CMS Manual System Department of Health & Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 2616 Date: December 21, 2012 Change Request 8137 SUBJECT: January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 I. SUMMARY OF CHANGES: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The information related to this RUN is found in Chapter 4, Section 40.1, of Publication 100-04. EFFECTIVE DATE: January 1, 2013 IMPLEMENTATION DATE: January 7, 2013 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row. R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N/A III. FUNDING: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs): No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets For Medicare Administrative Contractors (MACs): The Medicare Administrative contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.
Transcript
CMS Manual System Department of Health & Human Services (DHHS)
Change Request 8137 SUBJECT: January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 I. SUMMARY OF CHANGES: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The information related to this RUN is found in Chapter 4, Section 40.1, of Publication 100-04. EFFECTIVE DATE: January 1, 2013 IMPLEMENTATION DATE: January 7, 2013 Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents. II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.
R/N/D CHAPTER / SECTION / SUBSECTION / TITLE
N/A III. FUNDING: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs): No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets For Medicare Administrative Contractors (MACs): The Medicare Administrative contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. IV. ATTACHMENTS: Recurring Update Notification *Unless otherwise specified, the effective date is the date of service.
Attachment - Recurring Update Notification
Pub. 100-04 Transmittal: 2616 Date: December 21, 2012 Change Request: 8137 SUBJECT: January 2013 Integrated Outpatient Code Editor (I/OCE) Specifications Version 14.0 EFFECTIVE DATE: January 1, 2013 IMPLEMENTATION DATE: January 7, 2013 I. GENERAL INFORMATION A. Background: This instruction informs the Fiscal Intermediaries (FIs), A/B MACs, RHHIs and the Fiscal Intermediary Shared System (FISS) that the I/OCE was updated for January 1, 2013. The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated OCE which eliminates the need to update, install, and maintain two separate OCE software packages on a quarterly basis. B. Policy: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The I/OCE specifications will be posted to the CMS Website and can be found at http://www.cms.gov/OutpatientCodeEdit/. II. BUSINESS REQUIREMENTS TABLE Use "Shall" to denote a mandatory requirement. Number Requirement Responsibility A/B
MAC DME
MAC
FI
CARRIER
RHHI
Shared-System
Maintainers
Other
Part A
Pa r t
B
FISS
MCS
VMS
CWF
8137.1 The Shared System Maintainer shall install the Integrated OCE (I/OCE) into their systems.
X
8137.2 Medicare contractors shall identify the I/OCE specifications on the CMS Website at http://www.cms.gov/OutpatientCodeEdit/
X X X X
III. PROVIDER EDUCATION TABLE Number Requirement Responsibility
A/B MAC
DME
MAC
FI
CARRIER
RHHI
Other
Pa r t
A
Pa r t
B 8137.3 MLN Article : A provider education article related to
this instruction will be available at http://www.cms.hhs.gov/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in the contractor’s next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.
X X X
IV. SUPPORTING INFORMATION Section A: Recommendations and supporting information associated with listed requirements: N/A Use "Should" to denote a recommendation. X-Ref Requirement Number
Recommendations or other supporting information:
Section B: All other recommendations and supporting information: CR 5344, Transmittal 1107: Notification of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release V. CONTACTS Pre-Implementation Contact(s): Yvonne Young, [email protected] , Anita Antkowiak, [email protected] , Marina Kushnirova, [email protected] Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR) or Contractor Manager, as applicable. VI. FUNDING Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs): No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets Section B: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS do not construe this as a change to the MAC Statement of Work. The contractor is not
obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements. Attachment
Appendix M Summary of Modifications
The modifications of the IOCE for the January 2013 release (V14.0) are summarized in the table below. Readers should also read through the entire document and note the highlighted sections, which also indicate changes from the prior release of the software. Some IOCE modifications in the update may also be retroactively added to prior releases. If so, the retroactive date will appear in the 'Effective Date' column.
# Type Effective Date
Edits Affected
Modification
1. Logic 1/1/13 24 Modify the software to maintain 28 prior quarters (7 years) of programs in each release. Remove older versions with each release. (The earliest version date included in this January 2013 release will be 4/1/06.
2. Logic 1/1/13 Modify the criteria for assignment of the electrophysiology/ablation composite APC (appK): *Assign the composite APC 8000 if there is a single code present from group C, or if there is one code from group A and one code from group B. *If multiple codes from group C are present, assign the APC to the code with the lowest numerical value and assign SI of N to additional group C codes on the same day. *If the criteria for APC assignment are met from group C as well as groups A&B, assign the APC to the group C code and assign the SI of N to the codes from groups A&B. * Terminated group C codes (with modifier 52 or 73) will be assigned to the composite APC and have the terminated procedure discount applied.
3 Logic 1/1/13 84 Apply edit 84 (claim lacks required primary code) to PHP claims if new psychiatric add-on codes
are submitted without a code for the primary service on the same day. 4. Logic 1/1/13 Modify the PHP logic to ignore the psychiatric add-on codes in the count of the number of
services (3 or 4) required to assign the PHP APCs. 5. Logic 1/1/13 63, 64 Deactivate edits 63 and 64. 6. Logic 1/1/13 81 Add Occupational therapy (G0129) and Activity therapy (G0176) to the list for edit 81. 7. Logic 1/1/13 40 Add four modifiers (24, 57, LM and RI) to the list of NCCI modifiers. 8. Logic 4/1/06 18 Remove code 58611 from the Inpatient Separate Procedure list. 9. Content 1/1/13 - Make HCPCS/APC/SI changes as specified by CMS (data change files). 10.
Content
1/1/13
20, 40 Implement version 19.0 of the NCCI (as modified for applicable institutional providers). [All edits combined in a single file, in code1/code2 format; mutually exclusive pairs no longer differentiated].
11. Content 1/1/13 71, 77 Update procedure/device & device/procedure edit requirements 12. Content 1/1/13 - Update the PHP list A &B 13. Content 1/1/13 80, 81 Update code lists used for edits 80 and 81 14. Content 1/1/13 Update composite APC requirements 15. Content 1/1/13 78 Update nuclear medicine/radiolabeled products list 16. Content 1/1/13 22 Add new modifiers CH, CI, CJ, CK, CL, CM, CN, LM and RI to the valid modifier list. 17. Content 1/1/13 - Update the skin substitute list 18. Content 1/1/13 84 Update the list of primary procedures reportable with Add-on code 33225:
Add 33222 and 33223. 19. Doc 1/1/13 - Create 508-compliant versions of the specifications & Summary of Data Changes documents for
publication on the CMS web site. 20. Other 1/1/13 - Deliver quarterly software update & all related documentation and files to users via electronic
means.
FINAL
Summary of Data Changes
Integrated OCE v 14.0
Effective January 1, 2013
Table of Contents
CPT codes, descriptions, and material only are Copyright 2012 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data
contained herein. Applicable FARS/DFARS restrictions apply to government use. DEFINITIONS ............................................................................................................................................ 8
• The “old” column describes the attribute prior to the change being made in the current update, which is indicated in the “new” column. If the effective date of the change is the same as the effective date of the new update, ‘old’ describes the attribute up to the last day of the previous quarter. If the effective date is retroactive, then ‘old’ describes the attribute for the same date in the previous release of the software.
• “Unassigned”, “Pre-defined” or “Placeholder” in APC or HCPCS descriptions indicates that the APC or HCPCS code is
inactive. When the APC or HCPCS code is activated, it becomes valid for use in the OCE, and a new description appears in the “new description” column, with the appropriate effective date.
• Activation Date (ActivDate) indicates the mid-quarter date of FDA approval for a drug, or the mid-quarter date of a new
or changed code resulting from a National Coverage Determination (NCD). The Activation Date is the date the code becomes valid for use in the OCE. If the Activation Date is blank, then the effective date takes precedence.
• Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. A code is not
valid for use in the OCE after its termination date.
• For codes with SI of “Q1, Q2, and Q3”, the APC assignment is the standard APC to which the code would be assigned if it is paid separately.
APC CHANGES
Added APCs The following APC(s) were added to the IOCE, effective 01-01-13 APC APCDesc StatusIndicator 00059 Level I Strapping S 00177 Level I Echocardiogram with Contrast S 00178 Level II Echocardiogram with Contrast S 01431 Centruroides immune f(ab) G 01432 Arbutamine hcl injection K 01433 Calcitonin salmon injection K 01434 Testosterone enanthate inj K 01435 Injection estrone per 1 MG K 01437 Gatifloxacin injection K 01438 Diazoxide injection K 01439 Aprotonin, 10,000 kiu K 01440 Inj desmopressin acetate K 01441 Intraocular Fomivirsen na K 01442 Non-HEU TC-99M add-on/dose K 01443 Icatibant injection K 01444 Oral everolimus K 01445 Methylnaltrexone injection K 01446 Visualization adjunct K 01447 Interferon alfacon-1 inj K 09294 Inj, taliglucerase alfa G 09295 Injection, carfilzomib G 09296 Injection, ziv-aflibercept G
APC Description Changes The following APC(s) had description changes, effective 01-01-13 APC Old Description New Description 00031 Smoking Cessation Services Level I Health and Behavior Services 00058 Level I Strapping and Cast Application Level I Cast Application 00107 Insertion of Cardioverter-Defibrillator Pulse
Generator Level I Implantation of Cardioverter-Defibrillators (ICDs)
00108 Insertion/Replacement/Repair of AICD Leads, Generator, and Pacing Electrodes
Level II Implantation of Cardioverter-Defibrillators (ICDs)
00215 Level I Nerve and Muscle Tests Level I Nerve and Muscle Services 00216 Level III Nerve and Muscle Tests Level III Nerve and Muscle Services 00218 Level II Nerve and Muscle Tests Level II Nerve and Muscle Services 00412 IMRT Treatment Delivery Level III Radiation Therapy 00432 Health and Behavior Services Level II Health and Behavior Services 00814 Asparaginase injection Asparaginase, NOS 01232 Mitomycin 5 MG inj Mitomycin injection 01244 Integra DRT skin sub Integra DRT 01421 Imported Lipodox inj Imported lipodox inj 01429 Flexhd or allopatch hd Flexhd/Allopatchhd/matrixhd 09286 Injection, belatacept Belatacept injection 09287 Inj, brentuximab vedotin Brentuximab vedotin inj 09289 Inj, erwinia chrysanthemi Erwinaze injection 09366 EpiFix wound cover Epifix
APC Status Indicator Changes The following APC(s) had Status Indicator changes, effective 01-01-13 APC Old SI New SI 00031 X S 01339 G K 01340 G K 01352 G K 01413 G K 09258 G K 09259 G K 09260 G K 09261 G K 09263 G K 09264 G K 09265 G K 09268 G K 09269 G K 09270 G K 09271 G K 09272 G K 09273 G K 09274 G K 09276 G K 09278 G K 09367 G K
HCPCS/CPT PROCEDURE CODE CHANGES
Added HCPCS/CPT Procedure Codes
The following new HCPCS/CPT code(s) were added to the IOCE, effective 01-01-13 HCPCS CodeDesc SI APC Edit ActivDate TermDate 0309T Prescrl fuse w/ instr l4/l5 C 00000 0310T Motor function mapping ntms S 00218 0311T Cal & alys cntrl artl press S 00099 0312T Laps impltj nstim vagus C 00000 0313T Laps rmvl nstim array vagus T 00687 0314T Laps rmvl vgl arry & pls gen T 00688 0315T Rmvl vagus nerve pls gen T 00688 0316T Replc vagus nerve pls gen S 00039 0317T Elec alys vagus nrv pls gen S 00690 0318T Replace aortic valve tthorac C 00000 0319T Insert subq defib w/eltrd T 00107 0320T Insert subq defib electrode T 00106 0321T Insert subq defib pls gen T 00107 0322T Rmvl subq defib pls gen T 00105 0323T Rmvl & replc subq pls gen T 00107 0324T Rmvl subq defib electrode T 00105 0325T Repos subq defib eltrd &/gen T 00105 0326T Ephys eval subq implt defib N 00000 0327T Implt subq defib interogat S 00690 0328T Implt subq defib sys dev evl S 00690 0580F Multidisciplinary care plan E 00000 28 0581F Pt trnsfrd from anesth to cc E 00000 28 0582F No trnsfr from anesth to cc E 00000 28 0583F Transfer care checklist used E 00000 28 0584F No transfercare chklist used E 00000 28 1500F Symptom+sign symm polyneuro E 00000 28 1501F Not initial eval for cond E 00000 28 1502F Pt queried pain fxn w/ instr E 00000 28 1503F Pt queried symp resp insuff E 00000 28 1504F Pt has resp insufficiency E 00000 28 1505F Pt has no resp insufficiency E 00000 28 22586 Prescrl fuse w/ instr l5/s1 C 00000 23473 Revis reconst shoulder joint T 00425 23474 Revis reconst shoulder joint C 00000 24370 Revise reconst elbow joint T 00425 24371 Revise reconst elbow joint T 00425 31647 Bronchial valve init insert T 00415 31648 Bronchial valve addl insert T 00415 31649 Bronchial valve remov init T 00076 31651 Bronchial valve remov addl T 00415 31660 Bronch thermoplsty 1 lobe T 00415 31661 Bronch thermoplsty 2/> lobes T 00415 32554 Aspirate pleura w/o imaging T 00070 32555 Aspirate pleura w/ imaging T 00070 32556 Insert cath pleura w/o image T 00070 32557 Insert cath pleura w/ image T 00070 32701 Thorax stereo rad targetw/tx B 00000 62 33361 Replace aortic valve perq C 00000 33362 Replace aortic valve open C 00000 33363 Replace aortic valve open C 00000 33364 Replace aortic valve open C 00000 33365 Replace aortic valve open C 00000 33367 Replace aortic valve w/byp C 00000 33368 Replace aortic valve w/byp C 00000 33369 Replace aortic valve w/byp C 00000 33990 Insert vad artery access C 00000 33991 Insert vad art&vein access C 00000 33992 Remove vad different session C 00000 33993 Reposition vad diff session C 00000 36221 Place cath thoracic aorta Q2 00279
HCPCS CodeDesc SI APC Edit ActivDate TermDate 36222 Place cath carotid/inom art Q2 00279 36223 Place cath carotid/inom art Q2 00279 36224 Place cath carotd art Q2 00280 36225 Place cath subclavian art Q2 00279 36226 Place cath vertebral art Q2 00280 36227 Place cath xtrnl carotid N 00000 36228 Place cath intracranial art N 00000 37197 Remove intrvas foreign body T 00623 37211 Thrombolytic art therapy T 00621 37212 Thrombolytic venous therapy T 00621 37213 Thromblytic art/ven therapy T 00622 37214 Cessj therapy cath removal T 00622 3751F Electrodiag polyneuro 6mon E 00000 28 3752F no electrodiag polyneuro6mon E 00000 28 3753F Pt has symp+signs neuropathy E 00000 28 3754F Screening tests dm done E 00000 28 3755F Cog+behav imprmnt scrng done E 00000 28 3756F Pt w/pseudobulb affect/als E 00000 28 3757F Pt w/no pseudobulbaffect/als E 00000 28 3758F Pt ref pulmon fx test/peak E 00000 28 3759F Pt scrn dysphag/wt loss/nutr E 00000 28 3760F Pt w/dysphag/wt loss/nutr E 00000 28 3761F Pt w/o dysphag/wt loss/nutr E 00000 28 3762F Patient is dysarthric E 00000 28 3763F Patient is not dysarthric E 00000 28 38243 Transplj hematopoietic boost S 00111 43206 Esoph optical endomicroscopy T 00419 43252 Uppr gi opticl endomicrscopy T 00419 44705 Prepare fecal microbiota B 00000 62 4540F Disease modif pharmacothxpy E 00000 28 4541F Pt offered tx for pseudobulb E 00000 28 4550F noninvas resp support talk E 00000 28 4551F Nutritional support offered E 00000 28 4552F Pt ref for speech lang path E 00000 28 4553F Pt asst re end life issues E 00000 28 4554F Pt recvd inhal anesthetic E 00000 28 4555F Pt recvd no inhal anesthic E 00000 28 4556F Ptw/ 3+ post-op nausea+vomm E 00000 28 4557F Pt w/o 3+ post-opnausea+vomm E 00000 28 4558F Pt recvd 2 rx anti-emetagnts E 00000 28 4559F 1 bodytemp >=35.5cw/in 30min E 00000 28 4560F Anesth w/o gen/neurax anesth E 00000 28 4561F Pt w/coronary artery stent E 00000 28 4562F Pt w/o coronary artery stent E 00000 28 4563F Pt recvd aspirin w/in 24 hrs E 00000 28 52287 Cystoscopy chemodenervation T 00161 64615 Chemodenerv musc migraine T 00204 78012 Thyroid uptake measurement S 00389 78013 Thyroid imaging w/blood flow S 00390 78014 Thyroid imaging w/blood flow S 00391 78071 Parathyrd planar w/wo subtrj X 00317 78072 Parathyrd planar w/spect&ct X 00317 81161 DMD dup/delet analysis E 00000 9 81201 Apc gene full sequence A 00000 81202 Apc gene known fam variants A 00000 81203 Apc gene dup/delet variants A 00000 81235 Egfr gene com variants A 00000 81252 Gjb2 gene full sequence A 00000 81253 Gjb2 gene known fam variants A 00000 81254 Gjb6 gene com variants A 00000 81321 Pten gene full sequence A 00000
HCPCS CodeDesc SI APC Edit ActivDate TermDate 81322 Pten gene known fam variant A 00000 81323 Pten gene dup/delet variant A 00000 81324 Pmp22 gene dup/delet A 00000 81325 Pmp22 gene full sequence A 00000 81326 Pmp22 gene known fam variant A 00000 81479 Unlisted molecular pathology A 00000 81500 Onco (ovar) two proteins A 00000 81503 Onco (ovar) five proteins A 00000 81506 Endo assay seven anal A 00000 81508 Ftl cgen abnor two proteins A 00000 81509 Ftl cgen abnor 3 proteins A 00000 81510 Ftl cgen abnor three anal A 00000 81511 Ftl cgen abnor four anal A 00000 81512 Ftl cgen abnor five anal A 00000 81599 Unlisted maaa E 00000 9 82777 Galectin 3 A 00000 86152 Cell enumeration & id X 00342 86153 Cell enumeration phys interp X 00342 86711 John cunningham antibody A 00000 86828 Hla class i&ii antibody qual A 00000 86829 Hla class i/ii antibody qual A 00000 86830 Hla class i phenotype qual A 00000 86831 Hla class ii phenotype qual A 00000 86832 Hla class i high defin qual A 00000 86833 Hla class ii high defin qual A 00000 86834 Hla class i semiquant panel A 00000 86835 Hla class ii semiquant panel A 00000 87631 Resp virus 3-11 targets A 00000 87632 Resp virus 6-11 targets A 00000 87633 Resp virus 12-25 targets A 00000 87910 Genotype cytomegalovirus A 00000 87912 Genotype dna hepatitis b A 00000 88375 Optical endomicroscpy interp X 00342 90653 Flu vaccine adjuvant im E 00000 9 90672 Flu vaccine 4 valent nasal L 00000 90685 Flu vac no prsv 4 val 6-35 m E 00000 28 90686 Flu vac no prsv 4 val 3 yrs+ E 00000 28 90687 Flu vaccine 4 val 6-35 mo im E 00000 28 90688 Flu vacc 4 val 3 yrs plus im E 00000 28 90739 Hep b vacc adult 2 dose im E 00000 9 90785 Psytx complex interactive N 00000 90791 Psych diagnostic evaluation Q3 00323 90792 Psych diag eval w/med srvcs Q3 00323 90832 Psytx pt&/family 30 minutes Q3 00322 90833 Psytx pt&/fam w/e&m 30 min N 00000 90834 Psytx pt&/family 45 minutes Q3 00323 90836 Psytx pt&/fam w/e&m 45 min N 00000 90837 Psytx pt&/family 60 minutes Q3 00323 90838 Psytx pt&/fam w/e&m 60 min N 00000 90839 Psytx crisis initial 60 min Q3 00323 90840 Psytx crisis ea addl 30 min N 00000 90863 Pharmacologic mgmt w/psytx E 00000 28 91112 Gi wireless capsule measure X 00361 92920 Prq cardiac angioplast 1 art T 00083 92921 Prq cardiac angio addl art T 00083 92924 Prq card angio/athrect 1 art T 00082 92925 Prq card angio/athrect addl T 00082 92928 Prq card stent w/angio 1 vsl T 00104 92929 Prq card stent w/angio addl T 00104 92933 Prq card stent/ath/angio T 00104 92934 Prq card stent/ath/angio T 00104
HCPCS CodeDesc SI APC Edit ActivDate TermDate 92937 Prq revasc byp graft 1 vsl T 00104 92938 Prq revasc byp graft addl T 00104 92941 Prq card revasc mi 1 vsl T 00104 92943 Prq card revasc chronic 1vsl T 00104 92944 Prq card revasc chronic addl T 00104 93653 Ep & ablate supravent arrhyt Q3 08000 93654 Ep & ablate ventric tachy Q3 08000 93655 Ablate arrhythmia add on N 00000 93656 Tx atrial fib pulm vein isol Q3 08000 93657 Tx l/r atrial fib addl N 00000 95017 Perq & icut allg test venoms X 00381 95018 Perq&ic allg test drugs/biol X 00381 95076 Ingest challenge ini 120 min X 00361 95079 Ingest challenge addl 60 min X 00360 95782 Polysom <6 yrs 4/> paramtrs S 00209 95783 Polysom <6 yrs cpap/bilvl S 00209 95907 Motor&/sens 1-2 nrv cndj tst S 00215 95908 Motor&/sens 3-4 nrv cndj tst S 00215 95909 Motor&/sens 5-6 nrv cndj tst S 00215 95910 Motor&sens 7-8 nrv cndj test S 00215 95911 Motor&sen 9-10 nrv cndj test S 00218 95912 Motor&sen 11-12 nrv cnd test S 00218 95913 Motor&sens 13/> nrv cnd test S 00218 95924 Ans parasymp & symp w/tilt S 00218 95940 Ionm in operatng room 15 min N 00000 95941 Ionm remote/>1 pt or per hr N 00000 95943 Parasymp&symp hrt rate test S 00215 99485 Suprv interfacilty transport B 00000 62 99486 Suprv interfac trnsport addl B 00000 62 99487 Cmplx chron care w/o pt vsit N 00000 99488 Cmplx chron care w/ pt vsit N 00000 99489 Complx chron care addl30 min N 00000 99495 Trans care mgmt 14 day disch V 00605 99496 Trans care mgmt 7 day disch V 00606 A4435 1pc ost pch drain hgh output A 00000 A9586 Florbetapir F18 E 00000 9 C9294 Inj, taliglucerase alfa G 09294 55 C9295 Injection, carfilzomib G 09295 55 C9296 Injection, ziv-aflibercept G 09296 55 C9600 Perc drug-el cor stent sing T 00656 55 C9601 Perc drug-el cor stent bran T 00656 55 C9602 Perc d-e cor stent ather s T 00656 55 C9603 Perc d-e cor stent ather br T 00656 55 C9604 Perc d-e cor revasc t cabg s T 00656 55 C9605 Perc d-e cor revasc t cabg b T 00656 55 C9606 Perc d-e cor revasc w AMI s T 00656 55 C9607 Perc d-e cor revasc chro sin T 00656 55 C9608 Perc d-e cor revasc chro add T 00656 55 D0190 Screening of a patient E 00000 28 D0191 Assessment of a patient E 00000 28 D0364 Cone beam ct capt & interp E 00000 28 D0365 Cone beam ct interprete man E 00000 28 D0366 Cone beam ct interprete max E 00000 28 D0367 Cone beam ct interp both jaw E 00000 28 D0368 Cone beam ct interprete TMJ E 00000 28 D0369 Max MRI capture & interprete E 00000 28 D0370 Max ultrasound capt & interp E 00000 28 D0371 Sialoendoscopy capt & interp E 00000 28 D0380 Cone beam ct capture limited E 00000 28 D0381 Cone beam ct capt mandible E 00000 28 D0382 Cone beam ct capt maxilla E 00000 28
HCPCS CodeDesc SI APC Edit ActivDate TermDate D0383 Cone beam ct both jaws E 00000 28 D0384 Cone beam ct capture TMJ E 00000 28 D0385 Max MRI image capture E 00000 28 D0386 Max ultrasound image capture E 00000 28 D0391 Imterprete diagnostic image E 00000 28 D1208 Topical app of fluoride E 00000 28 D2929 Prefab porc/ceram crown pri E 00000 28 D2981 Inlay repair E 00000 28 D2982 Onlay repair E 00000 28 D2983 Veneer repair E 00000 28 D2990 Resin infiltration of lesion E 00000 28 D4212 Gingivectomy/plasty rest E 00000 28 D4277 Soft tissue graft firsttooth E 00000 28 D4278 Soft tissue graft addl tooth E 00000 28 D6051 Interim abutment E 00000 28 D6101 Debridement of a periimplant E 00000 28 D6102 Debridement & contouring E 00000 28 D6103 Bone graft repair perimplant E 00000 28 D6104 Bone graft time of implant E 00000 28 D7921 Collect & appl blood product E 00000 28 D7952 Sinus augmentation vertical E 00000 28 D9975 External bleaching home app E 00000 28 E0670 Seg pneum int legs/trunk Y 00000 61 E2378 Pw actuator replacement Y 00000 61 G0452 Molecular pathology interpr B 00000 62 G0453 Cont intraop neuro monitor N 00000 G0454 MD document visit by NPP B 00000 62 G0455 Fecal microbiota prep instil X 00340 G0456 Neg pre wound <=50 sq cm T 00016 G0457 Neg pres wound >50 sq cm T 00016 G0458 LDR Prostate Brachy comp rat B 00000 62 G8919 Mst rcnt sys bp <140mmg M 00000 72 G8920 Mst rcnt sys bp >=140mmhg M 00000 72 G8921 Mst rcnt dia bp <90mmhg M 00000 72 G8922 Mst rcnt dia bp >=90mmhg M 00000 72 G8923 LVEF < 40% or lvsd M 00000 72 G8924 Spiro EV1/FVC <60% COPD
sym M 00000 72
G8925 Spiro>=60% or pt no COPD sym M 00000 72 G8926 Spiro no perf or doc M 00000 72 G8927 Adj chem pres AJCC III M 00000 72 G8928 Adj chem not pres rsn spec M 00000 72 G8929 Adj cmo not pres rsn not gvn M 00000 72 G8930 Assess of dep @ initial eval M 00000 72 G8931 Asses of dep not documented M 00000 72 G8932 Suicd rsk assessed init eval M 00000 72 G8933 Suicide risk not assessed M 00000 72 G8934 LVEF <40% or dep lv sys fcn M 00000 72 G8935 Rx ACE or ARB therapy M 00000 72 G8936 Pt not eligible ACE/ARB M 00000 72 G8937 No rx ACE/ARB therapy M 00000 72 G8938 BMI calc, pt no f/u plan elg M 00000 72 G8939 Pain assess doc, f/u no doc M 00000 72 G8940 Srn clin dep doc no f/u pln M 00000 72 G8941 No doc elder scrn, pt no el M 00000 72 G8942 Doc fcn/care plan w/30 days M 00000 72 G8943 LDLC not pres w/i 12 mo prir M 00000 72 G8944 AJCC Mel cnr stg 0 - IIC M 00000 72 G8945 Aneurysm <=6 cm for men M 00000 72 G8946 MIBM but no dx of breast CA M 00000 72 G8947 1 or more neuropsych M 00000 72
HCPCS CodeDesc SI APC Edit ActivDate TermDate G8948 No neuropsych symptoms M 00000 72 G8949 Doc pt reas on counsel diet M 00000 72 G8950 Pre-htn or htn doc, f/u indc M 00000 72 G8951 Pre-htn/htn doc, no pt f/u M 00000 72 G8952 Pre-htn/htn, no f/u, not gvn M 00000 72 G8953 Oncology MG qual act perform M 00000 72 G8954 Pt data rpt qual clin db reg M 00000 72 G8955 Most recent assess vol mgmt M 00000 72 G8956 Pt rcv HeDia outpt dyls fac M 00000 72 G8957 Pt no HeDia in outpt fac M 00000 72 G8958 Assess vol mgmt not doc M 00000 72 G8959 Clin tx MDD comm to tx clin M 00000 72 G8960 Clin tx MDD not comm M 00000 72 G8961 CSIT lowrisk surg pts preop M 00000 72 G8962 CSIT on pt any reas 30 days M 00000 72 G8963 CSI per asx pt w/PCI 2 yrs M 00000 72 G8964 CSI any other than PCI 2 yr M 00000 72 G8965 CSIT perf on low CHD rsk M 00000 72 G8966 CSIT perf sx or high CHD rsk M 00000 72 G8967 Wrfrn or oral antigoag pres M 00000 72 G8968 Md rsn no pres Wrfrn or othr M 00000 72 G8969 Pt rsn no pres Wrfrn or othr M 00000 72 G8970 No rsk fac or 1 mod risk TE M 00000 72 G8971 Warfrn or othr antcog no rx M 00000 72 G8972 1>=risk or>= mod risk for TE M 00000 72 G8973 Mst rcnt Hbb < 10g/dL M 00000 72 G8974 Hgb not doc rns not gvn M 00000 72 G8975 Hgb <10g/dL, med rsn M 00000 72 G8976 Hgb >= 10 g/dL M 00000 72 G8977 Oncology measures grp M 00000 72 G8978 Mobility current status E 00000 28 G8979 Mobility goal status E 00000 28 G8980 Mobility D/C status E 00000 28 G8981 Body pos current status E 00000 28 G8982 Body pos goal status E 00000 28 G8983 Body pos D/C status E 00000 28 G8984 Carry current status E 00000 28 G8985 Carry goal status E 00000 28 G8986 Carry D/C status E 00000 28 G8987 Self care current status E 00000 28 G8988 Self care goal status E 00000 28 G8989 Self care D/C status E 00000 28 G8990 Other PT/OT current status E 00000 28 G8991 Other PT/OT goal status E 00000 28 G8992 Other PT/OT D/C status E 00000 28 G8993 Sub PT/OT current status E 00000 28 G8994 Sub PT/OT goal status E 00000 28 G8995 Sub PT/OT D/C status E 00000 28 G8996 Swallow current status E 00000 28 G8997 Swallow goal status E 00000 28 G8998 Swallow D/C status E 00000 28 G8999 Motor speech current status E 00000 28 G9158 Motor speech D/C status E 00000 28 G9159 Lang comp current status E 00000 28 G9160 Lang comp goal status E 00000 28 G9161 Lang comp D/C status E 00000 28 G9162 Lang express current status E 00000 28 G9163 Lang express goal status E 00000 28 G9164 Lang express D/C status E 00000 28 G9165 Atten current status E 00000 28 G9166 Atten goal status E 00000 28
HCPCS CodeDesc SI APC Edit ActivDate TermDate G9167 Atten D/C status E 00000 28 G9168 Memory current status E 00000 28 G9169 Memory goal status E 00000 28 G9170 Memory D/C status E 00000 28 G9171 Voice current status E 00000 28 G9172 Voice goal status E 00000 28 G9173 Voice D/C status E 00000 28 G9174 Speech lang current status E 00000 28 G9175 Speech lang goal status E 00000 28 G9176 Speech lang D/C status E 00000 28 G9186 Motor speech goal status E 00000 28 J0178 Aflibercept injection G 01420 J0485 Belatacept injection G 09286 J0716 Centruroides immune f(ab) G 01431 J0890 Peginesatide injection A 00000 J1050 Medroxyprogesterone acetate N 00000 J1741 Ibuprofen injection N 00000 J1744 Icatibant injection K 01443 J2212 Methylnaltrexone injection K 01445 J7178 Human fibrinogen conc inj K 01414 J7315 Opthalmic mitomycin N 00000 J7527 Oral everolimus K 01444 J9002 Doxil injection K 07046 J9019 Erwinaze injection G 09289 J9042 Brentuximab vedotin inj G 09287 L5859 Knee-shin pro flex/ext cont A 00000 L7902 Tension ring, vac erect dev A 00000 L8605 Inj bulking agent anal canal N 00000 Q4131 Epifix G 09366 Q4132 Grafix core G 09368 Q4133 Grafix prime G 09369 Q4134 hMatrix E 00000 28 Q4135 Mediskin E 00000 28 Q4136 EZderm E 00000 28 Q9969 Non-HEU TC-99M add-on/dose K 01442 S9110 Telemonitoring/home per mnth E 00000 28 V5281 Ald fm/dm system, monaural E 00000 50 V5282 Ald fm/dm system binaural E 00000 50 V5283 Ald neck, loop ind receiver E 00000 50 V5284 Ald FM/DM ear level receiver E 00000 50 V5285 Ald fm/dm aud input receiver E 00000 50 V5286 Ald blu tooth fm/dm receiver E 00000 50 V5287 Ald fm/dm receiver, NOS E 00000 50 V5288 Ald fm/dm transmitter ald E 00000 50 V5289 Ald fm/dm adapt/boot couplin E 00000 50 V5290 Ald transmitter microphone E 00000 50
Deleted HCPCS/CPT Procedure Codes The following HCPCS/CPT code(s) were deleted from the IOCE, effective 01-01-13 HCPCS CodeDesc 0030T Antiprothrombin antibody 0048T Implant ventricular device 0050T Removal circulation assist 0173T Iop monit io pressure 0242T Gi tract transit & pres meas 0250T Insert bronchial valve 0251T Remov bronchial valve 0252T Remov bronch valve addl 0256T Evasc aortic hrt valve
HCPCS CodeDesc 0257T Opn tthrc aortic hrt valve 0258T Aortic hrt valv w/o card byp 0259T Aortic hrt valve w/card byp 0276T Bronch thermoplasty 1 lobe 0277T Bronch thermoplasty lobes 0279T Ctc test 0280T Ctc test w/i & r 29590 Application of foot splint 31656 Bronchoscopy inj for x-ray 31715 Injection for bronchus x-ray 32420 Puncture/clear lung 32421 Thoracentesis for aspiration 32422 Thoracentesis w/tube insert 37201 Transcatheter therapy infuse 37203 Transcatheter retrieval 37209 Change iv cath at thromb tx 43234 Upper gi endoscopy exam 65805 Drainage of eye 71040 Contrast x-ray of bronchi 71060 Contrast x-ray of bronchi 75650 Artery x-rays head & neck 75660 Artery x-rays head & neck 75662 Artery x-rays head & neck 75665 Artery x-rays head & neck 75671 Artery x-rays head & neck 75676 Artery x-rays neck 75680 Artery x-rays neck 75685 Artery x-rays spine 75900 Intravascular cath exchange 75961 Retrieval broken catheter 78000 Thyroid single uptake 78001 Thyroid multiple uptakes 78003 Thyroid suppress/stimul 78006 Thyroid imaging with uptake 78007 Thyroid image mult uptakes 78010 Thyroid imaging 78011 Thyroid imaging with flow 83890 Molecule isolate 83891 Molecule isolate nucleic 83892 Molecular diagnostics 83893 Molecule dot/slot/blot 83894 Molecule gel electrophor 83896 Molecular diagnostics 83897 Molecule nucleic transfer 83898 Molecule nucleic ampli each 83900 Molecule nucleic ampli 2 seq 83901 Molecule nucleic ampli addon 83902 Molecular diagnostics 83903 Molecule mutation scan 83904 Molecule mutation identify 83905 Molecule mutation identify 83906 Molecule mutation identify 83907 Lyse cells for nucleic ext 83908 Nucleic acid signal ampli 83909 Nucleic acid high resolute 83912 Genetic examination 83913 Molecular rna stabilization 83914 Mutation ident ola/sbce/aspe 88384 Eval molecular probes 11-50 88385 Eval molecul probes 51-250 88386 Eval molecul probes 251-500
HCPCS CodeDesc 90665 Lyme disease vaccine im 90701 Dtp vaccine im 90718 Td vaccine > 7 im 90801 Psy dx interview 90802 Intac psy dx interview 90804 Psytx office 20-30 min 90805 Psytx off 20-30 min w/e&m 90806 Psytx off 45-50 min 90807 Psytx off 45-50 min w/e&m 90808 Psytx office 75-80 min 90809 Psytx off 75-80 w/e&m 90810 Intac psytx off 20-30 min 90811 Intac psytx 20-30 w/e&m 90812 Intac psytx off 45-50 min 90813 Intac psytx 45-50 min w/e&m 90814 Intac psytx off 75-80 min 90815 Intac psytx 75-80 w/e&m 90816 Psytx hosp 20-30 min 90817 Psytx hosp 20-30 min w/e&m 90818 Psytx hosp 45-50 min 90819 Psytx hosp 45-50 min w/e&m 90821 Psytx hosp 75-80 min 90822 Psytx hosp 75-80 min w/e&m 90823 Intac psytx hosp 20-30 min 90824 Intac psytx hsp 20-30 w/e&m 90826 Intac psytx hosp 45-50 min 90827 Intac psytx hsp 45-50 w/e&m 90828 Intac psytx hosp 75-80 min 90829 Intac psytx hsp 75-80 w/e&m 90857 Intac group psytx 90862 Medication management 92980 Insert intracoronary stent 92981 Insert intracoronary stent 92982 Coronary artery dilation 92984 Coronary artery dilation 92995 Coronary atherectomy 92996 Coronary atherectomy add-on 93651 Ablate heart dysrhythm focus 93652 Ablate heart dysrhythm focus 95010 Percut allergy titrate test 95015 Id allergy titrate-drug/bug 95075 Ingestion challenge test 95900 Motor nerve conduction test 95903 Motor nerve conduction test 95904 Sense nerve conduction test 95920 Intraop nerve test add-on 95934 H-reflex test 95936 H-reflex test C9279 Injection, ibuprofen C9286 Injection, belatacept C9287 Inj, brentuximab vedotin C9288 Inj, centruroides (scorpion) C9289 Inj, erwinia chrysanthemi C9366 EpiFix wound cover C9368 Grafix core C9369 Grafix prime D0360 Cone beam ct D0362 Cone beam, two dimensional D1203 Topical app fluoride child D1204 Topical app fluoride adult D4271 Free soft tissue graft proc
HCPCS CodeDesc D6254 Interim pontic D6795 Interim retainer crown D6970 Post & core plus retainer D6972 Prefab post & core plus reta D6973 Core build up for retainer D6976 Each addtnl cast post D6977 Each addtl prefab post G0290 Drug-eluting stents, single G0291 Drug-eluting stents,each add G0911 Assess activity symptoms G0912 No Assess activity symptoms G8447 Pt vis doc use EHR cer ATCB G8448 Pt vis doc w/PQRI qual EHR G8468 ACE/ARB rx pt w/abn lvef G8469 Pt w/abn lvef inelig ACE/ARB G8470 Pt w/ normal lvef G8471 LVEF not performed/doc G8472 ACE/ARB no rx pt w/abn lvef G8524 Patch closure conv CEA G8525 No patch closure CEA G8526 No patch closure conv CEA G8546 CAP measures grp G8550 CAP MG qual act perform G8675 BP Syst >= 140 mmHg G8676 BP Diast >= 90 mmHg G8677 BP Syst < 130 mmHg G8678 BP Syst >=130 - 139 mmHg G8679 BP Diast < 80 mmHg G8680 BP Diast 80-89 mmHg G8695 Lvef >=40% G8715 Hemodialysis not 3 times wk G8716 Pt reas not great 1.2Kt/V G8727 Hemo, perit, or kidney trans G8750 Signs of melanoma present G8760 Epilepsy MG qual act perform G8786 Severity of angina assess G8787 Angina present G8788 Angina absent G8789 Severity angina not assess G8802 Pregnancy test order G8803 Doc reas no pregnancy test G8805 Pregnancy test not order G8819 Aneurysm <= 5.5 cm G8820 Aneurysm 5.6-6.0 cm G8821 Aneurysm not infarenal G8822 Male aneurysms >6cm G8823 Female aneurysm >6cm G8824 Female aneurysm 5.6-6.0 cm G8828 Aneurysm <= 5.5cm for men G8829 Aneurysm 5.6-6.0 cm for men G8830 Aneurysm >6cm for men G8831 Aneurysm >-6cm for women G8832 Aneurysm 5.6-6.0 women G8836 Stroke or TIA <120 days CEA G8837 Stroke or TIA >120 days CEA G8847 Pos Air Press not prescribed G8901 Epilepsy Measures Group G9141 Influenza A H1N1,admin w cou G9142 Influenza A H1N1, vaccine J1051 Medroxyprogesterone inj J1055 Medrxyprogester acetate inj
HCPCS Description Changes The following code descriptions were changed, effective 10-01-12 HCPCS Old Description New Description G9157 Transesophageal Doppler mon Transesoph doppl cardiac mon The following code descriptions were changed, effective 01-01-13 HCPCS Old Description New Description 00542 Anesth remvl pleura Anesthesia removal pleura 00561 Anesth heart surg < 1 yr Anesth heart surg <1 yr 01924 Anes ther interven rad art Anes ther interven rad artrl 01925 Anes ther interven rad car Anes ther interven rad card 01930 Anes ther interven rad vei Anes ther interven rad vein 01931 Anes ther interven rad tip Anes ther interven rad tips 0206T Pptr dbs alys car elec dta Remote algorithm analys ecg 0294T Ins lt atrl press mont addon Ins lt atrl mont pres lead 0306T Icar ischm mntrng interr eva icar ischm mntr interr eval 0529F Intrvl 3+yrs pts clnscp docd Intrvl 3/>yr pts clnscp docd 1052F Type location activity asses Type location activityasses 1100F Ptfalls assess-docd ge2+/yr Ptfalls assess-docd ge2>/yr 11200 Removal of skin tags Removal of skin tags <w/15 11300 Shave skin lesion Shave skin lesion 0.5 cm/< 11301 Shave skin lesion Shave skin lesion 0.6-1.0 cm 11302 Shave skin lesion Shave skin lesion 1.1-2.0 cm 11303 Shave skin lesion Shave skin lesion >2.0 cm 11305 Shave skin lesion Shave skin lesion 0.5 cm/< 11306 Shave skin lesion Shave skin lesion 0.6-1.0 cm 11307 Shave skin lesion Shave skin lesion 1.1-2.0 cm 11308 Shave skin lesion Shave skin lesion >2.0 cm 11310 Shave skin lesion Shave skin lesion 0.5 cm/< 11311 Shave skin lesion Shave skin lesion 0.6-1.0 cm 11312 Shave skin lesion Shave skin lesion 1.1-2.0 cm 11313 Shave skin lesion Shave skin lesion >2.0 cm 1134F Epsd bk pain for =< 6 wks Epsd bk pain for 6 wks/< 1135F Epsd bk pain for > 6 wks Epsd bk pain for >6 wks 1136F Epsd bk pain for <= 12 wks Epsd bk pain for 12 wks/< 1137F Epsd bk pain for > 12 wks Epsd bk pain for >12 wks 11400 Exc tr-ext b9+marg 0.5 < cm Exc tr-ext b9+marg 0.5 cm< 11403 Exc tr-ext b9+marg 2.1-3 cm Exc tr-ext b9+marg 2.1-3cm/< 11406 Exc tr-ext b9+marg > 4.0 cm Exc tr-ext b9+marg >4.0 cm 11420 Exc h-f-nk-sp b9+marg 0.5 < Exc h-f-nk-sp b9+marg 0.5/< 11426 Exc h-f-nk-sp b9+marg > 4 cm Exc h-f-nk-sp b9+marg >4 cm 11440 Exc face-mm b9+marg 0.5 < cm Exc face-mm b9+marg 0.5 cm/< 11446 Exc face-mm b9+marg > 4 cm Exc face-mm b9+marg >4 cm 11600 Exc tr-ext mal+marg 0.5 < cm Exc tr-ext mal+marg 0.5 cm/< 11606 Exc tr-ext mal+marg > 4 cm Exc tr-ext mal+marg >4 cm 11620 Exc h-f-nk-sp mal+marg 0.5 < Exc h-f-nk-sp mal+marg 0.5/<
HCPCS Old Description New Description 11626 Exc s/n/h/f/g mal+mrg > 4 cm Exc s/n/h/f/g mal+mrg >4 cm 11646 Exc f/e/e/n/l mal+mrg > 4 cm Exc f/e/e/n/l mal+mrg >4 cm 11719 Trim nail(s) Trim nail(s) any number 11770 Removal of pilonidal lesion Remove pilonidal cyst simple 11771 Removal of pilonidal lesion Remove pilonidal cyst exten 11772 Removal of pilonidal lesion Remove pilonidal cyst compl 11900 Injection into skin lesions Inject skin lesions </w 7 11901 Added skin lesions injection Inject skin lesions >7 11920 Correct skin color defects Correct skin color 6.0 cm/< 11921 Correct skin color defects Corect skin color 6.1-20.0cm 11922 Correct skin color defects Correct skin color ea 20.0cm 11950 Therapy for contour defects Tx contour defects 1 cc/< 11951 Therapy for contour defects Tx contour defects 1.1-5.0cc 11952 Therapy for contour defects Tx contour defects 5.1-10cc 11954 Therapy for contour defects Tx contour defects >10.0 cc 11976 Removal of contraceptive cap Remove contraceptive capsule 12001 Repair superficial wound(s) Rpr s/n/ax/gen/trnk 2.5cm/< 12002 Repair superficial wound(s) Rpr s/n/ax/gen/trnk2.6-7.5cm 12004 Repair superficial wound(s) Rpr s/n/ax/gen/trk7.6-12.5cm 12005 Repair superficial wound(s) Rpr s/n/a/gen/trk12.6-20.0cm 12006 Repair superficial wound(s) Rpr s/n/a/gen/trk20.1-30.0cm 12007 Repair superficial wound(s) Rpr s/n/ax/gen/trnk >30.0 cm 12011 Repair superficial wound(s) Rpr f/e/e/n/l/m 2.5 cm/< 12013 Repair superficial wound(s) Rpr f/e/e/n/l/m 2.6-5.0 cm 12014 Repair superficial wound(s) Rpr f/e/e/n/l/m 5.1-7.5 cm 12015 Repair superficial wound(s) Rpr f/e/e/n/l/m 7.6-12.5 cm 12016 Repair superficial wound(s) Rpr fe/e/en/l/m 12.6-20.0 cm 12017 Repair superficial wound(s) Rpr fe/e/en/l/m 20.1-30.0 cm 12018 Repair superficial wound(s) Rpr f/e/e/n/l/m >30.0 cm 12031 Intmd wnd repair s/a/t/ext Intmd rpr s/a/t/ext 2.5 cm/< 12032 Intmd wnd repair s/a/t/ext Intmd rpr s/a/t/ext 2.6-7.5 12034 Intmd wnd repair s/tr/ext Intmd rpr s/tr/ext 7.6-12.5 12035 Intmd wnd repair s/a/t/ext Intmd rpr s/a/t/ext 12.6-20 12036 Intmd wnd repair s/a/t/ext Intmd rpr s/a/t/ext 20.1-30 12037 Intmd wnd repair s/tr/ext Intmd rpr s/tr/ext >30.0 cm 12041 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit 2.5cm/< 12042 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit2.6-7.5 12044 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit7.6-12.5 12045 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit12.6-20 12046 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit20.1-30 12047 Intmd wnd repair n-hf/genit Intmd rpr n-hf/genit >30.0cm 12051 Intmd wnd repair face/mm Intmd rpr face/mm 2.5 cm/< 12052 Intmd wnd repair face/mm Intmd rpr face/mm 2.6-5.0 cm 12053 Intmd wnd repair face/mm Intmd rpr face/mm 5.1-7.5 cm 12054 Intmd wnd repair face/mm Intmd rpr face/mm 7.6-12.5cm 12055 Intmd wnd repair face/mm Intmd rpr face/mm 12.6-20 cm 12056 Intmd wnd repair face/mm Intmd rpr face/mm 20.1-30.0 12057 Intmd wnd repair face/mm Intmd rpr face/mm >30.0 cm 13100 Repair of wound or lesion Cmplx rpr trunk 1.1-2.5 cm 13101 Repair of wound or lesion Cmplx rpr trunk 2.6-7.5 cm 13102 Repair wound/lesion add-on Cmplx rpr trunk addl 5cm/< 13120 Repair of wound or lesion Cmplx rpr s/a/l 1.1-2.5 cm 13121 Repair of wound or lesion Cmplx rpr s/a/l 2.6-7.5 cm 13122 Repair wound/lesion add-on Cmplx rpr s/a/l addl 5 cm/> 13131 Repair of wound or lesion Cmplx rpr f/c/c/m/n/ax/g/h/f 13132 Repair of wound or lesion Cmplx rpr f/c/c/m/n/ax/g/h/f 13133 Repair wound/lesion add-on Cmplx rpr f/c/c/m/n/ax/g/h/f 13150 Repair of wound or lesion Cmplx rpr e/n/e/l 1.0 cm/< 13151 Repair of wound or lesion Cmplx rpr e/n/e/l 1.1-2.5 cm 13152 Repair of wound or lesion Cmplx rpr e/n/e/l 2.6-7.5 cm 13153 Repair wound/lesion add-on Cmplx rpr e/n/e/l addl 5cm/<
HCPCS Old Description New Description 14000 Skin tissue rearrangement Tis trnfr trunk 10 sq cm/< 14001 Skin tissue rearrangement Tis trnfr trunk 10.1-30sqcm 14020 Skin tissue rearrangement Tis trnfr s/a/l 10 sq cm/< 14021 Skin tissue rearrangement Tis trnfr s/a/l 10.1-30 sqcm 14040 Skin tissue rearrangement Tis trnfr f/c/c/m/n/a/g/h/f 14041 Skin tissue rearrangement Tis trnfr f/c/c/m/n/a/g/h/f 14060 Skin tissue rearrangement Tis trnfr e/n/e/l 10 sq cm/< 14061 Skin tissue rearrangement Tis trnfr e/n/e/l10.1-30sqcm 14301 Skin tissue rearrangement Tis trnfr any 30.1-60 sq cm 14302 Skin tissue rearrange add-on Tis trnfr addl 30 sq cm/< 14350 Skin tissue rearrangement Filleted finger/toe flap 15570 Form skin pedicle flap Skin pedicle flap trunk 15572 Form skin pedicle flap Skin pedicle flap arms/legs 15574 Form skin pedicle flap Pedcle fh/ch/ch/m/n/ax/g/h/f 15576 Form skin pedicle flap Pedicle e/n/e/l/ntroral 15600 Skin graft Delay flap trunk 15610 Skin graft Delay flap arms/legs 15620 Skin graft Delay flap f/c/c/n/ax/g/h/f 15630 Skin graft Delay flap eye/nos/ear/lip 15750 Neurovascular pedicle graft Neurovascular pedicle flap 15775 Hair transplant punch grafts Hair trnspl 1-15 punch grfts 15776 Hair transplant punch grafts Hair trnspl >15 punch grafts 15780 Abrasion treatment of skin Dermabrasion total face 15781 Abrasion treatment of skin Dermabrasion segmental face 15782 Abrasion treatment of skin Dermabrasion other than face 15783 Abrasion treatment of skin Dermabrasion suprfl any site 15832 Excise excessive skin tissue Excise excessive skin thigh 15833 Excise excessive skin tissue Excise excessive skin leg 15834 Excise excessive skin tissue Excise excessive skin hip 15835 Excise excessive skin tissue Excise excessive skin buttck 15836 Excise excessive skin tissue Excise excessive skin arm 15837 Excise excessive skin tissue Excise excess skin arm/hand 15838 Excise excessive skin tissue Excise excess skin fat pad 15839 Excise excessive skin tissue Excise excess skin & tissue 15840 Graft for face nerve palsy Nerve palsy fascial graft 15841 Graft for face nerve palsy Nerve palsy muscle graft 15842 Flap for face nerve palsy Nerve palsy microsurg graft 15850 Removal of sutures Remove sutures same surgeon 15851 Removal of sutures Remove sutures diff surgeon 15876 Suction assisted lipectomy Suction lipectomy head&neck 15877 Suction assisted lipectomy Suction lipectomy trunk 15878 Suction assisted lipectomy Suction lipectomy upr extrem 15879 Suction assisted lipectomy Suction lipectomy lwr extrem 20553 Inject trigger points =/> 3 Inject trigger points 3/> 21011 Exc face les sc < 2 cm Exc face les sc <2 cm 21012 Exc face les sbq 2 cm/> Exc face les sbq 2 cm/< 21141 Reconstruct midface lefort Lefort i-1 piece w/o graft 21142 Reconstruct midface lefort Lefort i-2 piece w/o graft 21143 Reconstruct midface lefort Lefort i-3/> piece w/o graft 21145 Reconstruct midface lefort Lefort i-1 piece w/ graft 21146 Reconstruct midface lefort Lefort i-2 piece w/ graft 21147 Reconstruct midface lefort Lefort i-3/> piece w/ graft 21150 Reconstruct midface lefort Lefort ii anterior intrusion 21151 Reconstruct midface lefort Lefort ii w/bone grafts 21154 Reconstruct midface lefort Lefort iii w/o lefort i 21155 Reconstruct midface lefort Lefort iii w/ lefort i 21159 Reconstruct midface lefort Lefort iii w/fhdw/o lefort i 21160 Reconstruct midface lefort Lefort iii w/fhd w/ lefort i 21310 Treatment of nose fracture Closed tx nose fx w/o manj 21315 Treatment of nose fracture Closed tx nose fx w/o stablj 21320 Treatment of nose fracture Closed tx nose fx w/ stablj
HCPCS Old Description New Description 21325 Treatment of nose fracture Open tx nose fx uncomplicatd 21330 Treatment of nose fracture Open tx nose fx w/skele fixj 21335 Treatment of nose fracture Open tx nose & septal fx 21336 Treat nasal septal fracture Open tx septal fx w/wo stabj 21337 Treat nasal septal fracture Closed tx septal&nose fx 21338 Treat nasoethmoid fracture Open nasoethmoid fx w/o fixj 21339 Treat nasoethmoid fracture Open nasoethmoid fx w/ fixj 21340 Treatment of nose fracture Perq tx nasoethmoid fx 21343 Treatment of sinus fracture Open tx dprsd front sinus fx 21344 Treatment of sinus fracture Open tx compl front sinus fx 21345 Treat nose/jaw fracture Closed tx nose/jaw fx 21346 Treat nose/jaw fracture Opn tx nasomax fx w/fixj 21347 Treat nose/jaw fracture Opn tx nasomax fx multple 21348 Treat nose/jaw fracture Opn tx nasomax fx w/graft 21355 Treat cheek bone fracture Perq tx malar fracture 21356 Treat cheek bone fracture Opn tx dprsd zygomatic arch 21360 Treat cheek bone fracture Opn tx dprsd malar fracture 21365 Treat cheek bone fracture Opn tx complx malar fx 21366 Treat cheek bone fracture Opn tx complx malar w/grft 21385 Treat eye socket fracture Opn tx orbit fx transantral 21386 Treat eye socket fracture Opn tx orbit fx periorbital 21387 Treat eye socket fracture Opn tx orbit fx combined 21390 Treat eye socket fracture Opn tx orbit periorbtl implt 21395 Treat eye socket fracture Opn tx orbit periorbt w/grft 21400 Treat eye socket fracture Closed tx orbit w/o manipulj 21401 Treat eye socket fracture Closed tx orbit w/ manipulj 21406 Treat eye socket fracture Opn tx orbit fx w/o implant 21407 Treat eye socket fracture Opn tx orbit fx w/implant 21408 Treat eye socket fracture Opn tx orbit fx w/bone grft 22015 I&d p-spine l/s/ls I&d abscess p-spine l/s/ls 22206 Cut spine 3 col thor Incis spine 3 column thorac 22207 Cut spine 3 col lumb Incis spine 3 column lumbar 22208 Cut spine 3 col addl seg Incis spine 3 column adl seg 22210 Revision of neck spine Incis 1 vertebral seg cerv 22212 Revision of thorax spine Incis 1 vertebral seg thorac 22214 Revision of lumbar spine Incis 1 vertebral seg lumbar 22216 Revise extra spine segment Incis addl spine segment 22220 Revision of neck spine Incis w/discectomy cervical 22222 Revision of thorax spine Incis w/discectomy thoracic 22224 Revision of lumbar spine Incis w/discectomy lumbar 22305 Treat spine process fracture Closed tx spine process fx 22310 Treat spine fracture Closed tx vert fx w/o manj 22315 Treat spine fracture Closed tx vert fx w/manj 22800 Fusion of spine Post fusion </6 vert seg 22802 Fusion of spine Post fusion 7-12 vert seg 22804 Fusion of spine Post fusion 13/> vert seg 22808 Fusion of spine Ant fusion 2-3 vert seg 22810 Fusion of spine Ant fusion 4-7 vert seg 22812 Fusion of spine Ant fusion 8/> vert seg 28890 High energy eswt plantar f Hi enrgy eswt plantar fascia 3022F Lvef >=40% systolic Lvef >/=40% systolic 3025F Spirom fev/fvc<70% w/copd Spirom fev/fvc <70% w/copd 3027F Spirom fev/fvc>=70%/w/o copd Spirom fev/fvc>/=70%/w/ocopd 3035F O2 saturation<=88% /pao<=55 O2 saturation</=88%/pao</=55 3037F O2 saturation> 88% /pao>55 O2 saturation >88%/pao>55 hg 3040F Fev<40% predicted value Fev <40% predicted value 3042F Fev>=40% predicted value Fev >/=40% predicted value 3046F Hemoglobin a1c level > 9.0% Hemoglobin a1c level >9.0% 3050F Ldl-c >= 130 mg/dl Ldl-c >/= 130 mg/dl 3077F Syst bp >= 140 mm hg Syst bp >/= 140 mm hg 3078F Diast bp < 80 mm hg Diast bp <80 mm hg
HCPCS Old Description New Description 3080F Diast bp >= 90 mm hg Diast bp >/= 90 mm hg 3082F Kt/v <1.2 Kt/v >1.2 3083F Kt/v > 1.2 <1.7 Kt/v =/> 1.2 & <1.7 3112F Ct/mri brain done >24 hrs Ct/mri brain done 24 hrs 3281F Hgb lvl < 11 g/dl Hgb lvl <11 g/dl 3322F Melanoma>ajcc stage 0 or ia Melanomaajcc stage 0 or ia 3493F No hist cd4+ cell count<350 No hist cd4+ cell count <350 3498F Cd4+ cell >=15% (hiv) Cd4+ cell =15% (hiv) 35152 Repair artery rupture knee Repair ruptd popliteal art 3520F Cdifficile testing performe Cdifficile testing performed 35501 Artery bypass graft Art byp grft ipsilat carotid 35506 Artery bypass graft Art byp grft subclav-carotid 35508 Artery bypass graft Art byp grft carotid-vertbrl 35509 Artery bypass graft Art byp grft contral carotid 35510 Artery bypass graft Art byp grft carotid-brchial 35511 Artery bypass graft Art byp grft subclav-subclav 35512 Artery bypass graft Art byp grft subclav-brchial 35515 Artery bypass graft Art byp grft subclav-vertbrl 35516 Artery bypass graft Art byp grft subclav-axilary 35518 Artery bypass graft Art byp grft axillary-axilry 35521 Artery bypass graft Art byp grft axill-femoral 35522 Artery bypass graft Art byp grft axill-brachial 35523 Artery bypass graft Art byp grft brchl-ulnr-rdl 35525 Artery bypass graft Art byp grft brachial-brchl 35526 Artery bypass graft Art byp grft aor/carot/innom 35531 Artery bypass graft Art byp grft aorcel/aormesen 35533 Artery bypass graft Art byp grft axill/fem/fem 35535 Artery bypass graft Art byp grft hepatorenal 35536 Artery bypass graft Art byp grft splenorenal 35537 Artery bypass graft Art byp grft aortoiliac 35538 Artery bypass graft Art byp grft aortobi-iliac 35539 Artery bypass graft Art byp grft aortofemoral 35540 Artery bypass graft Art byp grft aortbifemoral 35556 Artery bypass graft Art byp grft fem-popliteal 35558 Artery bypass graft Art byp grft fem-femoral 35560 Artery bypass graft Art byp grft aortorenal 35563 Artery bypass graft Art byp grft ilioiliac 35565 Artery bypass graft Art byp grft iliofemoral 35566 Artery bypass graft Art byp fem-ant-post tib/prl 35570 Artery bypass graft Art byp tibial-tib/peroneal 35571 Artery bypass graft Art byp pop-tibl-prl-other 35583 Vein bypass graft Vein byp grft fem-popliteal 35585 Vein bypass graft Vein byp fem-tibial peroneal 35587 Vein bypass graft Vein byp pop-tibl peroneal 35601 Artery bypass graft Art byp common ipsi carotid 35606 Artery bypass graft Art byp carotid-subclavian 35612 Artery bypass graft Art byp subclav-subclavian 35616 Artery bypass graft Art byp subclav-axillary 35621 Artery bypass graft Art byp axillary-femoral 35623 Bypass graft not vein Art byp axillary-pop-tibial 35626 Artery bypass graft Art byp aorsubcl/carot/innom 35631 Artery bypass graft Art byp aor-celiac-msn-renal 35632 Artery bypass graft Art byp ilio-celiac 35633 Artery bypass graft Art byp ilio-mesenteric 35634 Artery bypass graft Art byp iliorenal 35636 Artery bypass graft Art byp spenorenal 35637 Artery bypass graft Art byp aortoiliac 35638 Artery bypass graft Art byp aortobi-iliac 35642 Artery bypass graft Art byp carotid-vertebral 35645 Artery bypass graft Art byp subclav-vertebrl 35646 Artery bypass graft Art byp aortobifemoral
HCPCS Old Description New Description 35647 Artery bypass graft Art byp aortofemoral 35650 Artery bypass graft Art byp axillary-axillary 35654 Artery bypass graft Art byp axill-fem-femoral 35656 Artery bypass graft Art byp femoral-popliteal 35661 Artery bypass graft Art byp femoral-femoral 35663 Artery bypass graft Art byp ilioiliac 35665 Artery bypass graft Art byp iliofemoral 35666 Artery bypass graft Art byp fem-ant-post tib/prl 35671 Artery bypass graft Art byp pop-tibl-prl-other 35681 Composite bypass graft Composite byp grft pros&vein 35682 Composite bypass graft Composite byp grft 2 veins 35683 Composite bypass graft Composite byp grft 3/> segmt 35691 Arterial transposition Art trnsposj vertbrl carotid 35693 Arterial transposition Art trnsposj subclavian 35694 Arterial transposition Art trnsposj subclav carotid 35695 Arterial transposition Art trnsposj carotid subclav 36405 Bl draw < 3 yrs scalp vein Bl draw <3 yrs scalp vein 36406 Bl draw < 3 yrs other vein Bl draw <3 yrs other vein 36410 Non-routine bl draw > 3 yrs Non-routine bl draw 3/> yrs 36440 Bl push transfuse 2 yr or < Bl push transfuse 2 yr/< 38240 Bn marrow/stm transplt allo Transplt allo hct/donor 38241 Bn marrow/stm transplt auto Transplt autol hct/donor 38242 Lymphocyte infuse transplant Transplt allo lymphocytes 4142F Corticoster sparng txmnt rxd Corticoster sparng thrpy rxd 4175F Vis of >= 20/40 w/in 90 days Vis 20/40/> w/in 90 days 4194F Pt rcvng>10mg daily predniso Pt rcvng10mg daily predniso 4240F Instr xrcz 4bk pn >12 weeks Instr xrcz back pain 12 wks 4242F Sprvsd xrcz bk pn >12 weeks Sprvsd xrcz back pn >12 wks 4481F Pt rcvng ace/arb blker<3mons Pt rcvng ace/arb blker >3mos 5010F Macul result to phy mng dm Macul result phy/qhp mng dm 5020F Txmnts 2 main Dr by 1 mon Txmnts 2 phys/qhp by 1 mon 62310 Inject spine c/t Inject spine cerv/thoracic 62311 Inject spine l/s (cd) Inject spine lumbar/sacral 62318 Inject spine w/cath c/t Inject spine w/cath crv/thrc 62319 Inject spine w/cath l/s (cd) Inject spine w/cath lmb/scrl 63001 Removal of spinal lamina Remove spine lamina 1/2 crvl 63003 Removal of spinal lamina Remove spine lamina 1/2 thrc 63005 Removal of spinal lamina Remove spine lamina 1/2 lmbr 63011 Removal of spinal lamina Remove spine lamina 1/2 scrl 63012 Removal of spinal lamina Remove lamina/facets lumbar 63015 Removal of spinal lamina Remove spine lamina >2 crvcl 63016 Removal of spinal lamina Remove spine lamina >2 thrc 63017 Removal of spinal lamina Remove spine lamina >2 lmbr 63045 Removal of spinal lamina Remove spine lamina 1 crvl 63046 Removal of spinal lamina Remove spine lamina 1 thrc 63047 Removal of spinal lamina Remove spine lamina 1 lmbr 63050 Cervical laminoplasty Cervical laminoplsty 2/> seg 63055 Decompress spinal cord Decompress spinal cord thrc 63056 Decompress spinal cord Decompress spinal cord lmbr 63064 Decompress spinal cord Decompress spinal cord thrc 63081 Removal of vertebral body Remove vert body dcmprn crvl 63085 Removal of vertebral body Remove vert body dcmprn thrc 63087 Removal of vertebral body Remov vertbr dcmprn thrclmbr 63090 Removal of vertebral body Remove vert body dcmprn lmbr 63101 Removal of vertebral body Remove vert body dcmprn thrc 63102 Removal of vertebral body Remove vert body dcmprn lmbr 63185 Incise spinal column/nerves Incise spine nrv half segmnt 63190 Incise spinal column/nerves Incise spine nrv >2 segmnts 63191 Incise spinal column/nerves Incise spine accessory nerve 63194 Incise spinal column & cord Incise spine & cord cervical 63195 Incise spinal column & cord Incise spine & cord thoracic
HCPCS Old Description New Description 63196 Incise spinal column & cord Incise spine&cord 2 trx crvl 63197 Incise spinal column & cord Incise spine&cord 2 trx thrc 63198 Incise spinal column & cord Incise spin&cord 2 stgs crvl 63199 Incise spinal column & cord Incise spin&cord 2 stgs thrc 63200 Release of spinal cord Release spinal cord lumbar 63250 Revise spinal cord vessels Revise spinal cord vsls crvl 63251 Revise spinal cord vessels Revise spinal cord vsls thrc 63252 Revise spinal cord vessels Revise spine cord vsl thrlmb 63265 Excise intraspinal lesion Excise intraspinl lesion crv 63266 Excise intraspinal lesion Excise intrspinl lesion thrc 63267 Excise intraspinal lesion Excise intrspinl lesion lmbr 63268 Excise intraspinal lesion Excise intrspinl lesion scrl 63270 Excise intraspinal lesion Excise intrspinl lesion crvl 63271 Excise intraspinal lesion Excise intrspinl lesion thrc 63272 Excise intraspinal lesion Excise intrspinl lesion lmbr 63273 Excise intraspinal lesion Excise intrspinl lesion scrl 63275 Biopsy/excise spinal tumor Bx/exc xdrl spine lesn crvl 63276 Biopsy/excise spinal tumor Bx/exc xdrl spine lesn thrc 63277 Biopsy/excise spinal tumor Bx/exc xdrl spine lesn lmbr 63278 Biopsy/excise spinal tumor Bx/exc xdrl spine lesn scrl 63280 Biopsy/excise spinal tumor Bx/exc idrl spine lesn crvl 63281 Biopsy/excise spinal tumor Bx/exc idrl spine lesn thrc 63282 Biopsy/excise spinal tumor Bx/exc idrl spine lesn lmbr 63283 Biopsy/excise spinal tumor Bx/exc idrl spine lesn scrl 63285 Biopsy/excise spinal tumor Bx/exc idrl imed lesn cervl 63286 Biopsy/excise spinal tumor Bx/exc idrl imed lesn thrc 63287 Biopsy/excise spinal tumor Bx/exc idrl imed lesn thrlmb 63290 Biopsy/excise spinal tumor Bx/exc xdrl/idrl lsn any lvl 63295 Repair of laminectomy defect Repair laminectomy defect 63300 Removal of vertebral body Remove vert xdrl body crvcl 63301 Removal of vertebral body Remove vert xdrl body thrc 63302 Removal of vertebral body Remove vert xdrl body thrlmb 63303 Removal of vertebral body Remov vert xdrl bdy lmbr/sac 63304 Removal of vertebral body Remove vert idrl body crvcl 63305 Removal of vertebral body Remove vert idrl body thrc 63306 Removal of vertebral body Remov vert idrl bdy thrclmbr 63307 Removal of vertebral body Remov vert idrl bdy lmbr/sac 64802 Remove sympathetic nerves Sympathectomy cervical 64820 Remove sympathetic nerves Sympathectomy digital artery 64823 Remove sympathetic nerves Sympathectomy supfc palmar 64885 Nerve graft head or neck Nerve graft head/neck </4 cm 64886 Nerve graft head or neck Nerve graft head/neck >4 cm 64890 Nerve graft hand or foot Nerve graft hand/foot </4 cm 64891 Nerve graft hand or foot Nerve graft hand/foot >4 cm 64892 Nerve graft arm or leg Nerve graft arm/leg <4 cm 64893 Nerve graft arm or leg Nerve graft arm/leg >4 cm 64895 Nerve graft hand or foot Nerve graft hand/foot </4 cm 64896 Nerve graft hand or foot Nerve graft hand/foot >4 cm 64897 Nerve graft arm or leg Nerve graft arm/leg </4 cm 64898 Nerve graft arm or leg Nerve graft arm/leg >4 cm 67810 Biopsy of eyelid Biopsy eyelid & lid margin 70100 X-ray exam of jaw X-ray exam of jaw <4views 70110 X-ray exam of jaw X-ray exam of jaw 4/> views 70543 Mri orbt/fac/nck w/o & w/dye Mri orbt/fac/nck w/o &w/dye 70551 Mri brain w/o dye Mri brain stem w/o dye 70552 Mri brain w/dye Mri brain stem w/dye 70553 Mri brain w/o & w/dye Mri brain stem w/o & w/dye 71010 Chest x-ray Chest x-ray 1 view frontal 71015 Chest x-ray Chest x-ray stereo frontal 71020 Chest x-ray Chest x-ray 2vw frontal&latl 71021 Chest x-ray Chest x-ray frnt lat lordotc
HCPCS Old Description New Description 71022 Chest x-ray Chest x-ray frnt lat oblique 71030 Chest x-ray Chest x-ray 4/> views 71034 Chest x-ray and fluoroscopy Chest x-ray&fluoro 4/> views 71035 Chest x-ray Chest x-ray special views 71100 X-ray exam of ribs X-ray exam ribs uni 2 views 71101 X-ray exam of ribs/chest X-ray exam unilat ribs/chest 71110 X-ray exam of ribs X-ray exam ribs bil 3 views 71111 X-ray exam of ribs/chest X-ray exam ribs/chest4/> vws 71120 X-ray exam of breastbone X-ray exam breastbone 2/>vws 71130 X-ray exam of breastbone X-ray strenoclavic jt 3/>vws 72010 X-ray exam of spine X-ray exam spine ap&lat 72020 X-ray exam of spine X-ray exam of spine 1 view 72040 X-ray exam of neck spine X-ray exam neck spine 3/<vws 72050 X-ray exam of neck spine X-ray exam neck spine 4/5vws 72052 X-ray exam of neck spine X-ray exam neck spine 6/>vws 72069 X-ray exam of trunk spine X-ray exam trunk spine stand 72070 X-ray exam of thoracic spine X-ray exam thorac spine 2vws 72072 X-ray exam of thoracic spine X-ray exam thorac spine 3vws 72074 X-ray exam of thoracic spine X-ray exam thorac spine4/>vw 72080 X-ray exam of trunk spine X-ray exam trunk spine 2 vws 72090 X-ray exam of trunk spine X-ray exam scloiosis erect 72100 X-ray exam of lower spine X-ray exam l-s spine 2/3 vws 72110 X-ray exam of lower spine X-ray exam l-2 spine 4/>vws 72114 X-ray exam of lower spine X-ray exam l-s spine bending 72120 X-ray exam of lower spine X-ray bend only l-s spine 72200 X-ray exam sacroiliac joints X-ray exam si joints 72202 X-ray exam sacroiliac joints X-ray exam si joints 3/> vws 72220 X-ray exam of tailbone X-ray exam sacrum tailbone 72240 Contrast x-ray of neck spine Myelography neck spine 72255 Contrast x-ray thorax spine Myelography thoracic spine 72265 Contrast x-ray lower spine Myelography l-s spine 72270 Contrast x-ray spine Myelogphy 2/> spine regions 72285 X-ray c/t spine disk Discography cerv/thor spine 74240 X-ray exam upper gi tract X-ray upper gi delay w/o kub 74241 X-ray exam upper gi tract X-rayupper gi delay w/kub 74245 X-ray exam upper gi tract X-ray upper gi&small intest 75600 Contrast x-ray exam of aorta Contrast exam thoracic aorta 75605 Contrast x-ray exam of aorta Contrast exam thoracic aorta 75625 Contrast x-ray exam of aorta Contrast exam abdominl aorta 75872 Vein x-ray skull Vein x-ray skull epidural 75885 Vein x-ray liver Vein x-ray liver w/hemodynam 75887 Vein x-ray liver Vein x-ray liver w/o hemodyn 75889 Vein x-ray liver Vein x-ray liver w/hemodynam 76376 3d render w/o postprocess 3d render w/intrp postproces 76377 3d rendering w/postprocess 3d render w/intrp postproces 78070 Parathyroid nuclear imaging Parathyroid planar imaging 78075 Adrenal nuclear imaging Adrenal cortex & medulla img 82746 Blood folic acid serum Assay of folic acid serum 82985 Glycated protein Assay of glycated protein 83001 Gonadotropin (FSH) Assay of gonadotropin (fsh) 83002 Gonadotropin (LH) Assay of gonadotropin (lh) 83150 Assay of for hva Assay of homovanillic acid 83491 Assay of corticosteroids Assay of corticosteroids 17 83498 Assay of progesterone Assay of progesterone 17-d 83499 Assay of progesterone Assay of progesterone 20- 83775 Assay of md enzyme Assay malate dehydrogenase 83880 Natriuretic peptide Assay of natriuretic peptide 84081 Amniotic fluid enzyme test Assay phosphatidylglycerol 84402 Assay of testosterone Assay of free testosterone 84445 Assay of tsi Assay of tsi globulin 85210 Blood clot factor II test Clot factor ii prothrom spec
HCPCS Old Description New Description 85220 Blood clot factor V test Blooc clot factor v test 85230 Blood clot factor VII test Clot factor vii proconvertin 85240 Blood clot factor VIII test Clot factor viii ahg 1 stage 85244 Blood clot factor VIII test Clot factor viii reltd antgn 85245 Blood clot factor VIII test Clot factor viii vw ristoctn 85246 Blood clot factor VIII test Clot factor viii vw antigen 85247 Blood clot factor VIII test Clot factor viii multimetric 85250 Blood clot factor IX test Clot factor ix ptc/chrstmas 85260 Blood clot factor X test Clot factor x stuart-power 85270 Blood clot factor XI test Clot factor xi pta 85280 Blood clot factor XII test Clot factor xii hageman 85290 Blood clot factor XIII test Clot factor xiii fibrin stab 85291 Blood clot factor XIII test Clot factor xiii fibrin scrn 85292 Blood clot factor assay Clot factor fletcher fact 85293 Blood clot factor assay Clot factor wght kininogen 85300 Antithrombin III test Antithrombin iii activity 85301 Antithrombin III test Antithrombin iii antigen 85302 Blood clot inhibitor antigen Clot inhibit prot c antigen 85303 Blood clot inhibitor test Clot inhibit prot c activity 85305 Blood clot inhibitor assay Clot inhibit prot s total 85306 Blood clot inhibitor test Clot inhibit prot s free 85345 Coagulation time Coagulation time lee & white 85347 Coagulation time Coagulation time activated 85348 Coagulation time Coagulation time otr method 85380 Fibrin degradation vte Fibrin degradj d-dimer 85384 Fibrinogen Fibrinogen activity 85385 Fibrinogen Fibrinogen antigen 85390 Fibrinolysins screen Fibrinolysins screen i&r 85475 Hemolysin Hemolysin acid 86000 Agglutinins febrile Agglutinins febrile antigen 86077 Physician blood bank service Phys blood bank serv xmatch 86078 Physician blood bank service Phys blood bank serv reactj 86079 Physician blood bank service Phys blood bank serv authrj 86146 Glycoprotein antibody Beta-2 glycoprotein antibody 86147 Cardiolipin antibody Cardiolipin antibody ea ig 86148 Phospholipid antibody Anti-phospholipid antibody 86225 DNA antibody Dna antibody native 86308 Heterophile antibodies Heterophile antibody screen 86309 Heterophile antibodies Heterophile antibody titer 86310 Heterophile antibodies Heterophile antibody absrbj 86329 Immunodiffusion Immunodiffusion nes 86376 Microsomal antibody Microsomal antibody each 86403 Particle agglutination test Particle agglut antbdy scrn 86406 Particle agglutination test Particle agglut antbdy titr 86430 Rheumatoid factor test Rheumatoid factor test qual 86651 Encephalitis antibody Encephalitis californ antbdy 86652 Encephalitis antibody Encephaltis east eqne anbdy 86653 Encephalitis antibody Encephaltis st louis antbody 86654 Encephalitis antibody Encephaltis west eqne antbdy 86664 Epstein-barr antibody Epstein-barr nuclear antigen 86665 Epstein-barr antibody Epstein-barr capsid vca 86671 Fungus antibody Fungus nes antibody 86677 Helicobacter pylori Helicobacter pylori antibody 86684 Hemophilus influenza Hemophilus influenza antibdy 86689 HTLV/HIV confirmatory test Htlv/hiv confirmj antibody 86692 Hepatitis delta agent Hepatitis delta agent antbdy 86694 Herpes simplex test Herpes simplex nes antbdy 86695 Herpes simplex test Herpes simplex type 1 test 86696 Herpes simplex type 2 Herpes simplex type 2 test 86698 Histoplasma Histoplasma antibody 86701 HIV-1 Hiv-1antibody
HCPCS Old Description New Description 86702 HIV-2 Hiv-2 antibody 86703 Hiv-1/hiv-2 single result Hiv-1/hiv-2 1 result antbdy 86707 Hep be antibody Hepatitis be antibody 86708 Hep a antibody total Hepatitis a total antibody 86709 Hep a antibody igm Hepatitis a igm antibody 86723 Listeria monocytogenes ab Listeria monocytogenes 86970 RBC pretreatment Rbc pretx incubatj w/chemicl 86971 RBC pretreatment Rbc pretx incubatj w/enzymes 86972 RBC pretreatment Rbc pretx incubatj w/density 86975 Rbc pretreatment serum Rbc serum pretx incubj drugs 86976 Rbc pretreatment serum Rbc serum pretx id dilution 86977 Rbc pretreatment serum Rbc serum pretx incubj/inhib 87015 Specimen concentration Specimen infect agnt concntj 87045 Feces culture bacteria Feces culture aerobic bact 87046 Stool cultr bacteria each Stool cultr aerobic bact ea 87070 Culture bacteria other Culture othr specimn aerobic 87071 Culture bacteri aerobic othr Culture aerobic quant other 87498 Enterovirus dna amp probe Enterovirus probe&revrs trns 87521 Hepatitis c rna amp probe Hepatitis c probe&rvrs trnsc 87522 Hepatitis c rna quant Hepatitis c revrs trnscrpj 87535 Hiv-1 dna amp probe Hiv-1 probe&reverse trnscrpj 87536 Hiv-1 dna quant Hiv-1 quant&revrse trnscrpj 87538 Hiv-2 dna amp probe Hiv-2 probe&revrse trnscripj 87539 Hiv-2 dna quant Hiv-2 quant&revrse trnscripj 87902 Genotype dna hepatitis c Genotype dna/rna hep c 87906 Genotype dna hiv reverse t Genotype dna/rna hiv 90655 Flu vaccine no preserv 6-35m Flu vac no prsv 3 val 6-35 m 90700 Dtap vaccine < 7 yrs im Dtap vaccine > 7 yrs im 90702 Dt vaccine < 7 im Dt vaccine > 7 yrs im 90714 Td vaccine no prsrv >/= 7 im Td vaccine no prsrv 7/> im 90715 Tdap vaccine >7 im Tdap vaccine 7 yrs/> im 90746 Hep b vaccine adult im Hep b vacc adult 3 dose im 90951 Esrd serv 4 visits p mo <2 Esrd serv 4 visits p mo <2yr 90952 Esrd serv 2-3 vsts p mo <2 Esrd serv 2-3 vsts p mo <2yr 90953 Esrd serv 1 visit p mo <2 Esrd serv 1 visit p mo <2yrs 90963 Esrd home pt serv p mo <2 Esrd home pt serv p mo <2yrs 91038 Esoph imped funct test > 1h Esoph imped funct test > 1hr 92012 Eye exam established pat Eye exam establish patient 92014 Eye exam & treatment Eye exam&tx estab pt 1/>vst 92015 Refraction Determine refractive state 92315 Prescription of contact lens Rx cntact lens aphakia 1 eye 92316 Prescription of contact lens Rx cntact lens aphakia 2 eye 92317 Prescription of contact lens Rx corneoscleral cntact lens 92340 Fitting of spectacles Fit spectacles monofocal 92341 Fitting of spectacles Fit spectacles bifocal 92342 Fitting of spectacles Fit spectacles multifocal 92352 Special spectacles fitting Fit aphakia spectcl monofocl 92353 Special spectacles fitting Fit aphakia spectcl multifoc 92354 Special spectacles fitting Fit spectacles single system 92355 Special spectacles fitting Fit spectacles compound lens 92358 Eye prosthesis service Aphakia prosth service temp 92601 Cochlear implt f/up exam < 7 Cochlear implt f/up exam <7 92602 Reprogram cochlear implt < 7 Reprogram cochlear implt 7/> 92603 Cochlear implt f/up exam 7 > Cochlear implt f/up exam 7/> 92604 Reprogram cochlear implt 7 > Reprogram cochlear implt 7/> 92973 Percut coronary thrombectomy Prq coronary mech thrombect 93282 Icd device prog eval 1 sngl Icd device progr eval 1 sngl 93286 Pre-op pm device eval Peri-px pacemaker device evl 93287 Pre-op icd device eval Peri-px icd device eval&prgr 93880 Extracranial study Extracranial bilat study 93882 Extracranial study Extracranial uni/ltd study
HCPCS Old Description New Description 93886 Intracranial study Intracranial complete study 93888 Intracranial study Intracranial limited study 94729 C0 diffuse capacity Co/membane diffuse capacity 95024 Id allergy test drug/bug Icut allergy test drug/bug 95027 Id allergy titrate-airborne Icut allergy titrate-airborn 95028 Id allergy test-delayed type Icut allergy test-delayed 95125 Immunotherapy many antigens Immunotherapy 2/> injections 95130 Immunotherapy insect venom Immntx 1 sting insect 95131 Immunotherapy insect venoms Immntx 2 sting insects 95132 Immunotherapy insect venoms Immntx 3 sting insects 95133 Immunotherapy insect venoms Immntx 4 sting insects 95134 Immunotherapy insect venoms Immntx 5 sting insects 95808 Polysomnography 1-3 Polysom any age 1-3> param 95810 Polysomnography 4 or more Polysom 6/> yrs 4/> param 95811 Polysomnography w/cpap Polysom 6/>yrs cpap 4/> parm 95905 Motor/sens nrve conduct test Motor &/ sens nrve cndj test 95921 Autonomic nerv function test Autonomic nrv parasym inervj 95922 Autonomic nerv function test Autonomic nrv adrenrg inervj 95923 Autonomic nerv function test Autonomic nrv syst funj test 96922 Laser tx skin > 500 sq cm Laser tx skin >500 sq cm 97140 Manual therapy Manual therapy 1/> regions 97598 Rmvl devital tis addl 20 cm< Rmvl devital tis addl 20cm/< 97605 Neg press wound tx < 50 cm Neg press wound tx </=50 cm 97606 Neg press wound tx > 50 cm Neg press wound tx >50 cm 98925 Osteopathic manipulation Osteopath manj 1-2 regions 98926 Osteopathic manipulation Osteopath manj 3-4 regions 98927 Osteopathic manipulation Osteopath manj 5-6 regions 98928 Osteopathic manipulation Osteopath manj 7-8 regions 98929 Osteopathic manipulation Osteopath manj 9-10 regions 98940 Chiropractic manipulation Chiropract manj 1-2 regions 98941 Chiropractic manipulation Chiropract manj 3-4 regions 98942 Chiropractic manipulation Chiropractic manj 5 regions 98943 Chiropractic manipulation Chiropract manj xtrspinl 1/> 99000 Specimen handling Specimen handling office-lab 99001 Specimen handling Specimen handling pt-lab 99002 Device handling Device handling phys/qhp 99070 Special supplies Special supplies phys/qhp 99143 Mod cs by same phys < 5 yrs Mod sedat phys/qhp <5 yrs 99144 Mod cs by same phys 5 yrs + Mod sedat phys/qhp 5yrs/> 99145 Mod cs by same phys add-on Mod sedat phys/qhp ea 15 min 99148 Mod cs diff phys < 5 yrs Mod sed diff phys/qhp<5 yrs 99149 Mod cs diff phys 5 yrs + Mod sed diff phys/qhp 5/>yrs 99150 Mod cs diff phys add-on Mod sed diff phys/qhp add on 99174 Ocular photoscreening Ocular instrumnt screen bil 99363 Anticoag mgmt init Anticoagulant mgmt initial 99364 Anticoag mgmt subseq Anticoagulant mgmt subseq 99366 Team conf w/pat by hc pro Team conf w/pat by hc prof 99381 Init pm e/m new pat inf Init pm e/m new pat infant 99391 Per pm reeval est pat inf Per pm reeval est pat infant 99441 Phone e/m by phys 5-10 min Phone e/m phys/qhp 5-10 min 99442 Phone e/m by phys 11-20 min Phone e/m phys/qhp 11-20 min 99443 Phone e/m by phys 21-30 min Phone e/m phys/qhp 21-30 min 99444 Online e/m by phys Online e/m by phys/qhp A9584 Iodine i-123 ioflupane Iodine I-123 ioflupane C9724 EPS gast cardia plic EPS stomach plic D0220 Intraoral periapical first f Intraoral periapical first D0270 Dental bitewing single film Dental bitewing single image D0272 Dental bitewings two films Dental bitewings two images D0273 Bitewings - three films Bitewings - three images D0274 Dental bitewings four films Bitewings four images D0277 Vert bitewings-sev to eight Vert bitewings 7 to 8 images
HCPCS Old Description New Description D0290 Dental film skull/facial bon Skull/facial bone image D0321 Dental other tmj films Other TMJ images by report D0330 Dental panoramic film Panoramic image D0340 Dental cephalometric film Cephalometric image D4210 Gingivectomy/plasty per quad Gingivectomy/plasty 4 or mor D4211 Gingivectomy/plasty per toot Gingivectomy/plasty 1 to 3 D4260 Osseous surgery per quadrant Osseous surgery 4 or more D4261 Osseous surgl-3teethperquad Osseous surg 1 to 3 teeth D6975 Coping metal Coping D6980 Bridge repair Fixed partial repair D7951 Sinus aug w bone/bone sup Sinus aug w bone or bone sub E2368 Power wc motor replacement Pwr wc drivewheel motor repl E2369 Pwr wc gear box replacement Pwr wc drivewheel gear repl E2370 Pwr wc motor/gear box combo Pwr wc dr wh motor/gear comb G0416 Sat biopsy prostate 1-20 spc Sat biopsy 10-20 G0444 Depression Screen annual Depression screen annual G8895 Anticoag prescribe Antrom prescribe G8896 Doc med reas no anticoag Doc med reas no antihtrom G8897 Anticoag not prescribe Antithrom not prescribe G8908 Pt doc w burn prior to D/C Pt doc w burn prior to D/C G8909 Pt doc no burn prior to D/C Pt doc no burn prior to D/C G8912 Pt doc with wrong event Pt doc with wrong event G8918 Pt w/o preop order IV AB pr Pt w/o preop order IV AB pro G9151 MAPCP demo State MAPCP demo state J1561 Gamunex, Gamunex-C,
Gammaked Gamunex-C/Gammaked
J9020 Asparaginase injection Asparaginase, NOS J9280 Mitomycin 5 MG inj Mitomycin injection Q2049 Imported Lipodox inj Imported lipodox inj Q4126 Memoderm Memoderm/derma/tranz/integup Q4128 Flexhd or allopatch hd Flexhd/Allopatchhd/matrixhd V5267 Hearing aid supply/accessory Hearing aid sup/access/dev
HCPCS Changes- APC, Status Indicator and/or Edit Assignments The following code(s) had an APC and/or SI and/or edit change, effective 10-01-12 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit G9157 Transesoph doppl cardiac mon M B 72 62 The following code(s) had an APC and/or SI and/or edit change, effective 01-01-13 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 0183T Wound ultrasound 00015 00013 0184T Exc rectal tumor endoscopic 00149 00150 0249T Ligation hemorrhoid w/us 00155 00150 0299T Esw wound healing init wound 00340 00133 X T 0300T Esw wound healing addl
wound 00340 00133 X T
0528F Rcmnd flw-up 10 yrs docd E M 28 72 1052F Type location activityasses M E 72 28 11047 Deb bone add-on 00020 00019 1110F Pt lft inpt fac w/in 60 days M E 72 28 1116F Auric/peri pain assessed M E 72 28 1121F Subs eval for condition M E 72 28 11623 Exc s/n/h/f/g mal+mrg 2.1-3 00021 00020 15115 Epidrm a-grft face/nck/hf/g 00135 00136 19290 Place needle wire breast 00000 00340 N Q1 2014F Mental status assess M E 72 28 2035F Tymp memb motion examd M E 72 28
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 20926 Removal of tissue for graft 00135 00136 21010 Incision of jaw joint 00254 00256 21026 Excision of facial bone(s) 00256 00254 21029 Contour of face bone lesion 00256 00254 21044 Removal of jaw bone lesion 00256 00254 21073 Mnpj of tmj w/anesth 00252 00254 21085 Prepare face/oral prosthesis 00253 00252 21120 Reconstruction of chin 00254 00256 21181 Contour cranial bone lesion 00254 00256 21195 Reconst lwr jaw w/o fixation 00256 00254 21198 Reconstr lwr jaw segment 00256 00254 21230 Rib cartilage graft 00256 00254 21235 Ear cartilage graft 00254 00253 21338 Open nasoethmoid fx w/o fixj 00254 00256 21346 Opn tx nasomax fx w/fixj 00254 00256 21360 Opn tx dprsd malar fracture 00254 00256 21401 Closed tx orbit w/ manipulj 00253 00252 21421 Treat mouth roof fracture 00254 00256 21451 Treat lower jaw fracture 00252 00253 21454 Treat lower jaw fracture 00254 00256 21485 Reset dislocated jaw 00253 00254 21497 Interdental wiring 00253 00252 21685 Hyoid myotomy & suspension 00252 00254 22856 Cerv artific diskectomy 00000 00208 C T 23931 Drainage of arm bursa 00008 00007 29130 Application of finger splint 00058 00059 29131 Application of finger splint 00058 00059 29200 Strapping of chest 00058 00059 29240 Strapping of shoulder 00058 00059 29260 Strapping of elbow or wrist 00058 00059 29280 Strapping of hand or finger 00058 00059 29520 Strapping of hip 00058 00059 29530 Strapping of knee 00058 00059 29540 Strapping of ankle and/or ft 00058 00059 29550 Strapping of toes 00058 00059 29582 Apply multlay comprs upr leg 00058 00059 29583 Apply multlay comprs upr arm 00058 00059 29584 Appl multlay comprs
arm/hand 00058 00059
30110 Removal of nose polyp(s) 00253 00252 30115 Removal of nose polyp(s) 00253 00254 30124 Removal of nose lesion 00252 00254 30130 Excise inferior turbinate 00253 00254 30220 Insert nasal septal button 00252 00253 3025F Spirom fev/fvc <70% w/copd M E 72 28 3027F Spirom
fev/fvc>/=70%/w/ocopd M E 72 28
3028F O2 saturation doc rev M E 72 28 30320 Remove nasal foreign body 00253 00254 30400 Reconstruction of nose 00256 00254 3074F Syst bp lt 130 mm hg M E 72 28 3075F Syst bp ge 130 - 139mm hg M E 72 28 3077F Syst bp >/= 140 mm hg M E 72 28 3078F Diast bp <80 mm hg M E 72 28 3079F Diast bp 80-89 mm hg M E 72 28 30801 Ablate inf turbinate superf 00252 00253 3080F Diast bp >/= 90 mm hg M E 72 28 3085F Suicide risk assessed M E 72 28 30930 Ther fx nasal inf turbinate 00253 00254 31070 Exploration of frontal sinus 00254 00256 3110F Pres/absn hmrhg/lesion docd M E 72 28
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 3111F Ct/mri brain done w/in 24hrs M E 72 28 3112F Ct/mri brain done 24 hrs M E 72 28 31200 Removal of ethmoid sinus 00256 00254 31201 Removal of ethmoid sinus 00256 00254 31205 Removal of ethmoid sinus 00256 00254 31240 Nasal/sinus endoscopy surg 00074 00075 31528 Laryngoscopy and dilation 00074 00075 31529 Laryngoscopy and dilation 00074 00075 31541 Larynscop w/tumr exc + scope 00074 00075 31578 Removal of larynx lesion 00075 00074 31610 Incision of windpipe 00254 00256 31612 Puncture/clear windpipe 00254 00256 31629 Bronchoscopy/needle bx each 00076 00415 31634 Bronch w/balloon occlusion 00076 00415 32552 Remove lung catheter 00078 00070 S T 4012F Warfarin therapy rx M E 72 28 4050F Ht care plan doc M E 72 28 40527 Reconstruct lip with flap 00254 00256 40805 Removal foreign body mouth 00252 00254 40814 Excise/repair mouth lesion 00253 00254 40819 Excise lip or cheek fold 00252 00253 40842 Reconstruction of mouth 00254 00256 41000 Drainage of mouth lesion 00253 00252 41007 Drainage of mouth lesion 00253 00254 41016 Drainage of mouth lesion 00252 00254 41017 Drainage of mouth lesion 00252 00253 41116 Excision of mouth lesion 00253 00254 41500 Fixation of tongue 00254 00253 41512 Tongue suspension 00252 00254 41520 Reconstruction tongue fold 00252 00254 4165F 3d-crt/imrt received M E 72 28 4180F Adjv thxpyrxd/rcvd colon ca M E 72 28 41820 Excision gum each quadrant 00252 00254 41823 Excision of gum lesion 00254 00256 41828 Excision of gum lesion 00253 00254 41830 Removal of gum tissue 00253 00254 41850 Treatment of gum lesion 00253 00254 41870 Gum graft 00254 00256 41872 Repair gum 00253 00254 4200F External beam to prost only M E 72 28 4201F Extrnl beam other than prost M E 72 28 42107 Excision lesion mouth roof 00254 00256 42120 Remove palate/lesion 00256 00254 42140 Excision of uvula 00252 00253 42145 Repair palate pharynx/uvula 00254 00256 42182 Repair palate 00256 00254 42225 Reconstruct cleft palate 00256 00254 42235 Repair palate 00253 00254 42300 Drainage of salivary gland 00253 00252 42305 Drainage of salivary gland 00253 00254 42335 Removal of salivary stone 00253 00254 42408 Excision of salivary cyst 00253 00254 42409 Drainage of salivary cyst 00253 00254 42450 Excise sublingual gland 00254 00256 42508 Parotid duct diversion 00256 00254 42650 Dilation of salivary duct 00252 00253 42665 Ligation of salivary duct 00254 00256 4267F Comprssion thxpy prescribed M E 72 28 42800 Biopsy of throat 00252 00253 42825 Removal of tonsils 00254 00256 42830 Removal of adenoids 00254 00256
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 42842 Extensive surgery of throat 00254 00256 42860 Excision of tonsil tags 00254 00256 42900 Repair throat wound 00252 00254 4290F Pt scrned for inj drug use M E 72 28 4293F Pt scrnd hgh-risk sex behav M E 72 28 42950 Reconstruction of throat 00254 00256 42962 Control throat bleeding 00256 00254 43030 Throat muscle surgery 00253 00254 4330F Cnslng epi spec sfty issues M E 72 28 43770 Lap place gastr adj device 00131 00132 43887 Remove gastric port open 00135 00136 45005 Drainage of rectal abscess 00149 00155 45100 Biopsy of rectum 00149 00155 45172 Exc rect tum transanal full 00149 00150 45337 Sigmoidoscopy & decompress 00146 00147 45338 Sigmoidoscopy w/tumr
remove 00146 00147
45341 Sigmoidoscopy w/ultrasound 00146 00147 45905 Dilation of anal sphincter 00149 00155 45910 Dilation of rectal narrowing 00149 00155 45990 Surg dx exam anorectal 00149 00155 46040 Incision of rectal abscess 00149 00155 46060 Incision of rectal abscess 00149 00155 46080 Incision of anal sphincter 00149 00155 46230 Removal of anal tags 00149 00155 46288 Repair anal fistula 00149 00150 46320 Removal of hemorrhoid clot 00149 00155 46505 Chemodenervation anal musc 00149 00155 46606 Anoscopy and biopsy 00146 00147 46608 Anoscopy remove for body 00146 00147 46706 Repr of anal fistula w/glue 00150 00149 46754 Removal of suture from anus 00149 00155 46940 Treatment of anal fissure 00149 00155 49442 Place cecostomy tube perc 00149 00155 60502 Re-explore parathyroids 00256 00254 6070F Pt asked/cnsld aed effects M E 72 28 6090F Pt/caregiver counsel safety M E 72 28 64569 Revise/repl vagus n eltrd 00687 00040 T S 65779 Cover eye w/membrane suture T Q2 65930 Remove blood clot from eye 00234 00673 66155 Glaucoma surgery 00234 00673 66185 Revise eye shunt 00234 00673 66605 Removal of iris 00234 00673 69005 Drain external ear lesion 00008 00007 69140 Remove ear canal lesion(s) 00254 00256 69150 Extensive ear canal surgery 00252 00254 69222 Clean out mastoid cavity 00253 00252 69405 Catheterize middle ear canal 00252 00253 69440 Exploration of middle ear 00254 00256 69502 Mastoidectomy 00254 00256 69650 Release middle ear bone 00254 00256 69666 Repair middle ear structures 00256 00254 69667 Repair middle ear structures 00256 00254 69676 Remove middle ear nerve 00256 00254 69700 Close mastoid fistula 00256 00254 70110 X-ray exam of jaw 4/> views 00260 00261 70120 X-ray exam of mastoids 00260 00261 70150 X-ray exam of facial bones 00260 00261 70200 X-ray exam of eye sockets 00260 00261 70220 X-ray exam of sinuses 00260 00261 71030 Chest x-ray 4/> views 00260 00261
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 71101 X-ray exam unilat ribs/chest 00260 00261 71110 X-ray exam ribs bil 3 views 00260 00261 72072 X-ray exam thorac spine 3vws 00260 00261 72120 X-ray bend only l-s spine 00260 00261 73520 X-ray exam of hips 00260 00261 73564 X-ray exam knee 4 or more 00260 00261 74240 X-ray upper gi delay w/o kub 00276 00277 74241 X-rayupper gi delay w/kub 00276 00277 74246 Contrst x-ray uppr gi tract 00276 00277 74247 Contrst x-ray uppr gi tract 00276 00277 74270 Contrast x-ray exam of colon 00276 00277 74283 Contrast x-ray exam of colon 00276 00277 75898 Follow-up angiography 00261 00397 76001 Fluoroscope exam extensive N B N/A 62 76873 Echograp trans r pros study 00266 00267 77073 X-rays bone length studies 00260 00261 77424 Io rad tx delivery by x-ray 00000 00065 N S 77425 Io rad tx deliver by elctrns 00000 00065 N S 77469 Io radiation tx management N B N/A 62 80500 Lab pathology consultation 00342 00433 81200 Aspa gene E A 28 N/A 81205 Bckdhb gene E A 28 N/A 81206 Bcr/abl1 gene major bp E A 28 N/A 81207 Bcr/abl1 gene minor bp E A 28 N/A 81208 Bcr/abl1 gene other bp E A 28 N/A 81209 Blm gene E A 28 N/A 81210 Braf gene E A 28 N/A 81211 Brca1&2 seq & com dup/del E A 28 N/A 81212 Brca1&2 185&5385&6174
var E A 28 N/A
81213 Brca1&2 uncom dup/del var E A 28 N/A 81214 Brca1 full seq & com dup/del E A 28 N/A 81215 Brca1 gene known fam variant E A 28 N/A 81216 Brca2 gene full sequence E A 28 N/A 81217 Brca2 gene known fam variant E A 28 N/A 81220 Cftr gene com variants E A 28 N/A 81221 Cftr gene known fam variants E A 28 N/A 81222 Cftr gene dup/delet variants E A 28 N/A 81223 Cftr gene full sequence E A 28 N/A 81224 Cftr gene intron poly t E A 28 N/A 81225 Cyp2c19 gene com variants E A 28 N/A 81226 Cyp2d6 gene com variants E A 28 N/A 81227 Cyp2c9 gene com variants E A 28 N/A 81228 Cytogen micrarray copy nmbr E A 28 N/A 81229 Cytogen m array copy no&snp E A 28 N/A 81240 F2 gene E A 28 N/A 81241 F5 gene E A 28 N/A 81242 Fancc gene E A 28 N/A 81243 Fmr1 gene detection E A 28 N/A 81244 Fmr1 gene characterization E A 28 N/A 81245 Flt3 gene E A 28 N/A 81250 G6pc gene E A 28 N/A 81251 Gba gene E A 28 N/A 81255 Hexa gene E A 28 N/A 81256 Hfe gene E A 28 N/A 81257 Hba1/hba2 gene E A 28 N/A 81260 Ikbkap gene E A 28 N/A 81261 Igh gene rearrange amp meth E A 28 N/A 81262 Igh gene rearrang dir probe E A 28 N/A 81263 Igh vari regional mutation E A 28 N/A 81264 Igk rearrangeabn clonal pop E A 28 N/A
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 81265 Str markers specimen anal E A 28 N/A 81266 Str markers spec anal addl E A 28 N/A 81267 Chimerism anal no cell selec E A 28 N/A 81268 Chimerism anal w/cell select E A 28 N/A 81270 Jak2 gene E A 28 N/A 81275 Kras gene E A 28 N/A 81280 Long qt synd gene full seq E A 28 N/A 81281 Long qt synd known fam var E A 28 N/A 81282 Long qt syn gene dup/dlt var E A 28 N/A 81290 Mcoln1 gene E A 28 N/A 81291 Mthfr gene E A 28 N/A 81292 Mlh1 gene full seq E A 28 N/A 81293 Mlh1 gene known variants E A 28 N/A 81294 Mlh1 gene dup/delete variant E A 28 N/A 81295 Msh2 gene full seq E A 28 N/A 81296 Msh2 gene known variants E A 28 N/A 81297 Msh2 gene dup/delete variant E A 28 N/A 81298 Msh6 gene full seq E A 28 N/A 81299 Msh6 gene known variants E A 28 N/A 81300 Msh6 gene dup/delete variant E A 28 N/A 81301 Microsatellite instability E A 28 N/A 81302 Mecp2 gene full seq E A 28 N/A 81303 Mecp2 gene known variant E A 28 N/A 81304 Mecp2 gene dup/delet variant E A 28 N/A 81310 Npm1 gene E A 28 N/A 81315 Pml/raralpha com breakpoints E A 28 N/A 81316 Pml/raralpha 1 breakpoint E A 28 N/A 81317 Pms2 gene full seq analysis E A 28 N/A 81318 Pms2 known familial variants E A 28 N/A 81319 Pms2 gene dup/delet variants E A 28 N/A 81330 Smpd1 gene common variants E A 28 N/A 81331 Snrpn/ube3a gene E A 28 N/A 81332 Serpina1 gene E A 28 N/A 81340 Trb@ gene rearrange amplify E A 28 N/A 81341 Trb@ gene rearrange dirprobe E A 28 N/A 81342 Trg gene rearrangement anal E A 28 N/A 81350 Ugt1a1 gene E A 28 N/A 81355 Vkorc1 gene E A 28 N/A 81370 Hla i & ii typing lr E A 28 N/A 81371 Hla i & ii type verify lr E A 28 N/A 81372 Hla i typing complete lr E A 28 N/A 81373 Hla i typing 1 locus lr E A 28 N/A 81374 Hla i typing 1 antigen lr E A 28 N/A 81375 Hla ii typing ag equiv lr E A 28 N/A 81376 Hla ii typing 1 locus lr E A 28 N/A 81377 Hla ii type 1 ag equiv lr E A 28 N/A 81378 Hla i & ii typing hr E A 28 N/A 81379 Hla i typing complete hr E A 28 N/A 81380 Hla i typing 1 locus hr E A 28 N/A 81381 Hla i typing 1 allele hr E A 28 N/A 81382 Hla ii typing 1 loc hr E A 28 N/A 81383 Hla ii typing 1 allele hr E A 28 N/A 81400 Mopath procedure level 1 E A 28 N/A 81401 Mopath procedure level 2 E A 28 N/A 81402 Mopath procedure level 3 E A 28 N/A 81403 Mopath procedure level 4 E A 28 N/A 81404 Mopath procedure level 5 E A 28 N/A 81405 Mopath procedure level 6 E A 28 N/A 81406 Mopath procedure level 7 E A 28 N/A 81407 Mopath procedure level 8 E A 28 N/A 81408 Mopath procedure level 9 E A 28 N/A
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 86078 Phys blood bank serv reactj 00343 00433 86079 Phys blood bank serv authrj 00342 00433 86870 RBC antibody identification 00346 00347 86975 Rbc serum pretx incubj drugs 00346 00347 88112 Cytopath cell enhance tech 00343 00433 88120 Cytp urne 3-5 probes ea spec 00344 00661 88121 Cytp urine 3-5 probes cmptr 00344 00661 88160 Cytopath smear other source 00433 00342 88161 Cytopath smear other source 00433 00342 88162 Cytopath smear other source 00343 00433 88185 Flowcytometry/tc add-on 00433 00342 88187 Flowcytometry/read 2-8 00342 00433 88188 Flowcytometry/read 9-15 00343 00433 88189 Flowcytometry/read 16 & > 00343 00433 88304 Tissue exam by pathologist 00343 00433 88309 Tissue exam by pathologist 00344 00661 88321 Microslide consultation 00433 00342 88329 Path consult introp 00433 00342 88331 Path consult intraop 1 bloc 00343 00433 88334 Intraop cyto path consult 2 00433 00342 88347 Immunofluorescent study 00343 00433 88356 Analysis nerve 00344 00343 88361 Tumor
immunohistochem/comput 00344 00343
88365 Insitu hybridization (fish) 00344 00343 89257 Sperm identification 00343 00433 89280 Assist oocyte fertilization 00344 00343 90477 Adenovirus vaccine type 7 E N 9 N/A 90644 Meningoccl hib vac 4 dose im E N 9 N/A 90706 Rubella vaccine sc N E N/A 28 90867 Tcranial magn stim tx plan 00218 00216 90868 Tcranial magn stim tx deli 00218 00216 90869 Tcran magn stim redetemine 00218 00216 93229 Remote 30 day ecg tech supp 00209 00213 93740 Temperature gradient studies 00367 00368 94010 Breathing capacity test 00367 00368 94014 Patient recorded spirometry 00367 00368 94015 Patient recorded spirometry 00367 00368 94453 Hast w/oxygen titrate 00367 00368 94680 Exhaled air analysis o2 00368 00369 94770 Exhaled carbon dioxide test 00368 00369 95145 Antigen therapy services 00437 00436 95250 Glucose monitoring cont 00607 00606 96120 Neuropsych tst admin w/comp 00382 00373 96153 Intervene hlth/behave group 00432 00031 96366 Ther/proph/diag iv inf addon 00437 00436 99406 Behav chng smoking 3-10 min X S 99407 Behav chng smoking > 10 min X S C1749 Endo, colon, retro imaging 01749 00000 H N C8921 TTE w or w/o fol w/cont, com 00128 00178 C8922 TTE w or w/o fol w/cont, f/u 00128 00177 C8923 2D TTE w or w/o fol w/con,co 00128 00177 C8924 2D TTE w or w/o fol w/con,fu 00128 00177 C8925 2D TEE w or w/o fol w/con,in 00128 00178 C8926 TEE w or w/o fol w/cont,cong 00128 00178 C8927 TEE w or w/o fol w/cont, mon 00128 00177 C8928 TTE w or w/o fol w/con,stres 00128 00178 C8929 TTE w or wo fol
wcon,Doppler 00128 00178
C8930 TTE w or w/o contr, cont ECG 00128 00178 C9254 Injection, lacosamide 09254 00000 K N
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit C9275 Hexaminolevulinate HCl 09275 00000 G N C9367 Endoform Dermal Template G K G0010 Admin hepatitis b vaccine 00437 00436 G0130 Single energy x-ray study 00260 00261 G0175 OPPS Service,sched team conf 00607 00608 G0246 Followup eval of foot pt lop 00605 00604 G0379 Direct refer hospital observ 00604 00608 G0397 Alcohol/subs interv >30 min 00322 00432 G0417 Sat biopsy prostate 21-40 01505 00661 S X G0418 Sat biopsy prostate 41-60 01506 00661 S X G0419 Sat biopsy prostate: >60 01508 00661 S X G0436 Tobacco-use counsel 3-10 min X S G0437 Tobacco-use counsel>10min 00031 00432 X S J0221 Lumizyme injection G K J0350 Injection anistreplase 30 u E N 9 N/A J0364 Apomorphine hydrochloride 01360 00000 K N J0365 Aprotonin, 10,000 kiu 00000 01439 N K J0395 Arbutamine hcl injection 00000 01432 E K 9 N/A J0588 Incobotulinumtoxin a G K J0597 C-1 esterase, berinert G K J0630 Calcitonin salmon injection 00000 01433 N K J0775 Collagenase, clost hist inj G K J0840 Crotalidae poly immune fab G K J0897 Denosumab injection G K J0900 Testosterone enanthate inj 00000 01434 N K J1290 Ecallantide injection G K J1435 Injection estrone per 1 MG 00000 01435 E K 9 N/A J1452 Intraocular Fomivirsen na 00000 01441 E K 9 N/A J1455 Foscarnet sodium injection 01359 00000 K N J1557 Gammaplex injection G K J1590 Gatifloxacin injection 00000 01437 N K J1730 Diazoxide injection 00000 01438 N K J1756 Iron sucrose injection 09046 00000 K N J2170 Mecasermin injection 01308 00000 K N J2460 Oxytetracycline injection E N 9 N/A J2513 Pentastarch 10% solution 01222 00000 K N J2597 Inj desmopressin acetate 00000 01440 N K J2670 Totazoline hcl injection N E N/A 28 J2760 Phentolaine mesylate inj 01358 00000 K N J2995 Inj streptokinase /250000 IU 01226 00000 K N J3030 Sumatriptan succinate / 6 MG 01374 00000 K N J3095 Telavancin injection G K J3262 Tocilizumab injection G K J3310 Perphenazine injeciton 01304 00000 K N J3350 Urea injection 01306 00000 K N J3357 Ustekinumab injection G K J3385 Velaglucerase alfa G K J3400 Triflupromazine hcl inj E N 9 N/A J7183 Wilate injection G K J7191 Factor VIII (porcine) 01279 00000 K N J7335 Capsaicin 8% patch G K J7665 Mannitol for inhaler M N 72 N/A J8562 Oral fludarabine phosphate G K J9043 Cabazitaxel injection G K J9206 Irinotecan injection 00830 00000 K N J9212 Interferon alfacon-1 inj 00000 01447 N K J9215 Interferon alfa-n3 inj 00865 00000 K N J9302 Ofatumumab injection G K J9307 Pralatrexate injection G K J9315 Romidepsin injection G K J9390 Vinorelbine tartrate inj 01412 00000 K N
HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit L8680 Implt neurostim elctr each N E N/A 28 L8682 Implt neurostim radiofq rec N E N/A 28 L8683 Radiofq trsmtr for implt neu A E N/A 28 L8684 Radiof trsmtr implt scrl neu A E N/A 28 L8685 Implt nrostm pls gen sng rec N E N/A 28 L8686 Implt nrostm pls gen sng non N E N/A 28 L8687 Implt nrostm pls gen dua rec N E N/A 28 L8688 Implt nrostm pls gen dua non N E N/A 28 M0064 Visit for drug monitoring 00607 00606 Q0174 Thiethylperazine maleate10mg 01425 00000 K N Q2043 Sipuleucel-T auto CD54+ G K Q9968 Visualization adjunct 00000 01446 N K
Hcpcs Edit Changes The following code(s) were added to the list of male procedures, effective 01-01-13 Hcpcs G0458 The following code(s) were added to the list of female procedures, effective 01-01-13 Hcpcs 81500 81503 81508 81509 81510 81511 81512
HCPCS 64615 The following code(s) were added to the nuclear medicine list, effective 01-01-13 HCPCS 78012 78013 78014 78071 78072
Mental Health Changes The following code(s) were added to the mental health list that are not approved for the partial hospitalization program, effective 01-01-13 HCPCS 90839 The following code(s) were added to the mental health list that are not payable outside the partial hospitalization program, effective 01-01-13 HCPCS G0129 G0176
Skin Substitute Product Changes The following code(s) were added to the skin substitute product list, effective 01-01-13 HCPCS Q4131 Q4132 Q4133 The following code(s) were removed from the skin substitute product list, effective 01-01-13 HCPCS Q4100 Q4130
MODIFIERS
Added Modifiers
The following modifier(s) were added to the list of valid modifiers, effective 01-01-13 modif ACTIVATIONDATE CH 0 CI 0 CJ 0 CK 0 CL 0 CM 0 CN 0 LM 0 RI 0
