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Community Health Options: Advanced Imaging CPT Code List

CPT® Category CPT® Code Description Code Cardiac Rhythm Transcatheter insertion or replacement of permanent leadless pacemaker, right ventricular, including imaging guidance (eg, , Implantable Devices 33274 venous ultrasound, ventriculography, femoral venography) and device evaluation (eg, interrogation or programming), when performed (CRID) Cardiac Rhythm Implantable Devices 33275 Transcatheter removal of permanent leadless pacemaker, right ventricular (CRID) Cardiac Rhythm Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring, including deployment Implantable Devices 33289 and calibration of the sensor, right heart catheterization, selective pulmonary catheterization, radiological supervision and interpretation, (CRID) and pulmonary artery angiography, when performed Radiology: MR 70336 M R I T M J Radiology: CT 70450 C T Head Without Contrast Radiology: CT 70460 C T Head With Contrast Radiology: CT 70470 C T Head Without & With Contrast Radiology: CT 70480 C T Orbit Without Contrast Radiology: CT 70481 C T Orbit With Contrast Radiology: CT 70482 C T Orbit Without & With Contrast Radiology: CT 70486 C T Maxillofacial Without Contrast Radiology: CT 70487 C T Maxillofacial With Contrast Radiology: CT 70488 C T Maxillofacial Without & With Contrast Radiology: CT 70490 C T Soft Tissue Neck Without Contrast Radiology: CT 70491 C T Soft Tissue Neck With Contrast Radiology: CT 70492 C T Soft Tissue Neck Without & With Contrast Radiology: CT 70496 C T Angiography Head Radiology: CT 70498 C T Angiography Neck Radiology: MR 70540 M R I Orbit, Face,Neck and/or Without Contrast Radiology: MR 70542 M R I Face, Orbit, Neck With Contrast Radiology: MR 70543 M R I Face, Orbit, Neck With & Without Contrast

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: MR 70544 M R A Head Without Contrast Radiology: MR 70545 M R A Head With Contrast Radiology: MR 70546 M R A Head With & Without Contrast Radiology: MR 70547 M R A Neck Without Contrast Radiology: MR 70548 M R A Neck With Contrast Radiology: MR 70549 M R A Neck With & Without Contrast Radiology: MR 70551 M R I Head Without Contrast Radiology: MR 70552 M R I Head With Contrast Radiology: MR 70553 M R I Head With & Without Contrast Radiology: MR 70554 MRI Brain, functional MRI Radiology: MR 70555 MRI Brain, functional MRI, requiring physician Radiology: CT 71250 C T Thorax Without Contrast Radiology: CT 71260 C T Thorax With Contrast Radiology: CT 71270 C T Thorax Without & With Contrast

Radiology: CT 71275 C T Angiography Chest Without Contrast Material, Followed by Contrast Material and Further Sections,Including Image Postprocessing

Radiology: MR 71550 M R I Chest Without Contrast Radiology: MR 71551 M R I Chest With Contrast Radiology: MR 71552 M R I Chest With & Without Contrast Radiology: MR 71555 M R A Chest (Excluding Myocardium) With Or Without Contrast Radiology: CT 72125 C T Cervical Spine Without Contrast Radiology: CT 72126 C T Cervical Spine With Contrast Radiology: CT 72127 C T Cervical Spine Without & With Contrast Radiology: CT 72128 C T Thoracic Spine Without Contrast Radiology: CT 72129 C T Thoracic Spine With Contrast Radiology: CT 72130 C T Thoracic Spine Without & With Contrast Radiology: CT 72131 C T Lumbar Spine Without Contrast Radiology: CT 72132 C T Lumbar Spine With Contrast Radiology: CT 72133 C T Lumbar Spine Without & With Contrast Radiology: MR 72141 M R I Cervical Spine Without Contrast Radiology: MR 72142 M R I Cervical Spine With Contrast Radiology: MR 72146 M R I Thoracic Spine Without Contrast Radiology: MR 72147 M R I Thoracic Spine With Contrast

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: MR 72148 M R I Lumbar Spine Without Contrast Radiology: MR 72149 M R I Lumbar Spine With Contrast Radiology: MR 72156 M R I Cervical Spine With & Without Contrast Radiology: MR 72157 M R I Thoracic Spine With & Without Contrast Radiology: MR 72158 M R I Lumbar Spine With & Without Contrast Radiology: MR 72159 M R A With Or Without Contrast Radiology: CT 72191 C T Angiography Pelvis Radiology: CT 72192 C T Pelvis Without Contrast Radiology: CT 72193 C T Pelvis With Contrast Radiology: CT 72194 C T Pelvis Without & With Contrast Radiology: MR 72195 M R I Pelvis Without Contrast Radiology: MR 72196 M R I Pelvis With Contrast Radiology: MR 72197 M R I Pelvis With & Without Contrast Radiology: MR 72198 M R A Pelvis With Or Without Contrast Radiology: CT 73200 C T Upper Extremity Without Contrast Radiology: CT 73201 C T Upper Extremity With Contrast Radiology: CT 73202 C T Upper Extremity Without & With Contrast Radiology: CT 73206 C T Angiography Upper Extremity Radiology: MR 73218 M R I Upper Extremity Without Contrast Radiology: MR 73219 M R I Upper Extremity With Contrast Radiology: MR 73220 M R I Upper Extremity With & Without Contrast Radiology: MR 73221 M R I Upper Extremity Without Contrast Radiology: MR 73222 M R I Upper Extremity Joint With Contrast Radiology: MR 73223 M R I Upper Extremity Joint With & Without Contrast Radiology: MR 73225 M R A Upper Extremity With Or Without Contrast Radiology: CT 73700 C T Lower Extremity Without Contrast Radiology: CT 73701 C T Lower Extremity With Contrast Radiology: CT 73702 C T Lower Extremity Without & With Contrast Radiology: CT 73706 C T Angiography Lower Extremity Radiology: MR 73718 M R I Lower Extremity Without Contrast Radiology: MR 73719 M R I Lower Extremity With Contrast Radiology: MR 73720 M R I Lower Extremity With & Without Contrast Radiology: MR 73721 M R I Lower Extremity Joint Without Contrast

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: MR 73722 M R I Lower Extremity Joint With Contrast Radiology: MR 73723 M R I Lower Extremity Joint With & Without Contrast Radiology: MR 73725 M R A Lower Extremity With Or Without Contrast Radiology: CT 74150 C T Abdomen Without Contrast Radiology: CT 74160 C T Abdomen With Contrast Radiology: CT 74170 C T Abdomen Without & With Contrast

Radiology: CT 74174 CT angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing

Radiology: CT 74175 C T Angiography Abdomen Radiology: CT 74176 CT ABDOMEN AND PELVIS WITHOUT CONTRAST Radiology: CT 74177 CT ABDOMEN AND PELVIS WITH CONTRAST COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL IN ONE OR BOTH BODY REGIONS, Radiology: CT 74178 FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS IN ONE OR BOTH BODY REGIONS Radiology: MR 74181 M R I Abdomen Without Contrast Radiology: MR 74182 M R I Abdomen With Contrast Radiology: MR 74183 M R I Abdomen With & Without Contrast Radiology: MR 74185 M R A Abdomen With Or Without Contrast Radiology: CT 74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non-contrast Radiology: CT 74262 images, if performed Radiology: CT 74263 Computed tomographic (CT) colonography, screening, including image postprocessing

Radiology: MR 74712 Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first gestation Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional Radiology: MR 74713 gestation (List separately in addition to code for primary procedure) Cardiac: MR 75557 Cardiac magnetic resonance imaging for morphology and function without contrast material Cardiac: MR 75559 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and Cardiac: MR 75561 further sequences Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and Cardiac: MR 75563 further sequences; with stress imaging Cardiac: MR 75565 Cardiac magnetic resonance imaging for velocity flow mapping (list separately in addition to code for primary procedure) Cardiac: CT 75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including 3d image Cardiac: CT 75572 postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the setting of congenital heart Cardiac: CT 75573 disease (including 3d image postprocessing, assessment of lv cardiac function, rv structure and function and evaluation of venous structures, if performed) Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3d Cardiac: CT 75574 image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluation of venous structures, if performed) Radiology: CT 75635 C T Angiography Abdominal Aorta 3D Imaging 76376 3D Rendering W/O Postprocessing 3D Imaging 76377 3D Rendering W Postprocessing Radiology: CT 76380 C T Limited Or Localized Follow-Up Study Radiology: MR 76390 M R I Spectroscopy Radiology: MRI 76391 Magnetic resonance (eg, vibration) elastography Radiology: CT 76497 Unlisted computed tomography procedure Radiology: MR 76498 Unlisted MRI Procedure Ultrasound: U/S 76506 US ECHOENCEPHALOGRAPHY (non-OB) Ultrasound: U/S 76536 US SOFT TISSUE HEAD AND NECK (non-OB) Ultrasound: U/S 76604 US CHEST REAL TIME WITH IMAGE DOCUMENTATION (non-OB) Ultrasound: U/S 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete (non-OB) Ultrasound: U/S 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited (non-OB) Ultrasound: U/S 76700 ULTRASOUND ABDOMINAL REAL TIME WITH IMAGE DOCUMENTATION (non-OB) Ultrasound: U/S 76705 U/S SINGLE ORGAN (non-OB) Ultrasound: U/S ULTRASOUND, ABDOMINAL AORTA, REAL TIME WITH IMAGE DOCUMENTATION, SCREENING STUDY FOR ABDOMINAL 76706 (non-OB) AORTIC ANEURYSM (AAA) Ultrasound: U/S 76770 ULTRASOUND,RETROPEROTONRAL,REAL TIME WITH IMAGE DOCUMENTATION;COMPLETE (non-OB) Ultrasound: U/S Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited 76775 (non-OB) Ultrasound: U/S 76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation (non-OB) Ultrasound: U/S 76800 US ECHO SPINAL CANAL (non-OB)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code

Ultrasound: OB U/S 76801 Ultrasound Obstetrical Pelvis, Pregnant Uterus, First Trimester less than 14 Weeks Single Or First Gestation

Ultrasound: OB U/S 76802 Ultrasound Obstetrical Pelvis, Pregnant Uterus, First Trimester less than 14 Weeks Each Additional Gestation

Ultrasound: OB U/S 76805 Ultrasound Obstetrical Pelvis, Pregnant Uterus, B-Scan

Ultrasound: OB U/S 76810 Ultrasound Obstetrical Pelvis Complete, Multiple Gestation After 1st Trimester

Ultrasound: OB U/S 76811 Ultrasound Pregnant Uterus Fetal & Maternal Evaluation Plus Fetal Anatomic Evaluation Transabdominal Single Or First Gestation

Ultrasound: OB U/S 76812 Ultrasound Pregnant Uterus Fetal & Maternal Evaluation Plus Fetal Anatomic Evaluation Transabdominal Each Additional Gestation

Ultrasound: OB U/S 76813 Ultrasound, pregnant uterus, real time with image documentation

Ultrasound: OB U/S 76814 Ultrasound, pregnant uterus, real time with image documentation

Ultrasound: OB U/S 76815 Ultrasound Obstetrical Pelvis Limited (Gestational Age, Heart Beat, Emergency)

Ultrasound: OB U/S 76816 Ultrasound Obstetrical Pelvis Follow Up Or Repeat

Ultrasound: OB U/S 76817 Ultrasound Pregnant Uterus Transvaginal

Ultrasound: OB U/S 76818 Fetal Biophysical Profile

Ultrasound: OB U/S 76819 Fetal Biophysical Profile Without Stress Non Stress

Ultrasound: OB U/S 76820 DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY

Ultrasound: OB U/S 76821 DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY

Ultrasound: OB U/S 76825 Ultrasound Obstetrical Echocardiography, Fetal, Cardiovascular System

Ultrasound: OB U/S 76826 Follow Up Or Repeat Study

Ultrasound: OB U/S 76827 Doppler Echocardiography Fetal Complete

Ultrasound: OB U/S 76828 Follow Up Or Repeat Study Ultrasound: U/S 76830 U/S TRANSVAGINAL (non-OB)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Ultrasound: U/S 76831 HYSTEROSONOGRAPHY W OR W/O COL (non-OB) Ultrasound: U/S 76856 ULTRASOUND PELCIC REAL TIME WITH IMAGE DOCUMENTATION;COMPLETE (non-OB) Ultrasound: U/S 76857 US PEL LIM OR F/U (non-OB) Ultrasound: U/S 76870 US ECHO SCROTUM (non-OB) Ultrasound: U/S 76872 U/S TRANSRECTAL (non-OB) Ultrasound: U/S 76881 Ultrasound, extremity, non-vascular, real time with image documentation; complete (non-OB) Ultrasound: U/S 76882 Ultrasound, extremity, non-vascular, real time with image documentation; limited, anatomic specific (non-OB) Ultrasound: U/S 76885 US ECHO, INFANT HIPS REALTIME (non-OB) Ultrasound: U/S 76886 US,Infant Hips,Real Time;Limited, Static (non-OB) Ultrasound: U/S 76970 US STUDY FOLLOW UP (non-OB) Ultrasound: U/S 76975 Ultrasound Gastrointestinal, Endoscopic (non-OB) Ultrasound: U/S 76978 Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion (non-OB) Ultrasound: U/S Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate 76979 (non-OB) injection (List separately in addition to code for primary procedure) Ultrasound: U/S 76999 Echo examination procedure (non-OB) Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization Radiology: MR 77021 device) radiological supervision and interpretation Radiology: MR 77022 Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation Radiology: BMRI 77046 Magnetic resonance imaging, breast, without contrast material; unilateral Radiology: BMRI 77047 Magnetic resonance imaging, breast, without contrast material; bilateral Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion Radiology: BMRI 77048 detection, characterization and pharmacokinetic analysis), when performed; unilateral Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion Radiology: BMRI 77049 detection, characterization and pharmacokinetic analysis), when performed; bilateral Radiology: CT 77078 Computed Tomography, mineral density study, 1 or more sites; axial skeleton Radiology: MR 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: Nuclear 78012 Medicine Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed) Radiology: Nuclear 78013 Medicine Thyroid imaging (including vascular flow, when performed) Radiology: Nuclear Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including 78014 Medicine stimulation, suppression, or discharge, when performed) Radiology: Nuclear 78015 Medicine Thyroid Met Imaging Radiology: Nuclear 78016 Medicine Thyroid Met Imaging With Additional Studies Radiology: Nuclear 78018 Medicine Thyroid Scan Whole Body Radiology: Nuclear 78020 Medicine Thyroid Carcinoma Metastases Uptake Radiology: Nuclear 78070 Medicine Parathyroid planar imaging (including subtraction, when performed) Radiology: Nuclear 78071 Medicine Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) Radiology: Nuclear Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed 78072 Medicine tomography (CT) for anatomical localization Radiology: Nuclear 78075 Adrenal Nuclear Imaging Medicine Radiology: Nuclear 78102 Bone Marrow Imaging, Limited Medicine Radiology: Nuclear 78103 Bone Marrow Imaging, Multiple Medicine Radiology: Nuclear 78104 Bone Marrow Imaging, Whole Body Medicine Radiology: Nuclear 78140 Labeled Red Cell Sequestration Medicine Radiology: Nuclear 78185 Spleen Imaging With & Without Vascular Flow Medicine Radiology: Nuclear 78195 Lymph System Imaging Medicine Radiology: Nuclear 78201 Liver Imaging Medicine Radiology: Nuclear 78202 Liver Imaging With Flow Medicine Radiology: Nuclear 78205 Liver Imaging SPECT (3D) Medicine

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: Nuclear 78215 Liver & Spleen Imaging Medicine Radiology: Nuclear 78216 Liver & Spleen Imaging With Flow Medicine Radiology: Nuclear 78226 Hepatobiliary system imaging, including gallbladder when present; Medicine Radiology: Nuclear Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative 78227 Medicine measurement(s) when performed Radiology: Nuclear 78230 Salivary Gland Imaging Medicine Radiology: Nuclear 78231 Serial Salivary Gland Medicine Radiology: Nuclear 78232 Salivary Gland Function Exam Medicine Radiology: Nuclear 78258 Esophogus Motility Study Medicine Radiology: Nuclear 78261 Gastric Mucosa Imaging Medicine Radiology: Nuclear 78262 Gastroesophageal Reflux Exam Medicine Radiology: Nuclear 78264 Gastric Emptying Study Medicine Radiology: Nuclear 78265 Medicine Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Radiology: Nuclear 78266 Medicine Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Radiology: Nuclear 78278 GI Bleeder Scan Medicine Radiology: Nuclear 78290 Meckels Diverticulum Imaging Medicine Radiology: Nuclear 78291 Leveen Shunt Patency Exam Medicine Radiology: Nuclear 78300 Bone Or Joint Imaging Limited Medicine Radiology: Nuclear 78305 Bone Or Joint Imaging Multiple Medicine Radiology: Nuclear 78306 Bone Scan Whole Body Medicine Radiology: Nuclear 78315 Bone Scan 3 Phase Study Medicine

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: Nuclear 78320 Bone Joint Imaging Tomo Test SPECT Medicine Radiology: Nuclear 78414 Non-Imaging Heart Function Medicine Radiology: Nuclear 78428 Cardiac Shunt Imaging Medicine Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall motion[s] and/or ejection CPET 78429 fraction[s], when performed), single study; with concurrently acquired computed tomography transmission scan

Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], CPET 78430 when performed); single study, at rest or stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] and/or ejection fraction[s], CPET 78431 when performed); multiple studies at rest and stress (exercise or pharmacologic), with concurrently acquired computed tomography transmission scan

Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall CPET 78432 motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability);

Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study (including ventricular wall CPET 78433 motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial viability); with concurrently acquired computed tomography transmission scan Radiology: Nuclear 78445 Radionuclide Venogram Non-Cardiac Medicine

Cardiac: Myocardial 78451 myocardial perfusion imaging, tomographic (spect) including attenuation correction, qualitative or quantitative wall motion, ejection Perfusion Imaging 78451 fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or (Nuclear Stress) pharmacologic)

Cardiac: Myocardial Myocardial perfusion imaging, tomographic (spect) (including attenuation correction, qualitative or quantitative wall motion, ejection Perfusion Imaging 78452 fraction by first pass or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or (Nuclear Stress) pharmacologic) and/or redistribution and/or rest reinjection

Cardiac: Myocardial Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, Perfusion Imaging 78453 additional quantification, when performed); single study, at rest or stress (exercise or pharmacologic) (Nuclear Stress)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code

Cardiac: Myocardial Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, Perfusion Imaging 78454 additional quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or (Nuclear Stress) rest reinjection

Radiology: Nuclear 78457 Venous Thrombosis Imaging Unilateral Medicine Radiology: Nuclear 78458 Venous Thrombosis Images, Bilateral Medicine Cardiac: PET 78459 Myocardial imaging, positron emission tomography (pet), metabolic evaluation Radiology: Nuclear 78466 Myocardial Infarction Scan Medicine Radiology: Nuclear 78468 Heart Infarct Image Ejection Fraction Medicine Radiology: Nuclear 78469 Heart Infarct Image 3D SPECT Medicine Radiology: Nuclear 78472 CARDIAC BLOODPOOL IMG, SINGLE Medicine Radiology: Nuclear 78473 CARDIAC BLOODPOOL IMG, MULTI Medicine Radiology: Nuclear 78481 Heart First Pass Single Medicine Radiology: Nuclear 78483 Cardiac Blood Pool Imaging -- Multiple Medicine Myocardial imaging, positron emission tomography (PET), perfusion study(including ventricular wall motion[s] and/or ejection fraction[s], Cardiac: PET 78491 when performed); single study, at rest or stress (exercise or pharmacologic) Myocardial imaging, positron emission tomography (PET), perfusion study(including ventricular wall motion[s] and/or ejection fraction[s], Cardiac: PET 78492 when performed); multiple studies at rest and/or stress (exercise or pharmacologic) Radiology: Nuclear 78494 Cardiac Blood Pool Imaging , SPECT Medicine Radiology: Nuclear 78496 Cardiac Blood Pool Imaging - Single Study @ Rest Medicine Radiology: Nuclear 78499 Unlisted Cardiovascular Procedure Medicine Radiology: Nuclear 78579 Pulmonary ventilation imaging (eg, aerosol or gas) Medicine Radiology: Nuclear 78580 Pulmonary perfusion imaging (eg, particulate) Medicine Radiology: Nuclear 78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging Medicine

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: Nuclear 78597 Quantitative differential pulmonary perfusion, including imaging when performed Medicine Radiology: Nuclear 78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed Medicine Radiology: Nuclear 78600 Brain Imaging Limited Static Medicine Radiology: Nuclear 78601 Brain Limited Imaging And Flow Medicine Radiology: Nuclear 78605 Brain Imaging Complete Medicine Radiology: Nuclear 78606 Brain Imaging Complete With Flow Medicine Radiology: Nuclear 78607 Brain Imaging 3D Medicine Radiology: PET 78608 Brain Imaging, Positron Emission Tomography (PET) Metabolic Evaluation Radiology: PET 78609 Brain Imaging, Positron Emission Tomography (PET) Perfusion Evaluation Radiology: Nuclear 78610 Brain Flow Imaging Only Medicine Radiology: Nuclear 78630 Cisternogram (Cerebrospinal Fluid Flow) Medicine Radiology: Nuclear 78635 Cerebrospinal Ventriculography Medicine Radiology: Nuclear 78645 CSF Shunt Evaluation Medicine Radiology: Nuclear 78647 Cerebrospinal Fluid Scan (Tomographic) SPECT Medicine Radiology: Nuclear 78650 C S F Leakage Detection And Localization Medicine Radiology: Nuclear 78660 Radiopharmaceutical Dacryocystography Medicine Radiology: Nuclear 78699 Medicine Unlisted Nuclear Medicine Procedure Radiology: Nuclear 78700 Kidney Imaging Morphology Medicine Radiology: Nuclear 78701 Kidney Imaging With Vascular Flow Medicine Radiology: Nuclear 78707 Kidney Imaging With Vascular Flow & Function Single Study Without Pharmacological Intervention Medicine Radiology: Nuclear 78708 Kidney Imaging Single Study With Pharmacological Intervention Medicine

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Radiology: Nuclear 78709 Kidney Imaging - Multiple Studies Without & With Pharmacological Intervention Medicine Radiology: Nuclear 78710 Kidney Imaging - Tomographic (SPECT) Medicine Radiology: Nuclear 78725 Kidney Function Study - Non-Imaging Radioisotopic Medicine Radiology: Nuclear 78730 Urinary Bladder Residual Study Medicine Radiology: Nuclear 78740 Ureteral Reflux Study Medicine Radiology: Nuclear 78761 Testicular Imaging With Vascular Flow Medicine

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow Radiology: Nuclear 78800 and blood pool imaging, when performed); planar, single limited area (includes vascular flow and blood pool imaging, when performed); Medicine planar, single (includes vascular flow and blood pool imaging, when performed); planar, single

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow Radiology: Nuclear 78801 and blood pool imaging, when performed); planar, 2 or more mulitple areas (eg, abdomen and pelvis, head and chest), 1 or more days Medicine imaging or single area imaging over 2 or more days Radiology: Nuclear Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow 78802 Medicine and blood pool imaging, when performed); planar, whole body, single day imaging Radiology: Nuclear Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow 78803 Medicine and blood pool imaging, when performed); tomographic (SPECT) , single area (eg, head, neck, chest, pelvis), single day imaging Radiology: Nuclear Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow 78804 Medicine and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging Radiology: Nuclear 78805 Radiopharm Localization Of Abscess, Limited Area Medicine Radiology: Nuclear 78806 Radiopharm Localization Of Abscess, Whole Body Medicine Radiology: Nuclear 78807 Radiopharm Localization Of Abscess, Tomographic SPECT Medicine Radiology: PET 78811 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); LIMITED AREA (EG, CHEST, HEAD/NECK) Radiology: PET 78812 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); BASE TO MID-THIGH Radiology: PET 78813 POSITRON EMISSION TOMOGRAPHY (PET); WHOLE BODY

Radiology: PET 78814 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; LIMITED AREA (EG CHEST, HEAD/NECK)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code

Radiology: PET 78815 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; SKULL BASE TO MID-THIGH TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY Radiology: PET 78816 (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION; WHOLE BODY Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission Nuclear Medicine 78830 scan for anatomical review, localization and determination/detection of pathology, single area (eg, head, neck, chest, pelvis), single day imaging Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow Nuclear Medicine 78831 and blood pool imaging, when performed); tomographic (SPECT), minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) with concurrently acquired computed tomography (CT) transmission Nuclear Medicine 78832 scan for anatomical review, localization and determination/detection of pathology, minimum 2 areas (eg, pelvis and knees, abdomen and pelvis), single day imaging, or single area imaging over 2 or more days

Cardiac: ECHO 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete Cardiac: ECHO 93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with Cardiac: ECHO 93306 spectral doppler echocardiography, and with color flow doppler echocardiography Cardiac: ECHO 93307 Echocardiography, transthoracic, real-time with image documentation (2d) with or without m-mode recording; complete

Cardiac: ECHO 93308 Echocardiography, transthoracic, real-time with image documentation (2d) with or without m-mode recording; follow-up or limited study

Cardiac: ECHO 93312 TEE 2D;Incl Probe Placement, Imaging/Interp/Report Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); placement of Cardiac: ECHO 93313 transesophageal probe only Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); image acquisition, Cardiac: ECHO 93314 interpretation and report only Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image acquisition, interpretation and Cardiac: ECHO 93315 report Cardiac: ECHO 93316 Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only Cardiac: ECHO 93317 Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report only Cardiac: ECHO 93318 Echo transesophageal intraop Cardiac: ECHO Echocardiography, transthoracic, real-time with image documentation (2d), with or without m-mode recording, during rest and 93350 STRESS cardiovascular stress test, with interpretation and report

Cardiac: ECHO 93351 Echocardiography, transthoracic, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and STRESS cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically induced stress, with interpretation

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Cardiac: ECHO 93352 STRESS Use of echocardiographic contrast agent during stress echocardiography (list separately in addition to code for primary procedure) Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (List separately in addition to codes for ECHO 93356 echocardiography imaging) Cardiac: Diagnostic RIGHT HEART CATHETERIZATION INCLUDING MEASUREMENT(S) OF OXYGEN SATURATION AND CARDIAC OUTPUT, WHEN 93451 Heart Cath PERFORMED

Cardiac: Diagnostic Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when 93452 Heart Cath performed

Cardiac: Diagnostic Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and 93453 Heart Cath interpretation, when performed

Cardiac: Diagnostic Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, 93454 Heart Cath imaging supervision and interpretation

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic 93455 imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) Heart Cath including intraprocedural injection(s) for bypass graft angiography

Cardiac: Diagnostic Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, 93456 Heart Cath imaging supervision and interpretation; with right heart catheterization

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic 93457 imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) Heart Cath including intraprocedural injection(s) for bypass graft angiography and right heart catheterization

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic 93458 imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when Heart Cath performed

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic 93459 imaging supervision and interpretation; with left heart catheterization including intraprocedural injection(s) for left ventriculography, when Heart Cath performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic 93460 imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left Heart Cath ventriculography, when performed Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: Diagnostic imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left 93461 Heart Cath ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass graft angiography

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Cardiac: Diagnostic Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for 93462 Heart Cath primary procedure)

Cardiac: Diagnostic 93530 RIGHT HEART CATHETERIZATION (CHD) Heart Cath

Cardiac: Diagnostic 93531 RIGHT/LEFT HEART CATHETERIZATION (CHD) Heart Cath

Cardiac: Diagnostic 93532 RIGHT/LEFT HEART CATHETERIZATION (CHD-TS) Heart Cath

Cardiac: Diagnostic 93533 RIGHT/LEFT HEART CATHETERIZATION (CAD-ASD) Heart Cath Ultrasound: U/S 93880 DUPLEX SCAN EXTRACRANIAL ARTER (non-OB) Ultrasound: U/S 93882 DUPLEX SCAN EXTRACRANIAL ARTER (non-OB) Ultrasound: U/S 93886 TRANSCRANIAL DOPPLER STUDY INT (non-OB) Ultrasound: U/S 93888 TRANSCRANIAL DOPPLER STUDY INT (non-OB) Ultrasound: U/S 93890 Transcranial Doppler vasoreactivity study (non-OB) Ultrasound: U/S 93892 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection (non-OB) Ultrasound: U/S 93893 Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection (non-OB) Ultrasound: U/S 93922 NON-INVASIVE PHYSIOLOGIC STUDI (non-OB) Ultrasound: U/S 93923 NON-INVASIVE PHYSIOLOGIC STUDI (non-OB) Ultrasound: U/S 93924 NON-INVASIVE PHYSIOLOGIC STUDI (non-OB) Ultrasound: U/S 93925 DUPLEX SCAN LOW EXT. ART. OR A (non-OB) Ultrasound: U/S 93926 DUPLEX SCAN LOW EXT. ART. OR A (non-OB) Ultrasound: U/S 93930 DUPLEX SCAN UP EXT. ART. OR AR (non-OB)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Ultrasound: U/S 93931 DUPLEX SCAN UP EXT. ART. OR AR (non-OB) Ultrasound: U/S 93970 DUPLEX SCAN EXT. VEINS, COMPLE (non-OB) Ultrasound: U/S 93971 DUPLEX SCAN EXT. VEINS, UNILAT (non-OB) Ultrasound: U/S 93975 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study (non-OB) Ultrasound: U/S 93976 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study (non-OB) Ultrasound: U/S 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study (non-OB) Ultrasound: U/S 93979 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; cunilateral or limited study (non-OB) Ultrasound: U/S 93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study (non-OB) Ultrasound: U/S 93981 Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study (non-OB) Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete DGUS 93985 bilateral study Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; complete DGUS 93986 unilateral study Ultrasound: U/S 93990 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) (non-OB) Ultrasound: U/S 93998 UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY (non-OB) Radiology: CT 0042T CT PERFUSION BRAIN Cardiac Rhythm Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics) Implantable Devices 0399T (List separately in addition to code for primary procedure) (CRID) Cardiac Rhythm Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging Implantable Devices 0515T supervision and interpretation, when performed; complete system (includes electrode and generator [transmitter and battery]) (CRID) Cardiac Rhythm Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging Implantable Devices 0516T supervision and interpretation, when performed; electrode only (CRID) Insertion of wireless cardiac stimulator for left ventricular pacing, including device interrogation and programming, and imaging CRID 0517T supervision and interpretation, when performed; pulse generator component(s) (battery and/or transmitter) only Cardiac Rhythm Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or Implantable Devices 0519T transmitter) (CRID)

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Cardiac Rhythm Removal and replacement of wireless cardiac stimulator for left ventricular pacing; pulse generator component(s) (battery and/or Implantable Devices 0520T transmitter), including placement of a new electrode (CRID)

Insertion or replacement of implantable cardioverter-defibrillator system with substernal electrode(s), including all imaging guidance and CRID 0571T electrophysiological evaluation (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters), when performed

CRID 0572T Insertion of substernal implantable defibrillator electrode Radiology: MR C8900 MRA Abdomen with contrast Radiology: MR C8901 MRA Abdomen without contrast Radiology: MR C8902 MRA Abdomen with and w/o contrast Radiology: MR C8903 MRI Breast w/ contrast, unilateral Radiology: MR C8905 MRI Breast w. and w/o contrast, unilateral Radiology: MR C8906 MRI BREAST BILATERAL w/ CONTRAST Radiology: MR C8908 MRI BREAST BILATERAL w/ and w/o CONTRAST Radiology: MR C8909 MRA chest w/contrast (excluding myocardium) Radiology: MR C8910 MRA chest w/o contrast (excluding myocardium) Radiology: MR C8911 MRA chest (excluding myocardium) Radiology: MR C8912 MRA lower extremity w/ contrast Radiology: MR C8913 MRA lower extremity w/o contrast Radiology: MR C8914 MRA lower extremity w/ and w/o contrast Radiology: MR C8918 MRA pelvis w/ contrast Radiology: MR C8919 MRA pelvis w/o contrast Radiology: MR C8920 MRA pelvis w/ and w/o contrast Cardiac: ECHO C8921 Transthoracic echocardiography w/contrast for congenital cardiac anomalies; complete Cardiac: ECHO C8922 Transthoracic echocardiography w/contrast for congenital cardiac anomalies; f/u or limited study Cardiac: ECHO C8923 Transthoracic echocardiography w/contrast, real-time w/image documentation (2d), w/wo m-mode recording; complete

Cardiac: ECHO C8924 Transthoracic echocardiography w/contrast, real-time w/image documentation (2d), w/wo m-mode recording; f/u or limited study

Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, real time with image documentation Cardiac: ECHO C8925 (2D) (with or without M-mode recording); including probe placement, image acquisition, interpretation and report Transesophageal echocardiography (TEE) with contrast, or without contrast followed by with contrast, for congenital cardiac anomalies; Cardiac: ECHO C8926 including probe placement, image acquisition, interpretation and report Transthoracic echocardiography w/contrast, real-time w/image documentation (2d), w/wo m-mode recording, during rest and Cardiac: ECHO C8928 cardiovascular stress test, w/interpretation and report

Effective: 1/1/2020 CPT® Category CPT® Code Description Code Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), Cardiac: ECHO C8929 includes m-mode recording, when performed, complete, with spectral doppler echocardiography, and with color flow doppler echocardiography Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or Cardiac: ECHO C8930 pharmacologically induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with physician supervision Radiology: MR C8931 MRA, W/DYE, SPINAL CANAL Radiology: MR C8932 MRA, W/O DYE, SPINAL CANAL Radiology: MR C8933 MRA, W/O&W/DYE, SPINAL CANAL Radiology: MR C8934 MRA, W/DYE, UPPER EXTREMITY Radiology: MR C8935 MRA, W/O DYE, UPPER EXTR Radiology: MR C8936 MRA, W/O&W/DYE, UPPER EXTR Radiology: PET G0219 PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS Radiology: PET G0235 PET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY FOR INITIAL DIAGNOSIS OF BREAST CANCER AND/OR Radiology: PET G0252 SURGICAL PLANNING FOR BREAST CANCER Radiology: CT G0297 Low-dose Computed Tomography For Lung Cancer Screening Radiology: MR S8037 Magnetic resonance cholangiopancreato-graphy (MRCP) Radiology: MR S8042 MAGNETIC RESONANCE IMAGING (MRI), LOW-FIELD SCINTIMAMMOGRAPHY (RADIOIMMUNOSCINTIGRAPHY OF THE BREAST), UNILATERAL, INCLUDING SUPPLY OF Radiology: CT S8080 RADIOPHARMACEUTICAL FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL HEAD COINCIDENCE DETECTION SYSTEM. (Non- Radiology: PET S8085 dedicated PET scan) Radiology: CT S8092 ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINET)

CPT copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1/1/2020 Community Health Options: MSK Comprehensive CPT Code List

Category CPT® Code CPT® Code Description ALLOGRAFT, MORSELIZED, OR PLACEMENT OF OSTEOPROMOTIVE MATERIAL, FOR SPINE SURGERY ONLY (LIST Spine Surgery 20930 SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE ALLOGRAFT, STRUCTURAL, FOR SPINE SURGERY ONLY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY Spine Surgery 20931 PROCEDURE) AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); LOCAL (EG, ,SPINOUS PROCESS, Spine Surgery 20936 OR LAMINAR FRAGMENTS) OBTAINED FROM SAME INCISION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); MORSELIZED (THROUGH SEPARATE Spine Surgery 20937 SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) AUTOGRAFT FOR SPINE SURGERY ONLY (INCLUDES HARVESTING THE GRAFT); STRUCTURAL,BICORTICAL OR Spine Surgery 20938 TRICORTICAL (THROUGH SEPARATE SKIN OR FASCIAL INCISION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Spine Surgery 20974 ELECTRICAL STIMULATION TO AID BONE HEALING; NON INVASIVE (NONOPERATIVE) Spine Surgery 20975 ELECTRICAL STIMULATION TO AID BONE HEALING; INVASIVE (OPERATIVE) PERCUTANEOUS VERTEBROPLASTY(BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL Spine Surgery 22510 OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; CERVICOTHORACIC PERCUTANEOUS VERTEBROPLASTY(BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL Spine Surgery 22511 OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBOSACRAL

PERCUTANEOUS VERTEBROPLASTY(BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL Spine Surgery 22512 OR BILATERAL INJECTION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL CERVICOTHORACIC OR LUMBOSACRAL VERTEBRAL BODY( LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

PERCUTANEOUS VERTEBRAL AUGMENATION, INCLUDING CAVITY CREATION(FRACTURE REDUCTION AND BONE BIOPSY Spine Surgery 22513 INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMGAING GUIDANCE; THORACIC

PERCUTANEOUS , INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE Spine Surgery 22514 BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL, OR BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; LUMBAR

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

PERCUTANEOUS VERTEBRAL AUGMENATION, INCLUDING CAVITY CREATION(FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE(EG, KYPHOPLASTY), 1 VERTEBRAL BODY, UNILATERAL OR Spine Surgery 22515 BILATERAL CANNULATION, INCLUSIVE OF ALL IMAGING GUIDANCE; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

PERCUTANEOUS INTRADISCAL ELECTROTHERMAL ANNULOPLASTY, UNILATERAL OR BILATERAL INCLUDING Interventional Pain 22526 FLUOROSCOPIC GUIDANCE; SINGLE LEVEL PERCUTANEOUS INTRADISCAL ELECTROTHERMAL ANNULOPLASTY, UNILATERAL OR BILATERAL INCLUDING Interventional Pain 22527 FLUOROSCOPIC GUIDANCE; ONCE OR MORE ADDITIONAL LEVELS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) , LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL TO PREPARE INTERSPACE Spine Surgery 22533 (OTHER THAN FOR DECOMPRESSION); LUMBAR ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE Spine Surgery 22534 (OTHER THAN FOR DECOMPRESSION); THORACIC OR LUMBAR, EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELYIN ADDITION TO CODE FOR PRIMARY PROCEDURE) ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY Spine Surgery 22551 AND DECOMPRESSION OF AND/OR NERVE ROOTS; CERVICAL BELOW C2 ARTHRODESIS, ANTERIOR INTERBODY, INCLUDING DISC SPACE PREPARATION, DISCECTOMY, OSTEOPHYTECTOMY Spine Surgery 22552 AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS; CERVICAL BELOW C2, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR SEPARATE PROCEDURE) ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE Spine Surgery 22554 (OTHER THAN FOR DECOMPRESSION); CERVICAL BELOW C2 ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE Spine Surgery 22558 (OTHER THAN FOR DECOMPRESSION); LUMBAR ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE Spine Surgery 22585 (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Spine Surgery 22600 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; CERVICAL BELOW C2 SEGMENT ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH LATERAL TRANSVERSE Spine Surgery 22612 TECHNIQUE, WHEN PERFORMED) ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; EACH ADDITIONAL VERTEBRAL Spine Surgery 22614 SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING AND/OR DISCECTOMY TO PREPARE Spine Surgery 22630 INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; LUMBAR ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, INCLUDING LAMINECTOMY AND/OR DISCECTOMY TO PREPARE Spine Surgery 22632 INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE; EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE Spine Surgery 22633 INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE AND SEGMENT; LUMBAR

Effective: 1/1/2020 Category CPT® Code CPT® Code Description ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR Spine Surgery 22634 DECOMPRESSION); EACH ADDITIONAL INTERSPACE AND SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) INTERNAL SPINAL FIXATION BY WIRING OF SPINOUS PROCESSES (LIST SEPARATELY IN ADDITION TO CODE FOR Spine Surgery 22841 PRIMARY PROCEDURE) POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND Spine Surgery 22842 SUBLAMINAR WIRES); 3 TO 6 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND Spine Surgery 22843 SUBLAMINAR WIRES); 7 TO 12 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) POSTERIOR SEGMENTAL INSTRUMENTATION (EG, PEDICLE FIXATION, DUAL RODS WITH MULTIPLE HOOKS AND Spine Surgery 22844 SUBLAMINAR WIRES); 13 OR MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) ANTERIOR INSTRUMENTATION; 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY Spine Surgery 22845 PROCEDURE) ANTERIOR INSTRUMENTATION; 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY Spine Surgery 22846 PROCEDURE) ANTERIOR INSTRUMENTATION; 8 OF MORE VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR Spine Surgery 22847 PRIMARY PROCEDURE) PELVIC FIXATION (ATTACHMENT OF CAUDAL END OF INSTRUMENTATION TO PELVIC BONY STRUCTURES) OTHER THAN Spine Surgery 22848 (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN CONJUNCTION WITH INTERBODY Spine Surgery 22853 ARTHRODESIS, EACH INTERSPACE (LIST PERFORMED, TO SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS, EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG, SCREWS, FLANGES), WHEN PERFORMED, TO VERTEBRAL Spine Surgery 22854 (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) TOTAL DISC (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE Spine Surgery 22856 PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION), SINGLE INTERSPACE, CERVICAL TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY TO PREPARE Spine Surgery 22857 INTERSPACE (OTHER THAN FOR DECOMPRESSION), SINGLE INTERSPACE, LUMBAR

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDING DISCECTOMY WITH END PLATE Spine Surgery 22858 PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION); SECOND LEVEL, CERVICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG, SYNTHETIC CAGE, MESH, METHYLMETHACRYLATE) Spine Surgery 22859 TO INTERVERTEBRAL DISC SPACE OR VERTEBRAL BODY DEFECT WITHOUT INTERBODY ARTHRODESIS, EACH CONTIGUOUS EFECT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, SINGLE Spine Surgery 22861 INTERSPACE; CERVICAL REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, SINGLE Spine Surgery 22862 INTERSPACE; LUMBAR INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT FUSION, Spine Surgery 22867 INCLUDING IMAGE GUIDANCE WHEN PERFORMED, WITH OPEN DECOMPRESSION, LUMBAR; SINGLE LEVEL INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT FUSION, Spine Surgery 22868 INCLUDING IMAGE GUIDANCE WHEN PERFORMED, WITH OPEN DECOMPRESSION, LUMBAR; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT OPEN Spine Surgery 22869 DECOMPRESSION OR FUSION, INCLUDING IMAGE GUIDANCE WHEN PERFORMED, LUMBAR; SINGLE LEVEL INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE, WITHOUT OPEN Spine Surgery 22870 DECOMPRESSION OR FUSION, INCLUDING IMAGE GUIDANCE WHEN PERFORMED, LUMBAR; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Joint Services 23000 Removal of subdeltoid calcareous deposits, open Joint Services 23020 Capsular contracture release (eg, Sever type procedure) Joint Services 23120 Claviculectomy; partial Joint Services 23130 or acromionectomy, partial, with or without coracoacromial release Joint Services 23410 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acute Joint Services 23412 Repair of ruptured musculotendinous cuff (eg, rotator cuff) open;chronic Joint Services 23415 Coracoacromial ligament release, with or without acromioplasty Joint Services 23420 Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty) Joint Services 23430 Tenodesis of long tendon of biceps Joint Services 23440 Resection or transplantation of long tendon of biceps Joint Services 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation Joint Services 23455 Capsulorrhaphy, anterior;with labral repair (eg, Bankart procedure) Joint Services 23460 Capsulorrhaphy, anterior, any type; with bone block

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Joint Services 23462 Capsulorrhaphy, anterior, any type;with coracoid process transfer Joint Services 23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block Joint Services 23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability Joint Services 23470 ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER [GLENOID AND PROXIMAL HUMERAL REPLACEMENT (E.G., Joint Services 23472 TOTAL SHOULDER)] REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL OR GLENOID Joint Services 23473 COMPONENT REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDING ALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID Joint Services 23474 COMPONENT INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR Interventional Pain 27096 CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED Joint Services 27125 HEMIARTHROPLASTY, HIP, PARTIAL (E.G., FEMORAL STEM PROSTHESIS, BIPOLAR ARTHROPLASTY) ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY), Joint Services 27130 WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT CONVERSION OF PREVIOUS HIP SURGERY TO TOTAL HIP ARTHROPLASTY, WITH OR WITHOUT AUTOGRAFT OR Joint Services 27132 ALLOGRAFT Joint Services 27134 REVISION OF TOTAL HIP ARTHROPLASTY; BOTH COMPONENTS, WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT REVISION OF TOTAL HIP ARTHROPLASTY; ACETABULAR COMPONENT ONLY, WITH OR WITHOUT AUTOGRAFT OR Joint Services 27137 ALLOGRAFT REVISION OF TOTAL HIP ARTHROPLASTY; FEMORAL COMPONENT ONLY, WITH OR WITHOUT AUTOGRAFT OR Joint Services 27138 ALLOGRAFT Joint Services 27332 , with excision of semilunar (meniscectomy) knee; medial OR lateral Joint Services 27333 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateral Joint Services 27334 Arthrotomy, with , knee; anterior OR posterior Joint Services 27335 Arthrotomy, with synovectomy, knee;anterior AND posterior including popliteal area Joint Services 27403 Arthrotomy with meniscus repair, knee Joint Services 27412 Autologous chondrocyte implantation, knee Joint Services 27415 Osteochondral allograft, knee, open Joint Services 27416 Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s]) Joint Services 27418 Anterior tibial tubercleplasty (eg, Maquet type procedure) Joint Services 27420 Reconstruction of dislocating patella; (eg, Hauser type procedure) Reconstruction of dislocating patella;with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite Joint Services 27422 type procedure) Joint Services 27424 Reconstruction of dislocating patella;with patellectomy

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Joint Services 27425 Lateral retinacular release, open Joint Services 27427 Ligamentous reconstruction (augmentation), knee; extra-articular Joint Services 27428 Ligamentous reconstruction (augmentation), knee;intra-articular (open) Joint Services 27429 Ligamentous reconstruction (augmentation), knee;intra-articular (open) and extra-articular Joint Services 27430 Quadricepsplasty (eg, Bennett or Thompson type) Joint Services 27438 ARTHROPLASTY, PATELLA; WITH PROSTHESIS Joint Services 27440 ARTHROPLASTY, KNEE, TIBIAL PLATEAU Joint Services 27441 ARTHROPLASTY, KNEE, TIBIAL PLATEAU; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY

Joint Services 27442 ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY

Joint Services 27443 ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; WITH DEBRIDEMENT AND PARTIAL SYNOVECTOMY

Joint Services 27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL OR LATERAL COMPARTMENT ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA Joint Services 27447 RESURFACING (TOTAL KNEE ARTHROPLASTY) Joint Services 27486 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT

Joint Services 27487 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; FEMORAL AND ENTIRE TIBIAL COMPONENT

Joint Services 29805 , SHOULDER, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) Joint Services 29806 ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPHY Joint Services 29807 ARTHROSCOPY, SHOULDER, SLAP REPAIR Joint Services 29819 ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY Joint Services 29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL Joint Services 29821 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE Joint Services 29822 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED Joint Services 29823 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD Joint Services 29824 PROCEDURE) ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OF ADHESIONS, WITH OUR WITHOUT Joint Services 29825 MANIPULATION ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, Joint Services 29826 WITH CORACOACROMIAL LIGAMENT (IE, ARCH) RELEASE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Joint Services 29827 ARTHROSCOPY, SHOULDER, SURGICAL; WITH ROTATOR CUFF REPAIR Joint Services 29828 ARTHROSCOPY, SHOULDER, BICEPS TENODESIS

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Joint Services 29860 ARTHROSCOPY, HIP, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) Joint Services 29861 ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), Joint Services 29862 ABRASION ARTHROPLASTY, AND/OR RESECTION OF LABRUM Joint Services 29863 ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL AUTOGRAFT(S) (EG, MOSAICPLASTY) (INCLUDES HARVESTING OF Joint Services 29866 THE AUTOGRAFT[S]) Joint Services 29867 ARTHROSCOPY, KNEE, SURGICAL; OSTEOCHONDRAL ALLOGRAFT (EG, MOSAICPLASTY) ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTATION (INCLUDES ARTHROTOMY FOR MENISCAL INSERTION(, Joint Services 29868 MEDIAL OR LATERAL Joint Services 29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVAL BIOPSY (SEPARATE PROCEDURE) Joint Services 29871 ARTHROSCOPY, KNEE, SURGICAL; FOR , LAVAGE AND DRAINAGE Joint Services 29873 ARTHROSCOPY, KNEE, SURGICAL; WITH LATERAL RELEASE ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY OR FOREIGN BODY ( EG OSTEOCHONDRITIS Joint Services 29874 DISSECANS FRAGMENTATION, CHONDRAL FRAGMENTATION) Joint Services 29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE)

Joint Services 29876 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2 OR MORE COMPARTMENTS (EG, MEDIAL OR LATERAL)

Joint Services 29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR Joint Services 29879 MULTIPLE DRILLING OR MICROFRACTURE ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING) Joint Services 29880 INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT (S) WHEN PERFORMED ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) Joint Services 29881 INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT (S) WHEN PERFORMED Joint Services 29882 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCAL REPAIR (MEDIAL OR LATERAL) Joint Services 29883 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCAL REPAIR (MEDIAL AND LATERAL) ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITH OR WITHOUT MANIPULATION (SEPARATE Joint Services 29884 PROCEDURE) ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH , WITH OR Joint Services 29885 WITHOUT (INCLUDING DEBRIDEMENT OF BASE OF LESION) Joint Services 29886 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL Joint Services 29887 FIXATION Joint Services 29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Joint Services 29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION

Joint Services 29914 ARTHROSCOPY, HIP, SURGICAL; WITH FEMOROPLASTY (IE, TREATMENT OF CAM LESION) Joint Services 29915 ARTHROSCOPY, HIP, SURGICAL; WITH ACETABULOPLASTY (IE, TREATMENT OF PINCER LESION) Joint Services 29916 ARTHROSCOPY, HIP, SURGICAL; WITH LABRAL REPAIR PERCUTANEOUS LYSIS OF EPIDURAL ADHESIONS USING SOLUTION INJECTION (E.G., HYPERTONIC SALINE, ENZYME) OR Interventional Pain 62263 MECHANICAL MEANS (E.G., CATHETER) INCLUDING RADIOLOGIC 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 Interventional Pain 62264 MECHANICAL MEANS (E.G., CATHETER) INCLUDING RADIOLOGIC LOCALIZATION (INCLUDES CONTRAST WHEN ADMINISTERED), MULTIPLE ADHESIOLYSIS SESSIONS; 1 DAY INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR Interventional Pain 62280 WITHOUT OTHER THERAPEUTIC SUBSTANCE; SUBARACHNOID INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR Interventional Pain 62281 WITHOUT OTHER THERAPEUTIC SUBSTANCE; EPIDURAL, CERVICAL OR THORACIC INJECTION/INFUSION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, ICED SALINE SOLUTIONS), WITH OR Interventional Pain 62282 WITHOUT OTHER THERAPEUTIC SUBSTANCE; EPIDURAL, LUMBAR, SACRAL (CAUDAL) DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISC, ANY METHOD UTILIZING NEEDLE BASED TECHNIQUE TO REMOVE DISC MATERIAL UNDER FLUOROSCOPIC IMAGING OR OTHER FORM Interventional Pain 62287 OF INDIRECT VISUALIZATION, WITH DISCOGRAPHY AND/OR EPIDURAL INJECTION(S) AT THE TREATED LEVEL(S), WHEN PERFORMED, SINGLE OR MULTIPLE LEVELS, LUMBAR INJECTION PROCEDURE FOR CHEMONUCLEOLYSIS, INCLUDING DISCOGRAPHY, INTERVERTEBRAL DISC, SINGLE, OR Interventional Pain 62292 MULTIPLE LEVELS, LUMBAR INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, Interventional Pain 62320 OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITHOUT IMAGING GUIDANCE INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, Interventional Pain 62321 INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, Interventional Pain 62322 OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITHOUT IMAGING GUIDANCE INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEMENT, Interventional Pain 62323 INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER Interventional Pain 62324 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) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER Interventional Pain 62325 SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, CERVICAL OR THORACIC; WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER Interventional Pain 62326 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) (EG, ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER Interventional Pain 62327 SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INTERLAMINAR EPIDURAL OR SUBARACHNOID, LUMBAR OR SACRAL (CAUDAL); WITH IMAGING GUIDANCE (IE, FLUOROSCOPY OR CT) IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM Interventional Pain 62350 MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITHOUT LAMINECTOMY IMPLANTATION, REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER, FOR LONG-TERM Interventional Pain 62351 MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP OR IMPLANTABLE RESERVOIR/INFUSION PUMP; WITH LAMINECTOMY IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS Interventional Pain 62360 RESERVOIR IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; SUBCUTANEOUS Interventional Pain 62361 RESERVOIR; NONPROGRAMMABLE PUMP IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION; PROGRAMMABLE Interventional Pain 62362 PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING ENDOSCOPIC DECOMPRESSION OF SPINAL CORD, NERVE ROOT(S), INCLUDING LAMINOTOMY, PARTIAL , Spine Surgery 62380 , DISCECTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, 1 INTERSPACE, LUMBAR

LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT Spine Surgery 63001 FACETECTOMY, FORAMINOTOMY OR DISCECTOMY (EG, ), 1 OR 2 VERTEBRAL SEGMENTS; CERVICAL LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT Spine Surgery 63005 FACETECTOMY, FORAMINOTOMY OR DISCECTOMY (EG, SPINAL STENOSIS), 1 OR 2 VERTEBRAL SEGMENTS; LUMBAR, EXCEPT FOR SPONDYLOLISTHESIS

LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/OR PARS INTER-ARTICULARIS WITH DECOMPRESSION OF Spine Surgery 63012 CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS, LUMBAR (GILL TYPE PROCEDURE)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT Spine Surgery 63015 FACETECTOMY, FORAMINOTOMY OR DISCECTOMY (EG, SPINAL STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; CERVICAL LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT Spine Surgery 63017 FACETECTOMY, FORAMINOTOMY OR DISCECTOMY (EG, SPINAL STENOSIS), MORE THAN 2 VERTEBRAL SEGMENTS; LUMBAR

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, Spine Surgery 63020 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, CERVICAL

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, Spine Surgery 63030 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, Spine Surgery 63035 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 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, Spine Surgery 63040 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; CERVICAL LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, Spine Surgery 63042 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; LUMBAR

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, Spine Surgery 63043 FORMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, 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, Spine Surgery 63044 FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC, REEXPLORATION, SINGLE INTERSPACE; EACH ADDITIONAL LUMBAR INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

LAMINECTOMY, FACETECTOMY AND FORMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL Spine Surgery 63045 CORD, CAUDA EQUINA AND/OR NERVE ROOT[S], [EG, SPINAL OR LATERAL RECESS STENOSIS], SINGLE VERTEBRAL SEGMENT; CERVICAL LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL OR BILATERAL WITH DECOMPRESSION OF SPINAL Spine Surgery 63047 CORD, CAUDA EQUINA AND/OR NERVE ROOT(S), [EG,SPINAL OR LATERAL 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], [EG, SPINAL OR LATERAL RECESS STENOSIS]), SINGLE VERTEBRAL Spine Surgery 63048 SEGMENT; EACH ADDITIONAL SEGMENT, CERVICAL, THORACIC, OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Spine Surgery 63050 , CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, 2 OR MORE VERTEBRAL SEGMENTS

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, 2 OR MORE VERTEBRAL SEGMENTS; WITH Spine Surgery 63051 RECONSTRUCTION OF THE POSTERIOR BONY ELEMENTS (INCLUDING THE APPLICATION OF BRIDGING BONE GRAFT AND NON-SEGMENTAL FIXATION DEVICES (EG, WIRE, SUTURE, MINI-PLATES), WHEN PERFORMED)

TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, Spine Surgery 63056 HERNIATED INTERVERTEBRAL DISC), SINGLE SEGMENT; LUMBAR (INCLUDING TRANSFACET, OR LATERAL EXTRAFORAMINAL APPROACH) (EG, FAR LATERAL HERNIATED INTERVERTEBRAL DISC) TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD, EQUINA AND/OR NERVE ROOT(S) (EG, Spine Surgery 63057 HERNIATED INTERVERTEBRAL DISC), SINGLE SEGMENT; EACH ADDITIONAL SEGMENT, THORACIC OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) DISCECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S), INCLUDING Spine Surgery 63075 OSTEOPHYTECTOMY; CERVICAL, SINGLE INTERSPACE DISCECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S), INCLUDING Spine Surgery 63076 OSTEOPHYTECTOMY; CERVICAL, EACH ADDITIONAL INTERSPACE (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 Spine Surgery 63081 nerve root(s); cervical, single segment Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or Spine Surgery 63082 nerve root(s); cervical, each additional segment (List separately in addition to code for primary procedure) Interventional Pain 63650 PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY, EPIDURAL Interventional Pain 63655 LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR Interventional Pain 63685 INDUCTIVE COUPLING Injection(s), anesthetic agent(s) and/or steroid; nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or Interventional Pain 64451 computed tomography) INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE Interventional Pain 64479 (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE LEVEL INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE Interventional Pain 64480 (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE Interventional Pain 64483 (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE LEVEL INJECTION, ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH IMAGING GUIDANCE Interventional Pain 64484 (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES Interventional Pain 64490 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL

Effective: 1/1/2020 Category CPT® Code CPT® Code Description INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES Interventional Pain 64491 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), 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 Interventional Pain 64492 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), 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 Interventional Pain 64493 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES Interventional Pain 64494 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), 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 Interventional Pain 64495 INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Interventional Pain 64510 INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICAL SYMPATHETIC) Interventional Pain 64520 INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC)

Interventional Pain 64625 Radiofrequency ablation, nerves innervating the sacroiliac joint, with image guidance (ie, fluoroscopy or computed tomography) DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE Interventional Pain 64633 (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE Interventional Pain 64634 (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE Interventional Pain 64635 (FLUROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE Interventional Pain 64636 (FLUROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) REMOVAL OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH,EACH ADDITIONAL INTERSPACE, Spine Surgery 0095T CERVICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, EACH Spine Surgery 0098T ADDITIONAL INTERSPACE, CERVICAL (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC), ANTERIOR APPROACH, INCLUDINGDISCECTOMY TO PREPARE Spine Surgery 0163T INTERSPACE (OTHER THAN FOR DECOMPRESSION),EACH ADDITIONAL INTERSPACE, LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) REMOVAL OF TOTAL DISC ARTHROPLASTY, (ARTIFICIAL DISC), ANTERIOR APPROACH,EACH ADDITIONAL INTERSPACE, Spine Surgery 0164T LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

REVISION INCLUDING REPLACEMENT OF TOTAL DISC ARTHROPLASTY (ARTIFICIALDISC), ANTERIOR APPROACH, EACH Spine Surgery 0165T ADDITIONAL INTERSPACE, LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, Interventional Pain 0228T CERVICAL/THORACIC; SINGLE LEVEL INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, Interventional Pain 0229T CERVICAL OR THORACIC; EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, Interventional Pain 0230T LUMBAR OR SACRAL; SINGLE LEVEL INJECTION(S), ANESTHETIC AGENT AND/OR STEROID, TRANSFORAMINAL EPIDURAL, WITH ULTRASOUND GUIDANCE, Interventional Pain 0231T LUMBAR OR SACRAL; EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DESCECTOMY, FACETECTOMY AND/OR FORAMINTOMY), Interventional Pain 0274T ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (E.G. FLUORSOCPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; CERVICAL OR THORACIC. PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DESCECTOMY, FACETECTOMY AND/OR FORAMINTOMY), Interventional Pain 0275T ANY METHOD, UNDER INDIRECT IMAGE GUIDANCE (E.G. FLUORSOCPIC, CT), SINGLE OR MULTIPLE LEVELS, UNILATERAL OR BILATERAL; LUMBAR

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and excision of Spine Surgery C9757 herniated intervertebral disc, and repair of annular defect with implantation of bone anchored annular closure device, including annular defect measurement, alignment and sizing assessment, and image guidance; 1 interspace, lumbar

Spine Surgery E0748 OSTEOGENESIS STIMULATOR; ELECTRICAL, NONINVASIVE, SPINAL APPLICATIONS Spine Surgery E0749 OSTEOGENESIS STIMULATOR; ELECTRICAL, SURGICALLY IMPLANTED INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC Interventional Pain G0260 AGENT, WITH OR WITHOUT ARTHROGRAPHY Spine Surgery S2360 PERCUTANEOUS VERTEBROPLASTY, ONE VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; CERVICAL

Spine Surgery S2361 EACH ADDITIONAL CERVICAL VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)

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Effective: 1/1/2020