Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total 00170 Anesthesia for intraoral procedures, including biopsy; not otherwise specified 7 7 Approved 7 7 00813 Anesthesia for combined upper and lower gastrointestinal endoscopic procedures, endoscope introduced both proximal to and distal to the duodenum 1 1 Approved 1 1 01112 Anesthesia for bone marrow aspiration and/or biopsy, anterior or posterior iliac crest 2 2 Approved 2 2 01250 Anesthesia for all procedures on nerves, muscles, tendons, fascia, and bursae of upper leg 1 1 Approved 1 1 0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; initial insertion 4 4 Approved 4 4 0296T EXT ECG RECORDING 1 1 Approved 1 1 0297T EXT ECG SCAN W/REPORT 4 4 Approved 4 4 0359T Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardized and non-standardized tests, detailed behavioral history, patient observat 2 2 Approved 2 2 0360T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient 2 2 Approved 2 2 0361T Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the pa 2 2 Approved 2 2 0364T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; first 30 minutes of technician time 2 2 Approved 2 2 H1189_PC632 Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total 0365T Adaptive behavior treatment by protocol, administered by technician, face-to-face with one patient; each additional 30 minutes of technician time (List separately in addition to code for primary procedure) 2 2 Approved 2 2 0368T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; first 30 minutes of patient face-to-face time 2 2 Approved 2 2 0369T Adaptive behavior treatment with protocol modification administered by physician or other qualified health care professional with one patient; each additional 30 minutes of patient face-to- face time (List separately in addition to code for primary procedu 2 2 Approved 2 2 0370T Family adaptive behavior treatment guidance, administered by physician or other qualified health care professional (without the patient present) 2 2 Approved 2 2 0376T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, into the trabecular meshwork; each additional device insertion (List separately in addition to code for primary procedure) 4 4 Approved 4 4 0402T Collagen cross-linking of cornea (including removal of the corneal epithelium and intraoperative pachymetry when performed) 1 1 Approved 1 1 10005 Fine needle aspiration biopsy, including ultrasound guidance; first lesion 1 1 Approved 1 1 11005 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure 1 1 Approved 1 1 11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 2 2 Approved 2 2 11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less 15 15 Approved 15 15 Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total 11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less 2 2 Approved 2 2 11045 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 1 Approved 1 1 11046 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 1 Approved 1 1 11102 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion 1 1 Approved 1 1 11103 Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure) 1 1 Approved 1 1 11106 Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion 1 1 Approved 1 1 11406 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm 1 1 Approved 1 1 11420 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less 1 1 Approved 1 1 11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less 1 1 Approved 1 1 11442 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm 2 2 Approved 2 2 Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total 11622 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm 1 1 Approved 1 1 11623 Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm 1 1 Approved 1 1 11642 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cm 4 4 Approved 4 4 11643 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cm 2 2 Approved 2 2 11750 Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal; 1 1 Approved 1 1 11760 Repair of nail bed 1 1 Approved 1 1 11770 Excision of pilonidal cyst or sinus; simple 1 1 Approved 1 1 11900 Injection, intralesional; up to and including 7 lesions 2 2 Approved 2 2 11970 Replacement of tissue expander with permanent prosthesis 1 1 Approved 1 1 11981 Insertion, non-biodegradable drug delivery implant 1 1 Approved 1 1 12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less 1 1 Approved 1 1 13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 2 2 Approved 2 2 13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm 2 2 Approved 2 2 13160 Secondary closure of surgical wound or dehiscence, extensive or complicated 1 1 Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total Approved 1 1 14020 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or less 1 1 Approved 1 1 14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less 1 1 Approved 1 1 14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm 1 1 Approved 1 1 14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 1 1 Approved 1 1 14061 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cm 1 1 Approved 1 1 14301 Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm 1 1 Approved 1 1 14302 Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure) 1 1 Approved 1 1 15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children 2 2 Approved 2 2 15003 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each 1 1 Approved 1 1 15004 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or 1 1 Approved 1 1 Approval and Denials with Overturns Service Category with Description Approved Denied Partially Approved Grand Total 15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 4 4 Approved 4 4 15101 Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately