SJH Procedures - ENT Service New Name Old Name CPT Code Service ADENOIDECTOMY ADENOIDECTOMY 42830 Adenoidectomy, primary; younger than age 12 ENT 42831 Adenoidectomy, primary; age 12 or over ENT 42835 Adenoidectomy, secondary; younger than age 12 ENT 42836 Adenoidectomy, secondary; age 12 or over ENT ADENOIDECTOMY, WITH BILATERAL MYRINGOTOMY AND MYRINGOTOMY W TUBES W ADENOIDECTOMY BILATERAL 42830 Adenoidectomy, primary; younger than age 12 ENT TYMPANOSTOMY TUBE INSERTION 42831 Adenoidectomy, primary; age 12 or over ENT 42835 Adenoidectomy, secondary; younger than age 12 ENT 42836 Adenoidectomy, secondary; age 12 or over ENT 69433 Tympanostomy (requiring insertion of ventilating tube), local ENT or topical anesthesia 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia ADENOIDECTOMY, WITH UNILATERAL MYRINGOTOMY AND MYRINGOTOMY W TUBES W ADENOIDECTOMY UNILATERAL 42830 Adenoidectomy, primary; younger than age 12 ENT TYMPANOSTOMY TUBE INSERTION 42831 Adenoidectomy, primary; age 12 or over ENT 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia ALVEOLOPLASTY, MAXILLA OR MANDIBLE ALVEOLOPLASTY MAXILLA/MANDIBLE 41874 Alveoloplasty, each quadrant (specify) Maxillofacial, ENT APPLICATION, GRAFT, SKIN, FULL-THICKNESS GRAFT SKIN FULL THICKNESS 15200 Full thickness graft, free, including direct closure of donor site, Plastics, ENT trunk; 20 sq cm or less 15201 Full thickness graft, free, including direct closure of donor site, Plastics, ENT trunk; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure) 15220 Full thickness graft, free, including direct closure of donor site, Plastics, ENT scalp, arms, and/or legs; 20 sq cm or less 15221 Full thickness graft, free, including direct closure of donor site, Plastics, ENT scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure) 15240 Full thickness graft, free, including direct closure of donor site, Plastics, ENT forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 15241 Full thickness graft, free, including direct closure of donor site, Plastics, ENT forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure) 15260 Full thickness graft, free, including direct closure of donor site, Plastics, ENT nose, ears, eyelids, and/or lips; 20 sq cm or less 15261 Full thickness graft, free, including direct closure of donor site, Plastics, ENT nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (list separately in addition to code for primary procedure) APPLICATION, GRAFT, SKIN, SPLIT-THICKNESS GRAFT SKIN SPLIT THICKNESS 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or Plastics, General, Vascular, ENT less, or 1% of body area of infants and children (except 15050)

Page 1 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service APPLICATION, GRAFT, SKIN, SPLIT-THICKNESS GRAFT SKIN SPLIT THICKNESS 15101 Split-thickness autograft, trunk, arms, legs; each additional 100 Plastics, General, Vascular, ENT sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure) 15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, Plastics, General, Vascular, ENT ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 15121 Split-thickness autograft, face, scalp, eyelids, mouth, neck, Plastics, General, Vascular, ENT ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition BIOPSY OR EXCISION, LESION, FACE AND NECK EXCISION/BIOPSY (MASS/LESION/LIPOMA/CYST) FACE/NECK General, Gynecology, Plastics, ENT, Maxillofacial BIOPSY OR EXCISION, LESION, FACE AND NECK, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE FACE/NECK 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Aesthetics, Urology, code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Aesthetics, Urology, addition to code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Aesthetics, Urology, Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Aesthetics, Urology, separately in addition to code for primary procedure) Maxillofacial, ENT, Thoracic, Vascular, Cardiovascular, Plastics, Orthopedics BIOPSY OR EXCISION, LESION, FACE AND NECK, USING CO2 LASER EXCISE/BIOPSY(MASS/LESION/LIPOMA/CYST) FACE/NECK W CO2 LASER 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Aesthetics, single lesion Cardiovascular, Colorectal, ENT, Maxillofacial, Plastics, Orthopedics, Spine, Thoracic, Urology, Vascular

Page 2 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service BIOPSY OR EXCISION, LESION, FACE AND NECK, USING CO2 LASER EXCISE/BIOPSY(MASS/LESION/LIPOMA/CYST) FACE/NECK W CO2 LASER 11104 Punch biopsy of skin (including simple closure, when General, Aesthetics, performed); single lesion Cardiovascular, Colorectal, ENT, Maxillofacial, Plastics, Orthopedics, Spine, Thoracic, Urology, Vascular 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Aesthetics, when performed); single lesion Cardiovascular, Colorectal, ENT, Maxillofacial, Plastics, Orthopedics, Spine, Thoracic, Urology, Vascular 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, General, Aesthetics, chemosurgery, surgical curettement), premalignant lesions (eg, Cardiovascular, Colorectal, actinic keratoses); first lesion ENT, Maxillofacial, Plastics, Orthopedics, Spine, Thoracic, Urology, Vascular BIOPSY OR EXCISION, LESION, LOWER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE LOWER BODY 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Orthopedics, Plastics, Urology, code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Orthopedics, Plastics, Urology, addition to code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Orthopedics, Plastics, Urology, Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry

Page 3 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service BIOPSY OR EXCISION, LESION, LOWER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE LOWER BODY 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Orthopedics, Plastics, Urology, separately in addition to code for primary procedure) Aesthetics, Vascular, Maxillofacial, Thoracic, Cardiovascular, ENT, Colorectal, Podiatry BIOPSY OR EXCISION, LESION, UPPER BODY EXCISION/BIOPSY ( MASS/LESION/LIPOMA/CYST) UPPER BODY General, Gynecology, Orthopedics, Plastics, ENT BIOPSY OR EXCISION, LESION, UPPER BODY, 2 OR MORE EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) MULTIPLE UPPER BODY 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Gynecology, each separate/additional lesion (list separately in addition to Orthopedics, Plastics, code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11104 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11105 Punch biopsy of skin (including simple closure, when General, Gynecology, performed); each separate/additional lesion (list separately in Orthopedics, Plastics, addition to code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); single lesion Orthopedics, Plastics, Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Gynecology, when performed); each separate/additional lesion (list Orthopedics, Plastics, separately in addition to code for primary procedure) Aesthetics, Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Vascular BIOPSY OR EXCISION, LESION, UPPER BODY, USING CO2 LASER EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) UPPER BODY W CO2 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); General, Aesthetics, single lesion Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Orthopedics, Plastics

Page 4 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service BIOPSY OR EXCISION, LESION, UPPER BODY, USING CO2 LASER EXCISE/BIOPSY (MASS/LESION/LIPOMA/CYST) UPPER BODY W CO2 11104 Punch biopsy of skin (including simple closure, when General, Aesthetics, performed); single lesion Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Orthopedics, Plastics 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, General, Aesthetics, when performed); single lesion Cardiac/Thoracic Robotics, Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Orthopedics, Plastics 17000 Destruction (eg, laser surgery, electrosurgery, cryosurgery, General, Aesthetics, chemosurgery, surgical curettement), premalignant lesions (eg, Cardiac/Thoracic Robotics, actinic keratoses); first lesion Cardiovascular, Colorectal, ENT, Maxillofacial, Spine, Orthopedics, Plastics CANALOPLASTY, EAR CANALPLASTY 69310 Reconstruction of external auditory canal (meatoplasty) (eg, ENT for stenosis due to injury, infection) (separate procedure) 69320 Reconstruction external auditory canal for congenital atresia, ENT single stage 69631 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction 69632 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration) 69633 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular repl 69635 Tympanoplasty with antrotomy or mastoidotomy (including ENT canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction CLOSED REDUCTION, FRACTURE, NASAL BONE CLOSED REDUCTION FRACTURE NOSE 21315 Closed treatment of nasal bone fracture; without stabilization ENT 21320 Closed treatment of nasal bone fracture; with stabilization ENT CLOSED REPAIR MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION ENT CLOSURE, WOUND, USING ROTATION FLAP GRAFT FLAP/CLOSURE/ROTATION 14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq Plastics, ENT cm or less 14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 Plastics, ENT sq cm to 30.0 sq cm 14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or Plastics, ENT legs; defect 10 sq cm or less 14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or Plastics, ENT legs; defect 10.1 sq cm to 30.0 sq cm 14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, Plastics, ENT chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less

Page 5 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service CLOSURE, WOUND, USING ROTATION FLAP GRAFT FLAP/CLOSURE/ROTATION 14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, Plastics, ENT 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 Plastics, ENT and/or lips; defect 10 sq cm or less 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears Plastics, ENT and/or lips; defect 10.1 sq cm to 30.0 sq cm 14301 Adjacent tissue transfer or rearrangement, any area; defect Plastics, ENT 30.1 sq cm to 60.0 sq cm 14302 Adjacent tissue transfer or rearrangement, any area; each Plastics, ENT additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) DILATION, EUSTACHIAN TUBE EUSTACHIAN TUBE DILATION 69799 Unlisted procedure, middle ear ENT DISSECTION, NECK DISSECTION NECK *31365 Laryngectomy; total, with radical neck dissection ENT *31368 Laryngectomy; subtotal supraglottic, with radical neck ENT dissection *31390 Pharyngolaryngectomy, with radical neck dissection; without ENT reconstruction *31395 Pharyngolaryngectomy, with radical neck dissection; with ENT reconstruction 38720 Cervical lymphadenectomy (complete) ENT *38724 Cervical lymphadenectomy (modified radical neck dissection) ENT *42426 Excision of parotid tumor or parotid gland; total, with ENT unilateral radical neck dissection *60254 Thyroidectomy, total or subtotal for malignancy; with radical ENT neck dissection DRUG INDUCED SLEEP ENDOSCOPY ENT ENDOSCOPY, NOSE ENDOSCOPY NASAL 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate ENT procedure) 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy ENT (via inferior meatus or canine fossa puncture) 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy ENT (via puncture of sphenoidal face or cannulation of ostium) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior)

Page 6 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service ENDOSCOPY, NOSE ENDOSCOPY NASAL 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) ENDOSCOPY, PARANASAL SINUS SINOSCOPY 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate ENT procedure) 31233 Nasal/sinus endoscopy, diagnostic with maxillary sinusoscopy ENT (via inferior meatus or canine fossa puncture) 31235 Nasal/sinus endoscopy, diagnostic with sphenoid sinusoscopy ENT (via puncture of sphenoidal face or cannulation of ostium) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior)

Page 7 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service ENDOSCOPY, PARANASAL SINUS SINOSCOPY 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) EUSTACHIAN TUBOPLASTY EUSTACHIAN TUBOPLASTY 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia EXCISION, LESION OR MASS, EAR EXCISION LESION/MASS EAR 11310 Shaving of epidermal or dermal lesion, single lesion, face, ears, ENT eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less 11311 Shaving of epidermal or dermal lesion, single lesion, face, ears, ENT eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cm 11312 Shaving of epidermal or dermal lesion, single lesion, face, ears, ENT eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cm 11313 Shaving of epidermal or dermal lesion, single lesion, face, ears, ENT eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cm 11440 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less 11441 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm

Page 8 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service EXCISION, LESION OR MASS, EAR EXCISION LESION/MASS EAR 11442 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm 11443 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm 11444 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm 11446 Excision, other benign lesion including margins, except skin tag ENT (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm 11640 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter 0.5 cm or less 11641 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter 0.6 to 1.0 cm 11642 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter 1.1 to 2.0 cm 11643 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter 2.1 to 3.0 cm 11644 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter 3.1 to 4.0 cm 11646 Excision, malignant lesion including margins, face, ears, eyelids, ENT nose, lips; excised diameter over 4.0 cm 69145 Excision soft tissue lesion, external auditory canal ENT 69540 Excision aural polyp ENT 69550 Excision aural glomus tumor; transcanal ENT 69552 Excision aural glomus tumor; transmastoid ENT *69554 Excision aural glomus tumor; extended (extratemporal) ENT EXCISION, MASS, SUBMANDIBULAR RESECTION SUBMANDIBULAR MASS 21040 Excision of benign tumor or cyst of mandible, by enucleation ENT and/or curettage EXCISION, PAROTID GLAND PAROTIDECTOMY 42410 Excision of parotid tumor or parotid gland; lateral lobe, ENT without nerve dissection 42415 Excision of parotid tumor or parotid gland; lateral lobe, with ENT dissection and preservation of facial nerve 42420 Excision of parotid tumor or parotid gland; total, with ENT dissection and preservation of facial nerve 42425 Excision of parotid tumor or parotid gland; total, en bloc ENT removal with sacrifice of facial nerve *42426 Excision of parotid tumor or parotid gland; total, with ENT unilateral radical neck dissection EXCISION, SUBMANDIBULAR GLAND EXCISION SUBMANDIBULAR GLAND 42440 Excision of submandibular (submaxillary) gland ENT EXCISION, THYROGLOSSAL DUCT CYST EXCISION THYROGLOSSAL DUCT CYST 60280 Excision of thyroglossal duct cyst or sinus; ENT 60281 Excision of thyroglossal duct cyst or sinus; recurrent ENT EXCISIONAL BIOPSY, LESION, OROPHARYNX EXCISION/BIOPSY (MASS/LESION/CYST) ORAL/ PHARYNGEAL 42800 Biopsy; oropharynx ENT, Maxillofacial 42808 Excision or destruction of lesion of pharynx, any method ENT, Maxillofacial

Page 9 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS) FUNCTIONAL ENDOSCOPIC SINUS SURGERY 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation)

Page 10 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), USING COMPUTER- FUNCTIONAL ENDOSCOPIC SINUS SURGERY W NAVIGATOR 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT ASSISTED NAVIGATION debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation)

Page 11 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), USING COMPUTER- FUNCTIONAL ENDOSCOPIC SINUS SURGERY W NAVIGATOR 61782 Stereotactic computer-assisted (navigational) procedure; ENT ASSISTED NAVIGATION cranial, extradural (List separately in addition to code for primary procedure) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), USING COMPUTER- FUNCTIONAL ENDOSCOPIC SINUS SURGERY W TURBINATE REDUCTION W 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT ASSISTED NAVIGATION, WITH NASAL TURBINATE REDUCTION NAVIGATOR 61782 Stereotactic computer-assisted (navigational) procedure; ENT cranial, extradural (List separately in addition to code for primary procedure) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), USING COMPUTER- FUNCTIONAL ENDOSCOPIC SINUS SURGERY W TURBINATE W 30130 Excision inferior turbinate, partial or complete, any method ENT ASSISTED NAVIGATION, WITH SEPTOPLASTY AND INFERIOR NASAL SEPTOPLASTY W NAVIGATOR TURBINATE MICRODEBRIDEMENT 30140 Submucous resection inferior turbinate, partial or complete, ENT any method 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft 30801 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial 30802 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT Page 12 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), USING COMPUTER- FUNCTIONAL ENDOSCOPIC SINUS SURGERY W TURBINATE W 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT ASSISTED NAVIGATION, WITH SEPTOPLASTY AND INFERIOR NASAL SEPTOPLASTY W NAVIGATOR removal of tissue from the sphenoid sinus TURBINATE MICRODEBRIDEMENT 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) 61782 Stereotactic computer-assisted (navigational) procedure; ENT cranial, extradural (List separately in addition to code for primary procedure) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH BALLOON FUNCTIONAL ENDOSCOPIC SINUS SURGERY BALLOON SINUPLASTY 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT SINUPLASTY ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SEPTOPLASTY 30520 Septoplasty or submucous resection, with or without cartilage ENT SEPTOPLASTY scoring, contouring or replacement with graft 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT

Page 13 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SEPTOPLASTY 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT SEPTOPLASTY (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY SEPTOPLASTY TURBINATE 30130 Excision inferior turbinate, partial or complete, any method ENT SEPTOPLASTY AND TURBINATE REDUCTION 30140 Submucous resection inferior turbinate, partial or complete, ENT any method 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft 30801 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial 30802 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) 31231 Nasal endoscopy, diagnostic, unilateral or bilateral (separate ENT procedure) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY SEPTO-SINUPLASTY 30130 Excision inferior turbinate, partial or complete, any method ENT SEPTOPLASTY, SINUPLASTY, AND NASAL TURBINATE REDUCTION TURBINATE REDUCTION

Page 14 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY SEPTO-SINUPLASTY 30140 Submucous resection inferior turbinate, partial or complete, ENT SEPTOPLASTY, SINUPLASTY, AND NASAL TURBINATE REDUCTION TURBINATE REDUCTION any method 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY W TURBINATE 30130 Excision inferior turbinate, partial or complete, any method ENT TURBINATE REDUCTION 30140 Submucous resection inferior turbinate, partial or complete, ENT any method 30801 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial 30802 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus

Page 15 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL FUNCTIONAL ENDOSCOPIC SINUS SURGERY W TURBINATE 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT TURBINATE REDUCTION including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH NASAL VALVE FUNCTIONAL ENDOSCOPIC SINUS SURGERY W NASAL VALVEPLASTY 31299 Unlisted procedure, accessory sinuses ENT REPAIR FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SEPTORHINOPLASTY 30420 Rhinoplasty, primary; including major septal repair ENT RHINOSEPTOPLASTY 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region

Page 16 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SEPTORHINOPLASTY *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT RHINOSEPTOPLASTY fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH SINUPLASTY FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SINUPLASTY W TURBINATE 30130 Excision inferior turbinate, partial or complete, any method ENT AND NASAL TURBINATE REDUCTION REDUCTION 30140 Submucous resection inferior turbinate, partial or complete, ENT any method 31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or ENT debridement (separate procedure) 31238 Nasal/sinus endoscopy, surgical; with control of nasal ENT hemorrhage 31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy ENT 31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection ENT *31241 Nasal/sinus endoscopy, surgical; with ligation of ENT sphenopalatine artery 31253 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performed 31254 Nasal/sinus endoscopy, surgical with ethmoidectomy; partial ENT (anterior) 31255 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior) 31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT 31257 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy 31259 Nasal/sinus endoscopy, surgical with ethmoidectomy; total ENT (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinus 31267 Nasal/sinus endoscopy, surgical, with maxillary antrostomy; ENT with removal of tissue from maxillary sinus 31276 Nasal/sinus endoscopy, surgical, with frontal sinus exploration, ENT including removal of tissue from frontal sinus, when performed 31287 Nasal/sinus endoscopy, surgical, with sphenoidotomy; ENT

Page 17 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service FUNCTIONAL ENDOSCOPIC SINUS SURGERY (FESS), WITH SINUPLASTY FUNCTIONAL ENDOSCOPIC SINUS SURGERY W SINUPLASTY W TURBINATE 31288 Nasal/sinus endoscopy, surgical, with sphenoidotomy; with ENT AND NASAL TURBINATE REDUCTION REDUCTION removal of tissue from the sphenoid sinus *31290 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; ethmoid region *31291 Nasal/sinus endoscopy, surgical, with repair of cerebrospinal ENT fluid leak; sphenoid region 31292 Nasal/sinus endoscopy, surgical; with medial or inferior orbital ENT wall decompression 31293 Nasal/sinus endoscopy, surgical; with medial orbital wall and ENT inferior orbital wall decompression 31294 Nasal/sinus endoscopy, surgical; with optic nerve ENT decompression 31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ENT ostium (eg, balloon dilation), transnasal or via canine fossa 31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ENT ostium (eg, balloon dilation) 31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid ENT sinus ostium (eg, balloon dilation) 31298 Nasal/sinus endoscopy, surgical; with dilation of frontal and ENT sphenoid sinus ostia (eg, balloon dilation) INJECTION, CIDOFOVIR INJECTION CIDOFOVIR 96372 Therapeutic, prophylactic, or diagnostic injection (specify ENT substance or drug); subcutaneous or intramuscular 96373 Therapeutic, prophylactic, or diagnostic injection (specify ENT substance or drug); intra-arterial 96374 Therapeutic, prophylactic, or diagnostic injection (specify ENT substance or drug); intravenous push, single or initial substance/drug INSERTION,BONE ANCHORED HEARING AID ENT INSERTION,PROSTHESIS,COCHLEAR ENT INSERTION,STIMULATOR,UPPER AIRWAY ENT KTP LASER General, ENT LARYNGOSCOPY PANENDOSCOPY ENT 31505 Laryngoscopy, indirect; diagnostic (separate procedure) ENT LARYNGOSCOPY 31505 Laryngoscopy, indirect; diagnostic (separate procedure) ENT 31510 Laryngoscopy, indirect; with biopsy ENT PANENDOSCOPY ENT 31510 Laryngoscopy, indirect; with biopsy ENT LARYNGOSCOPY 31511 Laryngoscopy, indirect; with removal of foreign body ENT PANENDOSCOPY ENT 31511 Laryngoscopy, indirect; with removal of foreign body ENT 31512 Laryngoscopy, indirect; with removal of lesion ENT LARYNGOSCOPY 31512 Laryngoscopy, indirect; with removal of lesion ENT PANENDOSCOPY ENT 31513 Laryngoscopy, indirect; with vocal cord injection ENT LARYNGOSCOPY 31513 Laryngoscopy, indirect; with vocal cord injection ENT PANENDOSCOPY ENT 31515 Laryngoscopy direct, with or without tracheoscopy; for ENT aspiration LARYNGOSCOPY 31515 Laryngoscopy direct, with or without tracheoscopy; for ENT aspiration

Page 18 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service LARYNGOSCOPY LARYNGOSCOPY 31520 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT newborn PANENDOSCOPY ENT 31520 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT newborn LARYNGOSCOPY 31525 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT except newborn PANENDOSCOPY ENT 31525 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT except newborn 31526 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT with operating microscope or telescope LARYNGOSCOPY 31526 Laryngoscopy direct, with or without tracheoscopy; diagnostic, ENT with operating microscope or telescope PANENDOSCOPY ENT 31527 Laryngoscopy direct, with or without tracheoscopy; with ENT insertion of obturator LARYNGOSCOPY 31527 Laryngoscopy direct, with or without tracheoscopy; with ENT insertion of obturator PANENDOSCOPY ENT 31528 Laryngoscopy direct, with or without tracheoscopy; with ENT dilation, initial LARYNGOSCOPY 31528 Laryngoscopy direct, with or without tracheoscopy; with ENT dilation, initial 31529 Laryngoscopy direct, with or without tracheoscopy; with ENT dilation, subsequent PANENDOSCOPY ENT 31529 Laryngoscopy direct, with or without tracheoscopy; with ENT dilation, subsequent LARYNGOSCOPY 31530 Laryngoscopy, direct, operative, with foreign body removal; ENT PANENDOSCOPY ENT 31530 Laryngoscopy, direct, operative, with foreign body removal; ENT LARYNGOSCOPY 31531 Laryngoscopy, direct, operative, with foreign body removal; ENT with operating microscope or telescope PANENDOSCOPY ENT 31531 Laryngoscopy, direct, operative, with foreign body removal; ENT with operating microscope or telescope LARYNGOSCOPY 31535 Laryngoscopy, direct, operative, with biopsy; ENT PANENDOSCOPY ENT 31535 Laryngoscopy, direct, operative, with biopsy; ENT 31536 Laryngoscopy, direct, operative, with biopsy; with operating ENT microscope or telescope LARYNGOSCOPY 31536 Laryngoscopy, direct, operative, with biopsy; with operating ENT microscope or telescope 31540 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; PANENDOSCOPY ENT 31540 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; 31541 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; with operating microscope or telescope LARYNGOSCOPY 31541 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; with operating microscope or telescope

Page 19 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service LARYNGOSCOPY PANENDOSCOPY ENT 31545 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) LARYNGOSCOPY 31545 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) 31546 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft) PANENDOSCOPY ENT 31546 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft) 31560 Laryngoscopy, direct, operative, with arytenoidectomy; ENT LARYNGOSCOPY 31560 Laryngoscopy, direct, operative, with arytenoidectomy; ENT 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with ENT operating microscope or telescope PANENDOSCOPY ENT 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with ENT operating microscope or telescope 31570 Laryngoscopy, direct, with injection into vocal cord(s), ENT therapeutic; LARYNGOSCOPY 31570 Laryngoscopy, direct, with injection into vocal cord(s), ENT therapeutic; 31571 Laryngoscopy, direct, with injection into vocal cord(s), ENT therapeutic; with operating microscope or telescope PANENDOSCOPY ENT 31571 Laryngoscopy, direct, with injection into vocal cord(s), ENT therapeutic; with operating microscope or telescope LARYNGOSCOPY 31572 Laryngoscopy, flexible; with ablation or destruction of lesion(s) ENT with laser, unilateral PANENDOSCOPY ENT 31572 Laryngoscopy, flexible; with ablation or destruction of lesion(s) ENT with laser, unilateral LARYNGOSCOPY 31573 Laryngoscopy, flexible; with therapeutic injection(s) (eg, ENT chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral PANENDOSCOPY ENT 31573 Laryngoscopy, flexible; with therapeutic injection(s) (eg, ENT chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateral 31574 Laryngoscopy, flexible; with injection(s) for augmentation (eg, ENT percutaneous, transoral), unilateral LARYNGOSCOPY 31574 Laryngoscopy, flexible; with injection(s) for augmentation (eg, ENT percutaneous, transoral), unilateral 31575 Laryngoscopy, flexible; diagnostic ENT PANENDOSCOPY ENT 31575 Laryngoscopy, flexible; diagnostic ENT 31576 Laryngoscopy, flexible; with biopsy(ies) ENT LARYNGOSCOPY 31576 Laryngoscopy, flexible; with biopsy(ies) ENT PANENDOSCOPY ENT 31577 Laryngoscopy, flexible; with removal of foreign body(s) ENT

Page 20 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service LARYNGOSCOPY LARYNGOSCOPY 31577 Laryngoscopy, flexible; with removal of foreign body(s) ENT PANENDOSCOPY ENT 31578 Laryngoscopy, flexible; with removal of lesion(s), non-laser ENT LARYNGOSCOPY 31578 Laryngoscopy, flexible; with removal of lesion(s), non-laser ENT PANENDOSCOPY ENT 31579 Laryngoscopy, flexible or rigid telescopic, with stroboscopy ENT LARYNGOSCOPY 31579 Laryngoscopy, flexible or rigid telescopic, with stroboscopy ENT LARYNGOSCOPY, USING CO2 LASER LARYNGOSCOPY W CO2 LASER 31512 Laryngoscopy, indirect; with removal of lesion ENT 31540 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; 31541 Laryngoscopy, direct, operative, with excision of tumor and/or ENT stripping of vocal cords or epiglottis; with operating microscope or telescope 31545 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) 31546 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft) 31560 Laryngoscopy, direct, operative, with arytenoidectomy; ENT 31561 Laryngoscopy, direct, operative, with arytenoidectomy; with ENT operating microscope or telescope MASTOIDECTOMY ENT MICROLARYNGOSCOPY, DIRECT, WITH BIOPSY IF INDICATED LARYNGOSCOPY MICRO DIRECT W BIOPSY/LARYNGOSCOPY MICRO DIRECT 31535 Laryngoscopy, direct, operative, with biopsy; ENT 31536 Laryngoscopy, direct, operative, with biopsy; with operating ENT microscope or telescope MICROLARYNGOSCOPY, DIRECT, WITH BIOPSY, USING CO2 LASER LARYNGOSCOPY MICRO DIRECT BIOPSY W CO2 LASER 31536 Laryngoscopy, direct, operative, with biopsy; with operating ENT microscope or telescope MICROLARYNGOSCOPY, DIRECT, WITH VOCAL CORD INJECTION LARYNGOSCOPY MICRO DIRECT W VOCAL CORD INJECTION 31571 Laryngoscopy, direct, with injection into vocal cord(s), ENT therapeutic; with operating microscope or telescope MICROLARYNGOSCOPY, DIRECT, WITH VOCAL CORD POLYPECTOMY LARYNGOSCOPY MICRO DIRECT W VOCAL CORD POLYPECTOMY 31545 Laryngoscopy, direct, operative, with operating microscope or ENT telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s) MYOTOMY, ESOPHAGUS, CERVICAL APPROACH, FOR ZENKER'S ESOPHAGEAL DIVERTICULUM/MYOTOMY/CERVICAL APPROACH (ZENKERS) 43130 Diverticulectomy of hypopharynx or esophagus, with or Thoracic, ENT DIVERTICULUM REPAIR without myotomy; cervical approach MYRINGOPLASTY, FAT PATCH MYRINGOTOMY W FAT GRAFT 69620 Myringoplasty (surgery confined to drumhead and donor area) ENT MYRINGOTOMY MYRINGOTOMY 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia MYRINGOTOMY, WITH TYMPANOSTOMY TUBE INSERTION MYRINGOTOMY W TUBES 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia 69433 Tympanostomy (requiring insertion of ventilating tube), local ENT or topical anesthesia

Page 21 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service MYRINGOTOMY, WITH TYMPANOSTOMY TUBE INSERTION MYRINGOTOMY W TUBES 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia MYRINGOTOMY, WITH TYMPANOSTOMY TUBE REMOVAL MYRINGOTOMY W TUBE REMOVAL 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia 69424 Ventilating tube removal requiring general anesthesia ENT OPEN REDUCTION INTERNAL FIXATION (ORIF), FRACTURE, BONE, OPEN REDUCTION INTERNAL FIXATION NOSE/ETHMOID FRACTURE 21330 Open treatment of nasal fracture; complicated, with internal ENT ETHMOID OR NASAL and/or external skeletal fixation OPEN REDUCTION INTERNAL FIXATION (ORIF), FRACTURE, OPEN REDUCT INTERNAL FIXATION ZYGOMA/FRONTAL/ORBIT FRACTURE 21365 Open treatment of complicated (eg, comminuted or involving ENT ZYGOMATICOMAXILLARY COMPLEX cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approaches *21366 Open treatment of complicated (eg, comminuted or involving ENT cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft) OPEN REPAIR MANDIBULAR FRACTURE WITH INTERDENTAL FIXATION ENT REDUCTION, NASAL TURBINATE, ENDOSCOPIC, USING CAUTERY REDUCTION/CAUTERY TURBINATE ENDOSCOPIC 30130 Excision inferior turbinate, partial or complete, any method ENT REDUCTION, NASAL TURBINATE, WITHOUT ENDOSCOPY, USING CAUTERY REDUCTION/CAUTERY TURBINATE (NON-ENDOSCOPIC) 30801 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficial 30802 Ablation, soft tissue of inferior turbinates, unilateral or ENT bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal) REMOVAL, CERUMEN, IMPACTED DISIMPACTION CERUMEN 69209 Removal impacted cerumen using irrigation/lavage, unilateral ENT 69210 Removal impacted cerumen requiring instrumentation, ENT unilateral REMOVAL, TYMPANOSTOMY TUBE REMOVAL EAR TUBE 69424 Ventilating tube removal requiring general anesthesia ENT REMOVAL, TYMPANOSTOMY TUBE, WITH PATCH MYRINGOPLASTY REMOVAL EAR TUBE W PATCH 69424 Ventilating tube removal requiring general anesthesia ENT 69610 Tympanic membrane repair, with or without site preparation ENT of perforation for closure, with or without patch 69620 Myringoplasty (surgery confined to drumhead and donor area) ENT REMOVAL,STIMULATOR,UPPER AIRWAY ENT REPAIR, NASAL VALVE VALVEPLASTY NASAL 30465 Repair of nasal vestibular stenosis (eg, spreader grafting, ENT lateral nasal wall reconstruction) REPAIR, NASAL VALVE, USING SEPTAL CARTILAGE GRAFT REPAIR NASAL VALVE W SEPTOCARTILAGE GRAFT 20912 Cartilage graft; nasal septum ENT 30465 Repair of nasal vestibular stenosis (eg, spreader grafting, ENT lateral nasal wall reconstruction) REPAIR, TYMPANIC MEMBRANE, USING PATCH INSERTION TYMPANIC PATCH 69610 Tympanic membrane repair, with or without site preparation ENT of perforation for closure, with or without patch REVISION, MASTOIDECTOMY ENT REVISION, RHINOPLASTY RHINOPLASTY REVISION 30430 Rhinoplasty, secondary; minor revision (small amount of nasal Aesthetics, Plastics, ENT tip work)

Page 22 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service REVISION, RHINOPLASTY RHINOPLASTY REVISION 30435 Rhinoplasty, secondary; intermediate revision (bony work with Aesthetics, Plastics, ENT osteotomies) 30450 Rhinoplasty, secondary; major revision (nasal tip work and Aesthetics, Plastics, ENT osteotomies) RHINOPLASTY RHINOPLASTY 30400 Rhinoplasty, primary; lateral and alar cartilages and/or Aesthetics, ENT, Plastics elevation of nasal tip 30410 Rhinoplasty, primary; complete, external parts including bony Aesthetics, ENT, Plastics pyramid, lateral and alar cartilages, and/or elevation of nasal tip 30420 Rhinoplasty, primary; including major septal repair Aesthetics, ENT, Plastics 30430 Rhinoplasty, secondary; minor revision (small amount of nasal Aesthetics, ENT, Plastics tip work) 30435 Rhinoplasty, secondary; intermediate revision (bony work with Aesthetics, ENT, Plastics osteotomies) 30450 Rhinoplasty, secondary; major revision (nasal tip work and Aesthetics, ENT, Plastics osteotomies) 30460 Rhinoplasty for nasal deformity secondary to congenital cleft Aesthetics, ENT, Plastics lip and/or palate, including columellar lengthening; tip only 30462 Rhinoplasty for nasal deformity secondary to congenital cleft Aesthetics, ENT, Plastics lip and/or palate, including columellar lengthening; tip, septum, osteotomies RHINOSEPTOPLASTY SEPTORHINOPLASTY 30420 Rhinoplasty, primary; including major septal repair ENT 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft RHINOSEPTOPLASTY, CLOSED SEPTORHINOPLASTY CLOSED 30420 Rhinoplasty, primary; including major septal repair ENT 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft RHINOSEPTOPLASTY, OPEN SEPTORHINOPLASTY OPEN 30430 Rhinoplasty, secondary; minor revision (small amount of nasal ENT tip work) 30435 Rhinoplasty, secondary; intermediate revision (bony work with ENT osteotomies) 30450 Rhinoplasty, secondary; major revision (nasal tip work and ENT osteotomies) SEPTOPLASTY, NOSE SEPTOPLASTY 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft SEPTOPLASTY, NOSE, WITH ENDOSCOPIC NASAL TURBINATE REDUCTION SEPTOPLASTY W TURBINATE CAUTERY/REDUCTION 30130 Excision inferior turbinate, partial or complete, any method ENT USING CAUTERY 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft SEPTOPLASTY, NOSE, WITH NASAL SEPTAL BUTTON INSERTION NASAL SEPTOPLASTY W BUTTON IMPLANT 30220 Insertion, nasal septal prosthesis (button) ENT 30520 Septoplasty or submucous resection, with or without cartilage ENT scoring, contouring or replacement with graft SIALODOCHOPLASTY ENT SIALOLITHECTOMY ENT SIALOLITHOTOMY,INTRAORAL ENT STAPEDECTOMY,TOTAL, USING MICROSCOPE ENT

Page 23 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service SURGICAL FRACTURE, INFERIOR NASAL TURBINATE REPAIR NASAL INFERIOR TURBINATE FRACTURE 30930 Fracture nasal inferior turbinate(s), therapeutic ENT SURGICAL PROCUREMENT, GRAFT, CARTILAGE, EAR CARTILAGE GRAFT FROM EAR 21235 Graft; ear cartilage, autogenous, to nose or ear (includes ENT, Plastics obtaining graft) TONSILLECTOMY TONSILLECTOMY 42825 Tonsillectomy, primary or secondary; younger than age 12 ENT 42826 Tonsillectomy, primary or secondary; age 12 or over ENT TONSILLECTOMY AND ADENOIDECTOMY TONSILLECTOMY ADENOIDECTOMY 42820 Tonsillectomy and adenoidectomy; younger than age 12 ENT 42821 Tonsillectomy and adenoidectomy; age 12 or over ENT TONSILLECTOMY AND ADENOIDECTOMY, WITH BILATERAL TONSILLECTOMY ADENOIDECTOMY + MYRINGOTOMY W TUBES 42820 Tonsillectomy and adenoidectomy; younger than age 12 ENT MYRINGOTOMY AND TYMPANOSTOMY TUBE INSERTION BILATERAL 42821 Tonsillectomy and adenoidectomy; age 12 or over ENT 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia 69433 Tympanostomy (requiring insertion of ventilating tube), local ENT or topical anesthesia 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia TONSILLECTOMY, WITH BILATERAL MYRINGOTOMY AND TONSILECTOMY + MYRINGOTOMY W TUBES BILATERAL 42825 Tonsillectomy, primary or secondary; younger than age 12 ENT TYMPANOSTOMY TUBE INSERTION 42826 Tonsillectomy, primary or secondary; age 12 or over ENT 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia TONSILLECTOMY, WITH MYRINGOTOMY AND TYMPANOSTOMY TUBE TONSILECTOMY + MYRINGOTOMY W TUBES UNILATERAL 42825 Tonsillectomy, primary or secondary; younger than age 12 ENT INSERTION 42826 Tonsillectomy, primary or secondary; age 12 or over ENT 69420 Myringotomy including aspiration and/or eustachian tube ENT inflation 69421 Myringotomy including aspiration and/or eustachian tube ENT inflation requiring general anesthesia 69433 Tympanostomy (requiring insertion of ventilating tube), local ENT or topical anesthesia 69436 Tympanostomy (requiring insertion of ventilating tube), ENT general anesthesia TYMPANOPLASTY TYMPANOPLASTY 69610 Tympanic membrane repair, with or without site preparation ENT of perforation for closure, with or without patch 69620 Myringoplasty (surgery confined to drumhead and donor area) ENT 69631 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction 69632 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration)

Page 24 of 25 * Indicates Inpatient only CPT Code/Procedure SJH Procedures - ENT Service New Name Old Name CPT Code Service TYMPANOPLASTY TYMPANOPLASTY 69633 Tympanoplasty without mastoidectomy (including canalplasty, ENT atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total ossicular repl 69635 Tympanoplasty with antrotomy or mastoidotomy (including ENT canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction 69636 Tympanoplasty with antrotomy or mastoidotomy (including ENT canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction 69637 Tympanoplasty with antrotomy or mastoidotomy (including ENT canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis [porp], total 69641 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction 69642 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction 69643 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction 69644 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); with intact or reconstructed canal wall, with ossicular chain reconstruction 69645 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); radical or complete, without ossicular chain reconstruction 69646 Tympanoplasty with mastoidectomy (including canalplasty, ENT middle ear surgery, tympanic membrane repair); radical or complete, with ossicular chain reconstruction UVULECTOMY UVULECTOMY 42140 Uvulectomy, excision of uvula ENT

Page 25 of 25 * Indicates Inpatient only CPT Code/Procedure