Appendix A for LCD Independent Diagnostic Testing

Appendix A for LCD Independent Diagnostic Testing Facilities (IDTFs)

CPT Codes

MOD

Rev Description Supervising physician Qualification Requirements

Technician Qualification

51725 &TC 2 Simple Cyctometrogram Urology,OB/GYNE

Personally trained staff

51726 &TC 2 Conplex cystometrogram Urology,OB/GYNE


51736 &TC 2 Simple Uroflowmetry Urology,OB/GYNE


51741 &TC 2 Complex uroflowmetry Urology,OB/GYNE


51772 &TC 2 Urethral presssure profile Urology,OB/GYNE


51784 &TC 2 Electromyography Urology,OB/GYNE


51785 &TC 2 Needle electromyography Urology,OB/GYNE


51792 &TC 2 Stimulus evoked response Urology,OB/GYNE


51795 &TC 2 Voiding pressure studies Urology,OB/GYNE


51797 &TC 2 Voiding pressure studies Urology,OB/GYNE


51798 &TC 1 Measurement of post-voiding

Urology,OB/GYNE, Radiology


54240 &TC 2 Penile plethysmography Urology, Pulmonology Personally trained staff

54250 &TC 1 Nocturnal penile tumescence

Urology, Pulmonology Personally trained staff

59020 &TC 2 Fetel contraction stress studies

Radiology, OB/GYNE Certified Radiology Tech

59025 &TC 1 Fetal non-stress studies Radiology, OB/GYNE Certified Radiology Tech

62367 &TC 2 Electronic analysis of Programmable, implanted pump

Anesthesia, PM&R, Pain Mgnt, Oncology

RN

62368 &TC 2 - with reprogramming Anesthesia, PM&R, Pain Mgnt, Oncology

RN

70010 &TC 3 Contrast x-ray of brain Radiologist Physician Only Service

70015 &TC 3 Contrast x-ray of brain Radiologist Physician Only Service 70030 &TC 1 X-ray eye for foreign body Radiologist Certified Radiology Tech

70100 &TC 1 X-ray exam of jaw Radiologist Certified Radiology Tech

70110 &TC 1 X-ray exam of jaw Radiologist Certified Radiology Tech

70120 &TC 1 X-ray exam of mastoids Radiologist Certified Radiology Tech

70130 &TC 1 X-ray exam of mastoids Radiologist Certified Radiology Tech

70134 &TC 1 X-ray exam of middle ear Radiologist Certified Radiology Tech

70140 &TC 1 X-ray exam of facial bones Radiologist Certified Radiology Tech

CPT Codes

MOD



70150 &TC 1 X-ray exam of facial bones Radiologist Certified Radiology Tech

70160 &TC 1 X-ray exam of nasal bones Radiologist Certified Radiology Tech

70170 &TC 3 X-ray exam of tear duct S&I Radiologist Certified Radiology Tech

70190 &TC 1 X-ray exam of eye sockets Radiologist Certified Radiology Tech

70200 &TC 1 X-ray exam of eye sockets Radiologist Certified Radiology Tech

70210 &TC 1 X-ray exam of sinuses Radiologist Certified Radiology Tech

70220 &TC 1 X-ray exam of sinuses Radiologist Certified Radiology Tech

70240 &TC 1 X-ray exam, pituitary saddle Radiologist Certified Radiology Tech

70250 &TC 1 X-ray exam of skull Radiologist Certified Radiology Tech

70260 &TC 1 X-ray exam of skull Radiologist Certified Radiology Tech

70300 &TC 1 X-ray exam of teeth Radiologist/DDS/ Maxofacial Surgeon

Certified Radiology Tech

70310 &TC 1 X-ray exam of teeth Radiologist/DDS/ Maxofacial Surgeon


70320 &TC 1 Full mouth x-ray of teeth Radiologist/DDS/ Maxofacial Surgeon


70328 &TC 1 X-ray exam of jaw joint Radiologist/DDS/ Maxofacial Surgeon


70330 &TC 1 X-ray exam of jaw joints Radiologist/DDS/ Maxofacial Surgeon


70332 &TC 3 X-ray exam of jaw joint Radiologist/DDS/ Maxofacial Surgeon


70336 &TC 2 Magnetic image, jaw joint Radiologist Certified Radiology Tech

70350 &TC 1 X-ray head for orthodontia Radiologist/DDS/ Maxofacial Surgeon


70355 &TC 1 Panoramic x-ray of jaws Radiologist/DDS/ Maxofacial Surgeon


70360 &TC 1 X-ray exam of neck Radiologist Certified Radiology Tech

70370 &TC 3 Throat x-ray & fluoroscopy Radiologist, Otolarngology


70371 &TC 3 Speech evaluation, complex Radiologist, Otolarngology


70373 &TC 3 Contrast x-ray of larynx Radiologist, Otolarngology


70380 &TC 1 X-ray exam of salivary gland

Radiologist Certified Radiology Tech

70390 &TC 3 X-ray exam of salivary duct Radiologist Certified Radiology Tech

70450 &TC 1 Ct head/brain w/o dye Radiologist Certified Radiology Tech

CPT Codes

MOD



70460 &TC 2 Ct head/brain w/dye Radiologist Certified Radiology Tech

70470 &TC 2 Ct head/brain w/o & w/dye Radiologist Certified Radiology Tech

70480 &TC 1 Ct orbit/ear/fossa w/o dye Radiologist Certified Radiology Tech

70481 &TC 2 Ct orbit/ear/fossa w/dye Radiologist Certified Radiology Tech

70482 &TC 2 Ct orbit/ear/fossa w/o& w/dye


70486 &TC 1 Ct maxillofacial w/o dye Radiologist Certified Radiology Tech

70487 &TC 2 Ct maxillofacial w/dye Radiologist Certified Radiology Tech

70488 &TC 2 Ct maxillofacial w/o & w/dye


70490 &TC 1 Ct soft tissue neck w/o dye Radiologist Certified Radiology Tech

70491 &TC 2 Ct soft tissue neck w/dye Radiologist Certified Radiology Tech

70492 &TC 2 Ct sft tsue nck w/o & w/dye Radiologist Certified Radiology Tech

70496 &TC 2 Ct angiography, head Radiologist Certified Radiology Tech

70498 &TC 2 Ct angiography, neck Radiologist Certified Radiology Tech

70540 &TC 1 Mri orbit/face/neck w/o dye Radiologist Certified Radiology Tech

70542 &TC 2 Mri orbit/face/neck w/dye Radiologist Certified Radiology Tech

70543 &TC 2 Mri orbt/fac/nck w/o & w/dye


70544 &TC 1 Mri angiography head w/o dye


70545 &TC 2 Mr angiography head w/dye Radiologist Certified Radiology Tech

70546 &TC 2 Mri angiograph head w/o&w/dye


70547 &TC 1 Mri angiography neck w/o dye


70548 &TC 2 Mri angiography neck w/dye


70549 &TC 2 Mri angiograph neck w/o&w/dye


70551 &TC 1 Mri brain w/o dye Radiologist Certified Radiology Tech

70552 &TC 2 Mri brain w/dye Radiologist Certified Radiology Tech

CPT Codes

MOD



70553 &TC 2 Mri brain w/o & w/dye Radiologist Certified Radiology Tech

70554 &TC 2 Functional MRI brain Radiologist Certified Radiology Tech

70555 &TC 2 MRI brain Radiologist Certified Radiology Tech

70557 &TC 1 Mri brain w/o dye Radiologist Certified Radiology Tech

70558 &TC 2 Mri brain w/dye Radiologist Certified Radiology Tech

70559 &TC 2 Mri brain w/o & w/dye Radiologist Certified Radiology Tech

71010 &TC 1 Chest x-ray Radiologist Certified Radiology Tech





71023 &TC 3 Chest x-ray and fluoroscopy Radiologist Certified Radiology Tech


71034 &TC 3 Chest x-ray and fluoroscopy Radiologist Certified Radiology Tech


71040 &TC 3 Contrast x-ray of bronchi Radiologist Certified Radiology Tech

71060 &TC 3 Contrast x-ray of bronchi Radiologist Certified Radiology Tech

71090 &TC 3 X-ray & pacemaker insertion


71100 &TC 1 X-ray exam of ribs Radiologist Certified Radiology Tech

71101 &TC 1 X-ray exam of ribs/chest Radiologist Certified Radiology Tech

71110 &TC 1 X-ray exam of ribs Radiologist Certified Radiology Tech

71111 &TC 1 X-ray exam of ribs/chest Radiologist Certified Radiology Tech

71120 &TC 1 X-ray exam of breastbone Radiologist Certified Radiology Tech

71130 &TC 1 X-ray exam of breastbone Radiologist Certified Radiology Tech

71250 &TC 1 Ct thorax w/o dye Radiologist Certified Radiology Tech

71260 &TC 2 Ct thorax w/dye Radiologist Certified Radiology Tech

CPT Codes

MOD



71270 &TC 2 Ct thorax w/o & w/dye Radiologist Certified Radiology Tech

71275 &TC 2 Ct angiography, chest Radiologist Certified Radiology Tech

71550 &TC 1 Mri chest w/o dye Radiologist Certified Radiology Tech

71551 &TC 2 Mri chest w/dye Radiologist Certified Radiology Tech

71552 &TC 2 Mri chest w/o & w/dye Radiologist Certified Radiology Tech

71555 &TC 2 Mri angio chest w or w/o dye


72010 &TC 1 X-ray exam of spine Radiologist, Ortho Certified Radiology Tech

72020 &TC 1 X-ray exam of spine Radiologist, Ortho Certified Radiology Tech

72040 &TC 1 X-ray exam of neck spine Radiologist, Ortho Certified Radiology Tech



72069 &TC 1 X-ray exam of trunk spine Radiologist, Ortho Certified Radiology Tech

72070 &TC 1 X-ray exam of thoracic spine

Radiologist, Ortho Certified Radiology Tech







72100 &TC 1 X-ray exam of lower spine Radiologist, Ortho Certified Radiology Tech




72125 &TC 1 Ct neck spine w/o dye Radiologist, Ortho Certified Radiology Tech

72126 &TC 2 Ct neck spine w/dye Radiologist, Ortho Certified Radiology Tech

72127 &TC 2 Ct neck spine w/o & w/dye Radiologist, Ortho Certified Radiology Tech

CPT Codes

MOD



72128 &TC 1 Ct chest spine w/o dye Radiologist, Ortho Certified Radiology Tech

72129 &TC 2 Ct chest spine w/dye Radiologist, Ortho Certified Radiology Tech

72130 &TC 2 Ct chest spine w/o & w/dye Radiologist, Ortho Certified Radiology Tech

72131 &TC 1 Ct lumbar spine w/o dye Radiologist, Ortho Certified Radiology Tech

72132 &TC 2 Ct lumbar spine w/dye Radiologist, Ortho Certified Radiology Tech

72133 &TC 2 Ct lumbar spine w/o & w/dye


72141 &TC 1 Mri neck spine w/o dye Radiologist, Ortho Certified Radiology Tech

72142 &TC 2 Mri neck spine w/dye Radiologist, Ortho Certified Radiology Tech

72146 &TC 1 MRI chest spine w/o dye Radiologist, Ortho Certified Radiology Tech

72147 &TC 2 MRI chest spine w/dye Radiologist, Ortho Certified Radiology Tech

72148 &TC 1 MRI lumbar spine w/o dye Radiologist, Ortho Certified Radiology Tech

72149 &TC 2 MRI lumbar spine w/dye Radiologist, Ortho Certified Radiology Tech

72156 &TC 2 MRI neck spine w/o & w/dye


72157 &TC 2 MRI chest spine w/o & w/dye


72158 &TC 2 MRI lumbar spine w/o & w/dye


72159 &TC 9 N/A Radiologist, Ortho N/A

72170 &TC 1 X-ray exam of pelvis Radiologist, Ortho Certified Radiology Tech

72190 &TC 1 X-ray exam of pelvis Radiologist, Ortho Certified Radiology Tech

72191 &TC 2 Ct angiograph pelv w/o&w/dye


72192 &TC 1 Ct pelvis w/o dye Radiologist, Ortho Certified Radiology Tech

72193 &TC 2 Ct pelvis w/dye Radiologist, Ortho Certified Radiology Tech

72194 &TC 2 Ct pelvis w/o & w/dye Radiologist, Ortho Certified Radiology Tech

72195 &TC 1 Mri pelvis w/o dye Radiologist, Ortho Certified Radiology Tech

72196 &TC 1 MRI pelvis w/dye Radiologist, Ortho Certified Radiology Tech

72197 &TC 2 MRI pelvis w/o & w/dye Radiologist, Ortho Certified Radiology Tech

CPT Codes

MOD



72198 &TC 2 MRI angio pelvis w/o & w/dye


72200 &TC 1 X-ray exam sacroiliac joints Radiologist, Ortho Certified Radiology Tech

72202 &TC 1 X-ray exam sacroiliac joints Radiologist, Ortho Certified Radiology Tech

72220 &TC 1 X-ray exam of tailbone Radiologist, Ortho Certified Radiology Tech

72240 &TC 3 Contrast x-ray of neck spine Radiologist, Ortho Certified Radiology Tech

72255 &TC 3 Contrast x-ray, thorax spine Radiologist, Ortho Certified Radiology Tech

72265 &TC 3 Contrast x-ray, lower spine Radiologist, Ortho Certified Radiology Tech

72270 &TC 3 Contrast x-ray, spine Radiologist, Ortho Certified Radiology Tech

72275 &TC 3 Epidurography, S & I Radiologist, Ortho Certified Radiology Tech

72285 &TC 3 X-ray c/t spine disk Radiologist, Ortho Certified Radiology Tech

72295 &TC 1 X-ray of lower spine disk Radiologist, Ortho Certified Radiology Tech

73000 &TC 1 X-ray exam of collar bone Radiologist, Ortho Certified Radiology Tech

73010 &TC 1 X-ray exam of shoulder blade


73020 &TC 1 X-ray exam of shoulder Radiologist, Ortho Certified Radiology Tech

73030 &TC 1 X-ray exam of shoulder Radiologist, Ortho Certified Radiology Tech

73040 &TC 3 Contrast x-ray of shoulder Radiologist, Ortho Certified Radiology Tech

73050 &TC 1 X-ray exam of shoulders Radiologist, Ortho Certified Radiology Tech

73060 &TC 1 X-ray exam of humerus Radiologist, Ortho Certified Radiology Tech

73070 &TC 1 X-ray exam of elbow Radiologist, Ortho Certified Radiology Tech

73080 &TC 1 X-ray exam of elbow Radiologist, Ortho Certified Radiology Tech

73085 &TC 3 Contrast x-ray of elbow Radiologist, Ortho Certified Radiology Tech

73090 &TC 1 X-ray exam of forearm Radiologist, Ortho Certified Radiology Tech

73092 &TC 1 X-ray exam of arm, infant Radiologist, Ortho Certified Radiology Tech

73100 &TC 1 X-ray exam of wrist Radiologist, Ortho Certified Radiology Tech

73110 &TC 1 X-ray exam of wrist Radiologist, Ortho Certified Radiology Tech

73115 &TC 3 Contrast x-ray of wrist Radiologist, Ortho Certified Radiology Tech

CPT Codes

MOD



73120 &TC 1 X-ray exam of hand Radiologist, Ortho Certified Radiology Tech

73130 &TC 1 X-ray exam of hand Radiologist, Ortho Certified Radiology Tech

73140 &TC 1 X-ray exam of finger(s) Radiologist, Ortho Certified Radiology Tech

73200 &TC 1 Ct upper extremity w/o dye Radiologist, Ortho Certified Radiology Tech

73201 &TC 2 Ct upper extremity w/dye Radiologist, Ortho Certified Radiology Tech

73202 &TC 2 Ct uppr extremity w/o&w/dye


73206 &TC 2 Ct angio upr extrm w/o&w/dye


73218 &TC 1 MRI upper extremity (UE) w/o dye


73219 &TC 2 MRI UE w/dye Radiologist, Ortho Certified Radiology Tech

73220 &TC 1 MRI UE w/o & W/dye Radiologist, Ortho Certified Radiology Tech

73221 &TC 1 MRI joint UE w/o dye Radiologist, Ortho Certified Radiology Tech

73222 &TC 2 MRI joint UE w/dye Radiologist, Ortho Certified Radiology Tech

73223 &TC 2 MRI joint UE w/o & w/dye Radiologist, Ortho Certified Radiology Tech

73225 &TC 9 N/A Radiologist, Ortho N/A

73500 &TC 1 X-ray exam of hip Radiologist, Ortho Certified Radiology Tech


73520 &TC 1 X-ray exam of hips Radiologist, Ortho Certified Radiology Tech

73525 &TC 3 Contrast x-ray of hip Radiologist, Ortho Certified Radiology Tech


73540 &TC 1 X-ray exam of pelvis & hips Radiologist, Ortho Certified Radiology Tech

73542 &TC 1 X-ray exam, sacroiliac joint Radiologist, Ortho Certified Radiology Tech

73550 &TC 1 X-ray exam of thigh Radiologist, Ortho Certified Radiology Tech

73560 &TC 1 X-ray exam of knee, 1 or 2 Radiologist, Ortho Certified Radiology Tech

73562 &TC 1 X-ray exam of knee, 3 Radiologist, Ortho Certified Radiology Tech

73564 &TC 1 X-ray exam, knee, 4 or more


73565 &TC 1 X-ray exam of knees Radiologist, Ortho Certified Radiology Tech

CPT Codes

MOD



73580 &TC 3 Contrast x-ray of knee joint Radiologist, Ortho Certified Radiology Tech

73590 &TC 1 X-ray exam of lower leg Radiologist, Ortho Certified Radiology Tech

73592 &TC 1 X-ray exam of leg, infant Radiologist, Ortho Certified Radiology Tech

73600 &TC 1 X-ray exam of ankle Radiologist, Ortho Certified Radiology Tech

73610 &TC 1 X-ray exam of ankle Radiologist, Ortho Certified Radiology Tech

73615 &TC 3 Contrast x-ray of ankle Radiologist, Ortho Certified Radiology Tech

73620 &TC 1 X-ray exam of foot Radiologist, Ortho Certified Radiology Tech

73630 &TC 1 X-ray exam of foot Radiologist, Ortho Certified Radiology Tech

73650 &TC 1 X-ray exam of heel Radiologist, Ortho Certified Radiology Tech

73660 &TC 1 X-ray exam of toe(s) Radiologist, Ortho Certified Radiology Tech

73700 &TC 1 Ct lower extremity w/o dye Radiologist, Ortho Certified Radiology Tech

73701 &TC 2 Ct lower extremity w/dye Radiologist, Ortho Certified Radiology Tech

73702 &TC 2 Ct lwr extremity w/o&w/dye


73706 &TC 2 Ct angio lwr extr w/o&w/dye


73718 &TC 1 MRI lower extremity w/o dye


73719 &TC 2 MRI lower extremity w/dye Radiologist, Ortho Certified Radiology Tech

73720 &TC 1 MRI lwr extremity w/o & w/dye


73721 &TC 1 MRI jnt of lwr extre w/o dye


73722 &TC 2 MRI joint of lwr extr w/dye Radiologist, Ortho Certified Radiology Tech

73723 &TC 2 MRI joint lwr extr w/o&w/dye


73725 &TC 2 MRI ang lwr ext w or w/o dye


74000 &TC 1 X-ray exam of abdomen Radiologist Certified Radiology Tech



74022 &TC 1 X-ray exam series, abdomen Radiologist Certified Radiology Tech

74150 &TC 1 Ct abdomen w/o dye Radiologist Certified Radiology Tech

CPT Codes

MOD



74160 &TC 2 Ct abdomen w/dye Radiologist Certified Radiology Tech

74170 &TC 2 Ct abdomen w/o & w/dye Radiologist Certified Radiology Tech

74175 &TC 2 Ct angio abdom w/o & w/dye


74176 CT abd & pelvis w/o contrast

Radiologist Certified Radiologic Technologist (ARRT:R.T.-CT)

74177 CT abd & pelvis with contrast


74178 CT abd & pelvis w/o contrast in one or both body regions followed by contrast and further sections of one or both regions


74181 &TC 1 MRI abdomen w/o dye Radiologist Certified Radiology Tech

74182 &TC 2 MRI abdomen w/dye Radiologist Certified Radiology Tech

74183 &TC 2 MRI abdomen w/o & w/dye Radiologist Certified Radiology Tech

74185 &TC 2 MRI angio, abd w or w/o dye


74190 &TC 3 X-ray exam of peritoneum Radiologist Certified Radiology Tech

74210 &TC 3 Contrst x-ray exam of throat Radiologist Certified Radiology Tech

74220 &TC 3 Contrast x-ray, esophagus Radiologist Certified Radiology Tech

74230 &TC 3 Cine/vid x-ray, throat/esoph Radiologist Certified Radiology Tech

74240 &TC 3 X-ray exam, upper gi tract Radiologist Certified Radiology Tech



74246 &TC 3 Contrst x-ray uppr gi tract Radiologist Certified Radiology Tech



74250 &TC 3 X-ray exam of small bowel Radiologist Certified Radiology Tech



74261 computed tomographic (ct) colonography, diagnostic,

Radiologist Certified Radiologic Technologist

CPT Codes

MOD



including image postprocessing; without contrast material

(ARRT:R.T. .-CT)

74262 computed tomographic (ct) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast imagess, if performed

Radiologist Certified Radiologic Technologist (ARRT:R.T. .-CT)

74263 computed tomographic (ct) colonography, screening, including image postprocessing

Radiologist Certified Radiologic Technologist (ARRT:R.T. .-CT)

74270 &TC 3 Contrast x-ray exam of colon contrast enema


74280 &TC 3 Contrast x-ray exam of colon


74283 &TC 3 Contrast x-ray exam of colon


74290 &TC 1 Contrast x-ray, gallbladder Radiologist Certified Radiology Tech

74291 &TC 1 Contrast x-rays, gallbladder Radiologist Certified Radiology Tech

74300 &TC 3 X-ray bile ducts/pancreas Radiologist Certified Radiology Tech

74301 &TC 3 X-rays at surgery add-on Radiologist Certified Radiology Tech

74305 &TC 3 X-ray bile ducts/pancreas Radiologist Certified Radiology Tech

74320 &TC 3 Contrast x-ray of bile ducts Radiologist Certified Radiology Tech

74327 &TC 3 X-ray bile stone removal Radiologist Certified Radiology Tech

74328 &TC 3 X-ray bile duct endoscopy Radiologist Certified Radiology Tech

74329 &TC 3 X-ray for pancreas endoscopy


74330 &TC 3 X-ray bile/panc endoscopy Radiologist Certified Radiology Tech

74340 &TC 3 Radiologist Certified Radiology Tech





CPT Codes

MOD




74410 &TC 2 Contrst x-ray, urinary tract Radiologist or Urologist Certified Radiology Tech




74430 &TC 3 Contrast x-ray, bladder Radiologist or Urologist Certified Radiology Tech

74440 &TC 3 X-ray, male genital tract Radiologist or Urologist Certified Radiology Tech

74445 &TC 3 X-ray exam of penis Radiologist or Urologist Certified Radiology Tech

74450 &TC 3 X-ray, urethra/bladder Radiologist or Urologist Certified Radiology Tech

74455 &TC 3 X-ray, urethra/bladder Radiologist or Urologist Certified Radiology Tech

74470 &TC 3 X-ray exam of kidney lesion Radiologist or Urologist Certified Radiology Tech

74475 &TC 3 Radiologist or Urologist Certified Radiology Tech



74710 &TC 1 X-ray measurement of pelvis

Radiologist or OBGYN Certified Radiology Tech

74740 &TC 3 X-ray, female genital tract Radiologist or OBGYN Certified Radiology Tech

74742 &TC 3 X-ray, fallopian tube Radiologist or OBGYN Certified Radiology Tech

74775 &TC 3 X-ray exam of perineum Radiologist or OBGYN Certified Radiology Tech

75557 Heart MRI for morph & function w/o dye

Radiologist Certified Radiologic Technologist (ARRT:R.T.-MR) or ARMRIT-RT-MR

75559

Cardiac MRI/ morph & function


75561 Cardiac MRI/ morph & function w/o cintrast followed by with contrast and urther sequences


75563 Cardiac MRI morph & Function with and w/o contrast and with ; and stress imaging


CPT Codes

MOD



75565 Cardiac MRI for velocity flow mapping


75571 CT, heart, without contrast material, with quantitative evaluation of coronary calcium

Radiologist/Cardiologist Certified Radiologic Technologist

75572 CT, heart, with contrast material, for evaluation of cardiac structure and morphology ... assessment of cardiac function, ...


75573 CT heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart disease ...


75574 CT, heart, coronary arteries and bypass grafts (when present), with contrast material, ....


75600 &TC 3 Contrast x-ray exam of aorta Radiologist ,Vascular Surgery


75605 &TC 3 Contrast x-ray exam of aorta Radiologist,Vascular Surgery


75625 &TC 3 Contrast x-ray exam of aorta Radiologist, Vascular Surgery


75630 &TC 3 X-ray aorta, leg arteries Radiologist,Vascular Surgery


75635 &TC 3 Ct angio abdominal arteries Radiologist Certified Radiology Tech

75650 &TC 3 Artery x-rays, head & neck Radiologist,Vascular Surgery


75658 &TC 3 Artery x-rays, arm Radiologist,Vascular Surgery








CPT Codes

MOD





75676 &TC 3 Artery x-rays, neck Radiologist,Vascular Surgery


75680 &TC 3 Artery x-rays, neck Radiologist,Vascular Surgery


75685 &TC 3 Artery x-rays, spine Radiologist,Vascular Surgery


75705 &TC 3 Artery x-rays, spine Radiologist,Vascular Surgery


75710 &TC 3 Artery x-rays, arm/leg Radiologist,Vascular Surgery


75716 &TC 3 Artery x-rays, arms/legs Radiologist,Vascular Surgery


75722 &TC 3 Artery x-rays, kidney Radiologist,Vascular Surgery


75724 &TC 3 Artery x-rays, kidneys Radiologist,Vascular Surgery


75726 &TC 3 Artery x-rays, abdomen Radiologist,Vascular Surgery


75731 &TC 3 Artery x-rays, adrenal gland Radiologist,Vascular Surgery


75733 &TC 3 Artery x-rays, adrenals Radiologist,Vascular Surgery


75736 &TC 3 Artery x-rays, pelvis Radiologist,Vascular Surgery


75741 &TC 3 Artery x-rays, lung Radiologist,Vascular Surgery


75743 &TC 3 Artery x-rays, lungs Radiologist,Vascular Surgery


75746 &TC 3 Artery x-rays, lung Radiologist,Vascular Surgery


75756 &TC 3 Artery x-rays, chest Radiologist,Vascular Surgery


75774 &TC 3 Artery x-ray, each vessel Radiologist,Vascular Surgery


75791 Angiography, arteriovenous shunt

Radiologist,Vascular Surgery

Physician Only Service

75801 &TC 3 Lymph vessel x-ray, arm/leg Radiologist, Certified Radiology Tech

75803 &TC 3 Lymph vessel x-ray,arms/legs


75805 &TC 3 Lymph vessel x-ray, trunk Radiologist Certified Radiology Tech

75807 &TC 3 Lymph vessel x-ray, trunk Radiologist Certified Radiology Tech

75809 &TC 3 Nonvascular shunt, x-ray Radiologist Certified Radiology Tech

75810 &TC 3 Vein x-ray, spleen/liver Radiologist Certified Radiology Tech

75820 &TC Vein x-ray, arm/leg Radiologist Certified Radiology Tech

CPT Codes

MOD



75822 &TC Vein x-ray, arms/legs Radiologist Certified Radiology Tech

75825 &TC Vein x-ray, trunk Radiologist Certified Radiology Tech

75827 &TC Vein x-ray, chest Radiologist Certified Radiology Tech

75831 &TC 3 Vein x-ray, kidney Radiologist Certified Radiology Tech

75833 &TC 3 Vein x-ray, kidneys Radiologist Certified Radiology Tech

75840 &TC 3 Vein x-ray, adrenal gland Radiologist Certified Radiology Tech

75842 &TC 3 Vein x-ray, adrenal glands Radiologist Certified Radiology Tech

75860 &TC 3 Vein x-ray, neck Radiologist Certified Radiology Tech

75870 &TC 3 Vein x-ray, skull Radiologist Certified Radiology Tech

75872 &TC 3 Vein x-ray, skull Radiologist Certified Radiology Tech

75880 &TC 3 Vein x-ray, eye socket Radiologist Certified Radiology Tech

75885 &TC 3 Vein x-ray, liver Radiologist Certified Radiology Tech




75893 &TC 3 Venous sampling by catheter


75898 &TC 3 Follow-up angiography Radiologist Certified Radiology Tech

75900 &TC 3 Arterial catheter exchange Radiologist Certified Radiology Tech

75945 &TC 3 Intravascular us Radiologist Certified Radiology Tech

75946 &TC 3 Intravascular us add-on Radiologist Certified Radiology Tech

76000 &TC 3 Fluoroscope examination Multiple Certified Radiology Tech

76001 &TC 3 Fluoroscope exam, extensive

Multiple Certified Radiology Tech


76080 &TC 3 X-ray exam of fistula Radiologist Certified Radiology Tech

76098 &TC 1 X-ray exam, breast specimen


76100 &TC 2 X-ray exam of body section Radiologist Certified Radiology Tech

CPT Codes

MOD



76101 &TC 2 Complex body section x-ray Radiologist Certified Radiology Tech

76102 &TC 2 Complex body section x-rays


76120 &TC 2 Cine/video x-rays Radiologist Certified Radiology Tech

76125 &TC 2 Cine/video x-rays add-on Radiologist Certified Radiology Tech

76140 &TC 9 n/a n/a

76376 &TC 1 3D with interp and report MRI, Us or other tomography

Radiologist/Cardiologist Certified Radiology Tech

76377 &TC 1 Require imaging post processing

Radiologist/Cardiologist Certified Radiology Tech

76380 &TC 1 CAT scan follow-up study Radiologist Certified Radiology Tech

76390 &TC 9 Magnetic resonance spectroscopy

n/a n/a

76496 &TC 9 Unlisted Fluoroscopic procedure, diagnostic

n/a n/a

76497 &TC 9 Unlisted Ct Diagnostic n/a n/a

76498 &TC 9 Unlisted Dx MRI n/a n/a

76499 &TC 9 n/a n/a

76506 &TC 2 Echo exam of head Radiologist or Neurologist

RDMS

76510 &TC 3 Ophth us, b & quant a Ophthalmologist, optometrist or Radiologist

RDMS

76511 &TC 3 Ophth us, quant a only Ophthalmologist, optometrist or Radiologist

RDMS

76512 &TC 3 Ophth us, b w/non-quant a Ophthalmologist, optometrist or Radiologist

RDMS

76513 &TC 3 Echo exam of eye, water bath

Ophthalmologist or Radiologist

RDMS

76514 &TC 3 Echo exam of eye, thickness Ophthalmologist, optometrist or Radiologist

ARDMS

76516 &TC 2 Echo exam of eye Ophthalmologist, optometrist or Radiologist

ARDMS

76519 &TC 2 Echo exam of eye Ophthalmologist, optometrist or Radiologist

ARDMS

76529 &TC 2 Echo exam of eye Ophthalmologist or Radiologist

ARDMS

76536 &TC 1 Us exam of head and neck Radiologist or Neurologist

ARDMS RDMS or ARRT:R.T.-S

76604 &TC 1 Us exam, chest, b-scan Radiologist ARDMS RDMS or ARRT:R.T-S.

76645 &TC 1 Us exam, breast(s) Radiologist ARDMS RDMS or ARRT:R.T-S

CPT Codes

MOD



76700 &TC 1 Us exam, abdom, complete Radiologist ARDMS:RDMS-Adomen

76705 &TC 1 Echo exam of abdomen Radiologist ARDMS:RDMS-Adomen

76770 &TC 1 Us exam abdo back wall, comp

Radiologist ARDMS:RDMS-Adomen

76775 &TC 1 Us exam abdo back wall, lim

Radiologist ARDMS:RDMS-Adomen

76776

&TC 1 US transplanted Kidney & duplex

Radiologist ARDMS RDMS Ob/Gyne

76800 &TC 2 Us exam, spinal canal Radiologist ARDMS RDMS Ob/Gyne

76801 &TC 1 Ob us < 14 wks, single fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76802 &TC 1 Ob us < 14 wks, add’l fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76805 &TC 2 Ob us >/= 14 wks, sngl fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76810 &TC 2 Ob us >/= 14 wks, addl fetus

Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76811 &TC 2 Ob us, detailed, sngl fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76812 &TC 2 Ob us, detailed, addl fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76813 &TC 2 Ob us, transabd or trans vag Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76814 &TC 2 Ob us, transabd or trans vag, addl fetus

Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76815 &TC 2 Ob us, limited, fetus(s) Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76816 &TC 1 Ob us, follow-up, per fetus Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76817 &TC 3 Transvaginal us, obstetric Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76818 &TC 1 Fetal biophys profile w/nst Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76819 &TC 2 Fetal biophys profil w/o nst Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76820 &TC 2 Umbilical artery echo Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76821 &TC 2 Middle cerebral artery echo Radiologist/OBGYN ARDMS RDMS Ob/Gyne

76825 &TC 2 Echo exam of fetal heart Radiologist or OB/GYN/Cardiology

ARDMS RDMS Ob/Gyne


ARDMS RDMS Ob/Gyne


ARDMS RDMS Ob/Gyne


ARDMS RDMS Ob/Gyne

CPT Codes

MOD



76830 &TC 1 Transvaginal us, non-ob Radiologist or OB/GYN ARDMS RDMS Ob/Gyne

76831 &TC 3 Echo exam, uterus Radiologist or OB/GYN ARDMS RDMS Ob/Gyne

76856 &TC 1 Us exam, pelvic, complete Radiologist or OB/GYN ARDMS RDMS Ob/Gyne

76857 &TC 1 Us exam, pelvic, limited Radiologist or OB/GYN ARDMS RDMS Ob/Gyne

76870 &TC 1 Us exam, scrotum Radiologist or Urologist ARDMS RDMS Ob/Gyne

76872 &TC 1 Us, transrectal Radiologist or OB/GYN, Urologist

ARDMS RDMS Ob/Gyne

76873 &TC 1 Echograp trans r, pros study Radiologist or Urologist ARDMS RDMS Ob/Gyne

76881 US, extremity, nonvascular, real-time with image documentation; complete

Radiologist Credentialed by ARDMS RDMS or ARRT:R.T-S

76882 US, ext nonvascular real time with image documentation limited, anatomic specific

Radiologist Credentialed by ARDMS RDMS or ARRT:R.T-S

76885 &TC 2 Us exam infant hips, dynamic

Radiologist ARDMS RDMS Ob/Gyne

76886 &TC 2 Us exam infant hips, static Radiologist ARDMS RDMS Ob/Gyne

76930 &TC 3 Echo guide, cardiocentesis Radiologist /Cardiologist ARDMS RDMS Ob/Gyne

76932 &TC 3 Echo guide for heart biopsy Radiologist /Cardiologist Certified Radiology Tech

76937 &TC 3 Us guide, vascular access Radiologist, Vascular Surgeon

ARDMS RDMS Ob/Gyne

76940 &TC 1 Us guide, tissue ablation Radiologist ARDMS RDMS Ob/Gyne

76945 &TC 1 Echo guide, villus sampling Radiologist ARDMS RDMS Ob/Gyne

76946 &TC 1 Echo guide for amniocentesis

Radiologist Registered Ultrasounographer

76970 &TC 1 Ultrasound exam follow-up Radiologist ARDMS RDMS

76975 &TC 1 GI endoscopic ultrasound Radiologist ARDMS RDMS

76977 &TC 1 Us bone density measure Multiple Multiple

76998 &TC 9 n/a n/a

76999 &TC 9 n/a n/a

CPT Codes

MOD



77001 &TC 3 Multiple Certified Tech

77002 &TC 3 Needle localization by x-ray Multiple Certified Tech

77003 &TC 3 Fluoroguide for spine inject Multiple Certified Radiology Tech

77011 &TC 3 Ct scan for localization Radiologist Certified Radiology Tech

77012 &TC 3 Ct scan for needle biopsy Radiologist Certified Radiology Tech

77013 1 Radiologist Certified Radiology Tech


77021 &TC 3 Mr guidance for needle place



77031 &TC 3 Stereotactic breast biopsy Radiologist, Surgery Certified Radiology Tech

77032 &TC 3 X-ray of needle wire, breast Radiologist,Surgery Certified Radiology Tech

77051 &TC 1 Computer mammogram add-on

Radiology Certified Radiology Tech

77052 &TC 1 Computer mammogram add-on

Radiology Certified Radiology Tech

77053 &TC 3 X-ray of mammary duct Radiologist Certified Radiology Tech

77054 &TC 3 X-ray of mammary ducts Radiologist Certified Radiology Tech

77055 &TC 2 Mammogram, one breast Radiologist Certified Radiology Tech

77056 &TC 2 Mammogram, both breasts Radiologist Certified Radiology Tech

77057 &TC 1 Mammogram, screening Radiologist Certified Radiology Tech

77058 &TC 1 Magnetic image, breast Radiologist,Surgery Certified Radiology Tech

77059 &TC 1 Magnetic image, both breasts

Radiologist, Surgery Certified Radiology Tech

77071 &TC 1 X-ray stress view Radiologist Certified Radiology Tech

77072 &TC 1 X-rays for bone age Radiologist Certified Radiology Tech

77073 &TC 1 X-rays, bone evaluation Radiologist Certified Radiology Tech

77074 &TC 1 X-rays, bone survey Radiologist Certified Radiology Tech

77075 &TC 1 X-rays, bone survey Radiologist Certified Radiology Tech

77076 &TC 1 X-rays, bone evaluation Radiologist Certified Radiology Tech

CPT Codes

MOD



77077 &TC 1 Joint survey, single view Radiologist Certified Radiology Tech

77078 &TC 1 Ct bone density, axial Radiologist Certified Radiology Tech

77079 &TC 1 Ct bone density, peripheral Radiologist Certified Radiology Tech

77080 &TC 1 Dxa bone density, axial Radiologist Certified Radiology Tech

77081 &TC 1 Dxa bone density/peripheral Radiologist Certified Radiology Tech

77082 &TC 1 Dxa bone density/fracture Radiologist Certified Radiology Tech

77083 &TC 1 Radiographic absorptiometry


77084 &TC 1 MRI imaging bone marrow blood supply



78000 &TC 1 Thyroid, single uptake Nuclear Medicine or Radiology

Nuclear Medicine Tech

78001 &TC 1 Thyroid, multiple uptakes Nuclear Medicine or Radiology


78003 &TC 1 Thyroid suppress/stimul Nuclear Medicine or Radiology


78006 &TC 1 Thyroid imaging with uptake

Nuclear Medicine or Radiology


78007 &TC 1 Thyroid image, mult uptakes



78010 &TC 1 Thyroid imaging Nuclear Medicine or Radiology


78011 &TC 1 Thyroid imaging with flow Nuclear Medicine or Radiology


78015 &TC 1 Thyroid met imaging Nuclear Medicine or Radiology


78016 &TC 1 Thyroid met imaging/studies



78018 &TC 1 Thyroid met imaging, body Nuclear Medicine or Radiology


78020 &TC 1 Thyroid met uptake Nuclear Medicine or Radiology


78070 &TC 1 Parathyroid nuclear imaging Nuclear Medicine or Radiology


78075 &TC 1 Adrenal nuclear imaging Nuclear Medicine or Radiology


78099 &TC 9 n/a n/a

78102 &TC 1 Bone marrow imaging, ltd Nuclear Medicine or Radiology


78103 &TC 1 Bone marrow imaging, mult Nuclear Medicine or Radiology


78104 &TC 1 Bone marrow imaging, body Nuclear Medicine or Radiology


CPT Codes

MOD



78110 &TC 1 Plasma volume, single Nuclear Medicine or Radiology


78111 &TC 1 Plasma volume, multiple Nuclear Medicine or Radiology


78120 &TC 1 Red cell mass, single Nuclear Medicine or Radiology


78121 &TC 1 Red cell mass, multiple Nuclear Medicine or Radiology


78122 &TC 1 Blood volume Nuclear Medicine or Radiology


78130 &TC 1 Red cell survival study Nuclear Medicine or Radiology


78135 &TC 1 Red cell survival kinetics Nuclear Medicine or Radiology


78140 &TC 1 Red cell sequestration Nuclear Medicine or Radiology


78185 &TC 1 Spleen imaging Nuclear Medicine or Radiology


78190 &TC 1 Platelet survival, kinetics Nuclear Medicine or Radiology


78191 &TC 1 Platelet survival Nuclear Medicine or Radiology


78195 &TC 1 Lymph system imaging Nuclear Medicine or Radiology


78199 &TC 9 n/a n/a

78201 &TC 1 Liver imaging Nuclear Medicine or Radiology


78202 &TC 1 Liver imaging with flow Nuclear Medicine or Radiology


78205 &TC 1 Liver imaging (3D) Nuclear Medicine or Radiology


78206 &TC 1 Liver image (3d) with flow Nuclear Medicine or Radiology


78215 &TC 1 Liver and spleen imaging Nuclear Medicine or Radiology


78216 &TC 1 Liver & spleen image/flow Nuclear Medicine or Radiology


78220 &TC 1 Liver function study Nuclear Medicine or Radiology


78223 &TC 1 Hepatobiliary imaging Nuclear Medicine or Radiology


78230 &TC 1 Salivary gland imaging Nuclear Medicine or Radiology


78231 &TC 1 Serial salivary imaging Nuclear Medicine or Radiology


78232 &TC 1 Salivary gland function exam



78258 &TC 1 Esophageal motility study Nuclear Medicine or Radiology


78261 &TC 1 Gastric mucosa imaging Nuclear Medicine or Radiology


CPT Codes

MOD



78262 &TC 1 Gastroesophageal reflux exam



78264 &TC 1 Gastric emptying study Nuclear Medicine or Radiology


78267 &TC 9 n/a n/a

78270 &TC 1 Vit B-12 absorption exam Nuclear Medicine or Radiology


78271 &TC 1 Vit b-12 absrp exam, int fac Nuclear Medicine or Radiology


78272 &TC 1 Vit B-12 absorp, combined Nuclear Medicine or Radiology


78278 &TC 1 Acute GI blood loss imaging



78282 &TC 1 GI protein loss exam Nuclear Medicine or Radiology


78290 &TC 1 Meckel’s divert exam Nuclear Medicine or Radiology


78291 &TC 1 Leveen/shunt patency exam Nuclear Medicine or Radiology


78299 &TC 9 n/a n/a

78300 &TC 1 Bone imaging, limited area Nuclear Medicine or Radiology


78305 &TC 1 Bone imaging, multiple areas



78306 &TC 1 Bone imaging, whole body Nuclear Medicine or Radiology


78315 &TC 1 Bone imaging, 3 phase Nuclear Medicine or Radiology


78320 &TC 1 Bone imaging (3D) Nuclear Medicine or Radiology


78350 &TC 9 n/a n/a

78351 &TC 9 n/a n/a

78399 &TC 9 n/a n/a

78414 &TC 1 Non-imaging heart function Nuclear Medicine, Cardiology or Radiology


78428 &TC 1 Cardiac shunt imaging Nuclear Medicine, Cardiology or Radiology


78445 &TC 1 Vascular flow imaging Nuclear Medicine, Cardiology or Radiology


78451 Myocardial perfusion imaging, tomographic (spect)... single study, at rest or stress (exercise or pharmacologic)

Nuclear Medicine, Cardiology or Radiology

Credentialed by ARRT:R.T.-N or CNMT

78452 Myocardial perfusion imaging, tomographic (spect); multiple studies, at rest and/or stress (exercise or pharmacologic)



CPT Codes

MOD



and/or redistribution and/or rest reinjection

78453 myocardial perfusion imaging, planar; single study, at rest or stress (exercise or pharmacologic)



78454 myocardial perfusion imaging, planar multiple studies, at rest and/or stresss(exercise or pharmacologic) and/or redistribution and/or rest reinjectiion



78456 &TC 9 Acute venous thrombus image

n/a n/a

78457 &TC 1 Venous thrombosis imaging Radiology, Cardiology Certified Radiology Tech

78458 &TC 1 Ven thrombosis images, bilat

Radiology, Cardiology Certified Radiology Tech

78459 &TC 1 Heart muscle imaging (PET)

Radiology, Cardiology Certified Radiology Tech

78466 &TC 1 Heart infarct image Radiology, Cardiology Certified Radiology Tech

78468 &TC 1 Heart infarct image (ef) Radiology, Cardiology Certified Radiology Tech

78469 &TC 1 Heart infarct image (3D) Radiology, Cardiology Certified Radiology Tech

78472 &TC 1 Gated heart, planar, single Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78473 &TC 1 Gated heart, multiple Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78481 &TC 1 Heart first pass, single Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78483 &TC 1 Heart first pass, multiple Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78491 &TC 1 Heart image (pet), single Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78492 &TC 1 Heart image (pet), multiple Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78494 &TC 1 Heart image, spect Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology

Certified Radiology Tech Nuclear Medicine Tech

78496 &TC 1 Heart first pass add-on Board Certified (ABMS) Nuclear Medicine, Cardiology or Radiology


78499 %TC

9 n/a Certified Radiology Tech Nuclear Medicine Tech

78580 &TC Lung perfusion imaging Nuclear Medicine or Radiology, Pulmonology


78584 &TC Lung V/Q image single breath

Nuclear Medicine or Radiology, Pulmonology


78585 &TC Lung V/Q imaging Nuclear Medicine or Radiology, Pulmonology


CPT Codes

MOD



78586 &TC Aerosol lung image, single Nuclear Medicine or Radiology, Pulmonology


78587 &TC Aerosol lung image, multiple

Nuclear Medicine or Radiology, Pulmonology


78588 &TC Perfusion lung image Nuclear Medicine or Radiology, Pulmonology


78591 &TC Vent image, 1 breath, 1 proj Nuclear Medicine or Radiology, Pulmonology


78593 &TC Vent image, 1 proj, gas Nuclear Medicine or Radiology, Pulmonology


78594 &TC Vent image, mult proj, gas Nuclear Medicine or Radiology, Pulmonology


78596 &TC Lung differential function Nuclear Medicine or Radiology, Pulmonology


78599 &TC n/a Nuclear Medicine Tech

78600 &TC 1 Brain imaging, ltd static Nuclear Medicine or Radiology


78601 &TC 1 Brain imaging, ltd w/flow Nuclear Medicine or Radiology


78605 &TC 1 Brain imaging, complete Nuclear Medicine or Radiology


78606 &TC 1 Brain imaging, compl w/flow



78607 &TC 1 Brain imaging (3D) Nuclear Medicine or Radiology


78608 &TC 1 Brain imaging (PET) Nuclear Medicine or Radiology


78609 &TC 1 Brain imaging (PET) Nuclear Medicine or Radiology


78610 &TC 1 Brain flow imaging only Nuclear Medicine or Radiology


78615 &TC 1 Cerebral vascular flow image



78630 &TC 1 Cerebrospinal fluid scan Nuclear Medicine or Radiology


78635 &TC 1 CSF ventriculography Nuclear Medicine or Radiology


78645 &TC 1 CSF shunt evaluation Nuclear Medicine or Radiology


78647 &TC 1 Cerebrospinal fluid scan Nuclear Medicine or Radiology


78650 &TC 1 CSF leakage imaging Nuclear Medicine or Radiology


78660 &TC 1 Nuclear exam of tear flow Nuclear Medicine or Radiology


78700 &TC 1 Kidney imaging, static Nuclear Medicine or Radiology, Neurosurgery


78701 &TC 1 Kidney imaging with flow Nuclear Medicine or Radiology, Neurosurgery


78707 &TC 1 Kidney flow/function image Nuclear Medicine or Radiology, Neurosurgery


CPT Codes

MOD







78710 &TC 1 Kidney imaging SPECT Nuclear Medicine or Radiology, Neurosurgery


78725 &TC 1 Kidney function study Nuclear Medicine or Radiology, Neurosurgery


78730 &TC 1 Urinary bladder retention Nuclear Medicine or Radiology, Neurosurgery


78740 &TC 1 Ureteral reflux study Nuclear Medicine or Radiology, Neurosurgery


78761 &TC 1 Testicular imaging/flow Nuclear Medicine or Radiology, Neurosurgery


78800 &TC 1 Tumor imaging, limited area Nuclear Medicine or Radiology


78801 &TC 1 Tumor imaging, mult areas Nuclear Medicine or Radiology


78802 &TC 1 Tumor imaging, whole body Nuclear Medicine or Radiology


78803 &TC 1 Tumor imaging (3D) Nuclear Medicine or Radiology


78804 &TC 1 Tumor imaging, whole body Nuclear Medicine or Radiology


78805 &TC 1 Abscess imaging, ltd area Nuclear Medicine or Radiology


78806 &TC 1 Abscess imaging, whole body



78807 &TC 1 Nuclear localization/abscess Nuclear Medicine or Radiology


78811 &TC 1 Tumor imaging (pet), limited

Radiology, Cardiology Certified Radiology Tech Nuclear Medicine Tech

78812 &TC 1 Tumor image (pet)/skul-thigh



78813 &TC 1 Tumor image (pet) full body Nuclear Medicine or Radiology


78814 &TC 1 Tumor image pet/ct, limited Nuclear Medicine or Radiology


78815 &TC 1 Tumorimage pet/ct skul-thigh



78816 &TC 1 Tumor image pet/ct full body



78999 &TC 9 n/a n/a

91010 &TC 3 Esophagus motility study Gastroenterologist Personally Trained Staff

91013 Esophageal motility study with interp. & report; with stimulation or perfusion during 2-dimensional data study

Gastroenterologist GI trained RN, LPN

CPT Codes

MOD



91020 &TC 3 Gastric motility Gastroenterologist Personally Trained Staff

91022 &TC 3 Duodenal motility study Gastroenterologist Personally Trained Staff

91030 &TC 3 Acid perfusion of esophagus Gastroenterologist, Otolaryngologist

Personally Trained Staff

91065 &TC 1 Breath hydrogen test Gastroenterologist RN, Personally Trained Staff

91110 &TC 9 GI Capsule endoscopy n/a n/a

91117 Colon motility study, min 6 hrs continuous recording (including provocation tests, eg, meal, intracolonic balloon distension, pharmacologic agents, if performed), w interp & report

Gastroenterologist GI trained RN, LPN

91120 &TC 3 Rectal sensation test Gastroenterologist or Colorectal Surgeon

RN,Personally Trained Staff

91122 &TC 3 Anal pressure record Gastroenterologist or Colorectal Surgeon

RN, Personally Trained Staff

91132 &TC 9 Electrogastrography n/a n/a

91133 &TC 9 Electrogastrography w/test n/a n/a

91299 &TC 9 n/a n/a

92015 1 Opthal Opthalmic Assistant or Tech

92025 &TC 1 Opthal Opthalmic Assistant or Tech

92060 &TC 1 Ophth, Optometry Opthalmic Assistant or Tech

92065 &TC 1 Ophth, Optometry

92081 &TC 1 Visual field examination(s) Ophth, Optometry Opthalmic Assistant or Tech



92100 &TC 9 Serial tonometry exam(s) Ophthalmologist, Opthalmic Assistant or Tech

92120 &TC 9 Tonography & eye evaluation

Ophthalmologist, Neurologist or Optometrist

Opthalmic Assistant or Tech

92130 &TC 9 Water provocation tonography

Ophthalmologist or Optometrist


92132 Scanning computerized ophthalmic dx imaging


CPT Codes

MOD



anterior segment with interp & report

92133 Scanning computerized ophthalmic dx imaging posterior segment with interp & report



92134 …retina Ophthalmologist or Optometrist


92136 &TC 1 Ophthalmic biometry Ophthalmologist or Optometrist


92140 &TC 9 Glaucoma provocative tests Ophthalmologist or Optometrist


92225 &TC 9 Special eye exam, initial Ophthalmologist or Optometrist


92226 &TC 9 Special eye exam, subsequent



92227 Remote imaging for detection of retinal dse in pt with diabetes with md review , Interp & report, unilat or bilateral



92228 Remote imaging for monitoring and management of active retinal dse with md review , Interp & report, unilat or bilateral



92230 &TC 9 Eye exam with photos Ophthalmologist or Optometrist


92235 &TC 2 Eye exam with photos Ophth Opthalmic Assistant or Tech

92240 &TC 2 Icg angiography Ophthalmologist, Neurologist or Optometrist


92250 &TC 1 Eye exam with photos Ophthalmologist, Neurologist or Optometrist


92260 &TC 9 Ophthalmoscopy/dynamometry

Ophthalmologist Opthalmic Assistant, RN or Tech

92265 &TC 3 Eye muscle evaluation Ophthalmologist, Neurologist or Optometrist

Opthalmic Assistant, RN or Tech

92270 &TC 3 Electro-oculography Ophthalmologist, Neurologist or Optometrist


92275 &TC 3 Electroretinography Ophthalmologist, Neurologist or Optometrist


92283 &TC 1 Color vision examination Ophthalmologist, Neurologist or Optometrist


92284 &TC 1 Dark adaptation eye exam Ophthalmologist, Neurologist or


CPT Codes

MOD



Optometrist

92285 &TC 1 Eye photography Ophthalmologist, Neurologist or Optometrist


92286 &TC 2 Internal eye photography Ophthalmologist, Neurologist or Optometrist


92287 &TC 9 Internal eye photography Ophthalmologist Opthalmic Assistant or Tech

92504 &TC 9 N/A N/A

92506 &TC 9 N/A N/A

92507 &TC 9 N/A N/A

92508 &TC 9 N/A N/A

92511 &TC 9 N/A N/A

92512 &TC 9 N/A N/A

92516 &TC 9 N/A N/A

92520 &TC 9 N/A N/A

92526 &TC 9 N/A N/A

92531 &TC 9 N/A N/A

92532 &TC 9 N/A N/A

93533 &TC 9 N/A N/A

93534 &TC 9 N/A N/A

92541 &TC 5 Spontaneous nystagmus test Neurologist or Otolaryngologist

Audiologist,Personally trained Assistant

92542 &TC 5 Positional nystagmus test Neurologist or Otolaryngologist


92543 &TC 5 Caloric vestibular test Neurologist or Otolaryngologist


92544 &TC 5 Optokinetic nystagmus test Neurologist or Otolaryngologist


92545 &TC 5 Oscillating tracking test Neurologist or Otolaryngologist


92546 &TC 5 Sinusoidal rotational test Neurologist or Otolaryngologist


92547 &TC 5 Supplemental electrical test Neurologist or Otolaryngologist


92548 &TC 5 Posturography Neurologist or Otolaryngologist


CPT Codes

MOD



92550 Tympanometry Neurologist or Otolaryngologist

Audiologist, Personally trained Assistant

93551 &TC 9 N/A N/A

92552 &TC 5 Pure tone audiometry, air Neurologist or Otolaryngologist


92553 &TC 5 Audiometry, air & bone Neurologist or Otolaryngologist


92555 &TC 5 Speech threshold audiometry

Neurologist or Otolaryngologist


92556 5 Speech audiometry, complete



92557 5 Comprehensive hearing test Neurologist or Otolaryngologist


93559 &TC 9 N/A N/A

93560 &TC 9 N/A N/A

92561 5 Bekesy audiometry, diagnosis



92562 5 Loudness balance test Neurologist or Otolaryngologist


92563 5 Tone decay hearing test Neurologist or Otolaryngologist


92564 5 Sisi hearing test Neurologist or Otolaryngologist


92565 5 Stenger test, pure tone Neurologist or Otolaryngologist


92567 5 Tympanometry Neurologist or Otolaryngologist


92568 5 Acoustic reflex testing Neurologist or Otolaryngologist


92570 Acoustic immittance testing Neurologist or Otolaryngologist

Audiologist, Personally trained Assistant

92571 5 Filtered speech hearing test Neurologist or Otolaryngologist


92572 5 Staggered spondaic word test



92575 5 Sensorineural acuity test Neurologist or Otolaryngologist


92576 5 Synthetic sentence test Neurologist or Otolaryngologist


92577 5 Stenger test, speech Neurologist or Otolaryngologist


92579 5 Visual audiometry (vra) Neurologist or Otolaryngologist


92582 5 Conditioning play audiometry



92583 5 Select picture audiometry Neurologist or Otolaryngologist


92584 5 Electrocochleography Neurologist or Otolaryngologist


CPT Codes

MOD



92585 &TC 5 Auditor evoke potent, compre



92586 5 Auditor evoke potent, limit Neurologist or Otolaryngologist


92587 &TC 5 Evoked auditory test Neurologist or Otolaryngologist


92588 &TC 5 Evoked auditory test Neurologist or Otolaryngologist


92590 9 n/a n/a

92591 9 n/a n/a

92592 9 n/a n/a

92593 9 n/a n/a

92594 9 n/a n/a

92595 9 n/a n/a

92596 Ear protector evaluation Neurologist or Otolaryngologist


92610 9 n/a n/a

92611 9 n/a n/a

92612 9 n/a n/a

92613 9 n/a n/a

92614 9 n/a n/a

92615 9 n/a n/a

92616 9 n/a n/a

92617 9 n/a n/a

92700 9 n/a n/a

93000 1 Electrocardiogram, complete

Internist or Cardiologist CCI: CCT, RN

93005 1 Electrocardiogram, tracing Internist or Cardiologist CCI: CCT, RN

93010 9 Electrocardiogram report Internist or Cardiologist n/a

93015 2 Cardiovascular stress test Internist or Cardiologist RN/PA



CPT Codes

MOD




93024 &TC 3 Cardiac drug stress test Internist or Cardiologist RN/PA

93025 9 Microvolt t-wave assess Internist or Cardiologist RN PA- ACLS certified

93040 1 Rhythm ECG with report Internist or Cardiologist CCI, CCT, RN

93041 1 Rhythm ECG, tracing Internist or Cardiologist CCI, RN, LPN

93042 9 Rhythm ECG, report Internist or Cardiologist Physician Only Service

93224 1 External electrocardiographic recording up to 48 hours by cont recording and storage, includes recording, scanning analysis with report, MD review and interpretation

Cardiologist CCI, RN, LPN

93225 1 Recording (includes connection, recording and disconnection)


93226 1 Scanning analysis with report


93227 9 Physician review and interpretation

Cardiologist Physician Only Service

93228 Ext mobile cardiovascular telemetry with ecg recording concurrent computeriaed real time data….up to 30 days, MD review and interp. With report

Cardiologist CCI-CCT, RN, LPN

93229 ECG Recording -Technical support connect and pt instructionm, analysis and MD prescribed transmission of daily and emergent data reports


93268 1 External pt and auto activated electrocardiographic rhythm recording -24 hrs attended monitoring , 30 day record/review & interp

Cardiologist Physician Only Service

93270 1 ECG recording (includes connection, recording and disconnection)


93271 1 ECG transmission download and analysis


93272 9 ECG-MD review, interpret n/a n/a

CPT Codes

MOD



93278 &TC 1 ECG/signal-averaged Cardiologist CCI: CCT, RN

93279 Eval pacemaker-single lead Cardiologist RN or CCI-CCT

93280 Eval pacemaker-dual lead Cardiologist RN or CCI-CCT

93281 Eval pacemaker-multiple lead

Cardiologist RN or CCI-CCT

93282 Eval cardio-def single lead Cardiologist RN or CCI-CCT

93283 Eval cardio-def dual lead Cardiologist RN or CCI-CCT

93284 Eval cardio-def mulitple lead


93285 Eval of Implantable loop recorder


93288 Eval device, (in person) pacemaker mulitple lead


93289 Eval device, (in person) Cardio-def


93290 Eval device, (in person) implantable monitor


93291 Eval device, (in person) implantable monitor


93293

Transtelephonic pacemaker evaluation


93294 Interrogation device eval pacemaker (Remote)


93295 Device eval cardioverter-defib system


93296 Pacemaker or implantable defib data acquisition


93297 Implantable cardiovascular monitor analsysis


93298 Implantable loop recorder Cardiologist RN or CCI-CCT

93299 Implantable cardiovascular monitor or loop recorder


93303 &TC 1 Echo transthoracic Cardiologist ARDMS-RDCS; CCI: RCS

93304 &TC 1 Echo transthoracic Cardiologist ARDMS-RDCS; CCI: RCS

93306 Echo transthoracic, includs M mode

Cardiologist ARDMS-RDCS, CCI: RCS

93307 &TC 1 Echo exam of heart, includes M mode recording

Cardiologist ARDMS-RDCS; CCI: RCS

93308 &TC 1 Echo exam of heart includes M mode recording limited study

Cardiologist ARDMS-RDCS; CCI: RCS

93312 &TC 3 Echo transesophageal Cardiologist ARDMS-RDCS; CCI: RCS

CPT Codes

MOD



93313 3 Echo transesophageal Cardiologist ARDMS-RDCS; CCI: RCS



93316 3 Echo transesophageal Cardiologist ARDMS-RDCS; CCI: RCS


93318 9 Echo transesophageal intraop

n/a n/a

93320 &TC 1 Doppler echo exam, heart Cardiologist ARDMS-RDCS,

93321 &TC 1 Doppler echo exam, heart Cardiologist ARDMS RDCS,

93325 &TC 1 Doppler color flow add-on Cardiologist ARDMS RDCS,

93350 &TC 1 Echo transthoracic with M mode recording

Cardiologist ARDMS RDCS, CCI: RCS

93351 &TC 1 Echo transthoracic with M mode includes continuous ecg monitoring with MD supervision

Cardiology ARDMS: RDCS: CCI: RCS

93352 Use of echocardiographic contrast during stress echo

Cardiology ARDMS: RDCS: CCI: RCS

93451 Rt heart Cath Cardiology, Cardiac Surgery


93452 LT heart Cath Cardiology, Cardiac Surgery


93453 Combined heart cath Cardiology, Cardiac Surgery


93454 Catheter placement coronary artery

Cardiology, Cardiac Surgery


93455 Catheter placement bypass Cardiology, Cardiac Surgery


93456 Bypass… with rt heart cath Cardiology, Cardiac Surgery


93457 ….cath placement in bypass graft and rt heart cath



93458 …….with left heart Cath Cardiology, Cardiac Surgery


93459 Cath in coronary artery…with left heart cath



93460 Cath in coronary artery…with rt and lt heart cath



93461 ….with bypass graft angiography



CPT Codes

MOD



93462 Lt heart cath by transseptal puncture….



93463 Pharmacologic agent adm Cardiology, Cardiac Surgery


93503 3 n/a n/a

93505 &TC 3 Cardiology Certified Radiology Tech







93563 Inj proc during cardiac cath Cardiology, Cardiac Surgery


93564 …selective opacification of aortocoronary



93565 ….selective lt vent or lt atrial angiography



93566 ….selective rt vent or rt atrial angiography



93567 …for supravalvular aortography



93568 ….for pulmonary angiography





93600 &TC 3 Bundle of His recording Cardiologist RN, Certified Radiology Tech

93602 &TC 3 Intra-atrial recording Cardiologist RN, Certified Radiology Tech

93603 &TC 3 Right ventricular recording Cardiologist RN, Certified Radiology Tech

93607 &TC 3 Cardiologist RN, Certified Radiology Tech

93609 &TC 3 Map tachycardia, add-on Cardiologist RN, Certified Radiology Tech

93610 &TC 3 Intra-atrial pacing Cardiologist RN, Certified Radiology Tech

93612 &TC 3 Intraventricular pacing Cardiologist RN, Certified Radiology Tech

CPT Codes

MOD



93613 &TC 3 Electrophys map 3d, add-on Cardiologist RN, Certified Radiology Tech

93615 &TC 3 Esophageal recording Cardiologist RN, Certified Radiology Tech

93616 &TC 3 Esophageal recording Cardiologist RN, Certified Radiology Tech

93618 &TC 3 Heart rhythm pacing Cardiologist RN, Certified Radiology Tech

93619 &TC 3 Electrophysiology evaluation

Cardiologist RN, Certified Radiology Tech







93623 &TC 3 Stimulation, pacing heart Cardiologist RN, Certified Radiology Tech

93624 &TC 3 Electrophysiologic study Cardiologist RN, Certified Radiology Tech

93631 &TC 3 Heart pacing, mapping Cardiologist RN, Certified Radiology Tech

93640 &TC 3 Evaluation heart device Cardiologist RN, Certified Radiology Tech





93650 9 n/a n/a

93651 9 n/a n/a

93652 9 n/a n/a

93660 &TC 3 Tilt table evaluation Cardiologist RN, Certified Radiology Tech

93662 9 Intracardiac ecg (ice) n/a n/a

93701 &TC 1 Bioimpedance, thoracic Radiology RN, Certified Radiology Tech

93720 1 Total body plethysmography

Pulmonologist Respiratory Tech

93721 1 Plethysmography tracing Pulmonologist Respiratory Tech

93722 9 Plethysmography report n/a n/a

93724 &TC 3 Analyze pacemaker system Cardiologist RN/CCI or CCT

93740 &TC 1 Temperature gradient studies

Cardiologist RN/CCI or CCT

93750 Interrogation of ventricular assist device (VAD)

Cardiologist RN

CPT Codes

MOD



93760 9 N/A N/A

93762 9 N/A N/A

93770 &TC 1 Measure venous pressure Cardiologist RN/CCI or CCT

93784 9 N/A N/A

93786 9 N/A N/A

93788 9 N/A N/A

93790 9 Review/report BP recording N/A N/A

93875 &TC 1 Extracranial study Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS


ARDMS:RVT CCI:RVS


ARDMS:RVT CCI:RVS

93886 &TC 1 Intracranial study Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93888 &TC 1 Intracranial study Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93890 &TC 1 Tcd, vasoreactivity study Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93892 &TC 1 Tcd, emboli detect w/o inj Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93893 &TC 1 Tcd, emboli detect w/inj Radiologist, Neurologist or Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93922 &TC 1 Noninvasive physiologic studies UE or LE arteries

Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93923 &TC 1 Complete bilat noninvasive physiologic studies UE or LE arteries study

Radiologist , Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93924 &TC 1 Noninvasive physiologic studies LE arteries at rest and after treadmill test…

Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93925 &TC 1 Lower extremity study Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93926 &TC 1 Lower extremity study Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93930 &TC 1 Upper extremity study Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

CPT Codes

MOD



93931 &TC 1 Upper extremity study Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93965 &TC 1 Extremity study Radiologist, Cardiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS


ARDMS:RVT CCI:RVS


ARDMS:RVT CCI:RVS

93975 &TC 1 Vascular study Radiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93976 &TC 1 Vascular study Radiologist , Vascular Surgeon

ARDMS:RVT CCI:RVS

93978 &TC 1 Vascular study Radiologist , Vascular Surgeon

ARDMS:RVT CCI:RVS

93979 &TC 1 Vascular study Radiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93980 &TC 1 Penile vascular study Radiologist or Urologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93981 &TC 1 Penile vascular study Radiologist or Urologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

93990 &TC 1 Doppler flow testing Radiologist, Vascular Surgeon

ARDMS:RVT CCI:RVS

94010 &TC 1 Breathing capacity test Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94014 1 Patient recorded spirometry Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94015 5 Patient recorded spirometry Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94016 9 Review patient spirometry N/A N/A

94060 &TC 2 Evaluation of wheezing Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94070 &TC 2 Evaluation of wheezing Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94150 &TC 9 Vital capacity test Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94200 &TC 1 Lung function test (MBC/MVV)

Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94240 &TC 1 Residual lung capacity Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94250 &TC 1 Expired gas collection Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94260 &TC 1 Thoracic gas volume Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94350 &TC 1 Lung nitrogen washout curve


94360 1 Measure airflow resistance Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94370 1 Breath airway closing volume


94375 1 Respiratory flow volume loop


CPT Codes

MOD



94400 2 CO2 breathing response curve


94450 2 Hypoxia response curve Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94620 1 Pulmonary stress test/simple Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94621 1 Pulm stress test/complex Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94640 9 N/A N/A

94642 9 N/A N/A

94660 9 N/A N/A

94662 9 N/A N/A

94664 2 Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94667 9 N/A N/A

94668 9 N/A N/A

94680 &TC 2 Exhaled air analysis, o2 Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94681 &TC 2 Exhaled air analysis, o2/co2 Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94690 &TC 1 Exhaled air analysis Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94720 &TC 1 Monoxide diffusing capacity


94725 &TC 1 Membrane diffusion capacity


94750 &TC 1 Pulmonary compliance study


94760 1 Measure blood oxygen level Pulmonologist NBRC: CPFT, RPFT, RRT/RN



94770 &TC 1 Exhaled carbon dioxide test Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94772 &TC 1 Breath recording, infant Pulmonologist NBRC: CPFT, RPFT, RRT/RN

94799 &TC 9 N/A N/A

95004 2 Percut allergy skin tests Otolaryngologist/Allergy/ Immunology

RN

95010 9 N/A N/A

CPT Codes

MOD



95012 1 Pulmonologist RN

95015 9 N/A N/A

95024 2 Id allergy test, drug/bug Otolaryngologist/Allergy/ Immunology

RN

95027 2 Id allergy titrate-airborne Otolaryngologist/Allergy/ Immunology

RN

95028 2 Id allergy test-delayed type Otolaryngologist/Allergy/ Immunology

RN

95044 2 Allergy patch tests Otolaryngologist/Allergy/ Immunology

RN

95052 2 Photo patch test Otolaryngologist/Allergy/ Immunology

RN

95056 2 Photosensitivity tests Otolaryngologist/Allergy/ Immunology

RN

95060 3 Eye allergy tests Otolaryngologist/Allergy/ Immunology

Physician only service

95065 3 Nose allergy test Otolaryngologist/Allergy/ Immunology

Physician only service

95070 3 Bronchial allergy tests Allergy/Immunology CMS had Otolaryngologist- removed

RN

95071 3 Bronchial allergy tests Allergy/Immunology CMS had Otolaryngologist- only removing oto

RN

95075 &TC 9 Ingestion challenge test N/A N/A

95800 Sleep study, unattended, recording HR, oxy sat, resp analysis and sleep time *only used in a facility

Pulmonologist, Neurologist or Certified by ABSM

Credentialed by BRPT, NBRC, or ABRET (Polysomography)

95801 Sleep study, unattended, min HR, oxy sat and , resp analysis and sleep time *only used in a facility

Pulmonologist, Neurologist or Certified by ABSM

Credentialed by BRPT, NBRC, or ABRET (Polysomography)

95805 &TC 1 Multiple sleep latency test Pulmonologist,Neurologist or Certified by ABSM

ABRET: R.EEG T, BRPT: RPSGT, NBRC: CPFT, RPFT, CRTT, RRTT

95806 &TC 1 Sleep study, unattended Pulmonologist,Neurologist or Certified by ABSM


95807 &TC 1 Sleep study, attended Pulmonologist,Neurologist or Certified by ABSM


CPT Codes

MOD



95808 &TC 1 Polysomnography, 1-3 Pulmonologist,Neurologist or Certified by ABSM


95810 &TC 1 Polysomnography, 4 or more

Pulmonologist,Neurologist or Certified by ABSM


95811 &TC 1 Polysomnography w/cpap Pulmonologist,Neurologist or Certified by ABSM


95812 &TC 1 Eeg, 41-60 minutes Pulmonologist,Neurologist or Certified by ABSM


95813 &TC 1 Eeg, over 1 hour Pulmonologist,Neurologist or Certified by ABSM


95816 &TC 1 Eeg, awake and drowsy Pulmonologist,Neurologist or Certified by ABSM


95819 &TC 1 Eeg, awake and asleep Pulmonologist,Neurologist or Certified by ABSM


95822 &TC 1 Eeg, coma or sleep only Pulmonologist,Neurologist or Certified by ABSM


95824 &TC 1 Eeg, cerebral death only Pulmonologist,Neurologist or Certified by ABSM


95827 &TC 1 Eeg, all night recording Pulmonologist,Neurologist or Certified by ABSM


95829 &TC 1 Pulmonologist,Neurologist or Certified by ABSM


95830 9 Insert electrodes for EEG N/A N/A

95860 &TC 6a Muscle test, one limb Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or

AAET R. EDT, Physical therapist who is a qualified electrophysiologic clinic specialist

CPT Codes

MOD



American Board of Neurophysiology

95861 &TC 6a Muscle test, 2 limbs Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med

AAET R. EDT, Physical therapist who is a qualified electrophysiologic clinic specialist;





95865 &TC 6a Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med


95866 &TC 6a Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med


95867 &TC 6a Muscle test cran nerv unilat Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med


95868 &TC 6a Muscle test cran nerve bilat Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or American Board of Neurophysiology


95869 &TC 6a Muscle test, thor paraspinal Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or American Board of Neurophysiology


95870 &TC 6a Muscle test, nonparaspinal Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b)

AAET R. EDT, Physical therapist who is a qualified electrophysiologic clinic

CPT Codes

MOD



Clinical Neurophysiology, or American Board of Neurophysiology

specialist

95872 &TC 66 Muscle test, one fiber Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or American Board of Neurophysiology


95873 &TC 9 n/a n/a

95874 &TC 9 n/a n/a

95875 &TC 3 Limb exercise test Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or c) American Board of Neurophysiology


95900 &TC 77a Motor nerve conduction test n/a n/a

95903 &TC 77a Motor nerve conduction test n/a n/a

95904 &TC 77a Sense nerve conduction test n/a n/a

95921 &TC 2 Autonomic nerv function test

Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or c) American Board of Neurophysiology



Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or c) American Board of Neurophysiology



Neurology or Physiatrist with additional cert. by a) American Board of electrodiagnostic med, b) Clinical Neurophysiology, or c) American Board of


CPT Codes

MOD



Neurophysiology

95925 &TC 21 Somatosensory testing Neurologist ABRET: R. EEG T



95928 &TC 21 C motor evoked, uppr limbs Neurologist ABRET: R. EEG T

95929 &TC 21 C motor evoked, lwr limbs Neurologist ABRET: R. EEG T

95930 &TC 21 Visual evoked potential test Neurologist ABRET: R. EEG T

95933 &TC 77a Blink reflex test n/a n/a

95934 &TC 77a H-reflex test n/a n/a

95936 &TC 77a H-reflex test n/a n/a

95937 &TC 77a Neuromuscular junction test n/a n/a

95950 &TC 1 Ambulatory eeg monitoring Neurologist ABRET as R. EEG T

95951 &TC 1 EEG monitoring/videorecord

Neurologist ABRET as R. EEG T

95953 &TC 1 EEG monitoring/computer Neurologist ABRET as R. EEG T

95954 &TC 3 EEG monitoring/giving drugs

Neurologist Physician only service

95956 &TC 1 Eeg monitoring, cable/radio Neurologist ABRET as R. EEG T

95955 &TC 2 Neurologist ABRET as R. EEG T

95957 &TC 1 EEG digital analysis Neurologist ABRET as R. EEG T

95958 &TC 3 EEG monitoring/function test

Neurologist ABRET as R. EEG T



95965 &TC 2 Neurologist ABRET as R. EEG T or PhD neurophysiologist



95999 &TC 9 n/a n/a

96000 &TC 3 Motion analysis, video/3d Neurologist PT w/ ABPTS

CPT Codes

MOD



96001 &TC Motion test w/ft press meas Neurologist PT w/ ABPTS

96002 &TC Dynamic surface emg Neurologist Physician Only Service

96003 &TC Dynamic fine wire emg Neurologist Physician Only Service

96004 &TC Phys review of motion tests Neurologist Physician only service

96101 4 Psychiatry, Clinical Psychology or qualified Independent Psychologist

Training commensurate with American Psychological Association Standards





















CPT Codes

MOD



G0001 &TC 9 N/A N/A

G0027 &TC 9 N/A N/A

G0101 &TC 9 N/A N/A

G0104 &TC 9 N/A N/A

G0105 &TC 9 N/A N/A

G0106 &TC 3 Radiology Certified Radiology Tech

G0117 &TC 2 Ohpth Ophthalmic Assistant or Tech

G0118 &TC 2 Ophth Ophthalmic Assistant or Tech

G0130 &TC 1 Multiple Certified Radiology Tech




G0219 &TC 9 n/a n/a

G0235 &TC 9 n/a n/a

G0255 &TC 9 N/A N/A

G0275 &TC 3 Cardiology Certified Radiology Tech

G0278 &TC 3 Cardiology Certified Radiology Tech


G0389 &TC 1 Radiology ARDMS: RDMS-Abdomen

P3001 &TC 9 N/A N/A

Q0035 &TC 1 Cardiology CCT, RT

Revision History: 01/01/2011- Code update- Added 74176, 74177, 74178, 76881, 76882, 91013, 91117, 92132, 92133, 92134, 92227, 92228, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93563, 93564, 93565, 93566, 93567, 93568; 95800, 95801; Removed deleted codes 76150, 76350, 76490, 76880, 91000, 91011 91012, 91052, 91055, 92135, 93012, 93014, 93230, 93231, 93232, 93233, 93235, 93236, 93237, 93508, 93510, 93511, 93514, 93524, 93526, 93527, 93528, 93529, 93539, 93540, 93541, 93542, 93543, 93544, 93545, 93555, 93556;Description changes 93224-93229,

93268, 93270, 93271, 93272, 93922, 93923, 93924; Correction-technician requirements for 93228 & 93229 changed to CCI-CCT, RN, LPN 01/01/2010-Added new codes -74261-74263, 75557, 75559, 75561, 75563, 75565, 75571-75574, 75791, 78451-78454, 92550, 92570, 93750; Removed deleted codes-75552-75556, 75790, 78460-78465, 78478, 78480, 92569, 0144T-0151T, also removed previously deleted codes 75552-75556, 94656, 94657, 94665; 01/01/2009-09 Code Update to Appendix A: Removed deleted codes 78890, 78891, 93731-93736, 93741- 93744, Added 93228, 93229, 93279-93285, 93288-93299, 93306, 93351, 93352; Code description changes to 74270, 93307, 93308, 93230-93237, 93268-93272, 93307, 93308, 93350 & correction made to remove formerly deleted codes 93737 & 93738

Documents

Appendix A for LCD Independent Diagnostic Testing