Codes Description 00851 Anesthesia for tubal ligation/transaction Anesthesia for procedures on male genitalia (including open 00921 urethral procedures); vasectomy, unilateral/bilateral 11976 Removable, implantable contraceptive capsules 11981 Insertion, non-biodegradable drug delivery implant 11982 Removal, non-biodegradable drug delivery implant Removal with reinsertion, non-biodegradable drug delivery 11983 implant 36415 Collection of venous blood by venipuncture 36416 Collection of capillary blood specimen (e.g. finger, heel, earstick)

Vasectomy, unilateral or bilateral (separate procedure), including 55250 postoperative semen examinations 55450 Ligation (percutaneous) of vas deferens, unilateral or bilateral (separate procedure) 58300 Insertion of intrauterine device (IUD) 58301 Removal of intrauterine device (IUD) (Essure) - Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or 58340 hysterosalpingography

(Essure) - Hysteroscopy, surgical; with bilateral tube cannulation 58565 to induce occlusion by placement of permanent implants 58600 Ligation or transection of fallopian tubes 58615 Occlusion of fallopian tubes by device Laparoscopy, surgical; w/ fulguration of oviducts by device (with 58670 or without transection) 58671 Laparoscopy, surgical; with occlusion of oviducts by device (e.g. band, clip, etc) (Essure) - Hysterosalpinogography, radiologic supervision and 74740 interpretation 76830 Ultrasound transvaginal Urinalysis by dip stick/tablet reagent; non-automated without 81002 microscopy (CLIA waiver list) 81025 Urine pregnancy test by visual color comparison methods (CLIA waiver list) 83020 Hemoglobin fractionation and quantitation; electrophoresis 84703 Gonadotropin chorionic qualitative (CLIA waiver list) 85013 Blood count; spun microhematocrit (CLIA waiver list) 85014 Hematocrit 85018 Hemoglobin 86592 Syphilis test qualitative (EG VDRL RPR ART) 86689 Antibody; HTLV or HIV antibody confirmatory test (EG western blot) 86701 Antibody HIV 1 87081 Culture bacterial screening only for single organisms 87164 Dark field examination any source (e.g. penile, vaginal, oral, skin) 87210 Smear primary source with interpretation wet mount with simple stain 87490 Chlamydia trachomatis direct probe technique 87491 Chlamydia trachomatis amplified probe technique 87590 Neisseria gonorrhea direct probe technique 87591 Neisseria gonorrhea amplified probe technique 88141 Cytopathology cervical or vaginal Cytopathology cervical or vaginal, thin layer preparation; manual 88142 screening under physician supervision 88143 Cytopathology cervical or vaginal, with manual screening and rescreening

Cytopathology smears cervical or vaginal; screening by automated 88147 system under physician supervision Cytopathology smears cervical or vaginal; screening by automated 88148 system with manual rescreening Cytopathology slides cervical or vaginal; manual screening under 88150 physical supervision Cytopathology slides cervical or vaginal; with manual and 88152 computer-assisted rescreening under physician supervision Cytopathology slides cervical or vaginal, with manual screening 88153 and rescreening under physician supervision Cytopathology slides cervical or vaginal; with manual screenings 88154 and computer-assisted rescreening 88155 Cytopathology slides cervical or vaginal definitive hormonal evaluation 88164 Cytopathology slides cervical or vaginal (the Bethesda system)

Cytopathology slides cervical or vaginal (the Bethesda system); 88165 under physician's supervision

Cytopathology slides cervical or vaginal (the Bethesda system); 88166 with manual screenings and computer-assisted rescreening Cytopathology slides cervical or vaginal (the Bethesda system); with manual screening and computer-assisted rescreening using 88167 cell selection

Cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation; 88174 screening by automated system, under physician supervision Cytopath c/v automated thin layer preparation, with screening by automated system and manual rescreening or review, under 88175 physician supervision 88302 Level II - surgical pathology, gross and microscopic examination 90471 Immunization admin; 1 vaccine - administration of the HPV vaccine (HPV) 90649 HPV vaccine, Quad, 3-dose 96372 Therapeutic, prophylactic, or diagnostic injection; subcutaneous or intramuscular 99201-99205 New patient or established patient - office or other outpatient visit 99211-99215 New patient or established patient - office or other outpatient visit A4261 Cervical cap for contraceptive use A4266 Diaphragm A4267 Condoms A4268 Contraceptive supply, condom, female A4269 Contraceptive supply, spermicide (e.g. foam, gel) J1055 Injection, medroxprogesterone acetate for contraceptive use, 150 mg J1056 Injection, medroxprogesterone acetate/estradiol cypionate, 5 mg/25 mg J7300 Intrauterine copper contraceptive J7302 Levonorgestrel-releasing intrauterine contraceptive system Contraceptive supply, hormone containing vaginal ring (use this J7303 code for Nuvaring Vaginal Ring) J7304 Contraceptive supply, hormone containing patch

(Nexplanon) - Etonogestrel (contraceptive) implant system, J7307 including implant and supplies Contraceptive intrauterine device (e.g. progestacert IUD), S4989 including implants and supplies S4993 Contraceptive pills for birth control