Blue Cross Medicare Advantage Radiology Code List

Category CPT® Code CPT® Code Description 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other 3D Imaging 76376 tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other 3D Imaging 76377 tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation

BMRI 77046 Magnetic resonance imaging, breast, without contrast material; unilateral

BMRI 77047 Magnetic resonance imaging, breast, without contrast material; bilateral Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion BMRI 77048 detection, characterization and pharmacokinetic analysis), when performed; unilateral Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection (CAD real-time lesion BMRI 77049 detection, characterization and pharmacokinetic analysis), when performed; bilateral Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside, dobutamine, milrinone, or other Contrast 93463 agent) including assessing hemodynamic measurements before, during, after and repeat pharmacologic agent administration, when Pharmaceutical performed (List separately in addition to code for primary procedure) Contrast A9577 Injection, gadobenate dimeglumine (multihance), per ml Pharmaceutical Contrast A9578 Injection, gadobenate dimeglumine (multihance multipack), per ml Pharmaceutical Contrast A9580 Sodium fluoride F-18, diagnostic, per study dose, up to 30 millicuries Pharmaceutical Contrast Q9951 Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9953 Injection, iron-based magnetic resonance contrast agent, per ml Pharmaceutical Contrast Q9954 Oral magnetic resonance contrast agent, per 100 ml Pharmaceutical

Effective: 1/1/2020 Category CPT® Code CPT® Code Description Contrast Q9958 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9959 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9960 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9961 High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9962 High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9963 High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9964 High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml Pharmaceutical Contrast Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml Pharmaceutical CT 70450 Computed tomography, head or brain; without contrast material CT 70460 Computed tomography, head or brain; with contrast material(s) CT 70470 Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections CT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material CT 70481 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast CT 70482 material(s) and further sections CT 70486 Computed tomography, maxillofacial area; without contrast material CT 70487 Computed tomography, maxillofacial area; with contrast material(s)

CT 70488 Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections

CT 70490 Computed tomography, soft tissue neck; without contrast material CT 70491 Computed tomography, soft tissue neck; with contrast material(s)

CT 70492 Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image CT 70496 postprocessing Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image CT 70498 postprocessing

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

CT 71250 Computed tomography, thorax; without contrast material CT 71260 Computed tomography, thorax; with contrast material(s) CT 71270 Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and CT 71275 image postprocessing CT 72125 Computed tomography, cervical spine; without contrast material CT 72126 Computed tomography, cervical spine; with contrast material

CT 72127 Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections

CT 72128 Computed tomography, thoracic spine; without contrast material CT 72129 Computed tomography, thoracic spine; with contrast material

CT 72130 Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections

CT 72131 Computed tomography, lumbar spine; without contrast material CT 72132 Computed tomography, lumbar spine; with contrast material CT 72133 Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image CT 72191 postprocessing CT 72192 Computed tomography, pelvis; without contrast material CT 72193 Computed tomography, pelvis; with contrast material(s) CT 72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections CT 73200 Computed tomography, upper extremity; without contrast material CT 73201 Computed tomography, upper extremity; with contrast material(s)

CT 73202 Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if performed, and CT 73206 image postprocessing CT 73700 Computed tomography, lower extremity; without contrast material CT 73701 Computed tomography, lower extremity; with contrast material(s)

CT 73702 Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and CT 73706 image postprocessing CT 74150 Computed tomography, abdomen; without contrast material CT 74160 Computed tomography, abdomen; with contrast material(s)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

CT 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and CT 74174 image postprocessing Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image CT 74175 postprocessing CT 74176 Computed tomography, abdomen and pelvis; without contrast material CT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) CT 74178 and further sections in one or both body regions CT 74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) including non- CT 74262 contrast images, if performed CT 74263 Computed tomographic (CT) colonography, screening, including image postprocessing Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), CT 75635 including noncontrast images, if performed, and image postprocessing CT 76380 Computed tomography, limited or localized follow-up study CT 76497 Unlisted computed tomography procedure (eg, diagnostic, interventional) CT 77011 Computed tomography guidance for stereotactic localization CT 77013 Computed tomography guidance for, and monitoring of, parenchymal tissue ablation CT 77078 Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of parametric maps CT 0042T with determination of cerebral blood flow, cerebral blood volume, and mean transit time

Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review CT 0174T for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary procedure)

Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review CT 0175T for interpretation and report, with or without digitization of film radiographic images, chest radiograph(s), performed remote from primary interpretation CT G0297 Low dose ct scan (ldct) for lung cancer screening CT S8080 Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical CT S8092 Electron beam computed tomography (also known as ultrafast ct, cine ct) DEXA 77080 Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine) Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) (eg, radius, wrist, DEXA 77081 heel) DEXA 77082 Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; vertebral fracture assessment Dual-energy x-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including DEXA 77085 vertebral fracture assessment

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

DEXA 77086 Vertebral fracture assessment via dual-energy x-ray absorptiometry (DXA) DIAGNOSTIC 74260 Duodenography, hypotonic RADIOLOGY

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural DIAGNOSTIC 75956 hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial endoprosthesis plus descending thoracic RADIOLOGY aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, intramural DIAGNOSTIC 75957 hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial endoprosthesis plus descending RADIOLOGY thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation

DIAGNOSTIC Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, 75958 RADIOLOGY dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological supervision and interpretation DIAGNOSTIC Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as needed, to level of 75959 RADIOLOGY celiac origin, radiological supervision and interpretation DIAGNOSTIC Manual application of stress performed by physician or other qualified health care professional for joint radiography, including 77071 RADIOLOGY contralateral joint if indicated DIAGNOSTIC 77072 Bone age studies RADIOLOGY DIAGNOSTIC 77073 Bone length studies (orthoroentgenogram, scanogram) RADIOLOGY DIAGNOSTIC 77077 Joint survey, single view, 2 or more joints (specify) RADIOLOGY

Diagnostic Radiology Q9982 Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries

Diagnostic Radiology Q9983 Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries Fluoroscopy (separate procedure), up to 1 hour physician or other qualified health care professional time, other than 71023 or 71034 FLUOROSCOPY 76000 (eg, cardiac fluoroscopy) Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic physician or other FLUOROSCOPY 76001 qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial biopsy)

Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast injections through access site or FLUOROSCOPY 77001 catheter with related venography radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure) INTERVENTIONAL Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate venous access, 75901 RAD radiologic supervision and interpretation

Effective: 1/1/2020 Category CPT® Code CPT® Code Description INTERVENTIONAL Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device lumen, radiologic 75902 RAD supervision and interpretation INTERVENTIONAL 78808 Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid adenoma) RAD INTERVENTIONAL 75705 Angiography, spinal, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75710 Angiography, extremity, unilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75716 Angiography, extremity, bilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75726 Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and interpretation S&I INTERVENTIONAL 75731 Angiography, adrenal, unilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75733 Angiography, adrenal, bilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation S&I INTERVENTIONAL 75741 Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75743 Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75746 Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation S&I INTERVENTIONAL 75756 Angiography, internal mammary, radiological supervision and interpretation S&I INTERVENTIONAL Angiography, selective, each additional vessel studied after basic examination, radiological supervision and interpretation (List 75774 S&I separately in addition to code for primary procedure)

Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, INTERVENTIONAL 75791 image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and S&I adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation INTERVENTIONAL 75801 Lymphangiography, extremity only, unilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75803 Lymphangiography, extremity only, bilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75805 Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75807 Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation S&I

Effective: 1/1/2020 Category CPT® Code CPT® Code Description INTERVENTIONAL Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, ventriculoperitoneal shunt, 75809 S&I indwelling infusion pump), radiological supervision and interpretation INTERVENTIONAL 75810 Splenoportography, radiological supervision and interpretation S&I INTERVENTIONAL 75820 Venography, extremity, unilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75822 Venography, extremity, bilateral, radiological supervision and interpretation S&I INTERVENTIONAL 75825 Venography, caval, inferior, with serialography, radiological supervision and interpretation S&I INTERVENTIONAL 75827 Venography, caval, superior, with serialography, radiological supervision and interpretation S&I INTERVENTIONAL 75831 Venography, renal, unilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75833 Venography, renal, bilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75840 Venography, adrenal, unilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75842 Venography, adrenal, bilateral, selective, radiological supervision and interpretation S&I INTERVENTIONAL 75860 Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and interpretation S&I INTERVENTIONAL 75870 Venography, superior sagittal sinus, radiological supervision and interpretation S&I INTERVENTIONAL 75872 Venography, epidural, radiological supervision and interpretation S&I INTERVENTIONAL 75880 Venography, orbital, radiological supervision and interpretation S&I INTERVENTIONAL 75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation S&I INTERVENTIONAL 75887 Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and interpretation S&I INTERVENTIONAL 75889 Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation S&I INTERVENTIONAL 75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation S&I INTERVENTIONAL Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological supervision and 75893 S&I interpretation INTERVENTIONAL 75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation S&I

Effective: 1/1/2020 Category CPT® Code CPT® Code Description INTERVENTIONAL 75896 Transcatheter therapy, infusion, other than for thrombolysis, radiological supervision and interpretation S&I INTERVENTIONAL Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other than for 75898 S&I thrombolysis INTERVENTIONAL 75945 Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; initial vessel S&I INTERVENTIONAL Intravascular ultrasound (non-coronary vessel), radiological supervision and interpretation; each additional non-coronary vessel (List 75946 S&I separately in addition to code for primary procedure)

Angiography, arteriovenous shunt (eg, dialysis patient fistula/graft), complete evaluation of dialysis access, including fluoroscopy, INTERVENTIONAL 75962 image documentation and report (includes injections of contrast and all necessary imaging from the arterial anastomosis and S&I adjacent artery through entire venous outflow including the inferior or superior vena cava), radiological supervision and interpretation INTERVENTIONAL Transluminal balloon angioplasty, each additional peripheral artery other than renal or other visceral artery, iliac or lower extremity, 75964 S&I radiological supervision and interpretation (List separately in addition to code for primary procedure) INTERVENTIONAL 75966 Transluminal balloon angioplasty, renal or other visceral artery, radiological supervision and interpretation S&I INTERVENTIONAL Transluminal balloon angioplasty, each additional visceral artery, radiological supervision and interpretation (List separately in 75968 S&I addition to code for primary procedure) INTERVENTIONAL 75970 Transcatheter biopsy, radiological supervision and interpretation S&I INTERVENTIONAL 75978 Transluminal balloon angioplasty, venous (eg, subclavian stenosis), radiological supervision and interpretation S&I INTERVENTIONAL 75980 Percutaneous transhepatic biliary drainage with contrast monitoring, radiological supervision and interpretation S&I INTERVENTIONAL Percutaneous placement of drainage catheter for combined internal and external biliary drainage or of a drainage stent for internal 75982 S&I biliary drainage in patients with an inoperable mechanical biliary obstruction, radiological supervision and interpretation INTERVENTIONAL Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), radiological 75984 S&I supervision and interpretation INTERVENTIONAL Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, abscess, specimen 75989 S&I collection), with placement of catheter, radiological supervision and interpretation MAMMOGRAPHY 77053 Mammary ductogram or galactogram, single duct, radiological supervision and interpretation MAMMOGRAPHY 77054 Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation MAMMOGRAPHY G0202 Screening mammography, producing direct digital image, bilateral, all views; CAD included MAMMOGRAPHY G0204 Diagnostic mammography, producing direct 2-d digital image, bilateral, all views; CAD included MAMMOGRAPHY G0206 Diagnostic mammography, producing direct 2-d digital image, unilateral, all views; CAD included MAMMOGRAPHY G0279 Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206) MR 70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) MR 70540 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

MR 70542 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast material(s) and MR 70543 further sequences MR 70544 Magnetic resonance angiography, head; without contrast material(s) MR 70545 Magnetic resonance angiography, head; with contrast material(s)

MR 70546 Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further sequences

MR 70547 Magnetic resonance angiography, neck; without contrast material(s) MR 70548 Magnetic resonance angiography, neck; with contrast material(s)

MR 70549 Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further sequences

MR 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material MR 70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by contrast material(s) and MR 70553 further sequences Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body part movement MR 70554 and/or visual stimulation, not requiring physician or psychologist administration Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional MR 70555 testing Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast MR 71550 material(s) Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with contrast MR 71551 material(s) Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); without contrast MR 71552 material(s), followed by contrast material(s) and further sequences MR 71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) MR 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material MR 72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) MR 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material MR 72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) MR 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material MR 72149 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and MR 72156 further sequences; cervical Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and MR 72157 further sequences; thoracic Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast material(s) and MR 72158 further sequences; lumbar

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

MR 72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) MR 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) MR 72196 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s)

MR 72197 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and further sequences

MR 72198 Magnetic resonance angiography, pelvis, with or without contrast material(s) MR 73218 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) MR 73219 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by contrast MR 73220 material(s) and further sequences MR 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) MR 73222 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by contrast material(s) MR 73223 and further sequences MR 73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s) MR 73718 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) MR 73719 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by contrast MR 73720 material(s) and further sequences MR 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material MR 73722 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by contrast material(s) MR 73723 and further sequences MR 73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) MR 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) MR 74182 Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast material(s) and further MR 74183 sequences MR 74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; single or first MR 74712 gestation Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; each additional MR 74713 gestation (List separately in addition to code for primary procedure) MR 76390 Magnetic resonance spectroscopy MR 76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional) Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or placement of localization MR 77021 device) radiological supervision and interpretation

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

MR 77022 Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation

MR 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, intracranial for MR 0398T movement disorder including stereotactic navigation and frame placement when performed MR C8900 Magnetic resonance angiography with contrast, abdomen MR C8901 Magnetic resonance angiography without contrast, abdomen MR C8902 Magnetic resonance angiography without contrast followed by with contrast, abdomen MR C8903 Magnetic resonance imaging with contrast, breast; unilateral MR C8905 Magnetic resonance imaging without contrast followed by with contrast, breast; unilateral MR C8906 Magnetic resonance imaging with contrast, breast; bilateral MR C8908 Magnetic resonance imaging without contrast followed by with contrast, breast; bilateral MR C8909 Magnetic resonance angiography with contrast, chest (excluding myocardium) MR C8910 Magnetic resonance angiography without contrast, chest (excluding myocardium) MR C8911 Magnetic resonance angiography without contrast followed by with contrast, chest (excluding myocardium) MR C8912 Magnetic resonance angiography with contrast, lower extremity MR C8913 Magnetic resonance angiography without contrast, lower extremity MR C8914 Magnetic resonance angiography without contrast followed by with contrast, lower extremity MR C8918 Magnetic resonance angiography with contrast, pelvis MR C8919 Magnetic resonance angiography without contrast, pelvis MR C8920 Magnetic resonance angiography without contrast followed by with contrast, pelvis MR C8931 Magnetic resonance angiography with contrast, spinal canal and contents MR C8932 Magnetic resonance angiography without contrast, spinal canal and contents MR C8933 Magnetic resonance angiography without contrast followed by with contrast, spinal canal and contents MR C8934 Magnetic resonance angiography with contrast, upper extremity MR C8935 Magnetic resonance angiography without contrast, upper extremity MR C8936 Magnetic resonance angiography without contrast followed by with contrast, upper extremity MR S8037 Magnetic resonance cholangiopancreatography (mrcp) MR S8042 Magnetic resonance imaging (mri), low-field MRI 76391 Magnetic resonance (eg, vibration) elastography

Nuclear Medicine 78012 Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, when performed)

Nuclear Medicine 78013 Thyroid imaging (including vascular flow, when performed); Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative measurement(s) (including Nuclear Medicine 78014 stimulation, suppression, or discharge, when performed)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Nuclear Medicine 78015 Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) Nuclear Medicine 78016 Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) Nuclear Medicine 78018 Thyroid carcinoma metastases imaging; whole body Nuclear Medicine 78020 Thyroid carcinoma metastases uptake (List separately in addition to code for primary procedure) Nuclear Medicine 78070 Parathyroid planar imaging (including subtraction, when performed); Nuclear Medicine 78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired Nuclear Medicine 78072 computed tomography (CT) for anatomical localization Nuclear Medicine 78075 Adrenal imaging, cortex and/or medulla Nuclear Medicine 78102 Bone marrow imaging; limited area Nuclear Medicine 78103 Bone marrow imaging; multiple areas Nuclear Medicine 78104 Bone marrow imaging; whole body Nuclear Medicine 78110 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling Nuclear Medicine 78111 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings Nuclear Medicine 78120 Red cell volume determination (separate procedure); single sampling Nuclear Medicine 78121 Red cell volume determination (separate procedure); multiple samplings Whole blood volume determination, including separate measurement of plasma volume and red cell volume (radiopharmaceutical Nuclear Medicine 78122 volume-dilution technique) Nuclear Medicine 78130 Red cell survival study; Nuclear Medicine 78135 Red cell survival study; differential organ/tissue kinetics (eg, splenic and/or hepatic sequestration) Nuclear Medicine 78140 Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) Nuclear Medicine 78185 Spleen imaging only, with or without vascular flow Nuclear Medicine 78190 Kinetics, study of platelet survival, with or without differential organ/tissue localization Nuclear Medicine 78191 Platelet survival study Nuclear Medicine 78195 Lymphatics and lymph nodes imaging Nuclear Medicine 78201 Liver imaging; static only Nuclear Medicine 78202 Liver imaging; with vascular flow Nuclear Medicine 78205 Liver imaging (SPECT); Nuclear Medicine 78215 Liver and spleen imaging; static only Nuclear Medicine 78216 Liver and spleen imaging; with vascular flow Nuclear Medicine 78226 Hepatobiliary system imaging, including gallbladder when present; Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative Nuclear Medicine 78227 measurement(s) when performed Nuclear Medicine 78230 Salivary gland imaging; Nuclear Medicine 78231 Salivary gland imaging; with serial images

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Nuclear Medicine 78232 Salivary gland function study Nuclear Medicine 78258 Esophageal motility Nuclear Medicine 78261 Gastric mucosa imaging Nuclear Medicine 78262 Gastroesophageal reflux study Nuclear Medicine 78264 Gastric emptying imaging study (eg, solid, liquid, or both); Nuclear Medicine 78265 Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit Nuclear Medicine 78266 Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days Nuclear Medicine 78267 Urea breath test, C-14 (isotopic); acquisition for analysis Nuclear Medicine 78268 Urea breath test, C-14 (isotopic); analysis Nuclear Medicine 78270 Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor Nuclear Medicine 78271 Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor Nuclear Medicine 78272 Vitamin B-12 absorption studies combined, with and without intrinsic factor Nuclear Medicine 78278 Acute gastrointestinal blood loss imaging Nuclear Medicine 78282 Gastrointestinal protein loss Nuclear Medicine 78290 Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) Nuclear Medicine 78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt) Nuclear Medicine 78300 Bone and/or joint imaging; limited area Nuclear Medicine 78305 Bone and/or joint imaging; multiple areas Nuclear Medicine 78306 Bone and/or joint imaging; whole body Nuclear Medicine 78315 Bone and/or joint imaging; 3 phase study Nuclear Medicine 78320 Bone and/or joint imaging; tomographic (SPECT) Nuclear Medicine 78350 Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry Nuclear Medicine 78351 Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry, 1 or more sites Nuclear Medicine 78445 Non-cardiac vascular flow imaging (ie, angiography, venography) Nuclear Medicine 78456 Acute venous thrombosis imaging, peptide Nuclear Medicine 78457 Venous thrombosis imaging, venogram; unilateral Nuclear Medicine 78458 Venous thrombosis imaging, venogram; bilateral Nuclear Medicine 78579 Pulmonary ventilation imaging (eg, aerosol or gas) Nuclear Medicine 78580 Pulmonary perfusion imaging (eg, particulate) Nuclear Medicine 78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging Nuclear Medicine 78585 Pulmonary perfusion imaging, particulate, with ventilation; rebreathing and washout, with or without single breath Nuclear Medicine 78597 Quantitative differential pulmonary perfusion, including imaging when performed Nuclear Medicine 78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed Nuclear Medicine 78600 Brain imaging, less than 4 static views;

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Nuclear Medicine 78601 Brain imaging, less than 4 static views; with vascular flow Nuclear Medicine 78605 Brain imaging, minimum 4 static views; Nuclear Medicine 78606 Brain imaging, minimum 4 static views; with vascular flow Nuclear Medicine 78607 Brain imaging, tomographic (SPECT) Nuclear Medicine 78610 Brain imaging, vascular flow only Nuclear Medicine 78630 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography Nuclear Medicine 78635 Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography Nuclear Medicine 78645 Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation Nuclear Medicine 78647 Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT) Nuclear Medicine 78650 Cerebrospinal fluid leakage detection and localization Nuclear Medicine 78660 Radiopharmaceutical dacryocystography Nuclear Medicine 78700 Kidney imaging morphology; Nuclear Medicine 78701 Kidney imaging morphology; with vascular flow Nuclear Medicine 78707 Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, angiotensin Nuclear Medicine 78708 converting enzyme inhibitor and/or diuretic) Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological intervention (eg, Nuclear Medicine 78709 angiotensin converting enzyme inhibitor and/or diuretic) Nuclear Medicine 78710 Kidney imaging morphology; tomographic (SPECT) Nuclear Medicine 78725 Kidney function study, non-imaging radioisotopic study Nuclear Medicine 78730 Urinary bladder residual study (List separately in addition to code for primary procedure) Nuclear Medicine 78740 Ureteral reflux study (radiopharmaceutical voiding cystogram) Nuclear Medicine 78761 Testicular imaging with vascular flow

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular Nuclear Medicine 78800 flow and blood pool imaging, when performed); planar, single limited area (includes vascular flow and blood pool imaging, when performed); planar, single (includes vascular flow and blood pool imaging, when performed); planar, single

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular Nuclear Medicine 78801 flow and blood pool imaging, when performed); planar, 2 or more mulitple areas (eg, abdomen and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular Nuclear Medicine 78802 flow and blood pool imaging, when performed); planar, whole body, single day imaging Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular Nuclear Medicine 78803 flow and blood pool imaging, when performed); tomographic (SPECT) , single area (eg, head, neck, chest, pelvis), single day imaging

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular Nuclear Medicine 78804 flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days imaging

Nuclear Medicine 78805 Radiopharmaceutical localization of inflammatory process; limited area Nuclear Medicine 78806 Radiopharmaceutical localization of inflammatory process; whole body Nuclear Medicine 78807 Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) PET 78608 Brain imaging, positron emission tomography (PET); metabolic evaluation PET 78609 Brain imaging, positron emission tomography (PET); perfusion evaluation PET 78811 Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) PET 78812 Positron emission tomography (PET) imaging; skull base to mid-thigh PET 78813 Positron emission tomography (PET) imaging; whole body Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and PET 78814 anatomical localization imaging; limited area (eg, chest, head/neck) Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and PET 78815 anatomical localization imaging; skull base to mid-thigh Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and PET 78816 anatomical localization imaging; whole body PET G0219 Pet imaging whole body; melanoma for non-covered indications PET G0235 Pet imaging, any site, not otherwise specified Pet imaging, full and partial-ring PET scanners only, for initial diagnosis of breast cancer and/or surgical planning for breast cancer PET G0252 (e.g., initial staging of axillary lymph nodes)

PET S8085 Fluorine-18 fluorodeoxyglucose (F-18 fdg) imaging using dual-head coincidence detection system (non-dedicated PET scan) RADIOISOTOPE A4641 Radiopharmaceutical, diagnostic, not otherwise classified CONTRAST RADIOISOTOPE A9500 Technetium Tc-99m sestamibi, diagnostic, per study dose CONTRAST RADIOISOTOPE A9501 Technetium Tc-99m teboroxime, diagnostic, per study dose CONTRAST RADIOISOTOPE A9502 Technetium Tc-99m tetrofosmin, diagnostic, per study dose CONTRAST RADIOISOTOPE A9503 Technetium Tc-99m medronate, diagnostic, per study dose, up to 30 millicuries CONTRAST RADIOISOTOPE A9504 Technetium Tc-99m apcitide, diagnostic, per study dose, up to 20 millicuries CONTRAST RADIOISOTOPE A9505 Thallium Tl-201 thallous chloride, diagnostic, per millicurie CONTRAST RADIOISOTOPE A9507 Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries CONTRAST

Effective: 1/1/2020 Category CPT® Code CPT® Code Description RADIOISOTOPE A9508 Iodine I-131 iobenguane sulfate, diagnostic, per 0.5 millicurie CONTRAST RADIOISOTOPE A9509 Iodine I-123 sodium iodide, diagnostic, per millicurie CONTRAST RADIOISOTOPE A9510 Technetium Tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries CONTRAST RADIOISOTOPE A9512 Technetium Tc-99m pertechnetate, diagnostic, per millicurie CONTRAST RADIOISOTOPE A9513 Supply of radiopharmaceutical diagnostic imaging agent, technetium Tc 99m mebrofenin, per mCi CONTRAST RADIOISOTOPE A9516 Iodine I-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries CONTRAST RADIOISOTOPE A9520 Technetium Tc-99m tilmanocept, diagnostic, up to 0.5 millicuries CONTRAST RADIOISOTOPE A9521 Technetium Tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries CONTRAST RADIOISOTOPE A9524 Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries CONTRAST RADIOISOTOPE A9526 Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries CONTRAST RADIOISOTOPE A9528 Iodine I-131 sodium iodide capsule(s), diagnostic, per millicurie CONTRAST RADIOISOTOPE A9529 Iodine I-131 sodium iodide solution, diagnostic, per millicurie CONTRAST RADIOISOTOPE A9531 Iodine I-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) CONTRAST RADIOISOTOPE A9532 Iodine I-125 serum albumin, diagnostic, per 5 microcuries CONTRAST RADIOISOTOPE A9536 Technetium Tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries CONTRAST RADIOISOTOPE A9537 Technetium Tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries CONTRAST RADIOISOTOPE A9538 Technetium Tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries CONTRAST RADIOISOTOPE A9539 Technetium Tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries CONTRAST RADIOISOTOPE A9540 Technetium Tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries CONTRAST RADIOISOTOPE A9541 Technetium Tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries CONTRAST

Effective: 1/1/2020 Category CPT® Code CPT® Code Description RADIOISOTOPE A9547 Indium In-111 oxyquinoline, diagnostic, per 0.5 millicurie CONTRAST RADIOISOTOPE A9548 Indium In-111 pentetate, diagnostic, per 0.5 millicurie CONTRAST RADIOISOTOPE A9550 Technetium Tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie CONTRAST RADIOISOTOPE A9551 Technetium Tc-99m succimer, diagnostic, per study dose, up to 10 millicuries CONTRAST RADIOISOTOPE A9552 Fluorodeoxyglucose F-18 fdg, diagnostic, per study dose, up to 45 millicuries CONTRAST RADIOISOTOPE A9553 Chromium Cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries CONTRAST RADIOISOTOPE A9554 Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries CONTRAST RADIOISOTOPE A9555 Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries CONTRAST RADIOISOTOPE A9556 Gallium ga-67 citrate, diagnostic, per millicurie CONTRAST RADIOISOTOPE A9557 Technetium Tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries CONTRAST RADIOISOTOPE A9558 xenon xe-133 gas, diagnostic, per 10 millicuries CONTRAST RADIOISOTOPE A9560 Technetium Tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries CONTRAST RADIOISOTOPE A9561 Technetium Tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries CONTRAST RADIOISOTOPE A9562 Technetium Tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries CONTRAST RADIOISOTOPE A9566 Technetium Tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries CONTRAST RADIOISOTOPE A9567 Technetium Tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries CONTRAST RADIOISOTOPE A9568 Technetium Tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries CONTRAST RADIOISOTOPE A9569 Technetium Tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose CONTRAST RADIOISOTOPE A9570 Indium In-111 labeled autologous white blood cells, diagnostic, per study dose CONTRAST RADIOISOTOPE A9571 Indium In-111 labeled autologous platelets, diagnostic, per study dose CONTRAST

Effective: 1/1/2020 Category CPT® Code CPT® Code Description RADIOISOTOPE A9572 Indium In-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries CONTRAST RADIOISOTOPE A9576 Injection, gadoteridol, (prohance multipack), per ml CONTRAST RADIOISOTOPE A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml CONTRAST RADIOISOTOPE A9582 Iodine I-123 iobenguane, diagnostic, per study dose, up to 15 millicuries CONTRAST RADIOISOTOPE A9583 Injection, gadofosveset trisodium, 1 ml CONTRAST RADIOISOTOPE A9585 Injection, gadobutrol, 0.1 ml CONTRAST RADIOISOTOPE A9698 Non-radioactive contrast imaging material, not otherwise classified, per study CONTRAST RADIOISOTOPE A9699 Radiopharmaceutical, therapeutic, not otherwise classified CONTRAST RADIOISOTOPE A9700 Supply of injectable contrast material for use in echocardiography, per study CONTRAST RADIOISOTOPE Q9968 Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg CONTRAST ULTRASOUND 76496 Unlisted fluoroscopic procedure (eg, diagnostic, interventional) ULTRASOUND 76930 Ultrasonic guidance for pericardiocentesis, imaging supervision and interpretation ULTRASOUND 76932 Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation of selected vessel ULTRASOUND 76937 patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent recording and reporting (List separately in addition to code for primary procedure) ULTRASOUND 76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation ULTRASOUND 76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and ULTRASOUND 76942 interpretation ULTRASOUND 76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation ULTRASOUND 76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation ULTRASOUND 76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation

Ultrasound 76978 Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional lesion with separate Ultrasound 76979 injection (List separately in addition to code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), Ultrasound: OB U/S 76801 transabdominal approach; single or first gestation

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), Ultrasound: OB U/S 76802 transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks Ultrasound: OB U/S 76805 0 days), transabdominal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks Ultrasound: OB U/S 76810 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic Ultrasound: OB U/S 76811 examination, transabdominal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal anatomic Ultrasound: OB U/S 76812 examination, transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, Ultrasound: OB U/S 76813 transabdominal or transvaginal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, Ultrasound: OB U/S 76814 transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or Ultrasound: OB U/S 76815 qualitative amniotic fluid volume), 1 or more fetuses Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by measuring standard Ultrasound: OB U/S 76816 growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or confirmed to be abnormal on a previous scan), transabdominal approach, per fetus

Ultrasound: OB U/S 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal

Ultrasound: OB U/S 76818 Fetal biophysical profile; with non-stress testing

Ultrasound: OB U/S 76819 Fetal biophysical profile; without non-stress testing

Ultrasound: OB U/S 76820 Doppler velocimetry, fetal; umbilical artery

Ultrasound: OB U/S 76821 Doppler velocimetry, fetal; middle cerebral artery

Ultrasound: OB U/S 76825 Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode recording; follow- Ultrasound: OB U/S 76826 up or repeat study

Ultrasound: OB U/S 76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete

Ultrasound: OB U/S 76828 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat study

Effective: 1/1/2020 Category CPT® Code CPT® Code Description Echoencephalography, real time with image documentation (gray scale) (for determination of ventricular size, delineation of cerebral Ultrasound: U/S 76506 contents, and detection of fluid masses or other intracranial abnormalities), including A-mode encephalography as secondary ( non-OB) component where indicated Ultrasound: U/S 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation ( non-OB) Ultrasound: U/S 76604 Ultrasound, chest (includes mediastinum), real time with image documentation ( non-OB) Ultrasound: U/S 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete ( non-OB) Ultrasound: U/S 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited ( non-OB) Ultrasound: U/S 76700 Ultrasound, abdominal, real time with image documentation; complete ( non-OB) Ultrasound: U/S 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) ( non-OB) Ultrasound: U/S 76706 Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm (AAA) ( non-OB) Ultrasound: U/S 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete ( non-OB) Ultrasound: U/S 76775 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited ( non-OB) Ultrasound: U/S 76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation ( non-OB) Ultrasound: U/S 76800 Ultrasound, spinal canal and contents ( non-OB) Ultrasound: U/S 76830 Ultrasound, transvaginal ( non-OB) Ultrasound: U/S 76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed ( non-OB) Ultrasound: U/S 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete ( non-OB) Ultrasound: U/S 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) ( non-OB) Ultrasound: U/S 76870 Ultrasound, scrotum and contents ( non-OB) Ultrasound: U/S 76872 Ultrasound, transrectal; ( non-OB) Ultrasound: U/S 76881 Ultrasound, complete joint (i.e., joint space and peri-articular soft tissue structures) real-time with image documentation ( non-OB) Ultrasound: U/S Ultrasound, limited, joint or other nonvascular extremity structure(s) (e.g., joint space, peri-articular tendon[s], muscle[s], nerve[s], 76882 ( non-OB) other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation

Effective: 1/1/2020 Category CPT® Code CPT® Code Description Ultrasound: U/S Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health care 76885 ( non-OB) professional manipulation) Ultrasound: U/S Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other qualified health care 76886 ( non-OB) professional manipulation) Ultrasound: U/S 76970 Ultrasound study follow-up (specify) ( non-OB) Ultrasound: U/S 76975 Gastrointestinal endoscopic ultrasound, supervision and interpretation ( non-OB) Ultrasound: U/S 76999 Unlisted ultrasound procedure (eg, diagnostic, interventional) ( non-OB) Ultrasound: U/S 93880 Duplex scan of extracranial arteries; complete bilateral study ( non-OB) Ultrasound: U/S 93882 Duplex scan of extracranial arteries; unilateral or limited study ( non-OB) Ultrasound: U/S 93886 Transcranial Doppler study of the intracranial arteries; complete study ( non-OB) Ultrasound: U/S 93888 Transcranial Doppler study of the intracranial arteries; limited study ( non-OB) Ultrasound: U/S 93890 Transcranial Doppler study of the intracranial arteries; vasoreactivity study ( non-OB) Ultrasound: U/S 93892 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection ( non-OB) Ultrasound: U/S 93893 Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection ( non-OB) Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording and analysis at 1-2 Ultrasound: U/S 93922 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 ( non-OB) levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels)

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and Ultrasound: U/S 93923 anterior tibial/dorsalis pedis arteries plus segmental volume plethysmography at 3 or more levels, or ankle/brachial indices at distal ( non-OB) posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler Ultrasound: U/S waveform or volume plethysmography recording and analysis at rest with ankle/brachial indices immediately after and at timed 93924 ( non-OB) intervals following performance of a standardized protocol on a motorized treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study

Ultrasound: U/S 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study ( non-OB) Ultrasound: U/S 93926 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study ( non-OB) Ultrasound: U/S 93930 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study ( non-OB) Ultrasound: U/S 93931 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study ( non-OB) Ultrasound: U/S 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study ( non-OB) Ultrasound: U/S 93971 Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study ( non-OB) Ultrasound: U/S 93975 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study ( non-OB) Ultrasound: U/S 93976 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study ( non-OB) Ultrasound: U/S 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study ( non-OB) Ultrasound: U/S 93979 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study ( non-OB) Ultrasound: U/S 93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study ( non-OB) Ultrasound: U/S 93981 Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study ( non-OB) Ultrasound: U/S Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; 93985 ( non-OB) complete bilateral study Ultrasound: U/S Duplex scan of arterial inflow and venous outflow for preoperative vessel assessment prior to creation of hemodialysis access; 93986 ( non-OB) complete unilateral study Ultrasound: U/S 93990 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) ( non-OB) Ultrasound: U/S 93998 Unlisted noninvasive vascular diagnostic study ( non-OB) Unlisted 78099 Unlisted endocrine procedure, diagnostic nuclear medicine Unlisted 78199 Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine Unlisted 78299 Unlisted gastrointestinal procedure, diagnostic nuclear medicine

Effective: 1/1/2020 Category CPT® Code CPT® Code Description

Unlisted 78399 Unlisted musculoskeletal procedure, diagnostic nuclear medicine Unlisted 78599 Unlisted respiratory procedure, diagnostic nuclear medicine Unlisted 78799 Unlisted genitourinary procedure, diagnostic nuclear medicine Unlisted 78999 Unlisted miscellaneous procedure, diagnostic nuclear medicine

Effective: 1/1/2020