sign in sign up
<<
Home , Endomicroscopy, Omentopexy, Sermorelin

Department of Health & CMS Manual System Human Services (DHHS) Pub 100-04 Medicare Claims Processing Centers for Medicare & Medicaid Services (CMS) Transmittal 2838 Date: December 13, 2013 Change Request 8548

SUBJECT: January 2014 Integrated Outpatient Code Editor (I/OCE) Specifications Version 15.0

I. SUMMARY OF CHANGES: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The attached Recurring Updated Notification applies to 100-04, Chapter 4, section 40.1.

EFFECTIVE DATE: January 1, 2014 IMPLEMENTATION DATE: January 6, 2014

Disclaimer for manual changes only: The revision date and transmittal number apply only to red italicized material. Any other material was previously published and remains unchanged. However, if this revision contains a table of contents, you will receive the new/revised information only, and not the entire table of contents.

II. CHANGES IN MANUAL INSTRUCTIONS: (N/A if manual is not updated) R=REVISED, N=NEW, D=DELETED-Only One Per Row.

R/N/D CHAPTER / SECTION / SUBSECTION / TITLE N/A

III. FUNDING: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs) and/or Carriers: No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets

For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS does not construe this as a change to the MAC statement of Work. The contractor is not obliged to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

IV. ATTACHMENTS: Recurring Update Notification

*Unless otherwise specified, the effective date is the date of service.

Attachment - Recurring Update Notification

Pub. 100-04 Transmittal: 2838 Date: December 13, 2013 Change Request: 8548

SUBJECT: January 2014 Integrated Outpatient Code Editor (I/OCE) Specifications Version 15.0

EFFECTIVE DATE: January 1, 2014 IMPLEMENTATION DATE: January 6, 2014

I. GENERAL INFORMATION

A. Background: This instruction informs the A/B MACs, the HHH MACs and the Fiscal Intermediary Shared System (FISS) that the I/OCE is being updated for January 1, 2014. The I/OCE routes all institutional outpatient claims (which includes non-OPPS hospital claims) through a single integrated OCE, which eliminates the need to update, install, and maintain two separate OCE software packages on a quarterly basis. The attached Recurring Update Notification applies to 100-04, Chapter 4, section 40.1.

B. Policy: This notification provides the Integrated OCE instructions and specifications for the Integrated OCE that will be utilized under the OPPS and Non-OPPS for hospital outpatient departments, community mental health centers, all non-OPPS providers, and for limited services when provided in a home health agency not under the Home Health Prospective Payment System or to a hospice patient for the treatment of a non-terminal illness. The I/OCE specifications will be posted to the CMS Website and can be found at http://www.cms.gov/OutpatientCodeEdit/.

II. BUSINESS REQUIREMENTS TABLE

"Shall" denotes a mandatory requirement, and "should" denotes an optional requirement.

Number Requirement Responsibility A/B D F C R Shared- Other MAC M I A H System E R H Maintainers A B H R I F M V C H M I I C M W H A E S S S F C R S 8548.1 The Shared System Maintainer shall install the X Integrated OCE (I/OCE) into their systems.

8548.2 Medicare contractors shall identify the I/OCE X X X specifications on the CMS Website at http://www.cms.gov/OutpatientCodeEdit/

III. PROVIDER EDUCATION TABLE

Number Requirement Responsibility

A/B D F C R Other MAC M I A H E R H A B H R I H M I H A E C R 8548.3 MLN Article : A provider education article related X X to this instruction will be available at http://www.cms.gov/Outreach-and- Education/Medicare-Learning-Network- MLN/MLNMattersArticles/ shortly after the CR is released. You will receive notification of the article release via the established "MLN Matters" listserv. Contractors shall post this article, or a direct link to this article, on their Web sites and include information about it in a listserv message within one week of the availability of the provider education article. In addition, the provider education article shall be included in the contractor’s next regularly scheduled bulletin. Contractors are free to supplement MLN Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

IV. SUPPORTING INFORMATION

Section A: Recommendations and supporting information associated with listed requirements: N/A

"Should" denotes a recommendation.

X-Ref Recommendations or other supporting information: Requirement Number

Section B: All other recommendations and supporting information: CR 5344, Transmittal 1107: Notification of an Integrated Outpatient Code Editor (OCE) for the July 2007 Release

V. CONTACTS

Pre-Implementation Contact(s): Yvonne Young, [email protected] , Anita Antkowiak, [email protected] , Marina Kushnirova, [email protected]

Post-Implementation Contact(s): Contact your Contracting Officer's Representative (COR) or Contractor Manager, as applicable.

VI. FUNDING

Section A: For Fiscal Intermediaries (FIs), Regional Home Health Intermediaries (RHHIs), and/or Carriers: No additional funding will be provided by CMS; Contractors activities are to be carried out with their operating budgets

Section B: For Medicare Administrative Contractors (MACs): The Medicare Administrative Contractor is hereby advised that this constitutes technical direction as defined in your contract. CMS do not construe this as a change to the MAC Statement of Work. The contractor is not obligated to incur costs in excess of the amounts allotted in your contract unless and until specifically authorized by the Contracting Officer. If the contractor considers anything provided, as described above, to be outside the current scope of work, the contractor shall withhold performance on the part(s) in question and immediately notify the Contracting Officer, in writing or by e-mail, and request formal directions regarding continued performance requirements.

(Attachments 2)

Appendix M Summary of Modifications

The modifications of the IOCE for the January 2014 release (V15.0) are summarized in the table below. Readers should also read through the entire document and note the highlighted sections, which also indicate changes from the prior release of the software.

Some IOCE modifications in the update may also be retroactively added to prior releases. If so, the retroactive date will appear in the 'Effective Date' column.

# Type Effective Edits Modification Date Affected 1. Logic 1/1/2014 24 Modify the software to maintain 28 prior quarters (7 years) of programs in each release. Remove older versions with each release. (The earliest version date included in this January 2014 release is 4/1/2007). 2. Logic 1/1/2014 - Modify Extended Assessment and Management composite APC assignment criteria (appendix K) - Delete composite APCs 8002 and 8003 - Add new EAM composite 8009 3. Logic 1/1/2014 Deactivate special logic to make separate payment for certain skin substitute products when billed with specified skin substitute application procedures (appendix N). 4. Logic 1/1/2014 87 Implement new edit to require that specific skin substitute products (high cost vs. low cost) be submitted with specific skin substitute application procedures (appendix N). Edit description: Skin substitute application procedure without appropriate skin substitute product code (RTP) Edit criteria: A list A skin substitute application procedure is submitted without a list A skin substitute product; or a list B skin substitute application procedure is submitted without a list B skin substitute product on the same date of service. 5. Logic 1/1/2014 Change the SI from N to A for any laboratory code (code list) submitted on 14x bill type. 6. Logic 1/1/2014 Deactivate the logic for assignment of payment adjustment flags 7 & 8 with modifiers FB & FC for offset payment reduction. 7. Logic 1/1/2014 Deactivate Payment Adjustment Flags 7 & 8. 8. Logic 1/1/2014 75 Modify edit 75 (Incorrect billing of modifier FB or FC) to apply if modifier FB or FC is submitted on any line/any SI on a claim. 9. Logic 1/1/2014 78 Deactivate edit 78 (() Claim lacks required radiolabeled product) 10. Logic 1/1/2014 85 Deactivate edit 85 (Claim lacks required device code or required procedure code). 11. Logic 1/1/2014 Add code 97610 to the ‘Sometimes Therapy’ list/logic (Change SI to A if submitted with a therapy revenue code or therapy modifier) 12. Logic 8/16/2013 67 Implement mid-quarter FDA approval coverage for code 90688. 13. Content 1/1/2014 - Make HCPCS/APC/SI changes as specified by CMS (data change files). 14. Content 1/1/2014 20, 40 Implement version 20.0 of the NCCI (as modified for applicable institutional providers). 15. Content 1/1/2014 22 Add new modifier PM (Post mortem) to the valid modifier list 16. Content 1/1/2014 8 Update procedure/sex conflict edit list 17. Content 1/1/2014 71, 77 Update procedure/device & device/procedure edit requirements 18. Content 1/1/2014 84 Update the add-on/primary procedure pair edit requirements for PHP claims (G0463 added as a primary code when reported with psychiatric add-on codes) 19. Doc 1/1/2014 - Revise SI descriptions: S = Procedure or service, not discounted when multiple T = Procedure or service, multiple reduction applies 20. Doc 1/1/2014 - Update appendix F, G,K, N 21. Doc 1/1/2014 - Add new flags & code lists to data files (HcpcsMap) and user manuals (app B) for edits 87. 22. Doc 1/1/2014 - Remove code lists from user manuals (app B, C) for deactivated edit (78) & modifier FB/FC logic 23. Other 1/1/2014 - Create 508-compliant versions of the specifications & Summary of Data Changes documents for publication on the CMS web site. 24. Other 1/1/2014 - Deliver quarterly software update & all related documentation and files to users via electronic means.

FINAL

Summary of Data Changes

Integrated OCE v 15.0

Effective January 1, 2014

Table of Contents

CPT codes, descriptions, and material only are Copyright 2013 American Medical Association. All Rights Reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable FARS/DFARS restrictions apply to government use.

DEFINITIONS ...... 8 APC CHANGES ...... 9 Added APCs ...... 9 Deleted APCs ...... 9 APC Description Changes ...... 11 APC Status Indicator Changes ...... 12 HCPCS/CPT PROCEDURE CODE CHANGES ...... 12 Added HCPCS/CPT Procedure Codes ...... 12 Deleted HCPCS/CPT Procedure Codes ...... 19 HCPCS Description Changes ...... 21 HCPCS Changes- APC, Status Indicator and/or Edit Assignments ...... 26 Hcpcs Edit Changes ...... 65 HCPCS Approval and/or Termination Date Changes ...... 65 Edit Assignments ...... 65 Radiolabeled product Changes ...... 66 Edit Assignments ...... 67 Procedure/ Device Pair Changes ...... 69 Add-on/Primary Procedure Pair Changes ...... 70 Skin Substitute Product Changes ...... 70 Skin Substitute Procedure Changes ...... 71 Lab Services Procedure Changes ...... 71 Skin Substitute High Cost Product Procedure Changes ...... 89 Skin Substitute Low Cost Product Procedure Changes ...... 89 Skin Substitute High Cost Procedure Changes ...... 90 Skin Substitute Low Cost Procedure Changes ...... 90 MODIFIERS ...... 90 Added Modifiers ...... 90

DEFINITIONS

 A blank in a field indicates ‘no change’

 The “old” column describes the attribute prior to the change being made in the current update, which is indicated in the “new” column. If the effective date of the change is the same as the effective date of the new update, ‘old’ describes the attribute up to the last day of the previous quarter. If the effective date is retroactive, then ‘old’ describes the attribute for the same date in the previous release of the software.

 “Unassigned”, “Pre-defined” or “Placeholder” in APC or HCPCS descriptions indicates that the APC or HCPCS code is inactive. When the APC or HCPCS code is activated, it becomes valid for use in the OCE, and a new description appears in the “new description” column, with the appropriate effective date.

 Activation Date (ActivDate) indicates the mid-quarter date of FDA approval for a drug, or the mid-quarter date of a new or changed code resulting from a National Coverage Determination (NCD). The Activation Date is the date the code becomes valid for use in the OCE. If the Activation Date is blank, then the effective date takes precedence.

 Termination Date (TermDate) indicates the mid-quarter date when a code or change becomes inactive. A code is not valid for use in the OCE after its termination date.

 For codes with SI of “Q1, Q2, and Q3”, the APC assignment is the standard APC to which the code would be assigned if it is paid separately. APC CHANGES

Added APCs

The following APC(s) were added to the IOCE, effective 01-01-14 APC APCDesc StatusIndicator 00205 Level III Male Genital Procedures T 00219 Vascular Ligation T 00326 Level I Skin Repair T 00327 Level II Skin Repair T 00328 Level III Skin Repair T 00329 Level IV Skin Repair T 00351 Level VII Anterior Segment Eye Procedures T 00420 Level II Minor Procedures X 00431 Level IV Closed Treatment Fracture T 00435 Level III Extended EEG, Sleep, and Cardiovascular S Studies 00631 Level 1 Examinations & Related Services V 00632 Level 2 Examinations & Related Services V 00633 Level 3 Examinations & Related Services V 00634 Hospital Clinic Visits V 01454 Mumps vaccine sc K 01455 Foscarnet sodium injection K 01456 Pentobarbital sodium inj K 01457 Totazoline hcl injection K 01458 Phentolaine mesylate inj K 01459 Urea injection K 01460 Interferon alfa-2a inj K 01464 Factor VIII (porcine) K 01465 Tacrolimus ex rel oral 0.1mg G 01466 Inj, vincristine sul lip 1mg G 01467 Factor IX recombinant G 01468 Inj Aripiprazole Ext Rel 1mg K 01469 Inj, Filgrastim G-CSF 1mcg K 01471 Injection, Pertuzumab, 1 mg G 01472 Inj beta interferon im 1 mcg K 01473 Interferon alfa-n3 inj K 01474 Certolizumab pegol inj 1mg K 01475 Golimumab for iv use 1mg K 08009 Extended Assessment & Management Composite V 09441 Inj, ferric carboxymaltose G 09497 Loxapine, inhalation powder G

Deleted APCs

The following APC(s) were deleted from the IOCE, effective 01-01-14 APC APCDesc 00002 Fine Needle Biopsy/Aspiration 00003 Bone Marrow Biopsy/Aspiration 00091 Level II Vascular Ligation 00092 Level I Vascular Ligation 00127 Level IV Stereotactic Radiosurgery, MRgFUS, and MEG 00133 Level I Skin Repair 00134 Level II Skin Repair 00135 Level III Skin Repair 00136 Level IV Skin Repair APC APCDesc 00137 Level V Skin Repair 00140 Esophageal Dilation without 00350 Administration of flu and PPV vaccine 00397 Vascular Imaging 00409 Red Blood Cell Tests 00604 Level 1 Hospital Clinic Visits 00605 Level 2 Hospital Clinic Visits 00606 Level 3 Hospital Clinic Visits 00607 Level 4 Hospital Clinic Visits 00608 Level 5 Hospital Clinic Visits 00728 Filgrastim 300 mcg injection 00735 Ampho b cholesteryl sulfate 00828 Gemcitabine hcl injection 00884 Rho d immune globulin inj 00900 Alglucerase injection 00917 injection 01167 Inj, epirubicin hcl 01221 Dimethyl sulfoxide 50% 01239 Rotavirus vacc 2 dose oral 01240 Apligraf skin sub 01241 Oasis wound matrix skin sub 01242 Oasis burn matrix skin sub 01243 Integra BMWD skin sub 01244 Integra DRT 01245 Dermagraft skin sub 01246 Graftjacket skin sub 01247 Integra matrix skin sub 01248 Primatrix skin sub 01249 Cymetra allograft 01250 Graftjacket express allograf 01251 Integra flowable wound matri 01252 Gammagraft skin sub 01270 Alloderm skin sub 01275 Vivaglobin, inj 01287 Alloskin skin sub 01307 Oral busulfan 01339 Oral fludarabine phosphate 01342 Matristem micromatrix 01344 Gonadorelin hydroch/ 100 mcg 01345 Theraskin 01347 Oxacillin sodium injeciton 01349 Anidulafungin injection 01351 Matristem wound matrix 01355 Itraconazole injection 01357 Inj protirelin per 250 mcg 01414 Human fibrinogen conc inj 01423 Minocycline hydrochloride 01427 Alloskin 01428 Arthroflex 01429 Flexhd/Allopatchhd/matrixhd 01432 Arbutamine hcl injection 01434 Testosterone enanthate inj 01435 Injection estrone per 1 MG 01437 Gatifloxacin injection 01438 Diazoxide injection 01441 Intraocular Fomivirsen na 01444 Oral everolimus 01446 Visualization adjunct 01447 Interferon alfacon-1 inj 01452 Memoderm/derma/tranz/integup 01453 hMatrix APC APCDesc 01461 Mediskin 01462 EZderm 01830 Power bone marrow bx needle 01840 Telescopic intraocular lens 01886 Catheter, ablation 02210 Methyldopate hcl injection 03050 Sermorelin acetate injection 07034 Somatropin injection 07036 Urokinase 250,000 IU inj 07049 Filgrastim 480 mcg injection 07051 Leuprolide acetate implant 08002 Level I Extended Assessment & Management Composite 08003 Level II Extended Assessment & Management Composite 09022 IM inj interferon beta 1-a 09023 Rho d immune globulin 09244 Regadenoson injection 09248 Inj, clevidipine butyrate 09249 Certolizumab pegol inj 09282 Inj, ceftaroline fosamil 09283 Injection, acetaminophen 09285 Patch, lidocaine/tetracaine 09292 Injection, pertuzumab 09358 SurgiMend, fetal 09360 SurgiMend, neonatal 09363 Integra Meshed Bil Wound Mat 09365 Oasis tri-layer wound matrix 09406 Iodine I-123 ioflupane

APC Description Changes

The following APC(s) had description changes, effective 01-01-14 APC Old Description New Description 00028 Level I Breast Level I Breast and Skin Surgery 00029 Level II Breast Surgery Level II Breast and Skin Surgery 00030 Level III Breast Surgery Level III Breast and Skin Surgery 00065 Level I Stereotactic Radiosurgery, MRgFUS, and IORT, MRgFUS, and MEG MEG 00066 Level II Stereotactic Radiosurgery, MRgFUS, and Level I Stereotactic Radiosurgery MEG 00067 Level III Stereotactic Radiosurgery, MRgFUS, and Level II Stereotactic Radiosurgery MEG 00093 Vascular Reconstruction/Fistula Repair without Vascular Reconstruction/Fistula Repair Device 00106 Insertion/Replacement of Pacemaker Leads and/or Insertion/Replacement/Repair of Pacemaker Electrodes Generator, Leads, and/or Electrodes 00340 Minor Ancillary Procedures Level I Minor Procedures 00648 Level IV Breast Surgery Level IV Breast and Skin Surgery 01356 Zoldedronic acid 1mg Zoledronic Acid 1mg 01463 Tc 99m tilmanocept Tc99 Tilmanocept diag 0.5mci 09130 Injection, IVIG Bivigam Inj, Imm Glob Bivigam, 500mg 09131 In ado-trastuzumab emtansine Inj, Ado-trastuzumab Emt 1mg 09294 Inj, taliglucerase alfa Inj, Taliglucerace Alfa 10 u 09295 Injection, carfilzomib Injection, Carfilzomib, 1 mg 09296 Injection, ziv-aflibercept Inj, ziv-aflibercept, 1mg 09297 Omacetaxine mepesuccinate Inj, Omacetaxine Mep, 0.01mg 09298 Injection, ocriplasmin Inj, Ocriplasmin, 0.125 mg

APC Status Indicator Changes

The following APC(s) had Status Indicator changes, effective 01-01-14 APC Old SI New SI 00947 G K 01311 G K 01353 G K 01416 G K 01426 G K 09281 G K 09284 G K 09286 G K 09287 G K

HCPCS/CPT PROCEDURE CODE CHANGES

Added HCPCS/CPT Procedure Codes

The following new HCPCS/CPT code(s) were added to the IOCE, effective 01-01-14 HCPCS CodeDesc SI APC Edit ActivDate TermDate 0335T Extraosseous joint stblztion T 00062 0336T Lap ablat uterine fibroids T 00174 0337T Endothel fxnassmnt non-invas S 00097 0338T Trnscth renal symp denrv unl S 00279 0339T Trnscth renal symp denrv bil S 00279 0340T Ablate pulm tumors + extnsn T 00423 0341T Quant pupillometry w/ rprt N 00000 0342T Thxp apheresis w/ hdl delip S 00112 0343T Transcath mtral vlve repair C 00000 0344T Transcath mtral vlve repair C 00000 0345T Transcath mtral vlve repair C 00000 0346T Ultrasound N 00000 10030 Guide cathet fluid drainage T 00006 19081 Bx breast 1st lesion strtctc T 00005 19082 Bx breast add lesion strtctc N 00000 19083 Bx breast 1st lesion us imag T 00005 19084 Bx breast add lesion us imag N 00000 19085 Bx breast 1st lesion mr imag T 00005 19086 Bx breast add lesion mr imag N 00000 19281 Perq device breast 1st imag Q2 00420 19282 Perq device breast ea imag N 00000 19283 Perq dev breast 1st strtctc Q2 00420 19284 Perq dev breast add strtctc N 00000 19285 Perq dev breast 1st us imag Q2 00420 19286 Perq dev breast add us imag N 00000 19287 Perq dev breast 1st mr guide Q2 00420 19288 Perq dev breast add mr guide N 00000 23333 Remove shoulder fb deep T 00020 23334 Shoulder prosthesis removal T 00022 23335 Shoulder prosthesis removal C 00000 33366 Trcath replace aortic valve C 00000 34841 Endovasc visc aorta 1 graft C 00000 34842 Endovasc visc aorta 2 graft C 00000 34843 Endovasc visc aorta 3 graft C 00000 34844 Endovasc visc aorta 4 graft C 00000 HCPCS CodeDesc SI APC Edit ActivDate TermDate 34845 Visc & infraren abd 1 prosth C 00000 34846 Visc & infraren abd 2 prosth C 00000 34847 Visc & infraren abd 3 prosth C 00000 34848 Visc & infraren abd 4+ prost C 00000 37217 Stent placemt retro carotid C 00000 37236 Open/perq place stent 1st T 00229 37237 Open/perq place stent ea add T 00083 37238 Open/perq place stent same T 00229 37239 Open/perq place stent ea add T 00083 37241 Vasc embolize/occlude venous T 00082 37242 Vasc embolize/occlude T 00082 37243 Vasc embolize/occlude organ T 00082 37244 Vasc embolize/occlude bleed T 00082 43191 Esophagoscopy rigid trnso dx T 00141 43192 Esophagoscp rig trnso inject T 00419 43193 Esophagoscp rig trnso biopsy T 00419 43194 Esophagoscp rig trnso rem fb T 00419 43195 Esophagoscopy rigid balloon T 00419 43196 Esophagoscp guide wire dilat T 00419 43197 Esophagoscopy flex dx brush T 00141 43198 Esophagosc flex trnsn biopsy T 00141 43211 Esophagoscop mucosal resect T 00141 43212 Esophagoscop stent placement T 00384 43213 Esophagoscopy retro balloon T 00419 43214 Esophagosc dilate balloon 30 T 00419 43229 Esophagoscopy lesion ablate T 00422 43233 Egd balloon dil esoph30 mm/> T 00419 43253 Egd us transmural injxn/mark T 00419 43254 Egd endo mucosal resection T 00141 43266 Egd endoscopic stent place T 00384 43270 Egd lesion ablation T 00419 43274 Ercp duct stent placement T 00151 43275 Ercp remove forgn body duct T 00151 43276 Ercp stent exchange w/dilate T 00151 43277 Ercp ea duct/ampulla dilate T 00151 43278 Ercp lesion ablate w/dilate T 00151 49405 Image cath fluid colxn visc T 00037 49406 Image cath fluid peri/retro T 00037 49407 Image cath fluid trns/vgnl T 00685 52356 Cysto/uretero w/ T 00429 64616 Chemodenerv musc neck dyston T 00204 64617 Chemodener muscle larynx emg T 00206 64642 Chemodenerv 1 extremity 1-4 T 00206 64643 Chemodenerv 1 extrem 1-4 ea N 00000 64644 Chemodenerv 1 extrem 5/> mus T 00206 64645 Chemodenerv 1 extrem 5/> ea N 00000 64646 Chemodenerv trunk musc 1-5 T 00206 64647 Chemodenerv trunk musc 6/> T 00206 66183 Insert ant drainage device T 00673 77293 Respirator motion mgmt simul N 00000 80155 Drug screen quant A 00000 80159 Drug screen quant clozapine A 00000 80169 Drug screen quant everolimus A 00000 80171 Drug screen quant gabapentin A 00000 80175 Drug screen quan lamotrigine A 00000 80177 Drug scrn quan levetiracetam A 00000 80180 Drug scrn quan mycophenolate A 00000 80183 Drug scrn quant oxcarbazepin A 00000 80199 Drug screen quant tiagabine A 00000 80203 Drug screen quant zonisamide A 00000 81287 Mgmt gene methylation anal A 00000 HCPCS CodeDesc SI APC Edit ActivDate TermDate 81504 Oncology tissue of origin A 00000 81507 Fetal aneuploidy trisom risk A 00000 87661 Trichomonas vaginalis amplif A 00000 88343 Immunohisto antibod add slid E 00000 28 9001F Aortic aneurysm<5cm diam ct E 00000 28 9002F Aortic aneurysm 5-5.4cm diam E 00000 28 9003F Aortic anrysm5.5-5.9cm diam M 00000 72 9004F Aortic anrysm 6/> cm diam M 00000 72 9005F Asympt carot/vrtbrbas sten E 00000 28 9006F Sympt sten-tia/strk<120days M 00000 72 9007F Other carot sten 120 days/> M 00000 72 90673 Flu vacc riv3 no preserv L 00000 92521 Evaluation of speech fluency A 00000 92522 Evaluate speech production A 00000 92523 Speech sound lang comprehen A 00000 92524 Behavral qualit analys voice A 00000 93582 Perq transcath closure pda T 00434 93583 Perq transcath septal reduxn C 00000 94669 Mechanical chest wall oscill S 00077 97610 Low frequency non-thermal us T 00013 99446 Interprof phone/online 5-10 E 00000 9 99447 Interprof phone/online 11-20 E 00000 9 99448 Interprof phone/online 21-30 E 00000 9 99449 Interprof phone/online 31/> E 00000 9 99481 Tot body syst hypothermia N 00000 99482 Selective head hypothermia N 00000 A4555 CA Tx E-Stim Electr/Transduc E 00000 9 A7047 Resp Suction Oral Interface N 00000 A9520 Tc99 Tilmanocept diag 0.5mci G 01463 A9575 Inj Gadoterate Meglumi 0.1mL N 00000 A9599 Radiopha dx beta amyloid pet N 00000 C5271 Low cost skin substitute app T 00327 55 C5272 Low cost skin substitute app N 00000 55 C5273 Low cost skin substitute app T 00328 55 C5274 Low cost skin substitute app N 00000 55 C5275 Low cost skin substitute app T 00327 55 C5276 Low cost skin substitute app N 00000 55 C5277 Low cost skin substitute app T 00327 55 C5278 Low cost skin substitute app N 00000 55 C9133 Factor IX recombinant G 01467 55 C9441 Inj, ferric carboxymaltose G 09441 55 C9497 Loxapine, inhalation powder G 09497 55 C9737 Lap esoph augmentation T 00174 55 D0393 Trtmnt simulation 3d image E 00000 9 D0394 Digital sub 2 or more images E 00000 9 D0395 Fusion 2 or more 3d images E 00000 9 D0601 Caries risk assess low risk E 00000 9 D0602 Caries risk assess mod risk E 00000 9 D0603 Caries risk assess high risk E 00000 9 D1999 Unspecified preventive proc E 00000 9 D2921 Reattach tooth fragment E 00000 9 D2941 Int therapeutic restoration E 00000 9 D2949 Restorative foundation E 00000 9 D3355 Pulpal regeneration initial E 00000 9 D3356 Pulpal regeneration interim E 00000 9 D3357 Pulpal regeneration complete E 00000 9 D3427 Periradicular surgery E 00000 9 D3428 Bone graft peri per tooth E 00000 9 D3429 Bone graft peri each addl E 00000 9 D3431 Biological materials E 00000 9 D3432 Guided tissue regeneration E 00000 9 HCPCS CodeDesc SI APC Edit ActivDate TermDate D4921 Gingival irrigation per quad E 00000 9 D5863 Overdenture complete max E 00000 9 D5864 Overdenture partial max E 00000 9 D5865 Overdenture complete mandib E 00000 9 D5866 Overdenture partial mandib E 00000 9 D5994 Peridontal medicament E 00000 9 D6011 Second stage implant surgery E 00000 9 D6013 Surgical place mini implant E 00000 9 D6052 Semi precision attach abut E 00000 9 D8694 Repair fixed retainers E 00000 9 D9985 Sales tax E 00000 9 E0766 Elec Stim Cancer Treatment Y 00000 61 E1352 O2 flow reg pos inspir press Y 00000 61 G0461 Immunohisto/cyto chem 1st st X 00433 G0462 Immunohisto/cyto chem add N 00000 G0463 Hospital outpt clinic visit Q3 00634 G9188 Beta not given no reason M 00000 72 G9189 Beta pres or already taking M 00000 72 G9190 Medical reason for no beta M 00000 72 G9191 Pt reason for no beta M 00000 72 G9192 System reason for no beta M 00000 72 G9193 Doc not eligible for dep med M 00000 72 G9194 Mdd pt treated for 180d M 00000 72 G9195 Mdd pt not treated for 180d M 00000 72 G9196 Med reason for no ceph M 00000 72 G9197 Order for ceph M 00000 72 G9198 No order for ceph no reason M 00000 72 G9199 Doc reason for no vte M 00000 72 G9200 No reason for no vte M 00000 72 G9201 Vte given upon admission M 00000 72 G9202 Hep c aby pos M 00000 72 G9203 Hep c rna done prior to med M 00000 72 G9204 No reason for no hep c rna M 00000 72 G9205 Hep c antiviral started M 00000 72 G9206 Hep c therapy started M 00000 72 G9207 Hep c genotype prior to med M 00000 72 G9208 No reason for no hep c geno M 00000 72 G9209 Hep c rna 4to12 wk after med M 00000 72 G9210 No hepc rna after med docrsn M 00000 72 G9211 No hepc rna after med no rsn M 00000 72 G9212 Doc of dsm-iv init eval M 00000 72 G9213 No doc of dsm-iv M 00000 72 G9214 Cd4 count documented M 00000 72 G9215 No cd4 count no reason M 00000 72 G9216 No pcp proph at dx no reason M 00000 72 G9217 No pcp proph low cd4 norsn M 00000 72 G9218 No pcp prop low at cd4 norsn M 00000 72 G9219 No oder pjp for med reason M 00000 72 G9220 No order for pjp for medrsn M 00000 72 G9221 Pjp proph prescribed M 00000 72 G9222 Pjp proph ordered low cd4 M 00000 72 G9223 Pjp proph ordered cd4 low M 00000 72 G9224 Medrsn no foot exam M 00000 72 G9225 Norsn no foot exam M 00000 72 G9226 3 comp foot exam completed M 00000 72 G9227 Docrsn no care plan M 00000 72 G9228 Gc chl syp documented M 00000 72 G9229 Ptrsn no gc chl syp test M 00000 72 G9230 Norsn for gc chl syp test M 00000 72 G9231 Doc esrd dia trans preg M 00000 72 G9232 Docrsn no comm comorb M 00000 72 HCPCS CodeDesc SI APC Edit ActivDate TermDate G9233 Tkr composite M 00000 72 G9234 Tkr intent M 00000 72 G9235 Gs mg composite M 00000 72 G9236 Op rad mg composite M 00000 72 G9237 Gs mg intent M 00000 72 G9238 Op rad mg intent M 00000 72 G9239 Docrsn for catheter M 00000 72 G9240 Doc pt w cath maint dia M 00000 72 G9241 Doc pt w out cath maint dia M 00000 72 G9242 Doc viral load >=200 M 00000 72 G9243 Doc viral load <200 M 00000 72 G9244 Antiviral not ordered M 00000 72 G9245 Antiviral ordered M 00000 72 G9246 No med visit in 24mo M 00000 72 G9247 1 med visit in 24mo M 00000 72 G9248 No med visit 6mo M 00000 72 G9249 Med visit w in 6mo M 00000 72 G9250 Doc of pain comfort 48hr M 00000 72 G9251 Doc no pain comfort 48hr M 00000 72 G9252 Neo detect scrn colo M 00000 72 G9253 No neo detect scrn colo M 00000 72 G9254 Doc pt dischg >2d M 00000 72 G9255 Doc pt dischg <=2d M 00000 72 G9256 Doc death after cas M 00000 72 G9257 Doc after cas M 00000 72 G9258 Doc stroke after cea M 00000 72 G9259 Doc surv no stroke after cas M 00000 72 G9260 Doc death after cea M 00000 72 G9261 Doc surv no stroke after cea M 00000 72 G9262 Doc death in hosp aaa repair M 00000 72 G9263 Doc surv in hosp aaa repair M 00000 72 G9264 Docrsn for cath maint dia M 00000 72 G9265 Doc cath >90d for maint dia M 00000 72 G9266 Norsn pt cath >=90d M 00000 72 G9267 Doc comp or mort w in 30d M 00000 72 G9268 Doc comp or mort w in 90d M 00000 72 G9269 Doc no comp or mort w in 30d M 00000 72 G9270 Doc no comp or mort w in 90d M 00000 72 G9271 LDL under 100 M 00000 72 G9272 LDL 100 and over M 00000 72 G9273 Sys<140 and dia<90 M 00000 72 G9274 BP out of nrml limits M 00000 72 G9275 Doc of non tobacco user M 00000 72 G9276 Doc of tobacco user M 00000 72 G9277 Doc daily aspirin or contra M 00000 72 G9278 Doc no daily aspirin M 00000 72 G9279 Pne scrn done doc vac done M 00000 72 G9280 Pne not given norsn M 00000 72 G9281 Pne scrn done doc not ind M 00000 72 G9282 Doc medrsn no histo type M 00000 72 G9283 Hist type doc on report M 00000 72 G9284 No hist type doc on report M 00000 72 G9285 Site not small cell lung ca M 00000 72 G9286 Doc antibio order w in 7d M 00000 72 G9287 No doc antibio order w in 7d M 00000 72 G9288 Doc medrsn no hist type rpt M 00000 72 G9289 Doc type nsm lung ca M 00000 72 G9290 No doc type nsm lung ca M 00000 72 G9291 Not nsm lung ca M 00000 72 G9292 Medrsn no pt category M 00000 72 G9293 No pt category on report M 00000 72 HCPCS CodeDesc SI APC Edit ActivDate TermDate G9294 Pt cat and thck on report M 00000 72 G9295 Non cutaneous loc M 00000 72 G9296 Doc share dec prior proc M 00000 72 G9297 No doc share dec prior proc M 00000 72 G9298 Eval risk vte card 30d prior M 00000 72 G9299 No eval risk vte card prior M 00000 72 G9300 Doc medrsn no compl antibio M 00000 72 G9301 Doc compl inf antibio M 00000 72 G9302 Norsn incomp inf antibio M 00000 72 G9303 Norsn no pros info op rpt M 00000 72 G9304 Pros info op rpt M 00000 72 G9305 No interv req for leak M 00000 72 G9306 Interv req for leak M 00000 72 G9307 No ret for surg w in 30d M 00000 72 G9308 Unplnd ret to surg w in 30d M 00000 72 G9309 No unplnd hosp readm in 30d M 00000 72 G9310 Unplnd hosp readm in 30d M 00000 72 G9311 No surg site infection M 00000 72 G9312 Surgical site infection M 00000 72 G9313 Docrsn not first line amox M 00000 72 G9314 Norsn not first line amox M 00000 72 G9315 Doc first line amox M 00000 72 G9316 Doc comm risk calc M 00000 72 G9317 No doc comm risk calc M 00000 72 G9318 Image std nomenclature M 00000 72 G9319 Image not std nomenclature M 00000 72 G9320 Medrsn no std nomenclature M 00000 72 G9321 Doc count of ct in 12mo M 00000 72 G9322 No doc count of ct in 12mo M 00000 72 G9323 Mdrsn no doc cnt of ct M 00000 72 G9324 Not all data norsn M 00000 72 G9325 Medrsn no ct rpt to reg M 00000 72 G9326 Norsn no ct rpt to reg M 00000 72 G9327 Ct rpt to reg M 00000 72 G9328 Medrsn no dicom format doc M 00000 72 G9329 Norsn no dicom format doc M 00000 72 G9340 Dicom format doc on rpt M 00000 72 G9341 Srch for ct w in 12 mos M 00000 72 G9342 No srch for ct in 12mo norsn M 00000 72 G9343 Medrsn no dicom srch M 00000 72 G9344 Sysrsn no dicom srch M 00000 72 G9345 Follow up pulm nod M 00000 72 G9346 No follow up pulm nod M 00000 72 G9347 No follow up pulm nod norsn M 00000 72 G9348 Docrsn no sinus ct dx M 00000 72 G9349 Doc sinus ct 28d M 00000 72 G9350 No doc sinus ct 28d or dx M 00000 72 G9351 Doc >1 sinus ct w 90d dx M 00000 72 G9352 Not >1 sinus ct w 90d dx M 00000 72 G9353 Medrsn >1 sinus ct w 90d dx M 00000 72 G9354 Norsn >1 sinus ct w 90d dx M 00000 72 G9355 No early ind/delivery M 00000 72 G9356 Early ind/delivery M 00000 72 G9357 Pp eval/edu perf M 00000 72 G9358 Pp eval/edu not perf M 00000 72 G9359 Doc of neg or man pos tb scn M 00000 72 G9360 No doc of neg or man pos tb M 00000 72 J0151 Inj Adenosine Diag 1mg N 00000 J0401 Inj Aripiprazole Ext Rel 1mg K 01468 J0717 Certolizumab pegol inj 1mg K 01474 J1442 Inj, Filgrastim G-CSF 1mcg K 01469 HCPCS CodeDesc SI APC Edit ActivDate TermDate J1446 Inj, tbo-filgrastim, 5 mcg E 00000 9 J1556 Inj, Imm Glob Bivigam, 500mg G 09130 J1602 Golimumab for iv use 1mg K 01475 J3060 Inj, Taliglucerace Alfa 10 u G 09294 J3489 Zoledronic Acid 1mg K 01356 J7301 Skyla 13.5mg E 00000 50 J7316 Inj, Ocriplasmin, 0.125 mg G 09298 J7508 Tacrolimus ex rel oral 0.1mg G 01465 J9047 Injection, Carfilzomib, 1 mg G 09295 J9262 Inj, Omacetaxine Mep, 0.01mg G 09297 J9306 Injection, Pertuzumab, 1 mg G 01471 J9354 Inj, Ado-trastuzumab Emt 1mg G 09131 J9371 Inj, vincristine sul lip 1mg G 01466 J9400 Inj, ziv-aflibercept, 1mg G 09296 L0455 TLSO flex trnk sj-t9 pre ots A 00000 L0457 TLSO flex trnk sj-ss pre ots A 00000 L0467 TLSO r fram soft pre ots A 00000 L0469 TLSO rig fram pelvic pre ots A 00000 L0641 LO rig pos pnl L1-L5 pre ots A 00000 L0642 LO sag ri an/pos pnl pre ots A 00000 L0643 LSO sag ctr rigi pos pre ots A 00000 L0648 LSO sag r an/pos pnl pre ots A 00000 L0649 LSO sc r pos/lat pnl pre ots A 00000 L0650 LSO sc r ant/pos pnl pre ots A 00000 L0651 LSO sag-co shell pnl pre ots A 00000 L1812 Ko elastic w/joints pre ots A 00000 L1833 Ko adj jnt pos r sup pre ots A 00000 L1848 Ko dbl upright w/air pre ots A 00000 L3678 So hard plas stabili pre ots A 00000 L3809 Whfo w/o joints pre ots A 00000 L3916 Who nontorsion jnts pre ots A 00000 L3918 Metacarp fx orthosis pre ots A 00000 L3924 Hfo without joints pre ots A 00000 L3930 Hfo nontorsion jnts pre ots A 00000 L4361 Pneuma/vac walk boot pre ots A 00000 L4387 Non-pneum walk boot pre ots A 00000 L4397 Static or dynami afo pre ots A 00000 L5969 Ak/ft Power Asst Incl Motors A 00000 L8679 Imp Neurosti Pls Gn Any Type A 00000 Q0161 Chlorpromazine hcl 5mg oral N 00000 Q2028 Inj, Sculptra, 0.5mg B 00000 62 Q3027 Inj beta interferon im 1 mcg K 01472 Q3028 Inj beta interferon sq 1 mcg E 00000 9 Q4137 Amnioexcel or biodexcel, 1cm N 00000 Q4138 BioDfence DryFlex, 1cm N 00000 Q4139 Amnio or biodmatrix, inj 1cc N 00000 Q4140 Biodfence 1cm N 00000 Q4141 Alloskin ac, 1 cm N 00000 Q4142 Xcm biologic tiss matrix 1cm N 00000 Q4143 Repriza, 1cm N 00000 Q4145 Epifix, inj, 1mg N 00000 Q4146 Tensix, 1cm N 00000 Q4147 Architect ecm, 1cm N 00000 Q4148 Neox 1k, 1cm N 00000 Q4149 Excellagen, 0.1 cc N 00000 S9960 Air ambulanc nonemerg fixed E 00000 9 S9961 Air ambulan nonemerg rotary E 00000 9 T4544 Adlt disp und/pull on abv xl E 00000 9

Deleted HCPCS/CPT Procedure Codes

The following HCPCS/CPT code(s) were deleted from the IOCE, effective 01-01-14 HCPCS CodeDesc 0078T Endovasc aort repr w/device 0079T Endovasc visc extnsn repr 0080T Endovasc aort repr rad s&i 0081T Endovasc visc extnsn s&i 0124T Conjunctival drug placement 0183T Wound ultrasound 0185T Comptr probability analysis 0186T Suprachoroidal drug delivery 0192T Insert ant segment drain ext 0260T Hypthrm bdy neonate 28d/< 0261T Hypthrm head neonate 28d/< 0318T Replace aortic valve tthorac 13150 Cmplx rpr e/n/e/l 1.0 cm/< 19102 Bx breast percut w/image 19103 Bx breast percut w/device 19290 Place needle wire breast 19291 Place needle wire breast 19295 Place breast clip percut 23331 Remove shoulder foreign body 23332 Remove shoulder foreign body 32201 Drain percut lung lesion 37204 Transcatheter occlusion 37205 Transcath iv stent percut 37206 Transcath iv stent/perc addl 37207 Transcath iv stent open 37208 Transcath iv stent/open addl 37210 Embolization uterine fibroid 42802 Biopsy of throat 43219 endoscopy 43228 Esoph endoscopy ablation 43256 Uppr gi endoscopy w/stent 43258 Operative upper GI endoscopy 43267 Endo cholangiopancreatograph 43268 Endo cholangiopancreatograph 43269 Endo cholangiopancreatograph 43271 Endo cholangiopancreatograph 43272 Endo cholangiopancreatograph 43456 Dilate esophagus 43458 Dilate esophagus 44901 Drain app abscess percut 47011 Percut drain lesion 48511 Drain pancreatic pseudocyst 49021 Drain abdominal abscess 49041 Drain percut abdom abscess 49061 Drain percut retroper absc 50021 Renal abscess percut drain 58823 Drain pelvic abscess percut 64613 Destroy nerve neck muscle 64614 Destroy nerve extrem musc 75960 Transcath iv stent rs&i 77031 Stereotact guide for brst bx 77032 Guidance for needle breast 92506 Speech/hearing evaluation C1204 Tc 99m tilmanocept C9130 Injection, IVIG Bivigam C9131 In ado-trastuzumab emtansine C9292 Injection, pertuzumab HCPCS CodeDesc C9294 Inj, taliglucerase alfa C9295 Injection, carfilzomib C9296 Injection, ziv-aflibercept C9297 Omacetaxine mepesuccinate C9298 Injection, ocriplasmin C9736 Lap ablate uteri fibroid rf G0275 Renal angio, cardiac cath G8459 Doc pt rec antivir treat G8462 Pt inelig couns no antvir tx G8463 Pt rec antiviral treat doc G8553 Prescrip transmit via ERx sy G8556 Ref to doc otolog eval G8557 Pt inelig ref otolog eval G8558 No ref to doc otolog eval G8588 Sys BP <140 G8589 Sys BP >= 140 G8590 Dia BP < 90 G8591 Dia BP >= 90 G8592 No BP measure G8596 No LDL perf G8603 Spok lang comp score G8604 No high score spok lang G8605 No spok lang comp score G8606 Attention score G8607 No high score attention G8608 No attention score G8609 Memory score G8610 No high score memory G8611 No memory score G8612 Moto speech score G8613 No high score moto speech G8614 No moto speech score G8615 Reading score G8616 No high score reading G8617 No reading score G8618 Spok lang exp score G8619 No high score spok lang exp G8620 No spok lang exp score G8621 Writing score G8622 No high score writing G8623 No writing score G8624 Swallowing score G8625 No high score swallowing G8626 No swallowing score G8642 Hrdshp rural w/o internet G8643 Hrdshp w/o suff pharm w/eRx G8644 EP no prescribe priv G8741 Not tx spoken lang G8742 Not tx attention G8743 Not tx memory G8744 Not tx motor speech G8745 Not tx reading G8746 Not tx spoken lang express G8747 Not tx writing G8748 Not tx swallowing G8790 Systolic <130mmHg G8791 Systolic 130-139mmHg G8792 Systolic >=140mmHg G8793 Diastolic <80mmHg G8794 Diastolic 80-89mmHg G8795 Diastolic >=90mmHg HCPCS CodeDesc G8796 BP not doc G8799 Anticoag ordered G8800 Doc reas anticoag not order G8801 Anticoag not ordered G8812 Pt not elig CTA, duplex, MRA G8813 CTA, duplex, MRA performed G8814 No CTA, duplex, MRA G8827 Aneurysm <= 5.5cm for women G8835 Asymptom no trans G8919 Mst rcnt sys bp <140mmg G8920 Mst rcnt sys bp >=140mmhg G8921 Mst rcnt dia bp <90mmhg G8922 Mst rcnt dia bp >=90mmhg G8945 Aneurysm <=6 cm for men G8954 Pt data rpt qual clin db reg J0152 Adenosine injection J0718 Certolizumab pegol inj J1440 Filgrastim 300 mcg injection J1441 Filgrastim 480 mcg injection J3487 Zoledronic acid J3488 Reclast injection J9002 Doxil injection L0430 Dewall posture protector Q0090 Skyla 13.5mg Q0165 Prochlorperazine maleate10mg Q0168 Dronabinol 5mg oral Q0170 Promethazine HCl 25 mg oral Q0171 Chlorpromazine HCl 10mg oral Q0172 Chlorpromazine HCl 25mg oral Q0176 Perphenazine 8mg oral Q0178 Hydroxyzine pamoate 50mg Q2027 Sculptra injection Q2033 Influenza Vaccine, (Flublok) Q2051 Zoldedronic acid 1mg Q3025 IM inj interferon beta 1-a Q3026 Subc inj interferon beta-1a S3625 Maternal triple screen test S3626 Maternal serum quad screen S3833 Comp APC sequence S3834 Sing mutation APC

HCPCS Description Changes

The following code descriptions were changed, effective 01-01-14 HCPCS Old Description New Description 0052T Replace component heart syst Replace thrc unit hrt syst 0053T Replace component heart syst Replace implantable hrt syst 0054T Bone surgery using computer Bone srgry cmptr fluor image 0055T Bone surgery using computer Bone srgry cmptr ct/mri imag 0092T Artific disc addl Artific disc addl cervical 0095T Artific diskectomy addl Rmvl artific disc addl crvcl 0195T Prescrl fuse w/o instr L5/S1 Prescrl fuse w/o instr l5/s1 0196T Prescrl fuse w/o instr L4/L5 Prescrl fuse w/o instr l4/l5 0263T Im B1 mrw cel ther cmpl Im b1 mrw cel ther cmpl 0264T Im B1 mrw cel ther xcl hrvst Im b1 mrw cel ther xcl hrvst 0265T Im B1 mrw cel ther hrvst onl Im b1 mrw cel ther hrvst onl 0306T icar ischm mntr interr eval Icar ischm mntr interr eval 0575F HIV rna plan care docd Hiv rna plan care docd 1040F Dsm-iv info mdd docd Dsm-5 info mdd docd HCPCS Old Description New Description 1052F Type location activityasses Type location activityassess 1118F GERD symps assessed 12 month Gerd symps assessed 12 month 1130F Bk pain + fxn assessed Bk pain & fxn assessed 1205F EPI etiol synd rvwd and docd Epi etiol synd rvwd and docd 2021F Dilat macul+ exam done Dilat maculor exam done 21015 Resect face tum < 2 cm Resect face/scalp tum < 2 cm 21016 Resect face tum 2 cm/> Resect face/scalp tum 2 cm/> 21557 Resect neck tum < 5 cm Resect neck thorax tumor<5cm 21558 Resect neck tum 5 cm/> Resect neck tumor 5 cm/> 22586 Prescrl fuse w/ instr l5/s1 Prescrl fuse w/ instr l5-s1 22904 Resect abd tum < 5 cm Radical resect abd tumor<5cm 22905 Resect abd tum 5 cm/> Rad resect abd tumor 5 cm/> 23077 Resect shoulder tum < 5 cm Resect shoulder tumor < 5 cm 23078 Resect shoulder tum 5 cm/> Resect shoulder tumor 5 cm/> 26117 Exc hand tum ra < 3 cm Rad resect hand tumor < 3 cm 26118 Exc hand tum ra 3 cm/> Rad resect hand tumor 3 cm/> 3016F Pt scrnd unhlthy OH use Pt scrnd unhlthy oh use 3082F Kt/v >1.2 Kt/v <1.2 3115F Quant results activity +symp Quant results activity &symp 3267F path rprt w/ pt pn cat et al Path rprt w/ pt pn cat et al 3269F Bone scn b/4 txmnt/aftr Dx Bone scn b/4 txmnt/aftr dx 3270F No bone scn b/4 txmnt/aftrDx No bone scn b/4 txmnt/aftrdx 3274F Prost Cncr rsk not lw/md/hgh Prost cncr rsk not lw/md/hgh 3278F Serum lvls CA/iPTH/lpd ord Serum lvls ca/ipth/lpd ord 3280F Hgb lvl 11-12.9 g/dL Hgb lvl 11-12.9 g/dl 3285F IOP down <15% of pre-svc lvl Iop down <15% of pre-svc lvl 3290F Pt=D(Rh)- and unsensitized Pt=d(rh)- and unsensitized 3300F AJCC stage docd b/4 thxpy Ajcc stage docd b/4 thxpy 3316F ER- or PR- breast cancer Er- or pr- breast cancer 3321F AJCC cncr 0/IA melan docd Ajcc cncr 0/ia melan docd 33222 Revise pocket pacemaker Relocation pocket pacemaker 33223 Revise pocket for defib Relocate pocket for defib 3370F AJCC brst cncr stage 0 docd Ajcc brst cncr stage 0 docd 3376F AJCC brstcncr stage 2 docd Ajcc brstcncr stage 2 docd 3378F AJCC brstcncr stage 3 docd Ajcc brstcncr stage 3 docd 3380F AJCC brstcncr stage 4 docd Ajcc brstcncr stage 4 docd 3382F AJCC cln cncr stage 0 docd Ajcc cln cncr stage 0 docd 3384F AJCC cln cncr stage 1 docd Ajcc cln cncr stage 1 docd 3386F AJCC cln cncr stage 2 docd Ajcc cln cncr stage 2 docd 3388F AJCC cln cncr stage 3 docd Ajcc cln cncr stage 3 docd 3390F AJCC cln cncr stage 4 docd Ajcc cln cncr stage 4 docd 3455F TB scrng done-interpd 6mon Tb scrng done-interpd 6mon 3475F Disease progn RA poor docd Disease progn ra poor docd 3476F Disease progn RA good docd Disease progn ra good docd 3491F HIV unsure baby of HIV+moms Hiv unsure baby of hiv+moms 3494F CD4+cell count <200cells/mm3 Cd4+cell count <200cells/mm3 3497F CD4+ cell percentage <15% Cd4+ cell percentage <15% 3502F HIV rna vrl ld

HCPCS Changes- APC, Status Indicator and/or Edit Assignments

The following code(s) had an APC and/or SI and/or edit change, effective 10-01-12 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit G0409 CORF related serv 15 mins ea M B 72 62

The following code(s) had an APC and/or SI and/or edit change, effective 07-01-13 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 90688 Flu vacc 4 val 3 yrs plus im E L 28 N/A

The following code(s) had an APC and/or SI and/or edit change, effective 10-01-13 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit A9586 Florbetapir F18 E N 9 N/A

The following code(s) had an APC and/or SI and/or edit change, effective 01-01-14 **A blank in the field indicates no change. HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 0071T U/s leiomyomata ablate <200 00067 00065 0072T U/s leiomyomata ablate >200 00067 00065 0172T Lumbar spine process addl 00052 00000 T N 0190T Place intraoc radiation src 00237 00000 T N 0206T Cptr dbs alys car elec dta 00340 00420 0214T Njx paravert w/us cer/thor 00204 00000 T N 0215T Njx paravert w/us cer/thor 00204 00000 T N 0217T Njx paravert w/us lumb/sac 00204 00000 T N 0218T Njx paravert w/us lumb/sac 00204 00000 T N 0222T Plmt post facet implt addl 00050 00000 T N 0227T hra w/biopsy 00146 00147 0229T Njx tfrml eprl w/us cer/thor 00206 00000 T N 0231T Njx tfrml eprl w/us lumb/sac 00206 00000 T N 0232T Njx platelet plasma 00340 00420 0241T Esoph motility w/stim/perf 00361 00000 X N 0269T Rev/remvl crtd sns dev total T Q2 0270T Rev/remvl crtd sns dev lead T Q2 0271T Rev/remvl crtd sns dev gen T Q2 0284T Periph field stimul revise T Q2 0285T Periph field stimul analys 00218 00216 0299T Esw wound healing init wound 00133 00326 0300T Esw wound healing addl wound 00133 00000 T N 0307T Rmvl icar ischm mntrng dvce T Q2 0308T Insj ocular telescope prosth 00234 00351 0314T Laps rmvl vgl arry & pls gen T Q2 0315T Rmvl vagus nerve pls gen T Q2 0322T Rmvl subq defib pls gen T Q2 0323T Rmvl & replc subq pls gen T Q2 0324T Rmvl subq defib electrode T Q2 0331T Heart symp image plnr 00398 00377 0332T Heart symp image plnr spect 00398 00377 0334T Perq stablj sacroiliac joint 00208 00052 0575F Hiv rna plan care docd M E 72 9 10021 Fna w/o image 00002 00015 1040F Dsm-5 info mdd docd M E 72 9 11001 Debride infected skin add-on 00013 00000 T N 11010 Debride skin at fx site 00019 00020 11012 Deb skin bone at fx site 00019 00020 11045 Deb subq tissue add-on 00016 00000 T N 11046 Deb musc/fascia add-on 00016 00000 T N 11047 Deb bone add-on 00019 00000 T N 11101 Biopsy skin add-on 00013 00000 T N 11201 Remove skin tags add-on 00013 00000 T N 11621 Exc s/n/h/f/g mal+mrg 0.6-1 00019 00020 11640 Exc f/e/e/n/l mal+mrg 0.5cm< 00019 00020 11641 Exc f/e/e/n/l mal+mrg 0.6-1 00019 00020 11642 Exc f/e/e/n/l mal+mrg 1.1-2 00019 00020 11720 Debride nail 1-5 00013 00012 11721 Debride nail 6 or more 00013 00012 11730 Removal of nail plate 00013 00015 11732 Remove nail plate add-on 00013 00000 T N 11760 Repair of nail bed 00133 00326 11762 Reconstruction of nail bed 00136 00328 11920 Correct skin color 6.0 cm/< 00134 00327 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 11921 Corect skin color 6.1-20.0cm 00134 00327 11922 Correct skin color ea 20.0cm 00134 00000 T N 11950 Tx contour defects 1 cc/< 00134 00327 11951 Tx contour defects 1.1-5.0cc 00134 00327 11952 Tx contour defects 5.1-10cc 00134 00327 11954 Tx contour defects >10.0 cc 00133 00326 11960 Insert tissue expander(s) 00137 00329 11971 Remove tissue expander(s) T Q2 11976 Remove contraceptive capsule T Q2 11980 Implant hormone pellet(s) 00340 00420 11981 Insert drug implant device 00340 00420 11982 Remove drug implant device 00340 00420 11983 Remove/insert drug implant 00340 00420 12001 Rpr s/n/ax/gen/trnk 2.5cm/< 00133 00013 12002 Rpr s/n/ax/gen/trnk2.6-7.5cm 00133 00013 12004 Rpr s/n/ax/gen/trk7.6-12.5cm 00133 00013 12005 Rpr s/n/a/gen/trk12.6-20.0cm 00133 00013 12006 Rpr s/n/a/gen/trk20.1-30.0cm 00133 00326 12007 Rpr s/n/ax/gen/trnk >30.0 cm 00133 00013 12011 Rpr f/e/e/n/l/m 2.5 cm/< 00133 00013 12013 Rpr f/e/e/n/l/m 2.6-5.0 cm 00133 00013 12014 Rpr f/e/e/n/l/m 5.1-7.5 cm 00133 00013 12015 Rpr f/e/e/n/l/m 7.6-12.5 cm 00133 00013 12016 Rpr fe/e/en/l/m 12.6-20.0 cm 00133 00013 12017 Rpr fe/e/en/l/m 20.1-30.0 cm 00133 00013 12018 Rpr f/e/e/n/l/m >30.0 cm 00134 00013 12020 Closure of split wound 00135 00327 12021 Closure of split wound 00134 00326 12031 Intmd rpr s/a/t/ext 2.5 cm/< 00134 00326 12032 Intmd rpr s/a/t/ext 2.6-7.5 00134 00326 12034 Intmd rpr s/tr/ext 7.6-12.5 00134 00326 12035 Intmd rpr s/a/t/ext 12.6-20 00134 00327 12036 Intmd rpr s/a/t/ext 20.1-30 00134 00327 12037 Intmd rpr s/tr/ext >30.0 cm 00134 00327 12041 Intmd rpr n-hf/genit 2.5cm/< 00133 00326 12042 Intmd rpr n-hf/genit2.6-7.5 00134 00326 12044 Intmd rpr n-hf/genit7.6-12.5 00134 00326 12045 Intmd rpr n-hf/genit12.6-20 00134 00326 12046 Intmd rpr n-hf/genit20.1-30 00134 00326 12047 Intmd rpr n-hf/genit >30.0cm 00134 00327 12051 Intmd rpr face/mm 2.5 cm/< 00134 00326 12052 Intmd rpr face/mm 2.6-5.0 cm 00134 00326 12053 Intmd rpr face/mm 5.1-7.5 cm 00134 00326 12054 Intmd rpr face/mm 7.6-12.5cm 00133 00326 12055 Intmd rpr face/mm 12.6-20 cm 00134 00326 12056 Intmd rpr face/mm 20.1-30.0 00134 00326 12057 Intmd rpr face/mm >30.0 cm 00134 00326 13100 Cmplx rpr trunk 1.1-2.5 cm 00135 00327 13101 Cmplx rpr trunk 2.6-7.5 cm 00135 00327 13102 Cmplx rpr trunk addl 5cm/< 00134 00000 T N 13120 Cmplx rpr s/a/l 1.1-2.5 cm 00134 00326 13121 Cmplx rpr s/a/l 2.6-7.5 cm 00134 00327 13122 Cmplx rpr s/a/l addl 5 cm/> 00133 00000 T N 13131 Cmplx rpr f/c/c/m/n/ax/g/h/f 00134 00326 13132 Cmplx rpr f/c/c/m/n/ax/g/h/f 00135 00327 13133 Cmplx rpr f/c/c/m/n/ax/g/h/f 00134 00000 T N 13151 Cmplx rpr e/n/e/l 1.1-2.5 cm 00135 00327 13152 Cmplx rpr e/n/e/l 2.6-7.5 cm 00135 00327 13153 Cmplx rpr e/n/e/l addl 5cm/< 00134 00000 T N 13160 Late closure of wound 00137 00328 14000 Tis trnfr trunk 10 sq cm/< 00136 00328 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 14001 Tis trnfr trunk 10.1-30sqcm 00136 00328 14020 Tis trnfr s/a/l 10 sq cm/< 00136 00328 14021 Tis trnfr s/a/l 10.1-30 sqcm 00136 00328 14040 Tis trnfr f/c/c/m/n/a/g/h/f 00136 00328 14041 Tis trnfr f/c/c/m/n/a/g/h/f 00136 00328 14060 Tis trnfr e/n/e/l 10 sq cm/< 00136 00328 14061 Tis trnfr e/n/e/l10.1-30sqcm 00136 00328 14301 Tis trnfr any 30.1-60 sq cm 00137 00329 14302 Tis trnfr addl 30 sq cm/< 00137 00000 T N 14350 Filleted finger/toe flap 00137 00328 15002 Wound prep trk/arm/leg 00135 00327 15003 Wound prep addl 100 cm 00135 00000 T N 15004 Wound prep f/n/hf/g 00134 00327 15005 Wnd prep f/n/hf/g addl cm 00135 00000 T N 15040 Harvest cultured skin graft 00134 00327 15050 Skin pinch graft 00134 00327 15100 Skin splt grft trnk/arm/leg 00137 00329 15101 Skin splt grft t/a/l add-on 00137 00000 T N 15110 Epidrm autogrft trnk/arm/leg 00135 00329 15111 Epidrm autogrft t/a/l add-on 00135 00000 T N 15115 Epidrm a-grft face/nck/hf/g 00136 00328 15116 Epidrm a-grft f/n/hf/g addl 00134 00000 T N 15120 Skn splt a-grft fac/nck/hf/g 00137 00329 15121 Skn splt a-grft f/n/hf/g add 00137 00000 T N 15130 Derm autograft trnk/arm/leg 00136 00329 15131 Derm autograft t/a/l add-on 00136 00000 T N 15135 Derm autograft face/nck/hf/g 00136 00328 15136 Derm autograft f/n/hf/g add 00136 00000 T N 15150 Cult skin grft t/arm/leg 00134 00328 15151 Cult skin grft t/a/l addl 00134 00000 T N 15152 Cult skin graft t/a/l +% 00134 00000 T N 15155 Cult skin graft f/n/hf/g 00134 00329 15156 Cult skin grft f/n/hfg add 00134 00000 T N 15157 Cult epiderm grft f/n/hfg +% 00134 00000 T N 15200 Skin full graft trunk 00136 00329 15201 Skin full graft trunk add-on 00136 00000 T N 15220 Skin full graft sclp/arm/leg 00136 00328 15221 Skin full graft add-on 00135 00000 T N 15240 Skin full grft face/genit/hf 00136 00328 15241 Skin full graft add-on 00134 00000 T N 15260 Skin full graft een & lips 00136 00328 15261 Skin full graft add-on 00136 00000 T N 15271 Skin sub graft trnk/arm/leg 00134 00328 15272 Skin sub graft t/a/l add-on 00133 00000 T N 15273 Skin sub grft t/arm/lg child 00135 00329 15274 Skn sub grft t/a/l child add 00134 00000 T N 15275 Skin sub graft face/nk/hf/g 00134 00328 15276 Skin sub graft f/n/hf/g addl 00133 00000 T N 15277 Skn sub grft f/n/hf/g child 00135 00328 15278 Skn sub grft f/n/hf/g ch add 00134 00000 T N 15570 Skin pedicle flap trunk 00137 00328 15572 Skin pedicle flap arms/legs 00137 00328 15574 Pedcle fh/ch/ch/m/n/ax/g/h/f 00137 00328 15576 Pedicle e/n/e/l/ntroral 00137 00328 15600 Delay flap trunk 00137 00329 15610 Delay flap arms/legs 00137 00329 15620 Delay flap f/c/c/n/ax/g/h/f 00137 00328 15630 Delay flap eye/nos/ear/lip 00137 00328 15650 Transfer skin pedicle flap 00137 00328 15731 Forehead flap w/vasc pedicle 00137 00329 15732 Muscle-skin graft head/neck 00137 00328 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 15734 Muscle-skin graft trunk 00137 00329 15736 Muscle-skin graft arm 00137 00328 15738 Muscle-skin graft leg 00137 00329 15740 Island pedicle flap graft 00136 00328 15750 Neurovascular pedicle flap 00137 00328 15760 Composite skin graft 00137 00328 15770 Derma-fat-fascia graft 00137 00329 15775 Hair trnspl 1-15 punch grfts 00133 00326 15776 Hair trnspl >15 punch grafts 00133 00326 15777 Acellular derm matrix implt 00136 00000 T N 15781 Dermabrasion segmental face 00019 00020 15787 Abrasion lesions add-on 00013 00000 T N 15819 Plastic surgery neck 00134 00328 15820 Revision of lower eyelid 00137 00328 15821 Revision of lower eyelid 00137 00328 15822 Revision of upper eyelid 00137 00328 15823 Revision of upper eyelid 00137 00328 15824 Removal of forehead wrinkles 00137 00328 15825 Removal of neck wrinkles 00137 00328 15826 Removal of brow wrinkles 00137 00329 15828 Removal of face wrinkles 00137 00329 15829 Removal of skin wrinkles 00137 00329 15830 Exc skin abd 00022 00030 15840 Nerve palsy fascial graft 00137 00329 15841 Nerve palsy muscle graft 00137 00329 15842 Nerve palsy microsurg graft 00137 00329 15845 Skin and muscle repair face 00137 00329 15847 Exc skin abd add-on 00022 00000 T N 15852 Dressing change not for burn 00340 00420 15860 Test for blood flow in graft 00340 00420 15876 Suction lipectomy head&neck 00137 00329 15877 Suction lipectomy trunk 00137 00329 15878 Suction lipectomy upr extrem 00137 00329 15879 Suction lipectomy lwr extrem 00137 00329 15920 Removal of tail bone ulcer 00019 00020 15922 Removal of tail bone ulcer 00137 00328 15934 Remove sacrum pressure sore 00137 00329 15935 Remove sacrum pressure sore 00137 00329 15936 Remove sacrum pressure sore 00136 00328 15937 Remove sacrum pressure sore 00137 00328 15944 Remove hip pressure sore 00137 00328 15945 Remove hip pressure sore 00137 00327 15946 Remove hip pressure sore 00137 00329 15952 Remove thigh pressure sore 00136 00329 15953 Remove thigh pressure sore 00136 00329 15956 Remove thigh pressure sore 00136 00328 15958 Remove thigh pressure sore 00136 00329 16000 Initial treatment of burn(s) 00013 00012 17003 Destruct premalg les 2-14 00012 00000 T N 17312 Mohs addl stage 00694 00000 T N 17314 Mohs addl stage t/a/l 00694 00000 T N 17315 Mohs surg addl block 00694 00000 T N 17340 Cryotherapy of skin 00013 00012 19001 Drain breast lesion add-on 00002 00000 T N 19126 Excision addl breast lesion 00028 00000 T N 19328 Removal of breast implant T Q2 19330 Removal of implant material T Q2 20101 Explore wound chest 00137 00328 20102 Explore wound abdomen 00137 00328 2028F Foot exam performed M E 72 9 20520 Removal of foreign body 00019 00020 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 20660 Apply rem fixation device 00138 00139 T Q2 20665 Removal of fixation device 00340 00420 X Q2 20670 Removal of support implant T Q2 20680 Removal of support implant T Q2 20694 Remove bone fixation device T Q2 20910 Remove cartilage for graft 00137 00327 20912 Remove cartilage for graft 00137 00329 20920 Removal of fascia for graft 00136 00329 20922 Removal of fascia for graft 00136 00329 20926 Removal of tissue for graft 00136 00329 21044 Removal of jaw bone lesion 00254 00256 21110 Interdental fixation T Q2 21195 Reconst lwr jaw w/o fixation 00254 00256 21230 Rib cartilage graft 00254 00256 21315 Closed tx nose fx w/o stablj 00253 00252 21445 Treat dental ridge fracture 00254 00256 22103 Remove extra spine segment 00208 00000 T N 22315 Closed tx vert fx w/manj 00139 00431 22522 Percut vertebroplasty addl 00050 00000 T N 22525 Percut kyphoplasty add-on 00052 00000 T N 22614 Spine fusion extra segment 00208 00000 T N 22851 Apply spine prosth device 00050 00000 T N 23397 Muscle transfers 00052 00051 23465 Repair shoulder capsule 00052 00051 23520 Treat clavicle dislocation 00138 00431 23540 Treat clavicle dislocation 00129 00138 23600 Treat humerus fracture 00129 00138 23605 Treat humerus fracture 00139 00431 23625 Treat humerus fracture 00139 00431 23650 Treat shoulder dislocation 00129 00138 23665 Treat dislocation/fracture 00138 00139 23675 Treat dislocation/fracture 00129 00138 23921 Amputation follow-up surgery 00136 00329 24160 Remove elbow joint implant T Q2 24164 Remove radius head implant T Q2 24200 Removal of arm foreign body 00019 00020 24344 Reconstruct elbow lat ligmnt 00052 00051 24346 Reconstruct elbow med ligmnt 00052 00051 24400 Revision of humerus 00052 00051 24500 Treat humerus fracture 00129 00138 24505 Treat humerus fracture 00129 00138 24530 Treat humerus fracture 00129 00138 24565 Treat humerus fracture 00129 00138 24576 Treat humerus fracture 00129 00138 24577 Treat humerus fracture 00129 00138 24600 Treat elbow dislocation 00129 00138 24620 Treat elbow fracture 00139 00431 24640 Treat elbow dislocation 00129 00138 24650 Treat radius fracture 00129 00138 24675 Treat ulnar fracture 00129 00138 25250 Removal of wrist prosthesis T Q2 25251 Removal of wrist prosthesis T Q2 25259 Manipulate wrist w/anesthes 00139 00431 25365 Revise radius & ulna 00052 00051 25391 Lengthen radius or ulna 00052 00051 25400 Repair radius or ulna 00052 00051 25425 Repair/graft radius or ulna 00052 00051 25440 Repair/graft wrist bone 00052 00051 25505 Treat fracture of radius 00138 00139 25535 Treat fracture of ulna 00129 00138 25600 Treat fracture radius/ulna 00129 00138 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 25605 Treat fracture radius/ulna 00138 00139 25622 Treat wrist bone fracture 00129 00138 25624 Treat wrist bone fracture 00138 00139 25630 Treat wrist bone fracture 00129 00138 25635 Treat wrist bone fracture 00129 00138 25650 Treat wrist bone fracture 00129 00138 25660 Treat wrist dislocation 00129 00138 25675 Treat wrist dislocation 00129 00138 25690 Treat wrist dislocation 00139 00431 25830 Fusion radioulnar jnt/ulna 00052 00051 25929 Amputation follow-up surgery 00136 00328 26125 Release palm contracture 00053 00000 T N 26320 Removal of implant from hand T Q2 26605 Treat metacarpal fracture 00129 00138 26607 Treat metacarpal fracture 00139 00431 26641 Treat thumb dislocation 00129 00138 26675 Treat hand dislocation 00129 00138 26700 Treat knuckle dislocation 00129 00138 26705 Treat knuckle dislocation 00129 00138 26706 Pin knuckle dislocation 00139 00431 26725 Treat finger fracture each 00129 00138 26740 Treat finger fracture each 00129 00138 26742 Treat finger fracture each 00129 00138 26755 Treat finger fracture each 00129 00138 26775 Treat finger dislocation 00045 00426 T S 26861 Fusion of finger jnt add-on 00054 00000 T N 26863 Fuse/graft added joint 00054 00000 T N 27193 Treat pelvic ring fracture 00129 00138 27194 Treat pelvic ring fracture 00045 00139 27230 Treat thigh fracture 00129 00138 27250 Treat hip dislocation 00129 00138 27252 Treat hip dislocation 00045 00139 27257 Treat hip dislocation 00045 00139 27265 Treat hip dislocation 00129 00138 27267 Cltx thigh fx 00129 00431 27358 Remove femur lesion/fixation 00050 00000 T N 27409 Repair of knee ligaments 00052 00051 27501 Treatment of thigh fracture 00129 00138 27502 Treatment of thigh fracture 00139 00431 27503 Treatment of thigh fracture 00129 00138 27508 Treatment of thigh fracture 00129 00138 27517 Treat thigh fx growth plate 00129 00138 27520 Treat kneecap fracture 00129 00138 27530 Treat knee fracture 00129 00138 27532 Treat knee fracture 00139 00431 27538 Treat knee fracture(s) 00129 00138 27550 Treat knee dislocation 00129 00138 27562 Treat kneecap dislocation 00045 00139 27652 Repair/graft achilles tendon 00052 00051 27692 Revise additional leg tendon 00051 00000 T N 27704 Removal of ankle implant T Q2 27750 Treatment of tibia fracture 00129 00138 27752 Treatment of tibia fracture 00139 00431 27760 Cltx medial ankle fx 00129 00138 27762 Cltx med ankle fx w/mnpj 00139 00431 27780 Treatment of fibula fracture 00129 00138 27786 Treatment of ankle fracture 00129 00138 27788 Treatment of ankle fracture 00129 00138 27808 Treatment of ankle fracture 00129 00138 27810 Treatment of ankle fracture 00129 00139 27816 Treatment of ankle fracture 00129 00138 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 27818 Treatment of ankle fracture 00138 00139 27824 Treat lower leg fracture 00129 00138 27825 Treat lower leg fracture 00139 00431 27840 Treat ankle dislocation 00129 00138 28400 Treatment of heel fracture 00129 00138 28435 Treatment of ankle fracture 00129 00431 28470 Treat metatarsal fracture 00129 00138 28475 Treat metatarsal fracture 00129 00138 28495 Treat big toe fracture 00129 00138 28515 Treatment of toe fracture 00129 00138 28570 Treat foot dislocation 00129 00138 28575 Treat foot dislocation 00139 00431 28630 Treat toe dislocation 00129 00138 28635 Treat toe dislocation 00045 00431 28665 Treat toe dislocation 00045 00426 T S 29580 Application of paste boot 00058 00426 29582 Apply multlay comprs upr leg 00059 00426 29824 Shoulder arthroscopy/surgery 00041 00042 29826 Shoulder arthroscopy/surgery 00041 00000 T N 29830 Elbow arthroscopy 00041 00042 29835 Elbow arthroscopy/surgery 00041 00042 29836 Elbow arthroscopy/surgery 00041 00042 29892 Ankle arthroscopy/surgery 00052 00051 29901 Mcp joint arthroscopy surg 00041 00042 30000 Drainage of nose lesion 00251 00250 30300 Remove nasal foreign body 00340 00420 30801 Ablate inf turbinate superf 00253 00252 30915 Ligation nasal sinus artery 00092 00219 30920 Ligation upper jaw artery 00092 00219 3092F Mdd in remission M E 72 9 31200 Removal of ethmoid sinus 00254 00256 31231 Nasal endoscopy dx 00072 00071 31235 Nasal/sinus endoscopy dx 00074 00073 31237 Nasal/sinus endoscopy surg 00074 00073 31238 Nasal/sinus endoscopy surg 00074 00073 31239 Nasal/sinus endoscopy surg 00075 00074 31240 Nasal/sinus endoscopy surg 00075 00074 31254 Revision of ethmoid sinus 00075 00074 31256 Exploration maxillary sinus 00075 00074 31267 Endoscopy maxillary sinus 00075 00074 31297 Sinus endo w/balloon dil 00075 00074 31510 Laryngoscopy with biopsy 00074 00073 31511 Remove foreign body larynx 00072 00071 31515 Laryngoscopy for aspiration 00074 00073 31525 Dx laryngoscopy excl nb 00074 00073 31526 Dx laryngoscopy w/oper scope 00074 00073 31527 Laryngoscopy for treatment 00075 00074 31528 Laryngoscopy and dilation 00075 00074 31529 Laryngoscopy and dilation 00075 00074 31530 Laryngoscopy w/fb removal 00074 00073 31531 Laryngoscopy w/fb & op scope 00074 00073 31541 Larynscop w/tumr exc + scope 00075 00074 31545 Remove vc lesion w/scope 00075 00073 31561 Larynscop remve cart + scop 00075 00074 31570 Laryngoscope w/vc inj 00074 00073 31571 Laryngoscop w/vc inj + scope 00075 00074 31575 Diagnostic laryngoscopy 00072 00071 31576 Laryngoscopy with biopsy 00074 00073 31577 Remove foreign body larynx 00073 00072 31578 Removal of larynx lesion 00074 00073 31579 Diagnostic laryngoscopy 00073 00072 HCPCS CodeDesc Old APC New APC Old SI New SI Old Edit New Edit 31632 Bronchoscopy/lung bx addl 00076 00000 T N 31633 Bronchoscopy/needle bx addl 00076 00000 T N 31637 Bronchoscopy stent add-on 00076 00000 T N 31649 Bronchial valve remov addl T Q2 31651 Bronchial valve addl insert 00415 00000 T N 31717 Bronchial brush biopsy 00073 00072 31720 Clearance of airways 00077 00102 31730 Intro windpipe wire/tube 00073 00072 3216F Pt immunity to hep b docd M E 72 9 3218F Rna tstng hep c docd done M E 72 9 3220F Hep c quant rna tstng docd M E 72 9 32552 Remove lung catheter T Q2 3266F Hepc gn tstng docd b/4txmnt M E 72 9 33215 Reposition pacing-defib lead 00105 00103 33222 Relocation pocket pacemaker 00136 00328 33223 Relocate pocket for defib 00136 00328 33226 Reposition l ventric lead 00105 00103 33233 Removal of pm generator T Q2 33234 Removal of pacemaker system T Q2 33235 Removal pacemaker electrode T Q2 33241 Remove pulse generator T Q2 33244 Remove eltrd transven T Q2 33284 Remove pat-active ht record 00020 00021 T Q2 3490F History aids-defining cond M E 72 9 3492F History cd4+ cell count <350 M E 72 9 3493F No hist cd4+ cell count <350 M E 72 9 3500F Cd4+cell cnt/% docd as done M E 72 9 3502F Hiv rna vrl ld

Hcpcs Edit Changes

The following code(s) were added to the list of female procedures, effective 01-01-14 Hcpcs 0336T 81507 J7301

HCPCS Approval and/or Termination Date Changes

The following code(s) had approval and /or termination date changes HCPCS Old ApprovalDt New ApprovalDt Old TerminationDt New TerminationDt 90688 0 20130816

Edit Assignments

The following code(s) were added to edit 67, 68, 69 or 83 effective 07-01-13 HCPCS Edit# ActivDate TermDate 90688 67 20130816

The following code(s) were added to the conditional bilateral list, effective 01-01-14 HCPCS 19081 19083 19085 19281 19283 19285 19287 23333 23334 23335 37217 37236 37237 37238 37239 52356 64616 64617 66183

Radiolabeled product Changes

The following code(s) were removed from the radiolabeled product list, effective 01-01-14 HCPCS A4641 A4642 A9500 A9501 A9502 A9503 A9504 A9505 A9507 A9508 A9509 A9510 A9512 A9516 A9517 A9521 A9524 A9526 A9527 A9528 A9529 A9530 A9531 A9532 A9536 A9537 A9538 A9539 A9540 A9541 A9542 A9543 A9544 A9545 A9546 A9547 A9548 A9550 A9551 A9552 A9553 A9554 A9555 A9556 A9557 A9558 A9559 A9560 A9561 A9562 A9563 A9564 A9566 A9567 A9568 A9569 A9570 HCPCS A9571 A9572 A9580 A9582 A9584 A9600 A9604 A9699 C1716 C1717 C1719 C2616 C2634 C2635 C2636 C2638 C2639 C2640 C2641 C2642 C2643 C2698 C2699 C9898

Edit Assignments

The following code(s) were removed from the nuclear medicine list, effective 01-01-14 HCPCS 78012 78013 78014 78015 78016 78018 78020 78070 78071 78072 78075 78099 78102 78103 78104 78110 78111 78120 78121 78122 78130 78135 78140 78185 78190 78191 78195 78199 78201 78202 HCPCS 78205 78206 78215 78216 78226 78227 78230 78231 78232 78258 78261 78262 78264 78270 78271 78272 78278 78282 78290 78291 78299 78300 78305 78306 78315 78320 78399 78414 78428 78445 78451 78452 78453 78454 78456 78457 78458 78459 78466 78468 78469 78472 78473 78481 78483 78491 78492 78494 78496 78499 78579 78580 78582 78597 78598 78599 78600 78601 78605 78606 78607 HCPCS 78608 78610 78630 78635 78645 78647 78650 78660 78699 78700 78701 78707 78708 78709 78710 78725 78730 78740 78761 78799 78800 78801 78802 78803 78804 78805 78806 78807 78811 78812 78813 78814 78815 78816 78999

Procedure/ Device Pair Changes

The following procedure/device code pair requirements were removed, effective 01-01-14 Proc Device1 37205 C1874 37205 C1875 37205 C1876 37205 C1877 37205 C2617 37205 C2625 37206 C1874 37206 C1875 37206 C1876 37206 C1877 37206 C2617 37206 C2625 37207 C1874 37207 C1875 37207 C1876 37207 C1877 37207 C2617 37207 C2625 37208 C1874 Proc Device1 37208 C1875 37208 C1876 37208 C1877 37208 C2617 37208 C2625 43256 C1874 43256 C1875 43256 C1876 43256 C1877 43256 C2617 43256 C2625 64569 C1778

Add-on/Primary Procedure Pair Changes

The following add-on/primary procedure pair requirements were added, effective 01-01-14 Addon Primary 90785 G0463 90833 G0463 90836 G0463 90838 G0463

Skin Substitute Product Changes

The following code(s) were removed from the skin substitute product list, effective 01-01-14 HCPCS C9358 C9360 C9363 Q4101 Q4102 Q4103 Q4104 Q4105 Q4106 Q4107 Q4108 Q4110 Q4111 Q4112 Q4113 Q4114 Q4115 Q4116 Q4118 Q4119 Q4121 Q4122 Q4123 Q4124 Q4125 Q4126 Q4127 Q4128 Q4131 Q4132 HCPCS Q4133 Q4134 Q4135 Q4136

Skin Substitute Procedure Changes

The following code(s) were removed from the skin substitute procedure list, effective 01-01-14 HCPCS 15271 15272 15273 15274 15275 15276 15277 15278

Lab Services Procedure Changes

The following code(s) were added to the lab services procedure list, effective 01-01-14 HCPCS 36415 80047 80048 80051 80053 80061 80069 80074 80076 80102 80150 80152 80154 80156 80157 80158 80160 80162 80164 80166 80168 80170 80172 80173 80174 80176 80178 80182 80184 80185 80186 80188 80190 80192 HCPCS 80194 80195 80196 80197 80198 80200 80201 80202 80299 80400 80402 80406 80408 80410 80412 80414 80415 80416 80417 80418 80420 80422 80424 80426 80428 80430 80432 80434 80435 80436 80438 80439 80440 81000 81001 81002 81003 81005 81007 81015 81020 81025 81050 81099 82000 82003 82009 82010 82013 82016 82017 82024 82030 82040 82042 82043 82044 82045 82055 82075 82085 HCPCS 82088 82101 82103 82104 82105 82106 82107 82108 82120 82127 82128 82131 82135 82136 82139 82140 82143 82145 82150 82154 82157 82160 82163 82164 82172 82175 82180 82190 82205 82232 82239 82240 82247 82248 82252 82261 82270 82271 82272 82274 82286 82300 82306 82308 82310 82330 82331 82340 82355 82360 82365 82370 82373 82374 82375 82376 82378 82379 82380 82382 82383 HCPCS 82384 82387 82390 82397 82415 82435 82436 82438 82441 82465 82480 82482 82485 82486 82487 82488 82489 82491 82492 82495 82507 82520 82523 82525 82528 82530 82533 82540 82541 82542 82543 82544 82550 82552 82553 82554 82565 82570 82575 82585 82595 82600 82607 82608 82610 82615 82626 82627 82633 82634 82638 82646 82649 82651 82652 82654 82656 82657 82658 82664 82666 HCPCS 82668 82670 82671 82672 82677 82679 82690 82693 82696 82705 82710 82715 82725 82726 82728 82731 82735 82742 82746 82747 82757 82759 82760 82775 82776 82777 82784 82785 82787 82800 82803 82805 82810 82820 82930 82938 82941 82943 82945 82946 82947 82948 82950 82951 82952 82953 82955 82960 82962 82963 82965 82975 82977 82978 82979 82980 82985 83001 83002 83003 83008 HCPCS 83009 83010 83012 83013 83014 83015 83018 83020 83021 83026 83030 83033 83036 83037 83045 83050 83051 83055 83060 83065 83068 83069 83070 83071 83080 83088 83090 83150 83491 83497 83498 83499 83500 83505 83516 83518 83519 83520 83525 83527 83528 83540 83550 83570 83582 83586 83593 83605 83615 83625 83630 83631 83632 83633 83634 83655 83661 83662 83663 83664 83670 HCPCS 83690 83695 83698 83700 83701 83704 83718 83719 83721 83727 83735 83775 83785 83788 83789 83805 83825 83835 83840 83857 83858 83861 83864 83866 83872 83873 83874 83876 83880 83883 83885 83887 83915 83916 83918 83919 83921 83925 83930 83935 83937 83945 83950 83951 83970 83986 83987 83992 83993 84022 84030 84035 84060 84061 84066 84075 84078 84080 84081 84085 84087 HCPCS 84100 84105 84106 84110 84112 84119 84120 84126 84127 84132 84133 84134 84135 84138 84140 84143 84144 84145 84146 84150 84152 84153 84154 84155 84156 84157 84160 84163 84165 84166 84181 84182 84202 84203 84206 84207 84210 84220 84228 84233 84234 84235 84238 84244 84252 84255 84260 84270 84275 84285 84295 84300 84302 84305 84307 84311 84315 84375 84376 84377 84378 HCPCS 84379 84392 84402 84403 84425 84430 84431 84432 84436 84437 84439 84442 84443 84445 84446 84449 84450 84460 84466 84478 84479 84480 84481 84482 84484 84485 84488 84490 84510 84512 84520 84525 84540 84545 84550 84560 84577 84578 84580 84583 84585 84586 84588 84590 84591 84597 84600 84620 84630 84681 84702 84703 84704 84830 84999 85002 85004 85007 85008 85009 85013 HCPCS 85014 85018 85025 85027 85032 85041 85044 85045 85046 85048 85049 85055 85130 85170 85175 85210 85220 85230 85240 85244 85245 85246 85247 85250 85260 85270 85280 85290 85291 85292 85293 85300 85301 85302 85303 85305 85306 85307 85335 85337 85345 85347 85348 85360 85362 85366 85370 85378 85379 85380 85384 85385 85390 85397 85400 85410 85415 85420 85421 85441 85445 HCPCS 85460 85461 85475 85520 85525 85530 85536 85540 85547 85549 85555 85557 85576 85597 85598 85610 85611 85612 85613 85635 85651 85652 85660 85670 85675 85705 85730 85732 85810 85999 86000 86001 86003 86005 86021 86022 86023 86038 86039 86060 86063 86140 86141 86146 86147 86148 86152 86155 86156 86157 86160 86161 86162 86171 86185 86200 86215 86225 86226 86235 86243 HCPCS 86255 86256 86277 86280 86294 86300 86301 86304 86305 86308 86309 86310 86316 86317 86318 86320 86325 86327 86329 86331 86332 86334 86335 86336 86337 86340 86341 86343 86344 86352 86353 86355 86356 86357 86359 86360 86361 86367 86376 86378 86382 86384 86386 86403 86406 86430 86431 86480 86481 86590 86592 86593 86602 86603 86606 86609 86611 86612 86615 86617 86618 HCPCS 86619 86622 86625 86628 86631 86632 86635 86638 86641 86644 86645 86648 86651 86652 86653 86654 86658 86663 86664 86665 86666 86668 86671 86674 86677 86682 86684 86687 86688 86689 86692 86694 86695 86696 86698 86701 86702 86703 86704 86705 86706 86707 86708 86709 86710 86711 86713 86717 86720 86723 86727 86729 86732 86735 86738 86741 86744 86747 86750 86753 86756 HCPCS 86757 86759 86762 86765 86768 86771 86774 86777 86778 86780 86784 86787 86788 86789 86790 86793 86800 86803 86804 86805 86806 86807 86808 86812 86813 86816 86817 86821 86822 86825 86826 86828 86829 86830 86831 86832 86833 86834 86835 86849 86940 86941 87001 87003 87015 87040 87045 87046 87070 87071 87073 87075 87076 87077 87081 87084 87086 87088 87101 87102 87103 HCPCS 87106 87107 87109 87110 87116 87118 87140 87143 87147 87149 87150 87152 87153 87158 87164 87166 87168 87169 87172 87176 87177 87181 87184 87185 87186 87187 87188 87190 87197 87205 87206 87207 87209 87210 87220 87230 87250 87252 87253 87254 87255 87260 87265 87267 87269 87270 87271 87272 87273 87274 87275 87276 87277 87278 87279 87280 87281 87283 87285 87290 87299 HCPCS 87300 87301 87305 87320 87324 87327 87328 87329 87332 87335 87336 87337 87338 87339 87340 87341 87350 87380 87385 87389 87390 87391 87400 87420 87425 87427 87430 87449 87450 87451 87470 87471 87472 87475 87476 87477 87480 87481 87482 87485 87486 87487 87490 87491 87492 87493 87495 87496 87497 87498 87500 87501 87502 87503 87510 87511 87512 87515 87516 87517 87520 HCPCS 87521 87522 87525 87526 87527 87528 87529 87530 87531 87532 87533 87534 87535 87536 87537 87538 87539 87540 87541 87542 87550 87551 87552 87555 87556 87557 87560 87561 87562 87580 87581 87582 87590 87591 87592 87620 87621 87622 87631 87632 87633 87640 87641 87650 87651 87652 87653 87660 87797 87798 87799 87800 87801 87802 87803 87804 87807 87808 87809 87810 87850 HCPCS 87880 87899 87900 87901 87902 87903 87904 87905 87906 87910 87912 87999 88130 88140 88142 88143 88147 88148 88150 88152 88153 88154 88155 88164 88165 88166 88167 88174 88175 88230 88233 88235 88237 88239 88240 88241 88245 88248 88249 88261 88262 88263 88264 88267 88269 88271 88272 88273 88274 88275 88280 88283 88285 88289 88371 88372 88720 88738 88740 88741 88749 HCPCS 89050 89051 89055 89060 89125 89160 89190 89300 89310 89320 89321 89322 89325 89329 89330 89331

Skin Substitute High Cost Product Procedure Changes

The following code(s) were added to the skin substitute high cost product list, effective 01-01-14 HCPCS Q4101 Q4106 Q4107 Q4110 Q4116 Q4122 Q4125 Q4126 Q4127 Q4131 Q4132 Q4133 Q4134

Skin Substitute Low Cost Product Procedure Changes

The following code(s) were added to the skin substitute low cost product list, effective 01-01-14 HCPCS C9358 C9360 C9363 Q4100 Q4102 Q4103 Q4104 Q4105 Q4108 Q4111 Q4115 Q4117 Q4119 Q4120 Q4121 Q4123 Q4124 HCPCS Q4128 Q4129 Q4135 Q4136 Q4137 Q4138 Q4140 Q4141 Q4142 Q4143 Q4146 Q4147 Q4148

Skin Substitute High Cost Procedure Changes

The following code(s) were added to the skin substitute high cost procedure list, effective 01-01-14 HCPCS 15271 15273 15275 15277

Skin Substitute Low Cost Procedure Changes

The following code(s) were added to the skin substitute low cost procedure list, effective 01-01-14 HCPCS C5271 C5273 C5275 C5277

MODIFIERS

Added Modifiers

The following modifier(s) were added to the list of valid modifiers, effective 01-01-14 modif ACTIVATIONDATE PM 0