CARDIOVASCULAR SYSTEM SURGERY
Donor cardiectomy
Donor cardiectomy-pneumonectomy
Heart transplant
Heart-lung transplant
Varicose vein ligation, division, excision, or
stripping
DIGESTIVE SYSTEM SURGERY
Anterior gastropexy for hiatal hernia
Excision tonsil tags
Frenuloplasty
Gastric bypass for morbid obesity
Gastroplasty for morbid obesity
Hemorrhoidal surgery, except when unresponsive to
conservative
treatment
Elective Revision of colostomy
Elective Revision of ileostomy
Surgical treatment for morbid obesity
Vermilionectomy, with mucosal advancement
EAR, NOSE AND THROAT SURGERY
Adenoidectomy
Excision of soft tissue lesion of the ear
Excision of exostosis
Excision of tonsil tags
Functional reconstruction of the internal nose
Insertion of nasal septal prosthesis
Lysis of intranasal synechia
Myringotomy with or without Tubes
Orthognathic surgery
Repair of oronasal fistula
Rhinoplasty
Septoplasty or submucous resection
Sleep Apnea surgery
Tonsillectomy
Treatment for temporomandibular joint dysfunction
and disorders,
including surgery and appliances
Tympanoplasty
EYE SURGERY
Blepharoptosis repair
Canthoplasty
Cataract surgery
Closure of lacrimal punctum
Conjunctivodacryocystotomy
Conjunctivorhinostomy
Corneal relaxing incision
Corneal wedge resection
Correction of lid retraction
Correction of everted punctum
Epikeratoplasty
Keratomileusis
Keratophakia
Keratoprosthesis
Modification of ocular implant
Photorefractive keratectomy
Plastic repair of canaliculi
Radial keratotomy
Reconstruction of eyelid
Reduction of overcorrection of ptosis
Release of extensive scar tissue
Removal or revision of orbital implant
Strabismus surgery
Transposition extraocular muscle
LASIK (Laser-Assisted in Situ Keratomileusis)
GENERAL SURGERY
Any operative procedure or any portion of a
procedure performed
primarily to improve physical appearance and/or treat a mental
condition through change in bodily form
Any costs incurred for organ transplantation,
whether incurred by recipient or donor, including bone marrow
transplants, and tissue typing
Non-emergency Herniorrhaphy
Oral and maxillofacial surgery, unless required as a
result of injury incurred while in the custody of the USMS and
preauthorized
by the Office of Interagency Medical Services
Plastic surgery
Reconstructive surgery unless required as a result
of injury incurred while in the custody of the USMS and
preauthorized by the Office of Interagency Medical Services
Removal of implant material
Stand-by surgeons
Surgical treatment for morbid obesity
Surgical correction of congenital anomalies
GENITAL SYSTEM (FEMALE) SURGERY
Construction of artificial vagina
Dilation of vagina under anesthesia
Excision of vaginal septum
Fimbrioplasty
Genitoplasty
Hymenotomy, simple incision
Hysteroplasty to repair uterine anomaly
Intersex surgery, female to male
Intersex surgery, male to female
Ligation or transection of fallopian tubes
Non-emergency hysterectomy
Plastic repair of introitus
Reversal of surgically induced sterility
Salpingostomy
Transcervical introduction of fallopian tube
catheter
Transection of fallopian tube, minilaparotomy
Transposition of ovary
Tubotubal anastomosis
Uterine suspension
Voluntary sterilization
GENITAL SYSTEM (MALE) SURGERY
Circumcision
Epididymovasostomy, anastomosis epididymis to vas
deferens
Excision, penile plaque
Genitoplasty
Insertion penile prosthesis
Insertion of testicular prosthesis
Intersex surgery, female to male
Intersex surgery, male to female
Ligation of vas deferens
Plastic operation on penis to correct angulation
Removal/repair/replacement of penile prosthesis
Repair of hypospadias complications
Reversal of surgically induced sterility
Surgical correction of abnormality in penile
prosthesis
Transurethral balloon dilation, prostatic urethra
Vasectomy
Vasotomy
Vasovasotomy, vasovasorrhaphy
Voluntary sterilization
INTEGUMENTARY SYSTEM SURGERY (SKIN, SUBCU-
TANEOUS AND AREOLAR TISSUE, BREAST)
Acne surgery
Arthoscopy of the temporomandibular joint
Augmentation of the mandibular body or angle
Blepharoplasty
Bone graft, nasal maxillary and malar areas
Breast reconstruction
Cartilage graft
Cervicoplasty
Condylectomy of the temporomandibular joint
Coronoidectomy
Correction of inverted nipples
Excision of excessive skin
Fascia lata graft
Genitoplasty
Graft for facial nerve paralysis
Hair transplant
Immediate insertion of breast prosthesis after
mastectomy
Insertion of tissue expander
Insertion of contraceptive capsules
Ligament Release of Tarsal Tunnel
Mammoplasty
Mastectomy for gynecomastia
Mastopexy
Meniscectomy of the temporomandibular joint
Muscle Resection
Nipple/areola reconstruction
Nipple exploration
Non-emergency Herniorrhaphy
Periprosthetic capsulectomy, breast
Reconstruction of nail bed
Reconstructive surgery
Reduction of the forehead
Removal by contouring of a benign tumor of the
facial bone
Removal of tissue expander
Removal of sutures under anesthesia
Removal of intact mammary implant
Removal of contraceptive capsules
Replacement of tissue expander
Revision reconstructed breast
Rhytidectomy
Skin graft
Submucosal Resection
Subperiosteal implant
Suction assisted lipectomy
Tissue graft
Treatment for temporomandibular joint dysfunction
and disorders,
including surgery and appliances
NERVOUS SYSTEM SURGERY
Burr holes, implantation neurostimulator electrodes
Craniectomy, implantation neurostimulator electrodes
Incision/subcutaneous placement neurostimulator
generator/receiver
Incision and subcutaneous placement/cranial
neurostimulator
Incision/subcutaneous placement neurostimulator
generator/receiver
Laminectomy, implantation neurostimulator electrodes
Percutaneous implantation neurostimulator electrodes
Revision/removal spinal neurostimulator
generator/receiver
Revision or removal/cranial neurostimulator
Revision/removal peripheral neurostimulator
electrodes
Revision/removal intracranial neurostimulator
electrodes
Revision/removal peripheral neurostimulator
generator/receiver
ORTHOPEDIC SURGERY
Arthrocentesis, unless acute
Arthroplasty
Arthroscopy-surgical
Arthrotomy
Bone graft
Carpal Tunnel Decompression, unless serious enough
to result in nerve damage or unremitting pain
Condylectomy
Diagnostic arthroscopy, with or without biopsy
Disc repair, or discectomy, unless due to severe
pain that is unresponsive to conservative treatment or with clear
evidence of motor impairment
Foot Surgery, including Bunionectomy
Hammertoe operation, for cock-up fifth toe
Joint Reconstruction
Ligament Release of Tarsal Tunnel
Myotomy
Non-emergency back (disc) surgery
Non-emergency limb amputation
Non-emergency Reconstruction of the mandible
Orthognathic surgery
Osteoplasty for orthognathic deformities
Osteotomy of the facial bones
Osteotomy of the mandible
Osteoplasty of ramus, with or without bone graft
Osteotomy of the body of the mandible
Osteotomy-segmented or subapical-per sextant or
quadrant
Partial ostectomy
Radical resection of mandible with bone graft
Reconstruction of cleft foot
Reconstruction of the toe
Skin grafts
Synovectomy
Transosseous implant
Transseptal fiberotomy
URINARY SYSTEM SURGERY
Donor nephrectomy
Recipient nephrectomy
Renal autotransplantation, reimplantation
Renal homotransplantation
Renal transplantation with recipient nephrectomy
