Schedule of Charges 2018-19

EMERGENCY

Index Policy and guidelines 00 Package Inclusions & Exclusions 00 Department of Cardiac Sciences 00 - Cardiology 00 - CTVS 00 Department of Women & Child Care 00 - Obs & Gynae 00 - Paediatrics 00 Department of Neuro Sciences 00 - Neurology 00 - Neuro sciences 00 Department of Orthopaedics & Joint Replacement 00 - Orthopaedics 00 Department of Renal Sciences (header in one page) 00 - Nephrology 00 - Urology 00 Department of Oncology Sciences 00 - Medical Oncology 00 - Onco Surgery 00 - Radiation Oncology 00 Department of Gastroenterology 00 - Medical Gastroenterology 00 Other departments and services 00 - GI General Surgery Sciences 00 - Vascular Surgery 00 - Plastic Surgery 00 - ENT 00 - Ophthalmology 00 - Critical Care 00 - Pulmonology 00 - Anaesthesia & Pain Management 00 - IVF 00 - Psychiatry 00 - Internal medicine & Diabetes 00 - Dermatology 00 - Dental 00 - Emergency 00 - Consultation 00 - Lab diagnostics 00 - Radiology 00 - Nuclear Medicine 00 - Physiotherapy 00 - Administration 00 - In Patient Services 00 - Medical Equipment 00 - Yoga 00 - Home Care 00

1 Policy and Guidelines

1. Outpatient Consultation: OPD Consultation charges shall follow the following Bands: Bands Slab (Rs.) Speciality Consultants 700 Super Speciality Consultants 900

2. Registration Charges a) Rs. 150 per registration to be charged from all patients coming to Manipal Hospital for the first time. b) One follow-up visit for OPD is free within 3 days and One Post-op discharge visit is free within 7 days. 3. Admission & Documentation Charges One time admission charges of Rs 1000 to be charged for every IP admissions except Daycare and New Borns. In case TPA patient, Documentation charges ofRs500 be extra for filing and applicable for all admission except Day Care and New Borns. 4. MLC Charges In MLC cases an additional charges of Rs. 1,000 shall be levied to cover extra cost incurred by hospitals. This shall only be applicable for MLC cases where patient gets admitted to our hospital and also applicable for Outside registered MLC cases. This shall not be applicable for cases where there is direct discharge from Triage/ER 5. Triage Policy c) Triage/ER be charges will be charged @ Rs. 500 per hour however first 3 hour of stay shall not be charged. d) Triple Room Bed Tariff will be applicable for mapping all other services including the consultant visit, investigations, procedures etc. e) If the patient gets admitted as inpatient from emergency, Triage bed charges and EMO Consultation will not be levied and Charges in such cases will be levied based on the selected room category f) During day time (8am to 8 pm), Consultation by specialists and super specialists will be charged as per OPD rates. 6. Emergency Visit a) Night Emergency Timings are from 8:00PM to 8:00AM. b) Emergency Consultant Charges (Full Day) will be charged at Rs. 750. c) During Night,Specialists OR Super specialist Consultation will be charged at twice the day time charges. d) If the Specialist Doctor is present in theOPD during non emergency hours, no extra charge for Emergency reference except for normal tariff will be levied. 7. Day Care Policy a) Day Care room charges will be Rs 3000 b) Consultant Visit Charges, Surgeon fee, Procedure fee and other charges will be charged as per Triple Room bed category. c) In case of Day Care surgical procedures, Primary Surgeon shall charge consultation for one visit only. 8. Billing Cycle a) Billing cycle will start from the time of admission and is from 12 noon to 12 noon. Therefore, 12 noon is the checkout time for discharge. This policy however is not applicable in case of Day care. b) At the time of discharge, a grace period of three (3) hours will be given and shall not attract additional charges, however beyond 3 hrs grace period, full day bed charges shall be levied for that day. c) Bed and Inpatient Consultation Charges:

Sl No Bed Category Bed Charges Consultant Charges 1 Triple Room 3700 1100 2 Double Room 5900 1300 3 Single Room 9800 1700 4 Daycare Room Charges 3000 1100 5 ICU/CCU/CTICU 13300 2500

2 Sl No Bed Category Bed Charges Consultant Charges 6 PICU 13300 2500 7 NICU - High Intensive 13300 2500 8 NICU - Low Intensive 11600 2500 9 HDU 11600 1700

9. Room Policy a) Room tariff includes standard fittings in the room according to the type of Occupancy / Laundry Services / Food & Beverage for Patients only / House-keeping services. b) Any additional Food & Beverage for anybody other than Patient will be charged as per our cafeteria tariff. Any additional Food & Beverage for Patient will be charged extra as per the cafeteria tariff. c) If the Patient’s Attendant retains the room while the Patient is in HDU/ICU/NICU/PICU additional charges for the Room and Food & Beverage would be levied. In such cases Room would be provided subject to availability. d) ICU bed tariff includes Room rent, RMO charges, Nursing Charges,Infusion/ Syringe Pump , Oxygen, Pulse Oxymeter and Cardiac Monitoring. ICU bed tariff does not include Specialty Doctors Visit, Intensivist Charges, Ventilator / Bipap(Initiation or Maintenance Charges), DVT Pump , Alpha Bed , any special monitoring/ equipment, Investigations, Procedures, Consumables and Medicines. e) Single Room Tariff will be applicable for mapping of all the charges like procedures, surgeries, investigations etc with ICU Bed category. f) If a new born baby with mother is admitted, the charges levied for the mother shall be applicable in the baby’s case New born baby shall be charged as per the bed category of mother for all the services rendered. 10. IP Consultation Policy a) In IPD, the admitting doctor (Primary Consultant) will be entitled to maximum of two IP visits per day. Doctor charges are twice a day either by doctor / unit / team. b) IP Night Visit Charges (8pm to 8 am) are applicable as per bed category where consultants come in night and admission takes place which is twice the normal rates. c) In ICU/CCU/CTICU/HDU, One visit will be charged by respective critical care unit (Intensivist) and one visit will be charged by admitting consultant. d) Paediatrician consult for new born will be charged as per mother’s category. e) In case of surgery, up to first 24 hrs of surgery, no IPD consult of primary surgeon or unit will be charged to patient. Thereafter, they may be charged up to two visits per day. f) Dietician Charges as per Bed Category will be applicable once during patient stay in the hospital and shall be ordered at the beginning. It shall be charged from Inpatient admissions excluding Day Care, NICU and other patients where this service is not availed. 11. Surgery / Anesthesia Charges Description % of Surgeon fee OT/Cath Lab Charges 110% Anesthesia Charges 25% Minor OT Charges (Ground Floor) 2500 per sitting

b) Standby Charges for Anesthetist will be charged at 20% of the Professional Fee for all surgeries and procedures, wherever applicable. c) If standby Anesthetist is required during MRI/CT Rs 1000 shall be levied and shall be charged over and above the respective procedure charges. 12. Policy Related to Surgery a) In case of multiple surgeries, the surgery with the higher surgeon fee will be considered as Primary surgery and all other charge related calculations will be based on this Primary Surgery. b) If the same surgeon performs more than one procedure in the same sitting, on the same area of body and is related, then the surgery costing the higher shall be billed as 100% followed by the Surgeries costing lesser at 50 % each. If the surgeries are carried out on different body parts and is unrelated by the same/different surgeons then the both the surgeries will be charged full as per the schedule. However Prior approval from DMS would be required for charging second surgery.

3 c) In case a surgeon requires the presence of another surgeon – Co opted surgeon (This does not mean an assistant surgeon and is a surgeon of different department whose services are sought for surgery) may be levied. However, in special cases and with concurrence of DMS, additionally for routine cases 25% of the surgical fee and for emergency 50% of the surgical fee will be charged. Patients in such cases should be informed beforehand about this additional charge during surgery. d) If two or more surgeons perform two or more different surgeries / procedures, they shall be entitled to their individual full surgeon’s fee for their respective procedures. The Procedure charges shall be levied for each procedure. 13. Redo / Re exploration Policy a) For Redo/ Reexploration Surgery within 24 hrs, only consumables shall be charged (no extra cost for Surgeon Fee, OT or Anaesthesia) with prior approval from DMS. b) For Redo/ Re-explorationSurgery after 24 hrs, 100% of surgeon fee. However, OT charges, Anaesthesia fee shall be charges as per the tariff. consumables & pharmacy will be charged as per actuals. 14. Change of Category of Bed a) In case a patient is transferred from a lower to a higher category of room after the surgery / procedure, all the charges including surgery / procedure/ investigations will be charged according to the higher bed category however the bed charges and the doctors visit charges would be as per the higher room category from the day of transfer. b) In case the patient is transferred from higher to lower category of room after the surgery / procedure, all thecharges including surgery / procedure / investigations and other particulars till the time of transfer will be charged according to the original / higher room category however the bed charges and the doctor’s visit charge would be as per the opted/ lower bed category from the day & time of transfer. c) When a patient is admitted directly to an ICU bed, the charges for procedure/ surgery / investigations shall be according to Single room category during the stay in ICU. However, if the patient opts for occupancy higher than the Single room category at the time of transfer from ICU, the procedure/ surgery / investigation shall be charged according to the higher category from the day of transfer. d) At the time of transfer from ICU, if the patient opts for a bed category lower than the Single Room, the cost of procedure/ surgery/ investigations already done shall be charged as per Single Room category only. e) If the patient is transferred to ICU during the course of IP stay, then the surgery / procedure/ investigations shall remain same as per original Bed occupied charges. However, ICU charges will be levied during actual duration of stay in the ICU. f) In case of packages if up gradation of bed is done the package would be charged as per higher bed category. g) Where a patient is to be admitted and the desired category of bed is not available, the patient may be admitted in the next available higher category bed & would be shifted to the desired bed category as soon as available. Patient will be charged as per the desired bed category. In case patient refuses to shift and choose to stay in the provided higher category then the complete bill will be as per the higher bed category. 15. Equipment Charging Policy: a) Wherever any special equipment will be used for the surgery or procedure, it will be charged additional for the below mentioned list @ 20% of surgeon fees b) For equipments other than mentioned below shall be charged as mentioned in SOC. c) In case of Multiple surgeries, the special equipment charges would be taken as per higher Surgeon Fees. d) If More than one In-house equipment is used for the patient in one sitting, then only one equipment (higher value) will be charged. e) In case C arm is used along with any other equipment, then the charges for C-Arm shall also be levied in addition to the other equipment charge. f) If outsourced (rental) equipment is also used with in-house equipment, then both will be charged. g) Disposable and handheld accessories for special equipment will be charged additional as per actuals 16. Advance Policy: Minimum Advance to be collected as per Room Category Single room - Rs 50,000/- Double room - Rs 30,000/- Triple room - Rs 15,000/- Day Care - Rs 10,000/-

4 1. CASH PATIENTS A. Medical / Conservative Management 80% Of the Total estimate given to the patient is to be deposited at the time of Admission. OR Minimum Advance Deposit as per Room Category B. Surgical Management 100% of the Estimated expenses to be taken as an advance at the time of admission /before giving OT clearance.Cases where package rates are applicable, entire package cost is to be taken as Advance. 2. TPA PATIENTS A. Medical /Conservative Management • In cases where TPA full approval has been received- minimum Rs 5000/- is to be taken against the non payable items. • In cases where approval received is lesser than the estimate provided- differential amount to be collected at the time of Admission (80% of the total estimate or the Minimum advance against Room category). • In cases where approval is not received then it will be treated as Cash patient till approval is received and minimum advance is deposited as per Room Category highlighted above. B. Surgical Management • In cases where TPA full approval has been received- minimum Rs 5000/- is to be taken against the non payable items. • In cases where approval received is lesser than the estimate provided- differential amount to be collected at the time of Admission (100% of the total estimate). • In cases where approval is not received then it will be treated as Cash patient till approval is received and 100% of the estimated expenses to be taken as an advance. Cases where package rates are applicable, entire package cost is to be taken as Advance.

Note: In all cases where inappropriate advance is deposited by patient (after approved by the concerned authority-AMS/ MOD) an UNDERTAKING FROM PATIENT IS MANDATORY. LIFE THREATNING CASES (also during silent hours) do not require mandatory advance deposit at the time of admission. In all cases where proper advance is not taken, an UNDERTAKING will be taken by patient/attendant after receiving approval from the DMS/MOD.

16. Refund Policy: Any refund of amount less than Rs 5000/- would be made in cash. Any refund of amount for Rs 5000/- or more would be made by cheque or NEFT in the name of the patient /attendant only. Refund cheques can be collected after settlement of bill on submission of original advance receipt. 17. Other Rules • All implants used in the surgery / package will be charged as per hospital policy • For Radiology investigations, patient will get CD’s instead of films, however Film charges for the procedure / investigation will be charged extra if asked for.CD’s will be provided along with the report. • No discounts are applicable on Packages and Outsource Investigations or TPA cases etc. • No separate invoice will be provided in any circumstances.Implant sticker (if any) will be provided as per request andapproval by DMS. • High Risk Policy , separate surgical codes for high risk cases • Any tax as per Government policy will be levied as per actual e.g. Service tax on cosmetic surgery procedures, TDS, TCS etc. Note(s): This policy is applicable only for prevailing Financial Year and schedule of charges is liable to change without prior notice

5 Inclusions / Exclusion

6 Obs & Gyn Packages

7 Service Billing Billing Triple Double Single Package name code Group Subgroup Bed Room Room

OBG KOBG003 NORMAL DELIVERY -PACKAGE Package 60000 67000 75000 PACKAGE

Ward Stay upto 2 days,Admission charges, Procedure Fees, Consultation by Obs & Gyn during package days, Labour Room Charges, Inclusions Investigation as specified in Annexure - 1a, Continuous Fetal Monitoring, Pharmacy & Consumable upto 7000.

Stay above Package days will be billed as per actuals, Investigations and Blood & blood Products and any other service not Exclusions specified, Cross referral visit ,High value medicine, Epidural Analgesia not included.

OBG KOBG004 NORMAL DELIVERY -BABY PACKAGE Package 1 1 1 PACKAGE

Stay alongwith mother for 2 days, Paediatric resuscitation charges, Consultations by the paediatrician during package days, Inclusions Vaccination of baby (OPV+Hep.B+ BCG), Pulse oxymetry Screening for Critical Congenital Heart Disease, New Born Screening, Investigation as specified in Annexure 1b- Pharmacy & Consumable upto Rs 1000.

Stay above Package days and stay in NICU will be billed as per actuals , Investigations and Blood & blood Products and any other Exclusions service not specified in inclusion, Cross referral visit ,High value medicine not included.

OBG KOBG023 INSTRUMENTAL DELIVERY -PACKAGE Package 62000 70000 80000 PACKAGE

OBG KOBG024 INSTRUMENTAL DELIVERY -BABY PACKAGE Package 1 1 1 PACKAGE

OBG KKOBG005 CAESARIAN SECTION - PACKAGE Package 67000 75000 85000 PACKAGE

Ward Stay upto 3 days, Surgeon fees, Anaesthetist Fees, OT and Anasthsesia charge,Consultation by the operating surgeon during Inclusions package days, Continuous Fetal Monitoring, Investigation as specified in Annexure 1a, Pharmacy & Consumable upto Rs 15000.

Stay beyond limit, Investigation , Blood & Blood Products and any other service not specified , Epidural Analgesia not included Exclusions ,Pediatric package as per Delivery Baby Charges.Cross Referral Visit

OBG KOBG006 CAESARIAN SECTION - BABY PACKAGE Package 1 1 1 PACKAGE

Room stay alongwith mother up to 3 days, Paediatric resuscitation charges, Consultations by the paediatrician during package Inclusions days, Vaccination of baby (OPV+Hep.B+ BCG), Pulse oxymetry Screening for Critical Congenital Heart Disease, New Born Screening, Investigation as specified in Annexure 1b, Pharmacy & Consumable upto Rs 1000.

OBG KKOBG025 CAESARIAN SECTION - PACKAGE- M Package 80000 90000 105000 PACKAGE

8 Service Billing Billing Triple Double Single Package name code Group Subgroup Bed Room Room

Stay beyond limit, Investigation , Blood & Blood Products and any other service not specified , Pulse oxymetry Screening for Critical Exclusions Congenital Heart Disease, New Born Screening, Epidural Analgesia not included ,Pediatric package as per Delivery Baby Charges. Cross Referral Visit

OBG KOBG026 CAESARIAN SECTION - BABY PACKAGE-M Package 1 1 1 PACKAGE

OBG KKOBG027 CAESARIAN SECTION - PACKAGE-High Risk Package 84000 94000 106000 PACKAGE

OBG KOBG028 CAESARIAN SECTION - BABY PACKAGE -High Risk Package 1 1 1 PACKAGE

OBG KKOBG010 D & C OR MTP UNDER GA - PACKAGE Package 15000 17000 20000 PACKAGE

Room Stay upto 1 day , Surgeon Fees, Anaesthetist Fees, OT & Anaesthesia Charges ,PAC,Routine Pharmacy & consumable up to Rs Inclusions 2500.

Stay beyond limit, Investigations ,Blood and Blood products and any other service not specified in inclusions. Pharmacy & Exclusions Consumable over and above the limit defined, Cross referral visit.

Annexure Annexure: 1 a Investigation: Mother QTY H0014 Complete Blood Counts (Automated) 1 H0059 Prothrombin Time - PT (Automated/ Clotting Assay ) 1 POBG029 CONTINUOUS FETAL MONITORING 1

Annexure: 1 b Investigation: New Born PCYT53 New Born screenings - CYT(7 Days) 1 PPED069 OAE SCREENING 1 B0107 Neonatal Blood Grouping & AB Screening 1

9 Ortho Packages

10 Service Billing Double Single Package name Billing Subgroup Triple Bed code Group Room Room ORTHOPAEDICS KKORT016 TOTAL KNEE REPLACEMENT - UNILATERAL - PACKAGE Package 169990 187000 203980 PACKAGE Ward Stay upto 7 days, Admission charges, Procedure Fees, Consultation by Orthopaedic, Cardiology , Internal Medicine during Inclusions package days, OT Charges, Investigation as specified in Annexure , OT Pharmacy & Consumable upto Rs 13,000 , OT Consumables upto Rs 20,000 , Physiotherapy during days, Radiology upto Rs 2,200. Stay above Package days will be billed as per actuals, ICU Stay ,Investigations and Blood & blood Products and any other service not Exclusions specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication ORTHOPAEDICS KKORT019 TOTAL KNEE REPLACEMENT - BILATERAL - PACKAGE Package 316790 348500 380150 PACKAGE Ward Stay upto 10 days, Admission charges, Procedure Fees, Consultation by Orthopaedic, Cardiology , Internal Medicine during Inclusions package days, OT Charges, Investigation as specified in Annexure , OT Pharmacy & Consumable upto Rs 25,000 , OT Consumables upto Rs 30,000 , Physiotherapy during package days, Radiology upto Rs 4,000. Stay above Package days will be billed as per actuals, ICU Stay ,Investigations and Blood & blood Products and any other service not Exclusions specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication ORTHOPAEDICS KKORT017 TOTAL HIP REPLACEMENT - UNILATERAL - PACKAGE Package 200890 221000 241070 PACKAGE Ward Stay upto 7 days, Admission charges, Procedure Fees, Consultation by Orthopaedic, Cardiology , Internal Medicine during Inclusions package days, OT Charges, Investigation as specified in Annexure , OT Pharmacy & Consumable upto Rs 13,000 , OT Consumables upto Rs 20,000 , Physiotherapy during package days, Radiology upto Rs 2,600. Stay above Package days will be billed as per actuals, ICU Stay ,Investigations and Blood & blood Products and any other service not Exclusions specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined , Discharge Medication. ORTHOPAEDICS KKORT020 TOTAL HIP REPLACEMENT - BILATERAL - PACKAGE Package 285890 314500 343060 PACKAGE Ward Stay upto 10 days, Admission charges, Procedure Fees, Consultation by Orthopaedic, Cardiology , Internal Medicine during Inclusions package days, OT Charges, Investigation as specified in Annexure , OT Pharmacy & Consumable upto Rs 25,000 , OT Consumables upto Rs 30,000 , Physiotherapy for package days, Radiology upto Rs 3,600. Stay above Package days will be billed as per actuals, ICU Stay ,Investigations and Blood & blood Products and any other service not Exclusions specified, Cross referral visit ,High value medicine, Pharmacy & Consumable over and above the limit defined.

Annexure LAB INVESTIGATIONS COVERED QTY B0036 Packed RBC/RCC - Reserve/Crossmatch 2 H0006 APTT ( Automated / Clotting Assay ) 1 H0029 Haemoglobin ( Automated ) 2 H0052 PCV (Packed Cell Volume) ( Automated ) 2 H0059 Prothrombin Time -PT ( Automated/ Clotting Assay ) 2 H0090 Urine Routine and Microscopy ( Qualitative Method) 2 C0432 Renal Panel - I - Random 1 H0014 Complete Blood Counts (Automated) 1 M0089 HBSAG (Rapid Test) 1 M0115 HIV I & II (Rapid Test) 1 M0180 Urine Culture 1 PROCEDURES - AS PER BELOW LIST QTY DCAR001 E C G - Adult 1 DCAR003 Echo-Cardiogram 1 PANA001 PATIENT CONTROLLED ANALGESIA 1

11 CTVS Package

12 Double Single Service code Package name Triple Bed Room Room

KCTS003 CABG + VALVE SURGERY PACKAGE 3,35,210 3,99,050 4,62,900

Stay upto 8 days, OT /Ward Pharmacy Rs 67,000/- OT /Ward Stock upto Rs. 1,00,600/- , Surgeon Fees, Anaesthetist Fees, OT & Inclusion Anaesthesia Charges, Lab Services Rs 33,500 , Radiology Services - Rs 10,100/- , Oxygen , Ventillator , Cardiac Monitor Charges

Stay more than limit, Pharmacy/ Consumables/Investigation/blood more than the limit specified, Vist of any other speciality Exclusion doctor, Cost of Graft/implant extra, Cell Saver, IABP, Valve, Hemofilter, Swan Ganz catheter, Maze Procedure additional , Discharge Medication

KCTS045 CABG PACKAGE 2,74,810 3,02,320 3,29,780

Stay upto 8 days, OT /Ward Pharmacy Rs 55,000/- OT /Ward Stock upto Rs. 82,400/- , Surgeon Fees, Anaesthetist Fees, OT Inclusion & Anaesthesia Charges, Lab Services Rs 27,500 , Radiology Services - Rs 8,200/- , Oxygen , Ventillator , Cardiac Monitor Charges

KCTS004 CLOSURE OF ASD PACKAGE 3,26,030 3,88,130 4,50,230

Stay upto 8 days, OT /Ward Pharmacy Rs 65,200/- OT /Ward Stock upto Rs. 97,800/- , Surgeon Fees, Anaesthetist Fees, OT Inclusion & Anaesthesia Charges, Lab Services Rs 32,600 , Radiology Services - Rs 9,800/- , Oxygen , Ventillator , Cardiac Monitor Charges

KCTS005 CLOSURE OF PDA PACKAGE 2,30,880 2,74,850 3,18,830

Stay upto 8 days, OT /Ward Pharmacy Rs 46,200/- OT /Ward Stock upto Rs. 69,300/- , Surgeon Fees, Anaesthetist Fees, OT Inclusion & Anaesthesia Charges, Lab Services Rs 23,100 , Radiology Services - Rs 6,900/- , Oxygen , Ventillator , Cardiac Monitor Charges

KCTS014 HEART SURGERY - (CLOSED) PACKAGE 2,51,650 2,99,580 3,47,510

Stay upto 8 days, OT /Ward Pharmacy Rs 50,300/- OT /Ward Stock upto Rs. 75,500/- , Surgeon Fees, Anaesthetist Fees, OT Inclusion & Anaesthesia Charges, Lab Services Rs 25,200 , Radiology Services - Rs 7,500/- , Oxygen , Ventillator , Cardiac Monitor Charges

KCTS015 HEART SURGERY - (OPEN) PACKAGE 4,14,660 4,93,640 5,72,620

Stay upto 8 days, OT /Ward Pharmacy Rs 82,900/- OT /Ward Stock upto Rs. 1,24,400/- , Surgeon Fees, Anaesthetist Fees, OT & Inclusion Anaesthesia Charges, Lab Services Rs 41,500 , Radiology Services - Rs 12,400/- , Oxygen , Ventillator , Cardiac Monitor Charges

KCTS032 VALVE MULTIPLE PACKAGE 3,59,240 4,27,660 4,96,090

Stay upto 8 days, OT /Ward Pharmacy Rs 71,800/- OT /Ward Stock upto Rs. 1,07,800/- , Surgeon Fees, Anaesthetist Fees, OT & Inclusion Anaesthesia Charges, Lab Services Rs 35,900 , Radiology Services - Rs 10,800/- , Oxygen , Ventillator , Cardiac Monitor Charges

13 Double Single Service code Package name Triple Bed Room Room

KCTS034 VALVE SINGLE PACKAGE 2,93,430 3,49,320 4,05,210

Stay upto 8 days, OT /Ward Pharmacy Rs 58,700/- OT /Ward Stock upto Rs. 88,000/- , Surgeon Fees, Anaesthetist Fees, OT Inclusion & Anaesthesia Charges, Lab Services Rs 29,300 , Radiology Services - Rs 8,800/- , Oxygen , Ventillator , Cardiac Monitor Charges

14 Cardiology Packages

15 Service Triple Double Single Package name code Bed Room Room

KCAR002 ANGIOGRAM CORONARY PACKAGE 17,080 18,790 20,500

Stay upto 1 day, Pharmacy & consumables during package days , Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

Stay more than limit, Pharmacy/ Consumables/Investigation more than specified days, Vist of any other speciality doctor, Exclusion Physiotherapy, Cost of Stent/Graft/Valve Implant extra, General Anesthesia /Regional Anesthesia charges additional if required , High Value Medicine ,Discharge Medication.

KCAR006 ANGIOGRAM PERIPHERAL PACKAGE 16,670 19,840 23,020

Stay upto 1 day, Pharmacy & consumables during package days , Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR007 ANGIOGRAM RENAL/CAROTID PACKAGE 16,670 19,840 23,020

Stay upto 1 day, Pharmacy & consumables during package days , Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR012 ANGIOPLASTY PTCA - SINGLE VESSEL PACKAGE 1,06,950 1,17,650 1,28,340

Stay upto 3 days, Pharmacy & consumables during package days, 1 Balloon ,Surgeon fee, Cath lab charge and investigations as Inclusion specified in Annexure.

KCAR011 ANGIOPLASTY PTCA - MULTIPLE VESSEL PACKAGE 2,03,950 2,42,800 2,81,650

Stay upto 3 days, Pharmacy & consumables during package days, 1 Balloon ,Surgeon fee, Cath lab charge and investigations as Inclusion specified in Annexure.

KCAR010 ANGIOPLASTY PRIMARY - SINGLE VESSEL PACKAGE 2,02,860 2,41,500 2,80,140

Stay upto 3 days, Pharmacy & consumables during package days, 1 Balloon ,Surgeon fee, Cath lab charge and investigations as Inclusion specified in Annexure.

KCAR008 ANGIOPLASTY PERIPHERAL PACKAGE 1,03,850 1,23,630 1,43,410

Stay upto 3 days, Pharmacy & consumables during package days, 1 Balloon ,Surgeon fee, Cath lab charge and investigations as Inclusion specified in Annexure.

KCAR023 PERMANENT PACEMAKER IMPLANTATION - SINGLE CHAMBER PACKAGE 70,500 83,900 97,400

16 Service Triple Double Single Package name code Bed Room Room

Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR022 PERMANENT PACEMAKER IMPLANTATION - DOUBLE CHAMBER PACKAGE 81,000 96,400 1,11,900

Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR014 BIVENTRICULAR PACING PACKAGE 2,03,470 2,42,220 2,80,980

Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR021 EPS DIAGNOSTIC PACKAGE 54,830 65,270 75,710

Stay upto 2 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR026 RF ABLATION SIMPLE PACKAGE 81,510 97,040 1,12,560

Stay upto 2 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR029 RF ABLATION COMPLEX PACKAGE 1,18,700 1,41,310 1,63,920

Stay upto 2 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR018 DEVICE CLOSURE - PDA PACKAGE 73,060 86,970 1,00,890

Stay upto 5 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR017 DEVICE CLOSURE - ASD PACKAGE 1,06,990 1,27,370 1,47,750

Stay upto 5 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

17 Service Triple Double Single Package name code Bed Room Room

KCAR013 BALLON SEPTOSTOMY PACKAGE 74,990 89,270 1,03,560

Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

KCAR015 BPV/BAV PACKAGE 78,850 93,870 1,08,890

Stay upto 3 days, Pharmacy & consumables during package days ,Surgeon fee, Cath lab charge and investigations as specified in Inclusion Annexure.

INVESTIGATION ANNEXURES: (Any of the investigation from the below mentioned)

Subgroup Service Name Service Code HAEMATOLOGY APTT ( Automated / Clotting Assay ) H0006 HAEMATOLOGY Complete Blood Counts (Automated) H0014 HAEMATOLOGY Prothrombin Time -PT ( Automated/ Clotting Assay ) H0059 MICROBIOLOGY HBSAG (Rapid Test) M0089 MICROBIOLOGY Hepatitis B Surface Antigen (Hbsag) - Elisa M0101 MICROBIOLOGY Hepatitis C Virus Antibody (Elisa) M0103 MICROBIOLOGY HIV I & II (Rapid Test) M0115 MICROBIOLOGY Human Immuno Virus (HIV I + II) - Elisa M0128 BIOCHEMISTRY Bilirubin - Direct C0042 BIOCHEMISTRY Bilirubin -Total C0043 BIOCHEMISTRY Bilirubin Total/Direct C0044 BIOCHEMISTRY Blood Gas Analysis C0052 BIOCHEMISTRY Cholesterol - Hdl C0079 BIOCHEMISTRY Cholestrol - Ldl C0082 BIOCHEMISTRY Electrolytes (Na, K & Cl) C0142 BIOCHEMISTRY Lipid Profile C0214 BIOCHEMISTRY Liver Function Test C0218 BIOCHEMISTRY T.Chol/Hdl.Chol Ratio C0320 BIOCHEMISTRY Transferrin Saturation C0334 BIOCHEMISTRY Renal Panel - I - Fasting C0429 BIOCHEMISTRY Renal Panel - II - Fasting C0430 BIOCHEMISTRY Renal Panel - III - Fasting C0431

18 Subgroup Service Name Service Code BIOCHEMISTRY Renal Panel - I - Random C0432 BIOCHEMISTRY Renal Panel - II - Random C0433 BIOCHEMISTRY Renal Panel - III - Random C0434 CARDIOLOGY Echo-Cardiogram DCAR003 XRAY Plain Xray Dept/Portable Xray Dept DRAD114 HAEMATOLOGY Differential Count( Automated Cell Counter ) H0018 HAEMATOLOGY ESR ( Automated ) H0019 HAEMATOLOGY Haemoglobin ( Automated ) H0029 HAEMATOLOGY Hb,TLC, DLC ( Automated ) H0034 HAEMATOLOGY Platelet Count ( Automated ) H0055 HAEMATOLOGY Bleeding and Clotting Time( Ivys & Lee Method ) H0008 HAEMATOLOGY RBC Count ( Automated ) H0060 HAEMATOLOGY TC (Total Count)( Automated ) H0074 HAEMATOLOGY Urine Routine and Microscopy ( Qualitative Method) H0090 BIOCHEMISTRY Bun (Blood Urea Nitrogen) C0059 BIOCHEMISTRY Calcium - Total C0066 BIOCHEMISTRY Cholesterol - Total C0080 BIOCHEMISTRY Cholesterol - Vldl C0081 BIOCHEMISTRY Creatinine- Serum C0105 BIOCHEMISTRY Glucose - Fasting C0168 BIOCHEMISTRY Glucose - Post Prandial (Ppbs) C0169 BIOCHEMISTRY Glucose (Urine Random) C0170 BIOCHEMISTRY Glucose ( Spot ) C0172 BIOCHEMISTRY Phosphorus - Serum C0263 BIOCHEMISTRY Potassium - Serum C0290 BIOCHEMISTRY Protein Total C0297 BIOCHEMISTRY SGOT ( Ast ) C0311 BIOCHEMISTRY SGPT ( Alt ) C0312 BIOCHEMISTRY Sodium - Serum C0315 BIOCHEMISTRY Total Protein/ Albumin / Globulin /A:G C0332 BIOCHEMISTRY Uric Acid - Serum C0341 BLOOD BANK Blood Grouping Rh Typing & Antibody B0007 CARDIOLOGY E C G - Adult DCAR001

19 Department of Cardiac Sciences

20 Cardiology

21 Cardiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

CARDIOLOGY ANGIO KCAR006 ANGIOGRAM PERIPHERAL PACKAGE Package 0 16670 19840 23020 PACKAGE

CARDIOLOGY ANGIO KCAR007 ANGIOGRAM RENAL/CAROTID PACKAGE Package 0 16670 19840 23020 PACKAGE

CARDIOLOGY ANGIO KCAR002 ANGIOGRAM CORONARY PACKAGE Package 0 17080 18790 20500 PACKAGE

CARDIOLOGY ANGIO KCAR004 ANGIOGRAM DAYCARE PACKAGE Package 0 17080 18790 20500 PACKAGE

ANGIOGRAM CORONARY + PERIPHERAL CARDIOLOGY ANGIO KCAR003 Package 0 29710 35370 41030 PACKAGE PACKAGE

CARDIOLOGY PLASTY KCAR008 ANGIOPLASTY PERIPHERAL PACKAGE Package 0 103850 123630 143410 PACKAGE

ANGIOPLASTY PRIMARY - SINGLE CARDIOLOGY PLASTY KCAR010 Package 0 202860 241500 280140 VESSEL PACKAGE PACKAGE

ANGIOPLASTY PTCA - SINGLE VESSEL CARDIOLOGY PLASTY KCAR012 Package 0 106950 117650 128340 PACKAGE PACKAGE

ANGIOPLASTY PTCA - MULTIPLE VESSEL CARDIOLOGY PLASTY KCAR011 Package 0 203950 242800 281650 PACKAGE PACKAGE

DIAGNOSTIC PAEDIATRIC CARDIOLOGY ANGIO KCAR020 Package 0 37800 45000 52200 CATHETERIZATION PACKAGE PACKAGE

KCAR030 FRACTIONAL FLOW RESERVE Package CARDIOLOGY PACKAGE 0 26090 31050 36020

KCAR033 FFR- Cath Procedure Package CARDIOLOGY PACKAGE 0 30550 36370 42190

KCAR035 IVUS-Cath Procedure Package CARDIOLOGY PACKAGE 0 36230 43130 50030

KCAR021 EPS DIAGNOSTIC PACKAGE Package CARDIOLOGY PACKAGE 0 54830 65270 75710

KCAR018 DEVICE CLOSURE - PDA PACKAGE Package CARDIOLOGY PACKAGE 0 73060 86970 100890

KCAR017 DEVICE CLOSURE - ASD PACKAGE Package CARDIOLOGY PACKAGE 0 106990 127370 147750

KCAR013 BALLON SEPTOSTOMY PACKAGE Package CARDIOLOGY PACKAGE 0 74990 89270 103560

KCAR015 BPV/BAV PACKAGE Package CARDIOLOGY PACKAGE 0 78850 93870 108890

KCAR024 PTMC / PTMV PACKAGE Package CARDIOLOGY PACKAGE 0 81510 97040 112560

KCAR025 PTSMA PACKAGE Package CARDIOLOGY PACKAGE 0 152630 181700 210780

KCAR026 RF ABLATION SIMPLE PACKAGE Package CARDIOLOGY PACKAGE 0 81510 97040 112560

KCAR029 RF ABLATION COMPLEX PACKAGE Package CARDIOLOGY PACKAGE 0 118700 141310 163920

CARDIOLOGY PLASTY KCAR016 CARTO PACKAGE Package 0 161690 192490 223280 PACKAGE

PERMANENT PACEMAKER KCAR023 IMPLANTATION - SINGLE CHAMBER Package CARDIOLOGY PACKAGE 0 70500 83900 97400 PACKAGE

22 Cardiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PERMANENT PACEMAKER KCAR022 IMPLANTATION - DOUBLE CHAMBER Package CARDIOLOGY PACKAGE 0 81000 96400 111900 PACKAGE

CARDIOLOGY PLASTY KCAR014 BIVENTRICULAR PACING PACKAGE Package 0 203470 242220 280980 PACKAGE

DCAR001 ECG- Adult Procedure CARDIOLOGY 360 360 400 440

DCAR020 6 MINUTE CARDIAC WALK Procedure CARDIOLOGY 610 640 770 890

PCAR008 FLASH CARD ANALYSIS Procedure CARDIOLOGY 760 800 950 1110

PCAR010 LIFE STYLE COUNSELLING Procedure CARDIOLOGY 760 800 950 1110

PCAR011 PACEMAKER ANALYSIS Procedure CARDIOLOGY 960 1010 1200 1390

DCAR018 EVENT RECORDER - CARDIOLOGY Procedure CARDIOLOGY 1100 1150 1370 1590

PACEMAKER INTERROGATION / DCAR013 Procedure CARDIOLOGY 1780 1860 2220 2570 PROGRAMME - Single Chamber

PCAR001 COMPACT DISC - COST Procedure CARDIOLOGY 1910 2010 2390 2770

PACEMAKER INTERROGATION / DCAR014 Procedure CARDIOLOGY 2330 2440 2910 3370 PROGRAMME - Dual chamber

DCAR003 Echo-Cardiogram Procedure CARDIOLOGY 3000 3000 3300 3600

DCAR019 ECHO CARDIOGRAM - (N) Procedure CARDIOLOGY 3830 4030 4790 5560

DCAR002 Echo-Cardiogram - Paediatrics Procedure CARDIOLOGY 2600 2730 3250 3770

PCAR006 ECHO-SCREENING Procedure CARDIOLOGY 960 1010 1200 1390

DCAR023 3D - ECHO Procedure CARDIOLOGY 3560 3740 4450 5160

DCAR012 Tread Mill Test Procedure CARDIOLOGY 2500 2500 2750 3000

PCAR009 HOLTER Procedure CARDIOLOGY 2740 2880 3430 3970

DCAR022 STRESS ECHO Procedure CARDIOLOGY 3560 3740 4450 5160

TEE - TRANSOESOPHAGEAL PCAR012 Procedure CARDIOLOGY 4240 4450 5290 6140 ECHOCARDIOGRAPHY

DCAR024 CRT ECHO ( PRE & POST ECHOS) Procedure CARDIOLOGY 4240 4450 5290 6140

DCAR021 ANGIODEFENDER Procedure CARDIOLOGY 3140 3300 3930 4560

DCAR015 BIVENTRICULAR PACING / CRT Procedure CARDIOLOGY 3420 3590 4270 4960

DCAR016 EXTENDED HOLTER Procedure CARDIOLOGY 3420 3590 4270 4960

DCAR017 AMBULATORY BP RECORDER Procedure CARDIOLOGY 3560 3740 4450 5160

PCAR013 PERICARDIAL ASPIRATION Procedure CARDIOLOGY 11480 12060 14350 16650

PCAR014 T P I (TEMPORARY PACING) Procedure CARDIOLOGY 11480 12060 14350 16650

PCAR015 IABP Procedure CARDIOLOGY 39620 41600 49530 57450

23 CTVS

24 CTVS

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group CARDIOTHORACIC KCTS014 HEART SURGERY - (CLOSED) PACKAGE Package 0 251650 299580 347510 SURGERY PACKAGE CARDIOTHORACIC KCTS015 HEART SURGERY - (OPEN) PACKAGE Package 0 414660 493640 572620 SURGERY PACKAGE CARDIOTHORACIC KCTS005 CLOSURE OF PDA PACKAGE Package 0 230880 274850 318830 SURGERY PACKAGE CARDIOTHORACIC KCTS004 CLOSURE OF ASD PACKAGE Package 0 326030 388130 450230 SURGERY PACKAGE CARDIOTHORACIC KCTS045 CABG PACKAGE Package 0 274810 302320 329780 SURGERY PACKAGE CABG + VALVE SURGERY (DIABETIC) CARDIOTHORACIC KCTS036 Package 0 354040 421480 488920 PACKAGE SURGERY PACKAGE CARDIOTHORACIC KCTS003 CABG + VALVE SURGERY PACKAGE Package 0 335210 399050 462900 SURGERY PACKAGE CARDIOTHORACIC KCTS034 VALVE SINGLE PACKAGE Package 0 293430 349320 405210 SURGERY PACKAGE CARDIOTHORACIC KCTS032 VALVE MULTIPLE PACKAGE Package 0 359240 427660 496090 SURGERY PACKAGE CARDIOTHORACIC KCTSP01 ARTERIAL SWITCH OPERATION - PAED Package 0 307070 365560 424050 SURGERY PACKAGE CARDIOTHORACIC KCTSP26 VALVE SINGLE - PAED Package 0 326030 388130 450230 SURGERY PACKAGE CARDIOTHORACIC KCTSP04 CLOSURE OF PDA - PAED Package 0 246460 293400 340340 SURGERY PACKAGE CARDIOTHORACIC KCTSP02 BT SHUNT - PAED Package 0 252980 301160 349350 SURGERY PACKAGE CARDIOTHORACIC KCTSP05 CLOSURE OF VSD - SIMPLE - PAED Package 0 337140 401350 465570 SURGERY PACKAGE CARDIOTHORACIC KCTSP28 CoA - COARCTATION OF AORTA - PAED Package 0 351510 418460 485410 SURGERY PACKAGE CARDIOTHORACIC KCTSP10 GLENN OPERATION ON BYPASS - PAED Package 0 351510 418460 485410 SURGERY PACKAGE CARDIOTHORACIC KCTSP06 COMPLEX TOF - PAED Package 0 354040 421480 488920 SURGERY PACKAGE TAPVC - TOTAL ANOMALOUS CARDIOTHORACIC KCTSP27 Package 0 360560 429240 497920 PULOMNARY VENOUS DRAINAGE - PAED SURGERY PACKAGE CARDIOTHORACIC KCTSP08 FONTAN OPERATION - PAED Package 0 374330 445630 516930 SURGERY PACKAGE CARDIOTHORACIC KCTSP03 CLOSURE OF ASD - PAED Package 0 374930 446350 517760 SURGERY PACKAGE CARDIOTHORACIC KCTSP15 REPAIRS OF AV CANAL - PAED Package 0 379520 451810 524100 SURGERY PACKAGE CARDIOTHORACIC KCTSP31 COMPLEX VSD - PAED Package 0 381450 454110 526770 SURGERY PACKAGE CARDIOTHORACIC KCTSP22 TRUNCUS ARTERIOSUS - PAED Package 0 395820 471220 546610 SURGERY PACKAGE CARDIOTHORACIC KCTSP12 HEART SURGERY - (OPEN) - PAED Package 0 451850 537920 623980 SURGERY PACKAGE

25 Department of Women & Child Care

26 Obstetrics & Gynaecology

27 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup CAESARIAN SECTION - BABY - KOBG006 Package OBG PACKAGE 0 1 1 1 PACKAGE KOBG004 NORMAL DELIVERY - BABY- PACKAGE Package OBG PACKAGE 0 1 1 1 KKOBG010 D & C OR MTP UNDER GA - PACKAGE Package OBG PACKAGE 0 15000 17000 20000 KOBG003 NORMAL DELIVERY - PACKAGE Package OBG PACKAGE 0 60000 67000 75000 KKOBG005 CAESARIAN SECTION - PACKAGE Package OBG PACKAGE 0 67000 75000 85000 New INSTRUMENTAL DELIVERY PACKAGE Package OBG PACKAGE 0 62000 70000 80000 New CAESARIAN SECTION -M- PACKAGE Package OBG PACKAGE 0 80000 90000 105000 CAESARIAN SECTION -(High Risk)- New Package OBG PACKAGE 0 84000 94000 106000 PACKAGE KOBG015 NORMAL DELIVERY - TWINS PACKAGE Package OBG PACKAGE 0 71730 85390 99050 KKOBG017 CAESARIAN SECTION - TWINS PACKAGE Package OBG PACKAGE 0 97810 116440 135070 KRKOBG004 ROBOTIC SURGERY PACKAGE - 2 - OBG Package OBG PACKAGE 0 374930 446350 517760 FETAL KKFET003 Laser Ablation Package Package MEDICINE 0 65210 77630 90050 PACKAGE KKOBG009 HYSTERECTOMY - PACKAGE Package OBG PACKAGE 0 86100 102500 118900 NST OBSERVATION IN MATERNITY - PER POBG032 Procedure OBG 280 290 350 410 HOUR POBG033 REMOTE FETAL MONITORING - NST Procedure OBG 1780 1860 2220 2570 POBG013 FETAL MONITORING Procedure OBG 640 670 800 920 POBG029 CONTINUOUS FETAL MONITORING Procedure OBG 1180 1240 1470 1710 POBG024 VAGINAL SWAB - OBG Procedure OBG 360 380 450 520 POBG011 EARLY PREGNANCY / NUCHAL SCAN - A Procedure OBG 960 1010 1200 1390 POBG003 COST OF CD- EXTRA - USG D&C/MTP Procedure OBG 1180 1240 1470 1710 POBG001 CAUTERISATION UNDER LA Procedure OBG 2050 2150 2560 2970 POBG020 US GUIDED ASPIRATION OF CYST - A Procedure OBG 2330 2440 2910 3370 POBG022 US GUIDED MTP - D&C - 1 Procedure OBG 2330 2440 2910 3370 POBG038 IUCD REMOVAL Procedure OBG 2600 2730 3250 3770 POBG004 CRYO SURGERY Procedure OBG 2740 2880 3430 3970 EXAMINATION UNDER ANAESTHESIA - POBG012 Procedure OBG 3010 3160 3760 4360 POBG POBG006 CYST ASPIRATION - B - OBG Procedure OBG 3420 3590 4270 4960 POBG023 US GUIDED MTP - D&C - 2 Procedure OBG 3420 3590 4270 4960 POBG021 US GUIDED ASPIRATION OF CYST - B Procedure OBG 3830 4030 4790 5560 POBG034 REMOTE FETAL MONITORING - CTG Procedure OBG 4370 4590 5470 6340 MTP - MEDICAL TERMINATION OF POBG030 Procedure OBG 4510 4740 5640 6540 PREGNANCY (CHEMICAL) POBG POBG015 HYSTEROSCOPY & D&C UNDER LA Procedure OBG 4930 5170 6160 7140 POBG005 CYST ASPIRATION - A - OBG Procedure OBG 5740 6030 7180 8330

28 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup POBG019 MID TRIMESTER MTP - POBG Procedure OBG 7650 8030 9560 11090 POBG042 COPPER T INSERTION Procedure OBG 8740 9180 10930 12680 POBG018 IUI (PER SESSION) Procedure OBG 8740 9180 10930 12680 POBG014 GARTNERS CYST EXCESSION - POBG Procedure OBG 9840 10330 12300 14260 POBG031 MID TRIMESTER MTP - PRO Procedure OBG 12850 13490 16060 18630 POBG040 CERVICAL CAUTERISATION Procedure OBG 17080 17940 21350 24770 POBG041 VULVAL BIOPSY Procedure OBG 17080 17940 21350 24770 COLPOSCOPY WITH/WITH OUT CERVIX POBG039 Procedure OBG 17760 18650 22200 25750 BIOPSY POBG037 MIRENA INSERTION Procedure OBG 17760 18650 22200 25750 POBG035 VABC Procedure OBG 19130 20090 23910 27740 FETAL PFET006 EMERGENCY SCAN / UNSCHEDULED Procedure 340 360 420 490 MEDICINE FETAL PFET079 FOLLICULAR IMAGING - SINGLE SITTING Procedure 640 670 800 920 MEDICINE FETAL PFET017 LIQUOR SERIAL Procedure 660 690 820 960 MEDICINE FETAL PFET001 COUNSELLING Procedure 760 800 950 1110 MEDICINE FETAL PFET018 LIQUOR / BPP SERIAL Procedure 1040 1090 1300 1510 MEDICINE FETAL PFET027 RECORDING AND CD - A Procedure 1040 1090 1300 1510 MEDICINE FETAL PFET080 USG EQUIPMENT CHARGES Procedure 1100 1150 1370 1590 MEDICINE FETAL PFET002 COUNSELLING GENETIC Procedure 1180 1240 1470 1710 MEDICINE FETAL PFET019 LIQUOR / BPP / DOP SERIAL Procedure 1300 1370 1630 1890 MEDICINE EARLY PREGNANCY SCAN ROUTINE FETAL PFET003 Procedure 1510 1590 1890 2190 (TAS OR TVS) MEDICINE FETAL PFET010 GYNAEC SCAN TAS SIMPLE Procedure 1510 1590 1890 2190 MEDICINE FETAL PFET070 REPEAT EARLY PREGNANCY SCAN Procedure 1510 1590 1890 2190 MEDICINE FETAL PFET020 DOPPLER STUDY Procedure 1650 1730 2060 2390 MEDICINE FETAL PFET007 FOLLICULAR IMAGING [ A ] Procedure 1910 2010 2390 2770 MEDICINE EARLY PREGNANCY SCAN DETAILED FETAL PFET004 Procedure 2050 2150 2560 2970 (TAS & TVS) MEDICINE FETAL PFET011 GYNAEC SCAN TAS COMPLEX Procedure 2050 2150 2560 2970 MEDICINE

29 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup FETAL PFET021 NUCHAL TRANSLUCENCY SCAN Procedure 2190 2300 2740 3170 MEDICINE TRIMESTER SCAN THIRD - WITH BASIC FETAL PFET084 Procedure 2190 2300 2740 3170 DOPPLER - A MEDICINE FETAL PFET005 EARLY PREGNANCY SCAN + GYNAEC Procedure 2470 2590 3080 3570 MEDICINE NUCHAL TRANSLUCENCY SCAN + FETAL PFET022 Procedure 2470 2590 3080 3570 DOPPLER MEDICINE TRIMESTER SCAN THIRD - WITH BASIC FETAL PFET035 Procedure 2470 2590 3080 3570 DOPPLER MEDICINE FETAL PFET071 EARLY PREGNANCY SCAN - TWINS Procedure 2600 2730 3250 3770 MEDICINE FETAL PFET012 GYNAEC SCAN DETAILED - A Procedure 2600 2730 3250 3770 MEDICINE FETAL PFET029 TRIMESTER SCAN MID Procedure 2600 2730 3250 3770 MEDICINE FETAL PFET008 FOLLICULAR IMAGING [ B ] Procedure 2740 2880 3430 3970 MEDICINE TRIMESTER SCAN THIRD - WITH FETAL PFET036 Procedure 2740 2880 3430 3970 COMPLETE DOPPLER MEDICINE EARLY PREGNANCY SCAN + GYNAEC FETAL PFET081 Procedure 3140 3300 3930 4560 - B MEDICINE EARLY PREGNANCY SCAN - MULTIPLE FETAL PFET072 Procedure 3140 3300 3930 4560 GESTATION MEDICINE FETAL PFET013 GYNAEC SCAN DETAILED - B Procedure 3280 3450 4100 4760 MEDICINE NUCHAL TRANSLUCENCY SCAN FETAL PFET023 Procedure 3280 3450 4100 4760 COMPLEX MEDICINE TRIMESTER SCAN MID - WITH UTA FETAL PFET030 Procedure 3280 3450 4100 4760 DOPPLER MEDICINE FETAL PFET068 ULTRSOUND GUIDED D&C Procedure 3280 3450 4100 4760 MEDICINE FETAL PFET050 AMNIOCENTESIS - A Procedure 3560 3740 4450 5160 MEDICINE FETAL PFET060 INTRAMNIOTIC PROCEDURE - A Procedure 3560 3740 4450 5160 MEDICINE FETAL PFET009 FOLLICULAR FRESH (GYNAEC + CYCLE) Procedure 3700 3880 4620 5360 MEDICINE FETAL PFET024 NUCHAL TRANSLUCENCY SCAN TWINS Procedure 3700 3880 4620 5360 MEDICINE FETAL PFET014 GYNAEC SCAN COMPLEX Procedure 3830 4030 4790 5560 MEDICINE FETAL PFET031 TRIMESTER SCAN MID - COMPLEX Procedure 3830 4030 4790 5560 MEDICINE FETAL PFET085 ULTRSOUND GUIDED D&C - B Procedure 3830 4030 4790 5560 MEDICINE

30 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup FETAL PFET015 GYNAEC SCAN COMPLEX 3D - SIMPLE Procedure 4240 4450 5290 6140 MEDICINE FETAL PFET082 TRIMESTER SCAN MID - COMPLEX - B Procedure 4240 4450 5290 6140 MEDICINE FETAL PFET032 TRIMESTER SCAN MID - FETAL ECHO Procedure 4240 4450 5290 6140 MEDICINE FETAL PFET026 NUCHAL TRANSLUCENCY SCAN 3D Procedure 4510 4740 5640 6540 MEDICINE NUCHAL TRANSLUCENCY SCAN FETAL PFET025 Procedure 4510 4740 5640 6540 MULTIPLE GEST MEDICINE TRIMESTER SCAN MID - MULTIPLE FETAL PFET033 Procedure 4510 4740 5640 6540 GEST MEDICINE FETAL PFET051 AMNIOCENTESIS - B Procedure 5190 5450 6490 7530 MEDICINE TRIMESTER SCAN MID - FETAL ECHO FETAL PFET034 Procedure 5740 6030 7180 8330 ABNORMAL MEDICINE TRIMESTER SCAN MID - TWINS FETAL PFET074 Procedure 5740 6030 7180 8330 COMPLEX MEDICINE FETAL PFET053 CHORION VILLUS SAMPLING - A Procedure 6160 6470 7700 8930 MEDICINE FETAL PFET055 CORDOCENTESIS - A Procedure 6280 6600 7850 9110 MEDICINE FETAL PFET061 INTRAMNIOTIC PROCEDURE - B Procedure 6280 6600 7850 9110 MEDICINE TRIMESTER SCAN MID - FETAL ECHO FETAL PFET083 Procedure 6280 6600 7850 9110 ABNORMAL - B MEDICINE GYNAEC SCAN COMPLEX 3D - FETAL PFET016 Procedure 6420 6740 8030 9310 COMPLEX MEDICINE FETAL PFET073 TRIMESTER SCAN MID - TRIPLETS Procedure 6420 6740 8030 9310 MEDICINE FETAL PFET052 AMNIOCENTESIS - C Procedure 7390 7760 9230 10710 MEDICINE FETAL PFET065 SONOHYSTEROGRAM Procedure 7390 7760 9230 10710 MEDICINE FETAL PFET037 TRIMESTER SCAN - 3D/4D - A Procedure 7650 8030 9560 11090 MEDICINE FETAL PFET054 CHORION VILLUS SAMPLING - B Procedure 9300 9760 11620 13480 MEDICINE FETAL PFET056 CORDOCENTESIS - B Procedure 9570 10050 11960 13880 MEDICINE FETAL PFET066 SONOHYSTEROGRAM WITH CD Procedure 9570 10050 11960 13880 MEDICINE FETAL PFET067 SONOSALPINGOGRAM Procedure 9570 10050 11960 13880 MEDICINE FETAL PFET069 CYST ASPIRATION Procedure 10110 10620 12640 14660 MEDICINE

31 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup FETAL PFET038 TRIMESTER SCAN - 3D/4D - B Procedure 10670 11200 13330 15460 MEDICINE FETAL PFET057 FETAL REDUCTION - LEVEL1 Procedure 11480 12060 14350 16650 MEDICINE FETAL PFET062 INTRAUTERINE TRANSFUSION -LEVEL1 Procedure 11760 12350 14700 17050 MEDICINE FETAL PFET058 FETAL REDUCTION - LEVEL2 Procedure 17080 17940 21350 24770 MEDICINE FETAL PFET063 INTRAUTERINE TRANSFUSION -LEVEL2 Procedure 17760 18650 22200 25750 MEDICINE FETOSCOPIC CORD COAGULATION - FETAL PFET075 Procedure 20500 21520 25620 29720 LEVEL 1 MEDICINE FETAL PFET059 FETAL REDUCTION - LEVEL3 Procedure 21180 22240 26470 30700 MEDICINE FETAL PFET064 INTRAUTERINE TRANSFUSION -LEVEL3 Procedure 23230 24400 29040 33690 MEDICINE FETOSCOPIC CORD COAGULATION - FETAL PFET076 Procedure 31420 32990 39280 45560 LEVEL 2 MEDICINE FETAL PFET077 LASER ABLATION - LEVEL 1 Procedure 31420 32990 39280 45560 MEDICINE FETAL PFET078 LASER ABLATION - LEVEL 2 Procedure 42360 44480 52950 61420 MEDICINE BARTHOLINS ABSCESS DRAINAGE LOBG001 L1 Surgery OBG SURGERY 0 4500 5360 6220 (OBG) # L1 Bartholin's cyst excision / LOBG015 L1 Surgery OBG SURGERY 0 4500 5360 6220 marsupialisation (OBG) # L1 LOBG002 BIOPSY VAGINAL (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG003 CAUTERISATION UNDER LA (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG005 CERVICAL CAUTERISATION (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG014 Cervical dilatation (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 CERVICAL POLYPECTOMY/BIOPSY (OBG) LOBG004 L1 Surgery OBG SURGERY 0 4500 5360 6220 # L1 COLPOSCOPY WITH/WITH OUT CERVIX LOBG006 L1 Surgery OBG SURGERY 0 4500 5360 6220 BIOPSY (OBG) # L1 LOBG013 Cryosurgery (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 EUA (AS SOLE PROCEDURE) WITH/WITH LOBG007 L1 Surgery OBG SURGERY 0 4500 5360 6220 OUT ABSCESS DRAINAGE (OBG) # L1 LOBG008 IUCD INSERTION (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG009 IUCD REMOVAL (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG010 MIRENA INSERTION (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG012 Multiload Insertion (OBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG011 VAGINAL DILATATIONS (LOBG) # L1 L1 Surgery OBG SURGERY 0 4500 5360 6220 LOBG029 AMPUTATION OF CERVIX (OBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380

32 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup LOBG021 CERVICAL ENCIRCLAGE (OBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380 CERVICAL / VAGINAL TEAR REPAIR LOBG016 L2 Surgery OBG SURGERY 0 8240 9810 11380 (LOBG) # L2 Diagnostic hysteroscopy (As Sole LOBG026 L2 Surgery OBG SURGERY 0 8240 9810 11380 Procedure) (OBG) # L2 DILATATION & CURETTAGE WITH LOBG025 L2 Surgery OBG SURGERY 0 8240 9810 11380 MIRENA INSERTION (OBG) # L2 FENTONS/HYMENECTOMY OPERATION LOBG017 L2 Surgery OBG SURGERY 0 8240 9810 11380 (OBG) # L2 Hysteroscopic Removal of IUCD (OBG) LOBG027 L2 Surgery OBG SURGERY 0 8240 9810 11380 # L2 Hysteroscopy and cervical biopsy (OBG) LOBG028 L2 Surgery OBG SURGERY 0 8240 9810 11380 # L2 MANUAL REMOVAL OF PLACENTA (OBG) LOBG031 L2 Surgery OBG SURGERY 0 8240 9810 11380 # L2 PERINEAL TEAR REPAIR - 2ND DEGREE LOBG018 L2 Surgery OBG SURGERY 0 8240 9810 11380 (OBG) # L2 REMOVAL OF VAGINAL CYSTS (LOBG) LOBG019 L2 Surgery OBG SURGERY 0 8240 9810 11380 # L2 LOBG020 SECONDARY SUTURE (LOBG) # L2 L2 Surgery OBG SURGERY 0 8240 9810 11380 LOBG030 CONISATION OF CERVIX (OBG) # L3 L3 Surgery OBG SURGERY 0 10820 12880 14940 Hysteroscopy with D & C with or LOBG034 L3 Surgery OBG SURGERY 0 10820 12880 14940 without cervical biopsy (OBG) # L3 PERINEAL TEAR REPAIR - 3RD DEGREE LOBG032 L3 Surgery OBG SURGERY 0 10820 12880 14940 (OBG) # L3 TUBECTOMY - OPEN (AS SOLE LOBG033 L3 Surgery OBG SURGERY 0 10820 12880 14940 PROCEDURE) (OBG) # L3 LOBG052 Hysteroscopic polypectomy (LOBG) # L4 L4 Surgery OBG SURGERY 0 12350 14700 17060 Suction evacuation molar pregnancy LOBG135 L4 Surgery OBG SURGERY 0 13700 16310 18910 # L4 LOBG044 Anterior Colporraphy (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 Diagnostic Hysterolaparoscopy +/- CPT LOBG050 L4 Surgery OBG SURGERY 0 14790 17610 20420 (OBG) # L4 Diagnostic laparoscopy with/without LOBG043 chromopertubation/D & C/Drilling (OBG) L4 Surgery OBG SURGERY 0 14790 17610 20420 # L4 DIAGNOSTIC LAPAROTOMY WITH/ LOBG038 WITHOUT LAVAGE/BIOPSY (AS SOLE L4 Surgery OBG SURGERY 0 14790 17610 20420 PROCEDURE) (OBG) # L4 Hysteroscopic Myomectomy (LOBG) LOBG051 L4 Surgery OBG SURGERY 0 14790 17610 20420 # L4 Hysteroscopic Resection of LOBG054 L4 Surgery OBG SURGERY 0 14790 17610 20420 endometrium (OBG) # L4 Hysteroscopic Resection of fibroid polyp LOBG053 L4 Surgery OBG SURGERY 0 14790 17610 20420 (OBG) # L4

33 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup Hysteroscopic Resection of Synechae LOBG055 L4 Surgery OBG SURGERY 0 14790 17610 20420 (OBG) # L4 Hysteroscopic septum resection (OBG) LOBG056 L4 Surgery OBG SURGERY 0 14790 17610 20420 # L4 LAPAROTOMY ADHESIOLYSIS (AS SOLE LOBG037 L4 Surgery OBG SURGERY 0 14790 17610 20420 PROCEDURE) (OBG) # L4 LOBG035 LAP OVARIAN BIOPSY (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 LOBG036 LAP STERILISATION + MTP (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 LOBG046 Perineal floor repair (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 LOBG045 Posterior Colporraphy (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 Sacropinous fixation Unilateral (OBG) LOBG047 L4 Surgery OBG SURGERY 0 14790 17610 20420 # L4 SALPHINGO-OOPHERECTOMY LOBG039 L4 Surgery OBG SURGERY 0 14790 17610 20420 UNILATERAL - OPEN (LOBG) # L4 SALPHINGO-OOPHERECTOMY LOBG128 L4 Surgery OBG SURGERY 0 14790 17610 20420 UNILATERAL - OPEN (OBG) # L4 Salpingo oophorectomy Unilateral / LOBG049 L4 Surgery OBG SURGERY 0 14790 17610 20420 Bilateral - Laparoscopic (OBG) # L4 SCAR ENDOMETRIOSIS WIDE EXCISION LOBG040 L4 Surgery OBG SURGERY 0 14790 17610 20420 (OBG) # L4 LOBG042 TUBOPLASTY UNILATERAL (OBG) # L4 L4 Surgery OBG SURGERY 0 14790 17610 20420 LOBG057 ABDOMINAL CERVICOPEXY (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 Diagnostic Hysterolaparoscopy + LOBG089 L5 Surgery OBG SURGERY 0 18010 21440 24870 drilling (OBG) # L5 LOBG058 FOTHERGILLS OPERATION (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 Hysterolaparoscopy and adhesiolysis LOBG091 L5 Surgery OBG SURGERY 0 18010 21440 24870 and/or CPT (OBG) # L5 Hysterolaparoscopy and cystectomy LOBG090 L5 Surgery OBG SURGERY 0 18010 21440 24870 and\or CPT (OBG) # L5 Hysteroscopic Resection of polyp with LOBG092 L5 Surgery OBG SURGERY 0 18010 21440 24870 endometrial curettage (OBG) # L5 LOBG077 Laparoscopic Circlage (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 Laparoscopic myomectomy Single LOBG074 L5 Surgery OBG SURGERY 0 18010 21440 24870 (OBG) # L5 Laparoscopic ovarian cystectomy (OBG) LOBG070 L5 Surgery OBG SURGERY 0 18010 21440 24870 # L5 LAPAROSCOPIC SALPHINGO- LOBG061 L5 Surgery OBG SURGERY 0 18010 21440 24870 OOPHERECTOMY (UL/BL) (OBG) # L5 Laparoscopy adhesiolysis with/without LOBG069 L5 Surgery OBG SURGERY 0 18010 21440 24870 biopsy (As Sole Procedure) (OBG) # L5 Laparoscopy for ovarian fixation (OBG) LOBG073 L5 Surgery OBG SURGERY 0 18010 21440 24870 # L5 Laparoscopy for ovarian torsion (OBG) LOBG071 L5 Surgery OBG SURGERY 0 18010 21440 24870 # L5

34 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup Laparoscopy for ruptured ovarian cyst LOBG072 L5 Surgery OBG SURGERY 0 18010 21440 24870 (OBG) # L5 LOBG075 Laparoscopy for TO MASS (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LAPAROTOMY ECTOPIC GESTATION LOBG062 L5 Surgery OBG SURGERY 0 18010 21440 24870 (OBG) # L5 Laparotomy for Ovarian cyst torsion LOBG085 L5 Surgery OBG SURGERY 0 18010 21440 24870 (OBG) # L5 LAPAROTOMY + OVARIAN LOBG059 L5 Surgery OBG SURGERY 0 18010 21440 24870 CYSTECTOMY (OBG) # L5 LAPAROTOMY + SALPHINGECTOMY LOBG060 L5 Surgery OBG SURGERY 0 18010 21440 24870 (UL/BL) (OBG) # L5 Lap ectopic unruptured / ruptured LOBG068 L5 Surgery OBG SURGERY 0 18010 21440 24870 (OBG) # L5 LOBG083 Mesh repair Anterior (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG084 Mesh repair Posterior (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG048 Myomectomy - OPEN (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG082 NDVH (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 SALPHINGO-OOPHERECTOMY LOBG063 L5 Surgery OBG SURGERY 0 18010 21440 24870 BILATERAL - OPEN (OBG) # L5 SCAR ENDOMETRIOSIS WIDE EXCISION LOBG064 L5 Surgery OBG SURGERY 0 18010 21440 24870 AND MESH REPAIR (OBG) # L5 Surgery for Ectopic pregnancy (OBG) LOBG088 L5 Surgery OBG SURGERY 0 18010 21440 24870 # L5 LOBG087 Surgery for TO Mass (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 TAH with/with out adhesiolysis (OBG) LOBG079 L5 Surgery OBG SURGERY 0 18010 21440 24870 # L5 LOBG131 TOT Sling Procedure (URO-OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG130 TVT Sling Procedure (URO-OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG081 Vaginal hysterectomy (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG066 VULVECTOMY SIMPLE (OBG) # L5 L5 Surgery OBG SURGERY 0 18010 21440 24870 LOBG095 LSCS WITH TUBECTOMY (LOBG) # L5B L5B Surgery OBG SURGERY 0 21870 26030 30200 INTERNAL ILIAC ARTERY LIGATION - LOBG129 L6 Surgery OBG SURGERY 0 23160 27570 31980 BILATERAL (SS) (OBG) # L6 SACROCOLPOPEXY - OPEN (SS) (OBG) LOBG105 L6 Surgery OBG SURGERY 0 23160 27570 31980 # L6 LOBG094 VVF REPAIR (SS) (OBG) # L6 L6 Surgery OBG SURGERY 0 23160 27570 31980 LOBG076 Burch colpo suspension (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LOBG097 Classical Caesarian Section (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 Hysteroscopic Myomectomy under LAP LOBG114 L6 Surgery OBG SURGERY 0 27010 32150 37290 guidance (OBG) # L6 Laparoscopic myomectomy multiple LOBG103 L6 Surgery OBG SURGERY 0 27010 32150 37290 (OBG) # L6

35 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup LOBG098 LSCS for TWINS (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LSCS @ MICU / pre or post MICU (OBG) LOBG102 L6 Surgery OBG SURGERY 0 27010 32150 37290 # L6 LOBG100 LSCS + myomectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LOBG099 LSCS + ovarian cystectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LSCS + PPH + B Lynch/Internal illiac LOBG096 L6 Surgery OBG SURGERY 0 27010 32150 37290 artery ligation (OBG) # L6 Myomectomy MULTIPLE - OPEN (OBG) LOBG086 L6 Surgery OBG SURGERY 0 27010 32150 37290 # L6 Sacropinous fixation bilateral (OBG) # LOBG113 L6 Surgery OBG SURGERY 0 27010 32150 37290 L6 LOBG101 Surgery for ruptured uterus (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 TAH + bilateral salpingectomy/ LOBG106 L6 Surgery OBG SURGERY 0 27010 32150 37290 Salphingo-oopherectomy (OBG) # L6 LOBG107 TAH + cystectomy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LOBG109 TAH + cystocele repair (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LOBG108 TAH + sacrocolpopexy (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 LOBG065 TUBOPLASTY BILATERAL (OBG) # L6 L6 Surgery OBG SURGERY 0 27010 32150 37290 Vaginal Hysterectomy with AP repair LOBG110 L6 Surgery OBG SURGERY 0 27010 32150 37290 (OBG) # L6 Vaginal hysterectomy with LOBG112 L6 Surgery OBG SURGERY 0 27010 32150 37290 Sacrospinous fixation (OBG) # L6 Vaginal hysterectomy with SO (OBG) LOBG111 L6 Surgery OBG SURGERY 0 27010 32150 37290 # L6 VAULT PROLAPSE OPERATION LOBG093 - SACROSPINOUS FIXATION - L6 Surgery OBG SURGERY 0 27010 32150 37290 UNILATERAL (OBG) # L6 HYSTERECTOMY (LOBG) [RS 5 days LOBG027RS LR Surgery OBG SURGERY 0 29590 35220 40850 Package] # LR MYOMECTOMY (LOBG) [RS 5 days LOBG061RS LR Surgery OBG SURGERY 0 29590 35220 40850 Package] # LR SACROCOLPOPEXY - (LOBG) (RS 5 days LOBG001RS LR Surgery OBG SURGERY 0 29590 35220 40850 Package) # LR SACROCOLPOPEXY - LAPAROSCOPIC LOBG120 L7 Surgery OBG SURGERY 0 30860 36740 42620 (SS) (OBG) # L7 Laparoscopic BURCH Coloposuspension LOBG133 L7 Surgery OBG SURGERY 0 36010 42870 49730 (OBG) # L7 Laparoscopic surgery for endometriosis LOBG119 L7 Surgery OBG SURGERY 0 36010 42870 49730 (OBG) # L7 LOBG118 OBSTETRIC HYSTERECTOMY # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730 LOBG115 RVF REPAIR (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730 LOBG116 SCHAUTA'S OPERATION (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730

36 Obstetrics & Gynaecology

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup TAH + BS/BSO + sacrocolpopexy (OBG) LOBG121 L7 Surgery OBG SURGERY 0 36010 42870 49730 # L7 LOBG122 TAH + omentectomy , PLND (OBG) # L7 L7 Surgery OBG SURGERY 0 36010 42870 49730

Unification procedure for septate uterus LOBG123 L7 Surgery OBG SURGERY 0 36010 42870 49730 (OBG) # L7

VAULT PROLAPSE OPERATION - LOBG117 SACROSPINOUS FIXATION - BILATERAL L7 Surgery OBG SURGERY 0 36010 42870 49730 (OBG) # L7

LAP ASSISTED VAGINAL LOBG078 L6 Surgery OBG SURGERY 0 38140 41960 45770 HYSTERECTOMY (LAVH) (OBG) # L6

WERTHIM'S HYSTRECTOMY RADICAL LOBG126 L8 Surgery OBG SURGERY 0 38580 45930 53280 (SS) (OBG) # L8

LOBG124 VAGINOPLASTY (LOBG) # L8 L8 Surgery OBG SURGERY 0 45010 53580 62150

LOBG125 PELVIC EXTENTERATION (SS) (OBG) # L9 L9 Surgery OBG SURGERY 0 46300 55120 63930

37 Paediatrics

38 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC PPDE001 DASII SCALE Procedure 2870 3010 3580 4160 DEVELOPMENT PAEDIATRIC PPDE002 CAT / CLAMS Procedure 2330 2440 2910 3370 DEVELOPMENT PAEDIATRIC PPDE003 MCHAT Procedure 1040 1090 1300 1510 DEVELOPMENT PAEDIATRIC PPDE004 CARS Procedure 1180 1240 1470 1710 DEVELOPMENT PAEDIATRIC PPDE005 ADHD Procedure 1910 2010 2390 2770 DEVELOPMENT PAEDIATRIC PPDE006 INFANIB SCALE Procedure 820 860 1030 1190 DEVELOPMENT AGES & STAGES DEVELOPMENTAL PAEDIATRIC PPDE007 Procedure 1650 1730 2060 2390 SCREENING DEVELOPMENT PAEDIATRIC LPSR001 EUA (AS SOLE PROCEDURE) (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR002 CYSTOSCOPY-DIAGNOSTIC (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR003 GENITOGRAM UNDER GA (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY INTERCOSTAL TUBE DRAINAGE (PSR) PAEDIATRIC LPSR004 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY PAEDIATRIC LPSR005 MUSCLE BIOPSY (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR006 ON TABLE M C U (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR007 DJ STENT REMOVAL (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR008 CENTRAL LINE REMOVAL (PSR) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY PAEDIATRIC LPSR009 Chemoport removal (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR010 INCISION AND DRAINAGE (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR011 LYMPH NODE BIOPSY-S (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR012 SKIN GRAFTING SIMPLE (LPSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR013 SKIN SUTURING (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY SUTURING OF MINOR INJURIES (PSR) PAEDIATRIC LPSR014 L2 Surgery 0 8240 9810 11380 # L2 SURGERY PAEDIATRIC LPSR015 TONGUE TIE RELEASE (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR016 wedge excision toe nail (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY

39 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC LPSR017 CIRCUMCISION (LPSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR018 CYSTOSCOPY DYE STUDY (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR019 LABIAL SEPERATION (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR020 MEATOPLASTY (LPSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY COLECTOMY TOTAL (LPSR) [RS 10 PAEDIATRIC LPSR020RS LR Surgery 0 29590 35220 40850 days Package] # LR SURGERY PAEDIATRIC LPSR021 NEONATAL CIRCUMCISION (PSR) # L3 L3 Surgery 0 10820 12880 14940 SURGERY PAEDIATRIC LPSR022 RECTAL BIOPSY (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR023 RECTAL POLYP EXCISION (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY PAEDIATRIC LPSR024 SUPRPUBIC CYSTOSTOMY (PSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY ACCESSORY FINGER OR TOE EXCISION PAEDIATRIC LPSR025 L2 Surgery 0 8240 9810 11380 (PSR) # L2 SURGERY MAJOR WOUND DEBRIDEMENT (PSR) PAEDIATRIC LPSR026 L3 Surgery 0 10820 12880 14940 # L3 SURGERY PAEDIATRIC LPSR027 CYST EXCISION (PSR) # L3 L3 Surgery 0 10820 12880 14940 SURGERY FULL/PARTIAL THICKNESS RECTAL PAEDIATRIC LPSR028 L3 Surgery 0 10820 12880 14940 BIOPSY (PSR) # L3 SURGERY HERNIOTOMY INGUINAL/FEMORAL -UL PAEDIATRIC LPSR029 L3 Surgery 0 10820 12880 14940 - (PEDIATRIC) (PSR) # L3 SURGERY PAEDIATRIC LPSR030 INFANT HERNIA -UL (PSR) # L3 L3 Surgery 0 10820 12880 14940 SURGERY SKIN GRAFTING INTERMEDIATE (LPSR) PAEDIATRIC LPSR031 L3 Surgery 0 10820 12880 14940 # L3 SURGERY THIERSCHS WIRING FOR RECTALSE PAEDIATRIC LPSR032 L3 Surgery 0 10820 12880 14940 (PSR) # L3 SURGERY BRONCHOSCOPY- DIAGNOSTIC WITH PAEDIATRIC LPSR033 L3 Surgery 0 10820 12880 14940 OR WITHOUT BIOPSY (PSR) # L3 SURGERY GASTROSTOMY/JEJUNOSTOMY (PSR) PAEDIATRIC LPSR034 L3 Surgery 0 10820 12880 14940 # L3 SURGERY PAEDIATRIC LPSR035 TRACHEOSTOMY (LPSR) # L3 L3 Surgery 0 10820 12880 14940 SURGERY PAEDIATRIC LPSR036 CENTRAL LINE INSERTION (PSR) # L3 L3 Surgery 0 10820 12880 14940 SURGERY 'HERNIA SIMPLE UMBLICAL, EPI (LPSR) PAEDIATRIC LPSR037 L4 Surgery 0 14790 17610 20420 ' # L4 SURGERY HYPOSPADIAS FISTULA CLOSURE PAEDIATRIC LPSR038 L4 Surgery 0 14790 17610 20420 (PSR) # L4 SURGERY

40 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PRE-AURICULAR SINUS EXCISION PAEDIATRIC LPSR039 L4 Surgery 0 14790 17610 20420 (PSR) # L4 SURGERY SYNDACTYLY RELEASE UNILATERAL PAEDIATRIC LPSR040 L4 Surgery 0 14790 17610 20420 (PSR) # L4 SURGERY PAEDIATRIC LPSR041 APPENDICECTOMY - OPEN (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY BRONCHOSCOPY + BRANCHOGRAM PAEDIATRIC LPSR042 L4 Surgery 0 14790 17610 20420 (PSR) # L4 SURGERY BRONCHOSCOPY + FB REMOVAL (PSR) PAEDIATRIC LPSR043 L4 Surgery 0 14790 17610 20420 # L4 SURGERY GASTRECTOMY RADICAL (LPSR) [RS PAEDIATRIC LPSR043RS LR Surgery 0 29590 35220 40850 10 days Package] # LR SURGERY CHEMOPORT/HICKMAN CATHETER PAEDIATRIC LPSR044 L4 Surgery 0 14790 17610 20420 INSERTION (PSR) # L4 SURGERY PAEDIATRIC LPSR045 CYSTOSCOPY DEFLUX INJ. (PSR) # L5 L5 Surgery 0 8370 9200 10040 SURGERY PAEDIATRIC LPSR046 CYSTOSCOPY PUV FULG (PSR) # L5 L5 Surgery 0 8370 9200 10040 SURGERY LAPAROTOMY ADHESIOLYSIS - SOLE PAEDIATRIC LPSR047 L4 Surgery 0 14790 17610 20420 PROCEDURE (PSR) # L4 SURGERY ORCHIDOPEXY UNILATERAL (LPSR) PAEDIATRIC LPSR048 L4 Surgery 0 14790 17610 20420 # L4 SURGERY ORCHIDOPEXY-SF-II-UNILATERAL PAEDIATRIC LPSR049 L5 Surgery 0 18010 21440 24870 (PSR) # L5 SURGERY ORCHIDOPEXY-SF-I-UNILATERAL (PSR) PAEDIATRIC LPSR050 L4 Surgery 0 14790 17610 20420 # L4 SURGERY ORCHIDECTOMY UNILATERAL (PSR) PAEDIATRIC LPSR051 L4 Surgery 0 14790 17610 20420 # L4 SURGERY PERIANAL FISTULA EXCISION (PSR) PAEDIATRIC LPSR052 L4 Surgery 0 14790 17610 20420 # L4 SURGERY PAEDIATRIC LPSR053 SKIN GRAFTING MAJOR (LPSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY STERNOMASTOID TENOTOMY (PSR) PAEDIATRIC LPSR054 L4 Surgery 0 14790 17610 20420 # L4 SURGERY PAEDIATRIC LPSR055 SURGERY OF RANULA (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY PAEDIATRIC LPSR056 VESICOSTOMY (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY PAEDIATRIC LPSR057 VESICOSTOMY CLOSURE (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY CUTANEOUS URETEROSTOMY PAEDIATRIC LPSR058 L4 Surgery 0 14790 17610 20420 UNILATERAL (LPSR) # L4 SURGERY CUT-URETEROSTOMY CLOSURE - PAEDIATRIC LPSR059 L4 Surgery 0 14790 17610 20420 UNILATERAL (PSR) # L4 SURGERY HERNIOTOMY -INGUINAL/FEMORAL PAEDIATRIC LPSR060 L4 Surgery 0 14790 17610 20420 -BL (PSR) # L4 SURGERY

41 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC LPSR061 ANOPLASTY (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY PAEDIATRIC LPSR062 HYPOSPADIAS - CHORDEE (PSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY MULTIPLE ACCESSORY FINGERS PAEDIATRIC LPSR063 L4 Surgery 0 14790 17610 20420 EXCISION (PSR) # L4 SURGERY PAEDIATRIC LPSR064 INFANT HERNIA - BL (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY PAEDIATRIC LPSR065 ORCHIDECTOMY RADICAL (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY ORCHIDECTOMY UNILATERAL - PAEDIATRIC LPSR066 L5 Surgery 0 18010 21440 24870 LAPAROSCOPIC (PSR) # L5 SURGERY SUBMANDIBULAR GLAND EXCISION PAEDIATRIC LPSR067 L5 Surgery 0 18010 21440 24870 (LPSR) # L5 SURGERY SUPRAPUBIC CYSTOLITHOTOMY PAEDIATRIC LPSR068 L5 Surgery 0 18010 21440 24870 INCLUDING CYSTOSCOPY (PSR) # L5 SURGERY BRANCHIAL/THYROGLASSAL FISTULA PAEDIATRIC LPSR069 L5 Surgery 0 18010 21440 24870 EXCISION (PSR) # L5 SURGERY CERVICAL ESOPHAGOSTOMY (PSR) PAEDIATRIC LPSR070 L5 Surgery 0 18010 21440 24870 # L5 SURGERY PAEDIATRIC LPSR071 CLITOROPLASTY (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY PAEDIATRIC LPSR072 COLOSTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY COLOSTOMY CLOSURE/REVISION PAEDIATRIC LPSR073 L5 Surgery 0 18010 21440 24870 (LPSR) # L5 SURGERY LAPROTOMY OP CHOLANGIO (PSR) PAEDIATRIC LPSR074 L5 Surgery 0 18010 21440 24870 # L5 SURGERY LYMPHATIC CYST EXCISION MINOR PAEDIATRIC LPSR075 L5 Surgery 0 18010 21440 24870 (PSR) # L5 SURGERY PAEDIATRIC LPSR076 MAJOR SKIN GRAFTING (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY PAEDIATRIC LPSR077 ORCHIDOPEXY BILATERAL (LPSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY ORCHIDOPEXY-SF-I-BILATERAL (PSR) PAEDIATRIC LPSR078 L5 Surgery 0 18010 21440 24870 # L5 SURGERY ORCHIDOPEXY-SF-II-BILATERAL (PSR) PAEDIATRIC LPSR079 L5B Surgery 0 21870 26030 30200 # L5B SURGERY PAEDIATRIC LPSR080 PYLOROMYOTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY RECTAL PROLAPSE SURGERY (PSR) PAEDIATRIC LPSR081 L5 Surgery 0 18010 21440 24870 # L5 SURGERY SYNDACTYLY RELEASE BILATERAL PAEDIATRIC LPSR082 L5 Surgery 0 18010 21440 24870 (PSR) # L5 SURGERY PAEDIATRIC LPSR083 UMBILICAL EXPLORATION (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY

42 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC LPSR084 URETEROLITHOTOMY (LPSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY CYSTOSCOPY URETROCOLE WITH OR PAEDIATRIC LPSR085 WITHOUR URETERIC REIMPLANTATION L5 Surgery 0 8370 9200 10040 SURGERY - UNILATERAL (PSR) # L5 PAEDIATRIC LPSR086 HYPOSPADIAS - MATHIEU (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY HYPOSPADIAS - SNODGRASS (PSR) PAEDIATRIC LPSR087 L5B Surgery 0 21870 26030 30200 # L5B SURGERY HYPOSPADIAS 2ND STG PAEDIATRIC LPSR088 L5B Surgery 0 21870 26030 30200 URETHROPLASTY (PSR) # L5B SURGERY PAEDIATRIC LPSR089 LAP APPENDICECTOMY (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY PAEDIATRIC LPSR090 ORCHIDECTOMY BILATERAL (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY PAEDIATRIC LPSR091 CUT BACK VAGINOPLASTY (PSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY CYSTOSCOPY URETROCOLE WITH OR PAEDIATRIC LPSR092 WITHOUR URETERIC REIMPLANTATION L5 Surgery 0 18010 21440 24870 SURGERY - BILATERAL (PSR) # L5 PAEDIATRIC LPSR093 LAP SPLEENECTOMY (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY PAEDIATRIC LPSR094 SPLENECTOMY - OPEN (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY URETERIC REIMPLANTATION PAEDIATRIC LPSR095 L6 Surgery 0 27010 32150 37290 UNILATERAL (PSR) # L6 SURGERY ADRENELECTOMY UNILATERAL (LPSR) PAEDIATRIC LPSR096 L6 Surgery 0 27010 32150 37290 # L6 SURGERY PAEDIATRIC LPSR097 BLADDER NECK REPAIR (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY CUTANEOUS URETEROSTOMY PAEDIATRIC LPSR098 L6 Surgery 0 27010 32150 37290 BILATERAL (LPSR) # L6 SURGERY CUT-URETEROSTOMY CLOSURE - PAEDIATRIC LPSR099 L6 Surgery 0 27010 32150 37290 BILATERAL (PSR) # L6 SURGERY GASTRIC BYPASS PAEDIATRIC LPSR100 GASTROJEJJUNOYLOROPLASTY (PSR) L6 Surgery 0 27010 32150 37290 SURGERY # L6 PAEDIATRIC LPSR101 PYELOPLASTY - INFANT (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY PAEDIATRIC LPSR102 MAGPI (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY CYSTIC HYGROMA EXCISION - SMALL PAEDIATRIC LPSR103 L6 Surgery 0 27010 32150 37290 (PSR) # L6 SURGERY NEPHRECTOMY SIMPLE/BENIGN - PAEDIATRIC LPSR104 L5 Surgery 0 18010 21440 24870 UNILATERAL - SPSR (PSR) # L5 SURGERY ORCHIDECTOMY BILATERAL - PAEDIATRIC LPSR105 L6 Surgery 0 27010 32150 37290 LAPAROSCOPIC (PSR) # L6 SURGERY

43 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC LPSR106 PYELOPLASTY (LPSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY REPAIR OF MYELOMENIGOCELE (PSR) PAEDIATRIC LPSR107 L6 Surgery 0 27010 32150 37290 # L6 SURGERY PAEDIATRIC LPSR108 THYROIDECTOMY PARTIAL (LPSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY PAEDIATRIC LPSR109 URETEROURETEROSTOMY (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY URTEROCELE UNILATERAL EXCISION PAEDIATRIC LPSR110 L6 Surgery 0 27010 32150 37290 (PSR) # L6 SURGERY VATS VIDEO ASSISTED PAEDIATRIC LPSR111 THORACOSCOPY SURGERY (LPSR) # L6 Surgery 0 27010 32150 37290 SURGERY L6 PAEDIATRIC LPSR112 COLECTOMY PARTIAL (LPSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY REPAIR OF EXAMPHALOS MINOR (PSR) PAEDIATRIC LPSR113 L6 Surgery 0 27010 32150 37290 # L6 SURGERY PAEDIATRIC LPSR114 ANAL TRANSPOSITION (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY HERNIA COMPLICATED DIAPH/ PAEDIATRIC LPSR115 L6 Surgery 0 27010 32150 37290 REGIONAL/HIATUS (PSR) # L6 SURGERY PAEDIATRIC LPSR116 OVARIAN TUMOURS (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY THORACOTOMY DECORTICATION (PSR) PAEDIATRIC LPSR117 L6 Surgery 0 27010 32150 37290 # L6 SURGERY PAEDIATRIC LPSR118 KASAIS PROCEDURE (PSR) # L6 L6 Surgery 0 27010 32150 37290 SURGERY CONDUIT OPERATIONS - Construction PAEDIATRIC LPSR119 of ileal conduit including ureteric L7 Surgery 0 36010 42870 49730 SURGERY implantation (LPSR) # L7 CYSTIC HYGROMA EXCISION - LARGE PAEDIATRIC LPSR120 L7 Surgery 0 36010 42870 49730 (PSR) # L7 SURGERY PAEDIATRIC LPSR121 NEPHROURETERECTOMY (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR122 PENAS OPERATION (PSARP) (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY REPAIR OF EXTROPHY OF BLADDER (I/ PAEDIATRIC LPSR123 L7 Surgery 0 36010 42870 49730 II) (PSR) # L7 SURGERY PAEDIATRIC LPSR124 THYROIDECTOMY TOTAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY BILATERAL URETEROCELE EXCISION PAEDIATRIC LPSR125 L7 Surgery 0 36010 42870 49730 (PSR) # L7 SURGERY CHOLEDOCHEL CYST EXCISION (LPSR) PAEDIATRIC LPSR126 L7 Surgery 0 36010 42870 49730 # L7 SURGERY PAEDIATRIC LPSR127 EPISPADIAS REPAIR STAGE I (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY

44 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup EPISPADIAS REPAIR STAGE II (LPSR) PAEDIATRIC LPSR128 L7 Surgery 0 36010 42870 49730 # L7 SURGERY PAEDIATRIC LPSR129 GASTRECTOMY PARTIAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR130 MAJOR Z-PLASTY (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR131 NEPHRECTOMY RADICAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR132 RADICAL PAROTIDECTOMY (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR133 REPAIR OF GASTROSCHISIS (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY RETROPERITONEAL TUMOR EXCISION PAEDIATRIC LPSR134 L7 Surgery 0 36010 42870 49730 (PSR) # L7 SURGERY SURGERY OF BLADDER EXTEROPHY PAEDIATRIC LPSR135 L7 Surgery 0 36010 42870 49730 (TOT. CORR) (PSR) # L7 SURGERY SURGERY OF EXOMPHALOS MAJOR PAEDIATRIC LPSR136 L7 Surgery 0 36010 42870 49730 (PSR) # L7 SURGERY SURGERY OF GASTROSCHISIS (TOTAL PAEDIATRIC LPSR137 L7 Surgery 0 36010 42870 49730 CORRECTION) (PSR) # L7 SURGERY URETERIC REIMPLANTATION PAEDIATRIC LPSR138 L7 Surgery 0 36010 42870 49730 BILATERAL (PSR) # L7 SURGERY URETHROPLASTY SINGLE STAGE PAEDIATRIC LPSR139 L7 Surgery 0 36010 42870 49730 (LPSR) # L7 SURGERY PAEDIATRIC LPSR140 COLECTOMY TOTAL (LPSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY PAEDIATRIC LPSR141 LADDS PRACEDURE (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY LAPAROTOMY INTESTINAL RESECTION PAEDIATRIC LPSR142 L7 Surgery 0 36010 42870 49730 (PSR) # L7 SURGERY PAEDIATRIC LPSR143 NISSENS FUNDOPLICATION (PSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY ADRENELECTOMY BILATERAL (PSR) PAEDIATRIC LPSR144 L8 Surgery 0 45010 53580 62150 # L8 SURGERY DEFINITIVE SURGERY FOR T E F (PSR) PAEDIATRIC LPSR145 L8 Surgery 0 45010 53580 62150 # L8 SURGERY PAEDIATRIC LPSR146 FEMINISING GENITOPLASTY (PSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY PAEDIATRIC LPSR147 GASTRECTOMY RADICAL (PSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY GASTRECTOMY TOTAL/SUBTOTAL PAEDIATRIC LPSR148 L8 Surgery 0 45010 53580 62150 (LPSR) # L8 SURGERY HIRSPRUNGS PULL THROUGH (PSR) PAEDIATRIC LPSR149 L8 Surgery 0 45010 53580 62150 # L8 SURGERY OESOPHAGEAL REPLACEMENT (PSR) PAEDIATRIC LPSR150 L8 Surgery 0 45010 53580 62150 # L8 SURGERY

45 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC LPSR151 THORACTOMY MED MASS (PSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY PAEDIATRIC LPSR152 VAGINOPLASTY (LPSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY LOBECTOMY/PNEUMONECTOMY (PSR) PAEDIATRIC LPSR153 L8 Surgery 0 45010 53580 62150 # L8 SURGERY PAEDIATRIC LPSR154 PANCREATECTOMY (PSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY SACROCOCCYGEAL TERATOMA PAEDIATRIC LPSR155 L8 Surgery 0 45010 53580 62150 EXCISION (PSR) # L8 SURGERY PAEDIATRIC LPSR156 PORTA SYSTEMATIC SHUNT (PSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY PAEDIATRIC LPSR157 HEPATECTOMY (PSR) # L9 L9 Surgery 0 54020 64300 74590 SURGERY SURGERY FOR CRANIOSYNOSTOSIS PAEDIATRIC LPSR158 L9 Surgery 0 54020 64300 74590 (PSR) # L9 SURGERY CIRCUMCISSION WITH HERNIA PAEDIATRIC LPSR160 L5B Surgery 0 21870 26030 30200 OPERATION (PSR) # L5B SURGERY PAEDIATRIC PPSR001 ARTERIAL LINE - PERIPHERAL - PSR Procedure SURGERY 900 950 1130 1310 PROCEDURE PAEDIATRIC PPSR002 ASCITIC TAP - PSR Procedure SURGERY 590 620 740 860 PROCEDURE PAEDIATRIC BIOPSY-1 LIVER,KIDNEY,PLEURA PPSR003 Procedure SURGERY 1180 1240 1470 1710 EXCLUDING HISTOLOGY & USC - PSR PROCEDURE PAEDIATRIC BIOPSY-2 FINE NEEDLE GLAND BIOPSY PPSR004 Procedure SURGERY 1100 1150 1370 1590 BONE MARROW - PSR PROCEDURE PAEDIATRIC PPSR005 BRONCHOSCOPY - FLEXIBLE Procedure SURGERY 5610 5890 7010 8130 PROCEDURE PAEDIATRIC PPSR006 CENTRAL LINE - PSR Procedure SURGERY 1510 1590 1890 2190 PROCEDURE PAEDIATRIC CONTINUOUS ARTERIO-VENOUS PPSR007 Procedure SURGERY 1510 1590 1890 2190 HAEMO-FILTRATI - PSR PROCEDURE PAEDIATRIC PPSR008 CRANIAL U/s - PSR Procedure SURGERY 610 640 770 890 PROCEDURE PAEDIATRIC PPSR009 DIALYSIS PERITONEAL - PSR Procedure SURGERY 6160 6470 7700 8930 PROCEDURE PAEDIATRIC ENDOTRACHEAL INTUBATION (NOT IN PPSR010 Procedure SURGERY 320 330 390 460 ICU) - PSR PROCEDURE

46 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC EXCHANGE TRANSFUSION EXCLUDING PPSR011 Procedure SURGERY 3560 3740 4450 5160 BLOOD,DRUGS,TUBES,SYR,OT - PSR PROCEDURE PAEDIATRIC PPSR012 EXCHANGE TRANSFUSION REPEAT Procedure SURGERY 2870 3010 3580 4160 PROCEDURE PAEDIATRIC PPSR013 HICKMAN REMOVAL - PSR Procedure SURGERY 2330 2440 2910 3370 PROCEDURE PAEDIATRIC INFUSION OF VASOACTIVE DRUGS - PPSR014 Procedure SURGERY 450 480 570 660 PSR PROCEDURE PAEDIATRIC PPSR015 INHALED NITRIC OXIDE - PSR Procedure SURGERY 3700 3880 4620 5360 PROCEDURE PAEDIATRIC PPSR017 INTERCOSTAL DRAINAGE - PSR Procedure SURGERY 1240 1300 1540 1790 PROCEDURE PAEDIATRIC PPSR018 LUMBAR PUNCTURE - PSR Procedure SURGERY 560 580 690 810 PROCEDURE PAEDIATRIC MISCELLANEOUS PROCEDURE - NOT PPSR019 Procedure SURGERY 640 670 800 920 IN ICU - PPSR PROCEDURE PAEDIATRIC PPSR020 MISCELLANEOUS PROCEDURE ICU Procedure SURGERY 590 620 740 860 PROCEDURE PAEDIATRIC MONITORS FOR 24 HRS OR LESS -NOT PPSR021 Procedure SURGERY 360 380 450 520 IN ICU - PPSR PROCEDURE PAEDIATRIC NEBULIZER FOR ASTHMA EXCL O2 & PPSR022 Procedure SURGERY 140 150 180 210 DRUGS (Is PROCEDURE PAEDIATRIC NEBULIZER FOR WHOLE DAY (MORE PPSR023 Procedure SURGERY 360 380 450 520 THAN 4 TREATMENTS) - PSR PROCEDURE PAEDIATRIC NEBULIZER TREATMENT FOR ASTHMA PPSR024 Procedure SURGERY 70 80 90 110 (REPEAT TREATMENT) PROCEDURE PAEDIATRIC NEONATAL CARE DURING ROP PPSR025 Procedure SURGERY 1100 1150 1370 1590 SURGERY - PSR PROCEDURE PAEDIATRIC PPSR026 NEONATAL HEARING TEST - PSR Procedure SURGERY 1910 2010 2390 2770 PROCEDURE PAEDIATRIC NEURODEVELOPMENT ASSESSMENT PPSR027 Procedure SURGERY 450 480 570 660 - PSR PROCEDURE

47 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC OBSERVATION NURSERY DAILY OR PPSR028 Procedure SURGERY 180 190 220 260 LESS CHARGES - PSR PROCEDURE PAEDIATRIC PPSR030 PICU INTENSIVE CHARGES - HIGH Procedure SURGERY 1300 1370 1630 1890 PROCEDURE PAEDIATRIC PPSR031 PICU INTENSIVE CHARGES - LOW Procedure SURGERY 960 1010 1200 1390 PROCEDURE PAEDIATRIC PLASMA PARTIAL EXCHANGE TRANS PPSR032 Procedure SURGERY 2190 2300 2740 3170 - PSR PROCEDURE PAEDIATRIC PPSR033 PLASMA PHERESIS - PSR Procedure SURGERY 2050 2150 2560 2970 PROCEDURE PAEDIATRIC PLEURAL PERICARDIAL/SUBDURAL/ PPSR034 Procedure SURGERY 1100 1150 1370 1590 VENTRICULAR TAPS - PSR PROCEDURE PAEDIATRIC PPSR035 RESPIRATORY THERAPY / WEEK - PSR Procedure SURGERY 1780 1860 2220 2570 PROCEDURE PAEDIATRIC PPSR036 RESUSCIATION - BABY CARE - LSCS Procedure SURGERY 2190 2300 2740 3170 PROCEDURE PAEDIATRIC PPSR037 RESUSCIATION - BABY CARE - ND Procedure SURGERY 1650 1730 2060 2390 PROCEDURE PAEDIATRIC PPSR038 SEDATION INTERMEDIATE - PSR Procedure SURGERY 1180 1240 1470 1710 PROCEDURE PAEDIATRIC PPSR039 SPIROMETRY - PAEDIATRIC - PPSR Procedure SURGERY 1180 1240 1470 1710 PROCEDURE PAEDIATRIC PPSR040 SUPRAPUBIC BLADDER TAP - PSR Procedure SURGERY 560 580 690 810 PROCEDURE PAEDIATRIC PPSR041 SURFACTANT THERAPY - PSR Procedure SURGERY 6020 6320 7520 8730 PROCEDURE PAEDIATRIC TOTAL PARENTRAL NUTRITION PPSR042 Procedure SURGERY 2330 2440 2910 3370 PLANNING & FORMULATION - PSR PROCEDURE PAEDIATRIC PPSR043 TRANSFUSION - PSR Procedure SURGERY 1100 1150 1370 1590 PROCEDURE PAEDIATRIC PPSR044 UMBILICAL ARTERIAL LINE - PSR Procedure SURGERY 1240 1300 1540 1790 PROCEDURE

48 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PAEDIATRIC PPSR045 UMBILICAL VENOUS LINE - PSR Procedure SURGERY 900 950 1130 1310 PROCEDURE PAEDIATRIC PPSR046 VENESECTION - PSR Procedure SURGERY 820 860 1030 1190 PROCEDURE PAEDIATRIC VENTILATION THERAPY - HI PPSR047 Procedure SURGERY 4510 4740 5640 6540 FREQUENCY - PSR PROCEDURE PAEDIATRIC PPSR048 WARMER TREATMENT - PSR Procedure SURGERY 140 150 180 210 PROCEDURE PAEDIATRIC PPSR049 HYDROSTATIC REDUCTION (PSR) Procedure SURGERY 10390 10910 12990 15060 PROCEDURE PPED001 ARTERIAL LINE PERIPHERAL Procedure PAEDIATRICS 780 810 970 1120 PPED002 ASCITIC TAP - PED Procedure PAEDIATRICS 510 540 640 740 BABY CARE CHARGES INCLUDING PPED003 Procedure PAEDIATRICS 130 140 160 190 ROOM AFTER DELIVERY/DAY BIOPSY-1 LIVER,KIDNEY,PLEURA PPED004 Procedure PAEDIATRICS 1180 1240 1470 1710 EXCLUDING HISTOLOGY & USC - PED BIOPSY-2 FINE NEEDLE GLAND BIOPSY PPED005 Procedure PAEDIATRICS 960 1010 1200 1390 BONE MARROW - PED PPED006 BRONCHOSCOPY FLEXIBLE - PED Procedure PAEDIATRICS 3790 3980 4730 5490 BRONCHOSCOPY FLEXIBLE - (W/O PPED007 Procedure PAEDIATRICS 4100 4300 5120 5940 SEDATION) BRONCHOSCOPY FLEXIBLE - (WITH PPED008 Procedure PAEDIATRICS 4240 4450 5290 6140 SEDATION) PPED009 CAUTERY OF UMBILICAL GRANULOMA Procedure PAEDIATRICS 210 220 260 310 PPED010 CENTRAL LINE - PED Procedure PAEDIATRICS 1340 1410 1670 1940 CONTINUOUS ARTERIO-VENOUS PPED011 Procedure PAEDIATRICS 1300 1370 1630 1890 HAEMO-FILTRATI - PED PPED012 CRANIAL U/S - PED Procedure PAEDIATRICS 430 450 540 620 PPED013 CYSTOSCOPY+RGP Procedure PAEDIATRICS 1370 1440 1720 1990 PPED014 CYSTOSCOPY-DIAGNOSTIC - PPED Procedure PAEDIATRICS 1040 1090 1300 1510 PPED015 CYSTOSCOPY-FULGURATION Procedure PAEDIATRICS 2870 3010 3580 4160 PPED016 DEV.ASST NICU GRADUATE Procedure PAEDIATRICS 420 440 520 610 PPED017 DEV.ASST PICU GRADUATE Procedure PAEDIATRICS 420 440 520 610 PPED018 DIALYSIS PERITONEAL - PED Procedure PAEDIATRICS 5580 5860 6980 8090 ENDOTRACHEAL INTUBATION (NOT IN PPED019 Procedure PAEDIATRICS 280 290 350 410 ICU) - PED PPED020 EXCHANGE TRANFUSIONS REPEAT Procedure PAEDIATRICS 2870 3010 3580 4160 EXCHANGE TRANSFUSION EXCLUDING PPED021 Procedure PAEDIATRICS 3250 3410 4060 4710 BLOOD,DRUGS,TUBES,SYR,OT - PED

49 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PPED022 HICKMAN REMOVAL - PED Procedure PAEDIATRICS 2330 2440 2910 3370 PPED023 HYDROSTATIC REDUCTION (PED) Procedure PAEDIATRICS 10390 10910 12990 15060 INFUSION OF VASOACTIVE DRUGS - PPED024 Procedure PAEDIATRICS 370 390 460 540 PED INFUSION PUMP (NOT IN ICU) 24 HRS PPED025 Procedure PAEDIATRICS 190 200 230 270 OR LES PPED026 INHALED NITRIC OXIDE - PED Procedure PAEDIATRICS 3240 3400 4040 4690 PPED028 INTERCOSTAL DRAINAGE - PED Procedure PAEDIATRICS 1120 1180 1400 1620 PPED029 LACTATION COUNSELING Procedure PAEDIATRICS 740 780 920 1070 PPED030 LUMBAR PUNCTURE - PED Procedure PAEDIATRICS 500 520 620 720 PPED031 MISCELLANEOUS PROCEDURE Procedure PAEDIATRICS 510 540 640 740 MISCELLANEOUS PROCEDURE - PPED032 Procedure PAEDIATRICS 420 440 520 610 MINOR MISCELLANEOUS PROCEDURE - NOT PPED033 Procedure PAEDIATRICS 640 670 800 920 IN ICU - PPED MONITORS FOR 24 HRS OR LESS -NOT PPED034 Procedure PAEDIATRICS 360 380 450 520 IN ICU - PPED NEBULIZER FOR ASTHMA EXCL O2 & PPED035 Procedure PAEDIATRICS 140 150 180 210 DRUGS NEBULIZER FOR WHOLE DAY (MORE PPED036 Procedure PAEDIATRICS 360 380 450 520 THAN 4 TREATMENTS) - PED NEONATAL CARE DURING ROP PPED038 Procedure PAEDIATRICS 820 860 1030 1190 SURGERY - PED PPED039 NEONATAL HEARING TEST - PED Procedure PAEDIATRICS 740 780 920 1070 NEURODEVELOPMENT ASSESSMENT PPED040 Procedure PAEDIATRICS 360 380 450 520 - PED PPED041 NEW BORN BABY PACKAGE (N.D) Procedure PAEDIATRICS 2050 2150 2560 2970 PPED042 NEW BORN BABY PACKAGE (CAE) Procedure PAEDIATRICS 3420 3590 4270 4960 OBSERVATION NURSERY DAILY OR PPED044 Procedure PAEDIATRICS 140 150 180 210 LESS CHARGES - PED PPED046 PICU HIGH INTENSIVE CHARGES Procedure PAEDIATRICS 1300 1370 1630 1890 PPED047 PICU LOW INTENSIVE CHARGES Procedure PAEDIATRICS 960 1010 1200 1390 PLASMA PARTIAL EXCHANGE TRANS PPED048 Procedure PAEDIATRICS 1720 1800 2150 2490 - PED PPED049 PLASMA PHERESIS - PED Procedure PAEDIATRICS 2050 2150 2560 2970 PLEURAL PERICARDIAL/SUBDURAL/ PPED050 Procedure PAEDIATRICS 990 1040 1240 1440 VENTRICULAR TAPS - PED PPED051 RESPIRATORY THERAPY / WEEK - PED Procedure PAEDIATRICS 1530 1610 1920 2220 PPED052 RESUSCITATION - BABY CARE (ND) Procedure PAEDIATRICS 1450 1530 1820 2110 RESUSCITATION ACTIVE DURING PPED053 Procedure PAEDIATRICS 1560 1640 1950 2260 CAESAREAN SECTION

50 Paediatrics

Surgery Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Level Group Subgroup PPED054 RESUSCITATION NORMAL DELIVERY Procedure PAEDIATRICS 790 830 980 1140 PPED055 SEDATION INTERMEDIATE - PED Procedure PAEDIATRICS 1050 1100 1310 1520 PPED056 SPIROMETRY - PED Procedure PAEDIATRICS 1100 1150 1370 1590 PPED057 SPIROMETRY - PAEDIATRIC - PPED Procedure PAEDIATRICS 1100 1150 1370 1590 PPED058 SUPRAPUBIC BLADDER TAP - PED Procedure PAEDIATRICS 480 500 590 690 PPED059 SURFACTANT THERAPY - PED Procedure PAEDIATRICS 5170 5430 6460 7490 PPED060 SUTURE REMOVAL - PPED Procedure PAEDIATRICS 260 270 320 370 TOTAL PARENTRAL NUTRITION PPED061 Procedure PAEDIATRICS 1740 1830 2180 2520 PLANNING & FORMULATION - PED PPED062 TRANSFUSION - PED Procedure PAEDIATRICS 950 1000 1180 1370 PPED063 UMBILICAL ARTERIAL LINE - PED Procedure PAEDIATRICS 1120 1180 1400 1620 PPED064 UMBILICAL VENOUS LINE - PED Procedure PAEDIATRICS 780 810 970 1120 PPED065 VENESECTION - PED Procedure PAEDIATRICS 740 780 920 1070 VENTILATION THERAPY - HI PPED066 Procedure PAEDIATRICS 4170 4380 5210 6040 FREQUENCY - PED PPED067 WARMER TREATMENT - PED Procedure PAEDIATRICS 130 140 160 190 PPED068 WOUND DRESSING Procedure PAEDIATRICS 280 290 350 410 PPED069 OAE SCREENING Procedure PAEDIATRICS 680 720 850 990 PPED070 ABR SCREENING & TYMPANOMETRY Procedure PAEDIATRICS 610 640 770 890 OAE, ABR SCREENING & PPED071 Procedure PAEDIATRICS 1180 1240 1470 1710 TYMPANOMETRY PPED084 SWEAT TEST ANALYSIS Procedure PAEDIATRICS 1780 1860 2220 2570 PHOTOTHERAPY CHARGES PER DAY PPED085 Procedure PAEDIATRICS 130 140 160 190 - PED OBSERVATION CHARGES PER HOUR PPED086 Procedure PAEDIATRICS 360 380 450 520 (NICU) BAYLEY NEURODEVELOPMENT PPED087 Procedure PAEDIATRICS 2300 2420 2880 3340 ASSESSMENT < 24 Months BAYLEY NEURODEVELOPMENT PPED088 Procedure PAEDIATRICS 3830 4030 4790 5560 ASSESSMENT >24 Month PPED089 SKIN BIOPSY - PED Procedure PAEDIATRICS 6420 6740 8030 9310 PPED090 CRYO - A - PED Procedure PAEDIATRICS 640 670 800 920 PPED091 CRYO - B - PED Procedure PAEDIATRICS 1240 1300 1540 1790 PPED092 CRYO - C - PED Procedure PAEDIATRICS 2330 2440 2910 3370 PPED093 CRYO - D - PED Procedure PAEDIATRICS 4370 4590 5470 6340 PPED094 CURETTAGE - PED Procedure PAEDIATRICS 1650 1730 2060 2390 PPED095 INTRA LESIONAL INJECTION - PED Procedure PAEDIATRICS 1510 1590 1890 2190

51 Department of Neuro Sciences

52 Neurology

53 Neurology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PNEU046 TRACHEOSTOMY TUBE CHANGE - NEU Procedure NEUROLOGY 760 800 950 1110 PNEU008 COUNSELLING -PER SESSION Procedure NEUROLOGY 1240 1300 1540 1790 PNEU015 EMG NEEDLE - DISPOSABLE Procedure NEUROLOGY 1240 1300 1540 1790 PNEU016 EMG ONE MUSCLE Procedure NEUROLOGY 1240 1300 1540 1790 PNEU031 MMSE ASSESSMENT Procedure NEUROLOGY 1240 1300 1540 1790 PNEU036 NCV SINGLE NERVE Procedure NEUROLOGY 1370 1440 1720 1990 PNEU002 ARTERIAL LINE - NEU Procedure NEUROLOGY 1510 1590 1890 2190 PNEU041 RESUSCITATION ACTIVE - NEU Procedure NEUROLOGY 1510 1590 1890 2190 PNEU042 SEDATION CHARGE - NEU Procedure NEUROLOGY 1650 1730 2060 2390 PNEU007 CENTRAL LINE - NEU Procedure NEUROLOGY 1780 1860 2220 2570 BONE MARROW ASPIRATION BIOPSY (A) - PNEU003 Procedure NEUROLOGY 1910 2010 2390 2770 PNEU DEMYLINATING/ AUTOIMMUNE DISEASE PNEU033 Procedure NEUROLOGY 1910 2010 2390 2770 MANAGEMENT PNEU054 EEG SCREENING Procedure NEUROLOGY 1910 2010 2390 2770 PNEU018 EP BAER Procedure NEUROLOGY 1910 2010 2390 2770 PNEU039 NEUROMUSCULAR DISEASE MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770 PNEU024 SEIZURE / EPILEPSY MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770 PNEU043 STROKE MANAGEMENT Procedure NEUROLOGY 1910 2010 2390 2770 PNEU022 EP V E P Procedure NEUROLOGY 2050 2150 2560 2970 PNEU020 EP S S E P (1 NERVE) Procedure NEUROLOGY 2330 2440 2910 3370 PNEU037 NEOSTIGMINE TEST Procedure NEUROLOGY 2330 2440 2910 3370 PNEU010 EEG Procedure NEUROLOGY 2500 2500 2750 3000 PNEU055 ENCEPHALOPATHY MANAGEMENT Procedure NEUROLOGY 2870 3010 3580 4160 PNEU019 EP BAER (DIFFERENT STIMULI) Procedure NEUROLOGY 2870 3010 3580 4160 PNEU023 EP V E P (DIFF STIMULI)_ Procedure NEUROLOGY 2870 3010 3580 4160 PNEU005 BRAIN MAPPING Procedure NEUROLOGY 3010 3160 3760 4360 PNEU001 ADVANCED EMG/MISC ELECTROPHYSIOLOGY Procedure NEUROLOGY 3560 3740 4450 5160 PNEU009 DETAILED HIGHER FUNCTION ASSESSMENT Procedure NEUROLOGY 3560 3740 4450 5160 PNEU017 EMG UPTO 3 MUSCLES Procedure NEUROLOGY 3560 3740 4450 5160 PNEU026 ICU PROCEDURES CHARGES Procedure NEUROLOGY 3560 3740 4450 5160 PNEU050 INTENSIVE CARE MONITORING CHARGES Procedure NEUROLOGY 3560 3740 4450 5160 PNEU045 TENSILON TESTING Procedure NEUROLOGY 3560 3740 4450 5160 PNEU021 EP S S E P (MORE THAN ONE NERVE) Procedure NEUROLOGY 3830 4030 4790 5560 PNEU034 NCV - UPTO 4 NERVES Procedure NEUROLOGY 3970 4170 4960 5760 PNEU030 LUMBAR PUNCHURE CHARGES Procedure NEUROLOGY 4370 4590 5470 6340 PNEU011 EEG PORTABLE Procedure NEUROLOGY 4650 4880 5810 6740 PNEU004 BOTOLINIUM TOXIN INJECTION Procedure NEUROLOGY 4790 5030 5980 6940 PNEU006 CARPAL TUNNEL INJECTION Procedure NEUROLOGY 4790 5030 5980 6940 PNEU014 EMG MORE THAN 3 MUSCLES Procedure NEUROLOGY 5880 6180 7350 8530 PNEU013 EEG PORTABLE UPTO 4 HRS Procedure NEUROLOGY 7110 7470 8890 10310

54 Neurology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PNEU027 IMMUNOTHERAPY - NEU Procedure NEUROLOGY 7110 7470 8890 10310 PNEU029 LUMAR PUNCTURE PRESSURE MONITORING Procedure NEUROLOGY 7110 7470 8890 10310 PNEU032 MUSCLE BIOPSY Procedure NEUROLOGY 7110 7470 8890 10310 PNEU035 NCV MORE THAN 4 NERVES Procedure NEUROLOGY 7110 7470 8890 10310 NEUROLOGICAL INFECTION / INFLAMMATION PNEU056 Procedure NEUROLOGY 7110 7470 8890 10310 MANAGEMENT PARKINSON'S DISEASE/MOVEMENT PNEU040 Procedure NEUROLOGY 7110 7470 8890 10310 DISORDER MANAGEMENT PNEU038 NERVE BIOPSY Procedure NEUROLOGY 7390 7760 9230 10710 PNEU047 VIDEO MONITERING -UPTO 4 HOURS Procedure NEUROLOGY 8200 8610 10250 11890 PNEU051 VIDEO EEG less than 4 hrs Procedure NEUROLOGY 8480 8900 10600 12290 PNEU012 EEG PORTABLE MORE THAN 4 HRS Procedure NEUROLOGY 9570 10050 11960 13880 PNEU052 VIDEO EEG 4 hrs- 12 hrs Procedure NEUROLOGY 9570 10050 11960 13880 PNEU057 Intra Operative DBS monitoring Procedure NEUROLOGY 11500 12080 14380 16680 PNEU053 VIDEO EEG 12 hrs- 24 hrs Procedure NEUROLOGY 11760 12350 14700 17050 PNEU049 VIDEO MONITORING-4-12 HRS Procedure NEUROLOGY 14350 15060 17930 20800 PNEU025 EPILEPSY SURGERY WORKUP Procedure NEUROLOGY 17760 18650 22200 25750 STROKE REVASCULARISATION WORKUP/ PNEU044 Procedure NEUROLOGY 19130 20090 23910 27740 MONITORING PNEU048 VIDEO MONITORING -12-24 HOURS Procedure NEUROLOGY 23910 25110 29890 34670 PNPSY05 Cognitive Stimulation Per Session Procedure NEUROPSYCHOLOGY 260 270 320 370 PNPSY07 Brief Psychological Assessment Procedure NEUROPSYCHOLOGY 500 520 620 720 PNPSY04 Counseling NPSY Procedure NEUROPSYCHOLOGY 520 550 650 760 PNPSY08 Developmental / Behavioral Assessment Procedure NEUROPSYCHOLOGY 760 800 950 1110 PNPSY18 Psychotherapy Per Session NPSY Procedure NEUROPSYCHOLOGY 760 800 950 1110 PNPSY09 Aptitude Test / Career Guidance Procedure NEUROPSYCHOLOGY 960 1010 1200 1390 PNPSY12 Assessment of Cognition/Attitudes Procedure NEUROPSYCHOLOGY 960 1010 1200 1390 PNPSY13 Assessment of Memory/Intelligence Procedure NEUROPSYCHOLOGY 1240 1300 1540 1790 PNPSY10 Disability/ SLD Assessment Procedure NEUROPSYCHOLOGY 1240 1300 1540 1790 PNPSY19 Couple / Family Therapy( per session) Procedure NEUROPSYCHOLOGY 1370 1440 1720 1990 PNPSY14 Assessment of Cognitive Functions Procedure NEUROPSYCHOLOGY 1510 1590 1890 2190 PNPSY15 Assessment of Personality & IPR Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770 PNPSY11 Child & Adolescent Assessment Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770 PNPSY17 Couple / Family Assessment Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770 Neuropsychological Assessment Specific PNPSY01 Procedure NEUROPSYCHOLOGY 1910 2010 2390 2770 Domain PNPSY16 Psycho diagnostic Assessment Procedure NEUROPSYCHOLOGY 2470 2590 3080 3570 PNPSY06 Cognitive Retraining Up to 5 Sessions Procedure NEUROPSYCHOLOGY 3280 3450 4100 4760 Neuropsychological Assessment Partial / PNPSY02 Procedure NEUROPSYCHOLOGY 3700 3880 4620 5360 Diagnostic Neuropsychological Assessment Complete PNPSY03 Procedure NEUROPSYCHOLOGY 7390 7760 9230 10710 Profile

55 Neuro Surgery

56 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group NEUROSURGERY PNSR015 COGNITIVE STIMULATION - NSR Procedure 420 440 520 610 PROCEDURE NEUROSURGERY PNSR028 WOUND REPAIR - MINOR Procedure 480 500 590 690 PROCEDURE ASSESSMENT - PSYCHOLOGICAL NEUROSURGERY PNSR007 Procedure 560 580 690 810 MISC PROCEDURE NEUROSURGERY PNSR003 ASSESSMENT - DEVELOPMENTAL Procedure 640 670 800 920 PROCEDURE ASSESSMENT - SPECIFIC NEUROSURGERY PNSR008 Procedure 640 670 800 920 PSYCHOLOGICAL FUNCTIONS PROCEDURE NEUROSURGERY PNSR012 COGNITIVE BEHAVIOUR THERAPY Procedure 640 670 800 920 PROCEDURE NEUROSURGERY PNSR014 COGNITIVE RETRAINING - NSR Procedure 640 670 800 920 PROCEDURE NEUROSURGERY PNSR010 BLOCK Procedure 660 690 820 960 PROCEDURE NEUROSURGERY PNSR020 PARKINSONS ASSESSMENT Procedure 760 800 950 1110 PROCEDURE NEUROSURGERY PNSR019 LUMBAR DRAIN Procedure 960 1010 1200 1390 PROCEDURE NEUROSURGERY PNSR009 BIOPSY NEUROSURGERY Procedure 1100 1150 1370 1590 PROCEDURE NEUROSURGERY PNSR027 WOUND REPAIR - MAJOR Procedure 1100 1150 1370 1590 PROCEDURE COGNITIVE FUNCTIONS NEUROSURGERY PNSR013 Procedure 1240 1300 1540 1790 ASSESSMENT - NSR PROCEDURE PERSONALITY & INTERPERSONAL NEUROSURGERY PNSR023 Procedure 1300 1370 1630 1890 RELATIONS - NSR PROCEDURE ASSESSMENT - GENERAL NEUROSURGERY PNSR005 Procedure 2050 2150 2560 2970 PSYCHOLOGICAL PROCEDURE NEUROSURGERY PNSR022 PERCUTANEOUS PROCEDURE - SI Procedure 2050 2150 2560 2970 PROCEDURE NEUROSURGERY PNSR026 ULTRASOUND (NEUROSURGERY) Procedure 2600 2730 3250 3770 PROCEDURE NEUROSURGERY PNSR017 FAZET CHIZOTOMY Procedure 2740 2880 3430 3970 PROCEDURE NEUROSURGERY PNSR025 TCD Procedure 2870 3010 3580 4160 PROCEDURE ICU PROCEDURE CHARGES NEUROSURGERY PNSR018 Procedure 3140 3300 3930 4560 (NEUROSURGERY) PROCEDURE ASSESSMENT - NEURO NEUROSURGERY PNSR006 Procedure 3700 3880 4620 5360 PSYCHOLOGICAL PROCEDURE LUMBAR PUNCHURE (NEURO NEUROSURGERY PNSR030 Procedure 3830 4030 4790 5560 SURGERY) PROCEDURE RF LESION FOR TRIGEMINAL NEUROSURGERY PNSR024 Procedure 3970 4170 4960 5760 NEURALGIA PROCEDURE

57 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group NEUROSURGERY PNSR021 PERCUTANEOUS PROCEDURE - CO Procedure 4100 4300 5120 5940 PROCEDURE NEUROSURGERY PNSR002 ANGIOGRAPHY - RESTRICTED Procedure 6020 6320 7520 8730 PROCEDURE NEUROSURGERY PNSR001 ANGIOGRAPHY - 4 VESSEL - PNSR Procedure 12570 13200 15720 18230 PROCEDURE NEUROSURGERY PNSR011 BONE MARROW ASPIRATION Procedure 26650 27980 33310 38640 PROCEDURE CARPAL TUNNEL INJECTION (LNSR) NEURO LNSR300 L1 Surgery 0 4500 5360 6220 # L1 SURGERY NEURO LNSR301 CHAMBER ASPIRATION (LNSR) # L1 L1 Surgery 0 4500 5360 6220 SURGERY NEURO LNSR302 CISTERNAL PUNCTURE (LNSR) # L1 L1 Surgery 0 4500 5360 6220 SURGERY LUMBAR PUNTURE IN OT (LNSR) NEURO LNSR303 L1 Surgery 0 4500 5360 6220 # L1 SURGERY LUMBAR TAP DIAGNOSTIC (LNSR) NEURO LNSR304 L1 Surgery 0 4500 5360 6220 # L1 SURGERY SECONDARY SUTURING (LNSR) NEURO LNSR305 L1 Surgery 0 4500 5360 6220 # L1 SURGERY SUTURE REMOVAL UNDER GA NEURO LNSR306 L1 Surgery 0 4500 5360 6220 (LNSR) # L1 SURGERY WOUND DEBRIDEMENT AND NEURO LNSR307 L1 Surgery 0 4500 5360 6220 REPAIR (LNSR) # L1 SURGERY NEURO LNSR308 BIOPSY MUSCLE (LNSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY NEURO LNSR309 BIOPSY NERVE (LNSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY NEURO LNSR310 CSF LEAK REPAIR (LNSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY EXTERNAL LUMBAR DRAIN (LNSR) NEURO LNSR311 L2 Surgery 0 8240 9810 11380 # L2 SURGERY HEMATOMA SUBDURAL ACUTE NEURO LNSR312 L2 Surgery 0 8240 9810 11380 (POST-OP) (LNSR) # L2 SURGERY LUMBAR TAP DIAGNOSTIC + NEURO LNSR313 L2 Surgery 0 8240 9810 11380 PRESSURE MONITOR (LNSR) # L2 SURGERY NEURO LNSR314 NEUROLYSIS (LNSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY NEURO LNSR315 STA BIOPSY (LNSR) # L2 L2 Surgery 0 8240 9810 11380 SURGERY STELLATE GANGLION BLOCK NEURO LNSR316 L2 Surgery 0 8240 9810 11380 (LNSR) # L2 SURGERY VENTRICULAR PUNCTURE (LNSR) NEURO LNSR317 L2 Surgery 0 8240 9810 11380 # L2 SURGERY

58 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ANGIOGRAPHY DIAGNOSTIC A) NEURO LNSR404 SINGLE/TWO VESSEL (LNSR) - L3 Surgery 0 10820 12880 14940 SURGERY CATH # L3 CARPAL TUNNEL RELEASE (LNSR) NEURO LNSR318 L3 Surgery 0 10820 12880 14940 # L3 SURGERY NERVE ENTRAPMENT RELEASE NEURO LNSR319 L3 Surgery 0 10820 12880 14940 (LNSR) # L3 SURGERY SCALP TUMOR EXCISION (LNSR) NEURO LNSR320 L3 Surgery 0 10820 12880 14940 # L3 SURGERY ANGIOGRAM SPINAL DIAGNOSTIC NEURO LNSR432 L4 Surgery 0 14790 17610 20420 SINGLE ARTERY (LNSR) # L4 SURGERY ANGIOGRAPHY DIAGNOSTIC B) NEURO LNSR405 L4 Surgery 0 14790 17610 20420 FOUR VESSEL (LNSR) - CATH # L4 SURGERY ANGIOGRAPHY SPINAL (LNSR) - NEURO LNSR406 L4 Surgery 0 14790 17610 20420 CATH # L4 SURGERY BURR HOLE - DIAGNOSTIC (LNSR) NEURO LNSR321 L4 Surgery 0 14790 17610 20420 # L4 SURGERY CARPAL TUNNEL RELEASE - NEURO LNSR322 L4 Surgery 0 14790 17610 20420 MICROSCOPIC (LNSR) # L4 SURGERY MICROSCOPIC NERVE NEURO LNSR323 ENTRAPMENT RELEASE (LNSR) L4 Surgery 0 14790 17610 20420 SURGERY # L4 NEURO LNSR324 TRACHEOSTOMY (LNSR) # L4 L4 Surgery 0 14790 17610 20420 SURGERY TRANS VENOUS ANGIOGRAM NEURO LNSR407 L4 Surgery 0 14790 17610 20420 (LNSR) - CATH # L4 SURGERY VENTRICULAR TAP (DONE IN OT) NEURO LNSR325 L4 Surgery 0 14790 17610 20420 (LNSR) # L4 SURGERY BRAIN BIOPSY BURR HOLE (LNSR) NEURO LNSR326 L5 Surgery 0 18010 21440 24870 # L5 SURGERY CAROTID LIGATION (as sole NEURO LNSR327 L5 Surgery 0 18010 21440 24870 procedure) (LNSR) # L5 SURGERY NEURO LNSR328 CYST TAPPING (LNSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY NEURO LNSR329 EVD (LNSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY NEURO LNSR330 ICP MONITORING (LNSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY NEUROMA EXCISIONS - NEURO LNSR331 L5 Surgery 0 18010 21440 24870 PERIPHERAL NERVE (LNSR) # L5 SURGERY NEURO LNSR332 RF LESIONING (LNSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY NEURO LNSR333 SYMPATHECTOMY (LNSR) # L5 L5 Surgery 0 18010 21440 24870 SURGERY WADA TEST - CATH (LNSR) - CATH NEURO LNSR409 L5 Surgery 0 18010 21440 24870 # L5 SURGERY

59 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ANGIOGRAPHY THERAPEUTIC, NEURO LNSR408 stent, clips, balloons etc (LNSR) - L5 Surgery 0 21870 26030 30200 SURGERY CATH # L5 EMBOLIZATION B) AVM (INCLUDING NEURO LNSR418 ANGIO) - STAGED PROCEDURE - Surgery 0 21870 26030 30200 SURGERY CATH INTRA ARTERIAL DRUG INFUSION NEURO LNSR415 L8 Surgery 0 21870 26030 30200 (LNSR) - CATH # L8 SURGERY INTRACRANIAL THROMBOLYSIS NEURO LNSR413 L8 Surgery 0 21870 26030 30200 MECHANICAL (LNSR) - CATH # L8 SURGERY INTRACRANIAL VENOUS SINUS NEURO LNSR414 L8 Surgery 0 21870 26030 30200 SAMPLING (LNSR) - CATH # L8 SURGERY BURR HOLE AND SUBDURAL NEURO LNSR334 L6 Surgery 0 27010 32150 37290 LAVAGE (LNSR) # L6 SURGERY BURR HOLE ICP MONITORING NEURO LNSR335 L6 Surgery 0 27010 32150 37290 (LNSR) # L6 SURGERY BURR HOLES FRONTOPARIETAL NEURO LNSR336 L6 Surgery 0 27010 32150 37290 AND LAVAGE (LNSR) # L6 SURGERY CAROTID ANGIOPLASTY (LNSR) - NEURO LNSR412 L6 Surgery 0 27010 32150 37290 CATH # L6 SURGERY EMBOLIZATION A) TUMOUR (LNSR) NEURO LNSR410 L6 Surgery 0 27010 32150 37290 - CATH # L6 SURGERY RESERVOIR PLACEMENT (LNSR) NEURO LNSR337 L6 Surgery 0 27010 32150 37290 # L6 SURGERY SHUNT PROCEDURES - VP/TP NEURO LNSR338 L6 Surgery 0 27010 32150 37290 (LNSR) # L6 SURGERY TWIST DRILL CRANIOSTOMY NEURO LNSR339 L6 Surgery 0 27010 32150 37290 (LNSR) # L6 SURGERY ANGIOGRAM SPINAL DIAGNOSTIC NEURO LNSR428 L7 Surgery 0 36010 42870 49730 MULTIPLE ARTERIES (LNSR) # L7 SURGERY ANGIOGRAPHY THERAPEUTIC - NEURO LNSR417 L7 Surgery 0 36010 42870 49730 COILS - CATH # L7 SURGERY BONE FLAP REPLACEMENT (LNSR) NEURO LNSR340 L7 Surgery 0 36010 42870 49730 # L7 SURGERY NEURO LNSR341 ETV (LNSR) # L7 L7 Surgery 0 36010 42870 49730 SURGERY MICROSCOPIC CAROTID NEURO LNSR342 L7 Surgery 0 36010 42870 49730 ENDARTERECTOMY (LNSR) # L7 SURGERY MICROSCOPIC THIRD NEURO LNSR343 L7 Surgery 0 36010 42870 49730 VENTRICULOSTOMY (LNSR) # L7 SURGERY MINI CRANIOTOMY FOR SDH NEURO LNSR344 L7 Surgery 0 36010 42870 49730 (LNSR) # L7 SURGERY NEURO ENDOSCOPIC PROCEDURES NEURO LNSR345 L7 Surgery 0 36010 42870 49730 (LNSR) # L7 SURGERY RE-EXPLORATION CRANIOTOMY NEURO LNSR346 L7 Surgery 0 36010 42870 49730 (LNSR) # L7 SURGERY

60 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SHUNT PROCEDURES -SYRINX/ NEURO LNSR347 L7 Surgery 0 36010 42870 49730 PROGRAMMABLE (LNSR) # L7 SURGERY SPINAL UNILATERAL APPROACH NEURO LNSR423 AND BILATERAL DECOMPRESSION L7 Surgery 0 36010 42870 49730 SURGERY (LNSR) # L7 BRACHIAL PLEXUS EXPLORATION NEURO LNSR422 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY CARNIOTOMY FOR CHRONIC SDH NEURO LNSR348 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY CAROTID BODY TUMOR EXCISION NEURO LNSR349 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY NEURO LNSR350 CORTICAL MAPPING (LNSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY CRANIOPLASTY ACRYLIC (LNSR) NEURO LNSR351 L8 Surgery 0 45010 53580 62150 # L8 SURGERY NEURO LNSR352 CRANIOPLASTY MESH (LNSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY CRANIOPLASTY WITH BONE FLAP NEURO LNSR353 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY CRANIOTOMY ACUTE SDH (LNSR) NEURO LNSR354 L8 Surgery 0 45010 53580 62150 # L8 SURGERY CRANIOTOMY AND MICROVASCULAR NEURO LNSR355 L8 Surgery 0 45010 53580 62150 DECOMPRESSION FOR TRIGEMINAL SURGERY NEURALGIA (LNSR) # L8 CRANIOTOMY FOR BRAIN ABSCESS NEURO LNSR356 L8 Surgery 0 45010 53580 62150 LIKE LESIONS (LNSR) # L8 SURGERY CRANIOTOMY FOR CONTUSIONS NEURO LNSR357 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY CRANIOTOMY FOR CONVEXITY NEURO LNSR358 L8 Surgery 0 45010 53580 62150 LESIONS (LNSR) # L8 SURGERY CRANIOTOMY FOR CSF NEURO LNSR359 L8 Surgery 0 45010 53580 62150 RHINORRHEA REPAIR (LNSR) # L8 SURGERY CRANIOTOMY FOR NEURO LNSR361 DECOMPRESSION OF INFECTIVE L8 Surgery 0 45010 53580 62150 SURGERY DISORDERS (LNSR) # L8 CRANIOTOMY FOR NEURO LNSR360 DECOMPRESSION OF MALIGNANT L8 Surgery 0 45010 53580 62150 SURGERY INFARCTS (LNSR) # L8 CRANIOTOMY FOR DEPRESSED NEURO LNSR362 L8 Surgery 0 45010 53580 62150 FRACTURE (LNSR) # L8 SURGERY CRANIOTOMY FOR EDH (LNSR) # NEURO LNSR363 L8 Surgery 0 45010 53580 62150 L8 SURGERY NEURO LNSR364 CRANIOTOMY FOR ICH (LNSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY

61 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CRANIOTOMY FOR NEURO LNSR365 INTRAVENTRICULAR LESIONS L8 Surgery 0 45010 53580 62150 SURGERY (LNSR) # L8 CRANIOTOMY FOR SELLAR NEURO LNSR366 SUPRASELLAR LESIONS (LNSR) L8 Surgery 0 45010 53580 62150 SURGERY # L8 CRANIOTOMY FOR NEURO LNSR367 SUPRATENTORIAL LESIONS (LNSR) L8 Surgery 0 45010 53580 62150 SURGERY # L8 DECOMPRESSIVE CRANIOTOMY NEURO LNSR368 L8 Surgery 0 45010 53580 62150 (LNSR) # L8 SURGERY EMBOLIZATION B) AVM (INCLUDING NEURO LNSR419 ANGIO)- SINGLE STAGE - CATH # L8 Surgery 0 45010 53580 62150 SURGERY L8 ENDOSCOPIC CSF REPAIR (LNSR) NEURO LNSR369 L8 Surgery 0 45010 53580 62150 # L8 SURGERY ENDOSCOPIC HEMATOMA NEURO LNSR421 L8 Surgery 0 45010 53580 62150 EVACUATION(LNSR) # L8 SURGERY ENDOVASCULAR STROKE NEURO LNSR427 L8 Surgery 0 45010 53580 62150 INTERVENTION (LNSR) # L8 SURGERY OPEN NEURAL TUBE DEFECTS NEURO LNSR370 (MENINGOMYELOCOELE/ L8 Surgery 0 45010 53580 62150 SURGERY MENINGOCOLE/) (LNSR) # L8 STEREOTACTIC EVACUATION OF NEURO LNSR372 L8 Surgery 0 45010 53580 62150 ICH (LNSR) # L8 SURGERY STEREOTACTIC SURGERY (LNSR) NEURO LNSR373 L8 Surgery 0 45010 53580 62150 # L8 SURGERY STEREOTAXY FOR MOVEMENT NEURO LNSR374 L8 Surgery 0 45010 53580 62150 DISORDERS (LNSR) # L8 SURGERY NEURO LNSR371 STERIOTACTIC BIOPSY (LNSR) # L8 L8 Surgery 0 45010 53580 62150 SURGERY STEROTACTIC ASPIRATION OF NEURO LNSR375 L8 Surgery 0 45010 53580 62150 CYSTS (LNSR) # L8 SURGERY TRANSPHENOIDAL MICROSCOPIC NEURO LNSR376 SURGERY FOR SELLAR LESIONS L8 Surgery 0 45010 53580 62150 SURGERY (LNSR) # L8 BRAIN BYPASS PROCEDURES NEURO LNSR379 L9 Surgery 0 54020 64300 74590 (LNSR) # L9 SURGERY CLIPPING OF ANEURYSM (LNSR) NEURO LNSR380 L9 Surgery 0 54020 64300 74590 # L9 SURGERY CLOSED NEURAL TUBE DEFECTS (DIASTOMETAMYELIA/ NEURO LNSR381 L9 Surgery 0 54020 64300 74590 LIPOMENINGOCOELE/TETHERED SURGERY CORD) (LNSR) # L9 CRANIOFACIAL ADVANCEMENT FOR NEURO LNSR424 L9 Surgery 0 54020 64300 74590 CRANIOSYNOSTOSIS (LNSR) # L9 SURGERY CRANIOTOMY FOR BRAIN STEM NEURO LNSR383 L9 Surgery 0 54020 64300 74590 LESIONS (LNSR) # L9 SURGERY

62 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CRANIOTOMY FOR CEREBELLAR NEURO LNSR384 L9 Surgery 0 54020 64300 74590 LESIONS (LNSR) # L9 SURGERY CRANIOTOMY FOR CLIVAL/ NEURO LNSR385 L9 Surgery 0 54020 64300 74590 PETROUS TUMORS (LNSR) # L9 SURGERY CRANIOTOMY FOR CP ANGLE NEURO LNSR386 L9 Surgery 0 54020 64300 74590 TUMORS (LNSR) # L9 SURGERY CRANIOTOMY FOR EPILEPSY/ NEURO LNSR387 L9 Surgery 0 54020 64300 74590 FUNCTIONAL SURGERY (LNSR) # L9 SURGERY CRANIOTOMY FOR PINEAL REGION NEURO LNSR388 L9 Surgery 0 54020 64300 74590 LESIONS (LNSR) # L9 SURGERY CRANIOTOMY FOR POSTERIOR NEURO LNSR391 L9 Surgery 0 54020 64300 74590 FOSSA TUMORS (LNSR) # L9 SURGERY CRANIOTOMY FOR POST. FOSSA NEURO LNSR389 L9 Surgery 0 54020 64300 74590 HEMATOMAS (LNSR) # L9 SURGERY CRANIOTOMY FOR POST. FOSSA NEURO LNSR390 L9 Surgery 0 54020 64300 74590 INFARCTS (LNSR) # L9 SURGERY DEEP BRAIN STIMULATION (LNSR) NEURO LNSR392 L9 Surgery 0 54020 64300 74590 # L9 SURGERY ENDOSCOPIC CRANIO FACIAL NEURO LNSR425 L9 Surgery 0 54020 64300 74590 CORRECTIVE SURGERY (LNSR) # L9 SURGERY ENDOSCOPIC SELLAR REGION NEURO LNSR426 L9 Surgery 0 54020 64300 74590 MASS EXCISION (LNSR) # L9 SURGERY ENDOSCOPIC SELLAR NEURO LNSR394 L9 Surgery 0 54020 64300 74590 SUPRASELLAR LESION (LNSR) # L9 SURGERY ENDOVASCULAR ANEURYSM NEURO LNSR431 L9 Surgery 0 54020 64300 74590 COILING (LNSR) # L9 SURGERY ENDOVASCULAR FLOW DIVERTER NEURO LNSR430 L9 Surgery 0 54020 64300 74590 PROCDURE (LNSR) # L9 SURGERY NEURO LNSR395 EXCISION OF AVM (LNSR) # L9 L9 Surgery 0 54020 64300 74590 SURGERY EXCISION OF SPINAL AVM (LNSR) NEURO LNSR396 L9 Surgery 0 54020 64300 74590 # L9 SURGERY SPINAL ENDOVASCULAR NEURO LNSR429 L9 Surgery 0 54020 64300 74590 PROCEDURE (LNSR) # L9 SURGERY ANEURYSM WITH AVM SURGERY NEURO LNSR377 L9 Surgery 0 63010 75010 87020 (LNSR) # L9 SURGERY ANEURYSM WITH NEURO LNSR378 RECONSTRUCTION SURGERY L9 Surgery 0 63010 75010 87020 SURGERY (LNSR) # L9 GIANT MENINGIOMA SURGERY (>5 NEURO LNSR397 L9 Surgery 0 63010 75010 87020 CM in DIAMETER) (LNSR) # L9 SURGERY MULTICENTRIC GLIOMAS NEURO LNSR400 SURGERY(TWO PATHOLOGIES AT L9 Surgery 0 63010 75010 87020 SURGERY TWO LOCATIONS) (LNSR) # L9

63 Neuro Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group COMPLEX BYPASS PROCEDURES SURGERY (OA/JUMP GRAFTS/HIGH NEURO LNSR382 L9 Surgery 0 72020 85740 99450 FLOW/ANEURYSM WITH BYPASS) SURGERY (LNSR) # L9 COMPLEX CEREBRAL ARTERY NEURO LNSR420 L9 Surgery 0 72020 85740 99450 ANEURYSM CLIPPING # L9 SURGERY DUAL LEVEL SPLIT CORDS NEURO LNSR393 SURGERY(TWO PATHOLOGIES AT L9 Surgery 0 72020 85740 99450 SURGERY TWO LOCATIONS) (LNSR) # L9 Evacuation of SDH & NEURO LNSR433 Surgery 0 72020 85740 99450 Decompressive carniectomy SURGERY Evacuation of SDH + Decompressive craniectomy + NEURO LNSR434 L9 Surgery 0 72020 85740 99450 Bone Flap placement in Abdomen SURGERY # L9 GIANT PITUITARY SURGERY (>5 CM NEURO LNSR398 L9 Surgery 0 72020 85740 99450 in DIAMETER) (LNSR) # L9 SURGERY GUIDED /MONITORED CRANIOTOMY FOR BRAIN TUMORS(NEURO NEURO LNSR399 L9 Surgery 0 72020 85740 99450 NAVIGATION/INTRA OPERATIVE SURGERY MONITORING) (LNSR) # L9 MULTIPLE ANEURYSMS SURGERY NEURO LNSR401 L9 Surgery 0 72020 85740 99450 (LNSR) # L9 SURGERY SPLIT CORD WITH TIGHT FILUM NEURO LNSR402 SURGERY(TWO PATHOLOGIES AT L9 Surgery 0 72020 85740 99450 SURGERY TWO LOCATIONS) (LNSR) # L9 TETHERED CORD WITH SPLIT CORD NEURO LNSR403 SURGERY(TWO PATHOLOGIES AT L9 Surgery 0 72020 85740 99450 SURGERY TWO LOCATIONS) (LNSR) # L9 ANGIOGRAPHY DIAGNOSTIC B) STROKE LNSR436 FOUR VESSEL (PARI) (LNSR) - CATH L4 Surgery INTERVENTION 0 14790 17610 20420 # L4 SURGERY STROKE ENDOVASCULAR STROKE LNSR435 L8 Surgery INTERVENTION 0 45010 53580 62150 INTERVENTION (PARI) (LNSR) # L8 SURGERY

64 Department of Orthopaedics & Joint Replacement

65 Orthopaedics

66 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TOTAL KNEE REPLACEMENT - ORTHOPAEDICS KKORT016 Package 0 169990 187000 203980 UNILATERAL - PACKAGE PACKAGE TOTAL HIP REPLACEMENT - ORTHOPAEDICS KKORT017 Package 0 200890 221000 241070 UNILATERAL - PACKAGE PACKAGE TOTAL HIP REPLACEMENT - ORTHOPAEDICS KKORT020 Package 0 285890 314500 343060 BILATERAL - PACKAGE PACKAGE TOTAL KNEE REPLACEMENT - ORTHOPAEDICS KKORT019 Package 0 316790 348500 380150 BILATERAL - PACKAGE PACKAGE PORT007 CONTINUOUS PASSIVE MOVEMENT Procedure ORTHOPAEDICS 115 120 145 165 PORT010 DRESSING CHARGE (MINOR) Procedure ORTHOPAEDICS 125 130 155 180 PORT009 DRESSING CHARGE (MEDIUM) Procedure ORTHOPAEDICS 210 220 265 305 PORT008 DRESSING CHARGE (MAJOR) Procedure ORTHOPAEDICS 230 240 290 335 PORT055 SUTURE REMOVAL - MEDIUM - ORT Procedure ORTHOPAEDICS 210 220 265 305 PLASTER POST SLAB - ELBOW PORT034 Procedure ORTHOPAEDICS 230 240 290 335 ABOVE PORT048 STRAPPING FINGER Procedure ORTHOPAEDICS 230 240 290 335 PORT052 STRAPPING TOES Procedure ORTHOPAEDICS 230 240 290 335 PORT054 SUTURE REMOVAL - MAJOR - ORT Procedure ORTHOPAEDICS 230 240 290 335 COLLES FRACTURE ANTERIOR OR PORT004 Procedure ORTHOPAEDICS 275 290 345 400 POST SLAB 5.4 PLASTER POST SLAB - KNEE PORT035 Procedure ORTHOPAEDICS 275 290 345 400 BELOW PORT039 SKIN TRACTION Procedure ORTHOPAEDICS 275 290 345 400 PORT040 ST PIN REMOVAL Procedure ORTHOPAEDICS 275 290 345 400 STRAPPING COLAR AND CUFF PORT045 Procedure ORTHOPAEDICS 295 310 370 430 SLING INTER ARTICULAR INJECTION - PORT017 Procedure ORTHOPAEDICS 335 350 420 485 MINOR PORT022 JOINT ASPIRATION - MINOR - PORT Procedure ORTHOPAEDICS 335 350 420 485 PORT025 K-WIRES REMOVAL - MINOR Procedure ORTHOPAEDICS 335 350 420 485 PORT056 SUTURE REMOVAL - MINOR - ORT Procedure ORTHOPAEDICS 335 350 420 485 ORTHOPAEDIC AND FINGERS - PORT026 Procedure ORTHOPAEDICS 355 375 445 515 PLASTER FULL ORTHOPAEDIC AND FINGERS - PORT027 Procedure ORTHOPAEDICS 355 375 445 515 POST SLAB INTER ARTICULAR INJECTION - PORT016 Procedure ORTHOPAEDICS 440 460 550 640 MEDIUM PORT021 JOINT ASPIRATION - MEDIUM Procedure ORTHOPAEDICS 440 460 550 640 PORT024 K-WIRES REMOVAL - MEDIUM Procedure ORTHOPAEDICS 440 460 550 640 PORT042 STRAPPING ANKLE Procedure ORTHOPAEDICS 440 460 550 640 PORT046 STRAPPING ELBOW Procedure ORTHOPAEDICS 440 460 550 640

67 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PORT049 STRAPPING KNEE Procedure ORTHOPAEDICS 440 460 550 640 PORT053 STRAPPING WRIST Procedure ORTHOPAEDICS 440 460 550 640 PORT028 PLASTER FULL - ELBOW ABOVE Procedure ORTHOPAEDICS 505 530 630 730 PORT044 STRAPPING CHEST Procedure ORTHOPAEDICS 505 530 630 730 INTER ARTICULAR INJECTION - PORT015 Procedure ORTHOPAEDICS 545 570 680 790 MAJOR PORT020 JOINT ASPIRATION - MAJOR Procedure ORTHOPAEDICS 590 620 740 855 COLLES FRACTURE BELOW ELBOW PORT005 Procedure ORTHOPAEDICS 640 670 800 930 5.3.1 EXTERNAL FIXATOR REMOVAL - PORT013 Procedure ORTHOPAEDICS 640 670 800 930 MINOR PORT029 PLASTER FULL - KNEE ABOVE Procedure ORTHOPAEDICS 640 670 800 930 PORT030 PLASTER FULL SLAB - KNEE ABOVE Procedure ORTHOPAEDICS 640 670 800 930 PORT043 STRAPPING BALL BANDAGE Procedure ORTHOPAEDICS 640 670 800 930 PORT051 STRAPPING SHOULDER Procedure ORTHOPAEDICS 640 670 800 930 PORT047 STRAPPING FIGURE OF 8 BANDAGE Procedure ORTHOPAEDICS 670 705 840 970 STRAPPING NASAL BONE PORT050 Procedure ORTHOPAEDICS 670 705 840 970 FRACTURE PORT036 PT BRACING - PORT Procedure ORTHOPAEDICS 800 840 1000 1160 PLASTER OF PARIS APPLICATION - PORT033 Procedure ORTHOPAEDICS 860 905 1075 1245 MINOR - ORT EXTERNAL FIXATOR REMOVAL - PORT012 Procedure ORTHOPAEDICS 1155 1215 1445 1675 MEDIUM PORT018 JACKET - MINERVA 5.12 Procedure ORTHOPAEDICS 1240 1300 1550 1800 PORT023 K-WIRES REMOVAL - MAJOR Procedure ORTHOPAEDICS 1240 1300 1550 1800 PORT041 STERNAL MARROW ASPIRATION Procedure ORTHOPAEDICS 1240 1300 1550 1800 PLASTER OF PARIS APPLICATION - PORT032 Procedure ORTHOPAEDICS 1300 1365 1625 1885 MEDIUM - ORT PORT057 TUBE PLASTER 5.9 Procedure ORTHOPAEDICS 1365 1435 1705 1980 CLOSED REDUCTION OF PORT003 Procedure ORTHOPAEDICS 1440 1510 1800 2090 FRACTURES - MINOR EXTERNAL FIXATOR REMOVAL - PORT011 Procedure ORTHOPAEDICS 1440 1510 1800 2090 MAJOR PLASTER OF PARIS APPLICATION - PORT031 Procedure ORTHOPAEDICS 1440 1510 1800 2090 MAJOR - ORT PORT006 COLLES FRACTURE FULL PLASTER Procedure ORTHOPAEDICS 2155 2265 2695 3125 PORT019 JACKET - PLASTER 5.13 Procedure ORTHOPAEDICS 2300 2415 2875 3335 PORT037 SHOULDER SPIKA 5.14 Procedure ORTHOPAEDICS 2300 2415 2875 3335 PORT038 SINGLE HIP SPIKA ADULT CHILD Procedure ORTHOPAEDICS 2300 2415 2875 3335 CLOSED REDUCTION OF PORT002 Procedure ORTHOPAEDICS 2445 2565 3055 3545 FRACTURES - MEDIUM

68 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EXTERNAL FIXATOR REMOVAL - PORT014 Procedure ORTHOPAEDICS 2445 2565 3055 3545 SUPRA CLOSED REDUCTION OF PORT001 Procedure ORTHOPAEDICS 4735 4970 5920 6865 FRACTURES - MAJOR - PORT BONE BIOPSY - MINOR (Needle ORTHOPEDICS LORT001 Biopsy from subcutaneous bone ) L1 Surgery 4505 4730 5630 6530 SURGERY (ORT) # L1 CLOSED REDUCTION OF DISLOCATIONS INCLUDING ORTHOPEDICS LORT002 PLASTER APPLICATION - L1 Surgery 4505 4730 5630 6530 SURGERY MINOR (Closed reduction of Interphalangeal dislocations IMPLANT REMOVAL MINOR (Removal of percutaneous pins/ ORTHOPEDICS LORT003 L1 Surgery 4505 4730 5630 6530 wires and change of plaster) (ORT) SURGERY # L1 INCISION & DRAINAGE - MINOR ORTHOPEDICS LORT004 (Subcutaneous Abcesses or L1 Surgery 4505 4730 5630 6530 SURGERY Haematoma) (ORT) # L1 JOINT ASPIRATION - MINOR ORTHOPEDICS LORT005 (Aspiration of small superficial L1 Surgery 4505 4730 5630 6530 SURGERY joint) (ORT) # L1 WOUND DEBRIDEMENT MINOR (Debridement of Gustilo Type 1 ORTHOPEDICS LORT006 L1 Surgery 4505 4730 5630 6530 compound injuries or equivalent) SURGERY (ORT) # L1 ORTHOPEDICS LORT007 WOUND DRESSING (ORT) # L1 L1 Surgery 4505 4730 5630 6530 SURGERY AMPUTATION TOE, DIGIT - MINOR ORTHOPEDICS LORT008 L2 Surgery 0 8655 10305 11955 (Single) (ORT) # L2 SURGERY ARTHROTOMY INTER (Arthrotomy ORTHOPEDICS LORT009 of small joints of hands and feet) L2 Surgery 0 8655 10305 11955 SURGERY (ORT) # L2 BONE BIOPSY - INTER (Open Biopsy ORTHOPEDICS LORT010 of Subcutaneous Bones (Eg: Ulna, L2 Surgery 0 8655 10305 11955 SURGERY Tibia)) (ORT) # L2 BOTOX INJECTION ONE SITE ORTHOPEDICS LORT011 L2 Surgery 0 8655 10305 11955 (ORT) # L2 SURGERY CLOSED REDUCTION OF DISLOCATIONS INCLUDING ORTHOPEDICS LORT012 PLASTER APPLICATION INTER L2 Surgery 0 8655 10305 11955 SURGERY (Closed Reduction of TM joint, wrist, MCP or MTP jo CLOSED REDUCTION OF FRACTURES INTER INCLUDING ORTHOPEDICS LORT013 PLASTER APPLICATION (Closed L2 Surgery 0 8655 10305 11955 SURGERY Reduction of Distal Radius) (ORT) # L2

69 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CLUB FOOT MANIPULATION/ PERCUTANEOUS TENOTOMY ORTHOPEDICS LORT014 L2 Surgery 0 8655 10305 11955 INCLUDING CAST APPLICATION - SURGERY UNILATERAL (ORT) # L2 DEQUERVAIN'S RELEASE (SORT) ORTHOPEDICS LORT015 L2 Surgery 0 8655 10305 11955 # L2 SURGERY ORTHOPEDICS LORT016 EPIDURAL INJECTION (ORT) # L2 L2 Surgery 0 8655 10305 11955 SURGERY FOREIGN BODY REMOVAL - ORTHOPEDICS LORT017 L2 Surgery 0 8655 10305 11955 SURFACE (NON CAVITY) (ORT) # L2 SURGERY IMPLANT REMOVAL INTER (Removal of Deep seated K-wires, ORTHOPEDICS LORT018 TBWs,TENS nails and Rush L2 Surgery 0 8655 10305 11955 SURGERY Pins, Screws alone including Dynamizatio INCISION & DRAINAGE - INTER (Subfascial or Intra/intermuscular ORTHOPEDICS LORT019 L2 Surgery 0 8655 10305 11955 abscesses or Haematoma) (ORT) SURGERY # L2 INTRA-ARTICULAR INJECTION ORTHOPEDICS LORT020 L2 Surgery 0 8655 10305 11955 (ORT) # L2 SURGERY JOINT ASPIRATION INTER WITH ORTHOPEDICS LORT021 INTRA-ARTICULAR INJECTION L2 Surgery 0 8655 10305 11955 SURGERY (ORT) # L2 M U A (Manipulation under GA of a ORTHOPEDICS LORT022 stiff joint- Shoulder, Elbow, Knee) - L2 Surgery 0 8655 10305 11955 SURGERY AS SOLE PROCEDURE (ORT) # L2 OSTEOMYELITIS SURGERY MINOR ORTHOPEDICS LORT023 (Removal of subcutaneous L2 Surgery 0 8655 10305 11955 SURGERY sequestrum) (ORT) # L2 SECONDARY SUTURING MINOR ORTHOPEDICS LORT024 (Wound size 5cm or less) (ORT) L2 Surgery 0 8655 10305 11955 SURGERY # L2 ORTHOPEDICS LORT025 SKELETAL TRACTION (ORT) # L2 L2 Surgery 0 8655 10305 11955 SURGERY SKIN GRAFTING MINOR (Wound ORTHOPEDICS LORT026 L2 Surgery 0 8655 10305 11955 size 5cm or less) (ORT) # L2 SURGERY WOUND DEBRIDEMENT INTER (Debridement of Gustilo Type 2 ORTHOPEDICS LORT027 L2 Surgery 0 8655 10305 11955 compound injuries or equivalent) SURGERY (ORT) # L2 WOUND DRESSING WITH CHANGE ORTHOPEDICS LORT028 L2 Surgery 0 8655 10305 11955 OF PLASTER (ORT) # L2 SURGERY ADDUCTOR TENOTOMY (SORT) # ORTHOPEDICS LORT029 L3 Surgery 0 11365 13530 15695 L3 SURGERY AMPUTATIONS - INTER (Amputations of Digits/ ORTHOPEDICS LORT030 L3 Surgery 0 11365 13530 15695 Toes (Multiple) excuding Ray SURGERY amputation) (ORT) # L3

70 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ARTHROGRAM - HIP - ONE JOINT ORTHOPEDICS LORT031 L3 Surgery 0 11365 13530 15695 (ORT) # L3 SURGERY ORTHOPEDICS LORT032 BICEPS TENOTOMY (ORT) # L3 L3 Surgery 0 11365 13530 15695 SURGERY BONE GRAFTING AUTOGENOUS ORTHOPEDICS LORT033 L3 Surgery 0 11365 13530 15695 ILIAC CREST (ORT) # L3 SURGERY Bone /Soft tissue Tumour Surgery Inter (Curretage of Bone Tumours ORTHOPEDICS LORT034 L3 Surgery 0 11365 13530 15695 of Digits/ Excisional Biopsy of Soft SURGERY tissue tumours <5 BOTOX INJECTION TWO SITES ORTHOPEDICS LORT035 L3 Surgery 0 11365 13530 15695 (ORT) # L3 SURGERY CARPAL TUNNEL RELEASE ORTHOPEDICS LORT036 L3 Surgery 0 11365 13530 15695 (UNILATERAL) (ORT) # L3 SURGERY EXTERNAL FIXATOR REMOVAL ORTHOPEDICS LORT037 L3 Surgery 0 11365 13530 15695 (ORT) # L3 SURGERY FASCIOTOMY - FOREARM OR LEG ORTHOPEDICS LORT038 L3 Surgery 0 11365 13530 15695 (ORT) # L3 SURGERY ORTHOPEDICS LORT039 GANGLION EXCISION (ORT) # L3 L3 Surgery 0 11365 13530 15695 SURGERY MUA WITH INTRA-ARTICULAR ORTHOPEDICS LORT040 L3 Surgery 0 11365 13530 15695 INJECTION (ORT) # L3 SURGERY Open/Closed Reduction & Percutaneous/Internal Fixation ORTHOPEDICS LORT041 L3 Surgery 0 11365 13530 15695 of Fractures- Inter including Cast SURGERY application,(including Phalang OPEN REDUCTION OF DISLOCATION - INTER INCLUDING CAST ORTHOPEDICS LORT042 L3 Surgery 0 11365 13530 15695 APPLICATION (Open Reduction of SURGERY small joints of hands and feet) (ORT SECONDARY SUTURING INTER ORTHOPEDICS LORT043 (Wound size exceeding 5 cm) (ORT) L3 Surgery 0 11365 13530 15695 SURGERY # L3 SKIN GRAFTING INTER (Wound size ORTHOPEDICS LORT044 L3 Surgery 0 11365 13530 15695 5-15 cm) (ORT) # L3 SURGERY ORTHOPEDICS LORT045 SYNOVIAL BIOPSY (ORT) # L3 L3 Surgery 0 11365 13530 15695 SURGERY TENDON REPAIR INTER (Tendon ORTHOPEDICS LORT046 L3 Surgery 0 11365 13530 15695 gap less than 2 cm) (ORT) # L3 SURGERY TRIGGER FINGER RELEASE (SORT) ORTHOPEDICS LORT047 L3 Surgery 0 11365 13530 15695 # L3 SURGERY ARTHRODESIS INTER WITH INTERNAL FIXATION & CAST ORTHOPEDICS LORT048 L4 Surgery 0 15535 18495 21455 APPLICATION (Arthrodesis of SURGERY Interphalangeal joints) (ORT) # L4 ARTHROSCOPY -DIAGNOSTIC - AS ORTHOPEDICS LORT049 L4 Surgery 0 15535 18495 21455 SOLE PROCEDURE (ORT) # L4 SURGERY

71 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ARTHROTOMY MAJOR (Arthrotomy ORTHOPEDICS LORT050 of Major joints- Hip, Knee, ankle, L4 Surgery 0 15535 18495 21455 SURGERY shoulder, elbow, wrist) (ORT) # L4 BONE GRAFTING INTER -AUTOGENOUS (Bone Grafting ORTHOPEDICS LORT051 -AUTOGENOUS from Proximal ulna, L4 Surgery 0 15535 18495 21455 SURGERY Proximal Tibia or Distal radius) (ORT) # BOTOX INJECTION THREE OR ORTHOPEDICS LORT052 L4 Surgery 0 15535 18495 21455 MORE SITES IN A LIMB (ORT) # L4 SURGERY CLOSED REDUCTION OF DISLOCATIONS INCLUDING ORTHOPEDICS LORT053 PLASTER APPLICATION MAJOR L4 Surgery 0 15535 18495 21455 SURGERY (Closed Reduction of Major Joints -Shoulder, Elbow, CLOSED REDUCTION OF FRACTURES - MAJOR - SORT ORTHOPEDICS LORT054 INCLUDING PLASTER APPLICATION L4 Surgery 0 15535 18495 21455 SURGERY (Closed Reduction of Radius & Ulna, Humerus, CLUB FOOT MANIPULATION/ PERCUTANEOUS TENOTOMY ORTHOPEDICS LORT055 L4 Surgery 0 15535 18495 21455 INCLUDING CAST APPLICATION - SURGERY BILATERAL (ORT) # L4 CONGENITAL DISLOCATION CLOSED REDUCTION -and ORTHOPEDICS LORT056 Frog POP (including dynamic L4 Surgery 0 15535 18495 21455 SURGERY arthrogram, traction and soft tissue release) ( ORTHOPEDICS LORT139 Excision Arthroplasty Hip Surgery 0 15535 18495 21455 SURGERY FASCIA RELEASE SURGERY (ORT) ORTHOPEDICS LORT057 L4 Surgery 0 15535 18495 21455 # L4 SURGERY FOREIGN BODY REMOVAL - DEEP ORTHOPEDICS LORT058 L4 Surgery 0 15535 18495 21455 (CAVITY) (ORT) # L4 SURGERY IMPLANT REMOVAL MAJOR (Removal of Plate & screws, ORTHOPEDICS LORT059 L4 Surgery 0 15535 18495 21455 intramedullary nails excluding Rush SURGERY pins & TENS nails) (ORT) # L4 ORTHOPEDICS LORT060 JOINT DEBRIDEMENT (ORT) # L4 L4 Surgery 0 15535 18495 21455 SURGERY OPEN REDUCTION OF DISLOCATION - MAJOR INCLUDING INTERNAL ORTHOPEDICS LORT061 FIXATION & CAST APPLICATION L4 Surgery 0 15535 18495 21455 SURGERY (Open Reduction of Major Joints -Sh OSTEOMYELITIS SURGERY INTER (Curettage, Debridement and/or ORTHOPEDICS LORT062 L4 Surgery 0 15535 18495 21455 Sequestrectomy of Bones of hands SURGERY and feet excluding Talus & C

72 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group OSTEOTOMIES INTER WITH INTERNAL FIXATION AND ORTHOPEDICS LORT063 CAST APPLICATION (Corrective L4 Surgery 0 15535 18495 21455 SURGERY osteotomies of Phalanges , Metacarpals and Met SOFT TISSUE CORRECTION OF DEFORMITIES -INTER WITH ORTHOPEDICS LORT064 L4 Surgery 0 15535 18495 21455 INTERNAL FIXATION & CAST SURGERY APPLICATION (ORT) # L4 SURGERY FOR POLIO CEREBRAL PALSY - INTER INCLUDING CAST ORTHOPEDICS LORT065 L4 Surgery 0 15535 18495 21455 APPLICATION (TENOTOMY/TENDON SURGERY RELEASE) (ORT) # L4 TORTICOLLIS-UNIPOLAR RELEASE ORTHOPEDICS LORT066 L4 Surgery 0 15535 18495 21455 (ORT) # L4 SURGERY WOUND DEBRIDEMENT MAJOR (Debridement of Gustilo Type 3 ORTHOPEDICS LORT067 L4 Surgery 0 15535 18495 21455 (including subtypes) compound SURGERY injuries or equivalent) (ORT) # L4 ORTHOPEDICS LORT068 AC JOINT EXCISION (ORT) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ORTHOPEDICS LORT069 AC JOINT FIXATION (ORT) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ARTHROSCOPIC SURGERY - MAJOR (Arthroscopic Meniscal surgeries, ORTHOPEDICS LORT070 L5 Surgery 0 18910 22515 26115 synovectomy, Debridement, SURGERY Microdrilling, Cartilage Biopsy BICEPS TENODESIS -OPEN (ORT) ORTHOPEDICS LORT071 L5 Surgery 0 18910 22515 26115 # L5 SURGERY Bone /Soft tissue Tumour Surgery Major (Curretage of Bone Tumours ORTHOPEDICS LORT072 L5 Surgery 0 18910 22515 26115 of Long bones including cast SURGERY application/ Excisional B CARPAL TUNNEL RELEASE ORTHOPEDICS LORT073 L5 Surgery 0 18910 22515 26115 (BILATERAL) (ORT) # L5 SURGERY CLUB FOOT SURGERY INCLUDING CAST APPLICATION (PMSTR/ ORTHOPEDICS LORT074 L5 Surgery 0 18910 22515 26115 LATERAL COLUMN PROCEDURES/ SURGERY JESS) (ORT) # L5 CORE DECOMPRESSION FOR AVN ORTHOPEDICS LORT075 L5 Surgery 0 18910 22515 26115 (ORT) # L5 SURGERY ORTHOPEDICS LORT076 EXCISION RADIAL HEAD (ORT) # L5 L5 Surgery 0 18910 22515 26115 SURGERY EXTERNAL FIXATOR APPLICATION ORTHOPEDICS LORT077 L5 Surgery 0 18910 22515 26115 (ORT) # L5 SURGERY HEMIARTHROPLASTY - HIP OR ORTHOPEDICS LORT078 L5 Surgery 0 18910 22515 26115 SHOULDER (ORT) # L5 SURGERY ORTHOPEDICS LORT079 INTER LOCKING NAILING (ORT) # L5 L5 Surgery 0 18910 22515 26115 SURGERY

73 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group Opn/Clos Reductn & Percutan/Intnl Fixatn of Maj Lng Bones incdg Cast ORTHOPEDICS LORT080 L5 Surgery 0 18910 22515 26115 applicatn (incdg Plating/TENS nailg SURGERY of Lng bones,Bi OSTEOMYELITIS SURGERY MAJOR (Curettage, Debridement and/ ORTHOPEDICS LORT081 L5 Surgery 0 18910 22515 26115 or Sequestrectomy of Major long SURGERY bones Bones including Talus & ca ORTHOPEDICS LORT082 PATELLECTOMY (ORT) # L5 L5 Surgery 0 18910 22515 26115 SURGERY Posterior decompression of dorsal ORTHOPEDICS LORT083 L5 Surgery 0 18910 22515 26115 Spine Multiple levels (ORT) # L5 SURGERY Posterior decompression of dorsal ORTHOPEDICS LORT084 L5 Surgery 0 18910 22515 26115 Spine - Single level (ORT) # L5 SURGERY SHOULDER ROTATOR CUFF REPAIR ORTHOPEDICS LORT085 L5 Surgery 0 18910 22515 26115 (ORT) # L5 SURGERY SKIN GRAFTING MAJOR (Wound ORTHOPEDICS LORT086 L5 Surgery 0 18910 22515 26115 size > 15 cm) (ORT) # L5 SURGERY SLIPPED CAPITAL FEMORAL EPIPHYSIS- PROPHYLACTIC ORTHOPEDICS LORT087 L5 Surgery 0 18910 22515 26115 PINNING INCLUDING CAST SURGERY APPLICATION (ORT) # L5 SURGERY FOR POLIO CEREBRAL PALSY - MAJOR INCLUDING CAST ORTHOPEDICS LORT088 APPLICATION - SINGLE SITE SOFT L5 Surgery 0 18910 22515 26115 SURGERY TISSUE RELEASE/SINGLE TENDON TRAN TENDON LENGTHENING (ORT) ORTHOPEDICS LORT089 INCLUDING CAST APPLICATION L5 Surgery 0 18910 22515 26115 SURGERY (ORT) # L5 TENDON REPAIR MAJOR INCLUDING CAST APPLICATION ORTHOPEDICS LORT090 (Repair of Tendoachilles, patellar L5 Surgery 0 18910 22515 26115 SURGERY tendon or quadriceps tendon) (ORT) # L TORTICOLLIS-BIPOLAR RELEASE ORTHOPEDICS LORT091 L5 Surgery 0 18910 22515 26115 (ORT) # L5 SURGERY AMPUTATIONS - MAJOR (Amputations- Lisfrancs, Symes, ORTHOPEDICS LORT092 L6 Surgery 0 28355 33755 39155 Transtibial, Transfemoral, Forearm SURGERY & Transhumeral) (ORT) # L6 ARTHRODESIS MAJOR INCLUDING INTERNAL FIXATION & CAST ORTHOPEDICS LORT093 L6 Surgery 0 28355 33755 39155 APPLICATION (Arthrodesis of Major SURGERY Joints including Shoulder, elcow, ARTHROSCOPIC FROZEN ORTHOPEDICS LORT094 L6 Surgery 0 28355 33755 39155 SHOULDER RELEASE (ORT) # L6 SURGERY ARTHROSCOPIC SUBACROMIAL ORTHOPEDICS LORT095 L6 Surgery 0 28355 33755 39155 DECOMPRESSION (ORT) # L6 SURGERY

74 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group AUTOLOGOUS CHONDROCYTE ORTHOPEDICS LORT096 L6 Surgery 0 28355 33755 39155 IMPLANTATION (ORT) # L6 SURGERY CONGENITAL DISLOCATION OPEN REDUCTION and Frog POP ORTHOPEDICS LORT097 (including traction and innominate/ L6 Surgery 0 28355 33755 39155 SURGERY femoral ostetotomy/pelvic & femora CORE DECOMPRESSION FOR AVN ORTHOPEDICS LORT098 L6 Surgery 0 28355 33755 39155 WITH ABI (ORT) # L6 SURGERY CORRECTIVE SURGERIES FOR CONGENITAL DISLOCATIONS- ORTHOPEDICS LORT099 L6 Surgery 0 28355 33755 39155 MAJOR INCLUDING CAST SURGERY APPLICATION (ORT) # L6 CORRECTIVE SURGERIES FOR CONGENITAL VERTICAL TALUS, ORTHOPEDICS LORT100 L6 Surgery 0 28355 33755 39155 INCLUDING CAST APPLICATION SURGERY (ORT) # L6 DISARTICULATION - HIP, KNEE OR ORTHOPEDICS LORT101 L6 Surgery 0 28355 33755 39155 SHOULDER (ORT) # L6 SURGERY HIGH TIBIAL OSTEOTOMY ORTHOPEDICS LORT102 INCLUDING INTERNAL FIXATION & L6 Surgery 0 28355 33755 39155 SURGERY CAST APPLICATION (ORT) # L6 LIGAMENT RECONSTRUCTION- ORTHOPEDICS LORT103 L6 Surgery 0 28355 33755 39155 MAJOR JOINT (ORT) # L6 SURGERY NERVE SURGERY MAJOR (Neurolysis with or without ORTHOPEDICS LORT104 L6 Surgery 0 28355 33755 39155 Transposition of peripheral nerves, SURGERY nerve suturing) (ORT) # L6 OPEN REDUCTION OF DISLOCATION - SUPRA INCLUDING INTERNAL ORTHOPEDICS LORT105 L6 Surgery 0 28355 33755 39155 FIXATION AND CAST APPLICATION SURGERY (Open reduction of Old unreduced OSTEOTOMIES MAJOR INCLUDING INTERNAL FIXATION AND CAST ORTHOPEDICS LORT106 APPLICATION (Osteotomies of L6 Surgery 0 28355 33755 39155 SURGERY major long bones including Talus, cal PATELLA RECURRENT ORTHOPEDICS LORT107 DISLOCATION INCLUDING CAST L6 Surgery 0 28355 33755 39155 SURGERY APPLICATION (ORT) # L6 SHOULDER RECURRENT ORTHOPEDICS LORT108 DISLOCATION-CORRECTIVE L6 Surgery 0 28355 33755 39155 SURGERY SURGERY (ORT) # L6 SHOULDER RESURFACING ORTHOPEDICS LORT109 L6 Surgery 0 28355 33755 39155 ARTHROPLASTY (ORT) # L6 SURGERY SLIPPED CAPITAL FEMORAL EPIPHYSIS- OPEN REDUCTION/ ORTHOPEDICS LORT110 SURGICAL DISLOCATION L6 Surgery 0 28355 33755 39155 SURGERY INCLUDING CAST APPLICATION (ORT) # L6

75 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SURGERY FOR NON UNION OF FRACTURES MAJOR INCLUDING ORTHOPEDICS LORT111 L6 Surgery 0 28355 33755 39155 INTERNAL FIXATION & CAST SURGERY APPLICATION (ORT) # L6 TENDON TRANSFER INCLUDING ORTHOPEDICS LORT112 CAST APPLICATION - SINGLE (ORT) L6 Surgery 0 28355 33755 39155 SURGERY # L6 TOTAL KNEE ARTHROPLASTY (ORT) ORTHOPEDICS LORT113 L6 Surgery 0 28355 33755 39155 # L6 SURGERY AC JOINT RECONSTRUCTION (ORT) ORTHOPEDICS LORT114 L7 Surgery 0 37815 45020 52220 # L7 SURGERY ARTHROSCOPIC BICEPS ORTHOPEDICS LORT115 L7 Surgery 0 37815 45020 52220 TENODESIS (ORT) # L7 SURGERY ARTHROSCOPIC LABRAL REPAIR ORTHOPEDICS LORT116 MAJOR (eg: isolated pathology) L7 Surgery 0 37815 45020 52220 SURGERY (ORT) # L7 ARTHROSCOPIC SLAP REPAIR (ORT) ORTHOPEDICS LORT117 L7 Surgery 0 37815 45020 52220 # L7 SURGERY ARTHROSCOPIC SURGERY - SUPRA (Arthroscopic Ligament ORTHOPEDICS LORT118 Reconstruction, OATS, including L7 Surgery 0 37815 45020 52220 SURGERY additional meniscal surgeries) (ORT) BONE TUMOUR SURGERY SUPRA (Tumour Excision and Limb ORTHOPEDICS LORT119 preservation including Bone L7 Surgery 0 37815 45020 52220 SURGERY grafting & internal Fixation) (ORT) # L7 CORE DECOMPRESSION FOR AVN ORTHOPEDICS LORT120 WITH FIBULAR BONE GRAFTING L7 Surgery 0 37815 45020 52220 SURGERY (ORT) # L7 ILIZAROV/ DISTRACTOR FOR UPPER ORTHOPEDICS LORT121 L7 Surgery 0 37815 45020 52220 LIMB (ORT) # L7 SURGERY ORTHOPEDICS LORT122 LIMB LENGTHENING (ORT) # L7 L7 Surgery 0 37815 45020 52220 SURGERY OPEN REDUCTION AND INTERNAL FIXATION OF FRACTURES - SUPRA ORTHOPEDICS LORT123 L7 Surgery 0 37815 45020 52220 INCLUDING CAST APPLICATION SURGERY (ORT) # L7 PELVIC OSTEOTOMY/ ORTHOPEDICS LORT124 L7 Surgery 0 37815 45020 52220 ACETABULOPLASTY (ORT) # L7 SURGERY SURGERY FOR NON UNION OF FRACTURES SUPRA INCLUDING ORTHOPEDICS LORT125 L7 Surgery 0 37815 45020 52220 INTERNAL FIXATION & CAST SURGERY APPLICATION (ORT) # L7 TOTAL JOINT REPLACEMENTS ORTHOPEDICS LORT126 (KNEE, HIP, SHOULDER & ELBOW, L7 Surgery 0 37815 45020 52220 SURGERY PRIMARY) (ORT) # L7

76 Orthopaedics

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group AMPUTATIONS - SUPRA ORTHOPEDICS LORT127 (Forequarter, Hindquarter, L8 Surgery 0 47265 56270 65270 SURGERY Hemipelvectomy) (ORT) # L8 ARTHROSCOPIC LABRAL REPAIR ORTHOPEDICS LORT128 - SUPRA (Eg: BANKART + SLAP L8 Surgery 0 47265 56270 65270 SURGERY REPAIR) (ORT) # L8 ARTHROSCOPIC SUBACROMIAL ORTHOPEDICS LORT129 DECOMPRESSION + ACJ EXCISION L8 Surgery 0 47265 56270 65270 SURGERY (ORT) # L8 CEREBRAL PALSY- MULTILEVEL SURGERY IN ONE LIMB (BONY ORTHOPEDICS LORT130 L8 Surgery 0 47265 56270 65270 AND SOFT TISSUE DEFORMITY SURGERY CORRECTION) (ORT) # L8 ORTHOPEDICS LORT131 CERVICAL RIB EXCISION (ORT) # L8 L8 Surgery 0 47265 56270 65270 SURGERY REVISION PAEDIATRIC HIP ORTHOPEDICS LORT132 L8 Surgery 0 47265 56270 65270 SURGERY (ORT) # L8 SURGERY REVISION TOTAL HIP ORTHOPEDICS LORT133 L8 Surgery 0 47265 56270 65270 REPLACEMENT (ORT) # L8 SURGERY REVISION TOTAL KNEE ORTHOPEDICS LORT134 L8 Surgery 0 47265 56270 65270 REPLACEMENT (ORT) # L8 SURGERY SURGERY FOR POLIO CEREBRAL PALSY - SUPRA INCLUDING CAST ORTHOPEDICS LORT135 APPLICATION (COMBINED BONY L8 Surgery 0 47265 56270 65270 SURGERY AND SOFT TISSUE PROCEDURE WITH FIXATI TELESCOPIC NAILING IN ORTHOPEDICS LORT136 OSTEOGENESIS IMPERFECTA (ORT) L8 Surgery 0 47265 56270 65270 SURGERY # L8 REVERSE SHOULDER ORTHOPEDICS LORT137 L9 Surgery 0 56710 67515 78315 REPLACEMENT (ORT) # L9 SURGERY

77 Department of Renal Sciences

78 Nephrology

79 Nephrology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

NEPHROLOGY KNEP005 KIDNEY BIOPSY (N) Package 0 30550 36370 42190 PACKAGE RENAL TRANSPLANT RECIPIENT NEPHROLOGY KKNEP002 Package 0 554250 659820 765390 PACKAGE PACKAGE NEPHROLOGY KKNEP001 RENAL TRANSPLANT DONOR PACKAGE Package 0 1 1 1 PACKAGE RENAL TRANSPLANT RECIPIENT NEPHROLOGY KKNEP009 Package 0 717260 853880 990500 SUBSIDIES PACKAGE PACKAGE LIVER LIVER TRANSPLANT ? DONOR KKLTP005 Package TRANSPLANT 0 1 1 1 PACKAGE PACKAGE LIVER kidney &Pancreas TRANSPLANT KKLTP006 Package TRANSPLANT 0 1158000 1378570 1599140 RECIPIENT PACKAGE PACKAGE Bed / Nursing Charges for less than PNEP044 Procedure NEPHROLOGY 560 580 690 810 2 Hrs OBSERVATION AND MINOR PNEP030 Procedure NEPHROLOGY 760 800 950 1110 PROCEDURE Bed / Nursing Charges for more than PNEP045 Procedure NEPHROLOGY 920 970 1150 1340 2 Hrs SCREENING ULTRASOUND CHARGES PNEP050 Procedure NEPHROLOGY 1100 1150 1370 1590 - RICU RENAL-IV DRUG THERAPY CHARGES PNEP054 ( IV Cyclophosphamide / IV Rituximab Procedure NEPHROLOGY 3420 3590 4270 4960 Infusion ) PNEP076 CENTRAL LINE WITH USG Procedure NEPHROLOGY 4100 4300 5120 5940 NEW DIALYSIS INITIATION & PNEP052 Procedure NEPHROLOGY 4100 4300 5120 5940 TREATMENT PLANNING ULTRASOUND SCREENING AND PNEP049 GUIDANCE FOR CENTRAL VENOUS Procedure NEPHROLOGY 4100 4300 5120 5940 CATHETER(CVC) INSERTION POST TRANSPLANT PLANNING - FIRST PNEP059 Procedure NEPHROLOGY 5470 5740 6830 7930 VISIT PRE - TRANSPLANT COUNSELLING PNEP051 FOR RENAL TRANSPLANT (RECIPIENT Procedure NEPHROLOGY 8200 8610 10250 11890 / DONOR) IMMUNOSUPRESSIVE DRUG THERAPY PNEP053 Procedure NEPHROLOGY 8740 9180 10930 12680 PLANNING PNEP029 KIDNEY BIOPSY Procedure NEPHROLOGY 12020 12620 15030 17430 ABOi Compatible Kidney Transplant PNEP065 Procedure NEPHROLOGY 13670 14350 17080 19810 Management ABOi Compatible Kidney Transplant PNEP064 Procedure NEPHROLOGY 13670 14350 17080 19810 Preparation PNEP063 Post Kidney Transplant Desensitization Procedure NEPHROLOGY 13670 14350 17080 19810 PNEP062 Pre Kidney Transplant Desensitization Procedure NEPHROLOGY 13670 14350 17080 19810 NEPHROLOGY PNEP055 ACT (Activated Clotting Time) TEST Procedure 280 290 350 410 DIALYSIS

80 Nephrology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

NEPHROLOGY PNEP060 BIO SCAN ANALYSIS - FULL TEST Procedure 630 660 780 910 DIALYSIS BIO SCAN ANALYSIS - SEGAMENTAL NEPHROLOGY PNEP061 Procedure 760 800 950 1110 TEST DIALYSIS NEPHROLOGY PNEP047 MAINTENANCE DIALYSIS (BSHT) Procedure 820 860 1030 1190 DIALYSIS NEPHROLOGY PNEP036 PLEURAL/ ASCITIC TAPPING Procedure 2050 2150 2560 2970 DIALYSIS MAINTENANCE DIALYSIS ( Above 15 NEPHROLOGY PNEP077 Procedure 2210 2320 2760 3210 years ) DIALYSIS NEPHROLOGY PNEP073 SDHD - Short Daily Hemo Dialysis Procedure 2470 2590 3080 3570 DIALYSIS MAINTENANCE DIALYSIS ( Above 12 NEPHROLOGY PNEP040 Procedure 2520 2650 3150 3660 years ) DIALYSIS MAINTENANCE DIALYSIS ( Above 8 NEPHROLOGY PNEP039 Procedure 2680 2820 3350 3890 years ) DIALYSIS MAINTENANCE DIALYSIS ( Above 4 NEPHROLOGY PNEP038 Procedure 2830 2980 3540 4110 years ) DIALYSIS NEPHROLOGY PNEP008 DIALYSIS - GC - 10% Procedure 3140 3300 3930 4560 DIALYSIS NEPHROLOGY PNEP009 DIALYSIS - GC - 100% Procedure 3140 3300 3930 4560 DIALYSIS NEPHROLOGY PNEP010 DIALYSIS - GC - 20% Procedure 3140 3300 3930 4560 DIALYSIS NEPHROLOGY PNEP016 MAINTENANCE DIALYSIS Procedure 3140 3300 3930 4560 DIALYSIS DIALYSIS NOCTURNAL - ( Above 12 NEPHROLOGY PNEP043 Procedure 3280 3450 4100 4760 years ) DIALYSIS DIALYSIS NOCTURNAL - ( Above 8 NEPHROLOGY PNEP042 Procedure 3700 3880 4620 5360 years ) DIALYSIS NEPHROLOGY PNEP056 SINGLE USE DIALYSIS Procedure 3700 3880 4620 5360 DIALYSIS DIALYSIS NOCTURNAL - ( Above 4 NEPHROLOGY PNEP041 Procedure 3900 4100 4880 5660 years ) DIALYSIS NEPHROLOGY PNEP037 CAPD -TRANSFER SET CHANGE Procedure 4100 4300 5120 5940 DIALYSIS NEPHROLOGY PNEP022 DIALYSIS NOCTURNAL Procedure 4100 4300 5120 5940 DIALYSIS NEPHROLOGY PNEP023 DIALYSIS NOCTURNAL - GC - 20% Procedure 4100 4300 5120 5940 DIALYSIS NEPHROLOGY PNEP011 DIALYSIS - HEPARIN FREE Procedure 4460 4680 5570 6460 DIALYSIS NEPHROLOGY PNEP034 NO REUSE DIALYSIS Procedure 4700 4930 5870 6810 DIALYSIS NEPHROLOGY PNEP033 PLASMAPHERESIS (SUBSEQUENT) Procedure 5470 5740 6830 7930 DIALYSIS

81 Nephrology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

NEPHROLOGY PNEP048 PERMCATH REMOVAL / REPOSITION Procedure 6160 6470 7700 8930 DIALYSIS NEPHROLOGY PNEP078 DIALYSIS 1ST Procedure 7390 7760 9230 10710 DIALYSIS NEPHROLOGY PNEP079 DIALYSIS EMERGENCY Procedure 7390 7760 9230 10710 DIALYSIS NEPHROLOGY PNEP072 DIALYSIS OP DELUX Procedure 7510 7890 9390 10890 DIALYSIS NEPHROLOGY PNEP007 DIALYSIS - CYCLED PERITONEAL Procedure 8200 8610 10250 11890 DIALYSIS NEPHROLOGY PNEP017 DIALYSIS MOBILE - A Procedure 8200 8610 10250 11890 DIALYSIS DIALYSIS - SUSTAINED LOW NEPHROLOGY PNEP013 Procedure 8200 8610 10250 11890 EFFICIENCY DIALYSIS NEPHROLOGY PNEP003 CATHETERISATION - FEMORAL Procedure 8880 9330 11100 12880 DIALYSIS NEPHROLOGY PNEP068 Endotoxin quantitative test Dialysate Procedure 9020 9470 11270 13080 DIALYSIS NEPHROLOGY PNEP066 Endotoxin quantitative test R.O water Procedure 9020 9470 11270 13080 DIALYSIS Endotoxin quantitative test Sterile NEPHROLOGY PNEP069 Procedure 9020 9470 11270 13080 water DIALYSIS NEPHROLOGY PNEP067 Endotoxin quantitative test UF water Procedure 9020 9470 11270 13080 DIALYSIS NEPHROLOGY PNEP024 DIALYSIS PERITONEAL - NEP Procedure 9370 9830 11710 13580 DIALYSIS NEPHROLOGY PNEP018 DIALYSIS MOBILE - B Procedure 9570 10050 11960 13880 DIALYSIS NEPHROLOGY PNEP019 DIALYSIS MOBILE - C Procedure 10930 11480 13660 15850 DIALYSIS NEPHROLOGY PNEP002 CATHETERISATION - DOUBLE LUMEN IJ Procedure 11620 12200 14520 16850 DIALYSIS CONTINUOUS RENAL REPLACEMENT NEPHROLOGY PNEP070 Procedure 11900 12490 14870 17250 THERAPY - ONLINE DIALYSIS NEPHROLOGY PNEP006 CVVH - MULTIFILTERATE Procedure 13390 14060 16740 19410 DIALYSIS CONTINUOUS RENAL REPLACEMENT NEPHROLOGY PNEP071 Procedure 20500 21520 25620 29720 THERAPY - OFFLINE DIALYSIS NEPHROLOGY PNEP001 CAPD TRAINING /COUNSELING Procedure 24590 25820 30740 35660 DIALYSIS NEPHROLOGY PNEP005 CVVH - PRISMA Procedure 24590 25820 30740 35660 DIALYSIS NEPHROLOGY PNEP035 PERM CATH MATERIAL CHARGES Procedure 25960 27260 32450 37640 DIALYSIS NEPHROLOGY PNEP032 PLASMAPHERESIS (1ST) Procedure 35530 37300 44410 51510 DIALYSIS

82 Nephrology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

NEPHROLOGY PNEP031 PERM CATH Procedure 39620 41600 49530 57450 DIALYSIS DFPP - DOUBLE DFPP - DOUBLE NEPHROLOGY PNEP075 FILTRATION PLASMA PHERESIS Procedure 45080 47340 56350 65370 DIALYSIS (SUBSEQUENT) PLASMAPHERESIS WITH GLYCOSORB NEPHROLOGY PNEP058 Procedure 50560 53090 63200 73310 COLUMN DIALYSIS PLASMAPHERESIS WITH DIALYSIS AND NEPHROLOGY PNEP057 Procedure 57390 60260 71740 83210 GLYCOSORB COLUMN DIALYSIS DFPP - DOUBLE FILTRATION PLASMA NEPHROLOGY PNEP074 Procedure 65580 68860 81970 95090 PHERESIS DIALYSIS

83 Urology

84 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ROBOTIC SURGERY PACKAGE - 1 UROLOGY KRKURO001 Package 0 293430 349320 405210 - URO PACKAGE PURO286 OXYGEN HOURLY - PURO Procedure UROLOGY 70 80 90 110 PURO283 INJECTION IM - PURO Procedure UROLOGY 100 100 120 140 PURO282 INJECTION IV-PURO Procedure UROLOGY 100 100 120 140 PURO281 INJECTION S/C - PURO Procedure UROLOGY 100 100 120 140 PURO284 IV CANULIZATION - PURO Procedure UROLOGY 100 100 120 140 PURO301 GRBS - PURO Procedure UROLOGY 110 110 130 160 FOLEY'S CATHETER CHANGING - PURO291 Procedure UROLOGY 200 210 250 290 PURO PURO290 FOLEY'S CATHETERIZATION - PURO Procedure UROLOGY 200 210 250 290 PURO287 NEBULIZATION - PURO Procedure UROLOGY 200 210 250 290 PURO295 BCG(INJECTION) - PURO Procedure UROLOGY 260 270 320 370 PURO302 BLADDER WASH - PURO Procedure UROLOGY 260 270 320 370 PURO296 CALIBRATION - PURO Procedure UROLOGY 260 270 320 370 CIC( CLEAN INTERMITENT PURO297 Procedure UROLOGY 260 270 320 370 CATHETER) - PURO PURO298 SUTURING MINOR - PURO Procedure UROLOGY 260 270 320 370 PURO292 WOUND DRESSING MINOR - PURO Procedure UROLOGY 260 270 320 370 PURO285 ECG - PURO Procedure UROLOGY 380 400 480 560 BED / NURSING CHARGES FOR PURO288 Procedure UROLOGY 480 500 590 690 LESS THAN 2HRS - PURO SPC(SUPRAPUBIC CATHETER) - PURO303 Procedure UROLOGY 480 500 590 690 PURO PURO299 SUTURING MEDIUM - PURO Procedure UROLOGY 480 500 590 690 WOUND DRESSING MEDIUM - PURO293 Procedure UROLOGY 480 500 590 690 PURO PURO300 SUTURING MAJOR - PURO Procedure UROLOGY 760 800 950 1110 PURO294 WOUND DRESSING MAJOR - PURO Procedure UROLOGY 760 800 950 1110 BED/ NURSING CHARGES FOR PURO289 Procedure UROLOGY 960 1010 1200 1390 MORE THAN 2HRS - PURO PURO015 UROFLOWMETRY Procedure UROLOGY 960 1010 1200 1390 PURO012 ELECTROMYGRAPHY Procedure UROLOGY 1300 1370 1630 1890 PURO014 URETHRAL PRESSURE PROFILE Procedure UROLOGY 1300 1370 1630 1890 PURO009 CYSTOMETRY Procedure UROLOGY 3700 3880 4620 5360 PURO016 AVF - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO008 CAVEMOSOMETRY Procedure UROLOGY 4510 4740 5640 6540 PURO052 CIRCUMCISSION - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO011 CYSTOGRAM Procedure UROLOGY 4510 4740 5640 6540

85 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group DJ STENT REMOVAL/CYSTOSCOPY PURO077 Procedure UROLOGY 4510 4740 5640 6540 WITH GA PURO078 EPIDIDYMECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO090 FRENEULOPLASTY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO096 HYDROCELECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO108 MEATOPLASTY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO120 ORCHIDECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO145 PENILE BIOPSY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO184 TESTICULAR BIOPSY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO196 TROCAR CYCTOSTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO203 TROCAR CYSTOSCOPY Procedure UROLOGY 4510 4740 5640 6540 PURO245 VARICOCELE LIGATION DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO257 VASECTOMY - DCOS1 Procedure UROLOGY 4510 4740 5640 6540 PURO013 PRESSURE FLOW METER Procedure UROLOGY 4650 4880 5810 6740 PURO017 AVF - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO079 EPIDIDYMECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO097 HYDROCELECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO109 MEATOPLASTY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO121 ORCHIDECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO146 PENILE BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO159 PROSTATE BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO185 TESTICULAR BIOPSY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO197 TROCAR CYCTOSTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO246 VARICOCELE LIGATION DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO258 VASECTOMY - DCOS1A Procedure UROLOGY 4790 5030 5980 6940 PURO158 PROSTATE BIOPSY - DCOS1 Procedure UROLOGY 5060 5320 6330 7340 PURO076 DJ STENT REMOVAL/CYSTOSCOPY Procedure UROLOGY 5330 5600 6660 7730 PURO053 CIRCUMCISSION - DCOS1A Procedure UROLOGY 5470 5740 6830 7930 PURO018 AVF - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO010 CYSTOMETRY WITH PF STUDY Procedure UROLOGY 5610 5890 7010 8130 PURO080 EPIDIDYMECTOMY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO091 FRENEULOPLASTY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO098 HYDROCELECTOMY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO110 MEATOPLASTY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO122 ORCHIDECTOMY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO147 PENILE BIOPSY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO160 PROSTATE BIOPSY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130

86 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO186 TESTICULAR BIOPSY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO204 TROCAR CYSTOSTOMY - DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO247 VARICOCELE LIGATION DCOS2 Procedure UROLOGY 5610 5890 7010 8130 PURO081 EPIDIDYMECTOMY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO099 HYDROCELECTOMY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO111 MEATOPLASTY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO123 ORCHIDECTOMY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO148 PENILE BIOPSY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PROSTATE BIOPSY - DCOS2 WITH PURO161 Procedure UROLOGY 6020 6320 7520 8730 GA PURO198 TROCAR CYCTOSTOMY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO248 VARICOCELE LIGATION DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO260 VASECTOMY - DCOS2A Procedure UROLOGY 6020 6320 7520 8730 PURO054 CIRCUMCISSION - DCOS2 Procedure UROLOGY 6560 6890 8200 9510 PURO144 PENILE BIOPSY - PURO Procedure UROLOGY 6700 7030 8370 9710 PURO157 PENILE BIOPSY WITH GA Procedure UROLOGY 6700 7030 8370 9710 PURO170 PROSTATE NEEDLE BIOPSY Procedure UROLOGY 6700 7030 8370 9710 PROSTATE NEEDLE BIOPSY WITH PURO171 Procedure UROLOGY 6700 7030 8370 9710 GA PURO019 AVF - DCOS2A Procedure UROLOGY 7110 7470 8890 10310 PURO055 CIRCUMCISSION - DCOS2A Procedure UROLOGY 7110 7470 8890 10310 PURO259 VASECTOMY - DCOS2 Procedure UROLOGY 7110 7470 8890 10310 PURO187 TESTICULAR BIOPSY - DCOS2A Procedure UROLOGY 7390 7760 9230 10710 PURO020 AVF - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO056 CIRCUMCISSION - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO082 EPIDIDYMECTOMY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO092 FRENEULOPLASTY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO100 HYDROCELECTOMY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO112 MEATOPLASTY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO124 ORCHIDECTOMY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO149 PENILE BIOPSY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO188 TESTICULAR BIOPSY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO249 VARICOCELE LIGATION DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO261 VASECTOMY - DCOS3 Procedure UROLOGY 7930 8320 9910 11490 PURO021 AVF - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO083 EPIDIDYMECTOMY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO101 HYDROCELECTOMY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290

87 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO125 ORCHIDECTOMY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO150 PENILE BIOPSY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO163 PROSTATE BIOPSY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO199 TROCAR CYCTOSTOMY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO250 VARICOCELE LIGATION DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO262 VASECTOMY - DCOS3A Procedure UROLOGY 8480 8900 10600 12290 PURO205 TROCAR CYSTOSTOMY - DCOS3 Procedure UROLOGY 8740 9180 10930 12680 PURO028 BLADDER BIOPSY - DCEP1 Procedure UROLOGY 9020 9470 11270 13080 PURO040 BNI - DCEP1 Procedure UROLOGY 9020 9470 11270 13080 PURO132 PCN - DCEP1 Procedure UROLOGY 9020 9470 11270 13080 PURO162 PROSTATE BIOPSY - DCOS3 Procedure UROLOGY 9020 9470 11270 13080 PURO209 URETERIC MEATOTOMY - DCEP1 Procedure UROLOGY 9020 9470 11270 13080 PURO244 URS + STENTING DECP1 Procedure UROLOGY 9020 9470 11270 13080 PURO269 VIU - DCEP1 Procedure UROLOGY 9020 9470 11270 13080 PURO029 BLADDER BIOPSY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880 PURO041 BNI - DCEP1A Procedure UROLOGY 9570 10050 11960 13880 PURO057 CIRCUMCISSION - DCOS3A Procedure UROLOGY 9570 10050 11960 13880 PURO065 CYSTOLITHOPAXY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880 PURO113 MEATOPLASTY - DCOS3A Procedure UROLOGY 9570 10050 11960 13880 PURO133 PCN - DCEP1A Procedure UROLOGY 9570 10050 11960 13880 PURO189 TESTICULAR BIOPSY - DCOS3A Procedure UROLOGY 9570 10050 11960 13880 PURO210 URETERIC MEATOTOMY - DCEP1A Procedure UROLOGY 9570 10050 11960 13880 PURO228 URS - DCEP51A Procedure UROLOGY 9570 10050 11960 13880 PURO022 AVF - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO064 CYSTOLITHOPAXY - DCEP1 Procedure UROLOGY 10110 10620 12640 14660 PURO084 EPIDIDYMECTOMY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO102 HYDROCELECTOMY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO114 MEATOPLASTY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO151 PENILE BIOPSY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO164 PROSTATE BIOPSY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO172 STENTING - DCEP1 Procedure UROLOGY 10110 10620 12640 14660 PURO190 TESTICULAR BIOPSY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO206 TROCAR CYSTOSTOMY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO231 URS - DECP1 Procedure UROLOGY 10110 10620 12640 14660 PURO251 VARICOCELE LIGATION DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO263 VASECTOMY - DCOS4 Procedure UROLOGY 10110 10620 12640 14660 PURO085 EPIDIDYMECTOMY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850

88 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO103 HYDROCELECTOMY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO115 MEATOPLASTY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO127 ORCHIDECTOMY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO152 PENILE BIOPSY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO173 STENTING - DCEP1A Procedure UROLOGY 10930 11480 13660 15850 PURO200 TROCAR CYCTOSTOMY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO233 URS + STENTING DCEP1A Procedure UROLOGY 10930 11480 13660 15850 PURO252 VARICOCELE LIGATION DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO264 VASECTOMY - DCOS4A Procedure UROLOGY 10930 11480 13660 15850 PURO270 VIU - DCEP1A Procedure UROLOGY 10930 11480 13660 15850 PURO058 CIRCUMCISSION - DCOS4 Procedure UROLOGY 11480 12060 14350 16650 PURO023 AVF - DCOS4A Procedure UROLOGY 11760 12350 14700 17050 PURO093 FRENEULOPLASTY - DCOS4 Procedure UROLOGY 11760 12350 14700 17050 PURO126 ORCHIDECTOMY - DCOS4 Procedure UROLOGY 11760 12350 14700 17050 PURO059 CIRCUMCISSION - DCOS4A Procedure UROLOGY 12020 12620 15030 17430 PURO191 TESTICULAR BIOPSY - DCOS4A Procedure UROLOGY 12020 12620 15030 17430 PURO024 AVF - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO060 CIRCUMCISSION - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO086 EPIDIDYMECTOMY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO094 FRENEULOPLASTY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO104 HYDROCELECTOMY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO116 MEATOPLASTY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO128 ORCHIDECTOMY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO153 PENILE BIOPSY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO165 PROSTATE BIOPSY - DCOS4A Procedure UROLOGY 12300 12910 15370 17830 PURO166 PROSTATE BIOPSY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO192 TESTICULAR BIOPSY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO207 TROCAR CYSTOSTOMY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO253 VARICOCELE LIGATION DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO265 VASECTOMY - DCOS5 Procedure UROLOGY 12300 12910 15370 17830 PURO025 AVF - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO051 BNI - DECP2 Procedure UROLOGY 13390 14060 16740 19410 PURO087 EPIDIDYMECTOMY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO105 HYDROCELECTOMY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO117 MEATOPLASTY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO129 ORCHIDECTOMY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO134 PCN - DCEP2 Procedure UROLOGY 13390 14060 16740 19410

89 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO154 PENILE BIOPSY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO167 PROSTATE BIOPSY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO193 TESTICULAR BIOPSY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO201 TROCAR CYCTOSTOMY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO211 URETERIC MEATOTOMY - DCEP2 Procedure UROLOGY 13390 14060 16740 19410 PURO234 URS + STENTING DCEP2 Procedure UROLOGY 13390 14060 16740 19410 PURO254 VARICOCELE LIGATION DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO266 VASECTOMY - DCOS5A Procedure UROLOGY 13390 14060 16740 19410 PURO271 VIU - DCEP2 Procedure UROLOGY 13390 14060 16740 19410 PURO031 BLADDER BIOPSY - DCEP2A Procedure UROLOGY 14350 15060 17930 20800 PURO042 BNI - DCEP2A Procedure UROLOGY 14350 15060 17930 20800 PURO089 EPIDIDYMECTOMY - DOCS6 Procedure UROLOGY 14350 15060 17930 20800 PURO095 FRENEULOPLASTY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO106 HYDROCELECTOMY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO118 MEATOPLASTY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO135 PCN - DCEP2A Procedure UROLOGY 14350 15060 17930 20800 PURO155 PENILE BIOPSY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO168 PROSTATE BIOPSY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO194 TESTICULAR BIOPSY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO208 TROCAR CYSTOSTOMY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO212 URETERIC MEATOTOMY - DCEP2A Procedure UROLOGY 14350 15060 17930 20800 PURO255 VARICOCELE LIGATION DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO267 VASECTOMY - DCOS6 Procedure UROLOGY 14350 15060 17930 20800 PURO030 BLADDER BIOPSY - DCEP2 Procedure UROLOGY 15040 15790 18790 21800 PURO061 CIRCUMCISSION - DCOS5A Procedure UROLOGY 15040 15790 18790 21800 PURO066 CYSTOLITHOPAXY - DCEP2 Procedure UROLOGY 15040 15790 18790 21800 PURO174 STENTING - DCEP2 Procedure UROLOGY 15040 15790 18790 21800 PURO221 URS - DCEP2 Procedure UROLOGY 15040 15790 18790 21800 PURO027 AVF - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO063 CIRCUMCISSION - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO088 EPIDIDYMECTOMY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO107 HYDROCELECTOMY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO119 MEATOPLASTY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO130 ORCHIDECTOMY - DCOS6 Procedure UROLOGY 15710 16500 19640 22780 PURO131 ORCHIDECTOMY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO156 PENILE BIOPSY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO169 PROSTATE BIOPSY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780

90 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO175 STENTING - DCEP2A Procedure UROLOGY 15710 16500 19640 22780 PURO195 TESTICULAR BIOPSY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO202 TROCAR CYCTOSTOMY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO235 URS + STENTING DCEP2A Procedure UROLOGY 15710 16500 19640 22780 PURO268 VASECTOMY - DCOS6A Procedure UROLOGY 15710 16500 19640 22780 PURO272 VIU - DCEP2A Procedure UROLOGY 15710 16500 19640 22780 PURO026 AVF - DCOS6 Procedure UROLOGY 16400 17220 20500 23780 PURO062 CIRCUMCISSION - DCOS6 Procedure UROLOGY 16400 17220 20500 23780 PURO067 CYSTOLITHOPAXY - DCEP2A Procedure UROLOGY 16400 17220 20500 23780 PURO222 URS - DCEP2A Procedure UROLOGY 16400 17220 20500 23780 PURO032 BLADDER BIOPSY - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO043 BNI - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO068 CYSTOLITHOPAXY - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO136 PCN - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO176 STENTING - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO213 URETERIC MEATOTOMY - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO236 URS + STENTING DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO256 VARICOCELE LIGATION DCOS6A Procedure UROLOGY 17760 18650 22200 25750 PURO273 VIU - DCEP3 Procedure UROLOGY 17760 18650 22200 25750 PURO033 BLADDER BIOPSY - DCEP3A Procedure UROLOGY 19130 20090 23910 27740 PURO044 BNI - DCEP3A Procedure UROLOGY 19130 20090 23910 27740 PURO069 CYSTOLITHOPAXY - DCEP3A Procedure UROLOGY 19130 20090 23910 27740 PURO137 PCN - DCEP3A Procedure UROLOGY 19130 20090 23910 27740 PURO177 STENTING - DCEP3A Procedure UROLOGY 19130 20090 23910 27740 PURO034 BLADDER BIOPSY - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO045 BNI - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO138 PCN - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO178 STENTING - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO215 URETERIC MEATOTOMY - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO223 URS - DCEP3 Procedure UROLOGY 19820 20810 24770 28740 PURO238 URS + STENTING DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO275 VIU - DCEP4 Procedure UROLOGY 19820 20810 24770 28740 PURO214 URETERIC MEATOTOMY - DCEP3A Procedure UROLOGY 21180 22240 26470 30700 PURO237 URS + STENTING DCEP3A Procedure UROLOGY 21180 22240 26470 30700 PURO035 BLADDER BIOPSY - DCEP4A Procedure UROLOGY 21870 22960 27330 31700 PURO046 BNI - DCEP4A Procedure UROLOGY 21870 22960 27330 31700 PURO071 CYSTOLITHOPAXY - DCEP4A Procedure UROLOGY 21870 22960 27330 31700

91 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO139 PCN - DCEP4A Procedure UROLOGY 21870 22960 27330 31700 PURO216 URETERIC MEATOTOMY - DCEP4A Procedure UROLOGY 21870 22960 27330 31700 PURO224 URS - DCEP3A Procedure UROLOGY 21870 22960 27330 31700 PURO225 URS - DCEP4 Procedure UROLOGY 21870 22960 27330 31700 PURO274 VIU - DCEP3A Procedure UROLOGY 21870 22960 27330 31700 PURO276 VIU - DCEP4A Procedure UROLOGY 21870 22960 27330 31700 PURO036 BLADDER BIOPSY - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO047 BNI - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO072 CYSTOLITHOPAXY - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO140 PCN - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO180 STENTING - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO217 URETERIC MEATOTOMY - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO227 URS - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO240 URS + STENTING DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO277 VIU - DCEP5 Procedure UROLOGY 22540 23670 28180 32690 PURO070 CYSTOLITHOPAXY - DCEP4 Procedure UROLOGY 23230 24400 29040 33690 PURO037 BLADDER BIOPSY - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO048 BNI - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO073 CYSTOLITHOPAXY - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO141 PCN - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO179 STENTING - DCEP4A Procedure UROLOGY 23910 25110 29890 34670 PURO181 STENTING - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO218 URETERIC MEATOTOMY - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO226 URS - DCEP4A Procedure UROLOGY 23910 25110 29890 34670 PURO229 URS - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO239 URS + STENTING DCEP4A Procedure UROLOGY 23910 25110 29890 34670 PURO241 URS + STENTING DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO278 VIU - DCEP5A Procedure UROLOGY 23910 25110 29890 34670 PURO038 BLADDER BIOPSY - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO049 BNI - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO074 CYSTOLITHOPAXY - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO142 PCN - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO182 STENTING - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO219 URETERIC MEATOTOMY - DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO232 URS - DECP6 Procedure UROLOGY 24590 25820 30740 35660 PURO242 URS + STENTING DCEP6 Procedure UROLOGY 24590 25820 30740 35660 PURO279 VIU - DCEP6 Procedure UROLOGY 24590 25820 30740 35660

92 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PURO039 BLADDER BIOPSY - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO050 BNI - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO143 PCN - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO183 STENTING - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO220 URETERIC MEATOTOMY - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO230 URS - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO243 URS + STENTING DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO280 VIU - DCEP6A Procedure UROLOGY 26650 27980 33310 38640 PURO075 CYSTOLITHOPAXY - DCEP6A Procedure UROLOGY 30070 31570 37580 43590 UROLOGY PURO001 LITHOTRIPSY / ESWL - PURO1 Procedure 14350 15060 17930 20800 LITHOTRIPSY UROLOGY PURO002 LITHOTRIPSY / ESWL - PURO2 Procedure 19820 20810 24770 28740 LITHOTRIPSY UROLOGY PURO003 LITHOTRIPSY / ESWL - PURO3 Procedure 24590 25820 30740 35660 LITHOTRIPSY UROLOGY PURO004 LITHOTRIPSY / ESWL - PURO4 Procedure 28700 30130 35870 41610 LITHOTRIPSY UROLOGY PURO005 LITHOTRIPSY / ESWL - PURO5 Procedure 31420 32990 39280 45560 LITHOTRIPSY UROLOGY PURO006 LITHOTRIPSY / ESWL - PURO6 Procedure 35530 37300 44410 51510 LITHOTRIPSY UROLOGY PURO007 LITHOTRIPSY / ESWL - PURO7 Procedure 39620 41600 49530 57450 LITHOTRIPSY UROLOGY LURO001 CLOSURE OF S P C (URO) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY CYSTOSCOPY SAME AS PANENDOS UROLOGY LURO002 L1 Surgery 4290 4500 5360 6220 (URO) # L1 SURGERY 'J' STENTING OF URETER UROLOGY LURO003 L1 Surgery 4290 4500 5360 6220 UNILATERAL (URO) # L1 SURGERY PROSTALIC NEEDLE BIOPSY (URO) UROLOGY LURO004 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY RETROGRADE CATHETERISATION UROLOGY LURO005 L1 Surgery 4290 4500 5360 6220 OR BULB URETE (URO) # L1 SURGERY UROLOGY LURO006 STENT REMOVAL (URO) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY URETERIC CATHETERISATION UROLOGY LURO007 L1 Surgery 4290 4500 5360 6220 (UNILATERAL) (URO) # L1 SURGERY UROLOGY LURO008 VASOGRAM (URO) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY UROLOGY LURO009 CIRCUMCISION (URO) (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY DILATATION OF URETHRA (URO) UROLOGY LURO010 L2 Surgery 0 8240 9810 11380 (URO) # L2 SURGERY

93 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group UROLOGY LURO011 EPIDIDYMAL BIOPSY (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY UROLOGY LURO012 FRENULOPLASTY (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY MEATOTOMY URETHRAL) (URO) UROLOGY LURO013 L2 Surgery 0 8240 9810 11380 # L2 SURGERY UROLOGY LURO014 PCN (UNILATERAL) (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY UROLOGY LURO015 PENILE BIOPSY (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY SUPRAPUBIC CYSTOSTOMY (URO) UROLOGY LURO016 L2 Surgery 0 8240 9810 11380 (URO) # L2 SURGERY TESTICULAR BIOPSY (URO) (URO) UROLOGY LURO017 L2 Surgery 0 8240 9810 11380 # L2 SURGERY UROLOGY LURO018 TROCAR CYSTOSTOMY (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY URETERIC CATHETERISATION UROLOGY LURO019 L2 Surgery 0 8240 9810 11380 (BILATERAL) (URO) # L2 SURGERY UROLOGY LURO020 VASECTOMY (URO) (URO) # L2 L2 Surgery 0 8240 9810 11380 SURGERY CYSTOLITHALOPAXY MANUAL UROLOGY LURO064 INCLUDING CYSTOSCOPY (URO) L5 Surgery 0 8370 9200 10040 SURGERY # L5 OPEN BLADDER NECK SUSPENSION UROLOGY LURO078 INCLUDING CYSTOSCOPY (URO) L5 Surgery 0 8370 9200 10040 SURGERY # L5 UROLOGY LURO021 A.V.FISTULA (URO) # L3 L3 Surgery 0 10820 12880 14940 SURGERY BIOPSY OF BLADDER TUMOUR UROLOGY LURO022 INCLUDING ENDOSCOPIC L3 Surgery 0 10820 12880 14940 SURGERY EXAMINATION (URO) # L3 ENDOSCOPIC TEFLON PASTE INJE UROLOGY LURO024 L3 Surgery 0 10820 12880 14940 (URO) # L3 SURGERY ENDOSCOPIC URETERIC UROLOGY LURO025 L3 Surgery 0 10820 12880 14940 MEATOTOMY (URO) # L3 SURGERY EPIDIDYMAL CYST EXCISION (URO) UROLOGY LURO026 L3 Surgery 0 10820 12880 14940 # L3 SURGERY EPIDIDYMECTOMY - UNILATERAL UROLOGY LURO027 L3 Surgery 0 10820 12880 14940 (URO) # L3 SURGERY EPIDIDYMO VASOSTOMY UROLOGY LURO028 L3 Surgery 0 10820 12880 14940 UNILATERAL (URO) # L3 SURGERY FOURNIER'S GANGRENE UROLOGY LURO029 L3 Surgery 0 10820 12880 14940 DEBRIDEMENT (URO) (URO) # L3 SURGERY HYDROCELECTOMY UNILATERAL UROLOGY LURO030 L3 Surgery 0 10820 12880 14940 (URO) (URO) # L3 SURGERY 'J' STENTING OF URETER UROLOGY LURO031 L3 Surgery 0 10820 12880 14940 BILATERAL (URO) # L3 SURGERY

94 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group UROLOGY LURO032 MEATOPLASTY (LURO) # L3 L3 Surgery 0 10820 12880 14940 SURGERY UROLOGY LURO033 PCN (BILATERAL) (URO) # L3 L3 Surgery 0 10820 12880 14940 SURGERY POST TURP CLOT EVACUATION UROLOGY LURO034 L3 Surgery 0 10820 12880 14940 (URO) # L3 SURGERY PROSTATE BIOPSY (ENDOSCOPIC UROLOGY LURO035 BIOPSY INCLUDING CYSTOSCOPY) L3 Surgery 0 10820 12880 14940 SURGERY (URO) # L3 UROLOGY LURO036 RELOOK PCNL (URO) # L3 L3 Surgery 0 10820 12880 14940 SURGERY STENTING FOR UROSEPSIS (URO) UROLOGY LURO023 L3 Surgery 0 10820 12880 14940 # L3 SURGERY URETERORENOSCOPY DIAGNOSTIC UROLOGY LURO037 L3 Surgery 0 10820 12880 14940 (URO) # L3 SURGERY URETHRAL CARUNCLE EXCISION UROLOGY LURO038 L3 Surgery 0 10820 12880 14940 (URO) # L3 SURGERY VISUAL OPTICAL/INTERNAL URET UROLOGY LURO039 L3 Surgery 0 10820 12880 14940 MILD STRUCT (URO) # L3 SURGERY UROLOGY LURO040 A.V.GRAFT (URO) # L4 L4 Surgery 0 14790 17610 20420 SURGERY BLADDER INJURY REPAIR (URO) UROLOGY LURO041 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY BLADDER NECK INCISION UROLOGY LURO042 WITH CYSTOSCOPY (AS SOLE L4 Surgery 0 14790 17610 20420 SURGERY PROCEDURE) (URO) # L4 DIAGNOSTIC UROLOGY LURO043 L4 Surgery 0 14790 17610 20420 RETROPERITONOSCOPY (URO) # L4 SURGERY DRAINAGE OF PERINEPHRIC / UROLOGY LURO044 RETROPERITONEAL ABSCESS L4 Surgery 0 14790 17610 20420 SURGERY (URO) # L4 EPIDIDYMECTOMY - BILATERAL UROLOGY LURO045 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY EPIDIDYMO VASOSTOMY UROLOGY LURO046 L4 Surgery 0 14790 17610 20420 BILATERAL (URO) # L4 SURGERY ILEO-INGUINAL NODE DISSECTION UROLOGY LURO047 L4 Surgery 0 14790 17610 20420 - UNILATERAL (URO) # L4 SURGERY INGUINAL/ FEMORAL HERNIA MESH UROLOGY LURO059 L4 Surgery 0 14790 17610 20420 REPAIR UNILATERAL (URO) # L4 SURGERY INGUINAL NODE DISSECTION - UROLOGY LURO048 L4 Surgery 0 14790 17610 20420 UNILATERAL (URO) # L4 SURGERY LAPAROSCOPIC DEROOFING OF UROLOGY LURO049 L4 Surgery 0 14790 17610 20420 CYST (URO) # L4 SURGERY UROLOGY LURO050 NEPHROSTOMY PCN) (URO) # L4 L4 Surgery 0 14790 17610 20420 SURGERY ORCHIDECTOMY RADICAL (URO) UROLOGY LURO051 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY

95 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ORCHIDOPEXY UNILATERAL (URO) UROLOGY LURO052 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY ORCHIDUCTOMY UNILATERAL UROLOGY LURO053 L4 Surgery 0 14790 17610 20420 (URO) (URO) # L4 SURGERY PERINEAL DRAINAGE OF UROLOGY LURO054 L4 Surgery 0 14790 17610 20420 PROSTATESS (URO) # L4 SURGERY RACANALISATION OF VAS - UROLOGY LURO055 L4 Surgery 0 14790 17610 20420 UNILATERAL (URO) # L4 SURGERY SUPRAPUBIC CYSTOLITHOTOMY UROLOGY LURO056 INCLUDING CYSTOSCOPY (URO) L4 Surgery 0 14790 17610 20420 SURGERY (URO) # L4 URETERIC CALCULI BASKETING UROLOGY LURO057 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY VARICOCELE LIGATION UNILATERAL UROLOGY LURO058 L4 Surgery 0 14790 17610 20420 (URO) # L4 SURGERY AMPUTATION OF PENIS - PARTIAL UROLOGY LURO060 L5 Surgery 0 18010 21440 24870 (URO) (URO) # L5 SURGERY UROLOGY LURO061 BRACHIAL FISTULA (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY CAPD CATHETER INSERTIONS UROLOGY LURO062 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY CUTANEOUS URETEROSTOMY UROLOGY LURO063 L5 Surgery 0 18010 21440 24870 UNILATERAL (URO) (URO) # L5 SURGERY UROLOGY LURO065 DIVERTICULECTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY UROLOGY LURO066 ENDO PYELOTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY ENDOSCOPIC BLADDER NECK UROLOGY LURO067 L5 Surgery 0 18010 21440 24870 SUSP (URO) # L5 SURGERY ENDOSCOPIC RAIL ROADING OF UROLOGY LURO068 L5 Surgery 0 18010 21440 24870 URETHRA (URO) # L5 SURGERY ENDOSCOPIC REALIGNMENT OF UROLOGY LURO069 L5 Surgery 0 18010 21440 24870 URETHRA (URO) # L5 SURGERY HYDROCELECTOMY BILATERAL UROLOGY LURO070 L5 Surgery 0 18010 21440 24870 (URO) (URO) # L5 SURGERY INGUINAL HERNIA - MESH REPAIR UROLOGY LURO106 UNDER LA - UNILATERAL (URO) L5 Surgery 0 18010 21440 24870 SURGERY # L5 LAPAROSCOPIC BLADDER NECK UROLOGY LURO071 L5 Surgery 0 18010 21440 24870 SUSPENSION (URO) # L5 SURGERY LAPAROSCOPIC CAPD INSERTION UROLOGY LURO072 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY LAPAROSCOPIC ORCHIDOPEXY - UROLOGY LURO073 L5 Surgery 0 18010 21440 24870 UNILATERAL (URO) (URO) # L5 SURGERY LAPARSCOPIC UROLOGY LURO074 L5 Surgery 0 18010 21440 24870 URETEROLITHOTOMY (URO) # L5 SURGERY

96 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LASER PROSTATECTOMY (URO) UROLOGY LURO075 L5 Surgery 0 18010 21440 24870 # L5 SURGERY UROLOGY LURO076 LASER URS (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY UROLOGY LURO077 NEPHROPEXY (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPEN RAIL ROADING OF URETHRA UROLOGY LURO079 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY UROLOGY LURO080 OPEN RENAL BIOPSY (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY ORCHIDECTOMY UNILATERAL - UROLOGY LURO081 OPEN/LAPAROSCOPIC (URO) (URO) L5 Surgery 0 18010 21440 24870 SURGERY # L5 ORCHIDOPEXY BILATERAL (URO) UROLOGY LURO082 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY PEYRONIES PLAQUE EXCISION & UROLOGY LURO083 L5 Surgery 0 18010 21440 24870 RUCTI (URO) # L5 SURGERY POSTERIOR UETHRAL VALVE FULN UROLOGY LURO084 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY PSOAS HITCH WITH UROLOGY LURO085 URETERONEOCYSTOSTOMY (URO) L5 Surgery 0 18010 21440 24870 SURGERY # L5 UROLOGY LURO086 RIRS - UNILATERAL (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY SURGERY FOR PRIAPSIM (URO) UROLOGY LURO087 L5 Surgery 0 18010 21440 24870 # L5 SURGERY THERAPEUTIC UROLOGY LURO088 L5 Surgery 0 18010 21440 24870 RETROPERITONOSCOPY (URO) # L5 SURGERY UROLOGY LURO089 TORTION TESTIS (URO) (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY UROLOGY LURO090 TOT SLING PROCEDURE (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY TRANSANAL EXCISION OF TUMOUR UROLOGY LURO105 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY UROLOGY LURO091 TRANSPLANT STENTING (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY TRANS URETHRAL RESECTION OF UROLOGY LURO092 L5 Surgery 0 18010 21440 24870 BL TUMOUR & FULG (URO) # L5 SURGERY UROLOGY LURO093 TVT SLING PROCEDURE (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY URETEROLITHOTOMY (URO) (URO) UROLOGY LURO095 L5 Surgery 0 18010 21440 24870 # L5 SURGERY URETERO RENOSCOPY CALCULOUS UROLOGY LURO094 L5 Surgery 0 18010 21440 24870 AL (URO) # L5 SURGERY URETHRAL DIVERTECULUM UROLOGY LURO096 EXCISION INCLUDING CYSTOSCOPY L5 Surgery 0 18010 21440 24870 SURGERY (URO) # L5

97 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group URETHRAL FISTULA CLOSURE UROLOGY LURO097 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY UROLOGY LURO098 URETHROLITHOTOMY (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY UROLOGY LURO099 URETHROLYSIS (URO) # L5 L5 Surgery 0 18010 21440 24870 SURGERY URETHROPLASTY 2ND STAGE REPA UROLOGY LURO100 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY URETHROPLASTY I STAGE REPAIR UROLOGY LURO101 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY VARICOCELE LEGATION BILATERAL UROLOGY LURO102 L5 Surgery 0 18010 21440 24870 (URO) # L5 SURGERY VENOUS LEGATION FOR UROLOGY LURO103 L5 Surgery 0 18010 21440 24870 IMPOTENCY (URO) (URO) # L5 SURGERY VISUAL OPTICAL/INTERNAL URET UROLOGY LURO104 L5 Surgery 0 18010 21440 24870 CORETHRO UR (URO) # L5 SURGERY ADRENALECTOMY UNILATERAL UROLOGY LURO159 L6 Surgery 0 27010 32150 37290 (URO) (URO) # L6 SURGERY ADRENELECTOMY UNILATERAL UROLOGY LURO107 L6 Surgery 0 27010 32150 37290 (URO) (URO) # L6 SURGERY AMPUTATION TOTAL OF PENIS & UROLOGY LURO108 L6 Surgery 0 27010 32150 37290 GUINAL BLOCK (URO) # L6 SURGERY ARTIFICAL URINARY SPHINCTER UROLOGY LURO109 L6 Surgery 0 27010 32150 37290 PLACEMENT (URO) # L6 SURGERY BAORI FLAP WITH UROLOGY LURO110 L6 Surgery 0 27010 32150 37290 URETERONEOCYY (URO) # L6 SURGERY BLOCK DISSECTION INGUINAL UROLOGY LURO111 L6 Surgery 0 27010 32150 37290 UNLATERAL (URO) (URO) # L6 SURGERY CUTANEOUS URETEROSTOMY UROLOGY LURO112 L6 Surgery 0 27010 32150 37290 BILATERAL (URO) (URO) # L6 SURGERY CYSTECTOMY PARTIAL INCLUDING UROLOGY LURO113 L6 Surgery 0 27010 32150 37290 CYSTOSCOPY (URO) # L6 SURGERY CYSTOCELE MESH REPAIR (URO) UROLOGY LURO114 L6 Surgery 0 27010 32150 37290 # L6 SURGERY EXTROPHY BLADDER REPAIR (URO) UROLOGY LURO115 L6 Surgery 0 27010 32150 37290 # L6 SURGERY HYPOSPADIAS REPAIR STAGE II UROLOGY LURO117 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY HYPOSPADIAS REPAIR STAGE I UROLOGY LURO116 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY ILEO-INGUINAL NODE DISSECTION UROLOGY LURO118 L6 Surgery 0 27010 32150 37290 - BILATERAL (URO) # L6 SURGERY INFERIOR CALYCO URETEROSTOMY UROLOGY LURO119 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY INGUINAL/ FEMORAL HERNIA MESH UROLOGY LURO160 L6 Surgery 0 27010 32150 37290 REPAIR BILATERAL (URO) # L6 SURGERY

98 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group INGUINAL NODE DISSECTION - UROLOGY LURO120 L6 Surgery 0 27010 32150 37290 BILATERAL (URO) # L6 SURGERY LAPAROSCOPIC LYMPHOCELE UROLOGY LURO121 L6 Surgery 0 27010 32150 37290 DRAINAGE (URO) # L6 SURGERY LAPAROSCOPIC NEPHRECTOMY UROLOGY LURO122 L6 Surgery 0 27010 32150 37290 SIMPLE (URO) (URO) # L6 SURGERY LAPAROSCOPIC UROLOGY LURO123 NEPHROURETERECTOMY SIMPLE L6 Surgery 0 27010 32150 37290 SURGERY (URO) # L6 LAPAROSCOPIC ORCHIDOPEXY - UROLOGY LURO124 L6 Surgery 0 27010 32150 37290 BILATERAL (URO) (URO) # L6 SURGERY LAPAROSCOPIC PYELOLYMPHATIC UROLOGY LURO125 L6 Surgery 0 27010 32150 37290 DISCONNECTION (URO) # L6 SURGERY LAPAROSCOPIC URETEROLYSIS UROLOGY LURO126 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY LAPAROSCOPIC VVF REPAIR (URO) UROLOGY LURO127 L6 Surgery 0 27010 32150 37290 # L6 SURGERY LAPAROTOMY FRACTURE PELVIS & UROLOGY LURO128 L6 Surgery 0 27010 32150 37290 RUPTURE URETHRA (URO) # L6 SURGERY LAPARSCOPIC PYELOLITHOTOMY UROLOGY LURO129 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY NEPHRECTOMY SIMPLE/BENIGN - UROLOGY LURO130 L6 Surgery 0 27010 32150 37290 UNILATERAL (URO) # L6 SURGERY NEPHROLITHOTOMY INCLUDING UROLOGY LURO132 CYSTOSCOPY AND RETROGRADE L6 Surgery 0 27010 32150 37290 SURGERY CATHETERISATION (URO) # L6 NEPHRO URETERECTOMY SIMPLE) UROLOGY LURO131 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY OPEN SURGERY FOR FRACTURE UROLOGY LURO133 PELVIS WITH BLADDER AND L6 Surgery 0 27010 32150 37290 SURGERY URETHRAL INJURY (URO) # L6 ORCHIDECTOMY BILATERAL - UROLOGY LURO134 OPEN/LAPAROSCOPIC (URO) (URO) L6 Surgery 0 27010 32150 37290 SURGERY # L6 PENILE PROSTHESIS UROLOGY LURO136 L6 Surgery 0 27010 32150 37290 IMPLANTATIONS (URO) # L6 SURGERY PENILE PROSTHESIS UROLOGY LURO135 L6 Surgery 0 27010 32150 37290 IMPLANTATION (URO) # L6 SURGERY PENILE/URETHRA INJURY REPAIR UROLOGY LURO137 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY PERCUEAREOUS UROLOGY LURO138 L6 Surgery 0 27010 32150 37290 NEPHROSTOLITHOTCNL (URO) # L6 SURGERY PERINEAL URETHROSTOMY (URO) UROLOGY LURO139 L6 Surgery 0 27010 32150 37290 # L6 SURGERY PROSTATECTOMY RETROPUBIC UROLOGY LURO140 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY

99 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PROSTATECTOMY UROLOGY LURO141 TRANSURETHRAL (TURP) (URO) L6 Surgery 0 27010 32150 37290 SURGERY # L6 UROLOGY LURO142 PUBOVAGINAL SLING (URO) # L6 L6 Surgery 0 27010 32150 37290 SURGERY UROLOGY LURO143 PYELOLITHOTOMY (UROLOGY) # L6 L6 Surgery 0 27010 32150 37290 SURGERY UROLOGY LURO144 PYELOPLASTY (UROLOGY) # L6 L6 Surgery 0 27010 32150 37290 SURGERY RACANALISATION OF VAS - UROLOGY LURO145 L6 Surgery 0 27010 32150 37290 BILATERAL (URO) # L6 SURGERY RECTOCELE MESH REPAIR (URO) UROLOGY LURO146 L6 Surgery 0 27010 32150 37290 # L6 SURGERY REIMPLANTATION OF URETER UROLOGY LURO147 L6 Surgery 0 27010 32150 37290 UNILATERAL (URO) # L6 SURGERY SACROCOLPOPEXY - OPEN (URO) UROLOGY LURO158 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY TOTAL AMPUTATION OF PENIS UROLOGY LURO148 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY UROLOGY LURO150 TRANSPLANT PCN (URO) # L6 L6 Surgery 0 27010 32150 37290 SURGERY TRANSPLANT RE-EXPLORATION UROLOGY LURO151 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY TRANSPLANT URETERIC UROLOGY LURO152 L6 Surgery 0 27010 32150 37290 REIMPLANTATION (URO) # L6 SURGERY TRANSURETERO URETEROSTOMY UROLOGY LURO153 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY URETERIC INJURY REPAIR (URO) UROLOGY LURO154 L6 Surgery 0 27010 32150 37290 # L6 SURGERY VVF REPAIR TRANSVESICAL REPA UROLOGY LURO155 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY VVF REPAIR VAGINAL APPROACH UROLOGY LURO156 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY YV PLASTY OF BLADDER NECK UROLOGY LURO157 L6 Surgery 0 27010 32150 37290 (URO) # L6 SURGERY ADRENELECTOMY UNILATERAL UROLOGY LURO004RS LR Surgery 0 29590 35220 40850 (LURO) [RS 5 days Package] # LR SURGERY AUGMENTATION CYSTOPLASTY UROLOGY LURO007RS LR Surgery 0 29590 35220 40850 (LURO) [RS 10 days Package] # LR SURGERY BAORI FLAP WITH UROLOGY LURO009RS URETERONEOCYY (LURO) [RS 5 LR Surgery 0 29590 35220 40850 SURGERY days Package] # LR CYSTECTOMY RADICAL WITH DIVE UROLOGY LURO022RS LR Surgery 0 29590 35220 40850 (LURO) [RS 10 days Package] # LR SURGERY HEMINEPHRECTOMY (LURO) [RS 5 UROLOGY LURO183RS LR Surgery 0 29590 35220 40850 days Package] # LR SURGERY

100 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group NEPHRECTOMY PARTIAL (LURO) UROLOGY LURO051RS LR Surgery 0 29590 35220 40850 [RS 5 days Package] # LR SURGERY NEPHRECTOMY RADICAL (LURO) UROLOGY LURO053RS LR Surgery 0 29590 35220 40850 [RS 5 days Package] # LR SURGERY NEPHRECTOMY SIMPLE/BENIGN - UROLOGY LURO052RS LR Surgery 0 29590 35220 40850 LURO [RS 5 days Package] # LR SURGERY NEPHRO URETERECTOMY RADICAL UROLOGY LURO054RS LR Surgery 0 29590 35220 40850 (LURO) [RS 5 days Package] # LR SURGERY NEPHRO URETERECTOMY SIMPLE) UROLOGY LURO055RS LR Surgery 0 29590 35220 40850 (LURO) [RS 5 days Package] # LR SURGERY PROSTATECTOMY RADICAL (LURO) UROLOGY LURO083RS LR Surgery 0 29590 35220 40850 [RS 5 days Package] # LR SURGERY PROSTATECTOMY RETROPUBIC UROLOGY LURO084RS LR Surgery 0 29590 35220 40850 (LURO) [RS 5 days Package] # LR SURGERY PSOAS HITCH WITH UROLOGY LURO086RS URETERONEOCMY (LURO) [RS 5 LR Surgery 0 29590 35220 40850 SURGERY days Package] # LR PYELOPLASTY (LURO) [RS 5 days UROLOGY LURO088RS LR Surgery 0 29590 35220 40850 Package] # LR SURGERY REIMPLANTATION OF URETER UROLOGY LURO093RS BILATERAL (LURO) [RS 5 days LR Surgery 0 29590 35220 40850 SURGERY Package] # LR REIMPLANTATION OF URETER UROLOGY LURO094RS UNILATERAL (LURO) [RS 5 days LR Surgery 0 29590 35220 40850 SURGERY Package] # LR SACROCOLPOPEXY (LURO) [RS 5 UROLOGY LURO184RS LR Surgery 0 29590 35220 40850 days Package] # LR SURGERY VVF REPAIR TRANSVESICAL REPA UROLOGY LURO126RS LR Surgery 0 29590 35220 40850 (LURO) [RS 5 days Package] # LR SURGERY AUGMENTATION CYSTOPLASTY UROLOGY LURO161 INCLUDING CYSTOSCOPY (URO) L7 Surgery 0 36010 42870 49730 SURGERY # L7 AUTO TRANSPLANTATION OF UROLOGY LURO162 L7 Surgery 0 36010 42870 49730 KIDNEY (URO) # L7 SURGERY CYSTECTOMY RADICAL WITH DIVE UROLOGY LURO163 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY EPISPADIAS REPAIR STAGE II (URO) UROLOGY LURO164 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY EPISPADIUS REPAIR STAGE I (URO) UROLOGY LURO165 L7 Surgery 0 36010 42870 49730 # L7 SURGERY UROLOGY LURO166 ILEAL CONDUIT (URO) # L7 L7 Surgery 0 36010 42870 49730 SURGERY UROLOGY LURO167 ILEAL NEOBLADDER (URO) # L7 L7 Surgery 0 36010 42870 49730 SURGERY ILEAL REPLACEMENT OF URETER UROLOGY LURO168 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY

101 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group INGUINAL HERNIA - MESH REPAIR UROLOGY LURO189 L7 Surgery 0 36010 42870 49730 UNDER LA - BILATERAL (URO) # L7 SURGERY LAPAROSCOPIC ADRENALECTOMY UROLOGY LURO169 L7 Surgery 0 36010 42870 49730 - UNILATERAL (URO) (URO) # L7 SURGERY LAPAROSCOPIC REIMPLANTATION UROLOGY LURO170 OF URETER (UNILATERAL) (URO) L7 Surgery 0 36010 42870 49730 SURGERY # L7 LAPAROSCOPIC RETROPERITONEAL UROLOGY LURO171 L7 Surgery 0 36010 42870 49730 NODE DISSECTION (URO) # L7 SURGERY NEPHRECTOMY RADICAL (URO) UROLOGY LURO172 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY NEPHRO URETERECTOMY RADICAL UROLOGY LURO173 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY PROSTATECTOMY RADICAL (URO) UROLOGY LURO174 L7 Surgery 0 36010 42870 49730 # L7 SURGERY RECTAL BLADDER WITH PELVIC CY UROLOGY LURO175 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY RECTAL NEOBLADDER (MAINZ UROLOGY LURO176 L7 Surgery 0 36010 42870 49730 POUCH) (URO) # L7 SURGERY REDUCTION CYSTOPLASTY (URO) UROLOGY LURO177 L7 Surgery 0 36010 42870 49730 # L7 SURGERY REIMPLANTATION OF URETER UROLOGY LURO178 L7 Surgery 0 36010 42870 49730 BILATERAL (URO) # L7 SURGERY RETROPERITONEAL TUMER EXCISIK UROLOGY LURO179 L7 Surgery 0 36010 42870 49730 DISSECTION (URO) # L7 SURGERY UROLOGY LURO180 RIRS - BILATERAL (URO) # L7 L7 Surgery 0 36010 42870 49730 SURGERY SACROCOLPOPEXY - UROLOGY LURO188 L7 Surgery 0 36010 42870 49730 LAPAROSCOPIC (URO) (URO) # L7 SURGERY TOTAL VAULT PROLPASE MESH UROLOGY LURO181 L7 Surgery 0 36010 42870 49730 REPAIR (URO) # L7 SURGERY URETEROSIGMOIDOSTOMY (URO) UROLOGY LURO182 L7 Surgery 0 36010 42870 49730 # L7 SURGERY URETHROPLASTY (BUCCAL UROLOGY LURO183 L7 Surgery 0 36010 42870 49730 MUCOSA) (URO) # L7 SURGERY URETHROPLASTY UROLOGY LURO184 (BULBOPROSTATIC ANASTOMOTIC) L7 Surgery 0 36010 42870 49730 SURGERY (URO) # L7 URETHROPLASTY (PENILE SKIN UROLOGY LURO185 L7 Surgery 0 36010 42870 49730 FLAP) (URO) # L7 SURGERY URETHROPLASTY SINGLE STAGE UROLOGY LURO187 L7 Surgery 0 36010 42870 49730 (URO) (URO) # L7 SURGERY URETHROPLASTY (TRANSPUBIC) UROLOGY LURO186 L7 Surgery 0 36010 42870 49730 (URO) # L7 SURGERY ADRENALECTOMY BILATERAL UROLOGY LURO190 L8 Surgery 0 45010 53580 62150 (URO) (URO) # L8 SURGERY

102 Urology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC ADRENALECTOMY UROLOGY LURO191 L8 Surgery 0 45010 53580 62150 - BILATERAL (URO) (URO) # L8 SURGERY LAPAROSCOPIC DONOR UROLOGY LURO192 L8 Surgery 0 45010 53580 62150 NEPHRECTOMY (URO) # L8 SURGERY LAPAROSCOPIC NEPHRECTOMY UROLOGY LURO193 L8 Surgery 0 45010 53580 62150 PARTIAL (URO) # L8 SURGERY LAPAROSCOPIC NEPHRECTOMY UROLOGY LURO194 L8 Surgery 0 45010 53580 62150 RADICAL (URO) # L8 SURGERY LAPAROSCOPIC UROLOGY LURO195 NEPHROURETERECTOMY RADICAL L8 Surgery 0 45010 53580 62150 SURGERY (URO) # L8 LAPAROSCOPIC PYELOPLASTY UROLOGY LURO196 L8 Surgery 0 45010 53580 62150 (URO) # L8 SURGERY LAPAROSCOPIC REIMPLANTATION UROLOGY LURO197 L8 Surgery 0 45010 53580 62150 OF URETER (BILATERAL) (URO) # L8 SURGERY NEPHRECTOMY PARTIAL (URO) UROLOGY LURO198 L8 Surgery 0 45010 53580 62150 (URO) # L8 SURGERY TRANSPLANT NEPHRECTOMY UROLOGY LURO149 L6 Surgery 0 45050 49560 54060 (URO) # L6 SURGERY ROBOTIC PACKAGE SURGERY - 2 - UROLOGY LURO187RS LR Surgery 0 51820 61690 71560 5 Days - URO # LR SURGERY CONDUIT OPERATIONS (OPEN TOTAL CYSTECTOMY (WITH UROLOGY LURO204 L9 Surgery 0 54020 64300 74590 CONSTRUCTION OF INTESTINAL SURGERY CONDUIT OF BLADDER) (URO) # L9 LAPAROSCOPIC RADICAL UROLOGY LURO200 CYSTECTOMY + ILEAL CONDUIT L9 Surgery 0 54020 64300 74590 SURGERY (URO) # L9 LAPAROSCOPIC RADICAL UROLOGY LURO201 CYSTECTOMY + NEOBLADDER L9 Surgery 0 54020 64300 74590 SURGERY (URO) # L9 LAPAROSCOPIC RADICAL UROLOGY LURO202 CYTSTECTOMY + MAINZ II POUCH L9 Surgery 0 54020 64300 74590 SURGERY (URO) # L9 LAPAROSCOPIC RADICAL UROLOGY LURO199 L9 Surgery 0 54020 64300 74590 PROSTATECTOMY (URO) # L9 SURGERY RENAL TRANSPLANTATION (URO) UROLOGY LURO203 L9 Surgery 0 54020 64300 74590 # L9 SURGERY

103 Department of Oncology Sciences

104 Medical Oncology

105 Medical Oncology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PONM053 DRESSING MINOR - ONM Procedure ONCOLOGY MEDICAL 200 210 250 290 PONM052 DRESSING MEDIUM - ONM Procedure ONCOLOGY MEDICAL 220 230 280 320 PONM024 INJ. VIT/IRON - 1 DAY Procedure ONCOLOGY MEDICAL 480 500 590 690 PONM025 INJ. VIT/IRON - 5 DAY Procedure ONCOLOGY MEDICAL 640 670 800 920 PONM002 BIOPSY - PUNCH Procedure ONCOLOGY MEDICAL 1910 2010 2390 2770 PONM003 BIOPSY - TRU CUT Procedure ONCOLOGY MEDICAL 1910 2010 2390 2770 TRANS- PONM046 THORACICLUNG,PLEURAL,MEDBIO Procedure ONCOLOGY MEDICAL 2470 2590 3080 3570 OFLESI UN CT(B) CHEMOTHERAPY PROCEDURE - PONM050 Procedure ONCOLOGY MEDICAL 2730 2730 3000 3280 WEEKLY PONM001 ASCITIC TAPPING (A) Procedure ONCOLOGY MEDICAL 3420 3590 4270 4960 CHEMOTHERAPY PROCEDURES- PONM008 Procedure ONCOLOGY MEDICAL 3630 3810 4530 5260 INTRA ARTERIAL PONM037 PLEURAL TAPPING (A) Procedure ONCOLOGY MEDICAL 5190 5450 6490 7530 BONE MARROW ASPIRATION BIOPSY PONM004 Procedure ONCOLOGY MEDICAL 6020 6320 7520 8730 (A) - PONM CHEMOTHERAPY PROCEDURES- PONM009 Procedure ONCOLOGY MEDICAL 6090 6390 7610 8830 INTRA CAVITARY HEMOSTASIS & THROMROPHILIA PONM048 Procedure ONCOLOGY MEDICAL 6160 6470 7700 8930 EVALUATION & PLAN CHEMOTHERAPY PROCEDURE - PONM049 Procedure ONCOLOGY MEDICAL 7550 7930 9430 10940 MINOR CHEMOTHERAPY PROCEDURES- PONM011 Procedure ONCOLOGY MEDICAL 8270 8690 10340 11990 SINGLE DAY REPLACEMENT THERAPY FACTOR / PONM051 Procedure ONCOLOGY MEDICAL 8740 9180 10930 12680 PLASMA PONM023 IMMUNOTHERAPY - ONM Procedure ONCOLOGY MEDICAL 9660 10150 12080 14010 PONM036 PIC - PERIPHERAL LINE Procedure ONCOLOGY MEDICAL 10390 10910 12990 15060 CHEMOTHERAPY PROCEDURES- PONM010 Procedure ONCOLOGY MEDICAL 13000 13650 16250 18850 MULTIPLE DAY PONM047 BIOLOGICAL Procedure ONCOLOGY MEDICAL 13670 14350 17080 19810 PONM055 ALLOGENIC STEM CELL HARVESTING Procedure ONCOLOGY MEDICAL 38250 40170 47820 55470 AUTOLOGOUS STEM CELL PONM054 Procedure ONCOLOGY MEDICAL 38250 40170 47820 55470 HARVESTING CRYO PRESERVATION & STORAGE OF PONM056 Procedure ONCOLOGY MEDICAL 51870 54460 64840 75210 STEM CELLS CHEMOTHERAPY CONTINUOUS PONM007 Procedure ONCOLOGY MEDICAL 56080 58880 70100 81310 INFUSIONAL

106 Medical Oncology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PONM044 STEM CELL MOBILIZATION (7 DAYS) Procedure ONCOLOGY MEDICAL 66950 70290 83680 97070 PONM005 BONE MARROW RE-INFUSION Procedure ONCOLOGY MEDICAL 87440 91810 109300 126790 PONM043 STEM CELL COLLECTION Procedure ONCOLOGY MEDICAL 106560 111890 133200 154520 GVHD PROPHYLAXIS FOR ALLOGENIC PONM020 Procedure ONCOLOGY MEDICAL 112040 117640 140050 162450 TRANSPLANTS ONLY CONDITIONING THERAPY FOR PONM013 Procedure ONCOLOGY MEDICAL 129790 136280 162240 188200 TRANSPLANT POST TRANSPLANT CARE FOR 30 PONM039 Procedure ONCOLOGY MEDICAL 215860 226650 269820 312990 DAYS ONCOLOGY MEDICAL KONR018 BMT Donor Package -II Package 0 1 1 1 PACKAGE ONCOLOGY MEDICAL KONR019 BMT Donor Package -III Package 0 1 1 1 PACKAGE ONCOLOGY MEDICAL KONR012 BMT Subsidies Recipient Package -II Package 0 1207500 1437500 1667500 PACKAGE ONCOLOGY MEDICAL KONM006 BMT RECIPIENT PACKAGE (MIPC) Package 0 2948720 3510380 4072040 PACKAGE PSTM001 ALLOGENIC STEM CELL INJ Procedure STEMPUTICS 142090 149190 177610 206020 PSTM002 AUTOLOGUS STEMCELL INJ Procedure STEMPUTICS 162580 170710 203220 235740

107 Onco Surgery

108 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY POMS001 SKIN TRACTION - POMS Procedure MUSCULOSKELETAL 280 290 350 410 PROCEDURE ONCOLOGY POMS003 MINOR DRESSING - POMS Procedure MUSCULOSKELETAL 420 440 520 610 PROCEDURE ONCOLOGY OTHER MINOR PROCEDURE - POMS005 Procedure MUSCULOSKELETAL 420 440 520 610 POMS PROCEDURE ONCOLOGY POMS002 SLAB REMOVAL - POMS Procedure MUSCULOSKELETAL 420 440 520 610 PROCEDURE ONCOLOGY POMS004 SUTURE REMOVAL - POMS Procedure MUSCULOSKELETAL 420 440 520 610 PROCEDURE ONCOLOGY POMS006 BELOW ELBOW SLAB - POMS Procedure MUSCULOSKELETAL 560 580 690 810 PROCEDURE ONCOLOGY POMS007 CAST REMOVAL - POMS Procedure MUSCULOSKELETAL 560 580 690 810 PROCEDURE ONCOLOGY K-WIRE REMOVAL & DRESSING - POMS009 Procedure MUSCULOSKELETAL 680 720 850 990 POMS PROCEDURE ONCOLOGY POMS008 MAJOR DRESSING - POMS Procedure MUSCULOSKELETAL 680 720 850 990 PROCEDURE ONCOLOGY POMS010 BELOW KNEE SLAB - POMS Procedure MUSCULOSKELETAL 820 860 1030 1190 PROCEDURE ONCOLOGY POMS011 JOINT ASPIRATION - POMS Procedure MUSCULOSKELETAL 820 860 1030 1190 PROCEDURE ONCOLOGY POMS012 ABOVE KNEE SLAB - POMS Procedure MUSCULOSKELETAL 960 1010 1200 1390 PROCEDURE ONCOLOGY POMS013 ABOVE ELBOW SLAB - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590 PROCEDURE ONCOLOGY POMS014 BELOW ELBOW CAST - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590 PROCEDURE ONCOLOGY POMS015 STRAPPING - POMS Procedure MUSCULOSKELETAL 1100 1150 1370 1590 PROCEDURE ONCOLOGY POMS016 ABOVE ELBOW CAST - POMS Procedure MUSCULOSKELETAL 1650 1730 2060 2390 PROCEDURE ONCOLOGY POMS017 BELOW KNEE CAST - POMS Procedure MUSCULOSKELETAL 1650 1730 2060 2390 PROCEDURE 109 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY POMS018 ABOVE KNEE CAST - POMS Procedure MUSCULOSKELETAL 1910 2010 2390 2770 PROCEDURE ONCOLOGY POMS020 NEEDLE BIOPSY - POMS Procedure MUSCULOSKELETAL 2050 2150 2560 2970 PROCEDURE ONCOLOGY SKELETAL TRACTION (CALCANEUS/ POMS019 Procedure MUSCULOSKELETAL 2050 2150 2560 2970 TIBIA/FEMUR) IN ER - POMS PROCEDURE ONCOLOGY POMS021 TRUCUT BIOPSY - POMS Procedure MUSCULOSKELETAL 2050 2150 2560 2970 PROCEDURE ONCOLOGY BONE MARROW ASPIRATION - POMS022 Procedure MUSCULOSKELETAL 2740 2880 3430 3970 POMS PROCEDURE ONCOLOGY LOMS001 Aspiration-MSONCO # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY Bone Marrow Aspiration-MSONCO LOMS003 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 # L1 SURGERY ONCOLOGY LOMS002 Closed Reduction-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS004 Hip Spica POP Cast # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS005 Implant Removal- Minor MSONCO Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS006 Inision & Drainage-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS007 K-Wire Fixation-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS008 Major Wound Dressing # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY Manipulation Under Anasthesia LOMS009 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 (MUA)- Minor # L1 SURGERY ONCOLOGY LOMS010 Minor Amputation-Upper Limb # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY Minor Tumor Excision-Upper Limb LOMS011 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 # L1 SURGERY

110 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LOMS012 Skeletal Traction # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS013 Skin Grafting-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS014 Trucut Bone Biospy # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS015 Wound Debridement-Minor # L1 L1 Surgery MUSCULOSKELETAL 4290 4500 5360 6220 SURGERY ONCOLOGY LOMS016 Implant Removal- MSONCO # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS017 Incision & Drainage-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS018 K-Wire Fixation-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY Manipulation Under Anasthesia LOMS019 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 (MUA)-Major # L2 SURGERY ONCOLOGY LOMS020 Minor Amputation-Lower limb # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY Minor Tumor Excision-Lower Limb LOMS021 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 # L2 SURGERY ONCOLOGY LOMS022 Nerve Surgery-Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS023 Open Biopsy # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS024 Osteotomy-Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS029 Pedicled Flaps - Minor # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS025 Skin Grafting # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS026 Spinal Biopsy # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY

111 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LOMS027 Tendon Transfer # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS028 Wound Debridement-Major # L2 L2 Surgery MUSCULOSKELETAL 0 8240 9810 11380 SURGERY ONCOLOGY LOMS038 Arthrodesis-Small Joint # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY LOMS030 Bone Grafting-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY LOMS033 Curettage - Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY External Fixator Application-Minor LOMS032 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 # L3 SURGERY ONCOLOGY LOMS034 K-Nail # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY Limb salvage with Modular LOMS039 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 Megaprosthesis - Minor # L3 SURGERY ONCOLOGY Nerve Surgery-Major MSONCO LOMS035 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 # L3 SURGERY ONCOLOGY LOMS036 Plate Osteosynthesis-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY LOMS037 Skin Grafting-Major # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY LOMS031 Tumor Excision-Minor # L3 L3 Surgery MUSCULOSKELETAL 0 10820 12880 14940 SURGERY ONCOLOGY LOMS043 Arthrodesis - Wrist - Minor # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 SURGERY ONCOLOGY LOMS040 Axillary Clearance # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 SURGERY ONCOLOGY LOMS042 Curettage - Major # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 SURGERY ONCOLOGY Excision of Bone segment - Major LOMS045 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 # L4 SURGERY ONCOLOGY LOMS041 Groin Node Dissection # L4 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 SURGERY 112 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY Limb Salvage with custom made LOMS046 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 Megaprosthesis - Minor # L4 SURGERY ONCOLOGY Megaprosthesis Reconstruction LOMS044 L4 Surgery MUSCULOSKELETAL 0 14790 17610 20420 # L4 SURGERY ONCOLOGY LOMS049 Above Elbow Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS050 Above Knee Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS059 AMP Hemiarthroplasty # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS060 Arthrodesis-Ankle # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS063 Arthrodesisc- Wrist - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS062 Arthrodesis-Hip # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS061 Arthrodesis - Knee - Minor # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS047 Below Elbow Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS048 Below Knee Amputation # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY Bipolar Hemiarthroplasty - Minor LOMS052 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 # L5 SURGERY ONCOLOGY LOMS054 Extended Curettage # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY Forequarter Amputation - Minor LOMS051 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 # L5 SURGERY ONCOLOGY Humerus Hemiarthroplasty - Minor LOMS053 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 # L5 SURGERY ONCOLOGY Implant Removal - Major MSONCO LOMS055 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 # L5 SURGERY

113 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LOMS056 Interlocking Nail # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS057 Nail Cement Spacer # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS066 Osteotomy - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY Pedicled Fibula Transfer - Minor LOMS068 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 # L5 SURGERY ONCOLOGY LOMS067 Pedicled Flaps - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS065 Plate Osteosynthesis - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS069 TKR Megaprosthesis - Minor # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS064 Tumor Excision - Major # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY LOMS058 Vertebroplasty MSONCO # L5 L5 Surgery MUSCULOSKELETAL 0 18010 21440 24870 SURGERY ONCOLOGY Allograft + Vascularised Fibula LOMS085 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Reconstruction - Major # L6 SURGERY ONCOLOGY LOMS071 Arthrodesis - Knee - Major # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 SURGERY ONCOLOGY LOMS070 Balloon Kyphoplasty-MSONCO # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 SURGERY ONCOLOGY Bipolar Hemiarthroplasty- LOMS076 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Megaprosthesis # L6 SURGERY ONCOLOGY Bone Allograft Reconstruction - LOMS084 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Minor # L6 SURGERY ONCOLOGY ECRT (Extra-corporeal Radiation & LOMS080 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Reimplantation) - Minor # L6 SURGERY ONCOLOGY Extended Curettage + Bone LOMS072 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Grafting - Major # L6 SURGERY

114 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY Extended Curettage + Cementing LOMS073 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 # L6 SURGERY ONCOLOGY External Fixator Application-Major LOMS074 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 # L6 SURGERY ONCOLOGY Forequarter Amputation - Major LOMS077 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 # L6 SURGERY ONCOLOGY LOMS081 Free Vascularised Fibula Graft # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 SURGERY ONCOLOGY Humerus Hemiarthroplasty - Major LOMS078 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 # L6 SURGERY ONCOLOGY Ilizarov External Fixator (IEF)/ LRS LOMS075 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Application # L6 SURGERY ONCOLOGY Internal hemipelvectomy Type II + LOMS083 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 III - Minor # L6 SURGERY ONCOLOGY Internal Hemipelvectomy Type I - LOMS082 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 Minor # L6 SURGERY ONCOLOGY LOMS086 Partial Sacrectomy - Minor # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 SURGERY ONCOLOGY Total Elbow Replacement - Minor LOMS087 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 # L6 SURGERY ONCOLOGY LOMS079 Tumor Excision - Supra major # L6 L6 Surgery MUSCULOSKELETAL 0 27010 32150 37290 SURGERY ONCOLOGY Allograft Prosthetic Composite LOMS096 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 (APC) - Minor # L7 SURGERY Anterior Spinal Cord ONCOLOGY LOMS098 Decompression & Instrumentation L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 - Minor # L7 SURGERY ONCOLOGY Anterior Spinal Cord LOMS097 T7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Decompression - Minor # T7 SURGERY ONCOLOGY Arthrodesis Knee - Supra Major LOMS095 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 # L7 SURGERY ONCOLOGY Arthrodesis Wrist - Supra Major LOMS094 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 # L7 SURGERY

115 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY Bipolar Hemiarthroplasty- LOMS099 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Megaprosthesis - Major # L7 SURGERY ONCOLOGY Bone Allograft + Free Vascularised LOMS106 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Fibula Reconstruction # L7 SURGERY ONCOLOGY Bone Allograft Reconstruction - LOMS105 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Major # L7 SURGERY ONCOLOGY ECRT (Extra-corporeal Radiation & LOMS100 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Reimplantation) # L7 SURGERY ONCOLOGY ECRT (Extra-corporeal Radiation & LOMS089 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Reimplantation) - Major UL # L7 SURGERY ONCOLOGY Excision of Bone Segment - Supra LOMS088 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Major # L7 SURGERY ONCOLOGY Extended Curettage - Supra Major LOMS093 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 # L7 SURGERY ONCOLOGY Free Vascularised Fibula Graft LOMS101 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 -Major # L7 SURGERY ONCOLOGY Internal Hemipelvectomy Type I + II LOMS104 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 + III/I +II+ IV - Minor # L7 SURGERY ONCOLOGY Internal hemipelvectomy Type II + LOMS103 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 III - Major # L7 SURGERY ONCOLOGY Internal Hemipelvectomy Type I - LOMS102 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 Major # L7 SURGERY ONCOLOGY Pedicled Fibula Transfer - Major LOMS090 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 # L7 SURGERY ONCOLOGY LOMS107 Rotationplasty - Minor # L7 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 SURGERY ONCOLOGY LOMS091 TKR Megaprosthesis # L7 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 SURGERY ONCOLOGY Total Elbow Replacement - Major LOMS092 L7 Surgery MUSCULOSKELETAL 0 36010 42870 49730 # L7 SURGERY Anterior Spinal Cord ONCOLOGY LOMS113 Decompression & Instrumentation L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 - Supra Major # L8 SURGERY

116 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY Bone Allograft + Free Vascularised LOMS117 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Fibula Reconstruction - Major # L8 SURGERY ONCOLOGY Bone Allograft Reconstruction - LOMS116 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Supra Major # L8 SURGERY ONCOLOGY ECRT (Extra-corporeal Radiation & LOMS112 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Reimplantation) - Pelvis # L8 SURGERY ONCOLOGY Internal Hemipelvectomy Type I + II LOMS115 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 + III/I +II+ IV - Major # L8 SURGERY ONCOLOGY Internal hemipelvectomy Type II + LOMS114 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 III - Supra Major # L8 SURGERY ONCOLOGY LOMS118 Partial Sacrectomy - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 SURGERY ONCOLOGY Pedicled Fibula Transfer - Supra LOMS108 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Major # L8 SURGERY ONCOLOGY LOMS122 Rotationplasty - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 SURGERY ONCOLOGY LOMS110 THR Megaprosthesis - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 SURGERY ONCOLOGY LOMS109 TKR Megaprosthesis - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 SURGERY ONCOLOGY Total Elbow Replacement - Supra LOMS111 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Major # L8 SURGERY ONCOLOGY Total Femur Replacement - Major LOMS120 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 # L8 SURGERY ONCOLOGY Total Humerus Replacement - LOMS121 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 Supra Major # L8 SURGERY ONCOLOGY LOMS119 Total Sacrectomy - Major # L8 L8 Surgery MUSCULOSKELETAL 0 45010 53580 62150 SURGERY Bone Allograft + Free Vascularised ONCOLOGY LOMS123 Fibula Reconstruction - Supra L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 Major # L9 SURGERY ONCOLOGY ECRT (Extra-corporeal Radiation & LOMS126 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 Reimplantation) - Supra Major # L9 SURGERY

117 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY Internal Hemipelvectomy Type I + II LOMS124 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 + III/I +II+ IV - Supra Major # L9 SURGERY ONCOLOGY Limb Salvage with custom made LOMS130 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 Megaprosthesis - Major # L9 SURGERY ONCOLOGY Limb salvage with Modular LOMS131 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 Megaprosthesis # L9 SURGERY ONCOLOGY LOMS129 Rotationplasty - Supra Major # L9 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 SURGERY ONCOLOGY TKR Megaprosthesis - Supra Major LOMS127 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 # L9 SURGERY ONCOLOGY Total Femur Replacement - Supra LOMS128 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 Major # L9 SURGERY ONCOLOGY Total Sacrectomy - Supra Major LOMS125 L9 Surgery MUSCULOSKELETAL 0 54020 64300 74590 # L9 SURGERY D & C FRACTIONAL CURATTAGE ONCOLOGY LONS001 L1 Surgery 4505 4730 5630 6530 (ONS) # L1 SURGERY ONCOLOGY LONS003 DRESSING SIMPLE (ONS) # L1 L1 Surgery 4505 4730 5630 6530 SURGERY ONCOLOGY LONS004 EUA (LONS) # L1 L1 Surgery 4505 4730 5630 6530 SURGERY ONCOLOGY LONS005 FNAC (LONS) # L1 L1 Surgery 4505 4730 5630 6530 SURGERY INCISIONAL + DRAINAGE (ONS) ONCOLOGY LONS006 L1 Surgery 4505 4730 5630 6530 # L1 SURGERY ONCOLOGY LONS007 PUNCH BIOPSY (LONS) # L1 L1 Surgery 4505 4730 5630 6530 SURGERY RE-EXPLORATION FOR BLEEDING ONCOLOGY LONS002 L1 Surgery 4505 4730 5630 6530 (ONS) # L1 SURGERY SIGMOIDOSCOPY - RIGID (LONS) ONCOLOGY LONS008 L1 Surgery 4505 4730 5630 6530 # L1 SURGERY TRANS-RECTAL/TRANSPERINEAL ONCOLOGY LONS009 L1 Surgery 4505 4730 5630 6530 BIOPSY OF PROSTATE (ONS) # L1 SURGERY BRONCHOSCOPY A) - RIGID (ONS) ONCOLOGY LONS010 L2 Surgery 0 8655 10305 11955 # L2 SURGERY CERVICAL POLYPECTOMY (ONS) ONCOLOGY LONS011 L2 Surgery 0 8655 10305 11955 # L2 SURGERY ONCOLOGY LONS012 CHEMOPORT REMOVAL (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY CORE BIOPSY /TRUCUT BIOPSY ONCOLOGY LONS013 L2 Surgery 0 8655 10305 11955 (ONS) # L2 SURGERY

118 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LONS014 CYSTOSCOPY (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY DIRECT LARYNGOSCOPY (ONS) ONCOLOGY LONS015 L2 Surgery 0 8655 10305 11955 # L2 SURGERY ONCOLOGY LONS016 DL-SCOPY (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY ONCOLOGY LONS017 DRESSING EXTENSIVE (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY EXCISION OF MELANOMA (LONS) ONCOLOGY LONS018 L2 Surgery 0 8655 10305 11955 # L2 SURGERY EXCISION OF MUCOSAL ONCOLOGY LONS019 L2 Surgery 0 8655 10305 11955 MELANOMA (ONS) # L2 SURGERY EXCISION OF SKIN LESION (ONS) ONCOLOGY LONS020 L2 Surgery 0 8655 10305 11955 # L2 SURGERY EXPLORATORY CERVICOTOMY ONCOLOGY LONS021 L2 Surgery 0 8655 10305 11955 (ONS) # L2 SURGERY ONCOLOGY LONS022 ICD - PLACEMENT (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY INTRA PERITONEAL - CHEMOPORT ONCOLOGY LONS023 L2 Surgery 0 8655 10305 11955 REMOVAL (ONS) # L2 SURGERY ONCOLOGY LONS024 LOCAL ROTATION FLAP (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY LYMPHNODE BIOPSY EXCISION - ONCOLOGY LONS025 L2 Surgery 0 8655 10305 11955 SONS (ONS) # L2 SURGERY NASOPHARYNGOSCOPY INCLUDING ONCOLOGY LONS026 L2 Surgery 0 8655 10305 11955 BIOPSY (ONS) # L2 SURGERY ONCOLOGY LONS027 SECONDARY SUTURING (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY ONCOLOGY LONS028 SPLIT SKIN GRAFTING (ONS) # L2 L2 Surgery 0 8655 10305 11955 SURGERY CIRCUMCISSION FOR PREPUCIAL ONCOLOGY LONS029 L3 Surgery 0 11365 13530 15695 MALIGNANCY (ONS) # L3 SURGERY ONCOLOGY LONS030 CONISATION (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY ONCOLOGY LONS032 CORDECTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY ONCOLOGY LONS031 CORD STRIPPING (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY DIAGNOSTIC CALDWELL-LUC ONCOLOGY LONS033 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY ONCOLOGY LONS034 DIVISION OF FLAPS (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY EXCISION OF BASAL CELL CARCI) ONCOLOGY LONS035 L3 Surgery 0 11365 13530 15695 (LONS) # L3 SURGERY EXCISION OF PREMALIGNANT LES ONCOLOGY LONS036 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY

119 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EXCISION OF SUBCUTANEOUS ONCOLOGY LONS037 L3 Surgery 0 11365 13530 15695 LESION (ONS) # L3 SURGERY FRACTIONAL CURRATAGE (ONS) ONCOLOGY LONS038 L3 Surgery 0 11365 13530 15695 # L3 SURGERY HICKMAN CATHETER INSERTION ONCOLOGY LONS039 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY HYSTEROSCOPY INCLUDING BIOPSY, DILATATION, CURETTAGE ONCOLOGY LONS040 AND POLYPECTOMY WITH/ L3 Surgery 0 11365 13530 15695 SURGERY WITHOUT MERINA INSERTION (ONS) # L3 ONCOLOGY LONS041 LATERAL RHINOTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY LOCAL EXCISION OF LIP LESION ONCOLOGY LONS042 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY ONCOLOGY LONS043 MICRODOCHECTOMY (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY ONCOLOGY LONS044 MOURES OPERATION (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY MUCOSAL SHAVE OF LIP LESION ONCOLOGY LONS045 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY OESOPHAGOSCOPY - RIGID ONCOLOGY LONS046 L3 Surgery 0 11365 13530 15695 INCLUDING BIOPSY (ONS) # L3 SURGERY ONCOLOGY LONS047 OPEN BONE BIOPSY (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY PALATAL FENESTRATION (ONS) ONCOLOGY LONS048 L3 Surgery 0 11365 13530 15695 # L3 SURGERY SUSPENSION LARYNGOSCOPY ONCOLOGY LONS049 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY ONCOLOGY LONS050 TARSORRAPHY - SONS (ONS) # L3 L3 Surgery 0 11365 13530 15695 SURGERY TRACHEO OESOPHAGEAL ONCOLOGY LONS051 L3 Surgery 0 11365 13530 15695 PUNCTURE (ONS) # L3 SURGERY WIDE EXCISION OF SCALP TUMOR ONCOLOGY LONS052 L3 Surgery 0 11365 13530 15695 (ONS) # L3 SURGERY ONCOLOGY LONS053 ALVEOLECTOMY (ONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY CHEMOPORT INSERTION (LONS) ONCOLOGY LONS054 L4 Surgery 0 15535 18495 21455 # L4 SURGERY DIAGNOSTIC THORACOSCOPY +/- ONCOLOGY LONS055 L4 Surgery 0 15535 18495 21455 BIOPSY (ONS) # L4 SURGERY EXCISION BENIGN TUMOR NECK ONCOLOGY LONS056 L4 Surgery 0 15535 18495 21455 (LONS) # L4 SURGERY EXCISION OF BASAL CELL CARCITH ONCOLOGY LONS057 L4 Surgery 0 15535 18495 21455 RECONSTRUCTION (ONS) # L4 SURGERY

120 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EXCISION OF LACRIMAL GLAND TB) ONCOLOGY LONS058 L4 Surgery 0 15535 18495 21455 (ONS) # L4 SURGERY EXCISION OF MUCOSAL ONCOLOGY LONS059 MELANOMAECONSTRUCTION L4 Surgery 0 15535 18495 21455 SURGERY (ONS) # L4 EXCISION OF PARATHYROID ONCOLOGY LONS060 L4 Surgery 0 15535 18495 21455 ADENOMA/CARCINOMA (ONS) # L4 SURGERY FEEDING ENTEROSTOMY (ONS) ONCOLOGY LONS061 L4 Surgery 0 15535 18495 21455 # L4 SURGERY ONCOLOGY LONS062 GASTROSTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY INTRA PERITONEAL - CHEMOPORT ONCOLOGY LONS063 L4 Surgery 0 15535 18495 21455 INSERTION (ONS) # L4 SURGERY LAPAROSCOPIC OMENTAL / ONCOLOGY LONS064 L4 Surgery 0 15535 18495 21455 PERITONEAL BIOPSY (ONS) # L4 SURGERY ONCOLOGY LONS065 LEEP (ONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY LID EXCISION WITH ONCOLOGY LONS066 L4 Surgery 0 15535 18495 21455 RECONSTRUCION (ONS) # L4 SURGERY ONCOLOGY LONS067 LUMPECTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY ONCOLOGY LONS068 MLS (ONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY NARROW FIELD LARYNGECTOMY ONCOLOGY LONS069 L4 Surgery 0 15535 18495 21455 (ONS) # L4 SURGERY ONCOLOGY LONS070 PDT (ONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY RADICAL ORCHIDECTOMY (LONS) ONCOLOGY LONS071 L4 Surgery 0 15535 18495 21455 # L4 SURGERY SCELENE TRIANGLE DISSECTION ONCOLOGY LONS072 L4 Surgery 0 15535 18495 21455 (LONS) # L4 SURGERY ONCOLOGY LONS073 SIMPLE MASTECTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY SUBMANDIBULAR GLAND ONCOLOGY LONS074 L4 Surgery 0 15535 18495 21455 EXCISION (LONS) # L4 SURGERY THEREPEUTIC CALDWELL-LUC ONCOLOGY LONS075 L4 Surgery 0 15535 18495 21455 (ONS) # L4 SURGERY ONCOLOGY LONS076 TRACHEOSTOMY (LONS) # L4 L4 Surgery 0 15535 18495 21455 SURGERY WIDE EXCISION OF CARCINOMA ONCOLOGY LONS077 L4 Surgery 0 15535 18495 21455 BUCOSA (ONS) # L4 SURGERY WIDE EXCISION OF FLOOR MOUTH ONCOLOGY LONS078 L4 Surgery 0 15535 18495 21455 (ONS) # L4 SURGERY AMPUTATION OF PENIS - PARTIAL ONCOLOGY LONS079 L5 Surgery 0 18910 22515 26115 (LONS) # L5 SURGERY

121 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group BILATERAL OOPHRECTOMY (LONS) ONCOLOGY LONS080 L5 Surgery 0 18910 22515 26115 # L5 SURGERY BILATERAL ORCHIDECTOMY (LONS) ONCOLOGY LONS081 L5 Surgery 0 18910 22515 26115 # L5 SURGERY BREAST LESION EXCISION (ONS) ONCOLOGY LONS082 L5 Surgery 0 18910 22515 26115 # L5 SURGERY CENTRAL COMPARTMENT NECK ONCOLOGY LONS083 L5 Surgery 0 18910 22515 26115 DISSECTION (ONS) # L5 SURGERY ONCOLOGY LONS085 COLOSTOMY -END (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS084 COLOSTOMY - LOOP (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY DEFUNCTIONING COLOSTOMY ONCOLOGY LONS086 L5 Surgery 0 18910 22515 26115 (LONS) # L5 SURGERY ONCOLOGY LONS087 DIAPHRAGM STRIPPING (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS088 DISTAL FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS089 DOUBLE FLAP (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY EXCISION OF MALIGNANT LESION ONCOLOGY LONS090 (NOT OTHERWISE SPECIFIED) L5 Surgery 0 18910 22515 26115 SURGERY (ONS) # L5 EXCISION OF MELANOMA WITH ONCOLOGY LONS091 L5 Surgery 0 18910 22515 26115 RECONSTRUCTION (ONS) # L5 SURGERY ONCOLOGY LONS092 EXCISION OF PINNA (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY EXCISION OF UNILATERAL ONCOLOGY LONS093 L5 Surgery 0 18910 22515 26115 PULMOTASTASIS (ONS) # L5 SURGERY EXCISION THYROGLOSSAL CYST/ ONCOLOGY LONS094 L5 Surgery 0 18910 22515 26115 TRACT (ONS) # L5 SURGERY EXPLORATORY THOROCOTOMY ONCOLOGY LONS095 L5 Surgery 0 18910 22515 26115 (LONS) # L5 SURGERY EXTERNAL AUDITORY CANAL EXCI) ONCOLOGY LONS096 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY FEEDING JEJUNOSTOMY (LONS) ONCOLOGY LONS097 L5 Surgery 0 18910 22515 26115 # L5 SURGERY GLOMUS TUMOR EXCISION (ONS) ONCOLOGY LONS098 L5 Surgery 0 18910 22515 26115 # L5 SURGERY ONCOLOGY LONS099 GLOSSECTOMY HEMI (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY HEPATIC RESECTION - WEDGE ONCOLOGY LONS100 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY HYSTEROSCOPY WITH RESECTION ONCOLOGY LONS101 L5 Surgery 0 18910 22515 26115 OF FIBROID (ONS) # L5 SURGERY

122 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LONS102 ILEOSTOMY END (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS103 ILEOSTOMY LOOP (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY INCISIONAL HERNIA MESH REPAIR ONCOLOGY LONS104 WITH/WITHOUT ADHESIOLYSIS L5 Surgery 0 18910 22515 26115 SURGERY (ONS) # L5 ONCOLOGY LONS105 LAPAROSCOPIC BSO (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY LAPAROSCOPIC VENTRAL HERNIA ONCOLOGY LONS106 L5 Surgery 0 18910 22515 26115 MESH REPAIR (ONS) # L5 SURGERY ONCOLOGY LONS107 LARYNGO FISSURE (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS109 MEDIAN STERNOTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY MEDIASTINAL LYMPHADUCTOMY ONCOLOGY LONS110 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY ONCOLOGY LONS111 MEDIASTINOSCOPY (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY MIRP - MINIMALLY INVASIVE RADIO ONCOLOGY LONS112 L5 Surgery 0 18910 22515 26115 GUIDED PARATHYROID (ONS) # L5 SURGERY ONCOLOGY LONS113 MUSCLE FLAP (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS114 OMENTECTOMY (LONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS115 PALATECTOMY PARTIAL (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY PAN ENDOSCOPY - SONS (ONS) ONCOLOGY LONS116 L5 Surgery 0 18910 22515 26115 # L5 SURGERY ONCOLOGY LONS117 PEDICLE FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY RECONCOTRUCTION OF GASTRIC ONCOLOGY LONS119 L5 Surgery 0 18910 22515 26115 RES (LONS) # L5 SURGERY ONCOLOGY LONS120 REGIONAL FLAPS (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY RETROPERITONEAL LYMPHNODE ONCOLOGY LONS121 L5 Surgery 0 18910 22515 26115 BIOPSY (ONS) # L5 SURGERY ONCOLOGY LONS122 REVISION COLOSTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS123 RFA (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ROLL - RADIO GUIDED OCCULT ONCOLOGY LONS124 L5 Surgery 0 18910 22515 26115 LESION LOCALIZATION (ONS) # L5 SURGERY SENTINEL NODE BIOPSY (LONS) ONCOLOGY LONS125 L5 Surgery 0 18910 22515 26115 # L5 SURGERY

123 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LONS126 SIMPLE HYSTRECTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS127 SINGLE FLAP (LONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY ONCOLOGY LONS128 SPLEENECTOMY (LONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY SUPERIOR MEDIASTINAL CLEARAN ONCOLOGY LONS129 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY TENDON LENGTHENING /TENDOM ONCOLOGY LONS130 L5 Surgery 0 18910 22515 26115 SUTURES (ONS) # L5 SURGERY TENSION SUTURING OF BURST ONCOLOGY LONS131 L5 Surgery 0 18910 22515 26115 ABDOMEN (ONS) # L5 SURGERY THERAPEUTIC LAPAROSCOPY ONCOLOGY LONS132 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY THERAPEUTIC THORACOSCOPY ONCOLOGY LONS133 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY THEREPEUTIC ENDOSCOPY (LONS) ONCOLOGY LONS134 L5 Surgery 0 18910 22515 26115 # L5 SURGERY TICKHOFF LINBERG PROCEDURE ONCOLOGY LONS135 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY ONCOLOGY LONS136 TOTAL MASTECTOMY (ONS) # L5 L5 Surgery 0 18910 22515 26115 SURGERY TRACHEO-OESOPHAGEAL SHUNT ONCOLOGY LONS137 L5 Surgery 0 18910 22515 26115 (ONS) # L5 SURGERY WIDE EXCISION OF PALATE (ONS) ONCOLOGY LONS138 L5 Surgery 0 18910 22515 26115 # L5 SURGERY WIDE EXCISION OF SOFT TISSUE ONCOLOGY LONS139 L5 Surgery 0 18910 22515 26115 TUMOR (ONS) # L5 SURGERY AMPUTATION ABOVE KNEE (LONS) ONCOLOGY LONS140 L6 Surgery 0 28355 33755 39155 # L6 SURGERY AMPUTATION BELOW KNEE (LONS) ONCOLOGY LONS141 L6 Surgery 0 28355 33755 39155 # L6 SURGERY AMPUTATION OF TOTAL PENIS ONCOLOGY LONS142 L6 Surgery 0 28355 33755 39155 (LONS) # L6 SURGERY AXILLARY CLEARANCE LEVEL I & II ONCOLOGY LONS143 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY BREAST LOCAL ONCOPLASTY ONCOLOGY LONS145 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY BYPASS PROCEDURES (INTESTINE ONCOLOGY LONS146 L6 Surgery 0 28355 33755 39155 FOR TUMORS) (ONS) # L6 SURGERY CIRCULAR PHARYNGECTOMY (ONS) ONCOLOGY LONS147 L6 Surgery 0 28355 33755 39155 # L6 SURGERY ONCOLOGY LONS148 COLOSTOMY -CLOSURE (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY D2 LYMPHADENECTOMY (ONS) ONCOLOGY LONS149 L6 Surgery 0 28355 33755 39155 # L6 SURGERY

124 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY LONS150 ENUCLEATION OF EYE (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY ETHMOIDO-SPHENOIDECTOMY ONCOLOGY LONS151 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY EXCISION BRACHIAL FISTULA ONCOLOGY LONS152 L6 Surgery 0 28355 33755 39155 (LONS) # L6 SURGERY EXCISION OF ADRENAL TUMORS ONCOLOGY LONS153 L6 Surgery 0 28355 33755 39155 (LONS) # L6 SURGERY EXCISION OF CARCINOID TUMORS ONCOLOGY LONS154 L6 Surgery 0 28355 33755 39155 (LONS) # L6 SURGERY EXCISION OF INSULINOMAS (LONS) ONCOLOGY LONS155 L6 Surgery 0 28355 33755 39155 # L6 SURGERY EXCISION OF ORAL TUMORS VIA ONCOLOGY LONS156 L6 Surgery 0 28355 33755 39155 ROUGH APPROACH (ONS) # L6 SURGERY GASTROJEJUNOSTOMY & ONCOLOGY LONS157 L6 Surgery 0 28355 33755 39155 VAGOTOMY (LONS) # L6 SURGERY GLOSSECTOMY PARTIAL (ONS) ONCOLOGY LONS158 L6 Surgery 0 28355 33755 39155 # L6 SURGERY HEPATIC RESECTION ONCOLOGY LONS159 L6 Surgery 0 28355 33755 39155 SEGMENTECTOMY (ONS) # L6 SURGERY ONCOLOGY LONS160 ILEOSTOMY CLOSURE (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY INFRASTRUCTURAL ONCOLOGY LONS161 L6 Surgery 0 28355 33755 39155 MAXILLECTOMY (ONS) # L6 SURGERY INTERNAL ILIAC ARTERY LIGATION ONCOLOGY LONS144 L6 Surgery 0 28355 33755 39155 B/L (ONS) # L6 SURGERY LAPAROTOMY & ADHESIOLYSIS (AS ONCOLOGY LONS162 L6 Surgery 0 28355 33755 39155 SOLE PROCEDURE) (ONS) # L6 SURGERY LARYNGECTOMY - FRONTO ONCOLOGY LONS163 L6 Surgery 0 28355 33755 39155 LATERAL (ONS) # L6 SURGERY LYMPHADENECTOMY (NOT ONCOLOGY LONS108 L6 Surgery 0 28355 33755 39155 OTHERWISE SPECIFIED) (ONS) # L6 SURGERY MANDIBULOTOMY WITH ONCOLOGY LONS164 L6 Surgery 0 28355 33755 39155 MANDIBULAR SWING (ONS) # L6 SURGERY MARGINAL MANDIBULECTOMY ONCOLOGY LONS165 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY MAXILLECTOMY - PARTIAL (ONS) ONCOLOGY LONS166 L6 Surgery 0 28355 33755 39155 # L6 SURGERY MESORECTAL EXCISION (TME) ONCOLOGY LONS167 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY MUSCLE GROUP EXCISION (ONS) ONCOLOGY LONS168 L6 Surgery 0 28355 33755 39155 # L6 SURGERY ONCOLOGY LONS169 MYOCUTANEOUS FLAP (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY ONCOLOGY LONS170 NERVE GRAFTING (LONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY

125 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ORBITAL EXENTERATION (ONS) ONCOLOGY LONS171 L6 Surgery 0 28355 33755 39155 # L6 SURGERY PAN HYSTERECTOMY/TOTAL ONCOLOGY LONS172 HYSTERECTOMY + B/L BSO (ONS) L6 Surgery 0 28355 33755 39155 SURGERY # L6 PARA AORTIC LYMPHADECTOMY ONCOLOGY LONS173 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY PARTIAL PHARYNGECTOMY (LONS) ONCOLOGY LONS174 L6 Surgery 0 28355 33755 39155 # L6 SURGERY PLND - PELVIC LYMPHADECTOMY ONCOLOGY LONS175 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY ONCOLOGY LONS118 PORT-A-CATH (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY PTERYGO PALATINE FOSSA ONCOLOGY LONS176 L6 Surgery 0 28355 33755 39155 DISSED) (ONS) # L6 SURGERY ONCOLOGY LONS177 QUADRANTECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY RADICAL CHOLECYSTECTOMY AND ONCOLOGY LONS178 L6 Surgery 0 28355 33755 39155 LYMPHADENECTOMY (ONS) # L6 SURGERY RESECTION ANASTAMOSIS BOWEL ONCOLOGY LONS179 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY SACRECTOMY - PARTIAL (ONS) ONCOLOGY LONS180 L6 Surgery 0 28355 33755 39155 # L6 SURGERY SEGMENTAL MANDIBULECTOMY ONCOLOGY LONS181 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY ONCOLOGY LONS182 SHOELACE REPAIR (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY SUBTOTAL GLOSSECTOMY (ONS) ONCOLOGY LONS183 L6 Surgery 0 28355 33755 39155 # L6 SURGERY THYROID ISTHMECTOMY (ONS) ONCOLOGY LONS184 L6 Surgery 0 28355 33755 39155 # L6 SURGERY ONCOLOGY LONS185 THYROID LOBECTOMY (LONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY TOTAL MASTECTOMY + SLNB ONCOLOGY LONS186 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY TOTAL PALATATECTOMY (ONS) # ONCOLOGY LONS187 L6 Surgery 0 28355 33755 39155 L6 SURGERY ONCOLOGY LONS188 TRACHELECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY TRANSANAL ENDOSCPIC ONCOLOGY LONS189 L6 Surgery 0 28355 33755 39155 MICROSURGERY (TEM) (ONS) # L6 SURGERY TRUP & TUR BLADDER TUMOUR ONCOLOGY LONS190 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY ONCOLOGY LONS191 TUR-BT (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY

126 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TWO FIELD LYMPHADENECTOMY ONCOLOGY LONS192 L6 Surgery 0 28355 33755 39155 (LONS) # L6 SURGERY UNILATERAL ILEO-INGUINAL ONCOLOGY LONS193 L6 Surgery 0 28355 33755 39155 BLOCK DISSECTION (ONS) # L6 SURGERY URINARY DIVERSION PROCEDURES ONCOLOGY LONS194 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY ONCOLOGY LONS195 VULVECTOMY (ONS) # L6 L6 Surgery 0 28355 33755 39155 SURGERY WEDGE RESECTION OF LUNG ONCOLOGY LONS196 L6 Surgery 0 28355 33755 39155 (ONS) # L6 SURGERY WIDE EXCISION OF SCALP TUMOR ONCOLOGY LONS197 L6 Surgery 0 28355 33755 39155 RECONSTRUCTION (ONS) # L6 SURGERY ABDOMINO-PERINEAL RESECTION ONCOLOGY LONS001RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY ANTERIOR RESECTION (LONS) [RS ONCOLOGY LONS009RS LR Surgery 0 31070 36990 42905 10 days Package] # LR SURGERY BYPASS PROCEDURES (LONS) [RS ONCOLOGY LONS016RS LR Surgery 0 31070 36990 42905 10 days Package] # LR SURGERY CLOSURE OF COLOSTOMY (LONS) ONCOLOGY LONS021RS LR Surgery 0 31070 36990 42905 [RS 10 days Package] # LR SURGERY D2 LYMPHADENECTOMY (LONS) ONCOLOGY LONS260RS LR Surgery 0 31070 36990 42905 [RS 10 days Package] # LR SURGERY DEFUNCTIONING COLOSTOMY ONCOLOGY LONS032RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY DIAGNOSTIC LAPAROSCOPY - ONCOLOGY LONS034RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY DIAGNOSTIC THORACOSCOPY ONCOLOGY LONS035RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY DISTAL PANCREATECTOMY (LONS) ONCOLOGY LONS038RS LR Surgery 0 31070 36990 42905 [RS 10 days Package] # LR SURGERY EXCISION OF ADRENAL TUMORS ONCOLOGY LONS050RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY EXCISION OF BILATERAL ONCOLOGY LONS053RS PULMONASTASIS (LONS) [RS 5 LR Surgery 0 31070 36990 42905 SURGERY days Package] # LR EXCISION OF CARCINOID TUMORS ONCOLOGY LONS054RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY EXCISION OF INSULINOMAS (LONS) ONCOLOGY LONS056RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY EXCISION OF PARA PHARYNGEAL ONCOLOGY LONS065RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY EXCISION OF PARATHYROID ONCOLOGY LONS066RS ADENOMA/CARCINOMA (LONS) [RS LR Surgery 0 31070 36990 42905 SURGERY 5 days Package] # LR EXCISION OF UNILATERAL ONCOLOGY LONS074RS PULMOTASTASIS (LONS) [RS 5 LR Surgery 0 31070 36990 42905 SURGERY days Package] # LR

127 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EXPLORATORY THOROCOTOMY ONCOLOGY LONS078RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY FEEDING ENTEROSTOMY (LONS) ONCOLOGY LONS256RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY GLOMUS TUMOR EXCISION (LONS) ONCOLOGY LONS086RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY HARTMANN'S PROCEDURE (LONS) ONCOLOGY LONS268RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY HEMICOLECTOMY (LONS) [RS 10 ONCOLOGY LONS089RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY HEPATATECTOMY (LONS) [RS 5 ONCOLOGY LONS090RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY IVOR LEWIS ESOPHAGECTOMY ONCOLOGY LONS096RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY LAPAROSCOPIC OMENTAL / ONCOLOGY LONS252RS PERITONEAL BIOPSY (LONS) [RS 5 LR Surgery 0 31070 36990 42905 SURGERY days Package] # LR LOBECTOMY - LUNG (LONS) [RS 5 ONCOLOGY LONS109RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY LYMPHADENECTOMY (LONS) [RS 5 ONCOLOGY LONS265RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY MEDIASTINAL / THORACIC TUMOR ONCOLOGY LONS058RS RESECTION (LONS) [RS 5 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR MESORECTAL EXCISION (TME) ONCOLOGY LONS263RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY OESOPHAGECTOMY TOTAL- ONCOLOGY LONS134RS ORRINGRGAN TRANPOSITION LR Surgery 0 31070 36990 42905 SURGERY (LONS) [RS 10 days Package] # LR OESOPHAGO GASTRECTOMY IVOR- ONCOLOGY LONS135RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY PAN HYSTERECTOMY (LONS) [RS 5 ONCOLOGY LONS147RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY PARA AORTIC LYMPHADECTOMY ONCOLOGY LONS148RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY PARTIAL/SUBTAOTAL GASTRO FOR ONCOLOGY LONS150RS CARCINNOMA (LONS) [RS 10 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR PELVIC EXENTRATION (LONS) [RS ONCOLOGY LONS152RS LR Surgery 0 31070 36990 42905 10 days Package] # LR SURGERY PLND - PELVIC LYMPHADECTOMY ONCOLOGY LONS153RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY POUCHES FOR URINARY RESERVIO ONCOLOGY LONS156RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY PULMONARY METASTATECTOMY ONCOLOGY LONS266RS UNILATERAL (LONS) [RS 5 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR

128 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group RADICAL CYSTECTOMY (LONS) [RS ONCOLOGY LONS160RS LR Surgery 0 31070 36990 42905 10 days Package] # LR SURGERY RADICAL GASTRECTOMY R0-R4 ONCOLOGY LONS161RS RNS) (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905 SURGERY # LR RADICAL NEPHRECTOMY (LONS) ONCOLOGY LONS166RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY RADICAL NEPHRECTOMY WITH ONCOLOGY LONS167RS CAVE) (LONS) [RS 5 days Package] LR Surgery 0 31070 36990 42905 SURGERY # LR RADICAL PLEURO- ONCOLOGY LONS170RS PNEUMONECTOMY (LONS) [RS 5 LR Surgery 0 31070 36990 42905 SURGERY days Package] # LR RECONSTRUCTION OF GASTRIC ONCOLOGY LONS173RS RES (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905 SURGERY # LR RESECTION ANASTAMOSIS BOWEL ONCOLOGY LONS175RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY RESECTION OF HEPATO-BILIARY ONCOLOGY LONS178RS NCIES (LONS) [RS 10 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR RESECTION OF ONCOLOGY LONS179RS RETROPERITONEALE) TUMOR LR Surgery 0 31070 36990 42905 SURGERY (LONS) [RS 5 days Package] # LR RESECTION OF RETROPERITONEALINTRASPINAL ONCOLOGY LONS180RS LR Surgery 0 31070 36990 42905 EXT (LONS) [RS 5 days Package] SURGERY # LR RETROPERITONEAL LYMPH NODE ONCOLOGY LONS181RS DN RPLND) (LONS) [RS 5 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR REVISION THYROIDECTOMY / ONCOLOGY LONS274RS COMPLETION THYROIDECTOMY LR Surgery 0 31070 36990 42905 SURGERY (LONS) [RS 5 days Package] # LR SEGMENTAL RESECTION - LUNG ONCOLOGY LONS188RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY SPLEENECTOMY (LONS) [RS 5 days ONCOLOGY LONS194RS LR Surgery 0 31070 36990 42905 Package] # LR SURGERY STAGING LAPROTOMY FOR ONCOLOGY LONS197RS CARCINRY (LONS) [RS 10 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR STAGING LAPROTOMY (LONS) [RS ONCOLOGY LONS196RS LR Surgery 0 31070 36990 42905 10 days Package] # LR SURGERY SUBTOTAL GASTRECTOMY (LONS) ONCOLOGY LONS200RS LR Surgery 0 31070 36990 42905 [RS 10 days Package] # LR SURGERY SURGERY FOR APUDOMAS (LONS) ONCOLOGY LONS206RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY

129 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SURGERY FOR CARCINOMA OVARY ONCOLOGY LONS207RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY THERAPEUTIC LAPAROSCOPY ONCOLOGY LONS211RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY THERAPEUTIC THORACOSCOPY ONCOLOGY LONS212RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY THREE FIELD LYMPHADENECTOMY ONCOLOGY LONS215RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY THREE STAGE OESOPHAGECTOMY ONCOLOGY LONS216RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY THYROIDECTOMY (LONS) [RS 5 ONCOLOGY LONS276RS LR Surgery 0 31070 36990 42905 days Package] # LR SURGERY THYROID ISTHMECTOMY (LONS) ONCOLOGY LONS218RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY THYROID LOBECTOMY (LONS) [RS ONCOLOGY LONS219RS LR Surgery 0 31070 36990 42905 5 days Package] # LR SURGERY TOTAL PROCTO-COLECTOMY WITH ONCOLOGY LONS226RS AL ANASTOMOSIS (LONS) [RS 10 LR Surgery 0 31070 36990 42905 SURGERY days Package] # LR TOTAL PROCTO-COLECTOMY WITH ONCOLOGY LONS227RS MY (LONS) [RS 10 days Package] LR Surgery 0 31070 36990 42905 SURGERY # LR TOTAL PROCTOCOLECTOMY WITH ONCOLOGY LONS228RS POCH AND ANASTOMOSIS (LONS) LR Surgery 0 31070 36990 42905 SURGERY [RS 10 days Package] # LR TOTAL THYROIDECTOMY FOR LARGE MULTINODULAR GOITRE/ ONCOLOGY LONS273RS LR Surgery 0 31070 36990 42905 RETROSTERNAL EXTENSION SURGERY (LONS) [RS 5 days Package] # LR TOTAL THYROIDECTOMY (LONS) ONCOLOGY LONS229RS LR Surgery 0 31070 36990 42905 [RS 5 days Package] # LR SURGERY TRIPPLE BYPASS SURGERY (FOR ONCOLOGY LONS270RS OBSTRUCTIVE JAUNDICE) (LONS) LR Surgery 0 31070 36990 42905 SURGERY [RS 10 days Package] # LR TWO FIELD LYMPHADENECTOMY ONCOLOGY LONS237RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY URINARY DIVERSION PROCEDURES ONCOLOGY LONS239RS LR Surgery 0 31070 36990 42905 (LONS) [RS 10 days Package] # LR SURGERY VATS VIDEO ASSISTED ONCOLOGY LONS240RS THORACOSCOPY SURGERY (LONS) LR Surgery 0 31070 36990 42905 SURGERY [RS 10 days Package] # LR WERTHIM'S HYSTRECTOMY RADIC ONCOLOGY LONS241RS LR Surgery 0 31070 36990 42905 (LONS) [RS 5 days Package] # LR SURGERY WHIPPLE'S PANCRETO- ONCOLOGY LONS242RS DUODENECT (LONS) [RS 10 days LR Surgery 0 31070 36990 42905 SURGERY Package] # LR AXILLARY CLEARANCE LEVEL I,II,III ONCOLOGY LONS198 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY

130 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group BCT/PARTIAL MASTECTOMY /WIDE ONCOLOGY LONS200 EXCISION FOR BREAST CANCER L7 Surgery 0 37815 45020 52220 SURGERY (ONS) # L7 CAROTID BODY TUMOR EXCISION ONCOLOGY LONS201 L7 Surgery 0 37815 45020 52220 (LONS) # L7 SURGERY CHEST WALL RESECTION AND ONCOLOGY LONS202 L7 Surgery 0 37815 45020 52220 RECONSTRUCTION (ONS) # L7 SURGERY ONCOLOGY LONS203 COMPOSITE FLAP (ONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY COMPOSITE RESECTION (ONS) # ONCOLOGY LONS204 L7 Surgery 0 37815 45020 52220 L7 SURGERY ONCOLOGY LONS205 CRICO-HYOIDOPEXY (ONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY EXCISION OF BILATERAL ONCOLOGY LONS206 L7 Surgery 0 37815 45020 52220 PULMONASTASIS (ONS) # L7 SURGERY EXCISION OF MEDIASTINAL TUMO ONCOLOGY LONS207 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY EXCISION OF PARA PHARYNGEAL ONCOLOGY LONS208 L7 Surgery 0 37815 45020 52220 TUMOUR (ONS) # L7 SURGERY EXCISION OF RETRO RECTAL ONCOLOGY LONS209 L7 Surgery 0 37815 45020 52220 TUMOR (ONS) # L7 SURGERY EXCISION OF SOFT TISSUE ONCOLOGY LONS210 L7 Surgery 0 37815 45020 52220 SARCOMA NECK (ONS) # L7 SURGERY EXPLORATORY LAPAROTOMY ONCOLOGY LONS211 FOR MALIGNANT INTESTINAL L7 Surgery 0 37815 45020 52220 SURGERY OBSTRUCTION (ONS) # L7 FREE MICRO-VASCULAR FLAP ONCOLOGY LONS212 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY HARTMANN'S PROCEDURE (ONS) ONCOLOGY LONS213 L7 Surgery 0 37815 45020 52220 # L7 SURGERY ONCOLOGY LONS214 HEMICOLECTOMY (LONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY ONCOLOGY LONS215 HIP DISARTICULATION (ONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY ILEO INGUINAL BLOCK DISSECTION ONCOLOGY LONS199 L7 Surgery 0 37815 45020 52220 BILATERAL (ONS) # L7 SURGERY MODIFIED RADICAL MASTATECTOMY (EXCLUDING ONCOLOGY LONS216 L7 Surgery 0 37815 45020 52220 LYMPH NODE SAMPLING) (ONS) SURGERY # L7 PARTIAL/SUBTAOTAL GASTRO FOR ONCOLOGY LONS217 L7 Surgery 0 37815 45020 52220 CARCINNOMA (LONS) # L7 SURGERY ONCOLOGY LONS218 PERITONECTOMY (ONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY POSTERIOR PHARYNGEAL WALL RE ONCOLOGY LONS219 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY

131 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group POST-MASTECTOMY ONCOLOGY LONS220 L7 Surgery 0 37815 45020 52220 RECONSTRUCTION (ONS) # L7 SURGERY PULMONARY METASTATECTOMY ONCOLOGY LONS221 L7 Surgery 0 37815 45020 52220 BILATERAL (ONS) # L7 SURGERY RADICAL HEMICOLECTOMY WITH ONCOLOGY LONS222 L7 Surgery 0 37815 45020 52220 LYMPHADENECTOMY (ONS) # L7 SURGERY RADICAL MASTOIDECTOMY ONCOLOGY LONS223 INCLUDING MEATOPLASTY (ONS) L7 Surgery 0 37815 45020 52220 SURGERY # L7 RADICAL NECK DISSECTION (ONS) ONCOLOGY LONS224 L7 Surgery 0 37815 45020 52220 # L7 SURGERY RADICAL NEPHRECTOMY (ONS) ONCOLOGY LONS225 L7 Surgery 0 37815 45020 52220 # L7 SURGERY RADICAL PROSTATECTOMY (ONS) ONCOLOGY LONS226 L7 Surgery 0 37815 45020 52220 # L7 SURGERY RADICAL TRACHELECTOMY (ONS) ONCOLOGY LONS227 L7 Surgery 0 37815 45020 52220 # L7 SURGERY RADICAL VULVECTOMY + SLNB ONCOLOGY LONS228 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY RESECTION OF HEPATO-BILIARY ONCOLOGY LONS229 L7 Surgery 0 37815 45020 52220 MALIGNENCIES (ONS) # L7 SURGERY RESECTION OF ONCOLOGY LONS230 RETROPERITONEALINTRASPINAL L7 Surgery 0 37815 45020 52220 SURGERY EXT (ONS) # L7 RETROPERITONEAL LYMPH NODE ONCOLOGY LONS231 L7 Surgery 0 37815 45020 52220 DISSECTION (RPLND) (ONS) # L7 SURGERY REVISION RADICAL NECK ONCOLOGY LONS232 L7 Surgery 0 37815 45020 52220 DISSECTION (ONS) # L7 SURGERY SECOND LOOK LAPROTOMY ONCOLOGY LONS233 L7 Surgery 0 37815 45020 52220 (LONS) # L7 SURGERY SEGMENTAL RESECTION - LUNG ONCOLOGY LONS234 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY SELECTIVE NECK DISSECTION ONCOLOGY LONS235 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY SLEEVE RESECTION OF TRACHEAL ONCOLOGY LONS236 L7 Surgery 0 37815 45020 52220 (ONS) # L7 SURGERY SUBCUTANEOUS MASTECTOMY ONCOLOGY LONS237 L7 Surgery 0 37815 45020 52220 (LONS) # L7 SURGERY SUBTOTAL GASTRECTOMY (LONS) ONCOLOGY LONS238 L7 Surgery 0 37815 45020 52220 # L7 SURGERY SUBTOTAL TEMPORAL BONE ONCOLOGY LONS239 L7 Surgery 0 37815 45020 52220 EXCISION (ONS) # L7 SURGERY SUPERFICIAL PAROTIDECTOMY ONCOLOGY LONS240 L7 Surgery 0 37815 45020 52220 (LONS) # L7 SURGERY SUPRA OMOHYOID NECK ONCOLOGY LONS241 L7 Surgery 0 37815 45020 52220 DISSECTION (ONS) # L7 SURGERY

132 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SURGERY FOR APUDOMAS (LONS) ONCOLOGY LONS242 L7 Surgery 0 37815 45020 52220 # L7 SURGERY SURGERY FOR OVARIAN CYST AND ONCOLOGY LONS243 L7 Surgery 0 37815 45020 52220 TUMOUR (ONS) # L7 SURGERY SURGERY FOR SALIVARY GLAND ONCOLOGY LONS244 L7 Surgery 0 37815 45020 52220 TUMOURS (ONS) # L7 SURGERY THREE FIELD LYMPHADENECTOMY ONCOLOGY LONS245 L7 Surgery 0 37815 45020 52220 (LONS) # L7 SURGERY ONCOLOGY LONS246 THYMECTOMY (ONS) # L7 L7 Surgery 0 37815 45020 52220 SURGERY TOTAL MANDIBULECTOMY WITH ONCOLOGY LONS247 L7 Surgery 0 37815 45020 52220 RECTION (ONS) # L7 SURGERY TOTAL MASTECTOMY FOR BREAST CANCER WITH LEVEL ONCOLOGY LONS248 L7 Surgery 0 37815 45020 52220 1 & 2 AXILLARY LYMPHNODE SURGERY CLEARANCE (ONS) # L7 TOTAL THYROIDECTOMY FOR ONCOLOGY LONS249 L7 Surgery 0 37815 45020 52220 TUMORS (ONS) # L7 SURGERY TRIPPLE BYPASS SURGERY (FOR ONCOLOGY LONS250 OBSTRUCTIVE JAUNDICE) (ONS) L7 Surgery 0 37815 45020 52220 SURGERY # L7 TYPE -I MODIFIED RADICAL ONCOLOGY LONS251 L7 Surgery 0 37815 45020 52220 HYSTERECTOMY (ONS) # L7 SURGERY VATS VIDEO ASSISTED ONCOLOGY LONS252 THORACOSCOPY SURGERY (LONS) L7 Surgery 0 37815 45020 52220 SURGERY # L7 AMPUTATION FORE-QUARTER ONCOLOGY LONS253 L8 Surgery 0 47265 56270 65270 (LONS) # L8 SURGERY ANTERIOR MEDIASTINAL TUMOUR ONCOLOGY LONS254 L8 Surgery 0 47265 56270 65270 RESECTION (ONS) # L8 SURGERY BUCCO-PHARYNGECTOMY (ONS) ONCOLOGY LONS255 L8 Surgery 0 47265 56270 65270 # L8 SURGERY COMPARTMENTAL EXCISION FOR ONCOLOGY LONS256 L8 Surgery 0 47265 56270 65270 STS (ONS) # L8 SURGERY COMPOSITE RESECTION WITH ONCOLOGY LONS257 L8 Surgery 0 47265 56270 65270 RECTION (ONS) # L8 SURGERY DISTAL PANCREATECTOMY (LONS) ONCOLOGY LONS258 L8 Surgery 0 47265 56270 65270 # L8 SURGERY EXCISION OF CHEST WALL TUMOR ONCOLOGY LONS259 L8 Surgery 0 47265 56270 65270 AND RECONSTRUCTION (ONS) # L8 SURGERY EXCISION OF MESENTERIC MASS ONCOLOGY LONS260 L8 Surgery 0 47265 56270 65270 (LONS) # L8 SURGERY EXCISION OF SOFT TISSUE TUMOG ONCOLOGY LONS261 L8 Surgery 0 47265 56270 65270 VASCULAR GRAFTS (ONS) # L8 SURGERY EXTRAPLEURAL PNEUMONECTOMY ONCOLOGY LONS262 L8 Surgery 0 47265 56270 65270 (ONS) # L8 SURGERY

133 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group FOREQUARTER AMPUTATION (ONS) ONCOLOGY LONS263 L8 Surgery 0 47265 56270 65270 # L8 SURGERY FUNCTIONAL NECK DISSECTION ONCOLOGY LONS264 L8 Surgery 0 47265 56270 65270 (LONS) # L8 SURGERY ONCOLOGY LONS265 HEMI PELVECTOMY (ONS) # L8 L8 Surgery 0 47265 56270 65270 SURGERY INFRATEMPORAL FOSSA RESECTIO ONCOLOGY LONS266 L8 Surgery 0 47265 56270 65270 (ONS) # L8 SURGERY INTERNAL HEMIPELVECTOMY ONCOLOGY LONS267 L8 Surgery 0 47265 56270 65270 (ONS) # L8 SURGERY LARYNGECTOMY - HEMI (LONS) ONCOLOGY LONS268 L8 Surgery 0 47265 56270 65270 # L8 SURGERY LARYNGECTOMY - NEAR TOTAL ONCOLOGY LONS269 L8 Surgery 0 47265 56270 65270 FOR MALIGNANCY (ONS) # L8 SURGERY LARYNGECTOMY - SUPRACRICOID ONCOLOGY LONS270 L8 Surgery 0 47265 56270 65270 FOR MALIGNANCY (ONS) # L8 SURGERY LARYNGECTOMY - SUPRAGLOTTIC ONCOLOGY LONS271 L8 Surgery 0 47265 56270 65270 (ONS) # L8 SURGERY LARYNGO PHARYNGO ONCOLOGY LONS272 L8 Surgery 0 47265 56270 65270 OESOPHAGECTOMY (ONS) # L8 SURGERY LATERAL CRANIOFACIAL ONCOLOGY LONS273 L8 Surgery 0 47265 56270 65270 RESECTION (ONS) # L8 SURGERY MAXILLECTOMY RADICAL (ONS) ONCOLOGY LONS275 L8 Surgery 0 47265 56270 65270 # L8 SURGERY MAXILLECTOMY - TOTAL (ONS) ONCOLOGY LONS274 L8 Surgery 0 47265 56270 65270 # L8 SURGERY MODIFIED NECK DISSECTION I & II ONCOLOGY LONS276 L8 Surgery 0 47265 56270 65270 (LONS) # L8 SURGERY MUSCLE GROUP EXCISION WITH ONCOLOGY LONS277 L8 Surgery 0 47265 56270 65270 TRANSFER PROCEDURE (ONS) # L8 SURGERY PARTIAL CRICOTRACHEAL ONCOLOGY LONS278 L8 Surgery 0 47265 56270 65270 RESECTION (ONS) # L8 SURGERY PARTIAL NEPHRECTOMY (ONS) ONCOLOGY LONS279 L8 Surgery 0 47265 56270 65270 # L8 SURGERY POUCHES FOR URINARY RESERVIO ONCOLOGY LONS280 L8 Surgery 0 47265 56270 65270 (LONS) # L8 SURGERY RADICAL CYSTECTOMY WITH OUT ONCOLOGY LONS281 L8 Surgery 0 47265 56270 65270 CONDUIT (ONS) # L8 SURGERY RADICAL MASTATECTOMY (LONS) ONCOLOGY LONS282 L8 Surgery 0 47265 56270 65270 # L8 SURGERY RADICAL MAXILLECTOMY FOR ONCOLOGY LONS283 L8 Surgery 0 47265 56270 65270 MALIGNANCY (ONS) # L8 SURGERY RADICAL ONCOLOGY LONS284 MAXILLOETHMOIDECTOMY (LONS) L8 Surgery 0 47265 56270 65270 SURGERY # L8

134 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group RADICAL NEPHRECTOMY WITH ONCOLOGY LONS285 L8 Surgery 0 47265 56270 65270 CAVE) (ONS) # L8 SURGERY RADICAL NEPHRECTOMY WITH ONCOLOGY LONS286 L8 Surgery 0 47265 56270 65270 LYMPHADENECTOMY (ONS) # L8 SURGERY RADICAL VULVECTOMY WITH ONCOLOGY LONS287 L8 Surgery 0 47265 56270 65270 RECONSTRUCTION (ONS) # L8 SURGERY RESECTION OF BONE TUMOR ONCOLOGY LONS288 L8 Surgery 0 47265 56270 65270 WITHONSERVATION (ONS) # L8 SURGERY RESECTION OF RETROPERITONEAL ONCOLOGY LONS289 L8 Surgery 0 47265 56270 65270 TUMOR (ONS) # L8 SURGERY REVERSAL OF HARTMANS ONCOLOGY LONS290 L8 Surgery 0 47265 56270 65270 PROCEDURE (ONS) # L8 SURGERY REVISION SURGERY FOR PAROTID ONCOLOGY LONS291 L8 Surgery 0 47265 56270 65270 TUMOUR (ONS) # L8 SURGERY REVISION THYROIDECTOMY / ONCOLOGY LONS292 COMPLETION THYROIDECTOMY L8 Surgery 0 47265 56270 65270 SURGERY (ONS) # L8 ONCOLOGY LONS293 SACRECTOMY - TOTAL (ONS) # L8 L8 Surgery 0 47265 56270 65270 SURGERY ONCOLOGY LONS294 SCAPULECTOMY (ONS) # L8 L8 Surgery 0 47265 56270 65270 SURGERY SKIN SPARING/NAC SPARING ONCOLOGY LONS295 MASTECTOMY FOR BREAST L8 Surgery 0 47265 56270 65270 SURGERY CANCER (ONS) # L8 STAGING LAPROTOMY FOR ONCOLOGY LONS296 L8 Surgery 0 47265 56270 65270 CARCINOMA (ONS) # L8 SURGERY SURGERY FOR CARCINOMA OVARY ONCOLOGY LONS297 L8 Surgery 0 47265 56270 65270 PELVIC CONFINED (ONS) # L8 SURGERY SURGERY FOR CHOLONGIO ONCOLOGY LONS298 CA WITH HJ WITHOUT LIVER L8 Surgery 0 47265 56270 65270 SURGERY RESECTION (ONS) # L8 TEMPORAL BONE EXCISION - ONCOLOGY LONS299 L8 Surgery 0 47265 56270 65270 SONS (ONS) # L8 SURGERY ONCOLOGY LONS300 THORACOPLASTY (ONS) # L8 L8 Surgery 0 47265 56270 65270 SURGERY THYROIDECTOMY FOR ONCOLOGY LONS301 RETROSTERNAL EXTENSION (ONS) L8 Surgery 0 47265 56270 65270 SURGERY # L8 TOTAL GLOSSECTOMY WITH ONCOLOGY LONS302 L8 Surgery 0 47265 56270 65270 RECONON (ONS) # L8 SURGERY TOTAL MASTECTOMY FOR BREAST ONCOLOGY LONS303 CANCER WITH LEVEL 1,2,3 L8 Surgery 0 47265 56270 65270 SURGERY AXILLARY CLEARANCE (ONS) # L8 TOTAL THYROIDECTOMY FOR MALIGNANCY + CENTRAL ONCOLOGY LONS304 L8 Surgery 0 47265 56270 65270 COMPARTMENT LYMPHNODE SURGERY DISSECTION (ONS) # L8

135 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TYPE II MODIFIED RADICAL ONCOLOGY LONS305 L8 Surgery 0 47265 56270 65270 HYSTRECTOMY (ONS) # L8 SURGERY WERTHIM'S HYSTRECTOMY ONCOLOGY LONS307 L8 Surgery 0 47265 56270 65270 RADICAL (ONS) # L8 SURGERY WIDE FIELD LARYNGECTOMY & ONCOLOGY LONS306 PARTIAL PHARYNGECTOMY (ONS) L8 Surgery 0 47265 56270 65270 SURGERY # L8 ABDOMINO-PERINEAL RESECTION ONCOLOGY LONS308 WITH TME +ANP+STOMA (ONS) L9 Surgery 0 56710 67515 78315 SURGERY # L9 ANTERIOR CRANIOFACIAL ONCOLOGY LONS309 L9 Surgery 0 56710 67515 78315 RESECTION (ONS) # L9 SURGERY ANTERIOR RESECTION - LOW ONCOLOGY LONS310 ANTERIOR RESECTION LAR +TME L9 Surgery 0 56710 67515 78315 SURGERY + ANP (ONS) # L9 BCT/PARTIAL MASTECTOMY /WIDE EXCISION FOR BREAST CANCER ONCOLOGY LONS356 L9 Surgery 0 56710 67515 78315 + SENTINEL NODE BIOPSY (LONS) SURGERY # L9 COMPOSITE RESECTION WITH ONCOLOGY LONS311 UNILATERAL MOD RADICAL NECK L9 Surgery 0 56710 67515 78315 SURGERY DISSECTION (ONS) # L9 EXTENDED CRICOTRACHEAL ONCOLOGY LONS312 RESECTION & ANASTOMOSIS L9 Surgery 0 56710 67515 78315 SURGERY (ONS) # L9 HEPATATECTOMY MAJOR (ONS) ONCOLOGY LONS313 L9 Surgery 0 56710 67515 78315 # L9 SURGERY IVOR LEWIS ESOPHAGECTOMY FOR ONCOLOGY LONS314 L9 Surgery 0 56710 67515 78315 MALIGNANCY (ONS) # L9 SURGERY LOBECTOMY - LUNG -RADICAL ONCOLOGY LONS315 L9 Surgery 0 56710 67515 78315 (ONS) # L9 SURGERY MAJOR SARCOMA RESECTION ONCOLOGY LONS316 L9 Surgery 0 56710 67515 78315 (ONS) # L9 SURGERY MAXILLECTOMY + ORBITAL ONCOLOGY LONS317 L9 Surgery 0 56710 67515 78315 EXENTERATION (ONS) # L9 SURGERY OESOPHAGECTOMY TOTAL- ONCOLOGY LONS318 ORRINGER TRANPOSITION FOR L9 Surgery 0 56710 67515 78315 SURGERY MALIGNANCY (ONS) # L9 OESOPHAGO GASTRECTOMY IVOR- ONCOLOGY LONS319 L9 Surgery 0 56710 67515 78315 FOR MALIGNANCY (ONS) # L9 SURGERY PARAPHARYNGEAL TUMOUR ONCOLOGY LONS320 L9 Surgery 0 56710 67515 78315 EXCISION (ONS) # L9 SURGERY ONCOLOGY LONS321 PELVIC EXENTRATION (ONS) # L9 L9 Surgery 0 56710 67515 78315 SURGERY PERITONECTOMY + HIPEC (ONS) ONCOLOGY LONS322 L9 Surgery 0 56710 67515 78315 # L9 SURGERY RADICAL CYSTECTOMY WITH ONCOLOGY LONS323 L9 Surgery 0 56710 67515 78315 CONDUIT (ONS) # L9 SURGERY RADICAL GASTRECTOMY D2-D4 ONCOLOGY LONS324 L9 Surgery 0 56710 67515 78315 136 LYMPHADENECTOMY (ONS) # L9 SURGERY Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group RADICAL PAROTIDECTOMY (LONS) ONCOLOGY LONS325 L9 Surgery 0 56710 67515 78315 # L9 SURGERY RADICAL PLEURO- ONCOLOGY LONS326 PNEUMONECTOMY WITH L9 Surgery 0 56710 67515 78315 SURGERY LYMPHADENECTOMY (ONS) # L9 RADICAL VULVECTOMY + BLOCK ONCOLOGY LONS327 L9 Surgery 0 56710 67515 78315 DISSECTION (ONS) # L9 SURGERY RESECTION OF ANTERIOR ONCOLOGY LONS328 ABDOMIL TUMOR & RECON. (LONS) L9 Surgery 0 56710 67515 78315 SURGERY # L9 ONCOLOGY LONS329 ROBOTIC SURGERY (ONS) # L9 L9 Surgery 0 56710 67515 78315 SURGERY SURGERY FOR CARCINOMA OVARY ONCOLOGY LONS330 L9 Surgery 0 56710 67515 78315 - EXTENSIVE (ONS) # L9 SURGERY SURGERY FOR HILAR CHOLONGIO ONCOLOGY LONS331 L9 Surgery 0 56710 67515 78315 WITH LIVER RESECTION (ONS) # L9 SURGERY THREE STAGE OESOPHAGECTOMY ONCOLOGY LONS332 L9 Surgery 0 56710 67515 78315 FOR MALIGNANCY (ONS) # L9 SURGERY TOAL LARYNGECTOMY WITH ONCOLOGY LONS333 PARTIAL PHARYNGECTOMY (ONS) L9 Surgery 0 56710 67515 78315 SURGERY # L9 TOTAL LARYNGECTOMY+PARTIAL PHARYNGECTOMY + UNILATERAL ONCOLOGY LONS341 L9 Surgery 0 56710 67515 78315 MODIFIED RADICAL NECK SURGERY DISSECTION (ONS) # L9 TOTAL PAROTIDECTOMY WITH ONCOLOGY LONS334 L9 Surgery 0 56710 67515 78315 CONON FACIAL NERVE (ONS) # L9 SURGERY TOTAL PROCTO-COLECTOMY WITH ONCOLOGY LONS335 L9 Surgery 0 56710 67515 78315 AL ANASTOMOSIS (LONS) # L9 SURGERY TOTAL PROCTO-COLECTOMY WITH ONCOLOGY LONS336 L9 Surgery 0 56710 67515 78315 MY (LONS) # L9 SURGERY TOTAL PROCTOCOLECTOMY WITH ONCOLOGY LONS337 POCH AND ANASTOMOSIS (LONS) L9 Surgery 0 56710 67515 78315 SURGERY # L9 TOTAL THYROIDECTOMY FOR MALIGNANCY + UNILATERAL ONCOLOGY LONS338 L9 Surgery 0 56710 67515 78315 FUNCTIONAL NECK DISSECTION SURGERY (ONS) # L9 TYPE - III EXTENDED RADICAL ONCOLOGY LONS339 L9 Surgery 0 56710 67515 78315 HYSTERECTOMY (ONS) # L9 SURGERY WHIPPLE'S PANCRETO- ONCOLOGY LONS340 L9 Surgery 0 56710 67515 78315 DUODENECTOMY (ONS) # L9 SURGERY BCT/PARTIAL MASTECTOMY /WIDE EXCISION FOR BREAST CANCER ONCOLOGY LONS357 + SENTINEL NODE BIOPSY + L9 Surgery 0 66160 78765 91365 SURGERY AXILLARY CLEARANCE LEVEL I,II,III (LONS

137 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group COMPOSITE RESECTION WITH NECK ONCOLOGY LONS347 DISSECTION WITH ITF CLEARANCE L9 Surgery 0 66160 78765 91365 SURGERY (ONS) # L9 MAJOR LUNG RESECTION ONCOLOGY LONS350 SURGERY WITH MEDIASTINAL L9 Surgery 0 66160 78765 91365 SURGERY LYMPHADENECTOMY (ONS) # L9 PELVIC EXENTRATION WITH ONCOLOGY LONS343 CONDUIT/COMPLEX STOMAS (ONS) L9 Surgery 0 66160 78765 91365 SURGERY # L9 BILATERAL CA - BREAST SURGERY ONCOLOGY LONS351 WITH LYMPHADENECTOMY (ONS) L9 Surgery 0 75620 90025 104430 SURGERY # L9 COMPOSITE RESECTION WITH ONCOLOGY LONS346 BILATERAL NECK DISSECTION (ONS) L9 Surgery 0 75620 90025 104430 SURGERY # L9 EXTENSIVE CA OVARY SURGERY ONCOLOGY LONS344 WITH BOWEL RESECTION (ONS) L9 Surgery 0 75620 90025 104430 SURGERY # L9 EXTENSIVE CA OVARY SURGERY ONCOLOGY LONS345 L9 Surgery 0 75620 90025 104430 WITH IP CHEMOPORT (ONS) # L9 SURGERY RADICAL GASTRECTOMY FOR MALIGNANCY + D2 EXTENDED LYMPHADENECTOMY + ONCOLOGY LONS354 L9 Surgery 0 75620 90025 104430 FEEDING JEJUNOSTOMY + SURGERY RECONSTRUCTION OF GASTRIC REMNANT CON RADICAL HYSTERECTOMY FOR MALIGNANCY+BILATERAL PELVIC ONCOLOGY LONS353 LYMPHADENECTOMY+PARA-AORTIC L9 Surgery 0 75620 90025 104430 SURGERY SYSTEMATIC LYMPHADENECTOMY (ONS) # L9 RADICAL PAROTIDECTOMY WITH ONCOLOGY LONS348 L9 Surgery 0 75620 90025 104430 NECK DISSECTION (ONS) # L9 SURGERY THREE STAGE OESOPHAGECTOMY + TWO FIELD LYMPHADENECTOMY ONCOLOGY LONS349 L9 Surgery 0 75620 90025 104430 + FEEDING JEJUNOSTOMY + SURGERY PYLOROPLASTY (ONS) # L9 TOTAL THYROIDECTOMY ONCOLOGY LONS342 FOR TUMUORS + CENTRAL L9 Surgery 0 75620 90025 104430 SURGERY COMPARTMENT + FND (ONS) # L9 DRESSING CHARGE - MINOR - ONCOLOGY PONS001 Procedure 210 220 265 305 PONS SURGICAL DRESSING CHARGE - MEDIUM - ONCOLOGY PONS002 Procedure 275 290 345 400 PONS SURGICAL DRESSING CHARGE - MAJOR - ONCOLOGY PONS003 Procedure 355 375 445 515 PONS SURGICAL ONCOLOGY PONS029 SUTURING - PONS Procedure 440 460 550 640 SURGICAL ONCOLOGY PONS011 EUA (A) - PONS Procedure 620 650 775 900 SURGICAL ONCOLOGY PONS010 DRESSING MAJOR - PONS Procedure 670 705 840 970 SURGICAL ONCOLOGY PONS012 FNAC - PONS Procedure 670 705 840 970 SURGICAL

138 Onco Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ONCOLOGY PONS028 SMEAR CYTOLOGY - PONS Procedure 1155 1215 1445 1675 SURGICAL ONCOLOGY PONS009 DIRECT LARYNGOSCOPY (A) - PONS Procedure 1300 1365 1625 1885 SURGICAL ONCOLOGY PONS014 ICD INSERTION - PONS Procedure 1365 1435 1705 1980 SURGICAL ONCOLOGY PONS013 HYPO PHARYNGOSCOPY (A) - PONS Procedure 1585 1665 1980 2300 SURGICAL ONCOLOGY PONS015 J-NEEDLE BIOPSY (A) - PONS Procedure 1585 1665 1980 2300 SURGICAL OESOPHAGO-GASTRO- ONCOLOGY PONS021 Procedure 1585 1665 1980 2300 DUODENOSCOPY (A) - PONS SURGICAL OESOPHAGOSCOPY RIGID (A) - ONCOLOGY PONS022 Procedure 1585 1665 1980 2300 PONS SURGICAL PARANASAL SINUS ENDOSCOPY ONCOLOGY PONS024 Procedure 1585 1665 1980 2300 (A) - PONS SURGICAL COLONOSCOPY (LIMITED) (A) - ONCOLOGY PONS006 Procedure 1735 1820 2170 2515 PONS SURGICAL ONCOLOGY PONS020 NASOPHARYNGOSCOPY (A) - PONS Procedure 1735 1820 2170 2515 SURGICAL PLEURODESIS & ICD INSERTION - ONCOLOGY PONS025 Procedure 1735 1820 2170 2515 PONS SURGICAL ONCOLOGY PONS019 MICRO LARYNGOSCOPY (A) - PONS Procedure 1870 1965 2340 2710 SURGICAL ONCOLOGY PONS004 BIOPSY - TRU CUT - PONS Procedure 2005 2105 2505 2905 SURGICAL BRONCHOSCOPY (A) - FLEXIBLE - ONCOLOGY PONS005 Procedure 2005 2105 2505 2905 PONS SURGICAL ONCOLOGY PONS027 PROCEDURE MINOR - PONS Procedure 2005 2105 2505 2905 SURGICAL ONCOLOGY PONS007 CYSTOSCOPY (A) - PONS Procedure 3160 3320 3950 4580 SURGICAL ONCOLOGY PONS016 LASERISATION (B) - PONS Procedure 3160 3320 3950 4580 SURGICAL MICRO LARYNGEAL SURGERY (B) ONCOLOGY PONS018 Procedure 3445 3615 4305 4995 - PONS SURGICAL ONCOLOGY PONS017 MEDIASTINOSCOPY (B) - PONS Procedure 3740 3925 4675 5425 SURGICAL DIAGNOSTIC LAPAROSCOPY (B) - ONCOLOGY PONS008 Procedure 3885 4080 4855 5635 PONS SURGICAL ONCOLOGY PONS023 PAN-ENDOSCOPY (B) - PONS Procedure 4170 4380 5215 6045 SURGICAL ONCOLOGY PONS026 PROCEDURE INTERMEDIATE - PONS Procedure 5745 6030 7180 8330 SURGICAL ONCOLOGY PONS030 COLPOSCOPY (PONS) Procedure 6470 6795 8090 9380 SURGICAL ROBOTIC SURGERY PACKAGE - 1 - SURGICAL KRKONS001 Package 0 293430 349320 405210 SUR ONCO ONCOLOGY PACKAGE ROBOTIC SURGERY PACKAGE - 2 - SURGICAL KKONS002 Package 0 374930 446350 517760 SUR ONCO ONCOLOGY PACKAGE

139 Radiation Onco

140 Radiation Onco

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ONCOLOGY PONR042 IRRADIATION CHARGES - BLOOD - PONR Procedure 450 480 570 660 RADIATION ONCOLOGY PONR024 RADIOLOGIST PROFESSIONAL CHARGES Procedure 1040 1090 1300 1510 RADIATION ONCOLOGY PONR038 BRACHYTHERAPY Procedure 5190 5450 6490 7530 RADIATION ONCOLOGY PONR040 BRACHYTHERAPY SUBSEQUENT Procedure 5190 5450 6490 7530 RADIATION ONCOLOGY PONR041 NIMTLY - GILOMA STUDY Procedure 31420 32990 39280 45560 RADIATION ONCOLOGY PONR014 IMRT Procedure 27000 45930 56430 62580 RADIATION ONCOLOGY PONR039 LINAC Procedure 11480 12060 14350 16650 RADIATION LINAC

141 Department of Gastroenterology

142 Medical Gastroenterology

143 Medical Gastroenterology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group MEDICAL KGAM001 CAPSULE ENDOSCOPY PACKAGE Package GASTROENTEROLOGY 0 54100 64400 74710 PACKAGE GASTROENTEROLOGY PLGAM047 ASCITIC TAPPING - DIAGNOSTIC Procedure 2330 2440 2910 3370 MEDICAL GASTROENTEROLOGY PLGAM005 COLONOSCOPY (LIMITED) Procedure 3970 4170 4960 5760 MEDICAL OGD (OESAPHGO GASTRO GASTROENTEROLOGY PLGAM034 Procedure 3970 4170 4960 5760 DUODENOSCOPY) MEDICAL GASTROENTEROLOGY PLGAM002 ASCITIC TAPPING - THERAPEUTIC Procedure 5470 5740 6830 7930 MEDICAL GASTROENTEROLOGY PLGAM008 COLONOSCOPY WITH BIOPSY - LTD Procedure 5470 5740 6830 7930 MEDICAL GASTROENTEROLOGY PLGAM048 OGD STENT REMOVAL Procedure 5470 5740 6830 7930 MEDICAL GASTROENTEROLOGY PLGAM093 PEG REMOVAL Procedure 5470 5740 6830 7930 MEDICAL GASTROENTEROLOGY PLGAM037 OGD WITH BIOPSY Procedure 5740 6030 7180 8330 MEDICAL GASTROENTEROLOGY PLGAM092 HYDROGEN BREATH TEST Procedure 6840 7180 8540 9910 MEDICAL GASTROENTEROLOGY PLGAM091 UREA BREATH TEST Procedure 6840 7180 8540 9910 MEDICAL GASTROENTEROLOGY PLGAM097 OGD NG TUBE PLACEMENT Procedure 7390 7760 9230 10710 MEDICAL GASTROENTEROLOGY PLGAM006 COLONOSCOPY FULL Procedure 7840 7840 8630 9410 MEDICAL INTRA-OPERATIVE OGD (WITH OR GASTROENTEROLOGY PLGAM098 Procedure 9020 9470 11270 13080 WITHOUT BIOPSY) MEDICAL NJ TUBE PLACEMENT (SINGLE MODALITY GASTROENTEROLOGY PLGAM095 Procedure 9020 9470 11270 13080 USED) MEDICAL GASTROENTEROLOGY PLGAM094 COLONOSCOPY FULL WITH BIOPSY Procedure 9300 9760 11620 13480 MEDICAL GASTROENTEROLOGY PLGAM089 MANOMETRY Procedure 9300 9760 11620 13480 MEDICAL GASTROENTEROLOGY PLGAM090 MANOMETRY - OESOPHAGAL Procedure 9300 9760 11620 13480 MEDICAL GASTROENTEROLOGY PLGAM088 PH METRY Procedure 12020 12620 15030 17430 MEDICAL GASTROENTEROLOGY PLGAM010 ENDOSCOPIC BOUGIE DILATATION Procedure 12300 12910 15370 17830 MEDICAL GASTROENTEROLOGY PLGAM033 LIVER BIOPSY Procedure 12300 12910 15370 17830 MEDICAL GASTROENTEROLOGY PLGAM043 PILES BANDING Procedure 12300 12910 15370 17830 MEDICAL

144 Medical Gastroenterology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NJ TUBE PLACEMENT (MULTIPLE GASTROENTEROLOGY PLGAM087 Procedure 12570 13200 15720 18230 MODALITY USED) MEDICAL GASTROENTEROLOGY PLGAM020 ENDOSCOPIC ULTRASOUND / GI TRACT Procedure 12850 13490 16060 18630 MEDICAL GASTROENTEROLOGY PLGAM024 ERCP DIAGNOSTIC Procedure 12850 13490 16060 18630 MEDICAL GASTROENTEROLOGY PLGAM067 PEG REPLACEMENT Procedure 12850 13490 16060 18630 MEDICAL GASTROENTEROLOGY PLGAM082 ENTEROSCOPY DIAGNOSTIC Procedure 13110 13770 16390 19010 MEDICAL GASTROENTEROLOGY PLGAM077 FIBRO SCAN Procedure 13110 13770 16390 19010 MEDICAL GASTROENTEROLOGY PLGAM035 OGD FOREIGN BODY REMOVAL - SIMPLE Procedure 13110 13770 16390 19010 MEDICAL GASTROENTEROLOGY PLGAM054 COLONIC DECOMPRESSION Procedure 13670 14350 17080 19810 MEDICAL GASTROENTEROLOGY PLGAM083 ENTEROSCOPY + BIOPSY Procedure 15040 15790 18790 21800 MEDICAL INTRA-OPERATIVE COLONOSCOPY (WITH GASTROENTEROLOGY PLGAM099 Procedure 15040 15790 18790 21800 OR WITHOUT BIOPSY) MEDICAL GASTROENTEROLOGY PLGAM069 REPEAT APC Procedure 15710 16500 19640 22780 MEDICAL GASTROENTEROLOGY PLGAM068 REPEAT EVL Procedure 15710 16500 19640 22780 MEDICAL GASTROENTEROLOGY PLGAM066 ENDOSCOPIC BALLOON DILATATION Procedure 18450 19370 23060 26750 MEDICAL ENDOSCOPIC ULTRASOUND PANCREATO GASTROENTEROLOGY PLGAM021 Procedure 18450 19370 23060 26750 BILIARY MEDICAL GASTROENTEROLOGY PLGAM096 ENDOSCOPIC VARICEAL LIGATION Procedure 18450 19370 23060 26750 MEDICAL OGD PEG (PERCUTANEOUS ENDOSCOPIC GASTROENTEROLOGY PLGAM036 Procedure 18450 19370 23060 26750 GASTROSTOMY) MEDICAL GASTROENTEROLOGY PLGAM041 PAPILLOTOMY ACCESS Procedure 19130 20090 23910 27740 MEDICAL GASTROENTEROLOGY PLGAM051 ENDOSCOPIC APC Procedure 23230 24400 29040 33690 MEDICAL GASTROENTEROLOGY PLGAM052 EUS - LYMPHNODE BIOPSY Procedure 23230 24400 29040 33690 MEDICAL GASTROENTEROLOGY PLGAM071 ERCP THERAPEUTIC (SIMPLE) Procedure 23910 25110 29890 34670 MEDICAL GASTROENTEROLOGY PLGAM044 POLYPECTOMY COLON / GI TRACT Procedure 23910 25110 29890 34670 MEDICAL OGD - FOREIGN BODY REMOVAL - GASTROENTEROLOGY PLGAM049 Procedure 27330 28700 34160 39620 DIFFICULT MEDICAL

145 Medical Gastroenterology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ENDOSCOPIC HAEMOSTASIS (GI GASTROENTEROLOGY PLGAM011 Procedure 28700 30130 35870 41610 HAEMOSTASIS) MEDICAL GASTROENTEROLOGY PLGAM012 ENDOSCOPIC METAL STENTING Procedure 28700 30130 35870 41610 MEDICAL GASTROENTEROLOGY PLGAM084 ENTEROSCOPY THERAPEUTIC Procedure 28700 30130 35870 41610 MEDICAL GASTROENTEROLOGY PLGAM046 EUS - CELIAC GANGLION BLOCK Procedure 28700 30130 35870 41610 MEDICAL GASTROENTEROLOGY PLGAM038 OGD(ACHALASIA DILATATION) Procedure 28700 30130 35870 41610 MEDICAL GASTROENTEROLOGY PLGAM100 Intragastric ballon placement Procedure 28750 30190 35940 41690 MEDICAL GASTROENTEROLOGY PLGAM085 EMR Procedure 31420 32990 39280 45560 MEDICAL ERCP - ACCESS PAPILLOTOMY, STONE GASTROENTEROLOGY PLGAM057 Procedure 31420 32990 39280 45560 EXTRACTION/STENTING MEDICAL GASTROENTEROLOGY PLGAM055 EUS + PANCREATIC BIOPSY Procedure 31420 32990 39280 45560 MEDICAL POLYPECTOMY+HAEMOCLIP GASTROENTEROLOGY PLGAM073 Procedure 31420 32990 39280 45560 APPLICATION MEDICAL ACCESSORY PAPILLA SPHINCTEROTOMY GASTROENTEROLOGY PLGAM075 Procedure 36900 38740 46120 53500 +STENT MEDICAL GASTROENTEROLOGY PLGAM076 ENDOSCOPIC AMPULECTOMY Procedure 36900 38740 46120 53500 MEDICAL GASTROENTEROLOGY PLGAM056 ENDOSCOPIC PANCREATIC THERAPY Procedure 36900 38740 46120 53500 MEDICAL GASTROENTEROLOGY PLGAM014 ENDOSCOPIC PSEUDO CYST DRAINAGE Procedure 36900 38740 46120 53500 MEDICAL GASTROENTEROLOGY PLGAM026 ERCP MECHANICAL LITHOTRIPSY Procedure 36900 38740 46120 53500 MEDICAL GASTROENTEROLOGY PLGAM086 ESD Procedure 36900 38740 46120 53500 MEDICAL ERCP +BILIARY STRICTURE DILATATION GASTROENTEROLOGY PLGAM074 Procedure 38250 40170 47820 55470 +STENTING MEDICAL GASTROENTEROLOGY PLGAM102 Redo POEM Procedure 46000 48300 57500 66700 MEDICAL GASTROENTEROLOGY PLGAM079 ERCP AND DIAGNOSTIC SPYGLASS Procedure 54650 57390 68310 79240 MEDICAL GASTROENTEROLOGY PLGAM080 ERCP AND SPYGLASS BIOPSY Procedure 58750 61680 73430 85180 MEDICAL GASTROENTEROLOGY PLGAM081 ERCP AND SPYGLASS LITHOTRIPSY Procedure 62850 65990 78560 91130 MEDICAL GASTROENTEROLOGY PLGAM101 POEM Procedure 69000 72450 86250 100050 MEDICAL

146 Other departments and services

147 GI General Surgery Sciences

148 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SURGICAL KKGAS007 Whipples Surgery package (KMC) Package GASTROENTEROLOGY 0 195620 232880 270140 PACKAGE SURGICAL BARIATRIC SURGERY PACKAGE - KKGAS008 Package GASTROENTEROLOGY 0 350180 416880 483580 SLEEVE PACKAGE SURGICAL BARIATRIC SURGERY PACKAGE - KKGAS009 Package GASTROENTEROLOGY 0 392440 467190 541940 BYPASS PACKAGE GENERAL SURGERY PGEN011 DRESSING - MINOR - 5CM Procedure 120 130 150 170 PROCEDURE GENERAL SURGERY PGEN012 DRESSING - MEDIUM - 5-10 CM Procedure 260 270 320 370 PROCEDURE DRESSING MAJOR - 10 CM 2-3 GENERAL SURGERY PGEN013 Procedure 520 550 650 760 WOUNDS PROCEDURE GENERAL SURGERY PGEN010 COMPRESSION BANDAGE Procedure 1040 1090 1300 1510 PROCEDURE GENERAL SURGERY PGEN001 SUTURING - PGEN Procedure 1040 1090 1300 1510 PROCEDURE GENERAL SURGERY PGEN009 FNAC - PGEN Procedure 1650 1730 2060 2390 PROCEDURE INCISION & DRAINAGE - MINOR - GENERAL SURGERY PGEN005 Procedure 1780 1860 2220 2570 PGEN PROCEDURE DEBRIDEMENT - MINOR (INCL GENERAL SURGERY PGEN002 Procedure 2050 2150 2560 2970 DRESSING) PROCEDURE INCISION & DRINAGAE - MAJOR - GENERAL SURGERY PGEN006 Procedure 2050 2150 2560 2970 PGEN PROCEDURE GENERAL SURGERY PGEN007 NAIL EXCISION - TOTAL AVULSION Procedure 2050 2150 2560 2970 PROCEDURE DEBRIDEMENT - MAJOR (INCL GENERAL SURGERY PGEN003 Procedure 4100 4300 5120 5940 DRESSING) PROCEDURE GENERAL SURGERY PGEN008 NAIL EXCISION - WIDGE EXCISION Procedure 6280 6600 7850 9110 PROCEDURE EXCISION LESION (CYST,LIPOMA GENERAL SURGERY PGEN004 Procedure 6840 7180 8540 9910 ETC) PROCEDURE GASTROENTEROLOGY LGAS001 EUA (LGAS) # L1 L1 Surgery 0 4500 5360 6220 SURGERY GASTROENTEROLOGY LGAS002 I & D MINOR (LGAS) # L1 L1 Surgery 0 4500 5360 6220 SURGERY LYMPHNODE BIOPSY EXCISION - GASTROENTEROLOGY LGAS006 L2 Surgery 0 8240 9810 11380 (LGAS) # L2 SURGERY GASTROENTEROLOGY LGAS003 TRU - CUT BIOPSY (LGAS) # L2 L2 Surgery 0 8240 9810 11380 SURGERY WOUND DEBRIDEMENT MEDIUM GASTROENTEROLOGY LGAS004 L2 Surgery 0 8240 9810 11380 (LGAS) # L2 SURGERY WOUND DEBRIDEMENT MINOR GASTROENTEROLOGY LGAS005 L2 Surgery 0 8240 9810 11380 (LGAS) # L2 SURGERY

149 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GASTROENTEROLOGY LGAS007 EUA/FISTULA - LOW (LGAS) # L3 L3 Surgery 0 10820 12880 14940 SURGERY HAEMORHOIDECTOMY WITH EUA GASTROENTEROLOGY LGAS011 L3 Surgery 0 10820 12880 14940 (LGAS) # L3 SURGERY HERNIA FEMORAL/INGUINAL GASTROENTEROLOGY LGAS008 L3 Surgery 0 10820 12880 14940 UNILATERAL (LGAS) # L3 SURGERY HERNIA SIMPLE UMBLICAL, EPI) GASTROENTEROLOGY LGAS009 L3 Surgery 0 10820 12880 14940 (LGAS) # L3 SURGERY GASTROENTEROLOGY LGAS010 I & D MAJOR (LGAS) # L3 L3 Surgery 0 10820 12880 14940 SURGERY ADHESIOLYSIS WITH OR WITHOUT GASTROENTEROLOGY LGAS012 BOPSY OPEN (AS SOLE PROCEDURE) L4 Surgery 0 14790 17610 20420 SURGERY (LGAS) # L4 APPENDICECTOMY OPEN (LGAS) GASTROENTEROLOGY LGAS013 L4 Surgery 0 14790 17610 20420 # L4 SURGERY GASTROENTEROLOGY LGAS014 CHEMOPORT INSERTION (LGAS) # L4 L4 Surgery 0 14790 17610 20420 SURGERY GASTROENTEROLOGY LGAS015 EUA/FISTULA - HIGH (LGAS) # L4 L4 Surgery 0 14790 17610 20420 SURGERY FEEDING JEJUNOSTOMY (LGAS) # GASTROENTEROLOGY LGAS024 L4 Surgery 0 14790 17610 20420 L4 SURGERY GASTROENTEROLOGY LGAS016 GASTROSTOMY (LGAS) # L4 L4 Surgery 0 14790 17610 20420 SURGERY INCISIONAL HERNIA - MESH REPAIR GASTROENTEROLOGY LGAS017 L4 Surgery 0 14790 17610 20420 (LGAS) # L4 SURGERY INGUINAL HERNIA MESH REPAIR - GASTROENTEROLOGY LGAS018 L4 Surgery 0 14790 17610 20420 UNILATERAL (LGAS) # L4 SURGERY INTRAOPERATIVE BOWEL GASTROENTEROLOGY LGAS019 L4 Surgery 0 14790 17610 20420 PREPARATION (LGAS) # L4 SURGERY INTRAOPERATIVE GASTROENTEROLOGY LGAS020 L4 Surgery 0 14790 17610 20420 CHOLANGIOGRAPHY (LGAS) # L4 SURGERY LAPAROSCOPIC CHOLECYSTOSTOMY - BILE DRAINAGE TO OUTSIDE GASTROENTEROLOGY LGAS173 L4 Surgery 0 14790 17610 20420 IN SITUATIONS OF SEVERE SURGERY INFLAMMATION [LGAS] # L4 LAPAROTOMY AND PERITONEAL GASTROENTEROLOGY LGAS026 LAVAGE (AS SOLE PROCEDURE) L4 Surgery 0 14790 17610 20420 SURGERY (LGAS) # L4 LAPROSCOPIC HERNIA OPERATION GASTROENTEROLOGY LGAS021 L4 Surgery 0 14790 17610 20420 (LGAS) # L4 SURGERY LAPROSCOPY DIAGNOSTIC GASTROENTEROLOGY LGAS022 INCLUDING BIOPSY (AS SOLE L4 Surgery 0 14790 17610 20420 SURGERY PROCEDURE) (LGAS) # L4 MECKLE'S DIVERTICULECTOMY GASTROENTEROLOGY LGAS027 L4 Surgery 0 14790 17610 20420 OPEN (LGAS) # L4 SURGERY STAPLER HAEMORHOIDECTOMY GASTROENTEROLOGY LGAS025 L4 Surgery 0 14790 17610 20420 (LGAS) # L4 SURGERY

150 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GASTROENTEROLOGY LGAS023 SUTURING MAJOR (LGAS) # L4 L4 Surgery 0 14790 17610 20420 SURGERY DEFUNCTIONING COLOSTOMY GASTROENTEROLOGY LGAS030 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY DUODENOJEJUNOSTOMY - OPEN GASTROENTEROLOGY LGAS043 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY GASTROJEJUNOSTOMY & GASTROENTEROLOGY LGAS041 L5 Surgery 0 18010 21440 24870 VAGOTOMY - OPEN (LGAS) # L5 SURGERY GASTROSTOMY LAPAROSCOPIC GASTROENTEROLOGY LGAS045 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY GRACILOPLASTY (UNILATERAL) GASTROENTEROLOGY LGAS031 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY HERNIA FEMORAL/INGUINAL GASTROENTEROLOGY LGAS032 L5 Surgery 0 18010 21440 24870 BILATERAL (LGAS) # L5 SURGERY GASTROENTEROLOGY LGAS033 ILEOSTOMY (LGAS) # L5 L5 Surgery 0 18010 21440 24870 SURGERY LAPAROSCOPIC SINGLE INCISION GASTROENTEROLOGY LGAS034 PARAUMBILICAL HERNIA REPAIR L5 Surgery 0 18010 21440 24870 SURGERY (LGAS) # L5 LAPAROTOMY RE-EXPLORATION GASTROENTEROLOGY LGAS046 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY LAPROSCOPIC ADHESIOLYSIS GASTROENTEROLOGY LGAS028 INCLUDING BIOPSY (AS SOLE L5 Surgery 0 18010 21440 24870 SURGERY PROCEDURE) (LGAS) # L5 LAPROSCOPIC APPENDICECTOMY GASTROENTEROLOGY LGAS035 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY LAPROSCOPIC CHOLECYSTECTOMY GASTROENTEROLOGY LGAS042 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY LAPROSCOPIC INCISIONAL HERNIA GASTROENTEROLOGY LGAS036 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY LAPROSCOPIC L.N.BIOPSY (LGAS) GASTROENTEROLOGY LGAS037 L5 Surgery 0 18010 21440 24870 # L5 SURGERY LYMPH NODE BIOPSY - GASTROENTEROLOGY LGAS047 INTRAPERITONIAL - OPEN (LGAS) L5 Surgery 0 18010 21440 24870 SURGERY # L5 MECKLE'S DIVERTICULECTOMY GASTROENTEROLOGY LGAS048 L5 Surgery 0 18010 21440 24870 LAPAROSCOPIC (LGAS) # L5 SURGERY GASTROENTEROLOGY LGAS038 OMENTECTOMY (LGAS) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPEN LIVER ABSESS DRAINAGE GASTROENTEROLOGY LGAS029 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY PYLOROPLASTY/PYLOROMYOTOMY GASTROENTEROLOGY LGAS044 L5 Surgery 0 18010 21440 24870 (LGAS) # L5 SURGERY SINGLE INCISION LAPAROSCOPIC GASTROENTEROLOGY LGAS039 L5 Surgery 0 18010 21440 24870 APPENDECTOMY (LGAS) # L5 SURGERY SMALL BOWEL STRICTUROPLASTY GASTROENTEROLOGY LGAS040 L5 Surgery 0 18010 21440 24870 (SINGLE) (LGAS) # L5 SURGERY

151 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GASTROENTEROLOGY LGAS054 ANOPROCTOPLASTY (LGAS) # L6 L6 Surgery 0 27010 32150 37290 SURGERY CBD EXPLORATION & SPHINCTERO GASTROENTEROLOGY LGAS055 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY CHOLECYSTECTOMY + CBD GASTROENTEROLOGY LGAS056 L6 Surgery 0 27010 32150 37290 EXPLORATION (LGAS) # L6 SURGERY CHOLECYSTECTOMY - OPEN (LGAS) GASTROENTEROLOGY LGAS049 L6 Surgery 0 27010 32150 37290 # L6 SURGERY CLOSURE OF DUODENAL SMALL GASTROENTEROLOGY LGAS057 L6 Surgery 0 27010 32150 37290 BOWEL FISTULA (LGAS) # L6 SURGERY COLOSTOMY CLOSURE/REVISION GASTROENTEROLOGY LGAS050 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY EMERGENCY LAPAROSCOPIC APPENDECTOMY (LAPAROSCOPIC GASTROENTEROLOGY LGAS051 L6 Surgery 0 27010 32150 37290 ACUTE ABDOMEN + LAPAROSCOPIC SURGERY APPENDECTOMY) (LGAS) # L6 GASTROENTEROLOGY LGAS071 FUNDOPLICATION (LGAS) # L6 L6 Surgery 0 27010 32150 37290 SURGERY GASTRIC - SLEEVE RESECTION GASTROENTEROLOGY LGAS058 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY GASTROENTEROLOGY LGAS052 ILEOSTOMY CLOSURE (LGAS) # L6 L6 Surgery 0 27010 32150 37290 SURGERY INGUINAL HERNIA MESH REPAIR - GASTROENTEROLOGY LGAS059 L6 Surgery 0 27010 32150 37290 BILATERIAL (LGAS) # L6 SURGERY GASTROENTEROLOGY LGAS200 INLAY MESH HERNIOPLASTY # L6 L6 Surgery 0 27010 32150 37290 SURGERY LAPAROSCOPIC CHOLECYSTECTOMY GASTROENTEROLOGY LGAS060 FOR ACUTE CHOLECYSTITIS (LGAS) L6 Surgery 0 27010 32150 37290 SURGERY # L6 LAPAROSCOPIC CHOLECYSTECTOMY GASTROENTEROLOGY LGAS061 FOR COMPLICATED GALLSTONE L6 Surgery 0 27010 32150 37290 SURGERY DISEASE (LGAS) # L6 LAPAROSCOPIC GASTROENTEROLOGY LGAS072 DUODENOJEJUNOSTOMY (LGAS) L6 Surgery 0 27010 32150 37290 SURGERY # L6 LAPROSCOPIC PERFORATION GASTROENTEROLOGY LGAS062 L6 Surgery 0 27010 32150 37290 CLOSURE (LGAS) # L6 SURGERY LARGE BOWEL RESECTION AND GASTROENTEROLOGY LGAS073 L6 Surgery 0 27010 32150 37290 ANASTOMOSIS (LGAS) # L6 SURGERY MUCOSAL ADVANCEMENT FLAP GASTROENTEROLOGY LGAS063 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY RE-EXPLORATION FOR INTRA- GASTROENTEROLOGY LGAS064 L6 Surgery 0 27010 32150 37290 ABDOMINAL BLEEDING (LGAS) # L6 SURGERY ROUX Y LOOP CONSTRUCTION GASTROENTEROLOGY LGAS065 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY SINGLE INCISION LAPAROSCOPIC GASTROENTEROLOGY LGAS066 L6 Surgery 0 27010 32150 37290 CHOLECYSTECTOMY (LGAS) # L6 SURGERY

152 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SMALL BOWEL RESECTION AND GASTROENTEROLOGY LGAS067 L6 Surgery 0 27010 32150 37290 ANASTOMOSIS (LGAS) # L6 SURGERY SMALL BOWEL STRICTUROPLASTY GASTROENTEROLOGY LGAS068 L6 Surgery 0 27010 32150 37290 (MULTIPLE) (LGAS) # L6 SURGERY GASTROENTEROLOGY LGAS053 SPLENECTOMY - OPEN (LGAS) # L6 L6 Surgery 0 27010 32150 37290 SURGERY TRANSDUODENAL GASTROENTEROLOGY LGAS069 L6 Surgery 0 27010 32150 37290 SPHINCTEROPLASTY (LGAS) # L6 SURGERY TRASNANAL EXCISION OF TUMOR GASTROENTEROLOGY LGAS070 L6 Surgery 0 27010 32150 37290 (LGAS) # L6 SURGERY LAPROSCOPIC COLECTOMY (LGAS) GASTROENTEROLOGY LGAS129 L8 Surgery 0 34550 38000 41460 # L8 SURGERY ABDOMINO-PERINEAL RESECTION GASTROENTEROLOGY LGAS098 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY CHOLEDOCHODUDENOSTOMY GASTROENTEROLOGY LGAS081 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY CYSTOGASTROSTOMY / GASTROENTEROLOGY LGAS082 L7 Surgery 0 36010 42870 49730 CYSTOJEJUNOSTOMY (LGAS) # L7 SURGERY DUODENAL DIVERTICULIZATION GASTROENTEROLOGY LGAS095 L7 Surgery 0 36010 42870 49730 PROCEDURE (LGAS) # L7 SURGERY DUODENAL DIVERTICULUM GASTROENTEROLOGY LGAS105 L7 Surgery 0 36010 42870 49730 EXCISION (LGAS) # L7 SURGERY EMERGENCY LAPAROTOMY FOR GASTROENTEROLOGY LGAS077 INTESTINAL OBSTRUCTION (LGAS) L7 Surgery 0 36010 42870 49730 SURGERY # L7 EXCISION OF INSULINOMAS (LGAS) GASTROENTEROLOGY LGAS078 L7 Surgery 0 36010 42870 49730 # L7 SURGERY GASTROENTEROLOGY LGAS104 FISTULOJEJUNOSTOMY (LGAS) # L7 L7 Surgery 0 36010 42870 49730 SURGERY GASTROENTEROLOGY LGAS083 GASTRECTOMY PARTIAL (LGAS) # L7 L7 Surgery 0 36010 42870 49730 SURGERY GRACILOPLASTY (BILATERAL) (LGAS) GASTROENTEROLOGY LGAS074 L7 Surgery 0 36010 42870 49730 # L7 SURGERY HYDATID CYST - GASTROENTEROLOGY LGAS084 L7 Surgery 0 36010 42870 49730 CYSTOPERIYSTECTOMY (LGAS) # L7 SURGERY GASTROENTEROLOGY LGAS174 LADDS PRACEDURE (LGAS) # L7 L7 Surgery 0 36010 42870 49730 SURGERY LAPAROSCOPIC CBD EXPLORATION GASTROENTEROLOGY LGAS079 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY LAPAROSCOPIC GASTROENTEROLOGY LGAS110 CYSTOGASTROSTOMY / L7 Surgery 0 36010 42870 49730 SURGERY CYSTOJEJUNOSTOMY (LGAS) # L7 LAPAROSCOPIC LARGE BOWEL GASTROENTEROLOGY LGAS108 RESECTION AND ANASTOMOSIS L7 Surgery 0 36010 42870 49730 SURGERY (LGAS) # L7 LAPAROSCOPIC LIVER ABSCESS GASTROENTEROLOGY LGAS085 L7 Surgery 0 36010 42870 49730 DRAINAGE (LGAS) # L7 SURGERY

153 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC REPAIR PROLAPSE GASTROENTEROLOGY LGAS109 L7 Surgery 0 36010 42870 49730 RECTUM MESH REPAIR (LGAS) # L7 SURGERY LAPROSCOPIC ANTE REFLUX GASTROENTEROLOGY LGAS096 L7 Surgery 0 36010 42870 49730 OPERATION (LGAS) # L7 SURGERY LAPROSCOPIC HYDATID CYST GASTROENTEROLOGY LGAS086 L7 Surgery 0 36010 42870 49730 EXCISION (LGAS) # L7 SURGERY LAPROSCOPIC RECTOPEXY (LGAS) GASTROENTEROLOGY LGAS080 L7 Surgery 0 36010 42870 49730 # L7 SURGERY LAPROSCOPIC SMALL BOWEL GASTROENTEROLOGY LGAS087 L7 Surgery 0 36010 42870 49730 RESECTION (LGAS) # L7 SURGERY LAPROSCOPIC SPLENECTOMY GASTROENTEROLOGY LGAS075 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY LAPROSCOPIC TV + GASTROENTEROLOGY LGAS088 L7 Surgery 0 36010 42870 49730 GASTROJEJUNOSTOMY (LGAS) # L7 SURGERY LATERAL PANCREATICO GASTROENTEROLOGY LGAS097 L7 Surgery 0 36010 42870 49730 JEJUNOSTOMY (LGAS) # L7 SURGERY GASTROENTEROLOGY LGAS175 LeVEEN SHUNT # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPEN ACHALASIA CARDIA GASTROENTEROLOGY LGAS100 L7 Surgery 0 36010 42870 49730 OPERATION (LGAS) # L7 SURGERY OPEN RIGHT/LEFT HEMICOLECTOMY GASTROENTEROLOGY LGAS089 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY PARTIAL/SUBTAOTAL GASTRECTOMY GASTROENTEROLOGY LGAS090 L7 Surgery 0 36010 42870 49730 FOR CARCINOMA (LGAS) # L7 SURGERY GASTROENTEROLOGY LGAS102 PERITONECTOMY (LGAS) # L7 L7 Surgery 0 36010 42870 49730 SURGERY RADICAL SMALL BOWEL RESECTION GASTROENTEROLOGY LGAS103 L7 Surgery 0 36010 42870 49730 FOR TUMOR (LGAS) # L7 SURGERY RECTOVAGINAL FISTULA REPAIR GASTROENTEROLOGY LGAS107 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY REPAIR PROLAPSE RECTUM (LGAS) GASTROENTEROLOGY LGAS076 L7 Surgery 0 36010 42870 49730 # L7 SURGERY RETROPERITONEAL TUMOR GASTROENTEROLOGY LGAS091 L7 Surgery 0 36010 42870 49730 EXCISION (LGAS) # L7 SURGERY RF ABLATION OF LIVER LESION GASTROENTEROLOGY LGAS092 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY GASTROENTEROLOGY LGAS093 SPLENORRAPHY (LGAS) # L7 L7 Surgery 0 36010 42870 49730 SURGERY SUBTOTAL GASTRECTOMY (LGAS) GASTROENTEROLOGY LGAS094 L7 Surgery 0 36010 42870 49730 # L7 SURGERY SURGERY FOR ANAL INCONTINENCE GASTROENTEROLOGY LGAS106 L7 Surgery 0 36010 42870 49730 (LGAS) # L7 SURGERY SURGERY FOR ENTEROCUTANEOUS GASTROENTEROLOGY LGAS099 L7 Surgery 0 36010 42870 49730 FISTULA (LGAS) # L7 SURGERY VASCULAR RESECTION AND GASTROENTEROLOGY LGAS101 L7 Surgery 0 36010 42870 49730 RECONSTRUCTION (LGAS) # L7 SURGERY

154 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC GASTROENTEROLOGY LGAS179 CHOLEDOCHODUODENOSTOMY L8 Surgery 0 38580 45930 53280 SURGERY (LGAS) : L8 # L8 GASTROENTEROLOGY LGAS144 AMPULLECTOMY (LGAS) # L8 L8 Surgery 0 45010 53580 62150 SURGERY GASTROENTEROLOGY LGAS118 ANTERIOR RESECTION (LGAS) # L8 L8 Surgery 0 45010 53580 62150 SURGERY CHOLEDOCHEL CYST EXCISION + ROUX-EN-Y GASTROENTEROLOGY LGAS114 L8 Surgery 0 45010 53580 62150 HEPATICOJEJUNOSTOMY (LGAS) SURGERY # L8 DISTAL PANCREATECTOMY (LGAS) GASTROENTEROLOGY LGAS119 L8 Surgery 0 45010 53580 62150 # L8 SURGERY DISTAL SPLENORENAL SHUNT GASTROENTEROLOGY LGAS120 L8 Surgery 0 45010 53580 62150 (LGAS) # L8 SURGERY EMERGENCY LAPAROTOMY FOR GI GASTROENTEROLOGY LGAS116 L8 Surgery 0 45010 53580 62150 BLEED (LGAS) # L8 SURGERY EMERGENCY LAPAROTOMY FOR GASTROENTEROLOGY LGAS121 L8 Surgery 0 45010 53580 62150 MESENTERIC ISCHEMIA (LGAS) # L8 SURGERY ESOPHAGEAL GASTROENTEROLOGY LGAS122 REPLACEMENT(GASTRIC PULL UP) L8 Surgery 0 45010 53580 62150 SURGERY (LGAS) # L8 ESOPHAGO-GASTRIC GASTROENTEROLOGY LGAS123 DEVASCULARIZATION + L8 Surgery 0 45010 53580 62150 SURGERY SPLENECTOMY (LGAS) # L8 EXCISION OF MESENTERIC MASS GASTROENTEROLOGY LGAS124 L8 Surgery 0 45010 53580 62150 (LGAS) # L8 SURGERY GASTROENTEROLOGY LGAS125 FREYS PROCEDURE (LGAS) # L8 L8 Surgery 0 45010 53580 62150 SURGERY HEPATODUODENAL LIGAMENT GASTROENTEROLOGY LGAS126 L8 Surgery 0 45010 53580 62150 LYMPHADENECTOMY (LGAS) # L8 SURGERY INTERPOSITION PORTACAVAL SHUNT GASTROENTEROLOGY LGAS127 L8 Surgery 0 45010 53580 62150 (LGAS) # L8 SURGERY GASTROENTEROLOGY LGAS142 LAPAROSCOPIC APR (LGAS) # L8 L8 Surgery 0 45010 53580 62150 SURGERY LAPAROSCOPIC CHOLEDOCHEL CYST EXCISION + ROUX-EN-Y GASTROENTEROLOGY LGAS115 L8 Surgery 0 45010 53580 62150 HEPATICOJEJUNOSTOMY (LGAS) SURGERY # L8 LAPAROSCOPIC GASTRIC BYPASS GASTROENTEROLOGY LGAS149 PROCEDURE FOR OBESITY (LGAS) L8 Surgery 0 45010 53580 62150 SURGERY # L8 LAPAROSCOPIC LIVER RESECTION GASTROENTEROLOGY LGAS128 L8 Surgery 0 45010 53580 62150 NONANATOMICAL (LGAS) # L8 SURGERY LAPAROSCOPIC REPAIR PROLAPSE RECTUM MESH REPAIR + GASTROENTEROLOGY LGAS148 L8 Surgery 0 45010 53580 62150 RESECTION ANASTOMOSIS (LGAS) SURGERY # L8

155 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC VAGOTOMY/ GASTROENTEROLOGY LGAS146 L8 Surgery 0 45010 53580 62150 GASTRIC BYPASS (LGAS) # L8 SURGERY LAPAROTOMY WITH MULTIPLE GASTROENTEROLOGY LGAS147 PROCEDURES (BLUNT AND L8 Surgery 0 45010 53580 62150 SURGERY PENETRATING INJURIES) (LGAS) # L8 LAPROSCOPIC ACHALRIA CARDIA GASTROENTEROLOGY LGAS111 L8 Surgery 0 45010 53580 62150 OPERATION (LGAS) # L8 SURGERY LIVER TRAUMA (DEBRIDEMENT/ GASTROENTEROLOGY LGAS130 L8 Surgery 0 45010 53580 62150 RESECTION) (LGAS) # L8 SURGERY LOW ANTERIOR RESECTION WITH GASTROENTEROLOGY LGAS131 L8 Surgery 0 45010 53580 62150 ILEOSTOMY (LGAS) # L8 SURGERY MODULAR ANTEGRADE DISTAL GASTROENTEROLOGY LGAS132 L8 Surgery 0 45010 53580 62150 PANCREATECTOMY (LGAS) # L8 SURGERY NONANATOMICAL LIVER RESECTION GASTROENTEROLOGY LGAS133 / LATERAL SEGMENTECTOMY (LGAS) L8 Surgery 0 45010 53580 62150 SURGERY # L8 PANCREAS PRESERVING GASTROENTEROLOGY LGAS145 L8 Surgery 0 45010 53580 62150 DUODENECTOMY (LGAS) # L8 SURGERY PANCREATIC NECROSECTOMY/ GASTROENTEROLOGY LGAS112 ABSCESS DRAINAGE OPEN/ L8 Surgery 0 45010 53580 62150 SURGERY LAPAROSCOPIC (LGAS) # L8 PANCREATIC TRAUMA GASTROENTEROLOGY LGAS134 (DEBRIDEMENT/RESECTION) L8 Surgery 0 45010 53580 62150 SURGERY (LGAS) # L8 PORTA SYSTEMIC SHUNT (LGAS) GASTROENTEROLOGY LGAS140 L8 Surgery 0 45010 53580 62150 # L8 SURGERY RADICAL SUBTOTAL GASTRECTOMY GASTROENTEROLOGY LGAS135 L8 Surgery 0 45010 53580 62150 R0-R4 RNS) (LGAS) # L8 SURGERY RESECTION OF ANTERIOR GASTROENTEROLOGY LGAS136 ABDOMINAL TUMOR & RECON. L8 Surgery 0 45010 53580 62150 SURGERY (LGAS) # L8 ROUX-EN-Y GASTROENTEROLOGY LGAS137 HEPATICOJEJUNOSTOMY (LGAS) L8 Surgery 0 45010 53580 62150 SURGERY # L8 SILS ADVANCED PROCEDURES GASTROENTEROLOGY LGAS138 (COLECTOMY / CARDIOMYOTOMY / L8 Surgery 0 45010 53580 62150 SURGERY FUNDOPLICATION) (LGAS) # L8 SPLEEN PRESERVING DISTAL GASTROENTEROLOGY LGAS139 L8 Surgery 0 45010 53580 62150 PANCREATECTOMY (LGAS) # L8 SURGERY SPLENORENAL SHUNT +/- GASTROENTEROLOGY LGAS117 L8 Surgery 0 45010 53580 62150 SPLENECTOMY (LGAS) # L8 SURGERY SUBTOTAL COLECTOMY WITH GASTROENTEROLOGY LGAS143 ILEORECTAL ANASTOMOSIS (LGAS) L8 Surgery 0 45010 53580 62150 SURGERY # L8 TOTAL PROCTO-COLECTOMY WITH GASTROENTEROLOGY LGAS141 L8 Surgery 0 45010 53580 62150 ILEOSTOMY (LGAS) # L8 SURGERY VIDEO ASSISTED RETROPERITONEAL GASTROENTEROLOGY LGAS113 L8 Surgery 0 45010 53580 62150 DEBRIDEMENT (VARD) (LGAS) # L8 SURGERY

156 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group 3-STAGE TRANSTHORACIC GASTROENTEROLOGY LGAS155 L9 Surgery 0 54020 64300 74590 OESOPHAGECTOMY (LGAS) # L9 SURGERY ANTERIOR RESECTION - LOW GASTROENTEROLOGY LGAS170 ANTERIOR RESECTION LAR +TME + L9 Surgery 0 54020 64300 74590 SURGERY ANP Laparoscopic (LGAS) # L9 DUODENUM PRESERVING GASTROENTEROLOGY LGAS169 PANCREATECTOMY / TOTAL L9 Surgery 0 54020 64300 74590 SURGERY PANCREATECTOMY (LGAS) # L9 EXCISION OF VISCERAL ARTERY GASTROENTEROLOGY LGAS176 L9 Surgery 0 54020 64300 74590 ANEURYSM # L9 SURGERY EXTENDED CHOLECYSTECTOMY GASTROENTEROLOGY LGAS150 (LYMPADENECTOMY + LIVER L9 Surgery 0 54020 64300 74590 SURGERY RESECTION) (LGAS) # L9 INTESTINAL VAGINOPLASTY (LGAS) GASTROENTEROLOGY LGAS180 L9 Surgery 0 54020 64300 74590 # L9 SURGERY LAPAROSCOPIC DISTAL GASTROENTEROLOGY LGAS151 L9 Surgery 0 54020 64300 74590 PANCREATECTOMY (LGAS) # L9 SURGERY LAPAROSCOPIC HEPATECTOMY- GASTROENTEROLOGY LGAS156 L9 Surgery 0 54020 64300 74590 ANATOMICAL (LGAS) # L9 SURGERY LAPAROSCOPIC SPLEEN- GASTROENTEROLOGY LGAS152 PRESERVING DISTAL L9 Surgery 0 54020 64300 74590 SURGERY PANCREATECTOMY (LGAS) # L9 Laparoscopic subtotal/total GASTROENTEROLOGY LGAS178 L9 Surgery 0 54020 64300 74590 colectomy(LGAS):L9 # L9 SURGERY LAPROSCOPIC APR / ANT GASTROENTEROLOGY LGAS157 L9 Surgery 0 54020 64300 74590 RESECTION (LGAS) # L9 SURGERY LAPROSCOPIC GASTRECTOMY GASTROENTEROLOGY LGAS153 L9 Surgery 0 54020 64300 74590 (LGAS) # L9 SURGERY MAJOR HEPATATECTOMY (LGAS) GASTROENTEROLOGY LGAS158 L9 Surgery 0 54020 64300 74590 # L9 SURGERY MEDIAN PANCREATECTOMY WITH GASTROENTEROLOGY LGAS159 L9 Surgery 0 54020 64300 74590 RECONSTRUCTION (LGAS) # L9 SURGERY OESOPHAGECTOMY TOTAL- GASTROENTEROLOGY LGAS160 ORRINGER TRANPOSITION (LGAS) L9 Surgery 0 54020 64300 74590 SURGERY # L9 OESOPHAGO GASTRECTOMY IVOR- GASTROENTEROLOGY LGAS161 L9 Surgery 0 54020 64300 74590 LEWIS (LGAS) # L9 SURGERY RADICAL EXCISION OF BILE DUCT GASTROENTEROLOGY LGAS177 L9 Surgery 0 54020 64300 74590 (LGAS) :L9 # L9 SURGERY RADICAL TOTAL GASTRECTOMY GASTROENTEROLOGY LGAS154 (R0-R4 RNS) +/- RECONSTRUCTION L9 Surgery 0 54020 64300 74590 SURGERY POUCH (LGAS) # L9 REDO-HEPATICOJEJUNOSTOMY GASTROENTEROLOGY LGAS168 L9 Surgery 0 54020 64300 74590 (LGAS) # L9 SURGERY REPAIR OF COMPLICATED BILIARY GASTROENTEROLOGY LGAS162 L9 Surgery 0 54020 64300 74590 STRICTURE (LGAS) # L9 SURGERY RETROSTERNAL COLONIC BYPASS GASTROENTEROLOGY LGAS163 L9 Surgery 0 54020 64300 74590 (LGAS) # L9 SURGERY

157 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ROUX Y HEPATICOJEJUNOSTOMY GASTROENTEROLOGY LGAS164 FOR PORTAL BILIOPATHY (LGAS) # L9 Surgery 0 54020 64300 74590 SURGERY L9 SILS SUPRAMAJOR (DISTAL PANCREATECTOMY/ GASTROENTEROLOGY LGAS171 CYSTOGASTRECTOMY/TOTAL L9 Surgery 0 54020 64300 74590 SURGERY PROCTOCOLECTOMY ETC (LGAS) # L9 SILS SUPRAMAJOR (DISTAL PANCREATECTOMY/ GASTROENTEROLOGY LGAS165 CYSTOGASTROSCTOMY/TOTAL L9 Surgery 0 54020 64300 74590 SURGERY PROCTOCOLECTOMY COLECTOMY) (LGAS) # L9 TOTAL PROCTOCOLECTOMY WITH GASTROENTEROLOGY LGAS166 POUCH ANAL ANASTOMOSIS (LGAS) L9 Surgery 0 54020 64300 74590 SURGERY # L9 WHIPPLE'S PANCRETO- GASTROENTEROLOGY LGAS167 L9 Surgery 0 54020 64300 74590 DUODENECTOMY (LGAS) # L9 SURGERY DS0017 Diagnostic laproscopy Surgery GENERAL SURGERY 0 1110 1320 1530 ANAL DILATATION (AS SOLE LGEN001 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 PROCEDURE) (GEN) # L1 BANDING / INJECTION OF PILES LGEN002 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 (GEN) # L1 LGEN003 CORN EXCISION (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 LGEN008 DRESSING - MINOR (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 EAR LOBE REPAIR UNILATERAL LGEN004 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 (LGEN) # L1 EUA (AS SOLE PROCEDURE) (GEN) LGEN005 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 # L1 LGEN006 FNAC (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 LGEN007 I & D MINOR (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 LGEN012 MOLE EXCISION (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 LGEN013 PUNCH BIOPSY (LGEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 SIGMOIDOSCOPY - RIGID (LGEN) LGEN014 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 # L1 LGEN009 SKIN BIOPSY (GEN) # L1 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 WOUND DEBRIDEMENT MINOR LGEN010 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 (LGEN) # L1 WOUND SUTURING MINOR (GEN) LGEN011 L1 Surgery GENERAL SURGERY 4290 4500 5360 6220 # L1 LGEN015 AMPUTATION OF TOE (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 CAPD CATHETER REMOVAL-(GEN):L2 LGEN417 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 CHEMOPORT/ HICKMAN CATHETER LGEN029 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 REMOVAL (GEN) # L2

158 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LGEN016 CIRCUMCISION (LGEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 CORE BIOPSY /TRUCUT BIOPSY LGEN041 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 (GEN) # L2 CYSTOSCOPY SAME AS LGEN028 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 PANENDOSOPY (GEN) # L2 EAR LOBE REPAIR BILATERAL (GEN) LGEN017 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 EUA/ ANAL SPHINCTEROTOMY (GEN) LGEN018 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 EXCISION OF SKIN LESION (GEN) LGEN036 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 LGEN031 FASCIOTOMY MINOR (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN030 FRENULOPLASTY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN019 GANGLION EXCISION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN032 ICD - PLACEMENT (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 INTRA PERITONEAL - CHEMOPORT LGEN033 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 REMOVAL (GEN) # L2 LIPOMA EXCISION - SMALL (GEN) LGEN020 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 LOCAL EXCISION OF LIP LESION LGEN034 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 (GEN) # L2 LYMPHNODE BIOPSY EXCISION (GEN) LGEN042 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 LGEN021 MUSCLE BIOPSY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN022 NAIL EXCISION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 SEBACEOUS CYST EXCISION (GEN) LGEN023 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 LGEN035 SECONDARY SUTURING (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN024 SINUS EXPLORATION (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN038 SKIN GRAFT MINOR (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN037 SPLIT SKIN GRAFTING (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 SUCTION BANDING/ INFRA RED LGEN025 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 COAGULATION (GEN) # L2 SUPRAPUBIC CYSTOSTOMY (GEN) LGEN039 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 # L2 LGEN040 TESTICULAR BIOPSY (GEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 LGEN026 VASECTOMY (LGEN) # L2 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 WOUND SUTURING INTERMEDIATE LGEN027 L2 Surgery GENERAL SURGERY 0 8240 9810 11380 (GEN) # L2 Axillary Lymph Node Biopsy (LGEN) LGEN418 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 L3 # L3 CARPAL TUNNEL DECOMPRESSION - LGEN056 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 UNILATERAL (GEN) # L3

159 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group Cervical Lymph Node Biopsy (LGEN) LGEN419 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 L3 # L3 CIRCUMCISSION UNDER LA (GEN):L3 LGEN425 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 LGEN043 DERMOID CYST EXCISION (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 LGEN051 DRESSING - MAJOR (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 EPIDIDYMAL CYST EXCISION (GEN) LGEN057 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 EPIDIDYMECTOMY - UNILATERAL LGEN058 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 EPIDIDYMO VASOSTOMY LGEN059 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 UNILATERAL (GEN) # L3 LGEN044 EUA/ LOW FISTULA (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 EXCISION OF SUBCUTANEOUS LGEN065 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 LESION (GEN) # L3 FOURNIER'S GANGRENE LGEN060 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 DEBRIDEMENT (GEN) # L3 HAEMORHOIDECTOMY WITH EUA + LGEN061 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 SIGMOIDOSCOPY (GEN) # L3 HAEMORRHOIDECTOMY WITH EUA LGEN045 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 HYDROCELECTOMY UNILATERAL LGEN046 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (LGEN) # L3 LGEN047 I & D MAJOR (LGEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 LGEN048 MICRODOCHECTOMY (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 MUCOSAL SHAVE OF LIP LESION LGEN067 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 LGEN062 OPEN BONE BIOPSY (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 PAROTID DUCT CALCULI REMOVAL LGEN063 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 PILONIDAL SINUS EXCISION (GEN) LGEN049 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 SEBACEOUS CYST EXCISION LGEN050 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 MULTIPLE (GEN) # L3 SFJ LIGATION STRIPPING - LGEN069 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 UNILATERAL (GEN) # L3 SIMPLE INGUINAL/FEMORAL HERNIA LGEN052 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 REPAIR - UNILATERAL (GEN) # L3 SIMPLE UMBLICAL HERNIA / LGEN412 EPIGASTRIC HERNIA REPAIR - (GEN) L3 Surgery GENERAL SURGERY 0 10820 12880 14940 : L3 # L3 SKIN GRAFT INTERMEDIATE (GEN) LGEN066 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 SUBMANDIBULAR SALIVARY DUCT LGEN064 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 CALCULUS REMOVAL (GEN) # L3

160 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VASECTOMY UNDER LA (GEN):L3 LGEN426 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 WIDE EXCISION OF SCALP TUMOR LGEN068 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 LGEN053 WIDE LOCAL EXCISION (GEN) # L3 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 WOUND DEBRIDEMENT MAJOR LGEN054 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 (GEN) # L3 WOUND SUTURING MAJOR (GEN) LGEN055 L3 Surgery GENERAL SURGERY 0 10820 12880 14940 # L3 ADHESIOLYSIS WITH OR WITHOUT LGEN102 BOPSY OPEN (AS SOLE PROCEDURE) L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 AMPUTATIONS FOOT/HAND (GEN) LGEN070 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 LGEN071 APPENDICECTOMY OPEN (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 CHEMOPORT/ HICKMAN CATHETER LGEN073 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 INSERTION (GEN) # L4 DIAGNOSTIC THORACOSCOPY +/- LGEN091 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 BIOPSY (GEN) # L4 EPIDIDYMECTOMY - BILATERAL LGEN093 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 EPIDIDYMO VASOSTOMY BILATERAL LGEN094 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 EPIGASTRIC HERNIA ?MESH REPAIR- LGEN416 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN):L4 # L4 LGEN074 EUA/ HIGH FISTULA (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 EXCISION BENIGN TUMOR NECK LGEN092 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 EXCISION OF PARATHYROID LGEN075 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 ADENOMA/CARCINOMA (GEN) # L4 LGEN097 FASCIOTOMY MAJOR (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 FEEDING JEJUNOSTOMY (LGEN) # LGEN096 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 L4 LGEN095 GASTROSTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 GYNAECOMASTIA UNILATERAL (GEN) LGEN077 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 HADFIELDS PROCEDURE (GEN) # LGEN078 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 L4 INGUINAL/ FEMORAL HERNIA MESH LGEN079 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 REPAIR UNILATERAL (GEN) # L4 INTERNAL ILIAC ARTERY LIGATION - LGEN099 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 UNILATERAL (GEN) # L4 INTRAOPERATIVE LGEN101 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 CHOLANGIOGRAPHY (GEN) # L4

161 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group INTRA PERITONEAL - CHEMOPORT LGEN100 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 INSERTION (GEN) # L4 LAPAROTOMY AND PERITONEAL LGEN103 LAVAGE (AS SOLE PROCEDURE) L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 LIPOMA EXCISION - LARGE (GEN) LGEN080 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 LGEN104 LOCAL ROTATION FLAPS (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 LUMBAR SYMPATHECTOMY (GEN) LGEN114 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 LGEN081 LUMPECTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 MECKLE'S DIVERTICULECTOMY LGEN072 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 OPEN (GEN) # L4 OOPHERECTOMY - UNILATERAL LGEN105 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 ORCHIDOPEXY - UNILATERAL (LGEN) LGEN082 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 PARATHYROID HYPERPLASIA LGEN076 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 EXCISION (GEN) # L4 PARAUMBILICAL HERNIA MESH LGEN089 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 REPAIR (GEN) # L4 PILONIDAL SUNUS EXCISON WITH LGEN083 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 PRIMARY CLOSURE (GEN) # L4 RADICAL ORCHIDECTOMY (LGEN) LGEN106 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 SCALENE TRIANGLE DISSECTION LGEN084 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 SFJ LIGATION STRIPPING PERF LGEN113 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 LIGATION - UNILATERAL (GEN) # L4 SIMPLE MASTECTOMY WITH/ LGEN085 WITHOUT AXILLARY LYMPHNODE L4 Surgery GENERAL SURGERY 0 14790 17610 20420 BIOPSY - UNILATERAL (GEN) # L4 LGEN107 SKIN GRAFT MAJOR (GEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 STAPLER HAEMORHOIDECTOMY+ LGEN098 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 SIGMOIDOSCOPY (GEN) # L4 STAPLER HAEMORRHOIDECTOMY LGEN086 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 TENDON LENGTHENING/SUTURING LGEN108 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 LGEN087 TRACHEOSTOMY (LGEN) # L4 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 UMBILICAL HERNIA MESH REPAIR LGEN088 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 URINARY BLADDER REPAIR (GEN) LGEN109 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 # L4 VAGOTOMY WITH OUT GASTRIC LGEN112 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 BYPASS -OPEN (GEN) # L4

162 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VARICOCELE LIGATION UNILATERAL LGEN110 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 (GEN) # L4 WIDE EXCISION OF CARCINOMA - LGEN111 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 BUCCAL MUCOSA (GEN) # L4 WIDE LOCAL EXCISION + MESH LGEN090 L4 Surgery GENERAL SURGERY 0 14790 17610 20420 REPAIR (GEN) # L4 AMPUTATION BELOW KNEE (LGEN) LGEN115 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 AMPUTATION OF PENIS - PARTIAL LGEN138 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (LGEN) # L5 AMPUTATIONS BELOW ELBOW (GEN) LGEN116 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 AVULSION OF VENOUS LGEN118 PERFORATORS UNILATERAL (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 CARPAL TUNNEL DECOMPRESSION - LGEN140 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 BILATERAL (GEN) # L5 COMPLICATED INGUINAL HERNIA- LGEN414 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN:)L5 # L5 DEFUNCTIONING COLOSTOMY (GEN) LGEN139 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 DIAGNOSTIC LAPAROSCOPY (WITH LGEN119 OR WITHOUT BIOPSY/LAVAGE)(AS L5 Surgery GENERAL SURGERY 0 18010 21440 24870 SOLE PROCEDURE) (GEN) # L5 DUODENOJEJUNOSTOMY - OPEN LGEN142 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 EUA/ HIGH FISTULA WITH DIVERSION LGEN120 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 EXCISION OF MALIGNANT LESION LGEN157 (NOT OTHERWISE SPECIFIED) (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 GASTROJEJUNOSTOMY & LGEN146 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 VAGOTOMY - OPEN (GEN) # L5 GASTROSTOMY LAPAROSCOPIC LGEN143 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 GLOMUS TUMOR EXCISION (GEN) LGEN144 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 LGEN145 GLOSSECTOMY HEMI (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 HYDROCELECTOMY BILATERAL LGEN121 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (LGEN) # L5 ILEO INGUINAL BLOCK DISSECTION - LGEN147 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 UNILATERAL (GEN) # L5 INCISIONAL HERNIA MESH REPAIR LGEN122 WITH/WITHOUT ADHESIOLYSIS (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 INGUINAL HERNIA - MESH REPAIR LGEN123 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 UNDER LA - UNILATERAL (GEN) # L5

163 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC ADHESIOLYSIS LGEN124 (INCLUDING BIOPSY) AS SOLE L5 Surgery GENERAL SURGERY 0 18010 21440 24870 PROCEDURE (GEN) # L5 LAPAROSCOPIC APPENDICECTOMY LGEN125 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LAPAROSCOPIC CHOLECYSTECTOMY LGEN130 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LAPAROSCOPIC ECTOPIC LGEN156 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 UNRUPTURED/RUPTURED (GEN) # L5 LAPAROSCOPIC HERNIA REPAIR LGEN126 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LAPAROSCOPIC INGUINAL/ FEMORAL LGEN127 HERNIA MESH REPAIR UNILATERAL L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LAPAROSCOPIC OVARIAN LGEN155 CYSTECTOMY UNILATERAL (GEN) L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 LAPAROSCOPIC VARICOCELE LGEN128 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 OPERATION (GEN) # L5 LAPAROSCOPIC VENTRAL HERNIA LGEN129 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 MESH REPAIR (GEN) # L5 LAPAROSCOPIY AND PACKING OF LGEN151 LIVER WITH PERITONEAL LAVAGE L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LAPAROTOMY AND PACKING OF LGEN150 LIVER WITH PERITONEAL LAVAGE L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 LIPOMA EXCISION - MULTIPLE (GEN) LGEN148 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 LYMPH NODE BIOPSY - LGEN149 INTRAPERITONIAL - OPEN (GEN) # L5 Surgery GENERAL SURGERY 0 18010 21440 24870 L5 MECKLE'S DIVERTICULECTOMY LGEN117 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 LAPAROSCOPIC (GEN) # L5 MIRP - MINIMALLY INVASIVE RADIO LGEN131 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 GUIDED PARATHYROID (GEN) # L5 LGEN158 OMENTECTOMY (LGEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 OOPHERECTOMY - BILATERAL (GEN) LGEN159 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 OPEN LIVER ABSESS DRAINAGE LGEN152 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 ORCHIDECTOMY UNILATERAL - LGEN154 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 OPEN/LAPAROSCOPIC (GEN) # L5 ORCHIDOPEXY - BILATERAL (LGEN) LGEN132 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 PILONIDAL SINUS EXCISION WITH LGEN133 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 FLAP (GEN) # L5

164 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LGEN160 PORT-A-CATH (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 RECONSTRUCTION OF GASTRIC RES LGEN161 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (LGEN) # L5 RECURRENT INGUINAL HERNIA- LGEN413 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN):L5 # L5 LGEN162 REGIONAL FLAPS (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 RETROPERITONEAL LYMPHNODE LGEN165 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 BIOPSY (GEN) # L5 LGEN163 REVISION COLOSTOMY (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 LGEN166 RFA (GEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 ROLL - RADIO GUIDED OCCULT LGEN164 LESION LOCALIZATION AND L5 Surgery GENERAL SURGERY 0 18010 21440 24870 EXCISION (GEN) # L5 LGEN167 SENTINEL NODE BIOPSY (LGEN) # L5 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 SFJ LIGATION STRIPPING - LGEN176 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 BILATERAL (GEN) # L5 SILS INCISIONAL HERNIA REPAIR LGEN169 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 SILS OF ANY SIMPLE LGEN170 PROCEDURE (APPENDICECTOMY/ L5 Surgery GENERAL SURGERY 0 18010 21440 24870 CHLECYSTECTOMY ETC) (GEN) # L5 SILS VENTRAL HERNIA REPAIR (GEN) LGEN168 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 SIMPLE INGUINAL/FEMORAL HERNIA LGEN134 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 REPAIR - BILATERAL (GEN) # L5 SMALL BOWEL STRICTUROPLASTY LGEN153 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (SINGLE) (GEN) # L5 SUBMANDIBULAR GLAND EXCISION LGEN135 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (LGEN) # L5 SYMPETHECTOMY-CERVICAL/ LGEN177 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 THORACIC (GEN) # L5 THERAPEUTIC LAPAROSCOPY (GEN) LGEN171 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 # L5 THERAPEUTIC THORACOSCOPY LGEN141 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5 THERAPEUTIC THORACOSCOPY LGEN172 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (LGEN) # L5 THYROGLOSSAL / BRANCHIAL CYST LGEN136 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 OR FISTULA (GEN) # L5 TORTION TESTIS BILATERAL LGEN173 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 FIXATION (GEN) # L5 UMBILICAL HERNIA MESH REPAIR LGEN137 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 UNDER LA (GEN) # L5 VARICOCELE LEGATION BILATERAL LGEN174 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 (GEN) # L5

165 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group Wide excision of abdominal wall LGEN424 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 with mesh repair (LGEN) L5 # L5 WIDE EXCISION OF SOFT TISSUE LGEN175 L5 Surgery GENERAL SURGERY 0 18010 21440 24870 TUMOR (GEN) # L5 ADRENALECTOMY UNILATERAL (SS) LGEN204 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 AMPUTATION ABOVE KNEE (SS) LGEN178 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 AMPUTATION OF TOTAL PENIS (SS) LGEN205 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 LGEN179 ANOPROCTOPLASTY (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 AVULSION OF VENOUS LGEN180 PERFORATORS - BILATERAL (SS) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 AXILLARY CLEARANCE LEVEL I & II LGEN206 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (SS) (GEN) # L6 CHOLECYSTECTOMY + CBD LGEN182 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 EXPLORATION (SS) (GEN) # L6 CHOLECYSTECTOMY - OPEN (SS) LGEN181 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 CLOSURE OF DUODENAL SMALL LGEN209 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 BOWEL FISTULA (SS) (GEN) # L6 COMPLICATED APPENDICECTOMY- LGEN415 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN):L6 # L6 EXCISION OF CARCINOID TUMORS LGEN208 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (SS) (GEN) # L6 LGEN213 FUNDOPLICATION (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 GASTRIC - SLEEVE RESECTION (SS) LGEN186 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 GLOSSECTOMY PARTIAL (SS) (GEN) LGEN214 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 GYNAECOMASTIA BILATERAL (SS) LGEN187 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 INTERNAL ILIAC ARTERY LIGATION - LGEN219 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 BILATERAL (SS) (GEN) # L6 LAPAROSCOPIC CARDIOMYOTOMY LGEN190 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (SS) (GEN) # L6 LAPAROSCOPIC CBD EXPLORATION LGEN184 AND SPHINCTROTOMY (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 LAPAROSCOPIC CHOLECYSTECTOMY LGEN191 FOR ACUTE CHOLECYSTITIS (SS) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 LAPAROSCOPIC CHOLECYSTECTOMY LGEN192 FOR COMPLICATED GALLSTONE L6 Surgery GENERAL SURGERY 0 23160 27570 31980 DISEASE (SS) (GEN) # L6

166 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC LGEN211 DUODENOJEJUNOSTOMY (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 LAPAROSCOPIC NEPHRECTOMY LGEN225 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 SIMPLE (SS) (GEN) # L6 LAPAROSCOPIC ORCHIDOPEXY - LGEN223 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 BILATERAL (SS) (GEN) # L6 LAPAROSCOPIC PERFORATION LGEN193 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 CLOSURE (SS) (GEN) # L6 LAPROSCOPIC CHOLECYSTECTOMY LGEN183 + CBD EXPLORATION (SS) (GEN) # L6 Surgery GENERAL SURGERY 0 23160 27570 31980 L6 LARGE BOWEL RESECTION AND LGEN221 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 ANASTOMOSIS (SS) (GEN) # L6 MELANOMA EXCISSION (SS) (GEN) LGEN231 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 MUSCLE FLAP SINGLE (SS) (GEN) LGEN229 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 MYOCUTANEOUS FLAP (SS) (GEN) LGEN230 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 OPEN SPLENECTOMY (SS) (GEN) LGEN195 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 ORCHIDECTOMY BILATERAL - OPEN/ LGEN224 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 LAPAROSCOPIC (SS) (GEN) # L6 PARTIAL PAROTIDECTOMY WITH LGEN199 FACIAL NERVE EXCISION (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 PLND - PELVIC LYMPHADECTOMY LGEN232 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (SS) (GEN) # L6 PULMONARY METASTATECTOMY LGEN233 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 UNILATERAL (SS) (GEN) # L6 RADICAL CHOLECYSTECTOMY AND LGEN234 LYMPHADENECTOMY (SS) (GEN) # L6 Surgery GENERAL SURGERY 0 23160 27570 31980 L6 SFJ LIGATION STRIPPING PERF LGEN246 LIGATION - BILATERAL (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 SIMPLE MASTECTOMY WITH/ LGEN196 WITHOUT AXILLARY LYMPHNODE L6 Surgery GENERAL SURGERY 0 23160 27570 31980 BIOPSY - BILATERAL (SS) (GEN) # L6 SINGLE INCISION LAPAROSCOPIC LGEN197 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 CHOLECYSTECTOMY (SS) (GEN) # L6 SMALL BOWEL RESECTION AND LGEN220 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 ANASTOMOSIS (SS) (GEN) # L6 SMALL BOWEL STRICTUROPLASTY LGEN237 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (MULTIPLE) (LGEN) # L6

167 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SMALL BOWEL STRICTUROPLASTY LGEN222 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (MULTIPLE) (SS) (GEN) # L6 SUBTOTAL GLOSSECTOMY (SS) LGEN236 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 SUPERFICIAL PAROTIDECTOMY WITH LGEN198 FACIAL NERVE EXCISION (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 THYROID ISTHMECTOMY (SS) (GEN) LGEN200 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 THYROID LOBECTOMY (SS) (GEN) LGEN201 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 TOTAL MASTECTOMY + SLNB (SS) LGEN202 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 TRANSANAL ENDOSCPIC LGEN239 MICROSURGERY (TEM) (SS) (GEN) L6 Surgery GENERAL SURGERY 0 23160 27570 31980 # L6 TRANSDUODENAL LGEN240 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 SPHINCTEROPLASTY (LGEN) # L6 TRANSDUODENAL LGEN210 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 SPHINCTEROPLASTY (SS) (GEN) # L6 URINARY DIVERSION PROCEDURES LGEN241 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (SS) (GEN) # L6 VARICOSE VEINS UNILATERAL (open LGEN245 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 / laser) + AVULSION (SS) (GEN) # L6 VARICSOE VEINS UNILATERAL (open LGEN228 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 / laser) + AVULSION (SS) (GEN) # L6 LGEN242 VVF REPAIR (SS) (GEN) # L6 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 WEDGE RESECTION OF LUNG (SS) LGEN244 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 (GEN) # L6 WIDE EXCISION OF SCALP TUMOR LGEN243 L6 Surgery GENERAL SURGERY 0 23160 27570 31980 RECONSTRUCTION (SS) (GEN) # L6 COLOSTOMY/ILEOSTOMY CLOSURE/ LGEN207 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 REVISION (GEN) # L6 EMERGENCY LAPAROSCOPIC APPENDECTOMY (LAPAROSCOPIC LGEN212 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 ACUTE ABDOMEN + LAPAROSCOPIC APPENDECTOMY) (GEN) # L6 EXCISION OF ABDOMINAL WALL LGEN185 LESION WITH MESH REPAIR (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290 # L6 HYSTERECTOMY WITH SALPHINGO LGEN216 - OPHERECTOMY - BILATERAL (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290 # L6 HYSTERECTOMY WITH SALPHINGO - LGEN215 OPHERECTOMY - UNILATERAL (GEN) L6 Surgery GENERAL SURGERY 0 27010 32150 37290 # L6 INGUINAL/ FEMORAL HERNIA MESH LGEN189 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 REPAIR BILATERAL (GEN) # L6

168 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group Laparoscopic Appendicectomy for LGEN420 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 Abscess/Mass (LGEN) L6 # L6 LAPAROSCOPIC HYSTERECTOMY LGEN218 WITH SALPHINGO - OPHERECTOMY L6 Surgery GENERAL SURGERY 0 27010 32150 37290 - BILATERAL (GEN) # L6 LAPAROSCOPIC HYSTERECTOMY LGEN217 WITH SALPHINGO - OPHERECTOMY L6 Surgery GENERAL SURGERY 0 27010 32150 37290 - UNILATERAL (GEN) # L6 LAPAROSCOPIC INCISIONAL HERNIA LGEN188 MESH REPAIR WITH/WITHOUT L6 Surgery GENERAL SURGERY 0 27010 32150 37290 ADHESIOLYSIS (GEN) # L6 LAPAROSCOPIC OVARIAN LGEN226 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 CYSTECTOMY BILATERAL (GEN) # L6 LAPAROSCOPIC UMBILICAL HERNIA LGEN203 MESH REPAIR WITH/WITHOUT L6 Surgery GENERAL SURGERY 0 27010 32150 37290 ADHESIOLYSIS (GEN) # L6 Laparoscopic ventral hernia repair LGEN421 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 with adhesiolysis (LGEN) L6 # L6 LAP HYSTERECTOMY WITH/WITHOUT LGEN227 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 ADHESIOLYSIS (GEN) # L6 LGEN194 LUMPECTOMY MULTIPLE (GEN) # L6 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 RE-EXPLORATION FOR INTRA- LGEN235 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 ABDOMINAL BLEEDING (GEN) # L6 THYROIDECTOMY FOR LARGE LGEN238 L6 Surgery GENERAL SURGERY 0 27010 32150 37290 MULTINODULAR GOITRE (GEN) # L6 AXILLARY CLEARANCE LEVEL I,II,III LGEN262 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 BCT/PARTIAL MASTECTOMY /WIDE LGEN247 EXCISION FOR BREAST CANCER (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 CHEST WALL RESECTION AND LGEN263 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 RECONSTRUCTION (SS) (GEN) # L7 CHOLEDOCHODUDENOSTOMY (SS) LGEN282 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 CYSTOGASTROSTOMY / LGEN248 CYSTOJEJUNOSTOMY (SS) (GEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 DUODENAL DIVERTICULIZATION LGEN266 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 PROCEDURE (SS) (GEN) # L7 DUODENAL DIVERTICULUM LGEN267 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 EXCISION (SS) (GEN) # L7 EXCISION OF INSULINOMAS (SS) LGEN275 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 EXCISION OF RETRO RECTAL TUMOR LGEN303 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 EXCISION OF SOFT TISSUE LGEN307 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 SARCOMA NECK (SS) (GEN) # L7

169 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GASTRECTOMY PARTIAL (SS) (GEN) LGEN250 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 HARTMANS PROCEDURE - OPEN LGEN251 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 HYDATID CYST - LGEN270 CYSTOPERIYSTECTOMY (SS) (GEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 HYSTERECTOMY RADICAL (SS) (GEN) LGEN272 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 ILEO INGUINAL BLOCK DISSECTION - LGEN274 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 BILATERAL (SS) (GEN) # L7 LAPAROSCOPIC ADRENALECTOMY - LGEN277 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 UNILATERAL (SS) (GEN) # L7 LAPAROSCOPIC LGEN283 CHOLEDOCHODUDENOSTOMY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LAPAROSCOPIC CYSTOGASTROSTOMY / LGEN249 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 CYSTOJEJUNOSTOMY (SS) (GEN) # L7 LAPAROSCOPIC HYDATID CYST LGEN271 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 EXCISION (SS) (GEN) # L7 LAPAROSCOPIC HYSTERECTOMY LGEN273 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 RADICAL (SS) (GEN) # L7 LAPAROSCOPIC LARGE BOWEL LGEN276 RESECTION AND ANASTOMOSIS (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LAPAROSCOPIC LATERAL LGEN286 PANCREATICO JEJUNOSTOMY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LAPAROSCOPIC LIVER ABSCESS LGEN281 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 DRAINAGE (SS) (GEN) # L7 LAPAROSCOPIC SPLENECTOMY (SS) LGEN255 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LATERAL PANCREATICO LGEN285 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 JEJUNOSTOMY (SS) (GEN) # L7 LGEN288 LOBECTOMY LUNG (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 MELANOMA EXCISION WITH LGEN290 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 RECONSTRUCTION (SS) (GEN) # L7 MODIFIED RADICAL MASTATECTOMY LGEN317 (EXCLUDING LYMPH NODE L7 Surgery GENERAL SURGERY 0 30860 36740 42620 SAMPLING) (SS) (GEN) # L7 MUSCLE FLAP MULTIPLE (SS) (GEN) LGEN289 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 OPEN ACHALASIA CARDIA LGEN287 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 OPERATION (SS) (GEN) # L7 OPEN PANCREATICO JEJUNOSTOMY LGEN284 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7

170 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group OPEN RIGHT/LEFT HEMICOLECTOMY LGEN269 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 PARTIAL PAROTIDECTOMY WITH LGEN259 FACIAL NERVE PRESERVATION (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LGEN292 PERITONECTOMY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 POST-MASTECTOMY LGEN293 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 RECONSTRUCTION (SS) (GEN) # L7 PULMONARY METASTATECTOMY LGEN294 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 BILATERAL (SS) (GEN) # L7 RADICAL HEMICOLECTOMY WITH LGEN295 LYMPHADENECTOMY (SS) (GEN) # L7 Surgery GENERAL SURGERY 0 30860 36740 42620 L7 RADICAL NECK DISSECTION (SS) LGEN296 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 RADICAL SMALL BOWEL RESECTION LGEN301 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 FOR TUMOR (SS) (GEN) # L7 RESECTION OF HEPATO-BILIARY LGEN297 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 MALIGNACIES (SS) (GEN) # L7 RETROPERITONEAL LYMPH NODE LGEN298 DISSECTION (RPLND) (SS) (GEN) # L7 Surgery GENERAL SURGERY 0 30860 36740 42620 L7 REVISION RADICAL NECK LGEN299 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 DISSECTION (SS) (GEN) # L7 RF ABLATION OF LIVER LESION (SS) LGEN300 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 SECOND LOOK LAPROTOMY (SS) LGEN304 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 SEGMENTAL RESECTION - LUNG LGEN306 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 SELECTIVE NECK DISSECTION (SS) LGEN305 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 LGEN265 SPLENORRAPHY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 SUBCUTANEOUS MASTECTOMY (SS) LGEN291 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 SUBTOTAL GASTRECTOMY (SS) LGEN257 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 SUPERFICIAL PAROTIDECTOMY WITH LGEN258 FACIAL NERVE PRESERVATION (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 SUPRA OMOHYOID NECK LGEN308 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 DISSECTION (SS) (GEN) # L7 SURGERY FOR ANAL INCONTINENCE LGEN313 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (SS) (GEN) # L7 SURGERY FOR APUDOMAS (SS) LGEN311 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7

171 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SURGERY FOR ENTEROCUTANEOUS LGEN312 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 FISTULA (SS) (GEN) # L7 SURGERY FOR OVARIAN CYST AND LGEN309 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 TUMOUR (SS) (GEN) # L7 SURGERY FOR SALIVARY GLAND LGEN310 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 TUMOURS (SS) (GEN) # L7 LGEN314 THYMECTOMY (SS) (GEN) # L7 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 TOTAL MASTECTOMY FOR BREAST CANCER WITH LEVEL 1 & 2 LGEN260 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 AXILLARY LYMPHNODE CLEARANCE (SS) (GEN) # L7 TOTAL THYROIDECTOMY FOR LGEN261 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 TUMORS (SS) (GEN) # L7 VASCULAR RESECTION AND LGEN316 L7 Surgery GENERAL SURGERY 0 30860 36740 42620 RECONSTRUCTION (SS) (GEN) # L7 VATS VIDEO ASSISTED LGEN315 THORACOSCOPY SURGERY (LGEN) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 # L7 VATS VIDEO ASSISTED LGEN264 THORACOSCOPY SURGERY (SS) L7 Surgery GENERAL SURGERY 0 30860 36740 42620 (GEN) # L7 EMERGENCY LAPAROTOMY FOR LGEN268 INTESTINAL OBSTRUCTION (GEN) L7 Surgery GENERAL SURGERY 0 36010 42870 49730 # L7 INGUINAL HERNIA - MESH REPAIR LGEN252 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 UNDER LA - BILATERAL (GEN) # L7 LAPAROSCOPIC INGUINAL/ FEMORAL LGEN253 HERNIA MESH REPAIR BILATERAL L7 Surgery GENERAL SURGERY 0 36010 42870 49730 (GEN) # L7 LAPAROSCOPIC RECTOPEXY (GEN) LGEN254 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 # L7 LAPAROSCOPIC REPAIR PROLAPSE LGEN280 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 RECTUM MESH REPAIR (GEN) # L7 PROLAPSE RECTUM REPAIR - LGEN279 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 DELORME'S PROCEDURE (GEN) # L7 PROLAPSE RECTUM REPAIR WITH/ LGEN278 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 WITHOUT MESH (GEN) # L7 LGEN256 RECTOPEXY - OPEN (GEN) # L7 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 RECTOVAGINAL FISTULA REPAIR LGEN302 L7 Surgery GENERAL SURGERY 0 36010 42870 49730 (GEN) # L7 ADRENALECTOMY BILATERAL (SS) LGEN335 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 CHOLEDOCHEL CYST EXCISION + ROUX-EN-Y LGEN318 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 HEPATICOJEJUNOSTOMY (SS) (GEN) # L8

172 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group DISTAL PANCREATECTOMY (SS) LGEN366 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 DISTAL SPLENORENAL SHUNT (SS) LGEN338 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 EMERGENCY LAPAROTOMY FOR GI LGEN340 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 BLEED (SS) (GEN) # L8 EMERGENCY LAPAROTOMY FOR LGEN341 MESENTERIC ISCHEMIA (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 ESOPHAGEAL LGEN342 REPLACEMENT(GASTRIC PULL UP) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (SS) (GEN) # L8 ESOPHAGO-GASTRIC LGEN343 DEVASCULARIZATION + L8 Surgery GENERAL SURGERY 0 38580 45930 53280 SPLENECTOMY (SS) (GEN) # L8 EXCISION OF CHEST WALL TUMO LGEN336 AND RECONSTRUCTION (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 LGEN345 FREYS PROCEDURE (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 FUNCTIONAL NECK DISSECTION (SS) LGEN344 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 HEPATICOJEJUNOSTOMY (SS) (GEN) LGEN321 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 Incision Hernia repair-open LGEN427 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 component separation # L8 INTERPOSITION PORTACAVAL SHUNT LGEN350 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (SS) (GEN) # L8 LAPAROSCOPIC ACHALASIA CARDIA LGEN359 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 OPERATION (SS) (GEN) # L8 LAPAROSCOPIC ADRENALECTOMY - LGEN352 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 BILATERAL (SS) (GEN) # L8 LAPAROSCOPIC APR/ANT LGEN358 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 RESECTION (SS) (GEN) # L8 LAPAROSCOPIC CHOLEDOCHEL CYST EXCISION + ROUX-EN-Y LGEN357 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 HEPATICOJEJUNOSTOMY (SS) (GEN) # L8 LAPAROSCOPIC COLECTOMY (SS) LGEN323 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 LAPAROSCOPIC FUNDOPLICATION LGEN324 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (SS) (GEN) # L8 LAPAROSCOPIC GASTRIC BYPASS LGEN356 PROCEDURE FOR OBESITY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 LAPAROSCOPIC LIVER RESECTION LGEN349 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 NONANATOMICAL (SS) (GEN) # L8

173 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC TV AND LGEN326 GASTROJEJUNOSTOMY (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 LAPAROSCOPIC VAGOTOMY/ LGEN325 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 GASTRIC BYPASS (SS) (GEN) # L8 LAPAROTOMY WITH MULTIPLE PROCEDURES (BLUNT AND LGEN351 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 PENETRATING INJURIES) (SS) (GEN) # L8 LIVER TRAUMA (DEBRIDEMENT/ LGEN361 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 RESECTION) (LGEN) # L8 LIVER TRAUMA (DEBRIDEMENT/ LGEN348 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 RESECTION) (SS) (GEN) # L8 MODIFIED NECK DISSECTION I & II LGEN362 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (SS) (GEN) # L8 NEPHRECTOMY PARTIAL (SS) (GEN) LGEN365 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 NONANATOMICAL LIVER RESECTION LGEN347 / LATERAL SEGMENTECTOMY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 LGEN363 OESOPHAGECTOMY (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 PANCREAS PRESERVING LGEN339 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 DUODENECTOMY (SS) (GEN) # L8 PANCREATIC NECROSECTOMY/ LGEN355 ABSCESS DRAINAGE OPEN/ L8 Surgery GENERAL SURGERY 0 38580 45930 53280 LAPAROSCOPIC (SS) (GEN) # L8 PARTIAL PANCREATECTOMY (SS) LGEN367 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 PORTA SYSTEMIC SHUNT (SS) (GEN) LGEN368 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 RADICAL SUBTOTAL GASTRECTOMY LGEN327 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (R0-R4 RNS) (SS) (GEN) # L8 RESECTION OF ANTERIOR LGEN369 ABDOMINAL TUMOR & RECON. (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 RESECTION OF RETROPERITONEAL LGEN370 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 TUMOR (SS) (GEN) # L8 REVERSAL OF HARTMANS LGEN328 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 PROCEDURE (SS) (GEN) # L8 REVISION SURGERY FOR PAROTID LGEN364 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 TUMOUR (SS) (GEN) # L8 REVISION THYROIDECTOMY / LGEN329 COMPLETION THYROIDECTOMY (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 ROUX-EN-Y LGEN371 HEPATICOJEJUNOSTOMY (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8

174 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group SILS ADVANCED PROCEDURES LGEN346 (COLECTOMY / CARDIOMYOTOMY / L8 Surgery GENERAL SURGERY 0 38580 45930 53280 FUNDOPLICATION) (SS) (GEN) # L8 SKIN SPARING/NAC SAPRING LGEN330 MASTECTOMY FOR BREAST CANCER L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (SS) (GEN) # L8 SPLENORENAL SHUNT +/- LGEN337 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 SPLENECTOMY (SS) (GEN) # L8 STAGING LAPROTOMY FOR LGEN372 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 CARCINOMA (SS) (GEN) # L8 SUBTOTAL COLECTOMY WITH LGEN375 ILEORECTAL ANASTOMOSIS (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 SURGERY FOR CARCINOMA OVARY LGEN373 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 PELVIC CONFINED (SS) (GEN) # L8 SURGERY FOR CHOLONGIO CA WITH LGEN374 HJ WITHOUT LIVER RESECTION (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 THYROIDECTOMY FOR LGEN331 RETROSTERNAL EXTENSION (SS) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 (GEN) # L8 LGEN332 TOTAL COLECTOMY (SS) (GEN) # L8 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 TOTAL MASTECTOMY FOR BREAST LGEN333 CANCER WITH LEVEL 1,2,3 AXILLARY L8 Surgery GENERAL SURGERY 0 38580 45930 53280 CLEARANCE (SS) (GEN) # L8 TOTAL THYROIDECTOMY FOR MALIGNANCY + CENTRAL LGEN334 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 COMPARTMENT LYMPHNODE DISSECTION (SS) (GEN) # L8 VARICSOE VEINS BILATERAL (open / LGEN360 L8 Surgery GENERAL SURGERY 0 38580 45930 53280 laser) + AVULSION (SS) (GEN) # L8 VIDEO ASSISTED RETROPERITONEAL LGEN376 DEBRIDEMENT (VARD) (SS) (GEN) L8 Surgery GENERAL SURGERY 0 38580 45930 53280 # L8 DIAPHRAGMATIC HERNIA LGEN319 REPAIR WITH/WITHOUT MESH - L8 Surgery GENERAL SURGERY 0 45010 53580 62150 LAPAROSCOPIC (GEN) # L8 DIAPHRAGMATIC HERNIA REPAIR LGEN320 WITH/WITHOUT MESH - OPEN (GEN) L8 Surgery GENERAL SURGERY 0 45010 53580 62150 # L8 High anterior resection (LGEN) L8 LGEN422 L8 Surgery GENERAL SURGERY 0 45010 53580 62150 # L8 INCISIONAL HERNIA MESH REPAIR LGEN322 L8 Surgery GENERAL SURGERY 0 45010 53580 62150 WITH ABDOMINOPLASTY (GEN) # L8 Laparoscopic assisted LGEN423 L8 Surgery GENERAL SURGERY 0 45010 53580 62150 Hemicolectomy (LGEN) L8 # L8

175 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAPAROSCOPIC REPAIR PROLAPSE RECTUM MESH REPAIR + LGEN354 L8 Surgery GENERAL SURGERY 0 45010 53580 62150 RESECTION ANASTOMOSIS (GEN) # L8 PROLAPSE RECTUM REPAIR WITH/ WITHOUT MESH WITH RESECTION LGEN353 L8 Surgery GENERAL SURGERY 0 45010 53580 62150 ANASTOMOSIS WITH BOWEL (GEN) # L8 ABDOMINO-PERINEAL RESECTION LGEN383 WITH TME +ANP+STOMA (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 # L9 ANTERIOR RESECTION - LOW LGEN385 ANTERIOR RESECTION LAR +TME + L9 Surgery GENERAL SURGERY 0 46300 55120 63930 ANP Laparoscopic (SS) (GEN) # L9 ANTERIOR RESECTION - LOW LGEN384 ANTERIOR RESECTION LAR +TME + L9 Surgery GENERAL SURGERY 0 46300 55120 63930 ANP (SS) (GEN) # L9 DUODENUM PRESERVING LGEN388 PANCREATECTOMY / TOTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930 PANCREATECTOMY (SS) (GEN) # L9 EXTENDED CHOLECYSTECTOMY LGEN377 (LYMPADENECTOMY + LIVER L9 Surgery GENERAL SURGERY 0 46300 55120 63930 RESECTION) (SS) (GEN) # L9 Incision Hernia repair- laparoscopy LGEN428 Surgery GENERAL SURGERY 0 46300 55120 63930 component separation LAPAROSCOPIC DISTAL LGEN391 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 PANCREATECTOMY (SS) (GEN) # L9 LAPAROSCOPIC GASTRECTOMY (SS) LGEN378 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 LAPAROSCOPIC HEPATECTOMY- LGEN393 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 ANATOMICAL (SS) (GEN) # L9 LAPAROSCOPIC OESOPHAGO LGEN390 GASTRECTOMY IVOR- LEWIS (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 LAPAROSCOPIC SPLEEN- LGEN392 PRESERVING DISTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930 PANCREATECTOMY (SS) (GEN) # L9 MAJOR HEPATATECTOMY (SS) (GEN) LGEN394 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 # L9 MAJOR SARCOMA RESECTION (SS) LGEN386 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 MEDIAN PANCREATECTOMY WITH LGEN395 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 RECONSTRUCTION (SS) (GEN) # L9 OESOPHAGECTOMY TOTAL- LGEN396 ORRINGER TRANPOSITION (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 OESOPHAGO GASTRECTOMY IVOR- LGEN389 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 LEWIS (SS) (GEN) # L9

176 GI General Surgery Sciences

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group RADICAL GASTRECTOMY D2-D4 LGEN398 LYMPHADENECTOMY (SS) (GEN) # L9 Surgery GENERAL SURGERY 0 46300 55120 63930 L9 RADICAL PAROTIDECTOMY (SS) LGEN397 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 RADICAL TOTAL GASTRECTOMY LGEN379 (R0-R4 RNS) +/- RECONSTRUCTION L9 Surgery GENERAL SURGERY 0 46300 55120 63930 POUCH (SS) (GEN) # L9 REDO-HEPATICOJEJUNOSTOMY (SS) LGEN403 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 REPAIR OF COMPLICATED BILIARY LGEN400 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 STRICTURE (SS) (GEN) # L9 RETROSTERNAL COLONIC BYPASS LGEN401 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (SS) (GEN) # L9 ROUX Y HEPATICOJEJUNOSTOMY LGEN402 FOR PORTAL BILIOPATHY (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 # L9 SILS SUPRAMAJOR (DISTAL PANCREATECTOMY/ LGEN406 CYSTOGASTRECTOMY/TOTAL L9 Surgery GENERAL SURGERY 0 46300 55120 63930 PROCTOCOLECTOMY ETC (SS) (GEN) # L9 SURGERY FOR CARCINOMA OVARY - LGEN404 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 EXTENSIVE (SS) (GEN) # L9 SURGERY FOR HILAR CHOLONGIO LGEN405 WITH LIVER RESECTION (SS) (GEN) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 # L9 THREE STAGE OESOPHAGECTOMY LGEN407 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 FOR MALIGNANCY (SS) (GEN) # L9 TOTAL PAROTIDECTOMY (SS) (GEN) LGEN380 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 # L9 TOTAL PROCTOCOLECTOMY WITH LGEN381 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 ILEOSTOMY/ POUCH (SS) (GEN) # L9 TOTAL PROCTOCOLECTOMY WITH LGEN408 POUCH ANAL ANASTOMOSIS (SS) L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (GEN) # L9 TOTAL THYROIDECTOMY FOR MALIGNANCY + UNILATERAL LGEN382 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 FUNCTIONAL NECK DISSECTION (SS) (GEN) # L9 VASCULAR TRAUMA EXPLORATION LGEN409 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 (SS) (GEN) # L9 WERTHIM'S HYSTRECTOMY LGEN410 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 RADICAL (SS) (GEN) # L9 WHIPPLE'S PANCRETO- LGEN387 L9 Surgery GENERAL SURGERY 0 46300 55120 63930 DUODENECTOMY (SS) (GEN) # L9 LGEN399 ROBOTIC SURGERY (GEN) # L9 L9 Surgery GENERAL SURGERY 0 54020 64300 74590

177 Vascular Surgery

178 Vascular Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VASCULAR SURGERY PVAS009 FOOT WEAR SUGGESTION Procedure 360 380 450 520 PROCEDURE VASCULAR SURGERY PVAS011 HALF YEARLY REVIEW Procedure 360 380 450 520 PROCEDURE VASCULAR SURGERY PVAS015 MONTHLY REVIEW Procedure 360 380 450 520 PROCEDURE VASCULAR SURGERY PVAS001 ANNUAL REVIEW Procedure 680 720 850 990 PROCEDURE VASCULAR SURGERY PVAS014 HYPERKERATOSIS Procedure 680 720 850 990 PROCEDURE VASCULAR SURGERY PVAS016 NAIL CARE Procedure 680 720 850 990 PROCEDURE VASCULAR SURGERY PVAS020 NEW PATIENT ASSESSMENT Procedure 680 720 850 990 PROCEDURE VASCULAR SURGERY PVAS003 CALLUS EXCISION Procedure 960 1010 1200 1390 PROCEDURE VASCULAR SURGERY PVAS007 DEBRIDEMENT - MINOR - PVAS Procedure 960 1010 1200 1390 PROCEDURE VASCULAR SURGERY PVAS006 DEBRIDEMENT - MAJOR Procedure 1370 1440 1720 1990 PROCEDURE VASCULAR SURGERY PVAS018 NAIL EXCISION - PARTIAL Procedure 2330 2440 2910 3370 PROCEDURE VASCULAR SURGERY PVAS002 BURSITIS Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS005 CORN EXCISION - PVAS Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS010 GANGLION EXCISION - PVAS Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS017 NAIL EXCISION - COMPLETE Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS019 NEUROMA EXCISION Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS021 SINUS EXCISION Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS022 SOFT TISSUE CYSTS Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS023 TOE AMPUTATION Procedure 4510 4740 5640 6540 PROCEDURE VASCULAR SURGERY PVAS024 STENT GRAFTING Procedure 18300 19220 22880 26530 PROCEDURE VASCULAR SURGERY PVAS004 CLAW TOE Procedure 22540 23670 28180 32690 PROCEDURE VASCULAR SURGERY PVAS008 EXOSTOSIS Procedure 22540 23670 28180 32690 PROCEDURE VASCULAR SURGERY PVAS013 HAMMER TOE Procedure 22540 23670 28180 32690 PROCEDURE

179 Vascular Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VASCULAR SURGERY PVAS012 HALLUX VALGUS Procedure 26650 27980 33310 38640 PROCEDURE LVAS001 CALLUS EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220 LVAS002 CORN EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220 LVAS003 DEBRIDEMENT-MINOR (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220 LVAS004 I & D MINOR (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220 LVAS005 NAIL EXCISION (VAS) # L1 L1 Surgery VASCULAR SURGERY 4290 4500 5360 6220 LVAS006 AMPUTATIONS TOE/DIGIT (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 LVAS007 AV FISTULA CLOSURE (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 DEBRIDEMENT-INTERMEDIATE (VAS) LVAS008 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 # L2 EXCISION OF BURSA FOR BURSITIS LVAS009 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 (VAS) # L2 LVAS010 GANGLION EXCISION (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 LVAS011 SKIN GRAFT MINOR (VAS) # L2 L2 Surgery VASCULAR SURGERY 0 8240 9810 11380 AMPUTATIONS TOE/DIGIT - LVAS012 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 MULTIPLE (VAS) # L3 AV FISTULA MINOR (SINGLE) (VAS) LVAS013 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 # L3 LVAS014 DEBRIDEMENT-MAJOR (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 EMBOLECTOMY-BRACHIAL (VAS) LVAS015 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 # L3 LVAS016 FASCIOTOMY (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 LVAS017 I & D MAJOR (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 SFJ LIGATION STRIPPING - LVAS018 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 UNILATERAL (VAS) # L3 LVAS019 SKIN GRAFT INTER (VAS) # L3 L3 Surgery VASCULAR SURGERY 0 10820 12880 14940 AMPUTATIONS FOOT/HAND (VAS) LVAS020 L4 Surgery VASCULAR SURGERY 0 14790 17610 20420 # L4 LUMBAR SYMPATHECTOMY (VAS) LVAS022 L4 Surgery VASCULAR SURGERY 0 14790 17610 20420 # L4 SFJ LIGATION STRIPPING PERF LVAS021 L4 Surgery VASCULAR SURGERY 0 14790 17610 20420 LIGATION - UNILATERAL (VAS) # L4 AMPUTATION BELOW ELBOW (VAS) LVAS023 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 AMPUTATION BELOW KNEE (LVAS) LVAS024 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 ARTERIO-VENOUS MALFORMATION LVAS025 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 MINOR (< 5 CM DIA) (VAS) # L5 AV FISTULA/GRAFT EXPLORATION LVAS027 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 (VAS) # L5

180 Vascular Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group AV FISTULA MAJOR (REDO LVAS026 SURGERIES AND MULTIPLE) (VAS) L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 AVULSION OF VENOUS LVAS028 PERFORATORS- UNILATERAL (VAS) L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 LVAS029 ELVT UNILATERAL (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 EMBOLECTOMY - FEMORAL (VAS) LVAS030 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 EMBOLECTOMY-POPLITEAL (VAS) LVAS031 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 LVAS032 GRAFT THROMBECTOMY (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 PATCH GRAFT ANGIOPLASTY (VAS) LVAS033 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 # L5 SFJ LIGATION STRIPPING - LVAS034 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 BILATERAL (VAS) # L5 LVAS035 SKIN GRAFT MAJOR (VAS) # L5 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 STRIPPING PERF LIGATION- LVAS036 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 AVULSIONS - UNILATERAL (VAS) # L5 THORACOSCOPIC SYMPATHECTOMY LVAS037 L5 Surgery VASCULAR SURGERY 0 18010 21440 24870 (VAS) # L5 AMPUTATION ABOVE KNEE (LVAS) LVAS038 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 # L6 ARTERIO-VENOUS MALFORMATION LVAS039 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 INTER (5-10 CM DIA) (VAS) # L6 LVAS040 AVGRAFT FOR DIALYSIS (VAS) # L6 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 AVULSION OF VENOUS LVAS041 PERFORATORS- BILATERAL (VAS) L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 # L6 CERVICAL RIB & RELATED LVAS042 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 PROCEDURE (VAS) # L6 EMBOLECTOMY + FASCIOTOMY LVAS043 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 (VAS) # L6 SFJ LIGATION STRIPPING PERF LVAS044 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 LIGATION - BILATERAL (VAS) # L6 VARICOSE VEINS UNILATERAL (open LVAS045 L6 Surgery VASCULAR SURGERY 0 27010 32150 37290 / laser) + AVULSION (VAS) # L6 AORTO ILIAC ENDARTERECTOMY LVAS046 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 (VAS) # L7 ARTERIO-VENOUS MALFORMATION LVAS047 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 MAJOR (> 10 CM DIA) (VAS) # L7 BYPASS TO UPPER LIMB ARTERIES LVAS048 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 (VAS) # L7 CAROTID ENDARTERECTOMY (LVAS) LVAS049 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 # L7

181 Vascular Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LVAS050 ELVT BILATERAL (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 LVAS051 FEMORO DISTAL BYPASS (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 FEMORO POPLITUL BYPASS (VAS) LVAS052 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 # L7 LVAS70 IVC Filter (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 36010 42870 49730 STRIPPING PERF LIGATION LVAS053 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 AVULSIONS - BILATERAL (VAS) # L7 SYMPETHECTOMY-CERVICAL/THO LVAS054 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 (VAS) # L7 LVAS68 Tibial Vessel Angioplasty (VAS) # L7 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 VASCULAR BYPASS/ LVAS055 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 RECONSTRUCTION (VAS) # L7 VASCULAR TRAUMA EXPLORATION LVAS056 L7 Surgery VASCULAR SURGERY 0 36010 42870 49730 E/ANGIO (VAS) # L7 AORTIC ANEURYSM ABDOMINAL LVAS057 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 (VAS) # L8 BASILIC VEIN TRANSPOSITION (VAS) LVAS058 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 # L8 LVAS059 CAROTID BODY TUMOUR (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 Multiple Vessels Angioplasty LVAS67 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 (ballooning)(VAS) # L8 LVAS060 RE DO BYPASS (VAS) # L8 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 Single Vessel angioplasty & stenting LVAS69 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 (VAS) # L8 VARICOSE VEIN BILATERAL (open / LVAS061 L8 Surgery VASCULAR SURGERY 0 45010 53580 62150 laser) + AVULSION (VAS) # L8 AORTIC ANEURYSM ABDOMINO LVAS062 L9 Surgery VASCULAR SURGERY 0 54020 64300 74590 THORACIC (VAS) # L9 AORTIC ANUERYSM COMPLICATED LVAS063 L9 Surgery VASCULAR SURGERY 0 54020 64300 74590 (RUPTURED/LEAKING) (VAS) # L9 Multiple Vessel Angioplasty & LVAS66 L9 Surgery VASCULAR SURGERY 0 54020 64300 74590 stenting (VAS) # L9 SEQUENTIAL / COMPOSITE GRAFT LVAS064 L9 Surgery VASCULAR SURGERY 0 54020 64300 74590 (VAS) # L9

182 Plastic Surgery

183 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PLASTIC SURGERY PPLS524 Dressing Small - A - PLS Procedure 130 140 160 190 PROCEDURE PLASTIC SURGERY PPLS525 Dressing Medium - B - PLS Procedure 220 230 280 320 PROCEDURE Dressing Multiple/Small-Medium PLASTIC SURGERY PPLS526 Procedure 260 270 320 370 - PLS PROCEDURE PLASTIC SURGERY PPLS527 Dressing Intermediate - PLS Procedure 380 400 480 560 PROCEDURE PLASTIC SURGERY PPLS528 Dressing Large - PLS Procedure 760 800 950 1110 PROCEDURE PLASTIC SURGERY PPLS529 Dressing Extra Large - PLS Procedure 960 1010 1200 1390 PROCEDURE PLASTIC RECONSTRUCTIVE PLASTIC SURGERY PPLS391 Procedure 1100 1150 1370 1590 SRUGERY - CAT 1 - PPLS PROCEDURE ABDOMINAL FLAP - 2ND STAGE PLASTIC SURGERY PPLS002 Procedure 1370 1440 1720 1990 DELAY OF FLAP - PPLS PROCEDURE PLASTIC SURGERY PPLS122 DEBRIDEMENT - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS133 DRESSING CHARGES - PPLS Procedure 1370 1440 1720 1990 PROCEDURE D & S FINGER INJURIES EACH - PLASTIC SURGERY PPLS120 Procedure 1370 1440 1720 1990 PPLS PROCEDURE PLASTIC SURGERY PPLS228 INCISION BIOPSY - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS229 INGROWING NAIL EXCISION - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS230 INJECTION SCLEROTHERAPY - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS231 INJECTION THERAPY KELOID - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS236 ISLET WIRING - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS239 JESS FRAME REMOVAL - PPLS Procedure 1370 1440 1720 1990 PROCEDURE PLASTIC SURGERY PPLS455 SERIAL EXCISION - MINOR - PPLS Procedure 1370 1440 1720 1990 PROCEDURE SUTURE OF WOUNDS - MINOR - PLASTIC SURGERY PPLS465 Procedure 1370 1440 1720 1990 PPLS PROCEDURE PLASTIC SURGERY PPLS521 PRS 001 Procedure 1780 1860 2220 2570 PROCEDURE PLASTIC SURGERY PPLS530 I & D - Plastic Surgery - Minor - PLS Procedure 1910 2010 2390 2770 PROCEDURE PLASTIC SURGERY PPLS532 Suturing - Minor - PLS Procedure 1910 2010 2390 2770 PROCEDURE PLASTIC SURGERY PPLS241 K WIRE EACH-PPLS Procedure 2330 2440 2910 3370 PROCEDURE

184 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PLASTIC SURGERY PPLS270 LOCAL ANASTHESIA - PPLS Procedure 2330 2440 2910 3370 PROCEDURE PLASTIC SURGERY PPLS346 NERVE BLOCK - PPLS Procedure 2330 2440 2910 3370 PROCEDURE PLASTIC RECONSTRUCTIVE PLASTIC SURGERY PPLS392 Procedure 2330 2440 2910 3370 SURGERY - CAT 2 - PPLS PROCEDURE ALOPOECIA CORR. SCALP PLASTIC SURGERY PPLS013 Procedure 2470 2590 3080 3570 REDUCTION - PPLS PROCEDURE PLASTIC SURGERY PPLS022 ARCH BAR REMOVAL - PPLS Procedure 2470 2590 3080 3570 PROCEDURE CARPAL TUNNEL DECOMPRESSION - PLASTIC SURGERY PPLS072 Procedure 2470 2590 3080 3570 MINOR - PPLS PROCEDURE CHANGE OF DRESSING - MINOR - PLASTIC SURGERY PPLS076 Procedure 2470 2590 3080 3570 PPLS PROCEDURE CORRECTION MALLET FINGER PLASTIC SURGERY PPLS107 Procedure 2470 2590 3080 3570 CONSERVATIVE - PPLS PROCEDURE PLASTIC SURGERY PPLS127 DERMABRASIONS - MINOR - PPLS Procedure 2470 2590 3080 3570 PROCEDURE PLASTIC SURGERY PPLS121 D & S MULTIPLE - PPLS Procedure 2470 2590 3080 3570 PROCEDURE PLASTIC SURGERY PPLS143 EXCISION BIOPSY - PPLS Procedure 2470 2590 3080 3570 PROCEDURE PLASTIC SURGERY PPLS174 FIELD BLOCK - PPLS Procedure 2470 2590 3080 3570 PROCEDURE PLASTIC SURGERY PPLS226 IMF & ARCH BARS - PPLS Procedure 2470 2590 3080 3570 PROCEDURE PLASTIC SURGERY PPLS436 REVISION AMPUTAION - PPLS Procedure 2470 2590 3080 3570 PROCEDURE SUTURE OF WOUNDS - MEDIUM - PLASTIC SURGERY PPLS464 Procedure 2470 2590 3080 3570 PPLS PROCEDURE PLASTIC SURGERY PPLS522 PRS 002 Procedure 2870 3010 3580 4160 PROCEDURE PLASTIC SURGERY PPLS523 PRS 003 Procedure 2870 3010 3580 4160 PROCEDURE PLASTIC RECONSTRUCTIVE PLASTIC SURGERY PPLS393 Procedure 3420 3590 4270 4960 SURGERY - CAT 3 - PPLS PROCEDURE PLASTIC SURGERY PPLS531 I & D - Plastic Surgery - Major - PLS Procedure 3700 3880 4620 5360 PROCEDURE PLASTIC SURGERY PPLS533 Suturing - Major - PLS Procedure 3700 3880 4620 5360 PROCEDURE PLASTIC SURGERY PPLS323 MINIPLATE REMOVAL - PPLS Procedure 3830 4030 4790 5560 PROCEDURE PLASTIC SURGERY PPLS437 REVISION AMPUTATION SSG - PPLS Procedure 3830 4030 4790 5560 PROCEDURE PLASTIC SURGERY PPLS498 TRIGGER FINGER - PPLS Procedure 3830 4030 4790 5560 PROCEDURE

185 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PLASTIC SURGERY PPLS070 CAPSULOTOMY - PPLS Procedure 4510 4740 5640 6540 PROCEDURE PLASTIC SURGERY PPLS106 CORN EXCISSION - PPLS Procedure 4510 4740 5640 6540 PROCEDURE PLASTIC SURGERY PPLS173 FAT GRAFTS - PPLS Procedure 4510 4740 5640 6540 PROCEDURE KOLLAGEN APPLICATION MINOR - PLASTIC SURGERY PPLS246 Procedure 4510 4740 5640 6540 PPLS PROCEDURE LAGOPHTHALMOUS CORRECTION PLASTIC SURGERY PPLS249 Procedure 4510 4740 5640 6540 - PPLS PROCEDURE PLASTIC SURGERY PPLS476 TENOSINOVITIS EXCISSION - PPLS Procedure 4510 4740 5640 6540 PROCEDURE PLASTIC SURGERY PPLS514 WOUND DRESSING MINOR Procedure 4510 4740 5640 6540 PROCEDURE ARTHRODESIS EACH FINGER JOINT PLASTIC SURGERY PPLS028 Procedure 4930 5170 6160 7140 - PPLS PROCEDURE HAIR TRANSPLANT EACH SITTING PLASTIC SURGERY PPLS210 Procedure 4930 5170 6160 7140 - PPLS PROCEDURE PLASTIC SURGERY PPLS329 NAIL GRAFTING - PPLS Procedure 4930 5170 6160 7140 PROCEDURE PTOSIS CORRECTION - MINOR - PLASTIC SURGERY PPLS421 Procedure 4930 5170 6160 7140 PPLS PROCEDURE SUTURE OF WOUNDS - MAJOR - PLASTIC SURGERY PPLS463 Procedure 4930 5170 6160 7140 PPLS PROCEDURE PLASTIC SURGERY PPLS454 SERIAL EXCISION - MAJOR - PPLS Procedure 5190 5450 6490 7530 PROCEDURE PLASTIC SURGERY PPLS265 LIPO INJECTION MINOR - PPLS Procedure 5610 5890 7010 8130 PROCEDURE PLASTIC SURGERY PPLS362 NEUROLYSIS MINOR - PPLS Procedure 5610 5890 7010 8130 PROCEDURE PLASTIC SURGERY PPLS172 FASCIOTOMY MINOR - PPLS Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS197 GANGLION EXCISSION - PPLS Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS302 MEATOPLASTY Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS469 TATOOING - PPLS Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS513 WOUND DRESSING MAJOR - PPLS Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS517 Z-PLASTY MINOR - PPLS Procedure 6700 7030 8370 9710 PROCEDURE PLASTIC SURGERY PPLS115 CROSS FINGER FLAP - PPLS Procedure 7390 7760 9230 10710 PROCEDURE EARLOBE SEPARATION REPAIRS - PLASTIC SURGERY PPLS137 Procedure 7650 8030 9560 11090 PPLS PROCEDURE

186 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PLASTIC SURGERY PPLS001 ABBE FLAP - PPLS Procedure 7930 8320 9910 11490 PROCEDURE ALOPECIA (BALDNESS/SCALP) HAIR PLASTIC SURGERY PPLS010 Procedure 7930 8320 9910 11490 TSPT-INTER - PPLS PROCEDURE PLASTIC SURGERY PPLS017 AMPUTATIONS (EACH DIGIT) Procedure 7930 8320 9910 11490 PROCEDURE PLASTIC SURGERY PPLS023 ARCHBAR - PPLS Procedure 7930 8320 9910 11490 PROCEDURE ARCHBAR WIRING (SEC PLASTIC SURGERY PPLS024 Procedure 7930 8320 9910 11490 MANDIBULAR) - PPLS PROCEDURE CARPAL TUNNEL DECOMPRESSION - PLASTIC SURGERY PPLS071 Procedure 7930 8320 9910 11490 INTER - PPLS PROCEDURE CHANGE OF DRESSING - INTER - PLASTIC SURGERY PPLS075 Procedure 7930 8320 9910 11490 PPLS PROCEDURE PLASTIC SURGERY PPLS098 COLUMELLA LENGTHENING - PPLS Procedure 7930 8320 9910 11490 PROCEDURE COMMISSUROTOMY PLASTIC SURGERY PPLS099 Procedure 7930 8320 9910 11490 RECONSTRCTION - PPLS PROCEDURE EYELID REPAIR ECTROPION - INTER PLASTIC SURGERY PPLS152 Procedure 7930 8320 9910 11490 - PPLS PROCEDURE FACIAL INJURIES SOFT TISSUE - PLASTIC SURGERY PPLS158 Procedure 7930 8320 9910 11490 INTER - PPLS PROCEDURE PLASTIC SURGERY PPLS242 KELOID/HYPER EX WITH SSG - PPLS Procedure 7930 8320 9910 11490 PROCEDURE PLASTIC SURGERY PPLS459 SSG SMALL - PPLS Procedure 7930 8320 9910 11490 PROCEDURE PLASTIC SURGERY PPLS494 TRACHEOSTOMY - PPLS Procedure 7930 8320 9910 11490 PROCEDURE PLASTIC SURGERY PPLS520 Z-PLASTY SINGLE - PPLS Procedure 7930 8320 9910 11490 PROCEDURE PLASTIC SURGERY PPLS148 EXCISSIONAL DEBREDIMENT - PPLS Procedure 8740 9180 10930 12680 PROCEDURE PLASTIC SURGERY PPLS444 ROTATION FLAP - PPLS Procedure 8740 9180 10930 12680 PROCEDURE PLASTIC SURGERY PPLS097 COLOBOMA - PPLS Procedure 9020 9470 11270 13080 PROCEDURE PLASTIC SURGERY PPLS128 DERMAL GRAFT - PPLS Procedure 9020 9470 11270 13080 PROCEDURE PLASTIC SURGERY PPLS511 W PLASTY-PPLS Procedure 9020 9470 11270 13080 PROCEDURE PLASTIC SURGERY PPLS449 SCAR EXCISION - PPLS Procedure 9300 9760 11620 13480 PROCEDURE CHELIOPLASTY AUGMENTATION - PLASTIC SURGERY PPLS079 Procedure 11210 11770 14010 16250 PPLS PROCEDURE PLASTIC SURGERY PPLS171 FASCIOTOMY MAJOR - PPLS Procedure 11210 11770 14010 16250 PROCEDURE

187 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GLOMOUS TUMOUR EXCISSION - PLASTIC SURGERY PPLS201 Procedure 11210 11770 14010 16250 PPLS PROCEDURE PLASTIC SURGERY PPLS518 Z-PLASTY MODERATE - PPLS Procedure 11210 11770 14010 16250 PROCEDURE PTOSIS CORRECTION - MAJOR - PLASTIC SURGERY PPLS420 Procedure 12020 12620 15030 17430 PPLS PROCEDURE PLASTIC SURGERY PPLS060 BROW LIFT - PPLS Procedure 12300 12910 15370 17830 PROCEDURE PLASTIC SURGERY PPLS258 LIP AUGMENTATION - PPLS Procedure 13390 14060 16740 19410 PROCEDURE PLASTIC SURGERY PPLS260 LIP LIFT - PPLS Procedure 13390 14060 16740 19410 PROCEDURE PLASTIC SURGERY PPLS361 NEUROLYSIS MAJOR - PPLS Procedure 13390 14060 16740 19410 PROCEDURE PLASTIC SURGERY PPLS386 PERFORATOR FLAP - PPLS Procedure 13390 14060 16740 19410 PROCEDURE CHEEK RECONSTRUCTION MINOR PLASTIC SURGERY PPLS078 Procedure 14350 15060 17930 20800 - PPLS PROCEDURE ALOPECIA (BALDNESS/SCALP) HAIR PLASTIC SURGERY PPLS011 Procedure 15710 16500 19640 22780 TSPT-MAJOR - PPLS PROCEDURE PLASTIC SURGERY PPLS069 CANTHOPLASTY - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS080 CHELIOPLASTY REDUCTION - PPLS Procedure 15710 16500 19640 22780 PROCEDURE CHIN AUGMENTATION IMPLANT - PLASTIC SURGERY PPLS084 Procedure 15710 16500 19640 22780 PPLS PROCEDURE DEGLOVING INJURIES OF LIMBS & PLASTIC SURGERY PPLS123 Procedure 15710 16500 19640 22780 RECONS. MAJOR - PPLS PROCEDURE PLASTIC SURGERY PPLS151 EYELID MINOR REPAIR - PPLS Procedure 15710 16500 19640 22780 PROCEDURE EYELID REPAIR ENTROPION - MAJOR PLASTIC SURGERY PPLS153 Procedure 15710 16500 19640 22780 - PPLS PROCEDURE PLASTIC SURGERY PPLS238 JESS FRAME APPLICATION - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS259 LIP DOUBLE - PPLS Procedure 15710 16500 19640 22780 PROCEDURE MILLARDS PROCEDURE UNILATERAL PLASTIC SURGERY PPLS322 Procedure 15710 16500 19640 22780 - PPLS PROCEDURE SCAR EXCISION & CONTRACTURE PLASTIC SURGERY PPLS450 Procedure 15710 16500 19640 22780 SSG - PPLS PROCEDURE SCARS DERMABRASION - MINOR PLASTIC SURGERY PPLS453 Procedure 15710 16500 19640 22780 - PPLS PROCEDURE PLASTIC SURGERY PPLS458 SSG MOD - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS471 TENDON - REPAIR - PRIMARY - PPLS Procedure 15710 16500 19640 22780 PROCEDURE

188 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PLASTIC SURGERY PPLS487 TISSUE EXPANDOR REMOVAL - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS510 V-Y-FLAP - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS515 Y-V PLASTY - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS516 Z-PLASTY MAJOR - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS519 Z-PLASTY MULTIPLE - PPLS Procedure 15710 16500 19640 22780 PROCEDURE PLASTIC SURGERY PPLS055 BRACHIOPLASTY - PPLS Procedure 17760 18650 22200 25750 PROCEDURE BLEPHAROPLASTY (SEC EYELIDS) PLASTIC SURGERY PPLS040 Procedure 18450 19370 23060 26750 UNILATERAL - PPLS PROCEDURE PLASTIC SURGERY PPLS451 SCAR MAJOR - PPLS Procedure 18450 19370 23060 26750 PROCEDURE PLASTIC SURGERY PPLS452 SCAR REVISION - PPLS Procedure 18450 19370 23060 26750 PROCEDURE PLASTIC SURGERY PPLS264 LIPO INJECTION MAJOR - PPLS Procedure 22540 23670 28180 32690 PROCEDURE CHEEK RECONSTRUCTION MAJOR PLASTIC SURGERY PPLS077 Procedure 27330 28700 34160 39620 - PPLS PROCEDURE ALARBASE RECONSTRUCTIONS - PLASTIC SURGERY PPLS007 Procedure 31420 32990 39280 45560 BILATERAL - PPLS PROCEDURE ALOPECIA (BALDNESS/SCALP) HAIR PLASTIC SURGERY PPLS012 Procedure 31420 32990 39280 45560 TSPT-SUPRA - PPLS PROCEDURE AUGMENTATION WITH IMPLANT PLASTIC SURGERY PPLS031 Procedure 31420 32990 39280 45560 BICOST OF IMPLANT ETC - PPLS PROCEDURE BLEPHAROPLASTY (SEC EYELIDS) PLASTIC SURGERY PPLS039 Procedure 31420 32990 39280 45560 BILATERAL - PPLS PROCEDURE PLASTIC SURGERY PPLS088 CLEFT LIP & PALATE - PPLS Procedure 31420 32990 39280 45560 PROCEDURE F.T.GRAFT FULL THICKNESS GRAFT PLASTIC SURGERY PPLS156 Procedure 31420 32990 39280 45560 - PPLS PROCEDURE MILLARDS PROCEDURE BILATERAL PLASTIC SURGERY PPLS321 Procedure 31420 32990 39280 45560 - PPLS PROCEDURE PLASTIC SURGERY PPLS267 LIPO SCULPTION MINOR - PPLS Procedure 34160 35870 42700 49530 PROCEDURE PLASTIC SURGERY PPLS266 LIPO SCULPTION MAJOR - PPLS Procedure 45080 47340 56350 65370 PROCEDURE LPLS001 ARCH BAR REMOVAL (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 LPLS002 CORN EXCISSION (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 CORRECTION MALLET FINGER LPLS003 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 CONSERVATIVE (LPLS) # L1 LPLS004 DEBRIDEMENT (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220

189 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group DEBRIDEMENT & SUTURING - ONE LPLS005 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 FINGER (LPLS) # L1 DERMABRASIONS - MINOR (LPLS) LPLS006 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 # L1 EAR LOBE REPAIR UNILATERAL LPLS007 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 (LPLS) # L1 LPLS008 I & D MINOR (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 LPLS009 INCISION BIOPSY (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 INGROWING NAIL EXCISION (LPLS) LPLS010 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 # L1 INJECTION SCLEROTHERAPY (LPLS) LPLS011 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 # L1 INJECTION THERAPY KELOID - LPLS012 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 SINGLE AREA (LPLS) # L1 LPLS013 LOCAL ANASTHESIA (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 LPLS014 NERVER BIOPSY (LPLS) # L1 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 SUTURE OF WOUNDS - MINOR LPLS015 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 (LPLS) # L1 WOUND DRESSING - MINOR (LPLS) LPLS016 L1 Surgery PLASTIC SURGERY 4290 4500 5360 6220 # L1 ABDOMINAL FLAP - 2ND STAGE LPLS017 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 DELAY OF FLAP (LPLS) # L2 ARCHBAR WIRING - SINGLE JAW LPLS018 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 ARTERY/NERVE/MUSCLE BIOPSY LPLS019 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 DEBRIDEMENT AND SUTURRING - LPLS021 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 SMALL (LPLS) # L2 DEBRIDEMENT & SUTURING - TWO LPLS020 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 FINGERS (LPLS) # L2 DERMABRASIONS - INTER (LPLS) LPLS022 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 DIGITAL NERVE REPAIR SINGLE LPLS023 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 EAR LOBE REPAIR BILATERAL (LPLS) LPLS024 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 LPLS025 ESCHARECTOMY MINOR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 EXCISION WITH PRIMARY SUTURING LPLS026 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 FACIAL INJURIES SOFT TISSUE - LPLS027 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 MINOR (LPLS) # L2 LPLS028 FASCIOTOMY MINOR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 LPLS029 FAT GRAFTS (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380

190 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group FINGER TIP INJURY - SINGLE (LPLS) LPLS030 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 FOREIGN BODY REMOVAL (LPLS) LPLS031 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 LPLS032 FRENULOPLASTY (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 HEMATOMA EVACUATION (LPLS) # LPLS033 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 L2 IMPLANT REMOVAL SINGLE (LPLS) LPLS034 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 INJECTION THERAPY KELOID - LPLS035 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 MULTIPLE AREAS (LPLS) # L2 INTR. FIX .METACARPAL PHALANX K LPLS036 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 WIRE - SINGLE (LPLS) # L2 LPLS037 ISLET WIRING (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 LPLS038 JESS FRAME REMOVAL (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 KOLLAGEN APPLICATION MINOR LPLS039 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 LPLS040 NAIL BED REPAIR (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 LPLS041 NERVE BLOCK (LPLS) # L2 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 PRESSURE SORE EXCISION LPLS042 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 EXCLUDING REPAIR (LPLS) # L2 REVISION AMPUTAION - SINGLE LPLS043 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 SERIAL EXCISION - MINOR (LPLS) LPLS044 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 SUTURE OF WOUNDS - MEDIUM LPLS045 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 TENOSINOVITIS EXCISSION (LPLS) LPLS046 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 # L2 WOUND DRESSING - INTERMEDIATE LPLS047 L2 Surgery PLASTIC SURGERY 0 8240 9810 11380 (LPLS) # L2 ALOPOECIA CORRECTION BY SCALP LPLS048 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 REDUCTION (LPLS) # L3 ARCHBAR WIRING - DOUBLE JAW LPLS049 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 LPLS050 ARTHRODESIS MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 ARTHRODESIS SINGLE FINGER LPLS051 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 JOINT (LPLS) # L3 BONE GRAFTS (AS ADJUVANT LPLS052 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 PROCEDURE) - SMALL (LPLS) # L3 CARPAL TUNNEL DECOMPRESSION - LPLS053 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 UNILATERAL (LPLS) # L3 LPLS054 CARTILAGE GRAFTS (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940

191 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CORRECTIVE OSTEOTOMY EACH LPLS055 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 FINGER (LPLS) # L3 LPLS056 CYST/FISTULA EXCISION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 EXCISION WITH GRAFTING (LPLS) LPLS057 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 # L3 LPLS058 EYELID REPAIR MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 FIXATION OF FRACTURE LPLS059 METACARPAL AND PHALYNGES - L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 SINGLE (LPLS) # L3 FOREIGN BODY GRANULOMA LPLS060 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 EXCISSION (LPLS) # L3 LPLS061 GANGLION EXCISSION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS062 I & D MAJOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 INTR. FIX .METACARPAL PHALANX K LPLS063 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 WIRE - TWO FINGERS (LPLS) # L3 JESS FRAME APPLICATION MINOR LPLS064 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 KELOID/HYPERTROPHIC SCAR LPLS066 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 EXCISION WITH SSG (LPLS) # L3 K WIRE INCLUDING CLOSED LPLS065 REDUCTION AND CAST APPLICATION L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 LPLS067 MEATOPLASTY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 MEDIAN NERVE DECOMPRESSION LPLS068 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 LPLS069 NAIL BED GRAFTING (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 NASAL BONE FRACTURE REDUCTION LPLS070 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 NECROTISING FASCIATIS MINOR LPLS071 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 NERVE ENTRAPMENT RELEASE LPLS072 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 LPLS073 NERVE REPAIR SINGLE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS074 NEUROMA EXCISSION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS075 OTOPLASTY STAGE III (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS076 POLYDACTYLY SIMPLE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 POST MASTECTOMY LPLS077 RECONSTRUCTION - NIPPLE (LPLS) L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 # L3 PRESSURE SORES LPLS078 RECONSTRUCTION MINOR (LPLS) L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 # L3 LPLS079 REGIONAL BLOCK (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940

192 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group REVISION AMPUTATION SSG - LPLS080 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 SINGLE (LPLS) # L3 LPLS081 SCAR EXCISION (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS082 SSG SMALL (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS083 TARSORRAPHY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LCOS001 TATOOING (LCOS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 TISSUE EXPANDERS INSERTION - LPLS084 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 SMALL (LPLS) # L3 LPLS089 TRIGGER FINGER (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS085 VERRUCAE (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS086 Y-V PLASTY (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 LPLS087 Z-PLASTY MINOR (LPLS) # L3 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 ZYGOMA CLOSED REDUCTION LPLS088 L3 Surgery PLASTIC SURGERY 0 10820 12880 14940 (LPLS) # L3 LPLS090 ABBE FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS091 AMPUTATION FOOT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS092 AMPUTATION HAND (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS093 APPROACH OSTEOTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 AREOLA NIPPLE RECONSTRUCTION LPLS094 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS095 A-V FISTILA (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 BOUTENIERE DEFORMITY LPLS096 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 CORRECTION (LPLS) # L4 CAMPTODACTYLY UNILATERAL LPLS097 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS098 CANTHOPLASTY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS099 CAPSULOTOMY - JOINT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 CHEEK RECONSTRUCTION MINOR LPLS100 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 CLEFT LIP NASAL DEFORMITY LPLS101 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 PRIMARY CORRECTION (LPLS) # L4 CLEFT PALATE - ANTERIOR (LPLS) LPLS102 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 COLUMELLA LENGTHENING (LPLS) LPLS103 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 COMMISSURE RECONSTRUCTION LPLS104 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS105 CONJUNCTIVAL FLAPS (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS106 CROSS FINGER FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 DEBRIDEMENT AND SUTURRING - LPLS108 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 INTERMEDIATE (LPLS) # L4

193 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group DEBRIDEMENT & SUTURING - LPLS107 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 MULTIPLE FINGERS (LPLS) # L4 DERMABRASIONS - MAJOR (LPLS) LPLS109 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 LPLS110 DERMAL GRAFT (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS111 DERMOID EXCISION (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 DISTRACTION OSTEOTOMIES MINOR LPLS112 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 DUPUYTRENS UNILATERAL (LPLS) LPLS113 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 EARLOBE SEPARATION REPAIRS LPLS114 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS115 ESCHARECTOMY MAJOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 EXCISION WITH LOCAL FLAP (LPLS) LPLS116 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 EXCISSIONAL DEBREDIMENT (LPLS) LPLS117 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 EYELID REPAIR ECTROPION - LPLS118 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 INCLUDING GRAFT/FLAP (LPLS) # L4 FACIAL INJURIES SOFT TISSUE - LPLS119 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 INTER (LPLS) # L4 LPLS120 FASCIOTOMY MAJOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 FINGER JOINT REPLACEMENT LPLS121 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 SINGLE (LPLS) # L4 FINGER TIP INJURY - MULTI (LPLS) LPLS122 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 LPLS123 FLAPS LOCAL FLAP (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 FTG UPTO 9 SQUARE CENTIMETER LPLS124 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 IN AREA (LPLS) # L4 GYNAECOMASTIA UNILATERAL LCOS002 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LCOS) # L4 LPLS125 HEMANGIOMAS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 HYMEN RECONSTRUCTION (LPLS) LPLS126 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 HYPOSPADIAS CORRECTION STAGE I LPLS127 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 IMPLANT REMOVAL MULTIPLE LPLS128 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 INTERPHALANGEAL JOINT LPLS129 RECONSTRUCTION EACH (LPLS) # L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 L4 INTR. FIX .METACARPAL PHALANX LPLS130 K WIRE - MULTIPLE FINGERS (LPLS) L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4

194 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group KELOID/HYPERTROPHIC SCAR - LPLS131 INTRA LESIONAL EXCISION (LPLS) L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 KOLLAGEN APPLICATION MAJOR LPLS132 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LAGOPHTHALMOUS CORRECTION LPLS133 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS134 LATERAL RHINOTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS135 LUMPECTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 MANDIBLE FRACTURE FIXATION LPLS136 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 WIRE/SCREW (LPLS) # L4 MAXILLA # RECONSTRUCTION LE- LPLS137 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 FORT - I -UNILATERAL (LPLS) # L4 MELANOCYTE GRAFT - SMALL LPLS138 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 MENNGOCOELE CORRECTIVE LPLS139 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 SURGERY (LPLS) # L4 METCARPOPHALENGEAL JOINT ORIF LPLS140 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 NERVE REPAIR DIGITAL MULTIPLE LPLS141 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS142 NERVE TRANSPOSITION (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS143 NEUROLYSIS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 ORAL COMMISSURE LPLS144 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 COMMISUROPLASTY (LPLS) # L4 LPLS145 OTOPLASTY STAGE II (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS146 PERIOSTEOPLASTY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS147 PLATE REMOVAL (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 POLYDACTYLY EXCISION - MINOR LPLS148 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 PTOSIS CORRECTION - UNILATERAL LPLS149 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 RECONSTRUCTION OF LIP LOCAL LPLS150 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 FLAP (LPLS) # L4 RE-EXPLORATION OF FLAPS (LPLS) LPLS151 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 REVISION AMPUTATION MULTI (LPLS) LPLS152 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 SKIN GRAFTS AS ADJUVANT LPLS153 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 PROCEDURE (LPLS) # L4 SUBMANDIBULAR GLAND EXCISION LPLS154 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS156 TENDON GRAFT EACH (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420

195 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TENDON - REPAIR - PRIMARY (LPLS) LPLS155 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 TENDON TRANSFER SINGLE (LPLS) LPLS157 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 TISSUE EXPANDOR INSERTION - LPLS158 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 FINAL INSET - SMALL (LPLS) # L4 LPLS159 TRACHEOSTOMY (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS160 TRANSNASAL WIRING (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 LPLS161 TUBE FLAPS MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 UMBILICAL HERNIA MESH REPAIR LPLS162 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 LPLS163 VOMER FLAPS (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 WEBBING CORRCTION SURGERIES LPLS165 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 (LPLS) # L4 WOUND DRESSING - MAJOR (LPLS) LPLS166 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 # L4 LPLS164 W PLASTY - MINOR (LPLS) # L4 L4 Surgery PLASTIC SURGERY 0 14790 17610 20420 ALARBASE RECONSTRUCTIONS - LPLS167 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 UNILATERAL (LPLS) # L5 ALARBASE RESECTIONS CLEFT LIP LPLS168 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 DEFORMITY (LPLS) # L5 ALOPECIA HAIR TSPT-MINOR (LPLS) LPLS169 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 ALVEOLUS ANTERIOR PALATE LPLS170 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 REPAIR - UNILATERAL (LPLS) # L5 LPLS171 AMPUTATION FOREARM (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 ANGLE FRACTURE UNILATERAL LPLS172 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 LPLS173 ANKYLOSIS HAND (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 ARTHRODESIS MULTI FINGER JOINT LPLS174 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 ARTHROPLASTY SINGLE JOINT LPLS175 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 BELOW ELBOW/ ABOVE ELBOW LPLS176 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 AMPUTATION (LPLS) # L5 BONE GRAFTS (AS ADJUVANT LPLS177 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 PROCEDURE) - LARGE (LPLS) # L5 LPLS178 CABLE GRAFTS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 CARPAL TUNNEL DECOMPRESSION - LPLS179 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 BILATERAL (LPLS) # L5 CLEFT LIP - INCOMPLETE (LPLS) LPLS180 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 CLEFT PALATE - FISTULA (LPLS) # LPLS181 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 L5

196 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LPLS182 COLOBOMA REPAIR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 COMPOSITE GRAFTS MINOR (LPLS) LPLS183 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 CORRECTIVE OSTEOTOMY MULTI LPLS184 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 FINGER (LPLS) # L5 CROSS FACIAL NERVE GRAFT (LPLS) LPLS185 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 CROSS NERVE TRANSFER (LPLS) LPLS186 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 CUP EAR CORRECTIONS UNILATERAL LPLS187 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 DEGLOVING INJIRIES DEBRIDEMENT LPLS188 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 DISTRACTION OSTEOTOMIES LPLS189 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 MAJOR (LPLS) # L5 DOUBLE LIP CORRECTION (LCOS) LCOS003 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 DOUBLE OPPOSING ZEEPLASTY LPLS190 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 DUPUYTRENS CORRECTION WITH LPLS191 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 GRAFT (LPLS) # L5 EARLOBE RECONSTRUCTIONS WITH LPLS192 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 FLAP (LPLS) # L5 EXCISION OF MALIGNENT LESION LPLS193 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 EXCISION WITH REGIONAL FLAP LPLS194 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 EXTERNAL AUDITORY CANAL LPLS195 RECONSTRUCTION SSG FLAP (LPLS) L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 EYELID REPAIR ENTROPION - LPLS196 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 INCLUDING GRAFT/FLAP (LPLS) # L5 LPLS197 EYELID REPAIR MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS198 EYELID REPAIR TUMORS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS199 FASCIAL FLAPS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 FOOT FLAPS MUSCLE FLAPS (LPLS) LPLS200 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 FRACTURE MAXILLA - INTERNAL LPLS201 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 FIXATION (LPLS) # L5 LPLS202 FRONTALIS SLING (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS203 GALEAL FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LCOS004 GENIOPLASTY IMPLANT (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 GILLIES ELEVATION OF ARCH (LPLS) LPLS204 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5

197 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group GYNAECOMASTIA LIPOEXCISION LCOS005 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 UNILATERAL (LCOS) # L5 HAND DEFORMITY CORRECTION LPLS205 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 MINOR (LPLS) # L5 HAND INJURY ONE SURFACE (LPLS) LPLS206 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 HYPOSPADIAS CORRECTION STAGE LPLS207 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 III (LPLS) # L5 LPLS208 IMF & ARCH BARS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 JESS FRAME APPLICATION LPLS209 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 INTERMEDIATE (LPLS) # L5 LCOS006 LIP AUGMENTATION (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LCOS007 LIPO INJECTION MINOR (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LOCAL ONCOPLASTY LEVEL I (UPTO LPLS210 20 % VOLUME OF BREAST) (LPLS) L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 MALLET FINGER CORRECTION LPLS211 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 MAXILLA # RECONSTRUCTION LE- LPLS212 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 FORT - I -BILATERAL (LPLS) # L5 MAXILLA RECONSTRUCTION MINOR LPLS213 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 LCOS008 MELANOCYTE GRAFT (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 MELANOMA-EX-CLOSURE SSG LPLS214 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 LPLS215 MENINGO MYELOCELE (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 METCARPOPHALENGEAL JOINT LPLS216 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 ORTHOPLASTY SINGLE (LPLS) # L5 METCARPOPHALENGEAL JOINT LPLS217 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 REPLACEMENT SINGLE (LPLS) # L5 NASAL BONE #/RECONSTRUCTION LPLS218 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 NASAL RECONSTRUCTION MINOR LPLS219 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 NECROTISING FASCITIS MAJOR LPLS220 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 LPLS221 NEO-URETHRA I (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 NERVE REPAIR INCLUDING LPLS222 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 GRAFTING (LPLS) # L5 NERVE REPAIR MULTIPLE (LPLS) # LPLS223 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 L5 NIPPLE AREOLA RECONSTRUCTION LPLS224 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 MAJOR (LPLS) # L5 LPLS225 ORO NASAL FISTULA (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870

198 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group PAROTID GLAND - EXCISION (LPLS) LPLS226 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 LPLS227 PERFORATOR FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS228 PERICRANIL FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 PILONIDAL SURGERY WITH Z PLASTY LPLS229 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 POLYDACTYLY EXCISION - MAJOR LPLS230 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 PRESSURE SORES LPLS231 RECONSTRUCTION MODERATE L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 REVASCULIRAZATION FINGER MINOR LPLS232 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 REVISION AMPUTATION SSG - MULTI LPLS233 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 LPLS234 RHINOPHYMA (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 SAGITAL SPLIT OSTEOTOMY LPLS235 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 UNILATERAL (LPLS) # L5 SCALP FLAPS JURI FLAPS (LPLS) LPLS236 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 LCOS025 SCAR REVISION (LCOS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 SERIAL EXCISION - MAJOR (LPLS) LPLS237 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5 LPLS238 SPASTICITY RELEASE (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS239 SSG MOD (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 SUTURE OF WOUNDS - LARGE LPLS240 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 SWAN NECK DEFORMITY LPLS241 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 CORRECTION (LPLS) # L5 SYNDACTYLY - SIMPLE (SINGLE) LPLS242 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 THUMB RECONSTRUCTION MINOR LPLS243 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 (LPLS) # L5 TISSUE EXPANDER INSERTION - LPLS244 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LARGE (LPLS) # L5 LPLS245 TONGUE FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS246 TORTICOLLIS (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS247 TRANSPOSITION FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS248 V-Y-FLAP (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS249 W PLASTY - MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 LPLS250 Z-PLASTY MAJOR (LPLS) # L5 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 ZYGOMA FRACTURE ORIF (LPLS) LPLS251 L5 Surgery PLASTIC SURGERY 0 18010 21440 24870 # L5

199 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group ALVEOLUS ANTERIOR PALATE LPLS252 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 REPAIR - BILATERAL (LPLS) # L6 ANGLE FRACTURE BILATERAL (LPLS) LPLS253 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 ARTERIO-VENOUS MALFORMATION LPLS254 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 MINOR (LPLS) # L6 LPLS255 ARTHRODESIS MOJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 AUGMENTATION MAMMOPLASTY LCOS009 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 UNILATERAL (LCOS) # L6 LPLS256 AXIAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 BELOW KNEE/ABOVE KNEE LPLS257 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 AMPUTATIONS (LPLS) # L6 BLEPHAROPLASTY UNILATERAL LCOS010 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LCOS) # L6 BOUTINERRE DEFORMITY LPLS258 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CORRECTION (LPLS) # L6 BRACHIOPLASTY - UNILATERAL LCOS011 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LCOS) # L6 BREAST RECONSTRUCTION MINOR LPLS259 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 CARPAL TUNNEL RELEASE WITH LPLS260 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 NEUROLYSIS (LPLS) # L6 CERVICAL RIB OPERATION (LPLS) LPLS261 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 CHEEK RECONSTRUCTION MAJOR LPLS262 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 CHELIOPLASTY AUGMENTATION LPLS263 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 CHELIOPLASTY REDUCTION (LCOS) LCOS012 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 CHIN AUGMENTATION IMPLANT LCOS013 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LCOS) # L6 CHIN AUGMENTATION WITH LCOS014 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CARTILAGE (LCOS) # L6 LCOS015 CHIN REDUCTION (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CLEFT LIP SCAR REVISIONS (LPLS) LPLS265 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 LPLS264 CLEFT LIP - UNILATERAL (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS266 CLEFT OF SOFT PALATE (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CLEFT PALATE - SECONDARY (LPLS) LPLS267 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 CLEFT PALATE - UNILATERAL (LPLS) LPLS268 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 CONTRACTURES RELEASE WITH SSG LPLS269 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6

200 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CUT FISTULA HYPOSPADIAS LPLS270 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CORRECTION (LPLS) # L6 CYSTIC HYGROMA EXCISION - LPLS271 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SMALL (LPLS) # L6 DEBRIDEMENT AND SUTURRING - LPLS272 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LARGE (LPLS) # L6 DEGLOVING INJURIES OF LIMBS & LPLS273 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 RECONS. MAJOR (LPLS) # L6 LPLS274 DELTOPECTORAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS275 DISTANT FLAP - DELAY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 DISTRACTION OSTEOGENESIS (LPLS) LPLS276 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 DUPUYTRENS BOTH HANDS (LPLS) LPLS277 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 FACIAL NERVE PRIMARY REPAIR LPLS278 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 FINGER REPLANTATION NAIL BED LPLS279 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 FIXATION OF FRACTURE LPLS280 METACARPAL AND PHALYNGES - L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 MULTIPLE (LPLS) # L6 FOOT FLAPS FASCIOCUTANEOUS LPLS281 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS282 FORE HEAD FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 FORE HEAD RECONSTRUCTION LPLS283 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 FRACTURE MANDIBLE OPEN LPLS284 REDUCTION/INTERNAL FIATION L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 FTG OVER 9 SQUARE CM IN AREA LPLS285 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 GASTRONEMIOUS MUSCLE FLAP LPLS286 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 GLOMOUS TUMOUR EXCISSION LPLS287 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 'GLUTEAL LATERAL ,MEDIAL, THIGH LCOS016 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 PLASTY MINOR (LCOS) ' # L6 LPLS288 GROIN FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 GYNAECOMASTIA BILATERAL (LCOS) LCOS017 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 HAIR TRANSPLANT EACH SITTING LPLS289 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 HAND INJURY TWO SURFACES LPLS290 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 HAND RECONSTRUCTION + SSG LPLS291 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6

201 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group HEMIFACIAL ATROPHY CORRECTION LPLS292 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 HYPOGLOSSAL NERVE TRANSFER LPLS293 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 HYPOSPADIAS CORRECTION STAGE LPLS294 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 II (LPLS) # L6 LPLS295 ISLAND FLAPS (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 KELOID/HYPER EXCISION / SSG LPLS296 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LIP AUGMENTATION BOTH LIPS LCOS018 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LCOS) # L6 LCOS019 LIP MACROCHELIA (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS298 LIPO FILL SMALL AREA (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LCOS060 LIPOSCULPTURE MINOR (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LIPOSUCTION MINOR (UPTO 2 LTS) LPLS299 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS297 LIP RECONSTRUCTION (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LOWER LIP RECONSTRUCTION LPLS300 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LYMPHOEDEMA SURGERY MAJOR LPLS301 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 MACRODACTYLY CORRECTION LPLS302 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LCOS020 MALLAR IMPLANT (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 MAXILLA # RECONSTRUCTION LE- LPLS303 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 FORT - II - UNILATERAL (LPLS) # L6 MELANOCYTE GRAFT - LARGE LPLS304 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS305 MELANOMA EXCISSION (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS306 MID FACE OSTEOTOMY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 MILLARDS PROCEDURE UNILATERAL LPLS307 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 MUSCLE FLAP SINGLE (LPLS) (LPLS) LPLS308 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 MYOCUTANEOUS FLAP (LPLS) (LPLS) LPLS309 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 NASAL RECONSTRUCTION - MAJOR LPLS310 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS311 NASO ETHMOID # (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 NECK BURN CONTRACTURE WITH LPLS312 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SSG (LPLS) # L6 LPLS313 NEO-URETHRA II (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS314 NERVE GRAFT SINGLE (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290

202 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group NERVES SECONDARY REPAIR (LPLS) LPLS315 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 LPLS316 NEUROLYSIS MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS317 ORBITAL OSTEOTOMY (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LPLS318 PALATAL FISTULA (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LCOS021 PANNICULECTOMY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 PENILE DYSFUNCTION - IMPLANT LPLS319 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 INSERTION (LPLS) # L6 LPLS320 PHARYGEAL FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 PLATYSMA BAND CORRECTION LPLS321 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS322 POLYDACTELY COMPLEX (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LCOS022 PROFILOPLASTY MINOR (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 PTOSIS CORRECTION - BILATERAL LPLS323 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS324 REANIMATION - MINOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LCOS023 RHINOPLASTY PRIMARY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 ROMBERG'S DISEASE CORRECTIVE LPLS325 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SURGERIES (LPLS) # L6 SAGITAL SPLIT OSTEOTOMY LPLS326 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 BILATERAL (LPLS) # L6 SCAR EXCISION & CONTRACTURE LCOS024 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SSG (LCOS) # L6 LPLS327 SSG MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SUBCONDYLAR FRACTURE LPLS328 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 UNILATERAL (LPLS) # L6 LPLS329 SURAL ATERY FLAP (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 SWAN NECK DEFORMITY LPLS330 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 CORRECTION (LPLS) # L6 SYNDACTYLY - COMPLEX (SINGLE) LPLS331 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 SYNDACTYLY - SIMPLE (MULTIPLE) LPLS332 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 TEMPOROMANDIBULAR JOINT LPLS333 ANKYLOSIS RELEASE - UNILATERAL L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 TENDON TRANSFER MULTIPLE LPLS334 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 THREADLIFT (UPTO 2 THREADS) LCOS026 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LCOS) # L6 THUMB / FINGER IMPLANT (LPLS) LPLS335 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 # L6 THUMB RECONSTRUCTION LPLS336 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 MODERATE (LPLS) # L6

203 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TISSUE EXPANDOR INSERTION - LPLS337 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 FINAL INSET - LARGE (LPLS) # L6 TRUNK RECONSTRUCTION MINOR LPLS338 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 LPLS339 TUBE FLAPS MAJOR (LPLS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 LCOS027 UMBULICOPLASTY (LCOS) # L6 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 V-Y REPAIR PHARYNGOPLASTY LPLS340 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 ZONE II FLEXOR TENDON REPAIR LPLS341 L6 Surgery PLASTIC SURGERY 0 27010 32150 37290 (LPLS) # L6 ABDOMINAL WALL LPLS342 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 RECONSTRUCTION (LPLS) # L7 LCOS028 ABDOMINOPLASTY MINI (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 ALARBASE RECONSTRUCTIONS - LPLS343 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 BILATERAL (LPLS) # L7 AUGMENTATION MAMMOPLASTY LPLS344 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 BILATERAL (LPLS) # L7 LPLS345 BLOW OUT # OF ORBIT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LPLS346 BONE FLAP (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 BRACHIAL PLEXUS INJURY NERVE LPLS347 EXPLORATION & NEUROLYSIS (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 BREAST AUGMENTATION WITH LCOS029 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 IMPLANT UNLATERAL (LCOS) # L7 CAMPTODACTYLY FINGER- LPLS348 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 BILATERAL/ MULTIPLE (LPLS) # L7 CHEST WALL RECONSTRUCTION LPLS349 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 CHIN AUGMENTATION INCLUDING LCOS030 BONE GRAFT / OSTEOTOMY (LCOS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LPLS350 CLEFT LIP - BILATERAL (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 CLEFT LIP NASAL DEFORMITY LPLS352 SECONDARY CORRECTION (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LPLS351 CLEFT LIP - SECONDARY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 CLEFT PALATE - BILATERAL (LPLS) LPLS353 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 COMPOSITE GRAFTS MAJOR (LPLS) LPLS354 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 CONTRACTURES POST BURN WITH LPLS355 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 NECK FLAP (LPLS) # L7 CRANIOSTENOSIS CORRECTION - LPLS356 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 SINGLE SUTURE (LPLS) # L7

204 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group CUP EAR CORRECTIONS BILATERAL LPLS357 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 CYSTIC HYGROMA EXCISION - LPLS358 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LARGE (LPLS) # L7 DEBRIDEMENT WITH SUTURING AND LPLS359 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 KOLLAGEN APPLICATION (LPLS) # L7 DERMOID CYST COMPLEX (LPLS) LPLS360 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 DISTANT FLAP - DIVISION/INSET LPLS361 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 DISTRACTION OSTEOGENESIS LPLS362 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LIMBS (LPLS) # L7 DUPUYTRENS CORRECTION WITH LPLS363 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FLAPS (LPLS) # L7 EPISPADIAS EXTROPHY REPAIR LPLS364 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS365 EXSTROPHY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FACIAL INJURIES SOFT TISSUE - LPLS366 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 MAJOR (LPLS) # L7 LPLS367 FACIAL NERVE GRAFT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FACIAL NERVE SECONDARY LPLS368 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 RECONSTRUCTION (LPLS) # L7 FACIAL RECONSTRUCTION (MINOR/ LPLS369 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 SINGLE FLAP) (LPLS) # L7 LCOS031 FACIAL RESURFACING (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FASCIO CUTANEOUS FLAPS (LPLS) LPLS370 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 FINGER JOINT REPLACEMENT MULTI LPLS371 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 FINGER REPLANTATION EACH (LPLS) LPLS372 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 FINGER REPLANTATIONS TIP (LPLS) LPLS373 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 FRONTO ORBITAL OSTEOTOMY LPLS374 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 GENIOPLASTY WITH GRAFTS (LCOS) LCOS032 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 GRACELLIS FLAP TRANSFER (LPLS) LPLS375 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 GYNAECOMASTIA LIPOEXCISION LCOS033 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 BILATERAL (LCOS) # L7 HAND DEFORMITY CORRECTION LPLS376 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 MAJOR (LPLS) # L7 HAND RECONSTRUCTION + GRAFT LPLS377 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7

205 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LPLS378 HEMANGIOMAS MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 HYPOPHARYNGEAL LPLS379 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 RECONSTRUCTION (LPLS) # L7 JAW TUMORS LE-FORT OSTEOTOMY LPLS380 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 JESS FRAME APPLICATION MAJOR LPLS381 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 KRUKENBERG OPERATION (LPLS) LPLS382 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LEVATOR APONEURESIS LPLS383 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 CORRECTION SURGERY (LPLS) # L7 LIMB RECONSTRUCTION + SSG LPLS384 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS385 LIP LIFT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LIPOBRACHIOPLASTY - UNILATERAL LCOS034 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LCOS) # L7 LPLS386 LIPO INJECTION MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LIPOSUCTION (< 4 LTRS) (LCOS) # LCOS061 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 L7 LIPOSUCTION INTER (2-4 LTS) (LPLS) LPLS387 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LOCAL ONCOPLASTY LEVEL II (UPTO LPLS388 40 % VOLUME OF BREAST) (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LOWER LIMB RECONSTRUCTION LPLS389 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 CROSS LEG FLAP (LPLS) # L7 LYMPHEDEMA REDUCTION (LPLS) LPLS391 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LPLS390 LYMPHEDEMA - SHUNT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 MALOCCLUSION CORRECTION LPLS392 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 SURGERY (LPLS) # L7 MANDIBLE SPLITING PROCEDURE LPLS393 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 MANDIBULAR OSTEOTOMY (LPLS) LPLS394 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 MANGLED FOOT RECONSTRUCTION LPLS395 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 MASTOPEXY UNILATERAL (LPLS) LPLS396 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 MAXILLA # RECONSTRUCTION LE- LPLS397 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FORT - II - BILATERAL (LPLS) # L7 MAXILLA # RECONSTRUCTION LE- LPLS398 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FORT - III - UNILATERAL (LPLS) # L7 LPLS399 MAXILLARY SWING (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730

206 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group MEDIAL PLANTAR ARTERY FLAP LPLS400 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 MELANOMA EXCISION WITH LPLS401 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 RECONSTRUCTION (LPLS) # L7 METCARPOPHALENGEAL JOINT LPLS402 REPLACEMENT MULTIPLE (LPLS) L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 MICROTIA RECONSTRUCTION (LPLS) LPLS403 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 MID FACE RECONSTRUCTION (LPLS) LPLS404 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 MUSCLE FLAP MULTIPLE (LPLS) LPLS405 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 NASOETHMOID FRACTURES ORIF LPLS406 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS407 NECK CONTOURING (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 NERVE PRSERVING PAROTIDECTOMY LPLS408 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LCOS035 NOSE TIP CORRECTION (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 OBESITY - LIPECTOMY - ANTERIOR LCOS036 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 OR POSTERIOR (LCOS) # L7 ORAL CAVITY RECONSTRUCTION LPLS409 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS410 OTOPLASTY STAGE I (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 LPLS411 PALATOPLASTY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 PECTORALIS MAJOR MYOCUTANEOS LPLS412 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 FLAP (LPLS) # L7 LPLS413 PHARYNGOPLASTY (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 PROFILOPLASTY MODERATE (LPLS) LPLS414 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LPLS415 REANIMATION - MAJOR (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 REDUCTION MAMMOPLASTY LPLS416 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 UNILATERAL (LPLS) # L7 REVASCULARIZATION MAJOR (LPLS) LPLS417 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 REVASCULIRAZATION FINGER LPLS418 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 MAJOR (LPLS) # L7 RHINO-PLASTY COSMETIC PRIMARY LPLS419 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 SCALP RECONSTRUCTION MAJOR LPLS420 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS421 SSG EXT (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 SYNDACTYLY - COMPLEX (MULTIPLE) LPLS422 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7

207 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group TEMPOROMANDIBULAR JOINT LPLS423 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 ARTHROPLASTY (LPLS) # L7 TENDON - REPAIR - SECONDARY LPLS424 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LCOS037 THIGH LIFT (LCOS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 THUMB RECONSTRUCTION MAJOR LPLS425 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LPLS426 TRAPEZIOUS FLAP (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 UNICORONAL CRANIOISTENOSIS LPLS427 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 CORRECTION (LPLS) # L7 VAGINAL RECONSTRUCTION (LPLS) LPLS428 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 # L7 LPLS429 VAGINAL REJUVINATION (LPLS) # L7 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 ZYGOMA WITH ORBITAL FLOOR ORIF LPLS430 L7 Surgery PLASTIC SURGERY 0 36010 42870 49730 (LPLS) # L7 LCOS038 ABDOMINOPLASTY (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 ALOPECIA HAIR TSPT-MAJOR (LPLS) LPLS431 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 ANAL SPINCHTER RECONSTRUCTION LPLS432 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 ANEURYSMAL BONE CYST EXCISION LPLS433 AND RECONOSTRUCTION (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 ANGIOFIBROMA EXCISION (LPLS) LPLS434 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 AQUIRED CRANIAL DEFECT LPLS435 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CORRECTION (LPLS) # L8 ARTERIO-VENOUS MALFORMATION LPLS436 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 MAJOR (LPLS) # L8 ARTHROPLASTY MULTIPLE JOINTS LPLS437 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 AUGMENTATION RHINOPLASTY WITH LCOS039 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 BONE GRAFT (LCOS) # L8 AURICLE TOTAL LOSS LPLS438 RECONSTRUCTION LONG (LPLS) # L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 L8 BLEPHAROPLASTY BILATERAL LCOS040 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LCOS) # L8 BONE GRAFT VASCULARISED (LPLS) LPLS439 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 BRACHIAL PLEXUS NERVE REPAIR LPLS440 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 BRACHIAL PLEXUS TRANSFER - LPLS441 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 MUSCLE (LPLS) # L8 BRACHIOPLASTY - BILATERAL LCOS041 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LCOS) # L8

208 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group BREAST RECONSTRUCTION MAJOR LPLS442 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LPLS443 BROW LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LPLS444 CLEFT LIP & PALATE (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CRANIAL VAULT REMODELLING LPLS445 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 CRANIOFACIAL CLEFTS LPLS446 MICROSOMIA CORRECTION (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS448 CRANIOPLASTY ACRYLIC (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CRANIOPLASTY WITH BONE GRAFT LPLS447 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 CRITICAL REVASCULARISATION LPLS449 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 DEGLOVING INJURIES OF LIMBS & LPLS450 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 RECONS. SUPRA (LPLS) # L8 DISTRACTION OSTEOGENESIS FACE LPLS451 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 ENCEPHACOCELE SURGERY (LPLS) LPLS452 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LCOS043 FACE LIFT REGULAR (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FACIAL RECONSTRUCTION LPLS453 (MODERATE/DOUBLE FLAP) (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS454 FOREHEAD LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LPLS455 FREE FLAPS MINOR (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FRONTO ORBITAL ADVANCEMENT LPLS456 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 FUNCTIONAL MUSCLE TRANSFER LPLS457 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 GENIOPLASTY WITH OSTEOTOMY LPLS458 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 GLOBAL PLEXES NEUOLYSIS (LPLS) LPLS459 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 GLUTEAL LATERAL & MED. THIGH LPLS460 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 PLASTY MAJOR (LPLS) # L8 LPLS461 HAND INJURY COMPLEX (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 HAND RECONSTRUCTION + FLAP LPLS462 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 INTRAVELARVELOPLASTY (LPLS) LPLS463 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS464 KARAPANDZIC FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LPLS465 LATERAL ARM FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LPLS466 LATERAL THIGH FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150

209 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LATTISMUSS DORSI FLAP (LPLS) LPLS467 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LIMB RECONSTRUCTION + GRAFT LPLS468 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LIMB REVASCULIRAZATION (LPLS) LPLS469 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS470 LIPO FILL LARGE AREA (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LIPOSCULPTURE MAJOR (LCOS) # LCOS063 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 L8 LIPOSUCTION MAJOR (4-6 LTS) LPLS471 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LOCAL ONCOPLASTY BILATERAL LPLS472 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LOCAL ONCOPLASTY LEVEL III (OVER LPLS473 40 % VOLUME OF BREAST) (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LOWER LIMB RECONSTRUCTION BONE TRANSFER/FC FLAPS WITH LPLS474 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 SSG/MUSCLE FLAPS WITH SSG (LPLS) # L8 LYMPHOEDEMA SURGERY SUPRA LPLS475 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LCOS044 MASTOPEXY BILATERAL (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 MAXILLA # RECONSTRUCTION LE- LPLS476 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FORT - III - BILATERAL (LPLS) # L8 MAXILLA RECONSTRUCTION MAJOR LPLS477 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 METCARPOPHALENGEAL JOINT LPLS478 ORTHOPLASTY MULTIPLE (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 MICROVASCULAR FLAP - MINOR LPLS479 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 LPLS480 MID FACE LIFT (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 MILLARDS PROCEDURE BILATERAL LPLS481 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 MUCOPERIOSTEAL FLAP FOR LPLS482 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 SECONDARY PALATE (LPLS) # L8 MULTIPLE/ COMMUNITED MANDIBLE LPLS484 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FRACTURE (LPLS) # L8 MULTIPLE TENDON/ NERVE/ ARTERY LPLS483 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 REPAIR (LPLS) # L8 NASAL RECONSTRUCTION SUPRA LPLS485 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 NECK CONTRACTURE RELEASE WITH LPLS486 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FLAP (LPLS) # L8 LCOS064 NECK LIFT (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150

210 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LPLS487 NERVE GRAFT MULTIPLE (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 ORBITAL EXPANSION SURGERY LPLS488 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 OSTEOTOMY ASSYMETRY LPLS489 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CORRECTION (LPLS) # L8 PECTORALIS MAJOR MYOCUTANEOS LPLS490 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 FLAP WITH SSG (LPLS) # L8 LPLS491 POLANDS SYNDROME (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 LPLS492 POLLICIZATION (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 PRESSURE SORES LPLS493 RECONSTRUCTION MAJOR (LPLS) L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS494 RADIAL FOREARM FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 RECONSTRUCTION OF BREAST WITH LPLS495 AUTOGENOUS FLAPS - UNILATERAL L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 RECTUS ABDOMINUS FLAP (TRAM) LPLS496 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 REDUCTION MAMMOPLASTY LPLS497 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 BILATERAL (LPLS) # L8 LCOS046 RHYTIDECTOMY (LCOS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 SECONDARY CLEFT LIP AND NOSE LPLS498 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CORRECTION (LPLS) # L8 STERNUM RECONSTRUCTION (LPLS) LPLS499 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 SUBCONDYLAR FRACTURE LPLS500 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 BILATERAL (LPLS) # L8 SYNDACTYLY. COMPLICATED (LPLS) LPLS501 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 LPLS502 TEMPORALIS FLAP (LPLS) # L8 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 TEMPOROMANDIBULAR JOINT LPLS503 ANKYLOSIS RELEASE - BILATERAL L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 THREADLIFT (3 OR MORE THREADS) LCOS047 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LCOS) # L8 TOE TRANSFER COMPLETE (LPLS) LPLS504 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 TONGUE RECONSTRUCTION (LPLS) LPLS505 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 TRUNK RECONSTRUCTION MAJOR LPLS506 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 (LPLS) # L8 VAGINAL RECONSTUCTION (LPLS) LPLS507 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 # L8 VELO PHARYNGEAL INCOMPETANCE LPLS508 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CORRECTION (LPLS) # L8

211 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VOLKMAN'S CONTRACTURE LPLS509 L8 Surgery PLASTIC SURGERY 0 45010 53580 62150 CORRECTION (LPLS) # L8 AUGMENTATION MASTOPEXY (LCOS) LCOS048 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 BLEPHAROPLASTY FOUR LIDS LCOS049 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LCOS) # L9 LCOS050 BODY CONTOURING (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 BRACHIAL PLEXUS NERVE GRAFTING LPLS510 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 BRACHIAL PLEXUS TRANSFER (LPLS) LPLS511 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 BREAST AUGMENTATION WITH LCOS051 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 IMPLANT BILATERAL (LCOS) # L9 CLEFT LIP COMPOSITE SECONDARY LPLS512 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 NOSE CORRECTION (LPLS) # L9 CLEFT REPAIR - ALL IN ONE (LPLS) LPLS513 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 LCOS052 COMPOSITE FACE LIFT (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 CORRECTIVE RHINOPLASTY (LCOS) LCOS042 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 CRANIOFACIAL CLEFTS SYNOSTOSIS LPLS514 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 CRANIOSTENOSIS CORRECTION - LPLS515 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 MULTIPLE SUTURES (LPLS) # L9 LPLS516 DIEP FLAP (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 LCOS053 ENDOSCOPIC LIFT (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 LPLS517 FACIAL BIPARTITION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 FACIAL RECONSTRUCTION (MAJOR/ LPLS518 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 DOUBLE FLAP+SSG) (LPLS) # L9 FOREARM REPLANTATION (LPLS) LPLS519 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 FOUR LID BLEPHEROPLASTY (LPLS) LPLS520 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 FUNCTIONAL MUSCLE TRASFER LPLS521 INCLUDING CLOSURE OF L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 SECONDARY DEFECT (LPLS) # L9 GENDER CHANGE SURGERY (LPLS) LPLS522 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 HAND RECONSTRUCTION + GRAFT LPLS523 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 + FLAP (LPLS) # L9 LPLS524 HAND REPLANTATION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 HYPERTELORISM CORRECTION LPLS525 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 LIMB RECONSTRUCTION + GRAFT + LPLS526 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 FLAP (LPLS) # L9

212 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LIPOABDOMINOPLASTY MAJOR LCOS065 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LCOS) # L9 LIPOABDOMINOPLASTY MINI (LCOS) LCOS067 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 LIPOABDOMINOPLASTY MINOR LCOS054 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LCOS) # L9 LIPOBRACHIOPLASTY - BILATERAL LCOS055 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LCOS) # L9 LIPOSUCTION (4 to 6 LTRS) (LCOS) LCOS062 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 MANDIBLE RECONSTRUCTION LPLS527 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 MEGA LIPOSUCTION ( > 6 LTRS) LCOS056 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LCOS) # L9 MICROGNATHIA CORRECTION (LCOS) LCOS057 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 MICROVASCULAR FLAP - MAJOR LPLS528 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 OBESITY - LIPECTOMY - ANTERIOR LCOS058 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 & POSTERIOR (LCOS) # L9 PAN FACIAL FRACTURE CORRECTION LPLS529 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 (LPLS) # L9 PANFACIAL FRACTURE WITH SOFT LPLS530 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 TISSUE CORRECTION (LPLS) # L9 PLAGIOCEPHALY COMPOSITE LPLS531 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 CORRECTION (LPLS) # L9 LCOS059 PROFILOPLASTY MAJOR (LCOS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 REIMPLANTATION / LPLS532 REVASCULARISATION MAJOR (LPLS) L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 RHINOPLASTY COMPOSITE (LCOS) LCOS066 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 RHINOPLASTY SECONDARY (LCOS) LCOS045 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 LPLS533 THUMB REPLANTATION (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 TOE TRANSFER SEGMENTAL (LPLS) LPLS534 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 UPPER LIMB REPLANTATION (LPLS) LPLS535 L9 Surgery PLASTIC SURGERY 0 54020 64300 74590 # L9 HAND RECONSTRUCTION LPLS540 COMPOSITE (GRAFT+FLAP+SSG) L9 Surgery PLASTIC SURGERY 0 63010 75010 87020 (LPLS) # L9 PENILE RECONSTRUCTION (LPLS) LPLS543 L9 Surgery PLASTIC SURGERY 0 63010 75010 87020 # L9 TRANSSEXUAL SURGERY (LPLS) # LPLS545 L9 Surgery PLASTIC SURGERY 0 63010 75010 87020 L9

213 Plastic Surgery

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group BREAST RECONSTRUCTION SUPRA LPLS536 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 (LPLS) # L9 EXCISION WITH FREE FLAP (LPLS) LPLS537 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 # L9 FACIAL RECONSTRUCTION COMPLEX LPLS538 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 (LPLS) # L9 LPLS539 FREE FLAPS MAJOR (LPLS) # L9 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 LIMB RECONSTRUCTION LPLS541 COMPOSITE (GRAFT+FLAP+SSG) L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 (LPLS) # L9 MULTIPLE TOE TRANSFER (LPLS) LPLS542 L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 # L9 RECONSTRUCTION OF BREAST WITH LPLS544 AUTOGENOUS FLAPS - BILATERAL L9 Surgery PLASTIC SURGERY 0 72020 85740 99450 (LPLS) # L9

214 ENT

215 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup FOLLOW UP CONSULTATION AFTER PENT019 Procedure ENT 70 80 90 110 SPEECH THERAPY/VISIT PENT035 PAEDIATRIC FREE FIELD ASSESSMENT Procedure ENT 110 110 130 160 PENT042 PURE TONE SCREENING TEST Procedure ENT 110 110 130 160 FOLLOWING UP FOR REHABILITATION & PENT020 Procedure ENT 120 130 150 170 ADVISE HEARING AND ORIENTATION AND PENT025 Procedure ENT 120 130 150 170 COUNSELLING PENT039 PROFESSIONAL HEARING AID TRIAL Procedure ENT 130 140 160 190 SPECIAL TEST FOR DIFFERENTIAL PENT049 Procedure ENT 130 140 160 190 DIAGNOSIS PENT051 SPEECH DISCRIMINATION SCORE 3.7 Procedure ENT 130 140 160 190 SPEECH DISORDERS DIAGNOSIS & PENT052 Procedure ENT 130 140 160 190 CONSULTATION PENT041 PURE TONE AUDIOLOGICAL EVALUATION Procedure ENT 200 210 250 290 PENT050 SPEECH ASSESSMENT 3.8 Procedure ENT 200 210 250 290 PENT053 SPEECH THERAPY FOR ADULT Procedure ENT 200 210 250 290 SPEECH THERAPY FOR CHILDREN (FIRST PENT054 Procedure ENT 200 210 250 290 5 SES PENT056 STUD CHARGES Procedure ENT 200 210 250 290 PENT059 TRACHEOSTOMY TUBE CHANGE - ENT Procedure ENT 200 210 250 290 PENT011 DRESSING - MEDIUM - PENT Procedure ENT 220 230 280 320 PENT012 DRESSING - MINOR - PENT Procedure ENT 220 230 280 320 PENT040 PURE TONE AUDIOGRAM Procedure ENT 220 230 280 320 PENT047 SISI AND TONE DECAY Procedure ENT 220 230 280 320 SPEECH THERAPY PER SESSION OF 30- PENT055 Procedure ENT 220 230 280 320 40 MINUTES 3.9 PENT006 CAUTERISATION - PENT Procedure ENT 260 270 320 370 PENT057 SYRINGING 3.13 Procedure ENT 260 270 320 370 PENT016 EAR SYRINGE FOR ONE SIDE Procedure ENT 280 290 350 410 PENT028 IMMITANCE TESTING Procedure ENT 280 290 350 410 PENT060 ULTRASONIC SINOSCOPY Procedure ENT 280 290 350 410 PENT007 CHEMICAL CAUTERY OF THE NOSE Procedure ENT 340 360 420 490 PENT048 SPECIAL AUDIOLOGICAL TESTS Procedure ENT 340 360 420 490 PENT061 WASONCE SYNOSCOPY Procedure ENT 360 380 450 520 PENT068 Allergy Test Single Antigen Procedure ENT 370 390 460 540 PENT002 ANT NASAL PACKING Procedure ENT 420 440 520 610 PENT010 DRESSING - MAJOR Procedure ENT 420 440 520 610 PENT014 EAR LOBE REPAIR UNILATERAL Procedure ENT 420 440 520 610 PENT021 FOREIGN BODIES EAR - PENT Procedure ENT 420 440 520 610

216 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup PENT022 FOREIGN BODIES NOSE - PENT Procedure ENT 420 440 520 610 PENT044 REMOVAL OF FOREIGN BODY EAR Procedure ENT 420 440 520 610 PENT045 REMOVAL OF FOREIGN BODY NOSE Procedure ENT 420 440 520 610 MULTIPLE HEARING ASSESSMENT TEST PENT031 Procedure ENT 450 480 570 660 FOR ADULTS PENT003 BILATERAL ANTRAL WASHOUT Procedure ENT 480 500 590 690 PENT023 HEARING AID ANALYSIS 3.6 Procedure ENT 480 500 590 690 PENT024 HEARING AID SELECTION 3.5 Procedure ENT 480 500 590 690 PENT029 IMPEDENCE AND OTHER TESTS Procedure ENT 480 500 590 690 INTRALESIONAL INJECTIONS FOR PENT066 Procedure ENT 480 500 590 690 KELOIDS EXAMINATION AND SUCTION TOILET OF PENT018 Procedure ENT 500 520 620 720 EAR PENT030 IMPEDENCE AUDIOMETRY Procedure ENT 500 520 620 720 PENT032 MYRINGOTOMY WITH GROMMET Procedure ENT 610 640 770 890 PENT017 ENG Procedure ENT 640 670 800 920 PENT026 HEARING SCREENING TEST Procedure ENT 640 670 800 920 PENT027 HOPKINGS Procedure ENT 640 670 800 920 PENT033 NASAL ENDOSCOPY Procedure ENT 640 670 800 920 PENT013 EAR LOBE REPAIR BILATERAL - PENT Procedure ENT 660 690 820 960 PENT015 EAR PIERCING Procedure ENT 660 690 820 960 PENT009 DIAGNOSTIC NASAL ENDOSCOPY - PENT Procedure ENT 680 720 850 990 PENT043 QUINSY DRAINAGE - I + D Procedure ENT 680 720 850 990 BRAINSTEM EVOKED RESPONSE PENT004 Procedure ENT 760 800 950 1110 AUDIOMETER BRAINSTEM EVOKED RESPONSE PENT005 Procedure ENT 900 950 1130 1310 AUDIOMETRY (BERA) PENT038 POST NASAL PACKING Procedure ENT 1040 1090 1300 1510 PENT046 REPAIR EAR LOBE 3.12 Procedure ENT 1100 1150 1370 1590 PENT037 POLYP REMOVAL UNDER LA 3.14 Procedure ENT 1370 1440 1720 1990 PENT008 DIAGNOSTIC CAUTERY OF THE NOSE Procedure ENT 1510 1590 1890 2190 PENT034 NASOPHARYNGOSCOPY (FIBRE OPTIC) Procedure ENT 1510 1590 1890 2190 PERITONSILLAR ABSCESS DRAINAGE PENT036 Procedure ENT 1510 1590 1890 2190 UNDER LA PENT067 VIDEONYSTAGMOGRAPHY - (VNG) Procedure ENT 2740 2880 3430 3970 PENT069 Allergy Test Package 10 Antigens Procedure ENT 3480 3650 4350 5040 PENT058 THYROPLASTY Procedure ENT 4100 4300 5120 5940 PENT126 Surflink Remote Procedure ENT 10240 10750 12800 14850 PENT070 Allergy Test Package 35 Antigens Procedure ENT 12170 12780 15210 17650

217 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup PENT119 Aries -4 Procedure ENT 15300 16060 19120 22180 PENT118 Aries -3 Procedure ENT 16970 17820 21210 24600 PENT123 Aries PRO-4 Procedure ENT 17600 18480 22000 25520 PENT116 Aries -1 Procedure ENT 18230 19140 22790 26430 PENT122 Aries PRO-3 Procedure ENT 19440 20410 24300 28190 PENT117 Aries -2 Procedure ENT 19960 20960 24950 28940 PENT127 Surflink Remote microphone Procedure ENT 20700 21740 25880 30020 PENT120 Aries PRO-1 Procedure ENT 21110 22160 26380 30600 PENT121 Aries PRO-2 Procedure ENT 22830 23970 28540 33100 PENT072 Audibel A4 Gold Procedure ENT 27030 28380 33790 39190 PENT125 Surflink Media Procedure ENT 31630 33210 39540 45860 PENT112 Start 5 Procedure ENT 36230 38040 45290 52530 PENT124 Surflink Mobile 2 Procedure ENT 36230 38040 45290 52530 PENT071 Audibel A4 Platinum Procedure ENT 38530 40460 48160 55870 PENT115 Start 7 Tinnitus Procedure ENT 40250 42270 50320 58370 PENT107 Start 7 Procedure ENT 46000 48300 57500 66700 PENT114 Start 8 Tinnitus Procedure ENT 46000 48300 57500 66700 PENT087 Start 5-A Procedure ENT 48300 50720 60380 70040 PENT102 Start 1000 Procedure ENT 57500 60380 71880 83380 PENT111 Start 6 Procedure ENT 63250 66420 79070 91720 PENT080 Start 9 wireless Procedure ENT 70150 73660 87690 101720 PENT086 Start 6-A Procedure ENT 74750 78490 93440 108390 PENT106 Start 8 Procedure ENT 75900 79700 94880 110060 PENT085 Start i1000 Procedure ENT 80500 84530 100630 116730 PENT075 Start wireless 1000 Procedure ENT 80500 84530 100630 116730 PENT101 Start 1200 Procedure ENT 92000 96600 115000 133400 PENT110 Anthem XT Silver Procedure ENT 103500 108680 129380 150080 PENT113 Audibel A2 gold tinnitus Procedure ENT 113850 119550 142320 165090 PENT105 Audibel A2 Silver Procedure ENT 115000 120750 143750 166750 PENT097 Anthem XT Silver-3 Procedure ENT 120750 126790 150940 175090 PENT084 Start i1200 Procedure ENT 120750 126790 150940 175090 PENT074 Start wireless 1200 Procedure ENT 120750 126790 150940 175090 PENT100 Audibel A4 Silver-1 Procedure ENT 132250 138870 165320 191770 PENT078 Audibel A3 wireless Silver Procedure ENT 138000 144900 172500 200100 PENT094 Audibel A2 Silver-3 Procedure ENT 144900 152150 181130 210110 PENT091 Pro-1 Procedure ENT 163300 171470 204130 236790 PENT083 Audibel A4i Silver Procedure ENT 166750 175090 208440 241790

218 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup PENT073 Audibel A4 Silver Procedure ENT 166750 175090 208440 241790 PENT109 Anthem XT Gold Procedure ENT 181700 190790 227130 263470 PENT104 Audibel A2 Gold Procedure ENT 201250 211320 251570 291820 PENT096 Anthem XT Gold-2 Procedure ENT 218500 229430 273130 316830 PENT099 Audibel A4 Gold-1 Procedure ENT 224250 235470 280320 325170 PENT077 Audibel A3 wireless Gold Procedure ENT 235750 247540 294690 341840 PENT093 Audibel A2 Gold-2 Procedure ENT 241500 253580 301880 350180 PENT082 Audibel A4i Gold Procedure ENT 270250 283770 337820 391870 PENT108 Anthem XT Platinum Procedure ENT 272550 286180 340690 395200 PENT090 Pro Procedure ENT 276000 289800 345000 400200 PENT103 Audibel A2 Platinum Procedure ENT 302450 317580 378070 438560 PENT095 Anthem XT Platinum-1 Procedure ENT 304750 319990 380940 441890 PENT098 Audibel A4 Platinum-1 Procedure ENT 322000 338100 402500 466900 PENT092 Audibel A2 Platinum -1 Procedure ENT 339250 356220 424070 491920 PENT076 Audibel A3 wireless Platinum Procedure ENT 345000 362250 431250 500250 PENT089 Premium-1 Procedure ENT 362250 380370 452820 525270 PENT081 Audibel A4i Platinum Procedure ENT 385250 404520 481570 558620 PENT088 Premium Procedure ENT 419750 440740 524690 608640 LENT001 ANTERIOR NASAL PACKING (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 LENT002 BIOPSY LESION EAR (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 LENT003 BIOPSY LESION NOSE (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 LENT004 BIOPSY LESION THROAT (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 EAR LOBE REPAIR UNILATERAL (SENT) LENT005 L1 Surgery ENT SURGERY 4290 4500 5360 6220 # L1 EUM EARS & SUCTION CLEARANCE OF LENT006 L1 Surgery ENT SURGERY 4290 4500 5360 6220 WAX (ENT) # L1 LENT008 I & D FURUNCLE : EAR / NOSE (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 LENT007 I & D NECK ABSCESS (ENT) # L1 L1 Surgery ENT SURGERY 4290 4500 5360 6220 I & D PERITONSILLAR ABSCESS (ENT) LENT009 L1 Surgery ENT SURGERY 4290 4500 5360 6220 # L1 MYRINGOTOMY - UNILATERAL (ENT) # LENT010 L1 Surgery ENT SURGERY 4290 4500 5360 6220 L1 POST NASAL SURGERY BLEEDING LENT012 FOLLOWING INHOUSE NASAL SURGERY L1 Surgery ENT SURGERY 4290 4500 5360 6220 (ENT) # L1 POST TONSILLECTOMY BLEEDING LENT011 FOLLOWING INHOUSE TONSILLECTOMY/ L1 Surgery ENT SURGERY 4290 4500 5360 6220 ADENOIDECTOMY (ENT) # L1 DIAGNOSTIC NASAL ENDOSCOPY AS LENT013 L1 Surgery ENT SURGERY 5400 5400 5940 6480 SOLE PROCEDURE (ENT) # L1

219 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup ADENOIDECTOMY CURETTAGE (ENT) # LENT017 L2 Surgery ENT SURGERY 0 8240 9810 11380 L2 ANTERIOR & POSTERIOR NASAL LENT014 L2 Surgery ENT SURGERY 0 8240 9810 11380 PACKING (ENT) # L2 LENT015 ANTRAL WASH OUT (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 LENT016 AURAL POLYPECTOMY (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 DIRECT LARYNGOSCOPY / LENT018 PHARYNGOSCOPY WITH/WITHOUT L2 Surgery ENT SURGERY 0 8240 9810 11380 BIOPSY (ENT) # L2 LENT019 EAR LOBE REPAIR: BILATERAL (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 ENDOSCOPIC CAUTERY FOR EPISTAXIS LENT020 L2 Surgery ENT SURGERY 0 8240 9810 11380 (ENT) # L2 EUM & CLEARANCE OF KERATOSIS LENT021 L2 Surgery ENT SURGERY 0 8240 9810 11380 OBTURANS (ENT) # L2 EXCISION BIOPSY CERVICAL LYMPH LENT034 L2 Surgery ENT SURGERY 0 8240 9810 11380 NODE (ENT) # L2 LENT031 FOREIGN BODY EAR (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 LENT030 FOREIGN BODY NOSE (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 LENT022 I & D HAEMATOMA AURIS (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 I & D MASTOID ABSCESS / LENT023 L2 Surgery ENT SURGERY 0 8240 9810 11380 PREAURICULAR ABSCESS (ENT) # L2 I & D SEPTAL HAEMATOMA / ABSCESS LENT024 L2 Surgery ENT SURGERY 0 8240 9810 11380 (ENT) # L2 INTRATYMPANIC GENTAMICIN / STEROID LENT025 L2 Surgery ENT SURGERY 0 8240 9810 11380 INJECTION (ENT) # L2 LENT026 MYRINGOTOMY - BILATERAL (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 LENT032 NASOLABIAL CYST EXCISION (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 NASOPHARYNGOSCOPY (ENDOSCOPIC) LENT027 L2 Surgery ENT SURGERY 0 8240 9810 11380 & BIOPSY (ENT) # L2 PARTIAL TRIMMING TURBINATES (ENT) LENT033 L2 Surgery ENT SURGERY 0 8240 9810 11380 # L2 RADIOFREQUENCY TURBINOPLASTY LENT028 L2 Surgery ENT SURGERY 0 8240 9810 11380 (ENT) # L2 LENT029 TONGUE TIE RELEASE (ENT) # L2 L2 Surgery ENT SURGERY 0 8240 9810 11380 ADENOIDECTOMY MICRODEBRIDER / LENT035 L3 Surgery ENT SURGERY 0 10820 12880 14940 COBLATION ASSISSTED (ENT) # L3 DIAGNOSTIC BRONCHOSCOPY (ENT) # LENT036 L3 Surgery ENT SURGERY 0 10820 12880 14940 L3 EUM MYRINGOTOMY & GROMMET LENT044 L3 Surgery ENT SURGERY 0 10820 12880 14940 INSERTION (ENT) # L3 LENT037 EXCISION LESION PINNA (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940 FESS : MINOR ( UNCINECTOMY, MMA, LENT049 L3 Surgery ENT SURGERY 0 10820 12880 14940 ANT ETHMOIDECTOMY) (ENT) # L3

220 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup LENT038 FOREIGN BODY PHARYNX (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940 FRACTURE NASAL BONES REDUCTION LENT039 L3 Surgery ENT SURGERY 0 10820 12880 14940 (ENT) # L3 LENT040 I & D LUDWIGS ANGINA (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940 I & D PARAPHARYNGEAL / LENT041 RETROPHARYNGEAL ABSCESS (ENT) # L3 Surgery ENT SURGERY 0 10820 12880 14940 L3 INTRANASAL ANTROSTOMY INCLUDING LENT042 L3 Surgery ENT SURGERY 0 10820 12880 14940 ENDOSCOPIC AND BILATERAL (ENT) # L3 MICROLARYNGOSCOPY & BIOPSY (ENT) LENT050 L3 Surgery ENT SURGERY 0 10820 12880 14940 # L3 NASAL POLYPECTOMY - BILATERAL LENT045 L3 Surgery ENT SURGERY 0 10820 12880 14940 (INCLUDING ENDOSCOPIC) (ENT) # L3 LENT051 OESOPHAGEAL DILATATION (ENT) # L3 L3 Surgery ENT SURGERY 0 10820 12880 14940 OESOPHAGOSCOPY DIAGNOSTIC LENT048 L3 Surgery ENT SURGERY 0 10820 12880 14940 INCLUDING BIOPSY (ENT) # L3 REVISION LARYNGOTRACHEOPLASTY LENT043 L3 Surgery ENT SURGERY 0 10820 12880 14940 (ENT) # L3 SUBMANDIBULAR SALIVARY DUCT LENT046 L3 Surgery ENT SURGERY 0 10820 12880 14940 CALCULUS REMOVAL (ENT) # L3 UVULOPLASTY / RADIOFREQ TO PALATE LENT047 L3 Surgery ENT SURGERY 0 10820 12880 14940 & OROPHARYNX (ENT) # L3 ADENOIDECTOMY + GROMMET LENT073 L4 Surgery ENT SURGERY 0 14790 17610 20420 INSERTION (ENT) # L4 LENT074 ADENOTONSILLECTOMY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 BRONCHOSCOPY FOR REMOVAL OF LENT060 L4 Surgery ENT SURGERY 0 14790 17610 20420 FOREIGN BODY (ENT) # L4 LENT052 CALDWELL LUC OPERATION (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 CLOSURE OROANTRAL FISTULA (ENT) LENT053 L4 Surgery ENT SURGERY 0 14790 17610 20420 # L4 CRICOPHARYNGEAL MYOTOMY (ENT) LENT054 L4 Surgery ENT SURGERY 0 14790 17610 20420 # L4 EXCISION BENIGN TUMOUR NECK (ENT) LENT056 L4 Surgery ENT SURGERY 0 14790 17610 20420 # L4 EXCISION LESION BUCCAL MUCOSA LENT057 L4 Surgery ENT SURGERY 0 14790 17610 20420 (ENT) # L4 EXCISION PREAURICULAR SINUS (ENT) LENT058 L4 Surgery ENT SURGERY 0 14790 17610 20420 # L4 LENT059 EXCISION RANULA (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 FESS : INTER (MINOR + POLYPECTOMY LENT075 L4 Surgery ENT SURGERY 0 14790 17610 20420 + POST ETHMOIDECTOMY) (ENT) # L4 FRACTURE REDUCTION MAXILLA/ LENT061 L4 Surgery ENT SURGERY 0 14790 17610 20420 ZYGOMA (ENT) # L4 LENT062 FRONTAL SINUS TREPHINE (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420

221 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup MEATOPLASTY: BONY AND LENT063 L4 Surgery ENT SURGERY 0 14790 17610 20420 CARTILAGINOUS (ENT) # L4 MICROLARYNGOSCOPY & EXCISION LENT064 L4 Surgery ENT SURGERY 0 14790 17610 20420 LESION (ENT) # L4 MICROLARYNGOSCOPY & STRIPPING LENT065 L4 Surgery ENT SURGERY 0 14790 17610 20420 (ENT) # L4 LENT066 MYRINGOPLASTY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 NASAL POLYPECTOMY + ANTRAL WASH LENT067 L4 Surgery ENT SURGERY 0 14790 17610 20420 OUT (BILATERAL) (ENT) # L4 OESOPHAGOSCOPY DIAGNOSTIC LENT055 INCLUDING FOREIGN BODY REMOVAL L4 Surgery ENT SURGERY 0 14790 17610 20420 (ENT) # L4 LENT076 SEPTOPLASTY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 SUBMUCOUS RESECTION OF NASAL LENT068 L4 Surgery ENT SURGERY 0 14790 17610 20420 SEPTUM (ENT) # L4 TONSILLECTOMY : COBLATION LENT069 L4 Surgery ENT SURGERY 0 14790 17610 20420 ASSISSTED (ENT) # L4 TONSILLECTOMY : DISSECTION TECH LENT070 L4 Surgery ENT SURGERY 0 14790 17610 20420 (ENT) # L4 LENT071 TRACHEOSTOMY (SENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 LENT077 TYMPANOPLASTY : TYPE 1 (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 LENT072 TYMPANOTOMY (ENT) # L4 L4 Surgery ENT SURGERY 0 14790 17610 20420 ADENOTONSILLECTOMY + GROMMET LENT100 L5 Surgery ENT SURGERY 0 18010 21440 24870 INSERTION (ENT) # L5 LENT078 BALOON SINUPLASTY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 BRANCHIAL CYST/FISTULA EXCISION LENT079 L5 Surgery ENT SURGERY 0 18010 21440 24870 (ENT) # L5 LENT101 CHOANAL ATRESIA REPAIR (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 LENT080 CORTICAL MASTOIDECTOMY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 FACIAL NERVE DECOMPRESSION (ENT) LENT109 L5 Surgery ENT SURGERY 0 18010 21440 24870 # L5 LENT103 FESS + ADENOIDECTOMY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 FESS: MAJOR (INTER + SPHENOID & LENT104 L5 Surgery ENT SURGERY 0 18010 21440 24870 FRONTAL SINUS SURGERY) (ENT) # L5 FESS + TURBINATE REDUCTION (ENT) LENT102 L5 Surgery ENT SURGERY 0 18010 21440 24870 # L5 GLOMUS TYMPANICUM EXCISION (ENT) LENT105 L5 Surgery ENT SURGERY 0 18010 21440 24870 # L5 I & D LUDWIGS ANGINA + LENT081 L5 Surgery ENT SURGERY 0 18010 21440 24870 TRACHEOSTOMY (ENT) # L5 INJECTION FOR VOCAL CORD LENT082 L5 Surgery ENT SURGERY 0 18010 21440 24870 MEDIALIZATION (ENT) # L5 LARYNGOFISSURE & EXCISION LESION LENT106 L5 Surgery ENT SURGERY 0 18010 21440 24870 (ENT) # L5

222 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup LENT083 LARYNGOMALACIA SURGERY (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 LARYNGOTRACHEOPLASTY & T - TUBE LENT107 L5 Surgery ENT SURGERY 0 18010 21440 24870 INSERTION (ENT) # L5 LASER ARYTENOIDECTOMY / PARTIAL LENT085 L5 Surgery ENT SURGERY 0 18010 21440 24870 CORDECTOMY (ENT) # L5 LASER LARYNGEAL AND TRACHEAL LENT086 L5 Surgery ENT SURGERY 0 18010 21440 24870 SURGERIES (ENT) # L5 MICROLARYNGOSCOPY & KEEL LENT087 L5 Surgery ENT SURGERY 0 18010 21440 24870 INSERTION (ENT) # L5 MICROLARYNGOSCOPY & LASER LENT088 L5 Surgery ENT SURGERY 0 18010 21440 24870 SURGERY (ENT) # L5 PANENDOSCOPY & BIOPSY (ONS) (ENT) LENT089 L5 Surgery ENT SURGERY 0 18010 21440 24870 # L5 POST NASAL SURGERY BLEEDING RE- LENT091 L5 Surgery ENT SURGERY 0 18010 21440 24870 EXPLORATION (ENT) # L5 POST TONSILLECTOMY/ LENT090 ADENOIDECTOMY BLEEDING RE- L5 Surgery ENT SURGERY 0 18010 21440 24870 EXPLORATION (ENT) # L5 LENT092 RHINOPHYMA EXCISION (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 SEPTOPLASTY + TURBINATE REDUCTION LENT108 L5 Surgery ENT SURGERY 0 18010 21440 24870 (ENT) # L5 SPHENOPALATINE ARTERY CLIPPING / LENT093 L5 Surgery ENT SURGERY 0 18010 21440 24870 CAUTERY (ENT) # L5 SUBMANDIBULAR SALIVARY GLAND LENT094 L5 Surgery ENT SURGERY 0 18010 21440 24870 EXCISION (ENT) # L5 SUTURE LATERALISATION OF VOCAL LENT095 L5 Surgery ENT SURGERY 0 18010 21440 24870 CORD (ENT) # L5 THYROGLOSSAL CYST/FISTULA LENT096 L5 Surgery ENT SURGERY 0 18010 21440 24870 EXCISION (ENT) # L5 LENT084 TONSILLECTOMY LASER (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 TRACHEO OESOPHAGEAL PUNCTURE & LENT097 L5 Surgery ENT SURGERY 0 18010 21440 24870 VOICE PROSTHESIS (ENT) # L5 TRACHEOSTOMY FOR STRIDOR (ENT) LENT098 L5 Surgery ENT SURGERY 0 18010 21440 24870 # L5 LENT099 YOUNGS OPERATION (ENT) # L5 L5 Surgery ENT SURGERY 0 18010 21440 24870 LENT113 GLOSSECTOMY PARTIAL (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980 LENT120 PARTIAL GLOSSECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980 LENT128 THYROID ISTHMECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980 LENT129 THYROID LOBECTOMY (SS) (ENT) # L6 L6 Surgery ENT SURGERY 0 23160 27570 31980 BALOON DILATATION OF AIRWAY LENT110 STENOSIS INCLUDING BRONCHOSCOPY L6 Surgery ENT SURGERY 0 27010 32150 37290 (ENT) # L6

223 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup BONE ANCHORED HEARING AID (BAHA) LENT111 L6 Surgery ENT SURGERY 0 27010 32150 37290 (ENT) # L6 ENDOSCOPIC DACRYOCYSTORHINOSTOMY INCLUDING LENT112 L6 Surgery ENT SURGERY 0 27010 32150 37290 INSERTION AND LATER REMOVAL OF TUBE (ENT) # L6 ENDOSCOPIC FRONTO SPHENO LENT134 L6 Surgery ENT SURGERY 0 27010 32150 37290 ETHMOIDECTOMY (ENT) # L6 LENT130 FESS + CALDWELL LUC OP (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 LENT131 FESS + SEPTOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 LATERAL PHARYNGOTOMY AND LENT115 L6 Surgery ENT SURGERY 0 27010 32150 37290 PROCEED (ENT) # L6 LATERAL RHINOTOMY AND MEDIAL LENT116 L6 Surgery ENT SURGERY 0 27010 32150 37290 MAXILLECTOMY (ENT) # L6 MANDIBULECTOMY: SEGMENTAL / HEMI LENT117 L6 Surgery ENT SURGERY 0 27010 32150 37290 (ENT) # L6 LENT118 MASTOID TYMPANOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 LENT119 OPEN RHINOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 LENT132 OSSICULOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 PHARYNGEAL POUCH EXCISION (ENT) LENT121 L6 Surgery ENT SURGERY 0 27010 32150 37290 # L6 LENT122 PINNAPLASTY / OTOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 RHINOPLASTY : REDUCTION / LENT123 L6 Surgery ENT SURGERY 0 27010 32150 37290 AUGMENTATION (ENT) # L6 LENT133 SEPTORHINOPLASTY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 SPHENOPALATINE + ETHMOIDAL LENT124 L6 Surgery ENT SURGERY 0 27010 32150 37290 ARTERY CLIPPING (ENT) # L6 LENT125 STAPEDECTOMY (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 LENT126 STYLOID PROCESS EXCISION (ENT) # L6 L6 Surgery ENT SURGERY 0 27010 32150 37290 THYROPLASTY TECHNIQUES (1-4) (ENT) LENT114 L6 Surgery ENT SURGERY 0 27010 32150 37290 # L6 UVULO PALATO LENT127 PHARYNGOPLASTY(UVP3) + L6 Surgery ENT SURGERY 0 27010 32150 37290 TONSILLECTOMY (ENT) # L6 ENDOSCOPIC PITUITARY SURGERY (SS) LENT136 L7 Surgery ENT SURGERY 0 30860 36740 42620 (ENT) # L7 FACIAL NERVE DECOMPRESSION LENT148 L7 Surgery ENT SURGERY 0 30860 36740 42620 INCLUDING GRAFTING (SS) (ENT) # L7 SUPERFICIAL PAROTIDECTOMY (SS) LENT139 L7 Surgery ENT SURGERY 0 30860 36740 42620 (ENT) # L7 TEMPORAL BONE RESECTION: PARTIAL LENT141 L7 Surgery ENT SURGERY 0 30860 36740 42620 (SS) (ENT) # L7 TEMPORAL BONE RESECTION : LENT147 L7 Surgery ENT SURGERY 0 30860 36740 42620 SUBTOTAL (SS) (ENT) # L7

224 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup TOTAL THYROIDECTOMY FOR TUMORS LENT142 L7 Surgery ENT SURGERY 0 30860 36740 42620 (SS) (ENT) # L7 COMBINED APPROACH TYMPANOPLASTY LENT143 - INTACT CANAL WALL TYMPANOPLASTY L7 Surgery ENT SURGERY 0 36010 42870 49730 (ENT) # L7 ENDOLYMPHATIC SAC SURGERY (ENT) LENT144 L7 Surgery ENT SURGERY 0 36010 42870 49730 # L7 ENDOSCOPIC ORBITAL DECOMPRESSION LENT135 L7 Surgery ENT SURGERY 0 36010 42870 49730 (ENT) # L7 FRONTAL SINUS OSTEOPLASTIC / LENT145 L7 Surgery ENT SURGERY 0 36010 42870 49730 OBLITERATION SURGERY (ENT) # L7 GLOMUS JUGULARE EXCISION (ENT) # LENT149 L7 Surgery ENT SURGERY 0 36010 42870 49730 L7 LENT137 LABYRINTHECTOMY (ENT) # L7 L7 Surgery ENT SURGERY 0 36010 42870 49730 MODIFIED RADICAL MASTOIDECTOMY LENT138 L7 Surgery ENT SURGERY 0 36010 42870 49730 INCLUDING MEATOPLASTY (ENT) # L7 RADICAL MASTOIDECTOMY INCLUDING LENT146 L7 Surgery ENT SURGERY 0 36010 42870 49730 MEATOPLASTY (ENT) # L7 SURGERY FOR SLEEP APNOEA: NASAL LENT140 L7 Surgery ENT SURGERY 0 36010 42870 49730 SURGERY + UVP3 (ENT) # L7 FUNCTIONAL NECK DISSECTION (SS) LENT153 L8 Surgery ENT SURGERY 0 38580 45930 53280 (ENT) # L8 PARTIAL CRICOTRACHEAL RESECTION LENT155 L8 Surgery ENT SURGERY 0 38580 45930 53280 (SS) (ENT) # L8 PARTIAL LARYNGECTOMY (HORIZONTAL LENT156 L8 Surgery ENT SURGERY 0 38580 45930 53280 / VERTICAL) (SS) (ENT) # L8 RADICAL MAXILLECTOMY (SS) (ENT) # LENT157 L8 Surgery ENT SURGERY 0 38580 45930 53280 L8 RADICAL / MODIFIED RADICAL NECK LENT158 L8 Surgery ENT SURGERY 0 38580 45930 53280 DISSECTION (SS) (ENT) # L8 REVISION THYROIDECTOMY / LENT162 COMPLETION THYROIDECTOMY (SS) L8 Surgery ENT SURGERY 0 38580 45930 53280 (ENT) # L8 THYROIDECTOMY FOR RETROSTERNAL LENT163 L8 Surgery ENT SURGERY 0 38580 45930 53280 EXTENSION (SS) (ENT) # L8 LENT159 TOTAL LARYNGECTOMY (SS) (ENT) # L8 L8 Surgery ENT SURGERY 0 38580 45930 53280 LENT160 TOTAL MAXILLECTOMY (SS) (ENT) # L8 L8 Surgery ENT SURGERY 0 38580 45930 53280 TOTAL THYROIDECTOMY FOR MALIGNANCY + CENTRAL LENT164 L8 Surgery ENT SURGERY 0 38580 45930 53280 COMPARTMENT LYMPHNODE DISSECTION (SS) (ENT) # L8 TRACHEAL RESECTION & ANASTOMOSIS LENT161 L8 Surgery ENT SURGERY 0 38580 45930 53280 (SS) (ENT) # L8 COCHLEAR IMPLANT SURGERY (ENT) LENT165 L8 Surgery ENT SURGERY 0 45010 53580 62150 # L8 LENT150 CSF OTORRHOEA REPAIR (ENT) # L8 L8 Surgery ENT SURGERY 0 45010 53580 62150

225 ENT

Surgery Billing Code Description Billing Group MHDOP MHDTRP MHDDOU MHDSIGL Level Subgroup LENT151 CSF RHINORRHOEA REPAIR (ENT) # L8 L8 Surgery ENT SURGERY 0 45010 53580 62150 ENDOSCOPIC OPTIC NERVE LENT152 L8 Surgery ENT SURGERY 0 45010 53580 62150 DECOMPRESSION (ENT) # L8 LARYNGOTRACHEOPLASTY WITH RIB LENT154 L8 Surgery ENT SURGERY 0 45010 53580 62150 GRAFT (ENT) # L8 LENT167 COMMANDO OPERATION (SS) (ENT) # L9 L9 Surgery ENT SURGERY 0 46300 55120 63930 CRANIOFACIAL RESECTION (SS) (ENT) LENT168 L9 Surgery ENT SURGERY 0 46300 55120 63930 # L9 EXTENDED CRICOTRACHEAL RESECTION LENT170 L9 Surgery ENT SURGERY 0 46300 55120 63930 & ANASTOMOSIS (SS) (ENT) # L9 GLOSSECTOMY TOTAL + NECK LENT171 L9 Surgery ENT SURGERY 0 46300 55120 63930 DISSECTION (SS) (ENT) # L9 LARYNGOPHARYNGECTOMY + NECK LENT172 L9 Surgery ENT SURGERY 0 46300 55120 63930 DISSECTION (SS) (ENT) # L9 MAXILLECTOMY + ORBITAL LENT173 L9 Surgery ENT SURGERY 0 46300 55120 63930 EXENTERATION (SS) (ENT) # L9 PARAPHARYNGEAL TUMOUR EXCISION LENT175 L9 Surgery ENT SURGERY 0 46300 55120 63930 (SS) (ENT) # L9 PAROTIDECTOMY + NECK DISSECTION LENT176 L9 Surgery ENT SURGERY 0 46300 55120 63930 (SS) (ENT) # L9 RADICAL PAROTIDECTOMY (SS) (ENT) LENT177 L9 Surgery ENT SURGERY 0 46300 55120 63930 # L9 TOTAL THYROIDECTOMY FOR MALIGNANCY + UNILATERAL LENT178 L9 Surgery ENT SURGERY 0 46300 55120 63930 FUNCTIONAL NECK DISSECTION (SS) (ENT) # L9 ACOUSTIC NEUROMA EXCISION (ENT) LENT166 L9 Surgery ENT SURGERY 0 54020 64300 74590 # L9 ENDOSCOPIC LOTHROP OP/ DRAF 111 LENT169 L9 Surgery ENT SURGERY 0 54020 64300 74590 (ENT) # L9 NASOPHARYNGEAL ANGIOFIBROMA LENT174 L9 Surgery ENT SURGERY 0 54020 64300 74590 EXCISION (ENT) # L9

226 Ophthalmology

227 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY KOPT012 VITRECTOMY - A - PKG - DC Package 0 23430 27890 32350 PACKAGE OPTHALMOLOGY KOPT051 ECCE + PC IOL - PACKAGE - IP Package 0 35260 41980 48700 PACKAGE OPTHALMOLOGY KOPT049 SICS + PC IOL - PACKAGE - IP Package 0 35260 41980 48700 PACKAGE DAY CARE CATARACT- REVISED OPTHALMOLOGY KOPT058 Package 0 39130 46580 54030 PACKAGE PACKAGE OPTHALMOLOGY KOPT037 ECCE + PC IOL - PACKAGE - DC Package 0 40460 48160 55870 PACKAGE OPTHALMOLOGY KOPT013 VITRECTOMY - B - PKG - DC Package 0 41060 48880 56700 PACKAGE PHOTODYNAMIC ONE EYE without DYE OPTHALMOLOGY KOPT027 Package 0 41780 49740 57700 - PACKAGE PACKAGE OPTHALMOLOGY KOPT035 SICS + PC IOL - PACKAGE - DC Package 0 41910 49890 57870 PACKAGE OPTHALMOLOGY KOPT039 PHACO SURGERY - PACKAGE - IP Package 0 42990 51180 59370 PACKAGE OPTHALMOLOGY KOPT043 MICS CATARACT PACKAGE - IP Package 0 47580 56640 65700 PACKAGE OPTHALMOLOGY KOPT014 VITRECTOMY - C - PKG - DC Package 0 47580 56640 65700 PACKAGE OPTHALMOLOGY KOPT011 DAY CARE CATARACT- PACKAGE - DC Package 0 52290 62250 72210 PACKAGE OPTHALMOLOGY KOPT047 ICL SPHERICAL - PACKAGE - IP Package 0 52770 62820 72870 PACKAGE TRABECULECTOMY AND PHACO OPTHALMOLOGY KOPT042 Package 0 52770 62820 72870 PACKAGE - IP PACKAGE OPTHALMOLOGY KOPT048 ICL TORIC - PACKAGE - IP Package 0 56760 67570 78380 PACKAGE OPTHALMOLOGY KOPT034 INTRAVITREOUS LUCENTIS INJECTION Package 0 56760 67570 78380 PACKAGE OPTHALMOLOGY KOPT015 VITRECTOMY - D - PKG - DC Package 0 57360 68290 79210 PACKAGE OPTHALMOLOGY KOPT017 TORIC CATARACT PACKAGE - DC Package 0 60020 71450 82880 PACKAGE OPTHALMOLOGY KOPT021 VITRECTOMY & CATARACT PACKAGE Package 0 61350 73030 84710 PACKAGE TRABECULECTOMY AND PHACO OPTHALMOLOGY KOPT018 Package 0 63520 75620 87720 PACKAGE - DC PACKAGE OPTHALMOLOGY KOPT056 VITRECTOMY - D - PKG - IP Package 0 63880 76050 88220 PACKAGE OPTHALMOLOGY KOPT016 MFL CATARACT PACKAGE - DC Package 0 67020 79790 92550 PACKAGE OZURDEX INJECTION PROCEDURE - PKG OPTHALMOLOGY KOPT023 Package 0 86940 103500 120060 - DC PACKAGE

228 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY KOPT059 Intravitreal Eylea Package 0 99540 118500 137460 PACKAGE CHALAZION OPERATION DRESSING - POPT009 Procedure OPTHALMOLOGY 110 110 130 160 OPT POPT025 IOP ONLY Procedure OPTHALMOLOGY 130 140 160 190 POPT026 LACRIMAL SAC SYRINGING Procedure OPTHALMOLOGY 140 150 180 210 POPT039 ORTHO-OPTIC CHECK UP 4.7 Procedure OPTHALMOLOGY 140 150 180 210 POPT049 PLEPOPTIC EXERCISES 4.9 Procedure OPTHALMOLOGY 140 150 180 210 POPT052 REFRACTION/FUNDOSCOPY 4.6 Procedure OPTHALMOLOGY 140 150 180 210 SUB CONJUNCTIVAL/SUB TENON'S POPT058 Procedure OPTHALMOLOGY 140 150 180 210 RETROBULBEA POPT066 SUCTION CUP Procedure OPTHALMOLOGY 200 210 250 290 CAUTERISATION OF ULCER / ONE EYE POPT005 Procedure OPTHALMOLOGY 220 230 280 320 4.1.1 GONIOSCOPY OR 3 MIRROR POPT021 Procedure OPTHALMOLOGY 220 230 280 320 EXAMINATION POPT040 ORTHO-OPTIC EXERCISES 4.8 Procedure OPTHALMOLOGY 220 230 280 320 POPT059 SUTURE REMOVAL & DRESSING - OPT Procedure OPTHALMOLOGY 220 230 280 320 SYRINGING OF LACRIMAL SAC ONE EYE POPT061 Procedure OPTHALMOLOGY 220 230 280 320 4.3.1 POPT019 FOREIGN BODY REMOVAL 4.5 Procedure OPTHALMOLOGY 260 270 320 370 POPT051 REFRACTION ONLY Procedure OPTHALMOLOGY 280 290 350 410 DS0010 Fundus fluorescence angiography Procedure OPTHALMOLOGY 290 310 360 420 POPT043 PERIMETRY FIELD TEST 4.10 Procedure OPTHALMOLOGY 320 330 390 460 POPT053 REMOVAL OF CORNEAL FOREIGN BODY Procedure OPTHALMOLOGY 320 330 390 460 POPT055 RETROBULAR INJECTION ONE EYE 4.2 Procedure OPTHALMOLOGY 320 330 390 460 CAUTERISATION OF ULCER BOTH EYES POPT006 Procedure OPTHALMOLOGY 340 360 420 490 4.1.2 POPT020 FUNDUS PHOTOGRAPHS Procedure OPTHALMOLOGY 340 360 420 490 SYRINGING OF LACRIMAL SAC BOTH POPT060 Procedure OPTHALMOLOGY 340 360 420 490 EYES 4.3.2 POPT018 FOLLOW-UP EXAMINATION Procedure OPTHALMOLOGY 420 440 520 610 POPT056 SPECULAR MICROSCOPY Procedure OPTHALMOLOGY 420 440 520 610 POPT012 CONTACT LENS FOLLOW-UP Procedure OPTHALMOLOGY 450 480 570 660 POPT041 PACHYMETRY Procedure OPTHALMOLOGY 450 480 570 660 RETROBULAR INJECTION BOTH EYES POPT054 Procedure OPTHALMOLOGY 450 480 570 660 4.2.2 POPT042 PARACENTESIS 4.4 Procedure OPTHALMOLOGY 520 550 650 760 POPT050 POST OPERATIVE OPTHAL KIT Procedure OPTHALMOLOGY 590 620 740 860 POPT064 WART EXCISION Procedure OPTHALMOLOGY 590 620 740 860

229 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level CHALAZION OPERATION BOTH EYES POPT008 Procedure OPTHALMOLOGY 680 720 850 990 4.11.2 POPT013 CORNEAL TOPOGRAPHY Procedure OPTHALMOLOGY 680 720 850 990 POPT082 DRESSING (OPTHAL) Procedure OPTHALMOLOGY 690 730 870 1010 POPT010 CHALAZION OPERATION ONE EYE 4.11 Procedure OPTHALMOLOGY 760 800 950 1110 POPT014 ELECTROLYSIS Procedure OPTHALMOLOGY 760 800 950 1110 POPT057 SQUINT INVESTIGATION Procedure OPTHALMOLOGY 760 800 950 1110 POPT011 CONTACT LENS FITTING & REFRACTION Procedure OPTHALMOLOGY 820 860 1030 1190 POPT001 A SCAN BIOMETRY Procedure OPTHALMOLOGY 960 1010 1200 1390 POPT063 VISUAL FIELD PERIMETRY (PER EYE) Procedure OPTHALMOLOGY 1100 1150 1370 1590 POPT002 ABERROMETRY Procedure OPTHALMOLOGY 1180 1240 1470 1710 POPT004 B SCAN ULTRA SONOGRAPHY Procedure OPTHALMOLOGY 1180 1240 1470 1710 ARTIFICIAL EYE PROSTHESIS (INCLUDING POPT003 Procedure OPTHALMOLOGY 1240 1300 1540 1790 PROSTHESIS) POPT083 WOUND DEBRIDEMENT (OPTHAL) Procedure OPTHALMOLOGY 1270 1330 1590 1840 POPT072 OP TRICORT PROCEDURE Procedure OPTHALMOLOGY 1370 1440 1720 1990 POPT007 CHALAZION I & C Procedure OPTHALMOLOGY 1650 1730 2060 2390 OPTICAL COHERENCE TOMOGRAPHY- POPT038 Procedure OPTHALMOLOGY 1650 1730 2060 2390 (F/U SCAN) ARTIFICAL EYE PROSTHESIS FITTING/ POPT074 Procedure OPTHALMOLOGY 1730 1820 2160 2510 CONFORMER POPT031 LASIK DIAGNOSTIC TEST Procedure OPTHALMOLOGY 2190 2300 2740 3170 POPT065 YAG LASER PROCEDURE Procedure OPTHALMOLOGY 2190 2300 2740 3170 OPTICAL COHERENCE TOMOGRAPHY- POPT036 Procedure OPTHALMOLOGY 2330 2440 2910 3370 (1-EYE) POPT035 LIO FOCAL Procedure OPTHALMOLOGY 2470 2590 3080 3570 POPT015 EQUIPMENT CHRGES FOR PHACO Procedure OPTHALMOLOGY 2870 3010 3580 4160 POPT081 Botox injetion (one side) Procedure OPTHALMOLOGY 2880 3020 3600 4170 POPT077 EPILATION / INJECTIONS/ FB REMOVAL Procedure OPTHALMOLOGY 2880 3020 3600 4170 POPT076 EXCISION/I & D OF EYE LID LESION Procedure OPTHALMOLOGY 2880 3020 3600 4170 POPT075 SUTURING/ CRYO /CAUTERY Procedure OPTHALMOLOGY 2880 3020 3600 4170 POPT078 TUBE /IMPLANT REMOVAL Procedure OPTHALMOLOGY 2880 3020 3600 4170 POPT017 FFA Procedure OPTHALMOLOGY 3140 3300 3930 4560 POPT027 LASER (PER EYE/PER SITTING) Procedure OPTHALMOLOGY 3970 4170 4960 5760 POPT079 CANTHOTOMY Procedure OPTHALMOLOGY 4030 4230 5040 5840 POPT016 EQUIPMENT CHRGES FOR VITRECTOMY Procedure OPTHALMOLOGY 4240 4450 5290 6140 OPTICAL COHERENCE TOMOGRAPHY- POPT037 Procedure OPTHALMOLOGY 4370 4590 5470 6340 (2-EYES) POPT029 LASER ROP FOR Procedure OPTHALMOLOGY 4510 4740 5640 6540

230 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level POPT044 PHACOEMULSIFICATION Procedure OPTHALMOLOGY 5610 5890 7010 8130 CT / MR DCG (Includes injecting the dye POPT080 Procedure OPTHALMOLOGY 5750 6040 7190 8340 in the Radiology Department) POPT030 LASER ROP PACKAGE (PER EYE) Procedure OPTHALMOLOGY 6700 7030 8370 9710 POPT073 ICG ANGIOGRAPHY Procedure OPTHALMOLOGY 7460 7830 9320 10810 INTRAVITREAL TRIAMCINOLONE POPT023 Procedure OPTHALMOLOGY 9570 10050 11960 13880 INJECTION - POPT POPT028 LASER PACKAGE (PER EYE) Procedure OPTHALMOLOGY 11210 11770 14010 16250 POPT068 INTRAVITREAL AVASTIN INJECTION - C Procedure OPTHALMOLOGY 12850 13490 16060 18630 POPT062 TRANSPUPILLARY THERMOTHERAPY Procedure OPTHALMOLOGY 12850 13490 16060 18630 POPT067 INTRAVITREAL AVASTIN INJECTION - B Procedure OPTHALMOLOGY 17760 18650 22200 25750 POPT024 INTRAVITREAL AVASTIN INJECTION (A) Procedure OPTHALMOLOGY 22540 23670 28180 32690 POPT022 INTRAVITREAL LUCENTIS INJECTION Procedure OPTHALMOLOGY 23910 25110 29890 34670 LASIK SURGERY SPECIAL SCHEME (ONE OPTHALMOLOGY POPT033 Procedure 23230 24400 29040 33690 EYES) LASIK OPTHALMOLOGY POPT071 LASIK SURGERY STANDARD (ONE EYE) Procedure 31420 32990 39280 45560 LASIK LASIK TREATMENT CUSTOMISED (ONE OPTHALMOLOGY POPT070 Procedure 36900 38740 46120 53500 EYE) LASIK LASIK SURGERY SPECIAL SCHEME OPTHALMOLOGY POPT032 Procedure 46450 48780 58070 67360 (BOTH EYES) LASIK OPTHALMOLOGY POPT034 LASIK SURGERY (BOTH EYES) Procedure 54650 57390 68310 79240 LASIK LASIK TREATMENT CUSTOMISED (BOTH OPTHALMOLOGY POPT069 Procedure 65580 68860 81970 95090 EYES) LASIK Cauterisation including cryotherapy to OPTHALMOLOGY LOPT001 L1 Surgery 4290 4500 5360 6220 conjunctival lesion (OPT) # L1 SURGERY OPTHALMOLOGY LOPT002 Chalazion - Single (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Conformer/ shell fitting under GA (OPT) OPTHALMOLOGY LOPT003 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY OPTHALMOLOGY LOPT004 Corneal scraping for culture (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY OPTHALMOLOGY LOPT005 Drainage of conjunctival cyst (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY OPTHALMOLOGY LOPT006 Drainage of lesion of eyelid (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Electro epilation (Single eyelid) (OPT) OPTHALMOLOGY LOPT016 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY OPTHALMOLOGY LOPT007 Endoscopic Evaluation (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY EXAMINATION UNDER ANESTHESIA (OPT) OPTHALMOLOGY LOPT019 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY

231 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Excision of lesion of eyelid - small (< 5 OPTHALMOLOGY LOPT008 L1 Surgery 4290 4500 5360 6220 MM) (OPT) # L1 SURGERY Exploration of conjunctiva (including OPTHALMOLOGY LOPT017 L1 Surgery 4290 4500 5360 6220 removal of foreign body) (OPT) # L1 SURGERY OPTHALMOLOGY LOPT020 FORCED DUCTION TEST (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Injection into anterior chamber (OPT) OPTHALMOLOGY LOPT018 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY OPTHALMOLOGY LOPT009 Injection into eyelid (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Injection of botulinum toxin into OPTHALMOLOGY LOPT010 extraocular or periocular muscles (OPT) L1 Surgery 4290 4500 5360 6220 SURGERY # L1 OPTHALMOLOGY LOPT021 LIO (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY OPTHALMOLOGY LOPT011 Removal of corneal suture (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Removal of superficial corneal foreign OPTHALMOLOGY LOPT012 L1 Surgery 4290 4500 5360 6220 body (OPT) # L1 SURGERY OPTHALMOLOGY LOPT022 RETINAL CRYO (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY OPTHALMOLOGY LOPT013 Subconjunctival injection (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY Suture of conjunctiva - 5 and less (OPT) OPTHALMOLOGY LOPT014 L1 Surgery 4290 4500 5360 6220 # L1 SURGERY OPTHALMOLOGY LOPT015 Tube Removal (OPT) # L1 L1 Surgery 4290 4500 5360 6220 SURGERY OPTHALMOLOGY LOPT040 Canthotomy (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Chalazion - Multiple (UNILATERAL) (OPT) OPTHALMOLOGY LOPT048 L2 Surgery 0 8240 9810 11380 # L2 SURGERY contour correction of lid - minor (OPT) OPTHALMOLOGY LOPT023 L2 Surgery 0 8240 9810 11380 # L2 SURGERY Correction of trichiasis by electrolysis/ OPTHALMOLOGY LOPT041 L2 Surgery 0 8240 9810 11380 diathermy/cryotherapy/laser (OPT) # L2 SURGERY OPTHALMOLOGY LOPT024 Cryotherapy of eye lid (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Curettage/cryotherapy of lesion of eyelid OPTHALMOLOGY LOPT042 L2 Surgery 0 8240 9810 11380 (OPT) # L2 SURGERY CYCLOCRYOPHOTOCOAGULATION (OPT) OPTHALMOLOGY LOPT049 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT050 DIODE CPC (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT043 Drainage of conjuctival Cyst (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY

232 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Electro epilation (Multiple eyelids) (OPT) OPTHALMOLOGY LOPT051 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT044 Endo DCR (ophthal stand by) (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Endoscopic Evaluation with Currettege OPTHALMOLOGY LOPT025 L2 Surgery 0 8240 9810 11380 (OPT) # L2 SURGERY Endoscopic tube Insertion/removal OPTHALMOLOGY LOPT026 L2 Surgery 0 8240 9810 11380 without DCR (OPT) # L2 SURGERY OPTHALMOLOGY LOPT052 EUA + LIO (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Excision/biopsy of conjunctival lesion OPTHALMOLOGY LOPT031 L2 Surgery 0 8240 9810 11380 (OPT) # L2 SURGERY OPTHALMOLOGY LOPT027 Excision of lesion of cornea (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Excision of lesion of eyelid - large (> 5 OPTHALMOLOGY LOPT028 L2 Surgery 0 8240 9810 11380 MM) /multiple (OPT) # L2 SURGERY OPTHALMOLOGY LOPT029 Excision of lesion of sclera (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT030 Excision of pterygium (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT047 Eyelid Repair (Unilateral) (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Incisional biopsy - Extra occulor (OPT) OPTHALMOLOGY LOPT032 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT033 Infracture of Inferior turbinate (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY INJECTION INTO ANTERIOR CHAMBER/ OPTHALMOLOGY LOPT053 L2 Surgery 0 8240 9810 11380 AC WASH (OPT) # L2 SURGERY Intralessional sclerosing agents (OPT) OPTHALMOLOGY LOPT045 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT054 INTRAVITREAL INJECTION (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT034 Multiple Injections into eye lid (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT035 Paracentesis (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Probing and syringing (unilateral) (OPT) OPTHALMOLOGY LOPT036 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT037 Punctal Surgery (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Radiotherapy to conjunctival lesion (OPT) OPTHALMOLOGY LOPT038 L2 Surgery 0 8240 9810 11380 # L2 SURGERY OPTHALMOLOGY LOPT055 socket impression under GA (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Suture of conjunctiva - 6 and more (OPT) OPTHALMOLOGY LOPT056 L2 Surgery 0 8240 9810 11380 # L2 SURGERY

233 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY LOPT039 Tarsorrhaphy (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY OPTHALMOLOGY LOPT046 Wound detridement - minor (OPT) # L2 L2 Surgery 0 8240 9810 11380 SURGERY Amniotic membrane Transplant (OPT) OPTHALMOLOGY LOPT057 L3 Surgery 0 10820 12880 14940 # L3 SURGERY OPTHALMOLOGY LOPT058 Bilateral Probing / Syringing (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY C3R TREATMENT FOR KERATOCONUS - OPTHALMOLOGY LOPT085 L3 Surgery 0 10820 12880 14940 UNILATERAL (OPT) # L3 SURGERY Chalizion - Multiple (BILATERAL) (OPT) OPTHALMOLOGY LOPT080 L3 Surgery 0 10820 12880 14940 # L3 SURGERY Ciliary body ablation with cryo/laser OPTHALMOLOGY LOPT060 L3 Surgery 0 10820 12880 14940 (OPT) # L3 SURGERY OPTHALMOLOGY LOPT081 Excision of lesion of eyebrow (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY Excision of lession of canthus/ eyelid < 5 OPTHALMOLOGY LOPT061 L3 Surgery 0 10820 12880 14940 MM (OPT) # L3 SURGERY OPTHALMOLOGY LOPT082 Exploration of eyelid (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY Extracapsular extraction with implant - OPTHALMOLOGY LOPT062 L3 Surgery 0 10820 12880 14940 unilateral (OPT) # L3 SURGERY Extracapsular extraction without implant OPTHALMOLOGY LOPT063 L3 Surgery 0 10820 12880 14940 - unilateral (OPT) # L3 SURGERY OPTHALMOLOGY LOPT059 Filler injection (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY Goniosynechialysis or goniopuncture OPTHALMOLOGY LOPT064 L3 Surgery 0 10820 12880 14940 (with laser or operatively) (OPT) # L3 SURGERY Implantation of synthetic corneal rings OPTHALMOLOGY LOPT065 for keratoconus (including INTACS) (OPT) L3 Surgery 0 10820 12880 14940 SURGERY # L3 OPTHALMOLOGY LOPT066 Incision of lacrimal Sac (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT067 Iridocyclectomy (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT086 LENSECTOMY (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT068 Mucosal graft to conjunctiva (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY PNEUMORETINOPEXY + CRYO/LASER OPTHALMOLOGY LOPT087 L3 Surgery 0 10820 12880 14940 (OPT) # L3 SURGERY PTERYGIUM EXCISION WITH AUTOGRAFT OPTHALMOLOGY LOPT088 L3 Surgery 0 10820 12880 14940 (OPT) # L3 SURGERY OPTHALMOLOGY LOPT069 Puncto-canaliculoplasty (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY

234 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Removal of foreign body from anterior OPTHALMOLOGY LOPT070 L3 Surgery 0 10820 12880 14940 chamber (OPT) # L3 SURGERY OPTHALMOLOGY LOPT071 Removal of lens IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT072 Repair of corneal wound (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT073 Repair of scleral laceration (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT074 Scar Revision - minor (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT075 Secondary insertion of IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT089 SICS WITH PC IOL (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT090 SILICON OIL REMOVAL (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY Surgical correction of squint horizontal OPTHALMOLOGY LOPT076 L3 Surgery 0 10820 12880 14940 1 muscle (OPT) # L3 SURGERY Surgical correction of squint inferior OPTHALMOLOGY LOPT077 L3 Surgery 0 10820 12880 14940 oblique muscle (OPT) # L3 SURGERY OPTHALMOLOGY LOPT083 Suture of eyebrow (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY Suturring of eyelid laceration (as sole OPTHALMOLOGY LOPT084 L3 Surgery 0 10820 12880 14940 procedure) (OPT) # L3 SURGERY OPTHALMOLOGY LOPT078 Symblepharon release (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT079 Tarsorrhaphy (McLAUGHLEN) (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT091 VITRECTOMY (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT092 VITREOUS BIOPSY (OPT) # L3 L3 Surgery 0 10820 12880 14940 SURGERY OPTHALMOLOGY LOPT125 Anterior Orbitotomy (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT126 Blepharaplasty- one eyelid (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY CORNEO-SCLERAL TEAR REPAIR (OPT) OPTHALMOLOGY LOPT093 L4 Surgery 0 14790 17610 20420 # L4 SURGERY Correction of entropion - lower lid - OPTHALMOLOGY LOPT127 L4 Surgery 0 14790 17610 20420 Weiss procedure (OPT) # L4 SURGERY Correction of entropion - upper lid (OPT) OPTHALMOLOGY LOPT128 L4 Surgery 0 14790 17610 20420 # L4 SURGERY OPTHALMOLOGY LOPT094 Correction of epicanthus (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Cyclodialysis (separation of ciliary body) OPTHALMOLOGY LOPT095 L4 Surgery 0 14790 17610 20420 (OPT) # L4 SURGERY

235 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY LOPT096 DCT (Dacryo cystectomy) (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT097 Drainage of orbit (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT098 Ectropion Surgery (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT099 Entropion (simple) (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT100 Excision of lesion of iris (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Excision of lession of canthus/ eyelid > 5 OPTHALMOLOGY LOPT130 L4 Surgery 0 14790 17610 20420 MM (SOPT) # L4 SURGERY Excission / Biopsy of lacrimal gland OPTHALMOLOGY LOPT101 L4 Surgery 0 14790 17610 20420 (OPT) # L4 SURGERY Excission Conj/ Corneal lession with OPTHALMOLOGY LOPT102 L4 Surgery 0 14790 17610 20420 cryotherapy (OPT) # L4 SURGERY Excission of Extensive warts (growth) OPTHALMOLOGY LOPT103 L4 Surgery 0 14790 17610 20420 (OPT) # L4 SURGERY OPTHALMOLOGY LOPT104 Exploration of orbit (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Eye Lid Reconstruction without graft OPTHALMOLOGY LOPT105 L4 Surgery 0 14790 17610 20420 (OPT) # L4 SURGERY OPTHALMOLOGY LOPT129 Eyelid Repair (bilateral) (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT106 Flap division (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Frontalis sling surgery (unilateral) (OPT) OPTHALMOLOGY LOPT107 L4 Surgery 0 14790 17610 20420 # L4 SURGERY OPTHALMOLOGY LOPT108 gold weight implantaion (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Goniotomy (surgical treatment of OPTHALMOLOGY LOPT109 L4 Surgery 0 14790 17610 20420 glaucoma) (OPT) # L4 SURGERY OPTHALMOLOGY LOPT110 Lateral Tarsal strip (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT111 Lid split with cryotherapy (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT112 MMG (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Phakoemulsification of lens with implant OPTHALMOLOGY LOPT113 L4 Surgery 0 14790 17610 20420 - unilateral (OPT) # L4 SURGERY Phakoemulsification of lens without OPTHALMOLOGY LOPT114 L4 Surgery 0 14790 17610 20420 implant unilateral (OPT) # L4 SURGERY Punctal suturing with 10-0 nylon (OPT) OPTHALMOLOGY LOPT115 L4 Surgery 0 14790 17610 20420 # L4 SURGERY Removal of foreign body from iris (OPT) OPTHALMOLOGY LOPT116 L4 Surgery 0 14790 17610 20420 # L4 SURGERY

236 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY LOPT117 Revision of squint surgery (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY SCELAR FIXATED IOL IMPLANT WITH OPTHALMOLOGY LOPT131 L4 Surgery 0 14790 17610 20420 VITRECTOMY (OPT) # L4 SURGERY OPTHALMOLOGY LOPT132 scleral buckle (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT118 Scleral graft (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY Surgical correction of squint with OPTHALMOLOGY LOPT121 L4 Surgery 0 14790 17610 20420 adjustable sutures (OPT) # L4 SURGERY Surgical correction of squint horizontal OPTHALMOLOGY LOPT119 2 muscles (in one eye, or one muscle in L4 Surgery 0 14790 17610 20420 SURGERY each of two eyes) (OPT) # L4 Surgical correction of squint other OPTHALMOLOGY LOPT120 L4 Surgery 0 14790 17610 20420 vertical muscles (OPT) # L4 SURGERY Surgical trabeculectomy or other OPTHALMOLOGY LOPT122 penetrating glaucoma procedures (OPT) L4 Surgery 0 14790 17610 20420 SURGERY # L4 OPTHALMOLOGY LOPT123 Tarsorrhaphy (bilateral) (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT133 vitrectomy + ERM peeling (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT136 vitrectomy + IOL removal (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT134 vitrectomy + lensectomy (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT135 Vitrectomy + SFIOL (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY OPTHALMOLOGY LOPT124 Wound debridement (major) (OPT) # L4 L4 Surgery 0 14790 17610 20420 SURGERY C3R TREATMENT FOR KERATOCONUS - OPTHALMOLOGY LOPT164 L5 Surgery 0 18010 21440 24870 BILATERAL (OPT) # L5 SURGERY Complex glaucoma surgery (including OPTHALMOLOGY LOPT138 anti-metabolites/insertion of seton (OPT) L5 Surgery 0 18010 21440 24870 SURGERY # L5 CORNEO-SCLERAL TEAR AND IRIS OPTHALMOLOGY LOPT165 L5 Surgery 0 18010 21440 24870 PROPLAPSE REPAIR (OPT) # L5 SURGERY Correction of entropion lower lid or OPTHALMOLOGY LOPT160 L5 Surgery 0 18010 21440 24870 upper lid, including graft/flap (OPT) # L5 SURGERY Correction of lower lid or upper lid OPTHALMOLOGY LOPT161 L5 Surgery 0 18010 21440 24870 ectropion with graft/flap (OPT) # L5 SURGERY Correction of Ptosis of eyelid - Simple/ OPTHALMOLOGY LOPT139 L5 Surgery 0 18010 21440 24870 unilateral (OPT) # L5 SURGERY Cosmetic Procedure (Moderate) (OPT) OPTHALMOLOGY LOPT140 L5 Surgery 0 18010 21440 24870 # L5 SURGERY Debulking of lesion tumour (simple) OPTHALMOLOGY LOPT141 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY

237 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Descemets stripping endothelial OPTHALMOLOGY LOPT142 L5 Surgery 0 18010 21440 24870 keratoplasty (DSEK) (OPT) # L5 SURGERY Enucleation / Eviseratiobn of eye ball OPTHALMOLOGY LOPT143 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY Excision of lession of orbit- medical OPTHALMOLOGY LOPT162 L5 Surgery 0 18010 21440 24870 approach (OPT) # L5 SURGERY excission of extensive eyelid lesions =/- OPTHALMOLOGY LOPT137 L5 Surgery 0 18010 21440 24870 frozen section (OPT) # L5 SURGERY Excission of lesion of orbit- anterior OPTHALMOLOGY LOPT144 L5 Surgery 0 18010 21440 24870 approach (OPT) # L5 SURGERY Exploration of orbit (as sole procedure) OPTHALMOLOGY LOPT145 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY Extensive Repair of eyelid (unilateral ) OPTHALMOLOGY LOPT146 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY External Dacryocysto- OPTHALMOLOGY LOPT147 L5 Surgery 0 18010 21440 24870 rhinostomy(External DCR) (OPT) # L5 SURGERY OPTHALMOLOGY LOPT148 FTSG (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT166 ICL - UNILATERAL (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT149 Inferior Orbitotomy (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY Lamellar graft (keratoplasty) to cornea OPTHALMOLOGY LOPT150 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY Lateral Canthal Reconstruction (OPT) OPTHALMOLOGY LOPT151 L5 Surgery 0 18010 21440 24870 # L5 SURGERY OPTHALMOLOGY LOPT152 Lens implant/exchange (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY Lid split with cryotherapy(bilateral) (OPT) OPTHALMOLOGY LOPT153 L5 Surgery 0 18010 21440 24870 # L5 SURGERY Limbal Stem Cell Allograft Transplant OPTHALMOLOGY LOPT154 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY MFL IMPALNT WITH PHACO - OPTHALMOLOGY LOPT167 L5 Surgery 0 18010 21440 24870 UNILATERAL (OPT) # L5 SURGERY MICS with PCIOL - UNILATERAL (OPT) OPTHALMOLOGY LOPT168 L5 Surgery 0 18010 21440 24870 # L5 SURGERY OPTHALMOLOGY LOPT163 Mucous membrane graft (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY Perforating graft (keratoplasty) to cornea OPTHALMOLOGY LOPT155 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY PHACO WITH IOL AND OPTHALMOLOGY LOPT169 L5 Surgery 0 18010 21440 24870 TRABECULECTOMY (OPT) # L5 SURGERY Revision of previous glaucoma surgery OPTHALMOLOGY LOPT156 L5 Surgery 0 18010 21440 24870 (OPT) # L5 SURGERY SB + CRYO/LASER+DRAINAGE (OPT) OPTHALMOLOGY LOPT170 L5 Surgery 0 18010 21440 24870 # L5 SURGERY

238 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY LOPT157 Scar Revision - Major (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY Simple Reconstruction of socket(not OPTHALMOLOGY LOPT158 L5 Surgery 0 18010 21440 24870 including implant or graft) (OPT) # L5 SURGERY OPTHALMOLOGY LOPT159 Split skin graft (SSG) (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY TORIC IOL IMPLANT WITH PHACO - OPTHALMOLOGY LOPT171 L5 Surgery 0 18010 21440 24870 UNILATERAL (OPT) # L5 SURGERY OPTHALMOLOGY LOPT173 VIT + EL + BB (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT172 VIT + EL (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT174 VIT + ERM +ILM (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT175 VIT + MP + EL (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY VIT + MP + LASER + SOI +/- BB (OPT) OPTHALMOLOGY LOPT176 L5 Surgery 0 18010 21440 24870 # L5 SURGERY OPTHALMOLOGY LOPT177 VIT + PFCL + LASER + SOI (OPT) # L5 L5 Surgery 0 18010 21440 24870 SURGERY OPTHALMOLOGY LOPT179 Blepharoplasty two eyelids (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY Correction of ptosis of eyelid- complex/ OPTHALMOLOGY LOPT195 L6 Surgery 0 27010 32150 37290 uinlateral (OPT) # L6 SURGERY Correction of Ptosis of eyelid - Simple/ OPTHALMOLOGY LOPT178 L6 Surgery 0 27010 32150 37290 Bilateral (OPT) # L6 SURGERY Correction of ptosis of eyelid with OPTHALMOLOGY LOPT196 L6 Surgery 0 27010 32150 37290 autologous fascia lata (OPT) # L6 SURGERY Cosmetic Procedure (Eextensive) (OPT) OPTHALMOLOGY LOPT180 L6 Surgery 0 27010 32150 37290 # L6 SURGERY Dacryocysto-rhinostomy, including OPTHALMOLOGY LOPT181 L6 Surgery 0 27010 32150 37290 insertion of tube (OPT) # L6 SURGERY Debulking of lession (complex) (OPT) OPTHALMOLOGY LOPT182 L6 Surgery 0 27010 32150 37290 # L6 SURGERY OPTHALMOLOGY LOPT183 Endonasal DCR (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY Enucleation / Eviseration of Eyeball with OPTHALMOLOGY LOPT184 L6 Surgery 0 27010 32150 37290 implant (OPT) # L6 SURGERY Excission of lession orbit- Endoscopic OPTHALMOLOGY LOPT185 L6 Surgery 0 27010 32150 37290 approach (OPT) # L6 SURGERY Extensive repair of Eyelids- bialteral OPTHALMOLOGY LOPT197 L6 Surgery 0 27010 32150 37290 (OPT) # L6 SURGERY Eyelid Reconstruction - unilateral / OPTHALMOLOGY LOPT186 L6 Surgery 0 27010 32150 37290 complex (OPT) # L6 SURGERY Frontalis sling surgery (bilateral) (OPT) OPTHALMOLOGY LOPT187 L6 Surgery 0 27010 32150 37290 # L6 SURGERY

239 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Grafts to eyelid/socket from other sites OPTHALMOLOGY LOPT189 L6 Surgery 0 27010 32150 37290 (OPT) # L6 SURGERY Insertion of valve into anterior chamber OPTHALMOLOGY LOPT188 L6 Surgery 0 27010 32150 37290 of eye (OPT) # L6 SURGERY MICS + PCIOL + TRABECULECTOMY OPTHALMOLOGY LOPT199 L6 Surgery 0 27010 32150 37290 (OPT) # L6 SURGERY OPTHALMOLOGY LOPT198 Orbital Exploration (complex) (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY Reconstruction of socket with implant or OPTHALMOLOGY LOPT190 L6 Surgery 0 27010 32150 37290 graft (Simple) (OPT) # L6 SURGERY Removal of foreign body from orbit (OPT) OPTHALMOLOGY LOPT191 L6 Surgery 0 27010 32150 37290 # L6 SURGERY OPTHALMOLOGY LOPT192 Revision of corneal graft (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT193 Secondary Ball Implantation (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT194 Superior Orbitotomy (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT200 VIT + ILM + FGE + GAS/SOI (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT201 VIT + IOFB +/- SOI +/- LASER (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT203 VIT + MP + EL +/- BB (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY OPTHALMOLOGY LOPT202 VIT + MP + EL + SOI (OPT) # L6 L6 Surgery 0 27010 32150 37290 SURGERY VIT + SB + LASER + GAS/SOI +/- PFCL OPTHALMOLOGY LOPT204 L6 Surgery 0 27010 32150 37290 (OPT) # L6 SURGERY Correction of ptosis of eyelid- complex/ OPTHALMOLOGY LOPT206 L7 Surgery 0 36010 42870 49730 Bilateral (OPT) # L7 SURGERY OPTHALMOLOGY LOPT207 Correction of tele canthus (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY Corretion of ptossi of eye lid- bilateral OPTHALMOLOGY LOPT208 L7 Surgery 0 36010 42870 49730 (OPT) # L7 SURGERY OPTHALMOLOGY LOPT209 Debulking (MAJOR) (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT210 DFG (Dermis fat graft) (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY Excission of lesion of orbit- lateral OPTHALMOLOGY LOPT211 L7 Surgery 0 36010 42870 49730 orbitotomy (OPT) # L7 SURGERY Eyelid Reconstruction - Bilateral / OPTHALMOLOGY LOPT205 L7 Surgery 0 36010 42870 49730 complex (OPT) # L7 SURGERY OPTHALMOLOGY LOPT218 ICL - BILATERAL (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY

240 Ophthalmology

Surgery Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level OPTHALMOLOGY LOPT212 Lateral Orbitotomy (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT213 Orbital decompression (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT214 Orbital fracture repair (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY Reconstruction of socket with implant OPTHALMOLOGY LOPT215 L7 Surgery 0 36010 42870 49730 and graft (complex) (OPT) # L7 SURGERY OPTHALMOLOGY LOPT219 ROP SURGERY (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT216 Temporalis fascia transfer (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT217 Trans Nasal wiring (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY OPTHALMOLOGY LOPT220 VIT + IOFB + EL + SOI +/- BB (OPT) # L7 L7 Surgery 0 36010 42870 49730 SURGERY VIT + MP + EL + SOI/GAS +/- BB (OPT) OPTHALMOLOGY LOPT221 L7 Surgery 0 36010 42870 49730 # L7 SURGERY VIT + PFCL + EL + SOI +/- BB (OPT) # OPTHALMOLOGY LOPT222 L7 Surgery 0 36010 42870 49730 L7 SURGERY OPTHALMOLOGY LOPT223 Exenteration of the Orbit (OPT) # L8 L8 Surgery 0 45010 53580 62150 SURGERY

241 Ophthalmology Critical Care

242 Critical Care

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PCRC012 DRESSING MINOR - CRC Procedure CRITICAL CARE 70 80 90 110 PCRC053 ECG -CRC Procedure CRITICAL CARE 110 110 130 160 PCRC030 SUTURING MINOR - CRC Procedure CRITICAL CARE 120 130 150 170 PCRC020 NEBULIZATION - CRC Procedure CRITICAL CARE 140 150 180 210 PHYSIOTHERAPY CHEST / BREATHING PCRC024 Procedure CRITICAL CARE 140 150 180 210 EXERCISE PCRC054 NG TUBE PLACEMENT - CRC Procedure CRITICAL CARE 180 190 220 260 PCRC001 ALPHA BED - ALPHA Procedure CRITICAL CARE 190 200 230 270 PCRC011 DRESSING MAJOR - CRC Procedure CRITICAL CARE 190 200 230 270 PCRC019 MISCELLANEOUS PROCEDURE - CRC Procedure CRITICAL CARE 200 210 250 290 PCRC029 SUTURING MAJOR - CRC Procedure CRITICAL CARE 220 230 280 320 PCRC056 TRACHEOSTOMY TUBE CHANGE PER - CRC Procedure CRITICAL CARE 320 330 390 460 PCRC002 ALPHA BED - ALPHATRANCELL Procedure CRITICAL CARE 370 390 460 540 PCRC016 LUMBAR PUNCTURE - CRC Procedure CRITICAL CARE 440 460 550 640 PCRC035 ICU Screening Ultrasound Procedure CRITICAL CARE 480 500 590 690 OphthalmologyPCRC018 MISC PROCEDURE IN ICU Procedure CRITICAL CARE 480 500 590 690 PCRC006 ASCITIC TAP - CRC Procedure CRITICAL CARE 490 510 610 710 PCRC003 ALPHA BED - ALPHAXCELL Procedure CRITICAL CARE 610 640 770 890 PCRC050 INTRA HOSPITAL TRANSPORT - CRC Procedure CRITICAL CARE 640 670 800 920 PCRC055 SEDATION MAJOR - CRC Procedure CRITICAL CARE 640 670 800 920 PCRC039 APEX BED - PM100 - B4 Procedure CRITICAL CARE 650 680 810 940 PCRC023 PFT - SPIROMETRY Procedure CRITICAL CARE 660 690 820 960 PCRC021 NIGHT OXIMETRY Procedure CRITICAL CARE 680 720 850 990 PCRC026 PLEURAL TAPPING - CRC Procedure CRITICAL CARE 680 720 850 990 PCRC038 APEX BED - DYNAFLOW Procedure CRITICAL CARE 780 810 970 1120 PCRC027 POP CHARGES Procedure CRITICAL CARE 820 860 1030 1190 PCRC004 ALPHA BED - NIMBUS Procedure CRITICAL CARE 920 970 1150 1340 PCRC037 ALPHA BED - FLOWTRON Procedure CRITICAL CARE 940 980 1170 1360 PCRC034 TRANSPORT Procedure CRITICAL CARE 1040 1090 1300 1510 PCRC005 ARTERIAL LINE - CRC Procedure CRITICAL CARE 1060 1120 1330 1540 PCRC052 CPR - CRC Procedure CRITICAL CARE 1060 1120 1330 1540 PCRC017 MINITRACHEOSTOMY Procedure CRITICAL CARE 1090 1140 1360 1570 PCRC033 TRACHEOSTOMY MINI - PCRC Procedure CRITICAL CARE 1090 1140 1360 1570 PCRC015 LARGE VOLUME AND PARACENTESIS Procedure CRITICAL CARE 1180 1240 1470 1710 BONE MARROW/PLEURAL/LIVER/LUNG/ PCRC007 Procedure CRITICAL CARE 1240 1300 1540 1790 TISSUE BI PCRC010 CENTRAL LINE - CRC Procedure CRITICAL CARE 1240 1300 1540 1790 PCRC028 REUSCITATION (ACTIVE) Procedure CRITICAL CARE 1240 1300 1540 1790

243 Critical Care

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PCRC014 INTERCOSTAL DRAINAGE - CRC Procedure CRITICAL CARE 1260 1320 1570 1820 PCRC040 ENDOTRACHEAL INTUBATION - CRC Procedure CRITICAL CARE 1570 1650 1960 2270 PCRC051 INTER HOSPITAL TRANSPORT - CRC Procedure CRITICAL CARE 1570 1650 1960 2270 PCRC031 TPN PLANNING Procedure CRITICAL CARE 1630 1710 2030 2360 PCRC032 TRACHEOSTOMY - PCRC Procedure CRITICAL CARE 1630 1710 2030 2360 PCRC025 PLEURAL BIOPSY - CRC Procedure CRITICAL CARE 1740 1830 2180 2520 PCRC008 BRONCHOSCOPIC PROCEDURE - CRC Procedure CRITICAL CARE 1780 1860 2220 2570 PCRC047 TCD - CRC Procedure CRITICAL CARE 1880 1970 2350 2720 PCRC009 BRONCHOSCOPY - CRC Procedure CRITICAL CARE 1980 2080 2480 2870 PCRC058 BIPAP INITIATION CHARGES Procedure CRITICAL CARE 3000 3000 3000 3000 PCRC057 VENTILLATION INITIATION CHARGES Procedure CRITICAL CARE 3000 3000 3000 3000 HD CATHETER INSERTION TRIPLE/DOUBLE PCRC048 Procedure CRITICAL CARE 3120 3280 3900 4520 LUMEN-CRC PCRC044 INITIATION OF DIALYSIS -CRC Procedure CRITICAL CARE 4100 4300 5120 5940 PLEURAL DRAIN USG GUIDED PCRC042 Procedure CRITICAL CARE 4980 5230 6230 7230 (THERAPEUTIC) - CRC ASCITIC TAP USG GUIDED-THERAPEUTIC PCRC043 Procedure CRITICAL CARE 5240 5500 6550 7590 -CRC PCRC045 INITIATION OF INOTROPES - CRC Procedure CRITICAL CARE 6230 6540 7780 9030 PCRC046 PRONE VENTILATION - CRC Procedure CRITICAL CARE 6230 6540 7780 9030 PPIC019 OXYGEN HOURLY Procedure PAEDIATRIC ICU 70 80 90 110 PPIC018 NEBULIZATION FOR ASTHMA Procedure PAEDIATRIC ICU 130 140 160 190 PPIC017 NEBULIZATION - PIC Procedure PAEDIATRIC ICU 130 140 160 190 PPIC020 PICU HOURLY CHARGE Procedure PAEDIATRIC ICU 190 200 230 270 PPIC009 ENDOTRACHEAL INTUBATION Procedure PAEDIATRIC ICU 330 340 410 470 PPIC024 SEDATION CHARGE - PIC Procedure PAEDIATRIC ICU 330 340 410 470 PPIC011 INFUSION OF VASOACTIVE DRUGS - PIC Procedure PAEDIATRIC ICU 420 440 520 610 PPIC012 INITIAL STABILIZATION Procedure PAEDIATRIC ICU 480 500 590 690 PPIC002 ASCITIC TAP - PIC Procedure PAEDIATRIC ICU 560 580 690 810 PPIC015 LUMBAR PUNCTURE - PIC Procedure PAEDIATRIC ICU 560 580 690 810 PPIC026 SUPRAPUBIC BLADDER TAP - PIC Procedure PAEDIATRIC ICU 560 580 690 810 PPIC016 MISCELLANEOUS PROCEDURE - PIC Procedure PAEDIATRIC ICU 610 640 770 890 PPIC028 ULTRASOUND CRANIAL Procedure PAEDIATRIC ICU 760 800 950 1110 PPIC029 VENESECTION - PIC Procedure PAEDIATRIC ICU 760 800 950 1110 PPIC001 ARTERIAL LINE - PERIPHERAL - PIC Procedure PAEDIATRIC ICU 840 890 1050 1220 PPIC025 SPIROMETRY - PIC Procedure PAEDIATRIC ICU 950 1000 1180 1370

244 Critical Care

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PLEURAL PERICARDIAL / SUBDULAR / PPIC022 Procedure PAEDIATRIC ICU 1050 1100 1310 1520 VENTRICULAR TAP PPIC014 INTERCOASTAL DRAINAGE Procedure PAEDIATRIC ICU 1150 1210 1440 1670 PPIC003 BIOPSY - BONE MARROW AND ASPIRATION Procedure PAEDIATRIC ICU 1180 1240 1470 1710 PPIC004 BIOPSY - LIVER KIDNEY Procedure PAEDIATRIC ICU 1180 1240 1470 1710 PPIC006 CENTRAL LINE - PIC Procedure PAEDIATRIC ICU 1360 1430 1700 1970 PPIC023 RESUSCITATION ACTIVE - PIC Procedure PAEDIATRIC ICU 1370 1440 1720 1990 CONTINUOUS ARTERIO-VENOUS HAEMO PPIC007 Procedure PAEDIATRIC ICU 1510 1590 1890 2190 FILTRATION PPIC027 TOTAL PARENTAL NUTRITION PLANNING Procedure PAEDIATRIC ICU 1820 1910 2280 2640 PPIC021 PLASMA PHRESIS Procedure PAEDIATRIC ICU 2050 2150 2560 2970 PPIC010 EXCHANGE TRANFUSION Procedure PAEDIATRIC ICU 2550 2670 3180 3690 PPIC005 BRONCHOSCOPY FLEXIABLE Procedure PAEDIATRIC ICU 3800 3990 4750 5510 PPIC008 DIALYSIS - PERITONEAL Procedure PAEDIATRIC ICU 5610 5890 7010 8130

245 Pulmonology

246 Pulmonology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group INTERVENTIONAL KIPM045 Sleep lab-titration study procedure Package PULMONOLOGY 0 12080 14380 16680 MEDICINE PACKAGE INTERVENTIONAL KIPM044 EBUS grade 2 with OT Package PULMONOLOGY 0 27780 33070 38360 MEDICINE PACKAGE INTERVENTIONAL KIPM043 Thoracoscopy and pleural BX Package PULMONOLOGY 0 27780 33070 38360 MEDICINE PACKAGE PAEDIATRIC PPUL003 SPIROMETRY - PEP Procedure 1100 1150 1370 1590 PULMONOLOGY PAEDIATRIC PPUL001 BRONCHOSCOPY FLEXIBLE - PEP Procedure 4370 4590 5470 6340 PULMONOLOGY PAEDIATRIC PPUL002 SLEEP STUDY Procedure 7930 8320 9910 11490 PULMONOLOGY RESPIRATORY PRES006 PLEURAL TAPPING - RES Procedure MEDICINE 820 860 1030 1190 PULMNOLOGY RESPIRATORY PRES007 PULMONARY FUNCTION TEST Procedure MEDICINE 820 860 1030 1190 PULMNOLOGY RESPIRATORY PRES014 SIX MINUTE WALK TEST Procedure MEDICINE 820 860 1030 1190 PULMNOLOGY RESPIRATORY PRES003 FNAC LUNG Procedure MEDICINE 1910 2010 2390 2770 PULMNOLOGY RESPIRATORY PRES005 PLEURAL BIOPSY - RES Procedure MEDICINE 2190 2300 2740 3170 PULMNOLOGY RESPIRATORY PRES010 PLEURAL THROMBOLYSIS Procedure MEDICINE 3010 3160 3760 4360 PULMNOLOGY RESPIRATORY PRES002 BRONCHOSCOPY FIBREOPTIC - RES Procedure MEDICINE 3280 3450 4100 4760 PULMNOLOGY RESPIRATORY PRES012 PLEURODESIS Procedure MEDICINE 3420 3590 4270 4960 PULMNOLOGY RESPIRATORY PRES009 DIFFUSION STUDY Procedure MEDICINE 4100 4300 5120 5940 PULMNOLOGY RESPIRATORY TBNA (TRANS BRONCHIAL NEEDLE PRES013 Procedure MEDICINE 4790 5030 5980 6940 ASPIRATION) PULMNOLOGY RESPIRATORY PRES008 TITRATION SLEEP STUDY Procedure MEDICINE 5060 5320 6330 7340 PULMNOLOGY

247 Pulmonology

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group RESPIRATORY PRES004 ICD INSERTION Procedure MEDICINE 6700 7030 8370 9710 PULMNOLOGY RESPIRATORY PRES017 Sleep study procedure Procedure MEDICINE 8050 8460 10070 11680 PULMNOLOGY RESPIRATORY PRES011 VIDEO BRONCHOSCOPY Procedure MEDICINE 9840 10330 12300 14260 PULMNOLOGY RESPIRATORY PRES001 BASELINE SLEEP STUDY Procedure MEDICINE 10930 11480 13660 15850 PULMNOLOGY RESPIRATORY TRANS BRONCHIAL LUNG BIOPSY PRES015 Procedure MEDICINE 12770 13410 15960 18510 (TBLB PULMNOLOGY RESPIRATORY PRES019 Lab sleep study Procedure MEDICINE 19730 20710 24660 28600 PULMNOLOGY RESPIRATORY Bronchoscopy closure of PRES021 Procedure MEDICINE 34500 36230 43130 50030 bronchopleural fistula PULMNOLOGY RESPIRATORY PRES020 Pleuroscopy Procedure MEDICINE 34500 36230 43130 50030 PULMNOLOGY RESPIRATORY PRES023 EBUS procedure Procedure MEDICINE 40250 42270 50320 58370 PULMNOLOGY EBUS Linear staging & Biopsy RESPIRATORY LRES001 L3 Surgery 0 10820 12880 14940 under GA -OT procedure # L3 MEDICINE SURGERY

248 Anaesthesia & Pain Management

249 Anaesthesia & Pain Management

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

ANAESTHESIA PANA023 Interventional - Level 1 Procedure 360 380 450 520 PROCEDURES ANAESTHESIA PANA017 CT Scan (Simple) Procedure 480 500 590 690 PROCEDURES ANAESTHESIA PANA024 Interventional - Level 2 Procedure 520 550 650 760 PROCEDURES ANAESTHESIA PANA008 LUMBAR PUNCTURE Procedure 590 620 740 860 PROCEDURES ANAESTHESIA PANA018 CT Scan (Complex) Procedure 680 720 850 990 PROCEDURES ANAESTHESIA PANA032 Difficult IV Cannulation - ANA Procedure 690 730 870 1010 PROCEDURES ANAESTHESIA PANA019 MRI Scan (Simple) Procedure 740 780 920 1070 PROCEDURES ANAESTHESIA PANA001 PATIENT CONTROLLED ANALGESIA Procedure 960 1010 1200 1390 PROCEDURES ANAESTHESIA PANA020 MRI Scan (Complex) Procedure 1090 1140 1360 1570 PROCEDURES ANAESTHESIA PANA035 Monitored Anaesthesia Consul(MAC) Procedure 1150 1210 1440 1670 PROCEDURES ANAESTHESIA PANA021 CT Guided Procedure Procedure 1180 1240 1470 1710 PROCEDURES ANAESTHESIA PANA002 RECORDING AND CD-A (Upto 1/2Hour) Procedure 1180 1240 1470 1710 PROCEDURES ANAESTHESIA PANA022 US Guided Procedure Procedure 1180 1240 1470 1710 PROCEDURES ANAESTHESIA PANA025 Interventional - Level 3 Procedure 1240 1300 1540 1790 PROCEDURES ANAESTHESIA PANA006 ARTERIAL LINE Procedure 1300 1370 1630 1890 PROCEDURES ANAESTHESIA PANA010 REUSCITATION (ACTIVE) - ANA Procedure 1300 1370 1630 1890 PROCEDURES ANAESTHESIA PANA004 ENTANOX FOR LABOUR ANALGESIA Procedure 1370 1440 1720 1990 PROCEDURES ANAESTHESIA PANA007 CENTRAL LINE Procedure 1510 1590 1890 2190 PROCEDURES Anesthesia Administration Charges - ANAESTHESIA PANA033 Procedure 1540 1620 1920 2230 ANA PROCEDURES ANAESTHESIA PANA026 Interventional - Level 4 Procedure 2330 2440 2910 3370 PROCEDURES ANAESTHESIA PANA013 OBSTETRIC ANALGESIA Procedure 2330 2440 2910 3370 PROCEDURES ANAESTHESIA PANA012 POST OPERATIVE EPIDURAL ANALGESIA Procedure 2330 2440 2910 3370 PROCEDURES RECORDING AND CD-B (More than ANAESTHESIA PANA003 Procedure 2330 2440 2910 3370 1/2Hour) PROCEDURES

250 Anaesthesia & Pain Management

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

ANAESTHESIA PANA015 EPIDURAL INJECTION - ANA Procedure 2600 2730 3250 3770 PROCEDURES ANAESTHESIA PANA005 BRACHY ANAESTHESIA Procedure 2740 2880 3430 3970 PROCEDURES ANAESTHESIA PANA031 Caudal Epidural Anesthesia - ANA Procedure 2760 2900 3450 4010 PROCEDURES ANAESTHESIA PANA029 Unilateral Minor Block - ANA Procedure 2760 2900 3450 4010 PROCEDURES ANAESTHESIA PANA014 LUMBAR DRAIN PLACEMENT - ANA Procedure 3140 3300 3930 4560 PROCEDURES ANAESTHESIA PANA009 BRONCHOSCOPY FIBREOPTIC Procedure 3420 3590 4270 4960 PROCEDURES ANAESTHESIA PANA027 Interventional - Level 5 Procedure 3970 4170 4960 5760 PROCEDURES ANAESTHESIA PANA034 Unilateral Major Block - ANA Procedure 4140 4350 5180 6010 PROCEDURES SEDATION CHARGES (INTERVENTIONAL INTERVENTIONAL PAIN PIPM014 Procedure 6840 7180 8540 9910 PAIN MEDICINE) MEDICINE INTERVENTIONAL PAIN KIPM010 CONTINOUS PLEXUS BLOCK PACKAGE Package 0 16910 20130 23350 MEDICINE PACKAGE DIFFERENTIAL DIAGNOSTIC BLOCK INTERVENTIONAL PAIN KIPM011 Package 0 16910 20130 23350 PACKAGE MEDICINE PACKAGE INTER SCALENE BLOCK/SUPRA INTERVENTIONAL PAIN KIPM014 Package 0 16910 20130 23350 CLAVICULAR/LUM WITH STIM PACKAGE MEDICINE PACKAGE INTERVENTIONAL PAIN KIPM001 Genicular nerve block of knees Package 0 30920 36800 42690 MEDICINE PACKAGE LUMBAR FACET BLOCK PER INTERVENTIONAL PAIN KIPM003 Package 0 30920 36800 42690 SITEUNDER FLUOROSCOPY PACKAGE MEDICINE PACKAGE LUMBAR MEDIAN NERVE INJECTION INTERVENTIONAL PAIN KIPM004 PER SITE UNDER FLUOROSCOPY Package 0 30920 36800 42690 MEDICINE PACKAGE PACKAGE LUMBAR ROOT INJECTION UNDER INTERVENTIONAL PAIN KIPM005 Package 0 30920 36800 42690 FLUOROSCOPY PACKAGE MEDICINE PACKAGE INTERVENTIONAL PAIN KIPM029 LUMBAR FACET BILATERAL PACKAGE Package 0 32610 38820 45030 MEDICINE PACKAGE SACROILIAC INJECTION UNDER INTERVENTIONAL PAIN KIPM027 Package 0 32610 38820 45030 FLUOROSCOPY-BILATERAL PACKAGE MEDICINE PACKAGE PAIN PALLIATIVE PPPS013 GROUP THERAPHY Procedure 340 360 420 490 MEDICINE PAIN PALLIATIVE PPPS001 BIO-FEEDBACK Procedure 420 440 520 610 MEDICINE PAIN PALLIATIVE PPPS015 INDIVIDUAL COUNSELLING Procedure 420 440 520 610 MEDICINE PAIN PALLIATIVE PPPS030 PSYCHOANALYSIS Procedure 420 440 520 610 MEDICINE

251 Anaesthesia & Pain Management

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PAIN PALLIATIVE PPPS032 PSYCHOTHERAPHY Procedure 420 440 520 610 MEDICINE PAIN PALLIATIVE PPPS008 COGNITIVE-BEHAVIORAL THERAPY Procedure 560 580 690 810 MEDICINE PAIN PALLIATIVE PPPS007 COGNITIVE BEHAVIOURAL THERAPHY Procedure 560 580 690 810 MEDICINE PAIN PALLIATIVE PPPS017 INITIAL SCREENING AND COUNSELLING Procedure 560 580 690 810 MEDICINE INITIAL SCREENING & COUNSELLING PAIN PALLIATIVE PPPS016 Procedure 560 580 690 810 - PPS MEDICINE PAIN PALLIATIVE PPPS012 FAMILY COUNSELLING Procedure 590 620 740 860 MEDICINE PAIN PALLIATIVE PPPS014 GROUP THERAPY Procedure 590 620 740 860 MEDICINE PAIN PALLIATIVE PPPS033 RELAXATION THERAPY Procedure 610 640 770 890 MEDICINE PAIN PALLIATIVE PPPS031 PSYCHOMETRIC TESTS Procedure 640 670 800 920 MEDICINE PAIN PALLIATIVE PPPS018 INTER COSTAL BLOCK PER SITE Procedure 1040 1090 1300 1510 MEDICINE PAIN PALLIATIVE PPPS041 TRIGGER POINT INJECTIONS Procedure 1040 1090 1300 1510 MEDICINE PAIN PALLIATIVE PPPS009 CONTINOUS PLEXUS BLOCK Procedure 3140 3300 3930 4560 MEDICINE PAIN PALLIATIVE PPPS021 INTRA PLEURAL CATHETER BLOCK Procedure 3700 3880 4620 5360 MEDICINE PAIN PALLIATIVE PPPS029 PARAVERTEBRAL CATHETER BLOCK Procedure 3700 3880 4620 5360 MEDICINE PAIN PALLIATIVE PPPS035 SPHENOPALATINE BLOCK 1 Procedure 3700 3880 4620 5360 MEDICINE INTER SCALENE BLOCK/SUPRA PAIN PALLIATIVE PPPS020 Procedure 4650 4880 5810 6740 CLAVICULAR/LUM WITH STIM MEDICINE INTER SCALENE BLOCK/SUPRA PAIN PALLIATIVE PPPS019 Procedure 4650 4880 5810 6740 CLAVICU/LUM WITHOUT STIM MEDICINE PAIN PALLIATIVE PPPS037 STELLATE BLOCK Procedure 4650 4880 5810 6740 MEDICINE PAIN PALLIATIVE PPPS004 CERVICAL EPIDURAL STEROIDS Procedure 5740 6030 7180 8330 MEDICINE PAIN PALLIATIVE PPPS022 LIDOCAINE INFUSION TESTS Procedure 5740 6030 7180 8330 MEDICINE PAIN PALLIATIVE PPPS023 LUMBAR EPIDURAL STEROIDS Procedure 5740 6030 7180 8330 MEDICINE PAIN PALLIATIVE PPPS039 THORACIC EPIDURAL STEROIDS Procedure 5740 6030 7180 8330 MEDICINE

252 Anaesthesia & Pain Management

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PAIN PALLIATIVE PPPS010 DIFFERENTIAL DIAGNOSTIC BLOCK Procedure 7650 8030 9560 11090 MEDICINE LUMBAR SYMPATHETIC BLOCK UNDER PAIN PALLIATIVE PPPS028 Procedure 7650 8030 9560 11090 FLUOROSCOPY MEDICINE SACROILIAC INJECTION UNDER PAIN PALLIATIVE PPPS034 Procedure 8740 9180 10930 12680 FLUOROSCOPY MEDICINE LUMBAR FACET BLOCK PER PAIN PALLIATIVE PPPS025 Procedure 9020 9470 11270 13080 SITEUNDER FLUOROSCOPY MEDICINE PAIN PALLIATIVE PPPS011 DREZ LESION UNDER FLUOROSCOPY Procedure 9570 10050 11960 13880 MEDICINE LUMBAR ROOT INJECTION UNDER PAIN PALLIATIVE PPPS027 Procedure 9570 10050 11960 13880 FLUOROSCOPY MEDICINE THORACIC GANGLIOLYSIS UNDER PAIN PALLIATIVE PPPS040 Procedure 9570 10050 11960 13880 FLUOROSCOPY OR CT MEDICINE CELIAC PLEXUS BLOCK UNDER PAIN PALLIATIVE PPPS003 Procedure 9840 10330 12300 14260 FLUOROSCOPY MEDICINE CERVICAL FACET BLOCK PER SITE PAIN PALLIATIVE PPPS006 Procedure 9840 10330 12300 14260 UNDER FLUOROSCOPY MEDICINE LUMBAR MEDIAN NERVE INJECTION PAIN PALLIATIVE PPPS026 Procedure 9840 10330 12300 14260 PER SITE UNDER FLUOR MEDICINE PAIN PALLIATIVE PPPS036 SPHENOPALATINE BLOCK 2 Procedure 9840 10330 12300 14260 MEDICINE SUPERIOR HYPOGASTRIC PLEXUS PAIN PALLIATIVE PPPS038 Procedure 9840 10330 12300 14260 BLOCK UNDER FLUOROSCOP MEDICINE CERVICAL EPIDURAL STEROIDS UNDER PAIN PALLIATIVE PPPS005 Procedure 10390 10910 12990 15060 FLUOROSCOPY MEDICINE LUMBAR EPIDURAL STEROIDS UNDER PAIN PALLIATIVE PPPS024 Procedure 10390 10910 12990 15060 FLUOROSCOPY MEDICINE CAUDAL BLOCK WITH NEUROLYSIS PAIN PALLIATIVE PPPS002 Procedure 10930 11480 13660 15850 UNDER FLUORO MEDICINE PRHU002 CBT Procedure RHEUMATOLOGY 360 380 450 520 INTRA ARTICULAR INJECTION - MINOR PRHU007 Procedure RHEUMATOLOGY 360 380 450 520 - RHE PRHU001 ASPIRATION (DASP-RHE) Procedure RHEUMATOLOGY 590 620 740 860 PRHU008 REHAB Procedure RHEUMATOLOGY 590 620 740 860 INTRA ARTICULAR INJECTION - PRHU006 Procedure RHEUMATOLOGY 680 720 850 990 MEDIUM - RHE INTRA ARTICULAR INJECTION - MAJOR PRHU005 Procedure RHEUMATOLOGY 1240 1300 1540 1790 - RHE PRHU003 INFUSION - TYPE 1 LESS RISK Procedure RHEUMATOLOGY 1370 1440 1720 1990 PRHU004 INFUSION - TYPE 2 DIFFICULT Procedure RHEUMATOLOGY 3830 4030 4790 5560

253 IVF

254 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group VASOGRAPHY - MICROSURG (LAND) LAND001 L2 Surgery IVF ART SURGERY 0 8240 9810 11380 L2 # L2 LAND002 FRENULOPLASTY (LAND) L3 # L3 L3 Surgery IVF ART SURGERY 0 10820 12880 14940 LAND003 TESA (LAND) L3 # L3 L3 Surgery IVF ART SURGERY 0 10820 12880 14940 CYSTSCOPY AND DILATATION OF LAND004 L4 Surgery IVF ART SURGERY 0 14790 17610 20420 URETHRA UNDER GA (LAND) L4 # L4 PESA - MICROSURG PERC EPI LAND005 L4 Surgery IVF ART SURGERY 0 14790 17610 20420 SPERM ASP (LAND) L4 # L4 CIRCUMCISION UNDER GA (LAND) LAND006 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 L5 # L5 ELECTRO EJACULATION (LAND) L5 LAND007 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 # L5 LAND008 EVERSION SAC (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 LAND009 ORCHIDECTOMY U/L (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 LAND010 MESA (LAND) L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 LAND011 ORCHIDECTOMY B/L (LAND) L6 # L6 L6 Surgery IVF ART SURGERY 0 27010 32150 37290 ORCHIDOPEXY - MICROSURG (U/L) LAND012 L6 Surgery IVF ART SURGERY 0 27010 32150 37290 (LAND) L6 # L6 TUR - EJACULATORY DUCT (LAND) LAND013 L6 Surgery IVF ART SURGERY 0 27010 32150 37290 L6 # L6 LAND014 MICRO TESE (LAND) L6 # L6 L6 Surgery IVF ART SURGERY 0 27010 32150 37290 Micro Surgical VARICOCELE(UL) LAND015 L6 Surgery IVF ART SURGERY 0 27010 32150 37290 (LAND) L6 # L6 ORCHIDOPEXY - MICROSURGERY LAND016 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 (B/L) (LAND) L7 # L7 SURGERY FOR PRIAPISM (LAND) L7 LAND017 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 # L7 SUSPENSORY LIGAMENT SURGERY LAND018 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 (LAND) L7 # L7 Micro Surgical VARICOCELE(BL) LAND019 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 (LAND) L7 # L7 LAND020 VVA (LAND) L7 # L7 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 LAND021 VEA (LAND) L7 # L7 L7 Surgery IVF ART SURGERY 0 36010 42870 49730 VENOUS LEAK SURGERY (LAND) L8 LAND022 L8 Surgery IVF ART SURGERY 0 45010 53580 62150 # L8 PLAQUE /CURVATURE Surgery LAND023 L8 Surgery IVF ART SURGERY 0 45010 53580 62150 (LAND) L8 # L8 Lengheing Procedure (LAND) L9 # LAND024 L9 Surgery IVF ART SURGERY 0 54020 64300 74590 L9 LAND025 Penile prosthesis (LAND) L9 # L9 L9 Surgery IVF ART SURGERY 0 54020 64300 74590 CORPOROPLICATION Surgery (LAND) LAND026 L8 Surgery IVF ART SURGERY 0 45010 53580 62150 L8 # L8 LAND027 TVT Sling Procedure (IVF ) # L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870

255 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group LAND028 TOT Sling Procedure (IVF ) # L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 LAND029 Bilateral Hydrocoelectomy L5 # L5 L5 Surgery IVF ART SURGERY 0 18010 21440 24870 Diagnostic Hysteroscopy (ANR) L2 LANR001 L2 Surgery IVF ART SURGERY 0 8240 9810 11380 # L2 IVF ART PAND001 ACROSIN PROACROSIN ASSAY Procedure 1040 1090 1300 1510 PROCEDURES ADDITIONAL EMPRO TRANFER IN IVF ART PAND002 Procedure 34160 35870 42700 49530 SAME CYCLE PROCEDURES IVF ART PAND003 AID Procedure 20500 21520 25620 29720 PROCEDURES IVF ART PAND004 AID-CANCEL CYCLE REFUND Procedure 11210 11770 14010 16250 PROCEDURES IVF ART PAND005 AIH Procedure 17760 18650 22200 25750 PROCEDURES IVF ART PAND006 AIH-CANCEL CYCLE REFUND Procedure 8480 8900 10600 12290 PROCEDURES IVF ART PAND007 ANTISPERM ANTIBODY SPERM TEST Procedure 1650 1730 2060 2390 PROCEDURES ASSESSMENT OF REACTIVE OXYGEN IVF ART PAND008 Procedure 2050 2150 2560 2970 SPECIES PROCEDURES ASSESSMENT OF THE INTEGRITY OF IVF ART PAND009 Procedure 2050 2150 2560 2970 SPERM CHROMATIN ST PROCEDURES IVF ART PAND010 CIRCUMCISION Procedure 20500 21520 25620 29720 PROCEDURES CIS TEST - COMBINED INJECTION & IVF ART PAND011 Procedure 3140 3300 3930 4560 STIMULATION PROCEDURES IVF ART PAND012 CYST ASPIRATION - USG GUIDED Procedure 6160 6470 7700 8930 PROCEDURES IVF ART PAND013 CYST ASPIRATION - B - AND Procedure 5190 5450 6490 7530 PROCEDURES IVF ART PAND014 DONOR SAMPLE PROCESSING Procedure 9840 10330 12300 14260 PROCEDURES DONOR SEMEN SAMPLE WITHOUT IVF ART PAND015 Procedure 6160 6470 7700 8930 PROCESSING PROCEDURES IVF ART PAND016 DONOR SPERM FOR IVF/ICSI Procedure 12300 12910 15370 17830 PROCEDURES IVF ART PAND017 EGG DONATION (DLX) THIRD PARTY Procedure 194010 203710 242510 281310 PROCEDURES IVF ART PAND018 EGG DONATION (NOR) THIRD PARTY Procedure 184440 193660 230550 267440 PROCEDURES EGG SHARING (DLX) SELF CYCLE- IVF ART PAND019 Procedure 194010 203710 242510 281310 SEC.RECIPIENT PROCEDURES EGG SHARING (NOR) SELF CYCLE- IVF ART PAND020 Procedure 169410 177880 211760 245640 SEC.RECIPIENT PROCEDURES

256 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EIPDIDYMAL - TESTIS SPERM IVF ART PAND021 Procedure 31420 32990 39280 45560 ASPIRATION PROCEDURES IVF ART PAND022 ELECTRO EJACULATION Procedure 10670 11200 13330 15460 PROCEDURES EMBRYO DONATION CYCLING - IVF ART PAND023 Procedure 194010 203710 242510 281310 (DLX) PROCEDURES EMBRYO DONATION CYCLING - IVF ART PAND024 Procedure 184440 193660 230550 267440 (NOR) PROCEDURES EMBRYO DONATION NON-CYCLING IVF ART PAND025 Procedure 169410 177880 211760 245640 (DLX) PROCEDURES EMBRYO DONATION NON-CYCLING IVF ART PAND026 Procedure 143460 150630 179320 208010 (NOR) PROCEDURES IVF ART PAND028 ENDOMETRIAL BIOPSY Procedure 3140 3300 3930 4560 PROCEDURES IVF ART PAND029 ESTIMATION OF DNA CONTENT Procedure 2050 2150 2560 2970 PROCEDURES IVF ART PAND030 FOLLICULAR SCAN Procedure 1510 1590 1890 2190 PROCEDURES IVF ART PAND031 FRENULOPLASTY - PAND Procedure 20500 21520 25620 29720 PROCEDURES IVF ART PAND032 HEMI ZONA BINDING ASSAY Procedure 8200 8610 10250 11890 PROCEDURES IN-VITRO CERVICAL MUCUS IVF ART PAND033 Procedure 1040 1090 1300 1510 PENETRATION TEST PROCEDURES IVF ART PAND034 IUCD INSERTION - AND Procedure 5190 5450 6490 7530 PROCEDURES IVF ART PAND035 IUCD REMOVAL - AND Procedure 3140 3300 3930 4560 PROCEDURES IVF ART PAND036 IUI ONLY Procedure 8740 9180 10930 12680 PROCEDURES IVF ART PAND037 IVF CANCEL - TOTAL CYCLE Procedure 12850 13490 16060 18630 PROCEDURES IVF ART PAND038 IVF COUNSELLING Procedure 560 580 690 810 PROCEDURES IVF ART PAND039 IVF/ICSI-(DLX) 3 CYCLE PACKAGE Procedure 398940 418890 498670 578460 PROCEDURES IVF ART PAND040 IVF/ICSI-(NOR) 3 CYCLE PACKAGE Procedure 330630 347160 413290 479410 PROCEDURES IVF ART PAND041 IVF/ICSI-DELUXE Procedure 177610 186490 222010 257530 PROCEDURES IVF ART PAND042 IVF/ICSI-NORMAL Procedure 146190 153500 182740 211980 PROCEDURES IVF-ICSI CANCEL CYCLE AFTER EGG IVF ART PAND043 Procedure 73780 77470 92220 106980 ASPIRATION PROCEDURES IVF-ICSI CANCEL CYCLE BEFORE IVF ART PAND044 Procedure 31420 32990 39280 45560 EGG ASPIRATION PROCEDURES

257 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group IVF ART PAND045 MESA Procedure 23230 24400 29040 33690 PROCEDURES IVF ART PAND046 PESA Procedure 17760 18650 22200 25750 PROCEDURES IVF ART PAND047 POLYPECTOMY Procedure 4100 4300 5120 5940 PROCEDURES SELF FROZEN (DLX) EMBRYO IVF ART PAND048 Procedure 98380 103290 122970 142640 TRANSFER PROCEDURES SELF FROZEN (NOR) EMPRYO IVF ART PAND049 Procedure 81980 86080 102470 118860 TRANSFER PROCEDURES SELF FROZEN EMBRYO TR-CANCEL IVF ART PAND050 Procedure 42360 44480 52950 61420 - DLX PROCEDURES SELF FROZEN EMBRYO TR-CANCEL IVF ART PAND051 Procedure 68310 71730 85390 99050 - NOR PROCEDURES IVF ART PAND052 SEMEN ANALYSIS (IVF) Procedure 560 580 690 810 PROCEDURES IVF ART PAND053 SEMEN PROCESSING - HUSBAND Procedure 3970 4170 4960 5760 PROCEDURES IVF ART PAND054 SEXUAL COUNSELING Procedure 560 580 690 810 PROCEDURES IVF ART PAND055 SINGLE SCAN Procedure 820 860 1030 1190 PROCEDURES SLIDE FOR SPERM - POST IVF ART PAND056 Procedure 220 230 280 320 EJACULATORY URINE PROCEDURES IVF ART PAND057 SONOSALPHINGOGRAM Procedure 3140 3300 3930 4560 PROCEDURES IVF ART PAND058 SPERM FUNCTION TEST Procedure 760 800 950 1110 PROCEDURES IVF ART PAND059 SURROGACY-FOR MARRIED COUPLE Procedure 422160 443270 527700 612130 PROCEDURES IVF ART PAND060 SURROGACY-FOR SINGLE PARENT Procedure 422160 443270 527700 612130 PROCEDURES IVF ART PAND061 TESA Procedure 20500 21520 25620 29720 PROCEDURES IVF ART PAND062 TESE Procedure 31420 32990 39280 45560 PROCEDURES TESTICULAR SPERM/EPIDIDYMAL IVF ART PAND063 Procedure 12300 12910 15370 17830 SPERM - CRYO PROCEDURES TISSUE - TESTICULAR/OVARIAN IVF ART PAND064 Procedure 20500 21520 25620 29720 CYRO PRESERVAT PROCEDURES IVF ART PAND065 TISSUE FOR SPERM Procedure 1040 1090 1300 1510 PROCEDURES IVF ART PAND066 USG ASPIRATION OF CYST - A Procedure 3140 3300 3930 4560 PROCEDURES IVF ART PAND067 USG ASPIRATION OF CYST - B Procedure 2470 2590 3080 3570 PROCEDURES

258 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group IVF ART PAND068 VAGINAL SWAB - AND Procedure 560 580 690 810 PROCEDURES IVF ART PAND069 VASECTOMY Procedure 24590 25820 30740 35660 PROCEDURES INFECTIOUS SAMPLE IVF ART PAND070 Procedure 7390 7760 9230 10710 CYROFREEZING PROCEDURES IVF ART PAND071 DNA FRAGMENTATION INDEX Procedure 2870 3010 3580 4160 PROCEDURES TEMPORARY CRYO FREEZING + DFI IVF ART PAND072 Procedure 6160 6470 7700 8930 FOR A MONTH PROCEDURES IVF-ICSI CANCEL CYCLE AFTER EGG IVF ART PAND073 Procedure 106560 111890 133200 154520 ASPIRATION - DELUXE PROCEDURES IVF-ICSI CANCEL CYCLE BEFORE IVF ART PAND074 Procedure 42360 44480 52950 61420 EGG ASPIRATION - DELUXE PROCEDURES IVF ART PAND075 Surrogate FET Repeat cycle Procedure 146190 153500 182740 211980 PROCEDURES IVF ART PAND076 Surrogate FET Fresh cycle Procedure 230890 242430 288610 334790 PROCEDURES IVF ART PAND077 EMBRYO FREEZING SINGLE STRAW Procedure 31420 32990 39280 45560 PROCEDURES EMBRYO FREEZING ADDITIONAL IVF ART PAND078 Procedure 15710 16500 19640 22780 STRAW PROCEDURES IVF ART PAND079 OVARIAN TISSUE CRYOFREEZING Procedure 61480 64560 76850 89150 PROCEDURES RENEWAL OF OVARIAN TISSUE IVF ART PAND080 Procedure 31420 32990 39280 45560 CRYOFREEZING PROCEDURES IVF ART PAND081 AID - REF Procedure 17080 17940 21350 24770 PROCEDURES IVF ART PAND082 AIH - REF Procedure 15040 15790 18790 21800 PROCEDURES EGG DONATION (DLX) THIRD PARTY IVF ART PAND083 Procedure 194010 203710 242510 281310 - REF PROCEDURES EGG DONATION (NOR) THIRD PARTY IVF ART PAND084 Procedure 184440 193660 230550 267440 - REF PROCEDURES EMBRYO DONATION CYCLING - IVF ART PAND085 Procedure 194010 203710 242510 281310 (DLX) - REF PROCEDURES EMBRYO DONATION CYCLING - IVF ART PAND086 Procedure 184440 193660 230550 267440 (NOR) - REF PROCEDURES IVF ART PAND087 IVF/ICSI-NORMAL - REF Procedure 146190 153500 182740 211980 PROCEDURES IVF ART PAND088 IVF/ICSI-DELUXE - REF Procedure 177610 186490 222010 257530 PROCEDURES IVF ART PAND089 Annexin V Binding Procedure 420 440 520 610 PROCEDURES IVF ART PAND090 Caspase 3 activity Procedure 760 800 950 1110 PROCEDURES

259 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group IVF ART PAND091 Acrosin Proteolytic activity Procedure 760 800 950 1110 PROCEDURES IVF ART PAND092 Alfa neutral glucosidase Procedure 480 500 590 690 PROCEDURES IVF ART PAND093 ROS Estimation Procedure 1180 1240 1470 1710 PROCEDURES ADDITIONAL MEDIA & DISPOSABLE IVF ART PAND094 Procedure 15710 16500 19640 22780 COST IN IVF PROCEDURES CASA - COMPUTER ASSISTED IVF ART PAND095 Procedure 1650 1730 2060 2390 SEMEN ANALYSIS PROCEDURES CASA + DFI (DNA FRAGMENTATION IVF ART PAND096 Procedure 3420 3590 4270 4960 INDEX) PROCEDURES IVF ART PAND097 CASA + DFI + ROS 1 Procedure 4930 5170 6160 7140 PROCEDURES IVF ART PAND098 CASA + DFI + TRIAL WASH Procedure 7650 8030 9560 11090 PROCEDURES IVF ART PAND099 CASA + TRIAL WASH Procedure 6020 6320 7520 8730 PROCEDURES IVF ART PAND100 CRYO FREEZING - 1 YEAR Procedure 16400 17220 20500 23780 PROCEDURES IVF ART PAND101 CRYO FREEZING - 1 YEAR RENEWAL Procedure 16400 17220 20500 23780 PROCEDURES IVF ART PAND102 CRYO FREEZING - 3 MONTHS Procedure 7650 8030 9560 11090 PROCEDURES CRYO FREEZING - 3 MONTHS IVF ART PAND103 Procedure 7650 8030 9560 11090 RENEWAL PROCEDURES CRYO FREEZING - 45 days (NON - IVF ART PAND104 Procedure 6020 6320 7520 8730 RENEWAL) PROCEDURES CRYO FREEZING - INFECTIOUS IVF ART PAND105 Procedure 15040 15790 18790 21800 SAMPLE - 3 MONTHS PROCEDURES CRYO FREEZING - INFECTIOUS IVF ART PAND106 Procedure 18450 19370 23060 26750 SAMPLE -1 YEAR PROCEDURES IVF ART PAND107 CRYO FROZEN SAMPLE DISPATCH Procedure 8480 8900 10600 12290 PROCEDURES IVF ART PAND108 ROS - REACTIVE OXYGEN SPECIES Procedure 2600 2730 3250 3770 PROCEDURES IVF ART PAND109 SEMEN PCR Procedure 4930 5170 6160 7140 PROCEDURES IVF ART PAND110 SEMEN TRIAL PROCESSING Procedure 4930 5170 6160 7140 PROCEDURES IVF ART PAND111 TESTICULAR BIOPSY HPE Procedure 3420 3590 4270 4960 PROCEDURES TESTICULAR TISSUE EXAMINATION IVF ART PAND112 Procedure 2600 2730 3250 3770 (TESE) PROCEDURES EMBRYO CRYO FREEZING - IVF ART PAND113 Procedure 15710 16500 19640 22780 ADDITIONAL STRAW PROCEDURES

260 IVF

Surgery Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Level Group EMBRYO CRYO FREEZING - IVF ART PAND114 Procedure 36900 38740 46120 53500 RENEUAL 1 YEAR (PER STRAW) PROCEDURES EMBRYO CRYO FREEZING - IVF ART PAND115 RENEUAL 1 YEAR (PER STRAW) Procedure 49190 51650 61490 71320 PROCEDURES (INFECTIOUS SAMPLE) EMBRYO CRYO FREEZING - SINGLE IVF ART PAND116 Procedure 36900 38740 46120 53500 STRAW PROCEDURES EMBRYO CRYO FREEZING - SINGLE IVF ART PAND117 Procedure 49190 51650 61490 71320 STRAW (INFECTIOUS SAMPLE) PROCEDURES IVF ART PAND118 EMBRYOSCOPE CHARGES Procedure 72410 76030 90510 104990 PROCEDURES IVF ART PAND119 FET - CANCELLATION Procedure 9020 9470 11270 13080 PROCEDURES IUI - PROCEDURE CHARGES IVF ART PAND120 Procedure 27330 28700 34160 39620 INFECTIOUS (AIH/ AID) PROCEDURES IVF ART PAND121 IVF / ICSI - OOCYTE DONATION Procedure 323800 339990 404750 469510 PROCEDURES IVF ART PAND122 MOCK TRANSFER CHARGES Procedure 6420 6740 8030 9310 PROCEDURES OOCYTE VITRIFICATION - IVF ART PAND123 Procedure 31420 32990 39280 45560 ADDITIONAL STRAW PROCEDURES OOCYTE VITRIFICATION - SINGLE IVF ART PAND124 Procedure 54650 57390 68310 79240 STRAW PROCEDURES IVF ART PAND125 SEQUENTIAL ET Procedure 10930 11480 13660 15850 PROCEDURES IVF ART PAND126 SURROGATE ET CHARGES Procedure 248660 261090 310820 360550 PROCEDURES IVF ART PAND127 IVF Additional Drug Package Procedure 392110 411710 490130 568560 PROCEDURES IVF ART PAND128 IVF visiting consultant Procedure 214500 225230 268130 311030 PROCEDURES IVF ART PAND129 IVF ART PROCEDURES Procedure 28750 30190 35940 41690 PROCEDURES

261 Psychiatry

262 Psychiatry

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PPSY001 ALCOHOL AVERSION THERAPY Procedure PSYCHIATRY 820 860 1030 1190 PPSY002 BEHAVIOUR ASSESMENT Procedure PSYCHIATRY 560 580 690 810 PPSY003 BEHAVIOUR THERAPY Procedure PSYCHIATRY 340 360 420 490 PPSY004 COGNITIVE BEHAVIOURAL THERAPY Procedure PSYCHIATRY 640 670 800 920 COGNITIVE FUNCTIONS ASSESSMENT PPSY005 Procedure PSYCHIATRY 1240 1300 1540 1790 - PSY PPSY006 COGNITIVE RETRAINING - PSY Procedure PSYCHIATRY 640 670 800 920 PPSY007 COGNITIVE STIMULATION - PSY Procedure PSYCHIATRY 420 440 520 610 PPSY008 COUNSELLING - PSY Procedure PSYCHIATRY 500 520 620 720 PPSY009 COUNSELLING-N Procedure PSYCHIATRY 520 550 650 760 PPSY010 DIAGNOSTICS Procedure PSYCHIATRY 1040 1090 1300 1510 PPSY011 ECT (PER SITTING) Procedure PSYCHIATRY 760 800 950 1110 PPSY012 ECT PER SITTING WITH ANA Procedure PSYCHIATRY 820 860 1030 1190 PPSY013 FULL ASSESSMENT Procedure PSYCHIATRY 1650 1730 2060 2390 GENERAL PSYCHOLOGICAL PPSY014 Procedure PSYCHIATRY 2050 2150 2560 2970 ASSESSMENT PPSY015 INFANT ASSESMENT Procedure PSYCHIATRY 640 670 800 920 INITIAL SCREENING & COUNSELLING PPSY016 Procedure PSYCHIATRY 560 580 690 810 - PSY PPSY017 IQ ASSESSMENT Procedure PSYCHIATRY 560 580 690 810 PPSY018 LEARNING DISABILITY ASSESSMENT Procedure PSYCHIATRY 760 800 950 1110 PPSY019 NALOXONE TEST Procedure PSYCHIATRY 2870 3010 3580 4160 PPSY020 NARCO ANALYSIS Procedure PSYCHIATRY 820 860 1030 1190 PPSY021 NEUROPSYCHOLOGICAL ASSESSMENT Procedure PSYCHIATRY 3700 3880 4620 5360 PERSONALITY & INTERPERSONAL PPSY022 Procedure PSYCHIATRY 1240 1300 1540 1790 RELATIONS - PSY PPSY023 PSYCHOLOGICAL ASSESSMENT-MISC Procedure PSYCHIATRY 560 580 690 810 PPSY024 PSYCHOTHERAPHY & CONSULTATION Procedure PSYCHIATRY 640 670 800 920 PPSY025 PSYCHOTHERAPY (PER SESSION) Procedure PSYCHIATRY 340 360 420 490 SPECIFIC PSYCHOLOGICAL FUNCTIONS- PPSY026 Procedure PSYCHIATRY 640 670 800 920 ASSESSMENT

263 Internal medicine & Diabetes

264 Internal medicine & Diabetes

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group DIABETES PDIB003 ENDOCRINE-GRBS Procedure 100 100 120 140 ENDOCRINOLOGY DIABETES PDIB002 ENDOCRINE DYNAMIC TEST - MINOR Procedure 820 860 1030 1190 ENDOCRINOLOGY DIABETES PDIB001 ENDOCRINE DYNAMIC TEST - MAJOR Procedure 1650 1730 2060 2390 ENDOCRINOLOGY GASTRIC LAVAGE ROUTINE - GERIATRIC PGER011 Procedure GERIATRIC MEDICINE 70 80 90 110 MEDICINE PGER008 ENEMA - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 100 100 120 140 SPOT GLUCOSE CHECK - GERIATRIC PGER019 Procedure GERIATRIC MEDICINE 100 100 120 140 MEDICINE DECOMPRESSION OF PNEUMOTHORAX PGER006 Procedure GERIATRIC MEDICINE 110 110 130 160 - GERIATRIC MEDICINE STEAM INHALATION - GERIATRIC PGER020 Procedure GERIATRIC MEDICINE 110 110 130 160 MEDICINE DIABETIC EDUCATION - GERIATRIC PGER007 Procedure GERIATRIC MEDICINE 130 140 160 190 MEDICINE GASTRIC LAVAGE POISONING - PGER010 Procedure GERIATRIC MEDICINE 200 210 250 290 GERIATRIC MEDICINE INTRA ARTICULAR INJECTION - MINOR PGER015 Procedure GERIATRIC MEDICINE 260 270 320 370 - GERIATRIC MEDICINE INTRA ARTICULAR INJECTION - PGER014 Procedure GERIATRIC MEDICINE 360 380 450 520 MEDIUM - GERIATRIC MEDICINE INTRA ARTICULAR INJECTION - MAJOR PGER013 Procedure GERIATRIC MEDICINE 480 500 590 690 - GERIATRIC MEDICINE VENESECTION/CUT DOWN - GERIATRIC PGER023 Procedure GERIATRIC MEDICINE 680 720 850 990 MEDICINE ACTH STIMULATION TEST (SHORT & PGER002 Procedure GERIATRIC MEDICINE 820 860 1030 1190 LONG) - GERIATRIC MEDICINE FNA OF THYROID - GERIATRIC PGER009 Procedure GERIATRIC MEDICINE 820 860 1030 1190 MEDICINE INSULIN TOLERANCE TEST - GERIATRIC PGER012 Procedure GERIATRIC MEDICINE 820 860 1030 1190 MEDICINE PROLONGED HYPOGLYCAEMIC TEST - PGER018 Procedure GERIATRIC MEDICINE 820 860 1030 1190 GERIATRIC MEDICINE TEST FOR DIABETES INSIPIDUS - PGER021 Procedure GERIATRIC MEDICINE 820 860 1030 1190 GERIATRIC MEDICINE TRH STIMULATION TEST - GERIATRIC PGER022 Procedure GERIATRIC MEDICINE 820 860 1030 1190 MEDICINE BONE MARROW PROCEDURE - PGER003 Procedure GERIATRIC MEDICINE 1040 1090 1300 1510 GERIATRIC MEDICINE BRONCHOSCOPIC PROCEDURE - PGER004 Procedure GERIATRIC MEDICINE 1510 1590 1890 2190 GERIATRIC MEDICINE BRONCHOSCOPY - GERIATRIC PGER005 Procedure GERIATRIC MEDICINE 2190 2300 2740 3170 MEDICINE

265 Internal medicine & Diabetes

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ABDOMINAL TAPPING - GERIATRIC PGER001 Procedure GERIATRIC MEDICINE 2600 2730 3250 3770 MEDICINE INTER COSTAL DRAINAGE PLUS PGER031 THERAPEUTIC PROCEDURE - GERIATRIC Procedure GERIATRIC MEDICINE 2600 2730 3250 3770 MEDICINE CENTRAL LINE PLACEMENT - PGER029 Procedure GERIATRIC MEDICINE 3140 3300 3930 4560 GERIATRIC MEDICINE INTER COSTAL TUBE INSERTION - PGER028 Procedure GERIATRIC MEDICINE 3140 3300 3930 4560 GERIATRIC MEDICINE PLEURAL ASPIRATION - GERIATRIC PGER024 Procedure GERIATRIC MEDICINE 3140 3300 3930 4560 MEDICINE PLEURAL BIOPSY - GERIATRIC PGER027 Procedure GERIATRIC MEDICINE 3140 3300 3930 4560 MEDICINE PGER025 FNAC MED - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 3560 3740 4450 5160 LUMBAR PUNCTURES - GERIATRIC PGER017 Procedure GERIATRIC MEDICINE 3700 3880 4620 5360 MEDICINE BONE MARROW ASPIRATION & BIOPSY PGER026 Procedure GERIATRIC MEDICINE 5060 5320 6330 7340 - GERIATRIC MEDICINE ABDOMEN TAPPINGS THERAPEUTIC - PGER030 Procedure GERIATRIC MEDICINE 5610 5890 7010 8130 GERIATRIC MEDICINE PGER016 LIVER BIOPSY - GERIATRIC MEDICINE Procedure GERIATRIC MEDICINE 11210 11770 14010 16250 PINT011 GASTRIC LAVAGE ROUTINE Procedure INTERNAL MEDICINE 70 80 90 110 PINT008 ENEMA - INT Procedure INTERNAL MEDICINE 100 100 120 140 PINT019 SPOT GLUCOSE CHECK Procedure INTERNAL MEDICINE 100 100 120 140 PINT006 DECOMPRESSION OF PNEUMOTHORAX Procedure INTERNAL MEDICINE 110 110 130 160 PINT020 STEAM INHALATION Procedure INTERNAL MEDICINE 110 110 130 160 PINT007 DIABETIC EDUCATION Procedure INTERNAL MEDICINE 130 140 160 190 PINT010 GASTRIC LAVAGE POISONING Procedure INTERNAL MEDICINE 200 210 250 290 INTRA ARTICULAR INJECTION - MINOR PINT015 Procedure INTERNAL MEDICINE 260 270 320 370 - INT INTRA ARTICULAR INJECTION - PINT014 Procedure INTERNAL MEDICINE 360 380 450 520 MEDIUM - INT INTRA ARTICULAR INJECTION - MAJOR PINT013 Procedure INTERNAL MEDICINE 480 500 590 690 - INT PINT023 VENESECTION/CUT DOWN Procedure INTERNAL MEDICINE 680 720 850 990 ACTH STIMULATION TEST (SHORT & PINT002 Procedure INTERNAL MEDICINE 820 860 1030 1190 LONG) PINT009 FNA OF THYROID Procedure INTERNAL MEDICINE 820 860 1030 1190 PINT012 INSULIN TOLERANCE TEST Procedure INTERNAL MEDICINE 820 860 1030 1190 PINT018 PROLONGED HYPOGLYCAEMIC TEST Procedure INTERNAL MEDICINE 820 860 1030 1190 PINT021 TEST FOR DIABETES INSIPIDUS Procedure INTERNAL MEDICINE 820 860 1030 1190

266 Internal medicine & Diabetes

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PINT022 TRH STIMULATION TEST Procedure INTERNAL MEDICINE 820 860 1030 1190 PINT003 BONE MARROW PROCEDURE Procedure INTERNAL MEDICINE 1040 1090 1300 1510 PINT004 BRONCHOSCOPIC PROCEDURE - INT Procedure INTERNAL MEDICINE 1510 1590 1890 2190 PINT005 BRONCHOSCOPY - INT Procedure INTERNAL MEDICINE 2190 2300 2740 3170 PINT001 ABDOMINAL TAPPING - INT.MED Procedure INTERNAL MEDICINE 2600 2730 3250 3770 INTER COSTAL DRAINAGE PLUS PINT031 Procedure INTERNAL MEDICINE 2600 2730 3250 3770 THERAPEUTIC PROCEDURE PINT029 CENTRAL LINE PLACEMENT Procedure INTERNAL MEDICINE 3140 3300 3930 4560 PINT028 INTER COSTAL TUBE INSERTION Procedure INTERNAL MEDICINE 3140 3300 3930 4560 PINT024 PLEURAL ASPIRATION Procedure INTERNAL MEDICINE 3140 3300 3930 4560 PINT027 PLEURAL BIOPSY Procedure INTERNAL MEDICINE 3140 3300 3930 4560 PINT025 FNAC - INT MED Procedure INTERNAL MEDICINE 3560 3740 4450 5160 PINT017 LUMBAR PUNCTURES Procedure INTERNAL MEDICINE 3700 3880 4620 5360 PINT026 BONE MARROW ASPIRATION & BIOPSY Procedure INTERNAL MEDICINE 5060 5320 6330 7340 PINT030 ABDOMEN TAPPINGS THERAPEUTIC Procedure INTERNAL MEDICINE 5610 5890 7010 8130 PINT016 LIVER BIOPSY - INT Procedure INTERNAL MEDICINE 11210 11770 14010 16250

267 Dermatology

268 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER001 ABDOMEN Procedure DERMATOLOGY 14350 15060 17930 20800 PDER002 ACNE SCAR RESURFACING Procedure DERMATOLOGY 35530 37300 44410 51510 PDER003 ANTERIOR NECK Procedure DERMATOLOGY 5470 5740 6830 7930 PDER004 ARMS+HANDS+AXILLA Procedure DERMATOLOGY 25280 26550 31600 36660 PDER005 AUTOLOGOUS MINIGRAFTING Procedure DERMATOLOGY 760 800 950 1110 AUTOLOGOUS MINIGRAFTING - ERBIUM PDER006 Procedure DERMATOLOGY 1240 1300 1540 1790 YAG LASER PDER007 AXILLA Procedure DERMATOLOGY 5190 5450 6490 7530 PDER008 BACK Procedure DERMATOLOGY 23230 24400 29040 33690 PDER009 BEARDED FACE Procedure DERMATOLOGY 6420 6740 8030 9310 PDER010 BENIGN SKIN LESIONS REMOVAL - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER011 BENIGN SKIN LESIONS REMOVAL - B Procedure DERMATOLOGY 9570 10050 11960 13880 PDER012 BENIGN SKIN LESIONS REMOVAL - C Procedure DERMATOLOGY 11760 12350 14700 17050 PDER013 BETWEEN EYEBROWS Procedure DERMATOLOGY 2470 2590 3080 3570 PDER014 BIKINI LINE Procedure DERMATOLOGY 5880 6180 7350 8530 PDER015 BLISTER GRAFTING Procedure DERMATOLOGY 3280 3450 4100 4760 PDER016 BOTOX PER UNIT Procedure DERMATOLOGY 760 800 950 1110 PDER017 BUTTOCKS Procedure DERMATOLOGY 6420 6740 8030 9310 PDER018 CHEEKS Procedure DERMATOLOGY 5470 5740 6830 7930 PDER019 CHEMICAL CAUTERY - A Procedure DERMATOLOGY 500 520 620 720 PDER020 CHEMICAL CAUTERY - B Procedure DERMATOLOGY 960 1010 1200 1390 PDER021 CHEMICAL CAUTERY - C Procedure DERMATOLOGY 1300 1370 1630 1890 PDER022 CHEMICAL CAUTERY - D Procedure DERMATOLOGY 1780 1860 2220 2570 CHEMOTHERAPHY PROCEDURE PDER023 Procedure DERMATOLOGY 960 1010 1200 1390 MAINTANENCE PDER024 CHEST Procedure DERMATOLOGY 10670 11200 13330 15460 PDER025 CHIN Procedure DERMATOLOGY 5330 5600 6660 7730 PDER026 COMEDO EXTRACTION Procedure DERMATOLOGY 560 580 690 810 PDER027 CRYO - A Procedure DERMATOLOGY 560 580 690 810 PDER028 CRYO - B Procedure DERMATOLOGY 1100 1150 1370 1590 PDER029 CRYO - C Procedure DERMATOLOGY 1910 2010 2390 2770 PDER030 CRYO - D Procedure DERMATOLOGY 3970 4170 4960 5760 PDER031 CURETTAGE Procedure DERMATOLOGY 1510 1590 1890 2190 PDER032 CUTANEOUS RESURFACING - A Procedure DERMATOLOGY 4650 4880 5810 6740 PDER033 CUTANEOUS RESURFACING - B Procedure DERMATOLOGY 6160 6470 7700 8930 PDER034 CUTANEOUS RESURFACING - C Procedure DERMATOLOGY 7650 8030 9560 11090 PDER035 CUTANEOUS RESURFACING - D Procedure DERMATOLOGY 15710 16500 19640 22780

269 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER036 CUTANEOUS RESURFACING - E Procedure DERMATOLOGY 31420 32990 39280 45560 PDER037 DEEP PEEL Procedure DERMATOLOGY 23910 25110 29890 34670 PDER038 DERMABRASION ( A ) PER SQ.CM Procedure DERMATOLOGY 640 670 800 920 PDER039 DERMABRASION ( B ) PER SQ.CM Procedure DERMATOLOGY 1510 1590 1890 2190 PDER040 DERMABRASION ( C ) PER SQ.CM Procedure DERMATOLOGY 2050 2150 2560 2970 PDER041 DERMABRASION ( D ) PER SQ.CM Procedure DERMATOLOGY 2600 2730 3250 3770 PDER042 DERMAROLLER Procedure DERMATOLOGY 28700 30130 35870 41610 PDER043 EAR & NOSE PIERCING Procedure DERMATOLOGY 760 800 950 1110 PDER044 EARS Procedure DERMATOLOGY 4370 4590 5470 6340 PDER045 ELECTROCAUTERY - A Procedure DERMATOLOGY 820 860 1030 1190 PDER046 ELECTROCAUTERY - B Procedure DERMATOLOGY 1510 1590 1890 2190 PDER047 ELECTROCAUTERY - C Procedure DERMATOLOGY 2050 2150 2560 2970 PDER048 ELECTROCAUTERY - D Procedure DERMATOLOGY 3280 3450 4100 4760 PDER049 ELECTROLYSIS OF HAIR (PER HAIR) Procedure DERMATOLOGY 70 80 90 110 ELECTROLYSIS OF HAIR FULL FACE PDER050 Procedure DERMATOLOGY 8740 9180 10930 12680 (PACKAGE) PDER051 ENTIRE ARMS Procedure DERMATOLOGY 12850 13490 16060 18630 PDER052 ENTIRE LEGS Procedure DERMATOLOGY 32790 34430 40990 47550 EXPRESSION OF MOLLOSCUM BODIES PDER053 Procedure DERMATOLOGY 1510 1590 1890 2190 (A) EXPRESSION OF MOLLOSCUM BODIES PDER054 Procedure DERMATOLOGY 1910 2010 2390 2770 (B) PDER055 FACIAL REJUVINATION Procedure DERMATOLOGY 16400 17220 20500 23780 PDER056 FEET Procedure DERMATOLOGY 4370 4590 5470 6340 PDER057 FILLERS RESTYLANE 0.5 ML Procedure DERMATOLOGY 31420 32990 39280 45560 PDER058 FILLERS RESTYLANE 1.0 ML Procedure DERMATOLOGY 47820 50210 59780 69340 PDER059 FOREARMS Procedure DERMATOLOGY 7650 8030 9560 11090 PDER060 FOREHEAD Procedure DERMATOLOGY 5470 5740 6830 7930 PDER061 FULL ARMS WITH HANDS Procedure DERMATOLOGY 25960 27260 32450 37640 FULL FACE RESURFACING FOR PDER062 Procedure DERMATOLOGY 71050 74600 88810 103020 RHYTIDES B PDER063 HANDS Procedure DERMATOLOGY 4370 4590 5470 6340 PDER064 HIPS Procedure DERMATOLOGY 7650 8030 9560 11090 PDER065 HYPERTROPHIC SCARS - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER066 HYPERTROPHIC SCARS - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER067 HYPERTROPHIC SCARS - C Procedure DERMATOLOGY 23910 25110 29890 34670 PDER068 I & D MINOR Procedure DERMATOLOGY 1240 1300 1540 1790 PDER069 IM INJECTION Procedure DERMATOLOGY 140 150 180 210

270 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER070 INNER THIGHS Procedure DERMATOLOGY 10930 11480 13660 15850 PDER071 INNER THIGHS AND BIKINI Procedure DERMATOLOGY 13110 13770 16390 19010 PDER072 INTRA LESS IONAL INJECTION Procedure DERMATOLOGY 1300 1370 1630 1890 PDER073 IONTOPHORESIS PER SITTING Procedure DERMATOLOGY 760 800 950 1110 PDER074 KNEE AND LOWER LEGS Procedure DERMATOLOGY 13670 14350 17080 19810 PDER075 LASER THERAPY CO2 MAJOR Procedure DERMATOLOGY 10930 11480 13660 15850 PDER076 LASER THERAPY CO2 MEDIUM Procedure DERMATOLOGY 6560 6890 8200 9510 PDER077 LASER THERAPY CO2 MINOR Procedure DERMATOLOGY 3280 3450 4100 4760 PDER078 LASER THERAPY CO2 SUPRA MAJOR Procedure DERMATOLOGY 15040 15790 18790 21800 PDER079 LEGS BELOW KNEE Procedure DERMATOLOGY 12850 13490 16060 18630 PDER080 LIGHT PEEL Procedure DERMATOLOGY 11760 12350 14700 17050 LITE LASER PEEL - FULL FACE SKIN PDER081 Procedure DERMATOLOGY 23910 25110 29890 34670 RESURFACI PDER082 MICRODERMA - 1 Procedure DERMATOLOGY 3140 3300 3930 4560 PDER083 MICRODERMA - 2 Procedure DERMATOLOGY 2190 2300 2740 3170 PDER084 MILIA EXTRACTION ( A ) Procedure DERMATOLOGY 900 950 1130 1310 PDER085 MILIA EXTRACTION ( B ) Procedure DERMATOLOGY 560 580 690 810 PDER086 MINOR PROCEDURE Procedure DERMATOLOGY 1510 1590 1890 2190 PDER087 NAIL EXCISION - PDER Procedure DERMATOLOGY 590 620 740 860 PDER088 NAIL EXCISION (MAJOR) Procedure DERMATOLOGY 8200 8610 10250 11890 PDER089 NAIL EXCISION (MINOR) Procedure DERMATOLOGY 2470 2590 3080 3570 PDER090 NARROW HOLE EXTENSION TECHNIQUE Procedure DERMATOLOGY 4240 4450 5290 6140 PDER091 NIPPLE / CLEAVAGE Procedure DERMATOLOGY 4370 4590 5470 6340 NON-ABLATIVE PULSED RADIO PDER092 Procedure DERMATOLOGY 4370 4590 5470 6340 FREQUENCY PDER093 PARING Procedure DERMATOLOGY 1240 1300 1540 1790 PDER094 PATCH TEST PER PATCH (IMPORTED) Procedure DERMATOLOGY 220 230 280 320 PDER095 PATCH TEST PER PATCH (INDIAN) Procedure DERMATOLOGY 220 230 280 320 PDER096 PEEL DEEP PER SQ.INCH Procedure DERMATOLOGY 1780 1860 2220 2570 PDER097 PEEL INTERMEDIATE PER SQ.INCH Procedure DERMATOLOGY 1240 1300 1540 1790 PDER098 PEEL NEO STRATA FULL Procedure DERMATOLOGY 3700 3880 4620 5360 PDER099 PEEL NEO STRATA INTERMEDIATE Procedure DERMATOLOGY 3280 3450 4100 4760 PDER100 PEEL NEO STRATA LIMITED Procedure DERMATOLOGY 2190 2300 2740 3170 PDER101 PEEL SUPERFICIAL PER SQ.INCH Procedure DERMATOLOGY 900 950 1130 1310 PDER102 PEEL TCA EASY CLASSIC Procedure DERMATOLOGY 5880 6180 7350 8530 PDER103 PERINEURAL INJECTION Procedure DERMATOLOGY 1240 1300 1540 1790 PDER104 PHOTOTEST Procedure DERMATOLOGY 2470 2590 3080 3570

271 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER105 PHOTOTHERAPY - A Procedure DERMATOLOGY 520 550 650 760 PODOPHYLLUM APPLICATION (PER PDER106 Procedure DERMATOLOGY 760 800 950 1110 SETTING) PDER107 POSTERIOR NECK Procedure DERMATOLOGY 5470 5740 6830 7930 PDER109 PROVOCATION TEST Procedure DERMATOLOGY 200 210 250 290 PDER110 PUNCH EVACUATION OF CYST Procedure DERMATOLOGY 4370 4590 5470 6340 RESURFACING OF PERIOCULAR AND PDER111 Procedure DERMATOLOGY 23910 25110 29890 34670 PERIORAL REG PDER112 SCLEROTHERAPY Procedure DERMATOLOGY 3560 3740 4450 5160 PDER113 SIDE BURNS Procedure DERMATOLOGY 4370 4590 5470 6340 PDER114 SKIN BIOPSY Procedure DERMATOLOGY 5470 5740 6830 7930 PDER115 SKIN BIOPSY (FIRST TIME) Procedure DERMATOLOGY 3280 3450 4100 4760 SKIN BIOPSY (SUBSEQUENT BIOPSY ON PDER116 Procedure DERMATOLOGY 1240 1300 1540 1790 SAME PATIENT) PDER117 SKIN BIOPSY FROM FACE Procedure DERMATOLOGY 5880 6180 7350 8530 PDER118 SKIN SMEAR FOR AFB Procedure DERMATOLOGY 500 520 620 720 PDER119 SOAKS Procedure DERMATOLOGY 200 210 250 290 PDER120 SOFT LASER - A Procedure DERMATOLOGY 2470 2590 3080 3570 PDER121 SOFT LASER - B Procedure DERMATOLOGY 3560 3740 4450 5160 PDER122 TATOOING PER SQ. CM Procedure DERMATOLOGY 960 1010 1200 1390 PDER123 TZANCK TEST Procedure DERMATOLOGY 760 800 950 1110 PDER124 UMBILICUS TO PUBIS Procedure DERMATOLOGY 5880 6180 7350 8530 PDER125 UPPER ARMS Procedure DERMATOLOGY 6420 6740 8030 9310 PDER126 UPPER LIP Procedure DERMATOLOGY 5330 5600 6660 7730 PDER127 WOODS LAMP Procedure DERMATOLOGY 1240 1300 1540 1790 PDER128 AUTOLOGOUS SERUM SKIN TEST Procedure DERMATOLOGY 4240 4450 5290 6140 PDER129 TRICHOGRAM Procedure DERMATOLOGY 3560 3740 4450 5160 PDER130 MICRODERMA III Procedure DERMATOLOGY 3560 3740 4450 5160 PDER131 ELECTRO PHONOPHERESIS Procedure DERMATOLOGY 2870 3010 3580 4160 MICRODERMA & ELECTRO PDER132 Procedure DERMATOLOGY 4650 4880 5810 6740 PHONOPHERESIS PDER133 DRESSING - PDER Procedure DERMATOLOGY 480 500 590 690 PDER134 DRESSING - MAJOR - PDER Procedure DERMATOLOGY 260 270 320 370 PDER135 DRESSING - INTER - PDER Procedure DERMATOLOGY 200 210 250 290 PDER136 DRESSING - MINOR - PDER Procedure DERMATOLOGY 130 140 160 190 PDER137 FUNGUS IDENTIFICATION - DERM Procedure DERMATOLOGY 1370 1440 1720 1990 PDER138 DERMAROLLER - A (PER SESSION) Procedure DERMATOLOGY 11760 12350 14700 17050 ERBIUM YAG RECIPIENT SITE LASER - PDER139 Procedure DERMATOLOGY 11760 12350 14700 17050 SMALL

272 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ERBIUM YAG RECIPIENT SITE LASER - PDER140 Procedure DERMATOLOGY 23910 25110 29890 34670 MEDIUM ERBIUM YAG RECIPIENT SITE LASER - PDER141 Procedure DERMATOLOGY 35530 37300 44410 51510 LARGE ERBIUM YAG RECIPIENT SITE LASER - PDER142 Procedure DERMATOLOGY 47820 50210 59780 69340 EXTENSIVE PDER143 Q SWITCH HEAD - A Procedure DERMATOLOGY 11760 12350 14700 17050 PDER144 Q SWITCH HEAD - B Procedure DERMATOLOGY 23910 25110 29890 34670 PDER145 Q SWITCH HEAD - C Procedure DERMATOLOGY 35530 37300 44410 51510 PDER146 Q SWITCH HEAD - D Procedure DERMATOLOGY 58750 61680 73430 85180 PDER147 TATOOS - A Procedure DERMATOLOGY 3560 3740 4450 5160 PDER148 TATOOS - B Procedure DERMATOLOGY 7110 7470 8890 10310 PDER149 TATOOS - C Procedure DERMATOLOGY 11760 12350 14700 17050 PDER150 NEVUS OF OTA - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER151 NEVUS OF OTA - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER152 NEVUS OF OTA - C Procedure DERMATOLOGY 19130 20090 23910 27740 ER PIXEL HEAD (SKIN REJUVENATION) PDER153 Procedure DERMATOLOGY 7110 7470 8890 10310 - A PDER154 ER PIXEL HEAD (ACNE SCARS) - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER155 ER PIXEL HEAD - C Procedure DERMATOLOGY 17080 17940 21350 24770 PDER156 SIDE LOCKS Procedure DERMATOLOGY 4370 4590 5470 6340 PDER157 FULL FACE Procedure DERMATOLOGY 14350 15060 17930 20800 PDER158 FULL LEGS Procedure DERMATOLOGY 25960 27260 32450 37640 PDER159 FULL HAND Procedure DERMATOLOGY 21870 22960 27330 31700 PDER160 BELOW ELBOW HANDS Procedure DERMATOLOGY 11760 12350 14700 17050 PDER161 UNDER ARMS Procedure DERMATOLOGY 5190 5450 6490 7530 PDER162 CHEST FRONT Procedure DERMATOLOGY 23910 25110 29890 34670 PDER163 BIKINI Procedure DERMATOLOGY 8740 9180 10930 12680 PDER164 FULL BODY Procedure DERMATOLOGY 86070 90370 107590 124800 PDER165 SR (570-950) SKIN REJUVENATION - A Procedure DERMATOLOGY 8480 8900 10600 12290 PDER166 SR (570-950) SKIN REJUVENATION - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER167 SR (570-950) SKIN REJUVENATION - C Procedure DERMATOLOGY 19130 20090 23910 27740 PDER168 ST SKIN TIGHTENING - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER169 ST SKIN TIGHTENING - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER170 420-950 - A Procedure DERMATOLOGY 11760 12350 14700 17050 PDER171 420-950 - B Procedure DERMATOLOGY 19130 20090 23910 27740 PDER172 SKIN TIGHTENING - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER173 SKIN TIGHTENING - B Procedure DERMATOLOGY 11760 12350 14700 17050

273 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER174 ACTIVE ACNE VULGARIS Procedure DERMATOLOGY 4650 4880 5810 6740 PDER175 ACNE CONGLOBATA Procedure DERMATOLOGY 11760 12350 14700 17050 PDER176 ACNE SCAR REVISION Procedure DERMATOLOGY 11760 12350 14700 17050 POST ACNE HYPER PIGMENTATION PDER177 Procedure DERMATOLOGY 7110 7470 8890 10310 FACE POST INFLAMMATORY HYPER PDER178 Procedure DERMATOLOGY 7110 7470 8890 10310 PIGMENTATION - A POST INFLAMMATORY HYPER PDER179 Procedure DERMATOLOGY 11760 12350 14700 17050 PIGMENTATION - B POST INFLAMMATORY HYPER PDER180 Procedure DERMATOLOGY 17080 17940 21350 24770 PIGMENTATION - C PDER181 NEVUS OF OTA Procedure DERMATOLOGY 11760 12350 14700 17050 PDER182 EPILIDES LONG Procedure DERMATOLOGY 7110 7470 8890 10310 PDER183 EPILIDES VERY LONG Procedure DERMATOLOGY 19130 20090 23910 27740 PDER184 TATOO REMOVAL - RED Procedure DERMATOLOGY 11760 12350 14700 17050 PDER185 TATOO REMOVAL - GREEN Procedure DERMATOLOGY 4790 5030 5980 6940 PDER186 TATOO REMOVAL - BLACK Procedure DERMATOLOGY 7110 7470 8890 10310 PDER187 CAFE AU LAIT MACULES-PER LESION Procedure DERMATOLOGY 3560 3740 4450 5160 PDER188 LENTIGINES - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER189 LENTIGINES - B Procedure DERMATOLOGY 19130 20090 23910 27740 PDER190 DYSCHROMIA Procedure DERMATOLOGY 7110 7470 8890 10310 PDER191 MELASMA Procedure DERMATOLOGY 7110 7470 8890 10310 PDER192 FACIAL FINE LINES - A Procedure DERMATOLOGY 7110 7470 8890 10310 PDER193 FACIAL FINE LINES - B Procedure DERMATOLOGY 11760 12350 14700 17050 PDER194 STRIAE SHORT Procedure DERMATOLOGY 11760 12350 14700 17050 PDER195 STRIAE LONG Procedure DERMATOLOGY 19130 20090 23910 27740 PDER196 BECKERS NEVUS - A Procedure DERMATOLOGY 11760 12350 14700 17050 PDER197 BECKERS NEVUS - B Procedure DERMATOLOGY 19130 20090 23910 27740 PDER198 PERI ORBITAL PIGMENTATION Procedure DERMATOLOGY 8480 8900 10600 12290 PDER199 NEVUS SPILUS Procedure DERMATOLOGY 11760 12350 14700 17050 PDER200 MONGOLIAN SPOT - A Procedure DERMATOLOGY 11760 12350 14700 17050 PDER201 MONGOLIAN SPOT - B Procedure DERMATOLOGY 7110 7470 8890 10310 PDER202 PIGMENTED DEMARCATION LINE Procedure DERMATOLOGY 8480 8900 10600 12290 POST ACNE HYPER PIGMENTATION PDER203 Procedure DERMATOLOGY 11760 12350 14700 17050 TRUNK PDER204 TRAMATIC SCAR - TRUNK Procedure DERMATOLOGY 11760 12350 14700 17050 PDER205 TRAMATIC SCAR - LIMBS Procedure DERMATOLOGY 7110 7470 8890 10310

274 Dermatology

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PDER206 DIFFUSE FACIAL PIGMENTATION Procedure DERMATOLOGY 11760 12350 14700 17050 PDER207 ROSACEA Procedure DERMATOLOGY 5880 6180 7350 8530 PDER208 FLAT SEB KERATOSIS Procedure DERMATOLOGY 7110 7470 8890 10310 PDER209 HYPERTROPHIC SCAR Procedure DERMATOLOGY 11760 12350 14700 17050 PDER210 KELOID Procedure DERMATOLOGY 11760 12350 14700 17050 PDER211 LAX ABDOMEN WITH STRIAE Procedure DERMATOLOGY 58750 61680 73430 85180 PDER212 LASER 360 Procedure DERMATOLOGY 83350 87510 104180 120850 PDER213 SUBCISION Procedure DERMATOLOGY 1240 1300 1540 1790 PDER216 ABLATIVE RADIO FREQUENCY - A Procedure DERMATOLOGY 7650 8030 9560 11090 PDER217 ABLATIVE RADIO FREQUENCY - B Procedure DERMATOLOGY 10930 11480 13660 15850 PDER218 ABLATIVE RADIO FREQUENCY - C Procedure DERMATOLOGY 21870 22960 27330 31700 PDER219 TATOO REMOVAL BLACK 5*5 CMS Procedure DERMATOLOGY 9840 10330 12300 14260 PDER220 Prick Test Single Antigen Procedure DERMATOLOGY 370 390 460 540 PDER221 Prick Test Package 10 Antigens Procedure DERMATOLOGY 3480 3650 4350 5040 PDER222 Prick Test Package 35 Antigens Procedure DERMATOLOGY 12170 12780 15210 17650 PDER223 Prick Test Package 60 Antigens Procedure DERMATOLOGY 20500 21520 25620 29720 PDER224 TGTPHOTOTHERAPY per session Procedure DERMATOLOGY 1500 1570 1870 2170 PDER225 TGTPHOTOTHERAPY 3 session Procedure DERMATOLOGY 3450 3630 4320 5010 PDER226 TGTPHOTOTHERAPY - 6 session Procedure DERMATOLOGY 7480 7850 9350 10840 PDER227 TGTPHOTOTHERAPY - 12 session Procedure DERMATOLOGY 16450 17270 20560 23850

275 Dental

276 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Root canal treatment with Single Por KDEN005 Package DENTAL PACKAGE 0 20650 24590 28520 crown(per ) KDEN007 BlueSky Implant with SinglePor crown Package DENTAL PACKAGE 0 78510 93470 108420 PDEN001 BITE RAISING APPLIANCE Procedure DENTAL MEDICINE 3560 3740 4450 5160 PDEN002 BLEACHING PROCEDURE (IN-CLINIC) Procedure DENTAL MEDICINE 3560 3740 4450 5160 PDEN003 BLEACHING TRAY - SINGLE Procedure DENTAL MEDICINE 2470 2590 3080 3570 PDEN004 CATLANS APPLIANCE Procedure DENTAL MEDICINE 3560 3740 4450 5160 PDEN005 CERAMIC INLAY Procedure DENTAL MEDICINE 17760 18650 22200 25750 PDEN006 CLEFT LIP Procedure DENTAL MEDICINE 19130 20090 23910 27740 PDEN007 CLEFT PALATE - PDEN Procedure DENTAL MEDICINE 14350 15060 17930 20800 PDEN008 COMPLETE DENTURES (SINGLE ARCH) Procedure DENTAL MEDICINE 10670 11200 13330 15460 CROWN - E-MAX SAME DAY (LAMINATES/ PDEN009 Procedure DENTAL MEDICINE 13110 13770 16390 19010 INLAY/ONLAY) CROWN - FULL CERAMIC (ZIRCONA/ PDEN010 Procedure DENTAL MEDICINE 21180 22240 26470 30700 CERCON) PDEN011 CROWN AND BRIDGE CERAMIC EU STD Procedure DENTAL MEDICINE 9840 10330 12300 14260 CROWN AND BRIDGE CERAMIC FULL PDEN012 Procedure DENTAL MEDICINE 17760 18650 22200 25750 TERACOM CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN013 Procedure DENTAL MEDICINE 15710 16500 19640 22780 CAST CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN014 Procedure DENTAL MEDICINE 14350 15060 17930 20800 INCERAM CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN015 Procedure DENTAL MEDICINE 4370 4590 5470 6340 MET CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN016 Procedure DENTAL MEDICINE 17080 17940 21350 24770 NOBLE CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN017 Procedure DENTAL MEDICINE 7390 7760 9230 10710 POR CROWN AND BRIDGE CROWN-SINGLE UNIT PDEN018 Procedure DENTAL MEDICINE 820 860 1030 1190 TEMPO CROWN AND BRIDGE SINGLE UNIT PDEN019 Procedure DENTAL MEDICINE 5880 6180 7350 8530 COMPOSITE W PDEN020 EXTRACTION SURGICAL Procedure DENTAL MEDICINE 1300 1370 1630 1890 PDEN021 EXTRACTIONS CHILD MILK TOOTH Procedure DENTAL MEDICINE 420 440 520 610 FLEXIBLE DENTURE (UNILATERAL & PDEN022 Procedure DENTAL MEDICINE 11760 12350 14700 17050 BILATERAL) PER ARCH PDEN023 GLASS FIBER POST Procedure DENTAL MEDICINE 4240 4450 5290 6140 PDEN024 IMPLACTED MOLAR INCLUDING LA 7.7 Procedure DENTAL MEDICINE 1300 1370 1630 1890 PDEN025 IMPLANT BIOCARE NOBEL Procedure DENTAL MEDICINE 48200 50610 60250 69890 IMPLANT ENDO-S PER DALLABONA - PDEN026 Procedure DENTAL MEDICINE 11210 11770 14010 16250 METAL

277 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

IMPLANT ENDO-S PER DALLABONA - PDEN027 Procedure DENTAL MEDICINE 5060 5320 6330 7340 METAL FEMALE COMPONENT PDEN028 IMPLANT E-Z-A - DEN Procedure DENTAL MEDICINE 20500 21520 25620 29720 PDEN029 IMPLANT E-Z-S - DEN Procedure DENTAL MEDICINE 17760 18650 22200 25750 PDEN030 IMPLANT E-Z-U - DEN Procedure DENTAL MEDICINE 19130 20090 23910 27740 PDEN031 IMPLANT INTERVENTIONAL PROCEDURE Procedure DENTAL MEDICINE 2330 2440 2910 3370 PDEN032 IMPLANT MIS SEVEN Procedure DENTAL MEDICINE 19130 20090 23910 27740 PDEN033 IMPLANT TRI-D - PDEN Procedure DENTAL MEDICINE 14350 15060 17930 20800 PDEN034 IMPLANT TRI-N - PDEN Procedure DENTAL MEDICINE 17080 17940 21350 24770 IMPLANT TRI PER DALLABONA - RUBBER PDEN035 Procedure DENTAL MEDICINE 3560 3740 4450 5160 COMPONENT PDEN036 INLAY - METAL Procedure DENTAL MEDICINE 4370 4590 5470 6340 PDEN037 INTRA ORAL X-RAY Procedure DENTAL MEDICINE 340 360 420 490 PDEN038 METAL CAST POST Procedure DENTAL MEDICINE 3700 3880 4620 5360 PDEN039 OCCLUSAL ADJUSTMENT FULL Procedure DENTAL MEDICINE 1650 1730 2060 2390 PDEN040 OCCLUSAL ADJUSTMENT LIMITED Procedure DENTAL MEDICINE 1180 1240 1470 1710 PDEN041 OCCLUSAL NIGHT GUARD/SPLINT HARD Procedure DENTAL MEDICINE 1910 2010 2390 2770 PDEN042 OCCLUSAL NIGHT GUARD/SPLINT SOFT Procedure DENTAL MEDICINE 3560 3740 4450 5160 PDEN043 OPTURATOR Procedure DENTAL MEDICINE 12020 12620 15030 17430 PDEN044 ORAL CANCER SCREENING Procedure DENTAL MEDICINE 2470 2590 3080 3570 PDEN045 ORAL MUCOSAL BIOPSY Procedure DENTAL MEDICINE 2330 2440 2910 3370 PDEN046 ORAL MUCOSAL LESION MANAGEMENT Procedure DENTAL MEDICINE 1780 1860 2220 2570 PDEN047 ORAL PROPHYLAXIS (SCALING / SITTING) Procedure DENTAL MEDICINE 1300 1370 1630 1890 PDEN048 OROFACIAL PAIN MANAGEMENT Procedure DENTAL MEDICINE 2330 2440 2910 3370 PDEN049 OSMF MANAGEMENT Procedure DENTAL MEDICINE 7110 7470 8890 10310 PDEN050 PIT AND FISSURE SEALANT APPLICATION Procedure DENTAL MEDICINE 900 950 1130 1310 PROHYLACTIC TOPICAL FLUORIDE PDEN051 Procedure DENTAL MEDICINE 820 860 1030 1190 APPLICATION PDEN052 PROSTHETICS DENTURE RELINING Procedure DENTAL MEDICINE 2740 2880 3430 3970 PDEN053 PROSTHETICS DENTURE REPAIR Procedure DENTAL MEDICINE 1510 1590 1890 2190 PDEN054 PROSTHETICS FULL DENTURE (U/L) Procedure DENTAL MEDICINE 16400 17220 20500 23780 PROSTHETICS FULL DENTURE U/L CROSS PDEN055 Procedure DENTAL MEDICINE 21180 22240 26470 30700 LINKED PROSTHETICS IMMEDIATE DENTURE - PDEN056 Procedure DENTAL MEDICINE 3970 4170 4960 5760 PARTIAL PDEN057 PROSTHETICS OVER DENTURES Procedure DENTAL MEDICINE 19130 20090 23910 27740 PROSTHETICS PARTIAL DENTURE - PDEN058 Procedure DENTAL MEDICINE 1370 1440 1720 1990 ACRYLIC PDEN059 PROSTHETICS PARTIAL DENTURE - CAST Procedure DENTAL MEDICINE 19820 20810 24770 28740

278 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PDEN060 PROSTHETICS REPLACE ONE TOOTH Procedure DENTAL MEDICINE 590 620 740 860 PDEN061 PULP CAPPING Procedure DENTAL MEDICINE 760 800 950 1110 PDEN062 PULPECTOMY Procedure DENTAL MEDICINE 1780 1860 2220 2570 PDEN063 RADIOGRAPHS BITE WING Procedure DENTAL MEDICINE 260 270 320 370 PDEN064 RADIOGRAPHS CEPHALOGRAM Procedure DENTAL MEDICINE 960 1010 1200 1390 PDEN065 R. V. G INTRA ORAL PERIAPICAL X- Ray Procedure DENTAL MEDICINE 340 360 420 490 PDEN066 RADIOGRAPHS OCCLUSAL Procedure DENTAL MEDICINE 340 360 420 490 PDEN067 RADIOGRAPHS ORTHOPANTOGRAM (OPG) Procedure DENTAL MEDICINE 610 640 770 890 PDEN068 RECEMENTING BRIDGE Procedure DENTAL MEDICINE 610 640 770 890 PDEN069 RECEMENTING CROWN Procedure DENTAL MEDICINE 360 380 450 520 REMOVABLE ORTHODONTICS - MINOR - PDEN070 Procedure DENTAL MEDICINE 7930 8320 9910 11490 PDEN RESTORATIONS AMALGAM/SILVER PDEN071 Procedure DENTAL MEDICINE 500 520 620 720 PRIMARY TOOT RESTORATIONS/FILLINGS AMALGAM/ PDEN072 Procedure DENTAL MEDICINE 1040 1090 1300 1510 SILVER PER PDEN073 RESTORATIONS/FILLINGS COMPOMER Procedure DENTAL MEDICINE 1300 1370 1630 1890 RESTORATIONS/FILLINGS COMPOSITE PDEN074 Procedure DENTAL MEDICINE 1370 1440 1720 1990 RESIN AN RESTORATIONS/FILLINGS COMPOSITE PDEN075 Procedure DENTAL MEDICINE 1180 1240 1470 1710 RESIN PO PDEN076 RESTORATIONS/FILLINGS DYCAL/CA(OH)2 Procedure DENTAL MEDICINE 340 360 420 490 PDEN077 RESTORATIONS/FILLINGS GLASS IONOMER Procedure DENTAL MEDICINE 900 950 1130 1310 PDEN078 RESTORATIONS/FILLINGS MIRACLE MIX Procedure DENTAL MEDICINE 610 640 770 890 PDEN079 RESTORATIONS/FILLINGS ONLAY Procedure DENTAL MEDICINE 680 720 850 990 RESTORATIONS/FILLINGS PRIMARY TOOTH PDEN080 Procedure DENTAL MEDICINE 610 640 770 890 CLAS RESTORATIONS/FILLINGS TEMPORARY / PDEN081 Procedure DENTAL MEDICINE 360 380 450 520 SEDATI PDEN082 ROOT CANAL TREATMENT ANTERIOR Procedure DENTAL MEDICINE 3280 3450 4100 4760 PDEN083 ROOT CANAL TREATMENT BICUSPID Procedure DENTAL MEDICINE 4370 4590 5470 6340 PDEN084 ROOT CANAL TREATMENT MOLAR Procedure DENTAL MEDICINE 4790 5030 5980 6940 PDEN085 ROOT PLANNING Procedure DENTAL MEDICINE 760 800 950 1110 PDEN086 SCAR REVISION OF SUTURING Procedure DENTAL MEDICINE 11760 12350 14700 17050 PDEN087 SPACE MAINTAINER Procedure DENTAL MEDICINE 1240 1300 1540 1790 PDEN088 STAGE - 1 - DEN Procedure DENTAL MEDICINE 11210 11770 14010 16250 PDEN089 STAGE - 2 - DEN Procedure DENTAL MEDICINE 4930 5170 6160 7140 PDEN090 STAGE - 3 - DEN Procedure DENTAL MEDICINE 4650 4880 5810 6740 PDEN091 THERAPEUTIC PULPOTOMY Procedure DENTAL MEDICINE 1510 1590 1890 2190

279 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PDEN092 WOUND DEBRIDEMENT Procedure DENTAL MEDICINE 8480 8900 10600 12290 PDEN093 ZIMMER DENTAL IMPLANT WITH CROWN Procedure DENTAL MEDICINE 46450 48780 58070 67360 ZIMMER DENTAL IMPLANT WITHOUT PDEN094 Procedure DENTAL MEDICINE 34160 35870 42700 49530 CROWN PDEN095 LAVA CROWN & BRIDGES Procedure DENTAL MEDICINE 25280 26550 31600 36660 PDEN096 SS II & SIII WITH SOLID ABUTMENT Procedure DENTAL MEDICINE 19130 20090 23910 27740 PDEN097 MS NARROW RIDGE Procedure DENTAL MEDICINE 17080 17940 21350 24770 PDEN098 MS OVERDENTURES WITH RETAINER CAP Procedure DENTAL MEDICINE 17080 17940 21350 24770 PDEN099 3M ESSENTIAL CROWN Procedure DENTAL MEDICINE 18450 19370 23060 26750 PDEN100 FIBRE POST Procedure DENTAL MEDICINE 1240 1300 1540 1790 PDEN101 VICRYL Procedure DENTAL MEDICINE 590 620 740 860 PDEN102 CERAMIC REPAIR Procedure DENTAL MEDICINE 820 860 1030 1190 PDEN103 SURGICEL Procedure DENTAL MEDICINE 2050 2150 2560 2970 PDEN104 BLUE SKY IMPLANT Procedure DENTAL MEDICINE 34160 35870 42700 49530 PDEN105 S S CROWN Procedure DENTAL MEDICINE 4370 4590 5470 6340 PDEN106 STRIP CROWN Procedure DENTAL MEDICINE 3280 3450 4100 4760 PDEN107 CHAIR SIDE RELINING Procedure DENTAL MEDICINE 1780 1860 2220 2570 PDEN108 ANTERIOR DIRECT VENEER (Per Tooth) Procedure DENTAL MEDICINE 3560 3740 4450 5160 POSTERIOR COMPOSITE FILLING (Per PDEN109 Procedure DENTAL MEDICINE 2740 2880 3430 3970 Tooth) PDEN110 DIASTEMA CLOSURE ( Per Unit) Procedure DENTAL MEDICINE 3700 3880 4620 5360 PDEN111 BLEACHING (Per Tooth) Procedure DENTAL MEDICINE 960 1010 1200 1390 PDEN112 CERAMIC LAMINATE (Per Tooth) Procedure DENTAL MEDICINE 15710 16500 19640 22780 PDEN113 CERAMIC VENEER (Per Tooth) Procedure DENTAL MEDICINE 18450 19370 23060 26750 PDEN114 THINEER (Per Tooth) Procedure DENTAL MEDICINE 14350 15060 17930 20800 HOME BLEACH / OFFICE BLEACH U/L PDEN115 Procedure DENTAL MEDICINE 4510 4740 5640 6540 (Excluding Material) PDEN116 DEPIGMENTATION OF GUMS (Per Segment) Procedure DENTAL MEDICINE 3700 3880 4620 5360 PDEN117 CROWN LENGTHENING ( Per Tooth) Procedure DENTAL MEDICINE 1910 2010 2390 2770 IVOCLAR COMPLETE DENTURE ( UPPER / PDEN118 Procedure DENTAL MEDICINE 17760 18650 22200 25750 LOWER ) PDEN119 WALPLAST ( FLEXIBLE DENTURE ) Procedure DENTAL MEDICINE 15040 15790 18790 21800 Nobel Active Implant Package (without PDEN120 Procedure DENTAL MEDICINE 88530 92960 110660 128370 crown) MULTIUNIT ABUTMENT STRAIGHT/ PDEN121 Procedure DENTAL MEDICINE 21870 22960 27330 31700 ANGULATED PER UNIT MULTIUNIT ABATMENT SCREW RETAINED PDEN122 Procedure DENTAL MEDICINE 18450 19370 23060 26750 RESTORATION PDEN123 CERAMIC SINGLE ARCH DENTURES Procedure DENTAL MEDICINE 27330 28700 34160 39620 PDEN124 Re-TREATMENT ROOT CANAL Procedure DENTAL MEDICINE 6420 6740 8030 9310

280 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PDEN125 SINUS LIFT (Cost for the Graft extra) Procedure DENTAL MEDICINE 18450 19370 23060 26750 PDEN126 RANDOM GLUCOSE (Checking) - Dental Procedure DENTAL MEDICINE 110 110 130 160 RADIOGRAPHS ORTHOPANTOGRAM (OPG PDEN127 Procedure DENTAL MEDICINE 820 860 1030 1190 - R) PDEN128 Crown Zirconia Ziecon (10 Yrs) Procedure DENTAL MEDICINE 10390 10910 12990 15060 PDEN129 Bridge Zirconia Ziecon (10 Yrs) Procedure DENTAL MEDICINE 10390 10910 12990 15060 PDEN130 Crown Zirconia Orodent Italya (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810 PDEN131 Bridge Zirconia Orodent Italya (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810 PDEN132 Crown PFM CAD/CAM Procedure DENTAL MEDICINE 5190 5450 6490 7530 PDEN133 Noritake Zirconia Katana (10 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810 PDEN134 Zirconia Amman Girrbach (5 Yrs) Procedure DENTAL MEDICINE 13670 14350 17080 19810 PDEN135 Crown PFZ Procedure DENTAL MEDICINE 5190 5450 6490 7530 PDEN136 Sky Fast & Fixed (Single Arch) All On Four Procedure DENTAL MEDICINE 225430 236700 281780 326870 PDEN137 Sky Fast & Fixed (Single Arch) All On Six Procedure DENTAL MEDICINE 330630 347160 413290 479410 PDEN138 Fast & Fixed Analogue Procedure DENTAL MEDICINE 5190 5450 6490 7530 PDEN139 3M Translucent Crown and Bridges Procedure DENTAL MEDICINE 12420 13050 15530 18010 PDEN140 3M Monolith Crown and Bridges Procedure DENTAL MEDICINE 11180 11740 13980 16210 3M Porcelain Fused Metal CAD CAM Crown PDEN141 Procedure DENTAL MEDICINE 10190 10700 12740 14780 and Bridge PDEN142 Osstem Implant with abutment Procedure DENTAL MEDICINE 19880 20870 24840 28820 PDEN143 Osstem Implant impression coping (per) Procedure DENTAL MEDICINE 4350 4570 5440 6310 PDEN144 Osstem Implant analog(per) Procedure DENTAL MEDICINE 1060 1120 1330 1540 PDEN145 Osstem Implant tube cylinder (per) Procedure DENTAL MEDICINE 3910 4110 4890 5670 PDEN146 PRP-procedure Procedure DENTAL MEDICINE 2880 3020 3600 4170 PDEN147 Soft tissue laser Treatment (per quadrant) Procedure DENTAL MEDICINE 8050 8460 10070 11680 ADJUNCTIVE ORTHODONTICS ON FIXING DENTAL PDOD001 Procedure 22540 23670 28180 32690 STG-1 ORTHODONTICS ADJUNCTIVE ORTHODONTICS ON FIXING DENTAL PDOD002 Procedure 4370 4590 5470 6340 STG-2 ORTHODONTICS ADJUNCTIVE ORTHODONTICS ON FIXING DENTAL PDOD003 Procedure 2870 3010 3580 4160 STG-3 ORTHODONTICS ANCHORAGE APPLIANCES IMPLANT DENTAL PDOD004 Procedure 7110 7470 8890 10310 ANCHORAGE ORTHODONTICS DENTAL PDOD005 ANCHORAGE APPLIANCES LINGUAL ARCH Procedure 3830 4030 4790 5560 ORTHODONTICS ANCHORAGE APPLIANCES NANCE HOLDING DENTAL PDOD006 Procedure 3830 4030 4790 5560 ARCH/TPA ORTHODONTICS DENTAL PDOD007 APPLIANCE REPAIR Procedure 1300 1370 1630 1890 ORTHODONTICS ARCH EXPANSION APPLIANCE HYRAX DENTAL PDOD008 Procedure 14350 15060 17930 20800 APPLIANCES ORTHODONTICS

281 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

ARCH EXPANSION APPLIANCE DENTAL PDOD009 Procedure 14350 15060 17930 20800 HYRAX+REVER-PULLHEADGEAR STG-1 ORTHODONTICS ARCH EXPANSION APPLIANCE DENTAL PDOD010 Procedure 4790 5030 5980 6940 HYRAX+REVER-PULLHEADGEAR STG-2 ORTHODONTICS ARCH EXPANSION APPLIANCE QUAD HELIX DENTAL PDOD011 Procedure 11760 12350 14700 17050 APPLIANCES ORTHODONTICS ARCH EXPANSION APPLIANCE REMOVABLE DENTAL PDOD012 Procedure 9570 10050 11960 13880 EXPANSION APPL ORTHODONTICS DENTAL PDOD013 ARCHWIRE REPLACEMENT Procedure 1300 1370 1630 1890 ORTHODONTICS DENTAL PDOD014 BEGGS TECHNIQUE ON FIXIING STG-1 Procedure 23910 25110 29890 34670 ORTHODONTICS DENTAL PDOD015 BEGGS TECHNIQUE ON FIXIING STG-2 Procedure 7110 7470 8890 10310 ORTHODONTICS DENTAL PDOD016 BEGGS TECHNIQUE ON FIXIING STG-3 Procedure 4790 5030 5980 6940 ORTHODONTICS DENTAL PDOD017 BONDED RETAINERS: EACH ARCH Procedure 3420 3590 4270 4960 ORTHODONTICS DENTAL PDOD018 BRACKET REPAIR Procedure 900 950 1130 1310 ORTHODONTICS DENTAL PDOD019 BRACKET REPLACEMENT Procedure 820 860 1030 1190 ORTHODONTICS DENTAL PDOD020 DISTAL ZIG I STAGE Procedure 16400 17220 20500 23780 ORTHODONTICS DENTAL PDOD021 DISTALIZATION APPLIANCE STG-1 Procedure 14350 15060 17930 20800 ORTHODONTICS DENTAL PDOD022 DISTALIZATION APPLIANCE STG-2 Procedure 4790 5030 5980 6940 ORTHODONTICS DENTAL PDOD023 DISTULISATION APPLIANCE K LOOP Procedure 16400 17220 20500 23780 ORTHODONTICS FIXED PEA (CERAMIC BRACKETS) ON DENTAL PDOD024 Procedure 47820 50210 59780 69340 FIXING STG-1 ORTHODONTICS FIXED PEA (CERAMIC BRACKETS) ON DENTAL PDOD025 Procedure 13110 13770 16390 19010 FIXING STG-2 ORTHODONTICS FIXED PEA (CERAMIC BRACKETS) ON DENTAL PDOD026 Procedure 13110 13770 16390 19010 FIXING STG-3 ORTHODONTICS FIXED PEA (CERAMIC BRACKETS) ON DENTAL PDOD027 Procedure 7930 8320 9910 11490 FIXING STG-4 ORTHODONTICS FIXED PEA (STAINLESS STEEL) ON FIXING DENTAL PDOD028 Procedure 36900 38740 46120 53500 STG-1 ORTHODONTICS FIXED PEA (STAINLESS STEEL) ON FIXING DENTAL PDOD029 Procedure 6420 6740 8030 9310 STG-2 ORTHODONTICS FIXED PEA (STAINLESS STEEL) ON FIXING DENTAL PDOD030 Procedure 6560 6890 8200 9510 STG-3 ORTHODONTICS FIXED PEA (STAINLESS STEEL) ON FIXING DENTAL PDOD031 Procedure 5190 5450 6490 7530 STG-4 ORTHODONTICS

282 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL PDOD032 Procedure 40990 43040 51240 59430 FIXING STG-1 ORTHODONTICS FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL PDOD033 Procedure 11760 12350 14700 17050 FIXING STG-2 ORTHODONTICS FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL PDOD034 Procedure 11760 12350 14700 17050 FIXING STG-3 ORTHODONTICS FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL PDOD035 Procedure 7110 7470 8890 10310 FIXING STG-4 ORTHODONTICS FIXED PEA(CERAMIC) WITHOUT CASE ON DENTAL PDOD036 Procedure 2600 2730 3250 3770 FIXING STG-5 ORTHODONTICS DENTAL PDOD037 FIXED PEA(S.STEEL) ON FIXING V STAGE Procedure 2600 2730 3250 3770 ORTHODONTICS FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL PDOD038 Procedure 34160 35870 42700 49530 CASE) STG-1 ORTHODONTICS FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL PDOD039 Procedure 6420 6740 8030 9310 CASE) STG-2 ORTHODONTICS FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL PDOD040 Procedure 6840 7180 8540 9910 CASE) STG-3 ORTHODONTICS FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL PDOD041 Procedure 4790 5030 5980 6940 CASE) STG-4 ORTHODONTICS FIXED PEA(S.STEEL) ON FIXING(WITHOUT DENTAL PDOD042 Procedure 2600 2730 3250 3770 CASE) STG-5 ORTHODONTICS FIXED PEA(SIMPLE CAS/SINGLE ARCH) ON DENTAL PDOD043 Procedure 23230 24400 29040 33690 FIXING STG-1 ORTHODONTICS FIXED PEA(SIMPLE CAS/SINGLE ARCH) ON DENTAL PDOD044 Procedure 5880 6180 7350 8530 FIXING STG-2 ORTHODONTICS FIXED PEA(SIMPLE CAS/SINGLE ARCH) ON DENTAL PDOD045 Procedure 5880 6180 7350 8530 FIXING STG-3 ORTHODONTICS FIXED PEA(SIMPLE CAS/SINGLE ARCH) ON DENTAL PDOD046 Procedure 3560 3740 4450 5160 FIXING STG-4 ORTHODONTICS FUNCTIONAL APPLIANCE REMOVABLE ON DENTAL PDOD047 Procedure 10390 10910 12990 15060 FIXING STG-1 ORTHODONTICS FUNCTIONAL APPLIANCE REMOVABLE ON DENTAL PDOD048 Procedure 5190 5450 6490 7530 FIXING STG-2 ORTHODONTICS FUNCTIONAL APPLIANCES FIXED ON FIXING DENTAL PDOD049 Procedure 9570 10050 11960 13880 STG-1 ORTHODONTICS FUNCTIONAL APPLIANCES FIXED ON FIXING DENTAL PDOD050 Procedure 5190 5450 6490 7530 STG-2 ORTHODONTICS GROWTH MODULATION APPLIANCE ON DENTAL PDOD051 Procedure 18450 19370 23060 26750 FIXING STG-1 ORTHODONTICS GROWTH MODULATION APPLIANCE ON DENTAL PDOD052 Procedure 4790 5030 5980 6940 FIXING STG-2 ORTHODONTICS GROWTH MODULATION FUNC+HEADGEAR DENTAL PDOD053 Procedure 14350 15060 17930 20800 STG-1 ORTHODONTICS GROWTH MODULATION FUNC+HEADGEAR DENTAL PDOD054 Procedure 4790 5030 5980 6940 STG-2 ORTHODONTICS

283 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

GROWTH MODULATION FUNC+HEADGEAR DENTAL PDOD055 Procedure 4790 5030 5980 6940 STG-3 ORTHODONTICS DENTAL PDOD056 GROWTH MODULATION HEAD GEAR STG-1 Procedure 17760 18650 22200 25750 ORTHODONTICS DENTAL PDOD057 GROWTH MODULATION HEADGEAR STG-2 Procedure 5880 6180 7350 8530 ORTHODONTICS DENTAL PDOD058 HYRAX APPLIANCES Procedure 18450 19370 23060 26750 ORTHODONTICS DENTAL PDOD059 INDIRECT BONDING(EXTRA) Procedure 5880 6180 7350 8530 ORTHODONTICS DENTAL PDOD060 LINGUAL HOLDING ARCH Procedure 4790 5030 5980 6940 ORTHODONTICS DENTAL PDOD061 NANCE HOLDING ARCH Procedure 4790 5030 5980 6940 ORTHODONTICS DENTAL PDOD062 PENDULUM STG Procedure 5060 5320 6330 7340 ORTHODONTICS DENTAL PDOD063 POST SURGICAL ORTHODONTICS Procedure 11760 12350 14700 17050 ORTHODONTICS DENTAL PDOD064 QUAD HELIX APPLIANCES Procedure 7650 8030 9560 11090 ORTHODONTICS DENTAL PDOD065 REMOVABLE APPLIANCE REPAIR Procedure 1300 1370 1630 1890 ORTHODONTICS REMOVABLE APPLIANCE UPP/LOW PLATES DENTAL PDOD066 Procedure 7650 8030 9560 11090 REMOVABLE STG-1 ORTHODONTICS DENTAL PDOD067 REMOVABLE APPLIANCES ON FIXING STG-1 Procedure 7110 7470 8890 10310 ORTHODONTICS DENTAL PDOD068 REMOVABLE APPLIANCES ON FIXING STG-2 Procedure 4790 5030 5980 6940 ORTHODONTICS REMOVABLE APPLIANCES SINGLE ARCH DENTAL PDOD069 Procedure 4790 5030 5980 6940 STG-1 ORTHODONTICS REMOVABLE APPLIANCES SINGLE ARCH DENTAL PDOD070 Procedure 1300 1370 1630 1890 STG-2 ORTHODONTICS DENTAL PDOD071 REMOVABLE EXPANSION APPLIANCES Procedure 7110 7470 8890 10310 ORTHODONTICS REMOVABLE ORTHODONTICS - MINOR - DENTAL PDOD072 Procedure 9300 9760 11620 13480 PDOD ORTHODONTICS RETENTION APPLIANCE REMOVABLE EACH DENTAL PDOD073 Procedure 1910 2010 2390 2770 ARCH ORTHODONTICS DENTAL PDOD074 RETENTIVE PHASE Procedure 3830 4030 4790 5560 ORTHODONTICS DENTAL PDOD075 SINGLE ARCH ON FIXING STG-1 Procedure 8200 8610 10250 11890 ORTHODONTICS DENTAL PDOD076 SINGLE ARCH ON FIXING STG-2 Procedure 2600 2730 3250 3770 ORTHODONTICS DENTAL PDOD077 SS-ARCH-EXPANSION-HYRAX APPLIANCES Procedure 15040 15790 18790 21800 ORTHODONTICS

284 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

SS-ARCH-EXPANSION-QUAD HELIX DENTAL PDOD078 Procedure 7650 8030 9560 11090 APPLIANCES ORTHODONTICS SS-ARCH-EXPANSION-REMOVABLE DENTAL PDOD079 Procedure 7110 7470 8890 10310 EXPANSION APPLIANCES ORTHODONTICS DENTAL PDOD080 SS-BONDED RETAINERS:EACH ARCH Procedure 2870 3010 3580 4160 ORTHODONTICS DENTAL PDOD081 SS-BRACKET REPAIR Procedure 900 950 1130 1310 ORTHODONTICS DENTAL PDOD082 SS-DISTULISATION APPL-K.LOOP Procedure 16400 17220 20500 23780 ORTHODONTICS DENTAL PDOD083 SS-DISTULISATION APPL-STG-1 Procedure 14350 15060 17930 20800 ORTHODONTICS DENTAL PDOD084 SS-DISTULISATION APPL-STG-2 Procedure 4790 5030 5980 6940 ORTHODONTICS DENTAL PDOD085 SS-FIXED APPLIANCE-BEG-FIXED-STG-1 Procedure 23910 25110 29890 34670 ORTHODONTICS DENTAL PDOD086 SS-FIXED APPLIANCE-BEG-FIXED-STG-2 Procedure 7110 7470 8890 10310 ORTHODONTICS DENTAL PDOD087 SS-FIXED APPLIANCE-BEG-FIXED-STG-3 Procedure 520 550 650 760 ORTHODONTICS DENTAL PDOD088 SS-FIXED-PEA-CERAMICBRACKET-STG-1 Procedure 47820 50210 59780 69340 ORTHODONTICS DENTAL PDOD089 SS-FIXED-PEA-CERAMICBRACKET-STG-2 Procedure 12850 13490 16060 18630 ORTHODONTICS DENTAL PDOD090 SS-FIXED-PEA-CERAMICBRACKET-STG-3 Procedure 12850 13490 16060 18630 ORTHODONTICS DENTAL PDOD091 SS-FIXED-PEA-CERAMICBRACKET-STG-4 Procedure 7650 8030 9560 11090 ORTHODONTICS DENTAL PDOD092 SS-FUNCTIONAL APPLIANCE STG-1 Procedure 10390 10910 12990 15060 ORTHODONTICS DENTAL PDOD093 SS-FUNCTIONAL APPLIANCE STG-2 Procedure 5190 5450 6490 7530 ORTHODONTICS DENTAL PDOD094 SS-FUNCTIONAL APPLIANCE-FIXED STG-2 Procedure 5190 5450 6490 7530 ORTHODONTICS DENTAL PDOD095 SS-FUNCTIONAL APPLIANCE-FIXED-STG-1 Procedure 9570 10050 11960 13880 ORTHODONTICS SS-GROWTH-MODULATION-HEADGEAR- DENTAL PDOD096 Procedure 14350 15060 17930 20800 STG-1 ORTHODONTICS SS-GROWTH-MODULATION-HEADGEAR- DENTAL PDOD097 Procedure 14350 15060 17930 20800 STG-2 ORTHODONTICS DENTAL PDOD098 SS-LINGUAL HOLDING ARCH Procedure 3830 4030 4790 5560 ORTHODONTICS DENTAL PDOD099 SS-NANCE HOLDING ARCH Procedure 3830 4030 4790 5560 ORTHODONTICS DENTAL PDOD100 SS-REMOVABLE APPLIANCE REPAIR Procedure 1300 1370 1630 1890 ORTHODONTICS

285 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

SS-REMOVABLE-APPLIANCES-UPP/LOW- DENTAL PDOD101 Procedure 7650 8030 9560 11090 PLATES-STG-1 ORTHODONTICS SS-RETENTION APPLIANCE REMOVABLE DENTAL PDOD102 Procedure 1510 1590 1890 2190 EACH ARCH ORTHODONTICS SS-STRAIGHTWIRE-TECHNIQUE-FIXED- DENTAL PDOD103 Procedure 43730 45910 54660 63400 STG-1 ORTHODONTICS SS-STRAIGHTWIRE-TECHNIQUE-FIXED- DENTAL PDOD104 Procedure 6420 6740 8030 9310 STG-2 ORTHODONTICS SS-STRAIGHTWIRE-TECHNIQUE-FIXED- DENTAL PDOD105 Procedure 6420 6740 8030 9310 STG-3 ORTHODONTICS SS-STRAIGHTWIRE-TECHNIQUE-FIXED- DENTAL PDOD106 Procedure 5190 5450 6490 7530 STG-4 ORTHODONTICS SURGICAL ORTHODONTICS FACE BOW DENTAL PDOD107 Procedure 2600 2730 3250 3770 TRANSFER ORTHODONTICS SURGICAL ORTHODONTICS PRE-SURGICAL DENTAL PDOD108 Procedure 35530 37300 44410 51510 ORTHODONTICS ORTHODONTICS SURGICAL ORTHODONTICS SURGICAL DENTAL PDOD109 Procedure 2600 2730 3250 3770 SPLINT(DOUBLE ARCH) ORTHODONTICS SURGICAL ORTHODONTICS SURGICAL DENTAL PDOD110 Procedure 1300 1370 1630 1890 SPLINT(SINGLE ARCH) ORTHODONTICS DENTAL PDOD111 MINOR REMOVABLE ORTHODONTICS Procedure 10390 10910 12990 15060 ORTHODONTICS DENTAL ORAL PDOX001 ABSCESS DRAINAGE EXTRA ORAL Procedure 2470 2590 3080 3570 MAXILLOFACIAL DENTAL ORAL PDOX002 ABSCESS DRAINAGE INTRA ORAL Procedure 760 800 950 1110 MAXILLOFACIAL DENTAL ORAL PDOX003 ADDITIONAL TOOTH APICETOMY Procedure 1510 1590 1890 2190 MAXILLOFACIAL DENTAL ORAL PDOX004 ADDITIONAL TOOTH IN GA Procedure 450 480 570 660 MAXILLOFACIAL ADDITIONAL TOOTH IN MEDICALY DENTAL ORAL PDOX005 Procedure 340 360 420 490 COMPROMISED MAXILLOFACIAL DENTAL ORAL PDOX006 ALVEOLECTOMY/PLASTY Procedure 2870 3010 3580 4160 MAXILLOFACIAL DENTAL ORAL PDOX007 ANKYLOSIS TMJ (BILATERAL) Procedure 4370 4590 5470 6340 MAXILLOFACIAL DENTAL ORAL PDOX008 ANKYLOSIS TMJ (UNILATERAL) Procedure 3420 3590 4270 4960 MAXILLOFACIAL DENTAL ORAL PDOX009 APICOECTOMY Procedure 4100 4300 5120 5940 MAXILLOFACIAL DENTAL ORAL PDOX010 BELOW KNEE FULL PLASTER Procedure 1370 1440 1720 1990 MAXILLOFACIAL DENTAL ORAL PDOX011 BIMAXILLARY OSTEOTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX012 BLEEDING SOCKET Procedure 450 480 570 660 MAXILLOFACIAL

286 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

DENTAL ORAL PDOX015 CALDWEL-LUC PROCEDURE Procedure 1910 2010 2390 2770 MAXILLOFACIAL DENTAL ORAL PDOX016 CARTILAGE GRAFTING Procedure 2870 3010 3580 4160 MAXILLOFACIAL DENTAL ORAL PDOX017 CYST ENUCLEATION Procedure 4240 4450 5290 6140 MAXILLOFACIAL DENTAL ORAL PDOX018 CYST ESCISION - G.A. Procedure 7110 7470 8890 10310 MAXILLOFACIAL DENTAL ORAL PDOX019 DENTAL CLEARANCE UNDER GA Procedure 4790 5030 5980 6940 MAXILLOFACIAL DENTAL ORAL PDOX021 DRY SOCKET DRESSING Procedure 320 330 390 460 MAXILLOFACIAL DENTAL ORAL PDOX022 EXCISIONAL BIOPSY Procedure 1510 1590 1890 2190 MAXILLOFACIAL EXTRACTION ADDITIONAL TOOTH SAME DENTAL ORAL PDOX023 Procedure 340 360 420 490 SITTIN MAXILLOFACIAL DENTAL ORAL PDOX024 EXTRACTION ADULT / TOOTH Procedure 610 640 770 890 MAXILLOFACIAL DENTAL ORAL PDOX025 EXTRACTION GROSSLY DECAYED Procedure 1180 1240 1470 1710 MAXILLOFACIAL EXTRACTION MEDICALLY COMPROMISED DENTAL ORAL PDOX026 Procedure 900 950 1130 1310 PATIENT MAXILLOFACIAL DENTAL ORAL PDOX027 EXTRACTION OF SINGLE TOOTH / GA Procedure 1300 1370 1630 1890 MAXILLOFACIAL DENTAL ORAL PDOX028 FAT PAD GRAFT (BILATERAL) Procedure 3830 4030 4790 5560 MAXILLOFACIAL DENTAL ORAL PDOX029 FAT PAD GRAFT (UNILATERAL) Procedure 2870 3010 3580 4160 MAXILLOFACIAL DENTAL ORAL PDOX030 FNAC - DEM Procedure 320 330 390 460 MAXILLOFACIAL DENTAL ORAL PDOX031 FOCAL ALVEOLECTOMY Procedure 760 800 950 1110 MAXILLOFACIAL DENTAL ORAL PDOX032 FRACTURE ALVEOLOUS Procedure 2470 2590 3080 3570 MAXILLOFACIAL DENTAL ORAL PDOX033 FRACTURE BILATERAL ORRIF Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX034 FRACTURE JAW Procedure 9570 10050 11960 13880 MAXILLOFACIAL DENTAL ORAL PDOX035 FRACTURE MALAR CLOSED REDUCTION Procedure 9570 10050 11960 13880 MAXILLOFACIAL DENTAL ORAL PDOX036 FRACTURE MALAR ORIF Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX037 FRACTURE MANDIBLE - ARCH BARS Procedure 7110 7470 8890 10310 MAXILLOFACIAL DENTAL ORAL PDOX038 FRACTURE MAXILLA ORRIF LE FORTE 1 Procedure 14350 15060 17930 20800 MAXILLOFACIAL

287 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

DENTAL ORAL PDOX039 FRACTURE MAXILLA ORRIF LE FORTE 2 Procedure 17080 17940 21350 24770 MAXILLOFACIAL DENTAL ORAL PDOX040 FRACTURE MAXILLA ORRIF LE FORTE 3 Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX041 FRACTURE MAXILLA WITH SPLIT PALATE Procedure 23910 25110 29890 34670 MAXILLOFACIAL DENTAL ORAL PDOX042 FRACTURE MULTIPLE - ORRIF Procedure 14350 15060 17930 20800 MAXILLOFACIAL DENTAL ORAL PDOX043 FRACTURE UNILATERAL ORRIF Procedure 11760 12350 14700 17050 MAXILLOFACIAL DENTAL ORAL PDOX044 FRENECTOMY Procedure 2470 2590 3080 3570 MAXILLOFACIAL DENTAL ORAL PDOX045 GENIOPLASTY Procedure 17080 17940 21350 24770 MAXILLOFACIAL DENTAL ORAL PDOX046 GINGIVAL/SOFT TISSUE GRAFTING Procedure 4790 5030 5980 6940 MAXILLOFACIAL DENTAL ORAL PDOX047 GINGIVECTOMY/PLASTY/QUADRANT Procedure 2600 2730 3250 3770 MAXILLOFACIAL DENTAL ORAL PDOX048 HEMIMANDIBULECTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX049 IMPACTION BONY Procedure 5880 6180 7350 8530 MAXILLOFACIAL DENTAL ORAL PDOX050 IMPACTION SOFT TISSUE Procedure 3560 3740 4450 5160 MAXILLOFACIAL DENTAL ORAL PDOX051 IMPLANT ENDO-A Procedure 32790 34430 40990 47550 MAXILLOFACIAL DENTAL ORAL PDOX052 IMPLANT ENDO-S Procedure 28700 30130 35870 41610 MAXILLOFACIAL DENTAL ORAL PDOX053 IMPLANT ENDO-U Procedure 27330 28700 34160 39620 MAXILLOFACIAL DENTAL ORAL PDOX054 IMPLANT E-Z-A - DEM Procedure 20500 21520 25620 29720 MAXILLOFACIAL DENTAL ORAL PDOX055 IMPLANT E-Z-S - DEM Procedure 17760 18650 22200 25750 MAXILLOFACIAL DENTAL ORAL PDOX056 IMPLANT E-Z-U - DEM Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX057 IMPLANT TRI-D - PDOX Procedure 14350 15060 17930 20800 MAXILLOFACIAL DENTAL ORAL PDOX058 IMPLANT TRI-N - PDOX Procedure 17080 17940 21350 24770 MAXILLOFACIAL DENTAL ORAL PDOX059 INCISION BIOPSY - PDOX Procedure 610 640 770 890 MAXILLOFACIAL DENTAL ORAL PDOX060 INTRA ARTICULAR INJECTION - (MAJOR) Procedure 590 620 740 860 MAXILLOFACIAL DENTAL ORAL PDOX061 INTRA ARTICULAR INJECTION - (MEDIUM) Procedure 450 480 570 660 MAXILLOFACIAL

288 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

DENTAL ORAL PDOX062 INTRA ARTICULAR INJECTION - (MINOR) Procedure 340 360 420 490 MAXILLOFACIAL INTRA ARTICULAR INJECTION - (SUPRA DENTAL ORAL PDOX063 Procedure 560 580 690 810 MAJOR) MAXILLOFACIAL DENTAL ORAL PDOX064 INTRA ORAL FLAPS Procedure 2600 2730 3250 3770 MAXILLOFACIAL DENTAL ORAL PDOX065 LEPORT I OSTEOTOMY Procedure 23910 25110 29890 34670 MAXILLOFACIAL DENTAL ORAL PDOX066 MALAR AUGMENTATION Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX067 MANDIBLE BODY OSTEOTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX068 MANDIBLE DISLOCATION Procedure 1650 1730 2060 2390 MAXILLOFACIAL DENTAL ORAL PDOX069 MANDIBLE RAMUS OSTEOTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX070 MANDIBLE SEGMENTAL OSTEOTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX071 MAXILLA SEGMENTAL OSTEOTOMY Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX072 MAXILLECTOMY Procedure 14350 15060 17930 20800 MAXILLOFACIAL DENTAL ORAL PDOX073 NASO ETHMOID FRACTURE Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX074 ORBITAL BLOW OUT FRACTURE Procedure 19130 20090 23910 27740 MAXILLOFACIAL DENTAL ORAL PDOX075 ORO ANTRAL FISTULA Procedure 9570 10050 11960 13880 MAXILLOFACIAL DENTAL ORAL PDOX076 ORO NASAL FISTULA - PDOX Procedure 9570 10050 11960 13880 MAXILLOFACIAL DENTAL ORAL PDOX077 ORTHOGNATHIC MODEL SURGERY Procedure 2470 2590 3080 3570 MAXILLOFACIAL DENTAL ORAL PDOX078 OSSEOUS SURGERY Procedure 5610 5890 7010 8130 MAXILLOFACIAL DENTAL ORAL PDOX079 PT BRACING - PDOX Procedure 320 330 390 460 MAXILLOFACIAL DENTAL ORAL PDOX080 PALATEL FENESTRATION Procedure 3420 3590 4270 4960 MAXILLOFACIAL DENTAL ORAL PDOX081 PAN FACIAL FRACTURES Procedure 23910 25110 29890 34670 MAXILLOFACIAL DENTAL ORAL PDOX082 PERICORONAL FLAP EXCISION Procedure 1370 1440 1720 1990 MAXILLOFACIAL PERIODONTAL FLAP SURGERY (COST OF DENTAL ORAL PDOX083 Procedure 3970 4170 4960 5760 GRAFT MAXILLOFACIAL PLASTER OF PARIS APPLICATION - MAJOR DENTAL ORAL PDOX084 Procedure 1510 1590 1890 2190 - DEM MAXILLOFACIAL

289 Dental

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PLASTER OF PARIS APPLICATION - MEDIUM DENTAL ORAL PDOX085 Procedure 1180 1240 1470 1710 - DEM MAXILLOFACIAL PLASTER OF PARIS APPLICATION - MINOR DENTAL ORAL PDOX086 Procedure 760 800 950 1110 - DEM MAXILLOFACIAL DENTAL ORAL PDOX087 REIMPLANTATION OF TOOTH Procedure 1910 2010 2390 2770 MAXILLOFACIAL DENTAL ORAL PDOX088 REPAIR OF HARD / SOFT PALATE Procedure 4790 5030 5980 6940 MAXILLOFACIAL DENTAL ORAL PDOX089 ROOT RESECTION Procedure 2470 2590 3080 3570 MAXILLOFACIAL DENTAL ORAL PDOX090 SEGMENTAL RESECTION Procedure 3830 4030 4790 5560 MAXILLOFACIAL DENTAL ORAL PDOX091 SIAL OLITH EXCISION Procedure 4790 5030 5980 6940 MAXILLOFACIAL DENTAL ORAL PDOX092 SKIN GRAFTS Procedure 960 1010 1200 1390 MAXILLOFACIAL DENTAL ORAL PDOX093 SOFT TISSUE REPAIR INTRAORAL / LA Procedure 1300 1370 1630 1890 MAXILLOFACIAL DENTAL ORAL PDOX094 STAGE - 1 - DEM Procedure 9840 10330 12300 14260 MAXILLOFACIAL DENTAL ORAL PDOX095 STAGE - 1 TRI Procedure 4650 4880 5810 6740 MAXILLOFACIAL DENTAL ORAL PDOX096 STAGE - 2 - DEM Procedure 4930 5170 6160 7140 MAXILLOFACIAL DENTAL ORAL PDOX097 STAGE - 3 - DEM Procedure 4650 4880 5810 6740 MAXILLOFACIAL DENTAL ORAL PDOX098 SUBMANDIBULAR GLAND EXCISION Procedure 7110 7470 8890 10310 MAXILLOFACIAL DENTAL ORAL PDOX099 SURGICAL EXISION - CYST TUMOR Procedure 3970 4170 4960 5760 MAXILLOFACIAL SURGICAL REMOVAL IN MEDICALY DENTAL ORAL PDOX100 Procedure 1910 2010 2390 2770 COMPROMISED MAXILLOFACIAL DENTAL ORAL PDOX101 SURGICAL REMOVAL WITH CURETTAGE Procedure 1300 1370 1630 1890 MAXILLOFACIAL DENTAL ORAL PDOX102 SURGICAL SPLINTING Procedure 1910 2010 2390 2770 MAXILLOFACIAL DENTAL ORAL PDOX103 SUTURE REMOVAL (MAJOR) Procedure 220 230 280 320 MAXILLOFACIAL DENTAL ORAL PDOX104 SUTURE REMOVAL (MEDIUM) Procedure 200 210 250 290 MAXILLOFACIAL DENTAL ORAL PDOX105 TONGUE TIE RELEASE - PDOX Procedure 3560 3740 4450 5160 MAXILLOFACIAL DENTAL ORAL PDOX106 TRANSPLANTATION Procedure 1240 1300 1540 1790 MAXILLOFACIAL DENTAL ORAL PDOX107 VESTIBULAR EXTENSION Procedure 2600 2730 3250 3770 MAXILLOFACIAL DENTAL ORAL PDOX108 VESTIBULOPLASTY Procedure 1240 1300 1540 1790 MAXILLOFACIAL

290 Emergency

291 Emergency

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ACCIDENT PAEA001 BLOOD PRESSURE CHECK - AEA Emergency 50 50 60 70 EMERGENCY ADULT ACCIDENT PAEA009 GRBS - BLOOD SUGAR - AEA Emergency 50 50 60 70 EMERGENCY ADULT ACCIDENT PAEA020 OXYGEN INHALATION PER HOUR - AEA Emergency 50 50 60 70 EMERGENCY ADULT ACCIDENT PAEA012 INJECTION -IM - AEA Emergency 70 70 80 100 EMERGENCY ADULT ACCIDENT PAEA010 INJECTION - IV - AEA Emergency 70 70 80 100 EMERGENCY ADULT ACCIDENT PAEA011 INJECTION - SC - AEA Emergency 70 70 80 100 EMERGENCY ADULT ACCIDENT PAEA014 IV CANNULATION - AEA Emergency 70 70 80 100 EMERGENCY ADULT ACCIDENT PAEA007 ENEMA - AEA Emergency 80 80 100 110 EMERGENCY ADULT ACCIDENT PAEA018 NEBULISATION - PER EPISODE - AEA Emergency 80 80 100 110 EMERGENCY ADULT ACCIDENT PAEA029 TUBE INSERTION - NG - AEA Emergency 80 80 100 110 EMERGENCY ADULT ACCIDENT PAEA005 DRESSING - MINOR - AEA Emergency 100 100 120 140 EMERGENCY ADULT ACCIDENT PAEA026 SUTURE REMOVAL - MINOR - AEA Emergency 120 130 150 170 EMERGENCY ADULT ACCIDENT PAEA002 CATHETERIZATION - AEA Emergency 140 150 180 200 EMERGENCY ADULT ACCIDENT PAEA006 ECG - AEA Emergency 150 160 190 220 EMERGENCY ADULT OBSERVATION CHARGE - 3 TO 6 HRS ACCIDENT PAEA019 Emergency 160 170 200 230 - AEA EMERGENCY ADULT ACCIDENT PAEA004 DRESSING - MEDIUM - AEA Emergency 180 190 230 260 EMERGENCY ADULT ACCIDENT PAEA025 SUTURE REMOVAL - MEDIUM - AEA Emergency 180 190 230 260 EMERGENCY ADULT ACCIDENT PAEA028 SUTURING MINOR - AEA Emergency 180 190 230 260 EMERGENCY ADULT ACCIDENT PAEA015 IV INFUSION - AEA Emergency 280 290 350 400 EMERGENCY ADULT EMERGENCY SCREENING CHARGES - ACCIDENT PAEA034 Emergency 350 370 440 510 AEA EMERGENCY ADULT ACCIDENT PAEA008 GASTRIC LAVAGE - AEA Emergency 350 370 440 510 EMERGENCY ADULT ACCIDENT PAEA038 PROTHROMBIN (INSTANT) - AEA Emergency 350 370 440 510 EMERGENCY ADULT ACCIDENT PAEA027 SUTURING MEDIUM - AEA Emergency 350 370 440 510 EMERGENCY ADULT

292 Emergency

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ACCIDENT PAEA023 POP MINOR - AEA Emergency 420 450 530 610 EMERGENCY ADULT ACCIDENT PAEA040 DRESSING MAJOR - AEA Emergency 470 490 580 670 EMERGENCY ADULT EMERGENCY ROOM RENT PER HOUR ACCIDENT PAEA056 Emergency 500 500 500 500 (AEA) EMERGENCY ADULT ACCIDENT PAEA039 SUTURING MAJOR - AEA Emergency 580 610 730 840 EMERGENCY ADULT ACCIDENT PAEA022 POP MEDIUM - AEA Emergency 630 670 790 920 EMERGENCY ADULT ACCIDENT PAEA036 QUICK MALARIA PARASITE TEST - AEA Emergency 690 720 860 990 EMERGENCY ADULT ACCIDENT PAEA046 FAST SCAN - AEA Emergency 700 730 870 1010 EMERGENCY ADULT ACCIDENT PAEA043 LUMBAR PUNCTURE - AEA Emergency 700 730 870 1010 EMERGENCY ADULT ACCIDENT PAEA055 Regional Analgesia - AEA Emergency 740 780 920 1070 EMERGENCY ADULT ACCIDENT PAEA021 POP MAJOR - AEA Emergency 760 800 950 1100 EMERGENCY ADULT ACCIDENT PAEA016 MEDICO LEGAL CHARGES - AEA Emergency 1000 1000 1000 1000 EMERGENCY ADULT ACCIDENT PAEA049 PLEURAL TAPPING - AEA Emergency 1050 1110 1320 1530 EMERGENCY ADULT ACCIDENT PAEA041 ARTERIAL LINE - AEA Emergency 1160 1220 1450 1680 EMERGENCY ADULT ACCIDENT PAEA035 STAT CARDIAC ENZYMES - AEA Emergency 1390 1460 1740 2010 EMERGENCY ADULT ACCIDENT PAEA037 SHORTNESS OF BREATH PANEL - AEA Emergency 1630 1710 2040 2360 EMERGENCY ADULT ACCIDENT PAEA003 CPR - AEA Emergency 1740 1820 2170 2520 EMERGENCY ADULT ACCIDENT PAEA044 ICD INSERTION - AEA Emergency 1740 1820 2170 2520 EMERGENCY ADULT ACCIDENT PAEA052 NONINVASIVE VENTILATION - AEA Emergency 1740 1820 2170 2520 EMERGENCY ADULT CLOSED REDUCTION OF DISLOCATION ACCIDENT PAEA047 Emergency 2310 2430 2890 3350 - AEA EMERGENCY ADULT ACCIDENT PAEA048 PROCEDURAL SEDATION - AEA Emergency 2310 2430 2890 3350 EMERGENCY ADULT ACCIDENT PAEA053 TRANSCUTANEOUS PACING - AEA Emergency 2310 2430 2890 3350 EMERGENCY ADULT ACCIDENT PAEA013 INTUBATION - AEA Emergency 2890 3040 3610 4190 EMERGENCY ADULT ACCIDENT PAEA051 CARDIOVERSION - AEA Emergency 3470 3640 4340 5030 EMERGENCY ADULT

293 Emergency

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group ACCIDENT PAEA050 THROMBOLYSIS - AEA Emergency 3470 3640 4340 5030 EMERGENCY ADULT ACCIDENT PAEA042 ASCITIC TAPPING - AEA Emergency 3890 4080 4860 5640 EMERGENCY ADULT ACCIDENT PAEA045 CENTRAL LINE PLACEMENT - AEA Emergency 4050 4250 5060 5870 EMERGENCY ADULT PAEDIATRIC PPER018 INJECTION -IM - PPER Emergency 60 60 70 80 EMERGENCY PAEDIATRIC PPER019 INJECTION - IV - PER Emergency 60 60 70 80 EMERGENCY PAEDIATRIC PPER020 INJECTION - SC - PER Emergency 60 60 70 80 EMERGENCY PAEDIATRIC PPER023 IV CANNULATION - PER Emergency 80 80 100 110 EMERGENCY PAEDIATRIC PPER029 OXYGEN INHALATION PER HOUR - PER Emergency 80 80 100 110 EMERGENCY PAEDIATRIC PPER028 NG TUBE PLACEMENT Emergency 110 120 140 160 EMERGENCY PAEDIATRIC PPER007 DRESSING - PPER Emergency 130 140 160 190 EMERGENCY PAEDIATRIC PPER009 ECG - PPER Emergency 130 140 160 190 EMERGENCY PAEDIATRIC PPER027 NEBULISATION - PER EPISODE Emergency 130 140 160 190 EMERGENCY PAEDIATRIC PPER024 IV INFUSION - PER INFUSION Emergency 140 150 180 200 EMERGENCY PAEDIATRIC PPER051 WARMER Emergency 140 150 180 200 EMERGENCY PAEDIATRIC PPER012 ENEMA - PER Emergency 160 170 200 230 EMERGENCY PAEDIATRIC PPER041 SUTURE REMOVAL - PER Emergency 180 190 230 260 EMERGENCY PAEDIATRIC PPER044 SUTURE REMOVAL & DRESSING - PER Emergency 210 230 270 310 EMERGENCY PAEDIATRIC PPER052 SUTURING INTERMEDIATE - PER Emergency 210 230 270 310 EMERGENCY PAEDIATRIC PPER056 HAEMOGLOBIN ( AUTOMATED - EC 4+ ) Emergency 230 240 280 320 EMERGENCY PAEDIATRIC PPER003 CATHETERIZATION - PER Emergency 240 250 290 340 EMERGENCY PAEDIATRIC PPER067 IV INFUSION - WITH MOINTORING Emergency 270 280 330 390 EMERGENCY PAEDIATRIC PPER048 TRACHEOSTOMY TUBE CHANGE - PER Emergency 270 280 330 390 EMERGENCY INFUSION OF VASOACTIVE DRUGS - PAEDIATRIC PPER017 Emergency 350 370 440 510 PER EMERGENCY

294 Emergency

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PAEDIATRIC PPER036 POP MINOR - PER Emergency 390 410 490 570 EMERGENCY PAEDIATRIC PPER040 SUPRAPUBIC ASPIRATION Emergency 420 450 530 610 EMERGENCY PAEDIATRIC PPER005 CONTINUOUS NEBULISATION Emergency 450 470 560 640 EMERGENCY PAEDIATRIC PPER013 GASTRIC LAVAGE - PER Emergency 460 480 570 660 EMERGENCY PAEDIATRIC PPER047 SUTURING MINOR - PER Emergency 470 490 580 670 EMERGENCY EMERGENCY ROOM RENT GENERAL PAEDIATRIC PPER011 Emergency 500 500 500 500 PER HOUR EMERGENCY PAEDIATRIC PPER010 EMERGENCY ROOM RENT - PER HOUR Emergency 500 500 500 500 EMERGENCY PAEDIATRIC PPER001 ASCITIC TAP - PER Emergency 530 560 660 770 EMERGENCY PAEDIATRIC PPER054 DRESSING BURNS - MINOR Emergency 530 560 660 770 EMERGENCY PAEDIATRIC PPER026 LUMBAR PUNCTURE - PER Emergency 530 560 660 770 EMERGENCY PAEDIATRIC PPER049 TRANSFUSION - PER Emergency 630 670 790 920 EMERGENCY PAEDIATRIC PPER050 VENESECTION - PER Emergency 630 670 790 920 EMERGENCY PAEDIATRIC PPER035 POP MEDIUM - PER Emergency 660 690 820 950 EMERGENCY PAEDIATRIC PPER032 PERIPHERAL ARTERIAL LINE Emergency 690 720 860 990 EMERGENCY PROTHROMBIN TIME -PT ( PAEDIATRIC PPER057 AUTOMATED/ CLOTTING ASSAY - PT/ Emergency 690 720 860 990 EMERGENCY INR) RENAL PANEL - III - FASTING (CHEM PAEDIATRIC PPER058 Emergency 690 720 860 990 8+) EMERGENCY GROWTH HARMONE STIMULATION PAEDIATRIC PPER014 Emergency 700 730 870 1010 TEST EMERGENCY PAEDIATRIC PPER016 INCISSION & DRAINAGE - PPER Emergency 700 730 870 1010 EMERGENCY PAEDIATRIC PPER030 PAEDIATRIC ER STABILIZATION Emergency 700 730 870 1010 EMERGENCY PAEDIATRIC PPER034 POP MAJOR - PER Emergency 770 810 960 1120 EMERGENCY PAEDIATRIC PPER022 INTUBATION - PER Emergency 790 830 990 1150 EMERGENCY PAEDIATRIC PPER033 PLEURAL TAP Emergency 790 830 990 1150 EMERGENCY

295 Emergency

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group PAEDIATRIC PPER031 PERICARDIAL TAP Emergency 840 890 1050 1220 EMERGENCY PAEDIATRIC PPER021 INTERCOSTAL DRAINAGE - PER Emergency 900 940 1120 1300 EMERGENCY PAEDIATRIC PPER025 LIVER BIOPSY - PER Emergency 900 940 1120 1300 EMERGENCY PAEDIATRIC PPER037 SEDATION MAJOR Emergency 910 950 1130 1310 EMERGENCY PAEDIATRIC PPER045 SUTURING MAJOR - PER Emergency 960 1010 1200 1390 EMERGENCY BONE MARROW ASPIRATION AND PAEDIATRIC PPER002 Emergency 1050 1110 1320 1530 BIOPSY EMERGENCY PAEDIATRIC PPER004 CENTRAL LINE - PER Emergency 1050 1110 1320 1530 EMERGENCY PAEDIATRIC PPER008 DRESSING BURNS - MAJOR Emergency 1050 1110 1320 1530 EMERGENCY PAEDIATRIC PPER060 EMERGENCY ROOM RENT - 12 HOURS Emergency 1050 1110 1320 1530 EMERGENCY INCISSION & DRAINAGE - PPER- PAEDIATRIC PPER065 Emergency 1050 1110 1320 1530 (MAJOR) EMERGENCY PAEDIATRIC PPER066 SEDATION FOR BRONCHOSCOPY Emergency 1050 1110 1320 1530 EMERGENCY SEDATION FOR INTRAARTICULAR PAEDIATRIC PPER061 Emergency 1050 1110 1320 1530 INJECTION(less than 3joints) EMERGENCY PAEDIATRIC PPER068 SEDATION MINOR -PER Emergency 1050 1110 1320 1530 EMERGENCY PAEDIATRIC PPER059 BLOOD GAS ANALYSIS (CG 4+ ) Emergency 1220 1280 1530 1770 EMERGENCY PAEDIATRIC PPER006 CPR - PER Emergency 1320 1380 1650 1910 EMERGENCY PAEDIATRIC PPER015 HICKMAN REMOVAL - PER Emergency 1370 1440 1710 1980 EMERGENCY BLOOD GAS ANALYSIS WITH PAEDIATRIC PPER055 Emergency 1400 1470 1750 2030 ELECTROLYTES (EG 7+ ) EMERGENCY SEDATION FOR INTRAARTICULAR PAEDIATRIC PPER062 Emergency 2100 2210 2630 3050 INJECTION( greater than 3joints) EMERGENCY PAEDIATRIC PPER063 SEDATION FOR SKIN LESION Emergency 2630 2760 3290 3810 EMERGENCY SEDATION FOR GI FOREIGN BODY PAEDIATRIC PPER064 Emergency 5250 5520 6570 7620 REMOVAL EMERGENCY

296 Consultation

297 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

CAEA001 CONSULTATION EMERGENCY - ADULT Consultation CONSULTATION OP 900 900 900 900 CONSULTATION EMERGENCY CAEA003 Consultation CONSULTATION OP 700 700 700 700 SUPERSPECIALITY DAY - ADULT CONSULTATION EMERGENCY CAEA005 Consultation CONSULTATION OP 700 700 700 700 SUPERSPECIALITY NIGHT - ADULT CAEA006 CONSULTATION EMERGENCY Consultation CONSULTATION OP 750 750 750 750 CANA001 CONSULTATION ANAESTHESIA Consultation CONSULTATION OP 700 0 0 0 CAND001 CONSULTATION ANDROLOGY - IVF Consultation CONSULTATION OP 700 0 0 0 CONSULTATION CARDIOLOGY CCAN001 Consultation CONSULTATION OP 900 0 0 0 ANAESTHESIA CCAP001 CONSULTATION CARDIOLOGY PAEDIATRIC Consultation CONSULTATION OP 900 0 0 0 CCAR001 CONSULTATION CARDIOLOGY Consultation CONSULTATION OP 900 0 0 0 CCPSY01 CONSULTATION CHILD PSYCHOLOGY Consultation CONSULTATION OP 900 0 0 0 CONSULTATION CARDIOTHORACIC CCTS001 Consultation CONSULTATION OP 900 0 0 0 SURGERY CCYT001 CONSULTATION CYTOGENETICS Consultation CONSULTATION OP 900 0 0 0 CDEN001 CONSULTATION DENTAL - MEDICINE Consultation CONSULTATION OP 700 0 0 0 CDER001 CONSULTATION DERMATOLOGY Consultation CONSULTATION OP 700 0 0 0 CONSULTATION DIABETES AND CDIB001 Consultation CONSULTATION OP 900 0 0 0 ENDOCRINOLOGY CDIE001 CONSULTATION DIETARY Consultation CONSULTATION OP 500 CDIE002 HEALTHY DIET PACKAGE Consultation CONSULTATION OP 580 0 0 0 CDOD001 CONSULTATION DENTAL - ORTHODONTICS Consultation CONSULTATION OP 700 0 0 0 CDOM001 CONSULTATION DENTAL - ORAL MEDICINE Consultation CONSULTATION OP 700 0 0 0 CDOX001 CONSULTATION DENTAL - ORAL MAX Consultation CONSULTATION OP 700 0 0 0 CENT001 CONSULTATION ENT Consultation CONSULTATION OP 700 0 0 0 CFET001 CONSULTATION FETAL MEDICINE Consultation CONSULTATION OP 700 0 0 0 CGAM001 CONSULTATION GASTRO MEDICAL Consultation CONSULTATION OP 900 0 0 0 CGAS001 CONSULTATION GASTRO SURGICAL Consultation CONSULTATION OP 900 0 0 0 CGEN001 CONSULTATION GENERAL SURGERY Consultation CONSULTATION OP 700 0 0 0 CGEN003 Discounted consultation (Bariatric surgery) Consultation CONSULTATION OP 420 420 420 420 CGER001 CONSULTATION GERIATRICS Consultation CONSULTATION OP 700 0 0 0 CHOMC01 HOME CARE CONSULTATION Consultation CONSULTATION OP 1020 0 0 0 CINF001 CONSULTATION INFECTIOUS DISEASES Consultation CONSULTATION OP 900 0 0 0 CINT001 CONSULTATION INTERNAL MEDICINE Consultation CONSULTATION OP 700 0 0 0 CONSULTATION INTERVENTIONAL PAIN CIPM001 Consultation CONSULTATION OP 900 0 0 0 MEDICINE CONSULTATION INTERVENTIONAL CIRAD01 Consultation CONSULTATION OP 900 0 0 0 RADIOLOGY CLTS001 CONSULTATION LIVER TRANSPLANT Consultation CONSULTATION OP 900 0 0 0

298 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

CONSULTATION GEN.SUR - MINIMAL CMAS001 Consultation CONSULTATION OP 700 0 0 0 ACCESS SURGERY CMHC001 CONSULTATION HEALTH CHECK Consultation CONSULTATION OP 100 0 0 0 CNEP001 CONSULTATION NEPHROLOGY Consultation CONSULTATION OP 900 0 0 0 CNEU001 CONSULTATION NEUROLOGY Consultation CONSULTATION OP 900 0 0 0 CNPSY01 CONSULTATION NEUROPSYCHOLOGY Consultation CONSULTATION OP 900 0 0 0 CNSR001 CONSULTATION NEUROSURGERY Consultation CONSULTATION OP 900 0 0 0 CNUC001 CONSULTATION NUCLEAR MEDICINE Consultation CONSULTATION OP 900 0 0 0 COBG001 CONSULTATION O. B. G. Consultation CONSULTATION OP 700 0 0 0 CONSULTATION OPTHALMOLOGY - COCU001 Consultation CONSULTATION OP 700 0 0 0 OCCUPLASTY CONM001 CONSULTATION ONCOLOGY - MEDICAL Consultation CONSULTATION OP 900 0 0 0 CONR001 CONSULTATION ONCOLOGY - RADIATION Consultation CONSULTATION OP 900 0 0 0 CONS001 CONSULTATION ONCOLOGY - SURGICAL Consultation CONSULTATION OP 900 0 0 0 COPT001 CONSULTATION OPTHALMOLOGY Consultation CONSULTATION OP 700 0 0 0 CORT001 CONSULTATION ORTHOPAEDICS Consultation CONSULTATION OP 700 0 0 0 CORTS01 CONSULTATION ORTHOSPINE Consultation CONSULTATION OP 900 0 0 0 CPAL001 CONSULTATION PAEDIATRIC ALLERGIST Consultation CONSULTATION OP 900 0 0 0 CONSULTATION PAEDIATRIC CPDR001 Consultation CONSULTATION OP 900 0 0 0 DERMATOLOGY CONSULTATION PAEDIATRIC CPDS001 Consultation CONSULTATION OP 900 0 0 0 DEVELOPMENTAL SPECIALIST CPED001 CONSULTATION PAEDIATRIC Consultation CONSULTATION OP 700 0 0 0 CPED002 CONSULTATION NEW BORN Consultation CONSULTATION OP 900 0 0 0 CPED003 CONSULTATION NEONATOLOGY Consultation CONSULTATION OP 900 0 0 0 CONSULTATION PAEDIATRIC CPEN001 Consultation CONSULTATION OP 900 0 0 0 ENDOCRINOLOGY CPER001 PAEDIATRIC EMERGENCY-CONSULTATION Consultation CONSULTATION OP 900 0 0 0 CPER002 CONSULTATION SPECIALITY Consultation CONSULTATION OP 700 0 0 0 CPER003 CONSULTATION SUPER SPECIALITY Consultation CONSULTATION OP 900 0 0 0 CPIC001 CONSULTATION PAEDIATRIC ICU Consultation CONSULTATION OP 700 0 0 0 CPLC001 CONSULTATION PAEDIATRIC LACTATION Consultation CONSULTATION OP 900 0 0 0 CPLS001 CONSULTATION PLASTIC SURGERY Consultation CONSULTATION OP 900 0 0 0 CONSULTATION PHYSICAL MEDICINE - CPMR001 Consultation CONSULTATION OP 700 0 0 0 REHAB CONSULTATION PAEDIATRIC CPNN001 Consultation CONSULTATION OP 900 0 0 0 NEONATOLOGY CPNU001 CONSULTATION PAEDIATRIC NEUROLOGY Consultation CONSULTATION OP 900 0 0 0 CONSULTATION PAEDIATRIC CPORT001 Consultation CONSULTATION OP 900 0 0 0 ORTHOPAEDICS

299 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

CONSULTATION PAIN & PALLIATIVE CPPS001 Consultation CONSULTATION OP 700 0 0 0 SERVICES CPRC001 CONSULTATION PAIN RELIEF Consultation CONSULTATION OP 700 0 0 0 CONSULTATION PAEDIATRIC CPRHE01 Consultation CONSULTATION OP 900 0 0 0 RHEUMATOLOGY CPSR001 CONSULTATION PAEDIATRIC SURGERY Consultation CONSULTATION OP 900 0 0 0 CPSY001 CONSULTATION PSYCHIATRY Consultation CONSULTATION OP 900 0 0 0 CONSULTATION PAEDIATRIC CPUL001 Consultation CONSULTATION OP 900 0 0 0 PULMONOLOGY CRAD01 CONSULTATION Radiology & Imaging Consultation CONSULTATION OP 900 0 0 0 CRES001 CONSULTATION RESPIRATORY MEDICINE Consultation CONSULTATION OP 900 0 0 0 CRHU001 CONSULTATION RHEUMATOLOGY Consultation CONSULTATION OP 900 0 0 0 CSCC001 CONSULTATION SPINE CARE Consultation CONSULTATION OP 900 0 0 0 CONSULTATION SPORTS & EXERCISE CSPO001 Consultation CONSULTATION OP 700 0 0 0 MEDICINE CURO001 CONSULTATION UROLOGY Consultation CONSULTATION OP 900 0 0 0 CVAS001 CONSULTATION VASCULAR SURGERY Consultation CONSULTATION OP 900 0 0 0 CYOG001 CONSULTATION YOGATHERAPY Consultation CONSULTATION OP 700 0 0 0 Body Composition Analysis and Diet DIET544 Consultation CONSULTATION OP 580 0 0 0 Consultation DIET549 NEPHROLOGY DIET CONSULTATION Consultation CONSULTATION OP 390 0 0 0 ECON003 E CONSULTATION & WATSON charges Consultation CONSULTATION OP 9980 0 0 0 E CONSULTATION ONCOLOGY SECOND ECON004 Consultation CONSULTATION OP 2100 0 0 0 OPINION SERVICES REFOrder Referral Order Consultation CONSULTATION OP 0 Inpatient CIPD007 DIETARY WARDS- CONSULTATION CONSULTATION IP 0 500 600 800 Services Inpatient CIPANA01 ANAESTHESIA - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPAND01 ANDROLOGY IVF - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPCAR02 CARDIOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPCNI02 CARDIOLOGY(NI) - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services CARDIOTHORACIC SURGERY - Inpatient CIPCTS01 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPD008 CONSULTATION - IPD CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPCRC02 CRITICAL CARE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPCYT02 CYTOGENETICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services

300 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Inpatient CIPDEN01 DENTAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPDER02 DERMATOLOGY-CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services DIABETES AND ENDOCRINOLOGY - Inpatient CIPDIB02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPENT01 ENT - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPFET02 FETAL MEDICINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPGAM02 GASTRO MEDICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPGAS01 GASTRO SURGICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPGEN01 GENERAL SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPGER02 GERIATRICS- CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPIND02 INFECTIOUS DISEASES - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPINT02 INTERNAL MEDICINE- CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services INTERVENTIONAL PAIN MEDICINE- Inpatient CIPIPM03 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services INTERVENTIONAL RADIOLOGY - Inpatient CIPIR001 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPLTS01 LIVER TRANSPLANT - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPMLC01 MEDICO LEGAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPPED05 NEONATOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPNEP02 NEPHROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPNEU02 NEUROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPNPSY2 NEUROPSYCHOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPNSR01 NEUROSURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPPED04 NEW BORN - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPNUC02 NUCLEAR MEDICINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPOBG01 OBS & GYNAECOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services

301 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Inpatient CIPONM02 ONCOLOGY MEDICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services ONCOLOGY RADIATION - CONSULTATION Inpatient CIPONR02 CONSULTATION IP 0 1100 1300 1700 IP Services Inpatient CIPONS01 ONCOLOGY SURGICAL - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPOPT01 OPTHALMOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPORT01 ORTHOPAEDICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPORTS1 ORTHO SPINE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPPED02 PAEDIATRICS - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services PAEDIATRICS DEVELOPMENT - Inpatient CIPPDS02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services PAEDIATRICS ENDOCRINOLOGY - Inpatient CIPEN002 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services PAEDIATRICS NEUROLOGY - Inpatient CIPPNEU2 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services PAEDIATRICS PULMONOLOGY - Inpatient CIPPUL02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services PAEDIATRICS RHEUMATOLOGY - Inpatient CIPPRHE2 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPPSR01 PAEDIATRIC SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services PAIN & PALLIATIVE SERVICES - Inpatient CIPPPS02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPPR002 PAIN RELIEF - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services PHYSICAL MEDICINE REHABILITATION - Inpatient CIPPMR02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPPLS01 PLASTIC SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPPSY02 PSYCHIATRY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services RESPIRATORY MEDICINE - CONSULTATION Inpatient CIPRES02 CONSULTATION IP 0 1100 1300 1700 IP Services Inpatient CIPRHU02 RHEUMATOLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPSCC01 SPINE CARE - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services SPORTS & EXERCISE MEDICINE- Inpatient CIPSPO02 CONSULTATION IP 0 1100 1300 1700 CONSULTATION IP Services Inpatient CIPURO01 UROLOGY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services

302 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Inpatient CIPVAS01 VASCULAR SURGERY - CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPYOG02 YOGATHERAPY -CONSULTATION IP CONSULTATION IP 0 1100 1300 1700 Services Inpatient CIPICU08 ICU CROSS CONSULTATION PER DAY CONSULTATION IP 0 1250 1250 1250 Services HIGH DEPENDENCY CONSULTATION Inpatient CIPHDU01 CONSULTATION IP 0 1300 1300 1300 CHARGES Services ANDROLOGY IVF - CONSULTATION IP- Inpatient CIPAND02 CONSULTATION IP 0 2200 2600 3400 NIGHT Services Inpatient CIPCAR03 CARDIOLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services CARDIOLOGY(NI) - CONSULTATION IP- Inpatient CIPCNI03 CONSULTATION IP 0 2200 2600 3400 NIGHT Services CARDIOTHORACIC SURGERY - Inpatient CIPCTS02 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services CRITICAL CARE - CONSULTATION IP - Inpatient CIPCRC03 CONSULTATION IP 0 2200 2600 3400 NIGHT Services Inpatient CIPCYT03 CYTOGENETICS - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services Inpatient CIPDEN02 DENTAL - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services Inpatient CIPDER03 DERMATOLOGY- CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services DIABETES AND ENDOCRINOLOGY - Inpatient CIPDIB03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services Inpatient CIPENT02 ENT - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services FETAL MEDICINE - CONSULTATION IP- Inpatient CIPFET03 CONSULTATION IP 0 2200 2600 3400 NIGHT Services GASTRO MEDICAL - CONSULTATION IP- Inpatient CIPGAM03 CONSULTATION IP 0 2200 2600 3400 NIGHT Services GASTRO SURGICAL - CONSULTATION Inpatient CIPGAS02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services GENERAL SURGERY - CONSULTATION Inpatient CIPGEN02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services Inpatient CIPGER03 GERIATRICS- CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services INFECTIOUS DISEASES - CONSULTATION Inpatient CIPIND03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services INTERNAL MEDICINE- CONSULTATION Inpatient CIPINT03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services INTERVENTIONAL PAIN MEDICINE - Inpatient CIPIPM02 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services INTERVENTIONAL RADIOLOGY - Inpatient CIPIR002 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services

303 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

LIVER TRANSPLANT - CONSULTATION Inpatient CIPLTS02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services NEONATOLOGY - CONSULTATION IP - Inpatient CIPPED07 CONSULTATION IP 0 2200 2600 3400 NIGHT Services Inpatient CIPNEP03 NEPHROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services Inpatient CIPNEU03 NEUROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services NEUROPSYCHOLOGY - CONSULTATION Inpatient CIPNPSY3 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services NEUROSURGERY - CONSULTATION IP- Inpatient CIPNSR02 CONSULTATION IP 0 2200 2600 3400 NIGHT Services NUCLEAR MEDICINE - CONSULTATION Inpatient CIPNUC03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services OBS & GYNAECOLOGY - CONSULTATION Inpatient CIPOBG02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services ONCOLOGY MEDICAL - CONSULTATION Inpatient CIPONM03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services ONCOLOGY RADIATION - CONSULTATION Inpatient CIPONR03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services ONCOLOGY SURGICAL - CONSULTATION Inpatient CIPONS02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services OPTHALMOLOGY - CONSULTATION IP- Inpatient CIPOPT02 CONSULTATION IP 0 2200 2600 3400 NIGHT Services ORTHOPAEDICS - CONSULTATION IP- Inpatient CIPORT02 CONSULTATION IP 0 2200 2600 3400 NIGHT Services Inpatient CIPORTS2 ORTHO SPINE - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services Inpatient CIPPED03 PAEDIATRICS - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services PAEDIATRICS DEVELOPMENT - Inpatient CIPPDS03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PAEDIATRICS ENDOCRINOLOGY - Inpatient CIPEN003 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PAEDIATRICS NEUROLOGY - Inpatient CIPPNEU3 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PAEDIATRICS PULMONOLOGY - Inpatient CIPPUL03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PAEDIATRICS RHEUMATOLOGY - Inpatient CIPPRHE3 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PAEDIATRIC SURGERY - CONSULTATION Inpatient CIPPSR02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services PAIN & PALLIATIVE SERVICES - Inpatient CIPPPS03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services

304 Consultation

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Inpatient CIPPR003 PAIN RELIEF - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services PHYSICAL MEDICINE REHABILITATION - Inpatient CIPPMR03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services PLASTIC SURGERY - CONSULTATION Inpatient CIPPLS02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services Inpatient CIPPSY03 PSYCHIATRY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services RESPIRATORY MEDICINE - CONSULTATION Inpatient CIPRES03 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services RHEUMATOLOGY - CONSULTATION IP- Inpatient CIPRHU03 CONSULTATION IP 0 2200 2600 3400 NIGHT Services Inpatient CIPSCC02 SPINE CARE - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services SPORTS & EXERCISE MEDICINE- Inpatient CIPSPO03 CONSULTATION IP 0 2200 2600 3400 CONSULTATION IP-NIGHT Services Inpatient CIPURO02 UROLOGY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services VASCULAR SURGERY - CONSULTATION Inpatient CIPVAS02 CONSULTATION IP 0 2200 2600 3400 IP-NIGHT Services Inpatient CIPYOG03 YOGATHERAPY - CONSULTATION IP-NIGHT CONSULTATION IP 0 2200 2600 3400 Services Inpatient CIPICU07 ICU CONSULTATION PER DAY CONSULTATION IP 0 2500 2500 2500 Services

305 Lab diagnostics

306 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0492 Creatinine- Serum (Nephro camp) Lab Diagnostic Services BIOCHEMISTRY 60 60 70 90 C0168 Glucose - Fasting Lab Diagnostic Services BIOCHEMISTRY 120 120 140 160 C0171 Glucose - Random Lab Diagnostic Services BIOCHEMISTRY 120 120 140 160 C0170 Glucose (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 140 150 170 200 C0370 Urine PH Lab Diagnostic Services BIOCHEMISTRY 140 150 170 200 C0059 Bun (Blood Urea Nitrogen) Lab Diagnostic Services BIOCHEMISTRY 160 160 190 210 C0014 Albumin - Serum Lab Diagnostic Services BIOCHEMISTRY 170 170 200 230 C0034 Ascitic Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0029 Ascitic Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0031 Ascitic Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0491 Cardio HS - CRP(Thesis study) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0115 CSF - Sugar Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0127 Drain Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0476 Glucose 1 Hour Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0169 Glucose - Post Prandial (Ppbs) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0172 Glucose ( Spot ) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0173 Glucose (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0251 Pd Fluid - PH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0462 Plasma/Blood pH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0283 Pleural Fluid - PH Lab Diagnostic Services BIOCHEMISTRY 170 180 210 250 C0290 Potassium - Serum Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250 C0315 Sodium - Serum Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250 C0314 Sodium (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 190 190 220 250 C0403 Ascitic Fluid - pH Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0042 Bilirubin - Direct Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0122 Dialysis Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0128 Drain Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0390 Drain Fluid - pH Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0391 Drain Fluid - Phosphorus Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0135 Drain Fluid - Total Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0244 Pd Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0253 Pd Fluid - Total Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0258 Peritonial Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0260 Peritonial Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0273 Pleural Fluid - Albumin Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0281 Pleural Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0287 Pleural Fluid- Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280

307 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0311 SGOT ( Ast ) Lab Diagnostic Services BIOCHEMISTRY 200 200 230 260 C0312 SGPT ( Alt ) Lab Diagnostic Services BIOCHEMISTRY 200 200 230 260 C0318 Synovial Fluid - Glucose Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0319 Synovial Fluid - Protein Lab Diagnostic Services BIOCHEMISTRY 200 200 240 280 C0263 Phosphorus - Serum Lab Diagnostic Services BIOCHEMISTRY 220 220 260 290 C0080 Cholesterol - Total Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0114 CSF - Protein Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0394 Drain Fluid - Bicarbonate Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0130 Drain Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0131 Drain Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0133 Drain Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0134 Drain Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0408 Drain Fluid - Uric Acid Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0265 Phosphorus - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0373 Urine Protein - Random Lab Diagnostic Services BIOCHEMISTRY 220 230 270 310 C0105 Creatinine- Serum Lab Diagnostic Services BIOCHEMISTRY 240 240 280 320 C0028 Ascitic Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0404 Ascitic Fluid - Phosphorus Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0405 Ascitic Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0406 Ascitic Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0077 Chloride - Serum Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0078 Chloride - Urine ( 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0076 Chloride (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0110 CSF - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0249 Pd Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0252 Pd Fluid - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0255 Pd Fuild - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0264 Phosphorus - Urine (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0277 Pleural Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0284 Pleural Fluid - PHosphorus Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0285 Pleural Fluid - Potassium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0288 Pleural Fluie - Sodium Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0289 Potassium (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0291 Potassium (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0313 Sodium (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0317 Synovial Fluid - Chloride Lab Diagnostic Services BIOCHEMISTRY 250 260 310 360 C0398 Ascitic Fluid - BUN Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390

308 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0400 Ascitic Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0401 Ascitic Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0040 Bicarbonate - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0041 Bicarbonate - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0102 Creatinine (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0103 Creatinine - (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0106 Cryoglobulins (Qual.) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0121 Dialysis Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0123 Dialysis Fluid - Urea Nitrogen Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0392 Drain Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0136 Drain Fluid - Urea Nitrogen Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0247 Pd Fluid - Bun Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0254 Pd Fluid - Uric Acid Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0256 Pd Fulid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0275 Pleural Fluid - Bun Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0278 Pleural Fluid - Cholesterol Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0280 Pleural Fluid - Creatinine Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0420 Post HD Blood Urea Nitrogen (BUN) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0421 Post HD Creatinine - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0418 Pre HD Blood Urea Nitrogen (BUN) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0419 Pre HD Creatinine - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 Total Protein/ Albumin / Globulin C0332 Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 /A:G C0339 Urea Nitrogen (Urine 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0340 Urea Nitrogen (Urine Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0341 Uric Acid - Serum Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0342 Uric Acid - Urine ( 24 Hrs ) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0343 Uric Acid - Urine (Random) Lab Diagnostic Services BIOCHEMISTRY 270 290 340 390 C0043 Bilirubin -Total Lab Diagnostic Services BIOCHEMISTRY 300 300 350 390 C0297 Protein Total Lab Diagnostic Services BIOCHEMISTRY 300 300 350 390 C0044 Bilirubin Total/Direct Lab Diagnostic Services BIOCHEMISTRY 310 310 360 410 C0079 Cholesterol - Hdl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480 C0081 Cholesterol - Vldl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480 C0082 Cholestrol - Ldl Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480 C0335 Triglycerides Lab Diagnostic Services BIOCHEMISTRY 330 350 410 480 C0399 Ascitic Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0032 Ascitic Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510

309 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0459 Breast Milk Sodium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0393 Drain Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0407 Drain Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0461 Fluid for chyle(triglycerides) Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0386 Magnesium - Urine (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0248 Pd Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0270 Plerural Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0276 Pleural Fluid - Calcium Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0368 Urine Mucopolysaccharides Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0372 Urine Protein - 24 Hrs Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 C0350 Urine - Protein Creatinine Ratio Lab Diagnostic Services BIOCHEMISTRY 350 370 440 510 GGT (Gamma Glutamyl C0166 Lab Diagnostic Services BIOCHEMISTRY 410 430 510 590 Transpeptidase) C0338 TSH (Thyroid Stimulating Hormone) Lab Diagnostic Services BIOCHEMISTRY 450 450 520 590 C0009 Acid PHosphatase - Total Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640 C0030 Ascitic Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640 C0203 Iron Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640 C0286 Pleural Fluid - Triglycerides Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640 C0460 Stool for Electrolytes Lab Diagnostic Services BIOCHEMISTRY 440 460 550 640 C0101 Creatine PHosphokinase (Cpk) Lab Diagnostic Services BIOCHEMISTRY 480 480 560 630 C0219 Magnesium - Serum Lab Diagnostic Services BIOCHEMISTRY 480 480 560 630 C0018 Alp (Alkaline PHosphatase) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0066 Calcium - Total Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0064 Calcium (Urine - 24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0067 Calcium - Urine(Random) Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0426 Sweat Chloride Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0320 T.Chol/Hdl.Chol Ratio Lab Diagnostic Services BIOCHEMISTRY 460 490 580 670 C0021 Amylase - Serum Lab Diagnostic Services BIOCHEMISTRY 500 500 580 650 C0107 CSF (Protein , Sugar, Chloride) Lab Diagnostic Services BIOCHEMISTRY 500 500 580 650 C0402 Ascitic Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0065 Calcium - Ionised Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0104 Creatinine Clearance Test Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0113 CSF - Ldh Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0132 Drain Fluid - L D H Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0389 Drain Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 Haemoglobin Variant Analysis ( C0493 Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 JMC) C0208 LDH Total Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740

310 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0220 Magnesium - Urine (Rand) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0250 Pd Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0259 Peritonial Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0282 Pleural Fluid - Magnesium Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0322 T4 (Thyroxine - Total) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0367 Urine Micro Albumin (24Hrs) Lab Diagnostic Services BIOCHEMISTRY 510 530 630 740 C0154 Free T3 Lab Diagnostic Services BIOCHEMISTRY 540 540 630 710 C0271 Pleural Fluid - Ldh Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780 C0321 T3 (Triiodothyronine) Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780 C0366 Urine Micro Albumin (Random) Lab Diagnostic Services BIOCHEMISTRY 540 570 680 780 C0434 Renal Panel - III - Random Lab Diagnostic Services BIOCHEMISTRY 580 600 720 830 C0475 Glucose Tolerance Test GDM Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0176 Glucose Tolerance Test (GTT ) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0194 Immunoglobulin - A (Iga) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0196 Immunoglobulin - G (Igg) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0197 Immunoglobulin - M (Igm) Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0431 Renal Panel - III - Fasting Lab Diagnostic Services BIOCHEMISTRY 620 650 770 900 C0424 Cystatin - C Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930 C0205 Iron With TIBC Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930 Qualitative Screening For C0300 Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930 Aminoaciduria C0334 Transferrin Saturation Lab Diagnostic Services BIOCHEMISTRY 640 680 800 930 Acid PHosphatase - Total & C0008 Lab Diagnostic Services BIOCHEMISTRY 670 700 830 960 Prostatic C0279 Pleural Fluid - Cpk Lab Diagnostic Services BIOCHEMISTRY 670 700 830 960 Urine Electrolytes - Na, K & Cl C0363 Lab Diagnostic Services BIOCHEMISTRY 670 700 830 960 (Random) C0143 Electrolytes (Na, K, Cl and Bicarb) Lab Diagnostic Services BIOCHEMISTRY 710 710 820 930 C0422 Cardio HS - CRP Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080 C0142 Electrolytes (Na, K & Cl) Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080 C0423 sTfr - Soluble Transferrin Receptor Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080 C0348 Urinary Microalb & Creatinine Ratio Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080 Urine Electrolytes - Na, K & Cl (24 C0362 Lab Diagnostic Services BIOCHEMISTRY 740 780 930 1080 Hrs) C0027 Ascitic Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0083 Cholinesterase(Pseudo) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0129 Drain Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0146 Everolimus (Certican) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160

311 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0158 FSH ( Follicle Stimulating Hormone ) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0212 LH ( Lutenizing Hormone ) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0217 Lithium Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0240 Osmolality - Serum Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0239 Osmolality - Urine (Rand) Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0274 Pleural Fluid - Amylase Lab Diagnostic Services BIOCHEMISTRY 800 840 1000 1160 C0214 Lipid Profile Lab Diagnostic Services BIOCHEMISTRY 850 850 980 1110 C0148 Ferritin Lab Diagnostic Services BIOCHEMISTRY 900 900 1040 1170 C0425 Retinol Binding Protein (RBP) Lab Diagnostic Services BIOCHEMISTRY 880 920 1100 1270 C0020 Ammonia Lab Diagnostic Services BIOCHEMISTRY 950 950 1100 1240 C0213 Lipase- Serum Lab Diagnostic Services BIOCHEMISTRY 950 950 1100 1240 C0155 Freet4 (Thyroxin-Free) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0156 Fructosamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0207 Kidney Profile Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0216 Lipoprotein (A) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 Protein Electrophoresis With T.P & C0296 Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 Alb C0351 Urine Drug - Amphetamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0353 Urine Drug - Cocaine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0354 Urine Drug - Metamphetamine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0355 Urine Drug - Methadone Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0358 Urine Drug-Methaquolone Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0356 Urine Drug - Morphine (Opiates) Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0357 Urine Drug - PHencyclidine Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0359 Urine Drug-Propoxyphene Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0360 Urine Durg - Barbiturates Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0361 Urine Durg - Benzodiazepines Lab Diagnostic Services BIOCHEMISTRY 930 980 1170 1350 C0052 Blood Gas Analysis Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0089 Complement 3 (C3) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0112 CSF - Lactate Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0447 Custic Fibrosis - Blood Spot Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0234 Neonatal TSH Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0242 Osmolality - Urine (24Hrs) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0480 PKU (Phenyl Ketone Uria) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0267 Plasma Lactate ( Lactic Acid ) Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0294 Prolactin Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 C0345 Urinary Calculi Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470

312 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Urine Drug - Marijuana C0352 Lab Diagnostic Services BIOCHEMISTRY 1010 1060 1260 1470 (Cannabinoids) C0153 Free PSA Lab Diagnostic Services BIOCHEMISTRY 1070 1070 1240 1400 C0013 AFP (Alpha Feto Protein) Lab Diagnostic Services BIOCHEMISTRY 1080 1080 1250 1410 C0177 Glycated Hemoglobin ( Hba1C ) Lab Diagnostic Services BIOCHEMISTRY 1090 1090 1260 1420 C0053 Blood Gas Analysis With Electrolytes Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 C0090 Complement 4 (C4) Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 C0100 Creatine Kinase With Ck-Mb Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 G 6 Pd (Glucose 6 PHos C0162 Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 Dehydrogenase) C0195 Immunoglobulin - E (Ige) Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 C0293 Progesterone Lab Diagnostic Services BIOCHEMISTRY 1070 1120 1330 1550 C0218 Liver Function Test Lab Diagnostic Services BIOCHEMISTRY 1190 1190 1370 1550 C0024 Apoplipoprotein - A1 & B Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0429 Renal Panel - I - Fasting Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0432 Renal Panel - I - Random Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0301 R. O Water Analysis Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0326 Testosterone (Total) Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0371 Urine Porphobilinogen (Quan) Lab Diagnostic Services BIOCHEMISTRY 1150 1200 1430 1660 C0330 Thyroid Profile (T3 T4 Tsh) Lab Diagnostic Services BIOCHEMISTRY 1250 1250 1440 1630 C0438 90 min post glucose Insulin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0096 Cortisol 4 Pm Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0097 Cortisol 8 Am Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0095 Cortisol - Midnight Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0093 Cortisol ( Random ) Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0144 Estradiol ( E2 ) Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0186 Hhc Screening Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0200 Insulin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 Neonatal Screening - Cystic C0233 Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 Fibrosis C0333 Transferrin Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0374 Urine Protein Electrophoresis Lab Diagnostic Services BIOCHEMISTRY 1200 1260 1500 1740 C0033 Ascitic Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1270 1330 1590 1840 C0439 120 min post glucose Insulin Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0436 30 min post glucose Insulin Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0437 60 min post glucose Insulin Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0011 Adenosine Deaminase (Ada) Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0109 CSF - Ada Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940

313 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0395 Drain Fluid - ADA Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0446 Inhibin A Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0257 Pericaridal Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0383 Synovial Fluid - ADA Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0364 Urine Fluoride Lab Diagnostic Services BIOCHEMISTRY 1340 1400 1670 1940 C0337 Troponin - I (Qual) Lab Diagnostic Services BIOCHEMISTRY 1430 1430 1650 1860 C0070 Carbamazepine(Tegretol) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0075 Ceruloplasmin Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0092 Copper (Serum) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0179 Growth Hormone ( H Gh ) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0181 Haemoglobin Variant Analysis Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0182 Haptoglobin Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0272 Pleural Fluid - Ada Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0298 PSA (Prostatic Specific Antigen) Lab Diagnostic Services BIOCHEMISTRY 1470 1550 1840 2130 C0074 CEA (Carcino Embryonic Antigen) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0091 Copper (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0098 Cortisol- Free (24 Hrs Urine) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0125 Digoxin Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0164 Galactosemia Screening Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0165 Gall Stone Analysis Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0188 Homocystine (Plasma) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0232 Neonatal Galactose Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0261 Phenobarbital Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0349 Urinary Xylose Excretion ( 5 Hrs ) Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0375 Valproic Acid Lab Diagnostic Services BIOCHEMISTRY 1610 1690 2010 2330 C0048 Blood Alcohol / Salivary-Alcohol Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0474 Bone Specific Alkaline Phosphatase Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0108 CSF For Oligoclonal Band Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0157 FSH & LH Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0215 Lipid Tetrad Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0262 Phenytoin Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0328 Theophylline ( Aminophylline ) Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0329 Thyroglobulin Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0379 Xylose Absorption Test - Blood Lab Diagnostic Services BIOCHEMISTRY 1730 1820 2160 2510 C0484 Bilirubin And Hb variant Analysis Lab Diagnostic Services BIOCHEMISTRY 1820 1910 2270 2640 C0004 17(Oh)P-Neonatal (Heel Prick) Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700 C0099 C-Peptide Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700

314 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0111 CSF - IGG Index Lab Diagnostic Services BIOCHEMISTRY 1860 1960 2330 2700 C0376 Vitamin B12 Lab Diagnostic Services BIOCHEMISTRY 2020 2020 2330 2630 C0026 Arsenic ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0035 Benzodiazepines and Metabolites Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0038 Beta Crosslaps Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0039 Beta Crosslaps (Ctx1) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0124 Dialysis Fluid Analysis Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0145 Estriol - E3 (Unconjugated) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0149 Fluoride - Urine Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0151 Folic Acid (Folate) Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0190 Hypertension Profile Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0441 Nicotine(Cotinine) - Urine Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0473 Osteocalcin Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0243 P1Np Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0458 Urinary Aluminium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0457 Urinary Berrylium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 Urinary Delta Amino Levulinic C0346 Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 Acid(Ala) C0455 Urinary Manganese Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 C0456 Urinary Vanadium Lab Diagnostic Services BIOCHEMISTRY 2000 2100 2500 2900 17-Oh P (17 Alpha Hydroxy C0005 Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 Progesterone) C0025 Arsenic ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 C0119 Dhea -Sulphate Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 Immunoglobulins ( IGA, IGG, IGM, C0198 Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 Ige ) C0209 Lead ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 C0331 Tissue Transglutaminase (TTG-A) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 C0380 Zinc ( Serum ) Lab Diagnostic Services BIOCHEMISTRY 2130 2240 2660 3090 C0488 Bile-Acids Lab Diagnostic Services BIOCHEMISTRY 2240 2360 2800 3250 C0428 Adiponectin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0037 Beta 2 Microglobulin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0047 Bismuth (Blood) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0046 Bismuth ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0086 Citrate, 24 Hour Urine Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0159 FSH, LH & Prolactin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0210 Lead ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0221 Manganese - Blood Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290

315 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0222 Mercury - Blood Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0223 Mercury - Urine Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0235 Nickel ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0236 Nickel ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0440 Nicotine(Cotinine) - Serum Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0306 Selenium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0307 Selenium ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 Sex Hormone Binding C0310 Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 Globulin(SHBG) C0463 Urinary Gold Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0344 Urinary V M A (24 Hrs) Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 C0449 Urine B2 Microglobulin Lab Diagnostic Services BIOCHEMISTRY 2270 2380 2830 3290 Ace (Angiotensin Converting C0007 Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 Enzyme) C0019 Alpha 1 Antitrypsin Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0085 Chromium (Urine) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0088 Cobalt ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0120 Diabetic Profile Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0152 Free Androgen Index (Clia/Elisa) Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0347 Urinary Metanephrines Lab Diagnostic Services BIOCHEMISTRY 2400 2520 3000 3480 C0397 Blood Gold Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0485 Blood Silver (Ag) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0486 Blood Tin (Sn) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0061 Cadmium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0062 Cadmium ( Urine ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0068 Cancer Antigen - CA 15-3 Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0084 Chromium ( Blood ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 C0087 Cobalt ( Serum ) Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 Heavy Metals Analysis-Blood(Lead/ C0185 Lab Diagnostic Services BIOCHEMISTRY 2540 2660 3170 3680 Arsenic/Mercury) C0010 Acth , Plasma Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0060 CA - 125 Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0069 Cancer Antigen - CA 19-9 Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0427 HOMA Score Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0224 Methotrexate Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0487 NT- ProBNP Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0299 Pth Intact With Total Calcium Lab Diagnostic Services BIOCHEMISTRY 2800 2940 3500 4060 C0192 IGF-1 (Somatomedin- C) Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240

316 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0191 IGF Bp-3 Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240 C0325 Testosterone (Free) Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240 C0369 Urine Oxalate Excretion Lab Diagnostic Services BIOCHEMISTRY 2930 3070 3660 4240 C0467 Brain Natriuretic Peptide Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440 C0160 FSH, LH, Prolactin & Progesterone Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440 C0430 Renal Panel - II - Fasting Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440 C0433 Renal Panel - II - Random Lab Diagnostic Services BIOCHEMISTRY 3060 3220 3830 4440 C0465 Total Vitamin D Lab Diagnostic Services BIOCHEMISTRY 3080 3240 3850 4470 C0016 Aldolase Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630 C0454 Aryl Sulphatase A Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630 C0451 Islet Cell Antibody Lab Diagnostic Services BIOCHEMISTRY 3200 3360 3990 4630 C0003 17 Ketosteroids ( 24 Hrs Urine ) Lab Diagnostic Services BIOCHEMISTRY 3330 3500 4160 4830 5-Hiaa (5-Hydroxy Indole Acetic C0006 Lab Diagnostic Services BIOCHEMISTRY 3330 3500 4160 4830 Acid) C0063 Calcitonin Lab Diagnostic Services BIOCHEMISTRY 3330 3500 4160 4830 C0126 Dihydrotestosterone ( Dht) Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020 C0161 FSH, LH, Prolactin & Testosterone Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020 C0327 Testosterone, Free & Total Lab Diagnostic Services BIOCHEMISTRY 3470 3640 4330 5020 C0022 Androstenedione Lab Diagnostic Services BIOCHEMISTRY 3600 3780 4500 5220 C0118 CYFRA 21-1, Lung Cancer Marker Lab Diagnostic Services BIOCHEMISTRY 3730 3920 4670 5410 C0202 Insulin Antibodies Lab Diagnostic Services BIOCHEMISTRY 3730 3920 4670 5410 C0482 Cyclosporine A ( W B ) (LCMS) Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610 C0483 Cyclosporine C2 Assay (LCMS) Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610 C0167 Glucode Insulin Package Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610 C0302 Red Cell Folate Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610 C0469 Urine for Free Light chains Lab Diagnostic Services BIOCHEMISTRY 3870 4060 4830 5610 C0481 Inhalant Allergans Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790 Neutrophil gelatinase-associated C0468 Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790 lipocalin (NGAL) C0308 Serum Gastrin Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790 C0323 Tacrolimus Lab Diagnostic Services BIOCHEMISTRY 3990 4190 4990 5790 C0058 Blood Spot-Amino Acids Lab Diagnostic Services BIOCHEMISTRY 4130 4330 5160 5980 C0479 ROMA Index Lab Diagnostic Services BIOCHEMISTRY 4130 4330 5160 5980 C0435 Anti Mullerian Hormone(AMH) Lab Diagnostic Services BIOCHEMISTRY 4530 4760 5660 6570 C0472 IGG4 Lab Diagnostic Services BIOCHEMISTRY 4800 5040 6000 6960 C0206 Kappa & Lambda Light Chains Lab Diagnostic Services BIOCHEMISTRY 5190 5450 6490 7520 C0001 1,25 Dihydroxy Vitamin Lab Diagnostic Services BIOCHEMISTRY 5860 6160 7330 8500 C0178 GNRH-Stimulation Test Lab Diagnostic Services BIOCHEMISTRY 5860 6160 7330 8500

317 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

C0002 1,25 Dihydroxy Vitamin D Lab Diagnostic Services BIOCHEMISTRY 6000 6300 7490 8690 C0141 Drugs of Abuse - Urine Lab Diagnostic Services BIOCHEMISTRY 6000 6300 7490 8690 C0138 Drug of Abuse - (Company) Lab Diagnostic Services BIOCHEMISTRY 6130 6440 7660 8890 Drugs of Abuse - 9 Drugs C0140 Lab Diagnostic Services BIOCHEMISTRY 6390 6710 7980 9260 (Company) C0137 Drug of Abuse - (Company-10 Drug) Lab Diagnostic Services BIOCHEMISTRY 7450 7830 9310 10800 C0365 Urine Immunofixation Lab Diagnostic Services BIOCHEMISTRY 7720 8110 9650 11190 C0072 Catecholamines - Urine(24Hrs) Lab Diagnostic Services BIOCHEMISTRY 7990 8390 9990 11580 C0193 Immunofixation Electrophoresis Lab Diagnostic Services BIOCHEMISTRY 7990 8390 9990 11580 C0180 Growth Hormone - Stimulation Test Lab Diagnostic Services BIOCHEMISTRY 8520 8940 10640 12350 C0309 Serum Immunofixation Lab Diagnostic Services BIOCHEMISTRY 8520 8940 10640 12350 C0448 Amiodarone Lab Diagnostic Services BIOCHEMISTRY 8790 9220 10980 12740 C0268 Plasma Renin Activity Lab Diagnostic Services BIOCHEMISTRY 8790 9220 10980 12740 C0324 Tandem Mass Spectrometry Lab Diagnostic Services BIOCHEMISTRY 9580 10060 11970 13890 C0409 Chromogranin A Lab Diagnostic Services BIOCHEMISTRY 10390 10910 12980 15060 C0163 Gad Antibodies-Igg Lab Diagnostic Services BIOCHEMISTRY 10910 11460 13640 15820 C0452 LDL Subfractions Lab Diagnostic Services BIOCHEMISTRY 10910 11460 13640 15820 C0453 Urine for PNS 100+ Lab Diagnostic Services BIOCHEMISTRY 11450 12020 14310 16600 C0387 Inhibin-B Lab Diagnostic Services BIOCHEMISTRY 11980 12580 14970 17370 CPP(Cryopoor plasma) - Reserve/ B0018 Lab Diagnostic Services BLOOD BANK 60 60 70 90 Crossmatch Cryoprecipitate(CRYO) - Reserve/ B0060 Lab Diagnostic Services BLOOD BANK 60 60 70 90 Crossmatch RDP/PC (Platelets) - Reserve/ B0061 Lab Diagnostic Services BLOOD BANK 60 60 70 90 Crossmatch B0047 Rh - Du Test /Weak - D Test Lab Diagnostic Services BLOOD BANK 140 150 170 200 Pooled Platelet Concentrate(PPC) - B0141 Lab Diagnostic Services BLOOD BANK 170 180 210 250 Reserve / Crossmatch - Paediatric B0007 Blood Grouping & Rh Typing Lab Diagnostic Services BLOOD BANK 270 290 340 390 B0024 FFP (Plasma) - Reserve/Crossmatch Lab Diagnostic Services BLOOD BANK 320 330 400 460 Neonatal Unit - FFP/CPP - Reserve/ B0092 Lab Diagnostic Services BLOOD BANK 320 330 400 460 Crossmatch Neonatal Unit - PRBC - Reserve/ B0091 Lab Diagnostic Services BLOOD BANK 320 330 400 460 Crossmatch Packed RBC/RCC - Reserve/ B0036 Lab Diagnostic Services BLOOD BANK 320 330 400 460 Crossmatch Blood Screening and Compatibility B0009 Lab Diagnostic Services BLOOD BANK 330 350 410 480 Report Sickle Cell Test For Blood Bags/ B0048 Lab Diagnostic Services BLOOD BANK 330 350 410 480 Donors

318 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Whole Blood(WB) - Reserve/ B0055 Lab Diagnostic Services BLOOD BANK 330 350 410 480 Crossmatch Pooled Platelet Concentrate(PPC) - B0140 Lab Diagnostic Services BLOOD BANK 340 360 420 490 Reserve / Crossmatch B0054 Theraupetic Phlebotomy Lab Diagnostic Services BLOOD BANK 440 460 550 640 Platelet Pheresi Blood Grouping B0071 Lab Diagnostic Services BLOOD BANK 490 510 610 700 and CBC B0012 Coombs Test Direct (DCT Or DAT) Lab Diagnostic Services BLOOD BANK 560 590 700 820 B0013 Coombs Test Indirect (ICT Or IAT) Lab Diagnostic Services BLOOD BANK 560 590 700 820 B0155 Donath Landsteiner test Lab Diagnostic Services BLOOD BANK 560 590 700 820 B0046 Rh Antibody Titre /Anti - D Titre. Lab Diagnostic Services BLOOD BANK 580 600 720 830 Blood Grouping, Rh Type and B0008 Lab Diagnostic Services BLOOD BANK 600 630 750 870 Antibody Screen B0022 Day Care Charges Lab Diagnostic Services BLOOD BANK 640 680 800 930 Neonatal Blood Grouping & AB B0107 Lab Diagnostic Services BLOOD BANK 670 700 830 960 Screening B0015 Coombs Test - DAT (Mono Specific) Lab Diagnostic Services BLOOD BANK 720 760 900 1040 B0003 Antibody Titer Lab Diagnostic Services BLOOD BANK 740 780 930 1080 B0002 Antibody Screening Lab Diagnostic Services BLOOD BANK 760 790 940 1090 Cryo Precipitates - Reserve/ B0108 Lab Diagnostic Services BLOOD BANK 900 950 1120 1300 Crossmatch & Issue Fresh Frozen Plasma - Reserve/ B0109 Lab Diagnostic Services BLOOD BANK 960 1000 1190 1390 Crossmatch & Issue B0068 Antenatal Antibody Screening Lab Diagnostic Services BLOOD BANK 1010 1060 1260 1470 B0014 Coombs Test(Direct and Indirect) Lab Diagnostic Services BLOOD BANK 1010 1060 1260 1470 B0001 Antibody Identification Lab Diagnostic Services BLOOD BANK 1040 1090 1290 1500 Platelet Phereisis - Screening For B0040 Lab Diagnostic Services BLOOD BANK 1070 1120 1330 1550 TTD Neonatal Single donor Platelets B0149 Lab Diagnostic Services BLOOD BANK 1120 1180 1400 1630 (SDP) ?Reserve/ cross Match Paediatric Single donor Platelets B0147 Lab Diagnostic Services BLOOD BANK 1120 1180 1400 1630 (SDP) ?Reserve/ cross Match SDP- Apheresis Platelets - Reserve/ B0063 Lab Diagnostic Services BLOOD BANK 1120 1180 1400 1630 Crossmatch Granulocyte Concentrate Reserve / B0144 Lab Diagnostic Services BLOOD BANK 1180 1240 1470 1710 Cross match & Issue Platelet Rich Concentrates (PRC) - B0111 Lab Diagnostic Services BLOOD BANK 1290 1360 1610 1870 Reserve/Crossmatch & Issue B0139 ABO Antibody Titer Lab Diagnostic Services BLOOD BANK 1460 1530 1820 2120 B0065 Antigen Phenotyping - Red Cell Lab Diagnostic Services BLOOD BANK 1610 1690 2010 2330 B0004 Antigen Phenotyping - Red Cells. Lab Diagnostic Services BLOOD BANK 1610 1690 2010 2330

319 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

HIT (Heparin Induced B0066 Lab Diagnostic Services BLOOD BANK 1730 1820 2160 2510 Thrombocytopenia) B0028 Intrauterine Transfusion Lab Diagnostic Services BLOOD BANK 1850 1950 2310 2680 B0067 PNH Test for CD55/CD59 Lab Diagnostic Services BLOOD BANK 1860 1960 2330 2700 Therapetic Red Cell Exchange - B0073 Lab Diagnostic Services BLOOD BANK 1860 1960 2330 2700 Manual Packed Red Cells - Reserve/ Crossmatch & Issue (Basic+ B0110 4th Gen NAT-P+Donor AB Lab Diagnostic Services BLOOD BANK 1960 2060 2450 2850 screen+SAGM+AUTO BG/CM/ Hb+MP.Syp ELISA) Blood Transfusion Package 1 ( Day B0126 Lab Diagnostic Services BLOOD BANK 2020 2120 2520 2930 care+CBC+ RC Filter-1) B0093 Transfusion Workup Lab Diagnostic Services BLOOD BANK 2540 2660 3170 3680 B0023 DMSO(5Ml) Lab Diagnostic Services BLOOD BANK 2670 2800 3340 3870 Stem Cell Storage(Liquid N2) Per B0051 Lab Diagnostic Services BLOOD BANK 2670 2800 3340 3870 Day Blood Transfusion Package 2 ( Day B0127 Lab Diagnostic Services BLOOD BANK 2690 2830 3360 3900 care+CBC+ RC Filter-2) PRP XMatch & Issue((Basic+ B0146 4thGen HIV+NAT+Donor AB Lab Diagnostic Services BLOOD BANK 2800 2940 3500 4060 screen+BCbag) B0059 NAT Tests Lab Diagnostic Services BLOOD BANK 3330 3500 4160 4830 Platelet Antibody SCREEN/CROSS B0154 Lab Diagnostic Services BLOOD BANK 5600 5880 7000 8120 MATCH B0151 VEGF ?Quantitative Lab Diagnostic Services BLOOD BANK 5600 5880 7000 8120 B0021 Cryopreservation Bag(Each) Lab Diagnostic Services BLOOD BANK 9320 9790 11650 13520 B0152 Bone Marrow Processing ( Manual ) Lab Diagnostic Services BLOOD BANK 11200 11760 14000 16240 Single donor platelets(SDP) - Reserve Crossmatch & Issue B0112 Lab Diagnostic Services BLOOD BANK 13770 14460 17210 19960 (Basic+4th Gen+NAT-P+Donor AB screen + Auto BG / Hb,MP.Syp ELIS B0038 Plasmapheresis Lab Diagnostic Services BLOOD BANK 16640 17470 20790 24120 B0145 Apheresis Granulocyte Concentrate Lab Diagnostic Services BLOOD BANK 16800 17640 21000 24360 B0010 BMP/MNC Processing - Trials Lab Diagnostic Services BLOOD BANK 19300 20270 24130 27990 B0027 LEUKAPHERESIS Lab Diagnostic Services BLOOD BANK 19300 20270 24130 27990 Stem Cell Cryopreservation B0049 Lab Diagnostic Services BLOOD BANK 20620 21660 25780 29900 Procedure Per Patient Bone Marrow Processing B0153 Lab Diagnostic Services BLOOD BANK 22400 23520 28000 32480 Automated B0039 Platelet Depletion Procedure Lab Diagnostic Services BLOOD BANK 24620 25850 30780 35700 B0050 Stem Cell PHeresis(Each Collection) Lab Diagnostic Services BLOOD BANK 31940 33530 39920 46310

320 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

B0070 Blood Bank Procedural Charges Lab Diagnostic Services BLOOD BANK 42340 44460 52920 61390 B0069 Allogenic Leukapheresis Lab Diagnostic Services BLOOD BANK 113710 119390 142130 164870 B0094 Autologous Leukapheresis Lab Diagnostic Services BLOOD BANK 248820 261270 311030 360790 BLOOD PACK B0123 Irradiation Charges-PRBC/RDP Lab Diagnostic Services 230 240 280 330 (PRODUCTS) BLOOD PACK B0124 Irradiation Charges -SDP Lab Diagnostic Services 230 240 280 330 (PRODUCTS) Cryopoorplasma - Issue (Basic+ BLOOD PACK B0119 4th Gen HIV+NAT+Donor AB Lab Diagnostic Services 840 890 1050 1220 (PRODUCTS) screen+Buffy coat bags) Cryoprecipitate - Issue (Basic+ BLOOD PACK B0118 4th Gen HIV+NAT+Donor AB Lab Diagnostic Services 840 890 1050 1220 (PRODUCTS) screen+Buffy coat bags) Neonatal Unit - FFP/CPP (Basic+NAT+Miscl)- Issue (Basic+ BLOOD PACK B0121 Lab Diagnostic Services 870 910 1080 1260 4th Gen HIV+NAT+Donor AB (PRODUCTS) screen+Buffy coat bags) Fresh Frozen Plasma (FFP) - Issue (Basic+ 4th Gen+ NAT- BLOOD PACK B0117 P+Leukoreduction+Donor AB Lab Diagnostic Services 920 970 1150 1340 (PRODUCTS) screen+SAGM+AUTO BG/Hb +MP. Syp ELISA) BLOOD PACK B0125 Leukoreduction charges-PRBC Lab Diagnostic Services 980 1030 1230 1430 (PRODUCTS) Leukoreduction charges-1 Set of BLOOD PACK B0122 Lab Diagnostic Services 1010 1060 1260 1470 RDP/1 SDP (PRODUCTS) BLOOD PACK B0056 Whole Blood - Issue Lab Diagnostic Services 1180 1240 1470 1710 (PRODUCTS) Platelet concentrate (RDP) - Issue (Basic+ 4th Gen +NAT- BLOOD PACK B0115 P+Leukoreduction+Donor Lab Diagnostic Services 1240 1300 1540 1790 (PRODUCTS) AB screen+SAGM+ BUFFY COAT+AUTO BG/Hb +MP Neonatal Unit - PRBC - Issue (Basic+ 4th Gen +NAT- BLOOD PACK B0120 P+Leukoreduction+Donor AB Lab Diagnostic Services 1650 1730 2060 2390 (PRODUCTS) screen+SAGM+AUTO BG/Hb +MP. Syp ELISA) Neonatal Single donor Platelets BLOOD PACK B0150 Lab Diagnostic Services 2360 2470 2940 3420 (SDP) ? Issue (PRODUCTS) Packed Red Blood Cells(PRBC) - Issue (Basic+ 4th Gen NAT- BLOOD PACK B0114 P+Leukoreduction+Donor AB Lab Diagnostic Services 2660 2790 3320 3850 (PRODUCTS) screen+SAGM+AUTO BG/Hb +MP. Syp ELISA) Pooled Platelet Concentrate(PPC) - Issue Paediatric (Basic+ 4th Gen BLOOD PACK B0143 Lab Diagnostic Services 4710 4940 5880 6830 +NAT-P+Leukoreduction+Donor AB (PRODUCTS) screen+SAGM+ BUFFY C

321 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Paediatric Single donor Platelets BLOOD PACK B0148 Lab Diagnostic Services 7840 8240 9800 11370 (SDP) ? Issue (PRODUCTS) Pooled Platelet Concentrate(PPC) -Issue (Basic+ 4th Gen +NAT- BLOOD PACK B0142 P+Leukoreduction+Donor Lab Diagnostic Services 8400 8820 10500 12180 (PRODUCTS) AB screen+SAGM+ BUFFY COAT+AUTO BG/H Single donor platelets(SDP) - Issue (Basic+4th Gen+NAT-P+ BLOOD PACK B0116 Lab Diagnostic Services 13660 14340 17070 19800 Leukoreduction+ Donor AB screen (PRODUCTS) + Auto BG / Hb,MP.Syp ELISA)) Tumour markers Beta Hcg &Alpha DS0005 Lab Diagnostic Services CYTOGENETICS 260 270 320 370 Feto protein PCYT50 PROCESSING FEE - CYT Lab Diagnostic Services CYTOGENETICS 800 840 1000 1160 PCYT28 GENETIC COUNSELLING-A - CYT Lab Diagnostic Services CYTOGENETICS 1200 1260 1500 1740 DNA-ISOLATION & STORAGE FOR 2 PCYT12 Lab Diagnostic Services CYTOGENETICS 1470 1550 1840 2130 YEARS - CYT(2 years) DS0012 Karyotyping Aminiotic Fluid Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440 B DS0012 Karyotyping Blood Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440 C DS0012 Karyotyping Bone Marrow Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440 D DS0012 Karyotyping Chorion Villus Lab Diagnostic Services CYTOGENETICS 1680 1770 2100 2440 A PCYT29 GENETIC COUNSELLING-B - CYT Lab Diagnostic Services CYTOGENETICS 1860 1960 2330 2700 Genetic Counselling / PCYT30 Lab Diagnostic Services CYTOGENETICS 2270 2380 2830 3290 Documentation BIOCHEMICAL SCREENING - CYT(7 PCYT08 Lab Diagnostic Services CYTOGENETICS 2930 3070 3660 4240 Days) PCYT53 New Born screenings - CYT(7 Days) Lab Diagnostic Services CYTOGENETICS 3030 3180 3780 4390 CULTURE-PERIPHERAL BLOOD - PCYT11 Lab Diagnostic Services CYTOGENETICS 3470 3640 4330 5020 CYT(14Days) PCYT38 MOLECULAR TEST-A - CYT Lab Diagnostic Services CYTOGENETICS 3470 3640 4330 5020 Pre-eclampsia Screening (PAPP- PCYT56 Lab Diagnostic Services CYTOGENETICS 3820 4020 4780 5540 A+PLGF) 1ST TRIMESTER SCREENING PCYT01 DOUBLE TEST -( BETA HCG + PAPP Lab Diagnostic Services CYTOGENETICS 4130 4330 5160 5980 -A) - CYT(7 Days) PCYT39 MOLECULAR TEST-B - CYT Lab Diagnostic Services CYTOGENETICS 4260 4470 5320 6180 Double test with Pre-eclampsia PCYT55 Lab Diagnostic Services CYTOGENETICS 4480 4710 5600 6500 screening (?-hCG+PAPP-A+PLGF) 2ND TRIMESTER SCREENING QUADRUPLE TEST - ( BETA HCG + PCYT02 Lab Diagnostic Services CYTOGENETICS 5060 5310 6320 7330 AFP + UE3 + INHIBIN -A) - CYT(7 Days)

322 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

KARYOTYPING-BONE MARROW (LC) PCYT34 Lab Diagnostic Services CYTOGENETICS 5320 5590 6650 7720 - CYT(10 Days) KARYOTYPING-PERIPHERAL BLOOD PCYT36 Lab Diagnostic Services CYTOGENETICS 5320 5590 6650 7720 - CYT(14 Days) KARYOTYPING-CORD BLOOD - PCYT35 Lab Diagnostic Services CYTOGENETICS 5590 5870 6990 8110 CYT(10 Days) PCYT40 MOLECULAR TEST-C - CYT Lab Diagnostic Services CYTOGENETICS 6000 6300 7490 8690 FANCONI'S ANEMIA/STRESS PCYT13 CYTOGENETICS OR BREAKAGE Lab Diagnostic Services CYTOGENETICS 6660 6990 8320 9650 STUDY - CYT KARYOTYPING-BONE MARROW - PCYT33 Lab Diagnostic Services CYTOGENETICS 6660 6990 8320 9650 CYT(10 Days) PCYT41 MOLECULAR TEST-D - CYT Lab Diagnostic Services CYTOGENETICS 6660 6990 8320 9650 PCYT24 FISH-5q or 7q - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430 FISH STUDY AML1/ETO - CYT(4 PCYT15 Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430 Days) PCYT19 FISH STUDY-CHR-18 - CYT(3 Days) Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430 FISH STUDY-PML/RARA - CYT(3 PCYT23 Lab Diagnostic Services CYTOGENETICS 7200 7550 8990 10430 Days) PCYT17 FISH STUDY-BCR/ABL - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 FISH STUDY-CHR-13,21 - CYT(3 PCYT18 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 Days) FISH STUDY-CHR-X & Y - CYT(4 PCYT20 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 Days) FISH STUDY-DIGEORGE SYNDROME PCYT21 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 (DGS) - CYT(8 Days) FISH STUDY -PRADER WILLIAM PCYT16 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 SYNDROME - CYT(8 Days) FISH STUDY-WILLIAM SYNDROME PCYT25 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 (NEW CODE) - CYT(8 Days) KARYOTYPING-AMNIOTIC FLUID/ PCYT32 Lab Diagnostic Services CYTOGENETICS 7450 7830 9310 10800 CHORINIC VILLI (LC) - CYT(20 Days) PCYT26 FISH-CBFB - CYT(4 Days) Lab Diagnostic Services CYTOGENETICS 7720 8110 9650 11190 FISH-MLL(11Q23DEL) - CYT(4 PCYT27 Lab Diagnostic Services CYTOGENETICS 7720 8110 9650 11190 Days) PCYT42 MOLECULAR TEST-E - CYT Lab Diagnostic Services CYTOGENETICS 8520 8940 10640 12350 Y-MICRODELETION STUDY - CYT(14 PCYT51 Lab Diagnostic Services CYTOGENETICS 8790 9220 10980 12740 Days) KARYO TYPING - OTHERS - CYT(14 PCYT52 Lab Diagnostic Services CYTOGENETICS 9320 9790 11650 13520 Days) KARYOTYPING AMNIOTIC FLUID/ PCYT31 Lab Diagnostic Services CYTOGENETICS 10390 10910 12980 15060 CHORIONIC VILLI - CYT(20 Days) PCYT43 MOLECULAR TEST-F - CYT Lab Diagnostic Services CYTOGENETICS 10390 10910 12980 15060

323 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

BLOOD PANEL (KARYO+FISH) - PCYT09 Lab Diagnostic Services CYTOGENETICS 10640 11180 13300 15430 CYT(14 Days) PCYT44 MOLECULAR TEST-G - CYT Lab Diagnostic Services CYTOGENETICS 11980 12580 14970 17370 FISH STUDY - CHR-13,18,21 - PCYT14 Lab Diagnostic Services CYTOGENETICS 12250 12860 15310 17760 CYT(4 Days) ATAXIA TELENGIECTASIS PCYT05 Lab Diagnostic Services CYTOGENETICS 12520 13140 15640 18150 (BLEOMYCIN ASSAY) - CYT BONE MARROW PANEL PCYT10 Lab Diagnostic Services CYTOGENETICS 12520 13140 15640 18150 (KARYO+FISH) - CYT PCYT22 FISH STUDY-HER2 - CYT(7 Days) Lab Diagnostic Services CYTOGENETICS 13040 13690 16300 18910 PCYT03 ABORTUS SAMPLE - CYT(1 Month) Lab Diagnostic Services CYTOGENETICS 13310 13980 16640 19300 PCYT45 MOLECULAR TEST-H - CYT Lab Diagnostic Services CYTOGENETICS 15300 16070 19130 22190 MDS PANEL (KARYO+FISH 5Q-7Q) - PCYT37 Lab Diagnostic Services CYTOGENETICS 17970 18870 22460 26050 CYT(10 Days) AML PANEL PCYT04 (KARYO+AML1ETO+CBFB+MLL) - Lab Diagnostic Services CYTOGENETICS 21300 22360 26620 30880 CYT(10 Days) PCYT46 MOLECULAR TEST-I - CYT Lab Diagnostic Services CYTOGENETICS 21960 23050 27440 31840 PCYT47 MOLECULAR TEST-J - CYT Lab Diagnostic Services CYTOGENETICS 30600 32130 38250 44370 PCYT48 MOLECULAR TEST-K - CYT Lab Diagnostic Services CYTOGENETICS 33270 34930 41580 48240 PCYT07 BCRA 1& 2 - CYT(3-4 weeks) Lab Diagnostic Services CYTOGENETICS 39920 41920 49900 57880 PCYT49 NIFTY (T21,18,13) - CYT Lab Diagnostic Services CYTOGENETICS 42340 44460 52920 61390 PCYT54 NIPT (MEDGENOME) Lab Diagnostic Services CYTOGENETICS 42340 44460 52920 61390 PCYT06 AUTISM PANEL - CYT(4-6 weeks) Lab Diagnostic Services CYTOGENETICS 50560 53090 63200 73310 H0135 Platelet + IPF Lab Diagnostic Services HAEMATOLOGY 50 50 50 50 H0071 Stool Routine ( Qualitative Method ) Lab Diagnostic Services HAEMATOLOGY 150 150 180 200 Absolute Eosinophil Count ( H0001 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Automated ) Differential Count( Automated Cell H0018 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Counter ) H0047 Nasal Smear For Eosinophils Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0054 PH (Urine/Body Fluids/Blood) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0065 Specific Gravity (Urine/Body Fluids) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Stool Complete(Includes Routine H0067 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 With Occult Blood) Stool For Reducing Sugar ( H0068 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Qualitative Method ) H0070 Stool Occult Blood ( Benzidine ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0074 TC (Total Count)( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Urine Analysis Glucose and H0076 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Ketones( Automated )

324 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Urine Analysis Protein and Glucose( H0077 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Automated ) Urine Analysis Sp.Gr., PH, Proteins H0078 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 and Glucose H0080 Urine Fat ( Qualitaitve ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0079 Urine For Bile Salt and Bile Pigment Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0082 Urine For Eosinophilia Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0084 Urine For Ketone ( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0085 Urine For Protein( Automated ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Urine For Reducing Substane( H0086 Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Benzidine ) H0087 Urine For Sugar ( Benedict ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0089 Urine Occult Blood( Benzidine ) Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 H0091 Urine Urobilinogen Lab Diagnostic Services HAEMATOLOGY 170 180 210 250 Absolute Lymphocyte Count ( H0002 Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 Automated ) Absolute Neutrophil Count( H0003 Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 Automated ) CLOT Retraction Test ( Clotting H0012 Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 Assay ) Fibrinogen Degradation Products- H0024 Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 Qualitative H0029 Haemoglobin ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 H0115 Immature Granulocytes Count Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 H0060 RBC Count ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 H0098 Stool Fat Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 H0092 Urine/Nasal Smear For Eosinophils Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 H0093 Urobilinogen (Urine) ( Automated ) Lab Diagnostic Services HAEMATOLOGY 200 200 240 280 Urine Routine and Microscopy ( H0090 Lab Diagnostic Services HAEMATOLOGY 250 250 290 330 Qualitative Method) APT and Downey Test( Alkali H0005 Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 Denaturation) H0028 Gastric Aspirate For Polymorphs Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 H0035 Heinz Bodies Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 H0132 I/T ration for neonate Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 H0063 Sickle Cell Test Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 H0134 Smear for Malaria Parasite (MP) Lab Diagnostic Services HAEMATOLOGY 270 290 340 390 DS0008 Bone marrow study Lab Diagnostic Services HAEMATOLOGY 280 300 350 410 Bence Jones Protein Qualitative ( H0007 Lab Diagnostic Services HAEMATOLOGY 330 350 410 480 Thermal Method )

325 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

H0008 Bleeding Time Lab Diagnostic Services HAEMATOLOGY 330 350 410 480 H0019 ESR ( Automated ) Lab Diagnostic Services HAEMATOLOGY 350 350 410 460 PCV (Packed Cell Volume) ( H0052 Lab Diagnostic Services HAEMATOLOGY 350 350 410 460 Automated ) Synovial Fluid For Crystals ( H0073 Lab Diagnostic Services HAEMATOLOGY 330 350 410 480 Polarised Light ) Urine For Chylhria ( Qualitative H0081 Lab Diagnostic Services HAEMATOLOGY 330 350 410 480 Method ) CLOT Solubility Test ( Clotting H0013 Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 Assay ) Concentration Method For Fecal H0015 Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 Parasites( Formal S H0051 PAS Stain Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 H0056 Pregnancy test Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 H0083 Urine For Haemoglobin Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 Urine Myoglobin( Qualitative H0088 Lab Diagnostic Services HAEMATOLOGY 350 370 440 510 Method ) H0034 Hb,TLC, DLC ( Automated ) Lab Diagnostic Services HAEMATOLOGY 390 400 480 560 H0014 Complete Blood Counts (Automated) Lab Diagnostic Services HAEMATOLOGY 420 420 490 550 H0106 Ascetic fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0009 Body Fluid Cell Count/Type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0016 CSF Cell Count and Cell Type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0111 Gastric Fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 Haemosiderinuria ( Perls Prussian H0031 Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 Blue ) Immunoflorescence Method For H0036 Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 Malaria H0037 Iron Stain ( Perls Prussian Blue ) Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0110 Liver abscess cell count & Cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0044 Microfilaria Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 Pericardial Fluid cell count & cell H0108 Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 type H0107 Pleural Fluid cell count & Cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 H0112 Synovial fluid cell count & cell type Lab Diagnostic Services HAEMATOLOGY 440 460 550 640 Other Fluids - Cell Count and Cell H0049 Lab Diagnostic Services HAEMATOLOGY 460 490 580 670 Type Peritoneal fluid cell count & cell H0109 Lab Diagnostic Services HAEMATOLOGY 460 490 580 670 type H0061 Reticulocyte Count ( Automated ) Lab Diagnostic Services HAEMATOLOGY 540 540 630 710 H0053 Peripheral Smear Examination(P.S) Lab Diagnostic Services HAEMATOLOGY 550 550 640 720 Prothrombin Time -PT ( Automated/ H0059 Lab Diagnostic Services HAEMATOLOGY 550 550 640 720 Clotting Assay )

326 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

H0033 Hb, TLC, DLC, ESR ( Automated ) Lab Diagnostic Services HAEMATOLOGY 540 570 680 780 H0032 Hams Test ( Acidified Serum Test ) Lab Diagnostic Services HAEMATOLOGY 580 600 720 830 H0026 Foetal Erythrocytes Lab Diagnostic Services HAEMATOLOGY 620 650 770 900 H0043 Methemoglobin ( Evelyn & Malloy ) Lab Diagnostic Services HAEMATOLOGY 670 700 830 960 Activated Partial Thromboplastin H0050 Lab Diagnostic Services HAEMATOLOGY 740 780 930 1080 Time(1:1mix) Osmotic Fragility Test ( Calorimetric H0048 Lab Diagnostic Services HAEMATOLOGY 740 780 930 1080 Method ) H0039 LE Cell Test ( Qualitative Method ) Lab Diagnostic Services HAEMATOLOGY 800 840 1000 1160 H0045 Myeloperoxidase (Mpo) Lab Diagnostic Services HAEMATOLOGY 800 840 1000 1160 Sucrose Lysis Test ( Qualitative H0072 Lab Diagnostic Services HAEMATOLOGY 800 840 1000 1160 Method ) H0006 APTT ( Automated / Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270 H0038 LAP Score Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270 H0064 Smear For Review Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270 Stool For Trypsin ( Proteolytic H0069 Lab Diagnostic Services HAEMATOLOGY 880 920 1100 1270 Enzyme Activity ) FDP-Semiquantitative-Thrombo H0023 Lab Diagnostic Services HAEMATOLOGY 1010 1060 1260 1470 Wellco Test H0113 Bone Marrow Review Slide Lab Diagnostic Services HAEMATOLOGY 1200 1260 1500 1740 H0105 Bone Marrow Smear Examination Lab Diagnostic Services HAEMATOLOGY 1200 1260 1500 1740 H0046 NAE Lab Diagnostic Services HAEMATOLOGY 1270 1330 1590 1840 D-Dimer Test (Immunometri Flow H0017 Lab Diagnostic Services HAEMATOLOGY 1470 1550 1840 2130 Through) Fibrinogen Level ( Automated / H0025 Lab Diagnostic Services HAEMATOLOGY 1610 1690 2010 2330 Clotting Assay ) Thrombin Time ( Automated / H0075 Lab Diagnostic Services HAEMATOLOGY 1610 1690 2010 2330 Clotting Assay ) Lymphoma - Leukemia Markers H0041 Lab Diagnostic Services HAEMATOLOGY 2400 2520 3000 3480 (FC) H0099 Factor V Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680 H0100 Factor VII Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680 H0022 Factor VIII Assay ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680 H0102 Factor X Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 2540 2660 3170 3680 H0136 CD 20 Lab Diagnostic Services HAEMATOLOGY 2670 2800 3340 3870 H0020 Factor IX Assay ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 2670 2800 3340 3870 Lupus Anti Coagulant (Russells H0040 Lab Diagnostic Services HAEMATOLOGY 2670 2800 3340 3870 Viper Venom) H0133 CD 19 Lab Diagnostic Services HAEMATOLOGY 3470 3640 4330 5020 H0139 Factor (X III) Quantitative Lab Diagnostic Services HAEMATOLOGY 4480 4710 5600 6500 H0131 Factor II Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 4530 4760 5660 6570

327 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

H0137 CD 19 & 20 Lab Diagnostic Services HAEMATOLOGY 4660 4900 5830 6760 H0140 VWF Antigen Assay Lab Diagnostic Services HAEMATOLOGY 4840 5090 6050 7020 H0141 HIT Antibody Lab Diagnostic Services HAEMATOLOGY 5450 5720 6810 7900 H0130 FLAER test for PNH Lab Diagnostic Services HAEMATOLOGY 5730 6010 7160 8300 H0101 Factor XI Assay (Clotting Assay) Lab Diagnostic Services HAEMATOLOGY 5860 6160 7330 8500 H0097 Platelet Aggregation Test Lab Diagnostic Services HAEMATOLOGY 6390 6710 7980 9260 Protein C ( Automated / Clotting H0057 Lab Diagnostic Services HAEMATOLOGY 6520 6850 8150 9460 Assay ) Protein S ( Automated / Clotting H0058 Lab Diagnostic Services HAEMATOLOGY 6520 6850 8150 9460 Assay ) H0004 Antithrombin III ( Clotting Assay ) Lab Diagnostic Services HAEMATOLOGY 6660 6990 8320 9650 H0142 Factor V Leiden Mutation Lab Diagnostic Services HAEMATOLOGY 7260 7630 9080 10530 H0123 FISH for BCR/ABL Lab Diagnostic Services HAEMATOLOGY 7450 7830 9310 10800 H0120 PML-RARA Qualitative Lab Diagnostic Services HAEMATOLOGY 7720 8110 9650 11190 Factor V Leiden ( Automated / H0021 Lab Diagnostic Services HAEMATOLOGY 7990 8390 9990 11580 Clotting Assay ) H0103 Ristocetin Co Factor Activity Lab Diagnostic Services HAEMATOLOGY 7990 8390 9990 11580 H0117 FISH for AML-ETO(8-21) Lab Diagnostic Services HAEMATOLOGY 8260 8670 10320 11970 H0027 FV-APA Resistance Lab Diagnostic Services HAEMATOLOGY 8520 8940 10640 12350 H0129 BCR / ABL Qualitative Analysis Lab Diagnostic Services HAEMATOLOGY 9050 9510 11320 13130 Lymphoma - Leukemia 4 Markers H0116 Lab Diagnostic Services HAEMATOLOGY 9050 9510 11320 13130 (Fc) H0122 PCR for PDGER Mutation Lab Diagnostic Services HAEMATOLOGY 9050 9510 11320 13130 H0118 FISH for 11q23 Lab Diagnostic Services HAEMATOLOGY 10910 11460 13640 15820 H0119 PCR for JAK 2 mutation Lab Diagnostic Services HAEMATOLOGY 10910 11460 13640 15820 H0138 MRD (ALL) Lab Diagnostic Services HAEMATOLOGY 12100 12710 15120 17540 H0114 Stem Cell Enumeration (FC) Lab Diagnostic Services HAEMATOLOGY 12780 13420 15980 18530 H0128 BCR / ABL Quantitative Analysis Lab Diagnostic Services HAEMATOLOGY 15980 16770 19970 23160 Flowcytometry for Acute Leukemia H0126 Lab Diagnostic Services HAEMATOLOGY 16640 17470 20790 24120 Panel H0124 CML IRMA Mutation Lab Diagnostic Services HAEMATOLOGY 17300 18160 21620 25080 H0125 MDS Panel Lab Diagnostic Services HAEMATOLOGY 17970 18870 22460 26050 P0008 Duplicate Slide Charges Lab Diagnostic Services HISTOPATHOLOGY 170 180 210 250 DS0019 Immuno-histo Chemistry Lab Diagnostic Services HISTOPATHOLOGY 170 180 210 250 P0113 Kidney biopsy ? slide review Lab Diagnostic Services HISTOPATHOLOGY 560 590 700 820 P0002 Aspiration Fluid Cytology (1 - 3) Lab Diagnostic Services HISTOPATHOLOGY 580 600 720 830 P0075 PAP Smear Lab Diagnostic Services HISTOPATHOLOGY 640 680 800 930 P0057 Slide Review Lab Diagnostic Services HISTOPATHOLOGY 740 780 930 1080 P0003 Aspiration Fluid Cytology (4 - 7) Lab Diagnostic Services HISTOPATHOLOGY 1070 1120 1330 1550

328 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

P0004 Block Review Lab Diagnostic Services HISTOPATHOLOGY 1070 1120 1330 1550 P0015 Histopathology (Medium Size) Lab Diagnostic Services HISTOPATHOLOGY 1120 1180 1400 1630 P0058 Slide Review With Blocks Lab Diagnostic Services HISTOPATHOLOGY 1200 1260 1500 1740 P0016 Histopathology (Small Specimen) Lab Diagnostic Services HISTOPATHOLOGY 1370 1370 1580 1790 P0080 Kidney biopsy - Light microscopy Lab Diagnostic Services HISTOPATHOLOGY 1340 1400 1670 1940 P0001 Aspiration Fluid Cytology (> 8) Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330 P0093 Immuno histochemistry BcL-6 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330 P0089 Immuno histochemistry CD -23 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330 P0090 Immuno histochemistry CD -43 Lab Diagnostic Services HISTOPATHOLOGY 1610 1690 2010 2330 P0091 Immuno histochemistry CD -X2 Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510 P0092 Immuno histochemistry WT-1 Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510 P0053 Indirect IF Lab Diagnostic Services HISTOPATHOLOGY 1730 1820 2160 2510 P0108 IHC-IgG4 Lab Diagnostic Services HISTOPATHOLOGY 1820 1910 2270 2640 P0011 Frozen Section Lab Diagnostic Services HISTOPATHOLOGY 2000 2100 2500 2900 P0033 Immunofluorescence Panel Lab Diagnostic Services HISTOPATHOLOGY 2000 2100 2500 2900 P0068 Immunohistochemistry C4d Lab Diagnostic Services HISTOPATHOLOGY 2130 2240 2660 3090 P0112 IHC-PLA2R Lab Diagnostic Services HISTOPATHOLOGY 2240 2360 2800 3250 Histopath & Immunoflorescence P0012 Lab Diagnostic Services HISTOPATHOLOGY 2270 2380 2830 3290 Kidney Bone marrow biopsy with special P0096 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 stain P0088 Immunohistochemistry - 79a Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0102 Immunohistochemistry Arginase-1 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0038 Immunohisto Chemistry BCL - 2 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0105 Immunohistochemistry CA 19.9 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0069 Immunohistochemistry Cd10 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0035 Immunohisto Chemistry CD117 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0026 Immuno Histochemistry CD 15 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0020 Immuno Histo Chemistry - (Cd20) Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0028 Immuno Histochemistry Cd34 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0039 Immunohisto Chemistry Cd5 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0043 Immunohistochemistry Cyclic DI Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0024 Immuno Histo Chemistry - Desmin Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0104 Immunohistochemistry DOG-1 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0099 Immunohistochemistry GCDFP-15 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0101 Immunohistochemistry Glypican -3 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 Immunohistochemistry Inhibin- P0100 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 Alpha

329 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

P0067 Immunohistochemistry Ki-67 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 IMMUNOHISTOCHEMISTRY P0076 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 MYELOPEROXIDASE (MPO) P0097 Immunohistochemistry Napsin A Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0098 Immunohistochemistry P40 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0103 Immunohistochemistry Pax-8 Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0052 Immunohistochemistry SMA Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0094 Immunohistochemistry - SV40 TAg Lab Diagnostic Services HISTOPATHOLOGY 2400 2520 3000 3480 P0017 HMB 45 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0029 Immunochemistry CD68 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0040 Immunohistochemistry A F P Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0086 Immunohistochemistry - ALK 1 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0077 Immunohistochemistry - AMACR Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 Immunohistochemistry - Amyloid P0084 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 AA P0034 Immunohisto Chemistry Calretinin Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0025 Immuno Histochemistry CD 138 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0087 Immunohistochemistry - CD1a Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0027 Immuno Histochemistry CD 30 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0036 Immunohisto Chemistry CD31 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0085 Immunohistochemistry - CMV Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0074 Immuno Histo Chemistry D1 clone Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0045 Immunohistochemistry GFAP Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0078 Immunohistochemistry - HMWCK Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0047 Immunohistochemistry LCA (CD 45) Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0072 Immuno histochemistry myoD1 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0049 Immunohistochemistry PGR Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0050 Immunohistochemistry PSA Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 Immunohistochemistry S - 100 P0051 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 Protein P0071 Immuno histochemistry TTF Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 P0023 Immuno Histo Chemistry Vimentin Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 Kidney biopsy- P0081 Lab Diagnostic Services HISTOPATHOLOGY 2540 2660 3170 3680 Immunofluorescence P0014 Histopathology (Large Size) Lab Diagnostic Services HISTOPATHOLOGY 2730 2730 3140 3550 P0030 Immunochemistry CD99 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0031 Immunochemistry Chromogranin Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0032 Immunochemistry Synaptophysin Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870

330 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

P0041 Immunohistochemistry CK20 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0042 Immunohistochemistry CK7 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0044 Immunohistochemistry E M A Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0046 Immunohistochemistry HMB45 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0048 Immunohistochemistry PAN C K Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0073 Immuno Histo Chemistry Tdt Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0066 Immuno histochemistry TTF-1 Lab Diagnostic Services HISTOPATHOLOGY 2670 2800 3340 3870 P0019 Immuno Histo Chemistry - (Cd3) Lab Diagnostic Services HISTOPATHOLOGY 2800 2940 3500 4060 P0021 Immuno Histo Chemistry E R Lab Diagnostic Services HISTOPATHOLOGY 2930 3070 3660 4240 P0022 Immuno Histo Chemistry P R Lab Diagnostic Services HISTOPATHOLOGY 2930 3070 3660 4240 Immunohisto Chemistry C - Erb P0037 Lab Diagnostic Services HISTOPATHOLOGY 3060 3220 3830 4440 (Her2Neu) P0055 Perinatal Specimen Lab Diagnostic Services HISTOPATHOLOGY 3060 3220 3830 4440 Immuno Florescence & Light P0018 Lab Diagnostic Services HISTOPATHOLOGY 3200 3360 3990 4630 Microscopy P0009 EGFR IHC Lab Diagnostic Services HISTOPATHOLOGY 3330 3500 4160 4830 P0013 Histopathology (Extra Large) Lab Diagnostic Services HISTOPATHOLOGY 3930 3930 4520 5110 Kidney, transplant biopsy - Light P0083 Lab Diagnostic Services HISTOPATHOLOGY 3870 4060 4830 5610 microscopy & C4d IHC Immunohistochemistry - HMWCK P0079 Lab Diagnostic Services HISTOPATHOLOGY 4260 4470 5320 6180 & AMACR Kidney biopsy- P0082 Immunofluorescence & light Lab Diagnostic Services HISTOPATHOLOGY 4260 4470 5320 6180 microscopy Immuno histochemistry Kappa & P0070 Lab Diagnostic Services HISTOPATHOLOGY 5190 5450 6490 7520 Lamda light cha P0056 Second Opinion Charges Lab Diagnostic Services HISTOPATHOLOGY 5860 6160 7330 8500 P0010 Electron Microscopy Lab Diagnostic Services HISTOPATHOLOGY 8260 8670 10320 11970 Immunohistochemistry 2 to 5 P0109 Lab Diagnostic Services HISTOPATHOLOGY 8470 8900 10590 12280 markers Immunohistochemistry 6 to 8 P0110 Lab Diagnostic Services HISTOPATHOLOGY 10890 11440 13610 15790 markers Immunohistochemistry more than P0111 Lab Diagnostic Services HISTOPATHOLOGY 13310 13980 16640 19300 8 markers P0106 Clinical Fetal Autopsy Lab Diagnostic Services HISTOPATHOLOGY 26620 27950 33270 38590 P0095 Electron Microscope (out source) Lab Diagnostic Services HISTOPATHOLOGY 36290 38110 45360 52620 BRCA - 1/Brca - 2 (Addl Family P0007 Lab Diagnostic Services HISTOPATHOLOGY 98460 103390 123080 142770 Member) P0006 BRCA - 1 / Brca - 2 Lab Diagnostic Services HISTOPATHOLOGY 102460 107590 128080 148570 LABORATORY LMISC02 Home collection charge (0 - 2 km) Lab Diagnostic Services 170 180 210 250 MISC CHARGES

331 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

LABORATORY LMISC03 Home collection charge (2 - 5 km) Lab Diagnostic Services 270 290 340 390 MISC CHARGES LABORATORY LMISC04 Home collection charge (5 - 10 km) Lab Diagnostic Services 330 350 410 480 MISC CHARGES LABORATORY LMISC05 Home collection charge (10 -15 km) Lab Diagnostic Services 440 460 550 640 MISC CHARGES Home collection charge (15 - 20 LABORATORY LMISC06 Lab Diagnostic Services 580 600 720 830 km) MISC CHARGES Home Collection Charges More than LABORATORY LMISC07 Lab Diagnostic Services 740 780 930 1080 20 Kms MISC CHARGES LABORATORY LMISC09 Pecaso Analysis Lab Diagnostic Services 217730 228620 272160 315710 MISC CHARGES M0188 Wet Mount Microscopy Lab Diagnostic Services MICROBIOLOGY 220 230 270 310 M0085 Grams Stain Smear Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 M0088 Hanging Drop Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 India Ink Preparation For M0130 Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 Cryptococcus Scraping/Smear For Fungus (Koh M0161 Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 Preparation) Skin Clipping For AFB (M. Leprae) M0163 Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 Smear M0164 Smear For Actinomyces Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 M0165 Smear For Diphtheria Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 M0166 Smear For Nocardia Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 M0183 VDRL Test (Quantitative) - RPR Lab Diagnostic Services MICROBIOLOGY 270 290 340 390 Dark Ground Microscopy For M0062 Lab Diagnostic Services MICROBIOLOGY 330 350 410 480 Spirochoetes M0191 H-Pylori Rapid Urease Test Lab Diagnostic Services MICROBIOLOGY 330 350 410 480 M0001 AFB Smear/Z.N.Staining Lab Diagnostic Services MICROBIOLOGY 350 370 440 510 M0226 Flow cytometry collection Lab Diagnostic Services MICROBIOLOGY 350 370 440 510 M0171 Sterility Test Lab Diagnostic Services MICROBIOLOGY 440 460 550 640 M0053 Cold Agglutination Test Lab Diagnostic Services MICROBIOLOGY 510 530 630 740 Special Stain (Modified Kinyoun M0167 Lab Diagnostic Services MICROBIOLOGY 540 570 680 780 Stain) M0239 HP camp HBsag Lab Diagnostic Services MICROBIOLOGY 550 580 690 800 M0232 Chikungunya IgM ELISA Lab Diagnostic Services MICROBIOLOGY 600 600 600 600 M0267 Dengue IGG Lab Diagnostic Services MICROBIOLOGY 600 600 600 600 M0268 Dengue IGM Lab Diagnostic Services MICROBIOLOGY 600 600 600 600 M0207 Dengue NS1 antigen (ELISA) Lab Diagnostic Services MICROBIOLOGY 600 600 600 600 M0189 Widal Test Lab Diagnostic Services MICROBIOLOGY 660 660 760 860 M0213 Viral Assay Lab Diagnostic Services MICROBIOLOGY 640 680 800 930

332 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

M0193 Stool for Rota and Adenovirus Lab Diagnostic Services MICROBIOLOGY 670 700 830 960 M0020 Anti Streptolysin 0 Titre Lab Diagnostic Services MICROBIOLOGY 740 780 930 1080 M0035 Brucella Agglutination Test Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160 M0077 Extra Antibiotic Sens (Each) Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160 M0157 Rheumatoid Factor Assay Lab Diagnostic Services MICROBIOLOGY 800 840 1000 1160 M0136 Malaria Antigen Lab Diagnostic Services MICROBIOLOGY 870 870 1010 1140 Hepatitis B Surface Antigen (Hbsag) M0101 Lab Diagnostic Services MICROBIOLOGY 900 900 1040 1170 - Elisa M0038 C-Reactive Protein Lab Diagnostic Services MICROBIOLOGY 880 920 1100 1270 Water Analysis (For Bacterial M0185 Lab Diagnostic Services MICROBIOLOGY 880 920 1100 1270 Contamination) Human Immuno Virus (HIV I + II) M0128 Lab Diagnostic Services MICROBIOLOGY 950 950 1100 1240 - Elisa M0032 Bile For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0043 Cervical Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0066 Ear Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0078 Eye Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0083 Fungus Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0212 HIV P24 Antigen Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0129 I/V Fluid For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0151 Nasal Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 Salmonella Vi Antibody (Tube M0160 Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 Agglutination) M0162 Semen Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0168 Sputum Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0174 Throat Swab Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0176 Tissue For Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0184 Vitreous Fluid Culture Lab Diagnostic Services MICROBIOLOGY 1010 1060 1260 1470 M0069 Endotracheal Suction Culture Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550 M0115 HIV I & II (Rapid Test) Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550 M0179 TPHA Test Lab Diagnostic Services MICROBIOLOGY 1070 1120 1330 1550 M0180 Urine Culture Lab Diagnostic Services MICROBIOLOGY 1170 1170 1350 1530 M0052 CMV-IGM Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 M0056 CSF E.Coli K1/N. Meningitidis B Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 CSF Haemophilus Influenzae B M0057 Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Antigen CSF Meningococcal Antigen (A, C, M0058 Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Y, W-135) M0059 CSF Pneumococcal Antigen Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660

333 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

M0060 CSF Streptococcus Group B Antigen Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 M0063 Dengue IGG & IGM Lab Diagnostic Services MICROBIOLOGY 1200 1200 1200 1200 M0079 Faeces Culture (Stool Culture) Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 M0112 Herpes Simplex Virus-1 IGG Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Herpes Simplex Virus-2 IGG M0113 Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Antibody (Elisa) M0114 HICC Screening Test Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 M0142 Miscellaneous Culture Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Paul Bunnel Test (For Infectious M0152 Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 Mononucleosis) M0186 Weil Felix Test Lab Diagnostic Services MICROBIOLOGY 1150 1200 1430 1660 M0051 CMV-IGG Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740 M0087 H.Pylori IGG Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740 M0156 PUS Culture Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740 M0177 Toxoplasma IGG Test Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740 M0178 Toxoplasma IGM Test Lab Diagnostic Services MICROBIOLOGY 1200 1260 1500 1740 Cytomegalovirus (CMV) IgG avidity M0262 Lab Diagnostic Services MICROBIOLOGY 1240 1300 1540 1790 (Outsourced) M0241 Cytomegalovirus IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1240 1300 1540 1790 M0109 Hepatits D Virus (Antibody) Elisa Lab Diagnostic Services MICROBIOLOGY 1270 1330 1590 1840 M0141 Microfilarial Antibody Lab Diagnostic Services MICROBIOLOGY 1270 1330 1590 1840 M0089 HBSAG (Rapid Test) Lab Diagnostic Services MICROBIOLOGY 1340 1340 1550 1750 Chlamydia trachomatis IgG M0260 Lab Diagnostic Services MICROBIOLOGY 1350 1420 1680 1950 antibodies (Outsourced) Chlamydia trachomatis IgM M0261 Lab Diagnostic Services MICROBIOLOGY 1350 1420 1680 1950 antibodies (Outsourced) M0005 Anaerobic Culture Lab Diagnostic Services MICROBIOLOGY 1430 1430 1650 1860 M0235 Chikungunya PCR Lab Diagnostic Services MICROBIOLOGY 1500 1500 1500 1500 M0064 Dengue Virus Rt - Pcr Lab Diagnostic Services MICROBIOLOGY 1500 1500 1500 1500 M0103 Hepatitis C Virus Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1540 1540 1780 2010 M0009 Anti Cardiolipin - IGA Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 M0036 Brucella IGG Antibody Test Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 M0037 Brucella IGM Antibody Test Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 M0055 CSF Culture Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 M0080 Fluids Culture Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 M0097 Hepatitis B Core IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 Herpes Simplex Virus (1+2) IGM M0110 Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 (Elisa) M0158 Rubella IGG Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130

334 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

M0159 Rubella IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1470 1550 1840 2130 Anti Beta 2 Glycoprotein 1 Antibody M0195 Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 Screening M0010 Anti Cardiolipin - IGG Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0011 Anti Cardiolipin - IGM Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0034 Bone Marrow Culture Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0054 Cryptococcus Antigen - Latex Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0098 Hepatitis B Core Total Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0099 Hepatitis B E Antibody Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0100 Hepatitis B E Antigen Lab Diagnostic Services MICROBIOLOGY 1610 1690 2010 2330 M0221 Dengue Panel Lab Diagnostic Services MICROBIOLOGY 1800 1800 1800 1800 M0013 Anti Hbs Ag Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510 M0017 Anti Nuclear Antibody (Ana) - IF Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510 Hepatitis A Virus -Total (Igg+Igm) M0096 Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510 Antibodies M0137 Malaria IgG Antibodies Lab Diagnostic Services MICROBIOLOGY 1730 1820 2160 2510 M0242 Rubella IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1850 1950 2310 2680 M0095 Hepatitis A Virus - IGM Antibody Lab Diagnostic Services MICROBIOLOGY 1860 1960 2330 2700 M0243 Toxoplasma IgG Avidity Lab Diagnostic Services MICROBIOLOGY 1910 2000 2380 2770 M0228 HAIN'S TEST Lab Diagnostic Services MICROBIOLOGY 1940 2040 2430 2810 M0012 Anti Ds-DNA Antibody (Elisa) Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900 M0033 Blood Culture and Sensitivity Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900 M0134 Leptospira IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900 M0140 Measles IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 2000 2100 2500 2900 Anti-Glomerular Basement M0255 Membrane IgG Antibodies (anti- Lab Diagnostic Services MICROBIOLOGY 2080 2180 2590 3010 GBM) (Outsourced) M0245 Anti GBM IgG antibodies Lab Diagnostic Services MICROBIOLOGY 2240 2360 2800 3250 M0046 Chlamydia IGA Lab Diagnostic Services MICROBIOLOGY 2270 2380 2830 3290 M0061 Cytomegalovirus (If) Lab Diagnostic Services MICROBIOLOGY 2270 2380 2830 3290 M0006 Anca IF Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480 M0042 CD4/CD8Counts Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480 M0139 Measles IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480 Mycobacterial culture - Automated M0229 Lab Diagnostic Services MICROBIOLOGY 2400 2520 3000 3480 (MGIT) Chlamydia pneumonia IgA M0257 Lab Diagnostic Services MICROBIOLOGY 2470 2590 3080 3580 antibodies (Outsourced) Chlamydia pneumonia IgG M0259 Lab Diagnostic Services MICROBIOLOGY 2470 2590 3080 3580 antibodies (Outsourced)

335 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Chlamydia pneumonia IgM M0258 Lab Diagnostic Services MICROBIOLOGY 2470 2590 3080 3580 antibodies (Outsourced) M0231 Xpert MTB/RIF assay (GeneXpert) Lab Diagnostic Services MICROBIOLOGY 2470 2590 3080 3580 M0028 Antisperm Antibody Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680 M0200 Aspergillus galactomannan antigen Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680 M0144 Mumps IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680 M0181 Varicella Zoster IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 2540 2660 3170 3680 M0224 Procalcitonin /CRP Lab Diagnostic Services MICROBIOLOGY 2670 2800 3340 3870 M0182 Varicella Zoster IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 2670 2800 3340 3870 M0067 Echinococcus Antibodies IGG Lab Diagnostic Services MICROBIOLOGY 2800 2940 3500 4060 M0122 HLA B27 (Flowcytometry) Lab Diagnostic Services MICROBIOLOGY 2800 2940 3500 4060 Thyroid Antibody -Thyroglobulin/ M0175 Lab Diagnostic Services MICROBIOLOGY 2800 2940 3500 4060 Microsomal M0236 ANCA profile ELISA Lab Diagnostic Services MICROBIOLOGY 3030 3180 3780 4390 M0133 Leptospira - Rapid - IGM Lab Diagnostic Services MICROBIOLOGY 3060 3220 3830 4440 M0155 Procalcitonin Lab Diagnostic Services MICROBIOLOGY 3060 3220 3830 4440 M0048 Chlamydia IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 M0049 Clostridium Difficile Toxin Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 M0223 Endotoxin test (Qualitative) Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 M0123 HLA Cross Match With Dtt Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 M0146 Mumps IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 Parvo virus B19 DNA PCR M0253 Lab Diagnostic Services MICROBIOLOGY 3200 3360 3990 4630 (Outsourced) M0025 Anticysticercal Antibody Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830 M0070 Entamoeba Histolytica Antibodies Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830 Mycoplasma Pneumoniae IGG M0149 Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830 Antibodies Mycoplasma Pneumoniae IGM M0150 Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830 Antibodies M0190 Yersenia Culture Lab Diagnostic Services MICROBIOLOGY 3330 3500 4160 4830 Anti-Parietal Cell Antibody M0256 Lab Diagnostic Services MICROBIOLOGY 3360 3530 4200 4880 (Outsourced) M0234 TB FERON Lab Diagnostic Services MICROBIOLOGY 3450 3630 4320 5010 M0015 Anti Mitochondrial Antibodies, AMA Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020 Epstein Barr Virus (Early Antigen M0072 Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020 IGG) Epstein Barr Virus (Nuclear Antigen) M0073 Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020 IGG M0074 Epstein Barr Virus (Vca) IGG Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020

336 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

M0075 Epstein Barr Virus (Vca) IGM Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020 M0107 Hepatitis E Virus IGM Antibody Lab Diagnostic Services MICROBIOLOGY 3470 3640 4330 5020 M0263 Parvovirus B19 IgG (Outsourced) Lab Diagnostic Services MICROBIOLOGY 3480 3650 4340 5040 M0076 Erythropoietin Lab Diagnostic Services MICROBIOLOGY 3600 3780 4500 5220 M0201 Parvovirus IgM antibodies Lab Diagnostic Services MICROBIOLOGY 3730 3920 4670 5410 M0196 Auto Immune Hepatitis Panel Lab Diagnostic Services MICROBIOLOGY 3870 4060 4830 5610 Anti Smooth Muscle Antibodies- M0019 Lab Diagnostic Services MICROBIOLOGY 3990 4190 4990 5790 Immunofluresence M0094 Helicobacter Pylori IGM Antibodies Lab Diagnostic Services MICROBIOLOGY 3990 4190 4990 5790 M0024 Anti-Ccp Antibodies Lab Diagnostic Services MICROBIOLOGY 4130 4330 5160 5980 M0154 Pneumocystis Carinii (LF) Lab Diagnostic Services MICROBIOLOGY 4130 4330 5160 5980 M0237 Anti phospholipase 2 receptor IIF Lab Diagnostic Services MICROBIOLOGY 4240 4450 5300 6140 M0093 Helicobacter Pylori IGA Antibodies Lab Diagnostic Services MICROBIOLOGY 4260 4470 5320 6180 HEPATITIS B REAL TIME PCR M0240 Lab Diagnostic Services MICROBIOLOGY 4260 4470 5320 6180 QUALITATIVE M0214 H1N1 - Test Lab Diagnostic Services MICROBIOLOGY 4500 4500 4500 4500 M0225 HPV -Hybrid Digene Lab Diagnostic Services MICROBIOLOGY 4420 4640 5520 6400 M0187 Western Blot Report Lab Diagnostic Services MICROBIOLOGY 4530 4760 5660 6570 Epstein Barr virus (EBV) DNA PCR M0254 Lab Diagnostic Services MICROBIOLOGY 4760 5000 5950 6910 (Outsourced) M0218 Anti- Desmoglein antibody Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960 M0068 Endomysial IGA Antibodies Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960 M0197 HLA B27 - PCR Lab Diagnostic Services MICROBIOLOGY 4800 5040 6000 6960 M0222 DSA (Donor Specific Antibody) Lab Diagnostic Services MICROBIOLOGY 5190 5450 6490 7520 Japanese Encephalitis Virus Rt - M0131 Lab Diagnostic Services MICROBIOLOGY 5860 6160 7330 8500 PCR (Qualitative) M0026 Antigliadin IGA Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690 M0027 Antigliadin IGG Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690 M0050 CMV-DNA PCR Qualitative Lab Diagnostic Services MICROBIOLOGY 6000 6300 7490 8690 HIV-1 RNA Quantitative RT PCR M0238 Lab Diagnostic Services MICROBIOLOGY 6050 6360 7560 8770 (viral load) M0264 Galactomannan (Outsourced) Lab Diagnostic Services MICROBIOLOGY 6160 6470 7700 8940 M0211 HSV 1 & 2- Real Time PCR Lab Diagnostic Services MICROBIOLOGY 6250 6570 7820 9070 M0003 AFB Susceptibility:Custom Lab Diagnostic Services MICROBIOLOGY 6390 6710 7980 9260 M0047 Chlamydia IGG Antibodies Lab Diagnostic Services MICROBIOLOGY 6390 6710 7980 9260 M0244 AFB susceptibility, SIREP Panel Lab Diagnostic Services MICROBIOLOGY 6720 7060 8400 9750 Food Allergy Panel M0081 Lab Diagnostic Services MICROBIOLOGY 6930 7270 8660 10040 (Immunochromatography) Hepatitis C Virus Real Time PCR M0233 Lab Diagnostic Services MICROBIOLOGY 6930 7270 8660 10040 (Qualitative)

337 Lab diagnostics

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

M0018 Anti Nuclear Antibody (Ana) Profile Lab Diagnostic Services MICROBIOLOGY 7200 7550 8990 10430 AFB speciation- Common M0251 Lab Diagnostic Services MICROBIOLOGY 7280 7650 9100 10560 (Outsourced) Fungal Susceptinility Mic Panel (4 M0082 Lab Diagnostic Services MICROBIOLOGY 7450 7830 9310 10800 Drugs) Hepatitis C Virus Genotyping M0249 Lab Diagnostic Services MICROBIOLOGY 8680 9120 10850 12590 (Outsourced) M0209 JC/BK DNA PCR Lab Diagnostic Services MICROBIOLOGY 9320 9790 11650 13520 Anti Acetylcholine Receptor M0008 Lab Diagnostic Services MICROBIOLOGY 9850 10340 12310 14280 Antibody M0203 Auto Immune hepatitis profile Lab Diagnostic Services MICROBIOLOGY 11180 11740 13980 16210 M0227 HLA Flowcytometry Cross Match Lab Diagnostic Services MICROBIOLOGY 11180 11740 13980 16210 M0246 Hepatitis B virus DNA Quantitative Lab Diagnostic Services MICROBIOLOGY 11200 11760 14000 16240 MIC test for Non-Tuberculosis M0252 Lab Diagnostic Services MICROBIOLOGY 11200 11760 14000 16240 Mycobacteria (NTM) (Outsourced) M0065 Dengue Virus Typing Strains 1,2,3,4 Lab Diagnostic Services MICROBIOLOGY 12520 13140 15640 18150 M0102 Hepatitis B Virus Ymdd Mutation Lab Diagnostic Services MICROBIOLOGY 12520 13140 15640 18150 Hepatitis C Virus PCR Quantitative M0104 Lab Diagnostic Services MICROBIOLOGY 15300 16070 19130 22190 (Viral Load) HIV-1 Genotypic Resistance M0250 Lab Diagnostic Services MICROBIOLOGY 15680 16470 19600 22740 (Outsourced) CMV DNA Realtime PCR M0219 Lab Diagnostic Services MICROBIOLOGY 17300 18160 21620 25080 (Quantitative) M0121 HLA Ab&Dr Lab Diagnostic Services MICROBIOLOGY 23290 24450 29110 33770

338 Radiology

339 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

DEXA Single Site bone Radiology DRAD227 BMD 2330 2440 2910 3370 densitometry Diagnostic Services DEXA Hip And Spine bone Radiology DRAD228 BMD 3850 4050 4820 5590 densitometry Diagnostic Services DEXA Three Site bone Radiology DRAD229 BMD 5260 5530 6580 7630 densitometry Diagnostic Services Radiology DRAD230 DEXA Whole Body BMD 5260 5530 6580 7630 Diagnostic Services Radiology DRAD084 Imaging Services CT 440 440 510 570 Diagnostic Services Computed tomogram (CT scan) Radiology DS0013 C CT 500 500 580 650 OTHERS - PLAIN Diagnostic Services Radiology DRAD373 CT Radiotherapy plan - 8 cuts(N) CT 890 890 1020 1150 Diagnostic Services CT SCANNOGARAM LOWER Radiology DRAD149 CT 950 950 1090 1230 LIMBS Diagnostic Services Radiology DRAD423 CT JOINT Limited study CT 1640 1640 1890 2130 Diagnostic Services Radiology DRAD202 CT JOINTS WITH 3D CT 1770 1770 2030 2290 Diagnostic Services Radiology DRAD367 CT 3D surface rendering CT 1890 1890 2170 2450 Diagnostic Services Radiology DRAD398 CT spine (3 vertebral levels) plain CT 2080 2080 2400 2710 Diagnostic Services Radiology DRAD447 CT PNS coronal CT 2140 2140 2460 2780 Diagnostic Services Radiology DRAD441 CT sella / pituitary CT 2330 2330 2680 3030 Diagnostic Services Radiology DRAD374 CT Brachy planning - 1(N) CT 2400 2400 2750 3110 Diagnostic Services Radiology DRAD436 CT Head & Brain(N) CT 2520 2520 2900 3270 Diagnostic Services Stroke 1 CT Brain with MRI Radiology DRAD1129 CT 2620 2620 3010 3410 Diffusion Diagnostic Services Radiology DRAD450 CT Brain & IAM(N) CT 2770 2770 3190 3600 Diagnostic Services Radiology DRAD041 CT Kub Plain CT 2770 2770 3190 3600 Diagnostic Services Radiology DRAD408 CT wrist both sides CT 2770 2770 3190 3600 Diagnostic Services Radiology DRAD409 CT wrist left side CT 2770 2770 3190 3600 Diagnostic Services Radiology DRAD410 CT wrist right side CT 2770 2770 3190 3600 Diagnostic Services Radiology DRAD425 CT lower abdomen CT 2830 2830 3260 3680 Diagnostic Services

340 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD437 CT Brain & Coronals CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD399 CT cervical spine CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD420 CT foot both sides CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD421 CT foot left side CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD422 CT foot right side CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD411 CT hand both sides CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD412 CT hand left side CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD413 CT hand right side CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD439 CT head (bone window) CT 3030 3030 3480 3930 Diagnostic Services CT IAM / Temporal bone high Radiology DRAD446 CT 3030 3030 3480 3930 resolution Diagnostic Services Radiology DRAD417 CT Joint both ankle CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD405 CT Joint both Elbow CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD414 CT Joint both knees CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD402 CT Joint Both Shoulder CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD418 CT Joint left ankle CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD406 CT Joint left elbow CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD415 CT Joint left knee CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD403 CT Joint left shoulder CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD419 CT Joint right ankle CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD407 CT Joint right elbow CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD416 CT Joint right knee CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD404 CT Joint right shoulder CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD438 CT Maxillo fascial CT 3030 3030 3480 3930 Diagnostic Services

341 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD427 CT sacro iliac joints CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD400 CT Thoracic spine CT 3030 3030 3480 3930 Diagnostic Services Radiology DRAD043 CT Orbits CT 3080 3080 3550 4010 Diagnostic Services Radiology DRAD434 CT Thorax High Resolution lungs CT 3080 3080 3550 4010 Diagnostic Services Radiology DRAD449 CT sterotactic localization CT 3270 3270 3760 4250 Diagnostic Services Radiology DRAD045 CT Pelvis CT 3400 3400 3910 4420 Diagnostic Services Radiology DRAD424 CT upper abdomen CT 3520 3520 4050 4580 Diagnostic Services Radiology DRAD375 CT Brachy planning - 2 (N) CT 3650 3650 4200 4740 Diagnostic Services Radiology DRAD201 CT EXTREMITIES WITH 3D CT 3650 3650 4200 4740 Diagnostic Services Radiology DRAD401 CT Lumbar spine CT 3650 3650 4200 4740 Diagnostic Services Radiology DRAD432 CT Thorax CT 3650 3650 4200 4740 Diagnostic Services Radiology DRAD435 CT neck(N) CT 3770 3770 4340 4900 Diagnostic Services Radiology DRAD366 CT Brain with PNS(N) CT 3900 3900 4490 5070 Diagnostic Services Radiology DRAD440 CT head with 3D scan CT 3900 3900 4490 5070 Diagnostic Services Radiology DRAD426 CT hip joint both sides CT 3900 3900 4490 5070 Diagnostic Services Stroke 2 CT Brain with MRI Radiology DRAD1130 CT 4370 4370 5020 5670 Diffusion with MRA Intracranial Diagnostic Services CT Thorax & High Resolution Radiology DRAD433 CT 4780 4780 5500 6210 study Diagnostic Services Radiology DRAD428 CT abdomen and pelvis CT 5790 5790 6660 7520 Diagnostic Services Computed tomogram (CT scan) Radiology DS0013 B CT SPECIAL 550 580 690 800 BRAIN/SPINE - CONTRAST Diagnostic Services Radiology DRAD1137 CT NAVIGATION PROTOCOL CT SPECIAL 2570 2700 3210 3720 Diagnostic Services Radiology DRAD358 CT Virtual Endoscopy CT SPECIAL 4370 4590 5460 6340 Diagnostic Services Radiology DRAD369 CT Denta scan CT SPECIAL 5260 5530 6580 7630 Diagnostic Services Radiology DRAD059 CT-Calcium Scoring CT SPECIAL 6300 6610 7870 9130 Diagnostic Services

342 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD161 CT-TRAUMA BRAIN & C SPINE CT SPECIAL 7190 7550 8980 10420 Diagnostic Services Radiology DRAD371 CT Perfusion (N) CT SPECIAL 8740 9180 10920 12670 Diagnostic Services Radiology DRAD200 CT ANGIO PAEDIATRIC CT SPECIAL 10010 10520 12520 14520 Diagnostic Services Radiology DRAD370 CT Bronchoscopy(N) CT SPECIAL 10530 11060 13160 15270 Diagnostic Services Radiology DRAD368 CT Colonography(N) CT SPECIAL 13480 14150 16850 19540 Diagnostic Services Radiology DRAD052 CT-Angio Coronary CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD378 CT Angiography intracranial CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD379 CT Angiography neck CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD386 CT Angiography - Renal CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD215 CT TRPHASE LIVER VOLUME CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD377 CT Urogram(N) CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD393 CT venography intracranial CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD394 CT venography neck CT SPECIAL 16040 16840 20050 23260 Diagnostic Services Radiology DRAD050 CT-Angio (One Region) CT SPECIAL 17330 18200 21660 25130 Diagnostic Services Radiology DRAD1108 CT Chest Angio CT SPECIAL 17330 18200 21660 25130 Diagnostic Services CT Angiography neck & Radiology DRAD380 CT SPECIAL 17970 18870 22460 26050 intracranial Diagnostic Services Radiology DRAD055 CT-Angio Head & Neck CT SPECIAL 17970 18870 22460 26050 Diagnostic Services CT venography neck & Radiology DRAD395 CT SPECIAL 17970 18870 22460 26050 intracranial Diagnostic Services Radiology DRAD396 CT venography thorax CT SPECIAL 17970 18870 22460 26050 Diagnostic Services Radiology DRAD051 CT-Angio Aortic CT SPECIAL 19250 20220 24070 27920 Diagnostic Services Radiology DRAD382 CT Angiography abdominal aorta CT SPECIAL 19250 20220 24070 27920 Diagnostic Services Radiology DRAD381 CT Angiography thoracic aorta CT SPECIAL 19250 20220 24070 27920 Diagnostic Services CT-POLYTRAUMA HEMIBODY Radiology DRAD203 (BRAIN, C-SPINE & THROAX WITH CT SPECIAL 19890 20890 24860 28840 Diagnostic Services CONTRAST)

343 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD058 CT-Cabg Evaluation CT SPECIAL 21180 22240 26470 30710 Diagnostic Services Radiology DRAD150 CT TRIPHASE ABDOMEN & PELVIS CT SPECIAL 21180 22240 26470 30710 Diagnostic Services Radiology DRAD397 CT venography whole abdomen CT SPECIAL 21180 22240 26470 30710 Diagnostic Services Radiology DRAD389 CT Angiography lower limbs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD388 CT Angiography thighs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD387 CT Angiography upper limbs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD056 CT-Angio Peripheral CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD392 CT Venography lower limbs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD391 CT Venography thighs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD390 CT Venography upper limbs CT SPECIAL 21820 22910 27270 31630 Diagnostic Services Radiology DRAD384 CT Angiography abdomen CT SPECIAL 23100 24260 28880 33500 Diagnostic Services Radiology DRAD383 CT Angiography abdomen & chest CT SPECIAL 24380 25600 30470 35350 Diagnostic Services Radiology DRAD385 CT Angiography whole abdomen CT SPECIAL 24380 25600 30470 35350 Diagnostic Services CT ANGIOGRAPHY AORTA & Radiology DRAD1136 CT SPECIAL 25670 26950 32080 37220 PERIPHERAL Diagnostic Services CT-POLYTRAUMA WHOLEBODY (BRAIN, C-SPINE, THROAX Radiology DRAD204 CT SPECIAL 28230 29640 35290 40930 ABDOMEN, PELVIS WITH Diagnostic Services CONTRAST) CT-Angiography Coronary & Radiology DRAD362 CT SPECIAL 29520 30990 36900 42800 Renal Diagnostic Services CT-Tripple Rule Out (Pulm, Aorta Radiology DRAD365 CT SPECIAL 35930 37730 44910 52100 & Coronary)(N) Diagnostic Services DOPPLER VEIN MARKING LSV Radiology DRAD164 DOPPLER 1230 1290 1530 1780 FOR BYPASS GRAFT Diagnostic Services Radiology DRAD254 Doppler & Ultrasound scrotum DOPPLER 1680 1760 2090 2430 Diagnostic Services Radiology DRAD238 Doppler left arm arterial DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD241 Doppler left arm venous DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD244 Doppler left leg arterial DOPPLER 2460 2580 3070 3560 Diagnostic Services

344 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD247 Doppler left leg venous DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD237 Doppler right arm arterial DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD240 Doppler right arm venous DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD243 Doppler right leg arterial DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD246 Doppler right leg venous DOPPLER 2460 2580 3070 3560 Diagnostic Services Radiology DRAD234 Doppler of Renal artery DOPPLER 2830 2970 3540 4100 Diagnostic Services Radiology DRAD235 Doppler penile DOPPLER 2830 2970 3540 4100 Diagnostic Services Doppler Vein Marking / Mapping Radiology DRAD255 DOPPLER 2830 2970 3540 4100 varicose veins single limb Diagnostic Services Doppler carotid & Vertebral Radiology DRAD231 DOPPLER 3220 3380 4020 4660 vessels Diagnostic Services Radiology DRAD1156 Doppler Petrous Artery DOPPLER 3220 3380 4020 4660 Diagnostic Services Radiology DRAD232 Doppler Abdomen(N) DOPPLER 3350 3520 4180 4850 Diagnostic Services Radiology DRAD233 Doppler of transplanted kidney DOPPLER 3350 3520 4180 4850 Diagnostic Services Radiology DRAD245 Doppler both legs venous DOPPLER 3600 3780 4500 5220 Diagnostic Services Radiology DRAD239 Doppler both arms venous DOPPLER 4250 4460 5310 6160 Diagnostic Services Radiology DRAD250 Doppler left arm venous & arterial DOPPLER 4490 4720 5610 6510 Diagnostic Services Doppler left lower limb venous & Radiology DRAD253 DOPPLER 4490 4720 5610 6510 arterial Diagnostic Services Doppler right arm venous & Radiology DRAD249 DOPPLER 4490 4720 5610 6510 arterial Diagnostic Services Doppler right lower limb venous Radiology DRAD252 DOPPLER 4490 4720 5610 6510 & arterial Diagnostic Services Radiology DRAD236 Doppler both arms arterial DOPPLER 4890 5130 6110 7090 Diagnostic Services Radiology DRAD242 Doppler both legs arterial DOPPLER 4890 5130 6110 7090 Diagnostic Services Doppler Vein Marking / Mapping Radiology DRAD256 DOPPLER 4890 5130 6110 7090 varicose veins both limbs Diagnostic Services Doppler both upper limbs venous Radiology DRAD248 DOPPLER 5390 5660 6740 7820 & arterial Diagnostic Services Doppler both lower limbs venous Radiology DRAD251 DOPPLER 6300 6610 7870 9130 & arterial Diagnostic Services

345 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DS0003 Mamogram MAMMOGRAM 330 350 420 480 Diagnostic Services Radiology DRAD454 Mammography Extra view MAMMOGRAM 770 810 970 1120 Diagnostic Services Radiology DRAD451 Mammography (L) MAMMOGRAM 1810 1900 2260 2620 Diagnostic Services Radiology DRAD452 Mammography (R) MAMMOGRAM 1810 1900 2260 2620 Diagnostic Services Radiology DRAD087 Mammogram Both Breasts MAMMOGRAM 2460 2580 3070 3560 Diagnostic Services Mammographic Localization Or Radiology DRAD206 MAMMOGRAM 8220 8630 10280 11920 Biopsy Diagnostic Services Magnetic resonance imaging Radiology DS0014 A MR 580 580 670 750 (MRI) BRAIN/SPINE - PLAIN Diagnostic Services Magnetic resonance imaging Radiology DS0014 C MR 580 580 670 750 (MRI) OTHERS - PLAIN Diagnostic Services Radiology DRAD1135 MRI NAVIGATION PROTOCOL MR 1800 1800 2070 2330 Diagnostic Services Radiology DRAD350 MRI Diffusion(N) MR 3060 3060 3520 3970 Diagnostic Services Radiology DRAD1132 MRI LIVER-IRON ESTIMATE MR 3680 3680 4230 4780 Diagnostic Services Radiology DRAD208 MR ANGIOGRAPHY INTRACRANIAL MR 4270 4270 4910 5540 Diagnostic Services MR ANGIOGRAPHY NECK Radiology DRAD166 MR 4270 4270 4910 5540 VESSELS Diagnostic Services MRI Angiography intracranial Radiology DRAD281 MR 4270 4270 4910 5540 without contrast Diagnostic Services MRI Angiography neck vessels Radiology DRAD284 MR 4270 4270 4910 5540 without contrast Diagnostic Services Radiology DRAD165 MR VENOGRAPHY INTRACRANIAL MR 4270 4270 4910 5540 Diagnostic Services MR Venography intracranial Radiology DRAD283 MR 4270 4270 4910 5540 without contrast Diagnostic Services Radiology DRAD352 MRI Limited(N) MR 4990 4990 5740 6480 Diagnostic Services MR ANGIO & VENOGRAM Radiology DRAD167 MR 5480 5480 6300 7120 INTRACRANIAL Diagnostic Services MR Angio & Venogram Radiology DRAD285 MR 5480 5480 6300 7120 intracranial without contrast Diagnostic Services MRI Angiography neck & Radiology DRAD282 MR 5480 5480 6300 7120 intracranial without contrast Diagnostic Services Stroke 3 MRI Limited with MRA Radiology DRAD1131 MR 5820 5820 6690 7560 Intracranial Diagnostic Services Radiology DRAD279 MRCP(N) MR 6110 6110 7030 7940 Diagnostic Services

346 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

MR ANGIOGRAPHY INTRACRANIAL Radiology DRAD209 MR 6740 6740 7750 8750 & NECK VESSELS Diagnostic Services Radiology DRAD098 MR Joints MR 7550 7550 8680 9810 Diagnostic Services Radiology DRAD295 MRI angiography both thighs MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD290 MRI angiography left forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD288 MRI angiography left upper arm MR 8270 8270 9510 10740 Diagnostic Services MRI angiography lower abdomen Radiology DRAD294 MR 8270 8270 9510 10740 / pelvis Diagnostic Services Radiology DRAD289 MRI angiography right forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD287 MRI angiography right upper arm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD291 MRI angiography thorax MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD293 MRI angiography upper abdomen MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD308 MRI brachial plexus MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD344 MRI brain MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD354 MRI Brain & IAM MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD306 MRI cervical spine MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD335 MRI foot MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD338 MRI hip joints MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD334 MRI left ankle MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD320 MRI left elbow MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD322 MRI left forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD326 MRI left hand MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD330 MRI left knee joint MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD316 MRI left shoulder MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD318 MRI left upper arm MR 8270 8270 9510 10740 Diagnostic Services

347 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD324 MRI left wrist MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD309 MRI lumbar plexus MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD310 MRI lumbo-sacral spine MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD343 MRI neck MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD286 MRI neck & carotid angiography MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD105 MRI One Region MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD347 MRI orbit MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD346 MRI Para nasal sinuses ( PNS ) MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD336 MRI pelvis MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD339 MRI perineum MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD345 MRI Pituitary fossa/sella MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD292 MRI renal angiography MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD333 MRI right ankle MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD319 MRI right elbow MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD321 MRI right forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD325 MRI right hand MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD329 MRI right knee joint MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD315 MRI right shoulder MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD317 MRI right upper arm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD323 MRI right wrist MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD337 MRI sacro-iliac joints MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD327 MRI thigh MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD307 MRI thoracic spine MR 8270 8270 9510 10740 Diagnostic Services

348 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD342 MRI thorax MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD348 MRI TM joint MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD340 MRI upper abdomen MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD305 MRI venography both lower legs MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD304 MRI venography both thighs MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD300 MRI venography left forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD298 MRI venography left upper arm MR 8270 8270 9510 10740 Diagnostic Services MRI venography lower abdomen Radiology DRAD303 MR 8270 8270 9510 10740 / pelvis Diagnostic Services Radiology DRAD299 MRI venography right forearm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD297 MRI venography right upper arm MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD301 MRI venography thorax MR 8270 8270 9510 10740 Diagnostic Services Radiology DRAD302 MRI venography upper abdomen MR 8270 8270 9510 10740 Diagnostic Services MRI Angio abdomen with both Radiology DRAD355 MR 9160 9160 10530 11900 lower limbs Diagnostic Services Radiology DRAD278 MRI Mammography MR 9160 9160 10530 11900 Diagnostic Services Radiology DRAD1134 MRI BRAIN & FMR MR 9430 9430 10840 12250 Diagnostic Services Radiology DRAD1133 MRI BRAIN & SPECTROSCOPY MR 9430 9430 10840 12250 Diagnostic Services Radiology DRAD351 MRI Brain Plus(N) MR 9870 9870 11350 12830 Diagnostic Services Radiology DRAD314 MRI Spine plus(N) MR 9970 9970 11460 12950 Diagnostic Services Radiology DRAD099 MR Joints (Both) MR 12120 12120 13940 15750 Diagnostic Services Radiology DRAD331 MRI lower legs MR 14580 14580 16770 18950 Diagnostic Services Radiology DRAD341 MRI whole abdomen MR 14580 14580 16770 18950 Diagnostic Services Radiology DRAD146 MRI ABDOMEN & PELVIS MR 14640 14640 16830 19020 Diagnostic Services Radiology DRAD332 MRI both ankles MR 15800 15800 18170 20530 Diagnostic Services

349 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD328 MRI both knee joints MR 15800 15800 18170 20530 Diagnostic Services Radiology DRAD349 MRI Both TM joint MR 15800 15800 18170 20530 Diagnostic Services Radiology DRAD311 MRI spine MR 15800 15800 18170 20530 Diagnostic Services Radiology RADIOLOGY INVASIVE DS0006 Ultrasound guided biopsyt 550 580 690 800 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1066 T - Tube cholangiogram OT(N) 2570 2700 3210 3720 Diagnostic Services PROCEDURES JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE DRAD1115 3150 3310 3940 4570 INJECTION-SINGLE Diagnostic Services PROCEDURES JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE DRAD1119 4310 4520 5380 6240 INJECTION Diagnostic Services PROCEDURES U/S GUIDED FNA / DIAGNOSTIC Radiology RADIOLOGY INVASIVE DRAD1123 4440 4660 5550 6430 ASPIRATION Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1061 CT guided aspiration 5340 5610 6670 7740 Diagnostic Services PROCEDURES CT GUIDED FNA / DIAGNOSTIC Radiology RADIOLOGY INVASIVE DRAD1124 5340 5610 6670 7740 ASPIRATION Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1056 Ultrasound guided breast biopsy 5340 5610 6670 7740 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1054 Ultrasound guided aspiration(N) 6230 6540 7790 9030 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD170 Nasogastric Tube Insertion 6360 6680 7950 9220 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1071 Xray Nasogastric Tube Insertion 6360 6680 7950 9220 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1141 Paed Central Line 6420 6740 8020 9300 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1069 Xray myelogram ( Dorsal ) 6420 6740 8020 9300 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1140 PERM CATH PROCEDURE CHARGE 7070 7420 8830 10240 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1060 CT guided FNAC 7390 7760 9230 10710 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1058 CT Guided Joint Injection 7390 7760 9230 10710 Diagnostic Services PROCEDURES JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE DRAD1116 7390 7760 9230 10710 INJECTION-UPTO 3 JOINTS Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1126 PICK LINE INSERTION 7390 7760 9230 10710 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1053 Ultrasound guided FNAC 7390 7760 9230 10710 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1068 Xray myelogram ( cervical ) 7390 7760 9230 10710 Diagnostic Services PROCEDURES

350 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology RADIOLOGY INVASIVE DRAD1070 Xray myelogram ( Lumbar) 7390 7760 9230 10710 Diagnostic Services PROCEDURES Mammographic biopsy / Radiology RADIOLOGY INVASIVE DRAD1065 8020 8420 10030 11630 localization Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1055 Ultrasound Guided Drainage 8020 8420 10030 11630 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1139 BILIARY STENT Deployment 8340 8760 10430 12100 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1112 PYLORIC DILATATION - PKG 8610 9040 10760 12480 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD173 Nasojejunal Tube Insertion 9510 9980 11880 13790 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD172 US/CT Guided Biopsy 9510 9980 11880 13790 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1072 Xray Nasojejunal Tube Insertion 9510 9980 11880 13790 Diagnostic Services PROCEDURES JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE DRAD1117 10660 11200 13330 15460 INJECTION-UPTO 5 JOINTS Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1127 TUNNEL LINE INSERTION 10660 11200 13330 15460 Diagnostic Services PROCEDURES HD Catheter Double Lumen - Radiology RADIOLOGY INVASIVE DRAD1138 10910 11450 13630 15810 Radiology Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1063 CT guided Biopsy 10980 11530 13730 15920 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1062 CT guided drainage 10980 11530 13730 15920 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1064 CT myelogram 10980 11530 13730 15920 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1057 Ultrasound Guided Biopsy 10980 11530 13730 15920 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD442 CT cisternography 12460 13080 15570 18060 Diagnostic Services PROCEDURES JOINT / TENDON SHEATH Radiology RADIOLOGY INVASIVE DRAD1118 17010 17860 21260 24660 INJECTION-UPTO 7 JOINTS Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1125 CELIAC PLEXUS BLOCK 19190 20150 23980 27820 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1121 PTBD STEP 2 19190 20150 23980 27820 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD196 Angio Cerebral 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD174 Angiogram Mesenteric 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD197 Angiogram Peripheral 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD198 Angiogram Renal 23620 24800 29530 34250 Diagnostic Services PROCEDURES

351 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology RADIOLOGY INVASIVE DRAD1120 PTBD STEP 1 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1067 Tubal Recanalization(N) 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1122 URETRIC STENTING 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD140 Venogram 23620 24800 29530 34250 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1114 SCLEROTHERAPHY - PKG 25870 27160 32330 37500 Diagnostic Services PROCEDURES VARICOCELE EMBOLIZATION - Radiology RADIOLOGY INVASIVE DRAD1113 33950 35650 42440 49230 PKG Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD199 Angioplasty 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD183 IVC Filter placement 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD182 Nephrostomy 42790 44930 53490 62050 Diagnostic Services PROCEDURES Percutaneous Biliary Drainage/ Radiology RADIOLOGY INVASIVE DRAD176 42790 44930 53490 62050 Stenting Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD179 Percutaneous Cholesystostomy 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD180 Percutaneous Gastrostomy 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD178 Radiofrequency Ablation (RFA) 42790 44930 53490 62050 Diagnostic Services PROCEDURES Transarterial Chemoembolisation Radiology RADIOLOGY INVASIVE DRAD177 42790 44930 53490 62050 (TACE) Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD181 Transjugular biopsy 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD175 Venoplasty 42790 44930 53490 62050 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1142 Hepatic Venous / IVC stenting 44910 47150 56130 65110 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD186 Therasphere Treatment 64160 67360 80190 93030 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD184 Arterial/Venous Embolisation 73780 77470 92230 106980 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD1143 Mesentric Angiogram for Y 90 73780 77470 92230 106980 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD185 TIPSS 73780 77470 92230 106980 Diagnostic Services PROCEDURES Radiology RADIOLOGY INVASIVE DRAD188 Uterine Fibroid Embolisation 73780 77470 92230 106980 Diagnostic Services PROCEDURES Vascular stent/stent graft Radiology RADIOLOGY INVASIVE DRAD187 73780 77470 92230 106980 Insertion Diagnostic Services PROCEDURES

352 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD1094 Second Opinion - Single X-Ray RADIOLOGY MISC 60 60 70 80 Diagnostic Services Second Opinion - multiple Radiology DRAD1095 RADIOLOGY MISC 110 120 140 160 X-Rays(N) Diagnostic Services Radiology DRAD1092 Ultrasound extra film charges(N) RADIOLOGY MISC 160 170 200 230 Diagnostic Services Radiology DRAD1087 CD 1 Soft copy X-Ray RADIOLOGY MISC 170 180 210 240 Diagnostic Services Radiology DRAD1091 X-ray Extra film charges RADIOLOGY MISC 200 210 250 290 Diagnostic Services Radiology DRAD1093 CT //MRI Extra film charges(N) RADIOLOGY MISC 220 240 280 320 Diagnostic Services Radiology DRAD1082 Ionic contrast (20 ml) RADIOLOGY MISC 240 250 290 340 Diagnostic Services Radiology DRAD1083 Rectal contrast (20ml ionic)(N) RADIOLOGY MISC 240 250 290 340 Diagnostic Services CD 2 Soft copy X-Rays'/ Radiology DRAD1088 RADIOLOGY MISC 290 310 360 420 Ultrasound Diagnostic Services Radiology DRAD1073 Non-ionic contrast 300mg(10 ml) RADIOLOGY MISC 430 460 540 630 Diagnostic Services Second Opinion - Radiology DRAD1100 RADIOLOGY MISC 500 520 620 720 Investigations(N) Diagnostic Services Second Opinion - Radiology DRAD1101 RADIOLOGY MISC 500 520 620 720 Mammogram(N) Diagnostic Services Computed tomogram (CT scan) Radiology DS0013 D RADIOLOGY MISC 550 580 690 800 OTHERS - CONTRAST Diagnostic Services Radiology DRAD1096 Second Opinion - Single CT RADIOLOGY MISC 580 610 720 830 Diagnostic Services Radiology DRAD1074 Non-ionic contrast 300mg (20 ml) RADIOLOGY MISC 590 620 730 850 Diagnostic Services Radiology DRAD1089 CD 3 Soft copy CT scan / MRI RADIOLOGY MISC 720 760 900 1040 Diagnostic Services Radiology DRAD1098 Second Opinion - MRI(N) RADIOLOGY MISC 770 810 970 1120 Diagnostic Services Magnetic resonance imaging Radiology DS0014 B RADIOLOGY MISC 830 870 1040 1200 (MRI) BRAIN/SPINE - CONTRAST Diagnostic Services Magnetic resonance imaging Radiology DS0014 D RADIOLOGY MISC 830 870 1040 1200 (MRI) OTHERS - CONTRAST Diagnostic Services Radiology DRAD1161 MRI/CT ANAESTHESIA CARE RADIOLOGY MISC 1000 1000 1000 1000 Diagnostic Services Second Opinion - Serial Radiology DRAD1102 RADIOLOGY MISC 970 1020 1210 1410 Mammogram(N) Diagnostic Services Radiology DRAD1090 DVD soft copy CT scan / MRI(N) RADIOLOGY MISC 990 1040 1240 1440 Diagnostic Services Radiology DRAD1075 non-ionic contrast 300mg (40 ml) RADIOLOGY MISC 990 1040 1240 1440 Diagnostic Services

353 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Second Opinion - Serial CT Radiology DRAD1097 RADIOLOGY MISC 1090 1150 1370 1580 Studies(N) Diagnostic Services Radiology DRAD1081 Oral contrast (100 ml)(N) RADIOLOGY MISC 1100 1160 1380 1600 Diagnostic Services Radiology DRAD1076 Non-ionic contrast 300mg (50 ml) RADIOLOGY MISC 1160 1220 1450 1680 Diagnostic Services Radiology DRAD1079 Non-ionic contrast 350mg (50 ml) RADIOLOGY MISC 1380 1450 1720 2000 Diagnostic Services RADIOLOGIST ASSISTANCE FEE Radiology DRAD224 RADIOLOGY MISC 1540 1620 1930 2240 - 1 Diagnostic Services Second Opinion - Serial MRI Radiology DRAD1099 RADIOLOGY MISC 1540 1620 1930 2240 Studies(N) Diagnostic Services Non-ionic contrast 300mg (80 Radiology DRAD1077 RADIOLOGY MISC 1980 2080 2480 2880 ml)(N) Diagnostic Services Non-ionic contrast 300mg (100 Radiology DRAD1078 RADIOLOGY MISC 2200 2310 2750 3190 ml) Diagnostic Services RADIOLOGIST ASSISTANCE FEE Radiology DRAD225 RADIOLOGY MISC 2460 2580 3070 3560 - 2 Diagnostic Services Non-ionic contrast 350mg (100 Radiology DRAD1080 RADIOLOGY MISC 2590 2720 3240 3750 ml) Diagnostic Services Radiology DRAD103 MRI Contrast 10Ml RADIOLOGY MISC 3030 3180 3790 4390 Diagnostic Services RADIOLOGIST ASSISTANCE FEE Radiology DRAD226 RADIOLOGY MISC 3600 3780 4500 5220 - 3 Diagnostic Services Radiology DRAD1085 MRI Contrast 20Ml(N) RADIOLOGY MISC 6050 6360 7570 8780 Diagnostic Services Radiology DRAD097 MR Bolus Contrast RADIOLOGY MISC 8470 8900 10590 12290 Diagnostic Services Radiology DRAD1086 MRI double dose contrast(N) RADIOLOGY MISC 8470 8900 10590 12290 Diagnostic Services USG as an emergency procedures Radiology DS0004 ULTRASOUND 220 240 280 320 if facility not available at GH Diagnostic Services Radiology DRAD258 Ultrasound portable ( Eqp)(N) ULTRASOUND 1230 1290 1530 1780 Diagnostic Services Radiology DRAD266 Ultrasound endorectal(N) ULTRASOUND 1290 1360 1610 1870 Diagnostic Services Radiology DRAD265 Ultrasound endovaginal(N) ULTRASOUND 1290 1360 1610 1870 Diagnostic Services Radiology DRAD269 Ultrasound Pelvis(N) ULTRASOUND 1290 1360 1610 1870 Diagnostic Services Radiology DRAD276 Ultrasound small parts(N) ULTRASOUND 1290 1360 1610 1870 Diagnostic Services Radiology DRAD261 Ultrasound breast ULTRASOUND 1540 1620 1930 2240 Diagnostic Services ULTRASOUND FOR EARLY Radiology DRAD262 ULTRASOUND 1540 1620 1930 2240 PREGNANCY Diagnostic Services

354 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Ultrasound for undescended Radiology DRAD263 ULTRASOUND 1540 1620 1930 2240 testis Diagnostic Services Radiology DRAD259 Ultrasound joint ULTRASOUND 1540 1620 1930 2240 Diagnostic Services Radiology DRAD128 Ultra Sound (Nicu) - Portable ULTRASOUND 1540 1620 1930 2240 Diagnostic Services Radiology DRAD274 Ultrasound salivary gland ULTRASOUND 1540 1620 1930 2240 Diagnostic Services Radiology DRAD129 Ultrasound Abdomen ULTRASOUND 1680 1760 2090 2430 Diagnostic Services Radiology DRAD268 Ultrasound abdomen n pelvis ULTRASOUND 1680 1760 2090 2430 Diagnostic Services Radiology DRAD270 Ultrasound KUB ULTRASOUND 1680 1760 2090 2430 Diagnostic Services Ultrasound scrotum with colour Radiology DRAD264 ULTRASOUND 1680 1760 2090 2430 doppler Diagnostic Services Ultrasound musculoskeletal Radiology DRAD260 ULTRASOUND 1810 1900 2260 2620 system Diagnostic Services Radiology DRAD273 Ultrasound neck ULTRASOUND 1810 1900 2260 2620 Diagnostic Services Ultrasound neurosonography ( Radiology DRAD275 ULTRASOUND 1810 1900 2260 2620 cranial ultrasound ) Diagnostic Services Radiology DRAD271 Ultrasound thorax ULTRASOUND 1810 1900 2260 2620 Diagnostic Services Radiology DRAD272 Ultrasound thyroid ULTRASOUND 1810 1900 2260 2620 Diagnostic Services Radiology DRAD257 Ultrasound (Gen) - Portable(N) ULTRASOUND 2060 2160 2580 2990 Diagnostic Services Radiology DRAD267 Ultrasound transplant kidney ULTRASOUND 2330 2440 2910 3370 Diagnostic Services Radiology DRAD277 Ultra Sound Follicular Study(N) ULTRASOUND 2460 2580 3070 3560 Diagnostic Services Radiology DRAD1128 ULTRASOUND (EMERGENCY) ULTRASOUND 3470 3640 4340 5030 Diagnostic Services Radiology DRAD168 INTRAOPERATIVE ULTRASOUND ULTRASOUND 7700 8090 9630 11170 Diagnostic Services Radiology DRAD119 Radiology Services XRAY 110 120 140 160 Diagnostic Services Radiology DRAD114 Plain Xray Dept XRAY 420 440 530 610 Diagnostic Services Radiology DRAD487 Xray acromio clavicular joint (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD488 Xray acromio clavicular joint (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD495 Xray ankle AP (bilateral) XRAY 420 440 530 610 Diagnostic Services

355 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD496 Xray ankle AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD497 Xray ankle AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD499 Xray ankle lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD500 Xray ankle lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD502 Xray ankle oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD503 Xray ankle oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD505 Xray ankle stress view (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD506 Xray ankle stress view (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD513 Xray arm / humerus AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD514 Xray arm / humerus AP (R) XRAY 420 440 530 610 Diagnostic Services Xray arm / humerus AP with Radiology DRAD515 XRAY 420 440 530 610 elbow (L) Diagnostic Services Xray arm / humerus AP with Radiology DRAD516 XRAY 420 440 530 610 elbow (R) Diagnostic Services Xray arm / humerus AP with Radiology DRAD517 XRAY 420 440 530 610 shoulder (L) Diagnostic Services Xray arm / humerus AP with Radiology DRAD518 XRAY 420 440 530 610 shoulder (R) Diagnostic Services Radiology DRAD519 Xray arm / humerus lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD520 Xray arm / humerus lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray arm / humerus lateral with Radiology DRAD521 XRAY 420 440 530 610 elbow (L) Diagnostic Services Xray arm / humerus lateral with Radiology DRAD522 XRAY 420 440 530 610 elbow (R) Diagnostic Services Radiology DRAD528 Xray calcaneum axial (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD529 Xray calcaneum axial (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD531 Xray calcaneum lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD532 Xray calcaneum lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD1153 X-ray Caldwell View XRAY 420 440 530 610 Diagnostic Services

356 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD537 Xray cervical spine AP view XRAY 420 440 530 610 Diagnostic Services Xray cervical spine lateral for Radiology DRAD539 XRAY 420 440 530 610 cranio-vertebrae junction Diagnostic Services Xray cervical spine (lateral) in Radiology DRAD534 XRAY 420 440 530 610 extension Diagnostic Services Xray cervical spine (lateral) in Radiology DRAD535 XRAY 420 440 530 610 flexion Diagnostic Services Radiology DRAD540 Xray cervical spine lateral view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD542 Xray cervical spine oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD543 Xray cervical spine oblique (R) XRAY 420 440 530 610 Diagnostic Services Xray cervical spine open mouth Radiology DRAD544 XRAY 420 440 530 610 for CV junction Diagnostic Services Radiology DRAD547 Xray cervico-dorsal spine AP view XRAY 420 440 530 610 Diagnostic Services Xray cervico-dorsal spine lateral Radiology DRAD548 XRAY 420 440 530 610 view Diagnostic Services Xray cervico-dorsal spine Radiology DRAD549 XRAY 420 440 530 610 swimmers view Diagnostic Services Radiology DRAD550 Xray chest AP XRAY 420 440 530 610 Diagnostic Services Radiology DRAD551 Xray chest AP for ribs bucky film XRAY 420 440 530 610 Diagnostic Services Radiology DRAD552 Xray chest apicogram XRAY 420 440 530 610 Diagnostic Services Radiology DRAD553 Xray chest decubitus (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD554 Xray chest decubitus (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD555 Xray chest lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD556 Xray chest lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD557 Xray chest oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD558 Xray chest oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD561 Xray chest PA (CXR) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD562 Xray chest PA penetrating XRAY 420 440 530 610 Diagnostic Services Radiology DRAD564 Xray clavicle AP view (L) XRAY 420 440 530 610 Diagnostic Services

357 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD566 Xray coccyx AP XRAY 420 440 530 610 Diagnostic Services Radiology DRAD570 Xray dorsal lumbar spine AP view XRAY 420 440 530 610 Diagnostic Services Xray dorsal lumbar spine lateral Radiology DRAD571 XRAY 420 440 530 610 view Diagnostic Services Radiology DRAD573 Xray dorsal spine AP view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD574 Xray dorsal spine lateral view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD575 Xray dorsal spine oblique view (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD576 Xray dorsal spine oblique view (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD577 Xray ear pinna - soft tissue (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD578 Xray ear pinna - soft tissue (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD581 Xray elbow AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD582 Xray elbow AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD583 Xray elbow lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD584 Xray elbow lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD586 Xray ethmoid sinus (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD587 Xray ethmoid sinus (R) XRAY 420 440 530 610 Diagnostic Services Xray femur (including hip joint) Radiology DRAD596 XRAY 420 440 530 610 AP (L) Diagnostic Services Xray femur (including hip joint) Radiology DRAD597 XRAY 420 440 530 610 AP (R) Diagnostic Services Xray femur (including hip joint) Radiology DRAD598 XRAY 420 440 530 610 lateral (L) Diagnostic Services Xray femur (including knee joint) Radiology DRAD604 XRAY 420 440 530 610 AP (L) Diagnostic Services Xray femur (including knee joint) Radiology DRAD605 XRAY 420 440 530 610 AP (R) Diagnostic Services Xray femur (including knee joint) Radiology DRAD607 XRAY 420 440 530 610 lateral (L) Diagnostic Services Xray femur (including knee joint) Radiology DRAD608 XRAY 420 440 530 610 lateral (R) Diagnostic Services Radiology DRAD616 Xray femur lateral (L) XRAY 420 440 530 610 Diagnostic Services

358 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD617 Xray femur lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray first carpo metacarpal joint Radiology DRAD619 XRAY 420 440 530 610 (L) Diagnostic Services Xray first carpo metacarpal joint Radiology DRAD620 XRAY 420 440 530 610 (R) Diagnostic Services Radiology DRAD629 Xray foot AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD633 Xray foot for arch lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD634 Xray foot for arch lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD635 Xray foot lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD636 Xray foot lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD638 Xray foot oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD643 Xray forearm AP (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD644 Xray forearm AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD645 Xray forearm AP (R) XRAY 420 440 530 610 Diagnostic Services Xray forearm for foreign body Radiology DRAD646 XRAY 420 440 530 610 localisation (L) Diagnostic Services Xray forearm for foreign body Radiology DRAD647 XRAY 420 440 530 610 localisation (R) Diagnostic Services Radiology DRAD663 Xray hand AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD664 Xray hand AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD655 Xray hand ( ball catcher's view ) XRAY 420 440 530 610 Diagnostic Services Xray hand for foreign body Radiology DRAD668 XRAY 420 440 530 610 localisation (L) Diagnostic Services Xray hand for foreign body Radiology DRAD669 XRAY 420 440 530 610 localisation (R) Diagnostic Services Radiology DRAD670 Xray hand lateral (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD671 Xray hand lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD672 Xray hand lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD673 Xray hand oblique (bilateral) XRAY 420 440 530 610 Diagnostic Services

359 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD674 Xray hand oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD675 Xray hand oblique (R) XRAY 420 440 530 610 Diagnostic Services Xray hand - soft tissue AP view Radiology DRAD652 XRAY 420 440 530 610 (bilateral) Diagnostic Services Xray hand - soft tissue AP view Radiology DRAD653 XRAY 420 440 530 610 (L) Diagnostic Services Xray hand - soft tissue AP view Radiology DRAD654 XRAY 420 440 530 610 (R) Diagnostic Services Radiology DRAD682 Xray heel axial (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD683 Xray heel axial (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD688 Xray heel lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD689 Xray heel lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD693 Xray hip AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD694 Xray hip AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD696 Xray hip lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD697 Xray hip lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray iliac crest for bone age ( Radiology DRAD700 XRAY 420 440 530 610 pelvis AP view ) Diagnostic Services Radiology DRAD712 Xray knee AP (erect) (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD713 Xray knee AP (erect) (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD714 Xray knee AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD715 Xray knee AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD718 Xray knee lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD723 Xray knee tunnel / axial view (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD724 Xray knee tunnel / axial view (R) XRAY 420 440 530 610 Diagnostic Services Xray left hand for bone age (PA Radiology DRAD727 XRAY 420 440 530 610 view) Diagnostic Services Radiology DRAD738 Xray leg AP (L) XRAY 420 440 530 610 Diagnostic Services

360 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD739 Xray leg AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD741 Xray leg AP with ankle (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD742 Xray leg AP with ankle (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD744 Xray leg AP with knee (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD745 Xray leg AP with knee (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD747 Xray leg lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD748 Xray leg lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD750 Xray leg lateral with ankle (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD751 Xray leg lateral with ankle (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD753 Xray leg lateral with knee (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD754 Xray leg lateral with knee (R) XRAY 420 440 530 610 Diagnostic Services Xray lower leg for foreign body Radiology DRAD758 XRAY 420 440 530 610 localisation (L) Diagnostic Services Xray lower leg for foreign body Radiology DRAD759 XRAY 420 440 530 610 localisation (R) Diagnostic Services Xray lumbar spine AP erect (Lt Radiology DRAD762 XRAY 420 440 530 610 bending) Diagnostic Services Xray lumbar spine lateral erect Radiology DRAD765 XRAY 420 440 530 610 extension Diagnostic Services Xray lumbar spine lateral erect Radiology DRAD766 XRAY 420 440 530 610 flexion Diagnostic Services Radiology DRAD770 Xray lumbar spine oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD771 Xray lumbar spine oblique (R) XRAY 420 440 530 610 Diagnostic Services Xray lumbosacral spine AP erect Radiology DRAD774 XRAY 420 440 530 610 (Lt bending) Diagnostic Services Xray lumbosacral spine AP erect Radiology DRAD775 XRAY 420 440 530 610 (Rt bending) Diagnostic Services Xray lumbosacral spine lateral Radiology DRAD777 XRAY 420 440 530 610 erect extension Diagnostic Services Xray lumbosacral spine lateral Radiology DRAD778 XRAY 420 440 530 610 erect flexion Diagnostic Services Xray lumbosacral spine lateral Radiology DRAD780 XRAY 420 440 530 610 view Diagnostic Services

361 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD785 Xray lunate (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD786 Xray lunate (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD789 Xray mandible oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD790 Xray mandible oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD792 Xray mastoid lateral oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD793 Xray mastoid lateral oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD795 Xray mastoid stenver's view (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD796 Xray mastoid stenver's view (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD797 Xray mastoid towne's view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD799 Xray mastoid view schuller (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD800 Xray mastoid view schuller (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD801 Xray middle finger AP & lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD802 Xray middle finger AP & lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray modified stenver's view for Radiology DRAD803 XRAY 420 440 530 610 cochlear implant ) (L) Diagnostic Services Xray modified stenver's view for Radiology DRAD804 XRAY 420 440 530 610 cochlear implant ) (R) Diagnostic Services Radiology DRAD806 Xray nasal bone lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD807 Xray nasal bone lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray nasopharyn Lateral for Radiology DRAD808 XRAY 420 440 530 610 adenoids Diagnostic Services Radiology DRAD810 Xray optic foramen (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD811 Xray optic foramen (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD815 Xray orbit AP (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD816 Xray orbit AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD817 Xray orbit AP (R) XRAY 420 440 530 610 Diagnostic Services

362 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD818 Xray orbit caldwel (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD819 Xray orbit caldwel (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD820 Xray orbit caldwel (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD621 Xray orbit for floor (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD622 Xray orbit for floor (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD623 Xray orbit for floor (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD639 Xray orbit for foreign body (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD640 Xray orbit for foreign body (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD844 Xray orbit for roof (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD845 Xray orbit for roof (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD846 Xray orbit for roof(R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD705 Xray orbit inferior fissure (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD706 Xray orbit inferior fissure(R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD825 Xray orbit lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD826 Xray orbit lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD827 Xray orbit PA (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD828 Xray orbit PA (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD829 Xray orbit PA (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD925 Xray orbit superior fissure (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD926 Xray orbit superior fissure (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD835 Xray patella tangential (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD836 Xray patella tangential (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD1154 X-ray Pelvis PA XRAY 420 440 530 610 Diagnostic Services

363 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD838 Xray penis ( soft tissue ) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD840 Xray pisiform (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD841 Xray pisiform (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD978 Xray plain department XRAY 420 440 530 610 Diagnostic Services Xray sacro coccyx spine / Radiology DRAD848 XRAY 420 440 530 610 junction - AP Diagnostic Services Radiology DRAD854 Xray sacroiliac joint oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD855 Xray sacroiliac joint oblique (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD851 Xray sacroiliac joint PA (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD852 Xray sacroiliac joint PA ( R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD856 Xray sacrum AP XRAY 420 440 530 610 Diagnostic Services Radiology DRAD858 Xray sacrum lateral XRAY 420 440 530 610 Diagnostic Services Radiology DRAD863 Xray scapula AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD866 Xray scapula axial (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD867 Xray scapula axial (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD869 Xray scapula lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD870 Xray scapula lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD872 Xray scapula Y - view (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD873 Xray scapula Y - view (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD881 Xray shoulder axial (axillary) (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD882 Xray shoulder axial (axillary) (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD884 Xray shoulder lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD885 Xray shoulder lateral (R) XRAY 420 440 530 610 Diagnostic Services Xray shoulder lateral Radiology DRAD887 XRAY 420 440 530 610 transthoracic (L) Diagnostic Services

364 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray shoulder lateral Radiology DRAD888 XRAY 420 440 530 610 transthoracic (R) Diagnostic Services Radiology DRAD889 Xray skull AP XRAY 420 440 530 610 Diagnostic Services Xray skull base / basal view / Radiology DRAD892 XRAY 420 440 530 610 submento-vertebral view Diagnostic Services Xray skull cone down lateral for Radiology DRAD893 XRAY 420 440 530 610 sella ( pitutary fossa ) Diagnostic Services Radiology DRAD894 Xray skull for jugular foramen XRAY 420 440 530 610 Diagnostic Services Radiology DRAD896 Xray skull lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD897 Xray skull lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD898 Xray skull maxilla XRAY 420 440 530 610 Diagnostic Services Radiology DRAD899 Xray skull occipito-frontal view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD900 Xray skull per orbital view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD901 Xray skull tangential view XRAY 420 440 530 610 Diagnostic Services Xray skull Towne's / fronto- Radiology DRAD902 XRAY 420 440 530 610 occipital 15 deg Diagnostic Services Xray skull Towne's / fronto- Radiology DRAD903 XRAY 420 440 530 610 occipital 20 deg Diagnostic Services Xray skull Towne's / fronto- Radiology DRAD904 XRAY 420 440 530 610 occipital 30 deg Diagnostic Services Radiology DRAD908 Xray sphenoid sinus (lateral) XRAY 420 440 530 610 Diagnostic Services Xray sterno clacicular joint AP Radiology DRAD909 XRAY 420 440 530 610 (bilateral) Diagnostic Services Radiology DRAD911 Xray sterno clavicular joint AP (R) XRAY 420 440 530 610 Diagnostic Services Xray sterno clavicular joint Radiology DRAD913 XRAY 420 440 530 610 oblique (L) Diagnostic Services Xray sterno clavicular joint Radiology DRAD914 XRAY 420 440 530 610 oblique (R) Diagnostic Services Radiology DRAD915 Xray sternum AP XRAY 420 440 530 610 Diagnostic Services Radiology DRAD916 Xray sternum lateral XRAY 420 440 530 610 Diagnostic Services Radiology DRAD917 Xray sternum oblique (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD918 Xray sternum oblique (R) XRAY 420 440 530 610 Diagnostic Services

365 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray submandibular gland area Radiology DRAD919 XRAY 420 440 530 610 (L) Diagnostic Services Xray submandibular gland area Radiology DRAD920 XRAY 420 440 530 610 (R) Diagnostic Services Radiology DRAD922 Xray subtalar joint (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD923 Xray subtalar joint (R) XRAY 420 440 530 610 Diagnostic Services Xray temporo mandibular joints Radiology DRAD928 XRAY 420 440 530 610 (closed mouth) (L) Diagnostic Services Xray temporo mandibular joints Radiology DRAD929 XRAY 420 440 530 610 (closed mouth) (R) Diagnostic Services Xray temporo mandibular joints Radiology DRAD934 XRAY 420 440 530 610 (open mouth) (L) Diagnostic Services Xray temporo mandibular joints Radiology DRAD935 XRAY 420 440 530 610 (open mouth) (R) Diagnostic Services Radiology DRAD943 Xray thigh for soft tissue AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD944 Xray thigh for soft tissue AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD945 Xray thoracic inlet view XRAY 420 440 530 610 Diagnostic Services Radiology DRAD951 Xray trapezium (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD952 Xray trapezium (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD953 Xray wrist and hand for bone age XRAY 420 440 530 610 Diagnostic Services Radiology DRAD960 Xray wrist AP (bilateral) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD961 Xray wrist AP (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD962 Xray wrist AP (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD967 Xray wrist carpal tunnel (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD968 Xray wrist carpal tunnel (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD970 Xray wrist lateral (L) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD971 Xray wrist lateral (R) XRAY 420 440 530 610 Diagnostic Services Radiology DRAD972 Xray zygomatic arch base XRAY 420 440 530 610 Diagnostic Services Xray zygomatic arch oblique Radiology DRAD973 XRAY 420 440 530 610 tangential Diagnostic Services

366 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD974 Xray zygomatic arch Towne's XRAY 420 440 530 610 Diagnostic Services Radiology DRAD1110 AVP X-ray - (BCCI) XRAY 440 470 550 640 Diagnostic Services Radiology DRAD1111 AVP X-ray - Interpretation (BCCI) XRAY 440 470 550 640 Diagnostic Services Radiology DRAD478 Xray abdomen AP supine XRAY 500 520 620 720 Diagnostic Services Xray abdomen for foreign body Radiology DRAD479 XRAY 500 520 620 720 localisation Diagnostic Services Radiology DRAD480 Xray abdomen lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD481 Xray abdomen lateral (R) XRAY 500 520 620 720 Diagnostic Services Xray abdomen left lateral Radiology DRAD483 XRAY 500 520 620 720 decubitus Diagnostic Services Xray abdomen oblique for GB Radiology DRAD484 XRAY 500 520 620 720 area Diagnostic Services Xray abdomen right lateral Radiology DRAD482 XRAY 500 520 620 720 decubitus Diagnostic Services Xray abdomen urinary bladder Radiology DRAD485 XRAY 500 520 620 720 area supine ( KUBU) Diagnostic Services Radiology DRAD490 Xray ankle AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD491 Xray ankle AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD493 Xray ankle AP & stress view (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD494 Xray ankle AP & stress view (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD498 Xray ankle lateral (bilateral) XRAY 500 520 620 720 Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD507 XRAY 500 520 620 720 (L) Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD508 XRAY 500 520 620 720 (R) Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD509 XRAY 500 520 620 720 with elbow (L) Diagnostic Services Radiology DRAD527 Xray calcaneum axial (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD533 Xray cephalogram XRAY 500 520 620 720 Diagnostic Services Radiology DRAD565 Xray clavicle AP view (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD568 Xray coccyx lateral XRAY 500 520 620 720 Diagnostic Services

367 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD579 Xray elbow AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD580 Xray elbow AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD585 Xray ethmoid sinus (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD588 Xray feet (bilateral) AP XRAY 500 520 620 720 Diagnostic Services Radiology DRAD613 Xray femur AP (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD614 Xray femur AP (R) XRAY 500 520 620 720 Diagnostic Services Xray femur (including hip joint) Radiology DRAD599 XRAY 500 520 620 720 lateral (R) Diagnostic Services Radiology DRAD626 Xray foot AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD627 Xray foot AP & oblique (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD628 Xray foot AP & oblique (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD630 Xray foot AP (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD637 Xray foot oblique (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD641 Xray forearm AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD642 Xray forearm AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Xray forearm with elbow AP & Radiology DRAD648 XRAY 500 520 620 720 lateral (L) Diagnostic Services Xray forearm with wrist AP & Radiology DRAD650 XRAY 500 520 620 720 lateral (L) Diagnostic Services Xray forearm with wrist AP & Radiology DRAD651 XRAY 500 520 620 720 lateral (R) Diagnostic Services Radiology DRAD662 Xray hand AP (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD657 Xray hand AP & Lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD661 Xray hand AP & oblique (R) XRAY 500 520 620 720 Diagnostic Services Xray hand ulnar deviation (for Radiology DRAD677 XRAY 500 520 620 720 scaphoid) (L) Diagnostic Services Xray hand ulnar deviation (for Radiology DRAD678 XRAY 500 520 620 720 scaphoid) (R) Diagnostic Services Radiology DRAD681 Xray heel axial (bilateral) XRAY 500 520 620 720 Diagnostic Services

368 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD686 Xray heel lateral & axial (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD702 Xray index finger AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD711 Xray knee AP (erect) (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD717 Xray knee lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD720 Xray knee skyline (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD721 Xray knee skyline (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD725 Xray KUB XRAY 500 520 620 720 Diagnostic Services Xray left elbow for bone age (AP Radiology DRAD726 XRAY 500 520 620 720 & lateral view) Diagnostic Services Radiology DRAD737 Xray leg AP (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD729 Xray leg AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD730 Xray leg AP & lateral (R) XRAY 500 520 620 720 Diagnostic Services Xray leg AP & lateral with ankle Radiology DRAD732 XRAY 500 520 620 720 (L) Diagnostic Services Radiology DRAD740 Xray leg AP with ankle (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD743 Xray leg AP with knee (bilateral) XRAY 500 520 620 720 Diagnostic Services Xray leg lateral with ankle Radiology DRAD749 XRAY 500 520 620 720 (bilateral) Diagnostic Services Xray leg lateral with knee Radiology DRAD752 XRAY 500 520 620 720 (bilateral) Diagnostic Services Radiology DRAD755 Xray little finger AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Xray lumbar spine AP erect (Rt Radiology DRAD763 XRAY 500 520 620 720 bending) Diagnostic Services Radiology DRAD764 Xray lumbar spine AP view XRAY 500 520 620 720 Diagnostic Services Radiology DRAD768 Xray lumbar spine lateral view XRAY 500 520 620 720 Diagnostic Services Radiology DRAD776 Xray lumbosacral spine AP view XRAY 500 520 620 720 Diagnostic Services Xray lumbosacral spine oblique Radiology DRAD782 XRAY 500 520 620 720 (L) Diagnostic Services Xray lumbosacral spine oblique Radiology DRAD783 XRAY 500 520 620 720 (R) Diagnostic Services

369 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD784 Xray lunate (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD787 Xray mandible AP XRAY 500 520 620 720 Diagnostic Services Radiology DRAD805 Xray nasal bone lateral (bilateral) XRAY 500 520 620 720 Diagnostic Services Xray orbit superior fissure Radiology DRAD924 XRAY 500 520 620 720 (bilateral) Diagnostic Services Xray paranasal sinus Water's Radiology DRAD830 XRAY 500 520 620 720 view Diagnostic Services Radiology DRAD832 Xray patella PA & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD833 Xray patella PA & lateral (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD834 Xray patella tangential (bilateral) XRAY 500 520 620 720 Diagnostic Services Xray pelvis AP (including both Radiology DRAD837 XRAY 500 520 620 720 hips) Diagnostic Services Radiology DRAD839 Xray pisiform (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD842 Xray ring finger AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Xray sacro coccyx spine / junction Radiology DRAD849 XRAY 500 520 620 720 - lateral Diagnostic Services Radiology DRAD850 Xray sacroiliac joint PA (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD864 Xray scapula AP (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD878 Xray shoulder AP (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD879 Xray shoulder AP (R) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD891 Xray skull AP for styloid process XRAY 500 520 620 720 Diagnostic Services Radiology DRAD905 Xray soft tissue neck AP XRAY 500 520 620 720 Diagnostic Services Radiology DRAD907 Xray soft tissue neck lateral XRAY 500 520 620 720 Diagnostic Services Radiology DRAD910 Xray sterno clavicular joint AP (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD921 Xray subtalar joint (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD949 Xray Thumb AP (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD950 Xray trapezium (bilateral) XRAY 500 520 620 720 Diagnostic Services

370 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD955 Xray wrist AP & lateral (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD958 Xray wrist AP & oblique (L) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD966 Xray wrist carpal tunnel (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD969 Xray wrist lateral (bilateral) XRAY 500 520 620 720 Diagnostic Services Radiology DRAD530 Xray calcaneum lateral (bilateral) XRAY 530 560 660 770 Diagnostic Services Radiology DRAD476 Xray abdomen AP erect XRAY 600 630 750 870 Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD510 XRAY 600 630 750 870 with elbow (R) Diagnostic Services Radiology DRAD525 Xray calcaneum axial & lateral (L) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD526 Xray calcaneum axial & lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD625 Xray foot AP & lateral (L) XRAY 600 630 750 870 Diagnostic Services Xray forearm with elbow AP & Radiology DRAD649 XRAY 600 630 750 870 lateral (R) Diagnostic Services Radiology DRAD658 Xray hand AP & Lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD660 Xray hand AP & oblique (L) XRAY 600 630 750 870 Diagnostic Services Xray hand ulnar deviation (for Radiology DRAD676 XRAY 600 630 750 870 scaphoid) (bilateral) Diagnostic Services Radiology DRAD685 Xray heel lateral & axial (L) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD687 Xray heel lateral (bilateral) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD701 Xray index finger AP & lateral (L) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD710 Xray knee AP (bilateral) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD708 Xray knee AP & lateral (L) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD709 Xray knee AP & lateral (R) XRAY 600 630 750 870 Diagnostic Services Xray leg AP and lateral with knee Radiology DRAD736 XRAY 600 630 750 870 (R) Diagnostic Services Xray leg AP & lateral with ankle Radiology DRAD733 XRAY 600 630 750 870 (R) Diagnostic Services Radiology DRAD735 Xray leg AP & lateral with knee (L) XRAY 600 630 750 870 Diagnostic Services

371 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD746 Xray leg lateral (bilateral) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD756 Xray little finger AP & lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD976 Xray Orthopantomogram XRAY 600 630 750 870 Diagnostic Services Radiology DRAD843 Xray ring finger AP & lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD947 Xray thumb AP & lateral (L) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD948 Xray thumb AP & lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD956 Xray wrist AP & lateral (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD959 Xray wrist AP & oblique (R) XRAY 600 630 750 870 Diagnostic Services Radiology DRAD115 Plain Xray-Portable XRAY 640 670 800 930 Diagnostic Services Radiology DRAD591 Xray feet (bilateral) lateral XRAY 640 670 800 930 Diagnostic Services Radiology DRAD612 Xray femur AP (bilateral) XRAY 640 670 800 930 Diagnostic Services Xray hand AP, LAT,ulnar deviation Radiology DRAD679 XRAY 640 670 800 930 (for scaphoid) (L) Diagnostic Services Xray hand AP , Lateral & oblique Radiology DRAD666 XRAY 640 670 800 930 (L) Diagnostic Services Radiology DRAD592 Xray feet (bilateral) oblique XRAY 770 810 970 1120 Diagnostic Services Xray hand AP , Lateral & oblique Radiology DRAD667 XRAY 770 810 970 1120 (R) Diagnostic Services Xray hand AP.LAT.ulnar deviation Radiology DRAD680 XRAY 770 810 970 1120 (for scaphoid) (R) Diagnostic Services Xray orbit inferior fissure Radiology DRAD704 XRAY 770 810 970 1120 (bilateral) Diagnostic Services Radiology DRAD1150 X-ray Whole Lower limb AP XRAY 770 810 970 1120 Diagnostic Services Radiology DRAD1151 X-ray Whole Lower limb LAT XRAY 770 810 970 1120 Diagnostic Services Radiology DRAD1144 X-ray Whole spine AP XRAY 770 810 970 1120 Diagnostic Services Radiology DRAD1147 X-ray Whole spine AP LT Bending XRAY 770 810 970 1120 Diagnostic Services Radiology DRAD1146 X-ray Whole spine AP RT Bending XRAY 770 810 970 1120 Diagnostic Services Xray acromio clavicular joint Radiology DRAD486 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services

372 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray ankle AP & stress view Radiology DRAD492 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Radiology DRAD501 Xray ankle oblique (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD504 Xray ankle stress view (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD511 XRAY 850 890 1060 1230 with shoulder (L) Diagnostic Services Xray cervical spine AP & lateral Radiology DRAD536 XRAY 850 890 1060 1230 view Diagnostic Services Xray cervical spine in flexion & Radiology DRAD975 XRAY 850 890 1060 1230 extension Diagnostic Services Xray cervical spine oblique Radiology DRAD541 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray cervico-dorsal spine AP & Radiology DRAD545 XRAY 850 890 1060 1230 lateral view Diagnostic Services Xray cervico-dorsal spine AP & Radiology DRAD546 XRAY 850 890 1060 1230 swimmers view Diagnostic Services Radiology DRAD559 Xray chest PA & lateral (L) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD560 Xray chest PA & lateral (R) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD563 Xray clavicle AP view (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD590 Xray feet (bilateral) AP & oblique XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD610 Xray femur AP & lateral (L) XRAY 850 890 1060 1230 Diagnostic Services Xray femur (including hip joint) AP Radiology DRAD595 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray femur (including knee joint) Radiology DRAD603 XRAY 850 890 1060 1230 AP (bilateral) Diagnostic Services Xray femur (including knee joint) Radiology DRAD601 XRAY 850 890 1060 1230 AP & lateral (L) Diagnostic Services Xray femur (including knee joint) Radiology DRAD606 XRAY 850 890 1060 1230 lateral (bilateral) Diagnostic Services Radiology DRAD615 Xray femur lateral (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Xray first carpo metacarpal joint Radiology DRAD618 XRAY 850 890 1060 1230 (bilateral)AP & lateral Diagnostic Services Radiology DRAD624 Xray Foetogram XRAY 850 890 1060 1230 Diagnostic Services Xray foot AP , Lateral & oblique Radiology DRAD631 XRAY 850 890 1060 1230 (L) Diagnostic Services Xray foot AP , Lateral & oblique Radiology DRAD632 XRAY 850 890 1060 1230 (R) Diagnostic Services

373 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD684 Xray heel lateral & axial (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD691 Xray hip AP & lateral (L) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD692 Xray hip AP & lateral (R) XRAY 850 890 1060 1230 Diagnostic Services Xray hips including thighs Radiology DRAD699 (AP view for hip dislocation) - XRAY 850 890 1060 1230 Diagnostic Services bilateral Radiology DRAD703 Xray infantogram XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD716 Xray knee lateral (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Xray knee tunnel / axial view Radiology DRAD722 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray lumbar spine AP erect (Lt & Radiology DRAD761 XRAY 850 890 1060 1230 Rt bending) Diagnostic Services Xray lumbar spine oblique Radiology DRAD769 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray lumbosacral spine AP erect Radiology DRAD773 XRAY 850 890 1060 1230 (Lt & Rt bending) Diagnostic Services Xray mastoid lateral oblique Radiology DRAD791 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray mastoid view schuller Radiology DRAD798 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Radiology DRAD809 Xray optic foramen (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD814 Xray orbit AP & lateral (R) XRAY 850 890 1060 1230 Diagnostic Services Xray orbit for foreign body Radiology DRAD822 XRAY 850 890 1060 1230 localisation (L) Diagnostic Services Xray orbit for foreign body Radiology DRAD823 XRAY 850 890 1060 1230 localisation (R) Diagnostic Services Radiology DRAD824 Xray orbit lateral (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Xray sacro coccyx spine / junction Radiology DRAD847 XRAY 850 890 1060 1230 - AP & Lateral Diagnostic Services Radiology DRAD857 Xray sacrum AP & lateral XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD1155 X-ray Scaphoid view XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD862 Xray scapula AP (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD860 Xray scapula AP & lateral (L) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD865 Xray scapula axial (bilateral) XRAY 850 890 1060 1230 Diagnostic Services

374 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology DRAD868 Xray scapula lateral (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD871 Xray scapula Y - view (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD875 Xray shoulder AP & lateral (L) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD883 Xray shoulder lateral (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Xray shoulder lateral Radiology DRAD886 XRAY 850 890 1060 1230 transthoracic (bilateral) Diagnostic Services Radiology DRAD890 Xray skull AP & lateral XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD906 Xray soft tissue neck AP & lateral XRAY 850 890 1060 1230 Diagnostic Services Xray sterno clavicular joint Radiology DRAD912 XRAY 850 890 1060 1230 oblique (bilateral) Diagnostic Services Xray temporo mandibular joints Radiology DRAD927 XRAY 850 890 1060 1230 (closed mouth) (bilateral) Diagnostic Services Xray temporo mandibular joints Radiology DRAD933 XRAY 850 890 1060 1230 (open mouth) (bilateral) Diagnostic Services Xray thigh for foreign body Radiology DRAD937 XRAY 850 890 1060 1230 localisation (L) Diagnostic Services Xray thigh for foreign body Radiology DRAD938 XRAY 850 890 1060 1230 localisation (R) Diagnostic Services Xray thigh for soft tissue AP Radiology DRAD942 XRAY 850 890 1060 1230 (bilateral) Diagnostic Services Xray thigh for soft tissue AP & Radiology DRAD940 XRAY 850 890 1060 1230 lateral (L) Diagnostic Services Xray thigh for soft tissue AP & Radiology DRAD941 XRAY 850 890 1060 1230 lateral (R) Diagnostic Services Radiology DRAD964 Xray wrist AP, lateral & oblique (L) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD957 Xray wrist AP & oblique (bilateral) XRAY 850 890 1060 1230 Diagnostic Services Radiology DRAD719 Xray knee skyline (bilateral) XRAY 910 950 1130 1310 Diagnostic Services Radiology DRAD477 Xray abdomen AP erect & supine XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD489 Xray ankle AP & lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Xray arm / humerus AP & lateral Radiology DRAD512 XRAY 970 1020 1210 1410 with shoulder (R) Diagnostic Services Radiology DRAD567 Xray coccyx AP & lateral XRAY 970 1020 1210 1410 Diagnostic Services Xray dorsal spine AP & lateral Radiology DRAD572 XRAY 970 1020 1210 1410 view Diagnostic Services

375 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray dorso-lumbar spine AP & Radiology DRAD569 XRAY 970 1020 1210 1410 lateral view Diagnostic Services Radiology DRAD589 Xray feet (bilateral) AP & lateral XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD611 Xray femur AP & lateral (R) XRAY 970 1020 1210 1410 Diagnostic Services Xray femur (including hip joint) AP Radiology DRAD593 XRAY 970 1020 1210 1410 & lateral (L) Diagnostic Services Xray femur (including hip joint) AP Radiology DRAD594 XRAY 970 1020 1210 1410 & lateral (R) Diagnostic Services Xray femur (including knee joint) Radiology DRAD602 XRAY 970 1020 1210 1410 AP & lateral (R) Diagnostic Services Radiology DRAD656 Xray hand AP & Lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD659 Xray hand AP & oblique (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD695 Xray hip lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD707 Xray knee AP & lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD728 Xray leg AP & lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Xray lumbar spine AP & lateral Radiology DRAD760 XRAY 970 1020 1210 1410 view Diagnostic Services Xray lumbar spine lateral erect Radiology DRAD767 XRAY 970 1020 1210 1410 flexion & extension Diagnostic Services Xray lumbosacral spine AP & Radiology DRAD772 XRAY 970 1020 1210 1410 lateral view Diagnostic Services Xray lumbosacral spine lateral Radiology DRAD779 XRAY 970 1020 1210 1410 erect flexion & extension Diagnostic Services Xray lumbosacral spine oblique Radiology DRAD781 XRAY 970 1020 1210 1410 (bilateral) Diagnostic Services Radiology DRAD788 Xray mandible oblique (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Xray mastoid stenver's view Radiology DRAD794 XRAY 970 1020 1210 1410 (bilateral) Diagnostic Services Radiology DRAD813 Xray orbit AP & lateral (L) XRAY 970 1020 1210 1410 Diagnostic Services Xray sacroiliac joint oblique Radiology DRAD853 XRAY 970 1020 1210 1410 (bilateral) Diagnostic Services Radiology DRAD861 Xray scapula AP & lateral (R) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD877 Xray shoulder AP (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD876 Xray shoulder AP & lateral (R) XRAY 970 1020 1210 1410 Diagnostic Services

376 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray shoulder axial (axillary) Radiology DRAD880 XRAY 970 1020 1210 1410 (bilateral) Diagnostic Services Radiology DRAD895 Xray skull lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Xray temporo mandibular joints Radiology DRAD931 XRAY 970 1020 1210 1410 (open & closed mouth) (L) Diagnostic Services Xray temporo mandibular joints Radiology DRAD932 XRAY 970 1020 1210 1410 (open & closed mouth) (R) Diagnostic Services Xray Thoraco Lumber Spine AP Radiology DRAD946 XRAY 970 1020 1210 1410 Latral Diagnostic Services Radiology DRAD965 Xray wrist AP, lateral & oblique (R) XRAY 970 1020 1210 1410 Diagnostic Services Radiology DRAD954 Xray wrist AP & lateral (bilateral) XRAY 970 1020 1210 1410 Diagnostic Services Xray calcaneum axial & lateral Radiology DRAD524 XRAY 1170 1230 1460 1700 (bilateral) Diagnostic Services Xray cervical spine in flexion, Radiology DRAD538 XRAY 1170 1230 1460 1700 extension & neutral Diagnostic Services Xray hand AP , Lateral & oblique Radiology DRAD665 XRAY 1170 1230 1460 1700 (bilateral) Diagnostic Services Xray leg AP & lateral with knee Radiology DRAD734 XRAY 1170 1230 1460 1700 (bilateral) Diagnostic Services Xray lower leg for foreign body Radiology DRAD757 XRAY 1170 1230 1460 1700 localisation (bilateral) Diagnostic Services Xray both lower limbs complete Radiology DRAD523 XRAY 1420 1490 1780 2060 (bilateral) - children Diagnostic Services Xray leg AP & lateral with ankle Radiology DRAD731 XRAY 1420 1490 1780 2060 (bilateral) Diagnostic Services Xray temporo mandibular joints Radiology DRAD930 XRAY 1540 1620 1930 2240 (open & closed mouth) (bilateral) Diagnostic Services Radiology DRAD1152 X-ray Whole Lower limb AP & LAT XRAY 1540 1620 1930 2240 Diagnostic Services Radiology DRAD1145 X-ray Whole spine AP & LAT XRAY 1540 1620 1930 2240 Diagnostic Services X-ray Whole spine AP RT & LT Radiology DRAD1148 XRAY 1540 1620 1930 2240 Bending Diagnostic Services X-ray Whole spine LAT Flexion & Radiology DRAD1149 XRAY 1540 1620 1930 2240 Extension Diagnostic Services Radiology DRAD609 Xray femur AP & lateral (bilateral) XRAY 1680 1760 2090 2430 Diagnostic Services Radiology DRAD690 Xray hip AP & lateral (bilateral) XRAY 1680 1760 2090 2430 Diagnostic Services Xray shoulder AP & lateral Radiology DRAD874 XRAY 1810 1900 2260 2620 (bilateral) Diagnostic Services Radiology DRAD698 X-ray Skeletal survey XRAY 4890 5130 6110 7090 Diagnostic Services

377 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Xray abdomen lateral decubitus Radiology Diagnostic DRAD981 XRAY PORTABLE 720 760 900 1040 ( L) (Port) Services Xray abdomen lateral decubitus Radiology Diagnostic DRAD982 XRAY PORTABLE 720 760 900 1040 ( R) (Port) Services Radiology Diagnostic DRAD980 Xray abdomen sitting AP (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD979 Xray abdomen supine AP (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD983 Xray ankle AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD984 Xray ankle AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD985 Xray ankle AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD986 Xray ankle AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD987 Xray ankle AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD988 Xray ankle lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD989 Xray ankle lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD991 Xray arm / humerus AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD992 Xray arm / humerus AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Xray arm / humerus lateral (L) Radiology Diagnostic DRAD993 XRAY PORTABLE 720 760 900 1040 (Port) Services Xray arm / humerus lateral (R) Radiology Diagnostic DRAD994 XRAY PORTABLE 720 760 900 1040 (Port) Services Radiology Diagnostic DRAD995 Xray cervical spine (lateral) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD996 Xray chest AP (Port) XRAY PORTABLE 720 760 900 1040 Services Xray chest lateral decubitus (L) Radiology Diagnostic DRAD997 XRAY PORTABLE 720 760 900 1040 (Port) Services Xray chest lateral decubitus (R) Radiology Diagnostic DRAD998 XRAY PORTABLE 720 760 900 1040 (Port) Services Radiology Diagnostic DRAD999 Xray elbow AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1000 Xray elbow AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1001 Xray elbow AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1002 Xray elbow AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1003 Xray elbow lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services

378 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology Diagnostic DRAD1004 Xray elbow lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1005 Xray feet (bilateral) AP (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1007 Xray femur AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1008 Xray femur AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1009 Xray foot AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1011 Xray foot AP / oblique ( L ) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1012 Xray foot AP / oblique (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1010 Xray foot AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1013 Xray foot oblique (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1014 Xray foot oblique (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1015 Xray forearm AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Xray forearm AP & lateral (R) Radiology Diagnostic DRAD1016 XRAY PORTABLE 720 760 900 1040 (Port) Services Radiology Diagnostic DRAD1017 Xray forearm AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1018 Xray forearm AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1019 Xray forearm lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1020 Xray forearm lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1023 Xray hand AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1021 Xray hand AP & oblique (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1022 Xray hand AP & oblique (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1024 Xray hand AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1025 Xray hand lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1026 Xray hand lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1027 Xray hand oblique (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1028 Xray hand oblique (R) (Port) XRAY PORTABLE 720 760 900 1040 Services

379 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology Diagnostic DRAD1030 Xray hip AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1031 Xray hip AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1034 Xray knee AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1032 Xray knee AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1033 Xray knee AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1035 Xray knee AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1036 Xray knee AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1037 Xray knee lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1038 Xray knee lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1041 Xray leg AP (bilateral) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1039 Xray leg AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1040 Xray leg AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1042 Xray leg AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1043 Xray leg AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1044 Xray leg lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1045 Xray leg lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1029 Xray pelvis with both hip (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1046 Xray skull lateral (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1047 Xray wrist AP & lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1048 Xray wrist AP & lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1049 Xray wrist AP (L) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1050 Xray wrist AP (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD1051 Xray wrist lateral (L) (Port) XRAY PORTABLE 720 760 900 1040 Services

380 Radiology

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Radiology Diagnostic DRAD1052 Xray wrist lateral (R) (Port) XRAY PORTABLE 720 760 900 1040 Services Radiology Diagnostic DRAD468 Xray screening fluoroscopy XRAY SPECIAL 420 440 530 610 Services Radiology Diagnostic DRAD207 MICTURATING CYSTOURETHGRAM XRAY SPECIAL 1540 1620 1930 2240 Services Radiology Diagnostic DRAD472 Xray Fluroscopic Procedure - 1 XRAY SPECIAL 1540 1620 1930 2240 Services Radiology Diagnostic DRAD470 X-ray Distal Loopogram XRAY SPECIAL 1930 2030 2410 2800 Services Radiology Diagnostic DRAD460 Xray Barium swallow XRAY SPECIAL 2190 2300 2740 3180 Services Radiology Diagnostic DRAD471 X-ray Dacrocystogram XRAY SPECIAL 2460 2580 3070 3560 Services Radiology Diagnostic DRAD473 Xray Fluroscopic Procedure - II XRAY SPECIAL 2460 2580 3070 3560 Services Radiology Diagnostic DRAD456 Xray Barium enema infant XRAY SPECIAL 2700 2830 3370 3910 Services Xray Ascending uretherogram ( Radiology Diagnostic DRAD474 XRAY SPECIAL 2830 2970 3540 4100 ASU ) Services Radiology Diagnostic DRAD463 Xray ERCP XRAY SPECIAL 2830 2970 3540 4100 Services Radiology Diagnostic DRAD464 Xray Fistulogram/ Sinogram XRAY SPECIAL 2830 2970 3540 4100 Services Radiology Diagnostic DRAD475 Xray Sailogram XRAY SPECIAL 2830 2970 3540 4100 Services Radiology Diagnostic DRAD461 Xray T - tube cholangiogram XRAY SPECIAL 2830 2970 3540 4100 Services Radiology Diagnostic DRAD459 Xray Barium meal upper GI XRAY SPECIAL 3350 3520 4180 4850 Services Radiology Diagnostic DRAD469 Xray hysterosalpingogram ( HSG ) XRAY SPECIAL 3470 3640 4340 5030 Services Xray Micturating Radiology Diagnostic DRAD462 XRAY SPECIAL 3470 3640 4340 5030 cystouretherogram ( MCU ) Services Xray Barium enema infant- Radiology Diagnostic DRAD457 XRAY SPECIAL 3850 4050 4820 5590 Reduction Services Radiology Diagnostic DRAD125 Tilt Table Test XRAY SPECIAL 4120 4320 5150 5970 Services Radiology Diagnostic DRAD455 Xray Barium enema XRAY SPECIAL 4120 4320 5150 5970 Services Radiology Diagnostic DRAD466 Xray IVU Routine XRAY SPECIAL 4490 4720 5610 6510 Services Radiology Diagnostic DRAD458 Xray Barium meal follow through XRAY SPECIAL 4890 5130 6110 7090 Services Xray small bowel barium enema ( Radiology Diagnostic DRAD467 XRAY SPECIAL 7450 7820 9310 10800 enteroclysis ) Services

381 Nuclear Medicine

382 Nuclear Medicine

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NUCLEAR MEDICINE KNUM005 YTTRIUM THERASPHERES THERAPY-1 Package 0 92620 110260 127900 PACKAGE NUCLEAR MEDICINE KNUM017 RADIOEMBOLISATION Package 0 301880 359380 416880 PACKAGE NUCLEAR MEDICINE KNUM013 Rhenium PACKAGE Package 0 326030 388130 450230 PACKAGE NUCLEAR MEDICINE KNUM014 Lu DOTA PRRT PACKAGE Package 0 391230 465750 540270 PACKAGE NUCLEAR MEDICINE KNUM016 TARE with RHENIUM LIPIODOC Package 0 423840 504570 585300 PACKAGE NUCLEAR MEDICINE KNUM006 YTTRIUM THERASPHERES THERAPY-2 Package 0 1036160 1233520 1430890 PACKAGE PNUC134 SECOND OPINION - (NUCLEAR MEDICINE) - I Procedure NUCLEAR MEDICINE 820 860 1030 1190 PNUC135 SECOND OPINION - (NUCLEAR MEDICINE) - II Procedure NUCLEAR MEDICINE 1510 1590 1890 2190 PNUC136 DAT - SCAN Procedure NUCLEAR MEDICINE 11480 12060 14350 16650 Pfizer Study - Vascular Surgery-Lung PNUC133 Procedure NUCLEAR MEDICINE 12080 12680 15100 17510 Perfusion Scan PNUC137 PET CT - 1 Procedure NUCLEAR MEDICINE 24590 25820 30740 35660 PNUC138 PET CT - 2 Procedure NUCLEAR MEDICINE 28700 30130 35870 41610 PNUC129 SAMARIUM - 153 EDTMP Procedure NUCLEAR MEDICINE 34160 35870 42700 49530 PNUC132 HYNIC - TOC - 3 PATIENT Procedure NUCLEAR MEDICINE 45080 47340 56350 65370 PNUC131 HYNIC - TOC - 2 PATIENT Procedure NUCLEAR MEDICINE 56020 58820 70030 81230 PNUC130 HYNIC - TOC - 1 PATIENT Procedure NUCLEAR MEDICINE 88810 93250 111010 128770 NUCLEAR MEDICINE - DS0009 B Cardiac Thallium Scan Procedure 580 610 720 840 GAMMA NUCLEAR MEDICINE - DS0009 A Renal Radioisotope scan Procedure 580 610 720 840 GAMMA NUCLEAR MEDICINE - DS0009 C Thyroid Radio Iodine Scan Procedure 580 610 720 840 GAMMA NUCLEAR MEDICINE - DS0007 Nuclear bone scan Procedure 1150 1210 1440 1670 GAMMA NUCLEAR MEDICINE - PNUC007 GAMMA CAMERA WITH LOW DOSE CT Procedure 3420 3590 4270 4960 GAMMA NUCLEAR MEDICINE - PNUC013 LIVER SCAN Procedure 3420 3590 4270 4960 GAMMA NUCLEAR MEDICINE - PNUC050 TESTICULAR SCAN Procedure 3420 3590 4270 4960 GAMMA NUCLEAR MEDICINE - PNUC056 THYROID SCAN Procedure 3970 4170 4960 5760 GAMMA NUCLEAR MEDICINE - PNUC023 MUGA SCAN (REST) Procedure 4510 4740 5640 6540 GAMMA NUCLEAR MEDICINE - PNUC005 ESOPHAGIAL TRANSIT TIME Procedure 5060 5320 6330 7340 GAMMA

383 Nuclear Medicine

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NUCLEAR MEDICINE - PNUC008 GASTRIC EMPTYING TIME Procedure 5060 5320 6330 7340 GAMMA NUCLEAR MEDICINE - PNUC040 RENAL SCAN - DMSA Procedure 5060 5320 6330 7340 GAMMA NUCLEAR MEDICINE - PNUC041 RENAL SCAN - DTPA Procedure 5060 5320 6330 7340 GAMMA NUCLEAR MEDICINE - PNUC045 SALIVARY SCAN Procedure 5060 5320 6330 7340 GAMMA NUCLEAR MEDICINE - PNUC047 SENTINEL LYMPH NODE BIOPSY Procedure 5610 5890 7010 8130 GAMMA NUCLEAR MEDICINE - PNUC010 HEPATOBILIARY SCAN Procedure 6020 6320 7520 8730 GAMMA NUCLEAR MEDICINE - PNUC044 RENAL SCAN-EC Procedure 6020 6320 7520 8730 GAMMA NUCLEAR MEDICINE - PNUC002 BONE SCAN Procedure 6560 6890 8200 9510 GAMMA NUCLEAR MEDICINE - PNUC001 BONE MARROW SCAN Procedure 6700 7030 8370 9710 GAMMA NUCLEAR MEDICINE - PNUC015 LUNG V/Q Procedure 6700 7030 8370 9710 GAMMA NUCLEAR MEDICINE - PNUC018 MECKELS SCAN Procedure 7110 7470 8890 10310 GAMMA NUCLEAR MEDICINE - PNUC059 WHOLE BODY IODINE SCAN Procedure 7110 7470 8890 10310 GAMMA NUCLEAR MEDICINE - PNUC009 GI BLEED STUDY Procedure 7390 7760 9230 10710 GAMMA NUCLEAR MEDICINE - PNUC017 LYMPHOSCINTIGRAPHY Procedure 7390 7760 9230 10710 GAMMA NUCLEAR MEDICINE - PNUC024 MUGA SCAN (STRESS) Procedure 7390 7760 9230 10710 GAMMA NUCLEAR MEDICINE - PNUC057 VUR STUDY Procedure 7390 7760 9230 10710 GAMMA NUCLEAR MEDICINE - PNUC014 LUNG PERFUSION SCAN Procedure 7650 8030 9560 11090 GAMMA NUCLEAR MEDICINE - PNUC016 LUNG VENTILATION SCAN Procedure 7650 8030 9560 11090 GAMMA NMCFP001 CARDIAC FITNESS PERFUSION NUCLEAR MEDICINE - PNUC027 Procedure 7650 8030 9560 11090 SCAN GAMMA NUCLEAR MEDICINE - PNUC022 MILK SCAN (GE REFLUX SCAN) Procedure 7930 8320 9910 11490 GAMMA NUCLEAR MEDICINE - PNUC004 DENATURED RBC SCAN Procedure 9020 9470 11270 13080 GAMMA NUCLEAR MEDICINE - PNUC003 BRAIN SPECT Procedure 10930 11480 13660 15850 GAMMA NUCLEAR MEDICINE - PNUC046 SCINTIMAMMOGRAPHY Procedure 10930 11480 13660 15850 GAMMA

384 Nuclear Medicine

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NUCLEAR MEDICINE - PNUC029 PARATHYROID SCAN Procedure 12020 12620 15030 17430 GAMMA NUCLEAR MEDICINE - PNUC025 MYOCARDIAL PERFUSION SCAN Procedure 14350 15060 17930 20800 GAMMA MYOCARDIAL PERFUSION SCAN - NUCLEAR MEDICINE - PNUC026 Procedure 15710 16500 19640 22780 DOBUTAMINE GAMMA NUCLEAR MEDICINE - PNUC058 WB TETROFOSMIN/SESTAL MIBI SCAN Procedure 17760 18650 22200 25750 GAMMA NUCLEAR MEDICINE - PNUC006 GALLIUM SCAN Procedure 19820 20810 24770 28740 GAMMA NUCLEAR MEDICINE - PNUC020 MIBG SCAN Procedure 20500 21520 25620 29720 GAMMA NUCLEAR MEDICINE - PNUC140 Ga DOTANOC Procedure 26680 28020 33350 38690 GAMMA NUCLEAR MEDICINE - PNUC141 Ga PSMA Procedure 26680 28020 33350 38690 GAMMA NUCLEAR MEDICINE - PNUC048 STRONTIUM 89 - METASTATIC BONE PAIN Procedure 109300 114770 136620 158480 GAMMA NUCLEAR MEDICINE - PNUC028 OCTREOTIDE SCAN Procedure 143460 150630 179320 208010 GAMMA NUCLEAR MEDICINE - PNUC021 MIBG THERAPY . I. 131 Procedure 165320 173580 206650 239710 GAMMA NUCLEAR MEDICINE PNUC101 KIT-BONE MARROW SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC102 KIT-BONE SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC104 KIT-ESOPHAGEAL TRANSIT TIME Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC106 KIT-GASTRIC EMPTYING TIME Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC108 KIT-HEPATOBILIARY SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC109 KIT-LIVER SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC110 KIT-LUNG PERFUSION SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC113 KIT-MECKELS Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC114 KIT-MIBG Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC119 KIT-OCTREOTIDE SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC123 KIT-RENAL SCAN(ADULT) Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC122 KIT-RENAL SCAN EC Procedure 130 140 160 190 - KITS

385 Nuclear Medicine

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NUCLEAR MEDICINE PNUC125 KIT-STRONTIUM THERAPY Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC126 KIT-THYROID SCAN Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC127 KIT-VUR SCAN(ADULT) Procedure 130 140 160 190 - KITS NUCLEAR MEDICINE PNUC105 KIT-GALLIUM Procedure 220 230 280 320 - KITS NUCLEAR MEDICINE PNUC111 KIT-LUNG VENTILATION SCAN Procedure 220 230 280 320 - KITS NUCLEAR MEDICINE PNUC112 KIT-LYMPHOSCINTIGRAPHY Procedure 220 230 280 320 - KITS NUCLEAR MEDICINE PNUC103 KIT-BRAIN SPECT Procedure 260 270 320 370 - KITS NUCLEAR MEDICINE PNUC107 KIT-GI BLEED Procedure 260 270 320 370 - KITS NUCLEAR MEDICINE PNUC120 KIT-PARATHYROID SCAN Procedure 260 270 320 370 - KITS NUCLEAR MEDICINE PNUC124 KIT-SCINTIMAMMOGRAPHY Procedure 260 270 320 370 - KITS NUCLEAR MEDICINE PNUC128 KIT-VUR SCAN(PEDIATRIC) Procedure 260 270 320 370 - KITS NUCLEAR MEDICINE PNUC116 KIT-MUGA Procedure 320 330 390 460 - KITS KIT-MYOCARDIAL PERFUSION NUCLEAR MEDICINE PNUC118 Procedure 320 330 390 460 SCAN(REGULAR) - KITS NUCLEAR MEDICINE PNUC115 KIT-MILK SCAN Procedure 360 380 450 520 - KITS NUCLEAR MEDICINE PNUC121 KIT-RENAL SCAN (PEDIATRIC) Procedure 360 380 450 520 - KITS KIT-MYOCARDIAL PERFUSION SCAN (DOB/ NUCLEAR MEDICINE PNUC117 Procedure 450 480 570 660 ADENOSINE) - KITS NUCLEAR MEDICINE PNUC030 PET CT-BONE SCAN Procedure 11210 11770 14010 16250 - PET CT NUCLEAR MEDICINE PNUC031 PET CT-CARDIAC VIABILITY Procedure 18450 19370 23060 26750 - PET CT NUCLEAR MEDICINE PNUC032 PET CT-FDG BRAIN Procedure 19130 20090 23910 27740 - PET CT NUCLEAR MEDICINE PNUC139 PET CT LIMITED STUDY Procedure 24590 25820 30740 35660 - PET CT NUCLEAR MEDICINE PNUC033 PET CT-WHOLE BODY Procedure 34160 35870 42700 49530 - PET CT RADIOIODINE THERAPY WHOLE - BODY NUCLEAR MEDICINE - PNUC037 Procedure 2740 2880 3430 3970 SURGERY THERAPY NUCLEAR MEDICINE - PNUC012 IODINE THERAPY FOR TOXICOSIS (5 MCI) Procedure 6700 7030 8370 9710 THERAPY

386 Nuclear Medicine

Billing Code Description Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL Group NUCLEAR MEDICINE - PNUC011 IODINE THERAPY FOR TOXICOSIS (10 MCI) Procedure 8740 9180 10930 12680 THERAPY NUCLEAR MEDICINE - PNUC053 THYROID CANCER TREATMENT (< 50mCi) Procedure 26650 27980 33310 38640 THERAPY NUCLEAR MEDICINE - PNUC038 RADIONUCLIDE THERAPY - PKG Procedure 34160 35870 42700 49530 THERAPY NUCLEAR MEDICINE - PNUC055 THYROID CANCER TREATMENT (50-100mCi) Procedure 50560 53090 63200 73310 THERAPY NUCLEAR MEDICINE - PNUC054 THYROID CANCER TREATMENT (>100mCi) Procedure 60120 63120 75140 87170 THERAPY NUCLEAR MEDICINE - PNUC049 STRONTIUM THERAPY FOR BONE METS Procedure 165320 173580 206650 239710 THERAPY NUCLEAR MEDICINE LNUC001 CO-OPTED SURGEON'S FEE (LNUC) Surgery 0 6430 7660 8880 SURGERY

387 Physiotherapy

388 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY016 CRUTCHES (LEND CHARGES PER DAY) Physiotheraphy 70 70 90 100 GYM PHYSICAL MEDICINE PPHY090 WALKERS (LENDING CHARGES) Physiotheraphy 70 70 90 100 GYM PHYSICAL MEDICINE PPHY091 WAX AND SIMPLE EXCERCISE Physiotheraphy 80 90 100 120 GYM PHYSICAL MEDICINE PPHY006 ASSESSMENT CHARGES Physiotheraphy 100 110 130 150 GYM PHYSICAL MEDICINE PPHY018 EVALUATION - PPHY Physiotheraphy 100 110 130 150 GYM PHYSICAL MEDICINE PPHY054 INFRA RED RAYS Physiotheraphy 100 110 130 150 GYM PHYSICAL MEDICINE PPHY021 EXERCISE HIP MOBILISATION Physiotheraphy 130 130 160 180 GYM PHYSICAL MEDICINE PPHY108 KINESIOTAPING Physiotheraphy 160 170 200 230 GYM PHYSICAL MEDICINE PPHY080 SPLINTING(MAKING) Physiotheraphy 160 170 200 230 GYM MC-GS-PHYSIOTHERAPY ADDITIONAL PHYSICAL MEDICINE PPMR040 Physiotheraphy 170 180 210 240 MODALITY GYM PHYSICAL MEDICINE PPHY013 COLD PACK Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY041 GAIT TRAINING Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY053 INFANT STIMULATION Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY058 MOIST HEAT Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY081 SUSPENSION THERAPY Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY084 TENS Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY087 ULTRASOUND THERAPY Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY093 WHEEL CHAIR MOBILISATION Physiotheraphy 200 210 250 290 GYM PHYSICAL MEDICINE PPHY079 SPEECH+SWALLOWING COMBINED Physiotheraphy 220 240 280 320 GYM PHYSICAL MEDICINE PPHY082 SWALLOWING ASSESMENT Physiotheraphy 220 240 280 320 GYM PHYSICAL MEDICINE PPHY088 VOICE ASSESMENT Physiotheraphy 220 240 280 320 GYM PHYSICAL MEDICINE PPHY026 EXERCISES - GENERAL BODY 1 Physiotheraphy 280 290 350 400 GYM FALLS PREVENTION/JOINT PROTECTION PHYSICAL MEDICINE PPHY032 Physiotheraphy 280 290 350 400 TECHNIQUES/ENERGY CNSN GYM

389 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY042 GB I STRETCHING/STRENGTHENING Physiotheraphy 280 290 350 400 GYM PHYSICAL MEDICINE PPHY055 INTERFERENTIAL THERAPY Physiotheraphy 280 290 350 400 GYM PHYSICAL MEDICINE PPHY056 LASER THERAPY / INTER X Physiotheraphy 280 290 350 400 GYM MICROWAVE/SHORTWAVE DIATHERMY PHYSICAL MEDICINE PPHY057 Physiotheraphy 280 290 350 400 PER SESSION GYM PHYSICAL MEDICINE PPHY083 SWALLOWING THERAPY Physiotheraphy 280 290 350 400 GYM PHYSICAL MEDICINE PPHY089 VOICE THERAPY Physiotheraphy 280 290 350 400 GYM PHYSICAL MEDICINE PPHY092 WAX BATH Physiotheraphy 280 290 350 400 GYM PHYSICAL MEDICINE PPHY009 CERVICAL/LUMBAR TRACTION Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY010 CHEST MANIPULATION Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY014 COMA STIMULATION Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY099 ELECTRICAL STIMULATION- GROUP Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY030 EXERCISES & AMBULATION 1 Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY043 GB II STRETCHING+STRENGTHENING Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY045 HAND REHABILITATION CLINIC Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY060 NEURODEVELOPMENTAL TRAINING Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY059 NEURODEVELOPMENT & ROODS Physiotheraphy 300 320 380 440 GYM NEUROLOGICAL BIO-FEED PHYSICAL MEDICINE PPHY061 Physiotheraphy 300 320 380 440 BACK(AUDITORY) GYM NEUROLOGICAL BIO-FEED PHYSICAL MEDICINE PPHY062 Physiotheraphy 300 320 380 440 BACK(SENSORY) GYM NEUROLOGICAL BIO-FEED PHYSICAL MEDICINE PPHY063 Physiotheraphy 300 320 380 440 BACK(VISUAL) GYM PHYSICAL MEDICINE PPHY075 Sensory Integration Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY086 TILT TABLE Physiotheraphy 300 320 380 440 GYM PHYSICAL MEDICINE PPHY111 MAT EXERCISES Physiotheraphy 310 330 390 450 GYM PHYSICAL MEDICINE PPHY113 MOTOMED- EXERCISES Physiotheraphy 310 330 390 450 GYM

390 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY123 Yoga therapy One session Physiotheraphy 330 350 420 480 GYM PHYSICAL MEDICINE PPMR038 TRIGGER POINT/ MYOFASCIAL RELEASE Physiotheraphy 350 360 430 500 GYM PHYSICAL MEDICINE PPHY130 NICU Physiotherapy Physiotheraphy 360 370 440 520 GYM PHYSICAL MEDICINE PPHY008 BREATHINGEXCERCISES Physiotheraphy 370 390 460 530 GYM BREATHING EXERCISES AND POSTURAL PHYSICAL MEDICINE PPHY007 Physiotheraphy 370 390 460 530 DRAINAGE GYM PHYSICAL MEDICINE PPHY012 COGNITIVE/PERCEPTUAL RE-TRAINING Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY020 EXERCISE ELBOW MOBILISATION Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY096 EXERCISE-FACE Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY025 EXERCISES - BACK Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY095 EXERCISE SHOLDER MOBILISATION - I Physiotheraphy 370 390 460 530 GYM EXERCISE SHOLDER MOBILISATION - PHYSICAL MEDICINE PPHY094 Physiotheraphy 370 390 460 530 I(with modalities) GYM PHYSICAL MEDICINE PPHY028 EXERCISES - KNEE Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY029 EXERCISES - NECK Physiotheraphy 370 390 460 530 GYM EXERCISE WRIST AND FINGER PHYSICAL MEDICINE PPHY024 Physiotheraphy 370 390 460 530 MOBILISATION GYM PHYSICAL MEDICINE PPHY106 GAIT TRAINING II Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY064 PAEDIATRIC REHAB EXS Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPHY067 POST-NATAL EXS Physiotheraphy 370 390 460 530 GYM PHYSICAL MEDICINE PPMR039 MC-GS-PHYSIOTHERAPY 1 SESSION Physiotheraphy 390 410 490 560 GYM PHYSICAL MEDICINE PPHY019 EXERCISE ANKLE MOBILISATION Physiotheraphy 400 420 500 580 GYM PHYSICAL MEDICINE PPMR037 GAIT TRAINING - REHAB Physiotheraphy 400 420 500 580 GYM PHYSICAL MEDICINE PPMR030 INFANT STIMULATION PROGRAM - I Physiotheraphy 400 420 500 580 GYM PHYSICAL MEDICINE PPHY001 ADL TRAINING Physiotheraphy 440 470 550 640 GYM PHYSICAL MEDICINE PPMR041 Balance & Coordination Activity Physiotheraphy 440 470 550 640 GYM

391 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

Dry Needling technique for Trigger PHYSICAL MEDICINE PPHY116 Physiotheraphy 440 470 550 640 Points GYM PHYSICAL MEDICINE PPHY027 EXERCISES - GENERAL BODY 2 Physiotheraphy 440 470 550 640 GYM PHYSICAL MEDICINE PPHY040 FUNCTIONAL ABILITY TRAINING Physiotheraphy 440 470 550 640 GYM PHYSICAL MEDICINE PPHY046 HAND REHABILITATION(MOTOR) Physiotheraphy 440 470 550 640 GYM HAND REHABILITATION (SENSORY RE- PHYSICAL MEDICINE PPHY044 Physiotheraphy 440 470 550 640 EDUCATION) GYM LYMPHOEDEMA REDUCTION PHYSICAL MEDICINE PPMR033 Physiotheraphy 440 470 550 640 (UNILATERAL) GYM PHYSICAL MEDICINE PPHY110 OBG PHYSIOTHERAPY CONSULTATION Physiotheraphy 440 470 550 640 GYM PHYSICAL MEDICINE PPHY076 Shoulder Package Physiotheraphy 440 470 550 640 GYM PHYSICAL MEDICINE PPHY017 ELECTRICAL STIMULATION Physiotheraphy 470 490 580 670 GYM PERSONALISED EXERCISE PROGRAM PHYSICAL MEDICINE PPMR035 Physiotheraphy 470 490 580 670 BASIC GYM PHYSICAL MEDICINE PPHY085 TETRA/PARAPLEGIA PACKAGE Physiotheraphy 470 490 580 670 GYM PHYSICAL MEDICINE PPHY119 Fine Motor Activity Physiotheraphy 500 520 620 720 GYM PHYSICAL MEDICINE PPHY115 ICU physiotherapy Physiotheraphy 500 520 620 720 GYM PHYSICAL MEDICINE PPHY121 Clinical Pilates (One Session) Physiotheraphy 540 570 680 790 GYM PHYSICAL MEDICINE PPHY068 ERGONOMIC CONSULTATION Physiotheraphy 540 570 680 790 GYM PHYSICAL MEDICINE PPHY022 EXERCISE KNEE MOBILISATION Physiotheraphy 540 570 680 790 GYM PHYSICAL MEDICINE PPHY035 FITNESS PROGRAM - OP/ HALF HOUR Physiotheraphy 540 570 680 790 GYM PHYSICAL MEDICINE PPHY118 Sensory Integration Intervention Physiotheraphy 550 580 690 800 GYM PHYSICAL MEDICINE PPHY124 Yoga therapy Two session Physiotheraphy 550 580 690 800 GYM PHYSICAL MEDICINE PPHY002 ADVANCED NEUROLOGICAL DISORDERS Physiotheraphy 570 590 710 820 GYM PHYSICAL MEDICINE PPHY011 CHEST PHYSIO + ROM EXERCISES Physiotheraphy 570 590 710 820 GYM CONTINUOUS PASSIVE MOTION DEVICE PHYSICAL MEDICINE PPHY015 Physiotheraphy 570 590 710 820 (CPMD) GYM PHYSICAL MEDICINE PPHY031 EXERCISES & AMBULATION 2 Physiotheraphy 570 590 710 820 GYM

392 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY023 EXERCISE SHOLDER MOBILISATION Physiotheraphy 570 590 710 820 GYM PHYSICAL MEDICINE PPHY047 HEMIPLEGIA PACKAGE Physiotheraphy 570 590 710 820 GYM LYMPHOEDEMA REDUCTION PHYSICAL MEDICINE PPMR034 Physiotheraphy 570 590 710 820 (BILATERAL) GYM PHYSICAL MEDICINE PPHY072 Rehab EXS I Physiotheraphy 570 590 710 820 GYM PHYSICAL MEDICINE PPHY074 Rom Activities Physiotheraphy 570 590 710 820 GYM PHYSICAL MEDICINE PPHY114 NDT- ADULT HEMIPLEGIA Physiotheraphy 610 640 760 880 GYM PERSONALISED EXERCISE PROGRAM PHYSICAL MEDICINE PPMR036 Physiotheraphy 610 640 760 880 ADVANCED GYM PHYSICAL MEDICINE PPHY048 HOME CARE MANAGEMENT - < 1 KM Physiotheraphy 680 710 840 980 GYM PHYSICAL MEDICINE PPHY097 P & E EXERCISES Physiotheraphy 680 710 840 980 GYM PHYSICAL MEDICINE PPHY104 ASPIRATION Physiotheraphy 730 770 910 1060 GYM PHYSICAL MEDICINE PPHY102 BACLOFEN PROGRAMMING Physiotheraphy 730 770 910 1060 GYM PHYSICAL MEDICINE PPHY103 DRESSING Physiotheraphy 730 770 910 1060 GYM PLASTER APPLICATION/SERIAL PHYSICAL MEDICINE PPHY101 Physiotheraphy 730 770 910 1060 CASTING GYM PHYSICAL MEDICINE PPHY073 Rehab EXS II + Gait Physiotheraphy 730 770 910 1060 GYM PHYSICAL MEDICINE PPHY120 Hand Writing Assessment & Training Physiotheraphy 830 870 1040 1200 GYM PHYSICAL MEDICINE PPHY125 Yoga Therapy Three Session Physiotheraphy 830 870 1040 1200 GYM PHYSICAL MEDICINE PPHY112 BWSTT- BIODEX GAIT TRAINING Physiotheraphy 850 890 1060 1230 GYM PHYSICAL MEDICINE PPHY049 HOME CARE MANAGEMENT 3-4KMS Physiotheraphy 850 890 1060 1230 GYM PHYSICAL MEDICINE PPHY003 ANTE-NATAL EXERCISE Physiotheraphy 920 960 1150 1330 GYM PHYSICAL MEDICINE PPHY070 COMPREHENSIVE P & E SOLUTIONS - 1 Physiotheraphy 920 960 1150 1330 GYM PHYSICAL MEDICINE PPMR029 HOME PHYSIOTHERAPY Physiotheraphy 920 960 1150 1330 GYM PHYSICAL MEDICINE PPHY131 Lamaze Session Physiotheraphy 920 960 1150 1330 GYM PHYSICAL MEDICINE PPHY126 Yoga Therapy Four Session Physiotheraphy 990 1040 1240 1440 GYM

393 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY050 HOME CARE MANAGEMENT 4-6KMS Physiotheraphy 1040 1090 1300 1500 GYM PHYSICAL MEDICINE PPMR023 REHAB HOME CARE 3-4KMS Physiotheraphy 1090 1150 1370 1580 GYM PHYSICAL MEDICINE PPHY127 Yoga Therapy Five Session Physiotheraphy 1100 1160 1380 1600 GYM PHYSICAL MEDICINE PPHY051 HOME CARE MANAGEMENT 6-9KMS Physiotheraphy 1160 1220 1450 1680 GYM PHYSICAL MEDICINE PPHY052 HOME CARE MANAGEMENT 9-12KMS Physiotheraphy 1340 1400 1670 1930 GYM COMPREHENSIVE P and E SOLUTIONS PHYSICAL MEDICINE PPHY071 Physiotheraphy 1460 1530 1820 2110 - 2 GYM PHYSICAL MEDICINE PPMR024 REHAB HOME CARE 4-6KMS Physiotheraphy 1580 1660 1970 2290 GYM PHYSICAL MEDICINE PPHY128 Yoga Therapy Group Session( 15 Days) Physiotheraphy 1650 1740 2070 2400 GYM PHYSICAL MEDICINE PPHY109 ERGONOMIC CONSULTATION - ON SITE Physiotheraphy 2060 2160 2580 2990 GYM PHYSICAL MEDICINE PPMR025 REHAB HOME CARE 6-9KMS Physiotheraphy 2060 2160 2580 2990 GYM Sensory Integration Assessment / Home PHYSICAL MEDICINE PPHY117 Physiotheraphy 2200 2310 2750 3190 Exercise Program GYM PHYSICAL MEDICINE PPMR026 REHAB HOME CARE 9-12KMS Physiotheraphy 2420 2550 3030 3510 GYM PHYSICAL MEDICINE PPHY132 Lamaze Session ( 4 sessions) Physiotheraphy 2640 2780 3300 3830 GYM PHYSICAL MEDICINE PPHY039 FITNESS PROGRAM (PM) Physiotheraphy 2670 2800 3330 3860 GYM PHYSICAL MEDICINE PPHY129 Yoga Therapy Group Session( 30 days) Physiotheraphy 2750 2890 3440 3990 GYM PHYSICAL MEDICINE PPHY133 Lamaze Session(5 Sessions) Physiotheraphy 3300 3470 4130 4790 GYM PHYSICAL MEDICINE PPHY005 ANTE-NATAL PACKAGE MEDICARE Physiotheraphy 3630 3820 4540 5270 GYM PHYSIO PACKAGES FOR CARDIAC PHYSICAL MEDICINE PPHY066 Physiotheraphy 3630 3820 4540 5270 CASES(10 DAYS IN WARD) GYM PHYSIO PACKAGES FOR CARDIAC PHYSICAL MEDICINE PPHY065 Physiotheraphy 3630 3820 4540 5270 CASES (5 DAYS IN ITU) GYM PHYSICAL MEDICINE PPHY134 Lamaze Session( 6 sessions) Physiotheraphy 3960 4160 4950 5750 GYM PHYSICAL MEDICINE PPHY122 Clinical Pilates (10 Sessions) Physiotheraphy 4400 4620 5500 6380 GYM CORE STRENGTHENING PHYSICAL MEDICINE PPHY098 Physiotheraphy 4480 4710 5600 6500 SOLUTIONS(7DAYS) GYM PHYSICAL MEDICINE PPHY004 ANTE-NATAL PACKAGE Physiotheraphy 7260 7630 9080 10530 GYM

394 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PHYSICAL MEDICINE PPHY037 FITNESS PROGRAM (3 MTHS) Physiotheraphy 7260 7630 9080 10530 GYM ERGONOMIC AWARNESS CLINIC - PHYSICAL MEDICINE PPHY069 Physiotheraphy 12710 13350 15890 18430 PACKAGE GYM PHYSICAL MEDICINE PPHY038 FITNESS PROGRAM (6 MTHS) Physiotheraphy 12710 13350 15890 18430 GYM PHYSICAL MEDICINE PPHY036 FITNESS PROGRAM (1YEAR) Physiotheraphy 21180 22240 26470 30710 GYM PHYSICAL MEDICINE KPHY002 Rehabilitation package - 10 DAYS Package 0 148040 176240 204440 GYM PACKAGE PHYSICAL MEDICINE PPMR031 INFANT STIMULATION PROGRAM - II Physiotheraphy 370 390 460 530 REHAB INTERVENTION PPMR015 POP REMOVAL Physiotheraphy PHYSIOTHERAPHY 70 70 90 100 PPMR028 PPMR028 SPEECH II Physiotheraphy PHYSIOTHERAPHY 300 320 380 440 PPMR020 SUTURE REMOVAL - PPMR Physiotheraphy PHYSIOTHERAPHY 300 320 380 440 PPMR027 PPMR027 SPEECH I Physiotheraphy PHYSIOTHERAPHY 370 390 460 530 PPMR007 DRESSING - PPMR Physiotheraphy PHYSIOTHERAPHY 400 420 500 580 PPHY078 SPEECH THERAPY Physiotheraphy PHYSIOTHERAPHY 440 470 550 640 PPMR032 INFANT STIMULATION PROGRAM - NICU Physiotheraphy PHYSIOTHERAPHY 570 590 710 820 PPMR012 ORTHOTICCHECK-UP/MODIFICATION Physiotheraphy PHYSIOTHERAPHY 570 590 710 820 PPMR016 REHAB 1 Physiotheraphy PHYSIOTHERAPHY 570 590 710 820 PPMR021 TRACHEOSTOMY TUBE CHANGE Physiotheraphy PHYSIOTHERAPHY 570 590 710 820 PPHY077 SPEECH ASSESMENT & COUNSELLING Physiotheraphy PHYSIOTHERAPHY 590 620 730 850 PPMR001 ASPIRATION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR002 BACLOFFEN PUMP PROGRAM Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR004 BOTULINUM INJECTION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 CLEAN INTERMITTENT PPMR005 Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 CATHETERIZATION PPMR006 DEBRIDEMENT - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR008 EVALUATION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR009 INCISSION & DRAINAGE - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR010 INJECTION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR011 INTRA ARTICULAR INJECTION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR014 PLASTER APPLICATION Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR017 REHAB 2 Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR018 SERIAL CASTING Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR019 SHUNT PROGRAM Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR022 TRIGGER POINT INJECTION - PPMR Physiotheraphy PHYSIOTHERAPHY 730 770 910 1060 PPMR003 BACLOFFEN REFILLING Physiotheraphy PHYSIOTHERAPHY 1820 1910 2270 2640 PPMR013 PHENOL BLOCK Physiotheraphy PHYSIOTHERAPHY 2670 2800 3330 3860

395 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PSPO099 ASSISTED STRETCHING Procedure SPORTS MEDICINE 360 380 450 520 PSPO004 CRYOTHERAPY SESSION Procedure SPORTS MEDICINE 450 480 570 660 PSPO096 KINESIO TAPING - PSPO Procedure SPORTS MEDICINE 450 480 570 660 PSPO087 BACK PAIN EXERCISE ( 1 SESSION ) Procedure SPORTS MEDICINE 520 550 650 760 PSPO071 WEIGHT MANAGEMENT ( 1 SESSION ) Procedure SPORTS MEDICINE 520 550 650 760 PSPO094 BODY COMPOSITION ANALYSIS Procedure SPORTS MEDICINE 590 620 740 860 PSPO029 SPORTS MASSAGE Procedure SPORTS MEDICINE 590 620 740 860 CORE STABILITY EXCERCISES (1 PSPO102 Procedure SPORTS MEDICINE 610 640 770 890 SESSION) RESPIRATORY REHABILITATION ( PSPO089 Procedure SPORTS MEDICINE 640 670 800 920 ASTHMA / COPD ) - SINGLE SESSION PSPO091 FITNESS PROGRAM STAFF Procedure SPORTS MEDICINE 660 690 820 960 PSPO039 FUNCTIONAL FASCIAL TAPING Procedure SPORTS MEDICINE 680 720 850 990 MUSCULO-SKELETAL TREATMENT PSPO014 Procedure SPORTS MEDICINE 680 720 850 990 (MANUAL) PREVENTIVE STRENGTHENING - PSPO018 Procedure SPORTS MEDICINE 760 800 950 1110 MEDICARE OTHER STAFF RHEUMATOID ARTHRITIS EXERCISES ( 1 PSPO081 Procedure SPORTS MEDICINE 760 800 950 1110 SESSION ) OSTEOPOROSIS EXERCISES ( 1 PSPO083 Procedure SPORTS MEDICINE 820 860 1030 1190 SESSION ) PSPO097 2D SCAN Procedure SPORTS MEDICINE 900 950 1130 1310 PHYSIOTHERAPY EXERCISE SESSION - PSPO016 THERABAND / GYM BALL / STABILITY Procedure SPORTS MEDICINE 900 950 1130 1310 TRAINING MEDICAL BACK & NECK PSPO092 Procedure SPORTS MEDICINE 960 1010 1200 1390 REHABILITATION PSPO086 NUTRITIONAL COUNSELING Procedure SPORTS MEDICINE 960 1010 1200 1390 PSPO054 VIBROGYM - 1 Procedure SPORTS MEDICINE 960 1010 1200 1390 PRIMUS TREATMENT WITHOUT MSC / PSPO028 Procedure SPORTS MEDICINE 1100 1150 1370 1590 PSC PSPO041 HEEL RAISE Procedure SPORTS MEDICINE 1180 1240 1470 1710 PERI-MENOPAUSAL EXERCISE ( SINGLE PSPO069 Procedure SPORTS MEDICINE 1180 1240 1470 1710 SESSION ) FITNESS ASSESSMENT - BASIC PSPO072 Procedure SPORTS MEDICINE 1240 1300 1540 1790 PACKAGE FITNESS EVALUATION / PRE- PSPO085 PARTICIPATION SCREENING ( 1 SESSION Procedure SPORTS MEDICINE 1240 1300 1540 1790 ) PREVENTIVE STRENGTHENING - PSPO017 Procedure SPORTS MEDICINE 1240 1300 1540 1790 MEDICARE HOD'S PSPO025 PRIMUS TREATMENT - ASSESSMENT Procedure SPORTS MEDICINE 1240 1300 1540 1790 PSPO060 Gait Analysis Procedure SPORTS MEDICINE 1300 1370 1630 1890

396 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

EXECUTIVE EXERCISE PROGRAM ( PSPO075 SINGLE SESSION ) + NUTRITIONAL Procedure SPORTS MEDICINE 1510 1590 1890 2190 GUIDANCE PRIMUS TREATMENT WITH MSC / PSC PSPO027 Procedure SPORTS MEDICINE 1780 1860 2220 2570 6 SESSIONS PSPO077 CARDIAC SESSION ( 3 SESSIONS ) Procedure SPORTS MEDICINE 1910 2010 2390 2770 OBESITY AND DIABETES EXERCISE ( 3 PSPO079 Procedure SPORTS MEDICINE 1910 2010 2390 2770 SESSIONS ) PSPO074 RMR Procedure SPORTS MEDICINE 2050 2150 2560 2970 MEDICAL BACK & NECK PSPO093 REHABILITATION AND PREVENTIVE Procedure SPORTS MEDICINE 2330 2440 2910 3370 STRENGTHENING & CONDITIONING PSPO045 TEST - LACTATE THRESHOLD Procedure SPORTS MEDICINE 2330 2440 2910 3370 PSPO063 Weight Management Programme Procedure SPORTS MEDICINE 2330 2440 2910 3370 POST - PARTUM EXERCISES (2 PSPO066 Procedure SPORTS MEDICINE 2470 2590 3080 3570 SESSIONS) PSPO064 PREGNANCY EXERCISES (3 SESSIONS) Procedure SPORTS MEDICINE 2600 2730 3250 3770 WEIGHT MANAGEMENT ( 5 SESSIONS ) PSPO070 Procedure SPORTS MEDICINE 2600 2730 3250 3770 + DIET MANAGEMENT ( 1 SESSION ) PSPO040 HEEL PAIN REL. Procedure SPORTS MEDICINE 2740 2880 3430 3970 PSPO061 Musculoskeletal Assessement Procedure SPORTS MEDICINE 3420 3590 4270 4960 PSPO046 TEST - METABOLIC Procedure SPORTS MEDICINE 3420 3590 4270 4960 PREVENTIVE STRENGTHENING & PSPO019 Procedure SPORTS MEDICINE 3830 4030 4790 5560 CONDITIONING - 1 MEMBERSHIP EXECUTIVE EXERCISE PROGRAM ( 3 PSPO076 Procedure SPORTS MEDICINE 4510 4740 5640 6540 SESSION ) + NUTRITIONAL GUIDANCE PSPO047 TEST - VO2 Procedure SPORTS MEDICINE 4510 4740 5640 6540 RESPIRATORY REHABILITATION ( PSPO090 Procedure SPORTS MEDICINE 4790 5030 5980 6940 ASTHMA / COPD ) - 8 SESSIONS PREVENTIVE STRENGTHENING & PSPO023 Procedure SPORTS MEDICINE 4930 5170 6160 7140 CONDITIONING - 6 ASSISTED SESSIONS RHEUMATOID ARTHRITIS EXERCISES ( 8 PSPO082 Procedure SPORTS MEDICINE 5060 5320 6330 7340 SESSION ) PSPO055 VIBROGYM - 6 Procedure SPORTS MEDICINE 5330 5600 6660 7730 FITNESS ASSESSMENT - ADVANCED PSPO073 Procedure SPORTS MEDICINE 5610 5890 7010 8130 PACKAGE PSPO088 BACK PAIN EXERCISE ( 12 SESSION ) Procedure SPORTS MEDICINE 6020 6320 7520 8730 OSTEOPOROSIS EXERCISES ( 8 PSPO084 Procedure SPORTS MEDICINE 6020 6320 7520 8730 SESSION ) PSPO078 CARDIAC SESSION ( 12 SESSIONS ) Procedure SPORTS MEDICINE 7110 7470 8890 10310 OBESITY AND DIABETES EXERCISE ( 12 PSPO080 Procedure SPORTS MEDICINE 7110 7470 8890 10310 SESSIONS ) PSPO098 CUSTOMIZED INSOLE AND 2D SCAN Procedure SPORTS MEDICINE 7650 8030 9560 11090

397 Physiotherapy

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

CUSTOMIZED INSOLE & 2D SCAN FOR PSPO103 Procedure SPORTS MEDICINE 8070 8470 10080 11690 GOLFERS HIGH ALTITUDE TRAINING (12 PSPO101 Procedure SPORTS MEDICINE 8480 8900 10600 12290 SESSIONS) PREVENTIVE STRENGTHENING & PSPO020 CONDITIONING - 12 ASSISTED Procedure SPORTS MEDICINE 8740 9180 10930 12680 SESSIONS PREVENTIVE STRENGTHENING & PSPO022 CONDITIONING - 3 ASSISTED SESSIONS Procedure SPORTS MEDICINE 8740 9180 10930 12680 & MEMBERSHIP POST - PARTUM EXERCISES (8 PSPO067 Procedure SPORTS MEDICINE 9570 10050 11960 13880 SESSIONS) PSPO065 PREGNANCY EXERCISES (12 SESSIONS) Procedure SPORTS MEDICINE 9840 10330 12300 14260 MEDICAL BACK & NECK PSPO008 Procedure SPORTS MEDICINE 10670 11200 13330 15460 REHABILITATION* - 6 PSPO056 VIBROGYM - 12 Procedure SPORTS MEDICINE 10670 11200 13330 15460 PREVENTIVE STRENGTHENING & PSPO024 CONDITIONING - 6 ASSISTED SESSIONS Procedure SPORTS MEDICINE 15710 16500 19640 22780 & MEMBERSHIP HIGH ALTITUDE TRAINING (24 PSPO100 Procedure SPORTS MEDICINE 17080 17940 21350 24770 SESSIONS) POST - PARTUM EXERCISES (16 PSPO068 Procedure SPORTS MEDICINE 19130 20090 23910 27740 SESSIONS) MEDICAL BACK & NECK PSPO009 Procedure SPORTS MEDICINE 19820 20810 24770 28740 REHABILITATION* - 12 PREVENTIVE STRENGTHENING & PSPO021 CONDITIONING - 12 ASSISTED Procedure SPORTS MEDICINE 26650 27980 33310 38640 SESSIONS & MEMBERSHIP MEDICAL BACK & NECK PSPO010 Procedure SPORTS MEDICINE 28700 30130 35870 41610 REHABILITATION* - 18 MEDICAL BACK & NECK PSPO011 Procedure SPORTS MEDICINE 38250 40170 47820 55470 REHABILITATION* - 24

398 Administration

399 Administration

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PADM042 ACLS / BLS / OTHERS Administration ADMINISTRATION 10 10 10 10 PADM075 WAITING LOUNGE KIT Administration ADMINISTRATION 40 40 40 40 PADM058 SC INJECTION Administration ADMINISTRATION 80 80 80 80 PADM055 IM INJECTIONS Administration ADMINISTRATION 100 100 100 100 PADM056 IM INJECTIONS (SHOT) Administration ADMINISTRATION 100 100 100 100 PADM028 NEBULIZATION Administration ADMINISTRATION 110 110 110 110 PADM046 DUPLICATE DISCHARGE SUMMARY Administration ADMINISTRATION 130 130 130 130 PADM043 DUPLICATE HOSPITAL CARD Administration ADMINISTRATION 130 130 130 130 PADM057 IV INJECTION (SHOT) Administration ADMINISTRATION 130 130 130 130 PADM060 IV INJECTION SLOW PUSH Administration ADMINISTRATION 210 210 210 210 PADM003 CERTIFICATE OF BIRTH Administration ADMINISTRATION 230 230 230 230 PADM061 IV INFUSION 1 HOUR Administration ADMINISTRATION 280 280 280 280 PADM038 WAITING LOUNGE-12 Hrs Administration ADMINISTRATION 370 370 370 370 PADM039 WAITING LOUNGE-24 Hrs Administration ADMINISTRATION 480 480 480 480 PADM040 Documentation Processing Fee Administration ADMINISTRATION 500 500 500 500 PADM062 IV INFUSION 2 HOUR Administration ADMINISTRATION 530 530 530 530 PADM063 IV INFUSION 3 HOUR Administration ADMINISTRATION 690 690 690 690 PADM064 IV INFUSION 4 HOUR Administration ADMINISTRATION 790 790 790 790 PADM082 GUEST HOUSE -24 Hrs Administration ADMINISTRATION 1260 1260 1260 1260 PADM083 GUEST HOUSE (SPL) -24 Hrs Administration ADMINISTRATION 1580 1580 1580 1580 PADM051 MEDICAL SUPPORT TEAM CHARGES Administration ADMINISTRATION 2000 2000 2000 2000 PADM077 INTERNATIONAL ASSISTANCE CHARGES Administration ADMINISTRATION 12080 12080 12080 12080 IENT008 Agil Family - Oticon Administration ADMINISTRATION 194250 194250 194250 194250 PADM086 HEALTHIFYME GOLD Administration ADMINISTRATION 2999 PADM087 HEALTHIFYME GOLD PLUS Administration ADMINISTRATION 5499 PADM089 HEALTHIFYME PLATINUM PLUS Administration ADMINISTRATION 13999 PADM084 HEALTHIFYME SILVER Administration ADMINISTRATION 2199 PADM085 HEALTHIFYME SILVER PLUS Administration ADMINISTRATION 4099 PADM090 HEALTHIFYME ULTIMATE Administration ADMINISTRATION 19999 PADM091 HEALTHIFYME ULTIMATE PLUS Administration ADMINISTRATION 24999 PADM100 MORTUARY ROOM CHARGES Miscellaneous MISCELLANEOUS 1000 1000 1000 1000

400 In Patient Services

401 In Patient Services

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

AREG001 Registration Registration REGISTRATION CHARGES 150 150 150 150

IPBEDC1 Admission Charges Inpatient Services ADMISSION CHARGES 1000 1000 1000 1000

IPBEDC206 BED CHARGES - MICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300

IPBEDC210 BED CHARGES - CCU Inpatient Services ICU BED CHARGES 0 13300 13300 13300

IPBEDC211 BED CHARGES - CTICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300

IPBEDC212 BED CHARGES - DAYCARE Inpatient Services IP BED CHARGES 0 3000 3000 3000

IPBEDC215 BED CHARGES - PICU Inpatient Services ICU BED CHARGES 0 13300 13300 13300

IPBEDC300 BED CHARGES - SINGLE Inpatient Services IP BED CHARGES 0 3700 5900 9800

IPBEDC301 BED CHARGES - DOUBLE Inpatient Services IP BED CHARGES 0 3700 5900 5900

IPBEDC302 BED CHARGES - TRIPLE Inpatient Services IP BED CHARGES 0 3700 3700 3700

BED CHARGES - MICU IPBEDC303 Inpatient Services ICU BED CHARGES 0 13300 13300 13300 ISOLATION

BED CHARGES - PICU IPBEDC304 Inpatient Services ICU BED CHARGES 0 13300 13300 13300 ISOLATION

BED CHARGES - NICU IPBEDC306 Inpatient Services ICU BED CHARGES 0 13300 13300 13300 HIGH INTENSIVE

BED CHARGES - NICU IPBEDC307 Inpatient Services ICU BED CHARGES 0 11600 11600 11600 LOW INTENSIVE

BED CHARGES - DUAL IPBEDC308 Inpatient Services IP DUAL BED CHARGES 0 3700 5900 9800 OCCUPANCY SINGLE

BED CHARGES - DUAL IPBEDC309 Inpatient Services IP DUAL BED CHARGES 0 3700 5900 5900 OCCUPANCY DOUBLE

BED CHARGES - DUAL IPBEDC310 Inpatient Services IP DUAL BED CHARGES 0 3700 3700 3700 OCCUPANCY TRIPLE

402 Medical Equipment

403 Medical Equipment

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

AMED001 CARDIAC MONITOR - PER DAY Inpatient Services MEDICAL EQUIPMENT 390 410 490 570

AMED002 C-ARM CHARGES PER HOUR Inpatient Services MEDICAL EQUIPMENT 0 3780 6860 9610

AMED003 HARMONIC SCALPEL Inpatient Services MEDICAL EQUIPMENT 2480 3620 6860 10210

AMED004 INFUSION PUMP - PER DAY Inpatient Services MEDICAL EQUIPMENT 370 440 530 630

AMED005 LAPROSCOPIC INSTRUMENT Inpatient Services MEDICAL EQUIPMENT 3130 4480 7290 10580

AMED007 OXYGEN CHARGES PER HOUR Inpatient Services MEDICAL EQUIPMENT 350 350 350 350

AMED010 OXYGEN CHARGES Inpatient Services MEDICAL EQUIPMENT 0 5000 5000 5000

AMED011 VENTILATION CHARGES Inpatient Services MEDICAL EQUIPMENT 0 3000 3000 3000

AMED012 VENTILATION CHARGES - BIPAP Inpatient Services MEDICAL EQUIPMENT 0 2750 2750 2750

VENTILATION CHARGES WITH OXYGEN AMED013 Inpatient Services MEDICAL EQUIPMENT 10500 10500 10500 10500 - PER DAY

VENTILATION CHARGES (Bi Pap) WITH AMED014 Inpatient Services MEDICAL EQUIPMENT 9400 9400 9400 9400 OXYGEN - PER DAY

AMED015 CUSA MACHINE Inpatient Services MEDICAL EQUIPMENT 2610 2740 3260 3780

AMED016 LIGASURE Inpatient Services MEDICAL EQUIPMENT 2480 4100 7070 9500

AMED017 COMPUTER NAVIGATION Inpatient Services MEDICAL EQUIPMENT 3290 3460 4110 4770

AMED018 ERBE BICLAMP Inpatient Services MEDICAL EQUIPMENT 1940 2030 2420 2810

AMED019 MICROSCOPE - Other Departments Inpatient Services MEDICAL EQUIPMENT 3860 4050 4820 5590

AMED020 MICROSCOPE - ENT, OPTHAL Inpatient Services MEDICAL EQUIPMENT 1590 1670 1990 2300

AMED021 SAP - THERAPY MACHINE CHARGES Inpatient Services MEDICAL EQUIPMENT 2610 2740 3260 3780

INTRA-OP NERVE MONITORING AMED022 Inpatient Services MEDICAL EQUIPMENT 3860 4050 4820 5590 SYSTEM

AMED023 C-ARM ( SINGLE SHOT - SURGEON) Inpatient Services MEDICAL EQUIPMENT 690 720 860 990

AMED024 C-ARM SINGLE SHOT (ANESTHESIA) Inpatient Services MEDICAL EQUIPMENT 690 720 860 990

AMED026 NIM ECLIPSE MACHINE CHARGES Inpatient Services MEDICAL EQUIPMENT 3740 3930 4680 5430

AMED027 MICROSCOPE - ENT, OPTHAL (Minor) Inpatient Services MEDICAL EQUIPMENT 460 480 570 660

VENTILATION CHARGES (NIV AMED028 Inpatient Services MEDICAL EQUIPMENT 1200 1200 1200 1200 PORTABLE)

VENTILATION CHARGES (NIV AMED029 Inpatient Services MEDICAL EQUIPMENT 6090 6400 7620 8840 PORTABLE) WITH OXYGEN - PER DAY

NEURO NAVIGATION SYSTEM AMED030 Inpatient Services MEDICAL EQUIPMENT 13050 13700 16310 18910 CHARGES

SURGICAL BONE DRILL - Short AMED031 Inpatient Services MEDICAL EQUIPMENT 1840 2320 2540 2750 duration Use

404 Medical Equipment

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

SURGICAL BONE DRILL - Long AMED032 Inpatient Services MEDICAL EQUIPMENT 7340 9070 10040 11070 duration Use

AMED033 LUMINAS LASER - CHARGES Inpatient Services MEDICAL EQUIPMENT 9720 11610 13230 14850

AMED036 URETROSCOPE - CHARGES Inpatient Services MEDICAL EQUIPMENT 19280 20250 24100 27960

AMED037 FLEXIBLE URETEROSCOPE CHARGES Inpatient Services MEDICAL EQUIPMENT 3740 3930 4680 5430

AMED038 I -DRIVE STAPLER Inpatient Services MEDICAL EQUIPMENT 4100 4320 4320 4320

BIOLITEC LASER CHARGES - AMED039 Inpatient Services MEDICAL EQUIPMENT 11880 12960 12960 12960 UNILATERAL

BIOLITEC LASER CHARGES - AMED040 Inpatient Services MEDICAL EQUIPMENT 15660 16200 16200 16200 BILATERAL

AMED041 CO2 LASER ?LUMENIS Inpatient Services MEDICAL EQUIPMENT 39690 41680 49620 57560

AMED042 FIBRE ENDURE CO2 Inpatient Services MEDICAL EQUIPMENT 51910 54500 64880 75260

AMED043 HFNC WITH OXYGEN PER DAY Inpatient Services MEDICAL EQUIPMENT 2160 2160 2160 2160

AMED044 HFNC Nasal Prongs Inpatient Services MEDICAL EQUIPMENT 2700 2700 2700 2700

AMED045 HFNC Tubings Inpatient Services MEDICAL EQUIPMENT 2270 2390 2840 3290

ARTHROSCOPE INSTRUMENT AMED046 Inpatient Services MEDICAL EQUIPMENT 3020 3020 4540 6050 CHARGES

PEDME01 Nitric Oxide Therapy Charges Per Day Inpatient Services MEDICAL EQUIPMENT 10890 11440 13620 15790

PEDME02 NITRIC OXIDE CHARGE up to 6 HOURS Inpatient Services MEDICAL EQUIPMENT 3290 3460 4110 4770

NITRIC OXIDE CHARGE for 6 Hrs to PEDME03 Inpatient Services MEDICAL EQUIPMENT 5910 6200 7380 8560 12 Hrs

NITRIC OXIDE CHARGE for 12 Hrs to PEDME04 Inpatient Services MEDICAL EQUIPMENT 8390 8810 10490 12170 18 Hrs

NITRIC OXIDE CHARGE for 18 Hrs to PEDME05 Inpatient Services MEDICAL EQUIPMENT 10890 11440 13620 15790 24 Hrs

405 Yoga

406 Yoga

Code Description Billing Group Billing Subgroup MHDOP MHDTRP MHDDOU MHDSIGL

PYOG006 M-SPECIAL TECHNIQUES (PER SESSION) Procedure YOGA THERAPY 360 380 450 520

PYOG010 SPECIAL TECHNIQUES (PER SESSION) Procedure YOGA THERAPY 360 380 450 520

PYOG009 RELAXATION THERAPY (PER SESSION) Procedure YOGA THERAPY 450 480 570 660

PYOG005 M-RELAXATION THERAPY (PER SESSION) Procedure YOGA THERAPY 480 500 590 690

PYOG008 M-YOGATHERAPY (PER SESSION) Procedure YOGA THERAPY 640 670 800 920

PYOG002 GROUP POSITIVE HEALTH PACKAGE Procedure YOGA THERAPY 680 720 850 990

PYOG004 M-GROUP POSITIVE HEALTH PACKAGE Procedure YOGA THERAPY 680 720 850 990

PYOG011 YOGA THERAPY (PER SESSION) Procedure YOGA THERAPY 680 720 850 990

GROUP INTEGRATED YOGIC PRACTICS (12 PYOG001 Procedure YOGA THERAPY 2330 2440 2910 3370 SESSION)

M-GROUP INTEGRATED YOGIC PRACTICS PYOG003 Procedure YOGA THERAPY 2330 2440 2910 3370 (12 SESSION)

PYOG007 M-YOGATHERAPY PACKAGE (12 SESSION) Procedure YOGA THERAPY 5610 5890 7010 8130

PYOG012 YOGA THERAPY PACKAGE (12 SESSION) Procedure YOGA THERAPY 5610 5890 7010 8130

407 Home Care

408 Home Care

Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Group Subgroup PHOM123 Suture removal (each suture) additional service Procedure HOME CARE 30 30 30 40 PHOM076 BP check additional service Procedure HOME CARE 40 40 50 60 PHOM124 Staple removal (each staple) additional service Procedure HOME CARE 40 40 50 60 PHOM059 Suture removal (each suture) Procedure HOME CARE 40 40 50 60 PHOM006 BP check Procedure HOME CARE 50 50 60 70 PHOM060 Staple removal (each staple) Procedure HOME CARE 50 50 60 70 Baby Nail cutting / weighing the baby additional PHOM072 Procedure HOME CARE 60 70 80 90 service

PHOM097 GRBS Check additional service Procedure HOME CARE 60 70 80 90

PHOM117 Sample Collection additional service Procedure HOME CARE 60 70 80 90

PHOM120 SpO2 Check additional service Procedure HOME CARE 60 70 80 90

PHOM002 Baby Nail cutting / weighing the baby Procedure HOME CARE 70 80 90 110 PHOM027 GRBS Check Procedure HOME CARE 70 80 90 110 PHOM046 Sample Collection Procedure HOME CARE 70 80 90 110 PHOM049 SpO2 Check Procedure HOME CARE 70 80 90 110 PHOM070 HOME LAB SAMPLE COLLECTION CHARGES Procedure HOME CARE 120 120 150 170 PHOM082 Colostomy care / bag change additional service Procedure HOME CARE 130 140 160 190 PHOM083 Counselling for breast feeding additional service Procedure HOME CARE 130 140 160 190 Hot formentation (Breast Engorgment) additional PHOM078 Procedure HOME CARE 130 140 160 190 service PHOM099 IM injection (Shot) [Homecare] additional service Procedure HOME CARE 130 140 160 190 PHOM103 IV injection (Shot) [Homecare] additional service Procedure HOME CARE 130 140 160 190 PHOM104 IV injection slow push [Homecare] additional service Procedure HOME CARE 130 140 160 190 PHOM110 Nail Cutting additional service Procedure HOME CARE 130 140 160 190 PHOM112 Perineal Care additional service Procedure HOME CARE 130 140 160 190 PHOM118 SC injection [Homecare] additional service Procedure HOME CARE 130 140 160 190 PHOM119 Sitz bath additional service Procedure HOME CARE 130 140 160 190 PHOM122 Suppository / Tablet insertion additional service Procedure HOME CARE 130 140 160 190 PHOM125 Urobag change additional service Procedure HOME CARE 130 140 160 190 PHOM012 Colostomy care / bag change Procedure HOME CARE 150 160 190 220 PHOM013 Counselling for breast feeding Procedure HOME CARE 150 160 190 220 PHOM008 Hot formentation (Breast Engorgment) Procedure HOME CARE 150 160 190 220 PHOM029 IM injection (Shot) [Homecare] Procedure HOME CARE 150 160 190 220 PHOM032 IV injection (Shot) [Homecare] Procedure HOME CARE 150 160 190 220 PHOM033 IV injection slow push [Homecare] Procedure HOME CARE 150 160 190 220 PHOM039 Nail Cutting Procedure HOME CARE 150 160 190 220 PHOM041 Perineal Care Procedure HOME CARE 150 160 190 220

409 Home Care

Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Group Subgroup PHOM047 SC injection [Homecare] Procedure HOME CARE 150 160 190 220 PHOM048 Sitz bath Procedure HOME CARE 150 160 190 220 PHOM052 Suppository / Tablet insertion Procedure HOME CARE 150 160 190 220 PHOM053 Urobag change Procedure HOME CARE 150 160 190 220 PHOM071 Baby Bath & Massage additional service Procedure HOME CARE 190 200 230 270 Bladder Training (Clamping and releasing) additional PHOM077 Procedure HOME CARE 190 200 230 270 service PHOM080 Catheter care additional service Procedure HOME CARE 190 200 230 270 Chemoport access needle (Insertion / Removal) PHOM086 Procedure HOME CARE 190 200 230 270 additional service PHOM088 Chest Physiotherpay additional service Procedure HOME CARE 190 200 230 270 PHOM090 Drain Care additional service Procedure HOME CARE 190 200 230 270 Dressing (Bed sores, surgical, diabetic) - Minor PHOM091 Procedure HOME CARE 190 200 230 270 additional service General Visitation (BP/GRBS/PR/RR/SpO2/Temp. check) PHOM096 Procedure HOME CARE 190 200 230 270 additional service PHOM098 Hair wash additional service Procedure HOME CARE 190 200 230 270 I.V. Drip Administration (each hour) additional charge PHOM101 Procedure HOME CARE 190 200 230 270 additional service PHOM105 IV line insertion / removal additional service Procedure HOME CARE 190 200 230 270 PHOM108 Mouth Care additional service Procedure HOME CARE 190 200 230 270 PHOM109 Nebulisation additional service Procedure HOME CARE 190 200 230 270 PHOM113 Post natal exercises (After Delivery) additional service Procedure HOME CARE 190 200 230 270 PHOM116 Ryle's Tube Feeding additional service Procedure HOME CARE 190 200 230 270 PHOM021 Dressing (Bed sores, surgical, diabetic) - Minor Procedure HOME CARE 200 210 250 290 PHOM038 Nebulisation Procedure HOME CARE 200 210 250 290 PHOM001 Baby Bath & Massage Procedure HOME CARE 220 230 280 320 PHOM007 Bladder Training (Clamping and releasing) Procedure HOME CARE 220 230 280 320 PHOM010 Catheter care Procedure HOME CARE 220 230 280 320 PHOM016 Chemoport access needle (Insertion / Removal) Procedure HOME CARE 220 230 280 320 PHOM018 Chest Physiotherpay Procedure HOME CARE 220 230 280 320 PHOM020 Drain Care Procedure HOME CARE 220 230 280 320 PHOM026 General Visitation (BP/GRBS/PR/RR/SpO2/Temp. check) Procedure HOME CARE 220 230 280 320 PHOM028 Hair wash Procedure HOME CARE 220 230 280 320 PHOM061 I.V. Drip Administration (each hour) additional charge Procedure HOME CARE 220 230 280 320 PHOM034 IV line insertion / removal Procedure HOME CARE 220 230 280 320 PHOM037 Mouth Care Procedure HOME CARE 220 230 280 320 PHOM042 Post natal exercises (After Delivery) Procedure HOME CARE 220 230 280 320 PHOM045 Ryle's Tube Feeding Procedure HOME CARE 220 230 280 320

410 Home Care

Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Group Subgroup PHOM0128 Humidifier-Daily Procedure HOME CARE 230 250 290 340 PHOM079 Catheter removal additional service Procedure HOME CARE 260 270 320 370 PHOM085 Chemoport flushing additional service Procedure HOME CARE 260 270 320 370 PHOM095 Enema (Proctoclysis / Entofoam) additional service Procedure HOME CARE 260 270 320 370 PHOM106 Intermittent Catheterisation additional service Procedure HOME CARE 260 270 320 370 PHOM107 Manual Evacuation additional service Procedure HOME CARE 260 270 320 370 PHOM121 Suctioning (oral) additional service Procedure HOME CARE 260 270 320 370 PHOM009 Catheter removal Procedure HOME CARE 280 290 350 410 PHOM015 Chemoport flushing Procedure HOME CARE 280 290 350 410 PHOM025 Enema (Proctoclysis / Entofoam) Procedure HOME CARE 280 290 350 410 PHOM035 Intermittent Catheterisation Procedure HOME CARE 280 290 350 410 PHOM036 Manual Evacuation Procedure HOME CARE 280 290 350 410 PHOM050 Suctioning (oral) Procedure HOME CARE 280 290 350 410 PHOM054 Visit Charges 0 - 2 KMS Procedure HOME CARE 300 320 380 440 PHOM089 Death Care additional service Procedure HOME CARE 320 330 390 460 Dressing (Bed sores, surgical, diabetic) - Medium PHOM092 Procedure HOME CARE 320 330 390 460 additional service PHOM114 Range of Motion (ROM) additional service Procedure HOME CARE 320 330 390 460 PHOM019 Death Care Procedure HOME CARE 350 370 440 510 PHOM022 Dressing (Bed sores, surgical, diabetic) - Medium Procedure HOME CARE 350 370 440 510 PHOM043 Range of Motion (ROM) Procedure HOME CARE 350 370 440 510 PHOM073 Bath / Back Care / Bed Making additional service Procedure HOME CARE 370 390 460 540 PHOM094 ECG additional service Procedure HOME CARE 370 390 460 540 PHOM111 Oxygen Administration per hour additional service Procedure HOME CARE 370 390 460 540 PHOM003 Bath / Back Care / Bed Making Procedure HOME CARE 410 430 510 590 PHOM024 ECG Procedure HOME CARE 410 430 510 590 PHOM040 Oxygen Administration per hour Procedure HOME CARE 430 450 540 620 PHOM063 Visit Charges 2.1 - 4 KMS Procedure HOME CARE 430 450 540 620 PHOM075 Bladder Irrigation additional service Procedure HOME CARE 440 460 550 640 PHOM074 Bladder Wash additional service Procedure HOME CARE 440 460 550 640 PHOM081 Catheterisation additional service Procedure HOME CARE 440 460 550 640 PHOM087 Chemo Medicine Infusion additional service Procedure HOME CARE 440 460 550 640 PHOM084 Colostomy Irrigation additional service Procedure HOME CARE 440 460 550 640 Dressing (Bed sores, surgical, diabetic) - Major PHOM093 Procedure HOME CARE 440 460 550 640 additional service PHOM100 I.V. Drip Administration additional service Procedure HOME CARE 440 460 550 640 PHOM102 IV infusion (Injection with Saline) additional service Procedure HOME CARE 440 460 550 640

411 Home Care

Billing Billing Code Description MHDOP MHDTRP MHDDOU MHDSIGL Group Subgroup PHOM115 Ryle's Tube Insertion additional service Procedure HOME CARE 440 460 550 640 PHOM005 Bladder Irrigation Procedure HOME CARE 480 500 590 690 PHOM004 Bladder Wash Procedure HOME CARE 480 500 590 690 PHOM011 Catheterisation Procedure HOME CARE 480 500 590 690 PHOM017 Chemo Medicine Infusion Procedure HOME CARE 480 500 590 690 PHOM014 Colostomy Irrigation Procedure HOME CARE 480 500 590 690 PHOM023 Dressing (Bed sores, surgical, diabetic) - Major Procedure HOME CARE 480 500 590 690 PHOM030 I.V. Drip Administration for 1st Hour Procedure HOME CARE 480 500 590 690 PHOM031 IV infusion (Injection with Saline) Procedure HOME CARE 480 500 590 690 PHOM044 Ryle's Tube Insertion Procedure HOME CARE 480 500 590 690 PHOM064 Visit Charges 4.1 - 6 KMS Procedure HOME CARE 480 500 590 690 PHOM065 Visit Charges 6.1 - 8 KMS Procedure HOME CARE 560 580 690 810 PHOM0130 Pulse Oxymeter (15 day package) Procedure HOME CARE 610 640 760 880 PHOM066 Visit Charges 8.1 - 10 KMS Procedure HOME CARE 630 660 780 910 PHOM067 Visit Charges 10.1 - 12 KMS Procedure HOME CARE 680 720 850 990 PHOM0126 NIV / BiPAP Procedure HOME CARE 710 740 880 1020 PHOM135 IP Attender Service Homecare - 12 Hrs/day Procedure HOME CARE 750 790 940 1090 PHOM068 Visit Charges 12.1 - 14 KMS Procedure HOME CARE 750 790 940 1090 PHOM069 Visit Charges 14.1 - 16 KMS Procedure HOME CARE 880 920 1100 1270 PHOM126 Western Airbed Procedure HOME CARE 1040 1090 1300 1510 PHOM0131 Pulse Oxymeter (30 day package) Procedure HOME CARE 1210 1270 1510 1760 PHOM138 Homecare Subscription Procedure HOME CARE 1250 1310 1560 1810 PHOM0129 Humidifier (15 Days ) Procedure HOME CARE 2300 2420 2880 3340 PHOM0132 Airbed (Sale) Procedure HOME CARE 4260 4470 5320 6170 PHOM0133 Humidifier ( 30 Days ) Procedure HOME CARE 4600 4830 5750 6670 PHOM0127 NIV / BiPAP 15 day package Procedure HOME CARE 6040 6340 7550 8760 PHOM0134 C-Pap ( 30 days) Procedure HOME CARE 6900 7250 8630 10010 PHOM136 IP Attender Service Homecare - 12 Hrs/day for 15 days Procedure HOME CARE 7460 7830 9320 10810 PHOM137 IP Attender Service Homecare - 24 Hrs/day for 15 days Procedure HOME CARE 18630 19570 23290 27020

412 413 HUMAN CARE MEDICAL CHARITABLE TRUST Adjoining MTNL Building, Main Road, Sector 6, Dwarka, New Delhi - 110 075 Mail id: [email protected] www.manipalhospitals.com | www.hcmct.in 1800 3001 4000 / 011 4967 4967 414