Notice Date: April 28, 2021 To: Ohio Medicaid Providers From: CareSource Subject: Prior Authorization Updates Effective Date: April 26, 2021

CareSource values our partnership with our providers. As result of your feedback, and to support you in these unprecedented times, we have adjusted prior authorization requirements. The addendum to this announcement includes codes that are being removed from requiring prior authorization. We are pleased to present this change and reduce the administrative burden to our providers.

Providers should use the Procedure Code Lookup Tool to instantly view whether a service code requires prior authorization from CareSource. Effective April 26, 2021, the tool will reflect that the codes in the addendum do not require prior authorization from CareSource.

Questions? For questions related to prior authorization requirements, providers may contact CareSource Utilization Management at 1-800-488-0134. Our hours of operation are Monday to Friday, 8 a.m. to 6 p.m. Eastern Standard Time.

OH-MED-P-566513

Addendum – Codes Removed from Prior Authorization Effective April 26, 2021 Code Description Category Product Filing Category 10030 Image‐guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst) Ambulatory Surgery Elective Surgery‐Diagnostic 10120 Incision and removal of foreign body, subcutaneous tissues; simple Ambulatory Surgery Elective Surgery‐Dermatology 10121 Incision and removal of foreign body, subcutaneous tissues; complicated Ambulatory Surgery Elective Surgery‐Dermatology 10180 Incision and drainage, complex, postoperative wound infection Ambulatory Surgery Elective Surgery‐Dermatology 11000 Debridement of extensive eczematous or infected skin; up to 10% of body surface Ambulatory Surgery Elective Surgery‐Dermatology 11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent m Ambulatory Surgery Elective Surgery‐Dermatology 11010 Debridement including removal of foreign material at the site of an open fracture and/or an open dis Ambulatory Surgery Elective Surgery‐Dermatology 11011 Debridement including removal of foreign material at the site of an open fracture and/or an open dis Ambulatory Surgery Elective Surgery‐Dermatology 11012 Debridement including removal of foreign material at the site of an open fracture and/or an open dis Ambulatory Surgery Elective Surgery‐Dermatology 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if perform Ambulatory Surgery Elective Surgery‐Dermatology 11046 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed Ambulatory Surgery Elective Surgery‐Dermatology 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (L Ambulatory Surgery Elective Surgery‐Dermatology 11105 Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (Li Ambulatory Surgery Elective Surgery‐Dermatology 11107 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/addi Ambulatory Surgery Elective Surgery‐Dermatology 11313 Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membra Ambulatory Surgery Elective Surgery‐Dermatology 11400 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology

Code Description Category Product Filing Category 11401 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology 11402 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology 11403 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology 11404 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology 11406 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or Ambulatory Surgery Elective Surgery‐Dermatology 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11421 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11422 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11423 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11424 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11426 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, h Ambulatory Surgery Elective Surgery‐Dermatology 11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology 11441 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology 11442 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology 11443 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology 11444 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology

Code Description Category Product Filing Category 11446 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ea Ambulatory Surgery Elective Surgery‐Dermatology 11450 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate rep Ambulatory Surgery Elective Surgery‐Dermatology 11451 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repair Ambulatory Surgery Elective Surgery‐Dermatology 11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate rep Ambulatory Surgery Elective Surgery‐Dermatology 11463 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repair Ambulatory Surgery Elective Surgery‐Dermatology 11470 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with si Ambulatory Surgery Elective Surgery‐Dermatology 11471 Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with co Ambulatory Surgery Elective Surgery‐Dermatology 11601 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm Ambulatory Surgery Elective Surgery‐Dermatology 11602 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cm Ambulatory Surgery Elective Surgery‐Dermatology 11603 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cm Ambulatory Surgery Elective Surgery‐Dermatology 11604 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cm Ambulatory Surgery Elective Surgery‐Dermatology 11606 Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cm Ambulatory Surgery Elective Surgery‐Dermatology 11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter Ambulatory Surgery Elective Surgery‐Dermatology 11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter Ambulatory Surgery Elective Surgery‐Dermatology 11624 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter Ambulatory Surgery Elective Surgery‐Dermatology 11626 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter Ambulatory Surgery Elective Surgery‐Dermatology

Code Description Category Product Filing Category 11641 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 Ambulatory Surgery Elective Surgery‐Dermatology 11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 Ambulatory Surgery Elective Surgery‐Dermatology 11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 Ambulatory Surgery Elective Surgery‐Dermatology 11644 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 Ambulatory Surgery Elective Surgery‐Dermatology 11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over Ambulatory Surgery Elective Surgery‐Dermatology 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent Ambulatory Surgery Elective Surgery‐Dermatology 11771 Excision of pilonidal cyst or sinus; extensive Ambulatory Surgery Elective Surgery‐Dermatology 11772 Excision of pilonidal cyst or sinus; complicated Ambulatory Surgery Elective Surgery‐Dermatology 12005 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, Elective Surgery‐ trunk and/or extrem Ambulatory Surgery Derm/Plastics 12017 Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or Elective Surgery‐ mucous membranes; 20.1 Ambulatory Surgery Derm/Plastics 12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12032 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12035 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12036 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12037 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities Elective Surgery‐ (excluding hands and feet); Ambulatory Surgery Derm/Plastics 12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; Elective Surgery‐ 2.5 cm or less Ambulatory Surgery Derm/Plastics

Code Description Category Product Filing Category 12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; Elective Surgery‐ 2.6 cm to 7.5 cm Ambulatory Surgery Derm/Plastics 12044 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; Elective Surgery‐ 7.6 cm to 12.5 cm Ambulatory Surgery Derm/Plastics 12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous Elective Surgery‐ membranes; 2.5 cm or l Ambulatory Surgery Derm/Plastics 12052 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous Elective Surgery‐ membranes; 2.6 cm to 5 Ambulatory Surgery Derm/Plastics 12053 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous Elective Surgery‐ membranes; 5.1 cm to 7 Ambulatory Surgery Derm/Plastics 12054 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous Elective Surgery‐ membranes; 7.6 cm to 1 Ambulatory Surgery Derm/Plastics 13100 Elective Surgery‐ Repair, complex, trunk; 1.1 cm to 2.5 cm Ambulatory Surgery Derm/Plastics 13101 Elective Surgery‐ Repair, complex, trunk; 2.6 cm to 7.5 cm Ambulatory Surgery Derm/Plastics 13102 Repair, complex, trunk; each additional 5 cm or less (List separately in Elective Surgery‐ addition to code for primar Ambulatory Surgery Derm/Plastics 13120 Elective Surgery‐ Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm Ambulatory Surgery Derm/Plastics 13121 Elective Surgery‐ Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm Ambulatory Surgery Derm/Plastics 13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands Elective Surgery‐ and/or feet; 1.1 cm Ambulatory Surgery Derm/Plastics 13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands Elective Surgery‐ and/or feet; 2.6 cm Ambulatory Surgery Derm/Plastics 13151 Elective Surgery‐ Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm Ambulatory Surgery Derm/Plastics 13152 Elective Surgery‐ Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm Ambulatory Surgery Derm/Plastics 14000 Elective Surgery‐ Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less Ambulatory Surgery Derm/Plastics

Code Description Category Product Filing Category 15002 Surgical preparation or creation of recipient site by excision of open wounds, Elective Surgery‐ burn eschar, or scar Ambulatory Surgery Derm/Plastics 15200 Full thickness graft, free, including direct closure of donor site, trunk; 20 sq Inpatient Surgical cm or less Procedures IP Surgical Procedures‐Grafts 15241 Full thickness graft, free, including direct closure of donor site, forehead, Elective Surgery‐ cheeks, chin, mouth, n Ambulatory Surgery Derm/Plastics 15274 Application of skin substitute graft to trunk, arms, legs, total wound surface Elective Surgery‐ area greater than or Ambulatory Surgery Derm/Plastics 15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, Elective Surgery‐ ears, lips, or intrao Ambulatory Surgery Derm/Plastics 15600 Elective Surgery‐ Delay of flap or sectioning of flap (division and inset); at trunk Ambulatory Surgery Derm/Plastics 15777 Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue Elective Surgery‐ reinforcement (eg, br Ambulatory Surgery Derm/Plastics 17004 Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), pr Ambulatory Surgery Elective Surgery‐Dermatology 17106 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cm Ambulatory Surgery Elective Surgery‐Dermatology 17107 Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cm Ambulatory Surgery Elective Surgery‐Dermatology 17261 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17262 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17263 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17264 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17270 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17271 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology

Code Description Category Product Filing Category 17272 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17273 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17276 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17280 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17281 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17282 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 17283 Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgica Ambulatory Surgery Elective Surgery‐Dermatology 19020 Mastotomy with exploration or drainage of abscess, deep Ambulatory Surgery Elective Surgery 19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when pe Ambulatory Surgery Elective Surgery‐Radiology 19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when pe Ambulatory Surgery Elective Surgery‐Radiology 19084 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when pe Ambulatory Surgery Elective Surgery‐Radiology 19085 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when pe Ambulatory Surgery Elective Surgery‐Radiology 19110 Nipple exploration, with or without excision of a solitary lactiferous duct or a Elective Surgery‐ papilloma lactifero Ambulatory Surgery Excision/Resection 19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant Elective Surgery‐ breast tissue, duct les Ambulatory Surgery Excision/Resection 19125 Excision of breast lesion identified by preoperative placement of radiological Elective Surgery‐ marker, open; single Ambulatory Surgery Excision/Resection 19296 Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast Ambulatory Surgery Elective Surgery 19328 Removal of intact mammary implant Ambulatory Surgery Elective Surgery‐Plastics

Code Description Category Product Filing Category 20005 Incision and drainage of soft tissue abscess, subfascial (ie, involves the soft tissue below the dee Ambulatory Surgery Elective Surgery 20102 Exploration of penetrating wound (separate procedure); abdomen/flank/back Ambulatory Surgery Elective Surgery 20103 Exploration of penetrating wound (separate procedure); extremity Ambulatory Surgery Elective Surgery 20205 Elective Surgery‐ Biopsy, muscle; deep Ambulatory Surgery Ortho/Rheumatology 20206 Elective Surgery‐ Biopsy, muscle, percutaneous needle Ambulatory Surgery Ortho/Rheumatology 20225 Elective Surgery‐ Biopsy, bone, trocar, or needle; deep (eg, vertebral body, femur) Ambulatory Surgery Ortho/Rheumatology 20240 Biopsy, bone, open; superficial (eg, ilium, sternum, spinous process, ribs, Elective Surgery‐ trochanter of femur) Ambulatory Surgery Ortho/Rheumatology 20245 Elective Surgery‐ Biopsy, bone, open; deep (eg, humerus, ischium, femur) Ambulatory Surgery Ortho/Rheumatology 20250 Elective Surgery‐ Biopsy, vertebral body, open; thoracic Ambulatory Surgery Ortho/Rheumatology 20525 Elective Surgery‐ Removal of foreign body in muscle or tendon sheath; deep or complicated Ambulatory Surgery Ortho/Rheumatology 20650 Insertion of wire or pin with application of skeletal traction, including removal (separate procedur Ambulatory Surgery Elective Surgery‐Orthopedic 20662 Application of halo, including removal; pelvic Ambulatory Surgery Elective Surgery‐Orthopedic 20670 Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) Ambulatory Surgery Elective Surgery‐Orthopedic 20693 Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] a Ambulatory Surgery Elective Surgery‐Orthopedic 20694 Removal, under anesthesia, of external fixation system Ambulatory Surgery Elective Surgery‐Orthopedic 20902 Bone graft, any donor area; major or large Ambulatory Surgery Elective Surgery‐Orthopedic 20950 Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 20982 Ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including co Ambulatory Surgery Elective Surgery‐Orthopedic 21012 Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greater Ambulatory Surgery Elective Surgery 21013 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than Ambulatory Surgery Elective Surgery 21014 Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or g Ambulatory Surgery Elective Surgery 21026 Elective Surgery‐ Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s) Ambulatory Surgery Oral/Maxillofacial 21029 Elective Surgery‐ Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia) Ambulatory Surgery Oral/Maxillofacial 21030 Excision of benign tumor or cyst of maxilla or zygoma by enucleation and Elective Surgery‐ curettage Ambulatory Surgery Oral/Maxillofacial 21031 Elective Surgery‐ Excision of torus mandibularis Ambulatory Surgery Oral/Maxillofacial 21032 Elective Surgery‐ Excision of maxillary torus palatinus Ambulatory Surgery Oral/Maxillofacial 21040 Elective Surgery‐ Excision of benign tumor or cyst of mandible, by enucleation and/or curettage Ambulatory Surgery Oral/Maxillofacial 21073 Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an Elective Surgery‐ anesthesia service (ie, Ambulatory Surgery Oral/Maxillofacial 21235 Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) Ambulatory Surgery Elective Surgery‐Grafts 21240 Arthroplasty, temporomandibular joint, with or without autograft (includes Elective Surgery‐ obtaining graft) Ambulatory Surgery Oral/Maxillofacial 21243 Elective Surgery‐ Arthroplasty, temporomandibular joint, with prosthetic joint replacement Ambulatory Surgery Oral/Maxillofacial 21325 Open treatment of nasal fracture; uncomplicated Ambulatory Surgery Elective Surgery‐ENT 21330 Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixation Ambulatory Surgery Elective Surgery‐ENT 21335 Open treatment of nasal fracture; with concomitant open treatment of fractured septum Ambulatory Surgery Elective Surgery‐ENT 21336 Open treatment of nasal septal fracture, with or without stabilization Ambulatory Surgery Elective Surgery‐ENT

Code Description Category Product Filing Category 21338 Open treatment of nasoethmoid fracture; without external fixation Ambulatory Surgery Elective Surgery‐ENT 21339 Open treatment of nasoethmoid fracture; with external fixation Ambulatory Surgery Elective Surgery‐ENT 21356 Elective Surgery‐ Open treatment of depressed zygomatic arch fracture (eg, Gillies approach) Ambulatory Surgery ENT/Maxillofacial 21440 Closed treatment of mandibular or maxillary alveolar ridge fracture (separate Elective Surgery‐ procedure) Ambulatory Surgery ENT/Maxillofacial 21445 Open treatment of mandibular or maxillary alveolar ridge fracture (separate Elective Surgery‐ procedure) Ambulatory Surgery ENT/Maxillofacial 21501 Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; Ambulatory Surgery Elective Surgery‐ENT 21510 Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thorax Ambulatory Surgery Elective Surgery‐ENT 21552 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater Ambulatory Surgery Elective Surgery‐ENT 21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm Ambulatory Surgery Elective Surgery‐ENT 21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 Ambulatory Surgery Elective Surgery‐ENT 21600 Elective Surgery‐ Excision of rib, partial Ambulatory Surgery Thoracic/Ortho 21627 Elective Surgery‐ Sternal debridement Ambulatory Surgery Thoracic/Ortho 21720 Division of sternocleidomastoid for torticollis, open operation; without cast Elective Surgery‐ application Ambulatory Surgery Thoracic/Ortho 21811 Open treatment of rib fracture(s) with internal fixation, includes Elective Surgery‐ thoracoscopic visualization when Ambulatory Surgery Thoracic/Ortho 21825 Elective Surgery‐ Open treatment of sternum fracture with or without skeletal fixation Ambulatory Surgery Thoracic/Ortho 21920 Biopsy, soft tissue of back or flank; superficial Ambulatory Surgery Elective Surgery 21925 Biopsy, soft tissue of back or flank; deep Ambulatory Surgery Elective Surgery 22010 Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or c Ambulatory Surgery Elective Surgery‐Spinal

Code Description Category Product Filing Category 22015 Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbo Ambulatory Surgery Elective Surgery‐Spinal 22310 Closed treatment of vertebral body fracture(s), without manipulation, requiring and including castin Ambulatory Surgery Elective Surgery‐Spinal 22326 Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, Ambulatory Surgery Elective Surgery‐Spinal 22505 Manipulation of spine requiring anesthesia, any region Ambulatory Surgery Elective Surgery‐Spinal 22900 Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); Elective Surgery‐ less than 5 cm Ambulatory Surgery Musculoskeletal Procedures 22902 Elective Surgery‐ Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cm Ambulatory Surgery Musculoskeletal Procedures 23030 Elective Surgery‐ Incision and drainage, shoulder area; deep abscess or hematoma Ambulatory Surgery Musculoskeletal Procedures 23071 Elective Surgery‐ Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greater Ambulatory Surgery Musculoskeletal Procedures 23075 Elective Surgery‐ Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm Ambulatory Surgery Musculoskeletal Procedures 23140 Elective Surgery‐ Excision or curettage of bone cyst or benign tumor of clavicle or scapula; Ambulatory Surgery Musculoskeletal Procedures 23155 Excision or curettage of bone cyst or benign tumor of proximal humerus; with Elective Surgery‐ autograft (includes obt Ambulatory Surgery Musculoskeletal Procedures 23182 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, Elective Surgery‐ osteomyelitis), scapula Ambulatory Surgery Musculoskeletal Procedures 23330 Elective Surgery‐ Removal of foreign body, shoulder; subcutaneous Ambulatory Surgery Musculoskeletal Procedures 23333 Elective Surgery‐ Removal of foreign body, shoulder; deep (subfascial or intramuscular) Ambulatory Surgery Musculoskeletal Procedures 23505 Closed treatment of clavicular fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23520 Closed treatment of sternoclavicular dislocation; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23525 Closed treatment of sternoclavicular dislocation; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23540 Closed treatment of acromioclavicular dislocation; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23550 Open treatment of acromioclavicular dislocation, acute or chronic; Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 23552 Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obta Ambulatory Surgery Elective Surgery‐Orthopedic 23570 Closed treatment of scapular fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23585 Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when per Ambulatory Surgery Elective Surgery‐Orthopedic 23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23605 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with Ambulatory Surgery Elective Surgery‐Orthopedic 23615 Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixatio Ambulatory Surgery Elective Surgery‐Orthopedic 23616 Open treatment of proximal humeral (surgical or anatomical neck) fracture, Inpatient Surgical IP Surgical Procedures‐ includes internal fixatio Procedures Orthopedic 23620 Closed treatment of greater humeral tuberosity fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23625 Closed treatment of greater humeral tuberosity fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 23630 Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 23650 Closed treatment of shoulder dislocation, with manipulation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 23655 Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 23665 Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipula Ambulatory Surgery Elective Surgery‐Orthopedic 23700 Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocat Ambulatory Surgery Elective Surgery‐Orthopedic 23921 Disarticulation of shoulder; secondary closure or scar revision Ambulatory Surgery Elective Surgery‐Orthopedic 23935 Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone Elective Surgery‐ abscess), humerus or elbo Ambulatory Surgery Musculoskeletal Procedures 24065 Elective Surgery‐ Biopsy, soft tissue of upper arm or elbow area; superficial Ambulatory Surgery Musculoskeletal Procedures

Code Description Category Product Filing Category 24065 Elective Surgery‐ Biopsy, soft tissue of upper arm or elbow area; superficial Ambulatory Surgery Musculoskeletal Procedures 24066 Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or Elective Surgery‐ intramuscular) Ambulatory Surgery Musculoskeletal Procedures 24066 Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or Elective Surgery‐ intramuscular) Ambulatory Surgery Musculoskeletal Procedures 24071 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm Elective Surgery‐ or greater Ambulatory Surgery Musculoskeletal Procedures 24073 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, Inpatient Surgical IP Surgical Procedures‐ intramuscular); 5 cm or gre Procedures Orthopedic 24075 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less Elective Surgery‐ than 3 cm Ambulatory Surgery Musculoskeletal Procedures 24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, Elective Surgery‐ intramuscular); less than 5 Ambulatory Surgery Musculoskeletal Procedures 24105 Elective Surgery‐ Excision, olecranon bursa Ambulatory Surgery Musculoskeletal Procedures 24164 Elective Surgery‐ Implant removal; radial head Ambulatory Surgery Musculoskeletal Procedures 24201 Removal of foreign body, upper arm or elbow area; deep (subfascial or Elective Surgery‐ intramuscular) Ambulatory Surgery Musculoskeletal Procedures 24300 Elective Surgery‐ Manipulation, elbow, under anesthesia Ambulatory Surgery Musculoskeletal Procedures 24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's Elective Surgery‐ elbow); percutaneous Ambulatory Surgery Musculoskeletal Procedures 24500 Closed treatment of humeral shaft fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24505 Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction Ambulatory Surgery Elective Surgery‐Orthopedic 24515 Open treatment of humeral shaft fracture with plate/screws, with or without cerclage Ambulatory Surgery Elective Surgery‐Orthopedic 24516 Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cercl Ambulatory Surgery Elective Surgery‐Orthopedic 24530 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar e Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 24535 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar e Ambulatory Surgery Elective Surgery‐Orthopedic 24545 Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when Ambulatory Surgery Elective Surgery‐Orthopedic 24546 Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when Ambulatory Surgery Elective Surgery‐Orthopedic 24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24565 Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24575 Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when Ambulatory Surgery Elective Surgery‐Orthopedic 24576 Closed treatment of humeral condylar fracture, medial or lateral; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24577 Closed treatment of humeral condylar fracture, medial or lateral; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24579 Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when per Ambulatory Surgery Elective Surgery‐Orthopedic 24586 Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus an Ambulatory Surgery Elective Surgery‐Orthopedic 24600 Treatment of closed elbow dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 24605 Treatment of closed elbow dislocation; requiring anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 24615 Open treatment of acute or chronic elbow dislocation Ambulatory Surgery Elective Surgery‐Orthopedic 24620 Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna w Ambulatory Surgery Elective Surgery‐Orthopedic 24635 Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna wit Ambulatory Surgery Elective Surgery‐Orthopedic 24650 Closed treatment of radial head or neck fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24655 Closed treatment of radial head or neck fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 24666 Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 24670 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without ma Ambulatory Surgery Elective Surgery‐Orthopedic 24675 Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manip Ambulatory Surgery Elective Surgery‐Orthopedic 24685 Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes int Ambulatory Surgery Elective Surgery‐Orthopedic 25000 Elective Surgery‐ Incision, extensor tendon sheath, wrist (eg, deQuervains disease) Ambulatory Surgery Musculoskeletal Procedures 25001 Elective Surgery‐ Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis) Ambulatory Surgery Musculoskeletal Procedures 25020 Decompression fasciotomy, forearm and/or wrist, flexor OR extensor Elective Surgery‐ compartment; without debridement Ambulatory Surgery Musculoskeletal Procedures 25028 Elective Surgery‐ Incision and drainage, forearm and/or wrist; deep abscess or hematoma Ambulatory Surgery Musculoskeletal Procedures 25065 Elective Surgery‐ Biopsy, soft tissue of forearm and/or wrist; superficial Ambulatory Surgery Musculoskeletal Procedures 25066 Elective Surgery‐ Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular) Ambulatory Surgery Musculoskeletal Procedures 25071 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm Elective Surgery‐ or greater Ambulatory Surgery Musculoskeletal Procedures 25075 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less Elective Surgery‐ than 3 cm Ambulatory Surgery Musculoskeletal Procedures 25101 Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of Ambulatory Surgery Elective Surgery‐Arthrotomy 25109 Elective Surgery‐ Excision of tendon, forearm and/or wrist, flexor or extensor, each Ambulatory Surgery Musculoskeletal Procedures 25110 Elective Surgery‐ Excision, lesion of tendon sheath, forearm and/or wrist Ambulatory Surgery Musculoskeletal Procedures 25111 Elective Surgery‐ Excision of ganglion, wrist (dorsal or volar); primary Ambulatory Surgery Musculoskeletal Procedures 25112 Elective Surgery‐ Excision of ganglion, wrist (dorsal or volar); recurrent Ambulatory Surgery Musculoskeletal Procedures

Code Description Category Product Filing Category 25248 Elective Surgery‐ Exploration with removal of deep foreign body, forearm or wrist Ambulatory Surgery Musculoskeletal Procedures 25259 Elective Surgery‐ Manipulation, wrist, under anesthesia Ambulatory Surgery Musculoskeletal Procedures 25500 Closed treatment of radial shaft fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25505 Closed treatment of radial shaft fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25515 Open treatment of radial shaft fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 25520 Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar j Ambulatory Surgery Elective Surgery‐Orthopedic 25525 Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed trea Ambulatory Surgery Elective Surgery‐Orthopedic 25526 Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatm Ambulatory Surgery Elective Surgery‐Orthopedic 25530 Closed treatment of ulnar shaft fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25545 Open treatment of ulnar shaft fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 25560 Closed treatment of radial and ulnar shaft fractures; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25565 Closed treatment of radial and ulnar shaft fractures; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25574 Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radiu Ambulatory Surgery Elective Surgery‐Orthopedic 25575 Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radiu Ambulatory Surgery Elective Surgery‐Orthopedic 25600 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl Ambulatory Surgery Elective Surgery‐Orthopedic 25605 Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, incl Ambulatory Surgery Elective Surgery‐Orthopedic 25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation Ambulatory Surgery Elective Surgery‐Orthopedic 25607 Open treatment of distal radial extra‐articular fracture or epiphyseal separation, with internal fix Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 25608 Open treatment of distal radial intra‐articular fracture or epiphyseal separation; with internal fix Ambulatory Surgery Elective Surgery‐Orthopedic 25609 Open treatment of distal radial intra‐articular fracture or epiphyseal separation; with internal fix Ambulatory Surgery Elective Surgery‐Orthopedic 25622 Closed treatment of carpal scaphoid (navicular) fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25624 Closed treatment of carpal scaphoid (navicular) fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 25628 Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 25630 Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulati Ambulatory Surgery Elective Surgery‐Orthopedic 25635 Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, Ambulatory Surgery Elective Surgery‐Orthopedic 25645 Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each bone Ambulatory Surgery Elective Surgery‐Orthopedic 25650 Closed treatment of ulnar styloid fracture Ambulatory Surgery Elective Surgery‐Orthopedic 25652 Open treatment of ulnar styloid fracture Ambulatory Surgery Elective Surgery‐Orthopedic 25670 Open treatment of radiocarpal or intercarpal dislocation, 1 or more bones Ambulatory Surgery Elective Surgery‐Orthopedic 25675 Closed treatment of distal radioulnar dislocation with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 26020 Elective Surgery‐ Drainage of tendon sheath, digit and/or palm, each Ambulatory Surgery Musculoskeletal Procedures 26040 Elective Surgery‐ Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneous Ambulatory Surgery Musculoskeletal Procedures 26045 Elective Surgery‐ Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial Ambulatory Surgery Musculoskeletal Procedures 26055 Elective Surgery‐ Tendon sheath incision (eg, for trigger finger) Ambulatory Surgery Musculoskeletal Procedures 26070 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; Elective Surgery‐ carpometacarpal joint Ambulatory Surgery Musculoskeletal Procedures 26075 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; Elective Surgery‐ metacarpophalangeal joi Ambulatory Surgery Musculoskeletal Procedures

Code Description Category Product Filing Category 26080 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; Elective Surgery‐ interphalangeal joint, Ambulatory Surgery Musculoskeletal Procedures 26110 Elective Surgery‐ Arthrotomy with biopsy; interphalangeal joint, each Ambulatory Surgery Musculoskeletal Procedures 26111 Excision, tumor or vascular malformation, soft tissue of hand or finger, Elective Surgery‐ subcutaneous; 1.5 cm or gre Ambulatory Surgery Musculoskeletal Procedures 26115 Excision, tumor or vascular malformation, soft tissue of hand or finger, Elective Surgery‐ subcutaneous; less than 1.5 Ambulatory Surgery Musculoskeletal Procedures 26140 Synovectomy, proximal interphalangeal joint, including extensor Elective Surgery‐ reconstruction, each interphalangeal Ambulatory Surgery Musculoskeletal Procedures 26160 Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or Elective Surgery‐ ganglion), hand or f Ambulatory Surgery Musculoskeletal Procedures 26170 Elective Surgery‐ Excision of tendon, palm, flexor or extensor, single, each tendon Ambulatory Surgery Musculoskeletal Procedures 26185 Elective Surgery‐ Sesamoidectomy, thumb or finger (separate procedure) Ambulatory Surgery Musculoskeletal Procedures 26260 Elective Surgery‐ Radical resection of tumor, proximal or middle phalanx of finger Ambulatory Surgery Musculoskeletal Procedures 26320 Elective Surgery‐ Removal of implant from finger or hand Ambulatory Surgery Musculoskeletal Procedures 26357 Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath Inpatient Surgical IP Surgical Procedures‐ (eg, no man's land); se Procedures Orthopedic 26432 Closed treatment of distal extensor tendon insertion, with or without Elective Surgery‐ percutaneous pinning (eg, mall Ambulatory Surgery Musculoskeletal Procedures 26476 Elective Surgery‐ Lengthening of tendon, extensor, hand or finger, each tendon Ambulatory Surgery Musculoskeletal Procedures 26490 Elective Surgery‐ Opponensplasty; superficialis tendon transfer type, each tendon Ambulatory Surgery Musculoskeletal Procedures 26535 Arthroplasty, interphalangeal joint; each joint Ambulatory Surgery Elective Surgery‐Arthroplasty 26600 Closed treatment of metacarpal fracture, single; without manipulation, each bone Ambulatory Surgery Elective Surgery‐Orthopedic 26605 Closed treatment of metacarpal fracture, single; with manipulation, each bone Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 26607 Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone Ambulatory Surgery Elective Surgery‐Orthopedic 26615 Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone Ambulatory Surgery Elective Surgery‐Orthopedic 26641 Closed treatment of carpometacarpal dislocation, thumb, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 26645 Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulatio Ambulatory Surgery Elective Surgery‐Orthopedic 26650 Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), wi Ambulatory Surgery Elective Surgery‐Orthopedic 26665 Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal Ambulatory Surgery Elective Surgery‐Orthopedic 26675 Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; re Ambulatory Surgery Elective Surgery‐Orthopedic 26685 Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when pe Ambulatory Surgery Elective Surgery‐Orthopedic 26686 Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reduc Ambulatory Surgery Elective Surgery‐Orthopedic 26700 Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 26715 Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performe Ambulatory Surgery Elective Surgery‐Orthopedic 26725 Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with man Ambulatory Surgery Elective Surgery‐Orthopedic 26727 Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, fi Ambulatory Surgery Elective Surgery‐Orthopedic 26735 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes i Ambulatory Surgery Elective Surgery‐Orthopedic 26740 Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with Ambulatory Surgery Elective Surgery‐Orthopedic 26742 Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with Ambulatory Surgery Elective Surgery‐Orthopedic 26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includ Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 26755 Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 26756 Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, each Ambulatory Surgery Elective Surgery‐Orthopedic 26765 Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when perf Ambulatory Surgery Elective Surgery‐Orthopedic 26770 Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 26775 Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthes Ambulatory Surgery Elective Surgery‐Orthopedic 26776 Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 26785 Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, sin Ambulatory Surgery Elective Surgery‐Orthopedic 27000 Elective Surgery‐ Tenotomy, adductor of hip, percutaneous (separate procedure) Ambulatory Surgery Musculoskeletal Procedures 27043 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or Elective Surgery‐ greater Ambulatory Surgery Musculoskeletal Procedures 27047 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 Elective Surgery‐ cm Ambulatory Surgery Musculoskeletal Procedures 27062 Elective Surgery‐ Excision; trochanteric bursa or calcification Ambulatory Surgery Musculoskeletal Procedures 27181 Open treatment of slipped femoral epiphysis; osteotomy and internal fixation Ambulatory Surgery Elective Surgery‐Orthopedic 27198 Clsd tx pelvic ring fX Ambulatory Surgery Elective Surgery‐Orthopedic 27200 Closed treatment of coccygeal fracture Ambulatory Surgery Elective Surgery‐Orthopedic 27215 Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pe Ambulatory Surgery Elective Surgery‐Orthopedic 27220 Closed treatment of acetabulum (hip socket) fracture(s); without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27232 Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeleta Ambulatory Surgery Elective Surgery‐Orthopedic 27235 Percutaneous skeletal fixation of femoral fracture, proximal end, neck Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 27238 Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; withou Ambulatory Surgery Elective Surgery‐Orthopedic 27246 Closed treatment of greater trochanteric fracture, without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27256 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by a Ambulatory Surgery Elective Surgery‐Orthopedic 27257 Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by a Ambulatory Surgery Elective Surgery‐Orthopedic 27265 Closed treatment of post hip arthroplasty dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 27266 Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 27275 Manipulation, hip joint, requiring general anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 27301 Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee Elective Surgery‐ region Ambulatory Surgery Musculoskeletal Procedures 27306 Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure) Ambulatory Surgery Elective Surgery 27324 Elective Surgery‐ Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular) Ambulatory Surgery Musculoskeletal Procedures 27327 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 Elective Surgery‐ cm Ambulatory Surgery Musculoskeletal Procedures 27328 Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, Elective Surgery‐ intramuscular); less than 5 cm Ambulatory Surgery Musculoskeletal Procedures 27337 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or Elective Surgery‐ greater Ambulatory Surgery Musculoskeletal Procedures 27347 Elective Surgery‐ Excision of lesion of meniscus or capsule (eg, cyst, ganglion), knee Ambulatory Surgery Musculoskeletal Procedures 27369 Injection procedure for contrast knee arthrography or contrast enhanced Elective Surgery‐ CT/MRI knee arthrography Ambulatory Surgery Musculoskeletal Procedures 27372 Elective Surgery‐ Removal of foreign body, deep, thigh region or knee area Ambulatory Surgery Musculoskeletal Procedures 27425 Elective Surgery‐ Lateral retinacular release, open Ambulatory Surgery Musculoskeletal Procedures 27500 Closed treatment of femoral shaft fracture, without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 27502 Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal trac Ambulatory Surgery Elective Surgery‐Orthopedic 27509 Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or suprac Ambulatory Surgery Elective Surgery‐Orthopedic 27510 Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27516 Closed treatment of distal femoral epiphyseal separation; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27519 Open treatment of distal femoral epiphyseal separation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 27520 Closed treatment of patellar fracture, without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27524 Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy Ambulatory Surgery Elective Surgery‐Orthopedic 27530 Closed treatment of tibial fracture, proximal (plateau); without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when Ambulatory Surgery Elective Surgery‐Orthopedic 27536 Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation Ambulatory Surgery Elective Surgery‐Orthopedic 27538 Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without ma Ambulatory Surgery Elective Surgery‐Orthopedic 27540 Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes interna Ambulatory Surgery Elective Surgery‐Orthopedic 27550 Closed treatment of knee dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 27556 Open treatment of knee dislocation, includes internal fixation, when performed; without primary liga Ambulatory Surgery Elective Surgery‐Orthopedic 27557 Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamen Ambulatory Surgery Elective Surgery‐Orthopedic 27560 Closed treatment of patellar dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 27570 Manipulation of knee joint under general anesthesia (includes application of traction or other fixat Ambulatory Surgery Elective Surgery‐Orthopedic 27601 Elective Surgery‐ Decompression fasciotomy, leg; posterior compartment(s) only Ambulatory Surgery Musculoskeletal Procedures

Code Description Category Product Filing Category 27603 Elective Surgery‐ Incision and drainage, leg or ankle; deep abscess or hematoma Ambulatory Surgery Musculoskeletal Procedures 27606 Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesia Ambulatory Surgery Elective Surgery 27614 Elective Surgery‐ Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular) Ambulatory Surgery Musculoskeletal Procedures 27630 Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg Elective Surgery‐ and/or ankle Ambulatory Surgery Musculoskeletal Procedures 27632 Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or Elective Surgery‐ greater Ambulatory Surgery Musculoskeletal Procedures 27658 Elective Surgery‐ Repair, flexor tendon, leg; primary, without graft, each tendon Ambulatory Surgery Musculoskeletal Procedures 27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27752 Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, wit Ambulatory Surgery Elective Surgery‐Orhtopedic 27756 Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins Ambulatory Surgery Elective Surgery‐Orhtopedic 27758 Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with Ambulatory Surgery Elective Surgery‐Orhtopedic 27759 Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, wit Ambulatory Surgery Elective Surgery‐Orhtopedic 27760 Closed treatment of medial malleolus fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27762 Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal t Ambulatory Surgery Elective Surgery‐Orhtopedic 27766 Open treatment of medial malleolus fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orhtopedic 27767 Closed treatment of posterior malleolus fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27768 Closed treatment of posterior malleolus fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27769 Open treatment of posterior malleolus fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orhtopedic 27780 Closed treatment of proximal fibula or shaft fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic

Code Description Category Product Filing Category 27784 Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orhtopedic 27786 Closed treatment of distal fibular fracture (lateral malleolus); without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27788 Closed treatment of distal fibular fracture (lateral malleolus); with manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27792 Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when perf Ambulatory Surgery Elective Surgery‐Orhtopedic 27808 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and post Ambulatory Surgery Elective Surgery‐Orhtopedic 27810 Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and post Ambulatory Surgery Elective Surgery‐Orhtopedic 27816 Closed treatment of trimalleolar ankle fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27818 Closed treatment of trimalleolar ankle fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orhtopedic 27822 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial an Ambulatory Surgery Elective Surgery‐Orhtopedic 27823 Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial an Ambulatory Surgery Elective Surgery‐Orhtopedic 27824 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibia Ambulatory Surgery Elective Surgery‐Orhtopedic 27825 Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibia Ambulatory Surgery Elective Surgery‐Orhtopedic 27829 Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, wh Ambulatory Surgery Elective Surgery‐Orhtopedic 27840 Closed treatment of ankle dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orhtopedic 27842 Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal f Ambulatory Surgery Elective Surgery‐Orhtopedic 27848 Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or Ambulatory Surgery Elective Surgery‐Orhtopedic 27860 Manipulation of ankle under general anesthesia (includes application of traction or other fixation a Ambulatory Surgery Elective Surgery‐Orhtopedic

Code Description Category Product Filing Category 28002 Incision and drainage below fascia, with or without tendon sheath Elective Surgery‐ involvement, foot; single bursal s Ambulatory Surgery Musculoskeletal Procedures 28003 Incision and drainage below fascia, with or without tendon sheath Elective Surgery‐ involvement, foot; multiple areas Ambulatory Surgery Musculoskeletal Procedures 28008 Elective Surgery‐ Fasciotomy, foot and/or toe Ambulatory Surgery Musculoskeletal Procedures 28010 Elective Surgery‐ Tenotomy, percutaneous, toe; single tendon Ambulatory Surgery Musculoskeletal Procedures 28011 Elective Surgery‐ Tenotomy, percutaneous, toe; multiple tendons Ambulatory Surgery Musculoskeletal Procedures 28020 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tar Ambulatory Surgery Elective Surgery‐Arthrotomy 28022 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangea Ambulatory Surgery Elective Surgery‐Arthrotomy 28024 Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal jo Ambulatory Surgery Elective Surgery‐Arthrotomy 28035 Elective Surgery‐ Release, tarsal tunnel (posterior tibial nerve decompression) Ambulatory Surgery Musculoskeletal Procedures 28039 Elective Surgery‐ Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greater Ambulatory Surgery Musculoskeletal Procedures 28041 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5 Elective Surgery‐ cm or greater Ambulatory Surgery Musculoskeletal Procedures 28043 Elective Surgery‐ Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm Ambulatory Surgery Musculoskeletal Procedures 28045 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less Elective Surgery‐ than 1.5 cm Ambulatory Surgery Musculoskeletal Procedures 28046 Radical resection of tumor (eg, malignant neoplasm), soft tissue of foot or Inpatient Surgical IP Surgical Procedures‐ toe; less than 3 cm Procedures Orthopedic 28060 Elective Surgery‐ Fasciectomy, plantar fascia; partial (separate procedure) Ambulatory Surgery Musculoskeletal Procedures 28062 Elective Surgery‐ Fasciectomy, plantar fascia; radical (separate procedure) Ambulatory Surgery Musculoskeletal Procedures

Code Description Category Product Filing Category 28070 Elective Surgery‐ Synovectomy; intertarsal or tarsometatarsal joint, each Ambulatory Surgery Musculoskeletal Procedures 28080 Elective Surgery‐ Excision, interdigital (Morton) neuroma, single, each Ambulatory Surgery Musculoskeletal Procedures 28086 Elective Surgery‐ Synovectomy, tendon sheath, foot; flexor Ambulatory Surgery Musculoskeletal Procedures 28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) Elective Surgery‐ (eg, cyst or ganglion) Ambulatory Surgery Musculoskeletal Procedures 28107 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, Elective Surgery‐ except talus or calcaneus; Ambulatory Surgery Musculoskeletal Procedures 28108 Elective Surgery‐ Excision or curettage of bone cyst or benign tumor, phalanges of foot Ambulatory Surgery Musculoskeletal Procedures 28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28111 Ostectomy, complete excision; first metatarsal head Ambulatory Surgery Elective Surgery‐Orthopedic 28112 Ostectomy, complete excision; other metatarsal head (second, third or fourth) Ambulatory Surgery Elective Surgery‐Orthopedic 28113 Ostectomy, complete excision; fifth metatarsal head Ambulatory Surgery Elective Surgery‐Orthopedic 28119 Ostectomy, calcaneus; for spur, with or without plantar fascial release Ambulatory Surgery Elective Surgery‐Orthopedic 28120 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomye Ambulatory Surgery Elective Surgery‐Orthopedic 28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomye Ambulatory Surgery Elective Surgery‐Orthopedic 28150 Phalangectomy, toe, each toe Ambulatory Surgery Elective Surgery‐Orthopedic 28153 Resection, condyle(s), distal end of phalanx, each toe Ambulatory Surgery Elective Surgery‐Orthopedic 28160 Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each Ambulatory Surgery Elective Surgery‐Orthopedic 28175 Inpatient Surgical IP Surgical Procedures‐ Radical resection of tumor; phalanx of toe Procedures Orthopedic 28190 Removal of foreign body, foot; subcutaneous Ambulatory Surgery Elective Surgery‐Orthopedic 28192 Removal of foreign body, foot; deep Ambulatory Surgery Elective Surgery‐Orthopedic 28193 Removal of foreign body, foot; complicated Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon Ambulatory Surgery Elective Surgery‐Orthopedic 28222 Tenolysis, flexor, foot; multiple tendons Ambulatory Surgery Elective Surgery‐Orthopedic 28225 Tenolysis, extensor, foot; single tendon Ambulatory Surgery Elective Surgery‐Orthopedic 28230 Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28232 Tenotomy, open, tendon flexor; toe, single tendon (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28234 Tenotomy, open, extensor, foot or toe, each tendon Ambulatory Surgery Elective Surgery‐Orthopedic 28238 Reconstruction (advancement), posterior tibial tendon with excision of Elective Surgery‐ accessory tarsal navicular bo Ambulatory Surgery Reconstruction 28240 Tenotomy, lengthening, or release, abductor hallucis muscle Ambulatory Surgery Elective Surgery‐Orthopedic 28250 Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28270 Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28272 Capsulotomy; interphalangeal joint, each joint (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) Ambulatory Surgery Elective Surgery‐Orthopedic 28286 Correction, cock‐up fifth toe, with plastic skin closure (eg, Ruiz‐Mora type procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head Ambulatory Surgery Elective Surgery‐Orthopedic 28304 Osteotomy, tarsal bones, other than calcaneus or talus; Ambulatory Surgery Elective Surgery‐Orthopedic 28306 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars Ambulatory Surgery Elective Surgery‐Orthopedic 28307 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatars Ambulatory Surgery Elective Surgery‐Orthopedic 28308 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than fir Ambulatory Surgery Elective Surgery‐Orthopedic 28310 Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate proce Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 28313 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, Elective Surgery‐ overlapping second toe, f Ambulatory Surgery Reconstruction 28315 Sesamoidectomy, first toe (separate procedure) Ambulatory Surgery Elective Surgery‐Orthopedic 28322 Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft) Ambulatory Surgery Elective Surgery‐Orthopedic 28344 Elective Surgery‐ Reconstruction, toe(s); polydactyly Ambulatory Surgery Reconstruction 28345 Elective Surgery‐ Reconstruction, toe(s); syndactyly, with or without skin graft(s), each web Ambulatory Surgery Reconstruction 28400 Closed treatment of calcaneal fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28405 Closed treatment of calcaneal fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28406 Percutaneous skeletal fixation of calcaneal fracture, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28415 Open treatment of calcaneal fracture, includes internal fixation, when performed; Ambulatory Surgery Elective Surgery‐Orthopedic 28420 Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac Ambulatory Surgery Elective Surgery‐Orthopedic 28430 Closed treatment of talus fracture; without manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28435 Closed treatment of talus fracture; with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28445 Open treatment of talus fracture, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28446 Open osteochondral autograft, talus (includes obtaining graft[s]) Ambulatory Surgery Elective Surgery‐Orthopedic 28450 Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 28455 Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 28465 Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, whe Ambulatory Surgery Elective Surgery‐Orthopedic 28470 Closed treatment of metatarsal fracture; without manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 28475 Closed treatment of metatarsal fracture; with manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 28476 Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each Ambulatory Surgery Elective Surgery‐Orthopedic 28496 Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic

Code Description Category Product Filing Category 28505 Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when perfor Ambulatory Surgery Elective Surgery‐Orthopedic 28525 Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, Ambulatory Surgery Elective Surgery‐Orthopedic 28555 Open treatment of tarsal bone dislocation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28585 Open treatment of talotarsal joint dislocation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28600 Closed treatment of tarsometatarsal joint dislocation; without anesthesia Ambulatory Surgery Elective Surgery‐Orthopedic 28606 Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28615 Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28645 Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28666 Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulation Ambulatory Surgery Elective Surgery‐Orthopedic 28675 Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed Ambulatory Surgery Elective Surgery‐Orthopedic 28755 Arthrodesis, great toe; interphalangeal joint Ambulatory Surgery Elective Surgery‐Orthopedic 28810 Amputation, metatarsal, with toe, single Ambulatory Surgery Elective Surgery‐Orthopedic 28820 Amputation, toe; metatarsophalangeal joint Ambulatory Surgery Elective Surgery‐Orthopedic 28825 Amputation, toe; interphalangeal joint Ambulatory Surgery Elective Surgery‐Orthopedic 29305 Application of hip spica cast; 1 leg Ambulatory Surgery Elective Surgery‐Orthopedic 29345 Application of long leg cast (thigh to toes); Ambulatory Surgery Elective Surgery‐Orthopedic 29355 Application of long leg cast (thigh to toes); walker or ambulatory type Ambulatory Surgery Elective Surgery‐Orthopedic 29710 Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc. Ambulatory Surgery Elective Surgery‐Orthopedic 29826 Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with Ambulatory Surgery Arthroscopies/Arthroplasties 29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament Ambulatory Surgery Arthroscopies/Arthroplasties

Code Description Category Product Filing Category 29855 Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes inter Ambulatory Surgery Arthroscopies/Arthroplasties 29856 Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes intern Ambulatory Surgery Arthroscopies/Arthroplasties 29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) i Ambulatory Surgery Arthroscopies/Arthroplasties 29893 Endoscopic plantar fasciotomy Ambulatory Surgery Arthroscopies/Arthroplasties 30117 Excision or destruction (eg, laser), intranasal lesion; internal approach Ambulatory Surgery Elective Surgery‐ENT 30120 Excision or surgical planing of skin of nose for rhinophyma Ambulatory Surgery Elective Surgery‐ENT 30320 Removal foreign body, intranasal; by lateral rhinotomy Ambulatory Surgery Elective Surgery‐ENT 30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement wit Ambulatory Surgery Reconstructive Services 30600 Repair fistula; oronasal Ambulatory Surgery Reconstructive Services 30906 Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subseque Ambulatory Surgery Elective Surgery‐ENT 30930 Fracture nasal inferior turbinate(s), therapeutic Ambulatory Surgery Elective Surgery‐ENT 31367 Inpatient Surgical IP Surgical Procedures‐ Laryngectomy; subtotal supraglottic, without radical neck dissection Procedures Pulmonary 31370 Inpatient Surgical IP Surgical Procedures‐ Partial laryngectomy (hemilaryngectomy); horizontal Procedures Pulmonary 31526 Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescop Ambulatory Surgery Elective Surgery‐Endoscopy 31529 Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequent Ambulatory Surgery Elective Surgery‐Endoscopy 31530 Laryngoscopy, direct, operative, with foreign body removal; Ambulatory Surgery Elective Surgery‐Endoscopy 31531 Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescope Ambulatory Surgery Elective Surgery‐Endoscopy 31535 Laryngoscopy, direct, operative, with biopsy; Ambulatory Surgery Elective Surgery‐Endoscopy 31536 Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope Ambulatory Surgery Elective Surgery‐Endoscopy 31540 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti Ambulatory Surgery Elective Surgery‐Endoscopy

Code Description Category Product Filing Category 31541 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglotti Ambulatory Surgery Elective Surgery‐Endoscopy 31545 Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of Ambulatory Surgery Elective Surgery‐Endoscopy 31571 Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or t Ambulatory Surgery Elective Surgery‐Endoscopy 31572 Laryngoplasty laryngeal sten Ambulatory Surgery Elective Surgery‐Endoscopy 31573 Largsc w/ther injection Ambulatory Surgery Elective Surgery‐Endoscopy 31574 Largsc w/njx augmentation Ambulatory Surgery Elective Surgery‐Endoscopy 31600 Tracheostomy, planned (separate procedure); Ambulatory Surgery Elective Surgery‐ENT 31601 Tracheostomy, planned (separate procedure); younger than 2 years Ambulatory Surgery Elective Surgery‐ENT 31613 Elective Surgery‐ Tracheostoma revision; simple, without flap rotation Ambulatory Surgery Replacement/Revision 31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with c Ambulatory Surgery Elective Surgery‐Endoscopy 31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchia Ambulatory Surgery Elective Surgery‐Endoscopy 31630 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bron Ambulatory Surgery Elective Surgery‐Endoscopy 31631 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of Ambulatory Surgery Elective Surgery‐Endoscopy 31636 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of Ambulatory Surgery Elective Surgery‐Endoscopy 31638 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of t Ambulatory Surgery Elective Surgery‐Endoscopy 31648 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of br Ambulatory Surgery Elective Surgery‐Endoscopy 31652 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial Ambulatory Surgery Elective Surgery‐Endoscopy 31653 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial Ambulatory Surgery Elective Surgery‐Endoscopy

Code Description Category Product Filing Category 31660 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial the Ambulatory Surgery Elective Surgery‐Endoscopy 31661 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial the Ambulatory Surgery Elective Surgery‐Endoscopy 31820 Surgical closure tracheostomy or fistula; without plastic repair Ambulatory Surgery Elective Surgery‐ENT 31825 Surgical closure tracheostomy or fistula; with plastic repair Ambulatory Surgery Elective Surgery‐ENT 31830 Revision of tracheostomy scar Ambulatory Surgery Elective Surgery‐ENT 32140 Thoracotomy; with cyst(s) removal, includes pleural procedure when Inpatient Surgical IP Surgical Procedures‐ performed Procedures Pulmonary 32550 Insertion of indwelling tunneled pleural catheter with cuff Ambulatory Surgery Elective Surgery‐Pulmonary 32608 Thoracoscopy; with diagnostic biopsy(ies) of lung nodule(s) or mass(es) (eg, wedge, incisional), uni Ambulatory Surgery Elective Surgery‐Endoscopy 32665 Thoracoscopy, surgical; with esophagomyotomy (Heller type) Ambulatory Surgery Elective Surgery‐Endoscopy 32666 Thoracoscopy, surgical; with therapeutic wedge resection (eg, mass, nodule), initial unilateral Ambulatory Surgery Elective Surgery‐Endoscopy 32998 Ablation therapy for reduction or eradication of 1 or more pulmonary Inpatient Surgical IP Surgical Procedures‐ tumor(s) including pleura or ch Procedures Pulmonary 33020 Elective Surgery‐ Pericardiotomy for removal of clot or foreign body (primary procedure) Ambulatory Surgery Cardiovasuclar 33025 Elective Surgery‐ Creation of pericardial window or partial resection for drainage Ambulatory Surgery Cardiovasuclar 33213 Elective Surgery‐ Insertion of pacemaker pulse generator only; with existing dual leads Ambulatory Surgery Cardiovasuclar 33215 Repositioning of previously implanted transvenous pacemaker or pacing Elective Surgery‐ cardioverter‐defibrillator (ri Ambulatory Surgery Cardiovasuclar 33222 Elective Surgery‐ Revision or relocation of skin pocket for pacemaker Ambulatory Surgery Cardiovasuclar 33223 Elective Surgery‐ Revision of skin pocket for cardioverter‐defibrillator Ambulatory Surgery Cardiovasuclar 33226 Repositioning of previously implanted cardiac venous system (left ventricular) Elective Surgery‐ electrode (including Ambulatory Surgery Cardiovasuclar

Code Description Category Product Filing Category 33228 Removal of permanent pacemaker pulse generator with replacement of Elective Surgery‐ pacemaker pulse generator; dual l Ambulatory Surgery Cardiovasuclar 33233 Elective Surgery‐ Removal of permanent pacemaker pulse generator only Ambulatory Surgery Cardiovasuclar 33234 Removal of transvenous pacemaker electrode(s); single lead system, atrial or Elective Surgery‐ ventricular Ambulatory Surgery Cardiovasuclar 33241 Elective Surgery‐ Removal of pacing cardioverter‐defibrillator pulse generator only Ambulatory Surgery Cardiovasuclar 33244 Removal of single or dual chamber pacing cardioverter‐defibrillator Elective Surgery‐ electrode(s); by transvenous ext Ambulatory Surgery Cardiovasuclar 33262 Removal of pacing cardioverter‐defibrillator pulse generator with Elective Surgery‐ replacement of pacing cardioverter Ambulatory Surgery Cardiovasuclar 33263 Removal of pacing cardioverter‐defibrillator pulse generator with Elective Surgery‐ replacement of pacing cardioverter Ambulatory Surgery Cardiovasuclar 33264 Removal of pacing cardioverter‐defibrillator pulse generator with Elective Surgery‐ replacement of pacing cardioverter Ambulatory Surgery Cardiovasuclar 33282 Elective Surgery‐ Implantation of patient‐activated cardiac event recorder Ambulatory Surgery Cardiovasuclar 33284 Elective Surgery‐ Removal of an implantable, patient‐activated cardiac event recorder Ambulatory Surgery Cardiovasuclar 33289 Transcatheter implantation of wireless pulmonary artery pressure sensor for Elective Surgery‐ long‐term hemodynamic mo Ambulatory Surgery Cardiovasuclar 33883 Placement of proximal extension prosthesis for endovascular repair of Elective Surgery‐ descending thoracic aorta (eg, Ambulatory Surgery Cardiovasuclar 33948 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support Elective Surgery‐ (ECLS) provided by physician; Ambulatory Surgery Cardiovasuclar 33952 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support Elective Surgery‐ (ECLS) provided by physician; Ambulatory Surgery Cardiovasuclar 33954 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support Elective Surgery‐ (ECLS) provided by physician; Ambulatory Surgery Cardiovasuclar 33967 Elective Surgery‐ Insertion of intra‐aortic balloon assist device, percutaneous Ambulatory Surgery Cardiovasuclar

Code Description Category Product Filing Category 33984 Extracorporeal membrane oxygenation (ECMO)/extracorporeal life support Elective Surgery‐ (ECLS) provided by physician; Ambulatory Surgery Cardiovasuclar 34151 Embolectomy or thrombectomy, with or without catheter; renal, celiac, Elective Surgery‐ mesentery, aortoiliac artery, Ambulatory Surgery Cardiovasuclar 34707 Endovascular repair of iliac artery by deployment of an ilio‐iliac tube Elective Surgery‐ endograft including pre‐proc Ambulatory Surgery Cardiovasuclar 35045 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and Elective Surgery‐ graft insertion, with Ambulatory Surgery Cardiovasuclar 35141 Direct repair of aneurysm, pseudoaneurysm, or excision (partial or total) and Elective Surgery‐ graft insertion, with Ambulatory Surgery Cardiovasuclar 35190 Elective Surgery‐ Repair, acquired or traumatic arteriovenous fistula; extremities Ambulatory Surgery Cardiovasuclar 35201 Elective Surgery‐ Repair blood vessel, direct; neck Ambulatory Surgery Cardiovasuclar 35206 Elective Surgery‐ Repair blood vessel, direct; upper extremity Ambulatory Surgery Cardiovasuclar 35207 Elective Surgery‐ Repair blood vessel, direct; hand, finger Ambulatory Surgery Cardiovasuclar 35221 Elective Surgery‐ Repair blood vessel, direct; intra‐abdominal Ambulatory Surgery Cardiovasuclar 35226 Elective Surgery‐ Repair blood vessel, direct; lower extremity Ambulatory Surgery Cardiovasuclar 35236 Elective Surgery‐ Repair blood vessel with vein graft; upper extremity Ambulatory Surgery Cardiovasuclar 35256 Elective Surgery‐ Repair blood vessel with vein graft; lower extremity Ambulatory Surgery Cardiovasuclar 36010 Elective Surgery‐ Introduction of catheter, superior or inferior vena cava Ambulatory Surgery Cardiovasuclar 36011 Selective catheter placement, venous system; first order branch (eg, renal Elective Surgery‐ vein, jugular vein) Ambulatory Surgery Cardiovasuclar 36012 Selective catheter placement, venous system; second order, or more Elective Surgery‐ selective, branch (eg, left adren Ambulatory Surgery Cardiovasuclar

Code Description Category Product Filing Category 36013 Elective Surgery‐ Introduction of catheter, right heart or main pulmonary artery Ambulatory Surgery Cardiovasuclar 36014 Elective Surgery‐ Selective catheter placement, left or right pulmonary artery Ambulatory Surgery Cardiovasuclar 36015 Elective Surgery‐ Selective catheter placement, segmental or subsegmental pulmonary artery Ambulatory Surgery Cardiovasuclar 36200 Elective Surgery‐ Introduction of catheter, aorta Ambulatory Surgery Cardiovasuclar 36215 Selective catheter placement, arterial system; each first order thoracic or Elective Surgery‐ brachiocephalic branch, Ambulatory Surgery Cardiovasuclar 36216 Selective catheter placement, arterial system; initial second order thoracic or Elective Surgery‐ brachiocephalic bran Ambulatory Surgery Cardiovasuclar 36217 Selective catheter placement, arterial system; initial third order or more Elective Surgery‐ selective thoracic or bra Ambulatory Surgery Cardiovasuclar 36221 Non‐selective catheter placement, thoracic aorta, with angiography of the Elective Surgery‐ extracranial carotid, vert Ambulatory Surgery Cardiovasuclar 36222 Selective catheter placement, common carotid or innominate artery, Elective Surgery‐ unilateral, any approach, with an Ambulatory Surgery Cardiovasuclar 36223 Selective catheter placement, common carotid or innominate artery, Elective Surgery‐ unilateral, any approach, with an Ambulatory Surgery Cardiovasuclar 36224 Selective catheter placement, internal carotid artery, unilateral, with Elective Surgery‐ angiography of the ipsilater Ambulatory Surgery Cardiovasuclar 36225 Selective catheter placement, subclavian or innominate artery, unilateral, Elective Surgery‐ with angiography of the i Ambulatory Surgery Cardiovasuclar 36226 Selective catheter placement, vertebral artery, unilateral, with angiography of Elective Surgery‐ the ipsilateral vert Ambulatory Surgery Cardiovasuclar 36245 Selective catheter placement, arterial system; each first order abdominal, Elective Surgery‐ pelvic, or lower extremit Ambulatory Surgery Cardiovasuclar 36246 Selective catheter placement, arterial system; initial second order abdominal, Elective Surgery‐ pelvic, or lower extr Ambulatory Surgery Cardiovasuclar 36251 Selective catheter placement (first‐order), main renal artery and any Elective Surgery‐ accessory renal artery(s) for Ambulatory Surgery Cardiovasuclar

Code Description Category Product Filing Category 36252 Selective catheter placement (first‐order), main renal artery and any Elective Surgery‐ accessory renal artery(s) for Ambulatory Surgery Cardiovasuclar 36500 Venous catheterization for selective organ blood sampling Ambulatory Surgery Elective Surgery 36557 Insertion of tunneled centrally inserted central venous catheter, without Elective Surgery‐ subcutaneous port or pump; Ambulatory Surgery Cardiovasuclar 36558 Insertion of tunneled centrally inserted central venous catheter, without Elective Surgery‐ subcutaneous port or pump; Ambulatory Surgery Cardiovasuclar 36560 Insertion of tunneled centrally inserted central venous access device, with Elective Surgery‐ subcutaneous port; young Ambulatory Surgery Cardiovasuclar 36561 Insertion of tunneled centrally inserted central venous access device, with Elective Surgery‐ subcutaneous port; age 5 Ambulatory Surgery Cardiovasuclar 36563 Insertion of tunneled centrally inserted central venous access device with Elective Surgery‐ subcutaneous pump Ambulatory Surgery Cardiovasuclar 36565 Insertion of tunneled centrally inserted central venous access device, Elective Surgery‐ requiring 2 catheters via 2 s Ambulatory Surgery Cardiovasuclar 36566 Insertion of tunneled centrally inserted central venous access device, Elective Surgery‐ requiring 2 catheters via 2 s Ambulatory Surgery Cardiovasuclar 36571 Insertion of peripherally inserted central venous access device, with Elective Surgery‐ subcutaneous port; age 5 years Ambulatory Surgery Cardiovasuclar 36576 Repair of central venous access device, with subcutaneous port or pump, Elective Surgery‐ central or peripheral insert Ambulatory Surgery Repair/Replacement 36581 Replacement, complete, of a tunneled centrally inserted central venous Elective Surgery‐ catheter, without subcutaneou Ambulatory Surgery Repair/Replacement 36582 Replacement, complete, of a tunneled centrally inserted central venous Elective Surgery‐ access device, with subcutane Ambulatory Surgery Repair/Replacement 36585 Replacement, complete, of a peripherally inserted central venous access Elective Surgery‐ device, with subcutaneous po Ambulatory Surgery Repair/Replacement 36595 Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) Elective Surgery‐ from central venous devi Ambulatory Surgery Cardiovasuclar 36818 Elective Surgery‐ Arteriovenous anastomosis, open; by upper arm cephalic vein transposition Ambulatory Surgery Cardiovasuclar 36819 Elective Surgery‐ Arteriovenous anastomosis, open; by upper arm basilic vein transposition Ambulatory Surgery Cardiovasuclar

Code Description Category Product Filing Category 36820 Elective Surgery‐ Arteriovenous anastomosis, open; by forearm vein transposition Ambulatory Surgery Cardiovasuclar 36821 Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate Elective Surgery‐ procedure) Ambulatory Surgery Cardiovasuclar 36825 Creation of arteriovenous fistula by other than direct arteriovenous Elective Surgery‐ anastomosis (separate procedure Ambulatory Surgery Cardiovasuclar 36830 Creation of arteriovenous fistula by other than direct arteriovenous Elective Surgery‐ anastomosis (separate procedure Ambulatory Surgery Cardiovasuclar 36832 Revision, open, arteriovenous fistula; without thrombectomy, autogenous or Elective Surgery‐ nonautogenous dialysis gr Ambulatory Surgery Revison/Repair 36833 Revision, open, arteriovenous fistula; with thrombectomy, autogenous or Elective Surgery‐ nonautogenous dialysis graft Ambulatory Surgery Revison/Repair 36901 Intro cath dialysis circuit Ambulatory Surgery Elective Surgery 36902 Intro cath dialysis circuit Ambulatory Surgery Elective Surgery 36903 Intro cath dialysis circuit Ambulatory Surgery Elective Surgery 36904 Thrmbc/nfs dialysis circuit Ambulatory Surgery Elective Surgery 36905 Thrmbc/nfs dialysis circuit Ambulatory Surgery Elective Surgery 36906 Thrmbc/nfs dialysis circuit Ambulatory Surgery Elective Surgery 36907 Balo angiop ctr dialysis seg Ambulatory Surgery Elective Surgery 36908 Stent plmt ctr dialysis seg Ambulatory Surgery Elective Surgery 36909 Dialysis circuit embolj Ambulatory Surgery Elective Surgery 37182 Insertion of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic Ambulatory Surgery Elective Surgery 37183 Revision of transvenous intrahepatic portosystemic shunt(s) (TIPS) (includes venous access, hepatic Ambulatory Surgery Elective Surgery 37186 Secondary percutaneous transluminal thrombectomy (eg, nonprimary mechanical, snare basket, suction t Ambulatory Surgery Elective Surgery 37191 Insertion of intravascular vena cava filter, endovascular approach including vascular access, vessel Ambulatory Surgery Elective Surgery 37192 Repositioning of intravascular vena cava filter, endovascular approach including vascular access, ve Ambulatory Surgery Elective Surgery

Code Description Category Product Filing Category 37193 Retrieval (removal) of intravascular vena cava filter, endovascular approach including vascular acce Ambulatory Surgery Elective Surgery 37200 Transcatheter biopsy Ambulatory Surgery Elective Surgery 37211 Transcatheter therapy, arterial infusion for thrombolysis other than coronary or intracranial, any m Ambulatory Surgery Elective Surgery 37212 Transcatheter therapy, venous infusion for thrombolysis, any method, including radiological supervis Ambulatory Surgery Elective Surgery 37213 Transcatheter therapy, arterial or venous infusion for thrombolysis other than coronary, any method, Ambulatory Surgery Elective Surgery 37609 Ligation or biopsy, temporal artery Ambulatory Surgery Elective Surgery 37700 Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions Ambulatory Surgery Elective Surgery 38206 Blood‐derived hematopoietic progenitor cell harvesting for transplantation, per collection; autologo Ambulatory Surgery Elective Surgery 38221 Bone marrow; biopsy, needle or trocar Ambulatory Surgery Elective Surgery 38222 Diagnostic bone marrow; biopsy(ies) and aspiration(s) Ambulatory Surgery Elective Surgery 38232 Bone marrow harvesting for transplantation; autologous Ambulatory Surgery Elective Surgery 38242 Allogeneic lymphocyte infusions Ambulatory Surgery Elective Surgery 38305 Drainage of lymph node abscess or lymphadenitis; extensive Ambulatory Surgery Elective Surgery 38510 Biopsy or excision of lymph node(s); open, deep cervical node(s) Ambulatory Surgery Elective Surgery‐Biopsy 38520 Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad Ambulatory Surgery Elective Surgery‐Biopsy 38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) Ambulatory Surgery Elective Surgery‐Biopsy 38531 Biopsy or excision of lymph node(s); open, inguinofemoral node(s) Ambulatory Surgery Elective Surgery‐Biopsy 39010 Mediastinotomy with exploration, drainage, removal of foreign body, or biopsy; transthoracic approac Ambulatory Surgery Elective Surgery 39401 Mediastinoscopy; includes biopsy(ies) of mediastinal mass (eg, lymphoma), when performed Ambulatory Surgery Elecitve Surgery‐Endoscopy 40500 Vermilionectomy (lip shave), with mucosal advancement Ambulatory Surgery Elective Surgery‐GI 40510 Excision of lip; transverse wedge excision with primary closure Ambulatory Surgery Elective Surgery‐GI 40520 Excision of lip; V‐excision with primary direct linear closure Ambulatory Surgery Elective Surgery‐GI

Code Description Category Product Filing Category 40525 Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) Ambulatory Surgery Elective Surgery‐GI 40650 Repair lip, full thickness; vermilion only Ambulatory Surgery Elective Surgery‐GI 40805 Elective Surgery‐ Removal of embedded foreign body, vestibule of mouth; complicated Ambulatory Surgery Oral/Maxillofacial 40814 Excision of lesion of mucosa and submucosa, vestibule of mouth; with Elective Surgery‐ complex repair Ambulatory Surgery Oral/Maxillofacial 40816 Excision of lesion of mucosa and submucosa, vestibule of mouth; complex, Elective Surgery‐ with excision of underlying Ambulatory Surgery Oral/Maxillofacial 40818 Elective Surgery‐ Excision of mucosa of vestibule of mouth as donor graft Ambulatory Surgery Oral/Maxillofacial 40819 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, Elective Surgery‐ frenectomy) Ambulatory Surgery Oral/Maxillofacial 41009 Intraoral incision and drainage of abscess, cyst, or hematoma of tongue or Elective Surgery‐ floor of mouth; masticato Ambulatory Surgery Oral/Maxillofacial 41017 Extraoral incision and drainage of abscess, cyst, or hematoma of floor of Elective Surgery‐ mouth; submandibular Ambulatory Surgery Oral/Maxillofacial 41112 Elective Surgery‐ Excision of lesion of tongue with closure; anterior 2/3 Ambulatory Surgery Oral/Maxillofacial 41113 Elective Surgery‐ Excision of lesion of tongue with closure; posterior 1/3 Ambulatory Surgery Oral/Maxillofacial 41115 Elective Surgery‐ Excision of lingual frenum (frenectomy) Ambulatory Surgery Oral/Maxillofacial 41520 Elective Surgery‐ Frenoplasty (surgical revision of frenum, eg, with Z‐plasty) Ambulatory Surgery Oral/Maxillofacial 41530 Submucosal ablation of the tongue base, radiofrequency, 1 or more sites, per Elective Surgery‐ session Ambulatory Surgery Oral/Maxillofacial 41806 Elective Surgery‐ Removal of embedded foreign body from dentoalveolar structures; bone Ambulatory Surgery Oral/Maxillofacial 41826 Excision of lesion or tumor (except listed above), dentoalveolar structures; Elective Surgery‐ with simple repair Ambulatory Surgery Oral/Maxillofacial 41827 Excision of lesion or tumor (except listed above), dentoalveolar structures; Elective Surgery‐ with complex repair Ambulatory Surgery Oral/Maxillofacial

Code Description Category Product Filing Category 41872 Elective Surgery‐ Gingivoplasty, each quadrant (specify) Ambulatory Surgery Oral/Maxillofacial 41874 Elective Surgery‐ Alveoloplasty, each quadrant (specify) Ambulatory Surgery Oral/Maxillofacial 42140 Elective Surgery‐ Uvulectomy, excision of uvula Ambulatory Surgery Oral/Maxillofacial 42182 Elective Surgery‐ Repair, laceration of palate; over 2 cm or complex Ambulatory Surgery Oral/Maxillofacial 42226 Elective Surgery‐ Lengthening of palate, and pharyngeal flap Ambulatory Surgery Oral/Maxillofacial 42235 Elective Surgery‐ Repair of anterior palate, including vomer flap Ambulatory Surgery Oral/Maxillofacial 42300 Elective Surgery‐ Drainage of abscess; parotid, simple Ambulatory Surgery Oral/Maxillofacial 42305 Elective Surgery‐ Drainage of abscess; parotid, complicated Ambulatory Surgery Oral/Maxillofacial 42330 Sialolithotomy; submandibular (submaxillary), sublingual or parotid, Elective Surgery‐ uncomplicated, intraoral Ambulatory Surgery Oral/Maxillofacial 42335 Elective Surgery‐ Sialolithotomy; submandibular (submaxillary), complicated, intraoral Ambulatory Surgery Oral/Maxillofacial 42405 Elective Surgery‐ Biopsy of salivary gland; incisional Ambulatory Surgery Oral/Maxillofacial 42408 Elective Surgery‐ Excision of sublingual salivary cyst (ranula) Ambulatory Surgery Oral/Maxillofacial 42410 Excision of parotid tumor or parotid gland; lateral lobe, without nerve Elective Surgery‐ dissection Ambulatory Surgery Excision/Resection 42415 Excision of parotid tumor or parotid gland; lateral lobe, with dissection and Elective Surgery‐ preservation of facial Ambulatory Surgery Excision/Resection 42420 Excision of parotid tumor or parotid gland; total, with dissection and Elective Surgery‐ preservation of facial nerve Ambulatory Surgery Excision/Resection 42426 Excision of parotid tumor or parotid gland; total, with unilateral radical neck Inpatient Surgical dissection Procedures IP Surgical Procedures‐GI

Code Description Category Product Filing Category 42440 Elective Surgery‐ Excision of submandibular (submaxillary) gland Ambulatory Surgery Excision/Resection 42450 Elective Surgery‐ Excision of sublingual gland Ambulatory Surgery Excision/Resection 42505 Plastic repair of salivary duct, sialodochoplasty; secondary or complicated Ambulatory Surgery Elective Surgery‐Plastics 42720 Incision and drainage abscess; retropharyngeal or parapharyngeal, intraoral approach Ambulatory Surgery Elective Surgery ‐ENT 42725 Incision and drainage abscess; retropharyngeal or parapharyngeal, external Inpatient Surgical approach Procedures IP Surgical Procedures‐GI 42808 Excision or destruction of lesion of pharynx, any method Ambulatory Surgery Elective Surgery ‐ENT 42810 Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues Ambulatory Surgery Elective Surgery ‐ENT 42815 Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or in Ambulatory Surgery Elective Surgery ‐ENT 42820 Tonsillectomy and adenoidectomy; younger than age 12 Ambulatory Surgery Elective Surgery ‐ENT 42821 Tonsillectomy and adenoidectomy; age 12 or over Ambulatory Surgery Elective Surgery ‐ENT 42825 Tonsillectomy, primary or secondary; younger than age 12 Ambulatory Surgery Elective Surgery ‐ENT 42826 Tonsillectomy, primary or secondary; age 12 or over Ambulatory Surgery Elective Surgery ‐ENT 42830 Adenoidectomy, primary; younger than age 12 Ambulatory Surgery Elective Surgery ‐ENT 42831 Adenoidectomy, primary; age 12 or over Ambulatory Surgery Elective Surgery ‐ENT 42835 Adenoidectomy, secondary; younger than age 12 Ambulatory Surgery Elective Surgery ‐ENT 42836 Adenoidectomy, secondary; age 12 or over Ambulatory Surgery Elective Surgery ‐ENT 42842 Radical resection of tonsil, tonsillar pillars, and/or retromolar trigone; without Inpatient Surgical closure Procedures IP Surgical Procedures‐GI 42900 Suture pharynx for wound or injury Ambulatory Surgery Elective Surgery ‐ENT 42953 Pharyngoesophageal repair Ambulatory Surgery Elective Surgery ‐ENT 42961 Control oropharyngeal hemorrhage, primary or secondary (eg, post‐ tonsillectomy); complicated, requir Ambulatory Surgery Elective Surgery ‐ENT 42962 Control oropharyngeal hemorrhage, primary or secondary (eg, post‐ tonsillectomy); with secondary surg Ambulatory Surgery Elective Surgery ‐ENT

Code Description Category Product Filing Category 42972 Control of nasopharyngeal hemorrhage, primary or secondary (eg, postadenoidectomy); with secondary s Ambulatory Surgery Elective Surgery ‐ENT 43193 Esophagoscopy, rigid, transoral; with biopsy, single or multiple Ambulatory Surgery Elective Surgery‐Endoscopy 43195 Esophagoscopy, rigid, transoral; with balloon dilation (less than 30 mm diameter) Ambulatory Surgery Elective Surgery‐Endoscopy 43212 Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre‐ and post‐dilat Ambulatory Surgery Elective Surgery‐Endoscopy 43213 Esophagoscopy, flexible, transoral; with dilation of esophagus, by balloon or dilator, retrograde (i Ambulatory Surgery Elective Surgery‐Endoscopy 43214 Esophagoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diameter or large Ambulatory Surgery Elective Surgery‐Endoscopy 43217 Esophagoscopy, rigid or flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare te Ambulatory Surgery Elective Surgery‐Endoscopy 43229 Esophagoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (include Ambulatory Surgery Elective Surgery‐Endoscopy 43231 Esophagoscopy, rigid or flexible; with endoscopic ultrasound examination Ambulatory Surgery Elective Surgery‐Endoscopy 43233 Esophagogastroduodenoscopy, flexible, transoral; with dilation of esophagus with balloon (30 mm diam Ambulatory Surgery Elective Surgery‐Endoscopy 43252 Esophagogastroduodenoscopy, flexible, transoral; with optical endomicroscopy Ambulatory Surgery Elective Surgery‐Endoscopy 43253 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic ultrasound‐guided transmural i Ambulatory Surgery Elective Surgery‐Endoscopy 43254 Esophagogastroduodenoscopy, flexible, transoral; with endoscopic mucosal resection Ambulatory Surgery Elective Surgery‐Endoscopy 43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of spe Ambulatory Surgery Elective Surgery‐Endoscopy 43266 Esophagogastroduodenoscopy, flexible, transoral; with placement of endoscopic stent (includes pre‐ a Ambulatory Surgery Elective Surgery‐Endoscopy 43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesio Ambulatory Surgery Elective Surgery‐Endoscopy 43332 Repair, paraesophageal hiatal hernia (including fundoplication), via Inpatient Surgical laparotomy, except neonatal; wi Procedures IP Surgical Procedures‐GI

Code Description Category Product Filing Category 43420 Elective Surgery‐GI Closure of esophagostomy or fistula; cervical approach Ambulatory Surgery procedures 43450 Elective Surgery‐GI Dilation of esophagus, by unguided sound or bougie, single or multiple passes Ambulatory Surgery procedures 43453 Elective Surgery‐GI Dilation of esophagus, over guide wire Ambulatory Surgery procedures 43520 Inpatient Surgical Pyloromyotomy, cutting of pyloric muscle (Fredet‐Ramstedt type operation) Procedures IP Surgical Procedures‐GI 43648 Laparoscopy, surgical; revision or removal of gastric neurostimulator electrodes, antrum Ambulatory Surgery Laparascopies 43840 Gastrorrhaphy, suture of perforated duodenal or gastric ulcer, wound, or Elective Surgery‐GI injury Ambulatory Surgery procedures 43870 Elective Surgery‐GI Closure of gastrostomy, surgical Ambulatory Surgery procedures 43880 Elective Surgery‐GI Closure of gastrocolic fistula Ambulatory Surgery procedures 44050 Inpatient Surgical Reduction of volvulus, intussusception, internal hernia, by laparotomy Procedures IP Surgical Procedures‐GI 44110 Excision of 1 or more lesions of small or large intestine not requiring Elective Surgery‐GI anastomosis, exteriorization Ambulatory Surgery procedures 44140 Inpatient Surgical Colectomy, partial; with anastomosis Procedures IP Surgical Procedures‐GI 44188 Laparoscopy, surgical, colostomy or skin level cecostomy Ambulatory Surgery Laparascopies 44202 Laparoscopy, surgical; enterectomy, resection of small intestine, single resection and anastomosis Ambulatory Surgery Laparascopies 44227 Laparoscopy, surgical, closure of enterostomy, large or small intestine, with resection and anastomo Ambulatory Surgery Laparascopies 44300 Placement, enterostomy or cecostomy, tube open (eg, for feeding or Elective Surgery‐GI decompression) (separate procedur Ambulatory Surgery procedures 44340 Revision of colostomy; simple (release of superficial scar) (separate Elective Surgery‐GI procedure) Ambulatory Surgery procedures 44346 Revision of colostomy; with repair of paracolostomy hernia (separate Elective Surgery‐GI procedure) Ambulatory Surgery procedures

Code Description Category Product Filing Category 44602 Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, Elective Surgery‐GI wound, injury or ruptu Ambulatory Surgery procedures 44603 Suture of small intestine (enterorrhaphy) for perforated ulcer, diverticulum, Elective Surgery‐GI wound, injury or ruptu Ambulatory Surgery procedures 44640 Elective Surgery‐GI Closure of intestinal cutaneous fistula Ambulatory Surgery procedures 44661 Elective Surgery‐GI Closure of enterovesical fistula; with intestine and/or bladder resection Ambulatory Surgery procedures 44900 Elective Surgery‐GI Incision and drainage of appendiceal abscess; open Ambulatory Surgery procedures 44950 Elective Surgery‐GI Appendectomy; Ambulatory Surgery procedures 44970 Laparoscopy, surgical, appendectomy Ambulatory Surgery Laparoscopies 45020 Elective Surgery‐GI Incision and drainage of deep supralevator, pelvirectal, or retrorectal abscess Ambulatory Surgery procedures 45100 Elective Surgery‐GI Biopsy of anorectal wall, anal approach (eg, congenital megacolon) Ambulatory Surgery procedures 45334 Sigmoidoscopy, flexible; with control of bleeding (eg, injection, bipolar cautery, unipolar cautery, Ambulatory Surgery Elective Surgery‐Endoscopy 45346 Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre‐ and Ambulatory Surgery Elective Surgery‐Endoscopy 45347 Sigmoidoscopy, flexible; with placement of endoscopic stent (includes pre‐ and post‐dilation and gui Ambulatory Surgery Elective Surgery‐Endoscopy 45349 Sigmoidoscopy, flexible; with endoscopic mucosal resection Ambulatory Surgery Elective Surgery‐Endoscopy 45350 Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids) Ambulatory Surgery Elective Surgery‐Endoscopy 45915 Removal of fecal impaction or foreign body (separate procedure) under Elective Surgery‐GI anesthesia Ambulatory Surgery procedures 46020 Elective Surgery‐GI Placement of seton Ambulatory Surgery procedures 46030 Elective Surgery‐GI Removal of anal seton, other marker Ambulatory Surgery procedures

Code Description Category Product Filing Category 46040 Incision and drainage of ischiorectal and/or perirectal abscess (separate Elective Surgery‐GI procedure) Ambulatory Surgery procedures 46045 Incision and drainage of intramural, intramuscular, or submucosal abscess, Elective Surgery‐GI transanal, under anesthes Ambulatory Surgery procedures 46060 Incision and drainage of ischiorectal or intramural abscess, with fistulectomy Elective Surgery‐GI or fistulotomy, submu Ambulatory Surgery procedures 46080 Elective Surgery‐GI Sphincterotomy, anal, division of sphincter (separate procedure) Ambulatory Surgery procedures 46200 Elective Surgery‐GI Fissurectomy, including sphincterotomy, when performed Ambulatory Surgery procedures 46221 Elective Surgery‐GI Hemorrhoidectomy, internal, by rubber band ligation(s) Ambulatory Surgery procedures 46250 Elective Surgery‐GI Hemorrhoidectomy, external, 2 or more columns/groups Ambulatory Surgery procedures 46255 Elective Surgery‐GI Hemorrhoidectomy, internal and external, single column/group; Ambulatory Surgery procedures 46257 Hemorrhoidectomy, internal and external, single column/group; with Elective Surgery‐GI fissurectomy Ambulatory Surgery procedures 46260 Elective Surgery‐GI Hemorrhoidectomy, internal and external, 2 or more columns/groups; Ambulatory Surgery procedures 46261 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with Elective Surgery‐GI fissurectomy Ambulatory Surgery procedures 46262 Hemorrhoidectomy, internal and external, 2 or more columns/groups; with Elective Surgery‐GI fistulectomy, including fiss Ambulatory Surgery procedures 46270 Elective Surgery‐GI Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous Ambulatory Surgery procedures 46275 Elective Surgery‐GI Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric Ambulatory Surgery procedures 46280 Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, Elective Surgery‐GI suprasphincteric, e Ambulatory Surgery procedures 46285 Elective Surgery‐GI Surgical treatment of anal fistula (fistulectomy/fistulotomy); second stage Ambulatory Surgery procedures

Code Description Category Product Filing Category 46288 Elective Surgery‐GI Closure of anal fistula with rectal advancement flap Ambulatory Surgery procedures 46505 Elective Surgery‐GI Chemodenervation of internal anal sphincter Ambulatory Surgery procedures 46601 Anoscopy; diagnostic, with high‐resolution magnification (HRA) (eg, Elective Surgery‐GI colposcope, operating microscope Ambulatory Surgery procedures 46604 Elective Surgery‐GI Anoscopy; with dilation (eg, balloon, guide wire, bougie) Ambulatory Surgery procedures 46607 Anoscopy; with high‐resolution magnification (HRA) (eg, colposcope, Elective Surgery‐GI operating microscope) and chemic Ambulatory Surgery procedures 46700 Elective Surgery‐GI Anoplasty, plastic operation for stricture; adult Ambulatory Surgery procedures 46707 Repair of anorectal fistula with plug (eg, porcine small intestine submucosa Elective Surgery‐GI [SIS]) Ambulatory Surgery procedures 46900 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum Elective Surgery‐GI contagiosum, herpetic vesicle), Ambulatory Surgery procedures 46924 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum Elective Surgery‐GI contagiosum, herpetic vesicle), Ambulatory Surgery procedures 46940 Curettage or cautery of anal fissure, including dilation of anal sphincter Elective Surgery‐GI (separate procedure); ini Ambulatory Surgery procedures 46946 Hemorrhoidectomy, internal, by ligation other than rubber band; 2 or more Elective Surgery‐GI hemorrhoid columns/groups Ambulatory Surgery procedures 46947 Elective Surgery‐GI Hemorrhoidopexy (eg, for prolapsing internal hemorrhoids) by stapling Ambulatory Surgery procedures 47100 Elective Surgery‐GI Biopsy of liver, wedge Ambulatory Surgery procedures 47382 Elective Surgery‐GI Ablation, 1 or more liver tumor(s), percutaneous, radiofrequency Ambulatory Surgery procedures 47383 Elective Surgery‐GI Ablation, 1 or more liver tumor(s), percutaneous, cryoablation Ambulatory Surgery procedures 47490 Cholecystostomy, percutaneous, complete procedure, including imaging Elective Surgery‐GI guidance, catheter placement, c Ambulatory Surgery procedures

Code Description Category Product Filing Category 47532 Injection procedure for cholangiography, percutaneous, complete diagnostic Elective Surgery‐GI procedure including imagi Ambulatory Surgery procedures 47533 Placement of biliary drainage catheter, percutaneous, including diagnostic Elective Surgery‐GI cholangiography when perf Ambulatory Surgery procedures 47534 Placement of biliary drainage catheter, percutaneous, including diagnostic Elective Surgery‐GI cholangiography when perf Ambulatory Surgery procedures 47536 Exchange of biliary drainage catheter (eg, external, internal‐external, or Elective Surgery‐GI conversion of internal‐ex Ambulatory Surgery procedures 47538 Placement of stent(s) into a bile duct, percutaneous, including diagnostic Elective Surgery‐GI cholangiography, imaging Ambulatory Surgery procedures 47541 Placement of access through the biliary tree and into small bowel to assist Elective Surgery‐GI with an endoscopic bilia Ambulatory Surgery procedures 47543 Endoluminal biopsy(ies) of biliary tree, percutaneous, any method(s) (eg, Elective Surgery‐GI brush, forceps, and/or nee Ambulatory Surgery procedures 47562 Laparoscopy, surgical; cholecystectomy Ambulatory Surgery Laparoscopies 47563 Laparoscopy, surgical; cholecystectomy with cholangiography Ambulatory Surgery Laparoscopies 47564 Laparoscopy, surgical; cholecystectomy with exploration of common duct Ambulatory Surgery Laparoscopies 47600 Inpatient Surgical Cholecystectomy; Procedures IP Surgical Procedures‐GI 47605 Inpatient Surgical Cholecystectomy; with cholangiography Procedures IP Surgical Procedures‐GI 47610 Inpatient Surgical Cholecystectomy with exploration of common duct; Procedures IP Surgical Procedures‐GI 48102 Elective Surgery‐GI Biopsy of pancreas, percutaneous needle Ambulatory Surgery procedures 48510 Elective Surgery‐GI External drainage, pseudocyst of pancreas; open Ambulatory Surgery procedures 49250 Elective Surgery‐GI Umbilectomy, omphalectomy, excision of umbilicus (separate procedure) Ambulatory Surgery procedures 49255 Elective Surgery‐GI Omentectomy, epiploectomy, resection of omentum (separate procedure) Ambulatory Surgery procedures

Code Description Category Product Filing Category 49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) Ambulatory Surgery Laparoscopies 49321 Laparoscopy, surgical; with biopsy (single or multiple) Ambulatory Surgery Laparoscopies 49322 Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple) Ambulatory Surgery Laparoscopies 49323 Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity Ambulatory Surgery Laparoscopies 49324 Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter Ambulatory Surgery Laparoscopies 49325 Laparoscopy, surgical; with revision of previously placed intraperitoneal cannula or catheter, with Ambulatory Surgery Laparoscopies 49405 Image‐guided fluid collection drainage by catheter (eg, abscess, hematoma, Elective Surgery‐GI seroma, lymphocele, cyst) Ambulatory Surgery procedures 49406 Image‐guided fluid collection drainage by catheter (eg, abscess, hematoma, Elective Surgery‐GI seroma, lymphocele, cyst) Ambulatory Surgery procedures 49407 Image‐guided fluid collection drainage by catheter (eg, abscess, hematoma, Elective Surgery‐GI seroma, lymphocele, cyst) Ambulatory Surgery procedures 49418 Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal Elective Surgery‐GI chemotherapy instillat Ambulatory Surgery procedures 49419 Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, Elective Surgery‐GI totally implantable) Ambulatory Surgery procedures 49421 Elective Surgery‐GI Insertion of tunneled intraperitoneal catheter for dialysis, open Ambulatory Surgery procedures 49422 Elective Surgery‐GI Removal of tunneled intraperitoneal catheter Ambulatory Surgery procedures 49440 Insertion of gastrostomy tube, percutaneous, under fluoroscopic guidance Elective Surgery‐GI including contrast injectio Ambulatory Surgery procedures 49446 Conversion of gastrostomy tube to gastro‐jejunostomy tube, percutaneous, Elective Surgery‐GI under fluoroscopic guidance Ambulatory Surgery procedures 49451 Replacement of duodenostomy or jejunostomy tube, percutaneous, under Elective Surgery‐GI fluoroscopic guidance including Ambulatory Surgery procedures 49495 Repair, initial inguinal hernia, full term infant younger than age 6 months, or Elective Surgery‐GI preterm infant older Ambulatory Surgery procedures

Code Description Category Product Filing Category 49500 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or Elective Surgery‐GI without hydrocelectomy Ambulatory Surgery procedures 49570 Repair epigastric hernia (eg, preperitoneal fat); reducible (separate Elective Surgery‐GI procedure) Ambulatory Surgery procedures 49580 Elective Surgery‐GI Repair umbilical hernia, younger than age 5 years; reducible Ambulatory Surgery procedures 49582 Repair umbilical hernia, younger than age 5 years; incarcerated or Elective Surgery‐GI strangulated Ambulatory Surgery procedures 49585 Elective Surgery‐GI Repair umbilical hernia, age 5 years or older; reducible Ambulatory Surgery procedures 49587 Elective Surgery‐GI Repair umbilical hernia, age 5 years or older; incarcerated or strangulated Ambulatory Surgery procedures 49900 Elective Surgery‐GI Suture, secondary, of abdominal wall for evisceration or dehiscence Ambulatory Surgery procedures 49905 Omental flap, intra‐abdominal (List separately in addition to code for primary Elective Surgery‐GI procedure) Ambulatory Surgery procedures 50205 Inpatient Surgical IP Surgical Procedures‐ Renal biopsy; by surgical exposure of kidney Procedures Urology 50384 Removal (via snare/capture) of internally dwelling ureteral stent via percutaneous approach, includi Ambulatory Surgery Elective Surgery‐Urology 50395 Introduction of guide into renal pelvis and/or ureter with dilation to establish nephrostomy tract, Ambulatory Surgery Elective Surgery‐Urology 50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogr Ambulatory Surgery Elective Surgery‐Urology 50433 Placement of nephroureteral catheter, percutaneous, including diagnostic nephrostogram and/or ureter Ambulatory Surgery Elective Surgery‐Urology 50434 Convert nephrostomy catheter to nephroureteral catheter, percutaneous, including diagnostic nephrost Ambulatory Surgery Elective Surgery‐Urology 50437 Dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance ( Ambulatory Surgery Elective Surgery‐Urology 50590 Lithotripsy, extracorporeal shock wave Ambulatory Surgery Elective Surgery‐Urology 50693 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram whe Ambulatory Surgery Elective Surgery‐Urology

Code Description Category Product Filing Category 50694 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram whe Ambulatory Surgery Elective Surgery‐Urology 50695 Placement of ureteral stent, percutaneous, including diagnostic nephrostogram and/or ureterogram whe Ambulatory Surgery Elective Surgery‐Urology 50705 Ureteral embolization or occlusion, including imaging guidance (eg, ultrasound and/or fluoroscopy) a Ambulatory Surgery Elective Surgery‐Urology 51040 Cystostomy, cystotomy with drainage Ambulatory Surgery Elective Surgery‐Urology 51590 Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including Inpatient Surgical IP Surgical Procedures‐ intestine anastomosis; Procedures Urology 51596 Cystectomy, complete, with continent diversion, any open technique, using Inpatient Surgical IP Surgical Procedures‐ any segment of small and/o Procedures Urology 51725 Simple cystometrogram (CMG) (eg, spinal manometer) Ambulatory Surgery Elective Surgery‐Urology 51728 Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bla Ambulatory Surgery Elective Surgery‐Urology 51729 Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bla Ambulatory Surgery Elective Surgery‐Urology 51792 Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time) Ambulatory Surgery Elective Surgery‐Urology 52001 Cystourethroscopy with irrigation and evacuation of multiple obstructing clots Ambulatory Surgery Elective Surgery‐Urology 52214 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder nec Ambulatory Surgery Elective Surgery‐Urology 52224 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR ( Ambulatory Surgery Elective Surgery‐Urology 52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SM Ambulatory Surgery Elective Surgery‐Urology 52235 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; ME Ambulatory Surgery Elective Surgery‐Urology 52240 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LA Ambulatory Surgery Elective Surgery‐Urology 52260 Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal Ambulatory Surgery Elective Surgery‐Urology

Code Description Category Product Filing Category 52265 Cystourethroscopy, with dilation of bladder for interstitial cystitis; local anesthesia Ambulatory Surgery Elective Surgery‐Urology 52276 Cystourethroscopy with direct vision internal urethrotomy Ambulatory Surgery Elective Surgery‐Urology 52277 Cystourethroscopy, with resection of external sphincter (sphincterotomy) Ambulatory Surgery Elective Surgery‐Urology 52300 Cystourethroscopy; with resection or fulguration of orthotopic ureterocele(s), unilateral or bilater Ambulatory Surgery Elective Surgery‐Urology 52301 Cystourethroscopy; with resection or fulguration of ectopic ureterocele(s), unilateral or bilateral Ambulatory Surgery Elective Surgery‐Urology 52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder Ambulatory Surgery Elective Surgery‐Urology 52315 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder Ambulatory Surgery Elective Surgery‐Urology 52317 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; Ambulatory Surgery Elective Surgery‐Urology 52318 Litholapaxy: crushing or fragmentation of calculus by any means in bladder and removal of fragments; Ambulatory Surgery Elective Surgery‐Urology 52320 Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus Ambulatory Surgery Elective Surgery‐Urology 52325 Cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (eg, Ambulatory Surgery Elective Surgery‐Urology 52327 Cystourethroscopy (including ureteral catheterization); with subureteric injection of implant materi Ambulatory Surgery Elective Surgery‐Urology 52330 Cystourethroscopy (including ureteral catheterization); with manipulation, without removal of ureter Ambulatory Surgery Elective Surgery‐Urology 52334 Cystourethroscopy with insertion of ureteral guide wire through kidney to establish a percutaneous n Ambulatory Surgery Elective Surgery‐Urology 52341 Cystourethroscopy; with treatment of ureteral stricture (eg, balloon dilation, laser, electrocautery Ambulatory Surgery Elective Surgery‐Urology 52342 Cystourethroscopy; with treatment of ureteropelvic junction stricture (eg, balloon dilation, laser, Ambulatory Surgery Elective Surgery‐Urology 52344 Cystourethroscopy with ureteroscopy; with treatment of ureteral stricture (eg, balloon dilation, las Ambulatory Surgery Elective Surgery‐Urology

Code Description Category Product Filing Category 52345 Cystourethroscopy with ureteroscopy; with treatment of ureteropelvic junction stricture (eg, balloon Ambulatory Surgery Elective Surgery‐Urology 52346 Cystourethroscopy with ureteroscopy; with treatment of intra‐renal stricture (eg, balloon dilation, Ambulatory Surgery Elective Surgery‐Urology 52351 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic Ambulatory Surgery Elective Surgery‐Urology 52352 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or Inpatient Surgical IP Surgical Procedures‐ manipulation of calculus (ur Procedures Urology 52353 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization i Ambulatory Surgery Elective Surgery‐Urology 52354 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral o Ambulatory Surgery Elective Surgery‐Urology 52402 Cystourethroscopy with transurethral resection or incision of ejaculatory ducts Ambulatory Surgery Elective Surgery‐Urology 52450 Inpatient Surgical IP Surgical Procedures‐ Transurethral incision of prostate Procedures Urology 52640 Transurethral resection; of postoperative bladder neck contracture Ambulatory Surgery Elective Surgery‐Urology 53275 Excision or fulguration; urethral prolapse Ambulatory Surgery Elective Surgery‐Urology 53450 Urethromeatoplasty, with mucosal advancement Ambulatory Surgery Elective Surgery‐Urology 53460 Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure) Ambulatory Surgery Elective Surgery‐Urology 54015 Elective Surgery‐Male Incision and drainage of penis, deep Ambulatory Surgery Reproductive 54100 Elective Surgery‐Male Biopsy of penis; (separate procedure) Ambulatory Surgery Reproductive 54115 Elective Surgery‐Male Removal foreign body from deep penile tissue (eg, plastic implant) Ambulatory Surgery Reproductive 54160 Circumcision, surgical excision other than clamp, device, or dorsal slit; Elective Surgery‐Male neonate (28 days of age or Ambulatory Surgery Reproductive 54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older Elective Surgery‐Male than 28 days of age Ambulatory Surgery Reproductive 54162 Elective Surgery‐Male Lysis or excision of penile post‐circumcision adhesions Ambulatory Surgery Reproductive

Code Description Category Product Filing Category 54163 Elective Surgery‐Male Repair incomplete circumcision Ambulatory Surgery Reproductive 54230 Elective Surgery‐Male Injection procedure for corpora cavernosography Ambulatory Surgery Reproductive 54406 Removal of all components of a multi‐component, inflatable penile prosthesis Elective Surgery‐Male without replacement of Ambulatory Surgery Reproductive 54415 Removal of non‐inflatable (semi‐rigid) or inflatable (self‐contained) penile Elective Surgery‐Male prosthesis, without rep Ambulatory Surgery Reproductive 54512 Elective Surgery‐Male Excision of extraparenchymal lesion of testis Ambulatory Surgery Reproductive 54520 Orchiectomy, simple (including subcapsular), with or without testicular Elective Surgery‐Male prosthesis, scrotal or ingui Ambulatory Surgery Reproductive 54830 Elective Surgery‐Male Excision of local lesion of epididymis Ambulatory Surgery Reproductive 54840 Elective Surgery‐Male Excision of spermatocele, with or without epididymectomy Ambulatory Surgery Reproductive 54860 Elective Surgery‐Male Epididymectomy; unilateral Ambulatory Surgery Reproductive 55040 Elective Surgery‐Male Excision of hydrocele; unilateral Ambulatory Surgery Reproductive 55041 Elective Surgery‐Male Excision of hydrocele; bilateral Ambulatory Surgery Reproductive 55060 Elective Surgery‐Male Repair of tunica vaginalis hydrocele (Bottle type) Ambulatory Surgery Reproductive 55110 Elective Surgery‐Male Scrotal exploration Ambulatory Surgery Reproductive 55120 Elective Surgery‐Male Removal of foreign body in scrotum Ambulatory Surgery Reproductive 55150 Inpatient Surgical IP Surgical Procedures‐Male Resection of scrotum Procedures Reproductive 55250 Vasectomy, unilateral or bilateral (separate procedure), including Elective Surgery‐Male postoperative semen examination(s Ambulatory Surgery Reproductive

Code Description Category Product Filing Category 55500 Elective Surgery‐Male Excision of hydrocele of spermatic cord, unilateral (separate procedure) Ambulatory Surgery Reproductive 55520 Elective Surgery‐Male Excision of lesion of spermatic cord (separate procedure) Ambulatory Surgery Reproductive 55530 Excision of varicocele or ligation of spermatic veins for varicocele; (separate Elective Surgery‐Male procedure) Ambulatory Surgery Reproductive 55874 Transperineal placement of biodegradable material, peri‐prostatic, single or Elective Surgery‐Male multiple injection(s), Ambulatory Surgery Reproductive 56440 Elective Surgery‐Male Marsupialization of Bartholin's gland cyst Ambulatory Surgery Reproductive 56740 Elective Surgery‐Female Excision of Bartholin's gland or cyst Ambulatory Surgery Reproductive 56800 Elective Surgery‐Female Plastic repair of introitus Ambulatory Surgery Reproductive 56810 Elective Surgery‐Female Perineoplasty, repair of perineum, nonobstetrical (separate procedure) Ambulatory Surgery Reproductive 57000 Elective Surgery‐Female Colpotomy; with exploration Ambulatory Surgery Reproductive 57023 Incision and drainage of vaginal hematoma; non‐obstetrical (eg, post‐trauma, Elective Surgery‐Female spontaneous bleeding) Ambulatory Surgery Reproductive 57065 Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, Elective Surgery‐Female cryosurgery, chemosu Ambulatory Surgery Reproductive 57120 Elective Surgery‐Female Colpocleisis (Le Fort type) Ambulatory Surgery Reproductive 57156 Insertion of a vaginal radiation afterloading apparatus for clinical Elective Surgery‐Female brachytherapy Ambulatory Surgery Reproductive 57200 Elective Surgery‐Female Colporrhaphy, suture of injury of vagina (nonobstetrical) Ambulatory Surgery Reproductive 57210 Colpoperineorrhaphy, suture of injury of vagina and/or perineum Elective Surgery‐Female (nonobstetrical) Ambulatory Surgery Reproductive 57240 Anterior colporrhaphy, repair of cystocele with or without repair of Elective Surgery‐Female urethrocele Ambulatory Surgery Reproductive

Code Description Category Product Filing Category 57250 Elective Surgery‐Female Posterior colporrhaphy, repair of rectocele with or without perineorrhaphy Ambulatory Surgery Reproductive 57268 Elective Surgery‐Female Repair of enterocele, vaginal approach (separate procedure) Ambulatory Surgery Reproductive 57461 Colposcopy of the cervix including upper/adjacent vagina; with loop electrode Elective Surgery‐Female conization of the cerv Ambulatory Surgery Reproductive 57520 Conization of cervix, with or without fulguration, with or without dilation and Elective Surgery‐Female curettage, with or w Ambulatory Surgery Reproductive 57522 Conization of cervix, with or without fulguration, with or without dilation and Elective Surgery‐Female curettage, with or w Ambulatory Surgery Reproductive 57530 Elective Surgery‐Female Trachelectomy (cervicectomy), amputation of cervix (separate procedure) Ambulatory Surgery Reproductive 57545 Elective Surgery‐Female Excision of cervical stump, abdominal approach; with pelvic floor repair Ambulatory Surgery Reproductive 57550 Elective Surgery‐Female Excision of cervical stump, vaginal approach; Ambulatory Surgery Reproductive 57700 Elective Surgery‐Female Cerclage of uterine cervix, nonobstetrical Ambulatory Surgery Reproductive 57720 Elective Surgery‐Female Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach Ambulatory Surgery Reproductive 58120 Elective Surgery‐Female Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) Ambulatory Surgery Reproductive 58340 Catheterization and introduction of saline or contrast material for saline Elective Surgery‐Female infusion sonohysterograph Ambulatory Surgery Reproductive 58353 Elective Surgery‐Female Endometrial ablation, thermal, without hysteroscopic guidance Ambulatory Surgery Reproductive 58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or Elective Surgery‐Female polypectomy, with or without D Ambulatory Surgery Reproductive 58559 Elective Surgery‐Female Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method) Ambulatory Surgery Reproductive 58560 Hysteroscopy, surgical; with division or resection of intrauterine septum (any Elective Surgery‐Female method) Ambulatory Surgery Reproductive

Code Description Category Product Filing Category 58561 Elective Surgery‐Female Hysteroscopy, surgical; with removal of leiomyomata Ambulatory Surgery Reproductive 58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, Elective Surgery‐Female unilateral or bilateral Ambulatory Surgery Reproductive 58605 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, Elective Surgery‐Female postpartum, unilateral Ambulatory Surgery Reproductive 58615 Occlusion of fallopian tube(s) by device (eg, band, clip, Falope ring) vaginal or Elective Surgery‐Female suprapubic approac Ambulatory Surgery Reproductive 58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) Ambulatory Surgery Laparoscopies 58671 Laparoscopy, surgical; with occlusion of oviducts by device (eg, band, clip, or Falope ring) Ambulatory Surgery Laparoscopies 58700 Salpingectomy, complete or partial, unilateral or bilateral (separate Elective Surgery‐Female procedure) Ambulatory Surgery Reproductive 58720 Salpingo‐oophorectomy, complete or partial, unilateral or bilateral (separate Elective Surgery‐Female procedure) Ambulatory Surgery Reproductive 58805 Drainage of ovarian cyst(s), unilateral or bilateral (separate procedure); Elective Surgery‐Female abdominal approach Ambulatory Surgery Reproductive 58822 Elective Surgery‐Female Drainage of ovarian abscess; abdominal approach Ambulatory Surgery Reproductive 59012 Elective Surgery‐Maternity Cordocentesis (intrauterine), any method Ambulatory Surgery Care and Diagnostic 59015 Elective Surgery‐Maternity Chorionic villus sampling, any method Ambulatory Surgery Care and Diagnostic 59070 Elective Surgery‐Maternity Transabdominal amnioinfusion, including ultrasound guidance Ambulatory Surgery Care and Diagnostic 59150 Laparoscopic treatment of ectopic pregnancy; without salpingectomy and/or Elective Surgery‐Maternity oophorectomy Ambulatory Surgery Care and Diagnostic 59325 Elective Surgery‐Maternity Cerclage of cervix, during pregnancy; abdominal Ambulatory Surgery Care and Diagnostic 59812 Elective Surgery‐Maternity Treatment of incomplete abortion, any trimester, completed surgically Ambulatory Surgery Care and Diagnostic

Code Description Category Product Filing Category 59820 Elective Surgery‐Maternity Treatment of missed abortion, completed surgically; first trimester Ambulatory Surgery Care and Diagnostic 59821 Elective Surgery‐Maternity Treatment of missed abortion, completed surgically; second trimester Ambulatory Surgery Care and Diagnostic 59870 Elective Surgery‐Maternity Uterine evacuation and curettage for hydatidiform mole Ambulatory Surgery Care and Diagnostic 60210 Partial thyroid lobectomy, unilateral; with or without isthmusectomy Ambulatory Surgery Elective Surgery‐Endocrine 60280 Excision of thyroglossal duct cyst or sinus; Ambulatory Surgery Elective Surgery‐Endocrine 60281 Excision of thyroglossal duct cyst or sinus; recurrent Ambulatory Surgery Elective Surgery‐Endocrine 60512 Parathyroid autotransplantation (List separately in addition to code for primary procedure) Ambulatory Surgery Elective Surgery‐Endocrine 61107 Twist drill hole(s) for subdural, intracerebral, or ventricular puncture; for Elective Surgery‐Nervous implanting ventricular Ambulatory Surgery System 61782 Stereotactic computer‐assisted (navigational) procedure; cranial, extradural Elective Surgery‐Nervous (List separately in add Ambulatory Surgery System 61888 Elective Surgery‐Nervous Revision or removal of cranial neurostimulator pulse generator or receiver Ambulatory Surgery System 62256 Elective Surgery‐Nervous Removal of complete cerebrospinal fluid shunt system; without replacement Ambulatory Surgery System 62264 Percutaneous lysis of epidural adhesions using solution injection (eg, Elective Surgery‐Nervous hypertonic saline, enzyme) or Ambulatory Surgery System 62269 Elective Surgery‐Nervous Biopsy of spinal cord, percutaneous needle Ambulatory Surgery System 62290 Elective Surgery‐Nervous Injection procedure for discography, each level; lumbar Ambulatory Surgery System 62355 Elective Surgery‐Nervous Removal of previously implanted intrathecal or epidural catheter Ambulatory Surgery System 62360 Implantation or replacement of device for intrathecal or epidural drug Elective Surgery‐Nervous infusion; subcutaneous reserv Ambulatory Surgery System 62365 Removal of subcutaneous reservoir or pump, previously implanted for Elective Surgery‐Nervous intrathecal or epidural infusion Ambulatory Surgery System

Code Description Category Product Filing Category 63661 Removal of spinal neurostimulator electrode percutaneous array(s), including Elective Surgery‐Nervous fluoroscopy, when perfo Ambulatory Surgery System 63662 Removal of spinal neurostimulator electrode plate/paddle(s) placed via Elective Surgery‐Nervous laminotomy or laminectomy, in Ambulatory Surgery System 63663 Revision including replacement, when performed, of spinal neurostimulator Elective Surgery‐Nervous electrode percutaneous arr Ambulatory Surgery System 63688 Revision or removal of implanted spinal neurostimulator pulse generator or Elective Surgery‐Nervous receiver Ambulatory Surgery System 63744 Elective Surgery‐Nervous Replacement, irrigation or revision of lumbosubarachnoid shunt Ambulatory Surgery System 64612 Chemodenervation of muscle(s); muscle(s) innervated by facial nerve, Elective Surgery‐Nervous unilateral (eg, for blepharospa Ambulatory Surgery System 64633 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with Elective Surgery‐Nervous imaging guidance (fluorosc Ambulatory Surgery System 64635 Destruction by neurolytic agent, paravertebral facet joint nerve(s), with Elective Surgery‐Nervous imaging guidance (fluorosc Ambulatory Surgery System 64645 Chemodenervation of one extremity; each additional extremity, 5 or more Elective Surgery‐Nervous muscle(s) (List separately i Ambulatory Surgery System 64647 Elective Surgery‐Nervous Chemodenervation of trunk muscle(s); 6 or more muscle(s) Ambulatory Surgery System 64702 Elective Surgery‐Nervous Neuroplasty; digital, 1 or both, same digit Ambulatory Surgery System 64712 Elective Surgery‐Nervous Neuroplasty, major peripheral nerve, arm or leg, open; sciatic nerve Ambulatory Surgery System 64716 Elective Surgery‐Nervous Neuroplasty and/or transposition; cranial nerve (specify) Ambulatory Surgery System 64726 Elective Surgery‐Nervous Decompression; plantar digital nerve Ambulatory Surgery System 64774 Elective Surgery‐Nervous Excision of neuroma; cutaneous nerve, surgically identifiable Ambulatory Surgery System 64776 Elective Surgery‐Nervous Excision of neuroma; digital nerve, 1 or both, same digit Ambulatory Surgery System

Code Description Category Product Filing Category 65275 Repair of laceration; cornea, nonperforating, with or without removal foreign body Ambulatory Surgery Elective Surgery‐Eye/Ocular 65280 Repair of laceration; cornea and/or sclera, perforating, not involving uveal tissue Ambulatory Surgery Elective Surgery‐Eye/Ocular 65285 Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissu Ambulatory Surgery Elective Surgery‐Eye/Ocular 65286 Repair of laceration; application of tissue glue, wounds of cornea and/or sclera Ambulatory Surgery Elective Surgery‐Eye/Ocular 65290 Repair of wound, extraocular muscle, tendon and/or Tenon's capsule Ambulatory Surgery Elective Surgery‐Eye/Ocular 65426 Excision or transposition of pterygium; with graft Ambulatory Surgery Elective Surgery‐Eye/Ocular 65436 Removal of corneal epithelium; with application of chelating agent (eg, EDTA) Ambulatory Surgery Elective Surgery‐Eye/Ocular 65600 Multiple punctures of anterior cornea (eg, for corneal erosion, tattoo) Ambulatory Surgery Elective Surgery‐Eye/Ocular 65779 Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured Ambulatory Surgery Elective Surgery‐Eye/Ocular 65855 Trabeculoplasty by laser surgery, 1 or more sessions (defined treatment series) Ambulatory Surgery Elective Surgery‐Eye/Ocular 65860 Severing adhesions of anterior segment, laser technique (separate procedure) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor p Ambulatory Surgery Elective Surgery‐Eye/Ocular 66680 Repair of iris, ciliary body (as for iridodialysis) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66682 Suture of iris, ciliary body (separate procedure) with retrieval of suture through small incision (e Ambulatory Surgery Elective Surgery‐Eye/Ocular 66710 Ciliary body destruction; cyclophotocoagulation, transscleral Ambulatory Surgery Elective Surgery‐Eye/Ocular 66720 Ciliary body destruction; cryotherapy Ambulatory Surgery Elective Surgery‐Eye/Ocular 66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66762 Iridoplasty by photocoagulation (1 or more sessions) (eg, for improvement of vision, for widening of Ambulatory Surgery Elective Surgery‐Eye/Ocular 66770 Destruction of cyst or lesion iris or ciliary body (nonexcisional procedure) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66820 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloi Ambulatory Surgery Elective Surgery‐Eye/Ocular

Code Description Category Product Filing Category 66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloi Ambulatory Surgery Elective Surgery‐Eye/Ocular 66840 Removal of lens material; aspiration technique, 1 or more stages Ambulatory Surgery Elective Surgery‐Eye/Ocular 66850 Removal of lens material; phacofragmentation technique (mechanical or ultrasonic) (eg, phacoemulsifi Ambulatory Surgery Elective Surgery‐Eye/Ocular 66852 Removal of lens material; pars plana approach, with or without vitrectomy Ambulatory Surgery Elective Surgery‐Eye/Ocular 66940 Removal of lens material; extracapsular (other than 66840, 66850, 66852) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1‐stage procedure), ma Ambulatory Surgery Elective Surgery‐Eye/Ocular 66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) Ambulatory Surgery Elective Surgery‐Eye/Ocular 66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), ma Ambulatory Surgery Elective Surgery‐Eye/Ocular 67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal Ambulatory Surgery Elective Surgery‐Eye/Ocular 67010 Removal of vitreous, anterior approach (open sky technique or limbal incision); subtotal removal wit Ambulatory Surgery Elective Surgery‐Eye/Ocular 67015 Aspiration or release of vitreous, subretinal or choroidal fluid, pars plana approach (posterior scl Ambulatory Surgery Elective Surgery‐Eye/Ocular 67025 Injection of vitreous substitute, pars plana or limbal approach (fluid‐gas exchange), with or withou Ambulatory Surgery Elective Surgery‐Eye/Ocular 67028 Intravitreal injection of a pharmacologic agent (separate procedure) Ambulatory Surgery Elective Surgery‐Eye/Ocular 67031 Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery Ambulatory Surgery Elective Surgery‐Eye/Ocular 67105 Repair of retinal detachment, 1 or more sessions; photocoagulation, with or Inpatient Surgical without drainage of subr Procedures IP Surgical Procedures‐Neuro 67210 Destruction of localized lesion of retina (eg, macular edema, tumors), 1 or Inpatient Surgical more sessions; photocoag Procedures IP Surgical Procedures‐Neuro 67221 Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy Ambulatory Surgery Elective Surgery‐Eye/Ocular 67331 Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocul Ambulatory Surgery Elective Surgery‐Eye/Ocular

Code Description Category Product Filing Category 67345 Chemodenervation of extraocular muscle Ambulatory Surgery Elective Surgery‐Eye/Ocular 67700 Blepharotomy, drainage of abscess, eyelid Ambulatory Surgery Elective Surgery‐Eye/Ocular 67808 Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple Ambulatory Surgery Elective Surgery‐Eye/Ocular 67810 Incisional biopsy of eyelid skin including lid margin Ambulatory Surgery Elective Surgery‐Eye/Ocular 67840 Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure Ambulatory Surgery Elective Surgery‐Eye/Ocular 67850 Destruction of lesion of lid margin (up to 1 cm) Ambulatory Surgery Elective Surgery‐Eye/Ocular 67880 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy; Ambulatory Surgery Elective Surgery‐Eye/Ocular 67921 Repair of entropion; suture Ambulatory Surgery Elective Surgery‐Eye/Ocular 67923 Repair of entropion; excision tarsal wedge Ambulatory Surgery Elective Surgery‐Eye/Ocular 67935 Suture of recent wound, eyelid, involving lid margin, tarsus, and/or palpebral conjunctiva direct cl Ambulatory Surgery Elective Surgery‐Eye/Ocular 67950 Canthoplasty (reconstruction of canthus) Ambulatory Surgery Elective Surgery‐Eye/Ocular 68115 Excision of lesion, conjunctiva; over 1 cm Ambulatory Surgery Elective Surgery‐Eye/Ocular 68130 Excision of lesion, conjunctiva; with adjacent sclera Ambulatory Surgery Elective Surgery‐Eye/Ocular 68135 Destruction of lesion, conjunctiva Ambulatory Surgery Elective Surgery‐Eye/Ocular 68360 Conjunctival flap; bridge or partial (separate procedure) Ambulatory Surgery Elective Surgery‐Eye/Ocular 68420 Incision, drainage of lacrimal sac (dacryocystotomy or dacryocystostomy) Ambulatory Surgery Elective Surgery‐Eye/Ocular 68510 Biopsy of lacrimal gland Ambulatory Surgery Elective Surgery‐Eye/Ocular 68530 Removal of foreign body or dacryolith, lacrimal passages Ambulatory Surgery Elective Surgery‐Eye/Ocular 68540 Excision of lacrimal gland tumor; frontal approach Ambulatory Surgery Elective Surgery‐Eye/Ocular 68761 Closure of the lacrimal punctum; by plug, each Ambulatory Surgery Elective Surgery‐Eye/Ocular 68811 Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia Ambulatory Surgery Elective Surgery‐Eye/Ocular 68815 Probing of nasolacrimal duct, with or without irrigation; with insertion of tube or stent Ambulatory Surgery Elective Surgery‐Eye/Ocular 68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilatio Ambulatory Surgery Elective Surgery‐Eye/Ocular

Code Description Category Product Filing Category 69020 Elective Surgery‐Auditory Drainage external auditory canal, abscess Ambulatory Surgery System 69110 Elective Surgery‐Auditory Excision external ear; partial, simple repair Ambulatory Surgery System 69145 Elective Surgery‐Auditory Excision soft tissue lesion, external auditory canal Ambulatory Surgery System 69420 Elective Surgery‐Auditory Myringotomy including aspiration and/or eustachian tube inflation Ambulatory Surgery System 69421 Myringotomy including aspiration and/or eustachian tube inflation requiring Elective Surgery‐Auditory general anesthesia Ambulatory Surgery System 69436 Elective Surgery‐Auditory Tympanostomy (requiring insertion of ventilating tube), general anesthesia Ambulatory Surgery System 69610 Tympanic membrane repair, with or without site preparation of perforation Elective Surgery‐Auditory for closure, with or witho Ambulatory Surgery System 69620 Elective Surgery‐Auditory Myringoplasty (surgery confined to drumhead and donor area) Ambulatory Surgery System 69801 Elective Surgery‐Auditory Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal Ambulatory Surgery System 69990 Microsurgical techniques, requiring use of operating microscope (List separately in addition to code Ambulatory Surgery 81121 IDH2 (isocitrate dehydrogenase 2 [NADP+], mitochondrial) (eg, glioma), common variants (eg, R140W, R Lab Lab‐Genetics 81170 ABL1 (ABL proto‐oncogene 1, non‐receptor tyrosine kinase) (eg, acquired imatinib tyrosine kinase inh Lab Lab‐Genetics 81201 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene an Lab Lab‐Genetics 81202 APC (adenomatous polyposis coli) (eg, familial adenomatosis polyposis [FAP], attenuated FAP) gene an Lab Lab‐Genetics 81206 BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; major breakpoint, qual Lab Lab‐Chemistry 81207 BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; minor breakpoint, qual Lab Lab‐Chemistry

Code Description Category Product Filing Category 81208 BCR/ABL1 (t(9;22)) (eg, chronic myelogenous leukemia) translocation analysis; other breakpoint, qual Lab Lab‐Chemistry 81212 BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast an Lab Lab‐Chemistry 81215 BRCA1 (BRCA1, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known Lab Lab‐Chemistry 81217 BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) gene analysis; known Lab Lab‐Chemistry 81230 CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common Lab Lab‐Chemistry 81235 EGFR (epidermal growth factor receptor) (eg, non‐small cell lung cancer) gene analysis, common varia Lab Lab‐Genetics 81239 DMPK (DM1 protein kinase) (eg, myotonic dystrophy type 1) gene analysis; characterization of alleles Lab Lab‐Chemistry 81257 HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndro Lab Lab‐Chemistry 81259 HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndro Lab Lab‐Chemistry 81261 IGH@ (Immunoglobulin heavy chain locus) (eg, leukemias and lymphomas, B‐ cell), gene rearrangement an Lab Lab‐Chemistry 81265 Comparative analysis using Short Tandem Repeat (STR) markers; patient and comparative specimen (eg, Lab Lab‐Chemistry 81268 Chimerism (engraftment) analysis, post transplantation specimen (eg, hematopoietic stem cell), inclu Lab Lab‐Chemistry 81269 HBA1/HBA2 (alpha globin 1 and alpha globin 2) (eg, alpha thalassemia, Hb Bart hydrops fetalis syndro Lab Lab‐Chemistry 81272 KIT (v‐kit Hardy‐Zuckerman 4 feline sarcoma viral oncogene homolog) (eg, gastrointestinal stromal tu Lab Lab‐Chemistry 81275 KRAS (v‐Ki‐ras2 Kirsten rat sarcoma viral oncogene) (eg, carcinoma) gene analysis, variants in codon Lab Lab‐Chemistry 81292 MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non‐polyposis colorectal ca Lab Lab‐Chemistry

Code Description Category Product Filing Category 81296 MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (eg, hereditary non‐polyposis colorectal ca Lab Lab‐Chemistry 81301 Microsatellite instability analysis (eg, hereditary non‐polyposis colorectal cancer, Lynch syndrome) Lab Lab‐Chemistry 81311 NRAS (neuroblastoma RAS viral [v‐ras] oncogene homolog) (eg, colorectal carcinoma), gene analysis, v Lab Lab‐Chemistry 81315 PML/RARalpha, (t(15;17)), (promyelocytic leukemia/retinoic acid receptor alpha) (eg, promyelocytic l Lab Lab‐Chemistry 81328 SLCO1B1 (solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), g Lab Lab‐Chemistry 81340 TRB@ (T cell antigen receptor, beta) (eg, leukemia and lymphoma), gene rearrangement analysis to det Lab Lab‐Chemistry 81361 HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); common Lab Lab‐Chemistry 81364 HBB (hemoglobin, subunit beta) (eg, sickle cell anemia, beta thalassemia, hemoglobinopathy); full ge Lab Lab‐Chemistry 81371 HLA Class I and II typing, low resolution (eg, antigen equivalents); HLA‐A, ‐B, and ‐DRB1/3/4/5 (eg, Lab Lab‐Immunology 81372 HLA Class I typing, low resolution (eg, antigen equivalents); complete (ie, HLA‐ A, ‐B, and ‐C) Lab Lab‐Immunology 81373 HLA Class I typing, low resolution (eg, antigen equivalents); 1 locus (eg, HLA‐A, ‐B, or ‐C), each Lab Lab‐Immunology 81375 HLA Class II typing, low resolution (eg, antigen equivalents); HLA‐DRB1/3/4/5 and ‐DQB1 Lab Lab‐Immunology 81376 HLA Class II typing, low resolution (eg, antigen equivalents); 1 locus (eg, HLA‐ DRB1/3/4/5, ‐DQB1, ‐ Lab Lab‐Immunology 81378 HLA Class I and II typing, high resolution (ie, alleles or allele groups), HLA‐A, ‐ B, ‐C, and ‐DRB1 Lab Lab‐Immunology 81382 HLA Class II typing, high resolution (ie, alleles or allele groups); 1 locus (eg, HLA‐DRB1, ‐DRB3, ‐ Lab Lab‐Immunology 81383 HLA Class II typing, high resolution (ie, alleles or allele groups); 1 allele or allele group (eg, H Lab Lab‐Immunology

Code Description Category Product Filing Category 81402 Molecular pathology procedure, Level 3 (eg, >10 SNPs, 2‐10 methylated variants, or 2‐10 somatic vari Lab Lab‐Microbiology 81403 Molecular pathology procedure, Level 4 (eg, analysis of single exon by DNA sequence analysis, analys Lab Lab‐Microbiology 81411 Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome typ Lab Lab‐Microbiology 81450 Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, DNA and RNA analysis Lab Lab‐Microbiology 81455 Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm, DNA and RNA analys Lab Lab‐Microbiology 86147 Cardiolipin (phospholipid) antibody, each Ig class Lab Lab‐Immunology 86352 Cellular function assay involving stimulation (eg, mitogen or antigen) and detection of biomarker (e Lab Lab‐Immunology 86353 Lymphocyte transformation, mitogen (phytomitogen) or antigen induced blastogenesis Lab Lab‐Immunology 86805 Lymphocytotoxicity assay, visual crossmatch; with titration Lab Lab‐Immunology 86807 Serum screening for cytotoxic percent reactive antibody (PRA); standard method Lab Lab‐Immunology 86825 Human leukocyte antigen (HLA) crossmatch, non‐cytotoxic (eg, using flow cytometry); first serum samp Lab Lab‐Immunology 86826 Human leukocyte antigen (HLA) crossmatch, non‐cytotoxic (eg, using flow cytometry); each additional Lab Lab‐Immunology 86832 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, fl Lab Lab‐Immunology 86833 Antibody to human leukocyte antigens (HLA), solid phase assays (eg, microspheres or beads, ELISA, fl Lab Lab‐Immunology 86849 Unlisted immunology procedure Lab Lab‐Immunology 86920 Compatibility test each unit; immediate spin technique Lab Laboratory Services 87482 Infectious agent detection by nucleic acid (DNA or RNA); Candida species, quantification Lab Lab‐Microbiology 87483 CNS DNA AMP PROBE TYPE 12‐25 Lab Lab‐Microbiology

Code Description Category Product Filing Category 87505 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium Lab Lab‐Microbiology 87506 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium Lab Lab‐Microbiology 87507 Infectious agent detection by nucleic acid (DNA or RNA); gastrointestinal pathogen (eg, Clostridium Lab Lab‐Microbiology 87536 Infectious agent detection by nucleic acid (DNA or RNA); HIV‐1, reverse transcription and quantifica Lab Lab‐Microbiology 87632 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenz Lab Lab‐Microbiology 87633 Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenz Lab Lab‐Microbiology 87798 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe te Lab Lab‐Microbiology 87799 Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; quantification, ea Lab Lab‐Microbiology 87900 Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinfor Lab Lab‐Microbiology 87901 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV‐1, reverse transcriptase and pr Lab Lab‐Microbiology 87902 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis C virus Lab Lab‐Microbiology 87906 Infectious agent genotype analysis by nucleic acid (DNA or RNA); HIV‐1, other region (eg, integrase, Lab Lab‐Microbiology 87910 Infectious agent genotype analysis by nucleic acid (DNA or RNA); cytomegalovirus Lab Lab‐Microbiology 87912 Infectious agent genotype analysis by nucleic acid (DNA or RNA); Hepatitis B virus Lab Lab‐Microbiology 88120 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, Lab Lab‐Cytopathology 88121 Cytopathology, in situ hybridization (eg, FISH), urinary tract specimen with morphometric analysis, Lab Lab‐Cytopathology

Code Description Category Product Filing Category 88177 Cytopathology, evaluation of fine needle aspirate; immediate cytohistologic study to determine adequ Lab Lab‐Cytopathology 88185 Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; each additio Lab Lab‐Cytopathology 88230 Tissue culture for non‐neoplastic disorders; lymphocyte Lab Lab‐Genetic 88235 Tissue culture for non‐neoplastic disorders; amniotic fluid or chorionic villus cells Lab Lab‐Genetic 88237 Tissue culture for neoplastic disorders; bone marrow, blood cells Lab Lab‐Genetic 88249 Chromosome analysis for breakage syndromes; score 100 cells, clastogen stress (eg, diepoxybutane, mi Lab Lab‐Genetic 88262 Chromosome analysis; count 15‐20 cells, 2 karyotypes, with banding Lab Lab‐Genetic 88263 Chromosome analysis; count 45 cells for mosaicism, 2 karyotypes, with banding Lab Lab‐Genetic 88264 Chromosome analysis; analyze 20‐25 cells Lab Lab‐Genetic 88269 Chromosome analysis, in situ for amniotic fluid cells, count cells from 6‐12 colonies, 1 karyotype, Lab Lab‐Genetic 88275 Molecular cytogenetics; interphase in situ hybridization, analyze 100‐300 cells Lab Lab‐Genetic 88319 Special stain including interpretation and report; Group III, for enzyme constituents Lab Lab‐Pathology 88332 Pathology consultation during surgery; each additional tissue block with frozen section(s) (List sep Lab Lab‐Pathology 88334 Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each add Lab Lab‐Pathology 88341 Immunohistochemistry or immunocytochemistry, per specimen; each additional single antibody stain pro Lab Laboratory Services 88344 Immunohistochemistry or immunocytochemistry, per specimen; each multiplex antibody stain procedure Lab Lab‐Pathology 88346 Immunofluorescent study, each antibody; direct method Lab Lab‐Pathology 88350 Immunofluorescence, per specimen; each additional single antibody stain procedure (List separately i Lab Lab‐Pathology 88360 Morphometric analysis, tumor immunohistochemistry (eg, Her‐2/neu, estrogen receptor/progesterone rec Lab Lab‐Pathology

Code Description Category Product Filing Category 88361 Morphometric analysis, tumor immunohistochemistry (eg, Her‐2/neu, estrogen receptor/progesterone rec Lab Lab‐Pathology 88362 Nerve teasing preparations Lab Lab‐Pathology 88365 In situ hybridization (eg, FISH), each probe Lab Lab‐Pathology 88367 Morphometric analysis, in situ hybridization (quantitative or semi‐ quantitative), using computer‐ass Lab Lab‐Pathology 88377 Morphometric analysis, in situ hybridization (quantitative or semi‐ quantitative), manual, per specim Lab Lab‐Immunology 93505 Evaluation and Managment‐ Endomyocardial biopsy Evaluation & Management Cardiac 95004 Percutaneous tests (scratch, puncture, prick) with allergenic extracts, Evaluation and Management‐ immediate type reaction, inc Evaluation & Management Allergy 95017 Allergy testing, any combination of percutaneous (scratch, puncture, prick) Evaluation and Management‐ and intracutaneous (intr Evaluation & Management Allergy 95018 Allergy testing, any combination of percutaneous (scratch, puncture, prick) Evaluation and Management‐ and intracutaneous (intr Evaluation & Management Allergy 95024 Intracutaneous (intradermal) tests with allergenic extracts, immediate type Evaluation and Management‐ reaction, including test Evaluation & Management Allergy 95027 Intracutaneous (intradermal) tests, sequential and incremental, with Evaluation and Management‐ allergenic extracts for airborn Evaluation & Management Allergy 95028 Intracutaneous (intradermal) tests with allergenic extracts, delayed type Evaluation and Management‐ reaction, including readin Evaluation & Management Allergy 95044 Evaluation and Management‐ Patch or application test(s) (specify number of tests) Evaluation & Management Allergy 95079 Ingestion challenge test (sequential and incremental ingestion of test items, Evaluation and Management‐ eg, food, drug or othe Evaluation & Management Allergy 95180 Rapid desensitization procedure, each hour (eg, insulin, penicillin, equine Evaluation and Management‐ serum) Evaluation & Management Allergy 96413 Chemotherapy administration, intravenous infusion technique; up to 1 hour, Evaluation/Management‐ single or initial substan Evaluation & Management Chemotherpay 96415 Chemotherapy administration, intravenous infusion technique; each Evaluation/Management‐ additional hour (List separately i Evaluation & Management Chemotherpay

Code Description Category Product Filing Category 96416 Chemotherapy administration, intravenous infusion technique; initiation of Evaluation/Management‐ prolonged chemotherapy in Evaluation & Management Chemotherpay 96417 Chemotherapy administration, intravenous infusion technique; each Evaluation/Management‐ additional sequential infusion (di Evaluation & Management Chemotherpay 99157 Evaluation/Management‐ MOD SED OTHER PHYS/QHP EA Evaluation & Management Other Services 99174 Instrument‐based ocular screening (eg, photoscreening, automated‐ Evaluation/Management‐ refraction), bilateral Evaluation & Management Other Services 0016U Oncology (hematolymphoid neoplasia), RNA, BCR/ABL1 major and minor breakpoint fusion transcripts, qu Lab Lab‐Chemistry 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal appro Ambulatory Surgery 0295T External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm re Professional Services Professional Services 2015F Asthma impairment assessed (Asthma) Professional Services Professional Services