500 Items and Services

500 Items and Services List for Price Comparison Tool

 

This page has been archived.  It was last updated on 6/23/2023.  Starting January 1, 2024, price comparison tools must display information for all covered items and services.

CodeDescriptionPlain Language Description
J0702BETAMETHASONE ACET&SOD PHOSPInjection to treat reaction to a drug 
J1745INFLIXIMAB NOT BIOSIMIL 10MGA biologic medication
G0102Prostate cancer screening; digital rectal examination 
G0103Prostate cancer screening; prostate specific antigen test (psa) 
G0121Colon ca scrn; not hi risk indColorectal cancer screening; colonoscopy on individual not meeting criteria for high risk
G0105Colorectal ca scrn; hi risk indColorectal cancer screening; colonoscopy on individual at high risk
S0285Cnslt before screen colonoscColonoscopy consultation performed prior to a screening colonoscopy procedure
G0289Arthro, loose body + chondroArthroscopy, knee, surgical, for removal of loose body, foreign body, debridement/shaving of articular cartilage (chondroplasty) at the time of other surgical knee arthroscopy in a different compartment of the same knee
G0120Colon ca scrn; barium enemaColorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema
460SPINAL FUSION (POSTERIOR)Spinal fusion except cervical
470KNEE REPLACEMENTMajor joint replacement or reattachment of lower extremity
473SPINAL FUSION (ANTERIOR)Cervical spinal fusion
743HYSTERECTOMYUterine and adnexa procedures for non-malignancy
01960Anesthesia for vaginal delivery 
01961Anesthesia for cesarean delivery 
01967Anesthesia for labor during planned vaginal delivery 
01968Anesthesia for cesarean delivery following labor 
10005FNA W IMAGEFine needle aspiration biopsy, including ultrasound guidance; first lesion
10021FNA W/O IMAGEFine Needle Aspiration Biopsy without imaging
10040ACNE SURGERYIncision and Drainage Procedures on the Skin, Subcutaneous and Accessory Structures
10060DRAINAGE OF SKIN ABSCESSIncision and drainage of abscess; simple or single and complex or multiple
10140DRAINAGE OF HEMATOMA/FLUIDIncision and drainage of hematoma, seroma or fluid collection
10160PUNCTURE DRAINAGE OF LESIONPuncture aspiration of abscess, hematoma, bulla, or cyst 
11000DEBRIDE INFECTED SKINRemoval of infected skin
11056TRIM SKIN LESIONS 2 TO 4Paring or cutting of benign hyperkeratotic lesion
11102BIOPSY SKIN LESIONTangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); single lesion
11103BIOPSY SKIN ADD-ONTangential biopsy of skin (e.g., for example, shave, scoop, saucerize, curette); each separate/additional lesion
11200REMOVAL OF SKIN TAGS <W/15Removal of skin tags, multiple fibrocutaneous tags, any area 
11401EXC TR-EXT B9+MARG 0.6-1 CMUnder Excision-Benign Lesions Procedures on the Skin 0.6-1 CM
11422EXC H-F-NK-SP B9+MARG 1.1-2Under Excision-Benign Lesions Procedures on the Skin 1.1-2 CM
11602EXC TR-EXT MAL+MARG 1.1-2 CMExcision-Malignant Lesions
11721DEBRIDE NAIL 6 OR MORERemoval of 6 or more nails
11730REMOVAL OF NAIL PLATE Separation and removal of the entire nail plate or a portion of nail plate 
11900INJECT SKIN LESIONS </W 7Injections to remove up to 7 lesions on the skin
12001RPR S/N/AX/GEN/TRNK 2.5CM/<Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities
12011RPR F/E/E/N/L/M 2.5 CM/<Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes
17000DESTRUCT PREMALG LESIONDestruction of pre-cancerous lesion
17003DESTRUCT PREMALG LES 2-14Destruction of 2-14 pre-cancerous lesions
17110DESTRUCT B9 LESION 1-14Destruction of 1-14 common or plantar warts
17111DESTRUCT LESION 15 OR MOREDestruction of >15 common or plantar warts
17250CHEM CAUT OF GRANLTJ TISSUEChemical destruction of pre-cancerous lesions of the skin
17311MOHS 1 STAGE H/N/HF/GMicrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens
19120REMOVAL OF BREAST LESION 
20550INJ TENDON SHEATH/LIGAMENTInjection of medication into a tendon or ligament
20551INJ TENDON ORIGIN/INSERTIONInjection of medication into the tendon/ligament origin
20553INJECT TRIGGER POINTS 3/>Injection of medication into an area that triggers pain
20600DRAIN/INJ JOINT/BURSA W/O USDraining or injecting medication into a small joint/bursa without ultrasound
20605DRAIN/INJ JOINT/BURSA W/O USDraining or injecting medication into a large joint/bursa without ultrasound
20610DRAIN/INJ JOINT/BURSA W/O USDraining or injecting medication into a major joint/bursa without ultrasound
20612ASPIRATE/INJ GANGLION CYSTRemoval of fluid or injection of medication into a ganglion cyst
27440Revision of knee jointRepair of knee joint
27441Revision of knee jointRepair of knee joint
27442Revision of knee jointRepair of knee joint
27443Revision of knee jointRepair of knee joint
27445Revision of knee jointRepair of knee joint with hinged prosthesis
27446Revision of knee jointRepair of knee joint
28296CORRECTION HALLUX VALGUSUnder Repair, Revision, and/or Reconstruction Procedures on the Foot and Toes
29826Subacromial DecompressionShaving of shoulder bone using an endoscope 
29848WRIST ENDOSCOPY/SURGERYCarpal tunnel release
29880KNEE ARTHROSCOPY/SURGERYSurgery to remove of all or part of a torn meniscus in both medial and lateral compartments
29881KNEE ARTHROSCOPY/SURGERYSurgery to remove of all or part of a torn meniscus in one compartment
29888KNEE ARTHROSCOPY/SURGERYACL reconstruction
30520REPAIR OF NASAL SEPTUMRepair procedures of the nose
31231NASAL ENDOSCOPY DXNasal endoscopy, diagnostic, unilateral or bilateral 
31237NASAL/SINUS ENDOSCOPY SURG Surgical nasal/ sinus endoscopy with biopsy, polypectomy or debridement
31575DIAGNOSTIC LARYNGOSCOPYFlexible, fiberoptic diagnostic laryngoscopy 
36415ROUTINE VENIPUNCTURECollection of venous blood by venipuncture
36471NJX SCLRSNT MLT INCMPTNT VNInjections to remove spider veins on the limbs or trunk
36475ENDOVENOUS RF 1ST VEINAblation of incompetent vein
36478ENDOVENOUS LASER 1ST VEINLaser removal of incompetent vein
42820REMOVE TONSILS AND ADENOIDSRemoval of tonsils and adenoid glands patient younger than age 12  
42826REMOVAL OF TONSILSPrimary or secondary removal of tonsils 
42830REMOVAL OF ADENOIDS Primary removal of the adenoids
43235EGD DIAGNOSTIC BRUSH WASHDiagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope
43239EGD BIOPSY SINGLE/MULTIPLEBiopsy of the esophagus, stomach, and/or upper small bowel using an endoscope
43846Gastric restrictive procedure, with gastric bypass for morbid obesity; with small intestine reconstruction to limit absorptionSurgical procedure used for weight loss resulting in a partial removal of stomach
44388Colonoscopy thru stoma spxDiagnostic examination of large bowel using an endoscope which is inserted through abdominal opening
44389Colonoscopy with biopsyBiopsies of large bowel using an endoscope which is inserted through abdominal opening
44394Colonoscopy w/snareRemoval of large bowel polyps or growths using an endoscope
45378DIAGNOSTIC COLONOSCOPYDiagnostic examination of large bowel using an endoscope 
45379Colonoscopy w/fb removalRemoval of foreign bodies in large bowel using an endoscope
45380COLONOSCOPY AND BIOPSYBiopsy of large bowel using an endoscope 
45381Colonoscopy submucous njxInjections of large bowel using an endoscope
45382Colonoscopy w/control bleedControl of bleeding in large bowel using an endoscope
45384Colonoscopy w/lesion removalRemoval of polyps or growths in large bowel using an endoscope
45385COLONOSCOPY W/LESION REMOVAL Removal of polyps or growths of large bowel using an endoscope
45386Colonoscopy w/balloon dilatBalloon dilation of large bowel using an endoscope
45388Colonoscopy w/ablationDestruction of large bowel growths using an endoscope
45390Colonoscopy w/resectionRemoval of large bowel tissue using an endoscope
45391Colonoscopy w/endoscope usUltrasound examination of lower large bowel using an endoscope
45392Colonoscopy w/endoscopic fnbUltrasound guided needle aspiration or biopsy of lower large bowel using an endoscope
45398Colonoscopy w/band ligationTying of large bowel using an endoscope
47562LAPAROSCOPIC CHOLECYSTECTOMYRemoval of gallbladder using an endoscope 
47563LAPARO CHOLECYSTECTOMY/GRAPHGallbladder removal with use of an x-ray exam of the bile ducts
49505PRP I/HERN INIT REDUC >5 YRRepair of groin hernia patient age 5 years or older
49585RPR UMBIL HERN REDUC > 5 YRRepair of umbilical hernia in patients over 5 years old
49650LAP ING HERNIA REPAIR INITInguinal hernia repair done by laparoscope
50590FRAGMENTING OF KIDNEY STONE Surgical procedures on the kidney to break up and remove kidney stones
51741ELECTRO-UROFLOWMETRY FIRSTA diagnostic test used to measure the flow of urine
51798US URINE CAPACITY MEASUREUltrasound of bladder to measure urine capacity
52000CYSTOSCOPYProcedure on the bladder  
52310CYSTOSCOPY AND TREATMENTRemoving an indwelling ureteral stent by cystoscopy
52332CYSTOSCOPY AND TREATMENTUreteral stents inserted internally between the bladder and the kidney and will remain within the patient for a defined period of time  
55250EXCISION PROCEDURES ON THE VAS DEFERENSRemoval of sperm duct(s) 
55700Prostate biopsyBiopsy of prostate gland 
55866Surgical Procedures on the Prostate Surgical removal of prostate and surrounding lymph nodes using an endoscope
57022Incision and drainage of vaginal blood accumulation following delivery 
57288REPAIR BLADDER DEFECTReplacement of sling to support the bladder
57454BX/CURETT OF CERVIX W/SCOPEBiopsy of cervix or uterus
58100EXCISION PROCEDURES ON THE CORPUS UTERIBiopsy of the lining of the uterus 
58558HYSTEROSCOPY BIOPSYSurgical hysteroscopy with biopsy 
58563HYSTEROSCOPY ABLATIONSurgical procedure used to treat premenopausal abnormal uterine bleeding
58565HYSTEROSCOPY STERILIZATIONLaparoscopic/Hysteroscopic Procedures on the uterus
58571TLH W/T/O 250 G OR LESSLaparoscopic hysterectomy
58661LAPAROSCOPY REMOVE ADNEXA Removal of either benign or malignant tissue from the uterus, ovaries, fallopian tubes, or any of the surrounding tissues using a laparoscope 
58662LAPAROSCOPY EXCISE LESIONSRemoval of lesions of the ovary, pelvic viscera, or peritoneal surface
58671LAPAROSCOPY TUBAL BLOCKLaparoscopic tubal sterilization is surgery to block the fallopian tubes to prevent pregnancy 
59000AMNIOCENTESIS DIAGNOSTIC Removal of amniotic fluid from the uterus for diagnostic purposes
59025FETAL NON-STRESS TEST A common prenatal test used to check on a baby's health.
59400OBSTETRICAL CAREObstetrical pre- and postpartum care and vaginal delivery  
59409Vaginal delivery 
59410Vaginal delivery with post-delivery care 
59414Vaginal delivery of placenta 
59425Pre-delivery care 4-6 visits 
59426Pre-delivery care 7 or more visits 
59510CESAREAN DELIVERYCesarean delivery with pre- and post-delivery care
59514Cesarean delivery 
59515Cesarean delivery with post-delivery care 
59610VBAC DELIVERYVaginal delivery after prior cesarean delivery 
59612Vaginal delivery after prior cesarean delivery 
59614Vaginal delivery after prior cesarean delivery with post-delivery care 
62322SPINAL INJECTION FOR PAIN MANAGEMENTInjection of substance into spinal canal of lower back or sacrum using imaging guidance 
62323Injection of substance into spinal canal of lower back or sacrum using imaging guidance 
63030LOW BACK DISK SURGERYSurgical procedure to decompress a herniated vertebra 
64483Transforaminal Epidural Injection Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance 
64493INJ PARAVERT F JNT L/S 1 LEVInjection into lower back of nerve block using imaging guidance
64721CARPAL TUNNEL SURGERY Release of the transverse carpal ligament
66821YAG capusulotomy surgery Removal of recurring cataract in lens capsule using laser
66984CATARACT SURG W/IOL 1 STAGE Removal of cataract with insertion of lens
67028INJECTION EYE DRUGInjection of a pharmaceutical agent into the eye 
69210REMOVE IMPACTED EAR WAXRemoval of ear wax from one or both ears 
69436CREATE EARDRUM OPENING Insertion of tubes into one or both ears
70450CT HEAD/BRAIN W/O DYECT scan head or brain without dye 
70486CT MAXILLOFACIAL W/O DYECT Scan of the face and jaw without dye 
70491CT SOFT TISSUE NECK W/DYECT scan of neck with dye 
70551MRI BRAIN STEM W/O DYEMRI of brain stem without dye
70553MRI BRAIN STEM W/O & W/DYE MRI scan of brain before and after contrast
71045CHEST X-RAY Single view 
71046CHEST X-RAY2 views, front and back
71047CHEST X-RAY3 views
71048CHEST X-RAY4 or more views
71101X-RAY EXAM UNILAT RIBS/CHESTRadiologic examination of one side of the chest/ribs 
71250CT THORAX W/O DYECT scan of the thorax without dye 
71260CT THORAX W/DYECT scan of the thorax with dye 
71275CT ANGIOGRAPHY CHESTDiagnostic Radiology (Diagnostic Imaging) Procedures of the Chest
72040X-RAY EXAM NECK SPINE 2-3 VWRadiologic examination of the neck/spine, 2-3 views 
72050X-RAY EXAM NECK SPINE 4/5VWSRadiologic examination of the neck/spine, 4-5 views 
72070X-RAY EXAM THORAC SPINE 2VWSRadiologic examination of the middle spine, 2 views 
72072X-RAY EXAM THORAC SPINE 3VWSRadiologic examination of the middle spine, 3 views 
72100X-RAY EXAM L-S SPINE 2/3 VWSX-ray of the lower spine 2-3 views
72110X-RAY EXAM L-2 SPINE 4/>VWS X-ray of lower and sacral spine, minimum of 4 views
72131CT LUMBAR SPINE W/O DYE CT scan of lower spine without dye 
72141MRI NECK SPINE W/O DYEMRI of the neck or spine without dye
72146MRI CHEST SPINE W/O DYEMRI of chest and spine without dye 
72148MRI LUMBAR SPINE W/O DYEMRI scan of lower spinal canal 
72156MRI NECK SPINE W/O & W/DYEMRI of neck/spine with and without dye 
72157MRI CHEST SPINE W/O & W/DYEMRI of chest and spine with and without dye
72158MRI LUMBAR SPINE W/O & W/DYEMRI of lower back with and without dye 
72170X-RAY EXAM OF PELVIS Radiologic examination of the pelvis
72192CT PELVIS W/O DYECT of pelvis without dye
72193CT PELVIS W/DYECT scan, pelvis, with contrast
72195MRI PELVIS W/O DYEMRI of pelvis without dye
72197MRI PELVIS W/O & W/DYEMRI of pelvis before and after dye
73000X-RAY EXAM OF COLLAR BONE Radiologic examination of the collar bone
73030X-RAY EXAM OF SHOULDERRadiologic examination of the shoulder 
73070X-RAY EXAM OF ELBOW Radiologic examination, elbow; 2 views
73080X-RAY EXAM OF ELBOWRadiologic examination, elbow; 3 or more views 
73090X-RAY EXAM OF FOREARMRadiologic examination of the forearm 
73100X-RAY EXAM OF WRIST3 or more views
73110X-RAY EXAM OF WRISTUp to 3 views
73120X-RAY EXAM OF HANDX-ray of the hand with 2 views
73130X-RAY EXAM OF HANDX-ray of the hand with 3 or more views
73140X-RAY EXAM OF FINGER(S)Radiologic examination of the finger(s)  
73221MRI JOINT UPR EXTREM W/O DYEMRI of upper extremity without dye
73560X-RAY EXAM OF KNEE 1 OR 2Radiologic examination of the knee with 1 or 2 views
73562X-RAY EXAM OF KNEE 3Radiologic examination of the knee with 3 views
73564X-RAY EXAM KNEE 4 OR MORERadiologic examination of the knee with 4 or more views
73565X-RAY EXAM OF KNEESRadiologic examination of both knees
73590X-RAY EXAM OF LOWER LEGRadiologic examination of the lower leg 
73600X-RAY EXAM OF ANKLERadiologic examination of the ankle with 2 views
73610X-RAY EXAM OF ANKLERadiologic examination of the ankle with 3 views
73620X-RAY EXAM OF FOOTRadiologic examination, foot; 2 views
73630X-RAY EXAM OF FOOTRadiologic examination of the foot with 3 or more views
73650X-RAY EXAM OF HEELRadiologic examination of the heel 
73660X-RAY EXAM OF TOE(S)Radiologic examination of the toe(s) 
73700CT LOWER EXTREMITY W/O DYECT scan of leg without dye
73718MRI LOWER EXTREMITY W/O DYEMRI of leg without dye
73721MRI JNT OF LWR EXTRE W/O DYEMRI of lower extremity joint (knee/ankle) without dye
73722MRI JOINT OF LWR EXTR W/DYEMRI of lower extremity joint (knee/ankle) with dye
73723MRI JOINT LWR EXTR W/O&W/DYEMRI of lower extremity joint (knee/ankle) with and without dye
74022X-RAY EXAM SERIES ABDOMENSerial radiologic examination of the abdomen 
74150CT ABDOMEN W/O DYECT of abdomen without dye
74160CT ABDOMEN W/DYECT of abdomen with dye
74170CT ABDOMEN W/O & W/DYECT of abdomen with and without dye
74176CT ABD & PELVIS W/O CONTRASTCT of abdomen and pelvis without dye
74177CT ABD & PELV W/CONTRASTCT scan of abdomen and pelvis with contrast
74178CT ABD & PELV 1/> REGNSComputed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions
74181MRI ABDOMEN W/O DYEMRI of abdomen without dye
74183MRI ABDOMEN W/O & W/DYEMRI of abdomen without and with dye
76000CHEST X-RAYFlouroscopy, or x-ray "movie" that takes less than an hour
76512OPHTH US B W/NON-QUANT AUltrasound of the eye
76514ECHO EXAM OF EYE THICKNESSA diagnostic procedure that allows a provider to see the organs and other structures in the abdomen 
76536US EXAM OF HEAD AND NECKUltrasound of head and neck
76642ULTRASOUND BREAST LIMITEDLimited ultrasound of the breast 
76700US EXAM ABDOM COMPLETEUltrasound of abdomen with all areas scanned
76705ECHO EXAM OF ABDOMENA diagnostic procedure that allows a provider to see the organs and other structures in the abdomen 
76770US EXAM ABDO BACK WALL COMPUltrasound of back wall of the abdomen with all areas viewed
76775US EXAM ABDO BACK WALL LIMUltrasound of back wall of the abdomen with limited areas viewed
76801OB US < 14 WKS SINGLE FETUSAbdominal ultrasound of pregnant uterus (less than 14 weeks) single or first fetus
76805OB US >/= 14 WKS SNGL FETUSAbdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus
76811OB US DETAILED SNGL FETUSUltrasound of single fetus
76813OB US NUCHAL MEAS 1 GESTEvaluation through measurement of fetal nuchal translucency
76815OB US LIMITED FETUS(S)Ultrasound of fetus with limited views
76817TRANSVAGINAL US OBSTETRICTransvaginal ultrasound of uterus
76818FETAL BIOPHYS PROFILE W/NSTFetal biophysical profile with non-stress test
76819FETAL BIOPHYS PROFIL W/O NSTFetal biophysical profile without non-stress test
76830TRANSVAGINAL US NON-OBUltrasound of the pelvis through vagina
76831ECHO EXAM UTERUSA diagnostic procedure that allows a provider to see the uterus  
76856US EXAM PELVIC COMPLETEComplete ultrasound of the pelvis
76857US EXAM PELVIC LIMITEDLimited ultrasound of the pelvis
76870US EXAM SCROTUMUltrasound of the scrotum
76872US TRANSRECTALTransrectal ultrasound
76882US LMTD JT/NONVASC XTR STRUXDiagnostic ultrasound of an extremity excluding the bone, joints or vessels
77047MRI BOTH BREASTSMagnetic resonance imaging, breasts, without contrast material; bilateral
77065DX MAMMO INCL CAD UNIMammography of one breast
77066DX MAMMO INCL CAD BIMammography of both breasts
77067SCR MAMMO BI INCL CADMammography of both breasts-2 or more views
77080BONE DENSITY STUDY OF SPINE OR PELVISScan to measure bone mineral density (BMD) at the spine and hip 
77385Ntsty modul rad tx dlvr smplRadiation therapy delivery
77386Ntsty modul rad tx dlvr cplxRadiation therapy delivery
77387Guidance for radia tx dlvrGuidance for localization of target delivery of radiation treatment delivery
77412Radiation treatment deliveryRadiation treatment delivery
78014THYROID IMAGING W/BLOOD FLOWScan using a radioactive medication (radiopharmaceutical) to take pictures or images of the thyroid gland. 
78306BONE IMAGING WHOLE BODYA procedure most commonly ordered to detect areas of abnormal bone growth due to fractures, tumors, infection, or other bone issues
78452HT MUSCLE IMAGE SPECT MULTImage of the heart to assess perfusion
78815PET IMAGE W/CT SKULL-THIGHTumor imaging, positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization
80048METABOLIC PANEL TOTAL CABasic metabolic panel
80050GENERAL HEALTH PANEL General health panel
80051Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide) 
80053COMPREHEN METABOLIC PANELBlood test, comprehensive group of blood chemicals
80055OBSTETRIC PANELObstetric blood test panel
80061LIPID PANELBlood test, lipids (cholesterol and triglycerides)
80069RENAL FUNCTION PANELKidney function panel test
80074ACUTE HEPATITIS PANELAcute hepatitis panel 
80076HEPATIC FUNCTION PANELLiver function blood test panel
80081Blood test panel for obstetrics (cbc, differential wbc count, hepatitis b, hiv, rubella, syphilis, antibody screening, rbc, blood typing) 
80197ASSAY OF TACROLIMUSTest is used to measure the amount of the drug in the blood to determine whether the concentration has reached a therapeutic level and is below the toxic level
80307Drug test prsmv chem anlyzrTesting for presence of drug
81000URINALYSIS NONAUTO W/SCOPEManual urinalysis test with examination using microscope
81001URINALYSIS; MANUAL OR AUTO WITH OR WITHOUT MICROSCOPYManual urinalysis test with examination with or without using microscope
81002URINALYSIS NONAUTO W/O SCOPEManual urinalysis test with examination without using microscope
81003URINALYSIS; MANUAL OR AUTO WITH OR WITHOUT MICROSCOPYAutomated urinalysis test
81025URINE PREGNANCY TESTUrine pregnancy test 
82043UR ALBUMIN QUANTITATIVEUrine test to measure albumin
82044UR ALBUMIN SEMIQUANTITATIVEUrine test to measure albumin-semiquantitative
82248BILIRUBIN DIRECTMeasurement of direct bilirubin
82306VITAMIN D 25 HYDROXYBlood test to monitor vitamin D levels 
82553CREATINE MB FRACTIONBlood test to detect heart enzymes
82570ASSAY OF URINE CREATININETest to measure creatinine in the urine 
82607VITAMIN B-12Blood test to measure B-12 
82627DEHYDROEPIANDROSTERONEBlood test to measure an enzyme in the blood
82670ASSAY OF ESTRADIOL Blood test to measure a type of estrogen in the blood
82728ASSAY OF FERRITINTest to determine level of iron in the blood
82784ASSAY IGA/IGD/IGG/IGM EACHTest to determine levels of immunoglobulins in the blood
82803BLOOD GASES ANY COMBINATIONTest to measure arterial blood gases 
82947ASSAY GLUCOSE BLOOD QUANTQuantitative measure of glucose build up in the blood over time
82950GLUCOSE TESTTest of glucose level in the blood
82951GLUCOSE TOLERANCE TESTTest to predict likelihood of gestational diabetes
83001ASSAY OF GONADOTROPIN (FSH)Test of hormone in the blood
83002ASSAY OF GONADOTROPIN (LH)Test of hormone in the blood
83013H PYLORI (C-13) BREATHTest of breath for a stomach bacterium
83036GLYCOSYLATED HEMOGLOBIN TEST Blood test to measure average blood glucose levels for past 2-3 months
83516IMMUNOASSAY NONANTIBODYChemical test of the blood to measure presence or concentration of a substance in the blood 
83540ASSAY OF IRONBlood test to measure the amount of iron that is in transit in the body 
83550IRON BINDING TEST Blood test that measures the amount of iron carried in the blood
83655ASSAY OF LEADBlood test to determine the concentration of lead in the blood 
83718ASSAY OF LIPOPROTEINBlood test to measure the level of lipoproteins in the blood 
83880ASSAY OF NATRIURETIC PEPTIDE Blood test used to diagnose heart failure
84134ASSAY OF PREALBUMINBlood test to measure level of prealbumin  
84153ASSAY OF PSA TOTALPSA (prostate specific antigen)
84154PSA (prostate specific antigen) measurement 
84436ASSAY OF TOTAL THYROXINEBlood test to measure a type of thyroid hormone 
84439ASSAY OF FREE THYROXINEBlood test to evaluate thyroid function 
84443ASSAY THYROID STIM HORMONEBlood test, thyroid stimulating hormone (TSH)
84460ALANINE AMINO (ALT) (SGPT) Blood test to evaluate liver function
84480ASSAY TRIIODOTHYRONINE (T3)Blood test to evaluate thyroid function 
84484ASSAY OF TROPONIN QUANTBlood test to measure a certain protein in the blood to determine heart muscle damage 
84703CHORIONIC GONADOTROPIN ASSAYBlood test to assess for pregnancy 
85007BL SMEAR W/DIFF WBC COUNTBlood test to assess for infection 
85018HEMOGLOBINBlood test to measure levels of hemoglobin 
85025COMPLETE CBC W/AUTO DIFF WBCComplete blood cell count, with differential white blood cells, automated
85027COMPLETE CBC AUTOMATEDComplete blood count, automated
85610PROTHROMBIN TIMEBlood test, clotting time
85730THROMBOPLASTIN TIME PARTIALCoagulation assessment blood test
86039ANTINUCLEAR ANTIBODIES (ANA) Blood test to determine autoimmune disorders
86147CARDIOLIPIN ANTIBODY EA IGBlood test to determine cause of inappropriate blood clot formation 
86200CCP ANTIBODYBlood test to diagnose rheumatoid arthritis 
86300IMMUNOASSAY TUMOR CA 15-3 Blood test to monitor breast cancer
86304IMMUNOASSAY TUMOR CA 125Blood test to monitor for cancer 
86336INHIBIN ABlood test to monitor for cancer in the ovaries or testis 
86592SYPHILIS TEST NON-TREP QUAL Blood test to screen for syphilis
86644CMV ANTIBODYBlood test to monitor for cytomegalovirus 
86665EPSTEIN-BARR CAPSID VCA Blood test to diagnose mononucleosis
86677HELICOBACTER PYLORI ANTIBODYBlood test to if peptic ulcers are caused by a certain bacterium 
86703HIV-1/HIV-2 1 RESULT ANTBDY Blood test to diagnose HIV
86704HEP B CORE ANTIBODY TOTAL Blood test indicating infection with Hepatitis B
86708HEPATITIS A ANTIBODYBlood test indicating infection with Hepatitis A 
86762RUBELLA ANTIBODY Blood test to determine if antibodies exist for rubella
86765RUBEOLA ANTIBODY Blood test to determine if antibodies exist for measles
86780TREPONEMA PALLIDUMBlood test to determine existence of certain bacterium that causes syphilis 
86803HEPATITIS C AB TESTBlood test to determine infection with Hepatitis C 
86850RBC ANTIBODY SCREENBlood test to screen for antibodies that could harm red blood cells 
87040BLOOD CULTURE FOR BACTERIA Blood test to screen for bacteria in the blood
87046STOOL CULTR AEROBIC BACT EA Blood test to identify bacteria that may be contributing to symptoms in the gastrointestinal tract
87070CULTURE OTHR SPECIMN AEROBICTest of body fluid other than blood to assess for bacteria 
87077CULTURE AEROBIC IDENTIFYTest of a wound for type of bacterial infection 
87081CULTURE SCREEN ONLYMedical test to find an infection 
87086URINE CULTURE/COLONY COUNTCulture of the urine to determine number of bacteria 
87088URINE BACTERIA CULTURECulture of the urine to determine bacterial infection 
87101SKIN FUNGI CULTURE A procedure used to determine if fungi are present in an area of the body
87186MICROBE SUSCEPTIBLE MIC A test used to determine which medications work on bacteria for fungi
87205SMEAR GRAM STAINA lab test used to detect bacteria or fungi in a sample taken from the site of a suspected infection 
87210SMEAR WET MOUNT SALINE/INKA lab test to screen for evidence of vaginal infection 
87324CLOSTRIDIUM AG IA A test of the stool to diagnose Clostridium difficile (C. diff) infection
87389HIV-1 AG W/HIV-1 & HIV-2 ABTest for HIV 
87491CHYLMD TRACH DNA AMP PROBE Test that detects Chlamydia
87510GARDNER VAG DNA DIR PROBEBlood test for vaginitis 
87591N.GONORRHOEAE DNA AMP PROBBlood test for an STD
87624Hpv high-risk typesDetection test for human papillomavirus (hpv)
87653STREP B DNA AMP PROBEBlood test for strep infection 
87661TRICHOMONAS VAGINALIS AMPLIFBlood test for an STD 
87801DETECT AGNT MULT DNA AMPLIBlood test to determine genetic material of certain infectious agents 
87804INFLUENZA ASSAY W/OPTICFlu test
87807RSV ASSAY W/OPTIC Test for RSV
87880STREP A ASSAY W/OPTIC Test for strep A
88112CYTOPATH CELL ENHANCE TECHUrine test 
88141CYTOPATH C/V INTERPRETCervical cancer screening test with interpretation
88142CYTOPATH C/V THIN LAYER PAP smear
88150CYTOPATH C/V MANUALCervical cancer screening test done manually
88175CYTOPATH C/V AUTO FLUID REDO PAP smear
88305TISSUE EXAM BY PATHOLOGIST Test of tissues for diagnosis of abnormalities
88312SPECIAL STAINS GROUP 1Blood test to assist with diagnosis 
88313SPECIAL STAINS GROUP 2 Blood test to assist with diagnosis
88342IMMUNOHISTO ANTB 1ST STAINPathology test
90460IM ADMIN 1ST/ONLY COMPONENTImmunization administration in children <18
90471IMMUNIZATION ADMINImmunization administration by a medical assistant or nurse
90474IMMUNE ADMIN ORAL/NASAL ADDLImmunization administered orally or nasally
90632HEPA VACCINE ADULT IMHepatitis A vaccination for adults
90633HEPA VACC PED/ADOL 2 DOSE IMHepatitis A vaccination for adolescents and children
906494VHPV VACCINE 3 DOSE IM3-dose HPV vaccination
90656IIV3 VACC NO PRSV 0.5 ML IMFlu shot-high dose for 2019-2020 flu season given by injection
90658IIV3 VACCINE SPLT 0.5 ML IMPreservative free flu vaccine
90672LAIV4 VACCINE INTRANASALNasal flu vaccine
90681RV1 VACC 2 DOSE LIVE ORALRotavirus vaccination
90686IIV4 VACC NO PRSV 0.5 ML IMFlu shot-high dose for 2019-2020 flu season given by injection for people >65
90707MMR VACCINE SCMeasles, mumps and rubella vaccine
90710MMRV VACCINE SCmeaslesMeasles, mumps, rubella and varicella vaccine
90715TDAP VACCINE 7 YRS/> IMDiphtheria, tetanus acellular, and pertussis vaccine for adults
90716VAR VACCINE LIVE SUBQVaricella vaccine
90732PPSV23 VACC 2 YRS+ SUBQ/IMpneumococcal Pneumococcal vaccine
90734MENACWYD/MENACWYCRM VACC IMmeningococcal Meningococcal conjugate vaccine
90736HZV VACCINE LIVE SUBQShingles vaccine
90746HEPB VACCINE 3 DOSE ADULT IMHepatitis B vaccine
90791PSYCH DIAGNOSTIC EVALUATIONA diagnostic tool employed by a psychiatrist to diagnose problems with memory, thought processes, and behaviors 
90792PSYCH DIAG EVAL W/MED SRVCSA diagnostic tool employed by a psychiatrist to determine if medications are needed
90832PSYTX W PT 30 MINUTESPsychotherapy, 30 min
90833PSYTX W PT W E/M 30 MINPsychotherapy, 30 minutes with patient when performed with an evaluation and management service
90834PSYTX W PT 45 MINUTESPsychotherapy, 45 min
90836PSYTX W PT W E/M 45 MINPsychotherapy, 45 minutes with patient when performed with an evaluation and management service
90837PSYTX W PT 60 MINUTESPsychotherapy, 60 min
90838Psychotherapy, 60 minutes 
90839Psychotherapy for crisis, first 60 minutes 
90840Psychotherapy for crisis 
90846Family psychotherapy, 50 minutes Family psychotherapy, not including patient, 50 min 
90847FAMILY PSYTX W/PT 50 MINFamily psychotherapy, including patient, 50 min
90853GROUP PSYCHOTHERAPYGroup psychotherapy
92002EYE EXAM NEW PATIENTIntermediate exam
92004EYE EXAM NEW PATIENTComplete exam
92012EYE EXAM ESTABLISH PATIENTEye exam on an established patient  
92014EYE EXAM&TX ESTAB PT 1/>VSTEye exam and treatment for established patient
92083VISUAL FIELD EXAMINATION(S)An eye examination that can detect dysfunction in central and peripheral vision 
92133CMPTR OPHTH IMG OPTIC NERVEOptic nerve imaging
92507SPEECH/HEARING THERAPYTherapy for speech or hearing 
92523SPEECH SOUND LANG COMPREHENEvaluation of speech sound production with evaluation of language comprehension 
92552PURE TONE AUDIOMETRY AIRType of hearing test
93000ELECTROCARDIOGRAM COMPLETERoutine EKG using at least 12 leads including interpretation and report
93015CARDIOVASCULAR STRESS TEST Test to determine heart abnormalities
93303ECHO TRANSTHORACICTest to screen the heart for abnormalities 
93306Tte w/doppler completeUltrasound examination of heart including color-depicted blood flow rate, direction, and valve function
93307TTE W/O DOPPLER COMPLETEEcho without doppler study
93320DOPPLER ECHO EXAM HEARTEcho with doppler
93350STRESS TTE ONLY Stress test with echocardiogram
93452Cardiac CatheterizationInsertion of catheter into left heart for diagnosis
93798CARDIAC REHAB/MONITORUse of EKG to monitor cardiac rehabilitation 
93880EXTRACRANIAL BILAT STUDYStudy of vessels on both sides of the head and neck
93922UPR/L XTREMITY ART 2 LEVELSLimited bilateral noninvasive physiologic studies of upper or lower extremity arteries
93970EXTREMITY STUDYComplete bilateral study of the extremities
93971EXTREMITY STUDYOne sided or limited bilateral study
94010BREATHING CAPACITY TESTTest to determine how well oxygen moves from the lungs to the blood stream 
94060EVALUATION OF WHEEZING Test to determine if wheezing is present
94375RESPIRATORY FLOW VOLUME LOOP Graphical representation of inspiration and expiration
94726PULM FUNCT TST PLETHYSMOGRAPMeasures how much air is in the lungs after taking a deep breath 
94727PULM FUNCTION TEST BY GASMeasure of lung function and gas exchange 
94729CO/MEMBANE DIFFUSE CAPACITYTest to measure how well gases diffuse across lung surfaces
95004PERCUT ALLERGY SKIN TESTSAllergy test  
95115IMMUNOTHERAPY ONE INJECTIONAllergy shot-1 shot
95117IMMUNOTHERAPY INJECTIONSMultiple allergy shots
95810POLYSOM 6/> YRS 4/> PARAMSleep monitoring of patient (6 years or older) in sleep lab
95811POLYSOM 6/>YRS CPAP 4/> PARMSleep monitoring of patient (6 years or older) in sleep lab using CPAP
95860MUSCLE TEST ONE LIMBTest to measure electrical activity of muscles or nerves in 1 limb 
95861MUSCLE TEST 2 LIMBSTest to measure electrical activity of muscles or nerves in 2 limb 
95886MUSC TEST DONE W/N TEST COMP Test to assess for nerve damage
96110DEVELOPMENTAL SCREEN W/SCORE Childhood test to screen for developmental disabilities
96365THER/PROPH/DIAG IV INF INITIntravenous infusion, for therapy, prophylaxis, or diagnosis-initial infusion
96366THER/PROPH/DIAG IV INF ADDONIntravenous infusion, for therapy, prophylaxis, or diagnosis-additional infusions
96374THER/PROPH/DIAG INJ IV PUSHIntravenous infusion, for therapy, prophylaxis, or diagnosis-IV push
96375TX/PRO/DX INJ NEW DRUG ADDONIntravenous infusion, for treatment, prophylaxis, or diagnosis-new drug add on
96376TX/PRO/DX INJ SAME DRUG ADONIntravenous infusion, for treatment, prophylaxis, or diagnosis-same drug add on
96415CHEMO IV INFUSION ADDL HRChemotherapy infusion-each additional hour
96417CHEMO IV INFUS EACH ADDL SEQChemotherapy infusion-additional IV pushes of the same medication
97010HOT OR COLD PACKS THERAPYUse of external hot or cold packs 
97012MECHANICAL TRACTION THERAPYForm of decompression therapy of the spine
97014ELECTRIC STIMULATION THERAPYOne time use unattended
97016VASOPNEUMATIC DEVICE THERAPYMachines designed to pump cold water into an inflatable wrap or brace, compressing the enveloped area of the body 
97026INFRARED THERAPYLight-based method to treat pain and inflammation 
97032ELECTRICAL STIMULATIONRepeated application to one or more parts of the body
97033ELECTRIC CURRENT THERAPY

Psychiatric treatment in which seizures are electrically induced in patients to provide relief from mental disorders 

Attended Iontophoresis, 15 minute increments in a physical therapy setting or similar

97035ULTRASOUND THERAPYUse of sound waves to treat medical problems, especially musculoskeletal problems like inflammation from injuries 
97110THERAPEUTIC EXERCISESTherapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes
97112NEUROMUSCULAR REEDUCATIONA technique used by physical therapists to restore normal body movement patterns 
97113AQUATIC THERAPY/EXERCISESUse of water for therapy/exercises 
97116GAIT TRAINING THERAPYA type of physical therapy 
97124MASSAGE THERAPYUse of massage 
97140MANUAL THERAPY 1/> REGIONSManipulation of 1 or more regions of the body 
97530THERAPEUTIC ACTIVITIES Incorporates the use of multiple parameters, such as balance, strength, and range of motion, for a functional activity
97535SELF CARE MNGMENT TRAININGOccupational therapy
97597RMVL DEVITAL TIS 20 CM/<Debridement (for example, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps)
97811ACUPUNCT W/O STIMUL ADDL 15MAcupuncture without stimulation
97813ACUPUNCT W/STIMUL 15 MINAcupuncture with stimulation
98940CHIROPRACT MANJ 1-2 REGIONSChiropractic manipulation in 1-2 regions
98941CHIROPRACT MANJ 3-4 REGIONSChiropractic manipulation in 3-4 regions
98943CHIROPRACT MANJ XTRSPINL 1/>Chiropractic manipulation not of the spine
98966Hc pro phone call 5-10 minTelephone assessment and management service, 5-10 minutes of medical discussion
98967Hc pro phone call 11-20 minTelephone assessment and management service, 11-20 minutes of medical discussion
98968Hc pro phone call 21-30 minTelephone assessment and management service, 21-30 minutes of medical discussion
98970Qualified non physician health care professional online digital assessment and management est. patient 5-10 minutesQualified non physician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
98971Qualified non physician health care professional online digital assessment and management est. patient 11-20 minutes Qualified non physician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes
98972Qualified non physician health care professional online digital assessment and management for est. patients 21+ minutesQualified non physician health care professional online digital assessment and management, for an established patient, for up to 7 days, cumulative time during the 7 days; 21 or more minutes 
99051MED SERV EVE/WKEND/HOLIDAY Medical service during off-hours
99173VISUAL ACUITY SCREENEye test 
99202OFFICE/OUTPATIENT VISIT NEWNew patient office or other outpatient visit, typically 20 minutes
99203OFFICE/OUTPATIENT VISIT NEWNew patient office or other outpatient visit, typically 30 min
99204OFFICE/OUTPATIENT VISIT NEWNew patient office of other outpatient visit, typically 45 min
99205OFFICE/OUTPATIENT VISIT NEWNew patient office of other outpatient visit, typically 60 min
99211OFFICE/OUTPATIENT VISIT ESTOutpatient visit of established patient not requiring a physician
99212OFFICE/OUTPATIENT VISIT ESTOutpatient visit of established patient requiring a physician
99213OFFICE/OUTPATIENT VISIT ESTEstablished patient office or other outpatient visit, typically 15 minutes
99214OFFICE/OUTPATIENT VISIT ESTEstablished patient office or other outpatient visit, typically 25 minutes
99215OFFICE/OUTPATIENT VISIT ESTEstablished patient office or other outpatient, visit typically 40 minutes
99243OFFICE CONSULTATIONPatient office consultation, typically 40 min
99244OFFICE CONSULTATIONPatient office consultation, typically 60 min
99283Emergency dept visitEmergency department visit, moderately severe problem
99284Emergency dept visitEmergency department visit, problem of high severity
99285Emergency dept visitEmergency department visit, problem with significant threat to life or function
99381INIT PM E/M NEW PAT INFANTInitial visit for an infant
99382INIT PM E/M NEW PAT 1-4 YRSInitial visit for new patients 1-4 years old
99383PREV VISIT NEW AGE 5-11New preventative visit in new patients 5-11 years old
99384PREV VISIT NEW AGE 12-17New preventative visit in new patients 12-17 years old
99385PREV VISIT NEW AGE 18-39Initial new patient preventive medicine evaluation (18–39 years)
99386PREV VISIT NEW AGE 40-64Initial new patient preventive medicine evaluation (40–64 years)
99387INIT PM E/M NEW PAT 65+ YRSInitial visit for new patients 65 and older years old
99391PER PM REEVAL EST PAT INFANTPeriodic primary re-evaluation for an established infant patient
99392PREV VISIT EST AGE 1-4Initial visit for new patients 1-4 years old
99393PREV VISIT EST AGE 5-11New preventative visit in new patients 5-11 years old
99394PREV VISIT EST AGE 12-17New preventative visit in new patients 12-17 years old
99395PREV VISIT EST AGE 18-39Established patient periodic preventive medicine examination age 18-39 years
99396PREV VISIT EST AGE 40-64Established patient periodic preventive medicine examination age 40-64 years
99397PER PM REEVAL EST PAT 65+ YRPeriodic primary re-evaluation for an established patient 65 and older
99421 ONLINE DIGITAL EVALUATION AND MANAGEMENT SERVICE; 5-10 MINUTES Online digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 5-10 minutes
99422Online digital evaluation and management service; 11-20 minutesOnline digital evaluation and management service, for an established patient, for up to 7 days, cumulative time during the 7 days; 11-20 minutes 
99441Phone e/m phys/qhp 5-10 minPhysician telephone patient service, 5-10 minutes of medical discussion
99442Phone e/m phys/qhp 11-20 minPhysician telephone patient service, 11-20 minutes of medical discussion
99443Phone e/m phys/qhp 21-30 minPhysician telephone patient service, 21-30 minutes of medical discussion

 

 

Page Last Modified:
09/10/2024 06:18 PM