Department of Health & CMS Manual System Human Services (DHHS) Pub 100-04 Medicare Claims Centers for Medicare & Processing Medicaid Services (CMS) Transmittal 1061 Date: SEPTEMBER 18, 2006 Change Request 5256

Subject: October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non- OPPS OCE) Specifications Version 22.0

I. SUMMARY OF CHANGES: This instruction is to inform the Fiscal Intermediaries that the October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) specifications have been updated with new additions, deletions, and changes.

New / Revised Material Effective Date: October 1, 2006 Implementation Date: October 2, 2006

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: No additional funding will be provided by CMS; Contractor activities are to be carried out within their FY 2007 operating budgets.

IV. ATTACHMENTS:

Recurring Update Notification

*Unless otherwise specified, the effective date is the date of service. Attachment – Recurring Update Notification

Pub. 100-04 Transmittal: 1061 Date: September 18, 2006 Change Request 5256

SUBJECT: October 2006 Non-Outpatient Prospective Payment System Outpatient Code Editor (Non-OPPS OCE) Specifications Version 22.0

I. GENERAL INFORMATION

A. Background: The Non-OPPS OCE has been updated with any new additions, changes, and deletions to Healthcare Common Procedure Coding System/Current Procedural Terminology (HCPCS/CPT) codes. This OCE is used to process bills from hospitals not paid under the OPPS.

B. Policy: The following changes were made to version 21.3 of the Non-OPPS OCE.

Code Descriptions: • Update the Code Description Database with the same codes and descriptions used for OPPS OCE v7.3

Diagnosis Codes

New ICD-9-CM Diagnosis Codes

• The following new diagnosis codes and descriptions have been added to the list of valid ICD-9-CM diagnoses, effective 10/01/06: Diagnosis CodeDesc 0522 Postvaricella myelitis 05314 Herpes zoster myelitis 05474 Herpes simplex myelitis 23871 Essntial thrombocythemia 23872 Low grde myelody syn les 23873 Hi grde myelodys syn les 23874 Myelodyspls syn w 5q del 23875 Myelodysplastic synd NOS 23876 Myelofi w myelo metaplas 23879 Lymph/hematpoitc tis NEC 27730 Amyloidosis NOS 27731 Fam Mediterranean fever 27739 Amyloidosis NEC 28401 Constitution RBC aplasia 28409 Const aplastc anemia NEC 2841 Pancytopenia 2842 Myelophthisis 28800 Neutropenia NOS 28801 Congenital neutropenia 28802 Cyclic neutropenia Diagnosis CodeDesc 28803 Drug induced neutropenia 28804 Neutropenia d/t infectn 28809 Neutropenia NEC 2884 Hemophagocytic syndromes 28850 Leukocytopenia NOS 28851 Lymphocytopenia 28859 Decreased WBC count NEC 28860 Leukocytosis NOS 28861 Lymphocytosis-symptomatc 28862 Leukemoid reaction 28863 Monocytosis-symptomatic 28864 Plasmacytosis 28865 Basophilia 28869 Elevated WBC count NEC 28953 Neutropenic splenomegaly 28983 Myelofibrosis 32301 Enceph/encephmye oth dis 32302 Myelitis- oth viral dis 32341 Enceph/myelitis-oth inf 32342 Myelitis d/t oth infect 32351 Enceph/myel folwg immune 32352 Myelitis follwg immune 32361 Inf ac dis encephalomyel 32362 Postinf encephalitis NEC 32363 Postinfectious myelitis 32371 Toxic encph & encephlomy 32372 Toxic myelitis 32381 Enceph & encephlalo NEC 32382 Myelitis cause NEC 33183 Mild cognitive impairemt 33371 Athetoid cerebral palsy 33372 Acute dystonia d/t drugs 33379 Acq torsion dystonia NEC 33385 Subac dyskinesa d/t drug 33394 Restless Legs Syndrome 3380 Central pain syndrome 33811 Acute pain due to trauma 33812 Acute post-thoracot pain 33818 Acute postop pain NEC 33819 Acute pain NEC 33821 Chronc pain d/t trauma 33822 Chron post-thoracot pain 33828 Chronic postop pain NEC 33829 Chronic pain NEC 3383 Neoplasm related pain 3384 Chronic pain syndrome 34120 Acute myelitis NOS 34121 Acute myelitis oth cond 34122 Idiopathc trans myelitis 37743 Optic nerve hypoplasia 37960 Inflam postproc bleb NOS Diagnosis CodeDesc 37961 Inflam postproc bleb, 1 37962 Inflam postproc bleb, 2 37963 Inflam postproc bleb, 3 38915 Sensorneur hear loss uni 38916 Sensoneur hear loss asym 42983 Takotsubo syndrome 47811 Nasal mucositis (ulcer) 47819 Nasal & sinus dis NEC 5187 Transfsn rel ac lung inj 51911 Acute bronchospasm 51919 Trachea & bronch dis NEC 52181 Cracked tooth 52189 Dis hard tiss teeth NEC 52300 Acute gingititis, plaque 52301 Ac gingivitis,nonplaque 52310 Chronc gingititis,plaque 52311 Chr gingivitis-nonplaque 52330 Aggres periodontitis NOS 52331 Aggres periodontitis,loc 52332 Aggres periodontitis,gen 52333 Acute periodontitis 52340 Chronc periodontitis NOS 52341 Chr periodontitis, local 52342 Chron periodontitis,gen 52560 Unsat restore tooth NOS 52561 Open restoration margins 52562 Overhang dental restore 52563 Fx dental mat w/o loss 52564 Fx dentl material w loss 52565 Contour restore tooth 52566 Allergy dental res mat 52567 Poor aesthetics restore 52569 Unsat restore tooth NEC 52661 Perfor root canal space 52662 Endodontic overfill 52663 Endodontic underfill 52669 Periradicular path NEC 52800 Stomatitis/mucositis NOS 52801 Mucosits d/t antineo rx 52802 Mucositis d/t drugs NEC 52809 Stomatits & mucosits NEC 538 GI mucositis (ulceratve) 60820 Torsion of testis NOS 60821 Extravag tors sperm cord 60822 Intravag tors sperm cord 60823 Torsion appendix testis 60824 Torsion appy epididymis 61681 Mucositis cerv,vag,vulva 61689 Inflm cerv,vag,vulva NEC 61884 Cervical stump prolapse 62929 Fem genital mutilate NEC Diagnosis CodeDesc 62981 Hab abortr w/o curr preg 62989 Female genital disor NEC 64900 Tobacco use disord-unsp 64901 Tobacco use disor-delliv 64902 Tobacco use dis-del-p/p 64903 Tobacco use dis-antepart 64904 Tobacco use dis-postpart 64910 Obesity-unspecified 64911 Obesity-delivered 64912 Obesity-delivered w p/p 64913 Obesity-antepartum 64914 Obesity-postpartum 64920 Bariatric surg stat-unsp 64921 Bariatric surg stat-del 64922 Bariatric surg-del w p/p 64923 Bariatrc surg stat-antep 64924 Bariatrc surg stat w p/p 64930 Coagulation def-unspec 64931 Coagulation def-deliv 64932 Coagulatn def-del w p/p 64933 Coagulation def-antepart 64934 Coagulation def-postpart 64940 Epilepsy-unspecified 64941 Epilepsy-delivered 64942 Epilepsy-delivered w p/p 64943 Epilepsy-antepartum 64944 Epilepsy-postpartum 64950 Spotting-unspecified 64951 Spotting-delivered 64953 Spotting-antepartum 64960 Uterine size descrp-unsp 64961 Uterine size descrep-del 64962 Uterine size-del w p/p 64963 Uterine size des-antepar 64964 Uterine size descrep-p/p 72971 Nontraum comp syn-up ext 72972 Nontraum comp syn-low ex 72973 Nontrauma comp syn-abd 72979 Nontrauma comp syn NEC 7313 Major osseous defects 7687 Hypoxic-ischemic enceph 77087 NB respiratory arrest 77088 Hypoxemia of newborn 77581 NB acidosis NEC 77589 Neonat endo/met dis NEC 77985 NB cardiac arrest 78032 Complx febrile convulsns 78096 Generalized pain 78097 Altered mental status 78491 Postnasal drip 78499 Head & neck symptoms NEC Diagnosis CodeDesc 78864 Urinary hesitancy 78865 Straining on urination 79391 Image test incon d/t fat 79399 Abn find-body struct NEC 79506 Pap smr cytol evid malig 79581 Elev ca-embryoic antigen 79582 Elev ca antigen 125 79589 Abnorml tumor marker NEC 95890 Compartment syndrome NOS 95891 Trauma comp synd up ext 95892 Trauma comp synd low ext 95893 Trauma compart synd abd 95899 Trauma compart synd NEC 99520 Adv eff med/biol sub NOS 99521 Arthus phenomenon 99522 Adv eff anesthesia NOS 99523 Adverse eff insulin NOS 99527 Drug allergy NEC 99529 Adv eff med/biol NEC/NOS V1851 Family hx colonic polyps V1859 Fam hx digest disord NEC V2634 Male genetc test dis car V2635 Test male part hab abort V2639 Male genetic test NEC V4586 Bariatric surgery status V5830 Attn rem nonsurg dressng V5831 Attn rem surg dressing V5832 Attn removal of sutures V7211 Hearing exam-fail screen V7219 Exam ears & hearing NEC V8271 Screen-gentc dis carrier V8279 Genetic screening NEC V8551 BMI, pediatric <5% V8552 BMI, pediatric 5% - <85% V8553 BMI,pediatric 85% - <95% V8554 BMI,pediatric >= 95% V860 Estrogen recep pstv stat V861 Estrogen recep neg stat

Deleted ICD-9-CM Diagnosis Codes

• The following diagnosis codes have been deleted from the list of valid ICD-9-CM diagnosis codes, effective 10/01/06, and removed from any associated edits to which they were assigned:

Diagnosis CodeDesc 2387 Lymphoproliferat dis NOS 2773 Amyloidosis 2840 Congen aplastic anemia 2880 Agranulocytosis 3230 Encephalit in viral dis 3234 Oth encephalit d/t infec 3235 Postimmunizat encephalit 3236 Postinfect encephalitis 3237 Toxic encephalitis 3238 Encephalitis NEC 3337 Symptom torsion dystonia 4781 Nasal & sinus dis NEC 5191 Trachea/bronchus dis NEC 5218 Hard tiss dis teeth NEC 5230 Acute gingivitis 5231 Chronic gingivitis 5233 Acute periodontitis 5234 Chronic periodontitis 5280 Stomatitis 6082 Torsion of testis 6168 Female gen inflam NEC 6298 Female genital dis NEC 7758 Transient met dis NB NEC 7849 Symp invol head/neck NEC 7939 Abn find-body struct NEC 9952 Adv eff med/biol sub NOS V185 Family hx-gi disorders V583 Atten-surg dressng/sutur V721 Ear & hearing exam

HCPCS/CPT Procedure Codes

NEW HCPCS PROCEDURE CODES

• The following HCPCS code has been added to the list of valid codes for the OCE, effective 1/1/06 (OCE v21.1):

Code Code Description G8085 ESRD pt inelig autogenous Fis

• The following HCPCS code has been added to the list of valid codes for the OCE, effective 10/1/06 (OCE v22.0):

Code Code Description C9231 Injection, decitabine C9727 Insert palate implants H0049 Alcohol/drug screening H0050 Alcohol/drug service 15 min K0738 Portable gas oxygen system K0800 POV group 1 std up to 300 lbs K0801 POV group 1 hd 301-450 lbs K0802 POV group 1 vhd 451-600 lbs K0806 POV group 2 std up to 300lbs K0807 POV group 2 hd 301-450 lbs K0808 POV group 2 vhd 451-600 lbs K0812 Power operated vehicle NOC K0813 PWC gp 1 std port seat/back K0814 PWC gp 1 std port cap chair K0815 PWC gp 1 std seat/back K0816 PWC gp 1 std cap chair K0820 PWC gp 2 std port seat/back K0821 PWC gp 2 std port cap chair K0822 PWC gp 2 std seat/back K0823 PWC gp 2 std cap chair K0824 PWC gp 2 hd seat/back K0825 PWC gp 2 hd cap chair K0826 PWC gp2 vhd seat/back K0827 PWC gp 2 vhd cap chair K0828 PWC gp 2 xtra hd seat/back K0829 PWC gp 2 xtra hd cap chair K0830 PWC gp2 std seat elevate s/b K0831 PWC gp2 std seat elevate cap K0835 PWC gp2 std sing pow opt s/b K0836 PWC gp2 std sing pow opt cap K0837 PWC gp 2 hd sing pow opt s/b K0838 PWC gp 2 hd sing pow opt cap K0839 PWC gp2 vhd sing pow opt s/b K0840 PWC gp2 xhd sing pow opt s/b K0841 PWC gp2 std mult pow opt s/b K0842 PWC gp2 std mult pow opt cap K0843 PWC gp2 hd mult pow opt s/b K0848 PWC gp 3 std seat/back K0849 PWC gp 3 std cap chair K0850 PWC gp 3 hd seat/back K0851 PWC gp 3 hd cap chair K0852 PWC gp 3 vhd seat/back K0853 PWC gp 3 vhd cap chair K0854 PWC gp 3 xhd seat/back K0855 PWC gp 3 xhd cap chair K0856 PWC gp3 std sing pow opt s/b K0857 PWC gp3 std sing pow opt cap K0858 PWC gp3 hd sing pow opt s/b K0859 PWC gp3 hd sing pow opt cap K0860 PWC gp3 vhd sing pow opt s/b K0861 PWC gp3 std mult pow opt s/b K0862 PWC gp3 hd mult pow opt s/b K0863 PWC gp3 vhd mult pow opt s/b K0864 PWC gp3 xhd mult pow opt s/b K0868 PWC gp 4 std seat/back K0869 PWC gp 4 std cap chair K0870 PWC gp 4 hd seat/back K0871 PWC gp 4 vhd seat/back K0877 PWC gp4 std sing pow opt s/b K0878 PWC gp4 std sing pow opt cap K0879 PWC gp4 hd sing pow opt s/b K0880 PWC gp4 vhd sing pow opt s/b K0884 PWc gp4 std mult pow opt s/b K0885 PWC gp4 std mult pow opt cap K0886 PWC gp4 hd mult pow s/b K0890 PWC gp5 ped sing pow opt s/b K0891 PWC gp5 ped mult pow opt s/b K0898 Power wheelchair NOC K0899 Pow mobility dev no sadmerc S0147 Alglucosidase alfa 20 mg S2325 Hip core decompression

DELETED HCPCS PROCEDURE CODES

• The following codes have been deleted from the list of valid HCPCS for the OCE, effective 7/1/06 (OCE v21.3): HCPCS Code Description K0738 Matt, hospital bed K0739 Matt, hvy duty hospital bed K0740 Side rails, hospital bed S0116 Bevacizumab 100 mg S0198 Inj pegaptanib 0.3 mg S8075 CAD of digital mammogr S9022 Digital subtraction angiogra

MEDICARE OUTPATIENT CODE EDITS

Diagnosis Edit Modifications, effective 10/1/06:

Age Conflict: Newborn Diagnoses - Age 0 years

The following new & existing codes have been added to the list of codes allowed for newborns only:

Diagnosis 7687 77087 77088 77581 77589 77985 78092

Age Conflict: Pediatric Diagnoses - Age 0-17 years

The following new codes have been added to the list of pediatric diagnoses:

Diagnosis V8551 V8552 V8553 V8554

The following code has been removed from the list of pediatric diagnoses:

Diagnosis 78092

Age Conflict: Maternity Diagnoses - Age 12-55 years

The following new codes have been added to the list of maternity diagnoses:

Diagnosis 64900 64901 64902 64903 64904 64910 64911 64912 64913 64914 64920 64921 64922 64923 64924 Diagnosis 64930 64931 64932 64933 64934 64940 64941 64942 64943 64944 64950 64951 64953 64960 64961 64962 64963 64964

Sex Conflict: Diagnoses for Females Only

The following new & existing codes have been added to the list of codes allowed for females only:

Diagnosis 61681 61689 61884 62929 62981 62989 64900 64901 64902 64903 64904 64910 64911 64912 64913 64914 64920 64921 64922 64923 64924 64930 64931 Diagnosis 64932 64933 64934 64940 64941 64942 64943 64944 64950 64951 64953 64960 64961 64962 64963 64964 79506 79582 V2631 V2632

Sex Conflict: Diagnoses for Males Only

The following new codes have been added to the list of diagnoses allowed for males only:

Diagnosis 60820 60821 60822 60823 60824 V2634 V2635 V2639

Non-Covered List changes • The following code was removed from the list of Non-Covered procedures, effective 1/1/01 (OCE v16.1). [Code is/should be on the Non-reportable list for same period].

Code 99375

Non-Reportable List changes

* The following code was added to the list of Non-Reportable procedures, effective 1/1/06 (OCE v21.1)

Code G8085

* The following codes were added to the list of Non-Reportable procedures, effective 10/1/06 (OCE v22.0):

All valid HCPCS codes designated as ‘inpatient-only’ for OPPS (See appendix A)

NOTE: Inpatient-only codes that are already on the Non-Reportable list will retain their existing effective dates; new additions will be effective 10/1/06.

* The following code was removed from the list of Non-reportable procedures, effective 8/1/2000 (OCE v15.2). [Code is/should be on the Non-covered list for same period]. Code J7300

* The following code was removed from the list of Non-reportable procedures, effective 1/1/02 (OCE v17.1). [Code is/should be on the Non-covered list for same period]. Code E0481

* The following codes were removed from the list of Non-Reportable procedures, effective 10/1/06 (OCE v22.0):

All valid HCPCS codes that begin with ‘C’ (See appendix B)

II. BUSINESS REQUIREMENTS

“Shall" denotes a mandatory requirement "Should" denotes an optional requirement

Requirement Requirements Responsibility (place an “X” in the Number columns that apply) Shared Other System

r Maintainers FI RHHI Carrie DMERC FIS MC VM CW 5256.1 Shared System Maintainer shall install Non- OPPS OCE Version 22.0 into their systems. X X

5256.2 Fiscal Intermediaries shall inform providers of the Non-OPPS OCE changes for Version XX 22.0 detailed in this recurring change

notification.

III. PROVIDER EDUCATION

Requirement Requirements Responsibility (“X” indicates the Number columns that apply) F R C D Shared Other I H a M System H r E Maintainers I r R F M V C i C I C M W e S S S F r S 5256.3 A provider education article related to this XX instruction will be available at www.cms.hhs.gov/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 site and include information about it in a listserv message within 1 week of the availability of the provider education article. In addition, the provider education article shall be included in your next regularly scheduled bulletin and incorporated into any educational events on this topic. Contractors are free to supplement Medlearn Matters articles with localized information that would benefit their provider community in billing and administering the Medicare program correctly.

IV. SUPPORTING INFORMATION AND POSSIBLE DESIGN CONSIDERATIONS

A. Other Instructions: N/A

X-Ref Requirement # Instructions

B. Design Considerations: N/A

X-Ref Requirement # Recommendation for Medicare System Requirements

C. Interfaces: OPPS OCE/ PRICER

D. Contractor Financial Reporting /Workload Impact: N/A

E. Dependencies: N/A

F. Testing Considerations: N/A

V. SCHEDULE, CONTACTS, AND FUNDING

Effective Date: October 1, 2006 No additional funding will be provided by CMS; contractor Implementation Date: October 2, 2006 activities are to be carried out within their FY 2007 operating Pre-Implementation Contact(s): Diana budgets. Motsiopoulos at [email protected] or Antoinette Johnson at [email protected]

Post-Implementation Contact(s): Regional Office

Attachments

Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1 HCPCS CodeDesc 2 00176 Anesth, pharyngeal surgery 3 00192 Anesth, facial bone surgery 4 00214 Anesth, skull drainage 5 00215 Anesth, skull repair/fract 6 0021T Fetal oximetry, trnsvag/cerv 7 0024T Transcath cardiac reduction 8 00404 Anesth, surgery of breast 9 00406 Anesth, surgery of breast 10 00452 Anesth, surgery of shoulder 11 00474 Anesth, surgery of rib(s) 12 0048T Implant ventricular device 13 0049T External circulation assist 14 0050T Removal circulation assist 15 0051T Implant total heart system 16 00524 Anesth, chest drainage 17 0052T Replace component heart syst 18 0053T Replace component heart syst 19 00540 Anesth, chest surgery 20 00542 Anesth, release of lung 21 00546 Anesth, lung,chest wall surg 22 00560 Anesth, heart surg w/o pump 23 00561 Anesth, heart surg < age 1 24 00562 Anesth, heart surg w/pump 25 00580 Anesth, heart/lung transplnt 26 00604 Anesth, sitting procedure 27 00622 Anesth, removal of nerves 28 00632 Anesth, removal of nerves 29 00670 Anesth, spine, cord surgery 30 0075T Perq stent/chest vert art 31 0076T S&i stent/chest vert art 32 0077T Cereb therm perfusion probe 33 0078T Endovasc aort repr w/device 34 00792 Anesth, hemorr/excise liver 35 00794 Anesth, pancreas removal 36 00796 Anesth, for liver transplant 37 0079T Endovasc visc extnsn repr 38 00802 Anesth, fat layer removal 39 0080T Endovasc aort repr rad s&i 40 0081T Endovasc visc extnsn s&i 41 00844 Anesth, pelvis surgery 42 00846 Anesth, hysterectomy 43 00848 Anesth, pelvic organ surg 44 00864 Anesth, removal of bladder 45 00865 Anesth, removal of prostate 46 00866 Anesth, removal of adrenal 47 00868 Anesth, kidney transplant 48 00882 Anesth, major vein ligation 49 00904 Anesth, perineal surgery 50 00908 Anesth, removal of prostate 51 0090T Cervical artific disc

Page 1 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 52 0091T Lumbar artific disc 53 0092T Artific disc addl 54 00932 Anesth, amputation of penis 55 00934 Anesth, penis, nodes removal 56 00936 Anesth, penis, nodes removal 57 0093T Cervical artific diskectomy 58 00944 Anesth, vaginal hysterectomy 59 0094T Lumbar artific diskectomy 60 0095T Artific diskectomy addl 61 0096T Rev cervical artific disc 62 0097T Rev lumbar artific disc 63 0098T Rev artific disc addl 64 01140 Anesth, amputation at pelvis 65 01150 Anesth, pelvic tumor surgery 66 01212 Anesth, hip disarticulation 67 01214 Anesth, hip arthroplasty 68 01232 Anesth, amputation of femur 69 01234 Anesth, radical femur surg 70 01272 Anesth, femoral artery surg 71 01274 Anesth, femoral embolectomy 72 01402 Anesth, knee arthroplasty 73 01404 Anesth, amputation at knee 74 01442 Anesth, knee artery surg 75 01444 Anesth, knee artery repair 76 01486 Anesth, ankle replacement 77 01502 Anesth, lwr leg embolectomy 78 0153T Implant aneur sensor add-on 79 0157T Opn ins gastr eltrd for mo 80 0158T Opn redo gastr eltrd for mo 81 01632 Anesth, surgery of shoulder 82 01634 Anesth, shoulder joint amput 83 01636 Anesth, forequarter amput 84 01638 Anesth, shoulder replacement 85 01652 Anesth, shoulder vessel surg 86 01654 Anesth, shoulder vessel surg 87 01656 Anesth, arm-leg vessel surg 88 01756 Anesth, radical humerus surg 89 01990 Support for organ donor 90 11004 Debride genitalia & perineum 91 11005 Debride abdom wall 92 11006 Debride genit/per/abdom wall 93 11008 Remove mesh from abd wall 94 15756 Free myo/skin flap microvasc 95 15757 Free skin flap, microvasc 96 15758 Free fascial flap, microvasc 97 16035 Incision of burn scab, initi 98 16036 Escharotomy; add'l incision 99 19200 Removal of breast 100 19220 Removal of breast 101 19271 Revision of chest wall 102 19272 Extensive chest wall surgery

Page 2 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 103 19361 Breast reconstruction 104 19364 Breast reconstruction 105 19367 Breast reconstruction 106 19368 Breast reconstruction 107 19369 Breast reconstruction 108 20660 Apply, rem fixation device 109 20661 Application of head brace 110 20664 Halo brace application 111 20802 Replantation, arm, complete 112 20805 Replant forearm, complete 113 20808 Replantation hand, complete 114 20816 Replantation digit, complete 115 20824 Replantation thumb, complete 116 20827 Replantation thumb, complete 117 20838 Replantation foot, complete 118 20930 Spinal bone allograft 119 20931 Spinal bone allograft 120 20936 Spinal bone autograft 121 20937 Spinal bone autograft 122 20938 Spinal bone autograft 123 20955 Fibula bone graft, microvasc 124 20956 Iliac bone graft, microvasc 125 20957 Mt bone graft, microvasc 126 20962 Other bone graft, microvasc 127 20969 Bone/skin graft, microvasc 128 20970 Bone/skin graft, iliac crest 129 21045 Extensive jaw surgery 130 21141 Reconstruct midface, lefort 131 21142 Reconstruct midface, lefort 132 21143 Reconstruct midface, lefort 133 21145 Reconstruct midface, lefort 134 21146 Reconstruct midface, lefort 135 21147 Reconstruct midface, lefort 136 21151 Reconstruct midface, lefort 137 21154 Reconstruct midface, lefort 138 21155 Reconstruct midface, lefort 139 21159 Reconstruct midface, lefort 140 21160 Reconstruct midface, lefort 141 21172 Reconstruct orbit/forehead 142 21179 Reconstruct entire forehead 143 21180 Reconstruct entire forehead 144 21182 Reconstruct cranial bone 145 21183 Reconstruct cranial bone 146 21184 Reconstruct cranial bone 147 21188 Reconstruction of midface 148 21193 Reconst lwr jaw w/o graft 149 21194 Reconst lwr jaw w/graft 150 21196 Reconst lwr jaw w/fixation 151 21247 Reconstruct lower jaw bone 152 21255 Reconstruct lower jaw bone 153 21256 Reconstruction of orbit

Page 3 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 154 21268 Revise eye sockets 155 21343 Treatment of sinus fracture 156 21344 Treatment of sinus fracture 157 21346 Treat nose/jaw fracture 158 21347 Treat nose/jaw fracture 159 21348 Treat nose/jaw fracture 160 21360 Treat cheek bone fracture 161 21365 Treat cheek bone fracture 162 21366 Treat cheek bone fracture 163 21385 Treat eye socket fracture 164 21386 Treat eye socket fracture 165 21387 Treat eye socket fracture 166 21395 Treat eye socket fracture 167 21422 Treat mouth roof fracture 168 21423 Treat mouth roof fracture 169 21431 Treat craniofacial fracture 170 21432 Treat craniofacial fracture 171 21433 Treat craniofacial fracture 172 21435 Treat craniofacial fracture 173 21436 Treat craniofacial fracture 174 21510 Drainage of bone lesion 175 21615 Removal of rib 176 21616 Removal of rib and nerves 177 21620 Partial removal of sternum 178 21627 Sternal debridement 179 21630 Extensive sternum surgery 180 21632 Extensive sternum surgery 181 21705 Revision of neck muscle/rib 182 21740 Reconstruction of sternum 183 21750 Repair of sternum separation 184 21810 Treatment of rib fracture(s) 185 21825 Treat sternum fracture 186 22010 I&d, p-spine, c/t/cerv-thor 187 22015 I&d, p-spine, l/s/ls 188 22110 Remove part of neck vertebra 189 22112 Remove part, thorax vertebra 190 22114 Remove part, lumbar vertebra 191 22116 Remove extra spine segment 192 22210 Revision of neck spine 193 22212 Revision of thorax spine 194 22214 Revision of lumbar spine 195 22216 Revise, extra spine segment 196 22220 Revision of neck spine 197 22224 Revision of lumbar spine 198 22226 Revise, extra spine segment 199 22318 Treat odontoid fx w/o graft 200 22319 Treat odontoid fx w/graft 201 22325 Treat spine fracture 202 22326 Treat neck spine fracture 203 22327 Treat thorax spine fracture 204 22328 Treat each add spine fx

Page 4 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 205 22532 Lat thorax spine fusion 206 22533 Lat lumbar spine fusion 207 22534 Lat thor/lumb, add'l seg 208 22548 Neck spine fusion 209 22554 Neck spine fusion 210 22556 Thorax spine fusion 211 22558 Lumbar spine fusion 212 22585 Additional spinal fusion 213 22590 Spine & skull spinal fusion 214 22595 Neck spinal fusion 215 22600 Neck spine fusion 216 22610 Thorax spine fusion 217 22630 Lumbar spine fusion 218 22632 Spine fusion, extra segment 219 22800 Fusion of spine 220 22802 Fusion of spine 221 22804 Fusion of spine 222 22808 Fusion of spine 223 22810 Fusion of spine 224 22812 Fusion of spine 225 22818 Kyphectomy, 1-2 segments 226 22819 Kyphectomy, 3 or more 227 22830 Exploration of spinal fusion 228 22840 Insert spine fixation device 229 22841 Insert spine fixation device 230 22842 Insert spine fixation device 231 22843 Insert spine fixation device 232 22844 Insert spine fixation device 233 22845 Insert spine fixation device 234 22846 Insert spine fixation device 235 22847 Insert spine fixation device 236 22848 Insert pelv fixation device 237 22849 Reinsert spinal fixation 238 22850 Remove spine fixation device 239 22851 Apply spine prosth device 240 22852 Remove spine fixation device 241 22855 Remove spine fixation device 242 23200 Removal of collar bone 243 23210 Removal of shoulder blade 244 23220 Partial removal of humerus 245 23221 Partial removal of humerus 246 23222 Partial removal of humerus 247 23332 Remove shoulder foreign body 248 23472 Reconstruct shoulder joint 249 23900 Amputation of arm & girdle 250 23920 Amputation at shoulder joint 251 24900 Amputation of upper arm 252 24920 Amputation of upper arm 253 24930 Amputation follow-up surgery 254 24931 Amputate upper arm & implant 255 24940 Revision of upper arm

Page 5 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 256 25900 Amputation of forearm 257 25905 Amputation of forearm 258 25909 Amputation follow-up surgery 259 25915 Amputation of forearm 260 25920 Amputate hand at wrist 261 25924 Amputation follow-up surgery 262 25927 Amputation of hand 263 25931 Amputation follow-up surgery 264 26551 Great toe-hand transfer 265 26553 Single transfer, toe-hand 266 26554 Double transfer, toe-hand 267 26556 Toe joint transfer 268 26992 Drainage of bone lesion 269 27005 Incision of hip tendon 270 27006 Incision of hip tendons 271 27025 Incision of hip/thigh fascia 272 27030 Drainage of hip joint 273 27036 Excision of hip joint/muscle 274 27054 Removal of hip joint lining 275 27070 Partial removal of hip bone 276 27071 Partial removal of hip bone 277 27075 Extensive hip surgery 278 27076 Extensive hip surgery 279 27077 Extensive hip surgery 280 27078 Extensive hip surgery 281 27079 Extensive hip surgery 282 27090 Removal of hip prosthesis 283 27091 Removal of hip prosthesis 284 27120 Reconstruction of hip socket 285 27122 Reconstruction of hip socket 286 27125 Partial hip replacement 287 27130 Total hip arthroplasty 288 27132 Total hip arthroplasty 289 27134 Revise hip joint replacement 290 27137 Revise hip joint replacement 291 27138 Revise hip joint replacement 292 27140 Transplant femur ridge 293 27146 Incision of hip bone 294 27147 Revision of hip bone 295 27151 Incision of hip bones 296 27156 Revision of hip bones 297 27158 Revision of pelvis 298 27161 Incision of neck of femur 299 27165 Incision/fixation of femur 300 27170 Repair/graft femur head/neck 301 27175 Treat slipped epiphysis 302 27176 Treat slipped epiphysis 303 27177 Treat slipped epiphysis 304 27178 Treat slipped epiphysis 305 27179 Revise head/neck of femur 306 27181 Treat slipped epiphysis

Page 6 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 307 27185 Revision of femur epiphysis 308 27187 Reinforce hip bones 309 27215 Treat pelvic fracture(s) 310 27217 Treat pelvic ring fracture 311 27218 Treat pelvic ring fracture 312 27222 Treat hip socket fracture 313 27226 Treat hip wall fracture 314 27227 Treat hip fracture(s) 315 27228 Treat hip fracture(s) 316 27232 Treat thigh fracture 317 27236 Treat thigh fracture 318 27240 Treat thigh fracture 319 27244 Treat thigh fracture 320 27245 Treat thigh fracture 321 27248 Treat thigh fracture 322 27253 Treat hip dislocation 323 27254 Treat hip dislocation 324 27258 Treat hip dislocation 325 27259 Treat hip dislocation 326 27280 Fusion of sacroiliac joint 327 27282 Fusion of pubic bones 328 27284 Fusion of hip joint 329 27286 Fusion of hip joint 330 27290 Amputation of leg at hip 331 27295 Amputation of leg at hip 332 27303 Drainage of bone lesion 333 27365 Extensive leg surgery 334 27445 Revision of knee joint 335 27447 Total knee arthroplasty 336 27448 Incision of thigh 337 27450 Incision of thigh 338 27454 Realignment of thigh bone 339 27455 Realignment of knee 340 27457 Realignment of knee 341 27465 Shortening of thigh bone 342 27466 Lengthening of thigh bone 343 27468 Shorten/lengthen thighs 344 27470 Repair of thigh 345 27472 Repair/graft of thigh 346 27477 Surgery to stop leg growth 347 27479 Surgery to stop leg growth 348 27485 Surgery to stop leg growth 349 27486 Revise/replace knee joint 350 27487 Revise/replace knee joint 351 27488 Removal of knee prosthesis 352 27495 Reinforce thigh 353 27506 Treatment of thigh fracture 354 27507 Treatment of thigh fracture 355 27511 Treatment of thigh fracture 356 27513 Treatment of thigh fracture 357 27514 Treatment of thigh fracture

Page 7 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 358 27519 Treat thigh fx growth plate 359 27535 Treat knee fracture 360 27536 Treat knee fracture 361 27540 Treat knee fracture 362 27556 Treat knee dislocation 363 27557 Treat knee dislocation 364 27558 Treat knee dislocation 365 27580 Fusion of knee 366 27590 Amputate leg at thigh 367 27591 Amputate leg at thigh 368 27592 Amputate leg at thigh 369 27596 Amputation follow-up surgery 370 27598 Amputate lower leg at knee 371 27645 Extensive lower leg surgery 372 27646 Extensive lower leg surgery 373 27702 Reconstruct ankle joint 374 27703 Reconstruction, ankle joint 375 27712 Realignment of lower leg 376 27715 Revision of lower leg 377 27720 Repair of tibia 378 27722 Repair/graft of tibia 379 27724 Repair/graft of tibia 380 27725 Repair of lower leg 381 27727 Repair of lower leg 382 27880 Amputation of lower leg 383 27881 Amputation of lower leg 384 27882 Amputation of lower leg 385 27886 Amputation follow-up surgery 386 27888 Amputation of foot at ankle 387 28800 Amputation of midfoot 388 28805 Amputation thru metatarsal 389 31225 Removal of upper jaw 390 31230 Removal of upper jaw 391 31290 Nasal/sinus endoscopy, surg 392 31291 Nasal/sinus endoscopy, surg 393 31360 Removal of larynx 394 31365 Removal of larynx 395 31367 Partial removal of larynx 396 31368 Partial removal of larynx 397 31370 Partial removal of larynx 398 31375 Partial removal of larynx 399 31380 Partial removal of larynx 400 31382 Partial removal of larynx 401 31390 Removal of larynx & pharynx 402 31395 Reconstruct larynx & pharynx 403 31584 Treat larynx fracture 404 31587 Revision of larynx 405 31725 Clearance of airways 406 31760 Repair of windpipe 407 31766 Reconstruction of windpipe 408 31770 Repair/graft of bronchus

Page 8 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 409 31775 Reconstruct bronchus 410 31780 Reconstruct windpipe 411 31781 Reconstruct windpipe 412 31786 Remove windpipe lesion 413 31800 Repair of windpipe injury 414 31805 Repair of windpipe injury 415 32035 Exploration of chest 416 32036 Exploration of chest 417 32095 Biopsy through chest wall 418 32100 Exploration/biopsy of chest 419 32110 Explore/repair chest 420 32120 Re-exploration of chest 421 32124 Explore chest free adhesions 422 32140 Removal of lung lesion(s) 423 32141 Remove/treat lung lesions 424 32150 Removal of lung lesion(s) 425 32151 Remove lung foreign body 426 32160 Open chest heart massage 427 32200 Drain, open, lung lesion 428 32215 Treat chest lining 429 32220 Release of lung 430 32225 Partial release of lung 431 32310 Removal of chest lining 432 32320 Free/remove chest lining 433 32402 Open biopsy chest lining 434 32440 Removal of lung 435 32442 Sleeve pneumonectomy 436 32445 Removal of lung 437 32480 Partial removal of lung 438 32482 Bilobectomy 439 32484 Segmentectomy 440 32486 Sleeve lobectomy 441 32488 Completion pneumonectomy 442 32491 Lung volume reduction 443 32500 Partial removal of lung 444 32501 Repair bronchus add-on 445 32503 Resect apical lung tumor 446 32504 Resect apical lung tum/chest 447 32540 Removal of lung lesion 448 32650 Thoracoscopy, surgical 449 32651 Thoracoscopy, surgical 450 32652 Thoracoscopy, surgical 451 32653 Thoracoscopy, surgical 452 32654 Thoracoscopy, surgical 453 32655 Thoracoscopy, surgical 454 32656 Thoracoscopy, surgical 455 32657 Thoracoscopy, surgical 456 32658 Thoracoscopy, surgical 457 32659 Thoracoscopy, surgical 458 32660 Thoracoscopy, surgical 459 32661 Thoracoscopy, surgical

Page 9 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 460 32662 Thoracoscopy, surgical 461 32663 Thoracoscopy, surgical 462 32664 Thoracoscopy, surgical 463 32665 Thoracoscopy, surgical 464 32800 Repair lung hernia 465 32810 Close chest after drainage 466 32815 Close bronchial fistula 467 32820 Reconstruct injured chest 468 32850 Donor pneumonectomy 469 32851 Lung transplant, single 470 32852 Lung transplant with bypass 471 32853 Lung transplant, double 472 32854 Lung transplant with bypass 473 32855 Prepare donor lung, single 474 32856 Prepare donor lung, double 475 32900 Removal of rib(s) 476 32905 Revise & repair chest wall 477 32906 Revise & repair chest wall 478 32940 Revision of lung 479 32997 Total lung lavage 480 33015 Incision of heart sac 481 33020 Incision of heart sac 482 33025 Incision of heart sac 483 33030 Partial removal of heart sac 484 33031 Partial removal of heart sac 485 33050 Removal of heart sac lesion 486 33120 Removal of heart lesion 487 33130 Removal of heart lesion 488 33140 Heart revascularize (tmr) 489 33141 Heart tmr w/other procedure 490 33200 Insertion of heart pacemaker 491 33201 Insertion of heart pacemaker 492 33236 Remove electrode/thoracotomy 493 33237 Remove electrode/thoracotomy 494 33238 Remove electrode/thoracotomy 495 33243 Remove eltrd/thoracotomy 496 33245 Insert epic eltrd pace-defib 497 33246 Insert epic eltrd/generator 498 33250 Ablate heart dysrhythm focus 499 33251 Ablate heart dysrhythm focus 500 33253 Reconstruct atria 501 33261 Ablate heart dysrhythm focus 502 33300 Repair of heart wound 503 33305 Repair of heart wound 504 33310 Exploratory heart surgery 505 33315 Exploratory heart surgery 506 33320 Repair major blood vessel(s) 507 33321 Repair major vessel 508 33322 Repair major blood vessel(s) 509 33330 Insert major vessel graft 510 33332 Insert major vessel graft

Page 10 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 511 33335 Insert major vessel graft 512 33400 Repair of aortic valve 513 33401 Valvuloplasty, open 514 33403 Valvuloplasty, w/cp bypass 515 33404 Prepare heart-aorta conduit 516 33405 Replacement of aortic valve 517 33406 Replacement of aortic valve 518 33410 Replacement of aortic valve 519 33411 Replacement of aortic valve 520 33412 Replacement of aortic valve 521 33413 Replacement of aortic valve 522 33414 Repair of aortic valve 523 33415 Revision, subvalvular tissue 524 33416 Revise ventricle muscle 525 33417 Repair of aortic valve 526 33420 Revision of mitral valve 527 33422 Revision of mitral valve 528 33425 Repair of mitral valve 529 33426 Repair of mitral valve 530 33427 Repair of mitral valve 531 33430 Replacement of mitral valve 532 33460 Revision of tricuspid valve 533 33463 Valvuloplasty, tricuspid 534 33464 Valvuloplasty, tricuspid 535 33465 Replace tricuspid valve 536 33468 Revision of tricuspid valve 537 33470 Revision of pulmonary valve 538 33471 Valvotomy, pulmonary valve 539 33472 Revision of pulmonary valve 540 33474 Revision of pulmonary valve 541 33475 Replacement, pulmonary valve 542 33476 Revision of heart chamber 543 33478 Revision of heart chamber 544 33496 Repair, prosth valve clot 545 33500 Repair heart vessel fistula 546 33501 Repair heart vessel fistula 547 33502 Coronary artery correction 548 33503 Coronary artery graft 549 33504 Coronary artery graft 550 33505 Repair artery w/tunnel 551 33506 Repair artery, translocation 552 33507 Repair art, intramural 553 33510 CABG, vein, single 554 33511 CABG, vein, two 555 33512 CABG, vein, three 556 33513 CABG, vein, four 557 33514 CABG, vein, five 558 33516 Cabg, vein, six or more 559 33517 CABG, artery-vein, single 560 33518 CABG, artery-vein, two 561 33519 CABG, artery-vein, three

Page 11 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 562 33521 CABG, artery-vein, four 563 33522 CABG, artery-vein, five 564 33523 Cabg, art-vein, six or more 565 33530 Coronary artery, bypass/reop 566 33533 CABG, arterial, single 567 33534 CABG, arterial, two 568 33535 CABG, arterial, three 569 33536 Cabg, arterial, four or more 570 33542 Removal of heart lesion 571 33545 Repair of heart damage 572 33548 Restore/remodel, ventricle 573 33572 Open coronary endarterectomy 574 33600 Closure of valve 575 33602 Closure of valve 576 33606 Anastomosis/artery-aorta 577 33608 Repair anomaly w/conduit 578 33610 Repair by enlargement 579 33611 Repair double ventricle 580 33612 Repair double ventricle 581 33615 Repair, modified fontan 582 33617 Repair single ventricle 583 33619 Repair single ventricle 584 33641 Repair heart septum defect 585 33645 Revision of heart veins 586 33647 Repair heart septum defects 587 33660 Repair of heart defects 588 33665 Repair of heart defects 589 33670 Repair of heart chambers 590 33681 Repair heart septum defect 591 33684 Repair heart septum defect 592 33688 Repair heart septum defect 593 33690 Reinforce pulmonary artery 594 33692 Repair of heart defects 595 33694 Repair of heart defects 596 33697 Repair of heart defects 597 33702 Repair of heart defects 598 33710 Repair of heart defects 599 33720 Repair of heart defect 600 33722 Repair of heart defect 601 33730 Repair heart-vein defect(s) 602 33732 Repair heart-vein defect 603 33735 Revision of heart chamber 604 33736 Revision of heart chamber 605 33737 Revision of heart chamber 606 33750 Major vessel shunt 607 33755 Major vessel shunt 608 33762 Major vessel shunt 609 33764 Major vessel shunt & graft 610 33766 Major vessel shunt 611 33767 Major vessel shunt 612 33768 Cavopulmonary shunting

Page 12 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 613 33770 Repair great vessels defect 614 33771 Repair great vessels defect 615 33774 Repair great vessels defect 616 33775 Repair great vessels defect 617 33776 Repair great vessels defect 618 33777 Repair great vessels defect 619 33778 Repair great vessels defect 620 33779 Repair great vessels defect 621 33780 Repair great vessels defect 622 33781 Repair great vessels defect 623 33786 Repair arterial trunk 624 33788 Revision of pulmonary artery 625 33800 Aortic suspension 626 33802 Repair vessel defect 627 33803 Repair vessel defect 628 33813 Repair septal defect 629 33814 Repair septal defect 630 33820 Revise major vessel 631 33822 Revise major vessel 632 33824 Revise major vessel 633 33840 Remove aorta constriction 634 33845 Remove aorta constriction 635 33851 Remove aorta constriction 636 33852 Repair septal defect 637 33853 Repair septal defect 638 33860 Ascending aortic graft 639 33861 Ascending aortic graft 640 33863 Ascending aortic graft 641 33870 Transverse aortic arch graft 642 33875 Thoracic aortic graft 643 33877 Thoracoabdominal graft 644 33880 Endovasc taa repr incl subcl 645 33881 Endovasc taa repr w/o subcl 646 33883 Insert endovasc prosth, taa 647 33884 Endovasc prosth, taa, add-on 648 33886 Endovasc prosth, delayed 649 33889 Artery transpose/endovas taa 650 33891 Car-car bp grft/endovas taa 651 33910 Remove lung artery emboli 652 33915 Remove lung artery emboli 653 33916 Surgery of great vessel 654 33917 Repair pulmonary artery 655 33920 Repair pulmonary atresia 656 33922 Transect pulmonary artery 657 33924 Remove pulmonary shunt 658 33925 Rpr pul art unifocal w/o cpb 659 33926 Repr pul art, unifocal w/cpb 660 33930 Removal of donor heart/lung 661 33933 Prepare donor heart/lung 662 33935 Transplantation, heart/lung 663 33940 Removal of donor heart

Page 13 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 664 33944 Prepare donor heart 665 33945 Transplantation of heart 666 33960 External circulation assist 667 33961 External circulation assist 668 33967 Insert ia percut device 669 33968 Remove aortic assist device 670 33970 Aortic circulation assist 671 33971 Aortic circulation assist 672 33973 Insert balloon device 673 33974 Remove intra-aortic balloon 674 33975 Implant ventricular device 675 33976 Implant ventricular device 676 33977 Remove ventricular device 677 33978 Remove ventricular device 678 33979 Insert intracorporeal device 679 33980 Remove intracorporeal device 680 34001 Removal of artery clot 681 34051 Removal of artery clot 682 34151 Removal of artery clot 683 34401 Removal of vein clot 684 34451 Removal of vein clot 685 34502 Reconstruct vena cava 686 34800 Endovas aaa repr w/sm tube 687 34802 Endovas aaa repr w/2-p part 688 34803 Endovas aaa repr w/3-p part 689 34804 Endovas aaa repr w/1-p part 690 34805 Endovas aaa repr w/long tube 691 34808 Endovas iliac a device addon 692 34812 Xpose for endoprosth, femorl 693 34813 Femoral endovas graft add-on 694 34820 Xpose for endoprosth, iliac 695 34825 Endovasc extend prosth, init 696 34826 Endovasc exten prosth, add'l 697 34830 Open aortic tube prosth repr 698 34831 Open aortoiliac prosth repr 699 34832 Open aortofemor prosth repr 700 34833 Xpose for endoprosth, iliac 701 34834 Xpose, endoprosth, brachial 702 34900 Endovasc iliac repr w/graft 703 35001 Repair defect of artery 704 35002 Repair artery rupture, neck 705 35005 Repair defect of artery 706 35013 Repair artery rupture, arm 707 35021 Repair defect of artery 708 35022 Repair artery rupture, chest 709 35045 Repair defect of arm artery 710 35081 Repair defect of artery 711 35082 Repair artery rupture, aorta 712 35091 Repair defect of artery 713 35092 Repair artery rupture, aorta 714 35102 Repair defect of artery

Page 14 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 715 35103 Repair artery rupture, groin 716 35111 Repair defect of artery 717 35112 Repair artery rupture,spleen 718 35121 Repair defect of artery 719 35122 Repair artery rupture, belly 720 35131 Repair defect of artery 721 35132 Repair artery rupture, groin 722 35141 Repair defect of artery 723 35142 Repair artery rupture, thigh 724 35151 Repair defect of artery 725 35152 Repair artery rupture, knee 726 35182 Repair blood vessel lesion 727 35189 Repair blood vessel lesion 728 35211 Repair blood vessel lesion 729 35216 Repair blood vessel lesion 730 35221 Repair blood vessel lesion 731 35241 Repair blood vessel lesion 732 35246 Repair blood vessel lesion 733 35251 Repair blood vessel lesion 734 35271 Repair blood vessel lesion 735 35276 Repair blood vessel lesion 736 35281 Repair blood vessel lesion 737 35301 Rechanneling of artery 738 35311 Rechanneling of artery 739 35331 Rechanneling of artery 740 35341 Rechanneling of artery 741 35351 Rechanneling of artery 742 35355 Rechanneling of artery 743 35361 Rechanneling of artery 744 35363 Rechanneling of artery 745 35371 Rechanneling of artery 746 35372 Rechanneling of artery 747 35381 Rechanneling of artery 748 35390 Reoperation, carotid add-on 749 35400 Angioscopy 750 35450 Repair arterial blockage 751 35452 Repair arterial blockage 752 35454 Repair arterial blockage 753 35456 Repair arterial blockage 754 35480 Atherectomy, open 755 35481 Atherectomy, open 756 35482 Atherectomy, open 757 35483 Atherectomy, open 758 35501 Artery bypass graft 759 35506 Artery bypass graft 760 35507 Artery bypass graft 761 35508 Artery bypass graft 762 35509 Artery bypass graft 763 35510 Artery bypass graft 764 35511 Artery bypass graft 765 35512 Artery bypass graft

Page 15 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 766 35515 Artery bypass graft 767 35516 Artery bypass graft 768 35518 Artery bypass graft 769 35521 Artery bypass graft 770 35522 Artery bypass graft 771 35525 Artery bypass graft 772 35526 Artery bypass graft 773 35531 Artery bypass graft 774 35533 Artery bypass graft 775 35536 Artery bypass graft 776 35541 Artery bypass graft 777 35546 Artery bypass graft 778 35548 Artery bypass graft 779 35549 Artery bypass graft 780 35551 Artery bypass graft 781 35556 Artery bypass graft 782 35558 Artery bypass graft 783 35560 Artery bypass graft 784 35563 Artery bypass graft 785 35565 Artery bypass graft 786 35566 Artery bypass graft 787 35571 Artery bypass graft 788 35583 Vein bypass graft 789 35585 Vein bypass graft 790 35587 Vein bypass graft 791 35600 Harvest artery for cabg 792 35601 Artery bypass graft 793 35606 Artery bypass graft 794 35612 Artery bypass graft 795 35616 Artery bypass graft 796 35621 Artery bypass graft 797 35623 Bypass graft, not vein 798 35626 Artery bypass graft 799 35631 Artery bypass graft 800 35636 Artery bypass graft 801 35641 Artery bypass graft 802 35642 Artery bypass graft 803 35645 Artery bypass graft 804 35646 Artery bypass graft 805 35647 Artery bypass graft 806 35650 Artery bypass graft 807 35651 Artery bypass graft 808 35654 Artery bypass graft 809 35656 Artery bypass graft 810 35661 Artery bypass graft 811 35663 Artery bypass graft 812 35665 Artery bypass graft 813 35666 Artery bypass graft 814 35671 Artery bypass graft 815 35681 Composite bypass graft 816 35682 Composite bypass graft

Page 16 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 817 35683 Composite bypass graft 818 35691 Arterial transposition 819 35693 Arterial transposition 820 35694 Arterial transposition 821 35695 Arterial transposition 822 35697 Reimplant artery each 823 35700 Reoperation, bypass graft 824 35701 Exploration, carotid artery 825 35721 Exploration, femoral artery 826 35741 Exploration popliteal artery 827 35800 Explore neck vessels 828 35820 Explore chest vessels 829 35840 Explore abdominal vessels 830 35870 Repair vessel graft defect 831 35901 Excision, graft, neck 832 35905 Excision, graft, thorax 833 35907 Excision, graft, abdomen 834 36660 Insertion catheter, artery 835 36822 Insertion of cannula(s) 836 36823 Insertion of cannula(s) 837 37140 Revision of circulation 838 37145 Revision of circulation 839 37160 Revision of circulation 840 37180 Revision of circulation 841 37181 Splice spleen/kidney veins 842 37182 Insert hepatic shunt (tips) 843 37215 Transcath stent, cca w/eps 844 37616 Ligation of chest artery 845 37617 Ligation of abdomen artery 846 37618 Ligation of extremity artery 847 37660 Revision of major vein 848 37788 Revascularization, penis 849 38100 Removal of spleen, total 850 38101 Removal of spleen, partial 851 38102 Removal of spleen, total 852 38115 Repair of ruptured spleen 853 38380 Thoracic duct procedure 854 38381 Thoracic duct procedure 855 38382 Thoracic duct procedure 856 38562 Removal, pelvic lymph nodes 857 38564 Removal, abdomen lymph nodes 858 38724 Removal of lymph nodes, neck 859 38746 Remove thoracic lymph nodes 860 38747 Remove abdominal lymph nodes 861 38765 Remove groin lymph nodes 862 38770 Remove pelvis lymph nodes 863 38780 Remove abdomen lymph nodes 864 39000 Exploration of chest 865 39010 Exploration of chest 866 39200 Removal chest lesion 867 39220 Removal chest lesion

Page 17 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 868 39499 Chest procedure 869 39501 Repair diaphragm laceration 870 39502 Repair paraesophageal hernia 871 39503 Repair of diaphragm hernia 872 39520 Repair of diaphragm hernia 873 39530 Repair of diaphragm hernia 874 39531 Repair of diaphragm hernia 875 39540 Repair of diaphragm hernia 876 39541 Repair of diaphragm hernia 877 39545 Revision of diaphragm 878 39560 Resect diaphragm, simple 879 39561 Resect diaphragm, complex 880 39599 Diaphragm surgery procedure 881 41130 Partial removal of tongue 882 41135 Tongue and neck surgery 883 41140 Removal of tongue 884 41145 Tongue removal, neck surgery 885 41150 Tongue, mouth, jaw surgery 886 41153 Tongue, mouth, neck surgery 887 41155 Tongue, jaw, & neck surgery 888 42426 Excise parotid gland/lesion 889 42845 Extensive surgery of throat 890 42894 Revision of pharyngeal walls 891 42953 Repair throat, esophagus 892 42961 Control throat bleeding 893 42971 Control nose/throat bleeding 894 43045 Incision of esophagus 895 43100 Excision of esophagus lesion 896 43101 Excision of esophagus lesion 897 43107 Removal of esophagus 898 43108 Removal of esophagus 899 43112 Removal of esophagus 900 43113 Removal of esophagus 901 43116 Partial removal of esophagus 902 43117 Partial removal of esophagus 903 43118 Partial removal of esophagus 904 43121 Partial removal of esophagus 905 43122 Partial removal of esophagus 906 43123 Partial removal of esophagus 907 43124 Removal of esophagus 908 43135 Removal of esophagus pouch 909 43300 Repair of esophagus 910 43305 Repair esophagus and fistula 911 43310 Repair of esophagus 912 43312 Repair esophagus and fistula 913 43313 Esophagoplasty congenital 914 43314 Tracheo-esophagoplasty cong 915 43320 Fuse esophagus & stomach 916 43324 Revise esophagus & stomach 917 43325 Revise esophagus & stomach 918 43326 Revise esophagus & stomach

Page 18 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 919 43330 Repair of esophagus 920 43331 Repair of esophagus 921 43340 Fuse esophagus & intestine 922 43341 Fuse esophagus & intestine 923 43350 Surgical opening, esophagus 924 43351 Surgical opening, esophagus 925 43352 Surgical opening, esophagus 926 43360 Gastrointestinal repair 927 43361 Gastrointestinal repair 928 43400 Ligate esophagus veins 929 43401 Esophagus surgery for veins 930 43405 Ligate/staple esophagus 931 43410 Repair esophagus wound 932 43415 Repair esophagus wound 933 43420 Repair esophagus opening 934 43425 Repair esophagus opening 935 43460 Pressure treatment esophagus 936 43496 Free jejunum flap, microvasc 937 43500 Surgical opening of stomach 938 43501 Surgical repair of stomach 939 43502 Surgical repair of stomach 940 43520 Incision of pyloric muscle 941 43605 Biopsy of stomach 942 43610 Excision of stomach lesion 943 43611 Excision of stomach lesion 944 43620 Removal of stomach 945 43621 Removal of stomach 946 43622 Removal of stomach 947 43631 Removal of stomach, partial 948 43632 Removal of stomach, partial 949 43633 Removal of stomach, partial 950 43634 Removal of stomach, partial 951 43635 Removal of stomach, partial 952 43640 Vagotomy & pylorus repair 953 43641 Vagotomy & pylorus repair 954 43644 Lap gastric bypass/roux-en-y 955 43645 Lap gastr bypass incl smll i 956 43770 Lap, place gastr adjust band 957 43771 Lap, revise adjust gast band 958 43772 Lap, remove adjust gast band 959 43773 Lap, change adjust gast band 960 43774 Lap remov adj gast band/port 961 43800 Reconstruction of pylorus 962 43810 Fusion of stomach and bowel 963 43820 Fusion of stomach and bowel 964 43825 Fusion of stomach and bowel 965 43832 Place gastrostomy tube 966 43840 Repair of stomach lesion 967 43843 Gastroplasty w/o v-band 968 43845 Gastroplasty duodenal switch 969 43846 Gastric bypass for obesity

Page 19 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 970 43847 Gastric bypass incl small i 971 43848 Revision gastroplasty 972 43850 Revise stomach-bowel fusion 973 43855 Revise stomach-bowel fusion 974 43860 Revise stomach-bowel fusion 975 43865 Revise stomach-bowel fusion 976 43880 Repair stomach-bowel fistula 977 44005 Freeing of bowel adhesion 978 44010 Incision of small bowel 979 44015 Insert needle cath bowel 980 44020 Explore small intestine 981 44021 Decompress small bowel 982 44025 Incision of large bowel 983 44050 Reduce bowel obstruction 984 44055 Correct malrotation of bowel 985 44110 Excise intestine lesion(s) 986 44111 Excision of bowel lesion(s) 987 44120 Removal of small intestine 988 44121 Removal of small intestine 989 44125 Removal of small intestine 990 44126 Enterectomy w/o taper, cong 991 44127 Enterectomy w/taper, cong 992 44128 Enterectomy cong, add-on 993 44130 Bowel to bowel fusion 994 44132 Enterectomy, cadaver donor 995 44133 Enterectomy, live donor 996 44135 Intestine transplnt, cadaver 997 44136 Intestine transplant, live 998 44137 Remove intestinal allograft 999 44139 Mobilization of colon 1000 44140 Partial removal of colon 1001 44141 Partial removal of colon 1002 44143 Partial removal of colon 1003 44144 Partial removal of colon 1004 44145 Partial removal of colon 1005 44146 Partial removal of colon 1006 44147 Partial removal of colon 1007 44150 Removal of colon 1008 44151 Removal of colon/ileostomy 1009 44152 Removal of colon/ileostomy 1010 44153 Removal of colon/ileostomy 1011 44155 Removal of colon/ileostomy 1012 44156 Removal of colon/ileostomy 1013 44160 Removal of colon 1014 44187 Lap, ileo/jejuno-stomy 1015 44188 Lap, colostomy 1016 44202 Lap, enterectomy 1017 44203 Lap resect s/intestine, addl 1018 44204 Laparo partial colectomy 1019 44205 Lap colectomy part w/ileum 1020 44210 Laparo total proctocolectomy

Page 20 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1021 44211 Laparo total proctocolectomy 1022 44212 Laparo total proctocolectomy 1023 44227 Lap, close enterostomy 1024 44300 Open bowel to skin 1025 44310 Ileostomy/jejunostomy 1026 44314 Revision of ileostomy 1027 44316 Devise bowel pouch 1028 44320 Colostomy 1029 44322 Colostomy with biopsies 1030 44345 Revision of colostomy 1031 44346 Revision of colostomy 1032 44602 Suture, small intestine 1033 44603 Suture, small intestine 1034 44604 Suture, large intestine 1035 44605 Repair of bowel lesion 1036 44615 Intestinal stricturoplasty 1037 44620 Repair bowel opening 1038 44625 Repair bowel opening 1039 44626 Repair bowel opening 1040 44640 Repair bowel-skin fistula 1041 44650 Repair bowel fistula 1042 44660 Repair bowel-bladder fistula 1043 44661 Repair bowel-bladder fistula 1044 44680 Surgical revision, intestine 1045 44700 Suspend bowel w/prosthesis 1046 44715 Prepare donor intestine 1047 44720 Prep donor intestine/venous 1048 44721 Prep donor intestine/artery 1049 44800 Excision of bowel pouch 1050 44820 Excision of mesentery lesion 1051 44850 Repair of mesentery 1052 44899 Bowel surgery procedure 1053 44900 Drain app abscess, open 1054 44950 Appendectomy 1055 44955 Appendectomy add-on 1056 44960 Appendectomy 1057 45110 Removal of rectum 1058 45111 Partial removal of rectum 1059 45112 Removal of rectum 1060 45113 Partial proctectomy 1061 45114 Partial removal of rectum 1062 45116 Partial removal of rectum 1063 45119 Remove rectum w/reservoir 1064 45120 Removal of rectum 1065 45121 Removal of rectum and colon 1066 45123 Partial proctectomy 1067 45126 Pelvic exenteration 1068 45130 Excision of rectal prolapse 1069 45135 Excision of rectal prolapse 1070 45136 Excise ileoanal reservior 1071 45395 Lap, removal of rectum

Page 21 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1072 45397 Lap, remove rectum w/pouch 1073 45400 Laparoscopic proctopexy 1074 45402 Lap proctopexy w/sig resect 1075 45540 Correct rectal prolapse 1076 45550 Repair rectum/remove sigmoid 1077 45562 Exploration/repair of rectum 1078 45563 Exploration/repair of rectum 1079 45800 Repair rect/bladder fistula 1080 45805 Repair fistula w/colostomy 1081 45820 Repair rectourethral fistula 1082 45825 Repair fistula w/colostomy 1083 46705 Repair of anal stricture 1084 46710 Repr per/vag pouch sngl proc 1085 46712 Repr per/vag pouch dbl proc 1086 46715 Rep perf anoper fistu 1087 46716 Rep perf anoper/vestib fistu 1088 46730 Construction of absent anus 1089 46735 Construction of absent anus 1090 46740 Construction of absent anus 1091 46742 Repair of imperforated anus 1092 46744 Repair of cloacal anomaly 1093 46746 Repair of cloacal anomaly 1094 46748 Repair of cloacal anomaly 1095 46751 Repair of anal sphincter 1096 47010 Open drainage, liver lesion 1097 47015 Inject/aspirate liver cyst 1098 47100 Wedge biopsy of liver 1099 47120 Partial removal of liver 1100 47122 Extensive removal of liver 1101 47125 Partial removal of liver 1102 47130 Partial removal of liver 1103 47133 Removal of donor liver 1104 47135 Transplantation of liver 1105 47136 Transplantation of liver 1106 47140 Partial removal, donor liver 1107 47141 Partial removal, donor liver 1108 47142 Partial removal, donor liver 1109 47143 Prep donor liver, whole 1110 47144 Prep donor liver, 3-segment 1111 47145 Prep donor liver, lobe split 1112 47146 Prep donor liver/venous 1113 47147 Prep donor liver/arterial 1114 47300 Surgery for liver lesion 1115 47350 Repair liver wound 1116 47360 Repair liver wound 1117 47361 Repair liver wound 1118 47362 Repair liver wound 1119 47380 Open ablate liver tumor rf 1120 47381 Open ablate liver tumor cryo 1121 47400 Incision of liver duct 1122 47420 Incision of bile duct

Page 22 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1123 47425 Incision of bile duct 1124 47460 Incise bile duct sphincter 1125 47480 Incision of gallbladder 1126 47550 Bile duct endoscopy add-on 1127 47570 Laparo cholecystoenterostomy 1128 47600 Removal of gallbladder 1129 47605 Removal of gallbladder 1130 47610 Removal of gallbladder 1131 47612 Removal of gallbladder 1132 47620 Removal of gallbladder 1133 47700 Exploration of bile ducts 1134 47701 Bile duct revision 1135 47711 Excision of bile duct tumor 1136 47712 Excision of bile duct tumor 1137 47715 Excision of bile duct cyst 1138 47716 Fusion of bile duct cyst 1139 47720 Fuse gallbladder & bowel 1140 47721 Fuse upper gi structures 1141 47740 Fuse gallbladder & bowel 1142 47741 Fuse gallbladder & bowel 1143 47760 Fuse bile ducts and bowel 1144 47765 Fuse liver ducts & bowel 1145 47780 Fuse bile ducts and bowel 1146 47785 Fuse bile ducts and bowel 1147 47800 Reconstruction of bile ducts 1148 47801 Placement, bile duct support 1149 47802 Fuse liver duct & intestine 1150 47900 Suture bile duct injury 1151 48000 Drainage of abdomen 1152 48001 Placement of drain, pancreas 1153 48005 Resect/debride pancreas 1154 48020 Removal of pancreatic stone 1155 48100 Biopsy of pancreas, open 1156 48120 Removal of pancreas lesion 1157 48140 Partial removal of pancreas 1158 48145 Partial removal of pancreas 1159 48146 Pancreatectomy 1160 48148 Removal of pancreatic duct 1161 48150 Partial removal of pancreas 1162 48152 Pancreatectomy 1163 48153 Pancreatectomy 1164 48154 Pancreatectomy 1165 48155 Removal of pancreas 1166 48180 Fuse pancreas and bowel 1167 48400 Injection, intraop add-on 1168 48500 Surgery of pancreatic cyst 1169 48510 Drain pancreatic pseudocyst 1170 48520 Fuse pancreas cyst and bowel 1171 48540 Fuse pancreas cyst and bowel 1172 48545 Pancreatorrhaphy 1173 48547 Duodenal exclusion

Page 23 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1174 48551 Prep donor pancreas 1175 48552 Prep donor pancreas/venous 1176 48554 Transpl allograft pancreas 1177 48556 Removal, allograft pancreas 1178 49000 Exploration of abdomen 1179 49002 Reopening of abdomen 1180 49010 Exploration behind abdomen 1181 49020 Drain abdominal abscess 1182 49040 Drain, open, abdom abscess 1183 49060 Drain, open, retrop abscess 1184 49062 Drain to peritoneal cavity 1185 49201 Remove abdom lesion, complex 1186 49215 Excise sacral spine tumor 1187 49220 Multiple surgery, abdomen 1188 49255 Removal of omentum 1189 49425 Insert abdomen-venous drain 1190 49428 Ligation of shunt 1191 49605 Repair umbilical lesion 1192 49606 Repair umbilical lesion 1193 49610 Repair umbilical lesion 1194 49611 Repair umbilical lesion 1195 49900 Repair of abdominal wall 1196 49904 Omental flap, extra-abdom 1197 49905 Omental flap, intra-abdom 1198 49906 Free omental flap, microvasc 1199 50010 Exploration of kidney 1200 50040 Drainage of kidney 1201 50045 Exploration of kidney 1202 50060 Removal of kidney stone 1203 50065 Incision of kidney 1204 50070 Incision of kidney 1205 50075 Removal of kidney stone 1206 50100 Revise kidney blood vessels 1207 50120 Exploration of kidney 1208 50125 Explore and drain kidney 1209 50130 Removal of kidney stone 1210 50135 Exploration of kidney 1211 50205 Biopsy of kidney 1212 50220 Remove kidney, open 1213 50225 Removal kidney open, complex 1214 50230 Removal kidney open, radical 1215 50234 Removal of kidney & ureter 1216 50236 Removal of kidney & ureter 1217 50240 Partial removal of kidney 1218 50250 Cryoablate renal mass open 1219 50280 Removal of kidney lesion 1220 50290 Removal of kidney lesion 1221 50300 Remove cadaver donor kidney 1222 50320 Remove kidney, living donor 1223 50323 Prep cadaver renal allograft 1224 50325 Prep donor renal graft

Page 24 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1225 50327 Prep renal graft/venous 1226 50328 Prep renal graft/arterial 1227 50329 Prep renal graft/ureteral 1228 50340 Removal of kidney 1229 50360 Transplantation of kidney 1230 50365 Transplantation of kidney 1231 50370 Remove transplanted kidney 1232 50380 Reimplantation of kidney 1233 50400 Revision of kidney/ureter 1234 50405 Revision of kidney/ureter 1235 50500 Repair of kidney wound 1236 50520 Close kidney-skin fistula 1237 50525 Repair renal-abdomen fistula 1238 50526 Repair renal-abdomen fistula 1239 50540 Revision of horseshoe kidney 1240 50545 Laparo radical nephrectomy 1241 50546 Laparoscopic nephrectomy 1242 50547 Laparo removal donor kidney 1243 50548 Laparo remove w/ureter 1244 50580 Kidney endoscopy & treatment 1245 50600 Exploration of ureter 1246 50605 Insert ureteral support 1247 50610 Removal of ureter stone 1248 50620 Removal of ureter stone 1249 50630 Removal of ureter stone 1250 50650 Removal of ureter 1251 50660 Removal of ureter 1252 50700 Revision of ureter 1253 50715 Release of ureter 1254 50722 Release of ureter 1255 50725 Release/revise ureter 1256 50727 Revise ureter 1257 50728 Revise ureter 1258 50740 Fusion of ureter & kidney 1259 50750 Fusion of ureter & kidney 1260 50760 Fusion of ureters 1261 50770 Splicing of ureters 1262 50780 Reimplant ureter in bladder 1263 50782 Reimplant ureter in bladder 1264 50783 Reimplant ureter in bladder 1265 50785 Reimplant ureter in bladder 1266 50800 Implant ureter in bowel 1267 50810 Fusion of ureter & bowel 1268 50815 Urine shunt to intestine 1269 50820 Construct bowel bladder 1270 50825 Construct bowel bladder 1271 50830 Revise urine flow 1272 50840 Replace ureter by bowel 1273 50845 Appendico-vesicostomy 1274 50860 Transplant ureter to skin 1275 50900 Repair of ureter

Page 25 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1276 50920 Closure ureter/skin fistula 1277 50930 Closure ureter/bowel fistula 1278 50940 Release of ureter 1279 51060 Removal of ureter stone 1280 51525 Removal of bladder lesion 1281 51530 Removal of bladder lesion 1282 51535 Repair of ureter lesion 1283 51550 Partial removal of bladder 1284 51555 Partial removal of bladder 1285 51565 Revise bladder & ureter(s) 1286 51570 Removal of bladder 1287 51575 Removal of bladder & nodes 1288 51580 Remove bladder/revise tract 1289 51585 Removal of bladder & nodes 1290 51590 Remove bladder/revise tract 1291 51595 Remove bladder/revise tract 1292 51596 Remove bladder/create pouch 1293 51597 Removal of pelvic structures 1294 51800 Revision of bladder/urethra 1295 51820 Revision of urinary tract 1296 51840 Attach bladder/urethra 1297 51841 Attach bladder/urethra 1298 51845 Repair bladder neck 1299 51860 Repair of bladder wound 1300 51865 Repair of bladder wound 1301 51900 Repair bladder/vagina lesion 1302 51920 Close bladder-uterus fistula 1303 51925 Hysterectomy/bladder repair 1304 51940 Correction of bladder defect 1305 51960 Revision of bladder & bowel 1306 51980 Construct bladder opening 1307 53415 Reconstruction of urethra 1308 53448 Remov/replc ur sphinctr comp 1309 54125 Removal of penis 1310 54130 Remove penis & nodes 1311 54135 Remove penis & nodes 1312 54332 Revise penis/urethra 1313 54336 Revise penis/urethra 1314 54390 Repair penis and bladder 1315 54411 Remov/replc penis pros, comp 1316 54417 Remv/replc penis pros, compl 1317 54430 Revision of penis 1318 54535 Extensive testis surgery 1319 54650 Orchiopexy (Fowler-Stephens) 1320 55605 Incise sperm duct pouch 1321 55650 Remove sperm duct pouch 1322 55801 Removal of prostate 1323 55810 Extensive prostate surgery 1324 55812 Extensive prostate surgery 1325 55815 Extensive prostate surgery 1326 55821 Removal of prostate

Page 26 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1327 55831 Removal of prostate 1328 55840 Extensive prostate surgery 1329 55842 Extensive prostate surgery 1330 55845 Extensive prostate surgery 1331 55862 Extensive prostate surgery 1332 55865 Extensive prostate surgery 1333 55866 Laparo radical prostatectomy 1334 56630 Extensive vulva surgery 1335 56631 Extensive vulva surgery 1336 56632 Extensive vulva surgery 1337 56633 Extensive vulva surgery 1338 56634 Extensive vulva surgery 1339 56637 Extensive vulva surgery 1340 56640 Extensive vulva surgery 1341 57110 Remove vagina wall, complete 1342 57111 Remove vagina tissue, compl 1343 57112 Vaginectomy w/nodes, compl 1344 57270 Repair of bowel pouch 1345 57280 Suspension of vagina 1346 57282 Colpopexy, extraperitoneal 1347 57283 Colpopexy, intraperitoneal 1348 57292 Construct vagina with graft 1349 57305 Repair rectum-vagina fistula 1350 57307 Fistula repair & colostomy 1351 57308 Fistula repair, transperine 1352 57311 Repair urethrovaginal lesion 1353 57335 Repair vagina 1354 57531 Removal of cervix, radical 1355 57540 Removal of residual cervix 1356 57545 Remove cervix/repair pelvis 1357 58140 Myomectomy abdom method 1358 58146 Myomectomy abdom complex 1359 58150 Total hysterectomy 1360 58152 Total hysterectomy 1361 58180 Partial hysterectomy 1362 58200 Extensive hysterectomy 1363 58210 Extensive hysterectomy 1364 58240 Removal of pelvis contents 1365 58260 Vaginal hysterectomy 1366 58262 Vag hyst including t/o 1367 58263 Vag hyst w/t/o & vag repair 1368 58267 Vag hyst w/urinary repair 1369 58270 Vag hyst w/enterocele repair 1370 58275 Hysterectomy/revise vagina 1371 58280 Hysterectomy/revise vagina 1372 58285 Extensive hysterectomy 1373 58290 Vag hyst complex 1374 58291 Vag hyst incl t/o, complex 1375 58292 Vag hyst t/o & repair, compl 1376 58293 Vag hyst w/uro repair, compl 1377 58294 Vag hyst w/enterocele, compl

Page 27 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1378 58400 Suspension of uterus 1379 58410 Suspension of uterus 1380 58520 Repair of ruptured uterus 1381 58540 Revision of uterus 1382 58605 Division of fallopian tube 1383 58611 Ligate oviduct(s) add-on 1384 58700 Removal of fallopian tube 1385 58720 Removal of ovary/tube(s) 1386 58740 Revise fallopian tube(s) 1387 58750 Repair oviduct 1388 58752 Revise ovarian tube(s) 1389 58760 Remove tubal obstruction 1390 58805 Drainage of ovarian cyst(s) 1391 58822 Drain ovary abscess, percut 1392 58825 Transposition, ovary(s) 1393 58940 Removal of ovary(s) 1394 58943 Removal of ovary(s) 1395 58950 Resect ovarian malignancy 1396 58951 Resect ovarian malignancy 1397 58952 Resect ovarian malignancy 1398 58953 Tah, rad dissect for debulk 1399 58954 Tah rad debulk/lymph remove 1400 58956 Bso, omentectomy w/tah 1401 58960 Exploration of abdomen 1402 59120 Treat ectopic pregnancy 1403 59121 Treat ectopic pregnancy 1404 59130 Treat ectopic pregnancy 1405 59135 Treat ectopic pregnancy 1406 59136 Treat ectopic pregnancy 1407 59140 Treat ectopic pregnancy 1408 59325 Revision of cervix 1409 59350 Repair of uterus 1410 59514 Cesarean delivery only 1411 59525 Remove uterus after cesarean 1412 59620 Attempted vbac delivery only 1413 59830 Treat uterus infection 1414 59850 Abortion 1415 59851 Abortion 1416 59852 Abortion 1417 59855 Abortion 1418 59856 Abortion 1419 59857 Abortion 1420 60254 Extensive thyroid surgery 1421 60270 Removal of thyroid 1422 60271 Removal of thyroid 1423 60502 Re-explore parathyroids 1424 60505 Explore parathyroid glands 1425 60520 Removal of thymus gland 1426 60521 Removal of thymus gland 1427 60522 Removal of thymus gland 1428 60540 Explore adrenal gland

Page 28 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1429 60545 Explore adrenal gland 1430 60600 Remove carotid body lesion 1431 60605 Remove carotid body lesion 1432 60650 Laparoscopy adrenalectomy 1433 61105 Twist drill hole 1434 61107 Drill skull for implantation 1435 61108 Drill skull for drainage 1436 61120 Burr hole for puncture 1437 61140 Pierce skull for biopsy 1438 61150 Pierce skull for drainage 1439 61151 Pierce skull for drainage 1440 61154 Pierce skull & remove clot 1441 61156 Pierce skull for drainage 1442 61210 Pierce skull, implant device 1443 61250 Pierce skull & explore 1444 61253 Pierce skull & explore 1445 61304 Open skull for exploration 1446 61305 Open skull for exploration 1447 61312 Open skull for drainage 1448 61313 Open skull for drainage 1449 61314 Open skull for drainage 1450 61315 Open skull for drainage 1451 61316 Implt cran bone flap to abdo 1452 61320 Open skull for drainage 1453 61321 Open skull for drainage 1454 61322 Decompressive craniotomy 1455 61323 Decompressive lobectomy 1456 61332 Explore/biopsy eye socket 1457 61333 Explore orbit/remove lesion 1458 61340 Subtemporal decompression 1459 61343 Incise skull (press relief) 1460 61345 Relieve cranial pressure 1461 61440 Incise skull for surgery 1462 61450 Incise skull for surgery 1463 61458 Incise skull for brain wound 1464 61460 Incise skull for surgery 1465 61470 Incise skull for surgery 1466 61480 Incise skull for surgery 1467 61490 Incise skull for surgery 1468 61500 Removal of skull lesion 1469 61501 Remove infected skull bone 1470 61510 Removal of brain lesion 1471 61512 Remove brain lining lesion 1472 61514 Removal of brain abscess 1473 61516 Removal of brain lesion 1474 61517 Implt brain chemotx add-on 1475 61518 Removal of brain lesion 1476 61519 Remove brain lining lesion 1477 61520 Removal of brain lesion 1478 61521 Removal of brain lesion 1479 61522 Removal of brain abscess

Page 29 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1480 61524 Removal of brain lesion 1481 61526 Removal of brain lesion 1482 61530 Removal of brain lesion 1483 61531 Implant brain electrodes 1484 61533 Implant brain electrodes 1485 61534 Removal of brain lesion 1486 61535 Remove brain electrodes 1487 61536 Removal of brain lesion 1488 61537 Removal of brain tissue 1489 61538 Removal of brain tissue 1490 61539 Removal of brain tissue 1491 61540 Removal of brain tissue 1492 61541 Incision of brain tissue 1493 61542 Removal of brain tissue 1494 61543 Removal of brain tissue 1495 61544 Remove & treat brain lesion 1496 61545 Excision of brain tumor 1497 61546 Removal of pituitary gland 1498 61548 Removal of pituitary gland 1499 61550 Release of skull seams 1500 61552 Release of skull seams 1501 61556 Incise skull/sutures 1502 61557 Incise skull/sutures 1503 61558 Excision of skull/sutures 1504 61559 Excision of skull/sutures 1505 61563 Excision of skull tumor 1506 61564 Excision of skull tumor 1507 61566 Removal of brain tissue 1508 61567 Incision of brain tissue 1509 61570 Remove foreign body, brain 1510 61571 Incise skull for brain wound 1511 61575 Skull base/brainstem surgery 1512 61576 Skull base/brainstem surgery 1513 61580 Craniofacial approach, skull 1514 61581 Craniofacial approach, skull 1515 61582 Craniofacial approach, skull 1516 61583 Craniofacial approach, skull 1517 61584 Orbitocranial approach/skull 1518 61585 Orbitocranial approach/skull 1519 61586 Resect nasopharynx, skull 1520 61590 Infratemporal approach/skull 1521 61591 Infratemporal approach/skull 1522 61592 Orbitocranial approach/skull 1523 61595 Transtemporal approach/skull 1524 61596 Transcochlear approach/skull 1525 61597 Transcondylar approach/skull 1526 61598 Transpetrosal approach/skull 1527 61600 Resect/excise cranial lesion 1528 61601 Resect/excise cranial lesion 1529 61605 Resect/excise cranial lesion 1530 61606 Resect/excise cranial lesion

Page 30 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1531 61607 Resect/excise cranial lesion 1532 61608 Resect/excise cranial lesion 1533 61609 Transect artery, sinus 1534 61610 Transect artery, sinus 1535 61611 Transect artery, sinus 1536 61612 Transect artery, sinus 1537 61613 Remove aneurysm, sinus 1538 61615 Resect/excise lesion, skull 1539 61616 Resect/excise lesion, skull 1540 61618 Repair dura 1541 61619 Repair dura 1542 61624 Transcath occlusion, cns 1543 61680 Intracranial vessel surgery 1544 61682 Intracranial vessel surgery 1545 61684 Intracranial vessel surgery 1546 61686 Intracranial vessel surgery 1547 61690 Intracranial vessel surgery 1548 61692 Intracranial vessel surgery 1549 61697 Brain aneurysm repr, complx 1550 61698 Brain aneurysm repr, complx 1551 61700 Brain aneurysm repr, simple 1552 61702 Inner skull vessel surgery 1553 61703 Clamp neck artery 1554 61705 Revise circulation to head 1555 61708 Revise circulation to head 1556 61710 Revise circulation to head 1557 61711 Fusion of skull arteries 1558 61720 Incise skull/brain surgery 1559 61735 Incise skull/brain surgery 1560 61750 Incise skull/brain biopsy 1561 61751 Brain biopsy w/ct/mr guide 1562 61760 Implant brain electrodes 1563 61770 Incise skull for treatment 1564 61850 Implant neuroelectrodes 1565 61860 Implant neuroelectrodes 1566 61863 Implant neuroelectrode 1567 61864 Implant neuroelectrde, addl 1568 61867 Implant neuroelectrode 1569 61868 Implant neuroelectrde, add'l 1570 61870 Implant neuroelectrodes 1571 61875 Implant neuroelectrodes 1572 62000 Treat skull fracture 1573 62005 Treat skull fracture 1574 62010 Treatment of head injury 1575 62100 Repair brain fluid leakage 1576 62115 Reduction of skull defect 1577 62116 Reduction of skull defect 1578 62117 Reduction of skull defect 1579 62120 Repair skull cavity lesion 1580 62121 Incise skull repair 1581 62140 Repair of skull defect

Page 31 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1582 62141 Repair of skull defect 1583 62142 Remove skull plate/flap 1584 62143 Replace skull plate/flap 1585 62145 Repair of skull & brain 1586 62146 Repair of skull with graft 1587 62147 Repair of skull with graft 1588 62148 Retr bone flap to fix skull 1589 62161 Dissect brain w/scope 1590 62162 Remove colloid cyst w/scope 1591 62163 Neuroendoscopy w/fb removal 1592 62164 Remove brain tumor w/scope 1593 62165 Remove pituit tumor w/scope 1594 62180 Establish brain cavity shunt 1595 62190 Establish brain cavity shunt 1596 62192 Establish brain cavity shunt 1597 62200 Establish brain cavity shunt 1598 62201 Brain cavity shunt w/scope 1599 62220 Establish brain cavity shunt 1600 62223 Establish brain cavity shunt 1601 62256 Remove brain cavity shunt 1602 62258 Replace brain cavity shunt 1603 63043 Laminotomy, add'l cervical 1604 63044 Laminotomy, add'l lumbar 1605 63050 Cervical laminoplasty 1606 63051 C-laminoplasty w/graft/plate 1607 63076 Neck spine disk surgery 1608 63077 Spine disk surgery, thorax 1609 63078 Spine disk surgery, thorax 1610 63081 Removal of vertebral body 1611 63082 Remove vertebral body add-on 1612 63085 Removal of vertebral body 1613 63086 Remove vertebral body add-on 1614 63087 Removal of vertebral body 1615 63088 Remove vertebral body add-on 1616 63090 Removal of vertebral body 1617 63091 Remove vertebral body add-on 1618 63101 Removal of vertebral body 1619 63102 Removal of vertebral body 1620 63103 Remove vertebral body add-on 1621 63170 Incise spinal cord tract(s) 1622 63172 Drainage of spinal cyst 1623 63173 Drainage of spinal cyst 1624 63180 Revise spinal cord ligaments 1625 63182 Revise spinal cord ligaments 1626 63185 Incise spinal column/nerves 1627 63190 Incise spinal column/nerves 1628 63191 Incise spinal column/nerves 1629 63194 Incise spinal column & cord 1630 63195 Incise spinal column & cord 1631 63196 Incise spinal column & cord 1632 63197 Incise spinal column & cord

Page 32 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1633 63198 Incise spinal column & cord 1634 63199 Incise spinal column & cord 1635 63200 Release of spinal cord 1636 63250 Revise spinal cord vessels 1637 63251 Revise spinal cord vessels 1638 63252 Revise spinal cord vessels 1639 63265 Excise intraspinal lesion 1640 63266 Excise intraspinal lesion 1641 63267 Excise intraspinal lesion 1642 63268 Excise intraspinal lesion 1643 63270 Excise intraspinal lesion 1644 63271 Excise intraspinal lesion 1645 63272 Excise intraspinal lesion 1646 63273 Excise intraspinal lesion 1647 63275 Biopsy/excise spinal tumor 1648 63276 Biopsy/excise spinal tumor 1649 63277 Biopsy/excise spinal tumor 1650 63278 Biopsy/excise spinal tumor 1651 63280 Biopsy/excise spinal tumor 1652 63281 Biopsy/excise spinal tumor 1653 63282 Biopsy/excise spinal tumor 1654 63283 Biopsy/excise spinal tumor 1655 63285 Biopsy/excise spinal tumor 1656 63286 Biopsy/excise spinal tumor 1657 63287 Biopsy/excise spinal tumor 1658 63290 Biopsy/excise spinal tumor 1659 63295 Repair of laminectomy defect 1660 63300 Removal of vertebral body 1661 63301 Removal of vertebral body 1662 63302 Removal of vertebral body 1663 63303 Removal of vertebral body 1664 63304 Removal of vertebral body 1665 63305 Removal of vertebral body 1666 63306 Removal of vertebral body 1667 63307 Removal of vertebral body 1668 63308 Remove vertebral body add-on 1669 63700 Repair of spinal herniation 1670 63702 Repair of spinal herniation 1671 63704 Repair of spinal herniation 1672 63706 Repair of spinal herniation 1673 63707 Repair spinal fluid leakage 1674 63709 Repair spinal fluid leakage 1675 63710 Graft repair of spine defect 1676 63740 Install spinal shunt 1677 64752 Incision of vagus nerve 1678 64755 Incision of stomach nerves 1679 64760 Incision of vagus nerve 1680 64804 Remove sympathetic nerves 1681 64809 Remove sympathetic nerves 1682 64818 Remove sympathetic nerves 1683 64866 Fusion of facial/other nerve

Page 33 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1684 64868 Fusion of facial/other nerve 1685 65273 Repair of eye wound 1686 69155 Extensive ear/neck surgery 1687 69535 Remove part of temporal bone 1688 69554 Remove ear lesion 1689 69950 Incise inner ear nerve 1690 69970 Remove inner ear lesion 1691 75900 Intravascular cath exchange 1692 75952 Endovasc repair abdom aorta 1693 75953 Abdom aneurysm endovas rpr 1694 75954 Iliac aneurysm endovas rpr 1695 75956 Xray, endovasc thor ao repr 1696 75957 Xray, endovasc thor ao repr 1697 75958 Xray, place prox ext thor ao 1698 75959 Xray, place dist ext thor ao 1699 92970 Cardioassist, internal 1700 92971 Cardioassist, external 1701 92975 Dissolve clot, heart vessel 1702 92992 Revision of heart chamber 1703 92993 Revision of heart chamber 1704 99190 Special pump services 1705 99191 Special pump services 1706 99192 Special pump services 1707 99251 Initial inpatient consult 1708 99252 Initial inpatient consult 1709 99253 Initial inpatient consult 1710 99254 Initial inpatient consult 1711 99255 Initial inpatient consult 1712 99293 Ped critical care, initial 1713 99294 Ped critical care, subseq 1714 99295 Neonate crit care, initial 1715 99296 Neonate critical care subseq 1716 99298 Ic for lbw infant < 1500 gm 1717 99299 Ic, lbw infant 1500-2500 gm 1718 99356 Prolonged service, inpatient 1719 99357 Prolonged service, inpatient 1720 99433 Normal newborn care/hospital 1721 G0341 Percutaneous islet celltrans 1722 G0342 Laparoscopy islet cell trans 1723 G0343 Laparotomy islet cell transp 1724 H0049 Alcohol/drug screening 1725 H0050 Alcohol/drug service 15 min 1726 K0738 Portable gas oxygen system 1727 K0800 POV group 1 std up to 300 lbs 1728 K0801 POV group 1 hd 301-450 lbs 1729 K0802 POV group 1 vhd 451-600 lbs 1730 K0806 POV group 2 std up to 300lbs 1731 K0807 POV group 2 hd 301-450 lbs 1732 K0808 POV group 2 vhd 451-600 lbs 1733 K0812 Power operated vehicle NOC 1734 K0813 PWC gp 1 std port seat/back

Page 34 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1735 K0814 PWC gp 1 std port cap chair 1736 K0815 PWC gp 1 std seat/back 1737 K0816 PWC gp 1 std cap chair 1738 K0820 PWC gp 2 std port seat/back 1739 K0821 PWC gp 2 std port cap chair 1740 K0822 PWC gp 2 std seat/back 1741 K0823 PWC gp 2 std cap chair 1742 K0824 PWC gp 2 hd seat/back 1743 K0825 PWC gp 2 hd cap chair 1744 K0826 PWC gp2 vhd seat/back 1745 K0827 PWC gp 2 vhd cap chair 1746 K0828 PWC gp 2 xtra hd seat/back 1747 K0829 PWC gp 2 xtra hd cap chair 1748 K0830 PWC gp2 std seat elevate s/b 1749 K0831 PWC gp2 std seat elevate cap 1750 K0835 PWC gp2 std sing pow opt s/b 1751 K0836 PWC gp2 std sing pow opt cap 1752 K0837 PWC gp 2 hd sing pow opt s/b 1753 K0838 PWC gp 2 hd sing pow opt cap 1754 K0839 PWC gp2 vhd sing pow opt s/b 1755 K0840 PWC gp2 xhd sing pow opt s/b 1756 K0841 PWC gp2 std mult pow opt s/b 1757 K0842 PWC gp2 std mult pow opt cap 1758 K0843 PWC gp2 hd mult pow opt s/b 1759 K0848 PWC gp 3 std seat/back 1760 K0849 PWC gp 3 std cap chair 1761 K0850 PWC gp 3 hd seat/back 1762 K0851 PWC gp 3 hd cap chair 1763 K0852 PWC gp 3 vhd seat/back 1764 K0853 PWC gp 3 vhd cap chair 1765 K0854 PWC gp 3 xhd seat/back 1766 K0855 PWC gp 3 xhd cap chair 1767 K0856 PWC gp3 std sing pow opt s/b 1768 K0857 PWC gp3 std sing pow opt cap 1769 K0858 PWC gp3 hd sing pow opt s/b 1770 K0859 PWC gp3 hd sing pow opt cap 1771 K0860 PWC gp3 vhd sing pow opt s/b 1772 K0861 PWC gp3 std mult pow opt s/b 1773 K0862 PWC gp3 hd mult pow opt s/b 1774 K0863 PWC gp3 vhd mult pow opt s/b 1775 K0864 PWC gp3 xhd mult pow opt s/b 1776 K0868 PWC gp 4 std seat/back 1777 K0869 PWC gp 4 std cap chair 1778 K0870 PWC gp 4 hd seat/back 1779 K0871 PWC gp 4 vhd seat/back 1780 K0877 PWC gp4 std sing pow opt s/b 1781 K0878 PWC gp4 std sing pow opt cap 1782 K0879 PWC gp4 hd sing pow opt s/b 1783 K0880 PWC gp4 vhd sing pow opt s/b 1784 K0884 PWc gp4 std mult pow opt s/b 1785 K0885 PWC gp4 std mult pow opt cap

Page 35 of 36 Appendix A - Add NRL October 2006 Non-OPPS OCE

AB 1786 K0886 PWC gp4 hd mult pow s/b 1787 K0890 PWC gp5 ped sing pow opt s/b 1788 K0891 PWC gp5 ped mult pow opt s/b 1789 K0898 Power wheelchair NOC 1790 K0899 Pow mobility dev no sadmerc 1791 S0147 Alglucosidase alfa 20 mg 1792 S2325 Hip core decompression

Page 36 of 36 Appendix B - Remove NRL 2006 October Non-OPPS OCE

HCPCS CodeDesc C1178 BUSULFAN IV, 6 Mg C1300 HYPERBARIC Oxygen C1713 Anchor/screw bn/bn,tis/bn C1714 Cath, trans atherectomy, dir C1715 Brachytherapy needle C1716 Brachytx source, Gold 198 C1717 Brachytx source, HDR Ir-192 C1718 Brachytx source, Iodine 125 C1719 Brachytx sour,Non-HDR Ir-192 C1720 Brachytx sour, Palladium 103 C1721 AICD, dual chamber C1722 AICD, single chamber C1724 Cath, trans atherec,rotation C1725 Cath, translumin non-laser C1726 Cath, bal dil, non-vascular C1727 Cath, bal tis dis, non-vas C1728 Cath, brachytx seed adm C1729 Cath, drainage C1730 Cath, EP, 19 or few elect C1731 Cath, EP, 20 or more elec C1732 Cath, EP, diag/abl, 3D/vect C1733 Cath, EP, othr than cool-tip C1750 Cath, hemodialysis,long-term C1751 Cath, inf, per/cent/midline C1752 Cath,hemodialysis,short-term C1753 Cath, intravas ultrasound C1754 Catheter, intradiscal C1755 Catheter, intraspinal C1756 Cath, pacing, transesoph C1757 Cath, thrombectomy/embolect C1758 Catheter, ureteral C1759 Cath, intra echocardiography C1760 Closure dev, vasc C1762 Conn tiss, human(inc fascia) C1763 Conn tiss, non-human C1764 Event recorder, cardiac C1765 Adhesion barrier C1766 Intro/sheath,strble,non-peel C1767 Generator, neuro non-recharg C1768 Graft, vascular C1769 Guide wire C1770 Imaging coil, MR, insertable C1771 Rep dev, urinary, w/sling C1772 Infusion pump, programmable C1773 Ret dev, insertable C1776 Joint device (implantable) C1777 Lead, AICD, endo single coil C1778 Lead, neurostimulator C1779 Lead, pmkr, transvenous VDD C1780 Lens, intraocular (new tech) C1781 Mesh (implantable)

Page 1 of 4 Appendix B - Remove NRL 2006 October Non-OPPS OCE

C1782 Morcellator C1783 Ocular imp, aqueous drain de C1784 Ocular dev, intraop, det ret C1785 Pmkr, dual, rate-resp C1786 Pmkr, single, rate-resp C1787 Patient progr, neurostim C1788 Port, indwelling, imp C1789 Prosthesis, breast, imp C1813 Prosthesis, penile, inflatab C1814 Retinal tamp, silicone oil C1815 Pros, urinary sph, imp C1816 Receiver/transmitter, neuro C1817 Septal defect imp sys C1818 Integrated keratoprosthesis C1819 Tissue localization-excision C1820 Generator neuro rechg bat sy C1874 Stent, coated/cov w/del sys C1875 Stent, coated/cov w/o del sy C1876 Stent, non-coa/non-cov w/del C1877 Stent, non-coat/cov w/o del C1878 Matrl for vocal cord C1879 Tissue marker, implantable C1880 Vena cava filter C1881 Dialysis access system C1882 AICD, other than sing/dual C1883 Adapt/ext, pacing/neuro lead C1884 Embolization Protect syst C1885 Cath, translumin angio laser C1887 Catheter, guiding C1888 Endovas non-cardiac abl cath C1891 Infusion pump,non-prog, perm C1892 Intro/sheath,fixed,peel-away C1893 Intro/sheath, fixed,non-peel C1894 Intro/sheath, non-laser C1895 Lead, AICD, endo dual coil C1896 Lead, AICD, non sing/dual C1897 Lead, neurostim test kit C1898 Lead, pmkr, other than trans C1899 Lead, pmkr/AICD combination C1900 Lead, coronary venous C2614 Probe, perc lumb disc C2615 Sealant, pulmonary, liquid C2616 Brachytx source, Yttrium-90 C2617 Stent, non-cor, tem w/o del C2618 Probe, cryoablation C2619 Pmkr, dual, non rate-resp C2620 Pmkr, single, non rate-resp C2621 Pmkr, other than sing/dual C2622 Prosthesis, penile, non-inf C2625 Stent, non-cor, tem w/del sy C2626 Infusion pump, non-prog,temp C2627 Cath, suprapubic/cystoscopic

Page 2 of 4 Appendix B - Remove NRL 2006 October Non-OPPS OCE

C2628 Catheter, occlusion C2629 Intro/sheath, laser C2630 Cath, EP, cool-tip C2631 Rep dev, urinary, w/o sling C2632 Brachytx sol, I-125, per mCi C2633 Brachytx source, Cesium-131 C2634 Brachytx source, HA, I-125 C2635 Brachytx source, HA, P-103 C2636 Brachytx linear source,P-103 C2637 Brachytx, Ytterbium-169 C8900 MRA w/cont, abd C8901 MRA w/o cont, abd C8902 MRA w/o fol w/cont, abd C8903 MRI w/cont, breast, uni C8904 MRI w/o cont, breast, uni C8905 MRI w/o fol w/cont, brst, un C8906 MRI w/cont, breast, bi C8907 MRI w/o cont, breast, bi C8908 MRI w/o fol w/cont, breast, C8909 MRA w/cont, chest C8910 MRA w/o cont, chest C8911 MRA w/o fol w/cont, chest C8912 MRA w/cont, lwr ext C8913 MRA w/o cont, lwr ext C8914 MRA w/o fol w/cont, lwr ext C8918 MRA w/cont, pelvis C8919 MRA w/o cont, pelvis C8920 MRA w/o fol w/cont, pelvis C8950 IV inf, tx/dx, up to 1 hr C8951 IV inf, tx/dx, each addl hr C8952 Tx, prophy, dx IV push C8953 Chemotx adm, IV push C8954 Chemotx adm, IV inf up to 1h C8955 Chemotx adm, IV inf, addl hr C8957 Prolonged IV inf, req pump C9003 Palivizumab, per 50 mg C9113 Inj pantoprazole sodium, via C9121 Injection, argatroban C9220 Sodium hyaluronate C9221 Graftjacket Reg Matrix C9222 Graftjacket SftTis C9224 Injection, galsulfase C9225 Fluocinolone acetonide C9227 Injection, micafungin sodium C9228 Injection, tigecycline C9229 Injection ibandronate sodium C9230 Injection, abatacept C9399 Unclassified drugs or biolog C9716 Radiofrequency energy to anu C9723 Dyn IR Perf Img C9724 EPS gast cardia plic C9725 Place endorectal app

Page 3 of 4 Appendix B - Remove NRL 2006 October Non-OPPS OCE

C9726 Rxt breast appl place/remov C9727 Insert palate implants

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