Coverage Policies

Use the index below to search for coverage information on specific medical conditions.

Note: For Arkansas State or Public School employees, services subject to pre-authorization are managed by Active Health Management, as noted in their Summary Plan Description.

For coverage information on high tech imaging (MRI, CT, PET) and nuclear medicine, administered by Evicore, click here.

Medical Providers: Payment for care or services is based on eligibility, medical necessity and available benefits at time of service and is subject to all contractual exclusions and limitations, including pre-existing conditions if applicable.

Future eligibility cannot be guaranteed and should be rechecked at time of service. Verify benefits by signing into My Account or calling Customer Service at 800.235.7111 or 501.228.7111.

QualChoice follows care guidelines published by MCG Health.

QualChoice reserves the right to alter, amend, change or supplement medical policies as needed. QualChoice reviews and authorizes services and substances. CPT and HCPCS codes are listed as a convenience and any absent, new or changed codes do not alter the intent of the policy.

INDEX:
A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Effective Date: 01/01/2008 Title: Routine & Complex Office Procedures
Revision Date: 01/01/2016 Document: BI222:00
CPT Code(s):
Public Statement

Effective Date:

a)    This policy will apply to all services performed for groups new or renewing on or after 1-1-2015 which will become the new effective date.

b)    For all services referred to in this policy that were performed before the revision date, contact customer service for the rules that would apply.

1)    Procedures and lab tests performed by your doctor in the office may be routine or relatively complex.  Similarly, medications given in the doctor’s office may be routine and common, or more complex and less often used.  You may have different benefits depending on what sort of procedure is performed; your schedule of benefits tells you what cost share is required for different types of procedures.

2)    Providers need guidance to make, and to help members make, this distinction. This policy provides a list of all procedures, tests, and medications that are considered “routine” and all procedures, tests, and medications that are considered “complex.”  Any procedures, tests, or medications not listed in this policy are considered “advanced.”  If you have questions about a particular procedure, you may call our Customer Service Department for additional information.


Medical Statement

1)    QualChoice administered plans may require different cost shares for different types of procedures, in addition to the cost share for the office visit. It is important for physicians to be able to distinguish (and help members to distinguish) which procedures will be covered under the copayment as opposed to those that will not be --- requiring additional payment from the member. To facilitate that, the list of services classified as “routine” or “complex” is attached to this policy.

2)    These rules do not override any coverage exclusions, limitations, restrictions, preauthorization requirements or other rules that specify when a code will or will not be determined to be a covered service.

ROUTINE OFFICE PROCEDURES AND MEDICATIONS
CPT CODE CODE DESCRIPTION
11719 Trimming of nondystrophic nails, any number
11720 Debridement of nail(s) by any method(s); one to five
11721 Debridement of nail(s) by any method(s); six or more
11740 Evacuation of subungual hematoma
11900 Injection, intralesional; up to and including seven lesions
11901 Injection, intralesional; more than seven lesions
16000 Initial treatment, first degree burn, when no more than local treatment is required
16020 Dressings and / or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)
17000 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratoses); first lesion
17003 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)
17004 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesion (e.g., actinic keratoses); 15 or more lesions
17110 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions
17111 Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; 15 or more lesions
17250 Chemical cauterization of granulation tissue (proud flesh, sinus or fistula)
20526 Injection, therapeutic (e.g., local anesthetic, corticosteroid), carpal tunnel
20550 Injection(s); single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia")
20551 Injection(s); single tendon origin / insertion
20552 Injection(s); single or multiple trigger point(s), one or two muscle(s)
20553 Injection(s); single or multiple trigger point(s), three or more muscle(s)
20612 Aspiration and / or injection of ganglion cyst(s) any location
29130 Application of finger splint; static
29131 Application of finger splint; dynamic
29200 Strapping; thorax
29240 Strapping; shoulder
29260 Strapping; elbow or wrist
29280 Strapping; hand or finger
29520 Strapping; hip
29530 Strapping; knee
29540 Strapping; ankle and/or ft
29550 Strapping; toes
29580 Strapping; Unna boot
30300 Removal foreign body, intranasal; office type procedure
36000 Introduction of needle or intracatheter, vein
36415 Collection of venous blood by venipuncture
36416 Collection of capillary blood specimen (e.g., finger, heel, ear stick)
46500 Injection of sclerosing solution, hemorrhoids
46900 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical
46910 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; electrodessication
46916 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; cryosurgery
46917 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; laser surgery
51701 Insertion of non-indwelling bladder catheter (e.g. straight catheterization for residual urine)
64550 Application of surface (transcutaneous) neurostimulator
65205 Removal of foreign body, external eye; conjunctival superficial
69200 Removal foreign body from external auditory canal; without general anesthesia
69209 Removal impacted cerumen using irrigation/lavage, unilateral (new code 1/1/16)
69210 Removal impacted cerumen (separate procedure), one or both ears
70030 X-ray eye for foreign body
70100 X-ray exam of jaw
70110 X-ray exam of jaw
70120 X-ray exam of mastoids
70130 X-ray exam of mastoids
70134 X-ray exam of middle ear
70140 X-ray exam of facial bones
70150 X-ray exam of facial bones
70160 X-ray exam of nasal bones
70170 X-ray exam of tear duct
70190 X-ray exam of eye sockets
70200 X-ray exam of eye sockets
70210 X-ray exam of sinuses
70220 X-ray exam of sinuses
70240 X-ray exam, pituitary saddle
70250 X-ray exam of skull
70260 X-ray exam of skull
70300 X-ray exam of teeth
70310 X-ray exam of teeth
70320 Full mouth x-ray of teeth
70328 X-ray exam of jaw joint
70330 X-ray exam of jaw joints
70332 X-ray exam of jaw joint
70355 Panoramic x-ray of jaws
70360 X-ray exam of neck
71010 Chest x-ray
71015 Chest x-ray
71020 Chest x-ray
71021 Chest x-ray
71022 Chest x-ray
71030 Chest x-ray
71035 Chest x-ray
71100 X-ray exam of ribs
71101 X-ray exam of ribs/chest
71110 X-ray exam of ribs
71111 X-ray exam of ribs/chest
71120 X-ray exam of breastbone
71130 X-ray exam of breastbone
72010 X-ray exam of spine (code deleted 1/1/16)
72020 X-ray exam of spine
72040 X-ray exam of neck spine
72050 X-ray exam of neck spine
72052 X-ray exam of neck spine
72069 X-ray exam of trunk spine (code deleted 1/1/16)
72070 X-ray exam of thoracic spine
72072 X-ray exam of thoracic spine
72074 X-ray exam of thoracic spine
72080 X-ray exam of trunk spine
72081 X-ray exam of spine, entire thoracic and lumbar, including skull, cervical & sacral spine if performed; 1 view (new code 1/1/16)
72082 X-ray exam of spine, entire thoracic and lumbar, including skull, cervical & sacral spine if performed; 2 or 3 views (new code 1/1/16)
72083 X-ray exam of spine, entire thoracic and lumbar, including skull, cervical & sacral spine if performed; 4 or 5 views (new code 1/1/16)
72084 X-ray exam of spine, entire thoracic and lumbar, including skull, cervical & sacral spine if performed; minimum of 6 views (new code 1/1/16)
72090 X-ray exam of trunk spine (code deleted 1/1/16)
72100 X-ray exam of lower spine
72110 X-ray exam of lower spine
72114 X-ray exam of lower spine
72120 X-ray exam of lower spine
72170 X-ray exam of pelvis
72190 X-ray exam of pelvis
72200 X-ray exam sacroiliac joints
72202 X-ray exam sacroiliac joints
72220 X-ray exam of tailbone
73000 X-ray exam of collar bone
73010 X-ray exam of shoulder blade
73020 X-ray exam of shoulder
73030 X-ray exam of shoulder
73050 X-ray exam of shoulders
73060 X-ray exam of humerus
73070 X-ray exam of elbow
73080 X-ray exam of elbow
73090 X-ray exam of forearm
73092 X-ray exam of arm, infant
73100 X-ray exam of wrist
73110 X-ray exam of wrist
73120 X-ray exam of hand
73130 X-ray exam of hand
73140 X-ray exam of finger(s)
73500 X-ray exam of hip (code deleted 1/1/16)
73501 Radiologic examination, hip, unilateral, with pelvis when performed; 1 view (new code 1/1/16)
73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2 - 3 views (new code 1/1/16)
73503 Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views (new code 1/1/16)
73510 X-ray exam of hip (code deleted 1/1/16)
73520 X-ray exam of hips (code deleted 1/1/16)
73521 Radiologic examination, hips, bilateral, with pelvis when performed; 2 views (new code 1/1/16)
73522 Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views (new code 1/1/16)
73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views (new code 1/1/16)
73530 X-ray exam of hip (code deleted 1/1/16)
73540 X-ray exam of pelvis & hips (code deleted 1/1/16)
73550 X-ray exam of thigh (code deleted 1/1/16)
73551 Radiologic examination, femur; 1 view (new code 1/1/16)
73552 Radiologic examination, femur; minimum 2 views (new code 1/1/16)
73560 X-ray exam of knee, 1 or 2
73562 X-ray exam of knee, 3
73564 X-ray exam, knee, 4 or more
73565 X-ray exam of knees
73590 X-ray exam of lower leg
73592 X-ray exam of leg, infant
73600 X-ray exam of ankle
73610 X-ray exam of ankle
73620 X-ray exam of foot
73630 X-ray exam of foot
73650 X-ray exam of heel
73660 X-ray exam of toe(s)
74000 X-ray exam of abdomen
74010 X-ray exam of abdomen
74020 X-ray exam of abdomen
74022 X-ray exam series, abdomen
76010 X-ray, nose to rectum
80047 Metabolic panel ionized ca
80048 Metabolic panel total ca
80050 General health panel
80051 Electrolyte panel
80053 Comprehensive metabolic panel
80055 Obstetric panel
80061 Lipid panel
80069 Renal function panel
80074 Acute hepatitis panel
80076 Hepatic function panel
80081 Obstetric panel (includes HIV testing) (new code 1/1/16)
80100 Drug screen, qualitative/multi (code deleted 1/1/15)
80102 Drug confirmation (code deleted 1/1/15)
80300 Drug screen, any # of drug classes from Drug Class List A; any # of non-TLC devices or procedures (e.g., immunoassay) capable of being read by direct optical observation, incl. instrument-assisted when performed, per dt of svc
81000 Urinalysis, nonauto w/scope
81001 Urinalysis, auto w/scope
81002 Urinalysis nonauto w/o scope
81003 Urinalysis, auto, w/o scope
81005 Urinalysis
81007 Urine screen for bacteria
81015 Microscopic exam of urine
81020 Urinalysis, glass test
81025 Urine pregnancy test
82043 Microalbumin, quantitative
82044 Microalbumin, semiquant
82075 Assay of breath ethanol
82247 Bilirubin, total
82248 Bilirubin, direct
82270 Occult blood, feces
82271 Occult blood, other sources
82272 Occult blood feces, 1-3 tests
82274 Assay test for blood, fecal
82306 Assay of vitamin D
82310 Assay of calcium
82330 Assay of calcium
82465 Assay, blood/serum cholesterol
82550 Assay of Creatine Kinase (CK), (CPK); total
82565 Assay of creatinine
82570 Assay of urine creatinine
82575 Creatinine clearance test
82607 Vitamin B-12
82652 Assay of dihydroxyvitamin d
82670 Assay of estradiol
82671 Assay of estrogens
82672 Assay of estrogen
82677 Assay of estriol
82679 Assay of estrone
82728 Ferritin
82746 Blood folic acid serum
82947 Assay, glucose, blood quant
82948 Reagent strip/blood glucose
82950 Glucose test
82962 Glucose blood test
82977 Assay of GGT
83001 Gonadotropin (FSH)
83002 Gonadotropin (LH)
83013 H pylori (c-13), breath
83036 Glycosylated hemoglobin test
83498 Assay of progesterone
83499 Assay of progesterone
83540 Assay of iron
83550 Iron binding test
83615 Lactate (LD) (LDH) enzyme
83655 Assay of lead
83718 Assay of lipoprotein
83719 Assay of blood lipoprotein
83721 Assay of blood lipoprotein
83735 Assay of magnesium
84030 Assay of blood pku
84075 Assay alkaline phosphatase
84100 Assay of phosphorus
84132 Assay of serum potassium
84144 Assay of progesterone
84146 Assay of prolactin
84152 Assay of psa, complexed
84153 Assay of psa, total
84154 Assay of psa, free
84155 Assay of protein, serum
84156 Assay of protein, urine
84233 Assay of estrogen
84234 Assay of progesterone
84295 Assay of serum sodium
84300 Assay of urine sodium
84402 Assay of testosterone
84403 Assay of total testosterone
84432 Assay of thyroglobulin
84436 Assay of total thyroxine
84437 Assay of neonatal thyroxine
84439 Assay of free thyroxine
84442 Assay of thyroid activity
84443 Assay thyroid stim hormone
84450 Transferase (AST) (SGOT)
84460 Alanine amino (ALT) (SGPT)
84466 Assay of transferrin
84478 Assay of triglycerides
84479 Assay of thyroid (t3 or t4)
84480 Assay, triiodothyronine (t3)
84481 Free assay (FT-3)
84482 T3 reverse
84520 Assay of urea nitrogen
84525 Urea nitrogen semi-quant
84540 Assay of urine/urea-n
84550 Assay of blood/uric acid
85004 Automated diff wbc count
85007 Bl smear w/diff wbc count
85008 Bl smear w/o diff wbc count
85009 Manual diff wbc count b-coat
85013 Spun microhematocrit
85014 Hematocrit
85018 Hemoglobin
85025 Complete cbc w/auto diff wbc
85027 Complete cbc, automated
85032 Manual cell count, each
85041 Automated rbc count
85044 Manual reticulocyte count
85045 Automated reticulocyte count
85046 Reticyte/hgb concentrate
85048 Automated leukocyte count
85049 Automated platelet count
85055 Reticulated platelet assay
85610 Prothrombin time
85611 Prothrombin test
85651 Rbc sed rate, nonautomated
85652 Rbc sed rate, automated
85660 RBC sickle cell test
86140 C-reactive protein
86580 TB intradermal test
87210 Smear, wet mount, saline/ink
87430 Strep a ag, eia
87804 Influenza assay w/optic
87810 Chylmd trach assay w/optic
87850 Neisseria gonorrhoeae assay w/optic
87880 Strep a assay w/optic
90460 Immunization administration thru 18 yrs. of age via any route of administration, w/ counseling by physician or other qualified health care professional; first or only component of each vaccine or toxoid administered
90461 Immunization administration thru 18 yrs. of age via any route of administration, w/ counseling by physician or other qualified health care professional; each additional vaccine or toxoid component administered (add-on code)
90471 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); one vaccine (single or combination vaccine / toxoid)
90472 Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine / toxoid) (List separately in addition to code for primary procedure
90473 Immunization administration by intranasal or oral route; one vaccine (single or combination vaccine / toxoid)
90474 Immunization administration by intranasal or oral route; each additional vaccine (single or combination vaccine / toxoid) (List separately in addition to code for primary procedure)
90620 Meningococcal recombinant protein and outer membrane vesicle vaccine, serogroup B, 2 dose schedule, IM Use
90621 Meningococcal recombinant lipoprotein vaccine, serogroup B, 3 dose schedule, IM Use
90625 DTaP-HepB-IPV, IM use (new code 1/1/16)
90630 Influenza virus vaccine, quadrivalent (IIV4), split virus, preservative free, Intradermal Use
90632 Hep a vaccine, adult im
90633 Hep a vacc, ped/adol, 2 dose
90634 Hep a vacc, ped/adol, 3 dose
90636 Hep a/hep b vacc, adult im
90645 Hib vaccine, hboc, im (code deleted 1/1/16)
90646 Hib vaccine, prp-d, im (code deleted 1/1/16)
90647 Hib vaccine, prp-omp, im
90648 Hib vaccine, prp-t, im
90649 H papilloma vacc 3 dose im
90651 Human Papillomavirus vaccine types 6, 11, 16, 18, 31, 33, 45, 52, 58, nonavalent (HPV), 3 dose schedule, IM Use
90655 Flu vaccine no preserv 6-35m
90656 Flu vaccine no preserv 3 & >
90657 Flu vaccine, 3 yrs., im
90658 Flu vaccine, 3 yrs. & >, im
90660 Flu vaccine, nasal
90669 Pneumococcal vacc, ped <5 (code deleted 1/1/16)
90680 Rotavirus vacc 3 dose, oral
90690 Typhoid vaccine, oral
90691 Typhoid vaccine, im
90697 Diphtheria, tetanus toxoids, acellular pertussis vaccine, inactivated poliovirus vaccine, Haemophilus influenza type B PRP-OMP conjugate vaccine, and hepatitis B vaccine (DTaP-IPV-Hib-HepB), IM Use
90700 Dtap vaccine, < 7 yrs., im
90702 Dt vaccine < 7, im
90703 Tetanus vaccine, im (code deleted 1/1/16)
90704 Mumps vaccine, sc (code deleted 1/1/16)
90705 Measles vaccine, sc (code deleted 1/1/16)
90706 Rubella vaccine, sc (code deleted 1/1/16)
90707 Mmr vaccine, sc
90708 Measles-rubella vaccine, sc (code deleted 1/1/16)
90710 Mmrv vaccine, sc
90713 Poliovirus, ipv, sc/im
90714 Td vaccine no prsrv >/= 7 im
90715 Tdap vaccine >7 im
90716 Chicken pox vaccine, sc
90721 Dtap/hib vaccine, im (code deleted 1/1/16)
90723 Dtap-hep b-ipv vaccine, im
90732 Pneumococcal vaccine
90733 Meningococcal vaccine, sc
90734 Meningococcal vaccine, im
90736 Zoster vacc, sc
90740 Hepb vacc, ill pat 3 dose im
90743 Hep b vacc, adol, 2 dose, im
90744 Hepb vacc ped/adol 3 dose im
90746 Hep b vaccine, adult, im
90747 Hepb vacc, ill pat 4 dose im
90748 Hep b/hib vaccine, im
92015 Determination of refractive state
92020 Gonioscopy (separate procedure)
92025 Computerized corneal topography, unilateral or bilateral, with interpretation and report
92060 Sensorimotor examination with multiple measurements of ocular deviation (e.g., restrictive or paretic muscle with diplopia) with interpretation and report (separate procedure)
92071 Fitting of contact lens for treatment of ocular surface disease
92072 Fitting of contact lens for management of keratoconus, initial fitting
92081 Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (e.g., tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent)
92082 Visual field examination, unilateral or bilateral, with interpretation and report; intermediate examination (e.g., at least 2 isopters on Goldmann perimeter, or semiquantitative, automated suprathreshold screening program, Humphrey suprathreshold automatic diagnostic test, Octopus program 33)
92083 Visual field examination, unilateral or bilateral, with interpretation and report; extended examination (e.g., Goldmann visual fields with at least 3 isopters plotted and static determination within the central 30°, or quantitative, automated threshold perimetry, Octopus program G-1, 32 or 42, Humphrey visual field analyzer full threshold programs 30-2, 24-2, or 30/60-2
92145 Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report
92133 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral
92134 Scanning computerized ophthalmic diagnostic imaging, retina, with interpretation and report, unilateral or bilateral
92136 Ophthalmic biometry by partial coherence interferometry with intraocular lens power calculation
92140 Provocative tests for glaucoma, with interpretation and report, without tonography
92225 Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; initial
92226 Ophthalmoscopy, extended, with retinal drawing (e.g., for retinal detachment, melanoma), with interpretation and report; subsequent
92260 Ophthalmodynamometry
92283 Color vision examination, extended, e.g., anomaloscope or equivalent
92284 Dark adaptation examination with interpretation and report
92285 External ocular photography with interpretation and report for documentation of medical progress (e.g., close-up photography, slit lamp photography, goniophotography, stereo-photography)
92504 Binocular microscopy (separate diagnostic procedure)
92531 Spontaneous nystagmus, including gaze
92551 Screening test, pure tone, air only
92552 Pure tone audiometry (threshold); air only
92553 Pure tone audiometry (threshold); air and bone
92555 Speech audiometry threshold;
92556 Speech audiometry threshold; with speech recognition
92557 Comprehensive audiometry threshold evaluation and speech recognition (92553 and 92556 combined)
92560 Bekesy audiometry; screening
92561 Bekesy audiometry; diagnostic
92562 Loudness balance test, alternate binaural or monaural
92563 Tone decay test
92564 Short increment sensitivity index (SISI)
92565 Stenger test, pure tone
92567 Tympanometry (impedance testing)
92568 Acoustic reflex testing; threshold
92570 Acoustic immittance testing, includes tympanometry (impedence testing), acoustic reflex threshold testing, and acoustic reflex decay testing
92571 Filtered speech test
92572 Staggered spondaic word test
92575 Sensorineural acuity level test
92576 Synthetic sentence identification test
92577 Stenger test, speech
92579 Visual reinforcement audiometry (VRA)
92582 Conditioning play audiometry
92583 Select picture audiometry
92625 Assessment of tinnitus (including pitch, loudness matching, and masking)
93000 Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report
93005 Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report
93010 Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only
93040 Rhythm ECG, one to three leads; with interpretation and report
93041 Rhythm ECG, one to three leads; tracing only without interpretation and report
93042 Rhythm ECG, one to three leads; interpretation and report only
94010 Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation
94150 Vital capacity, total (separate procedure)
94200 Maximum breathing capacity, maximal voluntary ventilation
94726 Plethysmography for determination of lung volumes and, when performed, airway resistance
94760 Noninvasive ear or pulse oximetry for oxygen saturation; single determination
96372 Diagnostic, prophylactic, or therapeutic injection, subcutaneous or intramuscular
99070 Supplies/materials, provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered
99172 Visual function screening, automated or semi-automated bilateral quantitative determination of visual acuity, ocular alignment, color vision by pseudoisochromatic plates, and field of vision (may include all or some screening of the determination(s) for contract sensitivity, vision under glare)
99173 Screening test of visual acuity, quantitative, bilateral
99177 Instrument-based ocular screening, bilateral; with on-site analysis (new code 1/1/16)
G0008 Admin Influenza Virus Vac
G0009 Admin Pneumococcal Vaccine
G0101 Ca Screen; Pelvic/Breast Exam
G0102 Prostate Ca Screening; Dre
G0103 Psa, Total Screening
G0108 Diab Manage Trn Per Indiv
G0145 Scr C/V Cyto, Thin layer, Rescr
G0202 Screening mammography, producing direct digital image, bilateral, all views, professional component
G0475 HIV antigen/antibody, combination assay, screening (new code 1/1/16)
G0476 Infectious agent detection by nucleic acid; HPV, high risk types for cervical cancer screening, must be performed in addition to pap test (new code 1/1/16)
J0120 Tetracyclin Injection
J0171 Injection, adrenalin, epinephrine, 0.1 mg
J0280 Aminophyllin 250 Mg Inj
J0290 Ampicillin 500 Mg Inj
J0295 Ampicillin Sodium Per 1.5 Gm
J0330 Succinycholine Chloride Inj
J0461 Injection, atropine sulfate, 0.01 mg
J0558 Injection, penicillin G benzathine & penicillin G procaine, 100,000 units
J0561 Injection, penicillin G benzathine, 100,000 units
J0571 Buprenorphine, oral, 1 mg
J0572 Buprenorphine/naloxone, oral , less than or equal to 3 mg
J0573 Buprenorphine/naloxone, oral , greater than 3 mg but less than or equal to 6 mg
J0574 Buprenorphine/naloxone, oral, greater than 6 mg, but less than or equal to 10 mg
J0575 Buprenorphine/naloxone, oral, greater than 10 mg
J0595 Injection, butorphanol tartrate, 1 mg
J0610 Calcium Gluconate Injection
J0640 Leucovorin Calcium Injection
J0670 Inj Mepivacaine Hcl/10 Ml
J0690 Cefazolin Sodium Injection
J0695 Ceftolozane 50mg and tazobactam 25 mg Injection (new code 1/1/16)
J0696 Ceftriaxone Sodium Injection
J0697 Sterile Cefuroxime Injection
J0698 Cefotaxime Sodium Injection
J0702 Betamethasone Acet & Sod Phosp
J0714 Ceftazidime and avibactam, 0.5g/0.125g Injection (new code 1/1/16)
J0715 Ceftizoxime Sodium / 500 Mg
J0720 Chloramphenicol Sodium Injec
J0770 Colistimethate Sodium Inj
J0780 Prochlorperazine Injection
J0833 Injection, Cosyntropin, not otherwise specified, 0.25 mg
J0875 Dalbavancin 5mg Injection (new code 1/1/16)
J0945 Brompheniramine Maleate Inj
J1000 Depo-Estradiol Cypionate Inj
J1020 Methylprednisolone 20 Mg Inj
J1030 Methylprednisolone 40 Mg Inj
J1040 Methylprednisolone 80 Mg Inj
J1050 Injection, Medroxyprogesterone acetate, 1 mg
J1060 Testosterone Cypionate 1 Ml (PA required; see BI 305) (code deleted 1/1/15)
J1070 Testosterone Cypionate 100 Mg (PA required; see BI 305) (code deleted 1/1/15)
J1071 Injection, Testosterone Cypionate, 1 mg
J1080 Testosterone Cypionate 200 Mg (PA required; see BI305) (code deleted 1/1/15)
J1094 Injection, Dexamethasone Acetate, 1 Mg
J1100 Dexamethasone Sodium Phos
J1110 Inj Dihydroergotamine Mesylt
J1120 Acetazolamid Sodium Injection
J1160 Digoxin Injection
J1170 Hydromorphone Injection
J1200 Diphenhydramine Hcl Injection
J1245 Dipyridamole Injection
J1250 Inj Dobutamine Hcl/250 Mg
J1380 Estradiol Valerate 10 Mg Inj
J1410 Inj Estrogen Conjugate 25 Mg
J1435 Injection Estrone Per 1 Mg
J1450 Fluconazole
J1453 Fosaprepitant injection, 1 mg
J1580 Garamycin Gentamicin Inj
J1642 Inj Heparin Sodium Per 10 U
J1644 Inj Heparin Sodium Per 1000u
J1645 Dalteparin Sodium
J1670 Tetanus Immune Globulin Inj
J1720 Hydrocortisone Sodium Succ I
J1815 Injection, Insulin, Per 5 Units
J1885 Ketorolac Tromethamine Inj
J1940 Furosemide Injection
J2001 Injection, lidocaine hcl for intravenous infusion, 10 mg
J2010 Lincomycin Injection
J2060 Lorazepam Injection
J2150 Mannitol Injection
J2175 Meperidine Hydrochl /100 Mg
J2180 Meperidine/Promethazine Inj
J2250 Inj Midazolam Hydrochloride
J2270 Morphine Sulfate Injection
J2274 Injection, Morphine Sulfate, Preservative-Free for Epidural/Intrathecal Use, 10 mg
J2275 Morphine Sulfate Injection (code deleted 1/1/15)
J2300 Inj Nalbuphine Hydrochloride
J2360 Orphenadrine Injection
J2370 Phenylephrine Hcl Injection
J2407 Oritavancin, 10mg Injection (new code 1/1/16)
J2550 Promethazine Hcl Injection
J2675 Inj Progesterone Per 50 Mg
J2710 Neostigmine Methylslfte Inj
J2720 Inj Protamine Sulfate/10 Mg
J2765 Metoclopramide Hcl Injection
J2780 Ranitidine Hydrochloride Inj
J2810 Inj Theophylline Per 40 Mg
J2920 Methylprednisolone Injection
J2930 Methylprednisolone Injection
J2950 Promazine Hcl Injection
J3010 Fentanyl Citrate Injection
J3090 Tedizolid phosphate, 1mg Injection (new code 1/1/16)
J3105 Terbutaline Sulfate Inj
J3120 Testosterone Enanthate Inj (PA required; see BI 305) (code deleted 1/1/15)
J3121 Injection, Testosterone Enanthate, 1 mg
J3130 Testosterone Enanthate Inj (PA required; see BI 305) (code deleted 1/1/15)
J3145 Injection, Testosterone Undecanoate, 1 mg
J3230 Chlorpromazine Hcl Injection
J3260 Tobramycin Sulfate Injection
J3301 Triamcinolone Acetonide Inj
J3302 Triamcinolone Diacetate Inj
J3303 Triamcinolone Hexacetonl Inj
J3360 Diazepam Injection
J3410 Hydroxyzine Hcl Injection
J3420 Cyanocobalamin Injection
J3430 Vitamin K Phytonadione Inj
J3475 Inj Magnesium Sulfate
J3480 Inj Potassium Chloride
J7030 Normal Saline Solution Infus
J7042 5% Dextrose/Normal Saline
J7050 Normal Saline Solution Infus
J7060 5% Dextrose/Water
J7070 D5w Infusion
J7120 Ringers Lactate Infusion
J7121 5% Dextrose in alctated ringers infusion, up to 1000 cc (new code 1/1/16)
J7300 Intraut Copper Contraceptive
J7302 Levonorgestrel-releasing intrauterine contraceptive system, 52 mg
J7340 Carbidopa 5mg/levodopa 20mg enteral suspension (new code 1/1/16)
J7503 Tacrolimus, extended release, oral 0.25mg (new code 1/1/16)
J7512 Prednisone, immediate release or delayed release, oral, 1mg (new code 1/1/16)
J7609 Albuterol comp unit
J7611 Albuterol concentrated form
J7613 Albuterol unit dose
J7614 Levalbuterol unit dose





























COMPLEX OFFICE PROCEDURES AND MEDICATIONS
CPT CODE CODE DESCRIPTION
10021 Fine needle aspiration; without imaging guidance
10040 Acne surgery (e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)
10060 Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia; simple or single
10080 Incision and drainage of pilonidal cyst; simple
10120 Incision and removal of foreign body, subcutaneous tissues; simple
10140 Incision and drainage of hematoma, seroma or fluid collection
10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface
11001 Debridement of extensive eczematous or infected skin; each additional 10% of the body surface (List separately in addition to code for primary procedure)
11055 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion
11056 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); two to four lesions
11057 Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); more than four lesions
11100 Biopsy of skin, subcutaneous tissue and / or mucous membrane (including simple closure), unless otherwise listed; single lesion
11101 Biopsy of skin, subcutaneous tissue and / or mucous membrane (including simple closure), unless otherwise listed; each separate / additional lesion (List separately in addition to code for primary procedure)
11200 Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions
11201 Removal of skin tags, multiple fibrocutaneous tags, any area; each additional ten lesions (List separately in addition to code for primary procedure)
11300 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less
11301 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cm
11302 Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cm
11305 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
11306 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 cm TO 1.0 CM
11310 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less
11311 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm
11400 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less
11401 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm
11402 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm
11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less
11421 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm
11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less
11441 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm
11976 Removable, Implantable Contraceptive Capsules
12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and / or extremities (including hands and feet); 2.5 cm or less
12002 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and / or extremities (including hands and feet); 2.6 cm to 7.5 cm
12011 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and / or mucous membranes; 2.5 cm or less
17106 Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq. cm
17260 Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less
17261 Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cm
17270 Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less
17280 Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less
17340 Cryotherapy (CO2 slush, liquid N2) for acne
19000 Puncture aspiration of cyst of breast;
19001 Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure)
20600 Arthrocentesis, aspiration and / or injection; small joint or bursa (e.g., fingers, toes)
20605 Arthrocentesis, aspiration and / or injection; intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa)
20610 Arthrocentesis, aspiration and / or injection; major joint or bursa (e.g., shoulder, hip, knee joint, subacromial bursa)
30901 Control nasal hemorrhage, anterior, simple (limited cautery and / or packing) any method
30903 Control nasal hemorrhage, anterior, complex (extensive cautery and / or packing) any method
36400 Venipuncture, younger than age 3 years, necessitating physician`s skill, not to be used for routine venipuncture; femoral or jugular vein
36405 Venipuncture, younger than age 3 years, necessitating physician`s skill, not to be used for routine venipuncture; scalp vein
36406 Venipuncture, younger than age 3 years, necessitating physician`s skill, not to be used for routine venipuncture; other vein
36410 Venipuncture, younger than age 3 years, necessitating physician`s skill (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture)
36591 Collection of blood specimen from a completely implantable venous access device
36593 Declotting by thrombolytic agent of implanted vascular access device or catheter
42650 Dilation of salivary duct
42660 Dilation and catheterization of salivary duct, with or without injection
43450 Dilation of esophagus, by unguided sound or bougie, single or multiple passes
43453 Dilate esophagus, over guide wire
43756 Duodenal intubation and aspiration, diagnostic, includes image guidance; single specimen
43757 Duodenal intubation and aspiration, diagnostic, includes image guidance; collection of multiple fractional specimens w/ pancreatic or gallbladder stimulation, single or double lumen tube, includes drug administration
43760 Change gastrostomy tube
43761 Repositioning of the gastric feeding tube, any method, through the duodenum for enteric nutrition
45190 Destruction of rectal tumor, transanal approach
45520 Perirectal injection of sclerosing solution for prolapsed
46083 Incision of thrombosed hemorrhoid, external
46220 Papillectomy or excision of single tag, anus (separate procedure)
46230 Excision of external hemorrhoid tags and / or multiple papillae
46320 Enucleation or excision of external thrombotic hemorrhoid
46600 Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
46922 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision
46930 Destruction of internal hemorrhoid(s) by thermal energy
51100 Aspiration of bladder; by needle
51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
51736 Simple uroflowmetry (UFR) (e.g., stop-watch flow rate, mechanical uroflowmeter)
51798 Measurement of post-voiding residual urine and / or bladder capacity by ultrasound, non-imaging
53660 Dilation of female urethra including suppository and / or instillation; initial
53661 Dilation of female urethra including suppository and / or instillation; subsequent
56442 Hymenotomy, simple incision
56605 Biopsy of vulva/perineum (separate procedure); one lesion
56606 Biopsy of vulva/perineum (separate procedure); each separate additional lesion (List separately in addition to code for primary procedure)
57150 Irrigation of vagina and / or application of medicament for treatment of bacterial, parasitic, or fungoid disease
57160 Fitting and insertion of pessary or other intravaginal support device
57170 Diaphragm or cervical cap fitting with instructions
58100 Endometrial sampling (biopsy) with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure)
58300 Insertion of intrauterine device
58301 Removal of intrauterine device
65210 Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating
65220 Removal of foreign body, external eye; corneal, without slit lamp
65222 Removal of foreign body, external eye; corneal, with slit lamp
69100 Biopsy of external ear
68801 Dilation of lacrimal duct
68810 Probing of lacrimal duct
70350 X-ray head for orthodontia
70371 Speech evaluation, complex
74190 X-ray exam of peritoneum
74710 X-ray measurement of pelvis
74775 X-ray exam of perineum
77071 X-ray stress view
77072 X-rays for bone age
77073 X-rays, bone length studies
77074 X-rays, bone survey, limited
77075 X-rays, bone survey complete
77076 X-rays, bone survey, infant
77077 Joint survey, single view
80103 Drug analysis, tissue prep (code deleted 1/1/15)
80150 Assay of amikacin
80152 Assay of amitriptyline (code deleted 1/1/15)
80154 Assay of benzodiazepines (code deleted 1/1/15)
80156 Assay, carbamazepine, total
80157 Assay, carbamazepine, free
80158 Assay of cyclosporine
80160 Assay of desipramine (code deleted 1/1/15)
80162 Assay of digoxin
80164 Assay, dipropylacetic acid
80166 Assay of doxepin (code deleted 1/1/15)
80168 Assay of ethosuximide
80170 Assay of gentamicin
80172 Assay of gold (code deleted 1/1/15)
80173 Assay of haloperidol
80174 Assay of imipramine (code deleted 1/1/15)
80176 Assay of lidocaine
80178 Assay of lithium
80182 Assay of nortriptyline (code deleted 1/1/15)
80184 Assay of phenobarbital
80185 Assay of phenytoin, total
80186 Assay of phenytoin, free
80188 Assay of primidone
80190 Assay of procainamide
80192 Assay of procainamide
80194 Assay of quinidine
80195 Assay of sirolimus
80196 Assay of salicylate (code deleted 1/1/15)
80197 Assay of tacrolimus
80198 Assay of theophylline
80200 Assay of tobramycin
80201 Assay of topiramate
80202 Assay of vancomycin
80299 Quantitative assay, drug
80320 Alcohol confirmatory drug testing
80321 Alcohol biomarkers confirmatory drug testing; 1 or 2
80322 Alcohol biomarkers confirmatory drug testing; 3 or more
80323 Alkaloids confirmatory drug testing, not otherwise specified
80324 Amphetamines confirmatory drug testing; 1 or 2
80325 Amphetamines confirmatory drug testing; 3 or 4
80326 Amphetamines confirmatory drug testing; 5 or more
80327 Anabolic steroids confirmatory drug testing; 1 or 2
80328 Anabolic steroids confirmatory drug testing; 3 or more
80329 Analgesics, non-opioid confirmatory drug testing; 1 or 2
80330 Analgesics, non-opioid confirmatory drug testing; 3 to 5
80331 Analgesics, non-opioid confirmatory drug testing; 6 or more
80335 Antidepressants, tricyclic and other cyclicals confirmatory drug testing; 1 or 2
80336 Antidepressants, tricyclic and other cyclicals confirmatory drug testing; 3 - 5
80337 Antidepressants, tricyclic and other cyclicals confirmatory drug testing; 6 or more
80339 Antiepileptics, not otherwise specified confirmatory drug testing; 1 - 3
80340 Antiepileptics, not otherwise specified confirmatory drug testing; 4 - 6
80341 Antiepileptics, not otherwise specified confirmatory drug testing; 7 or more
80342 Antipsychotics, not otherwise specified confirmatory drug testing; 1 - 3
80343 Antipsychotics, not otherwise specified confirmatory drug testing; 4 - 6
80344 Antipsychotics, not otherwise specified confirmatory drug testing; 7 or more
80345 Barbiturates confirmatory drug testing
80346 Benzodiazepines confirmatory drug testing; 1 - 12
80347 Benzodiazepines confirmatory drug testing; 13 or more
80353 Cocaine confirmatory drug testing
80358 Methadone confirmatory drug testing
80361 Opiates confirmatory drug testing; 1 or more
80362 Opioids and Opiate analogs confirmatory drug testing; 1 or 2
80363 Opioids and Opiate analogs confirmatory drug testing; 3 or 4
80364 Opioids and Opiate analogs confirmatory drug testing; 5 or more
80369 Skeletal muscle relaxants confirmatory drug testing; 1 or 2
80370 Skeletal muscle relaxants confirmatory drug testing; 3 or more
80375 Drug(s) or substance(s), definitive, qualitative or quantitative drug testing, NOS; 1 - 3
80400 Acth stimulation panel
80402 Acth stimulation panel
80406 Acth stimulation panel
80408 Aldosterone suppression eval
80410 Calcitonin stimul panel
80412 CRH stimulation panel
80414 Testosterone response
80415 Estradiol response panel
80416 Renin stimulation panel
80417 Renin stimulation panel
80418 Pituitary evaluation panel
80420 Dexamethasone panel
80422 Glucagon tolerance panel
80424 Glucagon tolerance panel
80426 Gonadotropin hormone panel
80428 Growth hormone panel
80430 Growth hormone panel
80432 Insulin suppression panel
80434 Insulin tolerance panel
80435 Insulin tolerance panel
80436 Metyrapone panel
80438 TRH stimulation panel
80439 TRH stimulation panel
80440 TRH stimulation panel (code deleted 1/1/15)
80500 Lab pathology consultation
80502 Lab pathology consultation
81050 Urinalysis, volume measure
81099 Urinalysis test procedure
82000 Assay of blood acetaldehyde (code deleted 1/1/15)
82003 Assay of acetaminophen (code deleted 1/1/15)
82009 Test for acetone/ketones
82010 Acetone assay
82013 Acetylcholinesterase assay
82016 Acylcarnitines, qual
82017 Acylcarnitines, quant
82024 Assay of acth
82030 Assay of adp & amp
82040 Assay of serum albumin
82042 Assay of urine albumin
82045 Albumin, ischemia modified
82055 Assay of ethanol (code deleted 1/1/15)
82085 Assay of aldolase
82088 Assay of aldosterone
82101 Assay of urine alkaloids (code deleted 1/1/15)
82103 Alpha-1-antitrypsin, total
82104 Alpha-1-antitrypsin, pheno
82105 Alpha-fetoprotein, serum
82106 Alpha-fetoprotein, amniotic
82107 Alpha-fetoprotein l3
82108 Assay of aluminum
82120 Amines, vaginal fluid qual
82127 Amino acid, single qual
82128 Amino acids, mult qual
82131 Amino acids, single quant
82135 Assay, aminolevulinic acid
82136 Amino acids, quant, 2-5
82139 Amino acids, quan, 6 or more
82140 Assay of ammonia
82143 Amniotic fluid scan
82145 Assay of amphetamines (code deleted 1/1/15)
82150 Assay of amylase
82154 Androstanediol glucuronide
82157 Assay of androstenedione
82160 Assay of androsterone
82163 Assay of angiotensin II
82164 Angiotensin I enzyme test
82172 Assay of apolipoprotein
82175 Assay of arsenic
82180 Assay of ascorbic acid
82190 Atomic absorption
82205 Assay of barbiturates (code deleted 1/1/15)
82232 Assay of beta-2 protein
82239 Bile acids, total
82240 Bile acids, cholylglycine
82252 Fecal bilirubin test
82261 Assay of biotinidase
82286 Assay of bradykinin
82300 Assay of cadmium
82306 Vitamin D; 25 hydroxy, includes fraction(s), if performed
82308 Assay of calcitonin
82331 Calcium infusion test
82340 Assay of calcium in urine
82355 Calculus analysis, qual
82360 Calculus assay, quant
82365 Calculus spectroscopy
82370 X-ray assay, calculus
82373 Assay, c-d transfer measure
82374 Assay, blood carbon dioxide
82375 Assay, blood carbon monoxide
82376 Test for carbon monoxide
82378 Carcinoembryonic antigen
82379 Assay of carnitine
82380 Assay of carotene
82382 Assay, urine catecholamines
82383 Assay, blood catecholamines
82384 Assay, three catecholamines
82387 Assay of cathepsin-d
82390 Assay of ceruloplasmin
82397 Chemiluminescent assay
82415 Assay of chloramphenicol
82435 Assay of blood chloride
82436 Assay of urine chloride
82438 Assay, other fluid chlorides
82441 Test for chlorohydrocarbons
82480 Assay, serum cholinesterase
82482 Assay, rbc cholinesterase
82485 Assay, chondroitin sulfate
82486 Gas/liquid chromatography (code deleted 1/1/16)
82487 Paper chromatography (code deleted 1/1/16)
82488 Paper chromatography (code deleted 1/1/16)
82489 Thin layer chromatography (code deleted 1/1/16)
82491 Chromotography, quant, sing (code deleted 1/1/16)
82492 Chromotography, quant, mult (code deleted 1/1/16)
82495 Assay of chromium
82507 Assay of citrate
82520 Assay of cocaine (code deleted 1/1/15)
82523 Collagen crosslinks
82525 Assay of copper
82528 Assay of corticosterone
82530 Cortisol, free
82533 Total cortisol
82540 Assay of creatine
82541 Column chromatography, qual (code deleted 1/1/16)
82542 Column chromatography, quant
82543 Column chromatograph/isotope (code deleted 1/1/16)
82544 Column chromatograph/isotope (code deleted 1/1/16)
82552 Assay of cpk in blood
82553 Creatine, MB fraction
82554 Creatine, isoforms
82585 Assay of cryofibrinogen
82595 Assay of cryoglobulin
82600 Assay of cyanide
82608 B-12 binding capacity
82610 Cystatin c
82615 Test for urine cystines
82626 Dehydroepiandrosterone
82627 Dehydroepiandrosterone
82633 Desoxycorticosterone
82634 Deoxycortisol
82638 Assay of dibucaine number
82646 Assay of dihydrocodeinone (code deleted 1/1/15)
82649 Assay of dihydromorphinone (code deleted 1/1/15)
82651 Assay of dihydrotestosterone (code deleted 1/1/15)
82652 Vitamin D; 1, 25 dihydroxy, includes fraction(s), if performed
82654 Assay of dimethadione (code deleted 1/1/15)
82656 Pancreatic elastase, fecal
82657 Enzyme cell activity
82658 Enzyme cell activity, ra
82664 Electrophoretic test
82666 Assay of epiandrosterone (code deleted 1/1/15)
82668 Assay of erythropoietin
82690 Assay of ethchlorvynol (code deleted 1/1/15)
82693 Assay of ethylene glycol
82696 Assay of etiocholanolone
82705 Fats/lipids, feces, qual
82710 Fats/lipids, feces, quant
82715 Assay of fecal fat
82725 Assay of blood fatty acids
82726 Long chain fatty acids
82731 Assay of fetal fibronectin
82735 Assay of fluoride
82742 Assay of flurazepam (code deleted 1/1/15)
82747 Assay of folic acid, rbc
82757 Assay of semen fructose
82759 Assay of rbc galactokinase
82760 Assay of galactose
82775 Assay galactose transferase
82776 Galactose transferase test
82784 Assay of gammaglobulin igm
82785 Assay of gammaglobulin ige
82787 Igg 1, 2, 3 or 4, each
82800 Blood pH
82803 Blood gases: pH, pO2 & pCO2
82805 Blood gases w/o2 saturation
82810 Blood gases, O2 sat only
82820 Hemoglobin-oxygen affinity
82930 Gastric acid analysis, includes pH if performed, each specimen
82938 Gastrin test
82941 Assay of gastrin
82943 Assay of glucagon
82945 Glucose other fluid
82946 Glucagon tolerance test
82951 Glucose tolerance test (GTT)
82952 GTT-added samples
82953 Glucose-tolbutamide test (code deleted 1/1/15)
82955 Assay of g6pd enzyme
82960 Test for G6PD enzyme
82963 Assay of glucosidase
82965 Assay of gdh enzyme
82975 Assay of glutamine (code deleted 1/1/15)
82978 Assay of glutathione
82979 Assay, rbc glutathione
82980 Assay of glutethimide (code deleted 1/1/15)
82985 Glycated protein
83003 Assay, growth hormone (hgh)
83008 Assay of guanosine (code deleted 1/1/15)
83009 H pylori (c-13), blood
83010 Assay of haptoglobin, quant
83012 Assay of haptoglobins
83014 H pylori drug admin
83015 Heavy metal screen
83018 Quantitative screen, metals
83020 Hemoglobin electrophoresis
83021 Hemoglobin chromotography
83026 Hemoglobin, copper sulfate
83030 Fetal hemoglobin, chemical
83033 Fetal hemoglobin assay, qual
83037 Glycosylated hb, home device
83045 Blood methemoglobin test
83050 Blood methemoglobin assay
83051 Assay of plasma hemoglobin
83055 Blood sulfhemoglobin test (code deleted 1/1/15)
83060 Blood sulfhemoglobin assay
83065 Assay of hemoglobin heat
83068 Hemoglobin stability screen
83069 Assay of urine hemoglobin
83070 Assay of hemosiderin, qual
83071 Assay of hemosiderin, quant (code deleted 1/1/15)
83080 Assay of b hexosaminidase
83088 Assay of histamine
83090 Assay of homocystine
83150 Assay of for hva
83491 Assay of corticosteroids
83497 Assay of 5-hiaa
83500 Assay, free hydroxyproline
83505 Assay, total hydroxyproline
83516 Immunoassay, nonantibody
83518 Immunoassay, dipstick
83519 Immunoassay, nonantibody
83520 Immunoassay, RIA
83525 Assay of insulin
83527 Assay of insulin
83528 Assay of intrinsic factor
83570 Assay of idh enzyme
83582 Assay of ketogenic steroids
83586 Assay 17- ketosteroids
83593 Fractionation, ketosteroids
83605 Assay of lactic acid
83625 Assay of ldh enzymes
83630 Lactoferrin, fecal (qual)
83631 Lactoferrin, fecal (quant)
83632 Placental lactogen
83633 Test urine for lactose
83634 Assay of urine for lactose (code deleted 1/1/15)
83661 L/s ratio, fetal lung
83662 Foam stability, fetal lung
83663 Fluoro polarize, fetal lung
83664 Lamellar bdy, fetal lung
83670 Assay of lap enzyme
83690 Assay of lipase
83695 Assay of lipoprotein(a)
83698 Assay lipoprotein pla2
83700 Lipopro bld, electrophoretic
83701 Lipoprotein bld, hr fraction
83704 Lipoprotein, bld, by nmr
83727 Assay of lrh hormone
83775 Assay of md enzyme
83785 Assay of manganese
83788 Mass spectrometry qual (code deleted 1/1/16)
83789 Mass spectrometry quant
83805 Assay of meprobamate (code deleted 1/1/15)
83825 Assay of mercury
83835 Assay of metanephrines
83840 Assay of methadone (code deleted 1/1/15)
83857 Assay of methemalbumin
83858 Assay of methsuximide (code deleted 1/1/15)
83864 Mucopolysaccharides
83866 Mucopolysaccharides screen (code deleted 1/1/15)
83872 Assay synovial fluid mucin
83873 Assay of csf protein
83874 Assay of myoglobin
83880 Natriuretic peptide
83883 Assay, nephelometry not spec
83885 Assay of nickel
83887 Assay of nicotine (code deleted 1/1/15)
83916 Oligoclonal bands
83918 Organic acids, total, quant
83919 Organic acids, qual, each
83921 Organic acid, single, quant
83925 Assay of opiates (code deleted 1/1/15)
83930 Assay of blood osmolality
83935 Assay of urine osmolality
83937 Assay of osteocalcin
83945 Assay of oxalate
83950 Oncoprotein, her-2/neu
83970 Assay of parathormone
83986 Assay of body fluid acidity
83992 Assay for phencyclidine
83993 Assay for calprotectin fecal
84022 Assay of phenothiazine (code deleted 1/1/15)
84035 Assay of phenylketones
84060 Assay acid phosphatase
84061 Phosphatase, forensic exam
84066 Assay prostate phosphatase
84078 Assay alkaline phosphatase
84080 Assay alkaline phosphatases
84081 Amniotic fluid enzyme test
84085 Assay of rbc pg6d enzyme
84087 Assay phosphohexose enzymes
84105 Assay of urine phosphorus
84106 Test for porphobilinogen
84110 Assay of porphobilinogen
84119 Test urine for porphyrins
84120 Assay of urine porphyrins
84126 Assay of feces porphyrins
84127 Assay of feces porphyrins (code deleted 1/1/15)
84132 Assay of serum potassium
84133 Assay of urine potassium
84134 Assay of prealbumin
84135 Assay of pregnanediol
84138 Assay of pregnanetriol
84140 Assay of pregnenolone
84143 Assay of 17-hydroxypregneno
84146 Assay of Prolactin
84150 Assay of prostaglandin
84157 Assay of protein, other
84160 Assay of protein, any source
84163 Pappa, serum
84165 Protein e-phoresis, serum
84166 Protein e-phoresis/urine/csf
84181 Western blot test
84182 Protein, western blot test
84202 Assay RBC protoporphyrin
84203 Test RBC protoporphyrin
84206 Assay of proinsulin
84207 Assay of vitamin b-6
84210 Assay of pyruvate
84220 Assay of pyruvate kinase
84228 Assay of quinine
84235 Assay of endocrine hormone
84238 Assay, nonendocrine receptor
84244 Assay of renin
84252 Assay of vitamin b-2
84255 Assay of selenium
84260 Assay of serotonin
84270 Assay of sex hormone globul
84275 Assay of sialic acid
84285 Assay of silica
84302 Assay of sweat sodium
84305 Assay of somatomedin
84307 Assay of somatostatin
84311 Spectrophotometry
84315 Body fluid specific gravity
84375 Chromatogram assay, sugars
84376 Sugars, single, qual
84377 Sugars, multiple, qual
84378 Sugars, single, quant
84379 Sugars multiple quant
84392 Assay of urine sulfate
84425 Assay of vitamin b-1
84430 Assay of thiocyanate
84445 Assay of tsi
84446 Assay of vitamin e
84449 Assay of transcortin
84484 Assay of troponin, quant
84485 Assay duodenal fluid trypsin
84488 Test feces for trypsin
84490 Assay of feces for trypsin
84510 Assay of tyrosine
84512 Assay of troponin, qual
84545 Urea-N clearance test
84560 Assay of urine/uric acid
84577 Assay of feces/urobilinogen
84578 Test urine urobilinogen
84580 Assay of urine urobilinogen
84583 Assay of urine urobilinogen
84585 Assay of urine vma
84586 Assay of vip
84588 Assay of vasopressin
84590 Assay of vitamin a
84591 Assay of nos vitamin
84597 Assay of vitamin k
84600 Assay of volatiles
84620 Xylose tolerance test
84630 Assay of zinc
84681 Assay of c-peptide
84702 Chorionic gonadotropin test
84703 Chorionic gonadotropin assay
84704 Hcg, free betachain test
84830 Ovulation tests
84999 Clinical chemistry test
85002 Bleeding time test
85060 Blood smear interpretation
85097 Bone marrow interpretation
85130 Chromogenic substrate assay
85170 Blood clot retraction
85175 Blood clot lysis time
85210 Blood clot factor II test
85220 Blood clot factor V test
85230 Blood clot factor VII test
85240 Blood clot factor VIII test
85244 Blood clot factor VIII test
85245 Blood clot factor VIII test
85246 Blood clot factor VIII test
85247 Blood clot factor VIII test
85250 Blood clot factor IX test
85260 Blood clot factor X test
85270 Blood clot factor XI test
85280 Blood clot factor XII test
85290 Blood clot factor XIII test
85291 Blood clot factor XIII test
85292 Blood clot factor assay
85293 Blood clot factor assay
85300 Antithrombin III test
85301 Antithrombin III test
85302 Blood clot inhibitor antigen
85303 Blood clot inhibitor test
85305 Blood clot inhibitor assay
85306 Blood clot inhibitor test
85307 Assay activated protein c
85335 Factor inhibitor test
85337 Thrombomodulin
85345 Coagulation time
85347 Coagulation time
85348 Coagulation time
85360 Euglobulin lysis
85362 Fibrin degradation products
85366 Fibrinogen test
85370 Fibrinogen test
85378 Fibrin degrade, semiquant
85379 Fibrin degradation, quant
85380 Fibrin degradation, vte
85384 Fibrinogen
85385 Fibrinogen
85390 Fibrinolysins screen
85396 Clotting assay, whole blood
85400 Fibrinolytic plasmin
85410 Fibrinolytic antiplasmin
85415 Fibrinolytic plasminogen
85420 Fibrinolytic plasminogen
85421 Fibrinolytic plasminogen
85441 Heinz bodies, direct
85445 Heinz bodies, induced
85460 Hemoglobin, fetal
85461 Hemoglobin, fetal
85475 Hemolysin
85520 Heparin assay
85525 Heparin neutralization
85530 Heparin-protamine tolerance
85536 Iron stain peripheral blood
85540 Wbc alkaline phosphatase
85547 RBC mechanical fragility
85549 Muramidase
85555 RBC osmotic fragility
85557 RBC osmotic fragility
85576 Blood platelet aggregation
85597 Platelet neutralization
85612 Viper venom prothrombin time
85613 Russell viper venom, diluted
85635 Reptilase test
85670 Thrombin time, plasma
85675 Thrombin time, titer
85705 Thromboplastin inhibition
85730 Thromboplastin time, partial
85732 Thromboplastin time, partial
85810 Blood viscosity examination
85999 Hematology procedure
86000 Agglutinins, febrile
86021 WBC antibody identification
86022 Platelet antibodies
86023 Immunoglobulin assay
86038 Antinuclear antibodies
86039 Antinuclear antibodies (ANA)
86060 Antistreptolysin o, titer
86063 Antistreptolysin o, screen
86141 C-reactive protein, hs
86146 Glycoprotein antibody
86147 Cardiolipin antibody
86148 Phospholipid antibody
86155 Chemotaxis assay
86156 Cold agglutinin, screen
86157 Cold agglutinin, titer
86160 Complement, antigen
86161 Complement/function activity
86162 Complement, total (CH50)
86171 Complement fixation, each
86185 Counterimmunoelectrophoresis
86200 Ccp antibody
86215 Deoxyribonuclease, antibody
86225 DNA antibody
86226 DNA antibody, single strand
86235 Nuclear antigen antibody
86243 Fc receptor
86255 Fluorescent antibody, screen
86256 Fluorescent antibody, titer
86277 Growth hormone antibody
86280 Hemagglutination inhibition
86294 Immunoassay, tumor, qual
86300 Immunoassay, tumor, ca 15-3
86301 Immunoassay, tumor, ca 19-9
86304 Immunoassay, tumor, ca 125
86308 Heterophile antibodies
86309 Heterophile antibodies
86310 Heterophile antibodies
86316 Immunoassay, tumor other
86317 Immunoassay,infectious agent
86318 Immunoassay,infectious agent
86320 Serum immunoelectrophoresis
86325 Other immunoelectrophoresis
86327 Immunoelectrophoresis assay
86329 Immunodiffusion
86331 Immunodiffusion ouchterlony
86332 Immune complex assay
86334 Immunofix e-phoresis, serum
86335 Immunfix e-phorsis/urine/csf
86336 Inhibin A
86337 Insulin antibodies
86340 Intrinsic factor antibody
86341 Islet cell antibody
86343 Leukocyte histamine release
86344 Leukocyte phagocytosis
86353 Lymphocyte transformation
86355 B cells, total count
86356 Mononuclear cell antigen
86357 Nk cells, total count
86359 T cells, total count
86360 T cell, absolute count/ratio
86361 T cell, absolute count
86367 Stem cells, total count
86376 Microsomal antibody
86378 Migration inhibitory factor
86382 Neutralization test, viral
86384 Nitroblue tetrazolium dye
86403 Particle agglutination test
86406 Particle agglutination test
86430 Rheumatoid factor test
86431 Rheumatoid factor, quant
86480 Tb test, cell immun measure
86485 Skin test, candida
86486 Skin test, nos antigen
86490 Coccidioidomycosis skin test
86510 Histoplasmosis skin test
86590 Streptokinase, antibody
86592 Blood serology, qualitative
86593 Blood serology, quantitative
86602 Antinomyces antibody
86603 Adenovirus antibody
86606 Aspergillus antibody
86609 Bacterium antibody
86611 Bartonella antibody
86612 Blastomyces antibody
86615 Bordetella antibody
86617 Lyme disease antibody
86618 Lyme disease antibody
86619 Borrelia antibody
86622 Brucella antibody
86625 Campylobacter antibody
86628 Candida antibody
86631 Chlamydia antibody
86632 Chlamydia igm antibody
86635 Coccidioides antibody
86638 Q fever antibody
86641 Cryptococcus antibody
86644 CMV antibody
86645 CMV antibody, IgM
86648 Diphtheria antibody
86651 Encephalitis antibody
86652 Encephalitis antibody
86653 Encephalitis antibody
86654 Encephalitis antibody
86658 Enterovirus antibody
86663 Epstein-barr antibody
86664 Epstein-barr antibody
86665 Epstein-barr antibody
86666 Ehrlichia antibody
86668 Francisella tularensis
86671 Fungus antibody
86674 Giardia lamblia antibody
86677 Helicobacter pylori
86682 Helminth antibody
86684 Hemophilus influenza
86687 Htlv-i antibody
86688 Htlv-ii antibody
86689 HTLV/HIV confirmatory test
86692 Hepatitis, delta agent
86694 Herpes simplex test
86695 Herpes simplex test
86696 Herpes simplex type 2
86698 Histoplasma
86701 HIV-1
86702 HIV-2
86703 HIV-1/HIV-2, single assay
86704 Hep b core antibody, total
86705 Hep b core antibody, igm
86706 Hep b surface antibody
86707 Hep be antibody
86708 Hep A antibody, total
86709 Hep A antibody, igm
86710 Influenza virus antibody
86713 Legionella antibody
86717 Leishmania antibody
86720 Leptospira antibody
86723 Listeria monocytogenes ab
86727 Lymph choriomeningitis ab
86729 Lympho venereum antibody
86732 Mucormycosis antibody
86735 Mumps antibody
86738 Mycoplasma antibody
86741 Neisseria meningitidis
86744 Nocardia antibody
86747 Parvovirus antibody
86750 Malaria antibody
86753 Protozoa antibody nos
86756 Respiratory virus antibody
86757 Rickettsia antibody
86759 Rotavirus antibody
86762 Rubella antibody
86765 Rubeola antibody
86768 Salmonella antibody
86771 Shigella antibody
86774 Tetanus antibody
86777 Toxoplasma antibody
86778 Toxoplasma antibody, igm
86780 Treponema Pallidum
86784 Trichinella antibody
86787 Varicella-zoster antibody
86788 West Nile virus ab, igm
86789 West Nile virus antibody
86790 Virus antibody nos
86793 Yersinia antibody
86800 Thyroglobulin antibody
86803 Hepatitis c ab test
86804 Hep c ab test, confirm
86805 Lymphocytotoxicity assay
86806 Lymphocytotoxicity assay
86807 Cytotoxic antibody screening
86808 Cytotoxic antibody screening
86812 HLA typing, A, B, or C
86813 HLA typing, A, B, or C
86816 HLA typing, DR/DQ
86817 HLA typing, DR/DQ
86821 Lymphocyte culture, mixed
86822 Lymphocyte culture, primed
86849 Immunology procedure
86850 RBC antibody screen
86860 RBC antibody elution
86870 RBC antibody identification
86880 Coombs test, direct
86885 Coombs test, indirect, qual
86886 Coombs test, indirect, titer
86890 Autologous blood process
86891 Autologous blood, op salvage
86900 Blood typing, ABO
86901 Blood typing, Rh (D)
86902 Blood Typing, Serologic; antigen testing of donor blood using reagent serum, each antigen test
86904 Blood typing, patient serum
86905 Blood typing, RBC antigens
86906 Blood typing, Rh phenotype
86911 Blood typing, antigen system
86920 Compatibility test, spin
86921 Compatibility test, incubate
86922 Compatibility test, antiglob
86923 Compatibility test, electric
86940 Hemolysins/agglutinins, auto
86941 Hemolysins/agglutinins
87001 Small animal inoculation (code deleted 1/1/15)
87003 Small animal inoculation
87015 Specimen concentration
87040 Blood culture for bacteria
87045 Feces culture, bacteria
87046 Stool cultr, bacteria, each
87070 Culture, bacteria, other
87071 Culture bacteria aerobic other
87073 Culture bacteria anaerobic
87075 Cultr bacteria, except blood
87076 Culture anaerobe ident, each
87077 Culture aerobic identify
87081 Culture screen only
87084 Culture of specimen by kit
87086 Urine culture/colony count
87088 Urine bacteria culture
87101 Skin fungi culture
87102 Fungus isolation culture
87103 Blood fungus culture
87106 Fungi identification, yeast
87107 Fungi identification, mold
87109 Mycoplasma
87110 Chlamydia culture
87116 Mycobacteria culture
87118 Mycobacteria identification
87140 Culture type immunofluoresc
87143 Culture typing, glc/hplc
87147 Culture type, immunologic
87149 Culture type, nucleic acid
87152 Culture type pulse field gel
87158 Culture typing, added method
87164 Dark field examination
87166 Dark field examination
87168 Macroscopic exam arthropod
87169 Macroscopic exam parasite
87172 Pinworm exam
87176 Tissue homogenization, cultr
87177 Ova and parasites smears
87181 Microbe susceptible, diffuse
87184 Microbe susceptible, disk
87185 Microbe susceptible, enzyme
87186 Microbe susceptible, mic
87187 Microbe susceptible, mlc
87188 Microbe suscept, macrobroth
87190 Microbe suscept, mycobacteri
87197 Bactericidal level, serum
87205 Smear, gram stain
87206 Smear, fluorescent/acid stain
87207 Smear, special stain
87209 Smear, complex stain
87220 Tissue exam for fungi
87230 Assay, toxin or antitoxin
87250 Virus inoculate, eggs/animal
87252 Virus inoculation, tissue
87253 Virus inoculate tissue, addl
87254 Virus inoculation, shell via
87255 Genet virus isolate, hsv
87260 Adenovirus ag, if
87265 Pertussis ag, if
87267 Enterovirus antibody, dfa
87269 Giardia ag, if
87270 Chlamydia trachomatis ag, if
87271 Cytomegalovirus dfa
87272 Cryptosporidium ag, if
87273 Herpes simplex 2, ag, if
87274 Herpes simplex 1, ag, if
87275 Influenza b, ag, if
87276 Influenza a, ag, if
87277 Legionella micdadei, ag, if
87278 Legion pneumophilia ag, if
87279 Parainfluenza, ag, if
87280 Respiratory syncytial ag, if
87281 Pneumocystis carinii, ag, if
87283 Rubeola, ag, if
87285 Treponema pallidum, ag, if
87290 Varicella zoster, ag, if
87299 Antibody detection, nos, if
87300 Ag detection, polyval, if
87301 Adenovirus ag, eia
87305 Aspergillus ag, eia
87320 Chylmd trach ag, eia
87324 Clostridium ag, eia
87327 Cryptococcus neoform ag, eia
87328 Cryptosporidium ag, eia
87329 Giardia ag, eia
87332 Cytomegalovirus ag, eia
87335 E coli 0157 ag, eia
87336 Entamoeb hist dispr, ag, eia
87337 Entamoeb hist group, ag, eia
87338 Hpylori, stool, eia
87339 H pylori ag, eia
87340 Hepatitis b surface ag, eia
87341 Hepatitis b surface, ag, eia
87350 Hepatitis be ag, eia
87380 Hepatitis delta ag, eia
87385 Histoplasma capsule ag, eia
87390 Hiv-1 ag, eia
87391 Hiv-2 ag, eia
87400 Influenza a/b, ag, eia
87420 Resp syncytial ag, eia
87425 Rotavirus ag, eia
87427 Shiga-like toxin ag, eia
87449 Ag detect nos, eia, mult
87450 Ag detect nos, eia, single
87451 Ag detect polyval, eia, mult
87470 Bartonella, dna, dir probe
87471 Bartonella, dna, amp probe
87472 Bartonella, dna, quant
87475 Lyme dis, dna, dir probe
87476 Lyme dis, dna, amp probe
87477 Lyme dis, dna, quant
87480 Candida, dna, dir probe
87481 Candida, dna, amp probe
87482 Candida, dna, quant
87485 Chylmd pneum, dna, dir probe
87486 Chylmd pneum, dna, amp probe
87487 Chylmd pneum, dna, quant
87490 Chylmd trach, dna, dir probe
87491 Chylmd trach, dna, amp probe
87492 Chylmd trach, dna, quant
87495 Cytomeg, dna, dir probe
87496 Cytomeg, dna, amp probe
87497 Cytomeg, dna, quant
87498 Enterovirus, dna, amp probe
87500 Vancomycin, dna, amp probe
87505 Gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3 - 5 targets
87506 Gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6 - 11 targets
87507 Gastrointestinal pathogen, includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12 - 25 targets
87510 Gardner vag, dna, dir probe
87511 Gardner vag, dna, amp probe
87512 Gardner vag, dna, quant
87515 Hepatitis b, dna, dir probe
87516 Hepatitis b, dna, amp probe
87517 Hepatitis b, dna, quant
87520 Hepatitis c, rna, dir probe
87521 Hepatitis c, rna, amp probe
87522 Hepatitis c, rna, quant
87525 Hepatitis g, dna, dir probe
87526 Hepatitis g, dna, amp probe
87527 Hepatitis g, dna, quant
87528 Hsv, dna, dir probe
87529 Hsv, dna, amp probe
87530 Hsv, dna, quant
87531 Hhv-6, dna, dir probe
87532 Hhv-6, dna, amp probe
87533 Hhv-6, dna, quant
87534 Hiv-1, dna, dir probe
87535 Hiv-1, dna, amp probe
87536 Hiv-1, dna, quant
87537 Hiv-2, dna, dir probe
87538 Hiv-2, dna, amp probe
87539 Hiv-2, dna, quant
87540 Legion pneumo, dna, dir prob
87541 Legion pneumo, dna, amp prob
87542 Legion pneumo, dna, quant
87550 Mycobacteria, dna, dir probe
87551 Mycobacteria, dna, amp probe
87552 Mycobacteria, dna, quant
87555 M.tuberculo, dna, dir probe
87556 M.tuberculo, dna, amp probe
87557 M.tuberculo, dna, quant
87560 M.avium-intra, dna, dir prob
87561 M.avium-intra, dna, amp prob
87562 M.avium-intra, dna, quant
87580 M.pneumon, dna, dir probe
87581 M.pneumon, dna, amp probe
87582 M.pneumon, dna, quant
87590 N.gonorrhoeae, dna, dir prob
87591 N.gonorrhoeae, dna, amp prob
87592 N.gonorrhoeae, dna, quant
87620 Hpv, dna, dir probe (code deleted 1/1/15)
87621 Hpv, dna, amp probe (code deleted 1/1/15)
87622 Hpv, dna, quant (code deleted 1/1/15)
87623 Human Papillomavirus (HPV), low risk types (e.g., 6, 11, 42, 43, 44)
87624 Human Papillomavirus (HPV), high risk types (e.g., 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68)
87625 Human Papillomavirus (HPV), types 16 and 18 only, includes type 45, if performed
87640 Staph a, dna, amp probe
87641 Mr-staph, dna, amp probe
87650 Strep a, dna, dir probe
87651 Strep a, dna, amp probe
87652 Strep a, dna, quant
87653 Strep b, dna, amp probe
87660 Trichomonas vagin, dir probe
87797 Detect agent nos, dna, dir
87798 Detect agent nos, dna, amp
87799 Detect agent nos, dna, quant
87800 Detect agnt mult, dna, direc
87801 Detect agnt mult, dna, ampli
87802 Strep b assay w/optic
87803 Clostridium toxin a w/optic
87806 Infectious agent antigen detection by immunoassay with direct optical observation; HIV-1 antigen(s), with HIV-1 and HIV-2 antibodies
87807 Rsv assay w/optic
87808 Trichomonas assay w/optic
87809 Adenovirus assay w/optic
87899 Agent nos assay w/optic
87900 Phenotype, infect agent drug
87901 Genotype, dna, hiv reverse t
87902 Genotype, dna, hepatitis C
87903 Phenotype, dna hiv w/culture
87904 Phenotype, dna hiv w/clt add
87999 Microbiology procedure
88104 Cytopath fl nongyn, smears
88106 Cytopath fl nongyn, filter
88108 Cytopath, concentrate tech
88112 Cytopath, cell enhance tech
88130 Sex chromatin identification
88140 Sex chromatin identification
88141 Cytopath, c/v, interpret
88142 Cytopath, c/v, thin layer
88143 Cytopath c/v thin layer redo
88147 Cytopath, c/v, automated
88148 Cytopath, c/v, auto rescreen
88150 Cytopath, c/v, manual
88152 Cytopath, c/v, auto redo
88153 Cytopath, c/v, redo
88154 Cytopath, c/v, select
88155 Cytopath, c/v, index add-on
88160 Cytopath smear, other source
88161 Cytopath smear, other source
88162 Cytopath smear, other source
88164 Cytopath tbs, c/v, manual
88165 Cytopath tbs, c/v, redo
88166 Cytopath tbs, c/v, auto redo
88167 Cytopath tbs, c/v, select
88172 Cytopathology eval of fna
88173 Cytopath eval, fna, report
88174 Cytopath, c/v auto, in fluid
88175 Cytopath c/v auto fluid redo
88182 Cell marker study
88184 Flowcytometry/ tc, 1 marker
88185 Flowcytometry/tc, add-on
88187 Flowcytometry/read, 2-8
88188 Flowcytometry/read, 9-15
88189 Flowcytometry/read, 16 & >
88199 Cytopathology procedure
88300 Surgical path, gross
88302 Tissue exam by pathologist
88304 Tissue exam by pathologist
88305 Tissue exam by pathologist
88307 Tissue exam by pathologist
88309 Tissue exam by pathologist
88311 Decalcify tissue
88312 Special stains
88313 Special stains
88314 Histochemical stain
88319 Enzyme histochemistry
88321 Microslide consultation
88323 Microslide consultation
88325 Comprehensive review of data
88329 Path consult intraop
88331 Path consult intraop, 1 bloc
88332 Path consult intraop, addÆl
88333 Intraop cyto path consult, 1
88334 Intraop cyto path consult, 2
88342 Immunohistochemistry
88346 Immunofluorescent study
88347 Immunofluorescent study (code deleted 1/1/16)
88355 Analysis, skeletal muscle
88356 Analysis, nerve
88358 Analysis, tumor
88360 Tumor immunohistochem/manual
88361 Tumor immunohistochem/comput
88362 Nerve teasing preparations
88371 Protein, western blot tissue
88372 Protein analysis w/probe
88380 Microdissection, laser
88381 Microdissection, manual
88399 Surgical pathology procedure
88720 Bilirubin, total, transcutaneous
89049 Chct for mal hyperthermia
89050 Body fluid cell count
89051 Body fluid cell count
89055 Leukocyte assessment, fecal
89060 Exam, synovial fluid crystals
89125 Specimen fat stain
89160 Exam feces for meat fibers
89190 Nasal smear for eosinophils
89220 Sputum specimen collection
89230 Collect sweat for test
89240 Pathology lab procedure
89310 Semen analysis w/count
89320 Semen anal vol/count/mot
90281 Human ig, im
90283 Human ig, iv
90371 Hep b ig, im
90375 Rabies ig, im/sc
90378 Respiratory syncytial virus, monoclonal antibody, recombinant, IM, 50 mg, ea
90384 Rh ig, full-dose, im
90385 Rh ig, minidose, im
90386 Rh ig, iv
90389 Tetanus ig, im
90396 Varicella-zoster ig, im
90399 Immune globulin
90585 Bcg vaccine, percut
90586 Bcg vaccine, intravesical
90675 Rabies vaccine, im
90717 Yellow fever vaccine, sc
90735 Encephalitis vaccine, sc (code deleted 1/1/16)
92358 Prosthesis service for aphakia, temporary (disposable or loan, including materials)
92532 Positional nystagmus test
92533 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests)
92534 Optokinetic nystagmus test
92541 Spontaneous nystagmus test, including gaze and fixation nystagmus, with recording
92542 Positional nystagmus test, minimum of 4 positions, with recording
92543 Caloric vestibular test, each irrigation (binaural, bithermal stimulation constitutes four tests), with recording (code deleted 1/1/16)
92544 Optokinetic nystagmus test, bidirectional, foveal or peripheral stimulation, w/recording
92545 Oscillating tracking test, with recording
92546 Sinusoidal vertical axis rotational testing
92547 Use of vertical electrodes (List separately in addition to code for primary procedure)
92559 Audiometric testing of groups
93050 Arterial pressure waveform analysis for assessment of central arterial pressures (new code 1/1/16)
93279 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead pacemaker system
93280 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead pacemaker system
93282 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; single lead transvenous implantable defibrillator system
93283 Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional; dual lead transvenous implantable defibrillator system
93288 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection, per patient encounter; single, dial, or multiple lead pacemaker system
93289 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection, per patient encounter; single, dial, or multiple lead transvenous implantable defibrillator system, including analysis of heart rhythm derived data elements
93292 Interrogation device evaluation (in person) with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection, per patient encounter; wearable defibrillator system
93293 Transtelephonic rhythm strip pacemaker evaluation(s) single, dual, or multiple lead pacemaker system, includes recording with and without magnet application with analysis, review and report(s) by a physician or other qualified health care professional, up to 90 days
93294 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead pacemaker system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
93295 Interrogation device evaluation(s) (remote), up to 90 days; single, dual, or multiple lead implantable defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional
93740 Temperature gradient studies
93784 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and / or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report
93786 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and / or computer disk, for 24 hours or longer; recording only
93788 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and / or computer disk, for 24 hours or longer; scanning analysis with report
93790 Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and / or computer disk, for 24 hours or longer; physician review with interpretation and report
94060 Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration
94070 Bronchospasm provocation evaluation, multiple spirometric determinations as in 94010, with administered agents (e.g., antigen(s), cold air, methacholine)
94250 Expired gas collection, quantitative, single procedure (separate procedure)
94375 Respiratory flow volume loop
94640 Pressurized or nonpressurized inhalation treatment for acute airway obstruction or for sputum induction for diagnostic purposes (e.g., with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing [IPPB] device)
94644 Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour
94645 Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure)
94664 Demonstration and / or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device
94726 Plethysmography for determination of lung volumes and, when performed, airway resistance
94727 Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes
94728 Airway resistance by impulse oscillometry
94761 Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (e.g., during exercise)
95831 Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk
95832 Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side
95833 Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands
95834 Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands
95851 Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine)
95852 Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side
96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
96361 Intravenous infusion, hydration; each additional hour (add-on code)
96373 Therapeutic, prophylactic, or diagnostic injection; Intra-arterial
96374 Therapeutic, prophylactic, or diagnostic injection; IV push, single or initial substance/drug
96375 Therapeutic, prophylactic, or diagnostic injection; each additional sequential IV push of a new substance/drug (add-on code)
96523 Irrigation of implanted venous access device for drug delivery systems
96567 Photodynamic therapy by external application of light to destroy premalignant and / or malignant lesions of the skin and adjacent mucosa (e.g., lip) by activation of photosensitive drug(s), each phototherapy exposure session
96900 Actinotherapy (ultraviolet light)
96902 Microscopic examination of hairs plucked or clipped by the examiner (excluding hair collected by the patient) to determine telogen and anagen counts, or structural hair shaft abnormality
96904 Whole body integumentary photography, for monitoring of high risk patients with dysplastic nevus syndrome or a history of dysplastic nevi, or patients with a personal or familial history of melanoma
96910 Photochemotherapy; tar and ultraviolet B (Goeckerman treatment) or petrolatum and ultraviolet B
96912 Photochemotherapy; psoralens and ultraviolet A (PUVA)
97597 Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; first 20 sq. cm or less
97598 Debridement, open wound, including topical application(s), wound assessment, use of a whirlpool, when performed and instruction(s) for ongoing care, per session, total wound(s) surface area; each additional 20 sq. cm, or part thereof (add-on code)
99170 Anogenital examination with colposcopic magnification in childhood for suspected trauma
99175 Ipecac or similar administration for individual emesis and continued observation until stomach adequately emptied of poison
99195 Phlebotomy, therapeutic (separate procedure)
 


Limits

All other coverage exclusions, limitations, restrictions, preauthorization requirements and other rules continue to apply.


Application to Products

This policy applies to all health plans administered by QualChoice, both those insured by QualChoice and those that are self-funded by the sponsoring employer, unless there is indication in this policy otherwise or a stated exclusion in your medical plan booklet.  Consult the individual plan sponsor Summary Plan Description (SPD) for self-insured plans or the specific Evidence of Coverage (EOC) for those plans insured by QualChoice.  In the event of a discrepancy between this policy and a self-insured customer’s SPD or the specific QualChoice EOC, the SPD or EOC, as applicable, will prevail.  State and federal mandates will be followed as they apply.


Changes: QualChoice reserves the right to alter, amend, change or supplement benefit interpretations as needed.