Procedure Code Description Removal of total disc arthroplasty (artificial disc), anterior approach, each additional 0095T interspace, cervical (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical (List separately in addition to code for 0098T primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), each additional interspace, lumbar 0163T (List separately in addition to code for primary procedure) Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional 0164T interspace, lumbar (List separately in addition to code for primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition to code for 0165T primary procedure) Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound 0228T guidance, cervical or thoracic; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, cervical or thoracic; each additional level (List separately in addition to code 0229T for primary procedure) Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound 0230T guidance, lumbar or sacral; single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with ultrasound guidance, lumbar or sacral; each additional level (List separately in addition to code for 0231T primary procedure) Percutaneous laminotomy/laminectomy (interlaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g., fluoroscopic, 0274T 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, discectomy, facetectomy and/or foraminotomy), any method, under indirect image guidance (e.g., fluoroscopic, 0275T CT), single or multiple levels, unilateral or bilateral; lumbar Allograft, morselized, or placement of osteopromotive material, for spine surgery only 20930 (List separately in addition to code for primary procedure)

Highmark Blue Shield is an independent licensee of the Blue Cross and Blue Shield Association.

Allograft, structural, for spine surgery only (List separately in addition to code for 20931 primary procedure) Autograft for spine surgery only (includes harvesting the graft); local (e.g., ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition 20936 to code for primary procedure) Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary 20937 procedure) Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code 20938 for primary procedure) 20974 Electrical stimulation to aid bone healing; noninvasive (nonoperative) 20975 Electrical stimulation to aid bone healing; invasive (operative) Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral 22510 body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral 22511 body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for 22512 primary procedure) Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., kyphoplasty), 1 22513 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., kyphoplasty), 1 22514 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (e.g., kyphoplasty), 1 22515 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including 22526 fluoroscopic guidance; single level Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code 22527 for primary procedure) Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare 22533 interspace (other than for decompression); lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional 22534 vertebral segment (List separately in addition to code for primary procedure) Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below 22551 C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate 22552 procedure) Arthrodesis, anterior interbody technique, including minimal discectomy to prepare 22554 interspace (other than for decompression); cervical below C2 2

Arthrodesis, anterior interbody technique, including minimal discectomy to prepare 22558 interspace (other than for decompression); lumbar Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately 22585 in addition to code for primary procedure) Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 22600 segment Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral 22612 transverse technique, when performed) Arthrodesis, posterior or posterolateral technique, single level; each additional 22614 vertebral segment (List separately in addition to code for primary procedure) Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy 22630 to prepare interspace (other than for decompression), single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each 22632 additional interspace (List separately in addition to code for primary procedure) Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace 22633 (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 decompression), single interspace and segment; each additional 22634 interspace Internal spinal fixation by wiring of spinous processes (List separately in addition to 22841 code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to 22842 code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to 22843 code for primary procedure) Posterior segmental instrumentation (e.g., pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition 22844 to code for primary procedure) Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code 22845 for primary procedure) Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code 22846 for primary procedure) Anterior instrumentation; 8 or more vertebral segments (List separately in addition to 22847 code for primary procedure) Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) 22848 other than sacrum (List separately in addition to code for primary procedure) Insertion of interbody biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace 22853 (List separately in addition to code for primary procedure) Insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh) with integral anterior instrumentation for device anchoring (e.g., screws, flanges), when 22854 performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) 3

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 preparation (includes osteophytectomy for nerve root or spinal cord 22856 decompression and microdissection); single interspace, cervical Total disc arthroplasty (artificial disc), anterior approach, including discectomy to 22857 prepare interspace (other than for decompression), single interspace, lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition 22858 to primary procedure) Insertion of intervertebral biomechanical device(s) (e.g., synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for 22859 primary procedure) Revision including replacement of total disc arthroplasty (artificial disc), anterior 22861 approach, single interspace; cervical Revision including replacement of total disc arthroplasty (artificial disc), anterior 22862 approach, single interspace; lumbar Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; 22867 single level Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including imaging guidance when performed, with open decompression, 22868 lumbar; second level (List separately in addition to code for primary procedure) Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression fusion, including image guidance when performed, lumber; single 22869 level Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; 22870 second level (List separately in addition to code for primary procedure) 23000 Removal of subdeltoid calcareous deposits, open 23020 Capsular contracture release (e.g., Sever type procedure) 23120 Claviculectomy; partial Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament 23130 release 23410 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; acute 23412 Repair of ruptured musculotendinous cuff (e.g., rotator cuff) open; chronic 23415 Coracoacromial ligament release, with or without acromioplasty Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes 23420 acromioplasty) 23430 Tenodesis of long tendon of biceps 23440 Resection or transplantation of long tendon of biceps 23450 Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operation 23455 Capsulorrhaphy, anterior; with labral repair (e.g., Bankart procedure) 23460 Capsulorrhaphy, anterior, any type; with bone block 23462 Capsulorrhaphy, anterior, any type; with coracoid process transfer

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23465 Capsulorrhaphy, glenohumeral joint, posterior, with or without bone block 23466 Capsulorrhaphy, glenohumeral joint, any type multi-directional instability 23470 Arthroplasty, glenohumeral joint; hemiarthroplasty Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral 23472 replacement (e.g., total shoulder)) Revision of total shoulder arthroplasty, including allograft when performed; humeral or 23473 glenoid component Revision of total shoulder arthroplasty, including allograft when performed; humeral 23474 and glenoid component Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance 27096 (fluoroscopy or CT) including arthrography when performed 27125 Hemiarthroplasty, hip, partial (e.g., femoral stem prosthesis, bipolar arthroplasty) Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip 27130 arthroplasty), with or without autograft or allograft Conversion of previous hip surgery to total hip arthroplasty, with or without autograft 27132 or allograft Revision of total hip arthroplasty; both components, with or without autograft or 27134 allograft Revision of total hip arthroplasty; acetabular component only, with or without 27137 autograft or allograft 27138 Revision of total hip arthroplasty; femoral component only, with or without allograft Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR 27332 lateral Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND 27333 lateral 27334 Arthrotomy, with synovectomy, knee; anterior OR posterior 27335 Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal area 27403 Arthrotomy with meniscus repair, knee 27412 Autologous chondrocyte implantation, knee 27415 Osteochondral allograft, knee, open Osteochondral autograft(s), knee, open (e.g., mosaicplasty) (includes harvesting of 27416 autograft[s]) 27418 Anterior tibial tubercleplasty (e.g., Maquet type procedure) 27420 Reconstruction of dislocating patella; (e.g., Hauser type procedure) Reconstruction of dislocating patella; with extensor realignment and/or muscle 27422 advancement or release (e.g., Campbell, Goldwaite type procedure) 27424 Reconstruction of dislocating patella; with patellectomy 27425 Lateral retinacular release, open 27427 Ligamentous reconstruction (augmentation), knee; extra-articular 27428 Ligamentous reconstruction (augmentation), knee; intra-articular (open) Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra- 27429 articular 27430 Quadricepsplasty (e.g., Bennett or Thompson type) 27438 Arthroplasty, patella; with prosthesis 27440 Arthroplasty, knee, tibial plateau; 27441 Arthroplasty, knee, tibial plateau; with debridement and partial synovectomy 27442 Arthroplasty, femoral condyles or tibial plateau(s), knee;

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Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial 27443 synovectomy 27446 Arthroplasty, knee, condyle and plateau; medial OR lateral compartment Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or 27447 without patella resurfacing (total knee arthroplasty) 27486 Revision of total knee arthroplasty, with or without allograft; 1 component Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial 27487 component 29805 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure) 29806 Arthroscopy, shoulder, surgical; capsulorrhaphy 29807 Arthroscopy, shoulder, surgical; repair of SLAP lesion 29819 Arthroscopy, shoulder, surgical; with removal of loose body or foreign body 29820 Arthroscopy, shoulder, surgical; synovectomy, partial 29821 Arthroscopy, shoulder, surgical; synovectomy, complete 29822 Arthroscopy, shoulder, surgical; debridement, limited 29823 Arthroscopy, shoulder, surgical; debridement, extensive Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface 29824 (Mumford procedure) Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without 29825 manipulation Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (i.e., arch) release, when performed (List 29826 separately in addition to code for primary procedure) 29827 Arthroscopy, shoulder, surgical; with rotator cuff repair 29828 Arthroscopy, shoulder, surgical; biceps tenodesis 29860 Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure) 29861 Arthroscopy, hip, surgical; with removal of loose body or foreign body Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage 29862 (chondroplasty), abrasion arthroplasty, and/or resection of labrum 29863 Arthroscopy, hip, surgical; with synovectomy Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes 29866 harvesting of the autograft[s]) 29867 Arthroscopy, knee, surgical; osteochondral allograft (e.g., mosaicplasty) Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal 29868 insertion), medial or lateral 29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) 29871 Arthroscopy, knee, surgical; for infection, lavage and drainage 29873 Arthroscopy, knee, surgical; with lateral release Arthroscopy, knee, surgical; for removal of loose body or foreign body (e.g., 29874 osteochondritis dissecans fragmentation, chondral fragmentation) Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection) 29875 (separate procedure) Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (e.g., medial 29876 or lateral) 29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where 29879 necessary) or multiple drilling or microfracture

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Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), 29880 same or separate compartment(s), when performed Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), 29881 same or separate compartment(s), when performed 29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 29883 Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral) Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation 29884 (separate procedure) Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, 29885 with or without internal fixation (including debridement of base of lesion) 29886 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with 29887 internal fixation Arthroscopically aided anterior cruciate ligament repair/augmentation or 29888 reconstruction Arthroscopically aided posterior cruciate ligament repair/augmentation or 29889 reconstruction 29914 Arthroscopy, hip, surgical; with femoroplasty (i.e., treatment of cam lesion) 29915 Arthroscopy, hip, surgical; with acetabuloplasty (i.e., treatment of pincer lesion) 29916 Arthroscopy, hip, surgical; with labral repair Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization 62263 (includes contrast when administered), multiple adhesiolysis sessions; 2 or more day Percutaneous lysis of epidural adhesions using solution injection (e.g., hypertonic saline, enzyme) or mechanical means (e.g., catheter) including radiologic localization 62264 (includes contrast when administered), multiple adhesiolysis sessions; 1 day Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), 62280 with or without other therapeutic substance; subarachnoid Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), 62281 with or without other therapeutic substance; epidural, cervical or thoracic Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions), 62282 with or 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 of indirect visualization, with discography and/or 62287 epidural injection Injection procedure for chemonucleolysis, including discography, intervertebral disc, 62292 single or multiple levels, lumbar Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; 62320 without imaging guidance Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, cervical or thoracic; with 62321 imaging guidance (ie, fluoroscopy or CT)

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Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); 62322 without imaging guidance Injection(s), of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, including needle or catheter placement, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); 62323 with imaging guidance (id, fluoroscopy or CT) Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, 62324 interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie 62325 fluoroscopy or CT) Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachoid, lumber or sacral (caudal); without imaging 62326 guidance Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (e.g., anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance 62327 (ie, fluoroscopy or CT) Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable 62350 reservoir/infusion pump; without laminectomy Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable 62351 reservoir/infusion pump; with laminectomy Implantation or replacement of device for intrathecal or epidural drug infusion; 62360 subcutaneous reservoir Implantation or replacement of device for intrathecal or epidural drug infusion; 62361 nonprogrammable pump Implantation or replacement of device for intrathecal or epidural drug infusion; 62362 programmable pump, including preparation of pump, with or without programming Endoscopic decompression of spinal cord, nerve root(s), including laminotomy, partial facetectomy, foraminotomy, discectomy and/or excision of herniated intervertebral 62380 disc, 1 interspace, lumbar Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 63001 vertebral segments; cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), 1 or 2 63005 vertebral segments; lumbar, except for spondylolisthesis

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Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type 63012 procedure) Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), more 63015 than 2 vertebral segments; cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (e.g., spinal stenosis), more 63017 than 2 vertebral segments; lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 63020 interspace, cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 63030 interspace, lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; each 63035 additional interspace, cervical or lumbar (List separately in addition to code for primary Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63040 reexploration, single interspace; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, 63042 reexploration, single interspace; lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional cervical interspace (List separately in 63043 addition to code for primary procedure) Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in 63044 addition to code for primary procedure) Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral 63045 recess stenosis]), single vertebral segment; cervical Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral 63047 recess stenosis]), single vertebral segment; lumbar Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, 63048 or lumbar (List separately in addition to code for primary procedure) Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral 63050 segments; Laminoplasty, cervical, with decompression of the spinal cord, 2 or more vertebral segments; with reconstruction of the posterior bony elements (including the application of bridging bone graft and non-segmental fixation devices [e.g., wire, 63051 suture, mini-plates], when performed)

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Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; lumbar (including transfacet, or lateral extraforaminal approach) (e.g., far lateral herniated intervertebral 63056 disc) Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (e.g., herniated intervertebral disc), single segment; each additional segment, 63057 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 63075 osteophytectomy; cervical, single interspace Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional interspace (List separately in addition to 63076 code for primary procedure) Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, single 63081 segment Vertebral corpectomy (vertebral body resection), partial or complete, anterior approach with decompression of spinal cord and/or nerve root(s); cervical, each 63082 additional segment (List separately in addition to code for primary procedure) 63650 Percutaneous implantation of neurostimulator electrode array, epidural 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct 63685 or inductive coupling Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging 64479 guidance (fluoroscopy or CT); cervical or thoracic, single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately 64480 in addition to code for primary procedure) Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging 64483 guidance (fluoroscopy or CT); lumbar or sacral, single level Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in 64484 addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or 64490 thoracic; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or 64491 thoracic; second level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary 64492 procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or 64493 sacral; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image guidance (fluoroscopy or CT), lumbar or 64494 sacral; second level (List separately in addition to code for primary procedure)

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Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves 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 64495 procedure) 64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging 64633 guidance (fluoroscopy or CT); cervical or thoracic, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional facet joint (List 64634 separately in addition to code for primary procedure) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging 64635 guidance (fluoroscopy or CT); lumbar or sacral, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional facet joint (List 64636 separately in addition to code for primary procedure) C1767 Generator, neurostimulator (implantable), nonrechargeable C1778 Lead, neurostimulator (implantable) C1787 Patient programmer, neurostimulator Generator, neurostimulator (implantable), with rechargeable battery and charging C1820 system Generator, neurostimulator (implantable), high frequency, with rechargeable battery C1822 and charging system C1883 Adaptor/extension, pacing lead or neurostimulator lead (implantable) E0748 Osteogenesis stimulator, electrical, noninvasive, spinal applications E0749 Osteogenesis stimulator, electrical, surgically implanted Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other G0260 therapeutic agent with and without arthrography

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