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Procedure Codes No Longer Requiring Prior

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Procedure Codes No Longer Requiring Prior 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
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