J-18 CPT Codes List.pdf

Code AMA Description Common Name Guideline Upper Airway

31231 Nasal Endoscopy, DX, Unilat/Bilat (Sep Proc) Nasal endoscopy 31235 Nasal/Sinus Endoscopy, DX w/Sphenoid Sinusoscopy Nasal endo w/sphenoidotomy 31237 Nasal/Sinus Endoscopy, Surgical; w/Bx, Polypectomy/Debridement (Sep

Proc) Nasal endoscopy w/polypectomy, surgical

31240 Nasal/Sinus Endoscopy, Surgical; w/Concha Bullosa Resection Nasal endo w/concha bullosa resection 31255 Nasal/Sinus Endoscopy, Surgical; w/Ethmoidectomy, Total (Anterior &

Posterior) Nasal endo w/ethmoidectomy, total

31256 Nasal/Sinus Endoscopy, Surgical, w/Maxillary Antrostomy; Nasal endoscopy w/maxillary antrostomy

31267 Nasal/Sinus endoscopy w/removal of tissue from maxillary sinus Nasal/Sinus endoscopy w/removal of tissue from maxillary sinus

31276 Nasal/Sinus Endoscopy, Surgical w/Frontal Sinus Exploration, w/wo Tissue Removal, Frontal Sinus

Nasal endo w/frontal sinusotomy;

Endoscopy, maxillary sinus

31541 Laryngoscopy Dir, Operative, w/Excision, Tumor/Strip Vocal Cords/Epiglottis; w/Microscope/Telescope

Laryngoscopy w/ excision

31545 Dir Laryngoscope, w/Non-Neoplastic Vocal Cord Lesion Removal, Submucous; Loc Flap Reconstruct

Laryngoscopy w/biopsy

42821 Tonsillectomy & Adenoidectomy; Age 12+ Tonsillectomy and adenoidectomy; "T&A"

42826 Tonsillectomy, Primary/Secondary; Age 12+ Tonsillectomy 70491 CT Scan, Soft Tissue Neck; w/Contrast Matl(s) CT Neck w/contrast 70540 MRI, Orbit, Face, & Neck; w/o Contrast Matl(s) MRI neck w/o contrast 76380 Computed tomography, limited or localized follow-up study

Lower Airway 31622 Bronchoscopy, Rigid/Flex, w/wo Fluoro Guid; w/wo Cell Washing (Sep

Proc) Bronchoscopy w/out biopsy; Dx bronchoscope/wash

31625 Bronchoscopy, Rigid/Flex, w/wo Fluoro Guid; w/Bronchial/Endobronchial Bx, Single/Multiple

Bronchoscopy w/biopsy

32402 Bx, Pleura; Open Open lung biopsy 32405 Bx, Lung/Mediastinum, Percutaneous Needle Biopsy of lung, percutaneous needle 71020 Radiologic Exam, Chest, 2 Views, Frontal & Lateral Chest X-Ray 71022 R di l i E Ch t 2 Vi F t l & L t l ith bli Ch t X R P i th i ti i d M t j tif

WTC CPT Codes List - 20100429

71022 Radiologic Exam, Chest, 2 Views, Frontal & Lateral with oblique projections

Chest X-Ray Prior authorization required. Must justify why oblique views are needed.

71250 CT Scan, Thorax; w/o Contrast Matl Chest CT w/out contrast 71260 CT Scan, Thorax; w/Contrast Matl(s) chest CTt w/contrast 71550 MRI, Chest; w/o Contrast Matl(s) Chest MRI w/o ocntraxt 78806 Radiopharmaceutical Localization, Abscess; Whole Body Gallium/Indium scan for inflammation Prior authorization required.

82024 Adrencorticotropic Hormone ACTH Stimulation Test 93720 Plethysmography, Total Body; w/Interpretation & Report Plethysmography (PFT) 94010 Spirometry w/Graphic Record/Vital Capacity/Flow Rate w/wo Maximal

Voluntary Ventilation Spirometry

94060 Bronchodilat Response/Spirometry Pre/Post Bronchodilator Admin Bronchodilation (PFT) 94070 Bronchospasm Provoc Eval, Multiple Spirometry Determinations, w/Admin Agents Methacholine challenge test (MCT)

94200 Maximum Breathing Capacity, Maximal Voluntary Ventilation Maximum breathing capacity, maximal voluntary ventilation; Lung function test

(MBC/MVV)

94375 Respiratory Flow Volume Loop Peak Flow meter; 'Respiratory flow volume loop

94620 Pulmonary Stress Test; Simple (eg, 6-minute Walk, Prolonged Exercise Test For Bronchospasm)

Pulmonary Stress Test

94664 Demonstrate &/Or Eval, Pt Use, Aerosol Generator/Nebulizer/Inhaler/IPPB Device

Demonstration and evaluation of patient using MDI or nebulizer

94680 Oxygen Uptake, Expired Gas Analysis; Rest & Exercise, Direct, Simple O2 sat rest/exercise; Exhaled air analysis

94681 Oxygen Uptake, Expired Gas Analysis; w/CO2 Output, Percentage Oxygen Extracted

Oxygen uptake, expired gas analysis

94720 Carbon Monoxide Diffusing Capacity DLCO (PFT) Musculoskeletal

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20552 Injection(s); Single/Multiple Trigger Point(s), 1-2 Muscles Trigger point 1 or 2 muscles 20553 Injection(s); Single/Multiple Trigger Point(s), 3> Muscle(s) Trigger point 3+ muscles 20605 Arthrocentesis, Aspiration &/Or Injection; Intermediate Joint/Bursa Injection intermediate joint 20610 Arthrocentesis, Aspiration &/Or Injection; Major Joint/Bursa Injection major joint; Drain/inject, joint/bursa 28899 Unlisted procedure; foot or toes Foot/toes surgery procedure Prior authorization required.

29824 Arthroscopy, Shoulder, Surgical; Distal Claviculectomy w/Articular

Surface Shoulder arthroscopy/surgery

72141 MRI, Cervical Spine; w/o Contrast Matl MRI Cervical Spine w/o contrast 72148 MRI, Lumbar Spine; w/o Contrast Matl MRI Lumbar Spine w/o contrast 73221 MRI, Any Joint, Upper Extremity; w/o Contrast Matl(s) MRI elbow, shoulder w/o contrast 73560 Radiologic Exam, Knee; 1/2 Views Knee X-Ray 73721 MRI, Any Joint, Lower Extremity; w/o Contrast Matl MRI (ankle, hip, knee, pelvis, wrist) 76377 3D Rendering w/Inter&Rept Of Computed Tomography, MRI, US/Oth

Tomographic Mod;Req Image Postprocess 3D rendering w/postprocess

95851 Range, Motion Measurements & Report; Each Extremity (Not Hand)/Each Trunk (Spine) Section

Range of motion all extremities except hand

95852 Range, Motion Measurements & Report; Hand, w/wo Compare, Normal Side

Range of motion - hand

95860 EMG, Needle; 1 Extremity w/wo Related Paraspinal Areas EMG, 1 extremity 95861 EMG, Needle; 2 Extremities w/wo Related Paraspinal Areas EMG, 2 extremities; Muscle test 95900 Nerve Conduction, Amplitude & Latency/Velocity Study, Each Nerve;

Motor, w/o F-Wave Study Nerve Conduction, motor w/o F-wave study

95903 Nerve Conduction, Amplitude & Latency/Velocity Study, Each Nerve;

Motor, w/F-Wave Study

Nerve Conduction, motor w/F-wave

95904 Nerve Conduction, Amplitude & Latency/Velocity Study, Each Nerve;

Motor, Sensory

Nerve Conduction, sensory

95934 H-Reflex, Amplitude & Latency Study; Record Gastrocnemius/Soleus Muscle

H-reflex

Gastrointestinal 00740 Anesthesia, Upper GI Endoscopy Proc, Proximal Duodenum Anesthesia for endoscopy of proximal duodenum 43200 Esophagoscopy, Rigid/Flexible; DX (Sep Proc) Esophagoscopy, rigid or flex 43235 Upper GI Endoscopy (EGD); DX, w/wo Specimen Collection, Brushing/Washing (Sep Proc) EGD w/brush/wash

43228 Esophagoscopy, rigid or flexible; with ablation of tumor(s), polyp(s), or Prior authorization required by LHI other lesion(s), not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique because this condition can also develop without GERD and that would not be covered by the program.

43239 Upper GI Endoscopy (EGD); w/Biopsy, Single/Multiple EGD w/Bx 43257 Upper gastrointestinal endoscopy including esophagus, stomach and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease

Prior authorization required by LHI because this condition can also develop without GERD and that would not be covered by the program.

43258 Endoscopy with ablation of tumor(s), polyp(s), or other lesion(s), not amendable to removal by hot biopsy forceps, bipolar cautery or snare technique

Prior authorization required by LHI because this condition can also develop without GERD and that would not be covered by the program.

43450 Dilatation of esophagus, by unguided sound or bougie, single or multiple passes

For use when the GI physician identifies diagnoses of "reflux" (530.81) with stricture.

43499 Unlisted procedure, esophagus. Prior authorization required by LHI because this condition can also develop without GERD and that would not be covered by the program.

43259 Endoscopy with endoscopic ultrasound exam, including the esophagus, stomach, and either the duodenum and/or jejunum as appropriate.

(Some specialists prefer to do this following ablation to measure outcome.)

Prior authorization required by LHI because this condition can also develop without GERD and that would not be covered by the program.

74150 CT Scan, Abdomen; w/o Contrast Matl Abdomenal CT scan w/o contrast 74160 CT Scan, Abdomen; w/Contrast Matl(s) Abdomenal CT w/contrast 74170 CT Scan, Abdomen; w/o Contrast Matl, Then w/Contrast Matl(s) &

Further Sections Abdomenal CT w/o & w /contrast

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74183 MRI, Abdomen; w/o Contrast Matl(s) Followed By Contrast Matl(s) &

Further Sequences Abdomenal MRI w/o & w/contrast

74220 Radiologic Exam; Esophagus Barium swallow x-ray, esophagus 74246 Radiological exam, gastro tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or w/out delayed films, w/out KUB

Upper GI barium swallow, no KUB

74247 Radiological exam, gastro tract, upper, air contrast, with specific high density barium, effervescent agent, with or without glucagon; with or w/out delayed films, WITH KUB

Upper GI barium swallow, with KUB

91010 Esophagus Motility Study Esophageal Motility 91034 Esoph/Gastroesoph Reflux Test; w/Nasal Catheter Ph Electrode

Place/Rec/Anal/Interp Esophageal reflux test w/pH electrode

92610 Eval, Oral & Pharyngeal Swallow Function Evaluate swallowing function 92612 Flexible Fiberoptic Endoscopic Eval, Swallow, Cine/Video Record Endoscopy swallow test (film)

Endocrine 60100 Bx Thyroid, Percutaneous Core Needle Needle Biopsy Thyroid

Cardiac 75557 Cardiac MRI For Morphology/Function w/o Contrast Material Cardiac MRI w/o contrast Serves as a rule out. Indicated if SOB or

Dypsnea related to decreased Cardiac Fx.

78464 Myocardial Perfusion Imaging; Spect, Single Study, Rest/Stress, w/wo Quantifications

Heart image (3d), single Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

78465 Myocardial Perfusion Imaging; Spect, Multiple Studies, Rest &/Or Stress & Redistribution

Heart image (3d), multiple Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

78478 Myocardial Perfusion w/Wall Motion, Qualitative/Quantitative Heart wall motion add-on Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

78480 Radionuclear Scan, Myocardial Perfusion w/ Ejection Fraction Heart function add-on Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

78588 Pulmonary Perfusion Imaging, Particulate w/Ventilation Imaging, Aerosol, 1+ Projections

Perfusion lung image Serves as a rule out. Indicated if SOB or Cx tightness or PULM HTN related to PULM Embolism is related to a primary WTC condition.

78890 Generation of automated data; interactive process involving nuclear Nuclear medicine data proc Serves as a rule out Indicated if SOB or78890 Generation of automated data; interactive process involving nuclear physician and/ or allied health professional personnel; simple manipulations and interpretation, not to exceed 30 minutes

Nuclear medicine data proc Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present. Or indicated if SOB or Cx tightness related to PULM Embolism is related to a primary WTC condition.

78891 Generation of automated data; interactive process involving nuclear physician and/ or allied health professional personnel; complex manipulations and interpretation, exceeding 30 minutes

Nuclear med data proc Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present. Or indicated if SOB or Cx tightness related to PULM Embolism is related to a primary WTC condition.

83090 Homocysteine Assay of homocystine Prior authorization required.

93015 Cardiovascular Stress Test w/ECG Monitor; w/Physician Supervision, Interpretation & Report Cardiovascular Stress Test (treadmill/ bike)

Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

93016 Cardiovascular Stress Test w/ECG Monitor; Physician Supervision Only, w/o Intpretation & Report

Cardiovascular stress test Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

93017 Cardiovascular Stress Test w/ECG Monitor; Tracing Only, w/o Interpretation & Report

Cardiovascular stress test Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

93018 Cardiovascular Stress Test w/ECG Monitor; Interpretation & Report Only Cardiovascular stress test Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

93041 Rhythm ECG, 1-3 Leads; Tracing Only w/o Interpretation & Report Rhythm ECG, tracing Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness related to Ischemia or decreased Fx is present.

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93230 ECG Monitor/24 Hrs, w/o Superimpostn, Miniaturized Tracing;

w/Recording, Analysis, Review, Interp ECG monitor/report, 24 hrs Serves as a rule out. Indicated if SOB or

Dypsnea or Cx tightness or Pulm HTN related to Arrythmia related to a WTC primary condition.

93307 ECG, Transthoracic, 2D Image Documentation, M-Mode Recording, Complete, w/o Doppler Echocardiograph

Echo w/doppler; 'Echo exam of heart Serves as a rule out. Indicated if SOB or Dypsnea related to decreased Cardiac Fx.

93320 Doppler Echocardiography; Complete Doppler echo exam, heart Serves as a rule out. Indicated if SOB or Dypsnea related to decreased Cardiac Fx.

93325 Doppler Color Flow Mapping Doppler color flow add-on Serves as a rule out. Indicated if SOB or Dypsnea related to decreased Cardiac Fx.

93350 Echocardiography, Transthoracic, Real-Time 2d, Cardiovascular Stress Test, Interpretation & Report

Echo transthoracic Serves as a rule out. Indicated if SOB or Dypsnea related to decreased Cardiac Fx.

93923 Non-Invasive Study, Extremity Artery, Complete Bilat, Multiple Levels/Special

Extremity study Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness or Pulm HTN related to WTC primary condition.

93970 Duplex Scan, Veins, Extremity; Complete Bilat Study Extremity study Serves as a rule out. Indicated if SOB or Dypsnea or Cx tightness or Pulm HTN related to WTC primary condition.

93976 Duplex Scan, Arterial Inflow, Venous Outflow, Abdominal/Pelvic/Retroperitoneal Organs; Limited

Vascular study Prior authorization required.

Other 10022 Fine Needle Aspiration; w/Imaging Guidance Fine needle aspiration with image 70551 MRI, Brain; w/o Contrast Matl MRI Brain w/o contrast Prior authorization required.

78805 Radiopharmaceutical Localization, Inflammatory Process; Limited Area Galium scan for inflamation, limited area Prior authorization required.

78811 Positron Emission Tomography (PET); Limited Area PET scan Prior authorization required.

92568 Acoustic Reflex Testing, Threshold Air bone Assessment Prior authorization required; Must justify in the context of complications of sinusitis and ENT surgical intervention.

99071 Patient Education Matls Provided By Physician Educational materials 99070 Supplies Provided By Physician Over & Above Those Included In The

Service Supplies and materials provided by physician

Prior authorization required. Use this code for supplies or materials that do not have a CPT codehave a CPT code.

Laboratory/Pathology Tests 36000 Introduction, Needle/Intracatheter, Vein Place needle in vein 36415 Collection, Venous Blood, Venipuncture Routine venipuncture 36600 Arterial Puncture, Withdrawal, Blood, DX Withdrawal of arterial blood 36620 Arterial Catheterization/Cannulation, Monitoring/Transfusion (Sep Proc);

Percutaneous Insertion catheter, artery

77002 Fluoroscopic Guidance For Needle Placement (eg, Biopsy, Aspiration, Injection, Localization Device).

77012 Computed Tomography Guidance For Needle Placement, Radiological Supervision And Interpretation

77080 DEXA, Bone Density Study, 1 Or More Sites; Axial Skeleton (eg, Hips, Pelvis, Spine)

Prior authorization required.

80048 Basic Metabolic Panel, Calcium, Total Basic Metabolic Panel 80053 Comprehensive Metabolic Panel Comp Metabolic Panel 80061 Lipid Panel Lipid Panel 80164 Assay Of Dipropylacetic Acid (Valproic Acid) Valproic acid free Prior authorization required.

81001 Urinalysis, Dip Stick/Tablet Reagent; Automated w/Microscopy Urine Chemical with micro 81003 Urinalysis, Dip Stick/Tablet Reagent; Automated, w/o Microscopy Urinalysis, routine 81015 Urinalysis; Microscopic Only Urine microscopic 82040 Albumin; Serum, Plasma Or Whole Blood Blood Albumin 82247 Bilirubin; Total Blood Bili total 82270 Bld Oclt Proxidase Actv Qual Feces 1 Deter Hemoccult; 'Test for blood, feces 82310 Calcium; Total Blood Calcium 82435 Chloride; Blood Blood Chloride 82465 Cholesterol, Serum/Whole Blood, Total Cholesterol 82565 Creatinine; Blood Creatinine 82785 Gammaglobulin; IgE IGE Quant Prior authorization required.

82947 Glucose; Quantitative, Blood (Except Reagent Strip) Blood Glucose

PT Codes List 20091002 4 of 12

82977 Glutamyltransferase, Gamma (GGT) Blood Gamma GTP 83540 Iron Iron Prior authorization required.

83615 Lactate Dehydrogenase (LD), (LDH) Blood LDH 83655 Lead Lead Prior authorization required.

83840 Methadone Methadone Prior authorization required.

84075 Phosphatase, Alkaline Alk Phosphatase 84100 Phosphorus Inorganic (Phosphate) Blood Phosphorus 84132 Potassium; Serum, Plasma Or Whole Blood Blood Potassium 84155 Protein, Total, Except By Refractometry; Serum, Plasma Or Whole Blood Blood Protein

84202 Protoporphyrin, RBC; Quantitative Protoporphyrin 84295 Sodium; Serum, Plasma Or Whole Blood Blood Sodium 84403 Testosterone; Total Assay of total testosterone Prior authorization required.

84436 Thyroxine; Total Total T4 84443 Thyroid Stimulating Hormone (TSH) TSH 84450 Transferase; Aspartate Amino (AST) (SGOT) AST (SGOT) 84460 Transferase; Alanine Amino (ALT) (SGPT) ALT (SGPT) 84478 Triglycerides Triglycerides 84480 Triiodothyronine T3; Total (TT-3) Total T3 84520 Urea Nitrogen; Quantitative Urea Nitrogen 85025 Blood Count; Complete CBC, Automated (HGB, HCT, RBC, WBC, &

Platelet) & Automated Differential WBC CBC PLT Diff; Complete cbc w/auto diff wbc

85651 Sedimentation Rate, Erythrocyte; Non-Automated ESR 86038 Antinuclear antibodies (ANA) Antinuclear antibodies Prior authorization required.

86039 Antinuclear Antibodies (ANA); Titer Alcohol, (Quant), Ana Quant Prior authorization required.

86140 C-Reactive Protein C-Reactive Protein Prior authorization required.

86256 Fluorescent Noninfectious Agent Antibody; Titer, Each Antibody Anti Neutro, Cyto Prior authorization required.

86334 Immunofixation Electrophoresis; Serum Immunofixation serum Prior authorization required.

86430 Rheumatoid Factor; Qualitative Rheumatoid factor Prior authorization required.

86592 Syphilis Test; Qualitative Syphilis RPR; Blood serology, qualitative Prior authorization required.

86677 Antibody; Helicobacter Pylori H. Pylori Prior authorization required.

87070 Culture, Bacterial; Any Other Source Except Urine/Blood/Stool, Aerobic, w/Isolatn/Presumptive ID Body fluid culture Prior authorization required.

87086 Culture, Bacterial; Quantitative Colony Count, Urine Urine culture Prior authorization required.

87116 Culture, Tubercle/Acid-Fast Bacilli Any Source, w/Isolation & Presumptive

ID Of Isolates AFB culture, respiratory Prior authorization required.

ID Of Isolates 87206 Smear, Prime Srce, w/Interpr; Fluoresc &/Or Acid Fast Stain, Bacteria/Fungi/Parasit/Virus/Cell Type AFB smear only Prior authorization required.

88172 Cytopathology, Eval Fine Needle Aspirate; Immediate Cytohistologic Study To Determine Accuracy

Cytopathology, evaluation of fine needle aspirate

88173 Cytopathology, Eval Fine Needle Aspirate; Interpretation & Report Cytopathology, interpretation and report of fine needle aspirate

97010 Modality; hot or cold packs- 15 minute increment 97112 Neuromuscular re-education- 15 minute increment Neuromuscular re-education 80076 Hepatic Function Panel Hepatic Profile Function 80100 Drug Screen, Qualitative; Multiple Drug Classes Chromatographic

Method, Each Proc Drug Screen Prior authorization required.

80152 Assay Of Amitriptyline Amitriptyline Level Prior authorization required.

80156 Assay Of Carbamazepine; Total Carbamzepine Prior authorization required.

80178 Assay Of Lithium Lithium Level Prior authorization required.

80182 Assay Of Nortriptyline Nortriptyline Level Prior authorization required.

82140 Ammonia Ammonia 82746 Folic Acid; Serum Vitamin B12, Folate, Serum 82787 Gammaglobulin; IgA, IgS, IgG, IgM, Each Quantitative immunoglobulins Prior authorization required.

83036 Hemoglobin; Glycosylated Hemoglobin AIC; Glycated hemoglobin test Prior authorization required.

84146 Prolactin Prolactin Prior authorization required.

85027 Blood Count; Complete CBC, Automated (HGB, HCT, RBC, WBC, &

Platelet) Complete cbc, automated

85652 Sedimentation Rate, Erythrocyte; Automated Rbc sed rate, automated 85730 Thromboplastin time, partial (PTT); Plasma/Whole Blood Thromboplastin time, partial 86701 Antibody; HIV-1 HIV Prior authorization required.

99000 Handling and/ or conveyance of specimen for transfer from the physician's office to a laboratory Specimen handling

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Allergy Testing

86003 Allergen Specific IgE; Quantitative/Semiquantitative, Each Allergen Bermuda Grass, Goosefoot profile, Maple, Plantain-W9, T8, American Elm, Allergen specific IGE

Rule out pertaining to a covered condition.

95004 Perc Tests (Scratch, Puncture, Prick) w/ Allergenic Extracts, Immediate Reaction, Specify Number

Percut allergy skin tests Rule out pertaining to a covered condition.

95024 Intracutaneous (intradermal) tests, with allergenic extracts, immediate type reaction, including test interpreatation and report by a physician, specify number of tests.

Rule out pertaining to a covered condition.

95027 Intracutaneous (Intradermal) Tests, w/ Allergenic Extracts, Airborne Allergens, Specify Number

Id allergy titrate-airborne Rule out pertaining to a covered condition.

Sleep Testing Procedures 95810 Polysomnography; Sleep Staging w/4+ Add'l Parameters, Attended Polysomnography 4 or more; sleep staging 95805 Multiple Sleep Latency Test, Multiple Trails Multiple sleep latency test 95811 Polysomnography; Sleep Staging w/4+ Add'l Parameters & CPAP, Attended* Polysomnography; sleep staging with CPAP or BlPAP

Physical Medicine and Rehabilitation 97001 Physical Therapy Eval Phys Ther Eval Prior authorization required.

97002 Physical Therapy Re-Eval Phys Ther Reeval Prior authorization required.

97003 Occupational Therapy Eval OT initial eval Prior authorization required.

97004 Occupational Therapy Re-Eval OT Re-Eval Prior authorization required.

97110 Therapeutic Proc, 1+ Areas, Each 15 Min; Therapeutic Exercises Therapeutic Exercise Prior authorization required.

97112 Therapeutic Proc, 1+ Areas, Each 15 Min; Neuromuscular Reeducation Neuromuscular re-education Prior authorization required.

97140 Myofascial release, manual therapy- 15 minute increment Prior authorization required.

97530 Therapeutic Actvities, Direct Patient Contact, Each 15 Min Functional/therapeutic activities 97535 Self Care/Home Management Training, Direct Contact, Each 15 Min Activities of Daily Living 97537 Community/Work Reintegration Training, Direct Contact, Each 15 Min Work reintegration/hour

97810 Acupuncture, 1+ Needles, w/o Electrical Stim; Init 15 Min Personal Contact

Acupuncture w/o electrical stimulation, initial 15 minutes

Prior authorization required.

97811 Acupuncture, 1/> Ndls w/o Elec Stimj Ea 15 Min Accupuncture w/o electrical stimulation, additional 15 minutes; [for 97810] - each additional 15 minutes of personal one-on-one contact with the patient, with re-i ti f dl ( )(Li t t l i

Prior authorization required.

insertion of needle(s)(List separately in addition to code for primary procedure)

97813 Acupuncture, 1/> Ndls w/Elec Stimj 1st 15 Min Acupuncture w/ electrical stimulation, initial 15 minutes

Prior authorization required.

97814 Acupuncture, 1/> Ndls w/Elec Stimj Ea 15 Min w/Re-Insj Acupuncture w/ electrical stimulation, additional 15 minutes

Prior authorization required.

ENT

00160 Anesthesia, Proc On Nose & Accessory Sinuses; NOS Anesthesia for procedures on nose and accessory sinuses; not otherwise specified

21330 Open Treatment, Nasal FX;Complicated, w/Int &/Or Ext Skeletal Fixation Treatment of nose fracture Prior authorization required.

30130 Excision Inferior Turbinate Partial/Complete Any Method Removal of turbinate bones 30140 Submucous Resection Inferior Turbinate, Partial/Complete, Any Method Removal of turbinate bones

30200 Injection Into Turbinate(s), Therapeutic Injection treatment of nose 30410 Rhinoplasty, Primary; Complete, Ext Parts w/Bony Pyramid, Lat & Alar

Cartilages &/Or Elev Nasal Tip Reconstruction of nose

30465 Repair, Nasal Vestibular Stenosis (Spreader Grafting, Lateral Nasal Wall Reconstruction)

Repair nasal stenosis

30520 Septoplasty/Submucous Resection w/wo Cartilage Scoring/Contouring/Graft

Repair of nasal septum

30620 Septal/Other Intranasal Dermatoplasty (Does Not Include Obtaining Graft) Intranasal reconstruction

30901 Control Nasal Hemorrhage, Anterior, Simple (Limited Cautery &/Or Packing) Any Method

Control of nosebleed

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30903 Control Nasal Hemorrhage, Anterior, Complex (Extensive Cautery &/Or

Packing) Any Method Control of nosebleed

31233 Nasal/Sinus Endoscopy, DX w/Maxillary Sinusoscopy Nasal/sinus endoscopy, dx 31238 Nasal/Sinus Endoscopy, Surgical; w/Control, Nasal Hemorrhage Nasal/sinus endoscopy, surg 31254 Nasal/Sinus Endoscopy, Surgical; w/Ethmoidectomy, Partial (Anterior) Nasal endo w/ ethmoidectomy, partial

31287 Nasal/Sinus Endoscopy, Surgical, w/Sphenoidotomy; Nasal/sinus endoscopy, surg 31288 Nasal/Sinus Endoscopy, Surgical, w/Sphenoidotomy; w/Tissue Removal, Sphenoid Sinus Nasal/sinus endoscopy, surg

31570 Laryngoscopy, Direct, w/Injection Into Vocal Cord(s), Therapeutic Laryngoscopy with injection 31575 Laryngoscopy, Flexible Fiberoptic; DX Diagnostic laryngoscopy 31579 Laryngoscopy, Flexible/Rigid Fiberoptic, w/Stroboscopy Diagnostic laryngoscopy 61795 Stereotactic Computer Assisted Volumetric (Navigational)

Intracranial/Extracranial/Spinal Proc Brain surgery using computer Prior authorization required.

69210 Removal Impacted Cerumen (Sep Proc), One/Both Ears Removal cerumen, auditory canal external; Remove impacted ear wax

Only use when necessary in order to perform a hearing test.

70486 CT Scan, Maxillofacial Area; w/o Contrast Matl CT maxillofacial w/o contrast 70487 CT Scan, Maxillofacial Area; w/Contrast Matl(s) CT maxillofacial w/contrast 70488 CT maxillofacial w/o and w/contrast, followed by further sections Use when procedure requires with and without contrast.

70490 CT Scan, Soft Tissue Neck; w/o Contrast Matl CT soft tissue neck w/o contrast 70553 MRI, Brain; w/o Contrast Matl, Then w/Contrastmatl (s) & Further

Sequences MRI brain w/o & w/contrast Prior authorization required.

76536 Ultrasound, Soft Tissues Of Head And Neck (Thyroid/Parathyroid/Parotid), Real Time w Image Document

US exam of head and neck

92504 Binocular Microscopy (Sep DX Proc) Ear microscopy examination May be reported when the physician is performing a diagnostic otologic exam that requires the use of the microscope because the examination or service cannot be performed with the otoscope

92557 Comprehensive Audiometry Threshold Eval & Speech Recognition Stenger test, speech Use for complication of sinusitis.

92567 Tympanometry (Impedance Testing) Audiogram with Tympanogram Use for complication of sinusitis.

92616 Flexible Fiberoptic Endoscopic Eval, Swallowing & Laryngeal Sensory

Test, Cine/Video Record FFEES w/laryngeal sense test

92617 Flex Fiberoptic Endoscop Eval Swallowing & Laryngeal Sensory Test, Cine/Video Record; Phys Interpre

Interprt FFEES/laryngeal test

93880 Duplex Scan Extracranial Arteries; Complete Bilat Study Extracranial arterial study Prior authorization required93880 Duplex Scan, Extracranial Arteries; Complete Bilat Study Extracranial arterial study Prior authorization required.

Lung

00320 Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck; not otherwise specified, age 1 year or older

Anesthesia for all procedures on esophagus, thyroid, larynx, trachea and lymphatic system of neck

00528 mediatinoscopy and diagnostic thoracoscopy not utilitzing one lung ventilation

Mediastinoscopy and diagnostic thorascopy not utilizing one lung ventilation

00541 Using one lung ventilation Using one lung ventilation 32602 Thoracoscopy, diagnostic (separate procedure); lungs and pleural space, with biopsy Thoracoscopy, diagnostic

32657 Thoracoscopy, surgical with wedge resection of lung, single or multiple Thoracoscopy, surgical

36000 Introduction of needle or intracatheter, vein Place needle in vein 36415 Collection of venous blood by venipuncture Routine venipuncture 36600 Arterial puncture, withdrawal of blood for diagnosis Withdrawal of arterial blood 36620 Arterial catheterization or cannulation for sampling monitoring or transfusion (separate procedure); percutaneous Insertion catheter, artery

39400 Mediastinoscopy, with or without biopsy Visualization of chest 71010 Radiologic examination, chest; single view, frontal Chest x-ray 71023 Radiologic examination, chest, two views, frontal and lateral with fluoroscopy Chest x-ray and fluoroscopy

71270 Computed tomography, thorax, without contrast material, followed by contrast material(s) and further sections

CT thorax w/o & w/contrast

71275 Computed tomographic angiography, chest (noncoronary), without contrast material(s), followed by contrast material(s) and further sections including image processing

CTA chest w/o & w/contrast Prior authorization required.

PT Codes List 20091002 7 of 12

78815 Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; skull base to mid-thigh

Tumor imaging, (PET) with concurrently acquired (CT) for attenuation correction and anatomical localization; limited area:

skull base to mid-thigh

Prior authorization required.

78816 Tumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization; whole body

Tumor imaging, (PET) with concurrently acquired (CT) for attenuation correction and anatomical localization; limited area:

whole body

Prior authorization required.

82803 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2, saturation)

Blood gases: pH, pO2 & pCO2

82805 Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2, saturation) with O2 saturation, by direct measurement, except pulse oximetry

Blood gases W/02 saturation

82946 Glucagon tolerance test Glucagon tolerance test Prior authorization required.

82948 Glucose; blood, reagent strip Reagent strip/blood glucose 83887 Nicotine Assay of nicotine Prior authorization required.

85300 Clotting inhibitors or anticoagulants; antithrombin III activity Antithrombin III test Prior authorization required.

85303 Clotting inhibitors or anticoagulants; protein C, activity Blood clot inhibitor test Prior authorization required.

85305 Clotting inhibitors or anticoagulants; protein S, total Blood clot inhibitor assay Prior authorization required.

85306 Clotting inhibitors or anticoagulants; protein S, free Blood clot inhibitor test Prior authorization required.

85610 Prothrombin time Prothrombin time Prior authorization required.

88108 Cytopathology, concentration technique, smears and interpretation (eg, Saccomanno technique) Cytopath, concentrate tech

88184 Flow cytometry, cell surface, sytoplasmic, or nuclear marker, technical component only; first marker

Flow cytometry, cell surface, cytoplastmic, or nuclear marker, technical component only; first marker

88185 Flow cytometry, cell surface, sytoplasmic, or nuclear marker, technical component only; each additional marker (list separately) in addition to code for first marker

[for 88184] - each additional marker

88187 Flow cytometry, interpretation; 2 to 8 markers Flow cytometry, interpretation; 2 to 8 markers

88304 Level III Surgical pathology, gross and microscopic examination Tissue exam by pathologist 88305 Level IV Surgical pathology, gross and microscopic examination Tissue exam by pathologist 88307 Level V Surgical pathology, gross and microscopic examination Tissue exam by pathologist 88311 Decalcification procedure (list separately) in addition to code for surgical Decalcify tissue pathology examination) 88312 Special stains (list separately in addition to coce for primary service);

Group I for microorganisms (eg, Gridley, acid fast, methanamine silver), each

Special stains Prior authorization required.

88321 Consultation and report on referred slides prepared elsewhere Microslide consultation 88331 Pathology consultation during surgery; first tissue block, with frozen sections(s), single specimen Path consult intraop, 1 bloc

88342 Immunohistochemistry (including tissue immonoperoxidase), each antibody

Immunohistochemistry

90760 Intravenous infusion, hydration; initial, up to 1 hour Hydration IV infusion, init 90774 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); intravenous push, single or initial substance/ drug Ther/proph/diag inj, IV push

93722 Plethysmography, Total Body; Interpretation & Report Only Plethysmography report 94150 Vital Capacity, Total (Sep Proc) Vital capacity test 94240 Functional Residual Capacity/Volume: Helium/Nitrogen Open

Circuit/Other Method Residual lung capacity

94260 Thoracic Gas Volume Thoracic gas volume 94350 Determination, Maldistribution, Inspired Gas: Nitrogen Washout Curve Lung nitrogen washout curve

94360 Determination, Resistance To Airflow, Oscillatory/Plethysmographic Methods

Measure airflow resistance

94370 Determination, Airway Closing Volume, Single Breath Tests Breath airway closing volume 94621 Pulmonary Stress Testing; Complex Pulm stress test/complex 94640 Pressurized/Nonpressurized Inhalation Rx, Airway Obstruction/DX

Sputum Induction Nebulizer Treatment

94760 Noninvasive Ear/Pulse Oximetry, Oxygen Saturation; Single Determination

Measure blood oxygen level

PT Codes List 20091002 8 of 12

94761 Noninvasive Ear/Pulse Oximetry, Oxygen Saturation; Multiple

Determinations Measure blood oxygen level

96360 Intravenous infusion, hydration; initial, up to 1 hour 96374 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); intravenous push, single or initial substance/ drug

Mental Health 90801 Psychiatric DX Interview Exam Initial Intake/psychiatric diagnostic 90802 Interactive Psychiatric DX Exam, Using Play Equipment/Px

Devices/Language Interpreter/Other Interactive Psychiatric diagnostic interview w/lang interpreter

90804 Individual Psychotherapy, Office, 20-30 Min Individual psychotherapy (20-30 minutes)

90805 Individual Psychotherapy, Office, 20-30 Min; w/E&M Individual psychotherapy, ~20-30 min w/medical evaluation

90806 Individual Psychotherapy, Office, 45-50 Min Individual psychotherapy (45-50 minutes)

90807 Individual Psychotherapy, Office, 45-50 Min; w/E&M Individual psychotherapy,~ 45-50 min w/medical evaluation

90808 Individual Psychotherapy, Office, 75-80 Min Psychiatric diagnostic interview examination

90811 Individual Psychotherapy, Office, Interactive, 20-30 Min; w/E&M Individual psychotherapy,w/language interpreter, ~20-30 min

90812 Individual Psychotherapy, Office, Interactive, 45-50 Min Individual psychotherapy,w/language interpreter, ~45-50 min

90813 Individual Psychotherapy, Office, Interactive, 45-50 Min; w/E&M Individ psychotherapy, w/lang interpreter,~45-50 min w/med eval

90846 Family Psychotherapy (w/o Patient Present) Family therapy without patient Prior authorization required.

90847 Family Psychotherapy (Conjoint Psychotherapy) (w/Patient Present) Family therapy with patient 90853 Group Psychotherapy (Other Than, Multiple-Family Group) Group therapy 90857 Interactive Group Psychotherapy Group psychotherapy 90862 Psychiatric Medication Management w/Minimal Psychotherapy Medication management 96101 Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities, personality and psychopathology, eg, MMPI, Rorschach, WAIS, per hour of the psychologist's or physicians's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report.

Psychological testing Prior authorization required.

96118 Neuropsycholgical testing (eg, Halstead-Reitan Neuropsychological Battery, Wechsler Momory Scales and Wisconsin Card Sorting Test) per hour of the psychologist's or physician's time, both face-to-face time with patient and time interpreting test results and preparing the report

Neuropsych tst by psych/phys Prior authorization required.

Ortho 20912 Cartilage Graft; Nasal Septum Remove cartilage for graft 62284 Injection Procedure Myelography/CT Spinal (Other Than C1-C2 And

Posterior Fossa) Injection for myelogram

62311 Injection, w/wo Contrast, DX/Therapeutic Substance, Epidural/Subarachnoid; Lumbar/Sacral

Inject spine l/s (cd)

62318 Injection/Infusion/Bolus, DX/Therapeutic Substance, Epidural/Subarachnoid; Cervical/Thoracic

Inject spine w/cath, c/t

72020 Radiologic Exam, Spine, Single View, Specify Level X-ray exam of spine 72040 Radiologic Exam, Spine, Cervical; 2 Or 3 Views X-ray exam of neck spine 72146 MRI, Thoracic Spine; w/o Contrast Matl MRI chest spine w/o contrast 72157 MRI, Spine w/o Contrast Matl, Then w/Contrast Matl(s); Thoracic MRI chest spine w/o & w/contrast 72158 MRI, Spine w/o Contrast Matl, Then w/Contrast Matl(s); Lumbar MRI lumbar spine w/o & w/contrast 72193 CT Scan, Pelvis; w/Contrast Matl(s) CT pelvis w/contrast 72194 CT Scan, Pelvis; w/o Contrast Matl, Then w/Contrast Matl(s) & Further

Sections CT pelvis w/o & w/contrast

72197 MRI, Pelvis; w/o Contrast Matl(s), Followed By Contrast Matl(s) & Further Sequences

MRI pelvis w/o & w/contrast

73030 Radiologic Exam, Shoulder; Complete, 2+ Views X-ray exam of shoulder 73110 Radiologic Exam, Wrist; Complete, 3+ Views X-ray exam of wrist 73723 MRI, Any Joint, Lower Extremity; w/o Contrast Matl(s), Followed By

Contrast Matl(s) & Further Seq MRI joint lwr extr w/o&w/contrast

PT Codes List 20091002 9 of 12

76000 Fluoroscopy, (Sep Proc), Up To 1 Hr Physician Time, Other Than

71023/71034 Fluoroscope examination

77003 Fluoroscopic Guidance And Localization Of Needle Or Catheter Tip For Spine Or Paraspinous Injection.

76376 3D Rendering w/Interp & Report Of Computed Tomography, MRI, US, Or Other Tomographic Modality

3D rendering w/o postprocess

76377 3D Rendering w/Inter&Rept Of Computed Tomography, MRI, US/Oth Tomographic Mod;Req Image Postprocess

3D rendering w/postprocess

76770 Ultrasound, Retroperitoneal (eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Complete

US exam abdo back wall, comp

76775 Ultrasound, Retroperitoneal (eg, Renal, Aorta, Nodes), Real Time With Image Documentation; Limited

US exam abdo back wall, lim

Preop 82085 Aldolase Assay of aldolase 83735 Magnesium Assay of magnesium 85007 Blood Count; Blood Smear, Microscop Exam w/Manual Differential WBC

Count Bl smear w/diff wbc count

85018 Blood Count; Hemoglobin Hemoglobin 86704 Hepatitis B Core Antibody (HBcAB); Total Hep b core antibody, total 86803 Hepatitis C Antibody Hepatitis c ab test 86850 Antibody Screen, RBC, Each Serum Technique RBC antibody screen 86900 Blood Typing; ABO Blood typing, ABO 86901 Blood Typing; Rh (D) Blood typing, Rh (D) 87340 Enzyme Immunoassay (EIA), Qualitative/Semiquantitative, Multiple Step;

Hepatitis B Surface Antigen Hepatitis b surface ag, eia

93000 Electrocardiogram, Routine w/At Least 12 Leads; w/Interpretation & Report

Electrocardiogram, complete

93005 Electrocardiogram, Routine w/At Least 12 Leads; Tracing Only w/o Interpretation & Report

Electrocardiogram, tracing

93010 Electrocardiogram, Routine w/At Least 12 Leads; Interpretation & Report Only

Electrocardiogram report

Rheum 82550 Creatine Kinase (CK), (CPK); Total Assay of ck (cpk) 82784 Gammaglobulin; IgA, IgS, IgG, IgM, Each Assay of gammaglobulin IgM Prior authorization required.

83891 Molecular Diagnostics; Isolation/Extraction Of Highly Purified Nucleic

Acid, Each (ie, DNA/RNA) Molecule isolate nucleic Prior authorization required.

83892 Molecular Diagnostics; Enzymatic Digestion Each Enzyme Treatment Molecular diagnostics Prior authorization required83892 Molecular Diagnostics; Enzymatic Digestion, Each Enzyme Treatment Molecular diagnostics Prior authorization required.

83896 Molecular DX; Nucleic Acid Probe, Each Molecular diagnostics Prior authorization required.

83908 Molecular Diagnostics; Amplification, Signal, Each Nucleic Acid

Sequence No common name given Prior authorization required.

83912 Molecular DX; Interpretation & Report Genetic examination Prior authorization required.

86147 Cardiolipin (Phospholipid) Antibody, Ea Ig Class Cardiolipin antibody Prior authorization required.

86225 Deoxyribonucleic Acid (DNA) Antibody; Native/Double Stranded DNA antibody Prior authorization required.

86235 Extractable Nuclear Antigen, Antibody To, Any Method, Each Antibody Nuclear antigen antibody Prior authorization required.

86353 Lymphocyte Transformation, Mitogen (Phytomitogen)/Antigen Induced Blastogenesis

Lymphocyte transformation Prior authorization required.

86644 Antibody; Cytomegalovirus (CMV) CMV antibody Prior authorization required.

86645 Antibody; Cytomegalovirus (CMV), IgM CMV antibody, IgM Prior authorization required.

86665 Antibody; Epstein-Barr (EB) Virus, Viral Capsid (VCA) Epstein-barr antibody Prior authorization required.

86695 Antibody; Herpes Simplex, Type I Herpes simplex test Prior authorization required.

86696 Antibody; Herpes Simplex, Type 2 Herpes simplex type 2 Prior authorization required.

86703 Antibody; HIV-1 & HIV-2, Single Assay HIV-1/HIV-2, single assay Prior authorization required.

Social Work 96150 Health & Behavior Assessment, Ea 15 Minutes; Initial Assessment Health and behavior assessment (eg health focused clinical interview, behavioral observations, psychophysiological monitoring, health oriented questionnaires), each 15 minutes face-to-face with the patient, initial assessment

PT Codes List 20091002 10 of 12

96151 Health & Behavior Assessment, Ea 15 Minutes; Re-Assessment Health and behavior assessment (eg health focused clinical interview, behavioral observations, psychophysiological monitoring, health oriented questionnaires), each 15 minutes

96152 Health & Behavior Intervention, Ea 15 Minutes; Individual Health and behavior intervention, each 15 minutes face-to-face individual

96153 Health & Behavior Intervention, Ea 15 Minutes; Group (2+ Patients) Health and behavior intervention, each 15 minutes face-to-face, group (2 or more patients)

96154 Health & Behavior Intervention, Ea 15 Minutes; Family (w/Patient Present)

Health and behavior intervention, each 15 minutes face-to-face, family with the patient present)

96155 Health & Behavior Intervention, Ea 15 Minutes; Family (w/o Patient Present)

Health and behavior intervention, each 15 minutes face-to-face, family without the patient present)

Prior authorization required.

Patient Visits 99058 Services Provided On An Emerg Basis In The Off,Which Disrupts Oth

Schd Off Svcs,In Add To Basic Svc Office emergency care

99201 Office/Op Visit, New Pt, 3 Key Components: Prob Focus Hx; Prob Focus Exam; Strtfrwd Med Decision

New Patient, problem focused 10 min.

'Office/outpatient visit

99202 Office/Op Visit, New Pt, 3 Key Components: Expand Prob Focus Hx;

Expand Prob Focus Exam; Strtfwd Decision

New Pt, expanded problem focus. 20 min.

Office/ outpatient

99203 Office/Op Visit, New Pt, 3 Key Components: Detailed Hx; Detailed Exam;

Med Decision Low Complexity

New Patient, low complexity 30 min

99204 Office/Op Visit, New Pt, 3 Key Components:Comprehensive Hx;Comprehensive Exam;Med Decisn Mod Complexity

New Patient, mod. Complexity 45 min.

Office/ outpatient.

99205 Office/Op Visit, New Pt, 3 Key Components:Comprehensive Hx;Comprehensiv Exam;Med Decisn High Complexity

New Patient, high complexity 60 min.

Office/ outpatient

99211 Office/Op Visit, Est Pt, Not Requiring Physician Presence, Typically 5 Min Estab. Patient, problem focused 5 min.

Office/ outpatient

99212 Office/Op Visit, Est Pt, 2 Key Components: Prob Focus Hx; Prob Focus Exam; Strtfwd Med Decision

Estab. Pt, expanded problem focus 10 min. Office/ outpatient

99213 Office/Op Visit, Est Pt, 2 Key Components: Expand Prob Hx; Expand Prob Exam;Med Decision Low Complexity

Estab. Patient, low complexity 15 min.

Office/ outpatient

99214 Office/Op Visit Est Pt 2 Key Components: Detailed Hx; Detailed Exam; Estab Patient mod Complexity 25 min99214 Office/Op Visit, Est Pt, 2 Key Components: Detailed Hx; Detailed Exam;

Med Decision Mod Complexity

Estab.Patient, mod. Complexity 25 min.

Office/ outpatient

99215 Office/Op Visit, Est Pt, 2 Key Components:Comprehensive Hx;Comprehensiv Exam;Med Decisn High Comple

Estab. Patient, high complexity 40 min.

Office/ outpatient

99231 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of thse 3 key components: a problem focused interval history; a problem focused examination; medical decision making that is straightforward or a of low complexity. Usually the patient is stable, recovering or improving.

Use only for the evaluation and management of a WTC related problem.

99232 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: an expanded problem focused interval history, an expanded problem focused examination, medical decision making of moderate complexity.

Usually the patient is responding inadequately to therapy or has developed a minor complication.

Use only for the evaluation and management of a WTC related problem.

99233 Subsequent hospital care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: a detailed interval history, a detailed examination, medical decision making of high complexity. Usually, the patient is unstable or has developed a significant complication or a significant new problem.

Use only for the evaluation and management of a WTC related problem.

99234 Obsv/Inpt Hosp Care 3 Key Components: Detail/Compr Hx; Detail/Compr Exam;Med Dec Strtfwd/Low Complexity

Observ/hosp same date

99238 Hospital Discharge Day Management; Up To 30 Min Hospital discharge day 99241 Office Consultation, 3 Key Components: Prob Focus Hx; Prob Focus

Exam; Strtfwd Med Decision Office consult, problem focused 15 min

99242 Office Consultation, 3 Key Components:Expand Prob Focus Hx;Expand Prob Focus Exam;Strtfwd Med Decision

Office consult, expanded problem focused 30 min

PT Codes List 20091002 11 of 12

99243 Office Consultation, 3 Key Components: Detailed Hx; Detailed Exam;

Med Decision Low Complexity Office consult, low complexity 40 min.

99244 Office Consultation, 3 Key Components:Comprehensive Hx;

Comprehensive Exam; Med Decision Mod Complexity

Office consult, mod. complexity 60 min

99245 Office Consultation, 3 Key Components: Comprehensive Hx;Comprehensive Exam;Med Decision High Complexity

Office consult, high complexity, 80 min

99252 Inpatient Consult, 3 Key Components:Expand Prob Focus Hx;Expand Prob Focus Exam;Strtfwd Med Decision

Initial inpatient consult

99253 Inpatient Consult, 3 Key Components: Detailed Hx; Detailed Exam; Med Decision Low Complexity

Initial inpatient consult

99283 Emergency Dept Visit,3 Key Components:Expand Prob Focus Hx;Expand Prob Focus Exam;Med Dec Mod Complexity

Emergency dept visit

99291 Critical Care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes.

Use only for the evaluation and management of a WTC related problem.

99292 Each additional 30 minutes (List separately in addition to code for primary service)

Use only for the evaluation and management of a WTC related problem associated with 99291.

99358 Prolonged evaluation and management service before and/or after direct (face-to-face) patient care (eg, review of extensive records and tests, communication with other professionals and/or the patient/family); first hour (List separately in addition to codes(s) for other physian service(s) and/or inpatient or outpatient Evaluation and Management service)

Use only for the evaluation and management of a WTC related problem.

99359 Each additional 30 minutes (List separately in addition to code for primary service)

Use only for the evaluation and management of a WTC related problem associated with 99359.

99441 Telephone evaluation and management service provided by a physician to an established patient, parent, or guardian not originating from a related E/M service provided within the previous 7 dyas nor leading to an E/M service or procedure within the next 24 hours or soonest available appointment; 5-10 minutes of medical discussion.

Use only for the evaluation and management of a WTC related problem.

99442 11-20 minutes of medical discussion Use only for the telephone evaluation and management of a WTC related problem associated with 99441.

99443 21-30 minutes of medical discussion Use only for the telephone evaluation and management of a WTC related problem associated with 99441.

99455 Work related or medical disability examination by the treating physician that includes: Completion of medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition; Formulation of a diagnosis, assessment of capabilities and stability, and calculation of impairment; Development of future medical treatment plan; and Completion of necessary documentation/certificates and report.

Use only for a work related or medical disability examination by the treating physician for a WTC related problem.

99456 Work related or medical disability examination by other than the treating physician that includes: Completion of medical history commensurate with the patient's condition; Performance of an examination commensurate with the patient's condition;…