2015 Facility Scoring Methodology for Blue Select

Transcription

2015 Facility Scoring Methodology for Blue Select
In keeping with its goal of providing members with high-quality, lower-cost health care, Blue Cross Blue Shield of North
Carolina (BCBSNC) developed the following methodology to best evaluate the quality and efficiency of partner facilities.
Based on evaluation results, BCBSNC will designate in-network facilities as Tier 1 or Tier 2 for its 2015 Blue Select plan.
This document describes the methodology used by BCBSNC for the Tiered Network product (Blue Select) for 2015 and
is provided for informational purposes only. Physician designation ratings are a guide to choosing a physician, practice
or medical group. Because ratings have a risk of error, they should not be the sole basis for selecting a doctor. Patients
should confer with their physician before making a decision.
Designation Overview
Tier designation is made at the facility level and only includes In-network Facilities contracted with BCBSNC. In-network
Facilities are designated as Tier 1 or Tier 2. BCBSNC will base its Tier 1 designation on quality and efficiency.
To be designated as Tier 1, a Facility must first meet the quality criteria. Facilities that are unable to meet the quality
criteria (described below) for the network are automatically designated with a Tier 2 status. Facilities that potentially
qualify for Tier 1 based on their quality evaluation will then be evaluated against BCBSNC’s efficiency criteria (described
below) to determine if the Facility meets the standards for Tier 1 status.
Facilities that meet both the quality and efficiency standards are designated with a Tier 1 status. Facilities that meet the
quality standard, but do not attain the efficiency standard, are designated with a Tier 2 status (with exceptions for
Critical Access facilities as defined by CMS).
Tiered Network Product Quality Thresholds for Facilities
For facilities, BCBSNC has introduced a methodology that utilizes Hospital Compare, a database administered by the
Centers for Medicare and Medicaid Services (CMS). Leveraging data downloaded on March 13, 2014 from the CMS
website (http://medicare.gov/hospitalcompare/), each facility was examined for their quality performance on twelve
measures, listed below, as reported in the database.
Measure
1
Hospital 30-day mortality rate for heart attack.
2
Hospital 30-day readmission rate for heart attack.
3
Hospital 30-day mortality rate for heart failure.
4
Hospital 30-day readmission rate for heart failure.
5
Hospital 30-day mortality rate for pneumonia.
6
Hospital 30-day readmission rate for pneumonia.
7
Heart failure patients given discharge instructions.
8
Heart attack patients given PCI within 90 minutes of arrival.
9
Heart attack patients given a prescription for a statin at discharge.
1
Reporting
Period
7/1/09 –
6/30/12
7/1/09 –
6/30/12
7/1/09 –
6/30/12
7/1/09 –
6/30/12
7/1/09 –
6/30/12
7/1/09 –
6/30/12
4/1/12 –
3/31/13
4/1/12 –
3/31/13
4/1/12 –
3/31/13
Measure
10 Pneumonia patients whose initial emergency room blood culture was performed prior to
the administration of the first hospital dose of antibiotics.
11 Pneumonia patients given the most appropriate initial antibiotic(s).
12
Weighted measure representing HCAHPS question "How do patients rate the hospital,
overall?" Response scale 1 (poor) to 10 (excellent). Weighted score calculated by summing
the products of (1*Percent rating 6 or lower), (2*Percent rating 7 or 8), and (3*Percent
rating 9 or 10). Resulting score falls between 100 and 300, higher value is better.
Reporting
Period
4/1/12 –
3/31/13
4/1/12 –
3/31/13
4/1/12 –
3/31/13
Facilities were awarded one point for each measure on which they reported data and performed above the 25th
percentile. Percentile distributions were calculated using data for all BCBSNC-contracted, non-government acute care
facilities in North Carolina, plus two in Virginia that are considered eligible for the Tiered product. Each facility’s earned
points were summed and divided by the number of potential points; if data were not reported for a measure due to low
volume, the earned and potential points were both reduced accordingly. Final scores ranged from 0 to 100% and
represent the percent of measures for which the facility meets the minimum quality standard. Facilities were required to
score at or above 67% across measures to be deemed quality eligible allowing them to be assessed on efficiency criteria
to determine tier designation; those scoring below 67% were automatically designated Tier 2 and were not given the
opportunity to bid into Tier 1.
Please note that BCBSNC will examine quality scores on an annual basis to determine if a facility’s tier designation
should be reclassified based on updated quality information.
Tiered Network Product Efficiency Threshold for Facilities
With the quality standards in place, BCBSNC then analyzed claims to stratify facilities on the basis of efficiency
performance. The objective of this analysis was to identify “automatic” Tier 1 (no proposal required) and proposaleligible Tier 2 Facilities.
Facilities were assigned to categories based on bed size, total volume, transfers and the provision of certain types of
services including burns, trauma, transplants, maternity, hip and knee arthroplasty, spine surgery, oncology, complex
cardiology, and complex neurology. Bed size was obtained from the NC Division of Health Services Regulation and
service volume was determined from claims for calendar year 2013. Peer cohorts were established using Cohort
Analysis, which identifies patterns of similarity in the selected characteristics and then classifies Facilities into groups,
called “Peer Cohorts” here forward.
Cohort Variable
Hospital Beds
Total Volume
Transfer
Maternity
Hip & Knee
Arthroplasty
Spine Surgery
Defined as
Total hospital beds (Source: NC Division of
Health Services Regulation, downloaded
1/30/2013 from
www.ncdhhs.gov/dhsr/reports.htm)
Total volume
Dichotomous indicator if volume of cases as
a result of a transfer from another facility
designated by discharge status => 10
Volume of maternity cases / total volume
Volume of hip and knee arthroplasty
cases/total volume
Dichotomous indicator if volume of spinal
surgery cases => 10
DRGs/MDCs defining service line
N/A
All
All
MDC 14
DRGs 209, 558, 471, 789, 818, 558, 471,
817
DRGs 756, 755, 558, 807, 884, 806, 865,
864
2
Cohort Variable
Oncology
Defined as
Dichotomous indicator if volume of
oncology cases >= 10
Complex
Cardiology
Complex
Neurology
Burns or Trauma
Dichotomous indicator if volume of complex
cardiology cases >= 10
Dichotomous indicator if volume of
craniotomy cases >= 10
Dichotomous indicator if total volume of
trauma or burns => 10
Dichotomous indicator if total volume of
transplants => 10
Transplants
DRGs/MDCs defining service line
MDC 17, DRGs 010, 011, 146, 147, 172,
173, 203, 257, 258, 259, 260, 274, 303, 306,
307, 318, 319, 336, 337, 338, 346, 354, 355,
357, 363, 366, 367
DRGs 104, 105, 106, 107, 108, 109, 115,
545, 546, 547, 548, 549, 850, 851, 852
DRGs 001, 002, 530, 738, 739, 879
Burns=MDC 22; Trauma=MDC 25
DRGs 103, 302, 480, 795, 803, 804, 805
Next, two metrics of efficiency performance were constructed based on inpatient and outpatient claims for Facilities
within each Peer Cohort. Data preparation and analytical approaches for the evaluation are described below.
Inpatient Costs








Analyses were conducted on inpatient case data for services performed between January 2013 – December 2013.
Includes Inpatient allowed facility costs only (i.e. no professional or ancillary costs)
Lines of business: Blue Options (Group Underwritten, ASO, State Health Plan, CDHP), Blue Advantage (Individual,
CDHP), Blue Select, Blue Value.
Excludes denials, Medicare crossovers, COB, and State Health Plan retirees.
To reduce the effect of outliers, allowed costs were truncated at the 95th percentile by AP-DRG. Analysis is limited
to those AP-DRGs performed at least 30 times at a minimum of two facilities statewide.
Two inpatient cost metrics were computed for “facility specific allowed costs” and the “average costs”.
o Average costs were calculated for each AP-DRG within a Peer Cohort if there were at least 30 cases in a
minimum of 2 facilities; if there was insufficient volume within a Peer Cohort, the costs reflect the average
cost for Facilities statewide.
o Your facility specific allowed costs and the average costs were summed separately for all cases with
sufficient AP-DRG / CPT volume.
Both Inpatient and Outpatient costs were forward-adjusted to reflect each facility’s new fee schedule increases for
the next calendar year once the final summary amounts were tabulated.
All DRGs were evaluated. If DRGs are missing, there was not enough volume to be evaluated. In the following
table, "Cohort" refers to the DRG analysis within the cohort only. "Statewide" refers to the DRG analysis done
statewide due to the low volume.
AP
DRG
Code
001
002
010
011
012
013
014
018
020
Description
CRANIOTOMY AGE >17 W CC
CRANIOTOMY AGE >17 W/O CC
NERVOUS SYSTEM NEOPLASMS W CC
NERVOUS SYSTEM NEOPLASMS W/O CC
DEGENERATIVE NERVOUS SYSTEM
DISORDERS
MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA
STROKE W INFARCT
CRANIAL & PERIPHERAL NERVE DISORDERS W
CC
NERVOUS SYSTEM INFECTION EXCEPT VIRAL
Peer
Cohort 1
Peer
Cohort 2
Peer
Cohort 3
Peer
Cohort 4
Peer
Cohort 5
statewide
statewide
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
cohort
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
3
Peer
Cohort 6
AP
DRG
Code
021
024
025
034
035
063
065
068
069
070
073
075
076
078
079
082
087
088
089
090
094
095
096
097
101
105
107
108
109
110
111
112
116
121
122
124
125
127
130
Description
MENINGITIS
VIRAL MENINGITIS
SEIZURE & HEADACHE AGE >17 W CC
SEIZURE & HEADACHE AGE >17 W/O CC
OTHER DISORDERS OF NERVOUS SYSTEM W
CC
OTHER DISORDERS OF NERVOUS SYSTEM W/O
CC
OTHER EAR, NOSE, MOUTH & THROAT O.R.
PROCEDURES
DYSEQUILIBRIUM
OTITIS MEDIA & URI AGE >17 W CC
OTITIS MEDIA & URI AGE >17 W/O CC
OTITIS MEDIA & URI AGE <18
OTHER EAR, NOSE, MOUTH & THROAT
DIAGNOSES AGE >17
MAJOR CHEST PROCEDURES
OTHER RESP SYSTEM O.R. PROCEDURES W CC
PULMONARY EMBOLISM
RESPIRATORY INFECTIONS & INFLAMMATIONS
EXC SIMPLE PNEUMONIA AGE >17 W CC
RESPIRATORY NEOPLASMS
PULMONARY EDEMA & RESPIRATORY FAILURE
CHRONIC OBSTRUCTIVE PULMONARY DISEASE
SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC
SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O
CC
PNEUMOTHORAX W CC
PNEUMOTHORAX W/O CC
BRONCHITIS & ASTHMA AGE >17 W CC
BRONCHITIS & ASTHMA AGE >17 W/O CC
OTHER RESPIRATORY SYSTEM DIAGNOSES W
CC
CARDIAC VALVE & OTHER MAJOR
CARDIOTHORACIC PROC W/O CARDIAC CATH
CORONARY BYPASS W/O PTCA W CARDIAC
CATH
OTHER CARDIOTHORACIC PROC W/O PDX
CONGENITAL ANOMALY
CORONARY BYPASS W/O PTCA W/O CARDIAC
CATH
MAJOR CARDIOVASCULAR PROCEDURES W CC
MAJOR CARDIOVASCULAR PROCEDURES W/O
CC
PERCUTANEOUS CARDIOVASCULAR PROC W/O
AMI,HEART FAILURE OR SHOCK
OTHER PERMANENT CARDIAC PACEMAKER
IMPLANT
CIRCULATORY DISORDERS W AMI & MAJOR
COMP, DISCHARGED ALIVE
CIRCULATORY DISORDERS W AMI W/O MAJOR
COMP, DISCHARGED ALIVE
CIRCULATORY DISORD EXCEPT AMI, W CARD
CATH & COMPLEX DIAG
CIRCULATORY DISORD EXCEPT AMI, W CARD
CATH W/O COMPLEX DIAG
HEART FAILURE & SHOCK
PERIPHERAL VASCULAR DISORDERS W CC
Peer
Cohort 1
Peer
Cohort 2
Peer
Cohort 3
Peer
Cohort 4
Peer
Cohort 5
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
cohort
statewide
cohort
statewide
cohort
statewide
cohort
statewide
cohort
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
statewide
cohort
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
cohort
statewide
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
statewide
4
Peer
Cohort 6
AP
DRG
Code
131
134
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
157
158
159
160
165
167
170
171
172
174
175
176
179
180
181
182
183
188
189
Description
PERIPHERAL VASCULAR DISORDERS W/O CC
HYPERTENSION
CARDIAC ARRHYTHMIA & CONDUCTION
DISORDERS W CC
CARDIAC ARRHYTHMIA & CONDUCTION
DISORDERS W/O CC
ANGINA PECTORIS
SYNCOPE & COLLAPSE W CC
SYNCOPE & COLLAPSE W/O CC
CHEST PAIN
OTHER CIRCULATORY SYSTEM DIAGNOSES W
CC
OTHER CIRCULATORY SYSTEM DIAGNOSES
W/O CC
RECTAL RESECTION W CC
RECTAL RESECTION W/O CC
MAJOR SMALL & LARGE BOWEL PROCEDURES
W CC
MAJOR SMALL & LARGE BOWEL PROCEDURES
W/O CC
PERITONEAL ADHESIOLYSIS W CC
PERITONEAL ADHESIOLYSIS W/O CC
MINOR SMALL & LARGE BOWEL PROCEDURES
W CC
MINOR SMALL & LARGE BOWEL PROCEDURES
W/O CC
STOMACH, ESOPHAGEAL & DUODENAL
PROCEDURES AGE >17 W CC
STOMACH, ESOPHAGEAL & DUODENAL
PROCEDURES AGE >17 W/O CC
ANAL & STOMAL PROCEDURES W CC
ANAL & STOMAL PROCEDURES W/O CC
HERNIA PROCEDURES EXCEPT INGUINAL &
FEMORAL AGE >17 W CC
HERNIA PROCEDURES EXCEPT INGUINAL &
FEMORAL AGE >17 W/O CC
APPENDECTOMY W COMPLICATED PRINCIPAL
DIAG W/O CC
APPENDECTOMY W/O COMPLICATED
PRINCIPAL DIAG W/O CC
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES
W CC
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES
W/O CC
DIGESTIVE MALIGNANCY W CC
G.I. HEMORRHAGE W CC
G.I. HEMORRHAGE W/O CC
COMPLICATED PEPTIC ULCER
INFLAMMATORY BOWEL DISEASE
G.I. OBSTRUCTION W CC
G.I. OBSTRUCTION W/O CC
ESOPHAGITIS, GASTROENT & MISC DIGEST
DISORD AGE >17 W CC
DISORD AGE >17 W/O CC
OTHER DIGESTIVE SYSTEM DIAGNOSES AGE
>17 W CC
OTHER DIGESTIVE SYSTEM DIAGNOSES AGE
>17 W/O CC
Peer
Cohort 1
Peer
Cohort 2
Peer
Cohort 3
Peer
Cohort 4
Peer
Cohort 5
statewide
statewide
statewide
cohort
statewide
cohort
statewide
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
statewide
cohort
cohort
statewide
statewide
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
statewide
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
statewide
5
Peer
Cohort 6
statewide
statewide
statewide
AP
DRG
Code
191
192
198
202
203
204
205
207
208
209
210
211
212
218
219
220
224
225
226
227
234
239
240
243
247
248
257
258
261
269
270
276
277
278
279
285
286
288
Description
PANCREAS, LIVER & SHUNT PROCEDURES W
CC
PANCREAS, LIVER & SHUNT PROCEDURES W/O
CC
CHOLECYSTECTOMY W/O C.D.E. W/O CC
CIRRHOSIS & ALCOHOLIC HEPATITIS
MALIGNANCY OF HEPATOBILIARY SYSTEM OR
PANCREAS
DISORDERS OF PANCREAS EXCEPT
MALIGNANCY
DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC
HEPA W CC
DISORDERS OF THE BILIARY TRACT W CC
DISORDERS OF THE BILIARY TRACT W/O CC
MAJ JOINT & LIMB REATTACH PROC OF LOW
EXT, EXC HIP, EXC FOR COMP
HIP & FEMUR PROCEDURES EXCEPT MAJOR
JOINT AGE >17 W CC
JOINT AGE >17 W/O CC
JOINT AGE <18
LOWER EXTREM & HUMER PROC EXC
HIP,FOOT,FEMUR AGE >17 W CC
HIP,FOOT,FEMUR AGE >17 W/O CC
HIP,FOOT,FEMUR AGE <18
SHOULDER,ELBOW OR FOREARM PROC,EXC
MAJOR JOINT PROC, W/O CC
FOOT PROCEDURES
SOFT TISSUE PROCEDURES W CC
SOFT TISSUE PROCEDURES W/O CC
OTHER MUSCULOSKELET SYS & CONN TISS
O.R. PROC W/O CC
PATHOLOGICAL FRACTURES & MUSCSKELET &
CONN TISS MALIGNANCY
CONNECTIVE TISSUE DISORDERS W CC
MEDICAL BACK PROBLEMS
SIGNS & SYMPTOMS OF MUSCULOSKELETAL
SYSTEM & CONN TISSUE
TENDONITIS, MYOSITIS & BURSITIS
TOTAL MASTECTOMY FOR MALIGNANCY W CC
TOTAL MASTECTOMY FOR MALIGNANCY W/O
CC
BREAST PROC FOR NON-MALIGNANCY EXCEPT
BIOPSY & LOCAL EXCISION
OTHER SKIN, SUBCUT TISS & BREAST PROC W
CC
OTHER SKIN, SUBCUT TISS & BREAST PROC
W/O CC
NON-MALIGNANT BREAST DISORDERS
CELLULITIS AGE >17 W CC
CELLULITIS AGE >17 W/O CC
CELLULITIS AGE <18
AMPUTAT OF LOW LIMB FOR
ENDOCRINE,NUTRIT,& METABOL DISORDERS
ADRENAL & PITUITARY PROCEDURES
GASTRIC PROCEDURES FOR OBESITY
Peer
Cohort 1
Peer
Cohort 3
Peer
Cohort 4
Peer
Cohort 5
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
cohort
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
Peer
Cohort 2
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
cohort
statewide
cohort
cohort
statewide
statewide
cohort
6
Peer
Cohort 6
statewide
statewide
statewide
statewide
AP
DRG
Code
290
294
295
296
297
298
300
301
302
303
304
305
310
311
315
316
320
321
322
323
324
331
334
335
350
357
358
359
361
368
369
370
371
372
373
374
375
376
Description
THYROID PROCEDURES
DIABETES AGE >35
DIABETES AGE <36
NUTRITIONAL & MISC METABOLIC DISORDERS
AGE >17 W CC
AGE >17 W/O CC
AGE <18
ENDOCRINE DISORDERS W CC
ENDOCRINE DISORDERS W/O CC
KIDNEY TRANSPLANT
KIDNEY,URETER & MAJ BLADDER PROC FOR
NEOPLASM
NON-NEOPLASM W CC
NON-NEOPLASM W/O CC
TRANSURETHRAL PROCEDURES W CC
TRANSURETHRAL PROCEDURES W/O CC
OTHER KIDNEY & URINARY TRACT
PROCEDURES
RENAL FAILURE
KIDNEY & URINARY TRACT INFECTIONS AGE
>17 W CC
>17 W/O CC
<18
URINARY STONES W CC, &/OR ESW
LITHOTRIPSY
URINARY STONES W/O CC
OTHER KIDNEY & URINARY TRACT DIAGNOSES
AGE >17 W CC
MAJOR MALE PELVIC PROCEDURES W CC
MAJOR MALE PELVIC PROCEDURES W/O CC
INFLAMMATION OF THE MALE REPRODUCTIVE
SYSTEM
UTERINE & ADNEXA PROC FOR OVARIAN OR
ADNEXAL MALIGNANCY
UTERINE & ADNEXA PROC FOR CA IN SITU &
NON-MALIGNANCY W CC
UTERINE & ADNEXA PROC FOR CA IN SITU &
NON-MALIGNANCY W/O CC
LAPAROSCOPY OR INCISIONAL TUBAL
INTERRUPTION
INFECTIONS, FEMALE REPRODUCTIVE SYSTEM
MENSTRUAL & OTHER FEMALE REPRODUCTIVE
SYSTEM DISORDERS
CESAREAN SECTION W CC
CESAREAN SECTION W/O CC
VAGINAL DELIVERY W COMPLICATING
DIAGNOSES
VAGINAL DELIVERY W/O COMPLICATING
DIAGNOSES
VAGINAL DELIVERY W STERILIZATION &/OR D&C
VAGINAL DELIVERY W O.R. PROC EXCEPT
STERIL &/OR D&C
POSTPARTUM & POST ABORTION DIAGNOSES
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7
statewide
AP
DRG
Code
377
378
379
380
395
397
398
399
403
410
415
416
418
419
420
421
422
423
425
426
427
430
442
443
447
449
450
451
452
453
461
462
463
464
468
469
470
471
477
478
Description
W/O O.R. PROCEDURE
POSTPARTUM & POST ABORTION DIAGNOSES
W O.R. PROCEDURE
ECTOPIC PREGNANCY
THREATENED ABORTION
ABORTION W/O D&C
RED BLOOD CELL DISORDERS AGE >17
COAGULATION DISORDERS
RETICULOENDOTHELIAL & IMMUNITY
DISORDERS W CC
RETICULOENDOTHELIAL & IMMUNITY
DISORDERS W/O CC
LYMPHOMA & NON-ACUTE LEUKEMIA W CC
CHEMOTHERAPY
O.R. PROCEDURE FOR INFECTIOUS &
PARASITIC DISEASES
SEPTICEMIA AGE >17
POSTOPERATIVE & POST-TRAUMATIC
INFECTIONS
FEVER OF UNKNOWN ORIGIN AGE >17 W CC
FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC
VIRAL ILLNESS AGE >17
VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN
AGE <18
OTHER INFECTIOUS & PARASITIC DISEASES
DIAGNOSES
ACUTE ADJUSTMENT REACTION &
PSYCHOSOCIAL DYSFUNCTION
DEPRESSIVE NEUROSES
NEUROSES EXCEPT DEPRESSIVE
PSYCHOSES
OTHER O.R. PROCEDURES FOR INJURIES W CC
OTHER O.R. PROCEDURES FOR INJURIES W/O
CC
ALLERGIC REACTIONS AGE >17
POISONING & TOXIC EFFECTS OF DRUGS AGE
>17 W CC
>17 W/O CC
<18
COMPLICATIONS OF TREATMENT W CC
COMPLICATIONS OF TREATMENT W/O CC
O.R. PROC W DIAGNOSES OF OTHER CONTACT
W HEALTH SERVICES
REHABILITATION
SIGNS & SYMPTOMS W CC
SIGNS & SYMPTOMS W/O CC
EXTENSIVE O.R. PROCEDURE UNRELATED TO
PRINCIPAL DIAGNOSIS
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE
DIAGNOSIS
UNGROUPABLE
BILATERAL OR MULTIPLE MAJOR JOINT PROCS
OF LOWER EXTREMITY
NON-EXTENSIVE O.R. PROCEDURE UNRELATED
TO PRINCIPAL DIAGNOSIS
OTHER VASCULAR PROCEDURES W CC
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8
Peer
Cohort 6
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statewide
AP
DRG
Code
479
482
491
493
494
530
531
532
533
538
539
540
541
543
544
545
546
547
549
550
551
552
553
555
556
557
558
559
560
561
563
564
565
Description
OTHER VASCULAR PROCEDURES W/O CC
TRACHEOSTOMY FOR FACE,MOUTH & NECK
DIAGNOSES
MAJOR JOINT & LIMB REATTACHMENT
PROCEDURES OF UPPER EXTREMITY
LAPAROSCOPIC CHOLECYSTECTOMY W/O
C.D.E. W CC
LAPAROSCOPIC CHOLECYSTECTOMY W/O
C.D.E. W/O CC
CRANIOTOMY W MAJOR CC
NERVOUS SYSTEM PROCEDURES EXCEPT
CRANIOTOMY W MAJOR CC
TIA, PRECEREBRAL OCCLUSIONS, SEIZURE &
HEADACHE W MAJOR CC
OTHER NERVOUS SYSTEM DISORD EXCEPT
TIA, SEIZURE & HEADACHE W MAJOR CC
MAJOR CHEST PROCEDURES W MAJOR CC
RESPIRATORY PROCEDURES EXCEPT MAJOR
CHEST W MAJOR CC
RESPIRATORY INFECTIONS & INFLAMMATIONS
EXC SIMPLE PNEUMONIA W MAJOR CC
SIMPLE PNEUMONIA & OTH RESPIRATORY
DISORD EXC BRONCHITIS, ASTHMA W MAJOR
CC
CIRC DISORDERS EXCEPT AMI, ENDOCARDITIS,
CHF & ARRHYTHMIA W MAJOR CC
CHF & CARDIAC ARRHYTHMIA W MAJOR CC
CARDIAC VALVE PROCEDURE W MAJOR CC
CORONARY BYPASS W MAJOR CC
OTHER CARDIOTHORACIC PROCEDURES W
MAJOR CC
MAJOR CARDIOVASCULAR PROCEDURES W
MAJOR CC
OTHER VASCULAR PROCEDURES W MAJOR CC
ESOPHAGITIS, GASTROENTERITIS &
UNCOMPLICATED ULCERS W MAJOR CC
DIGEST SYST DISORD EXCEPT
ESOPH,GASTROENT & UNCOMPL ULCERS W
MAJOR CC
DIGEST SYST PROC EXC HERNIA & MAJOR
STOMACH OR BOWEL PROC W MAJOR CC
PANCREAS,LIVER & OTH BIL TRACT PROC
EXCEPT LIVER TRANSPLNT W MAJOR CC
CHOLECYSTECTOMY AND OTHER
HEPATOBILIARY PROCEDURES W MAJOR CC
HEPATOBILIARY AND PANCREAS DISORDERS W
MAJOR CC
MAJOR MUSCULOSKELETAL PROCEDURES W
MAJOR CC
NON-MAJOR MUSCULOSKELETAL
PROCEDURES W MAJOR CC
MUSCULOSKEL DISORD EXC OSTEO,SEPTIC
ARTH & CONN TISSUE DIS W MAJOR CC
OSTEOMYELITIS, SEPTIC ARTHRITIS & CONN
TISSUE DISORDER W MAJOR CC
OTHER SKIN DISORDERS W MAJOR CC
SKIN & BREAST PROCEDURES W MAJOR CC
ENDOCRINE, NUTRIT & METAB PROC EXCEPT
LOWER LIMB AMPUTAT W MAJOR CC
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9
Peer
Cohort 6
statewide
statewide
AP
DRG
Code
566
567
568
569
573
574
576
577
580
581
582
583
584
585
586
588
607
611
612
613
614
618
619
620
621
626
627
628
629
630
639
650
Description
ENDOCRINE, NUTRIT & METAB DISORD EXC
EATING DISORDER OR CF W MAJOR CC
KIDNEY & URINARY TRACT PROCEDURES
EXCEPT KIDNEY TRANSPLANT W MAJOR CC
RENAL FAILURE W MAJOR CC
KIDNEY & URINARY TRACT DISORDERS EXCEPT
RENAL FAILURE W MAJOR CC
NON-RADICAL FEMALE REPRODUCTIVE
BLOOD, BLOOD FORMING ORGANS &
IMMUNOLOGICAL DISORDERS W MAJOR CC
ACUTE LEUKEMIA W MAJOR CC
MYELOPROLIF DISORDERS & POORLY
DIFFERENTIATED NEOPLASMS W MAJOR CC
SYSTEMIC INFECTIONS & PARASITIC DISORD
EXCEPT SEPTICEMIA W MAJOR CC
SYSTEMIC INFECTIONS & PARASITIC DISORDER
INJURIES, POISONINGS & TOXIC EFFECTS OF
DRUGS EXC MULTIPLE TRAUMA W MAJOR CC
PROCEDURES FOR INJURIES EXCEPT
MULTIPLE TRAUMA W MAJOR CC
SEPTICEMIA W MAJOR CC
MAJOR
STOMACH,ESOPHAGEAL,DUODENAL,SMALL &
LARGE BOWEL PROC W MAJOR CC
ENT & MOUTH DISORDERS AGE >17 W MAJOR
CC
BRONCHITIS & ASTHMA AGE >17 W MAJOR CC
NEONATE, BIRTHWT 1000-1499G, W/O SIGNIF
O.R. PROC, DISCHARGED ALIVE
NEONATE, BWT 1500-1999G, W/O SIGN O.R.
PROC,W MULT MAJ PROB OR MV 96+ HRS
O.R. PROC, W MAJOR PROB
O.R. PROC, W MINOR PROB
O.R. PROC, W OTHER PROB
O.R. PROC, W MAJOR PROB
O.R. PROC, W MINOR PROB
NEONATE, BWT 2000-2499G, W/O SIGNIF O.R.
PROC, W NORM NEWBORN DIAG
O.R. PROC, W OTHER PROB
NEONATE, BWT >2499G, W/O SIGN O.R. PROC,W
MULT MAJ PROB OR MV 96+ HRS
NEONATE, BIRTHWT >2499G, W/O SIGNIF O.R.
PROC, W MAJOR PROB
PROC, W MINOR PROB
NEONATE, BWT >2499G, W/O SIGNIF O.R. PROC,
W NORMAL NEWBORN DIAG
PROC, W OTHER PROB
NEONATE, TRANSFERRED <5 DAYS OLD, BORN
HERE
HIGH RISK CESAREAN SECTION W CC
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10
Peer
Cohort 6
AP
DRG
Code
651
652
714
731
732
733
739
740
744
745
748
750
751
755
756
757
758
761
763
767
768
769
772
773
774
775
777
784
786
789
793
796
797
804
807
808
810
813
814
Description
HIGH RISK CESAREAN SECTION W/O CC
HIGH RISK VAGINAL DELIVERY W
STERILIZATION AND/OR D&C
HIV W SIGNIFICANT RELATED DIAGNOSIS
SPINE, HIP, FEMUR OR LIMB PROC FOR
MULTIPLE SIGNIFICANT TRAUMA
OTHER O.R. PROCEDURE FOR MULTIPLE
SIGNIFICANT TRAUMA
HEAD, CHEST AND LOWER LIMB DIAGNOSES OF
MULTIPLE SIGNIFICANT TRAUMA
CRANIOTOMY AGE <18 W/O CC
CYSTIC FIBROSIS
OPIOID ABUSE OR DEPENDENCE W CC
OPIOID ABUSE OR DEPENDENCE W/O CC
COCAINE OR OTHER DRUG ABUSE OR
DEPENDENCE W/O CC
ALCOHOL ABUSE OR DEPENDENCE, W CC
ALCOHOL ABUSE OR DEPENDENCE, W/O CC
SPINAL FUSION W CC
SPINAL FUSION W/O CC
BACK & NECK PROCEDURES EXCEPT SPINAL
FUSION W CC
BACK & NECK PROCEDURES EXCEPT SPINAL
FUSION W/O CC
TRAUMATIC STUPOR & COMA, COMA >1 HR
TRAUMATIC STUPOR & COMA, COMA <1 HR AGE
<18
TRAUMATIC STUPOR & COMA, COMA <1 HR AGE
>17 W/O CC
SEIZURE & HEADACHE AGE <18 W CC
SEIZURE & HEADACHE AGE <18 W/O CC
SIMPLE PNEUMONIA & PLEURISY AGE <18 W CC
SIMPLE PNEUMONIA & PLEURISY AGE <18 W/O
CC
BRONCHITIS & ASTHMA AGE <18 W CC
BRONCHITIS & ASTHMA AGE <18 W/O CC
DISORD AGE <18 W/O CC
ACQUIRED HEMOLYTIC ANEMIA OR SICKLE
CELL CRISIS AGE <18
MAJOR HEAD & NECK PROCEDURES FOR
MALIGNANCY
KNEE REVISION OR MAJ JOINT & LIMB
REATTACH PROC OF LOW EXT, EXC HIP,FOR
COMP
PROC FOR MUL SIG TRAUMA EXC CRANIOTOMY
W NON-TRAUMATIC MAJOR CC
LOWER EXTREMITY REVASCULARIZATION W CC
LOWER EXTREMITY REVASCULARIZATION W/O
CC
AUTOLOGOUS BONE MARROW TRANSPLANT
COMBINED ANTERIOR/POSTERIOR SPINAL
FUSION W/O CC
PERCUTANEOUS CARDIOVASCULAR PROC W
AMI,HEART FAILURE OR SHOCK
INTRACRANIAL HEMORRHAGE
NONBACTERIAL GASTROENTERITIS &
ABDOMINAL PAIN AGE >17 W CC
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statewide
11
statewide
AP
DRG
Code
816
817
818
820
828
832
836
837
838
839
853
854
864
865
867
876
877
878
880
881
882
883
884
885
886
Description
ABDOMINAL PAIN AGE >17 W/O CC
ABDOMINAL PAIN AGE <18 W/O CC
HIP REVISION OR HIP REPLACEMENT FOR
COMPLICATIONS
HIP REPLACEMENT EXCEPT FOR
COMPLICATIONS
MALFUNCTIONS, REACTIONS & COMP OF GU
DEVICE/GRAFT/TRANSPLANT
NON-EXTENSIVE BURNS W/O INHAL INJ, CC OR
SIGNIFICANT TRAUMA
TRANSIENT ISCHEMIA
SPINAL PROCEDURES W CC
SPINAL PROCEDURES W/O CC
EXTRACRANIAL PROCEDURES W CC
EXTRACRANIAL PROCEDURES W/O CC
PERCUTANEOUS CARDIOVASCULAR
PROCEDURE W DRUG-ELUTING STENT W AMI
PERCUTANEOUS CARDIOVASCULAR
PROCEDURE W DRUG-ELUTING STENT W/O AMI
CERVICAL SPINAL FUSION W CC
CERVICAL SPINAL FUSION W/O CC
LOCAL EXCISION & REMOVAL OF INT FIX
DEVICES EXCEPT HIP & FEMUR W/O CC
CHEMO W ACUTE LEUKEMIA AS SDX OR W USE
OF HIGH DOSE CHEMO AGENT
ECMO OR TRACH W MV 96+ HRS OR PDX EXC
FACE, MOUTH & NECK W MAJ O.R.
TRACH W MV 96+ HRS OR PDX EXC FACE,
MOUTH & NECK W/O MAJ O.R.
ACUTE ISCHEMIC STROKE W USE OF
THROMBOLYTIC AGENT
RESPIRATORY SYSTEM DIAGNOSIS W MV 96+
HRS
RESPIRATORY SYSTEM DIAGNOSIS W MV <96
HRS
LAPAROSCOPIC APPENDECTOMY
SPINAL FUSION EXC CERV W CURVATURE OF
THE SPINE OR MALIGNANCY
OTHER ANTEPARTUM DIAGNOSES W O.R.
PROCEDURE
OTHER ANTEPARTUM DIAGNOSES W/O O.R.
PROCEDURE
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statewide
statewide
statewide
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
cohort
statewide
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
Peer
Cohort 6
statewide
statewide
statewide
statewide
Outpatient Costs






Includes Outpatient allowed facility costs (POS=22, POS=23) only (i.e. no professional or ancillary costs)
Dates of Service: January 2013 - December 2013
Lines of business: Blue Options (Group Underwritten, ASO, State Health Plan, CDHP), Blue Advantage (Individual,
CDHP), Blue Select, Blue Value.
Excludes denials, Medicare crossovers, COB, and State Health Plan retirees.
To reduce the effect of outliers, claims with allowed costs below the 5th percentile by CPT were dropped and
allowed costs were truncated at the 95th percentile by CPT.
CPTs were limited to those CPTs performed at least 30 times in at least 2 facilities statewide.
12




CPTs were further limited to those CPTs where CPT code is required according to BCBSNC policy titled “Provider
Update: Effective April 10, 2012 – BCBSNC Requires CPT and HCPCS Codes to be Included on UB-04 Claim
Submissions”.
Analysis excludes CPTs associated with the following revenue code groupings:
o Pharmacy
o IV Therapy
o Laboratory
o Pathology
o Blood and Blood Components
o Administration, Processing, and Storage for Blood and Blood Components
o Physical Therapy
o Occupational Therapy
o Speech Therapy - Language Pathology
o Free-Standing Clinic
o Hemodialysis - Outpatient or Home
o Peritoneal Dialysis - Outpatient or Home
o Continuous Ambulatory Peritoneal Dialysis (CAPD) - Outpatient or Home
o Continuous Cycling Peritioneal Dialysis (CCPD) - Outpatient or Home
o Miscellaneous Dialysis
o Other Therapeutic Services.
Your “facility specific allowed costs” and the “average costs” were also calculated for each facility’s outpatient
costs.
o Average costs were calculated for each AP-DRG within a Peer Cohort if there were at least 30 cases in a
minimum of 2 facilities; if there was insufficient volume within a Peer Cohort, the costs reflect the average
cost for Facilities statewide.
o Your facility specific allowed costs and the average costs were summed separately for all cases with
sufficient AP-DRG / CPT volume.
Both Inpatient and Outpatient costs were forward-adjusted to reflect each facility’s new fee schedule increases for
the next calendar year once the final summary amounts were tabulated.
For example, if a facility had a $100,000 inpatient facility specific cost based on calendar year 2012 data, and had a 4%
fee schedule increase effective 4/1/2013, then the Inpatient facility specific cost for that facility would be increased to
$104,000 for comparison purposes.
Note: Increases are prorated to reflect when the increase went into effect during the calendar year. To forward-adjust
the average cost metrics, the Peer Cohort weighted average increase was blended with the statewide weighted average
increase by facility based on how much each group contributed to the development of that facility’s average costs.
Once the facility specific allowed costs and the average cost metrics were forward-adjusted, the facility specific cost
metric was divided by the average cost metric for both inpatient and outpatient to create efficiency ratios. The
efficiency ratios were normalized to ensure that the weighted average for both inpatient and outpatient in any given
Peer Cohort was 1.0. Finally, each facility’s inpatient and outpatient normalized efficiency factors were blended using
the aggregate allowed Inpatient and Outpatient charges for their Peer Cohort.
For example, if Peer Cohort six had 60% of allowed charges associated with inpatient and 40% associated with
outpatient the inpatient normalized efficiency factor blend would be 60% inpatient/ 40% outpatient.
Note: If the normalized efficiency factor for a facility is 1.10 that would imply the facility is 10% less efficient than the
Peer Cohort average.
13
Next, all facilities were categorized into seven macro regions made up of various combinations of the 16 regions as
defined by the DOI per the Affordable Care Act. Facilities were categorized based where the majority of its claims
dollars originated from based on patient address. A crosswalk of these regional definitions by county is provided
below. Facilities that fell at or below the lowest 20th percentile of normalized efficiency factor within their given
macro region were deemed automatic Tier 1 and all other facilities were deemed to be request for proposal-eligible
Tier 2. CMS defined Critical Access facilities were excluded from this process and were also given automatic Tier 1
status.
County
ALAMANCE
ALEXANDER
ALLEGHANY
ANSON
ASHE
AVERY
BEAUFORT
BERTIE
BLADEN
BRUNSWICK
BUNCOMBE
BURKE
CABARRUS
CALDWELL
Camden
CARTERET
CASWELL
CATAWBA
CHATHAM
CHEROKEE
CHOWAN
CLAY
CLEVELAND
COLUMBUS
CRAVEN
CUMBERLAND
CURRITUCK
DARE
DAVIDSON
DAVIE
DUPLIN
DURHAM
EDGECOMBE
FORSYTH
FRANKLIN
ACA
Region
Region 11
Region 2
Region 3
Region 4
Region 3
Region 1
Region 16
Region 12
Region 9
Region 15
Region 1
Region 2
Region 4
Region 2
Region 12
Region 16
Region 11
Region 2
Region 11
Region 1
Region 12
Region 1
Region 5
Region 15
Region 16
Region 9
Region 12
Region 16
Region 6
Region 6
Region 15
Region 11
Region 14
Region 6
Region 13
Macro
Region
Triangle
Asheville
Asheville
Charlotte
Asheville
Asheville
Eastern
Eastern
Fayetteville
Wilmington
Asheville
Asheville
Charlotte
Asheville
Eastern
Eastern
Triangle
Asheville
Triangle
Asheville
Eastern
Asheville
Charlotte
Wilmington
Eastern
Fayetteville
Eastern
Eastern
Triad
Triad
Wilmington
Triangle
Eastern
Triad
Triangle
County
GASTON
Gates
Graham
GRANVILLE
Greene
GUILFORD
HALIFAX
HARNETT
HAYWOOD
HENDERSON
HERTFORD
HOKE
HYDE
IREDELL
JACKSON
JOHNSTON
Jones
LEE
LENOIR
LINCOLN
MACON
MADISON
MARTIN
MCDOWELL
MECKLENBURG
MITCHELL
MONTGOMERY
MOORE
NASH
NEW HANOVER
NORTHAMPTON
ONSLOW
ORANGE
Pamlico
PASQUOTANK
14
ACA
Region
Region 5
Region 12
Region 1
Region 10
Region 14
Region 7
Region 12
Region 9
Region 1
Region 1
Region 12
Region 9
Region 16
Region 2
Region 1
Region 13
Region 16
Region 11
Region 16
Region 5
Region 1
Region 1
Region 12
Region 1
Region 4
Region 1
Region 8
Region 8
Region 14
Region 15
Region 12
Region 15
Region 11
Region 16
Region 12
Macro
Region
Charlotte
Eastern
Asheville
Triangle
Eastern
Triad
Eastern
Fayetteville
Asheville
Asheville
Eastern
Fayetteville
Eastern
Asheville
Asheville
Triangle
Eastern
Triangle
Eastern
Charlotte
Asheville
Asheville
Eastern
Asheville
Charlotte
Asheville
Fayetteville
Fayetteville
Eastern
Wilmington
Eastern
Wilmington
Triangle
Eastern
Eastern
County
PENDER
PERQUIMANS
PERSON
PITT
POLK
RANDOLPH
RICHMOND
ROBESON
ROCKINGHAM
ROWAN
RUTHERFORD
SAMPSON
SCOTLAND
STANLY
STOKES

ACA
Region
Region 15
Region 12
Region 11
Region 14
Region 1
Region 7
Region 9
Region 9
Region 7
Region 4
Region 1
Region 9
Region 9
Region 4
Region 6
Macro
Region
Wilmington
Eastern
Triangle
Eastern
Asheville
Triad
Fayetteville
Fayetteville
Triad
Charlotte
Asheville
Fayetteville
Fayetteville
Charlotte
Triad
County
SURRY
SWAIN
TRANSYLVANIA
Tyrrell
UNION
VANCE
WAKE
WARREN
WASHINGTON
WATAUGA
WAYNE
WILKES
WILSON
YADKIN
YANCEY
ACA
Region
Region 6
Region 1
Region 1
Region 16
Region 4
Region 10
Region 13
Region 10
Region 16
Region 3
Region 14
Region 3
Region 14
Region 6
Region 1
All CPTs were evaluated. In the following table, "Cohort" refers to the CPT analysis within the cohort only.
"Statewide" refers to the DRG analysis done statewide due to the low volume. Outpatient CPT information was not
used to determine Peer Cohorts.
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
00100
Anesthesia for procedures on salivary glands, including biopsy
00102
ANESTHESIA FOR PROCEDURES ON INTEGUMENTARY SYSTEM
OF HEADAND/OR SALIVARY GLANDS, INCLUDING BIOPSY;
PLASTIC REPAIR OF CLEFT LIP
00103
BLEPHAROPLASTY
00104
ANESTHESIA FOR ELECTROCONVULSIVE THERAPY
00120
ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE,
ANDINNER EARINCLUDING BIOPSY; NOT OTHERWISE SPECIFIE D
cohort
00124
OTOSCOPY
statewide
00126
TYMPANOTOMY
00140
ANESTHESIA FOR PROCEDURES ON EYE; NOT OTHERWISE
SPECIFIED
00142
LENS SURGERY
00144
CORNEAL TRANSPLANT
cohort
00145
VITRECTOMY
00148
OPHTHALMOSCOPY
00160
ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY
SINUSES; NOT OTHERWISE SPECIFIED
00162
RADICAL SURGERY
statewide
00164
BIOPSY, SOFT TISSUE
statewide
00170
ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING
BIOPSY; NOT OTHERWISE SPECIFIED
00172
REPAIR OF CLEFT PALATE
00174
EXCISION OF RETROPHARYNGEAL TUMOR
00176
RADICAL SURGERY
00190
Macro
Region
Triad
Asheville
Asheville
Eastern
Charlotte
Triangle
Triangle
Triangle
Eastern
Asheville
Eastern
Asheville
Eastern
Triad
Asheville
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
ANESTHESIA FOR PROCEDURES ON FACIAL BONES; NOT
15
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
Peer
Cohort
6
OTHERWISE SPECIFIED
00192
RADICAL SURGERY (INCLUDING PROGNATHISM)
00210
ANESTHESIA FOR INTRACRANIAL PROCEDURES, NOT
OTHERWISE SPECIFIED
statewide
cohort
00211
Anesthesia for intracranial procedures; craniotomyor craniectomy for
evacuation of hematoma
statewide
00215
ELEVATION OF DEPRESSED SKULL FRACTURE, EXTRADURAL
(SIMPLE OR COMPOUND)
statewide
00220
SPINAL FLUID SHUNTING PROCEDURES
statewide
00300
ANESTHESIA FOR ALL PROCEDURES ON INTEGUMENTARY
SYSTEM OF NECK, INCLUDING SUBCUTANEOUS TISSUE
cohort
cohort
cohort
cohort
cohort
00320
ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID,
LARYNX, TRACHEA AND LYMPHATIC SYSTEM OF NECK; NOT
OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
00322
NEEDLE BIOPSY OF THYROID (FOR PROCEDURES ON CERVICAL
SPINE AND CORD, SEE 00600, 00604, 00670)
00326
ANESTHESIA, LARYNX & TRACHEA PROC; CHILDREN <1 YR
00350
ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK;
NOT OTHERWISE SPECIFIED
cohort
00352
SIMPLE LIGATION (FOR ARTERIOGRAPHY, SEE 01916)
statewide
00400
ANESTHESIA FOR PROCEDURES ON ANTERIOR
INTEGUMENTARY SYSTEM OF CHEST, INCLUDING
SUBCUTANEOUS TISSUE; NOT OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
00402
RECONSTRUCTIVE PROCEDURES ON BREAST (EG.
REDUCTIONOR AUGMENTATION MAMOPLASTY, MUSCLE FLAPS)
cohort
cohort
cohort
cohort
cohort
00404
RADICAL OR MODIFIED RADICAL PROCEDURES ON BREAST
cohort
cohort
cohort
cohort
cohort
00406
RADICAL OR MODIFIED RADICAL PROCEDURES ON BREAST
WITH INTERNAL MAMMARY NODE DISSECTION
cohort
cohort
cohort
00410
ELECTRICAL CONVERSION OF ARRHYTHMIAS
cohort
cohort
cohort
0042T
CEREBRAL PERFUSION ANALYSIS USING COMPUTED
TOMOGRAWITH CONTRAST ADMIN. INCLUDING POSTPROCESSING OF PARAMETRIC MAPS WITH DETERM. OF
CEREBRAL BLOOD VOLAND MEAN TRANSIT TIME
00450
ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA;
00454
BIOPSY OF CLAVICLE
00470
ANESTHESIA FOR PARTIAL RIB RESECTION; NOT OTHERWISE
SPECIFIED
statewide
00474
RADICAL PROCEDURES (EG. PECTUS EXCAVATUM)
statewide
00520
ANESTHESIA FOR CLOSED CHEST PROCEDURES (INCLUDING
ESOPHAGOSCOPY, BRONCHOSCOPY, DIAGNOSTIC
THORACOSCOPY); NOT OTHERWISE SPECIFIED
00524
PNEUMOCENTESIS
00528
ANESTHESIA FOR CLOSED CHEST PROCEDURES;
MEDIASTINOSCOPY AND DIAGNOSTIC THORACOSCOPY NOT
UTILIZING 1 LUNG VENTILATION
00530
ANESTHESIA FOR TRANSVENOUS PACEMAKER INSERTION
00532
ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION
cohort
00534
ANESTHESIA FOR TRANSVENOUS INSERTION OR REPLACEMENT
OF CARDIOVERTER/DEFIBRILLATOR (FOR TRANSTHORACIC
APPROACH, USE 00560)
cohort
00537
ANESTHESIA FOR CARDIAC ELECTROPHYSIOLOGIC
PROCEDURES INCLUDING RADIOFREQUENCY ABLATION
00540
ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING
LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM (INCLUDING
SURGICAL THORACOSCOPY); NOT OTHERWISE SPECIFIED
00548
INTRATHORACIC PROCEDURES ON THE TRACHEA AND BRONCHI
00600
ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND
CORD; NOT OTHERWISE SPECIFIED
00604
POSTERIOR CERVICAL LAMINECTOMY IN SITTING POSITION
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
16
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
00620
ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND
CORD; NOT OTHERWISE SPECIFIED
cohort
00625
ANESTHESIA FOR PROCEDURES ON THE THORACIC SPINE AND
CORD, VIA AN ANTERIOR TRANSTHORACIC APPROACH; NOT
UTILIZING 1 LUNG VENTILATION
00630
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; NOT
OTHERWISE SPECIFIED
00635
ANESTHESIA FOR PROCEDURES IN LUMBAR REGION;
DIAGNOSTIC OR THERAPEUTIC LUMBAR PUNCTURE.
00640
ANESTHESIA FOR MANIPULATION OF THE SPINE OR FOR
CLOSED PROCEDURES ON THE CERVICAL, THORACIC OR
LUMBAR SPINE
00670
ANESTHESIA FOR EXTENSIVE SPINE AND SPINAL CORD
PROCEDURES (EG, HARRINGTON ROD TECHNIQUE)
cohort
00700
ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR
ABDOMINAL WALL; NOT OTHERWISE SPECIFIED
cohort
00702
PERCUTANEOUS LIVER BIOPSY
00730
ANESTHESIA FOR PROCEDURES ON UPPER POSTERIOR
ABDOMINAL WALL
cohort
0073T
COMPENSATOR-BASED BEAM MODULATION TREATMENT
DELIVERY OF INVERSE PLANNED TREATMENT USING THREE OR
MORE HIGH RESOLUTION (MILLED OR CAST) COMPENSATOR
CONVERGENT BEAM MODULATED FIELDS, PER
statewide
00740
ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC
PROCEDURES
cohort
cohort
cohort
cohort
cohort
00750
ANESTHESIA FOR HERNIA REPAIRS IN UPPDER ABDOMEN; NOT
OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
00752
LUMBAR AND VENTRAL (INCISIONAL)HERNIAS AND/OR WOUND
DEHISCENCE
cohort
cohort
cohort
00754
OMPHALOCELE
statewide
00770
ANESTHESIA FOR ALL PROCEDURES ON MAJOR ABDOMINAL
BLOOD VESSELS
00790
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN
UPPERABDOMEN INCLUDING LAPAROSCOPY, NOT OTHERWISE
SPECIFIED
00792
PARTIAL HEPATECTOMY (EXCLUDING LIVER BIOPSY)
00797
ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN
W/LAPAROSCOPY; GASTRIC RESTRICT MORBIID OBESITY
00800
ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR
ABDOMINAL WALL; NOT OTHERWISE SPECIFIED
00810
ANESTHESIA FOR INTESTINAL ENDOSCOPIC PROCEDURES
cohort
00820
ANESTHESIA FOR PROCEDURES ON LOWER POSTERIOR
ABDOMINAL WALL
cohort
cohort
00830
ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; NOT
OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
00832
VENTRAL AND INCISIONAL HERNIAS
cohort
cohort
cohort
cohort
00834
ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN NOT
OTHERWISE SPECIFIED, UNDER 1 YEAR OF AGE
cohort
cohort
cohort
00836
ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN NOT
OTHERWISE SPECIFIED, INFANTS LESS THAN 37
WEEKGESTATIONAL AGE AT BIRTH AND LESS THAN 50 WEEKS
GESTATIONAL AGE AT TIME OF SURGERY
00840
ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN
LOWERABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE
SPECIFIED
cohort
cohort
00846
RADICAL HYSTERECTOMY
cohort
cohort
00851
ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN
W/LAPAROSCOPY; TUBAL LIGATION/TRANSECTION
00860
ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN
LOWERABDOMEN, INCLUDING URINARY TRACT; NOT
OTHERWISE SPECIFIED
00862
Peer
Cohort
2
cohort
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
17
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
RENAL PROCEDURES, INCLUDING UPPER 1/3 OF URETER, OR
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
DONOR NEPHRECTOMY
00865
RADICAL PROSTATECTOMY (SUPRAPUBIC, RETROPUBIC
00866
ADRENALECTOMY
00870
CYSTOLITHOTOMY
cohort
00872
ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK
WAVE; WITH WATER BATH
cohort
00873
WITHOUT WATER BATH
cohort
00880
ANESTHESIA FOR PROCEDURES ON MAJOR LOWER
ABDOMINALVESSELS; NOT OTHERWISE SPECIFIED
00902
ANORECTAL PROCEDURE (INCLUDING ENDOSCOPY AND/OR
BIOPSY
cohort
00904
RADICAL PERINEAL PROCEDURE
cohort
00906
VULVECTOMY
00908
PERINEAL PROSTATECTOMY
cohort
00910
ANESTHESIA FOR TRANSURETHRAL PROCEDURES
(INCLUDINGURETHROCYSTOSCOPY); NOT OTHERWISE
SPECIFIED
cohort
cohort
cohort
cohort
cohort
00912
TRANSURETHRAL RESECTION OF BLADDER TUMOR(S)
cohort
cohort
cohort
cohort
cohort
00914
TRANSURETHRAL RESECTION OF PROSTATE
cohort
cohort
cohort
cohort
cohort
00918
WITH FRAGMENTATION AND/OR REMOVAL OF URETERAL
CALCULUS
cohort
cohort
cohort
cohort
cohort
00920
ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL
GENITALIA; NOT OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
00921
VASECTOMY, UNILATERAL/BILATERAL
cohort
cohort
cohort
cohort
00922
SEMINAL VESICLES
statewide
00924
UNDESCENDED TESTIS, UNILATERAL OR BILATERAL
00926
RADICAL ORCHIECTOMY, INGUINAL
00928
RADICAL ORCHIECTOMY, ABDOMINAL
00930
ORCHIOPEXY, UNILATERAL OR BILATERAL
00938
INSERTION OF PENILE PROSTHESIS (PERINEAL APPROACH)
cohort
cohort
00940
ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY
OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); NOT
OTHERWISE SPECIFIED
cohort
cohort
00942
COLPOTOMY, COLPECTOMY, COLPORRHAPHY
cohort
cohort
00944
VAGINAL HYSTERECTOMY
cohort
00948
CERVICAL CERCLAGE
00952
HYSTEROSCOPY
01112
ANESTHESIA FOR BONE MARROW ASPIRATION AND/OR BIOPSY,
ANTERIOR OR POSTERIOR ILIAC CREST
01120
ANESTHESIA FOR PROCEDURES ON BONY PELVIS
statewide
01130
ANESTHESIA FOR BODY CAST APPLICATION OR REVISION
statewide
01170
ANESTHESIA FOR OPEN PROCEDURES INVOLVING SYMPHYSIS
PUBIS OR SACROILIAC JOINT
01190
INTRAPELVIC
01200
ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING HIP
JOINT
cohort
cohort
01202
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF HIP JOINT
cohort
cohort
01210
ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT;
cohort
01214
TOTAL HIP REPLACEMENT OR REVISION
01220
ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING UPPER
2/3 OF FEMUR
01230
ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF
FEMUR; NOT OTHERWISE SPECIFIED
01232
AMPUTATION
01250
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES
18
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
TENDONS, FASCIA, AND BURSAE OF UPPER LEG
01260
ANESTHESIA FOR ALL PROCEDURES ON INVOLVING VEINS OF
UPPER LEG, INCLUDING EXPLORATION
01270
ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF
UPPER LEG, INCLUDING BYPASS GRAFT; NOT OTHERWISE
SPECIFIED
01320
ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES,
TENDONS, FASCIA, AND BURSAE OF KNEE AND/OR POPLITEAL
AREA
cohort
01340
ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER 1/3 OF
FEMUR
statewide
01360
ANESTHESIA FOR ALL OPEN PROCEDURES ON LOWER 1/3 OF
FEMUR
01380
ANESTHESIA FOR ALL CLOSED PROCEDURES ON KNEE JOINT
cohort
cohort
cohort
01382
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF KNEE
JOINT
cohort
cohort
cohort
01390
ANESTHESIA FOR ALL CLOSED PROCEDURES ON UPPER ENDS
OF TIBIA, FIBULA, AND/OR PATELLA
01392
ANESTHESIA FOR ALL OPEN PROCEDURES ON UPPER ENDS OF
TIBIA, FIBULA, AND/OR PATELLA
cohort
cohort
cohort
cohort
cohort
01400
ANESTHESIA FOR OPEN PROCEDURES ON KNEE JOINT; NOT
OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
01402
TOTAL KNEE REPLACEMENT
cohort
cohort
cohort
cohort
01420
ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR
REPAIR INVOLVING KNEE JOINT
cohort
01430
ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND
POPLITEAL AREA; NOT OTHERWISE SPECIFIED
cohort
01462
ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER LEG,
ANKLE, AND FOOT
cohort
cohort
cohort
cohort
01464
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ANKLE
JOINT
cohort
cohort
cohort
cohort
01470
ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES,
TENDONS, AND FASCIA OF LOWER LEG, ANKLE, AND FOOT;NOT
OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
cohort
01472
REPAIR OF RUPTURED ACHILLES TENDON, WITH OR WITHOUT
GRAFT
cohort
cohort
cohort
cohort
cohort
01474
GASTROCNEMIUS RECESSION (EG. STRAYER PROCEDURE)
01480
ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWE
LEG, ANKLE, AND FOOT; NOT OTHERWISE SPECIFIED
cohort
cohort
cohort
cohort
01482
RADICAL RESECTION
cohort
cohort
cohort
01484
ODTEOTOMY OR OSTEOPLASTY OF TIBIA AND/OR FIBULA
01490
ANESTHESIA FOR LOWER LEG CAST APPLICATION, REMOVAL,
OR REPAIR
statewide
01500
ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER
LEGINCLUDING BYPASS GRAFT; NOT OTHERWISE SPECIFIED.
statewide
01520
ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; NOT
OTHERWISE SPECIFIED
statewide
01522
VENOUS THROMBECTOMY,DIRECT OR WITH CATHETER
statewide
0159T
Computer aided detection, including computer algorithm analysis of MRI
image data for lesion detection/ characterization, pharmacokinetic
analysis, with further physician review for interpretation, br
01610
TENDONS, FASCIA, AND BURSAE OF SHOULDER AND AXILLA
cohort
cohort
01620
ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERAL
HEAD ABD NECK, STERNOCLAVICULAR JOINT,
ACROMIOCLAVICULAR JOINT, AND SHOULDER JOINT
cohort
cohort
01622
ANESTHESIA FOR ARTROSCOPIC PROCEDURES OF SHOULDER
JOINT
01630
ANESTHESIA FOR OPEN PROCEDURES ON HUMERAL HEAD
ANDNECK, STERNOCLAVICULAR JOINT, ACROMIOCLAVICULAR
JOINT, AND SHOULDER JOINT; NOT OTHERWISE SPECIFIED
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
19
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
01650
ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER
AND AXILLA; NOT OTHERWISE SPECIFIED
01680
ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR
REPAIR; NOT OTHERWISE SPECIFIED
01710
ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES,
TENDONS, FASCIA, AND BURSAE OF UPPER ARM AND ELBOW;
01712
TENOTOMY, ELBOW TO SHOULDER, OPEN
01714
TENOPLASTY, ELBOW TO SHOULDER
01716
TENODESIS, RUPTURE OF LONG TENDON OF BICEPS
cohort
cohort
01730
ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERUS
AND ELBOW
cohort
cohort
01732
ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ELBOW
JOINT
01740
ANESTHESIA FOR OPEN PROCEDURES ON HUMERUS AND
ELBOW; NOT OTHERWISE SPECIFIED
01742
OSTEOTOMY OF HUMERUS
01744
REPAIR OF NONUNION OR MALUNION OF HUMERUS
cohort
01756
RADICAL PROCEDURES
cohort
01758
EXCISION OF CYST OR TUMOR OF HUMERUS
statewide
01760
TOTAL ELBOW REPLACEMENT
statewide
01770
ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER
ARMAND ELBOW; NOT OTHERWISE SPECIFIED
cohort
01780
ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND
ELBOW; NOT OTHERWISE SPECIFIED
statewide
01810
TENDONS, FASCIA, AND BURSAE OF FOREARM, WRIST,
ANDHAND
cohort
01820
ANESTHESIA FOR ALL CLOSED PROCEDURES ON RADIUS, ULNA,
WRIST, OR HAND BONES HAND
01830
ANESTHESIA FOR OPEN PROCEDURES ON RADIUS, ULNA,
WRIST, OR HAND BONES; NOT OTHERWISE SPECIFIED HAND
01832
TOTAL WRIST REPLACEMENT
01840
ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM,
WRIST, AND HAND; NOT OTHERWISE SPECIFIED
cohort
01844
ANESTHESIA FOR VASCULAR SHUNT, OR SHUNT REVISION, ANY
TYPE (EG. DIALYSIS)
cohort
0184T
Excision of rectal tumor, transanal endoscopic microsurgical approach
(i.e., TEMS), including muscularis propria (i.e., full thickness)
01850
ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM,
WRIST, AND HAND; NOT OTHERWISE SPECIFIED
01916
ANESTHESIA FOR ARTERIOGRAMS, NEEDLE; CAROTID OR
VERTEBRAL
0191T
Insertion of anterior segment aqueous drainage device, without
extraocular reservoir; internal approach, into the trabecular meshwork
01920
ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING
CORONARY ARTERIOGRAPHY AND VENTRICULOGRAPHY (NOT
TO INCLUDE SWAN-GANZ CATHETER)
01922
ANESTHESIA FOR NON-INVASIVE IMAGING OR RADIATION
THERAPY
01924
ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL,
ARTERIAL SYSTEM NOS
01925
ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL ARTERIAL
SYSTEM; CAROTID/CORONARY
01926
ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL ARTERIAL
SYSTEM; INTRACRANIAL/INTRACARDIAC/AORTIC
0192T
INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE
01930
ANES, THERAPEUTIC INTERVEN RADIOL,
VENOUS/LYMPHATISYSTEM W/O CENTRAL CIRC ACCESS; NOS
01931
ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL
Peer
Cohort
5
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
20
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
RADIOLOGICAL PROCEDURES INVOLVING THE
VENOUS/LYMPHATIC SYSTEM (NOT TO INCLUDE ACCESS TO
THE CENTRAL CIRCULATION); INTRAHEPATIC OR PORTAL
CIRCULATION (E.G., TR
01936
Anesthesia for percutaneous image guided procedures on the spine
and spinal cord; therapeutic
01951
ANESTHESIA FOR SECOND AND THIRD DEGREE BURN EXCISION OR DEBRIDEMENT WITH OR WITHOUT SKIN GRAFT- ING,
ANY SITE, FOR TOTAL BODY SURFACE AREA (TBSA) TREATED
DURING ANESTHESIA AND SURGERY; LESS 1% TOT
statewide
01960
ANESTHESIA FOR; VAGINAL DELIVERY ONLY
statewide
01962
ANESTHESIA FOR; URGENT HYSTERECTOMY FOLLOWING
DELIVERY
01965
ANESTHESIA FOR INCOMPLETE OR MISSED ABORTION
PROCEDURES
01966
ANESTHESIA FOR INDUCED ABORTION PROCEDURES
01968
CESAREAN DELIVERY FOLLOWING NEURAXIAL LABOR
ANALGEANESTHESIA ADD'L ANESTHESIA
01991
ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE
BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION IS
PERFORMED BY A DIFFERENT PHYSICIAN OR OTHER
QUALIFIEDHEALTH CARE PROFESSIONAL); OTHER THAN THE
PRONE P
01992
ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE
BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION IS
PERFORMED BY A DIFFERENT PHYSICIAN OR OTHER
QUALIFIEDHEALTH CARE PROFESSIONAL); PRONE POSITION
0227T
Anoscopy, high resolution (HRA) (with magnificaiton and chemical
agent enhancement); with biopsy(ies)
0238T
Transluminal peripheral atherectomy, including radiological supervision
and interpretation; iiac artery, each vessel
0240T
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE
ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY
WITH INTERPRETATION AND REPORT; WITH HIGH RESOLUTION
ESOPHAGEAL PRESSURE TOPOGRAPHY
0249T
Ligation, hemorrhoidal vascular bundle(s), including ultrasound
guidance
0275T
Percutaneous laminotomy/laminectomy (intralaminar approach) for
decompression of neural elements, (with or without ligamentous
resection, discectomy, facetectomy and/or foraminotomy) and method
under
0291T
Intravascular optical coherence tomography (coronary native vessel or
graft) during diagnostic evaluation and/or therapeutic intervention,
including imaging supervision, interpretation, and report; in
0296T
External electrocardiographic recording for more than 48 hours up to 21
days by continuous rhythm recording and storage; recording (includes
connection and initial recording)
cohort
cohort
0297T
External electrocardiographic recording for more than 48 hours up to 21
days by continuous rhythm recording and storage; scanning analysis
with report
cohort
cohort
0334T
Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally
invasive (indirect visualization), includes obtaining and applying
autograftor allograft (structural or morselized), when per
statewide
0360
OR SERVICES
statewide
0402
ULTRASOUND
10021
FINE NEEDLE ASPIRATION; W/OUT IMAGING GUIDANCE
10022
FINE NEEDLE ASPIRATION; W/IMAGING GUIDANCE
10040
*ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR
REMOVAL OFMULTIPLE MILIA, COMEDONES, CYSTS, PUSTULES)
10060
*INCISION AND DRAINAGE OF ABSCESS (EG,
CARBUNCLE,SUPPURATIVE HIDRADENITIS, CUTANEOUS OR
SUBCUTANEOUSABSCESS, CYST, FURUNCLE, OR PARONYCHIA);
SIMPLE OR SINGLE
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
cohort
21
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
10061
INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE,
SUPPURATIVEHIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS
ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED
OR MULTIPLE
cohort
cohort
cohort
cohort
cohort
10080
*INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE
cohort
cohort
cohort
cohort
cohort
10081
INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED
cohort
cohort
cohort
cohort
cohort
10120
*INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS
TISSUES;SIMPLE *INCISION AND REMOVAL OF FOREIGNBODY,
SUBCUTANEOUS TISSUES;
cohort
cohort
cohort
cohort
cohort
10121
INCISION AND REMOVAL OF FOREIGN BODY,
SUBCUTANEOUSTISSUES; COMPLICATED INCISION AND
REMOVAL OF FOR EIGN BODY, SUBCUTANEOUS TISSUES;
cohort
cohort
cohort
cohort
10140
*INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR
FLUIDCOLLECTION
cohort
cohort
cohort
cohort
cohort
10160
*PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR
CYST*PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA,
OR CYST
cohort
cohort
cohort
cohort
cohort
10180
INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE
WOUNDINFECTION
cohort
cohort
cohort
cohort
11000
*DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED
SKIN; UP TO10% OF BODY SURFACE
cohort
cohort
cohort
cohort
11005
DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND
FASCIA FOR NECROTIZING SOFT TISSUE INFECTION ABDOMINAL
WALL WITH OR WITHOUT FASCIAL CLOSURE
cohort
11008
Removal of prosthetic material or mesh, abdominal wall for infection
(e.g., for chronic or recurrentmesh infection or necrotizing soft tissue
infecti on)
statewide
11010
Debridement including removal of foreign material at the site of an open
fracture and/or an open dislocation (eg, excisional debridement); skin
and subcutaneous tissues
cohort
11011
fracture and/or an open dislocation (eg, excisional debridement); skin,
subcutaneous tissue, muscle fascia, and muscle
11012
fracture and/or an open dislocation (eg, excisional debridement); skin,
subcutaneous tissue, muscle fascia, muscle, and bone
cohort
cohort
cohort
cohort
cohort
11042
Debridement, subcutaneous tissue (includes epidermis and dermis, if
performed); first 20 sq cm or less
cohort
cohort
cohort
cohort
cohort
cohort
11043
Debridement, muscle and/or fascia (includes epidermis, dermis, and
subcutaneous tissue, if performed); first 20 sq cm or less
cohort
cohort
cohort
cohort
cohort
cohort
11044
Debridement, bone (includes epidermis, dermis, subcutaneous tissue,
muscle and/or fascia, if performed); first 20 sq cm or less
cohort
cohort
cohort
cohort
cohort
cohort
11045
Debridement, subcutaneous tissue (includes epidermis and dermis, if
performed); each additional 20 sq cm, or part thereof (List separately in
additionto code for primary procedure)
cohort
cohort
cohort
cohort
cohort
cohort
11046
Debridement, muscle and/or fascia (includes epidermis, dermis, and
subcutaneous tissue, if performed); each additional 20 sq cm, or part
thereof (Listseparately in addition to code for primary proced
cohort
cohort
cohort
cohort
cohort
11047
Debridement, bone (includes epidermis, dermis, subcutaneous tissue,
muscle and/or fascia, if performed); each additional 20 sq cm, or part
thereof (List separately in addition to code for primary proc
cohort
cohort
cohort
11055
PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG,
CORN OR CALLUS); SINGLE LESION PARING OR CUTTING OF
BENIGN HYPERKERATOTIC LESION (EG, CORN
cohort
cohort
cohort
cohort
cohort
11056
CORN OR CALLUS); TWO TO FOUR LESIONS PARING OR
CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN
cohort
cohort
cohort
cohort
cohort
11057
CORN OR CALLUS); MORE THAN FOUR LESIONS PARING OR
CUTTING OF BENIGN HYPERKERATOTIC LESION (EG,CORN
statewide
11100
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS
MEMBRANE(INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE
LISTED (SEPARATE PROCEDURE); SINGLE LESION
cohort
cohort
cohort
cohort
cohort
11101
BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS
cohort
cohort
cohort
cohort
cohort
22
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
cohort
statewide
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
Peer
Cohort
6
MEMBRANE(INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE
LISTED (SEPARATE PROCEDURE); EACH SEPARATE/ADDITIONAL
LESION (LIST
11200
*REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS,
ANYAREA; UP TO AND INCLUDING 15 LESIONS *REMOVAL OF
SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY
cohort
cohort
11201
Removal of skin tags, multiple fibrocutaneous tags, any area; each
additional 10 lesions, or part thereof (List separately in addition to code
for primary procedure)
cohort
cohort
11300
*SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE
LESION,TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM
ORLESS
cohort
11301
SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION,
TRUNK,ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0CM
11302
TRUNK,ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0CM
11306
SCALP,NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6
TO 1.0 CM
11308
SCALP,NECK, HANDS, FEET, GENITALIA; LESION DIAMETER
OVER 2.0 CM
11310
*SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION,
FACE,EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; 0.5 CM
OR LESS
11311
FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE;
LESION DIAMETER 0.6 TO 1.0 CM
11400
EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS
LISTEDELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER
0.5 CM OR LESS
cohort
cohort
cohort
cohort
cohort
11401
0.6 TO 1.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
11402
1.1 TO 2.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
11403
2.1 TO 3.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
11404
3.1 TO 4.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
11406
OVER 4.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
11420
LISTEDELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA;
LESION DIAMETER 0.5 CM OR LESS
cohort
cohort
cohort
cohort
cohort
cohort
11421
cohort
cohort
cohort
cohort
cohort
cohort
11422
cohort
cohort
cohort
cohort
cohort
cohort
11423
cohort
cohort
cohort
cohort
cohort
cohort
11424
cohort
cohort
cohort
cohort
cohort
cohort
11426
LESION DIAMETER OVER 4.0 CM
cohort
cohort
cohort
cohort
cohort
cohort
EXCISION, OTHER BENIGN LESION (UNLESS LISTED
cohort
cohort
cohort
cohort
cohort
11440
23
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
Peer
Cohort
6
ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS
MEMBRANE; LESION DIAMETER 0.5 CM OR LESS
11441
MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM
cohort
cohort
cohort
cohort
11442
cohort
cohort
cohort
cohort
11443
cohort
cohort
cohort
cohort
11444
cohort
cohort
cohort
cohort
11446
MEMBRANE; LESION DIAMETER OVER 4.0 CM
cohort
cohort
cohort
cohort
11450
EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR
HIDRADENITIS,AXILLARY; WITH SIMPLE OR INTERMEDIATE
REPAIR
cohort
cohort
cohort
cohort
11451
HIDRADENITIS,AXILLARY; WITH COMPLEX REPAIR
cohort
cohort
cohort
11462
HIDRADENITIS,INGUINAL; WITH SIMPLE OR INTERMEDIATE
REPAIR
cohort
cohort
cohort
cohort
11463
HIDRADENITIS,INGUINAL; WITH COMPLEX REPAIR
statewide
11470
HIDRADENITIS,PERIANAL, PERINEAL, OR UMBILICAL; WITH
SIMPLE OR INTERMEDIATE REPAIR
cohort
cohort
cohort
11471
HIDRADENITIS,PERIANAL, PERINEAL, OR UMBILICAL; WITH
COMPLEX REPAIR
cohort
11600
EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS;
LESIONDIAMETER 0.5 CM OR LESS
cohort
cohort
cohort
11601
LESIONDIAMETER 0.6 TO 1.0 CM
cohort
cohort
cohort
cohort
11602
cohort
cohort
cohort
cohort
cohort
11603
cohort
cohort
cohort
cohort
cohort
11604
cohort
cohort
cohort
cohort
11606
LESIONDIAMETER OVER 4.0 CM
cohort
cohort
cohort
cohort
11620
EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS,
FEET,GENITALIA; LESION DIAMETER 0.5 CM OR LESS EXCISION,
MALIGNANT LESION, SCALP, NECK, HANDS, FEET,
cohort
cohort
cohort
cohort
11621
FEET,GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM EXCISION,
cohort
cohort
cohort
cohort
11622
cohort
cohort
cohort
11623
cohort
cohort
cohort
cohort
11624
cohort
cohort
cohort
cohort
11626
FEET,GENITALIA; LESION DIAMETER OVER 4.0 CM EXCISION,
cohort
cohort
cohort
cohort
EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE,
cohort
cohort
cohort
11640
cohort
cohort
cohort
24
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
LIPS;LESION DIAMETER 0.5 CM OR LESS
11641
LIPS;LESION DIAMETER 0.6 TO 1.0 CM
cohort
cohort
cohort
11642
cohort
cohort
cohort
cohort
cohort
11643
cohort
cohort
cohort
cohort
11644
11646
LIPS;LESION DIAMETER OVER 4.0 CM
cohort
11719
TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER
cohort
11720
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO
FIVEDEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE
cohort
11721
DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR
MOREDEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR
MORE
11730
*AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE;
SINGLE
cohort
cohort
11732
AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE;
EACHADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION
TO CODE FOR PRIMARY PROCEDURE)
cohort
11740
EVACUATION OF SUBUNGUAL HEMATOMAEVACUATION OF
SUBUNGUAL HEMATOMA
11750
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE,
(EG, INGROWN OR DEFORMED NAIL) FOR PERMANENT
REMOVAL; EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR
COMPLETE, (EG,
11752
EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE,
(EG, INGROWN OR DEFORMED NAIL) FOR PERMANENT
REMOVAL; WITH AMPUTATION OF TUFT OF DISTAL PHALANX
11755
BIOPSY OF NAIL UNIT, ANY METHOD (EG, PLATE, BED,
MATRIX,HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS)
(SEPARATE PROCEDURE)
11760
REPAIR OF NAIL BEDREPAIR OF NAIL BED
11762
RECONSTRUCTION OF NAIL BED WITH GRAFTRECONSTRUCTION
OF NAIL BED WITH GRAFT
11765
WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR
INGROWNTOENAIL) WEDGE EXCISION OF SKIN OF NAIL FOLD
(EG, FOR INGROWN
cohort
cohort
cohort
cohort
cohort
11770
EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE
cohort
cohort
cohort
cohort
cohort
cohort
11771
EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE
cohort
cohort
cohort
cohort
cohort
cohort
11772
EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED
cohort
cohort
cohort
cohort
cohort
cohort
11900
*INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN
LESIONS
cohort
cohort
11901
*INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS
statewide
11921
TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE
OPAQUEPIGMENTS TO CORRECT COLOR DEFECTS OF SKIN,
INCLUDING MICROPIGMENTATION; 6.1 TO 20.0 SQ CM
statewide
11950
SUBCUTANEOUS INJECTION OF FILLING MATERIAL (EG,
COLLAGEN); 1CC OR LESS SUBCUTANEOUS INJECTION OF
FILLING MATERIAL (EG, COLLAGEN); 1
statewide
11951
SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG,
COLLAGEN);1.1 TO 5.0 CC SUBCUTANEOUS INJECTION
OF"FILLING" MATERIAL (EG, COLLAGEN);
11952
COLLAGEN);5.1 TO 10.0 CC SUBCUTANEOUS INJECTION OF
"FILLING" MATERIAL (EG, COLLAGEN);
11954
COLLAGEN);OVER 10.0 CC SUBCUTANEOUS INJECTION OF
"FILLING" MATERIAL (EG, COLLAGEN);
11960
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
25
cohort
statewide
statewide
INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
BREAST,INCLUDING SUBSEQUENT EXPANSION
11970
REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT
PROSTHESIS
cohort
cohort
cohort
cohort
cohort
11971
REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION
OFPROSTHESIS
cohort
cohort
cohort
cohort
cohort
11980
SUBCUTANEOUS HORMONE PELLET
IMPLANTATION(IMPLANTATION OF ESTRADIOL AND/OR
TESTOSTERONE PELLETS BENEATH THE SKIN
cohort
cohort
cohort
11981
INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
cohort
cohort
cohort
cohort
cohort
11982
REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT
cohort
cohort
cohort
cohort
11983
REMOVAL W/REINSERTION, NON-BIODEGRADABLE DRUG
DELIVERY IMPLANT
cohort
cohort
12001
*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP,
NECK,AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR
EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS
cohort
cohort
cohort
cohort
cohort
cohort
12002
EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM
cohort
cohort
cohort
cohort
cohort
cohort
12004
EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM
cohort
cohort
cohort
cohort
cohort
cohort
12005
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK,
AXILLAE,EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES
(INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM
cohort
cohort
cohort
cohort
cohort
12006
(INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM
cohort
cohort
cohort
12007
(INCLUDING HANDS AND FEET); OVER 30.0 CM
12011
*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS,
EYELIDS,NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR
LESS
cohort
cohort
cohort
cohort
cohort
12013
*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS,
EYELIDS,NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO
5.0 CM
cohort
cohort
cohort
cohort
cohort
12014
SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE,
EARS,EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1
CM TO 7.5 CM
cohort
cohort
cohort
cohort
cohort
12015
CM TO 12.5 CM
cohort
cohort
cohort
cohort
cohort
12016
CM TO 20.0 CM
cohort
cohort
cohort
12020
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE
CLOSURE
cohort
cohort
cohort
12021
TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH
PACKING
12031
Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities
(excluding hands and feet);2.5 cm or less
cohort
cohort
cohort
cohort
cohort
12032
(excluding hands and feet);2.6 cm to 7.5 cm
cohort
cohort
cohort
cohort
cohort
cohort
12034
cohort
cohort
cohort
cohort
cohort
cohort
12035
cohort
cohort
cohort
cohort
cohort
12036
cohort
cohort
cohort
cohort
12037
(excluding hands and feet);over 30.0 cm
cohort
cohort
cohort
12041
Repair, intermediate, wounds of neck, hands, feet and/or external
genitalia; 2.5 cm or less
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
26
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
12042
genitalia; 2.6 cm to 7.5 cm
cohort
cohort
cohort
cohort
cohort
12044
cohort
cohort
cohort
cohort
cohort
cohort
12045
cohort
cohort
12046
12051
Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or
mucous membranes; 2.5 cm or less
cohort
cohort
cohort
cohort
cohort
cohort
12052
mucous membranes; 2.6 cm to 5.0 cm
cohort
cohort
cohort
cohort
cohort
cohort
12053
cohort
cohort
cohort
cohort
12054
cohort
cohort
cohort
cohort
12055
cohort
cohort
cohort
12056
13101
REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM
cohort
cohort
cohort
cohort
13102
REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS
(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
cohort
cohort
cohort
cohort
13120
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5
CM
cohort
cohort
cohort
13121
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5
CM
13122
REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS;EACH
ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITIOTO
CODE FOR PRIMARY PROCEDURE)
13131
REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH,
NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5
CM REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN,MOUTH,
NECK,
13132
NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5
CM REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN,MOUTH,
NECK,
13133
NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET;EACH
ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITON TO
PRIMARY PROCEDURE)
13150
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM
OR LESS
13151
TO 2.5 CM
13152
TO 7.5 CM
13153
REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH
ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITION TO
13160
SECONDARY CLOSURE OF SURGICAL WOUND OR
DEHISCENCE,EXTENSIVEOR COMPLICATED
cohort
cohort
cohort
cohort
14000
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK;
DEFECT 10 SQ CM OR LESS ADJACENT TISSUE TRANSFER OR
REARRANGEMENT, TRUNK; DEFECT 10
cohort
cohort
cohort
cohort
14001
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK;
DEFECT10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE
TRANSFER OR REARRANGEMENT, TRUNK; DEFECT
cohort
cohort
cohort
cohort
14020
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP,
ARMSAND/OR LEGS; DEFECT 10 SQ CM OR LESS
ADJACENTTISSUE TRANSFER OR REARRANGEMENT, SCALP,
ARMS
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
27
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
14021
ARMSAND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM
ARMS
14040
ADJACENT TISSUE TRANSFER OR REARRANGEMENT,
FOREHEAD, CHEEKS,CHIN, MOUTH, NECK, AXILLAE, GENITALIA,
HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS
14041
ADJACENT TISSUE TRANSFER OR REARRANGEMENT,
FOREHEAD, CHEEKS,CHIN, MOUTH, NECK, AXILLAE, GENITALIA,
HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM
14060
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS,
NOSE,EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS
NOSE,
cohort
cohort
14061
NOSE,EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0SQ CM
NOSE,
cohort
cohort
14301
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA;
DEFECT 30.1 SQ CM TO 60.0 SQ CM
cohort
cohort
cohort
cohort
14302
ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA;
EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
cohort
cohort
cohort
cohort
14350
FILLETED FINGER OR TOE FLAP, INCLUDING
PREPARATIONOFRECIPIENT SITE
15002
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITEBY
EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR
(INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL
RELEASE OF SCAR CONTRACTURE, TRUNK, ARMS, LEGS; FIRS
cohort
cohort
15003
Surgical preparation or creation of recipient siteby excision of open
wounds, burn eschar, or scar (including subcutaneous tissues), or
incisional release of scar contracture, trunk, arms, legs; each
cohort
cohort
15004
SURGICAL PREPARATION OR CREATION OF RECIPIENT SITEBY
EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR
(INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL
RELEASE OF SCAR CONTRACTURE, FACE, SCALP, EYELIDS, M
cohort
cohort
15100
SPLIT GRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM ORLESS,
OR ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN
(EXCEPT 15050)
cohort
15101
SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ
CM,OR EACH ADDITIONAL ONE PERCENT OF BODY AREA OF
INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY
IN ADDITION TO
15115
EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK,
EARS, ORBITS, GENITALIA, HANDS, FEET, AND/ORMULTIPLE
DIGITS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY
AREA OF INFANTS AND CHILDREN
15120
SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK,
EARS,ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE
AREA OF INFANTS
15121
SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK,
EARS,ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE
DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL
ONE PERCENT OF BODY
15130
DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM
OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTSAND
CHILDREN
15135
DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK,
EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE
AREA OF INFANTS AND CHILDREN
15200
FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE
OFDONOR SITE, TRUNK; 20 SQ CM OR LESS FULL THICKNESS
GRAFT, FREE, INCLUDING DIRECT CLOSURE OF
15220
cohort
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
28
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
OFDONOR SITE, SCALP, ARMS, AND/OR LEGS; 20 SQ CM OR
LESS FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT
CLOSURE OF
15221
Full thickness graft, free, including direct closure of donor site, scalp,
arms, and/or legs; each additional 20 sq cm, or part thereof (List
separately in addition to code for primary procedure)
15240
OFDONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQCM OR LESS
cohort
cohort
cohort
cohort
cohort
15260
OFDONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS;20 SQ CM
OR LESS
cohort
cohort
cohort
cohort
cohort
15261
Full thickness graft, free, including direct closure of donor site, nose,
ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (List
separately in addition to code for primary procedu
15271
APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS,
LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM;FIRST
25 SQ CM OR LESS WOUND SURFACE AREA
cohort
cohort
cohort
cohort
15272
LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM;EACH
ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR P ART
THEREOF (LIST SEPARATELY IN ADDITION TO CODE F
cohort
cohort
cohort
cohort
15273
LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR
EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE
AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN
cohort
cohort
cohort
cohort
15274
LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR
EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND
SURFACE AREA, OR PART THEREOF, OR EACH ADDITIONA
cohort
cohort
cohort
cohort
15275
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP,
EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS,
FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA
UP TO 100 SQ CM; FIRST 25 SQ CM OR LES
cohort
cohort
cohort
cohort
15276
APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP,
EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS,
FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA
UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ
15574
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR
WITHOUTTRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,
AXILLAE, GENITALIA, HANDS OR FEET
cohort
cohort
15576
FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR
WITHOUTTRANSFER; EYELIDS, NOSE, EARS, LIPS, OR
INTRAORAL
cohort
cohort
15600
DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET);
ATTRUNK
cohort
15610
ATSCALP, ARMS, OR LEGS
statewide
15620
ATFOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, GENITALIA,
HANDS (EXCEPT 15625), OR FEET
cohort
15630
ATEYELIDS, NOSE, EARS, OR LIPS
cohort
cohort
15650
TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG,
ABDOMEN TO WRIST, "WALKING" TUBE), ANY LOCATION
cohort
cohort
15731
FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE
(EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP)
cohort
cohort
15732
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD
AND NECK(EG, TEMPORALIS, MASSETER,
STERNOCLEIDOMASTOID, LEVATOR SCAPULAE)
cohort
15734
MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP;
TRUNK
15736
UPPEREXTREMITY
15738
statewide
29
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
LOWEREXTREMITY
15740
FLAP; ISLAND PEDICLE REQUIRING IDENTIFICATION AND
DISSECTION OF AN ANATOMICALLY NAMED AXIAL VESSEL
15760
GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR
ORNASAL ALA), INCLUDING PRIMARY CLOSURE, DONOR AREA
15770
GRAFT; DERMA-FAT-FASCIA
statewide
15776
PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH
GRAFTSPUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN15
PUNCH GRAFTS
statewide
15777
IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL
MATRIX) FOR SOFT TISSUE REINFORCEMENT (EG, BREAST,
TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
15781
Dermabrasion; segmental, face
15821
BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE
HERNIATED FATPAD
15822
BLEPHAROPLASTY, UPPER EYELID;
15823
BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN
WEIGHTING DOWN LID
15829
RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC
SYSTEM (SMAS)FLAP
15830
EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE
(INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL
PANNICULECTOMY
cohort
cohort
15839
(INCLUDING LIPECTOMY); OTHER AREA
cohort
cohort
15847
(INCLUDES LIPECTOMY), ABDOMEN (EG, ABDOMINOPLASTY)
(INCLUDES UMBILICAL TRANSPOSITION AND FASCIAL
PLICATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PR
statewide
15850
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN
LOCAL), SAMESURGEON
15851
REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN
LOCAL),OTHER SURGEON
15852
DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER
ANESTHESIA(OTHER THAN LOCAL)
15876
SUCTION ASSISTED LIPECTOMY; HEAD AND NECK
15877
SUCTION ASSISTED LIPECTOMY; TRUNK
15878
SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY
statewide
15879
SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY
statewide
15931
EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY
SUTURE;EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY
SUTURE;
15946
EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY,
INPREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR
SKIN GRAFT CLOSURE
16000
INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO
MORETHANLOCAL TREATMENT
cohort
cohort
cohort
cohort
cohort
16020
*DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR
SUBSEQUENT;WITHOUT ANESTHESIA, OFFICE OR HOSPITAL,
SMALL *DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR
SUBSEQUENT;
cohort
cohort
cohort
cohort
cohort
16025
*DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR
SUBSEQUENT;WITHOUT ANESTHESIA, MEDIUM (EG, WHOLE
FACE OR WHOLE EXTREMITY)
cohort
cohort
cohort
cohort
16030
DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS
BURNS, INITIAL OR SUBSEQUENT; LARGE (EG, MORE THAN1
EXTREMITY, OR GREATER THAN 10% TOTAL BODY SURFA CE
AREA)
cohort
cohort
cohort
17000
Destruction (eg, laser surgery, electrosurgery, cryosurgery
chemosurgery, surgical curettement), premalignant lesions (eg, actinic
keratosis) first lesion
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
30
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
17003
DESTRUCTION BY ANY METHOD, INCLUDING LASER, WITH OR
WITHOUT SURGICAL CURETTEMENT, ALL BENIGN OR
PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER
THAN SKIN TAGS OR CUTANEOUS
statewide
17004
Destruction (eg, laser surgery, electrosurgery, cryosurgery
chemosurgery, surgical curettement), premalignant lesions (eg, actinic
keratosis) 15 or more lesions
statewide
17106
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE
LESIONS (EG,LASER TECHNIQUE); LESS THAN 10 SQ CM
LESIONS (EG,
17107
LESIONS (EG,LASER TECHNIQUE); 10.0 - 50.0 SQ CM
LESIONS (EG,
cohort
17108
LESIONS (EG,LASER TECHNIQUE); OVER 50.0 SQ CM
LESIONS(EG,
statewide
17110
Destruction (e.g., laser surgery, electrosurgery, cryosurgery,
chemosurgery, surgical curettement), of benign lesions other than skin
tags or cutaneous vascular proliferative lesions; up to 14 lesions
17111
DESTRUCTION BY ANY METHOD OF FLAT WARTS,
MOLLUSCUMCONTAGIOSUM, OR MILIA; 15 OR MORE LESIONS
17250
*CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD
FLESH, SINUS OR FISTULA)
17260
*DESTRUCTION, MALIGNANT LESION, ANY METHOD,
TRUNK,ARMS ORLEGS; LESION DIAMETER 0.5 CM OR LESS *DES
TRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR
statewide
17261
DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK,
ARMS ORLEGS; LESION DIAMETER 0.6 TO 1.0 CM DESTRUCTION,
MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR
statewide
17270
*DESTRUCTION, MALIGNANT LESION, ANY METHOD,
SCALP,NECK,HANDS, FEET, GENITALIA; LESION DIAMETER 0.5
CM OR LESS *DESTRUCTION, MALIGNANT LESION, ANY METHOD,
SCALP, NECK,
statewide
17271
DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP,
NECK,HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM
DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP,
NECK,
statewide
17280
*DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE,
EARS,EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION
DIAMETER 0.5 CM OR LESS
statewide
17311
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF
ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE
SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS,
MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON,
AND H
statewide
17312
MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF
ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE
SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS,
MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON,
AND H
statewide
17340
*CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE
statewide
17999
UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND
SUBCUTANEOUSTISSUE UNLISTED PROCEDURE, SKIN, MUCOUS
MEMBRANE AND SUBCUTANEOUS
cohort
cohort
cohort
19000
*PUNCTURE ASPIRATION OF CYST OF BREAST;
cohort
cohort
cohort
19001
PUNCTURE ASPIRATION OF CYST OF BREAST; EACH
ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE
FORPRIMARY PROCEDURE)
cohort
19020
MASTOTOMY WITH EXPLORATION OR DRAINAGE OF
ABSCESS,DEEP
19030
INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM
ORGALACTOGRAM
cohort
cohort
cohort
cohort
31
cohort
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
19100
*BIOPSY OF BREAST; NEEDLE CORE (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
19101
BIOPSY OF BREAST; INCISIONAL
cohort
cohort
cohort
cohort
cohort
19102
BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE,
USINGIMAGING GUIDANCE
cohort
cohort
cohort
cohort
cohort
19103
BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM
ASSISTED OR ROTATING BIOPSY DEVICE, USING IMAGING
GUIDANCE
cohort
cohort
cohort
cohort
cohort
19110
NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A
SOLITARYLACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS
DUCT
cohort
cohort
cohort
cohort
cohort
19112
EXCISION OF LACTIFEROUS DUCT FISTULA
19120
EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN
ORMALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LES
ION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE
OR FEMALE, 1 OR MORE LESIONS
cohort
cohort
cohort
cohort
cohort
cohort
19125
EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVEPLACEMENT OF RADIOLOGICAL MARKER; SINGLE
LESION
cohort
cohort
cohort
cohort
cohort
19126
EXCISION OF BREAST LESION IDENTIFIED BY
PREOPERATIVEPLACEMENT OF RADIOLOGICAL MARKER; EACH
ADDITIONAL LESION SEPARATELY IDENTIFIED BY A
RADIOLOGICAL MARKER (LIST
cohort
cohort
cohort
cohort
19260
EXCISION OF CHEST WALL TUMOR INCLUDING RIBS
cohort
cohort
19290
PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE,
BREAST;
cohort
cohort
cohort
cohort
19291
PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE,
BREAST; EACH ADDITIONAL LESION (LIST SEPARATELY IN
ADDITION TO CODE
cohort
cohort
cohort
cohort
19295
IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP,
PERCUTANEOUS, DURING BREAST BIOPSY/ASPIRATION (LIST
cohort
cohort
cohort
cohort
19297
Placement of radiotherapy afterloading expandable catheter (single or
multichannel) into the breast for interstitial radioelement application
following partial mastectomy, includes imaging guidance; c
19298
PLACEMENT OF RADIOTHERAPY AFTERLOADING
BRACHYTHERAPY CATHETERS INTO BREAST FOR INTERSTITIAL
RADIOELEMENT APPLICATION FOLLOWING PARTIAL
MASTECTOMY, INCL IMAGING GUIDANCE
19300
MASTECTOMY FOR GYNECOMASTIA
cohort
19301
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY,
QUADRANTECTOMY, SEGMENTECTOMY);
cohort
19302
MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY,
QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY
LYMPHADENECTOMY
19303
MASTECTOMY, SIMPLE, COMPLETE
cohort
19304
MASTECTOMY, SUBCUTANEOUS
cohort
19305
MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES,
AXILLARY LYMPH NODES
19307
MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH
NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT
EXCLUDING PECTORALIS MAJOR MUSCLE
19316
MASTOPEXY
cohort
19318
REDUCTION MAMMAPLASTY
cohort
19324
MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC
IMPLANTMAMMAPLASTY, AUGMENTATION; WITHOUT
PROSTHETIC IMPLANT
19325
MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC
IMPLANTMAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC
IMPLANT
19328
REMOVAL OF INTACT MAMMARY IMPLANTREMOVAL OF
INTACTMAMMARY IMPLANT
cohort
19330
REMOVAL OF MAMMARY IMPLANT MATERIALREMOVAL OF
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
32
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
19340
IMMEDIATE INSERTION OF BREAST PROSTHESIS
FOLLOWINGMASTOPEXY, MASTECTOMY OR IN
RECONSTRUCTION IMMEDIATE INSERTION OF BREAST
PROSTHESIS FOLLOWING
cohort
cohort
cohort
cohort
cohort
cohort
19342
DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING
MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION
DELAYEDINSERTION OF BREAST PROSTHESIS FOLLOWING
MASTOPEX Y,
cohort
cohort
cohort
cohort
cohort
cohort
19350
NIPPLE/AREOLA RECONSTRUCTION
cohort
cohort
cohort
cohort
19355
CORRECTION OF INVERTED NIPPLES
19357
BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH
TISSUEEXPANDER, INCLUDING SUBSEQUENT EXPANSION
19361
Breast reconstruction with latissimus dorsi flap, without prosthetic
implant
19364
BREAST RECONSTRUCTION WITH FREE FLAP
19366
BREAST RECONSTRUCTION WITH OTHER TECHNIQUE
19367
BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS
ABDOMINISMYOCUTANEOUS FLAP(TRAM), SINGLE PEDICLE,
INCLUDING CLOSURE OF DONOR SITE;
19370
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST
19371
PERIPROSTHETIC CAPSULECTOMY, BREAST
19380
REVISION OF RECONSTRUCTED BREAST
19396
PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT
19499
UNLISTED PROCEDURE, BREAST
cohort
20005
Incision and drainage of soft tissue abscess, subfascial (ie, involves the
soft tissue below the deep fascia)
cohort
20101
EXPLORATION OF PENETRATING WOUND (SEPARATE
PROCEDURE); CHEST
20102
PROCEDURE);ABDOMEN/FLANK/BACK
cohort
20103
PROCEDURE);EXTREMITY
cohort
20200
BIOPSY, MUSCLE; SUPERFICIAL
20205
BIOPSY, MUSCLE; DEEP
cohort
20206
*BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE
20220
BIOPSY, BONE, TROCAR OR NEEDLE; SUPERFICIAL (EG,
ILIUM,STERNUM, SPINOUS PROCESS, RIBS) BIOPSY, BONE,
TROCAR OR NEEDLE; SUPERFICIAL (EG, ILIUM,
20225
BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (VERTEBRAL
BODY,FEMUR) BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP
(VERTEBRAL BODY,
20240
BIOPSY, BONE, EXCISIONAL; SUPERFICIAL (EG, ILIUM,
STERNUM,SPINOUS PROCESS, RIBS, TROCHANTER OF FEMUR)
BIOPSY, BONE, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM,
20245
BIOPSY, BONE, EXCISIONAL; DEEP (EG, HUMERUS, ISCHIUM,
FEMUR)
2028F
Foot examination performed (includes examination through visual
inspection, sensory exam with monofilament, and pulse exam - report
when any of the 3 components are completed) (DM)
20500
*INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE
PROCEDURE)
20501
*INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM)
cohort
cohort
20520
*REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH;
SIMPLE *REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON
SHEATH; SIMPLE
cohort
cohort
20525
REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH;
DEEP OR COMPLICATED REMOVAL OF FOREIGN BODY IN
MUSCLE OR TENDON SHEATH; DEEP OR
20526
INJECTION, THERAPEUTIC (LOCAL ANESTHETIC
CORTICOSTEROID); CARPAL CANAL
CPT
Description
MAMMARY IMPLANT MATERIAL
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
33
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
CPT
Description
20550
*INJECTION, TENDON SHEATH, LIGAMENT, TRIGGER POINTS
ORGANGLION CYST
cohort
20551
INJECTION; TENDON ORIGIN/INSERTION
cohort
20552
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S);1 OR 2
MUSCLE(S)
cohort
cohort
cohort
cohort
cohort
cohort
20553
INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S);3 OR
MORE MUSCLE(S)
cohort
cohort
cohort
cohort
cohort
cohort
20600
*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL
JOINT,BURSA OR GANGLION CYST (EG, FINGERS,
TOES)*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SM
ALL JOINT,
cohort
cohort
cohort
cohort
cohort
cohort
20605
*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION;
INTERMEDIATEJOINT, BURSA OR GANGLION CYST (EG,
TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW
OR ANKLE, OLECRANON BURSA)
cohort
cohort
cohort
cohort
cohort
cohort
20610
*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR
JOINT ORBURSA (EG, SHOULDER, HIP, KNEE JOINT,
SUBACROMIAL BURSA) *ARTHROCENTESIS, ASPIRATION
AND/OR INJECTION; MAJOR JOINT OR
cohort
cohort
cohort
cohort
cohort
cohort
20612
ASPIRATION &/OR INJECTION, GANGLION CYST(S) ANY
LOCATION
cohort
cohort
cohort
cohort
cohort
20615
ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST
cohort
cohort
cohort
20650
*INSERTION OF WIRE OR PIN WITH APPLICATION OF
SKELETALTRACTION, INCLUDING REMOVAL (SEPARATE
PROCEDURE) *INSERTION OF WIRE OR PIN WITH APPLICATION
OF SKELETAL
statewide
20660
Application of cranial tongs, caliper, or stereotactic frame, including
removal (separate procedure)
cohort
20661
APPLICATION OF HALO, INCLUDING REMOVAL;
CRANIALAPPLICATION OF HALO, INCLUDING REMOVAL; CRANIAL
cohort
20665
REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER
INDIVIDUAL
statewide
20670
*REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN
ORROD) (SEPARATE PROCEDURE) *REMOVAL OF IMPLANT;
SUPERFICIAL, (EG, BURIED WIRE, PIN OR
20680
REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW,
METALBAND, NAIL, ROD OR PLATE) REMOVAL OF IMPLANT; DEEP
(EG, BURIED WIRE, PIN, SCREW, METAL
20690
APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE),
UNILATERAL, EXTERNAL FIXATION SYSTEM
20692
APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORETHAN
1 PLANE), UNILATERAL, EXTERNAL FIXATION SYST EM (EG,
ILIZAROV, MONTICELLI TYPE)
20693
ADJUSTMENT OR REVISION OF EXTERNAL FIXATION
SYSTEMREQUIRINGANESTHESIA (EG, NEW PIN(S) OR WIRE(S)
AN D/OR NEW RING(S) OR BAR(S))
20694
REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION
SYSTEM
20696
APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN 1
PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC
COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME),
INCLUDING IMAGING; INITIAL AND SUBSEQU
20822
REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL
TIP TOSUBLIMIS TENDON INSERTION); COMPLETE AMPUTATION
20900
Bone graft, any donor area; minor or small (e.g., dowel or button)
20902
Bone graft, any donor area; major or large
cohort
20912
Cartilage graft; nasal septum
cohort
cohort
20924
Tendon graft, from a distance (e.g., palmaris, toeextensor, plantaris)
cohort
cohort
cohort
20926
Tissue grafts, other (e.g., paratenon, far, dermis)
cohort
cohort
cohort
cohort
cohort
20930
Allograft, morselized, or placement of osteopromotive material, for spine
surgery only (List separately in addition to code for primary procedure)
cohort
cohort
cohort
cohort
cohort
20931
Allograft, structural, for spine surgery only (List separately in addition to
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
34
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
code for primary procedure)
20936
Autograft for spine surgery only (includes harvesting the graft); local
(e.g. ribs, spinous process,or laminar fragments) obtained from the
same inci sion
20937
Autograft for spine surgery only (includes harvesting the graft);
morselized (through separate skin or fascial incision)
20938
Autograft for spine surgery only (includes harvesting the graft);
structural, bicortical or tricortical (through separate skin or fascial
incision)
20982
ABLATION, BONE TUMOR(S) (EG, OSTEOID OSTEOMA,
METASTASIS) RADIOFREQUENCY, PERCUTANEOUS, INCLUDING
COMPUTED TOMOGRAPHIC GUIDANCE
cohort
20999
UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL
cohort
21011
EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP,
SUBCUTANEOUS; LESS THAN 2 CM
21012
EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP,
SUBCUTANEOUS; 2 CM OR GREATER
21013
EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP,
SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN2
CM
21014
EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP,
SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR
GREATER
cohort
21015
RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM),
SOFT TISSUE OF FACE OR SCALP; LESS THAN 2 CM
statewide
21016
SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER
cohort
21025
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE
ABSCESS);MANDIBLE
21026
EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE
ABSCESS);FACIAL BONE(S)
21030
EXCISION OF BENIGN TUMOR OR CYST OF FACIAL BONE OTHER
THANMANDIBLE
statewide
21032
EXCISION OF MAXILLARY TORUS PALATINUS
statewide
21034
EXCISION OF MALIGNANT TUMOR OF FACIAL BONE OTHER
THANMANDIBLE
statewide
21040
EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE;
SIMPLEEXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE;
SIMPLE
21046
EXCISION, BENIGN TUMOR/CYST, MANDIBL; INTRA-ORAL
OSTEOTOMY & PARTIAL MANDIBULECTOMY
cohort
21047
EXCISION, BENIGN TUMOR/CYST, MANDIBLE: EXTRA-ORAL
OSTEOMOTY & PARTIAL MANDIBULECTOMY
statewide
21048
EXCISION, BENIGN TUMOR/CYST, MAXILLA; INTRA-ORAL
OSTEOTOMY
21060
MENISCECTOMY, PARTIAL OR COMPLETE,
TEMPOROMANDIBULAR JOINT(SEPARATE PROCEDURE)
MENISCECTOMY, PARTIAL OR COMPLETE,
TEMPOROMANDIBULAR JOINT
statewide
21070
CORONOIDECTOMY (SEPARATE PROCEDURE)
statewide
21085
IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL
SPLINTIMPRESSION AND CUSTOM PREPARATION; ORAL
SURGICAL SPLINT
21089
UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDUREUNLISTED
MAXILLOFACIAL PROSTHETIC PROCEDURE
21110
APPLICATION OF INTERDENTAL FIXATION DEVICE FOR
CONDITIONSOTHER THAN FRACTURE OR DISLOCATION,
INCLUDES REMOVAL
21120
GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT,
PROSTHETIC MATERIAL) GENIOPLASTY; AUGMENTATION
(AUTOGRAFT, ALLOGRAFT, PROSTHETIC
21121
GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE
PIECEGENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
statewide
35
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
21122
GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE
OSTEOTOMIES(EG, WEDGE EXCISION OR BONE WEDGE
REVERSAL FOR ASYMMETRICAL CHIN)
statewide
21123
GENIOPLASTY; SLIDING, AUGMENTATION WITH
INTERPOSITIONAL BONEGRAFTS (INCLUDES OBTAINING
AUTOGRAFTS) GENIOPLASTY; SLIDING, AUGMENTATION WITH
INTERPOSITIONAL BONE
statewide
21141
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE,
SEGMENTMOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE
SYNDROME), WITHOUT BONE GRAFT
21142
RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES,
SEGMENTMOVEMENT IN ANY DIRECTION, WITHOUT BONE
GRAFT RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES,
SEGMENT
21143
RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE
PIECES,SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT
BONE GRAFT RECONSTRUCTION MIDFACE, LEFORT I; THREE OR
MORE PIECES,
21145
RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE,
SEGMENTMOVEMENT IN ANY DIRECTION, REQUIRING BONE
GRAFTS (INCLUDES OBTAINING AUTOGRAFTS)
cohort
21147
RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE
PIECES,SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING
BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) (EG,
UNGRAFTED BILATERAL
cohort
21181
RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF
CRANIALBONES (EG, FIBROUS DYSPLASIA), EXTRACRANIAL
21196
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY,
SAGITTALSPLIT; WITH INTERNAL RIGID FIXATION
RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY,
SAGITTAL
cohort
21198
OSTEOTOMY, MANDIBLE, SEGMENTALOSTEOTOMY,
MANDIBLE,SEGMENTAL
statewide
21210
GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS
(INCLUDESOBTAINING GRAFT)
statewide
21215
GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT)
cohort
21230
GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE
OR EAR(INCLUDES OBTAINING GRAFT)
21235
GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR
(INCLUDESOBTAINING GRAFT)
21240
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR
WITHOUTAUTOGRAFT (INCLUDES OBTAINING GRAFT)
ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR
WITHOUT
21244
RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH
TRANSOSTEAL BONEPLATE (EG, MANDIBULAR STAPLE BONE
PLATE)RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH
TRAN SOSTEAL BONE
21246
RECONSTRUCTION OF MANDIBLE OR MAXILLA,
SUBPERIOSTEALIMPLANT; COMPLETE RECONSTRUCTION OF
MANDIBLE ORMAXILLA, SUBPERIOSTEAL
21282
LATERAL CANTHOPEXY
21299
UNLISTED CRANIOFACIAL AND MAXILLOFACIAL
PROCEDUREUNLISTED CRANIOFACIAL AND MAXILLOFACIAL
PROCEDURE
21315
*CLOSED TREATMENT OF NASAL BONE FRACTURE;
WITHOUTSTABILIZATION *CLOSED TREATMENT OF NASAL BONE
FRACTURE; WITHOUT
21320
CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH
STABILIZATION CLOSED TREATMENT OF NASAL BONE
FRACTURE;WITH STABILIZATION
21325
OPEN TREATMENT OF NASAL FRACTURE;
UNCOMPLICATEDOPEN TREATMENT OF NASAL FRACTURE;
UNCOMPLICATED
21330
Peer
Cohort
6
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH
36
statewide
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
INTERNALAND/OR EXTERNAL SKELETAL FIXATION OPEN
TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH
INTERNAL
21335
OPEN TREATMENT OF NASAL FRACTURE; WITH
CONCOMITANTOPENTREATMENT OF FRACTURED SEPTUM
OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT
OPEN
cohort
cohort
cohort
21336
OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR
WITHOUTSTABILIZATION OPEN TREATMENT OF NASAL SEPTAL
FRACTURE, WITH OR WITHOUT
cohort
cohort
cohort
21337
CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH
ORWITHOUTSTABILIZATION CLOSED TREATMENT OF NASAL S
EPTAL FRACTURE, WITH OR WITHOUT
cohort
cohort
cohort
21343
OPEN TREATMENT OF DEPRESSED FRONTAL SINUS
FRACTUREOPEN TREATMENT OF DEPRESSED FRONTAL SINUS
FRACTURE
statewide
21346
OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE
(LEFORT II TYPE); WITH WIRING AND/OR LOCAL FIXATIONOPEN
TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT
II
statewide
21347
(LEFORT II TYPE); REQUIRING MULTIPLE OPEN APPROACHES
(LEFORT II
21355
*PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR
AREA,INCLUDINGZYGOMATIC ARCH AND MALAR TRIPOD, WITH
MA NIPULATION *PERCUTANEOUS TREATMENT OF FRACTURE
OFMALAR AREA, INCLUDING
21356
OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH
FRACTURE (EG,GILLIES APPROACH) OPEN TREATMENT OF
DEPRESSED ZYGOMATIC ARCH FRACTURE (EG,
cohort
21360
OPEN TREATMENT OF DEPRESSED MALAR FRACTURE,
INCLUDINGZYGOMATIC ARCH AND MALAR TRIPOD OPEN
TREATMENTOF DEPRESSED MALAR FRACTURE, INCLUDING
cohort
21365
OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR
INVOLVINGCRANIAL NERVE FORAMINA) FRACTURE(S) OF MALAR
AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD; WITH
INTERNAL FIXATION AND
cohort
21386
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT"
FRACTURE;PERIORBITAL APPROACH OPEN TREATMENT OF
ORBITAL FLOOR "BLOWOUT" FRACTURE;
21390
OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT"
FRACTURE;PERIORBITAL APPROACH, WITH ALLOPLASTIC OR
OTHER IMPLANT OPEN TREATMENT OF ORBITAL FLOOR
"BLOWOUT" FRACTURE;
cohort
21406
OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT;
WITHOUTIMPLANT OPEN TREATMENT OF FRACTURE OF ORBIT,
EXCEPT BLOWOUT; WITHOUT
cohort
21421
CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE
(LEFORT I TYPE), WITH INTERDENTAL WIRE FIXATION
ORFIXATION OF DENTURE OR SPLINT
21422
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE
(LEFORT ITYPE); OPEN TREATMENT OF PALATAL OR MAXILLARY
FRACTURE (LEFORT I
21423
OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE
(LEFORT ITYPE); COMPLICATED (COMMINUTED OR
INVOLVINGCRANIAL NERVE FORAMINA), MULTIPLE
APPROACHES
cohort
21440
CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY
ALVEOLAR RIDGEFRACTURE (SEPARATE PROCEDURE) CLOSED
TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE
statewide
21451
CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH
MANIPULATIONCLOSED TREATMENT OF MANDIBULAR
FRACTURE; WITH MANIPULATION
21452
PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE,
WITH EXTERNALFIXATION PERCUTANEOUS TREATMENT OF
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
37
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
MANDIBULAR FRACTURE, WITH EXTERNAL
21453
CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH
INTERDENTALFIXATION CLOSED TREATMENT OF MANDIBULAR
FRACTURE WITH INTERDENTAL
21461
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT
INTERDENTALFIXATION OPEN TREATMENT OF MANDIBULAR
FRACTURE; WITHOUT INTERDENTAL
21462
OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH
INTERDENTALFIXATION OPEN TREATMENT OF MANDIBULAR
FRACTURE; WITH INTERDENTAL
21465
OPEN TREATMENT OF MANDIBULAR CONDYLAR
FRACTUREOPENTREATMENT OF MANDIBULAR CONDYLAR
FRACTURE
21470
OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE
BYMULTIPLE SURGICAL APPROACHES INCLUDING INTERNAL
FIXATION, INTERDENTAL FIXATION, AND/OR WIRING OF
DENTURES OR SPLINTS
21480
CLOSED TREATMENT OF TEMPOROMANDIBULAR
DISLOCATION;INITIALOR SUBSEQUENT CLOSED TREATMENT OF
TEMPORO MANDIBULAR DISLOCATION; INITIAL
21497
INTERDENTAL WIRING, FOR CONDITION OTHER THAN
FRACTURE
21499
UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD
21501
INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA,
SOFTTISSUES OF NECK OR THORAX; INCISION AND DRAINAGE,
DEEP ABSCESS OR HEMATOMA, SOFT
21550
BIOPSY, SOFT TISSUE OF NECK OR THORAX
21552
EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR
THORAX, SUBCUTANEOUS; 3 CM OR GREATER
21554
THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR
GREATER
21555
THORAX, SUBCUTANEOUS; LESS THAN 3 CM
21556
THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5CM
21557
SOFT TISSUE OF NECK OR ANTERIOR THORAX; LESS THAN 5 CM
cohort
21600
EXCISION OF RIB, PARTIAL
21627
STERNAL DEBRIDEMENT
21685
HYOID MYOTOMY AND SUSPENSION
statewide
21720
DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS,
OPENOPERATION; WITHOUT CAST APPLICATION
statewide
21800
CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED,
EACHCLOSED TREATMENT OF RIB FRACTURE,
UNCOMPLICATED, EACH
21899
UNLISTED PROCEDURE, NECK OR THORAX
cohort
21920
BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL
cohort
21925
BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP
statewide
21930
EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK,
cohort
cohort
cohort
cohort
21931
cohort
cohort
cohort
cohort
21932
SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
cohort
cohort
cohort
cohort
21933
SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
cohort
cohort
cohort
cohort
21936
SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER
22102
PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT
(EG,SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC
BONY LESION, SINGLE VERTEBRAL SEGMENT; LUMBAR
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
38
cohort
cohort
cohort
cohort
statewide
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
CPT
Description
22114
PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC
BONYLESION, WITHOUT DECOMPRESSION OF SPINAL CORD OR
NERVE ROOT(S), SINGLE VERTEBRAL SEGMENT; LUMBAR
22318
OPEN TREATMENT AND/OR REDUCTION OF ODONTOID
FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS
ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING
PLACEMENT OF INTERNAL FIXATION; WITHOUT GRAFTING
22520
PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED
WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR
BILATERAL INJECTION; THORACIC
cohort
22521
BILATERAL INJECTION; LUMBAR
cohort
22522
BILATERAL INJECTION; EACH ADDITIONAL THORACIC OR
LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION T
22523
PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING
CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY
INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE,
1VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATI
22524
22525
22548
ARTHRODESIS, ANTERIOR TRANSORAL OR EXTRAORAL
TECHNIQUE,CLIVUS-C1-C2 (ATLAS-AXIS), WITH OR WITHOUT
EXCISION OF ODONTOID PROCESS
22551
Arthrodesis, anterior interbody, including disc space preparation,
discectomy, osteophytectomy and decompression of spinal cord and/or
nerve roots; cervical below C2
22552
Arthrodesis, anterior interbody, including disc space preparation,
discectomy, osteophytectomy and decompression of spinal cord and/or
nerve roots; cervical below C2, each additional interspace (List
22554
ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING
MINIMALDISKECTOMY TO PREPARE INTERSPACE (OTHER THAN
FOR DECOMPRESSION); CERVICAL BELOW C2
22558
FOR DECOMPRESSION); LUMBAR
22565
ADDED DURING FEE SCHEDULE LOAD PROCESS
22585
FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST
SEPARATELY
cohort
22600
ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE,
SINGLELEVEL; CERVICAL BELOW C2 SEGMENT
cohort
cohort
22612
SINGLE LEVEL; LUMBAR (WITH LATERAL TRANSVERSE
TECHNIQUE, WHEN PERFORMED)
cohort
cohort
22614
SINGLELEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST
cohort
cohort
22630
ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE,
SINGLEINTERSPACE; LUMBAR
cohort
22633
ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL
TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE
INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT
TO PREPARE INTERSPACE (OTHER THAN FOR
DECOMPRESSION),
cohort
22830
EXPLORATION OF SPINAL FUSION
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
39
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
22840
POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG,
HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1
INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW
FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION)
22842
Posterior segmental instrumentation (e.g., pediclefixation, dual rods with
multiple hooks and subla minar wires); 3 to 6 vertebral segments
22845
Anterior instrumentation; 2 to 3 vertebral segments
cohort
cohort
22846
Anterior instrumentation; 4 to 7 vertebral segments
cohort
cohort
22849
REINSERTION OF SPINAL FIXATION DEVICEREINSERTION OF
SPINAL FIXATION DEVICE
statewide
22850
REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION
(EG,HARRINGTON ROD) REMOVAL OF POSTERIOR
NONSEGMENTAL INSTRUMENTATION (EG,
cohort
cohort
22851
Application of intervertebral biomechanical device(s) (eg, synthetic
cage(s), methylmethacrylate) tovertebral defect or interspace (List
separately i n addition to code for primary procedure)
cohort
cohort
22852
REMOVAL OF POSTERIOR SEGMENTAL
INSTRUMENTATIONREMOVAL OF POSTERIOR SEGMENTAL
INSTRUMENTATION
cohort
cohort
22855
REMOVAL OF ANTERIOR INSTRUMENTATIONREMOVAL OF
ANTERIOR INSTRUMENTATION
cohort
22899
UNLISTED PROCEDURE, SPINEUNLISTED PROCEDURE, SPINE
cohort
cohort
cohort
22900
EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL,
cohort
cohort
cohort
cohort
22901
cohort
cohort
cohort
22902
cohort
cohort
cohort
cohort
22903
cohort
cohort
cohort
cohort
22905
SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER
cohort
22999
UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL
SYSTEM
cohort
cohort
cohort
23000
REMOVAL OF SUBDELTOID (OR INTRATENDINOUS)
CALCAREOUSDEPOSITS, ANY METHOD
cohort
cohort
23020
CAPSULAR CONTRACTURE RELEASE (EG, SEVER TYPE
PROCEDURE)
cohort
cohort
23030
INCISION AND DRAINAGE, SHOULDER AREA; DEEP
ABSCESSORHEMATOMA
23044
ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR
JOINT,INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL
OFFOREIGN BODY ARTHROTOMY, ACROMIOCLAVICULAR, STE
RNOCLAVICULAR JOINT,
23065
BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL
23071
EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA,
cohort
cohort
cohort
cohort
cohort
23073
cohort
cohort
cohort
cohort
cohort
cohort
23075
cohort
cohort
cohort
23076
cohort
cohort
cohort
23120
CLAVICULECTOMY; PARTIAL
cohort
cohort
cohort
cohort
cohort
23130
ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR
WITHOUTCORACOACROMIAL LIGAMENT RELEASE
cohort
cohort
cohort
cohort
cohort
23140
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN
TUMOROFCLAVICLE OR SCAPULA;
cohort
cohort
23150
TUMOROFPROXIMAL HUMERUS;
statewide
23156
TUMOROFPROXIMAL HUMERUS; WITH ALLOGRAFT
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
40
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
CPT
Description
23200
RADICAL RESECTION OF TUMOR; CLAVICLE
23330
REMOVAL OF FOREIGN BODY, SHOULDER;
SUBCUTANEOUSREMOVAL OF FOREIGN BODY, SHOULDER;
SUBCUTANEOUS
23331
REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG,
NEERHEMIARTHROPLASTY REMOVAL) REMOVAL OF FOREIGN
BODY,SHOULDER; DEEP (EG, NEER
23350
INJECTION PROCEDURE FOR SHOULDER ARTHROGRAPHY
cohort
23395
MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM;
SINGLE
cohort
23405
TENOTOMY, SHOULDER AREA; SINGLE TENDON
23410
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG,
ROTATOR CUFF);ACUTE
23412
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG,
ROTATOR CUFF);CHRONIC
23415
CORACOACROMIAL LIGAMENT RELEASE, WITH OR
WITHOUTACROMIOPLASTY
23420
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR)
CUFFAVULSION,CHRONIC (INCLUDES ACROMIOPLASTY)
23430
TENODESIS OF LONG TENDON OF BICEPS
23440
RESECTION OR TRANSPLANTATION OF LONG TENDON OF
BICEPS
statewide
23450
CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE
ORMAGNUSON TYPE OPERATION
cohort
23455
CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG,
BANKARTPROCEDURE)
cohort
23460
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK
23462
CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID
PROCESSTRANSFER
cohort
cohort
23465
CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH
ORWITHOUT BONE BLOCK
cohort
cohort
23466
CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPEMULTIDIRECTIONAL INSTABILITY
cohort
cohort
23470
ARTHROPLASTY, GLENOHUMERAL JOINT;
HEMIARTHROPLASTYARTHROPLASTY, GLENOHUMERAL JOINT;
HEMIARTHROPLASTY
cohort
cohort
cohort
23472
ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER
(GLENOIDAND PROXIMAL HUMERAL REPLACEMENT (EG,
TOTALSHOULDER)) ARTHROPLASTY, GLENOHUMERAL JOINT;
TOT AL SHOULDER (GLENOID
cohort
cohort
cohort
23474
REVISION OF TOTAL SHOULDER ARTHROPLASTY,
INCLUDINGALLOGRAFT WHEN PERFORMED; HUMERAL AND
GLENOID COM PONENT
23480
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL
FIXATION;
23485
OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL
FIXATION; WITHBONE GRAFT FOR NONUNION OR MALUNION
(INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION)
23500
CLOSED TREATMENT OF CLAVICULAR FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF CLAVICULAR
FRACTURE; WITHOUT
23505
CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH
MANIPULATIONCLOSED TREATMENT OF CLAVICULAR
23515
Open treatment of clavicular fracture, includes internal fixation when
performed
23525
CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION;
WITHMANIPULATION CLOSED TREATMENT OF
STERNOCLAVICULAR DISLOCATION; WITH
23530
OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION,
ACUTE ORCHRONIC; OPEN TREATMENT OF
STERNOCLAVICULARDISLOCATION, ACUTE OR
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
41
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
23540
CLOSED TREATMENT OF ACROMIOCLAVICULAR
DISLOCATION;WITHOUTMANIPULATION CLOSED TREATMENT OF
ACROMIOC LAVICULAR DISLOCATION; WITHOUT
23545
CLOSED TREATMENT OF ACROMIOCLAVICULAR
DISLOCATION;WITHMANIPULATION CLOSED TREATMENT OF
ACROMIOCLAV ICULAR DISLOCATION; WITH
23550
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION,
ACUTE ORCHRONIC; OPEN TREATMENT OF
ACROMIOCLAVICULAR DISLOCATION, ACUTE OR
cohort
cohort
cohort
cohort
cohort
23552
OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION,
ACUTE ORCHRONIC; WITH FASCIAL GRAFT (INCLUDES
OBTAINING GRAFT) OPEN TREATMENT OF
ACROMIOCLAVICULAR DISLOCATION, ACUTE OR
cohort
cohort
cohort
cohort
cohort
23585
Open treatment of scapular fracture (body, glenoidor acromion) includes
internal fixation, when per formed
cohort
cohort
23600
CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR
ANATOMICALNECK) FRACTURE; WITHOUT MANIPULATION
ANATOMICAL
cohort
23605
ANATOMICALNECK) FRACTURE; WITH MANIPULATION, WITH OR
WITHOUT SKELETAL TRACTION
cohort
cohort
cohort
cohort
23615
Open treatment of proximal humeral (surgical or anatomical neck)
fracture, includes internal fixation when performed, includes repair of
tuberosity(s)when performed;
cohort
cohort
cohort
cohort
cohort
23630
Open treatment of greater humeral tuberosity fracture, includes internal
fixation when performed
cohort
cohort
cohort
cohort
cohort
23650
CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH
MANIPULATION;WITHOUT ANESTHESIA CLOSED TREATMENT OF
SHOULDER DISLOCATION, WITH MANIPULATION;
cohort
cohort
cohort
cohort
cohort
23655
MANIPULATION;REQUIRING ANESTHESIA CLOSED TREATMENT
OF SHOULDER DISLOCATION, WITH MANIPULATION;
cohort
cohort
cohort
cohort
cohort
23660
OPEN TREATMENT OF ACUTE SHOULDER DISLOCATIONOPEN
TREATMENT OF ACUTE SHOULDER DISLOCATION
23665
FRACTURE OFGREATER HUMERAL TUBEROSITY, WITH
MANIPULATION CLOSED TREATMENT OF SHOULDER
DISLOCATION, WITH FRACTURE OF
23670
Open treatment of shoulder dislocation, with fracture of greater humeral
tuberosity, includes internal fixation when performed
23675
SURGICAL ORANATOMICAL NECK FRACTURE, WITH
MANIPULATION CLOSED TREATMENT OF SHOULDER
DISLOCATION, WITH SURGICAL OR
23680
Open treatment of shoulder dislocation, with surgical or anatomical neck
fracture, includes internalfixation when performed
23700
*MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT,
INCLUDINGAPPLICATION OF FIXATION APPARATUS
(DISLOCATION EXCLUDED)
cohort
cohort
cohort
cohort
cohort
23929
UNLISTED PROCEDURE, SHOULDER
cohort
cohort
cohort
cohort
cohort
23930
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP
ABSCESSOR HEMATOMA
statewide
23931
INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA
cohort
cohort
24000
ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE,
ORREMOVAL OF FOREIGN BODY ARTHROTOMY, ELBOW,
INCLUDING EXPLORATION, DRAINAGE, OR
24006
ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR
CAPSULARRELEASE (SEPARATE PROCEDURE)
24065
BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA;
SUPERFICIAL
24071
EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR
ELBOWAREA, SUBCUTANEOUS; 3 CM OR GREATER
24073
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
42
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
ELBOWAREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GRE
ATER
24075
ELBOWAREA, SUBCUTANEOUS; LESS THAN 3 CM
cohort
24076
ELBOWAREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5
CM
cohort
24079
SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM
ORGREATER
24101
ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH
ORWITHOUTBIOPSY, WITH OR WITHOUT REMOVAL ARTHROTOM
Y, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT
24102
ARTHROTOMY, ELBOW; WITH SYNOVECTOMY
24105
EXCISION, OLECRANON BURSA
24110
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR,
HUMERUS;
24120
EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF
HEADOR NECK OF RADIUS OR OLECRANON PROCESS;
24130
EXCISION, RADIAL HEAD
24140
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION,
ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), HUMERUS
cohort
cohort
24147
ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS),
OLECRANONPROCESS
cohort
cohort
24149
RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND
HETEROTOPICBONE, ELBOW, WITH CONTRACTURE RELEASE
24155
RESECTION OF ELBOW JOINT (ARTHRECTOMY)
24200
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW
AREA;SUBCUTANEOUS REMOVAL OF FOREIGN BODY, UPPER
ARM ORELBOW AREA;
statewide
24201
REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA;
DEEP(SUBFASCIAL OR INTRAMUSCULAR) REMOVAL OF FOREIGN
BODY, UPPER ARM OR ELBOW AREA; DEEP
statewide
24220
INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY
cohort
24300
MANIPULATION, ELBOW, UNDER ANESTHESIA
cohort
24301
MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR
ELBOW,SINGLE (EXCLUDING 24320-24331)
statewide
24305
TENDON LENGTHENING, UPPER ARM OR ELBOW, EACH TENDON
statewide
24310
TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH
TENDONTENOTOMY, OPEN, ELBOW TO SHOULDER, EACH
TENDON
24320
TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT
FREEGRAFT, ELBOW TO SHOULDER, SINGLE (SEDDONBROOKES TYPE PROCEDURE)
24331
FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE
ADVANCEMENT); WITH EXTENSOR ADVANCEMENT
24340
TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
cohort
24341
REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW,
EACHTENDON ORMUSCLE, PRIMARY OR SECONDARY
(EXCLUDES R OTATOR CUFF)
cohort
cohort
cohort
cohort
cohort
cohort
24342
REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON,
DISTAL,WITH OR WITHOUT TENDON GRAFT
cohort
cohort
cohort
cohort
cohort
cohort
24343
REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW,
W/LOCALTISSUE
cohort
cohort
cohort
24344
RECONSTRUCTION LATERAL COLLATERAL LIGAMENT ELBOW,
W/TENDON GRAFT W/HARVESTING, GRAFT
cohort
cohort
24345
REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, W/LOCAL
TISSUE
24346
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT ELBOW,
43
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
W/TENDON GRAFT W/HARVESTING, GRAFT
24357
Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow,
golfer's elbow); percutaneous
24358
golfer's elbow); debridement,soft tissue and/or bone, open
cohort
cohort
cohort
cohort
cohort
24359
golfer's elbow); debridement,soft tissue and/or bone, open with tendon
repair or reattachment
cohort
cohort
cohort
cohort
cohort
24360
ARTHROPLASTY, ELBOW; WITH MEMBRANE (EG, FASCIAL)
cohort
24363
ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND
PROXIMAL ULNAR PROSTHETIC REPLACEMENT (EG, TOTAL
ELBOW)
statewide
24365
ARTHROPLASTY, RADIAL HEAD;
24366
ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT
24400
OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION
24430
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT
GRAFT (EG, COMPRESSION TECHNIQUE)
24435
REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR
OTHERAUTOGRAFT (INCLUDES OBTAINING GRAFT)
24500
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF HUMERAL
SHAFT FRACTURE; WITHOUT
24505
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE;
WITHMANIPULATION, WITH OR WITHOUT SKELETAL TRACTION
CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH
24515
OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH
PLATE/SCREWS, WITH OR WITHOUT CERCLAGE OPEN
TREATMENTOF HUMERAL SHAFT FRACTURE WITH
PLATE/SCREWS,
cohort
24516
OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH
INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT
CERCLAGE AND/OR LOCKING SCREWS
cohort
24530
CLOSED TREATMENT OF SUPRACONDYLAR OR
TRANSCONDYLARHUMERALFRACTURE, WITH OR WITHOUT
INTERCONDYLAR EX TENSION; WITHOUT MANIPULATION
cohort
24535
CLOSED TREATMENT OF SUPRACONDYLAR OR
TRANSCONDYLARHUMERALFRACTURE, WITH OR WITHOUT
INTERCONDYLAR EX TENSION; WITH MANIPULATION, WITH OR
WITHOUT SKIN OR SKELETAL TRACTION
24538
PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR
ORTRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT
INTERCONDYLAR EXTENSION
cohort
cohort
cohort
cohort
24545
Open treatment of humeral supracondylar or transcondylar fracture,
includes internal fixation when performed; without intercondylar
extension
cohort
cohort
cohort
cohort
24546
Open treatment of humeral supracondylar or transcondylar fracture,
includes internal fixation when performed; with intercondylar extension
cohort
cohort
cohort
24560
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE,
MEDIAL OR LATERAL; WITHOUT MANIPULATION CLOSED
TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL
OR
24565
CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE,
MEDIAL OR LATERAL; WITH MANIPULATION CLOSED TREATMENT
OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR
24575
Open treatment of humeral epicondylar fracture, medial or lateral,
includes internal fixation when performed
cohort
24576
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE,
MEDIAL ORLATERAL; WITHOUT MANIPULATION CLOSED
TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR
cohort
24577
CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE,
MEDIAL ORLATERAL; WITH MANIPULATION CLOSED
TREATMENTOF HUMERAL CONDYLAR FRACTURE, MEDIAL OR
24579
Open treatment of humeral condylar fracture, medial, or lateral, includes
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
44
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
internal fixation when performed
24582
PERCUTANEOUS SKELETAL FIXATION OF HUMERAL
CONDYLARFRACTURE,MEDIAL OR LATERAL, WITH
MANIPULATION PE RCUTANEOUS SKELETAL FIXATION OF
HUMERAL CONDYLAR FRACTURE,
24586
OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR
DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUMERUS
AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS);
24600
TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT
ANESTHESIATREATMENT OF CLOSED ELBOW DISLOCATION;
WITHOUT ANESTHESIA
24605
TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING
ANESTHESIA TREATMENT OF CLOSED ELBOW DISLOCATION;
REQUIRING ANESTHESIA
24620
CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE
DISLOCATIONAT ELBOW (FRACTURE PROXIMAL END OF ULNA
WITH DISLOCATION OF RADIAL HEAD), WITH MANIPULATION
24635
Open treatment of Monteggia type of fracture dislocation at elbow
(fracture proximal end of ulna with dislocation of radial head), includes
24640
*CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN
CHILD,"NURSEMAID ELBOW", WITH MANIPULATION *CLOSED
TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD,
24650
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF RADIAL HEAD
OR NECK FRACTURE; WITHOUT
24655
CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE;
WITHMANIPULATION CLOSED TREATMENT OF RADIAL HEAD OR
NECK FRACTURE; WITH
cohort
24665
Open treatment of radial head or neck fracture, includes internal fixation
or radial head excision, when performed;
24666
Open treatment of radial head or neck fracture, includes internal fixation
or radial head excision, when performed; with radial head prosthetic
replacement
24670
Closed treatment of ulnar fracture, proximal end (e.g., olecranon or
coronoid process[es]); without manipulation
24675
Closed treatment of ulnar fracture, proximal end (e.g., olecranon or
coronoid process[es]); with manipulation
24685
Open treatment of ulnar fracture, proximal end (e.g., olecranon or
coronoid process[es]), includes internal fixation when performed
24999
UNLISTED PROCEDURE, HUMERUS OR ELBOW
25000
INCISION, EXTENSOR TENDON SHEATH, WRIST (EG,
DEQUERVAIN'SDISEASE)
25001
INCISION, FLEXOR TENDON SHEATH, WRIST (FLEXOR CARPI
RADIALIS)
statewide
25020
DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST;
FLEXOR OREXTENSOR COMPARTMENT
statewide
25024
DECOMPRES FASCIOTOMY, FOREARM &/OR WRIST, FLEXOR &
EXTENSOR COMPART; W/O DEBRIDE NONV MUSCLE/NERV
25028
INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP
ABSCESS ORHEMATOMA
25035
INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST
(EG,OSTEOMYELITIS OR BONE ABSCESS)
25040
ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT,
WITHEXPLORATION, DRAINAGE, ARTHROTOMY, RADIOCARPAL
OR MIDCARPAL JOINT, WITH
25071
EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST
AREA, SUBCUTANEOUS; 3 CM OR GREATER
25073
AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 3 CM OR GREATER
25075
AREA, SUBCUTANEOUS; LESS THAN 3 CM
25076
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
45
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN3 CM
25077
SOFT TISSUE OF FOREARM AND/OR WRIST AREA; LESS THAN 3
CM
25085
CAPSULOTOMY, WRIST (EG, CONTRACTURE)
25100
ARTHROTOMY, WRIST JOINT; WITH BIOPSY
25101
ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH
ORWITHOUT BIOPSY, WITH OR WITHOUT REMOVAL BODY
25105
ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY
25107
ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR
OFTRIANGULAR CARTILAGE, COMPLEX
25110
EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR
WRIST
cohort
25111
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY
cohort
25112
EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR);
RECURRENT
25115
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR
FOREARMTENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS,
TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS);
FLEXORS
25116
RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR
FOREARMTENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS,
TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS);
EXTENSORS, WITH OR
25118
SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST,
SINGLECOMPARTMENT;
25120
RADIUSOR ULNA (EXCLUDING HEAD OR NECK OF RADIU S AND
OLECRANON PROCESS);
cohort
25126
RADIUSOR ULNA (EXCLUDING HEAD OR NECK OF RADIU S AND
OLECRANON PROCESS); WITH ALLOGRAFT
statewide
25130
CARPALBONES;
25135
CARPALBONES; WITH AUTOGRAFT (INCLUDES OBTAININ G
GRAFT)
statewide
25150
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION
ORDIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); ULNA
statewide
25151
PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION
ORDIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS);
RADIUS
cohort
cohort
25210
CARPECTOMY; 1 BONE
cohort
cohort
25215
CARPECTOMY; ALL BONES OF PROXIMAL ROW
cohort
cohort
25230
RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE)
cohort
cohort
cohort
25240
EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH
TYPEOR MATCHED RESECTION)
cohort
cohort
cohort
25246
INJECTION PROCEDURE FOR WRIST ARTHROGRAPHY
cohort
cohort
cohort
25248
EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY,
FOREARM ORWRIST EXPLORATION WITH REMOVAL OF DEEP
FOREIGN BODY, FOREARM OR
statewide
25259
MANIPULATION, WRIST, UNDER ANESTHESIA
cohort
25260
REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR
WRIST;PRIMARY, SINGLE, EACH TENDON OR MUSCLE
25263
WRIST;SECONDARY, SINGLE, EACH TENDON OR MUSCLE
25265
WRIST;SECONDARY, WITH FREE GRAFT (INCLUDES OBTAINING
GRAFT), EACH TENDON OR MUSCLE
25270
REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM
AND/ORWRIST;PRIMARY, SINGLE, EACH TENDON OR MUSCLE
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
46
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
CPT
Description
25275
REPAIR, TENDON SHEATH, EXTENSOR FOREARM &/OR
WRISTW/FREE GRAFT
cohort
cohort
cohort
25280
LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR
TENDON,FOREARM AND/OR WRIST, SINGLE, EACH TENDON
cohort
cohort
cohort
25290
TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON,
FOREARMAND/ORWRIST, SINGLE, EACH TENDON TENOTOMY,
OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR
cohort
cohort
cohort
cohort
25295
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR
WRIST, SINGLE, EACH TENDON
cohort
cohort
cohort
25310
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR
EXTENSOR,FOREARM AND/OR WRIST, SINGLE; EACH TENDON
cohort
cohort
cohort
25312
TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR
EXTENSOR,FOREARM AND/OR WRIST, SINGLE; WITH TENDON
GRAFT(S) (INCLUDES OBTAINING GRAFT), EACH TENDON
cohort
cohort
cohort
25316
FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY,
VOLKMANNCONTRACTURE), FOREARM AND/OR WRIST; WITH
TENDON(S) TRANSFER
cohort
cohort
25320
CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, ANY
METHOD (EG,CAPSULODESIS, LIGAMENT REPAIR, TENDON
TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY,
CAPSULOTOMY AND OPEN REDUCTION) FOR
25332
ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION,
WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION
25337
RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL
ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT
TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON
GRAFT OR WEAVE,
25360
OSTEOTOMY; ULNA
25365
OSTEOTOMY; RADIUS AND ULNA
25390
OSTEOPLASTY, RADIUS OR ULNA; SHORTENING
25391
OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH
AUTOGRAFT
25400
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA;
WITHOUTGRAFT (EG, COMPRESSION TECHNIQUE)
cohort
25405
REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH
ILIACOR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT)
cohort
25415
REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA;
WITHOUTGRAFT (EG, COMPRESSION TECHNIQUE)
25425
REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA
25431
REPAIR, NONUNION, CARPAL BONE (EXCLUDING CARPAL
SCAPHOID) W/GRAFT, EACH BONE
25440
REPAIR OF NONUNION, SCAPHOID (NAVICULAR) BONE, WITH
ORWITHOUT RADIAL STYLOIDECTOMY (INCLUDES OBTAINING
GRAFT AND NECESSARY FIXATION)
25445
ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM
25447
ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR
CARPOMETACARPAL JOINTS
25500
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF RADIAL
SHAFT FRACTURE; WITHOUT
25505
CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH
MANIPULATIONCLOSED TREATMENT OF RADIAL SHAFT
cohort
cohort
cohort
cohort
25515
Open treatment of radial shaft fracture, includes internal fixation when
performed
cohort
cohort
cohort
cohort
25525
performed, and closed treatment of distal radioulnar joint dislocation
(Galeazzi fracture/ dislocation), includes percutaneous
cohort
cohort
25526
performed and open treatment of distal radioulnar joint dislocation
(Galeazzifracture/ dislocation), includes internal fixatio
cohort
cohort
cohort
25530
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF ULNAR SHAFT
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
47
Peer
Cohort
2
Peer
Cohort
3
25535
CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH
MANIPULATION CLOSED TREATMENT OF ULNAR SHAFT
cohort
cohort
25545
Open treatment of ulnar shaft fracture, includes internal fixation when
performed
cohort
cohort
cohort
25560
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT
FRACTURES;WITHOUT MANIPULATION CLOSED TREATMENT OF
RADIAL AND ULNAR SHAFT FRACTURES;
cohort
cohort
cohort
25565
CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT
FRACTURES; WITHMANIPULATION CLOSED TREATMENT OF
RADIAL AND ULNAR SHAFT FRACTURES; WITH
cohort
cohort
cohort
cohort
cohort
25574
Open treatment of radial AND ulnar shaft fractures, with internal fixation
when performed; of radiusOR ulna
cohort
cohort
cohort
cohort
25575
Open treatment of radial AND ulnar shaft fractures, with internal fixation
when performed; of radiusAND ulna
cohort
cohort
cohort
cohort
cohort
25600
Closed treatment of distal radial fracture (eg, Colles or Smith type) or
epiphyseal separation includes closed treatment of fracture of ulnar
styloid when performed; without manipulation
cohort
cohort
cohort
cohort
cohort
25605
CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG,
COLLES ORSMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR
WITHOUT FRACTURE OF ULNAR STYLOID; WITH MANIPULATION
cohort
cohort
cohort
cohort
cohort
25606
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL
FRACTURE OR EPIPHYSEAL SEPARATION
cohort
cohort
cohort
cohort
cohort
25607
OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR
FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL
FIXATION
cohort
cohort
cohort
cohort
cohort
cohort
25608
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR
FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL
FIXATION OF 2 FRAGMENTS
cohort
cohort
cohort
cohort
cohort
cohort
25609
OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR
FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL
FIXATION OF 3 OR MORE FRAGMENTS
cohort
cohort
cohort
cohort
cohort
cohort
25622
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR)
FRACTURE;WITHOUT MANIPULATION CLOSED TREATMENT OF
CARPAL SCAPHOID (NAVICULAR) FRACTURE;
cohort
cohort
25624
CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR)
FRACTURE;WITH MANIPULATION CLOSED TREATMENT OF
CARPAL SCAPHOID (NAVICULAR) FRACTURE;
25628
Open treatment of carpal scaphoid (navicular) fracture, includes internal
cohort
cohort
cohort
cohort
25635
CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING
CARPALSCAPHOID (NAVICULAR)); WITH MANIPULATION, EACH
BONE CLOSED TREATMENT OF CARPAL BONE FRACTURE
(EXCLUDING CARPAL
cohort
cohort
cohort
cohort
25645
OPEN TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING
CARPALSCAPHOID (NAVICULAR)), EACH BONE OPEN
TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL
cohort
cohort
cohort
cohort
25650
CLOSED TREATMENT OF ULNAR STYLOID FRACTURECLOSED
TREATMENT OF ULNAR STYLOID FRACTURE
cohort
cohort
cohort
25651
PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID
FRACTURE
cohort
cohort
cohort
25652
OPEN TREATMENT OF ULNAR STYLOID FRACTURE
cohort
cohort
cohort
cohort
cohort
25660
CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL
DISLOCATION, 1 OR MORE BONES, WITH MANIPULATION
cohort
cohort
25671
PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR
DISLOCATION
25675
CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION
WITHMANIPULATION CLOSED TREATMENT OF DISTAL
RADIOULNAR DISLOCATION WITH
25690
CLOSED TREATMENT OF LUNATE DISLOCATION, WITH
MANIPULATIONCLOSED TREATMENT OF LUNATE DISLOCATION,
WITH MANIPULATION
25800
ARTHRODESIS, WRIST; COMPLETE, WITHOUT BONE GRAFT
CPT
Peer
Cohort
1
Description
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
FRACTURE; WITHOUT
statewide
statewide
cohort
cohort
statewide
statewide
48
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
(INCLUDESRADIOCARPAL AND/OR INTERCARPAL AND/OR
CARPOMETACARPAL JOINTS)
25805
ARTHRODESIS, WRIST; WITH SLIDING GRAFT
25810
ARTHRODESIS, WRIST; WITH ILIAC OR OTHER AUTOGRAFT
(INCLUDES OBTAINING GRAFT)
statewide
25820
ARTHRODESIS, WRIST; LIMITED, WITHOUT BONE GRAFT
(EG,INTERCARPAL OR RADIOCARPAL)
25825
ARTHRODESIS, WRIST; WITH AUTOGRAFT (INCLUDES
OBTAININGGRAFT)
25999
UNLISTED PROCEDURE, FOREARM OR WRIST
26010
*DRAINAGE OF FINGER ABSCESS; SIMPLE
26011
*DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON)
26020
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH
cohort
cohort
cohort
26025
DRAINAGE OF PALMAR BURSA; SINGLE, BURSA
statewide
26034
INCISION, BONE CORTEX, HAND OR FINGER (EG,
OSTEOMYELITIS OR BONE ABSCESS)
cohort
cohort
cohort
26035
DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY
(EG,GREASE GUN)
statewide
26040
FASCIOTOMY, PALMAR (EG, DUPUYTRENS
CONTRACTURE);PERCUTANEOUS
26045
FASCIOTOMY, PALMAR (EG, DUPUYTRENS CONTRACTURE);
OPEN,PARTIAL
26055
TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER)
26075
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR
REMOVALOF LOOSE OR FOREIGN BODY;
METACARPOPHALANGEAL JOI NT, EACH
cohort
26080
ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR
REMOVALOF LOOSE OR FOREIGN BODY; INTERPHALANGEAL
JOINT, EACH
cohort
26110
ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH
26111
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE
OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER
26113
EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR
MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG,
INTRAMUSCULAR); 1.5 CM OR GREATER
26115
EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE
OF HAND OR FINGER, SUBCUTANEOUS; LESS THAN 1.5CM
26116
EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR
MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG,
INTRAMUSCULAR); LESS THAN 1.5 CM
26117
SOFT TISSUE OF HAND OR FINGER; LESS THAN 3 CM
statewide
26118
SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER
statewide
26121
FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY,
OTHERLOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING
26123
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF
SINGLEDIGITINCLUDING PROXIMAL INTERPHALANGEAL JOINT,
WI TH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE
REARRANGEMENT, OR SKIN GRAFTING
26125
FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF
SINGLEDIGITINCLUDING PROXIMAL INTERPHALANGEAL JOINT,
WI TH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE
REARRANGEMENT, OR SKIN GRAFTING
26130
SYNOVECTOMY, CARPOMETACARPAL JOINTSYNOVECTOMY,
CARPOMETACARPAL JOINT
26140
SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT,
INCLUDINGEXTENSOR RECONSTRUCTION, EACH
INTERPHALANGEAL JOINT SYNOVECTOMY, PROXIMAL
INTERPHALANGEAL JOINT, INCLUDING
26145
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
SYNOVECTOMY, TENDON SHEATH, RADICAL
49
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
(TENOSYNOVECTOMY),FLEXOR TENDON, PALM AND/OR FINGER,
EACH TENDONSYNOVECTOMY, TENDON SHEATH, RADICAL
(TENOSYNOVEC TOMY),
26160
EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG,
CYST,MUCOUS CYST, OR GANGLION), HAND OR FINGER
26170
Excision of tendon, palm, flexor or extensor, single, each tendon
26180
Excision of tendon, finger, flexor or extensor, each tendon
26185
SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE
PROCEDURE)
26200
TUMOROFMETACARPAL;
cohort
cohort
26210
TUMOROFPROXIMAL, MIDDLE OR DISTAL PHALANX OF FINGER;
cohort
cohort
26215
TUMOROFPROXIMAL, MIDDLE, OR DISTAL PHALANX OF FINGER;
WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
26230
ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METACARPAL
26235
ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); PROXIMAL
OR MIDDLE PHALANX OF FINGER
26236
ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL
PHALANX OF FINGER
26262
RADICAL RESECTION OF TUMOR, DISTAL PHALANX OF FINGER
26320
REMOVAL OF IMPLANT FROM FINGER OR HAND
statewide
26340
MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH
JOINT
statewide
26350
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN DIGITAL
FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); PRIMARY OR
SECONDARY WITHOUT FREE GRAFT, EACH TENDON
26352
REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN DIGITAL
FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); SECONDARY
WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH
TENDON
26356
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN DIGITAL
FLEXORTENDON SHEATH (EG, NO MAN'S LAND); PRIMARY, EACH
TENDON
cohort
26357
REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN DIGITAL
FLEXORTENDON SHEATH (EG, NO MAN'S LAND);
SECONDARY,EACH TENDON
cohort
26370
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH
INTACTSUPERFICIALIS TENDON; PRIMARY, EACH TENDON
26373
REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH
INTACTSUPERFICIALIS TENDON; SECONDARY WITHOUT FREE
GRAFT, EACH TENDON
cohort
26410
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY;
WITHOUTFREE GRAFT, EACH TENDON
cohort
26412
REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY;
WITHFREE GRAFT (INCLUDES OBTAINING GRAFT), EACHTENDON
cohort
26415
EXCISION OF EXTENSOR TENDON, IMPLANTATION OF
PROSTHETIC ROD FOR DELAYED TENDON GRAFT, HAND OR
FINGER
statewide
26418
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR
SECONDARY;WITHOUT FREE GRAFT, EACH TENDON
cohort
26420
REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR
SECONDARY; WITH FREE GRAFT (INCLUDES OBTAINING GRAFT)
EACH TENDON
cohort
26426
REPAIR OF EXTENSOR TENDON, CENTRAL SLIP,
SECONDARY(EG,BOUTONNIERE DEFORMITY); USING LOCAL
TISSUE(S) , INCLUDING LATERAL BAND(S), EACH TENDON
cohort
26432
CLOSED TREATMENT OF DISTAL EXTENSOR TENDON
INSERTION, WITHOR WITHOUT PERCUTANEOUS PINNING (EG,
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
50
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
MALLET FINGER)
26433
REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY
ORSECONDARY; WITHOUT GRAFT (EG, MALLET FINGER)
26437
REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON
26440
TENOLYSIS, FLEXOR TENDON; PALM OR FINGER; EACH TENDON
26442
TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH
TENDON
26445
TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER; EACH
TENDON
cohort
26450
TENOTOMY, FLEXOR, PALM, OPEN, EACH
TENDONTENOTOMY,FLEXOR, PALM, OPEN, EACH TENDON
statewide
26455
TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON
cohort
26460
TENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH
TENDONTENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH
TENDON
26471
TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT,
EACHJOINT
26474
TENODESIS; OF DISTAL JOINT, EACH JOINT
26479
SHORTENING OF TENDON, FLEXOR, HAND OR FINGER,
EACHTENDON
26480
TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL
AREA ORDORSUM OF HAND; WITHOUT FREE GRAFT, EACH
TENDON
26483
TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL
AREA ORDORSUM OF HAND; WITH FREE TENDON GRAFT
(INCLUDES OBTAINING GRAFT), EACH TENDON
26485
TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITHOUT
FREETENDON GRAFT, EACH TENDON
26489
TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITH FREE
TENDONGRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON
26492
OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT
(INCLUDESOBTAINING GRAFT), EACH TENDON
26497
TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION;
RING ANDSMALL FINGER
statewide
26500
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON;
WITHLOCALTISSUES (SEPARATE PROCEDURE)
statewide
26502
RECONSTRUCTION OF TENDON PULLEY, EACH TENDON;
WITHTENDON ORFASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
26510
CROSS INTRINSIC TRANSFER
26516
CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT
26520
CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL
JOINT, EACHJOINT
26525
CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT,
EACHJOINT
26530
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT
26531
ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH
PROSTHETICIMPLANT, EACH JOINT
26535
ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT
26536
ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH
PROSTHETICIMPLANT, EACH JOINT
26540
REPAIR OF COLLATERAL LIGAMENT,
METACARPOPHALANGEALORINTERPHALANGEAL JOINT
cohort
26541
RECONSTRUCTION, COLLATERAL LIGAMENT,
METACARPOPHALANGEALJOINT, SINGLE; WITH TENDON OR
FASCIAL GRAFT (INCLUDES OBTAINING GRAFT)
cohort
26542
METACARPOPHALANGEALJOINT, SINGLE; WITH LOCAL TISSUE
(EG, ADDUCTOR ADVANCEMENT)
26545
INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
51
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
JOINT
26546
REPAIR NON-UNION, METACARPAL OR PHALANX,
(INCLUDESOBTAININGBONE GRAFT WITH OR WITHOUT
EXTERNAL OR I NTERNAL FIXATION)
26548
REPAIR AND RECONSTRUCTION, FINGER, VOLAR
PLATE,INTERPHALANGEAL JOINT
26560
REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE;
WITH SKIN FLAPS
statewide
26561
WITH SKIN FLAPS AND GRAFTS
statewide
26562
COMPLEX(EG, INVOLVING BONE, NAILS)
26565
OSTEOTOMY; METACARPAL, EACH
cohort
26567
OSTEOTOMY; PHALANX OF FINGER, EACH
statewide
26568
OSTEOPLASTY, LENGTHENING, METACARPAL OR PHALANX
26580
REPAIR CLEFT HAND
statewide
26587
RECONSTRUCTION OF SUPERNUMERARY DIGIT, SOFT
TISSUEAND BONE
statewide
26600
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE;
WITHOUTMANIPULATION, EACH BONE CLOSED TREATMENT
OFMETACARPAL FRACTURE, SINGLE; WITHOUT
cohort
cohort
cohort
cohort
26605
CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE;
WITHMANIPULATION, EACH BONE CLOSED TREATMENT OF
METACARPAL FRACTURE, SINGLE; WITH
cohort
cohort
cohort
cohort
26608
PERCUTANEOUS SKELETAL FIXATION OF METACARPAL
FRACTURE, EACH BONE PERCUTANEOUS SKELETAL FIXATION
OF METACARPAL FRACTURE, EACH
cohort
cohort
cohort
cohort
cohort
26615
Open treatment of metacarpal fracture, single, includes internal fixation
when performed, each bone
cohort
cohort
cohort
cohort
cohort
26641
CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION,
THUMB, WITHMANIPULATION CLOSED TREATMENT OF
CARPOMETACARPAL DISLOCATION, THUMB, WITH
statewide
26645
CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE
DISLOCATION,THUMB (BENNETT FRACTURE), WITH
MANIPULATIONCLOSED TREATMENT OF CARPOMETACARPAL
FRACTURE DIS LOCATION,
cohort
cohort
26650
Percutaneous skeletal fixation of carpometacarpal fracture dislocation,
thumb (Bennett fracture), with manipulation
cohort
cohort
cohort
cohort
26665
Open treatment of carpometacarpal fracture dislocation, thumb (Bennett
fracture), includes internal fixation when performed
cohort
cohort
26670
OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH
MANIPULATION; WITHOUT ANESTHESIA
cohort
26675
OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH
MANIPULATION; REQUIRING ANESTHESIA
statewide
26676
PERCUTANEOUS SKELETAL FIXATION OF
CARPOMETACARPALDISLOCATION, OTHER THAN THUMB
(BENNETT FRACTURE), SINGLE, WITH MANIPULATION
cohort
26685
Open treatment of carpometacarpal dislocation, other than thumb;
includes internal fixation, when performed, each joint
26700
CLOSED TREATMENT OF METACARPOPHALANGEAL
DISLOCATION, SINGLE,WITH MANIPULATION; WITHOUT
ANESTHESIA CLOSED TREATMENT OF
METACARPOPHALANGEAL DISLOCATION, SINGLE,
cohort
cohort
26705
CLOSED TREATMENT OF METACARPOPHALANGEAL
DISLOCATION, SINGLE,WITH MANIPULATION; REQUIRING
ANESTHESIA CLOSED TREATMENT OF
METACARPOPHALANGEAL DISLOCATI ON, SINGLE,
cohort
cohort
26720
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE,
PROXIMAL ORMIDDLE PHALANX, FINGER OR THUMB; WITHOUT
MANIPULATION, EACH CLOSED TREATMENT OF
PHALANGEALSHAFT FRACTURE, PROXIMAL OR
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
52
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
26725
CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE,
PROXIMAL ORMIDDLE PHALANX, FINGER OR THUMB; WITH
MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL
TRACTION, EACH
cohort
cohort
cohort
cohort
cohort
26727
PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE
PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE
PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH
cohort
cohort
cohort
cohort
cohort
cohort
26735
Open treatment of phalangeal shaft fracture, proximal or middle
phalanx, finger or thumb, includes internal fixation when performed,
each
cohort
cohort
cohort
cohort
cohort
cohort
26742
CLOSED TREATMENT OF ARTICULAR FRACTURE,
INVOLVINGMETACARPOPHALANGEAL OR INTERPHALANGEAL
JOINT; WITH MANIPULATION, EACH
cohort
cohort
cohort
cohort
26746
Open treatment of articular fracture, involving metacarpophalangeal or
interphalangeal joint, includes internal fixation, when performed, each
cohort
cohort
cohort
cohort
cohort
26750
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE,
FINGER ORTHUMB; WITHOUT MANIPULATION, EACH CLOSED
TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR
cohort
cohort
cohort
cohort
26755
CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE,
FINGER ORTHUMB; WITH MANIPULATION, EACH CLOSED
TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR
cohort
cohort
cohort
cohort
cohort
26756
PERCUTANEOUS SKELETAL FIXATION OF DISTAL
PHALANGEALFRACTURE, FINGER OR THUMB, EACH
PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL
cohort
cohort
cohort
cohort
26765
Open treatment of distal phalangeal fracture, finger or thumb, includes
internal fixation when performed, each
cohort
cohort
cohort
cohort
cohort
26770
CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCATION,SINGLE, WITH MANIPULATION; WITHOUT
ANESTHESIA CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCA TION,
cohort
cohort
cohort
cohort
cohort
26775
CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCATION,SINGLE, WITH MANIPULATION; REQUIRING
ANESTHESIA CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCATION,
cohort
cohort
cohort
cohort
26785
Open treatment of interphalangeal joint dislocation, includes internal
fixation when performed, single
cohort
cohort
cohort
cohort
26841
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH
ORWITHOUTINTERNAL FIXATION;
cohort
cohort
26842
ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH
ORWITHOUTINTERNAL FIXATION; WITH AUTOGRAFT (INCLUDE S
OBTAINING GRAFT)
26843
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER
THANTHUMB;
26844
ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER
THANTHUMB; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT)
statewide
26850
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR
WITHOUTINTERNAL FIXATION;
cohort
26852
ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR
WITHOUTINTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES
OBTAINING GRAFT)
26860
ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT
INTERNALFIXATION;
cohort
26861
INTERNALFIXATION; EACH ADDITIONAL INTERPHALANGEAL
JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
cohort
26862
INTERNALFIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING
GRAFT)
26910
AMPUTATION, METACARPAL, WITH FINGER OR THUMB
(RAYAMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS
TRANSFER
26951
AMPUTATION, FINGER OR THUMB, PRIMARY OR
SECONDARY,ANY JOINTOR PHALANX, SINGLE, INCLUDING
NEURECTOMI ES; WITH DIRECT CLOSURE
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
53
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
26952
AMPUTATION, FINGER OR THUMB, PRIMARY OR
SECONDARY,ANY JOINTOR PHALANX, SINGLE, INCLUDING
NEURECTOMI ES; WITH LOCAL ADVANCEMENT FLAPS (V-Y,
HOOD)
26989
UNLISTED PROCEDURE, HANDS OR FINGERS
26990
INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA;
DEEPABSCESS OR HEMATOMA
26992
INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT
(EG,OSTEOMYELITIS OR BONE ABSCESS)
statewide
27000
TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE
PROCEDURE)
statewide
27001
TENOTOMY, ADDUCTOR OF HIP, OPEN
cohort
27006
TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP,
OPEN(SEPARATE PROCEDURE)
27025
FASCIOTOMY, HIP OR THIGH, ANY TYPE
statewide
27033
ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF
LOOSEOR FOREIGN BODY ARTHROTOMY, HIP, INCLUDING
EXPLORATION OR REMOVAL OF LOOSE
statewide
27036
CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT
EXCISIONOF HETEROTOPIC BONE, WITH RELEASE OF HIP
FLEXOR MUSCLES (IE, GLUTEUS MEDIUS, GLUTEUS MINIMUS,
TENSOR FASCIA LATAE, RECTUS
27040
BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL
27043
EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA,
cohort
27045
cohort
27047
27048
27059
SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER
27062
EXCISION; TROCHANTERIC BURSA OR CALCIFICATION
cohort
cohort
27066
Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis,
or greater trochanter of femur; deep (subfascial), includes autograft,
when performed
cohort
cohort
27080
COCCYGECTOMY, PRIMARY
cohort
cohort
27086
*REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS
TISSUE*REMOVAL OF FOREIGN BODY, PELVIS OR
HIP;SUBCUTANEOUS TISSUE
27093
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT
ANESTHESIA
27095
INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH
ANESTHESIA
27096
INJECTION PROCEDURE FOR SACROILIAC JOINT,
ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY
OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED
27130
ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL
PROSTHETICREPLACEMENT (TOTAL HIP REPLACEMENT), WITH
ORWITHOUT AUTOGRAFT OR ALLOGRAFT
27146
OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE;
27176
TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE
ORMULTIPLE PINNING, IN SITU
cohort
27187
PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR
WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, FEMORAL
NECK AND PROXIMAL FEMUR
statewide
27193
CLOSED TREATMENT OF PELVIC RING FRACTURE,
DISLOCATION,DIASTASIS OR SUBLUXATION; WITHOUT
MANIPULATIONCLOSED TREATMENT OF PELVIC RING
FRACTURE, DISLOC ATION,
statewide
27216
Percutaneous skeletal fixation of posterior pelvicbone fracture and/or
dislocation, for fracture pa tterns that disrupt the pelvic ring, unilateral
cohort
Peer
Cohort
6
cohort
statewide
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
54
cohort
cohort
statewide
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
(includes ipsilateral ilium, sacroiliac joint and/or
27227
OPEN TREATMENT OF ACETABULAR FRACTURE(S)
INVOLVINGANTERIOR OR POSTERIOR (ONE) COLUMN, OR A
FRACTURE RUNNING TRANSVERSELY ACROSS THE
ACETABULUM, WITH INTERNAL FIXATION
27230
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END,
NECK;WITHOUT MANIPULATION CLOSED TREATMENT OF
FEMORAL FRACTURE, PROXIMAL END, NECK;
27232
CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END,
NECK;WITH MANIPULATION, WITH OR WITHOUT
SKELETALTRACTION CLOSED TREATMENT OF FEMORAL
FRACTURE, P ROXIMAL END, NECK;
27235
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE,
PROXIMALEND, NECK, UNDISPLACED, MILDLY DISPLACED, OR
IMPACTED FRACTURE
27236
OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END,
NECK,INTERNAL FIXATION OR PROSTHETIC REPLACEMENT
(DIRECT FRACTURE EXPOSURE)
27240
CLOSED TREATMENT OF INTERTROCHANTERIC,
PERTROCHANTERIC, ORSUBTROCHANTERIC FEMORAL
FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR
SKELETAL TRACTION
27245
OPEN TREATMENT OF INTERTROCHANTERIC,
PERTROCHANTERIC ORSUBTROCHANTERIC FEMORAL
FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR
WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE
27250
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC;
WITHOUTANESTHESIA CLOSED TREATMENT OF HIP
DISLOCATION, TRAUMATIC; WITHOUT
27252
CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC;
REQUIRINGANESTHESIA CLOSED TREATMENT OF HIP
DISLOCATION, TRAUMATIC; REQUIRING
27256
*TREATMENT OF SPONTANEOUS HIP DISLOCATION
(DEVELOPMENTAL,INCLUDING CONGENITAL OR
PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION;
WITHOUT ANESTHESIA, WITHOUT MANIPULATION
statewide
27257
*TREATMENT OF SPONTANEOUS HIP DISLOCATION
(DEVELOPMENTAL,INCLUDING CONGENITAL OR
PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITH
MANIPULATION,REQUIRING ANESTHESIA
statewide
27258
OPEN TREATMENT OF SPONTANEOUS HIP
DISLOCATION(DEVELOPMENTAL, INCLUDING CONGENITAL OR
PATHOLOGICAL), REPLACEMENT OF FEMORAL HEAD IN
ACETABULUM (INCLUD ING
statewide
27265
CLOSED TREATMENT OF POST HIP ARTHROPLASTY
DISLOCATION;WITHOUT ANESTHESIA CLOSED TREATMENT OF
POST HIP ARTHROPLASTY DISLOCATION;
27266
DISLOCATION;REQUIRING REGIONAL OR GENERAL ANESTHESIA
DISLOCATION;
27275
*MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA
27280
ARTHRODESIS, SACROILIAC JOINT (INCLUDING
OBTAININGGRAFT)
cohort
cohort
27299
UNLISTED PROCEDURE, PELVIS OR HIP JOINT
cohort
27301
INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR
HEMATOMA,THIGH OR KNEE REGION
cohort
27303
INCISION, DEEP, WITH OPENING OF BONE CORTEX, FEMUROR
KNEE(EG, OSTEOMYELITIS OR BONE ABSCESS)
27305
FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN
cohort
cohort
27310
ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR
REMOVAL OF FOREIGN BODY (EG, INFECTION) ARTHROTOMY,
KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF
cohort
cohort
27323
BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
55
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
27327
EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA,
27328
27331
ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY,
ORREMOVAL OF LOOSE OR FOREIGN BODIES ARTHROTOMY,
KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR
27332
ARTHROTOMY, WITH EXCISION OF SEMILUNAR
CARTILAGE(MENISCECTOMY) KNEE; MEDIAL OR LATERAL
27333
ARTHROTOMY, WITH EXCISION OF SEMILUNAR
CARTILAGE(MENISCECTOMY) KNEE; MEDIAL AND LATERAL
27334
ARTHROTOMY, WITH SYNOVECTOMY KNEE; ANTERIOR OR
POSTERIOR
27337
cohort
cohort
cohort
27339
cohort
cohort
cohort
27340
EXCISION, PREPATELLAR BURSA
cohort
cohort
27345
EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG,
BAKERSCYST)
cohort
cohort
cohort
cohort
27347
EXCISION OF LESION OF MENISCUS OR CAPSULE (EG,
CYST,GANGLION), KNEE
cohort
cohort
cohort
cohort
27350
PATELLECTOMY OR HEMIPATELLECTOMY
cohort
cohort
cohort
27355
FEMUR;
cohort
cohort
27356
FEMUR;WITH ALLOGRAFT
27360
ORDIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/OR
FIBULA (EG, OSTEOMYELITIS OR BONE ABSCESS)
27364
SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER
27370
INJECTION PROCEDURE FOR KNEE ARTHROGRAPHY
27372
REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE
AREA
27380
SUTURE OF INFRAPATELLAR TENDON; PRIMARY
27381
SUTURE OF INFRAPATELLAR TENDON; SECONDARY
RECONSTRUCTION,INCLUDING FASCIAL OR TENDON GRAFT
cohort
27385
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE;
PRIMARY
cohort
27386
SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE;
SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR
TENDON GRAFT
27394
LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS,1
LEG
statewide
27395
LENGTHENING OF HAMSTRING TENDON; MULTIPLE
TENDONS,BILATERAL
statewide
27396
Transplant or transfer (with muscle redirection orrerouting), high (e.g.,
extensor to flexor); sing le tendon
27403
ARTHROTOMY WITH MENISCUS REPAIR, KNEE
cohort
27405
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE,
KNEE;COLLATERAL
cohort
27407
REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE,
KNEE;CRUCIATE
27412
AUTOLOGOUS CHONDROCYTE IMPLANTATION, KNEE
27415
OSTEOCHONDRAL ALLOGRAFT, KNEE, OPEN
27418
ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE
PROCEDURE)
27420
RECONSTRUCTION OF DISLOCATING PATELLA; (EG,
HAUSERTYPEPROCEDURE)
27422
RECONSTRUCTION OF DISLOCATING PATELLA; WITH
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
56
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
EXTENSORREALIGNMENT AND/OR MUSCLE ADVANCEMENT OR
RELEASE(EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)
27424
RECONSTRUCTION OF DISLOCATING PATELLA; WITH
PATELLECTOMY
27425
LATERAL RETINACULAR RELEASE (ANY METHOD)
cohort
cohort
cohort
cohort
cohort
27427
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION),
KNEE;EXTRA-ARTICULAR
cohort
cohort
cohort
cohort
cohort
27428
KNEE;INTRA-ARTICULAR (OPEN)
cohort
cohort
cohort
cohort
cohort
27429
KNEE;INTRA-ARTICULAR (OPEN) AND EXTRA-ARTICULAR
cohort
27430
QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE)
cohort
cohort
cohort
cohort
27435
CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE
cohort
cohort
cohort
27437
ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS
cohort
27438
ARTHROPLASTY, PATELLA; WITH PROSTHESIS
statewide
27440
ARTHROPLASTY, KNEE, TIBIAL PLATEAU;
statewide
27442
ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S),
KNEE;
cohort
27445
ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG,
WALLDIUSTYPE)
27446
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL
ORLATERALCOMPARTMENT
cohort
cohort
27447
ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND
LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA
RESURFACING (TOTAL KNEE REPLACEMENT)
cohort
cohort
27448
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITHOUT
FIXATION
27450
OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITH
FIXATION
27457
OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION
OROSTEOTOMY (INCLUDES CORRECTION OF GENU
VARUS(BOWLEG) OR GENU VALGUS (KNOCK-KNEE)); AFTER EPI
PHYSEAL CLOSURE
statewide
27472
REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD
ANDNECK; WITH ILIAC OR OTHER AUTOGENOUS BONE GRAFT
statewide
27475
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS);
DISTAL FEMUR
cohort
27477
ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS);
TIBIAAND FIBULA, PROXIMAL
statewide
27485
ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA
ORFIBULA (EG, GENU VARUS OR VALGUS)
27486
REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT
ALLOGRAFT; 1 COMPONENT
27488
REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE
PROSTHESIS,METHYLMETHACRYLATE WITH OR WITHOUT
INSERTION OF SPACER, KNEE
27495
WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, FEMUR
27500
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE,
WITHOUTMANIPULATION CLOSED TREATMENT OF FEMORAL
SHAFT FRACTURE, WITHOUT
cohort
cohort
27502
CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE,
WITHMANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL
TRACTION CLOSED TREATMENT OF FEMORAL SHAFT
FRACTURE, WITH
cohort
cohort
27506
OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR
WITHOUTEXTERNAL FIXATION, WITH INSERTION OF
INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE
AND/ORLOCKING SCREWS
statewide
27508
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END,
MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
57
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END,
MEDIAL OR
27509
PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE,
DISTALEND, MEDIAL OR LATERAL CONDYLE, OR
SUPRACONDYLAR OR TRANSCONDYLAR, WITH OR WITHOUT
INTERCONDYLAR EXTENSION, OR
27514
Open treatment of femoral fracture, distal end, medial or lateral condyle,
27516
CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL
SEPARATION;WITHOUT MANIPULATION CLOSED TREATMENT OF
DISTAL FEMORAL EPIPHYSEAL SEPARATION;
27524
OPEN TREATMENT OF PATELLAR FRACTURE, WITH
INTERNALFIXATION AND/OR PARTIAL OR COMPLETE
PATELLECTOMY AND SOFT TISSUE REPAIR
27530
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL
(PLATEAU);WITHOUT MANIPULATION CLOSED TREATMENT OF
TIBIAL FRACTURE, PROXIMAL (PLATEAU);
27532
CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL
(PLATEAU);WITH OR WITHOUT MANIPULATION, WITH SKELETAL
TRACTION CLOSED TREATMENT OF TIBIAL FRACTURE,
PROXIMAL (PLATEAU);
27535
Open treatment of tibial fracture, proximal (plateau); unicondylar,
27536
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL
(PLATEAU);BICONDYLAR, WITH OR WITHOUT INTERNAL FIXATION
OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLAT EAU);
27540
Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of
the knee, includes internal fixation when performed
27550
CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT
ANESTHESIACLOSED TREATMENT OF KNEE DISLOCATION;
WITHOUT ANESTHESIA
27552
CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING
ANESTHESIACLOSED TREATMENT OF KNEE DISLOCATION;
REQUIRING ANESTHESIA
cohort
cohort
27560
CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT
ANESTHESIACLOSED TREATMENT OF PATELLAR DISLOCATION;
WITHOUT ANESTHESIA
cohort
cohort
27562
CLOSED TREATMENT OF PATELLAR DISLOCATION;
REQUIRINGANESTHESIA CLOSED TREATMENT OF PATELLAR
DISLOCATION; REQUIRING
27566
OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR
WITHOUTPARTIAL OR TOTAL PATELLECTOMY OPEN
TREATMENTOF PATELLAR DISLOCATION, WITH OR WITHOUT
cohort
cohort
27570
*MANIPULATION OF KNEE JOINT UNDER GENERAL
ANESTHESIA(INCLUDES APPLICATION OF TRACTION OR OTHER
FIXATION DEVICES)
cohort
cohort
27590
AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL;
27599
UNLISTED PROCEDURE, FEMUR OR KNEE
27600
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR
LATERALCOMPARTMENTS ONLY
27601
DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR
COMPARTMENT(S) ONLY
27602
DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR
LATERAL, AND POSTERIOR COMPARTMENT(S)
cohort
cohort
27603
INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS
ORHEMATOMA
cohort
cohort
27606
TENOTOMY, PERCUTANEOUS, ACHILLES TENDON
(SEPARATEPROCEDURE); GENERAL ANESTHESIA
cohort
cohort
cohort
27610
ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE,
ORREMOVAL OF FOREIGN BODY ARTHROTOMY, ANKLE,
INCLUDING EXPLORATION, DRAINAGE, OR
cohort
cohort
cohort
27612
ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH
ORWITHOUT ACHILLES TENDON LENGTHENING
cohort
27614
BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
58
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
(SUBFASCIALOR INTRAMUSCULAR)
27616
SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER
27618
EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE
AREA,SUBCUTANEOUS; LESS THAN 3 CM
cohort
cohort
cohort
cohort
cohort
27619
AREA,SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM
cohort
cohort
cohort
cohort
cohort
27620
ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH
ORWITHOUTBIOPSY, WITH ARTHROTOMY, ANKLE, WITH JOIN T
EXPLORATION, WITH OR WITHOUT
cohort
cohort
cohort
cohort
27625
ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;
cohort
cohort
cohort
cohort
27626
ARTHROTOMY, WITH SYNOVECTOMY, ANKLE;
INCLUDINGTENOSYNOVECTOMY
cohort
cohort
cohort
27630
EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG,
CYST OR GANGLION), LEG AND/OR ANKLE
cohort
cohort
cohort
cohort
cohort
27632
AREA,SUBCUTANEOUS; 3 CM OR GREATER
cohort
cohort
cohort
cohort
27634
AREA,SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER
27635
TIBIA ORFIBULA;
27637
TIBIA ORFIBULA; WITH AUTOGRAFT (INCLUDES OBTAINING
GRAFT)
27638
TIBIA ORFIBULA; WITH ALLOGRAFT
cohort
27640
ORDIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); TIBIA
cohort
27641
ORDIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA
cohort
27645
RADICAL RESECTION OF TUMOR; TIBIA
27646
RADICAL RESECTION OF TUMOR; FIBULA
27647
RADICAL RESECTION OF TUMOR; TALUS OR CALCANEUS
27648
INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY
27650
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED
ACHILLESTENDON;
cohort
cohort
cohort
27652
REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED
ACHILLESTENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT)
cohort
cohort
cohort
27654
REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT
GRAFT
cohort
cohort
cohort
cohort
cohort
27658
REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT,
EACHTENDON
cohort
cohort
cohort
cohort
cohort
27659
REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR
WITHOUTGRAFT, EACH TENDON
cohort
cohort
cohort
cohort
cohort
27664
REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT,
EACHTENDON
cohort
cohort
cohort
cohort
cohort
27665
REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR
WITHOUTGRAFT, EACH TENDON
cohort
cohort
27675
REPAIR, DISLOCATING PERONEAL TENDONS; WITHOUT
FIBULAROSTEOTOMY
cohort
cohort
27676
REPAIR, DISLOCATING PERONEAL TENDONS; WITH
FIBULAROSTEOTOMY
27680
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR
ANKLE;SINGLE, EACH TENDON
27681
TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR
ANKLE;MULTIPLE TENDONS (THROUGH SEPARATE INCISION(S))
27685
LENGTHENING OR SHORTENING OF TENDON, LEG OR
ANKLE;SINGLETENDON (SEPARATE PROCEDURE)
27686
LENGTHENING OR SHORTENING OF TENDON, LEG OR
ANKLE;MULTIPLE TENDONS (THROUGH SAME INCISION), EACH
27687
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
59
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
Peer
Cohort
1
CPT
Description
27690
TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH
MUSCLEREDIRECTION OR REROUTING); SUPERFICIAL (EG,
ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT)
27691
MUSCLEREDIRECTION OR REROUTING); DEEP (EG, ANTERIOR
TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE,
FLEXOR
cohort
27692
MUSCLEREDIRECTION OR REROUTING); EACH ADDITIONAL
TENDON (LIST IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
cohort
27695
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL
cohort
27696
REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH
COLLATERAL LIGAMENTS
27698
REPAIR, SECONDARY DISRUPTED LIGAMENT, ANKLE,
COLLATERAL (EG,WATSON-JONES PROCEDURE)
27700
ARTHROPLASTY, ANKLE;
27702
Arthroplasty, ankle, with implant (total ankle)
27705
OSTEOTOMY; TIBIA
27707
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
OSTEOTOMY; FIBULA
cohort
cohort
27709
OSTEOTOMY; TIBIA AND FIBULA
statewide
27720
REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT,
(EG,COMPRESSION TECHNIQUE)
27722
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING
GRAFT
27724
REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR
OTHERAUTOGRAFT (INCLUDES OBTAINING GRAFT)
27726
Repair of fibula nonunion and/or malunion with internal fixation
27730
ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD;
DISTALTIBIA
statewide
27732
DISTALFIBULA
statewide
27734
DISTALTIBIA AND FIBULA
27745
WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, TIBIA
27750
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH
ORWITHOUTFIBULAR FRACTURE); WITHOUT MANIPULATION C
LOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR
WITHOUT
cohort
cohort
cohort
cohort
27752
CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH
ORWITHOUTFIBULAR FRACTURE); WITH MANIPULATION, WITH
OR WITHOUT SKELETAL TRACTION
cohort
cohort
cohort
cohort
27756
PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT
FRACTURE(WITH OR WITHOUT FIBULAR FRACTURE) (EG, PINS
OR SCREWS) PERCUTANEOUS SKELETAL FIXATION OF TIBIAL
SHAFT FRACTURE
cohort
cohort
27758
OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR
WITHOUTFIBULAR FRACTURE) WITH PLATE/SCREWS, WITH OR
WITHOUT CERCLAGE
27759
OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR
WITHOUTFIBULAR FRACTURE) BY INTRAMEDULLARY
IMPLANT,WITH OR WITHOUT INTERLOCKING SCREWS AND/OR
CERCL AGE
27760
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF MEDIAL
MALLEOLUS FRACTURE; WITHOUT
27762
CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE;
WITHMANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL
TRACTION CLOSED TREATMENT OF MEDIAL MALLEOLUS
FRACTURE; WITH
cohort
cohort
cohort
cohort
cohort
27766
Open treatment of medial malleolus fracture, includes internal fixation
when performed
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
60
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
27767
Closed treatment of posterior malleolus fracture; without manipulation
27768
Closed treatment of posterior malleolus fracture; with manipulation
27769
Open treatment of posterior malleolus fracture, includes internal fixation
when performed
27780
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT
FRACTURE;WITHOUT MANIPULATION CLOSED TREATMENT OF
PROXIMAL FIBULA OR SHAFT FRACTURE;
27781
CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT
FRACTURE; WITH MANIPULATION CLOSED TREATMENT OF
PROXIMAL FIBULA OR SHAFT FRACTURE; WITH
cohort
27784
Open treatment of proximal fibula or shaft fracture, includes internal
cohort
27786
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE
(LATERALMALLEOLUS); WITHOUT MANIPULATION CLOSED
TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL
27788
CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE
(LATERALMALLEOLUS); WITH MANIPULATION CLOSED
TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL
27792
Open treatment of distal fibular fracture (lateralmalleolus), includes
internal fixation when perfo rmed
27808
Closed treatment of bimalleolar ankle fracture, e.g., lateral and medial
malleoli, or lateral and posterior malleoli or medial and posterior
malleoli); without manipulation
27810
Closed treatment of bimalleolar ankle fracture, e.g., lateral and medial
malleoli, or lateral and posterior malleoli or medial and posterior
malleoli); with manipulation
27814
Open treatment of bimalleolar ankle fracture (e.g., lateral and medial
malleoli, or lateral and posterior malleoli, or medial and posterior
malleoli),includes internal fixation when performed
27816
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE;
WITHOUTMANIPULATION CLOSED TREATMENT OF
TRIMALLEOLAR ANKLE FRACTURE; WITHOUT
27818
CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE;
WITHMANIPULATION CLOSED TREATMENT OF TRIMALLEOLAR
ANKLE FRACTURE; WITH
cohort
cohort
cohort
cohort
cohort
27822
Open treatment of trimalleolar ankle fracture, includes internal fixation
when performed, medial and/or lateral malleolus; without fixation of
posterior lip
cohort
cohort
cohort
cohort
cohort
27823
Open treatment of trimalleolar ankle fracture, includes internal fixation
when performed, medial and/or lateral malleolus; with fixation of
posterior lip
cohort
cohort
cohort
cohort
27824
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING
ARTICULARPORTION OF DISTAL TIBIA (EG, PILON OR
TIBIALPLAFOND), WITH OR WITHOUT ANESTHESIA; WITHOUT
MANIPULATION
cohort
cohort
27825
CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING
ARTICULARPORTION OF DISTAL TIBIA (EG, PILON OR
TIBIALPLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKE
LETAL TRACTION AND/OR
cohort
cohort
cohort
cohort
cohort
27827
Open treatment of fracture of weight bearing articular surface/portion of
distal tibia (e.g., pilon or tibial plafond), with internal fixation when
performed; of tibia only
cohort
cohort
cohort
cohort
cohort
cohort
27828
Open treatment of fracture of weight bearing articular surface/portion of
distal tibia (e.g., pilon or tibial plafond), with internal fixation when
performed; of both tibia and fibula
cohort
cohort
cohort
cohort
cohort
27829
Open treatment of distal tibiofibular joint (syndesmosis) disruption,
cohort
cohort
cohort
cohort
cohort
cohort
27831
CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT
DISLOCATION;REQUIRING ANESTHESIA
statewide
27840
CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT
ANESTHESIACLOSED TREATMENT OF ANKLE DISLOCATION;
WITHOUT ANESTHESIA
cohort
cohort
cohort
cohort
27842
CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING
ANESTHESIA,WITH OR WITHOUT PERCUTANEOUS SKELETAL
FIXATION CLOSED TREATMENT OF ANKLE DISLOCATION;
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
61
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
REQUIRING ANESTHESIA,
27870
ARTHRODESIS, ANKLE, ANY METHOD
cohort
27871
ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL
statewide
27886
AMPUTATION LEG, THROUGH TIBIA AND FIBULA; REAMPUTATION
27899
UNLISTED PROCEDURE, LEG OR ANKLE
28002
*INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT
TENDON SHEATH INVOLVEMENT, FOOT; SINGLE BURSAL SPACE
28005
INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE
ABSCESS),FOOT
28008
FASCIOTOMY, FOOT AND/OR TOE
cohort
cohort
28010
TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON
cohort
cohort
28011
TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS
cohort
cohort
28020
ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR
REMOVAL OFLOOSE OR FOREIGN BODY; INTERTARSAL OR
TARSOMETATARSAL JOINT ARTHROTOMY, INCLUDING
EXPLORATION, DRAINAGE, OR REMOVAL OF
cohort
28022
REMOVAL OFLOOSE OR FOREIGN BODY;
METATARSOPHALANGEALJOINT ARTHROTOMY, INCLUDING
EXPLORATION, DRAINAG E, OR REMOVAL OF
28024
REMOVAL OFLOOSE OR FOREIGN BODY; INTERPHALANGEAL
JOINT ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR
REMOVAL OF
28035
RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL
NERVEDECOMPRESSION)
28039
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE,
SUBCUTANEOUS; 1.5 CM OR GREATER
28041
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL
(EG, INTRAMUSCULAR); 1.5 CM OR GREATER
28043
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE,
SUBCUTANEOUS; LESS THAN 1.5 CM
cohort
28045
EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL
(EG, INTRAMUSCULAR); LESS THAN 1.5 CM
cohort
28047
SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER
statewide
28060
FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE
PROCEDURE)
28062
FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE
PROCEDURE)
28070
SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL
JOINT,EACHSYNOVECTOMY; INTERTARSAL OR
TARSOMETATARSAL J OINT, EACH
28072
SYNOVECTOMY; METATARSOPHALANGEAL JOINT,
EACHSYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH
28080
EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH
28086
SYNOVECTOMY, TENDON SHEATH, FOOT;
FLEXORSYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR
28088
SYNOVECTOMY, TENDON SHEATH, FOOT;
EXTENSORSYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR
28090
EXCISION OF LESION, TENDON, TENDON SHEATH, OR
CAPSULE(INCLUDING SYNOVECTOMY) (EG, CYST OR
GANGLION);FOOT EXCISION OF LESION, TENDON, TENDON
SHEATH, OR CAPSULE
cohort
cohort
cohort
cohort
cohort
28092
EXCISION OF LESION, TENDON, TENDON SHEATH, OR
CAPSULE(INCLUDING SYNOVECTOMY) (EG, CYST OR
GANGLION);TOE(S), EACH EXCISION OF LESION, TENDON,
TENDON SHEATH, OR CAPSULE
cohort
cohort
cohort
cohort
cohort
28100
TALUS ORCALCANEUS;
cohort
cohort
cohort
cohort
28103
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
62
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
TALUS ORCALCANEUS; WITH ALLOGRAFT
28104
TARSALOR METATARSAL BONES, EXCEPT TALUS OR
CALCANEUS;
28107
TARSALOR METATARSAL BONES, EXCEPT TALUS OR
CALCANEUS; WITH ALLOGRAFT
28108
TUMOR,PHALANGES OF FOOT
cohort
cohort
cohort
cohort
cohort
28110
OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL
HEAD(BUNIONETTE) (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
28111
OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD
28112
OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD
(SECOND,THIRD OR FOURTH)
cohort
28113
OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD
cohort
28114
OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS,
WITHPARTIAL PROXIMAL PHALANGECTOMY, EXCLUDING FIRST
METATARSAL (EG, CLAYTON TYPE PROCEDURE)
cohort
28116
OSTECTOMY, EXCISION OF TARSAL COALITION
cohort
cohort
28118
OSTECTOMY, CALCANEUS;
cohort
cohort
cohort
28119
OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT
PLANTARFASCIAL RELEASE
cohort
cohort
cohort
cohort
cohort
28120
PARTIAL EXCISION (CRATERIZATION,
SAUCERIZATION,SEQUESTRECTOMY, OR DIAPHYSECTOMY)
BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR
CALCANEUS
cohort
cohort
cohort
cohort
cohort
28122
BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR
METATARSAL BONE, EXCEPT TALUS OR
cohort
cohort
cohort
cohort
28124
BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE
cohort
cohort
28126
RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH
TOE
cohort
28140
METATARSECTOMY
cohort
28150
PHALANGECTOMY, TOE, EACH TOE
28153
RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACHTOE
28160
HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION,
TOE,PROXIMAL END OF PHALANX, EACH
28173
RADICAL RESECTION OF TUMOR; METATARSAL
28175
RADICAL RESECTION OF TUMOR; PHALANX OF TOE
28190
*REMOVAL OF FOREIGN BODY, FOOT;
SUBCUTANEOUS*REMOVAL OF FOREIGN BODY, FOOT;
SUBCUTANEOUS
cohort
cohort
cohort
cohort
cohort
28192
REMOVAL OF FOREIGN BODY, FOOT; DEEPREMOVAL OF
FOREIGN BODY, FOOT; DEEP
cohort
cohort
cohort
cohort
cohort
cohort
28193
REMOVAL OF FOREIGN BODY, FOOT; COMPLICATEDREMOVAL
OF FOREIGN BODY, FOOT; COMPLICATED
28200
REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY,
WITHOUT FREE GRAFT, EACH TENDON
cohort
cohort
cohort
cohort
28202
REPAIR, TENDON, FLEXOR, FOOT; SECONDARY WITH FREE
GRAFT,EACH TENDON (INCLUDES OBTAINING GRAFT)
cohort
cohort
cohort
28208
REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY,
EACHTENDON
cohort
cohort
cohort
28220
TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON
statewide
28225
TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON
28230
TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR
MULTIPLETENDON(S) (SEPARATE PROCEDURE)
28232
TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
statewide
statewide
cohort
63
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
28234
TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON
28238
RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL
TENDON WITHEXCISION OF ACCESSORY NAVICULAR BONE (EG,
KIDNER TYPE PROCEDURE)
28240
TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS
MUSCLE
28250
DIVISION OF PLANTAR FASCIA AND MUSCLE (EG,
STEINDLERSTRIPPING) (SEPARATE PROCEDURE)
28260
CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY
(SEPARATEPROCEDURE)
28261
CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING
28262
CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING
POSTERIORTALOTIBIAL CAPSULOTOMY AND TENDON(S)
LENGTHENING(EG, RESISTANT CLUBFOOT DEFORMITY)
28270
CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR
WITHOUTTENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE)
cohort
cohort
28272
CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT
(SEPARATEPROCEDURE)
cohort
cohort
28280
SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN
TYPEPROCEDURE)
cohort
cohort
28285
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL
FUSION,PARTIALOR TOTAL PHALANGECTOMY)
cohort
cohort
28286
CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN
CLOSURE(EG, RUIZ-MORA TYPE PROCEDURE)
28288
OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY,
METATARSAL HEAD, EACH METATARSAL HEAD
cohort
cohort
cohort
28289
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY,
DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST
METATARSOPHALANGEAL JOINT
cohort
cohort
cohort
28290
CORRECTION, HALLUX VALGUS (BUNION), WITH OR
WITHOUTSESAMOIDECTOMY; SIMPLE EXOSTECTOMY (EG,
SILVER TYPE PROCEDURE)
cohort
cohort
cohort
28292
WITHOUTSESAMOIDECTOMY; KELLER, MCBRIDE, OR MAYO TYPE
PROCEDURE
cohort
cohort
cohort
28293
WITHOUTSESAMOIDECTOMY; RESECTION OF JOINT WITH
IMPLANT
cohort
cohort
cohort
28296
WITHOUTSESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY
(EG, MITCHELL, CHEVRON, OR CONCENTRIC TYPE
PROCEDURES)
cohort
cohort
cohort
cohort
cohort
cohort
28297
WITHOUTSESAMOIDECTOMY; LAPIDUS TYPE PROCEDURE
cohort
cohort
cohort
cohort
cohort
cohort
28298
WITHOUTSESAMOIDECTOMY; BY PHALANX OSTEOTOMY
cohort
cohort
cohort
cohort
cohort
cohort
28299
WITHOUTSESAMOIDECTOMY; BY OTHER METHODS (EG, DOUBLE
OSTEOTOMY)
cohort
cohort
cohort
cohort
cohort
cohort
28300
OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE
PROCEDURE),WITH OR WITHOUT INTERNAL FIXATION
cohort
cohort
cohort
cohort
cohort
cohort
28302
OSTEOTOMY; TALUS
cohort
cohort
28304
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR
TALUS;
cohort
cohort
28305
OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR
TALUS; WITHAUTOGRAFT (INCLUDES OBTAINING GRAFT) (EG,
FOWLER TYPE)
28306
OSTEOTOMY, WITH OR WITHOUT LENGTHENING,
SHORTENINGORANGULAR CORRECTION, METATARSAL; FIRST
METATARSA L
28307
SHORTENINGORANGULAR CORRECTION, METATARSAL; FIRST
METATARSA L WITH AUTOGRAFT (OTHER THAN FIRST TOE)
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
64
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
CPT
Description
Peer
Cohort
1
28308
SHORTENINGORANGULAR CORRECTION, METATARSAL; OTHER
THAN FIRS T METATARSAL, EACH
cohort
28309
SHORTENINGORANGULAR CORRECTION, METATARSAL;
MULTIPLE (EG, S WANSON TYPE CAVUS FOOT PROCEDURE)
28310
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL
CORRECTION;PROXIMAL PHALANX, FIRST TOE (SEPARATE
PROCEDURE)
cohort
28312
OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL
CORRECTION;OTHER PHALANGES, ANY TOE
cohort
28313
RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT
TISSUEPROCEDURES ONLY (EG, OVERLAPPING SECOND TOE,
FIFTH TOE, CURLY TOES)
cohort
cohort
cohort
28315
SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE)
cohort
cohort
cohort
28320
REPAIR, NONUNION OR MALUNION; TARSAL BONES
28322
REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR
WITHOUTBONE GRAFT (INCLUDES OBTAINING GRAFT)
28341
RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE
RESECTION
statewide
28344
RECONSTRUCTION, TOE(S); POLYDACTYLY
statewide
28345
RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT
SKINGRAFT(S), EACH WEB
28360
RECONSTRUCTION, CLEFT FOOT
28400
CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT
MANIPULATIONCLOSED TREATMENT OF CALCANEAL FRACTURE;
WITHOUT MANIPULATION
cohort
cohort
cohort
cohort
28415
Open treatment of calcaneal fracture, includes internal fixation when
performed;
cohort
cohort
cohort
cohort
28420
Open treatment of calcaneal fracture, includes internal fixation when
performed; with primary iliac or other autogenous bone graft (includes
obtaininggraft)
28435
CLOSED TREATMENT OF TALUS FRACTURE; WITH
MANIPULATIONCLOSED TREATMENT OF TALUS FRACTURE;
WITH MANIPULATION
28445
Open treatment of talus fracture, includes internal fixation when
performed
cohort
28465
Open treatment of tarsal bone fracture (except talus and calcaneus),
includes internal fixation whenperformed, each
cohort
28470
CLOSED TREATMENT OF METATARSAL FRACTURE;
WITHOUTMANIPULATION, EACH CLOSED TREATMENT OF
METATARSAL FRACTURE; WITHOUT
28475
CLOSED TREATMENT OF METATARSAL FRACTURE; WITH
MANIPULATION, EACH CLOSED TREATMENT OF METATARSAL
FRACTURE; WITH MANIPULATION,
28476
PERCUTANEOUS SKELETAL FIXATION OF METATARSAL
FRACTURE, WITH MANIPULATION, EACH PERCUTANEOUS
SKELETAL FIXATION OF METATARSAL FRACTURE, WITH
28485
Open treatment of metatarsal fracture, includes internal fixation when
performed, each
28490
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX
ORPHALANGES; WITHOUT MANIPULATION CLOSED TREATMENT
OF FRACTURE GREAT TOE, PHALANX OR
28495
CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX
ORPHALANGES; WITH MANIPULATION CLOSED TREATMENT OF
FRACTURE GREAT TOE, PHALANX OR
28496
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT
TOE,PHALANX OR PHALANGES, WITH MANIPULATION
PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT
TOE,
cohort
28505
Open treatment of fracture, great toe, phalanx or phalanges, includes
cohort
cohort
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES,
cohort
cohort
28510
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
65
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
Peer
Cohort
6
OTHERTHAN GREAT TOE; WITHOUT MANIPULATION, EACH
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGE S,
OTHER
28515
CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES,
OTHERTHAN GREAT TOE; WITH MANIPULATION, EACH CLOSED
TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER
28525
Open treatment of fracture, phalanx or phalanges, other than great toe,
includes internal fixation when performed, each
28530
CLOSED TREATMENT OF SESAMOID FRACTURECLOSED
TREATMENT OF SESAMOID FRACTURE
statewide
28531
OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR
WITHOUTINTERNAL FIXATION OPEN TREATMENT OF SESAMOID
FRACTURE, WITH OR WITHOUT
statewide
28540
CLOSED TREATMENT OF TARSAL BONE DISLOCATION,
OTHERTHANTALOTARSAL; WITHOUT ANESTHESIA CLOSED
TREATM ENT OF TARSAL BONE DISLOCATION, OTHER THAN
statewide
28545
CLOSED TREATMENT OF TARSAL BONE DISLOCATION,
OTHERTHANTALOTARSAL; REQUIRING ANESTHESIA CLOSED
TREA TMENT OF TARSAL BONE DISLOCATION, OTHER THAN
28555
Open treatment of tarsal bone dislocation, includes internal fixation
when performed
28585
Open treatment of talotarsal joint dislocation, includes internal fixation
when performed
28605
CLOSED TREATMENT OF TARSOMETATARSAL JOINT
DISLOCATION;REQUIRING ANESTHESIA CLOSED TREATMENT OF
TARSOMETATARSAL JOINT DISLOCATION;
28606
PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL
JOINTDISLOCATION, WITH MANIPULATION PERCUTANEOUS
SKELETAL FIXATION OF TARSOMETATARSAL JOINT
28615
Open treatment of tarsometatarsal joint dislocation, includes internal
28630
*CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT
DISLOCATION; WITHOUT ANESTHESIA *CLOSED TREATMENT
OFMETATARSOPHALANGEAL JOINT DISLOCATION;
28635
*CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT
DISLOCATION; REQUIRING ANESTHESIA *CLOSED TREATMENT
OF METATARSOPHALANGEAL JOINT DISLOCATION;
28636
PERCUTANEOUS SKELETAL FIXATION OF
METATARSOPHALANGEAL JOINT DISLOCATION, WITH
MANIPULATION PERCUTANEOUS SKELETAL FIXATION OF
METATARSOPHALANGEAL JOINT
cohort
cohort
28645
Open treatment of metatarsophalangeal joint dislocation includes
cohort
cohort
28660
*CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCATION;WITHOUT ANESTHESIA *CLOSED TREATMENT OF
INTERPHALANGEAL JOINT DISLOCATION;
cohort
cohort
28665
*CLOSED TREATMENT OF INTERPHALANGEAL JOINT
DISLOCATION;REQUIRING ANESTHESIA *CLOSED TREATMENT
OF INTERPHALANGEAL JOINT DISLOCATION;
28715
ARTHRODESIS; TRIPLEARTHRODESIS; TRIPLE
cohort
cohort
28725
ARTHRODESIS; SUBTALARARTHRODESIS; SUBTALAR
cohort
cohort
28730
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE
ORTRANSVERSE;
cohort
28735
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE
ORTRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT
CORRECTION)
cohort
28737
ARTHRODESIS, WITH TENDON LENGTHENING AND
ADVANCEMENT,MIDTARSAL NAVICULAR-CUNEIFORM (EG,
MILLER TYPE PROCEDURE)
28740
ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE
JOINT
cohort
cohort
cohort
cohort
cohort
28750
ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT
cohort
cohort
cohort
cohort
cohort
28755
ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
66
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
cohort
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
28760
ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER
TO FIRSTMETATARSAL NECK, GREAT TOE, INTERPHALANGEAL
JOINT (EG, JONES TYPE PROCEDURE)
cohort
28800
AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE
PROCEDURE)
28805
AMPUTATION, FOOT; TRANSMETATARSAL
cohort
cohort
28810
AMPUTATION, METATARSAL, WITH TOE, SINGLE
cohort
cohort
cohort
cohort
cohort
28820
AMPUTATION, TOE; METATARSOPHALANGEAL JOINT
cohort
cohort
cohort
cohort
cohort
28825
AMPUTATION, TOE; INTERPHALANGEAL JOINT
cohort
cohort
cohort
cohort
cohort
28899
UNLISTED PROCEDURE, FOOT OR TOES
cohort
cohort
cohort
cohort
cohort
29010
APPLICATION OF RISSER JACKET, LOCALIZER, BODY;
ONLYAPPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLY
statewide
29065
APPLICATION; SHOULDER TO HAND (LONG ARM)APPLICATION;
SHOULDER TO HAND (LONG ARM)
cohort
cohort
29075
APPLICATION; ELBOW TO FINGER (SHORT ARM)APPLICATION;
ELBOW TO FINGER (SHORT ARM)
cohort
cohort
29085
APPLICATION; HAND AND LOWER FOREARM
(GAUNTLET)APPLICATION; HAND AND LOWER FOREARM
(GAUNTLET)
29086
APPLICATION, CAST; FINGER (CONTRACTURE)
29105
APPLICATION OF LONG ARM SPLINT (SHOULDER TO
HAND)APPLICATION OF LONG ARM SPLINT (SHOULDER TO
HAND)
cohort
cohort
cohort
cohort
cohort
cohort
29125
APPLICATION OF SHORT ARM SPLINT (FOREARM TO
HAND);STATICAPPLICATION OF SHORT ARM SPLINT (FOREARM
TO HAND); STATIC
cohort
cohort
cohort
cohort
cohort
cohort
29126
APPLICATION OF SHORT ARM SPLINT (FOREARM TO
HAND);DYNAMICAPPLICATION OF SHORT ARM SPLINT
(FOREARM T O HAND); DYNAMIC
cohort
cohort
cohort
cohort
29130
APPLICATION OF FINGER SPLINT; STATICAPPLICATION
OFFINGER SPLINT; STATIC
cohort
cohort
cohort
cohort
29131
APPLICATION OF FINGER SPLINT; DYNAMICAPPLICATION OF
FINGER SPLINT; DYNAMIC
cohort
cohort
29200
STRAPPING; THORAX
29240
STRAPPING; SHOULDER (EG, VELPEAU)
cohort
cohort
cohort
cohort
cohort
29260
STRAPPING; ELBOW OR WRIST
cohort
cohort
cohort
cohort
cohort
29280
STRAPPING; HAND OR FINGER
cohort
cohort
cohort
cohort
cohort
29305
APPLICATION OF HIP SPICA CAST; 1 LEG
statewide
29325
APPLICATION OF HIP SPICA CAST; 1 AND ONE-HALF SPICA OR
BOTH LEGS
cohort
29345
APPLICATION OF LONG LEG CAST (THIGH TO
TOES);APPLICATION OF LONG LEG CAST (THIGH TO TOES);
29355
APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER
ORAMBULATORY TYPE APPLICATION OF LONG LEG CAST(THIGH
TO TOES); WALKER OR
29405
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO
TOES);APPLICATION OF SHORT LEG CAST (BELOW KNEE TO
TOES);
cohort
cohort
cohort
cohort
29425
APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);
WALKING OR AMBULATORY TYPE APPLICATION OF SHORTLEG
CAST (BELOW KNEE TO TOES); WALKING
cohort
cohort
cohort
cohort
29440
ADDING WALKER TO PREVIOUSLY APPLIED CASTADDING
WALKER TO PREVIOUSLY APPLIED CAST
29445
APPLICATION OF RIGID TOTAL CONTACT LEG CASTAPPLICATION
OF RIGID TOTAL CONTACT LEG CAST
29450
APPLICATION OF CLUBFOOT CAST WITH MOLDING OR
MANIPULATION,LONG OR SHORT LEG APPLICATION OF
CLUBFOOTCAST WITH MOLDING OR MANIPULATION,
29505
APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR
TOES)APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR
TOES)
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
67
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
29515
APPLICATION OF SHORT LEG SPLINT (CALF TO
FOOT)APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)
cohort
29520
STRAPPING; HIP
cohort
cohort
cohort
cohort
cohort
29530
STRAPPING; KNEE
cohort
cohort
cohort
cohort
cohort
29540
STRAPPING; ANKLE
cohort
cohort
cohort
cohort
cohort
29550
STRAPPING; TOES
cohort
cohort
cohort
cohort
29580
STRAPPING; UNNA BOOT
cohort
cohort
cohort
cohort
29581
APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM;
LEG(BELOW KNEE), INCLUDING ANKLE AND FOOT
cohort
cohort
cohort
29582
APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; THIGH
AND LEG, INCLUDING ANKLE AND FOOT, WHEN PERFORMED
statewide
29584
APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; UPPER
ARM, FOREARM, HAND, AND FINGERS
statewide
29705
REMOVAL OR BIVALVING; FULL ARM OR FULL LEG
CASTREMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST
29740
WEDGING OF CAST (EXCEPT CLUBFOOT CASTS)WEDGING OF
CAST (EXCEPT CLUBFOOT CASTS)
29799
UNLISTED PROCEDURE, CASTING OR STRAPPINGUNLISTED
PROCEDURE, CASTING OR STRAPPING
29804
ARTHROSCOPY, TEMPOROMANDIBULAR JOINT,
SURGICALARTHROSCOPY, TEMPOROMANDIBULAR JOINT,
SURGICAL
29805
ARTHROSCOPY, SHOULDER, DX, W/WO SYNOVIAL BIOPSY (SEP
PROC)
cohort
29806
ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPY
cohort
29807
REPAIR, SLAP LESION
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
29819
ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF
LOOSE BODY OR FOREIGN BODY ARTHROSCOPY, SHOULDER,
SURGICAL; WITH REMOVAL OF LOOSE BODY
cohort
cohort
cohort
cohort
cohort
cohort
29820
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY,
PARTIAL
cohort
cohort
cohort
cohort
cohort
29821
ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY,
COMPLETE
cohort
cohort
cohort
cohort
29822
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED
cohort
cohort
cohort
cohort
cohort
cohort
29823
ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT,
EXTENSIVE
cohort
cohort
cohort
cohort
cohort
cohort
29824
ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL
CLAVICULECTOMY W/ARTICULAR SURFACE
cohort
cohort
cohort
cohort
cohort
cohort
29825
ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND
RESECTION OFADHESIONS, WITH OR WITHOUT MANIPULATION
cohort
cohort
cohort
cohort
cohort
cohort
29826
ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF
SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY,
WITHCORACOACROMIAL LIGAMENT (IE, ARCH) RELEASE, WHEN
PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR
cohort
cohort
cohort
cohort
cohort
cohort
29827
ARTHROSCOPY, SHOULDER, SURGICAL; W/ROTATOR CUFF
REPAIR
cohort
cohort
cohort
cohort
cohort
cohort
29828
Arthroscopy, shoulder, surgical; biceps tenodesis
cohort
cohort
cohort
cohort
cohort
cohort
29834
ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE
BODY OR FOREIGN BODY ARTHROSCOPY, ELBOW, SURGICAL;
WITH REMOVAL OF LOOSE BODY OR
cohort
cohort
cohort
cohort
cohort
cohort
29835
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL
cohort
cohort
cohort
cohort
cohort
29836
ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE
cohort
cohort
29837
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED
cohort
29838
ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE
cohort
cohort
29840
ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT
SYNOVIALBIOPSY (SEPARATE PROCEDURE)
29844
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL
cohort
cohort
cohort
29845
ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE
cohort
cohort
29846
ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR
cohort
cohort
statewide
68
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
OFTRIANGULAR FIBROCARTILAGE AND/OR JOINT DEBRIDEMENT
29847
ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR
FRACTUREOR INSTABILITY
29848
ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF
TRANSVERSECARPAL LIGAMENT
cohort
29851
ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR
SPINE(S)AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE,WITH
OR WITHOUT MANIPULATION; WITH INTERNAL OR E XTERNAL
FIXATION (INCLUDES
cohort
29855
Arthroscopically aided treatment of tibial fracture, proximal (plateau);
unicondylar, includes internal fixation when performed (includes
arthroscopy)
29860
ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL
BIOPSY(SEPARATE PROCEDURE)
statewide
29861
ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE
BODY ORFOREIGN BODY ARTHROSCOPY, HIP, SURGICAL; WITH
REMOVAL OF LOOSE BODY OR
cohort
cohort
cohort
29862
ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING
OFARTICULAR CARTILAGE (CHONDROPLASTY),
ABRASIONARTHROPLASTY, AND/OR RESECTION OF LABRUM
cohort
cohort
cohort
cohort
29863
ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY
cohort
cohort
cohort
cohort
29866
Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g.,
mosaicplasty) (includes harvesting ofthe autograft[s])
29867
ARTHROSCOPY, KNEE, SURGICAL;OSTEOCHONDRAL
ALLOGRAFT IMPLANT W/SCOPE
statewide
29868
ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTION,
MEDIAL OR LATERAL W/SCOPE
cohort
29870
ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT
SYNOVIALBIOPSY (SEPARATE PROCEDURE)
cohort
29871
ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION,
LAVAGEANDDRAINAGE
29873
ARTHROSCOPY, KNEE, SURGICAL; W/LATERAL RELEASE
cohort
cohort
cohort
29874
ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE
BODY ORFOREIGN BODY (EG, OSTEOCHONDRITIS
DISSECANSFRAGMENTATION, CHONDRAL FRAGMENTATION)
cohort
cohort
29875
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG,
PLICAOR SHELF RESECTION) (SEPARATE PROCEDURE)
cohort
29876
ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2OR
MORE COMPARTMENTS (EG, MEDIAL OR LATERAL)
29877
ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING
OFARTICULAR CARTILAGE (CHONDROPLASTY)
29879
ARTHROSCOPY, KNEE, SURGICAL; ABRASION
ARTHROPLASTY(INCLUDESCHONDROPLASTY WHERE
NECESSARY) OR MULTIP LE DRILLING
29880
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY
(MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING)
INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
(CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S
29881
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY
(MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING)
INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE
(CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S)
29882
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR
(MEDIAL ORLATERAL)
29883
ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR
(MEDIALAND LATERAL)
29884
ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS,
WITHOR WITHOUT MANIPULATION (SEPARATE PROCEDURE)
29886
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR
INTACTOSTEOCHONDRITIS DISSECANS LESION
29887
ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR
INTACTOSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL
FIXATION
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
69
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
29888
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE
LIGAMENTREPAIR/AUGMENTATION OR RECONSTRUCTION
cohort
cohort
29889
ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE
LIGAMENTREPAIR/AUGMENTATION OR RECONSTRUCTION
cohort
cohort
cohort
cohort
cohort
cohort
29891
ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF
OSTEOCHONDRALDEFECT OF TALUS AND/OR TIBIA, INCLUDING
DRILLING OF THE DEFECT
cohort
cohort
cohort
cohort
29892
ARTHROSCOPICALLY AIDED REPAIR OF LARGE
OSTEOCHONDRITISDISSECANS LESION, TALAR DOME
FRACTURE, OR TIBIAL PLAFOND FRACTURE, WITH OR WITHOUT
INTERNAL FIXATION (INCLUDES
cohort
cohort
cohort
cohort
29893
ENDOSCOPIC PLANTAR FASCIOTOMY
cohort
cohort
cohort
cohort
cohort
29894
ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR
JOINTS),SURGICAL; WITH REMOVAL OF LOOSE BODY OR
FOREIGN BODY ARTHROSCOPY, ANKLE (TIBIOTALAR AND
FIBULOTALAR JOINTS),
cohort
cohort
29895
JOINTS),SURGICAL; SYNOVECTOMY, PARTIAL ARTHROSCOPY,
ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS),
cohort
cohort
29897
JOINTS),SURGICAL; DEBRIDEMENT, LIMITED ARTHROSCOPY,
cohort
29898
JOINTS),SURGICAL; DEBRIDEMENT, EXTENSIVE ARTHROSCOPY,
cohort
29899
ARTHROSCOPY, ANKLE, SURGICAL; W/ANKLE ARTHRODESIS
29906
Arthroscopy, subtalar joint, surgical; with debridement
29907
Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis
29914
Arthroscopy, hip, surgical; with femoroplasty (ie,treatment of cam lesion)
cohort
cohort
cohort
cohort
cohort
29915
Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment
of pincer lesion)
cohort
cohort
cohort
cohort
cohort
29916
Arthroscopy, subtalar joint, surgical; with labralrepair
cohort
cohort
cohort
cohort
cohort
cohort
29999
UNLISTED PROC, ARTHROSCOPY
cohort
cohort
cohort
cohort
cohort
cohort
30000
*DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL
APPROACH
cohort
30020
*DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM
statewide
30100
BIOPSY, INTRANASAL
30110
EXCISION, NASAL POLYP(S), SIMPLEEXCISION, NASAL POLYP(S),
SIMPLE
30115
EXCISION, NASAL POLYP(S), EXTENSIVEEXCISION,
NASALPOLYP(S), EXTENSIVE
30117
EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING
LASER),INTRANASAL LESION; INTERNAL APPROACH
cohort
30118
EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING
LASER),INTRANASAL LESION; EXTERNAL APPROACH (LATERAL
RHINOTOMY)
cohort
30125
EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE
ORCARTILAGE
cohort
cohort
30130
EXCISION TURBINATE, PARTIAL OR COMPLETE, ANY METHOD
cohort
cohort
cohort
cohort
cohort
cohort
30140
SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE,
ANYMETHOD
cohort
cohort
cohort
cohort
cohort
cohort
30150
RHINECTOMY; PARTIAL
30300
*REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE
PROCEDURE*REMOVAL FOREIGN BODY, INTRANASAL; OFFICE
TYPE PROCEDURE
30310
REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING
GENERALANESTHESIA REMOVAL FOREIGN BODY, INTRANASAL;
REQUIRING GENERAL
30400
RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES
AND/ORELEVATION OF NASAL TIP
statewide
30420
RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
70
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
30430
RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT
OFNASAL TIP WORK)
statewide
30450
RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP
WORK ANDOSTEOTOMIES)
statewide
30460
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO
CONGENITALCLEFT LIP AND/OR PALATE, INCLUDING
COLUMELLARLENGTHENING; TIP ONLY
30462
RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO
CONGENITALCLEFT LIP AND/OR PALATE, INCLUDING
COLUMELLARLENGTHENING; TIP, SEPTUM, OSTEOTOMIES
30465
REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER
GRAFTING, LATERAL NASAL WALL RECONSTRUCTION)
30520
SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR
WITHOUTCARTILAGE SCORING, CONTOURING OR
REPLACEMENT WITHGRAFT
30540
REPAIR CHOANAL ATRESIA; INTRANASAL
30545
REPAIR CHOANAL ATRESIA; TRANSPALATINE
30560
*LYSIS INTRANASAL SYNECHIA
30580
REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030
IFANTROTOMY IS INCLUDED)
30600
REPAIR FISTULA; ORONASAL
30620
SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES
NOTINCLUDEOBTAINING GRAFT)
30630
REPAIR NASAL SEPTAL PERFORATIONS
30801
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES,
UNILATERAL OR BILATERAL, ANY METHOD (EG,
ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE
VOLUME REDUCTION); SUPERFICIAL
30802
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES,
UNILATERAL OR BILATERAL, ANY METHOD (EG,
ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE
VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
30901
*CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED
CAUTERYAND/OR PACKING) ANY METHOD
30903
*CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX
(EXTENSIVECAUTERY AND/OR PACKING) ANY METHOD
30905
*CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH
POSTERIOR NASALPACKS AND/OR CAUTERIZATION, ANY
METHOD; INITIAL
30915
LIGATION ARTERIES; ETHMOIDAL
30920
LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY,
TRANSANTRAL
30930
FRACTURE NASAL TURBINATE(S), THERAPEUTIC
30999
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
UNLISTED PROCEDURE, NOSE
cohort
cohort
cohort
cohort
cohort
31000
*LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM
PUNCTURE OR NATURAL OSTIUM)
cohort
cohort
cohort
31002
*LAVAGE BY CANNULATION; SPHENOID SINUS
statewide
31020
SINUSOTOMY, MAXILLARY (ANTROTOMY);
INTRANASALSINUSOTOMY, MAXILLARY (ANTROTOMY);
INTRANASAL
cohort
cohort
31030
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELLLUC)WITHOUT REMOVAL OF ANTROCHOANAL POLYPS
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELLLUC)
31032
SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELLLUC)WITH REMOVAL OF ANTROCHOANAL POLYPS SINUSOTOMY,
MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC)
31040
PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH
31050
SINUSOTOMY, SPHENOID, WITH OR WITHOUT
BIOPSY;SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
cohort
31051
SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;
WITHMUCOSALSTRIPPING OR REMOVAL OF POLYP(S)
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
71
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
CPT
Description
31070
SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE
OPERATION)SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE
(TREPHINE OPERATION)
31080
SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT
OSTEOPLASTIC FLAP, BROW INCISION (INCLUDES ABLATION)
SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT
OSTEOPLASTIC FLAP,
31085
SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC
FLAP,CORONAL INCISION SINUSOTOMY FRONTAL;
OBLITERATIVE, WITH OSTEOPLASTIC FLAP,
31200
ETHMOIDECTOMY; INTRANASAL, ANTERIOR
cohort
31201
ETHMOIDECTOMY; INTRANASAL, TOTAL
statewide
31205
ETHMOIDECTOMY; EXTRANASAL, TOTAL
3120F
12-Lead ECG Performed (EM)
31225
MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION
31231
NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR
BILATERAL(SEPARATE PROCEDURE)
31233
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY
SINUSOSCOPY(VIA INFERIOR MEATUS OR CANINE FOSSA
PUNCTURE)
31235
NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID
SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE OR
CANNULATION OF OSTIUM)
31237
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY,
POLYPECTOMY ORDEBRIDEMENT (SEPARATE PROCEDURE)
31238
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF
EPISTAXIS
31239
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH
DACRYOCYSTORHINOSTOMY
31240
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA
BULLOSARESECTION
cohort
31254
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY,
PARTIAL(ANTERIOR)
31255
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY,
TOTAL(ANTERIOR AND POSTERIOR)
31256
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY
ANTROSTOMY;
31267
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY
ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY
SINUS
31276
NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL
SINUSEXPLORATION, WITH OR SINUS
31287
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
31288
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY;
WITHREMOVAL OF TISSUE FROM THE SPHENOID SINUS
31290
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR
OFCEREBROSPINAL FLUID LEAK; ETHMOID REGION
31291
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR
OFCEREBROSPINAL FLUID LEAK; SPHENOID REGION
statewide
31295
Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium
(eg, balloon dilation), transnasal or via canine fossa
statewide
31296
Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium
(eg, balloon dilation)
cohort
31297
Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium
(eg, balloon dilation)
statewide
31299
UNLISTED PROCEDURE, ACCESSORY SINUSES
31300
LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH
REMOVAL OFTUMOR OR LARYNGOCELE, CORDECTOMY
31500
INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE
31502
TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF
FISTULATRACT
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
statewide
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
72
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
31505
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE);
DIAGNOSTIC
31511
LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH
REMOVAL OFFOREIGN BODY LARYNGOSCOPY, INDIRECT
(SEPARATE PROCEDURE); WITH REMOVAL OF
31525
LARYNGOSCOPY DIRECT, WITH OR WITHOUT
TRACHEOSCOPY;DIAGNOSTIC, EXCEPT NEWBORN
cohort
cohort
cohort
cohort
31526
TRACHEOSCOPY;DIAGNOSTIC, WITH OPERATING MICROSCOPE
cohort
cohort
cohort
cohort
31528
TRACHEOSCOPY;WITHDILATATION, INITIAL LARYNGOSCOPY
DIRECT, WIT H OR WITHOUT TRACHEOSCOPY; WITH
cohort
cohort
cohort
cohort
31529
TRACHEOSCOPY;WITHDILATATION, SUBSEQUENT
LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY;
WITH
cohort
cohort
cohort
31530
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN
BODYREMOVAL; LARYNGOSCOPY, DIRECT, OPERATIVE, WITH
FO REIGN BODY REMOVAL;
cohort
cohort
cohort
cohort
31531
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN
BODYREMOVAL; WITH OPERATING MICROSCOPE
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY
REMOVAL;
31535
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
cohort
cohort
cohort
cohort
cohort
31536
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY;
WITHOPERATINGMICROSCOPE
cohort
cohort
cohort
cohort
cohort
31540
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF
TUMORAND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS;
cohort
cohort
cohort
cohort
cohort
31541
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF
TUMORAND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS;
WITH OPERATING MICROSCOPE
cohort
cohort
cohort
cohort
31545
LARNGOSCOPY, DIRECT, OPERATIVE, W/OPERATING MICROSCOPE OR TELESCOPE, W/SUBMUCOSAL REMOVAL OF NONNEOPLASTIC LESION(S) OF VOCAL CORD;
RECONSTRUCTIONW/LOCAL TISSUE FLAPS(S)
31560
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH
ARYTENOIDECTOMY;
31561
LARYNGOSCOPY, DIRECT, OPERATIVE, WITH
ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE
31570
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL
CORD(S),THERAPEUTIC;
31571
LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL
CORD(S),THERAPEUTIC; WITH OPERATING MICROSCOPE
31575
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC
31576
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY
cohort
31577
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL
OFFOREIGNBODY LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; W
ITH REMOVAL OF FOREIGN
statewide
31578
LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL
OFLESION
31579
LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH
STROBOSCOPY
31588
LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR
BURNS,RECONSTRUCTION AFTER PARTIAL LARYNGECTOMY)
cohort
cohort
cohort
31599
UNLISTED PROCEDURE, LARYNX
cohort
cohort
cohort
31611
CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND
SUBSEQUENTINSERTION OF AN ALARYNGEAL SPEECH
PROSTHESIS(EG, VOICE BUTTON, BLOM-SINGER PROSTHESIS)
statewide
31612
TRACHEAL PUNCTURE, PERCUTANEOUS WITH
TRANSTRACHEALASPIRATION AND/OR INJECTION
statewide
31613
TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION
statewide
31615
TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED
TRACHEOSTOMYINCISION
statewide
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
73
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
CPT
Description
31620
ENDOBRONCHIAL ULTRASOUND (EBUS) DURING
BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC
INTERVENTION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE(S))
31622
BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING
FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC,
WITH CELL WASHING, WHEN PERFORMED (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
cohort
31623
FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH
BRUSHING OR PROTECTED BRUSHINGS
cohort
cohort
cohort
cohort
cohort
31624
BRONCHIAL ALVEOLAR LAVAGE
cohort
cohort
cohort
cohort
cohort
31625
BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR
MULTIPLE SITES
cohort
cohort
cohort
cohort
cohort
31627
COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE[S])
31628
TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE
cohort
cohort
cohort
cohort
cohort
31629
TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), TRACHEA,
MAIN STEM AND/OR LOBAR BRONCHUS(I)
cohort
cohort
cohort
cohort
cohort
31630
TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF
FRACTURE
cohort
31631
PLACEMENT OF TRACHEAL STENT(S) (INCLUDES
TRACHEAL/BRONCHIAL DILATION AS REQUIRED)
31632
TRANSBRONCHIAL LUNG BIOPSY(S), EACH ADDITIONAL LOBE
PROCEDURE)
cohort
cohort
cohort
31633
TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), EACH
ADDITIONAL LOBE (LIST SEPARATELY IN ADDITION TO CODE
FOR PRIMARY
cohort
cohort
cohort
31635
REMOVAL OF FOREIGN BODY
cohort
cohort
31636
PLACEMENT OF BRONCHIAL STENT(S) (INCLUDES
TRACHEAL/BRONCHIAL DILATION AS REQUIRED), INITIAL
BRONCHUS
cohort
31640
EXCISION OF TUMOR
cohort
31641
DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY
METHOD OTHER THAN EXCISION (EG, LASER THERAPY,
CRYOTHERAPY)
statewide
31645
THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE,
Peer
Cohort
6
statewide
cohort
statewide
cohort
cohort
74
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
INITIAL (EG, DRAINAGE OF LUNG ABSCESS)
31720
CATHETER ASPIRATION (SEPARATE PROCEDURE);
NASOTRACHEAL
31800
SUTURE OF TRACHEAL WOUND OR INJURY; CERVICAL
statewide
31820
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT
PLASTICREPAIR
statewide
31825
SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH
PLASTICREPAIR
31830
REVISION OF TRACHEOSTOMY SCAR
31899
UNLISTED PROCEDURE, TRACHEA, BRONCHI
32400
*BIOPSY, PLEURA; PERCUTANEOUS NEEDLE
cohort
cohort
32405
BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE
cohort
cohort
cohort
cohort
cohort
32550
Insertion of indwelling tunneled pleural catheter with cuff
cohort
cohort
cohort
cohort
cohort
32551
TUBE THORACOSTOMY, INCLUDES CONNECTION TO
DRAINAGESYSTEM (EG, WATER SEAL), WHEN PERFORMED,
OPEN (SE PARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
32552
REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER
WITH CUFF
cohort
cohort
32553
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION
THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER),
PERCUTANEOUS, INTRA-THORACIC, SINGLE OR MULTIPLE
cohort
cohort
32554
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE
PLEURAL SPACE; WITHOUT IMAGING GUIDANCE
cohort
cohort
cohort
cohort
cohort
32555
THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE
PLEURAL SPACE; WITH IMAGING GUIDANCE
cohort
cohort
cohort
cohort
cohort
32556
PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF
INDWELLING CATHETER; WITHOUT IMAGING GUIDANCE
32557
PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF
INDWELLING CATHETER; WITH IMAGING GUIDANCE
32561
INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR
FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF
MULTILOCULATED EFFUSION); INITIAL DAY
statewide
32562
INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR
FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF
MULTILOCULATED EFFUSION); SUBSEQUENT DAY
statewide
32606
THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE);
MEDIASTINALSPACE, WITH BIOPSY
32609
THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA
32655
THORACOSCOPY, SURGICAL; WITH RESECTION-PLICATION OF
BULLAE, INCLUDES ANY PLEURAL PROCEDURE WHEN
PERFORMED
32663
THORACOSCOPY, SURGICAL; WITH LOBECTOMY (SINGLE LOBE)
32664
THORACOSCOPY, SURGICAL; WITH THORACIC
SYMPATHECTOMYTHORACOSCOPY, SURGICAL; WITH THORACIC
SYMPATHECTOMY
32666
THORACOSCOPY, SURGICAL; WITH THERAPEUTIC WEDGE
RESECTION (EG, MASS, NODULE), INITIAL UNILATERAL
statewide
32997
TOTAL LUNG LAVAGE (UNILATERAL)
statewide
32998
ABLATION THERAPY FOR REDUCTION OR ERADICATION OF 1OR
MORE PULMONARY TUMOR(S) INCLUDING PLEURA OR CH EST
WALL WHEN INVOLVED BY TUMOR EXTENSION,
PERCUTANEOUS, RADIOFREQUENCY, UNILATERAL
statewide
32999
UNLISTED PROCEDURE, LUNGS AND PLEURA
statewide
33010
*PERICARDIOCENTESIS; INITIAL
33202
INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG,
THORACOTOMY, MEDIAN STERNOTOMY, SUBXIPHOID
APPROACH)
33206
INSERTION OF NEW OR REPLACEMENT OF PERMANENT
PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL
33207
PACEMAKER WITH TRANSVENOUS ELECTRODE(S);
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
cohort
75
cohort
cohort
Peer
Cohort
6
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
33208
PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND
VENTRICULAR
cohort
cohort
cohort
cohort
33210
INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS
SINGLECHAMBER CARDIAC ELECTRODE OR PACEMAKER
CATHETER (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
33213
INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH
EXISTING DUAL LEADS
cohort
33215
REPOSITIONING, PREVIOUSLY IMPLANTED TRANSVENOUS
ELECTRODE/PACING CARDIOVERT-DEFIB ELECTRODE
33216
INSERTION OF A SINGLE TRANSVENOUS ELECTRODE,
PERMANENT PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR
33217
INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT
PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR
33218
REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT
PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR
33222
REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER
statewide
33223
REVISION OF SKIN POCKET FOR CARDIOVERTERDEFIBRILLATOR
cohort
cohort
33224
INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM,
FOR LEFT VENTRICULAR PACING, WITH ATTACHMENT TO
PREVIOUSLY PLACED PACEMAKER OR PACING CARDIOVERTERDEFIBRILLATOR PULSE GENERATOR (INCLUDING REVISI
33225
INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM,
FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF
PACING CARDIOVERTER-DEFIBRILLATOR OR PACEMAKER
PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMB
cohort
cohort
33227
REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR
WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR;
SINGLELEAD SYSTEM
33228
WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; DUAL
LEAD SYSTEM
33229
WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR;
MULTIPLE LEAD SYSTEM
33233
ONLY
cohort
cohort
33235
REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL
LEADSYSTEM
cohort
cohort
33241
REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR
PULSEGENERATOR ONLY
cohort
cohort
33244
REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR
PULSEGENERATOR AND/OR LEAD SYSTEM; BY OTHER THAN
THORACOTOMY REMOVAL OF IMPLANTABLE CARDIOVERTERDEFIBRILLATOR PULSE
cohort
cohort
33249
INSERTION OR REPLACEMENT OF PERMANENT PACING
CARDIOVERTER-DEFIBRILLATOR SYSTEM WITH TRANSVENOUS
LEAD(S), SINGLE OR DUAL CHAMBER
cohort
cohort
cohort
33262
PULSEGENERATOR WITH REPLACEMENT OF PACING
CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR; SINGLE
LEAD SYSTEM
cohort
cohort
cohort
33263
CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR; DUAL
LEAD SYSTEM
cohort
cohort
cohort
cohort
33264
CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR;
MULTIPLE LEAD SYSTEM
cohort
cohort
cohort
cohort
33282
IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT
RECORDER
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
VENTRICULAR
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
76
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
CPT
Description
33284
REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC
EVENT RECORDER
34111
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT
CATHETER;RADIAL OR ULNAR ARTERY, BY ARM INCISION
EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT
CATHETER;
34520
CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM
35045
DIRECT REPAIR OF ANEURYSM, FALSE ANEURYSM, OR
EXCISION(PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR
WITHOUT PATCH GRAFT; FOR ANEURYSM, FALSE ANEURYSM,
AND ASSOCIATED
35190
REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS
FISTULA;EXTREMITIES
35201
REPAIR BLOOD VESSEL, DIRECT; NECK
cohort
cohort
35206
REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY
cohort
cohort
35207
REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER
cohort
35221
REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL
35226
REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY
35301
Thromboendarterectomy, including patch graft, if performed; carotid,
vertebral, subclavian, by neck incision
35302
THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF
PERFORMED; SUPERFICIAL FEMORAL ARTERY
35390
REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE
THAN 1 MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY
IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
35471
Transluminal balloon angioplasty, percutaneous; renal or visceral artery
35472
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS;
AORTIC
35475
TRANSLUMINAL BALLOON ANGIOPLASTY,
PERCUTANEOUS;BRACHIOCEPHALIC TRUNK OR BRANCHES,
EACH VESSEL
cohort
cohort
cohort
cohort
cohort
35476
TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS;
VENOUS
cohort
cohort
cohort
cohort
cohort
35761
EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH
ORWITHOUT LYSIS OF ARTERY; OTHER VESSELS
cohort
cohort
35800
EXPLORATION FOR POSTOPERATIVE HEMORRHAGE,
THROMBOSIS ORINFECTION; NECK
cohort
cohort
35876
THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER
THANHEMODIALYSIS GRAFT OR FISTULA); WITH REVISION
OFARTERIAL OR VENOUS GRAFT
35903
EXCISION OF INFECTED GRAFT; EXTREMITY
statewide
36000
*INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN
cohort
36002
INJECTION (THROMBIN) PERCUTANEOUS TREATMENT
EXTREMITY PSEUDOANEURYSM
36005
INJECTION PROCEDURE FOR CONTRAST VENOGRAPHY
(INCLUDINGINTRODUCTION OF NEEDLE OR INTRACATHETER)
36010
INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA
CAVA
36011
Selective Catheter placement
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
36012
SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND
ORDER,OR MORE SELECTIVE, BRANCH (EG, LEFT ADRENAL
VEIN, PETROSAL SINUS)
cohort
cohort
36014
SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT
PULMONARY ARTERY
statewide
36015
SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR
SUBSEGMENTALPULMONARY ARTERY
cohort
cohort
36140
INTRODUCTION OF NEEDLE OR INTRACATHETER;
EXTREMITYARTERY
36147
INTRODUCTION OF NEEDLE AND/OR CATHETER,
ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS
(GRAFT/FISTULA); INITIAL ACCESS WITH COMPLETE
cohort
cohort
77
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
RADIOLOGICAL EVALUATIONOF DIALYSIS ACCESS, INCLUDING
FLUOROSCOPY, IMAGE
36148
INTRODUCTION OF NEEDLE AND/OR CATHETER,
ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS
(GRAFT/FISTULA); ADDITIONAL ACCESS FOR THERAPEUTIC
INTERVENTION (LISTSEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCED
cohort
cohort
cohort
cohort
36200
INTRODUCTION OF CATHETER, AORTA
cohort
cohort
cohort
cohort
36215
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH
FIRSTORDER THORACIC OR BRACHIOCEPHALIC BRANCH,
WITHIN A VASCULAR FAMILY
cohort
cohort
cohort
cohort
36216
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM;
INITIALSECOND ORDER THORACIC OR BRACHIOCEPHALIC
BRANCH, WITHIN A VASCULAR FAMILY
cohort
cohort
cohort
36217
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL
THIRDORDER OR MORE SELECTIVE THORACIC OR
BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY
cohort
cohort
cohort
36218
ADDITIONALSECOND ORDER, THIRD ORDER, AND BEYOND,
THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A
VASCULARFAMILY (LIST IN
cohort
cohort
36221
NON-SELECTIVE CATHETER PLACEMENT, THORACIC AORTA,
WITH ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID,
VERTEBRAL, AND/OR INTRACRANIAL VESSELS, UNILATERAL OR
BILATERAL, AND ALL ASSOCIATED RADIOLOGICAL SUPERVI
cohort
36222
SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR
INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH
ANGIOGRAPHY OF THE IPSILATERAL EXTRACRANIAL CAROTID
CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERV
cohort
36223
SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR
INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH
ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID
CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERV
cohort
36224
SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID
ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE
IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL
ASSOCIATED RADIOLOGICAL SUPERVISION AND
INTERPRETATION,
36225
SELECTIVE CATHETER PLACEMENT, SUBCLAVIAN OR
INNOMINATE ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF
THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL
ASSOCIATED RADIOLOGICAL SUPERVISION AND
INTERPRETATION, INC
36226
SELECTIVE CATHETER PLACEMENT, VERTEBRAL ARTERY,
UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL
VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL
SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAP
36227
SELECTIVE CATHETER PLACEMENT, EXTERNAL CAROTID
ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE
IPSILATERAL EXTERNAL CAROTID CIRCULATION AND ALL
ASSOCIATEDRADIOLOGICAL SUPERVISION AND
INTERPRETATION (LIST
36228
SELECTIVE CATHETER PLACEMENT, EACH INTRACRANIAL
BRANCH OF THE INTERNAL CAROTID OR VERTEBRAL ARTERIES,
UNILATERAL, WITH ANGIOGRAPHY OF THE SELECTED VESSEL
CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SU
36245
SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH
FIRST ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY
ARTERY BRANCH, WITHIN A VASCULAR FAMILY
cohort
cohort
cohort
cohort
36246
SECOND ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY
ARTERY BRANCH, WITHIN A VASCULAR FAMILY
cohort
cohort
cohort
cohort
36247
THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR
LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR
FAMILY
cohort
cohort
cohort
cohort
78
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
CPT
Description
36248
ADDITIONAL SECOND ORDER, THIRD ORDER, AND BEYOND,
ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH,
WITHIN A VASCULAR FAMILY (LIST IN ADDITION TO CODE
cohort
36251
SELECTIVE CATHETER PLACEMENT (FIRST-ORDER), MAIN
RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR
RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE
ANDCATHETER PLACEMENT(S), FLUOROSCOPY, CONTRAST INJE
cohort
cohort
cohort
cohort
36252
SELECTIVE CATHETER PLACEMENT (FIRST-ORDER), MAIN
RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR
RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE
ANDCATHETER PLACEMENT(S), FLUOROSCOPY, CONTRAST INJE
cohort
cohort
cohort
cohort
36253
SUPERSELECTIVE CATHETER PLACEMENT (ONE OR MORE
SECOND ORDER OR HIGHER RENAL ARTERY BRANCHES) RENAL
ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL
ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE, CATHETER
cohort
cohort
cohort
36254
SUPERSELECTIVE CATHETER PLACEMENT (ONE OR MORE
SECOND ORDER OR HIGHER RENAL ARTERY BRANCHES) RENAL
ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL
ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE, CATHETER
statewide
36262
REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP
36299
UNLISTED PROCEDURE, VASCULAR INJECTION
statewide
36406
VENIPUNCTURE, YOUNGER THAN AGE 3 YEARS,
NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER
QUALIFIED HEALTH CARE PROFESSIONAL, NOT TO BE USED
FOR ROUTINEVENIPUNCTURE; OTHER VEIN
statewide
36410
VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE
SKILL OF A PHYSICIAN OR OTHER QUALIFIED HEALTHCARE
PROFESSIONAL (SEPARATE PROCEDURE), FOR DIAGN OSTIC OR
THERAPEUTIC PURPOSES (NOT TO BE USED FOR
36415
*ROUTINE VENIPUNCTURE OR FINGER/HEEL/EAR STICK
FORCOLLECTION OF SPECIMEN(S) *ROUTINE VENIPUNCTURE
OR FINGER/HEEL/EAR STICK FOR
cohort
36416
COLLECTION OF CAPILLARY BLOOD SPECIMEN (EG, FINGER,
HEEL, EAR STICK)
cohort
36430
TRANSFUSION, BLOOD OR BLOOD
COMPONENTSTRANSFUSION,BLOOD OR BLOOD COMPONENTS
cohort
36470
*INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN
36471
*INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS,SAME
LEG
36475
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN,
EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND
MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN
TREATED
36478
EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE &
MONITORING, PERCUTANEOUS, LASER; FIRST VEIN TREATED
36479
EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE &
MONITORING, PERCUTANEOUS, LASER;2ND & SEBSEQUENT
VEINS TREATED IN A SINGLE EXTREMITY, EACH SEPARATE SIT
statewide
36481
PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY
METHOD
statewide
36500
VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD
SAMPLING
cohort
36511
THERAPEUTIC APHERESIS; WHITE BLOOD CELLS
statewide
36512
THERAPEUTIC APHERESIS; RED BLOOD CELLS
statewide
36513
THERAPEUTIC APHERESIS; PLATELETS
cohort
cohort
36514
THERAPEUTIC APHERESIS; PLASMA PHERESIS
cohort
cohort
36516
THERAPEUTIC APHERESIS, W/EXTRACOPPRL SELECTVE
FILTRATION & PLASMA REINFUSION
36522
PHOTOPHERESIS, EXTRACORPOREAL
36555
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
79
statewide
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
VENOUS CATHETER; UNDER 5 YEARS OF AGE
36556
INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL
VENOUS CATHETER; AGE 5 YEARS OR OLDER
36557
INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL
VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR
PUMP;UNDER 5 YEARS OF AGE
36558
VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR
PUMP;AGE 5 YEARS OR OLDER
36560
VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; UNDER
5 YEARS OF AGE
36561
VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5
YEARS OR OLDER
cohort
36563
VENOUS ACCESS DEVICE WITH SUBCUTANEOUS PUMP
cohort
36568
INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS
CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP;
UNDER 5 YEARS OF AGE
36569
CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP;
AGE 5 YEARS OR OLDER
cohort
cohort
36571
ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARSOR
OLDER
cohort
cohort
36575
REPAIR OF TUNNELED OR NON-TUNNELED CENTRAL VENOUS
ACCESS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP,
CENTRAL OR PERIPHERAL INSERTION SITE
36576
REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH
SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL
INSERTION SITE
36578
REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS
ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP,
CENTRALOR PERIPHERAL INSERTION SITE
36580
REPLACEMENT, COMPLETE, OF A NON-TUNNELED
CENTRALLYINSERTED CENTRAL VENOUS CATHETER, WITHOUT
SUBCUTA NEOUS PORT OR PUMP, THROUGH SAME VENOUS
ACCESS
36581
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY
INSERTED CENTRAL VENOUS CATHETER, WITHOUT
SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS
ACCESS
36582
REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY
INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH
SUBCUTANEOUS PORT, THROUGH SAME VENOUS ACCESS
36584
REPLACEMENT COMPLETE OF A PERIPHERALLY INSERTED
CENTRAL VENOUS CATHETER (PICC) WITHOUT SUBCUTANEOUS
PORT OR PUMP THROUGH SAME VENOUS ACCESS
36585
REPLACEMENT COMPLETE OF A PERIPHERALLY INSERTED
CENTRAL VENOUS ACCESS DEVICE WITH SUBCUTANEOUS
PORT THROUGH SAME VENOUS ACCESS
36589
REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER
WITHOUT SUBCUTANEOUS PORT OR PUMP
cohort
cohort
cohort
cohort
cohort
cohort
36590
REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE
WITH SUBCUTANEOUS PORT OR PUMP CENTRAL OR
PERIPHERAL INSERTION
cohort
cohort
cohort
cohort
cohort
cohort
36591
Collection of blood specimen from a completely implantable venous
access device
cohort
cohort
cohort
cohort
cohort
36592
Collection of blood specimen using established central or peripheral
catheter, venous, not otherwisespecified
cohort
cohort
cohort
cohort
36593
Declotting by thrombolytic agent of implanted vascular access device or
catheter
cohort
cohort
cohort
cohort
36595
MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE
MATERIAL (EG FIBRIN SHEATH) FROM CENTRAL VENOUS DEVICE
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
80
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
VIA SEPARATE VENOUS ACCESS
36596
MECHANICAL REMOVAL OF INTRALUMINAL
(INTRACATHETER)OBSTRUCTIVE MATERIAL FROM CENTRAL
VENOUS DEVICE THROUGH DEVICE LUMEN
36597
REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS
CATHETER UNDER FLUOROSCOPIC GUIDANCE
36598
CONTRAST INJECTION(S) FOR RADIOLOGIC EVALUATION
OFEXISTING CENTRAL VENOUS ACCESS DEVICE, INCLUDING
FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT
cohort
cohort
cohort
cohort
cohort
36600
*ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR
DIAGNOSIS
cohort
cohort
cohort
cohort
cohort
36620
ARTERIAL CATHETERIZATION OR CANNULATION FOR
SAMPLING,MONITORING OR TRANSFUSION (SEPARATE
PROCEDURE);PERCUTANEOUS ARTERIAL CATHETERIZATION OR
CANNULA TION FOR SAMPLING,
cohort
cohort
cohort
cohort
36680
PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION
cohort
cohort
cohort
cohort
36815
INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER
PURPOSE(SEPARATE PROCEDURE); ARTERIOVENOUS,
EXTERNAL REVISION, OR CLOSURE
36818
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM
CEPHALIC VEIN TRANSPOSITION
36819
ARTERIOVENOUS ANASTOMOSIS, OPEN; BY BASILIC VEIN
TRANSPOSITION
36820
ARTERIOVENOUS ANASTOMOSIS, OPEN; FOREARM VEIN
TRANSPOSITION
36821
ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (EG,
CIMINOTYPE) (SEPARATE ARTERIOVENOUS ANASTOMOSIS,
DIRECT, ANY SITE (EG, CIMINO
36825
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN
DIRECTARTERIOVENOUS ANASTOMOSIS (SEPARATE
PROCEDURE); AUTOGENOUS GRAFT
36830
CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN
DIRECTARTERIOVENOUS ANASTOMOSIS (SEPARATE
PROCEDURE); NONAUTOGENOUS GRAFT
36831
THROMBECTOMY, ARTERIOVENOUS FISTULA WITHOUT
REVISION,AUTOGENOUS OR NONAUTOGENOUS DIALYSIS
GRAFT (SEPARATE PROCEDURE)
36832
REVISION, ARTERIOVENOUS FISTULA; WITHOUT
THROMBECTOMY,AUTOGENOUS OR NONAUTOGENOUS,
DIALYSIS GRAFT (SEPARATE PROCEDURE)
36833
REVISION, ARTERIOVENOUS FISTULA; WITH
THROMBECTOMY,AUTOGENOUS OR NONAUTOGENOUS
DIALYSIS GRAFT (SEPARATE PROCEDURE)
36838
DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL)
UPPER EXTREMITY HEMODIALYSIS ACCESS (STEAL SYNDROME)
cohort
36860
EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE);
WITHOUTBALLOON CATHETER EXTERNAL CANNULA
DECLOTTING (SEPARATE PROCEDURE); WITHOUT
36870
THROMBECTOMY, PERCUTANOUS, ARTERIOVENOUS FISTULA,
AUTOGENOUS OR NONAUTOGENOUS GRAFT (INCLUDES
MECHANICAL THROMBUS EXTRACTION AND INTRA-GRAFT
THROMBOLYSIS)
37182
INSERTION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC
SHUNT(S)
statewide
37183
REVISION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC
SHUNT(S)
statewide
37184
PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL
THROMBECTOMY, NONCORONARY, ARTERIAL OR ARTERIAL
BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND
INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC
INJECTION(S)
37186
SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY
(EG, NONPRIMARY MECHANICAL, SNARE BASKET, SUCTION
TECHNIQUE), NONCORONARY, ARTERIAL OR ARTERIAL BYPASS
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
81
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRA
37187
PERCUTANEOUS TRANSLUMINAL MECHANICAL
THROMBECTOMY,VEIN(S), INCLUDING INTRAPROCEDURAL
PHARMACOLOGICA L THROMBOLYTIC INJECTIONS AND
FLUOROSCOPIC GUIDANCE
37191
INSERTION OF INTRAVASCULAR VENA CAVA FILTER,
ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS,
VESSELSELECTION, AND RADIOLOGICAL SUPERVISION AND
INTER PRETATION, INTRAPROCEDURAL ROADMAPPING, AND
IMAGIN
cohort
cohort
cohort
cohort
37193
RETRIEVAL (REMOVAL) OF INTRAVASCULAR VENA CAVA FILTER,
ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS,
VESSEL SELECTION, AND RADIOLOGICAL SUPERVISIONAND
INTERPRETATION, INTRAPROCEDURAL ROADMAPPING,
cohort
cohort
cohort
cohort
37195
THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION
statewide
37197
TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF
INTRAVASCULAR FOREIGN BODY (EG, FRACTURED VENOUS OR
ARTERIAL CATHETER), INCLUDES RADIOLOGICAL SUPERVISION
AND INTERPRETATION, AND IMAGING GUIDANCE (ULTRASOUND
cohort
cohort
cohort
37200
TRANSCATHETER BIOPSY
cohort
cohort
cohort
37202
TRANSCATHETER THERAPY, INFUSION OTHER THAN FOR
THROMBOLYSIS,ANY TYPE (EG, SPASMOLYTIC,
VASOCONSTRICTIVE)
statewide
37204
TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR
TUMORDESTRUCTION, TO ACHIEVE HEMOSTASIS, TO
OCCLUDEA VASCULAR MALFORMATION), PERCUTANEOUS, ANY
METH OD, NON-CENTRAL NERVOUS
cohort
cohort
cohort
37205
Transcatheter placement of an intravascular stent(s) (except coronary,
carotid, vertebral, iliac, and lower extremity arteries), percutaneous;
initialvessel
cohort
cohort
cohort
cohort
37206
Transcatheter placement of an intravascular stent(s) (except coronary,
carotid, vertebral, iliac, and lower extremity arteries), percutaneous;
each additional vessel (List separately in addition to co
cohort
cohort
cohort
37210
UTERINE FIBROID EMBOLIZATION (UFE, EMBOLIZATION OFTHE
UTERINE ARTERIES TO TREAT UTERINE FIBROIDS, L
EIOMYOMATA), PERCUTANEOUS APPROACH INCLUSIVE OF
VASCULAR ACCESS, VESSEL SELECTION, EMBOLIZATION, AND
cohort
cohort
cohort
37215
Transcatheter placement of intravascular stent(s),cervical carotid artery,
percutaneous with distal embolic protection
37220
Revascularization, endovascular, open or percutaneous, iliac artery,
unilateral, initial vessel; with transluminal angioplasty
37221
unilateral, initial vessel; with transluminal stent placement(s), includes
angioplasty within the same vessel, when performed
37222
each additional ipsilateral iliac vessel; with transluminal angioplasty (List
37223
each additional ipsilateral iliac vessel; with transluminal stent
placement(s), includes angioplasty within the same vessel, when p
37224
Revascularization, endovascular, open or percutaneous, femoral,
popliteal artery(s), unilateral; with transluminal angioplasty
37225
popliteal artery(s), unilateral; with atherectomy, includes angioplasty
within the same vessel, when performed
37226
popliteal artery(s), unilateral; with transluminal stent placement(s),
includes angioplasty within the same vessel, when performed
37227
popliteal artery(s), unilateral; with transluminal stent placement(s) and
atherectomy,includes angioplasty within the same vessel, when
37228
Revascularization, endovascular, open or percutaneous, tibial, peroneal
artery, unilateral, initial vessel; with transluminal angioplasty
37229
artery, unilateral, initial vessel; with atherectomy, includes angioplasty
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
82
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
within the same vessel, when performed
37230
artery, unilateral, initial vessel; with transluminal stent placement(s),
includes angioplasty within the same vessel, when perf
37232
Revascularization, endovascular, open or percutaneous, tibial/peroneal
artery, unilateral, each additional vessel; with transluminal angioplasty
(Listseparately in addition to code for primary proced
37233
Revascularization, endovascular, open or percutaneous, tibial/peroneal
artery, unilateral, each additional vessel; with atherectomy, includes
angioplasty within the same vessel, when performed (List s
37250
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL)
DURINGTHERAPEUTIC INTERVENTION; INITIAL VESSEL (LIST
37607
LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS
FISTULA
37609
LIGATION OR BIOPSY, TEMPORAL ARTERY
37617
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC,
RUPTURE);ABDOMEN
37618
LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC,
RUPTURE);EXTREMITY
statewide
37700
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN
ATSAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT
cohort
cohort
37718
LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUSVEIN
cohort
cohort
37722
LIGATION, DIVISION, AND STRIPPING, LONG (GREATER)
SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO
KNEE OR BELOW
37761
LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN,
INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG
37765
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20
STAB INCISIONS
cohort
37766
STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE
THAN 20 INCISIONS
cohort
37785
LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN
COHORT(S), 1 LEG
statewide
37790
PENILE VENOUS OCCLUSIVE PROCEDURE
statewide
37799
UNLISTED PROCEDURE, VASCULAR SURGERYUNLISTED
PROCEDURE, VASCULAR SURGERY
38100
SPLENECTOMY; TOTAL (SEPARATE PROCEDURE)
38101
SPLENECTOMY; PARTIAL
38115
REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR
WITHOUTPARTIAL SPLENECTOMY
statewide
38120
LAPAROSCOPY, SURGICAL, SPLENECTOMY
cohort
38129
UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN
statewide
38205
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL
HARVESTING FOR TRANSPLANTATION, PER COLLECTION;
ALLOGENEIC
statewide
38206
BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL
HARVESTING, TRANSPLANTATION/COLLECTION; AUTOLOGOUS
statewide
38207
TRANSPLANT PREPARATION, HEMATOPIETIC PROGENITOR
CELLS, CRYOPRESERVATION AND STORAGE
statewide
38208
TRANSPLANT PREPARATION OF HEMATOPOIETIC
PROGENITORCELLS; THAWING OF PREVIOUSLY FROZEN
HARVEST, WITH OUT WASHING, PER DONOR
statewide
38214
CELLS, PLASMA VOLUME DEPLETION
statewide
38215
CELLS, CELL CONC, PLASMA/MONONUCLEAR/ BUFFY COAT
38220
BONE MARROW ASPIRATION
cohort
cohort
cohort
cohort
cohort
38221
BONE MARROW BX. NEEDLE/TROCAR
cohort
cohort
cohort
cohort
cohort
38232
BONE MARROW HARVESTING FOR TRANSPLANTATION;
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
83
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
AUTOLOGOUS
38241
HEMATOPOIETIC PROGENITOR CELL (HPC); AUTOLOGOUS
TRANSPLANTATION
38242
ALLOGENEIC LYMPHOCYTE INFUSIONS
38500
BIOPSY OR EXCISION OF LYMPH NODE(S); SUPERFICIAL
(SEPARATEPROCEDURE)
cohort
cohort
cohort
cohort
cohort
38505
BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE,
SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY)
cohort
cohort
cohort
cohort
cohort
38510
BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP
CERVICALNODE(S)
cohort
cohort
cohort
cohort
cohort
cohort
38520
CERVICALNODE(S)WITH EXCISION SCALENE FAT PAD
38525
AXILLARYNODE(S)
cohort
cohort
cohort
38530
BIOPSY OR EXCISION OF LYMPH NODE(S); INTERNAL
MAMMARYNODE(S)
statewide
38542
DISSECTION, DEEP JUGULAR NODE(S)
statewide
38562
LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE
PROCEDURE);PELVIC AND PARA-AORTIC
cohort
cohort
cohort
38570
LAPAROSCOPY, SURGICAL;WITH RETROPERITONEAL LYMPH
NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE
cohort
cohort
cohort
38571
LAPAROSCOPY, SURGICAL;WITH BILATERAL TOTAL PELVIC
LYMPHADENECTOMY
cohort
cohort
cohort
38572
LAPAROSCOPY, SURGICAL;WITH BILATERAL TOTAL PELVIC
LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE SAMPLING
(BIOPSY), SINGLE OR MULTIPLE
cohort
cohort
cohort
38589
UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM
cohort
cohort
38700
SUPRAHYOID LYMPHADENECTOMYSUPRAHYOID
LYMPHADENECTOMY
38720
CERVICAL LYMPHADENECTOMY (COMPLETE)CERVICAL
LYMPHADENECTOMY (COMPLETE)
38724
CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK
DISSECTION) CERVICAL LYMPHADENECTOMY (MODIFIED
RADICAL NECK DISSECTION)
38740
AXILLARY LYMPHADENECTOMY; SUPERFICIALAXILLARY
LYMPHADENECTOMY; SUPERFICIAL
38745
AXILLARY LYMPHADENECTOMY; COMPLETEAXILLARY
LYMPHADENECTOMY; COMPLETE
cohort
cohort
cohort
38760
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL,
INCLUDINGCLOQUET'S NODE (SEPARATE PROCEDURE)
INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL,
INCLUDING
cohort
cohort
cohort
38770
PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL
ILIAC,HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE
PROCEDURE) PELVIC LYMPHADENECTOMY, INCLUDING
EXTERNAL ILIAC,
cohort
cohort
38790
INJECTION PROCEDURE; LYMPHANGIOGRAPHY
38792
INJECTION PROCEDURE; RADIOACTIVE TRACER FOR
IDENTIFICATION OF SENTINEL NODE
cohort
cohort
cohort
cohort
38900
Intraoperative identification (eg, mapping) of sentinel lymph node(s)
includes injection of non-radioactive dye, when performed (List
cohort
cohort
cohort
cohort
38999
UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM
cohort
cohort
cohort
cohort
39010
MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE,
REMOVALOFFOREIGN BODY, OR BIOPSY; TRANSTHORACIC
APPROACH , INCLUDING EITHER TRANSTHORACIC OR MEDIAN
STERNOTOMY
39220
RESECTION OF MEDIASTINAL TUMOR
39400
MEDIASTINOSCOPY, INCLUDES BIOPSY(IES), WHEN PERFORMED
39599
UNLISTED PROCEDURE, DIAPHRAGM
statewide
4048F
Documentation that administration of prophylactic parenteral antibiotic
was initiated within one hour (if fluoroquinolone or vancomycin, two
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
statewide
cohort
84
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
hours) prior to surgical incision (or start of procedure wh
40490
BIOPSY OF LIP
40510
EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH
PRIMARYCLOSURE
statewide
40525
EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH
LOCALFLAP (EG, ESTLANDER OR FAN)
40530
RESECTION OF LIP, MORE THAN ONE-FOURTH,
WITHOUTRECONSTRUCTION
statewide
40650
REPAIR LIP, FULL THICKNESS; VERMILION ONLY
cohort
40652
REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT
40654
REPAIR LIP, FULL THICKNESS; OVER ONE-HALF
VERTICALHEIGHT,OR COMPLEX
40700
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY;
PRIMARY,PARTIAL OR COMPLETE, UNILATERAL
cohort
40701
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY
BILATERAL, 1-STAGE PROCEDURE
statewide
40720
PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY,
BYRECREATION OF DEFECT AND RECLOSURE
cohort
cohort
cohort
40799
UNLISTED PROCEDURE, LIPS
cohort
cohort
cohort
40800
*DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE
OFMOUTH;SIMPLE *DRAINAGE OF ABSCESS, CYST, HEMATOM A,
VESTIBULE OF MOUTH;
cohort
cohort
cohort
40801
DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF
MOUTH;COMPLICATED DRAINAGE OF ABSCESS, CYST,
HEMATOMA, VESTIBULE OF MOUTH;
40804
*REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF
MOUTH;SIMPLE *REMOVAL OF EMBEDDED FOREIGN BODY,
VESTIBULE OF MOUTH;
40806
INCISION OF LABIAL FRENUM (FRENOTOMY)
40810
EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE
OFMOUTH; WITHOUT REPAIR
40812
OFMOUTH; WITH SIMPLE REPAIR
40814
OFMOUTH; WITH COMPLEX REPAIR
40819
EXCISION OF FRENUM, LABIAL OR BUCCAL
(FRENUMECTOMY,FRENULECTOMY, FRENECTOMY)
40820
DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH
BYPHYSICAL METHODS (EG, LASER, THERMAL, CRYO,
CHEMICAL)
40830
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR
LESSCLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM
OR LESS
cohort
40831
CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM
ORCOMPLEX CLOSURE OF LACERATION, VESTIBULE OF MOUTH;
OVER 2.5 CM OR
cohort
40840
VESTIBULOPLASTY; ANTERIORVESTIBULOPLASTY; ANTERIOR
41008
INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST,
ORHEMATOMA OF TONGUE INTRAORAL INCISION AND
DRAINAGE OF ABSCESS, CYST, OR
statewide
41010
INCISION OF LINGUAL FRENUM (FRENOTOMY)
cohort
41016
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST,
ORHEMATOMA OF FLOOR OF MOUTH; SUBMENTAL
EXTRAORALINCISION AND DRAINAGE OF ABSCESS, CYST, OR
statewide
41017
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST,
ORHEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR
EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR
41100
BIOPSY OF TONGUE; ANTERIOR TWO-THIRDSBIOPSY OF
TONGUE; ANTERIOR TWO-THIRDS
41105
BIOPSY OF TONGUE; POSTERIOR ONE-THIRDBIOPSY OF
TONGUE; POSTERIOR ONE-THIRD
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
85
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
41108
BIOPSY OF FLOOR OF MOUTHBIOPSY OF FLOOR OF MOUTH
41110
EXCISION OF LESION OF TONGUE WITHOUT CLOSURE
cohort
41112
EXCISION OF LESION OF TONGUE WITH CLOSURE;
ANTERIORTWO-THIRDS
cohort
41113
EXCISION OF LESION OF TONGUE WITH CLOSURE;
POSTERIORONE-THIRD
cohort
41114
EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL
TONGUEFLAP
41115
EXCISION OF LINGUAL FRENUM (FRENECTOMY)
cohort
cohort
cohort
41116
EXCISION, LESION OF FLOOR OF MOUTH
cohort
cohort
cohort
41120
GLOSSECTOMY; LESS THAN ONE-HALF TONGUE
cohort
cohort
41135
GLOSSECTOMY; PARTIAL, WITH UNILATERAL RADICAL
NECKDISSECTION
cohort
cohort
41250
*REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH
AND/OR ANTERIOR TWO-THIRDS OF TONGUE *REPAIR OF
LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR
cohort
cohort
41251
*REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONETHIRD OFTONGUE
41252
*REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER
2.6 CMOR COMPLEX *REPAIR OF LACERATION OF TONGUE,
FLOOR OF MOUTH, OVER 2.6 CM
41512
Tongue base suspension, permanent suture technique
41520
FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITHZPLASTY)
41599
UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH
41800
*DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM
DENTOALVEOLARSTRUCTURES
41820
GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT
statewide
41821
OPERCULECTOMY, EXCISION PERICORONAL TISSUES
statewide
41825
EXCISION OF LESION OR TUMOR (EXCEPT LISTED
ABOVE),DENTOALVEOLAR STRUCTURES; WITHOUT REPAIR
statewide
41826
ABOVE),DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR
41827
ABOVE),DENTOALVEOLAR STRUCTURES; WITH COMPLEX
REPAIR
41874
ALVEOLOPLASTY, EACH QUADRANT (SPECIFY)
41899
UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES
42000
*DRAINAGE OF ABSCESS OF PALATE, UVULA
42100
BIOPSY OF PALATE, UVULA
42104
EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE
cohort
cohort
cohort
42106
EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE
PRIMARYCLOSURE
cohort
cohort
cohort
42107
EXCISION, LESION OF PALATE, UVULA; WITH LOCAL
FLAPCLOSURE
statewide
42120
RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION
42140
UVULECTOMY, EXCISION OF UVULA
cohort
cohort
cohort
cohort
42145
PALATOPHARYNGOPLASTY (EG,
UVULOPALATOPHARYNGOPLASTY,UVULOPHARYNGOPLASTY)
cohort
cohort
cohort
cohort
42160
DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO
ORCHEMICAL)
statewide
42180
REPAIR, LACERATION OF PALATE; UP TO 2 CMREPAIR,
LACERATION OF PALATE; UP TO 2 CM
statewide
42182
REPAIR, LACERATION OF PALATE; OVER 2 CM OR
COMPLEXREPAIR, LACERATION OF PALATE; OVER 2 CM OR
COMPLEX
cohort
42200
PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD
PALATE ONLY
statewide
42205
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF
statewide
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
86
cohort
statewide
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
ALVEOLARRIDGE; SOFT TISSUE ONLY
42210
PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF
ALVEOLARRIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE
statewide
42220
PALATOPLASTY FOR CLEFT PALATE; SECONDARY
LENGTHENINGPROCEDURE
statewide
42225
PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT
PHARYNGEAL FLAP
statewide
42226
LENGTHENING OF PALATE, AND PHARYNGEAL FLAP
statewide
42235
REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP
42299
UNLISTED PROCEDURE, PALATE, UVULA
42300
*DRAINAGE OF ABSCESS; PAROTID, SIMPLE
42330
SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY),
SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL
SUBLINGUAL OR
42335
COMPLICATED,INTRAORAL SIALOLITHOTOMY; SUBMANDIBULAR
(SUBMAXILLARY), COMPLICATED,
42400
*BIOPSY OF SALIVARY GLAND; NEEDLE
42405
BIOPSY OF SALIVARY GLAND; INCISIONAL
cohort
42408
EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA)
statewide
42409
MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA)
42410
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL
LOBE,WITHOUT NERVE DISSECTION
cohort
cohort
cohort
cohort
42415
EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL
LOBE,WITH DISSECTION AND PRESERVATION OF FACIAL NERVE
cohort
cohort
cohort
cohort
42420
EXCISION OF PAROTID TUMOR OR PAROTID GLAND;
TOTAL,WITHDISSECTION AND PRESERVATION OF FACIAL NERVE
cohort
cohort
cohort
cohort
42440
EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND
cohort
cohort
cohort
cohort
42450
EXCISION OF SUBLINGUAL GLAND
42500
PLASTIC REPAIR OF SALIVARY DUCT,
SIALODOCHOPLASTY;PRIMARYOR SIMPLE PLASTIC REPAIR OF
SALIVARY DUCT , SIALODOCHOPLASTY; PRIMARY
42505
PLASTIC REPAIR OF SALIVARY DUCT,
SIALODOCHOPLASTY;SECONDARYOR COMPLICATED PLASTIC
REPAIR OF SALIVA RY DUCT, SIALODOCHOPLASTY; SECONDARY
42550
INJECTION PROCEDURE FOR SIALOGRAPHY
42650
*DILATION SALIVARY DUCT*DILATION SALIVARY DUCT
42699
UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS
42700
*INCISION AND DRAINAGE ABSCESS; PERITONSILLAR
42720
INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL
ORPARAPHARYNGEAL, INTRAORAL APPROACH
42800
BIOPSY; OROPHARYNX
42804
BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE
42806
BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY
LESION
42808
EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY
METHOD
cohort
cohort
42809
REMOVAL OF FOREIGN BODY FROM PHARYNX
cohort
cohort
42810
EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINEDTO
SKINAND SUBCUTANEOUS TISSUES
cohort
cohort
cohort
cohort
42815
EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR
FISTULA,EXTENDING BENEATH SUBCUTANEOUS TISSUES
AND/OR INTO PHARYNX
cohort
cohort
cohort
cohort
42820
TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12
cohort
cohort
cohort
cohort
cohort
cohort
42821
TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER
cohort
cohort
cohort
cohort
cohort
cohort
42825
TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
87
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
42826
TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER
cohort
cohort
cohort
cohort
cohort
cohort
42830
ADENOIDECTOMY, PRIMARY; UNDER AGE 12
cohort
cohort
cohort
cohort
cohort
cohort
42831
ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER
cohort
cohort
cohort
cohort
cohort
42835
ADENOIDECTOMY, SECONDARY; UNDER AGE 12
cohort
cohort
cohort
42836
ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER
42842
RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS,
AND/ORRETROMOLAR TRIGONE; WITHOUT CLOSURE
statewide
42860
EXCISION OF TONSIL TAGS
statewide
42870
EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY
METHOD(SEPARATEPROCEDURE)
42892
RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM
SINUS,DIRECT CLOSURE BY ADVANCEMENT OF LATERAL AND
POSTERIOR PHARYNGEAL WALLS
42950
PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION
ONPHARYNX)
42960
CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR
SECONDARY (EG, POSTTONSILLECTOMY); SIMPLE CONTROL
OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY
(EG,
42961
SECONDARY (EG, POSTTONSILLECTOMY); COMPLICATED,
REQUIRING HOSPITALIZATION CONTROL OROPHARYNGEAL
HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42962
SECONDARY (EG, POSTTONSILLECTOMY); WITH SECONDARY
SURGICAL INTERVENTION CONTROL OROPHARYNGEAL
HEMORRHAGE, PRIMARY OR SECONDARY (EG,
42970
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR
SECONDARY(EG, POSTADENOIDECTOMY); SIMPLE, WITH
POSTERIOR NASAL PACKS, WITH OR WITHOUT ANTERIOR
PACKSAND/OR CAUTERIZATION
42971
CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR
SECONDARY(EG, POSTADENOIDECTOMY); COMPLICATED,
REQUIRING HOSPITALIZATION
42999
UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS
43030
CRICOPHARYNGEAL MYOTOMYCRICOPHARYNGEAL MYOTOMY
43130
DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS,
WITHORWITHOUT MYOTOMY; CERVICAL APPROACH
43200
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC,
WITHORWITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING
O R WASHING (SEPARATE PROCEDURE)
43201
ESOPHAGOSCOPY, RIGID/FLEXIBLE; W/DIRECTED SUBMUCOSAL
INJECTION(S), ANY SUBSTANCE
cohort
43202
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE
ORMULTIPLE
cohort
43204
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION
SCLEROSISOF ESOPHAGEAL VARICES
43215
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF
FOREIGNBODY ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH
REMOVAL OF FOREIGN
43219
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF
PLASTIC TUBE OR STENT
43220
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON
DILATION(LESS THAN 30 MM DIAMETER) ESOPHAGOSCOPY,
RIGID OR FLEXIBLE; WITH BALLOON DILATION
43226
GUIDEWIRE FOLLOWED BY DILATION OVER GUIDE WIRE
GUIDE
43228
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION
OFTUMOR(S),POLYP(S), OR OTHER LESION(S), NOT AMENAB LE
TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR
SNARE TECHNIQUE
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
88
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
CPT
Description
43231
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC WITH OR
WITHOUT COLLECTION OF SPECIMENS BY BRUSHING OR
WASHING (SEPARATE PROCEDURE) WITH ENDOSCOPIC
ULTRASOUND EXAMINATION.
43232
ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH
TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR
TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S)
43235
UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING
ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR
JEJUNUMAS APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT
COLL ECTION OF
cohort
cohort
cohort
cohort
cohort
43236
UPPER GI ENDOSCOPY; W/DIRECTED SUBMUCOSAL
cohort
cohort
cohort
cohort
cohort
43237
ESOPHAGUS STOMACH AND EITHER THE DUODENUM AND/OR
JEJUNUM AS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND
EXAM LIMITED TO THE ESOPHAGUS
cohort
cohort
43238
ESOPHAGUS STOMACH AND EITHER THE DUODENUM AND/OR
JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC
ULTRASOUND-GUIDED INTRAMURAL OR FINE NEEDLE
ASPIRATION BIOPSY
statewide
43239
JEJUNUMAS APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE
43240
JEJUNUMAS APPROPRIATE; WITH TRANSMURAL DRAINAGE OF
PSEU DOCYST.
43242
JEJUNUMAS APPROPRIATE; WITH TRANSENDOSCOPIC
ULTRASOUND- GUIDED INTRAMURAL FINE NEEDLE
ASPIRATION/BIOPSY(S)
43243
JEJUNUMAS APPROPRIATE; WITH INJECTION SCLEROSIS OF
ESOP HAGEAL AND/OR
43244
JEJUNUMAS APPROPRIATE; WITH BAND LIGATION OF
ESOPHAGEAL AND/OR GASTRIC
cohort
43245
JEJUNUMAS APPROPRIATE; WITH DILATION OF GASTRIC
OUTLET FOR
43246
JEJUNUMAS APPROPRIATE; WITH DIRECTED PLACEMENT OF
PERCU TANEOUS
43247
JEJUNUMAS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY
43248
JEJUNUMAS APPROPRIATE; WITH INSERTION OF GUIDE WIRE
FOL LOWED BY
43249
JEJUNUMAS APPROPRIATE; WITH BALLOON DILATION OF
ESOPHAG US (LESS THAN
43250
JEJUNUMAS APPROPRIATE; WITH REMOVAL OF TUMOR(S),
POLYP( S), OR OTHER
43251
89
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
JEJUNUMAS APPROPRIATE; WITH REMOVAL OF TUMOR(S),
POLYP( S), OR OTHER
43255
JEJUNUMAS APPROPRIATE; WITH CONTROL OF BLEEDING, ANY
ME THOD
43256
JEJUNUMAS APPROPRIATE; WITH TRANSENDOSCOPIC STENT
PLACE MENT (INCLUDES PREDILATION)
43257
UPPER GASTROINTESTINAL ENDOSCOPY INCL ESOPHAGUS,
STOMACH, & EITHER THE DUODENUM AND/OR JEJUNUM AS
APPROPRIATE; WITH DELIVERY OF THERMAL ENERGY TO THE
MUSCLE OF LOWER ESOPHAGEAL SPHINCTER / GASTRIC
43258
JEJUNUMAS APPROPRIATE; WITH ABLATION OF TUMOR(S),
POLYP (S), OR OTHER
43259
JEJUNUMAS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND
EXAMI NATION
43260
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY
(ERCP);DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
SPECIMEN(S), BY BRUSHING OR WASHING (SEPARATE
PROCEDURE)
43261
(ERCP); WITH BIOPSY, SINGLE OR MULTIPLE
43262
(ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY
43263
(ERCP); WITH PRESSURE MEASUREMENT OF SPHINCTER OF
ODDI (PANCREATIC DUCT OR COMMON BILE DUCT)
43264
(ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF
STONE(S) FROM BILIARY AND/OR PANCREATIC DUCTS
43265
(ERCP); WITH ENDOSCOPIC RETROGRADE DESTRUCTION,
LITHOTRIPSY OF STONE(S), ANY METHOD
43267
(ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF
NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE
43268
(ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF TUBE
OR STENT INTO BILE OR PANCREATIC DUCT
43269
(ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF
FOREIGNBODY AND/OR CHANGE
43271
(ERCP); WITH ENDOSCOPIC RETROGRADE BALLOON DILATION
OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S)
43272
(ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR
OTHERLESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY
FORCEPS, BIPOLAR CAUTERY
43273
Endoscopic cannulation of papilla with direct visualization of common
bile duct(s) and/or pancreaticduct(s) (List separately in addition to
code(s) f or primary procedure)
43279
Laparoscopy, surgical esophagomyotomy (Heller type), with
fundoplasty, when performed
43280
LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC
FUNDOPLASTY(EG, NISSEN, TOUPET PROCEDURES)
43281
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL
HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED;
WITHOUT IMPLANTATION OF MESH
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
90
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
43282
LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL
HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH
IMPLANTATION OF MESH
cohort
43283
Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis
gastroplasty or wedge gastroplasty) (List separately in addition to code
for primary procedure)
statewide
43333
Repair, paraesophageal hiatal hernia (including fundoplication), via
laparotomy, except neonatal; with implantation of mesh or other
prosthesis
statewide
43450
*DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE,
SINGLE OR MULTIPLE PASSES *DILATION OF ESOPHAGUS, BY
UNGUIDED SOUND OR BOUGIE, SINGLE
43453
DILATION OF ESOPHAGUS, OVER GUIDE WIREDILATION OF
ESOPHAGUS, OVER GUIDE WIRE
statewide
43456
DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR,
RETROGRADEDILATION OF ESOPHAGUS, BY BALLOON OR
DILATOR, RETROGRADE
cohort
43458
DILATION OF ESOPHAGUS WITH BALLOON (30 MM
DIAMETERORLARGER) FOR ACHALASIA DILATION OF
ESOPHAGUS WI TH BALLOON (30 MM DIAMETER OR
43499
UNLISTED PROCEDURE, ESOPHAGUS
43520
PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDETRAMSTEDTTYPE OPERATION)
43631
GASTRECTOMY, PARTIAL, DISTAL; WITH
GASTRODUODENOSTOMY
statewide
43644
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; WITH GASTRIC BYPASS AND ROUX-EN-Y
GASTROENTEROSTOMY (RUOX LIMB 150 CM OR LESS)
cohort
43653
LAPAROSCOPY, SURGICAL;GASTOSTOMY, WITHOUT
CONSTRUCTION OF GASTRIC TUBE (EG. STAMM PROCEDURE
cohort
43659
LAPAROSCOPY, SURGICAL;UNLISTED LAPAROSCOPY
PROCEDURE , STOMACH
cohort
43752
Naso or oro gastric tube placement, necessitating physician's skill
cohort
43753
Gastric intubation and aspiration(s) therapeutic, necessitating
physician's skill (eg, for gastrointestinal hemorrhage), including lavage if
performed
cohort
cohort
cohort
cohort
cohort
43760
Change of gastrostomy tube, percutaneous, without imaging or
endoscopic guidance
cohort
cohort
cohort
cohort
cohort
43761
REPOSITIONING OF A NASO- OR ORO-GASTRIC FEEDING TUBE,
THROUGH THE DUODENUM FOR ENTERIC NUTRITION
43770
Laparoscopy, surgical, gastric restrictive procedure; placement of
adjustable gastric restrictive device (e.g., gastric band and
subcutaneous port components)
43771
Laparoscopy, surgical, gastric restrictive procedure; revision of
adjustable gastric restrictive device component only
43772
Laparoscopy, surgical, gastric restrictive procedure; removal of
adjustable gastric restrictive device component only
43773
Laparoscopy, surgical, gastric restrictive procedure; removal and
replacement of adjustable gastric restrictive device component only
cohort
43774
Laparoscopy, surgical, gastric restrictive procedure; removal of
adjustable gastric restrictive device and subcutaneous port components
cohort
43775
LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE
PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE
GASTRECTOMY)
cohort
43800
PYLOROPLASTY
43830
GASTROSTOMY, TEMPORARY (TUBE, RUBBER OR PLASTIC)
(SEPARATEPROCEDURE);
43870
CLOSURE OF GASTROSTOMY, SURGICAL
43880
CLOSURE OF GASTROCOLIC FISTULA
43886
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REVISION OF
SUBCUTANEOUS PORT COMPONENT ONLY
cohort
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
91
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
43887
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL OF
SUBCUTANEOUS PORT COMPONENT ONLY
43888
GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL AND
REPLACEMENT OF SUBCUTANEOUS PORT COMPONENT ONLY
cohort
43999
UNLISTED PROCEDURE, STOMACH
cohort
44005
ENTEROLYSIS (FREEING OF INTESTINAL ADHESION)
(SEPARATEPROCEDURE)
cohort
44055
CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS
AND/OR REDUCTION OF MIDGUT VOLVULUS (EG, LADD
PROCEDURE)
statewide
44120
ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE
RESECTION AND ANASTOMOSIS
44140
COLECTOMY, PARTIAL; WITH ANASTOMOSIS
44180
LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF
INTESTINAL ADHESION) (SEPARATE PROCEDURE)
44186
LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR
DECOMPRESSION OR FEEDING)
44187
LAPAROSCOPY, SURGICAL; ILEOSTOMY OR JEJUNOSTOMY,
NON-TUBE
cohort
44188
LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL
CECOSTOMY
statewide
44202
LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH
ANASTOMOSIS (INTRA OR EXTRACORPOREAL)
cohort
44204
LAPAROSCOPY, SURGICAL;COLECTOMY, PARTIAL, W/
ANASTOMOSIS
cohort
44205
LAPAROSCOPY, SURGICAL;COLECTOMY, PARTIAL, W/ REMOVAL
TERMINAL ILEUM W/ ILEOCOLOSTOMY
cohort
44213
LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN)
OFSPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PAR
TIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY
PROCEDURE)
statewide
44238
UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT
RECTUM)
44300
Placement, enterostomy or cecostomy, tube open (e.g., for feeding or
decompression) (separate procedure)
44310
ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE (SEPARATE
PROCEDURE)
44312
REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL
SCAR) (SEPARATE PROCEDURE)
44346
REVISION OF COLOSTOMY; WITH REPAIR OF PARACOLOSTOMY
HERNIA(SEPARATE PROCEDURE)
44360
SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND
SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM;
DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)
BY BRUSHING OR WASHING
cohort
44361
SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH
BIOPSY, SINGLE OR MULTIPLE
cohort
44366
CONTROL OF BLEEDING, ANY METHOD
cohort
44369
ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT
AMENABLE TO
44372
PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE
44376
SECONDPORTION OF DUODENUM, INCLUDING ILEUM;
DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S)
BY BRUSHING OR WASHING
44377
SECONDPORTION OF DUODENUM, INCLUDING ILEUM; WITH
Peer
Cohort
5
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
92
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
BIOPSY, SINGLE OR MULTIPLE
44380
ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR
WITHOUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR
WASHING (SEPARATE PROCEDURE)
statewide
44382
ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR
MULTIPLE
statewide
44385
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL
ORPELVIC) POUCH; DIAGNOSTIC, WITH OR WITHOUT
COLLECTION OF SPECIMEN(S) BY BRUSHING OR
WASHING(SEPARATE PROCEDURE)
cohort
44386
ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL
ORPELVIC) POUCH; WITH BIOPSY, SINGLE OR MULTIPLE
statewide
44388
COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR
44389
COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR
MULTIPLECOLONOSCOPY THROUGH STOMA; WITH BIOPSY,
SINGLE OR MULTIPLE
44392
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF
TUMOR(S),POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY
FORCEPS OR BIPOLAR CAUTERY
statewide
44394
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF
TUMOR(S),POLYP(S), OR OTHER LESION(S) BY SNARE
TECHNIQUE COLONOSCOPY THROUGH STOMA; WITH REMOVAL
OF TUMOR( S),
statewide
44500
INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG,MILLERABBOTT) (SEPARATE PROCEDURE)
44602
SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR
PERFORATEDULCER, DIVERTICULUM, WOUND, INJURY OR
RUPTURE; SINGLE PERFORATION
44604
SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR
PERFORATEDULCER, DIVERTICULUM, WOUND, INJURY OR
RUPTURE (SINGLE OR MULTIPLE PERFORATIONS); WITHOUT
COLOSTOMY
44615
INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND
ENTERORRHAPHY)WITH OR WITHOUT DILATION, FOR
INTESTINAL OBSTRUCTION
44620
CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE;
44680
INTESTINAL PLICATION (SEPARATE PROCEDURE)
44705
PREPARATION OF FECAL MICROBIOTA FOR INSTILLATION,
INCLUDING ASSESSMENT OF DONOR SPECIMEN
44799
UNLISTED PROCEDURE, INTESTINE
cohort
44800
EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY)
OROMPHALOMESENTERIC DUCT
cohort
44899
UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE
MESENTERY
cohort
44950
APPENDECTOMY;
cohort
44955
APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT
TIME OFOTHER MAJOR PROCEDURE (NOT AS SEPARATE
PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
44960
APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS
ORGENERALIZED PERITONITIS
44970
LAPAROSCOPY, SURGICAL; APPENDECTOMY
cohort
cohort
cohort
cohort
44979
UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX
cohort
cohort
cohort
cohort
45005
INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM
cohort
cohort
45100
BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG,
CONGENITALMEGACOLON)
cohort
cohort
45120
PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON),
ABDOMINAL AND PERINEAL APPROACH; WITH PULLTHROUGHPROCEDURE AND ANASTOMOSIS (EG, SWENSON,
DUHAMEL, OR SOAVE TYPE OPERATION)
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
93
cohort
cohort
statewide
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
45123
PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL
APPROACH
45130
EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS;
PERINEALAPPROACH
45171
EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT
INCLUDING MUSCULARIS PROPRIA (IE, PARTIAL THICKNESS)
cohort
cohort
cohort
45172
EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH;
INCLUDING MUSCULARIS PROPRIA (IE, FULL THICKNESS)
cohort
cohort
cohort
45190
DESTRUCTION OF RECTAL TUMOR, ANY METHOD
(EG,ELECTRODESICCATION) TRANSANAL APPROACH
cohort
cohort
cohort
45300
PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR
cohort
cohort
cohort
45303
PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION, ANY METHOD
45305
PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE
ORMULTIPLE
cohort
cohort
45307
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN
BODY
45308
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF
SINGLETUMOR,POLYP, OR OTHER LESION BY HOT BIOPSY
FORCEP S OR BIPOLAR CAUTERY
statewide
45309
PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF
SINGLETUMOR,POLYP, OR OTHER LESION BY SNARE
TECHNIQUE PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL
OF SINGLETUMOR,
cohort
45317
PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING,
ANYMETHOD
45320
PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF
TUMOR(S),POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO
BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE
TECHNIQUE(EG,
45330
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR
WASHING(SEPARATE PROCEDURE)
45331
SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR
MULTIPLESIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLEOR
MULTIPLE
45332
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN
BODYSIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN
BODY
cohort
45333
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF
TUMOR(S),POLYP(S),OR OTHER LESION(S) BY HOT BIOPSY
FORCEPS OR BIPOLAR CAUTERY SIGMOIDOSCOPY, FLEXIBLE;
WIT H REMOVAL OF TUMOR(S), POLYP(S),
cohort
cohort
45334
SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF
BLEEDING,ANYMETHOD SIGMOIDOSCOPY, FLEXIBLE; WITH
CONTROL OF BLEEDING, ANY
cohort
45335
SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL
cohort
45338
SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF
TUMOR(S),POLYP(S),OR OTHER LESION(S) BY SNARE
TECHNIQUE S IGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF
TUMOR(S), POLYP(S),
cohort
45339
SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF
TUMOR(S),POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO
BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE
45340
SIGMOIDSCOPY, FLEXIBLE; W/DILATION, BALLOON,
1/>STRJUCTURES
45341
SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR
W/OUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR
WASHING (SEPARATE PROCEDURE) WITH ENDOSCOPIC
ULTRASOUND EXAMINATION.
45342
SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC
ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE
statewide
statewide
cohort
cohort
cohort
statewide
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
94
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
NEEDLEASPIRATION/BIOPSY(S)
45378
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC
FLEXURE;DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF
SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR WITHOUT
COLON DECOMPRESSION
45379
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE;
WITHREMOVAL OF FOREIGN BODY COLONOSCOPY, FLEXIBLE,
PROXIMAL TO SPLENIC FLEXURE; WITH
45380
WITHBIOPSY, SINGLE OR MULTIPLE COLONOSCOPY, FLEXIBLE,
PROXIMAL TO SPLENIC FLEXURE; WITH
cohort
cohort
cohort
cohort
cohort
45381
W/DIRECTED SUBMUCOSA INJECTION(S), ANY SUBSTANCE
cohort
cohort
cohort
cohort
cohort
45382
WITHCONTROL OF BLEEDING, ANY METHOD COLONOSCOPY,
FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH
cohort
cohort
cohort
cohort
cohort
45383
WITHABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS,
BIPOLAR CAUTERY
cohort
cohort
cohort
cohort
cohort
45384
WITHREMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
cohort
cohort
cohort
45385
WITHREMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S)
BY SNARE TECHNIQUE
cohort
cohort
cohort
cohort
cohort
45386
COLONOSCPY, FLEXIBLE, PROXIMAL TO SPLENIC
FLEXURE;W/DILATION, BALLOON, 1/>STRICTURES
cohort
cohort
cohort
cohort
45387
WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES
PREDILATION)
45391
COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC
FLEXUREWITH ENDOSCOPIC ULTRASOUND EXAMINATION
cohort
cohort
45392
COLONOSPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE WITH
TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR
TRASMURAL FINE NEEDLE ASPIRATION/BIOSPY(S)
45400
LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE)
45499
UNLISTED LAPAROSCOPY PROCEDURE, RECTUM
45505
PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE
45541
PROCTOPEXY FOR PROLAPSE; PERINEAL APPROACH
45560
REPAIR OF RECTOCELE (SEPARATE PROCEDURE)
cohort
cohort
45905
*DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE)
UNDERANESTHESIA OTHER THAN LOCAL
cohort
cohort
45910
DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE)
UNDERANESTHESIA OTHER THAN LOCAL
cohort
45915
*REMOVAL OF FECAL IMPACTION OR FOREIGN BODY
(SEPARATEPROCEDURE) UNDER ANESTHESIA
cohort
cohort
cohort
cohort
45990
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA
(GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
cohort
cohort
cohort
cohort
45999
UNLISTED PROCEDURE, RECTUM
cohort
cohort
cohort
cohort
46020
PLACEMENT, SETON
cohort
cohort
cohort
cohort
cohort
46030
*REMOVAL OF ANAL SETON, OTHER MARKER
cohort
cohort
cohort
cohort
cohort
46040
INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR
PERIRECTALABSCESS (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
46045
INCISION AND DRAINAGE OF INTRAMURAL,
INTRAMUSCULARORSUBMUCOSAL ABSCESS, TRANSANAL,
UNDER ANESTHESIA
cohort
cohort
46050
*INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL
cohort
cohort
cohort
cohort
cohort
46060
INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL
ABSCESS,WITH FISTULECTOMY OR FISTULOTOMY,
SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON
cohort
cohort
cohort
cohort
46080
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
*SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER
95
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
(SEPARATEPROCEDURE)
46083
INCISION OF THROMBOSED HEMORRHOID, EXTERNAL
cohort
cohort
cohort
cohort
cohort
46200
FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN
PERFORMED
cohort
cohort
cohort
cohort
cohort
46220
EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS
cohort
cohort
cohort
cohort
cohort
46221
HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND
LIGATION(S)
cohort
cohort
cohort
cohort
cohort
46230
EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS
cohort
cohort
cohort
cohort
cohort
46250
HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE
COLUMNS/GROUPS
cohort
cohort
cohort
cohort
46255
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE
COLUMN/GROUP;
cohort
cohort
cohort
cohort
cohort
46257
COLUMN/GROUP; WITH FISSURECTOMY
cohort
cohort
cohort
cohort
46258
COLUMN/GROUP; WITH FISTULECTOMY, INCLUDING
FISSURECTOMY, WHEN PERFORMED
cohort
cohort
cohort
cohort
46260
HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR
MORECOLUMNS/GROUPS;
cohort
cohort
cohort
cohort
46261
MORECOLUMNS/GROUPS; WITH FISSURECTOMY
cohort
cohort
cohort
46262
MORECOLUMNS/GROUPS; WITH FISTULECTOMY, INCLUDING
FISS URECTOMY, WHEN PERFORMED
cohort
46270
SURGICAL TREATMENT OF ANAL
FISTULA(FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS
cohort
cohort
cohort
cohort
cohort
46275
SURGICAL TREATMENT OF ANAL FISTULA
(FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC
cohort
cohort
cohort
cohort
cohort
46280
SURGICAL TREATMENT OF ANAL FISTULA
(FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC,
SUPRASPHINCTERIC, EXTRASPHINCTERIC OR MULTIPLE,
INCLUDING PLACEMENT OF SETON, WHEN PERFORMED
cohort
cohort
cohort
cohort
cohort
46285
SURGICAL TREATMENT OF ANAL
FISTULA(FISTULECTOMY/FISTULOTOMY); SECOND STAGE
cohort
cohort
46288
CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP
cohort
cohort
46320
EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL
cohort
cohort
46500
*INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS
cohort
cohort
46505
CHEMODENERVATION OF INTERNAL ANAL SPHINCTER
cohort
46600
ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION
OFSPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE
PROCEDURE)
cohort
46604
ANOSCOPY; WITH DILATION, ANY METHOD
cohort
46606
ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE
cohort
46608
ANOSCOPY; WITH REMOVAL OF FOREIGN BODY
statewide
46610
ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR
OTHERLESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY
cohort
cohort
46612
ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS,OR
OTHER LESIONS BY HOT BIOPSY TECHNIQUE
cohort
cohort
46614
ANOSCOPY; WITH CONTROL OF BLEEDING, ANY METHOD
cohort
46615
ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR
OTHERLESION(S) NOT AMENABLE TO BIPOLAR CAUTERY
ORSNARE TECHNIQUE
cohort
46700
ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT
46706
REPAIR OF ANAL FISTULA W/FIBRIN GLUE
cohort
46750
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE;
ADULT
cohort
cohort
46761
SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT;
LEVATORMUSCLE IMBRICATION (PARK POSTERIOR ANAL
REPAIR)
cohort
cohort
46910
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
*DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA,
96
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE),
SIMPLE; ELECTRODESICCATION
46917
DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA,
SIMPLE; LASER SURGERY
46922
SIMPLE; SURGICAL EXCISION
cohort
cohort
cohort
cohort
46924
EXTENSIVE, ANY METHOD
cohort
cohort
cohort
cohort
46930
Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared
coagulation, cautery, radiofrequency)
cohort
cohort
cohort
46940
CURETTAGE OR CAUTERIZATION OF ANAL FISSURE,
INCLUDINGDILATION OF ANAL SPHINCTER (SEPARATE
PROCEDURE); INITIAL
46945
HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER
THANRUBBER BAND; SINGLE HEMORRHOID COLUMN/GROUP
46946
HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER
THANRUBBER BAND; 2 OR MORE HEMORRHOID
COLUMNS/GROUPS
46947
HEMORRHOIDOPEXY (EG,FOR PROLAPSING INTERNAL
HEMORRHOIDS) BY STAPLING
46999
UNLISTED PROCEDURE, ANUS
47000
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
*BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS
cohort
cohort
cohort
cohort
cohort
47001
BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED
PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST
cohort
cohort
cohort
cohort
cohort
47011
HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS
OR CYST, 1 OR 2 STAGES
cohort
47100
BIOPSY OF LIVER, WEDGE
cohort
47120
HEPATECTOMY, RESECTION OF LIVER; PARTIAL LOBECTOMY
statewide
47300
MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER
47350
MANAGEMENT OF LIVER HEMORRHAGE; SIMPLE SUTURE OF
LIVER WOUNDOR INJURY
statewide
47379
UNLISTED LAPAROSCOPIC PROCEDURE, LIVER
cohort
47382
ABLATION, 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS,
RADIOFREQUENCY
47399
UNLISTED PROCEDURE, LIVER
47490
Cholecystostomy, percutaneous, complete procedure,including imaging
guidance, catheter placement, c holecystogram when performed, and
radiological supervision and interpretation
statewide
47500
INJECTION PROCEDURE FOR PERCUTANEOUS
TRANSHEPATICCHOLANGIOGRAPHY INJECTION PROCEDURE
FOR PERCUTANEOUS TRANSHEPATIC
cohort
cohort
47505
INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH
ANEXISTING CATHETER (EG, PERCUTANEOUS TRANSHEPATIC
OR T-TUBE) INJECTION PROCEDURE FOR CHOLANGIOGRAPHY
THROUGH AN EXISTING
cohort
cohort
47510
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC
CATHETERFORBILIARY DRAINAGE
47511
INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR
INTERNALAND EXTERNAL BILIARY DRAINAGE
47525
CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER
47550
BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY)
(LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY
PROCEDURE)
47553
BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER
TRACT;WITH BIOPSY, SINGLE OR MULTIPLE
47554
TRACT;WITH REMOVAL OF STONE(S)
47555
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
97
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
TRACT;WITH DILATION OF BILIARY DUCT STRICTURE(S)WITHOUT
STENT BILIARY ENDOSCOPY, PERCUTANEOUS VI A T-TUBE OR
OTHER TRACT;
47556
TRACT;WITH DILATION OF BILIARY DUCT STRICTURE(S)WITH
STENT BILIARY ENDOSCOPY, PERCUTANEOUS VIA T -TUBE OR
OTHER TRACT;
47562
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY
cohort
cohort
cohort
cohort
cohort
47563
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH
CHOLANGIOGRAPHY
cohort
cohort
cohort
cohort
cohort
47564
LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH
EXPLORATION OF COMMON DUCT
cohort
cohort
cohort
cohort
47579
UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT
cohort
cohort
cohort
47600
CHOLECYSTECTOMY;
cohort
cohort
cohort
47605
CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY
47610
CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT;
47630
BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA TTUBETRACT, BASKET OR SNARE (EG, BURHENNE TECHNIQUE)
47765
ANASTOMOSIS, OF INTRAHEPATIC DUCTS AND
GASTROINTESTINALTRACT
47801
PLACEMENT OF CHOLEDOCHAL STENT
47999
UNLISTED PROCEDURE, BILIARY TRACT
48102
*BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE
48999
UNLISTED PROCEDURE, PANCREAS
49000
EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY
WITHORWITHOUT BIOPSY(S) (SEPARATE PROCEDURE)
EXPLORA TORY LAPAROTOMY, EXPLORATORY CELIOTOMY
WITH OR
49002
REOPENING OF RECENT LAPAROTOMY
49010
EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT
BIOPSY(S) (SEPARATE PROCEDURE) EXPLORATION,
RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S)
statewide
49020
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED
PERITONITIS,EXCLUSIVE OF APPENDICEAL ABSCESS; OPEN
cohort
49021
DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED
PERITONITIS,EXCLUSIVE OF APPENDICEAL ABSCESS;
PERCUTANEOUS
cohort
cohort
cohort
cohort
49061
DRAINAGE OF RETROPERITONEAL ABSCESS; PERCUTANEOUS
cohort
cohort
cohort
cohort
49082
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC);
WITHOUT IMAGING GUIDANCE
cohort
cohort
cohort
cohort
cohort
49083
ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC);
WITH IMAGING GUIDANCE
cohort
cohort
cohort
cohort
cohort
49084
PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN
PERFORMED
cohort
cohort
49180
*BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS,
PERCUTANEOUSNEEDLE
cohort
cohort
49203
Excision or destruction, open, intra-abdominal tumors, cysts or
endometriomas, 1 or more peritoneal,mesenteric, or retroperitoneal
primary or seconda ry tumors; largest tumor 5 cm diameter or less
cohort
cohort
49204
primary or seconda ry tumors; largest tumor 5.1-10.0 cm diameter
49205
primary or seconda ry tumors; largest tumor greater than 10.0 diamete
49215
EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR
49250
UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS
(SEPARATEPROCEDURE)
cohort
cohort
49255
OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM
(SEPARATEPROCEDURE)
cohort
cohort
cohort
LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND
cohort
cohort
cohort
49320
statewide
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
98
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
OMENTUM; DIAGNOSTIC , WITH OR WITHOUT COLLECTION OF
SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE
PROCEDURE)
49321
OMENTUM; WITH BIOPSY (SINGLE OR MULTIPLE)
cohort
cohort
cohort
cohort
cohort
49322
OMENTUM; WITH ASPIRATION OF CAVITY OR CYST (EG,
OVARIAN CYST) (SINGLE OR MULTIPLE)
cohort
cohort
cohort
cohort
cohort
49324
Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter
cohort
cohort
cohort
cohort
cohort
49325
LAPAROSCOPY, SURGICAL; WITH REVISION OF
PREVIOUSLYPLACED INTRAPERITONEAL CANNULA OR
CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE
MATERIAL IF PERFORMED
cohort
cohort
cohort
cohort
49326
LAPAROSCOPY, SURGICAL; WITH OMENTOPEXY (OMENTAL
TACKING PROCEDURE) (LIST SEPARATELY IN ADDITION TO
cohort
cohort
cohort
49329
OMENTUM; UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN,
PERITONEUM AND OMENTUM
cohort
cohort
cohort
cohort
49402
REMOVAL OF PERITONEAL FOREIGN BODY FROM
PERITONEALCAVITY
cohort
cohort
49411
PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION
THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER),
PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT
PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR M
cohort
cohort
49418
Insertion of tunneled intraperitoneal catheter (eg, dialysis,
intraperitoneal chemotherapy instillation, management of ascites),
complete procedure, including imaging guidance, catheter placement,
con
cohort
cohort
49419
Insertion of tunneled intraperitoneal catheter, with subcutaneous port
(ie, totally implantable)
49421
Insertion of tunneled intraperitoneal catheter fordialysis, open
49422
Removal of tunneled intraperitoneal catheter
49423
EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST
DRAINAGECATHETER UNDER RADIOLOGICAL GUIDANCE
(SEPARATEPROCEDURE)
49424
CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST
VIAPREVIOUSLY PLACED CATHETER (SEPARATE PROCEDURE)
49425
INSERTION OF PERITONEAL-VENOUS SHUNT
49426
REVISION OF PERITONEAL-VENOUS SHUNT
statewide
49427
INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR
EVALUATION OFPREVIOUSLY PLACED PERITONEAL-VENOUS
SHUNT
statewide
49435
INSERTION OF SUBCUTANEOUS EXTENSION TO
INTRAPERITONEAL CANNULA OR CATHETER WITH REMOTE
CHEST EXIT SITE (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
statewide
49440
Insertion of gastrostomy tube, percutaneous, underfluoroscopic
guidance including contrast injectio n(s), image documentation and
report
cohort
49441
Insertion of duodenostomy or jejunostomy tube, percutaneous, under
fluoroscopic guidance including contrast injection(s), image
documentation and report
49446
Conversion of gastrostomy tube to gastro-jejunostomy tube,
percutaneous, under fluoroscopic guidanceincluding contrast
injection(s), image documentat ion and report
cohort
cohort
49450
Replacement of gastrostomy or cecostomy (or other colonic) tube,
percutaneous, under fluoroscopic guidance including contrast
injection(s), image documentation and report
cohort
cohort
49451
Replacement of duodenostomy or jejunostomy tube, percutaneous,
under fluoroscopic guidance includingcontrast injection(s), image
documentation and re port
cohort
cohort
49452
Replacement of gastro-jejunostomy tube, percutaneous, under
fluoroscopic guidance including contrastinjection(s), image
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
99
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
documentation and report
49460
Mechanical removal of obstructive material from gastrostomy,
duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or
other colonic ) tube, anymethod, under fluoroscopic guidance including
con
49465
Contrast injection(s) for radiological evaluation of existing gastrostomy,
duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or
other colonic) tube, from a percutaneous approach including i
49491
REPAIR INIT INGUINAL HERNIA, PRETERM INFANT (BIRTH50 WKS
POSTCONCEPT)W/WO HYDROCELECT; REDUCIBLE
49495
REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH
OR WITHOUT HYDROCELECTOMY; REDUCIBLE
49496
REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH
OR WITHOUT HYDROCELECTOMY; INCARCERATED OR
STRANGULATED
49500
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER
5YEARS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE
cohort
49501
REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER
5YEARS, WITH OR WITHOUT HYDROCELECTOMY;
INCARCERATED OR STRANGULATED
cohort
49505
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR
OVER;REDUCIBLE
cohort
cohort
49507
REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR
OVER;INCARCERATED OR STRANGULATED
cohort
49520
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
49521
REPAIR RECURRENT INGUINAL HERNIA, ANY AGE;
INCARCERATED ORSTRANGULATED
cohort
cohort
cohort
cohort
cohort
49525
REPAIR INGUINAL HERNIA, SLIDING, ANY AGE
cohort
cohort
cohort
cohort
cohort
49540
REPAIR LUMBAR HERNIA
49550
REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE;
cohort
cohort
cohort
cohort
49553
REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED
ORSTRANGULATED
49560
REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE
cohort
cohort
cohort
cohort
cohort
cohort
49561
REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA;
INCARCERATED ORSTRANGULATED
cohort
cohort
cohort
cohort
cohort
cohort
49565
REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA;
REDUCIBLE
cohort
cohort
cohort
cohort
cohort
49566
REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA;
cohort
cohort
cohort
cohort
49568
Implantation of mesh or other prosthesis for open incisional or ventral
hernia repari or mesh for closure of debridement for necrotizing soft
tissue infection (List separately in addition to code for
cohort
cohort
cohort
cohort
cohort
cohort
49570
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT);
REDUCIBLE (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
cohort
49572
REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL
FAT);INCARCERATED OR STRANGULATED
cohort
cohort
cohort
cohort
cohort
49580
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE
cohort
cohort
cohort
49582
REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS;
49585
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE
cohort
cohort
cohort
cohort
cohort
cohort
49587
REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER;
INCARCERATEDOR STRANGULATED
cohort
cohort
cohort
cohort
cohort
cohort
49590
REPAIR SPIGELIAN HERNIA
49650
LAPAROSCOPY, SURGICAL; REPAIR INTIAL INQUINAL HERNIA
cohort
cohort
cohort
cohort
cohort
49651
LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INQUINAL
HERNIA
cohort
cohort
cohort
cohort
cohort
cohort
49652
Laparoscopy, surgical repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); reducible
cohort
cohort
cohort
cohort
cohort
cohort
49653
Laparoscopy, surgical repair, ventral, umbilical, spigelian or epigastric
hernia (includes mesh insertion, when performed); incarcerated or
strangulated
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
100
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
CPT
Description
49654
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion,
when performed); reducible
49655
Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion,
when performed); incarcerated or strangulated
cohort
cohort
cohort
cohort
49656
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh
insertion, when performed); reducible
cohort
cohort
cohort
cohort
49657
Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh
insertion, when performed); incarcerated or strangulated
cohort
cohort
cohort
cohort
49659
UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY,
HERNIORRHAPHY, HERNIOTOMY
cohort
cohort
cohort
cohort
cohort
49999
UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND
OMENTUM
cohort
cohort
cohort
cohort
cohort
50021
DRAINAGE OF PERIRENAL OR RENAL ABSCESS;
PERCUTANEOUS
cohort
cohort
50040
NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE
cohort
cohort
50060
NEPHROLITHOTOMY; REMOVAL OF CALCULUS
cohort
cohort
50075
NEPHROLITHOTOMY; REMOVAL OF LARGE STAGHORN
CALCULUS FILLING RENAL PELVIS AND CALYCES (INCLUDING
ANATROPHIC PYELOLITHOTOMY)
50080
PERCUTANEOUS NEPHROSTOLITHOTOMY OR
PYELOSTOLITHOTOMY, WITHOR WITHOUT DILATION,
ENDOSCOPY, LITHOTRIPSY, STENTING OR BASKET
EXTRACTION; UP TO 2 CM
50081
PERCUTANEOUS NEPHROSTOLITHOTOMY OR
PYELOSTOLITHOTOMY, WITHOR WITHOUT DILATION,
ENDOSCOPY, LITHOTRIPSY, STENTING OR BASKET
EXTRACTION; OVER 2 CM
50200
*RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE
50220
NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY
APPROACHINCLUDING RIB RESECTION;
statewide
50225
APPROACHINCLUDING RIB RESECTION; COMPLICATED
BECAUSE OF PREVIOUS SURGERY ON SAME KIDNEY
statewide
50230
APPROACHINCLUDING RIB RESECTION; RADICAL, WITH
REGIONAL LYMPHADENECTOMY AND/OR VENA CAVAL
THROMBECTOMY
statewide
50240
NEPHRECTOMY, PARTIAL
statewide
50382
REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF
INTERNALLY DWELLING URETERAL STENT VIA PERCUTANEOUS
APPROACH, INCLUDING RADIOLOGICAL SUPERVISION AND
INTERPRETATION
50384
REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY
DWELLINGURETERAL STENT VIA PERCUTANEOUS APPROACH,
INCLUDI NG RADIOLOGICAL SUPERVISION AND
INTERPRETATION
50385
Removal (via snare/capture) and replacement of internally dwelling
ureteral stent via transurethral approach, without use of cystoscopy,
including radiological supervision and interpretation
50386
Removal (via snare/capture) of internally dwellingureteral stent via
transurethral approach, withou t use of cystoscopy, including
radiological supervision and interpretation
50387
REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE
TRANSNEPHRIC URETERAL STENT (EG, EXTERNAL/INTERNAL
STENT) REQUIRING FLUOROSCOPIC GUIDANCE, INCLUDING
RADIOLOGICAL SUPERVISION AND INTERPRETATION
50389
REMOVAL OF NEPHROSTOMY TUBE, REQUIRING
FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT
INDWELLING URETERAL STENT)
50390
*ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS
BYNEEDLE, PERCUTANEOUS
50392
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL
PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
101
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
50393
INTRODUCTION OF URETERAL CATHETER OR STENT INTO
URETERTHROUGH RENAL PELVIS FOR DRAINAGE AND/OR
INJECTION, PERCUTANEOUS
cohort
50394
INJECTION PROCEDURE FOR PYELOGRAPHY (AS
NEPHROSTOGRAM,PYELOSTOGRAM, ANTEGRADE
PYELOURETEROGRAMS) THROUGH NEPHROSTOMY OR
PYELOSTOMY TUBE, OR INDWELLING URETERAL
50395
INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER
WITHDILATION TO ESTABLISH NEPHROSTOMY TRACT,
PERCUTANEOUS INTRODUCTION OF GUIDE INTO RENAL PELVIS
AND/OR URETER WITH
50398
*CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE
50400
PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION
ONRENAL PELVIS, WITH OR WITHOUT PLASTIC OPERATION ON
URETER, NEPHROPEXY, NEPHROSTOMY, PYELOSTOMY, OR
URETERAL SPLINTING;
50542
Laparoscopy, surgical; ablation of renal mass lesion(s), including
intraoperative ultrasound guidance and monitoring, when performed
50543
LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY
50544
LAPAROSCOPY, SURGICAL; PYELOPLASTY
50546
LAPAROSCOPY, SURGICAL; NEPHRECTOMY
statewide
50548
LAPAROSCOPICALLY ASSISTED NEPHROURETERECTOMY
statewide
50549
UNLISTED LAPAROSCOPY PROCEDURE, RENAL
statewide
50551
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY
ORPYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC
SERVICE;
statewide
50561
RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY
ORPYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION,
SERVICE; WITH
50570
RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY,
WITH ORWITHOUT IRRIGATION, INSTILLATION, OR
URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;
50590
LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE
cohort
50592
Ablation, one or more renal tumor(s), percutaneous, unilateral,
radiofrequency
cohort
50593
Ablation, renal tumor(s) unilateral, percutaneous,cryotherapy
50600
URETEROTOMY WITH EXPLORATION OR DRAINAGE
(SEPARATEPROCEDURE)
50605
URETEROTOMY FOR INSERTION OF INDWELLING STENT,
ALLTYPES
50610
URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER
50684
INJECTION PROCEDURE FOR URETEROGRAPHY OR
URETEROPYELOGRAPHY THROUGH URETEROSTOMY OR
INDWELLING URETERAL CATHETER
50688
*CHANGE OF URETEROSTOMY TUBE
50690
INJECTION PROCEDURE FOR VISUALIZATION OF ILEAL
CONDUITAND/OR URETEROPYELOGRAPHY, EXCLUSIVE OF
RADIOLOGIC SERVICE
50700
URETEROPLASTY, PLASTIC OPERATION ON URETER (EG,
STRICTURE)
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
50715
URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER
FORRETROPERITONEAL FIBROSIS
cohort
cohort
50727
REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY
TYPEUROSTOMY);
statewide
50780
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE
URETERTOBLADDER
50782
URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED
URETER TOBLADDER
50900
URETERORRHAPHY, SUTURE OF URETER (SEPARATE
PROCEDURE)
cohort
statewide
cohort
statewide
102
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
50949
UNLISTED LAPAROSCOPY PROCEDURE, URETER
cohort
50951
URETERAL ENDOSCOPY THROUGH ESTABLISHED
URETEROSTOMY, WITH ORWITHOUT IRRIGATION, INSTILLATION,
SERVICE;
cohort
cohort
cohort
cohort
50961
URETERAL ENDOSCOPY THROUGH ESTABLISHED
URETEROSTOMY, WITH ORWITHOUT IRRIGATION, INSTILLATION,
SERVICE;WITH REMOVAL OF FOREIGN
cohort
51040
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
cohort
cohort
cohort
cohort
cohort
51050
CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS,
WITHOUT VESICAL NECK RESECTION
cohort
cohort
cohort
cohort
cohort
51102
Aspiration of bladder; with insertion of suprapubic catheter
cohort
cohort
cohort
cohort
51520
CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK
(SEPARATEPROCEDURE)
51525
CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM,
SINGLE ORMULTIPLE (SEPARATE PROCEDURE)
51550
CYSTECTOMY, PARTIAL; SIMPLE
51570
CYSTECTOMY, COMPLETE; (SEPARATE PROCEDURE)
51600
*INJECTION PROCEDURE FOR CYSTOGRAPHY OR
VOIDINGURETHROCYSTOGRAPHY
51605
INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR
CONTRAST AND/OR CHAIN URETHROCYSTOGRAPHY
51610
INJECTION PROCEDURE FOR RETROGRADE
URETHROCYSTOGRAPHY
cohort
cohort
cohort
cohort
cohort
51700
*BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION
cohort
cohort
cohort
cohort
cohort
51701
INSERTION, NON-INDWELLING BLADDER CATHETER
cohort
cohort
cohort
cohort
cohort
51702
INSERTION, TEMPORARY INDWELLING BLADDER CATHETER;
SIMPLE
cohort
cohort
cohort
cohort
cohort
51703
INSERTION, TEMPORARY INDWELLING BLADDER CATHETER;
COMPLICATED
cohort
cohort
cohort
cohort
cohort
51705
*CHANGE OF CYSTOSTOMY TUBE; SIMPLE
statewide
51710
*CHANGE OF CYSTOSTOMY TUBE; COMPLICATED
statewide
51715
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE
SUBMUCOSALTISSUES OF THE URETHRA AND/OR BLADDER
NECK ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE
SUBMUCOSAL
51720
Bladder instillation of anticarcinogenic agent (including retention time)
statewide
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
51726
COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC
EQUIPMENT);
cohort
cohort
51727
EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES(IE,
URETHRAL CLOSURE PRESSURE PROFILE), ANY TECH NIQUE
cohort
cohort
51728
EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER
VOIDING PRESSURE), ANY TECHNIQUE
cohort
cohort
51729
EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER
VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE
STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE)
cohort
cohort
51736
SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW
RATE,MECHANICAL UROFLOWMETER)
statewide
51741
COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC
EQUIPMENT)
cohort
cohort
51784
ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR
URETHRALSPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQUE
cohort
cohort
51785
NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR
URETHRALSPHINCTER, ANY TECHNIQUE
statewide
51797
VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL,
GASTRIC, INTRAPERITONEAL) (LIST SEPARATELY INADDITION TO
statewide
cohort
cohort
103
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
51798
MEASUREMENT, POST-VOIDING RESIDUAL URINE &/OR
BLADDER CAPACITY, US, NON-IMAGING
cohort
51840
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY
(EG,MARSHALL-MARCHETTI- KRANTZ, BURCH); SIMPLE
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG,
51841
ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY
(EG,MARSHALL-MARCHETTI-KRANTZ, BURCH); COMPLICATED
(EG, SECONDARY REPAIR)
51845
ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR
WITHOUTENDOSCOPIC CONTROL (EG, STAMEY, RAZ, MODIFIED
PEREYRA)
cohort
cohort
51860
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR
RUPTURE;SIMPLE
cohort
cohort
51865
CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR
RUPTURE;COMPLICATED
51980
CUTANEOUS VESICOSTOMY
51990
LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR
STRESS INCONTINENCE
51992
LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS
INCONTINENCE (EG, FASCIA OR SYNTHETIC)
51999
UNLISTED LAPAROSCOPY PROCEDURE, BLADDER
52000
CYSTOURETHROSCOPY (SEPARATE
PROCEDURE)CYSTOURETHROSCOPY (SEPARATE PROCEDURE)
52001
CYSTOURETHROSCOPY W/IRRIGATON & EVACUATON CLOTS
52005
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION,
52007
CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION,
WITH BRUSH BIOPSY OF URETER
52204
Cystourethroscopy, with biopsy(s)
52214
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING
CRYOSURGERYOR LASER SURGERY) OF TRIGONE, BLADDER
NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL
GLANDS
52224
CRYOSURGERYOR LASER SURGERY) OR TREATMENT OF MINOR
(LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY
52234
CRYOSURGERYOR LASER SURGERY) AND/OR RESECTION OF;
SMALL BLADDER TUMOR(S) (0.5 TO 2.0 CM)
52235
MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM)
52240
LARGE BLADDER TUMOR(S)
52250
CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE
SUBSTANCE,WITH OR WITHOUT BIOPSY OR FULGURATION
CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE
SUBSTANCE,
cohort
cohort
52260
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR
INTERSTITIALCYSTITIS; GENERAL OR CONDUCTION
(SPINAL)ANESTHESIA CYSTOURETHROSCOPY, WITH DILATION
OF B LADDER FOR INTERSTITIAL
cohort
52265
INTERSTITIALCYSTITIS; LOCAL ANESTHESIA
INTERSTITIAL
52270
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY;
FEMALECYSTOURETHROSCOPY, WITH INTERNAL
URETHROTOMY; FEMALE
52275
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
104
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY;
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
52276
CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL
URETHROTOMYCYSTOURETHROSCOPY WITH DIRECT VISION
INTERNAL URETHROTOMY
cohort
cohort
cohort
cohort
cohort
52281
CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION
OFURETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT
MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR
CYSTOGRAPHY, MALE OR
cohort
cohort
cohort
cohort
cohort
52282
CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT
URETHRAL STENT
cohort
cohort
cohort
cohort
52283
CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO
STRICTURECYSTOURETHROSCOPY, WITH STEROID INJECTION
INTO STRICTURE
52287
CYSTOURETHROSCOPY, WITH INJECTION(S) FOR
CHEMODENERVATION OF THE BLADDER
cohort
cohort
52290
CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY,
UNILATERAL ORBILATERAL CYSTOURETHROSCOPY; WITH
URETERALMEATOTOMY, UNILATERAL OR
cohort
cohort
52300
CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION
OFORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL
OF
52301
OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL
OF ECTOPIC
52305
CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF
ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE
52310
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY,
CALCULUS,OR URETERAL STENT FROM URETHRA OR BLADDER
(SEPARATE PROCEDURE); SIMPLE
52315
CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY,
CALCULUS,OR URETERAL STENT FROM URETHRA OR BLADDER
(SEPARATE PROCEDURE); COMPLICATED
52317
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF
CALCULUSBY ANYMEANS IN BLADDER AND REMOVAL OF
FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM)
52318
LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF
CALCULUSBY ANYMEANS IN BLADDER AND REMOVAL OF
FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM)
52320
CYSTOURETHROSCOPY (INCLUDING URETERAL
CATHETERIZATION); WITHREMOVAL OF URETERAL CALCULUS
CATHETERIZATION); WITH
52325
CATHETERIZATION); WITHFRAGMENTATION OF URETERAL
CALCULUS (EG, ULTRASONIC OR ELECTRO-HYDRAULIC
TECHNIQUE)
52327
CATHETERIZATION); WITHSUBURETERIC INJECTION OF IMPLANT
MATERIAL CYSTOURETHROSCOPY (INCLUDING URETERAL
CATHETERIZATION); WITH
52330
CATHETERIZATION); WITHMANIPULATION, WITHOUT REMOVAL
OF URETERAL CALCULUS CYSTOURETHROSCOPY (INCLUDING
URETERAL CATHETERIZATION); WITH
52332
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING
URETERALSTENT (EG, GIBBONS OR DOUBLE-J TYPE)
CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING
URETERAL
52334
CYSTOURETHROSCOPY WITH INSERTION OF URETERAL
GUIDEWIRETHROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS
NE PHROSTOMY, RETROGRADE
52341
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL
STRICTURE (EG, BALLOON DILATION, LASER,
CPT
Description
MALECYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY;
MALE
statewide
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
105
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
ELECTROCAUTERY, AND INCISION)
52342
CYSTOURETHROSCOPY; WITH TREATMENT OF
URETEROPELVICJUNCTION STRICTURE (EG, BALLOON
DILATION, LASER, ELECTROCAUTERY, AND INCISION)
52344
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH
TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION,
LASER ELECTROCAUTERY, AND INCISION)
cohort
cohort
52345
CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH
TREATMENT OF URETEROPELVIC JUNCTURE STRICTURE (EG,
BALLOONDILATER ELECTROCAUTERY, AND INCISION)
cohort
cohort
52351
CYSTOURETHROSCOPY WITH URETEROSCOPY AND/OR
PYELOSCOPY; DIAGNOSTIC
cohort
cohort
52352
PYELOSCOPY; WITH REMOVAL OR MANIPULATION OR
CALCULUS (URETERAL CATHETERIZATION IS INCLUDED)
cohort
52353
PYELOSCOPY; WITH LITHROTIPSY (URETERAL
CATHETERIZATION ISINCLUDED)
cohort
52354
PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF LESION
52450
TRANSURETHRAL INCISION OF PROSTATETRANSURETHRAL
INCISION OF PROSTATE
cohort
52500
TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE
PROCEDURE)TRANSURETHRAL RESECTION OF BLADDER NECK
cohort
cohort
cohort
52601
TRANSURETHRAL ELECTROSURGICAL RESECTION OF
PROSTATE,INCLUDING CONTROL OF POSTOPERATIVE
BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY,
CYSTOURETHROSCOPY, URETHRAL
cohort
cohort
cohort
cohort
cohort
52630
Transurethral resection; residual or regrowth of obstructive prostate
tissue including control of postoperative bleeding, complete (vasectomy,
meatotomy, cystourethroscopy, urethral calibration and/o
cohort
cohort
cohort
cohort
52640
TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER
NECKCONTRACTURE TRANSURETHRAL RESECTION; OF
POSTOPERATIVE BLADDER NECK
cohort
cohort
cohort
cohort
52648
CONTACT LASER VAPORIZATION WITH OR WITHOUT
TRANSURETHRALRESECTION OF PROSTATE, INCLUDING
CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE
(VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY,
cohort
cohort
cohort
cohort
52649
Laser enucleation of the prostate with morcellation, including control of
postoperative bleeding, complete (vasectomy, meatotomy,
cystourethroscopy, urethral calibration and/or dilation, internal uret
cohort
cohort
cohort
53010
URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE
PROCEDURE); PERINEAL URETHRA, EXTERNAL
53020
MEATOTOMY, CUTTING OF MEATUS (SEPARATE
PROCEDURE);EXCEPTINFANT
53060
DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST
53200
BIOPSY OF URETHRA
53210
URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE
53230
EXCISION OF URETHRAL DIVERTICULUM (SEPARATE
PROCEDURE);FEMALE
53260
EXCISION OR FULGURATION; URETHRAL POLYP(S),
DISTALURETHRA
53265
EXCISION OR FULGURATION; URETHRAL CARUNCLE
53270
EXCISION OR FULGURATION; SKENE'S GLANDS
53400
URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM,
ORSTRICTURE (EG, JOHANNSEN TYPE)
53410
URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE
ANTERIORURETHRA
cohort
53420
URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR
OFPROSTATIC OR MEMBRANOUS URETHRA; FIRST STAGE
statewide
53430
URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
statewide
106
statewide
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
53440
OPERATION FOR CORRECTION OF MALE URINARY
INCONTINENCE, WITH OR WITHOUT INTRODUCTION OF
PROSTHESIS OPERATION FOR CORRECTION OF MALE URINARY
INCONTINENCE, WITH
cohort
53445
OPERATION FOR CORRECTION OF URINARY INCONTINENCE
WITHPLACEMENT OF INFLATABLE URETHRAL OR BLADDER
NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP AND/OR
RESERVOIR
cohort
cohort
cohort
cohort
cohort
53446
REMOVAL, INFLATABLE URETHRAL/BLADDER NECK SPHINCTER
W/PUMP/RESERVOIR/CUFF
cohort
cohort
53447
REMOVAL, REPAIR OR REPLACEMENT OF INFLATABLE
SPHINCTERINCLUDING PUMP AND/OR RESERVOIR AND/OR CUFF
REMOVAL, REPAIR OR REPLACEMENT OF INFLATABLE
SPHINCTER
53450
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
cohort
cohort
53460
URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL
URETHRALSEGMENT (RICHARDSON TYPE PROCEDURE)
cohort
cohort
53500
URETHROLYSIS TRANSVAGINAL SECONDARY OPEN
INCLUDINGCYSTOURETHROSCOPY (EG POSTSURGICAL
OBSTRUCTION SCARRING)
53502
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY,
FEMALE
statewide
53505
URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY;
PENILE
statewide
53520
CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS
FISTULA, MALE(SEPARATE PROCEDURE)
53600
*DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND
ORURETHRAL DILATOR, MALE; INITIAL *DILATION OF URETHRAL
STRICTURE BY PASSAGE OF SOUND OR
cohort
53605
DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY
PASSAGE OFSOUND OR URETHRAL DILATOR, MALE,
GENERALOR CONDUCTION (SPINAL) ANESTHESIA
statewide
53620
*DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM
ANDFOLLOWER, MALE; INITIAL *DILATION OF URETHRAL
STRICTURE BY PASSAGE OF FILIFORM AND
statewide
53665
DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION
(SPINAL)ANESTHESIA DILATION OF FEMALE URETHRA, GENERAL
OR CONDUCTION (SPINAL)
53855
INSERTION OF A TEMPORARY PROSTATIC URETHRAL
STENT,INCLUDING URETHRAL MEASUREMENT
53899
UNLISTED PROCEDURE, URINARY SYSTEMUNLISTED
PROCEDURE, URINARY SYSTEM
54000
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE
PROCEDURE);NEWBORN
54001
SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE
PROCEDURE);EXCEPT NEWBORN
54050
*DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA,
PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE),
SIMPLE; CHEMICAL *DESTRUCTION OF LESION(S), PENIS (EG,
CONDYLOMA, PAPILLOMA,
54055
*DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA,
PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE),
SIMPLE; ELECTRODESICCATION
54057
DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA,
SIMPLE; LASER SURGERY
54060
SIMPLE; SURGICAL EXCISION
54065
EXTENSIVE, ANY METHOD
54100
BIOPSY OF PENIS; CUTANEOUS (SEPARATE PROCEDURE)
54111
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITHGRAFT
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
statewide
cohort
cohort
cohort
107
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
TO 5 CM IN LENGTH EXCISION OF PENILE PLAQU E (PEYRONIE
DISEASE); WITH GRAFT TO
54112
EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE);
WITHGRAFTGREATER THAN 5 CM IN LENGTH EXCISION OF PEN
ILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT
statewide
54120
AMPUTATION OF PENIS; PARTIAL
statewide
54125
AMPUTATION OF PENIS; COMPLETE
statewide
54150
Circumcision, using clamp or other device with regional dorsal penile or
ring block
cohort
54160
Circumcision, surgical excision other than clamp, device, or dorsal slit;
neonate (28 days or less)
cohort
54161
CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP,
DEVICE OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE
cohort
cohort
cohort
cohort
cohort
54162
LYSIS/EXCISION, PENILE POSTCIRCUMCISION ADHESIONS
cohort
cohort
cohort
cohort
cohort
54163
REPAIR, INCOMPLETE CIRCUMCISION
cohort
cohort
cohort
cohort
cohort
54164
FRENULOTOMY, PENIS
cohort
cohort
54200
*INJECTION PROCEDURE FOR PEYRONIE DISEASE;
54220
IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM
54235
INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC
AGENT(S)(EG, PAPAVERINE, PHENTOLAMINE)
54300
PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF
CHORDEE (EG,HYPOSPADIAS), WITH OR WITHOUT
MOBILIZATION OF URETHRA
cohort
cohort
cohort
54304
PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE
OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH OR WITHOUT
TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS
cohort
cohort
cohort
54308
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR
(INCLUDINGURINARY DIVERSION); LESS THAN 3 CM
statewide
54312
URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR
(INCLUDINGURINARY DIVERSION); GREATER THAN 3 CM
statewide
54322
1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR
WITHOUTCHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL
ADVA NCEMENT (EG, MAGPI, V-FLAP)
54324
WITHOUTCHORDEE OR CIRCUMCISION); WITH URETHROPLASTY
BY L OCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP)
54326
WITHOUTCHORDEE OR CIRCUMCISION); WITH URETHROPLASTY
BY L OCAL SKIN FLAPS AND MOBILIZATION OF URETHRA
statewide
54328
WITHOUTCHORDEE OR CIRCUMCISION); WITH EXTENSIVE
DISSECTI ON TO CORRECT CHORDEE AND URETHROPLASTY
WITH LOCALSKIN FLAPS, SKIN GRAFT PATCH, AND/OR ISLAND
FLAP
cohort
cohort
54332
1-STAGE PROXIMAL PENILE OR PENOSCROTAL
HYPOSPADIASREPAIR REQUIRING EXTENSIVE DISSECTION TO
CORRECT CHORDEE AND URETHROPLASTY BY USE OF SKIN
GRAFT TUBE AND/OR ISLAND FLAP
cohort
cohort
54340
REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA,
STRICTURE,DIVERTICULA); BY CLOSURE, INCISION, OR
EXCISION, SIMPLE
statewide
54344
STRICTURE,DIVERTICULA); REQUIRING MOBILIZATION OF SKIN
FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT
statewide
54348
STRICTURE,DIVERTICULA); REQUIRING EXTENSIVE DISSECTION
AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT
(INCLUDES
54360
PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION
54380
PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO
EXTERNALSPHINCTER;
54401
INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF-
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
108
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
CONTAINED)
54405
INSERTION OF INFLATABLE (MULTI-COMPONENT) PENILE
PROSTHESIS,INCLUDING PLACEMENT OF PUMP, CYLINDERS,
AND/OR RESERVOIR
54408
REPAIR COMPONENTS(S) MULTICOMPONENT, INFLATABLE
PENILE PROSTHESIS
54410
REMOVAL & REPLACEMENT, MULTICOMPONENT INFLATABLE
PENILE PROSTHESIS, SAME SESSION
statewide
54411
REMOVAL & REPLACEMENT, MULTICOMPONENT INFLATABLE
PENILE PROSTHESIS, INFECTED, W/IRRIG & DEBRIDE
cohort
54416
REMOVAL & REPLACEMENT, NONINFLATABLE (SEMIRIGID)/INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS
54440
PLASTIC OPERATION OF PENIS FOR INJURY
54450
FORESKIN MANIPULATION INCLUDING LYSIS OF
PREPUTIALADHESIONSAND STRETCHING
54500
BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE)
54505
BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE)
54512
EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS
54520
ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR
WITHOUTTESTICULAR PROSTHESIS, SCROTAL OR INGUINAL
APPROACH
54522
ORCHIECTOMY, PARTIAL
54530
ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH
54550
EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR
SCROTALAREA)
54600
REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR
WITHOUTFIXATION OF CONTRALATERAL TESTIS
54620
FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE)
54640
ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA
REPAIR
54650
ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINAL
TESTIS(EG, FOWLER-STEPHENS)
54660
INSERTION OF TESTICULAR PROSTHESIS (SEPARATE
PROCEDURE)
statewide
54670
SUTURE OR REPAIR OF TESTICULAR INJURY
cohort
cohort
54690
LAPAROSCOPY, SURGICAL;ORCHIECTOMY
cohort
cohort
54692
LAPAROSCOPY, SURGICAL;ORCHIOPEXY FOR INTRAABDOMINAL TESTIS
54700
INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS
AND/ORSCROTALSPACE (EG, ABSCESS OR HEMATOMA)
cohort
cohort
cohort
cohort
cohort
54830
EXCISION OF LOCAL LESION OF EPIDIDYMIS
cohort
cohort
cohort
cohort
cohort
54840
EXCISION OF SPERMATOCELE, WITH OR WITHOUT
EPIDIDYMECTOMY
cohort
cohort
cohort
cohort
cohort
54860
EPIDIDYMECTOMY; UNILATERAL
cohort
cohort
cohort
cohort
55000
*PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS,
WITH ORWITHOUT INJECTION OF MEDICATION
cohort
cohort
cohort
cohort
55040
EXCISION OF HYDROCELE; UNILATERAL
cohort
cohort
cohort
cohort
55041
EXCISION OF HYDROCELE; BILATERAL
cohort
cohort
cohort
cohort
55060
REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE)
cohort
cohort
cohort
cohort
55100
*DRAINAGE OF SCROTAL WALL ABSCESS
cohort
cohort
cohort
cohort
55110
SCROTAL EXPLORATION
55120
REMOVAL OF FOREIGN BODY IN SCROTUM
55150
RESECTION OF SCROTUM
55175
SCROTOPLASTY; SIMPLE
55180
SCROTOPLASTY; COMPLICATED
55250
VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE
PROCEDURE),INCLUDING POSTOPERATIVE SEMEN
EXAMINATION(S)
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
statewide
statewide
cohort
cohort
109
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
55400
VASOVASOSTOMY, VASOVASORRHAPHY
statewide
55500
EXCISION OF HYDROCELE OF SPERMATIC CORD,
UNILATERAL(SEPARATE PROCEDURE)
55520
EXCISION OF LESION OF SPERMATIC CORD (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
cohort
55530
EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS
FORVARICOCELE; (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
55535
FORVARICOCELE; ABDOMINAL APPROACH
cohort
cohort
cohort
cohort
55540
FORVARICOCELE; WITH HERNIA REPAIR
statewide
55550
LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC
VEINS FOR VARICOCELE
cohort
cohort
cohort
cohort
55559
UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD
cohort
cohort
cohort
55700
BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE,
ANYAPPROACH
cohort
cohort
cohort
55706
Biopsies, prostate, needle, transperineal, stereotactic template guided
saturation sampling, including imaging guidance
55840
PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR
WITHOUTNERVESPARING;
55842
WITHOUTNERVESPARING; WITH LYMPH NODE BIOPSY(S)
(LIMITED PELVIC LYMPHADENECTOMY)
cohort
cohort
55845
WITHOUTNERVESPARING; WITH BILATERAL PELVIC
LYMPHADENECTO MY, INCLUDING EXTERNAL ILIAC,
HYPOGASTRIC AND OBTURATOR NODES
cohort
cohort
55866
Laparoscopy, surgical prostatectomy, retropubic radical, including nerve
sparing, includes robotic assistance, when performed
cohort
cohort
cohort
55873
CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES
ULTRASONIC GUIDANCE AND MONITORING)
cohort
cohort
cohort
55875
TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS
INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT
APPLICATION, WITH OR WITHOUT CYSTOSCOPY
cohort
cohort
cohort
cohort
55876
Placement of interstitial device(s) for radiation therapy guidance (eg,
fiducial markers, dosimeter), prostate (via needle, any approach), single
or multiple
cohort
cohort
cohort
cohort
55899
UNLISTED PROCEDURE, MALE GENITAL SYSTEM
cohort
cohort
cohort
cohort
55920
Placement of needles or catheters into pelvic organs and/or genitalia
(except prostate) for subsequent interstitial radioelement application
56405
*INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS
cohort
cohort
cohort
cohort
cohort
56420
*INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS
cohort
cohort
cohort
cohort
cohort
56440
MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST
cohort
cohort
cohort
cohort
56441
LYSIS OF LABIAL ADHESIONS
cohort
cohort
cohort
56442
HYMENOTOMY, SIMPLE INCISION
56501
DESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY
METHODDESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY
METHOD
56515
DESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY
METHODDESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY
METHOD
56605
BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1
LESION
cohort
56606
*BIOPSY OF VULVA OR PERINEUM (SEPARATE
PROCEDURE);EACHSEPARATE ADDITIONAL LESION (LIST
SEPARATELY I N ADDITION TO CODE FOR PRIMARY
PROCEDURE)
cohort
56620
VULVECTOMY SIMPLE; PARTIAL
cohort
56625
VULVECTOMY SIMPLE; COMPLETE
56630
VULVECTOMY, RADICAL, PARTIAL;
56700
PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
110
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
56740
EXCISION OF BARTHOLIN'S GLAND OR CYST
56800
PLASTIC REPAIR OF INTROITUS
56810
PERINEOPLASTY, REPAIR OF PERINEUM, NONOBSTETRICAL(SEPARATEPROCEDURE)
56820
COLPOSCOPY, VULVA
cohort
cohort
cohort
56821
COLPOSCOPY, VULVA; W/BIOPSY(S)
cohort
cohort
cohort
57000
COLPOTOMY; WITH EXPLORATION
cohort
cohort
cohort
57010
COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS
57023
INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NONOBSTETRICAL (EG, POST-TRAUMA, SPONTANEOUS BLEEDING)
57061
DESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY
METHODDESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY
METHOD
cohort
cohort
cohort
cohort
57065
DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY
METHODDESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY
METHOD
cohort
cohort
cohort
cohort
57100
*BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
57105
BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING
SUTURE(INCLUDING CYSTS)
statewide
57106
VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL;
cohort
cohort
cohort
57120
COLPOCLEISIS (LE FORT TYPE)
cohort
57130
EXCISION OF VAGINAL SEPTUM
cohort
cohort
cohort
57135
EXCISION OF VAGINAL CYST OR TUMOR
cohort
cohort
cohort
57155
Insertion of uterine tandem and/or vaginal ovoids for clinical
brachytherapy
cohort
cohort
57156
Insertion of a vaginal radiation afterloading apparatus for clinical
brachytherapy
cohort
cohort
57160
*FITTING AND INSERTION OF PESSARY OR OTHER
INTRAVAGINALSUPPORT DEVICE
cohort
cohort
57180
INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR
SPONTANEOUSOR TRAUMATIC NONOBSTETRICAL VAGINAL
HEMORRHAGE (SEPARATE PROCEDURE)
57200
COLPORRHAPHY, SUTURE OF INJURY OF VAGINA
(NONOBSTETRICAL)COLPORRHAPHY, SUTURE OF INJURY OF
VAGINA (NONOBSTETRICAL)
cohort
cohort
cohort
cohort
57210
COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA
AND/ORPERINEUM (NONOBSTETRICAL)
COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA
AND/OR
cohort
cohort
57220
PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL
APPROACH(EG, KELLY URETHRAL PLICATION) PLASTIC
OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH
57240
ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH
ORWITHOUTREPAIR OF URETHROCELE ANTERIOR
COLPORRHAP HY, REPAIR OF CYSTOCELE WITH OR WITHOUT
cohort
cohort
cohort
cohort
cohort
57250
POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR
WITHOUT PERINEORRHAPHY POSTERIOR COLPORRHAPHY,
REPAIR OF RECTOCELE WITH OR WITHOUT
cohort
cohort
cohort
cohort
cohort
57260
COMBINED ANTEROPOSTERIOR COLPORRHAPHY;COMBINED
ANTEROPOSTERIOR COLPORRHAPHY;
cohort
cohort
cohort
cohort
cohort
57265
COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH
ENTEROCELEREPAIR COMBINED ANTEROPOSTERIOR
COLPORRHAPHY;WITH ENTEROCELE
cohort
cohort
cohort
cohort
57267
INSERT MESH/PELVIC FLR ADDON
cohort
cohort
cohort
cohort
57268
REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
57270
REPAIR OF ENTEROCELE, ABDOMINAL APPROACH
(SEPARATEPROCEDURE)
cohort
57280
COLPOPEXY, ABDOMINAL APPROACHCOLPOPEXY, ABDOMINAL
APPROACH
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
111
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
57282
SACROSPINOUS LIGAMENT FIXATION FOR PROLAPSE OF
VAGINA
cohort
cohort
cohort
cohort
cohort
57283
COLPOPEXY, INTRAPERITONEAL
cohort
cohort
cohort
cohort
cohort
57284
Paravaginal defect repair (including repair of cystocele, if performed);
open abdominal approach
57285
Paravaginal defect repair (including repair of cystocele, if performed);
vaginal approach
57287
REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE
(EG, FASCIA OR SYNTHETIC)
cohort
cohort
57288
SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA
ORSYNTHETIC) SLING OPERATION FOR STRESS INCONTINENCE
(EG, FASCIA OR
cohort
cohort
57289
PEREYRA PROCEDURE, INCLUDING ANTERIOR
COLPORRHAPHYPEREYRA PROCEDURE, INCLUDING ANTERIOR
COLPORRHAPHY
57295
REVISION (INCLUDING REMOVAL) OF PROSTHETIC
VAGINALGRAFT, VAGINAL APPROACH
cohort
cohort
57300
CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR
TRANSANALAPPROACH
cohort
cohort
57308
CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL
APPROACH,WITH PERINEAL BODY RECONSTRUCTION, WITH OR
WITHOUT LEVATOR PLICATION
57310
CLOSURE OF URETHROVAGINAL FISTULA;
57320
CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH
57330
CLOSURE OF VESICOVAGINAL FISTULA; TRANSVESICAL
ANDVAGINALAPPROACH
57400
Dilation of vagina under anesthesia (other than local)
57410
Pelvic examination under anesthesia (other than local)
cohort
cohort
57415
Removal of impacted vaginal foreign body (separateprocedure) under
anesthesia (other than local)
cohort
cohort
57420
COLPOSCOPY ENTIRE VAGINA, W/CERVIX IF PRESENT
57421
COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT; W/BIOPSY
(S)
57425
LAPAROSCOPY SURGICAL COLPOPEXY (SUSPENSION OF
VAGINAL APEX)
57426
REVISION (INCLUDING REMOVAL) OF PROSTHETIC
VAGINALGRAFT, LAPAROSCOPIC APPROACH
57452
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
*COLPOSCOPY (VAGINOSCOPY); (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
57454
*COLPOSCOPY (VAGINOSCOPY); WITH BIOPSY(S) OF THE
CERVIXAND/OR ENDOCERVICAL CURETTAGE
cohort
cohort
cohort
cohort
cohort
57455
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/BIOPSY
(S), CERVIX
cohort
cohort
cohort
57456
COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA;
W/ENDOCERVICAL CURETTAGE
cohort
cohort
cohort
cohort
57460
COLPOSCOPY (VAGINOSCOPY); WITH LOOP ELECTRODE
EXCISIONPROCEDURE OF THE CERVIX
cohort
cohort
cohort
cohort
cohort
57461
COLPOSCOPY CERVIX W/UPPER ADJACENT VAGINA; W/LOOP
ELECTRODE CONIZATION CERVIX
cohort
cohort
cohort
cohort
cohort
57500
Biopsy of cervix, single or multiple, or local excision of lesion, with or
without fulguration (separate procedure)
cohort
cohort
cohort
cohort
cohort
57505
ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A
DILATION ANDCURETTAGE)
cohort
cohort
cohort
cohort
cohort
57510
CAUTERIZATION OF CERVIX; ELECTRO OR THERMAL
cohort
cohort
57511
*CAUTERIZATION OF CERVIX; CRYOCAUTERY, INITIAL OR
REPEAT
57513
CAUTERIZATION OF CERVIX; LASER ABLATION
cohort
cohort
57520
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION,WITH
ORWITHOUT DILATION AND CURETTAGE, WITH OR WI THOUT
REPAIR; COLD KNIFE OR LASER
cohort
cohort
cohort
cohort
57522
CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION,WITH
ORWITHOUT DILATION AND CURETTAGE, WITH OR WI THOUT
cohort
cohort
cohort
cohort
statewide
statewide
112
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
REPAIR; LOOP ELECTRODE EXCISION
57530
TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF
CERVIX(SEPARATEPROCEDURE)
57531
RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL
PELVICLYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE
SAMPLING BIOPSY, WITH OR WITHOUT REMOVAL OF TUBE(S),
WITH OR WITHOUT REMOVAL
57550
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
57556
EXCISION OF CERVICAL STUMP, VAGINAL APPROACH;
WITHREPAIR OFENTEROCELE
57700
CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL
57720
TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE
CERVIX,VAGINALAPPROACH
cohort
57800
*DILATION OF CERVICAL CANAL, INSTRUMENTAL
(SEPARATEPROCEDURE)
58100
*ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT
ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL
DILATION, ANY METHOD (SEPARATE PROCEDURE)
58110
ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN
CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN
ADDITION TO CODE FOR PRIMARY PROCEDURE)
58120
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR
THERAPEUTIC(NONOBSTETRICAL)
cohort
58140
MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS,
SINGLE ORMULTIPLE (SEPARATE PROCEDURE); ABDOMINAL
APPROACH
cohort
58145
MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS,
SINGLE ORMULTIPLE (SEPARATE PROCEDURE); VAGINAL
APPROACH
58146
MYOMECTOMY 5/>INTRAMURAL MYOMAS &/OR TOTAL WT>250
GMS,ABDOMINAL APPROACH
58150
TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX),
WITH ORWITHOUT REMOVAL OF TUBE(S), WITH OR
WITHOUTREMOVAL OF OVARY(S);
58180
SUPRACERVICAL ABDOMINAL HYSTERECTOMY
(SUBTOTALHYSTERECTOMY), WITH OR WITHOUT REMOVAL OF
TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S)
58200
TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL
VAGINECTOMY,WITH PARA-AORTIC AND PELVIC LYMPH NODE
SAMPLING, WITH OR WITHOUT REMOVAL OF TUBE(S), WITHOR
WITHOUT REMOVAL OF
58210
RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL
PELVIC LYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE
SAMPLING (BIOPSY), WITH OR WITHOUT REMOVAL OF TUBE(S),
WITH OR
58260
VAGINAL HYSTERECTOMY;
cohort
cohort
cohort
cohort
cohort
58262
VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S),
AND/OROVARY(S)
cohort
cohort
cohort
cohort
cohort
58263
VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S),
AND/OROVARY(S), WITH REPAIR OF ENTEROCELE
cohort
cohort
cohort
cohort
58267
VAGINAL HYSTERECTOMY; WITH COLPOURETHROCYSTOPEXY(MARSHALL-MARCHETTI-KRANTZ TYPE,
PEREYRA TYPE, WITHOR WITHOUT ENDOSCOPIC CONTROL)
58270
VAGINAL HYSTERECTOMY; WITH REPAIR OF ENTEROCELE
58275
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL
COLPECTOMY;
58280
VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL
COLPECTOMY; WITHREPAIR OF ENTEROCELE
58290
VAGINAL HYSTERECTOMY, UTERUS >250GMS;
cohort
58291
VAGINAL HYSTERECTOMY UTERUS >250 GMS; W/REMOVAL,
TUBE(S) &/OR OVARY(S)
cohort
58292
VAGINAL HYSTERECTOMY UTERUS >250GMS; W/REMOVAL,
TUBE(S) &/OR OVARY(S) W/REPAIR OF ENTEROCELE
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
113
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
58294
VAGINAL HYSTERECTOMY UTERUS >250 GMS; W/REPAIR OF
ENTEROCELE
cohort
cohort
58300
*INSERTION OF INTRAUTERINE DEVICE (IUD)*INSERTION OF
INTRAUTERINE DEVICE (IUD)
cohort
cohort
cohort
cohort
58301
REMOVAL OF INTRAUTERINE DEVICE (IUD)REMOVAL OF
INTRAUTERINE DEVICE (IUD)
cohort
cohort
cohort
cohort
cohort
58340
*CATHETERIZATION AND INTRODUCTION OF SALINE OR
CONTRASTMATERIAL FOR HYSTEROSONOGRAPHY OR
HYSTEROSALPINGOGRAPHY
cohort
cohort
cohort
cohort
cohort
58345
TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE
CATHETER FORDIAGNOSIS AND/OR RE-ESTABLISHING PATENCY
(ANY METHOD), WITH OR WITHOUT HYSTEROSALPINGOGRAPHY
cohort
cohort
58350
*CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS
cohort
cohort
cohort
cohort
58353
ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC
GUIDANCE.
cohort
cohort
cohort
cohort
58356
ENDOMETRIAL CRYOABLATION
58400
UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF
ROUNDLIGAMENTS, WITH LIGAMENTS; (SEPARATE PROCEDURE)
cohort
cohort
58520
HYSTERORRHAPHY, REPAIR OF RUPTURED UTERUS
(NONOBSTETRICAL)
cohort
cohort
58540
HYSTEROPLASTY, REPAIR OF UTERINE ANOMALY (STRASSMAN
TYPE)
statewide
58541
LAPAROSCOPY, SURGICAL, SUPRACERVICAL
HYSTERECTOMY,FOR UTERUS 250 G OR LESS;
cohort
cohort
cohort
cohort
cohort
58542
HYSTERECTOMY,FOR UTERUS 250 G OR LESS; WITH REMOVAL
OF TUBE(S) AND/OR OVARY(S)
cohort
cohort
cohort
cohort
cohort
58543
HYSTERECTOMY,FOR UTERUS GREATER THAN 250 G;
cohort
cohort
cohort
cohort
cohort
58544
HYSTERECTOMY,FOR UTERUS GREATER THAN 250 G; WITH
REMOVAL OF TU BE(S) AND/OR OVARY(S)
cohort
cohort
cohort
cohort
cohort
58545
LAPAROSCOPY, SURG, MYOMECTOMY; 1-4 INTRAMURAL
MYOMAS, TOTAL WT 250 GMS, &/OR REMOVE SURFACE MYOMAS
cohort
cohort
cohort
cohort
cohort
58546
LAPARPSCOPY, SURG, MYOMECTOMY; 5/> INTRAMURAL
MYOMAS &/OR TOTAL WT>250 GMS
cohort
cohort
cohort
cohort
58548
LAPAROSCOPY, SURGICAL, WITH RADICAL HYSTERECTOMY,
WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND
PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY), WITH
REMOVAL OF TUBE(S) AND OVARY(S), IF PERFORMED
cohort
cohort
cohort
58550
LAPAROSCOPY, SURGICAL; WITH VAGINAL HYSTERECTOMY
WITH OR WITHOUT REMOVAL OF TUBE(S),WITH OR
WITHOUTREMOVAL OF OVARY(S) (LAPAROSCOPIC ASSISTED
VAGINALHYSTERECTOMY)
cohort
cohort
cohort
cohort
cohort
58552
LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS
250 GMS/<; W/REMOVAL TUBE(S) &/OR OVARY(S)
cohort
cohort
cohort
cohort
cohort
58553
LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS
>250 GMS
cohort
cohort
cohort
cohort
58554
LAPAROSCOPY SURG W/VAGINAL HYSTERECTOMY, UTERUS
>250 GMS; W/REMOVE TUBE(S) &/OR OVARY(S)
cohort
cohort
cohort
cohort
58555
HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
58558
HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF
ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D &
C
cohort
cohort
cohort
cohort
cohort
58559
HYSTEROSCOPY, SURGICAL; WITH LYSIS OF
INTRAUTERINEADHESIONS (ANY METHOD)
cohort
cohort
cohort
cohort
58560
HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTIONOF
INTRAUTERINE SEPTUM (ANY METHOD)
cohort
cohort
58561
HYSTEROSCOPY, SURGICAL;WITH REMOVAL OF LEIOMYOMATA
cohort
cohort
cohort
cohort
58562
HYSTEROSCOPY, SURGICAL;WITH REMOVAL OF IMPACTED
FOREIGN BODY
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
58563
cohort
statewide
cohort
HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION
114
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
(ANY METHOD)
58565
HYSTEROSCOPY, STERILIZATION
cohort
cohort
cohort
cohort
58570
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
cohort
cohort
cohort
cohort
cohort
58571
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
with removal of tube(s) and/or ovary(s)
cohort
cohort
cohort
cohort
cohort
58572
Laparoscopy, surgical, with total hysterectomy, for uterus greater than
250 g;
cohort
cohort
cohort
cohort
58573
Laparoscopy, surgical, with total hysterectomy, for uterus greater than
250 g; with removal of tube(s) and/or ovary(s)
cohort
cohort
cohort
cohort
58578
UNLISTED LAPAROSCOPY PROCEDURE, UTERUS
cohort
cohort
cohort
cohort
58579
UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS
cohort
cohort
cohort
cohort
58600
LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S),
ABDOMINAL ORVAGINAL APPROACH, UNILATERAL OR
BILATERAL
cohort
cohort
58615
OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND,
CLIP,FALOPE RING) VAGINAL OR SUPRAPUBIC
APPROACHOCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG,
BA ND, CLIP,
cohort
cohort
cohort
cohort
58660
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS
(SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
58661
LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL
STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR
SALPINGECTOMY)
cohort
cohort
cohort
cohort
cohort
58662
LAPAROSCOPY, SURGICAL;WITH FULGURATION OR EXCISIONOF
LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL
SURFACE BY ANY METHOD
cohort
cohort
cohort
cohort
cohort
58670
LAPAROSCOPY, SURGICAL;WITH FULGURATION OF
OVIDUCTS(WITH OR WITHOUT TRANSECTION)
cohort
cohort
cohort
cohort
cohort
58671
LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY
DEVICE (EG. BAND, CLIP, OR FALOPE RING)
cohort
cohort
cohort
cohort
cohort
58672
LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY
58673
LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY
(SALPINGONEOSTOMY)
cohort
58679
UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY
(SALPINGONEOSTOMY)
cohort
cohort
cohort
cohort
58700
SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR
BILATERAL (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
58720
SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL,
UNILATERAL ORBILATERAL (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
58740
LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS)
cohort
cohort
58750
TUBOTUBAL ANASTOMOSIS
58770
SALPINGOSTOMY (SALPINGONEOSTOMY)
58800
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR
BILATERAL,(SEPARATE PROCEDURE); VAGINAL APPROACH
cohort
58805
DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR
BILATERAL,(SEPARATE PROCEDURE); ABDOMINAL APPROACH
statewide
58823
DRAINAGE OF PELVIC ABSCESS, TRANSVAGINAL OR
TRANSRECTALAPPROACH, PERCUTANEOUS (EG, OVARIAN,
PERICOLIC)
58900
BIOPSY OF OVARY, UNILATERAL OR BILATERAL
(SEPARATEPROCEDURE)
statewide
58925
OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL
cohort
cohort
58940
OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR
BILATERAL;
cohort
cohort
58950
Resection (initial) of ovarian, tubal or primary preitoneal malignancy with
bilateral salpingo-oophorectomy and omentectomy
58970
FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD
58999
Unlisted procedure, female genital system (nonobstetrical)
cohort
cohort
cohort
cohort
59000
*AMNIOCENTESIS, ANY METHOD
cohort
cohort
cohort
cohort
59001
cohort
cohort
statewide
cohort
statewide
statewide
cohort
cohort
statewide
cohort
statewide
statewide
statewide
AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID
115
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
REDUCTIOW/US
59015
CHORIONIC VILLUS SAMPLING, ANY METHOD
59020
*FETAL CONTRACTION STRESS TEST
59025
FETAL NON-STRESS TESTFETAL NON-STRESS TEST
59050
FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN
(IE,NON-ATTENDING PHYSICIAN) WITH WRITTEN REPORT;
SUPERVISION AND INTERPRETATION
59074
FETAL FLUID DRAINAGE (EG VESICOCENTESIS
THORACOCENTESIS PARACENTESIS) INCLUDING ULTRA- SOUND
GUIDANCE
statewide
59076
FETAL SHUNT PLACEMENT INCLUDING ULTRASOUND GUIDANCE
statewide
59120
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR
OVARIAN,REQUIRING SALPINGECTOMY AND/OR
OOPHORECTOMY, ABDOMINAL OR VAGINAL APPROACH
cohort
59121
SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR
OVARIAN,WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
statewide
59150
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY;
WITHOUTSALPINGECTOMY AND/OR OOPHORECTOMY
cohort
cohort
cohort
cohort
59151
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY;
WITHSALPINGECTOMY AND/OR OOPHORECTOMY
cohort
cohort
cohort
cohort
59160
CURETTAGE, POSTPARTUM
cohort
cohort
cohort
cohort
59200
INSERTION OF CERVICAL DILATOR (EG, LAMINARIA,
PROSTAGLANDIN)(SEPARATE PROCEDURE)
cohort
cohort
59300
EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING
cohort
cohort
59320
CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL
cohort
cohort
59325
CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL
59409
VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY
AND/ORFORCEPS);
statewide
59412
EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS
(LISTIN ADDITION TO CODE(S) FOR DELIVERY)
cohort
59414
DELIVERY OF PLACENTA (SEPARATE PROCEDURE)
59514
CESAREAN DELIVERY ONLY;
59812
TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER,
COMPLETEDSURGICALLY
cohort
cohort
cohort
cohort
59820
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY;
FIRSTTRIMESTER TREATMENT OF MISSED ABORTION,
COMPLETED SURGICALLY; FIRST
cohort
cohort
cohort
cohort
59821
TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY;
SECONDTRIMESTER TREATMENT OF MISSED ABORTION,
COMPLETED SURGICALLY; SECOND
cohort
cohort
cohort
cohort
59840
INDUCED ABORTION, BY DILATION AND CURETTAGE
cohort
cohort
59841
INDUCED ABORTION, BY DILATION AND EVACUATION
cohort
cohort
59856
INDUCED ABORTION, BY 1 OR MORE VAGINAL SUPPOSITORIES
(EG, PROSTAGLANDIN) WITH OR WITHOUT CERVICAL DILATION
(EG, LAMINARIA), INCLUDING HOSPITAL ADMISSION AND VISITS,
DELIVERY OF FETUS AND SECUNDINES; W
59866
MULTIFETAL PREGNANCY REDUCTION(S) (MPR)
59870
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM
MOLE
59871
REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA
(OTHERTHANLOCAL)
59899
UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY
60000
*INCISION AND DRAINAGE OF THYROGLOSSAL CYST, INFECTED
60100
*BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE
cohort
60200
EXCISION OF CYST OR ADENOMA OF THYROID, OR
TRANSECTION OFISTHMUS
cohort
60210
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR
WITHOUTISTHMUSECTOMY
cohort
60212
PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH
CONTRALATERALSUBTOTAL LOBECTOMY, INCLUDING
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
116
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
ISTHMUSECTOMY
60220
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR
WITHOUTISTHMUSECTOMY
cohort
cohort
cohort
cohort
cohort
cohort
60225
TOTAL THYROID LOBECTOMY, UNILATERAL; WITH
CONTRALATERALSUBTOTAL LOBECTOMY, INCLUDING
ISTHMUSECTOMY
cohort
cohort
cohort
cohort
cohort
cohort
60240
THYROIDECTOMY, TOTAL OR COMPLETE
cohort
cohort
cohort
cohort
cohort
60252
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY;
WITHLIMITED NECK DISSECTION
cohort
cohort
cohort
cohort
60254
THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY;
WITHRADICAL NECK DISSECTION
60260
THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID
TISSUEFOLLOWING PREVIOUS REMOVAL OF A PORTION OF
THYROID
60271
THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID
GLAND;CERVICAL APPROACH
60280
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
cohort
60281
EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS;
RECURRENT
statewide
60300
Aspiration and/or injection, thyroid cyst
cohort
60500
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
60502
PARATHYROIDECTOMY OR EXPLORATION OF
PARATHYROID(S);RE-EXPLORATION
cohort
cohort
60505
PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);
WITHMEDIASTINAL EXPLORATION, STERNAL SPLIT OR
TRANSTHORACIC APPROACH
cohort
cohort
60512
PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN
ADDITIONTO CODE FOR PRIMARY PROCEDURE)
cohort
cohort
cohort
60520
THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL
APPROACH(SEPARATE PROCEDURE)
cohort
cohort
cohort
60521
THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR
TRANSTHORACICAPPROACH, WITHOUT RADICAL MEDIASTINAL
DISSECTION (SEPARATE PROCEDURE)
cohort
cohort
60600
EXCISION OF CAROTID BODY TUMOR; WITHOUT EXCISION OF
CAROTID ARTERY
statewide
60650
LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIALOR
COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR
WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL
61055
*CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE;
WITHINJECTION OF DRUG OR OTHER SUBSTANCE FOR
DIAGNOSIS OR TREATMENT (EG, C1-C2)
61070
*PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR
ASPIRATION ORINJECTION PROCEDURE *PUNCTURE OF SHUNT
TUBING OR RESERVOIR FOR ASPIRATION OR
61210
Burr hole(s); for implanting ventricular catheter,reservoir, EEG
electrode(s), pressure recording d evice, or other cerebral monitoring
device (separate procedure)
statewide
61304
CRANIECTOMY OR CRANIOTOMY, EXPLORATORY;
SUPRATENTORIALCRANIECTOMY OR CRANIOTOMY,
EXPLORATORY; SUPRATENTORIAL
statewide
61343
CRANIECTOMY, SUBOCCIPITAL WITH CERVICAL LAMINECTOMY
FORDECOMPRESSION OF MEDULLA AND SPINAL CORD, WITH
OR WITHOUT DURAL GRAFT (EG, ARNOLD-CHIARI
MALFORMATION)
61500
CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE
LESION OF SKULL CRANIECTOMY; WITH EXCISION OF TUMOR
OR OTHER BONE LESION OF
61544
CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION
ORCOAGULATION OF CHOROID PLEXUS CRANIOTOMY WITH
ELEVATION OF BONE FLAP; FOR EXCISION OR
statewide
61550
CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL
SUTURE
statewide
61563
EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF
cohort
cohort
cohort
cohort
cohort
117
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CRANIALBONE (EG, FIBROUS DYSPLASIA); WITHOUT
OPTICNERVE DECOMPRESSION
61591
INFRATEMPORAL POST-AURICULAR APPROACH TO MIDDLE
CRANIALFOSSA (INTERNAL AUDITORY MEATUS, PETROUS APEX,
TENTORIUM, CAVERNOUS SINUS, PARASELLAR AREA,
INFRATEMPORAL FOSSA)
statewide
61605
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR
INFECTIOUS LESION OF INFRATEMPORAL FOSSA,
PARAPHARYNGEAL SPACE, PETROUS APEX; EXTRADURAL
statewide
61607
RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR
INFECTIOUS LESION OF PARASELLAR AREA, CAVERNOUS
SINUS, CLIVUS OR MIDLINE SKULL BASE; EXTRADURAL
statewide
61613
OBLITERATION OF CAROTID ANEURYSM,
ARTERIOVENOUSMALFORMATION, OR CAROTID-CAVERNOUS
FISTULA BY DISSECTION WITHIN CAVERNOUS SINUS
statewide
61623
ENDOVASC TEMP OCCLUSION HEAD/NCK W/VESSEL CATH
BALLOON POSITIONING/INFLATION NEUR MONIT, S&I
statewide
61624
METH OD; CENTRAL NERVOUS
61626
METH OD; NON-CENTRAL NERVOUS
61750
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING
BURRHOLE(S), FOR INTRACRANIAL LESION;
61751
STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING
BURRHOLE(S), FOR INTRACRANIAL LESION; WITH
COMPUTERIZED AXIAL TOMOGRAPHY
statewide
61781
Stereotactic computer-assisted (navigational) procedure; cranial,
intradural (List separately in addition to code for primary procedure)
cohort
cohort
61782
Stereotactic computer-assisted (navigational) procedure; cranial,
extradural (List separately in addition to code for primary procedure)
cohort
cohort
61867
TWIST DRILL, BURR HOLE, CRANIOTOMY, OR
CRANIECTOMYWITH STEREOTACTIC IMPLANTATION OF
NEUROSTIMULATOR ELECTRODE ARRAY IN SUBCORTICAL SITE
(EG, THALAMUS , GLOBUS PALLIDUS, SUBTHALAMIC NUCLEUS,
PERIVENTRI
statewide
61885
INCISION AND SUBCUTANEOUS PLACEMENT OF
CRANIALNEUROSTIMULATOR PULSE GENERATOR OR
RECEIVER, DIRECT ORINDUCTIVE COUPLING
cohort
cohort
61886
INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR
PULSE GENERATOR OR RECEIVER, DIRECT OR
INDUCTIVECOUPLING; WITH CONNECTION TO 2 OR MORE
ELECTRODE ARRAYS
cohort
cohort
61888
REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR
PULSEGENERATOR OR RECEIVER
62000
ELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE,
EXTRADURALELEVATION OF DEPRESSED SKULL FRACTURE;
SIMPLE, EXTRADURAL
62140
CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER
statewide
62142
REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL
statewide
62145
CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN
SURGERY
statewide
62146
CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING
BONEGRAFTS); UP TO 5 CM DIAMETER
statewide
62148
INCISION & RETRIEVAL SUBQ CRANIAL BONE GRAFT FOR
CRANIOPLASTY
statewide
62160
NEUROENDOSCOPY, INTRACRANIAL PLACE/REPLACE
VENTRICULAR CATH, SHUNT SYS/ENT DRAINAGE
statewide
62201
VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE;
STEREOTACTICMETHOD VENTRICULOCISTERNOSTOMY, THIRD
VENTRICLE; STEREOTACTIC
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
118
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
62220
CREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, AURICULARCREATION OF SHUNT; VENTRICULO-ATRIAL, JUGULAR, -AURICULAR
62223
CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL,
OTHERTERMINUS CREATION OF SHUNT; VENTRICULOPERITONEAL, -PLEURAL, OTHER
statewide
62225
REPLACEMENT OR IRRIGATION, VENTRICULAR
CATHETERREPLACEMENT OR IRRIGATION, VENTRICULAR
CATHETER
statewide
62230
REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED
VALVE, ORDISTAL CATHETER IN SHUNT SYSTEM REPLACEMENT
OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR
statewide
62252
REPROGRAMMING OF PROGRAMMABLE CSF SHUNT.
statewide
62256
REMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITHOUT
REPLACEMENTREMOVAL OF COMPLETE CSF SHUNT SYSTEM;
WITHOUT REPLACEMENT
statewide
62258
REMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITH
REPLACEMENT BYSIMILAR OR OTHER SHUNT AT SAME
OPERATION REMOVAL OF COMPLETE CSF SHUNT SYSTEM;
WITH REPLACEMENT BY
statewide
62264
LYSIS PERQ EPIDURAL ADHESIONS SOLUTION INJECTION/
MECHANICAL W/RADIOLOGIC LOCALIZATION; 1 DAY
62267
Percutaneous aspiration within the nucleus pulposus, intervertebral
disc, or paravertebral tissue for diagnostic purposes
62268
*PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX
62269
*BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE
cohort
62270
*SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC
cohort
62272
*SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL
FLUID (BY NEEDLE OR CATHETER)
62273
*INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT
PATCH*INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT
PATCH
62281
*INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL,
PHENOL,ICED SALINE SOLUTIONS); EPIDURAL, CERVICAL OR
THORACIC *INJECTION OF NEUROLYTIC SUBSTANCE (EG,
ALCOHOL, PHENOL,
62282
*INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL,
PHENOL,ICED SALINE SOLUTIONS); EPIDURAL, LUMBAR OR
CAUDAL *INJECTION OF NEUROLYTIC SUBSTANCE (EG,
ALCOHOL, PHENOL,
62284
Injection procedure for myelography and/or computed tomography,
spinal (other than C1-C2 and posterior fossa)
62287
DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS
PULPOSUS OF INTERVERTEBRAL DISC, ANY METHOD UTILIZING
NEEDLE BASED TECHNIQUE TO REMOVE DISC MATERIALUNDER
FLUOROSCOPIC IMAGING OR OTHER FORM OF INDIR
62290
*INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL;
LUMBAR
62291
*INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL;
CERVICAL
62310
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S)
(INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID,
OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES,
INCLUDING NEEDLE OR CATHETER PLACEM
62311
INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S)
(INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID,
OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES,
INCLUDING NEEDLE OR CATHETER PLACEM
62318
INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT,
CONTINUOUS INFUSION OR INTERMITTENT BOLUS,
OFDIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING
ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER
cohort
62319
INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT,
CONTINUOUS INFUSION OR INTERMITTENT BOLUS,
OFDIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING
cohort
Peer
Cohort
5
Peer
Cohort
6
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
119
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER
62350
IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL
OREPIDURAL CATHETER, FOR IMPLANTABLE RESERVOIR OR
IMPLANTABLE INFUSION PUMP; WITHOUT LAMINECTOMY
cohort
cohort
cohort
cohort
62362
IMPLANTATION OR REPLACEMENT OF DEVICE FOR
INTRATHECAL OREPIDURAL DRUG INFUSION; PROGRAMMABLE
PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT
PROGRAMMING
cohort
cohort
cohort
cohort
62367
ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP
FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES
EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG
PRESCRIPTION STATUS); WITHOUT REPROGRAMMING O
62368
FORINTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES
PRESCRIPTION
cohort
62369
PRESCRIPTION STATUS); WITH REPROGRAMMING AND
cohort
62370
PRESCRIPTION STATUS); WITH REPROGRAMMING AND
63001
LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION
OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT
FACETECTOMY, FORAMINOTOMY OR DISKECTOMY, (EG, SPINAL
STENOSIS), ONE OR TWO VERTEBRAL
63005
STENOSIS), ONE OR TWO VERTEBRAL
cohort
63012
LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS
AND/ORPARSINTER-ARTICULARIS WITH DECOMPRESSION OF
CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS,
LU MBAR (GILL TYPE
statewide
63015
STENOSIS), MORE THAN 2 VERTEBRAL
63017
STENOSIS), MORE THAN 2 VERTEBRAL
63020
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF
NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY,
FORAMINOTOMY AND/OR EXCISION OF HERNIATED
INTERVERTEBRAL DISC; 1 INTERSPACE, CERVICAL
63030
INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR
63035
INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE,
CERVICAL OR
63040
NERVEROOT(S), INCLUDING PARTIAL FACETECTOMY,
INTERVERTEBRAL DISK, RE-EXPLORATION;
63042
NERVEROOT(S), INCLUDING PARTIAL FACETECTOMY,
INTERVERTEBRAL DISK, RE-EXPLORATION;
63044
LAMINOTOMY (HEMILAMINECTOMY),WITH DECOMPRESSION
OFNERVEROOT(S),INCLUDING PARTIAL
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
120
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
FACETECTOMY,FORAMINOTOMY AND/OR EXCISION OF
HERNIATED INTERVERTEBRAL DISK,RE-EXPLORATION;EACH
ADDT'L LUMBAR INTERSPACE
63045
LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY
(UNILATERAL ORBILATERAL WITH DECOMPRESSION OF SPINAL
CORD,CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL O R
LATERAL RECESS
63046
LATERAL RECESS
63047
LATERAL RECESS
cohort
cohort
cohort
cohort
cohort
cohort
63048
LATERAL RECESS
cohort
cohort
cohort
cohort
cohort
cohort
63051
LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE
SPINAL CORD, 2 OR MORE VERTEBRAL SEGMENTS; WITH
RECONSTRUCTION OF THE POSTERIOR BONY ELEMENTS
(INCLUDING THE APPLICATION OF BRIDGING BONE GRAFT AND
NO
63055
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF
SPINAL CORD,EQUINA AND/OR NERVE ROOT(S) (EG,
HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT;
THORACIC
63056
HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT; LUMBAR
63057
HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT; EACH
ADDIT IONAL SEGMENT, THORACIC OR
63075
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF
SPINALCORD AND/OR NERVE ROOT(S), INCLUDING
OSTEOPHYTECT OMY; CERVICAL, SINGLE INTERSPACE
63076
DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF
SPINALCORD AND/OR NERVE ROOT(S), INCLUDING
OSTEOPHYTECT OMY; CERVICAL, EACH ADDITIONAL
INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE
63081
VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION),
PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH
DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S);
CERVICAL, SINGLE SEGMENT
cohort
63082
PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH
DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S);
CERVICAL, EACH ADDITIONAL SEGMENT
cohort
63200
LAMINECTOMY, WITH RELEASE OF TETHERED SPINAL
CORD,LUMBAR
63225
63252
LAMINECTOMY FOR EXCISION OR OCCLUSION OF
ARTERIOVENOUSMALFORMATION OF SPINAL CORD;
THORACOLUMBAR LAMINECTOMY FOR EXCISION OR
OCCLUSION OF ARTERIOVENOUS
63267
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL
LESIONOTHER THAN NEOPLASM, EXTRADURAL; LUMBAR
63273
LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER
THANNEOPLASM, INTRADURAL; SACRAL
statewide
63276
LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL
NEOPLASM;EXTRADURAL, THORACIC
statewide
63277
NEOPLASM;EXTRADURAL, LUMBAR
63281
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
statewide
121
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
NEOPLASM;INTRADURAL, EXTRAMEDULLARY, THORACIC
63302
PARTIAL OR COMPLETE, FOR EXCISION OF INTRASPINAL
LESION, SINGLE SEGMENT; EXTRADURAL, THORACIC BY
THORACOLUMBAR APPROACH
63650
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR
ELECTRODEARRAY, EPIDURAL PERCUTANEOUS IMPLANTATION
OF NEUROSTIMULATOR ELECTRODE
63655
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR
ELECTRODES, PLATE/PADDLE, EPIDURAL LAMINECTOMY FOR
IMPLANTATION OF NEUROSTIMULATOR ELECTRODES,
63661
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE
PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN
PERFORMED
63662
REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE
PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY,
INCLUDING FLUOROSCOPY, WHEN PERFORMED
63663
REVISION INCLUDING REPLACEMENT, WHEN PERFORMED,
OFSPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS
ARR AY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED
63685
INCISION AND SUBCUTANEOUS PLACEMENT OF
SPINALNEUROSTIMULATOR PULSE GENERATOR OR RECEIVER,
DIRECT OR INDUCTIVE COUPLING
63688
REVISION OR REMOVAL OF IMPLANTED SPINAL
NEUROSTIMULATORPULSE GENERATOR
63707
REPAIR OF DURAL/CSF LEAK, NOT REQUIRING LAMINECTOMY
statewide
63709
REPAIR OF DURAL/CSF LEAK OR PSEUDOMENINGOCELE,
WITHLAMINECTOMY
statewide
63710
DURAL GRAFT, SPINAL
statewide
63740
CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL,PLEURAL, OR OTHER; INCLUDING LAMINECTOMY
statewide
63741
CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL,PLEURAL, OR OTHER; PERCUTANEOUS, NOT REQUIRING
LAMINECTOMY
63744
REPLACEMENT, IRRIGATION OR REVISION OF
LUMBOSUBARACHNOIDSHUNT
64400
*INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY
DIVISIONOR BRANCH
cohort
cohort
cohort
cohort
cohort
64402
*INJECTION, ANESTHETIC AGENT; FACIAL NERVE
cohort
cohort
cohort
cohort
cohort
64405
*INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE
cohort
cohort
cohort
cohort
cohort
64410
*INJECTION, ANESTHETIC AGENT; PHRENIC NERVE
statewide
64412
*INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE
statewide
64413
*INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS
cohort
cohort
cohort
64415
*INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS
cohort
cohort
cohort
cohort
cohort
64416
Injection, anesthetic agent; brachialplexus, continuous infusion by
catheter (including catheter placement)
cohort
cohort
cohort
cohort
cohort
64417
*INJECTION, ANESTHETIC AGENT; AXILLARY NERVE
cohort
cohort
cohort
cohort
cohort
64418
*INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE
cohort
cohort
cohort
cohort
64420
*INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE
cohort
cohort
cohort
cohort
64421
*INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES,
MULTIPLE, REGIONAL BLOCK *INJECTION, ANESTHETIC AGENT;
INTERCOSTAL NERVES, MULTIPLE,
cohort
cohort
cohort
cohort
64425
*INJECTION, ANESTHETIC AGENT; ILIOINGUINAL,
ILIOHYPOGASTRIC NERVES
cohort
cohort
cohort
cohort
64430
*INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE
cohort
cohort
64435
*INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE)
NERVE
64445
*INJECTION, ANESTHETIC AGENT; SCIATIC NERVE
cohort
cohort
64446
Injection, anesthetic agent; sciatic nerve, continuous infusion by
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
122
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
64447
INJECTION ANESTHETIC AGENT; FEMORAL NERVE SINGLE
cohort
cohort
cohort
64448
Injection, anesthetic agent; femoral nerve, continuous infusion by
cohort
cohort
cohort
64449
Injection, anesthetic agent; lumbar plexus, posterior approach,
continuous infusion by catheter (including catheter placement)
64450
*INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE
ORBRANCH
cohort
64455
Injection(s), anesthetic agent and/or steriod, plantar common digital
nerve(s) (e.g., Morton's neuroma)
cohort
64479
Injection(s), anesthetic agent and/or steroid, transforaminal epidural,
with imaging guidance (fluoroscopy or CT); cervical or thoracic, single
level
cohort
64480
with imaging guidance (fluoroscopy or CT); cervical or thoracic, each
additional level (List separately in addition to code for
64483
with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level
64484
with imaging guidance (fluoroscopy or CT); lumbar or sacral, each
additional level (List separately in addition to code for prim
64490
INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT,
PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES
INNERVATING THAT JOINT) WITH IMAGE GUIDANCE
(FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE
LEVEL
64491
(FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND
LEVEL
64492
(FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND
ANY
64493
(FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL
64494
(FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL
(LIS
64495
(FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY
ADD
64505
*INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION
64510
*INJECTION, ANESTHETIC AGENT; STELLATE GANGLION
(CERVICALSYMPATHETIC)
64517
INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC
PLEXUS
64520
*INJECTION, ANESTHETIC AGENT; LUMBAR OR
THORACIC(PARAVERTEBRAL SYMPATHETIC)
64530
*INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR
WITHOUTRADIOLOGIC MONITORING
64555
ELECTRODE ARRAY; PERIPHERAL NERVE (EXCLUDES SACRAL
NERVE)
64561
ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL
PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED
cohort
Incision for implantation of cranial nerve (eg, vagus nerve)
cohort
64568
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
123
cohort
Peer
Cohort
6
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
neurostimulator electrode array and pulse generator
64570
Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode
array and pulse generator
64581
INCISION FOR IMPLANTATION OF NEUROSTIMULATOR
ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL
PLACEMENT)
cohort
cohort
cohort
cohort
cohort
64585
REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR
ELECTRODE ARRAY
cohort
cohort
cohort
cohort
cohort
64590
Insertion or replacement of peripheral or gastric neurostimulator pulse
generator or receiver, direct or inductive coupling
cohort
cohort
cohort
cohort
cohort
64595
Revision or removal of peripheral or gastric neurostimulator pulse
generator or receiver
cohort
cohort
cohort
cohort
cohort
64600
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL
NERVE;SUPRAORBITAL, INFRAORBITAL, MENTAL, OR INFERIOR
ALVEOLAR BRANCH
cohort
64605
DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL
NERVE;SECONDAND THIRD DIVISION BRANCHES AT FORAMEN
OVAL E
64611
Chemodenervation of parotid and submandibular salivary glands,
bilateral
64612
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED
BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM,
HEMIFACIAL SPASM)
cohort
cohort
cohort
64613
DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION
OF MUSCLE ENDPLATE); CERVICAL SPINAL MUSCLES (EG, FOR
SPASMODIC TORTICOLLIS)
cohort
cohort
cohort
cohort
64614
CHEMODENERVATION OF MUSCLE(S); EXTREMITY AND/OR
TRUNK MUSCLE(S) (EG, FOR DYSTONIA, CEREBRAL PALSY,
MULTIPLE SCLEROSIS)
cohort
cohort
cohort
64615
CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED
BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY
NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE)
cohort
cohort
64620
DESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE
cohort
cohort
64630
DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE
64633
DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL
FACET JOINT NERVE(S), WITH IMAGING GUIDANCE
(FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE
FACET JOINT
cohort
cohort
cohort
cohort
cohort
64634
(FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH
ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO
CODE F
cohort
cohort
cohort
cohort
cohort
64635
(FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET
JOINT
cohort
cohort
cohort
cohort
cohort
cohort
64636
(FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH
ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO
CODE FOR P
cohort
cohort
cohort
cohort
cohort
cohort
64640
DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL
NERVE ORBRANCH
cohort
cohort
cohort
cohort
cohort
64680
DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH
ORWITHOUT RADIOLOGIC MONITORING
cohort
cohort
cohort
cohort
cohort
64681
DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT
RADIOLOGIC MONITORING; SUPERIOR HYPOGASTRIC PLEXUS
64702
NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT
64704
NEUROPLASTY; NERVE OF HAND OR FOOT
cohort
64708
Neuroplasty, major peripheral nerve, arm or leg, open; other than
specified
cohort
64713
Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus
statewide
cohort
statewide
statewide
cohort
statewide
statewide
cohort
124
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
64716
NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE
(SPECIFY)
64718
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT
ELBOWNEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE
AT ELBOW
cohort
cohort
cohort
cohort
cohort
cohort
64719
NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT
WRISTNEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE
AT WRIST
cohort
cohort
cohort
cohort
cohort
cohort
64721
NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT
CARPALTUNNEL
cohort
cohort
cohort
cohort
cohort
cohort
64722
DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY)
cohort
cohort
64727
INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING
MICROSCOPE(LIST SEPARATELY IN ADDITION TO CODE FOR
NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL
NEUROLYSIS)
cohort
cohort
64732
TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE
statewide
64771
TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE,
EXTRADURAL
cohort
64772
TRANSECTION OR AVULSION OF OTHER SPINAL NERVE,
EXTRADURAL
64774
EXCISION OF NEUROMA; CUTANEOUS NERVE,
SURGICALLYIDENTIFIABLE
64776
EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME
DIGIT
cohort
64782
EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL
NERVE
cohort
64783
EXCISION OF NEUROMA; HAND OR FOOT, EACH
ADDITIONALNERVE,EXCEPT SAME DIGIT (LIST SEPARATELY IN
ADDIT ION TO CODE FOR PRIMARY PROCEDURE)
64784
EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT
SCIATIC
64788
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA;
CUTANEOUS NERVEEXCISION OF NEUROFIBROMA OR
NEUROLEMMOMA; CUTANEOUS NERVE
64790
EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR
PERIPHERALNERVE EXCISION OF NEUROFIBROMA OR
NEUROLEMMOMA; MAJOR PERIPHERAL
64795
BIOPSY OF NERVE
64820
SYMPATHECTOMY, DIGITAL ARTERIES, WITH MAGNIFICATION,
EACHDIGIT
cohort
64821
SYMPATHECTOMY; RADIAL ARTERY
statewide
64822
SYMPATHECTOMY; ULNAR ARTERY
64823
SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH
64831
SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE
64832
SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH
ADDITIONALDIGITAL NERVE (LIST SEPARATELY IN ADDITION TO
64834
SUTURE OF 1 NERVE; HAND OR FOOT, COMMON SENSORY
NERVE
cohort
64835
SUTURE OF 1 NERVE; MEDIAN MOTOR THENAR
cohort
64836
SUTURE OF 1 NERVE; ULNAR MOTOR
cohort
64837
SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT
PROCEDURE)
cohort
64856
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG,
EXCEPTSCIATIC; INCLUDING TRANSPOSITION
64857
SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG,
EXCEPTSCIATIC; WITHOUT TRANSPOSITION
cohort
64859
SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE
PROCEDURE)
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
125
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
64864
SUTURE OF FACIAL NERVE; EXTRACRANIAL
statewide
64868
ANASTOMOSIS; FACIAL-HYPOGLOSSAL
statewide
64885
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK;
UP TO 4 CM IN LENGTH NERVE GRAFT (INCLUDES OBTAINING
GRAFT), HEAD OR NECK; UP TO
64886
NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK;
MORETHAN 4 CM LENGTH NERVE GRAFT (INCLUDES OBTAINING
GRAFT), HEAD OR NECK; MORE
statewide
64892
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND,
ARMOR LEG; UP TO 4 CM LENGTH NERVE GRAFT (INCLUDES
OBTAINING GRAFT), SINGLE STRAND, ARM
statewide
64893
NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND,
ARMOR LEG; MORE THAN 4 CM LENGTH NERVE
GRAFT(INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM
64897
NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE
STRANDS(CABLE), ARM OR LEG; UP TO 4 CM LENGTH
statewide
64902
NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS
(CABLE)(LIST SEPARATELY IN ADDITION TO CODE FORPRIMARY
PROCEDURE)
statewide
64905
NERVE PEDICLE TRANSFER; FIRST STAGENERVE PEDICLE
TRANSFER; FIRST STAGE
statewide
64910
NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT
(EG, NERVE TUBE), EACH NERVE
64911
NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT
(INCLUDESHARVEST OF VEIN GRAFT), EACH NERVE
64999
UNLISTED PROCEDURE, NERVOUS SYSTEM
65091
EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT
65105
ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES
ATTACHEDTOIMPLANT
65140
INSERTION OF OCULAR IMPLANT SECONDARY; AFTER
ENUCLEATION,MUSCLES ATTACHED TO IMPLANT INSERTION OF
OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION,
65205
*REMOVAL OF FOREIGN BODY, EXTERNAL EYE;
CONJUNCTIVALSUPERFICIAL *REMOVAL OF FOREIGN BODY,
EXTERNAL EYE; CONJUNCTIVAL
cohort
cohort
65210
*REMOVAL OF FOREIGN BODY, EXTERNAL EYE;
CONJUNCTIVALEMBEDDED (INCLUDES CONCRETIONS),
SUBCONJUNCTIVAL, OR SCLERAL NONPERFORATING
cohort
cohort
65220
*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL,
WITHOUTSLIT LAMP *REMOVAL OF FOREIGN BODY, EXTERNAL
EYE; CORNEAL, WITHOUT
cohort
cohort
65222
*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH
SLITLAMP *REMOVAL OF FOREIGN BODY, EXTERNAL EYE;
CORNEAL, WITH SLIT
cohort
cohort
65235
REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR
CHAMBER OR LENS REMOVAL OF FOREIGN BODY,
INTRAOCULAR; FROM ANTERIOR CHAMBER
65270
*REPAIR OF LACERATION; CONJUNCTIVA, WITH OR
WITHOUTNONPERFORATING LACERATION SCLERA, DIRECT
CLOSURE
65275
REPAIR OF LACERATION; CORNEA, NONPERFORATING,
WITHORWITHOUT REMOVAL FOREIGN BODY
65280
REPAIR OF LACERATION; CORNEA AND/OR SCLERA,
PERFORATING, NOTINVOLVING UVEAL TISSUE
cohort
cohort
65285
REPAIR OF LACERATION; CORNEA AND/OR SCLERA,
PERFORATING,WITH REPOSITION OR RESECTION OF UVEAL
TISSUE
cohort
cohort
65400
EXCISION OF LESION, CORNEA (KERATECTOMY,
LAMELLAR,PARTIAL),EXCEPT PTERYGIUM
65420
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT
65426
EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT
65435
*REMOVAL OF CORNEAL EPITHELIUM; WITH OR
WITHOUTCHEMOCAUTERIZATION (ABRASION, CURETTAGE)
Peer
Cohort
6
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
126
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
65436
REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION
OFCHELATINGAGENT (EG, EDTA)
statewide
65450
DESTRUCTION OF LESION OF CORNEA BY
CRYOTHERAPY,PHOTOCOAGULATION OR
THERMOCAUTERIZATION
statewide
65710
Keratoplasty (corneal transplant); anterior lamellar
statewide
65730
Keratoplasty (corneal transplant); penetrating (except in aphakia or
pseudophakia)
65750
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING
(INAPHAKIA)
65755
KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING
(INPSEUDOPHAKIA)
65756
Keratoplasty (corneal transplant); endothelial
65757
Backbench preparation of corneal endothelial allograft prior to
transplantation (List separately in addition to code for primary
procedure)
65771
RADIAL KERATOTOMY
65772
CORNEAL RELAXING INCISION FOR CORRECTION OF
SURGICALLYINDUCED ASTIGMATISM
65775
CORNEAL WEDGE RESECTION FOR CORRECTION OF
SURGICALLY INDUCEDASTIGMATISM
65778
Placement of amniotic membrane on the ocular surface for wound
healing; self-retaining
statewide
65779
Placement of amniotic membrane on the ocular surface for wound
healing; single layer, sutured
statewide
65780
Ocular surface reconstruction; amniotic membrane transplantation,
multiple layers
65782
OCULAR SURFACE RECONSTRUCTION; LIMBAL
CONJUNCTIVALAUTOGRAFT (INCLUDES OBTAINING GRAFT)
cohort
65800
PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE
PROCEDURE); WITH REMOVAL OF AQUEOUS
statewide
65815
PARACENTESIS OF ANTERIOR CHAMBER OF EYE
(SEPARATEPROCEDURE); WITH REMOVAL OF BLOOD, WITH OR
WITHOUT IRRIGATION AND/OR AIR INJECTION
statewide
65850
TRABECULOTOMY AB EXTERNO
cohort
65855
TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE
SESSIONS(DEFINED TREATMENT SERIES)
cohort
65865
SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE,
INCISIONALTECHNIQUE (WITH OR WITHOUT INJECTION OF
AIROR LIQUID) (SEPARATE PROCEDURE); GONIOSYNECHIAE
statewide
65870
AIROR LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECH
IAE, EXCEPT
cohort
65875
AIROR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNEC
HIAE
65920
REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT
EYEREMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT
EYE
66020
INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); AIR
ORLIQUID
66030
*INJECTION, ANTERIOR CHAMBER (SEPARATE
PROCEDURE);MEDICATION
66130
EXCISION OF LESION, SCLERA
66170
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY
ABEXTERNO IN ABSENCE OF PREVIOUS SURGERY
66172
FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY
ABEXTERNO WITH SCARRING FROM PREVIOUS OCULAR
SURGERY OR TRAUMA (INCLUDES INJECTION OF ANTIFIBROTIC
AGENTS)
cohort
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
127
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
66175
Transluminal dilation of aqueous outflow canal; with retention of device
or stent
statewide
66180
AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR, (EG,
MOLTENO,SCHOCKET, DENVER-KRUPIN)
cohort
66185
REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR
66250
REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR
SEGMENT,ANY TYPE, EARLY OR LATE, MAJOR OR MINOR
PROCEDURE
66500
IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE);
EXCEPTTRANSFIXION
66600
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL
SECTION;FORREMOVAL OF LESION
statewide
66625
IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL
SECTION;PERIPHERAL FOR GLAUCOMA (SEPARATE
PROCEDURE)
cohort
66680
REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS)
statewide
66682
SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE)
WITHRETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG,
MCCANNEL SUTURE)
cohort
cohort
66710
CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION
cohort
cohort
66711
CILIARY ENDOSCOPIC ABLATION
cohort
cohort
66761
Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session)
cohort
cohort
cohort
66762
IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE
SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR WIDENING
OF ANTERIOR CHAMBER ANGLE)
cohort
cohort
66820
DISCISSION OF SECONDARY MEMBRANOUS CATARACT
(OPACIFIEDPOSTERIOR LENS CAPSULE AND/OR ANTERIOR
HYALOID); STAB INCISION TECHNIQUE (ZIEGLER OR WHEELER
KNIFE)
66821
DISCISSION OF SECONDARY MEMBRANOUS CATARACT
(OPACIFIEDPOSTERIOR LENS CAPSULE AND/OR ANTERIOR
HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE
STAGES)
66825
REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS,
REQUIRING ANINCISION (SEPARATE PROCEDURE)
66840
REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE
OR MORE STAGES
66850
REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION
TECHNIQUE(MECHANICAL OR ULTRASONIC) (EG,
PHACOEMULSIFICATION), WITH ASPIRATION
66852
REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH
ORWITHOUT VITRECTOMY
66920
REMOVAL OF LENS MATERIAL; INTRACAPSULAR
cohort
66930
REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR
DISLOCATED LENS
statewide
66940
REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN
66840,66850, 66852)
66982
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF
INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE),
MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND
ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIR
66983
INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION
OFINTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE)
66984
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF
INTRAOCULARLENS PROSTHESIS (ONE STAGE PROCEDURE),
MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND
ASPIRATION OR
cohort
66985
INSERTION OF INTRAOCULAR LENS PROSTHESIS
(SECONDARYIMPLANT), NOT ASSOCIATED WITH CONCURRENT
CATARACTREMOVAL
cohort
66986
EXCHANGE OF INTRAOCULAR LENS
66990
OPHTHALMIC ENDOSCOPE USE
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
128
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
CPT
Description
66999
UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE
67005
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY
TECHNIQUEOR LIMBAL INCISION); PARTIAL REMOVAL
cohort
cohort
67010
REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY
TECHNIQUEOR LIMBAL INCISION); SUBTOTAL REMOVAL
WITHMECHANICAL VITRECTOMY
cohort
cohort
cohort
67015
ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR
CHOROIDALFLUID, PARS PLANA APPROACH (POSTERIOR
SCLEROTOMY)
cohort
cohort
67025
INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR
LIMBALAPPROACH, (FLUID-GAS EXCHANGE), WITH OR WITHOUT
ASPIRATION (SEPARATE PROCEDURE)
cohort
cohort
67027
IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM
(EG,GANCICLOVIR IMPLANT), INCLUDES CONCOMITANT
REMOVAL OF VITREOUS
67028
INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT
(SEPARATEPROCEDURE)
67036
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH;
67039
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH
FOCALENDOLASER PHOTOCOAGULATION
67040
VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH
ENDOLASER PANRETINAL PHOTOCOAGULATION
67041
Vitrectomy, mechanical, pars plana approach; with removal of preretinal
cellular membrane (e.g., macular pucker)
67042
Vitrectomy, mechanical, pars plana approach; with removal of internal
limiting membrane of retina (e.g., for repair of macular hole, diabetic
macular edema), includes, if performed, intraocular tampon
67043
Vitrectomy, mechanical, pars plana approach; with removal of subretinal
membrane (e.g., choroidal neovascularization), includes, if performed,
intraocular tamponade i.e., air, gas or silicone oil) and
67101
REPAIR OF RETINAL DETACHMENT, ONE OR MORE
SESSIONS;CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT
DRAINAGE OF SUBRETINAL FLUID
67105
REPAIR OF RETINAL DETACHMENT, ONE OR MORE
SESSIONS;PHOTOCOAGULATION, WITH OR WITHOUT DRAINAGE
OF SUBRETINAL FLUID
67107
REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH
ASLAMELLAR SCLERAL DISSECTION, IMBRICATION OR
ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH
OR WITHOUT
cohort
67108
REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY,
ANYMETHOD,WITH OR WITHOUT AIR OR GAS TAMPONADE,
FOCA L ENDOLASER PHOTOCOAGULATION, CRYOTHERAPY,
DRAINAGE OF SUBRETINAL FLUID,
cohort
67110
REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR
OTHERGAS (EG, PNEUMATIC RETINOPEXY)
67112
REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING
ORVITRECTOMY, ON PATIENT HAVING PREVIOUS IPSILATERAL
RETINAL DETACHMENT REPAIR(S) USING SCLERAL BUCKLING
OR VITRECTOMY
67113
Repair of complex retinal detachment (e.g., proliferative
vitreoretinopathy, stage C-1 or greater, diabetic traction retinal
detachment, retinopathy of prematurity, retinal tear of greater than 90
deg
67120
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR
SEGMENT;EXTRAOCULAR REMOVAL OF IMPLANTED MATERIAL,
POSTERIOR SEGMENT;
cohort
67121
REMOVAL OF IMPLANTED MATERIAL, POSTERIOR
SEGMENT;INTRAOCULAR REMOVAL OF IMPLANTED MATERIAL,
POSTERIOR SEGMENT;
cohort
67141
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL
BREAK,LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR
MORE SESSIONS; CRYOTHERAPY, DIATHERMY
67145
PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL
BREAK,LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR
cohort
cohort
Peer
Cohort
6
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
129
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
4
Peer
Cohort
5
67208
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG,
MACULAREDEMA, TUMORS), ONE OR MORE SESSIONS;
CRYOTHERAPY, DIATHERMY
cohort
cohort
67210
DESTRUCTION OF LOCALIZED LESION OF RETINA (EG,
MACULAREDEMA, TUMORS), ONE OR MORE SESSIONS;
PHOTOCOAGULATION
cohort
cohort
67220
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG,
CHOROIDALNEOVASCULARIZATION), ONE OR MORE SESSION,
PHOTOCOAGULATION (LASER)
statewide
67221
DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG,
CHOROIDALNEOVASCULARIZATION);PHOTODYNAMIC THERAPY
(INCLUDES INTRAVENOUS INFUSION)
statewide
67227
Destruction of extensive or progressive retinopathy (e.g., diabetic
retinopathy), one or more sessions, cryotherapy, diathermy
cohort
cohort
67228
Treatment of extensive or progressive retinopathy,one or more
sessions; (e.g., diabetic retinopathy ), photocoagulation
cohort
cohort
67250
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT
GRAFT
67255
SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH
GRAFT
67311
STRABISMUS SURGERY, RECESSION OR RESECTION
PROCEDURE; ONEHORIZONTAL MUSCLE
cohort
67312
PROCEDURE; TWOHORIZONTAL MUSCLES
67314
PROCEDURE; ONEVERTICAL MUSCLE (EXCLUDING SUPERIOR
OBLIQUE)
67316
PROCEDURE; TWO ORMORE VERTICAL MUSCLES (EXCLUDING
SUPERIOR OBLIQUE)
67318
STRABISMUS SURGERY, ANY PROCEDURE, SUPERIOR OBLIQUE
MUSCLE
cohort
cohort
67320
TRANSPOSITION PROCEDURE (EG, FOR PARETIC
EXTRAOCULARMUSCLE), ANY EXTRAOCULAR MUSCLE
(SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
cohort
cohort
67331
STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE
SURGERY ORINJURY THAT DID NOT INVOLVE THE
EXTRAOCULAR MUSCLES (LIST SEPARATELY IN ADDITION TO
cohort
cohort
67332
STRABISMUS SURGERY ON PATIENT WITH SCARRING OF
EXTRAOCULARMUSCLES (EG, PRIOR OCULAR INJURY,
STRABISMUS OR RETINAL DETACHMENT SURGERY) OR
RESTRICTIVE MYOPATHY (EG, DYSTHYROID
cohort
cohort
67334
STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE
TECHNIQUE,WITH OR WITHOUT MUSCLE RECESSION (LIST
statewide
67335
PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS
SURGERY,INCLUDING POSTOPERATIVE ADJUSTMENT(S)
OFSUTURE(S) (LIST SEPARATELY IN ADDITION TO CODE F OR
SPECIFIC STRABISMUS
cohort
67340
STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR
REPAIR OFDETACHED EXTRAOCULAR MUSCLE(S) (LIST
statewide
67346
BIOPSY OF EXTRAOCULAR MUSCLE
67400
ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR
TRANSCONJUNCTIVALAPPROACH); FOR EXPLORATION, WITH OR
WITHOUT BIOPSY
cohort
67405
TRANSCONJUNCTIVALAPPROACH); WITH DRAINAGE ONLY
cohort
67412
TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF LESION
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
6
MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON
ARC)
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
130
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
67413
TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF FOREIGN
BODY ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR
TRANSCONJUNCTIVAL
67414
TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF BONE
FOR DECOMPRESSION
statewide
67420
ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL
APPROACH (EG,KROENLEIN); WITH REMOVAL OF LESION
cohort
67500
*RETROBULBAR INJECTION; MEDICATION (SEPARATE
PROCEDURE, DOESNOT INCLUDE SUPPLY OF MEDICATION)
statewide
67515
*INJECTION OF THERAPEUTIC AGENT INTO TENON'S CAPSULE
statewide
67550
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE);
INSERTION
statewide
67560
ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL
ORREVISION
statewide
67570
OPTIC NERVE DECOMPRESSION (EG, INCISION OR
FENESTRATION OFOPTIC NERVE SHEATH)
cohort
67599
UNLISTED PROCEDURE, ORBIT
statewide
67700
*BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID
67710
*SEVERING OF TARSORRHAPHY
67715
*CANTHOTOMY (SEPARATE PROCEDURE)
67800
EXCISION OF CHALAZION; SINGLE
67801
EXCISION OF CHALAZION; MULTIPLE, SAME LIDEXCISION OF
CHALAZION; MULTIPLE, SAME LID
67805
EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDSEXCISION
OF CHALAZION; MULTIPLE, DIFFERENT LIDS
cohort
67808
EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA
AND/ORREQUIRING HOSPITALIZATION, SINGLE OR MULTIPLE
EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA A
ND/OR
cohort
67825
*CORRECTION OF TRICHIASIS; EPILATION BY OTHER
THANFORCEPS(EG, BY ELECTROSURGERY, CRYOTHERAPY,
LASER SURGERY)
67840
*EXCISION OF LESION OF EYELID (EXCEPT CHALAZION)
WITHOUTCLOSURE OR WITH SIMPLE DIRECT CLOSURE
67850
*DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM)
67875
TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST
SUTURE)
67880
CONSTRUCTION OF INTERMARGINAL ADHESIONS,
MEDIANTARSORRHAPHY, OR CANTHORRHAPHY;
67882
CONSTRUCTION OF INTERMARGINAL ADHESIONS,
MEDIANTARSORRHAPHY, OR CANTHORRHAPHY; WITH
TRANSPOSITION OFTARSAL PLATE
67900
REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR
CORONALAPPROACH)
cohort
cohort
cohort
67901
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE
WITHSUTURE OR OTHER MATERIAL
cohort
cohort
cohort
67902
REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE
WITHFASCIAL SLING (INCLUDES OBTAINING FASCIA)
cohort
cohort
67903
REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR
RESECTIONORADVANCEMENT, INTERNAL APPROACH
statewide
67904
REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR
RESECTIONORADVANCEMENT, EXTERNAL APPROACH
67908
REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSOMULLER'SMUSCLE-LEVATOR RESECTION (EG, FASANELLASERVAT TYPE)
cohort
67911
CORRECTION OF LID RETRACTION
cohort
cohort
67912
CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF
UPPER EYELID LID LOAD (EG, GOLD WEIGHT)
cohort
cohort
67914
REPAIR OF ECTROPION; SUTURE
statewide
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
131
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
67917
REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE
(EG,KUHNT-SZYMANOWSKI OR TARSAL STRIP OPERATIONS)
67921
REPAIR OF ENTROPION; SUTURE
statewide
67923
REPAIR OF ENTROPION; EXCISION TARSAL WEDGE
statewide
67924
REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG,
WHEELER OPERATION)
statewide
67930
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID
MARGIN,TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT
CLOSURE; PARTIAL THICKNESS
statewide
67935
SUTURE OF RECENT WOUND, EYELID, INVOLVING LID
MARGIN,TARSUS, AND/OR PALPEBRAL CONJUNCTIVA) DIRECT
CLOSURE; FULL THICKNESS
cohort
67938
REMOVAL OF EMBEDDED FOREIGN BODY, EYELID
67950
CANTHOPLASTY (RECONSTRUCTION OF CANTHUS)
67961
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN,
TARSUS,CONJUNCTIVA, CANTHUS, OR FULL THICKNESS,MAY
INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICL E FLAP
WITH ADJACENT
67966
EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN,
TARSUS,CONJUNCTIVA, CANTHUS, OR FULL THICKNESS,MAY
INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICL E FLAP
WITH ADJACENT
67971
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER
OFTARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; UP TO
TWO-THIRDS OF EYELID, ONE STAGE OR FIRST STAGE
cohort
67973
RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER
OFTARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; TOTAL
EYELID, LOWER, ONE STAGE OR FIRST STAGE
67999
UNLISTED PROCEDURE, EYELIDS
68100
BIOPSY OF CONJUNCTIVA
68110
EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM
cohort
cohort
cohort
cohort
68115
EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM
cohort
cohort
cohort
cohort
68130
EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA
68135
*DESTRUCTION OF LESION, CONJUNCTIVA
statewide
68200
*SUBCONJUNCTIVAL INJECTION
cohort
cohort
68320
CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR
EXTENSIVEREARRANGEMENT
cohort
cohort
68325
CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE
GRAFT(INCLUDES OBTAINING GRAFT)
68335
REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA
ORBUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING GRAFT)
68360
CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE
PROCEDURE)
68399
UNLISTED PROCEDURE, CONJUNCTIVA
68440
*SNIP INCISION OF LACRIMAL PUNCTUM
68510
BIOPSY OF LACRIMAL GLAND
68530
REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL
PASSAGES
statewide
68700
PLASTIC REPAIR OF CANALICULI
cohort
cohort
68720
DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC
TONASAL CAVITY)
cohort
cohort
cohort
68750
CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA
TO NASALCAVITY); WITH INSERTION OF TUBE OR STENT
statewide
68760
CLOSURE OF THE LACRIMAL PUNCTUM; BY
THERMOCAUTERIZATION,LIGATION, OR LASER SURGERY
statewide
68801
*DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT
IRRIGATION
68810
*PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT
IRRIGATION;
cohort
cohort
68811
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT
132
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
IRRIGATION;REQUIRING GENERAL ANESTHESIA
68815
PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT
IRRIGATION;WITH INSERTION OF TUBE OR STENT
cohort
cohort
cohort
cohort
cohort
68816
Probing of nasolacrimal duct, with or without irrigation; with transluminal
balloon catheter dilation
cohort
cohort
cohort
cohort
cohort
68840
*PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT
IRRIGATION
cohort
cohort
68850
*INJECTION OF CONTRAST MEDIUM FOR
DACRYOCYSTOGRAPHY
68899
UNLISTED PROCEDURE, LACRIMAL SYSTEM
69000
*DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE
69005
DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA;
COMPLICATED
69020
*DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS
69100
BIOPSY EXTERNAL EAR
69110
EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR
69120
EXCISION EXTERNAL EAR; COMPLETE AMPUTATION
69145
EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL
cohort
cohort
cohort
cohort
cohort
69200
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY
CANAL;WITHOUTGENERAL ANESTHESIA
cohort
cohort
cohort
cohort
cohort
69205
REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY
CANAL;WITHGENERAL ANESTHESIA
cohort
cohort
cohort
cohort
cohort
69210
REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE),
ONEOR BOTHEARS
cohort
cohort
cohort
cohort
cohort
cohort
69220
DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG,
ROUTINECLEANING)
cohort
69300
OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE
REDUCTION
69310
RECONSTRUCTION OF EXTERNAL AUDITORY CANAL
(MEATOPLASTY) (EG,FOR STENOSIS DUE TO TRAUMA,
INFECTION), (SEPARATE PROCEDURE)
69399
UNLISTED PROCEDURE, EXTERNAL EAR
69420
*MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN
TUBEINFLATION
cohort
cohort
cohort
69421
*MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN
TUBEINFLATION REQUIRING GENERAL ANESTHESIA
cohort
cohort
cohort
cohort
cohort
69424
VENTILATING TUBE REMOVAL WHEN ORIGINALLY INSERTED BY
ANOTHERPHYSICIAN
cohort
cohort
cohort
cohort
cohort
69433
*TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING
TUBE),LOCAL OR TOPICAL ANESTHESIA
cohort
cohort
cohort
69436
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING
TUBE),GENERAL ANESTHESIA
cohort
cohort
cohort
69450
TYMPANOLYSIS, TRANSCANAL
cohort
69501
TRANSMASTOID ANTROTOMY ("SIMPLE" MASTOIDECTOMY)
statewide
69502
MASTOIDECTOMY; COMPLETE
69511
MASTOIDECTOMY; RADICAL
69535
RESECTION TEMPORAL BONE, EXTERNAL APPROACH
statewide
69540
EXCISION AURAL POLYP
statewide
69552
EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID
statewide
69601
REVISION MASTOIDECTOMY; RESULTING IN COMPLETE
MASTOIDECTOMY
69603
REVISION MASTOIDECTOMY; RESULTING IN RADICAL
MASTOIDECTOMY
69604
REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY
statewide
69610
TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE
PREPARATIONOR PERFORATION FOR CLOSURE, WITH OR
WITHOUT PATCH
cohort
cohort
69620
MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
133
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
DONOR AREA)
69631
TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING
CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY),
INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN
RECONSTRUCTION
69632
INITIAL OR REVISION; WITH OSSICULAR CHAIN
RECONSTRUCTION (EG, POSTFENESTRATION)
69633
INITIAL OR REVISION; WITH OSSICULAR CHAIN
RECONSTRUCTION AND SYNTHETIC PROSTHESIS
69635
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY
(INCLUDINGCANALPLASTY, ATTICOTOMY, MIDDLE EAR
SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITHOUT
OSSICULAR CHAIN RECONSTRUCTION
69637
TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY
(INCLUDINGCANALPLASTY, ATTICOTOMY, MIDDLE EAR
SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH
OSSICULAR CHAIN RECONSTRUCTION AND
69641
TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING
CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE
REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION
cohort
cohort
cohort
69642
REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION
cohort
cohort
cohort
69643
REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT
OSSICULAR CHAIN
cohort
cohort
cohort
69644
REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH
OSSICULAR CHAIN
cohort
cohort
cohort
69645
REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN
RECONSTRUCTION
cohort
cohort
69646
REPAIR); RADICAL OR COMPLETE, WITH OSSICULAR CHAIN
RECONSTRUCTION
69650
STAPES MOBILIZATION
statewide
69660
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT
OFOSSICULAR CONTINUITY, WITH OR WITHOUT USE OF
FOREIGN MATERIAL;
cohort
69661
STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT
OFOSSICULAR CONTINUITY, WITH OR WITHOUT USE OF
FOREIGN MATERIAL; WITH FOOTPLATE DRILL OUT
69662
REVISION OF STAPEDECTOMY OR STAPEDOTOMY
69700
CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE
PROCEDURE)
69710
IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC
BONECONDUCTION HEARING DEVICE IN TEMPORAL BONE
69711
REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE
CONDUCTION HEARINGDEVICE IN TEMPORAL BONE
69714
IMPLANTATION OSSEOINTEGRATED IMPLANT TEMPORAL
BONEW/ PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH
PROCESSOR/COCHLEAR STIMULATOR, WITHOUT
MASTIODECTOMY
69717
REPLACEMENT (INCLUDING REMOVAL OF EXISTING
DEVICE)OSSEOINTERGRATED IMPLANT, TEMPORAL BONE W/
PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH
PROCESSOR/COCHLEAR STIMULATOR W/OUT MASTOIDECTOMY
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
134
cohort
cohort
statewide
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
cohort
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
CPT
Description
69720
DECOMPRESSION FACIAL NERVE, INTRATEMPORAL;
LATERALTOGENICULATE GANGLION
69799
UNLISTED PROCEDURE, MIDDLE EAR
cohort
69801
Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal
cohort
69805
ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT
cohort
cohort
69806
ENDOLYMPHATIC SAC OPERATION; WITH SHUNT
cohort
cohort
69820
FENESTRATION SEMICIRCULAR CANAL
69930
COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT
MASTOIDECTOMY
69949
UNLISTED PROCEDURE, INNER EAR
69990
USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN
70015
CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL
70030
RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN
BODY
cohort
cohort
cohort
cohort
cohort
cohort
70100
RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN
FOURVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
70110
RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF
FOUR VIEWS
cohort
cohort
cohort
cohort
cohort
70140
RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE
VIEWS RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN
THREE VIEWS
cohort
cohort
cohort
cohort
70150
RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE,
MINIMUM OFTHREE VIEWS RADIOLOGIC EXAMINATION, FACIAL
BONES; COMPLETE, MINIMUM OF
cohort
cohort
cohort
cohort
cohort
70160
RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE,
MINIMUM OF 3 VIEWS
cohort
cohort
cohort
cohort
cohort
70170
DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT,
RADIOLOGICALSUPERVISION AND INTERPRETATION
70200
RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF
FOURVIEWS
cohort
cohort
cohort
70210
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN
THREE VIEWS
cohort
cohort
cohort
70220
RADIOLOGIC EXAMINATION, SINUSES, PARANASAL,
COMPLETE,MINIMUM OF THREE VIEWS
cohort
cohort
cohort
cohort
cohort
70250
RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS,
WITH ORWITHOUT STEREO RADIOLOGIC EXAMINATION, SKULL;
LESS THAN FOUR VIEWS, WITH OR
cohort
cohort
cohort
cohort
cohort
70260
RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF
FOURVIEWS, WITH OR WITHOUT STEREO RADIOLOGIC
EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR
cohort
cohort
cohort
cohort
cohort
70300
RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEWRADIOLOGIC
EXAMINATION, TEETH; SINGLE VIEW
70310
RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION,
LESSTHAN FULL MOUTH RADIOLOGIC EXAMINATION, TEETH;
PARTIAL EXAMINATION, LESS
70320
RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL
MOUTHRADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL
MOUTH
70328
RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT,
OPEN ANDCLOSED MOUTH; UNILATERAL RADIOLOGIC
EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND
70330
RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT,
OPEN ANDCLOSED MOUTH; BILATERAL RADIOLOGIC
EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND
cohort
cohort
cohort
cohort
cohort
70336
MAGNETIC RESONANCE (EG, PROTON) IMAGING,
TEMPOROMANDIBULARJOINT
cohort
cohort
cohort
cohort
cohort
70355
ORTHOPANTOGRAM (EG, PANORAMIC X-RAY)
cohort
cohort
cohort
cohort
70360
RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE
cohort
cohort
cohort
cohort
cohort
cohort
cohort
70371
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY
135
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CINE OR VIDEO RECORDING
70390
SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
70450
COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN;
WITHOUTCONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
70460
WITHCONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
70470
WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST
MATERIAL(S) AND FURTHER SECTIONS
cohort
cohort
cohort
cohort
cohort
70480
COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR
POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR;
WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
70481
POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR; WITH
CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
70482
POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR;
WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST
MATERIAL(S) AND FURTHER
cohort
cohort
cohort
cohort
cohort
70486
COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL
AREA;WITHOUTCONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
70487
AREA;WITHCONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
70488
AREA;WITHOUTCONTRAST MATERIAL, FOLLOWED BY
CONTRAST MA TERIAL(S) AND FURTHER SECTIONS
cohort
cohort
cohort
cohort
cohort
70490
COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK;
cohort
cohort
cohort
cohort
cohort
70491
cohort
cohort
cohort
cohort
cohort
70492
WITHOUTCONTRAST MATERIAL FOLLOWED BY CONTRAST
cohort
cohort
cohort
cohort
cohort
70496
Computed tomographic angiography, head, with contrast material(s),
including noncontrast images, if performed and image postprocessing
cohort
cohort
cohort
cohort
cohort
70498
Computed tomographic angiography, neck, with contrast material(s),
including noncontrast image, if performed, and image postprocessing
cohort
cohort
cohort
cohort
cohort
70540
Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck;
without contrast material(s)
cohort
cohort
cohort
cohort
cohort
70542
MAGNETIC RESONANCE (EG, PROTON) IMAGING; ORBIT, FACE,
AND NECK; WITH CONTRAST MATERIAL(S)
70543
MAGNETIC RESONANCE (EG, PROTON) IMAGING; ORBIT, FACE,
AND NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
CONTRAST MATERIAL(S) AND FURTHER SEQUENCES
cohort
cohort
cohort
cohort
cohort
70544
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
70545
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CONTRAST MATERIAL(S)
70546
MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S)
AND FURTHER SEQUENCES
cohort
cohort
cohort
cohort
cohort
70547
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
70548
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
70549
MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S)
AND FURTHER SEQUENCES
cohort
cohort
cohort
cohort
cohort
70551
MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN
(INCLUDINGBRAIN STEM); WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
70552
(INCLUDINGBRAIN STEM); WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
136
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
70553
(INCLUDINGBRAIN STEM); WITHOUT CONTRAST MATERIAL,
FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER
SEQUENCES
cohort
70554
MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL
MRI;INCLUDING TEST SELECTION AND ADMINISTRATION OF RE
PETITIVE BODY PART MOVEMENT AND/OR VISUAL STIMULATION,
NOT REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMIN
cohort
cohort
cohort
cohort
cohort
70555
MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL
MRI;REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATIO
N OF ENTIRE NEUROFUNCTIONAL TESTING
71010
RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL
cohort
cohort
cohort
cohort
cohort
cohort
71020
RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL
ANDLATERAL;
cohort
cohort
cohort
cohort
cohort
cohort
71021
ANDLATERAL; WITH APICAL LORDOTIC PROCEDURE
cohort
cohort
cohort
cohort
cohort
71022
ANDLATERAL; WITH OBLIQUE PROJECTIONS
cohort
cohort
cohort
cohort
71023
ANDLATERAL; WITH FLUOROSCOPY
cohort
cohort
71030
RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF
FOURVIEWS;
cohort
cohort
71035
RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG,
LATERALDECUBITUS, BUCKY STUDIES)
cohort
cohort
cohort
cohort
71100
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
71101
RADIOLOGIC EXAMINATION, RIBS, UNILATERAL;
INCLUDINGPOSTEROANTERIOR CHEST, MINIMUM OF THREE
VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
71110
RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS
cohort
cohort
cohort
cohort
cohort
71111
RADIOLOGIC EXAMINATION, RIBS, BILATERAL;
INCLUDINGPOSTEROANTERIOR CHEST, MINIMUM OF FOUR
VIEWS
cohort
cohort
cohort
cohort
cohort
71120
RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
71130
RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR
JOINTS,MINIMUM OF THREE VIEWS
cohort
cohort
cohort
cohort
71250
COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
cohort
71260
COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITH
CONTRASTMATERIAL(S)
cohort
cohort
cohort
cohort
cohort
cohort
71270
COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT
CONTRASTMATERIAL, FOLLOWED BY CONTRAST MATERIAL(S)
AND FURTHER SECTIONS
cohort
cohort
cohort
cohort
cohort
71275
Computed tomographic angiography, chest (noncoronary), with contrast
material(s), including noncontrast images, if performed, and image
postprocessing
cohort
cohort
cohort
cohort
cohort
71550
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG,
FOREVALUATION OF HILAR AND MEDIASTINAL
LYMPHADENOPATHY)
cohort
cohort
cohort
cohort
71552
MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG,
FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY); WITHOUT CONTRAST MATERIAL(S) FOLLOWED BY
cohort
cohort
cohort
cohort
71555
MAGNETIC RESONANCE ANGIOGRAPHY, CHEST
(EXCLUDINGMYOCARDIUM), WITH OR WITHOUT CONTRAST
MATERIAL(S)
cohort
cohort
cohort
cohort
72010
RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY
STUDY,ANTEROPOSTERIOR AND LATERAL
cohort
72020
RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY
LEVEL
cohort
cohort
cohort
cohort
cohort
cohort
72040
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 3 VIEWS OR LESS
cohort
cohort
cohort
cohort
cohort
cohort
72050
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 4 OR 5 VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
72052
RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 6 OR MOREVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
137
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
72069
RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR,
STANDING(SCOLIOSIS)
cohort
cohort
cohort
cohort
cohort
72070
RADIOLOGIC EXAMINATION, SPINE; THORACIC,
ANTEROPOSTERIOR ANDLATERAL
cohort
cohort
cohort
cohort
cohort
cohort
72072
ANTEROPOSTERIOR ANDLATERAL, INCLUDING SWIMMER'S VIEW
OF THECERVICOTHORACIC JUNCTION
cohort
cohort
cohort
cohort
cohort
cohort
72074
COMPLETE,INCLUDINGOBLIQUES, MINIMUM OF FOUR VIEWS
cohort
cohort
cohort
cohort
cohort
72080
RADIOLOGIC EXAMINATION, SPINE;
THORACOLUMBAR,ANTEROPOSTERIOR AND LATERAL
cohort
cohort
cohort
cohort
cohort
72090
RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY,
INCLUDINGSUPINE AND ERECT STUDIES
cohort
cohort
cohort
cohort
cohort
72100
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL;
ANTEROPOSTERIOR AND LATERAL
cohort
cohort
cohort
cohort
cohort
cohort
72110
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE,
WITHOBLIQUE VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
72114
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE,
INCLUDING BENDING VIEWS, MINIMUM OF 6 VIEWS
cohort
cohort
cohort
cohort
cohort
72120
RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; BENDING
VIEWS ONLY, 2 OR 3 VIEWS
cohort
cohort
cohort
cohort
cohort
72125
COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE;
cohort
cohort
cohort
cohort
cohort
72126
COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
72127
COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE;
cohort
cohort
cohort
cohort
cohort
72128
COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE;
cohort
cohort
cohort
cohort
cohort
72129
COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITH
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
72130
COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE;
cohort
cohort
cohort
cohort
72131
COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE;
cohort
cohort
cohort
cohort
cohort
72132
COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
cohort
72133
COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE;
cohort
cohort
cohort
72141
MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL
ANDCONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
cohort
72142
ANDCONTENTS, CERVICAL; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
72146
ANDCONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
72147
ANDCONTENTS, THORACIC; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
72148
ANDCONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
72149
ANDCONTENTS, LUMBAR; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
72156
ANDCONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY
CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL
cohort
cohort
cohort
cohort
cohort
72157
CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC
cohort
cohort
cohort
cohort
cohort
72158
CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR
cohort
cohort
cohort
cohort
cohort
138
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
72170
RADIOLOGIC EXAMINATION, PELVIS; ANTEROPOSTERIOR ONLY
cohort
cohort
cohort
cohort
cohort
72190
RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF
THREEVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
72191
Computed tomographic angiography, pelvis, with contrast material(s),
including noncontrast images, if performed, and image postprocessing
cohort
cohort
cohort
cohort
cohort
72192
COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
72193
COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITH
CONTRASTMATERIAL(S)
cohort
cohort
cohort
cohort
cohort
72194
COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT
cohort
cohort
cohort
cohort
cohort
72195
MAGNETIC RESONANCE (EG, PROTON) IMAGING; PELVIS;
WITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
72196
MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS
cohort
cohort
cohort
72197
MAGNETIC RESONANCE (EG, PROTON) IMAGING; PELVIS;
WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY
CONTRASTMATERIAL(S) AND FURTHER SEQUENCES
cohort
cohort
cohort
cohort
72198
MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR
WITHOUTCONTRAST MATERIAL(S)
cohort
cohort
cohort
72200
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN
THREEVIEWS
cohort
cohort
cohort
cohort
72202
RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR
MOREVIEWS
cohort
cohort
cohort
cohort
cohort
72220
RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUMOF
TWOVIEWS
cohort
cohort
cohort
cohort
cohort
72240
MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION
ANDINTERPRETATION
cohort
cohort
cohort
cohort
cohort
72255
MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION
ANDINTERPRETATION
72265
MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL
SUPERVISIONANDINTERPRETATION
cohort
cohort
cohort
cohort
cohort
72270
MYELOGRAPHY, ENTIRE SPINAL CANAL, RADIOLOGICAL
SUPERVISIONAND INTERPRETATION
cohort
cohort
cohort
cohort
cohort
72275
EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
cohort
cohort
72291
RADIOLOGICAL SUPERVISION AND INTERPRETATION,
PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL
AUGMENTATION, ORSACRAL AUGMENTATION (SACROPLASTY),
INCLUDING CAVI TY CREATION, PER VERTEBRAL BODY OR
SACRUM; UNDER F
cohort
72292
RADIOLOGICAL SUPERVISION AND INTERPRETATION,
PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL
AUGMENTATION, ORSACRAL AUGMENTATION (SACROPLASTY),
INCLUDING CAVI TY CREATION, PER VERTEBRAL BODY OR
SACRUM; UNDER C
statewide
72295
DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION
ANDINTERPRETATION
cohort
73000
RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE
cohort
cohort
73010
RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE
cohort
73020
RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW
73030
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM
OF TWOVIEWS
cohort
cohort
cohort
cohort
cohort
73040
RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY,
cohort
cohort
cohort
cohort
cohort
73050
RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS,
BILATERAL,WITH OR WITHOUT WEIGHTED DISTRACTION
cohort
cohort
cohort
cohort
cohort
73060
RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
73070
RADIOLOGIC EXAMINATION, ELBOW; ANTEROPOSTERIOR
ANDLATERALVIEWS
cohort
cohort
cohort
cohort
cohort
73080
RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF
THREEVIEWS
cohort
cohort
cohort
cohort
cohort
139
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
73085
RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY,
cohort
cohort
73090
RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR
AND LATERALVIEWS RADIOLOGIC EXAMINATION; FOREARM,
ANTEROPOSTERIOR AND LATERAL
cohort
cohort
cohort
cohort
cohort
73092
RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT,
MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
73100
RADIOLOGIC EXAMINATION, WRIST; ANTEROPOSTERIOR
ANDLATERALVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73110
RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF
THREEVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73115
RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY,
cohort
cohort
cohort
cohort
cohort
73120
RADIOLOGIC EXAMINATION, HAND; TWO VIEWS
cohort
cohort
cohort
cohort
cohort
73130
RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73140
RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73200
COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY;
cohort
cohort
cohort
cohort
cohort
cohort
73201
cohort
cohort
cohort
cohort
cohort
73202
cohort
cohort
73206
Computed tomographic angiography, upper extremity,with contrast
postprocessing
cohort
cohort
cohort
cohort
73218
MAGNETIC RESONANCE (EG, PROTON) IMAGING; UPPER
EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST
MATERIAL(S)
cohort
cohort
cohort
cohort
73219
MAGNETIC RESONANCE (EG, PROTON) IMAGING; UPPER
EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
73220
MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER
EXTREMITY,OTHER THAN JOINT
cohort
cohort
cohort
cohort
73221
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF
UPPER EXTREMITY
cohort
cohort
cohort
cohort
cohort
cohort
73222
UPPER EXTREMITY; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
cohort
73223
UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S),
SEQUENCES
cohort
cohort
cohort
cohort
cohort
73225
MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY,
WITH ORWITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
73500
RADIOLOGIC EXAMINATION, HIP; UNILATERAL, ONE VIEW
cohort
cohort
cohort
cohort
cohort
73510
RADIOLOGIC EXAMINATION, HIP, UNILATERAL;
COMPLETE,MINIMUMOF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73520
RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF
TWOVIEWS OF EACH HIP, INCLUDING ANTEROPOSTERIOR VIEW
OF PELVIS
cohort
cohort
cohort
cohort
cohort
cohort
73525
RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY,
cohort
cohort
cohort
cohort
cohort
cohort
73530
RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE
PROCEDURE
cohort
cohort
cohort
cohort
73540
RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT
ORCHILD,MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
73550
RADIOLOGIC EXAMINATION, FEMUR, ANTEROPOSTERIOR
ANDLATERALVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73560
RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73562
RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS
cohort
cohort
cohort
cohort
cohort
73564
RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE
VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
140
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
cohort
cohort
CPT
Description
Peer
Cohort
1
73565
RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES,
STANDING,ANTEROPOSTERIOR
cohort
73580
RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY,
73590
RADIOLOGIC EXAMINATION; TIBIA AND FIBULA,
ANTEROPOSTERIORAND LATERAL VIEWS
cohort
cohort
cohort
cohort
cohort
73592
RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT,
MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
73600
RADIOLOGIC EXAMINATION, ANKLE; ANTEROPOSTERIOR
ANDLATERALVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73610
RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF
THREEVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73615
RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY,
cohort
cohort
73620
RADIOLOGIC EXAMINATION, FOOT; ANTEROPOSTERIOR AND
LATERALVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73630
RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM
OFTHREEVIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73650
RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO
VIEWS
cohort
cohort
cohort
cohort
cohort
73660
RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
73700
COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY;
cohort
cohort
cohort
cohort
cohort
cohort
73701
cohort
cohort
cohort
cohort
cohort
73702
cohort
cohort
73706
Computed tomographic angiography, lower extremity,with contrast
postprocessing
cohort
cohort
cohort
cohort
cohort
73718
MAGNETIC RESONANCE (EG, PROTON) IMAGING; LOWER
EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST
MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
73719
MAGNETIC RESONANCE (EG, PROTON) IMAGING; LOWER
EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S)
cohort
cohort
73720
MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER
EXTREMITY,OTHER THAN JOINT
cohort
cohort
cohort
cohort
cohort
73721
LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL
cohort
cohort
cohort
cohort
cohort
73722
LOWER EXTREMITY; WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
73723
LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL(S),
SEQUENCES
cohort
cohort
cohort
cohort
cohort
73725
MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY,
WITH ORWITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
74000
RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE
ANTEROPOSTERIOR VIEW
cohort
cohort
cohort
cohort
cohort
74010
RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR
ANDADDITIONAL OBLIQUE AND CONE VIEWS
cohort
cohort
cohort
cohort
cohort
74020
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE,
INCLUDINGDECUBITUS AND/OR ERECT VIEWS
cohort
cohort
cohort
cohort
cohort
cohort
74022
RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE
ABDOMENSERIES, INCLUDING SUPINE, ERECT, AND/OR
DECUBITUS VIEWS, UPRIGHT PA CHEST
cohort
cohort
cohort
cohort
cohort
cohort
74150
COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT
CONTRASTMATERIAL
cohort
cohort
cohort
cohort
cohort
74160
COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITH
CONTRASTMATERIAL(S)
cohort
cohort
cohort
cohort
cohort
74170
COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT
cohort
cohort
cohort
cohort
cohort
141
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
74174
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN AND
PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING
NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE
POSTPROCESSING
cohort
cohort
cohort
cohort
cohort
74175
Computed tomographic angiography, abdomen, with contrast
postprocessing
cohort
cohort
cohort
cohort
cohort
74176
Computed tomography, abdomen and pelvis; without contrast material
cohort
cohort
cohort
cohort
cohort
cohort
74177
Computed tomography, abdomen and pelvis; with contrast material(s)
cohort
cohort
cohort
cohort
cohort
cohort
74178
Computed 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
cohort
cohort
cohort
cohort
cohort
cohort
74181
MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN
WITHOUT CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
74182
WITH CONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
74183
WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY WITH
cohort
cohort
cohort
cohort
cohort
74185
MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR
WITHOUTCONTRAST MATERIAL(S)
cohort
cohort
cohort
cohort
cohort
74210
RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL
ESOPHAGUS
cohort
cohort
cohort
74220
RADIOLOGIC EXAMINATION; ESOPHAGUS
cohort
cohort
cohort
cohort
cohort
74230
SWALLOWING FUNCTION, PHARYNX AND/OR ESOPHAGUS,
WITHCINERADIOGRAPHY AND/OR VIDEO
cohort
cohort
cohort
cohort
cohort
74240
RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER;
WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB
cohort
cohort
cohort
cohort
cohort
74241
WITH OR WITHOUT DELAYED FILMS, WITH KUB
cohort
cohort
cohort
cohort
cohort
74245
WITH SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS
cohort
cohort
cohort
cohort
cohort
74246
RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT,
UPPER, AIRCONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM,
EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH
OR WITHOUT DELAYED
cohort
cohort
cohort
cohort
cohort
74247
OR WITHOUT DELAYED
cohort
cohort
cohort
cohort
cohort
74249
SMALL BOWEL
cohort
cohort
cohort
cohort
cohort
74250
RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES
MULTIPLESERIAL FILMS
cohort
cohort
cohort
cohort
cohort
74251
RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES
MULTIPLESERIAL FILMS; VIA ENTEROCLYSIS TUBE
74261
COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC,
INCLUDING IMAGE POSTPROCESSING; WITHOUT
CONTRASTMATERIAL
74263
COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY,
SCREENING,INCLUDING IMAGE POSTPROCESSING
74270
Radiologic examination, colon; contrast (e.g., barium) enema, with or
without KUB
cohort
cohort
74280
RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH
SPECIFICHIGH DENSITY BARIUM, WITH OR WITHOUT GLUCAGON
cohort
cohort
74283
THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION
OFINTUSSUSCEPTION OR OTHER INTRALUMINAL OBSTRUCTION
(EG, MECONIUM ILEUS)
74290
CHOLECYSTOGRAPHY, ORAL CONTRAST;
74300
CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY;
CPT
Description
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
142
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
INTRAOPERATIVE,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
74301
ADDITIONALSETINTRAOPERATIVE, RADIOLOGICAL SUPERVISION
AND I NTERPRETATION (LIST SEPARATELY IN ADDITION TO
74305
POSTOPERATIVE,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
74320
CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC,
74327
POSTOPERATIVE BILIARY DUCT STONE REMOVAL,
PERCUTANEOUS VIAT-TUBE TRACT, BASKET OR SNARE (EG,
BURHENNE TECHNIQUE), RADIOLOGICAL SUPERVISION AND
INTERPRETATION
74328
ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL
SYSTEM,RADIOLOGICAL SUPERVISION AND INTERPRETATION
ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL
SYSTEM,
74329
ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL
SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION
ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL
SYSTEM,
74330
COMBINED ENDOSCOPIC CATHETERIZATION OF THE
BILIARYANDPANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL
SUPERV ISION AND INTERPRETATION
74340
INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG,MILLERABBOTT), INCLUDING MULTIPLE FLUOROSCOPIES AND FILMS,
74360
INTRALUMINAL DILATION OF STRICTURES AND/OR
OBSTRUCTIONS (EG,ESOPHAGUS), RADIOLOGICAL
SUPERVISION ANDINTERPRETATION
74363
PERCUTANEOUS TRANSHEPATIC DILATATION OF BILIARY
DUCTSTRICTURE WITH OR WITHOUT PLACEMENT OF STENT,
74400
UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR
WITHOUT KUB,WITH OR WITHOUT TOMOGRAPHY; UROGRAPHY
(PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB,
74410
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS
TECHNIQUE; UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR
BOLUS TECHNIQUE;
74415
UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS
TECHNIQUE; WITH NEPHROTOMOGRAPHY UROGRAPHY,
INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE;
cohort
74420
UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB
cohort
cohort
74425
UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM,
NEPHROSTOGRAM,LOOPOGRAM), RADIOLOGICAL SUPERVISION
AND INTERPRETATION
cohort
74430
CYSTOGRAPHY, MINIMUM OF THREE VIEWS,
74450
URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL
74455
URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL
74475
INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL
PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS,
74480
INTRODUCTION OF URETERAL CATHETER OR STENT INTO
URETERTHROUGH RENAL PELVIS FOR DRAINAGE AND/OR
INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
74485
DILATION OF NEPHROSTOMY, URETERS, OR URETHRA,
74710
PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
143
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
74740
HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION
ANDINTERPRETATION
cohort
cohort
cohort
74742
TRANSCERVICAL CATHETERIZATION OF FALLOPIAN
TUBE,RADIOLOGICAL SUPERVISION AND INTERPRETATION
cohort
cohort
74775
PERINEOGRAM (EG, VAGINOGRAM, FOR SEX
DETERMINATIONOR EXTENTOF ANOMALIES)
statewide
75557
Cardiac magnetic resonance imaging for morphology and function
without contrast material;
cohort
cohort
cohort
75561
without contrast material(s), followed by contrast material(s) and further
sequences;
cohort
cohort
cohort
75563
without contrast material(s), followed by contrast material(s) and further
sequences; with stress imaging
75565
CARDIAC MAGNETIC RESONANCE IMAGING FOR VELOCITY
FLOW MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
75571
COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST
MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY
CALCIUM
75572
COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL,
FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY
(INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF
CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRU
75573
COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL,
FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY
IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING
3D IMAGE POSTPROCESSING, ASSESSMENT OF LV C
75574
COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY
ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH
CONTRAST MATERIAL, INCLUDING 3D IMAGE
POSTPROCESSING(INCLUDING EVALUATION OF CARDIAC
STRUCTURE AND MO
75600
AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY,
75605
AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY,
cohort
cohort
75625
AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY,
cohort
cohort
75630
AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL
LOWEREXTREMITY, CATHETER, BY SERIALOGRAPHY,
75635
Computed tomographic angiography, abdominal aorta and bilateral
iliofemoral lower extremity runoff, with contrast material(s), including
noncontrast images, if performed, and image postprocessing.
75705
ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL
75710
ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL
cohort
cohort
cohort
cohort
cohort
75716
ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL
cohort
cohort
cohort
cohort
cohort
75726
ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE,
(WITH ORWITHOUT FLUSH AORTOGRAM), RADIOLOGICAL
cohort
cohort
cohort
75733
ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE,
75736
ANGIOGRAPHY, PELVIC, SELECTIVE OR
SUPRASELECTIVE,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
75741
ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE,
RADIOLOGICAL SUPERVISION
75743
ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE,
75756
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL
144
Peer
Cohort
6
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
75774
ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED
AFTERBASIC EXAMINATION, RADIOLOGICAL SUPERVISION AND
INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR
cohort
cohort
cohort
cohort
75791
ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS
PATIENT FISTULA/GRAFT), COMPLETE EVALUATION OF DIALYSIS
ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION
AND REPORT (INCLUDES INJECTIONS OF CONTRAST AN
statewide
75809
SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED
INDWELLINGNONVASCULAR SHUNT (EG, LEVEEN SHUNT,
VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL
cohort
cohort
75820
VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL
cohort
cohort
cohort
cohort
75822
VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL
cohort
cohort
cohort
75825
VENOGRAPHY, CAVAL, INFERIOR, WITH
SERIALOGRAPHY,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
cohort
cohort
cohort
cohort
75827
VENOGRAPHY, CAVAL, SUPERIOR, WITH
SERIALOGRAPHY,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
cohort
cohort
cohort
cohort
75831
VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE,
cohort
cohort
75833
VENOGRAPHY, RENAL, BILATERAL, SELECTIVE,
cohort
cohort
75860
VENOGRAPHY, SINUS OR JUGULAR, CATHETER,
statewide
75870
VENOGRAPHY, SUPERIOR SAGITTAL SINUS,
75885
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH
HEMODYNAMICEVALUATION, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
statewide
75887
PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT
INTERPRETATION
statewide
75889
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH
INTERPRETATION
cohort
cohort
75891
HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT
INTERPRETATION
cohort
cohort
75893
VENOUS SAMPLING THROUGH CATHETER, WITH OR
WITHOUTANGIOGRAPHY (EG, FOR PARATHYROID HORMONE,
RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION
cohort
cohort
75894
TRANSCATHETER THERAPY, EMBOLIZATION, ANY
METHOD,RADIOLOGICAL SUPERVISION AND INTERPRETATION
cohort
cohort
cohort
75896
TRANSCATHETER THERAPY, INFUSION, OTHER THAN FOR
THROMBOLYSIS, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
statewide
75898
ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOWUP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION
ORINFUSION, OTHER THAN FOR THROMBOLYSIS
cohort
cohort
cohort
75901
MECHANICAL REMOVE, PERICATHETER OBSTRUCTIVE MATL
FROM CVA DEVICE VIA SEP VENOUS ACCESS S&I
cohort
cohort
75945
INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL),
RADIOLOGICALSUPERVISION AND INTERPRETATION; INITIAL
VESSEL
75960
Transcatheter introduction of intravascular stent(s) (except coronary,
carotid, vertebral, iliac, and lower extremity artery), percutaneous and/or
open, radiological supervision and interpretation, ea
cohort
cohort
cohort
cohort
cohort
75962
TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY
OTHER THAN RENAL, OR OTHER VISCERAL ARTERY, ILIAC OR
LOWER EXTREMITY, RADIOLOGICAL SUPERVISION
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
145
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
Peer
Cohort
6
ANDINTERPRETATION
75966
TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER
VISCERALARTERY, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
cohort
cohort
75968
TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL
VISCERALARTERY, RADIOLOGICAL SUPERVISION AND
INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
cohort
cohort
75970
TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION
ANDINTERPRETATION
cohort
cohort
cohort
75978
TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG,
SUBCLAVIANSTENOSIS), RADIOLOGICAL SUPERVISION AND
INTERPRETATION
cohort
cohort
cohort
75982
PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR
COMBINEDINTERNAL AND EXTERNAL BILIARY DRAINAGE OR
OFA DRAINAGE STENT FOR INTERNAL BILIARY DRAINAGE I N
PATIENTS WITH AN
cohort
cohort
75984
Change of percutaneous tube or drainage catheter with contrast
monitoring (e.g., genitourinary system, abscess), radiological
supervision and interpretation
75989
RADIOLOGICAL GUIDANCE FOR PERCUTANEOUS DRAINAGE
OFABSCESS, OR SPECIMEN COLLECTION (IE, FLUOROSCOPY,
ULTRASOUND, OR COMPUTED TOMOGRAPHY), WITH PLACEM
ENT OF INDWELLING CATHETER,
76000
FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR
PHYSICIAN OR OTHER QUALIFIED HEALTH CARE
PROFESSIONALTIME, OTHER THAN 71023 OR 71034 (EG,
CARDIAC FLUO ROSCOPY)
76001
FLUOROSCOPY, PHYSICIAN OR OTHER QUALIFIED HEALTH
CARE PROFESSIONAL TIME MORE THAN 1 HOUR, ASSISTING A
NONRADIOLOGIC PHYSICIAN OR OTHER QUALIFIED HEALTH
CARE PROFESSIONAL (EG, NEPHROSTOLITHOTOMY, ERCP,
76010
RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR
FOREIGN BODY,SINGLE FILM, CHILD
76080
RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS
TRACTSTUDY, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
76098
RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
76100
RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION
(EG,TOMOGRAPHY), OTHER THAN WITH UROGRAPHY
cohort
cohort
76120
CINERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED
statewide
76125
CINERADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION
PROCEDURE)
statewide
76140
CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE,
WRITTENREPORT
statewide
76365
COMPUTERIZED TOMOGRAPHY GUIDANCE FOR CYST
ASPIRATION,RADIOLOGICAL SUPERVISION AND
INTERPRETATION
statewide
76376
3D RENDERING WITH INTERPRETATION AND REPORTING OF
COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING,
ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH
IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION;
NOT
cohort
cohort
cohort
cohort
76377
3D RENDERING WITH INTERPRETATION AND REPORTING OF
COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING,
ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH
IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION;
REQ
cohort
cohort
cohort
cohort
cohort
76380
COMPUTERIZED TOMOGRAPHY, LIMITED OR LOCALIZED
FOLLOW-UPSTUDY
cohort
cohort
cohort
cohort
cohort
76390
MAGNETIC RESONANCE SPECTROSCOPY
statewide
76496
UNLISTED FLUOROSCOPIC PROCEDURE
cohort
cohort
76497
UNLISTED COMPUTED TOMOGRAPHY PROCEDURE
cohort
cohort
146
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
76498
UNLISTED MAGNETIC RESONANCE PROCEDURE
76499
UNLISTED DIAGNOSTIC RADIOLOGIC PROCEDUREUNLISTED
DIAGNOSTIC RADIOLOGIC PROCEDURE
cohort
76506
Echoencephalography, real time with image documentation (gray sale)
(for determination of ventricular size, delineation of cerebral contents,
and detection of fluid masses or other intracranial abnorm
cohort
76512
OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC;
CONTACTB-SCAN (WITH OR WITHOUT SIMULTANEOUS A-SCAN)
statewide
76513
IMMERSION(WATER BATH) B-SCAN
statewide
76514
CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL
(DETERMINATION OF CORNEAL THICKNESS)
statewide
76519
OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, ASCAN; WITHINTRAOCULAR LENS POWER CALCULATION
statewide
76536
Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid,
parotid) real time with image documentation
cohort
cohort
cohort
cohort
cohort
76604
Ultrasound, chest (includes mediastinum), real time with image
documentation
cohort
cohort
cohort
cohort
cohort
76645
Ultrasound, breast(s) (unilateral or bilateral), real time with image
documentation
cohort
cohort
cohort
cohort
cohort
cohort
76700
Ultrasound, abdominal, real time with image documentation; complete
cohort
cohort
cohort
cohort
cohort
cohort
76705
ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH
IMAGEDOCUMENTATION; LIMITED (EG, SINGLE ORGAN,
QUADRANT, FOLLOW-UP)
cohort
cohort
cohort
cohort
cohort
cohort
76770
Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with
image documentation; complete
cohort
cohort
cohort
cohort
cohort
cohort
76775
ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA,
NODES),B-SCAN AND/OR REAL TIME WITH IMAGE
DOCUMENTATION; LIMITED
cohort
cohort
cohort
cohort
cohort
76776
ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX
DOPPLER WITH IMAGE DOCUMENTATION
cohort
cohort
cohort
cohort
76800
ECHOGRAPHY, SPINAL CANAL AND CONTENTS
cohort
cohort
cohort
cohort
cohort
76801
US,PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL &
MATERNAL, 1ST TRIMEST, TRANSABDOM SINGL/1ST GEST
cohort
cohort
cohort
cohort
cohort
76802
US,PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL &
MATERNAL, 1ST TRIMEST, TRANSABDOM;EA ADD'L GEST
cohort
cohort
76805
ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME
WITHIMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL
AND MATERNAL EVALUATION)
cohort
cohort
cohort
cohort
cohort
76810
WITHIMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL
AND MATERNAL EVALUATION), MULTIPLE GESTATION, AFTER
THE FIRST TRIMESTER
cohort
cohort
cohort
cohort
cohort
76811
US,PREG UTER, REAL TIME W/IMAGE DOC FETL & MATRNL +
DETL FETL EXM, TRANSABD; SINGL/1ST ADD'L GEST
cohort
cohort
cohort
cohort
76812
US,PREG UTER, REAL TIME W/IMAGE DOC FETAL & MATERNAL,+
DETAIL FETAL EXAM TRANSABD; EA ADD'L GEST
cohort
cohort
cohort
cohort
76813
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE
DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL
TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR
TRANSVAGINALAPPROACH; SINGLE OR FIRST GESTATION
cohort
cohort
cohort
cohort
76814
ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE
DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL
TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR
TRANSVAGINALAPPROACH; EACH ADDITIONAL GESTATION (LIST
SEPARAT
cohort
cohort
cohort
cohort
76815
WITHIMAGE DOCUMENTATION; LIMITED (FETAL SIZE, HEART
BEAT, PLACENTAL LOCATION, FETAL POSITION, OREMERGENCY
IN THE
cohort
cohort
cohort
cohort
cohort
76816
WITHIMAGE DOCUMENTATION; FOLLOW-UP OR REPEAT
cohort
cohort
cohort
cohort
cohort
cohort
cohort
147
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
76817
US,PREGNANT UTERUS,REAL TIME W/IMAGE DOCUMENT
TRANSVAGINAL
cohort
cohort
cohort
cohort
cohort
76818
FETAL BIOPHYSICAL PROFILE
cohort
cohort
cohort
cohort
76819
FETAL BIOPHYSICAL PROFILE : WITH NON-STRESS TESTING
cohort
cohort
cohort
cohort
76820
UMBILICAL ARTERY ECHO
cohort
cohort
cohort
76821
MIDDLE CEREBRAL ARTERY ECHO
cohort
cohort
cohort
76825
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM,
REAL TIMEWITH IMAGE DOCUMENTATION (2D) WITH OR
WITHOUT M-MODE RECORDING;
cohort
cohort
76826
ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM,
REAL TIMEWITH IMAGE DOCUMENTATION (2D) WITH OR
WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY
cohort
cohort
76827
DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR
SYSTEM,PULSED WAVE AND/OR CONTINUOUS WAVE WITH
SPECTRAL DISPLAY; COMPLETE
cohort
cohort
76828
DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR
SYSTEM,PULSED WAVE AND/OR CONTINUOUS WAVE WITH
SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY
cohort
cohort
76830
ECHOGRAPHY, TRANSVAGINAL
cohort
cohort
76831
HYSTEROSONOGRAPHY, WITH OR WITHOUT COLOR FLOW
DOPPLER
cohort
cohort
76856
Ultrasound, pelvic (nonobstetric), real time with image documentation;
complete
cohort
cohort
cohort
cohort
cohort
76857
ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL
TIMEWITH IMAGE DOCUMENTATION; LIMITED OR FOLLOW-UP
(EG, FOR FOLLICLES)
cohort
cohort
cohort
cohort
cohort
76870
ECHOGRAPHY, SCROTUM AND CONTENTS
cohort
cohort
cohort
cohort
cohort
76872
ECHOGRAPHY, TRANSRECTAL
cohort
cohort
cohort
cohort
cohort
76873
ECHOGRAPHY, PROSTATE VOLUME STUDAY FOR
BRACHYTHERAPY TREATMENT PLANNIN (SEPARATE
PROCEDURE)
cohort
cohort
cohort
cohort
cohort
76881
Ultrasound, extremity, nonvascular, real-time withimage documentation;
complete
cohort
cohort
cohort
cohort
cohort
76882
Ultrasound, extremity, nonvascular, real-time withimage documentation;
limited, anatomic specific
cohort
cohort
cohort
cohort
cohort
76885
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING
DOCUMENTATION; DYNAMIC (REQUIRING PHYSICIAN OR
OTHERQUALIFIED HEALTH CARE PROFESSIONAL
MANIPULATION)
cohort
cohort
cohort
cohort
76886
ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING
DOCUMENTATION; LIMITED, STATIC (NOT REQUIRING PHYSICIAN
OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
MANIPULATION)
cohort
cohort
cohort
cohort
76932
ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY,
RADIOLOGICAL SUPERVISION
76936
ULTRASOUND GUIDED COMPRESSION REPAIR OF
ARTERIALPSEUDO-ANEURYSM OR ARTERIOVENOUS FISTULAE
(INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION,
COMPRESSION OF LESION AND
76937
ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING
ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES,
DOCUMENTATION OF SELECTED VESSEL PATENCY,
CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF
VASCULAR NE
76940
Ultrasound guidance for, and monitoring of, parenchymal tissue ablation
statewide
76941
ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL
TRANSFUSION ORCORDOCENTESIS, RADIOLOGICAL
statewide
76942
ULTRASONIC GUIDANCE FOR NEEDLE
PLACEMENT(EG,BIOPSYASPIRATION, INJECTION,LOCALIZATION
DEVICE) IMAGINGSUPERVISION AND INTERPRETATION
76945
ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS
SAMPLING,RADIOLOGICAL SUPERVISION AND INTERPRETATION
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
cohort
statewide
148
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
76946
ULTRASONIC GUIDANCE FOR AMNIOCENTESIS,
76950
ECHOGRAPHY FOR PLACEMENT OF RADIATION THERAPY
FIELDS, B-SCAN
76965
ULTRASONIC GUIDANCE FOR INTERSTITIAL
RADIOELEMENTAPPLICATION ULTRASONIC GUIDANCE FOR
INTERSTITIAL RADIOELEMENT
cohort
76970
ULTRASOUND STUDY FOLLOW-UP (SPECIFY)
cohort
76998
ULTRASONIC GUIDANCE, INTRAOPERATIVE
cohort
cohort
cohort
cohort
cohort
76999
UNLISTED ULTRASOUND PROCEDURE
cohort
cohort
cohort
cohort
cohort
77001
FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS
DEVICE PLACEMENT, REPLACEMENT (CATHETER ONLY OR
COMPLETE), OR REMOVAL (INCLUDES FLUOROSCOPIC
GUIDANCE FOR VASCULAR ACCESS AND CATHETER
MANIPULATION, ANY
cohort
cohort
cohort
cohort
cohort
cohort
77002
FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG,
BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE)
cohort
cohort
cohort
cohort
cohort
cohort
77003
FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR
CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTICOR
THERAPEUTIC INJECTION PROCEDURES (EPIDURAL OR
SUBARACHNOID)
cohort
cohort
cohort
cohort
cohort
cohort
77011
COMPUTED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC
LOCALIZATION
77012
COMPUTED TOMOGRAPHY GUIDANCE FOR NEEDLE PLACEMENT
(EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE),
cohort
77013
COMPUTERIZED TOMOGRAPHY GUIDANCE FOR, AND
MONITORING OF, PARENCHYMAL TISSUE ABLATION
cohort
77014
COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF
RADIATION THERAPY FIELDS
cohort
77021
MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT
(EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION, OR
PLACEMENT OF LOCALIZATION DEVICE) RADIOLOGICAL
77031
STEREOTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY
OR NEEDLE PLACEMENT (EG, FOR WIRE LOCALIZATION OR FOR
INJECTION), EACH LESION, RADIOLOGICAL SUPERVISION AND
INTERPRETATION
77032
MAMMOGRAPHIC GUIDANCE FOR NEEDLE PLACEMENT,
BREAST(EG, FOR WIRE LOCALIZATION OR FOR INJECTION), EAC
H LESION, RADIOLOGICAL SUPERVISION AND INTERPRETATION
77051
COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM
ANALYSIS OF DIGITAL IMAGE DATA FOR LESION DETECTION)
WITH FURTHER REVIEW FOR INTERPRETATION, WITH OR
WITHOUT DIGITIZATION OF FILM RADIOGRAPHIC IMAGES; DIAG
77052
COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM
ANALYSIS OF DIGITAL IMAGE DATA FOR LESION DETECTION)
WITH FURTHER REVIEW FOR INTERPRETATION, WITH OR
WITHOUT DIGITIZATION OF FILM RADIOGRAPHIC IMAGES; SCRE
77053
MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT,
77054
MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS,
77055
MAMMOGRAPHY; UNILATERAL
cohort
cohort
cohort
cohort
cohort
77056
MAMMOGRAPHY; BILATERAL
cohort
cohort
cohort
cohort
cohort
77057
SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW FILM STUDY
OF EACH BREAST)
cohort
cohort
cohort
cohort
cohort
77058
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT
AND/ORWITH CONTRAST MATERIAL(S); UNILATERAL
cohort
cohort
cohort
cohort
77059
MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT
AND/ORWITH CONTRAST MATERIAL(S); BILATERAL
cohort
cohort
cohort
cohort
cohort
77072
BONE AGE STUDIES
cohort
cohort
cohort
cohort
cohort
77073
BONE LENGTH STUDIES (ORTHOROENTGENOGRAM,
cohort
cohort
cohort
cohort
statewide
cohort
cohort
149
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
SCANOGRAM)
77074
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG,
FOR METASTASES)
77075
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE
(AXIAL AND APPENDICULAR SKELETON)
77076
RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT
77077
JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS (SPECIFY)
cohort
77078
COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY,
1OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE)
cohort
77080
DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY
STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS,
SPINE)
cohort
cohort
77081
STUDY, 1 OR MORE SITES; APPENDICULAR SKELETON
(PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
cohort
cohort
77082
STUDY, 1 OR MORE SITES; VERTEBRAL FRACTURE
ASSESSMENT
77280
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING;
SIMPLE
cohort
77285
THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD
SETTING;INTERMEDIATE
cohort
77290
SETTING;COMPLEX
cohort
cohort
cohort
cohort
cohort
77295
SETTING;THREE-DIMENSIONAL
cohort
cohort
cohort
cohort
cohort
77300
BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS
DEPTHDOSE, TDF, NSD, GAP CALCULATION, OFF AXIS FACTOR,
TISSUE INHOMOGENEITY FACTORS, AS REQUIREDDURING
COURSE OF
cohort
cohort
cohort
cohort
cohort
77301
INTENSITY MODULATED RADIOTHERAPY PLAN W/DOSE VOLUME
HISTOGRAMS
cohort
cohort
cohort
cohort
cohort
77305
TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR
COMPUTERCALCULATED); SIMPLE (ONE OR TWO PARALLEL
OPPOSED UNMODIFIED PORTS DIRECTED TO A SINGLE AREA OF
INTEREST)
cohort
cohort
cohort
cohort
77310
COMPUTERCALCULATED); INTERMEDIATE (THREE OR MORE
TREATMENT PORTS DIRECTED TO A SINGLE AREA OF
INTEREST)
cohort
cohort
cohort
77315
COMPUTERCALCULATED); COMPLEX (MANTLE OR INVERTED Y,
TANGENTIAL PORTS, THE USE OF WEDGES, COMPENSATORS,
COMPLEX BLOCKING,
cohort
cohort
cohort
cohort
cohort
77321
SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMI-BODY,
TOTALBODY
cohort
cohort
cohort
cohort
cohort
77326
BRACHYTHERAPY ISODOSE CALCULATION; SIMPLE
(CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR
SOURCES/RIBBON APPLICATION, REMOTE AFTERLOADING
BRACHYTHERAPY, 1 TO 8 SOURCES)
cohort
cohort
cohort
77327
BRACHYTHERAPY ISODOSE CALCULATION; INTERMEDIATE
(MULTIPLANE DOSAGE CALCULATIONS, APPLICATION
INVOLVING 5 TO 10 SOURCES/RIBBONS, REMOTE
AFTERLOADING BRACHYTHERAPY, 9 TO 12
cohort
cohort
77328
BRACHYTHERAPY ISODOSE CALCULATION; COMPLEX
(MULTIPLANEISODOSE PLAN, VOLUME IMPLANT CALCULATIONS,
OVER 10 SOURCES/RIBBONS USED, SPECIAL SPATIAL
RECONSTRUCTION, REMOTE
77331
SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY),
ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN
SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY),
ONLY
77332
TREATMENT DEVICES, DESIGN AND CONSTRUCTION;
SIMPLE(SIMPLEBLOCK, SIMPLE BOLUS)
cohort
150
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
77333
INTERMEDIATE(MULTIPLE BLOCKS, STENTS, BITE BLOCKS,
SPECIAL BOLUS)
cohort
cohort
cohort
cohort
cohort
77334
COMPLEX(IRREGULAR BLOCKS, SPECIAL SHIELDS,
COMPENSATORS,WEDGES, MOLDS OR CASTS)
cohort
cohort
cohort
cohort
cohort
77336
CONTINUING MEDICAL PHYSICS CONSULTATION,
INCLUDINGASSESSMENT OF TREATMENT PARAMETERS,
QUALITY ASSURANCE OF DOSE DELIVERY, AND REVIEW OF
PATIENT TREATMENT DOCUMENTATION
cohort
cohort
cohort
cohort
cohort
77338
MULTI-LEAF COLLIMATOR(MLC) DEVICE(S) FOR
INTENSITYMODULATED RADIATION THERAPY (IMRT),DESIGN
AND CONSTRUCTION PER IMRT PLAN
cohort
cohort
cohort
cohort
cohort
77370
SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION
cohort
cohort
cohort
cohort
cohort
77371
Radiation treatment delivery, stereotactic radiosurgery (SRS), complete
course of treatment of cranial lesion(s) consisting of 1 session; multisourceCobalt 60 based
statewide
77373
STEREOTACTIC BODY RADIATION THERAPY, TREATMENT
DELIVERY, PER FRACTION TO 1 OR MORE LESIONS, INCLUDING
IMAGE GUIDANCE, ENTIRE COURSE NOT TO EXCEED 5
FRACTIONS
statewide
77399
UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS,
DOSIMETRY ANDTREATMENT DEVICES, AND SPECIAL SERVICES
cohort
77401
RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR
ORTHOVOLTAGE
statewide
77402
RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA,
SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS
OR NO BLOCKS; UP TO 5 MEV
77403
OR NO BLOCKS; 6-10 MEV
77404
OR NO BLOCKS; 11-19 MEV
cohort
77408
RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT
AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT
AREA, USE OF MULTIPLE BLOCKS; 6-10 MEV
cohort
77409
AREA, USE OF MULTIPLE BLOCKS; 11-19 MEV
77411
AREA, USE OF MULTIPLE BLOCKS; 20 MEV OR GREATER
77412
RADIATION TREATMENT DELIVERY, THREE OR MORE
SEPARATETREATMENT AREAS, CUSTOM BLOCKING,
TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM,
COMPENSATORS, SPECIAL PARTICLE BEAM (EG,
77413
cohort
cohort
77414
cohort
cohort
77416
77417
THERAPEUTIC RADIOLOGY PORT FILM(S)
cohort
cohort
cohort
77418
INTENSITY MODULATED RADIOTHERAPY PLAN, SINGLE/
MULTIPLE FIELDS/ARCS, PER SESSION
cohort
cohort
77421
STEREOSCOPIC X-RAY GUIDANCE FOR LOCALIZATION OF
TARGET VOLUME FOR THE DELIVERY OF RADIATION THERAPY
cohort
SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY
cohort
77470
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
151
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
IRRADIATION, HEMIBODY RADIATION, PER ORAL OR
ENDOCAVITARY IRRADIATION)
77750
INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION
77761
INTRACAVITARY RADIOELEMENT APPLICATION; SIMPLE
statewide
77762
INTRACAVITARY RADIOELEMENT APPLICATION; INTERMEDIATE
77763
INTRACAVITARY RADIOELEMENT APPLICATION; COMPLEX
77777
INTERSTITIAL RADIOELEMENT APPLICATION;
INTERMEDIATEINTERSTITIAL RADIOELEMENT APPLICATION;
INTERMEDIATE
cohort
77778
INTERSTITIAL RADIOELEMENT APPLICATION;
COMPLEXINTERSTITIAL RADIOELEMENT APPLICATION;
COMPLEX
cohort
cohort
cohort
cohort
77785
Remote afterloading high dose rate radionuclide brachytherapy; 1
channel
cohort
cohort
cohort
77786
Remote afterloading high dose rate radionuclide brachytherapy; 2-12
channels
cohort
cohort
cohort
77787
Remote afterloading high dose rate radionuclide brachytherapy; over 12
channels
77790
SUPERVISION, HANDLING, LOADING OF RADIOELEMENT
77799
UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY
78012
THYROID UPTAKE, SINGLE OR MULTIPLE QUANTITATIVE
MEASUREMENT(S) (INCLUDING STIMULATION, SUPPRESSION,
OR DISCHARGE, WHEN PERFORMED)
cohort
cohort
cohort
cohort
cohort
78013
THYROID IMAGING (INCLUDING VASCULAR FLOW, WHEN
PERFORMED);
cohort
cohort
cohort
cohort
cohort
78014
THYROID IMAGING (INCLUDING VASCULAR FLOW, WHEN
PERFORMED); WITH SINGLE OR MULTIPLE UPTAKE(S)
QUANTITATIVE MEASUREMENT(S) (INCLUDING STIMULATION,
SUPPRESSION, OR DISCHARGE, WHEN PERFORMED)
cohort
cohort
cohort
cohort
cohort
78015
THYROID CARCINOMA METASTASES IMAGING; LIMITED
AREA(EG, NECKAND CHEST ONLY)
cohort
cohort
78018
THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY
cohort
cohort
cohort
cohort
78020
THYROID CARCINOMA METASTASES UPTAKE (LIST SEPARATELY
INADDITION TO CODE FOR PRIMARY PROCEDURE)
cohort
cohort
78070
PARATHYROID PLANAR IMAGING (INCLUDING
SUBTRACTION,WHEN PERFORMED);
cohort
cohort
cohort
cohort
78071
SUBTRACTION,WHEN PERFORMED); WITH TOMOGRAPHIC
(SPECT)
cohort
cohort
cohort
cohort
78072
SUBTRACTION,WHEN PERFORMED); WITH TOMOGRAPHIC
(SPECT), AND CO NCURRENTLY ACQUIRED COMPUTED
TOMOGRAPHY (CT) FOR ANATOMICAL LOCALIZATION
cohort
cohort
cohort
78075
ADRENAL IMAGING, CORTEX AND/OR MEDULLA
78102
BONE MARROW IMAGING; LIMITED AREA
statewide
78104
BONE MARROW IMAGING; WHOLE BODY
statewide
78122
WHOLE BLOOD VOLUME DETERMINATION, INCLUDING
SEPARATEMEASUREMENT OF PLASMA VOLUME AND RED CELL
VOLUME(RADIOPHARMACEUTICAL VOLUME-DILUTION
TECHNIQUE)
statewide
78195
LYMPHATICS AND LYMPH GLANDS IMAGING
78201
LIVER IMAGING; STATIC ONLY
78202
LIVER IMAGING; WITH VASCULAR FLOW
78205
LIVER IMAGING (SPECT)
78215
LIVER AND SPLEEN IMAGING; STATIC ONLY
78216
LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW
78226
HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER
WHEN PRESENT;
cohort
cohort
78227
HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER
WHEN PRESENT; WITH PHARMACOLOGIC INTERVENTION,
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
152
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
Peer
Cohort
6
INCLUDING QUANTITATIVE MEASUREMENT(S) WHEN
PERFORMED
78264
GASTRIC EMPTYING STUDY
cohort
cohort
78267
UREA BREATH TEST, C-14; ACQUISITION FOR ANALYSIS
cohort
cohort
78268
UREA BREATH TEST, C-14; ANALYSIS
statewide
78278
ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING
cohort
cohort
cohort
cohort
78290
BOWEL IMAGING (EG, ECTOPIC GASTRIC MUCOSA,
MECKEL'SLOCALIZATION, VOLVULUS)
cohort
cohort
cohort
cohort
78300
BONE AND/OR JOINT IMAGING; LIMITED AREA
cohort
cohort
cohort
cohort
78305
BONE AND/OR JOINT IMAGING; MULTIPLE AREAS
cohort
cohort
78306
BONE AND/OR JOINT IMAGING; WHOLE BODY
cohort
cohort
cohort
cohort
cohort
cohort
78315
BONE AND/OR JOINT IMAGING; THREE PHASE STUDY
cohort
cohort
cohort
cohort
cohort
cohort
78320
BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT)
cohort
cohort
cohort
cohort
cohort
cohort
78428
CARDIAC SHUNT DETECTION
78445
NON-CARDIAC VASCULAR FLOW IMAGING (IE,
ANGIOGRAPHY,VENOGRAPHY)
78451
MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT)
(INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR
QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST
PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICAT
cohort
cohort
cohort
cohort
cohort
78452
MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT)
(INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR
QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST
PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICAT
cohort
cohort
cohort
cohort
cohort
78454
MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING
QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION
FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL
QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIE
statewide
78459
MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY
(PET),METABOLIC EVALUATION
statewide
78472
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM;
PLANAR,SINGLE STUDY AT REST OR STRESS (EXERCISE
AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS
EJECTIONFRACTION,
78473
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM;
MULTIPLESTUDIES, WALL MOTION STUDY PLUS EJECTION
FRACTION, AT REST AND STRESS (EXERCISE AND/OR
PHARMACOLOGIC), WITH OR WITHOUT
78492
(PET),PERFUSION; MULTIPLE STUDIES AT REST AND/OR STRESS
(PET),
78494
CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT,
ATREST, WALL MOTION STUDY PLUS EJECTION FRACTION, WITH
OR WITHOUT QUANTITATIVE PROCESSING
78579
PULMONARY VENTILATION IMAGING (EG, AEROSOL OR GAS)
78580
PULMONARY PERFUSION IMAGING (EG, PARTICULATE)
78582
PULMONARY VENTILATION (EG, AEROSOL OR GAS) AND
PERFUSION IMAGING
cohort
78597
QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION,
INCLUDING IMAGING WHEN PERFORMED
cohort
78598
QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION AND
VENTILATION (EG, AEROSOL OR GAS), INCLUDING IMAGING
WHEN PERFORMED
78606
Brain imaging, minimum 4 static views; with vascular flow
78607
Brain imaging, tomographic (SPECT)
78608
BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY
(PET);METABOLICEVALUATION BRAIN IMAGING, POSITRON EMIS
SION TOMOGRAPHY (PET); METABOLIC
cohort
78630
CEREBROSPINAL FLUID FLOW, IMAGING (NOT
INCLUDINGINTRODUCTION OF MATERIAL); CISTERNOGRAPHY
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
153
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
Peer
Cohort
5
CPT
Description
78645
CEREBROSPINAL FLUID FLOW, IMAGING (NOT
INCLUDINGINTRODUCTION OF MATERIAL); SHUNT EVALUATION
78650
CSF LEAKAGE DETECTION AND LOCALIZATION
78660
RADIOPHARMACEUTICAL
DACRYOCYSTOGRAPHYRADIOPHARMACEUTICAL
DACRYOCYSTOGRAPHY
cohort
cohort
78700
Kidney imaging morphology
cohort
cohort
78701
KIDNEY IMAGING; WITH VASCULAR FLOW
78707
with vascular flow and function, single study without pharmocological
intervention
cohort
cohort
cohort
cohort
cohort
78708
with vascular flow and function, single study, with pharmacological
intervention (eg, angiotension converting enzyme inhibitor and/or
diuretic)
cohort
cohort
cohort
cohort
cohort
78709
with vascular flow and function, multiple studies,with and without
pharmacological intervention (eg , angiotension converting enzyme
inhibitor and/or diuretic)
cohort
cohort
cohort
78710
Tomographic (SPECT)
cohort
78725
KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC
STUDY
statewide
78740
URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL
VOIDINGCYSTOGRAM) URETERAL REFLUX STUDY
(RADIOPHARMACEUTICAL VOIDING
cohort
78800
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR;
LIMITEDAREARADIOPHARMACEUTICAL LOCALIZATION OF
TUMOR; LI MITED AREA
cohort
78801
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; MULTIPLE
AREAS
cohort
78802
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; WHOLE
BODY
cohort
78803
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR;
TOMOGRAPHIC(SPECT)
cohort
78804
RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR
DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); WHOLE
BODY, REQUIRING TWO OR MORE DAYS IMAGING
78805
RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; LIMITED
AREARADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS;
LIMITED AREA
78806
RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS;
WHOLEBODY
78807
RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS;
TOMOGRAPHIC(SPECT)
78808
Injection procedure for radiopharmaceutical localization by non-imaging
probe study, intravenous (e.g., parathyroid adenoma)
78812
Positron emission tomography (PET) imaging; skull base to mid-thigh
78813
Positron emission tomography (PET) imaging; whole body
78814
Positron emission tomography (PET) with concurrently acquired
computed tomography (CT) for attenuation correction and anatomical
localization imaging;limited area (e.g., chest, head/neck)
78815
localization imaging;skull base to mid-thigh
cohort
cohort
cohort
cohort
cohort
78816
localization imaging;whole body
cohort
cohort
cohort
cohort
cohort
78999
UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC
NUCLEARMEDICINE
79005
NUCLEAR RX, ORAL ADMIN
cohort
cohort
79101
NUCLEAR RX, IV ADMIN
cohort
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
79403
RADIOPHARMACEUTICAL THERAPY, RADIOLABELED
MONOCLONAL ANTIBODY BY INTRAVENOUS INFUSION
cohort
cohort
79440
INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPYINTRAARTICULAR RADIOPHARMACEUTICAL THERAPY
statewide
154
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
79445
NUCLEAR RX, INTRA-ARTERIAL
80047
Basic metabolic panel (Calcium, ionized) This panel must include the
following: Calcium, ionized (82330), Carbon dioxide (82374), Chloride
(82435), Creatinine (82565), Glucose (82947), Potassium (8413
80048
Basic metabolic panel (Calcium, total) This panel must include the
following: Calcium, total (82310), Carbon dioxide (82374), Chloride
(82435), Creatinine (82565), Glucose (82947), Potassium (84132),
80050
General health panel This panel must include the following:
Comprehensive metabolic panel (80053), Blood count, complete (CBC),
automated and automated differential WBC count (85025 or 85027 and
85004
80053
Comprehensive metabolic panel This panel must include the following:
Albumin (82040), Bilirubin, total (82247), Calcium, total (82310), Carbon
dioxide(bicarbonate) (82374), Chloride (82435), Creatini
cohort
80061
Lipid panel This panel must include the following:Cholesterol, serum,
total (82465), Lipoprotein, d irect measurement, high density cholesterol
(HDL cholesterol) (83718), Triglycerides (84478)
cohort
80069
Renal function panel This panel must include the following: Albumin
(82040), Calcium, total (82310),Carbon dioxide (bicarbonate) (82374),
Chloride (8 2435), Creatinine (82565), Glucose (82947), Phosph
80074
Acute hepatitis panel This panel must include the following: Hepatitis A
antibody (HAAb), IgM antibody (86709), Hepatitis B core antibody
(HBcAb), IgMantibody (86705), Hepatitis B surface antigen (HB
80076
Hepatic function panel This panel must include thefollowing: Albumin
(82040), Bilirubin, total (822 47), Bilirubin, direct (82248), Phosphatase,
alkaline (84075), Protein, total (84155), Transferase,
statewide
80104
Drug screen, qualitative; multiple drug classes other than
chromatographic method, each procedure
statewide
80156
CARBAMAZEPINE(CLOSEST CLINICALLY EQUIVALENT CODE(S)
DELETED IN 1993: 82372)
statewide
80202
VANCOMYCIN
statewide
80299
QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED
statewide
81000
URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR
BILIRUBIN,GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES,
NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY
NUMBER OF THESE
81001
NUMBER OF THESE
81002
NUMBER OF THESE
81003
NUMBER OF THESE
81005
URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE,
EXCEPTIMMUNOASSAYS URINALYSIS; QUALITATIVE OR
SEMIQUANTITATIVE, EXCEPT
81015
URINALYSIS; MICROSCOPIC ONLYURINALYSIS; MICROSCOPIC
ONLY
81025
URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON
METHODSURINE PREGNANCY TEST, BY VISUAL COLOR
COMPARISON METHODS
81050
VOLUME MEASUREMENT FOR TIMED COLLECTION,
EACHVOLUME MEASUREMENT FOR TIMED COLLECTION, EACH
81201
APC (adenomatous polyposis coli) (e.g., familial adenomatosis
polyposis [FAP], attenuated FAP) gene analysis; full gene sequence
statewide
81205
BCKDHB (BRANCHED-CHAIN KETO ACID DEHYDROGENASE
E1,BETA POLYPEPTIDE) (EG, MAPLE SYRUP URINE DISEASE)
GENE ANALYSIS, COMMON VARIANTS (EG, R183P, G278S, E422X)
statewide
81206
BCR/ABL1 (T(9;22)) (EG, CHRONIC MYELOGENOUS LEUKEMIA)
TRANSLOCATION ANALYSIS; MAJOR BREAKPOINT, QUALITATIVE
statewide
Peer
Cohort
5
Peer
Cohort
6
statewide
155
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
OR QUANTITATIVE
81207
BCR/ABL1 (T(9;22)) (EG, CHRONIC MYELOGENOUS LEUKEMIA)
TRANSLOCATION ANALYSIS; MINOR BREAKPOINT, QUALITATIVE
OR QUANTITATIVE
statewide
81210
BRAF (V-RAF MURINE SARCOMA VIRAL ONCOGENE HOMOLOG
B1) (EG, COLON CANCER), GENE ANALYSIS, V600E VARIANT
statewide
81220
CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE
REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON
VARIANTS (EG, ACMG/ACOG GUIDELINES)
statewide
81223
CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE
REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS;
FULLGENE SEQUENCE
statewide
81225
CYP2C19 (CYTOCHROME P450, FAMILY 2, SUBFAMILY C,
POLYPEPTIDE 19) (EG, DRUG METABOLISM), GENE ANALYSIS,
COMMON VARIANTS (EG, *2, *3, *4, *8, *17)
statewide
81229
CYTOGENOMIC CONSTITUTIONAL (GENOME-WIDE) MICROARRAY
ANALYSIS; INTERROGATION OF GENOMIC REGIONS FOR COPY
NUMBER AND SINGLE NUCLEOTIDE POLYMORPHISM (SNP)
VARIANTS FOR CHROMOSOMAL ABNORMALITIES
statewide
81240
F2 (PROTHROMBIN, COAGULATION FACTOR II) (EG, HEREDITARY
HYPERCOAGULABILITY) GENE ANALYSIS, 20210G>A VARIANT
statewide
81241
F5 (COAGULATION FACTOR V) (EG, HEREDITARY
HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT
statewide
81243
FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILEX
MENTAL RETARDATION) GENE ANALYSIS; EVALUATION T O
DETECT ABNORMAL (EG, EXPANDED) ALLELES
statewide
81264
IGK@ (IMMUNOGLOBULIN KAPPA LIGHT CHAIN LOCUS)
(EG,LEUKEMIA AND LYMPHOMA, B-CELL), GENE
REARRANGEMEN T ANALYSIS, EVALUATION TO DETECT
ABNORMAL CLONAL POPULATION(S)
statewide
81265
COMPARATIVE ANALYSIS USING SHORT TANDEM REPEAT (STR)
MARKERS; PATIENT AND COMPARATIVE SPECIMEN (EG, PRETRANSPLANT RECIPIENT AND DONOR GERMLINE TESTING,
POST-TRANSPLANT NON-HEMATOPOIETIC RECIPIENT GER
statewide
81267
CHIMERISM (ENGRAFTMENT) ANALYSIS, POST
TRANSPLANTATION SPECIMEN (EG, HEMATOPOIETIC STEM
CELL), INCLUDES COMPARISON TO PREVIOUSLY PERFORMED
BASELINE ANALYSES; WITHOUT CELL SELECTION
statewide
81268
CHIMERISM (ENGRAFTMENT) ANALYSIS, POST
TRANSPLANTATION SPECIMEN (EG, HEMATOPOIETIC STEM
CELL), INCLUDES COMPARISON TO PREVIOUSLY PERFORMED
BASELINE ANALYSES; WITH CELL SELECTION (EG, CD3, CD33),
EACH
statewide
81270
JAK2 (JANUS KINASE 2) (EG, MYELOPROLIFERATIVE DISORDER)
GENE ANALYSIS, P.VAL617PHE (V617F) VARIANT
statewide
81275
KRAS (V-KI-RAS2 KIRSTEN RAT SARCOMA VIRAL ONCOGENE)
(EG, CARCINOMA) GENE ANALYSIS, VARIANTS IN CODONS 12
AND 13
statewide
81331
SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN
POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG,
PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME),
METHYLATION ANALYSIS
statewide
81370
HLA CLASS I AND II TYPING, LOW RESOLUTION (EG, ANTIGEN
EQUIVALENTS); HLA-A, -B, -C, -DRB1/3/4/5, AND-DQB1
statewide
81376
HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN
EQUIVALENTS); ONE LOCUS (EG, HLA-DRB1/3/4/5, -DQB1,-DQA1, DPB1, OR -DPA1), EACH
statewide
81378
HLA CLASS I AND II TYPING, HIGH RESOLUTION (IE, ALLELES OR
ALLELE GROUPS), HLA-A, -B, -C, AND -DRB1
statewide
81379
HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR
ALLELE GROUPS); COMPLETE (IE, HLA-A, -B, AND -C)
statewide
81382
HLA CLASS II TYPING, HIGH RESOLUTION (IE, ALLELES OR
ALLELE GROUPS); ONE LOCUS (EG, HLA-DRB1, -DRB3,-DRB4, DRB5, -DQB1, -DQA1, -DPB1, OR -DPA1), EAC H
statewide
81401
MOLECULAR PATHOLOGY PROCEDURE, LEVEL 2 (EG, 2-10 SNPS,
statewide
156
Peer
Cohort
5
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
1 METHYLATED VARIANT, OR 1 SOMATIC VARIANT [TYPICALLY
USING NONSEQUENCING TARGET VARIANT ANALYSIS], OR
DETECTION OF A DYNAMIC MUTATION DISORDER/T
81404
MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5 (EG, ANALYSIS
OF 2-5 EXONS BY DNA SEQUENCE ANALYSIS,
MUTATIONSCANNING OR DUPLICATION/DELETION VARIANTS OF
6-10 EXONS, OR CHARACTERIZATION OF A DYNAMIC MUTATION
statewide
81408
MOLECULAR PATHOLOGY PROCEDURE, LEVEL 9 (EG, ANALYSIS
OF >50 EXONS IN A SINGLE GENE BY DNA SEQUENCE ANALYSIS)
ATM (ATAXIA TELANGIECTASIA MUTATED) (EG, ATAXIA
TELANGIECTASIA), FULL GENE SEQUENCE CDH23 (
statewide
81479
UNLISTED MOLECULAR PATHOLOGY PROCEDURE
statewide
82003
ACETAMINOPHEN
82010
KETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETAHYDROXYBUTYRATE); QUANTITATIVE
82017
ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN (FOR
CARNITINE, SEE 82379)
82040
Albumin serum, plasma or whole blood
82043
ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE
82055
ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH
82103
ALPHA-1-ANTITRYPSIN; TOTAL(CLOSEST CLINICALLY
EQUIVALENT CODE(S), DELETED IN 1993: 86064, 86067)
82120
AMINES, VAGINAL FLUID, QUALITATIVE
82136
AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH
SPECIMEN
statewide
82139
AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE,
EACHSPECIMEN
statewide
82140
AMMONIA
82150
AMYLASE
82157
ANDROSTENEDIONE
statewide
82172
APOLIPOPROTEIN, EACH
statewide
82247
BILIRUBIN; TOTAL
statewide
82248
BILIRUBIN; DIRECT
82270
BLOOD, OCCULT; FECES, 1-3 SIMULTANEOUS DETERMINATIONS
82271
BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC),
QUALITATIVE; OTHER SOURCES
82272
Blood, occult, by peroxidase activity (e.g., guiac), qualitative, feces, 1-3
simultaneous determinations, performed for other than colorectal
neoplasmscreening
82300
CADMIUM
cohort
82310
CALCIUM; TOTALCALCIUM; TOTAL
statewide
82360
CALCULUS (STONE); QUANTITATIVE ANALYSIS, CHEMICAL
82373
CARBOHYDRATE DEFICIENT TRANSFERRIN
statewide
82379
CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN
statewide
82380
CAROTENE
statewide
82390
CERULOPLASMIN
statewide
82397
CHEMILUMINESCENT ASSAY
statewide
82438
CHLORIDE; OTHER SOURCE
statewide
82465
CHOLESTEROL, SERUM, TOTALCHOLESTEROL, SERUM, TOTAL
statewide
82491
CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID
ORHPLC); SINGLE ANALYTE NOT ELSEWHERE SPECIFIED,
SINGLE STATIONARY AND MOBILE PHASE
statewide
82492
CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID
ORHPLC); MULTIPLE ANALYTES, SINGLE STATIONARY AND
MOBILE PHASE
82495
CHROMIUM
82533
CORTISOL; TOTAL
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
157
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
82544
COLUMN CHROMATOGRAPHY/MASS SPECTOMETRY (EG,
GC/MS,ORHPLC/MS), ANALYTE NOT ELSEWHERE SPECIFIED;
STAB LE ISOTOPE DILUTION, MULTIPLE ANALYTES,
QUANTITATIVE, SINGLE STATIONARY
statewide
82550
CREATINE KINASE (CK), (CPK); TOTAL
statewide
82565
CREATININE; BLOOD
statewide
82570
CREATININE; OTHER SOURCE
statewide
82607
CYANOCOBALAMIN (VITAMIN B-12);CYANOCOBALAMIN (VITAMIN
B-12);
statewide
82626
DEHYDROEPIANDROSTERONE (DHEA)
statewide
82633
DESOXYCORTICOSTERONE, 11-
statewide
82634
DEOXYCORTISOL, 11-
statewide
82651
DIHYDROTESTOSTERONE (DHT)
82652
VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF
PERFORMED
82656
PANCREATIC ELASTASE, FECAL
statewide
82657
ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS,
ORTISSUE,NOT ELSEWHERE SPECIFIED; NONRADIOACTIVE SU
BSTRATE, EACH SPECIMEN
statewide
82658
ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS,
ORTISSUE,NOT ELSEWHERE SPECIFIED; RADIOACTIVE SUBST
RATE, EACH SPECIMEN
statewide
82670
ESTRADIOL
statewide
82705
FAT OR LIPIDS, FECES; QUALITATIVE
statewide
82728
FERRITIN
statewide
82731
FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS,SEMIQUANTITATIVE
statewide
82746
FOLIC ACID; SERUM
statewide
82784
GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH
statewide
82785
GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE
statewide
82787
GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN
SUBCLASSES (EG, IGG1, 2, 3, OR 4), EACH
82800
GASES, BLOOD, PH ONLYGASES, BLOOD, PH ONLY
82947
GLUCOSE; QUANTITATIVEGLUCOSE; QUANTITATIVE
82948
GLUCOSE; BLOOD, REAGENT STRIPGLUCOSE; BLOOD, REAGENT
STRIP
82955
GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD);
QUANTITATIVE
82962
GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S)
CLEARED BYTHE FDA SPECIFICALLY FOR HOME USE
GLUCOSE,BLOOD BY GLUCOSE MONITORING DEVICE(S)
CLEARED BY
82977
GLUTAMYLTRANSFERASE, GAMMA (GGT)
statewide
82978
GLUTATHIONE
statewide
83001
GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH)
statewide
83002
GONADOTROPIN; LUTEINIZING HORMONE (LH)
83005
83010
HAPTOGLOBIN; QUANTITATIVE
statewide
83021
HEMOGLOBIN FRACTIONATION AND QUANTITATION;
CHROMATOGRAPHY(EG, A2, S, C, AND/OR F)
statewide
83036
HEMOGLOBIN; GLYCATEDHEMOGLOBIN; GLYCATED
statewide
83090
HOMOCYSTINE
statewide
83498
HYDROXYPROGESTERONE, 17-D
statewide
83516
IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT
ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE OR
SEMIQUANTITATIVE, MULTIPLE STEP METHOD
statewide
83519
ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATIVE, BY
statewide
cohort
Peer
Cohort
5
cohort
statewide
statewide
statewide
cohort
statewide
statewide
cohort
cohort
statewide
statewide
158
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
RADIOIMMUNOASSAY (EG, RIA)
83520
ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATIVE,
statewide
83525
INSULIN; TOTALINSULIN; TOTAL
statewide
83540
IRON
statewide
83615
LACTATE DEHYDROGENASE (LD), (LDH);
83655
LEADLEAD
83690
LIPASE
cohort
83718
LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY
CHOLESTEROL(HDL CHOLESTEROL) LIPOPROTEIN, DIRECT
MEASUREMENT; HIGH DENSITY CHOLESTEROL
statewide
83721
LIPOPROTEIN, DIRECT MEASUREMENT; LDL
CHOLESTEROLLIPOPROTEIN, DIRECT MEASUREMENT; LDL
CHOLESTEROL
statewide
83735
MAGNESIUM
cohort
83789
MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY
(MS, MS/MS), ANALYTE NOT ELSEWHERE SPECIFIED;
QUANTITATIVE, EACH SPECIMEN
statewide
83840
METHADONE
83880
NATRIURETIC PEPTIDE
83883
NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED
statewide
83919
ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN
statewide
83921
ORGANIC ACID, SINGLE, QUANTITATIVE
statewide
83970
PARATHORMONE (PARATHYROID HORMONE)
statewide
83986
PH; BODY FLUID, NOT OTHERWISE SPECIFIED
83993
Calprotectin, fecal
statewide
84075
PHOSPHATASE, ALKALINE;
statewide
84087
PHOSPHOHEXOSE ISOMERASE
84100
PHOSPHORUS INORGANIC (PHOSPHATE);
84132
Potassium; serum, plasma or whole blood
statewide
84143
17-HYDROXYPREGNENOLONE
statewide
84144
PROGESTERONE
statewide
84146
PROLACTIN
statewide
84153
PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL (CLOSEST
CLINICALLYEQUIVALENT CODE(S), DELETED IN 1993: 80080)
statewide
84155
Protein, total, except by refractometry; serum, plasma or whole blood
statewide
84156
PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE
cohort
84165
PROTEIN; ELECTROPHORETIC FRACTIONATION AND
QUANTITATION
statewide
84166
PROTEIN E-PHORESIS/URINE/CSF
statewide
84176
84207
PYRIDOXAL PHOSPHATE (VITAMIN B-6)
statewide
84220
PYRUVATE KINASE
statewide
84244
RENIN
statewide
84295
Sodium; serum, plasma or whole blood
statewide
84376
SUGARS (MONO, DI, AND OLIGOSACCHARIDES); SINGLE
QUALITATIVE,EACH SPECIMEN
84378
SUGARS (MONO, DI, AND OLIGOSACCHARIDES);
SINGLEQUANTITATIVE, EACH SPECIMEN
statewide
84403
TESTOSTERONE; TOTALTESTOSTERONE; TOTAL
statewide
84425
THIAMINE (VITAMIN B-1)
statewide
84432
THYROGLOBULIN
statewide
84436
THYROXINE; TOTALTHYROXINE; TOTAL
statewide
84439
THYROXINE; FREETHYROXINE; FREE
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
159
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
CPT
Description
84443
THYROID STIMULATING HORMONE (TSH)
cohort
84446
TOCOPHEROL ALPHA (VITAMIN E)
statewide
84450
TRANSFERASE; ASPARTATE AMINO (AST) (SGOT)
statewide
84460
TRANSFERASE; ALANINE AMINO (ALT) (SGPT)
statewide
84466
TRANSFERRIN
statewide
84478
TRIGLYCERIDES
statewide
84480
TRIIODOTHYRONINE (T-3); TOTAL (TT-3)
84484
TROPONIN, QUANTITATIVE
84550
URIC ACID; BLOOD
statewide
84590
VITAMIN A
statewide
84681
C-PEPTIDE
statewide
84702
GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE
84703
GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE
statewide
85007
BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT (INCLUDES
RBCMORPHOLOGY AND PLATELET ESTIMATION)
cohort
85014
BLOOD COUNT; OTHER THAN SPUN HEMATOCRIT
cohort
85018
BLOOD COUNT; HEMOGLOBINBLOOD COUNT; HEMOGLOBIN
85025
BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED, ANDAUTOMATED COMPLETE DIFFERENTIAL WBC
COUNT (CBC)
85027
BLOOD COUNT; HEMOGRAM AND PLATELET COUNT,
AUTOMATED
85097
BONE MARROW; SMEAR INTERPRETATION ONLY, WITH OR
WITHOUTDIFFERENTIAL CELL COUNT
statewide
85210
CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC
statewide
85260
CLOTTING; FACTOR X (STUART-PROWER)
statewide
85280
CLOTTING; FACTOR XII (HAGEMAN)
statewide
85300
CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN
III,ACTIVITY
statewide
85303
CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C,
ACTIVITY
statewide
85347
COAGULATION TIME; ACTIVATED
statewide
85379
FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE
cohort
85598
Phospholipid neutralization; hexagonal phospholipid
statewide
85610
PROTHROMBIN TIME;
85613
RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED
statewide
85651
SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED
statewide
85652
SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED
85660
SICKLING OF RBC, REDUCTIONSICKLING OF RBC, REDUCTION
cohort
cohort
85730
THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE
BLOOD
cohort
cohort
86000
AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA,
MURINETYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER,
SCRUB TYPHUS), EACH ANTIGEN
statewide
86003
ALLERGEN SPECIFIC IGE; QUANTITATIVE OR
SEMIQUANTITATIVE,EACH ALLERGEN
statewide
86038
ANTINUCLEAR ANTIBODIES (ANA);ANTINUCLEAR ANTIBODIES
(ANA);
statewide
86039
ANTINUCLEAR ANTIBODIES (ANA); TITERANTINUCLEAR
ANTIBODIES (ANA); TITER
86060
ANTISTREPTOLYSIN 0; TITERANTISTREPTOLYSIN 0; TITER
86063
ANTISTREPTOLYSIN 0; SCREENANTISTREPTOLYSIN 0; SCREEN
86140
C-REACTIVE PROTEIN
cohort
86146
BETA 2 GLYCOPROTEIN I ANTIBODY, EACH
statewide
86147
CARDIOLIPIN (PHOSPHOLIPID) ANTIBODYCARDIOLIPIN
(PHOSPHOLIPID) ANTIBODY
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
160
cohort
statewide
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
86160
COMPLEMENT; ANTIGEN, EACH COMPONENT (CLOSEST
CLINICALLYEQUIVALENT CODE(S), DELETED IN 1993: 86159,
86163, 86164)
statewide
86225
DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR
DOUBLESTRANDED DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY;
NATIVE OR DOUBLE
statewide
86235
EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD
(EG,NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EACH ANTIBODY
86255
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN,
EACHANTIBODY FLUORESCENT NONINFECTIOUS AGENT
ANTIBODY; SCREEN, EACH
statewide
86256
FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER,
EACHANTIBODY FLUORESCENT NONINFECTIOUS AGENT
ANTIBODY; TITER, EACH
statewide
86317
IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY,
QUANTITATIVE, NOTOTHERWISE SPECIFIED
statewide
86331
IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE
(OUCHTERLONY),EACH ANTIGEN OR ANTIBODY
statewide
86334
IMMUNOFIXATION ELECTROPHORESIS
statewide
86335
IMMUNFIX E-PHORSIS/URINE/CSF
statewide
86341
ISLET CELL ANTIBODY
statewide
86355
B CELLS, TOTAL COUNT
statewide
86356
Mononuclear cell antigen, quantitative (e.g., flowcytometry), not
otherwise specified, each antigen
statewide
86357
NATURAL KILLER (NK) CELLS, TOTAL COUNT
statewide
86359
T CELLS; TOTAL COUNT
86361
T CELLS; ABSOLUTE CD4 COUNT
86403
PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY
86431
RHEUMATOID FACTOR; QUANTITATIVE
86480
Tuberculosis test, cell mediated immunity antigen response
measurement; gamma interferon
86580
SKIN TEST; TUBERCULOSIS, INTRADERMAL
statewide
86592
SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE
(EG, VDRL, RPR, ART)
cohort
86618
ANTIBODY; BORRELIA BURGDORFERI (LYME
DISEASE)ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)
86619
ANTIBODY; BORRELIA (RELAPSING FEVER)
statewide
86644
ANTIBODY; CYTOMEGALOVIRUS (CMV)ANTIBODY;
CYTOMEGALOVIRUS (CMV)
statewide
86645
ANTIBODY; CYTOMEGALOVIRUS (CMV), IGMANTIBODY;
CYTOMEGALOVIRUS (CMV), IGM
statewide
86663
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN
(EA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)
statewide
86664
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR
ANTIGEN(EBNA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR
ANTIGEN (EBNA)
statewide
86665
ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID
(VCA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID(VCA)
statewide
86666
ANTIBODY; EHRLICHIA
statewide
86682
ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED
statewide
86684
ANTIBODY; HEMOPHILUS INFLUENZA
statewide
86687
ANTIBODY; HTLV I
statewide
86692
ANTIBODY; HEPATITIS, DELTA AGENTANTIBODY; HEPATITIS,
DELTA AGENT
statewide
86694
ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE
TESTANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST
86695
ANTIBODY; HERPES SIMPLEX, TYPE 1
cohort
86696
ANTIBODY; HERPES SIMPLEX, TYPE 2
cohort
86703
ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT
cohort
Peer
Cohort
5
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
161
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
86704
HEPATITIS B CORE ANTIBODY (HBCAB); IGG AND IGMHEPATITIS
B CORE ANTIBODY (HBCAB); IGG AND IGM
86706
HEPATITIS B SURFACE ANTIBODY (HBSAB)HEPATITIS B
SURFACE ANTIBODY (HBSAB)
86708
HEPATITIS A ANTIBODY (HAAB); IGG AND IGMHEPATITIS A
ANTIBODY (HAAB); IGG AND IGM
statewide
86709
HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODYHEPATITISA
ANTIBODY (HAAB); IGM ANTIBODY
statewide
86735
ANTIBODY; MUMPS (CLOSEST CLINICALLY EQUIVALENT
CODE(S),DELETED IN 1993: 86540)
statewide
86747
ANTIBODY; PARVOVIRUS
86753
ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED
statewide
86757
RICKETTSIA
statewide
86762
ANTIBODY; RUBELLA
statewide
86765
ANTIBODY; RUBEOLA
statewide
86777
ANTIBODY; TOXOPLASMAANTIBODY; TOXOPLASMA
statewide
86778
ANTIBODY; TOXOPLASMA, IGMANTIBODY; TOXOPLASMA, IGM
86780
ANTIBODY; TREPONEMA PALLIDUM
86787
ANTIBODY; VARICELLA-ZOSTER
86790
ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED
statewide
86800
THYROGLOBULIN ANTIBODY
statewide
86803
HEPATITIS C ANTIBODY;HEPATITIS C ANTIBODY;
cohort
86825
HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NONCYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM
SAMPLE OR DILUTION
statewide
86829
ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID
PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW
CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE
OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I OR
statewide
86832
ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID
PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW
CYTOMETRY); HIGH DEFINITION QUALITATIVE PANEL FOR
IDENTIFICATION OF ANTIBODY SPECIFICITIES (EG, I
statewide
86850
ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE
(CLOSESTCLINICALLY EQUIVALENT CODE(S), DELETED IN 1993:
86016, 86031, 86083)
86885
Antihuman globulin test (Coombs test); indirect, qualitative, each
reagent red cell
86900
BLOOD TYPING; ABO (CLOSEST CLINICALLY EQUIVALENT
CODE(S),DELETED IN 1993: 86080, 86082)
86901
BLOOD TYPING; RH (D)(CLOSEST CLINICALLY
EQUIVALENTCODE(S), DELETED IN 1993: 86082, 86083, 86100)
87015
CONCENTRATION (ANY TYPE), FOR PARASITES, OVA, OR
TUBERCLEBACILLUS (TB, AFB)
cohort
cohort
87040
CULTURE, BACTERIAL, DEFINITIVE; BLOOD (INCLUDES
ANAEROBICSCREEN)
cohort
87045
CULTURE, BACTERIAL, DEFINITIVE; STOOL
cohort
87046
CULTURE, BACTERIAL; STOOL, ADDITIONAL PATHOGENS,
ISOLATION AND PRELIMINARY EXAMINATION (EG,
CAMPYLOBACTER, YERSINIA, VIBRO, E. COLI O157),EACH PLATE
87070
CULTURE, BACTERIAL, DEFINITIVE; ANY OTHER SOURCE
87071
CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH
ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES,
ANY SOURCE EXCEPT URINE, BLOOD OR STOOL
87073
CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH
ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES,
ANY SOURCE EXCEPT URINE, BLOOD OR STOOL
87075
CULTURE, BACTERIAL, ANY SOURCE; ANAEROBIC (ISOLATION)
cohort
87076
CULTURE, BACTERIAL, ANY SOURCE; DEFINITIVE
IDENTIFICATION,EACH ANAEROBIC ORGANISM, INCLUDING GAS
cohort
Peer
Cohort
5
Peer
Cohort
6
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
162
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
87077
CULTURE, BACTERIAL, ANY SOURCE; AEROBIC ISOLATE,
ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTI
FICATION, EACH ISOLATE
cohort
cohort
cohort
cohort
cohort
cohort
87081
CULTURE, BACTERIAL, SCREENING ONLY, FOR SINGLE
ORGANISMS
cohort
cohort
cohort
cohort
cohort
87085
CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS,
SCREENING ONLY, BY COMMERCIAL KIT (SPECIFY TYPE); WITH
COLONY COUNT CULTURE, PRESUMPTIVE, PATHOGENIC
ORGANISMS, SCREENING ONLY,
87086
CULTURE, BACTERIAL, URINE; QUANTITATIVE, COLONY COUNT
cohort
cohort
cohort
cohort
cohort
cohort
87088
CULTURE, BACTERIAL, URINE; IDENTIFICATION, IN ADDITION
TOQUANTITATIVE OR COMMERCIAL KIT CULTURE, BACTERIAL,
URINE; IDENTIFICATION, IN ADDITION TO
cohort
cohort
cohort
cohort
cohort
cohort
87101
CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT
PRESUMPTIVEIDENTIFICATION); SKIN
cohort
cohort
cohort
cohort
87102
PRESUMPTIVEIDENTIFICATION); OTHER SOURCE (EXCEPT
BLOOD)
cohort
cohort
cohort
cohort
87103
PRESUMPTIVEIDENTIFICATION); BLOOD
cohort
cohort
cohort
87106
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION,EACH ORGANISM;
YEAST (USE 87106 IN ADDITIONAL TO CODES 87101, 87102, OR
87103 WHEN APPROPRIATE)
cohort
cohort
cohort
cohort
87107
CULTURE, FUNGI, DEFINITIVE IDENTIFICATION,EACH ORGANISM;
MOLD (USE 87106 IN ADDITIONAL TO CODES 87101, 87102, OR
87103 WHEN APPROPRIATE)
cohort
cohort
cohort
cohort
87109
CULTURE, MYCOPLASMA, ANY SOURCE
cohort
cohort
cohort
cohort
87110
CULTURE, CHLAMYDIA
cohort
cohort
cohort
87116
CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB,
AFB,MYCOBACTERIA); ANY SOURCE, ISOLATION ONLY
cohort
cohort
cohort
87118
CULTURE, MYCOBACTERIA, DEFINITIVE IDENTIFICATION OF
EACHORGANISM
cohort
87140
CULTURE, TYPING; FLUORESCENT METHOD, EACH ANTISERUM
87147
CULTURE, TYPING; SEROLOGIC METHOD, AGGLUTINATION
GROUPING,PER ANTISERUM
87149
CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR
RNA) PROBE, DIRECT PROBE TECHNIQUE, PER CULTURE OR
ISOLATE, EACH ORGANISM PROBED
87153
CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID
SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF
THE 16S RRNA GENE)
87168
MACROSCOPIC EXAMINATION; ARTHROPOD
87169
MACROSCOPIC EXAMINATION; PARASITE
87172
PINWORM EXAM (EG, CELLOPHANE TAPE PREP)
87176
ENDOTOXIN, BACTERIAL (PYROGENS); HOMOGENIZATION,
TISSUE, FORCULTURE
cohort
cohort
cohort
cohort
cohort
87177
OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION
ANDIDENTIFICATION
cohort
cohort
cohort
cohort
cohort
87181
SENSITIVITY STUDIES, ANTIBIOTIC; AGAR DIFFUSION METHOD,
PER ANTIBIOTIC
cohort
cohort
cohort
cohort
cohort
87184
SENSITIVITY STUDIES, ANTIBIOTIC; DISK METHOD, PER PLATE
(12 OR FEWER DISKS)
cohort
cohort
cohort
cohort
cohort
87185
SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME
DETECTION (EG, BETA LACTAMASE), PER ENZYME
cohort
cohort
cohort
cohort
cohort
87186
SENSITIVITY STUDIES, ANTIBIOTIC; MICROTITER,
MINIMUMINHIBITORY CONCENTRATION (MIC), ANY NUMBER OF
ANTIBIOTICS
cohort
cohort
cohort
cohort
cohort
87188
SENSITIVITY STUDIES, ANTIBIOTIC; MACROTUBE DILUTION
METHOD, EACH ANTIBIOTIC
87190
SENSITIVITY STUDIES, ANTIBIOTIC; TUBERCLE
BACILLUS(TB,AFB), EACH DRUG
CPT
Description
CHROMATOGRAPHY
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
statewide
statewide
163
cohort
cohort
CPT
Description
Peer
Cohort
1
87205
SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; ROUTINE
STAINFOR BACTERIA, FUNGI, OR CELL TYPES
cohort
cohort
cohort
cohort
cohort
87206
SMEAR, PRIMARY SOURCE, WITH INTERPRETATION;
FLUORESCENTAND/OR ACID FAST STAIN FOR BACTERIA, FUNGI,
OR CELL TYPES
cohort
cohort
cohort
cohort
cohort
87207
SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; SPECIAL
STAINFOR INCLUSION BODIES OR INTRACELLULAR PARASITES
(EG, MALARIA, KALA AZAR, HERPES)
cohort
cohort
cohort
cohort
cohort
87209
SMEAR, PRIMARY SOURCE WITH INTERPRETATION;
COMPLEXSPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN)
F OR OVA AND PARASITES
cohort
cohort
cohort
cohort
cohort
87210
SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; WET
MOUNT WITHSIMPLE STAIN, FOR BACTERIA, FUNGI, OVA,
AND/OR PARASITES SMEAR, PRIMARY SOURCE, WITH
INTERPRETATION; WET MOUNT WITH
cohort
cohort
cohort
cohort
cohort
87220
TISSUE EXAMINATION FOR FUNGI (EG, KOH
SLIDE)TISSUEEXAMINATION FOR FUNGI (EG, KOH SLIDE)
cohort
cohort
cohort
87230
TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG,
CLOSTRIDIUMDIFFICILE TOXIN)
cohort
cohort
cohort
87252
VIRUS IDENTIFICATION; TISSUE CULTURE INOCULATION
ANDOBSERVATION
cohort
cohort
cohort
87253
VIRUS IDENTIFICATION; TISSUE CULTURE, ADDITIONAL
STUDIES(EG, HEMABSORPTION, NEUTRALIZATION) EACH
ISOLATE
cohort
87254
VIRUS ISOLATION; SHELL VIAL, INCLUDES IDENTIFICATION WITH
IMMUNOFLUORESCENCE STAIN, EACH VIRUS
87255
VIRUS ISOLATION; ID, NON-IMMUNOLOGIC METHOD, OTHER
THAN CYTOPATHIC EFFECT
87260
INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT
FLUORESCENTANTIBODY TECHNIQUE; ADENOVIRUS
FLUORESCENT
87265
FLUORESCENTANTIBODY TECHNIQUE; BORDETELLA
PERTUSSIS/PARAPERTUSSIS INFECTIOUS AGENT ANTIGEN
DETECTION BY DIRECT FLUORESCENT
87269
INFECTIOUS AGENT ANTIGEN DETECTION BY
IMMUNOFLUORESCENT TECHNIQUE; GIARDIA
87272
FLUORESCENT ANTIBODY TECHNIQUE;
CRYPTOSPORIDIUM/GIARDIA
87273
IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS
TYPE 2
87274
FLUORESCENTANTIBODY TECHNIQUE; HERPES SIMPLEX VIRUS
FLUORESCENT
cohort
87275
IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS
cohort
cohort
87276
FLUORESCENTANTIBODY TECHNIQUE; INFLUENZA A VIRUS
FLUORESCENT
cohort
cohort
87278
FLUORESCENTANTIBODY TECHNIQUE; LEGIONELLA
PNEUMOPHILA INFECTIOUS AGENT ANTIGEN DETECTION BY
DIRECT FLUORESCENT
statewide
87279
IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA VIRUS,
EACH TYPE
statewide
87280
FLUORESCENTANTIBODY TECHNIQUE; RESPIRATORY
SYNCYTIAL VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY
DIRECT FLUORESCENT
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
164
cohort
cohort
statewide
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
CPT
Description
87281
IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS CARINII
cohort
87290
FLUORESCENTANTIBODY TECHNIQUE; VARICELLA ZOSTER
VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT
FLUORESCENT
statewide
87299
FLUORESCENTANTIBODY TECHNIQUE, NOT OTHERWISE
SPECIFIED INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT
FLUO RESCENT
87300
IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR
MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM
cohort
cohort
87305
INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME
IMMUNOASSAY TECHNIQUE, QUALITATIVE OR
SEMIQUANTITATIVE,MULTIPLE-STEP METHOD; ASPERGILLUS
cohort
cohort
87320
IMMUNOASSAYTECHNIQUE, QUALITATIVE OR
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CHLAMYDIA
TRACHOMATIS
statewide
87324
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CLOSTRIDIUM
DIFFICILE TOXINA
87327
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; CRYPTOCOCCUS
NEOFORMANS
87328
SEMIQUANTITATIVE, MULTIPLE STEP METHOD;
CRYPTOSPORIDIUM/GIARDIA
cohort
87329
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; GIARDIA
cohort
87336
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; ENTAMOEBA
HISTOLYTICA DISPAR GROUP
cohort
87337
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; ENTAMOEBA
HISTOLYTICA GROUP
statewide
87338
IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HELICOBACTER
PYLORI, STOOL
cohort
87339
HELICOBACTER PYLORI
cohort
87340
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B
SURFACE ANTIGEN(HBSAG)
cohort
cohort
87341
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; HEPATITIS B
SURFACE ANTIGEN(HBSAG) NEUTRALIZATION
cohort
cohort
87350
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS BE
ANTIGEN (HBEAG)
cohort
cohort
87385
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HISTOPLASMA
CAPSULATUM
87389
SEMIQUANTITATIVE,MULTIPLE-STEP METHOD; HIV-1 ANTIGEN(S),
165
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
WITH HIV- 1 AND HIV-2 ANTIBODIES, SINGLE RESULT
87390
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HIV-1
87400
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; INFLUENZA, A OR
B, EACH
cohort
cohort
cohort
cohort
87420
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; RESPIRATORY
SYNCYTIAL VIRUS
cohort
cohort
cohort
cohort
87425
SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ROTAVIRUS
cohort
cohort
87427
SEMIQUANTITATIVE,MULTIPLE STEP METHOD; SHIGA-LIKE TOXIN
cohort
cohort
cohort
87430
SEMIQUANTITATIVE, MULTIPLE STEP METHOD;
STREPTOCOCCUS, GROUP A
cohort
cohort
cohort
cohort
cohort
87449
IMMUNOASSAYTECHNIQUE QUALITATIVE OR
SEMIQUANTITATIVE; MULTIPLE STEP METHOD, NOT OTHERWISE
SPECIFIED
cohort
cohort
cohort
cohort
cohort
87450
IMMUNOASSAYTECHNIQUE QUALITATIVE OR
SEMIQUANTITATIVE; SINGLE STEP METHOD, NOT OTHERWISE
SPECIFIED
87451
IMMUNOASSAY TECHNIQUE QUALITATIVE OR
SEMIQUANTITATIVE; MULTIPLE STEP METHOD,EACH
POLYVALENT ANTISERUM
87471
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA
ORRNA);BARTONELLA HENSELAE AND BARTONELLA QUINTANA,
AMPLIFIED PROBE TECHNIQUE
87476
ORRNA);BORRELIA BURGDORFERI, AMPLIFIED PROBE TECHNI
QUE
cohort
87481
ORRNA);CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE
statewide
87486
ORRNA);CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHNI
QUE
87490
ORRNA);CHLAMYDIA TRACHOMATIS, DIRECT PROBE TECHNIQU
E INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNAOR
RNA);
cohort
cohort
cohort
87491
ORRNA);CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHN
IQUE
cohort
cohort
cohort
cohort
cohort
87493
ORRNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLI FIED
PROBE TECHNIQUE
cohort
cohort
cohort
cohort
cohort
87496
ORRNA);CYTOMEGALOVIRUS, AMPLIFIED PROBE TECHNIQUE
ORRNA);
cohort
cohort
cohort
cohort
87497
ORRNA);CYTOMEGALOVIRUS, QUANTIFICATION INFECTIOUS
AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);
cohort
cohort
cohort
cohort
87498
ORRNA); ENTEROVIRUS, REVERSE TRANSCRIPTION AND AMPL
IFIED PROBE TECHNIQUE
cohort
cohort
cohort
87500
statewide
cohort
cohort
cohort
cohort
cohort
statewide
Infectious agent detection by nucleic acid (DNA orRNA); vancomycin
166
statewide
cohort
cohort
cohort
statewide
cohort
statewide
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
resistance (e.g., enterococcus s pecies van A, van B), amplified probe
technique
87501
Infectious agent detection by nucleic acid (DNA orRNA); influenza virus,
reverse transcription and amplified probe technique, each type or
subtype
statewide
87502
for multiple types or sub- types, reverse transcription and amplified
probe technique, first 2 types or sub-types
cohort
cohort
cohort
87503
for multiple types or sub- types, multiplex reverse transcription and
amplified probe technique, each additional influenza viru
cohort
cohort
cohort
87516
ORRNA);HEPATITIS B VIRUS, AMPLIFIED PROBE TECHNIQUE
INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR
RNA);
87517
ORRNA);HEPATITIS B VIRUS, QUANTIFICATION INFECTIOU S
AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);
87521
ORRNA); HEPATITIS C, REVERSE TRANSCRIPTION AND AMPL
IFIED PROBE TECHNIQUE
87522
ORRNA); HEPATITIS C, REVERSE TRANSCRIPTION AND QUAN
TIFICATION
87529
ORRNA);HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNI
QUE
87532
ORRNA);HERPES VIRUS-6, AMPLIFIED PROBE TECHNIQUE
statewide
87533
ORRNA);HERPES VIRUS-6, QUANTIFICATION INFECTIOUS A GENT
DETECTION BY NUCLEIC ACID (DNA OR RNA);
statewide
87535
ORRNA); HIV-1, REVERSE TRANSCRIPTION AND AMPLIFIED
PROBE TECHNIQUE
87536
ORRNA); HIV-1, REVERSE TRANSCRIPTION AND QUANTIFICA
TION
87556
ORRNA);MYCOBACTERIA TUBERCULOSIS, AMPLIFIED PROBE T
ECHNIQUE
87581
ORRNA);MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECHN
IQUE
87590
ORRNA);NEISSERIA GONORRHOEAE, DIRECT PROBE TECHNIQU
E INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNAOR
RNA);
cohort
cohort
87591
ORRNA);NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECHN
IQUE
cohort
cohort
cohort
cohort
cohort
87621
ORRNA);PAPILLOMAVIRUS, HUMAN, AMPLIFIED PROBE TECHN
IQUE
cohort
cohort
cohort
cohort
87631
ORRNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ A
VIRUS, CORONAVIRUS, METAPNEUMOVIRUS, PARAINFLUENZA
VIRUS, RESPIRATORY SYNCYTIAL VIRUS, RHINOVIRUS)
cohort
cohort
87632
cohort
cohort
87633
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
167
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
87640
ORRNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH
NIQUE
87641
ORRNA); STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTAN T,
AMPLIFIED PROBE TECHNIQUE
87653
ORRNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC
HNIQUE
87798
ORRNA); NOTOTHERWISE SPECIFIED, AMPLIFIED PROBE TEC
HNIQUE INFECTIOUS AGENT DETECTION BY NUCLEIC ACID(DNA
OR RNA); NOT
cohort
cohort
cohort
cohort
87799
ORRNA); NOTOTHERWISE SPECIFIED, QUANTIFICATION INF
ECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA);
NOT
cohort
cohort
cohort
cohort
87800
ORRNA),MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE
statewide
87801
ORRNA),MULTIPLE ORGANISMS; AMPLIFIED PROBE(S)
TECHNIQUE
cohort
cohort
cohort
cohort
cohort
87802
INFECTIOUS AGENT, IMMUNOASSAY, DIRECT
OBSERVATION;STREPTOCOCCUC GROUP B
cohort
cohort
87803
OBSERVATION;CLOSTRIDIUM DIFFICILE TOXIN A
87804
OBSERVATION;INFLUENZA
cohort
cohort
cohort
cohort
cohort
87807
RSV ASSAY W/OPTIC
cohort
cohort
cohort
cohort
cohort
87808
INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY
WITH DIRECT OPTICAL OBSERVATION; TRICHOMONAS
VAGINALIS
87810
Chlamydia trachomatis
87880
INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH
DIRECTOPTICAL OBSERVATION; STREPTOCOCCUS, GROUP A
DIRECT
cohort
cohort
87899
DIRECTOPTICAL OBSERVATION; NOT OTHERWISE SPECIFIED
DIRECT
cohort
cohort
87900
INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE
PREDICTION USING REGULARLY UPDATED GENOTYPIC
BIOINFORMATICS
statewide
87901
Infectious agent genotype analysis by nucleic acid(DNA or RNA); HIV-1,
reverse transcriptase and pr otease regions
cohort
cohort
87902
INFECTIOUS AGENT, GENOTYPE ANALYSIS, NUCLEIC ACID
(DNA/RNA); HEPATITIS C VIRUS
cohort
cohort
87903
INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID
(DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE
ANALYSIS, HIV 1; UP TO 10 DRUGS
statewide
87904
INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC
ACID(DNA OR RNA)WITH DRUG RESISTANCE TISSUE CULTURE
ANALYSIS,HIV1;EACH ADDITIONAL DRUG, UP TO 5 DRUGS(LIST
SEPARATELY IN ADDITION TO CODE PRIM PROCDUR
statewide
87999
UNLISTED MICROBIOLOGY PROCEDURE
statewide
88112
CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT
TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE
PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL
statewide
88142
CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING
SYSTEM),COLLECTED IN PRESERVATIVE FLUID,
AUTOMATEDTHIN LAYER PREPARATION; MANUAL SCREENING
UNDER P HYSICIAN SUPERVISION
88173
EVALUATION OF FINE NEEDLE ASPIRATE WITH OR
WITHOUTPREPARATION OF SMEARS; INTERPRETATION AND
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
168
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
Peer
Cohort
5
REPORT
88174
CYTOPATHOLOGY, CERVICAL/VAGINAL, AUTO THIN LAYER PREP;
AUTO SCREEN, WITH PHYSICIAN SUPERVISION
88175
CYTOPATHOLOGY, CERVICAL/VAGINAL,AUTO THIN LAYER PREP;
AUTO SCREEN & MANUAL RESCREEN, WITH PHYSICIAN
INTERPRETATION
88184
FLOWCYTOMETRY/ TC, 1 MARKER
statewide
88185
FLOWCYTOMETRY/TC, ADD-ON
statewide
88230
TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS;
LYMPHOCYTE
statewide
88237
TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE
MARROW, BLOOD CELLS
statewide
88261
CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE,
WITHBANDING
statewide
88262
CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES,
WITHBANDING
statewide
88264
CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS
statewide
88271
MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH)
statewide
88275
MOLECULAR CYTOGENETICS; INTERPHASE IN SITU
HYBRIDIZATION,ANALYZE 100-300 CELLS
statewide
88280
CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH
STUDY
statewide
88283
CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED
BANDINGTECHNIQUE (EG, NOR, C-BANDING)
statewide
88285
CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH
STUDY
statewide
88304
LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC
EXAMINATION
88305
LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC
EXAMINATION
cohort
88307
LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC
EXAMINATION
cohort
88311
DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION
TOCODE FOR SURGICAL PATHOLOGY EXAMINATION)
cohort
88312
SPECIAL STAIN INCLUDING INTERPRETATION AND
REPORT;GROUP I FOR MICROORGANISMS (EG, ACID FAST,
METHEN AMINE SILVER)
statewide
88313
SPECIAL STAIN INCLUDING INTERPRETATION AND
REPORT;GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT
STAIN FOR MICROORGANISMS, STAINS FOR ENZYME CONST
ITUENTS, OR IMMUNOCYTOCHEMISTRY AND IMMUNOHISTOCHE
88331
PATHOLOGY CONSULTATION DURING SURGERY; WITH
FROZENSECTION(S), SINGLE SPECIMEN
88334
Pathology consultation during surgery; cytologic examination (eg, touch
prep, squash prep), each additional site (List separately in addition to
88342
IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE
IMMUNOPEROXIDASE),EACH ANTIBODY
88346
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT
METHOD
statewide
88347
IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT
METHOD
statewide
88348
ELECTRON MICROSCOPY; DIAGNOSTIC
statewide
88361
MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTOCHEMISTRY
(EG, HER-2/NEU, ESTROGEN RECEPTOR/PROGESTERONE
RECEPTOR), QUANTITATIVE OR SEMIQUANTITATIVE
statewide
89051
CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CSF,
JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT
statewide
89055
LEUKOCYTE COUNT, FECAL
89060
Crystal identification by light microscopy with orwithout polarizing lens
analysis, tissue or any b ody fluid (except urine)
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
169
cohort
cohort
cohort
cohort
cohort
statewide
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
89220
SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED
TECHNIQUE (SEPARATE PROCEDURE)
89230
SWEAT COLLECTION BY IONTOPHORESIS
90287
Botulinum antitoxin, equine, any route
90371
Hepatitis B immune globulin (HBIg), human, for intramuscular use
90375
Rabies immune globulin (RIg), human, for intramuscular and/or
subcutaneous use
90376
Rabies immune globulin, heat-treated (Rig-HT), human, for
intramuscular and/or subcutaneous use
statewide
90460
IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE
VIA ANY ROUTE OF ADMINISTRATION, WITH COUNSELINGBY
PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFE
SSIONAL; FIRST OR ONLY COMPONENT OF EACH VACCINE O
cohort
cohort
90461
IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE
VIA ANY ROUTE OF ADMINISTRATION, WITH COUNSELINGBY
PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFE
SSIONAL; EACH ADDITIONAL VACCINE OR TOXOID COMPONE
cohort
cohort
90471
IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS,
INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR
INJECTIONS); 1 VACCINE (SINGLE OR COMBINATION
VACCINE/TOXOID)
cohort
cohort
cohort
cohort
cohort
90472
IMMUNIZATION ADMINISTRATION (INCLUDES
PERCUTANEOUS,INTRADERMAL, SUBCUTANEOUS,
INTRAMUSCULAR AND JET INJECTIONS AND/OR INTRANASAL OR
ORAL ADMINISTRATION); TWO OR MORE
cohort
cohort
cohort
cohort
cohort
90473
IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL
ROUTE; 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID)
statewide
90474
IMMUNIZATION ADMINISTRATION,INTRANASAL/ORAL; EA ADD'L
SINGLE/COMBINATION VACCINE/TOXOID
cohort
90585
Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for
percutaneous use
statewide
90586
Bacillus Calmette-Guerin vaccine (BCG) for bladdercancer, live, for
intravesical use
statewide
90632
Hepatitis A vaccine, adult dosage, for intramuscular use
statewide
90633
Hepatitis A vaccine, pediatric/adolescent dosage-2dose schedule, for
intramuscular use
cohort
90636
Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for
intramuscular use
statewide
90645
Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose
schedule), for intramuscular use
90646
Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster
use only, intramuscular use
90647
Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose
statewide
90648
Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose
statewide
90649
Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18
(quadrivalent), 3 dose schedule, for intramuscular use
cohort
cohort
90655
Influenza virus vaccine, trivalent, split virus, preservative free, when
administered to children 6-35 months of age, for intramuscular use
cohort
cohort
90656
Influenza virus vaccine, trivalent, split virus, preservative free, when
administered to individuals3 years and older, for intramuscular use
cohort
cohort
cohort
cohort
90657
Influenza virus vaccine, trivalent, split virus, when administered to
children 6-35 months of age, for intramuscular use
statewide
90658
Influenza virus vaccine, trivalent, split virus, when administered to
individuals 3 years of age andolder, for intramuscular use
cohort
cohort
cohort
90660
Influenza virus vaccine, trivalent, live, for intranasal use
statewide
90662
Influenza virus vaccine, split virus, preservationfree, enhanced
immunogenicity via increased antig en content, for intramuscular use
cohort
90669
PNEUMOCOCCAL CONJUGATE VACCINE, 7 VALENT, FOR
INTRAMUSCULAR USE
statewide
90670
Pneumococcal conjugate vaccine, 13 valent, for intramuscular use
cohort
Peer
Cohort
6
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
170
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
90675
Rabies vaccine, for intramuscular use
cohort
90680
Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use
cohort
cohort
cohort
cohort
90681
Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral
use
90686
Influenza virus vaccine, quadrivalent, split virus, preservative free, when
administered to individuals 3 years of age and older, for intramuscular
use
90696
Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus
vaccine, inactivated (DTaP-IPV), when administered to children 4 years
through6 years of age, for intramuscular use
90700
Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP),
when administered to individuals younger than 7 years, for
intramuscular use
90702
Diphtheria and tetanus toxoids (DT) absorbed when administered to
individuals younger than 7 years, for intramuscular use
90703
Tetanus toxoid absorbed, for intramuscular use
90707
MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE,
FORSUBCUTANEOUS USE
statewide
90710
Measles, mumps, rubella, and varicella vaccine (MMRV), live for
subcutaneous use
cohort
cohort
90713
POLIOVIRUS VACCINE, INACTIVATED, (IPV), FOR
SUBCUTANEOUS OR INTRAVMUSCULAR USE
cohort
cohort
90714
Tetanus and diphtheria toxoids (Td) absorbed, preservative free, when
administered to individuals 7years or older, for intramuscular use
90715
Tetanus diphtheria toxoids and acellular pertussisvaccine (Tdap), when
administered to individuals 7 years or older, for intramuscular use
90716
Varicella virus vaccine, live, for subcutaneous use
90723
Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and
poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use
90732
Pneumococcal polysaccharide vaccine, 23-valent, adult or
immunosuppressed patient dosage, when administered to individuals 2
years or older, for subcutaneous or intramuscular use
cohort
90733
Meningococcal polysaccharide vaccine (any group(s)), for
subcutaneous use
cohort
90734
Meningococcal conjugate vaccine, serogroups A, C, Y and W-135
(tetravalent), for intramuscular use
90736
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Zoster (shingles) vaccine, live, for subcutaneous injection
cohort
cohort
90740
Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3
dose schedule), for intramuscular use
cohort
cohort
90741
statewide
90743
Hepatitis B vaccine, adolescent (2 dose schedule),for intramuscular use
90744
Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for
intramuscular use
cohort
cohort
90746
Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular
use
cohort
cohort
90791
PSYCHIATRIC DIAGNOSTIC EVALUATION
cohort
cohort
90792
PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL
SERVICES
90832
PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY
MEMBER
90833
MEMBER WHEN PERFORMED WITH AN EVALUATION AND
MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE
statewide
90834
MEMBER
cohort
90836
MEMBER WHEN PERFORMED WITH AN EVALUATION AND
MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE
statewide
90837
cohort
statewide
cohort
cohort
statewide
171
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
MEMBER
90839
PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES
90847
FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH
PATIENT PRESENT) FAMILY PSYCHOTHERAPY
(CONJOINTPSYCHOTHERAPY) (WITH PATIENT
statewide
statewide
90853
GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY
GROUP) GROUP PSYCHOTHERAPY (OTHER THAN OF A
MULTIPLE-FAMILY GROUP)
cohort
cohort
cohort
90870
ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY
MONITORING);SINGLE SEIZURE ELECTROCONVULSIVE THERAPY
(INCLUDES NECESSARY MONITORING);
cohort
cohort
cohort
90901
BIOFEEDBACK TRAINING BY ANY MODALITY
statewide
90911
BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL
ORURETHRAL SPHINCTER, INCLUDING EMG AND/OR
MANOMETRY
statewide
90935
HEMODIALYSIS PROCEDURE WITH SINGLE EVALUATION BY
APHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI
ONAL
90945
DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG,
PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTHER
CONTINUOUS RENAL REPLACEMENT THERAPIES), WITH SINGLE
EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED HEALTH C
90947
DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG,
PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTHER
CONTINUOUS RENAL REPLACEMENT THERAPIES) REQUIRING
REPEATED EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED
HE
90999
UNLISTED DIALYSIS PROCEDURE, INPATIENT OR
OUTPATIENTUNLISTED DIALYSIS PROCEDURE, INPATIENT OR
OUTPATIENT
91010
ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE
ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY
WITH INTERPRETATION AND REPORT;
91020
GASTRIC MOTILITY (MANOMETRIC) STUDIES
91034
GASTROESOPHAGEAL REFLUX TEST
91035
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST, WITH
ELECTRODE
cohort
91037
ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX
TEST WITH NASAL CATHETER INTRALUMINAL IMPEDANCE
ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND
INTERPRETATION
cohort
91038
ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX
TEST WITH NASAL CATHETER INTRALUMINAL, > 1 HR
91065
BREATH HYDROGEN TEST (EG, FOR DETECTION OF
LACTASEDEFICIENCY)
91110
GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG,
CAPSULE ENDOSCOPY), ESOPHAGUS THROUGH ILEUM, WITH
INTERPRETATION AND REPORT
91112
GASTROINTESTINAL TRANSIT AND PRESSURE
MEASUREMENT,STOMACH THROUGH COLON, WIRELESS
CAPSULE, WITH INT ERPRETATION AND REPORT
91117
Colon motility (manometric) study, minimum 6 hourscontinuous
recording (including provocation tests , eg, meal, intracolonic balloon
distension, pharmacologic agents, if performed), with interpretatio
statewide
91120
RECTAL SENSATION TEST
statewide
91122
ANORECTAL MANOMETRY
91299
UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE
92015
DETERMINATION OF REFRACTIVE STATEDETERMINATION OF
REFRACTIVE STATE
statewide
92018
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION,
UNDERGENERALANESTHESIA, WITH OR WITHOUT
MANIPULATION O F GLOBE FOR PASSIVE RANGE OF MOTION OR
OTHER MANIPULATION TO FACILITATE
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
172
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
92019
OPHTHALMOLOGICAL EXAMINATION AND EVALUATION,
UNDERGENERALANESTHESIA, WITH OR WITHOUT
MANIPULATION O F GLOBE FOR PASSIVE RANGE OF MOTION OR
OTHER MANIPULATION TO FACILITATE
92025
COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR
BILATERAL, WITH INTERPRETATION AND REPORT
statewide
92081
VISUAL FIELD EXAMINATION, UNILATERAL OR
BILATERAL,WITHINTERPRETATION AND REPORT; LIMITED
EXAMINATIO N (EG, TANGENT SCREEN, AUTOPLOT, ARC
PERIMETER, OR SINGLE STIMULUS LEVEL
statewide
92082
VISUAL FIELD EXAMINATION, UNILATERAL OR
BILATERAL,WITHINTERPRETATION AND REPORT; INTERMEDIATE
EXAMI NATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN
PERIMETER, OR SEMIQUANTITATIVE,
statewide
92083
Visual field examination, unilateral or bilateral,with interpretation and
report; extended examinat ion (eg, Goldmann visual fields with at least
3 isopters plotted and static determination within the
statewide
92133
Scanning computerized ophthalmic diagnostic imaging, posterior
segment, with interpretation and report, unilateral or bilateral; optic
nerve
statewide
92134
Scanning computerized ophthalmic diagnostic imaging, posterior
segment, with interpretation and report, unilateral or bilateral; retina
statewide
92136
OPTHALMIC BIOMETRY BY PARTIAL COHERENCE
INTERFEROMETRY W/ INTRAOCULAR LENS CALCULATION
statewide
92140
PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION
ANDREPORT, WITHOUT TONOGRAPHY PROVOCATIVE
TESTSFOR GLAUCOMA, WITH INTERPRETATION AND
statewide
92235
FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME
IMAGING) WITHINTERPRETATION AND REPORT FLUORESCEIN
ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH
statewide
92240
INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES
MULTIFRAMEIMAGING) WITH INTERPRETATION AND REPORT
statewide
92250
FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND
REPORTFUNDUS PHOTOGRAPHY WITH INTERPRETATION AND
REPORT
statewide
92270
ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND
REPORTELECTRO-OCULOGRAPHY WITH INTERPRETATION AND
REPORT
92275
ELECTRORETINOGRAPHY WITH INTERPRETATION AND
REPORTELECTRORETINOGRAPHY WITH INTERPRETATION AND
REPORT
92285
EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION
AND REPORTFOR DOCUMENTATION OF MEDICAL PROGRESS
(EG,CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GON
IOPHOTOGRAPHY,
92499
UNLISTED OPHTHALMOLOGICAL SERVICE OR
PROCEDUREUNLISTED OPHTHALMOLOGICAL SERVICE OR
PROCEDURE
92502
OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL
ANESTHESIA
cohort
92504
BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC
PROCEDURE)
statewide
92506
EVALUATION OF SPEECH, LANGUAGE, VOICE,
COMMUNICATION,AUDITORY PROCESSING, AND/OR AURAL
REHABILITATION STATUS
92511
NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE
PROCEDURE)
cohort
92540
BASIC VESTIBULAR EVALUATION, INCLUDES SPONTANEOUS
NYSTAGMUS TEST WITH ECCENTRIC GAZE FIXATION
NYSTAGMUS, WITH RECORDING, POSITIONAL NYSTAGMUS
TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING,
OPTOKINETIC
cohort
92542
POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4
POSITIONS,WITHRECORDING POSITIONAL NYSTAGMUS TEST,
MINIMUM OF 4 POSITIONS, WITH
Peer
Cohort
5
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
173
cohort
cohort
cohort
cohort
cohort
statewide
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
CPT
Description
92543
CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL,
BITHERMAL STIMULATION CONSTITUTES 4 TESTS),
WITHRECORDING
92546
SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTINGSINUSOIDAL
VERTICAL AXIS ROTATIONAL TESTING
92547
USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION
TOCODE FOR PRIMARY PROCEDURE) USE OF VERTICAL
ELECTRODES (LIST SEPARATELY IN ADDITION TO
statewide
92550
TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS
cohort
cohort
cohort
cohort
92551
SCREENING TEST, PURE TONE, AIR ONLY
cohort
cohort
cohort
cohort
92552
PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY
cohort
cohort
cohort
cohort
92553
PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE
cohort
92555
SPEECH AUDIOMETRY THRESHOLD;
cohort
cohort
cohort
cohort
92556
SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH
RECOGNITION
cohort
cohort
cohort
cohort
92557
COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND
SPEECHRECOGNITION (92553 AND 92556 COMBINED)
cohort
cohort
cohort
cohort
92558
EVOKED OTOACOUSTIC EMISSIONS, SCREENING (QUALITATIVE
MEASUREMENT OF DISTORTION PRODUCT OR TRANSIENT
EVOKED OTOACOUSTIC EMISSIONS), AUTOMATED ANALYSIS
92563
TONE DECAY TEST
92565
STENGER TEST, PURE TONE
cohort
92567
TYMPANOMETRY (IMPEDANCE TESTING)
cohort
cohort
cohort
cohort
92568
ACOUSTIC REFLEX TESTING, THRESHOLD
cohort
cohort
cohort
cohort
92570
ACOUSTIC IMMITTANCE TESTING, INCLUDES
TYMPANOMETRY(IMPEDANCE TESTING), ACOUSTIC REFLEX
THRESHOLD TE STING, AND ACOUSTIC REFLEX DECAY TESTING
cohort
cohort
cohort
92572
STAGGERED SPONDAIC WORD TEST
92577
STENGER TEST, SPEECH
92579
VISUAL REINFORCEMENT AUDIOMETRY (VRA)
cohort
92582
CONDITIONING PLAY AUDIOMETRY
cohort
92583
SELECT PICTURE AUDIOMETRY
92584
ELECTROCOCHLEOGRAPHY
cohort
92585
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE
AUDIOMETRYAND/OR TESTING OF THE CENTRAL NERVOUS
SYSTEM
cohort
cohort
cohort
cohort
92586
AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE
AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS
SYSTEM; LIMITED
cohort
cohort
cohort
cohort
92587
DISTORTION PRODUCT EVOKED OTOACOUSTIC EMISSIONS;
LIMITED EVALUATION (TO CONFIRM THE PRESENCE OR
ABSENCE OF HEARING DISORDER, 3-6 FREQUENCIES) OR
TRANSIENT EVOKED OTOACOUSTIC EMISSIONS, WITH
INTERPRETA
cohort
cohort
cohort
cohort
92588
DISTORTION PRODUCT EVOKED OTOACOUSTIC EMISSIONS;
COMPREHENSIVE DIAGNOSTIC EVALUATION (QUANTITATIVE
ANALYSIS OF OUTER HAIR CELL FUNCTION BY COCHLEAR
MAPPING, MINIMUM OF 12 FREQUENCIES), WITH INTERPRETA
cohort
cohort
cohort
cohort
92590
HEARING AID EXAMINATION AND SELECTION; MONAURAL
statewide
92591
HEARING AID EXAMINATION AND SELECTION; BINAURAL
statewide
92592
HEARING AID CHECK; MONAURALHEARING AID CHECK;
MONAURAL
cohort
cohort
92593
HEARING AID CHECK; BINAURALHEARING AID CHECK; BINAURAL
cohort
cohort
92594
ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL
cohort
cohort
92595
ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL
cohort
cohort
92601
DX ANALYSIS COCHLEAR IMPLANT, PATIENT <7 YRS.
W/PROGRAMMING
statewide
92602
DX ANALYSIS COCHLEAR IMPLANT, PATIENT <7 YRS.
REPROGRAMMING
statewide
cohort
statewide
cohort
cohort
cohort
statewide
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
174
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
92603
DX ANALYSIS COCHLEAR IMPLANT, PATIENT >7 YRS.
W/PROGRAMMING
92604
DX ANALYSIS COCHLEAR IMPLANT, PATIENT >7 YRS.
REPROGRAMMING
92610
EVAL ORAL & PHARYNGEAL SWALLOW FUNCTION
statewide
92611
MOTION FLUOROSCOPIC EVAL SWALLOW FUNCTION CINE/
VIDEO RECORD
statewide
92612
FLEXIBLE FIBEROPTIC ENDOSCOPIC EVAL SWALLOW CINE/
VIDEO RECORD
92620
AUDITORY FUNCTION, 60 MIN
cohort
cohort
92621
EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT;
EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY INADDITION
cohort
cohort
92625
TINNITUS ASSESSMENT
statewide
92626
EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST
HOUR
cohort
92627
EVALUATION OF AUDITORY REHABILITATION STATUS;
EACHADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITIO N
statewide
92700
UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR
PROCEDURE
92920
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY;
SINGLE MAJOR CORONARY ARTERY OR BRANCH
cohort
cohort
cohort
92921
PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY;
EACH ADDITIONAL BRANCH OF A MAJOR CORONARY ARTERY
PROCEDURE)
cohort
cohort
cohort
92924
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY,
WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE
MAJOR CORONARY ARTERY OR BRANCH
statewide
92928
PERCUTANEOUS TRANSCATHETER PLACEMENT OF
INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY
WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR
BRANCH
cohort
cohort
cohort
cohort
92929
PERCUTANEOUS TRANSCATHETER PLACEMENT OF
INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY
WHEN PERFORMED; EACH ADDITIONAL BRANCH OF A MAJOR
CORONARY ARTERY (LIST SEPARATELY IN ADDITION TO CODE
FOR PRI
cohort
cohort
cohort
cohort
92933
PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY,
WITH INTRACORONARY STENT, WITH CORONARY ANGIOPLASTY
WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR
BRANCH
cohort
cohort
cohort
92937
PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR
THROUGH CORONARY ARTERY BYPASS GRAFT (INTERNAL
MAMMARY, FREE ARTERIAL, VENOUS), ANY COMBINATION OF
INTRACORONARY STENT, ATHERECTOMY AND ANGIOPLASTY, I
cohort
cohort
cohort
92938
PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR
THROUGH CORONARY ARTERY BYPASS GRAFT (INTERNAL
MAMMARY, FREE ARTERIAL, VENOUS), ANY COMBINATION OF
INTRACORONARY STENT, ATHERECTOMY AND ANGIOPLASTY, I
92941
PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF
ACUTE TOTAL/SUBTOTAL OCCLUSION DURING ACUTE
MYOCARDIAL INFARCTION, CORONARY ARTERY OR CORONARY
ARTERY BYPASS GRAFT, ANY COMBINATION OF
INTRACORONARY STEN
92943
CHRONIC TOTAL OCCLUSION, CORONARY ARTERY, CORONARY
ARTERY BRANCH, OR CORONARY ARTERY BYPASS GRAFT, ANY
COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AN
92944
CHRONIC TOTAL OCCLUSION, CORONARY ARTERY, CORONARY
ARTERY BRANCH, OR CORONARY ARTERY BYPASS GRAFT, ANY
COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AN
92950
CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST)
statewide
statewide
statewide
cohort
cohort
cohort
statewide
175
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
92953
TEMPORARY TRANSCUTANEOUS PACING
92960
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION
OFARRHYTHMIA, EXTERNAL
92961
CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF
ARRHYTHMIA; INTERNAL (SEPARATE PROCEDURE)
92971
Cardioassist-method of circulatory assist; external
92973
PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY
MECHANICAL (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
92974
TRANSCATHETER PLACEMENT, RADIATION DELIVERY
DEVICECORONARY INTRAVASCULAR BRACHYTHERAPY
92977
THROMBOLYSIS, CORONARY; BY INTRAVENOUS INFUSION
cohort
cohort
92978
INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT)
DURINGTHERAPEUTIC INTERVENTION INCLUDING
IMAGINGSUPERVISION, INTERPRETATION AND REPORT; INITIAL
VESSEL (LIST SEPARATELY
cohort
cohort
92979
INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT)
DURINGTHERAPEUTIC INTERVENTION INCLUDING
IMAGINGSUPERVISION, INTERPRETATION AND REPORT; EACH
ADD ITIONAL VESSEL (LIST
92986
PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE
statewide
92987
PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE
statewide
92990
PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY
VALVE
statewide
92997
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY
BALLOONANGIOPLASTY; SINGLE VESSEL
statewide
92998
PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY
BALLOONANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST
statewide
93000
ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12
LEADS; WITH INTERPRETATION AND REPORT
LEADS; WITH
cohort
cohort
cohort
cohort
cohort
93005
LEADS;TRACING ONLY, WITHOUT INTERPRETATION AND
REPORT ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST
12LEADS;
cohort
cohort
cohort
cohort
cohort
93010
LEADS;INTERPRETATION AND REPORT ONLY
LEADS;
cohort
cohort
93015
CARDIOVASCULAR STRESS TEST USING MAXIMAL OR
SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS
ELECTROCARDIOGRAPHIC MONITORING, AND/OR
PHARMACOLOGICAL STRESS; WITH SUPERVISION,
INTERPRETATION AND RE
statewide
93017
SUBMAXIMALTREADMILL OR BICYCLE EXERCISE, CONTINOUS
PHARMACOLOGICAL
cohort
cohort
cohort
cohort
cohort
93018
SUBMAXIMALTREADMILL OR BICYCLE EXERCISE, CONTINOUS
PHARMACOLOGICAL
statewide
93040
RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION
ANDREPORT
93041
RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY
WITHOUTINTERPRETATION AND REPORT
cohort
cohort
cohort
cohort
cohort
93225
External electrocardiographic recording up to 48 hours by continuous
rhythm recording and storage; recording (includes connection,
recording, and disconnection)
cohort
cohort
cohort
cohort
cohort
93226
External electrocardiographic recording up to 48 hours by continuous
rhythm recording and storage; scanning analysis with report
cohort
cohort
cohort
cohort
cohort
EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH
cohort
cohort
93229
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
176
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
93270
External patient and, when performed, auto activated
electrocardiographic rhythm derived event recording with symptomrelated memory loop with remote download capability up to 30 days, 24hour attende
cohort
cohort
cohort
cohort
cohort
93271
External patient and, when performed, auto activated
electrocardiographic rhythm derived event recording with symptomrelated memory loop with remote download capability up to 30 days, 24hour attende
cohort
cohort
cohort
cohort
93272
EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED
ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT
RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH
REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR
ATTENDE
93278
SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH
OR WITHOUTECG
93279
PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH
ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST
THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL
PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW
AN
cohort
cohort
93280
AN
cohort
cohort
93281
AN
statewide
93282
AN
statewide
93283
AN
cohort
cohort
93284
AN
cohort
cohort
93285
AN
statewide
93286
PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND
PROGRAMMING OF DEVICE SYSTEM PARAMETERS BEFORE OR
AFTER A SURGERY, PROCEDURE, OR TEST WITH
ANALYSIS,REVIEW AND REPORT BY A PHYSICIAN OR OTHER
QUALIFI
statewide
93287
PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND
PROGRAMMING OF DEVICE SYSTEM PARAMETERS BEFORE OR
AFTER A SURGERY, PROCEDURE, OR TEST WITH
ANALYSIS,REVIEW AND REPORT BY A PHYSICIAN OR OTHER
QUALIFI
statewide
93288
INTERROGATION DEVICE EVALUATION (IN PERSON) WITH
ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR
OTHERQUALIFIED HEALTH CARE PROFESSIONAL, INCLUDES
CONN ECTION, RECORDING AND DISCONNECTION PER PATIENT
CPT
Description
ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT
COMPUTERIZED REAL TIME DATA ANALYSIS AND GREATER
THAN 24 HOURS OF ACCESSIBLE ECG DATA STORAGE
(RETRIEVABLE WITH
177
statewide
statewide
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
Peer
Cohort
6
EN
93289
EN
93290
EN
93291
EN
cohort
cohort
93293
TRANSTELEPHONIC RHYTHM STRIP PACEMAKER
EVALUATION(S) SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER
SYSTEM, INCLUDES RECORDING WITH AND WITHOUT MAGNET
APPLICATION WITH ANALYSIS, REVIEW AND REPORT(S) BY A PH
cohort
cohort
cohort
93296
Interrogation device evaluation(s) (remote), up to90 days; single, dual,
or multiple lead pacemaker system or implantable cardioverterdefibrillator system, remote data acquisition(s), receipt of tra
cohort
cohort
cohort
93299
Interrogation device evaluation(s), (remote) up to30 days; implantable
cardiovascular monitor syste m or implantable loop recorded system,
remote dataacquisition(s), receipt of transmissions and tech
93303
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL
CARDIACANOMALIES; COMPLETE
93304
TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL
CARDIACANOMALIES; FOLLOW-UP OR LIMITED STUDY
cohort
cohort
93305
cohort
cohort
cohort
cohort
93306
Echocardiography, transthoracic, real-time with image documentation
(2D), includes M-mode recording,when performed, complete with
spectral Doppler ec hocardiography, and with color flow Doppler echoca
cohort
cohort
cohort
cohort
cohort
93307
(2D), includes M-mode recording,when performed, complete, without
spectral or col or Doppler echocardiography
cohort
cohort
cohort
cohort
cohort
93308
(2D), includes M-mode recording,when performed, follow-up or limited
study
cohort
cohort
cohort
cohort
cohort
93312
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH
IMAGEDOCUMENTATION (2D) (WITH OR WITHOUT M-MODE
RECORDING); INCLUDING PROBE PLACEMENT, IMAGE
ACQUISITION, INTERPRETATION
cohort
cohort
cohort
cohort
cohort
93313
ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH
IMAGEDOCUMENTATION (2D) (WITH OR WITHOUT M-MODE
RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE
ONLY
93315
TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL
CARDIACANOMALIES; INCLUDING PROBE PLACEMENT, IMAGE
ACQUISITION, INTERPRETATION AND REPORT
93318
ECHOCARDIOGRAPHY, TEE FOR MONITORING PURPOSES,
INCLUDING PROBE PLACEMENT, REAT TIME 2
DIMENSIONALIMAGE ACQUISITION AND INTERPRETATION
LEADING TO ONGOING ASSESSMENT OF CARDIAC PUMPING
FUNCTION
93320
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR
CONTINUOUS WAVEWITH SPECTRAL DISPLAY (LIST
SEPARATELY IN ADDITION TO CODES FOR
ECHOCARDIOGRAPHIC IMAGING); COMPLETE
cohort
cohort
93321
DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR
CONTINUOUS WAVEWITH SPECTRAL DISPLAY (LIST
SEPARATELY IN ADDITION TO CODES FOR
ECHOCARDIOGRAPHIC IMAGING); FOLLOW-UP OR LIMITED
STUDY
cohort
93325
DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
178
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
93350
(2D), includes M-mode recording,when performed, during rest and
cardiovascular st ress test using treadmill, bicycle exercise and/or
cohort
cohort
cohort
cohort
cohort
93351
ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH
IMAGE DOCUMENTATION (2D), INCLUDES M-MODE
RECORDING,WHEN PERFORMED, DURING REST AND
CARDIOVASCULAR ST RESS TEST USING TREADMILL, BICYCLE
EXERCISE AND/OR
cohort
cohort
cohort
cohort
cohort
93352
Use of echocardiographic contrast agent during stress
echocardiography (List separately in addition to code for primary
procedure)
cohort
cohort
93451
Right heart catheterization including measurement(s) of oxygen
saturation and cardiac output, when performed
cohort
cohort
cohort
cohort
93452
Left heart catheterization including intraprocedural injection(s) for left
ventriculography, imagingsupervision and interpretation, when
performed
cohort
cohort
cohort
cohort
93453
Combined right and left heart catheterization including intraprocedural
injection(s) for left ventriculography, imaging supervision and
interpretation, when performed
cohort
cohort
cohort
93454
Catheter placement in coronary artery(s) for coronary angiography,
including intraprocedural injection(s) for coronary angiography, imaging
supervision and interpretation;
cohort
cohort
cohort
cohort
93455
supervision and interpretation; with catheter placement(s) i
cohort
cohort
cohort
cohort
93456
supervision and interpretation; with right heart catheteriza
cohort
cohort
cohort
cohort
93457
supervision and interpretation; with catheter placement(s) i
cohort
cohort
93458
supervision and interpretation; with left heart catheterizat
cohort
cohort
cohort
cohort
cohort
93459
supervision and interpretation; with left heart catheterizat
cohort
cohort
cohort
cohort
cohort
93460
supervision and interpretation; with right and left heart ca
cohort
cohort
cohort
cohort
cohort
93461
supervision and interpretation; with right and left heart ca
cohort
cohort
cohort
cohort
cohort
93462
Left heart catheterization by transseptal puncturethrough intact septum
or by transapical puncture (List separately in addition to code for
primary procedure)
cohort
cohort
cohort
93463
Pharmacologic agent administration (eg, inhaled nitric oxide,
intravenous infusion of nitroprusside,dobutamine, milrinone, or other
agent) including assessing hemodynamic measurements before, during,
cohort
cohort
cohort
93464
Physiologic exercise study (eg, bicycle or arm ergometry) including
assessing hemodynamic measurements before and after (List
cohort
cohort
cohort
93503
INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER
(EG,SWAN-GANZ) FOR MONITORING PURPOSES
statewide
93505
Endomyocardial biopsy
statewide
93530
Right heart catheterization, for congenital cardiac anomalies
statewide
93531
Combined right heart catheterization and retrograde left heart
catheterization, for congenital cardiac anomalies
93533
Combined right heart catheterization and transseptal left heart
catheterization through existing septal opening, with or without
retrograde left heartcatheterization, for congenital cardiac anomalies
93563
Injection procedure during cardiac catheterizationincluding imaging
supervision, interpretation, an d report; for selective coronary
CPT
Description
MAPPING (LISTSEPARATELY IN ADDITION TO CODES FOR
ECHOCARDIOGRAPHY)
cohort
statewide
cohort
179
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
angiography during congenital heart catheterization (List separatel
93565
supervision, interpretation, an d report; for selective left ventricular or
left atrial angiography (List separately in addition to
93566
supervision, interpretation, an d report; for selective right ventricular or
rightatrial angiography (List separately in addition t
93567
supervision, interpretation, an d report; for supravalvular aortography
(List separately in addition to code for primary procedure)
93568
supervision, interpretation, an d report; for pulmonary angiography (List
93571
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE
DERIVEDCORONARY FLOW RESERVE MEASUREMENT
(CORONARY VESSEL OR GRAFT) DURING CORONARY
ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY
93572
INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE
DERIVEDCORONARY FLOW RESERVE MEASUREMENT
(CORONARY VESSEL OR GRAFT) DURING CORONARY
ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY
93580
PERC TRANSCATHETER CLOSURE CONGENITAL INTERATRIAL
COMMUNICATION W/IMPLANT
93581
PERC TRANSCATHETER CLOSURE CONGENITAL VENTRICULAR
SEPTAL DEFECT W/IMPLANT
93603
RIGHT VENTRICULAR RECORDING
statewide
93609
INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING OF
TACHYCARDIA SITE(S) WITH CATHETER MANIPULATION TO
RECORD FROM MULTIPLE SITES TO IDENTIFY ORIGIN OF
TACHYCARDIA
cohort
93612
INTRAVENTRICULAR PACING
statewide
93613
INTRACARDIAC ELECTROPHYSIOLOGIC 3- DIMENSIONAL
MAPPING
cohort
93616
ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH
ORWITHOUTVENTRICULAR ELECTROGRAM(S); WITH PACING
93618
INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING
93619
Comprehensive electrophysiologic evaluation with right atrial pacing
and recording, right ventricular pacing and recording, His bundle
recording, including insertion and repositioning of multiple elec
93620
Comprehensive electrophysiologic evaluation including insertion and
repositioning of multiple electrode catheters with induction or attempted
induction of arrhythmia; with right atrial pacing and reco
cohort
cohort
cohort
93621
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH
RIGHTATRIAL PACING AND RECORDING, RIGHT
VENTRICULARPACING AND RECORDING, HIS BUNDLE
RECORDING, INCL UDING INSERTION AND
cohort
cohort
cohort
93622
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH
RIGHTATRIAL PACING AND RECORDING, RIGHT
VENTRICULARPACING AND RECORDING, HIS BUNDLE
RECORDING, INCL UDING INSERTION AND
cohort
cohort
cohort
93623
PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS
DRUGINFUSION (LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
cohort
cohort
cohort
93624
Electrophysiologic follow-up study with pacing andrecording to test
effectiveness of therapy, inclu ding induction or attempted induction of
arrhythmia
statewide
93631
INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING
ANDMAPPING TO LOCALIZE THE SITE OF TACHYCARDIA OR
ZONE OF SLOW CONDUCTION FOR SURGICAL CORRECTION
statewide
93640
Electrophysiologic evaluation of single or dual chamber pacing
cardioverter-defibrillator leads including defibrillation threshold
evaluation (induction of arrhythmia, evaluation of sensing and pacing
statewide
93641
cardioverter-defibrillator leads including defibrillation threshold
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
180
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
evaluation (induction of arrhythmia, evaluation of sensing and pacing
93642
cardioverter-defibrillator (includes defibrillation threshold evaluation,
induction of arrhythmia, evaluation of sensing and pacing for a
93650
Intracardiac catheter ablation of atrioventricularnode function,
atrioventricular conduction for cr eation of complete heart block, with or
without temporary pacemaker placement
93653
COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION
INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE
ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED
INDUCTION OF AN ARRHYTHMIA WITH RIGHT ATRIAL PACING
AND RE
cohort
cohort
cohort
93654
INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE
ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED
INDUCTION OF AN ARRHYTHMIA WITH RIGHT ATRIAL PACING
AND RE
cohort
cohort
cohort
93655
INTRACARDIAC CATHETER ABLATION OF A DISCRETE
MECHANISM OF ARRHYTHMIA WHICH IS DISTINCT FROM THE
PRIMARY ABLATED MECHANISM, INCLUDING REPEAT
DIAGNOSTICMANEUVERS, TO TREAT A SPONTANEOUS OR
INDUCED ARRH
cohort
cohort
cohort
93656
INCLUDING TRANSSEPTAL CATHETERIZATIONS, INSERTION AND
REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH
INDUCTION OR ATTEMPTED INDUCTION OF AN ARRHYTHMIA W
cohort
cohort
cohort
93657
ADDITIONAL LINEAR OR FOCAL INTRACARDIAC CATHETER
ABLATION OF THE LEFT OR RIGHT ATRIUM FOR TREATMENT OF
ATRIAL FIBRILLATION REMAINING AFTER COMPLETION OF
PULMONARY VEIN ISOLATION (LIST SEPARATELY IN AD
cohort
cohort
cohort
93660
Evaluation of cardiovascular function with tilt table evaluation, with
continuous ECG monitoring andintermittent blood pressure monitoring,
with or w ithout pharmacological intervention
cohort
cohort
cohort
93662
INTRACARDIAC ECHOCARDIOGRAPHY DURING THERAPEUTIC/
DIAGNOSTIC INTERVENTION, INCLUDING IMAGING SUPERVISION
AND INTERPRETATION (LIST SEPARATELY INADDITION TO CODE
FOR PRIMARY PROCEDURE)
cohort
cohort
cohort
93750
INTERROGATION OF VENTRICULAR ASSIST DEVICE (VAD), IN
PERSON, WITH PHYSICIAN OR OTHER QUALIFIED HEALTH CARE
PROFESSIONAL ANALYSIS OF DEVICE PARAMETERS (EG,
DRIVELINES, ALARMS, POWER SURGES), REVIEW OF
93786
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A
SYSTEMSUCH AS MAGNETIC TAPE AND/OR COMPUTER DISK,
FOR 24 HOURS OR LONGER; RECORDING ONLY
cohort
cohort
93788
AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A
SYSTEMSUCH AS MAGNETIC TAPE AND/OR COMPUTER DISK,
FOR 24 HOURS OR LONGER; SCANNING ANALYSIS WITH REPORT
cohort
cohort
93797
PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
SERVICES FOR OUTPATIENT CARDIAC REHABILITATION;
WITHOUT CONTINUOUS ECG MONITORING (PER SESSION)
93799
UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE
93880
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE
BILATERALSTUDY
93882
DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR
LIMITED STUDY
cohort
93886
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL
ARTERIES;COMPLETE STUDY
cohort
93888
TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL
ARTERIES;LIMITED STUDY
93892
TCD, EMOLIDETECT W/O INJ
statewide
93893
TCD, EMOLI DETECT W/INJ
statewide
93922
Limited bilateral noninvasive physiologic studies of upper or lower
extremity arteries, (eg, for lower extremity: ankle/brachial indices at
distal posterior tibial and anterior tibial/dorsalis pedis a
cohort
cohort
cohort
cohort
cohort
Complete bilateral noninvasive physiologic studiesof upper or lower
cohort
cohort
cohort
cohort
cohort
93923
cohort
statewide
statewide
cohort
181
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
Peer
Cohort
6
extremity arteries, 3 or more l evels (eg, for lower extremity:
ankle/brachial indices at distal posterior tibial and anterior tibia
93924
Noninvasive physiologic studies of lower extremityarteries, at rest and
following treadmill stress testing, (ie, bidirectional Doppler waveform or
volume plethysmography recording and analysis at res
93925
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL
BYPASSGRAFTS; COMPLETE BILATERAL STUDY
cohort
cohort
cohort
cohort
cohort
93926
DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL
BYPASSGRAFTS; UNILATERAL OR LIMITED STUDY
cohort
cohort
cohort
cohort
cohort
93930
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL
BYPASSGRAFTS; COMPLETE BILATERAL STUDY
cohort
cohort
cohort
cohort
cohort
93931
DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL
BYPASSGRAFTS; UNILATERAL OR LIMITED STUDY
cohort
cohort
cohort
cohort
93965
NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY
VEINS,COMPLETE BILATERAL STUDY(EG, DOPPLER WAVEFORM
ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER
MANEUVERS,
cohort
cohort
cohort
93970
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING
RESPONSESTOCOMPRESSION AND OTHER MANEUVERS;
COMPLETE BILAT ERAL STUDY
cohort
cohort
cohort
cohort
cohort
cohort
93971
DUPLEX SCAN OF EXTREMITY VEINS INCLUDING
RESPONSESTOCOMPRESSION AND OTHER MANEUVERS;
UNILATERAL OR LIMITED STUDY
cohort
cohort
cohort
cohort
cohort
cohort
93975
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW
OFABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR
RETROPERITONEAL ORGANS; COMPLETE STUDY
cohort
cohort
cohort
cohort
cohort
93976
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW
OFABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR
RETROPERITONEAL ORGANS; LIMITED STUDY
cohort
cohort
cohort
cohort
cohort
93978
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC
VASCULATURE,OR BYPASS GRAFTS; COMPLETE STUDY
cohort
cohort
cohort
cohort
cohort
93979
DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC
VASCULATURE,OR BYPASS GRAFTS; UNILATERAL OR LIMITED
STUDY
cohort
cohort
cohort
93980
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF
PENILE VESSELS; COMPLETE STUDY
cohort
cohort
cohort
93981
DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF
PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY
93990
DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING
ARTERIALINFLOW, BODY OF ACCESS AND VENOUS OUTFLOW)
93998
UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY
94002
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF
PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED
OR CONTROLLED BREATHING; HOSPITAL
INPATIENT/OBSERVATION, INITIAL DAY
94003
VENTILATION ASSIST AND MANAGEMENT, INITIATION OF
PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED
OR CONTROLLED BREATHING; HOSPITAL
INPATIENT/OBSERVATION, EACH SUBSEQUENT DAY
94010
SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED
VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENT(S),
WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION
94011
MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY
FLOWSIN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE
statewide
94012
MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY
FLOWS, BEFORE AND AFTER BRONCHODILATOR, IN AN INFANT
ORCHILD THROUGH 2 YEARS OF AGE
statewide
94013
MEASUREMENT OF LUNG VOLUMES (IE, FUNCTIONAL RESIDUAL
CAPACITY ¢FRC!, FORCED VITAL CAPACITY ¢FVC!, AND
EXPIRATORY RESERVE VOLUME ¢ERV!) IN AN INFANT ORCHILD
THROUGH 2 YEARS OF AGE
statewide
94060
BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010,
BEFORE AND AFTER BRONCHODILATOR (AEROSOL OR
PARENTERAL)
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
182
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
94070
PROLONGED POSTEXPOSURE EVALUATION OF
BRONCHOSPASM WITHMULTIPLE SPIROMETRIC
DETERMINATIONS AFTER ANTIGEN, COLD AIR, METHACHOLINE
OR OTHER CHEMICAL AGENT, WITH SUBSEQUENT
cohort
94150
VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE)
94200
MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY
VENTILATION
94250
EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE
PROCEDURE(SEPARATE PROCEDURE)
94375
RESPIRATORY FLOW VOLUME LOOP
94452
HIGH ALTITUDE SIMULATION TEST (HAST), WITH
INTERPRETATION AND REPORT BY A PHYSICIAN OR OTHER
QUALIFIED HEALTH CARE PROFESSIONAL;
94620
Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged
exercise test for bronchospasm with pre- and post-spirometry and
oximetry
94621
PULMONARY STRESS TESTING; COMPLEX (INCLUDING
MEASUREMENTS OFCO2 PRODUCTION, O2 UPTAKE, AND
ELECTROCARDIOGRAPHIC RECORDINGS)
94640
NONPRESSURIZED INHALATION TREATMENT FOR ACUTE
AIRWAYOBSTRUCTION NONPRESSURIZED INHALATION
TREATMENTFOR ACUTE AIRWAY
94642
AEROSOL INHALATION OF PENTAMIDINE FOR
PNEUMOCYSTISCARINIIPNEUMONIA TREATMENT OR
PROPHYLAXIS
94644
CONTINUOUS INHALATION TREATMENT WITH AEROSOL
MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; FIRST HOUR
cohort
cohort
94645
CONTINUOUS INHALATION TREATMENT WITH AEROSOL
MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; EACH
ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE
cohort
94660
CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION
(CPAP),INITIATION AND MANAGEMENT
94664
AEROSOL OR VAPOR INHALATIONS FOR SPUTUM
MOBILIZATION,BRONCHODILATION, OR SPUTUM INDUCTION FOR
DIAGNOSTIC PURPOSES; INITIAL DEMONSTRATION AND/OR
EVALUATION
94667
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING,
ANDVIBRATION TO FACILITATE LUNG FUNCTION; INITIAL
DEMONSTRATION AND/OR EVALUATION
94668
MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING,
ANDVIBRATION TO FACILITATE LUNG FUNCTION; SUBSEQUENT
94680
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND
EXERCISE,DIRECT, SIMPLE OXYGEN UPTAKE, EXPIRED GAS
ANALYSIS; REST AND EXERCISE,
94690
OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST,
INDIRECT(SEPARATE PROCEDURE) OXYGEN UPTAKE, EXPIRED
GAS ANALYSIS; REST, INDIRECT
94726
PLETHYSMOGRAPHY FOR DETERMINATION OF LUNG VOLUMES
AND, WHEN PERFORMED, AIRWAY RESISTANCE
94727
GAS DILUTION OR WASHOUT FOR DETERMINATION OF LUNG
VOLUMES AND, WHEN PERFORMED, DISTRIBUTION OF
VENTILATION AND CLOSING VOLUMES
94728
AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY
94729
DIFFUSING CAPACITY (EG, CARBON MONOXIDE,
MEMBRANE)(LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCEDURE)
cohort
94750
PULMONARY COMPLIANCE STUDY, ANY METHOD
cohort
94760
NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN
SATURATION;SINGLE DETERMINATION
cohort
94761
SATURATION;MULTIPLE DETERMINATIONS (EG, DURING
EXERCISE)
cohort
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
183
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
94762
SATURATION; BY CONTINUOUS OVERNIGHT MONITORING
cohort
cohort
cohort
cohort
cohort
94770
CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY
INFRAREDANALYZER
cohort
cohort
cohort
cohort
cohort
94799
UNLISTED PULMONARY SERVICE OR PROCEDURE
cohort
cohort
cohort
cohort
cohort
95004
PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK)
WITHALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INC
LUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER
OF TESTS
cohort
cohort
95012
NITRIC OXIDE EXPIRED GAS DETERMINATION
95018
ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS
(SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS
(INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH DRUGS
OR BIOLOGICALS, IMMEDIATE TYPE REACTION, INCLUDING
statewide
95024
INTRACUTANEOUS (INTRADERMAL) TESTS WITH
ALLERGENICEXTRACTS, IMMEDIATE TYPE REACTION,
INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY
NUMBER OF TEST S
statewide
95044
PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF
TESTS)PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF
TESTS)
95070
INHALATION BRONCHIAL CHALLENGE TESTING (NOT
INCLUDINGNECESSARY PULMONARY FUNCTION TESTS); WITH
HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS
95076
INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL
INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER
SUBSTANCE); INITIAL 120 MINUTES OF TESTING
statewide
95079
INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL
INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER
SUBSTANCE); EACH ADDITIONAL 60 MINUTES OF TESTING (LIST
SEPARATELY IN ADDITION TO CODE FOR PRIMARY
statewide
95115
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY
NOTINCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE
INJECTION
cohort
cohort
cohort
95117
PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY
NOTINCLUDING PROVISION OF ALLERGENIC EXTRACTS; TWO
OR MORE INJECTIONS
cohort
cohort
cohort
95165
PROFESSIONAL SERVICES FOR THE SUPERVISION AND
PROVISION OFANTIGENS FOR ALLERGEN IMMUNOTHERAPY;
SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES)
95250
Ambulatory continuous glucose monitoring of interstitial tissue fluid via a
subcutaneous sensor for a minimum of 72 hours; sensor placement,
hook-up, calibration of monitor, patient training, removal
cohort
95782
POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP
STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF
SLEEP, ATTENDED BY A TECHNOLOGIST
cohort
95783
POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP
STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF
SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY
PRESSURE THERAPY OR BI-LEVEL VENTILATION, ATTENDED BY
statewide
95800
Sleep study, unattended, simultaneous recording; heart rate, oxygen
saturation, respiratory analysis(eg, by airflow or peripheral arterial tone),
and sleep time
95805
MULTIPLE SLEEP LATENCY OR MAINTENANCE OF
WAKEFULNESSTESTING, RECORDING, ANALYSIS AND
INTERPRETATION OF PHYSIOLOGICAL MEASUREMENTS OF
SLEEP DURING MULTIPLE TRIALS
cohort
cohort
95806
SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF,
HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFLOW,
AND RESPIRATORY EFFORT (EG, THORACOABDOMINAL
MOVEMENT)
cohort
cohort
95807
SLEEP STUDY, SIMULTANEOUS RECORDING OF
VENTILATION,RESPIRATORY EFFORT, ECG OR HEART RATE,
AND OXYGENSATURATION, ATTENDED BY A TECHNOLOGIST
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
184
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
95808
POLYSOMNOGRAPHY; ANY AGE, SLEEP STAGING WITH 1-3
ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A
TECHNOLOGIST
95810
POLYSOMNOGRAPHY; AGE 6 YEARS OR OLDER, SLEEP STAGING
WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP,
ATTENDED BY A TECHNOLOGIST
cohort
cohort
cohort
cohort
cohort
cohort
95811
POLYSOMNOGRAPHY; AGE 6 YEARS OR OLDER, SLEEP STAGING
WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, WITH
INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE
THERAPY OR BILEVEL VENTILATION, ATTENDED BY A
cohort
cohort
cohort
cohort
cohort
cohort
95812
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING;
UPTO ONEHOUR
cohort
cohort
cohort
cohort
95813
ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING;
GREATER THANONE HOUR
cohort
cohort
cohort
cohort
95816
ELECTROENCEPHALOGRAM (EEG) INCLUDING RECORDING
AWAKE ANDDROWSY, WITH HYPERVENTILATION AND/OR
PHOTIC STIMULATION
cohort
cohort
cohort
cohort
cohort
95819
ELECTROENCEPHALOGRAM (EEG) INCLUDING RECORDING
AWAKE ANDASLEEP, WITH HYPERVENTILATION AND/OR PHOTIC
STIMULATION
cohort
cohort
cohort
cohort
cohort
95831
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE);
EXTREMITY(EXCLUDING HAND) OR TRUNK, WITH REPORT
statewide
95834
MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE);
TOTALEVALUATION OF BODY, INCLUDING HANDS
statewide
95851
RANGE OF MOTION MEASUREMENTS AND REPORT
(SEPARATEPROCEDURE); EACH EXTREMITY (EXCLUDING HAND)
OR EACHTRUNK SECTION (SPINE)
statewide
95860
NEEDLE ELECTROMYOGRAPHY; 1 EXTREMITY WITH OR
WITHOUT RELATED PARASPINAL AREAS
cohort
cohort
cohort
cohort
cohort
95861
NEEDLE ELECTROMYOGRAPHY, TWO EXTREMITIES WITH OR
WITHOUTRELATED PARASPINAL AREAS
cohort
cohort
cohort
cohort
95865
NEEDLE ELECTROMYOGRAPHY; LARYNX
cohort
95867
NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED
MUSCLES,UNILATERAL
cohort
95868
NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED
MUSCLES,BILATERAL
cohort
95869
NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL
MUSCLES
95870
NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN
1 EXTREMITY OR NON-LIMB (AXIAL) MUSCLES (UNILATERAL OR
BILATERAL), OTHER THAN THORACIC PARASPINAL, CRANIAL
NERVE SUPPLIED MUSCLES, OR SPHINCTERS
95872
NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER
ELECTRODE, WITHQUANTITATIVE MEASUREMENT OF JITTER,
BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH
MUSCLE STUDIED
cohort
95873
ELECTRICAL STIMULATION FOR GUIDANCE IN
CONJUNCTIONWITH CHEMODENERVATION (LIST SEPARATELY IN
ADDITIO N TO CODE FOR PRIMARY PROCEDURE)
cohort
cohort
95874
NEEDLE ELECTROMYOGRAPHY FOR GUIDANCE IN
CONJUNCTION WITH CHEMODENERVATION (LIST SEPARATELY
IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
cohort
cohort
95875
ISCHEMIC LIMB EXERCISE WITH NEEDLE ELECTROMYOGRAPHY,
WITHLACTIC ACID DETERMINATION
statewide
95885
NEEDLE ELECTROMYOGRAPHY, EACH EXTREMITY, WITH
RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE WITH
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY
STUDY; LIMITED (LIST SEPARATELY IN ADDITION TO CODE F
cohort
cohort
cohort
cohort
95886
NEEDLE ELECTROMYOGRAPHY, EACH EXTREMITY, WITH
RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE WITH
NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY
STUDY; COMPLETE, FIVE OR MORE MUSCLES STUDIED, INNERV
cohort
cohort
cohort
cohort
95887
NEEDLE ELECTROMYOGRAPHY, NON-EXTREMITY (CRANIAL
NERVE SUPPLIED OR AXIAL) MUSCLE(S) DONE WITH NERVE
CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY (LIST
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
185
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO
95907
NERVE CONDUCTION STUDIES; 1-2 STUDIES
cohort
cohort
cohort
95908
cohort
cohort
cohort
cohort
cohort
95909
cohort
cohort
cohort
cohort
cohort
95910
cohort
cohort
cohort
cohort
95911
cohort
cohort
95912
cohort
cohort
cohort
95913
NERVE CONDUCTION STUDIES; 13 OR MORE STUDIES
cohort
cohort
cohort
95921
TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION;
CARDIOVAGAL INNERVATION (PARASYMPATHETIC FUNCTION),
INCLUDING 2 OR MORE OF THE FOLLOWING: HEART RATE
RESPONSE TO DEEP BREATHING WITH RECORDED R-R
INTERVAL
statewide
95922
VASOMOTORADRENERGIC INNERVATION (SYMPATHETIC
ADRENERGIC FUNCTION), INCLUDING BEAT-TO-BEAT BLOOD
PRESSURE AND R-R INTERVAL
statewide
95923
SUDOMOTOR, INCLUDING 1 OR MORE OF THE FOLLOWING:
QUANTITATIVE SUDOMOTOR AXON REFLEX TEST (QSART),
SILASTIC SWEAT IMPRINT, THERMOREGULATORY SWEAT TEST,
AND
statewide
95924
COMBINED PARASYMPATHETIC AND SYMPATHETIC
ADRENERGIC FUNCTION TESTING WITH AT LEAST 5 MINUTES OF
PASSIVE TILT
statewide
95925
SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL
STUDY,STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN
SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM;IN
UPPER LIMBS
cohort
cohort
cohort
95926
LOWER LIMBS
cohort
cohort
cohort
95927
THE TRUNK OR
95928
C MONTOR EVOKED, UPPER LIMBS
95929
C MONTOR EVOKED, LOWER LIMBS
95930
VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL
NERVOUSSYSTEM, CHECKERBOARD OR FLASH
cohort
cohort
95933
ORBICULARIS OCULI (BLINK) REFLEX, BY
ELECTRODIAGNOSTICTESTING
statewide
95937
NEUROMUSCULAR JUNCTION TESTING (REPETITIVE
STIMULATION, PAIRED STIMULI), EACH NERVE, ANY 1 METHOD
cohort
cohort
95938
STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR
SKINSITES, RECORDING FROM THE CENTRAL NERVOUS
SYSTEM; IN UPPER AND LOWER LIMBS
cohort
cohort
cohort
95939
STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR
SKINSITES, RECORDING FROM THE CENTRAL NERVOUS
SYSTEM; IN UPPER AND LOWER LIMBS
cohort
cohort
cohort
95940
CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY
MONITORING IN THE OPERATING ROOM, ONE ON ONE
MONITORING REQUIRING PERSONAL ATTENDANCE, EACH 15
MINUTES (LISTSEPARATELY IN ADDITION TO CODE FOR
PRIMARY PROCED
cohort
cohort
cohort
cohort
95950
MONITORING FOR IDENTIFICATION AND LATERALIZATION OF
CEREBRALSEIZURE FOCUS, ELECTROENCEPHALOGRAPHIC (EG,
8 CHANNEL EEG) RECORDING AND INTERPRETATION, EACH 24
HOURS
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
186
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
CPT
Description
95951
MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE
FOCUS BYCABLE OR RADIO, 16 OR MORE CHANNEL TELEMETRY,
COMBINED ELECTROENCEPHALOGRAPHIC (EEG) AND VIDEO
RECORDING AND
95953
Monitoring for localization of cerebral seizure focus by computerized
portable 16 or more channel EEG, electroencephalographic (EEG)
recording and interpretation, each 24 hours, unattended
95955
ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL
SURGERY(EG, CAROTID SURGERY)
95956
Monitoring for localization of cerebral seizure focus by cable or radio, 16
or more channel telemetry, electroencephalographic (EEG) recording
and interpretation, each 24 hours, attended by a technolo
cohort
95957
DIGITAL ANALYSIS OF ELECTROENCEPHALOGRAM (EEG) (EG,
FOREPILEPTIC SPIKE ANALYSIS)
cohort
95958
WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION,
INCLUDINGELECTROENCEPHALOGRAPHIC (EEG) MONITORING
statewide
95965
MAGNETOENCEPHALOGRAPHY (MEG), RECORD & ANALYSIS;
FOR SPONTANEOUS BRAIN MAGNETIC ACTIVITY
statewide
95966
FOR EVOKED MAGNETIC FIELDS, SINGLE MODALITY
statewide
95967
FOR EVOKED MAGNETIC FIELDS, EA ADD'L MODALITY
statewide
95970
ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR
PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE,
PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY
STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI
statewide
95971
cohort
cohort
cohort
cohort
cohort
95972
cohort
cohort
cohort
cohort
cohort
95973
statewide
95974
cohort
95978
ANALYZE NEUROSTIM BRAIN / 1 HOUR
statewide
95990
REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR
RESERVOIR FOR DRUG DELIVERY, SPINAL (INTRATHECAL,
EPIDURAL) OR BRAIN (INTRAVENTRICULAR), INCLUDES
ELECTRONIC ANALYSIS OF PUMP, WHEN PERFORMED;
95991
RESERVOIR FOR DRUG DELIVERY, SPINAL (INTRATHECAL,
EPIDURAL) OR BRAIN (INTRAVENTRICULAR), INCLUDES
ELECTRONIC ANALYSIS OF PUMP, WHEN PERFORMED;
REQUIRIN
statewide
95999
UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DIAGNOSTIC
PROCEDURE
statewide
96020
NEUROFUNCTIONAL TESTING SELECTION AND ADMINISTRATION
DURING NONINVASIVE IMAGING FUNCTIONAL BRAIN MAPPING,
WITH TEST ADMINISTERED ENTIRELY BY A PHYSICIAN OR
OTHER QUALIFIED HEALTH CARE PROFESSIONAL (IE
96101
Psychological testing (includes psychodiagnostic assessment of
emotionality, intellectual abilities,personality and psychopathology, e.g.,
MMPI, Rors chach, WAIS), per hour of the psychologist's or ph
96102
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC
ASSESSMENT OF EMOTIONALITY, INTELLECTUAL
ABILITIES,PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI
AND WAI S), WITH QUALIFIED HEALTH CARE PROFESSIONAL
INTERP
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
187
cohort
cohort
statewide
cohort
cohort
statewide
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
96103
PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC
ASSESSMENT OF EMOTIONALITY, INTELLECTUAL
ABILITIES,PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI),
ADMIN ISTERED BY A COMPUTER, WITH QUALIFIED HEALTH
CARE
statewide
96110
DEVELOPMENTAL SCREENING, WITH INTERPRETATION AND
REPORT, PER STANDARDIZED INSTRUMENT FORM
statewide
96111
DEVELOPMENTAL TESTING, (INCLUDES ASSESSMENT OF
MOTOR, LANGUAGE, SOCIAL, ADAPTIVE, AND/OR COGNITIVE
FUNCTIONING BY STANDARDIZED DEVELOPMENTAL
INSTRUMENTS) WITH INTERPRETATION AND REPORT
statewide
96116
NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF
THINKING, REASONING AND JUDGMENT, EG, ACQUIRED
KNOWLEDGE, ATTENTION, LANGUAGE, MEMORY, PLANNING AND
PROBLEM SOLVING, AND VISUAL SPATIAL ABILITIES),
statewide
96118
Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological
Battery, Wechsler Memory Scalesand Wisconsin Card Sorting Test),
per hour of the psychologist's or physician's time, both face-to-
statewide
96119
NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN
NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY
SCALES AND WISCONSIN CARD SORTING TEST), WITH
QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION
AND REPORT,
96360
Intravenous infusion, hydration; initial, 31 minutes to 1 hour
cohort
cohort
cohort
cohort
cohort
96361
Intravenous infusion, hydration; each additional hour (List separately in
addition to code for primary procedure)
cohort
cohort
cohort
cohort
cohort
96365
Intravenous infusion, for therapy, prophylaxis, ordiagnosis (specify
substance or drug); initial, u p to 1 hour
cohort
cohort
cohort
cohort
cohort
96366
substance or drug); each addit ional hour (List separately in addition to
cohort
cohort
cohort
cohort
cohort
96367
INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS,
ORDIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL
SEQUENTIAL INFUSION OF A NEW DRUG/SUBSTANCE, UP T O 1
HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR
cohort
cohort
cohort
cohort
cohort
96368
substance or drug); concurrent infusion (List separately in addition to
cohort
cohort
cohort
cohort
cohort
96372
Therapeutic, prophylactic, or diagnostic injection(specify substance or
drug); subcutaneous or intr amuscular
cohort
cohort
cohort
cohort
cohort
96373
drug); intra-arterial
cohort
cohort
96374
drug); intravenous push, si ngle or initial substance/drug
cohort
cohort
cohort
cohort
cohort
96375
drug); each additional sequ ential intravenous push of a new
substance/drug (List separately in addition to code for primary pro
cohort
cohort
cohort
cohort
cohort
96376
drug); each additional sequ ential intraveous push of the same
substance/drug provided in a facility (List separately in additio
cohort
cohort
cohort
cohort
cohort
96379
Unlisted therapeutic, prophylactic, or diagnostic intravenous or intraarterial injection or infusion
cohort
cohort
96401
CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR
INTRAMUSCULAR; NON-HORMONAL ANTI-NEOPLASTIC
cohort
cohort
cohort
cohort
cohort
96402
CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR
INTRAMUSCULAR; HORMONAL ANTI-NEOPLASTIC
cohort
cohort
cohort
cohort
cohort
96409
CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH
TECHNIQUE, SINGLE OR INITIAL SUBSTANCE/DRUG
cohort
cohort
cohort
cohort
cohort
96411
CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH
TECHNIQUE, EACH ADDITIONAL SUBSTANCE/DRUG (LIST
cohort
cohort
cohort
cohort
cohort
96413
CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION
TECHNIQUE; UP TO 1 HOUR, SINGLE OR INITIAL
SUBSTANCE/DRUG
cohort
cohort
cohort
cohort
cohort
statewide
188
cohort
cohort
Peer
Cohort
6
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
96415
TECHNIQUE; EACH ADDITIONAL HOUR (LIST SEPARATELY IN
cohort
cohort
cohort
cohort
cohort
96416
TECHNIQUE; INITIATION OF PROLONGED CHEMOTHERAPY
INFUSION (MORE THAN 8 HOURS), REQUIRING USE OF A
PORTABLE OR IMPLANTABLE PUMP
cohort
cohort
cohort
cohort
cohort
96417
TECHNIQUE; EACH ADDITIONAL SEQUENTIAL INFUSION
(DIFFERENT SUBSTANCE/DRUG), UP TO 1 HOUR (LIST
cohort
cohort
cohort
cohort
cohort
96420
CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH
TECHNIQUE CHEMOTHERAPY ADMINISTRATION, INTRAARTERIAL; PUSH TECHNIQUE
96446
Chemotherapy administration into the peritoneal cavity via indwelling
port or catheter
96450
CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG,
INTRATHECAL),REQUIRING AND INCLUDING LUMBAR PUNCTURE
CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG,
INTRATHECAL),
96521
REFILLING AND MAINTENANCE OF PORTABLE PUMP
96522
RESERVOIR FOR DRUG DELIVERY, SYSTEMIC (EG,
INTRAVENOUS, INTRA-ARTERIAL)
96523
IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR
DRUG DELIVERY SYSTEMS
96526
96542
CHEMOTHERAPY INJECTION, SUBARACHNOID OR
INTRAVENTRICULAR VIASUBCUTANEOUS RESERVOIR, SINGLE
OR MULTIPLE AGENTS
96549
UNLISTED CHEMOTHERAPY PROCEDURE
97001
PHYSICAL THERAPY EVALUATION
statewide
97028
APPLICATION OF A MODALITY TO ONE OR MORE AREAS;
ULTRAVIOLET APPLICATION OF A MODALITY TO ONE OR
MOREAREAS; ULTRAVIOLET
statewide
97116
THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15
MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING)
97150
THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE
INDIVIDUALS)THERAPEUTIC PROCEDURE(S), GROUP (2 OR
MORE INDIVIDUALS)
97250
(CODE DELETED IN 1999. TO REPORT, SEE 97140) MYOFA
97530
THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT
CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE
FUNCTIONAL PERFORMANCE), EACH 15 MINUTES
97532
DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION,
MEMORY, PROBLEM SOLVING (INCLUDES
COMPENSATORYTRAINING), DIRECT (ONE-ON-ONE) PATIENT
CONTACT, E ACH 15 MINUTES
97535
SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIESOF
DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL
PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN
USE OF ASSISTIVE TECHNOLOGY DEVICES/ADAPTIV
cohort
cohort
97597
Debridement (eg, high pressure waterjet with/without suction, sharp
selective debridement with scissors, scalpel and forceps), open wound,
(eg, fibrin, devitalized epidermis and/or dermis, exudate, de
cohort
cohort
cohort
cohort
cohort
97598
Debridement (eg, high pressure waterjet with/without suction, sharp
selective debridement with scissors, scalpel and forceps), open wound,
(eg, fibrin, devitalized epidermis and/or dermis, exudate, de
cohort
cohort
cohort
cohort
cohort
97602
REMOVAL OF DEVITALIZED TISSUE FROM
WOUND;NONSELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA,
WOUND ASSESS-MENT, AND INSTUCTION FOR ONGING CARE,
PER SESSION
cohort
cohort
cohort
cohort
cohort
97605
NEG PRESSURE WOUND THERAPY, < 50 CM
cohort
cohort
cohort
cohort
97606
NEG PRESSURE WOUND THERAPY, > 50 CM
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
189
cohort
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
97802
MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND
INTERVENTION, INDIVIDUAL, FACE TO FACE WITH THE PATIENT,
EACH 15 MINUTES
statewide
97803
MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND
INTERVENTION, INDIVIDUAL, FACE TO FACE WITH THE PATIENT,
EACH 15 MINUTES
statewide
97804
MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE
INDIVIDUALS),EACH 30 MINUTES
98926
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE
TOFOUR BODYREGIONS INVOLVED OSTEOPATHIC MANIPULATI
VE TREATMENT (OMT); THREE TO FOUR BODY
statewide
98929
OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN
BODYREGIONS INVOLVED OSTEOPATHIC
MANIPULATIVETREATMENT (OMT); NINE TO TEN BODY
statewide
98960
EDUCATION AND TRAINING FOR PATIENT SELF-MANAGEMENTBY
A QUALIFIED, NONPHYSICIAN HEALTH CARE PROFESSI ONAL
USING A STANDARDIZED CURRICULUM, FACE-TO-FACEWITH THE
PATIENT (COULD INCLUDE CAREGIVER/FAMILY)
statewide
99005
OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION
ANDMANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
THESE THREE KEY COMPONENTS:
statewide
99070
SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED
BY THE PHYSICIAN OR OTHER QUALIFIED HEALTH
CAREPROFESSIONAL OVER AND ABOVE THOSE USUALLY
INCLUDE D WITH THE OFFICE VISIT OR OTHER SERVICES
RENDERED
cohort
99100
ANESTHESIA FOR PATIENT OF EXTREME AGE, UNDER ONE YEAR
ANDOVER SEVENTY (LIST SEPARATELY IN ADDITION TO CODE
FOR PRIMARY ANESTHESIA PROCEDURE)
statewide
99140
ANESTHESIA COMPLICATED BY EMERGENCY CONDITIONS
(SPECIFY)(LIST SEPARATELY IN ADDITION TO CODE FOR
PRIMARY ANESTHESIA PROCEDURE)
statewide
99143
MODERATE SEDATION SERVICES (OTHER THAN THOSE
SERVICES DESCRIBED BY CODES 00100-01999) PROVIDED BY
THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE
PROFESSIONAL PERFORMING THE DIAGNOSTIC OR
THERAPEUTI
cohort
cohort
cohort
cohort
cohort
99144
THERAPEUTI
cohort
cohort
cohort
cohort
cohort
99145
THERAPEUTI
cohort
cohort
cohort
cohort
cohort
99148
SERVICES DESCRIBED BY CODES 00100-01999), PROVIDED BY
ONAL OTHER THAN THE HEALTH CARE PROFESSIONAL PERFO
cohort
cohort
cohort
cohort
99149
cohort
cohort
cohort
cohort
99150
cohort
cohort
cohort
99173
SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE,
BILATERAL
99183
PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL
ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN
THERAPY, PER SESSION
cohort
cohort
cohort
cohort
cohort
99195
PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE)
cohort
cohort
cohort
cohort
cohort
99201
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
statewide
cohort
cohort
cohort
statewide
190
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
99202
AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES
THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED
HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION
cohort
cohort
cohort
cohort
cohort
cohort
99203
THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED
EXAMINATION; MEDICAL DECISION MAKING OF LOW C
cohort
cohort
cohort
cohort
cohort
cohort
99204
THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY;
ACOMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKIN
cohort
cohort
cohort
cohort
cohort
cohort
99205
THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY;
ACOMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKIN
cohort
cohort
cohort
cohort
cohort
cohort
99211
AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT MAY
NOT REQUIRE THE PRESENCE OF A PHYSICIAN. USUALLY, THE
PRESENTING PROBLEM(S) ARE MINIMAL. TYPICALL
cohort
cohort
cohort
cohort
cohort
cohort
99212
AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH
REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A
PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINAT
cohort
cohort
cohort
cohort
cohort
cohort
99213
REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: AN
EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROB
cohort
cohort
cohort
cohort
cohort
cohort
99214
DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL D
cohort
cohort
cohort
cohort
cohort
99215
COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION;
cohort
cohort
cohort
cohort
cohort
99217
OBSERVATION CARE DISCHARGE DAY MANAGEMENT (THIS
CODE IS TO BE UTILIZED TO REPORT ALL SERVICES PROVIDED
TO A PATIENT ON DISCHARGE FROM "OBSERVATION STATUS" IF
THE DISCHARGE IS ON OTHER THAN THE INITIAL
cohort
cohort
cohort
cohort
cohort
99218
INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION
AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE 3
KEY COMPONENTS: A DETAILED OR COMPREHENSIVE HISTORY;
A DETAILED OR COMPREHENSIVE EXAMINATION; A
cohort
cohort
cohort
cohort
cohort
99219
AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3
KEY COMPONENTS: A COMPREHENSIVE HISTORY; A
COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAK
cohort
cohort
cohort
cohort
99220
AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3
KEY COMPONENTS: A COMPREHENSIVE HISTORY; A
COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAK
99224
SUBSEQUENT OBSERVATION CARE, PER DAY, FOR THE
EVALUATION AND MANAGEMENT OF A PATIENT, WHICH
REQUIRESAT LEAST 2 OF THESE 3 KEY COMPONENTS:
PROBLEM FOC USED INTERVAL HISTORY; PROBLEM FOCUSED
EXAMINATION
99231
SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION
AND MANAGEMENT OF A PATIENT, WHICH REQUIRES ATLEAST 2
OF THESE 3 KEY COMPONENTS: A PROBLEM FOCU SED
INTERVAL HISTORY; A PROBLEM FOCUSED EXAMINATIO
99234
OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE
EVALUATION AND MANAGEMENT OF A PATIENT INCLUDING
ADMISSION AND DISCHARGE ON THE SAME DATE, WHICH
REQUIRES THESE 3 KEY COMPONENTS: A DETAILED OR
CPT
Description
THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY;A
PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD ME
statewide
cohort
cohort
statewide
cohort
191
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
COMPREHE
99235
OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE
EVALUATION AND MANAGEMENT OF A PATIENT INCLUDING
ADMISSION AND DISCHARGE ON THE SAME DATE, WHICH
REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE
HISTOR
statewide
99241
OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT,
WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM
FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION;AND
STRAIGHTFORWARD MEDICAL DECISION MAKING. COUN
cohort
99242
WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED
PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM
FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL D
99243
WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED
HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION
MAKING OF LOW COMPLEXITY. COUNSELING AND/O
cohort
99244
WHICH REQUIRES THESE 3 KEY COMPONENTS: A
ANDMEDICAL DECISION MAKING OF MODERATE COMPLEXITY. C
cohort
99245
WHICH REQUIRES THESE 3 KEY COMPONENTS: A
ANDMEDICAL DECISION MAKING OF HIGH COMPLEXITY. COUNS
cohort
99252
INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED
PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN
EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED
PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD
MEDICA
99281
EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND
MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY
COMPONENTS: A PROBLEM FOCUSED HISTORY; A
PROBLEMFOCUSED EXAMINATION; AND STRAIGHTFORWARD
MEDICAL
cohort
cohort
cohort
cohort
cohort
cohort
99282
COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY;AN
EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDI
cohort
cohort
cohort
cohort
cohort
cohort
99283
COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY;AN
EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDI
cohort
cohort
cohort
cohort
cohort
cohort
99284
COMPONENTS: A DETAILED HISTORY; A DETAILED
EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE
CO
cohort
cohort
cohort
cohort
cohort
cohort
99285
COMPONENTS WITHIN THE CONSTRAINTS IMPOSED BY
THEURGENCY OF THE PATIENT'S CLINICAL CONDITION AND/O
cohort
cohort
cohort
cohort
cohort
cohort
99291
CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE
UNSTABLECRITICALLY ILL OR UNSTABLE CRITICALLY INJURED
PATIENT, REQUIRING THE CONSTANT ATTENDANCE OF THE
PHYSICIAN; FIRST
cohort
cohort
cohort
cohort
cohort
99292
CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE
CRITICALLYILL OR CRITICALLY INJURED PATIENT, REQUIRING
THE CONSTANT ATTENDANCE OF THE PHYSICIAN;
EACHADDITIONAL 30 MINUTES
cohort
cohort
cohort
cohort
cohort
99306
INITIAL NURSING FACILITY CARE, PER DAY, FOR THE
EVALUATION AND MANAGEMENT OF A PATIENT, WHICH
REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE
HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL
DECISIO
cohort
cohort
99341
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A
NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A
statewide
cohort
cohort
cohort
cohort
statewide
cohort
192
cohort
statewide
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED
EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION
MAK
99345
HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A
NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A
AND MEDICAL DECISION MAKING OF HIGH COMPLEXI
99351
99366
Medical team conference with interdisciplinary team of health care
professionals, face-to-face with patient and/or family, 30 minutes or
more, participation by nonphysician qualified health care profe
99374
SUPERVISION OF A PATIENT UNDER CARE OF HOME
HEALTHAGENCY (PATIENT NOT PRESENT) IN HOME,
DOMICILIARY OR EQUIVALENT ENVIRONMENT (EG, ALZHEIMER'S
FACILI TY) REQUIRING COMPLEX AND MULTIDISCIPLINARY CARE
M
statewide
99395
Periodic comprehensive preventive medicine reevaluation and
management of an individual including anage and gender appropriate
history, examination, counseling/anticipatory guidance/risk factor reduc
statewide
99396
Periodic comprehensive preventive medicine reevaluation and
management of an individual including anage and gender appropriate
history, examination, counseling/anticipatory guidance/risk factor reduc
99401
PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR
REDUCTION INTERVENTION(S) PROVIDED TO AN INDIVIDUAL
(SEPARATE PROCEDURE); APPROXIMATELY 15 MINUTES
99402
statewide
99403
statewide
99404
cohort
99406
Smoking and tobacco use cessation counseling visit; intermediate,
greater than 3 minutes up to 10 minutes
99407
Smoking and tobacco use cessation counseling visit; intensive, greater
than 10 minutes
99412
REDUCTION INTERVENTION(S) PROVIDED TO INDIVIDUALS IN A
GROUP SETTING (SEPARATE PROCEDURE); APPROXIMATELY 60
MINUTES
99460
Initial hospital or birthing center care, per day,for evaluation and
management of normal newborn i nfant
A0398
ALS ROUTINE DISPOSABLE SUPPLIES
A0422
AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN
SUPPLIES,LIFESUSTAINING SITUATION
A0425
GROUND MILEAGE , PER STATUTE MILE
cohort
cohort
cohort
cohort
A0426
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NONEMERGENCY TRANSPORT, LEVEL 1 (ALS 1)
cohort
cohort
cohort
cohort
A0427
AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY
TRANSPORT LEVEL 1
cohort
cohort
cohort
cohort
A0428
AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON- EMERGENCY
TRANSPORT (BLS)
cohort
cohort
cohort
cohort
A0429
AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY
TRANSPORT (BLS- EMERGENCY
cohort
cohort
cohort
A0430
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES,
TRANSPORT, ONE WAY (FIXED WING)
A0431
AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES,
TRANSPORT, ONE WAY (ROTARY WING)
A0433
ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2)
cohort
cohort
A0434
SPECIALTY CARE TRANSPORT (SCT)
cohort
cohort
A0435
FIXED WING AIR MILEAGE, PER STATUTE MILE
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
193
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
A0436
ROTARY WING AIR MILEAGE, PER STATUTE MILE
A0888
NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR
MILESTRAVELED BEYOND CLOSEST APPROPRIATE FACILITY)
A0998
AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT
A4206
Syringe with needle, sterile, 1 cc or less, each
statewide
A4208
SYRINGE WITH NEEDLE, STERILE 3CC, EACH
statewide
A4212
NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER
cohort
A4216
STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH,
10 ML
cohort
A4217
STERILE WATER/SALINE, 500 ML
A4218
STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML
statewide
A4220
REFILL KIT FOR IMPLANTABLE INFUSION PUMP
A4222
SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER
CASSETTE ORBAG (LIST DRUG SEPARATELY)
statewide
A4248
CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML
cohort
A4264
PERMANENT IMPLANTABLE CONTRACEPTIVE INTRATUBAL
OCCLUSION DEVICE(S) AND DELIVERY SYSTEM
cohort
cohort
cohort
A4270
DISPOSABLE ENDOSCOPE SHEATH, EACH
cohort
cohort
cohort
A4300
IMPLANTABLE ACCESS CATHETER (VENOUS, ARTERIAL,
EPIDURAL ORPERITONEAL), EXTERNAL ACCESS
A4301
IMPLANTABLE ACCESS TOTAL SYSTEM; CATHETER,
PORT/RESERVOIR(VENOUS, ARTERIAL OR EPIDURAL),
PERCUTANEOUS ACCESS
A4306
DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF
LESSTHAN 50 ML PER HOUR
A4310
INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT
CATHETER(ACCESSORIES ONLY)
A4314
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING
CATHETER,FOLEY TYPE, TWO-WAY LATEX WITH COATING
(TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC,
ETC.)
statewide
A4316
INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING
CATHETER,FOLEY TYPE, THREE-WAY, FOR CONTINUOUS
IRRIGATION
statewide
A4320
IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY
PURPOSE
statewide
A4322
IRRIGATION SYRINGE, BULB OR PISTON, EACH
statewide
A4334
URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH
A4335
INCONTINENCE SUPPLY; MISCELLANEOUS
A4338
INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH
COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR
HYDROPHILIC, ETC.), EACH
A4340
INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE,
MUSHROOM,WING, ETC.), EACH
A4344
INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE,
EACH
A4346
INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR
CONTINUOUSIRRIGATION, EACH
A4349
DISPOSABLE MALE EXTERNAL CATHETER
A4351
INTERMITTENT URINARY CATHETER; STRAIGHT TIP, EACH
A4353
INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES
A4355
IRRIGATION TUBING SET FOR CONTINUOUS BLADDER
IRRIGATIONTHROUGH A THREE-WAY INDWELLING FOLEY
CATHETER, EACH
A4357
BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR
WITHOUTANTI-REFLUX DEVICE, WITH OR WITHOUT TUBE, EACH
A4358
URINARY LEG BAG; VINYL, WITH OR WITHOUT TUBE, EACH
cohort
A4364
ADHESIVE FOR OSTOMY OR CATHETER; LIQUID (SPRAY,
BRUSH,ETC.), CEMENT, POWDER OR PASTE; ANY COMPOSITION
statewide
Peer
Cohort
5
Peer
Cohort
6
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
194
statewide
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
(E.G. SILICONE, LATEX, ETC.); PER OZ.
A4373
OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE,OR
ACCORDION), STANDARD WEAR, WITH BUILT-IN CONVEXITY,
ANY SIZE, EACH
A4421
OSTOMY SUPPLY; MISCELLANEOUS
A4463
SURGICAL DRESSING HOLDER, REUSABLE, EACH
A4465
NON-ELASTIC BINDER FOR EXTREMITY
A4466
GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR
SIMILAR STRETCHABLE MATERIAL, ANY TYPE, EACH
A4495
SURGICAL STOCKINGS THIGH LENGTH, EACH
A4550
SURGICAL TRAYS
A4562
PESSARY, NON RUBBER, ANY TYPE
A4565
SLINGS
cohort
cohort
A4570
SPLINT
cohort
cohort
A4614
PEAK EXPIRATORY FLOW RATE METER, HAND HELD
A4615
CANNULA, NASAL
A4616
TUBING (OXYGEN), PER FOOT
statewide
A4628
OROPHARYNGEAL SUCTION CATHETER, EACH
statewide
A4641
RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE
CLASSIFIED
cohort
cohort
cohort
A4648
Tissue marker, implantable, any type, each
cohort
cohort
cohort
cohort
A4649
SURGICAL SUPPLY; MISCELLANEOUS
cohort
cohort
cohort
cohort
A4719
"Y SET" TUBNG FOR PERITONEAL DIALYSIS
statewide
A4722
DIALYSATE SOLUTION ANY CONCENTRATION OF DEXTROSE
FLUID VOLUME GREATER THAN 1999CC BUT LESS THAN OR
EQUAL TO 2999CC FOR PERITONEAL DIALYSIS
statewide
A4725
DIALYSATE SOLUTION ANY CONCENTRATION OF DEXTROSE
FLUID VOLUME GREATER THAN 4999CC BUT LESS THAN OR
EQUAL TO 5999CC FOR PERITONEAL DIALYSIS
statewide
A5500
FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOWUP),CUSTOMPREPARATION AND SUPPLY OF OFF-THE-SHELF
DEP TH-INLAY SHOE MANUFACTURED TO ACCOMMODATE
MULTI- DENSITY INSERT(S), PER
statewide
A5512
FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT
FORMED, MOLDED TO FOOT AFTER EXTERNAL HEAT SOURCE
OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT
WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYE
A6021
Collagen dressing, sterile, size 16 sq. In. Or less, each
A6022
Collagen dressing, sterile, size more than 16 sq. In. But less than or
equal to 48 sq. In. , each
A6196
ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND
COVER, STERILE, PAD SIZE 16 SQ.IN. OR LESS, EACH DRESSING
cohort
cohort
cohort
cohort
A6197
COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS
THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING
cohort
cohort
cohort
cohort
A6199
FILLER, STERILE, PER 6 INCHES
statewide
A6207
CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS
cohort
cohort
cohort
A6209
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN.
OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
cohort
cohort
cohort
cohort
A6210
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE
MORETHAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN.,
WITHOUT ADHESIVE BORDER, EACH DRESSING
cohort
cohort
cohort
cohort
A6211
MORETHAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DR
ESSING
A6212
FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN.
OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
statewide
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
195
cohort
statewide
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
A6213
MORETHAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN.,
WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING
cohort
A6215
FOAM DRESSING, WOUND FILLER, STERILE, PER GRAM
A6222
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL
SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS,
WITHOUT ADHESIVE BORDER, EACH
A6223
GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL
SALINE, OR HYDROGEL, STERILE, PAD SIZE MORE THAN 16SQ
INCHES, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6234
HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE
16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH
DRESSING
A6240
HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE,
PER OUNCE
A6242
HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16
SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6248
HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE
cohort
cohort
A6250
SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS,
ANYTYPE, ANY SIZE
cohort
cohort
A6251
SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE,
PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER,
EACH DRESSING
statewide
A6252
PAD SIZE MORE THAN 16 SQ. IN., BUT LESS THAN OREQUAL TO
48 SQ. IN., WITHOUT ADHESIVE BORDER, EAC H DRESSING
cohort
A6253
PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVEBORDER,
EACH DRESSING
statewide
A6257
TRANSPARENT FILM, STERILE, 16 SQ. IN. OR LESS, EACH
DRESSING
cohort
cohort
A6258
TRANSPARENT FILM, STERILE, MORE THAN 16 SQ. IN. BUT LESS
cohort
cohort
A6259
TRANSPARENT FILM, STERILE, MORE THAN 48 SQ. IN., EACH
DRESSING
statewide
A6260
WOUND CLEANSERS, ANY TYPE, ANY SIZE
statewide
A6266
GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE,
OR ZINC PASTE, STERILE, ANY WIDTH, PER LINEAR YARD
A6402
GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN.
ORLESS, WITHOUT ADHESIVE BORDER, EACH DRESSING
A6407
PACKING STRIPS, NON-IMPREGNATED, STERILE, UP TO 2
INCHES IN WIDTH, PER LINEAR YARD
statewide
A6413
Adhesive bandage, first-aid type, any size, each
statewide
A6443
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NONSTERILE, WIDTH GREATER THAN
cohort
A6444
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NONSTERILE, WIDTH GREATER THAN
A6445
CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN,
STERILE, WIDTH LESS THAN THREE
cohort
cohort
A6446
STERILE, WIDTH GREATER THAN OR
cohort
cohort
A6447
STERILE, WIDTH GREATER THAN OR
statewide
A6448
LIGHT COMPRESSION BANDAGE, ELASTIC,
KNITTED/WOVEN,WIDTH LESS THAN THREE
statewide
A6449
KNITTED/WOVEN,WIDTH GREATER THAN OR EQUAL
cohort
A6450
KNITTED/WOVEN,WIDTH GREATER THAN OR EQUAL
statewide
A6451
MODERATE COMPRESSION BANDAGE, ELASTIC,
KNITTED/WOVEN, LOAD RESISTANCE OF 1.25
A6453
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
196
cohort
statewide
cohort
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
cohort
cohort
cohort
cohort
Peer
Cohort
5
Peer
Cohort
6
WOVEN, WIDTH LESS THAN THREE
A6454
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NONWOVEN, WIDTH GREATER THAN OR
A6455
SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NONWOVEN, WIDTH GREATER THAN OR
A6456
ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC,
KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE
INCHES AND LESS THAN FIVE INCHES, PER YARD
A6457
TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH,
PER LINEAR YARD
A6534
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 3040MMHG, EACH
statewide
A6535
GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 4050MMHG, EACH
statewide
A6538
GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP
STYLE, 40-50 MMHG, EACH
statewide
A6550
WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND
THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND
ACCESSORIES
A7000
CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH
cohort
A7002
TUBING, USED WITH SUCTION PUMP, EACH
statewide
A7003
ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED
PNEUMATIC NEBULIZER, DISPOSABLE
statewide
A7030
FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE
DEVICE, EACH
statewide
A7042
IMPLANTED PLEURAL CATHETER, EACH
A7043
VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH
IMPLANTED CATHETER
A7501
TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH
statewide
A7503
FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A
TRACHEOSTOMA HEAT
statewide
A7504
FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE
EXCHANGE SYSTEM, EACH
statewide
A7506
ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE
SYSTEM AND/OR WITH
statewide
A7521
TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED,
POLYVINYLCHLORIDE (PVC), SILICONE OR
A9150
NON-PRESCRIPTION DRUGS
A9152
SINGLE VITAMIN NOS
A9153
MULTI-VITAMIN NOS
A9270
NON-COVERED ITEM OR SERVICE
A9280
ALERT OR ALARM DEVICE, NOT OTHERWISE CLASSIFIED
A9500
TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDYDOSE
cohort
cohort
cohort
cohort
cohort
A9502
TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY
DOSE
cohort
cohort
cohort
cohort
cohort
A9503
TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER
STUDYDOSE, UP TO 30 MILLICURIES
cohort
cohort
cohort
cohort
cohort
A9505
THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC,
PERMILLICURIE
cohort
A9508
IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5
MILLICURIE
cohort
A9509
Iodine I-123 Sodium Iodide, diagnostic, per millicurie
A9510
TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER
cohort
cohort
A9512
TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER
MILLICURIE
cohort
cohort
cohort
cohort
cohort
A9516
Iodine I-123 Sodium Iodide, diagnostic, per 100 microcuries, up to 999
microcuries
cohort
cohort
cohort
cohort
cohort
A9517
IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER
cohort
cohort
cohort
cohort
statewide
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
197
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
cohort
cohort
cohort
MILLICURIE
A9521
TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY
DOSE, UP TO 25 MILLICURIES
A9524
IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5
MICROCURIES
statewide
A9526
NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE,UP
TO 40 MILLICURIES
statewide
A9527
IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC,PER
MILLICURIE
statewide
A9528
IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC,PER
MILLICURIE
cohort
cohort
A9529
IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER
MILLICURIE
cohort
cohort
A9530
IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER
MILLICURIE
cohort
cohort
A9531
IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE
(UP TO 100 MICROCURIES)
cohort
cohort
cohort
cohort
cohort
A9537
TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY
cohort
cohort
cohort
cohort
cohort
A9538
TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER
STUDY DOSE, UP TO 25 MILLICURIES
cohort
cohort
cohort
A9539
TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER
cohort
cohort
cohort
cohort
cohort
A9540
TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN,
DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES
cohort
cohort
cohort
cohort
cohort
A9541
TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER
cohort
cohort
cohort
cohort
cohort
A9543
YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER
TREATMENT DOSE, UP TO 40 MILLICURIES
cohort
cohort
A9547
INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE
cohort
cohort
A9548
INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE
cohort
A9550
TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER
STUDY DOSE, UP TO 25 MILLICURIE
statewide
A9551
TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY
A9552
FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER
A9554
IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY
DOSE, UP TO 10 MICROCURIES
statewide
A9555
RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60
MILLICURIES
statewide
A9556
GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE
A9557
TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE,
UP TO 25 MILLICURIES
A9558
XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES
A9560
TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC,
PER STUDY DOSE, UP TO 30 MILLICURIES
A9561
TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY
A9562
TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY
A9564
CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER
MILLICURIE
A9567
TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER
A9569
Technetium TC-99M Exametazime labeled autologous white blood
cells, diagnostic, per study dose
A9570
Indium IN-111 labeled autologous white blood cells, diagnostic, per
study dose
A9572
Indium IN-111 Pentetreotide, diagnostic, per studydose up to 6
millicuries
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
198
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
A9577
Injection, Gadobenate Dimeglumine (Multihance), per ml
A9579
Injection, Gadolinium-based magnetic resonance contrast agent, not
other wise specified (NOS), per ml
A9580
SODIUM FLUORIDE F-18, DIAGNOSTIC, PER STUDY DOSE, UP TO
30 MILLICURIES
A9581
INJECTION, GADOXETATE DISODIUM, 1 ML
cohort
cohort
A9582
IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP
TO 15 MILLICURIES
cohort
cohort
A9583
INJECTION, GADOFOSVESET TRISODIUM, 1 ML
statewide
A9584
IODINE 1-123 IOFLUPANE, DIAGNOSTIC, PER STUDY DOSE, UP
TO 5 MILLICURIES
A9585
INJECTION, GADOBUTROL, 0.1 ML
A9604
SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER
TREATMENT DOSE, UP TO 150 MILLICURIES
A9699
RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE
CLASSIFIED
A9999
MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT
OTHERWISE SPECIFIED
statewide
ADJUS
CLAIM WAITING REFUND
statewide
B4087
Gastrostomy/jejunostomy tube, standard, any material, any type, each
cohort
B4088
Gastrostomy/jejunostomy tube, low-profile, any material, any type, each
C1204
Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries
C1300
C code valid for UB claims only
cohort
cohort
cohort
cohort
cohort
C1713
cohort
cohort
cohort
cohort
cohort
C1714
cohort
cohort
cohort
cohort
C1715
cohort
cohort
C1717
C1721
C1722
cohort
Peer
Cohort
6
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
C1724
cohort
cohort
cohort
cohort
C1725
cohort
cohort
cohort
cohort
cohort
C1726
cohort
cohort
cohort
cohort
cohort
C1727
cohort
cohort
cohort
cohort
cohort
C1728
cohort
cohort
C1729
cohort
cohort
cohort
cohort
cohort
C1730
cohort
cohort
cohort
cohort
cohort
C1731
cohort
cohort
cohort
C1732
cohort
cohort
cohort
C1733
cohort
cohort
cohort
cohort
C1750
cohort
cohort
cohort
cohort
cohort
C1751
C CODE VALID FOR UB CLAIMS ONLY
cohort
cohort
cohort
cohort
cohort
C1752
cohort
cohort
cohort
C1753
cohort
cohort
cohort
cohort
cohort
C1755
cohort
cohort
cohort
cohort
cohort
C1756
C1757
cohort
cohort
cohort
cohort
cohort
C1758
cohort
cohort
cohort
cohort
cohort
C1759
cohort
cohort
cohort
C1760
cohort
cohort
cohort
cohort
cohort
C1762
cohort
cohort
cohort
cohort
cohort
C1763
cohort
cohort
cohort
cohort
C1764
cohort
cohort
cohort
cohort
C1765
cohort
cohort
cohort
cohort
cohort
statewide
cohort
199
cohort
CPT
Description
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
C1766
cohort
cohort
cohort
cohort
C1767
cohort
cohort
cohort
cohort
cohort
C1768
cohort
cohort
cohort
cohort
cohort
C1769
cohort
cohort
cohort
cohort
cohort
C1770
C1771
cohort
C1772
cohort
C1773
cohort
C1776
cohort
C1777
C1778
C1779
C1780
LENS, INTRAOCULAR (NEW TECHNOLOGY) [C CODES FOR
FACILITY CLAIMS ONLY]
cohort
cohort
cohort
cohort
cohort
C1781
cohort
cohort
cohort
cohort
cohort
cohort
C1782
cohort
cohort
cohort
cohort
cohort
C1783
cohort
cohort
cohort
cohort
C1784
cohort
cohort
cohort
cohort
C1785
cohort
cohort
cohort
cohort
C1786
C1787
cohort
cohort
cohort
cohort
cohort
C1788
cohort
cohort
cohort
cohort
cohort
C1789
cohort
cohort
cohort
cohort
cohort
C1813
cohort
cohort
cohort
cohort
C1814
C CODES VALID FOR UB ONLY
cohort
cohort
cohort
cohort
C1815
cohort
cohort
cohort
C1816
C1817
C1818
C1819
C1820
C1821
cohort
C1830
Powered bone marrow biopsy needle
cohort
cohort
cohort
cohort
C1874
cohort
cohort
cohort
cohort
C1875
C1876
C1877
C1878
C1879
cohort
cohort
cohort
cohort
C1880
cohort
cohort
cohort
cohort
C1881
C1882
C1883
C1884
C1885
C1886
CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY
(INSERTABLE) [C codes used by facilities only]
C1887
C CODES VALID FOR UB CLAIMS ONLY
C1888
C1892
C1893
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
200
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
C1894
cohort
C1895
C1897
C1898
C1899
C1900
C2615
C2616
C2617
cohort
cohort
cohort
cohort
cohort
C2618
cohort
cohort
cohort
cohort
cohort
C2621
cohort
cohort
C2625
cohort
cohort
cohort
cohort
C2626
C2627
cohort
cohort
cohort
cohort
C2628
cohort
cohort
cohort
cohort
C2629
C2630
C2631
C2634
C2638
C2639
C2641
C8900
C8901
C8902
C8905
C8906
C8907
C8908
C8909
C8910
C8911
C8912
C8913
C8914
C8918
C8919
C8920
cohort
C8922
statewide
C8923
C8924
C8925
C8928
C8929
C Code valid for UB claims only
C8930
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
C8936
Magnetic resonance angiography without contrast followed by with
contrast, upper extremity
statewide
C8957
statewide
C9113
cohort
C9257
statewide
C9285
Lidocaine 70 mg/tetracaine 70 mg, per patch [C codes should be used
statewide
cohort
statewide
cohort
201
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
by facilities only]
C9290
Injection, bupivacaine liposome, 1 mg [C codes valid with facility claims
only]
C9292
INJECTION, PERTUZUMAB, 10 MG C CODES CAN ONLY BE USED
ON UB FACILITY CLAIMS
C9352
C9359
C codes valid for UB claims only
cohort
cohort
C9362
cohort
cohort
C9399
statewide
C9600
Percutaneous transcatheter placement of drug eluting intracoronary
stent(s), with coronary angioplasty when performed; single major
coronary artery orbranch [C code for facility claims only]
C9601
Percutaneous transcatheter placement of drug-eluting intracoronary
stent(s), with coronary angioplasty when performed; each additional
branch of a major coronary artery (list separately in addition to
C9602
Percutaneous transluminal coronary atherectomy, with drug eluting
intracoronary stent, with coronaryangioplasty when performed; single
major coronary artery or branch [C code for facility claims only
C9604
Percutaneous transluminal revascularization of or through coronary
artery bypass graft (internal mammary, free arterial, venous), any
combination of drug-eluting intracoronary stent, atherectomy and a
C9606
Percutaneous transluminal revascularization of acute total/subtotal
occlusion during acute myocardial infarction, coronary artery or
coronary artery bypass graft, any combination of drug-eluting intr
C9607
Percutaneous transluminal revascularization of chronic total occlusion,
coronary artery, coronary artery branch, or coronary artery bypass graft,
any combination of drug-eluting intracoronary stent, a
C9724
Endoscopic full-thickness plication in the gastriccardia using endoscopic
plication system (eps); i ncludes endoscopy [C codes used for facility
claims only]
C9726
C9728
C9736
Laparoscopy, surgical, radiofrequency ablation of uterine fibroid(s),
including intraoperative guidance and monitoring, when performed
C9898
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
C codes valid for UB claims only
cohort
cohort
D0150
COMPREHENSIVE ORAL EVALUATION
statewide
D0210
Intraoral - complete series of radiographic images
D0220
Intraoral - periapical first radiographic image
cohort
cohort
D0230
Intraoral - periapical each additional radiographic image
cohort
cohort
D0240
Intraoral - 0cclusal radiographic image
statewide
D0272
Bitewings - two radiographic images
statewide
D0274
Bitewings - four radiographic images
D0470
DIAGNOSTIC CASTS
D1110
PROPHYLAXIS-ADULT
D1120
PROPHYLAXIS-CHILD
cohort
cohort
cohort
cohort
D1206
Topical application of fluoride varnish
cohort
cohort
cohort
cohort
D1208
Topical application of fluoride
cohort
cohort
cohort
D1351
SEALANT-PER TOOTH
cohort
cohort
cohort
D1510
SPACE MAINTAINER-FIXED UNILATERAL
statewide
D2140
AMALGAM RESTORATIONS - ONE SURFACE, PERMANENT
D2330
RESIN RESTORATIONS - ONE SURFACE, ANTERIOR
cohort
D2331
RESIN RESTORATIONS - TWO SURFACES, ANTERIOR
cohort
D2332
RESIN RESTORATIONS - THREE SURFACES, ANTERIOR
statewide
D2335
RESIN RESTORATIONS - FOUR OR MORE SURFACES OR
INVOLVINGINCISAL ANGLE (ANTERIOR)
cohort
D2390
RESIN-BASED COMPOSITE CROWN, ANTERIOR
cohort
cohort
D2391
RESIN-BASED COMPOSITE - ONE SURFACE,
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
202
cohort
cohort
cohort
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
D2392
RESIN-BASED COMPOSITE - TWO SURFACES,
cohort
cohort
D2393
RESIN-BASED COMPOSITE - THREE SURFACES,
cohort
cohort
D2394
RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES,
statewide
D2650
INLAY RESTORATIONS, COMPOSITE/RESIN-ONE SURFACE
(LABORATORY PROCESSED)
statewide
D2662
ONLAY - COMPOSITE/RESIN - TWO SURFACES
(LABORATORYPROCESSED
statewide
D2710
CROWN RESTORATIONS-RESIN (LABORATORY)
D2740
CROWN RESTORATIONS-PORCELAIN/CERAMIC SUBSTRATE
D2930
PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH
D2932
PREFABRICATED RESIN CROWN
D2934
PREFABRICATED ESTHETIC COATED STAINLESS STEEL
D2940
PROTECTIVE RESTORATION
D2980
Crown repair necessitated by restorative material failure
D2999
UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT
D3120
PULP CAP-INDIRECT
D3220
THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION)
cohort
D3221
GROSS PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT
statewide
D3230
PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY
TOOTH (EXCLUDING FINAL RESTORATION)
cohort
D3310
ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL
RESTORATION)
D3320
ENDODONTIC THERAPY, BICUSPID TOOTH (EXCLUDING FINAL
RESTORATION)
D3330
ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL
RESTORATION)
D4341
PERIODONTAL SCALING AND ROOT PLANING-PER QUADRANT
D7140
EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION
AND/OR FORCEPS REMOVAL)
cohort
D7241
REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH
UNUSUALSURGICAL COMPLICATIONS
statewide
D7250
SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING
PROCEDURE)
D7310
ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR
OR MORE TEETH OR TOOTH
E0105
CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL
MATERIALS, ADJUSTABLE OR FIXED, WITH TIPS
E0110
CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS
MATERIALS,ADJUSTABLE OR FIXED, PAIR, COMPLETE WITH TIPS
AND HANDGRIPS
E0112
CRUTCHES, UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR,
WITHPADS, TIPS AND HANDGRIPS
E0114
CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR
FIXED,PAIR, WITH PADS, TIPS AND HANDGRIPS
E0116
CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR
FIXED, WITH PAD, TIP, HANDGRIP, WITH OR WITHOUT SHOCK
ABSORBER, EACH
E0117
CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH
E0135
WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT
E0160
SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR
WITHOUT COMMODE
E0218
WATER CIRCULATING COLD PAD WITH PUMP
E0603
BREAST PUMP ELECTRIC (AC AND/OR DC), ANY TYPE
E0607
HOME BLOOD GLUCOSE MONITOR
E0621
SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON
E0781
AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE
CHANNELS, WITH ADMINISTRATIVE EQUIPMENT, WORN BY
PATIENT
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
203
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CPT
Description
E0782
INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE
E0870
TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY
TRACTION,(E.G. BUCK'S)
statewide
E0910
TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED,
WITHGRAB BAR
statewide
E1700
JAW MOTION REHABILITATION SYSTEM
G0008
ADMINISTRATION OF INFLUENZA VIRUS VACCINE
cohort
cohort
cohort
cohort
cohort
G0009
ADMINISTRATION OF PNEUMOCOCCAL VACCINE
cohort
cohort
cohort
cohort
cohort
G0010
ADMINISTRATION OF HEPATITIS B VACCINE
cohort
cohort
G0027
SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM
EXCLUDING HUHNER
statewide
G0101
CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND
CLINICAL BREAST EXAMINATION
G0102
PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAM
G0103
PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN
TEST (PSA)
statewide
G0104
COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY
cohort
G0105
COLORECTAL CANCER SCREENING; COLONOSCOPY ON
INDIVIDUAL ATHIGH RISK
cohort
cohort
G0108
DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING
SERVICES,INDIVIDUAL, PER SESSION
cohort
cohort
G0109
DIABETES SELF-MANAGEMENT TRAINING SERVICES, GROUP
SESSION,PER INDIVIDUAL
G0121
COLORECTAL CANCER SCREENING; COLONOSCOPY ON
INDIVIDUAL NOTMEETING CRITERIA FOR HIGH RISK
G0127
TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER
G0130
SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE
DENSITYSTUDY, ONE OR MORE SITES; APPENDICULAR
SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL)
statewide
G0145
SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY
REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID,
AUTOMATED THIN LAYER PREPARATION, WITH MANUAL
SCREENING AND
statewide
G0168
WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY
G0173
STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF
THERAPY IN ONE SESSION
statewide
G0176
ACTIVITY THERAPY, SUCH AS MUSIC, DANCE,ART, OR PLAY
THERAPY NOT FOR RECREATION RELATED TO CARE AND
TREATMENT OF PATIENTS DISABLING MENTAL HEALTH
PROBLEMS, PER SESSION (45 MINUTES OR MORE)
statewide
G0202
SCREENING MAMOGRAPHY PRODUCING DIRECT DIGITAL IMAGE,
BILATERAL ALL VIEWS.
cohort
cohort
cohort
cohort
cohort
cohort
G0204
DIAGNOSTIC MAMMOGRAPHY, DIRECT DIGITAL IMAGE,
BILATERAL ALL VIEWS.
cohort
cohort
cohort
cohort
cohort
cohort
G0206
DIAGNOSTIC MAMMOGRAPHY, DIRECT DIGITAL IMAGE,
UNILATERAL ALL VIEWS.
cohort
cohort
cohort
cohort
cohort
cohort
G0237
THERAPEUTIC PROCEDURES TO INCREASE STRENGTH OR
ENDURANCE OF RESPIRATORY MUSCLES, FACE TO FACE ONE
ON ONE EACH 15 MINUTES (INCLUDES MONITORING)
cohort
cohort
cohort
cohort
cohort
G0238
THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY
FUNCTION, OTHER THAN DESCRIBED BY G0237 ONE ON
ONEFACE TO FACE PER 15 MINUTES (INCLUDES MONITORING)
cohort
cohort
cohort
cohort
cohort
G0239
THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY
FUNCTION, OTHER THAN SERVICES DESCRIBED BY G0237 TWO
OR MORE (INCLUDING MONITORING)
cohort
cohort
cohort
cohort
cohort
G0251
LINEAR ACCELERATOR BASED STERIOTACTIC
RADIOSURGERYDELIVERY INCLUDING COLLIMATOR CAHNGE
AND CUSTOM PLUGGING FRACTIONED TREATMENT, ALL
LESIONS, PER SESSION, MAX 5 SESSIONS PER COURSE
G0257
UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN
ESRD PATIENT IN A HOSPITAL
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
204
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
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CPT
Description
G0259
INJECTION PROCEDURE FOR SACROILIAC JOINT;
ARTHROGRAPY
G0260
INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF
ANESTHETIC, STEROID
G0269
PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR
ARTIERIAL ACCESS SITE
G0275
RENAL ARTERY ANGIOGRAPHY (UNILATERAL OR
BILATERAL)PERFORMED AT THE TIME OF CARDIAC
CATHETERIZATION, INCLUDES CATHETER PLACEMENT,
INJECTION OF DYE,
G0278
ILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME
OF CARDIAC CATHETERIZATION
cohort
G0288
RECONSTRUCTION, COMPUTED TOMOGRAPHIC ANGIOGRAPHY
OF AORTA FOR SURGICAL PLANNING
G0289
ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE
BODY, FOREIGN BODY
G0339
IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASE
STEREOTACTIC RADIOSURGERY COMPLETE COURSE OF
THERAPY INONE SESSION OR FIRST SESSION OF
FRACTIONATED TREA TMENT
G0340
IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASED
STEREOTACTIC RADIOSURGERY DELIVERY INCLUDING
COLLIMATOR CHANGES AND CUSTOM PLUGGING
FRACTIONATED TREATMENT ALL LESIONS PER SESSION MAX 5
SESSIONS PER TREA
G0364
BONE MARROR ASPIRATE & BIOPSY
G0365
VESSEL MAPPING HEMO ACCESS
cohort
cohort
G0378
HOSPITAL OBSERVATION SERVICE, PER HOUR
cohort
G0379
DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION
CARE
cohort
G0380
Level I hospital emergency department visit provided in a type B
emergency department; (The ED must meet at least one of the following
requirements: (1) it is licensed by the state in which it is loc
G0381
Level 2 hospital emergency department visit provided in a type B
requirements:
G0382
requirements:
G0383
requirements:
G0384
requirements:
G0389
ULTRASOUND B-SCAN AND/OR REAL TIME WITH IMAGE
DOCUMENTATION; FOR ABDOMINAL AORTIC ANEURYSM (AAA)
SCREENING
cohort
G0390
TRAUMA RESPONSE TEAM ASSOCIATED WITH HOSPITAL
CRITICAL CARE SERVICE
G0399
HOME SLEEP STUDY TEST (HST) WITH TYPE III
PROTABLEMONITOR, UNATTENDED; MINIMUM OF 4 CHANNELS: 2
RESPIRATORY MOVEMENT/AIR FLOW, 1 ECG/HEART RATE, AND
1 OXYGEN SATURATION
G0402
INITIAL PREVENTIVE PHYSICAL EXAMINATION; FACE-TO-FACE
VISIT, SERVICES LIMITED TO NEW BENEFICIARY DURING THE
FIRST 12 MO OF MEDICARE ENROLLMENT
G0410
GROUP PSYCHOTHERAPY OTHER THAN OF A MULTIPLE-FAMILY
GROUP, IN A PARTIAL HOSPITALIZATION SETTING,
APPROXIMATELY 45 TO 50 MINUTES
G0424
PULMONARY REHABILITATION, INCLUDING EXERCISE (INCLUDES
MONITORING), ONE HOUR, PER SESSION,
G0431
DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES
BYHIGH COMPLEXITY TEST METHOD (E.G., IMMUNOASSAY, E
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cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
205
cohort
cohort
CPT
Peer
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Description
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NZYME ASSAY), PER PATIENT ENCOUNTER
G0435
Infectious agent antigen detection by rapid antibody test of oral mucosa
transudate, HIV-1 or HIV-2,screening
statewide
G0436
SMOKING AND TOBACCO CESSATION COUNSELING VISIT
FORTHE ASYMPTOMATIC PATIENT; INTERMEDIATE, GREATER T
HAN 3 MINUTES, UP TO 10 MINUTES
statewide
G8553
PRESCRIPTION(S) GENERATED AND TRANSMITTED VIA A
QUALIFIED ERX SYSTEM OR A CERTIFIED EHR SYSTEM
G9019
OSELTAMIVIR PHOSPHATE, ORAL
H0015
ALCOHOL AND/OR DRUG SERVICES; INTENSIVE
OUTPATIENTTREATMENT PROGRAM
statewide
H0035
MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS
THAN 24 HOURS
cohort
H075
MAJOR CHEST PROCEDURES
statewide
H181
G.I. OBSTRUCTION W/O CC
statewide
H189
OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC
statewide
H209
MAJ JOINT & LIMB REATTACH PROC OF LOW EXT, EXC HIPEXC
FOR COMP
H359
UTERINE + ADNEXA PROC FOR CA IN SITU + NON-MALIGNA
H373
VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES
H493
LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E W CC
H813
NONBACTERIAL GASTROENTERITIS & ABDOMINAL PAIN AGE >17
W/CC
statewide
H876
CHEMO W ACUTE LEUKEMIA AS SDX OR WITH USE OF HIGH
DOSE CHEMO AGENT
statewide
J0110
J0129
INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR
MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT
SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS
SELF ADMINISTERED)
J0130
INJECTION ABCIXIMAB, 10 MG
J0131
INJECTION, ACETAMINOPHEN, 10 MG
J0132
INJECTION, ACETYLCYSTEINE, 100 MG
statewide
J0133
INJECTION, ACYCLOVIR, 5 MG
statewide
J0150
INJECTION, ADENOSINE, 6 MG (NOT TO BE USED TO REPORT
ANYADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE
A9270)
J0152
INJECTION ADENOSINE 30MG (NOT TO BE USED TO REPORTANY
ADENOSINE PHOSPHATE)
J0171
INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG
J0178
Injection, aflibercept, 1 mg
statewide
J0180
AGALSIDASE BETA INJECTION, 1MG
statewide
J0221
INJECTION, ALGLUCOSIDASE ALFA, (LUMIZYME), 10 MG
J0278
INJECTION, AMIKACIN SULFATE, 100 MG
cohort
cohort
J0280
INJECTION, AMINOPHYLLIN, UP TO 250 MG
cohort
cohort
J0282
INJECTION, AMIODARONE HYDROCHLORINE, 30 MG
cohort
cohort
J0289
INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG
J0290
INJECTION, AMPICILLIN SODIUM,
J0295
INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER1.5
GM
cohort
cohort
J0330
INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG
cohort
cohort
J0360
INJECTION, HYDRALAZINE HCL, UP TO 20 MG
cohort
J0456
AZITHROMYCIN- INJECTION, AZITHROMYCIN, 500 MG
J0461
INJECTION, ATROPINE SULFATE, 0.01 MG
J0475
INJECTION, BACLOFEN, 10 MG
statewide
J0490
INJECTION, BELIMUMAB, 10 MG [Benlysta]
statewide
statewide
statewide
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
206
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
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cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
J0500
INJECTION, DICYCLOMINE HCL, UP TO 20 MG
cohort
J0561
INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS
cohort
J0583
INJECTION BIVALIRUDIN 1MG
cohort
cohort
J0585
INJECTION, ONABOTULINUMTOXINA, 1 UNIT
J0595
INJECTION BUTORPHANOL TARTRATE 1 MG
cohort
cohort
J0597
INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10
UNITS
J0610
INJECTION, CALCIUM GLUCONATE, PER 10 ML
J0630
INJECTION, CALCITONIN SALMON, UP TO 400 UNITS
J0640
INJECTION, LEUCOVORIN CALCIUM, PER 50 MG
cohort
J0650
statewide
J0670
INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML
J0690
INJECTION, CEFAZOLIN SODIUM,
J0692
INJECTION, CEFEPIME HYDROCHLORIDE, 500MG.
J0694
INJECTION, CEFOXITIN SODIUM, 1 GM
cohort
cohort
J0696
INJECTION, CEFTRIAXONE SODIUM, PER 250 MG
cohort
cohort
J0697
INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG
cohort
J0698
CEFOTAXIME SODIUM, PER GM
cohort
J0702
Injection, Betamethasone Acetate 3 mg and Betamethasone Sodium
Phosphate 3 mg
cohort
cohort
J0706
NJECTION CAFFEINE CITRATE 5MG
J0713
INJECTION, CEFTAZIDIME, PER 500 MG
cohort
cohort
J0725
INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS
J0735
INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG
J0740
INJECTION CIDOFOVIR, 375 MG
J0743
INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG
statewide
J0744
INJECTION CIPROFLOXACIN FOR INTRAVENOUS INFUSION
200MG
cohort
J0760
INJECTION, COLCHICINE, PER 1MG
J0780
INJECTION, PROCHLORPERAZINE, UP TO 10 MG
J0833
INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25
MG
J0834
INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG
J0840
INJECTION, CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), UP
TO 1 GRAM
statewide
J0850
INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN
INTRAVENOUS(HUMAN), PER VIAL
statewide
J0878
DAPTOMYCIN INJECTION 1MG
J0881
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRDUSE)
J0882
INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRDON
DIALYSIS)
statewide
J0885
INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS
cohort
J0886
INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS)
statewide
J0894
INJECTION, DECITABINE, 1 MG
J0895
INJECTION, DEFEROXAMINE MESYLATE, 500 MG PER 5 CC
J0897
INJECTION, DENOSUMAB, 1 MG [Prolia] [XGEVA]
J1020
INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG
J1030
J1040
J1050
Injection, medroxyprogesterone acetate, 1 mg
J1070
INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG
statewide
J1080
INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG
statewide
J1100
INJECTION, DEXAMETHOSONE SODIUM PHOSPHATE, UP TO
4MG/ML
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Cohort
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statewide
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
207
cohort
cohort
cohort
cohort
cohort
cohort
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CPT
Description
J1110
INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG
cohort
cohort
cohort
J1120
INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG
cohort
cohort
cohort
J1160
INJECTION, DIGOXIN, UP TO 0.5 MG
cohort
J1165
INJECTION, PHENYTOIN SODIUM, PER 50 MG
cohort
cohort
cohort
J1170
INJECTION, HYDROMORPHONE, UP TO 4 MG
cohort
cohort
cohort
cohort
J1200
INJECTION, DIPHENHYDRAMINE HCL,
cohort
cohort
cohort
cohort
J1212
INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML
J1245
INJECTION, DIPYRIDAMOLE, PER 10 MG
J1250
INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG
cohort
J1260
INJECTION, DOLASETRON MESYLATE, 1 MG
statewide
J1265
INJECTION, DOPAMINE HCL, 40 MG
cohort
J1300
Injection, Eculizumab, 10 mg
J1327
EPTIFIBATIDE INJECTION, 500 MG
cohort
J1335
INJECTION ERTAPENEM SODIUM 500MG
cohort
J1364
INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG
J1410
INJECTION, ESTROGEN
J1440
INJECTION, FILGRASTIM (G-CSF), 300 MCG
J1441
INJECTION, FILGRASTIM (G-CSF), 480 MCG
J1450
INJECTION FLUCONAZOLE, 200 MG
J1453
INJECTION, FOSAPREPITANT, 1 MG
J1455
INJECTION, FOSCARNET SODIUM, PER 1000 MG
J1459
INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NONLYOPHILIZED (E.G. LIQUID), 500 MG
J1559
INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG
J1561
Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.
g. Liquid), 500 mg
J1566
Injection, immune globulin, intravenous, lyophilized (e.g., powder), not
otherwise specified, 500 mg
statewide
J1569
Injection, immune globulin, (gammagard liquid), non-lyophilized, (e. g.
Liquid), 500 mg
statewide
J1570
INJECTION, GANCICLOVIR SODIUM, 500 MG
J1580
INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG
cohort
cohort
cohort
J1610
INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG
cohort
cohort
cohort
J1630
INJECTION, HALOPERIDOL, UP TO 5 MG
cohort
cohort
cohort
J1642
INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER
10UNITS
cohort
cohort
cohort
J1644
INJECTION, HEPARIN SODIUM, PER 1000 UNITS
cohort
cohort
J1645
INJECTION, DALTEPARIN SODIUM, PER 2500 IU
statewide
J1650
INJECTION, ENOXAPARIN SODIUM, 10 MG
cohort
cohort
cohort
J1652
INJECTION FONDAPARINUX SODIUM 0.5 MG.
cohort
J1670
INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250
UNITS
J1720
INJECTION, HYDROCORTISONE
J1725
INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG
[Makena]
J1740
INJECTION, IBANDRONATE SODIUM, 1 MG
J1742
INJECTION, IBUTILIDE FUMARATE, 1 MG
J1745
INJECTION INFLIXIMAB, 10MG
J1750
INJECTION, IRON DEXTRAN, 50MG
J1756
INJECTION IRON SUCROSE 1 MG.
cohort
J1790
INJECTION, DROPERIDOL, UP TO 5 MG
cohort
J1800
INJECTION, PROPRANOLOL HCL, UP TO 1 MG
cohort
J1815
INJECTION INSULIN PER 5 UNITS
cohort
Peer
Cohort
6
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
208
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Description
J1817
INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN
PUMP) PER 50 UNITS
J1885
INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG
cohort
cohort
J1940
INJECTION, FUROSEMIDE, UP TO 20 MG
cohort
cohort
J1950
INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION),
PER3.75 MG
J1953
INJECTION, LEVETIRACETAM, 10 MG
J1956
INJECTION, LEVOFLOXACIN, 250 MG
J1980
INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG
J2001
INJECTION LIDOCAINE HCL FOR INTRAVENOUS INFUSION 10 MG
cohort
cohort
cohort
cohort
cohort
J2060
INJECTION, LORAZEPAM, 2 MG
cohort
cohort
cohort
cohort
cohort
J2150
INJECTION, MANNITOL, 25% IN 50 ML
cohort
cohort
J2175
INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG
cohort
cohort
J2185
INJECTION MEROPENEM 100MG
cohort
cohort
cohort
J2210
INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG
cohort
cohort
cohort
J2248
INJECTION, MICAFUNGIN SODIUM, 1 MG
J2250
INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG
cohort
cohort
cohort
cohort
cohort
cohort
J2270
INJECTION, MORPHINE SULFATE, UP TO 10 MG
cohort
cohort
cohort
cohort
cohort
cohort
J2271
INJECTION, MORPHINE SULFATE, 100MG
J2275
INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE
STERILESOLUTION), PER 10 MG
cohort
cohort
cohort
J2280
INJECTION MOXIFLOXACIN 100MG
cohort
cohort
cohort
J2300
INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG
cohort
cohort
J2310
INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG
cohort
cohort
J2323
Injection, Natalizumab, 1 mg
J2353
INJECTION OCTREOTIDE DEPOT FORM FOR INTRAMUSCULAR
INJECTION 1 MG
cohort
J2354
INJECTION OCTREOTIDE NON-DEPOT FORM FOR SUBCUTANEOUS OR INTRAVENOUS
cohort
J2357
OMALIZUMAB INJECTION, 5MG
cohort
J2360
INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG
statewide
J2370
INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML
cohort
J2400
INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML
J2405
INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG
J2425
INJECTION, PALIFERMIN, 50 MICROGRAMS
statewide
J2430
INJECTION, PAMIDRONATE DISODIUM, PER 30 MG
statewide
J2440
INJECTION, PAPAVERINE HCL, UP TO 60 MG
J2469
PALONOSETRON HCL INJECTION, 25MCG
J2501
INJECTION PARICALCITOL 1 MCG.
J2505
INJECTION PEGFILGRASTIM 6 MG
J2507
INJECTION, PEGLOTICASE, 1 MG [Krystexxa]
J2515
INJECTION, PENTOBARBITAL SODIUM, PER 50 MG
J2540
INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS
J2543
INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1
GRAM0.125 GRAMS (1.125 GRAMS)
J2545
Pentamidine Isethionate, inhalation solution, FDA-approved final
product, non-compounded, administered through DME, unit dose form,
per 300 mg
J2550
INJECTION, PROMETHAZINE HCL, UP TO 50 MG
J2560
INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG
J2562
INJECTION, PLERIXAFOR, 1 MG
J2590
INJECTION, OXYTOCIN, UP TO 10 UNITS
cohort
J2597
INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG
cohort
J2690
INJECTION, PROCAINAMIDE HCL, UP TO 1 GM
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
209
CPT
Description
Peer
Cohort
1
J2710
INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG
cohort
J2720
INJECTION, PROTAMINE SULFATE, PER 10 MG
J2730
INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM
J2765
INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG
J2778
Injection, Ranibizumab, 0.1 mg
J2780
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG
cohort
cohort
J2785
INJECTION, REGADENOSON, 0.1 MG
cohort
cohort
cohort
cohort
J2788
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE,50
MICROGRAMS (250 I.U.)
cohort
J2790
INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300
MICROGRAMS (1500 I.U.)
cohort
J2791
Injection, RHO (D) immune globulin (human), (Rhophylac),
intramuscular or intravenous, 100 IU
statewide
J2792
INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS,
HUMAN,SOLVENT DETERGENT, 100 IU
J2795
INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG
cohort
J2800
INJECTION, METHOCARBAMOL, UP TO 10 ML
cohort
J2805
INJECTION, SINCALIDE, 5 MICROGRAMS
cohort
cohort
cohort
J2916
INJECTION SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE
INJECTION 12.5 MG
cohort
cohort
cohort
J2920
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UPTO
40 MG
cohort
cohort
cohort
cohort
cohort
J2930
INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UPTO
125 MG
cohort
cohort
cohort
cohort
cohort
J2997
INJECTION, ALTEPLASE RECOMBINANT, 1 MG
cohort
cohort
J3010
INJECTION, FENTANYL CITRATE, UP TO 2 ML
cohort
cohort
J3030
INJECTION, SUMATRIPTAN SUCCINATE, 6 MG, ADMINISTERED
UNDERDIRECT PHYSICIAN SUPERVISION, EXCLUDES SELF
ADMINISTRATION
cohort
cohort
cohort
J3101
INJECTION, TENECTEPLASE, 1 MG
statewide
J3105
INJECTION, TERBUTALINE SULFATE, UP TO 1 MG.
cohort
J3190
statewide
J3230
INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG
J3240
INJECTION, THYROTROPIN, UP TO 10 I.U.
cohort
J3243
INJECTION, TIGECYCLINE, 1 MG
statewide
J3260
INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG
cohort
J3262
INJECTION, TOCILIZUMAB, 1 MG
statewide
J3300
INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE,
1MG
statewide
J3301
INJECTION, TRIAMCINOLONE ACETONIDE, NOT
OTHERWISESPECIFIED, 10 MG
J3303
INJECTION TRIAMCINOLONE HEXACETONIDE, PER 5MG
J3315
INJECTION TRIPTORELIN PAMOATE 3.75 MG.
J3360
INJECTION, DIAZEPAM, UP TO 5 MG
cohort
cohort
cohort
J3370
INJECTION, VANCOMYCIN HCL, UP TO 500 MG
cohort
cohort
cohort
J3396
VERTEPORFIN INJECTION,0.1 MG
J3410
INJECTION, HYDROXYZINE HCL, UP TO 25 MG
cohort
cohort
cohort
J3411
INJECTION THIAMINE HCL 100MG
cohort
cohort
cohort
J3415
INJECTION PYRIDOXINE HCL 100MG
J3420
INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000MCG
cohort
cohort
cohort
J3430
INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG
cohort
cohort
cohort
J3465
INJECTION VORICONAZOLE 10 MG
J3470
INJECTION, HYALURONIDASE, UP TO 150 UNITS
cohort
J3471
INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER
1 USP UNIT (UP TO 999 USP UNITS)
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
statewide
statewide
210
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
CPT
Description
J3473
INJECTION, HYALURONIDASE, RECOMBINANT, 1 USP UNIT
J3475
INJECTION, MAGNESIUM SULFATE, PER 500 MG
cohort
cohort
cohort
cohort
cohort
J3480
INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ
cohort
cohort
cohort
cohort
cohort
J3486
INJECTION ZIPRASIDONE MESYLATE 10MG
J3487
Injection, Zoledronic acid (Zometa), 1 mg
cohort
cohort
cohort
J3488
Injection, Zoledronic Acid (Reclast), 1 mg
cohort
cohort
cohort
cohort
J3490
UNCLASSIFIED DRUGS
cohort
cohort
cohort
cohort
cohort
J3535
DRUG ADMINISTERED THROUGH A METERED DOSE INHALER
statewide
J3590
UNCLASSIFIED BIOLOGICS
cohort
cohort
J7020
J7030
INFUSION, NORMAL SALINE SOLUTION, 1000 CC
cohort
cohort
cohort
cohort
cohort
cohort
J7040
INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT)
cohort
cohort
cohort
cohort
cohort
cohort
J7042
5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT)
cohort
cohort
cohort
cohort
cohort
cohort
J7050
INFUSION, NORMAL SALINE SOLUTION, 250 CC
cohort
cohort
cohort
cohort
cohort
cohort
J7060
5% DEXTROSE/WATER (500 ML = 1 UNIT)
cohort
cohort
cohort
cohort
cohort
J7070
INFUSION, D5W, 1000 CC
cohort
cohort
cohort
cohort
J7100
INFUSION, DEXTRAN 40, 500 ML
J7120
RINGERS LACTATE INFUSION, UP TO 1000 CC
cohort
cohort
cohort
J7187
Injection, Von Willebrand factor complex (Humate-P), per IU VWF:RCO
J7192
FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER
I.U., NOT OTHERWISE SPECIFIED
J7194
FACTOR IX, COMPLEX, PER I.U.
statewide
J7195
FACTOR IX (ANTIHEMOPHILIAC FACTOR, RECOMBINANT) PER IU
statewide
J7300
INTRAUTERINE COPPER CONTRACEPTIVE
statewide
J7302
LEVONORGESTREL-RELEASING INTRAUTERINE
CONTRACEPTIVSYSTEM 52 MG
cohort
cohort
J7307
Etonogestrel (contraceptive) Implant System, including implant and
supplies
cohort
cohort
J7311
FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT
statewide
J7315
Mitomycin, opthalmic, 0. 2 mg
statewide
J7324
Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose
J7330
Autologous cultured chondrocytes, implant
J7500
AZATHIOPRINE - ORAL, TAB, 50 MG, 100S EA
J7502
CYCLOSPORINE, ORAL, 100 MG.
J7506
PREDNISONE, ORAL, PER 5 MG
J7507
TACROLIMUS, ORAL, PER 1 MG
J7509
METHYLPREDNISOLONE ORAL, PER 4 MG
J7510
PREDNISOLONE ORAL, PER 5 MG
J7517
statewide
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
statewide
statewide
cohort
statewide
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
MYCOPHENOLATE MOFETIL, ORAL, 250 MG
cohort
cohort
J7518
MYCOPHENOLIC ACID, ORAL, 180 MG
statewide
J7520
SIROLIMUS, ORAL, 1 MG
statewide
J7525
TACROLIMUS, PARENTERAL, 5 MG
statewide
J7605
Arformoterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, 15
micrograms
statewide
J7607
LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED
PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED
FORM, 0.5 MG
statewide
J7608
Acetylcysteine, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose form, per gram
cohort
J7609
ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT,
ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG
statewide
J7611
Albuterol, inhalation solution, FDA-approved finalproduct, noncompounded, administered through DME , concentrated form, 1 mg
cohort
cohort
211
cohort
cohort
cohort
cohort
cohort
CPT
Description
Peer
Cohort
1
J7612
Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 1 mg
cohort
cohort
cohort
cohort
J7613
Albuterol, inhalation solution, FDA-approved finalproduct, noncompounded, administered through DME , unit dose, 1 mg
cohort
cohort
cohort
cohort
cohort
J7614
Levalbuterol, inhalation solution, FDA-approved final product, noncompounded, administered through DME, unit dose, 0.5 mg
cohort
cohort
cohort
cohort
J7620
ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO
0.5 MG, FDA-APPROVED
cohort
cohort
cohort
J7622
BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED
PRODUCT, ADMINISTERED THROUGH
J7626
BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL
PRODUCT, NON-COMPOUNDED,
cohort
J7627
BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT,
ADMINISTERED THROUGH DME,
statewide
J7638
DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED
statewide
J7642
GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED
J7644
IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDAAPPROVED FINAL PRODUCT,
cohort
J7645
IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED
PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM,
PER MILLIGRAM
statewide
J7674
METHACHOLINE CHLORIDE ADM AS INHALATION SOLUTION
THROUGH A NEBULIZER, PER 1MG
J7676
Pentamidine Isethionate, inhalation solution, compounded product,
administered through DME, unit dose form, per 300 mg
J7799
NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED
THROUGHDME
J8498
ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT
OTHERWISESPECIFIED
J8499
PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS
cohort
cohort
cohort
J8501
APREPITANT, ORAL, 5MG
cohort
cohort
cohort
J8530
CYCLOPHOSPHAMIDE; ORAL, 25 MG
J8540
DEXAMETHASONE, ORAL, 0.25 MG
cohort
J8597
ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED
statewide
J8700
TEMOZOLMIDE, ORAL, 5 MG
J8999
PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS
J9000
INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG
cohort
cohort
J9002
Injection, Doxorubicin Hydrochloride, Liposomal, Doxil, 10 mg
cohort
cohort
J9010
INJECTION, ALEMTUZUMAB, 10 MG
statewide
J9017
INJECTION, ARSENIC TRIOXIDE, 1 MG
statewide
J9025
INJECTION, AZACITIDINE, 1 MG
J9033
INJECTION, BENDAMUSTINE HCL, 1 MG
cohort
cohort
J9035
BEVACIZUMAB INJECTION, 10MG
cohort
cohort
cohort
J9040
INJECTION, BLEOMYCIN SULFATE, 15 UNITS
cohort
cohort
J9041
BORTEZOMIB INJECTION, 0.1 MG
cohort
cohort
cohort
J9045
INJECTION, CARBOPLATIN, 50 MG
cohort
cohort
cohort
J9055
CETUXIMAB INJECTION, 10MG
cohort
cohort
J9060
INJECTION, CISPLATIN, POWDER OR S0LUTION, 10 MG
cohort
cohort
cohort
J9070
CYCLOPHOSPHAMIDE, 100 MG
cohort
cohort
cohort
J9098
INJECTION, CYTARABINE LIPOSOME, 10 MG
statewide
J9100
INJECTION, CYTARABINE, 100 MG
statewide
J9120
INJECTION, DACTINOMYCIN, 0.5 MG
J9130
DACARBAZINE, 100 MG
J9155
INJECTION, DEGARELIX, 1 MG
cohort
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
cohort
statewide
statewide
cohort
cohort
statewide
212
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
CPT
Description
J9171
INJECTION, DOCETAXEL, 1 MG
J9175
INJECTION, ELLIOTTS' B SOLUTION, 1 ML
statewide
J9178
INJECTION EPIRUBICIN HCL 2MG
cohort
J9179
INJECTION, ERIBULIN MESYLATE, 0.1 MG
J9181
INJECTION, ETOPOSIDE, 10 MG
cohort
cohort
J9185
INJECTION, FLUDARABINE PHOSPHATE, 50 MG
cohort
cohort
J9190
INJECTION, FLUOROURACIL, 500 MG
cohort
cohort
cohort
J9201
INJECTION, GEMCITABINE HYDROCHLORIDE, 200 MG
cohort
cohort
cohort
J9202
GOSERELIN ACETATE IMPLANT, PER 3.6 MG
J9206
INJECTION, IRINOTECAN, 20 MG
J9207
INJECTION, IXABEPILONE, 1 MG
statewide
J9208
INJECTION, IFOSFAMIDE, 1 GRAM
cohort
cohort
J9209
INJECTION, MESNA, 200 MG
cohort
cohort
J9217
LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG
J9218
LEUPROLIDE ACETATE, PER 1 MG
J9226
Histrelin implant (Supprelin LA), 50 mg
cohort
J9228
INJECTION, IPILIMUMAB, 1 MG [Yervoy]
statewide
J9245
INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG
J9250
METHOTREXATE SODIUM, 5 MG
J9260
METHOTREXATE SODIUM, 50 MG
J9261
INJECTION, NELARABINE, 50 MG
J9263
INJECTION OXALIPLATIN 0.5 MG
cohort
cohort
J9264
INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG
cohort
cohort
J9265
INJECTION, PACLITAXEL, 30 MG
cohort
cohort
J9266
INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL
J9270
INJECTION, PLICAMYCIN, 2.5 MG
cohort
cohort
J9280
Injection, mitomycin, 5 mg
cohort
cohort
J9303
Injection, Panitumumab, 10 mg
J9305
PEMETREXED INJECTION, 10MG
J9307
INJECTION, PRALATREXATE, 1 MG
J9310
INJECTION, RITUXIMAB, 100 MG
J9315
INJECTION, ROMIDEPSIN, 1 MG
statewide
J9328
INJECTION, TEMOZOLOMIDE, 1 MG
statewide
J9330
INJECTION, TEMSIROLIMUS, 1 MG
statewide
J9351
INJECTION, TOPOTECAN, 0.1 MG
J9355
INJECTION, TRASTUZUMAB, 10 MG
cohort
cohort
J9360
INJECTION, VINBLASTINE SULFATE, 1 MG
cohort
cohort
J9370
VINCRISTINE SULFATE, 1 MG
J9390
INJECTION, VINORELBINE TARTRATE, 10 MG
cohort
cohort
J9395
INJECTION, FULVESTRANT, 25 MG
cohort
cohort
J9999
NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS
statewide
L0120
CERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR)
L0130
CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO
PATIENT
L0140
CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR)
L0150
CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP
(PLASTICCOLLAR WITH MANDIBULAR/OCCIPITAL PIECE)
L0172
CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO
PIECE
cohort
cohort
L0174
CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO
PIECE WITH THORACIC EXTENSION
cohort
cohort
L0180
CERVICAL, MULTIPLE POST COLLAR,
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
statewide
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
213
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
OCCIPITAL/MANDIBULARSUPPORTS, ADJUSTABLE
L0458
TLSO TRIPLANAR CONTROL MODULAR SEGMENTED SPINAL
SYSTEM TWO RIGID PLASTIC SHELLS POSTERIOR EXTENDS
FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES
JUST INFERIOR TO THE SCAPULAR SPINE
L0484
TLSO TRIPLANAR CONTROL TWO PIECE RIGID PLASTIC SHELL
WITHOUT INTERFACE LINER
L0486
TLSO TRIPLANAR CONTROL TWO PIECE RIGID PLASTIC SHELL
WITH INTERFACE LINER
L0625
LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT,
POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA,
PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON
THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSU
cohort
L0627
LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR
AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM L-1 TO
BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE
TO REDUCE LOAD ON THE INTERVERTEBRAL DISC
cohort
L0628
LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBOSACRAL SUPPORT, POSTERIOR EXTENDS FROM
SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES
INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE
INTERVERTEBRAL DI
L0631
LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID
ANTERIOR AND POSTERIOR
L0636
LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL,
LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL
ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE,
POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO
statewide
L0999
ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
statewide
L1020
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD
statewide
L1030
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR
BOLSTER PAD
statewide
L1040
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR
ORLUMBARRIB PAD
statewide
L1050
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD
statewide
L1060
ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD
statewide
L1200
THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE
OFFURNISHING INITIAL ORTHOSIS ONLY
L1499
SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED
L1620
HO, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE,
PAVLIKHARNESS
L1652
HIP ORTHOSIS BILATERAL THIGH CUFFS WITH
ADJUSTABLEABDUCTOR SPREADER BAR
L1810
KO, ELASTIC WITH JOINTS
L1820
KO, ELASTIC WITH CONDYLAR PADS AND JOINTS
L1830
KO, IMMOBILIZER, CANVAS LONGITUDINAL
L1832
KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR
POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT,
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L1845
KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH
ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR
POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL,
WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PR
L1902
AFO, ANKLE GAUNTLET
L1930
AFO, PLASTIC
L1940
AFO, MOLDED TO PATIENT MODEL, PLASTIC
statewide
L1970
AFO, PLASTIC MOLDED TO PATIENT MODEL, WITH ANKLE JOINT
statewide
L1990
AFO, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION,
SOLIDSTIRRUP, CALF BAND/CUFF (DOUBLE BAR "BK" ORTHOSIS)
L2112
AFO, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT
L2114
AFO, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI-
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
statewide
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
214
cohort
cohort
statewide
statewide
cohort
cohort
Peer
Cohort
6
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
RIGID
L2275
ADDITION TO LOWER EXTREMITY, VARUS/VALGUS
CORRECTION,PLASTIC MODIFICATION, PADDED/LINED
L2999
LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED
L3000
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL,
"UCB"TYPE, BERKELEY SHELL, EACH
L3010
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT
MODEL,LONGITUDINAL ARCH SUPPORT, EACH
L3020
FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT
MODEL,LONGITUDINAL/METATARSAL SUPPORT, EACH
L3031
FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER
EXTREMITY ORTHOSIS, HIGH
L3160
FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE
L3204
ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR,
INFANT
statewide
L3224
ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED
ASANINTEGRAL PART OF A BRACE (ORTHOSIS)
statewide
L3260
AMBULATORY SURGICAL BOOT, EACH
cohort
cohort
L3265
PLASTAZOTE SANDAL, EACH
cohort
cohort
L3300
LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PERINCH
L3334
LIFT, ELEVATION, HEEL, PER INCH
L3610
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER,
CALIPERPLATE, NEW
statewide
L3630
TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER,
SOLIDSTIRRUP, NEW
statewide
L3650
SHOULDER ORTHOSIS, (SO), FIGURE OF "8" DESIGN ABDUCTION
RE- STRAINER
cohort
cohort
cohort
L3660
SO, FIGURE OF "8" DESIGN ABDUCTION RESTRAINER, CANVAS
ANDWEBBING
cohort
cohort
cohort
L3670
SO, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE)
cohort
cohort
cohort
L3702
ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING
AND ADJUSTMENT
statewide
L3720
EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE
MOTION
cohort
L3730
EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS,
EXTENSION/FLEXION ASSIST
statewide
L3763
ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY
INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
INCLUDES FITTING AND ADJUSTMENT
statewide
L3764
ELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE
NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY
statewide
L3765
ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT
JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM
FABRICATED, INCLUDES FITTING AND ADJUSTMENT
statewide
L3806
Wrist hand finger orthosis, includes one or more nontorsion joint(s),
turnbuckles, elastic bands/springs, may include soft interface material,
straps,custom fabricated, includes fitting and adjustmen
statewide
L3807
WHFO, EXTENSION ASSIST, WITH INFLATABLE PALMER
AIRSUPPORT, WITH OR WITHOUT THUMB EXTENSION
L3808
WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT JOINTS, MAY
INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM
FABRICATED, INCLUDES FITTING AND ADJUSTMENT
L3900
WHFO, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST
EXTENSION/FLEXION, FINGER FLEXION/EXTENSION, WRIST OR
FINGER DRIVEN
statewide
L3905
WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE
INCLUDESOFT INTERFACE, STRAPS, CUSTOM FABRICATED,
INCLUD ES FITTING AND ADJUSTMENT
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
statewide
statewide
statewide
statewide
215
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Description
L3906
WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDESFITTING
AND ADJUSTMENT
L3908
WHO, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED
L3913
HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
AND ADJUSTMENT
cohort
L3919
HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
AND ADJUSTMENT
cohort
L3921
HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE
statewide
L3923
HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
INTERFACE, STRAPS, PREFABRICATED, INCLUDES FITTING AND
ADJUSTMENT
cohort
cohort
cohort
L3925
Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal
(DIP), non torsion joint/spring, extension/flexion, may include soft
interface material, prefabricated, includes fitting and adju
cohort
cohort
cohort
L3929
Hand finger orthosis, includes one or more nontorsion joints(s),
turnbuckles, elastic bands/springs,may include soft interface material,
straps, pref abricated, includes fitting and adjustment
L3933
FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT
INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING
ANDADJUSTMENT
cohort
L3935
FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT
INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING AND
ADJUSTMENT
cohort
L3962
SEWHO, ABDUCTION POSITIONING, ERBS PALSEY DESIGN
L3982
UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR
L3984
UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST
L3999
UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED
L4205
REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER
15MINUTES
L4210
REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE
MINORPARTS
L4350
PNEUMATIC ANKLE CONTROL SPLINT (E.G., AIRCAST)
L4360
WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR
WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL,
PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT
L4386
NON-PNEUMATIC WALKING SPLINT WITH OR WITHOUT JOINTS
PREFABRICATED INCLUDES FITTING AND ADJUSTMENTS
cohort
L4396
STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT
INTERFACE MATERIAL, ADJUSTABLE FOR FIT, FOR POSITIONING,
MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED,
cohort
L8000
Breast prosthesis, mastectomy bra, without integrated breast prosthesis
form, any size, any type
statewide
L8015
EXTERNAL BREAST PROSTHESIS GARMENT, WITH
MASTECTOMY FORM,POST MASTECTOMY
statewide
L8020
BREAST PROSTHESIS, MASTECTOMY FORM
statewide
L8030
BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL
ADHESIVE
L8460
PROSTHETIC SHRINKER, ABOVE KNEE, EACH
L8509
TRACHEO-ESOPHAGEAL VOICE PROSTHESIS INSERTED BY A
LICENSED HEALTH CARE PROVIDER ANY TYPE
L8600
IMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL
L8603
COLLAGEN IMPLANT, URINARY TRACT, PER 2.5 CC
SYRINGE,INCLUDES SHIPPING AND NECESSARY SUPPLIES
L8604
INJECTABLE BULKING AGENT, DEXTRANOMER/HYALURONIC
ACID COPOLYMER IMPLANT, URINARY TRACT, 1 ML, INCLUDES
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
216
Peer
Cohort
6
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
CPT
Peer
Cohort
1
Description
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
Peer
Cohort
6
SHIPPING AND NECESSARY SUPPLIES
L8606
INJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY
TRACT, 1 ML SYRINGE
cohort
cohort
L8610
OCULAR IMPLANT
cohort
cohort
L8612
AQUEOUS SHUNT
L8613
OSSICULA IMPLANT
L8614
COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL
COMPONENTS
statewide
L8627
COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR,
COMPONENT, REPLACEMENT
statewide
L8670
VASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT
statewide
L8680
IMPLANTABLE NEUROSTIMULATOR ELECTRODE (WITH ANY
NUMBER OF CONTACT POINTS), EACH
cohort
L8681
PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH
IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE
GENERATOR,REPLACEMENT ONLY
cohort
L8686
IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE
ARRAY, NON-RECHARGEABLE, INCLUDES EXTENSION
L8687
IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL
ARRAY, RECHARGEABLE, INCLUDES EXTENSION
L8689
EXTERNAL RECHARGING SYSTEM FOR BATTERY (INTERNAL)
FOR USE WITH IMPLANTABLE NEUROSTIMULATOR
REPLACEMENT ONLY
statewide
L8690
AUDITORY OSSEOINTEGRATED DEVICE, INCLUDES ALL
INTERNAL AND EXTERNAL COMPONENTS
cohort
L8693
AUDITORY OSSEOINTEGRATED DEVICE ABUTMENT, ANY
LENGTH, REPLACEMENT ONLY
L8699
PROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED
P9041
INFUSION, ALBUMIN (HUMAN), 5%, 50 ML
P9045
INFUSION ALBUMIN (HUMAN), 5%, 250 ML.
P9047
INFUSION ALBUMIN (HUMAN) 25%, 50ML.
P9612
CATHETERIZATION FOR COLLECTION OF SPECIMEN,
SINGLEPATIENT, ALL PLACES OF SERVICE
cohort
Q0081
INFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC
DRUGS,PER VISIT
statewide
Q0091
SCREENING PAPANICOLAOU SMEAR; OBTAINING,
PREPARINGANDCONVEYANCE OF CERVICAL OR VAGINAL
SMEAR TO LAB ORATORY
cohort
Q0092
SET-UP PORTABLE X-RAY EQUIPMENT
Q0111
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
WET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL,
CERVICAL, OR SKIN SPECIMENS
cohort
cohort
Q0112
ALL POTASSIUM HYDROXIDE (KOH) PREPARATIONS
cohort
cohort
Q0114
FERN TEST
cohort
cohort
Q0138
INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON
DEFICIENCY ANEMIA, 1 MG (FOR NON-ESRD ON DIALYSIS)
Q0144
AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1
GRAM
cohort
cohort
Q0162
ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION
ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC
SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF
CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR
DOSAGE R
cohort
cohort
cohort
cohort
Q0163
DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA
APPROVEDPRESCRIPTION ANTI-EMETIC, FOR USE AS A
COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTIEMETICAT TIME OF CHEMOTHERAPY
cohort
cohort
cohort
cohort
Q0164
PROCHLORPERAZINE MALEATE, 5PRESCRIPTION ANTI-EMETIC,
FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV
ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY
cohort
Q0165
PROCHLORPERAZINE MALEATE, 10PRESCRIPTION ANTI-EMETIC,
FOR USE AS A COMPLETE THERAPEUTIC
cohort
cohort
statewide
cohort
cohort
statewide
cohort
217
cohort
cohort
cohort
cohort
cohort
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
CPT
Description
Q0167
DRONABINOL, 2.5 MG, ORAL, FDA APPROVED
PRESCRIPTIONANTI-EMETIC, FOR USE AS A COMPLETE
THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE
TIME OF CHEMOTHERAPY TREATMENT,
Q0168
DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTIONANTIEMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE
FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY
TREATMENT,
Q0169
PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA
COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC
AT THE TIME OF CHEMOTHERAPY
cohort
Q0170
PROMETHAZINE HYDROCHLORIDE, 25PRESCRIPTION ANTIEMETIC, FOR USE AS A COMPLETE THERAPEUTIC
cohort
Q0171
CHLORPROMAZINE HYDROCHLORIDE, 10PRESCRIPTION ANTIEMETIC, FOR USE AS A COMPLETE THERAPEUTIC
Q0172
CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA
COMPLETE THERAPEUTIC
cohort
Q0177
HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED
PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE
cohort
Q0178
HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED
PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE
Q0496
BATTERY, OTHER THAN LITHIUM-ION, FOR USE WITH ELECTRIC
OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,
REPLACEMENT ONLY
statewide
Q0498
HOLSTER FOR USE
statewide
Q0499
BELT/VEST/BAG FOR USE TO CARRY EXTERNAL
PERIPHERALCOMPONENTS OF ANY TYPE VENTRICULAR ASSIST
DEVICE, REPLACEMENT ONLY
statewide
Q0501
SHOWER COVER FOR USE WITH ELECTRIC OR
ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE,
REPLACEMENT ONLY
statewide
Q0508
Miscellaneous supply or accessory for use with an implanted ventricular
assist device (VAD)
statewide
Q2009
INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT
statewide
Q2026
Injection, Radiesse, 0.1 ml
statewide
Q2035
INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED
TO INDIVIDUALS 3 YEARS OF AGE AND OLDER,
FORINTRAMUSCULAR USE (AFLURIA)
cohort
Q2036
FORINTRAMUSCULAR USE (Flulaval)
statewide
Q2037
FORINTRAMUSCULAR USE (FLUVIRIN)
Q2038
TO INDIVIDUALS 3 YEARS OF AGE AND ODER, FOR
INTRAMUSCULAR USE (FLUZONE)
Q2043
Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated
with PAP-GM-CSF, including leukapheresis and all other preparatory
procedures, per infusion
Q2050
Injection, doxorubicin Hydrochloride, Liposomal, not otherwise
specified, 10 mg
Q2051
Injection, Zoledronic Acid, not otherwise specified, 1 mg
Q3001
RADIOELEMENTS FOR BRACHYTHERAPY, ANY TYPE, EACH
Q3014
TELEHEALTH ORIGINATING SITE FACILITY FEE
Q4021
CAST SUPPLIES SHORT ARM SPLINT ADULT (11 YEARS+)
PLASTER
Peer
Cohort
5
statewide
statewide
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
statewide
cohort
statewide
statewide
statewide
statewide
cohort
cohort
statewide
cohort
cohort
statewide
218
cohort
Peer
Cohort
6
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
Q4041
CAST SUPPLIES LONG LEG SPLINT ADULT (11 YEARS+) PLASTER
statewide
Q4042
CAST SUPPLIES LONG LEG SPLINT ADULT (11 YEARS+)
FIBERGLASS
statewide
Q4045
CAST SUPPLIES SHORT LEG SPLINT ADULT (11 YEARS+)
PLASTER
Q4046
CAST SUPPLIES SHORT LEG SPLINT ADULT (11 YEARS+)
FIBERGLASS
Q4049
FINGER SPLINT STATIC
Q4081
INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS)
Q4100
SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED
Q4101
APLIGRAF, PER SQUARE CENTIMETER
cohort
Q4102
OASIS WOUND MATRIX, PER SQUARE CENTIMETER
statewide
Q4112
CYMETRA, INJECTABLE, 1CC
Q4116
ALLODERM, PER SQUARE CENTIMETER
Q4119
Matristem wound matrix, psmx, rs, or psm, per square centimeter
Q9954
ORAL MAGNETIC RESONANCE CONTRAST AGENT, PER ML
Q9957
INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML
Q9958
HIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE
CONCENTRATION PER ML
Q9959
HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE
Q9961
statewide
Q9962
statewide
Q9963
cohort
cohort
Q9965
Low osmolar contrast material, 100-199 mg/ml iodine concentration, per
ml
cohort
cohort
Q9966
ml
cohort
cohort
Q9967
ml
cohort
cohort
cohort
Q9968
INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION
ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG
cohort
cohort
cohort
S0020
INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML
cohort
cohort
S0028
INJECTION FAMOTIDINE 20 MG.
cohort
cohort
cohort
cohort
S0030
INJECTION METRONIDAZOLE, 500MG
statewide
S0073
INJECTION, AZTREONAM, 500 MG
S0077
INJECTON CLINDAMYCIN PHOSPHATE 300MG.
cohort
cohort
S0106
BUPROPION HCI SUSTAINED RELEASE TABLET 150 MG PER
BOTTLE OF 60 TABLETS
cohort
cohort
S0109
METHADONE, ORAL, 5MG
cohort
cohort
S0119
ONDANSETRON, ORAL, 4 MG (FOR CIRCUMSTANCES
FALLINGUNDER THE MEDICARE STATUTE, USE HCPCS Q CODE)
cohort
cohort
S0138
FINASTERIDE, 5 MG.
S0164
INJECTION, PANTOPRAZOLE SODIUM, 40 MG
cohort
S0179
MEGESTROL ACETATE ORAL 20 MG.
statewide
S0183
PROCHLORPERAZINE MALEATE ORAL 5MG. (FOR CIRCUMSTANCES FALLING UNDER THE MEDICARE STATUTE USE Q0164Q0165
statewide
S0187
TAMOXIFEN CITRATE ORAL 10MG.
cohort
S0191
MISOPROSTOL, ORAL 200 MCG.
S0390
ROUTINE FOOT CARE; REMOVAL AND/OR TRIMMING OF CORNS,
CALLUSES AND/OR NAILS AND PREVENTATIVE MAINTENANCE
PER VISIT
S1015
IV TUBING EXTENSION SET
cohort
Peer
Cohort
6
cohort
statewide
statewide
cohort
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
cohort
cohort
statewide
cohort
statewide
cohort
cohort
cohort
statewide
statewide
statewide
219
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
CPT
Description
S1040
CRANIAL REMOLDING ORTHOSIS, PEDIATRIC, RIGID, WITHSOFT
INTERFACE MATERIAL,
S1090
Mometasone Furoae sinus implant, 370 micrograms
S2070
CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR
PYELOSCOPY; WITH ENDOSCOPIC LASER TREATMENT OF
URETERAL CALCULI ( INCLUDES URETEREAL CATHERIZATION)
S2083
ADJUSTMENT OF GASTRIC BAND DIAMETER VIA SUBCUTANEOUS PORT BY INJECTION OR ASPIRATION OF SALINE
S2117
ARTHROEREISIS, SUBTALAR
S2140
CORD BLOOD HARVESTING FOR TRANSPLANTATION ALLOGENIC
S2325
HIP CORE DECOMPRESSION
S2900
SURGICAL TECHNIQUES REQUIRING USE OF ROBOTICS
SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE
cohort
cohort
S4991
NICOTINE PATCHES, NON-LEGEND
cohort
cohort
S5010
5% DEXTROSE AND 0.45% NORMAL SALINE 1000ML.
statewide
S5011
5% DEXTROSE IN LACTATED RINGER'S 1000 ML.
cohort
S8096
PORTABLE PEAK FLOW METER
cohort
S8101
HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR
NEBULIZER; WITH MASK
statewide
S9443
LACTATION CLASSES, NON-PHYSICIAN PROVIDER PER SESSION
cohort
S9470
NUTRITIONAL COUNSELING, DIETITIAN VISIT
S9480
INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM
T001
INPATIENT MEDICAL
T5001
POSITIONING SEAT FOR PERSONS WITH SPECIAL ORTHOPEDIC
NEEDS
T5999
SUPPLY, NOT OTHERWISE SPECIFIED
V2627
SCLERAL COVER SHELL
statewide
V2630
ANTERIOR CHAMBER INTRAOCULAR LENS
cohort
cohort
V2632
POSTERIOR CHAMBER INTRAOCULAR LENS
cohort
cohort
cohort
cohort
cohort
V2785
PROCESSING, PRESERVING AND TRANSPORTING CORNEAL
TISSUE
cohort
cohort
cohort
cohort
cohort
V2787
Astigmatism correcting function of intraocular lens
cohort
cohort
cohort
cohort
cohort
V2788
PRESBYOPIA CORRECTING FUNCTION OF INTRAOCULAR LENS
cohort
cohort
cohort
cohort
cohort
V2790
AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION PER
PROCEDURE
cohort
cohort
cohort
cohort
cohort
V2797
VISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT OF
ANOTHER HCPCS VISION CODE
V5011
FITTING/ORIENTATION/CHECKING OF HEARING AID
V5014
REPAIR/MODIFICATION OF A HEARING AID
V5020
CONFORMITY EVALUATION
V5050
HEARING AID, MONAURAL, IN THE EAR
statewide
V5090
DISPENSING FEE, UNSPECIFIED HEARING AID
cohort
cohort
V5110
DISPENSING FEE, BILATERAL
cohort
cohort
V5130
BINAURAL, IN THE EAR
statewide
V5160
DISPENSING FEE, BINAURAL
statewide
V5241
DISPENSING FEE MONAURAL HEARING AID ANY TYPE
cohort
V5256
HEARING AID DIGITAL MONAURAL ITE
statewide
V5257
HEARING AID DIGITAL MONAURAL BTE
cohort
cohort
V5261
HEARING AID DIGITAL BINAURAL BTE
cohort
cohort
V5264
EAR MOLD/INSERT NOT DISPOSABLE ANY TYPE
cohort
cohort
V5266
BATTERY FOR USE IN HEARING DEVICE
cohort
cohort
V5267
Hearing aid supplies / accessories
cohort
cohort
V5274
ASSISTANT LEARNING DEVICE NOT OTHERWISE SPECIFIED
cohort
cohort
V5275
EAR IMPRESSION EACH
Peer
Cohort
6
statewide
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
cohort
statewide
statewide
statewide
cohort
cohort
cohort
cohort
cohort
cohort
statewide
cohort
cohort
statewide
statewide
statewide
statewide
statewide
statewide
statewide
cohort
statewide
220
cohort
CPT
Description
V5290
Assistive listening device, transmitter microphone, any type
V5299
HEARING SERVICE, MISCELLANEOUS
Peer
Cohort
1
Peer
Cohort
2
Peer
Cohort
3
Peer
Cohort
4
Peer
Cohort
5
statewide
cohort
221
cohort
Peer
Cohort
6

2015 Facility Scoring Methodology for Blue Select

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