Attachment Q CCN Utilization Review Code List.xlsx
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- Q201--CCN-Next Gen Medical
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- 36C10G26R0003
About this file
This file is an attachment listing Current Procedural Terminology (CPT) codes for ambulatory and surgical procedures, specifically a comprehensive catalog of medical service codes categorized across multiple specialties. The extensive document includes detailed CPT codes for procedures in areas such as cardiac surgery, orthopedics, neurology, oncology, imaging, radiation therapy, endoscopy, infusion therapy, and genetic testing, with each code indicating whether the procedure requires physician supervision (marked with Y or N).
The attachment provides a granular breakdown of medical services with corresponding codes, allowing precise medical billing and procedural documentation. Each CPT code includes specific details like the type of medical procedure, the anatomical region involved, and whether the procedure requires specialized equipment or techniques. The codes are organized systematically by medical specialty and procedure complexity, ranging from simple diagnostic procedures to complex surgical interventions, and include both invasive and non-invasive medical services across multiple healthcare domains.
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Final List for IEN 1.27 Service Categories Type Code Description TPA Clinical Review Y/N
| Ambulatory/Surgical | CPT | 10005 | Fine needle aspiration biopsy, including ultrasound guidance; first lesion | N | |
| Ambulatory/Surgical | CPT | 10007 | Fine needle aspiration biopsy, including fluoroscopic guidance; first lesion | N | |
| Ambulatory/Surgical | CPT | 10009 | Fine needle aspiration biopsy, including CT guidance; first lesion | N | |
| Ambulatory/Surgical | CPT | 10011 | Fine needle aspiration biopsy, including MR guidance; first lesion | N | |
| Ambulatory/Surgical | CPT | 10021 | Fine needle aspiration biopsy, without imaging guidance; first lesion | N | |
| Ambulatory/Surgical | CPT | 11102 | Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion | N | |
| Ambulatory/Surgical | CPT | 11104 | Punch biopsy of skin (including simple closure, when performed); single lesion | N | |
| Ambulatory/Surgical | CPT | 11106 | Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion | N | |
| Ambulatory/Surgical | CPT | 11950 | Subcutaneous injection of filling material (eg, collagen); 1 cc or less | N | |
| Ambulatory/Surgical | CPT | 11951 | Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 cc | N | |
| Ambulatory/Surgical | CPT | 11952 | Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 cc | N | |
| Ambulatory/Surgical | CPT | 11954 | Subcutaneous injection of filling material (eg, collagen); over 10.0 cc | N | |
| Ambulatory/Surgical | CPT | 11960 | Insertion of tissue expander(s) for other than breast, including subsequent expansion | N | |
| Ambulatory/Surgical | CPT | 11970 | Replacement of tissue expander with permanent implant | N | |
| Ambulatory/Surgical | CPT | 11971 | Removal of tissue expander without insertion of implant | N | |
| Ambulatory/Surgical | CPT | 13101 | Repair, complex, trunk; 2.6 cm to 7.5 cm | N | |
| Ambulatory/Surgical | CPT | 13132 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm | N | |
| Ambulatory/Surgical | CPT | 14000 | Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less | N | |
| Ambulatory/Surgical | CPT | 14001 | Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 14020 | Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less | N | |
| Ambulatory/Surgical | CPT | 14021 | Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 14040 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less | N | |
| Ambulatory/Surgical | CPT | 14041 | Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 14060 | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less | N | |
| Ambulatory/Surgical | CPT | 14061 | Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 14301 | Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 15570 | Formation of direct or tubed pedicle, with or without transfer; trunk | N | |
| Ambulatory/Surgical | CPT | 15572 | Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legs | N | |
| Ambulatory/Surgical | CPT | 15574 | Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feet | N | |
| Ambulatory/Surgical | CPT | 15730 | Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s) | N | |
| Ambulatory/Surgical | CPT | 15733 | Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sterNocleidomastoid, levator scapulae) | N | |
| Ambulatory/Surgical | CPT | 15734 | Muscle, myocutaneous, or fasciocutaneous flap; trunk | N | |
| Ambulatory/Surgical | CPT | 15738 | Muscle, myocutaneous, or fasciocutaneous flap; lower extremity | N | |
| Ambulatory/Surgical | CPT | 15740 | Flap; island pedicle requiring identification and dissection of an anatomically named axial vessel | N | |
| Ambulatory/Surgical | CPT | 15750 | Flap; neurovascular pedicle | N | |
| Ambulatory/Surgical | CPT | 15756 | Free muscle or myocutaneous flap with microvascular anastomosis | N | |
| Ambulatory/Surgical | CPT | 15757 | Free skin flap with microvascular anastomosis | N | |
| Ambulatory/Surgical | CPT | 15758 | Free fascial flap with microvascular anastomosis | N | |
| Ambulatory/Surgical | CPT | 15769 | Grafting of autologous soft tissue, other, harvested by direct excision (eg, fat, dermis, fascia) | N | |
| Ambulatory/Surgical | CPT | 15771 | Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate | N | |
| Ambulatory/Surgical | CPT | 15773 | Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate | N | |
| Ambulatory/Surgical | CPT | 15820 | Blepharoplasty, lower eyelid; | N | |
| Ambulatory/Surgical | CPT | 15821 | Blepharoplasty, lower eyelid; with extensive herniated fat pad | N | |
| Ambulatory/Surgical | CPT | 15822 | Blepharoplasty, upper eyelid; | N | |
| Ambulatory/Surgical | CPT | 15823 | Blepharoplasty, upper eyelid; with excessive skin weighting down lid | N | |
| Ambulatory/Surgical | CPT | 15830 | Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomy | N | |
| Ambulatory/Surgical | CPT | 17106 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm | N | |
| Ambulatory/Surgical | CPT | 17107 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 17108 | Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cm | N | |
| Ambulatory/Surgical | CPT | 17999 | Unlisted procedure, skin, mucous membrane and subcutaneous tissue | N | |
| Ambulatory/Surgical | CPT | 19000 | Puncture aspiration of cyst of breast; | N | |
| Ambulatory/Surgical | CPT | 19300 | Mastectomy for gynecomastia | N | |
| Ambulatory/Surgical | CPT | 19303 | Mastectomy, simple, complete | N | |
| Ambulatory/Surgical | CPT | 19316 | Mastopexy | N | |
| Ambulatory/Surgical | CPT | 19318 | Breast Reduction | N | |
| Ambulatory/Surgical | CPT | 19328 | Removal of intact breast implant | N | |
| Ambulatory/Surgical | CPT | 19330 | Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel) | N | |
| Ambulatory/Surgical | CPT | 19340 | Insertion of breast implant on same day of mastectomy (ie, immediate) | N | |
| Ambulatory/Surgical | CPT | 19342 | Insertion or replacement of breast implant on separate day from mastectomy | N | |
| Ambulatory/Surgical | CPT | 19350 | Nipple/areola reconstruction | N | |
| Ambulatory/Surgical | CPT | 19357 | Tissue expander placement in breast reconstruction, including subsequent expansion(s) | N | |
| Ambulatory/Surgical | CPT | 19361 | Breast reconstruction; with latissimus dorsi flap | N | |
| Ambulatory/Surgical | CPT | 19364 | Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap) | N | |
| Ambulatory/Surgical | CPT | 19367 | Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap | N | |
| Ambulatory/Surgical | CPT | 19368 | Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging) | N | |
| Ambulatory/Surgical | CPT | 19369 | Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (TRAM) flap | N | |
| Ambulatory/Surgical | CPT | 19370 | Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomy | N | |
| Ambulatory/Surgical | CPT | 19371 | Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contents | N | |
| Ambulatory/Surgical | CPT | 19396 | Preparation of moulage for custom breast implant | N | |
| Ambulatory/Surgical | CPT | 20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | N | |
| Ambulatory/Surgical | CPT | 20553 | Injection(s); single or multiple trigger point(s), 3 or more muscles | N | |
| Ambulatory/Surgical | CPT | 20600 | Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance | N | |
| Ambulatory/Surgical | CPT | 20604 | Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reporting | N | |
| Ambulatory/Surgical | CPT | 20605 | Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance | N | |
| Ambulatory/Surgical | CPT | 20606 | Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reporting | N | |
| Ambulatory/Surgical | CPT | 20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | N | |
| Ambulatory/Surgical | CPT | 20611 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reporting | N | |
| Ambulatory/Surgical | CPT | 20680 | Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) | Y | |
| Ambulatory/Surgical | CPT | 20974 | Electrical stimulation to aid bone healing; noninvasive (nonoperative) | Y | |
| Ambulatory/Surgical | CPT | 20975 | Electrical stimulation to aid bone healing; invasive (operative) | Y | |
| Ambulatory/Surgical | CPT | 20979 | Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative) | Y | |
| Ambulatory/Surgical | CPT | 21050 | Condylectomy, temporomandibular joint (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 21060 | Meniscectomy, partial or complete, temporomandibular joint (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 21070 | Coronoidectomy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 21073 | Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care) | N | |
| Ambulatory/Surgical | CPT | 21120 | Genioplasty; augmentation (autograft, allograft, prosthetic material) | N | |
| Ambulatory/Surgical | CPT | 21121 | Genioplasty; sliding osteotomy, single piece | N | |
| Ambulatory/Surgical | CPT | 21122 | Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) | N | |
| Ambulatory/Surgical | CPT | 21123 | Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21125 | Augmentation, mandibular body or angle; prosthetic material | N | |
| Ambulatory/Surgical | CPT | 21127 | Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft) | N | |
| Ambulatory/Surgical | CPT | 21137 | Reduction forehead; contouring only | N | |
| Ambulatory/Surgical | CPT | 21138 | Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) | N | |
| Ambulatory/Surgical | CPT | 21139 | Reduction forehead; contouring and setback of anterior frontal sinus wall | N | |
| Ambulatory/Surgical | CPT | 21141 | Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graft | N | |
| Ambulatory/Surgical | CPT | 21142 | Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graft | N | |
| Ambulatory/Surgical | CPT | 21143 | Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graft | N | |
| Ambulatory/Surgical | CPT | 21145 | Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21146 | Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft) | N | |
| Ambulatory/Surgical | CPT | 21147 | Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies) | N | |
| Ambulatory/Surgical | CPT | 21150 | Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome) | N | |
| Ambulatory/Surgical | CPT | 21151 | Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21154 | Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort I | N | |
| Ambulatory/Surgical | CPT | 21155 | Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort I | N | |
| Ambulatory/Surgical | CPT | 21159 | Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort I | N | |
| Ambulatory/Surgical | CPT | 21160 | Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort I | N | |
| Ambulatory/Surgical | CPT | 21172 | Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21175 | Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21179 | Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material) | N | |
| Ambulatory/Surgical | CPT | 21180 | Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts) | N | |
| Ambulatory/Surgical | CPT | 21181 | Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranial | N | |
| Ambulatory/Surgical | CPT | 21182 | Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cm | N | |
| Ambulatory/Surgical | CPT | 21183 | Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cm | N | |
| Ambulatory/Surgical | CPT | 21184 | Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cm | N | |
| Ambulatory/Surgical | CPT | 21188 | Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21193 | Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graft | N | |
| Ambulatory/Surgical | CPT | 21194 | Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21195 | Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation | N | |
| Ambulatory/Surgical | CPT | 21196 | Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixation | N | |
| Ambulatory/Surgical | CPT | 21198 | Osteotomy, mandible, segmental; | N | |
| Ambulatory/Surgical | CPT | 21199 | Osteotomy, mandible, segmental; with genioglossus advancement | N | |
| Ambulatory/Surgical | CPT | 21206 | Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard) | N | |
| Ambulatory/Surgical | CPT | 21208 | Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant) | N | |
| Ambulatory/Surgical | CPT | 21209 | Osteoplasty, facial bones; reduction | N | |
| Ambulatory/Surgical | CPT | 21210 | Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21215 | Graft, bone; mandible (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21230 | Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21235 | Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21240 | Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 21242 | Arthroplasty, temporomandibular joint, with allograft | N | |
| Ambulatory/Surgical | CPT | 21243 | Arthroplasty, temporomandibular joint, with prosthetic joint replacement | N | |
| Ambulatory/Surgical | CPT | 21244 | Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate) | N | |
| Ambulatory/Surgical | CPT | 21245 | Reconstruction of mandible or maxilla, subperiosteal implant; partial | N | |
| Ambulatory/Surgical | CPT | 21246 | Reconstruction of mandible or maxilla, subperiosteal implant; complete | N | |
| Ambulatory/Surgical | CPT | 21247 | Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia) | N | |
| Ambulatory/Surgical | CPT | 21248 | Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partial | N | |
| Ambulatory/Surgical | CPT | 21249 | Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); complete | N | |
| Ambulatory/Surgical | CPT | 21255 | Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts) | N | |
| Ambulatory/Surgical | CPT | 21256 | Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia) | N | |
| Ambulatory/Surgical | CPT | 21260 | Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approach | N | |
| Ambulatory/Surgical | CPT | 21261 | Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approach | N | |
| Ambulatory/Surgical | CPT | 21263 | Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancement | N | |
| Ambulatory/Surgical | CPT | 21267 | Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approach | N | |
| Ambulatory/Surgical | CPT | 21268 | Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approach | N | |
| Ambulatory/Surgical | CPT | 21270 | Malar augmentation, prosthetic material | N | |
| Ambulatory/Surgical | CPT | 21275 | Secondary revision of orbitocraniofacial reconstruction | N | |
| Ambulatory/Surgical | CPT | 21280 | Medial canthopexy (separate procedure) | N | |
| Ambulatory/Surgical | CPT | 21282 | Lateral canthopexy | N | |
| Ambulatory/Surgical | CPT | 21295 | Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approach | N | |
| Ambulatory/Surgical | CPT | 21296 | Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approach | N | |
| Ambulatory/Surgical | CPT | 21299 | Unlisted craniofacial and maxillofacial procedure | N | |
| Ambulatory/Surgical | CPT | 21320 | Closed treatment of nasal bone fracture with manipulation; with stabilization | N | |
| Ambulatory/Surgical | CPT | 21480 | Closed treatment of temporomandibular dislocation; initial or subsequent | N | |
| Ambulatory/Surgical | CPT | 21485 | Closed treatment of temporomandibular dislocation; complicated (eg, relegacy requiring intermaxillary fixation or splinting), initial or subsequent | N | |
| Ambulatory/Surgical | CPT | 21490 | Open treatment of temporomandibular dislocation | N | |
| Ambulatory/Surgical | CPT | 21550 | Biopsy, soft tissue of neck or thorax | N | |
| Ambulatory/Surgical | CPT | 21552 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater | N | |
| Ambulatory/Surgical | CPT | 21555 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm | N | |
| Ambulatory/Surgical | CPT | 21556 | Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm | N | |
| Ambulatory/Surgical | CPT | 21557 | Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cm | N | |
| Ambulatory/Surgical | CPT | 21558 | Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greater | N | |
| Ambulatory/Surgical | CPT | 21685 | Hyoid myotomy and suspension | N | |
| Ambulatory/Surgical | CPT | 21740 | Reconstructive repair of pectus excavatum or carinatum; open | N | |
| Ambulatory/Surgical | CPT | 21742 | Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy | N | |
| Ambulatory/Surgical | CPT | 21743 | Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy | N | |
| Ambulatory/Surgical | CPT | 21931 | Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater | N | |
| Ambulatory/Surgical | CPT | 22100 | Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervical | Y | |
| Ambulatory/Surgical | CPT | 22101 | Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22102 | Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22110 | Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervical | Y | |
| Ambulatory/Surgical | CPT | 22112 | Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22114 | Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22206 | Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracic | Y | |
| Ambulatory/Surgical | CPT | 22207 | Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbar | Y | |
| Ambulatory/Surgical | CPT | 22210 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical | Y | |
| Ambulatory/Surgical | CPT | 22212 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22214 | Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22220 | Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical | Y | |
| Ambulatory/Surgical | CPT | 22222 | Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22224 | Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22310 | Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracing | Y | |
| Ambulatory/Surgical | CPT | 22315 | Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or traction | Y | |
| Ambulatory/Surgical | CPT | 22318 | Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without grafting | Y | |
| Ambulatory/Surgical | CPT | 22319 | Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with grafting | Y | |
| Ambulatory/Surgical | CPT | 22325 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22326 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervical | Y | |
| Ambulatory/Surgical | CPT | 22327 | Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22510 | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic | Y | |
| Ambulatory/Surgical | CPT | 22511 | Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral | Y | |
| Ambulatory/Surgical | CPT | 22513 | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic | Y | |
| Ambulatory/Surgical | CPT | 22514 | Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22532 | Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic | Y | |
| Ambulatory/Surgical | CPT | 22533 | Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | Y | |
| Ambulatory/Surgical | CPT | 22548 | Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process | Y | |
| Ambulatory/Surgical | CPT | 22551 | Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 | Y | |
| Ambulatory/Surgical | CPT | 22554 | Arthrodesis, anterior interbody technique; including minimal discectomy to prepare interspace (other than for decompression); cervical below c2 | Y | |
| Ambulatory/Surgical | CPT | 22556 | Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic | Y | |
| Ambulatory/Surgical | CPT | 22558 | Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar | Y | |
| Ambulatory/Surgical | CPT | 22586 | Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S1 interspace | Y | |
| Ambulatory/Surgical | CPT | 22590 | Arthrodesis, posterior technique, craniocervical (occiput-C2) | Y | |
| Ambulatory/Surgical | CPT | 22595 | Arthrodesis, posterior technique, atlas-axis (C1-C2) | Y | |
| Ambulatory/Surgical | CPT | 22600 | Arthrodesis, posterior or posterolateral technique, single interspace; cervical below C2 segment | Y | |
| Ambulatory/Surgical | CPT | 22610 | Arthrodesis, posterior or posterolateral technique, single interspace; thoracic (with lateral transverse technique, when performed) | Y | |
| Ambulatory/Surgical | CPT | 22612 | Arthrodesis, posterior or posterolateral technique, single interspace; lumbar (with lateral transverse technique, when performed) | Y | |
| Ambulatory/Surgical | CPT | 22630 | Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace, lumbar; | Y | |
| Ambulatory/Surgical | CPT | 22633 | Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace, lumbar; | Y | |
| Ambulatory/Surgical | CPT | 22800 | Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22802 | Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22804 | Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22808 | Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22810 | Arthrodesis, posterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22812 | Arthrodesis, posterior, for spinal deformity, with or without cast; 8 or more vertebral segments | Y | |
| Ambulatory/Surgical | CPT | 22818 | Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments | Y | |
| Ambulatory/Surgical | CPT | 22819 | Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments | Y | |
| Ambulatory/Surgical | CPT | 22830 | Exploration of spinal fusion | Y | |
| Ambulatory/Surgical | CPT | 22849 | Reinsertion of spinal fixation device | Y | |
| Ambulatory/Surgical | CPT | 22850 | Removal of posterior nonsegmental instrumentation (eg, Harrington rod) | Y | |
| Ambulatory/Surgical | CPT | 22852 | Removal of posterior segmental instrumentation | Y | |
| Ambulatory/Surgical | CPT | 22855 | Removal of anterior instrumentation | Y | |
| Ambulatory/Surgical | CPT | 22856 | Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical | Y | |
| Ambulatory/Surgical | CPT | 22857 | Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar | Y | |
| Ambulatory/Surgical | CPT | 22861 | Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical | Y | |
| Ambulatory/Surgical | CPT | 22862 | Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22865 | Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar | Y | |
| Ambulatory/Surgical | CPT | 22899 | Unlisted procedure, spine | Y | |
| Ambulatory/Surgical | CPT | 23430 | Tendonesis of long tendon of biceps | Y | |
| Ambulatory/Surgical | CPT | 23470 | Arthroplasty, glenohumeral joint; hemiarthroplasty | Y | |
| Ambulatory/Surgical | CPT | 23472 | Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder)) | Y | |
| Ambulatory/Surgical | CPT | 23473 | Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component | Y | |
| Ambulatory/Surgical | CPT | 23474 | Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component | Y | |
| Ambulatory/Surgical | CPT | 24360 | Arthroplasty, elbow; with membrane (eg, fascial) | Y | |
| Ambulatory/Surgical | CPT | 24361 | Arthroplasty, elbow; with distal humeral prosthetic replacement | Y | |
| Ambulatory/Surgical | CPT | 24362 | Arthroplasty, elbow; with implant and fascia lata ligament reconstruction | Y | |
| Ambulatory/Surgical | CPT | 24363 | Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow) | Y | |
| Ambulatory/Surgical | CPT | 24365 | Arthroplasty, radial head; | Y | |
| Ambulatory/Surgical | CPT | 24366 | Arthroplasty, radial head; with implant | Y | |
| Ambulatory/Surgical | CPT | 24370 | Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component | Y | |
| Ambulatory/Surgical | CPT | 24371 | Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component | Y | |
| Ambulatory/Surgical | CPT | 25111 | Excision of ganglion, wrist (dorsal or volar); primary | Y | |
| Ambulatory/Surgical | CPT | 25310 | Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon | Y | |
| Ambulatory/Surgical | CPT | 25312 | Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendon | Y | |
| Ambulatory/Surgical | CPT | 25441 | Arthroplasty with prosthetic replacement; distal radius | Y | |
| Ambulatory/Surgical | CPT | 25442 | Arthroplasty with prosthetic replacement; distal ulna | Y | |
| Ambulatory/Surgical | CPT | 25443 | Arthroplasty with prosthetic replacement; scaphoid carpal (navicular) | Y | |
| Ambulatory/Surgical | CPT | 25444 | Arthroplasty with prosthetic replacement; lunate | Y | |
| Ambulatory/Surgical | CPT | 25446 | Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist) | Y | |
| Ambulatory/Surgical | CPT | 25449 | Revision of arthroplasty, including removal of implant, wrist joint | Y | |
| Ambulatory/Surgical | CPT | 25609 | Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments | Y | |
| Ambulatory/Surgical | CPT | 26055 | Tendon sheath incision (eg, for trigger finger) | Y | |
| Ambulatory/Surgical | CPT | 26160 | Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger | Y | |
| Ambulatory/Surgical | CPT | 26340 | Manipulation, finger joint, under anesthesia, each joint | Y | |
| Ambulatory/Surgical | CPT | 26480 | Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon | Y | |
| Ambulatory/Surgical | CPT | 26530 | Arthroplasty, metacarpophalangeal joint; each joint | Y | |
| Ambulatory/Surgical | CPT | 26535 | Arthroplasty, interphalangeal joint; each joint | Y | |
| Ambulatory/Surgical | CPT | 26989 | Unlisted procedure, hands or fingers | Y | |
| Ambulatory/Surgical | CPT | 27090 | Removal of hip prosthesis; (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 27091 | Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacer | Y | |
| Imaging: CT, PET, MRI, Nuclear Medicine | CPT | 27096 | Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed | Y | |
| Ambulatory/Surgical | CPT | 27120 | Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type) | Y | |
| Ambulatory/Surgical | CPT | 27125 | Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty) | Y | |
| Ambulatory/Surgical | CPT | 27130 | Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft | Y | |
| Ambulatory/Surgical | CPT | 27132 | Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft | Y | |
| Ambulatory/Surgical | CPT | 27134 | Revision of total hip arthroplasty; both components, with or without autograft or allograft | Y | |
| Ambulatory/Surgical | CPT | 27137 | Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft | Y | |
| Ambulatory/Surgical | CPT | 27138 | Revision of total hip arthroplasty; femoral component only, with or without allograft | Y | |
| Ambulatory/Surgical | CPT | 27279 | Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing device | Y | |
| Ambulatory/Surgical | CPT | 27280 | Arthrodesis, sacroiliac joint, open, includes obtaining bone graft, including instrumentation, when performed | Y | |
| Ambulatory/Surgical | CPT | 27403 | Arthrotomy with meniscus repair, knee | Y | |
| Ambulatory/Surgical | CPT | 27412 | Autologous chondrocyte implantation, knee | Y | |
| Ambulatory/Surgical | CPT | 27415 | Osteochondral allograft, knee, open | Y | |
| Ambulatory/Surgical | CPT | 27416 | Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s]) | Y | |
| Ambulatory/Surgical | CPT | 27437 | Arthroplasty, patella; without prosthesis | Y | |
| Ambulatory/Surgical | CPT | 27438 | Arthroplasty, patella; with prosthesis | Y | |
| Ambulatory/Surgical | CPT | 27440 | Arthroplasty, knee, tibial plateau; | Y | |
| Ambulatory/Surgical | CPT | 27441 | Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy | Y | |
| Ambulatory/Surgical | CPT | 27442 | Arthroplasty, femoral condyles or tibial plateau(s), knee; | Y | |
| Ambulatory/Surgical | CPT | 27443 | Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy | Y | |
| Ambulatory/Surgical | CPT | 27445 | Arthroplasty, knee, hinge prosthesis (eg, Walldius type) | Y | |
| Ambulatory/Surgical | CPT | 27446 | Arthroplasty, knee, condyle and plateau; medial OR lateral compartment | Y | |
| Ambulatory/Surgical | CPT | 27447 | Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) | Y | |
| Ambulatory/Surgical | CPT | 27486 | Revision of total knee arthroplasty, with or without allograft; 1 component | Y | |
| Ambulatory/Surgical | CPT | 27487 | Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component | Y | |
| Ambulatory/Surgical | CPT | 27488 | Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, knee | Y | |
| Ambulatory/Surgical | CPT | 27570 | Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) | Y | |
| Ambulatory/Surgical | CPT | 27650 | Repair, primary, open or percutaneous, ruptured Achilles tendon; | Y | |
| Ambulatory/Surgical | CPT | 27690 | Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot) | Y | |
| Ambulatory/Surgical | CPT | 27698 | Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure) | Y | |
| Ambulatory/Surgical | CPT | 27700 | Arthroplasty, ankle; | Y | |
| Ambulatory/Surgical | CPT | 27702 | Arthroplasty, ankle; with implant (total ankle) | Y | |
| Ambulatory/Surgical | CPT | 27703 | Arthroplasty, ankle; revision, total ankle | Y | |
| Ambulatory/Surgical | CPT | 28060 | Fasciectomy, plantar fascia; partial (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 28080 | Excision, interdigital (Morton) neuroma, single, each | Y | |
| Ambulatory/Surgical | CPT | 28285 | Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) | Y | |
| Ambulatory/Surgical | CPT | 28289 | Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implant | Y | |
| Ambulatory/Surgical | CPT | 28291 | Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint ; with implant | Y | |
| Ambulatory/Surgical | CPT | 28292 | Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with resection of proximal phalanx base, when performed, any method | Y | |
| Ambulatory/Surgical | CPT | 28296 | Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with distal metatarsal osteotomy, any metho | Y | |
| Ambulatory/Surgical | CPT | 28297 | Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method | Y | |
| Ambulatory/Surgical | CPT | 28298 | Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with proximal phalanx osteotomy, any method | Y | |
| Ambulatory/Surgical | CPT | 28299 | Correction, hallux valgus with bunionectomy, with sesamoidectomy when performed; with double osteotomy, any method | Y | |
| Ambulatory/Surgical | CPT | 29800 | Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29804 | Arthroscopy, temporomandibular joint, surgical | Y | |
| Ambulatory/Surgical | CPT | 29805 | Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29806 | Arthroscopy, shoulder, surgical; capsulorrhaphy | Y | |
| Ambulatory/Surgical | CPT | 29807 | Arthroscopy, shoulder, surgical; repair of SLAP lesion | Y | |
| Ambulatory/Surgical | CPT | 29819 | Arthroscopy, shoulder, surgical; with removal of loose body or foreign body | Y | |
| Ambulatory/Surgical | CPT | 29820 | Arthroscopy, shoulder, surgical; synovectomy, partial | Y | |
| Ambulatory/Surgical | CPT | 29821 | Arthroscopy, shoulder, surgical; synovectomy, complete | Y | |
| Ambulatory/Surgical | CPT | 29822 | Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) | Y | |
| Ambulatory/Surgical | CPT | 29823 | Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies]) | Y | |
| Ambulatory/Surgical | CPT | 29824 | Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) | Y | |
| Ambulatory/Surgical | CPT | 29825 | Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation | Y | |
| Ambulatory/Surgical | CPT | 29827 | Arthroscopy, shoulder, surgical; with rotator cuff repair | Y | |
| Ambulatory/Surgical | CPT | 29828 | Arthroscopy, shoulder, surgical; biceps tenodesis | Y | |
| Ambulatory/Surgical | CPT | 29830 | Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29834 | Arthroscopy, elbow, surgical; with removal of loose body or foreign body | Y | |
| Ambulatory/Surgical | CPT | 29835 | Arthroscopy, elbow, surgical; synovectomy, partial | Y | |
| Ambulatory/Surgical | CPT | 29836 | Arthroscopy, elbow, surgical; synovectomy, complete | Y | |
| Ambulatory/Surgical | CPT | 29837 | Arthroscopy, elbow, surgical; debridement, limited | Y | |
| Ambulatory/Surgical | CPT | 29838 | Arthroscopy, elbow, surgical; debridement, extensive | Y | |
| Ambulatory/Surgical | CPT | 29840 | Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29843 | Arthroscopy, wrist, surgical; for infection, lavage and drainage | Y | |
| Ambulatory/Surgical | CPT | 29844 | Arthroscopy, wrist, surgical; synovectomy, partial | Y | |
| Ambulatory/Surgical | CPT | 29845 | Arthroscopy, wrist, surgical; synovectomy, complete | Y | |
| Ambulatory/Surgical | CPT | 29847 | Arthroscopy, wrist, surgical; internal fixation for fracture or instability | Y | |
| Ambulatory/Surgical | CPT | 29848 | Endoscopy, wrist, surgical, with release of transverse carpal ligament | Y | |
| Ambulatory/Surgical | CPT | 29860 | Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29861 | Arthroscopy, hip, surgical; with removal of loose body or foreign body | Y | |
| Ambulatory/Surgical | CPT | 29862 | Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum | Y | |
| Ambulatory/Surgical | CPT | 29863 | Arthroscopy, hip, surgical; with synovectomy | Y | |
| Ambulatory/Surgical | CPT | 29866 | Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s]) | Y | |
| Ambulatory/Surgical | CPT | 29867 | Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty) | Y | |
| Ambulatory/Surgical | CPT | 29868 | Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral | Y | |
| Ambulatory/Surgical | CPT | 29870 | Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29871 | Arthroscopy, knee, surgical; for infection, lavage and drainage | Y | |
| Ambulatory/Surgical | CPT | 29873 | Arthroscopy, knee, surgical; with lateral release | Y | |
| Ambulatory/Surgical | CPT | 29874 | Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) | Y | |
| Ambulatory/Surgical | CPT | 29875 | Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29876 | Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral) | Y | |
| Ambulatory/Surgical | CPT | 29877 | Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) | Y | |
| Ambulatory/Surgical | CPT | 29879 | Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture | Y | |
| Ambulatory/Surgical | CPT | 29880 | Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | Y | |
| Ambulatory/Surgical | CPT | 29881 | Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed | Y | |
| Ambulatory/Surgical | CPT | 29882 | Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) | Y | |
| Ambulatory/Surgical | CPT | 29883 | Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral) | Y | |
| Ambulatory/Surgical | CPT | 29884 | Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) | Y | |
| Ambulatory/Surgical | CPT | 29885 | Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion) | Y | |
| Ambulatory/Surgical | CPT | 29886 | Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion | Y | |
| Ambulatory/Surgical | CPT | 29887 | Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation | Y | |
| Ambulatory/Surgical | CPT | 29888 | Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction | Y | |
| Ambulatory/Surgical | CPT | 29889 | Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction | Y | |
| Ambulatory/Surgical | CPT | 29891 | Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defect | Y | |
| Ambulatory/Surgical | CPT | 29892 | Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy) | Y | |
| Ambulatory/Surgical | CPT | 29893 | Endoscopic plantar fasciotomy | Y | |
| Ambulatory/Surgical | CPT | 29894 | Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body | Y | |
| Ambulatory/Surgical | CPT | 29895 | Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial | Y | |
| Ambulatory/Surgical | CPT | 29897 | Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited | Y | |
| Ambulatory/Surgical | CPT | 29898 | Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensive | Y | |
| Ambulatory/Surgical | CPT | 29899 | Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesis | Y | |
| Ambulatory/Surgical | CPT | 29901 | Arthroscopy, metacarpophalangeal joint, surgical; with debridement | Y | |
| Ambulatory/Surgical | CPT | 29902 | Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (eg, Stenar lesion) | Y | |
| Ambulatory/Surgical | CPT | 29914 | Arthroscopy, hip, surgical; with femoroplasty (i.e., treatment of cam lesion) | Y | |
| Ambulatory/Surgical | CPT | 29915 | Arthroscopy, hip, surgical; with acetabuloplasty (i.e., treatment of pincer lesion) | Y | |
| Ambulatory/Surgical | CPT | 29916 | Arthroscopy, hip, surgical; with labral repair | Y | |
| Ambulatory/Surgical | CPT | 30140 | Submucous resection inferior turbinate, partial or complete, any method | N | |
| Ambulatory/Surgical | CPT | 30400 | Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tip | N | |
| Ambulatory/Surgical | CPT | 30410 | Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip | N | |
| Ambulatory/Surgical | CPT | 30430 | Rhinoplasty, secondary; minor revision (small amount of nasal tip work) | N | |
| Ambulatory/Surgical | CPT | 30435 | Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) | N | |
| Ambulatory/Surgical | CPT | 30450 | Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) | N | |
| Ambulatory/Surgical | CPT | 30462 | Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies | N | |
| Ambulatory/Surgical | CPT | 30465 | Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction) | N | |
| Ambulatory/Surgical | CPT | 30520 | Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft | N | |
| Ambulatory/Surgical | CPT | 30540 | Repair choanal atresia; intranasal | N | |
| Ambulatory/Surgical | CPT | 30560 | Lysis intranasal synechia | N | |
| Ambulatory/Surgical | CPT | 30620 | Septal or other intranasal dermatoplasty (does not include obtaining graft) | N | |
| Ambulatory/Surgical | CPT | 31253 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed | N | |
| Ambulatory/Surgical | CPT | 31254 | Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior) | N | |
| Ambulatory/Surgical | CPT | 31255 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior) | N | |
| Ambulatory/Surgical | CPT | 31256 | Nasal/sinus endoscopy, surgical, with maxillary antrostomy; | N | |
| Ambulatory/Surgical | CPT | 31257 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy | N | |
| Ambulatory/Surgical | CPT | 31259 | Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus | N | |
| Ambulatory/Surgical | CPT | 31267 | Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinus | N | |
| Ambulatory/Surgical | CPT | 31295 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); maxillary sinus ostium, transnasal or via canine fossa | N | |
| Ambulatory/Surgical | CPT | 31296 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal sinus ostium | N | |
| Ambulatory/Surgical | CPT | 31297 | Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); sphenoid sinus ostium | N |
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