NEW YORK STATE MEDICAID PROGRAM ORDERED AMBULATORY PROCEDURE CODES Ordered Ambulatory Procedure Codes Table of Contents GENERAL INFORMATION ............................................................................................................. 6 LABORATORY SERVICES INFORMATION .................................................................................... 6 RADIOLOGY INFORMATION ......................................................................................................... 6 MMIS MODIFIERS ........................................................................................................................ 10 RADIOLOGY SERVICES .............................................................................................................. 11 DIAGNOSTIC RADIOLOGY (DIAGNOSTIC IMAGING)............................................................... 11 HEAD AND NECK.................................................................................................................. 11 CHEST .................................................................................................................................. 12 SPINE AND PELVIS .............................................................................................................. 13 UPPER EXTREMITIES .......................................................................................................... 14 LOWER EXTREMITIES ......................................................................................................... 15 ABDOMEN ............................................................................................................................ 16 GASTROINTESTINAL TRACT ............................................................................................... 17 URINARY TRACT .................................................................................................................. 18 GYNECOLOGICAL AND OBSTETRICAL ............................................................................... 18 HEART .................................................................................................................................. 18 VASCULAR PROCEDURES .................................................................................................. 19 MISCELLANEOUS PROCEDURES ........................................................................................ 20 DIAGNOSTIC ULTRASOUND ................................................................................................... 21 HEAD AND NECK.................................................................................................................. 21 CHEST .................................................................................................................................. 21 ABDOMEN AND RETROPERITONEUM ................................................................................. 21 SPINAL CANAL ..................................................................................................................... 21 PELVIS .................................................................................................................................. 22 GENITALIA ............................................................................................................................ 24 EXTREMITIES ....................................................................................................................... 24 VASCULAR STUDIES............................................................................................................ 24 ULTRASONIC GUIDANCE PROCEDURES ............................................................................ 24 MISCELLANEOUS ULTRASONIC PROCEDURE ................................................................... 24 RADIOLOGIC GUIDANCE ......................................................................................................... 26 FLUOROSCOPIC GUIDANCE ............................................................................................... 26 Version 2021-2 Page 2 of 73 Ordered Ambulatory Procedure Codes COMPUTED TOMOGRAPHY GUIDANCE .............................................................................. 26 MAGNETIC RESONANCE GUIDANCE .................................................................................. 26 BREAST, MAMMOGRAPHY ...................................................................................................... 26 BONE/JOINT STUDIES ............................................................................................................. 27 RADIATION ONCOLOGY .......................................................................................................... 28 CLINICAL TREATMENT PLANNING (EXTERNAL AND INTERNAL SOURCES) ..................... 28 MEDICAL RADIATION PHYSICS, DOSIMETRY, TREATMENT DEVICES AND SPECIAL SERVICES ............................................................................................................................ 28 MISCELLANEOUS PROCEDURES ........................................................................................ 29 RADIATION TREATMENT DELIVERY.................................................................................... 30 RADIATION TREATMENT MANAGEMENT ............................................................................ 30 PROTON BEAM TREATMENT DELIVERY ............................................................................. 31 HYPERTHERMIA................................................................................................................... 31 CLINICAL INTRACAVITARY HYPERTHERMIA ...................................................................... 31 CLINICAL BRACHYTHERAPY ............................................................................................... 31 NUCLEAR MEDICINE ............................................................................................................... 32 THERAPEUTIC...................................................................................................................... 37 POSITRON EMISSION TOMOGRAPHY (PET) .......................................................................... 40 MEDICINE SERVICES.................................................................................................................. 41 IMMUNIZATIONS ...................................................................................................................... 41 MISCELLANEOUS DRUGS AND SOLUTIONS .......................................................................... 45 HYDRATION, THERAPEUTIC, PROPHYLACTIC, DIAGNOSTIC INJECTIONS and INFUSIONS, and CHEMOTHERAPY and OTHER HIGHLY COMPLEX DRUG or HIGHLY COMPLEX BIOLOGIC AGENT ADMINISTRATION ....................................................................................................... 51 HYDRATION.......................................................................................................................... 51 THERAPEUTIC, PROPHYLACTIC AND DIAGNOSTIC INJECTIONS AND INFUSIONS (EXCLUDES CHEMOTHERAPY AND OTHER HIGHLY COMPLEX DRUG OR HIGHLY COMPLEX BIOLOGIC AGENT ADMINISTRATION) ................................................................ 51 CHEMOTHERAPY AND OTHER HIGHLY COMPLEX DRUG OR HIGHLY COMPLEX BIOLOGIC AGENT ADMINISTRATION .................................................................................. 52 CHEMOTHERAPY DRUGS ....................................................................................................... 53 GASTROENTEROLOGY ........................................................................................................... 56 OPHTHALMOLOGY .................................................................................................................. 57 GENERAL OPHTHALMOLOGICAL SERVICES ...................................................................... 57 SPECIAL OPHTHALMOLOGICAL SERVICES ........................................................................ 57 Version 2021-2 Page 3 of 73 Ordered Ambulatory Procedure Codes OPHTHALMOSCOPY ............................................................................................................ 58 MISCELLANEOUS SPECIALIZED SERVICES ....................................................................... 58 OTORHINOLARYNGOLOGIC & VESTIBULAR SERVICES ........................................................ 59 AUDIOLOGIC FUNCTION TESTS WITH MEDICAL DIAGNOSTIC EVALUATION.................... 59 CARDIOVASCULAR ................................................................................................................. 60 CARDIOGRAPHY .................................................................................................................. 60 CARDIOVASCULAR DEVICE MONITORING-IMPLANTABLE AND WEARABLE DEVICES ..... 61 ECHOCARDIOGRAPHY ........................................................................................................ 62 MISCELLANEOUS VASCULAR STUDIES .............................................................................. 63 NON INVASIVE VASCULAR DIAGNOSTIC STUDIES ................................................................ 63 CEREBROVASCULAR ARTERIAL STUDIES ......................................................................... 64 EXTREMITY ARTERIAL STUDIES (INCLUDING DIGITS) ....................................................... 64 EXTREMITY VENOUS STUDIES (INCLUDING DIGITS) ......................................................... 65 VISCERAL AND PENILE VASCULAR STUDIES ....................................................................