Blue Cross Blue Shield Arizona MSK Code List Medicare Commericial Medicare Procedure Commercial Advantage Description Claims Advantage Program eff date term Code Precert? Claims Studio? Precert? Studio? MSK - Joint 23000 Removal Of Subdeltoid Calcareous Deposits, Open N N Y N Sugery MSK - Joint 23020 Capsular Contracture Release (Eg, Sever Type Procedure) N N Y N Sugery MSK - Joint 23120 Claviculectomy; Partial N N Y N Sugery Acromioplasty Or Acromionectomy, Partial, With Or Without MSK - Joint 23130 N N Y N Coracoacromial Ligament Release Sugery Repair Of Ruptured Musculotendinous Cuff (Eg, Rotator Cuff) Open; MSK - Joint 23410 N N Y N Acute Sugery Repair Of Ruptured Musculotendinous Cuff (Eg, Rotator Cuff) MSK - Joint 23412 N N Y N Open;Chronic Sugery MSK - Joint 23415 Coracoacromial Ligament Release, With Or Without Acromioplasty N N Y N Sugery Reconstruction Of Complete Shoulder (Rotator) Cuff Avulsion, Chronic MSK - Joint 23420 N N Y N (Includes Acromioplasty) Sugery MSK - Joint 23430 Tenodesis Of Long Tendon Of Biceps N N Y N Sugery MSK - Joint 23440 Resection Or Transplantation Of Long Tendon Of Biceps N N Y N Sugery Capsulorrhaphy, Anterior; Putti-Platt Procedure Or Magnuson Type MSK - Joint 23450 N N Y N Operation Sugery MSK - Joint 23455 Capsulorrhaphy, Anterior;With Labral Repair (Eg, Bankart Procedure) N N Y N Sugery MSK - Joint 23460 Capsulorrhaphy, Anterior, Any Type; With Bone Block N N Y N Sugery MSK - Joint 23462 Capsulorrhaphy, Anterior, Any Type;With Coracoid Process Transfer N N Y N Sugery Effective: 6/1/2020 Medicare Commericial Medicare Procedure Commercial Advantage Description Claims Advantage Program eff date term Code Precert? Claims Studio? Precert? Studio? Capsulorrhaphy, Glenohumeral Joint, Posterior, With Or Without Bone MSK - Joint 23465 N N Y N Block Sugery Capsulorrhaphy, Glenohumeral Joint, Any Type Multi-Directional MSK - Joint 23466 N N Y N Instability Sugery MSK - Joint 23470 Arthroplasty, Glenohumeral Joint; Hemiarthroplasty N N Y N Sugery Arthroplasty, Glenohumeral Joint; Total Shoulder [Glenoid And MSK - Joint 23472 N N Y N Proximal Humeral Replacement (E.G., Total Shoulder)] Sugery Revision Of Total Shoulder Arthroplasty, Including Allograft When MSK - Joint 23473 N N Y N Performed; Humeral Or Glenoid Component Sugery Revision Of Total Shoulder Arthroplasty, Including Allograft When MSK - Joint 23474 N N Y N Performed; Humeral And Glenoid Component Sugery Hemiarthroplasty, Hip, Partial (E.G., Femoral Stem Prosthesis, Bipolar MSK - Joint 27125 N N Y N Arthroplasty) Sugery Arthroplasty, Acetabular And Proximal Femoral Prosthetic MSK - Joint 27130 Replacement (Total Hip Arthroplasty), With Or Without Autograft Or N N Y N Sugery Allograft Conversion Of Previous Hip Surgery To Total Hip Arthroplasty, With MSK - Joint 27132 N N Y N Or Without Autograft Or Allograft Sugery Revision Of Total Hip Arthroplasty; Both Components, With Or MSK - Joint 27134 N N Y N Without Autograft Or Allograft Sugery Revision Of Total Hip Arthroplasty; Acetabular Component Only, With MSK - Joint 27137 N N Y N Or Without Autograft Or Allograft Sugery Revision Of Total Hip Arthroplasty; Femoral Component Only, With Or MSK - Joint 27138 N N Y N Without Autograft Or Allograft Sugery Arthrotomy, With Excision Of Semilunar Cartilage (Meniscectomy) MSK - Joint 27332 N N Y N Knee; Medial OR Lateral Sugery Arthrotomy, With Excision Of Semilunar Cartilage (Meniscectomy) MSK - Joint 27333 N N Y N Knee; Medial AND Lateral Sugery MSK - Joint 27334 Arthrotomy, With Synovectomy, Knee; Anterior OR Posterior N N Y N Sugery Arthrotomy, With Synovectomy, Knee;Anterior AND Posterior MSK - Joint 27335 N N Y N Including Popliteal Area Sugery MSK - Joint 27403 Arthrotomy With Meniscus Repair, Knee N N Y N Sugery MSK - Joint 27412 Autologous Chondrocyte Implantation, Knee N N Y N Sugery MSK - Joint 27415 Osteochondral Allograft, Knee, Open N N Y N Sugery Effective: 6/1/2020 Medicare Commericial Medicare Procedure Commercial Advantage Description Claims Advantage Program eff date term Code Precert? Claims Studio? Precert? Studio? Osteochondral Autograft(S), Knee, Open (Eg, Mosaicplasty) (Includes MSK - Joint 27416 N N Y N Harvesting Of Autograft[S]) Sugery MSK - Joint 27418 Anterior Tibial Tubercleplasty (Eg, Maquet Type Procedure) N N Y N Sugery MSK - Joint 27420 Reconstruction Of Dislocating Patella; (Eg, Hauser Type Procedure) N N Y N Sugery Reconstruction Of Dislocating Patella;With Extensor Realignment MSK - Joint 27422 And/Or Muscle Advancement Or Release (Eg, Campbell, Goldwaite N N Y N Sugery Type Procedure) MSK - Joint 27424 Reconstruction Of Dislocating Patella;With Patellectomy N N Y N Sugery MSK - Joint 27425 Lateral Retinacular Release, Open N N Y N Sugery MSK - Joint 27427 Ligamentous Reconstruction (Augmentation), Knee; Extra-Articular N N Y N Sugery Ligamentous Reconstruction (Augmentation), Knee;Intra-Articular MSK - Joint 27428 N N Y N (Open) Sugery Ligamentous Reconstruction (Augmentation), Knee;Intra-Articular MSK - Joint 27429 N N Y N (Open) And Extra-Articular Sugery MSK - Joint 27430 Quadricepsplasty (Eg, Bennett Or Thompson Type) N N Y N Sugery MSK - Joint 27438 Arthroplasty, Patella; With Prosthesis N N Y N Sugery MSK - Joint 27440 Arthroplasty, Knee, Tibial Plateau N N Y N Sugery Arthroplasty, Knee, Tibial Plateau; With Debridement And Partial MSK - Joint 27441 N N Y N Synovectomy Sugery Arthroplasty, Femoral Condyles Or Tibial Plateau(S), Knee; With MSK - Joint 27442 N N Y N Debridement And Partial Synovectomy Sugery Arthroplasty, Femoral Condyles Or Tibial Plateau(S), Knee; With MSK - Joint 27443 N N Y N Debridement And Partial Synovectomy Sugery Arthroplasty, Knee, Condyle And Plateau; Medial Or Lateral MSK - Joint 27446 N N Y N Compartment Sugery Arthroplasty, Knee, Condyle And Plateau; Medial And Lateral MSK - Joint 27447 Compartments With Or Without Patella Resurfacing (Total Knee N N Y N Sugery Arthroplasty) Revision Of Total Knee Arthroplasty, With Or Without Allograft; 1 MSK - Joint 27486 N N Y N Component Sugery Effective: 6/1/2020 Medicare Commericial Medicare Procedure Commercial Advantage Description Claims Advantage Program eff date term Code Precert? Claims Studio? Precert? Studio? Revision Of Total Knee Arthroplasty, With Or Without Allograft; MSK - Joint 27487 N N Y N Femoral And Entire Tibial Component Sugery Arthroscopy, Shoulder, Diagnostic, With Or Without Synovial Biopsy MSK - Joint 29805 N N Y N (Separate Procedure) Sugery MSK - Joint 29806 Arthroscopy, Shoulder, Surgical; Capsulorrhaphy N N Y N Sugery MSK - Joint 29807 Arthroscopy, Shoulder, Slap Repair N N Y N Sugery Arthroscopy, Shoulder, Surgical; With Removal Of Loose Body Or MSK - Joint 29819 N N Y N Foreign Body Sugery MSK - Joint 29820 Arthroscopy, Shoulder, Surgical; Synovectomy, Partial N N Y N Sugery MSK - Joint 29821 Arthroscopy, Shoulder, Surgical; Synovectomy, Complete N N Y N Sugery MSK - Joint 29822 Arthroscopy, Shoulder, Surgical; Debridement, Limited N N Y N Sugery MSK - Joint 29823 Arthroscopy, Shoulder, Surgical; Debridement, Extensive N N Y N Sugery Arthroscopy, Shoulder, Surgical; Distal Claviculectomy Including Distal MSK - Joint 29824 N N Y N Articular Surface (Mumford Procedure) Sugery Arthroscopy, Shoulder, Surgical; With Lysis And Resection Of MSK - Joint 29825 N N Y N Adhesions, With Our Without Manipulation Sugery Arthroscopy, Shoulder, Surgical; Decompression Of Subacromial Space With Partial Acromioplasty, With Coracoacromial Ligament (Ie, MSK - Joint 29826 N N Y N Arch) Release, When Performed (List Separately In Addition To Code Sugery For Primary Procedure) MSK - Joint 29827 Arthroscopy, Shoulder, Surgical; With Rotator Cuff Repair N N Y N Sugery MSK - Joint 29828 Arthroscopy, Shoulder, Biceps Tenodesis N N Y N Sugery Arthroscopy, Hip, Diagnostic, With Or Without Synovial Biopsy MSK - Joint 29860 N N Y N (Separate Procedure) Sugery Arthroscopy, Hip, Surgical; With Removal Of Loose Body Or Foreign MSK - Joint 29861 N N Y N Body Sugery Arthroscopy, Hip, Surgical; With Debridement/Shaving Of Articular MSK - Joint 29862 Cartilage (Chondroplasty), Abrasion Arthroplasty, And/Or Resection N N Y N Sugery Of Labrum Effective: 6/1/2020 Medicare Commericial Medicare Procedure Commercial Advantage Description Claims Advantage Program eff date term Code Precert? Claims Studio? Precert? Studio? MSK - Joint 29863 Arthroscopy, Hip, Surgical; With Synovectomy N N Y N Sugery Arthroscopy, Knee, Surgical; Osteochondral Autograft(S) (Eg, MSK - Joint 29866 N N Y N Mosaicplasty) (Includes Harvesting Of The Autograft[S]) Sugery Arthroscopy, Knee, Surgical; Osteochondral Allograft (Eg, MSK - Joint 29867 N N Y N Mosaicplasty) Sugery Arthroscopy, Knee, Surgical; Meniscal Transplantation (Includes MSK - Joint 29868 N N Y N Arthrotomy For Meniscal Insertion, Medial Or Lateral) Sugery Arthroscopy, Knee, Diagnostic, With Or Without Synoval Biopsy MSK - Joint 29870 N N Y N (Separate Procedure) Sugery MSK - Joint 29871 Arthroscopy, Knee, Surgical; For Infection, Lavage And Drainage N N Y N Sugery MSK - Joint 29873 Arthroscopy, Knee, Surgical; With Lateral Release N N Y N Sugery Arthroscopy, Knee, Surgical; For Removal Of Loose Body Or Foreign MSK - Joint 29874 Body ( Eg Osteochondritis Dissecans Fragmentation, Chondral N N Y N Sugery Fragmentation) Arthroscopy, Knee, Surgical; Synovectomy, Limited (Eg Plica Or Shelf MSK - Joint 29875 N N Y N Resection) (Separate Procedure) Sugery Arthroscopy, Knee, Surgical; Synovectomy, Major, 2 Or More MSK - Joint 29876 N N Y N Compartments (Eg, Medial Or Lateral) Sugery Arthroscopy, Knee, Surgical;