDY; STATIC 771.. 78610 BRAIN IMAGING, VASCULAR FLOW ONLY 771.. 78660 RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY 771.. 78699 UNLISTED NERVOUS SYSTEM PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 771.. 78700 KIDNEY IMAGING; STATIC ONLY 771.. 78701 KIDNEY IMAGING; WITH VASCULAR FLOW 771.. 78704 KIDNEY IMAGING; WITH FUNCTION STUDY (IE, IMAGING RENOGRAM) 771.. 78707 KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY WITHOUT PHARMACOLOGICAL INTERVENTION 771.. 78715 KIDNEY VASCULAR FLOW ONLY 771.. 78730 URINARY BLADDER RESIDUAL STUDY 771.. 78760 TESTICULAR IMAGING; 771.. 78761 TESTICULAR IMAGING; WITH VASCULAR FLOW 771.. 78799 UNLISTED GENITOURINARY PROCEDURE, DIAGNOSTIC NUCLEAR MEDICINE 772.. Complex Planar Nuclear S 4.22 $213.83 $127.92 $42.77 Medicine 772.. 78007 THYROID IMAGING, WITH UPTAKE; MULTIPLE DETERMINATIONS 772.. 78016 THYROID CARCINOMA METASTASES IMAGING; WITH ADDITIONAL STUDIES (EG, URINARY RECOVERY) 772.. 78017 THYROID CARCINOMA METASTASES IMAGING; MULTIPLE AREAS 772.. 78018 THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY 772.. 78070 PARATHYROID IMAGING 772.. 78075 ADRENAL IMAGING, CORTEX AND/OR MEDULLA 772.. 78195 LYMPHATICS AND LYMPH GLANDS IMAGING 772.. 78220 LIVER FUNCTION STUDY WITH HEPATOBILIARY AGENTS, WITH SERIAL IMAGES 772.. 78223 HEPATOBILIARY DUCTAL SYSTEM IMAGING, INCLUDING GALLBLADDER, WITH OR WITHOUT PHARMACOLOGIC INTERVENTION, WITH OR WITHOUT QUANTITATIVE MEASUREMENT OF GALLBLADDER FUNCTION 772.. 78232 SALIVARY GLAND FUNCTION STUDY 772.. 78258 ESOPHAGEAL MOTILITY 772.. 78262 GASTROESOPHAGEAL REFLUX STUDY 772.. 78264 GASTRIC EMPTYING STUDY 772.. 78278 ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING 772.. 78291 PERITONEAL-VENOUS SHUNT PATENCY TEST (EG, FOR LEVEEN, DENVER SHUNT) 772.. 78315 BONE AND/OR JOINT IMAGING; THREE PHASE STUDY 772.. 78461 MYOCARDIAL PERFUSION IMAGING; MULTIPLE STUDIES, (PLANAR) AT REST AND/OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), AND REDISTRIBUTION AND/OR REST INJECTION, WITH OR WITHOUT QUANTIFICATION 772.. 78468 MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; WITH EJECTION FRACTION BY FIRST PASS TECHNIQUE 772.. 78472 CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; SINGLE STUDY AT REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT ADDITIONAL QUANTITATIVE PROCESSING 772.. 78473 MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT ADDITIONAL QUANTIFICATION 772.. 78483 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 772.. 78584 PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; SINGLE BREATH 772.. 78585 PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION; REBREATHING AND WASHOUT, WITH OR WITHOUT SINGLE BREATH 772.. 78594 PULMONARY VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASHOUT WITH OR WITHOUT SINGLE BREATH; MULTIPLE PROJECTIONS (EG, ANTERIOR, POSTERIOR, LATERAL VIEWS) 772.. 78596 PULMONARY QUANTITATIVE DIFFERENTIAL FUNCTION (VENTILATION/PERFUSION) STUDY 772.. 78606 BRAIN IMAGING, COMPLETE STUDY; WITH VASCULAR FLOW 772.. 78615 CEREBRAL BLOOD FLOW 772.. 78630 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); CISTERNOGRAPHY 772.. 78635 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); VENTRICULOGRAPHY 772.. 78645 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); SHUNT EVALUATION 772.. 78650 CSF LEAKAGE DETECTION AND LOCALIZATION [[Page 47823]] 772.. 78708 KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; SINGLE STUDY, WITH PHARMACOLOGICAL INTERVENTION (EG, ANGIOTENSIN CONVERTING ENZYME INHIBITOR AND/OR DIURETIC) 772.. 78709 KIDNEY IMAGING WITH VASCULAR FLOW AND FUNCTION; MULTIPLE STUDIES, WITH AND WITHOUT PHARMACOLOGICAL INTERVENTION (EG, ANGIOTENSIN CONVERTING ENZYME INHIBITOR AND/OR DIURETIC) 772.. 78740 URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM) 772.. 78800 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; LIMITED AREA 772.. 78801 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; MULTIPLE AREAS 772.. 78802 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; WHOLE BODY 772.. 78805 RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; LIMITED AREA 772.. 78806 RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; WHOLE BODY 781.. Standard SPECT Nuclear S 5.26 $266.52 $145.77 $53.30 Medicine 781.. 78205 LIVER IMAGING (SPECT) 781.. 78320 BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT) 781.. 78464 MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), SINGLE STUDY AT REST OR STRESS (EXERCISE AND/ OR PHARMACOLOGIC), WITH OR WITHOUT QUANTIFICATION 781.. 78469 MYOCARDIAL IMAGING, INFARCT AVID, PLANAR; TOMOGRAPHIC SPECT WITH OR WITHOUT QUANTIFICATION 781.. 78607 BRAIN IMAGING, COMPLETE STUDY; TOMOGRAPHIC (SPECT) 781.. 78647 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDING INTRODUCTION OF MATERIAL); TOMOGRAPHIC (SPECT) 781.. 78710 KIDNEY IMAGING, TOMOGRAPHIC (SPECT) 782.. Complex SPECT Nuclear Medicine S 9.28 $470.21 $275.04 $94.04 782.. 78465 MYOCARDIAL PERFUSION IMAGING; TOMOGRAPHIC (SPECT), MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE AND/OR PHARMACOLOGIC) AND REDISTRIBUTION AND/OR REST INJECTION, WITH OR WITHOUT QUANTIFICATION 782.. 78803 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; TOMOGRAPHIC (SPECT) 782.. 78807 RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; TOMOGRAPHIC (SPECT) 791.. Standard Therapeutic Nuclear S 15.83 $802.10 $562.06 $160.42 Medicine 791.. 79001 RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; SUBSEQUENT, EACH THERAPY 791.. 79100 RADIOPHARMACEUTICAL THERAPY, POLYCYTHEMIA VERA, CHRONIC LEUKEMIA, EACH TREATMENT 791.. 79300 INTERSTITIAL RADIOACTIVE COLLOID THERAPY 791.. 79400 RADIOPHARMACEUTICAL THERAPY, NONTHYROID, NONHEMATOLOGIC 791.. 79420 INTRAVASCULAR RADIOPHARMACEUTICAL THERAPY, PARTICULATE 791.. 79440 INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPY 791.. 79999 UNLISTED RADIOPHARMACEUTICAL THERAPEUTIC PROCEDURE 792.. Complex Therapeutic Nuclear S 4.80 $243.21 $144.19 $48.64 Medicine 792.. 79000 RADIOPHARMACEUTICAL THERAPY, HYPERTHYROIDISM; INITIAL, INCLUDING EVALUATION OF PATIENT 792.. 79020 RADIOPHARMACEUTICAL THERAPY, THYROID SUPPRESSION (EUTHYROID CARDIAC DISEASE), INCLUDING EVALUATION OF PATIENT 792.. 79030 RADIOPHARMACEUTICAL ABLATION OF GLAND FOR THYROID CARCINOMA 792.. 79035 RADIOPHARMACEUTICAL THERAPY FOR METASTASES OF THYROID CARCINOMA 792.. 79200 INTRACAVITARY RADIOACTIVE COLLOID THERAPY 861.. Immunology Tests X 0.13 $6.59 $3.62 $1.32 861.. 86485 SKIN TEST; CANDIDA 861.. 86490 SKIN TEST; COCCIDIOIDOMYCOSIS 861.. 86510 SKIN TEST; HISTOPLASMOSIS 861.. 86580 SKIN TEST; TUBERCULOSIS, INTRADERMAL 861.. 86585 SKIN TEST; TUBERCULOSIS, TINE TEST 861.. 86586 SKIN TEST; UNLISTED ANTIGEN, EACH 881.. Level I Pathology X 0.20 $10.13 $6.78 $2.03 881.. 88125 CYTOPATHOLOGY, FORENSIC (EG, SPERM) 881.. 88199 UNLISTED CYTOPATHOLOGY PROCEDURE 881.. 88300 LEVEL I - SURGICAL PATHOLOGY, GROSS EXAMINATION ONLY 881.. 88311 DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION) 881.. 88313 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP II, ALL OTHER, (EG, IRON, TRICHROME), EXCEPT IMMUNOCYTOCHEMISTRY AND IMMUNOPEROXIDASE STAINS, EACH 881.. 88399 UNLISTED SURGICAL PATHOLOGY PROCEDURE 881.. 89350 SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE) 881.. 89360 SWEAT COLLECTION BY IONTOPHORESIS 881.. 89399 UNLISTED MISCELLANEOUS PATHOLOGY TEST 881.. G0025 Collagen skin test kit 882.. Level II Pathology X 0.39 $19.76 $11.75 $3.95 882.. 80500 CLINICAL PATHOLOGY CONSULTATION; LIMITED, WITHOUT REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS 882.. 80502 CLINICAL PATHOLOGY CONSULTATION; COMPREHENSIVE, FOR A COMPLEX DIAGNOSTIC PROBLEM, WITH REVIEW OF PATIENT'S HISTORY AND MEDICAL RECORDS 882.. 85060 BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT 882.. 85097 BONE MARROW; SMEAR INTERPRETATION ONLY, WITH OR WITHOUT DIFFERENTIAL CELL COUNT 882.. 86077 BLOOD BANK PHYSICIAN SERVICES; DIFFICULT CROSS MATCH AND/OR EVALUATION OF IRREGULAR ANTIBODY(S), INTERPRETATION AND WRITTEN REPORT 882.. 86078 BLOOD BANK PHYSICIAN SERVICES; INVESTIGATION OF TRANSFUSION REACTION INCLUDING SUSPICION OF TRANSMISSIBLE DISEASE, INTERPRETATION AND WRITTEN REPORT 882.. 86079 BLOOD BANK PHYSICIAN SERVICES; AUTHORIZATION FOR DEVIATION FROM STANDARD BLOOD BANKING PROCEDURES (EG, USE OF OUTDATED BLOOD, TRANSFUSION OF RH INCOMPATIBLE UNITS), WITH WRITTEN REPORT 882.. 88104 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRETATION [[Page 47824]] 882.. 88106 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; FILTER METHOD ONLY WITH INTERPRETATION 882.. 88107 CYTOPATHOLOGY, FLUIDS, WASHINGS OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS AND FILTER PREPARATION WITH INTERPRETATION 882.. 88108 CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE) 882.. 88160 CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION 882.. 88161 CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION 882.. 88162 CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPLE STAINS 882.. 88172 EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT PREPARATION OF SMEARS; IMMEDIATE CYTOHISTOLOGIC STUDY TO DETERMINE ADEQUACY OF SPECIMEN(S) 882.. 88173 EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUT PREPARATION OF SMEARS; INTERPRETATION AND REPORT 882.. 88180 FLOW CYTOMETRY; EACH CELL SURFACE MARKER 882.. 88182 FLOW CYTOMETRY; CELL CYCLE OR DNA ANALYSIS 882.. 88302 LEVEL II - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION 882.. 88304 LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION 882.. 88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION 882.. 88312 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); GROUP I FOR MICROORGANISMS (EG, GRIDLEY, ACID FAST, METHENAMINE SILVER), EACH 882.. 88314 SPECIAL STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR SURGICAL PATHOLOGY EXAMINATION); HISTOCHEMICAL STAINING WITH FROZEN SECTION(S) 882.. 88318 DETERMINATIVE HISTOCHEMISTRY TO IDENTIFY CHEMICAL COMPONENTS (EG, COPPER, ZINC) 882.. 88319 DETERMINATIVE HISTOCHEMISTRY OR CYTOCHEMISTRY TO IDENTIFY ENZYME CONSTITUENTS, EACH 882.. 88321 CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE 882.. 88323 CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES 882.. 88325 CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT ON REFERRED MATERIAL 882.. 88329 PATHOLOGY CONSULTATION DURING SURGERY; 882.. 88331 PATHOLOGY CONSULTATION DURING SURGERY; WITH FROZEN SECTION(S), SINGLE SPECIMEN 882.. 88332 PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S) 882.. 88342 IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE), EACH ANTIBODY 882.. 88346 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD 882.. 88347 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD 883.. Level III Pathology X 0.65 $32.94 $20.34 $6.59 883.. 88307 LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION 883.. 88309 LEVEL VI - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION 883.. 88348 ELECTRON MICROSCOPY; DIAGNOSTIC 883.. 88349 ELECTRON MICROSCOPY; SCANNING 883.. 88355 MORPHOMETRIC ANALYSIS; SKELETAL MUSCLE 883.. 88356 MORPHOMETRIC ANALYSIS; NERVE 883.. 88358 MORPHOMETRIC ANALYSIS; TUMOR 883.. 88362 NERVE TEASING PREPARATIONS 883.. 88365 TISSUE IN SITU HYBRIDIZATION, INTERPRETATION AND REPORT 900.. Critical Care V 7.44 $376.98 $144.87 $75.40 900.. 99291 CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLE CRITICALLY ILL OR UNSTABLE CRITICALLY INJURED PATIENT, REQUIRING THE CONSTANT ATTENDANCE OF THE PHYSICIAN; FIRST HOUR 901.. Level I Immunization X 0.07 $3.55 $2.49 $0.71 901.. 90700 IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP) 901.. 90701 IMMUNIZATION, ACTIVE; DIPHTHERIA AND TETANUS TOXOIDS AND PERTUSSIS VACCINE (DTP) 901.. 90702 IMMUNIZATION, ACTIVE; DIPHTHERIA AND TETANUS TOXOIDS (DT) 901.. 90703 IMMUNIZATION, ACTIVE; TETANUS TOXOID 901.. 90704 IMMUNIZATION, ACTIVE; MUMPS VIRUS VACCINE, LIVE 901.. 90705 IMMUNIZATION, ACTIVE; MEASLES VIRUS VACCINE, LIVE, ATTENUATED 901.. 90706 IMMUNIZATION, ACTIVE; RUBELLA VIRUS VACCINE, LIVE 901.. 90708 IMMUNIZATION, ACTIVE; MEASLES AND RUBELLA VIRUS VACCINE, LIVE 901.. 90709 IMMUNIZATION, ACTIVE; RUBELLA AND MUMPS VIRUS VACCINE, LIVE 901.. 90710 IMMUNIZATION, ACTIVE; MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE 901.. 90711 IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND PERTUSSIS (DTP) AND INJECTABLE POLIOMYELITIS VACCINE 901.. 90714 IMMUNIZATION, ACTIVE; TYPHOID VACCINE 901.. 90718 IMMUNIZATION, ACTIVE; TETANUS AND DIPHTHERIA TOXOIDS ABSORBED, FOR ADULT USE (TD) 901.. 90719 IMMUNIZATION, ACTIVE; DIPHTHERIA TOXOID 901.. 90724 IMMUNIZATION, ACTIVE; INFLUENZA VIRUS VACCINE 901.. 90725 IMMUNIZATION, ACTIVE; CHOLERA VACCINE 901.. 90730 IMMUNIZATION, ACTIVE; HEPATITIS A VACCINE 901.. 90732 IMMUNIZATION, ACTIVE; PNEUMOCOCCAL VACCINE, POLYVALENT 901.. 90748 IMMUNIZATION, ACTIVE, HEPATITIS B AND HEMOPHILUS INFLUENZA B (HIB) VACCINE 901.. 90749 UNLISTED IMMUNIZATION PROCEDURE 901.. 95149 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); FIVE SINGLE STINGING INSECT VENOMS 901.. 95170 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; WHOLE BODY EXTRACT OF BITING INSECT OR OTHER ARTHROPOD (SPECIFY NUMBER OF DOSES) 901.. G0008 INFLUENZA VACCINE 901.. G0009 PNEUMOCOCCAL VACCINE 901.. Q0034 INFLUENZA VACCINE 902.. Level II Immunization X 1.78 $90.19 $41.47 $18.04 [[Page 47825]] 902.. 90707 IMMUNIZATION, ACTIVE; MEASLES, MUMPS AND RUBELLA VIRUS VACCINE, LIVE 902.. 90712 IMMUNIZATION, ACTIVE; POLIOVIRUS VACCINE, LIVE, ORAL (ANY TYPE(S)) 902.. 90713 IMMUNIZATION, ACTIVE; POLIOMYELITIS VACCINE 902.. 90716 IMMUNIZATION, ACTIVE; VARICELLA (CHICKEN POX) VACCINE 902.. 90717 IMMUNIZATION, ACTIVE; YELLOW FEVER VACCINE 902.. 90720 IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND PERTUSSIS (DTP) AND HEMOPHILUS INFLUENZA B (HIB) VACCINE 902.. 90733 IMMUNIZATION, ACTIVE; MENINGOCOCCAL POLYSACCHARIDE VACCINE (ANY GROUP(S)) 902.. 90737 IMMUNIZATION, ACTIVE; HEMOPHILUS INFLUENZA B 902.. 90741 IMMUNIZATION, PASSIVE; IMMUNE SERUM GLOBULIN, HUMAN (ISG) 902.. 90744 IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; NEWBORN TO 11 YEARS 902.. 90745 IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; 11-19 YEARS 902.. 90746 IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; 20 YEARS AND ABOVE 902.. 90747 IMMUNIZATION, ACTIVE, HEPATITIS B VACCINE; DIALYSIS OR IMMUNOSUPPRESSED PATIENT, ANY AGE 902.. G0010 HEPATITIS B VACCINE 903.. Level III Immunization X 1.16 $58.78 $25.65 $11.76 903.. 90721 IMMUNIZATION, ACTIVE; DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE (DTAP) AND HEMOPHILUS INFLUENZA B (HIB) VACCINE 903.. 90726 IMMUNIZATION, ACTIVE; RABIES VACCINE 903.. 90727 IMMUNIZATION, ACTIVE; PLAGUE VACCINE 903.. 90728 IMMUNIZATION, ACTIVE; BCG VACCINE 903.. 90735 IMMUNIZATION, ACTIVE; ENCEPHALITIS VIRUS VACCINE 903.. 90742 IMMUNIZATION, PASSIVE; SPECIFIC HYPERIMMUNE SERUM GLOBULIN (EG, HEPATITIS B, MEASLES, PERTUSSIS, RABIES, RHO(D), TETANUS, VACCINIA, VARICELLA-ZOSTER) 906.. Infusion Therapy except X 1.46 $73.98 $42.49 $14.80 Chemotherapy 906.. 36680 PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION 906.. 90780 IV INFUSION FOR THERAPY/DIAGNOSIS, ADMINISTERED BY PHYSICIAN OR UNDER DIRECT SUPERVISION OF PHYSICIAN; UP TO ONE HOUR 906.. 90781 IV INFUSION FOR THERAPY/DIAGNOSIS, ADMINISTERED BY PHYSICIAN OR UNDER DIRECT SUPERVISION OF PHYSICIAN; EACH ADDITIONAL HOUR, UP TO EIGHT (8) HOURS 906.. Q0081 INFUSION THERAPY 907.. Intramuscular Injections X 0.85 $43.07 $11.98 $8.61 907.. 90782 THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); SUBCUTANEOUS OR INTRAMUSCULAR 907.. 90783 THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRA-ARTERIAL 907.. 90784 THERAPEUTIC OR DIAGNOSTIC INJECTION (SPECIFY MATERIAL INJECTED); INTRAVENOUS 907.. 90788 INTRAMUSCULAR INJECTION OF ANTIBIOTIC (SPECIFY) 907.. 90799 UNLISTED THERAPEUTIC OR DIAGNOSTIC INJECTION 919.. Electroconvulsive Therapy S 3.17 $160.62 $80.00 $32.12 919.. 90870 ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); SINGLE SEIZURE 919.. 90871 ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); MULTIPLE SEIZURES, PER DAY 920.. Biofeedback and other Training S 1.17 $59.28 $29.61 $11.86 920.. 90901 BIOFEEDBACK TRAINING BY ANY MODALITY 920.. 90911 BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL OR URETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY 921.. Diabetes Education S 921.. 99078 PHYSICIAN EDUCATIONAL SERVICES RENDERED TO PATIENTS IN A GROUP SETTING (EG, PRENATAL, OBESITY, OR DIABETIC INSTRUCTIONS) 926.. Dialysis for other than ESRD S 4.28 $216.87 $69.83 $43.37 patients 926.. 90935 HEMODIALYSIS PROCEDURE WITH SINGLE PHYSICIAN EVALUATION 926.. 90937 HEMODIALYSIS PROCEDURE REQUIRING REPEATED EVALUATION(S) WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION 926.. 90945 DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION), WITH SINGLE PHYSICIAN EVALUATION 926.. 90947 DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL, HEMOFILTRATION) REQUIRING REPEATED EVALUATIONS, WITH OR WITHOUT SUBSTANTIAL REVISION OF DIALYSIS PRESCRIPTION 926.. 90997 HEMOPERFUSION (EG, WITH ACTIVATED CHARCOAL OR RESIN) 926.. 90999 UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT 928.. Alimentary Tests X 3.11 $157.58 $83.85 $31.52 928.. 89100 DUODENAL INTUBATION AND ASPIRATION; SINGLE SPECIMEN (EG, SIMPLE BILE STUDY OR AFFERENT LOOP CULTURE) PLUS APPROPRIATE TEST PROCEDURE 928.. 89105 DUODENAL INTUBATION AND ASPIRATION; COLLECTION OF MULTIPLE FRACTIONAL SPECIMENS WITH PANCREATIC OR GALLBLADDER STIMULATION, SINGLE OR DOUBLE LUMEN TUBE 928.. 89130 GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, FOR CHEMICAL ANALYSES OR CYTOPATHOLOGY; 928.. 89132 GASTRIC INTUBATION AND ASPIRATION, DIAGNOSTIC, EACH SPECIMEN, AFTER STIMULATION 928.. 89135 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); ONE HOUR 928.. 89136 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO HOURS 928.. 89140 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); TWO HOURS INCLUDING GASTRIC STIMULATION (EG, HISTALOG, PENTAGASTRIN) 928.. 89141 GASTRIC INTUBATION, ASPIRATION, AND FRACTIONAL COLLECTIONS (EG, GASTRIC SECRETORY STUDY); THREE HOURS, INCLUDING GASTRIC STIMULATION 928.. 91000 ESOPHAGEAL INTUBATION AND COLLECTION OF WASHINGS FOR CYTOLOGY, INCLUDING PREPARATION OF SPECIMENS (SEPARATE PROCEDURE) 928.. 91010 ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY; [[Page 47826]] 928.. 91011 ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY; WITH MECHOLYL OR SIMILAR STIMULANT 928.. 91012 ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY; WITH ACID PERFUSION STUDIES 928.. 91020 GASTRIC MOTILITY (MANOMETRIC) STUDIES 928.. 91030 ESOPHAGUS, ACID PERFUSION (BERNSTEIN) TEST FOR ESOPHAGITIS 928.. 91032 ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEAL REFLUX; 928.. 91033 ESOPHAGUS, ACID REFLUX TEST, WITH INTRALUMINAL PH ELECTRODE FOR DETECTION OF GASTROESOPHAGEAL REFLUX; PROLONGED RECORDING 928.. 91052 GASTRIC ANALYSIS TEST WITH INJECTION OF STIMULANT OF GASTRIC SECRETION (EG, HISTAMINE, INSULIN, PENTAGASTRIN, CALCIUM AND SECRETIN) 928.. 91055 GASTRIC INTUBATION, WASHINGS, AND PREPARING SLIDES FOR CYTOLOGY (SEPARATE PROCEDURE) 928.. 91060 GASTRIC SALINE LOAD TEST 928.. 91065 BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASE DEFICIENCY) 928.. 91100 INTESTINAL BLEEDING TUBE, PASSAGE, POSITIONING AND MONITORING 928.. 91105 GASTRIC INTUBATION, AND ASPIRATION OR LAVAGE FOR TREATMENT (EG, FOR INGESTED POISONS) 928.. 91299 UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE 928.. 95075 INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE SUCH AS METABISULFITE) 930.. Minor Eye Examinations X 1.02 $51.68 $22.83 $10.34 930.. 92060 SENSORIMOTOR EXAMINATION WITH MULTIPLE MEASUREMENTS OF OCULAR DEVIATION (EG, RESTRICTIVE OR PARETIC MUSCLE WITH DIPLOPIA) WITH INTERPRETATION AND REPORT (SEPARATE PROCEDURE) 930.. 92065 ORTHOPTIC AND/OR PLEOPTIC TRAINING, WITH CONTINUING MEDICAL DIRECTION AND EVALUATION 930.. 92081 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; LIMITED EXAMINATION (EG, TANGENT SCREEN, AUTOPLOT, ARC PERIMETER, OR SINGLE STIMULUS LEVEL AUTOMATED TEST, SUCH AS OCTOPUS 3 OR 7 EQUIVALENT) 930.. 92082 VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT; INTERMEDIATE EXAMINATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN PERIMETER, OR SEMIQUANTITATIVE, AUTOMATED SUPRATHRESHOLD SCREENING PROGRAM, HUMPHREY SUPRATHRESHOLD AUTOMATIC 930.. 92083 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!, OR QUANTITATIVE, AUTOMATED THRESHOLD PERI 930.. 92140 PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION AND REPORT, WITHOUT TONOGRAPHY 930.. 92283 COLOR VISION EXAMINATION, EXTENDED, EG, ANOMALOSCOPE OR EQUIVALENT 930.. 92284 DARK ADAPTATION EXAMINATION WITH INTERPRETATION AND REPORT 930.. 92285 EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORT FOR DOCUMENTATION OF MEDICAL PROGRESS (EG, CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GONIOPHOTOGRAPHY, STEREO- PHOTOGRAPHY) 931.. Level I Eye Tests X 0.74 $37.5 $21.47 $7.50 931.. 92120 TONOGRAPHY WITH INTERPRETATION AND REPORT, RECORDING INDENTATION TONOMETER METHOD OR PERILIMBAL SUCTION METHOD 931.. 92130 TONOGRAPHY WITH WATER PROVOCATION 931.. 92230 FLUORESCEIN ANGIOSCOPY WITH INTERPRETATION AND REPORT 931.. 92240 INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT 931.. 92250 FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT 931.. 92499 UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE 932.. Level II Eye Tests X 2.52 $127.69 $65.09 $25.54 932.. 92235 FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH INTERPRETATION AND REPORT 932.. 92265 NEEDLE OCULOELECTROMYOGRAPHY, ONE OR MORE EXTRAOCULAR MUSCLES, ONE OR BOTH EYES, WITH INTERPRETATION AND REPORT 932.. 92270 ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT 932.. 92286 SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH SPECULAR ENDOTHELIAL MICROSCOPY AND CELL COUNT 932.. 92287 SPECIAL ANTERIOR SEGMENT PHOTOGRAPHY WITH INTERPRETATION AND REPORT; WITH FLUORESCEIN ANGIOGRAPHY 936.. Fitting of Vision Aids X 0.52 $26.35 $9.49 $5.27 936.. 92311 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION; CORNEAL LENS FOR APHAKIA, ONE EYE 936.. 92312 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION; CORNEAL LENS FOR APHAKIA, BOTH EYES 936.. 92313 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION; CORNEOSCLERAL LENS 936.. 92315 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEAL LENS FOR APHAKIA, ONE EYE 936.. 92316 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEAL LENS FOR APHAKIA, BOTH EYES 936.. 92317 PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF CONTACT LENS, WITH MEDICAL SUPERVISION OF ADAPTATION AND DIRECTION OF FITTING BY INDEPENDENT TECHNICIAN; CORNEOSCLERAL LENS 936.. 92325 MODIFICATION OF CONTACT LENS (SEPARATE PROCEDURE), WITH MEDICAL SUPERVISION OF ADAPTATION 936.. 92326 REPLACEMENT OF CONTACT LENS 936.. 92330 PRESCRIPTION, FITTING, AND SUPPLY OF OCULAR PROSTHESIS (ARTIFICIAL EYE), WITH MEDICAL SUPERVISION OF ADAPTATION 936.. 92352 FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MONOFOCAL 936.. 92353 FITTING OF SPECTACLE PROSTHESIS FOR APHAKIA; MULTIFOCAL 936.. 92354 FITTING OF SPECTACLE MOUNTED LOW VISION AID; SINGLE ELEMENT SYSTEM 936.. 92355 FITTING OF SPECTACLE MOUNTED LOW VISION AID; TELESCOPIC OR OTHER COMPOUND LENS SYSTEM [[Page 47827]] 936.. 92358 PROSTHESIS SERVICE FOR APHAKIA, TEMPORARY (DISPOSABLE OR LOAN, INCLUDING MATERIALS) 936.. 92371 REPAIR AND REFITTING SPECTACLES; SPECTACLE PROSTHESIS FOR APHAKIA 940.. Otorhinolaryngologic Function X 3.04 $154.04 $51.98 $30.81 Tests 940.. 92512 NASAL FUNCTION STUDIES (EG, RHINOMANOMETRY) 940.. 92516 FACIAL NERVE FUNCTION STUDIES (EG, ELECTRONEURONOGRAPHY) 940.. 92520 LARYNGEAL FUNCTION STUDIES 940.. 92541 SPONTANEOUS NYSTAGMUS TEST, INCLUDING GAZE AND FIXATION NYSTAGMUS, WITH RECORDING 940.. 92542 POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING 940.. 92543 CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES FOUR TESTS), WITH 940.. 92544 OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL, FOVEAL OR PERIPHERAL STIMULATION, WITH RECORDING 940.. 92545 OSCILLATING TRACKING TEST, WITH RECORDING 940.. 92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING 940.. 92547 USE OF VERTICAL ELECTRODES IN ANY OR ALL OF ABOVE TESTS COUNTS AS ONE ADDITIONAL TEST 940.. 92548 COMPUTERIZED DYNAMIC POSTUROGRAPHY 940.. 92584 ELECTROCOCHLEOGRAPHY 940.. 92587 EVOKED OTOACOUSTIC EMISSIONS; LIMITED (SINGLE STIMULUS LEVEL, EITHER TRANSIENT OR DISTORTION PRODUCTS) 940.. 92588 EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE OR DIAGNOSTIC EVALUATION (COMPARISON OF TRANSIENT AND/OR DISTORTION PRODUCT OTOACOUSTIC EMISSIONS AT MULTIPLE LEVELS AND FREQUENCIES) 941.. Level I Audiometry X 0.74 $37.50 $13.56 $7.50 941.. 92552 PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY 941.. 92553 PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE 941.. 92555 SPEECH AUDIOMETRY THRESHOLD; 941.. 92556 SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION 941.. 92567 TYMPANOMETRY (IMPEDANCE TESTING) 941.. 92599 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE 942.. Level II Audiometry X 1.48 $74.99 $22.15 $15.00 942.. 92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION (92553 AND 92556 COMBINED) 942.. 92561 BEKESY AUDIOMETRY; DIAGNOSTIC 942.. 92562 LOUDNESS BALANCE TEST, ALTERNATE BINAURAL OR MONAURAL 942.. 92563 TONE DECAY TEST 942.. 92564 SHORT INCREMENT SENSITIVITY INDEX (SISI) 942.. 92565 STENGER TEST, PURE TONE 942.. 92568 ACOUSTIC REFLEX TESTING 942.. 92569 ACOUSTIC REFLEX DECAY TEST 942.. 92571 FILTERED SPEECH TEST 942.. 92572 STAGGERED SPONDAIC WORD TEST 942.. 92573 LOMBARD TEST 942.. 92575 SENSORINEURAL ACUITY LEVEL TEST 942.. 92576 SYNTHETIC SENTENCE IDENTIFICATION TEST 942.. 92577 STENGER TEST, SPEECH 942.. 92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) 942.. 92582 CONDITIONING PLAY AUDIOMETRY 942.. 92583 SELECT PICTURE AUDIOMETRY 942.. 92589 CENTRAL AUDITORY FUNCTION TEST(S) (SPECIFY) 942.. 92596 EAR PROTECTOR ATTENUATION MEASUREMENTS 947.. Resuscitation and S 4.07 $206.22 $109.61 $41.24 Cardioversion 947.. 31500 INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE 947.. 92950 CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST) 947.. 92953 TEMPORARY TRANSCUTANEOUS PACING 947.. 92960 CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA, EXTERNAL 947.. 99440 NEWBORN RESUSCITATION: PROVISION OF POSITIVE PRESSURE VENTILATION AND/OR CHEST COMPRESSIONS IN THE PRESENCE OF ACUTE INADEQUATE VENTILATION AND/OR CARDIAC OUTPUT 948.. Cardiac Rehabilitation X 0.81 $41.04 $16.95 $8.21 948.. 93797 PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING (PER SESSION) 948.. 93798 PHYSICIAN SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITH CONTINUOUS ECG MONITORING (PER SESSION) 949.. Cardiovascular Stress Test X 1.46 $73.98 $62.83 $14.80 949.. 93017 CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT 949.. 93024 ERGONOVINE PROVOCATION TEST 950.. Electrocardiogram (ECG) X 0.35 $17.73 $15.82 $3.55 950.. 93005 ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT 950.. 93041 RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUT INTERPRETATION AND REPORT 950.. Q0035 CARDIOKYMOGRAPHY 956.. Continuous ECG and Blood X 1.11 $56.24 $55.82 $11.25 Pressure Monitoring 956.. 93012 TELEPHONIC TRANSMISSION OF POST-SYMPTOM ELECTROCARDIOGRAM RHYTHM STRIP(S), PER 30 DAY PERIOD OF TIME; TRACING ONLY 956.. 93224 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; INCLUDES RECORDING, SCANNING ANALYSIS WITH REPORT, PHYSICIAN REVIEW AND INTERPRETATION [[Page 47828]] 956.. 93225 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; RECORDING (INCLUDES HOOK-UP, RECORDING, AND DISCONNECTION) 956.. 93226 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE, WITH VISUAL SUPERIMPOSITION SCANNING; SCANNING ANALYSIS WITH REPORT 956.. 93230 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE WITHOUT SUPERIMPOSITION SCANNING UTILIZING A DEVICE CAPABLE OF PRODUCING A FULL MINIATURIZED PRINTOUT; INCLUDES RECORDING, MICROPROCESSOR-BASED ANALYSIS 956.. 93231 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE WITHOUT SUPERIMPOSITION SCANNING UTILIZING A DEVICE CAPABLE OF PRODUCING A FULL MINIATURIZED PRINTOUT; RECORDING (INCLUDES HOOK-UP, RECORDING, AND DISCO 956.. 93232 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS ORIGINAL ECG WAVEFORM RECORDING AND STORAGE WITHOUT SUPERIMPOSITION SCANNING UTILIZING A DEVICE CAPABLE OF PRODUCING A FULL MINIATURIZED PRINTOUT; MICROPROCESSOR-BASED ANALYSIS WITH REPORT 956.. 93235 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTERIZED MONITORING AND NON- CONTINUOUS RECORDING, AND REAL-TIME DATA ANALYSIS UTILIZING A DEVICE CAPABLE OF PRODUCING INTERMITTENT FULL-SIZED WAVEFORM TRACINGS, POSSIBLY PATIENT ACTIVATED; INC 956.. 93236 ELECTROCARDIOGRAPHIC MONITORING FOR 24 HOURS BY CONTINUOUS COMPUTERIZED MONITORING AND NON- CONTINUOUS RECORDING, AND REAL-TIME DATA ANALYSIS UTILIZING A DEVICE CAPABLE OF PRODUCING INTERMITTENT FULL-SIZED WAVEFORM TRACINGS, POSSIBLY PATIENT ACTIVATED; MON 956.. 93268 PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY PERIOD OF TIME; INCLUDES TRANSMISSION, PHYSICIAN REVIEW AND INTERPRETATION 956.. 93270 PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY PERIOD OF TIME; RECORDING (INCLUDES HOOK-UP, RECORDING, AND DISCONNECTION) 956.. 93271 PATIENT DEMAND SINGLE OR MULTIPLE EVENT RECORDING WITH PRESYMPTOM MEMORY LOOP, PER 30 DAY PERIOD OF TIME; MONITORING, RECEIPT OF TRANSMISSIONS, AND ANALYSIS 956.. 93278 SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUT ECG 956.. G0004 ECG TRANSM PHYS REVIEW & INt 956.. G0005 ECG 24 HOUR RECORDING 956.. G0006 ECG TRANSMISSION & ANALYSIS 956.. G0015 POST SYMPTOM ECG TRACING 957.. Echocardiography S 2.83 $143.39 $117.07 $28.68 957.. 76825 ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; 957.. 76826 ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY 957.. 76827 DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE 957.. 76828 DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY 957.. 93303 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; COMPLETE 957.. 93304 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; FOLLOW-UP OR LIMITED STUDY 957.. 93307 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; COMPLETE 957.. 93308 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR LIMITED STUDY 957.. 93312 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M- MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT 957.. 93313 ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGE DOCUMENTATION (2D) (WITH OR WITHOUT M- MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY 957.. 93315 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT 957.. 93316 TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIAC ANOMALIES; PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY 957.. 93320 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93350); COMPLETE 957.. 93321 DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93350); FOLLOW-UP OR LIMITED STUDY 957.. 93325 DOPPLER COLOR FLOW VELOCITY MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR ECHOCARDIOGRAPHY 76825, 76826, 76827, 76828, 93303, 93304, 93307, 93308, 93312, 93314, 93315, 93317, 93320, 93321, 93350) 957.. 93350 ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), WITH OR WITHOUT M- MODE RECORDING, DURING REST AND CARDIOVASCULAR STRESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR PHARMACOLOGICALLY INDUCED STRESS, WITH INTERPRETATION AND REPOR 958.. Diagnostic Cardiac T 26.11 $1,322.98 $659.47 $264.60 Catheterization 958.. 93501 RIGHT HEART CATHETERIZATION 958.. 93503 INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG, SWAN-GANZ) FOR MONITORING PURPOSES 958.. 93505 ENDOMYOCARDIAL BIOPSY 958.. 93510 LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL ARTERY; PERCUTANEOUS 958.. 93511 LEFT HEART CATHETERIZATION, RETROGRADE, FROM THE BRACHIAL ARTERY, AXILLARY ARTERY OR FEMORAL ARTERY; BY CUTDOWN 958.. 93514 LEFT HEART CATHETERIZATION BY LEFT VENTRICULAR PUNCTURE 958.. 93524 COMBINED TRANSSEPTAL AND RETROGRADE LEFT HEART CATHETERIZATION 958.. 93526 COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION [[Page 47829]] 958.. 93527 COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTACT SEPTUM (WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION) 958.. 93528 COMBINED RIGHT HEART CATHETERIZATION WITH LEFT VENTRICULAR PUNCTURE (WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION) 958.. 93529 COMBINED RIGHT HEART CATHETERIZATION AND LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL OPENING (WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION) 958.. 93530 RIGHT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES 958.. 93531 COMBINED RIGHT HEART CATHETERIZATION AND RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES 958.. 93532 COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH INTACT SEPTUM WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES 958.. 93533 COMBINED RIGHT HEART CATHETERIZATION AND TRANSSEPTAL LEFT HEART CATHETERIZATION THROUGH EXISTING SEPTAL OPENING, WITH OR WITHOUT RETROGRADE LEFT HEART CATHETERIZATION, FOR CONGENITAL CARDIAC ANOMALIES 958.. 93536 PERCUTANEOUS INSERTION OF INTRA-AORTIC BALLOON CATHETER 960.. Cardiac Electrophysiologic S 4.24 $214.84 $144.41 $42.97 Tests/Procedures 960.. 93600 BUNDLE OF HIS RECORDING 960.. 93602 INTRA-ATRIAL RECORDING 960.. 93603 RIGHT VENTRICULAR RECORDING 960.. 93607 LEFT VENTRICULAR RECORDING 960.. 93609 INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING OF TACHYCARDIA SITE(S) WITH CATHETER MANIPULATION TO RECORD FROM MULTIPLE SITES TO IDENTIFY ORIGIN OF TACHYCARDIA 960.. 93610 INTRA-ATRIAL PACING 960.. 93612 INTRAVENTRICULAR PACING 960.. 93615 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S); 960.. 93616 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH OR WITHOUT VENTRICULAR ELECTROGRAM(S); WITH PACING 960.. 93618 INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING 960.. 93619 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING, INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS; WITHOUT INDUCTION OR ATTEMPTED INDUCTI 960.. 93620 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING, INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS; WITH INDUCTION OR ATTEMPTED INDUCTION 960.. 93621 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING, INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS; WITH LEFT ATRIAL RECORDINGS FROM CORON 960.. 93622 COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHT ATRIAL PACING AND RECORDING, RIGHT VENTRICULAR PACING AND RECORDING, HIS BUNDLE RECORDING, INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS; WITH LEFT VENTRICULAR RECORDINGS, WITH 960.. 93623 PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS DRUG INFUSION (USE THIS CODE WITH 93620, 93621, 93622) 960.. 93624 ELECTROPHYSIOLOGIC FOLLOW-UP STUDY WITH PACING AND RECORDING TO TEST EFFECTIVENESS OF THERAPY, INCLUDING INDUCTION OR ATTEMPTED INDUCTION OF ARRHYTHMIA 960.. 93631 INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING AND MAPPING TO LOCALIZE THE SITE OF TACHYCARDIA OR ZONE OF SLOW CONDUCTION FOR SURGICAL CORRECTION 960.. 93640 ELECTROPHYSIOLOGIC EVALUATION OF CARDIOVERTER-DEFIBRILLATOR LEADS (INCLUDES DEFIBRILLATION THRESHOLD TESTING AND SENSING FUNCTION) AT TIME OF INITIAL IMPLANTATION OR REPLACEMENT; 960.. 93641 ELECTROPHYSIOLOGIC EVALUATION OF CARDIOVERTER-DEFIBRILLATOR LEADS (INCLUDES DEFIBRILLATION THRESHOLD TESTING AND SENSING FUNCTION) AT TIME OF INITIAL IMPLANTATION OR REPLACEMENT; WITH TESTING OF CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR 960.. 93642 ELECTROPHYSIOLOGIC EVALUATION OF CARDIOVERTER-DEFIBRILLATOR (INCLUDES DEFIBRILLATION THRESHOLD EVALUATION, INDUCTION OF ARRHYTHMIA, EVALUATION OF SENSING AND PACING FOR ARRHYTHMIA TERMINATION, AND PROGRAMMING OR REPROGRAMMING OF SENSING OR THERAPEUTIC PAR 960.. 93650 INTRACARDIAC CATHETER ABLATION OF ATRIOVENTRICULAR NODE FUNCTION, ATRIOVENTRICULAR CONDUCTION FOR CREATION OF COMPLETE HEART BLOCK, WITH OR WITHOUT TEMPORARY PACEMAKER PLACEMENT 960.. 93651 INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF SUPRAVENTRICULAR TACHYCARDIA BY ABLATION OF FAST OR SLOW ATRIOVENTRICULAR PATHWAYS, ACCESSORY ATRIOVENTRICULAR CONNECTIONS OR OTHER ATRIAL FOCI, SINGLY OR IN COMBINATION 960.. 93652 INTRACARDIAC CATHETER ABLATION OF ARRHYTHMOGENIC FOCUS; FOR TREATMENT OF VENTRICULAR TACHYCARDIA 960.. 93660 EVALUATION OF CARDIOVASCULAR FUNCTION WITH TILT TABLE EVALUATION, WITH CONTINUOUS ECG MONITORING AND INTERMITTENT BLOOD PRESSURE MONITORING, WITH OR WITHOUT PHARMACOLOGICAL INTERVENTION 960.. 93724 ELECTRONIC ANALYSIS OF ANTITACHYCARDIA PACEMAKER SYSTEM (INCLUDES ELECTROCARDIOGRAPHIC RECORDING, PROGRAMMING OF DEVICE, INDUCTION AND TERMINATION OF TACHYCARDIA VIA IMPLANTED PACEMAKER, AND INTERPRETATION OF RECORDINGS) 966.. Electronic Analysis of X 0.39 $19.76 $12.43 $3.95 Pacemakers/other devices 966.. 62367 ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITHOUT REPROGRAMMING 966.. 62368 ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITH REPROGRAMMING 966.. 63690 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATION, CYCLING, IMPEDANCE AND PATIENT COMPLIANCE MEAS 966.. 63691 ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATION, CYCLING, IMPEDANCE AND PATIENT COMPLIANCE MEAS [[Page 47830]] 966.. 93731 ELECTRONIC ANALYSIS OF DUAL-CHAMBER PACEMAKER SYSTEM (INCLUDES EVALUATION OF PROGRAMMABLE PARAMETERS AT REST AND DURING ACTIVITY WHERE APPLICABLE, USING ELECTROCARDIOGRAPHIC RECORDING AND INTERPRETATION OF RECORDINGS AT REST AND DURING EXERCISE, ANALYSIS 966.. 93732 ELECTRONIC ANALYSIS OF DUAL-CHAMBER PACEMAKER SYSTEM (INCLUDES EVALUATION OF PROGRAMMABLE PARAMETERS AT REST AND DURING ACTIVITY WHERE APPLICABLE, USING ELECTROCARDIOGRAPHIC RECORDING AND INTERPRETATION OF RECORDINGS AT REST AND DURING EXERCISE, ANALYSIS 966.. 93733 ELECTRONIC ANALYSIS OF DUAL CHAMBER INTERNAL PACEMAKER SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, AND/OR TESTING OF SENSORY FUNCTION OF PACEMAKER), TELEPHONIC ANALYSIS 966.. 93734 ELECTRONIC ANALYSIS OF SINGLE CHAMBER PACEMAKER SYSTEM (INCLUDES EVALUATION OF PROGRAMMABLE PARAMETERS AT REST AND DURING ACTIVITY WHERE APPLICABLE, USING ELECTROCARDIOGRAPHIC RECORDING AND INTERPRETATION OF RECORDINGS AT REST AND DURING EXERCISE, ANALYSI 966.. 93735 ELECTRONIC ANALYSIS OF SINGLE CHAMBER PACEMAKER SYSTEM (INCLUDES EVALUATION OF PROGRAMMABLE PARAMETERS AT REST AND DURING ACTIVITY WHERE APPLICABLE, USING ELECTROCARDIOGRAPHIC RECORDING AND INTERPRETATION OF RECORDINGS AT REST AND DURING EXERCISE, ANALYSI 966.. 93736 ELECTRONIC ANALYSIS OF SINGLE CHAMBER INTERNAL PACEMAKER SYSTEM (MAY INCLUDE RATE, PULSE AMPLITUDE AND DURATION, CONFIGURATION OF WAVE FORM, AND/OR TESTING OF SENSORY FUNCTION OF PACEMAKER), TELEPHONIC ANALYSIS 966.. 93737 ELECTRONIC ANALYSIS OF CARDIOVERTER/DEFIBRILLATOR ONLY (INTERROGATION, EVALUATION OF PULSE GENERATOR STATUS); WITHOUT REPROGRAMMING 966.. 93738 ELECTRONIC ANALYSIS OF CARDIOVERTER/DEFIBRILLATOR ONLY (INTERROGATION, EVALUATION OF PULSE GENERATOR STATUS); WITH REPROGRAMMING 967.. Non-Invasive Vascular Studies X 1.70 $86.14 $57.40 $17.23 967.. 93720 PLETHYSMOGRAPHY, TOTAL BODY; WITH INTERPRETATION AND REPORT 967.. 93721 PLETHYSMOGRAPHY, TOTAL BODY; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT 967.. 93740 TEMPERATURE GRADIENT STUDIES 967.. 93799 UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE 967.. 93922 NON-INVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, SINGLE LEVEL, BILATERAL (EG, ANKLE/BRACHIAL INDICES, DOPPLER WAVEFORM ANALYSIS, VOLUME PLETHYSMOGRAPHY, TRANSCUTANEOUS OXYGEN TENSION MEASUREMENT) 967.. 93923 NON-INVASIVE PHYSIOLOGIC STUDIES OF UPPER OR LOWER EXTREMITY ARTERIES, MULTIPLE LEVELS OR WITH PROVOCATIVE FUNCTIONAL MANEUVERS, COMPLETE BILATERAL STUDY (EG, SEGMENTAL BLOOD PRESSURE MEASUREMENTS, SEGMENTAL DOPPLER WAVEFORM ANALYSIS, SEGMENTAL VOLUME PLE 967.. 93924 NON-INVASIVE PHYSIOLOGIC STUDIES OF LOWER EXTREMITY ARTERIES, AT REST AND FOLLOWING TREADMILL STRESS TESTING, COMPLETE BILATERAL STUDY 967.. 93965 NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS, COMPLETE BILATERAL STUDY (EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, PHLEBORHEOGRAPHY, IMPEDANCE PLETHYSMOGRAPHY) 968.. Vascular Ultrasound X 2.37 $120.09 $79.55 $24.02 968.. 93875 NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTRACRANIAL ARTERIES, COMPLETE BILATERAL STUDY (EG, PERIORBITAL FLOW DIRECTION WITH ARTERIAL COMPRESSION, OCULAR PNEUMOPLETHYSMOGRAPHY, DOPPLER ULTRASOUND SPECTRAL ANALYSIS) 968.. 93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERAL STUDY 968.. 93882 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY 968.. 93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; COMPLETE STUDY 968.. 93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES; LIMITED STUDY 968.. 93925 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY 968.. 93926 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY 968.. 93930 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; COMPLETE BILATERAL STUDY 968.. 93931 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY 968.. 93970 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; COMPLETE BILATERAL STUDY 968.. 93971 DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY 968.. 93975 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY 968.. 93976 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF ABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY 968.. 93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; COMPLETE STUDY 968.. 93979 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE, OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY 968.. 93980 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY 968.. 93981 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY 968.. 93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIAL INFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) 969.. Hyperbaric Oxygen S 2.65 $134.27 $141.70 $26.85 969.. 99183 PHYSICIAN ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION 971.. Level I Pulmonary Tests X 0.78 $39.52 $21.47 $7.90 971.. 94010 SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENT(S), WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION 971.. 94060 BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010, BEFORE AND AFTER BRONCHODILATOR (AEROSOL OR PARENTERAL) OR EXERCISE 971.. 94200 MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION 971.. 94250 EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE (SEPARATE PROCEDURE) 971.. 94260 THORACIC GAS VOLUME 971.. 94360 DETERMINATION OF RESISTANCE TO AIRFLOW, OSCILLATORY OR PLETHYSMOGRAPHIC METHODS 971.. 94375 RESPIRATORY FLOW VOLUME LOOP 971.. 94400 BREATHING RESPONSE TO CO2 (CO2 RESPONSE CURVE) 971.. 94450 BREATHING RESPONSE TO HYPOXIA (HYPOXIA RESPONSE CURVE) [[Page 47831]] 971.. 94762 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS OVERNIGHT MONITORING (SEPARATE PROCEDURE) 971.. 94770 CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRARED ANALYZER 971.. 94799 UNLISTED PULMONARY SERVICE OR PROCEDURE 972.. Level II Pulmonary Tests X 1.02 $51.68 $29.38 $10.34 972.. 94240 FUNCTIONAL RESIDUAL CAPACITY OR RESIDUAL VOLUME: HELIUM METHOD, NITROGEN OPEN CIRCUIT METHOD, OR OTHER METHOD 972.. 94350 DETERMINATION OF MALDISTRIBUTION OF INSPIRED GAS: MULTIPLE BREATH NITROGEN WASHOUT CURVE INCLUDING ALVEOLAR NITROGEN OR HELIUM EQUILIBRATION TIME 972.. 94370 DETERMINATION OF AIRWAY CLOSING VOLUME, SINGLE BREATH TESTS 972.. 94680 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, DIRECT, SIMPLE 972.. 94681 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; INCLUDING CO2 OUTPUT, PERCENTAGE OXYGEN EXTRACTED 972.. 94690 OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT (SEPARATE PROCEDURE) 972.. 94720 CARBON MONOXIDE DIFFUSING CAPACITY, ANY METHOD 972.. 94725 MEMBRANE DIFFUSION CAPACITY 973.. Level III Pulmonary Tests S 1.89 $95.77 $55.82 $19.15 973.. 94070 PROLONGED POSTEXPOSURE EVALUATION OF BRONCHOSPASM WITH MULTIPLE SPIROMETRIC DETERMINATIONS AFTER ANTIGEN, COLD AIR, METHACHOLINE OR OTHER CHEMICAL AGENT, WITH SPIROMETRY AS IN 94010 973.. 94620 PULMONARY STRESS TESTING, SIMPLE OR COMPLEX 973.. 94750 PULMONARY COMPLIANCE STUDY, ANY METHOD 973.. 94772 CIRCADIAN RESPIRATORY PATTERN RECORDING (PEDIATRIC PNEUMOGRAM), 12 TO 24 HOUR CONTINUOUS RECORDING, INFANT 973.. 95070 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WITH HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS 973.. 95071 INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDING NECESSARY PULMONARY FUNCTION TESTS); WITH ANTIGENS OR GASES, SPECIFY 976.. Pulmonary Therapy S 0.44 $22.29 $14.92 $4.46 976.. 94640 NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAY OBSTRUCTION 976.. 94642 AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTIS CARINII PNEUMONIA TREATMENT OR PROPHYLAXIS 976.. 94650 INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) TREATMENT, AIR OR OXYGEN, WITH OR WITHOUT NEBULIZED MEDICATION; INITIAL DEMONSTRATION AND/OR EVALUATION 976.. 94651 INTERMITTENT POSITIVE PRESSURE BREATHING (IPPB) TREATMENT, AIR OR OXYGEN, WITH OR WITHOUT NEBULIZED MEDICATION; SUBSEQUENT 976.. 94657 VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED OR CONTROLLED BREATHING; SUBSEQUENT DAYS 976.. 94660 CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT 976.. 94662 CONTINUOUS NEGATIVE PRESSURE VENTILATION (CNP), INITIATION AND MANAGEMENT 976.. 94664 AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES; INITIAL DEMONSTRATION AND/OR EVALUATION 976.. 94665 AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION, BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES; SUBSEQUENT 977.. Allergy Tests X 0.63 $31.92 $12.66 $6.38 977.. 95004 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS 977.. 95010 PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOLOGICALS OR VENOMS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS 977.. 95015 INTRACUTANEOUS (INTRADERMAL) TESTS, SEQUENTIAL AND INCREMENTAL, WITH DRUGS, BIOLOGICALS, OR VENOMS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS 977.. 95024 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, SPECIFY NUMBER OF TESTS 977.. 95027 SKIN END POINT TITRATION 977.. 95028 INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENIC EXTRACTS, DELAYED TYPE REACTION, INCLUDING READING, SPECIFY NUMBER OF TESTS 977.. 95044 PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS) 977.. 95052 PHOTO PATCH TEST(S) (SPECIFY NUMBER OF TESTS) 977.. 95056 PHOTO TESTS 977.. 95060 OPHTHALMIC MUCOUS MEMBRANE TESTS 977.. 95065 DIRECT NASAL MUCOUS MEMBRANE TEST 977.. 95078 PROVOCATIVE TESTING (EG, RINKEL TEST) 977.. 95180 RAPID DESENSITIZATION PROCEDURE, EACH HOUR (EG, INSULIN, PENICILLIN, HORSE SERUM) 977.. 95199 UNLISTED ALLERGY/CLINICAL IMMUNOLOGIC SERVICE OR PROCEDURE 978.. Allergy Injections X 0.31 $15.71 $3.39 $3.14 978.. 95115 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE INJECTION 978.. 95117 PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOT INCLUDING PROVISION OF ALLERGENIC EXTRACTS; TWO OR MORE INJECTIONS 978.. 95144 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY, SINGLE OR MULTIPLE ANTIGENS, SINGLE DOSE VIALS (SPECIFY NUMBER OF VIALS) 978.. 95145 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); SINGLE STINGING INSECT VENOM 978.. 95146 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); TWO SINGLE STINGING INSECT VENOMS 978.. 95147 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); THREE SINGLE STINGING INSECT VENOMS [[Page 47832]] 978.. 95148 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY (SPECIFY NUMBER OF DOSES); FOUR SINGLE STINGING INSECT VENOMS 978.. 95165 PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OF ANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES) 979.. Extended EEG Studies and Sleep S 10.17 $515.31 $288.83 $103.06 Studies 979.. 95805 MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESS TESTING, RECORDING, ANALYSIS AND INTERPRETATION OF PHYSIOLOGICAL MEASUREMENTS OF SLEEP DURING MULTIPLE TRIALS TO ASSESS SLEEPINESS 979.. 95806 SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND OXYGEN SATURATION, UNATTENDED BY A TECHNOLOGIST 979.. 95807 SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION, RESPIRATORY EFFORT, ECG OR HEART RATE, AND OXYGEN SATURATION, ATTENDED BY A TECHNOLOGIST 979.. 95808 POLYSOMNOGRAPHY; SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST 979.. 95810 POLYSOMNOGRAPHY; OF SLEEP, ATTENDED BY A TECHNOLOGIST SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST 979.. 95811 POLYSOMNOGRAPHY; OF SLEEP, ATTENDED BY A TECHNOLOGIST 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 979.. 95812 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; UP TO ONE HOUR 979.. 95813 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THAN ONE HOUR 979.. 95827 ELECTROENCEPHALOGRAM (EEG); ALL NIGHT SLEEP ONLY 979.. 95951 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL TELEMETRY, COMBINED ELECTROENCEPHALOGRAPHIC (EEG) AND VIDEO RECORDING AND INTERPRETATION (EG, FOR PRESURGICAL LOCALIZATION), EACH 24 HOURS 979.. 95953 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY COMPUTERIZED PORTABLE 16 OR MORE CHANNEL EEG, ELECTROENCEPHALOGRAPHIC (EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS 979.. 95954 PHARMACOLOGICAL OR PHYSICAL ACTIVATION REQUIRING PHYSICIAN ATTENDANCE DURING EEG RECORDING OF ACTIVATION PHASE (EG, THIOPENTAL ACTIVATION TEST) 979.. 95956 MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BY CABLE OR RADIO, 16 OR MORE CHANNEL TELEMETRY, ELECTROENCEPHALOGRAPHIC (EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS 979.. 95958 WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDING ELECTROENCEPHALOGRAPHIC (EEG) MONITORING 980.. Electroencephalogram S 2.15 $108.94 $57.86 $21.79 980.. 92275 ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT 980.. 95857 TENSILON TEST FOR MYASTHENIA GRAVIS; 980.. 95867 NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, UNILATERAL 980.. 95869 NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES 980.. 95870 NEEDLE ELECTROMYOGRAPHY; OTHER THAN PARASPINAL (EG, ABDOMEN, THORAX) 980.. 95900 NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE NERVE; MOTOR, WITHOUT F-WAVE STUDY 980.. 95921 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPATHETIC FUNCTION), INCLUDING TWO OR MORE OF THE FOLLOWING: HEART RATE RESPONSE TO DEEP BREATHING WITH RECORDED R-R INTERVAL, VALSALVA RATIO, AND 30:15 RATIO 980.. 95922 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTOR ADRENERGIC INNERVATION (SYMPATHETIC ADRENERGIC FUNCTION), INCLUDING BEAT-TO-BEAT BLOOD PRESSURE AND R-R INTERVAL CHANGES DURING VALSALVA MANEUVER AND AT LEAST FIVE MINUTES OF PASSIVE TILT 980.. 95923 TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING ONE OR MORE OF THE FOLLOWING: QUANTITATIVE SUDOMOTOR AXON REFLEX TEST (QSART), SILASTIC SWEAT IMPRINT, THERMOREGULATORY SWEAT TEST, AND CHANGES IN SYMPATHETIC SKIN POTENTIAL 980.. 95926 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN LOWER LIMBS 980.. 95927 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN THE TRUNK OR HEAD 980.. 95930 VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUS SYSTEM, CHECKERBOARD OR FLASH 980.. 95933 ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTIC TESTING 980.. 95934 H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD GASTROCNEMIUS/SOLEUS MUSCLE 980.. 95936 H-REFLEX, AMPLITUDE AND LATENCY STUDY; RECORD MUSCLE OTHER THAN GASTROCNEMIUS/SOLEUS MUSCLE 980.. 95937 NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY ONE METHOD 980.. 95950 MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRAL SEIZURE FOCUS, ELECTROENCEPHALOGRAPHIC (EG, 8 CHANNEL EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS 981.. Level I Nerve and Muscle Tests X 1.46 $73.98 $41.81 $14.80 981.. 92585 AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS SYSTEM 981.. 95858 TENSILON TEST FOR MYASTHENIA GRAVIS; WITH ELECTROMYOGRAPHIC RECORDING 981.. 95860 NEEDLE ELECTROMYOGRAPHY, ONE EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS 981.. 95861 NEEDLE ELECTROMYOGRAPHY, TWO EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS 981.. 95863 NEEDLE ELECTROMYOGRAPHY, THREE EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS 981.. 95864 NEEDLE ELECTROMYOGRAPHY, FOUR EXTREMITIES WITH OR WITHOUT RELATED PARASPINAL AREAS 981.. 95868 NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES, BILATERAL 981.. 95872 NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITH QUANTITATIVE MEASUREMENT OF JITTER, BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH MUSCLE STUDIED 981.. 95875 ISCHEMIC LIMB EXERCISE WITH NEEDLE ELECTROMYOGRAPHY, WITH LACTIC ACID DETERMINATION 981.. 95903 NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE NERVE; MOTOR, WITH F-WAVE STUDY 981.. 95904 NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH NERVE, ANY/ALL SITE(S) ALONG THE NERVE; SENSORY 981.. 95920 INTRAOPERATIVE NEUROPHYSIOLOGY TESTING, PER HOUR [[Page 47833]] 981.. 95925 SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER LIMBS 982.. Level II Nerve and Muscle X 1.39 $70.43 $38.87 $14.09 Tests 982.. 92585 Auditory evoked potential 982.. 95858 Tensilon test & myogram 982.. 95860 Muscle test, one limb 982.. 95861 Muscle test, two limbs 982.. 95863 Muscle test, 3 limbs 982.. 95864 Muscle test, 4 limbs 982.. 95868 Muscle test, head or neck 982.. 95872 Muscle test, one fiber 982.. 95875 Limb exercise test 982.. 95925 Somatosensory testing 987.. Subcutaneous or Intramuscular S .65 $32.94 $13.33 $6.59 Chemotherapy 987.. 96400 CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR, WITH OR WITHOUT LOCAL ANESTHESIA 987.. 96405 CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; UP TO AND INCLUDING 7 LESIONS 987.. 96406 CHEMOTHERAPY ADMINISTRATION, INTRALESIONAL; MORE THAN 7 LESIONS 987.. 96549 UNLISTED CHEMOTHERAPY PROCEDURE 987.. Q0083 Chemo other than infusion 988.. Chemotherapy except by S 4.15 $210.28 $97.52 $42.06 Extended Infusion 988.. 96408 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; PUSH TECHNIQUE 988.. 96410 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, UP TO ONE HOUR 988.. 96412 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH ADDITIONAL HOUR 988.. 96420 CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE 988.. 96422 CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, UP TO ONE HOUR 988.. 96423 CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, ONE TO 8 HOURS, EACH ADDITIONAL HOUR 989.. Chemotherapy by Extended S 1.72 $87.15 $40.68 $17.43 Infusion 989.. 96414 CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS; INFUSION TECHNIQUE, INITIATION OF PROLONGED INFUSION (MORE THAN 8 HOURS), REQUIRING THE USE OF A PORTABLE OR IMPLANTABLE PUMP 989.. 96425 CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; INFUSION TECHNIQUE, INITIATION OF PROLONGED INFUSION (MORE THAN 8 HOURS), REQUIRING THE USE OF A PORTABLE OR IMPLANTABLE PUMP 989.. 96440 CHEMOTHERAPY ADMINISTRATION INTO PLEURAL CAVITY, REQUIRING AND INCLUDING THORACENTESIS 989.. 96445 CHEMOTHERAPY ADMINISTRATION INTO PERITONEAL CAVITY, REQUIRING AND INCLUDING PERITONEOCENTESIS 989.. 96450 CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), REQUIRING AND INCLUDING LUMBAR PUNCTURE 989.. 96542 CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIA SUBCUTANEOUS RESERVOIR, SINGLE OR MULTIPLE AGENTS 989.. Q0084 Chemo, infusion only 989.. Q0085 Chemo, infusion and other technique 990.. Photochemotherapy S .43 $21.79 $8.14 $4.36 990.. 96900 ACTINOTHERAPY (ULTRAVIOLET LIGHT) 990.. 96910 PHOTOCHEMOTHERAPY; TAR AND ULTRAVIOLET B (GOECKERMAN TREATMENT) OR PETROLATUM AND ULTRAVIOLET B 990.. 96912 PHOTOCHEMOTHERAPY; PSORALENS AND ULTRAVIOLET A (PUVA) 990.. 96913 PHOTOCHEMOTHERAPY (GOECKERMAN AND/OR PUVA) FOR SEVERE PHOTORESPONSIVE DERMATOSES REQUIRING AT LEAST FOUR TO EIGHT HOURS OF CARE UNDER DIRECT SUPERVISION OF THE PHYSICIAN (INCLUDES APPLICATION OF MEDICATION AND DRESSINGS) 990.. 96999 UNLISTED SPECIAL DERMATOLOGICAL SERVICE OR PROCEDURE 997.. Manipulation Therapy S .69 $34.96 $7.23 $6.99 997.. 97250 MYOFASCIAL RELEASE/SOFT TISSUE MOBILIZATION, ONE OR MORE REGIONS 997.. 97260 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; ONE AREA 997.. 97261 MANIPULATION (CERVICAL, THORACIC, LUMBOSACRAL, SACROILIAC, HAND, WRIST) (SEPARATE PROCEDURE), PERFORMED BY PHYSICIAN; EACH ADDITIONAL AREA 997.. 98925 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); ONE TO TWO BODY REGIONS INVOLVED 997.. 98926 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TO FOUR BODY REGIONS INVOLVED 997.. 98927 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); FIVE TO SIX BODY REGIONS INVOLVED 997.. 98928 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); SEVEN TO EIGHT BODY REGIONS INVOLVED 997.. 98929 OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODY REGIONS INVOLVED 997.. 98940 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, ONE TO TWO REGIONS 997.. 98941 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, THREE TO FOUR REGIONS 997.. 98942 CHIROPRACTIC MANIPULATIVE TREATMENT (CMT); SPINAL, FIVE REGIONS 999.. Therapeutic Phlebotomy X .43 $21.79 $10.85 $4.36 999.. 99195 PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE) ---------------------------------------------------------------------------------------------------------------- [[Page 47834]] Addendum D.--Summary of Medical APCs ---------------------------------------------------------------------------------------------------------------- CPT \1\ APC HCPCS Description --------------------------------------------------------------------------\2\----------------------------------- 911 Low Level Clinic Visits 99201 Office/outpatient visit, new 99202 Office/outpatient visit, new 99211 Office/outpatient visit, est 99212 Office/outpatient visit, est 99241 Office consultation 99242 Office consultation 99271 Confirmatory consultation 99272 Confirmatory consultation G0101 Cancer Screening Exam, Women 913 Mid Level Clinic Visits 92002 Eye exam, new patient 92012 Eye exam established pt 99203 Office/outpatient visit, new 99213 Office/outpatient visit, est 99243 Office consultation 99273 Confirmatory consultation 915 High Level Clinic Visits 92004 Eye exam, new patient 92014 Eye exam & treatment 92506 Speech & hearing evaluation 99204 Office/outpatient visit, new 99205 Office/outpatient visit, new 99214 Office/outpatient visit, est 99215 Office/outpatient visit, est 99244 Office consultation 99245 Office consultation 99274 Confirmatory consultation 99275 Confirmatory consultation 951 Low Level Emergency Visits 99281 Emergency dept visit 99282 Emergency dept visit 953 Mid Level Emergency Visits 99283 Emergency dept visit 955 High Level Emergency Visits 99284 Emergency dept visit 99285 Emergency dept visit ---------------------------------------------------------------------------------------------------------------- \1\ CPT codes and descriptions only are copyright 1997 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. \2\ Copyright 1994 American Dental Association. All rights reserved. Note: Medical visit APCs are created by combining level of visit from Addendum D with reason for visit from Addendum E. Thus a midlevel clinic visit (99203) for an eye disorder groups to APC 91368. Addendum E.--Major Diagnostic Categories (MDCs) ------------------------------------------------------------------------ MDC Description ------------------------------------------------------------------------ 11... Well care and administrative 18... Skin and breast diseases 24... Musculoskeletal diseases 31... Ear, nose, mouth and throat diseases 33... Respiratory system diseases 36... Cardiovascular system diseases 41... Digestive system diseases 53... Kidney, urinary tract and male genital diseases 56... Female genital system diseases 57... Pregnancy and Neonatal Care 63... Nervous System Diseases 68... Eye Diseases 72... Trauma and poisoning 78... Major signs, symptoms and findings 82... Endocrine, nutritional and metabolic diseases 86... Immunologic and hematologic diseases 88... Malignancy 91... Psychiatric Disorders 97... Infectious disease 99... Unknown cause of mortality ------------------------------------------------------------------------ Addendum F.--ICD-9 Codes With Major Diagnostic Categories (MDCs) for Payment of Medical Visits Under the Hospital Outpatient PPS ------------------------------------------------------------------------ ICD-9 ICD-9 Description MDC ------------------------------------------------------------------------ 0010.... CHOLERA D/T VIB CHOLERAE............................ 41 0011.... CHOLERA D/T VIB EL TOR.............................. 41 0019.... CHOLERA NOS......................................... 41 [[Page 47835]] 0020.... TYPHOID FEVER....................................... 97 0021.... PARATYPHOID FEVER A................................. 97 0022.... PARATYPHOID FEVER B................................. 97 0023.... PARATYPHOID FEVER C................................. 97 0029.... PARATYPHOID FEVER NOS............................... 97 0030.... SALMONELLA ENTERITIS................................ 41 0031.... SALMONELLA SEPTICEMIA............................... 97 00320... LOCAL SALMONELLA INF NOS............................ 97 00321... SALMONELLA MENINGITIS............................... 97 00322... SALMONELLA PNEUMONIA................................ 33 00323... SALMONELLA ARTHRITIS................................ 24 00324... SALMONELLA OSTEOMYELITIS............................ 24 00329... LOCAL SALMONELLA INF NEC............................ 97 0038.... SALMONELLA INFECTION NEC............................ 97 0039.... SALMONELLA INFECTION NOS............................ 97 0040.... SHIGELLA DYSENTERIAE................................ 41 0041.... SHIGELLA FLEXNERI................................... 41 0042.... SHIGELLA BOYDII..................................... 41 0043.... SHIGELLA SONNEI..................................... 41 0048.... SHIGELLA INFECTION NEC.............................. 41 0049.... SHIGELLOSIS NOS..................................... 41 0050.... STAPH FOOD POISONING................................ 41 0051.... BOTULISM............................................ 97 0052.... FOOD POIS D/T C. PERFRIN............................ 41 0053.... FOOD POIS: CLOSTRID NEC............................. 41 0054.... FOOD POIS: V. PARAHAEM.............................. 41 00581... FOOD POISN D/T V. VULNIF............................ 41 00589... BACT FOOD POISONING NEC............................. 41 0059.... FOOD POISONING NOS.................................. 41 0060.... AC AMEBIASIS W/O ABSCESS............................ 41 0061.... CHR AMEBIASIS W/O ABSCES............................ 41 0062.... AMEBIC NONDYSENT COLITIS............................ 41 0063.... AMEBIC LIVER ABSCESS................................ 41 0064.... AMEBIC LUNG ABSCESS................................. 33 0065.... AMEBIC BRAIN ABSCESS................................ 97 0066.... AMEBIC SKIN ULCERATION.............................. 18 0068.... AMEBIC INFECTION NEC................................ 97 0069.... AMEBIASIS NOS....................................... 97 0070.... BALANTIDIASIS....................................... 41 0071.... GIARDIASIS.......................................... 41 0072.... COCCIDIOSIS......................................... 41 0073.... INTEST TRICHOMONIASIS............................... 41 0078.... PROTOZOAL INTEST DIS NEC............................ 41 0079.... PROTOZOAL INTEST DIS NOS............................ 41 00800... INTEST INFEC E COLI NOS............................. 41 00801... INT INF E COLI ENTRPATH............................. 41 00802... INT INF E COLI ENTRTOXGN............................ 41 00803... INT INF E COLI ENTRNVSV............................. 41 00804... INT INF E COLI ENTRHMRG............................. 41 00809... INT INF E COLI SPCF NEC............................. 41 0081.... ARIZONA ENTERITIS................................... 41 0082.... AEROBACTER ENTERITIS................................ 41 0083.... PROTEUS ENTERITIS................................... 41 00841... STAPHYLOCOCC ENTERITIS.............................. 41 00842... PSEUDOMONAS ENTERITIS............................... 41 00843... INT INFEC CAMPYLOBACTER............................. 41 00844... INT INF YRSNIA ENTRCLTCA............................ 41 00845... INT INF CLSTRDIUM DFCILE............................ 41 00846... INTES INFEC OTH ANEROBES............................ 41 00847... INT INF OTH GRM NEG BCTR............................ 41 00849... BACTERIAL ENTERITIS NEC............................. 41 0085.... BACTERIAL ENTERITIS NOS............................. 41 00861... INTES INFEC ROTAVIRUS............................... 41 00862... INTES INFEC ADENOVIRUS.............................. 41 00863... INT INF NORWALK VIRUS............................... 41 00864... INT INF OTH SML RND VRUS............................ 41 00865... INTES INFEC CALCIVIRUS.............................. 41 00866... INTES INFEC ASTROVIRUS.............................. 41 00867... INT INF ENTEROVIRUS NEC............................. 41 00869... OTHER VIRAL INTES INFEC............................. 41 0088.... VIRAL ENTERITIS NOS................................. 41 0090.... INFECTIOUS ENTERITIS NOS............................ 41 0091.... ENTERITIS OF INFECT ORIG............................ 41 0092.... INFECTIOUS DIARRHEA NOS............................. 41 0093.... DIARRHEA OF INFECT ORIG............................. 41 01000... PRIM TB COMPLEX-UNSPEC.............................. 33 [[Page 47836]] 01001... PRIM TB COMPLEX-NO EXAM............................. 33 01002... PRIM TB COMPLEX-EXM UNKN............................ 33 01003... PRIM TB COMPLEX-MICRO DX............................ 33 01004... PRIM TB COMPLEX-CULT DX............................. 33 01005... PRIM TB COMPLEX-HISTO DX............................ 33 01006... PRIM TB COMPLEX-OTH TEST............................ 33 01010... PRIM TB PLEURISY-UNSPEC............................. 33 01011... PRIM TB PLEURISY-NO EXAM............................ 33 01012... PRIM TB PLEUR-EXAM UNKN............................. 33 01013... PRIM TB PLEURIS-MICRO DX............................ 33 01014... PRIM TB PLEURISY-CULT DX............................ 33 01015... PRIM TB PLEURIS-HISTO DX............................ 33 01016... PRIM TB PLEURIS-OTH TEST............................ 33 01080... PRIM PROG TB NEC-UNSPEC............................. 33 01081... PRIM PROG TB NEC-NO EXAM............................ 33 01082... PRIM PR TB NEC-EXAM UNKN............................ 33 01083... PRIM PRG TB NEC-MICRO DX............................ 33 01084... PRIM PROG TB NEC-CULT DX............................ 33 01085... PRIM PRG TB NEC-HISTO DX............................ 33 01086... PRIM PRG TB NEC-OTH TEST............................ 33 01090... PRIMARY TB NOS-UNSPEC............................... 33 01091... PRIMARY TB NOS-NO EXAM.............................. 33 01092... PRIMARY TB NOS-EXAM UNKN............................ 33 01093... PRIMARY TB NOS-MICRO DX............................. 33 01094... PRIMARY TB NOS-CULT DX.............................. 33 01095... PRIMARY TB NOS-HISTO DX............................. 33 01096... PRIMARY TB NOS-OTH TEST............................. 33 01100... TB LUNG INFILTR-UNSPEC.............................. 33 01101... TB LUNG INFILTR-NO EXAM............................. 33 01102... TB LUNG INFILTR-EXM UNKN............................ 33 01103... TB LUNG INFILTR-MICRO DX............................ 33 01104... TB LUNG INFILTR-CULT DX............................. 33 01105... TB LUNG INFILTR-HISTO DX............................ 33 01106... TB LUNG INFILTR-OTH TEST............................ 33 01110... TB LUNG NODULAR-UNSPEC.............................. 33 01111... TB LUNG NODULAR-NO EXAM............................. 33 01112... TB LUNG NODUL-EXAM UNKN............................. 33 01113... TB LUNG NODULAR-MICRO DX............................ 33 01114... TB LUNG NODULAR-CULT DX............................. 33 01115... TB LUNG NODULAR-HISTO DX............................ 33 01116... TB LUNG NODULAR-OTH TEST............................ 33 01120... TB LUNG W CAVITY-UNSPEC............................. 33 01121... TB LUNG W CAVITY-NO EXAM............................ 33 01122... TB LUNG CAVITY-EXAM UNKN............................ 33 01123... TB LUNG W CAVIT-MICRO DX............................ 33 01124... TB LUNG W CAVITY-CULT DX............................ 33 01125... TB LUNG W CAVIT-HISTO DX............................ 33 01126... TB LUNG W CAVIT-OTH TEST............................ 33 01130... TB OF BRONCHUS-UNSPEC............................... 33 01131... TB OF BRONCHUS-NO EXAM.............................. 33 01132... TB OF BRONCHUS-EXAM UNKN............................ 33 01133... TB OF BRONCHUS-MICRO DX............................. 33 01134... TB OF BRONCHUS-CULT DX.............................. 33 01135... TB OF BRONCHUS-HISTO DX............................. 33 01136... TB OF BRONCHUS-OTH TEST............................. 33 01140... TB LUNG FIBROSIS-UNSPEC............................. 33 01141... TB LUNG FIBROSIS-NO EXAM............................ 33 01142... TB LUNG FIBROS-EXAM UNKN............................ 33 01143... TB LUNG FIBROS-MICRO DX............................. 33 01144... TB LUNG FIBROSIS-CULT DX............................ 33 01145... TB LUNG FIBROS-HISTO DX............................. 33 01146... TB LUNG FIBROS-OTH TEST............................. 33 01150... TB BRONCHIECTASIS-UNSPEC............................ 33 01151... TB BRONCHIECT-NO EXAM............................... 33 01152... TB BRONCHIECT-EXAM UNKN............................. 33 01153... TB BRONCHIECT-MICRO DX.............................. 33 01154... TB BRONCHIECT-CULT DX............................... 33 01155... TB BRONCHIECT-HISTO DX.............................. 33 01156... TB BRONCHIECT-OTH TEST.............................. 33 01160... TB PNEUMONIA-UNSPEC................................. 33 01161... TB PNEUMONIA-NO EXAM................................ 33 01162... TB PNEUMONIA-EXAM UNKN.............................. 33 01163... TB PNEUMONIA-MICRO DX............................... 33 01164... TB PNEUMONIA-CULT DX................................ 33 01165... TB PNEUMONIA-HISTO DX............................... 33 01166... TB PNEUMONIA-OTH TEST............................... 33 [[Page 47837]] 01170... TB PNEUMOTHORAX-UNSPEC.............................. 33 01171... TB PNEUMOTHORAX-NO EXAM............................. 33 01172... TB PNEUMOTHORX-EXAM UNKN............................ 33 01173... TB PNEUMOTHORAX-MICRO DX............................ 33 01174... TB PNEUMOTHORAX-CULT DX............................. 33 01175... TB PNEUMOTHORAX-HISTO DX............................ 33 01176... TB PNEUMOTHORAX-OTH TEST............................ 33 01180... PULMONARY TB NEC-UNSPEC............................. 33 01181... PULMONARY TB NEC-NO EXAM............................ 33 01182... PULMON TB NEC-EXAM UNKN............................. 33 01183... PULMON TB NEC-MICRO DX.............................. 33 01184... PULMON TB NEC-CULT DX............................... 33 01185... PULMON TB NEC-HISTO DX.............................. 33 01186... PULMON TB NEC-OTH TEST.............................. 33 01190... PULMONARY TB NOS-UNSPEC............................. 33 01191... PULMONARY TB NOS-NO EXAM............................ 33 01192... PULMON TB NOS-EXAM UNKN............................. 33 01193... PULMON TB NOS-MICRO DX.............................. 33 01194... PULMON TB NOS-CULT DX............................... 33 01195... PULMON TB NOS-HISTO DX.............................. 33 01196... PULMON TB NOS-OTH TEST.............................. 33 01200... TB PLEURISY-UNSPEC.................................. 33 01201... TB PLEURISY-NO EXAM................................. 33 01202... TB PLEURISY-EXAM UNKN............................... 33 01203... TB PLEURISY-MICRO DX................................ 33 01204... TB PLEURISY-CULT DX................................. 33 01205... TB PLEURISY-HISTOLOG DX............................. 33 01206... TB PLEURISY-OTH TEST................................ 33 01210... TB THORACIC NODES-UNSPEC............................ 33 01211... TB THORAX NODE-NO EXAM.............................. 33 01212... TB THORAX NODE-EXAM UNKN............................ 33 01213... TB THORAX NODE-MICRO DX............................. 33 01214... TB THORAX NODE-CULT DX.............................. 33 01215... TB THORAX NODE-HISTO DX............................. 33 01216... TB THORAX NODE-OTH TEST............................. 33 01220... ISOL TRACHEAL TB-UNSPEC............................. 31 01221... ISOL TRACHEAL TB-NO EXAM............................ 31 01222... ISOL TRACH TB-EXAM UNKN............................. 31 01223... ISOLAT TRACH TB-MICRO DX............................ 31 01224... ISOL TRACHEAL TB-CULT DX............................ 31 01225... ISOLAT TRACH TB-HISTO DX............................ 31 01226... ISOLAT TRACH TB-OTH TEST............................ 31 01230... TB LARYNGITIS-UNSPEC................................ 31 01231... TB LARYNGITIS-NO EXAM............................... 31 01232... TB LARYNGITIS-EXAM UNKN............................. 31 01233... TB LARYNGITIS-MICRO DX.............................. 31 01234... TB LARYNGITIS-CULT DX............................... 31 01235... TB LARYNGITIS-HISTO DX.............................. 31 01236... TB LARYNGITIS-OTH TEST.............................. 31 01280... RESP TB NEC-UNSPEC.................................. 33 01281... RESP TB NEC-NO EXAM................................. 33 01282... RESP TB NEC-EXAM UNKN............................... 33 01283... RESP TB NEC-MICRO DX................................ 33 01284... RESP TB NEC-CULT DX................................. 33 01285... RESP TB NEC-HISTO DX................................ 33 01286... RESP TB NEC-OTH TEST................................ 33 01300... TB MENINGITIS-UNSPEC................................ 63 01301... TB MENINGITIS-NO EXAM............................... 63 01302... TB MENINGITIS-EXAM UNKN............................. 63 01303... TB MENINGITIS-MICRO DX.............................. 63 01304... TB MENINGITIS-CULT DX............................... 63 01305... TB MENINGITIS-HISTO DX.............................. 63 01306... TB MENINGITIS-OTH TEST.............................. 63 01310... TUBRCLMA MENINGES-UNSPEC............................ 63 01311... TUBRCLMA MENING-NO EXAM............................. 63 01312... TUBRCLMA MENIN-EXAM UNKN............................ 63 01313... TUBRCLMA MENING-MICRO DX............................ 63 01314... TUBRCLMA MENING-CULT DX............................. 63 01315... TUBRCLMA MENING-HISTO DX............................ 63 01316... TUBRCLMA MENING-OTH TEST............................ 63 01320... TUBERCULOMA BRAIN-UNSPEC............................ 63 01321... TUBRCLOMA BRAIN-NO EXAM............................. 63 01322... TUBRCLMA BRAIN-EXAM UNKN............................ 63 01323... TUBRCLOMA BRAIN-MICRO DX............................ 63 01324... TUBRCLOMA BRAIN-CULT DX............................. 63 01325... TUBRCLOMA BRAIN-HISTO DX............................ 63 [[Page 47838]] 01326... TUBRCLOMA BRAIN-OTH TEST............................ 63 01330... TB BRAIN ABSCESS-UNSPEC............................. 63 01331... TB BRAIN ABSCESS-NO EXAM............................ 63 01332... TB BRAIN ABSC-EXAM UNKN............................. 63 01333... TB BRAIN ABSC-MICRO DX.............................. 63 01334... TB BRAIN ABSCESS-CULT DX............................ 63 01335... TB BRAIN ABSC-HISTO DX.............................. 63 01336... TB BRAIN ABSC-OTH TEST.............................. 63 01340... TUBRCLMA SP CORD-UNSPEC............................. 63 01341... TUBRCLMA SP CORD-NO EXAM............................ 63 01342... TUBRCLMA SP CD-EXAM UNKN............................ 63 01343... TUBRCLMA SP CRD-MICRO DX............................ 63 01344... TUBRCLMA SP CORD-CULT DX............................ 63 01345... TUBRCLMA SP CRD-HISTO DX............................ 63 01346... TUBRCLMA SP CRD-OTH TEST............................ 63 01350... TB SP CRD ABSCESS-UNSPEC............................ 63 01351... TB SP CRD ABSC-NO EXAM.............................. 63 01352... TB SP CRD ABSC-EXAM UNKN............................ 63 01353... TB SP CRD ABSC-MICRO DX............................. 63 01354... TB SP CRD ABSC-CULT DX.............................. 63 01355... TB SP CRD ABSC-HISTO DX............................. 63 01356... TB SP CRD ABSC-OTH TEST............................. 63 01360... TB ENCEPHALITIS-UNSPEC.............................. 63 01361... TB ENCEPHALITIS-NO EXAM............................. 63 01362... TB ENCEPHALIT-EXAM UNKN............................. 63 01363... TB ENCEPHALITIS-MICRO DX............................ 63 01364... TB ENCEPHALITIS-CULT DX............................. 63 01365... TB ENCEPHALITIS-HISTO DX............................ 63 01366... TB ENCEPHALITIS-OTH TEST............................ 63 01380... CNS TB NEC-UNSPEC................................... 63 01381... CNS TB NEC-NO EXAM.................................. 63 01382... CNS TB NEC-EXAM UNKN................................ 63 01383... CNS TB NEC-MICRO DX................................. 63 01384... CNS TB NEC-CULT DX.................................. 63 01385... CNS TB NEC-HISTO DX................................. 63 01386... CNS TB NEC-OTH TEST................................. 63 01390... CNS TB NOS-UNSPEC................................... 63 01391... CNS TB NOS-NO EXAM.................................. 63 01392... CNS TB NOS-EXAM UNKN................................ 63 01393... CNS TB NOS-MICRO DX................................. 63 01394... CNS TB NOS-CULT DX.................................. 63 01395... CNS TB NOS-HISTO DX................................. 63 01396... CNS TB NOS-OTH TEST................................. 63 01400... TB PERITONITIS-UNSPEC............................... 41 01401... TB PERITONITIS-NO EXAM.............................. 41 01402... TB PERITONITIS-EXAM UNKN............................ 41 01403... TB PERITONITIS-MICRO DX............................. 41 01404... TB PERITONITIS-CULT DX.............................. 41 01405... TB PERITONITIS-HISTO DX............................. 41 01406... TB PERITONITIS-OTH TEST............................. 41 01480... INTESTINAL TB NEC-UNSPEC............................ 41 01481... INTESTIN TB NEC-NO EXAM............................. 41 01482... INTEST TB NEC-EXAM UNKN............................. 41 01483... INTESTIN TB NEC-MICRO DX............................ 41 01484... INTESTIN TB NEC-CULT DX............................. 41 01485... INTESTIN TB NEC-HISTO DX............................ 41 01486... INTESTIN TB NEC-OTH TEST............................ 41 01500... TB OF VERTEBRA-UNSPEC............................... 24 01501... TB OF VERTEBRA-NO EXAM.............................. 24 01502... TB OF VERTEBRA-EXAM UNKN............................ 24 01503... TB OF VERTEBRA-MICRO DX............................. 24 01504... TB OF VERTEBRA-CULT DX.............................. 24 01505... TB OF VERTEBRA-HISTO DX............................. 24 01506... TB OF VERTEBRA-OTH TEST............................. 24 01510... TB OF HIP-UNSPEC.................................... 24 01511... TB OF HIP-NO EXAM................................... 24 01512... TB OF HIP-EXAM UNKN................................. 24 01513... TB OF HIP-MICRO DX.................................. 24 01514... TB OF HIP-CULT DX................................... 24 01515... TB OF HIP-HISTO DX.................................. 24 01516... TB OF HIP-OTH TEST.................................. 24 01520... TB OF KNEE-UNSPEC................................... 24 01521... TB OF KNEE-NO EXAM.................................. 24 01522... TB OF KNEE-EXAM UNKN................................ 24 01523... TB OF KNEE-MICRO DX................................. 24 01524... TB OF KNEE-CULT DX.................................. 24 [[Page 47839]] 01525... TB OF KNEE-HISTO DX................................. 24 01526... TB OF KNEE-OTH TEST................................. 24 01550... TB OF LIMB BONES-UNSPEC............................. 24 01551... TB LIMB BONES-NO EXAM............................... 24 01552... TB LIMB BONES-EXAM UNKN............................. 24 01553... TB LIMB BONES-MICRO DX.............................. 24 01554... TB LIMB BONES-CULT DX............................... 24 01555... TB LIMB BONES-HISTO DX.............................. 24 01556... TB LIMB BONES-OTH TEST.............................. 24 01560... TB OF MASTOID-UNSPEC................................ 31 01561... TB OF MASTOID-NO EXAM............................... 31 01562... TB OF MASTOID-EXAM UNKN............................. 31 01563... TB OF MASTOID-MICRO DX.............................. 31 01564... TB OF MASTOID-CULT DX............................... 31 01565... TB OF MASTOID-HISTO DX.............................. 31 01566... TB OF MASTOID-OTH TEST.............................. 31 01570... TB OF BONE NEC-UNSPEC............................... 24 01571... TB OF BONE NEC-NO EXAM.............................. 24 01572... TB OF BONE NEC-EXAM UNKN............................ 24 01573... TB OF BONE NEC-MICRO DX............................. 24 01574... TB OF BONE NEC-CULT DX.............................. 24 01575... TB OF BONE NEC-HISTO DX............................. 24 01576... TB OF BONE NEC-OTH TEST............................. 24 01580... TB OF JOINT NEC-UNSPEC.............................. 24 01581... TB OF JOINT NEC-NO EXAM............................. 24 01582... TB JOINT NEC-EXAM UNKN.............................. 24 01583... TB OF JOINT NEC-MICRO DX............................ 24 01584... TB OF JOINT NEC-CULT DX............................. 24 01585... TB OF JOINT NEC-HISTO DX............................ 24 01586... TB OF JOINT NEC-OTH TEST............................ 24 01590... TB BONE/JOINT NOS-UNSPEC............................ 24 01591... TB BONE/JT NOS-NO EXAM.............................. 24 01592... TB BONE/JT NOS-EXAM UNKN............................ 24 01593... TB BONE/JT NOS-MICRO DX............................. 24 01594... TB BONE/JT NOS-CULT DX.............................. 24 01595... TB BONE/JT NOS-HISTO DX............................. 24 01596... TB BONE/JT NOS-OTH TEST............................. 24 01600... TB OF KIDNEY-UNSPEC................................. 53 01601... TB OF KIDNEY-NO EXAM................................ 53 01602... TB OF KIDNEY-EXAM UNKN.............................. 53 01603... TB OF KIDNEY-MICRO DX............................... 53 01604... TB OF KIDNEY-CULT DX................................ 53 01605... TB OF KIDNEY-HISTO DX............................... 53 01606... TB OF KIDNEY-OTH TEST............................... 53 01610... TB OF BLADDER-UNSPEC................................ 53 01611... TB OF BLADDER-NO EXAM............................... 53 01612... TB OF BLADDER-EXAM UNKN............................. 53 01613... TB OF BLADDER-MICRO DX.............................. 53 01614... TB OF BLADDER-CULT DX............................... 53 01615... TB OF BLADDER-HISTO DX.............................. 53 01616... TB OF BLADDER-OTH TEST.............................. 53 01620... TB OF URETER-UNSPEC................................. 53 01621... TB OF URETER-NO EXAM................................ 53 01622... TB OF URETER-EXAM UNKN.............................. 53 01623... TB OF URETER-MICRO DX............................... 53 01624... TB OF URETER-CULT DX................................ 53 01625... TB OF URETER-HISTO DX............................... 53 01626... TB OF URETER-OTH TEST............................... 53 01630... TB URINARY NEC-UNSPEC............................... 53 01631... TB URINARY NEC-NO EXAM.............................. 53 01632... TB URINARY NEC-EXAM UNKN............................ 53 01633... TB URINARY NEC-MICRO DX............................. 53 01634... TB URINARY NEC-CULT DX.............................. 53 01635... TB URINARY NEC-HISTO DX............................. 53 01636... TB URINARY NEC-OTH TEST............................. 53 01640... TB EPIDIDYMIS-UNSPEC................................ 53 01641... TB EPIDIDYMIS-NO EXAM............................... 53 01642... TB EPIDIDYMIS-EXAM UNKN............................. 53 01643... TB EPIDIDYMIS-MICRO DX.............................. 53 01644... TB EPIDIDYMIS-CULT DX............................... 53 01645... TB EPIDIDYMIS-HISTO DX.............................. 53 01646... TB EPIDIDYMIS-OTH TEST.............................. 53 01650... TB MALE GENIT NEC-UNSPEC............................ 53 01651... TB MALE GEN NEC-NO EXAM............................. 53 01652... TB MALE GEN NEC-EX UNKN............................. 53 01653... TB MALE GEN NEC-MICRO DX............................ 53 [[Page 47840]] 01654... TB MALE GEN NEC-CULT DX............................. 53 01655... TB MALE GEN NEC-HISTO DX............................ 53 01656... TB MALE GEN NEC-OTH TEST............................ 53 01660... TB OVARY & TUBE-UNSPEC.............................. 56 01661... TB OVARY & TUBE-NO EXAM............................. 56 01662... TB OVARY/TUBE-EXAM UNKN............................. 56 01663... TB OVARY & TUBE-MICRO DX............................ 56 01664... TB OVARY & TUBE-CULT DX............................. 56 01665... TB OVARY & TUBE-HISTO DX............................ 56 01666... TB OVARY & TUBE-OTH TEST............................ 56 01670... TB FEMALE GEN NEC-UNSPEC............................ 56 01671... TB FEM GEN NEC-NO EXAM.............................. 56 01672... TB FEM GEN NEC-EXAM UNKN............................ 56 01673... TB FEM GEN NEC-MICRO DX............................. 56 01674... TB FEM GEN NEC-CULT DX.............................. 56 01675... TB FEM GEN NEC-HISTO DX............................. 56 01676... TB FEM GEN NEC-OTH TEST............................. 56 01690... GU TB NOS-UNSPEC.................................... 53 01691... GU TB NOS-NO EXAM................................... 53 01692... GU TB NOS-EXAM UNKN................................. 53 01693... GU TB NOS-MICRO DX.................................. 53 01694... GU TB NOS-CULT DX................................... 53 01695... GU TB NOS-HISTO DX.................................. 53 01696... GU TB NOS-OTH TEST.................................. 53 01700... TB SKIN/SUBCUTAN-UNSPEC............................. 18 01701... TB SKIN/SUBCUT-NO EXAM.............................. 18 01702... TB SKIN/SUBCUT-EXAM UNKN............................ 18 01703... TB SKIN/SUBCUT-MICRO DX............................. 18 01704... TB SKIN/SUBCUT-CULT DX.............................. 18 01705... TB SKIN/SUBCUT-HISTO DX............................. 18 01706... TB SKIN/SUBCUT-OTH TEST............................. 18 01710... ERYTHEMA NODOS TB-UNSPEC............................ 18 01711... ERYTHEM NODOS TB-NO EXAM............................ 18 01712... ERYTHEM NOD TB-EXAM UNKN............................ 18 01713... ERYTHEM NOD TB-MICRO DX............................. 18 01714... ERYTHEM NODOS TB-CULT DX............................ 18 01715... ERYTHEM NOD TB-HISTO DX............................. 18 01716... ERYTHEM NOD TB-OTH TEST............................. 18 01720... TB PERIPH LYMPH-UNSPEC.............................. 86 01721... TB PERIPH LYMPH-NO EXAM............................. 86 01722... TB PERIPH LYMPH-EXAM UNK............................ 86 01723... TB PERIPH LYMPH-MICRO DX............................ 86 01724... TB PERIPH LYMPH-CULT DX............................. 86 01725... TB PERIPH LYMPH-HISTO DX............................ 86 01726... TB PERIPH LYMPH-OTH TEST............................ 86 01730... TB OF EYE-UNSPEC.................................... 68 01731... TB OF EYE-NO EXAM................................... 68 01732... TB OF EYE-EXAM UNKN................................. 68 01733... TB OF EYE-MICRO DX.................................. 68 01734... TB OF EYE-CULT DX................................... 68 01735... TB OF EYE-HISTO DX.................................. 68 01736... TB OF EYE-OTH TEST.................................. 68 01740... TB OF EAR-UNSPEC.................................... 31 01741... TB OF EAR-NO EXAM................................... 31 01742... TB OF EAR-EXAM UNKN................................. 31 01743... TB OF EAR-MICRO DX.................................. 31 01744... TB OF EAR-CULT DX................................... 31 01745... TB OF EAR-HISTO DX.................................. 31 01746... TB OF EAR-OTH TEST.................................. 31 01750... TB OF THYROID-UNSPEC................................ 82 01751... TB OF THYROID-NO EXAM............................... 82 01752... TB OF THYROID-EXAM UNKN............................. 82 01753... TB OF THYROID-MICRO DX.............................. 82 01754... TB OF THYROID-CULT DX............................... 82 01755... TB OF THYROID-HISTO DX.............................. 82 01756... TB OF THYROID-OTH TEST.............................. 82 01760... TB OF ADRENAL-UNSPEC................................ 82 01761... TB OF ADRENAL-NO EXAM............................... 82 01762... TB OF ADRENAL-EXAM UNKN............................. 82 01763... TB OF ADRENAL-MICRO DX.............................. 82 01764... TB OF ADRENAL-CULT DX............................... 82 01765... TB OF ADRENAL-HISTO DX.............................. 82 01766... TB OF ADRENAL-OTH TEST.............................. 82 01770... TB OF SPLEEN-UNSPEC................................. 86 01771... TB OF SPLEEN-NO EXAM................................ 86 01772... TB OF SPLEEN-EXAM UNKN.............................. 86 [[Page 47841]] 01773... TB OF SPLEEN-MICRO DX............................... 86 01774... TB OF SPLEEN-CULT DX................................ 86 01775... TB OF SPLEEN-HISTO DX............................... 86 01776... TB OF SPLEEN-OTH TEST............................... 86 01780... TB ESOPHAGUS-UNSPEC................................. 41 01781... TB ESOPHAGUS-NO EXAM................................ 41 01782... TB ESOPHAGUS-EXAM UNKN.............................. 41 01783... TB ESOPHAGUS-MICRO DX............................... 41 01784... TB ESOPHAGUS-CULT DX................................ 41 01785... TB ESOPHAGUS-HISTO DX............................... 41 01786... TB ESOPHAGUS-OTH TEST............................... 41 01790... TB OF ORGAN NEC-UNSPEC.............................. 97 01791... TB OF ORGAN NEC-NO EXAM............................. 97 01792... TB ORGAN NEC-EXAM UNKN.............................. 97 01793... TB OF ORGAN NEC-MICRO DX............................ 97 01794... TB OF ORGAN NEC-CULT DX............................. 97 01795... TB OF ORGAN NEC-HISTO DX............................ 97 01796... TB OF ORGAN NEC-OTH TEST............................ 97 01800... ACUTE MILIARY TB-UNSPEC............................. 97 01801... ACUTE MILIARY TB-NO EXAM............................ 97 01802... AC MILIARY TB-EXAM UNKN............................. 97 01803... AC MILIARY TB-MICRO DX.............................. 97 01804... ACUTE MILIARY TB-CULT DX............................ 97 01805... AC MILIARY TB-HISTO DX.............................. 97 01806... AC MILIARY TB-OTH TEST.............................. 97 01880... MILIARY TB NEC-UNSPEC............................... 97 01881... MILIARY TB NEC-NO EXAM.............................. 97 01882... MILIARY TB NEC-EXAM UNKN............................ 97 01883... MILIARY TB NEC-MICRO DX............................. 97 01884... MILIARY TB NEC-CULT DX.............................. 97 01885... MILIARY TB NEC-HISTO DX............................. 97 01886... MILIARY TB NEC-OTH TEST............................. 97 01890... MILIARY TB NOS-UNSPEC............................... 97 01891... MILIARY TB NOS-NO EXAM.............................. 97 01892... MILIARY TB NOS-EXAM UNKN............................ 97 01893... MILIARY TB NOS-MICRO DX............................. 97 01894... MILIARY TB NOS-CULT DX.............................. 97 01895... MILIARY TB NOS-HISTO DX............................. 97 01896... MILIARY TB NOS-OTH TEST............................. 97 0200.... BUBONIC PLAGUE...................................... 97 0201.... CELLULOCUTANEOUS PLAGUE............................. 97 0202.... SEPTICEMIC PLAGUE................................... 97 0203.... PRIMARY PNEUMONIC PLAGUE............................ 33 0204.... SECONDARY PNEUMON PLAGUE............................ 33 0205.... PNEUMONIC PLAGUE NOS................................ 33 0208.... OTHER TYPES OF PLAGUE............................... 97 0209.... PLAGUE NOS.......................................... 97 0210.... ULCEROGLANDUL TULAREMIA............................. 97 0211.... ENTERIC TULAREMIA................................... 41 0212.... PULMONARY TULAREMIA................................. 33 0213.... OCULOGLANDULAR TULAREMIA............................ 97 0218.... TULAREMIA NEC....................................... 97 0219.... TULAREMIA NOS....................................... 97 0220.... CUTANEOUS ANTHRAX................................... 18 0221.... PULMONARY ANTHRAX................................... 33 0222.... GASTROINTESTINAL ANTHRAX............................ 41 0223.... ANTHRAX SEPTICEMIA.................................. 97 0228.... OTHER ANTHRAX MANIFEST.............................. 97 0229.... ANTHRAX NOS......................................... 97 0230.... BRUCELLA MELITENSIS................................. 97 0231.... BRUCELLA ABORTUS.................................... 97 0232.... BRUCELLA SUIS....................................... 97 0233.... BRUCELLA CANIS...................................... 97 0238.... BRUCELLOSIS NEC..................................... 97 0239.... BRUCELLOSIS NOS..................................... 97 024..... GLANDERS............................................ 97 025..... MELIOIDOSIS......................................... 97 0260.... SPIRILLARY FEVER.................................... 97 0261.... STREPTOBACILLARY FEVER.............................. 97 0269.... RAT-BITE FEVER NOS.................................. 97 0270.... LISTERIOSIS......................................... 97 0271.... ERYSIPELOTHRIX INFECTION............................ 97 0272.... PASTEURELLOSIS...................................... 97 0278.... ZOONOTIC BACT DIS NEC............................... 97 0279.... ZOONOTIC BACT DIS NOS............................... 97 0300.... LEPROMATOUS LEPROSY................................. 97 [[Page 47842]] 0301.... TUBERCULOID LEPROSY................................. 97 0302.... INDETERMINATE LEPROSY............................... 97 0303.... BORDERLINE LEPROSY.................................. 97 0308.... LEPROSY NEC......................................... 97 0309.... LEPROSY NOS......................................... 97 0310.... PULMONARY MYCOBACTERIA.............................. 33 0311.... CUTANEOUS MYCOBACTERIA.............................. 18 0318.... MYCOBACTERIAL DIS NEC............................... 97 0319.... MYCOBACTERIAL DIS NOS............................... 97 0320.... FAUCIAL DIPHTHERIA.................................. 31 0321.... NASOPHARYNX DIPHTHERIA.............................. 31 0322.... ANT NASAL DIPHTHERIA................................ 31 0323.... LARYNGEAL DIPHTHERIA................................ 31 03281... CONJUNCTIVAL DIPHTHERIA............................. 68 03282... DIPHTHERITIC MYOCARDITIS............................ 36 03283... DIPHTHERITIC PERITONITIS............................ 41 03284... DIPHTHERITIC CYSTITIS............................... 53 03285... CUTANEOUS DIPHTHERIA................................ 18 03289... DIPHTHERIA NEC...................................... 97 0329.... DIPHTHERIA NOS...................................... 97 0330.... BORDETELLA PERTUSSIS................................ 33 0331.... BORDETELLA PARAPERTUSSIS............................ 33 0338.... WHOOPING COUGH NEC.................................. 33 0339.... WHOOPING COUGH NOS.................................. 33 0340.... STREP SORE THROAT................................... 31 0341.... SCARLET FEVER....................................... 97 035..... ERYSIPELAS.......................................... 18 0360.... MENINGOCOCCAL MENINGITIS............................ 63 0361.... MENINGOCOCC ENCEPHALITIS............................ 63 0362.... MENINGOCOCCEMIA..................................... 97 0363.... MENINGOCOCC ADRENAL SYND............................ 97 03640... MENINGOCOCC CARDITIS NOS............................ 36 03641... MENINGOCOCC PERICARDITIS............................ 36 03642... MENINGOCOCC ENDOCARDITIS............................ 36 03643... MENINGOCOCC MYOCARDITIS............................. 36 03681... MENINGOCOCC OPTIC NEURIT............................ 68 03682... MENINGOCOCC ARTHROPATHY............................. 24 03689... MENINGOCOCCAL INFECT NEC............................ 97 0369.... MENINGOCOCCAL INFECT NOS............................ 97 037..... TETANUS............................................. 97 0380.... STREPTOCOCCAL SEPTICEMIA............................ 97 0382.... PNEUMOCOCCAL SEPTICEMIA............................. 97 0383.... ANAEROBIC SEPTICEMIA................................ 97 03840... GRAM-NEG SEPTICEMIA NOS............................. 97 03841... H. INFLUENAE SEPTICEMIA............................. 97 03842... E COLI SEPTICEMIA................................... 97 03843... PSEUDOMONAS SEPTICEMIA.............................. 97 03844... SERRATIA SEPTICEMIA................................. 97 03849... GRAM-NEG SEPTICEMIA NEC............................. 97 0388.... SEPTICEMIA NEC...................................... 97 0389.... SEPTICEMIA NOS...................................... 97 0390.... CUTANEOUS ACTINOMYCOSIS............................. 18 0391.... PULMONARY ACTINOMYCOSIS............................. 33 0392.... ABDOMINAL ACTINOMYCOSIS............................. 41 0393.... CERVICOFAC ACTINOMYCOSIS............................ 18 0394.... MADURA FOOT......................................... 18 0398.... ACTINOMYCOSIS NEC................................... 97 0399.... ACTINOMYCOSIS NOS................................... 97 0400.... GAS GANGRENE........................................ 97 0401.... RHINOSCLEROMA....................................... 97 0402.... WHIPPLE'S DISEASE................................... 41 0403.... NECROBACILLOSIS..................................... 97 04081... TROPICAL PYOMYOSITIS................................ 24 04089... BACTERIAL DISEASES NEC.............................. 97 04100... STREPTOCOCCUS UNSPECF............................... 97 04101... STREPTOCOCCUS GROUP A............................... 97 04102... STREPTOCOCCUS GROUP B............................... 97 04103... STREPTOCOCCUS GROUP C............................... 97 04104... STREPTOCOCCUS GROUP D............................... 97 04105... STREPTOCOCCUS GROUP G............................... 97 04109... OTHER STREPTOCOCCUS................................. 97 04110... STAPHYLOCOCCUS UNSPCFIED............................ 97 04111... STAPHYLOCOCCUS AUREUS............................... 97 04119... OTHER STAPHYLOCOCCUS................................ 97 0412.... PNEUMOCOCCUS INFECT NOS............................. 97 0413.... KLEBSIELLA INFECT NOS............................... 97 [[Page 47843]] 0414.... E. COLI INFECT NOS.................................. 97 0415.... H. INFLUENZAE INFECT NOS............................ 97 0416.... PROTEUS INFECTION NOS............................... 97 0417.... PSEUDOMONAS INFECT NOS.............................. 97 04181... MYCOPLASMA.......................................... 97 04182... BACILLUS FRAGILIS................................... 97 04183... CLOSTRIDIUM PERFRINGENS............................. 97 04184... OTHER ANAEROBES..................................... 97 04185... OTH GRAM NEGATV BACTERIA............................ 97 04186... HELICOBACTER PYLORI................................. 41 04189... OTH SPECF BACTERIA.................................. 97 0419.... BACTERIAL INFECTION NOS............................. 97 042..... HUMAN IMMUNO VIRUS DIS.............................. 86 04500... AC BULBAR POLIO-TYPE NOS............................ 63 04501... AC BULBAR POLIO-TYPE 1.............................. 63 04502... AC BULBAR POLIO-TYPE 2.............................. 63 04503... AC BULBAR POLIO-TYPE 3.............................. 63 04510... PARAL POLIO NEC-TYPE NOS............................ 63 04511... PARAL POLIO NEC-TYPE 1.............................. 63 04512... PARAL POLIO NEC-TYPE 2.............................. 63 04513... PARAL POLIO NEC-TYPE 3.............................. 63 04520... NONPARALY POLIO-TYPE NOS............................ 63 04521... NONPARALYT POLIO-TYPE 1............................. 63 04522... NONPARALYT POLIO-TYPE 2............................. 63 04523... NONPARALYT POLIO-TYPE 3............................. 63 04590... AC POLIO NOS-TYPE NOS............................... 63 04591... AC POLIO NOS-TYPE 1................................. 63 04592... AC POLIO NOS-TYPE 2................................. 63 04593... AC POLIO NOS-TYPE 3................................. 63 0460.... KURU................................................ 63 0461.... JAKOB-CREUTZFELDT DIS............................... 63 0462.... SUBAC SCLEROS PANENCEPH............................. 63 0463.... PROG MULTIFOC LEUKOENCEP............................ 63 0468.... CNS SLOW VIRUS INFEC NEC............................ 63 0469.... CNS SLOW VIRUS INFEC NOS............................ 63 0470.... COXSACKIE VIRUS MENING.............................. 63 0471.... ECHO VIRUS MENINGITIS............................... 63 0478.... VIRAL MENINGITIS NEC................................ 63 0479.... VIRAL MENINGITIS NOS................................ 63 048..... OTH ENTEROVIRAL CNS DIS............................. 97 0490.... LYMPHOCYTIC CHORIOMENING............................ 63 0491.... ADENOVIRAL MENINGITIS............................... 63 0498.... VIRAL ENCEPHALITIS NEC.............................. 63 0499.... VIRAL ENCEPHALITIS NOS.............................. 63 0500.... VARIOLA MAJOR....................................... 97 0501.... ALASTRIM............................................ 97 0502.... MODIFIED SMALLPOX................................... 97 0509.... SMALLPOX NOS........................................ 97 0510.... COWPOX.............................................. 97 0511.... PSEUDOCOWPOX........................................ 18 0512.... CONTAGIOUS PUSTULAR DERM............................ 18 0519.... PARAVACCINIA NOS.................................... 97 0520.... POSTVARICELLA ENCEPHALIT............................ 63 0521.... VARICELLA PNEUMONITIS............................... 33 0527.... VARICELLA COMPLICAT NEC............................. 97 0528.... VARICELLA COMPLICAT NOS............................. 97 0529.... VARICELLA UNCOMPLICATED............................. 97 0530.... HERPES ZOSTER MENINGITIS............................ 63 05310... H ZOSTER NERV SYST NOS.............................. 63 05311... GENICULATE HERPES ZOSTER............................ 63 05312... POSTHERPES TRIGEM NEURAL............................ 63 05313... POSTHERPES POLYNEUROPATH............................ 63 05319... H ZOSTER NERV SYST NEC.............................. 63 05320... HERPES ZOSTER OF EYELID............................. 68 05321... H ZOSTER KERATOCONJUNCT............................. 68 05322... H ZOSTER IRIDOCYCLITIS.............................. 68 05329... HERPES ZOSTER OF EYE NEC............................ 68 05371... H ZOSTER OTITIS EXTERNA............................. 31 05379... H ZOSTER COMPLICATED NEC............................ 97 0538.... H ZOSTER COMPLICATED NOS............................ 97 0539.... HERPES ZOSTER NOS................................... 18 0540.... ECZEMA HERPETICUM................................... 18 05410... GENITAL HERPES NOS.................................. 97 05411... HERPETIC VULVOVAGINITIS............................. 97 05412... HERPETIC ULCER OF VULVA............................. 97 05413... HERPETIC INFECT OF PENIS............................ 97 [[Page 47844]] 05419... GENITAL HERPES NEC.................................. 97 0542.... HERPETIC GINGIVOSTOMAT.............................. 31 0543.... HERPETIC ENCEPHALITIS............................... 63 05440... HERPES SIMPLEX EYE NOS.............................. 68 05441... HERPES SIMPLEX OF EYELID............................ 68 05442... DENDRITIC KERATITIS................................. 68 05443... H SIMPLEX KERATITIS................................. 68 05444... H SIMPLEX IRIDOCYCLITIS............................. 68 05449... HERPES SIMPLEX EYE NEC.............................. 68 0545.... HERPETIC SEPTICEMIA................................. 97 0546.... HERPETIC WHITLOW.................................... 18 05471... VISCERAL HERPES SIMPLEX............................. 41 05472... H SIMPLEX MENINGITIS................................ 63 05473... H SIMPLEX OTITIS EXTERNA............................ 31 05479... H SIMPLEX COMPLICAT NEC............................. 97 0548.... H SIMPLEX COMPLICAT NOS............................. 97 0549.... HERPES SIMPLEX NOS.................................. 18 0550.... POSTMEASLES ENCEPHALITIS............................ 63 0551.... POSTMEASLES PNEUMONIA............................... 33 0552.... POSTMEASLES OTITIS MEDIA............................ 31 05571... MEASLES KERATITIS................................... 68 05579... MEASLES COMPLICATION NEC............................ 97 0558.... MEASLES COMPLICATION NOS............................ 97 0559.... MEASLES UNCOMPLICATED............................... 97 05600... RUBELLA NERVE COMPL NOS............................. 63 05601... RUBELLA ENCEPHALITIS................................ 63 05609... RUBELLA NERVE COMPL NEC............................. 63 05671... ARTHRITIS DUE TO RUBELLA............................ 24 05679... RUBELLA COMPLICATION NEC............................ 97 0568.... RUBELLA COMPLICATION NOS............................ 97 0569.... RUBELLA UNCOMPLICATED............................... 97 0570.... ERYTHEMA INFECTIOSUM................................ 97 0578.... VIRAL EXANTHEMATA NEC............................... 97 0579.... VIRAL EXANTHEMATA NOS............................... 97 0600.... SYLVATIC YELLOW FEVER............................... 97 0601.... URBAN YELLOW FEVER.................................. 97 0609.... YELLOW FEVER NOS.................................... 97 061..... DENGUE.............................................. 97 0620.... JAPANESE ENCEPHALITIS............................... 63 0621.... WEST EQUINE ENCEPHALITIS............................ 63 0622.... EAST EQUINE ENCEPHALITIS............................ 63 0623.... ST LOUIS ENCEPHALITIS............................... 63 0624.... AUSTRALIAN ENCEPHALITIS............................. 63 0625.... CALIFORNIA ENCEPHALITIS............................. 97 0628.... MOSQUIT-BORNE ENCEPH NEC............................ 97 0629.... MOSQUIT-BORNE ENCEPH NOS............................ 97 0630.... RUSSIA SPR-SUMMER ENCEPH............................ 97 0631.... LOUPING ILL......................................... 97 0632.... CENT EUROPE ENCEPHALITIS............................ 63 0638.... TICK-BORNE ENCEPH NEC............................... 97 0639.... TICK-BORNE ENCEPH NOS............................... 97 064..... VIR ENCEPH ARTHROPOD NEC............................ 63 0650.... CRIMEAN HEMORRHAGIC FEV............................. 97 0651.... OMSK HEMORRHAGIC FEVER.............................. 97 0652.... KYASANUR FOREST DISEASE............................. 97 0653.... TICK-BORNE HEM FEVER NEC............................ 97 0654.... MOSQUITO-BORNE HEM FEVER............................ 97 0658.... ARTHROPOD HEM FEVER NEC............................. 97 0659.... ARTHROPOD HEM FEVER NOS............................. 97 0660.... PHLEBOTOMUS FEVER................................... 97 0661.... TICK-BORNE FEVER.................................... 97 0662.... VENEZUELAN EQUINE FEVER............................. 63 0663.... MOSQUITO-BORNE FEVER NEC............................ 97 0668.... ARTHROPOD VIRUS NEC................................. 97 0669.... ARTHROPOD VIRUS NOS................................. 97 0700.... HEPATITIS A WITH COMA............................... 78 0701.... HEPATITIS A W/O COMA................................ 41 07020... HPT B ACTE COMA WO DLTA............................. 78 07021... HPT B ACTE COMA W DLTA.............................. 78 07022... HPT B CHRN COMA WO DLTA............................. 78 07023... HPT B CHRN COMA W DLTA.............................. 78 07030... HPT B ACTE WO CM WO DLTA............................ 41 07031... HPT B ACTE WO CM W DLTA............................. 41 07032... HPT B CHRN WO CM WO DLTA............................ 41 07033... HPT B CHRN WO CM W DLTA............................. 41 07041... HPT C ACUTE W HEPAT COMA............................ 78 [[Page 47845]] 07042... HPT DLT WO B W HPT COMA............................. 78 07043... HPT E W HEPAT COMA.................................. 78 07044... CHRNC HPT C W HEPAT COMA............................ 78 07049... OTH VRL HEPAT W HPT COMA............................ 78 07051... HPT C ACUTE WO HPAT COMA............................ 41 07052... HPT DLT WO B WO HPT COMA............................ 41 07053... HPT E WO HEPAT COMA................................. 41 07054... CHRNC HPT C WO HPAT COMA............................ 41 07059... OTH VRL HPAT WO HPT COMA............................ 41 0706.... VIRAL HEPAT NOS W COMA.............................. 78 0709.... VIRAL HEPAT NOS W/O COMA............................ 41 071..... RABIES.............................................. 63 0720.... MUMPS ORCHITIS...................................... 53 0721.... MUMPS MENINGITIS.................................... 63 0722.... MUMPS ENCEPHALITIS.................................. 63 0723.... MUMPS PANCREATITIS.................................. 41 07271... MUMPS HEPATITIS..................................... 41 07272... MUMPS POLYNEUROPATHY................................ 63 07279... MUMPS COMPLICATION NEC.............................. 97 0728.... MUMPS COMPLICATION NOS.............................. 97 0729.... MUMPS UNCOMPLICATED................................. 97 0730.... ORNITHOSIS PNEUMONIA................................ 33 0737.... ORNITHOSIS COMPLICAT NEC............................ 97 0738.... ORNITHOSIS COMPLICAT NOS............................ 97 0739.... ORNITHOSIS NOS...................................... 97 0740.... HERPANGINA.......................................... 31 0741.... EPIDEMIC PLEURODYNIA................................ 33 07420... COXSACKIE CARDITIS NOS.............................. 36 07421... COXSACKIE PERICARDITIS.............................. 36 07422... COXSACKIE ENDOCARDITIS.............................. 36 07423... COXSACKIE MYOCARDITIS............................... 36 0743.... HAND, FOOT & MOUTH DIS.............................. 97 0748.... COXSACKIE VIRUS NEC................................. 97 075..... INFECTIOUS MONONUCLEOSIS............................ 97 0760.... TRACHOMA, INITIAL STAGE............................. 68 0761.... TRACHOMA, ACTIVE STAGE.............................. 68 0769.... TRACHOMA NOS........................................ 68 0770.... INCLUSION CONJUNCTIVITIS............................ 68 0771.... EPIDEM KERATOCONJUNCTIV............................. 68 0772.... PHARYNGOCONJUNCT FEVER.............................. 68 0773.... ADENOVIRAL CONJUNCT NEC............................. 68 0774.... EPIDEM HEM CONJUNCTIVIT............................. 68 0778.... VIRAL CONJUNCTIVITIS NEC............................ 68 07798... UNSP DS CONJUC CHLAMYDIA............................ 97 07799... UNSP DS CONJUC VIRUSES.............................. 97 0780.... MOLLUSCUM CONTAGIOSUM............................... 18 07810... VIRAL WARTS NOS..................................... 97 07811... CONDYLOMA ACUMINATUM................................ 97 07819... OTH SPECFD VIRAL WARTS.............................. 97 0782.... SWEATING FEVER...................................... 97 0783.... CAT-SCRATCH DISEASE................................. 97 0784.... FOOT & MOUTH DISEASE................................ 97 0785.... CYTOMEGALOVIRAL DISEASE............................. 97 0786.... HEM NEPHROSONEPHRITIS............................... 53 0787.... ARENAVIRAL HEM FEVER................................ 97 07881... EPIDEMIC VERTIGO.................................... 31 07882... EPIDEMIC VOMITING SYND.............................. 41 07888... OTH SPEC DIS CHLAMYDIAE............................. 97 07889... OTH SPEC DIS VIRUSES................................ 97 0790.... ADENOVIRUS INFECT NOS............................... 97 0791.... ECHO VIRUS INFECT NOS............................... 97 0792.... COXSACKIE VIRUS INF NOS............................. 97 0793.... RHINOVIRUS INFECT NOS............................... 97 0794.... HUMAN PAPILLOMA VIRUS............................... 97 07950... RETROVIRUS, UNSPECIFIED............................. 86 07951... HTLV-1 INFECTION OTH DIS............................ 86 07952... HTLV-II INFECTN OTH DIS............................. 86 07953... HIV-2 INFECTION OTH DIS............................. 86 07959... OTH SPECFIED RETROVIRUS............................. 86 07981... HANTAVIRUS INFECTION................................ 97 07988... OTH SPCF CHLAMYDIAL INFC............................ 97 07989... OTH SPECF VIRAL INFECTN............................. 97 07998... CHLAMYDIAL INFECTION NOS............................ 97 07999... VIRAL INFECTION NOS................................. 97 080..... LOUSE-BORNE TYPHUS.................................. 97 0810.... MURINE TYPHUS....................................... 97 [[Page 47846]] 0811.... BRILL'S DISEASE..................................... 97 0812.... SCRUB TYPHUS........................................ 97 0819.... TYPHUS NOS.......................................... 97 0820.... SPOTTED FEVERS...................................... 97 0821.... BOUTONNEUSE FEVER................................... 97 0822.... NORTH ASIAN TICK FEVER.............................. 97 0823.... QUEENSLAND TICK TYPHUS.............................. 97 0828.... TICK-BORNE RICKETTS NEC............................. 97 0829.... TICK-BORNE RICKETTS NOS............................. 97 0830.... Q FEVER............................................. 97 0831.... TRENCH FEVER........................................ 97 0832.... RICKETTSIALPOX...................................... 97 0838.... RICKETTSIOSES NEC................................... 97 0839.... RICKETTSIOSIS NOS................................... 97 0840.... FALCIPARUM MALARIA.................................. 97 0841.... VIVAX MALARIA....................................... 97 0842.... QUARTAN MALARIA..................................... 97 0843.... OVALE MALARIA....................................... 97 0844.... MALARIA NEC......................................... 97 0845.... MIXED MALARIA....................................... 97 0846.... MALARIA NOS......................................... 97 0847.... INDUCED MALARIA..................................... 97 0848.... BLACKWATER FEVER.................................... 97 0849.... MALARIA COMPLICATED NEC............................. 97 0850.... VISCERAL LEISHMANIASIS.............................. 97 0851.... CUTAN LEISHMANIAS URBAN............................. 18 0852.... CUTAN LEISHMANIAS ASIAN............................. 18 0853.... CUTAN LEISHMANIAS ETHIOP............................ 18 0854.... CUTAN LEISHMANIAS AMER.............................. 18 0855.... MUCOCUTAN LEISHMANIASIS............................. 18 0859.... LEISHMANIASIS NOS................................... 97 0860.... CHAGAS DISEASE OF HEART............................. 36 0861.... CHAGAS DIS OF OTH ORGAN............................. 97 0862.... CHAGAS DISEASE NOS.................................. 97 0863.... GAMBIAN TRYPANOSOMIASIS............................. 97 0864.... RHODESIAN TRYPANOSOMIAS............................. 97 0865.... AFRICAN TRYPANOSOMA NOS............................. 97 0869.... TRYPANOSOMIASIS NOS................................. 97 0870.... LOUSE-BORNE RELAPS FEVER............................ 97 0871.... TICK-BORNE RELAPS FEVER............................. 97 0879.... RELAPSING FEVER NOS................................. 97 0880.... BARTONELLOSIS....................................... 97 08881... LYME DISEASE........................................ 97 08882... BABESIOSIS.......................................... 97 08889... OTH ARTHROPOD-BORNE DIS............................. 97 0889.... ARTHROPOD-BORNE DIS NOS............................. 97 0900.... EARLY CONG SYPH SYMPTOM............................. 97 0901.... EARLY CONGEN SYPH LATENT............................ 97 0902.... EARLY CONGEN SYPH NOS............................... 97 0903.... SYPHILITIC KERATITIS................................ 68 09040... JUVENILE NEUROSYPH NOS.............................. 63 09041... CONGEN SYPH ENCEPHALITIS............................ 63 09042... CONGEN SYPH MENINGITIS.............................. 63 09049... JUVENILE NEUROSYPH NEC.............................. 63 0905.... LATE CONGEN SYPH SYMPTOM............................ 97 0906.... LATE CONGEN SYPH LATENT............................. 97 0907.... LATE CONGEN SYPH NOS................................ 97 0909.... CONGENITAL SYPHILIS NOS............................. 97 0910.... PRIMARY GENITAL SYPHILIS............................ 97 0911.... PRIMARY ANAL SYPHILIS............................... 41 0912.... PRIMARY SYPHILIS NEC................................ 97 0913.... SECONDARY SYPH SKIN................................. 18 0914.... SYPHILITIC ADENOPATHY............................... 97 09150... SYPHILITIC UVEITIS NOS.............................. 68 09151... SYPHILIT CHORIORETINITIS............................ 68 09152... SYPHILITIC IRIDOCYCLITIS............................ 68 09161... SYPHILITIC PERIOSTITIS.............................. 24 09162... SYPHILITIC HEPATITIS................................ 41 09169... SECOND SYPH VISCERA NEC............................. 41 0917.... SECOND SYPHILIS RELAPSE............................. 97 09181... ACUTE SYPHIL MENINGITIS............................. 63 09182... SYPHILITIC ALOPECIA................................. 18 09189... SECONDARY SYPHILIS NEC.............................. 97 0919.... SECONDARY SYPHILIS NOS.............................. 97 0920.... EARLY SYPH LATENT RELAPS............................ 97 0929.... EARLY SYPHIL LATENT NOS............................. 97 [[Page 47847]] 0930.... AORTIC ANEURYSM, SYPHIL............................. 36 0931.... SYPHILITIC AORTITIS................................. 36 09320... SYPHIL ENDOCARDITIS NOS............................. 36 09321... SYPHILITIC MITRAL VALVE............................. 36 09322... SYPHILITIC AORTIC VALVE............................. 36 09323... SYPHIL TRICUSPID VALVE.............................. 36 09324... SYPHIL PULMONARY VALVE.............................. 36 09381... SYPHILITIC PERICARDITIS............................. 36 09382... SYPHILITIC MYOCARDITIS.............................. 36 09389... CARDIOVASCULAR SYPH NEC............................. 36 0939.... CARDIOVASCULAR SYPH NOS............................. 36 0940.... TABES DORSALIS...................................... 63 0941.... GENERAL PARESIS..................................... 63 0942.... SYPHILITIC MENINGITIS............................... 63 0943.... ASYMPTOMAT NEUROSYPHILIS............................ 63 09481... SYPHILITIC ENCEPHALITIS............................. 63 09482... SYPHILITIC PARKINSONISM............................. 63 09483... SYPH DISSEM RETINITIS............................... 68 09484... SYPHILITIC OPTIC ATROPHY............................ 68 09485... SYPH RETROBULB NEURITIS............................. 63 09486... SYPHIL ACOUSTIC NEURITIS............................ 31 09487... SYPH RUPT CEREB ANEURYSM............................ 63 09489... NEUROSYPHILIS NEC................................... 63 0949.... NEUROSYPHILIS NOS................................... 63 0950.... SYPHILITIC EPISCLERITIS............................. 68 0951.... SYPHILIS OF LUNG.................................... 33 0952.... SYPHILITIC PERITONITIS.............................. 41 0953.... SYPHILIS OF LIVER................................... 41 0954.... SYPHILIS OF KIDNEY.................................. 53 0955.... SYPHILIS OF BONE.................................... 24 0956.... SYPHILIS OF MUSCLE.................................. 24 0957.... SYPHILIS OF TENDON/BURSA............................ 24 0958.... LATE SYMPT SYPHILIS NEC............................. 97 0959.... LATE SYMPT SYPHILIS NOS............................. 97 096..... LATE SYPHILIS LATENT................................ 97 0970.... LATE SYPHILIS NOS................................... 97 0971.... LATENT SYPHILIS NOS................................. 97 0979.... SYPHILIS NOS........................................ 97 0980.... ACUTE GC INFECT LOWER GU............................ 97 09810... GC (ACUTE) UPPER GU NOS............................. 97 09811... GC CYSTITIS (ACUTE)................................. 53 09812... GC PROSTATITIS (ACUTE).............................. 53 09813... GC ORCHITIS (ACUTE)................................. 97 09814... GC SEM VESICULIT (ACUTE)............................ 97 09815... GC CERVICITIS (ACUTE)............................... 97 09816... GC ENDOMETRITIS (ACUTE)............................. 97 09817... ACUTE GC SALPINGITIS................................ 97 09819... GC (ACUTE) UPPER GU NEC............................. 97 0982.... CHR GC INFECT LOWER GU.............................. 97 09830... CHR GC UPPER GU NOS................................. 53 09831... GC CYSTITIS, CHRONIC................................ 53 09832... GC PROSTATITIS, CHRONIC............................. 53 09833... GC ORCHITIS, CHRONIC................................ 97 09834... GC SEM VESICULITIS, CHR............................. 97 09835... GC CERVICITIS, CHRONIC.............................. 97 09836... GC ENDOMETRITIS, CHRONIC............................ 97 09837... GC SALPINGITIS (CHRONIC)............................ 97 09839... CHR GC UPPER GU NEC................................. 97 09840... GONOCOCCAL CONJUNCTIVIT............................. 68 09841... GONOCOCCAL IRIDOCYCLITIS............................ 68 09842... GONOCOCCAL ENDOPHTHALMIA............................ 68 09843... GONOCOCCAL KERATITIS................................ 68 09849... GONOCOCCAL EYE NEC.................................. 68 09850... GONOCOCCAL ARTHRITIS................................ 24 09851... GONOCOCCAL SYNOVITIS................................ 24 09852... GONOCOCCAL BURSITIS................................. 24 09853... GONOCOCCAL SPONDYLITIS.............................. 24 09859... GC INFECT JOINT NEC................................. 24 0986.... GONOCOCCAL INFEC PHARYNX............................ 31 0987.... GC INFECT ANUS & RECTUM............................. 97 09881... GONOCOCCAL KERATOSIS................................ 68 09882... GONOCOCCAL MENINGITIS............................... 63 09883... GONOCOCCAL PERICARDITIS............................. 36 09884... GONOCOCCAL ENDOCARDITIS............................. 36 09885... GONOCOCCAL HEART DIS NEC............................ 36 09886... GONOCOCCAL PERITONITIS.............................. 41 [[Page 47848]] 09889... GONOCOCCAL INF SITE NEC............................. 97 0990.... CHANCROID........................................... 97 0991.... LYMPHOGRANULOMA VENEREUM............................ 97 0992.... GRANULOMA INGUINALE................................. 97 0993.... REITER'S DISEASE.................................... 24 09940... UNSPCF NONGNCCL URETHRTS............................ 97 09941... CHLMYD TRACHOMATIS URETH............................ 97 09949... NONGC URTH OTH SPF ORGSM............................ 97 09950... OTH VD CHLM TRCH UNSP ST............................ 97 09951... OTH VD CHLM TRCH PHARYNX............................ 97 09952... OTH VD CHLM TRCH ANS RCT............................ 97 09953... OTH VD CHLM TRCH LOWR GU............................ 97 09954... OTH VD CHLM TRCH OTH GU............................. 97 09955... OT VD CHLM TRCH UNSPF GU............................ 97 09956... OT VD CHLM TRCH PRTONEUM............................ 97 09959... OTH VD CHLM TRCH SPCF ST............................ 97 0998.... VENEREAL DISEASE NEC................................ 97 0999.... VENEREAL DISEASE NOS................................ 97 1000.... LEPTOSPIROS ICTEROHEM............................... 97 10081... LEPTOSPIRAL MENINGITIS.............................. 63 10089... LEPTOSPIRAL INFECT NEC.............................. 63 1009.... LEPTOSPIROSIS NOS................................... 97 101..... VINCENT'S ANGINA.................................... 31 1020.... INITIAL LESIONS YAWS................................ 18 1021.... MULTIPLE PAPILLOMATA................................ 18 1022.... EARLY SKIN YAWS NEC................................. 18 1023.... HYPERKERATOSIS OF YAWS.............................. 18 1024.... GUMMATA AND ULCERS, YAWS............................ 18 1025.... GANGOSA............................................. 31 1026.... YAWS OF BONE & JOINT................................ 24 1027.... YAWS MANIFESTATIONS NEC............................. 97 1028.... LATENT YAWS......................................... 97 1029.... YAWS NOS............................................ 97 1030.... PINTA PRIMARY LESIONS............................... 18 1031.... PINTA INTERMED LESIONS.............................. 18 1032.... PINTA LATE LESIONS.................................. 97 1033.... PINTA MIXED LESIONS................................. 18 1039.... PINTA NOS........................................... 97 1040.... NONVENEREAL ENDEMIC SYPH............................ 97 1048.... SPIROCHETAL INFECT NEC.............................. 97 1049.... SPIROCHETAL INFECT NOS.............................. 97 1100.... DERMATOPHYT SCALP/BEARD............................. 18 1101.... DERMATOPHYTOSIS OF NAIL............................. 18 1102.... DERMATOPHYTOSIS OF HAND............................. 18 1103.... DERMATOPHYTOSIS OF GROIN............................ 18 1104.... DERMATOPHYTOSIS OF FOOT............................. 18 1105.... DERMATOPHYTOSIS OF BODY............................. 18 1106.... DEEP DERMATOPHYTOSIS................................ 18 1108.... DERMATOPHYTOSIS SITE NEC............................ 18 1109.... DERMATOPHYTOSIS SITE NOS............................ 18 1110.... PITYRIASIS VERSICOLOR............................... 18 1111.... TINEA NIGRA......................................... 18 1112.... TINEA BLANCA........................................ 18 1113.... BLACK PIEDRA........................................ 18 1118.... DERMATOMYCOSES NEC.................................. 18 1119.... DERMATOMYCOSIS NOS.................................. 18 1120.... THRUSH.............................................. 31 1121.... CANDIDAL VULVOVAGINITIS............................. 97 1122.... CANDIDIAS UROGENITAL NEC............................ 97 1123.... CUTANEOUS CANDIDIASIS............................... 18 1124.... CANDIDIASIS OF LUNG................................. 33 1125.... DISSEMINATED CANDIDIASIS............................ 97 11281... CANDIDAL ENDOCARDITIS............................... 36 11282... CANDIDAL OTITIS EXTERNA............................. 31 11283... CANDIDAL MENINGITIS................................. 63 11284... CANDIDAL ESOPHAGITIS................................ 97 11285... CANDIDAL ENTERITIS.................................. 97 11289... CANDIDIASIS SITE NEC................................ 97 1129.... CANDIDIASIS SITE NOS................................ 18 1140.... PRIMARY COCCIDIOIDOMYCOS............................ 33 1141.... PRIM CUTAN COCCIDIOID............................... 18 1142.... COCCIDIOIDAL MENINGITIS............................. 63 1143.... PROGRESS COCCIDIOID NEC............................. 97 1144.... CH PL COCCIDIOIDOMYCOSIS............................ 97 1145.... PL COCIDIOIDOMYCOSIS NOS............................ 97 1149.... COCCIDIOIDOMYCOSIS NOS.............................. 97 [[Page 47849]] 11500... HISTOPLASMA CAPSULAT NOS............................ 97 11501... HISTOPLASM CAPSUL MENING............................ 63 11502... HISTOPLASM CAPSUL RETINA............................ 68 11503... HISTOPLASM CAPS PERICARD............................ 36 11504... HISTOPLASM CAPS ENDOCARD............................ 36 11505... HISTOPLASM CAPS PNEUMON............................. 33 11509... HISTOPLASMA CAPSULAT NEC............................ 97 11510... HISTOPLASMA DUBOISII NOS............................ 97 11511... HISTOPLASM DUBOIS MENING............................ 63 11512... HISTOPLASM DUBOIS RETINA............................ 68 11513... HISTOPLASM DUB PERICARD............................. 36 11514... HISTOPLASM DUB ENDOCARD............................. 36 11515... HISTOPLASM DUB PNEUMONIA............................ 33 11519... HISTOPLASMA DUBOISII NEC............................ 97 11590... HISTOPLASMOSIS NOS.................................. 97 11591... HISTOPLASMOSIS MENINGIT............................. 63 11592... HISTOPLASMOSIS RETINITIS............................ 68 11593... HISTOPLASMOSIS PERICARD............................. 36 11594... HISTOPLASMOSIS ENDOCARD............................. 36 11595... HISTOPLASMOSIS PNEUMONIA............................ 33 11599... HISTOPLASMOSIS NEC.................................. 97 1160.... BLASTOMYCOSIS....................................... 97 1161.... PARACOCCIDIOIDOMYCOSIS.............................. 97 1162.... LOBOMYCOSIS......................................... 97 1170.... RHINOSPORIDIOSIS.................................... 97 1171.... SPOROTRICHOSIS...................................... 97 1172.... CHROMOBLASTOMYCOSIS................................. 97 1173.... ASPERGILLOSIS....................................... 97 1174.... MYCOTIC MYCETOMAS................................... 97 1175.... CRYPTOCOCCOSIS...................................... 97 1176.... ALLESCHERIOSIS...................................... 97 1177.... ZYGOMYCOSIS......................................... 97 1178.... DEMATIACIOUS FUNGI INF.............................. 97 1179.... MYCOSES NEC & NOS................................... 18 118..... OPPORTUNISTIC MYCOSES............................... 97 1200.... SCHISTOSOMA HAEMATOBIUM............................. 53 1201.... SCHISTOSOMA MANSONI................................. 41 1202.... SCHISTOSOMA JAPONICUM............................... 97 1203.... CUTANEOUS SCHISTOSOMA............................... 18 1208.... SCHISTOSOMIASIS NEC................................. 97 1209.... SCHISTOSOMIASIS NOS................................. 97 1210.... OPISTHORCHIASIS..................................... 41 1211.... CLONORCHIASIS....................................... 41 1212.... PARAGONIMIASIS...................................... 33 1213.... FASCIOLIASIS........................................ 41 1214.... FASCIOLOPSIASIS..................................... 41 1215.... METAGONIMIASIS...................................... 97 1216.... HETEROPHYIASIS...................................... 97 1218.... TREMATODE INFECTION NEC............................. 97 1219.... TREMATODE INFECTION NOS............................. 97 1220.... ECHINOCOCC GRANUL LIVER............................. 41 1221.... ECHINOCOCC GRANUL LUNG.............................. 33 1222.... ECHINOCOCC GRAN THYROID............................. 82 1223.... ECHINOCOCC GRANUL NEC............................... 97 1224.... ECHINOCOCC GRANUL NOS............................... 97 1225.... ECHINOCOC MULTILOC LIVER............................ 41 1226.... ECHINOCOCC MULTILOC NEC............................. 97 1227.... ECHINOCOCC MULTILOC NOS............................. 97 1228.... ECHINOCOCCOSIS NOS LIVER............................ 41 1229.... ECHINOCOCCOSIS NEC/NOS.............................. 97 1230.... TAENIA SOLIUM INTESTINE............................. 41 1231.... CYSTICERCOSIS....................................... 41 1232.... TAENIA SAGINATA INFECT.............................. 41 1233.... TAENIASIS NOS....................................... 41 1234.... DIPHYLLOBOTHRIAS INTEST............................. 41 1235.... SPARGANOSIS......................................... 41 1236.... HYMENOLEPIASIS...................................... 41 1238.... CESTODE INFECTION NEC............................... 41 1239.... CESTODE INFECTION NOS............................... 41 124..... TRICHINOSIS......................................... 97 1250.... BANCROFTIAN FILARIASIS.............................. 97 1251.... MALAYAN FILARIASIS.................................. 97 1252.... LOIASIS............................................. 97 1253.... ONCHOCERCIASIS...................................... 97 1254.... DIPETALONEMIASIS.................................... 97 1255.... MANSONELLA OZZARDI INFEC............................ 97 [[Continued on page 47851]]