2015 National Physician Fee Schedule Relative Value File January ReleaseCPT codes and descriptions only are copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply. Dental codes (D codes) are copyright 2014/15 American Dental Association. All Rights Reserved. RELEASED 12/23/2014

PHYSICIANSUPERVISION OF

STATUS GLOB DIAGNOSTICHCPCS MOD DESCRIPTION CODE DAYS PROCEDURESA0021 Outside state ambulance serv I XXX 09A0080 Noninterest escort in non er I XXX 09A0090 Interest escort in non er I XXX 09A0100 Nonemergency transport taxi I XXX 09A0110 Nonemergency transport bus I XXX 09A0120 Noner transport mini-bus I XXX 09A0130 Noner transport wheelch van I XXX 09A0140 Nonemergency transport air I XXX 09A0160 Noner transport case worker I XXX 09A0170 Transport parking fees/tolls I XXX 09A0180 Noner transport lodgng recip I XXX 09A0190 Noner transport meals recip I XXX 09A0200 Noner transport lodgng escrt I XXX 09A0210 Noner transport meals escort I XXX 09A0225 Neonatal emergency transport I XXX 09A0380 Basic life support mileage I XXX 09A0382 Basic support routine suppls X XXX 09A0384 Bls defibrillation supplies X XXX 09A0390 Advanced life support mileag I XXX 09A0392 Als defibrillation supplies X XXX 09A0394 Als iv drug therapy supplies X XXX 09A0396 Als esophageal intub suppls X XXX 09A0398 Als routine disposble suppls X XXX 09A0420 Ambulance waiting 1/2 hr X XXX 09A0422 Ambulance 02 life sustaining X XXX 09A0424 Extra ambulance attendant X XXX 09A0425 Ground mileage X XXX 09A0426 Als 1 X XXX 09A0427 Als1-emergency X XXX 09A0428 Bls X XXX 09A0429 Bls-emergency X XXX 09A0430 Fixed wing air transport X XXX 09A0431 Rotary wing air transport X XXX 09A0432 Pi volunteer ambulance co X XXX 09A0433 Als 2 X XXX 09A0434 Specialty care transport X XXX 09A0435 Fixed wing air mileage X XXX 09A0436 Rotary wing air mileage X XXX 09A0888 Noncovered ambulance mileage N XXX 09A0998 Ambulance response/treatment I XXX 09

A0999 Unlisted ambulance service X XXX 09A4206 1 cc sterile syringe&needle X XXX 09A4207 2 cc sterile syringe&needle X XXX 09A4208 3 cc sterile syringe&needle X XXX 09A4209 5+ cc sterile syringe&needle X XXX 09A4210 Nonneedle injection device N XXX 09A4211 Supp for self-adm injections P XXX 09A4212 Non coring needle or stylet P XXX 09A4213 20+ cc syringe only X XXX 09A4215 Sterile needle X XXX 09A4216 Sterile water/saline, 10 ml X XXX 09A4217 Sterile water/saline, 500 ml X XXX 09A4218 Sterile saline or water X XXX 09A4220 Infusion pump refill kit P XXX 09A4221 Maint drug infus cath per wk X XXX 09A4222 Infusion supplies with pump X XXX 09A4223 Infusion supplies w/o pump X XXX 09A4230 Infus insulin pump non needl X XXX 09A4231 Infusion insulin pump needle X XXX 09A4232 Syringe w/needle insulin 3cc I XXX 09A4233 Alkalin batt for glucose mon X XXX 09A4234 J-cell batt for glucose mon X XXX 09A4235 Lithium batt for glucose mon X XXX 09A4236 Silvr oxide batt glucose mon X XXX 09A4244 Alcohol or peroxide per pint X XXX 09A4245 Alcohol wipes per box X XXX 09A4246 Betadine/phisohex solution X XXX 09A4247 Betadine/iodine swabs/wipes X XXX 09A4248 Chlorhexidine antisept X XXX 09A4250 Urine reagent strips/tablets N XXX 09A4252 Blood ketone test or strip N XXX 09A4253 Blood glucose/reagent strips P XXX 09A4255 Glucose monitor platforms X XXX 09A4256 Calibrator solution/chips P XXX 09A4257 Replace lensshield cartridge X XXX 09A4258 Lancet device each P XXX 09A4259 Lancets per box P XXX 09A4261 Cervical cap contraceptive N XXX 09A4262 Temporary tear duct plug B XXX 09A4263 Permanent tear duct plug B XXX 09A4264 Intratubal occlusion device I XXX 09A4265 Paraffin P XXX 09A4266 Diaphragm I XXX 09A4267 Male condom I XXX 09A4268 Female condom I XXX 09A4269 Spermicide I XXX 09A4270 Disposable endoscope sheath B XXX 09A4280 Brst prsths adhsv attchmnt X XXX 09A4281 Replacement breastpump tube X XXX 09A4282 Replacement breastpump adpt X XXX 09

A4283 Replacement breastpump cap X XXX 09A4284 Replcmnt breast pump shield X XXX 09A4285 Replcmnt breast pump bottle X XXX 09A4286 Replcmnt breastpump lok ring X XXX 09A4290 Sacral nerve stim test lead X XXX 09A4300 Cath impl vasc access portal B XXX 09A4301 Implantable access syst perc P XXX 09A4305 Drug delivery system >=50 ml P XXX 09A4306 Drug delivery system <=50 ml P XXX 09A4310 Insert tray w/o bag/cath P XXX 09A4311 Catheter w/o bag 2-way latex P XXX 09A4312 Cath w/o bag 2-way silicone P XXX 09A4313 Catheter w/bag 3-way P XXX 09A4314 Cath w/drainage 2-way latex P XXX 09A4315 Cath w/drainage 2-way silcne P XXX 09A4316 Cath w/drainage 3-way P XXX 09A4320 Irrigation tray P XXX 09A4321 Cath therapeutic irrig agent X XXX 09A4322 Irrigation syringe P XXX 09A4326 Male external catheter P XXX 09A4327 Fem urinary collect dev cup P XXX 09A4328 Fem urinary collect pouch P XXX 09A4330 Stool collection pouch P XXX 09A4331 Extension drainage tubing X XXX 09A4332 Lube sterile packet X XXX 09A4333 Urinary cath anchor device X XXX 09A4334 Urinary cath leg strap X XXX 09A4335 Incontinence supply P XXX 09A4336 Urethral insert X XXX 09A4338 Indwelling catheter latex P XXX 09A4340 Indwelling catheter special P XXX 09A4344 Cath indw foley 2 way silicn P XXX 09A4346 Cath indw foley 3 way P XXX 09A4349 Disposable male external cat X XXX 09A4351 Straight tip urine catheter P XXX 09A4352 Coude tip urinary catheter P XXX 09A4353 Intermittent urinary cath X XXX 09A4354 Cath insertion tray w/bag P XXX 09A4355 Bladder irrigation tubing P XXX 09A4356 Ext ureth clmp or compr dvc P XXX 09A4357 Bedside drainage bag P XXX 09A4358 Urinary leg or abdomen bag P XXX 09A4360 Disposable ext urethral dev X XXX 09A4361 Ostomy face plate P XXX 09A4362 Solid skin barrier P XXX 09A4363 Ostomy clamp, replacement X XXX 09A4364 Adhesive, liquid or equal P XXX 09A4366 Ostomy vent X XXX 09A4367 Ostomy belt P XXX 09A4368 Ostomy filter X XXX 09

A4369 Skin barrier liquid per oz X XXX 09A4371 Skin barrier powder per oz X XXX 09A4372 Skin barrier solid 4x4 equiv X XXX 09A4373 Skin barrier with flange X XXX 09A4375 Drainable plastic pch w fcpl X XXX 09A4376 Drainable rubber pch w fcplt X XXX 09A4377 Drainable plstic pch w/o fp X XXX 09A4378 Drainable rubber pch w/o fp X XXX 09A4379 Urinary plastic pouch w fcpl X XXX 09A4380 Urinary rubber pouch w fcplt X XXX 09A4381 Urinary plastic pouch w/o fp X XXX 09A4382 Urinary hvy plstc pch w/o fp X XXX 09A4383 Urinary rubber pouch w/o fp X XXX 09A4384 Ostomy faceplt/silicone ring X XXX 09A4385 Ost skn barrier sld ext wear X XXX 09A4387 Ost clsd pouch w att st barr X XXX 09A4388 Drainable pch w ex wear barr X XXX 09A4389 Drainable pch w st wear barr X XXX 09A4390 Drainable pch ex wear convex X XXX 09A4391 Urinary pouch w ex wear barr X XXX 09A4392 Urinary pouch w st wear barr X XXX 09A4393 Urine pch w ex wear bar conv X XXX 09A4394 Ostomy pouch liq deodorant X XXX 09A4395 Ostomy pouch solid deodorant X XXX 09A4396 Peristomal hernia supprt blt X XXX 09A4397 Irrigation supply sleeve P XXX 09A4398 Ostomy irrigation bag P XXX 09A4399 Ostomy irrig cone/cath w brs P XXX 09A4400 Ostomy irrigation set P XXX 09A4402 Lubricant per ounce P XXX 09A4404 Ostomy ring each P XXX 09A4405 Nonpectin based ostomy paste X XXX 09A4406 Pectin based ostomy paste X XXX 09A4407 Ext wear ost skn barr <=4sq" X XXX 09A4408 Ext wear ost skn barr >4sq" X XXX 09A4409 Ost skn barr convex <=4 sq i X XXX 09A4410 Ost skn barr extnd >4 sq X XXX 09A4411 Ost skn barr extnd =4sq X XXX 09A4412 Ost pouch drain high output X XXX 09A4413 2 pc drainable ost pouch X XXX 09A4414 Ost sknbar w/o conv<=4 sq in X XXX 09A4415 Ost skn barr w/o conv >4 sqi X XXX 09A4416 Ost pch clsd w barrier/filtr X XXX 09A4417 Ost pch w bar/bltinconv/fltr X XXX 09A4418 Ost pch clsd w/o bar w filtr X XXX 09A4419 Ost pch for bar w flange/flt X XXX 09A4420 Ost pch clsd for bar w lk fl X XXX 09A4421 Ostomy supply misc X XXX 09A4422 Ost pouch absorbent material X XXX 09A4423 Ost pch for bar w lk fl/fltr X XXX 09

A4424 Ost pch drain w bar & filter X XXX 09A4425 Ost pch drain for barrier fl X XXX 09A4426 Ost pch drain 2 piece system X XXX 09A4427 Ost pch drain/barr lk flng/f X XXX 09A4428 Urine ost pouch w faucet/tap X XXX 09A4429 Urine ost pouch w bltinconv X XXX 09A4430 Ost urine pch w b/bltin conv X XXX 09A4431 Ost pch urine w barrier/tapv X XXX 09A4432 Os pch urine w bar/fange/tap X XXX 09A4433 Urine ost pch bar w lock fln X XXX 09A4434 Ost pch urine w lock flng/ft X XXX 09A4435 1pc ost pch drain hgh output X XXX 09A4450 Non-waterproof tape X XXX 09A4452 Waterproof tape X XXX 09A4455 Adhesive remover per ounce P XXX 09A4456 Adhesive remover, wipes X XXX 09A4458 Reusable enema bag X XXX 09A4459 Manual pump enema, reusable X XXX 09A4461 Surgicl dress hold non-reuse X XXX 09A4463 Surgical dress holder reuse X XXX 09A4465 Non-elastic extremity binder P XXX 09A4466 Elastic garment/covering I XXX 09A4470 Gravlee jet washer P XXX 09A4480 Vabra aspirator P XXX 09A4481 Tracheostoma filter X XXX 09A4483 Moisture exchanger X XXX 09A4490 Above knee surgical stocking N XXX 09A4495 Thigh length surg stocking N XXX 09A4500 Below knee surgical stocking N XXX 09A4510 Full length surg stocking N XXX 09A4520 Incontinence garment anytype N XXX 09A4550 Surgical trays B XXX 09A4554 Disposable underpads N XXX 09A4555 Ca tx e-stim electr/transduc I XXX 09A4556 Electrodes, pair P XXX 09A4557 Lead wires, pair P XXX 09A4558 Conductive gel or paste P XXX 09A4559 Coupling gel or paste X XXX 09A4561 Pessary rubber, any type X XXX 09A4562 Pessary, non rubber,any type X XXX 09A4565 Slings X XXX 09A4566 Should sling/vest/abrestrain I XXX 09A4570 Splint I XXX 09A4575 Hyperbaric o2 chamber disps N XXX 09A4580 Cast supplies (plaster) I XXX 09A4590 Special casting material I XXX 09A4595 Tens suppl 2 lead per month X XXX 09A4600 Sleeve, inter limb comp dev X XXX 09A4601 Lith ion non prosth recharge X XXX 09A4602 Replace lithium battery 1.5v X XXX 09

A4604 Tubing with heating element X XXX 09A4605 Trach suction cath close sys X XXX 09A4606 Oxygen probe used w oximeter X XXX 09A4608 Transtracheal oxygen cath X XXX 09A4611 Heavy duty battery X XXX 09A4612 Battery cables X XXX 09A4613 Battery charger X XXX 09A4614 Hand-held pefr meter X XXX 09A4615 Cannula nasal X XXX 09A4616 Tubing (oxygen) per foot X XXX 09A4617 Mouth piece X XXX 09A4618 Breathing circuits X XXX 09A4619 Face tent X XXX 09A4620 Variable concentration mask X XXX 09A4623 Tracheostomy inner cannula X XXX 09A4624 Tracheal suction tube X XXX 09A4625 Trach care kit for new trach X XXX 09A4626 Tracheostomy cleaning brush X XXX 09A4627 Spacer bag/reservoir N XXX 09A4628 Oropharyngeal suction cath X XXX 09A4629 Tracheostomy care kit X XXX 09A4630 Repl bat t.e.n.s. own by pt X XXX 09A4633 Uvl replacement bulb X XXX 09A4634 Replacement bulb th lightbox X XXX 09A4635 Underarm crutch pad X XXX 09A4636 Handgrip for cane etc X XXX 09A4637 Repl tip cane/crutch/walker X XXX 09A4638 Repl batt pulse gen sys X XXX 09A4639 Infrared ht sys replcmnt pad X XXX 09A4640 Alternating pressure pad X XXX 09A4641 Radiopharm dx agent noc C XXX 09A4642 In111 satumomab C XXX 09A4648 Implantable tissue marker X XXX 09A4649 Surgical supplies P XXX 09A4650 Implant radiation dosimeter X XXX 09A4651 Calibrated microcap tube X XXX 09A4652 Microcapillary tube sealant X XXX 09A4653 Pd catheter anchor belt X XXX 09A4657 Syringe w/wo needle X XXX 09A4660 Sphyg/bp app w cuff and stet X XXX 09A4663 Dialysis blood pressure cuff X XXX 09A4670 Automatic bp monitor, dial N XXX 09A4671 Disposable cycler set X XXX 09A4672 Drainage ext line, dialysis X XXX 09A4673 Ext line w easy lock connect X XXX 09A4674 Chem/antisept solution, 8oz X XXX 09A4680 Activated carbon filter, ea X XXX 09A4690 Dialyzer, each X XXX 09A4706 Bicarbonate conc sol per gal X XXX 09A4707 Bicarbonate conc pow per pac X XXX 09

A4708 Acetate conc sol per gallon X XXX 09A4709 Acid conc sol per gallon X XXX 09A4714 Treated water per gallon X XXX 09A4719 "y set" tubing X XXX 09A4720 Dialysat sol fld vol > 249cc X XXX 09A4721 Dialysat sol fld vol > 999cc X XXX 09A4722 Dialys sol fld vol > 1999cc X XXX 09A4723 Dialys sol fld vol > 2999cc X XXX 09A4724 Dialys sol fld vol > 3999cc X XXX 09A4725 Dialys sol fld vol > 4999cc X XXX 09A4726 Dialys sol fld vol > 5999cc X XXX 09A4728 Dialysate solution, non-dex X XXX 09A4730 Fistula cannulation set, ea X XXX 09A4736 Topical anesthetic, per gram X XXX 09A4737 Inj anesthetic per 10 ml X XXX 09A4740 Shunt accessory X XXX 09A4750 Art or venous blood tubing X XXX 09A4755 Comb art/venous blood tubing X XXX 09A4760 Dialysate sol test kit, each X XXX 09A4765 Dialysate conc pow per pack X XXX 09A4766 Dialysate conc sol add 10 ml X XXX 09A4770 Blood collection tube/vacuum X XXX 09A4771 Serum clotting time tube X XXX 09A4772 Blood glucose test strips X XXX 09A4773 Occult blood test strips X XXX 09A4774 Ammonia test strips X XXX 09A4802 Protamine sulfate per 50 mg X XXX 09A4860 Disposable catheter tips X XXX 09A4870 Plumb/elec wk hm hemo equip X XXX 09A4890 Repair/maint cont hemo equip R XXX 09A4911 Drain bag/bottle X XXX 09A4913 Misc dialysis supplies noc X XXX 09A4918 Venous pressure clamp X XXX 09A4927 Non-sterile gloves X XXX 09A4928 Surgical mask X XXX 09A4929 Tourniquet for dialysis, ea X XXX 09A4930 Sterile, gloves per pair X XXX 09A4931 Reusable oral thermometer X XXX 09A4932 Reusable rectal thermometer X XXX 09A5051 Pouch clsd w barr attached P XXX 09A5052 Clsd ostomy pouch w/o barr P XXX 09A5053 Clsd ostomy pouch faceplate P XXX 09A5054 Clsd ostomy pouch w/flange P XXX 09A5055 Stoma cap P XXX 09A5056 1 pc ost pouch w filter X XXX 09A5057 1 pc ost pou w built-in conv X XXX 09A5061 Pouch drainable w barrier at P XXX 09A5062 Drnble ostomy pouch w/o barr P XXX 09A5063 Drain ostomy pouch w/flange P XXX 09A5071 Urinary pouch w/barrier P XXX 09

A5072 Urinary pouch w/o barrier P XXX 09A5073 Urinary pouch on barr w/flng P XXX 09A5081 Stoma plug or seal, any type P XXX 09A5082 Continent stoma catheter P XXX 09A5083 Stoma absorptive cover X XXX 09A5093 Ostomy accessory convex inse P XXX 09A5102 Bedside drain btl w/wo tube P XXX 09A5105 Urinary suspensory P XXX 09A5112 Urinary leg bag P XXX 09A5113 Latex leg strap P XXX 09A5114 Foam/fabric leg strap P XXX 09A5120 Skin barrier, wipe or swab X XXX 09A5121 Solid skin barrier 6x6 P XXX 09A5122 Solid skin barrier 8x8 P XXX 09A5126 Disk/foam pad +or- adhesive P XXX 09A5131 Appliance cleaner P XXX 09A5200 Percutaneous catheter anchor X XXX 09A5500 Diab shoe for density insert X XXX 09A5501 Diabetic custom molded shoe X XXX 09A5503 Diabetic shoe w/roller/rockr X XXX 09A5504 Diabetic shoe with wedge X XXX 09A5505 Diab shoe w/metatarsal bar X XXX 09A5506 Diabetic shoe w/off set heel X XXX 09A5507 Modification diabetic shoe X XXX 09A5508 Diabetic deluxe shoe X XXX 09A5510 Compression form shoe insert X XXX 09A5512 Multi den insert direct form X XXX 09A5513 Multi den insert custom mold X XXX 09A6000 Wound warming wound cover N XXX 09A6010 Collagen based wound filler X XXX 09A6011 Collagen gel/paste wound fil X XXX 09A6021 Collagen dressing <=16 sq in X XXX 09A6022 Collagen drsg>16<=48 sq in X XXX 09A6023 Collagen dressing >48 sq in X XXX 09A6024 Collagen dsg wound filler X XXX 09A6025 Silicone gel sheet, each X XXX 09A6154 Wound pouch each P XXX 09A6196 Alginate dressing <=16 sq in P XXX 09A6197 Alginate drsg >16 <=48 sq in P XXX 09A6198 Alginate dressing > 48 sq in P XXX 09A6199 Alginate drsg wound filler P XXX 09A6203 Composite drsg <= 16 sq in P XXX 09A6204 Composite drsg >16<=48 sq in P XXX 09A6205 Composite drsg > 48 sq in P XXX 09A6206 Contact layer <= 16 sq in P XXX 09A6207 Contact layer >16<= 48 sq in P XXX 09A6208 Contact layer > 48 sq in P XXX 09A6209 Foam drsg <=16 sq in w/o bdr P XXX 09A6210 Foam drg >16<=48 sq in w/o b P XXX 09A6211 Foam drg > 48 sq in w/o brdr P XXX 09

A6212 Foam drg <=16 sq in w/border P XXX 09A6213 Foam drg >16<=48 sq in w/bdr P XXX 09A6214 Foam drg > 48 sq in w/border P XXX 09A6215 Foam dressing wound filler P XXX 09A6216 Non-sterile gauze<=16 sq in P XXX 09A6217 Non-sterile gauze>16<=48 sq P XXX 09A6218 Non-sterile gauze > 48 sq in P XXX 09A6219 Gauze <= 16 sq in w/border P XXX 09A6220 Gauze >16 <=48 sq in w/bordr P XXX 09A6221 Gauze > 48 sq in w/border P XXX 09A6222 Gauze <=16 in no w/sal w/o b P XXX 09A6223 Gauze >16<=48 no w/sal w/o b P XXX 09A6224 Gauze > 48 in no w/sal w/o b P XXX 09A6228 Gauze <= 16 sq in water/sal P XXX 09A6229 Gauze >16<=48 sq in watr/sal P XXX 09A6230 Gauze > 48 sq in water/salne P XXX 09A6231 Hydrogel dsg<=16 sq in X XXX 09A6232 Hydrogel dsg>16<=48 sq in X XXX 09A6233 Hydrogel dressing >48 sq in X XXX 09A6234 Hydrocolld drg <=16 w/o bdr P XXX 09A6235 Hydrocolld drg >16<=48 w/o b P XXX 09A6236 Hydrocolld drg > 48 in w/o b P XXX 09A6237 Hydrocolld drg <=16 in w/bdr P XXX 09A6238 Hydrocolld drg >16<=48 w/bdr P XXX 09A6239 Hydrocolld drg > 48 in w/bdr P XXX 09A6240 Hydrocolld drg filler paste P XXX 09A6241 Hydrocolloid drg filler dry P XXX 09A6242 Hydrogel drg <=16 in w/o bdr P XXX 09A6243 Hydrogel drg >16<=48 w/o bdr P XXX 09A6244 Hydrogel drg >48 in w/o bdr P XXX 09A6245 Hydrogel drg <= 16 in w/bdr P XXX 09A6246 Hydrogel drg >16<=48 in w/b P XXX 09A6247 Hydrogel drg > 48 sq in w/b P XXX 09A6248 Hydrogel drsg gel filler P XXX 09A6250 Skin seal protect moisturizr P XXX 09A6251 Absorpt drg <=16 sq in w/o b P XXX 09A6252 Absorpt drg >16 <=48 w/o bdr P XXX 09A6253 Absorpt drg > 48 sq in w/o b P XXX 09A6254 Absorpt drg <=16 sq in w/bdr P XXX 09A6255 Absorpt drg >16<=48 in w/bdr P XXX 09A6256 Absorpt drg > 48 sq in w/bdr P XXX 09A6257 Transparent film <= 16 sq in P XXX 09A6258 Transparent film >16<=48 in P XXX 09A6259 Transparent film > 48 sq in P XXX 09A6260 Wound cleanser any type/size P XXX 09A6261 Wound filler gel/paste /oz P XXX 09A6262 Wound filler dry form / gram P XXX 09A6266 Impreg gauze no h20/sal/yard P XXX 09A6402 Sterile gauze <= 16 sq in P XXX 09A6403 Sterile gauze>16 <= 48 sq in P XXX 09

A6404 Sterile gauze > 48 sq in P XXX 09A6407 Packing strips, non-impreg X XXX 09A6410 Sterile eye pad X XXX 09A6411 Non-sterile eye pad X XXX 09A6412 Occlusive eye patch X XXX 09A6413 Adhesive bandage, first-aid N XXX 09A6441 Pad band w>=3" <5"/yd X XXX 09A6442 Conform band n/s w<3"/yd X XXX 09A6443 Conform band n/s w>=3"<5"/yd X XXX 09A6444 Conform band n/s w>=5"/yd X XXX 09A6445 Conform band s w <3"/yd X XXX 09A6446 Conform band s w>=3" <5"/yd X XXX 09A6447 Conform band s w >=5"/yd X XXX 09A6448 Lt compres band <3"/yd X XXX 09A6449 Lt compres band >=3" <5"/yd X XXX 09A6450 Lt compres band >=5"/yd X XXX 09A6451 Mod compres band w>=3"<5"/yd X XXX 09A6452 High compres band w>=3"<5"yd X XXX 09A6453 Self-adher band w <3"/yd X XXX 09A6454 Self-adher band w>=3" <5"/yd X XXX 09A6455 Self-adher band >=5"/yd X XXX 09A6456 Zinc paste band w >=3"<5"/yd X XXX 09A6457 Tubular dressing X XXX 09A6501 Compres burngarment bodysuit X XXX 09A6502 Compres burngarment chinstrp X XXX 09A6503 Compres burngarment facehood X XXX 09A6504 Cmprsburngarment glove-wrist X XXX 09A6505 Cmprsburngarment glove-elbow X XXX 09A6506 Cmprsburngrmnt glove-axilla X XXX 09A6507 Cmprs burngarment foot-knee X XXX 09A6508 Cmprs burngarment foot-thigh X XXX 09A6509 Compres burn garment jacket X XXX 09A6510 Compres burn garment leotard X XXX 09A6511 Compres burn garment panty X XXX 09A6512 Compres burn garment, noc X XXX 09A6513 Compress burn mask face/neck X XXX 09A6530 Compression stocking bk18-30 N XXX 09A6531 Compression stocking bk30-40 X XXX 09A6532 Compression stocking bk40-50 X XXX 09A6533 Gc stocking thighlngth 18-30 N XXX 09A6534 Gc stocking thighlngth 30-40 N XXX 09A6535 Gc stocking thighlngth 40-50 N XXX 09A6536 Gc stocking full lngth 18-30 N XXX 09A6537 Gc stocking full lngth 30-40 N XXX 09A6538 Gc stocking full lngth 40-50 N XXX 09A6539 Gc stocking waistlngth 18-30 N XXX 09A6540 Gc stocking waistlngth 30-40 N XXX 09A6541 Gc stocking waistlngth 40-50 N XXX 09A6544 Gc stocking garter belt N XXX 09A6545 Grad comp non-elastic bk X XXX 09

A6549 G compression stocking N XXX 09A6550 Neg pres wound ther drsg set X XXX 09A7000 Disposable canister for pump X XXX 09A7001 Nondisposable pump canister X XXX 09A7002 Tubing used w suction pump X XXX 09A7003 Nebulizer administration set X XXX 09A7004 Disposable nebulizer sml vol X XXX 09A7005 Nondisposable nebulizer set X XXX 09A7006 Filtered nebulizer admin set X XXX 09A7007 Lg vol nebulizer disposable X XXX 09A7008 Disposable nebulizer prefill X XXX 09A7009 Nebulizer reservoir bottle X XXX 09A7010 Disposable corrugated tubing X XXX 09A7011 Nondispos corrugated tubing X XXX 09A7012 Nebulizer water collec devic X XXX 09A7013 Disposable compressor filter X XXX 09A7014 Compressor nondispos filter X XXX 09A7015 Aerosol mask used w nebulize X XXX 09A7016 Nebulizer dome & mouthpiece X XXX 09A7017 Nebulizer not used w oxygen X XXX 09A7018 Water distilled w/nebulizer X XXX 09A7020 Interface, cough stim device X XXX 09A7025 Replace chest compress vest X XXX 09A7026 Replace chst cmprss sys hose X XXX 09A7027 Combination oral/nasal mask X XXX 09A7028 Repl oral cushion combo mask X XXX 09A7029 Repl nasal pillow comb mask X XXX 09A7030 Cpap full face mask X XXX 09A7031 Replacement facemask interfa X XXX 09A7032 Replacement nasal cushion X XXX 09A7033 Replacement nasal pillows X XXX 09A7034 Nasal application device X XXX 09A7035 Pos airway press headgear X XXX 09A7036 Pos airway press chinstrap X XXX 09A7037 Pos airway pressure tubing X XXX 09A7038 Pos airway pressure filter X XXX 09A7039 Filter, non disposable w pap X XXX 09A7040 One way chest drain valve X XXX 09A7041 Water seal drain container X XXX 09A7044 Pap oral interface X XXX 09A7045 Repl exhalation port for pap X XXX 09A7046 Repl water chamber, pap dev X XXX 09A7047 Resp suction oral interface X XXX 09A7048 Vacuum drain bottle/tube kit X XXX 09A7501 Tracheostoma valve w diaphra X XXX 09A7502 Replacement diaphragm/fplate X XXX 09A7503 Hmes filter holder or cap X XXX 09A7504 Tracheostoma hmes filter X XXX 09A7505 Hmes or trach valve housing X XXX 09A7506 Hmes/trachvalve adhesivedisk X XXX 09

A7507 Integrated filter & holder X XXX 09A7508 Housing & integrated adhesiv X XXX 09A7509 Heat & moisture exchange sys X XXX 09A7520 Trach/laryn tube non-cuffed X XXX 09A7521 Trach/laryn tube cuffed X XXX 09A7522 Trach/laryn tube stainless X XXX 09A7523 Tracheostomy shower protect X XXX 09A7524 Tracheostoma stent/stud/bttn X XXX 09A7525 Tracheostomy mask X XXX 09A7526 Tracheostomy tube collar X XXX 09A7527 Trach/laryn tube plug/stop X XXX 09A8000 Soft protect helmet prefab X XXX 09A8001 Hard protect helmet prefab X XXX 09A8002 Soft protect helmet custom X XXX 09A8003 Hard protect helmet custom X XXX 09A8004 Repl soft interface, helmet X XXX 09A9150 Misc/exper non-prescript dru E XXX 09A9152 Single vitamin nos I XXX 09A9153 Multi-vitamin nos I XXX 09A9155 Artificial saliva X XXX 09A9180 Lice treatment, topical I XXX 09A9270 Non-covered item or service N XXX 09A9272 Disp wound suct, drsg/access I XXX 09A9273 Hot/cold h2obot/cap/col/wrap N XXX 09A9274 Ext amb insulin delivery sys I XXX 09A9275 Disp home glucose monitor N XXX 09A9276 Disposable sensor, cgm sys N XXX 09A9277 External transmitter, cgm N XXX 09A9278 External receiver, cgm sys N XXX 09A9279 Monitoring feature/devicenoc I XXX 09A9280 Alert device, noc N XXX 09A9281 Reaching/grabbing device N XXX 09A9282 Wig any type N XXX 09A9283 Foot press off load supp dev N XXX 09A9284 Non-electronic spirometer X XXX 09A9300 Exercise equipment N XXX 09A9500 Tc99m sestamibi C XXX 09A9501 Technetium tc-99m teboroxime C XXX 09A9502 Tc99m tetrofosmin C XXX 09A9503 Tc99m medronate C XXX 09A9504 Tc99m apcitide C XXX 09A9505 Tl201 thallium C XXX 09A9507 In111 capromab C XXX 09A9508 I131 iodobenguate, dx C XXX 09A9509 Iodine i-123 sod iodide mil C XXX 09A9510 Tc99m disofenin C XXX 09A9512 Tc99m pertechnetate C XXX 09A9516 Iodine i-123 sod iodide mic C XXX 09A9517 I131 iodide cap, rx C XXX 09A9520 Tc99 tilmanocept diag 0.5mci X XXX 09

A9521 Tc99m exametazime C XXX 09A9524 I131 serum albumin, dx C XXX 09A9526 Nitrogen n-13 ammonia C XXX 09A9527 Iodine i-125 sodium iodide C XXX 09A9528 Iodine i-131 iodide cap, dx C XXX 09A9529 I131 iodide sol, dx C XXX 09A9530 I131 iodide sol, rx C XXX 09A9531 I131 max 100uci C XXX 09A9532 I125 serum albumin, dx C XXX 09A9536 Tc99m depreotide C XXX 09A9537 Tc99m mebrofenin C XXX 09A9538 Tc99m pyrophosphate C XXX 09A9539 Tc99m pentetate C XXX 09A9540 Tc99m maa C XXX 09A9541 Tc99m sulfur colloid C XXX 09A9542 In111 ibritumomab, dx C XXX 09A9543 Y90 ibritumomab, rx C XXX 09A9544 I131 tositumomab, dx C XXX 09A9545 I131 tositumomab, rx C XXX 09A9546 Co57/58 C XXX 09A9547 In111 oxyquinoline C XXX 09A9548 In111 pentetate C XXX 09A9550 Tc99m gluceptate C XXX 09A9551 Tc99m succimer C XXX 09A9552 F18 fdg C XXX 09A9553 Cr51 chromate C XXX 09A9554 I125 iothalamate, dx C XXX 09A9555 Rb82 rubidium C XXX 09A9556 Ga67 gallium C XXX 09A9557 Tc99m bicisate C XXX 09A9558 Xe133 xenon 10mci C XXX 09A9559 Co57 cyano C XXX 09A9560 Tc99m labeled rbc C XXX 09A9561 Tc99m oxidronate C XXX 09A9562 Tc99m mertiatide C XXX 09A9563 P32 na phosphate C XXX 09A9564 P32 chromic phosphate C XXX 09A9566 Tc99m fanolesomab C XXX 09A9567 Technetium tc-99m aerosol C XXX 09A9568 Technetium tc99m arcitumomab C XXX 09A9569 Technetium tc-99m auto wbc C XXX 09A9570 Indium in-111 auto wbc C XXX 09A9571 Indium in-111 auto platelet C XXX 09A9572 Indium in-111 pentetreotide C XXX 09A9575 Inj gadoterate meglumi 0.1ml X XXX 09A9576 Inj prohance multipack X XXX 09A9577 Inj multihance X XXX 09A9578 Inj multihance multipack X XXX 09A9579 Gad-base mr contrast nos,1ml X XXX 09A9580 Sodium fluoride f-18 C XXX 09

A9581 Gadoxetate disodium inj X XXX 09A9582 Iodine i-123 iobenguane X XXX 09A9583 Gadofosveset trisodium inj X XXX 09A9584 Iodine i-123 ioflupane X XXX 09A9585 Gadobutrol injection X XXX 09A9586 Florbetapir f18 C YYY 09A9599 Radiopha dx beta amyloid pet C XXX 09A9600 Sr89 strontium C XXX 09A9604 Sm 153 lexidronam X XXX 09A9606 Radium ra223 dichloride ther X XXX 09A9698 Non-rad contrast materialnoc X XXX 09A9699 Radiopharm rx agent noc C XXX 09A9700 Echocardiography contrast E XXX 09A9900 Supply/accessory/service X XXX 09A9901 Delivery/set up/dispensing X XXX 09A9999 Dme supply or accessory, nos X XXX 09D0120 Periodic oral evaluation N XXX 09D0140 Limit oral eval problm focus N XXX 09D0145 Oral evaluation, pt < 3yrs N XXX 09D0150 Comprehensve oral evaluation R YYY 09D0160 Extensv oral eval prob focus N XXX 09D0170 Re-eval,est pt,problem focus N XXX 09D0171 Re-eval post-op visit N XXX 09D0180 Comp periodontal evaluation N XXX 09D0190 Screening of a patient N XXX 09D0191 Assessment of a patient N XXX 09D0210 Intraor complete film series I XXX 09D0220 Intraoral periapical first I XXX 09D0230 Intraoral periapical ea add I XXX 09D0240 Intraoral occlusal film R YYY 09D0250 Extraoral first film R YYY 09D0260 Extraoral ea additional film R YYY 09D0270 Dental bitewing single image R YYY 09D0272 Dental bitewings two images R YYY 09D0273 Bitewings - three images N XXX 09D0274 Bitewings four images R YYY 09D0277 Vert bitewings 7 to 8 images R XXX 09D0290 Skull/facial bone image I XXX 09D0310 Dental saliography I XXX 09D0320 Dental tmj arthrogram incl i I XXX 09D0321 Other tmj images by report I XXX 09D0322 Dental tomographic survey I XXX 09D0330 Panoramic image I XXX 09D0340 Cephalometric image I XXX 09D0350 Oral/facial photo images I XXX 09D0351 3d photographic image I XXX 09D0364 Cone beam ct capt & interp N XXX 09D0365 Cone beam ct interprete man N XXX 09D0366 Cone beam ct interprete max N XXX 09D0367 Cone beam ct interp both jaw N XXX 09

D0368 Cone beam ct interprete tmj N XXX 09D0369 Max mri capture & interprete N XXX 09D0370 Max ultrasound capt & interp N XXX 09D0371 Sialoendoscopy capt & interp N XXX 09D0380 Cone beam ct capture limited N XXX 09D0381 Cone beam ct capt mandible N XXX 09D0382 Cone beam ct capt maxilla N XXX 09D0383 Cone beam ct both jaws N XXX 09D0384 Cone beam ct capture tmj N XXX 09D0385 Max mri image capture N XXX 09D0386 Max ultrasound image capture N XXX 09D0391 Imterprete diagnostic image N XXX 09D0393 Trtmnt simulation 3d image N XXX 09D0394 Digital sub 2 or more images N XXX 09D0395 Fusion 2 or more 3d images N XXX 09D0415 Collection of microorganisms N XXX 09D0416 Viral culture R XXX 09D0417 Collect & prep saliva sample N XXX 09D0418 Analysis of saliva sample N XXX 09D0421 Gen tst suscept oral disease R XXX 09D0425 Caries susceptibility test N XXX 09D0431 Diag tst detect mucos abnorm R XXX 09D0460 Pulp vitality test R YYY 09D0470 Diagnostic casts N XXX 09D0472 Gross exam, prep & report R XXX 09D0473 Micro exam, prep & report R XXX 09D0474 Micro w exam of surg margins R XXX 09D0475 Decalcification procedure R XXX 09D0476 Spec stains for microorganis R XXX 09D0477 Spec stains not for microorg R XXX 09D0478 Immunohistochemical stains R XXX 09D0479 Tissue in-situ hybridization R XXX 09D0480 Cytopath smear prep & report R XXX 09D0481 Electron microscopy R XXX 09D0482 Direct immunofluorescence R XXX 09D0483 Indirect immunofluorescence R XXX 09D0484 Consult slides prep elsewher R XXX 09D0485 Consult inc prep of slides R XXX 09D0486 Access of transep cytol samp N XXX 09D0502 Other oral pathology procedu R YYY 09D0601 Caries risk assess low risk R XXX 09D0602 Caries risk assess mod risk R XXX 09D0603 Caries risk assess high risk R XXX 09D0999 Unspecified diagnostic proce R YYY 09D1110 Dental prophylaxis adult N XXX 09D1120 Dental prophylaxis child N XXX 09D1206 Topical fluoride varnish N XXX 09D1208 Topical app fluorid ex vrnsh N XXX 09D1310 Nutri counsel-control caries N XXX 09D1320 Tobacco counseling N XXX 09

D1330 Oral hygiene instruction N XXX 09D1351 Dental sealant per tooth N XXX 09D1352 Prev resin rest, perm tooth I XXX 09D1353 Sealant repair per tooth N XXX 09D1510 Space maintainer fxd unilat R YYY 09D1515 Fixed bilat space maintainer R YYY 09D1520 Remove unilat space maintain R YYY 09D1525 Remove bilat space maintain R YYY 09D1550 Recement space maintainer R YYY 09D1555 Remove fix space maintainer N XXX 09D1999 Unspecified preventive proc R XXX 09D2140 Amalgam one surface permanen N XXX 09D2150 Amalgam two surfaces permane N XXX 09D2160 Amalgam three surfaces perma N XXX 09D2161 Amalgam 4 or > surfaces perm N XXX 09D2330 Resin one surface-anterior N XXX 09D2331 Resin two surfaces-anterior N XXX 09D2332 Resin three surfaces-anterio N XXX 09D2335 Resin 4/> surf or w incis an N XXX 09D2390 Ant resin-based cmpst crown N XXX 09D2391 Post 1 srfc resinbased cmpst N XXX 09D2392 Post 2 srfc resinbased cmpst N XXX 09D2393 Post 3 srfc resinbased cmpst N XXX 09D2394 Post >=4srfc resinbase cmpst N XXX 09D2410 Dental gold foil one surface N XXX 09D2420 Dental gold foil two surface N XXX 09D2430 Dental gold foil three surfa N XXX 09D2510 Dental inlay metalic 1 surf N XXX 09D2520 Dental inlay metallic 2 surf N XXX 09D2530 Dental inlay metl 3/more sur N XXX 09D2542 Dental onlay metallic 2 surf N XXX 09D2543 Dental onlay metallic 3 surf N XXX 09D2544 Dental onlay metl 4/more sur N XXX 09D2610 Inlay porcelain/ceramic 1 su N XXX 09D2620 Inlay porcelain/ceramic 2 su N XXX 09D2630 Dental onlay porc 3/more sur N XXX 09D2642 Dental onlay porcelin 2 surf N XXX 09D2643 Dental onlay porcelin 3 surf N XXX 09D2644 Dental onlay porc 4/more sur N XXX 09D2650 Inlay composite/resin one su N XXX 09D2651 Inlay composite/resin two su N XXX 09D2652 Dental inlay resin 3/mre sur N XXX 09D2662 Dental onlay resin 2 surface N XXX 09D2663 Dental onlay resin 3 surface N XXX 09D2664 Dental onlay resin 4/mre sur N XXX 09D2710 Crown resin-based indirect N XXX 09D2712 Crown 3/4 resin-based compos N XXX 09D2720 Crown resin w/ high noble me N XXX 09D2721 Crown resin w/ base metal N XXX 09D2722 Crown resin w/ noble metal N XXX 09

D2740 Crown porcelain/ceramic subs N XXX 09D2750 Crown porcelain w/ h noble m N XXX 09D2751 Crown porcelain fused base m N XXX 09D2752 Crown porcelain w/ noble met N XXX 09D2780 Crown 3/4 cast hi noble met N XXX 09D2781 Crown 3/4 cast base metal N XXX 09D2782 Crown 3/4 cast noble metal N XXX 09D2783 Crown 3/4 porcelain/ceramic N XXX 09D2790 Crown full cast high noble m N XXX 09D2791 Crown full cast base metal N XXX 09D2792 Crown full cast noble metal N XXX 09D2794 Crown-titanium N XXX 09D2799 Provisional crown N XXX 09D2910 Recement inlay onlay or part N XXX 09D2915 Recement cast or prefab post N XXX 09D2920 Re-cement or re-bond crown N XXX 09D2921 Reattach tooth fragment N XXX 09D2929 Prefab porc/ceram crown pri N XXX 09D2930 Prefab stnlss steel crwn pri N XXX 09D2931 Prefab stnlss steel crown pe N XXX 09D2932 Prefabricated resin crown N XXX 09D2933 Prefab stainless steel crown N XXX 09D2934 Prefab steel crown primary N XXX 09D2940 Protective restoration N XXX 09D2941 Int therapeutic restoration N XXX 09D2949 Restorative foundation N XXX 09D2950 Core build-up incl any pins N XXX 09D2951 Tooth pin retention N XXX 09D2952 Post and core cast + crown N XXX 09D2953 Each addtnl cast post N XXX 09D2954 Prefab post/core + crown N XXX 09D2955 Post removal N XXX 09D2957 Each addtnl prefab post N XXX 09D2960 Laminate labial veneer N XXX 09D2961 Lab labial veneer resin N XXX 09D2962 Lab labial veneer porcelain N XXX 09D2970 Temp crown (fractured tooth) R XXX 09D2971 Add proc construct new crown N XXX 09D2975 Coping N XXX 09D2980 Crown repair N XXX 09D2981 Inlay repair N XXX 09D2982 Onlay repair N XXX 09D2983 Veneer repair N XXX 09D2990 Resin infiltration of lesion N XXX 09D2999 Dental unspec restorative pr R YYY 09D3110 Pulp cap direct N XXX 09D3120 Pulp cap indirect N XXX 09D3220 Therapeutic pulpotomy N XXX 09D3221 Gross pulpal debridement N XXX 09D3222 Part pulp for apexogenesis N XXX 09

D3230 Pulpal therapy anterior prim N XXX 09D3240 Pulpal therapy posterior pri N XXX 09D3310 End thxpy, anterior tooth N XXX 09D3320 End thxpy, bicuspid tooth N XXX 09D3330 End thxpy, molar N XXX 09D3331 Non-surg tx root canal obs N XXX 09D3332 Incomplete endodontic tx N XXX 09D3333 Internal root repair N XXX 09D3346 Retreat root canal anterior N XXX 09D3347 Retreat root canal bicuspid N XXX 09D3348 Retreat root canal molar N XXX 09D3351 Apexification/recalc initial N XXX 09D3352 Apexification/recalc interim N XXX 09D3353 Apexification/recalc final N XXX 09D3355 Pulpal regeneration initial N XXX 09D3356 Pulpal regeneration interim N XXX 09D3357 Pulpal regeneration complete N XXX 09D3410 Apicoectomy - anterior N XXX 09D3421 Root surgery bicuspid N XXX 09D3425 Root surgery molar N XXX 09D3426 Root surgery ea add root N XXX 09D3427 Periradicular surgery N XXX 09D3428 Bone graft peri per tooth N XXX 09D3429 Bone graft peri each addl N XXX 09D3430 Retrograde filling N XXX 09D3431 Biological materials N XXX 09D3432 Guided tissue regeneration N XXX 09D3450 Root amputation N XXX 09D3460 Endodontic endosseous implan R YYY 09D3470 Intentional replantation N XXX 09D3910 Isolation- tooth w rubb dam N XXX 09D3920 Tooth splitting N XXX 09D3950 Canal prep/fitting of dowel N XXX 09D3999 Endodontic procedure R YYY 09D4210 Gingivectomy/plasty 4 or mor I XXX 09D4211 Gingivectomy/plasty 1 to 3 I XXX 09D4212 Gingivectomy/plasty rest I XXX 09D4230 Ana crown exp 4 or> per quad N XXX 09D4231 Ana crown exp 1-3 per quad N XXX 09D4240 Gingival flap proc w/ planin N XXX 09D4241 Gngvl flap w rootplan 1-3 th N XXX 09D4245 Apically positioned flap N XXX 09D4249 Crown lengthen hard tissue N XXX 09D4260 Osseous surgery 4 or more R YYY 09D4261 Osseous surg 1 to 3 teeth N XXX 09D4263 Bone replce graft first site R YYY 09D4264 Bone replce graft each add R YYY 09D4265 Bio mtrls to aid soft/os reg N XXX 09D4266 Guided tiss regen resorble N XXX 09D4267 Guided tiss regen nonresorb N XXX 09

D4268 Surgical revision procedure R XXX 09D4270 Pedicle soft tissue graft pr R YYY 09D4273 Subepithelial tissue graft R YYY 09D4274 Distal/proximal wedge proc N XXX 09D4275 Soft tissue allograft N XXX 09D4276 Con tissue w dble ped graft N XXX 09D4277 Soft tissue graft firsttooth R XXX 09D4278 Soft tissue graft addl tooth R XXX 09D4320 Provision splnt intracoronal N XXX 09D4321 Provisional splint extracoro N XXX 09D4341 Periodontal scaling & root N XXX 09D4342 Periodontal scaling 1-3teeth N XXX 09D4355 Full mouth debridement R YYY 09D4381 Localized delivery antimicro R YYY 09D4910 Periodontal maint procedures N XXX 09D4920 Unscheduled dressing change N XXX 09D4921 Gingival irrigation per quad N XXX 09D4999 Unspecified periodontal proc N XXX 09D5110 Dentures complete maxillary N XXX 09D5120 Dentures complete mandible N XXX 09D5130 Dentures immediat maxillary N XXX 09D5140 Dentures immediat mandible N XXX 09D5211 Dentures maxill part resin N XXX 09D5212 Dentures mand part resin N XXX 09D5213 Dentures maxill part metal N XXX 09D5214 Dentures mandibl part metal N XXX 09D5225 Maxillary part denture flex N XXX 09D5226 Mandibular part denture flex N XXX 09D5281 Removable partial denture N XXX 09D5410 Dentures adjust cmplt maxil N XXX 09D5411 Dentures adjust cmplt mand N XXX 09D5421 Dentures adjust part maxill N XXX 09D5422 Dentures adjust part mandbl N XXX 09D5510 Dentur repr broken compl bas N XXX 09D5520 Replace denture teeth complt N XXX 09D5610 Dentures repair resin base N XXX 09D5620 Rep part denture cast frame N XXX 09D5630 Rep partial denture clasp N XXX 09D5640 Replace part denture teeth N XXX 09D5650 Add tooth to partial denture N XXX 09D5660 Add clasp to partial denture N XXX 09D5670 Replc tth&acrlc on mtl frmwk N XXX 09D5671 Replc tth&acrlc mandibular N XXX 09D5710 Dentures rebase cmplt maxil N XXX 09D5711 Dentures rebase cmplt mand N XXX 09D5720 Dentures rebase part maxill N XXX 09D5721 Dentures rebase part mandbl N XXX 09D5730 Denture reln cmplt maxil ch N XXX 09D5731 Denture reln cmplt mand chr N XXX 09D5740 Denture reln part maxil chr N XXX 09

D5741 Denture reln part mand chr N XXX 09D5750 Denture reln cmplt max lab N XXX 09D5751 Denture reln cmplt mand lab N XXX 09D5760 Denture reln part maxil lab N XXX 09D5761 Denture reln part mand lab N XXX 09D5810 Denture interm cmplt maxill N XXX 09D5811 Denture interm cmplt mandbl N XXX 09D5820 Denture interm part maxill N XXX 09D5821 Denture interm part mandbl N XXX 09D5850 Denture tiss conditn maxill N XXX 09D5851 Denture tiss condtin mandbl N XXX 09D5862 Precision attachment N XXX 09D5863 Overdenture complete max N XXX 09D5864 Overdenture partial max N XXX 09D5865 Overdenture complete mandib N XXX 09D5866 Overdenture partial mandib N XXX 09D5867 Replacement of precision att N XXX 09D5875 Prosthesis modification N XXX 09D5899 Removable prosthodontic proc N XXX 09D5911 Facial moulage sectional R YYY 09D5912 Facial moulage complete R YYY 09D5913 Nasal prosthesis I XXX 09D5914 Auricular prosthesis I XXX 09D5915 Orbital prosthesis I XXX 09D5916 Ocular prosthesis I XXX 09D5919 Facial prosthesis I XXX 09D5922 Nasal septal prosthesis I XXX 09D5923 Ocular prosthesis interim I XXX 09D5924 Cranial prosthesis I XXX 09D5925 Facial augmentation implant I XXX 09D5926 Replacement nasal prosthesis I XXX 09D5927 Auricular replacement I XXX 09D5928 Orbital replacement I XXX 09D5929 Facial replacement I XXX 09D5931 Surgical obturator I XXX 09D5932 Postsurgical obturator I XXX 09D5933 Refitting of obturator I XXX 09D5934 Mandibular flange prosthesis I XXX 09D5935 Mandibular denture prosth I XXX 09D5936 Temp obturator prosthesis I XXX 09D5937 Trismus appliance I XXX 09D5951 Feeding aid R YYY 09D5952 Pediatric speech aid I XXX 09D5953 Adult speech aid I XXX 09D5954 Superimposed prosthesis I XXX 09D5955 Palatal lift prosthesis I XXX 09D5958 Intraoral con def inter plt I XXX 09D5959 Intraoral con def mod palat I XXX 09D5960 Modify speech aid prosthesis I XXX 09D5982 Surgical stent I XXX 09

D5983 Radiation applicator R YYY 09D5984 Radiation shield R YYY 09D5985 Radiation cone locator R YYY 09D5986 Fluoride applicator N XXX 09D5987 Commissure splint R YYY 09D5988 Surgical splint I XXX 09D5991 Vesiculobullous disease carr N XXX 09D5992 Adjust max prost appliance I XXX 09D5993 Main/clean max prosthesis I XXX 09D5994 Peridontal medicament I XXX 09D5999 Maxillofacial prosthesis I XXX 09D6010 Odontics endosteal implant I XXX 09D6011 Second stage implant surgery I XXX 09D6012 Endosteal implant N XXX 09D6013 Surgical place mini implant N XXX 09D6040 Odontics eposteal implant I XXX 09D6050 Odontics transosteal implnt I XXX 09D6051 Interim abutment N XXX 09D6052 Semi precision attach abut R XXX 09D6055 Implant connecting bar I XXX 09D6056 Prefabricated abutment N XXX 09D6057 Custom abutment N XXX 09D6058 Abutment supported crown N XXX 09D6059 Abutment supported mtl crown N XXX 09D6060 Abutment supported mtl crown N XXX 09D6061 Abutment supported mtl crown N XXX 09D6062 Abutment supported mtl crown N XXX 09D6063 Abutment supported mtl crown N XXX 09D6064 Abutment supported mtl crown N XXX 09D6065 Implant supported crown N XXX 09D6066 Implant supported mtl crown N XXX 09D6067 Implant supported mtl crown N XXX 09D6068 Abutment supported retainer N XXX 09D6069 Abutment supported retainer N XXX 09D6070 Abutment supported retainer N XXX 09D6071 Abutment supported retainer N XXX 09D6072 Abutment supported retainer N XXX 09D6073 Abutment supported retainer N XXX 09D6074 Abutment supported retainer N XXX 09D6075 Implant supported retainer N XXX 09D6076 Implant supported retainer N XXX 09D6077 Implant supported retainer N XXX 09D6080 Implant maintenance I XXX 09D6090 Repair implant I XXX 09D6091 Repl semi/precision attach N XXX 09D6092 Recement supp crown N XXX 09D6093 Recement supp part denture N XXX 09D6094 Abut support crown titanium N XXX 09D6095 Odontics repr abutment I XXX 09D6100 Removal of implant I XXX 09

D6101 Debridement of a periimplant I XXX 09D6102 Debridement & contouring I XXX 09D6103 Bone graft repair perimplant I XXX 09D6104 Bone graft time of implant I XXX 09D6110 Implnt/abut remov dent max N XXX 09D6111 Implnt/abut remov dent mand N XXX 09D6112 Imp/abut rem dent part max N XXX 09D6113 Imp/abut rem dent part mand N XXX 09D6114 Implnt/abut fixed dent max N XXX 09D6115 Implnt/abut fixed dent mand N XXX 09D6116 Imp/abut fixed dent part max N XXX 09D6117 Imp/abut fixed dent part man N XXX 09D6190 Radio/surgical implant index N XXX 09D6194 Abut support retainer titani N XXX 09D6199 Implant procedure I XXX 09D6205 Pontic-indirect resin based N XXX 09D6210 Prosthodont high noble metal N XXX 09D6211 Bridge base metal cast N XXX 09D6212 Bridge noble metal cast N XXX 09D6214 Pontic titanium N XXX 09D6240 Bridge porcelain high noble N XXX 09D6241 Bridge porcelain base metal N XXX 09D6242 Bridge porcelain nobel metal N XXX 09D6245 Bridge porcelain/ceramic N XXX 09D6250 Bridge resin w/high noble N XXX 09D6251 Bridge resin base metal N XXX 09D6252 Bridge resin w/noble metal N XXX 09D6253 Provisional pontic N XXX 09D6545 Dental retainr cast metl N XXX 09D6548 Porcelain/ceramic retainer N XXX 09D6549 Resin retainer N XXX 09D6600 Porcelain/ceramic inlay 2srf N XXX 09D6601 Porc/ceram inlay >= 3 surfac N XXX 09D6602 Cst hgh nble mtl inlay 2 srf N XXX 09D6603 Cst hgh nble mtl inlay >=3sr N XXX 09D6604 Cst bse mtl inlay 2 surfaces N XXX 09D6605 Cst bse mtl inlay >= 3 surfa N XXX 09D6606 Cast noble metal inlay 2 sur N XXX 09D6607 Cst noble mtl inlay >=3 surf N XXX 09D6608 Onlay porc/crmc 2 surfaces N XXX 09D6609 Onlay porc/crmc >=3 surfaces N XXX 09D6610 Onlay cst hgh nbl mtl 2 srfc N XXX 09D6611 Onlay cst hgh nbl mtl >=3srf N XXX 09D6612 Onlay cst base mtl 2 surface N XXX 09D6613 Onlay cst base mtl >=3 surfa N XXX 09D6614 Onlay cst nbl mtl 2 surfaces N XXX 09D6615 Onlay cst nbl mtl >=3 surfac N XXX 09D6624 Inlay titanium N XXX 09D6634 Onlay titanium N XXX 09D6710 Crown-indirect resin based N XXX 09

D6720 Retain crown resin w hi nble N XXX 09D6721 Crown resin w/base metal N XXX 09D6722 Crown resin w/noble metal N XXX 09D6740 Crown porcelain/ceramic N XXX 09D6750 Crown porcelain high noble N XXX 09D6751 Crown porcelain base metal N XXX 09D6752 Crown porcelain noble metal N XXX 09D6780 Crown 3/4 high noble metal N XXX 09D6781 Crown 3/4 cast based metal N XXX 09D6782 Crown 3/4 cast noble metal N XXX 09D6783 Crown 3/4 porcelain/ceramic N XXX 09D6790 Crown full high noble metal N XXX 09D6791 Crown full base metal cast N XXX 09D6792 Crown full noble metal cast N XXX 09D6793 Provisional retainer crown N XXX 09D6794 Crown titanium N XXX 09D6920 Dental connector bar R YYY 09D6930 Recement/bond part denture N XXX 09D6940 Stress breaker N XXX 09D6950 Precision attachment N XXX 09D6980 Fixed partial repair N XXX 09D6985 Pediatric partial denture fx N XXX 09D6999 Fixed prosthodontic proc N XXX 09D7111 Extraction coronal remnants R XXX 09D7140 Extraction erupted tooth/exr R XXX 09D7210 Rem imp tooth w mucoper flp R YYY 09D7220 Impact tooth remov soft tiss R YYY 09D7230 Impact tooth remov part bony R YYY 09D7240 Impact tooth remov comp bony R YYY 09D7241 Impact tooth rem bony w/comp R YYY 09D7250 Tooth root removal R YYY 09D7251 Coronectomy I XXX 09D7260 Oral antral fistula closure R YYY 09D7261 Primary closure sinus perf R XXX 09D7270 Tooth reimplantation N XXX 09D7272 Tooth transplantation N XXX 09D7280 Exposure impact tooth orthod N XXX 09D7282 Mobilize erupted/malpos toot N XXX 09D7283 Place device impacted tooth R XXX 09D7285 Biopsy of oral tissue hard I XXX 09D7286 Biopsy of oral tissue soft I XXX 09D7287 Exfoliative cytolog collect I XXX 09D7288 Brush biopsy R XXX 09D7290 Repositioning of teeth N XXX 09D7291 Transseptal fiberotomy R YYY 09D7292 Screw retained plate N XXX 09D7293 Temp anchorage dev w flap N XXX 09D7294 Temp anchorage dev w/o flap N XXX 09D7295 Bone harvest,auto graft proc I XXX 09D7310 Alveoplasty w/ extraction I XXX 09

D7311 Alveoloplasty w/extract 1-3 N XXX 09D7320 Alveoplasty w/o extraction I XXX 09D7321 Alveoloplasty not w/extracts R XXX 09D7340 Vestibuloplasty ridge extens I XXX 09D7350 Vestibuloplasty exten graft I XXX 09D7410 Rad exc lesion up to 1.25 cm I XXX 09D7411 Excision benign lesion>1.25c I XXX 09D7412 Excision benign lesion compl I XXX 09D7413 Excision malig lesion<=1.25c I XXX 09D7414 Excision malig lesion>1.25cm I XXX 09D7415 Excision malig les complicat I XXX 09D7440 Malig tumor exc to 1.25 cm I XXX 09D7441 Malig tumor > 1.25 cm I XXX 09D7450 Rem odontogen cyst to 1.25cm I XXX 09D7451 Rem odontogen cyst > 1.25 cm I XXX 09D7460 Rem nonodonto cyst to 1.25cm I XXX 09D7461 Rem nonodonto cyst > 1.25 cm I XXX 09D7465 Lesion destruction I XXX 09D7471 Rem exostosis any site I XXX 09D7472 Removal of torus palatinus I XXX 09D7473 Remove torus mandibularis I XXX 09D7485 Surg reduct osseoustuberosit I XXX 09D7490 Maxilla or mandible resectio I XXX 09D7510 I&d absc intraoral soft tiss I XXX 09D7511 Incision/drain abscess intra R XXX 09D7520 I&d abscess extraoral I XXX 09D7521 Incision/drain abscess extra R XXX 09D7530 Removal fb skin/areolar tiss I XXX 09D7540 Removal of fb reaction I XXX 09D7550 Removal of sloughed off bone I XXX 09D7560 Maxillary sinusotomy I XXX 09D7610 Maxilla open reduct simple I XXX 09D7620 Clsd reduct simpl maxilla fx I XXX 09D7630 Open red simpl mandible fx I XXX 09D7640 Clsd red simpl mandible fx I XXX 09D7650 Open red simp malar/zygom fx I XXX 09D7660 Clsd red simp malar/zygom fx I XXX 09D7670 Closd rductn splint alveolus I XXX 09D7671 Alveolus open reduction I XXX 09D7680 Reduct simple facial bone fx I XXX 09D7710 Maxilla open reduct compound I XXX 09D7720 Clsd reduct compd maxilla fx I XXX 09D7730 Open reduct compd mandble fx I XXX 09D7740 Clsd reduct compd mandble fx I XXX 09D7750 Open red comp malar/zygma fx I XXX 09D7760 Clsd red comp malar/zygma fx I XXX 09D7770 Open reduc compd alveolus fx I XXX 09D7771 Alveolus clsd reduc stblz te I XXX 09D7780 Reduct compnd facial bone fx I XXX 09D7810 Tmj open reduct-dislocation I XXX 09

D7820 Closed tmp manipulation I XXX 09D7830 Tmj manipulation under anest I XXX 09D7840 Removal of tmj condyle I XXX 09D7850 Tmj meniscectomy I XXX 09D7852 Tmj repair of joint disc I XXX 09D7854 Tmj excisn of joint membrane I XXX 09D7856 Tmj cutting of a muscle I XXX 09D7858 Tmj reconstruction I XXX 09D7860 Tmj cutting into joint I XXX 09D7865 Tmj reshaping components I XXX 09D7870 Tmj aspiration joint fluid I XXX 09D7871 Lysis + lavage w catheters N XXX 09D7872 Tmj diagnostic arthroscopy I XXX 09D7873 Tmj arthroscopy lysis adhesn I XXX 09D7874 Tmj arthroscopy disc reposit I XXX 09D7875 Tmj arthroscopy synovectomy I XXX 09D7876 Tmj arthroscopy discectomy I XXX 09D7877 Tmj arthroscopy debridement I XXX 09D7880 Occlusal orthotic appliance I XXX 09D7899 Tmj unspecified therapy I XXX 09D7910 Dent sutur recent wnd to 5cm I XXX 09D7911 Dental suture wound to 5 cm I XXX 09D7912 Suture complicate wnd > 5 cm I XXX 09D7920 Dental skin graft I XXX 09D7921 Collect & appl blood product I XXX 09D7940 Reshaping bone orthognathic R YYY 09D7941 Bone cutting ramus closed I XXX 09D7943 Cutting ramus open w/graft I XXX 09D7944 Bone cutting segmented I XXX 09D7945 Bone cutting body mandible I XXX 09D7946 Reconstruction maxilla total I XXX 09D7947 Reconstruct maxilla segment I XXX 09D7948 Reconstruct midface no graft I XXX 09D7949 Reconstruct midface w/graft I XXX 09D7950 Mandible graft I XXX 09D7951 Sinus aug w bone or bone sub N XXX 09D7952 Sinus augmentation vertical N XXX 09D7953 Bone replacement graft N XXX 09D7955 Repair maxillofacial defects I XXX 09D7960 Frenulectomy/frenectomy I XXX 09D7963 Frenuloplasty N XXX 09D7970 Excision hyperplastic tissue I XXX 09D7971 Excision pericoronal gingiva I XXX 09D7972 Surg redct fibrous tuberosit I XXX 09D7980 Sialolithotomy I XXX 09D7981 Excision of salivary gland I XXX 09D7982 Sialodochoplasty I XXX 09D7983 Closure of salivary fistula I XXX 09D7990 Emergency tracheotomy I XXX 09D7991 Dental coronoidectomy I XXX 09

D7995 Synthetic graft facial bones I XXX 09D7996 Implant mandible for augment I XXX 09D7997 Appliance removal N XXX 09D7998 Intraoral place of fix dev N XXX 09D7999 Oral surgery procedure I XXX 09D8010 Limited dental tx primary N XXX 09D8020 Limited dental tx transition N XXX 09D8030 Limited dental tx adolescent N XXX 09D8040 Limited dental tx adult N XXX 09D8050 Intercep dental tx primary N XXX 09D8060 Intercep dental tx transitn N XXX 09D8070 Compre dental tx transition N XXX 09D8080 Compre dental tx adolescent N XXX 09D8090 Compre dental tx adult N XXX 09D8210 Orthodontic rem appliance tx N XXX 09D8220 Fixed appliance therapy habt N XXX 09D8660 Preorthodontic tx visit N XXX 09D8670 Periodic orthodontc tx visit N XXX 09D8680 Orthodontic retention N XXX 09D8690 Orthodontic treatment N XXX 09D8691 Repair ortho appliance N XXX 09D8692 Replacement retainer N XXX 09D8693 Rebond/recement retainers N XXX 09D8694 Repair fixed retainers N XXX 09D8999 Orthodontic procedure N XXX 09D9110 Tx dental pain minor proc R YYY 09D9120 Fix partial denture section N XXX 09D9210 Dent anesthesia w/o surgery I XXX 09D9211 Regional block anesthesia I XXX 09D9212 Trigeminal block anesthesia I XXX 09D9215 Local anesthesia I XXX 09D9219 Eval for deep sed/gen anesth I XXX 09D9220 General anesthesia I XXX 09D9221 General anesthesia ea ad 15m I XXX 09D9230 Analgesia R YYY 09D9241 Intravenous sedation I XXX 09D9242 Iv sedation ea ad 15 m I XXX 09D9248 Sedation (non-iv) R XXX 09D9310 Dental consultation I XXX 09D9410 Dental house call I XXX 09D9420 Hospital/asc call I XXX 09D9430 Office visit during hours I XXX 09D9440 Office visit after hours I XXX 09D9450 Case presentation tx plan I XXX 09D9610 Dent therapeutic drug inject I XXX 09D9612 Thera par drugs 2 or > admin N XXX 09D9630 Other drugs/medicaments R YYY 09D9910 Dent appl desensitizing med N XXX 09D9911 Appl desensitizing resin N XXX 09D9920 Behavior management N XXX 09

D9930 Treatment of complications R YYY 09D9931 Clean/inspect rem appliance N XXX 09D9940 Dental occlusal guard R YYY 09D9941 Fabrication athletic guard N XXX 09D9942 Repair/reline occlusal guard N XXX 09D9950 Occlusion analysis R YYY 09D9951 Limited occlusal adjustment R YYY 09D9952 Complete occlusal adjustment R YYY 09D9970 Enamel microabrasion N XXX 09D9971 Odontoplasty 1-2 teeth N XXX 09D9972 Extrnl bleaching per arch N XXX 09D9973 Extrnl bleaching per tooth N XXX 09D9974 Intrnl bleaching per tooth N XXX 09D9975 External bleaching home app N XXX 09D9985 Sales tax I XXX 09D9986 Missed appointment I XXX 09D9987 Cancelled appointment I XXX 09D9999 Adjunctive procedure I XXX 09G0008 Admin influenza virus vac X XXX 09G0009 Admin pneumococcal vaccine X XXX 09G0010 Admin hepatitis b vaccine X XXX 09G0027 Semen analysis X XXX 09G0101 Ca screen;pelvic/breast exam A XXX 09G0102 Prostate ca screening; dre A XXX 09G0103 Psa screening X XXX 09G0104 Ca screen;flexi sigmoidscope A 000 09G0105 Colorectal scrn; hi risk ind A 000 09G0105 53 Colorectal scrn; hi risk ind A 000 09G0106 Colon ca screen;barium enema A XXX 09G0106 TC Colon ca screen;barium enema A XXX 03G0106 26 Colon ca screen;barium enema A XXX 09G0108 Diab manage trn per indiv A XXX 09G0109 Diab manage trn ind/group A XXX 09G0117 Glaucoma scrn hgh risk direc T XXX 09G0118 Glaucoma scrn hgh risk direc T XXX 09G0120 Colon ca scrn; barium enema A XXX 09G0120 TC Colon ca scrn; barium enema A XXX 09G0120 26 Colon ca scrn; barium enema A XXX 09G0121 Colon ca scrn not hi rsk ind A 000 09G0121 53 Colon ca scrn not hi rsk ind A 000 09G0122 Colon ca scrn; barium enema N XXX 09G0122 TC Colon ca scrn; barium enema N XXX 09G0122 26 Colon ca scrn; barium enema N XXX 09G0123 Screen cerv/vag thin layer X XXX 09G0124 Screen c/v thin layer by md A XXX 09G0127 Trim nail(s) R 000 09G0128 Corf skilled nursing service R XXX 09G0129 Partial hosp prog service X XXX 09G0130 Single energy x-ray study A XXX 09G0130 TC Single energy x-ray study A XXX 01

G0130 26 Single energy x-ray study A XXX 09G0141 Scr c/v cyto,autosys and md A XXX 09G0143 Scr c/v cyto,thinlayer,rescr X XXX 09G0144 Scr c/v cyto,thinlayer,rescr X XXX 09G0145 Scr c/v cyto,thinlayer,rescr X XXX 09G0147 Scr c/v cyto, automated sys X XXX 09G0148 Scr c/v cyto, autosys, rescr X XXX 09G0151 Hhcp-serv of pt,ea 15 min X XXX 09G0152 Hhcp-serv of ot,ea 15 min X XXX 09G0153 Hhcp-svs of s/l path,ea 15mn X XXX 09G0154 Hhcp-svs of rn,ea 15 min X XXX 09G0155 Hhcp-svs of csw,ea 15 min X XXX 09G0156 Hhcp-svs of aide,ea 15 min X XXX 09G0157 Hhc pt assistant ea 15 E XXX 09G0158 Hhc ot assistant ea 15 E XXX 09G0159 Hhc pt maint ea 15 min E XXX 09G0160 Hhc occup therapy ea 15 E XXX 09G0161 Hhc slp ea 15 min E XXX 09G0162 Hhc rn e&m plan svs, 15 min E XXX 09G0163 Hhc lpn/rn obs/asses ea 15 E XXX 09G0164 Hhc lis nurse train ea 15 E XXX 09G0166 Extrnl counterpulse, per tx A XXX 09G0168 Wound closure by adhesive A 000 09G0175 Opps service,sched team conf X XXX 09G0176 Opps/php;activity therapy X XXX 09G0177 Opps/php; train & educ serv X XXX 09G0179 Md recertification hha pt A XXX 09G0180 Md certification hha patient A XXX 09G0181 Home health care supervision A XXX 09G0182 Hospice care supervision A XXX 09G0186 Dstry eye lesn,fdr vssl tech C YYY 09G0202 Screeningmammographydigital A XXX 09G0202 TC Screeningmammographydigital A XXX 09G0202 26 Screeningmammographydigital A XXX 09G0204 Diagnosticmammographydigital A XXX 09G0204 TC Diagnosticmammographydigital A XXX 09G0204 26 Diagnosticmammographydigital A XXX 09G0206 Diagnosticmammographydigital A XXX 09G0206 TC Diagnosticmammographydigital A XXX 09G0206 26 Diagnosticmammographydigital A XXX 09G0219 Pet img wholbod melano nonco N XXX 09G0219 TC Pet img wholbod melano nonco N XXX 01G0219 26 Pet img wholbod melano nonco N XXX 09G0235 Pet not otherwise specified N XXX 09G0235 TC Pet not otherwise specified N XXX 01G0235 26 Pet not otherwise specified N XXX 09G0237 Therapeutic procd strg endur A XXX 09G0238 Oth resp proc, indiv A XXX 09G0239 Oth resp proc, group A XXX 09G0245 Initial foot exam pt lops R XXX 09

G0246 Followup eval of foot pt lop R XXX 09G0247 Routine footcare pt w lops R ZZZ 09G0248 Demonstrate use home inr mon R XXX 01G0249 Provide inr test mater/equip R XXX 01G0250 Md inr test revie inter mgmt R XXX 09G0252 Pet imaging initial dx N XXX 09G0252 TC Pet imaging initial dx N XXX 09G0252 26 Pet imaging initial dx N XXX 09G0255 Current percep threshold tst N XXX 09G0255 TC Current percep threshold tst N XXX 01G0255 26 Current percep threshold tst N XXX 09G0257 Unsched dialysis esrd pt hos E XXX 09G0259 Inject for sacroiliac joint E XXX 09G0260 Inj for sacroiliac jt anesth E XXX 09G0268 Removal of impacted wax md A 000 09G0269 Occlusive device in vein art B XXX 09G0270 Mnt subs tx for change dx A XXX 09G0271 Group mnt 2 or more 30 mins A XXX 09G0276 Pild/placebo control clin tr R 000 09G0277 Hbot, full body chamber, 30m A XXX 09G0278 Iliac art angio,cardiac cath A ZZZ 09G0279 Tomosynthesis, mammo screen A ZZZ 09G0279 TC Tomosynthesis, mammo screen A ZZZ 09G0279 26 Tomosynthesis, mammo screen A ZZZ 09G0281 Elec stim unattend for press A XXX 09G0282 Elect stim wound care not pd N XXX 09G0283 Elec stim other than wound A XXX 09G0288 Recon, cta for surg plan A XXX 01G0289 Arthro, loose body + chondro A ZZZ 09G0293 Non-cov surg proc,clin trial E XXX 09G0294 Non-cov proc, clinical trial E XXX 09G0295 Electromagnetic therapy onc N XXX 09G0302 Pre-op service lvrs complete X XXX 09G0303 Pre-op service lvrs 10-15dos X XXX 09G0304 Pre-op service lvrs 1-9 dos X XXX 09G0305 Post op service lvrs min 6 X XXX 09G0306 Cbc/diffwbc w/o platelet X XXX 09G0307 Cbc without platelet X XXX 09G0328 Fecal blood scrn immunoassay X XXX 09G0329 Electromagntic tx for ulcers A XXX 09G0333 Dispense fee initial 30 day X XXX 09G0337 Hospice evaluation preelecti X XXX 09G0339 Robot lin-radsurg com, first C XXX 09G0340 Robt lin-radsurg fractx 2-5 C XXX 09G0341 Percutaneous islet celltrans A 000 09G0342 Laparoscopy islet cell trans A 090 09G0343 Laparotomy islet cell transp A 090 09G0364 Bone marrow aspirate &biopsy A ZZZ 09G0365 Vessel mapping hemo access A XXX 09G0365 TC Vessel mapping hemo access A XXX 01

G0365 26 Vessel mapping hemo access A XXX 09G0372 Md service required for pmd A XXX 09G0378 Hospital observation per hr X XXX 09G0379 Direct refer hospital observ X XXX 09G0380 Lev 1 hosp type b ed visit X XXX 09G0381 Lev 2 hosp type b ed visit X XXX 09G0382 Lev 3 hosp type b ed visit X XXX 09G0383 Lev 4 hosp type b ed visit X XXX 09G0384 Lev 5 hosp type b ed visit X XXX 09G0389 Ultrasound exam aaa screen A XXX 09G0389 TC Ultrasound exam aaa screen A XXX 01G0389 26 Ultrasound exam aaa screen A XXX 09G0390 Trauma respons w/hosp criti X XXX 09G0396 Alcohol/subs interv 15-30mn A XXX 09G0397 Alcohol/subs interv >30 min A XXX 09G0398 Home sleep test/type 2 porta C XXX 09G0398 TC Home sleep test/type 2 porta C XXX 09G0398 26 Home sleep test/type 2 porta C XXX 09G0399 Home sleep test/type 3 porta C XXX 09G0399 TC Home sleep test/type 3 porta C XXX 09G0399 26 Home sleep test/type 3 porta C XXX 09G0400 Home sleep test/type 4 porta C XXX 09G0400 TC Home sleep test/type 4 porta C XXX 09G0400 26 Home sleep test/type 4 porta C XXX 09G0402 Initial preventive exam A XXX 09G0403 Ekg for initial prevent exam A XXX 09G0404 Ekg tracing for initial prev A XXX 09G0405 Ekg interpret & report preve A XXX 09G0406 Inpt/tele follow up 15 A XXX 09G0407 Inpt/tele follow up 25 A XXX 09G0408 Inpt/tele follow up 35 A XXX 09G0409 Corf related serv 15 mins ea R XXX 09G0410 Grp psych partial hosp 45-50 X XXX 09G0411 Inter active grp psych parti X XXX 09G0412 Open tx iliac spine uni/bil A 090 09G0413 Pelvic ring fracture uni/bil A 090 09G0414 Pelvic ring fx treat int fix A 090 09G0415 Open tx post pelvic fxcture A 090 09G0416 Prostate biopsy, any mthd A XXX 09G0416 TC Prostate biopsy, any mthd A XXX 09G0416 26 Prostate biopsy, any mthd A XXX 09G0420 Ed svc ckd ind per session A XXX 09G0421 Ed svc ckd grp per session A XXX 09G0422 Intens cardiac rehab w/exerc A XXX 09G0423 Intens cardiac rehab no exer A XXX 09G0424 Pulmonary rehab w exer A XXX 09G0425 Inpt/ed teleconsult30 A XXX 09G0426 Inpt/ed teleconsult50 A XXX 09G0427 Inpt/ed teleconsult70 A XXX 09G0428 Collagen meniscus implant N XXX 09

G0429 Dermal filler injection(s) A 000 09G0431 Drug screen multiple class X XXX 09G0432 Eia hiv-1/hiv-2 screen X XXX 09G0433 Elisa hiv-1/hiv-2 screen X XXX 09G0434 Drug screen multi drug class X XXX 09G0435 Oral hiv-1/hiv-2 screen X XXX 09G0436 Tobacco-use counsel 3-10 min A XXX 09G0437 Tobacco-use counsel>10min A XXX 09G0438 Ppps, initial visit A XXX 09G0439 Ppps, subseq visit A XXX 09G0442 Annual alcohol screen 15 min A XXX 09G0443 Brief alcohol misuse counsel A XXX 09G0444 Depression screen annual A XXX 09G0445 High inten beh couns std 30m A XXX 09G0446 Intens behave ther cardio dx A XXX 09G0447 Behavior counsel obesity 15m A XXX 09G0448 Place perm pacing cardiovert E XXX 09G0451 Devlopment test interpt&rep A XXX 04G0452 26 Molecular pathology interpr A XXX 09G0453 Cont intraop neuro monitor A XXX 09G0454 Md document visit by npp A XXX 09G0455 Fecal microbiota prep instil A 000 09G0458 Ldr prostate brachy comp rat E XXX 09G0459 Telehealth inpt pharm mgmt A XXX 09G0460 Autologous prp for ulcers C YYY 09G0463 Hospital outpt clinic visit X XXX 09G0464 Colorec ca scr, sto bas dna X XXX 09G0466 Fqhc visit new patient X XXX 09G0467 Fqhc visit, estab pt X XXX 09G0468 Fqhc visit, ippe or awv X XXX 09G0469 Fqhc visit, mh new pt X XXX 09G0470 Fqhc visit, mh estab pt X XXX 09G0471 Ven blood coll snf/hha X XXX 09G0472 Hep c screen high risk/other X XXX 09G0473 Group behave couns 2-10 A XXX 09G0913 Improve visual funct M XXX 09G0914 Survey not complete M XXX 09G0915 No improve visual funct M XXX 09G0916 Satisfy with care M XXX 09G0917 Satisfy survey not complete M XXX 09G0918 No satisfy with care M XXX 09G3001 Admin + supply, tositumomab X XXX 09G6001 Echo guidance radiotherapy A XXX 09G6001 TC Echo guidance radiotherapy A XXX 09G6001 26 Echo guidance radiotherapy A XXX 09G6002 Stereoscopic x-ray guidance A XXX 09G6002 TC Stereoscopic x-ray guidance A XXX 09G6002 26 Stereoscopic x-ray guidance A XXX 09G6003 Radiation treatment delivery A XXX 09G6004 Radiation treatment delivery A XXX 09

G6005 Radiation treatment delivery A XXX 09G6006 Radiation treatment delivery A XXX 09G6007 Radiation treatment delivery A XXX 09G6008 Radiation treatment delivery A XXX 09G6009 Radiation treatment delivery A XXX 09G6010 Radiation treatment delivery A XXX 09G6011 Radiation treatment delivery A XXX 09G6012 Radiation treatment delivery A XXX 09G6013 Radiation treatment delivery A XXX 09G6014 Radiation treatment delivery A XXX 09G6015 Radiation tx delivery imrt A XXX 09G6016 Delivery comp imrt A XXX 09G6017 Intrafraction track motion C YYY 09G6018 Ileoscopy w/stent A 000 09G6019 Colonoscopy lesion removal A 000 09G6020 Colonoscopy w/stent A 000 09G6021 Unlisted px small intestine C YYY 09G6022 Sigmoidoscopy w/ablate tumr A 000 09G6023 Sigmoidoscopy w/stent A 000 09G6024 Lesion removal colonoscopy A 000 09G6025 Colonoscopy w/stent A 000 09G6027 Anoscopy hra w/spec collect C YYY 09G6028 Anoscopy hra w/biopsy C YYY 09G6030 Assay of amitriptyline X XXX 09G6031 Assay of benzodiazepines X XXX 09G6032 Assay of desipramine X XXX 09G6034 Assay of doxepin X XXX 09G6035 Assay of gold X XXX 09G6036 Assay of imipramine X XXX 09G6037 Assay of nortiptyline X XXX 09G6038 Assay of salicylate X XXX 09G6039 Assay of acetaminophen X XXX 09G6040 Assay of ethanol X XXX 09G6041 Assay of urine alkaloids X XXX 09G6042 Assay of amphetamines X XXX 09G6043 Assay of barbiturates X XXX 09G6044 Assay of cocaine X XXX 09G6045 Assay of dihydrocodeinone X XXX 09G6046 Assay of dihydromorphinone X XXX 09G6047 Assay of dihydrotestosterone X XXX 09G6048 Assay of dimethadione X XXX 09G6049 Asssay of epiandrosterone X XXX 09G6050 Assay of ethchlorvynol X XXX 09G6051 Assay of flurazepam X XXX 09G6052 Assay of meprobamate X XXX 09G6053 Assay of methadone X XXX 09G6054 Assay of methsuximide X XXX 09G6055 Assay of nicotine X XXX 09G6056 Assay of opiates X XXX 09G6057 Assay of phenothiazine X XXX 09

G6058 Drug confirmation X XXX 09G8395 Lvef>=40% doc normal or mild M XXX 09G8396 Lvef not performed M XXX 09G8397 Dil macula/fundus exam/w doc M XXX 09G8398 Dil macular/fundus not perfo M XXX 09G8399 Pt w/dxa document or order M XXX 09G8400 Pt w/dxa no document or orde M XXX 09G8401 Pt inelig osteo screen measu M XXX 09G8404 Low extemity neur exam docum M XXX 09G8405 Low extemity neur not perfor M XXX 09G8410 Eval on foot documented M XXX 09G8415 Eval on foot not performed M XXX 09G8416 Pt inelig footwear evaluatio M XXX 09G8417 Calc bmi abv up param f/u M XXX 09G8418 Calc bmi blw low param f/u M XXX 09G8419 Calc bmi out nrm param nof/u M XXX 09G8420 Calc bmi norm parameters M XXX 09G8421 Bmi not calculated M XXX 09G8422 Pt inelig bmi calculation M XXX 09G8427 Doc cur meds by prov M XXX 09G8428 Cur meds not document M XXX 09G8430 Pt inelig med check M XXX 09G8431 Pos clin depres scrn f/u doc M XXX 09G8432 Clin depression screen not d M XXX 09G8433 Pt inelig; scrn clin dep M XXX 09G8442 Pt inelig pain assessment M XXX 09G8450 Beta-bloc rx pt w/abn lvef M XXX 09G8451 Pt w/abn lvef inelig b-bloc M XXX 09G8452 Pt w/abn lvef b-bloc no rx M XXX 09G8458 Pt inelig geno no antvir tx M XXX 09G8460 Pt inelig rna no antvir tx M XXX 09G8461 Pt rec antivir treat hep c M XXX 09G8465 High risk recurrence pro ca M XXX 09G8473 Ace/arb thxpy rx'd M XXX 09G8474 Ace/arb not rx'd; doc reas M XXX 09G8475 Ace/arb thxpy not rx'd M XXX 09G8476 Bp sys <140 and dias <90 M XXX 09G8477 Bp sys>=140 and/or dias >=90 M XXX 09G8478 Bp not performed/doc M XXX 09G8482 Flu immunize order/admin M XXX 09G8483 Flu imm no admin doc rea M XXX 09G8484 Flu immunize no admin M XXX 09G8485 Report, diabetes measures M XXX 09G8486 Report, prev care measures M XXX 09G8487 Report ckd measures M XXX 09G8489 Cad measures grp M XXX 09G8490 Ra measures grp M XXX 09G8491 Hiv/aids measures grp M XXX 09G8494 Dm meas qual act perform M XXX 09G8495 Ckd meas qual act perform M XXX 09

G8496 Prev care mg qual act perfrm M XXX 09G8497 Cabg meas qual act perform M XXX 09G8498 Cad meas qual act perform M XXX 09G8499 Ra meas qual act perform M XXX 09G8500 Hiv meas qual act perform M XXX 09G8506 Pt rec ace/arb M XXX 09G8509 Pos pain assess no f/u doc M XXX 09G8510 Pt inelig neg scrn depres M XXX 09G8511 Clin depres scrn no f/u doc M XXX 09G8530 Auto av fistula recd M XXX 09G8531 Pt inelig; auto av fistula M XXX 09G8532 No auto av fistula; no reas M XXX 09G8535 Pt inelig no eld mal scrn M XXX 09G8536 No doc elder mal scrn M XXX 09G8539 Doc funct and care plan M XXX 09G8540 Pt inelig funct assess M XXX 09G8541 No doc cur funct assess M XXX 09G8542 Doc funct no deficiencies M XXX 09G8543 Cur funct asses; no care pln M XXX 09G8544 Cabg measures grp M XXX 09G8545 Hepc measures grp M XXX 09G8548 Hf measures grp M XXX 09G8549 Hepc mg qual act perform M XXX 09G8551 Hf mg qual act perform M XXX 09G8559 Pt ref doc oto eval I XXX 09G8560 Pt hx act drain prev 90 days I XXX 09G8561 Pt inelig for ref oto eval I XXX 09G8562 Pt no hx act drain 90 d I XXX 09G8563 Pt no ref oto reas no spec I XXX 09G8564 Pt ref oto eval I XXX 09G8565 Ver doc hear loss I XXX 09G8566 Pt inelig ref oto eval I XXX 09G8567 Pt no doc hear loss I XXX 09G8568 Pt no ref otolo no spec I XXX 09G8569 Prol intubation req M XXX 09G8570 No prol intub req M XXX 09G8571 Ster wd ifx 30 d postop M XXX 09G8572 No ster wd ifx M XXX 09G8573 Stk cabg M XXX 09G8574 No strk cabg M XXX 09G8575 Postop ren fail M XXX 09G8576 No postop ren fail M XXX 09G8577 Reop req bld grft oth M XXX 09G8578 No reop req bld grft oth M XXX 09G8598 Asp therp used M XXX 09G8599 No asp therp used M XXX 09G8600 Tpa initi w/in 3 hrs M XXX 09G8601 No elig tpa init w/in 3 hrs M XXX 09G8602 No tpa init w/in 3 hrs M XXX 09G8627 Surg proc w/in 30 days M XXX 09

G8628 No surg proc w/in 30 days M XXX 09G8633 Pharm ther osteo rx M XXX 09G8634 Pt no elg phar ther osteo M XXX 09G8635 No pharm ther osteo rx M XXX 09G8645 Asthma measures grp M XXX 09G8646 Asthma mg qual act perform M XXX 09G8647 Fun stat score knee >= 0 M XXX 09G8648 Fun stat score knee < 0 M XXX 09G8649 Fun stat score knee pt noelg M XXX 09G8650 Fun stat score knee not done M XXX 09G8651 Fun stat score hip >= 0 M XXX 09G8652 Fun stat score hip < 0 M XXX 09G8653 Fun stat score hip pt no elg M XXX 09G8654 Fun stat score hip not done M XXX 09G8655 Fun stat score le >= 0 M XXX 09G8656 Fun stat score le < 0 M XXX 09G8657 Fun stat score le pt no elg M XXX 09G8658 Fun stat score le not done M XXX 09G8659 Fun stat score ls >= 0 M XXX 09G8660 Fun stat score ls < 0 M XXX 09G8661 Fun stat score ls pt no elg M XXX 09G8662 Fun stat score ls not done M XXX 09G8663 Fun stat score shdl >=0 M XXX 09G8664 Fun stat score shdl < 0 M XXX 09G8665 Fun stat score shdl pt no el M XXX 09G8666 Fun stat score shdl not done M XXX 09G8667 Fun stat score ue >=0 M XXX 09G8668 Fun stat score ue < 0 M XXX 09G8669 Fun stat score ue pt no elg M XXX 09G8670 Fun stat score ue not done M XXX 09G8671 Fun stat score neck/ts >=0 M XXX 09G8672 Fun stat score neck/ts < 0 M XXX 09G8673 Fun stat scor nek/ts pt no e M XXX 09G8674 Fun stat scor nek/ts not don M XXX 09G8694 Lvef <40% M XXX 09G8696 Antithromb thx presc M XXX 09G8697 Antithromb no presc doc reas M XXX 09G8698 Antithromb no presc no reas M XXX 09G8708 Antibiotic not pres M XXX 09G8709 Med reas antibiotic pres M XXX 09G8710 Pt pres antibiotic M XXX 09G8711 Pres antibiotic M XXX 09G8712 Not pres antibiotic M XXX 09G8713 Spkt/v great 1.2 kt/v M XXX 09G8714 Hemodialysis 3 times week M XXX 09G8717 Less 1.2 kt/v M XXX 09G8718 Great 1.7 kt/v per week M XXX 09G8720 Less 1.7 kt/v per week M XXX 09G8721 Pt, pn, hist grade doc M XXX 09G8722 Med reas pt, pn, not doc M XXX 09

G8723 Spec sit not prim tumor M XXX 09G8724 Pt, pn, hist grade not doc M XXX 09G8725 Lipid profile perf doc M XXX 09G8726 Doc reas no lipid profile M XXX 09G8728 Lipid profile not perf M XXX 09G8730 Pain doc pos and plan M XXX 09G8731 Pain neg no plan M XXX 09G8732 No doc of pain M XXX 09G8733 Doc pos elder mal scrn plan M XXX 09G8734 Doc neg elder mal no plan M XXX 09G8735 Eld mal scrn pos no plan M XXX 09G8749 Signs of melanoma absent M XXX 09G8752 Sys bp less 140 M XXX 09G8753 Sys bp > or = 140 M XXX 09G8754 Dias bp less 90 M XXX 09G8755 Dias bp > or = 90 M XXX 09G8756 No bp measure doc M XXX 09G8757 Copd mg qual act perform M XXX 09G8758 Ibd mg qual act perform M XXX 09G8759 Osa mg qual act perform M XXX 09G8761 Dementia mg qual act perform M XXX 09G8762 Pd mg qual act perform M XXX 09G8765 Cataract mg qual act perform M XXX 09G8783 Bp scrn perf rec interval M XXX 09G8784 Pt no elig for bp assess M XXX 09G8785 Bp scrn no perf at interval M XXX 09G8797 Specimen site not esophagus M XXX 09G8798 Specimen site not prostate M XXX 09G8806 Transab or transvag us M XXX 09G8807 Doc reas no us M XXX 09G8808 No transab or transvag us M XXX 09G8809 Rh-immunoglobulin order M XXX 09G8810 Doc reas no rh-immuno M XXX 09G8811 No rh-immunoglobulin order M XXX 09G8815 Doc reas no statin therapy M XXX 09G8816 Statin med pres at disch M XXX 09G8817 Doc reas no statin med disch M XXX 09G8818 Pt disch to home by day#7 M XXX 09G8825 Pt not disch to home day#7 M XXX 09G8826 Pt disch home day #2 evar M XXX 09G8833 Pt not disch home day#2 evar M XXX 09G8834 Pt disch home day #2 cea M XXX 09G8838 Not disch home by day #2 M XXX 09G8839 Sleep apnea assess M XXX 09G8840 Doc reas no sleep apnea M XXX 09G8841 No sleep apnea assess M XXX 09G8842 Ahi or rdi initial dx M XXX 09G8843 Doc reas no ahi or rdi M XXX 09G8844 No ahi or rdi initial dx M XXX 09G8845 Pos airway press prescribed M XXX 09

G8846 Mod or severe osa M XXX 09G8848 Mild osa M XXX 09G8849 Doc reas no pos air press M XXX 09G8850 No pap prescribed M XXX 09G8851 Adhere pos air press therapy M XXX 09G8852 Pos air press prescribe M XXX 09G8853 Pos air press not prescribe M XXX 09G8854 Reas no adhere pos air pres M XXX 09G8855 Pos air press adhere no perf M XXX 09G8856 Ref for oto eval M XXX 09G8857 No elig ref for oto eval M XXX 09G8858 Not ref for oto eval M XXX 09G8861 Dxa ordered for osteo M XXX 09G8863 No assess bone loss M XXX 09G8864 Pneumococcal vaccine admin M XXX 09G8865 Doc med reas no pneumococcal M XXX 09G8866 Doc pt reas no pneumococcal M XXX 09G8867 No pneumococcal admin M XXX 09G8868 1st course antitnf M XXX 09G8869 Doc immun hep b 1st antitnf M XXX 09G8870 Hepb admin 1st antitnf M XXX 09G8871 No 1st antitnf M XXX 09G8872 Intraop image confirm excise M XXX 09G8873 Specimen not intraop image M XXX 09G8874 Tissue not image intraop M XXX 09G8875 Breast cancer dx min invsive M XXX 09G8876 Doc reas no min inv dx M XXX 09G8877 No brst cncr dx min invasive M XXX 09G8878 Sent lymph node biopsy M XXX 09G8879 Node neg inv brst cncr M XXX 09G8880 Doc reas no lymph node biop M XXX 09G8881 Brst cncr stage > t1n0m0 M XXX 09G8882 No sent lymph node biopsy M XXX 09G8883 Rev, comm, track, doc biopsy M XXX 09G8884 Doc reas biopsy not review M XXX 09G8885 No rev, comm, track biopsy M XXX 09G8898 Copd measures group M XXX 09G8899 Inflammatory bowel dis mg M XXX 09G8900 Obstructive sleep apnea mg M XXX 09G8902 Dementia measures group M XXX 09G8903 Parkinson's disease mg M XXX 09G8906 Cataract measures group M XXX 09G8907 Pt doc no events on discharg X XXX 09G8908 Pt doc w burn prior to d/c X XXX 09G8909 Pt doc no burn prior to d/c X XXX 09G8910 Pt doc to have fall in asc X XXX 09G8911 Pt doc no fall in asc X XXX 09G8912 Pt doc with wrong event X XXX 09G8913 Pt doc no wrong event X XXX 09G8914 Pt trans to hosp post d/c X XXX 09

G8915 Pt not trans to hosp at d/c X XXX 09G8916 Pt w iv ab given on time X XXX 09G8917 Pt w iv ab not given on time X XXX 09G8918 Pt w/o preop order iv ab pro X XXX 09G8923 Lvef < 40% or lvsd M XXX 09G8924 Spiro ev1/fvc <60% copd sym M XXX 09G8925 Spiro>=60% or pt no copd sym M XXX 09G8926 Spiro no perf or doc M XXX 09G8927 Adj chem pres ajcc iii M XXX 09G8928 Adj chem not pres rsn spec M XXX 09G8929 Adj cmo not pres rsn not gvn M XXX 09G8934 Lvef <40% or dep lv sys fcn M XXX 09G8935 Rx ace or arb therapy M XXX 09G8936 Pt not eligible ace/arb M XXX 09G8937 No rx ace/arb therapy M XXX 09G8938 Bmi calc, pt no f/u plan elg M XXX 09G8939 Pain assess doc, f/u no doc M XXX 09G8940 Srn clin dep doc no f/u pln M XXX 09G8941 No doc elder scrn, pt no el M XXX 09G8942 Doc fcn/care plan w/30 days M XXX 09G8944 Ajcc mel cnr stg 0 - iic M XXX 09G8946 Mibm but no dx of breast ca M XXX 09G8947 1 or more neuropsych M XXX 09G8948 No neuropsych symptoms M XXX 09G8950 Pre-htn or htn doc, f/u indc M XXX 09G8951 Pre-htn/htn doc, no pt f/u M XXX 09G8952 Pre-htn/htn, no f/u, not gvn M XXX 09G8953 Oncology mg qual act perform M XXX 09G8955 Most recent assess vol mgmt M XXX 09G8956 Pt rcv hedia outpt dyls fac M XXX 09G8958 Assess vol mgmt not doc M XXX 09G8959 Clin tx mdd comm to tx clin M XXX 09G8960 Clin tx mdd not comm M XXX 09G8961 Csit lowrisk surg pts preop M XXX 09G8962 Csit on pt any reas 30 days M XXX 09G8963 Csi per asx pt w/pci 2 yrs M XXX 09G8964 Csi any other than pci 2 yr M XXX 09G8965 Csit perf on low chd rsk M XXX 09G8966 Csit perf sx or high chd rsk M XXX 09G8967 Wrfrn or oral antigoag pres M XXX 09G8968 Md rsn no pres wrfrn or othr M XXX 09G8969 Pt rsn no pres wrfrn or othr M XXX 09G8970 No rsk fac or 1 mod risk te M XXX 09G8971 Warfrn or othr antcog no rx M XXX 09G8972 1>=risk or>= mod risk for te M XXX 09G8973 Mst rcnt hbb < 10g/dl M XXX 09G8974 Hgb not doc rns not gvn M XXX 09G8975 Hgb <10g/dl, med rsn M XXX 09G8976 Hgb >= 10 g/dl M XXX 09G8977 Oncology measures grp M XXX 09

G8978 Mobility current status Q XXX 09G8979 Mobility goal status Q XXX 09G8980 Mobility d/c status Q XXX 09G8981 Body pos current status Q XXX 09G8982 Body pos goal status Q XXX 09G8983 Body pos d/c status Q XXX 09G8984 Carry current status Q XXX 09G8985 Carry goal status Q XXX 09G8986 Carry d/c status Q XXX 09G8987 Self care current status Q XXX 09G8988 Self care goal status Q XXX 09G8989 Self care d/c status Q XXX 09G8990 Other pt/ot current status Q XXX 09G8991 Other pt/ot goal status Q XXX 09G8992 Other pt/ot d/c status Q XXX 09G8993 Sub pt/ot current status Q XXX 09G8994 Sub pt/ot goal status Q XXX 09G8995 Sub pt/ot d/c status Q XXX 09G8996 Swallow current status Q XXX 09G8997 Swallow goal status Q XXX 09G8998 Swallow d/c status Q XXX 09G8999 Motor speech current status Q XXX 09G9001 Mccd, initial rate X XXX 09G9002 Mccd,maintenance rate X XXX 09G9003 Mccd, risk adj hi, initial X XXX 09G9004 Mccd, risk adj lo, initial X XXX 09G9005 Mccd, risk adj, maintenance X XXX 09G9006 Mccd, home monitoring X XXX 09G9007 Mccd, sch team conf X XXX 09G9008 Mccd,phys coor-care ovrsght X XXX 09G9009 Mccd, risk adj, level 3 X XXX 09G9010 Mccd, risk adj, level 4 X XXX 09G9011 Mccd, risk adj, level 5 X XXX 09G9012 Other specified case mgmt X XXX 09G9013 Esrd demo bundle level i N XXX 09G9014 Esrd demo bundle-level ii N XXX 09G9016 Demo-smoking cessation coun N XXX 09G9017 Amantadine hcl 100mg oral X XXX 09G9018 Zanamivir,inhalation pwd 10m X XXX 09G9019 Oseltamivir phosphate 75mg X XXX 09G9020 Rimantadine hcl 100mg oral X XXX 09G9033 Amantadine hcl oral brand X XXX 09G9034 Zanamivir, inh pwdr, brand X XXX 09G9035 Oseltamivir phosp, brand X XXX 09G9036 Rimantadine hcl, brand X XXX 09G9050 Oncology work-up evaluation I XXX 09G9051 Oncology tx decision-mgmt I XXX 09G9052 Onc surveillance for disease I XXX 09G9053 Onc expectant management pt I XXX 09G9054 Onc supervision palliative I XXX 09

G9055 Onc visit unspecified nos I XXX 09G9056 Onc prac mgmt adheres guide I XXX 09G9057 Onc pract mgmt differs trial I XXX 09G9058 Onc prac mgmt disagree w/gui I XXX 09G9059 Onc prac mgmt pt opt alterna I XXX 09G9060 Onc prac mgmt dif pt comorb I XXX 09G9061 Onc prac cond noadd by guide I XXX 09G9062 Onc prac guide differs nos I XXX 09G9063 Onc dx nsclc stgi no progres M XXX 09G9064 Onc dx nsclc stg2 no progres M XXX 09G9065 Onc dx nsclc stg3a no progre M XXX 09G9066 Onc dx nsclc stg3b-4 metasta M XXX 09G9067 Onc dx nsclc dx unknown nos M XXX 09G9068 Onc dx sclc/nsclc limited M XXX 09G9069 Onc dx sclc/nsclc ext at dx M XXX 09G9070 Onc dx sclc/nsclc ext unknwn M XXX 09G9071 Onc dx brst stg1-2b hr,nopro M XXX 09G9072 Onc dx brst stg1-2 noprogres M XXX 09G9073 Onc dx brst stg3-hr, no pro M XXX 09G9074 Onc dx brst stg3-noprogress M XXX 09G9075 Onc dx brst metastic/ recur M XXX 09G9077 Onc dx prostate t1no progres M XXX 09G9078 Onc dx prostate t2no progres M XXX 09G9079 Onc dx prostate t3b-t4noprog M XXX 09G9080 Onc dx prostate w/rise psa M XXX 09G9083 Onc dx prostate unknwn nos M XXX 09G9084 Onc dx colon t1-3,n1-2,no pr M XXX 09G9085 Onc dx colon t4, n0 w/o prog M XXX 09G9086 Onc dx colon t1-4 no dx prog M XXX 09G9087 Onc dx colon metas evid dx M XXX 09G9088 Onc dx colon metas noevid dx M XXX 09G9089 Onc dx colon extent unknown M XXX 09G9090 Onc dx rectal t1-2 no progr M XXX 09G9091 Onc dx rectal t3 n0 no prog M XXX 09G9092 Onc dx rectal t1-3,n1-2noprg M XXX 09G9093 Onc dx rectal t4,n,m0 no prg M XXX 09G9094 Onc dx rectal m1 w/mets prog M XXX 09G9095 Onc dx rectal extent unknwn M XXX 09G9096 Onc dx esophag t1-t3 noprog M XXX 09G9097 Onc dx esophageal t4 no prog M XXX 09G9098 Onc dx esophageal mets recur M XXX 09G9099 Onc dx esophageal unknown M XXX 09G9100 Onc dx gastric no recurrence M XXX 09G9101 Onc dx gastric p r1-r2noprog M XXX 09G9102 Onc dx gastric unresectable M XXX 09G9103 Onc dx gastric recurrent M XXX 09G9104 Onc dx gastric unknown nos M XXX 09G9105 Onc dx pancreatc p r0 res no M XXX 09G9106 Onc dx pancreatc p r1/r2 no M XXX 09G9107 Onc dx pancreatic unresectab M XXX 09

G9108 Onc dx pancreatic unknwn nos M XXX 09G9109 Onc dx head/neck t1-t2no prg M XXX 09G9110 Onc dx head/neck t3-4 noprog M XXX 09G9111 Onc dx head/neck m1 mets rec M XXX 09G9112 Onc dx head/neck ext unknown M XXX 09G9113 Onc dx ovarian stg1a-b no pr M XXX 09G9114 Onc dx ovarian stg1a-b or 2 M XXX 09G9115 Onc dx ovarian stg3/4 noprog M XXX 09G9116 Onc dx ovarian recurrence M XXX 09G9117 Onc dx ovarian unknown nos M XXX 09G9123 Onc dx cml chronic phase M XXX 09G9124 Onc dx cml acceler phase M XXX 09G9125 Onc dx cml blast phase M XXX 09G9126 Onc dx cml remission M XXX 09G9128 Onc dx multi myeloma stage i M XXX 09G9129 Onc dx mult myeloma stg2 hig M XXX 09G9130 Onc dx multi myeloma unknown M XXX 09G9131 Onc dx brst unknown nos M XXX 09G9132 Onc dx prostate mets no cast M XXX 09G9133 Onc dx prostate clinical met M XXX 09G9134 Onc nhlstg 1-2 no relap no M XXX 09G9135 Onc dx nhl stg 3-4 not relap M XXX 09G9136 Onc dx nhl trans to lg bcell M XXX 09G9137 Onc dx nhl relapse/refractor M XXX 09G9138 Onc dx nhl stg unknown M XXX 09G9139 Onc dx cml dx status unknown M XXX 09G9140 Frontier extended stay demo X XXX 09G9143 Warfarin respon genetic test X XXX 09G9147 Outpt iv insulin tx any mea N XXX 09G9148 Medical home level 1 R XXX 09G9149 Medical home level ii R XXX 09G9150 Medical home level iii R XXX 09G9151 Mapcp demo state R XXX 09G9152 Mapcp demo community R XXX 09G9153 Mapcp demo physician R XXX 09G9156 Evaluation for wheelchair R XXX 09G9157 Transesoph doppl cardiac mon A XXX 09G9158 Motor speech d/c status Q XXX 09G9159 Lang comp current status Q XXX 09G9160 Lang comp goal status Q XXX 09G9161 Lang comp d/c status Q XXX 09G9162 Lang express current status Q XXX 09G9163 Lang express goal status Q XXX 09G9164 Lang express d/c status Q XXX 09G9165 Atten current status Q XXX 09G9166 Atten goal status Q XXX 09G9167 Atten d/c status Q XXX 09G9168 Memory current status Q XXX 09G9169 Memory goal status Q XXX 09G9170 Memory d/c status Q XXX 09

G9171 Voice current status Q XXX 09G9172 Voice goal status Q XXX 09G9173 Voice d/c status Q XXX 09G9174 Speech lang current status Q XXX 09G9175 Speech lang goal status Q XXX 09G9176 Speech lang d/c status Q XXX 09G9186 Motor speech goal status Q XXX 09G9187 Bpci home visit A XXX 09G9188 Beta not given no reason M XXX 09G9189 Beta pres or already taking M XXX 09G9190 Medical reason for no beta M XXX 09G9191 Pt reason for no beta M XXX 09G9192 System reason for no beta M XXX 09G9196 Med reason for no ceph M XXX 09G9197 Order for ceph M XXX 09G9198 No order for ceph no reason M XXX 09G9203 Hep c rna done prior to med M XXX 09G9204 No reason for no hep c rna M XXX 09G9205 Hep c antiviral started M XXX 09G9206 Hep c therapy started M XXX 09G9207 Hep c genotype prior to med M XXX 09G9208 No reason for no hep c geno M XXX 09G9209 Hep c rna 4to12 wk after med M XXX 09G9210 No hepc rna after med docrsn M XXX 09G9211 No hepc rna after med no rsn M XXX 09G9212 Doc of dsm-iv init eval M XXX 09G9213 No doc of dsm-iv M XXX 09G9217 No pcp proph low cd4 norsn M XXX 09G9219 No oder pjp for med reason M XXX 09G9222 Pjp proph ordered low cd4 M XXX 09G9223 Pjp proph ordered cd4 low M XXX 09G9225 Norsn no foot exam M XXX 09G9226 3 comp foot exam completed M XXX 09G9227 Docrsn no care plan M XXX 09G9228 Gc chl syp documented M XXX 09G9229 Ptrsn no gc chl syp test M XXX 09G9230 Norsn for gc chl syp test M XXX 09G9231 Doc esrd dia trans preg M XXX 09G9232 Docrsn no comm comorb M XXX 09G9233 Tkr composite M XXX 09G9234 Tkr intent M XXX 09G9235 Gs mg composite M XXX 09G9236 Op rad mg composite M XXX 09G9237 Gs mg intent M XXX 09G9238 Op rad mg intent M XXX 09G9239 Docrsn for catheter M XXX 09G9240 Doc pt w cath maint dia M XXX 09G9241 Doc pt w out cath maint dia M XXX 09G9242 Doc viral load >=200 M XXX 09G9243 Doc viral load <200 M XXX 09

G9244 Antiviral not ordered M XXX 09G9245 Antiviral ordered M XXX 09G9246 No med visit in 24mo M XXX 09G9247 1 med visit in 24mo M XXX 09G9250 Doc of pain comfort 48hr M XXX 09G9251 Doc no pain comfort 48hr M XXX 09G9254 Doc pt dischg >2d M XXX 09G9255 Doc pt dischg <=2d M XXX 09G9256 Doc death after cas M XXX 09G9257 Doc stroke after cas M XXX 09G9258 Doc stroke after cea M XXX 09G9259 Doc surv no stroke after cas M XXX 09G9260 Doc death after cea M XXX 09G9261 Doc surv no stroke after cea M XXX 09G9262 Doc death in hosp aaa repair M XXX 09G9263 Doc surv in hosp aaa repair M XXX 09G9264 Docrsn for cath maint dia M XXX 09G9265 Doc cath >90d for maint dia M XXX 09G9266 Norsn pt cath >=90d M XXX 09G9267 Doc comp or mort w in 30d M XXX 09G9268 Doc comp or mort w in 90d M XXX 09G9269 Doc no comp or mort w in 30d M XXX 09G9270 Doc no comp or mort w in 90d M XXX 09G9273 Sys<140 and dia<90 M XXX 09G9274 Bp out of nrml limits M XXX 09G9275 Doc of non tobacco user M XXX 09G9276 Doc of tobacco user M XXX 09G9277 Doc daily aspirin or contra M XXX 09G9278 Doc no daily aspirin M XXX 09G9279 Pne scrn done doc vac done M XXX 09G9280 Pne not given norsn M XXX 09G9281 Pne scrn done doc not ind M XXX 09G9282 Doc medrsn no histo type M XXX 09G9283 Hist type doc on report M XXX 09G9284 No hist type doc on report M XXX 09G9285 Site not small cell lung ca M XXX 09G9286 Doc antibio order w in 7d M XXX 09G9287 No doc antibio order w in 7d M XXX 09G9288 Doc medrsn no hist type rpt M XXX 09G9289 Doc type nsm lung ca M XXX 09G9290 No doc type nsm lung ca M XXX 09G9291 Not nsm lung ca M XXX 09G9292 Medrsn no pt category M XXX 09G9293 No pt category on report M XXX 09G9294 Pt cat and thck on report M XXX 09G9295 Non cutaneous loc M XXX 09G9296 Doc share dec prior proc M XXX 09G9297 No doc share dec prior proc M XXX 09G9298 Eval risk vte card 30d prior M XXX 09G9299 No eval riskk vte card prior M XXX 09

G9300 Doc medrsn no compl antibio M XXX 09G9301 Doc compl inf antibio M XXX 09G9302 Norsn incomp inf antibio M XXX 09G9303 Norsn no pros info op rpt M XXX 09G9304 Pros info op rpt M XXX 09G9305 No interv req for leak M XXX 09G9306 Interv req for leak M XXX 09G9307 No ret for surg w in 30d M XXX 09G9308 Unplnd ret to surg w in 30d M XXX 09G9309 No unplnd hosp readm in 30d M XXX 09G9310 Unplnd hosp readm in 30d M XXX 09G9311 No surg site infection M XXX 09G9312 Surgical site infection M XXX 09G9313 Docrsn not first line amox M XXX 09G9314 Norsn not first line amox M XXX 09G9315 Doc first line amox M XXX 09G9316 Doc comm risk calc M XXX 09G9317 No doc comm risk calc M XXX 09G9318 Image std nomenclature M XXX 09G9319 Image not std nomenclature M XXX 09G9320 Medrsn no std nomenclature M XXX 09G9321 Doc count of ct in 12mo M XXX 09G9322 No doc count of ct in 12mo M XXX 09G9323 Mdrsn no doc cnt of ct M XXX 09G9324 Not all data norsn M XXX 09G9325 Medrsn no ct rpt to reg M XXX 09G9326 Norsn no ct rpt to reg M XXX 09G9327 Ct rpt to reg M XXX 09G9328 Medrsn no dicom format doc M XXX 09G9329 Norsn no dicom format doc M XXX 09G9340 Dicom format doc on rpt M XXX 09G9341 Srch for ct w in 12 mos M XXX 09G9342 No srch for ct in 12mo norsn M XXX 09G9343 Medrsn no dicom srch M XXX 09G9344 Sysrsn no dicom srch M XXX 09G9345 Follow up pulm nod M XXX 09G9346 No follow up pulm nod M XXX 09G9347 No follow up pulm nod norsn M XXX 09G9348 Docrsn no sinus ct dx M XXX 09G9349 Doc sinus ct 28d M XXX 09G9350 No doc sinus ct 28d or dx M XXX 09G9351 Doc >1 sinus ct w 90d dx M XXX 09G9352 Not >1 sinus ct w 90d dx M XXX 09G9353 Medrsn >1 sinus ct w 90d dx M XXX 09G9354 Norsn >1 sinus ct w 90d dx M XXX 09G9355 No early ind/delivery M XXX 09G9356 Early ind/delivery M XXX 09G9357 Pp eval/edu perf M XXX 09G9358 Pp eval/edu not perf M XXX 09G9359 Doc of neg or man pos tb scn M XXX 09

G9360 No doc of neg or man pos tb M XXX 09G9361 Med ind for induction M XXX 09G9362 Mac or pnb w/o genanes >60m M XXX 09G9363 Mac or pnb w/o genanes <60m M XXX 09G9364 Sinus caus bac inx M XXX 09G9365 1high risk med ord M XXX 09G9366 1high risk no ord M XXX 09G9367 2high risk med ord M XXX 09G9368 2high risk no ord M XXX 09G9369 Fill 2 rx antipsych M XXX 09G9370 Not fill 2 rx antipsych M XXX 09G9376 Contd ret attach at 6mth f/u M XXX 09G9377 No ret attach after 6mt M XXX 09G9378 Contd ret attach f/u vis M XXX 09G9379 No acheive flat ret 6mth M XXX 09G9380 Off assis eol iss M XXX 09G9381 Doc med reas no offer eol M XXX 09G9382 No off assis eol M XXX 09G9383 Recd scrn hcv infec M XXX 09G9384 Doc med reas no offer eol M XXX 09G9385 Doc pt reas not rec hcv srn M XXX 09G9386 Scrn hcv infec not recd M XXX 09G9389 Unpln rup post cap M XXX 09G9390 No unpln rup post cap M XXX 09G9391 Achv refrac +1d M XXX 09G9392 Not achv refrac +1d M XXX 09G9393 Ini phq9 >9 remiss <5 M XXX 09G9394 Dx bipol, death, nhres, hosp M XXX 09G9395 Ini phq9 >9 no remiss >=5 M XXX 09G9396 Ini phq9 >9 not assess M XXX 09G9399 Doc disc tx choices M XXX 09G9400 Doc reas no disc tx opt M XXX 09G9401 No disc tx choices M XXX 09G9402 Recd f/u w/in 30d disch M XXX 09G9403 Doc reas no 30 day f/u M XXX 09G9404 No 30 day f/u M XXX 09G9405 Recd f/u w/in 7d disch M XXX 09G9406 Doc reas no 7d f/u M XXX 09G9407 No 7d f/u M XXX 09G9408 Card tamp w/in 30d M XXX 09G9409 No card tamp e/in 30d M XXX 09G9410 Admit w/in 180d req remov M XXX 09G9411 No admit w/in 180d req remov M XXX 09G9412 Admit w/in 180d req surg rev M XXX 09G9413 No admit req surg rev M XXX 09G9414 1dose menig vac btwn 11 & 13 M XXX 09G9415 No 1dose meni vac btwn 11&13 M XXX 09G9416 Tdap or td or 1tet/dipth M XXX 09G9417 No tdap or td or 1tet/dipth M XXX 09G9418 Lungcx bx rpt docs class M XXX 09

G9419 Med reas no rpt histo type M XXX 09G9420 Spec site no lung M XXX 09G9421 Lung cx bx rpt no doc class M XXX 09G9422 Rpt doc class histo type M XXX 09G9423 Med reas rpt no histo type M XXX 09G9424 Site no lung or lung cx M XXX 09G9425 Spec rpt no doc class histo M XXX 09G9426 Impr med time edarr pain med M XXX 09G9427 No impro med time pain med M XXX 09G9428 Rpt pt cat and pt1 M XXX 09G9429 Doc med reas no pt cat M XXX 09G9430 Spec site no cutaneous M XXX 09G9431 No pt cat and pt1 M XXX 09G9432 Asth controlled M XXX 09G9433 Death, nhres, hospice M XXX 09G9434 Asth not controlled M XXX 09G9435 Asp presc disch M XXX 09G9436 Asp not presc doc reas M XXX 09G9437 Asp not presc disch M XXX 09G9438 P2y inhib presc M XXX 09G9439 P2y inhib not presc doc reas M XXX 09G9440 P2y inhib not presc M XXX 09G9441 Statin presc disch M XXX 09G9442 Statin not presc doc reas M XXX 09G9443 Statin not presc disch M XXX 09G9448 Born 1945-1965 M XXX 09G9449 Hx bld transf b/f 1992 M XXX 09G9450 Hx injec drug use M XXX 09G9451 1x scrn hcv infect M XXX 09G9452 Doc med reas no scrn hcv M XXX 09G9453 Pt reas no hcv infect M XXX 09G9454 No hcv infect srn M XXX 09G9455 Abd imag w/us, ct or mri M XXX 09G9456 Doc med pt reas no hcc scrn M XXX 09G9457 No abd imag w/o reason M XXX 09G9458 Tob user recd cess interv M XXX 09G9459 Tob non-user M XXX 09G9460 No tob assess or cess inter M XXX 09G9463 Sinusitis intent M XXX 09G9464 Sinusitis comp M XXX 09G9465 Aoe intent M XXX 09G9466 Aoe comp M XXX 09G9467 Recd cortico >=10mg/day >60d M XXX 09G9468 No recd cortico>=10mg/d >60d M XXX 09G9469 Rec cortico>60d or 1rx 600mg M XXX 09G9470 No rec cortico>60d 1rx 600mg M XXX 09G9471 W/in 2yr dxa not order M XXX 09G9472 No dxa no med hx no rv sx M XXX 09H0001 Alcohol and/or drug assess I XXX 09H0002 Alcohol and/or drug screenin I XXX 09

H0003 Alcohol and/or drug screenin I XXX 09H0004 Alcohol and/or drug services I XXX 09H0005 Alcohol and/or drug services I XXX 09H0006 Alcohol and/or drug services I XXX 09H0007 Alcohol and/or drug services I XXX 09H0008 Alcohol and/or drug services I XXX 09H0009 Alcohol and/or drug services I XXX 09H0010 Alcohol and/or drug services I XXX 09H0011 Alcohol and/or drug services I XXX 09H0012 Alcohol and/or drug services I XXX 09H0013 Alcohol and/or drug services I XXX 09H0014 Alcohol and/or drug services I XXX 09H0015 Alcohol and/or drug services I XXX 09H0016 Alcohol and/or drug services I XXX 09H0017 Alcohol and/or drug services I XXX 09H0018 Alcohol and/or drug services I XXX 09H0019 Alcohol and/or drug services I XXX 09H0020 Alcohol and/or drug services I XXX 09H0021 Alcohol and/or drug training I XXX 09H0022 Alcohol and/or drug interven I XXX 09H0023 Alcohol and/or drug outreach I XXX 09H0024 Alcohol and/or drug preventi I XXX 09H0025 Alcohol and/or drug preventi I XXX 09H0026 Alcohol and/or drug preventi I XXX 09H0027 Alcohol and/or drug preventi I XXX 09H0028 Alcohol and/or drug preventi I XXX 09H0029 Alcohol and/or drug preventi I XXX 09H0030 Alcohol and/or drug hotline I XXX 09H0031 Mh health assess by non-md I XXX 09H0032 Mh svc plan dev by non-md I XXX 09H0033 Oral med adm direct observe I XXX 09H0034 Med trng & support per 15min I XXX 09H0035 Mh partial hosp tx under 24h I XXX 09H0036 Comm psy face-face per 15min I XXX 09H0037 Comm psy sup tx pgm per diem I XXX 09H0038 Self-help/peer svc per 15min I XXX 09H0039 Asser com tx face-face/15min I XXX 09H0040 Assert comm tx pgm per diem I XXX 09H0041 Fos c chld non-ther per diem I XXX 09H0042 Fos c chld non-ther per mon I XXX 09H0043 Supported housing, per diem I XXX 09H0044 Supported housing, per month I XXX 09H0045 Respite not-in-home per diem I XXX 09H0046 Mental health service, nos I XXX 09H0047 Alcohol/drug abuse svc nos I XXX 09H0048 Spec coll non-blood:a/d test I XXX 09H0049 Alcohol/drug screening I XXX 09H0050 Alcohol/drug service 15 min I XXX 09H1000 Prenatal care atrisk assessm I XXX 09H1001 Antepartum management I XXX 09

H1002 Carecoordination prenatal I XXX 09H1003 Prenatal at risk education I XXX 09H1004 Follow up home visit/prental I XXX 09H1005 Prenatalcare enhanced srv pk I XXX 09H1010 Nonmed family planning ed I XXX 09H1011 Family assessment I XXX 09H2000 Comp multidisipln evaluation I XXX 09H2001 Rehabilitation program 1/2 d I XXX 09H2010 Comprehensive med svc 15 min I XXX 09H2011 Crisis interven svc, 15 min I XXX 09H2012 Behav hlth day treat, per hr I XXX 09H2013 Psych hlth fac svc, per diem I XXX 09H2014 Skills train and dev, 15 min I XXX 09H2015 Comp comm supp svc, 15 min I XXX 09H2016 Comp comm supp svc, per diem I XXX 09H2017 Psysoc rehab svc, per 15 min I XXX 09H2018 Psysoc rehab svc, per diem I XXX 09H2019 Ther behav svc, per 15 min I XXX 09H2020 Ther behav svc, per diem I XXX 09H2021 Com wrap-around sv, 15 min I XXX 09H2022 Com wrap-around sv, per diem I XXX 09H2023 Supported employ, per 15 min I XXX 09H2024 Supported employ, per diem I XXX 09H2025 Supp maint employ, 15 min I XXX 09H2026 Supp maint employ, per diem I XXX 09H2027 Psychoed svc, per 15 min I XXX 09H2028 Sex offend tx svc, 15 min I XXX 09H2029 Sex offend tx svc, per diem I XXX 09H2030 Mh clubhouse svc, per 15 min I XXX 09H2031 Mh clubhouse svc, per diem I XXX 09H2032 Activity therapy, per 15 min I XXX 09H2033 Multisys ther/juvenile 15min I XXX 09H2034 A/d halfway house, per diem I XXX 09H2035 A/d tx program, per hour I XXX 09H2036 A/d tx program, per diem I XXX 09H2037 Dev delay prev dp ch, 15 min I XXX 09J0120 Tetracyclin injection E XXX 09J0129 Abatacept injection E XXX 09J0130 Abciximab injection E XXX 09J0131 Acetaminophen injection E XXX 09J0132 Acetylcysteine injection E XXX 09J0133 Acyclovir injection E XXX 09J0135 Adalimumab injection E XXX 09J0153 Adenosine inj 1mg E XXX 09J0171 Adrenalin epinephrine inject E XXX 09J0178 Aflibercept injection E XXX 09J0180 Agalsidase beta injection E XXX 09J0190 Inj biperiden lactate/5 mg E XXX 09J0200 Alatrofloxacin mesylate E XXX 09J0205 Alglucerase injection E XXX 09

J0207 Amifostine E XXX 09J0210 Methyldopate hcl injection E XXX 09J0215 Alefacept E XXX 09J0220 Alglucosidase alfa injection E XXX 09J0221 Lumizyme injection E XXX 09J0256 Alpha 1 proteinase inhibitor E XXX 09J0257 Glassia injection E XXX 09J0270 Alprostadil for injection E XXX 09J0275 Alprostadil urethral suppos E XXX 09J0278 Amikacin sulfate injection E XXX 09J0280 Aminophyllin 250 mg inj E XXX 09J0282 Amiodarone hcl E XXX 09J0285 Amphotericin b E XXX 09J0287 Amphotericin b lipid complex E XXX 09J0288 Ampho b cholesteryl sulfate E XXX 09J0289 Amphotericin b liposome inj E XXX 09J0290 Ampicillin 500 mg inj E XXX 09J0295 Ampicillin sodium per 1.5 gm E XXX 09J0300 Amobarbital 125 mg inj E XXX 09J0330 Succinycholine chloride inj E XXX 09J0348 Anidulafungin injection E XXX 09J0350 Injection anistreplase 30 u E XXX 09J0360 Hydralazine hcl injection E XXX 09J0364 Apomorphine hydrochloride E XXX 09J0365 Aprotonin, 10,000 kiu E XXX 09J0380 Inj metaraminol bitartrate E XXX 09J0390 Chloroquine injection E XXX 09J0395 Arbutamine hcl injection E XXX 09J0400 Aripiprazole injection E XXX 09J0401 Inj aripiprazole ext rel 1mg E XXX 09J0456 Azithromycin E XXX 09J0461 Atropine sulfate injection E XXX 09J0470 Dimecaprol injection E XXX 09J0475 Baclofen 10 mg injection E XXX 09J0476 Baclofen intrathecal trial E XXX 09J0480 Basiliximab E XXX 09J0485 Belatacept injection E XXX 09J0490 Belimumab injection E XXX 09J0500 Dicyclomine injection E XXX 09J0515 Inj benztropine mesylate E XXX 09J0520 Bethanechol chloride inject E XXX 09J0558 Peng benzathine/procaine inj E XXX 09J0561 Penicillin g benzathine inj E XXX 09J0571 Buprenorphine oral 1mg E XXX 09J0572 Buprenorphin/nalox up to 3mg E XXX 09J0573 Buprenorph/nalox 3.1 to 6mg E XXX 09J0574 Buprenorph/nalox 6.1 to 10mg E XXX 09J0575 Buprenorph/nalox over 10mg E XXX 09J0583 Bivalirudin E XXX 09J0585 Injection,onabotulinumtoxina E XXX 09

J0586 Abobotulinumtoxina E XXX 09J0587 Inj, rimabotulinumtoxinb E XXX 09J0588 Incobotulinumtoxin a E XXX 09J0592 Buprenorphine hydrochloride E XXX 09J0594 Busulfan injection E XXX 09J0595 Butorphanol tartrate 1 mg E XXX 09J0597 C-1 esterase, berinert E XXX 09J0598 C-1 esterase, cinryze E XXX 09J0600 Edetate calcium disodium inj E XXX 09J0610 Calcium gluconate injection E XXX 09J0620 Calcium glycer & lact/10 ml E XXX 09J0630 Calcitonin salmon injection E XXX 09J0636 Inj calcitriol per 0.1 mcg E XXX 09J0637 Caspofungin acetate E XXX 09J0638 Canakinumab injection E XXX 09J0640 Leucovorin calcium injection E XXX 09J0641 Levoleucovorin injection E XXX 09J0670 Inj mepivacaine hcl/10 ml E XXX 09J0690 Cefazolin sodium injection E XXX 09J0692 Cefepime hcl for injection E XXX 09J0694 Cefoxitin sodium injection E XXX 09J0696 Ceftriaxone sodium injection E XXX 09J0697 Sterile cefuroxime injection E XXX 09J0698 Cefotaxime sodium injection E XXX 09J0702 Betamethasone acet&sod phosp E XXX 09J0706 Caffeine citrate injection E XXX 09J0710 Cephapirin sodium injection E XXX 09J0712 Ceftaroline fosamil inj E XXX 09J0713 Inj ceftazidime per 500 mg E XXX 09J0715 Ceftizoxime sodium / 500 mg E XXX 09J0716 Centruroides immune f(ab) E XXX 09J0717 Certolizumab pegol inj 1mg E XXX 09J0720 Chloramphenicol sodium injec E XXX 09J0725 Chorionic gonadotropin/1000u E XXX 09J0735 Clonidine hydrochloride E XXX 09J0740 Cidofovir injection E XXX 09J0743 Cilastatin sodium injection E XXX 09J0744 Ciprofloxacin iv E XXX 09J0745 Inj codeine phosphate /30 mg E XXX 09J0760 Colchicine injection E XXX 09J0770 Colistimethate sodium inj E XXX 09J0775 Collagenase, clost hist inj E XXX 09J0780 Prochlorperazine injection E XXX 09J0795 Corticorelin ovine triflutal E XXX 09J0800 Corticotropin injection E XXX 09J0833 Cosyntropin injection nos E XXX 09J0834 Cosyntropin cortrosyn inj E XXX 09J0840 Crotalidae poly immune fab E XXX 09J0850 Cytomegalovirus imm iv /vial E XXX 09J0878 Daptomycin injection E XXX 09

J0881 Darbepoetin alfa, non-esrd E XXX 09J0882 Darbepoetin alfa, esrd use E XXX 09J0885 Epoetin alfa, non-esrd E XXX 09J0886 Epoetin alfa 1000 units esrd E XXX 09J0887 Epoetin beta esrd use E XXX 09J0888 Epoetin beta non esrd E XXX 09J0890 Peginesatide injection E XXX 09J0894 Decitabine injection E XXX 09J0895 Deferoxamine mesylate inj E XXX 09J0897 Denosumab injection E XXX 09J0945 Brompheniramine maleate inj E XXX 09J1000 Depo-estradiol cypionate inj E XXX 09J1020 Methylprednisolone 20 mg inj E XXX 09J1030 Methylprednisolone 40 mg inj E XXX 09J1040 Methylprednisolone 80 mg inj E XXX 09J1050 Medroxyprogesterone acetate E XXX 09J1071 Inj testosterone cypionate E XXX 09J1094 Inj dexamethasone acetate E XXX 09J1100 Dexamethasone sodium phos E XXX 09J1110 Inj dihydroergotamine mesylt E XXX 09J1120 Acetazolamid sodium injectio E XXX 09J1160 Digoxin injection E XXX 09J1162 Digoxin immune fab (ovine) E XXX 09J1165 Phenytoin sodium injection E XXX 09J1170 Hydromorphone injection E XXX 09J1180 Dyphylline injection E XXX 09J1190 Dexrazoxane hcl injection E XXX 09J1200 Diphenhydramine hcl injectio E XXX 09J1205 Chlorothiazide sodium inj E XXX 09J1212 Dimethyl sulfoxide 50% 50 ml E XXX 09J1230 Methadone injection E XXX 09J1240 Dimenhydrinate injection E XXX 09J1245 Dipyridamole injection E XXX 09J1250 Inj dobutamine hcl/250 mg E XXX 09J1260 Dolasetron mesylate E XXX 09J1265 Dopamine injection E XXX 09J1267 Doripenem injection E XXX 09J1270 Injection, doxercalciferol E XXX 09J1290 Ecallantide injection E XXX 09J1300 Eculizumab injection E XXX 09J1320 Amitriptyline injection E XXX 09J1322 Elosulfase alfa, injection E XXX 09J1324 Enfuvirtide injection E XXX 09J1325 Epoprostenol injection E XXX 09J1327 Eptifibatide injection E XXX 09J1330 Ergonovine maleate injection E XXX 09J1335 Ertapenem injection E XXX 09J1364 Erythro lactobionate /500 mg E XXX 09J1380 Estradiol valerate 10 mg inj E XXX 09J1410 Inj estrogen conjugate 25 mg E XXX 09

J1430 Ethanolamine oleate 100 mg E XXX 09J1435 Injection estrone per 1 mg E XXX 09J1436 Etidronate disodium inj E XXX 09J1438 Etanercept injection E XXX 09J1439 Inj ferric carboxymaltos 1mg E XXX 09J1442 Inj, filgrastim g-csf 1mcg E XXX 09J1446 Inj, tbo-filgrastim, 5 mcg E XXX 09J1450 Fluconazole E XXX 09J1451 Fomepizole, 15 mg E XXX 09J1452 Intraocular fomivirsen na E XXX 09J1453 Fosaprepitant injection E XXX 09J1455 Foscarnet sodium injection E XXX 09J1457 Gallium nitrate injection E XXX 09J1458 Galsulfase injection E XXX 09J1459 Inj ivig privigen 500 mg E XXX 09J1460 Gamma globulin 1 cc inj E XXX 09J1556 Inj, imm glob bivigam, 500mg E XXX 09J1557 Gammaplex injection E XXX 09J1559 Hizentra injection E XXX 09J1560 Gamma globulin > 10 cc inj E XXX 09J1561 Gamunex-c/gammaked E XXX 09J1562 Vivaglobin, inj E XXX 09J1566 Immune globulin, powder E XXX 09J1568 Octagam injection E XXX 09J1569 Gammagard liquid injection E XXX 09J1570 Ganciclovir sodium injection E XXX 09J1571 Hepagam b im injection E XXX 09J1572 Flebogamma injection E XXX 09J1573 Hepagam b intravenous, inj E XXX 09J1580 Garamycin gentamicin inj E XXX 09J1590 Gatifloxacin injection E XXX 09J1595 Injection glatiramer acetate E XXX 09J1599 Ivig non-lyophilized, nos E XXX 09J1600 Gold sodium thiomaleate inj E XXX 09J1602 Golimumab for iv use 1mg E XXX 09J1610 Glucagon hydrochloride/1 mg E XXX 09J1620 Gonadorelin hydroch/ 100 mcg E XXX 09J1626 Granisetron hcl injection E XXX 09J1630 Haloperidol injection E XXX 09J1631 Haloperidol decanoate inj E XXX 09J1640 Hemin, 1 mg E XXX 09J1642 Inj heparin sodium per 10 u E XXX 09J1644 Inj heparin sodium per 1000u E XXX 09J1645 Dalteparin sodium E XXX 09J1650 Inj enoxaparin sodium E XXX 09J1652 Fondaparinux sodium E XXX 09J1655 Tinzaparin sodium injection E XXX 09J1670 Tetanus immune globulin inj E XXX 09J1675 Histrelin acetate E XXX 09J1700 Hydrocortisone acetate inj E XXX 09

J1710 Hydrocortisone sodium ph inj E XXX 09J1720 Hydrocortisone sodium succ i E XXX 09J1725 Hydroxyprogesterone caproate E XXX 09J1730 Diazoxide injection E XXX 09J1740 Ibandronate sodium injection E XXX 09J1741 Ibuprofen injection E XXX 09J1742 Ibutilide fumarate injection E XXX 09J1743 Idursulfase injection E XXX 09J1744 Icatibant injection E XXX 09J1745 Infliximab injection E XXX 09J1750 Inj iron dextran E XXX 09J1756 Iron sucrose injection E XXX 09J1786 Imuglucerase injection E XXX 09J1790 Droperidol injection E XXX 09J1800 Propranolol injection E XXX 09J1810 Droperidol/fentanyl inj E XXX 09J1815 Insulin injection E XXX 09J1817 Insulin for insulin pump use E XXX 09J1826 Interferon beta-1a inj I XXX 09J1830 Interferon beta-1b / .25 mg E XXX 09J1835 Itraconazole injection E XXX 09J1840 Kanamycin sulfate 500 mg inj E XXX 09J1850 Kanamycin sulfate 75 mg inj E XXX 09J1885 Ketorolac tromethamine inj E XXX 09J1890 Cephalothin sodium injection E XXX 09J1930 Lanreotide injection E XXX 09J1931 Laronidase injection E XXX 09J1940 Furosemide injection E XXX 09J1945 Lepirudin E XXX 09J1950 Leuprolide acetate /3.75 mg E XXX 09J1953 Levetiracetam injection E XXX 09J1955 Inj levocarnitine per 1 gm E XXX 09J1956 Levofloxacin injection E XXX 09J1960 Levorphanol tartrate inj E XXX 09J1980 Hyoscyamine sulfate inj E XXX 09J1990 Chlordiazepoxide injection E XXX 09J2001 Lidocaine injection E XXX 09J2010 Lincomycin injection E XXX 09J2020 Linezolid injection E XXX 09J2060 Lorazepam injection E XXX 09J2150 Mannitol injection E XXX 09J2170 Mecasermin injection E XXX 09J2175 Meperidine hydrochl /100 mg E XXX 09J2180 Meperidine/promethazine inj E XXX 09J2185 Meropenem E XXX 09J2210 Methylergonovin maleate inj E XXX 09J2212 Methylnaltrexone injection E XXX 09J2248 Micafungin sodium injection E XXX 09J2250 Inj midazolam hydrochloride E XXX 09J2260 Inj milrinone lactate / 5 mg E XXX 09

J2265 Minocycline hydrochloride E XXX 09J2270 Morphine sulfate injection E XXX 09J2274 In morphine preservativ free E XXX 09J2278 Ziconotide injection E XXX 09J2280 Inj, moxifloxacin 100 mg E XXX 09J2300 Inj nalbuphine hydrochloride E XXX 09J2310 Inj naloxone hydrochloride E XXX 09J2315 Naltrexone, depot form E XXX 09J2320 Nandrolone decanoate 50 mg E XXX 09J2323 Natalizumab injection E XXX 09J2325 Nesiritide injection E XXX 09J2353 Octreotide injection, depot E XXX 09J2354 Octreotide inj, non-depot E XXX 09J2355 Oprelvekin injection E XXX 09J2357 Omalizumab injection E XXX 09J2358 Olanzapine long-acting inj E XXX 09J2360 Orphenadrine injection E XXX 09J2370 Phenylephrine hcl injection E XXX 09J2400 Chloroprocaine hcl injection E XXX 09J2405 Ondansetron hcl injection E XXX 09J2410 Oxymorphone hcl injection E XXX 09J2425 Palifermin injection E XXX 09J2426 Paliperidone palmitate inj E XXX 09J2430 Pamidronate disodium /30 mg E XXX 09J2440 Papaverin hcl injection E XXX 09J2460 Oxytetracycline injection E XXX 09J2469 Palonosetron hcl E XXX 09J2501 Paricalcitol E XXX 09J2503 Pegaptanib sodium injection E XXX 09J2504 Pegademase bovine, 25 iu E XXX 09J2505 Injection, pegfilgrastim 6mg E XXX 09J2507 Pegloticase injection E XXX 09J2510 Penicillin g procaine inj E XXX 09J2513 Pentastarch 10% solution E XXX 09J2515 Pentobarbital sodium inj E XXX 09J2540 Penicillin g potassium inj E XXX 09J2543 Piperacillin/tazobactam E XXX 09J2545 Pentamidine non-comp unit E XXX 09J2550 Promethazine hcl injection E XXX 09J2560 Phenobarbital sodium inj E XXX 09J2562 Plerixafor injection E XXX 09J2590 Oxytocin injection E XXX 09J2597 Inj desmopressin acetate E XXX 09J2650 Prednisolone acetate inj E XXX 09J2670 Totazoline hcl injection E XXX 09J2675 Inj progesterone per 50 mg E XXX 09J2680 Fluphenazine decanoate 25 mg E XXX 09J2690 Procainamide hcl injection E XXX 09J2700 Oxacillin sodium injeciton E XXX 09J2704 Inj, propofol, 10 mg E XXX 09

J2710 Neostigmine methylslfte inj E XXX 09J2720 Inj protamine sulfate/10 mg E XXX 09J2724 Protein c concentrate E XXX 09J2725 Inj protirelin per 250 mcg E XXX 09J2730 Pralidoxime chloride inj E XXX 09J2760 Phentolaine mesylate inj E XXX 09J2765 Metoclopramide hcl injection E XXX 09J2770 Quinupristin/dalfopristin E XXX 09J2778 Ranibizumab injection E XXX 09J2780 Ranitidine hydrochloride inj E XXX 09J2783 Rasburicase E XXX 09J2785 Regadenoson injection E XXX 09J2788 Rho d immune globulin 50 mcg E XXX 09J2790 Rho d immune globulin inj E XXX 09J2791 Rhophylac injection E XXX 09J2792 Rho(d) immune globulin h, sd E XXX 09J2793 Rilonacept injection E XXX 09J2794 Risperidone, long acting E XXX 09J2795 Ropivacaine hcl injection E XXX 09J2796 Romiplostim injection E XXX 09J2800 Methocarbamol injection E XXX 09J2805 Sincalide injection E XXX 09J2810 Inj theophylline per 40 mg E XXX 09J2820 Sargramostim injection E XXX 09J2850 Inj secretin synthetic human E XXX 09J2910 Aurothioglucose injeciton E XXX 09J2916 Na ferric gluconate complex E XXX 09J2920 Methylprednisolone injection E XXX 09J2930 Methylprednisolone injection E XXX 09J2940 Somatrem injection E XXX 09J2941 Somatropin injection E XXX 09J2950 Promazine hcl injection E XXX 09J2993 Reteplase injection E XXX 09J2995 Inj streptokinase /250000 iu E XXX 09J2997 Alteplase recombinant E XXX 09J3000 Streptomycin injection E XXX 09J3010 Fentanyl citrate injeciton E XXX 09J3030 Sumatriptan succinate / 6 mg E XXX 09J3060 Inj, taliglucerace alfa 10 u E XXX 09J3070 Pentazocine injection E XXX 09J3095 Telavancin injection E XXX 09J3101 Tenecteplase injection E XXX 09J3105 Terbutaline sulfate inj E XXX 09J3110 Teriparatide injection E XXX 09J3121 Inj testostero enanthate 1mg E XXX 09J3145 Testosterone undecanoate 1mg E XXX 09J3230 Chlorpromazine hcl injection E XXX 09J3240 Thyrotropin injection E XXX 09J3243 Tigecycline injection E XXX 09J3246 Tirofiban hcl E XXX 09

J3250 Trimethobenzamide hcl inj E XXX 09J3260 Tobramycin sulfate injection E XXX 09J3262 Tocilizumab injection E XXX 09J3265 Injection torsemide 10 mg/ml E XXX 09J3280 Thiethylperazine maleate inj E XXX 09J3285 Treprostinil injection E XXX 09J3300 Triamcinolone a inj prs-free E XXX 09J3301 Triamcinolone acet inj nos E XXX 09J3302 Triamcinolone diacetate inj E XXX 09J3303 Triamcinolone hexacetonl inj E XXX 09J3305 Inj trimetrexate glucoronate E XXX 09J3310 Perphenazine injeciton E XXX 09J3315 Triptorelin pamoate E XXX 09J3320 Spectinomycn di-hcl inj E XXX 09J3350 Urea injection E XXX 09J3355 Urofollitropin, 75 iu E XXX 09J3357 Ustekinumab injection E XXX 09J3360 Diazepam injection E XXX 09J3364 Urokinase 5000 iu injection E XXX 09J3365 Urokinase 250,000 iu inj E XXX 09J3370 Vancomycin hcl injection E XXX 09J3385 Velaglucerase alfa E XXX 09J3396 Verteporfin injection E XXX 09J3400 Triflupromazine hcl inj E XXX 09J3410 Hydroxyzine hcl injection E XXX 09J3411 Thiamine hcl 100 mg E XXX 09J3415 Pyridoxine hcl 100 mg E XXX 09J3420 Vitamin b12 injection E XXX 09J3430 Vitamin k phytonadione inj E XXX 09J3465 Injection, voriconazole E XXX 09J3470 Hyaluronidase injection E XXX 09J3471 Ovine, up to 999 usp units E XXX 09J3472 Ovine, 1000 usp units E XXX 09J3473 Hyaluronidase recombinant E XXX 09J3475 Inj magnesium sulfate E XXX 09J3480 Inj potassium chloride E XXX 09J3485 Zidovudine E XXX 09J3486 Ziprasidone mesylate E XXX 09J3489 Zoledronic acid 1mg E XXX 09J3490 Drugs unclassified injection E XXX 09J3520 Edetate disodium per 150 mg N XXX 09J3530 Nasal vaccine inhalation E XXX 09J3535 Metered dose inhaler drug N XXX 09J3570 Laetrile amygdalin vit b17 N XXX 09J3590 Unclassified biologics E XXX 09J7030 Normal saline solution infus E XXX 09J7040 Normal saline solution infus E XXX 09J7042 5% dextrose/normal saline E XXX 09J7050 Normal saline solution infus E XXX 09J7060 5% dextrose/water E XXX 09

J7070 D5w infusion E XXX 09J7100 Dextran 40 infusion E XXX 09J7110 Dextran 75 infusion E XXX 09J7120 Ringers lactate infusion E XXX 09J7131 Hypertonic saline sol E XXX 09J7178 Human fibrinogen conc inj E XXX 09J7180 Factor xiii anti-hem factor E XXX 09J7181 Factor xiii recomb a-subunit E XXX 09J7182 Factor viii recomb novoeight E XXX 09J7183 Wilate injection E XXX 09J7185 Xyntha inj E XXX 09J7186 Antihemophilic viii/vwf comp E XXX 09J7187 Humate-p, inj E XXX 09J7189 Factor viia E XXX 09J7190 Factor viii X XXX 09J7191 Factor viii (porcine) X XXX 09J7192 Factor viii recombinant nos X XXX 09J7193 Factor ix non-recombinant X XXX 09J7194 Factor ix complex X XXX 09J7195 Factor ix recombinant nos X XXX 09J7196 Antithrombin recombinant E XXX 09J7197 Antithrombin iii injection X XXX 09J7198 Anti-inhibitor X XXX 09J7199 Hemophilia clot factor noc X XXX 09J7200 Factor ix recombinan rixubis E XXX 09J7201 Factor ix fc fusion recomb E XXX 09J7300 Intraut copper contraceptive N XXX 09J7301 Levonorgestrel iu 13.5 mg N XXX 09J7302 Levonorgestrel iu 52 mg N XXX 09J7303 Contraceptive vaginal ring N XXX 09J7304 Contraceptive hormone patch N XXX 09J7306 Levonorgestrel implant sys I XXX 09J7307 Etonogestrel implant system I XXX 09J7308 Aminolevulinic acid hcl top E XXX 09J7309 Methyl aminolevulinate, top E XXX 09J7310 Ganciclovir long act implant E XXX 09J7311 Fluocinolone acetonide implt E XXX 09J7312 Dexamethasone intra implant E XXX 09J7315 Ophthalmic mitomycin E XXX 09J7316 Inj, ocriplasmin, 0.125 mg E XXX 09J7321 Hyalgan/supartz inj per dose E XXX 09J7323 Euflexxa inj per dose E XXX 09J7324 Orthovisc inj per dose E XXX 09J7325 Synvisc or synvisc-one E XXX 09J7326 Gel-one E XXX 09J7327 Monovisc inj per dose E XXX 09J7330 Cultured chondrocytes implnt E XXX 09J7336 Capsaicin 8% patch E XXX 09J7500 Azathioprine oral 50mg X XXX 09J7501 Azathioprine parenteral X XXX 09

J7502 Cyclosporine oral 100 mg E XXX 09J7504 Lymphocyte immune globulin X XXX 09J7505 Monoclonal antibodies X XXX 09J7506 Prednisone oral X XXX 09J7507 Tacrolimus imme rel oral 1mg E XXX 09J7508 Tacrolimus ex rel oral 0.1mg E XXX 09J7509 Methylprednisolone oral X XXX 09J7510 Prednisolone oral per 5 mg X XXX 09J7511 Antithymocyte globuln rabbit E XXX 09J7513 Daclizumab, parenteral E XXX 09J7515 Cyclosporine oral 25 mg E XXX 09J7516 Cyclosporin parenteral 250mg E XXX 09J7517 Mycophenolate mofetil oral E XXX 09J7518 Mycophenolic acid E XXX 09J7520 Sirolimus, oral E XXX 09J7525 Tacrolimus injection E XXX 09J7527 Oral everolimus E XXX 09J7599 Immunosuppressive drug noc X XXX 09J7604 Acetylcysteine comp unit E XXX 09J7605 Arformoterol non-comp unit E XXX 09J7606 Formoterol fumarate, inh E XXX 09J7607 Levalbuterol comp con E XXX 09J7608 Acetylcysteine non-comp unit E XXX 09J7609 Albuterol comp unit E XXX 09J7610 Albuterol comp con E XXX 09J7611 Albuterol non-comp con E XXX 09J7612 Levalbuterol non-comp con E XXX 09J7613 Albuterol non-comp unit E XXX 09J7614 Levalbuterol non-comp unit E XXX 09J7615 Levalbuterol comp unit E XXX 09J7620 Albuterol ipratrop non-comp E XXX 09J7622 Beclomethasone comp unit E XXX 09J7624 Betamethasone comp unit E XXX 09J7626 Budesonide non-comp unit E XXX 09J7627 Budesonide comp unit E XXX 09J7628 Bitolterol mesylate comp con E XXX 09J7629 Bitolterol mesylate comp unt E XXX 09J7631 Cromolyn sodium noncomp unit E XXX 09J7632 Cromolyn sodium comp unit E XXX 09J7633 Budesonide non-comp con E XXX 09J7634 Budesonide comp con E XXX 09J7635 Atropine comp con E XXX 09J7636 Atropine comp unit E XXX 09J7637 Dexamethasone comp con E XXX 09J7638 Dexamethasone comp unit E XXX 09J7639 Dornase alfa non-comp unit E XXX 09J7640 Formoterol comp unit E XXX 09J7641 Flunisolide comp unit E XXX 09J7642 Glycopyrrolate comp con E XXX 09J7643 Glycopyrrolate comp unit E XXX 09

J7644 Ipratropium bromide non-comp E XXX 09J7645 Ipratropium bromide comp E XXX 09J7647 Isoetharine comp con E XXX 09J7648 Isoetharine non-comp con E XXX 09J7649 Isoetharine non-comp unit E XXX 09J7650 Isoetharine comp unit E XXX 09J7657 Isoproterenol comp con E XXX 09J7658 Isoproterenol non-comp con E XXX 09J7659 Isoproterenol non-comp unit E XXX 09J7660 Isoproterenol comp unit E XXX 09J7665 Mannitol for inhaler E XXX 09J7667 Metaproterenol comp con E XXX 09J7668 Metaproterenol non-comp con E XXX 09J7669 Metaproterenol non-comp unit E XXX 09J7670 Metaproterenol comp unit E XXX 09J7674 Methacholine chloride, neb E XXX 09J7676 Pentamidine comp unit dose E XXX 09J7680 Terbutaline sulf comp con E XXX 09J7681 Terbutaline sulf comp unit E XXX 09J7682 Tobramycin non-comp unit E XXX 09J7683 Triamcinolone comp con E XXX 09J7684 Triamcinolone comp unit E XXX 09J7685 Tobramycin comp unit E XXX 09J7686 Treprostinil, non-comp unit E XXX 09J7699 Inhalation solution for dme E XXX 09J7799 Non-inhalation drug for dme E XXX 09J8498 Antiemetic rectal/supp nos E XXX 09J8499 Oral prescrip drug non chemo N XXX 09J8501 Oral aprepitant E XXX 09J8510 Oral busulfan E XXX 09J8515 Cabergoline, oral 0.25mg N XXX 09J8520 Capecitabine, oral, 150 mg E XXX 09J8521 Capecitabine, oral, 500 mg E XXX 09J8530 Cyclophosphamide oral 25 mg E XXX 09J8540 Oral dexamethasone E XXX 09J8560 Etoposide oral 50 mg E XXX 09J8562 Oral fludarabine phosphate E XXX 09J8565 Gefitinib oral I XXX 09J8597 Antiemetic drug oral nos E XXX 09J8600 Melphalan oral 2 mg E XXX 09J8610 Methotrexate oral 2.5 mg E XXX 09J8650 Nabilone oral E XXX 09J8700 Temozolomide E XXX 09J8705 Topotecan oral E XXX 09J8999 Oral prescription drug chemo E XXX 09J9000 Doxorubicin hcl injection E XXX 09J9010 Alemtuzumab injection E XXX 09J9015 Aldesleukin injection E XXX 09J9017 Arsenic trioxide injection E XXX 09J9019 Erwinaze injection E XXX 09

J9020 Asparaginase, nos E XXX 09J9025 Azacitidine injection E XXX 09J9027 Clofarabine injection E XXX 09J9031 Bcg live intravesical vac E XXX 09J9033 Bendamustine injection E XXX 09J9035 Bevacizumab injection E XXX 09J9040 Bleomycin sulfate injection E XXX 09J9041 Bortezomib injection E XXX 09J9042 Brentuximab vedotin inj E XXX 09J9043 Cabazitaxel injection E XXX 09J9045 Carboplatin injection E XXX 09J9047 Injection, carfilzomib, 1 mg E XXX 09J9050 Carmustine injection E XXX 09J9055 Cetuximab injection E XXX 09J9060 Cisplatin 10 mg injection E XXX 09J9065 Inj cladribine per 1 mg E XXX 09J9070 Cyclophosphamide 100 mg inj E XXX 09J9098 Cytarabine liposome inj E XXX 09J9100 Cytarabine hcl 100 mg inj E XXX 09J9120 Dactinomycin injection E XXX 09J9130 Dacarbazine 100 mg inj E XXX 09J9150 Daunorubicin injection E XXX 09J9151 Daunorubicin citrate inj E XXX 09J9155 Degarelix injection E XXX 09J9160 Denileukin diftitox inj E XXX 09J9165 Diethylstilbestrol injection E XXX 09J9171 Docetaxel injection E XXX 09J9175 Elliotts b solution per ml E XXX 09J9178 Inj, epirubicin hcl, 2 mg E XXX 09J9179 Eribulin mesylate injection E XXX 09J9181 Etoposide injection E XXX 09J9185 Fludarabine phosphate inj E XXX 09J9190 Fluorouracil injection E XXX 09J9200 Floxuridine injection E XXX 09J9201 Gemcitabine hcl injection E XXX 09J9202 Goserelin acetate implant E XXX 09J9206 Irinotecan injection E XXX 09J9207 Ixabepilone injection E XXX 09J9208 Ifosfamide injection E XXX 09J9209 Mesna injection E XXX 09J9211 Idarubicin hcl injection E XXX 09J9212 Interferon alfacon-1 inj E XXX 09J9213 Interferon alfa-2a inj E XXX 09J9214 Interferon alfa-2b inj E XXX 09J9215 Interferon alfa-n3 inj E XXX 09J9216 Interferon gamma 1-b inj E XXX 09J9217 Leuprolide acetate suspnsion E XXX 09J9218 Leuprolide acetate injeciton E XXX 09J9219 Leuprolide acetate implant E XXX 09J9225 Vantas implant E XXX 09

J9226 Supprelin la implant E XXX 09J9228 Ipilimumab injection E XXX 09J9230 Mechlorethamine hcl inj E XXX 09J9245 Inj melphalan hydrochl 50 mg E XXX 09J9250 Methotrexate sodium inj E XXX 09J9260 Methotrexate sodium inj E XXX 09J9261 Nelarabine injection E XXX 09J9262 Inj, omacetaxine mep, 0.01mg E XXX 09J9263 Oxaliplatin E XXX 09J9264 Paclitaxel protein bound E XXX 09J9266 Pegaspargase injection E XXX 09J9267 Paclitaxel injection E XXX 09J9268 Pentostatin injection E XXX 09J9270 Plicamycin (mithramycin) inj E XXX 09J9280 Mitomycin injection E XXX 09J9293 Mitoxantrone hydrochl / 5 mg E XXX 09J9300 Gemtuzumab ozogamicin inj E XXX 09J9301 Obinutuzumab inj E XXX 09J9302 Ofatumumab injection E XXX 09J9303 Panitumumab injection E XXX 09J9305 Pemetrexed injection E XXX 09J9306 Injection, pertuzumab, 1 mg E XXX 09J9307 Pralatrexate injection E XXX 09J9310 Rituximab injection E XXX 09J9315 Romidepsin injection E XXX 09J9320 Streptozocin injection E XXX 09J9328 Temozolomide injection E XXX 09J9330 Temsirolimus injection E XXX 09J9340 Thiotepa injection E XXX 09J9351 Topotecan injection E XXX 09J9354 Inj, ado-trastuzumab emt 1mg E XXX 09J9355 Trastuzumab injection E XXX 09J9357 Valrubicin injection E XXX 09J9360 Vinblastine sulfate inj E XXX 09J9370 Vincristine sulfate 1 mg inj E XXX 09J9371 Inj, vincristine sul lip 1mg E XXX 09J9390 Vinorelbine tartrate inj E XXX 09J9395 Injection, fulvestrant E XXX 09J9400 Inj, ziv-aflibercept, 1mg E XXX 09J9600 Porfimer sodium injection E XXX 09J9999 Chemotherapy drug E XXX 09M0075 Cellular therapy N XXX 09M0076 Prolotherapy N XXX 09M0100 Intragastric hypothermia N XXX 09M0300 Iv chelationtherapy N XXX 09M0301 Fabric wrapping of aneurysm N XXX 09P2028 Cephalin floculation test X XXX 09P2029 Congo red blood test X XXX 09P2031 Hair analysis N XXX 09P2033 Blood thymol turbidity X XXX 09

P2038 Blood mucoprotein X XXX 09P3000 Screen pap by tech w md supv X XXX 09P3001 Screening pap smear by phys A XXX 09P7001 Culture bacterial urine I XXX 09P9010 Whole blood for transfusion E XXX 09P9011 Blood split unit E XXX 09P9012 Cryoprecipitate each unit E XXX 09P9016 Rbc leukocytes reduced E XXX 09P9017 Plasma 1 donor frz w/in 8 hr E XXX 09P9019 Platelets, each unit E XXX 09P9020 Plaelet rich plasma unit E XXX 09P9021 Red blood cells unit E XXX 09P9022 Washed red blood cells unit E XXX 09P9023 Frozen plasma, pooled, sd X XXX 09P9031 Platelets leukocytes reduced X XXX 09P9032 Platelets, irradiated X XXX 09P9033 Platelets leukoreduced irrad X XXX 09P9034 Platelets, pheresis X XXX 09P9035 Platelet pheres leukoreduced X XXX 09P9036 Platelet pheresis irradiated X XXX 09P9037 Plate pheres leukoredu irrad X XXX 09P9038 Rbc irradiated X XXX 09P9039 Rbc deglycerolized X XXX 09P9040 Rbc leukoreduced irradiated X XXX 09P9041 Albumin (human),5%, 50ml X XXX 09P9043 Plasma protein fract,5%,50ml X XXX 09P9044 Cryoprecipitatereducedplasma X XXX 09P9045 Albumin (human), 5%, 250 ml X XXX 09P9046 Albumin (human), 25%, 20 ml X XXX 09P9047 Albumin (human), 25%, 50ml X XXX 09P9048 Plasmaprotein fract,5%,250ml X XXX 09P9050 Granulocytes, pheresis unit X XXX 09P9051 Blood, l/r, cmv-neg X XXX 09P9052 Platelets, hla-m, l/r, unit X XXX 09P9053 Plt, pher, l/r cmv-neg, irr X XXX 09P9054 Blood, l/r, froz/degly/wash X XXX 09P9055 Plt, aph/pher, l/r, cmv-neg X XXX 09P9056 Blood, l/r, irradiated X XXX 09P9057 Rbc, frz/deg/wsh, l/r, irrad X XXX 09P9058 Rbc, l/r, cmv-neg, irrad X XXX 09P9059 Plasma, frz between 8-24hour X XXX 09P9060 Fr frz plasma donor retested X XXX 09P9603 One-way allow prorated miles X XXX 09P9604 One-way allow prorated trip X XXX 09P9612 Catheterize for urine spec X XXX 09P9615 Urine specimen collect mult X XXX 09Q0035 Cardiokymography A XXX 09Q0035 TC Cardiokymography A XXX 01Q0035 26 Cardiokymography A XXX 09Q0081 Infusion ther other than che E XXX 09

Q0083 Chemo by other than infusion E XXX 09Q0084 Chemotherapy by infusion E XXX 09Q0085 Chemo by both infusion and o E XXX 09Q0091 Obtaining screen pap smear A XXX 09Q0092 Set up port xray equipment A XXX 09Q0111 Wet mounts/ w preparations X XXX 09Q0112 Potassium hydroxide preps X XXX 09Q0113 Pinworm examinations X XXX 09Q0114 Fern test X XXX 09Q0115 Post-coital mucous exam X XXX 09Q0138 Ferumoxytol, non-esrd E XXX 09Q0139 Ferumoxytol, esrd use E XXX 09Q0144 Azithromycin dihydrate, oral N XXX 09Q0161 Chlorpromazine hcl 5mg oral E XXX 09Q0162 Ondansetron oral E XXX 09Q0163 Diphenhydramine hcl 50mg X XXX 09Q0164 Prochlorperazine maleate 5mg X XXX 09Q0166 Granisetron hcl 1 mg oral X XXX 09Q0167 Dronabinol 2.5mg oral X XXX 09Q0169 Promethazine hcl 12.5mg oral X XXX 09Q0173 Trimethobenzamide hcl 250mg X XXX 09Q0174 Thiethylperazine maleate10mg X XXX 09Q0175 Perphenazine 4mg oral X XXX 09Q0177 Hydroxyzine pamoate 25mg X XXX 09Q0180 Dolasetron mesylate oral X XXX 09Q0181 Unspecified oral anti-emetic X XXX 09Q0478 Power adapter, combo vad E XXX 09Q0479 Power module combo vad, rep E XXX 09Q0480 Driver pneumatic vad, rep E XXX 09Q0481 Microprcsr cu elec vad, rep E XXX 09Q0482 Microprcsr cu combo vad, rep E XXX 09Q0483 Monitor elec vad, rep E XXX 09Q0484 Monitor elec or comb vad rep E XXX 09Q0485 Monitor cable elec vad, rep E XXX 09Q0486 Mon cable elec/pneum vad rep E XXX 09Q0487 Leads any type vad, rep only E XXX 09Q0488 Pwr pack base elec vad, rep E XXX 09Q0489 Pwr pck base combo vad, rep E XXX 09Q0490 Emr pwr source elec vad, rep E XXX 09Q0491 Emr pwr source combo vad rep E XXX 09Q0492 Emr pwr cbl elec vad, rep E XXX 09Q0493 Emr pwr cbl combo vad, rep E XXX 09Q0494 Emr hd pmp elec/combo, rep E XXX 09Q0495 Charger elec/combo vad, rep E XXX 09Q0496 Battery elec/combo vad, rep E XXX 09Q0497 Bat clps elec/comb vad, rep E XXX 09Q0498 Holster elec/combo vad, rep E XXX 09Q0499 Belt/vest elec/combo vad rep E XXX 09Q0500 Filters elec/combo vad, rep E XXX 09Q0501 Shwr cov elec/combo vad, rep E XXX 09

Q0502 Mobility cart pneum vad, rep E XXX 09Q0503 Battery pneum vad replacemnt E XXX 09Q0504 Pwr adpt pneum vad, rep veh E XXX 09Q0506 Lith-ion batt elec/pneum vad E XXX 09Q0507 Misc sup/acc ext vad E XXX 09Q0508 Mis sup/acc imp vad E XXX 09Q0509 Mis sup/ac imp vad nopay med E XXX 09Q0510 Dispens fee immunosupressive E XXX 09Q0511 Sup fee antiem,antica,immuno E XXX 09Q0512 Px sup fee anti-can sub pres E XXX 09Q0513 Disp fee inhal drugs/30 days E XXX 09Q0514 Disp fee inhal drugs/90 days E XXX 09Q0515 Sermorelin acetate injection E XXX 09Q1004 Ntiol category 4 X XXX 09Q1005 Ntiol category 5 X XXX 09Q2004 Bladder calculi irrig sol E XXX 09Q2009 Fosphenytoin inj pe E XXX 09Q2017 Teniposide, 50 mg E XXX 09Q2026 Radiesse injection E XXX 09Q2028 Inj, sculptra, 0.5mg E XXX 09Q2034 Agriflu vaccine X XXX 09Q2035 Afluria vacc, 3 yrs & >, im X XXX 09Q2036 Flulaval vacc, 3 yrs & >, im X XXX 09Q2037 Fluvirin vacc, 3 yrs & >, im X XXX 09Q2038 Fluzone vacc, 3 yrs & >, im X XXX 09Q2039 Nos flu vacc, 3 yrs & >, im X XXX 09Q2043 Sipuleucel-t auto cd54+ E XXX 09Q2049 Imported lipodox inj E XXX 09Q2050 Doxorubicin inj 10mg E XXX 09Q2052 Ivig demo, services/supplies E XXX 09Q3001 Brachytherapy radioelements C XXX 09Q3014 Telehealth facility fee X XXX 09Q3027 Inj beta interferon im 1 mcg E XXX 09Q3028 Inj beta interferon sq 1 mcg I XXX 09Q3031 Collagen skin test B XXX 09Q4001 Cast sup body cast plaster X XXX 09Q4002 Cast sup body cast fiberglas X XXX 09Q4003 Cast sup shoulder cast plstr X XXX 09Q4004 Cast sup shoulder cast fbrgl X XXX 09Q4005 Cast sup long arm adult plst X XXX 09Q4006 Cast sup long arm adult fbrg X XXX 09Q4007 Cast sup long arm ped plster X XXX 09Q4008 Cast sup long arm ped fbrgls X XXX 09Q4009 Cast sup sht arm adult plstr X XXX 09Q4010 Cast sup sht arm adult fbrgl X XXX 09Q4011 Cast sup sht arm ped plaster X XXX 09Q4012 Cast sup sht arm ped fbrglas X XXX 09Q4013 Cast sup gauntlet plaster X XXX 09Q4014 Cast sup gauntlet fiberglass X XXX 09Q4015 Cast sup gauntlet ped plster X XXX 09

Q4016 Cast sup gauntlet ped fbrgls X XXX 09Q4017 Cast sup lng arm splint plst X XXX 09Q4018 Cast sup lng arm splint fbrg X XXX 09Q4019 Cast sup lng arm splnt ped p X XXX 09Q4020 Cast sup lng arm splnt ped f X XXX 09Q4021 Cast sup sht arm splint plst X XXX 09Q4022 Cast sup sht arm splint fbrg X XXX 09Q4023 Cast sup sht arm splnt ped p X XXX 09Q4024 Cast sup sht arm splnt ped f X XXX 09Q4025 Cast sup hip spica plaster X XXX 09Q4026 Cast sup hip spica fiberglas X XXX 09Q4027 Cast sup hip spica ped plstr X XXX 09Q4028 Cast sup hip spica ped fbrgl X XXX 09Q4029 Cast sup long leg plaster X XXX 09Q4030 Cast sup long leg fiberglass X XXX 09Q4031 Cast sup lng leg ped plaster X XXX 09Q4032 Cast sup lng leg ped fbrgls X XXX 09Q4033 Cast sup lng leg cylinder pl X XXX 09Q4034 Cast sup lng leg cylinder fb X XXX 09Q4035 Cast sup lngleg cylndr ped p X XXX 09Q4036 Cast sup lngleg cylndr ped f X XXX 09Q4037 Cast sup shrt leg plaster X XXX 09Q4038 Cast sup shrt leg fiberglass X XXX 09Q4039 Cast sup shrt leg ped plster X XXX 09Q4040 Cast sup shrt leg ped fbrgls X XXX 09Q4041 Cast sup lng leg splnt plstr X XXX 09Q4042 Cast sup lng leg splnt fbrgl X XXX 09Q4043 Cast sup lng leg splnt ped p X XXX 09Q4044 Cast sup lng leg splnt ped f X XXX 09Q4045 Cast sup sht leg splnt plstr X XXX 09Q4046 Cast sup sht leg splnt fbrgl X XXX 09Q4047 Cast sup sht leg splnt ped p X XXX 09Q4048 Cast sup sht leg splnt ped f X XXX 09Q4049 Finger splint, static X XXX 09Q4050 Cast supplies unlisted X XXX 09Q4051 Splint supplies misc X XXX 09Q4074 Iloprost non-comp unit dose E XXX 09Q4081 Epoetin alfa, 100 units esrd E XXX 09Q4082 Drug/bio noc part b drug cap E XXX 09Q4100 Skin substitute, nos E XXX 09Q4101 Apligraf E XXX 09Q4102 Oasis wound matrix E XXX 09Q4103 Oasis burn matrix E XXX 09Q4104 Integra bmwd E XXX 09Q4105 Integra drt E XXX 09Q4106 Dermagraft E XXX 09Q4107 Graftjacket E XXX 09Q4108 Integra matrix E XXX 09Q4110 Primatrix E XXX 09Q4111 Gammagraft E XXX 09

Q4112 Cymetra injectable E XXX 09Q4113 Graftjacket xpress E XXX 09Q4114 Integra flowable wound matri E XXX 09Q4115 Alloskin E XXX 09Q4116 Alloderm E XXX 09Q4117 Hyalomatrix E XXX 09Q4118 Matristem micromatrix E XXX 09Q4119 Matristem wound matrix E XXX 09Q4120 Matristem burn matrix E XXX 09Q4121 Theraskin E XXX 09Q4122 Dermacell E XXX 09Q4123 Alloskin E XXX 09Q4124 Oasis tri-layer wound matrix E XXX 09Q4125 Arthroflex E XXX 09Q4126 Memoderm/derma/tranz/integup E XXX 09Q4127 Talymed E XXX 09Q4128 Flexhd/allopatchhd/matrixhd E XXX 09Q4129 Unite biomatrix E XXX 09Q4130 Strattice tm E XXX 09Q4131 Epifix X XXX 09Q4132 Grafix core X XXX 09Q4133 Grafix prime X XXX 09Q4134 Hmatrix X XXX 09Q4135 Mediskin X XXX 09Q4136 Ezderm X XXX 09Q4137 Amnioexcel or biodexcel, 1cm E XXX 09Q4138 Biodfence dryflex, 1cm E XXX 09Q4139 Amnio or biodmatrix, inj 1cc E XXX 09Q4140 Biodfence 1cm E XXX 09Q4141 Alloskin ac, 1 cm E XXX 09Q4142 Xcm biologic tiss matrix 1cm E XXX 09Q4143 Repriza, 1cm E XXX 09Q4145 Epifix, inj, 1mg E XXX 09Q4146 Tensix, 1cm E XXX 09Q4147 Architect ecm px fx 1 sq cm E XXX 09Q4148 Neox 1k, 1cm E XXX 09Q4149 Excellagen, 0.1 cc E XXX 09Q4150 Allowrap ds or dry 1 sq cm E XXX 09Q4151 Amnioband, guardian 1 sq cm E XXX 09Q4152 Dermapure 1 square cm E XXX 09Q4153 Dermavest 1 square cm E XXX 09Q4154 Biovance 1 square cm E XXX 09Q4155 Neoxflo or clarixflo 1 mg E XXX 09Q4156 Neox 100 1 square cm E XXX 09Q4157 Revitalon 1 square cm E XXX 09Q4158 Marigen 1 square cm E XXX 09Q4159 Affinity1 square cm E XXX 09Q4160 Nushield 1 square cm E XXX 09Q5001 Hospice or home hlth in home E XXX 09Q5002 Hospice/home hlth in asst lv E XXX 09

Q5003 Hospice in lt/non-skilled nf E XXX 09Q5004 Hospice in snf E XXX 09Q5005 Hospice, inpatient hospital E XXX 09Q5006 Hospice in hospice facility E XXX 09Q5007 Hospice in ltch E XXX 09Q5008 Hospice in inpatient psych E XXX 09Q5009 Hospice/home hlth, place nos E XXX 09Q5010 Hospice home care in hospice E XXX 09Q9951 Locm >= 400 mg/ml iodine,1ml E XXX 09Q9953 Inj fe-based mr contrast,1ml E XXX 09Q9954 Oral mr contrast, 100 ml E XXX 09Q9955 Inj perflexane lip micros,ml E XXX 09Q9956 Inj octafluoropropane mic,ml E XXX 09Q9957 Inj perflutren lip micros,ml E XXX 09Q9958 Hocm <=149 mg/ml iodine, 1ml E XXX 09Q9959 Hocm 150-199mg/ml iodine,1ml E XXX 09Q9960 Hocm 200-249mg/ml iodine,1ml E XXX 09Q9961 Hocm 250-299mg/ml iodine,1ml E XXX 09Q9962 Hocm 300-349mg/ml iodine,1ml E XXX 09Q9963 Hocm 350-399mg/ml iodine,1ml E XXX 09Q9964 Hocm>= 400mg/ml iodine, 1ml E XXX 09Q9965 Locm 100-199mg/ml iodine,1ml E XXX 09Q9966 Locm 200-299mg/ml iodine,1ml E XXX 09Q9967 Locm 300-399mg/ml iodine,1ml E XXX 09Q9968 Visualization adjunct E XXX 09Q9969 Non-heu tc-99m add-on/dose E XXX 09R0070 Transport portable x-ray C XXX 09R0075 Transport port x-ray multipl C XXX 09R0076 Transport portable ekg B XXX 09S0012 Butorphanol tartrate, nasal I XXX 09S0014 Tacrine hydrochloride, 10 mg I XXX 09S0017 Injection, aminocaproic acid I XXX 09S0020 Injection, bupivicaine hydro I XXX 09S0021 Injection, cefoperazone sod I XXX 09S0023 Injection, cimetidine hydroc I XXX 09S0028 Injection, famotidine, 20 mg I XXX 09S0030 Injection, metronidazole I XXX 09S0032 Injection, nafcillin sodium I XXX 09S0034 Injection, ofloxacin, 400 mg I XXX 09S0039 Injection, sulfamethoxazole I XXX 09S0040 Injection, ticarcillin disod I XXX 09S0073 Injection, aztreonam, 500 mg I XXX 09S0074 Injection, cefotetan disodiu I XXX 09S0077 Injection, clindamycin phosp I XXX 09S0078 Injection, fosphenytoin sodi I XXX 09S0080 Injection, pentamidine iseth I XXX 09S0081 Injection, piperacillin sodi I XXX 09S0088 Imatinib 100 mg I XXX 09S0090 Sildenafil citrate, 25 mg I XXX 09S0091 Granisetron 1mg I XXX 09

S0092 Hydromorphone 250 mg I XXX 09S0093 Morphine 500 mg I XXX 09S0104 Zidovudine, oral, 100 mg I XXX 09S0106 Bupropion hcl sr 60 tablets I XXX 09S0108 Mercaptopurine 50 mg I XXX 09S0109 Methadone oral 5mg I XXX 09S0117 Tretinoin topical 5 g I XXX 09S0119 Ondansetron 4 mg I XXX 09S0122 Inj menotropins 75 iu I XXX 09S0126 Inj follitropin alfa 75 iu I XXX 09S0128 Inj follitropin beta 75 iu I XXX 09S0132 Inj ganirelix acetat 250 mcg I XXX 09S0136 Clozapine, 25 mg I XXX 09S0137 Didanosine, 25 mg I XXX 09S0138 Finasteride, 5 mg I XXX 09S0139 Minoxidil, 10 mg I XXX 09S0140 Saquinavir, 200 mg I XXX 09S0142 Colistimethate inh sol mg I XXX 09S0145 Peg interferon alfa-2a/180 I XXX 09S0148 Peg interferon alfa-2b/10 I XXX 09S0155 Epoprostenol dilutant I XXX 09S0156 Exemestane, 25 mg I XXX 09S0157 Becaplermin gel 1%, 0.5 gm I XXX 09S0160 Dextroamphetamine I XXX 09S0164 Injection pantroprazole I XXX 09S0166 Inj olanzapine 2.5mg I XXX 09S0169 Calcitrol I XXX 09S0170 Anastrozole 1 mg I XXX 09S0171 Bumetanide 0.5 mg I XXX 09S0172 Chlorambucil 2 mg I XXX 09S0174 Dolasetron 50 mg I XXX 09S0175 Flutamide 125 mg I XXX 09S0176 Hydroxyurea 500 mg I XXX 09S0177 Levamisole 50 mg I XXX 09S0178 Lomustine 10 mg I XXX 09S0179 Megestrol 20 mg I XXX 09S0182 Procarbazine, oral I XXX 09S0183 Prochlorperazine 5 mg I XXX 09S0187 Tamoxifen 10 mg I XXX 09S0189 Testosterone pellet 75 mg I XXX 09S0190 Mifepristone, oral, 200 mg I XXX 09S0191 Misoprostol, oral, 200 mcg I XXX 09S0194 Vitamin suppl 100 caps I XXX 09S0195 Pneumo vaccine 5-9 yrs I XXX 09S0197 Prenatal vitamins 30 day I XXX 09S0199 Med abortion inc all ex drug I XXX 09S0201 Partial hospitalization serv I XXX 09S0207 Paramedicintercep nonhospals I XXX 09S0208 Paramed intrcept nonvol I XXX 09S0209 Wc van mileage per mi I XXX 09

S0215 Nonemerg transp mileage I XXX 09S0220 Medical conference by physic I XXX 09S0221 Medical conference, 60 min I XXX 09S0250 Comp geriatr assmt team I XXX 09S0255 Hospice refer visit nonmd I XXX 09S0257 End of life counseling I XXX 09S0260 H&p for surgery I XXX 09S0265 Genetic counsel 15 mins I XXX 09S0270 Home std case rate 30 days I XXX 09S0271 Home hospice case 30 days I XXX 09S0272 Home episodic case 30 days I XXX 09S0273 Md home visit outside cap I XXX 09S0274 Nurse practr visit outs cap I XXX 09S0280 Medical home, initial plan I XXX 09S0281 Medical home, maintenance I XXX 09S0302 Completed epsdt I XXX 09S0310 Hospitalist visit I XXX 09S0315 Disease management program I XXX 09S0316 Follow-up/reassessment I XXX 09S0317 Disease mgmt per diem I XXX 09S0320 Rn telephone calls to dmp I XXX 09S0340 Lifestyle mod 1st stage I XXX 09S0341 Lifestyle mod 2 or 3 stage I XXX 09S0342 Lifestyle mod 4th stage I XXX 09S0353 Cancer treatmentplan initial I XXX 09S0354 Cancer treatment plan change I XXX 09S0390 Rout foot care per visit I XXX 09S0395 Impression casting ft I XXX 09S0400 Global eswl kidney I XXX 09S0500 Dispos cont lens I XXX 09S0504 Singl prscrp lens I XXX 09S0506 Bifoc prscp lens I XXX 09S0508 Trifoc prscrp lens I XXX 09S0510 Non-prscrp lens I XXX 09S0512 Daily cont lens I XXX 09S0514 Color cont lens I XXX 09S0515 Scleral lens liquid bandage I XXX 09S0516 Safety frames I XXX 09S0518 Sunglass frames I XXX 09S0580 Polycarb lens I XXX 09S0581 Nonstnd lens I XXX 09S0590 Misc integral lens serv I XXX 09S0592 Comp cont lens eval I XXX 09S0595 New lenses in pts old frame I XXX 09S0596 Phakic iol refractive error I XXX 09S0601 Screening proctoscopy I XXX 09S0610 Annual gynecological examina I XXX 09S0612 Annual gynecological examina I XXX 09S0613 Ann breast exam I XXX 09S0618 Audiometry for hearing aid I XXX 09

S0620 Routine ophthalmological exa I XXX 09S0621 Routine ophthalmological exa I XXX 09S0622 Phys exam for college I XXX 09S0630 Removal of sutures I XXX 09S0800 Laser in situ keratomileusis I XXX 09S0810 Photorefractive keratectomy I XXX 09S0812 Phototherap keratect I XXX 09S0832 Low dose ct lung screening I XXX 09S1001 Deluxe item I XXX 09S1002 Custom item I XXX 09S1015 Iv tubing extension set I XXX 09S1016 Non-pvc intravenous administ I XXX 09S1030 Gluc monitor purchase I XXX 09S1031 Gluc monitor rental I XXX 09S1034 Art pancreas system I XXX 09S1035 Art pancreas inv disp sensor I XXX 09S1036 Art pancreas ext transmitter I XXX 09S1037 Art pancreas ext receiver I XXX 09S1040 Cranial remolding orthosis I XXX 09S1090 Mometasone sinus implant I XXX 09S2053 Transplantation of small int I XXX 09S2054 Transplantation of multivisc I XXX 09S2055 Harvesting of donor multivis I XXX 09S2060 Lobar lung transplantation I XXX 09S2061 Donor lobectomy (lung) I XXX 09S2065 Simult panc kidn trans I XXX 09S2066 Breast gap flap reconst I XXX 09S2067 Breast "stacked" diep/gap I XXX 09S2068 Breast diep or siea flap I XXX 09S2070 Cysto laser tx ureteral calc I XXX 09S2079 Lap esophagomyotomy I XXX 09S2080 Laup I XXX 09S2083 Adjustment gastric band I XXX 09S2095 Transcath emboliz microspher I XXX 09S2102 Islet cell tissue transplant I XXX 09S2103 Adrenal tissue transplant I XXX 09S2107 Adoptive immunotherapy I XXX 09S2112 Knee arthroscp harv I XXX 09S2115 Periacetabular osteotomy I XXX 09S2117 Arthroereisis, subtalar I XXX 09S2118 Total hip resurfacing I XXX 09S2120 Low density lipoprotein(ldl) I XXX 09S2140 Cord blood harvesting I XXX 09S2142 Cord blood-derived stem-cell I XXX 09S2150 Bmt harv/transpl 28d pkg I XXX 09S2152 Solid organ transpl pkg I XXX 09S2202 Echosclerotherapy I XXX 09S2205 Minimally invasive direct co I XXX 09S2206 Minimally invasive direct co I XXX 09S2207 Minimally invasive direct co I XXX 09

S2208 Minimally invasive direct co I XXX 09S2209 Minimally invasive direct co I XXX 09S2225 Myringotomy laser-assist I XXX 09S2230 Implant semi-imp hear I XXX 09S2235 Implant auditory brain imp I XXX 09S2260 Induced abortion 17-24 weeks I XXX 09S2265 Induced abortion 25-28 wks I XXX 09S2266 Induced abortion 29-31 wks I XXX 09S2267 Induced abortion 32 or more I XXX 09S2300 Arthroscopy, shoulder, surgi I XXX 09S2325 Hip core decompression I XXX 09S2340 Chemodenervation of abductor I XXX 09S2341 Chemodenerv adduct vocal I XXX 09S2342 Nasal endoscop po debrid I XXX 09S2348 Decompress disc rf lumbar I XXX 09S2350 Diskectomy, anterior, with d I XXX 09S2351 Diskectomy, anterior, with d I XXX 09S2360 Vertebroplast cerv 1st I XXX 09S2361 Vertebroplast cerv addl I XXX 09S2400 Fetal surg congen hernia I XXX 09S2401 Fetal surg urin trac obstr I XXX 09S2402 Fetal surg cong cyst malf I XXX 09S2403 Fetal surg pulmon sequest I XXX 09S2404 Fetal surg myelomeningo I XXX 09S2405 Fetal surg sacrococ teratoma I XXX 09S2409 Fetal surg noc I XXX 09S2411 Fetoscop laser ther ttts I XXX 09S2900 Robotic surgical system I XXX 09S3000 Bilat dil retinal exam I XXX 09S3005 Eval self-assess depression I XXX 09S3600 Stat lab I XXX 09S3601 Stat lab home/nf I XXX 09S3620 Newborn metabolic screening I XXX 09S3630 Eosinophil blood count I XXX 09S3645 Hiv-1 antibody testing of or I XXX 09S3650 Saliva test, hormone level; I XXX 09S3652 Saliva test, hormone level; I XXX 09S3655 Antisperm antibodies test I XXX 09S3708 Gastrointestinal fat absorpt I XXX 09S3721 Pca3 testing I XXX 09S3722 Dose optimization auc - 5fu I XXX 09S3800 Genetic testing als I XXX 09S3840 Dna analysis ret-oncogene I XXX 09S3841 Gene test retinoblastoma I XXX 09S3842 Gene test hippel-lindau I XXX 09S3844 Dna analysis deafness I XXX 09S3845 Gene test alpha-thalassemia I XXX 09S3846 Gene test beta-thalassemia I XXX 09S3849 Gene test niemann-pick I XXX 09S3850 Gene test sickle cell I XXX 09

S3852 Dna analysis apoe alzheimer I XXX 09S3853 Gene test myo musclr dyst I XXX 09S3854 Gene profile panel breast I XXX 09S3861 Genetic test brugada I XXX 09S3865 Comp genet test hyp cardiomy I XXX 09S3866 Spec gene test hyp cardiomy I XXX 09S3870 Cgh test developmental delay I XXX 09S3890 Fecal dna analysis I XXX 09S3900 Surface emg I XXX 09S3902 Ballistocardiogram I XXX 09S3904 Masters two step I XXX 09S4005 Interim labor facility globa I XXX 09S4011 Ivf package I XXX 09S4013 Compl gift case rate I XXX 09S4014 Compl zift case rate I XXX 09S4015 Complete ivf nos case rate I XXX 09S4016 Frozen ivf case rate I XXX 09S4017 Ivf canc a stim case rate I XXX 09S4018 F emb trns canc case rate I XXX 09S4020 Ivf canc a aspir case rate I XXX 09S4021 Ivf canc p aspir case rate I XXX 09S4022 Asst oocyte fert case rate I XXX 09S4023 Incompl donor egg case rate I XXX 09S4025 Donor serv ivf case rate I XXX 09S4026 Procure donor sperm I XXX 09S4027 Store prev froz embryos I XXX 09S4028 Microsurg epi sperm asp I XXX 09S4030 Sperm procure init visit I XXX 09S4031 Sperm procure subs visit I XXX 09S4035 Stimulated iui case rate I XXX 09S4037 Cryo embryo transf case rate I XXX 09S4040 Monit store cryo embryo 30 d I XXX 09S4042 Ovulation mgmt per cycle I XXX 09S4981 Insert levonorgestrel ius I XXX 09S4989 Contracept iud I XXX 09S4990 Nicotine patch legend I XXX 09S4991 Nicotine patch nonlegend I XXX 09S4993 Contraceptive pills for bc I XXX 09S4995 Smoking cessation gum I XXX 09S5000 Prescription drug, generic I XXX 09S5001 Prescription drug,brand name I XXX 09S5010 5% dextrose and 0.45% saline I XXX 09S5011 5% dextrose in lactated ring I XXX 09S5012 5% dextrose with potassium I XXX 09S5013 5%dextrose/0.45%saline1000ml I XXX 09S5014 D5w/0.45ns w kcl and mgs04 I XXX 09S5035 Hit routine device maint I XXX 09S5036 Hit device repair I XXX 09S5100 Adult daycare services 15min I XXX 09S5101 Adult day care per half day I XXX 09

S5102 Adult day care per diem I XXX 09S5105 Centerbased day care perdiem I XXX 09S5108 Homecare train pt 15 min I XXX 09S5109 Homecare train pt session I XXX 09S5110 Family homecare training 15m I XXX 09S5111 Family homecare train/sessio I XXX 09S5115 Nonfamily homecare train/15m I XXX 09S5116 Nonfamily hc train/session I XXX 09S5120 Chore services per 15 min I XXX 09S5121 Chore services per diem I XXX 09S5125 Attendant care service /15m I XXX 09S5126 Attendant care service /diem I XXX 09S5130 Homaker service nos per 15m I XXX 09S5131 Homemaker service nos /diem I XXX 09S5135 Adult companioncare per 15m I XXX 09S5136 Adult companioncare per diem I XXX 09S5140 Adult foster care per diem I XXX 09S5141 Adult foster care per month I XXX 09S5145 Child fostercare th per diem I XXX 09S5146 Ther fostercare child /month I XXX 09S5150 Unskilled respite care /15m I XXX 09S5151 Unskilled respitecare /diem I XXX 09S5160 Emer response sys instal&tst I XXX 09S5161 Emer rspns sys serv permonth I XXX 09S5162 Emer rspns system purchase I XXX 09S5165 Home modifications per serv I XXX 09S5170 Homedelivered prepared meal I XXX 09S5175 Laundry serv,ext,prof,/order I XXX 09S5180 Hh respiratory thrpy in eval I XXX 09S5181 Hh respiratory thrpy nos/day I XXX 09S5185 Med reminder serv per month I XXX 09S5190 Wellness assessment by nonph I XXX 09S5199 Personal care item nos each I XXX 09S5497 Hit cath care noc I XXX 09S5498 Hit simple cath care I XXX 09S5501 Hit complex cath care I XXX 09S5502 Hit interim cath care I XXX 09S5517 Hit declotting kit I XXX 09S5518 Hit cath repair kit I XXX 09S5520 Hit picc insert kit I XXX 09S5521 Hit midline cath insert kit I XXX 09S5522 Hit picc insert no supp I XXX 09S5523 Hip midline cath insert kit I XXX 09S5550 Insulin rapid 5 u I XXX 09S5551 Insulin most rapid 5 u I XXX 09S5552 Insulin intermed 5 u I XXX 09S5553 Insulin long acting 5 u I XXX 09S5560 Insulin reuse pen 1.5 ml I XXX 09S5561 Insulin reuse pen 3 ml I XXX 09S5565 Insulin cartridge 150 u I XXX 09

S5566 Insulin cartridge 300 u I XXX 09S5570 Insulin dispos pen 1.5 ml I XXX 09S5571 Insulin dispos pen 3 ml I XXX 09S8030 Tantalum ring application I XXX 09S8035 Magnetic source imaging I XXX 09S8037 Mrcp I XXX 09S8040 Topographic brain mapping I XXX 09S8042 Mri low field I XXX 09S8055 Us guidance fetal reduct I XXX 09S8080 Scintimammography I XXX 09S8085 Fluorine-18 fluorodeoxygluco I XXX 09S8092 Electron beam computed tomog I XXX 09S8096 Portable peak flow meter I XXX 09S8097 Asthma kit I XXX 09S8100 Spacer without mask I XXX 09S8101 Spacer with mask I XXX 09S8110 Peak expiratory flow rate (p I XXX 09S8120 O2 contents gas cubic ft I XXX 09S8121 O2 contents liquid lb I XXX 09S8130 Interferential stim 2 chan I XXX 09S8131 Interferential stim 4 chan I XXX 09S8185 Flutter device I XXX 09S8186 Swivel adaptor I XXX 09S8189 Trach supply noc I XXX 09S8210 Mucus trap I XXX 09S8262 Mandib ortho repos device I XXX 09S8265 Haberman feeder I XXX 09S8270 Enuresis alarm I XXX 09S8301 Infect control supplies nos I XXX 09S8415 Supplies for home delivery I XXX 09S8420 Custom gradient sleev/glov I XXX 09S8421 Ready gradient sleev/glov I XXX 09S8422 Custom grad sleeve med I XXX 09S8423 Custom grad sleeve heavy I XXX 09S8424 Ready gradient sleeve I XXX 09S8425 Custom grad glove med I XXX 09S8426 Custom grad glove heavy I XXX 09S8427 Ready gradient glove I XXX 09S8428 Ready gradient gauntlet I XXX 09S8429 Gradient pressure wrap I XXX 09S8430 Padding for comprssn bdg I XXX 09S8431 Compression bandage I XXX 09S8450 Splint digit I XXX 09S8451 Splint wrist or ankle I XXX 09S8452 Splint elbow I XXX 09S8460 Camisole post-mast I XXX 09S8490 100 insulin syringes I XXX 09S8930 Auricular electrostimulation I XXX 09S8940 Hippotherapy per session I XXX 09S8948 Low-level laser trmt 15 min I XXX 09

S8950 Complex lymphedema therapy, I XXX 09S8990 Pt or manip for maint I XXX 09S8999 Resuscitation bag I XXX 09S9001 Home uterine monitor with or I XXX 09S9007 Ultrafiltration monitor I XXX 09S9015 Automated eeg monitoring I XXX 09S9024 Paranasal sinus ultrasound I XXX 09S9025 Omnicardiogram/cardiointegra I XXX 09S9034 Eswl for gallstones I XXX 09S9055 Procuren or other growth fac I XXX 09S9056 Coma stimulation per diem I XXX 09S9061 Medical supplies and equipme I XXX 09S9083 Urgent care center global I XXX 09S9088 Services provided in urgent I XXX 09S9090 Vertebral axial decompressio I XXX 09S9097 Home visit wound care I XXX 09S9098 Home phototherapy visit I XXX 09S9110 Telemonitoring/home per mnth I XXX 09S9117 Back school visit I XXX 09S9122 Home health aide or certifie I XXX 09S9123 Nursing care in home rn I XXX 09S9124 Nursing care, in the home; b I XXX 09S9125 Respite care, in the home, p I XXX 09S9126 Hospice care, in the home, p I XXX 09S9127 Social work visit, in the ho I XXX 09S9128 Speech therapy, in the home, I XXX 09S9129 Occupational therapy, in the I XXX 09S9131 Pt in the home per diem I XXX 09S9140 Diabetic management program, I XXX 09S9141 Diabetic management program, I XXX 09S9145 Insulin pump initiation I XXX 09S9150 Evaluation by ocularist I XXX 09S9152 Speech therapy, re-eval I XXX 09S9208 Home mgmt preterm labor I XXX 09S9209 Home mgmt pprom I XXX 09S9211 Home mgmt gest hypertension I XXX 09S9212 Hm postpar hyper per diem I XXX 09S9213 Hm preeclamp per diem I XXX 09S9214 Hm gest dm per diem I XXX 09S9325 Hit pain mgmt per diem I XXX 09S9326 Hit cont pain per diem I XXX 09S9327 Hit int pain per diem I XXX 09S9328 Hit pain imp pump diem I XXX 09S9329 Hit chemo per diem I XXX 09S9330 Hit cont chem diem I XXX 09S9331 Hit intermit chemo diem I XXX 09S9335 Ht hemodialysis diem I XXX 09S9336 Hit cont anticoag diem I XXX 09S9338 Hit immunotherapy diem I XXX 09S9339 Hit periton dialysis diem I XXX 09

S9340 Hit enteral per diem I XXX 09S9341 Hit enteral grav diem I XXX 09S9342 Hit enteral pump diem I XXX 09S9343 Hit enteral bolus nurs I XXX 09S9345 Hit anti-hemophil diem I XXX 09S9346 Hit alpha-1-proteinas diem I XXX 09S9347 Hit longterm infusion diem I XXX 09S9348 Hit sympathomim diem I XXX 09S9349 Hit tocolysis diem I XXX 09S9351 Hit cont antiemetic diem I XXX 09S9353 Hit cont insulin diem I XXX 09S9355 Hit chelation diem I XXX 09S9357 Hit enzyme replace diem I XXX 09S9359 Hit anti-tnf per diem I XXX 09S9361 Hit diuretic infus diem I XXX 09S9363 Hit anti-spasmotic diem I XXX 09S9364 Hit tpn total diem I XXX 09S9365 Hit tpn 1 liter diem I XXX 09S9366 Hit tpn 2 liter diem I XXX 09S9367 Hit tpn 3 liter diem I XXX 09S9368 Hit tpn over 3l diem I XXX 09S9370 Ht inj antiemetic diem I XXX 09S9372 Ht inj anticoag diem I XXX 09S9373 Hit hydra total diem I XXX 09S9374 Hit hydra 1 liter diem I XXX 09S9375 Hit hydra 2 liter diem I XXX 09S9376 Hit hydra 3 liter diem I XXX 09S9377 Hit hydra over 3l diem I XXX 09S9379 Hit noc per diem I XXX 09S9381 Hit high risk/escort I XXX 09S9401 Anticoag clinic per session I XXX 09S9430 Pharmacy comp/disp serv I XXX 09S9433 Medical food oral 100% nutr I XXX 09S9434 Mod solid food suppl I XXX 09S9435 Medical foods for inborn err I XXX 09S9436 Lamaze class I XXX 09S9437 Childbirth refresher class I XXX 09S9438 Cesarean birth class I XXX 09S9439 Vbac class I XXX 09S9441 Asthma education I XXX 09S9442 Birthing class I XXX 09S9443 Lactation class I XXX 09S9444 Parenting class I XXX 09S9445 Pt education noc individ I XXX 09S9446 Pt education noc group I XXX 09S9447 Infant safety class I XXX 09S9449 Weight mgmt class I XXX 09S9451 Exercise class I XXX 09S9452 Nutrition class I XXX 09S9453 Smoking cessation class I XXX 09

S9454 Stress mgmt class I XXX 09S9455 Diabetic management program, I XXX 09S9460 Diabetic management program, I XXX 09S9465 Diabetic management program, I XXX 09S9470 Nutritional counseling, diet I XXX 09S9472 Cardiac rehabilitation progr I XXX 09S9473 Pulmonary rehabilitation pro I XXX 09S9474 Enterostomal therapy by a re I XXX 09S9475 Ambulatory setting substance I XXX 09S9476 Vestibular rehab per diem I XXX 09S9480 Intensive outpatient psychia I XXX 09S9482 Family stabilization 15 min I XXX 09S9484 Crisis intervention per hour I XXX 09S9485 Crisis intervention mental h I XXX 09S9490 Hit corticosteroid/diem I XXX 09S9494 Hit antibiotic total diem I XXX 09S9497 Hit antibiotic q3h diem I XXX 09S9500 Hit antibiotic q24h diem I XXX 09S9501 Hit antibiotic q12h diem I XXX 09S9502 Hit antibiotic q8h diem I XXX 09S9503 Hit antibiotic q6h diem I XXX 09S9504 Hit antibiotic q4h diem I XXX 09S9529 Venipuncture home/snf I XXX 09S9537 Ht hem horm inj diem I XXX 09S9538 Hit blood products diem I XXX 09S9542 Ht inj noc per diem I XXX 09S9558 Ht inj growth horm diem I XXX 09S9559 Hit inj interferon diem I XXX 09S9560 Ht inj hormone diem I XXX 09S9562 Ht inj palivizumab diem I XXX 09S9590 Ht irrigation diem I XXX 09S9810 Ht pharm per hour I XXX 09S9900 Christian sci pract visit I XXX 09S9901 Christian sci nurse visit I XXX 09S9960 Air ambulanc nonemerg fixed I XXX 09S9961 Air ambulan nonemerg rotary I XXX 09S9970 Health club membership yr I XXX 09S9975 Transplant related per diem I XXX 09S9976 Lodging per diem I XXX 09S9977 Meals per diem I XXX 09S9981 Med record copy admin I XXX 09S9982 Med record copy per page I XXX 09S9986 Not medically necessary svc I XXX 09S9988 Serv part of phase i trial I XXX 09S9989 Services outside us I XXX 09S9990 Services provided as part of I XXX 09S9991 Services provided as part of I XXX 09S9992 Transportation costs to and I XXX 09S9994 Lodging costs (e.g. hotel ch I XXX 09S9996 Meals for clinical trial par I XXX 09

S9999 Sales tax I XXX 09T1000 Private duty/independent nsg I XXX 09T1001 Nursing assessment/evaluatn I XXX 09T1002 Rn services up to 15 minutes I XXX 09T1003 Lpn/lvn services up to 15min I XXX 09T1004 Nsg aide service up to 15min I XXX 09T1005 Respite care service 15 min I XXX 09T1006 Family/couple counseling I XXX 09T1007 Treatment plan development I XXX 09T1009 Child sitting services I XXX 09T1010 Meals when receive services I XXX 09T1012 Alcohol/substance abuse skil I XXX 09T1013 Sign lang/oral interpreter I XXX 09T1014 Telehealth transmit, per min I XXX 09T1015 Clinic service I XXX 09T1016 Case management I XXX 09T1017 Targeted case management I XXX 09T1018 School-based iep ser bundled I XXX 09T1019 Personal care ser per 15 min I XXX 09T1020 Personal care ser per diem I XXX 09T1021 Hh aide or cn aide per visit I XXX 09T1022 Contracted services per day I XXX 09T1023 Program intake assessment I XXX 09T1024 Team evaluation & management I XXX 09T1025 Ped compr care pkg, per diem I XXX 09T1026 Ped compr care pkg, per hour I XXX 09T1027 Family training & counseling I XXX 09T1028 Home environment assessment I XXX 09T1029 Dwelling lead investigation I XXX 09T1030 Rn home care per diem I XXX 09T1031 Lpn home care per diem I XXX 09T1502 Medication admin visit I XXX 09T1503 Med admin, not oral/inject I XXX 09T1505 Elec med comp dev, noc I XXX 09T1999 Noc retail items andsupplies I XXX 09T2001 N-et; patient attend/escort I XXX 09T2002 N-et; per diem I XXX 09T2003 N-et; encounter/trip I XXX 09T2004 N-et; commerc carrier pass I XXX 09T2005 N-et; stretcher van I XXX 09T2007 Non-emer transport wait time I XXX 09T2010 Pasrr level i I XXX 09T2011 Pasrr level ii I XXX 09T2012 Habil ed waiver, per diem I XXX 09T2013 Habil ed waiver per hour I XXX 09T2014 Habil prevoc waiver, per d I XXX 09T2015 Habil prevoc waiver per hr I XXX 09T2016 Habil res waiver per diem I XXX 09T2017 Habil res waiver 15 min I XXX 09T2018 Habil sup empl waiver/diem I XXX 09

T2019 Habil sup empl waiver 15min I XXX 09T2020 Day habil waiver per diem I XXX 09T2021 Day habil waiver per 15 min I XXX 09T2022 Case management, per month I XXX 09T2023 Targeted case mgmt per month I XXX 09T2024 Serv asmnt/care plan waiver I XXX 09T2025 Waiver service, nos I XXX 09T2026 Special childcare waiver/d I XXX 09T2027 Spec childcare waiver 15 min I XXX 09T2028 Special supply, nos waiver I XXX 09T2029 Special med equip, noswaiver I XXX 09T2030 Assist living waiver/month I XXX 09T2031 Assist living waiver/diem I XXX 09T2032 Res care, nos waiver/month I XXX 09T2033 Res, nos waiver per diem I XXX 09T2034 Crisis interven waiver/diem I XXX 09T2035 Utility services waiver I XXX 09T2036 Camp overnite waiver/session I XXX 09T2037 Camp day waiver/session I XXX 09T2038 Comm trans waiver/service I XXX 09T2039 Vehicle mod waiver/service I XXX 09T2040 Financial mgt waiver/15min I XXX 09T2041 Support broker waiver/15 min I XXX 09T2042 Hospice routine home care I XXX 09T2043 Hospice continuous home care I XXX 09T2044 Hospice respite care I XXX 09T2045 Hospice general care I XXX 09T2046 Hospice long term care, r&b I XXX 09T2048 Bh ltc res r&b, per diem I XXX 09T2049 N-et; stretcher van, mileage I XXX 09T2101 Breast milk proc/store/dist I XXX 09T4521 Adult size brief/diaper sm N XXX 09T4522 Adult size brief/diaper med N XXX 09T4523 Adult size brief/diaper lg N XXX 09T4524 Adult size brief/diaper xl N XXX 09T4525 Adult size pull-on sm N XXX 09T4526 Adult size pull-on med N XXX 09T4527 Adult size pull-on lg N XXX 09T4528 Adult size pull-on xl N XXX 09T4529 Ped size brief/diaper sm/med N XXX 09T4530 Ped size brief/diaper lg N XXX 09T4531 Ped size pull-on sm/med N XXX 09T4532 Ped size pull-on lg N XXX 09T4533 Youth size brief/diaper N XXX 09T4534 Youth size pull-on N XXX 09T4535 Disposable liner/shield/pad N XXX 09T4536 Reusable pull-on any size N XXX 09T4537 Reusable underpad bed size N XXX 09T4538 Diaper serv reusable diaper N XXX 09T4539 Reuse diaper/brief any size N XXX 09

T4540 Reusable underpad chair size N XXX 09T4541 Large disposable underpad I XXX 09T4542 Small disposable underpad I XXX 09T4543 Adult disp brief/diap abv xl N XXX 09T4544 Adlt disp und/pull on abv xl N XXX 09T5001 Position seat spec orth need I XXX 09T5999 Supply, nos I XXX 09V2020 Vision svcs frames purchases X XXX 09V2025 Eyeglasses delux frames N XXX 09V2100 Lens spher single plano 4.00 X XXX 09V2101 Single visn sphere 4.12-7.00 X XXX 09V2102 Singl visn sphere 7.12-20.00 X XXX 09V2103 Spherocylindr 4.00d/12-2.00d X XXX 09V2104 Spherocylindr 4.00d/2.12-4d X XXX 09V2105 Spherocylinder 4.00d/4.25-6d X XXX 09V2106 Spherocylinder 4.00d/>6.00d X XXX 09V2107 Spherocylinder 4.25d/12-2d X XXX 09V2108 Spherocylinder 4.25d/2.12-4d X XXX 09V2109 Spherocylinder 4.25d/4.25-6d X XXX 09V2110 Spherocylinder 4.25d/over 6d X XXX 09V2111 Spherocylindr 7.25d/.25-2.25 X XXX 09V2112 Spherocylindr 7.25d/2.25-4d X XXX 09V2113 Spherocylindr 7.25d/4.25-6d X XXX 09V2114 Spherocylinder over 12.00d X XXX 09V2115 Lens lenticular bifocal X XXX 09V2118 Lens aniseikonic single X XXX 09V2121 Lenticular lens, single X XXX 09V2199 Lens single vision not oth c X XXX 09V2200 Lens spher bifoc plano 4.00d X XXX 09V2201 Lens sphere bifocal 4.12-7.0 X XXX 09V2202 Lens sphere bifocal 7.12-20. X XXX 09V2203 Lens sphcyl bifocal 4.00d/.1 X XXX 09V2204 Lens sphcy bifocal 4.00d/2.1 X XXX 09V2205 Lens sphcy bifocal 4.00d/4.2 X XXX 09V2206 Lens sphcy bifocal 4.00d/ove X XXX 09V2207 Lens sphcy bifocal 4.25-7d/. X XXX 09V2208 Lens sphcy bifocal 4.25-7/2. X XXX 09V2209 Lens sphcy bifocal 4.25-7/4. X XXX 09V2210 Lens sphcy bifocal 4.25-7/ov X XXX 09V2211 Lens sphcy bifo 7.25-12/.25- X XXX 09V2212 Lens sphcyl bifo 7.25-12/2.2 X XXX 09V2213 Lens sphcyl bifo 7.25-12/4.2 X XXX 09V2214 Lens sphcyl bifocal over 12. X XXX 09V2215 Lens lenticular bifocal X XXX 09V2218 Lens aniseikonic bifocal X XXX 09V2219 Lens bifocal seg width over X XXX 09V2220 Lens bifocal add over 3.25d X XXX 09V2221 Lenticular lens, bifocal X XXX 09V2299 Lens bifocal speciality X XXX 09V2300 Lens sphere trifocal 4.00d X XXX 09

V2301 Lens sphere trifocal 4.12-7. X XXX 09V2302 Lens sphere trifocal 7.12-20 X XXX 09V2303 Lens sphcy trifocal 4.0/.12- X XXX 09V2304 Lens sphcy trifocal 4.0/2.25 X XXX 09V2305 Lens sphcy trifocal 4.0/4.25 X XXX 09V2306 Lens sphcyl trifocal 4.00/>6 X XXX 09V2307 Lens sphcy trifocal 4.25-7/. X XXX 09V2308 Lens sphc trifocal 4.25-7/2. X XXX 09V2309 Lens sphc trifocal 4.25-7/4. X XXX 09V2310 Lens sphc trifocal 4.25-7/>6 X XXX 09V2311 Lens sphc trifo 7.25-12/.25- X XXX 09V2312 Lens sphc trifo 7.25-12/2.25 X XXX 09V2313 Lens sphc trifo 7.25-12/4.25 X XXX 09V2314 Lens sphcyl trifocal over 12 X XXX 09V2315 Lens lenticular trifocal X XXX 09V2318 Lens aniseikonic trifocal X XXX 09V2319 Lens trifocal seg width > 28 X XXX 09V2320 Lens trifocal add over 3.25d X XXX 09V2321 Lenticular lens, trifocal X XXX 09V2399 Lens trifocal speciality X XXX 09V2410 Lens variab asphericity sing X XXX 09V2430 Lens variable asphericity bi X XXX 09V2499 Variable asphericity lens X XXX 09V2500 Contact lens pmma spherical X XXX 09V2501 Cntct lens pmma-toric/prism X XXX 09V2502 Contact lens pmma bifocal X XXX 09V2503 Cntct lens pmma color vision X XXX 09V2510 Cntct gas permeable sphericl X XXX 09V2511 Cntct toric prism ballast X XXX 09V2512 Cntct lens gas permbl bifocl X XXX 09V2513 Contact lens extended wear X XXX 09V2520 Contact lens hydrophilic P XXX 09V2521 Cntct lens hydrophilic toric X XXX 09V2522 Cntct lens hydrophil bifocl X XXX 09V2523 Cntct lens hydrophil extend X XXX 09V2530 Contact lens gas impermeable X XXX 09V2531 Contact lens gas permeable X XXX 09V2599 Contact lens/es other type X XXX 09V2600 Hand held low vision aids X XXX 09V2610 Single lens spectacle mount X XXX 09V2615 Telescop/othr compound lens X XXX 09V2623 Plastic eye prosth custom X XXX 09V2624 Polishing artifical eye X XXX 09V2625 Enlargemnt of eye prosthesis X XXX 09V2626 Reduction of eye prosthesis X XXX 09V2627 Scleral cover shell X XXX 09V2628 Fabrication & fitting X XXX 09V2629 Prosthetic eye other type X XXX 09V2630 Anter chamber intraocul lens X XXX 09V2631 Iris support intraoclr lens X XXX 09

V2632 Post chmbr intraocular lens X XXX 09V2700 Balance lens X XXX 09V2702 Deluxe lens feature N XXX 09V2710 Glass/plastic slab off prism X XXX 09V2715 Prism lens/es X XXX 09V2718 Fresnell prism press-on lens X XXX 09V2730 Special base curve X XXX 09V2744 Tint photochromatic lens/es X XXX 09V2745 Tint, any color/solid/grad X XXX 09V2750 Anti-reflective coating X XXX 09V2755 Uv lens/es X XXX 09V2756 Eye glass case X XXX 09V2760 Scratch resistant coating X XXX 09V2761 Mirror coating X XXX 09V2762 Polarization, any lens X XXX 09V2770 Occluder lens/es X XXX 09V2780 Oversize lens/es X XXX 09V2781 Progressive lens per lens X XXX 09V2782 Lens, 1.54-1.65 p/1.60-1.79g X XXX 09V2783 Lens, >= 1.66 p/>=1.80 g X XXX 09V2784 Lens polycarb or equal X XXX 09V2785 Corneal tissue processing X XXX 09V2786 Occupational multifocal lens X XXX 09V2787 Astigmatism-correct function N XXX 09V2788 Presbyopia-correct function N XXX 09V2790 Amniotic membrane X XXX 09V2797 Vis item/svc in other code X XXX 09V2799 Misc vision item or service X XXX 09V5008 Hearing screening N XXX 09V5010 Assessment for hearing aid N XXX 09V5011 Hearing aid fitting/checking N XXX 09V5014 Hearing aid repair/modifying N XXX 09V5020 Conformity evaluation N XXX 09V5030 Body-worn hearing aid air N XXX 09V5040 Body-worn hearing aid bone N XXX 09V5050 Hearing aid monaural in ear N XXX 09V5060 Behind ear hearing aid N XXX 09V5070 Glasses air conduction N XXX 09V5080 Glasses bone conduction N XXX 09V5090 Hearing aid dispensing fee N XXX 09V5095 Implant mid ear hearing pros N XXX 09V5100 Body-worn bilat hearing aid N XXX 09V5110 Hearing aid dispensing fee N XXX 09V5120 Body-worn binaur hearing aid N XXX 09V5130 In ear binaural hearing aid N XXX 09V5140 Behind ear binaur hearing ai N XXX 09V5150 Glasses binaural hearing aid N XXX 09V5160 Dispensing fee binaural N XXX 09V5170 Within ear cros hearing aid N XXX 09V5180 Behind ear cros hearing aid N XXX 09

V5190 Glasses cros hearing aid N XXX 09V5200 Cros hearing aid dispens fee N XXX 09V5210 In ear bicros hearing aid N XXX 09V5220 Behind ear bicros hearing ai N XXX 09V5230 Glasses bicros hearing aid N XXX 09V5240 Dispensing fee bicros N XXX 09V5241 Dispensing fee, monaural N XXX 09V5242 Hearing aid, monaural, cic N XXX 09V5243 Hearing aid, monaural, itc N XXX 09V5244 Hearing aid, prog, mon, cic N XXX 09V5245 Hearing aid, prog, mon, itc N XXX 09V5246 Hearing aid, prog, mon, ite N XXX 09V5247 Hearing aid, prog, mon, bte N XXX 09V5248 Hearing aid, binaural, cic N XXX 09V5249 Hearing aid, binaural, itc N XXX 09V5250 Hearing aid, prog, bin, cic N XXX 09V5251 Hearing aid, prog, bin, itc N XXX 09V5252 Hearing aid, prog, bin, ite N XXX 09V5253 Hearing aid, prog, bin, bte N XXX 09V5254 Hearing id, digit, mon, cic N XXX 09V5255 Hearing aid, digit, mon, itc N XXX 09V5256 Hearing aid, digit, mon, ite N XXX 09V5257 Hearing aid, digit, mon, bte N XXX 09V5258 Hearing aid, digit, bin, cic N XXX 09V5259 Hearing aid, digit, bin, itc N XXX 09V5260 Hearing aid, digit, bin, ite N XXX 09V5261 Hearing aid, digit, bin, bte N XXX 09V5262 Hearing aid, disp, monaural N XXX 09V5263 Hearing aid, disp, binaural N XXX 09V5264 Ear mold/insert N XXX 09V5265 Ear mold/insert, disp N XXX 09V5266 Battery for hearing device N XXX 09V5267 Hearing aid sup/access/dev N XXX 09V5268 Ald telephone amplifier N XXX 09V5269 Alerting device, any type N XXX 09V5270 Ald, tv amplifier, any type N XXX 09V5271 Ald, tv caption decoder N XXX 09V5272 Tdd N XXX 09V5273 Ald for cochlear implant N XXX 09V5274 Ald unspecified N XXX 09V5275 Ear impression N XXX 09V5281 Ald fm/dm system, monaural N XXX 09V5282 Ald fm/dm system binaural N XXX 09V5283 Ald neck, loop ind receiver N XXX 09V5284 Ald fm/dm ear level receiver N XXX 09V5285 Ald fm/dm aud input receiver N XXX 09V5286 Ald blu tooth fm/dm receiver N XXX 09V5287 Ald fm/dm receiver, nos N XXX 09V5288 Ald fm/dm transmitter ald N XXX 09V5289 Ald fm/dm adapt/boot couplin N XXX 09

V5290 Ald transmitter microphone N XXX 09V5298 Hearing aid noc N XXX 09V5299 Hearing service R XXX 09V5336 Repair communication device N XXX 09V5362 Speech screening N XXX 01V5363 Language screening N XXX 01V5364 Dysphagia screening N XXX 010001F Heart failure composite I XXX 090005F Osteoarthritis composite I XXX 0900100 Anesth salivary gland J XXX 0900102 Anesth repair of cleft lip J XXX 0900103 Anesth blepharoplasty J XXX 0900104 Anesth electroshock J XXX 090012F Cap bacterial assess I XXX 0900120 Anesth ear surgery J XXX 0900124 Anesth ear exam J XXX 0900126 Anesth tympanotomy J XXX 090014F Comp preop assess cat surg I XXX 0900140 Anesth procedures on eye J XXX 0900142 Anesth lens surgery J XXX 0900144 Anesth corneal transplant J XXX 0900145 Anesth vitreoretinal surg J XXX 0900147 Anesth iridectomy J XXX 0900148 Anesth eye exam J XXX 090015F Melan follow-up complete I XXX 0900160 Anesth nose/sinus surgery J XXX 0900162 Anesth nose/sinus surgery J XXX 0900164 Anesth biopsy of nose J XXX 0900170 Anesth procedure on mouth J XXX 0900172 Anesth cleft palate repair J XXX 0900174 Anesth pharyngeal surgery J XXX 0900176 Anesth pharyngeal surgery J XXX 090019T Extracorp shock wv tx ms nos C XXX 0900190 Anesth face/skull bone surg J XXX 0900192 Anesth facial bone surgery J XXX 0900210 Anesth cranial surg nos J XXX 0900211 Anesth cran surg hemotoma J XXX 0900212 Anesth skull drainage J XXX 0900214 Anesth skull drainage J XXX 0900215 Anesth skull repair/fract J XXX 0900216 Anesth head vessel surgery J XXX 0900218 Anesth special head surgery J XXX 0900220 Anesth intrcrn nerve J XXX 0900222 Anesth head nerve surgery J XXX 0900300 Anesth head/neck/ptrunk J XXX 0900320 Anesth neck organ 1yr/> J XXX 0900322 Anesth biopsy of thyroid J XXX 0900326 Anesth larynx/trach < 1 yr J XXX 0900350 Anesth neck vessel surgery J XXX 0900352 Anesth neck vessel surgery J XXX 09

00400 Anesth skin ext/per/atrunk J XXX 0900402 Anesth surgery of breast J XXX 0900404 Anesth surgery of breast J XXX 0900406 Anesth surgery of breast J XXX 0900410 Anesth correct heart rhythm J XXX 090042T Ct perfusion w/contrast cbf C XXX 0900450 Anesth surgery of shoulder J XXX 0900454 Anesth collar bone biopsy J XXX 0900470 Anesth removal of rib J XXX 0900472 Anesth chest wall repair J XXX 0900474 Anesth surgery of rib J XXX 0900500 Anesth esophageal surgery J XXX 090051T Implant total heart system C XXX 090052T Replace thrc unit hrt syst C XXX 0900520 Anesth chest procedure J XXX 0900522 Anesth chest lining biopsy J XXX 0900524 Anesth chest drainage J XXX 0900528 Anes mediascpy & dx thorscpy J XXX 0900529 Anes medscpy&thorscpy 1 lung J XXX 090053T Replace implantable hrt syst C XXX 0900530 Anesth pacemaker insertion J XXX 0900532 Anesth vascular access J XXX 0900534 Anesth cardioverter/defib J XXX 0900537 Anesth cardiac electrophys J XXX 0900539 Anesth trach-bronch reconst J XXX 090054T Bone srgry cmptr fluor image C XXX 0900540 Anesth chest surgery J XXX 0900541 Anesth one lung ventilation J XXX 0900542 Anesthesia removal pleura J XXX 0900546 Anesth lung chest wall surg J XXX 0900548 Anesth trachea bronchi surg J XXX 090055T Bone srgry cmptr ct/mri imag C XXX 0900550 Anesth sternal debridement J XXX 0900560 Anesth heart surg w/o pump J XXX 0900561 Anesth heart surg <1 yr J XXX 0900562 Anesth hrt surg w/pmp age 1+ J XXX 0900563 Anesth heart surg w/arrest J XXX 0900566 Anesth cabg w/o pump J XXX 0900567 Anesth cabg w/pump J XXX 090058T Cryopreservation ovary tiss C XXX 0900580 Anesth heart/lung transplnt J XXX 0900600 Anesth spine cord surgery J XXX 0900604 Anesth sitting procedure J XXX 0900620 Anesth spine cord surgery J XXX 0900625 Anes spine tranthor w/o vent J XXX 0900626 Anes spine transthor w/vent J XXX 0900630 Anesth spine cord surgery J XXX 0900632 Anesth removal of nerves J XXX 0900635 Anesth lumbar puncture J XXX 0900640 Anesth spine manipulation J XXX 09

00670 Anesth spine cord surgery J XXX 0900700 Anesth abdominal wall surg J XXX 0900702 Anesth for liver biopsy J XXX 090071T Us leiomyomata ablate <200 C XXX 090072T Us leiomyomata ablate >200 C XXX 0900730 Anesth abdominal wall surg J XXX 0900740 Anesth upper gi visualize J XXX 090075T Perq stent/chest vert art C XXX 090075T TC Perq stent/chest vert art C XXX 090075T 26 Perq stent/chest vert art C XXX 0900750 Anesth repair of hernia J XXX 0900752 Anesth repair of hernia J XXX 0900754 Anesth repair of hernia J XXX 0900756 Anesth repair of hernia J XXX 090076T S&i stent/chest vert art C XXX 090076T TC S&i stent/chest vert art C XXX 090076T 26 S&i stent/chest vert art C XXX 0900770 Anesth blood vessel repair J XXX 0900790 Anesth surg upper abdomen J XXX 0900792 Anesth hemorr/excise liver J XXX 0900794 Anesth pancreas removal J XXX 0900796 Anesth for liver transplant J XXX 0900797 Anesth surgery for obesity J XXX 0900800 Anesth abdominal wall surg J XXX 0900802 Anesth fat layer removal J XXX 0900810 Anesth low intestine scope J XXX 0900820 Anesth abdominal wall surg J XXX 0900830 Anesth repair of hernia J XXX 0900832 Anesth repair of hernia J XXX 0900834 Anesth hernia repair < 1 yr J XXX 0900836 Anesth hernia repair preemie J XXX 0900840 Anesth surg lower abdomen J XXX 0900842 Anesth amniocentesis J XXX 0900844 Anesth pelvis surgery J XXX 0900846 Anesth hysterectomy J XXX 0900848 Anesth pelvic organ surg J XXX 090085T Breath test heart reject N XXX 0900851 Anesth tubal ligation J XXX 0900860 Anesth surgery of abdomen J XXX 0900862 Anesth kidney/ureter surg J XXX 0900864 Anesth removal of bladder J XXX 0900865 Anesth removal of prostate J XXX 0900866 Anesth removal of adrenal J XXX 0900868 Anesth kidney transplant J XXX 0900870 Anesth bladder stone surg J XXX 0900872 Anesth kidney stone destruct J XXX 0900873 Anesth kidney stone destruct J XXX 0900880 Anesth abdomen vessel surg J XXX 0900882 Anesth major vein ligation J XXX 0900902 Anesth anorectal surgery J XXX 09

00904 Anesth perineal surgery J XXX 0900906 Anesth removal of vulva J XXX 0900908 Anesth removal of prostate J XXX 0900910 Anesth bladder surgery J XXX 0900912 Anesth bladder tumor surg J XXX 0900914 Anesth removal of prostate J XXX 0900916 Anesth bleeding control J XXX 0900918 Anesth stone removal J XXX 0900920 Anesth genitalia surgery J XXX 0900921 Anesth vasectomy J XXX 0900922 Anesth sperm duct surgery J XXX 0900924 Anesth testis exploration J XXX 0900926 Anesth removal of testis J XXX 0900928 Anesth removal of testis J XXX 0900930 Anesth testis suspension J XXX 0900932 Anesth amputation of penis J XXX 0900934 Anesth penis nodes removal J XXX 0900936 Anesth penis nodes removal J XXX 0900938 Anesth insert penis device J XXX 0900940 Anesth vaginal procedures J XXX 0900942 Anesth surg on vag/urethral J XXX 0900944 Anesth vaginal hysterectomy J XXX 0900948 Anesth repair of cervix J XXX 090095T Rmvl artific disc addl crvcl C XXX 0900950 Anesth vaginal endoscopy J XXX 0900952 Anesth hysteroscope/graph J XXX 090098T Rev artific disc addl C XXX 090099T Implant corneal ring C XXX 090100T Prosth retina receive&gen C XXX 090101T Extracorp shockwv tx hi enrg C XXX 090102T Extracorp shockwv tx anesth C XXX 090103T Holotranscobalamin C XXX 090106T Touch quant sensory test C XXX 090107T Vibrate quant sensory test C XXX 090108T Cool quant sensory test C XXX 090109T Heat quant sensory test C XXX 090110T Nos quant sensory test C XXX 090111T Rbc membranes fatty acids C XXX 0901112 Anesth bone aspirate/bx J XXX 0901120 Anesth pelvis surgery J XXX 0901130 Anesth body cast procedure J XXX 0901140 Anesth amputation at pelvis J XXX 0901150 Anesth pelvic tumor surgery J XXX 0901160 Anesth pelvis procedure J XXX 0901170 Anesth pelvis surgery J XXX 0901173 Anesth fx repair pelvis J XXX 0901180 Anesth pelvis nerve removal J XXX 0901190 Anesth pelvis nerve removal J XXX 0901200 Anesth hip joint procedure J XXX 0901202 Anesth arthroscopy of hip J XXX 09

01210 Anesth hip joint surgery J XXX 0901212 Anesth hip disarticulation J XXX 0901214 Anesth hip arthroplasty J XXX 0901215 Anesth revise hip repair J XXX 0901220 Anesth procedure on femur J XXX 090123T Scleral fistulization C XXX 0901230 Anesth surgery of femur J XXX 0901232 Anesth amputation of femur J XXX 0901234 Anesth radical femur surg J XXX 0901250 Anesth upper leg surgery J XXX 090126T Chd risk imt study C XXX 0901260 Anesth upper leg veins surg J XXX 0901270 Anesth thigh arteries surg J XXX 0901272 Anesth femoral artery surg J XXX 0901274 Anesth femoral embolectomy J XXX 0901320 Anesth knee area surgery J XXX 0901340 Anesth knee area procedure J XXX 0901360 Anesth knee area surgery J XXX 0901380 Anesth knee joint procedure J XXX 0901382 Anesth dx knee arthroscopy J XXX 0901390 Anesth knee area procedure J XXX 0901392 Anesth knee area surgery J XXX 0901400 Anesth knee joint surgery J XXX 0901402 Anesth knee arthroplasty J XXX 0901404 Anesth amputation at knee J XXX 0901420 Anesth knee joint casting J XXX 0901430 Anesth knee veins surgery J XXX 0901432 Anesth knee vessel surg J XXX 0901440 Anesth knee arteries surg J XXX 0901442 Anesth knee artery surg J XXX 0901444 Anesth knee artery repair J XXX 0901462 Anesth lower leg procedure J XXX 0901464 Anesth ankle/ft arthroscopy J XXX 0901470 Anesth lower leg surgery J XXX 0901472 Anesth achilles tendon surg J XXX 0901474 Anesth lower leg surgery J XXX 0901480 Anesth lower leg bone surg J XXX 0901482 Anesth radical leg surgery J XXX 0901484 Anesth lower leg revision J XXX 0901486 Anesth ankle replacement J XXX 0901490 Anesth lower leg casting J XXX 0901500 Anesth leg arteries surg J XXX 0901502 Anesth lwr leg embolectomy J XXX 0901520 Anesth lower leg vein surg J XXX 0901522 Anesth lower leg vein surg J XXX 090159T Cad breast mri C ZZZ 090159T TC Cad breast mri C ZZZ 090159T 26 Cad breast mri C ZZZ 0901610 Anesth surgery of shoulder J XXX 0901620 Anesth shoulder procedure J XXX 09

01622 Anes dx shoulder arthroscopy J XXX 090163T Lumb artif diskectomy addl C YYY 0901630 Anesth surgery of shoulder J XXX 0901634 Anesth shoulder joint amput J XXX 0901636 Anesth forequarter amput J XXX 0901638 Anesth shoulder replacement J XXX 090164T Remove lumb artif disc addl C YYY 090165T Revise lumb artif disc addl C YYY 0901650 Anesth shoulder artery surg J XXX 0901652 Anesth shoulder vessel surg J XXX 0901654 Anesth shoulder vessel surg J XXX 0901656 Anesth arm-leg vessel surg J XXX 0901670 Anesth shoulder vein surg J XXX 0901680 Anesth shoulder casting J XXX 0901682 Anesth airplane cast J XXX 090169T Place stereo cath brain C XXX 090171T Lumbar spine proces distract C XXX 0901710 Anesth elbow area surgery J XXX 0901712 Anesth uppr arm tendon surg J XXX 0901714 Anesth uppr arm tendon surg J XXX 0901716 Anesth biceps tendon repair J XXX 090172T Lumbar spine process addl C XXX 0901730 Anesth uppr arm procedure J XXX 0901732 Anesth dx elbow arthroscopy J XXX 090174T Cad cxr with interp C XXX 0901740 Anesth upper arm surgery J XXX 0901742 Anesth humerus surgery J XXX 0901744 Anesth humerus repair J XXX 090175T Cad cxr remote C XXX 0901756 Anesth radical humerus surg J XXX 0901758 Anesth humeral lesion surg J XXX 0901760 Anesth elbow replacement J XXX 0901770 Anesth uppr arm artery surg J XXX 0901772 Anesth uppr arm embolectomy J XXX 090178T 64 lead ecg w/i&r C XXX 0101780 Anesth upper arm vein surg J XXX 0901782 Anesth uppr arm vein repair J XXX 090179T 64 lead ecg w/tracing C XXX 010180T 64 lead ecg w/i&r only C XXX 0901810 Anesth lower arm surgery J XXX 090182T Hdr elect brachytherapy C XXX 090182T TC Hdr elect brachytherapy C XXX 090182T 26 Hdr elect brachytherapy C XXX 0901820 Anesth lower arm procedure J XXX 0901829 Anesth dx wrist arthroscopy J XXX 0901830 Anesth lower arm surgery J XXX 0901832 Anesth wrist replacement J XXX 090184T Exc rectal tumor endoscopic C XXX 0901840 Anesth lwr arm artery surg J XXX 0901842 Anesth lwr arm embolectomy J XXX 09

01844 Anesth vascular shunt surg J XXX 0901850 Anesth lower arm vein surg J XXX 0901852 Anesth lwr arm vein repair J XXX 0901860 Anesth lower arm casting J XXX 090188T Videoconf crit care 74 min N XXX 090189T Videoconf crit care addl 30 N XXX 090190T Place intraoc radiation src C XXX 090191T Insert ant segment drain int C XXX 0901916 Anesth dx arteriography J XXX 0901920 Anesth catheterize heart J XXX 0901922 Anesth cat or mri scan J XXX 0901924 Anes ther interven rad artrl J XXX 0901925 Anes ther interven rad card J XXX 0901926 Anes tx interv rad hrt/cran J XXX 0901930 Anes ther interven rad vein J XXX 0901931 Anes ther interven rad tips J XXX 0901932 Anes tx interv rad th vein J XXX 0901933 Anes tx interv rad cran vein J XXX 0901935 Anesth perc img dx sp proc J XXX 0901936 Anesth perc img tx sp proc J XXX 090195T Prescrl fuse w/o instr l5/s1 C XXX 0901951 Anesth burn less 4 percent J XXX 0901952 Anesth burn 4-9 percent J XXX 0901953 Anesth burn each 9 percent J XXX 0901958 Anesth antepartum manipul J XXX 090196T Prescrl fuse w/o instr l4/l5 C XXX 0901960 Anesth vaginal delivery J XXX 0901961 Anesth cs delivery J XXX 0901962 Anesth emer hysterectomy J XXX 0901963 Anesth cs hysterectomy J XXX 0901965 Anesth inc/missed ab proc J XXX 0901966 Anesth induced ab procedure J XXX 0901967 Anesth/analg vag delivery J XXX 0901968 Anes/analg cs deliver add-on J XXX 0901969 Anesth/analg cs hyst add-on J XXX 090198T Ocular blood flow measure C XXX 0901990 Support for organ donor J XXX 0901991 Anesth nerve block/inj J XXX 0901992 Anesth n block/inj prone J XXX 0901996 Hosp manage cont drug admin J XXX 0901999 Unlisted anesth procedure J XXX 090200T Perq sacral augmt unilat inj C XXX 090201T Perq sacral augmt bilat inj C XXX 090202T Post vert arthrplst 1 lumbar C XXX 090205T Inirs each vessel add-on C ZZZ 090206T Cptr dbs alys car elec dta C XXX 090207T Clear eyelid gland w/heat C XXX 090208T Audiometry air only C XXX 090209T Audiometry air & bone C XXX 090210T Speech audiometry threshold C XXX 09

0211T Speech audiom thresh & recog C XXX 090212T Compre audiometry evaluation C XXX 090213T Njx paravert w/us cer/thor C XXX 090214T Njx paravert w/us cer/thor C ZZZ 090215T Njx paravert w/us cer/thor C ZZZ 090216T Njx paravert w/us lumb/sac C XXX 090217T Njx paravert w/us lumb/sac C ZZZ 090218T Njx paravert w/us lumb/sac C ZZZ 090219T Plmt post facet implt cerv C XXX 090220T Plmt post facet implt thor C XXX 090221T Plmt post facet implt lumb C XXX 090222T Plmt post facet implt addl C ZZZ 090223T Acoustic ecg w/i&r C XXX 090224T Acoustic ecg 1+ analysis C XXX 090225T Acoustic ecg analy & reprog C XXX 090228T Njx tfrml eprl w/us cer/thor C XXX 090229T Njx tfrml eprl w/us cer/thor C XXX 090230T Njx tfrml eprl w/us lumb/sac C XXX 090231T Njx tfrml eprl w/us lumb/sac C XXX 090232T Njx platelet plasma C XXX 090233T Skin glycation spectroscopy C XXX 090234T Trluml perip athrc renal art C YYY 090235T Trluml perip athrc visceral C YYY 090236T Trluml perip athrc abd aorta C YYY 090237T Trluml perip athrc brchiocph C YYY 090238T Trluml perip athrc iliac art C YYY 090240T Esoph motility 3d topography C YYY 090240T TC Esoph motility 3d topography C YYY 090240T 26 Esoph motility 3d topography C YYY 090241T Esoph motility w/stim/perf C YYY 090241T TC Esoph motility w/stim/perf C YYY 090241T 26 Esoph motility w/stim/perf C YYY 090243T Intm msr bronchodil wheeze C YYY 090243T TC Intm msr bronchodil wheeze C YYY 090243T 26 Intm msr bronchodil wheeze C YYY 090244T Cont msr bronchodil wheeze C YYY 090244T TC Cont msr bronchodil wheeze C YYY 090244T 26 Cont msr bronchodil wheeze C YYY 090249T Ligation hemorrhoid w/us C YYY 090253T Insert aqueous drain device C YYY 090254T Evasc rpr iliac art bifur C YYY 090255T Evasc rpr iliac art bifr s&i C YYY 090255T TC Evasc rpr iliac art bifr s&i C YYY 090255T 26 Evasc rpr iliac art bifr s&i C YYY 090262T Impltj pulm vlv evasc appr C YYY 090263T Im b1 mrw cel ther cmpl C XXX 090264T Im b1 mrw cel ther xcl hrvst C XXX 090265T Im b1 mrw cel ther hrvst onl C XXX 090266T Implt/rpl crtd sns dev total C YYY 090267T Implt/rpl crtd sns dev lead C YYY 09

0268T Implt/rpl crtd sns dev gen C YYY 090269T Rev/remvl crtd sns dev total C XXX 090270T Rev/remvl crtd sns dev lead C XXX 090271T Rev/remvl crtd sns dev gen C XXX 090272T Interrogate crtd sns dev C XXX 090273T Interrogate crtd sns w/pgrmg C XXX 090274T Perq lamot/lam crv/thrc C YYY 090275T Perq lamot/lam lumbar R XXX 090278T Tempr C XXX 090281T Laa closure w/implant C XXX 090282T Periph field stimul trial C XXX 090283T Periph field stimul perm C XXX 090284T Periph field stimul revise C XXX 090285T Periph field stimul analys C XXX 090286T Near ifr spectrsc of wounds C XXX 090287T Near ifr guide of vasc site C XXX 090288T Anoscopy w/rf delivery C XXX 090289T Laser inc for pkp/lkp donor C ZZZ 090290T Laser inc for pkp/lkp recip C ZZZ 090291T Iv oct for proc init vessel C ZZZ 090292T Iv oct for proc addl vessel C ZZZ 090293T Ins lt atrl press monitor C XXX 090294T Ins lt atrl mont pres lead C ZZZ 090295T Ext ecg complete C XXX 090296T Ext ecg recording C XXX 090297T Ext ecg scan w/report C XXX 090298T Ext ecg review and interp C XXX 090299T Esw wound healing init wound C XXX 090300T Esw wound healing addl wound C ZZZ 090301T Mw therapy for breast tumor C XXX 090302T Icar ischm mntrng sys compl C YYY 090303T Icar ischm mntrng sys eltrd C YYY 090304T Icar ischm mntrng sys device C YYY 090305T Icar ischm mntrng prgrm eval C XXX 090306T Icar ischm mntr interr eval C XXX 090307T Rmvl icar ischm mntrng dvce C YYY 090308T Insj ocular telescope prosth C YYY 090309T Prescrl fuse w/ instr l4/l5 C ZZZ 090310T Motor function mapping ntms C XXX 090311T Cal & alys cntrl artl press C XXX 090312T Laps impltj nstim vagus C XXX 090313T Laps rmvl nstim array vagus C XXX 090314T Laps rmvl vgl arry&pls gen C XXX 090315T Rmvl vagus nerve pls gen C XXX 090316T Replc vagus nerve pls gen C XXX 090317T Elec alys vagus nrv pls gen C XXX 090329T Mntr io press 24hrs/> uni/bi C YYY 090330T Tear film img uni/bi w/i&r C YYY 090331T Heart symp image plnr C YYY 090332T Heart symp image plnr spect C YYY 09

0333T Visual ep acuity screen auto C YYY 090335T Extraosseous joint stblztion C YYY 090336T Lap ablat uterine fibroids C YYY 090337T Endothel fxnassmnt non-invas C YYY 090338T Trnscth renal symp denrv unl C YYY 090339T Trnscth renal symp denrv bil C YYY 090340T Ablate pulm tumors + extnsn C YYY 090341T Quant pupillometry w/ rprt C YYY 090342T Thxp apheresis w/hdl delip C YYY 090345T Transcath mtral vlve repair C YYY 090346T Ultrasound elastography C YYY 090347T Ins bone device for rsa C YYY 090348T Rsa spine exam C YYY 090349T Rsa upper extr exam C YYY 090350T Rsa lower extr exam C YYY 090351T Intraop oct brst/node spec C YYY 090352T Oct brst/node i&r per spec C YYY 090353T Intraop oct breast cavity C YYY 090354T Oct breast surg cavity i&r C YYY 090355T Gi tract capsule endoscopy C YYY 090356T Insrt drug device for iop C YYY 090357T Cryopreservation oocyte(s) C XXX 090358T Bia whole body C YYY 090359T Behavioral id assessment C YYY 090360T Observ behav assessment C YYY 090361T Observ behav assess addl C ZZZ 090362T Expose behav assessment C YYY 090363T Expose behav assess addl C ZZZ 090364T Adaptive behavior treatment C YYY 090365T Adaptive behavior tx addl C ZZZ 090366T Group behavior treatment C YYY 090367T Group behav treatment addl C ZZZ 090368T Behavior treatment modified C YYY 090369T Behav treatment modify addl C ZZZ 090370T Fam behav treatment guidance C YYY 090371T Mult fam behav treat guide C YYY 090372T Social skills training group C YYY 090373T Exposure behavior treatment C YYY 090374T Expose behav treatment addl C ZZZ 090375T Total disc arthrp ant appr C XXX 090376T Insert ant segment drain int C XXX 090377T Anoscpy inj agent for incont C XXX 090378T Visual field assmnt rev/rprt C XXX 090379T Vis field assmnt tech suppt C XXX 090380T Comp animat ret imag series C XXX 090381T Ext h rate epi sz 14 days C XXX 090382T Ext h rate sz 14 day ri only C XXX 090383T Ext h rate sz up to 30 days C XXX 090384T Ex h rate sz 30 day ri only C XXX 090385T Ex h rate for sz ovr 30 day C XXX 09

0386T Ex h rate sz 30+ day ri only C XXX 090387T Leadless c pm ins/rpl ventr C XXX 090388T Leadless c pm remove ventr C XXX 090389T Prog eval inper leadls pm C XXX 090390T Periproc eval inper ledls pm C XXX 090391T Intergt eval inper leadls pm C XXX 090500F Initial prenatal care visit M XXX 090501F Prenatal flow sheet I XXX 090502F Subsequent prenatal care I XXX 090503F Postpartum care visit I XXX 090505F Hemodialysis plan docd I XXX 090507F Periton dialysis plan docd I XXX 090509F Urine incon plan docd M XXX 090513F Elev bp plan of care docd M XXX 090514F Care plan hgb docd esa pt I XXX 090516F Anemia plan of care docd I XXX 090517F Glaucoma plan of care docd M XXX 090518F Fall plan of care docd M XXX 090519F Pland chemo docd b/4 txmnt I XXX 090520F Rad dos limts b/4 3d rad M XXX 090521F Plan of care 4 pain docd M XXX 090525F Initial visit for episode I XXX 090526F Subs visit for episode M XXX 090528F Rcmnd flw-up 10 yrs docd M XXX 090529F Intrvl 3/>yr pts clnscp docd M XXX 090535F Dyspnea mngmnt plan docd I XXX 090540F Gluco mngmnt plan docd M XXX 090545F Follow up care plan mdd docd I XXX 090550F Cytopath report nongyn spcmn I XXX 090551F Cytopath report non routine I XXX 090555F Symptom mgmnt plan care docd I XXX 090556F Plan care lipid control docd I XXX 090557F Plan caremng angnl symptdocd M XXX 090575F Hiv rna plan care docd I XXX 090580F Multidisciplinary care plan I XXX 090581F Pt trnsfrd from anesth to cc I XXX 090582F No trnsfr from anesth to cc I XXX 090583F Transfer care checklist used I XXX 090584F No transfercare chklist used I XXX 091000F Tobacco use assessed I XXX 091002F Assess anginal symptom/level I XXX 0910021 Fna w/o image A XXX 0910022 Fna w/image A XXX 091003F Level of activity assess I XXX 0910030 Guide cathet fluid drainage A XXX 091004F Clin symp vol ovrld assess I XXX 0910040 Acne surgery A 010 091005F Asthma symptoms evaluate I XXX 091006F Osteoarthritis assess M XXX 0910060 Drainage of skin abscess A 010 09

10061 Drainage of skin abscess A 010 091007F Anti-inflm/anlgsc otc assess I XXX 091008F Gi/renal risk assess I XXX 0910080 Drainage of pilonidal cyst A 010 0910081 Drainage of pilonidal cyst A 010 091010F Severity angina by actvty M XXX 091011F Angina present M XXX 091012F Angina absent M XXX 0910120 Remove foreign body A 010 0910121 Remove foreign body A 010 0910140 Drainage of hematoma/fluid A 010 091015F Copd symptoms assess I XXX 0910160 Puncture drainage of lesion A 010 091018F Assess dyspnea not present I XXX 0910180 Complex drainage wound A 010 091019F Assess dyspnea present I XXX 091022F Pneumo imm status assess I XXX 091026F Co-morbid condition assess I XXX 091030F Influenza imm status assess I XXX 091031F Smoking & 2nd hand assessed I XXX 091032F Smoker/exposed 2nd hnd smoke I XXX 091033F Tobacco nonsmoker nor 2ndhnd I XXX 091034F Current tobacco smoker I XXX 091035F Smokeless tobacco user I XXX 091036F Tobacco non-user M XXX 091038F Persistent asthma M XXX 091039F Intermittent asthma M XXX 091040F Dsm-5 info mdd docd I XXX 091050F History of mole changes I XXX 091052F Type location activityassess I XXX 091055F Visual funct status assess I XXX 091060F Doc perm/cont/parox atr fib I XXX 091061F Doc lack perm+cont+parox fib I XXX 091065F Ischm stroke symp lt3 hrsb/4 I XXX 091066F Ischm stroke symp ge3 hrsb/4 I XXX 091070F Alarm symp assessed-absent I XXX 091071F Alarm symp assessed-1+ prsnt I XXX 091090F Pres/absn urine incon assess M XXX 091091F Urine incon characterized I XXX 091100F Ptfalls assess-docd ge2>/yr M XXX 0911000 Debride infected skin A 000 0911001 Debride infected skin add-on A ZZZ 0911004 Debride genitalia & perineum A 000 0911005 Debride abdom wall A 000 0911006 Debride genit/per/abdom wall A 000 0911008 Remove mesh from abd wall A ZZZ 091101F Pt falls assess-docd le1/yr M XXX 0911010 Debride skin at fx site A 010 0911011 Debride skin musc at fx site A 000 0911012 Deb skin bone at fx site A 000 09

11042 Deb subq tissue 20 sq cm/< A 000 0911043 Deb musc/fascia 20 sq cm/< A 000 0911044 Deb bone 20 sq cm/< A 000 0911045 Deb subq tissue add-on A ZZZ 0911046 Deb musc/fascia add-on A ZZZ 0911047 Deb bone add-on A ZZZ 0911055 Trim skin lesion R 000 0911056 Trim skin lesions 2 to 4 R 000 0911057 Trim skin lesions over 4 R 000 091110F Pt lft inpt fac w/in 60 days I XXX 0911100 Biopsy skin lesion A 000 0911101 Biopsy skin add-on A ZZZ 091111F Dschrg med/current med merge M XXX 091116F Auric/peri pain assessed I XXX 091118F Gerd symps assessed 12 month I XXX 091119F Init eval for condition I XXX 0911200 Removal of skin tags <w/15 A 010 0911201 Remove skin tags add-on A ZZZ 091121F Subs eval for condition I XXX 091123F Acp discuss/dscn mkr docd M XXX 091124F Acp discuss-no dscnmkr docd M XXX 091125F Amnt pain noted pain prsnt M XXX 091126F Amnt pain noted none prsnt M XXX 091127F New episode for condition I XXX 091128F Subs episode for condition I XXX 091130F Bk pain & fxn assessed I XXX 0911300 Shave skin lesion 0.5 cm/< A 000 0911301 Shave skin lesion 0.6-1.0 cm A 000 0911302 Shave skin lesion 1.1-2.0 cm A 000 0911303 Shave skin lesion >2.0 cm A 000 0911305 Shave skin lesion 0.5 cm/< A 000 0911306 Shave skin lesion 0.6-1.0 cm A 000 0911307 Shave skin lesion 1.1-2.0 cm A 000 0911308 Shave skin lesion >2.0 cm A 000 0911310 Shave skin lesion 0.5 cm/< A 000 0911311 Shave skin lesion 0.6-1.0 cm A 000 0911312 Shave skin lesion 1.1-2.0 cm A 000 0911313 Shave skin lesion >2.0 cm A 000 091134F Epsd bk pain for 6 wks/< I XXX 091135F Epsd bk pain for >6 wks I XXX 091136F Epsd bk pain for 12 wks/< I XXX 091137F Epsd bk pain for >12 wks I XXX 0911400 Exc tr-ext b9+marg 0.5 cm< A 010 0911401 Exc tr-ext b9+marg 0.6-1 cm A 010 0911402 Exc tr-ext b9+marg 1.1-2 cm A 010 0911403 Exc tr-ext b9+marg 2.1-3cm/< A 010 0911404 Exc tr-ext b9+marg 3.1-4 cm A 010 0911406 Exc tr-ext b9+marg >4.0 cm A 010 0911420 Exc h-f-nk-sp b9+marg 0.5/< A 010 0911421 Exc h-f-nk-sp b9+marg 0.6-1 A 010 09

11422 Exc h-f-nk-sp b9+marg 1.1-2 A 010 0911423 Exc h-f-nk-sp b9+marg 2.1-3 A 010 0911424 Exc h-f-nk-sp b9+marg 3.1-4 A 010 0911426 Exc h-f-nk-sp b9+marg >4 cm A 010 0911440 Exc face-mm b9+marg 0.5 cm/< A 010 0911441 Exc face-mm b9+marg 0.6-1 cm A 010 0911442 Exc face-mm b9+marg 1.1-2 cm A 010 0911443 Exc face-mm b9+marg 2.1-3 cm A 010 0911444 Exc face-mm b9+marg 3.1-4 cm A 010 0911446 Exc face-mm b9+marg >4 cm A 010 0911450 Removal sweat gland lesion A 090 0911451 Removal sweat gland lesion A 090 0911462 Removal sweat gland lesion A 090 0911463 Removal sweat gland lesion A 090 0911470 Removal sweat gland lesion A 090 0911471 Removal sweat gland lesion A 090 091150F Doc pt rsk death w/in 1yr I XXX 091151F Doc no pt rsk death w/in 1yr I XXX 091152F Doc advncd dis comfort 1st I XXX 091153F Doc advncd dis cmfrt not 1st I XXX 091157F Advnc care plan in rcrd I XXX 091158F Advnc care plan tlk docd I XXX 091159F Med list docd in rcrd I XXX 091160F Rvw meds by rx/dr in rcrd I XXX 0911600 Exc tr-ext mal+marg 0.5 cm/< A 010 0911601 Exc tr-ext mal+marg 0.6-1 cm A 010 0911602 Exc tr-ext mal+marg 1.1-2 cm A 010 0911603 Exc tr-ext mal+marg 2.1-3 cm A 010 0911604 Exc tr-ext mal+marg 3.1-4 cm A 010 0911606 Exc tr-ext mal+marg >4 cm A 010 0911620 Exc h-f-nk-sp mal+marg 0.5/< A 010 0911621 Exc s/n/h/f/g mal+mrg 0.6-1 A 010 0911622 Exc s/n/h/f/g mal+mrg 1.1-2 A 010 0911623 Exc s/n/h/f/g mal+mrg 2.1-3 A 010 0911624 Exc s/n/h/f/g mal+mrg 3.1-4 A 010 0911626 Exc s/n/h/f/g mal+mrg >4 cm A 010 0911640 Exc f/e/e/n/l mal+mrg 0.5cm< A 010 0911641 Exc f/e/e/n/l mal+mrg 0.6-1 A 010 0911642 Exc f/e/e/n/l mal+mrg 1.1-2 A 010 0911643 Exc f/e/e/n/l mal+mrg 2.1-3 A 010 0911644 Exc f/e/e/n/l mal+mrg 3.1-4 A 010 0911646 Exc f/e/e/n/l mal+mrg >4 cm A 010 091170F Fxnl status assessed M XXX 0911719 Trim nail(s) any number R 000 0911720 Debride nail 1-5 A 000 0911721 Debride nail 6 or more A 000 0911730 Removal of nail plate A 000 0911732 Remove nail plate add-on A ZZZ 0911740 Drain blood from under nail A 000 091175F Function stat assessed rvwd M XXX 09

11750 Removal of nail bed A 010 0911752 Remove nail bed/tip A 010 0911755 Biopsy nail unit A 000 0911760 Repair of nail bed A 010 0911762 Reconstruction of nail bed A 010 0911765 Excision of nail fold toe A 010 0911770 Remove pilonidal cyst simple A 010 0911771 Remove pilonidal cyst exten A 090 0911772 Remove pilonidal cyst compl A 090 091180F Thromboemb risk assessed I XXX 091181F Neuropsychia sympts assessed M XXX 091182F Neuropsychi sympt 1+present I XXX 091183F Neuropsychiatric symp absent I XXX 0911900 Inject skin lesions </w 7 A 000 0911901 Inject skin lesions >7 A 000 0911920 Correct skin color 6.0 cm/< R 000 0911921 Corect skin color 6.1-20.0cm R 000 0911922 Correct skin color ea 20.0cm R ZZZ 0911950 Tx contour defects 1 cc/< R 000 0911951 Tx contour defects 1.1-5.0cc R 000 0911952 Tx contour defects 5.1-10cc R 000 0911954 Tx contour defects >10.0 cc R 000 0911960 Insert tissue expander(s) A 090 0911970 Replace tissue expander A 090 0911971 Remove tissue expander(s) A 090 0911976 Remove contraceptive capsule R 000 0911980 Implant hormone pellet(s) A 000 0911981 Insert drug implant device A XXX 0911982 Remove drug implant device A XXX 0911983 Remove/insert drug implant A XXX 091200F Seizure type& frequ docd I XXX 0912001 Rpr s/n/ax/gen/trnk 2.5cm/< A 000 0912002 Rpr s/n/ax/gen/trnk2.6-7.5cm A 000 0912004 Rpr s/n/ax/gen/trk7.6-12.5cm A 000 0912005 Rpr s/n/a/gen/trk12.6-20.0cm A 000 0912006 Rpr s/n/a/gen/trk20.1-30.0cm A 000 0912007 Rpr s/n/ax/gen/trnk >30.0 cm A 000 0912011 Rpr f/e/e/n/l/m 2.5 cm/< A 000 0912013 Rpr f/e/e/n/l/m 2.6-5.0 cm A 000 0912014 Rpr f/e/e/n/l/m 5.1-7.5 cm A 000 0912015 Rpr f/e/e/n/l/m 7.6-12.5 cm A 000 0912016 Rpr fe/e/en/l/m 12.6-20.0 cm A 000 0912017 Rpr fe/e/en/l/m 20.1-30.0 cm A 000 0912018 Rpr f/e/e/n/l/m >30.0 cm A 000 0912020 Closure of split wound A 010 0912021 Closure of split wound A 010 0912031 Intmd rpr s/a/t/ext 2.5 cm/< A 010 0912032 Intmd rpr s/a/t/ext 2.6-7.5 A 010 0912034 Intmd rpr s/tr/ext 7.6-12.5 A 010 0912035 Intmd rpr s/a/t/ext 12.6-20 A 010 09

12036 Intmd rpr s/a/t/ext 20.1-30 A 010 0912037 Intmd rpr s/tr/ext >30.0 cm A 010 0912041 Intmd rpr n-hf/genit 2.5cm/< A 010 0912042 Intmd rpr n-hf/genit2.6-7.5 A 010 0912044 Intmd rpr n-hf/genit7.6-12.5 A 010 0912045 Intmd rpr n-hf/genit12.6-20 A 010 0912046 Intmd rpr n-hf/genit20.1-30 A 010 0912047 Intmd rpr n-hf/genit >30.0cm A 010 091205F Epi etiol synd rvwd and docd I XXX 0912051 Intmd rpr face/mm 2.5 cm/< A 010 0912052 Intmd rpr face/mm 2.6-5.0 cm A 010 0912053 Intmd rpr face/mm 5.1-7.5 cm A 010 0912054 Intmd rpr face/mm 7.6-12.5cm A 010 0912055 Intmd rpr face/mm 12.6-20 cm A 010 0912056 Intmd rpr face/mm 20.1-30.0 A 010 0912057 Intmd rpr face/mm >30.0 cm A 010 091220F Pt screened for depression I XXX 0913100 Cmplx rpr trunk 1.1-2.5 cm A 010 0913101 Cmplx rpr trunk 2.6-7.5 cm A 010 0913102 Cmplx rpr trunk addl 5cm/< A ZZZ 0913120 Cmplx rpr s/a/l 1.1-2.5 cm A 010 0913121 Cmplx rpr s/a/l 2.6-7.5 cm A 010 0913122 Cmplx rpr s/a/l addl 5 cm/> A ZZZ 0913131 Cmplx rpr f/c/c/m/n/ax/g/h/f A 010 0913132 Cmplx rpr f/c/c/m/n/ax/g/h/f A 010 0913133 Cmplx rpr f/c/c/m/n/ax/g/h/f A ZZZ 0913151 Cmplx rpr e/n/e/l 1.1-2.5 cm A 010 0913152 Cmplx rpr e/n/e/l 2.6-7.5 cm A 010 0913153 Cmplx rpr e/n/e/l addl 5cm/< A ZZZ 0913160 Late closure of wound A 090 091400F Prkns diag rviewed M XXX 0914000 Tis trnfr trunk 10 sq cm/< A 090 0914001 Tis trnfr trunk 10.1-30sqcm A 090 0914020 Tis trnfr s/a/l 10 sq cm/< A 090 0914021 Tis trnfr s/a/l 10.1-30 sqcm A 090 0914040 Tis trnfr f/c/c/m/n/a/g/h/f A 090 0914041 Tis trnfr f/c/c/m/n/a/g/h/f A 090 0914060 Tis trnfr e/n/e/l 10 sq cm/< A 090 0914061 Tis trnfr e/n/e/l10.1-30sqcm A 090 0914301 Tis trnfr any 30.1-60 sq cm A 090 0914302 Tis trnfr addl 30 sq cm/< A ZZZ 0914350 Filleted finger/toe flap A 090 091450F Symptoms improved/consist I XXX 091451F Sympt show clin import drop I XXX 091460F Qual card diag prior 12 mons M XXX 091461F No qual card diag prior12mon M XXX 091490F Dem severity classified mild M XXX 091491F Dem severity classified mod M XXX 091493F Dem severity class severe M XXX 091494F Cognit assessed and reviewed M XXX 09

1500F Symptom+sign symm polyneuro I XXX 0915002 Wound prep trk/arm/leg A 000 0915003 Wound prep addl 100 cm A ZZZ 0915004 Wound prep f/n/hf/g A 000 0915005 Wnd prep f/n/hf/g addl cm A ZZZ 091501F Not initial eval for cond I XXX 091502F Pt queried pain fxn w/ instr I XXX 091503F Pt queried symp resp insuff I XXX 091504F Pt has resp insufficiency I XXX 0915040 Harvest cultured skin graft A 000 091505F Pt has no resp insufficiency I XXX 0915050 Skin pinch graft A 090 0915100 Skin splt grft trnk/arm/leg A 090 0915101 Skin splt grft t/a/l add-on A ZZZ 0915110 Epidrm autogrft trnk/arm/leg A 090 0915111 Epidrm autogrft t/a/l add-on A ZZZ 0915115 Epidrm a-grft face/nck/hf/g A 090 0915116 Epidrm a-grft f/n/hf/g addl A ZZZ 0915120 Skn splt a-grft fac/nck/hf/g A 090 0915121 Skn splt a-grft f/n/hf/g add A ZZZ 0915130 Derm autograft trnk/arm/leg A 090 0915131 Derm autograft t/a/l add-on A ZZZ 0915135 Derm autograft face/nck/hf/g A 090 0915136 Derm autograft f/n/hf/g add A ZZZ 0915150 Cult skin grft t/arm/leg A 090 0915151 Cult skin grft t/a/l addl A ZZZ 0915152 Cult skin graft t/a/l +% A ZZZ 0915155 Cult skin graft f/n/hf/g A 090 0915156 Cult skin grft f/n/hfg add A ZZZ 0915157 Cult epiderm grft f/n/hfg +% A ZZZ 0915200 Skin full graft trunk A 090 0915201 Skin full graft trunk add-on A ZZZ 0915220 Skin full graft sclp/arm/leg A 090 0915221 Skin full graft add-on A ZZZ 0915240 Skin full grft face/genit/hf A 090 0915241 Skin full graft add-on A ZZZ 0915260 Skin full graft een & lips A 090 0915261 Skin full graft add-on A ZZZ 0915271 Skin sub graft trnk/arm/leg A 000 0915272 Skin sub graft t/a/l add-on A ZZZ 0915273 Skin sub grft t/arm/lg child A 000 0915274 Skn sub grft t/a/l child add A ZZZ 0915275 Skin sub graft face/nk/hf/g A 000 0915276 Skin sub graft f/n/hf/g addl A ZZZ 0915277 Skn sub grft f/n/hf/g child A 000 0915278 Skn sub grft f/n/hf/g ch add A ZZZ 0915570 Skin pedicle flap trunk A 090 0915572 Skin pedicle flap arms/legs A 090 0915574 Pedcle fh/ch/ch/m/n/ax/g/h/f A 090 0915576 Pedicle e/n/e/l/ntroral A 090 09

15600 Delay flap trunk A 090 0915610 Delay flap arms/legs A 090 0915620 Delay flap f/c/c/n/ax/g/h/f A 090 0915630 Delay flap eye/nos/ear/lip A 090 0915650 Transfer skin pedicle flap A 090 0915731 Forehead flap w/vasc pedicle A 090 0915732 Muscle-skin graft head/neck A 090 0915734 Muscle-skin graft trunk A 090 0915736 Muscle-skin graft arm A 090 0915738 Muscle-skin graft leg A 090 0915740 Island pedicle flap graft A 090 0915750 Neurovascular pedicle flap A 090 0915756 Free myo/skin flap microvasc A 090 0915757 Free skin flap microvasc A 090 0915758 Free fascial flap microvasc A 090 0915760 Composite skin graft A 090 0915770 Derma-fat-fascia graft A 090 0915775 Hair trnspl 1-15 punch grfts R 000 0915776 Hair trnspl >15 punch grafts R 000 0915777 Acellular derm matrix implt A ZZZ 0915780 Dermabrasion total face A 090 0915781 Dermabrasion segmental face A 090 0915782 Dermabrasion other than face A 090 0915783 Dermabrasion suprfl any site A 090 0915786 Abrasion lesion single A 010 0915787 Abrasion lesions add-on A ZZZ 0915788 Chemical peel face epiderm R 090 0915789 Chemical peel face dermal R 090 0915792 Chemical peel nonfacial R 090 0915793 Chemical peel nonfacial A 090 0915819 Plastic surgery neck A 090 0915820 Revision of lower eyelid A 090 0915821 Revision of lower eyelid A 090 0915822 Revision of upper eyelid A 090 0915823 Revision of upper eyelid A 090 0915824 Removal of forehead wrinkles R 000 0915825 Removal of neck wrinkles R 000 0915826 Removal of brow wrinkles R 000 0915828 Removal of face wrinkles R 000 0915829 Removal of skin wrinkles R 000 0915830 Exc skin abd R 090 0915832 Excise excessive skin thigh A 090 0915833 Excise excessive skin leg A 090 0915834 Excise excessive skin hip A 090 0915835 Excise excessive skin buttck A 090 0915836 Excise excessive skin arm A 090 0915837 Excise excess skin arm/hand A 090 0915838 Excise excess skin fat pad A 090 0915839 Excise excess skin & tissue A 090 0915840 Nerve palsy fascial graft A 090 09

15841 Nerve palsy muscle graft A 090 0915842 Nerve palsy microsurg graft A 090 0915845 Skin and muscle repair face A 090 0915847 Exc skin abd add-on C YYY 0915850 Remove sutures same surgeon B XXX 0915851 Remove sutures diff surgeon A 000 0915852 Dressing change not for burn A 000 0915860 Test for blood flow in graft A 000 0915876 Suction lipectomy head&neck R 000 0915877 Suction lipectomy trunk R 000 0915878 Suction lipectomy upr extrem R 000 0915879 Suction lipectomy lwr extrem R 000 0915920 Removal of tail bone ulcer A 090 0915922 Removal of tail bone ulcer A 090 0915931 Remove sacrum pressure sore A 090 0915933 Remove sacrum pressure sore A 090 0915934 Remove sacrum pressure sore A 090 0915935 Remove sacrum pressure sore A 090 0915936 Remove sacrum pressure sore A 090 0915937 Remove sacrum pressure sore A 090 0915940 Remove hip pressure sore A 090 0915941 Remove hip pressure sore A 090 0915944 Remove hip pressure sore A 090 0915945 Remove hip pressure sore A 090 0915946 Remove hip pressure sore A 090 0915950 Remove thigh pressure sore A 090 0915951 Remove thigh pressure sore A 090 0915952 Remove thigh pressure sore A 090 0915953 Remove thigh pressure sore A 090 0915956 Remove thigh pressure sore A 090 0915958 Remove thigh pressure sore A 090 0915999 Removal of pressure sore C YYY 0916000 Initial treatment of burn(s) A 000 0916020 Dress/debrid p-thick burn s A 000 0916025 Dress/debrid p-thick burn m A 000 0916030 Dress/debrid p-thick burn l A 000 0916035 Incision of burn scab initi A 000 0916036 Escharotomy addl incision A ZZZ 0917000 Destruct premalg lesion A 010 0917003 Destruct premalg les 2-14 A ZZZ 0917004 Destroy premal lesions 15/> A 010 0917106 Destruction of skin lesions A 090 0917107 Destruction of skin lesions A 090 0917108 Destruction of skin lesions A 090 0917110 Destruct b9 lesion 1-14 A 010 0917111 Destruct lesion 15 or more A 010 0917250 Chemical cautery tissue A 000 0917260 Destruction of skin lesions A 010 0917261 Destruction of skin lesions A 010 0917262 Destruction of skin lesions A 010 09

17263 Destruction of skin lesions A 010 0917264 Destruction of skin lesions A 010 0917266 Destruction of skin lesions A 010 0917270 Destruction of skin lesions A 010 0917271 Destruction of skin lesions A 010 0917272 Destruction of skin lesions A 010 0917273 Destruction of skin lesions A 010 0917274 Destruction of skin lesions A 010 0917276 Destruction of skin lesions A 010 0917280 Destruction of skin lesions A 010 0917281 Destruction of skin lesions A 010 0917282 Destruction of skin lesions A 010 0917283 Destruction of skin lesions A 010 0917284 Destruction of skin lesions A 010 0917286 Destruction of skin lesions A 010 0917311 Mohs 1 stage h/n/hf/g A 000 0917312 Mohs addl stage A ZZZ 0917313 Mohs 1 stage t/a/l A 000 0917314 Mohs addl stage t/a/l A ZZZ 0917315 Mohs surg addl block A ZZZ 0917340 Cryotherapy of skin A 010 0917360 Skin peel therapy A 010 0917380 Hair removal by electrolysis R 000 0917999 Skin tissue procedure C YYY 0919000 Drainage of breast lesion A 000 0919001 Drain breast lesion add-on A ZZZ 0919020 Incision of breast lesion A 090 0919030 Injection for breast x-ray A 000 0919081 Bx breast 1st lesion strtctc A 000 0919082 Bx breast add lesion strtctc A ZZZ 0919083 Bx breast 1st lesion us imag A 000 0919084 Bx breast add lesion us imag A ZZZ 0919085 Bx breast 1st lesion mr imag A 000 0919086 Bx breast add lesion mr imag A ZZZ 0919100 Bx breast percut w/o image A 000 0919101 Biopsy of breast open A 010 0919105 Cryosurg ablate fa each A 000 0919110 Nipple exploration A 090 0919112 Excise breast duct fistula A 090 0919120 Removal of breast lesion A 090 0919125 Excision breast lesion A 090 0919126 Excision addl breast lesion A ZZZ 0919260 Removal of chest wall lesion A 090 0919271 Revision of chest wall A 090 0919272 Extensive chest wall surgery A 090 0919281 Perq device breast 1st imag A 000 0919282 Perq device breast ea imag A ZZZ 0919283 Perq dev breast 1st strtctc A 000 0919284 Perq dev breast add strtctc A ZZZ 0919285 Perq dev breast 1st us imag A 000 09

19286 Perq dev breast add us imag A ZZZ 0919287 Perq dev breast 1st mr guide A 000 0919288 Perq dev breast add mr guide A ZZZ 0919296 Place po breast cath for rad A 000 0919297 Place breast cath for rad A ZZZ 0919298 Place breast rad tube/caths A 000 0919300 Removal of breast tissue A 090 0919301 Partial mastectomy A 090 0919302 P-mastectomy w/ln removal A 090 0919303 Mast simple complete A 090 0919304 Mast subq A 090 0919305 Mast radical A 090 0919306 Mast rad urban type A 090 0919307 Mast mod rad A 090 0919316 Suspension of breast A 090 0919318 Reduction of large breast A 090 0919324 Enlarge breast A 090 0919325 Enlarge breast with implant A 090 0919328 Removal of breast implant A 090 0919330 Removal of implant material A 090 0919340 Immediate breast prosthesis A 090 0919342 Delayed breast prosthesis A 090 0919350 Breast reconstruction A 090 0919355 Correct inverted nipple(s) A 090 0919357 Breast reconstruction A 090 0919361 Breast reconstr w/lat flap A 090 0919364 Breast reconstruction A 090 0919366 Breast reconstruction A 090 0919367 Breast reconstruction A 090 0919368 Breast reconstruction A 090 0919369 Breast reconstruction A 090 0919370 Surgery of breast capsule A 090 0919371 Removal of breast capsule A 090 0919380 Revise breast reconstruction A 090 0919396 Design custom breast implant A 000 0919499 Breast surgery procedure C YYY 092000F Blood pressure measure M XXX 0920005 I&d abscess subfascial A 010 092001F Weight record I XXX 092002F Clin sign vol ovrld assess I XXX 092004F Initial exam involved joints I XXX 092010F Vital signs recorded I XXX 0920100 Explore wound neck A 010 0920101 Explore wound chest A 010 0920102 Explore wound abdomen A 010 0920103 Explore wound extremity A 010 092014F Mental status assess I XXX 092015F Asthma impairment assessed I XXX 0920150 Excise epiphyseal bar A 090 092016F Asthma risk assessed I XXX 09

2018F Hydration status assess I XXX 092019F Dilated macul exam done M XXX 092020F Dilated fundus eval done I XXX 0920200 Muscle biopsy A 000 0920205 Deep muscle biopsy A 000 0920206 Needle biopsy muscle A 000 092021F Dilat maculor exam done I XXX 092022F Dil retina exam interp rev M XXX 0920220 Bone biopsy trocar/needle A 000 0920225 Bone biopsy trocar/needle A 000 092024F 7 field photo interp doc rev M XXX 0920240 Bone biopsy excisional A 010 0920245 Bone biopsy excisional A 010 0920250 Open bone biopsy A 010 0920251 Open bone biopsy A 010 092026F Eye image valid to dx rev M XXX 092027F Optic nerve head eval done M XXX 092028F Foot exam performed I XXX 092029F Complete phys skin exam done I XXX 092030F H2o stat docd normal I XXX 092031F H2o stat docd dehydrated I XXX 092035F Tymp memb motion examd I XXX 092040F Bk pn xm on init visit date I XXX 092044F Doc mntl tst b/4 bk trxmnt I XXX 092050F Wound char size etc docd I XXX 0920500 Injection of sinus tract A 010 0920501 Inject sinus tract for x-ray A 000 0920520 Removal of foreign body A 010 0920525 Removal of foreign body A 010 0920526 Ther injection carp tunnel A 000 0920527 Inj dupuytren cord w/enzyme A 000 0920550 Inj tendon sheath/ligament A 000 0920551 Inj tendon origin/insertion A 000 0920552 Inj trigger point 1/2 muscl A 000 0920553 Inject trigger points 3/> A 000 0920555 Place ndl musc/tis for rt A 000 092060F Pt talk eval hlthwkr re mdd I XXX 0920600 Drain/inj joint/bursa w/o us A 000 0920604 Drain/inj joint/bursa w/us A 000 0920605 Drain/inj joint/bursa w/o us A 000 0920606 Drain/inj joint/bursa w/us A 000 0920610 Drain/inj joint/bursa w/o us A 000 0920611 Drain/inj joint/bursa w/us A 000 0920612 Aspirate/inj ganglion cyst A 000 0920615 Treatment of bone cyst A 010 0920650 Insert and remove bone pin A 010 0920660 Apply rem fixation device A 000 0920661 Application of head brace A 090 0920662 Application of pelvis brace A 090 0920663 Application of thigh brace A 090 09

20664 Application of halo A 090 0920665 Removal of fixation device A 010 0920670 Removal of support implant A 010 0920680 Removal of support implant A 090 0920690 Apply bone fixation device A 090 0920692 Apply bone fixation device A 090 0920693 Adjust bone fixation device A 090 0920694 Remove bone fixation device A 090 0920696 Comp multiplane ext fixation A 090 0920697 Comp ext fixate strut change A 000 0920802 Replantation arm complete A 090 0920805 Replant forearm complete A 090 0920808 Replantation hand complete A 090 0920816 Replantation digit complete A 090 0920822 Replantation digit complete A 090 0920824 Replantation thumb complete A 090 0920827 Replantation thumb complete A 090 0920838 Replantation foot complete A 090 0920900 Removal of bone for graft A 000 0920902 Removal of bone for graft A 000 0920910 Remove cartilage for graft A 090 0920912 Remove cartilage for graft A 090 0920920 Removal of fascia for graft A 090 0920922 Removal of fascia for graft A 090 0920924 Removal of tendon for graft A 090 0920926 Removal of tissue for graft A 090 0920930 Sp bone algrft morsel add-on B XXX 0920931 Sp bone algrft struct add-on A ZZZ 0920936 Sp bone agrft local add-on B XXX 0920937 Sp bone agrft morsel add-on A ZZZ 0920938 Sp bone agrft struct add-on A ZZZ 0920950 Fluid pressure muscle A 000 0920955 Fibula bone graft microvasc A 090 0920956 Iliac bone graft microvasc A 090 0920957 Mt bone graft microvasc A 090 0920962 Other bone graft microvasc A 090 0920969 Bone/skin graft microvasc A 090 0920970 Bone/skin graft iliac crest A 090 0920972 Bone/skin graft metatarsal A 090 0920973 Bone/skin graft great toe A 090 0920974 Electrical bone stimulation A 000 0920975 Electrical bone stimulation A 000 0920979 Us bone stimulation A 000 0920982 Ablate bone tumor(s) perq A 000 0920983 Ablate bone tumor(s) perq A 000 0920985 Cptr-asst dir ms px A ZZZ 0920999 Musculoskeletal surgery C YYY 0921010 Incision of jaw joint A 090 0921011 Exc face les sc <2 cm A 090 0921012 Exc face les sbq 2 cm/> A 090 09

21013 Exc face tum deep < 2 cm A 090 0921014 Exc face tum deep 2 cm/> A 090 0921015 Resect face/scalp tum < 2 cm A 090 0921016 Resect face/scalp tum 2 cm/> A 090 0921025 Excision of bone lower jaw A 090 0921026 Excision of facial bone(s) A 090 0921029 Contour of face bone lesion A 090 0921030 Excise max/zygoma b9 tumor A 090 0921031 Remove exostosis mandible A 090 0921032 Remove exostosis maxilla A 090 0921034 Excise max/zygoma mal tumor A 090 0921040 Excise mandible lesion A 090 0921044 Removal of jaw bone lesion A 090 0921045 Extensive jaw surgery A 090 0921046 Remove mandible cyst complex A 090 0921047 Excise lwr jaw cyst w/repair A 090 0921048 Remove maxilla cyst complex A 090 0921049 Excis uppr jaw cyst w/repair A 090 0921050 Removal of jaw joint A 090 0921060 Remove jaw joint cartilage A 090 0921070 Remove coronoid process A 090 0921073 Mnpj of tmj w/anesth A 090 0921076 Prepare face/oral prosthesis A 010 0921077 Prepare face/oral prosthesis A 090 0921079 Prepare face/oral prosthesis A 090 0921080 Prepare face/oral prosthesis A 090 0921081 Prepare face/oral prosthesis A 090 0921082 Prepare face/oral prosthesis A 090 0921083 Prepare face/oral prosthesis A 090 0921084 Prepare face/oral prosthesis A 090 0921085 Prepare face/oral prosthesis A 010 0921086 Prepare face/oral prosthesis A 090 0921087 Prepare face/oral prosthesis A 090 0921088 Prepare face/oral prosthesis C 090 0921089 Prepare face/oral prosthesis C YYY 0921100 Maxillofacial fixation A 090 0921110 Interdental fixation A 090 0921116 Injection jaw joint x-ray A 000 0921120 Reconstruction of chin A 090 0921121 Reconstruction of chin A 090 0921122 Reconstruction of chin A 090 0921123 Reconstruction of chin A 090 0921125 Augmentation lower jaw bone A 090 0921127 Augmentation lower jaw bone A 090 0921137 Reduction of forehead A 090 0921138 Reduction of forehead A 090 0921139 Reduction of forehead A 090 0921141 Lefort i-1 piece w/o graft A 090 0921142 Lefort i-2 piece w/o graft A 090 0921143 Lefort i-3/> piece w/o graft A 090 09

21145 Lefort i-1 piece w/ graft A 090 0921146 Lefort i-2 piece w/ graft A 090 0921147 Lefort i-3/> piece w/ graft A 090 0921150 Lefort ii anterior intrusion A 090 0921151 Lefort ii w/bone grafts A 090 0921154 Lefort iii w/o lefort i A 090 0921155 Lefort iii w/ lefort i A 090 0921159 Lefort iii w/fhdw/o lefort i A 090 0921160 Lefort iii w/fhd w/ lefort i A 090 0921172 Reconstruct orbit/forehead A 090 0921175 Reconstruct orbit/forehead A 090 0921179 Reconstruct entire forehead A 090 0921180 Reconstruct entire forehead A 090 0921181 Contour cranial bone lesion A 090 0921182 Reconstruct cranial bone A 090 0921183 Reconstruct cranial bone A 090 0921184 Reconstruct cranial bone A 090 0921188 Reconstruction of midface A 090 0921193 Reconst lwr jaw w/o graft A 090 0921194 Reconst lwr jaw w/graft A 090 0921195 Reconst lwr jaw w/o fixation A 090 0921196 Reconst lwr jaw w/fixation A 090 0921198 Reconstr lwr jaw segment A 090 0921199 Reconstr lwr jaw w/advance A 090 0921206 Reconstruct upper jaw bone A 090 0921208 Augmentation of facial bones A 090 0921209 Reduction of facial bones A 090 0921210 Face bone graft A 090 0921215 Lower jaw bone graft A 090 0921230 Rib cartilage graft A 090 0921235 Ear cartilage graft A 090 0921240 Reconstruction of jaw joint A 090 0921242 Reconstruction of jaw joint A 090 0921243 Reconstruction of jaw joint A 090 0921244 Reconstruction of lower jaw A 090 0921245 Reconstruction of jaw A 090 0921246 Reconstruction of jaw A 090 0921247 Reconstruct lower jaw bone A 090 0921248 Reconstruction of jaw A 090 0921249 Reconstruction of jaw A 090 0921255 Reconstruct lower jaw bone A 090 0921256 Reconstruction of orbit A 090 0921260 Revise eye sockets A 090 0921261 Revise eye sockets A 090 0921263 Revise eye sockets A 090 0921267 Revise eye sockets A 090 0921268 Revise eye sockets A 090 0921270 Augmentation cheek bone A 090 0921275 Revision orbitofacial bones A 090 0921280 Revision of eyelid A 090 09

21282 Revision of eyelid A 090 0921295 Revision of jaw muscle/bone A 090 0921296 Revision of jaw muscle/bone A 090 0921299 Cranio/maxillofacial surgery C YYY 0921310 Closed tx nose fx w/o manj A 000 0921315 Closed tx nose fx w/o stablj A 010 0921320 Closed tx nose fx w/ stablj A 010 0921325 Open tx nose fx uncomplicatd A 090 0921330 Open tx nose fx w/skele fixj A 090 0921335 Open tx nose & septal fx A 090 0921336 Open tx septal fx w/wo stabj A 090 0921337 Closed tx septal&nose fx A 090 0921338 Open nasoethmoid fx w/o fixj A 090 0921339 Open nasoethmoid fx w/ fixj A 090 0921340 Perq tx nasoethmoid fx A 090 0921343 Open tx dprsd front sinus fx A 090 0921344 Open tx compl front sinus fx A 090 0921345 Closed tx nose/jaw fx A 090 0921346 Opn tx nasomax fx w/fixj A 090 0921347 Opn tx nasomax fx multple A 090 0921348 Opn tx nasomax fx w/graft A 090 0921355 Perq tx malar fracture A 010 0921356 Opn tx dprsd zygomatic arch A 010 0921360 Opn tx dprsd malar fracture A 090 0921365 Opn tx complx malar fx A 090 0921366 Opn tx complx malar w/grft A 090 0921385 Opn tx orbit fx transantral A 090 0921386 Opn tx orbit fx periorbital A 090 0921387 Opn tx orbit fx combined A 090 0921390 Opn tx orbit periorbtl implt A 090 0921395 Opn tx orbit periorbt w/grft A 090 0921400 Closed tx orbit w/o manipulj A 090 0921401 Closed tx orbit w/manipulj A 090 0921406 Opn tx orbit fx w/o implant A 090 0921407 Opn tx orbit fx w/implant A 090 0921408 Opn tx orbit fx w/bone grft A 090 0921421 Treat mouth roof fracture A 090 0921422 Treat mouth roof fracture A 090 0921423 Treat mouth roof fracture A 090 0921431 Treat craniofacial fracture A 090 0921432 Treat craniofacial fracture A 090 0921433 Treat craniofacial fracture A 090 0921435 Treat craniofacial fracture A 090 0921436 Treat craniofacial fracture A 090 0921440 Treat dental ridge fracture A 090 0921445 Treat dental ridge fracture A 090 0921450 Treat lower jaw fracture A 090 0921451 Treat lower jaw fracture A 090 0921452 Treat lower jaw fracture A 090 0921453 Treat lower jaw fracture A 090 09

21454 Treat lower jaw fracture A 090 0921461 Treat lower jaw fracture A 090 0921462 Treat lower jaw fracture A 090 0921465 Treat lower jaw fracture A 090 0921470 Treat lower jaw fracture A 090 0921480 Reset dislocated jaw A 000 0921485 Reset dislocated jaw A 090 0921490 Repair dislocated jaw A 090 0921495 Treat hyoid bone fracture A 090 0921497 Interdental wiring A 090 0921499 Head surgery procedure C YYY 0921501 Drain neck/chest lesion A 090 0921502 Drain chest lesion A 090 0921510 Drainage of bone lesion A 090 0921550 Biopsy of neck/chest A 010 0921552 Exc neck les sc 3 cm/> A 090 0921554 Exc neck tum deep 5 cm/> A 090 0921555 Exc neck les sc < 3 cm A 090 0921556 Exc neck tum deep < 5 cm A 090 0921557 Resect neck thorax tumor<5cm A 090 0921558 Resect neck tumor 5 cm/> A 090 0921600 Partial removal of rib A 090 0921610 Partial removal of rib A 090 0921615 Removal of rib A 090 0921616 Removal of rib and nerves A 090 0921620 Partial removal of sternum A 090 0921627 Sternal debridement A 090 0921630 Extensive sternum surgery A 090 0921632 Extensive sternum surgery A 090 0921685 Hyoid myotomy & suspension A 090 0921700 Revision of neck muscle A 090 0921705 Revision of neck muscle/rib A 090 0921720 Revision of neck muscle A 090 0921725 Revision of neck muscle A 090 0921740 Reconstruction of sternum A 090 0921742 Repair stern/nuss w/o scope C 090 0921743 Repair sternum/nuss w/scope C 090 0921750 Repair of sternum separation A 090 0921805 Treatment of rib fracture A 090 0921811 Optx of rib fx w/fixj scope A 000 0921812 Treatment of rib fracture A 000 0921813 Treatment of rib fracture A 000 0921820 Treat sternum fracture A 090 0921825 Treat sternum fracture A 090 0921899 Neck/chest surgery procedure C YYY 0921920 Biopsy soft tissue of back A 010 0921925 Biopsy soft tissue of back A 090 0921930 Exc back les sc < 3 cm A 090 0921931 Exc back les sc 3 cm/> A 090 0921932 Exc back tum deep < 5 cm A 090 09

21933 Exc back tum deep 5 cm/> A 090 0921935 Resect back tum < 5 cm A 090 0921936 Resect back tum 5 cm/> A 090 0922010 I&d p-spine c/t/cerv-thor A 090 0922015 I&d abscess p-spine l/s/ls A 090 0922100 Remove part of neck vertebra A 090 0922101 Remove part thorax vertebra A 090 0922102 Remove part lumbar vertebra A 090 0922103 Remove extra spine segment A ZZZ 0922110 Remove part of neck vertebra A 090 0922112 Remove part thorax vertebra A 090 0922114 Remove part lumbar vertebra A 090 0922116 Remove extra spine segment A ZZZ 0922206 Incis spine 3 column thorac A 090 0922207 Incis spine 3 column lumbar A 090 0922208 Incis spine 3 column adl seg A ZZZ 0922210 Incis 1 vertebral seg cerv A 090 0922212 Incis 1 vertebral seg thorac A 090 0922214 Incis 1 vertebral seg lumbar A 090 0922216 Incis addl spine segment A ZZZ 0922220 Incis w/discectomy cervical A 090 0922222 Incis w/discectomy thoracic A 090 0922224 Incis w/discectomy lumbar A 090 0922226 Revise extra spine segment A ZZZ 0922305 Closed tx spine process fx A 090 0922310 Closed tx vert fx w/o manj A 090 0922315 Closed tx vert fx w/manj A 090 0922318 Treat odontoid fx w/o graft A 090 0922319 Treat odontoid fx w/graft A 090 0922325 Treat spine fracture A 090 0922326 Treat neck spine fracture A 090 0922327 Treat thorax spine fracture A 090 0922328 Treat each add spine fx A ZZZ 0922505 Manipulation of spine A 010 0922510 Perq cervicothoracic inject A 010 0922511 Perq lumbosacral injection A 010 0922512 Vertebroplasty addl inject A ZZZ 0922513 Perq vertebral augmentation A 010 0922514 Perq vertebral augmentation A 010 0922515 Perq vertebral augmentation A ZZZ 0922526 Idet single level N 010 0922527 Idet 1 or more levels N ZZZ 0922532 Lat thorax spine fusion A 090 0922533 Lat lumbar spine fusion A 090 0922534 Lat thor/lumb addl seg A ZZZ 0922548 Neck spine fusion A 090 0922551 Neck spine fuse&remov bel c2 A 090 0922552 Addl neck spine fusion A ZZZ 0922554 Neck spine fusion A 090 0922556 Thorax spine fusion A 090 09

22558 Lumbar spine fusion A 090 0922585 Additional spinal fusion A ZZZ 0922586 Prescrl fuse w/ instr l5-s1 A 090 0922590 Spine & skull spinal fusion A 090 0922595 Neck spinal fusion A 090 0922600 Neck spine fusion A 090 0922610 Thorax spine fusion A 090 0922612 Lumbar spine fusion A 090 0922614 Spine fusion extra segment A ZZZ 0922630 Lumbar spine fusion A 090 0922632 Spine fusion extra segment A ZZZ 0922633 Lumbar spine fusion combined A 090 0922634 Spine fusion extra segment A ZZZ 0922800 Post fusion </6 vert seg A 090 0922802 Post fusion 7-12 vert seg A 090 0922804 Post fusion 13/> vert seg A 090 0922808 Ant fusion 2-3 vert seg A 090 0922810 Ant fusion 4-7 vert seg A 090 0922812 Ant fusion 8/> vert seg A 090 0922818 Kyphectomy 1-2 segments A 090 0922819 Kyphectomy 3 or more A 090 0922830 Exploration of spinal fusion A 090 0922840 Insert spine fixation device A ZZZ 0922841 Insert spine fixation device B XXX 0922842 Insert spine fixation device A ZZZ 0922843 Insert spine fixation device A ZZZ 0922844 Insert spine fixation device A ZZZ 0922845 Insert spine fixation device A ZZZ 0922846 Insert spine fixation device A ZZZ 0922847 Insert spine fixation device A ZZZ 0922848 Insert pelv fixation device A ZZZ 0922849 Reinsert spinal fixation A 090 0922850 Remove spine fixation device A 090 0922851 Apply spine prosth device A ZZZ 0922852 Remove spine fixation device A 090 0922855 Remove spine fixation device A 090 0922856 Cerv artific diskectomy A 090 0922857 Lumbar artif diskectomy R 090 0922858 Second level cer diskectomy A ZZZ 0922861 Revise cerv artific disc A 090 0922862 Revise lumbar artif disc R 090 0922864 Remove cerv artif disc A 090 0922865 Remove lumb artif disc R 090 0922899 Spine surgery procedure C YYY 0922900 Exc abdl tum deep < 5 cm A 090 0922901 Exc abdl tum deep 5 cm/> A 090 0922902 Exc abd les sc < 3 cm A 090 0922903 Exc abd les sc 3 cm/> A 090 0922904 Radical resect abd tumor<5cm A 090 0922905 Rad resect abd tumor 5 cm/> A 090 09

22999 Abdomen surgery procedure C YYY 0923000 Removal of calcium deposits A 090 0923020 Release shoulder joint A 090 0923030 Drain shoulder lesion A 010 0923031 Drain shoulder bursa A 010 0923035 Drain shoulder bone lesion A 090 0923040 Exploratory shoulder surgery A 090 0923044 Exploratory shoulder surgery A 090 0923065 Biopsy shoulder tissues A 010 0923066 Biopsy shoulder tissues A 090 0923071 Exc shoulder les sc 3 cm/> A 090 0923073 Exc shoulder tum deep 5 cm/> A 090 0923075 Exc shoulder les sc < 3 cm A 090 0923076 Exc shoulder tum deep < 5 cm A 090 0923077 Resect shoulder tumor < 5 cm A 090 0923078 Resect shoulder tumor 5 cm/> A 090 0923100 Biopsy of shoulder joint A 090 0923101 Shoulder joint surgery A 090 0923105 Remove shoulder joint lining A 090 0923106 Incision of collarbone joint A 090 0923107 Explore treat shoulder joint A 090 0923120 Partial removal collar bone A 090 0923125 Removal of collar bone A 090 0923130 Remove shoulder bone part A 090 0923140 Removal of bone lesion A 090 0923145 Removal of bone lesion A 090 0923146 Removal of bone lesion A 090 0923150 Removal of humerus lesion A 090 0923155 Removal of humerus lesion A 090 0923156 Removal of humerus lesion A 090 0923170 Remove collar bone lesion A 090 0923172 Remove shoulder blade lesion A 090 0923174 Remove humerus lesion A 090 0923180 Remove collar bone lesion A 090 0923182 Remove shoulder blade lesion A 090 0923184 Remove humerus lesion A 090 0923190 Partial removal of scapula A 090 0923195 Removal of head of humerus A 090 0923200 Resect clavicle tumor A 090 0923210 Resect scapula tumor A 090 0923220 Resect prox humerus tumor A 090 0923330 Remove shoulder foreign body A 010 0923333 Remove shoulder fb deep A 090 0923334 Shoulder prosthesis removal A 090 0923335 Shoulder prosthesis removal A 090 0923350 Injection for shoulder x-ray A 000 0923395 Muscle transfer shoulder/arm A 090 0923397 Muscle transfers A 090 0923400 Fixation of shoulder blade A 090 0923405 Incision of tendon & muscle A 090 09

23406 Incise tendon(s) & muscle(s) A 090 0923410 Repair rotator cuff acute A 090 0923412 Repair rotator cuff chronic A 090 0923415 Release of shoulder ligament A 090 0923420 Repair of shoulder A 090 0923430 Repair biceps tendon A 090 0923440 Remove/transplant tendon A 090 0923450 Repair shoulder capsule A 090 0923455 Repair shoulder capsule A 090 0923460 Repair shoulder capsule A 090 0923462 Repair shoulder capsule A 090 0923465 Repair shoulder capsule A 090 0923466 Repair shoulder capsule A 090 0923470 Reconstruct shoulder joint A 090 0923472 Reconstruct shoulder joint A 090 0923473 Revis reconst shoulder joint A 090 0923474 Revis reconst shoulder joint A 090 0923480 Revision of collar bone A 090 0923485 Revision of collar bone A 090 0923490 Reinforce clavicle A 090 0923491 Reinforce shoulder bones A 090 0923500 Treat clavicle fracture A 090 0923505 Treat clavicle fracture A 090 0923515 Treat clavicle fracture A 090 0923520 Treat clavicle dislocation A 090 0923525 Treat clavicle dislocation A 090 0923530 Treat clavicle dislocation A 090 0923532 Treat clavicle dislocation A 090 0923540 Treat clavicle dislocation A 090 0923545 Treat clavicle dislocation A 090 0923550 Treat clavicle dislocation A 090 0923552 Treat clavicle dislocation A 090 0923570 Treat shoulder blade fx A 090 0923575 Treat shoulder blade fx A 090 0923585 Treat scapula fracture A 090 0923600 Treat humerus fracture A 090 0923605 Treat humerus fracture A 090 0923615 Treat humerus fracture A 090 0923616 Treat humerus fracture A 090 0923620 Treat humerus fracture A 090 0923625 Treat humerus fracture A 090 0923630 Treat humerus fracture A 090 0923650 Treat shoulder dislocation A 090 0923655 Treat shoulder dislocation A 090 0923660 Treat shoulder dislocation A 090 0923665 Treat dislocation/fracture A 090 0923670 Treat dislocation/fracture A 090 0923675 Treat dislocation/fracture A 090 0923680 Treat dislocation/fracture A 090 0923700 Fixation of shoulder A 010 09

23800 Fusion of shoulder joint A 090 0923802 Fusion of shoulder joint A 090 0923900 Amputation of arm & girdle A 090 0923920 Amputation at shoulder joint A 090 0923921 Amputation follow-up surgery A 090 0923929 Shoulder surgery procedure C YYY 0923930 Drainage of arm lesion A 010 0923931 Drainage of arm bursa A 010 0923935 Drain arm/elbow bone lesion A 090 0924000 Exploratory elbow surgery A 090 0924006 Release elbow joint A 090 0924065 Biopsy arm/elbow soft tissue A 010 0924066 Biopsy arm/elbow soft tissue A 090 0924071 Exc arm/elbow les sc 3 cm/> A 090 0924073 Ex arm/elbow tum deep 5 cm/> A 090 0924075 Exc arm/elbow les sc < 3 cm A 090 0924076 Ex arm/elbow tum deep < 5 cm A 090 0924077 Resect arm/elbow tum < 5 cm A 090 0924079 Resect arm/elbow tum 5 cm/> A 090 0924100 Biopsy elbow joint lining A 090 0924101 Explore/treat elbow joint A 090 0924102 Remove elbow joint lining A 090 0924105 Removal of elbow bursa A 090 0924110 Remove humerus lesion A 090 0924115 Remove/graft bone lesion A 090 0924116 Remove/graft bone lesion A 090 0924120 Remove elbow lesion A 090 0924125 Remove/graft bone lesion A 090 0924126 Remove/graft bone lesion A 090 0924130 Removal of head of radius A 090 0924134 Removal of arm bone lesion A 090 0924136 Remove radius bone lesion A 090 0924138 Remove elbow bone lesion A 090 0924140 Partial removal of arm bone A 090 0924145 Partial removal of radius A 090 0924147 Partial removal of elbow A 090 0924149 Radical resection of elbow A 090 0924150 Resect distal humerus tumor A 090 0924152 Resect radius tumor A 090 0924155 Removal of elbow joint A 090 0924160 Remove elbow joint implant A 090 0924164 Remove radius head implant A 090 0924200 Removal of arm foreign body A 010 0924201 Removal of arm foreign body A 090 0924220 Injection for elbow x-ray A 000 0924300 Manipulate elbow w/anesth A 090 0924301 Muscle/tendon transfer A 090 0924305 Arm tendon lengthening A 090 0924310 Revision of arm tendon A 090 0924320 Repair of arm tendon A 090 09

24330 Revision of arm muscles A 090 0924331 Revision of arm muscles A 090 0924332 Tenolysis triceps A 090 0924340 Repair of biceps tendon A 090 0924341 Repair arm tendon/muscle A 090 0924342 Repair of ruptured tendon A 090 0924343 Repr elbow lat ligmnt w/tiss A 090 0924344 Reconstruct elbow lat ligmnt A 090 0924345 Repr elbw med ligmnt w/tissu A 090 0924346 Reconstruct elbow med ligmnt A 090 0924357 Repair elbow perc A 090 0924358 Repair elbow w/deb open A 090 0924359 Repair elbow deb/attch open A 090 0924360 Reconstruct elbow joint A 090 0924361 Reconstruct elbow joint A 090 0924362 Reconstruct elbow joint A 090 0924363 Replace elbow joint A 090 0924365 Reconstruct head of radius A 090 0924366 Reconstruct head of radius A 090 0924370 Revise reconst elbow joint A 090 0924371 Revise reconst elbow joint A 090 0924400 Revision of humerus A 090 0924410 Revision of humerus A 090 0924420 Revision of humerus A 090 0924430 Repair of humerus A 090 0924435 Repair humerus with graft A 090 0924470 Revision of elbow joint A 090 0924495 Decompression of forearm A 090 0924498 Reinforce humerus A 090 0924500 Treat humerus fracture A 090 0924505 Treat humerus fracture A 090 0924515 Treat humerus fracture A 090 0924516 Treat humerus fracture A 090 0924530 Treat humerus fracture A 090 0924535 Treat humerus fracture A 090 0924538 Treat humerus fracture A 090 0924545 Treat humerus fracture A 090 0924546 Treat humerus fracture A 090 0924560 Treat humerus fracture A 090 0924565 Treat humerus fracture A 090 0924566 Treat humerus fracture A 090 0924575 Treat humerus fracture A 090 0924576 Treat humerus fracture A 090 0924577 Treat humerus fracture A 090 0924579 Treat humerus fracture A 090 0924582 Treat humerus fracture A 090 0924586 Treat elbow fracture A 090 0924587 Treat elbow fracture A 090 0924600 Treat elbow dislocation A 090 0924605 Treat elbow dislocation A 090 09

24615 Treat elbow dislocation A 090 0924620 Treat elbow fracture A 090 0924635 Treat elbow fracture A 090 0924640 Treat elbow dislocation A 010 0924650 Treat radius fracture A 090 0924655 Treat radius fracture A 090 0924665 Treat radius fracture A 090 0924666 Treat radius fracture A 090 0924670 Treat ulnar fracture A 090 0924675 Treat ulnar fracture A 090 0924685 Treat ulnar fracture A 090 0924800 Fusion of elbow joint A 090 0924802 Fusion/graft of elbow joint A 090 0924900 Amputation of upper arm A 090 0924920 Amputation of upper arm A 090 0924925 Amputation follow-up surgery A 090 0924930 Amputation follow-up surgery A 090 0924931 Amputate upper arm & implant A 090 0924935 Revision of amputation A 090 0924940 Revision of upper arm C 090 0924999 Upper arm/elbow surgery C YYY 0925000 Incision of tendon sheath A 090 0925001 Incise flexor carpi radialis A 090 0925020 Decompress forearm 1 space A 090 0925023 Decompress forearm 1 space A 090 0925024 Decompress forearm 2 spaces A 090 0925025 Decompress forearm 2 spaces A 090 0925028 Drainage of forearm lesion A 090 0925031 Drainage of forearm bursa A 090 0925035 Treat forearm bone lesion A 090 0925040 Explore/treat wrist joint A 090 0925065 Biopsy forearm soft tissues A 010 0925066 Biopsy forearm soft tissues A 090 0925071 Exc forearm les sc 3 cm/> A 090 0925073 Exc forearm tum deep 3 cm/> A 090 0925075 Exc forearm les sc < 3 cm A 090 0925076 Exc forearm tum deep < 3 cm A 090 0925077 Resect forearm/wrist tum<3cm A 090 0925078 Resect forarm/wrist tum 3cm> A 090 0925085 Incision of wrist capsule A 090 0925100 Biopsy of wrist joint A 090 0925101 Explore/treat wrist joint A 090 0925105 Remove wrist joint lining A 090 0925107 Remove wrist joint cartilage A 090 0925109 Excise tendon forearm/wrist A 090 0925110 Remove wrist tendon lesion A 090 0925111 Remove wrist tendon lesion A 090 0925112 Reremove wrist tendon lesion A 090 0925115 Remove wrist/forearm lesion A 090 0925116 Remove wrist/forearm lesion A 090 09

25118 Excise wrist tendon sheath A 090 0925119 Partial removal of ulna A 090 0925120 Removal of forearm lesion A 090 0925125 Remove/graft forearm lesion A 090 0925126 Remove/graft forearm lesion A 090 0925130 Removal of wrist lesion A 090 0925135 Remove & graft wrist lesion A 090 0925136 Remove & graft wrist lesion A 090 0925145 Remove forearm bone lesion A 090 0925150 Partial removal of ulna A 090 0925151 Partial removal of radius A 090 0925170 Resect radius/ulnar tumor A 090 0925210 Removal of wrist bone A 090 0925215 Removal of wrist bones A 090 0925230 Partial removal of radius A 090 0925240 Partial removal of ulna A 090 0925246 Injection for wrist x-ray A 000 0925248 Remove forearm foreign body A 090 0925250 Removal of wrist prosthesis A 090 0925251 Removal of wrist prosthesis A 090 0925259 Manipulate wrist w/anesthes A 090 0925260 Repair forearm tendon/muscle A 090 0925263 Repair forearm tendon/muscle A 090 0925265 Repair forearm tendon/muscle A 090 0925270 Repair forearm tendon/muscle A 090 0925272 Repair forearm tendon/muscle A 090 0925274 Repair forearm tendon/muscle A 090 0925275 Repair forearm tendon sheath A 090 0925280 Revise wrist/forearm tendon A 090 0925290 Incise wrist/forearm tendon A 090 0925295 Release wrist/forearm tendon A 090 0925300 Fusion of tendons at wrist A 090 0925301 Fusion of tendons at wrist A 090 0925310 Transplant forearm tendon A 090 0925312 Transplant forearm tendon A 090 0925315 Revise palsy hand tendon(s) A 090 0925316 Revise palsy hand tendon(s) A 090 0925320 Repair/revise wrist joint A 090 0925332 Revise wrist joint A 090 0925335 Realignment of hand A 090 0925337 Reconstruct ulna/radioulnar A 090 0925350 Revision of radius A 090 0925355 Revision of radius A 090 0925360 Revision of ulna A 090 0925365 Revise radius & ulna A 090 0925370 Revise radius or ulna A 090 0925375 Revise radius & ulna A 090 0925390 Shorten radius or ulna A 090 0925391 Lengthen radius or ulna A 090 0925392 Shorten radius & ulna A 090 09

25393 Lengthen radius & ulna A 090 0925394 Repair carpal bone shorten A 090 0925400 Repair radius or ulna A 090 0925405 Repair/graft radius or ulna A 090 0925415 Repair radius & ulna A 090 0925420 Repair/graft radius & ulna A 090 0925425 Repair/graft radius or ulna A 090 0925426 Repair/graft radius & ulna A 090 0925430 Vasc graft into carpal bone A 090 0925431 Repair nonunion carpal bone A 090 0925440 Repair/graft wrist bone A 090 0925441 Reconstruct wrist joint A 090 0925442 Reconstruct wrist joint A 090 0925443 Reconstruct wrist joint A 090 0925444 Reconstruct wrist joint A 090 0925445 Reconstruct wrist joint A 090 0925446 Wrist replacement A 090 0925447 Repair wrist joints A 090 0925449 Remove wrist joint implant A 090 0925450 Revision of wrist joint A 090 0925455 Revision of wrist joint A 090 0925490 Reinforce radius A 090 0925491 Reinforce ulna A 090 0925492 Reinforce radius and ulna A 090 0925500 Treat fracture of radius A 090 0925505 Treat fracture of radius A 090 0925515 Treat fracture of radius A 090 0925520 Treat fracture of radius A 090 0925525 Treat fracture of radius A 090 0925526 Treat fracture of radius A 090 0925530 Treat fracture of ulna A 090 0925535 Treat fracture of ulna A 090 0925545 Treat fracture of ulna A 090 0925560 Treat fracture radius & ulna A 090 0925565 Treat fracture radius & ulna A 090 0925574 Treat fracture radius & ulna A 090 0925575 Treat fracture radius/ulna A 090 0925600 Treat fracture radius/ulna A 090 0925605 Treat fracture radius/ulna A 090 0925606 Treat fx distal radial A 090 0925607 Treat fx rad extra-articul A 090 0925608 Treat fx rad intra-articul A 090 0925609 Treat fx radial 3+ frag A 090 0925622 Treat wrist bone fracture A 090 0925624 Treat wrist bone fracture A 090 0925628 Treat wrist bone fracture A 090 0925630 Treat wrist bone fracture A 090 0925635 Treat wrist bone fracture A 090 0925645 Treat wrist bone fracture A 090 0925650 Treat wrist bone fracture A 090 09

25651 Pin ulnar styloid fracture A 090 0925652 Treat fracture ulnar styloid A 090 0925660 Treat wrist dislocation A 090 0925670 Treat wrist dislocation A 090 0925671 Pin radioulnar dislocation A 090 0925675 Treat wrist dislocation A 090 0925676 Treat wrist dislocation A 090 0925680 Treat wrist fracture A 090 0925685 Treat wrist fracture A 090 0925690 Treat wrist dislocation A 090 0925695 Treat wrist dislocation A 090 0925800 Fusion of wrist joint A 090 0925805 Fusion/graft of wrist joint A 090 0925810 Fusion/graft of wrist joint A 090 0925820 Fusion of hand bones A 090 0925825 Fuse hand bones with graft A 090 0925830 Fusion radioulnar jnt/ulna A 090 0925900 Amputation of forearm A 090 0925905 Amputation of forearm A 090 0925907 Amputation follow-up surgery A 090 0925909 Amputation follow-up surgery A 090 0925915 Amputation of forearm A 090 0925920 Amputate hand at wrist A 090 0925922 Amputate hand at wrist A 090 0925924 Amputation follow-up surgery A 090 0925927 Amputation of hand A 090 0925929 Amputation follow-up surgery A 090 0925931 Amputation follow-up surgery A 090 0925999 Forearm or wrist surgery C YYY 0926010 Drainage of finger abscess A 010 0926011 Drainage of finger abscess A 010 0926020 Drain hand tendon sheath A 090 0926025 Drainage of palm bursa A 090 0926030 Drainage of palm bursas A 090 0926034 Treat hand bone lesion A 090 0926035 Decompress fingers/hand A 090 0926037 Decompress fingers/hand A 090 0926040 Release palm contracture A 090 0926045 Release palm contracture A 090 0926055 Incise finger tendon sheath A 090 0926060 Incision of finger tendon A 090 0926070 Explore/treat hand joint A 090 0926075 Explore/treat finger joint A 090 0926080 Explore/treat finger joint A 090 0926100 Biopsy hand joint lining A 090 0926105 Biopsy finger joint lining A 090 0926110 Biopsy finger joint lining A 090 0926111 Exc hand les sc 1.5 cm/> A 090 0926113 Exc hand tum deep 1.5 cm/> A 090 0926115 Exc hand les sc < 1.5 cm A 090 09

26116 Exc hand tum deep < 1.5 cm A 090 0926117 Rad resect hand tumor < 3 cm A 090 0926118 Rad resect hand tumor 3 cm/> A 090 0926121 Release palm contracture A 090 0926123 Release palm contracture A 090 0926125 Release palm contracture A ZZZ 0926130 Remove wrist joint lining A 090 0926135 Revise finger joint each A 090 0926140 Revise finger joint each A 090 0926145 Tendon excision palm/finger A 090 0926160 Remove tendon sheath lesion A 090 0926170 Removal of palm tendon each A 090 0926180 Removal of finger tendon A 090 0926185 Remove finger bone A 090 0926200 Remove hand bone lesion A 090 0926205 Remove/graft bone lesion A 090 0926210 Removal of finger lesion A 090 0926215 Remove/graft finger lesion A 090 0926230 Partial removal of hand bone A 090 0926235 Partial removal finger bone A 090 0926236 Partial removal finger bone A 090 0926250 Extensive hand surgery A 090 0926260 Resect prox finger tumor A 090 0926262 Resect distal finger tumor A 090 0926320 Removal of implant from hand A 090 0926340 Manipulate finger w/anesth A 090 0926341 Manipulat palm cord post inj A 010 0926350 Repair finger/hand tendon A 090 0926352 Repair/graft hand tendon A 090 0926356 Repair finger/hand tendon A 090 0926357 Repair finger/hand tendon A 090 0926358 Repair/graft hand tendon A 090 0926370 Repair finger/hand tendon A 090 0926372 Repair/graft hand tendon A 090 0926373 Repair finger/hand tendon A 090 0926390 Revise hand/finger tendon A 090 0926392 Repair/graft hand tendon A 090 0926410 Repair hand tendon A 090 0926412 Repair/graft hand tendon A 090 0926415 Excision hand/finger tendon A 090 0926416 Graft hand or finger tendon A 090 0926418 Repair finger tendon A 090 0926420 Repair/graft finger tendon A 090 0926426 Repair finger/hand tendon A 090 0926428 Repair/graft finger tendon A 090 0926432 Repair finger tendon A 090 0926433 Repair finger tendon A 090 0926434 Repair/graft finger tendon A 090 0926437 Realignment of tendons A 090 0926440 Release palm/finger tendon A 090 09

26442 Release palm & finger tendon A 090 0926445 Release hand/finger tendon A 090 0926449 Release forearm/hand tendon A 090 0926450 Incision of palm tendon A 090 0926455 Incision of finger tendon A 090 0926460 Incise hand/finger tendon A 090 0926471 Fusion of finger tendons A 090 0926474 Fusion of finger tendons A 090 0926476 Tendon lengthening A 090 0926477 Tendon shortening A 090 0926478 Lengthening of hand tendon A 090 0926479 Shortening of hand tendon A 090 0926480 Transplant hand tendon A 090 0926483 Transplant/graft hand tendon A 090 0926485 Transplant palm tendon A 090 0926489 Transplant/graft palm tendon A 090 0926490 Revise thumb tendon A 090 0926492 Tendon transfer with graft A 090 0926494 Hand tendon/muscle transfer A 090 0926496 Revise thumb tendon A 090 0926497 Finger tendon transfer A 090 0926498 Finger tendon transfer A 090 0926499 Revision of finger A 090 0926500 Hand tendon reconstruction A 090 0926502 Hand tendon reconstruction A 090 0926508 Release thumb contracture A 090 0926510 Thumb tendon transfer A 090 0926516 Fusion of knuckle joint A 090 0926517 Fusion of knuckle joints A 090 0926518 Fusion of knuckle joints A 090 0926520 Release knuckle contracture A 090 0926525 Release finger contracture A 090 0926530 Revise knuckle joint A 090 0926531 Revise knuckle with implant A 090 0926535 Revise finger joint A 090 0926536 Revise/implant finger joint A 090 0926540 Repair hand joint A 090 0926541 Repair hand joint with graft A 090 0926542 Repair hand joint with graft A 090 0926545 Reconstruct finger joint A 090 0926546 Repair nonunion hand A 090 0926548 Reconstruct finger joint A 090 0926550 Construct thumb replacement A 090 0926551 Great toe-hand transfer A 090 0926553 Single transfer toe-hand A 090 0926554 Double transfer toe-hand A 090 0926555 Positional change of finger A 090 0926556 Toe joint transfer A 090 0926560 Repair of web finger A 090 0926561 Repair of web finger A 090 09

26562 Repair of web finger A 090 0926565 Correct metacarpal flaw A 090 0926567 Correct finger deformity A 090 0926568 Lengthen metacarpal/finger A 090 0926580 Repair hand deformity A 090 0926587 Reconstruct extra finger A 090 0926590 Repair finger deformity A 090 0926591 Repair muscles of hand A 090 0926593 Release muscles of hand A 090 0926596 Excision constricting tissue A 090 0926600 Treat metacarpal fracture A 090 0926605 Treat metacarpal fracture A 090 0926607 Treat metacarpal fracture A 090 0926608 Treat metacarpal fracture A 090 0926615 Treat metacarpal fracture A 090 0926641 Treat thumb dislocation A 090 0926645 Treat thumb fracture A 090 0926650 Treat thumb fracture A 090 0926665 Treat thumb fracture A 090 0926670 Treat hand dislocation A 090 0926675 Treat hand dislocation A 090 0926676 Pin hand dislocation A 090 0926685 Treat hand dislocation A 090 0926686 Treat hand dislocation A 090 0926700 Treat knuckle dislocation A 090 0926705 Treat knuckle dislocation A 090 0926706 Pin knuckle dislocation A 090 0926715 Treat knuckle dislocation A 090 0926720 Treat finger fracture each A 090 0926725 Treat finger fracture each A 090 0926727 Treat finger fracture each A 090 0926735 Treat finger fracture each A 090 0926740 Treat finger fracture each A 090 0926742 Treat finger fracture each A 090 0926746 Treat finger fracture each A 090 0926750 Treat finger fracture each A 090 0926755 Treat finger fracture each A 090 0926756 Pin finger fracture each A 090 0926765 Treat finger fracture each A 090 0926770 Treat finger dislocation A 090 0926775 Treat finger dislocation A 090 0926776 Pin finger dislocation A 090 0926785 Treat finger dislocation A 090 0926820 Thumb fusion with graft A 090 0926841 Fusion of thumb A 090 0926842 Thumb fusion with graft A 090 0926843 Fusion of hand joint A 090 0926844 Fusion/graft of hand joint A 090 0926850 Fusion of knuckle A 090 0926852 Fusion of knuckle with graft A 090 09

26860 Fusion of finger joint A 090 0926861 Fusion of finger jnt add-on A ZZZ 0926862 Fusion/graft of finger joint A 090 0926863 Fuse/graft added joint A ZZZ 0926910 Amputate metacarpal bone A 090 0926951 Amputation of finger/thumb A 090 0926952 Amputation of finger/thumb A 090 0926989 Hand/finger surgery C YYY 0926990 Drainage of pelvis lesion A 090 0926991 Drainage of pelvis bursa A 090 0926992 Drainage of bone lesion A 090 0927000 Incision of hip tendon A 090 0927001 Incision of hip tendon A 090 0927003 Incision of hip tendon A 090 0927005 Incision of hip tendon A 090 0927006 Incision of hip tendons A 090 0927025 Incision of hip/thigh fascia A 090 0927027 Buttock fasciotomy A 090 0927030 Drainage of hip joint A 090 0927033 Exploration of hip joint A 090 0927035 Denervation of hip joint A 090 0927036 Excision of hip joint/muscle A 090 0927040 Biopsy of soft tissues A 010 0927041 Biopsy of soft tissues A 090 0927043 Exc hip pelvis les sc 3 cm/> A 090 0927045 Exc hip/pelv tum deep 5 cm/> A 090 0927047 Exc hip/pelvis les sc < 3 cm A 090 0927048 Exc hip/pelv tum deep < 5 cm A 090 0927049 Resect hip/pelv tum < 5 cm A 090 0927050 Biopsy of sacroiliac joint A 090 0927052 Biopsy of hip joint A 090 0927054 Removal of hip joint lining A 090 0927057 Buttock fasciotomy w/dbrdmt A 090 0927059 Resect hip/pelv tum 5 cm/> A 090 0927060 Removal of ischial bursa A 090 0927062 Remove femur lesion/bursa A 090 0927065 Remove hip bone les super A 090 0927066 Remove hip bone les deep A 090 0927067 Remove/graft hip bone lesion A 090 0927070 Part remove hip bone super A 090 0927071 Part removal hip bone deep A 090 0927075 Resect hip tumor A 090 0927076 Resect hip tum incl acetabul A 090 0927077 Resect hip tum w/innom bone A 090 0927078 Rsect hip tum incl femur A 090 0927080 Removal of tail bone A 090 0927086 Remove hip foreign body A 010 0927087 Remove hip foreign body A 090 0927090 Removal of hip prosthesis A 090 0927091 Removal of hip prosthesis A 090 09

27093 Injection for hip x-ray A 000 0927095 Injection for hip x-ray A 000 0927096 Inject sacroiliac joint A 000 0927097 Revision of hip tendon A 090 0927098 Transfer tendon to pelvis A 090 0927100 Transfer of abdominal muscle A 090 0927105 Transfer of spinal muscle A 090 0927110 Transfer of iliopsoas muscle A 090 0927111 Transfer of iliopsoas muscle A 090 0927120 Reconstruction of hip socket A 090 0927122 Reconstruction of hip socket A 090 0927125 Partial hip replacement A 090 0927130 Total hip arthroplasty A 090 0927132 Total hip arthroplasty A 090 0927134 Revise hip joint replacement A 090 0927137 Revise hip joint replacement A 090 0927138 Revise hip joint replacement A 090 0927140 Transplant femur ridge A 090 0927146 Incision of hip bone A 090 0927147 Revision of hip bone A 090 0927151 Incision of hip bones A 090 0927156 Revision of hip bones A 090 0927158 Revision of pelvis A 090 0927161 Incision of neck of femur A 090 0927165 Incision/fixation of femur A 090 0927170 Repair/graft femur head/neck A 090 0927175 Treat slipped epiphysis A 090 0927176 Treat slipped epiphysis A 090 0927177 Treat slipped epiphysis A 090 0927178 Treat slipped epiphysis A 090 0927179 Revise head/neck of femur A 090 0927181 Treat slipped epiphysis A 090 0927185 Revision of femur epiphysis A 090 0927187 Reinforce hip bones A 090 0927193 Treat pelvic ring fracture A 090 0927194 Treat pelvic ring fracture A 090 0927200 Treat tail bone fracture A 090 0927202 Treat tail bone fracture A 090 0927215 Treat pelvic fracture(s) I 090 0927216 Treat pelvic ring fracture I 090 0927217 Treat pelvic ring fracture I 090 0927218 Treat pelvic ring fracture I 090 0927220 Treat hip socket fracture A 090 0927222 Treat hip socket fracture A 090 0927226 Treat hip wall fracture A 090 0927227 Treat hip fracture(s) A 090 0927228 Treat hip fracture(s) A 090 0927230 Treat thigh fracture A 090 0927232 Treat thigh fracture A 090 0927235 Treat thigh fracture A 090 09

27236 Treat thigh fracture A 090 0927238 Treat thigh fracture A 090 0927240 Treat thigh fracture A 090 0927244 Treat thigh fracture A 090 0927245 Treat thigh fracture A 090 0927246 Treat thigh fracture A 090 0927248 Treat thigh fracture A 090 0927250 Treat hip dislocation A 000 0927252 Treat hip dislocation A 090 0927253 Treat hip dislocation A 090 0927254 Treat hip dislocation A 090 0927256 Treat hip dislocation A 010 0927257 Treat hip dislocation A 010 0927258 Treat hip dislocation A 090 0927259 Treat hip dislocation A 090 0927265 Treat hip dislocation A 090 0927266 Treat hip dislocation A 090 0927267 Cltx thigh fx A 090 0927268 Cltx thigh fx w/mnpj A 090 0927269 Optx thigh fx A 090 0927275 Manipulation of hip joint A 010 0927279 Arthrodesis sacroiliac joint A 090 0927280 Fusion of sacroiliac joint A 090 0927282 Fusion of pubic bones A 090 0927284 Fusion of hip joint A 090 0927286 Fusion of hip joint A 090 0927290 Amputation of leg at hip A 090 0927295 Amputation of leg at hip A 090 0927299 Pelvis/hip joint surgery C YYY 0927301 Drain thigh/knee lesion A 090 0927303 Drainage of bone lesion A 090 0927305 Incise thigh tendon & fascia A 090 0927306 Incision of thigh tendon A 090 0927307 Incision of thigh tendons A 090 0927310 Exploration of knee joint A 090 0927323 Biopsy thigh soft tissues A 010 0927324 Biopsy thigh soft tissues A 090 0927325 Neurectomy hamstring A 090 0927326 Neurectomy popliteal A 090 0927327 Exc thigh/knee les sc < 3 cm A 090 0927328 Exc thigh/knee tum deep <5cm A 090 0927329 Resect thigh/knee tum < 5 cm A 090 0927330 Biopsy knee joint lining A 090 0927331 Explore/treat knee joint A 090 0927332 Removal of knee cartilage A 090 0927333 Removal of knee cartilage A 090 0927334 Remove knee joint lining A 090 0927335 Remove knee joint lining A 090 0927337 Exc thigh/knee les sc 3 cm/> A 090 0927339 Exc thigh/knee tum dep 5cm/> A 090 09

27340 Removal of kneecap bursa A 090 0927345 Removal of knee cyst A 090 0927347 Remove knee cyst A 090 0927350 Removal of kneecap A 090 0927355 Remove femur lesion A 090 0927356 Remove femur lesion/graft A 090 0927357 Remove femur lesion/graft A 090 0927358 Remove femur lesion/fixation A ZZZ 0927360 Partial removal leg bone(s) A 090 0927364 Resect thigh/knee tum 5 cm/> A 090 0927365 Resect femur/knee tumor A 090 0927370 Injection for knee x-ray A 000 0927372 Removal of foreign body A 090 0927380 Repair of kneecap tendon A 090 0927381 Repair/graft kneecap tendon A 090 0927385 Repair of thigh muscle A 090 0927386 Repair/graft of thigh muscle A 090 0927390 Incision of thigh tendon A 090 0927391 Incision of thigh tendons A 090 0927392 Incision of thigh tendons A 090 0927393 Lengthening of thigh tendon A 090 0927394 Lengthening of thigh tendons A 090 0927395 Lengthening of thigh tendons A 090 0927396 Transplant of thigh tendon A 090 0927397 Transplants of thigh tendons A 090 0927400 Revise thigh muscles/tendons A 090 0927403 Repair of knee cartilage A 090 0927405 Repair of knee ligament A 090 0927407 Repair of knee ligament A 090 0927409 Repair of knee ligaments A 090 0927412 Autochondrocyte implant knee A 090 0927415 Osteochondral knee allograft A 090 0927416 Osteochondral knee autograft A 090 0927418 Repair degenerated kneecap A 090 0927420 Revision of unstable kneecap A 090 0927422 Revision of unstable kneecap A 090 0927424 Revision/removal of kneecap A 090 0927425 Lat retinacular release open A 090 0927427 Reconstruction knee A 090 0927428 Reconstruction knee A 090 0927429 Reconstruction knee A 090 0927430 Revision of thigh muscles A 090 0927435 Incision of knee joint A 090 0927437 Revise kneecap A 090 0927438 Revise kneecap with implant A 090 0927440 Revision of knee joint A 090 0927441 Revision of knee joint A 090 0927442 Revision of knee joint A 090 0927443 Revision of knee joint A 090 0927445 Revision of knee joint A 090 09

27446 Revision of knee joint A 090 0927447 Total knee arthroplasty A 090 0927448 Incision of thigh A 090 0927450 Incision of thigh A 090 0927454 Realignment of thigh bone A 090 0927455 Realignment of knee A 090 0927457 Realignment of knee A 090 0927465 Shortening of thigh bone A 090 0927466 Lengthening of thigh bone A 090 0927468 Shorten/lengthen thighs A 090 0927470 Repair of thigh A 090 0927472 Repair/graft of thigh A 090 0927475 Surgery to stop leg growth A 090 0927477 Surgery to stop leg growth A 090 0927479 Surgery to stop leg growth A 090 0927485 Surgery to stop leg growth A 090 0927486 Revise/replace knee joint A 090 0927487 Revise/replace knee joint A 090 0927488 Removal of knee prosthesis A 090 0927495 Reinforce thigh A 090 0927496 Decompression of thigh/knee A 090 0927497 Decompression of thigh/knee A 090 0927498 Decompression of thigh/knee A 090 0927499 Decompression of thigh/knee A 090 0927500 Treatment of thigh fracture A 090 0927501 Treatment of thigh fracture A 090 0927502 Treatment of thigh fracture A 090 0927503 Treatment of thigh fracture A 090 0927506 Treatment of thigh fracture A 090 0927507 Treatment of thigh fracture A 090 0927508 Treatment of thigh fracture A 090 0927509 Treatment of thigh fracture A 090 0927510 Treatment of thigh fracture A 090 0927511 Treatment of thigh fracture A 090 0927513 Treatment of thigh fracture A 090 0927514 Treatment of thigh fracture A 090 0927516 Treat thigh fx growth plate A 090 0927517 Treat thigh fx growth plate A 090 0927519 Treat thigh fx growth plate A 090 0927520 Treat kneecap fracture A 090 0927524 Treat kneecap fracture A 090 0927530 Treat knee fracture A 090 0927532 Treat knee fracture A 090 0927535 Treat knee fracture A 090 0927536 Treat knee fracture A 090 0927538 Treat knee fracture(s) A 090 0927540 Treat knee fracture A 090 0927550 Treat knee dislocation A 090 0927552 Treat knee dislocation A 090 0927556 Treat knee dislocation A 090 09

27557 Treat knee dislocation A 090 0927558 Treat knee dislocation A 090 0927560 Treat kneecap dislocation A 090 0927562 Treat kneecap dislocation A 090 0927566 Treat kneecap dislocation A 090 0927570 Fixation of knee joint A 010 0927580 Fusion of knee A 090 0927590 Amputate leg at thigh A 090 0927591 Amputate leg at thigh A 090 0927592 Amputate leg at thigh A 090 0927594 Amputation follow-up surgery A 090 0927596 Amputation follow-up surgery A 090 0927598 Amputate lower leg at knee A 090 0927599 Leg surgery procedure C YYY 0927600 Decompression of lower leg A 090 0927601 Decompression of lower leg A 090 0927602 Decompression of lower leg A 090 0927603 Drain lower leg lesion A 090 0927604 Drain lower leg bursa A 090 0927605 Incision of achilles tendon A 010 0927606 Incision of achilles tendon A 010 0927607 Treat lower leg bone lesion A 090 0927610 Explore/treat ankle joint A 090 0927612 Exploration of ankle joint A 090 0927613 Biopsy lower leg soft tissue A 010 0927614 Biopsy lower leg soft tissue A 090 0927615 Resect leg/ankle tum < 5 cm A 090 0927616 Resect leg/ankle tum 5 cm/> A 090 0927618 Exc leg/ankle tum < 3 cm A 090 0927619 Exc leg/ankle tum deep <5 cm A 090 0927620 Explore/treat ankle joint A 090 0927625 Remove ankle joint lining A 090 0927626 Remove ankle joint lining A 090 0927630 Removal of tendon lesion A 090 0927632 Exc leg/ankle les sc 3 cm/> A 090 0927634 Exc leg/ankle tum dep 5 cm/> A 090 0927635 Remove lower leg bone lesion A 090 0927637 Remove/graft leg bone lesion A 090 0927638 Remove/graft leg bone lesion A 090 0927640 Partial removal of tibia A 090 0927641 Partial removal of fibula A 090 0927645 Resect tibia tumor A 090 0927646 Resect fibula tumor A 090 0927647 Resect talus/calcaneus tum A 090 0927648 Injection for ankle x-ray A 000 0927650 Repair achilles tendon A 090 0927652 Repair/graft achilles tendon A 090 0927654 Repair of achilles tendon A 090 0927656 Repair leg fascia defect A 090 0927658 Repair of leg tendon each A 090 09

27659 Repair of leg tendon each A 090 0927664 Repair of leg tendon each A 090 0927665 Repair of leg tendon each A 090 0927675 Repair lower leg tendons A 090 0927676 Repair lower leg tendons A 090 0927680 Release of lower leg tendon A 090 0927681 Release of lower leg tendons A 090 0927685 Revision of lower leg tendon A 090 0927686 Revise lower leg tendons A 090 0927687 Revision of calf tendon A 090 0927690 Revise lower leg tendon A 090 0927691 Revise lower leg tendon A 090 0927692 Revise additional leg tendon A ZZZ 0927695 Repair of ankle ligament A 090 0927696 Repair of ankle ligaments A 090 0927698 Repair of ankle ligament A 090 0927700 Revision of ankle joint A 090 0927702 Reconstruct ankle joint A 090 0927703 Reconstruction ankle joint A 090 0927704 Removal of ankle implant A 090 0927705 Incision of tibia A 090 0927707 Incision of fibula A 090 0927709 Incision of tibia & fibula A 090 0927712 Realignment of lower leg A 090 0927715 Revision of lower leg A 090 0927720 Repair of tibia A 090 0927722 Repair/graft of tibia A 090 0927724 Repair/graft of tibia A 090 0927725 Repair of lower leg A 090 0927726 Repair fibula nonunion A 090 0927727 Repair of lower leg A 090 0927730 Repair of tibia epiphysis A 090 0927732 Repair of fibula epiphysis A 090 0927734 Repair lower leg epiphyses A 090 0927740 Repair of leg epiphyses A 090 0927742 Repair of leg epiphyses A 090 0927745 Reinforce tibia A 090 0927750 Treatment of tibia fracture A 090 0927752 Treatment of tibia fracture A 090 0927756 Treatment of tibia fracture A 090 0927758 Treatment of tibia fracture A 090 0927759 Treatment of tibia fracture A 090 0927760 Cltx medial ankle fx A 090 0927762 Cltx med ankle fx w/mnpj A 090 0927766 Optx medial ankle fx A 090 0927767 Cltx post ankle fx A 090 0927768 Cltx post ankle fx w/mnpj A 090 0927769 Optx post ankle fx A 090 0927780 Treatment of fibula fracture A 090 0927781 Treatment of fibula fracture A 090 09

27784 Treatment of fibula fracture A 090 0927786 Treatment of ankle fracture A 090 0927788 Treatment of ankle fracture A 090 0927792 Treatment of ankle fracture A 090 0927808 Treatment of ankle fracture A 090 0927810 Treatment of ankle fracture A 090 0927814 Treatment of ankle fracture A 090 0927816 Treatment of ankle fracture A 090 0927818 Treatment of ankle fracture A 090 0927822 Treatment of ankle fracture A 090 0927823 Treatment of ankle fracture A 090 0927824 Treat lower leg fracture A 090 0927825 Treat lower leg fracture A 090 0927826 Treat lower leg fracture A 090 0927827 Treat lower leg fracture A 090 0927828 Treat lower leg fracture A 090 0927829 Treat lower leg joint A 090 0927830 Treat lower leg dislocation A 090 0927831 Treat lower leg dislocation A 090 0927832 Treat lower leg dislocation A 090 0927840 Treat ankle dislocation A 090 0927842 Treat ankle dislocation A 090 0927846 Treat ankle dislocation A 090 0927848 Treat ankle dislocation A 090 0927860 Fixation of ankle joint A 010 0927870 Fusion of ankle joint open A 090 0927871 Fusion of tibiofibular joint A 090 0927880 Amputation of lower leg A 090 0927881 Amputation of lower leg A 090 0927882 Amputation of lower leg A 090 0927884 Amputation follow-up surgery A 090 0927886 Amputation follow-up surgery A 090 0927888 Amputation of foot at ankle A 090 0927889 Amputation of foot at ankle A 090 0927892 Decompression of leg A 090 0927893 Decompression of leg A 090 0927894 Decompression of leg A 090 0927899 Leg/ankle surgery procedure C YYY 0928001 Drainage of bursa of foot A 010 0928002 Treatment of foot infection A 010 0928003 Treatment of foot infection A 090 0928005 Treat foot bone lesion A 090 0928008 Incision of foot fascia A 090 0928010 Incision of toe tendon A 090 0928011 Incision of toe tendons A 090 0928020 Exploration of foot joint A 090 0928022 Exploration of foot joint A 090 0928024 Exploration of toe joint A 090 0928035 Decompression of tibia nerve A 090 0928039 Exc foot/toe tum sc 1.5 cm/> A 090 09

28041 Exc foot/toe tum dep 1.5cm/> A 090 0928043 Exc foot/toe tum sc < 1.5 cm A 090 0928045 Exc foot/toe tum deep <1.5cm A 090 0928046 Resect foot/toe tumor < 3 cm A 090 0928047 Resect foot/toe tumor 3 cm/> A 090 0928050 Biopsy of foot joint lining A 090 0928052 Biopsy of foot joint lining A 090 0928054 Biopsy of toe joint lining A 090 0928055 Neurectomy foot A 090 0928060 Partial removal foot fascia A 090 0928062 Removal of foot fascia A 090 0928070 Removal of foot joint lining A 090 0928072 Removal of foot joint lining A 090 0928080 Removal of foot lesion A 090 0928086 Excise foot tendon sheath A 090 0928088 Excise foot tendon sheath A 090 0928090 Removal of foot lesion A 090 0928092 Removal of toe lesions A 090 0928100 Removal of ankle/heel lesion A 090 0928102 Remove/graft foot lesion A 090 0928103 Remove/graft foot lesion A 090 0928104 Removal of foot lesion A 090 0928106 Remove/graft foot lesion A 090 0928107 Remove/graft foot lesion A 090 0928108 Removal of toe lesions A 090 0928110 Part removal of metatarsal A 090 0928111 Part removal of metatarsal A 090 0928112 Part removal of metatarsal A 090 0928113 Part removal of metatarsal A 090 0928114 Removal of metatarsal heads A 090 0928116 Revision of foot A 090 0928118 Removal of heel bone A 090 0928119 Removal of heel spur A 090 0928120 Part removal of ankle/heel A 090 0928122 Partial removal of foot bone A 090 0928124 Partial removal of toe A 090 0928126 Partial removal of toe A 090 0928130 Removal of ankle bone A 090 0928140 Removal of metatarsal A 090 0928150 Removal of toe A 090 0928153 Partial removal of toe A 090 0928160 Partial removal of toe A 090 0928171 Resect tarsal tumor A 090 0928173 Resect metatarsal tumor A 090 0928175 Resect phalanx of toe tumor A 090 0928190 Removal of foot foreign body A 010 0928192 Removal of foot foreign body A 090 0928193 Removal of foot foreign body A 090 0928200 Repair of foot tendon A 090 0928202 Repair/graft of foot tendon A 090 09

28208 Repair of foot tendon A 090 0928210 Repair/graft of foot tendon A 090 0928220 Release of foot tendon A 090 0928222 Release of foot tendons A 090 0928225 Release of foot tendon A 090 0928226 Release of foot tendons A 090 0928230 Incision of foot tendon(s) A 090 0928232 Incision of toe tendon A 090 0928234 Incision of foot tendon A 090 0928238 Revision of foot tendon A 090 0928240 Release of big toe A 090 0928250 Revision of foot fascia A 090 0928260 Release of midfoot joint A 090 0928261 Revision of foot tendon A 090 0928262 Revision of foot and ankle A 090 0928264 Release of midfoot joint A 090 0928270 Release of foot contracture A 090 0928272 Release of toe joint each A 090 0928280 Fusion of toes A 090 0928285 Repair of hammertoe A 090 0928286 Repair of hammertoe A 090 0928288 Partial removal of foot bone A 090 0928289 Repair hallux rigidus A 090 0928290 Correction of bunion A 090 0928292 Correction of bunion A 090 0928293 Correction of bunion A 090 0928294 Correction of bunion A 090 0928296 Correction of bunion A 090 0928297 Correction of bunion A 090 0928298 Correction of bunion A 090 0928299 Correction of bunion A 090 0928300 Incision of heel bone A 090 0928302 Incision of ankle bone A 090 0928304 Incision of midfoot bones A 090 0928305 Incise/graft midfoot bones A 090 0928306 Incision of metatarsal A 090 0928307 Incision of metatarsal A 090 0928308 Incision of metatarsal A 090 0928309 Incision of metatarsals A 090 0928310 Revision of big toe A 090 0928312 Revision of toe A 090 0928313 Repair deformity of toe A 090 0928315 Removal of sesamoid bone A 090 0928320 Repair of foot bones A 090 0928322 Repair of metatarsals A 090 0928340 Resect enlarged toe tissue A 090 0928341 Resect enlarged toe A 090 0928344 Repair extra toe(s) A 090 0928345 Repair webbed toe(s) A 090 0928360 Reconstruct cleft foot A 090 09

28400 Treatment of heel fracture A 090 0928405 Treatment of heel fracture A 090 0928406 Treatment of heel fracture A 090 0928415 Treat heel fracture A 090 0928420 Treat/graft heel fracture A 090 0928430 Treatment of ankle fracture A 090 0928435 Treatment of ankle fracture A 090 0928436 Treatment of ankle fracture A 090 0928445 Treat ankle fracture A 090 0928446 Osteochondral talus autogrft A 090 0928450 Treat midfoot fracture each A 090 0928455 Treat midfoot fracture each A 090 0928456 Treat midfoot fracture A 090 0928465 Treat midfoot fracture each A 090 0928470 Treat metatarsal fracture A 090 0928475 Treat metatarsal fracture A 090 0928476 Treat metatarsal fracture A 090 0928485 Treat metatarsal fracture A 090 0928490 Treat big toe fracture A 090 0928495 Treat big toe fracture A 090 0928496 Treat big toe fracture A 090 0928505 Treat big toe fracture A 090 0928510 Treatment of toe fracture A 090 0928515 Treatment of toe fracture A 090 0928525 Treat toe fracture A 090 0928530 Treat sesamoid bone fracture A 090 0928531 Treat sesamoid bone fracture A 090 0928540 Treat foot dislocation A 090 0928545 Treat foot dislocation A 090 0928546 Treat foot dislocation A 090 0928555 Repair foot dislocation A 090 0928570 Treat foot dislocation A 090 0928575 Treat foot dislocation A 090 0928576 Treat foot dislocation A 090 0928585 Repair foot dislocation A 090 0928600 Treat foot dislocation A 090 0928605 Treat foot dislocation A 090 0928606 Treat foot dislocation A 090 0928615 Repair foot dislocation A 090 0928630 Treat toe dislocation A 010 0928635 Treat toe dislocation A 010 0928636 Treat toe dislocation A 010 0928645 Repair toe dislocation A 090 0928660 Treat toe dislocation A 010 0928665 Treat toe dislocation A 010 0928666 Treat toe dislocation A 010 0928675 Repair of toe dislocation A 090 0928705 Fusion of foot bones A 090 0928715 Fusion of foot bones A 090 0928725 Fusion of foot bones A 090 09

28730 Fusion of foot bones A 090 0928735 Fusion of foot bones A 090 0928737 Revision of foot bones A 090 0928740 Fusion of foot bones A 090 0928750 Fusion of big toe joint A 090 0928755 Fusion of big toe joint A 090 0928760 Fusion of big toe joint A 090 0928800 Amputation of midfoot A 090 0928805 Amputation thru metatarsal A 090 0928810 Amputation toe & metatarsal A 090 0928820 Amputation of toe A 090 0928825 Partial amputation of toe A 090 0928890 Hi enrgy eswt plantar fascia A 090 0928899 Foot/toes surgery procedure C YYY 0929000 Application of body cast A 000 0929010 Application of body cast A 000 0929015 Application of body cast A 000 0929035 Application of body cast A 000 0929040 Application of body cast A 000 0929044 Application of body cast A 000 0929046 Application of body cast A 000 0929049 Application of figure eight A 000 0929055 Application of shoulder cast A 000 0929058 Application of shoulder cast A 000 0929065 Application of long arm cast A 000 0929075 Application of forearm cast A 000 0929085 Apply hand/wrist cast A 000 0929086 Apply finger cast A 000 0929105 Apply long arm splint A 000 0929125 Apply forearm splint A 000 0929126 Apply forearm splint A 000 0929130 Application of finger splint A 000 0929131 Application of finger splint A 000 0929200 Strapping of chest A 000 0929240 Strapping of shoulder A 000 0929260 Strapping of elbow or wrist A 000 0929280 Strapping of hand or finger A 000 0929305 Application of hip cast A 000 0929325 Application of hip casts A 000 0929345 Application of long leg cast A 000 0929355 Application of long leg cast A 000 0929358 Apply long leg cast brace A 000 0929365 Application of long leg cast A 000 0929405 Apply short leg cast A 000 0929425 Apply short leg cast A 000 0929435 Apply short leg cast A 000 0929440 Addition of walker to cast A 000 0929445 Apply rigid leg cast A 000 0929450 Application of leg cast A 000 0929505 Application long leg splint A 000 09

29515 Application lower leg splint A 000 0929520 Strapping of hip A 000 0929530 Strapping of knee A 000 0929540 Strapping of ankle and/or ft A 000 0929550 Strapping of toes A 000 0929580 Application of paste boot A 000 0929581 Apply multlay comprs lwr leg A 000 0929582 Apply multlay comprs upr leg A 000 0929583 Apply multlay comprs upr arm A 000 0929584 Appl multlay comprs arm/hand A 000 0929700 Removal/revision of cast A 000 0929705 Removal/revision of cast A 000 0929710 Removal/revision of cast A 000 0929720 Repair of body cast A 000 0929730 Windowing of cast A 000 0929740 Wedging of cast A 000 0929750 Wedging of clubfoot cast A 000 0929799 Casting/strapping procedure C YYY 0929800 Jaw arthroscopy/surgery A 090 0929804 Jaw arthroscopy/surgery A 090 0929805 Shoulder arthroscopy dx A 090 0929806 Shoulder arthroscopy/surgery A 090 0929807 Shoulder arthroscopy/surgery A 090 0929819 Shoulder arthroscopy/surgery A 090 0929820 Shoulder arthroscopy/surgery A 090 0929821 Shoulder arthroscopy/surgery A 090 0929822 Shoulder arthroscopy/surgery A 090 0929823 Shoulder arthroscopy/surgery A 090 0929824 Shoulder arthroscopy/surgery A 090 0929825 Shoulder arthroscopy/surgery A 090 0929826 Shoulder arthroscopy/surgery A ZZZ 0929827 Arthroscop rotator cuff repr A 090 0929828 Arthroscopy biceps tenodesis A 090 0929830 Elbow arthroscopy A 090 0929834 Elbow arthroscopy/surgery A 090 0929835 Elbow arthroscopy/surgery A 090 0929836 Elbow arthroscopy/surgery A 090 0929837 Elbow arthroscopy/surgery A 090 0929838 Elbow arthroscopy/surgery A 090 0929840 Wrist arthroscopy A 090 0929843 Wrist arthroscopy/surgery A 090 0929844 Wrist arthroscopy/surgery A 090 0929845 Wrist arthroscopy/surgery A 090 0929846 Wrist arthroscopy/surgery A 090 0929847 Wrist arthroscopy/surgery A 090 0929848 Wrist endoscopy/surgery A 090 0929850 Knee arthroscopy/surgery A 090 0929851 Knee arthroscopy/surgery A 090 0929855 Tibial arthroscopy/surgery A 090 0929856 Tibial arthroscopy/surgery A 090 09

29860 Hip arthroscopy dx A 090 0929861 Hip arthro w/fb removal A 090 0929862 Hip arthr0 w/debridement A 090 0929863 Hip arthr0 w/synovectomy A 090 0929866 Autgrft implnt knee w/scope A 090 0929867 Allgrft implnt knee w/scope A 090 0929868 Meniscal trnspl knee w/scpe A 090 0929870 Knee arthroscopy dx A 090 0929871 Knee arthroscopy/drainage A 090 0929873 Knee arthroscopy/surgery A 090 0929874 Knee arthroscopy/surgery A 090 0929875 Knee arthroscopy/surgery A 090 0929876 Knee arthroscopy/surgery A 090 0929877 Knee arthroscopy/surgery A 090 0929879 Knee arthroscopy/surgery A 090 0929880 Knee arthroscopy/surgery A 090 0929881 Knee arthroscopy/surgery A 090 0929882 Knee arthroscopy/surgery A 090 0929883 Knee arthroscopy/surgery A 090 0929884 Knee arthroscopy/surgery A 090 0929885 Knee arthroscopy/surgery A 090 0929886 Knee arthroscopy/surgery A 090 0929887 Knee arthroscopy/surgery A 090 0929888 Knee arthroscopy/surgery A 090 0929889 Knee arthroscopy/surgery A 090 0929891 Ankle arthroscopy/surgery A 090 0929892 Ankle arthroscopy/surgery A 090 0929893 Scope plantar fasciotomy A 090 0929894 Ankle arthroscopy/surgery A 090 0929895 Ankle arthroscopy/surgery A 090 0929897 Ankle arthroscopy/surgery A 090 0929898 Ankle arthroscopy/surgery A 090 0929899 Ankle arthroscopy/surgery A 090 0929900 Mcp joint arthroscopy dx A 090 0929901 Mcp joint arthroscopy surg A 090 0929902 Mcp joint arthroscopy surg A 090 0929904 Subtalar arthro w/fb rmvl A 090 0929905 Subtalar arthro w/exc A 090 0929906 Subtalar arthro w/deb A 090 0929907 Subtalar arthro w/fusion A 090 0929914 Hip arthro w/femoroplasty A 090 0929915 Hip arthro acetabuloplasty A 090 0929916 Hip arthro w/labral repair A 090 0929999 Arthroscopy of joint C YYY 0930000 Drainage of nose lesion A 010 0930020 Drainage of nose lesion A 010 093006F Cxr doc rev I XXX 093008F Body mass index docd I XXX 0930100 Intranasal biopsy A 000 093011F Lipid panel doc rev I XXX 09

30110 Removal of nose polyp(s) A 010 0930115 Removal of nose polyp(s) A 090 0930117 Removal of intranasal lesion A 090 0930118 Removal of intranasal lesion A 090 0930120 Revision of nose A 090 0930124 Removal of nose lesion A 090 0930125 Removal of nose lesion A 090 0930130 Excise inferior turbinate A 090 093014F Screen mammo doc rev M XXX 0930140 Resect inferior turbinate A 090 093015F Cerv cancer screen docd I XXX 0930150 Partial removal of nose A 090 093016F Pt scrnd unhlthy oh use M XXX 0930160 Removal of nose A 090 093017F Colorectal ca screen doc rev M XXX 093018F Pre-prxd rsk et al docd I XXX 093019F Lvef assess planpost dschrge I XXX 093020F Lvf assess I XXX 0930200 Injection treatment of nose A 000 093021F Lvef mod/sever deprs syst M XXX 0930210 Nasal sinus therapy A 010 093022F Lvef >/=40% systolic M XXX 0930220 Insert nasal septal button A 010 093023F Spirom doc rev M XXX 093025F Spirom fev/fvc <70% w/copd I XXX 093027F Spirom fev/fvc>/=70%/w/ocopd I XXX 093028F O2 saturation doc rev I XXX 0930300 Remove nasal foreign body A 010 0930310 Remove nasal foreign body A 010 0930320 Remove nasal foreign body A 090 093035F O2 saturation</=88%/pao</=55 I XXX 093037F O2 saturation >88%/pao>55 hg I XXX 093038F Pulm fx w/in 12 mon b/4 surg I XXX 093040F Fev <40% predicted value I XXX 0930400 Reconstruction of nose R 090 0930410 Reconstruction of nose R 090 093042F Fev >/=40% predicted value I XXX 0930420 Reconstruction of nose R 090 0930430 Revision of nose R 090 0930435 Revision of nose R 090 093044F Hg a1c level lt 7.0% M XXX 093045F Hg a1c level 7.0-9.0% M XXX 0930450 Revision of nose R 090 093046F Hemoglobin a1c level >9.0% M XXX 0930460 Revision of nose A 090 0930462 Revision of nose A 090 0930465 Repair nasal stenosis A 090 093048F Ldl-c <100 mg/dl I XXX 093049F Ldl-c 100-129 mg/dl I XXX 093050F Ldl-c >/= 130 mg/dl I XXX 09

30520 Repair of nasal septum A 090 0930540 Repair nasal defect A 090 0930545 Repair nasal defect A 090 093055F Lvef less than/equal to 35% I XXX 093056F Lvef greater than 35% I XXX 0930560 Release of nasal adhesions A 010 0930580 Repair upper jaw fistula A 090 093060F Pos microalbuminuria rev M XXX 0930600 Repair mouth/nose fistula A 090 093061F Neg microalbuminuria rev M XXX 093062F Pos macroalbuminuria rev M XXX 0930620 Intranasal reconstruction A 090 0930630 Repair nasal septum defect A 090 093066F Nephropathy doc tx M XXX 093072F Low risk for retinopathy M XXX 093073F Pre-surg eye measures docd I XXX 093074F Syst bp lt 130 mm hg I XXX 093075F Syst bp ge 130 - 139mm hg I XXX 093077F Syst bp >/= 140 mm hg I XXX 093078F Diast bp <80 mm hg I XXX 093079F Diast bp 80-89 mm hg I XXX 093080F Diast bp >/= 90 mm hg I XXX 0930801 Ablate inf turbinate superf A 010 0930802 Ablate inf turbinate submuc A 010 093082F Kt/v <1.2 I XXX 093083F Kt/v =/> 1.2 & <1.7 I XXX 093084F Kt/v ge 1.7 I XXX 093085F Suicide risk assessed I XXX 093088F Mdd mild I XXX 093089F Mdd moderate I XXX 093090F Mdd severe w/o psych I XXX 0930901 Control of nosebleed A 000 0930903 Control of nosebleed A 000 0930905 Control of nosebleed A 000 0930906 Repeat control of nosebleed A 000 093091F Mdd severe w/psych I XXX 0930915 Ligation nasal sinus artery A 090 093092F Mdd in remission I XXX 0930920 Ligation upper jaw artery A 090 093093F Doc new diag 1st/addl mdd I XXX 0930930 Ther fx nasal inf turbinate A 010 093095F Central dexa results docd M XXX 093096F Central dexa ordered M XXX 0930999 Nasal surgery procedure C YYY 093100F Image test ref carot diam M XXX 0931000 Irrigation maxillary sinus A 010 0931002 Irrigation sphenoid sinus A 010 0931020 Exploration maxillary sinus A 090 0931030 Exploration maxillary sinus A 090 0931032 Explore sinus remove polyps A 090 09

31040 Exploration behind upper jaw A 090 0931050 Exploration sphenoid sinus A 090 0931051 Sphenoid sinus surgery A 090 0931070 Exploration of frontal sinus A 090 0931075 Exploration of frontal sinus A 090 0931080 Removal of frontal sinus A 090 0931081 Removal of frontal sinus A 090 0931084 Removal of frontal sinus A 090 0931085 Removal of frontal sinus A 090 0931086 Removal of frontal sinus A 090 0931087 Removal of frontal sinus A 090 0931090 Exploration of sinuses A 090 093110F Pres/absn hmrhg/lesion docd I XXX 093111F Ct/mri brain done w/in 24hrs I XXX 093112F Ct/mri brain done 24 hrs I XXX 093115F Quant results activity &symp I XXX 093117F Hf assessment tool completed I XXX 093118F Ny heart assoc class docd I XXX 093119F No eval activity clin symp I XXX 093120F 12-lead ecg performed M XXX 0931200 Removal of ethmoid sinus A 090 0931201 Removal of ethmoid sinus A 090 0931205 Removal of ethmoid sinus A 090 0931225 Removal of upper jaw A 090 0931230 Removal of upper jaw A 090 0931231 Nasal endoscopy dx A 000 0931233 Nasal/sinus endoscopy dx A 000 0931235 Nasal/sinus endoscopy dx A 000 0931237 Nasal/sinus endoscopy surg A 000 0931238 Nasal/sinus endoscopy surg A 000 0931239 Nasal/sinus endoscopy surg A 010 0931240 Nasal/sinus endoscopy surg A 000 0931254 Revision of ethmoid sinus A 000 0931255 Removal of ethmoid sinus A 000 0931256 Exploration maxillary sinus A 000 093126F Esoph bx rprt w/dyspl info M XXX 0931267 Endoscopy maxillary sinus A 000 0931276 Sinus endoscopy surgical A 000 0931287 Nasal/sinus endoscopy surg A 000 0931288 Nasal/sinus endoscopy surg A 000 0931290 Nasal/sinus endoscopy surg A 010 0931291 Nasal/sinus endoscopy surg A 010 0931292 Nasal/sinus endoscopy surg A 010 0931293 Nasal/sinus endoscopy surg A 010 0931294 Nasal/sinus endoscopy surg A 010 0931295 Sinus endo w/balloon dil A 000 0931296 Sinus endo w/balloon dil A 000 0931297 Sinus endo w/balloon dil A 000 0931299 Sinus surgery procedure C YYY 093130F Upper gi endoscopy performed I XXX 09

31300 Removal of larynx lesion A 090 093132F Doc ref upper gi endoscopy I XXX 0931320 Diagnostic incision larynx A 090 0931360 Removal of larynx A 090 0931365 Removal of larynx A 090 0931367 Partial removal of larynx A 090 0931368 Partial removal of larynx A 090 0931370 Partial removal of larynx A 090 0931375 Partial removal of larynx A 090 0931380 Partial removal of larynx A 090 0931382 Partial removal of larynx A 090 0931390 Removal of larynx & pharynx A 090 0931395 Reconstruct larynx & pharynx A 090 093140F Upper gi endo shows barrtts I XXX 0931400 Revision of larynx A 090 093141F Upper gi endo not barrtts I XXX 093142F Barium swallow test ordered I XXX 0931420 Removal of epiglottis A 090 093150F Forceps esoph biopsy done I XXX 0931500 Insert emergency airway A 000 0931502 Change of windpipe airway A 000 0931505 Diagnostic laryngoscopy A 000 0931510 Laryngoscopy with biopsy A 000 0931511 Remove foreign body larynx A 000 0931512 Removal of larynx lesion A 000 0931513 Injection into vocal cord A 000 0931515 Laryngoscopy for aspiration A 000 0931520 Dx laryngoscopy newborn A 000 0931525 Dx laryngoscopy excl nb A 000 0931526 Dx laryngoscopy w/oper scope A 000 0931527 Laryngoscopy for treatment A 000 0931528 Laryngoscopy and dilation A 000 0931529 Laryngoscopy and dilation A 000 0931530 Laryngoscopy w/fb removal A 000 0931531 Laryngoscopy w/fb & op scope A 000 0931535 Laryngoscopy w/biopsy A 000 0931536 Laryngoscopy w/bx & op scope A 000 0931540 Laryngoscopy w/exc of tumor A 000 0931541 Larynscop w/tumr exc + scope A 000 0931545 Remove vc lesion w/scope A 000 0931546 Remove vc lesion scope/graft A 000 093155F Cytogen test marrow b/4 tx M XXX 0931560 Laryngoscop w/arytenoidectom A 000 0931561 Larynscop remve cart + scop A 000 0931570 Laryngoscope w/vc inj A 000 0931571 Laryngoscop w/vc inj + scope A 000 0931575 Diagnostic laryngoscopy A 000 0931576 Laryngoscopy with biopsy A 000 0931577 Remove foreign body larynx A 000 0931578 Removal of larynx lesion A 000 09

31579 Diagnostic laryngoscopy A 000 0931580 Revision of larynx A 090 0931582 Revision of larynx A 090 0931584 Treat larynx fracture A 090 0931587 Revision of larynx A 090 0931588 Revision of larynx A 090 0931590 Reinnervate larynx A 090 0931595 Larynx nerve surgery A 090 0931599 Larynx surgery procedure C YYY 093160F Doc fe+ stores b/4 epo thx M XXX 0931600 Incision of windpipe A 000 0931601 Incision of windpipe A 000 0931603 Incision of windpipe A 000 0931605 Incision of windpipe A 000 0931610 Incision of windpipe A 090 0931611 Surgery/speech prosthesis A 090 0931612 Puncture/clear windpipe A 000 0931613 Repair windpipe opening A 090 0931614 Repair windpipe opening A 090 0931615 Visualization of windpipe A 000 0931620 Endobronchial us add-on A ZZZ 0931622 Dx bronchoscope/wash A 000 0931623 Dx bronchoscope/brush A 000 0931624 Dx bronchoscope/lavage A 000 0931625 Bronchoscopy w/biopsy(s) A 000 0931626 Bronchoscopy w/markers A 000 0931627 Navigational bronchoscopy A ZZZ 0931628 Bronchoscopy/lung bx each A 000 0931629 Bronchoscopy/needle bx each A 000 0931630 Bronchoscopy dilate/fx repr A 000 0931631 Bronchoscopy dilate w/stent A 000 0931632 Bronchoscopy/lung bx addl A ZZZ 0931633 Bronchoscopy/needle bx addl A ZZZ 0931634 Bronch w/balloon occlusion A 000 0931635 Bronchoscopy w/fb removal A 000 0931636 Bronchoscopy bronch stents A 000 0931637 Bronchoscopy stent add-on A ZZZ 0931638 Bronchoscopy revise stent A 000 0931640 Bronchoscopy w/tumor excise A 000 0931641 Bronchoscopy treat blockage A 000 0931643 Diag bronchoscope/catheter A 000 0931645 Bronchoscopy clear airways A 000 0931646 Bronchoscopy reclear airway A 000 0931647 Bronchial valve init insert A 000 0931648 Bronchial valve remov init A 000 0931649 Bronchial valve remov addl A ZZZ 0931651 Bronchial valve addl insert A ZZZ 0931660 Bronch thermoplsty 1 lobe A 000 0931661 Bronch thermoplsty 2/> lobes A 000 093170F Flow cyto done b/4 tx M XXX 09

31717 Bronchial brush biopsy A 000 0931720 Clearance of airways A 000 0931725 Clearance of airways A 000 0931730 Intro windpipe wire/tube A 000 0931750 Repair of windpipe A 090 0931755 Repair of windpipe A 090 0931760 Repair of windpipe A 090 0931766 Reconstruction of windpipe A 090 0931770 Repair/graft of bronchus A 090 0931775 Reconstruct bronchus A 090 0931780 Reconstruct windpipe A 090 0931781 Reconstruct windpipe A 090 0931785 Remove windpipe lesion A 090 0931786 Remove windpipe lesion A 090 0931800 Repair of windpipe injury A 090 0931805 Repair of windpipe injury A 090 0931820 Closure of windpipe lesion A 090 0931825 Repair of windpipe defect A 090 0931830 Revise windpipe scar A 090 0931899 Airways surgical procedure C YYY 093200F Barium swallow test not req I XXX 0932035 Thoracostomy w/rib resection A 090 0932036 Thoracostomy w/flap drainage A 090 0932096 Open wedge/bx lung infiltr A 090 0932097 Open wedge/bx lung nodule A 090 0932098 Open biopsy of lung pleura A 090 093210F Grp a strep test performed M XXX 0932100 Exploration of chest A 090 0932110 Explore/repair chest A 090 0932120 Re-exploration of chest A 090 0932124 Explore chest free adhesions A 090 0932140 Removal of lung lesion(s) A 090 0932141 Remove/treat lung lesions A 090 093215F Pt immunity to hep a docd M XXX 0932150 Removal of lung lesion(s) A 090 0932151 Remove lung foreign body A 090 093216F Pt immunity to hep b docd I XXX 0932160 Open chest heart massage A 090 093218F Rna tstng hep c docd done I XXX 093220F Hep c quant rna tstng docd I XXX 0932200 Drain open lung lesion A 090 0932215 Treat chest lining A 090 0932220 Release of lung A 090 0932225 Partial release of lung A 090 093230F Note hring tst w/in 6 mon I XXX 0932310 Removal of chest lining A 090 0932320 Free/remove chest lining A 090 0932400 Needle biopsy chest lining A 000 0932405 Percut bx lung/mediastinum A 000 0932440 Remove lung pneumonectomy A 090 09

32442 Sleeve pneumonectomy A 090 0932445 Removal of lung extrapleural A 090 0932480 Partial removal of lung A 090 0932482 Bilobectomy A 090 0932484 Segmentectomy A 090 0932486 Sleeve lobectomy A 090 0932488 Completion pneumonectomy A 090 0932491 Lung volume reduction R 090 093250F Nonprim loc anat bx site tum M XXX 0932501 Repair bronchus add-on A ZZZ 0932503 Resect apical lung tumor A 090 0932504 Resect apical lung tum/chest A 090 0932505 Wedge resect of lung initial A 090 0932506 Wedge resect of lung add-on A ZZZ 0932507 Wedge resect of lung diag A ZZZ 0932540 Removal of lung lesion A 090 0932550 Insert pleural cath A 000 0932551 Insertion of chest tube A 000 0932552 Remove lung catheter A 010 0932553 Ins mark thor for rt perq A 000 0932554 Aspirate pleura w/o imaging A 000 0932555 Aspirate pleura w/ imaging A 000 0932556 Insert cath pleura w/o image A 000 0932557 Insert cath pleura w/ image A 000 0932560 Treat pleurodesis w/agent A 000 0932561 Lyse chest fibrin init day A 000 0932562 Lyse chest fibrin subq day A 000 093260F Pt cat/pn cat/hist grd docd M XXX 0932601 Thoracoscopy diagnostic A 000 0932604 Thoracoscopy wbx sac A 000 0932606 Thoracoscopy w/bx med space A 000 0932607 Thoracoscopy w/bx infiltrate A 000 0932608 Thoracoscopy w/bx nodule A 000 0932609 Thoracoscopy w/bx pleura A 000 093265F Rna tstng hepc vir ord/docd I XXX 0932650 Thoracoscopy w/pleurodesis A 090 0932651 Thoracoscopy remove cortex A 090 0932652 Thoracoscopy rem totl cortex A 090 0932653 Thoracoscopy remov fb/fibrin A 090 0932654 Thoracoscopy contrl bleeding A 090 0932655 Thoracoscopy resect bullae A 090 0932656 Thoracoscopy w/pleurectomy A 090 0932658 Thoracoscopy w/sac fb remove A 090 0932659 Thoracoscopy w/sac drainage A 090 093266F Hepc gn tstng docd b/4txmnt I XXX 0932661 Thoracoscopy w/pericard exc A 090 0932662 Thoracoscopy w/mediast exc A 090 0932663 Thoracoscopy w/lobectomy A 090 0932664 Thoracoscopy w/ th nrv exc A 090 0932665 Thoracoscop w/esoph musc exc A 090 09

32666 Thoracoscopy w/wedge resect A 090 0932667 Thoracoscopy w/w resect addl A ZZZ 0932668 Thoracoscopy w/w resect diag A ZZZ 0932669 Thoracoscopy remove segment A 090 093267F Path rprt w/ pt pn cat et al M XXX 0932670 Thoracoscopy bilobectomy A 090 0932671 Thoracoscopy pneumonectomy A 090 0932672 Thoracoscopy for lvrs A 090 0932673 Thoracoscopy w/thymus resect A 090 0932674 Thoracoscopy lymph node exc A ZZZ 093268F Psa/t/glsc docd b/4 txmnt I XXX 093269F Bone scn b/4 txmnt/aftr dx M XXX 093270F No bone scn b/4 txmnt/aftrdx M XXX 0932701 Thorax stereo rad targetw/tx A XXX 093271F Low risk prostate cancer M XXX 093272F Med risk prostate cancer I XXX 093273F High risk prostate cancer I XXX 093274F Prost cncr rsk not lw/md/hgh I XXX 093278F Serum lvls ca/ipth/lpd ord I XXX 093279F Hgb lvl >/= 13 g/dl I XXX 093280F Hgb lvl 11-12.9 g/dl I XXX 0932800 Repair lung hernia A 090 093281F Hgb lvl <11 g/dl I XXX 0932810 Close chest after drainage A 090 0932815 Close bronchial fistula A 090 0932820 Reconstruct injured chest A 090 093284F Iop down >15% of pre-svc lvl M XXX 093285F Iop down <15% of pre-svc lvl M XXX 0932850 Donor pneumonectomy X XXX 0932851 Lung transplant single A 090 0932852 Lung transplant with bypass A 090 0932853 Lung transplant double A 090 0932854 Lung transplant with bypass A 090 0932855 Prepare donor lung single C XXX 0932856 Prepare donor lung double C XXX 093288F Fall risk assessment docd M XXX 093290F Pt=d(rh)- and unsensitized I XXX 0932900 Removal of rib(s) A 090 0932905 Revise & repair chest wall A 090 0932906 Revise & repair chest wall A 090 093291F Pt=d(rh)+ or sensitized I XXX 093292F Hiv tstng asked/docd/revwd I XXX 093293F Abo rh blood typing docd I XXX 093294F Grp b strep screening docd I XXX 0932940 Revision of lung A 090 0932960 Therapeutic pneumothorax A 000 0932997 Total lung lavage A 000 0932998 Perq rf ablate tx pul tumor A 000 0932999 Chest surgery procedure C YYY 093300F Ajcc stage docd b/4 thxpy M XXX 09

3301F Cancer stage docd metast M XXX 0933010 Drainage of heart sac A 000 0933011 Repeat drainage of heart sac A 000 0933015 Incision of heart sac A 090 0933020 Incision of heart sac A 090 0933025 Incision of heart sac A 090 0933030 Partial removal of heart sac A 090 0933031 Partial removal of heart sac A 090 0933050 Resect heart sac lesion A 090 0933120 Removal of heart lesion A 090 0933130 Removal of heart lesion A 090 0933140 Heart revascularize (tmr) A 090 0933141 Heart tmr w/other procedure A ZZZ 093315F Er+ or pr+ breast cancer M XXX 093316F Er- or pr- breast cancer M XXX 093317F Path rpt malig cancer docd I XXX 093318F Path rpt malig cancer docd I XXX 093319F X-ray/ct/ultrsnd et al ord M XXX 093320F No xray/ct/ et al ordd M XXX 0933202 Insert epicard eltrd open A 090 0933203 Insert epicard eltrd endo A 090 0933206 Insert heart pm atrial A 090 0933207 Insert heart pm ventricular A 090 0933208 Insrt heart pm atrial & vent A 090 093321F Ajcc cncr 0/ia melan docd M XXX 0933210 Insert electrd/pm cath sngl A 000 0933211 Insert card electrodes dual A 000 0933212 Insert pulse gen sngl lead A 090 0933213 Insert pulse gen dual leads A 090 0933214 Upgrade of pacemaker system A 090 0933215 Reposition pacing-defib lead A 090 0933216 Insert 1 electrode pm-defib A 090 0933217 Insert 2 electrode pm-defib A 090 0933218 Repair lead pace-defib one A 090 093322F Melanomaajcc stage 0 or ia M XXX 0933220 Repair lead pace-defib dual A 090 0933221 Insert pulse gen mult leads A 090 0933222 Relocation pocket pacemaker A 090 0933223 Relocate pocket for defib A 090 0933224 Insert pacing lead & connect A 000 0933225 L ventric pacing lead add-on A ZZZ 0933226 Reposition l ventric lead A 000 0933227 Remove&replace pm gen singl A 090 0933228 Remv&replc pm gen dual lead A 090 0933229 Remv&replc pm gen mult leads A 090 093323F Clin node stgng docdb/4 surg I XXX 0933230 Insrt pulse gen w/dual leads A 090 0933231 Insrt pulse gen w/mult leads A 090 0933233 Removal of pm generator A 090 0933234 Removal of pacemaker system A 090 09

33235 Removal pacemaker electrode A 090 0933236 Remove electrode/thoracotomy A 090 0933237 Remove electrode/thoracotomy A 090 0933238 Remove electrode/thoracotomy A 090 093324F Mri ct scan ord rvwd rqstd I XXX 0933240 Insrt pulse gen w/singl lead A 090 0933241 Remove pulse generator A 090 0933243 Remove eltrd/thoracotomy A 090 0933244 Remove elctrd transvenously A 090 0933249 Insj/rplcmt defib w/lead(s) A 090 093325F Preop asses 4 cataract surg I XXX 0933250 Ablate heart dysrhythm focus A 090 0933251 Ablate heart dysrhythm focus A 090 0933254 Ablate atria lmtd A 090 0933255 Ablate atria w/o bypass ext A 090 0933256 Ablate atria w/bypass exten A 090 0933257 Ablate atria lmtd add-on A ZZZ 0933258 Ablate atria x10sv add-on A ZZZ 0933259 Ablate atria w/bypass add-on A ZZZ 0933261 Ablate heart dysrhythm focus A 090 0933262 Rmvl& replc pulse gen 1 lead A 090 0933263 Rmvl & rplcmt dfb gen 2 lead A 090 0933264 Rmvl & rplcmt dfb gen mlt ld A 090 0933265 Ablate atria lmtd endo A 090 0933266 Ablate atria x10sv endo A 090 0933270 Ins/rep subq defibrillator A 090 0933271 Insj subq impltbl dfb elctrd A 090 0933272 Rmvl of subq defibrillator A 090 0933273 Repos prev impltbl subq dfb A 090 093328F Prfrmnc docd 2 wks b/4 surg I XXX 0933282 Implant pat-active ht record A 090 0933284 Remove pat-active ht record A 090 093330F Imaging study ordered (bkp) I XXX 0933300 Repair of heart wound A 090 0933305 Repair of heart wound A 090 093331F Bk imaging tst not ordered I XXX 0933310 Exploratory heart surgery A 090 0933315 Exploratory heart surgery A 090 0933320 Repair major blood vessel(s) A 090 0933321 Repair major vessel A 090 0933322 Repair major blood vessel(s) A 090 0933330 Insert major vessel graft A 090 0933335 Insert major vessel graft A 090 0933361 Replace aortic valve perq A 000 0933362 Replace aortic valve open A 000 0933363 Replace aortic valve open A 000 0933364 Replace aortic valve open A 000 0933365 Replace aortic valve open A 000 0933366 Trcath replace aortic valve A 000 0933367 Replace aortic valve w/byp A ZZZ 09

33368 Replace aortic valve w/byp A ZZZ 0933369 Replace aortic valve w/byp A ZZZ 093340F Mammo assess inc xray docd M XXX 0933400 Repair of aortic valve A 090 0933401 Valvuloplasty open A 090 0933403 Valvuloplasty w/cp bypass A 090 0933404 Prepare heart-aorta conduit A 090 0933405 Replacement of aortic valve A 090 0933406 Replacement of aortic valve A 090 093341F Mammo assess negative docd M XXX 0933410 Replacement of aortic valve A 090 0933411 Replacement of aortic valve A 090 0933412 Replacement of aortic valve A 090 0933413 Replacement of aortic valve A 090 0933414 Repair of aortic valve A 090 0933415 Revision subvalvular tissue A 090 0933416 Revise ventricle muscle A 090 0933417 Repair of aortic valve A 090 0933418 Repair tcat mitral valve A 090 0933419 Repair tcat mitral valve A ZZZ 093342F Mammo assess bengn docd M XXX 0933420 Revision of mitral valve A 090 0933422 Revision of mitral valve A 090 0933425 Repair of mitral valve A 090 0933426 Repair of mitral valve A 090 0933427 Repair of mitral valve A 090 093343F Mammo probably bengn docd M XXX 0933430 Replacement of mitral valve A 090 093344F Mammo assess susp docd M XXX 093345F Mammo assess hghlymalig doc M XXX 0933460 Revision of tricuspid valve A 090 0933463 Valvuloplasty tricuspid A 090 0933464 Valvuloplasty tricuspid A 090 0933465 Replace tricuspid valve A 090 0933468 Revision of tricuspid valve A 090 0933470 Revision of pulmonary valve A 090 0933471 Valvotomy pulmonary valve A 090 0933474 Revision of pulmonary valve A 090 0933475 Replacement pulmonary valve A 090 0933476 Revision of heart chamber A 090 0933478 Revision of heart chamber A 090 0933496 Repair prosth valve clot A 090 093350F Mammo bx proven malig docd M XXX 0933500 Repair heart vessel fistula A 090 0933501 Repair heart vessel fistula A 090 0933502 Coronary artery correction A 090 0933503 Coronary artery graft A 090 0933504 Coronary artery graft A 090 0933505 Repair artery w/tunnel A 090 0933506 Repair artery translocation A 090 09

33507 Repair art intramural A 090 0933508 Endoscopic vein harvest A ZZZ 093351F Neg scrn dep symp by deptool I XXX 0933510 Cabg vein single A 090 0933511 Cabg vein two A 090 0933512 Cabg vein three A 090 0933513 Cabg vein four A 090 0933514 Cabg vein five A 090 0933516 Cabg vein six or more A 090 0933517 Cabg artery-vein single A ZZZ 0933518 Cabg artery-vein two A ZZZ 0933519 Cabg artery-vein three A ZZZ 093352F No sig dep symp by dep tool I XXX 0933521 Cabg artery-vein four A ZZZ 0933522 Cabg artery-vein five A ZZZ 0933523 Cabg art-vein six or more A ZZZ 093353F Mild-mod dep symp by deptool I XXX 0933530 Coronary artery bypass/reop A ZZZ 0933533 Cabg arterial single A 090 0933534 Cabg arterial two A 090 0933535 Cabg arterial three A 090 0933536 Cabg arterial four or more A 090 093354F Clin sig dep sym by dep tool I XXX 0933542 Removal of heart lesion A 090 0933545 Repair of heart damage A 090 0933548 Restore/remodel ventricle A 090 0933572 Open coronary endarterectomy A ZZZ 0933600 Closure of valve A 090 0933602 Closure of valve A 090 0933606 Anastomosis/artery-aorta A 090 0933608 Repair anomaly w/conduit A 090 0933610 Repair by enlargement A 090 0933611 Repair double ventricle A 090 0933612 Repair double ventricle A 090 0933615 Repair modified fontan A 090 0933617 Repair single ventricle A 090 0933619 Repair single ventricle A 090 0933620 Apply r&l pulm art bands A 090 0933621 Transthor cath for stent A 090 0933622 Redo compl cardiac anomaly A 090 0933641 Repair heart septum defect A 090 0933645 Revision of heart veins A 090 0933647 Repair heart septum defects A 090 0933660 Repair of heart defects A 090 0933665 Repair of heart defects A 090 0933670 Repair of heart chambers A 090 0933675 Close mult vsd A 090 0933676 Close mult vsd w/resection A 090 0933677 Cl mult vsd w/rem pul band A 090 0933681 Repair heart septum defect A 090 09

33684 Repair heart septum defect A 090 0933688 Repair heart septum defect A 090 0933690 Reinforce pulmonary artery A 090 0933692 Repair of heart defects A 090 0933694 Repair of heart defects A 090 0933697 Repair of heart defects A 090 093370F Ajcc brst cncr stage 0 docd M XXX 0933702 Repair of heart defects A 090 0933710 Repair of heart defects A 090 093372F Ajcc brst cncr stage 1 docd M XXX 0933720 Repair of heart defect A 090 0933722 Repair of heart defect A 090 0933724 Repair venous anomaly A 090 0933726 Repair pul venous stenosis A 090 0933730 Repair heart-vein defect(s) A 090 0933732 Repair heart-vein defect A 090 0933735 Revision of heart chamber A 090 0933736 Revision of heart chamber A 090 0933737 Revision of heart chamber A 090 093374F Ajcc brst cncr stage 1 docd M XXX 0933750 Major vessel shunt A 090 0933755 Major vessel shunt A 090 093376F Ajcc brstcncr stage 2 docd M XXX 0933762 Major vessel shunt A 090 0933764 Major vessel shunt & graft A 090 0933766 Major vessel shunt A 090 0933767 Major vessel shunt A 090 0933768 Cavopulmonary shunting A ZZZ 0933770 Repair great vessels defect A 090 0933771 Repair great vessels defect A 090 0933774 Repair great vessels defect A 090 0933775 Repair great vessels defect A 090 0933776 Repair great vessels defect A 090 0933777 Repair great vessels defect A 090 0933778 Repair great vessels defect A 090 0933779 Repair great vessels defect A 090 093378F Ajcc brstcncr stage 3 docd M XXX 0933780 Repair great vessels defect A 090 0933781 Repair great vessels defect A 090 0933782 Nikaidoh proc A 090 0933783 Nikaidoh proc w/ostia implt A 090 0933786 Repair arterial trunk A 090 0933788 Revision of pulmonary artery A 090 093380F Ajcc brstcncr stage 4 docd M XXX 0933800 Aortic suspension A 090 0933802 Repair vessel defect A 090 0933803 Repair vessel defect A 090 0933813 Repair septal defect A 090 0933814 Repair septal defect A 090 093382F Ajcc cln cncr stage 0 docd M XXX 09

33820 Revise major vessel A 090 0933822 Revise major vessel A 090 0933824 Revise major vessel A 090 093384F Ajcc cln cncr stage 1 docd M XXX 0933840 Remove aorta constriction A 090 0933845 Remove aorta constriction A 090 0933851 Remove aorta constriction A 090 0933852 Repair septal defect A 090 0933853 Repair septal defect A 090 093386F Ajcc cln cncr stage 2 docd M XXX 0933860 Ascending aortic graft A 090 0933863 Ascending aortic graft A 090 0933864 Ascending aortic graft A 090 0933870 Transverse aortic arch graft A 090 0933875 Thoracic aortic graft A 090 0933877 Thoracoabdominal graft A 090 093388F Ajcc cln cncr stage 3 docd M XXX 0933880 Endovasc taa repr incl subcl A 090 0933881 Endovasc taa repr w/o subcl A 090 0933883 Insert endovasc prosth taa A 090 0933884 Endovasc prosth taa add-on A ZZZ 0933886 Endovasc prosth delayed A 090 0933889 Artery transpose/endovas taa A 000 0933891 Car-car bp grft/endovas taa A 000 093390F Ajcc cln cncr stage 4 docd M XXX 0933910 Remove lung artery emboli A 090 0933915 Remove lung artery emboli A 090 0933916 Surgery of great vessel A 090 0933917 Repair pulmonary artery A 090 0933920 Repair pulmonary atresia A 090 0933922 Transect pulmonary artery A 090 0933924 Remove pulmonary shunt A ZZZ 0933925 Rpr pul art unifocal w/o cpb A 090 0933926 Repr pul art unifocal w/cpb A 090 0933930 Removal of donor heart/lung X XXX 0933933 Prepare donor heart/lung C XXX 0933935 Transplantation heart/lung R 090 093394F Quant her2 ihc eval brst cx M XXX 0933940 Removal of donor heart X XXX 0933944 Prepare donor heart C XXX 0933945 Transplantation of heart R 090 0933946 Ecmo/ecls initiation venous A XXX 0933947 Ecmo/ecls initiation artery A XXX 0933948 Ecmo/ecls daily mgmt-venous A XXX 0933949 Ecmo/ecls daily mgmt artery A XXX 093395F Quant nonher2 ihc brst cx M XXX 0933951 Ecmo/ecls insj prph cannula A 000 0933952 Ecmo/ecls insj prph cannula A 000 0933953 Ecmo/ecls insj prph cannula A 000 0933954 Ecmo/ecls insj prph cannula A 000 09

33955 Ecmo/ecls insj ctr cannula A 000 0933956 Ecmo/ecls insj ctr cannula A 000 0933957 Ecmo/ecls repos perph cnula A 000 0933958 Ecmo/ecls repos perph cnula A 000 0933959 Ecmo/ecls repos perph cnula A 000 0933962 Ecmo/ecls repos perph cnula A 000 0933963 Ecmo/ecls repos perph cnula A 000 0933964 Ecmo/ecls repos perph cnula A 000 0933965 Ecmo/ecls rmvl perph cannula A 000 0933966 Ecmo/ecls rmvl prph cannula A 000 0933967 Insert i-aort percut device A 000 0933968 Remove aortic assist device A 000 0933969 Ecmo/ecls rmvl perph cannula A 000 0933970 Aortic circulation assist A 000 0933971 Aortic circulation assist A 090 0933973 Insert balloon device A 000 0933974 Remove intra-aortic balloon A 090 0933975 Implant ventricular device A XXX 0933976 Implant ventricular device A XXX 0933977 Remove ventricular device A XXX 0933978 Remove ventricular device A XXX 0933979 Insert intracorporeal device A XXX 0933980 Remove intracorporeal device A XXX 0933981 Replace vad pump ext A XXX 0933982 Replace vad intra w/o bp A XXX 0933983 Replace vad intra w/bp A XXX 0933984 Ecmo/ecls rmvl prph cannula A 000 0933985 Ecmo/ecls rmvl ctr cannula A 000 0933986 Ecmo/ecls rmvl ctr cannula A 000 0933987 Artery expos/graft artery A ZZZ 0933988 Insertion of left heart vent A 000 0933989 Removal of left heart vent A 000 0933990 Insert vad artery access A XXX 0933991 Insert vad art&vein access A XXX 0933992 Remove vad different session A XXX 0933993 Reposition vad diff session A XXX 0933999 Cardiac surgery procedure C YYY 0934001 Removal of artery clot A 090 0934051 Removal of artery clot A 090 0934101 Removal of artery clot A 090 0934111 Removal of arm artery clot A 090 0934151 Removal of artery clot A 090 0934201 Removal of artery clot A 090 0934203 Removal of leg artery clot A 090 0934401 Removal of vein clot A 090 0934421 Removal of vein clot A 090 0934451 Removal of vein clot A 090 0934471 Removal of vein clot A 090 0934490 Removal of vein clot A 090 093450F Dyspnea scrnd no-mild dysp I XXX 09

34501 Repair valve femoral vein A 090 0934502 Reconstruct vena cava A 090 093451F Dyspnea scrnd mod-high dysp I XXX 0934510 Transposition of vein valve A 090 093452F Dyspnea not screened I XXX 0934520 Cross-over vein graft A 090 0934530 Leg vein fusion A 090 093455F Tb scrng done-interpd 6mon M XXX 093470F Ra disease activity low M XXX 093471F Ra disease activity mod M XXX 093472F Ra disease activity high M XXX 093475F Disease progn ra poor docd M XXX 093476F Disease progn ra good docd M XXX 0934800 Endovas aaa repr w/sm tube A 090 0934802 Endovas aaa repr w/2-p part A 090 0934803 Endovas aaa repr w/3-p part A 090 0934804 Endovas aaa repr w/1-p part A 090 0934805 Endovas aaa repr w/long tube A 090 0934806 Aneurysm press sensor add-on A ZZZ 0934808 Endovas iliac a device addon A ZZZ 0934812 Xpose for endoprosth femorl A 000 0934813 Femoral endovas graft add-on A ZZZ 0934820 Xpose for endoprosth iliac A 000 0934825 Endovasc extend prosth init A 090 0934826 Endovasc exten prosth addl A ZZZ 0934830 Open aortic tube prosth repr A 090 0934831 Open aortoiliac prosth repr A 090 0934832 Open aortofemor prosth repr A 090 0934833 Xpose for endoprosth iliac A 000 0934834 Xpose endoprosth brachial A 000 0934839 Plnning pt spec fenest graft C YYY 0934841 Endovasc visc aorta 1 graft C YYY 0934842 Endovasc visc aorta 2 graft C YYY 0934843 Endovasc visc aorta 3 graft C YYY 0934844 Endovasc visc aorta 4 graft C YYY 0934845 Visc & infraren abd 1 prosth C YYY 0934846 Visc & infraren abd 2 prosth C YYY 0934847 Visc & infraren abd 3 prosth C YYY 0934848 Visc & infraren abd 4+ prost C YYY 093490F History aids-defining cond I XXX 0934900 Endovasc iliac repr w/graft A 090 093491F Hiv unsure baby of hiv+moms I XXX 093492F History cd4+ cell count <350 I XXX 093493F No hist cd4+ cell count <350 I XXX 093494F Cd4+cell count <200cells/mm3 M XXX 093495F Cd4+cell cnt 200-499 cells M XXX 093496F Cd4+ cell count + 500 cells M XXX 093497F Cd4+ cell percentage <15% I XXX 093498F Cd4+ cell =15% (hiv) I XXX 093500F Cd4+cell cnt/% docd as done I XXX 09

35001 Repair defect of artery A 090 0935002 Repair artery rupture neck A 090 0935005 Repair defect of artery A 090 0935011 Repair defect of artery A 090 0935013 Repair artery rupture arm A 090 093502F Hiv rna vrl ld <lmts quantif I XXX 0935021 Repair defect of artery A 090 0935022 Repair artery rupture chest A 090 093503F Hiv rna vrl ldnot<lmts quntf I XXX 0935045 Repair defect of arm artery A 090 0935081 Repair defect of artery A 090 0935082 Repair artery rupture aorta A 090 0935091 Repair defect of artery A 090 0935092 Repair artery rupture aorta A 090 093510F Doc tb scrng-rslts interpd M XXX 0935102 Repair defect of artery A 090 0935103 Repair artery rupture aorta A 090 093511F Chlmyd/gonrh tsts docd done I XXX 0935111 Repair defect of artery A 090 0935112 Repair artery rupture spleen A 090 093512F Syph scrng docd as done I XXX 0935121 Repair defect of artery A 090 0935122 Repair artery rupture belly A 090 093513F Hep b scrng docd as done I XXX 0935131 Repair defect of artery A 090 0935132 Repair artery rupture groin A 090 093514F Hep c scrng docd as done I XXX 0935141 Repair defect of artery A 090 0935142 Repair artery rupture thigh A 090 093515F Pt has docd immun to hep c I XXX 0935151 Repair defect of artery A 090 0935152 Repair ruptd popliteal art A 090 093517F Hbv assess&results intrp 1yr M XXX 0935180 Repair blood vessel lesion A 090 0935182 Repair blood vessel lesion A 090 0935184 Repair blood vessel lesion A 090 0935188 Repair blood vessel lesion A 090 0935189 Repair blood vessel lesion A 090 0935190 Repair blood vessel lesion A 090 093520F Cdifficile testing performed I XXX 0935201 Repair blood vessel lesion A 090 0935206 Repair blood vessel lesion A 090 0935207 Repair blood vessel lesion A 090 0935211 Repair blood vessel lesion A 090 0935216 Repair blood vessel lesion A 090 0935221 Repair blood vessel lesion A 090 0935226 Repair blood vessel lesion A 090 0935231 Repair blood vessel lesion A 090 0935236 Repair blood vessel lesion A 090 0935241 Repair blood vessel lesion A 090 09

35246 Repair blood vessel lesion A 090 0935251 Repair blood vessel lesion A 090 0935256 Repair blood vessel lesion A 090 0935261 Repair blood vessel lesion A 090 0935266 Repair blood vessel lesion A 090 0935271 Repair blood vessel lesion A 090 0935276 Repair blood vessel lesion A 090 0935281 Repair blood vessel lesion A 090 0935286 Repair blood vessel lesion A 090 0935301 Rechanneling of artery A 090 0935302 Rechanneling of artery A 090 0935303 Rechanneling of artery A 090 0935304 Rechanneling of artery A 090 0935305 Rechanneling of artery A 090 0935306 Rechanneling of artery A ZZZ 0935311 Rechanneling of artery A 090 0935321 Rechanneling of artery A 090 0935331 Rechanneling of artery A 090 0935341 Rechanneling of artery A 090 0935351 Rechanneling of artery A 090 0935355 Rechanneling of artery A 090 0935361 Rechanneling of artery A 090 0935363 Rechanneling of artery A 090 0935371 Rechanneling of artery A 090 0935372 Rechanneling of artery A 090 0935390 Reoperation carotid add-on A ZZZ 0935400 Angioscopy A ZZZ 0935450 Repair arterial blockage A 000 0935452 Repair arterial blockage A 000 0935458 Repair arterial blockage A 000 0935460 Repair venous blockage A 000 0935471 Repair arterial blockage A 000 0935472 Repair arterial blockage A 000 0935475 Repair arterial blockage R 000 0935476 Repair venous blockage A 000 093550F Low rsk thromboembolism I XXX 0935500 Harvest vein for bypass A ZZZ 0935501 Art byp grft ipsilat carotid A 090 0935506 Art byp grft subclav-carotid A 090 0935508 Art byp grft carotid-vertbrl A 090 0935509 Art byp grft contral carotid A 090 093551F Intrmed rsk thromboembolism I XXX 0935510 Art byp grft carotid-brchial A 090 0935511 Art byp grft subclav-subclav A 090 0935512 Art byp grft subclav-brchial A 090 0935515 Art byp grft subclav-vertbrl A 090 0935516 Art byp grft subclav-axilary A 090 0935518 Art byp grft axillary-axilry A 090 093552F Hgh risk for thromboembolism I XXX 0935521 Art byp grft axill-femoral A 090 09

35522 Art byp grft axill-brachial A 090 0935523 Art byp grft brchl-ulnr-rdl A 090 0935525 Art byp grft brachial-brchl A 090 0935526 Art byp grft aor/carot/innom A 090 0935531 Art byp grft aorcel/aormesen A 090 0935533 Art byp grft axill/fem/fem A 090 0935535 Art byp grft hepatorenal A 090 0935536 Art byp grft splenorenal A 090 0935537 Art byp grft aortoiliac A 090 0935538 Art byp grft aortobi-iliac A 090 0935539 Art byp grft aortofemoral A 090 0935540 Art byp grft aortbifemoral A 090 093555F Pt inr measurement performed I XXX 0935556 Art byp grft fem-popliteal A 090 0935558 Art byp grft fem-femoral A 090 0935560 Art byp grft aortorenal A 090 0935563 Art byp grft ilioiliac A 090 0935565 Art byp grft iliofemoral A 090 0935566 Art byp fem-ant-post tib/prl A 090 0935570 Art byp tibial-tib/peroneal A 090 0935571 Art byp pop-tibl-prl-other A 090 0935572 Harvest femoropopliteal vein A ZZZ 0935583 Vein byp grft fem-popliteal A 090 0935585 Vein byp fem-tibial peroneal A 090 0935587 Vein byp pop-tibl peroneal A 090 0935600 Harvest art for cabg add-on A ZZZ 0935601 Art byp common ipsi carotid A 090 0935606 Art byp carotid-subclavian A 090 0935612 Art byp subclav-subclavian A 090 0935616 Art byp subclav-axillary A 090 0935621 Art byp axillary-femoral A 090 0935623 Art byp axillary-pop-tibial A 090 0935626 Art byp aorsubcl/carot/innom A 090 0935631 Art byp aor-celiac-msn-renal A 090 0935632 Art byp ilio-celiac A 090 0935633 Art byp ilio-mesenteric A 090 0935634 Art byp iliorenal A 090 0935636 Art byp spenorenal A 090 0935637 Art byp aortoiliac A 090 0935638 Art byp aortobi-iliac A 090 0935642 Art byp carotid-vertebral A 090 0935645 Art byp subclav-vertebrl A 090 0935646 Art byp aortobifemoral A 090 0935647 Art byp aortofemoral A 090 0935650 Art byp axillary-axillary A 090 0935654 Art byp axill-fem-femoral A 090 0935656 Art byp femoral-popliteal A 090 0935661 Art byp femoral-femoral A 090 0935663 Art byp ilioiliac A 090 0935665 Art byp iliofemoral A 090 09

35666 Art byp fem-ant-post tib/prl A 090 0935671 Art byp pop-tibl-prl-other A 090 0935681 Composite byp grft pros&vein A ZZZ 0935682 Composite byp grft 2 veins A ZZZ 0935683 Composite byp grft 3/> segmt A ZZZ 0935685 Bypass graft patency/patch A ZZZ 0935686 Bypass graft/av fist patency A ZZZ 0935691 Art trnsposj vertbrl carotid A 090 0935693 Art trnsposj subclavian A 090 0935694 Art trnsposj subclav carotid A 090 0935695 Art trnsposj carotid subclav A 090 0935697 Reimplant artery each A ZZZ 093570F Rprt bone scint xref w xray M XXX 0935700 Reoperation bypass graft A ZZZ 0935701 Exploration carotid artery A 090 093572F Pt consid poss risk fx I XXX 0935721 Exploration femoral artery A 090 093573F Pt not consid poss risk fx I XXX 0935741 Exploration popliteal artery A 090 0935761 Exploration of artery/vein A 090 0935800 Explore neck vessels A 090 0935820 Explore chest vessels A 090 0935840 Explore abdominal vessels A 090 0935860 Explore limb vessels A 090 0935870 Repair vessel graft defect A 090 0935875 Removal of clot in graft A 090 0935876 Removal of clot in graft A 090 0935879 Revise graft w/vein A 090 0935881 Revise graft w/vein A 090 0935883 Revise graft w/nonauto graft A 090 0935884 Revise graft w/vein A 090 0935901 Excision graft neck A 090 0935903 Excision graft extremity A 090 0935905 Excision graft thorax A 090 0935907 Excision graft abdomen A 090 0936000 Place needle in vein B XXX 0936002 Pseudoaneurysm injection trt A 000 0936005 Injection ext venography A 000 0936010 Place catheter in vein A XXX 0936011 Place catheter in vein A XXX 0936012 Place catheter in vein A XXX 0936013 Place catheter in artery A XXX 0936014 Place catheter in artery A XXX 0936015 Place catheter in artery A XXX 0936100 Establish access to artery A XXX 0936120 Establish access to artery A XXX 0936140 Establish access to artery A XXX 0936147 Access av dial grft for eval A XXX 0936148 Access av dial grft for proc A ZZZ 0936160 Establish access to aorta A XXX 09

36200 Place catheter in aorta A 000 0936215 Place catheter in artery A XXX 0936216 Place catheter in artery A XXX 0936217 Place catheter in artery A XXX 0936218 Place catheter in artery A ZZZ 0936221 Place cath thoracic aorta A 000 0936222 Place cath carotid/inom art A 000 0936223 Place cath carotid/inom art A 000 0936224 Place cath carotd art A 000 0936225 Place cath subclavian art A 000 0936226 Place cath vertebral art A 000 0936227 Place cath xtrnl carotid A ZZZ 0936228 Place cath intracranial art A ZZZ 0936245 Ins cath abd/l-ext art 1st A XXX 0936246 Ins cath abd/l-ext art 2nd A 000 0936247 Ins cath abd/l-ext art 3rd A 000 0936248 Ins cath abd/l-ext art addl A ZZZ 0936251 Ins cath ren art 1st unilat A 000 0936252 Ins cath ren art 1st bilat A 000 0936253 Ins cath ren art 2nd+ unilat A 000 0936254 Ins cath ren art 2nd+ bilat A 000 0936260 Insertion of infusion pump A 090 0936261 Revision of infusion pump A 090 0936262 Removal of infusion pump A 090 0936299 Vessel injection procedure C YYY 0936400 Bl draw < 3 yrs fem/jugular A XXX 0936405 Bl draw <3 yrs scalp vein A XXX 0936406 Bl draw <3 yrs other vein A XXX 0936410 Non-routine bl draw 3/> yrs A XXX 0936415 Routine venipuncture X XXX 0936416 Capillary blood draw B XXX 0936420 Vein access cutdown < 1 yr A XXX 0936425 Vein access cutdown > 1 yr A XXX 0936430 Blood transfusion service A XXX 0936440 Bl push transfuse 2 yr/< A XXX 0936450 Bl exchange/transfuse nb A XXX 0936455 Bl exchange/transfuse non-nb A XXX 0936460 Transfusion service fetal A XXX 0936468 Injection(s) spider veins R 000 0936470 Injection therapy of vein A 010 0936471 Injection therapy of veins A 010 0936475 Endovenous rf 1st vein A 000 0936476 Endovenous rf vein add-on A ZZZ 0936478 Endovenous laser 1st vein A 000 0936479 Endovenous laser vein addon A ZZZ 0936481 Insertion of catheter vein A 000 093650F Eeg ordered rvwd reqstd I XXX 0936500 Insertion of catheter vein A 000 0936510 Insertion of catheter vein A 000 0936511 Apheresis wbc A 000 09

36512 Apheresis rbc A 000 0936513 Apheresis platelets A 000 0936514 Apheresis plasma A 000 0936515 Apheresis adsorp/reinfuse A 000 0936516 Apheresis selective A 000 0936522 Photopheresis A 000 0936555 Insert non-tunnel cv cath A 000 0936556 Insert non-tunnel cv cath A 000 0936557 Insert tunneled cv cath A 010 0936558 Insert tunneled cv cath A 010 0936560 Insert tunneled cv cath A 010 0936561 Insert tunneled cv cath A 010 0936563 Insert tunneled cv cath A 010 0936565 Insert tunneled cv cath A 010 0936566 Insert tunneled cv cath A 010 0936568 Insert picc cath A 000 0936569 Insert picc cath A 000 0936570 Insert picvad cath A 010 0936571 Insert picvad cath A 010 0936575 Repair tunneled cv cath A 000 0936576 Repair tunneled cv cath A 010 0936578 Replace tunneled cv cath A 010 0936580 Replace cvad cath A 000 0936581 Replace tunneled cv cath A 010 0936582 Replace tunneled cv cath A 010 0936583 Replace tunneled cv cath A 010 0936584 Replace picc cath A 000 0936585 Replace picvad cath A 010 0936589 Removal tunneled cv cath A 010 0936590 Removal tunneled cv cath A 010 0936591 Draw blood off venous device T XXX 0936592 Collect blood from picc T XXX 0936593 Declot vascular device A XXX 0936595 Mech remov tunneled cv cath A 000 0936596 Mech remov tunneled cv cath A 000 0936597 Reposition venous catheter A 000 0936598 Inj w/fluor eval cv device T 000 0936600 Withdrawal of arterial blood A XXX 0936620 Insertion catheter artery A 000 0936625 Insertion catheter artery A 000 0936640 Insertion catheter artery A 000 0936660 Insertion catheter artery A 000 0936680 Insert needle bone cavity A 000 0936800 Insertion of cannula A 000 0936810 Insertion of cannula A 000 0936815 Insertion of cannula A 000 0936818 Av fuse uppr arm cephalic A 090 0936819 Av fuse uppr arm basilic A 090 0936820 Av fusion/forearm vein A 090 0936821 Av fusion direct any site A 090 09

36823 Insertion of cannula(s) A 090 0936825 Artery-vein autograft A 090 0936830 Artery-vein nonautograft A 090 0936831 Open thrombect av fistula A 090 0936832 Av fistula revision open A 090 0936833 Av fistula revision A 090 0936835 Artery to vein shunt A 090 0936838 Dist revas ligation hemo A 090 0936860 External cannula declotting A 000 0936861 Cannula declotting A 000 0936870 Percut thrombect av fistula A 090 093700F Psych disorders assessed M XXX 0937140 Revision of circulation A 090 0937145 Revision of circulation A 090 0937160 Revision of circulation A 090 0937180 Revision of circulation A 090 0937181 Splice spleen/kidney veins A 090 0937182 Insert hepatic shunt (tips) A 000 0937183 Remove hepatic shunt (tips) A 000 0937184 Prim art mech thrombectomy A 000 0937185 Prim art m-thrombect add-on A ZZZ 0937186 Sec art m-thrombect add-on A ZZZ 0937187 Venous mech thrombectomy A 000 0937188 Venous m-thrombectomy add-on A 000 0937191 Ins endovas vena cava filtr A 000 0937192 Redo endovas vena cava filtr A 000 0937193 Rem endovas vena cava filter A 000 0937195 Thrombolytic therapy stroke C XXX 0937197 Remove intrvas foreign body A 000 093720F Cognit impairment assessed M XXX 0937200 Transcatheter biopsy A 000 0937202 Transcatheter therapy infuse A 000 0937211 Thrombolytic art therapy A 000 0937212 Thrombolytic venous therapy A 000 0937213 Thromblytic art/ven therapy A 000 0937214 Cessj therapy cath removal A 000 0937215 Transcath stent cca w/eps R 090 0937216 Transcath stent cca w/o eps N 090 0937217 Stent placemt retro carotid A 090 0937218 Stent placemt ante carotid A 090 0937220 Iliac revasc A 000 0937221 Iliac revasc w/stent A 000 0937222 Iliac revasc add-on A ZZZ 0937223 Iliac revasc w/stent add-on A ZZZ 0937224 Fem/popl revas w/tla A 000 0937225 Fem/popl revas w/ather A 000 0937226 Fem/popl revasc w/stent A 000 0937227 Fem/popl revasc stnt & ather A 000 0937228 Tib/per revasc w/tla A 000 0937229 Tib/per revasc w/ather A 000 09

37230 Tib/per revasc w/stent A 000 0937231 Tib/per revasc stent & ather A 000 0937232 Tib/per revasc add-on A ZZZ 0937233 Tibper revasc w/ather add-on A ZZZ 0937234 Revsc opn/prq tib/pero stent A ZZZ 0937235 Tib/per revasc stnt & ather A ZZZ 0937236 Open/perq place stent 1st A 000 0937237 Open/perq place stent ea add A ZZZ 0937238 Open/perq place stent same A 000 0937239 Open/perq place stent ea add A ZZZ 0937241 Vasc embolize/occlude venous A 000 0937242 Vasc embolize/occlude artery A 000 0937243 Vasc embolize/occlude organ A 000 0937244 Vasc embolize/occlude bleed A 000 093725F Screen depression performed M XXX 0937250 Iv us first vessel add-on A ZZZ 0937251 Iv us each add vessel add-on A ZZZ 093750F Ptnotrcvngsteroid>/=10mg/day I XXX 0937500 Endoscopy ligate perf veins A 090 0937501 Vascular endoscopy procedure C YYY 093751F Electrodiag polyneuro 6 mn I XXX 093752F No electrodiag polyneuro 6mn I XXX 093753F Pt has symp&signs neuropathy I XXX 093754F Screening tests dm done I XXX 093755F Cog&behav imprmnt scrng done I XXX 093756F Pt w/pseudobulb affect/als I XXX 0937565 Ligation of neck vein A 090 093757F Pt w/o pseudobulbaffect/als I XXX 093758F Pt ref pulm fx test/peakflow I XXX 093759F Pt scrn dysphag/wt loss/nutr I XXX 093760F Pt w/ dysphag/wt loss/nutr I XXX 0937600 Ligation of neck artery A 090 0937605 Ligation of neck artery A 090 0937606 Ligation of neck artery A 090 0937607 Ligation of a-v fistula A 090 0937609 Temporal artery procedure A 010 093761F Pt w/o dysphag/wt loss/nutr I XXX 0937615 Ligation of neck artery A 090 0937616 Ligation of chest artery A 090 0937617 Ligation of abdomen artery A 090 0937618 Ligation of extremity artery A 090 0937619 Ligation of inf vena cava A 090 093762F Patient is dysarthric I XXX 093763F Patient is not dysarthric I XXX 0937650 Revision of major vein A 090 0937660 Revision of major vein A 090 0937700 Revise leg vein A 090 0937718 Ligate/strip short leg vein A 090 0937722 Ligate/strip long leg vein A 090 0937735 Removal of leg veins/lesion A 090 09

3775F Adenoma detected screening M XXX 093776F Adenoma not detect screening M XXX 0937760 Ligate leg veins radical A 090 0937761 Ligate leg veins open A 090 0937765 Stab phleb veins xtr 10-20 A 090 0937766 Phleb veins - extrem 20+ A 090 0937780 Revision of leg vein A 090 0937785 Ligate/divide/excise vein A 090 0937788 Revascularization penis A 090 0937790 Penile venous occlusion A 090 0937799 Vascular surgery procedure C YYY 0938100 Removal of spleen total A 090 0938101 Removal of spleen partial A 090 0938102 Removal of spleen total A ZZZ 0938115 Repair of ruptured spleen A 090 0938120 Laparoscopy splenectomy A 090 0938129 Laparoscope proc spleen C YYY 0938200 Injection for spleen x-ray A 000 0938204 Bl donor search management B XXX 0938205 Harvest allogeneic stem cell R 000 0938206 Harvest auto stem cells R 000 0938207 Cryopreserve stem cells I XXX 0938208 Thaw preserved stem cells I XXX 0938209 Wash harvest stem cells I XXX 0938210 T-cell depletion of harvest I XXX 0938211 Tumor cell deplete of harvst I XXX 0938212 Rbc depletion of harvest I XXX 0938213 Platelet deplete of harvest I XXX 0938214 Volume deplete of harvest I XXX 0938215 Harvest stem cell concentrte I XXX 0938220 Bone marrow aspiration A XXX 0938221 Bone marrow biopsy A XXX 0938230 Bone marrow harvest allogen A 000 0938232 Bone marrow harvest autolog A 000 0938240 Transplt allo hct/donor R XXX 0938241 Transplt autol hct/donor R XXX 0938242 Transplt allo lymphocytes A 000 0938243 Transplj hematopoietic boost A 000 0938300 Drainage lymph node lesion A 010 0938305 Drainage lymph node lesion A 090 0938308 Incision of lymph channels A 090 0938380 Thoracic duct procedure A 090 0938381 Thoracic duct procedure A 090 0938382 Thoracic duct procedure A 090 0938500 Biopsy/removal lymph nodes A 010 0938505 Needle biopsy lymph nodes A 000 0938510 Biopsy/removal lymph nodes A 010 0938520 Biopsy/removal lymph nodes A 090 0938525 Biopsy/removal lymph nodes A 090 0938530 Biopsy/removal lymph nodes A 090 09

38542 Explore deep node(s) neck A 090 0938550 Removal neck/armpit lesion A 090 0938555 Removal neck/armpit lesion A 090 0938562 Removal pelvic lymph nodes A 090 0938564 Removal abdomen lymph nodes A 090 0938570 Laparoscopy lymph node biop A 010 0938571 Laparoscopy lymphadenectomy A 010 0938572 Laparoscopy lymphadenectomy A 010 0938589 Laparoscope proc lymphatic C YYY 0938700 Removal of lymph nodes neck A 090 0938720 Removal of lymph nodes neck A 090 0938724 Removal of lymph nodes neck A 090 0938740 Remove armpit lymph nodes A 090 0938745 Remove armpit lymph nodes A 090 0938746 Remove thoracic lymph nodes A ZZZ 0938747 Remove abdominal lymph nodes A ZZZ 0938760 Remove groin lymph nodes A 090 0938765 Remove groin lymph nodes A 090 0938770 Remove pelvis lymph nodes A 090 0938780 Remove abdomen lymph nodes A 090 0938790 Inject for lymphatic x-ray A 000 0938792 Ra tracer id of sentinl node A 000 0938794 Access thoracic lymph duct A 090 0938900 Io map of sent lymph node A ZZZ 0938999 Blood/lymph system procedure C YYY 0939000 Exploration of chest A 090 0939010 Exploration of chest A 090 0939200 Resect mediastinal cyst A 090 0939220 Resect mediastinal tumor A 090 0939400 Mediastinoscopy incl biopsy A 010 0939499 Chest procedure C YYY 0939501 Repair diaphragm laceration A 090 0939503 Repair of diaphragm hernia A 090 0939540 Repair of diaphragm hernia A 090 0939541 Repair of diaphragm hernia A 090 0939545 Revision of diaphragm A 090 0939560 Resect diaphragm simple A 090 0939561 Resect diaphragm complex A 090 0939599 Diaphragm surgery procedure C YYY 094000F Tobacco use txmnt counseling I XXX 094001F Tobacco use txmnt pharmacol I XXX 094003F Pt ed write/oral pts w/ hf I XXX 094004F Pt tobacco screen rcvd tlk M XXX 094005F Pharm thx for op rxd M XXX 094008F Beta-blocker therapy rxd/tkn M XXX 094010F Ace/arb therapy rxd/taken M XXX 094011F Oral antiplatelet therapy rx I XXX 094012F Warfarin therapy rx I XXX 094013F Statin therapy/currently tkn I XXX 094014F Written discharge instr prvd I XXX 09

4015F Persist asthma medicine ctrl I XXX 094016F Anti-inflm/anlgsc agent rx I XXX 094017F Gi prophylaxis for nsaid rx I XXX 094018F Therapy exercise joint rx I XXX 094019F Doc recpt counsl vit d/calc+ I XXX 094025F Inhaled bronchodilator rx M XXX 094030F Oxygen therapy rx I XXX 094033F Pulmonary rehab rec I XXX 094035F Influenza imm rec I XXX 094037F Influenza imm order/admin I XXX 094040F Pneumoc vac/admin/rcvd M XXX 094041F Doc order cefazolin/cefurox I XXX 094042F Doc antibio not given M XXX 094043F Doc order given stop antibio I XXX 094044F Doc order given vte prophylx M XXX 094045F Empiric antibiotic rx I XXX 094046F Doc antibio given b/4 surg M XXX 094047F Doc antibio given b/4 surg I XXX 094048F Doc antibio given b/4 surg I XXX 094049F Doc order given stop antibio M XXX 0940490 Biopsy of lip A 000 094050F Ht care plan doc I XXX 0940500 Partial excision of lip A 090 094051F Referred for an av fistula I XXX 0940510 Partial excision of lip A 090 094052F Hemodialysis via av fistula I XXX 0940520 Partial excision of lip A 090 0940525 Reconstruct lip with flap A 090 0940527 Reconstruct lip with flap A 090 094053F Hemodialysis via av graft I XXX 0940530 Partial removal of lip A 090 094054F Hemodialysis via catheter I XXX 094055F Pt rcvng periton dialysis I XXX 094056F Approp oral rehyd recommd I XXX 094058F Ped gastro ed given caregvr I XXX 094060F Psych svcs provided I XXX 094062F Pt referral psych docd I XXX 094063F Antidepres rxthxpy not rxd I XXX 094064F Antidepressant rx I XXX 094065F Antipsychotic rx I XXX 0940650 Repair lip A 090 0940652 Repair lip A 090 0940654 Repair lip A 090 094066F Ect provided I XXX 094067F Pt referral for ect docd I XXX 094069F Vte prophylaxis rcvd I XXX 094070F Dvt prophylx recvd day 2 I XXX 0940700 Repair cleft lip/nasal A 090 0940701 Repair cleft lip/nasal A 090 0940702 Repair cleft lip/nasal A 090 09

40720 Repair cleft lip/nasal A 090 094073F Oral antiplat thx rx dischrg I XXX 094075F Anticoag thx rx at dischrg M XXX 0940761 Repair cleft lip/nasal A 090 094077F Doc t-pa admin considered I XXX 094079F Doc rehab svcs considered I XXX 0940799 Lip surgery procedure C YYY 0940800 Drainage of mouth lesion A 010 0940801 Drainage of mouth lesion A 010 0940804 Removal foreign body mouth A 010 0940805 Removal foreign body mouth A 010 0940806 Incision of lip fold A 000 0940808 Biopsy of mouth lesion A 010 0940810 Excision of mouth lesion A 010 0940812 Excise/repair mouth lesion A 010 0940814 Excise/repair mouth lesion A 090 0940816 Excision of mouth lesion A 090 0940818 Excise oral mucosa for graft A 090 0940819 Excise lip or cheek fold A 090 0940820 Treatment of mouth lesion A 010 0940830 Repair mouth laceration A 010 0940831 Repair mouth laceration A 010 094084F Aspirin recvd w/in 24 hrs I XXX 0940840 Reconstruction of mouth R 090 0940842 Reconstruction of mouth R 090 0940843 Reconstruction of mouth R 090 0940844 Reconstruction of mouth R 090 0940845 Reconstruction of mouth R 090 094086F Aspirin/clopidogrel rxd M XXX 0940899 Mouth surgery procedure C YYY 094090F Pt rcvng epo thxpy M XXX 094095F Pt not rcvng epo thxpy I XXX 094100F Biphos thxpy vein ord/recvd M XXX 0941000 Drainage of mouth lesion A 010 0941005 Drainage of mouth lesion A 010 0941006 Drainage of mouth lesion A 090 0941007 Drainage of mouth lesion A 090 0941008 Drainage of mouth lesion A 090 0941009 Drainage of mouth lesion A 090 0941010 Incision of tongue fold A 010 0941015 Drainage of mouth lesion A 090 0941016 Drainage of mouth lesion A 090 0941017 Drainage of mouth lesion A 090 0941018 Drainage of mouth lesion A 090 0941019 Place needles h&n for rt A 000 094110F Int mam art used for cabg M XXX 0941100 Biopsy of tongue A 010 0941105 Biopsy of tongue A 010 0941108 Biopsy of floor of mouth A 010 0941110 Excision of tongue lesion A 010 09

41112 Excision of tongue lesion A 090 0941113 Excision of tongue lesion A 090 0941114 Excision of tongue lesion A 090 0941115 Excision of tongue fold A 010 0941116 Excision of mouth lesion A 090 0941120 Partial removal of tongue A 090 0941130 Partial removal of tongue A 090 0941135 Tongue and neck surgery A 090 0941140 Removal of tongue A 090 0941145 Tongue removal neck surgery A 090 094115F Beta blckr admin w/in 24 hrs M XXX 0941150 Tongue mouth jaw surgery A 090 0941153 Tongue mouth neck surgery A 090 0941155 Tongue jaw & neck surgery A 090 094120F Antibiot rxd/given M XXX 094124F Antibiot not rxd/given M XXX 0941250 Repair tongue laceration A 010 0941251 Repair tongue laceration A 010 0941252 Repair tongue laceration A 010 094130F Topical prep rx aoe M XXX 094131F Syst antimicrobial thx rx M XXX 094132F No syst antimicrobial thx rx M XXX 094133F Antihist/decong rx/recom I XXX 094134F No antihist/decong rx/recom I XXX 094135F Systemic corticosteroids rx I XXX 094136F Syst corticosteroids not rx I XXX 094140F Inhaled corticosteroids rxd M XXX 094142F Corticoster sparng thrpy rxd M XXX 094144F Alt long-term cntrl med rxd M XXX 094145F 2+ anti-hyprtnsv agents tkn I XXX 094148F Hep a vac injxn admin/recvd M XXX 094149F Hep b vac injxn admin/recvd M XXX 094150F Pt recvng antivir txmnt hepc I XXX 0941500 Fixation of tongue A 090 094151F Pt not recvng antiv hep c M XXX 0941510 Tongue to lip surgery A 090 0941512 Tongue suspension A 090 0941520 Reconstruction tongue fold A 090 094153F Combo pegintf/rib rx I XXX 0941530 Tongue base vol reduction A 010 094155F Hep a vac series prev recvd I XXX 094157F Hep b vac series prev recvd I XXX 094158F Pt edu re alcoh drnkng done I XXX 094159F Contrcp talk b/4 antiv txmnt I XXX 0941599 Tongue and mouth surgery C YYY 094163F Pt couns 4 txmnt opt prost I XXX 094164F Adjv hrmnl thxpy rxd M XXX 094165F 3d-crt/imrt received I XXX 094167F Hd bed tilted 1st day vent I XXX 094168F Pt care icu&vent w/in 24hrs I XXX 09

4169F No pt care icu/vent in 24hrs I XXX 094171F Pt rcvng esa thxpy I XXX 094172F Pt not rcvng esa thxpy I XXX 094174F Couns potent glauc impct I XXX 094175F Vis 20/40/> w/in 90 days M XXX 094176F Talk re uv light pt/crgvr I XXX 094177F Talk pt/crgvr re areds prev M XXX 094178F Antid glbln rcvd w/in 26wks I XXX 094179F Tamoxifen/ai prescribed M XXX 094180F Adjv thxpyrxd/rcvd colon ca I XXX 0941800 Drainage of gum lesion A 010 0941805 Removal foreign body gum A 010 0941806 Removal foreign body jawbone A 010 094181F Conformal radn thxpy rcvd I XXX 094182F No conformal radn thxpy I XXX 0941820 Excision gum each quadrant R 000 0941821 Excision of gum flap R 000 0941822 Excision of gum lesion R 010 0941823 Excision of gum lesion R 090 0941825 Excision of gum lesion A 010 0941826 Excision of gum lesion A 010 0941827 Excision of gum lesion A 090 0941828 Excision of gum lesion R 010 0941830 Removal of gum tissue R 010 094185F Continuous ppi or h2ra rcvd I XXX 0941850 Treatment of gum lesion R 000 094186F No cont ppi or h2ra rcvd I XXX 094187F Anti rheum drugthxpyrxd/gvn M XXX 0941870 Gum graft R 000 0941872 Repair gum R 090 0941874 Repair tooth socket R 090 094188F Approp ace/arb tstng done I XXX 094189F Approp digoxin tstng done I XXX 0941899 Dental surgery procedure C YYY 094190F Approp diuretic tstng done I XXX 094191F Approp anticonvuls tstng I XXX 094192F Pt not rcvng glucoco thxpy M XXX 094193F Pt rcvng<10mg daily predniso M XXX 094194F Pt rcvng10mg daily predniso M XXX 094195F Pt rcvng anti-rheum thxpy ra M XXX 094196F Ptnot rcvng anti-rhm thxpyra M XXX 094200F External beam to prost only I XXX 0942000 Drainage mouth roof lesion A 010 094201F Extrnl beam other than prost I XXX 094210F Ace/arb thxpy for mos/> I XXX 0942100 Biopsy roof of mouth A 010 0942104 Excision lesion mouth roof A 010 0942106 Excision lesion mouth roof A 010 0942107 Excision lesion mouth roof A 090 0942120 Remove palate/lesion A 090 09

42140 Excision of uvula A 090 0942145 Repair palate pharynx/uvula A 090 0942160 Treatment mouth roof lesion A 010 0942180 Repair palate A 010 0942182 Repair palate A 010 094220F Digoxin thxpy for 6 mos/> I XXX 0942200 Reconstruct cleft palate A 090 0942205 Reconstruct cleft palate A 090 094221F Diuretic thxpy for 6 mos/> I XXX 0942210 Reconstruct cleft palate A 090 0942215 Reconstruct cleft palate A 090 0942220 Reconstruct cleft palate A 090 0942225 Reconstruct cleft palate A 090 0942226 Lengthening of palate A 090 0942227 Lengthening of palate A 090 0942235 Repair palate A 090 0942260 Repair nose to lip fistula A 090 0942280 Preparation palate mold A 010 0942281 Insertion palate prosthesis A 010 0942299 Palate/uvula surgery C YYY 094230F Anticonv thxpy for 6 mos/> I XXX 0942300 Drainage of salivary gland A 010 0942305 Drainage of salivary gland A 090 0942310 Drainage of salivary gland A 010 0942320 Drainage of salivary gland A 010 0942330 Removal of salivary stone A 010 0942335 Removal of salivary stone A 090 0942340 Removal of salivary stone A 090 094240F Instr xrcz back pain 12 wks I XXX 0942400 Biopsy of salivary gland A 000 0942405 Biopsy of salivary gland A 010 0942408 Excision of salivary cyst A 090 0942409 Drainage of salivary cyst A 090 0942410 Excise parotid gland/lesion A 090 0942415 Excise parotid gland/lesion A 090 094242F Sprvsd xrcz back pn >12 wks I XXX 0942420 Excise parotid gland/lesion A 090 0942425 Excise parotid gland/lesion A 090 0942426 Excise parotid gland/lesion A 090 0942440 Excise submaxillary gland A 090 094245F Pt instr nrml lifest I XXX 0942450 Excise sublingual gland A 090 094248F Pt instr no bd rest 4 days/> I XXX 094250F Wrmng 4 surg normothermia M XXX 0942500 Repair salivary duct A 090 0942505 Repair salivary duct A 090 0942507 Parotid duct diversion A 090 0942509 Parotid duct diversion A 090 0942510 Parotid duct diversion A 090 094255F Anesth 60 min/> as docd M XXX 09

42550 Injection for salivary x-ray A 000 094256F Anesthe <60 min as docd I XXX 094260F Wound srfc culturetech used I XXX 0942600 Closure of salivary fistula A 090 094261F Tech other than surfc cultr I XXX 094265F Wet-dry dressings rx recmd I XXX 0942650 Dilation of salivary duct A 000 094266F No wet-dry drssings rx recmd I XXX 0942660 Dilation of salivary duct A 000 0942665 Ligation of salivary duct A 090 094267F Comprssion thxpy prescribed I XXX 094268F Pt ed re comp thxpy rcvd I XXX 094269F Appropos mthd offloading rxd I XXX 0942699 Salivary surgery procedure C YYY 094270F Pt rcvng anti r-viral thxpy I XXX 0942700 Drainage of tonsil abscess A 010 094271F Pt rcvng anti r-viral thxpy I XXX 0942720 Drainage of throat abscess A 010 0942725 Drainage of throat abscess A 090 094274F Flu immuno admind rcvd I XXX 094276F Potent antivir thxpy rxd I XXX 094279F Pcp prophylaxis rxd I XXX 094280F Pcp prophylax rxd 3mon low % I XXX 0942800 Biopsy of throat A 010 0942804 Biopsy of upper nose/throat A 010 0942806 Biopsy of upper nose/throat A 010 0942808 Excise pharynx lesion A 010 0942809 Remove pharynx foreign body A 010 0942810 Excision of neck cyst A 090 0942815 Excision of neck cyst A 090 0942820 Remove tonsils and adenoids A 090 0942821 Remove tonsils and adenoids A 090 0942825 Removal of tonsils A 090 0942826 Removal of tonsils A 090 0942830 Removal of adenoids A 090 0942831 Removal of adenoids A 090 0942835 Removal of adenoids A 090 0942836 Removal of adenoids A 090 0942842 Extensive surgery of throat A 090 0942844 Extensive surgery of throat A 090 0942845 Extensive surgery of throat A 090 0942860 Excision of tonsil tags A 090 0942870 Excision of lingual tonsil A 090 0942890 Partial removal of pharynx A 090 0942892 Revision of pharyngeal walls A 090 0942894 Revision of pharyngeal walls A 090 094290F Pt scrned for inj drug use I XXX 0942900 Repair throat wound A 010 094293F Pt scrnd hgh-risk sex behav I XXX 0942950 Reconstruction of throat A 090 09

42953 Repair throat esophagus A 090 0942955 Surgical opening of throat A 090 0942960 Control throat bleeding A 010 0942961 Control throat bleeding A 090 0942962 Control throat bleeding A 090 0942970 Control nose/throat bleeding A 090 0942971 Control nose/throat bleeding A 090 0942972 Control nose/throat bleeding A 090 0942999 Throat surgery procedure C YYY 094300F Pt rcvng warf thxpy I XXX 094301F Pt not rcvng warf thxpy I XXX 0943020 Incision of esophagus A 090 0943030 Throat muscle surgery A 090 0943045 Incision of esophagus A 090 094305F Pt ed re ft care inspct rcvd I XXX 094306F Pt tlk psych & rx opd addic I XXX 0943100 Excision of esophagus lesion A 090 0943101 Excision of esophagus lesion A 090 0943107 Removal of esophagus A 090 0943108 Removal of esophagus A 090 0943112 Removal of esophagus A 090 0943113 Removal of esophagus A 090 0943116 Partial removal of esophagus A 090 0943117 Partial removal of esophagus A 090 0943118 Partial removal of esophagus A 090 0943121 Partial removal of esophagus A 090 0943122 Partial removal of esophagus A 090 0943123 Partial removal of esophagus A 090 0943124 Removal of esophagus A 090 0943130 Removal of esophagus pouch A 090 0943135 Removal of esophagus pouch A 090 0943180 Esophagoscopy rigid trnso A 090 0943191 Esophagoscopy rigid trnso dx A 000 0943192 Esophagoscp rig trnso inject A 000 0943193 Esophagoscp rig trnso biopsy A 000 0943194 Esophagoscp rig trnso rem fb A 000 0943195 Esophagoscopy rigid balloon A 000 0943196 Esophagoscp guide wire dilat A 000 0943197 Esophagoscopy flex dx brush A 000 0943198 Esophagosc flex trnsn biopsy A 000 094320F Pt talk psychsoc&rx oh dpnd I XXX 0943200 Esophagoscopy flexible brush A 000 0943201 Esoph scope w/submucous inj A 000 0943202 Esophagoscopy flex biopsy A 000 0943204 Esoph scope w/sclerosis inj A 000 0943205 Esophagus endoscopy/ligation A 000 0943206 Esoph optical endomicroscopy A 000 0943211 Esophagoscop mucosal resect A 000 0943212 Esophagoscop stent placement A 000 0943213 Esophagoscopy retro balloon A 000 09

43214 Esophagosc dilate balloon 30 A 000 0943215 Esophagoscopy flex remove fb A 000 0943216 Esophagoscopy lesion removal A 000 0943217 Esophagoscopy snare les remv A 000 094322F Crgvr prov w/ ed addl rsrcs M XXX 0943220 Esophagoscopy balloon <30mm A 000 0943226 Esoph endoscopy dilation A 000 0943227 Esophagoscopy control bleed A 000 0943229 Esophagoscopy lesion ablate A 000 0943231 Esophagoscop ultrasound exam A 000 0943232 Esophagoscopy w/us needle bx A 000 0943233 Egd balloon dil esoph30 mm/> A 000 0943235 Egd diagnostic brush wash A 000 0943236 Uppr gi scope w/submuc inj A 000 0943237 Endoscopic us exam esoph A 000 0943238 Egd us fine needle bx/aspir A 000 0943239 Egd biopsy single/multiple A 000 094324F Pt queried prkns complic I XXX 0943240 Egd w/transmural drain cyst A 000 0943241 Egd tube/cath insertion A 000 0943242 Egd us fine needle bx/aspir A 000 0943243 Egd injection varices A 000 0943244 Egd varices ligation A 000 0943245 Egd dilate stricture A 000 0943246 Egd place gastrostomy tube A 000 0943247 Egd remove foreign body A 000 0943248 Egd guide wire insertion A 000 0943249 Esoph egd dilation <30 mm A 000 094325F Med txmnt options rvwd w/pt M XXX 0943250 Egd cautery tumor polyp A 000 0943251 Egd remove lesion snare A 000 0943252 Egd optical endomicroscopy A 000 0943253 Egd us transmural injxn/mark A 000 0943254 Egd endo mucosal resection A 000 0943255 Egd control bleeding any A 000 0943257 Egd w/thrml txmnt gerd A 000 0943259 Egd us exam duodenum/jejunum A 000 094326F Pt asked re symp auto dysfxn I XXX 0943260 Ercp w/specimen collection A 000 0943261 Endo cholangiopancreatograph A 000 0943262 Endo cholangiopancreatograph A 000 0943263 Ercp sphincter pressure meas A 000 0943264 Ercp remove duct calculi A 000 0943265 Ercp lithotripsy calculi A 000 0943266 Egd endoscopic stent place A 000 0943270 Egd lesion ablation A 000 0943273 Endoscopic pancreatoscopy A ZZZ 0943274 Ercp duct stent placement A 000 0943275 Ercp remove forgn body duct A 000 0943276 Ercp stent exchange w/dilate A 000 09

43277 Ercp ea duct/ampulla dilate A 000 0943278 Ercp lesion ablate w/dilate A 000 0943279 Lap myotomy heller A 090 094328F Pt asked re sleep disturb M XXX 0943280 Laparoscopy fundoplasty A 090 0943281 Lap paraesophag hern repair A 090 0943282 Lap paraesoph her rpr w/mesh A 090 0943283 Lap esoph lengthening A ZZZ 0943289 Laparoscope proc esoph C YYY 094330F Cnslng epi spec sfty issues I XXX 0943300 Repair of esophagus A 090 0943305 Repair esophagus and fistula A 090 0943310 Repair of esophagus A 090 0943312 Repair esophagus and fistula A 090 0943313 Esophagoplasty congenital A 090 0943314 Tracheo-esophagoplasty cong A 090 0943320 Fuse esophagus & stomach A 090 0943325 Revise esophagus & stomach A 090 0943327 Esoph fundoplasty lap A 090 0943328 Esoph fundoplasty thor A 090 0943330 Esophagomyotomy abdominal A 090 0943331 Esophagomyotomy thoracic A 090 0943332 Transab esoph hiat hern rpr A 090 0943333 Transab esoph hiat hern rpr A 090 0943334 Transthor diaphrag hern rpr A 090 0943335 Transthor diaphrag hern rpr A 090 0943336 Thorabd diaphr hern repair A 090 0943337 Thorabd diaphr hern repair A 090 0943338 Esoph lengthening A ZZZ 0943340 Fuse esophagus & intestine A 090 0943341 Fuse esophagus & intestine A 090 0943351 Surgical opening esophagus A 090 0943352 Surgical opening esophagus A 090 0943360 Gastrointestinal repair A 090 0943361 Gastrointestinal repair A 090 094340F Cnslng chldbrng women epi M XXX 0943400 Ligate esophagus veins A 090 0943401 Esophagus surgery for veins A 090 0943405 Ligate/staple esophagus A 090 0943410 Repair esophagus wound A 090 0943415 Repair esophagus wound A 090 0943420 Repair esophagus opening A 090 0943425 Repair esophagus opening A 090 0943450 Dilate esophagus 1/mult pass A 000 0943453 Dilate esophagus A 000 0943460 Pressure treatment esophagus A 000 0943496 Free jejunum flap microvasc C 090 0943499 Esophagus surgery procedure C YYY 094350F Cnslng provided symp mngmnt I XXX 0943500 Surgical opening of stomach A 090 09

43501 Surgical repair of stomach A 090 0943502 Surgical repair of stomach A 090 0943510 Surgical opening of stomach A 090 0943520 Incision of pyloric muscle A 090 0943605 Biopsy of stomach A 090 0943610 Excision of stomach lesion A 090 0943611 Excision of stomach lesion A 090 0943620 Removal of stomach A 090 0943621 Removal of stomach A 090 0943622 Removal of stomach A 090 0943631 Removal of stomach partial A 090 0943632 Removal of stomach partial A 090 0943633 Removal of stomach partial A 090 0943634 Removal of stomach partial A 090 0943635 Removal of stomach partial A ZZZ 0943640 Vagotomy & pylorus repair A 090 0943641 Vagotomy & pylorus repair A 090 0943644 Lap gastric bypass/roux-en-y A 090 0943645 Lap gastr bypass incl smll i A 090 0943647 Lap impl electrode antrum C YYY 0943648 Lap revise/remv eltrd antrum C YYY 0943651 Laparoscopy vagus nerve A 090 0943652 Laparoscopy vagus nerve A 090 0943653 Laparoscopy gastrostomy A 090 0943659 Laparoscope proc stom C YYY 0943752 Nasal/orogastric w/tube plmt A 000 0943753 Tx gastro intub w/asp A 000 0943754 Dx gastr intub w/asp spec A 000 0943755 Dx gastr intub w/asp specs A 000 0943756 Dx duod intub w/asp spec A 000 0943757 Dx duod intub w/asp specs A 000 0943760 Change gastrostomy tube A 000 0943761 Reposition gastrostomy tube A 000 0943770 Lap place gastr adj device A 090 0943771 Lap revise gastr adj device A 090 0943772 Lap rmvl gastr adj device A 090 0943773 Lap replace gastr adj device A 090 0943774 Lap rmvl gastr adj all parts A 090 0943775 Lap sleeve gastrectomy C YYY 0943800 Reconstruction of pylorus A 090 0943810 Fusion of stomach and bowel A 090 0943820 Fusion of stomach and bowel A 090 0943825 Fusion of stomach and bowel A 090 0943830 Place gastrostomy tube A 090 0943831 Place gastrostomy tube A 090 0943832 Place gastrostomy tube A 090 0943840 Repair of stomach lesion A 090 0943842 V-band gastroplasty N 090 0943843 Gastroplasty w/o v-band A 090 0943845 Gastroplasty duodenal switch A 090 09

43846 Gastric bypass for obesity A 090 0943847 Gastric bypass incl small i A 090 0943848 Revision gastroplasty A 090 0943850 Revise stomach-bowel fusion A 090 0943855 Revise stomach-bowel fusion A 090 0943860 Revise stomach-bowel fusion A 090 0943865 Revise stomach-bowel fusion A 090 0943870 Repair stomach opening A 090 0943880 Repair stomach-bowel fistula A 090 0943881 Impl/redo electrd antrum C YYY 0943882 Revise/remove electrd antrum C YYY 0943886 Revise gastric port open A 090 0943887 Remove gastric port open A 090 0943888 Change gastric port open A 090 0943999 Stomach surgery procedure C YYY 094400F Rehab thxpy options w/pt M XXX 0944005 Freeing of bowel adhesion A 090 0944010 Incision of small bowel A 090 0944015 Insert needle cath bowel A ZZZ 0944020 Explore small intestine A 090 0944021 Decompress small bowel A 090 0944025 Incision of large bowel A 090 0944050 Reduce bowel obstruction A 090 0944055 Correct malrotation of bowel A 090 0944100 Biopsy of bowel A 000 0944110 Excise intestine lesion(s) A 090 0944111 Excision of bowel lesion(s) A 090 0944120 Removal of small intestine A 090 0944121 Removal of small intestine A ZZZ 0944125 Removal of small intestine A 090 0944126 Enterectomy w/o taper cong A 090 0944127 Enterectomy w/taper cong A 090 0944128 Enterectomy cong add-on A ZZZ 0944130 Bowel to bowel fusion A 090 0944132 Enterectomy cadaver donor R XXX 0944133 Enterectomy live donor R XXX 0944135 Intestine transplnt cadaver R XXX 0944136 Intestine transplant live R XXX 0944137 Remove intestinal allograft C XXX 0944139 Mobilization of colon A ZZZ 0944140 Partial removal of colon A 090 0944141 Partial removal of colon A 090 0944143 Partial removal of colon A 090 0944144 Partial removal of colon A 090 0944145 Partial removal of colon A 090 0944146 Partial removal of colon A 090 0944147 Partial removal of colon A 090 0944150 Removal of colon A 090 0944151 Removal of colon/ileostomy A 090 0944155 Removal of colon/ileostomy A 090 09

44156 Removal of colon/ileostomy A 090 0944157 Colectomy w/ileoanal anast A 090 0944158 Colectomy w/neo-rectum pouch A 090 0944160 Removal of colon A 090 0944180 Lap enterolysis A 090 0944186 Lap jejunostomy A 090 0944187 Lap ileo/jejuno-stomy A 090 0944188 Lap colostomy A 090 0944202 Lap enterectomy A 090 0944203 Lap resect s/intestine addl A ZZZ 0944204 Laparo partial colectomy A 090 0944205 Lap colectomy part w/ileum A 090 0944206 Lap part colectomy w/stoma A 090 0944207 L colectomy/coloproctostomy A 090 0944208 L colectomy/coloproctostomy A 090 0944210 Laparo total proctocolectomy A 090 0944211 Lap colectomy w/proctectomy A 090 0944212 Laparo total proctocolectomy A 090 0944213 Lap mobil splenic fl add-on A ZZZ 0944227 Lap close enterostomy A 090 0944238 Laparoscope proc intestine C YYY 0944300 Open bowel to skin A 090 0944310 Ileostomy/jejunostomy A 090 0944312 Revision of ileostomy A 090 0944314 Revision of ileostomy A 090 0944316 Devise bowel pouch A 090 0944320 Colostomy A 090 0944322 Colostomy with biopsies A 090 0944340 Revision of colostomy A 090 0944345 Revision of colostomy A 090 0944346 Revision of colostomy A 090 0944360 Small bowel endoscopy A 000 0944361 Small bowel endoscopy/biopsy A 000 0944363 Small bowel endoscopy A 000 0944364 Small bowel endoscopy A 000 0944365 Small bowel endoscopy A 000 0944366 Small bowel endoscopy A 000 0944369 Small bowel endoscopy A 000 0944370 Small bowel endoscopy/stent A 000 0944372 Small bowel endoscopy A 000 0944373 Small bowel endoscopy A 000 0944376 Small bowel endoscopy A 000 0944377 Small bowel endoscopy/biopsy A 000 0944378 Small bowel endoscopy A 000 0944379 S bowel endoscope w/stent A 000 0944380 Small bowel endoscopy br/wa A 000 0944381 Small bowel endoscopy br/wa I 000 0944382 Small bowel endoscopy A 000 0944384 Small bowel endoscopy I 000 0944385 Endoscopy of bowel pouch A 000 09

44386 Endoscopy bowel pouch/biop A 000 0944388 Colonoscopy thru stoma spx A 000 0944389 Colonoscopy with biopsy A 000 0944390 Colonoscopy for foreign body A 000 0944391 Colonoscopy for bleeding A 000 0944392 Colonoscopy & polypectomy A 000 0944394 Colonoscopy w/snare A 000 0944401 Colonoscopy with ablation I 000 0944402 Colonoscopy w/stent plcmt I 000 0944403 Colonoscopy w/resection I 000 0944404 Colonoscopy w/injection I 000 0944405 Colonoscopy w/dilation I 000 0944406 Colonoscopy w/ultrasound I 000 0944407 Colonoscopy w/ndl aspir/bx I 000 0944408 Colonoscopy w/decompression I 000 094450F Self-care ed provided to pt I XXX 0944500 Intro gastrointestinal tube A 000 0944602 Suture small intestine A 090 0944603 Suture small intestine A 090 0944604 Suture large intestine A 090 0944605 Repair of bowel lesion A 090 0944615 Intestinal stricturoplasty A 090 0944620 Repair bowel opening A 090 0944625 Repair bowel opening A 090 0944626 Repair bowel opening A 090 0944640 Repair bowel-skin fistula A 090 0944650 Repair bowel fistula A 090 0944660 Repair bowel-bladder fistula A 090 0944661 Repair bowel-bladder fistula A 090 0944680 Surgical revision intestine A 090 094470F Icd counseling provided I XXX 0944700 Suspend bowel w/prosthesis A 090 0944701 Intraop colon lavage add-on A ZZZ 0944705 Prepare fecal microbiota I XXX 0944715 Prepare donor intestine C XXX 0944720 Prep donor intestine/venous A XXX 0944721 Prep donor intestine/artery A XXX 0944799 Unlisted px small intestine I XXX 094480F Pt rcvng ace/arb b-blockertx I XXX 0944800 Excision of bowel pouch A 090 094481F Pt rcvng ace/arb blker >3mos I XXX 0944820 Excision of mesentery lesion A 090 0944850 Repair of mesentery A 090 0944899 Bowel surgery procedure C YYY 0944900 Drain appendix abscess open A 090 0944950 Appendectomy A 090 0944955 Appendectomy add-on A ZZZ 0944960 Appendectomy A 090 0944970 Laparoscopy appendectomy A 090 0944979 Laparoscope proc app C YYY 09

4500F Ref to outpt card rehab prog M XXX 0945000 Drainage of pelvic abscess A 090 0945005 Drainage of rectal abscess A 010 0945020 Drainage of rectal abscess A 090 094510F Prev cardrehab qualcardevent M XXX 0945100 Biopsy of rectum A 090 0945108 Removal of anorectal lesion A 090 0945110 Removal of rectum A 090 0945111 Partial removal of rectum A 090 0945112 Removal of rectum A 090 0945113 Partial proctectomy A 090 0945114 Partial removal of rectum A 090 0945116 Partial removal of rectum A 090 0945119 Remove rectum w/reservoir A 090 0945120 Removal of rectum A 090 0945121 Removal of rectum and colon A 090 0945123 Partial proctectomy A 090 0945126 Pelvic exenteration A 090 0945130 Excision of rectal prolapse A 090 0945135 Excision of rectal prolapse A 090 0945136 Excise ileoanal reservior A 090 0945150 Excision of rectal stricture A 090 0945160 Excision of rectal lesion A 090 0945171 Exc rect tum transanal part A 090 0945172 Exc rect tum transanal full A 090 0945190 Destruction rectal tumor A 090 094525F Neuropsychia interven order M XXX 094526F Neuropsychia interven rcvd M XXX 0945300 Proctosigmoidoscopy dx A 000 0945303 Proctosigmoidoscopy dilate A 000 0945305 Proctosigmoidoscopy w/bx A 000 0945307 Proctosigmoidoscopy fb A 000 0945308 Proctosigmoidoscopy removal A 000 0945309 Proctosigmoidoscopy removal A 000 0945315 Proctosigmoidoscopy removal A 000 0945317 Proctosigmoidoscopy bleed A 000 0945320 Proctosigmoidoscopy ablate A 000 0945321 Proctosigmoidoscopy volvul A 000 0945327 Proctosigmoidoscopy w/stent A 000 0945330 Diagnostic sigmoidoscopy A 000 0945331 Sigmoidoscopy and biopsy A 000 0945332 Sigmoidoscopy w/fb removal A 000 0945333 Sigmoidoscopy & polypectomy A 000 0945334 Sigmoidoscopy for bleeding A 000 0945335 Sigmoidoscopy w/submuc inj A 000 0945337 Sigmoidoscopy & decompress A 000 0945338 Sigmoidoscopy w/tumr remove A 000 0945340 Sig w/tndsc balloon dilation A 000 0945341 Sigmoidoscopy w/ultrasound A 000 0945342 Sigmoidoscopy w/us guide bx A 000 09

45346 Sigmoidoscopy w/ablation I 000 0945347 Sigmoidoscopy w/plcmt stent I 000 0945349 Sigmoidoscopy w/resection I 000 0945350 Sgmdsc w/band ligation I 000 0945378 Diagnostic colonoscopy A 000 0945378 53 Diagnostic colonoscopy A 000 0945379 Colonoscopy w/fb removal A 000 0945380 Colonoscopy and biopsy A 000 0945381 Colonoscopy submucous njx A 000 0945382 Colonoscopy w/control bleed A 000 0945384 Colonoscopy w/lesion removal A 000 0945385 Colonoscopy w/lesion removal A 000 0945386 Colonoscopy w/balloon dilat A 000 0945388 Colonoscopy w/ablation I 000 0945389 Colonoscopy w/stent plcmt I 000 0945390 Colonoscopy w/resection I 000 0945391 Colonoscopy w/endoscope us A 000 0945392 Colonoscopy w/endoscopic fnb A 000 0945393 Colonoscopy w/decompression I 000 0945395 Lap removal of rectum A 090 0945397 Lap remove rectum w/pouch A 090 0945398 Colonoscopy w/band ligation I 000 0945399 Unlisted procedure colon I XXX 094540F Disease modif pharmacothxpy I XXX 0945400 Laparoscopic proc A 090 0945402 Lap proctopexy w/sig resect A 090 094541F Pt offered tx for pseudobulb I XXX 0945499 Laparoscope proc rectum C YYY 094550F Noninvas resp support talk I XXX 0945500 Repair of rectum A 090 0945505 Repair of rectum A 090 094551F Nutritional support offered I XXX 094552F Pt ref for speech lang path I XXX 0945520 Treatment of rectal prolapse A 000 094553F Pt asst re end life issues I XXX 094554F Pt recvd inhal anesthetic I XXX 0945540 Correct rectal prolapse A 090 0945541 Correct rectal prolapse A 090 094555F Pt recvd no inhal anesthic I XXX 0945550 Repair rectum/remove sigmoid A 090 094556F Pt w/ 3+ post-op nausea&vom I XXX 0945560 Repair of rectocele A 090 0945562 Exploration/repair of rectum A 090 0945563 Exploration/repair of rectum A 090 094557F Pt w/o 3+ post-opnausea&vom I XXX 094558F Pt recvd 2 rx anti-emet agt I XXX 094559F 1 bodytemp >=35.5cw/in 30min I XXX 094560F Anesth w/o gen/neurax anesth I XXX 094561F Pt w/ coronary artery stent I XXX 094562F Pt w/o coronary artery stent I XXX 09

4563F Pt recvd aspirin w/in 24 hrs I XXX 0945800 Repair rect/bladder fistula A 090 0945805 Repair fistula w/colostomy A 090 0945820 Repair rectourethral fistula A 090 0945825 Repair fistula w/colostomy A 090 0945900 Reduction of rectal prolapse A 010 0945905 Dilation of anal sphincter A 010 0945910 Dilation of rectal narrowing A 010 0945915 Remove rectal obstruction A 010 0945990 Surg dx exam anorectal A 000 0945999 Rectum surgery procedure C YYY 0946020 Placement of seton A 010 0946030 Removal of rectal marker A 010 0946040 Incision of rectal abscess A 090 0946045 Incision of rectal abscess A 090 0946050 Incision of anal abscess A 010 0946060 Incision of rectal abscess A 090 0946070 Incision of anal septum A 090 0946080 Incision of anal sphincter A 010 0946083 Incise external hemorrhoid A 010 0946200 Removal of anal fissure A 090 0946220 Excise anal ext tag/papilla A 010 0946221 Ligation of hemorrhoid(s) A 010 0946230 Removal of anal tags A 010 0946250 Remove ext hem groups 2+ A 090 0946255 Remove int/ext hem 1 group A 090 0946257 Remove in/ex hem grp & fiss A 090 0946258 Remove in/ex hem grp w/fistu A 090 0946260 Remove in/ex hem groups 2+ A 090 0946261 Remove in/ex hem grps & fiss A 090 0946262 Remove in/ex hem grps w/fist A 090 0946270 Remove anal fist subq A 090 0946275 Remove anal fist inter A 090 0946280 Remove anal fist complex A 090 0946285 Remove anal fist 2 stage A 090 0946288 Repair anal fistula A 090 0946320 Removal of hemorrhoid clot A 010 0946500 Injection into hemorrhoid(s) A 010 0946505 Chemodenervation anal musc A 010 0946600 Diagnostic anoscopy spx A 000 0946601 Diagnostic anoscopy I 000 0946604 Anoscopy and dilation A 000 0946606 Anoscopy and biopsy A 000 0946607 Diagnostic anoscopy & biopsy I 000 0946608 Anoscopy remove for body A 000 0946610 Anoscopy remove lesion A 000 0946611 Anoscopy A 000 0946612 Anoscopy remove lesions A 000 0946614 Anoscopy control bleeding A 000 0946615 Anoscopy A 000 09

46700 Repair of anal stricture A 090 0946705 Repair of anal stricture A 090 0946706 Repr of anal fistula w/glue A 010 0946707 Repair anorectal fist w/plug A 090 0946710 Repr per/vag pouch sngl proc A 090 0946712 Repr per/vag pouch dbl proc A 090 0946715 Rep perf anoper fistu A 090 0946716 Rep perf anoper/vestib fistu A 090 0946730 Construction of absent anus A 090 0946735 Construction of absent anus A 090 0946740 Construction of absent anus A 090 0946742 Repair of imperforated anus A 090 0946744 Repair of cloacal anomaly A 090 0946746 Repair of cloacal anomaly A 090 0946748 Repair of cloacal anomaly A 090 0946750 Repair of anal sphincter A 090 0946751 Repair of anal sphincter A 090 0946753 Reconstruction of anus A 090 0946754 Removal of suture from anus A 010 0946760 Repair of anal sphincter A 090 0946761 Repair of anal sphincter A 090 0946762 Implant artificial sphincter A 090 0946900 Destruction anal lesion(s) A 010 0946910 Destruction anal lesion(s) A 010 0946916 Cryosurgery anal lesion(s) A 010 0946917 Laser surgery anal lesions A 010 0946922 Excision of anal lesion(s) A 010 0946924 Destruction anal lesion(s) A 010 0946930 Destroy internal hemorrhoids A 090 0946940 Treatment of anal fissure A 010 0946942 Treatment of anal fissure A 010 0946945 Remove by ligat int hem grp A 090 0946946 Remove by ligat int hem grps A 090 0946947 Hemorrhoidopexy by stapling A 090 0946999 Anus surgery procedure C YYY 0947000 Needle biopsy of liver A 000 0947001 Needle biopsy liver add-on A ZZZ 0947010 Open drainage liver lesion A 090 0947015 Inject/aspirate liver cyst A 090 0947100 Wedge biopsy of liver A 090 0947120 Partial removal of liver A 090 0947122 Extensive removal of liver A 090 0947125 Partial removal of liver A 090 0947130 Partial removal of liver A 090 0947133 Removal of donor liver X XXX 0947135 Transplantation of liver R 090 0947136 Transplantation of liver R 090 0947140 Partial removal donor liver A 090 0947141 Partial removal donor liver A 090 0947142 Partial removal donor liver A 090 09

47143 Prep donor liver whole C XXX 0947144 Prep donor liver 3-segment C 090 0947145 Prep donor liver lobe split C XXX 0947146 Prep donor liver/venous A XXX 0947147 Prep donor liver/arterial A XXX 0947300 Surgery for liver lesion A 090 0947350 Repair liver wound A 090 0947360 Repair liver wound A 090 0947361 Repair liver wound A 090 0947362 Repair liver wound A 090 0947370 Laparo ablate liver tumor rf A 090 0947371 Laparo ablate liver cryosurg A 090 0947379 Laparoscope procedure liver C YYY 0947380 Open ablate liver tumor rf A 090 0947381 Open ablate liver tumor cryo A 090 0947382 Percut ablate liver rf A 010 0947383 Perq abltj lvr cryoablation A 010 0947399 Liver surgery procedure C YYY 0947400 Incision of liver duct A 090 0947420 Incision of bile duct A 090 0947425 Incision of bile duct A 090 0947460 Incise bile duct sphincter A 090 0947480 Incision of gallbladder A 090 0947490 Incision of gallbladder A 010 0947500 Injection for liver x-rays A 000 0947505 Injection for liver x-rays A 000 0947510 Insert catheter bile duct A 090 0947511 Insert bile duct drain A 090 0947525 Change bile duct catheter A 000 0947530 Revise/reinsert bile tube A 090 0947550 Bile duct endoscopy add-on A ZZZ 0947552 Biliary endo perq dx w/speci A 000 0947553 Biliary endoscopy thru skin A 000 0947554 Biliary endoscopy thru skin A 000 0947555 Biliary endoscopy thru skin A 000 0947556 Biliary endoscopy thru skin A 000 0947560 Laparoscopy w/cholangio A 000 0947561 Laparo w/cholangio/biopsy A 000 0947562 Laparoscopic cholecystectomy A 090 0947563 Laparo cholecystectomy/graph A 090 0947564 Laparo cholecystectomy/explr A 090 0947570 Laparo cholecystoenterostomy A 090 0947579 Laparoscope proc biliary C YYY 0947600 Removal of gallbladder A 090 0947605 Removal of gallbladder A 090 0947610 Removal of gallbladder A 090 0947612 Removal of gallbladder A 090 0947620 Removal of gallbladder A 090 0947630 Remove bile duct stone A 090 0947700 Exploration of bile ducts A 090 09

47701 Bile duct revision A 090 0947711 Excision of bile duct tumor A 090 0947712 Excision of bile duct tumor A 090 0947715 Excision of bile duct cyst A 090 0947720 Fuse gallbladder & bowel A 090 0947721 Fuse upper gi structures A 090 0947740 Fuse gallbladder & bowel A 090 0947741 Fuse gallbladder & bowel A 090 0947760 Fuse bile ducts and bowel A 090 0947765 Fuse liver ducts & bowel A 090 0947780 Fuse bile ducts and bowel A 090 0947785 Fuse bile ducts and bowel A 090 0947800 Reconstruction of bile ducts A 090 0947801 Placement bile duct support A 090 0947802 Fuse liver duct & intestine A 090 0947900 Suture bile duct injury A 090 0947999 Bile tract surgery procedure C YYY 0948000 Drainage of abdomen A 090 0948001 Placement of drain pancreas A 090 0948020 Removal of pancreatic stone A 090 0948100 Biopsy of pancreas open A 090 0948102 Needle biopsy pancreas A 010 0948105 Resect/debride pancreas A 090 0948120 Removal of pancreas lesion A 090 0948140 Partial removal of pancreas A 090 0948145 Partial removal of pancreas A 090 0948146 Pancreatectomy A 090 0948148 Removal of pancreatic duct A 090 0948150 Partial removal of pancreas A 090 0948152 Pancreatectomy A 090 0948153 Pancreatectomy A 090 0948154 Pancreatectomy A 090 0948155 Removal of pancreas A 090 0948160 Pancreas removal/transplant N XXX 0948400 Injection intraop add-on A ZZZ 0948500 Surgery of pancreatic cyst A 090 0948510 Drain pancreatic pseudocyst A 090 0948520 Fuse pancreas cyst and bowel A 090 0948540 Fuse pancreas cyst and bowel A 090 0948545 Pancreatorrhaphy A 090 0948547 Duodenal exclusion A 090 0948548 Fuse pancreas and bowel A 090 0948550 Donor pancreatectomy X XXX 0948551 Prep donor pancreas C XXX 0948552 Prep donor pancreas/venous A XXX 0948554 Transpl allograft pancreas R 090 0948556 Removal allograft pancreas A 090 0948999 Pancreas surgery procedure C YYY 0949000 Exploration of abdomen A 090 0949002 Reopening of abdomen A 090 09

49010 Exploration behind abdomen A 090 0949020 Drainage abdom abscess open A 090 0949040 Drain open abdom abscess A 090 0949060 Drain open retroperi abscess A 090 0949062 Drain to peritoneal cavity A 090 0949082 Abd paracentesis A 000 0949083 Abd paracentesis w/imaging A 000 0949084 Peritoneal lavage A 000 0949180 Biopsy abdominal mass A 000 0949203 Exc abd tum 5 cm or less A 090 0949204 Exc abd tum over 5 cm A 090 0949205 Exc abd tum over 10 cm A 090 0949215 Excise sacral spine tumor A 090 0949220 Multiple surgery abdomen A 090 0949250 Excision of umbilicus A 090 0949255 Removal of omentum A 090 0949320 Diag laparo separate proc A 010 0949321 Laparoscopy biopsy A 010 0949322 Laparoscopy aspiration A 010 0949323 Laparo drain lymphocele A 090 0949324 Lap insert tunnel ip cath A 010 0949325 Lap revision perm ip cath A 010 0949326 Lap w/omentopexy add-on A ZZZ 0949327 Lap ins device for rt A ZZZ 0949329 Laparo proc abdm/per/oment C YYY 0949400 Air injection into abdomen A 000 0949402 Remove foreign body adbomen A 090 0949405 Image cath fluid colxn visc A 000 0949406 Image cath fluid peri/retro A 000 0949407 Image cath fluid trns/vgnl A 000 0949411 Ins mark abd/pel for rt perq A 000 0949412 Ins device for rt guide open A ZZZ 0949418 Insert tun ip cath perc A 000 0949419 Insert tun ip cath w/port A 090 0949421 Ins tun ip cath for dial opn A 000 0949422 Remove tunneled ip cath A 010 0949423 Exchange drainage catheter A 000 0949424 Assess cyst contrast inject A 000 0949425 Insert abdomen-venous drain A 090 0949426 Revise abdomen-venous shunt A 090 0949427 Injection abdominal shunt A 000 0949428 Ligation of shunt A 010 0949429 Removal of shunt A 010 0949435 Insert subq exten to ip cath A ZZZ 0949436 Embedded ip cath exit-site A 010 0949440 Place gastrostomy tube perc A 010 0949441 Place duod/jej tube perc A 010 0949442 Place cecostomy tube perc A 010 0949446 Change g-tube to g-j perc A 000 0949450 Replace g/c tube perc A 000 09

49451 Replace duod/jej tube perc A 000 0949452 Replace g-j tube perc A 000 0949460 Fix g/colon tube w/device A 000 0949465 Fluoro exam of g/colon tube A 000 0949491 Rpr hern preemie reduc A 090 0949492 Rpr ing hern premie blocked A 090 0949495 Rpr ing hernia baby reduc A 090 0949496 Rpr ing hernia baby blocked A 090 0949500 Rpr ing hernia init reduce A 090 0949501 Rpr ing hernia init blocked A 090 0949505 Prp i/hern init reduc >5 yr A 090 0949507 Prp i/hern init block >5 yr A 090 0949520 Rerepair ing hernia reduce A 090 0949521 Rerepair ing hernia blocked A 090 0949525 Repair ing hernia sliding A 090 0949540 Repair lumbar hernia A 090 0949550 Rpr rem hernia init reduce A 090 0949553 Rpr fem hernia init blocked A 090 0949555 Rerepair fem hernia reduce A 090 0949557 Rerepair fem hernia blocked A 090 0949560 Rpr ventral hern init reduc A 090 0949561 Rpr ventral hern init block A 090 0949565 Rerepair ventrl hern reduce A 090 0949566 Rerepair ventrl hern block A 090 0949568 Hernia repair w/mesh A ZZZ 0949570 Rpr epigastric hern reduce A 090 0949572 Rpr epigastric hern blocked A 090 0949580 Rpr umbil hern reduc < 5 yr A 090 0949582 Rpr umbil hern block < 5 yr A 090 0949585 Rpr umbil hern reduc > 5 yr A 090 0949587 Rpr umbil hern block > 5 yr A 090 0949590 Repair spigelian hernia A 090 0949600 Repair umbilical lesion A 090 0949605 Repair umbilical lesion A 090 0949606 Repair umbilical lesion A 090 0949610 Repair umbilical lesion A 090 0949611 Repair umbilical lesion A 090 0949650 Lap ing hernia repair init A 090 0949651 Lap ing hernia repair recur A 090 0949652 Lap vent/abd hernia repair A 090 0949653 Lap vent/abd hern proc comp A 090 0949654 Lap inc hernia repair A 090 0949655 Lap inc hern repair comp A 090 0949656 Lap inc hernia repair recur A 090 0949657 Lap inc hern recur comp A 090 0949659 Laparo proc hernia repair C YYY 0949900 Repair of abdominal wall A 090 0949904 Omental flap extra-abdom A 090 0949905 Omental flap intra-abdom A ZZZ 0949906 Free omental flap microvasc C 090 09

49999 Abdomen surgery procedure C YYY 0950010 Exploration of kidney A 090 0950020 Renal abscess open drain A 090 0950040 Drainage of kidney A 090 0950045 Exploration of kidney A 090 095005F Pt counsld on exam for moles I XXX 0950060 Removal of kidney stone A 090 0950065 Incision of kidney A 090 0950070 Incision of kidney A 090 0950075 Removal of kidney stone A 090 0950080 Removal of kidney stone A 090 0950081 Removal of kidney stone A 090 095010F Macul result phy/qhp mng dm M XXX 0950100 Revise kidney blood vessels A 090 0950120 Exploration of kidney A 090 0950125 Explore and drain kidney A 090 0950130 Removal of kidney stone A 090 0950135 Exploration of kidney A 090 095015F Doc fx & test/txmnt for op M XXX 095020F Txmnts 2 phys/qhp by 1 mon I XXX 0950200 Renal biopsy perq A 000 0950205 Renal biopsy open A 090 0950220 Remove kidney open A 090 0950225 Removal kidney open complex A 090 0950230 Removal kidney open radical A 090 0950234 Removal of kidney & ureter A 090 0950236 Removal of kidney & ureter A 090 0950240 Partial removal of kidney A 090 0950250 Cryoablate renal mass open A 090 0950280 Removal of kidney lesion A 090 0950290 Removal of kidney lesion A 090 0950300 Remove cadaver donor kidney X XXX 0950320 Remove kidney living donor A 090 0950323 Prep cadaver renal allograft C XXX 0950325 Prep donor renal graft C XXX 0950327 Prep renal graft/venous A XXX 0950328 Prep renal graft/arterial A XXX 0950329 Prep renal graft/ureteral A XXX 0950340 Removal of kidney A 090 0950360 Transplantation of kidney A 090 0950365 Transplantation of kidney A 090 0950370 Remove transplanted kidney A 090 0950380 Reimplantation of kidney A 090 0950382 Change ureter stent percut A 000 0950384 Remove ureter stent percut A 000 0950385 Change stent via transureth A 000 0950386 Remove stent via transureth A 000 0950387 Change ext/int ureter stent A 000 0950389 Remove renal tube w/fluoro A 000 0950390 Drainage of kidney lesion A 000 09

50391 Instll rx agnt into rnal tub A 000 0950392 Insert kidney drain A 000 0950393 Insert ureteral tube A 000 0950394 Injection for kidney x-ray A 000 0950395 Create passage to kidney A 000 0950396 Measure kidney pressure A 000 0950398 Change kidney tube A 000 0950400 Revision of kidney/ureter A 090 0950405 Revision of kidney/ureter A 090 095050F Plan 2 main dr by 1 month M XXX 0950500 Repair of kidney wound A 090 0950520 Close kidney-skin fistula A 090 0950525 Repair renal-abdomen fistula A 090 0950526 Repair renal-abdomen fistula A 090 0950540 Revision of horseshoe kidney A 090 0950541 Laparo ablate renal cyst A 090 0950542 Laparo ablate renal mass A 090 0950543 Laparo partial nephrectomy A 090 0950544 Laparoscopy pyeloplasty A 090 0950545 Laparo radical nephrectomy A 090 0950546 Laparoscopic nephrectomy A 090 0950547 Laparo removal donor kidney A 090 0950548 Laparo remove w/ureter A 090 0950549 Laparoscope proc renal C YYY 0950551 Kidney endoscopy A 000 0950553 Kidney endoscopy A 000 0950555 Kidney endoscopy & biopsy A 000 0950557 Kidney endoscopy & treatment A 000 0950561 Kidney endoscopy & treatment A 000 0950562 Renal scope w/tumor resect A 090 0950570 Kidney endoscopy A 000 0950572 Kidney endoscopy A 000 0950574 Kidney endoscopy & biopsy A 000 0950575 Kidney endoscopy A 000 0950576 Kidney endoscopy & treatment A 000 0950580 Kidney endoscopy & treatment A 000 0950590 Fragmenting of kidney stone A 090 0950592 Perc rf ablate renal tumor A 010 0950593 Perc cryo ablate renal tum A 010 095060F Fndngs mammo 2pt w/in 3 days I XXX 0950600 Exploration of ureter A 090 0950605 Insert ureteral support A 090 0950610 Removal of ureter stone A 090 095062F Mammo result com to pt 5 day I XXX 0950620 Removal of ureter stone A 090 0950630 Removal of ureter stone A 090 0950650 Removal of ureter A 090 0950660 Removal of ureter A 090 0950684 Injection for ureter x-ray A 000 0950686 Measure ureter pressure A 000 09

50688 Change of ureter tube/stent A 010 0950690 Injection for ureter x-ray A 000 0950700 Revision of ureter A 090 0950715 Release of ureter A 090 0950722 Release of ureter A 090 0950725 Release/revise ureter A 090 0950727 Revise ureter A 090 0950728 Revise ureter A 090 0950740 Fusion of ureter & kidney A 090 0950750 Fusion of ureter & kidney A 090 0950760 Fusion of ureters A 090 0950770 Splicing of ureters A 090 0950780 Reimplant ureter in bladder A 090 0950782 Reimplant ureter in bladder A 090 0950783 Reimplant ureter in bladder A 090 0950785 Reimplant ureter in bladder A 090 0950800 Implant ureter in bowel A 090 0950810 Fusion of ureter & bowel A 090 0950815 Urine shunt to intestine A 090 0950820 Construct bowel bladder A 090 0950825 Construct bowel bladder A 090 0950830 Revise urine flow A 090 0950840 Replace ureter by bowel A 090 0950845 Appendico-vesicostomy A 090 0950860 Transplant ureter to skin A 090 0950900 Repair of ureter A 090 0950920 Closure ureter/skin fistula A 090 0950930 Closure ureter/bowel fistula A 090 0950940 Release of ureter A 090 0950945 Laparoscopy ureterolithotomy A 090 0950947 Laparo new ureter/bladder A 090 0950948 Laparo new ureter/bladder A 090 0950949 Laparoscope proc ureter C YYY 0950951 Endoscopy of ureter A 000 0950953 Endoscopy of ureter A 000 0950955 Ureter endoscopy & biopsy A 000 0950957 Ureter endoscopy & treatment A 000 0950961 Ureter endoscopy & treatment A 000 0950970 Ureter endoscopy A 000 0950972 Ureter endoscopy & catheter A 000 0950974 Ureter endoscopy & biopsy A 000 0950976 Ureter endoscopy & treatment A 000 0950980 Ureter endoscopy & treatment A 000 095100F Rsk fx ref w/n 24 hrs xray I XXX 0951020 Incise & treat bladder A 090 0951030 Incise & treat bladder A 090 0951040 Incise & drain bladder A 090 0951045 Incise bladder/drain ureter A 090 0951050 Removal of bladder stone A 090 0951060 Removal of ureter stone A 090 09

51065 Remove ureter calculus A 090 0951080 Drainage of bladder abscess A 090 0951100 Drain bladder by needle A 000 0951101 Drain bladder by trocar/cath A 000 0951102 Drain bl w/cath insertion A 000 0951500 Removal of bladder cyst A 090 0951520 Removal of bladder lesion A 090 0951525 Removal of bladder lesion A 090 0951530 Removal of bladder lesion A 090 0951535 Repair of ureter lesion A 090 0951550 Partial removal of bladder A 090 0951555 Partial removal of bladder A 090 0951565 Revise bladder & ureter(s) A 090 0951570 Removal of bladder A 090 0951575 Removal of bladder & nodes A 090 0951580 Remove bladder/revise tract A 090 0951585 Removal of bladder & nodes A 090 0951590 Remove bladder/revise tract A 090 0951595 Remove bladder/revise tract A 090 0951596 Remove bladder/create pouch A 090 0951597 Removal of pelvic structures A 090 0951600 Injection for bladder x-ray A 000 0951605 Preparation for bladder xray A 000 0951610 Injection for bladder x-ray A 000 0951700 Irrigation of bladder A 000 0951701 Insert bladder catheter A 000 0951702 Insert temp bladder cath A 000 0951703 Insert bladder cath complex A 000 0951705 Change of bladder tube A 000 0951710 Change of bladder tube A 000 0951715 Endoscopic injection/implant A 000 0951720 Treatment of bladder lesion A 000 0951725 Simple cystometrogram A 000 0951725 TC Simple cystometrogram A 000 0251725 26 Simple cystometrogram A 000 0951726 Complex cystometrogram A 000 0951726 TC Complex cystometrogram A 000 0251726 26 Complex cystometrogram A 000 0951727 Cystometrogram w/up A 000 0951727 TC Cystometrogram w/up A 000 0251727 26 Cystometrogram w/up A 000 0951728 Cystometrogram w/vp A 000 0951728 TC Cystometrogram w/vp A 000 0251728 26 Cystometrogram w/vp A 000 0951729 Cystometrogram w/vp&up A 000 0951729 TC Cystometrogram w/vp&up A 000 0251729 26 Cystometrogram w/vp&up A 000 0951736 Urine flow measurement A XXX 0951736 TC Urine flow measurement A XXX 0251736 26 Urine flow measurement A XXX 09

51741 Electro-uroflowmetry first A XXX 0951741 TC Electro-uroflowmetry first A XXX 0251741 26 Electro-uroflowmetry first A XXX 0951784 Anal/urinary muscle study A 000 0951784 TC Anal/urinary muscle study A 000 0251784 26 Anal/urinary muscle study A 000 0951785 Anal/urinary muscle study A 000 0951785 TC Anal/urinary muscle study A 000 0351785 26 Anal/urinary muscle study A 000 0951792 Urinary reflex study A 000 0951792 TC Urinary reflex study A 000 0251792 26 Urinary reflex study A 000 0951797 Intraabdominal pressure test A ZZZ 0951797 TC Intraabdominal pressure test A ZZZ 0251797 26 Intraabdominal pressure test A ZZZ 0951798 Us urine capacity measure A XXX 0951800 Revision of bladder/urethra A 090 0951820 Revision of urinary tract A 090 0951840 Attach bladder/urethra A 090 0951841 Attach bladder/urethra A 090 0951845 Repair bladder neck A 090 0951860 Repair of bladder wound A 090 0951865 Repair of bladder wound A 090 0951880 Repair of bladder opening A 090 0951900 Repair bladder/vagina lesion A 090 0951920 Close bladder-uterus fistula A 090 0951925 Hysterectomy/bladder repair A 090 0951940 Correction of bladder defect A 090 0951960 Revision of bladder & bowel A 090 0951980 Construct bladder opening A 090 0951990 Laparo urethral suspension A 090 0951992 Laparo sling operation A 090 0951999 Laparoscope proc bla C YYY 095200F Eval appros surg thxpy epi I XXX 0952000 Cystoscopy A 000 0952001 Cystoscopy removal of clots A 000 0952005 Cystoscopy & ureter catheter A 000 0952007 Cystoscopy and biopsy A 000 0952010 Cystoscopy & duct catheter A 000 0952204 Cystoscopy w/biopsy(s) A 000 0952214 Cystoscopy and treatment A 000 0952224 Cystoscopy and treatment A 000 0952234 Cystoscopy and treatment A 000 0952235 Cystoscopy and treatment A 000 0952240 Cystoscopy and treatment A 000 0952250 Cystoscopy and radiotracer A 000 0952260 Cystoscopy and treatment A 000 0952265 Cystoscopy and treatment A 000 0952270 Cystoscopy & revise urethra A 000 0952275 Cystoscopy & revise urethra A 000 09

52276 Cystoscopy and treatment A 000 0952277 Cystoscopy and treatment A 000 0952281 Cystoscopy and treatment A 000 0952282 Cystoscopy implant stent A 000 0952283 Cystoscopy and treatment A 000 0952285 Cystoscopy and treatment A 000 0952287 Cystoscopy chemodenervation A 000 0952290 Cystoscopy and treatment A 000 0952300 Cystoscopy and treatment A 000 0952301 Cystoscopy and treatment A 000 0952305 Cystoscopy and treatment A 000 0952310 Cystoscopy and treatment A 000 0952315 Cystoscopy and treatment A 000 0952317 Remove bladder stone A 000 0952318 Remove bladder stone A 000 0952320 Cystoscopy and treatment A 000 0952325 Cystoscopy stone removal A 000 0952327 Cystoscopy inject material A 000 0952330 Cystoscopy and treatment A 000 0952332 Cystoscopy and treatment A 000 0952334 Create passage to kidney A 000 0952341 Cysto w/ureter stricture tx A 000 0952342 Cysto w/up stricture tx A 000 0952343 Cysto w/renal stricture tx A 000 0952344 Cysto/uretero stricture tx A 000 0952345 Cysto/uretero w/up stricture A 000 0952346 Cystouretero w/renal strict A 000 0952351 Cystouretero & or pyeloscope A 000 0952352 Cystouretero w/stone remove A 000 0952353 Cystouretero w/lithotripsy A 000 0952354 Cystouretero w/biopsy A 000 0952355 Cystouretero w/excise tumor A 000 0952356 Cysto/uretero w/lithotripsy A 000 0952400 Cystouretero w/congen repr A 090 0952402 Cystourethro cut ejacul duct A 000 0952441 Cystourethro w/implant A 000 0952442 Cystourethro w/addl implant A ZZZ 0952450 Incision of prostate A 090 095250F Asthma discharge plan presnt I XXX 0952500 Revision of bladder neck A 090 0952601 Prostatectomy (turp) A 090 0952630 Remove prostate regrowth A 090 0952640 Relieve bladder contracture A 090 0952647 Laser surgery of prostate A 090 0952648 Laser surgery of prostate A 090 0952649 Prostate laser enucleation A 090 0952700 Drainage of prostate abscess A 090 0953000 Incision of urethra A 010 0953010 Incision of urethra A 090 0953020 Incision of urethra A 000 09

53025 Incision of urethra A 000 0953040 Drainage of urethra abscess A 090 0953060 Drainage of urethra abscess A 010 0953080 Drainage of urinary leakage A 090 0953085 Drainage of urinary leakage A 090 0953200 Biopsy of urethra A 000 0953210 Removal of urethra A 090 0953215 Removal of urethra A 090 0953220 Treatment of urethra lesion A 090 0953230 Removal of urethra lesion A 090 0953235 Removal of urethra lesion A 090 0953240 Surgery for urethra pouch A 090 0953250 Removal of urethra gland A 090 0953260 Treatment of urethra lesion A 010 0953265 Treatment of urethra lesion A 010 0953270 Removal of urethra gland A 010 0953275 Repair of urethra defect A 010 0953400 Revise urethra stage 1 A 090 0953405 Revise urethra stage 2 A 090 0953410 Reconstruction of urethra A 090 0953415 Reconstruction of urethra A 090 0953420 Reconstruct urethra stage 1 A 090 0953425 Reconstruct urethra stage 2 A 090 0953430 Reconstruction of urethra A 090 0953431 Reconstruct urethra/bladder A 090 0953440 Male sling procedure A 090 0953442 Remove/revise male sling A 090 0953444 Insert tandem cuff A 090 0953445 Insert uro/ves nck sphincter A 090 0953446 Remove uro sphincter A 090 0953447 Remove/replace ur sphincter A 090 0953448 Remov/replc ur sphinctr comp A 090 0953449 Repair uro sphincter A 090 0953450 Revision of urethra A 090 0953460 Revision of urethra A 090 0953500 Urethrlys transvag w/ scope A 090 0953502 Repair of urethra injury A 090 0953505 Repair of urethra injury A 090 0953510 Repair of urethra injury A 090 0953515 Repair of urethra injury A 090 0953520 Repair of urethra defect A 090 0953600 Dilate urethra stricture A 000 0953601 Dilate urethra stricture A 000 0953605 Dilate urethra stricture A 000 0953620 Dilate urethra stricture A 000 0953621 Dilate urethra stricture A 000 0953660 Dilation of urethra A 000 0953661 Dilation of urethra A 000 0953665 Dilation of urethra A 000 0953850 Prostatic microwave thermotx A 090 09

53852 Prostatic rf thermotx A 090 0953855 Insert prost urethral stent A 000 0953860 Transurethral rf treatment A 090 0953899 Urology surgery procedure C YYY 0954000 Slitting of prepuce A 010 0954001 Slitting of prepuce A 010 0954015 Drain penis lesion A 010 0954050 Destruction penis lesion(s) A 010 0954055 Destruction penis lesion(s) A 010 0954056 Cryosurgery penis lesion(s) A 010 0954057 Laser surg penis lesion(s) A 010 0954060 Excision of penis lesion(s) A 010 0954065 Destruction penis lesion(s) A 010 0954100 Biopsy of penis A 000 0954105 Biopsy of penis A 010 0954110 Treatment of penis lesion A 090 0954111 Treat penis lesion graft A 090 0954112 Treat penis lesion graft A 090 0954115 Treatment of penis lesion A 090 0954120 Partial removal of penis A 090 0954125 Removal of penis A 090 0954130 Remove penis & nodes A 090 0954135 Remove penis & nodes A 090 0954150 Circumcision w/regionl block A 000 0954160 Circumcision neonate A 010 0954161 Circum 28 days or older A 010 0954162 Lysis penil circumic lesion A 010 0954163 Repair of circumcision A 010 0954164 Frenulotomy of penis A 010 0954200 Treatment of penis lesion A 010 0954205 Treatment of penis lesion A 090 0954220 Treatment of penis lesion A 000 0954230 Prepare penis study A 000 0954231 Dynamic cavernosometry A 000 0954235 Penile injection A 000 0954240 Penis study A 000 0954240 TC Penis study A 000 0254240 26 Penis study A 000 0954250 Penis study A 000 0954250 TC Penis study A 000 0154250 26 Penis study A 000 0954300 Revision of penis A 090 0954304 Revision of penis A 090 0954308 Reconstruction of urethra A 090 0954312 Reconstruction of urethra A 090 0954316 Reconstruction of urethra A 090 0954318 Reconstruction of urethra A 090 0954322 Reconstruction of urethra A 090 0954324 Reconstruction of urethra A 090 0954326 Reconstruction of urethra A 090 09

54328 Revise penis/urethra A 090 0954332 Revise penis/urethra A 090 0954336 Revise penis/urethra A 090 0954340 Secondary urethral surgery A 090 0954344 Secondary urethral surgery A 090 0954348 Secondary urethral surgery A 090 0954352 Reconstruct urethra/penis A 090 0954360 Penis plastic surgery A 090 0954380 Repair penis A 090 0954385 Repair penis A 090 0954390 Repair penis and bladder A 090 0954400 Insert semi-rigid prosthesis A 090 0954401 Insert self-contd prosthesis A 090 0954405 Insert multi-comp penis pros A 090 0954406 Remove muti-comp penis pros A 090 0954408 Repair multi-comp penis pros A 090 0954410 Remove/replace penis prosth A 090 0954411 Remov/replc penis pros comp A 090 0954415 Remove self-contd penis pros A 090 0954416 Remv/repl penis contain pros A 090 0954417 Remv/replc penis pros compl A 090 0954420 Revision of penis A 090 0954430 Revision of penis A 090 0954435 Revision of penis A 090 0954440 Repair of penis C 090 0954450 Preputial stretching A 000 0954500 Biopsy of testis A 000 0954505 Biopsy of testis A 010 0954512 Excise lesion testis A 090 0954520 Removal of testis A 090 0954522 Orchiectomy partial A 090 0954530 Removal of testis A 090 0954535 Extensive testis surgery A 090 0954550 Exploration for testis A 090 0954560 Exploration for testis A 090 0954600 Reduce testis torsion A 090 0954620 Suspension of testis A 010 0954640 Suspension of testis A 090 0954650 Orchiopexy (fowler-stephens) A 090 0954660 Revision of testis A 090 0954670 Repair testis injury A 090 0954680 Relocation of testis(es) A 090 0954690 Laparoscopy orchiectomy A 090 0954692 Laparoscopy orchiopexy A 090 0954699 Laparoscope proc testis C YYY 0954700 Drainage of scrotum A 010 0954800 Biopsy of epididymis A 000 0954830 Remove epididymis lesion A 090 0954840 Remove epididymis lesion A 090 0954860 Removal of epididymis A 090 09

54861 Removal of epididymis A 090 0954865 Explore epididymis A 090 0954900 Fusion of spermatic ducts A 090 0954901 Fusion of spermatic ducts A 090 0955000 Drainage of hydrocele A 000 0955040 Removal of hydrocele A 090 0955041 Removal of hydroceles A 090 0955060 Repair of hydrocele A 090 0955100 Drainage of scrotum abscess A 010 0955110 Explore scrotum A 090 0955120 Removal of scrotum lesion A 090 0955150 Removal of scrotum A 090 0955175 Revision of scrotum A 090 0955180 Revision of scrotum A 090 0955200 Incision of sperm duct A 090 0955250 Removal of sperm duct(s) A 090 0955300 Prepare sperm duct x-ray A 000 0955400 Repair of sperm duct A 090 0955450 Ligation of sperm duct A 010 0955500 Removal of hydrocele A 090 0955520 Removal of sperm cord lesion A 090 0955530 Revise spermatic cord veins A 090 0955535 Revise spermatic cord veins A 090 0955540 Revise hernia & sperm veins A 090 0955550 Laparo ligate spermatic vein A 090 0955559 Laparo proc spermatic cord C YYY 0955600 Incise sperm duct pouch A 090 0955605 Incise sperm duct pouch A 090 0955650 Remove sperm duct pouch A 090 0955680 Remove sperm pouch lesion A 090 0955700 Biopsy of prostate A 000 0955705 Biopsy of prostate A 010 0955706 Prostate saturation sampling A 010 0955720 Drainage of prostate abscess A 090 0955725 Drainage of prostate abscess A 090 0955801 Removal of prostate A 090 0955810 Extensive prostate surgery A 090 0955812 Extensive prostate surgery A 090 0955815 Extensive prostate surgery A 090 0955821 Removal of prostate A 090 0955831 Removal of prostate A 090 0955840 Extensive prostate surgery A 090 0955842 Extensive prostate surgery A 090 0955845 Extensive prostate surgery A 090 0955860 Surgical exposure prostate A 090 0955862 Extensive prostate surgery A 090 0955865 Extensive prostate surgery A 090 0955866 Laparo radical prostatectomy A 090 0955870 Electroejaculation A 000 0955873 Cryoablate prostate A 090 09

55875 Transperi needle place pros A 090 0955876 Place rt device/marker pros A 000 0955899 Genital surgery procedure C YYY 0955920 Place needles pelvic for rt A 000 0955970 Sex transformation m to f C YYY 0955980 Sex transformation f to m C YYY 0956405 I & d of vulva/perineum A 010 0956420 Drainage of gland abscess A 010 0956440 Surgery for vulva lesion A 010 0956441 Lysis of labial lesion(s) A 010 0956442 Hymenotomy A 000 0956501 Destroy vulva lesions sim A 010 0956515 Destroy vulva lesion/s compl A 010 0956605 Biopsy of vulva/perineum A 000 0956606 Biopsy of vulva/perineum A ZZZ 0956620 Partial removal of vulva A 090 0956625 Complete removal of vulva A 090 0956630 Extensive vulva surgery A 090 0956631 Extensive vulva surgery A 090 0956632 Extensive vulva surgery A 090 0956633 Extensive vulva surgery A 090 0956634 Extensive vulva surgery A 090 0956637 Extensive vulva surgery A 090 0956640 Extensive vulva surgery A 090 0956700 Partial removal of hymen A 010 0956740 Remove vagina gland lesion A 010 0956800 Repair of vagina A 010 0956805 Repair clitoris A 090 0956810 Repair of perineum A 010 0956820 Exam of vulva w/scope A 000 0956821 Exam/biopsy of vulva w/scope A 000 0957000 Exploration of vagina A 010 0957010 Drainage of pelvic abscess A 090 0957020 Drainage of pelvic fluid A 000 0957022 I & d vaginal hematoma pp A 010 0957023 I & d vag hematoma non-ob A 010 0957061 Destroy vag lesions simple A 010 0957065 Destroy vag lesions complex A 010 0957100 Biopsy of vagina A 000 0957105 Biopsy of vagina A 010 0957106 Remove vagina wall partial A 090 0957107 Remove vagina tissue part A 090 0957109 Vaginectomy partial w/nodes A 090 0957110 Remove vagina wall complete A 090 0957111 Remove vagina tissue compl A 090 0957112 Vaginectomy w/nodes compl A 090 0957120 Closure of vagina A 090 0957130 Remove vagina lesion A 010 0957135 Remove vagina lesion A 010 0957150 Treat vagina infection A 000 09

57155 Insert uteri tandem/ovoids A 000 0957156 Ins vag brachytx device A 000 0957160 Insert pessary/other device A 000 0957170 Fitting of diaphragm/cap A 000 0957180 Treat vaginal bleeding A 010 0957200 Repair of vagina A 090 0957210 Repair vagina/perineum A 090 0957220 Revision of urethra A 090 0957230 Repair of urethral lesion A 090 0957240 Repair bladder & vagina A 090 0957250 Repair rectum & vagina A 090 0957260 Repair of vagina A 090 0957265 Extensive repair of vagina A 090 0957267 Insert mesh/pelvic flr addon A ZZZ 0957268 Repair of bowel bulge A 090 0957270 Repair of bowel pouch A 090 0957280 Suspension of vagina A 090 0957282 Colpopexy extraperitoneal A 090 0957283 Colpopexy intraperitoneal A 090 0957284 Repair paravag defect open A 090 0957285 Repair paravag defect vag A 090 0957287 Revise/remove sling repair A 090 0957288 Repair bladder defect A 090 0957289 Repair bladder & vagina A 090 0957291 Construction of vagina A 090 0957292 Construct vagina with graft A 090 0957295 Revise vag graft via vagina A 090 0957296 Revise vag graft open abd A 090 0957300 Repair rectum-vagina fistula A 090 0957305 Repair rectum-vagina fistula A 090 0957307 Fistula repair & colostomy A 090 0957308 Fistula repair transperine A 090 0957310 Repair urethrovaginal lesion A 090 0957311 Repair urethrovaginal lesion A 090 0957320 Repair bladder-vagina lesion A 090 0957330 Repair bladder-vagina lesion A 090 0957335 Repair vagina A 090 0957400 Dilation of vagina A 000 0957410 Pelvic examination A 000 0957415 Remove vaginal foreign body A 010 0957420 Exam of vagina w/scope A 000 0957421 Exam/biopsy of vag w/scope A 000 0957423 Repair paravag defect lap A 090 0957425 Laparoscopy surg colpopexy A 090 0957426 Revise prosth vag graft lap A 090 0957452 Exam of cervix w/scope A 000 0957454 Bx/curett of cervix w/scope A 000 0957455 Biopsy of cervix w/scope A 000 0957456 Endocerv curettage w/scope A 000 0957460 Bx of cervix w/scope leep A 000 09

57461 Conz of cervix w/scope leep A 000 0957500 Biopsy of cervix A 000 0957505 Endocervical curettage A 010 0957510 Cauterization of cervix A 010 0957511 Cryocautery of cervix A 010 0957513 Laser surgery of cervix A 010 0957520 Conization of cervix A 090 0957522 Conization of cervix A 090 0957530 Removal of cervix A 090 0957531 Removal of cervix radical A 090 0957540 Removal of residual cervix A 090 0957545 Remove cervix/repair pelvis A 090 0957550 Removal of residual cervix A 090 0957555 Remove cervix/repair vagina A 090 0957556 Remove cervix repair bowel A 090 0957558 D&c of cervical stump A 010 0957700 Revision of cervix A 090 0957720 Revision of cervix A 090 0957800 Dilation of cervical canal A 000 0958100 Biopsy of uterus lining A 000 0958110 Bx done w/colposcopy add-on A ZZZ 0958120 Dilation and curettage A 010 0958140 Myomectomy abdom method A 090 0958145 Myomectomy vag method A 090 0958146 Myomectomy abdom complex A 090 0958150 Total hysterectomy A 090 0958152 Total hysterectomy A 090 0958180 Partial hysterectomy A 090 0958200 Extensive hysterectomy A 090 0958210 Extensive hysterectomy A 090 0958240 Removal of pelvis contents A 090 0958260 Vaginal hysterectomy A 090 0958262 Vag hyst including t/o A 090 0958263 Vag hyst w/t/o & vag repair A 090 0958267 Vag hyst w/urinary repair A 090 0958270 Vag hyst w/enterocele repair A 090 0958275 Hysterectomy/revise vagina A 090 0958280 Hysterectomy/revise vagina A 090 0958285 Extensive hysterectomy A 090 0958290 Vag hyst complex A 090 0958291 Vag hyst incl t/o complex A 090 0958292 Vag hyst t/o & repair compl A 090 0958293 Vag hyst w/uro repair compl A 090 0958294 Vag hyst w/enterocele compl A 090 0958300 Insert intrauterine device N XXX 0958301 Remove intrauterine device A 000 0958321 Artificial insemination A 000 0958322 Artificial insemination A 000 0958323 Sperm washing A 000 0958340 Catheter for hysterography A 000 09

58345 Reopen fallopian tube A 010 0958346 Insert heyman uteri capsule A 090 0958350 Reopen fallopian tube A 010 0958353 Endometr ablate thermal A 010 0958356 Endometrial cryoablation A 010 0958400 Suspension of uterus A 090 0958410 Suspension of uterus A 090 0958520 Repair of ruptured uterus A 090 0958540 Revision of uterus A 090 0958541 Lsh uterus 250 g or less A 090 0958542 Lsh w/t/o ut 250 g or less A 090 0958543 Lsh uterus above 250 g A 090 0958544 Lsh w/t/o uterus above 250 g A 090 0958545 Laparoscopic myomectomy A 090 0958546 Laparo-myomectomy complex A 090 0958548 Lap radical hyst A 090 0958550 Laparo-asst vag hysterectomy A 090 0958552 Laparo-vag hyst incl t/o A 090 0958553 Laparo-vag hyst complex A 090 0958554 Laparo-vag hyst w/t/o compl A 090 0958555 Hysteroscopy dx sep proc A 000 0958558 Hysteroscopy biopsy A 000 0958559 Hysteroscopy lysis A 000 0958560 Hysteroscopy resect septum A 000 0958561 Hysteroscopy remove myoma A 000 0958562 Hysteroscopy remove fb A 000 0958563 Hysteroscopy ablation A 000 0958565 Hysteroscopy sterilization A 090 0958570 Tlh uterus 250 g or less A 090 0958571 Tlh w/t/o 250 g or less A 090 0958572 Tlh uterus over 250 g A 090 0958573 Tlh w/t/o uterus over 250 g A 090 0958578 Laparo proc uterus C YYY 0958579 Hysteroscope procedure C YYY 0958600 Division of fallopian tube A 090 0958605 Division of fallopian tube A 090 0958611 Ligate oviduct(s) add-on A ZZZ 0958615 Occlude fallopian tube(s) A 010 0958660 Laparoscopy lysis A 090 0958661 Laparoscopy remove adnexa A 010 0958662 Laparoscopy excise lesions A 090 0958670 Laparoscopy tubal cautery A 090 0958671 Laparoscopy tubal block A 090 0958672 Laparoscopy fimbrioplasty A 090 0958673 Laparoscopy salpingostomy A 090 0958679 Laparo proc oviduct-ovary C YYY 0958700 Removal of fallopian tube A 090 0958720 Removal of ovary/tube(s) A 090 0958740 Adhesiolysis tube ovary A 090 0958750 Repair oviduct A 090 09

58752 Revise ovarian tube(s) A 090 0958760 Fimbrioplasty A 090 0958770 Create new tubal opening A 090 0958800 Drainage of ovarian cyst(s) A 090 0958805 Drainage of ovarian cyst(s) A 090 0958820 Drain ovary abscess open A 090 0958822 Drain ovary abscess percut A 090 0958825 Transposition ovary(s) A 090 0958900 Biopsy of ovary(s) A 090 0958920 Partial removal of ovary(s) A 090 0958925 Removal of ovarian cyst(s) A 090 0958940 Removal of ovary(s) A 090 0958943 Removal of ovary(s) A 090 0958950 Resect ovarian malignancy A 090 0958951 Resect ovarian malignancy A 090 0958952 Resect ovarian malignancy A 090 0958953 Tah rad dissect for debulk A 090 0958954 Tah rad debulk/lymph remove A 090 0958956 Bso omentectomy w/tah A 090 0958957 Resect recurrent gyn mal A 090 0958958 Resect recur gyn mal w/lym A 090 0958960 Exploration of abdomen A 090 0958970 Retrieval of oocyte A 000 0958974 Transfer of embryo C 000 0958976 Transfer of embryo A 000 0958999 Genital surgery procedure C YYY 0959000 Amniocentesis diagnostic A 000 0959001 Amniocentesis therapeutic A 000 0959012 Fetal cord puncture prenatal A 000 0959015 Chorion biopsy A 000 0959020 Fetal contract stress test A 000 0959020 TC Fetal contract stress test A 000 0259020 26 Fetal contract stress test A 000 0959025 Fetal non-stress test A 000 0959025 TC Fetal non-stress test A 000 0159025 26 Fetal non-stress test A 000 0959030 Fetal scalp blood sample A 000 0959050 Fetal monitor w/report A XXX 0959051 Fetal monitor/interpret only A XXX 0959070 Transabdom amnioinfus w/us A 000 0959072 Umbilical cord occlud w/us A 000 0959074 Fetal fluid drainage w/us A 000 0959076 Fetal shunt placement w/us A 000 0959100 Remove uterus lesion A 090 0959120 Treat ectopic pregnancy A 090 0959121 Treat ectopic pregnancy A 090 0959130 Treat ectopic pregnancy A 090 0959135 Treat ectopic pregnancy A 090 0959136 Treat ectopic pregnancy A 090 0959140 Treat ectopic pregnancy A 090 09

59150 Treat ectopic pregnancy A 090 0959151 Treat ectopic pregnancy A 090 0959160 D & c after delivery A 010 0959200 Insert cervical dilator A 000 0959300 Episiotomy or vaginal repair A 000 0959320 Revision of cervix A 000 0959325 Revision of cervix A 000 0959350 Repair of uterus A 000 0959400 Obstetrical care A MMM 0959409 Obstetrical care A MMM 0959410 Obstetrical care A MMM 0959412 Antepartum manipulation A MMM 0959414 Deliver placenta A MMM 0959425 Antepartum care only A MMM 0959426 Antepartum care only A MMM 0959430 Care after delivery A MMM 0959510 Cesarean delivery A MMM 0959514 Cesarean delivery only A MMM 0959515 Cesarean delivery A MMM 0959525 Remove uterus after cesarean A ZZZ 0959610 Vbac delivery A MMM 0959612 Vbac delivery only A MMM 0959614 Vbac care after delivery A MMM 0959618 Attempted vbac delivery A MMM 0959620 Attempted vbac delivery only A MMM 0959622 Attempted vbac after care A MMM 0959812 Treatment of miscarriage A 090 0959820 Care of miscarriage A 090 0959821 Treatment of miscarriage A 090 0959830 Treat uterus infection A 090 0959840 Abortion R 010 0959841 Abortion R 010 0959850 Abortion R 090 0959851 Abortion R 090 0959852 Abortion R 090 0959855 Abortion R 090 0959856 Abortion R 090 0959857 Abortion R 090 0959866 Abortion (mpr) R 000 0959870 Evacuate mole of uterus A 090 0959871 Remove cerclage suture A 000 0959897 Fetal invas px w/us C YYY 0959898 Laparo proc ob care/deliver C YYY 0959899 Maternity care procedure C YYY 0960000 Drain thyroid/tongue cyst A 010 096005F Care level rationale doc I XXX 096010F Dysphag test done b/4 eating I XXX 0960100 Biopsy of thyroid A 000 096015F Dysphag test done b/4 eating I XXX 096020F Npo (nothing-mouth) ordered I XXX 09

60200 Remove thyroid lesion A 090 0960210 Partial thyroid excision A 090 0960212 Partial thyroid excision A 090 0960220 Partial removal of thyroid A 090 0960225 Partial removal of thyroid A 090 0960240 Removal of thyroid A 090 0960252 Removal of thyroid A 090 0960254 Extensive thyroid surgery A 090 0960260 Repeat thyroid surgery A 090 0960270 Removal of thyroid A 090 0960271 Removal of thyroid A 090 0960280 Remove thyroid duct lesion A 090 0960281 Remove thyroid duct lesion A 090 096030F Max sterile barriers follwd M XXX 0960300 Aspir/inj thyroid cyst A 000 096040F Appro rad ds dvcs techs docd I XXX 096045F Radxps in end rprt4fluro pxd M XXX 0960500 Explore parathyroid glands A 090 0960502 Re-explore parathyroids A 090 0960505 Explore parathyroid glands A 090 0960512 Autotransplant parathyroid A ZZZ 0960520 Removal of thymus gland A 090 0960521 Removal of thymus gland A 090 0960522 Removal of thymus gland A 090 0960540 Explore adrenal gland A 090 0960545 Explore adrenal gland A 090 0960600 Remove carotid body lesion A 090 0960605 Remove carotid body lesion A 090 0960650 Laparoscopy adrenalectomy A 090 0960659 Laparo proc endocrine C YYY 0960699 Endocrine surgery procedure C YYY 096070F Pt asked/cnsld aed effects I XXX 096080F Pt/caregiver queried falls I XXX 096090F Pt/caregiver counsel safety I XXX 096100F Verify pt site pxd docd I XXX 0961000 Remove cranial cavity fluid A 000 0961001 Remove cranial cavity fluid A 000 096101F Safety counseling dementia M XXX 096102F Safety counseling dem order M XXX 0961020 Remove brain cavity fluid A 000 0961026 Injection into brain canal A 000 0961050 Remove brain canal fluid A 000 0961055 Injection into brain canal A 000 0961070 Brain canal shunt procedure A 000 096110F Counsel prov driving risks M XXX 0961105 Twist drill hole A 090 0961107 Drill skull for implantation A 000 0961108 Drill skull for drainage A 090 0961120 Burr hole for puncture A 090 0961140 Pierce skull for biopsy A 090 09

61150 Pierce skull for drainage A 090 0961151 Pierce skull for drainage A 090 0961154 Pierce skull & remove clot A 090 0961156 Pierce skull for drainage A 090 0961210 Pierce skull implant device A 000 0961215 Insert brain-fluid device A 090 0961250 Pierce skull & explore A 090 0961253 Pierce skull & explore A 090 0961304 Open skull for exploration A 090 0961305 Open skull for exploration A 090 0961312 Open skull for drainage A 090 0961313 Open skull for drainage A 090 0961314 Open skull for drainage A 090 0961315 Open skull for drainage A 090 0961316 Implt cran bone flap to abdo A ZZZ 0961320 Open skull for drainage A 090 0961321 Open skull for drainage A 090 0961322 Decompressive craniotomy A 090 0961323 Decompressive lobectomy A 090 0961330 Decompress eye socket A 090 0961332 Explore/biopsy eye socket A 090 0961333 Explore orbit/remove lesion A 090 0961340 Subtemporal decompression A 090 0961343 Incise skull (press relief) A 090 0961345 Relieve cranial pressure A 090 0961450 Incise skull for surgery A 090 0961458 Incise skull for brain wound A 090 0961460 Incise skull for surgery A 090 0961480 Incise skull for surgery A 090 096150F Pt notrcvng1st antitnf txmnt M XXX 0961500 Removal of skull lesion A 090 0961501 Remove infected skull bone A 090 0961510 Removal of brain lesion A 090 0961512 Remove brain lining lesion A 090 0961514 Removal of brain abscess A 090 0961516 Removal of brain lesion A 090 0961517 Implt brain chemotx add-on A ZZZ 0961518 Removal of brain lesion A 090 0961519 Remove brain lining lesion A 090 0961520 Removal of brain lesion A 090 0961521 Removal of brain lesion A 090 0961522 Removal of brain abscess A 090 0961524 Removal of brain lesion A 090 0961526 Removal of brain lesion A 090 0961530 Removal of brain lesion A 090 0961531 Implant brain electrodes A 090 0961533 Implant brain electrodes A 090 0961534 Removal of brain lesion A 090 0961535 Remove brain electrodes A 090 0961536 Removal of brain lesion A 090 09

61537 Removal of brain tissue A 090 0961538 Removal of brain tissue A 090 0961539 Removal of brain tissue A 090 0961540 Removal of brain tissue A 090 0961541 Incision of brain tissue A 090 0961543 Removal of brain tissue A 090 0961544 Remove & treat brain lesion A 090 0961545 Excision of brain tumor A 090 0961546 Removal of pituitary gland A 090 0961548 Removal of pituitary gland A 090 0961550 Release of skull seams A 090 0961552 Release of skull seams A 090 0961556 Incise skull/sutures A 090 0961557 Incise skull/sutures A 090 0961558 Excision of skull/sutures A 090 0961559 Excision of skull/sutures A 090 0961563 Excision of skull tumor A 090 0961564 Excision of skull tumor A 090 0961566 Removal of brain tissue A 090 0961567 Incision of brain tissue A 090 0961570 Remove foreign body brain A 090 0961571 Incise skull for brain wound A 090 0961575 Skull base/brainstem surgery A 090 0961576 Skull base/brainstem surgery A 090 0961580 Craniofacial approach skull A 090 0961581 Craniofacial approach skull A 090 0961582 Craniofacial approach skull A 090 0961583 Craniofacial approach skull A 090 0961584 Orbitocranial approach/skull A 090 0961585 Orbitocranial approach/skull A 090 0961586 Resect nasopharynx skull A 090 0961590 Infratemporal approach/skull A 090 0961591 Infratemporal approach/skull A 090 0961592 Orbitocranial approach/skull A 090 0961595 Transtemporal approach/skull A 090 0961596 Transcochlear approach/skull A 090 0961597 Transcondylar approach/skull A 090 0961598 Transpetrosal approach/skull A 090 0961600 Resect/excise cranial lesion A 090 0961601 Resect/excise cranial lesion A 090 0961605 Resect/excise cranial lesion A 090 0961606 Resect/excise cranial lesion A 090 0961607 Resect/excise cranial lesion A 090 0961608 Resect/excise cranial lesion A 090 0961610 Transect artery sinus A ZZZ 0961611 Transect artery sinus A ZZZ 0961612 Transect artery sinus A ZZZ 0961613 Remove aneurysm sinus A 090 0961615 Resect/excise lesion skull A 090 0961616 Resect/excise lesion skull A 090 09

61618 Repair dura A 090 0961619 Repair dura A 090 0961623 Endovasc tempory vessel occl A 000 0961624 Transcath occlusion cns A 000 0961626 Transcath occlusion non-cns A 000 0961630 Intracranial angioplasty R XXX 0961635 Intracran angioplsty w/stent R XXX 0961640 Dilate ic vasospasm init N 000 0961641 Dilate ic vasospasm add-on N ZZZ 0961642 Dilate ic vasospasm add-on N ZZZ 0961680 Intracranial vessel surgery A 090 0961682 Intracranial vessel surgery A 090 0961684 Intracranial vessel surgery A 090 0961686 Intracranial vessel surgery A 090 0961690 Intracranial vessel surgery A 090 0961692 Intracranial vessel surgery A 090 0961697 Brain aneurysm repr complx A 090 0961698 Brain aneurysm repr complx A 090 0961700 Brain aneurysm repr simple A 090 0961702 Inner skull vessel surgery A 090 0961703 Clamp neck artery A 090 0961705 Revise circulation to head A 090 0961708 Revise circulation to head A 090 0961710 Revise circulation to head A 090 0961711 Fusion of skull arteries A 090 0961720 Incise skull/brain surgery A 090 0961735 Incise skull/brain surgery A 090 0961750 Incise skull/brain biopsy A 090 0961751 Brain biopsy w/ct/mr guide A 090 0961760 Implant brain electrodes A 090 0961770 Incise skull for treatment A 090 0961781 Scan proc cranial intra A ZZZ 0961782 Scan proc cranial extra A ZZZ 0961783 Scan proc spinal A ZZZ 0961790 Treat trigeminal nerve A 090 0961791 Treat trigeminal tract A 090 0961796 Srs cranial lesion simple A 090 0961797 Srs cran les simple addl A ZZZ 0961798 Srs cranial lesion complex A 090 0961799 Srs cran les complex addl A ZZZ 0961800 Apply srs headframe add-on A ZZZ 0961850 Implant neuroelectrodes A 090 0961860 Implant neuroelectrodes A 090 0961863 Implant neuroelectrode A 090 0961864 Implant neuroelectrde addl A ZZZ 0961867 Implant neuroelectrode A 090 0961868 Implant neuroelectrde addl A ZZZ 0961870 Implant neuroelectrodes A 090 0961880 Revise/remove neuroelectrode A 090 0961885 Insrt/redo neurostim 1 array A 090 09

61886 Implant neurostim arrays A 090 0961888 Revise/remove neuroreceiver A 010 0962000 Treat skull fracture A 090 0962005 Treat skull fracture A 090 0962010 Treatment of head injury A 090 0962100 Repair brain fluid leakage A 090 0962115 Reduction of skull defect A 090 0962117 Reduction of skull defect A 090 0962120 Repair skull cavity lesion A 090 0962121 Incise skull repair A 090 0962140 Repair of skull defect A 090 0962141 Repair of skull defect A 090 0962142 Remove skull plate/flap A 090 0962143 Replace skull plate/flap A 090 0962145 Repair of skull & brain A 090 0962146 Repair of skull with graft A 090 0962147 Repair of skull with graft A 090 0962148 Retr bone flap to fix skull A ZZZ 0962160 Neuroendoscopy add-on A ZZZ 0962161 Dissect brain w/scope A 090 0962162 Remove colloid cyst w/scope A 090 0962163 Zneuroendoscopy w/fb removal A 090 0962164 Remove brain tumor w/scope A 090 0962165 Remove pituit tumor w/scope A 090 0962180 Establish brain cavity shunt A 090 0962190 Establish brain cavity shunt A 090 0962192 Establish brain cavity shunt A 090 0962194 Replace/irrigate catheter A 010 0962200 Establish brain cavity shunt A 090 0962201 Brain cavity shunt w/scope A 090 0962220 Establish brain cavity shunt A 090 0962223 Establish brain cavity shunt A 090 0962225 Replace/irrigate catheter A 090 0962230 Replace/revise brain shunt A 090 0962252 Csf shunt reprogram A XXX 0962252 TC Csf shunt reprogram A XXX 0362252 26 Csf shunt reprogram A XXX 0962256 Remove brain cavity shunt A 090 0962258 Replace brain cavity shunt A 090 0962263 Epidural lysis mult sessions A 010 0962264 Epidural lysis on single day A 010 0962267 Interdiscal perq aspir dx A 000 0962268 Drain spinal cord cyst A 000 0962269 Needle biopsy spinal cord A 000 0962270 Spinal fluid tap diagnostic A 000 0962272 Drain cerebro spinal fluid A 000 0962273 Inject epidural patch A 000 0962280 Treat spinal cord lesion A 010 0962281 Treat spinal cord lesion A 010 0962282 Treat spinal canal lesion A 010 09

62284 Injection for myelogram A 000 0962287 Percutaneous diskectomy A 090 0962290 Inject for spine disk x-ray A 000 0962291 Inject for spine disk x-ray A 000 0962292 Injection into disk lesion A 090 0962294 Injection into spinal artery A 090 0962302 Myelography lumbar injection A 000 0962303 Myelography lumbar injection A 000 0962304 Myelography lumbar injection A 000 0962305 Myelography lumbar injection A 000 0962310 Inject spine cerv/thoracic A 000 0962311 Inject spine lumbar/sacral A 000 0962318 Inject spine w/cath crv/thrc A 000 0962319 Inject spine w/cath lmb/scrl A 000 0962350 Implant spinal canal cath A 010 0962351 Implant spinal canal cath A 090 0962355 Remove spinal canal catheter A 010 0962360 Insert spine infusion device A 010 0962361 Implant spine infusion pump A 010 0962362 Implant spine infusion pump A 010 0962365 Remove spine infusion device A 010 0962367 Analyze spine infus pump A XXX 0962368 Analyze sp inf pump w/reprog A XXX 0962369 Anal sp inf pmp w/reprg&fill A XXX 0962370 Anl sp inf pmp w/mdreprg&fil A XXX 0963001 Remove spine lamina 1/2 crvl A 090 0963003 Remove spine lamina 1/2 thrc A 090 0963005 Remove spine lamina 1/2 lmbr A 090 0963011 Remove spine lamina 1/2 scrl A 090 0963012 Remove lamina/facets lumbar A 090 0963015 Remove spine lamina >2 crvcl A 090 0963016 Remove spine lamina >2 thrc A 090 0963017 Remove spine lamina >2 lmbr A 090 0963020 Neck spine disk surgery A 090 0963030 Low back disk surgery A 090 0963035 Spinal disk surgery add-on A ZZZ 0963040 Laminotomy single cervical A 090 0963042 Laminotomy single lumbar A 090 0963043 Laminotomy addl cervical C ZZZ 0963044 Laminotomy addl lumbar C ZZZ 0963045 Remove spine lamina 1 crvl A 090 0963046 Remove spine lamina 1 thrc A 090 0963047 Remove spine lamina 1 lmbr A 090 0963048 Remove spinal lamina add-on A ZZZ 0963050 Cervical laminoplsty 2/> seg A 090 0963051 C-laminoplasty w/graft/plate A 090 0963055 Decompress spinal cord thrc A 090 0963056 Decompress spinal cord lmbr A 090 0963057 Decompress spine cord add-on A ZZZ 0963064 Decompress spinal cord thrc A 090 09

63066 Decompress spine cord add-on A ZZZ 0963075 Neck spine disk surgery A 090 0963076 Neck spine disk surgery A ZZZ 0963077 Spine disk surgery thorax A 090 0963078 Spine disk surgery thorax A ZZZ 0963081 Remove vert body dcmprn crvl A 090 0963082 Remove vertebral body add-on A ZZZ 0963085 Remove vert body dcmprn thrc A 090 0963086 Remove vertebral body add-on A ZZZ 0963087 Remov vertbr dcmprn thrclmbr A 090 0963088 Remove vertebral body add-on A ZZZ 0963090 Remove vert body dcmprn lmbr A 090 0963091 Remove vertebral body add-on A ZZZ 0963101 Remove vert body dcmprn thrc A 090 0963102 Remove vert body dcmprn lmbr A 090 0963103 Remove vertebral body add-on A ZZZ 0963170 Incise spinal cord tract(s) A 090 0963172 Drainage of spinal cyst A 090 0963173 Drainage of spinal cyst A 090 0963180 Revise spinal cord ligaments A 090 0963182 Revise spinal cord ligaments A 090 0963185 Incise spine nrv half segmnt A 090 0963190 Incise spine nrv >2 segmnts A 090 0963191 Incise spine accessory nerve A 090 0963194 Incise spine & cord cervical A 090 0963195 Incise spine & cord thoracic A 090 0963196 Incise spine&cord 2 trx crvl A 090 0963197 Incise spine&cord 2 trx thrc A 090 0963198 Incise spin&cord 2 stgs crvl A 090 0963199 Incise spin&cord 2 stgs thrc A 090 0963200 Release spinal cord lumbar A 090 0963250 Revise spinal cord vsls crvl A 090 0963251 Revise spinal cord vsls thrc A 090 0963252 Revise spine cord vsl thrlmb A 090 0963265 Excise intraspinl lesion crv A 090 0963266 Excise intrspinl lesion thrc A 090 0963267 Excise intrspinl lesion lmbr A 090 0963268 Excise intrspinl lesion scrl A 090 0963270 Excise intrspinl lesion crvl A 090 0963271 Excise intrspinl lesion thrc A 090 0963272 Excise intrspinl lesion lmbr A 090 0963273 Excise intrspinl lesion scrl A 090 0963275 Bx/exc xdrl spine lesn crvl A 090 0963276 Bx/exc xdrl spine lesn thrc A 090 0963277 Bx/exc xdrl spine lesn lmbr A 090 0963278 Bx/exc xdrl spine lesn scrl A 090 0963280 Bx/exc idrl spine lesn crvl A 090 0963281 Bx/exc idrl spine lesn thrc A 090 0963282 Bx/exc idrl spine lesn lmbr A 090 0963283 Bx/exc idrl spine lesn scrl A 090 09

63285 Bx/exc idrl imed lesn cervl A 090 0963286 Bx/exc idrl imed lesn thrc A 090 0963287 Bx/exc idrl imed lesn thrlmb A 090 0963290 Bx/exc xdrl/idrl lsn any lvl A 090 0963295 Repair laminectomy defect A ZZZ 0963300 Remove vert xdrl body crvcl A 090 0963301 Remove vert xdrl body thrc A 090 0963302 Remove vert xdrl body thrlmb A 090 0963303 Remov vert xdrl bdy lmbr/sac A 090 0963304 Remove vert idrl body crvcl A 090 0963305 Remove vert idrl body thrc A 090 0963306 Remov vert idrl bdy thrclmbr A 090 0963307 Remov vert idrl bdy lmbr/sac A 090 0963308 Remove vertebral body add-on A ZZZ 0963600 Remove spinal cord lesion A 090 0963610 Stimulation of spinal cord A 000 0963615 Remove lesion of spinal cord A 090 0963620 Srs spinal lesion A 090 0963621 Srs spinal lesion addl A ZZZ 0963650 Implant neuroelectrodes A 010 0963655 Implant neuroelectrodes A 090 0963661 Remove spine eltrd perq aray A 010 0963662 Remove spine eltrd plate A 090 0963663 Revise spine eltrd perq aray A 010 0963664 Revise spine eltrd plate A 090 0963685 Insrt/redo spine n generator A 010 0963688 Revise/remove neuroreceiver A 010 0963700 Repair of spinal herniation A 090 0963702 Repair of spinal herniation A 090 0963704 Repair of spinal herniation A 090 0963706 Repair of spinal herniation A 090 0963707 Repair spinal fluid leakage A 090 0963709 Repair spinal fluid leakage A 090 0963710 Graft repair of spine defect A 090 0963740 Install spinal shunt A 090 0963741 Install spinal shunt A 090 0963744 Revision of spinal shunt A 090 0963746 Removal of spinal shunt A 090 0964400 N block inj trigeminal A 000 0964402 N block inj facial A 000 0964405 N block inj occipital A 000 0964408 N block inj vagus A 000 0964410 N block inj phrenic A 000 0964412 N block inj spinal accessor A 000 0964413 N block inj cervical plexus A 000 0964415 N block inj brachial plexus A 000 0964416 N block cont infuse b plex A 000 0964417 N block inj axillary A 000 0964418 N block inj suprascapular A 000 0964420 N block inj intercost sng A 000 09

64421 N block inj intercost mlt A 000 0964425 N block inj ilio-ing/hypogi A 000 0964430 N block inj pudendal A 000 0964435 N block inj paracervical A 000 0964445 N block inj sciatic sng A 000 0964446 N blk inj sciatic cont inf A 000 0964447 N block inj fem single A 000 0964448 N block inj fem cont inf A 000 0964449 N block inj lumbar plexus A 000 0964450 N block other peripheral A 000 0964455 N block inj plantar digit A 000 0964479 Inj foramen epidural c/t A 000 0964480 Inj foramen epidural add-on A ZZZ 0964483 Inj foramen epidural l/s A 000 0964484 Inj foramen epidural add-on A ZZZ 0964486 Tap block unil by injection A 000 0964487 Tap block uni by infusion A 000 0964488 Tap block bi injection A 000 0964489 Tap block bi by infusion A 000 0964490 Inj paravert f jnt c/t 1 lev A 000 0964491 Inj paravert f jnt c/t 2 lev A ZZZ 0964492 Inj paravert f jnt c/t 3 lev A ZZZ 0964493 Inj paravert f jnt l/s 1 lev A 000 0964494 Inj paravert f jnt l/s 2 lev A ZZZ 0964495 Inj paravert f jnt l/s 3 lev A ZZZ 0964505 N block spenopalatine gangl A 000 0964508 N block carotid sinus s/p A 000 0964510 N block stellate ganglion A 000 0964517 N block inj hypogas plxs A 000 0964520 N block lumbar/thoracic A 000 0964530 N block inj celiac pelus A 000 0964550 Apply neurostimulator A 000 0964553 Implant neuroelectrodes A 010 0964555 Implant neuroelectrodes A 010 0964561 Implant neuroelectrodes A 010 0964565 Implant neuroelectrodes A 010 0964566 Neuroeltrd stim post tibial A 000 0964568 Inc for vagus n elect impl A 090 0964569 Revise/repl vagus n eltrd A 090 0964570 Remove vagus n eltrd A 090 0964575 Implant neuroelectrodes A 090 0964580 Implant neuroelectrodes A 090 0964581 Implant neuroelectrodes A 090 0964585 Revise/remove neuroelectrode A 010 0964590 Insrt/redo pn/gastr stimul A 010 0964595 Revise/rmv pn/gastr stimul A 010 0964600 Injection treatment of nerve A 010 0964605 Injection treatment of nerve A 010 0964610 Injection treatment of nerve A 010 0964611 Chemodenerv saliv glands A 010 09

64612 Destroy nerve face muscle A 010 0964615 Chemodenerv musc migraine A 010 0964616 Chemodenerv musc neck dyston A 010 0964617 Chemodener muscle larynx emg A 010 0964620 Injection treatment of nerve A 010 0964630 Injection treatment of nerve A 010 0964632 N block inj common digit A 010 0964633 Destroy cerv/thor facet jnt A 010 0964634 Destroy c/th facet jnt addl A ZZZ 0964635 Destroy lumb/sac facet jnt A 010 0964636 Destroy l/s facet jnt addl A ZZZ 0964640 Injection treatment of nerve A 010 0964642 Chemodenerv 1 extremity 1-4 A 000 0964643 Chemodenerv 1 extrem 1-4 ea A ZZZ 0964644 Chemodenerv 1 extrem 5/> mus A 000 0964645 Chemodenerv 1 extrem 5/> ea A ZZZ 0964646 Chemodenerv trunk musc 1-5 A 000 0964647 Chemodenerv trunk musc 6/> A 000 0964650 Chemodenerv eccrine glands A 000 0964653 Chemodenerv eccrine glands A 000 0964680 Injection treatment of nerve A 010 0964681 Injection treatment of nerve A 010 0964702 Revise finger/toe nerve A 090 0964704 Revise hand/foot nerve A 090 0964708 Revise arm/leg nerve A 090 0964712 Revision of sciatic nerve A 090 0964713 Revision of arm nerve(s) A 090 0964714 Revise low back nerve(s) A 090 0964716 Revision of cranial nerve A 090 0964718 Revise ulnar nerve at elbow A 090 0964719 Revise ulnar nerve at wrist A 090 0964721 Carpal tunnel surgery A 090 0964722 Relieve pressure on nerve(s) A 090 0964726 Release foot/toe nerve A 090 0964727 Internal nerve revision A ZZZ 0964732 Incision of brow nerve A 090 0964734 Incision of cheek nerve A 090 0964736 Incision of chin nerve A 090 0964738 Incision of jaw nerve A 090 0964740 Incision of tongue nerve A 090 0964742 Incision of facial nerve A 090 0964744 Incise nerve back of head A 090 0964746 Incise diaphragm nerve A 090 0964755 Incision of stomach nerves A 090 0964760 Incision of vagus nerve A 090 0964763 Incise hip/thigh nerve A 090 0964766 Incise hip/thigh nerve A 090 0964771 Sever cranial nerve A 090 0964772 Incision of spinal nerve A 090 0964774 Remove skin nerve lesion A 090 09

64776 Remove digit nerve lesion A 090 0964778 Digit nerve surgery add-on A ZZZ 0964782 Remove limb nerve lesion A 090 0964783 Limb nerve surgery add-on A ZZZ 0964784 Remove nerve lesion A 090 0964786 Remove sciatic nerve lesion A 090 0964787 Implant nerve end A ZZZ 0964788 Remove skin nerve lesion A 090 0964790 Removal of nerve lesion A 090 0964792 Removal of nerve lesion A 090 0964795 Biopsy of nerve A 000 0964802 Sympathectomy cervical A 090 0964804 Remove sympathetic nerves A 090 0964809 Remove sympathetic nerves A 090 0964818 Remove sympathetic nerves A 090 0964820 Sympathectomy digital artery A 090 0964821 Remove sympathetic nerves A 090 0964822 Remove sympathetic nerves A 090 0964823 Sympathectomy supfc palmar A 090 0964831 Repair of digit nerve A 090 0964832 Repair nerve add-on A ZZZ 0964834 Repair of hand or foot nerve A 090 0964835 Repair of hand or foot nerve A 090 0964836 Repair of hand or foot nerve A 090 0964837 Repair nerve add-on A ZZZ 0964840 Repair of leg nerve A 090 0964856 Repair/transpose nerve A 090 0964857 Repair arm/leg nerve A 090 0964858 Repair sciatic nerve A 090 0964859 Nerve surgery A ZZZ 0964861 Repair of arm nerves A 090 0964862 Repair of low back nerves A 090 0964864 Repair of facial nerve A 090 0964865 Repair of facial nerve A 090 0964866 Fusion of facial/other nerve A 090 0964868 Fusion of facial/other nerve A 090 0964872 Subsequent repair of nerve A ZZZ 0964874 Repair & revise nerve add-on A ZZZ 0964876 Repair nerve/shorten bone A ZZZ 0964885 Nerve graft head/neck </4 cm A 090 0964886 Nerve graft head/neck >4 cm A 090 0964890 Nerve graft hand/foot </4 cm A 090 0964891 Nerve graft hand/foot >4 cm A 090 0964892 Nerve graft arm/leg <4 cm A 090 0964893 Nerve graft arm/leg >4 cm A 090 0964895 Nerve graft hand/foot </4 cm A 090 0964896 Nerve graft hand/foot >4 cm A 090 0964897 Nerve graft arm/leg </4 cm A 090 0964898 Nerve graft arm/leg >4 cm A 090 0964901 Nerve graft add-on A ZZZ 09

64902 Nerve graft add-on A ZZZ 0964905 Nerve pedicle transfer A 090 0964907 Nerve pedicle transfer A 090 0964910 Nerve repair w/allograft A 090 0964911 Neurorraphy w/vein autograft A 090 0964999 Nervous system surgery C YYY 0965091 Revise eye A 090 0965093 Revise eye with implant A 090 0965101 Removal of eye A 090 0965103 Remove eye/insert implant A 090 0965105 Remove eye/attach implant A 090 0965110 Removal of eye A 090 0965112 Remove eye/revise socket A 090 0965114 Remove eye/revise socket A 090 0965125 Revise ocular implant A 090 0965130 Insert ocular implant A 090 0965135 Insert ocular implant A 090 0965140 Attach ocular implant A 090 0965150 Revise ocular implant A 090 0965155 Reinsert ocular implant A 090 0965175 Removal of ocular implant A 090 0965205 Remove foreign body from eye A 000 0965210 Remove foreign body from eye A 000 0965220 Remove foreign body from eye A 000 0965222 Remove foreign body from eye A 000 0965235 Remove foreign body from eye A 090 0965260 Remove foreign body from eye A 090 0965265 Remove foreign body from eye A 090 0965270 Repair of eye wound A 010 0965272 Repair of eye wound A 090 0965273 Repair of eye wound A 090 0965275 Repair of eye wound A 090 0965280 Repair of eye wound A 090 0965285 Repair of eye wound A 090 0965286 Repair of eye wound A 090 0965290 Repair of eye socket wound A 090 0965400 Removal of eye lesion A 090 0965410 Biopsy of cornea A 000 0965420 Removal of eye lesion A 090 0965426 Removal of eye lesion A 090 0965430 Corneal smear A 000 0965435 Curette/treat cornea A 000 0965436 Curette/treat cornea A 090 0965450 Treatment of corneal lesion A 090 0965600 Revision of cornea A 090 0965710 Corneal transplant A 090 0965730 Corneal transplant A 090 0965750 Corneal transplant A 090 0965755 Corneal transplant A 090 0965756 Corneal trnspl endothelial A 090 09

65757 Prep corneal endo allograft C ZZZ 0965760 Revision of cornea N XXX 0965765 Revision of cornea N XXX 0965767 Corneal tissue transplant N XXX 0965770 Revise cornea with implant A 090 0965771 Radial keratotomy N XXX 0965772 Correction of astigmatism A 090 0965775 Correction of astigmatism A 090 0965778 Cover eye w/membrane A 010 0965779 Cover eye w/membrane suture A 010 0965780 Ocular reconst transplant A 090 0965781 Ocular reconst transplant A 090 0965782 Ocular reconst transplant A 090 0965800 Drainage of eye A 000 0965810 Drainage of eye A 090 0965815 Drainage of eye A 090 0965820 Relieve inner eye pressure A 090 0965850 Incision of eye A 090 0965855 Laser surgery of eye A 010 0965860 Incise inner eye adhesions A 090 0965865 Incise inner eye adhesions A 090 0965870 Incise inner eye adhesions A 090 0965875 Incise inner eye adhesions A 090 0965880 Incise inner eye adhesions A 090 0965900 Remove eye lesion A 090 0965920 Remove implant of eye A 090 0965930 Remove blood clot from eye A 090 0966020 Injection treatment of eye A 010 0966030 Injection treatment of eye A 010 0966130 Remove eye lesion A 090 0966150 Glaucoma surgery A 090 0966155 Glaucoma surgery A 090 0966160 Glaucoma surgery A 090 0966170 Glaucoma surgery A 090 0966172 Incision of eye A 090 0966174 Translum dil eye canal A 090 0966175 Trnslum dil eye canal w/stnt A 090 0966179 Aqueous shunt eye w/o graft A 090 0966180 Aqueous shunt eye w/graft A 090 0966183 Insert ant drainage device A 090 0966184 Revision of aqueous shunt A 090 0966185 Revise aqueous shunt eye A 090 0966220 Repair eye lesion A 090 0966225 Repair/graft eye lesion A 090 0966250 Follow-up surgery of eye A 090 0966500 Incision of iris A 090 0966505 Incision of iris A 090 0966600 Remove iris and lesion A 090 0966605 Removal of iris A 090 0966625 Removal of iris A 090 09

66630 Removal of iris A 090 0966635 Removal of iris A 090 0966680 Repair iris & ciliary body A 090 0966682 Repair iris & ciliary body A 090 0966700 Destruction ciliary body A 090 0966710 Ciliary transsleral therapy A 090 0966711 Ciliary endoscopic ablation A 090 0966720 Destruction ciliary body A 090 0966740 Destruction ciliary body A 090 0966761 Revision of iris A 010 0966762 Revision of iris A 090 0966770 Removal of inner eye lesion A 090 0966820 Incision secondary cataract A 090 0966821 After cataract laser surgery A 090 0966825 Reposition intraocular lens A 090 0966830 Removal of lens lesion A 090 0966840 Removal of lens material A 090 0966850 Removal of lens material A 090 0966852 Removal of lens material A 090 0966920 Extraction of lens A 090 0966930 Extraction of lens A 090 0966940 Extraction of lens A 090 0966982 Cataract surgery complex A 090 0966983 Cataract surg w/iol 1 stage A 090 0966984 Cataract surg w/iol 1 stage A 090 0966985 Insert lens prosthesis A 090 0966986 Exchange lens prosthesis A 090 0966990 Ophthalmic endoscope add-on A ZZZ 0966999 Eye surgery procedure C YYY 0967005 Partial removal of eye fluid A 090 0967010 Partial removal of eye fluid A 090 0967015 Release of eye fluid A 090 0967025 Replace eye fluid A 090 0967027 Implant eye drug system A 090 0967028 Injection eye drug A 000 0967030 Incise inner eye strands A 090 0967031 Laser surgery eye strands A 090 0967036 Removal of inner eye fluid A 090 0967039 Laser treatment of retina A 090 0967040 Laser treatment of retina A 090 0967041 Vit for macular pucker A 090 0967042 Vit for macular hole A 090 0967043 Vit for membrane dissect A 090 0967101 Repair detached retina A 090 0967105 Repair detached retina A 090 0967107 Repair detached retina A 090 0967108 Repair detached retina A 090 0967110 Repair detached retina A 090 0967112 Rerepair detached retina A 090 0967113 Repair retinal detach cplx A 090 09

67115 Release encircling material A 090 0967120 Remove eye implant material A 090 0967121 Remove eye implant material A 090 0967141 Treatment of retina A 090 0967145 Treatment of retina A 090 0967208 Treatment of retinal lesion A 090 0967210 Treatment of retinal lesion A 090 0967218 Treatment of retinal lesion A 090 0967220 Treatment of choroid lesion A 090 0967221 Ocular photodynamic ther R 000 0967225 Eye photodynamic ther add-on A ZZZ 0967227 Treatment of retinal lesion A 090 0967228 Treatment of retinal lesion A 090 0967229 Tr retinal les preterm inf A 090 0967250 Reinforce eye wall A 090 0967255 Reinforce/graft eye wall A 090 0967299 Eye surgery procedure C YYY 0967311 Revise eye muscle A 090 0967312 Revise two eye muscles A 090 0967314 Revise eye muscle A 090 0967316 Revise two eye muscles A 090 0967318 Revise eye muscle(s) A 090 0967320 Revise eye muscle(s) add-on A ZZZ 0967331 Eye surgery follow-up add-on A ZZZ 0967332 Rerevise eye muscles add-on A ZZZ 0967334 Revise eye muscle w/suture A ZZZ 0967335 Eye suture during surgery A ZZZ 0967340 Revise eye muscle add-on A ZZZ 0967343 Release eye tissue A 090 0967345 Destroy nerve of eye muscle A 010 0967346 Biopsy eye muscle A 000 0967399 Unlisted px extraocular musc C YYY 0967400 Explore/biopsy eye socket A 090 0967405 Explore/drain eye socket A 090 0967412 Explore/treat eye socket A 090 0967413 Explore/treat eye socket A 090 0967414 Explr/decompress eye socket A 090 0967415 Aspiration orbital contents A 000 0967420 Explore/treat eye socket A 090 0967430 Explore/treat eye socket A 090 0967440 Explore/drain eye socket A 090 0967445 Explr/decompress eye socket A 090 0967450 Explore/biopsy eye socket A 090 0967500 Inject/treat eye socket A 000 0967505 Inject/treat eye socket A 000 0967515 Inject/treat eye socket A 000 0967550 Insert eye socket implant A 090 0967560 Revise eye socket implant A 090 0967570 Decompress optic nerve A 090 0967599 Orbit surgery procedure C YYY 09

67700 Drainage of eyelid abscess A 010 0967710 Incision of eyelid A 010 0967715 Incision of eyelid fold A 010 0967800 Remove eyelid lesion A 010 0967801 Remove eyelid lesions A 010 0967805 Remove eyelid lesions A 010 0967808 Remove eyelid lesion(s) A 090 0967810 Biopsy eyelid & lid margin A 000 0967820 Revise eyelashes A 000 0967825 Revise eyelashes A 010 0967830 Revise eyelashes A 010 0967835 Revise eyelashes A 090 0967840 Remove eyelid lesion A 010 0967850 Treat eyelid lesion A 010 0967875 Closure of eyelid by suture A 000 0967880 Revision of eyelid A 090 0967882 Revision of eyelid A 090 0967900 Repair brow defect A 090 0967901 Repair eyelid defect A 090 0967902 Repair eyelid defect A 090 0967903 Repair eyelid defect A 090 0967904 Repair eyelid defect A 090 0967906 Repair eyelid defect A 090 0967908 Repair eyelid defect A 090 0967909 Revise eyelid defect A 090 0967911 Revise eyelid defect A 090 0967912 Correction eyelid w/implant A 090 0967914 Repair eyelid defect A 090 0967915 Repair eyelid defect A 090 0967916 Repair eyelid defect A 090 0967917 Repair eyelid defect A 090 0967921 Repair eyelid defect A 090 0967922 Repair eyelid defect A 090 0967923 Repair eyelid defect A 090 0967924 Repair eyelid defect A 090 0967930 Repair eyelid wound A 010 0967935 Repair eyelid wound A 090 0967938 Remove eyelid foreign body A 010 0967950 Revision of eyelid A 090 0967961 Revision of eyelid A 090 0967966 Revision of eyelid A 090 0967971 Reconstruction of eyelid A 090 0967973 Reconstruction of eyelid A 090 0967974 Reconstruction of eyelid A 090 0967975 Reconstruction of eyelid A 090 0967999 Revision of eyelid C YYY 0968020 Incise/drain eyelid lining A 010 0968040 Treatment of eyelid lesions A 000 0968100 Biopsy of eyelid lining A 000 0968110 Remove eyelid lining lesion A 010 09

68115 Remove eyelid lining lesion A 010 0968130 Remove eyelid lining lesion A 090 0968135 Remove eyelid lining lesion A 010 0968200 Treat eyelid by injection A 000 0968320 Revise/graft eyelid lining A 090 0968325 Revise/graft eyelid lining A 090 0968326 Revise/graft eyelid lining A 090 0968328 Revise/graft eyelid lining A 090 0968330 Revise eyelid lining A 090 0968335 Revise/graft eyelid lining A 090 0968340 Separate eyelid adhesions A 090 0968360 Revise eyelid lining A 090 0968362 Revise eyelid lining A 090 0968371 Harvest eye tissue alograft A 010 0968399 Eyelid lining surgery C YYY 0968400 Incise/drain tear gland A 010 0968420 Incise/drain tear sac A 010 0968440 Incise tear duct opening A 010 0968500 Removal of tear gland A 090 0968505 Partial removal tear gland A 090 0968510 Biopsy of tear gland A 000 0968520 Removal of tear sac A 090 0968525 Biopsy of tear sac A 000 0968530 Clearance of tear duct A 010 0968540 Remove tear gland lesion A 090 0968550 Remove tear gland lesion A 090 0968700 Repair tear ducts A 090 0968705 Revise tear duct opening A 010 0968720 Create tear sac drain A 090 0968745 Create tear duct drain A 090 0968750 Create tear duct drain A 090 0968760 Close tear duct opening A 010 0968761 Close tear duct opening A 010 0968770 Close tear system fistula A 090 0968801 Dilate tear duct opening A 010 0968810 Probe nasolacrimal duct A 010 0968811 Probe nasolacrimal duct A 010 0968815 Probe nasolacrimal duct A 010 0968816 Probe nl duct w/balloon A 010 0968840 Explore/irrigate tear ducts A 010 0968850 Injection for tear sac x-ray A 000 0968899 Tear duct system surgery C YYY 0969000 Drain external ear lesion A 010 0969005 Drain external ear lesion A 010 0969020 Drain outer ear canal lesion A 010 0969090 Pierce earlobes N XXX 0969100 Biopsy of external ear A 000 0969105 Biopsy of external ear canal A 000 0969110 Remove external ear partial A 090 0969120 Removal of external ear A 090 09

69140 Remove ear canal lesion(s) A 090 0969145 Remove ear canal lesion(s) A 090 0969150 Extensive ear canal surgery A 090 0969155 Extensive ear/neck surgery A 090 0969200 Clear outer ear canal A 000 0969205 Clear outer ear canal A 010 0969210 Remove impacted ear wax uni A 000 0969220 Clean out mastoid cavity A 000 0969222 Clean out mastoid cavity A 010 0969300 Revise external ear R YYY 0969310 Rebuild outer ear canal A 090 0969320 Rebuild outer ear canal A 090 0969399 Outer ear surgery procedure C YYY 0969420 Incision of eardrum A 010 0969421 Incision of eardrum A 010 0969424 Remove ventilating tube A 000 0969433 Create eardrum opening A 010 0969436 Create eardrum opening A 010 0969440 Exploration of middle ear A 090 0969450 Eardrum revision A 090 0969501 Mastoidectomy A 090 0969502 Mastoidectomy A 090 0969505 Remove mastoid structures A 090 0969511 Extensive mastoid surgery A 090 0969530 Extensive mastoid surgery A 090 0969535 Remove part of temporal bone A 090 0969540 Remove ear lesion A 010 0969550 Remove ear lesion A 090 0969552 Remove ear lesion A 090 0969554 Remove ear lesion A 090 0969601 Mastoid surgery revision A 090 0969602 Mastoid surgery revision A 090 0969603 Mastoid surgery revision A 090 0969604 Mastoid surgery revision A 090 0969605 Mastoid surgery revision A 090 0969610 Repair of eardrum A 010 0969620 Repair of eardrum A 090 0969631 Repair eardrum structures A 090 0969632 Rebuild eardrum structures A 090 0969633 Rebuild eardrum structures A 090 0969635 Repair eardrum structures A 090 0969636 Rebuild eardrum structures A 090 0969637 Rebuild eardrum structures A 090 0969641 Revise middle ear & mastoid A 090 0969642 Revise middle ear & mastoid A 090 0969643 Revise middle ear & mastoid A 090 0969644 Revise middle ear & mastoid A 090 0969645 Revise middle ear & mastoid A 090 0969646 Revise middle ear & mastoid A 090 0969650 Release middle ear bone A 090 09

69660 Revise middle ear bone A 090 0969661 Revise middle ear bone A 090 0969662 Revise middle ear bone A 090 0969666 Repair middle ear structures A 090 0969667 Repair middle ear structures A 090 0969670 Remove mastoid air cells A 090 0969676 Remove middle ear nerve A 090 0969700 Close mastoid fistula A 090 0969710 Implant/replace hearing aid N XXX 0969711 Remove/repair hearing aid A 090 0969714 Implant temple bone w/stimul A 090 0969715 Temple bne implnt w/stimulat A 090 0969717 Temple bone implant revision A 090 0969718 Revise temple bone implant A 090 0969720 Release facial nerve A 090 0969725 Release facial nerve A 090 0969740 Repair facial nerve A 090 0969745 Repair facial nerve A 090 0969799 Middle ear surgery procedure C YYY 0969801 Incise inner ear A 000 0969805 Explore inner ear A 090 0969806 Explore inner ear A 090 0969820 Establish inner ear window A 090 0969840 Revise inner ear window A 090 0969905 Remove inner ear A 090 0969910 Remove inner ear & mastoid A 090 0969915 Incise inner ear nerve A 090 0969930 Implant cochlear device A 090 0969949 Inner ear surgery procedure C YYY 0969950 Incise inner ear nerve A 090 0969955 Release facial nerve A 090 0969960 Release inner ear canal A 090 0969970 Remove inner ear lesion A 090 0969979 Temporal bone surgery C YYY 0969990 Microsurgery add-on R ZZZ 0970010 Contrast x-ray of brain A XXX 0970015 Contrast x-ray of brain A XXX 0970015 TC Contrast x-ray of brain A XXX 0370015 26 Contrast x-ray of brain A XXX 0970030 X-ray eye for foreign body A XXX 0970030 TC X-ray eye for foreign body A XXX 0170030 26 X-ray eye for foreign body A XXX 097010F Pt info into recall system M XXX 0970100 X-ray exam of jaw <4views A XXX 0970100 TC X-ray exam of jaw <4views A XXX 0170100 26 X-ray exam of jaw <4views A XXX 0970110 X-ray exam of jaw 4/> views A XXX 0970110 TC X-ray exam of jaw 4/> views A XXX 0170110 26 X-ray exam of jaw 4/> views A XXX 0970120 X-ray exam of mastoids A XXX 09

70120 TC X-ray exam of mastoids A XXX 0170120 26 X-ray exam of mastoids A XXX 0970130 X-ray exam of mastoids A XXX 0970130 TC X-ray exam of mastoids A XXX 0170130 26 X-ray exam of mastoids A XXX 0970134 X-ray exam of middle ear A XXX 0970134 TC X-ray exam of middle ear A XXX 0170134 26 X-ray exam of middle ear A XXX 0970140 X-ray exam of facial bones A XXX 0970140 TC X-ray exam of facial bones A XXX 0170140 26 X-ray exam of facial bones A XXX 0970150 X-ray exam of facial bones A XXX 0970150 TC X-ray exam of facial bones A XXX 0170150 26 X-ray exam of facial bones A XXX 0970160 X-ray exam of nasal bones A XXX 0970160 TC X-ray exam of nasal bones A XXX 0170160 26 X-ray exam of nasal bones A XXX 0970170 X-ray exam of tear duct C XXX 0970170 TC X-ray exam of tear duct C XXX 0370170 26 X-ray exam of tear duct A XXX 0970190 X-ray exam of eye sockets A XXX 0970190 TC X-ray exam of eye sockets A XXX 0170190 26 X-ray exam of eye sockets A XXX 097020F Mammo assess cat in dbase I XXX 0970200 X-ray exam of eye sockets A XXX 0970200 TC X-ray exam of eye sockets A XXX 0170200 26 X-ray exam of eye sockets A XXX 0970210 X-ray exam of sinuses A XXX 0970210 TC X-ray exam of sinuses A XXX 0170210 26 X-ray exam of sinuses A XXX 0970220 X-ray exam of sinuses A XXX 0970220 TC X-ray exam of sinuses A XXX 0170220 26 X-ray exam of sinuses A XXX 0970240 X-ray exam pituitary saddle A XXX 0970240 TC X-ray exam pituitary saddle A XXX 0170240 26 X-ray exam pituitary saddle A XXX 097025F Pt infosys alarm 4 nxt mammo M XXX 0970250 X-ray exam of skull A XXX 0970250 TC X-ray exam of skull A XXX 0170250 26 X-ray exam of skull A XXX 0970260 X-ray exam of skull A XXX 0970260 TC X-ray exam of skull A XXX 0170260 26 X-ray exam of skull A XXX 0970300 X-ray exam of teeth A XXX 0970300 TC X-ray exam of teeth A XXX 0170300 26 X-ray exam of teeth A XXX 0970310 X-ray exam of teeth A XXX 0970310 TC X-ray exam of teeth A XXX 0170310 26 X-ray exam of teeth A XXX 0970320 Full mouth x-ray of teeth A XXX 09

70320 TC Full mouth x-ray of teeth A XXX 0170320 26 Full mouth x-ray of teeth A XXX 0970328 X-ray exam of jaw joint A XXX 0970328 TC X-ray exam of jaw joint A XXX 0170328 26 X-ray exam of jaw joint A XXX 0970330 X-ray exam of jaw joints A XXX 0970330 TC X-ray exam of jaw joints A XXX 0170330 26 X-ray exam of jaw joints A XXX 0970332 X-ray exam of jaw joint A XXX 0970332 TC X-ray exam of jaw joint A XXX 0370332 26 X-ray exam of jaw joint A XXX 0970336 Magnetic image jaw joint A XXX 0970336 TC Magnetic image jaw joint A XXX 0170336 26 Magnetic image jaw joint A XXX 0970350 X-ray head for orthodontia A XXX 0970350 TC X-ray head for orthodontia A XXX 0170350 26 X-ray head for orthodontia A XXX 0970355 Panoramic x-ray of jaws A XXX 0970355 TC Panoramic x-ray of jaws A XXX 0170355 26 Panoramic x-ray of jaws A XXX 0970360 X-ray exam of neck A XXX 0970360 TC X-ray exam of neck A XXX 0170360 26 X-ray exam of neck A XXX 0970370 Throat x-ray & fluoroscopy A XXX 0970370 TC Throat x-ray & fluoroscopy A XXX 0370370 26 Throat x-ray & fluoroscopy A XXX 0970371 Speech evaluation complex A XXX 0970371 TC Speech evaluation complex A XXX 0370371 26 Speech evaluation complex A XXX 0970373 Contrast x-ray of larynx A XXX 0970373 TC Contrast x-ray of larynx A XXX 0370373 26 Contrast x-ray of larynx A XXX 0970380 X-ray exam of salivary gland A XXX 0970380 TC X-ray exam of salivary gland A XXX 0170380 26 X-ray exam of salivary gland A XXX 0970390 X-ray exam of salivary duct A XXX 0970390 TC X-ray exam of salivary duct A XXX 0370390 26 X-ray exam of salivary duct A XXX 0970450 Ct head/brain w/o dye A XXX 0970450 TC Ct head/brain w/o dye A XXX 0170450 26 Ct head/brain w/o dye A XXX 0970460 Ct head/brain w/dye A XXX 0970460 TC Ct head/brain w/dye A XXX 0270460 26 Ct head/brain w/dye A XXX 0970470 Ct head/brain w/o & w/dye A XXX 0970470 TC Ct head/brain w/o & w/dye A XXX 0270470 26 Ct head/brain w/o & w/dye A XXX 0970480 Ct orbit/ear/fossa w/o dye A XXX 0970480 TC Ct orbit/ear/fossa w/o dye A XXX 0170480 26 Ct orbit/ear/fossa w/o dye A XXX 09

70481 Ct orbit/ear/fossa w/dye A XXX 0970481 TC Ct orbit/ear/fossa w/dye A XXX 0270481 26 Ct orbit/ear/fossa w/dye A XXX 0970482 Ct orbit/ear/fossa w/o&w/dye A XXX 0970482 TC Ct orbit/ear/fossa w/o&w/dye A XXX 0270482 26 Ct orbit/ear/fossa w/o&w/dye A XXX 0970486 Ct maxillofacial w/o dye A XXX 0970486 TC Ct maxillofacial w/o dye A XXX 0170486 26 Ct maxillofacial w/o dye A XXX 0970487 Ct maxillofacial w/dye A XXX 0970487 TC Ct maxillofacial w/dye A XXX 0270487 26 Ct maxillofacial w/dye A XXX 0970488 Ct maxillofacial w/o & w/dye A XXX 0970488 TC Ct maxillofacial w/o & w/dye A XXX 0270488 26 Ct maxillofacial w/o & w/dye A XXX 0970490 Ct soft tissue neck w/o dye A XXX 0970490 TC Ct soft tissue neck w/o dye A XXX 0170490 26 Ct soft tissue neck w/o dye A XXX 0970491 Ct soft tissue neck w/dye A XXX 0970491 TC Ct soft tissue neck w/dye A XXX 0270491 26 Ct soft tissue neck w/dye A XXX 0970492 Ct sft tsue nck w/o & w/dye A XXX 0970492 TC Ct sft tsue nck w/o & w/dye A XXX 0270492 26 Ct sft tsue nck w/o & w/dye A XXX 0970496 Ct angiography head A XXX 0970496 TC Ct angiography head A XXX 0270496 26 Ct angiography head A XXX 0970498 Ct angiography neck A XXX 0970498 TC Ct angiography neck A XXX 0270498 26 Ct angiography neck A XXX 0970540 Mri orbit/face/neck w/o dye A XXX 0970540 TC Mri orbit/face/neck w/o dye A XXX 0170540 26 Mri orbit/face/neck w/o dye A XXX 0970542 Mri orbit/face/neck w/dye A XXX 0970542 TC Mri orbit/face/neck w/dye A XXX 0270542 26 Mri orbit/face/neck w/dye A XXX 0970543 Mri orbt/fac/nck w/o &w/dye A XXX 0970543 TC Mri orbt/fac/nck w/o &w/dye A XXX 0270543 26 Mri orbt/fac/nck w/o &w/dye A XXX 0970544 Mr angiography head w/o dye A XXX 0970544 TC Mr angiography head w/o dye A XXX 0170544 26 Mr angiography head w/o dye A XXX 0970545 Mr angiography head w/dye A XXX 0970545 TC Mr angiography head w/dye A XXX 0270545 26 Mr angiography head w/dye A XXX 0970546 Mr angiograph head w/o&w/dye A XXX 0970546 TC Mr angiograph head w/o&w/dye A XXX 0270546 26 Mr angiograph head w/o&w/dye A XXX 0970547 Mr angiography neck w/o dye A XXX 0970547 TC Mr angiography neck w/o dye A XXX 01

70547 26 Mr angiography neck w/o dye A XXX 0970548 Mr angiography neck w/dye A XXX 0970548 TC Mr angiography neck w/dye A XXX 0270548 26 Mr angiography neck w/dye A XXX 0970549 Mr angiograph neck w/o&w/dye A XXX 0970549 TC Mr angiograph neck w/o&w/dye A XXX 0270549 26 Mr angiograph neck w/o&w/dye A XXX 0970551 Mri brain stem w/o dye A XXX 0970551 TC Mri brain stem w/o dye A XXX 0170551 26 Mri brain stem w/o dye A XXX 0970552 Mri brain stem w/dye A XXX 0970552 TC Mri brain stem w/dye A XXX 0270552 26 Mri brain stem w/dye A XXX 0970553 Mri brain stem w/o & w/dye A XXX 0970553 TC Mri brain stem w/o & w/dye A XXX 0270553 26 Mri brain stem w/o & w/dye A XXX 0970554 Fmri brain by tech A XXX 0970554 TC Fmri brain by tech A XXX 0270554 26 Fmri brain by tech A XXX 0970555 Fmri brain by phys/psych C XXX 0970555 TC Fmri brain by phys/psych C XXX 0270555 26 Fmri brain by phys/psych A XXX 0970557 Mri brain w/o dye C XXX 0970557 TC Mri brain w/o dye C XXX 0170557 26 Mri brain w/o dye A XXX 0970558 Mri brain w/dye C XXX 0970558 TC Mri brain w/dye C XXX 0270558 26 Mri brain w/dye A XXX 0970559 Mri brain w/o & w/dye C XXX 0970559 TC Mri brain w/o & w/dye C XXX 0270559 26 Mri brain w/o & w/dye A XXX 0971010 Chest x-ray 1 view frontal A XXX 0971010 TC Chest x-ray 1 view frontal A XXX 0171010 26 Chest x-ray 1 view frontal A XXX 0971015 Chest x-ray stereo frontal A XXX 0971015 TC Chest x-ray stereo frontal A XXX 0171015 26 Chest x-ray stereo frontal A XXX 0971020 Chest x-ray 2vw frontal&latl A XXX 0971020 TC Chest x-ray 2vw frontal&latl A XXX 0171020 26 Chest x-ray 2vw frontal&latl A XXX 0971021 Chest x-ray frnt lat lordotc A XXX 0971021 TC Chest x-ray frnt lat lordotc A XXX 0171021 26 Chest x-ray frnt lat lordotc A XXX 0971022 Chest x-ray frnt lat oblique A XXX 0971022 TC Chest x-ray frnt lat oblique A XXX 0171022 26 Chest x-ray frnt lat oblique A XXX 0971023 Chest x-ray and fluoroscopy A XXX 0971023 TC Chest x-ray and fluoroscopy A XXX 0371023 26 Chest x-ray and fluoroscopy A XXX 0971030 Chest x-ray 4/> views A XXX 09

71030 TC Chest x-ray 4/> views A XXX 0171030 26 Chest x-ray 4/> views A XXX 0971034 Chest x-ray&fluoro 4/> views A XXX 0971034 TC Chest x-ray&fluoro 4/> views A XXX 0371034 26 Chest x-ray&fluoro 4/> views A XXX 0971035 Chest x-ray special views A XXX 0971035 TC Chest x-ray special views A XXX 0171035 26 Chest x-ray special views A XXX 0971100 X-ray exam ribs uni 2 views A XXX 0971100 TC X-ray exam ribs uni 2 views A XXX 0171100 26 X-ray exam ribs uni 2 views A XXX 0971101 X-ray exam unilat ribs/chest A XXX 0971101 TC X-ray exam unilat ribs/chest A XXX 0171101 26 X-ray exam unilat ribs/chest A XXX 0971110 X-ray exam ribs bil 3 views A XXX 0971110 TC X-ray exam ribs bil 3 views A XXX 0171110 26 X-ray exam ribs bil 3 views A XXX 0971111 X-ray exam ribs/chest4/> vws A XXX 0971111 TC X-ray exam ribs/chest4/> vws A XXX 0171111 26 X-ray exam ribs/chest4/> vws A XXX 0971120 X-ray exam breastbone 2/>vws A XXX 0971120 TC X-ray exam breastbone 2/>vws A XXX 0171120 26 X-ray exam breastbone 2/>vws A XXX 0971130 X-ray strenoclavic jt 3/>vws A XXX 0971130 TC X-ray strenoclavic jt 3/>vws A XXX 0171130 26 X-ray strenoclavic jt 3/>vws A XXX 0971250 Ct thorax w/o dye A XXX 0971250 TC Ct thorax w/o dye A XXX 0171250 26 Ct thorax w/o dye A XXX 0971260 Ct thorax w/dye A XXX 0971260 TC Ct thorax w/dye A XXX 0271260 26 Ct thorax w/dye A XXX 0971270 Ct thorax w/o & w/dye A XXX 0971270 TC Ct thorax w/o & w/dye A XXX 0271270 26 Ct thorax w/o & w/dye A XXX 0971275 Ct angiography chest A XXX 0971275 TC Ct angiography chest A XXX 0271275 26 Ct angiography chest A XXX 0971550 Mri chest w/o dye A XXX 0971550 TC Mri chest w/o dye A XXX 0171550 26 Mri chest w/o dye A XXX 0971551 Mri chest w/dye A XXX 0971551 TC Mri chest w/dye A XXX 0271551 26 Mri chest w/dye A XXX 0971552 Mri chest w/o & w/dye A XXX 0971552 TC Mri chest w/o & w/dye A XXX 0271552 26 Mri chest w/o & w/dye A XXX 0971555 Mri angio chest w or w/o dye R XXX 0971555 TC Mri angio chest w or w/o dye R XXX 0271555 26 Mri angio chest w or w/o dye R XXX 09

72010 X-ray exam spine ap&lat A XXX 0972010 TC X-ray exam spine ap&lat A XXX 0172010 26 X-ray exam spine ap&lat A XXX 0972020 X-ray exam of spine 1 view A XXX 0972020 TC X-ray exam of spine 1 view A XXX 0172020 26 X-ray exam of spine 1 view A XXX 0972040 X-ray exam neck spine 2-3 vw A XXX 0972040 TC X-ray exam neck spine 2-3 vw A XXX 0172040 26 X-ray exam neck spine 2-3 vw A XXX 0972050 X-ray exam neck spine 4/5vws A XXX 0972050 TC X-ray exam neck spine 4/5vws A XXX 0172050 26 X-ray exam neck spine 4/5vws A XXX 0972052 X-ray exam neck spine 6/>vws A XXX 0972052 TC X-ray exam neck spine 6/>vws A XXX 0172052 26 X-ray exam neck spine 6/>vws A XXX 0972069 X-ray exam trunk spine stand A XXX 0972069 TC X-ray exam trunk spine stand A XXX 0172069 26 X-ray exam trunk spine stand A XXX 0972070 X-ray exam thorac spine 2vws A XXX 0972070 TC X-ray exam thorac spine 2vws A XXX 0172070 26 X-ray exam thorac spine 2vws A XXX 0972072 X-ray exam thorac spine 3vws A XXX 0972072 TC X-ray exam thorac spine 3vws A XXX 0172072 26 X-ray exam thorac spine 3vws A XXX 0972074 X-ray exam thorac spine4/>vw A XXX 0972074 TC X-ray exam thorac spine4/>vw A XXX 0172074 26 X-ray exam thorac spine4/>vw A XXX 0972080 X-ray exam trunk spine 2 vws A XXX 0972080 TC X-ray exam trunk spine 2 vws A XXX 0172080 26 X-ray exam trunk spine 2 vws A XXX 0972090 X-ray exam scloiosis erect A XXX 0972090 TC X-ray exam scloiosis erect A XXX 0172090 26 X-ray exam scloiosis erect A XXX 0972100 X-ray exam l-s spine 2/3 vws A XXX 0972100 TC X-ray exam l-s spine 2/3 vws A XXX 0172100 26 X-ray exam l-s spine 2/3 vws A XXX 0972110 X-ray exam l-2 spine 4/>vws A XXX 0972110 TC X-ray exam l-2 spine 4/>vws A XXX 0172110 26 X-ray exam l-2 spine 4/>vws A XXX 0972114 X-ray exam l-s spine bending A XXX 0972114 TC X-ray exam l-s spine bending A XXX 0172114 26 X-ray exam l-s spine bending A XXX 0972120 X-ray bend only l-s spine A XXX 0972120 TC X-ray bend only l-s spine A XXX 0172120 26 X-ray bend only l-s spine A XXX 0972125 Ct neck spine w/o dye A XXX 0972125 TC Ct neck spine w/o dye A XXX 0172125 26 Ct neck spine w/o dye A XXX 0972126 Ct neck spine w/dye A XXX 0972126 TC Ct neck spine w/dye A XXX 02

72126 26 Ct neck spine w/dye A XXX 0972127 Ct neck spine w/o & w/dye A XXX 0972127 TC Ct neck spine w/o & w/dye A XXX 0272127 26 Ct neck spine w/o & w/dye A XXX 0972128 Ct chest spine w/o dye A XXX 0972128 TC Ct chest spine w/o dye A XXX 0172128 26 Ct chest spine w/o dye A XXX 0972129 Ct chest spine w/dye A XXX 0972129 TC Ct chest spine w/dye A XXX 0272129 26 Ct chest spine w/dye A XXX 0972130 Ct chest spine w/o & w/dye A XXX 0972130 TC Ct chest spine w/o & w/dye A XXX 0272130 26 Ct chest spine w/o & w/dye A XXX 0972131 Ct lumbar spine w/o dye A XXX 0972131 TC Ct lumbar spine w/o dye A XXX 0172131 26 Ct lumbar spine w/o dye A XXX 0972132 Ct lumbar spine w/dye A XXX 0972132 TC Ct lumbar spine w/dye A XXX 0272132 26 Ct lumbar spine w/dye A XXX 0972133 Ct lumbar spine w/o & w/dye A XXX 0972133 TC Ct lumbar spine w/o & w/dye A XXX 0272133 26 Ct lumbar spine w/o & w/dye A XXX 0972141 Mri neck spine w/o dye A XXX 0972141 TC Mri neck spine w/o dye A XXX 0172141 26 Mri neck spine w/o dye A XXX 0972142 Mri neck spine w/dye A XXX 0972142 TC Mri neck spine w/dye A XXX 0272142 26 Mri neck spine w/dye A XXX 0972146 Mri chest spine w/o dye A XXX 0972146 TC Mri chest spine w/o dye A XXX 0172146 26 Mri chest spine w/o dye A XXX 0972147 Mri chest spine w/dye A XXX 0972147 TC Mri chest spine w/dye A XXX 0272147 26 Mri chest spine w/dye A XXX 0972148 Mri lumbar spine w/o dye A XXX 0972148 TC Mri lumbar spine w/o dye A XXX 0172148 26 Mri lumbar spine w/o dye A XXX 0972149 Mri lumbar spine w/dye A XXX 0972149 TC Mri lumbar spine w/dye A XXX 0272149 26 Mri lumbar spine w/dye A XXX 0972156 Mri neck spine w/o & w/dye A XXX 0972156 TC Mri neck spine w/o & w/dye A XXX 0272156 26 Mri neck spine w/o & w/dye A XXX 0972157 Mri chest spine w/o & w/dye A XXX 0972157 TC Mri chest spine w/o & w/dye A XXX 0272157 26 Mri chest spine w/o & w/dye A XXX 0972158 Mri lumbar spine w/o & w/dye A XXX 0972158 TC Mri lumbar spine w/o & w/dye A XXX 0272158 26 Mri lumbar spine w/o & w/dye A XXX 0972159 Mr angio spine w/o&w/dye R XXX 09

72159 TC Mr angio spine w/o&w/dye R XXX 0272159 26 Mr angio spine w/o&w/dye R XXX 0972170 X-ray exam of pelvis A XXX 0972170 TC X-ray exam of pelvis A XXX 0172170 26 X-ray exam of pelvis A XXX 0972190 X-ray exam of pelvis A XXX 0972190 TC X-ray exam of pelvis A XXX 0172190 26 X-ray exam of pelvis A XXX 0972191 Ct angiograph pelv w/o&w/dye A XXX 0972191 TC Ct angiograph pelv w/o&w/dye A XXX 0272191 26 Ct angiograph pelv w/o&w/dye A XXX 0972192 Ct pelvis w/o dye A XXX 0972192 TC Ct pelvis w/o dye A XXX 0172192 26 Ct pelvis w/o dye A XXX 0972193 Ct pelvis w/dye A XXX 0972193 TC Ct pelvis w/dye A XXX 0272193 26 Ct pelvis w/dye A XXX 0972194 Ct pelvis w/o & w/dye A XXX 0972194 TC Ct pelvis w/o & w/dye A XXX 0272194 26 Ct pelvis w/o & w/dye A XXX 0972195 Mri pelvis w/o dye A XXX 0972195 TC Mri pelvis w/o dye A XXX 0172195 26 Mri pelvis w/o dye A XXX 0972196 Mri pelvis w/dye A XXX 0972196 TC Mri pelvis w/dye A XXX 0272196 26 Mri pelvis w/dye A XXX 0972197 Mri pelvis w/o & w/dye A XXX 0972197 TC Mri pelvis w/o & w/dye A XXX 0272197 26 Mri pelvis w/o & w/dye A XXX 0972198 Mr angio pelvis w/o & w/dye A XXX 0972198 TC Mr angio pelvis w/o & w/dye A XXX 0272198 26 Mr angio pelvis w/o & w/dye A XXX 0972200 X-ray exam si joints A XXX 0972200 TC X-ray exam si joints A XXX 0172200 26 X-ray exam si joints A XXX 0972202 X-ray exam si joints 3/> vws A XXX 0972202 TC X-ray exam si joints 3/> vws A XXX 0172202 26 X-ray exam si joints 3/> vws A XXX 0972220 X-ray exam sacrum tailbone A XXX 0972220 TC X-ray exam sacrum tailbone A XXX 0172220 26 X-ray exam sacrum tailbone A XXX 0972240 Myelography neck spine A XXX 0972240 TC Myelography neck spine A XXX 0372240 26 Myelography neck spine A XXX 0972255 Myelography thoracic spine A XXX 0972255 TC Myelography thoracic spine A XXX 0372255 26 Myelography thoracic spine A XXX 0972265 Myelography l-s spine A XXX 0972265 TC Myelography l-s spine A XXX 0372265 26 Myelography l-s spine A XXX 09

72270 Myelogphy 2/> spine regions A XXX 0972270 TC Myelogphy 2/> spine regions A XXX 0372270 26 Myelogphy 2/> spine regions A XXX 0972275 Epidurography A XXX 0972275 TC Epidurography A XXX 0372275 26 Epidurography A XXX 0972285 Discography cerv/thor spine A XXX 0972285 TC Discography cerv/thor spine A XXX 0372285 26 Discography cerv/thor spine A XXX 0972295 X-ray of lower spine disk A XXX 0972295 TC X-ray of lower spine disk A XXX 0372295 26 X-ray of lower spine disk A XXX 0973000 X-ray exam of collar bone A XXX 0973000 TC X-ray exam of collar bone A XXX 0173000 26 X-ray exam of collar bone A XXX 0973010 X-ray exam of shoulder blade A XXX 0973010 TC X-ray exam of shoulder blade A XXX 0173010 26 X-ray exam of shoulder blade A XXX 0973020 X-ray exam of shoulder A XXX 0973020 TC X-ray exam of shoulder A XXX 0173020 26 X-ray exam of shoulder A XXX 0973030 X-ray exam of shoulder A XXX 0973030 TC X-ray exam of shoulder A XXX 0173030 26 X-ray exam of shoulder A XXX 0973040 Contrast x-ray of shoulder A XXX 0973040 TC Contrast x-ray of shoulder A XXX 0373040 26 Contrast x-ray of shoulder A XXX 0973050 X-ray exam of shoulders A XXX 0973050 TC X-ray exam of shoulders A XXX 0173050 26 X-ray exam of shoulders A XXX 0973060 X-ray exam of humerus A XXX 0973060 TC X-ray exam of humerus A XXX 0173060 26 X-ray exam of humerus A XXX 0973070 X-ray exam of elbow A XXX 0973070 TC X-ray exam of elbow A XXX 0173070 26 X-ray exam of elbow A XXX 0973080 X-ray exam of elbow A XXX 0973080 TC X-ray exam of elbow A XXX 0173080 26 X-ray exam of elbow A XXX 0973085 Contrast x-ray of elbow A XXX 0973085 TC Contrast x-ray of elbow A XXX 0373085 26 Contrast x-ray of elbow A XXX 0973090 X-ray exam of forearm A XXX 0973090 TC X-ray exam of forearm A XXX 0173090 26 X-ray exam of forearm A XXX 0973092 X-ray exam of arm infant A XXX 0973092 TC X-ray exam of arm infant A XXX 0173092 26 X-ray exam of arm infant A XXX 0973100 X-ray exam of wrist A XXX 0973100 TC X-ray exam of wrist A XXX 01

73100 26 X-ray exam of wrist A XXX 0973110 X-ray exam of wrist A XXX 0973110 TC X-ray exam of wrist A XXX 0173110 26 X-ray exam of wrist A XXX 0973115 Contrast x-ray of wrist A XXX 0973115 TC Contrast x-ray of wrist A XXX 0373115 26 Contrast x-ray of wrist A XXX 0973120 X-ray exam of hand A XXX 0973120 TC X-ray exam of hand A XXX 0173120 26 X-ray exam of hand A XXX 0973130 X-ray exam of hand A XXX 0973130 TC X-ray exam of hand A XXX 0173130 26 X-ray exam of hand A XXX 0973140 X-ray exam of finger(s) A XXX 0973140 TC X-ray exam of finger(s) A XXX 0173140 26 X-ray exam of finger(s) A XXX 0973200 Ct upper extremity w/o dye A XXX 0973200 TC Ct upper extremity w/o dye A XXX 0173200 26 Ct upper extremity w/o dye A XXX 0973201 Ct upper extremity w/dye A XXX 0973201 TC Ct upper extremity w/dye A XXX 0273201 26 Ct upper extremity w/dye A XXX 0973202 Ct uppr extremity w/o&w/dye A XXX 0973202 TC Ct uppr extremity w/o&w/dye A XXX 0273202 26 Ct uppr extremity w/o&w/dye A XXX 0973206 Ct angio upr extrm w/o&w/dye A XXX 0973206 TC Ct angio upr extrm w/o&w/dye A XXX 0273206 26 Ct angio upr extrm w/o&w/dye A XXX 0973218 Mri upper extremity w/o dye A XXX 0973218 TC Mri upper extremity w/o dye A XXX 0173218 26 Mri upper extremity w/o dye A XXX 0973219 Mri upper extremity w/dye A XXX 0973219 TC Mri upper extremity w/dye A XXX 0273219 26 Mri upper extremity w/dye A XXX 0973220 Mri uppr extremity w/o&w/dye A XXX 0973220 TC Mri uppr extremity w/o&w/dye A XXX 0273220 26 Mri uppr extremity w/o&w/dye A XXX 0973221 Mri joint upr extrem w/o dye A XXX 0973221 TC Mri joint upr extrem w/o dye A XXX 0173221 26 Mri joint upr extrem w/o dye A XXX 0973222 Mri joint upr extrem w/dye A XXX 0973222 TC Mri joint upr extrem w/dye A XXX 0273222 26 Mri joint upr extrem w/dye A XXX 0973223 Mri joint upr extr w/o&w/dye A XXX 0973223 TC Mri joint upr extr w/o&w/dye A XXX 0273223 26 Mri joint upr extr w/o&w/dye A XXX 0973225 Mr angio upr extr w/o&w/dye R XXX 0973225 TC Mr angio upr extr w/o&w/dye R XXX 0273225 26 Mr angio upr extr w/o&w/dye R XXX 0973500 X-ray exam of hip A XXX 09

73500 TC X-ray exam of hip A XXX 0173500 26 X-ray exam of hip A XXX 0973510 X-ray exam of hip A XXX 0973510 TC X-ray exam of hip A XXX 0173510 26 X-ray exam of hip A XXX 0973520 X-ray exam of hips A XXX 0973520 TC X-ray exam of hips A XXX 0173520 26 X-ray exam of hips A XXX 0973525 Contrast x-ray of hip A XXX 0973525 TC Contrast x-ray of hip A XXX 0373525 26 Contrast x-ray of hip A XXX 0973530 X-ray exam of hip C XXX 0973530 TC X-ray exam of hip C XXX 0373530 26 X-ray exam of hip A XXX 0973540 X-ray exam of pelvis & hips A XXX 0973540 TC X-ray exam of pelvis & hips A XXX 0173540 26 X-ray exam of pelvis & hips A XXX 0973550 X-ray exam of thigh A XXX 0973550 TC X-ray exam of thigh A XXX 0173550 26 X-ray exam of thigh A XXX 0973560 X-ray exam of knee 1 or 2 A XXX 0973560 TC X-ray exam of knee 1 or 2 A XXX 0173560 26 X-ray exam of knee 1 or 2 A XXX 0973562 X-ray exam of knee 3 A XXX 0973562 TC X-ray exam of knee 3 A XXX 0173562 26 X-ray exam of knee 3 A XXX 0973564 X-ray exam knee 4 or more A XXX 0973564 TC X-ray exam knee 4 or more A XXX 0173564 26 X-ray exam knee 4 or more A XXX 0973565 X-ray exam of knees A XXX 0973565 TC X-ray exam of knees A XXX 0173565 26 X-ray exam of knees A XXX 0973580 Contrast x-ray of knee joint A XXX 0973580 TC Contrast x-ray of knee joint A XXX 0373580 26 Contrast x-ray of knee joint A XXX 0973590 X-ray exam of lower leg A XXX 0973590 TC X-ray exam of lower leg A XXX 0173590 26 X-ray exam of lower leg A XXX 0973592 X-ray exam of leg infant A XXX 0973592 TC X-ray exam of leg infant A XXX 0173592 26 X-ray exam of leg infant A XXX 0973600 X-ray exam of ankle A XXX 0973600 TC X-ray exam of ankle A XXX 0173600 26 X-ray exam of ankle A XXX 0973610 X-ray exam of ankle A XXX 0973610 TC X-ray exam of ankle A XXX 0173610 26 X-ray exam of ankle A XXX 0973615 Contrast x-ray of ankle A XXX 0973615 TC Contrast x-ray of ankle A XXX 0373615 26 Contrast x-ray of ankle A XXX 09

73620 X-ray exam of foot A XXX 0973620 TC X-ray exam of foot A XXX 0173620 26 X-ray exam of foot A XXX 0973630 X-ray exam of foot A XXX 0973630 TC X-ray exam of foot A XXX 0173630 26 X-ray exam of foot A XXX 0973650 X-ray exam of heel A XXX 0973650 TC X-ray exam of heel A XXX 0173650 26 X-ray exam of heel A XXX 0973660 X-ray exam of toe(s) A XXX 0973660 TC X-ray exam of toe(s) A XXX 0173660 26 X-ray exam of toe(s) A XXX 0973700 Ct lower extremity w/o dye A XXX 0973700 TC Ct lower extremity w/o dye A XXX 0173700 26 Ct lower extremity w/o dye A XXX 0973701 Ct lower extremity w/dye A XXX 0973701 TC Ct lower extremity w/dye A XXX 0273701 26 Ct lower extremity w/dye A XXX 0973702 Ct lwr extremity w/o&w/dye A XXX 0973702 TC Ct lwr extremity w/o&w/dye A XXX 0273702 26 Ct lwr extremity w/o&w/dye A XXX 0973706 Ct angio lwr extr w/o&w/dye A XXX 0973706 TC Ct angio lwr extr w/o&w/dye A XXX 0273706 26 Ct angio lwr extr w/o&w/dye A XXX 0973718 Mri lower extremity w/o dye A XXX 0973718 TC Mri lower extremity w/o dye A XXX 0173718 26 Mri lower extremity w/o dye A XXX 0973719 Mri lower extremity w/dye A XXX 0973719 TC Mri lower extremity w/dye A XXX 0273719 26 Mri lower extremity w/dye A XXX 0973720 Mri lwr extremity w/o&w/dye A XXX 0973720 TC Mri lwr extremity w/o&w/dye A XXX 0273720 26 Mri lwr extremity w/o&w/dye A XXX 0973721 Mri jnt of lwr extre w/o dye A XXX 0973721 TC Mri jnt of lwr extre w/o dye A XXX 0173721 26 Mri jnt of lwr extre w/o dye A XXX 0973722 Mri joint of lwr extr w/dye A XXX 0973722 TC Mri joint of lwr extr w/dye A XXX 0273722 26 Mri joint of lwr extr w/dye A XXX 0973723 Mri joint lwr extr w/o&w/dye A XXX 0973723 TC Mri joint lwr extr w/o&w/dye A XXX 0273723 26 Mri joint lwr extr w/o&w/dye A XXX 0973725 Mr ang lwr ext w or w/o dye R XXX 0973725 TC Mr ang lwr ext w or w/o dye R XXX 0273725 26 Mr ang lwr ext w or w/o dye R XXX 0974000 X-ray exam of abdomen A XXX 0974000 TC X-ray exam of abdomen A XXX 0174000 26 X-ray exam of abdomen A XXX 0974010 X-ray exam of abdomen A XXX 0974010 TC X-ray exam of abdomen A XXX 01

74010 26 X-ray exam of abdomen A XXX 0974020 X-ray exam of abdomen A XXX 0974020 TC X-ray exam of abdomen A XXX 0174020 26 X-ray exam of abdomen A XXX 0974022 X-ray exam series abdomen A XXX 0974022 TC X-ray exam series abdomen A XXX 0174022 26 X-ray exam series abdomen A XXX 0974150 Ct abdomen w/o dye A XXX 0974150 TC Ct abdomen w/o dye A XXX 0174150 26 Ct abdomen w/o dye A XXX 0974160 Ct abdomen w/dye A XXX 0974160 TC Ct abdomen w/dye A XXX 0274160 26 Ct abdomen w/dye A XXX 0974170 Ct abdomen w/o & w/dye A XXX 0974170 TC Ct abdomen w/o & w/dye A XXX 0274170 26 Ct abdomen w/o & w/dye A XXX 0974174 Ct angio abd&pelv w/o&w/dye A XXX 0974174 TC Ct angio abd&pelv w/o&w/dye A XXX 0274174 26 Ct angio abd&pelv w/o&w/dye A XXX 0974175 Ct angio abdom w/o & w/dye A XXX 0974175 TC Ct angio abdom w/o & w/dye A XXX 0274175 26 Ct angio abdom w/o & w/dye A XXX 0974176 Ct abd & pelvis w/o contrast A XXX 0974176 TC Ct abd & pelvis w/o contrast A XXX 0174176 26 Ct abd & pelvis w/o contrast A XXX 0974177 Ct abd & pelv w/contrast A XXX 0974177 TC Ct abd & pelv w/contrast A XXX 0274177 26 Ct abd & pelv w/contrast A XXX 0974178 Ct abd & pelv 1/> regns A XXX 0974178 TC Ct abd & pelv 1/> regns A XXX 0274178 26 Ct abd & pelv 1/> regns A XXX 0974181 Mri abdomen w/o dye A XXX 0974181 TC Mri abdomen w/o dye A XXX 0174181 26 Mri abdomen w/o dye A XXX 0974182 Mri abdomen w/dye A XXX 0974182 TC Mri abdomen w/dye A XXX 0274182 26 Mri abdomen w/dye A XXX 0974183 Mri abdomen w/o & w/dye A XXX 0974183 TC Mri abdomen w/o & w/dye A XXX 0274183 26 Mri abdomen w/o & w/dye A XXX 0974185 Mri angio abdom w orw/o dye R XXX 0974185 TC Mri angio abdom w orw/o dye R XXX 0274185 26 Mri angio abdom w orw/o dye R XXX 0974190 X-ray exam of peritoneum C XXX 0974190 TC X-ray exam of peritoneum C XXX 0374190 26 X-ray exam of peritoneum A XXX 0974210 Contrst x-ray exam of throat A XXX 0974210 TC Contrst x-ray exam of throat A XXX 0374210 26 Contrst x-ray exam of throat A XXX 0974220 Contrast x-ray esophagus A XXX 09

74220 TC Contrast x-ray esophagus A XXX 0374220 26 Contrast x-ray esophagus A XXX 0974230 Cine/vid x-ray throat/esoph A XXX 0974230 TC Cine/vid x-ray throat/esoph A XXX 0374230 26 Cine/vid x-ray throat/esoph A XXX 0974235 Remove esophagus obstruction C XXX 0974235 TC Remove esophagus obstruction C XXX 0374235 26 Remove esophagus obstruction A XXX 0974240 X-ray upper gi delay w/o kub A XXX 0974240 TC X-ray upper gi delay w/o kub A XXX 0374240 26 X-ray upper gi delay w/o kub A XXX 0974241 X-rayupper gi delay w/kub A XXX 0974241 TC X-rayupper gi delay w/kub A XXX 0374241 26 X-rayupper gi delay w/kub A XXX 0974245 X-ray upper gi&small intest A XXX 0974245 TC X-ray upper gi&small intest A XXX 0374245 26 X-ray upper gi&small intest A XXX 0974246 Contrst x-ray uppr gi tract A XXX 0974246 TC Contrst x-ray uppr gi tract A XXX 0374246 26 Contrst x-ray uppr gi tract A XXX 0974247 Contrst x-ray uppr gi tract A XXX 0974247 TC Contrst x-ray uppr gi tract A XXX 0374247 26 Contrst x-ray uppr gi tract A XXX 0974249 Contrst x-ray uppr gi tract A XXX 0974249 TC Contrst x-ray uppr gi tract A XXX 0374249 26 Contrst x-ray uppr gi tract A XXX 0974250 X-ray exam of small bowel A XXX 0974250 TC X-ray exam of small bowel A XXX 0274250 26 X-ray exam of small bowel A XXX 0974251 X-ray exam of small bowel A XXX 0974251 TC X-ray exam of small bowel A XXX 0374251 26 X-ray exam of small bowel A XXX 0974260 X-ray exam of small bowel A XXX 0974260 TC X-ray exam of small bowel A XXX 0374260 26 X-ray exam of small bowel A XXX 0974261 Ct colonography dx A XXX 0974261 TC Ct colonography dx A XXX 0274261 26 Ct colonography dx A XXX 0974262 Ct colonography dx w/dye A XXX 0974262 TC Ct colonography dx w/dye A XXX 0274262 26 Ct colonography dx w/dye A XXX 0974263 Ct colonography screening N XXX 0974263 TC Ct colonography screening N XXX 0274263 26 Ct colonography screening N XXX 0974270 Contrast x-ray exam of colon A XXX 0974270 TC Contrast x-ray exam of colon A XXX 0374270 26 Contrast x-ray exam of colon A XXX 0974280 Contrast x-ray exam of colon A XXX 0974280 TC Contrast x-ray exam of colon A XXX 0374280 26 Contrast x-ray exam of colon A XXX 09

74283 Contrast x-ray exam of colon A XXX 0974283 TC Contrast x-ray exam of colon A XXX 0374283 26 Contrast x-ray exam of colon A XXX 0974290 Contrast x-ray gallbladder A XXX 0974290 TC Contrast x-ray gallbladder A XXX 0174290 26 Contrast x-ray gallbladder A XXX 0974300 X-ray bile ducts/pancreas C XXX 0974300 TC X-ray bile ducts/pancreas C XXX 0374300 26 X-ray bile ducts/pancreas A XXX 0974301 X-rays at surgery add-on C ZZZ 0974301 TC X-rays at surgery add-on C ZZZ 0374301 26 X-rays at surgery add-on A ZZZ 0974305 X-ray bile ducts/pancreas C XXX 0974305 TC X-ray bile ducts/pancreas C XXX 0374305 26 X-ray bile ducts/pancreas A XXX 0974320 Contrast x-ray of bile ducts A XXX 0974320 TC Contrast x-ray of bile ducts A XXX 0374320 26 Contrast x-ray of bile ducts A XXX 0974327 X-ray bile stone removal A XXX 0974327 TC X-ray bile stone removal A XXX 0374327 26 X-ray bile stone removal A XXX 0974328 X-ray bile duct endoscopy C XXX 0974328 TC X-ray bile duct endoscopy C XXX 0374328 26 X-ray bile duct endoscopy A XXX 0974329 X-ray for pancreas endoscopy C XXX 0974329 TC X-ray for pancreas endoscopy C XXX 0374329 26 X-ray for pancreas endoscopy A XXX 0974330 X-ray bile/panc endoscopy C XXX 0974330 TC X-ray bile/panc endoscopy C XXX 0374330 26 X-ray bile/panc endoscopy A XXX 0974340 X-ray guide for gi tube C XXX 0974340 TC X-ray guide for gi tube C XXX 0374340 26 X-ray guide for gi tube A XXX 0974355 X-ray guide intestinal tube C XXX 0974355 TC X-ray guide intestinal tube C XXX 0374355 26 X-ray guide intestinal tube A XXX 0974360 X-ray guide gi dilation C XXX 0974360 TC X-ray guide gi dilation C XXX 0374360 26 X-ray guide gi dilation A XXX 0974363 X-ray bile duct dilation C XXX 0974363 TC X-ray bile duct dilation C XXX 0374363 26 X-ray bile duct dilation A XXX 0974400 Contrst x-ray urinary tract A XXX 0974400 TC Contrst x-ray urinary tract A XXX 0274400 26 Contrst x-ray urinary tract A XXX 0974410 Contrst x-ray urinary tract A XXX 0974410 TC Contrst x-ray urinary tract A XXX 0274410 26 Contrst x-ray urinary tract A XXX 0974415 Contrst x-ray urinary tract A XXX 0974415 TC Contrst x-ray urinary tract A XXX 02

74415 26 Contrst x-ray urinary tract A XXX 0974420 Contrst x-ray urinary tract C XXX 0974420 TC Contrst x-ray urinary tract C XXX 0374420 26 Contrst x-ray urinary tract A XXX 0974425 Contrst x-ray urinary tract C XXX 0974425 TC Contrst x-ray urinary tract C XXX 0374425 26 Contrst x-ray urinary tract A XXX 0974430 Contrast x-ray bladder A XXX 0974430 TC Contrast x-ray bladder A XXX 0374430 26 Contrast x-ray bladder A XXX 0974440 X-ray male genital tract A XXX 0974440 TC X-ray male genital tract A XXX 0374440 26 X-ray male genital tract A XXX 0974445 X-ray exam of penis C XXX 0974445 TC X-ray exam of penis C XXX 0374445 26 X-ray exam of penis A XXX 0974450 X-ray urethra/bladder C XXX 0974450 TC X-ray urethra/bladder C XXX 0374450 26 X-ray urethra/bladder A XXX 0974455 X-ray urethra/bladder A XXX 0974455 TC X-ray urethra/bladder A XXX 0374455 26 X-ray urethra/bladder A XXX 0974470 X-ray exam of kidney lesion C XXX 0974470 TC X-ray exam of kidney lesion C XXX 0374470 26 X-ray exam of kidney lesion A XXX 0974475 X-ray control cath insert A XXX 0974475 TC X-ray control cath insert A XXX 0374475 26 X-ray control cath insert A XXX 0974480 X-ray control cath insert A XXX 0974480 TC X-ray control cath insert A XXX 0374480 26 X-ray control cath insert A XXX 0974485 X-ray guide gu dilation A XXX 0974485 TC X-ray guide gu dilation A XXX 0374485 26 X-ray guide gu dilation A XXX 0974710 X-ray measurement of pelvis A XXX 0974710 TC X-ray measurement of pelvis A XXX 0174710 26 X-ray measurement of pelvis A XXX 0974740 X-ray female genital tract A XXX 0974740 TC X-ray female genital tract A XXX 0374740 26 X-ray female genital tract A XXX 0974742 X-ray fallopian tube C XXX 0974742 TC X-ray fallopian tube C XXX 0374742 26 X-ray fallopian tube A XXX 0974775 X-ray exam of perineum C XXX 0974775 TC X-ray exam of perineum C XXX 0374775 26 X-ray exam of perineum A XXX 0975557 Cardiac mri for morph A XXX 0975557 TC Cardiac mri for morph A XXX 0175557 26 Cardiac mri for morph A XXX 0975559 Cardiac mri w/stress img A XXX 09

75559 TC Cardiac mri w/stress img A XXX 0275559 26 Cardiac mri w/stress img A XXX 0975561 Cardiac mri for morph w/dye A XXX 0975561 TC Cardiac mri for morph w/dye A XXX 0175561 26 Cardiac mri for morph w/dye A XXX 0975563 Card mri w/stress img & dye A XXX 0975563 TC Card mri w/stress img & dye A XXX 0175563 26 Card mri w/stress img & dye A XXX 0975565 Card mri veloc flow mapping A ZZZ 0975565 TC Card mri veloc flow mapping A ZZZ 0175565 26 Card mri veloc flow mapping A ZZZ 0975571 Ct hrt w/o dye w/ca test A XXX 0975571 TC Ct hrt w/o dye w/ca test A XXX 0275571 26 Ct hrt w/o dye w/ca test A XXX 0975572 Ct hrt w/3d image A XXX 0975572 TC Ct hrt w/3d image A XXX 0275572 26 Ct hrt w/3d image A XXX 0975573 Ct hrt w/3d image congen A XXX 0975573 TC Ct hrt w/3d image congen A XXX 0275573 26 Ct hrt w/3d image congen A XXX 0975574 Ct angio hrt w/3d image A XXX 0975574 TC Ct angio hrt w/3d image A XXX 0275574 26 Ct angio hrt w/3d image A XXX 0975600 Contrast exam thoracic aorta A XXX 0975600 TC Contrast exam thoracic aorta A XXX 0375600 26 Contrast exam thoracic aorta A XXX 0975605 Contrast exam thoracic aorta A XXX 0975605 TC Contrast exam thoracic aorta A XXX 0375605 26 Contrast exam thoracic aorta A XXX 0975625 Contrast exam abdominl aorta A XXX 0975625 TC Contrast exam abdominl aorta A XXX 0375625 26 Contrast exam abdominl aorta A XXX 0975630 X-ray aorta leg arteries A XXX 0975630 TC X-ray aorta leg arteries A XXX 0375630 26 X-ray aorta leg arteries A XXX 0975635 Ct angio abdominal arteries A XXX 0975635 TC Ct angio abdominal arteries A XXX 0275635 26 Ct angio abdominal arteries A XXX 0975658 Artery x-rays arm A XXX 0975658 TC Artery x-rays arm A XXX 0375658 26 Artery x-rays arm A XXX 0975705 Artery x-rays spine A XXX 0975705 TC Artery x-rays spine A XXX 0375705 26 Artery x-rays spine A XXX 0975710 Artery x-rays arm/leg A XXX 0975710 TC Artery x-rays arm/leg A XXX 0375710 26 Artery x-rays arm/leg A XXX 0975716 Artery x-rays arms/legs A XXX 0975716 TC Artery x-rays arms/legs A XXX 0375716 26 Artery x-rays arms/legs A XXX 09

75726 Artery x-rays abdomen A XXX 0975726 TC Artery x-rays abdomen A XXX 0375726 26 Artery x-rays abdomen A XXX 0975731 Artery x-rays adrenal gland A XXX 0975731 TC Artery x-rays adrenal gland A XXX 0375731 26 Artery x-rays adrenal gland A XXX 0975733 Artery x-rays adrenals A XXX 0975733 TC Artery x-rays adrenals A XXX 0375733 26 Artery x-rays adrenals A XXX 0975736 Artery x-rays pelvis A XXX 0975736 TC Artery x-rays pelvis A XXX 0375736 26 Artery x-rays pelvis A XXX 0975741 Artery x-rays lung A XXX 0975741 TC Artery x-rays lung A XXX 0375741 26 Artery x-rays lung A XXX 0975743 Artery x-rays lungs A XXX 0975743 TC Artery x-rays lungs A XXX 0375743 26 Artery x-rays lungs A XXX 0975746 Artery x-rays lung A XXX 0975746 TC Artery x-rays lung A XXX 0375746 26 Artery x-rays lung A XXX 0975756 Artery x-rays chest A XXX 0975756 TC Artery x-rays chest A XXX 0375756 26 Artery x-rays chest A XXX 0975774 Artery x-ray each vessel A ZZZ 0975774 TC Artery x-ray each vessel A ZZZ 0375774 26 Artery x-ray each vessel A ZZZ 0975791 Av dialysis shunt imaging A XXX 0975791 TC Av dialysis shunt imaging A XXX 0375791 26 Av dialysis shunt imaging A XXX 0975801 Lymph vessel x-ray arm/leg C XXX 0975801 TC Lymph vessel x-ray arm/leg C XXX 0375801 26 Lymph vessel x-ray arm/leg A XXX 0975803 Lymph vessel x-ray arms/legs C XXX 0975803 TC Lymph vessel x-ray arms/legs C XXX 0375803 26 Lymph vessel x-ray arms/legs A XXX 0975805 Lymph vessel x-ray trunk C XXX 0975805 TC Lymph vessel x-ray trunk C XXX 0375805 26 Lymph vessel x-ray trunk A XXX 0975807 Lymph vessel x-ray trunk C XXX 0975807 TC Lymph vessel x-ray trunk C XXX 0375807 26 Lymph vessel x-ray trunk A XXX 0975809 Nonvascular shunt x-ray A XXX 0975809 TC Nonvascular shunt x-ray A XXX 0375809 26 Nonvascular shunt x-ray A XXX 0975810 Vein x-ray spleen/liver C XXX 0975810 TC Vein x-ray spleen/liver C XXX 0375810 26 Vein x-ray spleen/liver A XXX 0975820 Vein x-ray arm/leg A XXX 0975820 TC Vein x-ray arm/leg A XXX 03

75820 26 Vein x-ray arm/leg A XXX 0975822 Vein x-ray arms/legs A XXX 0975822 TC Vein x-ray arms/legs A XXX 0375822 26 Vein x-ray arms/legs A XXX 0975825 Vein x-ray trunk A XXX 0975825 TC Vein x-ray trunk A XXX 0375825 26 Vein x-ray trunk A XXX 0975827 Vein x-ray chest A XXX 0975827 TC Vein x-ray chest A XXX 0375827 26 Vein x-ray chest A XXX 0975831 Vein x-ray kidney A XXX 0975831 TC Vein x-ray kidney A XXX 0375831 26 Vein x-ray kidney A XXX 0975833 Vein x-ray kidneys A XXX 0975833 TC Vein x-ray kidneys A XXX 0375833 26 Vein x-ray kidneys A XXX 0975840 Vein x-ray adrenal gland A XXX 0975840 TC Vein x-ray adrenal gland A XXX 0375840 26 Vein x-ray adrenal gland A XXX 0975842 Vein x-ray adrenal glands A XXX 0975842 TC Vein x-ray adrenal glands A XXX 0375842 26 Vein x-ray adrenal glands A XXX 0975860 Vein x-ray neck A XXX 0975860 TC Vein x-ray neck A XXX 0375860 26 Vein x-ray neck A XXX 0975870 Vein x-ray skull A XXX 0975870 TC Vein x-ray skull A XXX 0375870 26 Vein x-ray skull A XXX 0975872 Vein x-ray skull epidural A XXX 0975872 TC Vein x-ray skull epidural A XXX 0375872 26 Vein x-ray skull epidural A XXX 0975880 Vein x-ray eye socket A XXX 0975880 TC Vein x-ray eye socket A XXX 0375880 26 Vein x-ray eye socket A XXX 0975885 Vein x-ray liver w/hemodynam A XXX 0975885 TC Vein x-ray liver w/hemodynam A XXX 0375885 26 Vein x-ray liver w/hemodynam A XXX 0975887 Vein x-ray liver w/o hemodyn A XXX 0975887 TC Vein x-ray liver w/o hemodyn A XXX 0375887 26 Vein x-ray liver w/o hemodyn A XXX 0975889 Vein x-ray liver w/hemodynam A XXX 0975889 TC Vein x-ray liver w/hemodynam A XXX 0375889 26 Vein x-ray liver w/hemodynam A XXX 0975891 Vein x-ray liver A XXX 0975891 TC Vein x-ray liver A XXX 0375891 26 Vein x-ray liver A XXX 0975893 Venous sampling by catheter A XXX 0975893 TC Venous sampling by catheter A XXX 0375893 26 Venous sampling by catheter A XXX 0975894 X-rays transcath therapy C XXX 09

75894 TC X-rays transcath therapy C XXX 0375894 26 X-rays transcath therapy A XXX 0975896 X-rays transcath therapy C XXX 0975896 TC X-rays transcath therapy C XXX 0975896 26 X-rays transcath therapy A XXX 0975898 Follow-up angiography C XXX 0975898 TC Follow-up angiography C XXX 0975898 26 Follow-up angiography A XXX 0975901 Remove cva device obstruct A XXX 0975901 TC Remove cva device obstruct A XXX 0375901 26 Remove cva device obstruct A XXX 0975902 Remove cva lumen obstruct A XXX 0975902 TC Remove cva lumen obstruct A XXX 0375902 26 Remove cva lumen obstruct A XXX 0975945 Intravascular us C XXX 0975945 TC Intravascular us C XXX 0375945 26 Intravascular us A XXX 0975946 Intravascular us add-on C ZZZ 0975946 TC Intravascular us add-on C ZZZ 0375946 26 Intravascular us add-on A ZZZ 0975952 Endovasc repair abdom aorta C XXX 0975952 TC Endovasc repair abdom aorta C XXX 0375952 26 Endovasc repair abdom aorta A XXX 0975953 Abdom aneurysm endovas rpr C XXX 0975953 TC Abdom aneurysm endovas rpr C XXX 0375953 26 Abdom aneurysm endovas rpr A XXX 0975954 Iliac aneurysm endovas rpr C XXX 0975954 TC Iliac aneurysm endovas rpr C XXX 0375954 26 Iliac aneurysm endovas rpr A XXX 0975956 Xray endovasc thor ao repr C XXX 0975956 TC Xray endovasc thor ao repr C XXX 0375956 26 Xray endovasc thor ao repr A XXX 0975957 Xray endovasc thor ao repr C XXX 0975957 TC Xray endovasc thor ao repr C XXX 0375957 26 Xray endovasc thor ao repr A XXX 0975958 Xray place prox ext thor ao C XXX 0975958 TC Xray place prox ext thor ao C XXX 0375958 26 Xray place prox ext thor ao A XXX 0975959 Xray place dist ext thor ao C XXX 0975959 TC Xray place dist ext thor ao C XXX 0375959 26 Xray place dist ext thor ao A XXX 0975962 Repair arterial blockage A XXX 0975962 TC Repair arterial blockage A XXX 0375962 26 Repair arterial blockage A XXX 0975964 Repair artery blockage each A ZZZ 0975964 TC Repair artery blockage each A ZZZ 0375964 26 Repair artery blockage each A ZZZ 0975966 Repair arterial blockage A XXX 0975966 TC Repair arterial blockage A XXX 0375966 26 Repair arterial blockage A XXX 09

75968 Repair artery blockage each A ZZZ 0975968 TC Repair artery blockage each A ZZZ 0375968 26 Repair artery blockage each A ZZZ 0975970 Vascular biopsy C XXX 0975970 TC Vascular biopsy C XXX 0375970 26 Vascular biopsy A XXX 0975978 Repair venous blockage A XXX 0975978 TC Repair venous blockage A XXX 0375978 26 Repair venous blockage A XXX 0975980 Contrast xray exam bile duct C XXX 0975980 TC Contrast xray exam bile duct C XXX 0375980 26 Contrast xray exam bile duct A XXX 0975982 Contrast xray exam bile duct C XXX 0975982 TC Contrast xray exam bile duct C XXX 0375982 26 Contrast xray exam bile duct A XXX 0975984 Xray control catheter change A XXX 0975984 TC Xray control catheter change A XXX 0375984 26 Xray control catheter change A XXX 0975989 Abscess drainage under x-ray A XXX 0975989 TC Abscess drainage under x-ray A XXX 0375989 26 Abscess drainage under x-ray A XXX 0976000 Fluoroscope examination A XXX 0976000 TC Fluoroscope examination A XXX 0376000 26 Fluoroscope examination A XXX 0976001 Fluoroscope exam extensive C XXX 0976001 TC Fluoroscope exam extensive C XXX 0376001 26 Fluoroscope exam extensive A XXX 0976010 X-ray nose to rectum A XXX 0976010 TC X-ray nose to rectum A XXX 0176010 26 X-ray nose to rectum A XXX 0976080 X-ray exam of fistula A XXX 0976080 TC X-ray exam of fistula A XXX 0376080 26 X-ray exam of fistula A XXX 0976098 X-ray exam breast specimen A XXX 0976098 TC X-ray exam breast specimen A XXX 0176098 26 X-ray exam breast specimen A XXX 0976100 X-ray exam of body section A XXX 0976100 TC X-ray exam of body section A XXX 0176100 26 X-ray exam of body section A XXX 0976101 Complex body section x-ray A XXX 0976101 TC Complex body section x-ray A XXX 0276101 26 Complex body section x-ray A XXX 0976102 Complex body section x-rays A XXX 0976102 TC Complex body section x-rays A XXX 0276102 26 Complex body section x-rays A XXX 0976120 Cine/video x-rays A XXX 0976120 TC Cine/video x-rays A XXX 0276120 26 Cine/video x-rays A XXX 0976125 Cine/video x-rays add-on C ZZZ 0976125 TC Cine/video x-rays add-on C ZZZ 02

76125 26 Cine/video x-rays add-on A ZZZ 0976140 X-ray consultation I XXX 0976376 3d render w/intrp postproces A XXX 0976376 TC 3d render w/intrp postproces A XXX 0176376 26 3d render w/intrp postproces A XXX 0976377 3d render w/intrp postproces A XXX 0976377 TC 3d render w/intrp postproces A XXX 0376377 26 3d render w/intrp postproces A XXX 0976380 Cat scan follow-up study A XXX 0976380 TC Cat scan follow-up study A XXX 0176380 26 Cat scan follow-up study A XXX 0976390 Mr spectroscopy N XXX 0976390 TC Mr spectroscopy N XXX 0176390 26 Mr spectroscopy N XXX 0976496 Fluoroscopic procedure C XXX 0376496 TC Fluoroscopic procedure C XXX 0376496 26 Fluoroscopic procedure C XXX 0976497 Ct procedure C XXX 0276497 TC Ct procedure C XXX 0276497 26 Ct procedure C XXX 0976498 Mri procedure C XXX 0276498 TC Mri procedure C XXX 0276498 26 Mri procedure C XXX 0976499 Radiographic procedure C XXX 0976499 TC Radiographic procedure C XXX 0976499 26 Radiographic procedure C XXX 0976506 Echo exam of head A XXX 0976506 TC Echo exam of head A XXX 0176506 26 Echo exam of head A XXX 0976510 Ophth us b & quant a A XXX 0976510 TC Ophth us b & quant a A XXX 0276510 26 Ophth us b & quant a A XXX 0976511 Ophth us quant a only A XXX 0976511 TC Ophth us quant a only A XXX 0276511 26 Ophth us quant a only A XXX 0976512 Ophth us b w/non-quant a A XXX 0976512 TC Ophth us b w/non-quant a A XXX 0276512 26 Ophth us b w/non-quant a A XXX 0976513 Echo exam of eye water bath A XXX 0976513 TC Echo exam of eye water bath A XXX 0276513 26 Echo exam of eye water bath A XXX 0976514 Echo exam of eye thickness A XXX 0976514 TC Echo exam of eye thickness A XXX 0176514 26 Echo exam of eye thickness A XXX 0976516 Echo exam of eye A XXX 0976516 TC Echo exam of eye A XXX 0176516 26 Echo exam of eye A XXX 0976519 Echo exam of eye A XXX 0976519 TC Echo exam of eye A XXX 0176519 26 Echo exam of eye A XXX 09

76529 Echo exam of eye A XXX 0976529 TC Echo exam of eye A XXX 0176529 26 Echo exam of eye A XXX 0976536 Us exam of head and neck A XXX 0976536 TC Us exam of head and neck A XXX 0176536 26 Us exam of head and neck A XXX 0976604 Us exam chest A XXX 0976604 TC Us exam chest A XXX 0176604 26 Us exam chest A XXX 0976641 Ultrasound breast complete A XXX 0976641 TC Ultrasound breast complete A XXX 0176641 26 Ultrasound breast complete A XXX 0976642 Ultrasound breast limited A XXX 0976642 TC Ultrasound breast limited A XXX 0176642 26 Ultrasound breast limited A XXX 0976700 Us exam abdom complete A XXX 0976700 TC Us exam abdom complete A XXX 0176700 26 Us exam abdom complete A XXX 0976705 Echo exam of abdomen A XXX 0976705 TC Echo exam of abdomen A XXX 0176705 26 Echo exam of abdomen A XXX 0976770 Us exam abdo back wall comp A XXX 0976770 TC Us exam abdo back wall comp A XXX 0176770 26 Us exam abdo back wall comp A XXX 0976775 Us exam abdo back wall lim A XXX 0976775 TC Us exam abdo back wall lim A XXX 0176775 26 Us exam abdo back wall lim A XXX 0976776 Us exam k transpl w/doppler A XXX 0976776 TC Us exam k transpl w/doppler A XXX 0176776 26 Us exam k transpl w/doppler A XXX 0976800 Us exam spinal canal A XXX 0976800 TC Us exam spinal canal A XXX 0176800 26 Us exam spinal canal A XXX 0976801 Ob us < 14 wks single fetus A XXX 0176801 TC Ob us < 14 wks single fetus A XXX 0176801 26 Ob us < 14 wks single fetus A XXX 0976802 Ob us < 14 wks addl fetus A ZZZ 0176802 TC Ob us < 14 wks addl fetus A ZZZ 0176802 26 Ob us < 14 wks addl fetus A ZZZ 0976805 Ob us >/= 14 wks sngl fetus A XXX 0976805 TC Ob us >/= 14 wks sngl fetus A XXX 0176805 26 Ob us >/= 14 wks sngl fetus A XXX 0976810 Ob us >/= 14 wks addl fetus A ZZZ 0976810 TC Ob us >/= 14 wks addl fetus A ZZZ 0176810 26 Ob us >/= 14 wks addl fetus A ZZZ 0976811 Ob us detailed sngl fetus A XXX 0176811 TC Ob us detailed sngl fetus A XXX 0176811 26 Ob us detailed sngl fetus A XXX 0976812 Ob us detailed addl fetus A ZZZ 0176812 TC Ob us detailed addl fetus A ZZZ 01

76812 26 Ob us detailed addl fetus A ZZZ 0976813 Ob us nuchal meas 1 gest A XXX 0176813 TC Ob us nuchal meas 1 gest A XXX 0176813 26 Ob us nuchal meas 1 gest A XXX 0976814 Ob us nuchal meas add-on A XXX 0176814 TC Ob us nuchal meas add-on A XXX 0176814 26 Ob us nuchal meas add-on A XXX 0976815 Ob us limited fetus(s) A XXX 0976815 TC Ob us limited fetus(s) A XXX 0176815 26 Ob us limited fetus(s) A XXX 0976816 Ob us follow-up per fetus A XXX 0976816 TC Ob us follow-up per fetus A XXX 0176816 26 Ob us follow-up per fetus A XXX 0976817 Transvaginal us obstetric A XXX 0176817 TC Transvaginal us obstetric A XXX 0176817 26 Transvaginal us obstetric A XXX 0976818 Fetal biophys profile w/nst A XXX 0976818 TC Fetal biophys profile w/nst A XXX 0176818 26 Fetal biophys profile w/nst A XXX 0976819 Fetal biophys profil w/o nst A XXX 0976819 TC Fetal biophys profil w/o nst A XXX 0176819 26 Fetal biophys profil w/o nst A XXX 0976820 Umbilical artery echo A XXX 0976820 TC Umbilical artery echo A XXX 0176820 26 Umbilical artery echo A XXX 0976821 Middle cerebral artery echo A XXX 0976821 TC Middle cerebral artery echo A XXX 0176821 26 Middle cerebral artery echo A XXX 0976825 Echo exam of fetal heart A XXX 0976825 TC Echo exam of fetal heart A XXX 0176825 26 Echo exam of fetal heart A XXX 0976826 Echo exam of fetal heart A XXX 0976826 TC Echo exam of fetal heart A XXX 0176826 26 Echo exam of fetal heart A XXX 0976827 Echo exam of fetal heart A XXX 0976827 TC Echo exam of fetal heart A XXX 0176827 26 Echo exam of fetal heart A XXX 0976828 Echo exam of fetal heart A XXX 0976828 TC Echo exam of fetal heart A XXX 0176828 26 Echo exam of fetal heart A XXX 0976830 Transvaginal us non-ob A XXX 0976830 TC Transvaginal us non-ob A XXX 0176830 26 Transvaginal us non-ob A XXX 0976831 Echo exam uterus A XXX 0976831 TC Echo exam uterus A XXX 0376831 26 Echo exam uterus A XXX 0976856 Us exam pelvic complete A XXX 0976856 TC Us exam pelvic complete A XXX 0176856 26 Us exam pelvic complete A XXX 0976857 Us exam pelvic limited A XXX 09

76857 TC Us exam pelvic limited A XXX 0176857 26 Us exam pelvic limited A XXX 0976870 Us exam scrotum A XXX 0976870 TC Us exam scrotum A XXX 0176870 26 Us exam scrotum A XXX 0976872 Us transrectal A XXX 0976872 TC Us transrectal A XXX 0176872 26 Us transrectal A XXX 0976873 Echograp trans r pros study A XXX 0976873 TC Echograp trans r pros study A XXX 0276873 26 Echograp trans r pros study A XXX 0976881 Us xtr non-vasc complete A XXX 0976881 TC Us xtr non-vasc complete A XXX 0176881 26 Us xtr non-vasc complete A XXX 0976882 Us xtr non-vasc lmtd A XXX 0976882 TC Us xtr non-vasc lmtd A XXX 0176882 26 Us xtr non-vasc lmtd A XXX 0976885 Us exam infant hips dynamic A XXX 0976885 TC Us exam infant hips dynamic A XXX 0176885 26 Us exam infant hips dynamic A XXX 0976886 Us exam infant hips static A XXX 0976886 TC Us exam infant hips static A XXX 0176886 26 Us exam infant hips static A XXX 0976930 Echo guide cardiocentesis C XXX 0976930 TC Echo guide cardiocentesis C XXX 0376930 26 Echo guide cardiocentesis A XXX 0976932 Echo guide for heart biopsy C YYY 0976932 TC Echo guide for heart biopsy C YYY 0376932 26 Echo guide for heart biopsy A XXX 0976936 Echo guide for artery repair A XXX 0976936 TC Echo guide for artery repair A XXX 0376936 26 Echo guide for artery repair A XXX 0976937 Us guide vascular access A ZZZ 0976937 TC Us guide vascular access A ZZZ 0376937 26 Us guide vascular access A ZZZ 0976940 Us guide tissue ablation C YYY 0976940 TC Us guide tissue ablation C YYY 0376940 26 Us guide tissue ablation A XXX 0976941 Echo guide for transfusion C XXX 0976941 TC Echo guide for transfusion C XXX 0376941 26 Echo guide for transfusion A XXX 0976942 Echo guide for biopsy A XXX 0976942 TC Echo guide for biopsy A XXX 0376942 26 Echo guide for biopsy A XXX 0976945 Echo guide villus sampling C XXX 0976945 TC Echo guide villus sampling C XXX 0376945 26 Echo guide villus sampling A XXX 0976946 Echo guide for amniocentesis A XXX 0976946 TC Echo guide for amniocentesis A XXX 0376946 26 Echo guide for amniocentesis A XXX 09

76948 Echo guide ova aspiration A XXX 0976948 TC Echo guide ova aspiration A XXX 0376948 26 Echo guide ova aspiration A XXX 0976965 Echo guidance radiotherapy A XXX 0976965 TC Echo guidance radiotherapy A XXX 0376965 26 Echo guidance radiotherapy A XXX 0976970 Ultrasound exam follow-up A XXX 0976970 TC Ultrasound exam follow-up A XXX 0176970 26 Ultrasound exam follow-up A XXX 0976975 Gi endoscopic ultrasound C XXX 0976975 TC Gi endoscopic ultrasound C XXX 0376975 26 Gi endoscopic ultrasound A XXX 0976977 Us bone density measure A XXX 0976977 TC Us bone density measure A XXX 0176977 26 Us bone density measure A XXX 0976998 Us guide intraop C XXX 0976998 TC Us guide intraop C XXX 0376998 26 Us guide intraop A XXX 0976999 Echo examination procedure C XXX 0976999 TC Echo examination procedure C XXX 0976999 26 Echo examination procedure C XXX 0977001 Fluoroguide for vein device A ZZZ 0977001 TC Fluoroguide for vein device A ZZZ 0377001 26 Fluoroguide for vein device A ZZZ 0977002 Needle localization by xray A XXX 0977002 TC Needle localization by xray A XXX 0377002 26 Needle localization by xray A XXX 0977003 Fluoroguide for spine inject A XXX 0977003 TC Fluoroguide for spine inject A XXX 0377003 26 Fluoroguide for spine inject A XXX 0977011 Ct scan for localization A XXX 0977011 TC Ct scan for localization A XXX 0377011 26 Ct scan for localization A XXX 0977012 Ct scan for needle biopsy A XXX 0977012 TC Ct scan for needle biopsy A XXX 0377012 26 Ct scan for needle biopsy A XXX 0977013 Ct guide for tissue ablation C XXX 0977013 TC Ct guide for tissue ablation C XXX 0977013 26 Ct guide for tissue ablation A XXX 0977014 Ct scan for therapy guide A XXX 0977014 TC Ct scan for therapy guide A XXX 0277014 26 Ct scan for therapy guide A XXX 0977021 Mr guidance for needle place A XXX 0977021 TC Mr guidance for needle place A XXX 0377021 26 Mr guidance for needle place A XXX 0977022 Mri for tissue ablation C XXX 0977022 TC Mri for tissue ablation C XXX 0977022 26 Mri for tissue ablation A XXX 0977051 Computer dx mammogram add-on A ZZZ 0977051 TC Computer dx mammogram add-on A ZZZ 09

77051 26 Computer dx mammogram add-on A ZZZ 0977052 Comp screen mammogram add-on A ZZZ 0977052 TC Comp screen mammogram add-on A ZZZ 0977052 26 Comp screen mammogram add-on A ZZZ 0977053 X-ray of mammary duct A XXX 0977053 TC X-ray of mammary duct A XXX 0377053 26 X-ray of mammary duct A XXX 0977054 X-ray of mammary ducts A XXX 0977054 TC X-ray of mammary ducts A XXX 0377054 26 X-ray of mammary ducts A XXX 0977055 Mammogram one breast A XXX 0977055 TC Mammogram one breast A XXX 0977055 26 Mammogram one breast A XXX 0977056 Mammogram both breasts A XXX 0977056 TC Mammogram both breasts A XXX 0977056 26 Mammogram both breasts A XXX 0977057 Mammogram screening A XXX 0977057 TC Mammogram screening A XXX 0977057 26 Mammogram screening A XXX 0977058 Mri one breast A XXX 0977058 TC Mri one breast A XXX 0277058 26 Mri one breast A XXX 0977059 Mri both breasts A XXX 0977059 TC Mri both breasts A XXX 0277059 26 Mri both breasts A XXX 0977061 Breast tomosynthesis uni I XXX 0977061 TC Breast tomosynthesis uni I XXX 0977061 26 Breast tomosynthesis uni I XXX 0977062 Breast tomosynthesis bi I XXX 0977062 TC Breast tomosynthesis bi I XXX 0977062 26 Breast tomosynthesis bi I XXX 0977063 Breast tomosynthesis bi A XXX 0977063 TC Breast tomosynthesis bi A XXX 0977063 26 Breast tomosynthesis bi A XXX 0977071 X-ray stress view A XXX 0377072 X-rays for bone age A XXX 0977072 TC X-rays for bone age A XXX 0177072 26 X-rays for bone age A XXX 0977073 X-rays bone length studies A XXX 0977073 TC X-rays bone length studies A XXX 0177073 26 X-rays bone length studies A XXX 0977074 X-rays bone survey limited A XXX 0977074 TC X-rays bone survey limited A XXX 0177074 26 X-rays bone survey limited A XXX 0977075 X-rays bone survey complete A XXX 0977075 TC X-rays bone survey complete A XXX 0177075 26 X-rays bone survey complete A XXX 0977076 X-rays bone survey infant A XXX 0977076 TC X-rays bone survey infant A XXX 0177076 26 X-rays bone survey infant A XXX 09

77077 Joint survey single view A XXX 0977077 TC Joint survey single view A XXX 0177077 26 Joint survey single view A XXX 0977078 Ct bone density axial A XXX 0977078 TC Ct bone density axial A XXX 0177078 26 Ct bone density axial A XXX 0977080 Dxa bone density axial A XXX 0977080 TC Dxa bone density axial A XXX 0177080 26 Dxa bone density axial A XXX 0977081 Dxa bone density/peripheral A XXX 0977081 TC Dxa bone density/peripheral A XXX 0177081 26 Dxa bone density/peripheral A XXX 0977084 Magnetic image bone marrow A XXX 0977084 TC Magnetic image bone marrow A XXX 0177084 26 Magnetic image bone marrow A XXX 0977085 Dxa bone density study A XXX 0977085 TC Dxa bone density study A XXX 0177085 26 Dxa bone density study A XXX 0977086 Fracture assessment via dxa A XXX 0977086 TC Fracture assessment via dxa A XXX 0177086 26 Fracture assessment via dxa A XXX 0977261 Radiation therapy planning A XXX 0977262 Radiation therapy planning A XXX 0977263 Radiation therapy planning A XXX 0977280 Set radiation therapy field A XXX 0977280 TC Set radiation therapy field A XXX 0977280 26 Set radiation therapy field A XXX 0977285 Set radiation therapy field A XXX 0977285 TC Set radiation therapy field A XXX 0977285 26 Set radiation therapy field A XXX 0977290 Set radiation therapy field A XXX 0977290 TC Set radiation therapy field A XXX 0977290 26 Set radiation therapy field A XXX 0977293 Respirator motion mgmt simul A ZZZ 0977293 TC Respirator motion mgmt simul A ZZZ 0977293 26 Respirator motion mgmt simul A ZZZ 0977295 3-d radiotherapy plan A XXX 0977295 TC 3-d radiotherapy plan A XXX 0977295 26 3-d radiotherapy plan A XXX 0977299 Radiation therapy planning C XXX 0977299 TC Radiation therapy planning C XXX 0977299 26 Radiation therapy planning C XXX 0977300 Radiation therapy dose plan A XXX 0977300 TC Radiation therapy dose plan A XXX 0977300 26 Radiation therapy dose plan A XXX 0977301 Radiotherapy dose plan imrt A XXX 0977301 TC Radiotherapy dose plan imrt A XXX 0977301 26 Radiotherapy dose plan imrt A XXX 0977306 Telethx isodose plan simple A XXX 0977306 TC Telethx isodose plan simple A XXX 09

77306 26 Telethx isodose plan simple A XXX 0977307 Telethx isodose plan cplx A XXX 0977307 TC Telethx isodose plan cplx A XXX 0977307 26 Telethx isodose plan cplx A XXX 0977316 Brachytx isodose plan simple A XXX 0977316 TC Brachytx isodose plan simple A XXX 0977316 26 Brachytx isodose plan simple A XXX 0977317 Brachytx isodose intermed A XXX 0977317 TC Brachytx isodose intermed A XXX 0977317 26 Brachytx isodose intermed A XXX 0977318 Brachytx isodose complex A XXX 0977318 TC Brachytx isodose complex A XXX 0977318 26 Brachytx isodose complex A XXX 0977321 Special teletx port plan A XXX 0977321 TC Special teletx port plan A XXX 0977321 26 Special teletx port plan A XXX 0977331 Special radiation dosimetry A XXX 0977331 TC Special radiation dosimetry A XXX 0977331 26 Special radiation dosimetry A XXX 0977332 Radiation treatment aid(s) A XXX 0977332 TC Radiation treatment aid(s) A XXX 0977332 26 Radiation treatment aid(s) A XXX 0977333 Radiation treatment aid(s) A XXX 0977333 TC Radiation treatment aid(s) A XXX 0977333 26 Radiation treatment aid(s) A XXX 0977334 Radiation treatment aid(s) A XXX 0977334 TC Radiation treatment aid(s) A XXX 0977334 26 Radiation treatment aid(s) A XXX 0977336 Radiation physics consult A XXX 0977338 Design mlc device for imrt A XXX 0977338 TC Design mlc device for imrt A XXX 0977338 26 Design mlc device for imrt A XXX 0977370 Radiation physics consult A XXX 0977371 Srs multisource C XXX 0977372 Srs linear based A XXX 0977373 Sbrt delivery A XXX 0977385 Ntsty modul rad tx dlvr smpl I XXX 0977386 Ntsty modul rad tx dlvr cplx I XXX 0977387 Guidance for radiaj tx dlvr I XXX 0977399 External radiation dosimetry C XXX 0977399 TC External radiation dosimetry C XXX 0977399 26 External radiation dosimetry C XXX 0977401 Radiation treatment delivery A XXX 0977402 Radiation treatment delivery I XXX 0977407 Radiation treatment delivery I XXX 0977412 Radiation treatment delivery I XXX 0977417 Radiology port film(s) A XXX 0177422 Neutron beam tx simple A XXX 0977423 Neutron beam tx complex A XXX 0977424 Io rad tx delivery by x-ray X XXX 09

77425 Io rad tx deliver by elctrns X XXX 0977427 Radiation tx management x5 A XXX 0977431 Radiation therapy management A XXX 0977432 Stereotactic radiation trmt A XXX 0977435 Sbrt management A XXX 0977469 Io radiation tx management A XXX 0977470 Special radiation treatment A XXX 0977470 TC Special radiation treatment A XXX 0977470 26 Special radiation treatment A XXX 0977499 Radiation therapy management C XXX 0977499 TC Radiation therapy management C XXX 0977499 26 Radiation therapy management C XXX 0977520 Proton trmt simple w/o comp C XXX 0977522 Proton trmt simple w/comp C XXX 0977523 Proton trmt intermediate C XXX 0977525 Proton treatment complex C XXX 0977600 Hyperthermia treatment R XXX 0977600 TC Hyperthermia treatment R XXX 0977600 26 Hyperthermia treatment R XXX 0977605 Hyperthermia treatment R XXX 0977605 TC Hyperthermia treatment R XXX 0977605 26 Hyperthermia treatment R XXX 0977610 Hyperthermia treatment R XXX 0977610 TC Hyperthermia treatment R XXX 0977610 26 Hyperthermia treatment R XXX 0977615 Hyperthermia treatment R XXX 0977615 TC Hyperthermia treatment R XXX 0977615 26 Hyperthermia treatment R XXX 0977620 Hyperthermia treatment R XXX 0977620 TC Hyperthermia treatment R XXX 0977620 26 Hyperthermia treatment R XXX 0977750 Infuse radioactive materials A 090 0977750 TC Infuse radioactive materials A 090 0977750 26 Infuse radioactive materials A 090 0977761 Apply intrcav radiat simple A 090 0977761 TC Apply intrcav radiat simple A 090 0977761 26 Apply intrcav radiat simple A 090 0977762 Apply intrcav radiat interm A 090 0977762 TC Apply intrcav radiat interm A 090 0977762 26 Apply intrcav radiat interm A 090 0977763 Apply intrcav radiat compl A 090 0977763 TC Apply intrcav radiat compl A 090 0977763 26 Apply intrcav radiat compl A 090 0977776 Apply interstit radiat simpl A 090 0977776 TC Apply interstit radiat simpl A 090 0977776 26 Apply interstit radiat simpl A 090 0977777 Apply interstit radiat inter A 090 0977777 TC Apply interstit radiat inter A 090 0977777 26 Apply interstit radiat inter A 090 0977778 Apply interstit radiat compl A 090 09

77778 TC Apply interstit radiat compl A 090 0977778 26 Apply interstit radiat compl A 090 0977785 Hdr brachytx 1 channel A XXX 0977785 TC Hdr brachytx 1 channel A XXX 0977785 26 Hdr brachytx 1 channel A XXX 0977786 Hdr brachytx 2-12 channel A XXX 0977786 TC Hdr brachytx 2-12 channel A XXX 0977786 26 Hdr brachytx 2-12 channel A XXX 0977787 Hdr brachytx over 12 chan A XXX 0977787 TC Hdr brachytx over 12 chan A XXX 0977787 26 Hdr brachytx over 12 chan A XXX 0977789 Apply surface radiation A 000 0977789 TC Apply surface radiation A 000 0977789 26 Apply surface radiation A 000 0977790 Radiation handling A XXX 0977790 TC Radiation handling A XXX 0977790 26 Radiation handling A XXX 0977799 Radium/radioisotope therapy C XXX 0977799 TC Radium/radioisotope therapy C XXX 0977799 26 Radium/radioisotope therapy C XXX 0978012 Thyroid uptake measurement A XXX 0978012 TC Thyroid uptake measurement A XXX 0978012 26 Thyroid uptake measurement A XXX 0978013 Thyroid imaging w/blood flow A XXX 0978013 TC Thyroid imaging w/blood flow A XXX 0978013 26 Thyroid imaging w/blood flow A XXX 0978014 Thyroid imaging w/blood flow A XXX 0978014 TC Thyroid imaging w/blood flow A XXX 0978014 26 Thyroid imaging w/blood flow A XXX 0978015 Thyroid met imaging A XXX 0978015 TC Thyroid met imaging A XXX 0178015 26 Thyroid met imaging A XXX 0978016 Thyroid met imaging/studies A XXX 0978016 TC Thyroid met imaging/studies A XXX 0178016 26 Thyroid met imaging/studies A XXX 0978018 Thyroid met imaging body A XXX 0978018 TC Thyroid met imaging body A XXX 0178018 26 Thyroid met imaging body A XXX 0978020 Thyroid met uptake A ZZZ 0978020 TC Thyroid met uptake A ZZZ 0978020 26 Thyroid met uptake A ZZZ 0978070 Parathyroid planar imaging A XXX 0978070 TC Parathyroid planar imaging A XXX 0178070 26 Parathyroid planar imaging A XXX 0978071 Parathyrd planar w/wo subtrj A XXX 0978071 TC Parathyrd planar w/wo subtrj A XXX 0978071 26 Parathyrd planar w/wo subtrj A XXX 0978072 Parathyrd planar w/spect&ct A XXX 0978072 TC Parathyrd planar w/spect&ct A XXX 0978072 26 Parathyrd planar w/spect&ct A XXX 09

78075 Adrenal cortex & medulla img A XXX 0978075 TC Adrenal cortex & medulla img A XXX 0178075 26 Adrenal cortex & medulla img A XXX 0978099 Endocrine nuclear procedure C XXX 0978099 TC Endocrine nuclear procedure C XXX 0978099 26 Endocrine nuclear procedure C XXX 0978102 Bone marrow imaging ltd A XXX 0978102 TC Bone marrow imaging ltd A XXX 0178102 26 Bone marrow imaging ltd A XXX 0978103 Bone marrow imaging mult A XXX 0978103 TC Bone marrow imaging mult A XXX 0178103 26 Bone marrow imaging mult A XXX 0978104 Bone marrow imaging body A XXX 0978104 TC Bone marrow imaging body A XXX 0178104 26 Bone marrow imaging body A XXX 0978110 Plasma volume single A XXX 0978110 TC Plasma volume single A XXX 0178110 26 Plasma volume single A XXX 0978111 Plasma volume multiple A XXX 0978111 TC Plasma volume multiple A XXX 0178111 26 Plasma volume multiple A XXX 0978120 Red cell mass single A XXX 0978120 TC Red cell mass single A XXX 0178120 26 Red cell mass single A XXX 0978121 Red cell mass multiple A XXX 0978121 TC Red cell mass multiple A XXX 0178121 26 Red cell mass multiple A XXX 0978122 Blood volume A XXX 0978122 TC Blood volume A XXX 0178122 26 Blood volume A XXX 0978130 Red cell survival study A XXX 0978130 TC Red cell survival study A XXX 0178130 26 Red cell survival study A XXX 0978135 Red cell survival kinetics A XXX 0978135 TC Red cell survival kinetics A XXX 0178135 26 Red cell survival kinetics A XXX 0978140 Red cell sequestration A XXX 0978140 TC Red cell sequestration A XXX 0178140 26 Red cell sequestration A XXX 0978185 Spleen imaging A XXX 0978185 TC Spleen imaging A XXX 0178185 26 Spleen imaging A XXX 0978190 Platelet survival kinetics A XXX 0978190 TC Platelet survival kinetics A XXX 0178190 26 Platelet survival kinetics A XXX 0978191 Platelet survival A XXX 0978191 TC Platelet survival A XXX 0178191 26 Platelet survival A XXX 0978195 Lymph system imaging A XXX 0978195 TC Lymph system imaging A XXX 01

78195 26 Lymph system imaging A XXX 0978199 Blood/lymph nuclear exam C XXX 0978199 TC Blood/lymph nuclear exam C XXX 0978199 26 Blood/lymph nuclear exam C XXX 0978201 Liver imaging A XXX 0978201 TC Liver imaging A XXX 0178201 26 Liver imaging A XXX 0978202 Liver imaging with flow A XXX 0978202 TC Liver imaging with flow A XXX 0178202 26 Liver imaging with flow A XXX 0978205 Liver imaging (3d) A XXX 0978205 TC Liver imaging (3d) A XXX 0178205 26 Liver imaging (3d) A XXX 0978206 Liver image (3d) with flow A XXX 0978206 TC Liver image (3d) with flow A XXX 0178206 26 Liver image (3d) with flow A XXX 0978215 Liver and spleen imaging A XXX 0978215 TC Liver and spleen imaging A XXX 0178215 26 Liver and spleen imaging A XXX 0978216 Liver & spleen image/flow A XXX 0978216 TC Liver & spleen image/flow A XXX 0178216 26 Liver & spleen image/flow A XXX 0978226 Hepatobiliary system imaging A XXX 0978226 TC Hepatobiliary system imaging A XXX 0178226 26 Hepatobiliary system imaging A XXX 0978227 Hepatobil syst image w/drug A XXX 0978227 TC Hepatobil syst image w/drug A XXX 0178227 26 Hepatobil syst image w/drug A XXX 0978230 Salivary gland imaging A XXX 0978230 TC Salivary gland imaging A XXX 0178230 26 Salivary gland imaging A XXX 0978231 Serial salivary imaging A XXX 0978231 TC Serial salivary imaging A XXX 0178231 26 Serial salivary imaging A XXX 0978232 Salivary gland function exam A XXX 0978232 TC Salivary gland function exam A XXX 0178232 26 Salivary gland function exam A XXX 0978258 Esophageal motility study A XXX 0978258 TC Esophageal motility study A XXX 0178258 26 Esophageal motility study A XXX 0978261 Gastric mucosa imaging A XXX 0978261 TC Gastric mucosa imaging A XXX 0178261 26 Gastric mucosa imaging A XXX 0978262 Gastroesophageal reflux exam A XXX 0978262 TC Gastroesophageal reflux exam A XXX 0178262 26 Gastroesophageal reflux exam A XXX 0978264 Gastric emptying study A XXX 0978264 TC Gastric emptying study A XXX 0178264 26 Gastric emptying study A XXX 0978267 Breath tst attain/anal c-14 X XXX 09

78268 Breath test analysis c-14 X XXX 0978270 Vit b-12 absorption exam A XXX 0978270 TC Vit b-12 absorption exam A XXX 0178270 26 Vit b-12 absorption exam A XXX 0978271 Vit b-12 absrp exam int fac A XXX 0978271 TC Vit b-12 absrp exam int fac A XXX 0178271 26 Vit b-12 absrp exam int fac A XXX 0978272 Vit b-12 absorp combined A XXX 0978272 TC Vit b-12 absorp combined A XXX 0178272 26 Vit b-12 absorp combined A XXX 0978278 Acute gi blood loss imaging A XXX 0978278 TC Acute gi blood loss imaging A XXX 0178278 26 Acute gi blood loss imaging A XXX 0978282 Gi protein loss exam C XXX 0978282 TC Gi protein loss exam C XXX 0178282 26 Gi protein loss exam A XXX 0978290 Meckels divert exam A XXX 0978290 TC Meckels divert exam A XXX 0178290 26 Meckels divert exam A XXX 0978291 Leveen/shunt patency exam A XXX 0978291 TC Leveen/shunt patency exam A XXX 0178291 26 Leveen/shunt patency exam A XXX 0978299 Gi nuclear procedure C XXX 0978299 TC Gi nuclear procedure C XXX 0978299 26 Gi nuclear procedure C XXX 0978300 Bone imaging limited area A XXX 0978300 TC Bone imaging limited area A XXX 0178300 26 Bone imaging limited area A XXX 0978305 Bone imaging multiple areas A XXX 0978305 TC Bone imaging multiple areas A XXX 0178305 26 Bone imaging multiple areas A XXX 0978306 Bone imaging whole body A XXX 0978306 TC Bone imaging whole body A XXX 0178306 26 Bone imaging whole body A XXX 0978315 Bone imaging 3 phase A XXX 0978315 TC Bone imaging 3 phase A XXX 0178315 26 Bone imaging 3 phase A XXX 0978320 Bone imaging (3d) A XXX 0978320 TC Bone imaging (3d) A XXX 0178320 26 Bone imaging (3d) A XXX 0978350 Bone mineral single photon N XXX 0978350 TC Bone mineral single photon N XXX 0178350 26 Bone mineral single photon N XXX 0978351 Bone mineral dual photon N XXX 0978399 Musculoskeletal nuclear exam C XXX 0978399 TC Musculoskeletal nuclear exam C XXX 0978399 26 Musculoskeletal nuclear exam C XXX 0978414 Non-imaging heart function C XXX 0978414 TC Non-imaging heart function C XXX 0178414 26 Non-imaging heart function A XXX 09

78428 Cardiac shunt imaging A XXX 0978428 TC Cardiac shunt imaging A XXX 0178428 26 Cardiac shunt imaging A XXX 0978445 Vascular flow imaging A XXX 0978445 TC Vascular flow imaging A XXX 0178445 26 Vascular flow imaging A XXX 0978451 Ht muscle image spect sing A XXX 0978451 TC Ht muscle image spect sing A XXX 0178451 26 Ht muscle image spect sing A XXX 0978452 Ht muscle image spect mult A XXX 0978452 TC Ht muscle image spect mult A XXX 0178452 26 Ht muscle image spect mult A XXX 0978453 Ht muscle image planar sing A XXX 0978453 TC Ht muscle image planar sing A XXX 0178453 26 Ht muscle image planar sing A XXX 0978454 Ht musc image planar mult A XXX 0978454 TC Ht musc image planar mult A XXX 0178454 26 Ht musc image planar mult A XXX 0978456 Acute venous thrombus image A XXX 0978456 TC Acute venous thrombus image A XXX 0978456 26 Acute venous thrombus image A XXX 0978457 Venous thrombosis imaging A XXX 0978457 TC Venous thrombosis imaging A XXX 0178457 26 Venous thrombosis imaging A XXX 0978458 Ven thrombosis images bilat A XXX 0978458 TC Ven thrombosis images bilat A XXX 0178458 26 Ven thrombosis images bilat A XXX 0978459 Heart muscle imaging (pet) C XXX 0978459 TC Heart muscle imaging (pet) C XXX 0978459 26 Heart muscle imaging (pet) A XXX 0978466 Heart infarct image A XXX 0978466 TC Heart infarct image A XXX 0178466 26 Heart infarct image A XXX 0978468 Heart infarct image (ef) A XXX 0978468 TC Heart infarct image (ef) A XXX 0178468 26 Heart infarct image (ef) A XXX 0978469 Heart infarct image (3d) A XXX 0978469 TC Heart infarct image (3d) A XXX 0178469 26 Heart infarct image (3d) A XXX 0978472 Gated heart planar single A XXX 0978472 TC Gated heart planar single A XXX 0178472 26 Gated heart planar single A XXX 0978473 Gated heart multiple A XXX 0978473 TC Gated heart multiple A XXX 0178473 26 Gated heart multiple A XXX 0978481 Heart first pass single A XXX 0978481 TC Heart first pass single A XXX 0178481 26 Heart first pass single A XXX 0978483 Heart first pass multiple A XXX 0978483 TC Heart first pass multiple A XXX 01

78483 26 Heart first pass multiple A XXX 0978491 Heart image (pet) single C XXX 0978491 TC Heart image (pet) single C XXX 0178491 26 Heart image (pet) single A XXX 0978492 Heart image (pet) multiple C XXX 0978492 TC Heart image (pet) multiple C XXX 0178492 26 Heart image (pet) multiple A XXX 0978494 Heart image spect A XXX 0978494 TC Heart image spect A XXX 0178494 26 Heart image spect A XXX 0978496 Heart first pass add-on A ZZZ 0978496 TC Heart first pass add-on A ZZZ 0178496 26 Heart first pass add-on A ZZZ 0978499 Cardiovascular nuclear exam C XXX 0978499 TC Cardiovascular nuclear exam C XXX 0978499 26 Cardiovascular nuclear exam C XXX 0978579 Lung ventilation imaging A XXX 0978579 TC Lung ventilation imaging A XXX 0178579 26 Lung ventilation imaging A XXX 0978580 Lung perfusion imaging A XXX 0978580 TC Lung perfusion imaging A XXX 0178580 26 Lung perfusion imaging A XXX 0978582 Lung ventilat&perfus imaging A XXX 0978582 TC Lung ventilat&perfus imaging A XXX 0178582 26 Lung ventilat&perfus imaging A XXX 0978597 Lung perfusion differential A XXX 0978597 TC Lung perfusion differential A XXX 0178597 26 Lung perfusion differential A XXX 0978598 Lung perf&ventilat diferentl A XXX 0978598 TC Lung perf&ventilat diferentl A XXX 0178598 26 Lung perf&ventilat diferentl A XXX 0978599 Respiratory nuclear exam C XXX 0978599 TC Respiratory nuclear exam C XXX 0978599 26 Respiratory nuclear exam C XXX 0978600 Brain image < 4 views A XXX 0978600 TC Brain image < 4 views A XXX 0178600 26 Brain image < 4 views A XXX 0978601 Brain image w/flow < 4 views A XXX 0978601 TC Brain image w/flow < 4 views A XXX 0178601 26 Brain image w/flow < 4 views A XXX 0978605 Brain image 4+ views A XXX 0978605 TC Brain image 4+ views A XXX 0178605 26 Brain image 4+ views A XXX 0978606 Brain image w/flow 4 + views A XXX 0978606 TC Brain image w/flow 4 + views A XXX 0178606 26 Brain image w/flow 4 + views A XXX 0978607 Brain imaging (3d) A XXX 0978607 TC Brain imaging (3d) A XXX 0178607 26 Brain imaging (3d) A XXX 0978608 Brain imaging (pet) C XXX 09

78608 TC Brain imaging (pet) C XXX 0178608 26 Brain imaging (pet) A XXX 0978609 Brain imaging (pet) N XXX 0978609 TC Brain imaging (pet) N XXX 0178609 26 Brain imaging (pet) N XXX 0978610 Brain flow imaging only A XXX 0978610 TC Brain flow imaging only A XXX 0178610 26 Brain flow imaging only A XXX 0978630 Cerebrospinal fluid scan A XXX 0978630 TC Cerebrospinal fluid scan A XXX 0178630 26 Cerebrospinal fluid scan A XXX 0978635 Csf ventriculography A XXX 0978635 TC Csf ventriculography A XXX 0178635 26 Csf ventriculography A XXX 0978645 Csf shunt evaluation A XXX 0978645 TC Csf shunt evaluation A XXX 0178645 26 Csf shunt evaluation A XXX 0978647 Cerebrospinal fluid scan A XXX 0978647 TC Cerebrospinal fluid scan A XXX 0178647 26 Cerebrospinal fluid scan A XXX 0978650 Csf leakage imaging A XXX 0978650 TC Csf leakage imaging A XXX 0178650 26 Csf leakage imaging A XXX 0978660 Nuclear exam of tear flow A XXX 0978660 TC Nuclear exam of tear flow A XXX 0178660 26 Nuclear exam of tear flow A XXX 0978699 Nervous system nuclear exam C XXX 0978699 TC Nervous system nuclear exam C XXX 0978699 26 Nervous system nuclear exam C XXX 0978700 Kidney imaging morphol A XXX 0978700 TC Kidney imaging morphol A XXX 0178700 26 Kidney imaging morphol A XXX 0978701 Kidney imaging with flow A XXX 0978701 TC Kidney imaging with flow A XXX 0178701 26 Kidney imaging with flow A XXX 0978707 K flow/funct image w/o drug A XXX 0978707 TC K flow/funct image w/o drug A XXX 0178707 26 K flow/funct image w/o drug A XXX 0978708 K flow/funct image w/drug A XXX 0978708 TC K flow/funct image w/drug A XXX 0178708 26 K flow/funct image w/drug A XXX 0978709 K flow/funct image multiple A XXX 0978709 TC K flow/funct image multiple A XXX 0178709 26 K flow/funct image multiple A XXX 0978710 Kidney imaging (3d) A XXX 0978710 TC Kidney imaging (3d) A XXX 0178710 26 Kidney imaging (3d) A XXX 0978725 Kidney function study A XXX 0978725 TC Kidney function study A XXX 0178725 26 Kidney function study A XXX 09

78730 Urinary bladder retention A ZZZ 0978730 TC Urinary bladder retention A ZZZ 0178730 26 Urinary bladder retention A ZZZ 0978740 Ureteral reflux study A XXX 0978740 TC Ureteral reflux study A XXX 0178740 26 Ureteral reflux study A XXX 0978761 Testicular imaging w/flow A XXX 0978761 TC Testicular imaging w/flow A XXX 0178761 26 Testicular imaging w/flow A XXX 0978799 Genitourinary nuclear exam C XXX 0978799 TC Genitourinary nuclear exam C XXX 0978799 26 Genitourinary nuclear exam C XXX 0978800 Tumor imaging limited area A XXX 0978800 TC Tumor imaging limited area A XXX 0178800 26 Tumor imaging limited area A XXX 0978801 Tumor imaging mult areas A XXX 0978801 TC Tumor imaging mult areas A XXX 0178801 26 Tumor imaging mult areas A XXX 0978802 Tumor imaging whole body A XXX 0978802 TC Tumor imaging whole body A XXX 0178802 26 Tumor imaging whole body A XXX 0978803 Tumor imaging (3d) A XXX 0978803 TC Tumor imaging (3d) A XXX 0178803 26 Tumor imaging (3d) A XXX 0978804 Tumor imaging whole body A XXX 0978804 TC Tumor imaging whole body A XXX 0178804 26 Tumor imaging whole body A XXX 0978805 Abscess imaging ltd area A XXX 0978805 TC Abscess imaging ltd area A XXX 0178805 26 Abscess imaging ltd area A XXX 0978806 Abscess imaging whole body A XXX 0978806 TC Abscess imaging whole body A XXX 0178806 26 Abscess imaging whole body A XXX 0978807 Nuclear localization/abscess A XXX 0978807 TC Nuclear localization/abscess A XXX 0178807 26 Nuclear localization/abscess A XXX 0978808 Iv inj ra drug dx study A XXX 0978811 Pet image ltd area C XXX 0978811 TC Pet image ltd area C XXX 0178811 26 Pet image ltd area A XXX 0978812 Pet image skull-thigh C XXX 0978812 TC Pet image skull-thigh C XXX 0178812 26 Pet image skull-thigh A XXX 0978813 Pet image full body C XXX 0978813 TC Pet image full body C XXX 0178813 26 Pet image full body A XXX 0978814 Pet image w/ct lmtd C XXX 0978814 TC Pet image w/ct lmtd C XXX 0178814 26 Pet image w/ct lmtd A XXX 0978815 Pet image w/ct skull-thigh C XXX 09

78815 TC Pet image w/ct skull-thigh C XXX 0178815 26 Pet image w/ct skull-thigh A XXX 0978816 Pet image w/ct full body C XXX 0978816 TC Pet image w/ct full body C XXX 0178816 26 Pet image w/ct full body A XXX 0978999 Nuclear diagnostic exam C XXX 0978999 TC Nuclear diagnostic exam C XXX 0978999 26 Nuclear diagnostic exam C XXX 0979005 Nuclear rx oral admin A XXX 0979005 TC Nuclear rx oral admin A XXX 0979005 26 Nuclear rx oral admin A XXX 0979101 Nuclear rx iv admin A XXX 0979101 TC Nuclear rx iv admin A XXX 0979101 26 Nuclear rx iv admin A XXX 0979200 Nuclear rx intracav admin A XXX 0979200 TC Nuclear rx intracav admin A XXX 0979200 26 Nuclear rx intracav admin A XXX 0979300 Nuclr rx interstit colloid C XXX 0979300 TC Nuclr rx interstit colloid C XXX 0979300 26 Nuclr rx interstit colloid A XXX 0979403 Hematopoietic nuclear tx A XXX 0979403 TC Hematopoietic nuclear tx A XXX 0979403 26 Hematopoietic nuclear tx A XXX 0979440 Nuclear rx intra-articular A XXX 0979440 TC Nuclear rx intra-articular A XXX 0979440 26 Nuclear rx intra-articular A XXX 0979445 Nuclear rx intra-arterial C XXX 0979445 TC Nuclear rx intra-arterial C XXX 0979445 26 Nuclear rx intra-arterial A XXX 0979999 Nuclear medicine therapy C XXX 0979999 TC Nuclear medicine therapy C XXX 0979999 26 Nuclear medicine therapy C XXX 0980047 Metabolic panel ionized ca X XXX 0980048 Metabolic panel total ca X XXX 0980050 General health panel N XXX 0980051 Electrolyte panel X XXX 0980053 Comprehen metabolic panel X XXX 0980055 Obstetric panel I XXX 0980061 Lipid panel X XXX 0980069 Renal function panel X XXX 0980074 Acute hepatitis panel X XXX 0980076 Hepatic function panel X XXX 0980150 Assay of amikacin X XXX 0980155 Drug screen quant caffeine X XXX 0980156 Assay carbamazepine total X XXX 0980157 Assay carbamazepine free X XXX 0980158 Assay of cyclosporine X XXX 0980159 Drug screen quant clozapine X XXX 0980162 Assay of digoxin total X XXX 0980163 Assay of digoxin free X XXX 09

80164 Assay dipropylacetic acd tot X XXX 0980165 Dipropylacetic acid free X XXX 0980168 Assay of ethosuximide X XXX 0980169 Drug screen quant everolimus X XXX 0980170 Assay of gentamicin X XXX 0980171 Drug screen quant gabapentin X XXX 0980173 Assay of haloperidol X XXX 0980175 Drug screen quan lamotrigine X XXX 0980176 Assay of lidocaine X XXX 0980177 Drug scrn quan levetiracetam X XXX 0980178 Assay of lithium X XXX 0980180 Drug scrn quan mycophenolate X XXX 0980183 Drug scrn quant oxcarbazepin X XXX 0980184 Assay of phenobarbital X XXX 0980185 Assay of phenytoin total X XXX 0980186 Assay of phenytoin free X XXX 0980188 Assay of primidone X XXX 0980190 Assay of procainamide X XXX 0980192 Assay of procainamide X XXX 0980194 Assay of quinidine X XXX 0980195 Assay of sirolimus X XXX 0980197 Assay of tacrolimus X XXX 0980198 Assay of theophylline X XXX 0980199 Drug screen quant tiagabine X XXX 0980200 Assay of tobramycin X XXX 0980201 Assay of topiramate X XXX 0980202 Assay of vancomycin X XXX 0980203 Drug screen quant zonisamide X XXX 0980299 Quantitative assay drug X XXX 0980300 Drug screen non tlc devices X XXX 0980301 Drug screen class list a X XXX 0980302 Drug screen prsmptv 1 class X XXX 0980303 Drug screen one/mult class X XXX 0980304 Drug screen one/mult class X XXX 0980320 Drug screen quantalcohols X XXX 0980321 Alcohols biomarkers 1or 2 X XXX 0980322 Alcohols biomarkers 3/more X XXX 0980323 Alkaloids nos X XXX 0980324 Drug screen amphetamines 1/2 X XXX 0980325 Amphetamines 3or 4 X XXX 0980326 Amphetamines 5 or more X XXX 0980327 Anabolic steroid 1 or 2 X XXX 0980328 Anabolic steroid 3 or more X XXX 0980329 Analgesics non-opioid 1 or 2 X XXX 0980330 Analgesics non-opioid 3-5 X XXX 0980331 Analgesics non-opioid 6/more X XXX 0980332 Antidepressants class 1 or 2 X XXX 0980333 Antidepressants class 3-5 X XXX 0980334 Antidepressants class 6/more X XXX 0980335 Antidepressant tricyclic 1/2 X XXX 09

80336 Antidepressant tricyclic 3-5 X XXX 0980337 Tricyclic & cyclicals 6/more X XXX 0980338 Antidepressant not specified X XXX 0980339 Antiepileptics nos 1-3 X XXX 0980340 Antiepileptics nos 4-6 X XXX 0980341 Antiepileptics nos 7/more X XXX 0980342 Antipsychotics nos 1-3 X XXX 0980343 Antipsychotics nos 4-6 X XXX 0980344 Antipsychotics nos 7/more X XXX 0980345 Drug screening barbiturates X XXX 0980346 Benzodiazepines1-12 X XXX 0980347 Benzodiazepines 13 or more X XXX 0980348 Drug screening buprenorphine X XXX 0980349 Cannabinoids natural X XXX 0980350 Cannabinoids synthetic 1-3 X XXX 0980351 Cannabinoids synthetic 4-6 X XXX 0980352 Cannabinoid synthetic 7/more X XXX 0980353 Drug screening cocaine X XXX 0980354 Drug screening fentanyl X XXX 0980355 Gabapentin non-blood X XXX 0980356 Heroin metabolite X XXX 0980357 Ketamine and norketamine X XXX 0980358 Drug screening methadone X XXX 0980359 Methylenedioxyamphetamines X XXX 0980360 Methylphenidate X XXX 0980361 Opiates 1 or more X XXX 0980362 Opioids & opiate analogs 1/2 X XXX 0980363 Opioids & opiate analogs 3/4 X XXX 0980364 Opioid &opiate analog 5/more X XXX 0980365 Drug screening oxycodone X XXX 0980366 Drug screening pregabalin X XXX 0980367 Drug screening propoxyphene X XXX 0980368 Sedative hypnotics X XXX 0980369 Skeletal muscle relaxant 1/2 X XXX 0980370 Skel musc relaxant 3 or more X XXX 0980371 Stimulants synthetic X XXX 0980372 Drug screening tapentadol X XXX 0980373 Drug screening tramadol X XXX 0980374 Stereoisomer analysis X XXX 0980375 Drug/substance nos 1-3 X XXX 0980376 Drug/substance nos 4-6 X XXX 0980377 Drug/substance nos 7/more X XXX 0980400 Acth stimulation panel X XXX 0980402 Acth stimulation panel X XXX 0980406 Acth stimulation panel X XXX 0980408 Aldosterone suppression eval X XXX 0980410 Calcitonin stimul panel X XXX 0980412 Crh stimulation panel X XXX 0980414 Testosterone response X XXX 0980415 Estradiol response panel X XXX 09

80416 Renin stimulation panel X XXX 0980417 Renin stimulation panel X XXX 0980418 Pituitary evaluation panel X XXX 0980420 Dexamethasone panel X XXX 0980422 Glucagon tolerance panel X XXX 0980424 Glucagon tolerance panel X XXX 0980426 Gonadotropin hormone panel X XXX 0980428 Growth hormone panel X XXX 0980430 Growth hormone panel X XXX 0980432 Insulin suppression panel X XXX 0980434 Insulin tolerance panel X XXX 0980435 Insulin tolerance panel X XXX 0980436 Metyrapone panel X XXX 0980438 Trh stimulation panel X XXX 0980439 Trh stimulation panel X XXX 0980500 Lab pathology consultation A XXX 0980502 Lab pathology consultation A XXX 0981000 Urinalysis nonauto w/scope X XXX 0981001 Urinalysis auto w/scope X XXX 0981002 Urinalysis nonauto w/o scope X XXX 0981003 Urinalysis auto w/o scope X XXX 0981005 Urinalysis X XXX 0981007 Urine screen for bacteria X XXX 0981015 Microscopic exam of urine X XXX 0981020 Urinalysis glass test X XXX 0981025 Urine pregnancy test X XXX 0981050 Urinalysis volume measure X XXX 0981099 Urinalysis test procedure X XXX 0981161 Dmd dup/delet analysis X XXX 0981200 Aspa gene X XXX 0981201 Apc gene full sequence X XXX 0981202 Apc gene known fam variants X XXX 0981203 Apc gene dup/delet variants X XXX 0981205 Bckdhb gene X XXX 0981206 Bcr/abl1 gene major bp X XXX 0981207 Bcr/abl1 gene minor bp X XXX 0981208 Bcr/abl1 gene other bp X XXX 0981209 Blm gene X XXX 0981210 Braf gene X XXX 0981211 Brca1&2 seq & com dup/del X XXX 0981212 Brca1&2 185&5385&6174 var X XXX 0981213 Brca1&2 uncom dup/del var X XXX 0981214 Brca1 full seq & com dup/del X XXX 0981215 Brca1 gene known fam variant X XXX 0981216 Brca2 gene full sequence X XXX 0981217 Brca2 gene known fam variant X XXX 0981220 Cftr gene com variants X XXX 0981221 Cftr gene known fam variants X XXX 0981222 Cftr gene dup/delet variants X XXX 0981223 Cftr gene full sequence X XXX 09

81224 Cftr gene intron poly t X XXX 0981225 Cyp2c19 gene com variants X XXX 0981226 Cyp2d6 gene com variants X XXX 0981227 Cyp2c9 gene com variants X XXX 0981228 Cytogen micrarray copy nmbr X XXX 0981229 Cytogen m array copy no&snp X XXX 0981235 Egfr gene com variants X XXX 0981240 F2 gene X XXX 0981241 F5 gene X XXX 0981242 Fancc gene X XXX 0981243 Fmr1 gene detection X XXX 0981244 Fmr1 gene characterization X XXX 0981245 Flt3 gene X XXX 0981246 Flt3 gene analysis X XXX 0981250 G6pc gene X XXX 0981251 Gba gene X XXX 0981252 Gjb2 gene full sequence X XXX 0981253 Gjb2 gene known fam variants X XXX 0981254 Gjb6 gene com variants X XXX 0981255 Hexa gene X XXX 0981256 Hfe gene X XXX 0981257 Hba1/hba2 gene X XXX 0981260 Ikbkap gene X XXX 0981261 Igh gene rearrange amp meth X XXX 0981262 Igh gene rearrang dir probe X XXX 0981263 Igh vari regional mutation X XXX 0981264 Igk rearrangeabn clonal pop X XXX 0981265 Str markers specimen anal X XXX 0981266 Str markers spec anal addl X XXX 0981267 Chimerism anal no cell selec X XXX 0981268 Chimerism anal w/cell select X XXX 0981270 Jak2 gene X XXX 0981275 Kras gene X XXX 0981280 Long qt synd gene full seq X XXX 0981281 Long qt synd known fam var X XXX 0981282 Long qt syn gene dup/dlt var X XXX 0981287 Mgmt gene methylation anal X XXX 0981288 Mlh1 gene X XXX 0981290 Mcoln1 gene X XXX 0981291 Mthfr gene X XXX 0981292 Mlh1 gene full seq X XXX 0981293 Mlh1 gene known variants X XXX 0981294 Mlh1 gene dup/delete variant X XXX 0981295 Msh2 gene full seq X XXX 0981296 Msh2 gene known variants X XXX 0981297 Msh2 gene dup/delete variant X XXX 0981298 Msh6 gene full seq X XXX 0981299 Msh6 gene known variants X XXX 0981300 Msh6 gene dup/delete variant X XXX 0981301 Microsatellite instability X XXX 09

81302 Mecp2 gene full seq X XXX 0981303 Mecp2 gene known variant X XXX 0981304 Mecp2 gene dup/delet variant X XXX 0981310 Npm1 gene X XXX 0981313 Pca3/klk3 antigen X XXX 0981315 Pml/raralpha com breakpoints X XXX 0981316 Pml/raralpha 1 breakpoint X XXX 0981317 Pms2 gene full seq analysis X XXX 0981318 Pms2 known familial variants X XXX 0981319 Pms2 gene dup/delet variants X XXX 0981321 Pten gene full sequence X XXX 0981322 Pten gene known fam variant X XXX 0981323 Pten gene dup/delet variant X XXX 0981324 Pmp22 gene dup/delet X XXX 0981325 Pmp22 gene full sequence X XXX 0981326 Pmp22 gene known fam variant X XXX 0981330 Smpd1 gene common variants X XXX 0981331 Snrpn/ube3a gene X XXX 0981332 Serpina1 gene X XXX 0981340 Trb@ gene rearrange amplify X XXX 0981341 Trb@ gene rearrange dirprobe X XXX 0981342 Trg gene rearrangement anal X XXX 0981350 Ugt1a1 gene X XXX 0981355 Vkorc1 gene X XXX 0981370 Hla i & ii typing lr X XXX 0981371 Hla i & ii type verify lr X XXX 0981372 Hla i typing complete lr X XXX 0981373 Hla i typing 1 locus lr X XXX 0981374 Hla i typing 1 antigen lr X XXX 0981375 Hla ii typing ag equiv lr X XXX 0981376 Hla ii typing 1 locus lr X XXX 0981377 Hla ii type 1 ag equiv lr X XXX 0981378 Hla i & ii typing hr X XXX 0981379 Hla i typing complete hr X XXX 0981380 Hla i typing 1 locus hr X XXX 0981381 Hla i typing 1 allele hr X XXX 0981382 Hla ii typing 1 loc hr X XXX 0981383 Hla ii typing 1 allele hr X XXX 0981400 Mopath procedure level 1 X XXX 0981401 Mopath procedure level 2 X XXX 0981402 Mopath procedure level 3 X XXX 0981403 Mopath procedure level 4 X XXX 0981404 Mopath procedure level 5 X XXX 0981405 Mopath procedure level 6 X XXX 0981406 Mopath procedure level 7 X XXX 0981407 Mopath procedure level 8 X XXX 0981408 Mopath procedure level 9 X XXX 0981410 Aortic dysfunction/dilation X XXX 0981411 Aortic dysfunction/dilation X XXX 0981415 Exome sequence analysis X XXX 09

81416 Exome sequence analysis X XXX 0981417 Exome re-evaluation X XXX 0981420 Fetal chrmoml aneuploidy X XXX 0981425 Genome sequence analysis X XXX 0981426 Genome sequence analysis X XXX 0981427 Genome re-evaluation X XXX 0981430 Hearing loss sequence analys X XXX 0981431 Hearing loss dup/del analys X XXX 0981435 Hereditary colon cancer X XXX 0981436 Hereditary colon ca synd X XXX 0981440 Mitochondrial gene X XXX 0981445 Targeted genomic seq analys X XXX 0981450 Targeted genomic seq analys X XXX 0981455 Targeted genomic seq analys X XXX 0981460 Whole mitochondrial genome X XXX 0981465 Whole mitochondrial genome X XXX 0981470 X-linked intellectual dblt X XXX 0981471 X-linked intellectual dblt X XXX 0981479 Unlisted molecular pathology X XXX 0981500 Onco (ovar) two proteins I XXX 0981503 Onco (ovar) five proteins I XXX 0981504 Oncology tissue of origin X XXX 0981506 Endo assay seven anal I XXX 0981507 Fetal aneuploidy trisom risk X XXX 0981508 Ftl cgen abnor two proteins I XXX 0981509 Ftl cgen abnor 3 proteins I XXX 0981510 Ftl cgen abnor three anal I XXX 0981511 Ftl cgen abnor four anal I XXX 0981512 Ftl cgen abnor five anal I XXX 0981519 Oncology breast mrna X XXX 0981599 Unlisted maaa I XXX 0982009 Test for acetone/ketones X XXX 0982010 Acetone assay X XXX 0982013 Acetylcholinesterase assay X XXX 0982016 Acylcarnitines qual X XXX 0982017 Acylcarnitines quant X XXX 0982024 Assay of acth X XXX 0982030 Assay of adp & amp X XXX 0982040 Assay of serum albumin X XXX 0982042 Assay of urine albumin X XXX 0982043 Microalbumin quantitative X XXX 0982044 Microalbumin semiquant X XXX 0982045 Albumin ischemia modified X XXX 0982075 Assay of breath ethanol X XXX 0982085 Assay of aldolase X XXX 0982088 Assay of aldosterone X XXX 0982103 Alpha-1-antitrypsin total X XXX 0982104 Alpha-1-antitrypsin pheno X XXX 0982105 Alpha-fetoprotein serum X XXX 0982106 Alpha-fetoprotein amniotic X XXX 09

82107 Alpha-fetoprotein l3 X XXX 0982108 Assay of aluminum X XXX 0982120 Amines vaginal fluid qual X XXX 0982127 Amino acid single qual X XXX 0982128 Amino acids mult qual X XXX 0982131 Amino acids single quant X XXX 0982135 Assay aminolevulinic acid X XXX 0982136 Amino acids quant 2-5 X XXX 0982139 Amino acids quan 6 or more X XXX 0982140 Assay of ammonia X XXX 0982143 Amniotic fluid scan X XXX 0982150 Assay of amylase X XXX 0982154 Androstanediol glucuronide X XXX 0982157 Assay of androstenedione X XXX 0982160 Assay of androsterone X XXX 0982163 Assay of angiotensin ii X XXX 0982164 Angiotensin i enzyme test X XXX 0982172 Assay of apolipoprotein X XXX 0982175 Assay of arsenic X XXX 0982180 Assay of ascorbic acid X XXX 0982190 Atomic absorption X XXX 0982232 Assay of beta-2 protein X XXX 0982239 Bile acids total X XXX 0982240 Bile acids cholylglycine X XXX 0982247 Bilirubin total X XXX 0982248 Bilirubin direct X XXX 0982252 Fecal bilirubin test X XXX 0982261 Assay of biotinidase X XXX 0982270 Occult blood feces X XXX 0982271 Occult blood other sources X XXX 0982272 Occult bld feces 1-3 tests X XXX 0982274 Assay test for blood fecal X XXX 0982286 Assay of bradykinin X XXX 0982300 Assay of cadmium X XXX 0982306 Vitamin d 25 hydroxy X XXX 0982308 Assay of calcitonin X XXX 0982310 Assay of calcium X XXX 0982330 Assay of calcium X XXX 0982331 Calcium infusion test X XXX 0982340 Assay of calcium in urine X XXX 0982355 Calculus analysis qual X XXX 0982360 Calculus assay quant X XXX 0982365 Calculus spectroscopy X XXX 0982370 X-ray assay calculus X XXX 0982373 Assay c-d transfer measure X XXX 0982374 Assay blood carbon dioxide X XXX 0982375 Assay carboxyhb quant X XXX 0982376 Assay carboxyhb qual X XXX 0982378 Carcinoembryonic antigen X XXX 0982379 Assay of carnitine X XXX 09

82380 Assay of carotene X XXX 0982382 Assay urine catecholamines X XXX 0982383 Assay blood catecholamines X XXX 0982384 Assay three catecholamines X XXX 0982387 Assay of cathepsin-d X XXX 0982390 Assay of ceruloplasmin X XXX 0982397 Chemiluminescent assay X XXX 0982415 Assay of chloramphenicol X XXX 0982435 Assay of blood chloride X XXX 0982436 Assay of urine chloride X XXX 0982438 Assay other fluid chlorides X XXX 0982441 Test for chlorohydrocarbons X XXX 0982465 Assay bld/serum cholesterol X XXX 0982480 Assay serum cholinesterase X XXX 0982482 Assay rbc cholinesterase X XXX 0982485 Assay chondroitin sulfate X XXX 0982486 Gas/liquid chromatography X XXX 0982487 Paper chromatography X XXX 0982488 Paper chromatography X XXX 0982489 Thin layer chromatography X XXX 0982491 Chromotography quant sing X XXX 0982492 Chromotography quant mult X XXX 0982495 Assay of chromium X XXX 0982507 Assay of citrate X XXX 0982523 Collagen crosslinks X XXX 0982525 Assay of copper X XXX 0982528 Assay of corticosterone X XXX 0982530 Cortisol free X XXX 0982533 Total cortisol X XXX 0982540 Assay of creatine X XXX 0982541 Column chromotography qual X XXX 0982542 Column chromotography quant X XXX 0982543 Column chromotograph/isotope X XXX 0982544 Column chromotograph/isotope X XXX 0982550 Assay of ck (cpk) X XXX 0982552 Assay of cpk in blood X XXX 0982553 Creatine mb fraction X XXX 0982554 Creatine isoforms X XXX 0982565 Assay of creatinine X XXX 0982570 Assay of urine creatinine X XXX 0982575 Creatinine clearance test X XXX 0982585 Assay of cryofibrinogen X XXX 0982595 Assay of cryoglobulin X XXX 0982600 Assay of cyanide X XXX 0982607 Vitamin b-12 X XXX 0982608 B-12 binding capacity X XXX 0982610 Cystatin c X XXX 0982615 Test for urine cystines X XXX 0982626 Dehydroepiandrosterone X XXX 0982627 Dehydroepiandrosterone X XXX 09

82633 Desoxycorticosterone X XXX 0982634 Deoxycortisol X XXX 0982638 Assay of dibucaine number X XXX 0982652 Vit d 1 25-dihydroxy X XXX 0982656 Pancreatic elastase fecal X XXX 0982657 Enzyme cell activity X XXX 0982658 Enzyme cell activity ra X XXX 0982664 Electrophoretic test X XXX 0982668 Assay of erythropoietin X XXX 0982670 Assay of estradiol X XXX 0982671 Assay of estrogens X XXX 0982672 Assay of estrogen X XXX 0982677 Assay of estriol X XXX 0982679 Assay of estrone X XXX 0982693 Assay of ethylene glycol X XXX 0982696 Assay of etiocholanolone X XXX 0982705 Fats/lipids feces qual X XXX 0982710 Fats/lipids feces quant X XXX 0982715 Assay of fecal fat X XXX 0982725 Assay of blood fatty acids X XXX 0982726 Long chain fatty acids X XXX 0982728 Assay of ferritin X XXX 0982731 Assay of fetal fibronectin X XXX 0982735 Assay of fluoride X XXX 0982746 Assay of folic acid serum X XXX 0982747 Assay of folic acid rbc X XXX 0982757 Assay of semen fructose X XXX 0982759 Assay of rbc galactokinase X XXX 0982760 Assay of galactose X XXX 0982775 Assay galactose transferase X XXX 0982776 Galactose transferase test X XXX 0982777 Galectin-3 X XXX 0982784 Assay iga/igd/igg/igm each X XXX 0982785 Assay of ige X XXX 0982787 Igg 1 2 3 or 4 each X XXX 0982800 Blood ph X XXX 0982803 Blood gases any combination X XXX 0982805 Blood gases w/o2 saturation X XXX 0982810 Blood gases o2 sat only X XXX 0982820 Hemoglobin-oxygen affinity X XXX 0982930 Gastric analy w/ph ea spec X XXX 0982938 Gastrin test X XXX 0982941 Assay of gastrin X XXX 0982943 Assay of glucagon X XXX 0982945 Glucose other fluid X XXX 0982946 Glucagon tolerance test X XXX 0982947 Assay glucose blood quant X XXX 0982948 Reagent strip/blood glucose X XXX 0982950 Glucose test X XXX 0982951 Glucose tolerance test (gtt) X XXX 09

82952 Gtt-added samples X XXX 0982955 Assay of g6pd enzyme X XXX 0982960 Test for g6pd enzyme X XXX 0982962 Glucose blood test X XXX 0982963 Assay of glucosidase X XXX 0982965 Assay of gdh enzyme X XXX 0982977 Assay of ggt X XXX 0982978 Assay of glutathione X XXX 0982979 Assay rbc glutathione X XXX 0982985 Assay of glycated protein X XXX 0983001 Assay of gonadotropin (fsh) X XXX 0983002 Assay of gonadotropin (lh) X XXX 0983003 Assay growth hormone (hgh) X XXX 0983006 Growth stimulation gene 2 X XXX 0983009 H pylori (c-13) blood X XXX 0983010 Assay of haptoglobin quant X XXX 0983012 Assay of haptoglobins X XXX 0983013 H pylori (c-13) breath X XXX 0983014 H pylori drug admin X XXX 0983015 Heavy metal screen X XXX 0983018 Quantitative screen metals X XXX 0983020 Hemoglobin electrophoresis X XXX 0983020 26 Hemoglobin electrophoresis A XXX 0983021 Hemoglobin chromotography X XXX 0983026 Hemoglobin copper sulfate X XXX 0983030 Fetal hemoglobin chemical X XXX 0983033 Fetal hemoglobin assay qual X XXX 0983036 Glycosylated hemoglobin test X XXX 0983037 Glycosylated hb home device X XXX 0983045 Blood methemoglobin test X XXX 0983050 Blood methemoglobin assay X XXX 0983051 Assay of plasma hemoglobin X XXX 0983060 Blood sulfhemoglobin assay X XXX 0983065 Assay of hemoglobin heat X XXX 0983068 Hemoglobin stability screen X XXX 0983069 Assay of urine hemoglobin X XXX 0983070 Assay of hemosiderin qual X XXX 0983080 Assay of b hexosaminidase X XXX 0983088 Assay of histamine X XXX 0983090 Assay of homocystine X XXX 0983150 Assay of homovanillic acid X XXX 0983491 Assay of corticosteroids 17 X XXX 0983497 Assay of 5-hiaa X XXX 0983498 Assay of progesterone 17-d X XXX 0983499 Assay of progesterone 20- X XXX 0983500 Assay free hydroxyproline X XXX 0983505 Assay total hydroxyproline X XXX 0983516 Immunoassay nonantibody X XXX 0983518 Immunoassay dipstick X XXX 0983519 Ria nonantibody X XXX 09

83520 Immunoassay quant nos nonab X XXX 0983525 Assay of insulin X XXX 0983527 Assay of insulin X XXX 0983528 Assay of intrinsic factor X XXX 0983540 Assay of iron X XXX 0983550 Iron binding test X XXX 0983570 Assay of idh enzyme X XXX 0983582 Assay of ketogenic steroids X XXX 0983586 Assay 17- ketosteroids X XXX 0983593 Fractionation ketosteroids X XXX 0983605 Assay of lactic acid X XXX 0983615 Lactate (ld) (ldh) enzyme X XXX 0983625 Assay of ldh enzymes X XXX 0983630 Lactoferrin fecal (qual) X XXX 0983631 Lactoferrin fecal (quant) X XXX 0983632 Placental lactogen X XXX 0983633 Test urine for lactose X XXX 0983655 Assay of lead X XXX 0983661 L/s ratio fetal lung X XXX 0983662 Foam stability fetal lung X XXX 0983663 Fluoro polarize fetal lung X XXX 0983664 Lamellar bdy fetal lung X XXX 0983670 Assay of lap enzyme X XXX 0983690 Assay of lipase X XXX 0983695 Assay of lipoprotein(a) X XXX 0983698 Assay lipoprotein pla2 X XXX 0983700 Lipopro bld electrophoretic X XXX 0983701 Lipoprotein bld hr fraction X XXX 0983704 Lipoprotein bld by nmr X XXX 0983718 Assay of lipoprotein X XXX 0983719 Assay of blood lipoprotein X XXX 0983721 Assay of blood lipoprotein X XXX 0983727 Assay of lrh hormone X XXX 0983735 Assay of magnesium X XXX 0983775 Assay malate dehydrogenase X XXX 0983785 Assay of manganese X XXX 0983788 Mass spectrometry qual X XXX 0983789 Mass spectrometry quant X XXX 0983825 Assay of mercury X XXX 0983835 Assay of metanephrines X XXX 0983857 Assay of methemalbumin X XXX 0983861 Microfluid analy tears X XXX 0983864 Mucopolysaccharides X XXX 0983872 Assay synovial fluid mucin X XXX 0983873 Assay of csf protein X XXX 0983874 Assay of myoglobin X XXX 0983876 Assay myeloperoxidase X XXX 0983880 Assay of natriuretic peptide X XXX 0983883 Assay nephelometry not spec X XXX 0983885 Assay of nickel X XXX 09

83915 Assay of nucleotidase X XXX 0983916 Oligoclonal bands X XXX 0983918 Organic acids total quant X XXX 0983919 Organic acids qual each X XXX 0983921 Organic acid single quant X XXX 0983930 Assay of blood osmolality X XXX 0983935 Assay of urine osmolality X XXX 0983937 Assay of osteocalcin X XXX 0983945 Assay of oxalate X XXX 0983950 Oncoprotein her-2/neu X XXX 0983951 Oncoprotein dcp X XXX 0983970 Assay of parathormone X XXX 0983986 Assay ph body fluid nos X XXX 0983987 Exhaled breath condensate X XXX 0983992 Assay for phencyclidine X XXX 0983993 Assay for calprotectin fecal X XXX 0984030 Assay of blood pku X XXX 0984035 Assay of phenylketones X XXX 0984060 Assay acid phosphatase X XXX 0984061 Phosphatase forensic exam X XXX 0984066 Assay prostate phosphatase X XXX 0984075 Assay alkaline phosphatase X XXX 0984078 Assay alkaline phosphatase X XXX 0984080 Assay alkaline phosphatases X XXX 0984081 Assay phosphatidylglycerol X XXX 0984085 Assay of rbc pg6d enzyme X XXX 0984087 Assay phosphohexose enzymes X XXX 0984100 Assay of phosphorus X XXX 0984105 Assay of urine phosphorus X XXX 0984106 Test for porphobilinogen X XXX 0984110 Assay of porphobilinogen X XXX 0984112 Eval amniotic fluid protein X XXX 0984119 Test urine for porphyrins X XXX 0984120 Assay of urine porphyrins X XXX 0984126 Assay of feces porphyrins X XXX 0984132 Assay of serum potassium X XXX 0984133 Assay of urine potassium X XXX 0984134 Assay of prealbumin X XXX 0984135 Assay of pregnanediol X XXX 0984138 Assay of pregnanetriol X XXX 0984140 Assay of pregnenolone X XXX 0984143 Assay of 17-hydroxypregneno X XXX 0984144 Assay of progesterone X XXX 0984145 Procalcitonin (pct) X XXX 0984146 Assay of prolactin X XXX 0984150 Assay of prostaglandin X XXX 0984152 Assay of psa complexed X XXX 0984153 Assay of psa total X XXX 0984154 Assay of psa free X XXX 0984155 Assay of protein serum X XXX 09

84156 Assay of protein urine X XXX 0984157 Assay of protein other X XXX 0984160 Assay of protein any source X XXX 0984163 Pappa serum X XXX 0984165 Protein e-phoresis serum X XXX 0984165 26 Protein e-phoresis serum A XXX 0984166 Protein e-phoresis/urine/csf X XXX 0984166 26 Protein e-phoresis/urine/csf A XXX 0984181 Western blot test X XXX 0984181 26 Western blot test A XXX 0984182 Protein western blot test X XXX 0984182 26 Protein western blot test A XXX 0984202 Assay rbc protoporphyrin X XXX 0984203 Test rbc protoporphyrin X XXX 0984206 Assay of proinsulin X XXX 0984207 Assay of vitamin b-6 X XXX 0984210 Assay of pyruvate X XXX 0984220 Assay of pyruvate kinase X XXX 0984228 Assay of quinine X XXX 0984233 Assay of estrogen X XXX 0984234 Assay of progesterone X XXX 0984235 Assay of endocrine hormone X XXX 0984238 Assay nonendocrine receptor X XXX 0984244 Assay of renin X XXX 0984252 Assay of vitamin b-2 X XXX 0984255 Assay of selenium X XXX 0984260 Assay of serotonin X XXX 0984270 Assay of sex hormone globul X XXX 0984275 Assay of sialic acid X XXX 0984285 Assay of silica X XXX 0984295 Assay of serum sodium X XXX 0984300 Assay of urine sodium X XXX 0984302 Assay of sweat sodium X XXX 0984305 Assay of somatomedin X XXX 0984307 Assay of somatostatin X XXX 0984311 Spectrophotometry X XXX 0984315 Body fluid specific gravity X XXX 0984375 Chromatogram assay sugars X XXX 0984376 Sugars single qual X XXX 0984377 Sugars multiple qual X XXX 0984378 Sugars single quant X XXX 0984379 Sugars multiple quant X XXX 0984392 Assay of urine sulfate X XXX 0984402 Assay of free testosterone X XXX 0984403 Assay of total testosterone X XXX 0984425 Assay of vitamin b-1 X XXX 0984430 Assay of thiocyanate X XXX 0984431 Thromboxane urine X XXX 0984432 Assay of thyroglobulin X XXX 0984436 Assay of total thyroxine X XXX 09

84437 Assay of neonatal thyroxine X XXX 0984439 Assay of free thyroxine X XXX 0984442 Assay of thyroid activity X XXX 0984443 Assay thyroid stim hormone X XXX 0984445 Assay of tsi globulin X XXX 0984446 Assay of vitamin e X XXX 0984449 Assay of transcortin X XXX 0984450 Transferase (ast) (sgot) X XXX 0984460 Alanine amino (alt) (sgpt) X XXX 0984466 Assay of transferrin X XXX 0984478 Assay of triglycerides X XXX 0984479 Assay of thyroid (t3 or t4) X XXX 0984480 Assay triiodothyronine (t3) X XXX 0984481 Free assay (ft-3) X XXX 0984482 T3 reverse X XXX 0984484 Assay of troponin quant X XXX 0984485 Assay duodenal fluid trypsin X XXX 0984488 Test feces for trypsin X XXX 0984490 Assay of feces for trypsin X XXX 0984510 Assay of tyrosine X XXX 0984512 Assay of troponin qual X XXX 0984520 Assay of urea nitrogen X XXX 0984525 Urea nitrogen semi-quant X XXX 0984540 Assay of urine/urea-n X XXX 0984545 Urea-n clearance test X XXX 0984550 Assay of blood/uric acid X XXX 0984560 Assay of urine/uric acid X XXX 0984577 Assay of feces/urobilinogen X XXX 0984578 Test urine urobilinogen X XXX 0984580 Assay of urine urobilinogen X XXX 0984583 Assay of urine urobilinogen X XXX 0984585 Assay of urine vma X XXX 0984586 Assay of vip X XXX 0984588 Assay of vasopressin X XXX 0984590 Assay of vitamin a X XXX 0984591 Assay of nos vitamin X XXX 0984597 Assay of vitamin k X XXX 0984600 Assay of volatiles X XXX 0984620 Xylose tolerance test X XXX 0984630 Assay of zinc X XXX 0984681 Assay of c-peptide X XXX 0984702 Chorionic gonadotropin test X XXX 0984703 Chorionic gonadotropin assay X XXX 0984704 Hcg free betachain test X XXX 0984830 Ovulation tests X XXX 0984999 Clinical chemistry test X XXX 0985002 Bleeding time test X XXX 0985004 Automated diff wbc count X XXX 0985007 Bl smear w/diff wbc count X XXX 0985008 Bl smear w/o diff wbc count X XXX 09

85009 Manual diff wbc count b-coat X XXX 0985013 Spun microhematocrit X XXX 0985014 Hematocrit X XXX 0985018 Hemoglobin X XXX 0985025 Complete cbc w/auto diff wbc X XXX 0985027 Complete cbc automated X XXX 0985032 Manual cell count each X XXX 0985041 Automated rbc count X XXX 0985044 Manual reticulocyte count X XXX 0985045 Automated reticulocyte count X XXX 0985046 Reticyte/hgb concentrate X XXX 0985048 Automated leukocyte count X XXX 0985049 Automated platelet count X XXX 0985055 Reticulated platelet assay X XXX 0985060 Blood smear interpretation A XXX 0985097 Bone marrow interpretation A XXX 0985130 Chromogenic substrate assay X XXX 0985170 Blood clot retraction X XXX 0985175 Blood clot lysis time X XXX 0985210 Clot factor ii prothrom spec X XXX 0985220 Blooc clot factor v test X XXX 0985230 Clot factor vii proconvertin X XXX 0985240 Clot factor viii ahg 1 stage X XXX 0985244 Clot factor viii reltd antgn X XXX 0985245 Clot factor viii vw ristoctn X XXX 0985246 Clot factor viii vw antigen X XXX 0985247 Clot factor viii multimetric X XXX 0985250 Clot factor ix ptc/chrstmas X XXX 0985260 Clot factor x stuart-power X XXX 0985270 Clot factor xi pta X XXX 0985280 Clot factor xii hageman X XXX 0985290 Clot factor xiii fibrin stab X XXX 0985291 Clot factor xiii fibrin scrn X XXX 0985292 Clot factor fletcher fact X XXX 0985293 Clot factor wght kininogen X XXX 0985300 Antithrombin iii activity X XXX 0985301 Antithrombin iii antigen X XXX 0985302 Clot inhibit prot c antigen X XXX 0985303 Clot inhibit prot c activity X XXX 0985305 Clot inhibit prot s total X XXX 0985306 Clot inhibit prot s free X XXX 0985307 Assay activated protein c X XXX 0985335 Factor inhibitor test X XXX 0985337 Thrombomodulin X XXX 0985345 Coagulation time lee & white X XXX 0985347 Coagulation time activated X XXX 0985348 Coagulation time otr method X XXX 0985360 Euglobulin lysis X XXX 0985362 Fibrin degradation products X XXX 0985366 Fibrinogen test X XXX 09

85370 Fibrinogen test X XXX 0985378 Fibrin degrade semiquant X XXX 0985379 Fibrin degradation quant X XXX 0985380 Fibrin degradj d-dimer X XXX 0985384 Fibrinogen activity X XXX 0985385 Fibrinogen antigen X XXX 0985390 Fibrinolysins screen i&r X XXX 0985390 26 Fibrinolysins screen i&r A XXX 0985396 Clotting assay whole blood A XXX 0985397 Clotting funct activity X XXX 0985400 Fibrinolytic plasmin X XXX 0985410 Fibrinolytic antiplasmin X XXX 0985415 Fibrinolytic plasminogen X XXX 0985420 Fibrinolytic plasminogen X XXX 0985421 Fibrinolytic plasminogen X XXX 0985441 Heinz bodies direct X XXX 0985445 Heinz bodies induced X XXX 0985460 Hemoglobin fetal X XXX 0985461 Hemoglobin fetal X XXX 0985475 Hemolysin acid X XXX 0985520 Heparin assay X XXX 0985525 Heparin neutralization X XXX 0985530 Heparin-protamine tolerance X XXX 0985536 Iron stain peripheral blood X XXX 0985540 Wbc alkaline phosphatase X XXX 0985547 Rbc mechanical fragility X XXX 0985549 Muramidase X XXX 0985555 Rbc osmotic fragility X XXX 0985557 Rbc osmotic fragility X XXX 0985576 Blood platelet aggregation X XXX 0985576 26 Blood platelet aggregation A XXX 0985597 Phospholipid pltlt neutraliz X XXX 0985598 Hexagnal phosph pltlt neutrl X XXX 0985610 Prothrombin time X XXX 0985611 Prothrombin test X XXX 0985612 Viper venom prothrombin time X XXX 0985613 Russell viper venom diluted X XXX 0985635 Reptilase test X XXX 0985651 Rbc sed rate nonautomated X XXX 0985652 Rbc sed rate automated X XXX 0985660 Rbc sickle cell test X XXX 0985670 Thrombin time plasma X XXX 0985675 Thrombin time titer X XXX 0985705 Thromboplastin inhibition X XXX 0985730 Thromboplastin time partial X XXX 0985732 Thromboplastin time partial X XXX 0985810 Blood viscosity examination X XXX 0985999 Hematology procedure X XXX 0986000 Agglutinins febrile antigen X XXX 0986001 Allergen specific igg X XXX 09

86003 Allergen specific ige X XXX 0986005 Allergen specific ige X XXX 0986021 Wbc antibody identification X XXX 0986022 Platelet antibodies X XXX 0986023 Immunoglobulin assay X XXX 0986038 Antinuclear antibodies X XXX 0986039 Antinuclear antibodies (ana) X XXX 0986060 Antistreptolysin o titer X XXX 0986063 Antistreptolysin o screen X XXX 0986077 Phys blood bank serv xmatch A XXX 0986078 Phys blood bank serv reactj A XXX 0986079 Phys blood bank serv authrj A XXX 0986140 C-reactive protein X XXX 0986141 C-reactive protein hs X XXX 0986146 Beta-2 glycoprotein antibody X XXX 0986147 Cardiolipin antibody ea ig X XXX 0986148 Anti-phospholipid antibody X XXX 0986152 Cell enumeration & id X XXX 0986153 26 Cell enumeration phys interp A XXX 0986155 Chemotaxis assay X XXX 0986156 Cold agglutinin screen X XXX 0986157 Cold agglutinin titer X XXX 0986160 Complement antigen X XXX 0986161 Complement/function activity X XXX 0986162 Complement total (ch50) X XXX 0986171 Complement fixation each X XXX 0986185 Counterimmunoelectrophoresis X XXX 0986200 Ccp antibody X XXX 0986215 Deoxyribonuclease antibody X XXX 0986225 Dna antibody native X XXX 0986226 Dna antibody single strand X XXX 0986235 Nuclear antigen antibody X XXX 0986243 Fc receptor X XXX 0986255 Fluorescent antibody screen X XXX 0986255 26 Fluorescent antibody screen A XXX 0986256 Fluorescent antibody titer X XXX 0986256 26 Fluorescent antibody titer A XXX 0986277 Growth hormone antibody X XXX 0986280 Hemagglutination inhibition X XXX 0986294 Immunoassay tumor qual X XXX 0986300 Immunoassay tumor ca 15-3 X XXX 0986301 Immunoassay tumor ca 19-9 X XXX 0986304 Immunoassay tumor ca 125 X XXX 0986305 Human epididymis protein 4 X XXX 0986308 Heterophile antibody screen X XXX 0986309 Heterophile antibody titer X XXX 0986310 Heterophile antibody absrbj X XXX 0986316 Immunoassay tumor other X XXX 0986317 Immunoassay infectious agent X XXX 0986318 Immunoassay infectious agent X XXX 09

86320 Serum immunoelectrophoresis X XXX 0986320 26 Serum immunoelectrophoresis A XXX 0986325 Other immunoelectrophoresis X XXX 0986325 26 Other immunoelectrophoresis A XXX 0986327 Immunoelectrophoresis assay X XXX 0986327 26 Immunoelectrophoresis assay A XXX 0986329 Immunodiffusion nes X XXX 0986331 Immunodiffusion ouchterlony X XXX 0986332 Immune complex assay X XXX 0986334 Immunofix e-phoresis serum X XXX 0986334 26 Immunofix e-phoresis serum A XXX 0986335 Immunfix e-phorsis/urine/csf X XXX 0986335 26 Immunfix e-phorsis/urine/csf A XXX 0986336 Inhibin a X XXX 0986337 Insulin antibodies X XXX 0986340 Intrinsic factor antibody X XXX 0986341 Islet cell antibody X XXX 0986343 Leukocyte histamine release X XXX 0986344 Leukocyte phagocytosis X XXX 0986352 Cell function assay w/stim X XXX 0986353 Lymphocyte transformation X XXX 0986355 B cells total count X XXX 0986356 Mononuclear cell antigen X XXX 0986357 Nk cells total count X XXX 0986359 T cells total count X XXX 0986360 T cell absolute count/ratio X XXX 0986361 T cell absolute count X XXX 0986367 Stem cells total count X XXX 0986376 Microsomal antibody each X XXX 0986378 Migration inhibitory factor X XXX 0986382 Neutralization test viral X XXX 0986384 Nitroblue tetrazolium dye X XXX 0986386 Nuclear matrix protein 22 X XXX 0986403 Particle agglut antbdy scrn X XXX 0986406 Particle agglut antbdy titr X XXX 0986430 Rheumatoid factor test qual X XXX 0986431 Rheumatoid factor quant X XXX 0986480 Tb test cell immun measure X XXX 0986481 Tb ag response t-cell susp X XXX 0986485 Skin test candida C XXX 0986486 Skin test nos antigen A XXX 0986490 Coccidioidomycosis skin test A XXX 0986510 Histoplasmosis skin test A XXX 0986580 Tb intradermal test A XXX 0986590 Streptokinase antibody X XXX 0986592 Syphilis test non-trep qual X XXX 0986593 Syphilis test non-trep quant X XXX 0986602 Antinomyces antibody X XXX 0986603 Adenovirus antibody X XXX 0986606 Aspergillus antibody X XXX 09

86609 Bacterium antibody X XXX 0986611 Bartonella antibody X XXX 0986612 Blastomyces antibody X XXX 0986615 Bordetella antibody X XXX 0986617 Lyme disease antibody X XXX 0986618 Lyme disease antibody X XXX 0986619 Borrelia antibody X XXX 0986622 Brucella antibody X XXX 0986625 Campylobacter antibody X XXX 0986628 Candida antibody X XXX 0986631 Chlamydia antibody X XXX 0986632 Chlamydia igm antibody X XXX 0986635 Coccidioides antibody X XXX 0986638 Q fever antibody X XXX 0986641 Cryptococcus antibody X XXX 0986644 Cmv antibody X XXX 0986645 Cmv antibody igm X XXX 0986648 Diphtheria antibody X XXX 0986651 Encephalitis californ antbdy X XXX 0986652 Encephaltis east eqne anbdy X XXX 0986653 Encephaltis st louis antbody X XXX 0986654 Encephaltis west eqne antbdy X XXX 0986658 Enterovirus antibody X XXX 0986663 Epstein-barr antibody X XXX 0986664 Epstein-barr nuclear antigen X XXX 0986665 Epstein-barr capsid vca X XXX 0986666 Ehrlichia antibody X XXX 0986668 Francisella tularensis X XXX 0986671 Fungus nes antibody X XXX 0986674 Giardia lamblia antibody X XXX 0986677 Helicobacter pylori antibody X XXX 0986682 Helminth antibody X XXX 0986684 Hemophilus influenza antibdy X XXX 0986687 Htlv-i antibody X XXX 0986688 Htlv-ii antibody X XXX 0986689 Htlv/hiv confirmj antibody X XXX 0986692 Hepatitis delta agent antbdy X XXX 0986694 Herpes simplex nes antbdy X XXX 0986695 Herpes simplex type 1 test X XXX 0986696 Herpes simplex type 2 test X XXX 0986698 Histoplasma antibody X XXX 0986701 Hiv-1antibody X XXX 0986702 Hiv-2 antibody X XXX 0986703 Hiv-1/hiv-2 1 result antbdy X XXX 0986704 Hep b core antibody total X XXX 0986705 Hep b core antibody igm X XXX 0986706 Hep b surface antibody X XXX 0986707 Hepatitis be antibody X XXX 0986708 Hepatitis a total antibody X XXX 0986709 Hepatitis a igm antibody X XXX 09

86710 Influenza virus antibody X XXX 0986711 John cunningham antibody X XXX 0986713 Legionella antibody X XXX 0986717 Leishmania antibody X XXX 0986720 Leptospira antibody X XXX 0986723 Listeria monocytogenes X XXX 0986727 Lymph choriomeningitis ab X XXX 0986729 Lympho venereum antibody X XXX 0986732 Mucormycosis antibody X XXX 0986735 Mumps antibody X XXX 0986738 Mycoplasma antibody X XXX 0986741 Neisseria meningitidis X XXX 0986744 Nocardia antibody X XXX 0986747 Parvovirus antibody X XXX 0986750 Malaria antibody X XXX 0986753 Protozoa antibody nos X XXX 0986756 Respiratory virus antibody X XXX 0986757 Rickettsia antibody X XXX 0986759 Rotavirus antibody X XXX 0986762 Rubella antibody X XXX 0986765 Rubeola antibody X XXX 0986768 Salmonella antibody X XXX 0986771 Shigella antibody X XXX 0986774 Tetanus antibody X XXX 0986777 Toxoplasma antibody X XXX 0986778 Toxoplasma antibody igm X XXX 0986780 Treponema pallidum X XXX 0986784 Trichinella antibody X XXX 0986787 Varicella-zoster antibody X XXX 0986788 West nile virus ab igm X XXX 0986789 West nile virus antibody X XXX 0986790 Virus antibody nos X XXX 0986793 Yersinia antibody X XXX 0986800 Thyroglobulin antibody X XXX 0986803 Hepatitis c ab test X XXX 0986804 Hep c ab test confirm X XXX 0986805 Lymphocytotoxicity assay X XXX 0986806 Lymphocytotoxicity assay X XXX 0986807 Cytotoxic antibody screening X XXX 0986808 Cytotoxic antibody screening X XXX 0986812 Hla typing a b or c X XXX 0986813 Hla typing a b or c X XXX 0986816 Hla typing dr/dq X XXX 0986817 Hla typing dr/dq X XXX 0986821 Lymphocyte culture mixed X XXX 0986822 Lymphocyte culture primed X XXX 0986825 Hla x-math non-cytotoxic X XXX 0986826 Hla x-match noncytotoxc addl X XXX 0986828 Hla class i&ii antibody qual X XXX 0986829 Hla class i/ii antibody qual X XXX 09

86830 Hla class i phenotype qual X XXX 0986831 Hla class ii phenotype qual X XXX 0986832 Hla class i high defin qual X XXX 0986833 Hla class ii high defin qual X XXX 0986834 Hla class i semiquant panel X XXX 0986835 Hla class ii semiquant panel X XXX 0986849 Immunology procedure X XXX 0986850 Rbc antibody screen X XXX 0986860 Rbc antibody elution X XXX 0986870 Rbc antibody identification X XXX 0986880 Coombs test direct X XXX 0986885 Coombs test indirect qual X XXX 0986886 Coombs test indirect titer X XXX 0986890 Autologous blood process X XXX 0986891 Autologous blood op salvage X XXX 0986900 Blood typing serologic abo X XXX 0986901 Blood typing serologic rh(d) X XXX 0986902 Blood type antigen donor ea X XXX 0986904 Blood typing patient serum X XXX 0986905 Blood typing rbc antigens X XXX 0986906 Bld typing serologic rh phnt X XXX 0986910 Blood typing paternity test N XXX 0986911 Blood typing antigen system N XXX 0986920 Compatibility test spin X XXX 0986921 Compatibility test incubate X XXX 0986922 Compatibility test antiglob X XXX 0986923 Compatibility test electric X XXX 0986927 Plasma fresh frozen X XXX 0986930 Frozen blood prep X XXX 0986931 Frozen blood thaw X XXX 0986932 Frozen blood freeze/thaw X XXX 0986940 Hemolysins/agglutinins auto X XXX 0986941 Hemolysins/agglutinins X XXX 0986945 Blood product/irradiation X XXX 0986950 Leukacyte transfusion X XXX 0986960 Vol reduction of blood/prod X XXX 0986965 Pooling blood platelets X XXX 0986970 Rbc pretx incubatj w/chemicl X XXX 0986971 Rbc pretx incubatj w/enzymes X XXX 0986972 Rbc pretx incubatj w/density X XXX 0986975 Rbc serum pretx incubj drugs X XXX 0986976 Rbc serum pretx id dilution X XXX 0986977 Rbc serum pretx incubj/inhib X XXX 0986978 Rbc pretreatment serum X XXX 0986985 Split blood or products X XXX 0986999 Transfusion procedure X XXX 0987003 Small animal inoculation X XXX 0987015 Specimen infect agnt concntj X XXX 0987040 Blood culture for bacteria X XXX 0987045 Feces culture aerobic bact X XXX 09

87046 Stool cultr aerobic bact ea X XXX 0987070 Culture othr specimn aerobic X XXX 0987071 Culture aerobic quant other X XXX 0987073 Culture bacteria anaerobic X XXX 0987075 Cultr bacteria except blood X XXX 0987076 Culture anaerobe ident each X XXX 0987077 Culture aerobic identify X XXX 0987081 Culture screen only X XXX 0987084 Culture of specimen by kit X XXX 0987086 Urine culture/colony count X XXX 0987088 Urine bacteria culture X XXX 0987101 Skin fungi culture X XXX 0987102 Fungus isolation culture X XXX 0987103 Blood fungus culture X XXX 0987106 Fungi identification yeast X XXX 0987107 Fungi identification mold X XXX 0987109 Mycoplasma X XXX 0987110 Chlamydia culture X XXX 0987116 Mycobacteria culture X XXX 0987118 Mycobacteric identification X XXX 0987140 Culture type immunofluoresc X XXX 0987143 Culture typing glc/hplc X XXX 0987147 Culture type immunologic X XXX 0987149 Dna/rna direct probe X XXX 0987150 Dna/rna amplified probe X XXX 0987152 Culture type pulse field gel X XXX 0987153 Dna/rna sequencing X XXX 0987158 Culture typing added method X XXX 0987164 Dark field examination X XXX 0987164 26 Dark field examination A XXX 0987166 Dark field examination X XXX 0987168 Macroscopic exam arthropod X XXX 0987169 Macroscopic exam parasite X XXX 0987172 Pinworm exam X XXX 0987176 Tissue homogenization cultr X XXX 0987177 Ova and parasites smears X XXX 0987181 Microbe susceptible diffuse X XXX 0987184 Microbe susceptible disk X XXX 0987185 Microbe susceptible enzyme X XXX 0987186 Microbe susceptible mic X XXX 0987187 Microbe susceptible mlc X XXX 0987188 Microbe suscept macrobroth X XXX 0987190 Microbe suscept mycobacteri X XXX 0987197 Bactericidal level serum X XXX 0987205 Smear gram stain X XXX 0987206 Smear fluorescent/acid stai X XXX 0987207 Smear special stain X XXX 0987207 26 Smear special stain A XXX 0987209 Smear complex stain X XXX 0987210 Smear wet mount saline/ink X XXX 09

87220 Tissue exam for fungi X XXX 0987230 Assay toxin or antitoxin X XXX 0987250 Virus inoculate eggs/animal X XXX 0987252 Virus inoculation tissue X XXX 0987253 Virus inoculate tissue addl X XXX 0987254 Virus inoculation shell via X XXX 0987255 Genet virus isolate hsv X XXX 0987260 Adenovirus ag if X XXX 0987265 Pertussis ag if X XXX 0987267 Enterovirus antibody dfa X XXX 0987269 Giardia ag if X XXX 0987270 Chlamydia trachomatis ag if X XXX 0987271 Cytomegalovirus dfa X XXX 0987272 Cryptosporidium ag if X XXX 0987273 Herpes simplex 2 ag if X XXX 0987274 Herpes simplex 1 ag if X XXX 0987275 Influenza b ag if X XXX 0987276 Influenza a ag if X XXX 0987277 Legionella micdadei ag if X XXX 0987278 Legion pneumophilia ag if X XXX 0987279 Parainfluenza ag if X XXX 0987280 Respiratory syncytial ag if X XXX 0987281 Pneumocystis carinii ag if X XXX 0987283 Rubeola ag if X XXX 0987285 Treponema pallidum ag if X XXX 0987290 Varicella zoster ag if X XXX 0987299 Antibody detection nos if X XXX 0987300 Ag detection polyval if X XXX 0987301 Adenovirus ag eia X XXX 0987305 Aspergillus ag eia X XXX 0987320 Chylmd trach ag eia X XXX 0987324 Clostridium ag eia X XXX 0987327 Cryptococcus neoform ag eia X XXX 0987328 Cryptosporidium ag eia X XXX 0987329 Giardia ag eia X XXX 0987332 Cytomegalovirus ag eia X XXX 0987335 E coli 0157 ag eia X XXX 0987336 Entamoeb hist dispr ag eia X XXX 0987337 Entamoeb hist group ag eia X XXX 0987338 Hpylori stool eia X XXX 0987339 H pylori ag eia X XXX 0987340 Hepatitis b surface ag eia X XXX 0987341 Hepatitis b surface ag eia X XXX 0987350 Hepatitis be ag eia X XXX 0987380 Hepatitis delta ag eia X XXX 0987385 Histoplasma capsul ag eia X XXX 0987389 Hiv-1 ag w/hiv-1 & hiv-2 ab X XXX 0987390 Hiv-1 ag eia X XXX 0987391 Hiv-2 ag eia X XXX 0987400 Influenza a/b ag eia X XXX 09

87420 Resp syncytial ag eia X XXX 0987425 Rotavirus ag eia X XXX 0987427 Shiga-like toxin ag eia X XXX 0987430 Strep a ag eia X XXX 0987449 Ag detect nos eia mult X XXX 0987450 Ag detect nos eia single X XXX 0987451 Ag detect polyval eia mult X XXX 0987470 Bartonella dna dir probe X XXX 0987471 Bartonella dna amp probe X XXX 0987472 Bartonella dna quant X XXX 0987475 Lyme dis dna dir probe X XXX 0987476 Lyme dis dna amp probe X XXX 0987477 Lyme dis dna quant X XXX 0987480 Candida dna dir probe X XXX 0987481 Candida dna amp probe X XXX 0987482 Candida dna quant X XXX 0987485 Chylmd pneum dna dir probe X XXX 0987486 Chylmd pneum dna amp probe X XXX 0987487 Chylmd pneum dna quant X XXX 0987490 Chylmd trach dna dir probe X XXX 0987491 Chylmd trach dna amp probe X XXX 0987492 Chylmd trach dna quant X XXX 0987493 C diff amplified probe X XXX 0987495 Cytomeg dna dir probe X XXX 0987496 Cytomeg dna amp probe X XXX 0987497 Cytomeg dna quant X XXX 0987498 Enterovirus probe&revrs trns X XXX 0987500 Vanomycin dna amp probe X XXX 0987501 Influenza dna amp prob 1+ X XXX 0987502 Influenza dna amp probe X XXX 0987503 Influenza dna amp prob addl X XXX 0987505 Nfct agent detection gi X XXX 0987506 Iadna-dna/rna probe tq 6-11 X XXX 0987507 Iadna-dna/rna probe tq 12-25 X XXX 0987510 Gardner vag dna dir probe X XXX 0987511 Gardner vag dna amp probe X XXX 0987512 Gardner vag dna quant X XXX 0987515 Hepatitis b dna dir probe X XXX 0987516 Hepatitis b dna amp probe X XXX 0987517 Hepatitis b dna quant X XXX 0987520 Hepatitis c rna dir probe X XXX 0987521 Hepatitis c probe&rvrs trnsc X XXX 0987522 Hepatitis c revrs trnscrpj X XXX 0987525 Hepatitis g dna dir probe X XXX 0987526 Hepatitis g dna amp probe X XXX 0987527 Hepatitis g dna quant X XXX 0987528 Hsv dna dir probe X XXX 0987529 Hsv dna amp probe X XXX 0987530 Hsv dna quant X XXX 0987531 Hhv-6 dna dir probe X XXX 09

87532 Hhv-6 dna amp probe X XXX 0987533 Hhv-6 dna quant X XXX 0987534 Hiv-1 dna dir probe X XXX 0987535 Hiv-1 probe&reverse trnscrpj X XXX 0987536 Hiv-1 quant&revrse trnscrpj X XXX 0987537 Hiv-2 dna dir probe X XXX 0987538 Hiv-2 probe&revrse trnscripj X XXX 0987539 Hiv-2 quant&revrse trnscripj X XXX 0987540 Legion pneumo dna dir prob X XXX 0987541 Legion pneumo dna amp prob X XXX 0987542 Legion pneumo dna quant X XXX 0987550 Mycobacteria dna dir probe X XXX 0987551 Mycobacteria dna amp probe X XXX 0987552 Mycobacteria dna quant X XXX 0987555 M.tuberculo dna dir probe X XXX 0987556 M.tuberculo dna amp probe X XXX 0987557 M.tuberculo dna quant X XXX 0987560 M.avium-intra dna dir prob X XXX 0987561 M.avium-intra dna amp prob X XXX 0987562 M.avium-intra dna quant X XXX 0987580 M.pneumon dna dir probe X XXX 0987581 M.pneumon dna amp probe X XXX 0987582 M.pneumon dna quant X XXX 0987590 N.gonorrhoeae dna dir prob X XXX 0987591 N.gonorrhoeae dna amp prob X XXX 0987592 N.gonorrhoeae dna quant X XXX 0987623 Hpv low-risk types X XXX 0987624 Hpv high-risk types X XXX 0987625 Hpv types 16 & 18 only X XXX 0987631 Resp virus 3-5 targets X XXX 0987632 Resp virus 6-11 targets X XXX 0987633 Resp virus 12-25 targets X XXX 0987640 Staph a dna amp probe X XXX 0987641 Mr-staph dna amp probe X XXX 0987650 Strep a dna dir probe X XXX 0987651 Strep a dna amp probe X XXX 0987652 Strep a dna quant X XXX 0987653 Strep b dna amp probe X XXX 0987660 Trichomonas vagin dir probe X XXX 0987661 Trichomonas vaginalis amplif X XXX 0987797 Detect agent nos dna dir X XXX 0987798 Detect agent nos dna amp X XXX 0987799 Detect agent nos dna quant X XXX 0987800 Detect agnt mult dna direc X XXX 0987801 Detect agnt mult dna ampli X XXX 0987802 Strep b assay w/optic X XXX 0987803 Clostridium toxin a w/optic X XXX 0987804 Influenza assay w/optic X XXX 0987806 Hiv antigen w/hiv antibodies X XXX 0987807 Rsv assay w/optic X XXX 09

87808 Trichomonas assay w/optic X XXX 0987809 Adenovirus assay w/optic X XXX 0987810 Chylmd trach assay w/optic X XXX 0987850 N. gonorrhoeae assay w/optic X XXX 0987880 Strep a assay w/optic X XXX 0987899 Agent nos assay w/optic X XXX 0987900 Phenotype infect agent drug X XXX 0987901 Genotype dna hiv reverse t X XXX 0987902 Genotype dna/rna hep c X XXX 0987903 Phenotype dna hiv w/culture X XXX 0987904 Phenotype dna hiv w/clt add X XXX 0987905 Sialidase enzyme assay X XXX 0987906 Genotype dna/rna hiv X XXX 0987910 Genotype cytomegalovirus X XXX 0987912 Genotype dna hepatitis b X XXX 0987999 Microbiology procedure X XXX 0988000 Autopsy (necropsy) gross N XXX 0988005 Autopsy (necropsy) gross N XXX 0988007 Autopsy (necropsy) gross N XXX 0988012 Autopsy (necropsy) gross N XXX 0988014 Autopsy (necropsy) gross N XXX 0988016 Autopsy (necropsy) gross N XXX 0988020 Autopsy (necropsy) complete N XXX 0988025 Autopsy (necropsy) complete N XXX 0988027 Autopsy (necropsy) complete N XXX 0988028 Autopsy (necropsy) complete N XXX 0988029 Autopsy (necropsy) complete N XXX 0988036 Limited autopsy N XXX 0988037 Limited autopsy N XXX 0988040 Forensic autopsy (necropsy) N XXX 0988045 Coroners autopsy (necropsy) N XXX 0988099 Necropsy (autopsy) procedure N XXX 0988104 Cytopath fl nongyn smears A XXX 0988104 TC Cytopath fl nongyn smears A XXX 0988104 26 Cytopath fl nongyn smears A XXX 0988106 Cytopath fl nongyn filter A XXX 0988106 TC Cytopath fl nongyn filter A XXX 0988106 26 Cytopath fl nongyn filter A XXX 0988108 Cytopath concentrate tech A XXX 0988108 TC Cytopath concentrate tech A XXX 0988108 26 Cytopath concentrate tech A XXX 0988112 Cytopath cell enhance tech A XXX 0988112 TC Cytopath cell enhance tech A XXX 0988112 26 Cytopath cell enhance tech A XXX 0988120 Cytp urne 3-5 probes ea spec A XXX 0988120 TC Cytp urne 3-5 probes ea spec A XXX 0988120 26 Cytp urne 3-5 probes ea spec A XXX 0988121 Cytp urine 3-5 probes cmptr A XXX 0988121 TC Cytp urine 3-5 probes cmptr A XXX 0988121 26 Cytp urine 3-5 probes cmptr A XXX 09

88125 Forensic cytopathology A XXX 0988125 TC Forensic cytopathology A XXX 0988125 26 Forensic cytopathology A XXX 0988130 Sex chromatin identification X XXX 0988140 Sex chromatin identification X XXX 0988141 Cytopath c/v interpret A XXX 0988142 Cytopath c/v thin layer X XXX 0988143 Cytopath c/v thin layer redo X XXX 0988147 Cytopath c/v automated X XXX 0988148 Cytopath c/v auto rescreen X XXX 0988150 Cytopath c/v manual X XXX 0988152 Cytopath c/v auto redo X XXX 0988153 Cytopath c/v redo X XXX 0988154 Cytopath c/v select X XXX 0988155 Cytopath c/v index add-on X XXX 0988160 Cytopath smear other source A XXX 0988160 TC Cytopath smear other source A XXX 0988160 26 Cytopath smear other source A XXX 0988161 Cytopath smear other source A XXX 0988161 TC Cytopath smear other source A XXX 0988161 26 Cytopath smear other source A XXX 0988162 Cytopath smear other source A XXX 0988162 TC Cytopath smear other source A XXX 0988162 26 Cytopath smear other source A XXX 0988164 Cytopath tbs c/v manual X XXX 0988165 Cytopath tbs c/v redo X XXX 0988166 Cytopath tbs c/v auto redo X XXX 0988167 Cytopath tbs c/v select X XXX 0988172 Cytp dx eval fna 1st ea site A XXX 0988172 TC Cytp dx eval fna 1st ea site A XXX 0988172 26 Cytp dx eval fna 1st ea site A XXX 0988173 Cytopath eval fna report A XXX 0988173 TC Cytopath eval fna report A XXX 0988173 26 Cytopath eval fna report A XXX 0988174 Cytopath c/v auto in fluid X XXX 0988175 Cytopath c/v auto fluid redo X XXX 0988177 Cytp fna eval ea addl A ZZZ 0988177 TC Cytp fna eval ea addl A ZZZ 0988177 26 Cytp fna eval ea addl A ZZZ 0988182 Cell marker study A XXX 0988182 TC Cell marker study A XXX 0988182 26 Cell marker study A XXX 0988184 Flowcytometry/ tc 1 marker A XXX 0988185 Flowcytometry/tc add-on A ZZZ 0988187 Flowcytometry/read 2-8 A XXX 0988188 Flowcytometry/read 9-15 A XXX 0988189 Flowcytometry/read 16 & > A XXX 0988199 Cytopathology procedure C XXX 0988199 TC Cytopathology procedure C XXX 0988199 26 Cytopathology procedure C XXX 09

88230 Tissue culture lymphocyte X XXX 0988233 Tissue culture skin/biopsy X XXX 0988235 Tissue culture placenta X XXX 0988237 Tissue culture bone marrow X XXX 0988239 Tissue culture tumor X XXX 0988240 Cell cryopreserve/storage X XXX 0988241 Frozen cell preparation X XXX 0988245 Chromosome analysis 20-25 X XXX 0988248 Chromosome analysis 50-100 X XXX 0988249 Chromosome analysis 100 X XXX 0988261 Chromosome analysis 5 X XXX 0988262 Chromosome analysis 15-20 X XXX 0988263 Chromosome analysis 45 X XXX 0988264 Chromosome analysis 20-25 X XXX 0988267 Chromosome analys placenta X XXX 0988269 Chromosome analys amniotic X XXX 0988271 Cytogenetics dna probe X XXX 0988272 Cytogenetics 3-5 X XXX 0988273 Cytogenetics 10-30 X XXX 0988274 Cytogenetics 25-99 X XXX 0988275 Cytogenetics 100-300 X XXX 0988280 Chromosome karyotype study X XXX 0988283 Chromosome banding study X XXX 0988285 Chromosome count additional X XXX 0988289 Chromosome study additional X XXX 0988291 Cyto/molecular report A XXX 0988299 Cytogenetic study C XXX 0988300 Surgical path gross A XXX 0988300 TC Surgical path gross A XXX 0988300 26 Surgical path gross A XXX 0988302 Tissue exam by pathologist A XXX 0988302 TC Tissue exam by pathologist A XXX 0988302 26 Tissue exam by pathologist A XXX 0988304 Tissue exam by pathologist A XXX 0988304 TC Tissue exam by pathologist A XXX 0988304 26 Tissue exam by pathologist A XXX 0988305 Tissue exam by pathologist A XXX 0988305 TC Tissue exam by pathologist A XXX 0988305 26 Tissue exam by pathologist A XXX 0988307 Tissue exam by pathologist A XXX 0988307 TC Tissue exam by pathologist A XXX 0988307 26 Tissue exam by pathologist A XXX 0988309 Tissue exam by pathologist A XXX 0988309 TC Tissue exam by pathologist A XXX 0988309 26 Tissue exam by pathologist A XXX 0988311 Decalcify tissue A XXX 0988311 TC Decalcify tissue A XXX 0988311 26 Decalcify tissue A XXX 0988312 Special stains group 1 A XXX 0988312 TC Special stains group 1 A XXX 09

88312 26 Special stains group 1 A XXX 0988313 Special stains group 2 A XXX 0988313 TC Special stains group 2 A XXX 0988313 26 Special stains group 2 A XXX 0988314 Histochemical stains add-on A XXX 0988314 TC Histochemical stains add-on A XXX 0988314 26 Histochemical stains add-on A XXX 0988319 Enzyme histochemistry A XXX 0988319 TC Enzyme histochemistry A XXX 0988319 26 Enzyme histochemistry A XXX 0988321 Microslide consultation A XXX 0988323 Microslide consultation A XXX 0988323 TC Microslide consultation A XXX 0988323 26 Microslide consultation A XXX 0988325 Comprehensive review of data A XXX 0988329 Path consult introp A XXX 0988331 Path consult intraop 1 bloc A XXX 0988331 TC Path consult intraop 1 bloc A XXX 0988331 26 Path consult intraop 1 bloc A XXX 0988332 Path consult intraop addl A XXX 0988332 TC Path consult intraop addl A XXX 0988332 26 Path consult intraop addl A XXX 0988333 Intraop cyto path consult 1 A XXX 0988333 TC Intraop cyto path consult 1 A XXX 0988333 26 Intraop cyto path consult 1 A XXX 0988334 Intraop cyto path consult 2 A XXX 0988334 TC Intraop cyto path consult 2 A XXX 0988334 26 Intraop cyto path consult 2 A XXX 0988341 Immunohisto antibody slide A ZZZ 0988341 TC Immunohisto antibody slide A ZZZ 0988341 26 Immunohisto antibody slide A ZZZ 0988342 Immunohisto antibody stain A XXX 0988342 TC Immunohisto antibody stain A XXX 0988342 26 Immunohisto antibody stain A XXX 0988344 Immunohisto antibody slide A XXX 0988344 TC Immunohisto antibody slide A XXX 0988344 26 Immunohisto antibody slide A XXX 0988346 Immunofluorescent study A XXX 0988346 TC Immunofluorescent study A XXX 0988346 26 Immunofluorescent study A XXX 0988347 Immunofluorescent study A XXX 0988347 TC Immunofluorescent study A XXX 0988347 26 Immunofluorescent study A XXX 0988348 Electron microscopy A XXX 0988348 TC Electron microscopy A XXX 0988348 26 Electron microscopy A XXX 0988355 Analysis skeletal muscle A XXX 0988355 TC Analysis skeletal muscle A XXX 0988355 26 Analysis skeletal muscle A XXX 0988356 Analysis nerve A XXX 09

88356 TC Analysis nerve A XXX 0988356 26 Analysis nerve A XXX 0988358 Analysis tumor A XXX 0988358 TC Analysis tumor A XXX 0988358 26 Analysis tumor A XXX 0988360 Tumor immunohistochem/manual A XXX 0988360 TC Tumor immunohistochem/manual A XXX 0988360 26 Tumor immunohistochem/manual A XXX 0988361 Tumor immunohistochem/comput A XXX 0988361 TC Tumor immunohistochem/comput A XXX 0988361 26 Tumor immunohistochem/comput A XXX 0988362 Nerve teasing preparations A XXX 0988362 TC Nerve teasing preparations A XXX 0988362 26 Nerve teasing preparations A XXX 0988363 Xm archive tissue molec anal A XXX 0988364 Insitu hybridization (fish) A ZZZ 0988364 TC Insitu hybridization (fish) A ZZZ 0988364 26 Insitu hybridization (fish) A ZZZ 0988365 Insitu hybridization (fish) A XXX 0988365 TC Insitu hybridization (fish) A XXX 0988365 26 Insitu hybridization (fish) A XXX 0988366 Insitu hybridization (fish) A XXX 0988366 TC Insitu hybridization (fish) A XXX 0988366 26 Insitu hybridization (fish) A XXX 0988367 Insitu hybridization auto A XXX 0988367 TC Insitu hybridization auto A XXX 0988367 26 Insitu hybridization auto A XXX 0988368 Insitu hybridization manual A XXX 0988368 TC Insitu hybridization manual A XXX 0988368 26 Insitu hybridization manual A XXX 0988369 M/phmtrc alysishquant/semiq A ZZZ 0988369 TC M/phmtrc alysishquant/semiq A ZZZ 0988369 26 M/phmtrc alysishquant/semiq A ZZZ 0988371 Protein western blot tissue X XXX 0988371 26 Protein western blot tissue A XXX 0988372 Protein analysis w/probe X XXX 0988372 26 Protein analysis w/probe A XXX 0988373 M/phmtrc alys ishquant/semiq A ZZZ 0988373 TC M/phmtrc alys ishquant/semiq A ZZZ 0988373 26 M/phmtrc alys ishquant/semiq A ZZZ 0988374 M/phmtrc alys ishquant/semiq A XXX 0988374 TC M/phmtrc alys ishquant/semiq A XXX 0988374 26 M/phmtrc alys ishquant/semiq A XXX 0988375 Optical endomicroscpy interp A XXX 0988377 M/phmtrc alys ishquant/semiq A XXX 0988377 TC M/phmtrc alys ishquant/semiq A XXX 0988377 26 M/phmtrc alys ishquant/semiq A XXX 0988380 Microdissection laser A XXX 0988380 TC Microdissection laser A XXX 0988380 26 Microdissection laser A XXX 09

88381 Microdissection manual A XXX 0988381 TC Microdissection manual A XXX 0988381 26 Microdissection manual A XXX 0988387 Tiss exam molecular study A XXX 0988387 TC Tiss exam molecular study A XXX 0988387 26 Tiss exam molecular study A XXX 0988388 Tiss ex molecul study add-on A XXX 0988388 TC Tiss ex molecul study add-on A XXX 0988388 26 Tiss ex molecul study add-on A XXX 0988399 Surgical pathology procedure C XXX 0988399 TC Surgical pathology procedure C XXX 0988399 26 Surgical pathology procedure C XXX 0988720 Bilirubin total transcut X XXX 0988738 Hgb quant transcutaneous X XXX 0988740 Transcutaneous carboxyhb X XXX 0988741 Transcutaneous methb X XXX 0988749 In vivo lab service X XXX 0989049 Chct for mal hyperthermia A XXX 0989050 Body fluid cell count X XXX 0989051 Body fluid cell count X XXX 0989055 Leukocyte assessment fecal X XXX 0989060 Exam synovial fluid crystals X XXX 0989060 26 Exam synovial fluid crystals A XXX 0989125 Specimen fat stain X XXX 0989160 Exam feces for meat fibers X XXX 0989190 Nasal smear for eosinophils X XXX 0989220 Sputum specimen collection A XXX 0989230 Collect sweat for test A XXX 0989240 Pathology lab procedure C XXX 0989250 Cultr oocyte/embryo <4 days X XXX 0989251 Cultr oocyte/embryo <4 days X XXX 0989253 Embryo hatching X XXX 0989254 Oocyte identification X XXX 0989255 Prepare embryo for transfer X XXX 0989257 Sperm identification X XXX 0989258 Cryopreservation embryo(s) X XXX 0989259 Cryopreservation sperm X XXX 0989260 Sperm isolation simple X XXX 0989261 Sperm isolation complex X XXX 0989264 Identify sperm tissue X XXX 0989268 Insemination of oocytes X XXX 0989272 Extended culture of oocytes X XXX 0989280 Assist oocyte fertilization X XXX 0989281 Assist oocyte fertilization X XXX 0989290 Biopsy oocyte polar body X XXX 0989291 Biopsy oocyte polar body X XXX 0989300 Semen analysis w/huhner X XXX 0989310 Semen analysis w/count X XXX 0989320 Semen anal vol/count/mot X XXX 0989321 Semen anal sperm detection X XXX 09

89322 Semen anal strict criteria X XXX 0989325 Sperm antibody test X XXX 0989329 Sperm evaluation test X XXX 0989330 Evaluation cervical mucus X XXX 0989331 Retrograde ejaculation anal X XXX 0989335 Cryopreserve testicular tiss X XXX 0989337 Cryopreservation oocyte(s) X XXX 0989342 Storage/year embryo(s) X XXX 0989343 Storage/year sperm/semen X XXX 0989344 Storage/year reprod tissue X XXX 0989346 Storage/year oocyte(s) X XXX 0989352 Thawing cryopresrved embryo X XXX 0989353 Thawing cryopresrved sperm X XXX 0989354 Thaw cryoprsvrd reprod tiss X XXX 0989356 Thawing cryopresrved oocyte X XXX 0989398 Unlisted reprod med lab proc X XXX 099001F Aortic aneurysm<5cm diam ct I XXX 099002F Aortic aneurysm 5-5.4cm diam I XXX 099003F Aortic anrysm5.5-5.9cm diam M XXX 099004F Aortic anrysm 6/> cm diam M XXX 099005F Asympt carot/vrtbrbas sten I XXX 099006F Sympt sten-tia/strk<120days M XXX 099007F Other carot sten 120 days/> M XXX 0990281 Human ig im I XXX 0990283 Human ig iv I XXX 0990284 Human ig sc X XXX 0990287 Botulinum antitoxin I XXX 0990288 Botulism ig iv I XXX 0990291 Cmv ig iv I XXX 0990296 Diphtheria antitoxin E XXX 0990371 Hep b ig im E XXX 0990375 Rabies ig im/sc E XXX 0990376 Rabies ig heat treated E XXX 0990378 Rsv mab im 50mg X XXX 0990384 Rh ig full-dose im I XXX 0990385 Rh ig minidose im E XXX 0990386 Rh ig iv I XXX 0990389 Tetanus ig im I XXX 0990393 Vaccina ig im E XXX 0990396 Varicella-zoster ig im E XXX 0990399 Immune globulin I XXX 0990460 Im admin 1st/only component A XXX 0990461 Im admin each addl component A ZZZ 0990471 Immunization admin A XXX 0990472 Immunization admin each add A ZZZ 0990473 Immune admin oral/nasal R XXX 0990474 Immune admin oral/nasal addl R ZZZ 0990476 Adenovirus vaccine type 4 E XXX 0990477 Adenovirus vaccine type 7 E XXX 0990581 Anthrax vaccine sc or im E XXX 09

90585 Bcg vaccine percut E XXX 0990586 Bcg vaccine intravesical E XXX 0990630 Flu vacc iiv4 no preserv id X XXX 0990632 Hep a vaccine adult im E XXX 0990633 Hep a vacc ped/adol 2 dose E XXX 0990634 Hep a vacc ped/adol 3 dose E XXX 0990636 Hep a/hep b vacc adult im E XXX 0990644 Meningoccl hib vac 4 dose im X XXX 0990645 Hib vaccine hboc im E XXX 0990646 Hib vaccine prp-d im E XXX 0990647 Hib vaccine prp-omp im E XXX 0990648 Hib vaccine prp-t im E XXX 0990649 Hpv vaccine 4 valent im E XXX 0990650 Hpv vaccine 2 valent im E XXX 0990651 Hpv vaccine non valent im X XXX 0990653 Flu vaccine adjuvant im X XXX 0990654 Flu vacc iiv3 no preserv id X XXX 0990655 Flu vac no prsv 3 val 6-35 m X XXX 0990656 Flu vaccine no preserv 3 & > X XXX 0990657 Flu vaccine 3 yrs im X XXX 0990658 Flu vaccine 3 yrs & > im I XXX 0990660 Flu vaccine nasal X XXX 0990661 Flu vacc cell cult prsv free X XXX 0990662 Flu vacc prsv free inc antig X XXX 0990664 Flu vacc pandemic intranasal X XXX 0990666 Flu vac pandem prsrv free im X XXX 0990667 Flu vac pandemic adjuvant im X XXX 0990668 Flu vac pandemic splt im X XXX 0990669 Pneumococcal vacc 7 val im X XXX 0990670 Pneumococcal vacc 13 val im X XXX 0990672 Flu vaccine 4 valent nasal X XXX 0990673 Flu vacc riv3 no preserv X XXX 0990675 Rabies vaccine im E XXX 0990676 Rabies vaccine id E XXX 0990680 Rotovirus vacc 3 dose oral E XXX 0990681 Rotavirus vacc 2 dose oral E XXX 0990685 Flu vac no prsv 4 val 6-35 m X XXX 0990686 Flu vac no prsv 4 val 3 yrs+ X XXX 0990687 Flu vaccine 4 val 6-35 mo im X XXX 0990688 Flu vacc 4 val 3 yrs plus im X XXX 0990690 Typhoid vaccine oral E XXX 0990691 Typhoid vaccine im E XXX 0990692 Typhoid vaccine h-p sc/id E XXX 0990693 Typhoid vaccine akd sc E XXX 0990696 Dtap-ipv vacc 4-6 yr im E XXX 0990698 Dtap-hib-ip vaccine im E XXX 0990700 Dtap vaccine < 7 yrs im E XXX 0990702 Dt vaccine < 7 yrs im E XXX 0990703 Tetanus vaccine im E XXX 0990704 Mumps vaccine sc E XXX 09

90705 Measles vaccine sc E XXX 0990706 Rubella vaccine sc E XXX 0990707 Mmr vaccine sc E XXX 0990708 Measles-rubella vaccine sc E XXX 0990710 Mmrv vaccine sc E XXX 0990712 Oral poliovirus vaccine E XXX 0990713 Poliovirus ipv sc/im E XXX 0990714 Td vaccine no prsrv 7/> im E XXX 0990715 Tdap vaccine 7 yrs/> im E XXX 0990716 Chicken pox vaccine sc E XXX 0990717 Yellow fever vaccine sc E XXX 0990719 Diphtheria vaccine im E XXX 0990720 Dtp/hib vaccine im E XXX 0990721 Dtap/hib vaccine im E XXX 0990723 Dtap-hep b-ipv vaccine im I XXX 0990725 Cholera vaccine injectable E XXX 0990727 Plague vaccine im E XXX 0990732 Pneumococcal vacc 23 val im X XXX 0990733 Meningococcal vaccine sc E XXX 0990734 Meningococcal vaccine im E XXX 0990735 Encephalitis vaccine sc E XXX 0990736 Zoster vacc sc E XXX 0990738 Inactivated je vacc im I XXX 0990739 Hep b vacc adult 2 dose im X XXX 0990740 Hepb vacc ill pat 3 dose im X XXX 0990743 Hep b vacc adol 2 dose im X XXX 0990744 Hepb vacc ped/adol 3 dose im X XXX 0990746 Hep b vacc adult 3 dose im X XXX 0990747 Hepb vacc ill pat 4 dose im X XXX 0990748 Hep b/hib vaccine im I XXX 0990749 Vaccine toxoid E XXX 0990785 Psytx complex interactive A ZZZ 0990791 Psych diagnostic evaluation A XXX 0990792 Psych diag eval w/med srvcs A XXX 0990832 Psytx pt&/family 30 minutes A XXX 0990833 Psytx pt&/fam w/e&m 30 min A ZZZ 0990834 Psytx pt&/family 45 minutes A XXX 0990836 Psytx pt&/fam w/e&m 45 min A ZZZ 0990837 Psytx pt&/family 60 minutes A XXX 0990838 Psytx pt&/fam w/e&m 60 min A ZZZ 0990839 Psytx crisis initial 60 min A XXX 0990840 Psytx crisis ea addl 30 min A ZZZ 0990845 Psychoanalysis A XXX 0990846 Family psytx w/o patient R XXX 0990847 Family psytx w/patient R XXX 0990849 Multiple family group psytx R XXX 0990853 Group psychotherapy A XXX 0990863 Pharmacologic mgmt w/psytx I XXX 0990865 Narcosynthesis A XXX 0990867 Tcranial magn stim tx plan C 000 09

90868 Tcranial magn stim tx deli C 000 0990869 Tcran magn stim redetemine C 000 0990870 Electroconvulsive therapy A 000 0990875 Psychophysiological therapy N XXX 0990876 Psychophysiological therapy N XXX 0990880 Hypnotherapy A XXX 0990882 Environmental manipulation N XXX 0990885 Psy evaluation of records B XXX 0990887 Consultation with family B XXX 0990889 Preparation of report B XXX 0990899 Psychiatric service/therapy C XXX 0990901 Biofeedback train any meth A 000 0990911 Biofeedback peri/uro/rectal A 000 0990935 Hemodialysis one evaluation A 000 0990937 Hemodialysis repeated eval A 000 0990940 Hemodialysis access study X XXX 0990945 Dialysis one evaluation A 000 0990947 Dialysis repeated eval A 000 0990951 Esrd serv 4 visits p mo <2yr A XXX 0990952 Esrd serv 2-3 vsts p mo <2yr C XXX 0990953 Esrd serv 1 visit p mo <2yrs C XXX 0990954 Esrd serv 4 vsts p mo 2-11 A XXX 0990955 Esrd srv 2-3 vsts p mo 2-11 A XXX 0990956 Esrd srv 1 visit p mo 2-11 A XXX 0990957 Esrd srv 4 vsts p mo 12-19 A XXX 0990958 Esrd srv 2-3 vsts p mo 12-19 A XXX 0990959 Esrd serv 1 vst p mo 12-19 A XXX 0990960 Esrd srv 4 visits p mo 20+ A XXX 0990961 Esrd srv 2-3 vsts p mo 20+ A XXX 0990962 Esrd serv 1 visit p mo 20+ A XXX 0990963 Esrd home pt serv p mo <2yrs A XXX 0990964 Esrd home pt serv p mo 2-11 A XXX 0990965 Esrd home pt serv p mo 12-19 A XXX 0990966 Esrd home pt serv p mo 20+ A XXX 0990967 Esrd home pt serv p day <2 A XXX 0990968 Esrd home pt srv p day 2-11 A XXX 0990969 Esrd home pt srv p day 12-19 A XXX 0990970 Esrd home pt serv p day 20+ A XXX 0990989 Dialysis training complete X XXX 0990993 Dialysis training incompl X XXX 0990997 Hemoperfusion A 000 0990999 Dialysis procedure C XXX 0991010 Esophagus motility study A 000 0991010 TC Esophagus motility study A 000 0291010 26 Esophagus motility study A 000 0991013 Esophgl motil w/stim/perfus A ZZZ 0991013 TC Esophgl motil w/stim/perfus A ZZZ 0291013 26 Esophgl motil w/stim/perfus A ZZZ 0991020 Gastric motility studies A 000 0991020 TC Gastric motility studies A 000 02

91020 26 Gastric motility studies A 000 0991022 Duodenal motility study A 000 0991022 TC Duodenal motility study A 000 0291022 26 Duodenal motility study A 000 0991030 Acid perfusion of esophagus A 000 0991030 TC Acid perfusion of esophagus A 000 0291030 26 Acid perfusion of esophagus A 000 0991034 Gastroesophageal reflux test A 000 0991034 TC Gastroesophageal reflux test A 000 0291034 26 Gastroesophageal reflux test A 000 0991035 G-esoph reflx tst w/electrod A 000 0991035 TC G-esoph reflx tst w/electrod A 000 0291035 26 G-esoph reflx tst w/electrod A 000 0991037 Esoph imped function test A 000 0991037 TC Esoph imped function test A 000 0291037 26 Esoph imped function test A 000 0991038 Esoph imped funct test > 1hr A 000 0991038 TC Esoph imped funct test > 1hr A 000 0291038 26 Esoph imped funct test > 1hr A 000 0991040 Esoph balloon distension tst A 000 0991040 TC Esoph balloon distension tst A 000 0291040 26 Esoph balloon distension tst A 000 0991065 Breath hydrogen/methane test A 000 0991065 TC Breath hydrogen/methane test A 000 0991065 26 Breath hydrogen/methane test A 000 0991110 Gi tract capsule endoscopy A XXX 0991110 TC Gi tract capsule endoscopy A XXX 0991110 26 Gi tract capsule endoscopy A XXX 0991111 Esophageal capsule endoscopy A XXX 0991111 TC Esophageal capsule endoscopy A XXX 0991111 26 Esophageal capsule endoscopy A XXX 0991112 Gi wireless capsule measure A XXX 0991112 TC Gi wireless capsule measure A XXX 0991112 26 Gi wireless capsule measure A XXX 0991117 Colon motility 6 hr study A 000 0991120 Rectal sensation test A XXX 0991120 TC Rectal sensation test A XXX 0291120 26 Rectal sensation test A XXX 0991122 Anal pressure record A 000 0991122 TC Anal pressure record A 000 0291122 26 Anal pressure record A 000 0991132 Electrogastrography A XXX 0991132 TC Electrogastrography A XXX 0191132 26 Electrogastrography A XXX 0991133 Electrogastrography w/test A XXX 0991133 TC Electrogastrography w/test A XXX 0391133 26 Electrogastrography w/test A XXX 0991200 Liver elastography A XXX 0991200 TC Liver elastography A XXX 0191200 26 Liver elastography A XXX 09

91299 Gastroenterology procedure C XXX 0991299 TC Gastroenterology procedure C XXX 0991299 26 Gastroenterology procedure C XXX 0992002 Eye exam new patient A XXX 0992004 Eye exam new patient A XXX 0992012 Eye exam establish patient A XXX 0992014 Eye exam&tx estab pt 1/>vst A XXX 0992015 Determine refractive state N XXX 0992018 New eye exam & treatment A XXX 0992019 Eye exam & treatment A XXX 0992020 Special eye evaluation A XXX 0992025 Corneal topography A XXX 0992025 TC Corneal topography A XXX 0992025 26 Corneal topography A XXX 0992060 Special eye evaluation A XXX 0992060 TC Special eye evaluation A XXX 0192060 26 Special eye evaluation A XXX 0992065 Orthoptic/pleoptic training A XXX 0992065 TC Orthoptic/pleoptic training A XXX 0192065 26 Orthoptic/pleoptic training A XXX 0992071 Contact lens fitting for tx A XXX 0992072 Fit contac lens for managmnt A XXX 0992081 Visual field examination(s) A XXX 0992081 TC Visual field examination(s) A XXX 0192081 26 Visual field examination(s) A XXX 0992082 Visual field examination(s) A XXX 0992082 TC Visual field examination(s) A XXX 0192082 26 Visual field examination(s) A XXX 0992083 Visual field examination(s) A XXX 0992083 TC Visual field examination(s) A XXX 0192083 26 Visual field examination(s) A XXX 0992100 Serial tonometry exam(s) A XXX 0992132 Cmptr ophth dx img ant segmt A XXX 0992132 TC Cmptr ophth dx img ant segmt A XXX 0192132 26 Cmptr ophth dx img ant segmt A XXX 0992133 Cmptr ophth img optic nerve A XXX 0992133 TC Cmptr ophth img optic nerve A XXX 0192133 26 Cmptr ophth img optic nerve A XXX 0992134 Cptr ophth dx img post segmt A XXX 0992134 TC Cptr ophth dx img post segmt A XXX 0192134 26 Cptr ophth dx img post segmt A XXX 0992136 Ophthalmic biometry A XXX 0992136 TC Ophthalmic biometry A XXX 0992136 26 Ophthalmic biometry A XXX 0992140 Glaucoma provocative tests A XXX 0992145 Corneal hysteresis deter A XXX 0992145 TC Corneal hysteresis deter A XXX 0192145 26 Corneal hysteresis deter A XXX 0992225 Special eye exam initial A XXX 0992226 Special eye exam subsequent A XXX 09

92227 Remote dx retinal imaging A XXX 0992228 Remote retinal imaging mgmt A XXX 0992228 TC Remote retinal imaging mgmt A XXX 0192228 26 Remote retinal imaging mgmt A XXX 0992230 Eye exam with photos A XXX 0992235 Eye exam with photos A XXX 0992235 TC Eye exam with photos A XXX 0292235 26 Eye exam with photos A XXX 0992240 Icg angiography A XXX 0992240 TC Icg angiography A XXX 0292240 26 Icg angiography A XXX 0992250 Eye exam with photos A XXX 0992250 TC Eye exam with photos A XXX 0192250 26 Eye exam with photos A XXX 0992260 Ophthalmoscopy/dynamometry A XXX 0992265 Eye muscle evaluation A XXX 0992265 TC Eye muscle evaluation A XXX 0392265 26 Eye muscle evaluation A XXX 0992270 Electro-oculography A XXX 0992270 TC Electro-oculography A XXX 0192270 26 Electro-oculography A XXX 0992275 Electroretinography A XXX 0992275 TC Electroretinography A XXX 0192275 26 Electroretinography A XXX 0992283 Color vision examination A XXX 0992283 TC Color vision examination A XXX 0192283 26 Color vision examination A XXX 0992284 Dark adaptation eye exam A XXX 0992284 TC Dark adaptation eye exam A XXX 0192284 26 Dark adaptation eye exam A XXX 0992285 Eye photography A XXX 0992285 TC Eye photography A XXX 0192285 26 Eye photography A XXX 0992286 Internal eye photography A XXX 0992286 TC Internal eye photography A XXX 0192286 26 Internal eye photography A XXX 0992287 Internal eye photography A XXX 0992287 TC Internal eye photography A XXX 0992287 26 Internal eye photography A XXX 0992310 Contact lens fitting N XXX 0992311 Contact lens fitting A XXX 0992312 Contact lens fitting A XXX 0992313 Contact lens fitting A XXX 0992314 Prescription of contact lens N XXX 0992315 Rx cntact lens aphakia 1 eye A XXX 0992316 Rx cntact lens aphakia 2 eye A XXX 0992317 Rx corneoscleral cntact lens A XXX 0992325 Modification of contact lens A XXX 0992326 Replacement of contact lens A XXX 0992340 Fit spectacles monofocal N XXX 09

92341 Fit spectacles bifocal N XXX 0992342 Fit spectacles multifocal N XXX 0992352 Fit aphakia spectcl monofocl B XXX 0992353 Fit aphakia spectcl multifoc B XXX 0992354 Fit spectacles single system B XXX 0992355 Fit spectacles compound lens B XXX 0992358 Aphakia prosth service temp B XXX 0992370 Repair & adjust spectacles N XXX 0992371 Repair & adjust spectacles B XXX 0992499 Eye service or procedure C XXX 0992499 TC Eye service or procedure C XXX 0992499 26 Eye service or procedure C XXX 0992502 Ear and throat examination A 000 0992504 Ear microscopy examination A XXX 0992507 Speech/hearing therapy A XXX 0992508 Speech/hearing therapy A XXX 0992511 Nasopharyngoscopy A 000 0392512 Nasal function studies A XXX 0992516 Facial nerve function test A XXX 0992520 Laryngeal function studies A XXX 0992521 Evaluation of speech fluency A XXX 0992522 Evaluate speech production A XXX 0992523 Speech sound lang comprehen A XXX 0992524 Behavral qualit analys voice A XXX 0992526 Oral function therapy A XXX 0992531 Spontaneous nystagmus study B XXX 0992532 Positional nystagmus test B XXX 0992533 Caloric vestibular test B XXX 0992534 Optokinetic nystagmus test B XXX 0992540 Basic vestibular evaluation A XXX 0992540 TC Basic vestibular evaluation A XXX 0292540 26 Basic vestibular evaluation A XXX 0992541 Spontaneous nystagmus test A XXX 0992541 TC Spontaneous nystagmus test A XXX 0292541 26 Spontaneous nystagmus test A XXX 0992542 Positional nystagmus test A XXX 0992542 TC Positional nystagmus test A XXX 0292542 26 Positional nystagmus test A XXX 0992543 Caloric vestibular test A XXX 0992543 TC Caloric vestibular test A XXX 0292543 26 Caloric vestibular test A XXX 0992544 Optokinetic nystagmus test A XXX 0992544 TC Optokinetic nystagmus test A XXX 0292544 26 Optokinetic nystagmus test A XXX 0992545 Oscillating tracking test A XXX 0992545 TC Oscillating tracking test A XXX 0292545 26 Oscillating tracking test A XXX 0992546 Sinusoidal rotational test A XXX 0992546 TC Sinusoidal rotational test A XXX 0292546 26 Sinusoidal rotational test A XXX 09

92547 Supplemental electrical test A ZZZ 0292548 Posturography A XXX 0992548 TC Posturography A XXX 0292548 26 Posturography A XXX 0992550 Tympanometry & reflex thresh A XXX 0292551 Pure tone hearing test air N XXX 0992552 Pure tone audiometry air A XXX 0292553 Audiometry air & bone A XXX 0292555 Speech threshold audiometry A XXX 0292556 Speech audiometry complete A XXX 0292557 Comprehensive hearing test A XXX 0292558 Evoked auditory test qual X XXX 0992559 Group audiometric testing N XXX 0992560 Bekesy audiometry screen N XXX 0992561 Bekesy audiometry diagnosis A XXX 0292562 Loudness balance test A XXX 0292563 Tone decay hearing test A XXX 0292564 Sisi hearing test A XXX 0292565 Stenger test pure tone A XXX 0292567 Tympanometry A XXX 0292568 Acoustic refl threshold tst A XXX 0292570 Acoustic immitance testing A XXX 0292571 Filtered speech hearing test A XXX 0292572 Staggered spondaic word test A XXX 0292575 Sensorineural acuity test A XXX 0292576 Synthetic sentence test A XXX 0292577 Stenger test speech A XXX 0292579 Visual audiometry (vra) A XXX 0292582 Conditioning play audiometry A XXX 0292583 Select picture audiometry A XXX 0292584 Electrocochleography A XXX 0292585 Auditor evoke potent compre A XXX 0992585 TC Auditor evoke potent compre A XXX 0292585 26 Auditor evoke potent compre A XXX 0992586 Auditor evoke potent limit A XXX 0292587 Evoked auditory test limited A XXX 0992587 TC Evoked auditory test limited A XXX 0292587 26 Evoked auditory test limited A XXX 0992588 Evoked auditory tst complete A XXX 0992588 TC Evoked auditory tst complete A XXX 0292588 26 Evoked auditory tst complete A XXX 0992590 Hearing aid exam one ear N XXX 0992591 Hearing aid exam both ears N XXX 0992592 Hearing aid check one ear N XXX 0992593 Hearing aid check both ears N XXX 0992594 Electro hearng aid test one N XXX 0992595 Electro hearng aid tst both N XXX 0992596 Ear protector evaluation A XXX 0992597 Oral speech device eval A XXX 0992601 Cochlear implt f/up exam <7 A XXX 02

92602 Reprogram cochlear implt 7/> A XXX 0292603 Cochlear implt f/up exam 7/> A XXX 0292604 Reprogram cochlear implt 7/> A XXX 0292605 Ex for nonspeech device rx B XXX 0992606 Non-speech device service B XXX 0992607 Ex for speech device rx 1hr A XXX 0992608 Ex for speech device rx addl A ZZZ 0992609 Use of speech device service A XXX 0992610 Evaluate swallowing function A XXX 0992611 Motion fluoroscopy/swallow A XXX 0992612 Endoscopy swallow tst (fees) A XXX 0992613 Endoscopy swallow tst (fees) A XXX 0992614 Laryngoscopic sensory test A XXX 0992615 Eval laryngoscopy sense tst A XXX 0992616 Fees w/laryngeal sense test A XXX 0992617 Interprt fees/laryngeal test A XXX 0992618 Ex for nonspeech dev rx add B ZZZ 0992620 Auditory function 60 min A XXX 0292621 Auditory function + 15 min A ZZZ 0292625 Tinnitus assessment A XXX 0292626 Eval aud rehab status A XXX 0292627 Eval aud status rehab add-on A ZZZ 0292630 Aud rehab pre-ling hear loss I XXX 0992633 Aud rehab postling hear loss I XXX 0992640 Aud brainstem implt programg A XXX 0592700 Ent procedure/service C XXX 0992920 Prq cardiac angioplast 1 art A 000 0992921 Prq cardiac angio addl art B ZZZ 0992924 Prq card angio/athrect 1 art A 000 0992925 Prq card angio/athrect addl B ZZZ 0992928 Prq card stent w/angio 1 vsl A 000 0992929 Prq card stent w/angio addl B ZZZ 0992933 Prq card stent/ath/angio A 000 0992934 Prq card stent/ath/angio B ZZZ 0992937 Prq revasc byp graft 1 vsl A 000 0992938 Prq revasc byp graft addl B ZZZ 0992941 Prq card revasc mi 1 vsl A 000 0992943 Prq card revasc chronic 1vsl A 000 0992944 Prq card revasc chronic addl B ZZZ 0992950 Heart/lung resuscitation cpr A 000 0992953 Temporary external pacing A 000 0992960 Cardioversion electric ext A 000 0992961 Cardioversion electric int A 000 0992970 Cardioassist internal A 000 0992971 Cardioassist external A 000 0992973 Prq coronary mech thrombect A ZZZ 0992974 Cath place cardio brachytx A ZZZ 0992975 Dissolve clot heart vessel A 000 0992977 Dissolve clot heart vessel A XXX 0992978 Intravasc us heart add-on C ZZZ 09

92978 TC Intravasc us heart add-on C ZZZ 0392978 26 Intravasc us heart add-on A ZZZ 0992979 Intravasc us heart add-on C ZZZ 0992979 TC Intravasc us heart add-on C ZZZ 0392979 26 Intravasc us heart add-on A ZZZ 0992986 Revision of aortic valve A 090 0992987 Revision of mitral valve A 090 0992990 Revision of pulmonary valve A 090 0992992 Revision of heart chamber C 090 0992993 Revision of heart chamber C 090 0992997 Pul art balloon repr percut A 000 0992998 Pul art balloon repr percut A ZZZ 0993000 Electrocardiogram complete A XXX 0193005 Electrocardiogram tracing A XXX 0193010 Electrocardiogram report A XXX 0993015 Cardiovascular stress test A XXX 0293016 Cardiovascular stress test A XXX 0293017 Cardiovascular stress test A XXX 0293018 Cardiovascular stress test A XXX 0993024 Cardiac drug stress test A XXX 0993024 TC Cardiac drug stress test A XXX 0393024 26 Cardiac drug stress test A XXX 0993025 Microvolt t-wave assess A XXX 0993025 TC Microvolt t-wave assess A XXX 0193025 26 Microvolt t-wave assess A XXX 0993040 Rhythm ecg with report A XXX 0193041 Rhythm ecg tracing A XXX 0193042 Rhythm ecg report A XXX 0993224 Ecg monit/reprt up to 48 hrs A XXX 0193225 Ecg monit/reprt up to 48 hrs A XXX 0193226 Ecg monit/reprt up to 48 hrs A XXX 0193227 Ecg monit/reprt up to 48 hrs A XXX 0993228 Remote 30 day ecg rev/report A XXX 0993229 Remote 30 day ecg tech supp A XXX 0193260 Prgrmg dev eval impltbl sys A XXX 0993260 TC Prgrmg dev eval impltbl sys A XXX 0293260 26 Prgrmg dev eval impltbl sys A XXX 0993261 Interrogate subq defib A XXX 0993261 TC Interrogate subq defib A XXX 0293261 26 Interrogate subq defib A XXX 0993268 Ecg record/review A XXX 0193270 Remote 30 day ecg rev/report A XXX 0193271 Ecg/monitoring and analysis A XXX 0193272 Ecg/review interpret only A XXX 0993278 Ecg/signal-averaged A XXX 0993278 TC Ecg/signal-averaged A XXX 0193278 26 Ecg/signal-averaged A XXX 0993279 Pm device progr eval sngl A XXX 0993279 TC Pm device progr eval sngl A XXX 0293279 26 Pm device progr eval sngl A XXX 09

93280 Pm device progr eval dual A XXX 0993280 TC Pm device progr eval dual A XXX 0293280 26 Pm device progr eval dual A XXX 0993281 Pm device progr eval multi A XXX 0993281 TC Pm device progr eval multi A XXX 0293281 26 Pm device progr eval multi A XXX 0993282 Prgrmg eval implantable dfb A XXX 0993282 TC Prgrmg eval implantable dfb A XXX 0293282 26 Prgrmg eval implantable dfb A XXX 0993283 Prgrmg eval implantable dfb A XXX 0993283 TC Prgrmg eval implantable dfb A XXX 0293283 26 Prgrmg eval implantable dfb A XXX 0993284 Prgrmg eval implantable dfb A XXX 0993284 TC Prgrmg eval implantable dfb A XXX 0293284 26 Prgrmg eval implantable dfb A XXX 0993285 Ilr device eval progr A XXX 0993285 TC Ilr device eval progr A XXX 0293285 26 Ilr device eval progr A XXX 0993286 Peri-px pacemaker device evl A XXX 0993286 TC Peri-px pacemaker device evl A XXX 0293286 26 Peri-px pacemaker device evl A XXX 0993287 Peri-px device eval & prgr A XXX 0993287 TC Peri-px device eval & prgr A XXX 0293287 26 Peri-px device eval & prgr A XXX 0993288 Pm device eval in person A XXX 0993288 TC Pm device eval in person A XXX 0293288 26 Pm device eval in person A XXX 0993289 Interrog device eval heart A XXX 0993289 TC Interrog device eval heart A XXX 0293289 26 Interrog device eval heart A XXX 0993290 Icm device eval A XXX 0993290 TC Icm device eval A XXX 0293290 26 Icm device eval A XXX 0993291 Ilr device interrogate A XXX 0993291 TC Ilr device interrogate A XXX 0293291 26 Ilr device interrogate A XXX 0993292 Wcd device interrogate A XXX 0993292 TC Wcd device interrogate A XXX 0293292 26 Wcd device interrogate A XXX 0993293 Pm phone r-strip device eval A XXX 0993293 TC Pm phone r-strip device eval A XXX 0193293 26 Pm phone r-strip device eval A XXX 0993294 Pm device interrogate remote A XXX 0993295 Dev interrog remote 1/2/mlt A XXX 0993296 Pm/icd remote tech serv A XXX 0193297 Icm device interrogat remote A XXX 0993298 Ilr device interrogat remote A XXX 0993299 Icm/ilr remote tech serv C XXX 0193303 Echo transthoracic A XXX 0993303 TC Echo transthoracic A XXX 01

93303 26 Echo transthoracic A XXX 0993304 Echo transthoracic A XXX 0993304 TC Echo transthoracic A XXX 0193304 26 Echo transthoracic A XXX 0993306 Tte w/doppler complete A XXX 0993306 TC Tte w/doppler complete A XXX 0193306 26 Tte w/doppler complete A XXX 0993307 Tte w/o doppler complete A XXX 0993307 TC Tte w/o doppler complete A XXX 0193307 26 Tte w/o doppler complete A XXX 0993308 Tte f-up or lmtd A XXX 0993308 TC Tte f-up or lmtd A XXX 0193308 26 Tte f-up or lmtd A XXX 0993312 Echo transesophageal A XXX 0993312 TC Echo transesophageal A XXX 0393312 26 Echo transesophageal A XXX 0993313 Echo transesophageal A XXX 0393314 Echo transesophageal A XXX 0993314 TC Echo transesophageal A XXX 0393314 26 Echo transesophageal A XXX 0993315 Echo transesophageal C XXX 0993315 TC Echo transesophageal C XXX 0393315 26 Echo transesophageal A XXX 0993316 Echo transesophageal A XXX 0393317 Echo transesophageal C XXX 0993317 TC Echo transesophageal C XXX 0393317 26 Echo transesophageal A XXX 0993318 Echo transesophageal intraop C XXX 0993318 TC Echo transesophageal intraop C XXX 0193318 26 Echo transesophageal intraop A XXX 0993320 Doppler echo exam heart A ZZZ 0993320 TC Doppler echo exam heart A ZZZ 0193320 26 Doppler echo exam heart A ZZZ 0993321 Doppler echo exam heart A ZZZ 0993321 TC Doppler echo exam heart A ZZZ 0193321 26 Doppler echo exam heart A ZZZ 0993325 Doppler color flow add-on A ZZZ 0993325 TC Doppler color flow add-on A ZZZ 0193325 26 Doppler color flow add-on A ZZZ 0993350 Stress tte only A XXX 0993350 TC Stress tte only A XXX 0293350 26 Stress tte only A XXX 0993351 Stress tte complete A XXX 0993351 TC Stress tte complete A XXX 0293351 26 Stress tte complete A XXX 0993352 Admin ecg contrast agent A ZZZ 0993355 Echo transesophageal (tee) A XXX 0993451 Right heart cath A 000 0993451 TC Right heart cath A 000 0393451 26 Right heart cath A 000 09

93452 Left hrt cath w/ventrclgrphy A 000 0993452 TC Left hrt cath w/ventrclgrphy A 000 0393452 26 Left hrt cath w/ventrclgrphy A 000 0993453 R&l hrt cath w/ventriclgrphy A 000 0993453 TC R&l hrt cath w/ventriclgrphy A 000 0393453 26 R&l hrt cath w/ventriclgrphy A 000 0993454 Coronary artery angio s&i A 000 0993454 TC Coronary artery angio s&i A 000 0393454 26 Coronary artery angio s&i A 000 0993455 Coronary art/grft angio s&i A 000 0993455 TC Coronary art/grft angio s&i A 000 0393455 26 Coronary art/grft angio s&i A 000 0993456 R hrt coronary artery angio A 000 0993456 TC R hrt coronary artery angio A 000 0393456 26 R hrt coronary artery angio A 000 0993457 R hrt art/grft angio A 000 0993457 TC R hrt art/grft angio A 000 0393457 26 R hrt art/grft angio A 000 0993458 L hrt artery/ventricle angio A 000 0993458 TC L hrt artery/ventricle angio A 000 0393458 26 L hrt artery/ventricle angio A 000 0993459 L hrt art/grft angio A 000 0993459 TC L hrt art/grft angio A 000 0393459 26 L hrt art/grft angio A 000 0993460 R&l hrt art/ventricle angio A 000 0993460 TC R&l hrt art/ventricle angio A 000 0393460 26 R&l hrt art/ventricle angio A 000 0993461 R&l hrt art/ventricle angio A 000 0993461 TC R&l hrt art/ventricle angio A 000 0393461 26 R&l hrt art/ventricle angio A 000 0993462 L hrt cath trnsptl puncture A ZZZ 0993463 Drug admin & hemodynmic meas A ZZZ 0993464 Exercise w/hemodynamic meas A ZZZ 0993464 TC Exercise w/hemodynamic meas A ZZZ 0393464 26 Exercise w/hemodynamic meas A ZZZ 0993503 Insert/place heart catheter A 000 0993505 Biopsy of heart lining A 000 0993505 TC Biopsy of heart lining A 000 0393505 26 Biopsy of heart lining A 000 0993530 Rt heart cath congenital C 000 0993530 TC Rt heart cath congenital C 000 0393530 26 Rt heart cath congenital A 000 0993531 R & l heart cath congenital C 000 0993531 TC R & l heart cath congenital C 000 0393531 26 R & l heart cath congenital A 000 0993532 R & l heart cath congenital C 000 0993532 TC R & l heart cath congenital C 000 0393532 26 R & l heart cath congenital A 000 0993533 R & l heart cath congenital C 000 0993533 TC R & l heart cath congenital C 000 03

93533 26 R & l heart cath congenital A 000 0993561 Cardiac output measurement C 000 0993561 TC Cardiac output measurement C 000 0393561 26 Cardiac output measurement A 000 0993562 Card output measure subsq C 000 0993562 TC Card output measure subsq C 000 0393562 26 Card output measure subsq A 000 0993563 Inject congenital card cath A ZZZ 0993564 Inject hrt congntl art/grft A ZZZ 0993565 Inject l ventr/atrial angio A ZZZ 0993566 Inject r ventr/atrial angio A ZZZ 0993567 Inject suprvlv aortography A ZZZ 0993568 Inject pulm art hrt cath A ZZZ 0993571 Heart flow reserve measure C ZZZ 0993571 TC Heart flow reserve measure C ZZZ 0393571 26 Heart flow reserve measure A ZZZ 0993572 Heart flow reserve measure C ZZZ 0993572 TC Heart flow reserve measure C ZZZ 0393572 26 Heart flow reserve measure A ZZZ 0993580 Transcath closure of asd A 000 0993581 Transcath closure of vsd A 000 0993582 Perq transcath closure pda A 000 0993583 Perq transcath septal reduxn A 000 0993600 Bundle of his recording C 000 0993600 TC Bundle of his recording C 000 0393600 26 Bundle of his recording A 000 0993602 Intra-atrial recording C 000 0993602 TC Intra-atrial recording C 000 0393602 26 Intra-atrial recording A 000 0993603 Right ventricular recording C 000 0993603 TC Right ventricular recording C 000 0393603 26 Right ventricular recording A 000 0993609 Map tachycardia add-on C ZZZ 0993609 TC Map tachycardia add-on C ZZZ 0393609 26 Map tachycardia add-on A ZZZ 0993610 Intra-atrial pacing C 000 0993610 TC Intra-atrial pacing C 000 0393610 26 Intra-atrial pacing A 000 0993612 Intraventricular pacing C 000 0993612 TC Intraventricular pacing C 000 0393612 26 Intraventricular pacing A 000 0993613 Electrophys map 3d add-on A ZZZ 0993615 Esophageal recording C 000 0993615 TC Esophageal recording C 000 0393615 26 Esophageal recording A 000 0993616 Esophageal recording C 000 0993616 TC Esophageal recording C 000 0393616 26 Esophageal recording A 000 0993618 Heart rhythm pacing C 000 0993618 TC Heart rhythm pacing C 000 03

93618 26 Heart rhythm pacing A 000 0993619 Electrophysiology evaluation C 000 0993619 TC Electrophysiology evaluation C 000 0393619 26 Electrophysiology evaluation A 000 0993620 Electrophysiology evaluation C 000 0993620 TC Electrophysiology evaluation C 000 0393620 26 Electrophysiology evaluation A 000 0993621 Electrophysiology evaluation C ZZZ 0993621 TC Electrophysiology evaluation C ZZZ 0393621 26 Electrophysiology evaluation A ZZZ 0993622 Electrophysiology evaluation C ZZZ 0993622 TC Electrophysiology evaluation C ZZZ 0393622 26 Electrophysiology evaluation A ZZZ 0993623 Stimulation pacing heart C ZZZ 0993623 TC Stimulation pacing heart C ZZZ 0393623 26 Stimulation pacing heart A ZZZ 0993624 Electrophysiologic study C 000 0993624 TC Electrophysiologic study C 000 0393624 26 Electrophysiologic study A 000 0993631 Heart pacing mapping C 000 0993631 TC Heart pacing mapping C 000 0393631 26 Heart pacing mapping A 000 0993640 Evaluation heart device C 000 0993640 TC Evaluation heart device C 000 0393640 26 Evaluation heart device A 000 0993641 Electrophysiology evaluation C 000 0993641 TC Electrophysiology evaluation C 000 0393641 26 Electrophysiology evaluation A 000 0993642 Electrophysiology evaluation A 000 0993642 TC Electrophysiology evaluation A 000 0393642 26 Electrophysiology evaluation A 000 0993644 Electrophysiology evaluation A 000 0993644 TC Electrophysiology evaluation A 000 0393644 26 Electrophysiology evaluation A 000 0993650 Ablate heart dysrhythm focus A 000 0993653 Ep & ablate supravent arrhyt A 000 0993654 Ep & ablate ventric tachy A 000 0993655 Ablate arrhythmia add on A ZZZ 0993656 Tx atrial fib pulm vein isol A 000 0993657 Tx l/r atrial fib addl A ZZZ 0993660 Tilt table evaluation A 000 0993660 TC Tilt table evaluation A 000 0293660 26 Tilt table evaluation A 000 0993662 Intracardiac ecg (ice) C ZZZ 0993662 TC Intracardiac ecg (ice) C ZZZ 0393662 26 Intracardiac ecg (ice) A ZZZ 0993668 Peripheral vascular rehab N XXX 0993701 Bioimpedance cv analysis A XXX 0993702 Bis xtracell fluid analysis A XXX 0993724 Analyze pacemaker system A 000 09

93724 TC Analyze pacemaker system A 000 0393724 26 Analyze pacemaker system A 000 0993740 Temperature gradient studies B XXX 0993745 Set-up cardiovert-defibrill C XXX 0993745 TC Set-up cardiovert-defibrill C XXX 0293745 26 Set-up cardiovert-defibrill C XXX 0993750 Interrogation vad in person A XXX 0993770 Measure venous pressure B XXX 0993784 Ambulatory bp monitoring A XXX 0193786 Ambulatory bp recording A XXX 0193788 Ambulatory bp analysis A XXX 0993790 Review/report bp recording A XXX 0993797 Cardiac rehab A 000 0993798 Cardiac rehab/monitor A 000 0993799 Cardiovascular procedure C XXX 0993799 TC Cardiovascular procedure C XXX 0993799 26 Cardiovascular procedure C XXX 0993880 Extracranial bilat study A XXX 0993880 TC Extracranial bilat study A XXX 0193880 26 Extracranial bilat study A XXX 0993882 Extracranial uni/ltd study A XXX 0993882 TC Extracranial uni/ltd study A XXX 0193882 26 Extracranial uni/ltd study A XXX 0993886 Intracranial complete study A XXX 0993886 TC Intracranial complete study A XXX 0193886 26 Intracranial complete study A XXX 0993888 Intracranial limited study A XXX 0993888 TC Intracranial limited study A XXX 0193888 26 Intracranial limited study A XXX 0993890 Tcd vasoreactivity study A XXX 0993890 TC Tcd vasoreactivity study A XXX 0193890 26 Tcd vasoreactivity study A XXX 0993892 Tcd emboli detect w/o inj A XXX 0993892 TC Tcd emboli detect w/o inj A XXX 0193892 26 Tcd emboli detect w/o inj A XXX 0993893 Tcd emboli detect w/inj A XXX 0993893 TC Tcd emboli detect w/inj A XXX 0193893 26 Tcd emboli detect w/inj A XXX 0993895 Carotid intima atheroma eval N XXX 0993895 TC Carotid intima atheroma eval N XXX 0193895 26 Carotid intima atheroma eval N XXX 0993922 Upr/l xtremity art 2 levels A XXX 0993922 TC Upr/l xtremity art 2 levels A XXX 0193922 26 Upr/l xtremity art 2 levels A XXX 0993923 Upr/lxtr art stdy 3+ lvls A XXX 0993923 TC Upr/lxtr art stdy 3+ lvls A XXX 0193923 26 Upr/lxtr art stdy 3+ lvls A XXX 0993924 Lwr xtr vasc stdy bilat A XXX 0993924 TC Lwr xtr vasc stdy bilat A XXX 0193924 26 Lwr xtr vasc stdy bilat A XXX 09

93925 Lower extremity study A XXX 0993925 TC Lower extremity study A XXX 0193925 26 Lower extremity study A XXX 0993926 Lower extremity study A XXX 0993926 TC Lower extremity study A XXX 0193926 26 Lower extremity study A XXX 0993930 Upper extremity study A XXX 0993930 TC Upper extremity study A XXX 0193930 26 Upper extremity study A XXX 0993931 Upper extremity study A XXX 0993931 TC Upper extremity study A XXX 0193931 26 Upper extremity study A XXX 0993965 Extremity study A XXX 0993965 TC Extremity study A XXX 0193965 26 Extremity study A XXX 0993970 Extremity study A XXX 0993970 TC Extremity study A XXX 0193970 26 Extremity study A XXX 0993971 Extremity study A XXX 0993971 TC Extremity study A XXX 0193971 26 Extremity study A XXX 0993975 Vascular study A XXX 0993975 TC Vascular study A XXX 0193975 26 Vascular study A XXX 0993976 Vascular study A XXX 0993976 TC Vascular study A XXX 0193976 26 Vascular study A XXX 0993978 Vascular study A XXX 0993978 TC Vascular study A XXX 0193978 26 Vascular study A XXX 0993979 Vascular study A XXX 0993979 TC Vascular study A XXX 0193979 26 Vascular study A XXX 0993980 Penile vascular study A XXX 0993980 TC Penile vascular study A XXX 0193980 26 Penile vascular study A XXX 0993981 Penile vascular study A XXX 0993981 TC Penile vascular study A XXX 0193981 26 Penile vascular study A XXX 0993982 Aneurysm pressure sens study R XXX 0993990 Doppler flow testing A XXX 0993990 TC Doppler flow testing A XXX 0193990 26 Doppler flow testing A XXX 0993998 Noninvas vasc dx study proc C XXX 0994002 Vent mgmt inpat init day A XXX 0994003 Vent mgmt inpat subq day A XXX 0994004 Vent mgmt nf per day A XXX 0994005 Home vent mgmt supervision B XXX 0994010 Breathing capacity test A XXX 0994010 TC Breathing capacity test A XXX 01

94010 26 Breathing capacity test A XXX 0994011 Spirometry up to 2 yrs old A XXX 0994012 Spirmtry w/brnchdil inf-2 yr A XXX 0994013 Meas lung vol thru 2 yrs A XXX 0994014 Patient recorded spirometry A XXX 0194015 Patient recorded spirometry A XXX 0194016 Review patient spirometry A XXX 0994060 Evaluation of wheezing A XXX 0994060 TC Evaluation of wheezing A XXX 0294060 26 Evaluation of wheezing A XXX 0994070 Evaluation of wheezing A XXX 0994070 TC Evaluation of wheezing A XXX 0294070 26 Evaluation of wheezing A XXX 0994150 Vital capacity test B XXX 0994150 TC Vital capacity test B XXX 0194150 26 Vital capacity test B XXX 0994200 Lung function test (mbc/mvv) A XXX 0994200 TC Lung function test (mbc/mvv) A XXX 0194200 26 Lung function test (mbc/mvv) A XXX 0994250 Expired gas collection A XXX 0994250 TC Expired gas collection A XXX 0194250 26 Expired gas collection A XXX 0994375 Respiratory flow volume loop A XXX 0994375 TC Respiratory flow volume loop A XXX 0194375 26 Respiratory flow volume loop A XXX 0994400 Co2 breathing response curve A XXX 0994400 TC Co2 breathing response curve A XXX 0294400 26 Co2 breathing response curve A XXX 0994450 Hypoxia response curve A XXX 0994450 TC Hypoxia response curve A XXX 0294450 26 Hypoxia response curve A XXX 0994452 Hast w/report A XXX 0994452 TC Hast w/report A XXX 0294452 26 Hast w/report A XXX 0994453 Hast w/oxygen titrate A XXX 0994453 TC Hast w/oxygen titrate A XXX 0294453 26 Hast w/oxygen titrate A XXX 0994610 Surfactant admin thru tube A XXX 0994620 Pulmonary stress test/simple A XXX 0994620 TC Pulmonary stress test/simple A XXX 0194620 26 Pulmonary stress test/simple A XXX 0994621 Pulm stress test/complex A XXX 0994621 TC Pulm stress test/complex A XXX 0294621 26 Pulm stress test/complex A XXX 0994640 Airway inhalation treatment A XXX 0994642 Aerosol inhalation treatment C XXX 0994644 Cbt 1st hour A XXX 0994645 Cbt each addl hour A XXX 0994660 Pos airway pressure cpap A XXX 0994662 Neg press ventilation cnp A XXX 09

94664 Evaluate pt use of inhaler A XXX 0294667 Chest wall manipulation A XXX 0994668 Chest wall manipulation A XXX 0994669 Mechanical chest wall oscill A XXX 0994680 Exhaled air analysis o2 A XXX 0994680 TC Exhaled air analysis o2 A XXX 0294680 26 Exhaled air analysis o2 A XXX 0994681 Exhaled air analysis o2/co2 A XXX 0994681 TC Exhaled air analysis o2/co2 A XXX 0294681 26 Exhaled air analysis o2/co2 A XXX 0994690 Exhaled air analysis A XXX 0994690 TC Exhaled air analysis A XXX 0194690 26 Exhaled air analysis A XXX 0994726 Pulm funct tst plethysmograp A XXX 0994726 TC Pulm funct tst plethysmograp A XXX 0194726 26 Pulm funct tst plethysmograp A XXX 0994727 Pulm function test by gas A XXX 0994727 TC Pulm function test by gas A XXX 0194727 26 Pulm function test by gas A XXX 0994728 Pulm funct test oscillometry A XXX 0994728 TC Pulm funct test oscillometry A XXX 0194728 26 Pulm funct test oscillometry A XXX 0994729 Co/membane diffuse capacity A ZZZ 0994729 TC Co/membane diffuse capacity A ZZZ 0194729 26 Co/membane diffuse capacity A ZZZ 0994750 Pulmonary compliance study A XXX 0994750 TC Pulmonary compliance study A XXX 0194750 26 Pulmonary compliance study A XXX 0994760 Measure blood oxygen level T XXX 0194761 Measure blood oxygen level T XXX 0194762 Measure blood oxygen level A XXX 0194770 Exhaled carbon dioxide test A XXX 0994772 Breath recording infant C XXX 0994772 TC Breath recording infant C XXX 0194772 26 Breath recording infant C XXX 0994774 Ped home apnea rec compl C YYY 0994775 Ped home apnea rec hk-up C YYY 0994776 Ped home apnea rec downld C YYY 0994777 Ped home apnea rec report C YYY 0994780 Car seat/bed test 60 min A XXX 0994781 Car seat/bed test + 30 min A ZZZ 0994799 Pulmonary service/procedure C XXX 0994799 TC Pulmonary service/procedure C XXX 0994799 26 Pulmonary service/procedure C XXX 0995004 Percut allergy skin tests A XXX 0295012 Exhaled nitric oxide meas A XXX 0995017 Perq & icut allg test venoms A XXX 0995018 Perq&ic allg test drugs/biol A XXX 0995024 Icut allergy test drug/bug A XXX 0295027 Icut allergy titrate-airborn A XXX 02

95028 Icut allergy test-delayed A XXX 0295044 Allergy patch tests A XXX 0295052 Photo patch test A XXX 0295056 Photosensitivity tests A XXX 0295060 Eye allergy tests A XXX 0395065 Nose allergy test A XXX 0395070 Bronchial allergy tests A XXX 0295071 Bronchial allergy tests A XXX 0295076 Ingest challenge ini 120 min A XXX 0995079 Ingest challenge addl 60 min A ZZZ 0995115 Immunotherapy one injection A XXX 0995117 Immunotherapy injections A XXX 0995120 Immunotherapy one injection I XXX 0995125 Immunotherapy 2/> injections I XXX 0995130 Immntx 1 sting insect I XXX 0995131 Immntx 2 sting insects I XXX 0995132 Immntx 3 sting insects I XXX 0995133 Immntx 4 sting insects I XXX 0995134 Immntx 5 sting insects I XXX 0995144 Antigen therapy services A XXX 0995145 Antigen therapy services A XXX 0995146 Antigen therapy services A XXX 0995147 Antigen therapy services A XXX 0995148 Antigen therapy services A XXX 0995149 Antigen therapy services A XXX 0995165 Antigen therapy services A XXX 0995170 Antigen therapy services A XXX 0995180 Rapid desensitization A XXX 0995199 Allergy immunology services C XXX 0995250 Glucose monitoring cont A XXX 0995251 Gluc monitor cont phys i&r A XXX 0995782 Polysom <6 yrs 4/> paramtrs A XXX 0995782 TC Polysom <6 yrs 4/> paramtrs A XXX 0195782 26 Polysom <6 yrs 4/> paramtrs A XXX 0995783 Polysom <6 yrs cpap/bilvl A XXX 0995783 TC Polysom <6 yrs cpap/bilvl A XXX 0195783 26 Polysom <6 yrs cpap/bilvl A XXX 0995800 Slp stdy unattended A XXX 0995800 TC Slp stdy unattended A XXX 0195800 26 Slp stdy unattended A XXX 0995801 Slp stdy unatnd w/anal A XXX 0995801 TC Slp stdy unatnd w/anal A XXX 0195801 26 Slp stdy unatnd w/anal A XXX 0995803 Actigraphy testing A XXX 0995803 TC Actigraphy testing A XXX 0195803 26 Actigraphy testing A XXX 0995805 Multiple sleep latency test A XXX 0995805 TC Multiple sleep latency test A XXX 0195805 26 Multiple sleep latency test A XXX 0995806 Sleep study unatt&resp efft A XXX 09

95806 TC Sleep study unatt&resp efft A XXX 0195806 26 Sleep study unatt&resp efft A XXX 0995807 Sleep study attended A XXX 0995807 TC Sleep study attended A XXX 0195807 26 Sleep study attended A XXX 0995808 Polysom any age 1-3> param A XXX 0995808 TC Polysom any age 1-3> param A XXX 0195808 26 Polysom any age 1-3> param A XXX 0995810 Polysom 6/> yrs 4/> param A XXX 0995810 TC Polysom 6/> yrs 4/> param A XXX 0195810 26 Polysom 6/> yrs 4/> param A XXX 0995811 Polysom 6/>yrs cpap 4/> parm A XXX 0995811 TC Polysom 6/>yrs cpap 4/> parm A XXX 0195811 26 Polysom 6/>yrs cpap 4/> parm A XXX 0995812 Eeg 41-60 minutes A XXX 0995812 TC Eeg 41-60 minutes A XXX 0195812 26 Eeg 41-60 minutes A XXX 0995813 Eeg over 1 hour A XXX 0995813 TC Eeg over 1 hour A XXX 0195813 26 Eeg over 1 hour A XXX 0995816 Eeg awake and drowsy A XXX 0995816 TC Eeg awake and drowsy A XXX 0995816 26 Eeg awake and drowsy A XXX 0995819 Eeg awake and asleep A XXX 0995819 TC Eeg awake and asleep A XXX 0995819 26 Eeg awake and asleep A XXX 0995822 Eeg coma or sleep only A XXX 0995822 TC Eeg coma or sleep only A XXX 0995822 26 Eeg coma or sleep only A XXX 0995824 Eeg cerebral death only C XXX 0995824 TC Eeg cerebral death only C XXX 0195824 26 Eeg cerebral death only A XXX 0995827 Eeg all night recording A XXX 0995827 TC Eeg all night recording A XXX 0195827 26 Eeg all night recording A XXX 0995829 Surgery electrocorticogram A XXX 0995829 TC Surgery electrocorticogram A XXX 0195829 26 Surgery electrocorticogram A XXX 0995830 Insert electrodes for eeg A XXX 0995831 Limb muscle testing manual A XXX 0995832 Hand muscle testing manual A XXX 0995833 Body muscle testing manual A XXX 0995834 Body muscle testing manual A XXX 0995851 Range of motion measurements A XXX 0995852 Range of motion measurements A XXX 0995857 Cholinesterase challenge A XXX 0995860 Muscle test one limb A XXX 0995860 TC Muscle test one limb A XXX 6A95860 26 Muscle test one limb A XXX 0995861 Muscle test 2 limbs A XXX 09

95861 TC Muscle test 2 limbs A XXX 6A95861 26 Muscle test 2 limbs A XXX 0995863 Muscle test 3 limbs A XXX 0995863 TC Muscle test 3 limbs A XXX 6A95863 26 Muscle test 3 limbs A XXX 0995864 Muscle test 4 limbs A XXX 0995864 TC Muscle test 4 limbs A XXX 6A95864 26 Muscle test 4 limbs A XXX 0995865 Muscle test larynx A XXX 0995865 TC Muscle test larynx A XXX 6A95865 26 Muscle test larynx A XXX 0995866 Muscle test hemidiaphragm A XXX 0995866 TC Muscle test hemidiaphragm A XXX 6A95866 26 Muscle test hemidiaphragm A XXX 0995867 Muscle test cran nerv unilat A XXX 0995867 TC Muscle test cran nerv unilat A XXX 6A95867 26 Muscle test cran nerv unilat A XXX 0995868 Muscle test cran nerve bilat A XXX 0995868 TC Muscle test cran nerve bilat A XXX 6A95868 26 Muscle test cran nerve bilat A XXX 0995869 Muscle test thor paraspinal A XXX 0995869 TC Muscle test thor paraspinal A XXX 6A95869 26 Muscle test thor paraspinal A XXX 0995870 Muscle test nonparaspinal A XXX 0995870 TC Muscle test nonparaspinal A XXX 6A95870 26 Muscle test nonparaspinal A XXX 0995872 Muscle test one fiber A XXX 0995872 TC Muscle test one fiber A XXX 6695872 26 Muscle test one fiber A XXX 0995873 Guide nerv destr elec stim A ZZZ 0995873 TC Guide nerv destr elec stim A ZZZ 0395873 26 Guide nerv destr elec stim A ZZZ 0995874 Guide nerv destr needle emg A ZZZ 0995874 TC Guide nerv destr needle emg A ZZZ 0395874 26 Guide nerv destr needle emg A ZZZ 0995875 Limb exercise test A XXX 0995875 TC Limb exercise test A XXX 0395875 26 Limb exercise test A XXX 0995885 Musc tst done w/nerv tst lim A ZZZ 0995885 TC Musc tst done w/nerv tst lim A ZZZ 6A95885 26 Musc tst done w/nerv tst lim A ZZZ 0995886 Musc test done w/n test comp A ZZZ 0995886 TC Musc test done w/n test comp A ZZZ 6A95886 26 Musc test done w/n test comp A ZZZ 0995887 Musc tst done w/n tst nonext A ZZZ 0995887 TC Musc tst done w/n tst nonext A ZZZ 6A95887 26 Musc tst done w/n tst nonext A ZZZ 0995905 Motor &/ sens nrve cndj test A XXX 0995905 TC Motor &/ sens nrve cndj test A XXX 0195905 26 Motor &/ sens nrve cndj test A XXX 09

95907 Nvr cndj tst 1-2 studies A XXX 0995907 TC Nvr cndj tst 1-2 studies A XXX 7A95907 26 Nvr cndj tst 1-2 studies A XXX 0995908 Nrv cndj tst 3-4 studies A XXX 0995908 TC Nrv cndj tst 3-4 studies A XXX 7A95908 26 Nrv cndj tst 3-4 studies A XXX 0995909 Nrv cndj tst 5-6 studies A XXX 0995909 TC Nrv cndj tst 5-6 studies A XXX 7A95909 26 Nrv cndj tst 5-6 studies A XXX 0995910 Nrv cndj test 7-8 studies A XXX 0995910 TC Nrv cndj test 7-8 studies A XXX 7A95910 26 Nrv cndj test 7-8 studies A XXX 0995911 Nrv cndj test 9-10 studies A XXX 0995911 TC Nrv cndj test 9-10 studies A XXX 7A95911 26 Nrv cndj test 9-10 studies A XXX 0995912 Nrv cndj test 11-12 studies A XXX 0995912 TC Nrv cndj test 11-12 studies A XXX 7A95912 26 Nrv cndj test 11-12 studies A XXX 0995913 Nrv cndj test 13/> studies A XXX 0995913 TC Nrv cndj test 13/> studies A XXX 7A95913 26 Nrv cndj test 13/> studies A XXX 0995921 Autonomic nrv parasym inervj A XXX 0995921 TC Autonomic nrv parasym inervj A XXX 0295921 26 Autonomic nrv parasym inervj A XXX 0995922 Autonomic nrv adrenrg inervj A XXX 0995922 TC Autonomic nrv adrenrg inervj A XXX 0395922 26 Autonomic nrv adrenrg inervj A XXX 0995923 Autonomic nrv syst funj test A XXX 0995923 TC Autonomic nrv syst funj test A XXX 0395923 26 Autonomic nrv syst funj test A XXX 0995924 Ans parasymp & symp w/tilt A XXX 0995924 TC Ans parasymp & symp w/tilt A XXX 0995924 26 Ans parasymp & symp w/tilt A XXX 0995925 Somatosensory testing A XXX 0995925 TC Somatosensory testing A XXX 2195925 26 Somatosensory testing A XXX 0995926 Somatosensory testing A XXX 0995926 TC Somatosensory testing A XXX 2195926 26 Somatosensory testing A XXX 0995927 Somatosensory testing A XXX 0995927 TC Somatosensory testing A XXX 2195927 26 Somatosensory testing A XXX 0995928 C motor evoked uppr limbs A XXX 0995928 TC C motor evoked uppr limbs A XXX 0995928 26 C motor evoked uppr limbs A XXX 0995929 C motor evoked lwr limbs A XXX 0995929 TC C motor evoked lwr limbs A XXX 0995929 26 C motor evoked lwr limbs A XXX 0995930 Visual evoked potential test A XXX 0995930 TC Visual evoked potential test A XXX 09

95930 26 Visual evoked potential test A XXX 0995933 Blink reflex test A XXX 0995933 TC Blink reflex test A XXX 7A95933 26 Blink reflex test A XXX 0995937 Neuromuscular junction test A XXX 0995937 TC Neuromuscular junction test A XXX 7A95937 26 Neuromuscular junction test A XXX 0995938 Somatosensory testing A XXX 0995938 TC Somatosensory testing A XXX 2195938 26 Somatosensory testing A XXX 0995939 C motor evoked upr&lwr limbs A XXX 0995939 TC C motor evoked upr&lwr limbs A XXX 2195939 26 C motor evoked upr&lwr limbs A XXX 0995940 Ionm in operatng room 15 min A XXX 0395941 Ionm remote/>1 pt or per hr I XXX 0995943 Parasymp&symp hrt rate test C XXX 0995943 TC Parasymp&symp hrt rate test C XXX 0995943 26 Parasymp&symp hrt rate test C XXX 0995950 Ambulatory eeg monitoring A XXX 0995950 TC Ambulatory eeg monitoring A XXX 0195950 26 Ambulatory eeg monitoring A XXX 0995951 Eeg monitoring/videorecord C XXX 0995951 TC Eeg monitoring/videorecord C XXX 0195951 26 Eeg monitoring/videorecord A XXX 0995953 Eeg monitoring/computer A XXX 0995953 TC Eeg monitoring/computer A XXX 0195953 26 Eeg monitoring/computer A XXX 0995954 Eeg monitoring/giving drugs A XXX 0995954 TC Eeg monitoring/giving drugs A XXX 0395954 26 Eeg monitoring/giving drugs A XXX 0995955 Eeg during surgery A XXX 0995955 TC Eeg during surgery A XXX 0295955 26 Eeg during surgery A XXX 0995956 Eeg monitor technol attended A XXX 0995956 TC Eeg monitor technol attended A XXX 0195956 26 Eeg monitor technol attended A XXX 0995957 Eeg digital analysis A XXX 0995957 TC Eeg digital analysis A XXX 0195957 26 Eeg digital analysis A XXX 0995958 Eeg monitoring/function test A XXX 0995958 TC Eeg monitoring/function test A XXX 0395958 26 Eeg monitoring/function test A XXX 0995961 Electrode stimulation brain A XXX 0995961 TC Electrode stimulation brain A XXX 0395961 26 Electrode stimulation brain A XXX 0995962 Electrode stim brain add-on A ZZZ 0995962 TC Electrode stim brain add-on A ZZZ 0395962 26 Electrode stim brain add-on A ZZZ 0995965 Meg spontaneous C XXX 0995965 TC Meg spontaneous C XXX 09

95965 26 Meg spontaneous A XXX 0995966 Meg evoked single C XXX 0995966 TC Meg evoked single C XXX 0995966 26 Meg evoked single A XXX 0995967 Meg evoked each addl C ZZZ 0995967 TC Meg evoked each addl C ZZZ 0995967 26 Meg evoked each addl A ZZZ 0995970 Analyze neurostim no prog A XXX 0995971 Analyze neurostim simple A XXX 0995972 Analyze neurostim complex A XXX 0995973 Analyze neurostim complex A ZZZ 0995974 Cranial neurostim complex A XXX 0995975 Cranial neurostim complex A ZZZ 0995978 Analyze neurostim brain/1h A XXX 0995979 Analyz neurostim brain addon A ZZZ 0995980 Io anal gast n-stim init A XXX 0995981 Io anal gast n-stim subsq A XXX 0995982 Io ga n-stim subsq w/reprog A XXX 0995990 Spin/brain pump refil & main A XXX 0995991 Spin/brain pump refil & main A XXX 0995992 Canalith repositioning proc A XXX 0995999 Neurological procedure C XXX 0996000 Motion analysis video/3d A XXX 0996001 Motion test w/ft press meas A XXX 0996002 Dynamic surface emg A XXX 0996003 Dynamic fine wire emg A XXX 0996004 Phys review of motion tests A XXX 0996020 Functional brain mapping C XXX 0996020 TC Functional brain mapping C XXX 0396020 26 Functional brain mapping A XXX 0996040 Genetic counseling 30 min B XXX 0996101 Psycho testing by psych/phys A XXX 0496102 Psycho testing by technician A XXX 0496103 Psycho testing admin by comp A XXX 0496105 Assessment of aphasia A XXX 0496110 Developmental screen w/score N XXX 0496111 Developmental test extend A XXX 0496116 Neurobehavioral status exam A XXX 0496118 Neuropsych tst by psych/phys A XXX 0496119 Neuropsych testing by tec A XXX 0496120 Neuropsych tst admin w/comp A XXX 0496125 Cognitive test by hc pro A XXX 0996127 Brief emotional/behav assmt A XXX 0996150 Assess hlth/behave init A XXX 0996151 Assess hlth/behave subseq A XXX 0996152 Intervene hlth/behave indiv A XXX 0996153 Intervene hlth/behave group A XXX 0996154 Interv hlth/behav fam w/pt A XXX 0996155 Interv hlth/behav fam no pt N XXX 0996360 Hydration iv infusion init A XXX 09

96361 Hydrate iv infusion add-on A ZZZ 0996365 Ther/proph/diag iv inf init A XXX 0996366 Ther/proph/diag iv inf addon A ZZZ 0996367 Tx/proph/dg addl seq iv inf A ZZZ 0996368 Ther/diag concurrent inf A ZZZ 0996369 Sc ther infusion up to 1 hr A XXX 0996370 Sc ther infusion addl hr A ZZZ 0996371 Sc ther infusion reset pump A ZZZ 0996372 Ther/proph/diag inj sc/im A XXX 0996373 Ther/proph/diag inj ia A XXX 0996374 Ther/proph/diag inj iv push A XXX 0996375 Tx/pro/dx inj new drug addon A ZZZ 0996376 Tx/pro/dx inj same drug adon X ZZZ 0996379 Ther/prop/diag inj/inf proc C XXX 0996401 Chemo anti-neopl sq/im A XXX 0996402 Chemo hormon antineopl sq/im A XXX 0996405 Chemo intralesional up to 7 A 000 0996406 Chemo intralesional over 7 A 000 0996409 Chemo iv push sngl drug A XXX 0996411 Chemo iv push addl drug A ZZZ 0996413 Chemo iv infusion 1 hr A XXX 0996415 Chemo iv infusion addl hr A ZZZ 0996416 Chemo prolong infuse w/pump A XXX 0996417 Chemo iv infus each addl seq A ZZZ 0996420 Chemo ia push tecnique A XXX 0996422 Chemo ia infusion up to 1 hr A XXX 0996423 Chemo ia infuse each addl hr A ZZZ 0996425 Chemotherapy infusion method A XXX 0996440 Chemotherapy intracavitary A 000 0996446 Chemotx admn prtl cavity A XXX 0996450 Chemotherapy into cns A 000 0996521 Refill/maint portable pump A XXX 0996522 Refill/maint pump/resvr syst A XXX 0996523 Irrig drug delivery device T XXX 0996542 Chemotherapy injection A XXX 0996549 Chemotherapy unspecified C XXX 0996567 Photodynamic tx skin A XXX 0996570 Photodynmc tx 30 min add-on A ZZZ 0996571 Photodynamic tx addl 15 min A ZZZ 0996900 Ultraviolet light therapy A XXX 0996902 Trichogram B XXX 0996904 Whole body photography R XXX 0996910 Photochemotherapy with uv-b A XXX 0996912 Photochemotherapy with uv-a A XXX 0996913 Photochemotherapy uv-a or b A XXX 0996920 Laser tx skin < 250 sq cm A 000 0996921 Laser tx skin 250-500 sq cm A 000 0996922 Laser tx skin >500 sq cm A 000 0996999 Dermatological procedure C XXX 0997001 Pt evaluation A XXX 09

97002 Pt re-evaluation A XXX 0997003 Ot evaluation A XXX 0997004 Ot re-evaluation A XXX 0997005 Athletic train eval I XXX 0997006 Athletic train reeval I XXX 0997010 Hot or cold packs therapy B XXX 0997012 Mechanical traction therapy A XXX 0997014 Electric stimulation therapy I XXX 0997016 Vasopneumatic device therapy A XXX 0997018 Paraffin bath therapy A XXX 0997022 Whirlpool therapy A XXX 0997024 Diathermy eg microwave A XXX 0997026 Infrared therapy R XXX 0997028 Ultraviolet therapy A XXX 0997032 Electrical stimulation A XXX 0997033 Electric current therapy A XXX 0997034 Contrast bath therapy A XXX 0997035 Ultrasound therapy A XXX 0997036 Hydrotherapy A XXX 0997039 Physical therapy treatment C XXX 0997110 Therapeutic exercises A XXX 0997112 Neuromuscular reeducation A XXX 0997113 Aquatic therapy/exercises A XXX 0997116 Gait training therapy A XXX 0997124 Massage therapy A XXX 0997139 Physical medicine procedure C XXX 0997140 Manual therapy 1/> regions A XXX 0997150 Group therapeutic procedures A XXX 0997530 Therapeutic activities A XXX 0997532 Cognitive skills development A XXX 0997533 Sensory integration A XXX 0997535 Self care mngment training A XXX 0997537 Community/work reintegration A XXX 0997542 Wheelchair mngment training A XXX 0997545 Work hardening R XXX 0997546 Work hardening add-on R ZZZ 0997597 Rmvl devital tis 20 cm/< A 000 0997598 Rmvl devital tis addl 20cm/< A ZZZ 0997602 Wound(s) care non-selective B XXX 0997605 Neg press wound tx </=50 cm A XXX 0997606 Neg press wound tx >50 cm A XXX 0997607 Neg press wnd tx </=50 sq cm C XXX 0997608 Neg press wound tx >50 cm C XXX 0997610 Low frequency non-thermal us A XXX 0997750 Physical performance test A XXX 0997755 Assistive technology assess A XXX 0997760 Orthotic mgmt and training A XXX 0997761 Prosthetic training A XXX 0997762 C/o for orthotic/prosth use A XXX 0997799 Physical medicine procedure C XXX 09

97802 Medical nutrition indiv in A XXX 0997803 Med nutrition indiv subseq A XXX 0997804 Medical nutrition group A XXX 0997810 Acupunct w/o stimul 15 min N XXX 0997811 Acupunct w/o stimul addl 15m N ZZZ 0997813 Acupunct w/stimul 15 min N XXX 0997814 Acupunct w/stimul addl 15m N ZZZ 0998925 Osteopath manj 1-2 regions A 000 0998926 Osteopath manj 3-4 regions A 000 0998927 Osteopath manj 5-6 regions A 000 0998928 Osteopath manj 7-8 regions A 000 0998929 Osteopath manj 9-10 regions A 000 0998940 Chiropract manj 1-2 regions A 000 0998941 Chiropract manj 3-4 regions A 000 0998942 Chiropractic manj 5 regions A 000 0998943 Chiropract manj xtrspinl 1/> N XXX 0998960 Self-mgmt educ & train 1 pt B XXX 0998961 Self-mgmt educ/train 2-4 pt B XXX 0998962 Self-mgmt educ/train 5-8 pt B XXX 0998966 Hc pro phone call 5-10 min N XXX 0998967 Hc pro phone call 11-20 min N XXX 0998968 Hc pro phone call 21-30 min N XXX 0998969 Online service by hc pro N XXX 0999000 Specimen handling office-lab B XXX 0999001 Specimen handling pt-lab B XXX 0999002 Device handling phys/qhp B XXX 0999024 Postop follow-up visit B XXX 0999026 In-hospital on call service N XXX 0999027 Out-of-hosp on call service N XXX 0999050 Medical services after hrs B XXX 0999051 Med serv eve/wkend/holiday B XXX 0999053 Med serv 10pm-8am 24 hr fac B XXX 0999056 Med service out of office B XXX 0999058 Office emergency care B XXX 0999060 Out of office emerg med serv B XXX 0999070 Special supplies phys/qhp B XXX 0999071 Patient education materials B XXX 0999075 Medical testimony N XXX 0999078 Group health education B XXX 0999080 Special reports or forms B XXX 0999082 Unusual physician travel C XXX 0999090 Computer data analysis B XXX 0999091 Collect/review data from pt B XXX 0999100 Special anesthesia service B ZZZ 0999116 Anesthesia with hypothermia B ZZZ 0999135 Special anesthesia procedure B ZZZ 0999140 Emergency anesthesia B ZZZ 0999143 Mod sedat phys/qhp <5 yrs C XXX 0999144 Mod sedat phys/qhp 5yrs/> C XXX 0999145 Mod sedat phys/qhp ea 15 min C ZZZ 09

99148 Mod sed diff phys/qhp<5 yrs C XXX 0999149 Mod sed diff phys/qhp 5/>yrs C XXX 0999150 Mod sed diff phys/qhp add on C ZZZ 0999170 Anogenital exam child w imag A 000 0999172 Ocular function screen N XXX 0999173 Visual acuity screen N XXX 0999174 Ocular instrumnt screen bil N XXX 0999175 Induction of vomiting A XXX 0999183 Hyperbaric oxygen therapy A XXX 0999184 Hypothermia ill neonate A XXX 0999188 App topical fluoride varnish N XXX 0999190 Special pump services X XXX 0999191 Special pump services X XXX 0999192 Special pump services X XXX 0999195 Phlebotomy A XXX 0999199 Special service/proc/report C XXX 0999201 Office/outpatient visit new A XXX 0999202 Office/outpatient visit new A XXX 0999203 Office/outpatient visit new A XXX 0999204 Office/outpatient visit new A XXX 0999205 Office/outpatient visit new A XXX 0999211 Office/outpatient visit est A XXX 0999212 Office/outpatient visit est A XXX 0999213 Office/outpatient visit est A XXX 0999214 Office/outpatient visit est A XXX 0999215 Office/outpatient visit est A XXX 0999217 Observation care discharge A XXX 0999218 Initial observation care A XXX 0999219 Initial observation care A XXX 0999220 Initial observation care A XXX 0999221 Initial hospital care A XXX 0999222 Initial hospital care A XXX 0999223 Initial hospital care A XXX 0999224 Subsequent observation care A XXX 0999225 Subsequent observation care A XXX 0999226 Subsequent observation care A XXX 0999231 Subsequent hospital care A XXX 0999232 Subsequent hospital care A XXX 0999233 Subsequent hospital care A XXX 0999234 Observ/hosp same date A XXX 0999235 Observ/hosp same date A XXX 0999236 Observ/hosp same date A XXX 0999238 Hospital discharge day A XXX 0999239 Hospital discharge day A XXX 0999241 Office consultation I XXX 0999242 Office consultation I XXX 0999243 Office consultation I XXX 0999244 Office consultation I XXX 0999245 Office consultation I XXX 0999251 Inpatient consultation I XXX 09

99252 Inpatient consultation I XXX 0999253 Inpatient consultation I XXX 0999254 Inpatient consultation I XXX 0999255 Inpatient consultation I XXX 0999281 Emergency dept visit A XXX 0999282 Emergency dept visit A XXX 0999283 Emergency dept visit A XXX 0999284 Emergency dept visit A XXX 0999285 Emergency dept visit A XXX 0999288 Direct advanced life support B XXX 0999291 Critical care first hour A XXX 0999292 Critical care addl 30 min A ZZZ 0999304 Nursing facility care init A XXX 0999305 Nursing facility care init A XXX 0999306 Nursing facility care init A XXX 0999307 Nursing fac care subseq A XXX 0999308 Nursing fac care subseq A XXX 0999309 Nursing fac care subseq A XXX 0999310 Nursing fac care subseq A XXX 0999315 Nursing fac discharge day A XXX 0999316 Nursing fac discharge day A XXX 0999318 Annual nursing fac assessmnt A XXX 0999324 Domicil/r-home visit new pat A XXX 0999325 Domicil/r-home visit new pat A XXX 0999326 Domicil/r-home visit new pat A XXX 0999327 Domicil/r-home visit new pat A XXX 0999328 Domicil/r-home visit new pat A XXX 0999334 Domicil/r-home visit est pat A XXX 0999335 Domicil/r-home visit est pat A XXX 0999336 Domicil/r-home visit est pat A XXX 0999337 Domicil/r-home visit est pat A XXX 0999339 Domicil/r-home care supervis B XXX 0999340 Domicil/r-home care supervis B XXX 0999341 Home visit new patient A XXX 0999342 Home visit new patient A XXX 0999343 Home visit new patient A XXX 0999344 Home visit new patient A XXX 0999345 Home visit new patient A XXX 0999347 Home visit est patient A XXX 0999348 Home visit est patient A XXX 0999349 Home visit est patient A XXX 0999350 Home visit est patient A XXX 0999354 Prolonged service office A ZZZ 0999355 Prolonged service office A ZZZ 0999356 Prolonged service inpatient A ZZZ 0999357 Prolonged service inpatient A ZZZ 0999358 Prolong service w/o contact B XXX 0999359 Prolong serv w/o contact add B ZZZ 0999360 Physician standby services X XXX 0999363 Anticoagulant mgmt initial B XXX 09

99364 Anticoagulant mgmt subseq B XXX 0999366 Team conf w/pat by hc prof B XXX 0999367 Team conf w/o pat by phys B XXX 0999368 Team conf w/o pat by hc pro B XXX 0999374 Home health care supervision B XXX 0999375 Home health care supervision I XXX 0999377 Hospice care supervision B XXX 0999378 Hospice care supervision I XXX 0999379 Nursing fac care supervision B XXX 0999380 Nursing fac care supervision B XXX 0999381 Init pm e/m new pat infant N XXX 0999382 Init pm e/m new pat 1-4 yrs N XXX 0999383 Prev visit new age 5-11 N XXX 0999384 Prev visit new age 12-17 N XXX 0999385 Prev visit new age 18-39 N XXX 0999386 Prev visit new age 40-64 N XXX 0999387 Init pm e/m new pat 65+ yrs N XXX 0999391 Per pm reeval est pat infant N XXX 0999392 Prev visit est age 1-4 N XXX 0999393 Prev visit est age 5-11 N XXX 0999394 Prev visit est age 12-17 N XXX 0999395 Prev visit est age 18-39 N XXX 0999396 Prev visit est age 40-64 N XXX 0999397 Per pm reeval est pat 65+ yr N XXX 0999401 Preventive counseling indiv N XXX 0999402 Preventive counseling indiv N XXX 0999403 Preventive counseling indiv N XXX 0999404 Preventive counseling indiv N XXX 0999406 Behav chng smoking 3-10 min A XXX 0999407 Behav chng smoking > 10 min A XXX 0999408 Audit/dast 15-30 min N XXX 0999409 Audit/dast over 30 min N XXX 0999411 Preventive counseling group N XXX 0999412 Preventive counseling group N XXX 0999420 Health risk assessment test N XXX 0999429 Unlisted preventive service N XXX 0999441 Phone e/m phys/qhp 5-10 min N XXX 0999442 Phone e/m phys/qhp 11-20 min N XXX 0999443 Phone e/m phys/qhp 21-30 min N XXX 0999444 Online e/m by phys/qhp N XXX 0999446 Interprof phone/online 5-10 B XXX 0999447 Interprof phone/online 11-20 B XXX 0999448 Interprof phone/online 21-30 B XXX 0999449 Interprof phone/online 31/> B XXX 0999450 Basic life disability exam N XXX 0999455 Work related disability exam R XXX 0999456 Disability examination R XXX 0999460 Init nb em per day hosp A XXX 0999461 Init nb em per day non-fac A XXX 0999462 Sbsq nb em per day hosp A XXX 09

99463 Same day nb discharge A XXX 0999464 Attendance at delivery A XXX 0999465 Nb resuscitation A XXX 0999466 Ped crit care transport A XXX 0999467 Ped crit care transport addl A ZZZ 0999468 Neonate crit care initial A XXX 0999469 Neonate crit care subsq A XXX 0999471 Ped critical care initial A XXX 0999472 Ped critical care subsq A XXX 0999475 Ped crit care age 2-5 init A XXX 0999476 Ped crit care age 2-5 subsq A XXX 0999477 Init day hosp neonate care A XXX 0999478 Ic lbw inf < 1500 gm subsq A XXX 0999479 Ic lbw inf 1500-2500 g subsq A XXX 0999480 Ic inf pbw 2501-5000 g subsq A XXX 0999485 Suprv interfacilty transport B XXX 0999486 Suprv interfac trnsport addl B XXX 0999487 Cmplx chron care w/o pt vsit B XXX 0999489 Cmplx chron care addl 30 min B ZZZ 0999490 Chron care mgmt srvc 20 min A XXX 0999495 Trans care mgmt 14 day disch A XXX 0999496 Trans care mgmt 7 day disch A XXX 0999497 Advncd care plan 30 min I XXX 0999498 Advncd care plan addl 30 min I ZZZ 0999499 Unlisted e&m service C XXX 0999500 Home visit prenatal I XXX 0999501 Home visit postnatal I XXX 0999502 Home visit nb care I XXX 0999503 Home visit resp therapy I XXX 0999504 Home visit mech ventilator I XXX 0999505 Home visit stoma care I XXX 0999506 Home visit im injection I XXX 0999507 Home visit cath maintain I XXX 0999509 Home visit day life activity I XXX 0999510 Home visit sing/m/fam couns I XXX 0999511 Home visit fecal/enema mgmt I XXX 0999512 Home visit for hemodialysis I XXX 0999600 Home visit nos I XXX 0999601 Home infusion/visit 2 hrs I XXX 0999602 Home infusion each addtl hr I XXX 0999605 Mtms by pharm np 15 min X XXX 0999606 Mtms by pharm est 15 min X XXX 0999607 Mtms by pharm addl 15 min X XXX 09

2015 National Physician Fee Schedule Relative Value File January ReleaseCPT codes and descriptions only are copyright 2014 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.