Highmark Joint Services CPT Code List

CPT® Code CPT® Code Description 29916 Arthroscopy, hip, surgical; with labral repair 29915 Arthroscopy, hip, surgical; with acetabuloplasty (i.e., treatment of pincer lesion) 29914 Arthroscopy, hip, surgical; with femoroplasty (i.e., treatment of cam lesion) 29863 Arthroscopy, hip, surgical; with synovectomy 29862 Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrum 29861 Arthroscopy, hip, surgical; with removal of loose body or foreign body 29860 Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure) 27138 Revision of total hip arthroplasty; femoral component only, with or without allograft 27137 Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograft 27134 Revision of total hip arthroplasty; both components, with or without autograft or allograft 27132 Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograft 27130 Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograft 27125 Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty) 29889 Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstruction 29888 Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstruction 29887 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation 29886 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion

29885 Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)

29884 Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure) 29883 Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral) 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage 29881 (chondroplasty), same or separate compartment(s), when performed Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage 29880 (chondroplasty), same or separate compartment(s), when performed

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description 29879 Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 29876 Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial or lateral) 29875 Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) (separate procedure) 29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation) 29873 Arthroscopy, knee, surgical; with lateral release 29871 Arthroscopy, knee, surgical; for infection, lavage and drainage 29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) 29868 Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateral 29867 Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty) 29866 Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting of the autograft[s]) 29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy 29805 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) 27487 Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial component 27486 Revision of total knee arthroplasty, with or without allograft; 1 component 27447 Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty) 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment 27443 Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomy 27442 Arthroplasty, femoral condyles or tibial plateau(s), knee; 27441 Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy 27440 Arthroplasty, knee, tibial plateau; 27438 Arthroplasty, patella; with prosthesis 27430 Quadricepsplasty (e.g., Bennett or Thompson type) 27429 Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articular 27428 Ligamentous reconstruction (augmentation), knee; intra-articular (open) 27427 Ligamentous reconstruction (augmentation), knee; extra- articular 27425 Lateral retinacular release, open 27424 Reconstruction of dislocating patella; with patellectomy

27422 Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (e.g., Campbell, Goldwaite type procedure)

27420 Reconstruction of dislocating patella; (e.g., Hauser type procedure) 27418 Anterior tibial tubercleplasty (e.g., Maquet type procedure)

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description 27416 Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of autograft[s]) 27415 Osteochondral allograft, knee, open 27412 Autologous chondrocyte implantation, knee 27403 Arthrotomy with meniscus repair, knee 27335 Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area 27334 Arthrotomy, with synovectomy, knee; anterior OR posterior 27333 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateral 27332 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateral 29828 Arthroscopy, shoulder, surgical; biceps tenodesis 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed 29826 (List separately in addition to code for primary procedure) 29825 Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulation 29824 Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure) 29823 Arthroscopy, shoulder, surgical; debridement, extensive 29822 Arthroscopy, shoulder, surgical; debridement, limited 29821 Arthroscopy, shoulder, surgical; synovectomy, complete 29820 Arthroscopy, shoulder, surgical; synovectomy, partial 29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body 23474 Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid component 23473 Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid component 23472 Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (e.g., total shoulder)) 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty 23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability 23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block 23462 Capsulorrhaphy, anterior, any type; with coracoid process transfer 23460 Capsulorrhaphy, anterior, any type; with bone block 23455 Capsulorrhaphy, anterior; with labral repair (e.g., Bankart procedure) 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation 23440 Resection or transplantation of long tendon of biceps 23430 Tenodesis of long tendon of biceps 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) 23415 Coracoacromial ligament release, with or without acromioplasty

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description 23412 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic 23410 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute 23130 Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament release 23120 Claviculectomy; partial 23020 Capsular contracture release (e.g., Sever type procedure) 23000 Removal of subdeltoid calcareous deposits, open

CPT® copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

V1.2019 Effective: 1/1/2019 Highmark Interventional Pain Management CPT Code List

CPT® Code CPT® Code Description 22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to 22527 code for primary procedure) 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performed Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic 62263 localization (includes contrast when administered), multiple adhesiolysis sessions; 2 or more days Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic 62264 localization (includes contrast when administered), multiple adhesiolysis sessions; 1 day 62280 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid

62281 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic

62282 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal)

62292 Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including 62320 needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including 62321 needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT) Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including 62322 needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including 62323 needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT)

Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, 62324 antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, 62325 antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (i.e., fluoroscopy or CT)

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, 62326 antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, 62327 antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (i.e., fluoroscopy or CT) Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable 62350 reservoir/infusion pump; without laminectomy Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable 62351 reservoir/infusion pump; with laminectomy 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir 62361 Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump

62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming

63650 Percutaneous implantation of neurostimulator electrode array, epidural 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling 64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List 64480 separately in addition to code for primary procedure) 64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List 64484 separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64490 cervical or thoracic; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64491 cervical or thoracic; second level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64492 cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64493 lumbar or sacral; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64494 lumbar or sacral; second level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), 64495 lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, single facet joint

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List 64634 separately in addition to code for primary procedure) 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List 64636 separately in addition to code for primary procedure) 0228T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to 0229T code for primary procedure) 0230T Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to 0231T code for primary procedure) C1767 Generator, neurostimulator (implantable), nonrechargeable C1778 Lead, neurostimulator (implantable) C1787 Patient programmer, neurostimulator C1820 Generator, neurostimulator (implantable), with rechargeable battery and charging system C1822 Generator, neurostimulator (implantable), high frequency, with rechargeable battery and charging system C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable) G0259 Injection procedure for sacroiliac joint; arthrograpy G0260 Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography

CPT® copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

V1.2019 Effective: 1/1/2019 Highmark Joint Services CPT Code List

CPT® Code CPT® Code Description E0749 Osteogenesis stimulator, electrical, surgically implanted E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications

Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, 0275T facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g., fluoroscopic, CT), single or multiple levels, unilateral or bilateral; lumbar Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, 0274T facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g., fluoroscopic, CT), single or multiple levels, unilateral or bilateral; cervical or thoracic Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for 0165T primary procedure)

0164T Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, 0163T lumbar (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for 0098T primary procedure)

0095T Removal of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for primary procedure) Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each 63082 additional segment (List separately in addition to code for primary procedure) Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single 63081 segment Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in 63076 addition to code for primary procedure) 63075 Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single interspace Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; each additional 63057 segment, thoracic or lumbar (List separately in addition to code for primary procedure) Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; lumbar (including 63056 transfacet, or lateral extraforaminal approach) (e.g., far lateral herniated intervertebral disc)

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the 63051 application of bridging bone graft and non-segmental fixation devices [e.g., wire, suture, mini- plates], when performed) 63050 Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments;

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral 63048 recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral 63047 recess stenosis]), single vertebral segment; lumbar Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral 63045 recess stenosis]), single vertebral segment; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63044 reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure) Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63043 reexploration, single interspace; each additional cervical interspace (List separately in addition to code for primary procedure) Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63042 reexploration, single interspace; lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63040 reexploration, single interspace; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 63035 each additional interspace, cervical or lumbar (List separately in addition to code for primary procedure) Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 63030 interspace, lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 63020 interspace, cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 63017 more than 2 vertebral segments; lumbar 63015 Laminectomy with exploration and/or decompression of spinal Laminectomy with removal of abnormal facets and/or pars inter- articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill 63012 type procedure) 63005 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 63001 or 2 vertebral segments; cervical Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated 62380 intervertebral disc, 1 interspace, lumbar Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under 62287 fluoroscopic imaging or other form of indirect visualization, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, 22870 lumbar; second level (List separately in addition to code for primary procedure) Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, 22867 lumbar; single level

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description 22862 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar 22861 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical Insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without 22859 interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord 22858 decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure)

22857 Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord 22856 decompression and microdissection); single interspace, cervical Insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), 22854 when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)

Insertion of interbody biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when 22853 performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure

22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)

22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in 22844 addition to code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition 22843 to code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition 22842 to code for primary procedure) 22841 Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare 22634 interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare 22633 interspace (other than for decompression), single interspace and segment; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each 22632 additional interspace (List separately in addition to code for primary procedure)

22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar

22614 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)

22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)

V1.2019 Effective: 1/1/2019 CPT® Code CPT® Code Description 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List 22585 separately in addition to code for primary procedure) 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below 22552 C2, each additional interspace (List separately in addition to code for separate procedure) Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below 22551 C2 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional 22534 vertebral segment (List separately in addition to code for primary procedure) 22533 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar 22515 Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., 22514 kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbar Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., 22513 kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracic Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each 22512 additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)

22511 Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; 22510 cervicothoracic 20975 Electrical stimulation to aid bone healing; invasive (operative) 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition 20938 to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary 20937 procedure) Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in 20936 addition to code for primary procedure) 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, 22869 lumbar; single level 22865 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar 22864 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical 22532 Lateral Extracavitary Approach Technique ArthrodesisProcedures on the Spine (Vertebral Column).

CPT® copyright 2017 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

V1.2019 Effective: 1/1/2019