Moda MSK Code List

Moda Musculoskeletal CPT Code List

Category CPT® Code CPT® Code Description Interventional Pain Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (Fluoroscopy or CT) including arthrography when 27096 Mgmt performed Interventional Pain Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; 62280 Mgmt subarachnoid Interventional Pain Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; 62281 Mgmt epidural, cervical or thoracic Interventional Pain Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; 62282 Mgmt epidural, lumbar, sacral (caudal) Injection(s), of Diagnostic or Therapeutic Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Interventional Pain 62320 Including Neurolytic Substances, Including Needle or Catheter Placement, Interlaminar Epidural or Subarachnoid, Cervical or Mgmt Thoracic; Without Imaging Guidance Injection(s), of Diagnostic or Therapeutic Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Interventional Pain 62321 Including Neurolytic Substances, Including Needle or Catheter Placement, Interlaminar Epidural or Subarachnoid, Cervical or Mgmt Thoracic; With Imaging Guidance (Ie, Fluoroscopy or CT) Injection(s), of Diagnostic or Therapeutic Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Interventional Pain 62322 Including Neurolytic Substances, Including Needle or Catheter Placement, Interlaminar Epidural or Subarachnoid, Lumbar or Mgmt Sacral (Caudal); Without Imaging Guidance Injection(s), of Diagnostic or Therapeutic Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Interventional Pain 62323 Including Neurolytic Substances, Including Needle or Catheter Placement, Interlaminar Epidural or Subarachnoid, Lumbar or Mgmt Sacral (Caudal); With Imaging Guidance (Ie, Fluoroscopy or CT) Injection(s), Including Indwelling Catheter Placement, Continuous Infusion or Intermittent Bolus, of Diagnostic or Therapeutic Interventional Pain 62324 Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Including Neurolytic Substances, Interlaminar Mgmt Epidural or Subarachnoid, Cervical or Thoracic; Without Imaging Guidance

Injection(s), Including Indwelling Catheter Placement, Continuous Infusion or Intermittent Bolus, of Diagnostic or Therapeutic Interventional Pain 62325 Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Including Neurolytic Substances, Interlaminar Mgmt 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 Interventional Pain 62326 Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Including Neurolytic Substances, Interlaminar Mgmt Epidural or Subarachnoid, Lumbar or Sacral (Caudal); Without Imaging Guidance

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Injection(s), Including Indwelling Catheter Placement, Continuous Infusion or Intermittent Bolus, of Diagnostic or Therapeutic Interventional Pain 62327 Substance(s) (Eg, Anesthetic, Antispasmodic, Opioid, Steroid, Other Solution), Not Including Neurolytic Substances, Interlaminar Mgmt Epidural or Subarachnoid, Lumbar or Sacral (Caudal); With Imaging Guidance (Ie, Fluoroscopy or CT) Interventional Pain Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an 62350 Mgmt external pump or implantable reservoir/infusion pump; without laminectomy Interventional Pain Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an 62351 Mgmt external pump or implantable reservoir/infusion pump; with laminectomy Interventional Pain 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir Mgmt Interventional Pain 62361 Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump Mgmt Interventional Pain Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of 62362 Mgmt pump, with or without programming Interventional Pain Endoscopic Decompression of Spinal Cord, Nerve Root(s), Including Laminotomy, Partial Facetectomy, Foraminotomy, 62380 Mgmt Discectomy and/or Excision of Herniated Intervertebral Disc, 1 Interspace, Lumbar Interventional Pain 63650 Percutaneous implantation of neurostimulator electrode array, epidural Mgmt Interventional Pain 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural Mgmt Interventional Pain 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling Mgmt Interventional Pain Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (Fluoroscopy or CT); cervical or 64479 Mgmt thoracic, single level Interventional Pain Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (Fluoroscopy or CT); cervical or 64480 Mgmt thoracic, each additional level (List separately in addition to code for primary procedure) Interventional Pain Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (Fluoroscopy or CT); lumbar or sacral, 64483 Mgmt single level Interventional Pain Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (Fluoroscopy or CT); lumbar or sacral, 64484 Mgmt each additional level (List separately in addition to code for primary procedure) Interventional Pain Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image 64490 Mgmt guidance (Fluoroscopy or CT), cervical or thoracic; single level Interventional Pain Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image 64491 Mgmt 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 innervating that joint) with image Interventional Pain 64492 guidance (Fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary Mgmt procedure) Interventional Pain Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image 64493 Mgmt guidance (Fluoroscopy or CT), lumbar or sacral; single level

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Interventional Pain Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating that joint) with image 64494 Mgmt 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 innervating that joint) with image Interventional Pain 64495 guidance (Fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary Mgmt procedure) Interventional Pain 64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) Mgmt Interventional Pain 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) Mgmt Interventional Pain Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (Fluoroscopy or CT); cervical or thoracic, 64633 Mgmt single facet joint Interventional Pain Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (Fluoroscopy or CT); lumbar or sacral, 64634 Mgmt each additional facet joint (List separately in addition to code for primary procedure) Interventional Pain Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (Fluoroscopy or CT); lumbar or sacral, 64635 Mgmt single facet joint Interventional Pain Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (Fluoroscopy or CT); lumbar or sacral, 64636 Mgmt each additional facet joint (List separately in addition to code for primary procedure) Joint Surgery 23120 Shoulder Decompression Joint Surgery 23130 Shoulder Decompression Joint Surgery 23410 Shoulder Arthroscopy or Repair Joint Surgery 23412 Shoulder Arthroscopy or Repair Joint Surgery 23415 Shoulder Arthroscopy or Repair Joint Surgery 23420 Shoulder Arthroscopy or Repair Joint Surgery 23430 Biceps Tenodesis/Tenotomy Joint Surgery 23440 Biceps Tenodesis/Tenotomy Joint Surgery 23450 Shoulder Instability Correction Joint Surgery 23455 Shoulder Instability Correction Joint Surgery 23460 Shoulder Instability Correction Joint Surgery 23462 Shoulder Instability Correction Joint Surgery 23465 Shoulder Instability Correction Joint Surgery 23466 Shoulder Instability Correction Joint Surgery 23470 Shoulder Replacement - Partial Joint Surgery 23472 Shoulder Replacement - Total Joint Surgery 23473 Shoulder Replacement - Revision Joint Surgery 23474 Shoulder Replacement - Revision Joint Surgery 23490 Shoulder Arthroscopic or Open Repair for Type 1 Condition

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Joint Surgery 23700 MUA Shoulder Joint Surgery 27090 Hip Replacement- Removal Joint Surgery 27091 Hip Replacement- Removal Joint Surgery 27096 SI Joint Injection Joint Surgery 27125 Partial Hip Replacement/Resurfacing Joint Surgery 27130 Total Hip Replacement/Resurfacing Joint Surgery 27132 Total Hip Replacement/Resurfacing Joint Surgery 27134 Hip Replacement- Revision Joint Surgery 27137 Hip Replacement- Revision Joint Surgery 27138 Hip Replacement- Revision Joint Surgery 27146 Osteotomy - Hip Joint Surgery 27151 Osteotomy - Hip Joint Surgery 27156 Osteotomy - Hip Joint Surgery 27330 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27331 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27332 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27333 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27334 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27335 Incision and Drainage, Arthrotomy, Biopsy - Knee Joint Surgery 27403 Meniscal Surgery - Knee Joint Surgery 27405 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 27407 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 27409 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 27412 Autologous Chondrocyte Implantation - knee Joint Surgery 27415 Osteochondral allograft (mosaicplasty) Joint Surgery 27416 Osteochondral autograft (mosaicplasty) Joint Surgery 27418 Patella Tendon Realignment - Knee Joint Surgery 27420 Patella Tendon Realignment - Knee Joint Surgery 27422 Patella Tendon Realignment - Knee Joint Surgery 27424 Patella Tendon Realignment - Knee Joint Surgery 27425 Patella Tendon Realignment - Knee Joint Surgery 27427 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 27428 Cruciate/Collateral Ligament Surgery - Knee

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Joint Surgery 27429 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 27430 Quadricepsplasty/ Excision Bursa/ Patellectomy/ Removal foreign Body Joint Surgery 27435 Capsulotomy - Knee Joint Surgery 27437 Knee Partial Replacement - (Arthroplasty) Joint Surgery 27438 Knee Partial Replacement - (Arthroplasty) Joint Surgery 27440 Knee Partial Replacement - (Arthroplasty) Joint Surgery 27441 Knee Partial Replacement - (Arthroplasty) Joint Surgery 27442 Knee Total Replacement - (Arthroplasty) Joint Surgery 27443 Knee Total Replacement - (Arthroplasty) Joint Surgery 27445 Knee Total Replacement - (Arthroplasty) Joint Surgery 27446 Knee Total Replacement - (Arthroplasty) Joint Surgery 27447 Knee Total Replacement - (Arthroplasty) Joint Surgery 27486 Knee Replacement - Revision (Arthroplasty) Joint Surgery 27487 Knee Replacement - Revision (Arthroplasty) Joint Surgery 27488 Knee Replacement - Removal (Arthroplasty) Joint Surgery 27570 Anesthesia for manipulation of the spine or for closed procedures on the cervical, thoracic or lumbar spine Joint Surgery 29805 Shoulder Diagnostic Arthroscopy Joint Surgery 29806 Shoulder Instability Correction Joint Surgery 29807 Shoulder Instability Correction Joint Surgery 29819 Shoulder Foreign Body Removal Joint Surgery 29820 Synovectomy - Shoulder Joint Surgery 29821 Synovectomy - Shoulder Joint Surgery 29822 Shoulder Arthroscopy or Repair Joint Surgery 29823 Shoulder Arthroscopy or Repair Joint Surgery 29824 Shoulder Arthroscopy or Repair Joint Surgery 29825 Adhesions/Capsular Release Joint Surgery 29826 Shoulder Decompression Joint Surgery 29827 Shoulder Arthroscopy or Repair Joint Surgery 29828 Biceps Tenodesis/Tenotomy Joint Surgery 29860 Arthroscopic or Open Surgery - Hip Joint Surgery 29861 Arthroscopic or Open Surgery - Hip Joint Surgery 29862 Arthroscopic or Open Surgery - Hip Joint Surgery 29863 Arthroscopic or Open Surgery - Hip

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Joint Surgery 29866 Osteochondral autograft (mosaicplasty) Joint Surgery 29867 Osteochondral allograft (mosaicplasty) Joint Surgery 29868 Meniscal Transplantation - Knee Joint Surgery 29870 Diagnostic Arthroscopy - Knee Joint Surgery 29873 Patella Tendon Realignment - Knee Joint Surgery 29874 Removal Loose Body - Knee Joint Surgery 29875 Synovectomy - Knee Joint Surgery 29876 Synovectomy - Knee Joint Surgery 29877 Debridement/Chondroplasty - Knee Joint Surgery 29879 Abrasion/Subchondral Drilling/ Microfracturing Joint Surgery 29880 Meniscal Surgery - Knee Joint Surgery 29881 Meniscal Surgery - Knee Joint Surgery 29882 Meniscal Surgery - Knee Joint Surgery 29883 Meniscal Surgery - Knee Joint Surgery 29884 Lysis of adhesions, with or without manipulation - Knee Joint Surgery 29885 Abrasion/Subchondral Drilling/ Microfracturing Joint Surgery 29886 Abrasion/Subchondral Drilling/ Microfracturing Joint Surgery 29887 Abrasion/Subchondral Drilling/ Microfracturing Joint Surgery 29888 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 29889 Cruciate/Collateral Ligament Surgery - Knee Joint Surgery 29914 Arthroscopic or Open Surgery - Hip Joint Surgery 29915 Arthroscopic or Open Surgery - Hip Joint Surgery 29916 Arthroscopic or Open Surgery - Hip Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for Spine Surgery 20930 primary procedure) Spine Surgery 20931 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); Spine Surgery 22206 thoracic Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); Spine Surgery 22207 lumbar Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); Spine Surgery 22208 each additional vertebral segment (List separately in addition to code for primary procedure) Spine Surgery 22210 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervical Spine Surgery 22212 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracic Spine Surgery 22214 Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbar

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately Spine Surgery 22216 in addition to primary procedure) Spine Surgery 22220 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical Spine Surgery 22222 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic Spine Surgery 22224 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List Spine Surgery 22226 separately in addition to code for primary procedure) Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of Spine Surgery 22510 all imaging guidance; cervicothoracic Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of Spine Surgery 22511 all imaging guidance; lumbosacral Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of Spine Surgery 22512 all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) Spine Surgery 22513 Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance Spine Surgery 22514 Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance

Spine Surgery 22515 Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance

Spine Surgery 22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional Spine Surgery 22527 levels (List separately in addition to code for primary procedure) Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); Spine Surgery 22532 thoracic Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); Spine Surgery 22533 lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); Spine Surgery 22534 thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)

Spine Surgery 22548 Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid process Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord Spine Surgery 22551 and/or nerve roots; cervical below C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord Spine Surgery 22552 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 (other than for decompression); Spine Surgery 22554 cervical below C2 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); Spine Surgery 22556 thoracic

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); Spine Surgery 22558 lumbar Spine Surgery 22590 Arthrodesis, posterior technique, craniocervical (occiput-C2) Spine Surgery 22595 Arthrodesis, posterior technique, atlas-axis (C1-C2) Spine Surgery 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment

Spine Surgery 22610 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed)

Spine Surgery 22612 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to Spine Surgery 22614 code for primary procedure) Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for Spine Surgery 22630 decompression), single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for Spine Surgery 22632 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 including laminectomy and/or Spine Surgery 22633 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 Spine Surgery 22634 discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure) Spine Surgery 22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments Spine Surgery 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segments Spine Surgery 22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segments Spine Surgery 22808 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments Spine Surgery 22810 Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments Spine Surgery 22812 Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); Spine Surgery 22818 single or 2 segments Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or Spine Surgery 22819 more segments Spine Surgery 22830 Exploration of spinal fusion Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial Spine Surgery 22840 transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure) Spine Surgery 22841 Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral Spine Surgery 22842 segments (List separately in addition to code for primary procedure)

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral Spine Surgery 22843 segments (List separately in addition to code for primary procedure) Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more Spine Surgery 22844 vertebral segments (List separately in addition to code for primary procedure) Spine Surgery 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) Spine Surgery 22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) Spine Surgery 22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in Spine Surgery 22848 addition to code for primary procedure) Spine Surgery 22849 Reinsertion of spinal fixation device Insertion of Interbody Biomechanical Device(s) (Eg, Synthetic Cage, Mesh) With Integral Anterior Instrumentation For Device Anchoring (Eg, Screws, Flanges), When Conjunction With Interbody Arthrodesis, Each Interspace (List Performed, To Spine Surgery 22853 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 Corpectomy(Ies) (Vertebral Body Resection, Partial or Spine Surgery 22854 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 preparation (includes Spine Surgery 22856 osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for Spine Surgery 22857 decompression), single interspace, lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes Spine Surgery 22858 osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure) Insertion of Intervertebral Biomechanical Device(s) (Eg, Synthetic Cage, Mesh, Methylmethacrylate) To Intervertebral Disc Space Spine Surgery 22859 or Vertebral Body Defect Without Interbody Arthrodesis, Each Contiguous Efect (List Separately In Addition To Code For Primary Procedure)

Spine Surgery 22861 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical

Spine Surgery 22862 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar

Spine Surgery 22864 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical Spine Surgery 22865 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar Insertion of Interlaminar/Interspinous Process Stabilization/Distraction Device, Without Fusion, Including Image Guidance When Spine Surgery 22867 Performed, With Open Decompression, Lumbar; Single Level Insertion of Interlaminar/Interspinous Process Stabilization/Distraction Device, Without Fusion, Including Image Guidance When Spine Surgery 22868 Performed, With Open Decompression, Lumbar; Second Level (List Separately In Addition To Code For Primary Procedure)

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Insertion of Interlaminar/Interspinous Process Stabilization/Distraction Device, Without Open Decompression or Fusion, Including Spine Surgery 22869 Image Guidance When Performed, Lumbar; Single Level Insertion of Interlaminar/Interspinous Process Stabilization/Distraction Device, Without Open Decompression or Fusion, Including Spine Surgery 22870 Image Guidance When Performed, Lumbar; Second Level (List Separately In Addition To Code For Primary Procedure)

Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique Spine Surgery 62287 to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63001 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63003 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; thoracic Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63005 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; lumbar, except for spondylolisthesis Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63011 discectomy (eg, spinal stenosis), 1 or 2 vertebral segments; sacral Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for Spine Surgery 63012 spondylolisthesis, lumbar (Gill type procedure) Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63015 discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63016 discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or Spine Surgery 63017 discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision Spine Surgery 63020 of herniated intervertebral disc; 1 interspace, cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision Spine Surgery 63030 of herniated intervertebral disc; 1 interspace, lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision Spine Surgery 63035 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, foraminotomy and/or excision Spine Surgery 63040 of herniated intervertebral disc, reexploration, single interspace; cervical Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision Spine Surgery 63042 of herniated intervertebral disc, reexploration, single interspace; lumbar Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision Spine Surgery 63043 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, foraminotomy and/or excision Spine Surgery 63044 of herniated intervertebral disc, reexploration, single interspace; each additional lumbar interspace (List separately in addition to code for primary procedure)

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve Spine Surgery 63045 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; cervical Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve Spine Surgery 63046 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; thoracic Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve Spine Surgery 63047 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 Spine Surgery 63048 root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; each additional segment, cervical, thoracic, or lumbar (List separately in addition to code for primary procedure) Spine Surgery 63050 Laminoplasty, 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 reconstruction of the posterior Spine Surgery 63051 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, herniated intervertebral disc), single Spine Surgery 63055 segment; thoracic Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single Spine Surgery 63056 segment; lumbar (including transfacet, or lateral extraforaminal approach) (eg, far lateral herniated intervertebral disc)

Transpedicular approach with decompression of spinal cord, equina and/or nerve root(s) (eg, herniated intervertebral disc), single Spine Surgery 63057 segment; each additional segment, thoracic or lumbar (List separately in addition to code for primary procedure) Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; single Spine Surgery 63064 segment Costovertebral approach with decompression of spinal cord or nerve root(s) (eg, herniated intervertebral disc), thoracic; each Spine Surgery 63066 additional segment (List separately in addition to code for primary procedure) Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, single Spine Surgery 63075 interspace Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; cervical, each additional Spine Surgery 63076 interspace (List separately in addition to code for primary procedure) Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, single Spine Surgery 63077 interspace Discectomy, anterior, with decompression of spinal cord and/or nerve root(s), including osteophytectomy; thoracic, each additional Spine Surgery 63078 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) Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord Spine Surgery 63085 and/or nerve root(s); thoracic, single segment

V1.2019 Effective: 1/1/2019 Category CPT® Code CPT® Code Description Vertebral corpectomy (vertebral body resection), partial or complete, transthoracic approach with decompression of spinal cord Spine Surgery 63086 and/or nerve root(s); thoracic, each additional segment (List separately in addition to code for primary procedure) Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of Spine Surgery 63087 spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; single segment Vertebral corpectomy (vertebral body resection), partial or complete, combined thoracolumbar approach with decompression of Spine Surgery 63088 spinal cord, cauda equina or nerve root(s), lower thoracic or lumbar; each additional segment (List separately in addition to code for primary procedure)

Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with Spine Surgery 63090 decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; single segment

Vertebral corpectomy (vertebral body resection), partial or complete, transperitoneal or retroperitoneal approach with Spine Surgery 63091 decompression of spinal cord, cauda equina or nerve root(s), lower thoracic, lumbar, or sacral; each additional segment (List separately in addition to code for primary procedure) Removal of total disc arthroplasty, (artificial disc), anterior approach, each additional interspace, lumbar (List separately in addition Spine Surgery 0164T to code for primary procedure)

V1.2019 Effective: 1/1/2019