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Community Health Options: Advanced Imaging CPT Code List

CPT® Category CPT® Code Description Code 3D Imaging 76376 3D Rendering W/O Postprocessing 3D Imaging 76377 3D Rendering W Postprocessing Cardiac Rhythm Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local myocardial dynamics) Implantable 0399T (List separately in addition to code for primary procedure) Devices (CRID) 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) 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) Cardiac: RIGHT HEART CATHETERIZATION INCLUDING MEASUREMENT(S) OF OXYGEN SATURATION AND CARDIAC OUTPUT, WHEN Diagnostic Heart 93451 PERFORMED Cath Cardiac: Left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when Diagnostic Heart 93452 performed Cath Cardiac: Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and Diagnostic Heart 93453 interpretation, when performed Cath Cardiac: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Diagnostic Heart 93454 imaging supervision and interpretation Cath Cardiac: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Diagnostic Heart 93455 imaging supervision and interpretation; with catheter placement(s) in bypass graft(s) (internal mammary, free arterial venous grafts) Cath including intraprocedural injection(s) for bypass graft angiography

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Cardiac: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Diagnostic Heart 93456 imaging supervision and interpretation; with right heart catheterization Cath

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

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

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

Cardiac: Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Diagnostic Heart 93460 imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left Cath ventriculography, when performed Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, Cardiac: imaging supervision and interpretation; with right and left heart catheterization including intraprocedural injection(s) for left Diagnostic Heart 93461 ventriculography, when performed, catheter placement(s) in bypass graft(s) (internal mammary, free arterial, venous grafts) with bypass Cath graft angiography Cardiac: Left heart catheterization by transseptal puncture through intact septum or by transapical puncture (list separately in addition to code for Diagnostic Heart 93462 primary procedure) Cath Cardiac: Diagnostic Heart 93530 RIGHT HEART CATHETERIZATION (CHD) Cath Cardiac: Diagnostic Heart 93531 RIGHT/LEFT HEART CATHETERIZATION (CHD) Cath Cardiac: Diagnostic Heart 93532 RIGHT/LEFT HEART CATHETERIZATION (CHD-TS) Cath Cardiac: Diagnostic Heart 93533 RIGHT/LEFT HEART CATHETERIZATION (CAD-ASD) Cath 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

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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 93320 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; complete Cardiac: ECHO 93321 Doppler echocardiography, pulsed wave and/or continuous wave with spectral display; follow-up or limited study Cardiac: ECHO 93325 Doppler echocardiography color flow velocity mapping 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 Cardiac: ECHO C8925 documentation (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 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 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

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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 Cardiac: ECHO 93352 STRESS Use of echocardiographic contrast agent during stress echocardiography (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: 78451 myocardial perfusion imaging, tomographic (spect) including attenuation correction, qualitative or quantitative wall motion, Myocardial 78451 ejection fraction by first pass or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or Perfusion Imaging pharmacologic) (Nuclear Stress)

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

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

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

Cardiac: PET 78459 Myocardial imaging, positron emission tomography (pet), metabolic evaluation Cardiac: PET 78491 Myocardial imaging, positron emission tomography (pet), perfusion; single study at rest or stress Cardiac: PET 78492 Myocardial imaging, positron emission tomography (pet), perfusion; multiple studies at rest and/or stress

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 77046 Magnetic resonance imaging, breast, without contrast material; unilateral BMRI

Radiology: 77047 Magnetic resonance imaging, breast, without contrast material; bilateral BMRI

Radiology: Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real- 77048 BMRI time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral

Radiology: Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real- 77049 BMRI time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral 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: 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: 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

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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: 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: 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: 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: 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: 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: CT 75635 C T Angiography Abdominal Aorta Radiology: CT 76380 C T Limited Or Localized Follow-Up Study Radiology: CT 76497 Unlisted computed tomography procedure

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: CT 77078 Computed Tomography, mineral density study, 1 or more sites; axial skeleton Radiology: CT 0042T CT PERFUSION BRAIN Radiology: CT G0297 Low-dose Computed Tomography For Lung Cancer Screening SCINTIMAMMOGRAPHY (RADIOIMMUNOSCINTIGRAPHY OF THE BREAST), UNILATERAL, INCLUDING SUPPLY OF Radiology: CT S8080 RADIOPHARMACEUTICAL Radiology: CT S8092 ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINET) Radiology: MR 70336 M R I T M J 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 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: 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: 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 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

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: MR 72158 M R I Lumbar Spine With & Without Contrast Radiology: MR 72159 M R A Spinal Canal With Or Without 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: 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: 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 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: 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: 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) Radiology: MR 76390 M R I Spectroscopy Radiology: MR 76498 Unlisted MRI Procedure 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: MR 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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 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: MR S8037 Magnetic resonance cholangiopancreato-graphy (MRCP) Radiology: MR S8042 MAGNETIC RESONANCE IMAGING (MRI), LOW-FIELD

Radiology: MRI 76391 Magnetic resonance (eg, vibration) elastography

Radiology: 78012 Nuclear Medicine Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

Radiology: 78013 Nuclear Medicine Thyroid imaging (including vascular flow, when performed)

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78014 Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including Nuclear Medicine stimulation, suppression, or discharge, when performed)

Radiology: 78015 Nuclear Medicine Thyroid Met Imaging

Radiology: 78016 Nuclear Medicine Thyroid Met Imaging With Additional Studies

Radiology: 78018 Nuclear Medicine Thyroid Scan Whole Body

Radiology: 78020 Nuclear Medicine Thyroid Carcinoma Metastases Uptake

Radiology: 78070 Nuclear Medicine Parathyroid planar imaging (including subtraction, when performed)

Radiology: 78071 Nuclear Medicine Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT)

Radiology: 78072 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed Nuclear Medicine tomography (CT) for anatomical localization

Radiology: 78075 Adrenal Nuclear Imaging Nuclear Medicine

Radiology: 78102 Bone Marrow Imaging, Limited Nuclear Medicine

Radiology: 78103 Bone Marrow Imaging, Multiple Nuclear Medicine

Radiology: 78104 Bone Marrow Imaging, Whole Body Nuclear Medicine

Radiology: 78140 Labeled Red Cell Sequestration Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78185 Spleen Imaging With & Without Vascular Flow Nuclear Medicine

Radiology: 78195 Lymph System Imaging Nuclear Medicine

Radiology: 78201 Liver Imaging Nuclear Medicine

Radiology: 78202 Liver Imaging With Flow Nuclear Medicine

Radiology: 78205 Liver Imaging SPECT (3D) Nuclear Medicine

Radiology: 78206 Liver Imaging SPECT With Vasulcar Flow Nuclear Medicine

Radiology: 78215 Liver & Spleen Imaging Nuclear Medicine

Radiology: 78216 Liver & Spleen Imaging With Flow Nuclear Medicine

Radiology: 78226 Hepatobiliary system imaging, including gallbladder when present; Nuclear Medicine

Radiology: Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative 78227 Nuclear Medicine measurement(s) when performed

Radiology: 78230 Salivary Gland Imaging Nuclear Medicine

Radiology: 78231 Serial Salivary Gland Nuclear Medicine

Radiology: 78232 Salivary Gland Function Exam Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78258 Esophogus Motility Study Nuclear Medicine

Radiology: 78261 Gastric Mucosa Imaging Nuclear Medicine

Radiology: 78262 Gastroesophageal Reflux Exam Nuclear Medicine

Radiology: 78264 Gastric Emptying Study Nuclear Medicine

Radiology: 78265 Nuclear Medicine Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit

Radiology: 78266 Nuclear Medicine Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days

Radiology: 78278 GI Bleeder Scan Nuclear Medicine

Radiology: 78290 Meckels Diverticulum Imaging Nuclear Medicine

Radiology: 78291 Leveen Shunt Patency Exam Nuclear Medicine

Radiology: 78300 Bone Or Joint Imaging Limited Nuclear Medicine

Radiology: 78305 Bone Or Joint Imaging Multiple Nuclear Medicine

Radiology: 78306 Bone Scan Whole Body Nuclear Medicine

Radiology: 78315 Bone Scan 3 Phase Study Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78320 Bone Joint Imaging Tomo Test SPECT Nuclear Medicine

Radiology: 78414 Non-Imaging Heart Function Nuclear Medicine

Radiology: 78428 Cardiac Shunt Imaging Nuclear Medicine

Radiology: 78445 Radionuclide Venogram Non-Cardiac Nuclear Medicine

Radiology: 78457 Venous Thrombosis Imaging Unilateral Nuclear Medicine

Radiology: 78458 Venous Thrombosis Images, Bilateral Nuclear Medicine

Radiology: 78466 Myocardial Infarction Scan Nuclear Medicine

Radiology: 78468 Heart Infarct Image Ejection Fraction Nuclear Medicine

Radiology: 78469 Heart Infarct Image 3D SPECT Nuclear Medicine

Radiology: 78472 CARDIAC BLOODPOOL IMG, SINGLE Nuclear Medicine

Radiology: 78473 CARDIAC BLOODPOOL IMG, MULTI Nuclear Medicine

Radiology: 78481 Heart First Pass Single Nuclear Medicine

Radiology: 78483 Cardiac Blood Pool Imaging -- Multiple Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78494 Cardiac Blood Pool Imaging , SPECT Nuclear Medicine

Radiology: 78496 Cardiac Blood Pool Imaging - Single Study @ Rest Nuclear Medicine

Radiology: 78499 Unlisted Cardiovascular Procedure Nuclear Medicine

Radiology: 78579 Pulmonary ventilation imaging (eg, aerosol or gas) Nuclear Medicine

Radiology: 78580 Pulmonary perfusion imaging (eg, particulate) Nuclear Medicine

Radiology: 78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging Nuclear Medicine

Radiology: 78597 Quantitative differential pulmonary perfusion, including imaging when performed Nuclear Medicine

Radiology: 78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed Nuclear Medicine

Radiology: 78600 Brain Imaging Limited Static Nuclear Medicine

Radiology: 78601 Brain Limited Imaging And Flow Nuclear Medicine

Radiology: 78605 Brain Imaging Complete Nuclear Medicine

Radiology: 78606 Brain Imaging Complete With Flow Nuclear Medicine

Radiology: 78607 Brain Imaging 3D Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78610 Brain Flow Imaging Only Nuclear Medicine

Radiology: 78630 Cisternogram (Cerebrospinal Fluid Flow) Nuclear Medicine

Radiology: 78635 Cerebrospinal Ventriculography Nuclear Medicine

Radiology: 78645 CSF Shunt Evaluation Nuclear Medicine

Radiology: 78647 Cerebrospinal Fluid Scan (Tomographic) SPECT Nuclear Medicine

Radiology: 78650 C S F Leakage Detection And Localization Nuclear Medicine

Radiology: 78660 Radiopharmaceutical Dacryocystography Nuclear Medicine

Radiology: 78699 Nuclear Medicine Unlisted Nuclear Medicine Procedure

Radiology: 78700 Kidney Imaging Morphology Nuclear Medicine

Radiology: 78701 Kidney Imaging With Vascular Flow Nuclear Medicine

Radiology: 78707 Kidney Imaging With Vascular Flow & Function Single Study Without Pharmacological Intervention Nuclear Medicine

Radiology: 78708 Kidney Imaging Single Study With Pharmacological Intervention Nuclear Medicine

Radiology: 78709 Kidney Imaging - Multiple Studies Without & With Pharmacological Intervention Nuclear Medicine

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: 78710 Kidney Imaging - Tomographic (SPECT) Nuclear Medicine

Radiology: 78725 Kidney Function Study - Non-Imaging Radioisotopic Nuclear Medicine

Radiology: 78730 Urinary Bladder Residual Study Nuclear Medicine

Radiology: 78740 Ureteral Reflux Study Nuclear Medicine

Radiology: 78761 Testicular Imaging With Vascular Flow Nuclear Medicine

Radiology: 78800 Radiopharm Localization Of Tumor, Limited Area Nuclear Medicine

Radiology: 78801 Radiopharm Localization Of Tumor, Multiple Areas Nuclear Medicine

Radiology: 78802 Radiopharm Localization Of Tumor, Whole Body Nuclear Medicine

Radiology: 78803 Radiopharm Localization Of Tumor Tomographic (SPECT) Nuclear Medicine

Radiology: 78804 Radiopharm Localization Of Tumor, Whole Body Nuclear Medicine

Radiology: 78805 Radiopharm Localization Of Abscess, Limited Area Nuclear Medicine

Radiology: 78806 Radiopharm Localization Of Abscess, Whole Body Nuclear Medicine

Radiology: 78807 Radiopharm Localization Of Abscess, Tomographic SPECT Nuclear Medicine

Radiology: PET 78608 Brain Imaging, Positron Emission Tomography (PET) Metabolic Evaluation

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code Radiology: PET 78609 Brain Imaging, Positron Emission Tomography (PET) Perfusion Evaluation Radiology: PET 78811 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); LIMITED AREA (EG, CHEST, HEAD/NECK) Radiology: PET 78812 TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET); SKULL 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)

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 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 FLUORINE-18 FLUORODEOXYGLUCOSE (F-18 FDG) IMAGING USING DUAL HEAD COINCIDENCE DETECTION SYSTEM. (Non- Radiology: PET S8085 dedicated PET scan) 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)

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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) Ultrasound: U/S ( 76830 U/S TRANSVAGINAL non-OB) 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 76979 non-OB) separate injection (List separately in addition to code for primary procedure) Ultrasound: U/S ( 76999 Echo examination procedure non-OB) Ultrasound: U/S ( 93880 DUPLEX SCAN EXTRACRANIAL ARTER non-OB) Ultrasound: U/S ( 93882 DUPLEX SCAN EXTRACRANIAL ARTER non-OB)

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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) 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)

Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 CPT® Category CPT® Code Description Code 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)

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Updated: 1/31/2019 V1.2019 Effective: 1/1/2019 Community Health Options: MSK Comprehensive CPT Code List

Category CPT® Code CPT® Code Description 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) INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR Interventional Pain 27096 CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED 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

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description 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) 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 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

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

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, 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 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) 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)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description 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) 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 /LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS, (WITH OR WITHOUT LIGAMENTOUS RESECTION, DESCECTOMY, 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 INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID AND/OR OTHER THERAPEUTIC Interventional Pain G0260 AGENT, WITH OR WITHOUT ARTHROGRAPHY 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 ligament 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)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

Joint Services 23460 Capsulorrhaphy, anterior, any type; with bone block 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 , 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 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 synovectomy, 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 Joint Services 27425 Lateral retinacular release, open

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

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 Joint Services 29860 ARTHROSCOPY, HIP, DIAGNOSTIC, WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

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 INFECTION, 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

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 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 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, RIBS,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

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 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)

ARTHRODESIS, LATERAL EXTRACAVITARY TECHNIQUE, INCLUDING MINIMAL TO PREPARE INTERSPACE Spine Surgery 22533 (OTHER THAN FOR DECOMPRESSION); LUMBAR , 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 SPINAL CORD 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 LAMINECTOMY 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 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)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description 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 SACRUM (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 INTERVERTEBRAL DISC 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 ARTHROPLASTY (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

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)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

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)

ENDOSCOPIC DECOMPRESSION OF SPINAL CORD, NERVE ROOT(S), INCLUDING LAMINOTOMY, PARTIAL FACETECTOMY, 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, SPINAL STENOSIS), 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) 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

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description

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

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)

Updated: 12/22/2018 V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description 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) 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) 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)

Spine Surgery E0748 OSTEOGENESIS STIMULATOR; ELECTRICAL, NONINVASIVE, SPINAL APPLICATIONS Spine Surgery E0749 OSTEOGENESIS STIMULATOR; ELECTRICAL, SURGICALLY IMPLANTED

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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Updated: 12/22/2018 V1.2019 Effective: 1/1/2019