CPT Code List Vermont Health Care Price & Quality Transparency

CPT Code Description Plain Language Description Allergen Immunotherapy

95004 Percut Tests w/ Extrac Immed React # Allergy testing Professional Services Supervision 95165 Supervision of allergen preparation Provisions Antig Anesthesia 00790 Anes Interaperitoneal Inc Shunts; Nos Anesthesia for upper abdominal procedures 00840 Anes Interaperitoneal Low Abd; Nos Anesthesia for lower abdominal procedures Neuraxial Labor Analgesia/Anesthesia 01967 Epidural obstetric anesthesia For Planned V Laboratory / Pathology 80061 Lipid Panel Cholesterol and lipid testing 81000 UA dipstick/tablet; non-auto w/micro Microscopic and chemical urine testing 81002 Urinalysis dip stik/tablt;wo micro non-auto Chemical urine testing only Urine pregnancy test, by visual color 81025 Pregnancy test (urine) comparison methods 82270 Bld Occult; feces 103 simult determ Stool blood test 83036 HGB; glycated Hemoglobin A1C blood test 85018 Bld ct; hgb Hemoglobin test 85025 Bld Cnt; hemo/Plt, Auto, Cmplt Dif. Wbc Complete blood count (CBC) 85610 Prothrombin Time Blood clotting test (prothrombin time) 87880 Agt-immunassay dir obs; strep grp A Strep test, group A 88305 Level IV-Surg Path Gross/Micro Exam Level IV surgical pathology examination Medicine – Acute Care Office & Outpatient Visits 99209 Offic/Outpt E&M New Low-Mod 20 Min Office visit, new patient, 20 minutes 99203 Offic/Outpt E&M New Mod Sever 30 Min Office visit, new patient, 30 minutes 92204 Offic/Outpt E&M New Mod-Hi 45 Min Office visit, new patient, 45 minutes 99211 Offic/Outpt E&M Estab 5 Min Office visit, established patient, 5 minutes 99212 Offic/Outpt E&M Estab Minor 10 Min Office visit, established patient, 10 minutes 99213 Offic/Outpt E&M Estab Low-Mod 15 Min Office visit, established patient, 15 minutes 92214 Offic/Outpt E&M Estab Mod-Hi 25 Min Office visit, established patient, 25 minutes

11-1-09 1 92215 Offic/Outpt E&M Estab Mod-Hi 40 Min Office visit, established patient, 40 minutes Medicine – Eye & Ear Exams Ophthalmological exam; new patient, Eye examination, new patient, intermediate 92004 intermediate amount of time Ophthalmological services intermediate 92012 Ophth serv: Med exam; interm estab established patient Ophthalmological services comprehensive 92014 Ophth serv: Med exam; comp estab pt exam established 92015 Determ Refractive State Eye refraction determination 92567 Tympanometry Middle ear test (tympanometry) Medicine – Hospital ER (Emergency Room) Services 99282 Emergency Dept. Visit w/ Expanded Prob. Emergency room visit, low complexity Focused HX+Exam+Medical Decision Making of Low Complexity 99283 ER Visit – Ed Pt L3 Exp Prob H&E Mod Emergency room visit, moderate complexity Complx 99284 ER Visit – Ed Pt L4 Dtl H&E Mod Complx Emergency room visit, moderate complexity Dec 99285 Emergency Dept. Visit with Emergency room visit, high complexity Comprehensive HX+Exam and Medical Decision Making of High Complexity Medicine – Hospital Inpatient Services 99231 Subsqt hosp-DA E&M Stable 15 min Follow up hospital visit 15 minutes 99232 Inpatient care – subsqt hosp-DA E&M Minr Follow up hospital visit 25 minutes Compl 25 Min 99233 Subsqt Hosp-DA E&M Sig Compl 35 Min Follow up hospital visit 35 minutes 99238 Hospital Discharge Day Management; 30 Hospital discharge instructions to patients; minutes or less 30 minutes or less 99242 Offic Cons New/Estab Low 30 Min Office consultation 30 minutes 99243 Offic Cons New/Estab Mod 40 Min Office consultation 40 minutes 99244 Offic Cons New/Estab Mod-Hi 60 Min Office consultation 60 minutes Medicine – Immunizations Immunization administration under 8 years 90465 of age (includes percutaneous, Childhood immunization administration intradermal, subcutaneous, or intramu 90471 Immunization administration Immunization administration Immunization administration two or more 90472 Administration of multiple immunizations single or 90658 Influenza virus vaccine Influenza virus vaccine Tetanus and diphtheria toxoids for 90718 Tetanus and diphtheria vaccines intramuscular or Therapeutic, prophylactic or diagnostic 96372 Any injection injection

11-1-09 2 Medicine – Mental Health Visits Psychotherapy 20-30 minutes with medical 90805 Psychother Op 20-30 Min; w/ed E&M evaluation 90806 Psychother Ov/OP Behv Mod 45-50 mn Psychotherapy 45-40 minutes Psychotherapy 45-50 minutes with medical 90807 Psychother OP 45-50 Min; w/ Med E&M evaluation Group Medical Psychotherapy (other than 90853 of a multiple-family group) – one unit – 15 Group Psychotherapy 15 minutes minutes 90862 Pharm mgmt w/ script use & review Management of psychiatric medications Medicine – Non-Invasive Vascular Studies 93000 ECG-Routine 12 Lead; w/ Intrpt & Rpt Electrocardiogram (EKG) 93010 Ecointerpretation & Report Only Electrocardiogram reading and report only 94760 Noninvas Oximetry-O2 Sat; 1 Determ Test of blood oxygen saturation Medicine – Other Miscellaneous A4550 Surgical Trays Charge for surgical tray G0008 Admin Flu Virus Vac – No MD Fee Sched Administration of influenza virus vaccine G9001 Coordinated Care Fee, Initial Rate Coordinated care fee, initial rate Comprehensive Multidisciplinary H2000 Comprehensive Multidisciplinary Evaluation Evaluation J3420 INJ Vitamin B-12 Cyanocobalamin To 1 Vitamin B 12 injection Q0091 Screen Pap Smear Obtain Prep Convey Screening pap smear Contraceptive pills for birth control (One S4993 Birth control pills Unit = Clinical visit/encounter all-inclusive T1015 (replaces HMO copay and rural health All inclusive clinic visit clinics codes) Medicine – Preventive Care Visits Preventive Care Visit – Est Pt 99391 Well child care under one year of age Prevent/Healthy Under 1 Yr Preventive Care Visit – Est Pt Well child care between one and four years 99392 Prevent/Healthy 1-4 Yrs of age 99393 Est Pt Prevent/Healthy Person 5-11 Years Well child care, 5 to 11 years of age Preventive Care Visit – Est Pt Adolescent preventive care, 12-17 years of 99394 Prevent/Healthy 12-17 Yrs age 99395 Preven meds E&M Estab Pt; 18-39 Yr Preventive care, 18-39 years of age 99396 Preven Meds E&M Estab Pt; 40-64 Yr Preventive care, 40-64 years of age Physical Medicine – Physical Therapy (PT) / Chiropractic Procedures 97001 Physical Therapy Evaluation Physical Therapy Evaluation 97010 App. Of Modality, hot or cold packs Application of hot or cold packs 97012 Phys. Med, traction, mechanical Mechanical stimulation

11-1-09 3 Phys. Med – Electrical Stimulation 97014 Electrical stimulation (unattended) Appl. Of modality, electrical stimulation Electrical stimulation requiring constant 97032 (manual) provider attendance 97033 Phys. Med., iontophoresis Iontophoresis requiring constant attendance Ultrasonic therapy requiring constant 97035 Constant attendance, ultrasound attendance Phys. Med, Tx, 1 area, 30 Min, Ea. Vist; 97110 Therapeutic exercises (15 minutes) ther. Exerc Neuromuscular reeducation of movement, Neuromuscular reeducation of movement, 97112 balance, coordination balance, coordination 97113 Aquatic Therapy w/ exercises Aquatic treatments with exercises Manual therapy (eg. 97140 Mobililzation/manipulation, manual Manual therapy techniques lymphatic drainage, manual traction) Phys. Med. – Therapeutic/dynamic Use of dynamic physical medicine 97530 activities to improve function treatments to improve function 98928 Osteopath manip tx; 7-8 bod regions Osteopathic manipulative treaments Chiro Manipulation, spinal, one or two 98940 Chiropractice manipulation treatments regions Chiro, manipulation, spinal, three & four 98941 Chiropractice manipulation treatments regions 98942 Chiro, manipulation, spinal, five regions Chiropractice manipulation treatments Chiro, manipulation, extraspinal, one or 98943 Chiropractice manipulation treatments more regions Radiology Radiologic examination, chest; single view, 71010 Chest X-ray (single view) Frontal 71020 X-ray chest, two views, frontal and Late Chest X-Ray (two views) Cmpt Aided Detect phys Rev for Interpr; Computer aided reading of a screening 77052 Scr Mammo Mammogram 77057 Screening Mammography, Bilateral Screening Mammography Surgery 11100 BX Skin/Subq TISS (Sep Pro); 1 Les Skin biopsy 17000 Destrct – any methd – ben Les; w/Ane; 1 Destruction of a single skin lesion 17003 Destrct – any methd – 2-14. EA Destruction of multiple skin lesions 20610 Arthrocentesis/aspir/inj; major JT Aspiration or injection of a major joint 36415 Routine venipunct/finger/heel stick Obtaining a sample of blood 45378 Colonoscopy flex; DX (Sep Pro) Colonoscopy 45385 Colonoscopy flex; w/remove les-snare Colonoscopy with removal of lesion

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