Surgeries can be performed safely in various settings. This policy addresses individual and procedural factors influencing the need for potential urgent hospital-level care during outpatient procedures, thereby determining the appropriate site of service. Possible locations include off-campus and on-campus hospital outpatient departments, inpatient hospitals, ambulatory surgical centers (ASCs), and physician offices, each with varying costs. To ensure safe, timely and cost-effective care for specific surgical procedures, medical necessity will be reviewed, prioritizing the least expensive appropriate setting (physician's office, ASC, then outpatient hospital) unless clinical or geographic contraindications exist.
NEW YORK
New York Insurance Law Section 4909 and New York Public Health Law Section 4909, effective January 1, 2024, regulate how “health care plans” (as defined in the laws) use "site of service clinical review" to determine coverage for outpatient procedures.
“Site of service clinical review” is considered “utilization review” subject to Articles 49 of the NY Insurance and Public Health Laws and is defined as “clinical criteria applied by a health care plan for the purpose of determining whether non-urgent outpatient medical procedures and surgeries will be covered for a given insured or enrollee when rendered by a network participating provider at a hospital-based outpatient clinic rather than a free-standing ambulatory surgical center” (as such underlined terms are defined in the laws).
The laws mandate specific site of service clinical review obligations, including that health care plans must:
The laws also specify situations where services at a hospital-based outpatient clinic must be approved, such as when the patient's health condition necessitates it, when there is no capacity at a free-standing ambulatory surgical center in the applicable geographic area, or when using such a center would cause undue delay. Additionally, the laws require consideration of a patient's or provider's preference for a hospital-based outpatient clinic in certain circumstances.
The procedures identified within this policy will be considered medically necessary when performed in the lowest appropriate setting unless the following clinical or geographic contraindications are met:
Code Descriptions
Category III Codes
|
0275T |
PERCUTANEOUS LAMINOTOMY/LAMINECTOMY (INTERLAMINAR APPROACH) FOR DECOMPRESSION OF NEURAL ELEMENTS (WITH OR WITHOUT LIGAMENTOUS RESECTION DISCECTOMY FACETECTOMY AND/OR FORAMINOTOMY) ANY METHOD UNDER INDIRECT IMAGE GUIDANCE (EG FLUOROSCOPIC CT) SINGLE OR MULTIPLE LEVELS UNILATERAL OR BILATERAL LUMBAR |
Surgical Procedures Integumentary System
|
15780 |
DERMABRASION TOTAL FACE (EG FOR ACNE SCARRING FINE WRINKLING RHYTIDS GENERAL KERATOSIS) |
|
15782 |
DERMABRASION REGIONAL OTHER THAN FACE |
|
15783 |
DERMABRASION SUPERFICIAL ANY SITE (EG TATTOO REMOVAL) |
|
15786 |
ABRASION SINGLE LESION (EG KERATOSIS SCAR) |
|
15788 |
CHEMICAL PEEL FACIAL EPIDERMAL |
|
15789 |
CHEMICAL PEEL FACIAL DERMAL |
|
15792 |
CHEMICAL PEEL NON-FACIAL EPIDERMAL |
|
15793 |
CHEMICAL PEEL NON-FACIAL DERMAL |
|
15820 |
BLEPHAROPLASTY LOWER EYELID |
|
15821 |
BLEPHAROPLASTY LOWER EYELID WITH EXTENSIVE HERNIATED FAT PAD |
|
15822 |
BLEPHAROPLASTY UPPER EYELID |
|
15823 |
BLEPHAROPLASTY UPPER EYELID WITH EXTENSIVE SKIN WEIGHTING DOWN LID |
|
15830 |
EXCISION EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY) ABDOMEN INFRAUMBILICAL PANNICULECTOMY |
|
15839 |
EXCISION EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY) OTHER AREAS |
|
15847 |
EXCISION EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY) ABDOMEN (EG ABDOMINOPLASTY) (INCLUDES UMBILICAL TRANSPOSITION AND FASCIAL PLICATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
15877 |
SUCTION ASSISTED LIPECTOMY TRUNK |
|
15878 |
SUCTION ASSISTED LIPECTOMY UPPER EXTREMITY |
|
15879 |
SUCTION ASSISTED LIPECTOMY LOWER EXTREMITY |
|
17106 |
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG LASER TECHNIQUE) LESS THAN 10 SQ CM |
|
17107 |
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG LASER TECHNIQUE) 10.0- 50 SQ CM |
|
17108 |
DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG LASER TECHNIQUE) OVER 50 SQ CM |
|
17999 |
UNLISTED PROCEDURE SKIN MUCOUS MEMBRANE AND SUBCUTANEOUS TISSUE |
|
19318 |
BREAST REDUCTION |
Surgical Procedures on the Musculoskeletal System
|
20912 |
CARTILAGE GRAFT NASAL SEPTUM |
|
21089 |
UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE |
|
21110 |
APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONS OTHER THAN FRACTURE OR DISLOCATION INCLUDES REMOVAL |
|
22513 |
PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE THORACIC |
|
22514 |
PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE LUMBAR |
|
22515 |
PERCUTANEOUS VERTEBRAL AUGMENTATION INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE (EG KYPHOPLASTY) 1 VERTEBRAL BODY UNILATERAL OR BILATERAL CANNULATION INCLUSIVE OF ALL IMAGING GUIDANCE EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22551 |
ARTHRODESIS ANTERIOR INTERBODY INCLUDING DISC SPACE PREPARATION DISCECTOMY OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS CERVICAL BELOW C2 |
|
22552 |
ARTHRODESIS ANTERIOR INTERBODY INCLUDING DISC SPACE PREPARATION DISCECTOMY OSTEOPHYTECTOMY AND DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOTS CERVICAL BELOW C2 EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR SEPARATE PROCEDURE) |
|
22558 |
ARTHRODESIS ANTERIOR INTERBODY TECHNIQUE INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION) LUMBAR |
|
22585 |
ARTHRODESIS ANTERIOR INTERBODY TECHNIQUE INCLUDING MINIMAL DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION) EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22600 |
ARTHRODESIS POSTERIOR OR POSTEROLATERAL TECHNIQUE SINGLE INTERSPACE CERVICAL BELOW C2 SEGMENT |
|
22612 |
ARTHRODESIS POSTERIOR OR POSTEROLATERAL TECHNIQUE SINGLE INTERSPACE LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE WHEN PERFORMED) |
|
22614 |
ARTHRODESIS POSTERIOR OR POSTEROLATERAL TECHNIQUE SINGLE INTERSPACE EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22630 |
ARTHRODESIS POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY ANDOR DISCECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION) SINGLE INTERSPACE LUMBAR |
|
22633 |
ARTHRODESIS COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION) SINGLE INTERSPACE LUMBAR |
|
22634 |
ARTHRODESIS COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION) SINGLE INTERSPACE EACH ADDITIONAL INTERSPACE AND SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22840 |
POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG ARRINGTON ROD TECHNIQUE PEDICLE FIXATION ACROSS 1 INTERSPACE ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION SUBLAMINAR WIRING AT C1 FACET SCREW FIXATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22842 |
POSTERIOR SEGMENTAL INSTRUMENTATION (EG PEDICLE FIXATION DUAL RODS WITH MULTIPLE HOOKS AND SUBLAMINAR WIRES) 3 TO 6 VERTEBRAL SEGMENTS (L IST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22845 |
ANTERIOR INSTRUMENTATION 2 TO 3 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22846 |
ANTERIOR INSTRUMENTATION 4 TO 7 VERTEBRAL SEGMENTS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22853 |
INSERTION OF INTERBODY BIOMECHANICAL DEVICE(S) (EG SYNTHETIC CAGE MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG SCREWS FLANGES) WHEN PERFORMED TO INTERVERTEBRAL DISC SPACE IN CONJUNCTION WITH INTERBODY ARTHRODESIS EACH INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22854 |
INSERTION OF INTERVERTEBRAL BIOMECHANICAL DEVICE(S) (EG SYNTHETIC CAGE MESH) WITH INTEGRAL ANTERIOR INSTRUMENTATION FOR DEVICE ANCHORING (EG SCREWS FLANGES) WHEN PERFORMED TO VERTEBRAL CORPECTOMY(IES) (VERTEBRAL BODY RESECTION PARTIAL OR COMPLETE) DEFECT IN CONJUNCTION WITH INTERBODY ARTHRODESIS EACH CONTIGUOUS DEFECT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22856 |
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC) ANTERIOR APPROACH INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION) SINGLE INTERSPACE CERVICAL |
|
22858 |
TOTAL DISC ARTHROPLASTY (ARTIFICIAL DISC) ANTERIOR APPROACH INCLUDING DISCECTOMY WITH END PLATE PREPARATION (INCLUDES OSTEOPHYTECTOMY FOR NERVE ROOT OR SPINAL CORD DECOMPRESSION AND MICRODISSECTION) SECOND LEVEL CERVICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22870 |
INSERTION OF INTERLAMINAR/INTERSPINOUS PROCESS STABILIZATION/DISTRACTION DEVICE WITHOUT OPEN DECOMPRESSION OR FUSION INCLUDING IMAGE GUIDANCE WHEN PERFORMED LUMBAR SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
22899 |
UNLISTED PROCEDURE SPINE |
|
23000 |
REMOVAL OF SUBDELTOID CALCAREOUS DEPOSITS OPEN |
|
23020 |
CAPSULAR CONTRACTURE RELEASE (EG SEVER TYPE PROCEDURE) |
|
23120 |
CLAVICULECTOMY PARTIAL |
|
23130 |
ACROMIOPLASTY OR ACROMIONECTOMY PARTIAL WITH OR WITHOUT CORACOACROMIAL LIGAMENT RELEASE |
|
23410 |
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG ROTATOR CUFF) OPEN/ACUTE |
|
23412 |
REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG ROTATOR CUFF) OPEN CHRONIC |
|
23415 |
CORACOACROMIAL LIGAMENT RELEASE WITH OR WITHOUT ACROMIOPLASTY |
|
23420 |
RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFF AVULSION CHRONIC (INCLUDES ACROMIOPLASTY) |
|
23430 |
TENODESIS OF LONG TENDON OF BICEPS |
|
23440 |
RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS |
|
23450 |
CAPSULORRHAPHY ANTERIOR PUTTIPLATT PROCEDURE OR MAGNUSON TYPE OPERATION |
|
23455 |
CAPSULORRHAPHY ANTERIOR WITH LABRAL REPAIR (EG BANKART PROCEDURE) |
|
23462 |
CAPSULORRHAPHY ANTERIOR ANY TYPE WITH CORACOID PROCESS TRANSFER |
|
23470 |
ARTHROPLASTY GLENOHUMERAL JOINT HEMIARTHROPLASTY |
|
23472 |
ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER (GLENOID AND PROXIMAL HUMERAL REPLACEMENT (EG TOTAL SHOULDER)) |
|
27096 |
INJECTION PROCEDURE FOR SACROILIAC JOINT ANESTHETIC/STEROID WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED |
|
27130 |
ARTHROPLASTY ACETABULAR AND PROXIMAL FEMORAL PROSTHETIC REPLACEMENT (TOTAL HIP ARTHROPLASTY) WITH OR WITHOUT AUTOGRAFT OR ALLOGRAFT |
|
27279 |
ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS OR MINIMALLY INVASIVE (INDIRECT VISUALIZATION) WITH IMAGE GUIDANCE INCLUDES OBTAINING BONE GRAFT WHEN PERFORMED AND PLACEMENT OF TRANSFIXING DEVICE |
|
27403 |
ARTHROTOMY WITH MENISCUS REPAIR KNEE |
|
27412 |
AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE |
|
27415 |
OSTEOCHONDRAL ALLOGRAFT KNEE OPEN |
|
27416 |
OSTEOCHONDRAL AUTOGRAFT(S) KNEE OPEN (EG MOSAICPLASTY) (INCLUDES HARVESTING OF AUTOGRAFTS) |
|
27418 |
ANTERIOR TIBIAL TUBERCLEPLASTY (EG MAQUET TYPE PROCEDURE) |
|
27420 |
RECONSTRUCTION OF DISLOCATING PATELLA (EG HAUSER TYPE PROCEDURE) |
|
27422 |
RECONSTRUCTION OF DISLOCATING PATELLA WITH EXTENSOR REALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE (EG AMPBELL GOLDWAITE TYPE PROCEDURE) |
|
27427 |
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION) KNEE EXTRAARTICULAR |
|
27428 |
LIGAMENTOUS RECONSTRUCTION (AUGMENTATION) KNEE INTRAARTICULAR (OPEN) |
|
27438 |
ARTHROPLASTY PATELLA WITH PROSTHESIS |
|
27446 |
ARTHROPLASTY KNEE CONDYLE AND PLATEAU MEDIAL OR LATERAL COMPARTMENT |
|
27447 |
ARTHROPLASTY KNEE CONDYLE AND PLATEAU MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE ARTHROPLASTY) |
|
27599 |
UNLISTED PROCEDURE FEMUR OR KNEE |
|
28110 |
OSTECTOMY PARTIAL EXCISION FIFTH METATARSAL HEAD (BUNIONETTE) (SEPARATE PROCEDURE) |
|
28291 |
HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT WITH IMPLANT |
|
28295 |
CORRECTION HALLUX VALGUS WITH BUNIONECTOMY WITH SESAMOIDECTOMY WHEN PERFORMED WITH PROXIMAL METATARSAL OSTEOTOMY ANY METHOD |
|
28296 |
CORRECTION HALLUX VALGUS WITH BUNIONECTOMY WITH SESAMOIDECTOMY WHEN PERFORMED WITH DISTAL METATARSAL OSTEOTOMY ANY METHOD |
|
28297 |
CORRECTION HALLUX VALGUS WITH BUNIONECTOMY WITH SESAMOIDECTOMY WHEN PERFORMED WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS ANY METHOD |
|
28299 |
CORRECTION HALLUX VALGUS WITH BUNIONECTOMY WITH SESAMOIDECTOMY WHEN PERFORMED WITH DOUBLE OSTEOTOMY ANY METHOD |
|
28306 |
OSTEOTOMY WITH OR WITHOUT LENGTHENING SHORTENING OR ANGULAR CORRECTION METATARSAL FIRST METATARSAL |
|
28322 |
REPAIR NONUNION OR MALUNION METATARSAL WITH OR WITHOUT BONE GRAFT (INCLUDES OBTAINING GRAFT) |
|
28755 |
ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT |
|
29805 |
ARTHROSCOPY SHOULDER DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) |
|
29806 |
ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY |
|
29807 |
ARTHROSCOPY SHOULDER SURGICAL REPAIR OF SLAP LESION |
|
29819 |
ARTHROSCOPY SHOULDER SURGICAL WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY |
|
29820 |
ARTHROSCOPY SHOULDER SURGICAL SYNOVECTOMY PARTIAL |
|
29821 |
ARTHROSCOPY SHOULDER SURGICAL SYNOVECTOMY COMPLETE |
|
29822 |
ARTHROSCOPY SHOULDER SURGICAL DEBRIDEMENT LIMITED 1 OR 2 DISCRETE STRUCTURES (EG HUMERAL BONE HUMERAL ARTICULAR CARTILAGE GLENOID BONE GLENOID ARTICULAR CARTILAGE BICEPS TENDON BICEPS ANCHOR COMPLEX LABRUM ARTICULAR CAPSULE ARTICULAR SIDE OF THE ROTATOR CUFF BURSAL SIDE OF THE ROTATOR CUFF SUBACROMIAL BURSA FOREIGN BODIES) |
|
29823 |
ARTHROSCOPY SHOULDER SURGICAL DEBRIDEMENT EXTENSIVE 3 OR MORE DISCRETE STRUCTURES (EG HUMERAL BONE HUMERAL ARTICULAR CARTILAGE GLENOID BONE GLENOID ARTICULAR CARTILAGE BICEPS TENDON BICEPS ANCHOR COMPLEX LABRUM ARTICULAR CAPSULE ARTICULAR SIDE OF THE ROTATOR CUFF BURSAL SIDE OF THE ROTATOR CUFF SUBACROMIAL BURSA FOREIGN BODIES) |
|
29824 |
ARTHROSCOPY SHOULDER SURGICAL DISTAL CLAVICULECTOMY INCLUDING DISTAL ARTICULAR SURFACE (MUMFORD PROCEDURE) |
|
29825 |
ARTHROSCOPY SHOULDER SURGICAL WITH LYSIS AND RESECTION OF ADHESIONS WITH OR WITHOUT MANIPULATION |
|
29826 |
ARTHROSCOPY SHOULDER SURGICAL DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY WITH CORACOACROMIAL LIGAMENT (IE ARCH) RELEASE WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
29827 |
ARTHROSCOPY SHOULDER SURGICAL WITH ROTATOR CUFF REPAIR |
|
29828 |
ARTHROSCOPY SHOULDER SURGICAL BICEPS TENODESIS |
|
29860 |
ARTHROSCOPY HIP DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROCEDURE) |
|
29861 |
ARTHROSCOPY HIP SURGICAL WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY |
|
29862 |
ARTHROSCOPY HIP SURGICAL WITH DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) ABRASION ARTHROPLASTY AND/OR RESECTION OF LABRUM |
|
29863 |
ARTHROSCOPY HIP SURGICAL WITH SYNOVECTOMY |
|
29870 |
ARTHROSCOPY KNEE DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY (SEPARATE PROC) |
|
29873 |
ARTHROSCOPY KNEE SURGICAL WITH LATERAL RELEASE |
|
29874 |
ARTHROSCOPY KNEE SURGICAL FOR REMOVAL OF LOOSE OR FOREIGN BODY (EG OSTEOCHONDRITIS DISSECANS FRAGMENTATION CHONDRAL FRAGMENTATION) |
|
29875 |
ARTHROSCOPY KNEE SURGICAL SYNOVECTOMY LIMITED (EG PLICA OR SHELF RESECTION) (SEPARATE PROCEDURE) |
|
29876 |
ARTHROSCOPY KNEE SURGICAL SYNOVECTOMY MAJOR 2 OR MORE COMPARTMENTS (EG MEDIAL OR LATERAL) |
|
29877 |
ARTHROSCOPY KNEE SURGICAL DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) |
|
29879 |
ARTHROSCOPY KNEE SURGICAL ABRASION ARTHROPLASTY (INCLUDES CHONDROPLASTY WHERE NECESSARY) OR MULTIPLE DRILLING OR MICROFRACTURE |
|
29880 |
ARTHROSCOPY KNEE SURGICAL WITH MENISCECTOMY (MEDIAL AND LATERAL INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) SAME OR SEPARATE COMPARTMENT(S) WHEN PERFORMED |
|
29881 |
ARTHROSCOPY KNEE SURGICAL WITH MENISCECTOMY (MEDIAL OR LATERAL INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY) SAME OR SEPARATE COMPARTMENT(S) WHEN PERFORMED |
|
29882 |
ARTHROSCOPY KNEE SURGICAL WITH MENISCUS REPAIR (MEDIAL OR LATERAL) |
|
29883 |
ARTHROSCOPY KNEE SURGICAL WITH MENISCUS REPAIR (MEDIAL AND LATERAL) |
|
29884 |
ARTHROSCOPY KNEE SURGICAL WITH LYSIS OF ADHESIONS WITH OR WITHOUT MANIPULATION (SEPARATE PROCEDURE) |
|
29885 |
ARTHROSCOPY KNEE SURGICAL DRILLING FOR OSTEOCHONDRITIS DISSECANS WITH BONE GRAFTING WITH OR WITHOUT INTERNAL FIXATION INCLUDING DEBRIDEMENT OF BASE OF LESION) |
|
29886 |
ARTHROSCOPY KNEE SURGICAL DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION |
|
29887 |
ARTHROSCOPY KNEE SURGICAL DRILLING FOR INTACT OSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL FIXATION |
|
29888 |
ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION |
|
29889 |
ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENT REPAIR/AUGMENTATION OR RECONSTRUCTION |
|
29892 |
ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITIS DISSECANS LESION TALAR DOME FRACTURE OR TIBIAL PLAFOND FRACTURE WITH OR WITHOUT INTERNAL FIXATION (INCLUDES ARTHROSCOPY) |
|
29899 |
ARTHROSCOPY ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS) SURGICAL WITH ANKLE ARTHRODESIS |
|
29914 |
ARTHROSCOPY HIP SURGICAL WITH FEMOROPLASTY (IE TREATMENT OF CAM LESION) |
|
29915 |
ARTHROSCOPY HIP SURGICAL WITH ACETABULOPLASTY (IE TREATMENT OF PINCER LESION) |
|
29916 |
ARTHROSCOPY HIP SURGICAL WITH LABRAL REPAIR |
|
29999 |
UNLISTED PROCEDURE ARTHROSCOPY |
Surgical Procedures on the Respiratory System
|
30130 |
EXCISION INFERIOR TURBINATE PARTIAL OR COMPLETE ANY METHOD |
|
30420 |
RHINOPLASTY PRIMARY INCLUDING MAJOR SEPTAL REPAIR |
|
30435 |
RHINOPLASTY SECONDARY INTERMEDIATE REVISION (BONY WORK WITH OSTEOTOMIES) |
|
30520 |
SEPTOPLASTY OR SUBMUCOUS RESECTION WITH OR WITHOUT CARTILAGE SCORING CONTOURING OR REPLACEMENT WITH GRAFT |
|
30630 |
REPAIR NASAL SEPTAL PERFORATIONS |
|
31253 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH ETHMOIDECTOMY TOTAL (ANTERIOR AND POSTERIOR) INCLUDING FRONTAL SINUS EXPLORATION WITH REMOVAL OF TISSUE FROM FRONTAL SINUS WHEN PERFORMED |
|
31254 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH ETHMOIDECTOMY PARTIAL (ANTERIOR) |
|
31255 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH ETHMOIDECTOMY TOTAL (ANTERIOR AND POSTERIOR) |
|
31257 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH ETHMOIDECTOMY TOTAL (ANTERIOR AND POSTERIOR) INCLUDING SPHENOIDOTOMY |
|
31259 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH ETHMOIDECTOMY TOTAL (ANTERIOR AND POSTERIOR) INCLUDING SPHENOIDOTOMY WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS |
|
31295 |
NASAL/SINUS ENDOSCOPY SURGICAL WITH DILATION (EG BALLOON DILATION) MAXILLARY SINUS OSTIUM TRANSNASAL OR VIA CANINE FOSSA |
Surgical Procedures on the Cardiovascular System
|
33285 |
INSERTION SUBCUTANEOUS CARDIAC RHYTHM MONITOR INCLUDING PROGRAMMING |
|
36465 |
INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVERS TO GUIDE DISPERSION OF THE INJECTATE INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING SINGLE INCOMPETENT EXTREMITY TRUNCAL VEIN (EG GREAT SAPHENOUS VEIN ACCESSORY SAPHENOUS VEIN) |
|
36466 |
INJECTION OF NON-COMPOUNDED FOAM SCLEROSANT WITH ULTRASOUND COMPRESSION MANEUVERS TO GUIDE DISPERSION OF THE INJECTATE INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING MULTIPLE INCOMPETENT TRUNCAL VEINS (EG GREAT SAPHENOUS VEIN ACCESSORY SAPHENOUS VEIN) SAME LEG |
|
36470 |
INJECTION OF SCLEROSANT SINGLE INCOMPETENT VEIN (OTHER THAN TELANGIECTASIA) |
|
36471 |
INJECTION OF SCLEROSANT MULTIPLE INCOMPETENT VEINS (OTHER THAN TELANGIECTASIA) SAME LEG |
|
36473 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS MECHANOCHEMICAL FIRST VEIN TREATED |
|
36475 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS RADIOFREQUENCY FIRST VEIN TREATED |
|
36476 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS RADIOFREQUENCY SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
36478 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS LASER FIRST VEIN TREATED |
|
36479 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS LASER SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)’ |
|
36482 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG CRYANOACRYLATE) REMOTE FROM THE ACCESS SITE INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS FIRST VEIN TREATED |
|
36483 |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN EXTREMITY BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG CRYANOACRYLATE) REMOTE FROM THE ACCESS SITE INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING PERCUTANEOUS SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
37221 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS ILIAC ARTERY UNILATERAL INITIAL VESSEL WITH TRANSLUMINAL STENT PLACEMENT(S) INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL WHEN PERFORMED |
|
37224 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS FEMORAL POPLITEAL ARTERY(S) UNILATERAL WITH TRANSLUMINAL ANGIOPLASTY |
|
37225 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS FEMORAL POPLITEAL ARTERY(S) UNILATERAL WITH ATHERECTOMY INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL WHEN PERFORMED |
|
37226 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS FEMORAL POPLITEAL ARTERY(S) UNILATERAL WITH TRANSLUMINAL STENT PLACEMENT(S) INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL WHEN PERFORMED |
|
37227 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS FEMORAL POPLITEAL ARTERY(S) UNILATERAL WITH TRANSLUMINAL STENT PLACEMENT(S) AND ATHERECTOMY INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL WHEN PERFORMED |
|
37228 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS TIBIAL PERONEAL ARTERY UNILATERAL INITIAL VESSEL WITH TRANSLUMINAL ANGIOPLASTY |
|
37229 |
REVASCULARIZATION ENDOVASCULAR OPEN OR PERCUTANEOUS TIBIAL PERONEAL ARTERY UNILATERAL INITIAL VESSEL WITH ATHERECTOMY INCLUDES ANGIOPLASTY WITHIN THE SAME VESSEL WHEN PERFORMED |
|
37243 |
VASCULAR EMBOLIZATION OR OCCLUSION INCLUSIVE OF ALL RADIOLOGICAL SUPERVISION AND INTERPRETATION INTRAPROCEDURAL ROAD MAPPING AND IMAGING GUIDANCE NECESSARY TO COMPLETE THE INTERVENTION FOR TUMORS ORGAN ISCHEMIA OR INFARCTION |
|
37700 |
LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT SAPHENOFEMORAL JUNCTION OR DISTAL INTERRUPTIONS |
|
37761 |
LIGATION OF PERFORATOR VEIN(S) SUBFASCIAL OPEN INCLUDING ULTRASOUND GUIDANCE WHEN PERFORMED 1 LEG |
|
37765 |
STAB PHLEBECTOMY OF VARICOSE VEINS 1 EXTREMITY 10-20 STAB INCISIONS |
|
37766 |
STAB PHLEBECTOMY OF VARICOSE VEINS ONE EXTREMITY MORE THAN 20 INCISIONS |
|
37799 |
UNLISTED PROCEDURE VASCULAR SURGERY |
Surgical Procedures on the Digestive System
|
42821 |
TONSILLECTOMY AND ADENOIDECTOMY AGE 12 OR OVER |
|
42826 |
TONSILLECTOMY PRIMARY OR SECONDARY AGE 12 OR OVER |
|
42831 |
ADENOIDECTOMY PRIMARY AGE 12 OR OVER |
|
43774 |
LAPAROSCOPY SURGICAL GASTRIC RESTRICTIVE PROCEDURE REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS |
|
43775 |
LAPAROSCOPY SURGICAL GASTRIC RESTRICTIVE PROCEDURE LONGITUDINAL GASTRECTOMY (IE SLEEVE GASTRECTOMY) |
Surgical Procedures on the Urinary System
|
55899 |
UNLISTED PROCEDURE MALE GENITAL SYSTEM |
Surgical Procedures on the Nervous System
|
62320 |
INJECTION(S) OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG ANESTHETIC ANTISPASMODIC OPIOID STEROID OTHER SOLUTION) NOT INCLUDING NEUROLYTIC SUBSTANCES INCLUDING NEEDLE OR CATHETER PLACEMENT INTERLAMINAR EPIDURAL OR SUBARACHNOID CERVICAL OR THORACIC WITHOUT IMAGING GUIDANCE |
|
62321 |
INJECTION(S) OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG ANESTHETIC ANTISPASMODIC OPIOID STEROID OTHER SOLUTION) NOT INCLUDING NEUROLYTIC SUBSTANCES INCLUDING NEEDLE OR CATHETER PLACEMENT INTERLAMINAR EPIDURAL OR SUBARACHNOID CERVICAL OR THORACIC WITH IMAGING GUIDANCE (IE FLUOROSCOPY OR CT) |
|
62322 |
INJECTION(S) OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG ANESTHETIC ANTISPASMODIC OPIOID STEROID OTHER SOLUTION) NOT INCLUDING NEUROLYTIC SUBSTANCES INCLUDING NEEDLE OR CATHETER PLACEMENT INTERLAMINAR EPIDURAL OR SUBARACHNOID LUMBER OR SACRAL (CAUDAL) WITHOUT IMAGING GUIDANCE |
|
62323 |
INJECTION(S) OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (EG ANESTHETIC ANTISPASMODIC OPIOID STEROID OTHER SOLUTION) NOT INCLUDING NEUROLYTIC SUBSTANCES INCLUDING NEEDLE OR CATHETER PLACEMENT INTERLAMINAR EPIDURAL OR SUBARACHNOID LUMBER OR SACRAL (CAUDAL) WITH IMAGING GUIDANCE (IE FLUOROSCOPY OR CT) |
|
62350 |
IMPLANTATION REVISION OR REPOSITIONING OF TUNNELED INTRATHECAL OR EPIDURAL CATHETER FOR LONG TERM MEDICATION ADMINISTRATION VIA AN EXTERNAL PUMP WITHOUT LAMINECTOMY
|
|
62362 |
IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OR EPIDURAL DRUG INFUSION PROGRAMMABLE PUMP INCLUDING PREPARATION OF PUMP WITH OR WITHOUT PROGRAMMING |
|
62380 |
ENDOSCOPIC DECOMPRESSION OF SPINAL CORD NERVE ROOT(S) INCLUDING LAMINOTOMY PARTIAL FACETECTOMY FORAMINOTOMY DISCECTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC 1 INTERSPACE LUMBAR |
|
63030 |
LAMINOTOMY (HEMILAMINECTOMY) WITH DECOMPRESSION OF NERVE ROOT(S) INCLUDING PARTIAL FACETECTOMY FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC 1 INTERSPACE LUMBAR |
|
63035 |
LAMINOTOMY (HEMILAMINECTOMY) WITH DECOMPRESSION OF NERVE ROOT(S) INCLUDING PARTIAL FACETECTOMY FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC EACH ADDITIONAL INTERSPACE CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
63042 |
LAMINOTOMY (HEMILAMINECTOMY) WITH DECOMPRESSION OF NERVE ROOT(S) INCLUDING PARTIAL FACETECTOMY FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK RE-EXPLORATION SINGLE INTERSPACE LUMBAR |
|
63056 |
TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD EQUINA AND/OR NERVE ROOT(S) (EG HERNIATED INTERVERTEBRAL DISK) SINGLE SEGMENT LUMBAR (INCLUDING TRANSFACET OR LATERAL EXTRAFORAMINAL APPROACH) (EG FAR LATERAL HERNIATED INTERVERTEBRAL DISK) |
|
63650 |
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY EPIDURAL |
|
63655 |
LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES PLATE/PADDLE EPIDURAL |
|
63663 |
REVISION INCLUDING REPLACEMENT WHEN PERFORMED OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S) INCLUDING FLUOROSCOPY WHEN PERFORMED |
|
63664 |
REVISION INCLUDING REPLACEMENT WHEN PERFORMED OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY INCLUDING FLUOROSCOPY WHEN PERFORMED |
|
63685 |
INSERTION OR REPLACEMENT OF SPINAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER |
|
64479 |
INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC SINGLE LEVEL |
|
64480 |
INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64483 |
INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL SINGLE LEVEL |
|
64484 |
INJECTION(S) ANESTHETIC AGENT AND/OR STEROID TRANSFORAMINAL EPIDURAL WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL EACH ADDITIONAL LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64490 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC SINGLE LEVEL |
|
64491 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64492 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64493 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL SINGLE LEVEL |
|
64494 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64495 |
INJECTION(S) DIAGNOSTIC OR THERAPEUTIC AGENT PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64510 |
INJECTION ANESTHETIC AGENT STELLATE GANGLION (CERVICAL SYMPATHETIC) |
|
64520 |
INJECTION ANESTHETIC AGENT LUMBAR OR THORACIC (PARAVERTEBRAL SYMPATHETIC) |
|
64561 |
PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE IF PERFORMED |
|
64582 |
OPEN IMPLANTATION OF HYPOGLOSSAL NERVE NEUROSTIMULATOR ARRAY PULSE GENERATOR AND DISTAL RESPIRATORY SENSOR ELECTRODE OR ELECTRODE ARRAY |
|
64590 |
INSERTION OR REPLACEMENT OF PERIPHERAL SACRAL OR GASTRIC NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER REQUIRING POCKET CREATION AND CONNECTION BETWEEN ELECTRODE ARRAY AND PULSE GENERATOR OR RECEIVER |
|
64633 |
DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC SINGLE FACET JOINT |
|
64634 |
DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) CERVICAL OR THORACIC EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
|
64635 |
DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL SINGLE FACET JOINT |
|
64636 |
DESTRUCTION BY NEUROLYTIC AGENT PARAVERTEBRAL FACET JOINT NERVE(S) WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT) LUMBAR OR SACRAL EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
Surgical Procedures on the Eye and Ocular Adnexa
|
66989 |
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1STAGE PROCEDURE) MANUAL OR MECHANICAL TECHNIQUE (EG IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) COMPLEX REQUIRING DEVICES OR TECHNIQUES NOT GENERALLY USED IN ROUTINE CATARACT SURGERY (EG IRIS EXPANSION DEVICE SUTURE SUPPORT FOR INTRAOCULAR LENS OR PRIMARY POSTERIOR CAPSULORRHEXIS) OR PERFORMED ON PATIENTS IN THE AMBLYOGENIC DEVELOPMENTAL STAGE WITH INSERTION OF INTRAOCULAR (EG TRABECULAR MESHWORK SUPRACILIARY SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE WITHOUT EXTRAOCULAR RESERVOIR INTERNAL APPROACH ONE OR MORE |
|
66991 |
EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1 STAGE PROCEDURE) MANUAL OR MECHANICAL TECHNIQUE (EG IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION) WITH INSERTION OF INTRAOCULAR (EG TRABECULAR MESHWORK SUPRACILIARY SUPRACHOROIDAL) ANTERIOR SEGMENT AQUEOUS DRAINAGE DEVICE WITHOUT EXTRAOCULAR RESERVOIR INTERNAL APPROACH ONE OR MORE |
|
67900 |
REPAIR OF BROW PTOSIS (SUPRACILIARY MIDFOREHEAD OR CORONAL APPROACH) |
|
67901 |
REPAIR OF BLEPHAROPTOSIS FRONTALIS MUSCLE TECHNIQUE WITH SUTURE OR OTHER MATERIAL (EG BANKED FASCIA) |
|
67902 |
REPAIR OF BLEPHAROPTOSIS FRONTALIS MUSCLE TECHNIQUE WITH AUTOLOGOUS FASCIAL SLING (INCLUDES OBTAINING FASCIA) |
|
67903 |
REPAIR OF BLEPHAROPTOSIS (TARSO) LEVATOR RESECTION OR ADVANCEMENT INTERNAL APPROACH |
|
67904 |
REPAIR OF BLEPHAROPTOSIS (TARSO) LEVATOR RESECTION OR ADVANCEMENT EXTERNAL APPROACH |
|
67908 |
REPAIR OF BLEPHAROPTOSIS CONJUNCTIVO-TARSO-MULLER S MUSCLE-LEVATOR RESECTION (EG FASANELLA-SERVAT TYPE) |
|
67911 |
CORRECTION OF LID RETRACTION |
|
67999 |
UNLISTED PROCEDURE EYELIDS |
|
68899 |
UNLISTED PROCEDURE LACRIMAL SYSTEM |
Assorted Devices, Implants, and Systems
|
C1820 |
GENERATOR NEUROSTIMULATOR (IMPLANTABLE) NON-HIGH FREQUENCY WITH RECHARGEABLE BATTERY AND CHARGING SYSTEM |
|
C1822 |
GENERATOR NEUROSTIMULATOR (IMPLANTABLE) HIGH FREQUENCY WITH RECHARGEABLE BATTERY AND CHARGING SYSTEM |
Other Therapeutic Services and Supplies
|
C9757 |
LAMINOTOMY (HEMILAMINECTOMY) WITH DECOMPRESSION OF NERVE ROOT(S) INCLUDING PARTIAL FACETECTOMY FORAMINOTOMY AND EXCISION OF HERNIATED INTERVERTEBRAL DISC AND REPAIR OF ANNULAR DEFECT WITH IMPLANTATION OF BONE ANCHORED ANNULAR CLOSURE DEVICE INCLUDING ANNULAR DEFECT MEASUREMENT ALIGNMENT AND SIZING ASSESSMENT AND IMAGE GUIDANCE 1 INTERSPACE LUMBAR |
Miscellaneous Diagnostic and Therapeutic Services
|
G0260 |
INJECTION PROCEDURE FOR SACROILIAC JOINT PROVISION OF ANESTHETIC STERIOD AND/OR OTHER THERAPEUTIC AGENT AND ARTHROGRAPHY |
0275T |
15780 |
15782 |
15783 |
15786 |
15788 |
15789 |
15792 |
15793 |
15820 |
15821 |
15822 |
15823 |
15830 |
15839 |
15847 |
15877 |
15878 |
15879 |
17106 |
17107 |
17108 |
17999 |
19318 |
20912 |
21089 |
21110 |
22513 |
22514 |
22515 |
22551 |
22552 |
22558 |
22585 |
22600 |
22612 |
22614 |
22630 |
22633 |
22634 |
22840 |
22842 |
22845 |
22846 |
22853 |
22854 |
22856 |
22858 |
22870 |
22899 |
23000 |
23020 |
23120 |
23130 |
23410 |
23412 |
23415 |
23420 |
23430 |
23440 |
23450 |
23455 |
23462 |
23470 |
23472 |
27096 |
27130 |
27279 |
27403 |
27412 |
27415 |
27416 |
27418 |
27420 |
27422 |
27427 |
27428 |
27438 |
27446 |
27447 |
27599 |
28110 |
28291 |
28295 |
28296 |
28297 |
28299 |
28306 |
28322 |
28755 |
29805 |
29806 |
29807 |
29819 |
29820 |
29821 |
29822 |
29823 |
29824 |
29825 |
29826 |
29827 |
29828 |
29860 |
29861 |
29862 |
29863 |
29870 |
29873 |
29874 |
29875 |
29876 |
29877 |
29879 |
29880 |
29881 |
29882 |
29883 |
29884 |
29885 |
29886 |
29887 |
29888 |
29889 |
29892 |
29899 |
29914 |
29915 |
29916 |
29999 |
30130 |
30420 |
30435 |
30520 |
30630 |
31253 |
31254 |
31255 |
31257 |
31259 |
31295 |
33285 |
36465 |
36466 |
36470 |
36471 |
36473 |
36475 |
36476 |
36478 |
36479 |
36482 |
36483 |
37221 |
37224 |
37225 |
37226 |
37227 |
37228 |
37229 |
37243 |
37700 |
37761 |
37765 |
37766 |
37799 |
42821 |
42826 |
42831 |
43774 |
43775 |
55899 |
62320 |
62321 |
62322 |
62323 |
62350 |
62362 |
62380 |
63030 |
63035 |
63042 |
63056 |
63650 |
63655 |
63663 |
63664 |
63685 |
64479 |
64480 |
64483 |
64484 |
64490 |
64491 |
64492 |
64493 |
64494 |
64495 |
64510 |
64520 |
64561 |
64582 |
64590 |
64633 |
64634 |
64635 |
64636 |
66989 |
66991 |
67900 |
67901 |
67902 |
67903 |
67904 |
67908 |
67911 |
67999 |
68899 |
C1820 |
C1822 |
C9757 |
G0260 |
Refer to Medical Policy I-151, Site of Care, for additional information.
Refer to Medical Policy S-278, Blepharoplasty, Repair of Blepharoptosis, and Repair of Brow Ptosis, for additional information.
Refer to Medical Policy S-28, Cosmetic vs Reconstructive Surgery, for additional information.
Refer to Medical Policy M-77, Upper Gastrointestinal Endoscopy/Esophagoscopy, for additional information.
Refer to Medical Policy S-184, Gender Affirmation Treatment, for additional information.
Refer to Medical Policy S-201, Balloon Ostial Dilation of the Sinus and Implantable Sinus Stents for additional information.
Refer to Medical Policy S-284, Ankle Arthroscopy, for additional information.
Refer to Medical Policy S-337, Arthrodesis, Interphalangeal Joint, for additional information.
Refer to Medical Policy, Shoulder Arthroplasty (Total, Hemi, Reverse)/Arthrodesis, for additional information.
Refer to Medical Policy S-255, Lumbar Fusion (Arthrodesis) for additional information.
Refer to Medical Policy S-324, Spinal Fusion, Thoracic and Thoracolumbar, for additional information. Refer to Medical Policy S-36, Treatment of Benign or Premalignant Skin Conditions for additional information.
Refer to Medical Policy S-280, Surgical Treatment of Obstructive Sleep Apnea, for additional information.
Refer to Medical Policy S-55, Surgical Treatment of Varicose Veins, for additional information.
Refer to Medical Policy S-552, Sclerotherapy (Liquid or Microfoam), for additional information.
Refer to Medical Policy, S-258, Spinal Cord and Implantable Peripheral Nerve Stimulators, for additional information.
Refer to Medical Policy S-385, Spinal Cord and Dorsal Root Ganglion Stimulation, for additional information.
Refer to Medical Policy S-285, Spinal Cord and Dorsal Root Ganglion Stimulation, for additional information.
Refer to Medical Policy S-40, Implantable Intrathecal Drug Delivery Systems, for additional information.
Refer to Medical Policy S-331, Bariatric Surgery, for additional information.
Refer to Medical Policy R-15, Selective Internal Radiation Therapy (SIRT)/Radioembolization, for additional information.
Refer to Medical Policy S189, Epidural Steroid Injections, for additional information.
Refer to Medical Policy S-97, Treatment of the Prostate, for additional information.
Refer to Medical Policy S-275, Prostate Disease: Diagnosis, Staging, and Treatment, for additional information.
Refer to Medical Policy Z-61, Facet Joint Injections/Medial Branch Blocks, for additional information.
Refer to Medical Policy S-185, Knee Surgery – Arthroscopic and Open Procedure, for additional information.
Refer to Medical Policy S-150, Radiofrequency Joint Ablation-Denervation, for additional information.
Refer to Medical Policy S-131, Sacral Nerve Neuromodulation, for additional information.
American Society of Anesthesiology (ASA) Physical Status (PS) Classification:
Brittle diabetes: Diabetes that is difficult to control due to symptoms such as predominant hyperglycemia with recurrent ketoacidosis, predominant hypoglycemia, and mixed hyper- and hypo-glycemia.
New York Heart Association (NYHA) Functional Classification:
Obstructive sleep apnea (OSA): A sleep disorder that involves cessation or significant decrease in airflow in the presence of breathing effort.
A52.74 |
B67.0 |
B67.5 |
C22.0 |
C22.2 |
C22.3 |
C22.4 |
C22.7 |
C22.8 |
C22.9 |
D01.5 |
D50.0 |
D50.1 |
D50.8 |
D51.0 |
D51.1 |
D51.2 |
D51.3 |
D51.8 |
D52.0 |
D52.1 |
D52.8 |
D53.0 |
D53.1 |
D53.2 |
D53.8 |
D55.0 |
D55.1 |
D55.21 |
D55.29 |
D55.8 |
D56.0 |
D56.1 |
D56.2 |
D56.3 |
D56.4 |
D56.5 |
D56.8 |
D57.01 |
D57.02 |
D57.03 |
D57.09 |
D57.1 |
D57.20 |
D57.211 |
D57.212 |
D57.213 |
D57.218 |
D57.3 |
D57.40 |
D57.411 |
D57.412 |
D57.413 |
D57.418 |
D57.42 |
D57.431 |
D57.432 |
D57.433 |
D57.438 |
D57.439 |
D57.44 |
D57.451 |
D57.452 |
D57.453 |
D57.458 |
D57.80 |
D57.811 |
D57.812 |
D57.813 |
D57.818 |
D58.0 |
D58.1 |
D58.2 |
D58.8 |
D59.0 |
D59.10 |
D59.11 |
D59.12 |
D59.13 |
D59.19 |
D59.2 |
D59.31 |
D59.32 |
D59.39 |
D59.4 |
D59.5 |
D59.6 |
D59.8 |
D60.0 |
D60.1 |
D60.8 |
D61.01 |
D61.09 |
D61.1 |
D61.2 |
D61.3 |
D61.810 |
D61.811 |
D61.818 |
D61.82 |
D61.89 |
D62 |
D63.0 |
D63.1 |
D63.8 |
D64.1 |
D64.2 |
D64.3 |
D64.4 |
D64.81 |
D64.89 |
D65 |
D66 |
D67 |
D68.01 |
D68.020 |
D68.021 |
D68.022 |
D68.023 |
D68.03 |
D68.04 |
D68.09 |
D68.1 |
D68.2 |
D68.311 |
D68.312 |
D68.318 |
D68.32 |
D68.4 |
D68.51 |
D68.52 |
D68.59 |
D68.61 |
D68.62 |
D68.69 |
D68.8 |
D69.0 |
D69.1 |
D69.2 |
D69.3 |
D69.41 |
D69.42 |
D69.49 |
D69.51 |
D69.59 |
D69.8 |
D69.8 |
D69.9 |
D70.0 |
D70.1 |
D70.2 |
D70.3 |
D70.4 |
D70.8 |
D71 |
D72.0 |
D72.10 |
D72.110 |
D72.111 |
D72.118 |
D72.119 |
D72.12 |
D72.18 |
D72.19 |
D72.810 |
D72.818 |
D72.820 |
D72.821 |
D72.822 |
D72.823 |
D72.824 |
D72.825 |
D72.828 |
D72.89 |
D72.9 |
D73.0 |
D73.1 |
D73.2 |
D73.3 |
D73.4 |
D73.5 |
D73.81 |
D73.89 |
D74.0 |
D74.8 |
D74.9 |
D75.0 |
D75.1 |
D75.81 |
D75.821 |
D75.822 |
D75.828 |
D75.838 |
D75.84 |
D75.89 |
D75.9 |
D75.A |
D76.1 |
D76.2 |
D76.3 |
D77 |
D80.0 |
D80.1 |
D80.2 |
D80.3 |
D80.4 |
D80.5 |
D80.6 |
D80.7 |
D80.8 |
D81.0 |
D81.1 |
D81.2 |
D81.30 |
D81.31 |
D81.32 |
D81.39 |
D81.4 |
D81.5 |
D81.6 |
D81.7 |
D81.810 |
D81.818 |
D81.82 |
D81.89 |
D81.9 |
D82.0 |
D82.1 |
D82.2 |
D82.3 |
D82.4 |
D82.8 |
D83.0 |
D83.1 |
D83.2 |
D83.8 |
D84.0 |
D84.1 |
D84.81 |
D84.821 |
D84.822 |
D84.89 |
D86.0 |
D86.1 |
D86.2 |
D86.3 |
D86.81 |
D86.82 |
D86.83 |
D86.84 |
D86.85 |
D86.86 |
D86.87 |
D86.89 |
D89.0 |
D89.1 |
D89.3 |
D89.40 |
D89.41 |
D89.42 |
D89.43 |
D89.44 |
D89.49 |
D89.810 |
D89.811 |
D89.812 |
D89.82 |
D89.831 |
D89.832 |
D89.833 |
D89.834 |
D89.835 |
D89.89 |
D89.9 |
E08.10 |
E08.11 |
E08.649 |
E10.649 |
E10.9 |
E11.649 |
E13.649 |
E66.01 |
F01.50 |
F01.511 |
F01.518 |
F01.52 |
F01.53 |
F01.54 |
F01.A0 |
F01.A11 |
F01.A18 |
F01.A2 |
F01.A3 |
F01.A4 |
F01.B0 |
F01.B11 |
F01.B18 |
F01.B2 |
F01.B3 |
F01.B4 |
F01.C0 |
F01.C11 |
F01.C18 |
F01.C2 |
F01.C3 |
F01.C4 |
F02.80 |
F02.811 |
F02.818 |
F02.82 |
F02.83 |
F02.84 |
F02.A0 |
F02.A11 |
F02.A18 |
F02.A2 |
F02.A3 |
F02.A4 |
F02.B0 |
F02.B11 |
F02.B18 |
F02.B2 |
F02.B3 |
F02.B4 |
F02.C0 |
F02.C11 |
F02.C18 |
F02.C2 |
F02.C3 |
F02.C4 |
F03.90 |
F03.911 |
F03.918 |
F03.92 |
F03.93 |
F03.94 |
F03.A0 |
F03.A11 |
F03.A18 |
F03.A2 |
F03.A3 |
F03.A4 |
F03.B0 |
F03.B11 |
F03.B18 |
F03.B2 |
F03.B3 |
F03.B4 |
F03.C0 |
F03.C11 |
F03.C18 |
F03.C2 |
F03.C2 |
F03.C3 |
F03.C3 |
F03.C4 |
F03.C4 |
F04 |
F10.239 |
F10.27 |
F10.97 |
F11.10 |
F11.11 |
F12.11 |
F13.11 |
F13.27 |
F13.97 |
F14.11 |
F15.11 |
F18.17 |
F18.27 |
F18.97 |
F19.17 |
F19.27 |
F19.97 |
G30.0 |
G30.1 |
G30.8 |
G31.01 |
G31.09 |
G31.83 |
G45.0 |
G45.1 |
G45.2 |
G45.3 |
G45.4 |
G45.8 |
G45.9 |
G46.0 |
G46.1 |
G46.2 |
G47.33 |
I1A.0 |
I21.01 |
I21.02 |
I21.09 |
I21.11 |
I21.19 |
I21.21 |
I21.29 |
I21.3 |
I21.4 |
I25.10 |
I25.110 |
I25.111 |
I25.112 |
I25.118 |
I25.119 |
I25.2 |
I25.3 |
I25.41 |
I25.42 |
I25.5 |
I25.6 |
I25.700 |
I25.701 |
I25.702 |
I25.708 |
I25.710 |
I25.711 |
I25.712 |
I25.718 |
I25.720 |
I25.721 |
I25.722 |
I25.728 |
I25.730 |
I25.731 |
I25.732 |
I25.738 |
I25.750 |
I25.751 |
I25.752 |
I25.758 |
I25.760 |
I25.761 |
I25.762 |
I25.768 |
I25.790 |
I25.791 |
I25.792 |
I25.798 |
I25.810 |
I25.811 |
I25.812 |
I25.82 |
I25.83 |
I25.84 |
I25.89 |
I25.9 |
I34.0 |
I34.1 |
I34.2 |
I34.81 |
I34.89 |
I34.9 |
I35.0 |
I35.1 |
I35.2 |
I35.8 |
I35.9 |
I36.0 |
I36.1 |
I36.2 |
I36.8 |
I36.9 |
I37.0 |
I37.1 |
I37.2 |
I37.8 |
I37.9 |
I38 |
I39 |
I47.0 |
I47.9 |
I48.0 |
I48.11 |
I48.20 |
I48.21 |
I48.3 |
I48.4 |
I48.91 |
I48.92 |
I49.1 |
I49.2 |
I49.3 |
I49.40 |
I49.49 |
I49.5 |
I49.8 |
I50.22 |
I50.23 |
I50.32 |
I50.33 |
I50.42 |
I50.43 |
I50.812 |
I50.813 |
I63.00 |
I63.011 |
I63.012 |
I63.013 |
I63.02 |
I63.031 |
I63.032 |
I63.033 |
I63.09 |
I63.211 |
I63.212 |
I63.213 |
I63.22 |
I63.231 |
I63.232 |
I63.233 |
I63.29 |
I63.311 |
I63.312 |
I63.313 |
I63.321 |
I63.322 |
I63.323 |
I63.331 |
I63.332 |
I63.333 |
I63.341 |
I63.342 |
I63.343 |
I63.39 |
I63.511 |
I63.512 |
I63.513 |
I63.521 |
I63.522 |
I63.523 |
I63.531 |
I63.532 |
I63.533 |
I63.541 |
I63.542 |
I63.543 |
I63.59 |
I63.81 |
I63.89 |
I73.00 |
I73.01 |
I73.1 |
I73.81 |
I73.89 |
J41.0 |
J41.1 |
J41.8 |
J42 |
J43.0 |
J43.1 |
J43.2 |
J43.8 |
J44.0 |
J44.1 |
J44.9 |
J45.31 |
J45.32 |
J45.40 |
J45.41 |
J45.42 |
J45.50 |
J45.51 |
J45.52 |
J45.901 |
J45.902 |
J45.991 |
J45.998 |
J47.0 |
J47.1 |
J47.9 |
K70.0 |
K70.2 |
K70.30 |
K70.31 |
K70.9 |
K71.0 |
K71.10 |
K71.11 |
K71.7 |
K71.8 |
K71.9 |
K74.0 |
K74.00 |
K74.01 |
K74.02 |
K74.1 |
K74.2 |
K74.3 |
K74.4 |
K74.5 |
K74.60 |
K74.69 |
K75.1 |
K75.89 |
K75.9 |
K76.0 |
K76.1 |
K76.2 |
K76.3 |
K76.4 |
K76.5 |
K76.6 |
K76.7 |
K76.81 |
K76.89 |
K76.9 |
K77 |
M79.5 |
N18.5 |
N18.6 |
O09.01 |
O09.02 |
O09.03 |
O09.11 |
O09.12 |
O09.13 |
O09.211 |
O09.212 |
O09.213 |
O09.291 |
O09.292 |
O09.293 |
O09.31 |
O09.32 |
O09.33 |
O09.41 |
O09.42 |
O09.43 |
O09.511 |
O09.512 |
O09.513 |
O09.521 |
O09.522 |
O09.523 |
O09.611 |
O09.612 |
O09.613 |
O09.621 |
O09.622 |
O09.623 |
O09.71 |
O09.72 |
O09.73 |
O09.811 |
O09.812 |
O09.813 |
O09.821 |
O09.822 |
O09.823 |
O09.891 |
O09.892 |
O09.893 |
O09.A1 |
O09.A2 |
O09.A3 |
O10.011 |
O10.012 |
O10.013 |
O10.111 |
O10.112 |
O10.113 |
O10.211 |
O10.212 |
O10.213 |
O10.311 |
O10.312 |
O10.313 |
O10.411 |
O10.412 |
O10.413 |
O10.911 |
O10.912 |
O10.913 |
O11.1 |
O11.2 |
O11.3 |
O12.01 |
O12.02 |
O12.03 |
O12.11 |
O12.12 |
O12.13 |
O12.21 |
O12.22 |
O12.23 |
O13.1 |
O13.2 |
O13.3 |
O14.02 |
O14.03 |
O14.10 |
O14.12 |
O14.13 |
O14.22 |
O14.23 |
O14.92 |
O14.93 |
O15.02 |
O15.03 |
O15.1 |
O15.9 |
O16.1 |
O16.2 |
O16.3 |
O20.0 |
O20.8 |
O20.9 |
O21.0 |
O21.1 |
O21.2 |
O21.8 |
O21.9 |
O22.01 |
O22.02 |
O22.03 |
O22.11 |
O22.12 |
O22.13 |
O22.21 |
O22.22 |
O22.23 |
O22.31 |
O22.32 |
O22.33 |
O22.41 |
O22.42 |
O22.43 |
O22.51 |
O22.52 |
O22.53 |
O22.8X1 |
O22.8X2 |
O22.8X3 |
O23.01 |
O23.02 |
O23.03 |
O23.11 |
O23.12 |
O23.13 |
O23.21 |
O23.22 |
O23.23 |
O23.31 |
O23.32 |
O23.33 |
O23.41 |
O23.42 |
O23.43 |
O23.511 |
O23.512 |
O23.513 |
O23.521 |
O23.522 |
O23.523 |
O23.591 |
O23.592 |
O23.593 |
O23.91 |
O23.92 |
O23.93 |
O24.011 |
O24.012 |
O24.013 |
O24.111 |
O24.112 |
O24.113 |
O24.410 |
O24.414 |
O24.415 |
O24.811 |
O24.812 |
O24.813 |
O25.11 |
O25.12 |
O25.13 |
O26.01 |
O26.02 |
O26.03 |
O26.11 |
O26.12 |
O26.13 |
O26.21 |
O26.22 |
O26.23 |
O26.31 |
O26.32 |
O26.33 |
O26.41 |
O26.42 |
O26.43 |
O26.51 |
O26.52 |
O26.53 |
O26.611 |
O26.612 |
O26.613 |
O26.62 |
O26.63 |
O26.711 |
O26.712 |
O26.713 |
O26.811 |
O26.812 |
O26.813 |
O26.821 |
O26.822 |
O26.823 |
O26.831 |
O26.832 |
O26.833 |
O26.841 |
O26.842 |
O26.843 |
O26.851 |
O26.852 |
O26.853 |
O26.86 |
O26.872 |
O26.873 |
O26.891 |
O26.892 |
O26.893 |
O28.0 |
O28.1 |
O28.2 |
O28.3 |
O28.4 |
O28.5 |
O28.8 |
O28.9 |
O29.011 |
O29.012 |
O29.013 |
O29.021 |
O29.022 |
O29.023 |
O29.091 |
O29.092 |
O29.093 |
O29.111 |
O29.112 |
O29.113 |
O29.121 |
O29.122 |
O29.123 |
O29.191 |
O29.192 |
O29.193 |
O29.211 |
O29.212 |
O29.213 |
O29.291 |
O29.292 |
O29.293 |
O29.3X1 |
O29.3X2 |
O29.3X3 |
O29.41 |
O29.42 |
O29.43 |
O29.5X1 |
O29.5X2 |
O29.5X3 |
O29.61 |
O29.62 |
O29.63 |
O29.8X1 |
O29.8X2 |
O29.8X3 |
O29.91 |
O29.92 |
O29.93 |
O30.001 |
O30.002 |
O30.003 |
O30.011 |
O30.012 |
O30.013 |
O30.021 |
O30.022 |
O30.023 |
O30.031 |
O30.032 |
O30.033 |
O30.041 |
O30.042 |
O30.043 |
O30.091 |
O30.092 |
O30.093 |
O30.101 |
O30.102 |
O30.103 |
O30.111 |
O30.112 |
O30.113 |
O30.121 |
O30.122 |
O30.123 |
O30.131 |
O30.132 |
O30.133 |
O30.191 |
O30.192 |
O30.193 |
O30.201 |
O30.202 |
O30.203 |
O30.211 |
O30.212 |
O30.213 |
O30.221 |
O30.222 |
O30.223 |
O30.231 |
O30.232 |
O30.233 |
O30.291 |
O30.292 |
O30.293 |
O30.801 |
O30.802 |
O30.803 |
O30.811 |
O30.812 |
O30.813 |
O30.821 |
O30.822 |
O30.823 |
O30.831 |
O30.832 |
O30.833 |
O30.891 |
O30.892 |
O30.893 |
O30.91 |
O30.92 |
O30.93 |
O31.01X1 |
O31.01X2 |
O31.01X3 |
O31.01X4 |
O31.01X5 |
O31.01X9 |
O31.02X1 |
O31.02X2 |
O31.02X3 |
O31.02X4 |
O31.02X5 |
O31.02X9 |
O31.03X1 |
O31.03X2 |
O31.03X3 |
O31.03X4 |
O31.03X5 |
O31.03X9 |
O31.11X0 |
O31.11X1 |
O31.11X2 |
O31.11X3 |
O31.11X4 |
O31.11X5 |
O31.11X9 |
O31.12X0 |
O31.12X1 |
O31.12X2 |
O31.12X3 |
O31.12X4 |
O31.12X5 |
O31.12X9 |
O31.13X0 |
O31.13X1 |
O31.13X2 |
O31.13X3 |
O31.13X4 |
O31.13X5 |
O31.13X9 |
O31.21X0 |
O31.21X1 |
O31.21X2 |
O31.21X3 |
O31.21X4 |
O31.21X5 |
O31.21X9 |
O31.22X1 |
O31.22X2 |
O31.22X3 |
O31.22X4 |
O31.22X5 |
O31.22X9 |
O31.23X1 |
O31.23X2 |
O31.23X3 |
O31.23X4 |
O31.23X5 |
O31.23X9 |
O31.31X1 |
O31.31X2 |
O31.31X3 |
O31.31X4 |
O31.31X5 |
O31.31X9 |
O31.32X1 |
O31.32X2 |
O31.32X3 |
O31.32X4 |
O31.32X5 |
O31.32X9 |
O31.33X1 |
O31.33X2 |
O31.33X3 |
O31.33X4 |
O31.33X5 |
O31.33X9 |
O31.8X10 |
O31.8X11 |
O31.8X12 |
O31.8X13 |
O31.8X14 |
O31.8X15 |
O31.8X19 |
O31.8X20 |
O31.8X21 |
O31.8X22 |
O31.8X23 |
O31.8X24 |
O31.8X25 |
O31.8X29 |
O31.8X30 |
O31.8X31 |
O31.8X32 |
O31.8X33 |
O31.8X34 |
O31.8X35 |
O31.8X39 |
O32.0XX1 |
O32.0XX2 |
O32.0XX3 |
O32.0XX4 |
O32.0XX5 |
O32.1XX1 |
O32.1XX2 |
O32.1XX3 |
O32.1XX4 |
O32.1XX5 |
O32.1XX9 |
O32.2XX1 |
O32.2XX2 |
O32.2XX3 |
O32.2XX4 |
O32.2XX5 |
O32.2XX9 |
O32.3XX1 |
O32.3XX2 |
O32.3XX3 |
O32.3XX4 |
O32.3XX5 |
O32.3XX9 |
O32.4XX1 |
O32.4XX2 |
O32.4XX3 |
O32.4XX4 |
O32.4XX5 |
O32.4XX9 |
O32.6XX1 |
O32.6XX2 |
O32.6XX3 |
O32.6XX4 |
O32.6XX5 |
O32.6XX9 |
O32.8XX1 |
O32.8XX2 |
O32.8XX3 |
O32.8XX4 |
O32.8XX5 |
O32.8XX9 |
O33.0 |
O33.1 |
O33.2 |
O33.3XX1 |
O33.3XX2 |
O33.3XX3 |
O33.3XX4 |
O33.3XX5 |
O33.3XX9 |
O33.4XX1 |
O33.4XX2 |
O33.4XX3 |
O33.4XX4 |
O33.4XX5 |
O33.4XX9 |
O33.5XX1 |
O33.5XX2 |
O33.5XX3 |
O33.5XX4 |
O33.5XX5 |
O33.5XX9 |
O33.6XX1 |
O33.6XX2 |
O33.6XX3 |
O33.6XX4 |
O33.6XX5 |
O33.6XX9 |
O33.7 |
O33.7XX1 |
O33.7XX2 |
O33.7XX3 |
O33.7XX4 |
O33.7XX5 |
O33.7XX9 |
O33.8 |
O33.9 |
O34.01 |
O34.02 |
O34.03 |
O34.10 |
O34.11 |
O34.12 |
O34.13 |
O34.21 |
O34.211 |
O34.212 |
O34.218 |
O34.219 |
O34.22 |
O34.29 |
O34.31 |
O34.32 |
O34.33 |
O34.41 |
O34.42 |
O34.43 |
O34.511 |
O34.512 |
O34.513 |
O34.521 |
O34.522 |
O34.523 |
O34.531 |
O34.532 |
O34.533 |
O34.591 |
O34.592 |
O34.593 |
O34.61 |
O34.62 |
O34.63 |
O34.71 |
O34.72 |
O34.73 |
O34.81 |
O34.82 |
O34.83 |
O34.91 |
O34.92 |
O34.93 |
O35.0XX1 |
O35.0XX2 |
O35.0XX3 |
O35.0XX4 |
O35.0XX5 |
O35.0XX9 |
O35.1XX1 |
O35.1XX2 |
O35.1XX3 |
O35.1XX4 |
O35.1XX5 |
O35.1XX9 |
O35.2XX1 |
O35.2XX2 |
O35.2XX3 |
O35.2XX4 |
O35.2XX5 |
O35.2XX9 |
O35.3XX1 |
O35.3XX2 |
O35.3XX3 |
O35.3XX4 |
O35.3XX5 |
O35.3XX9 |
O35.4XX1 |
O35.4XX2 |
O35.4XX3 |
O35.4XX4 |
O35.4XX5 |
O35.4XX9 |
O35.5XX1 |
O35.5XX2 |
O35.5XX3 |
O35.5XX4 |
O35.5XX5 |
O35.5XX9 |
O35.6XX1 |
O35.6XX2 |
O35.6XX3 |
O35.6XX4 |
O35.6XX5 |
O35.6XX9 |
O35.7XX1 |
O35.7XX2 |
O35.7XX3 |
O35.7XX4 |
O35.7XX5 |
O35.7XX9 |
O35.8XX1 |
O35.8XX2 |
O35.8XX3 |
O35.8XX4 |
O35.8XX5 |
O35.8XX9 |
O36.0111 |
O36.0112 |
O36.0113 |
O36.0114 |
O36.0115 |
O36.0119 |
O36.0121 |
O36.0122 |
O36.0123 |
O36.0124 |
O36.0125 |
O36.0129 |
O36.0131 |
O36.0132 |
O36.0133 |
O36.0134 |
O36.0135 |
O36.0139 |
O36.0911 |
O36.0912 |
O36.0913 |
O36.0914 |
O36.0915 |
O36.0919 |
O36.0921 |
O36.0922 |
O36.0923 |
O36.0924 |
O36.0925 |
O36.0929 |
O36.0931 |
O36.0932 |
O36.0933 |
O36.0934 |
O36.0935 |
O36.0939 |
O36.1111 |
O36.1112 |
O36.1113 |
O36.1114 |
O36.1115 |
O36.1119 |
O36.1121 |
O36.1122 |
O36.1123 |
O36.1124 |
O36.1125 |
O36.1129 |
O36.1131 |
O36.1132 |
O36.1133 |
O36.1134 |
O36.1135 |
O36.1139 |
O36.1911 |
O36.1912 |
O36.1913 |
O36.1914 |
O36.1915 |
O36.1919 |
O36.1921 |
O36.1922 |
O36.1923 |
O36.1924 |
O36.1925 |
O36.1929 |
O36.1931 |
O36.1932 |
O36.1933 |
O36.1934 |
O36.1935 |
O36.1939 |
O36.21X1 |
O36.21X2 |
O36.21X3 |
O36.21X4 |
O36.21X5 |
O36.21X9 |
O36.22X1 |
O36.22X2 |
O36.22X3 |
O36.22X4 |
O36.22X5 |
O36.22X9 |
O36.23X1 |
O36.23X2 |
O36.23X3 |
O36.23X4 |
O36.23X5 |
O36.23X9 |
O36.4XX1 |
O36.4XX2 |
O36.4XX3 |
O36.4XX4 |
O36.4XX5 |
O36.4XX9 |
O36.5111 |
O36.5112 |
O36.5113 |
O36.5114 |
O36.5115 |
O36.5119 |
O36.5121 |
O36.5122 |
O36.5123 |
O36.5124 |
O36.5125 |
O36.5129 |
O36.5131 |
O36.5132 |
O36.5133 |
O36.5134 |
O36.5135 |
O36.5139 |
O36.5911 |
O36.5912 |
O36.5913 |
O36.5914 |
O36.5915 |
O36.5919 |
O36.5921 |
O36.5922 |
O36.5923 |
O36.5924 |
O36.5925 |
O36.5929 |
O36.5931 |
O36.5932 |
O36.5933 |
O36.5934 |
O36.5935 |
O36.5939 |
O36.61X1 |
O36.61X2 |
O36.61X3 |
O36.61X4 |
O36.61X5 |
O36.61X9 |
O36.62X1 |
O36.62X2 |
O36.62X3 |
O36.62X4 |
O36.62X5 |
O36.62X9 |
O36.63X1 |
O36.63X2 |
O36.63X3 |
O36.63X4 |
O36.63X5 |
O36.63X9 |
O36.71X1 |
O36.71X2 |
O36.71X3 |
O36.71X4 |
O36.71X5 |
O36.71X9 |
O36.72X1 |
O36.72X2 |
O36.72X3 |
O36.72X4 |
O36.72X5 |
O36.72X9 |
O36.73X1 |
O36.73X2 |
O36.73X3 |
O36.73X4 |
O36.73X5 |
O36.73X9 |
O36.80X1 |
O36.80X2 |
O36.80X3 |
O36.80X4 |
O36.80X5 |
O36.80X9 |
O36.8121 |
O36.8122 |
O36.8123 |
O36.8124 |
O36.8125 |
O36.8129 |
O36.8131 |
O36.8132 |
O36.8133 |
O36.8134 |
O36.8135 |
O36.8139 |
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O36.8212 |
O36.8213 |
O36.8214 |
O36.8215 |
O36.8219 |
O36.8221 |
O36.8222 |
O36.8223 |
O36.8224 |
O36.8225 |
O36.8229 |
O36.8231 |
O36.8232 |
O36.8233 |
O36.8234 |
O36.8235 |
O36.8239 |
O36.8311 |
O36.8312 |
O36.8313 |
O36.8314 |
O36.8315 |
O36.8319 |
O36.8321 |
O36.8322 |
O36.8323 |
O36.8324 |
O36.8325 |
O36.8329 |
O36.8331 |
O36.8332 |
O36.8333 |
O36.8334 |
O36.8335 |
O36.8339 |
O36.8911 |
O36.8912 |
O36.8913 |
O36.8914 |
O36.8915 |
O36.8919 |
O36.8921 |
O36.8922 |
O36.8923 |
O36.8924 |
O36.8925 |
O36.8929 |
O36.8931 |
O36.8932 |
O36.8933 |
O36.8934 |
O36.8935 |
O36.8939 |
O40.1XX1 |
O40.1XX2 |
O40.1XX3 |
O40.1XX4 |
O40.1XX5 |
O40.1XX9 |
O40.2XX1 |
O40.2XX2 |
O40.2XX3 |
O40.2XX4 |
O40.2XX5 |
O40.2XX9 |
O40.3XX1 |
O40.3XX2 |
O40.3XX3 |
O40.3XX4 |
O40.3XX5 |
O40.3XX9 |
O41.01X1 |
O41.01X2 |
O41.01X3 |
O41.01X4 |
O41.01X5 |
O41.01X9 |
O41.02X1 |
O41.02X2 |
O41.02X3 |
O41.02X4 |
O41.02X5 |
O41.02X9 |
O41.03X1 |
O41.03X2 |
O41.03X3 |
O41.03X4 |
O41.03X5 |
O41.03X9 |
O41.1010 |
O41.1011 |
O41.1012 |
O41.1013 |
O41.1014 |
O41.1015 |
O41.1019 |
O41.1020 |
O41.1021 |
O41.1022 |
O41.1023 |
O41.1024 |
O41.1025 |
O41.1029 |
O41.1031 |
O41.1032 |
O41.1033 |
O41.1034 |
O41.1035 |
O41.1039 |
O41.1211 |
O41.1212 |
O41.1213 |
O41.1214 |
O41.1215 |
O41.1219 |
O41.1221 |
O41.1222 |
O41.1223 |
O41.1224 |
O41.1225 |
O41.1229 |
O41.1231 |
O41.1232 |
O41.1233 |
O41.1234 |
O41.1235 |
O41.1239 |
O41.1411 |
O41.1412 |
O41.1413 |
O41.1414 |
O41.1415 |
O41.1419 |
O41.1421 |
O41.1422 |
O41.1423 |
O41.1424 |
O41.1425 |
O41.1429 |
O41.1431 |
O41.1432 |
O41.1433 |
O41.1434 |
O41.1435 |
O41.1439 |
O41.8X11 |
O41.8X12 |
O41.8X13 |
O41.8X14 |
O41.8X15 |
O41.8X19 |
O41.8X21 |
O41.8X22 |
O41.8X23 |
O41.8X24 |
O41.8X25 |
O41.8X29 |
O41.8X31 |
O41.8X32 |
O41.8X33 |
O41.8X34 |
O41.8X35 |
O41.8X39 |
O41.91X0 |
O41.91X1 |
O41.91X2 |
O41.91X3 |
O41.91X4 |
O41.91X5 |
O41.91X9 |
O41.92X0 |
O41.92X1 |
O41.92X2 |
O41.92X3 |
O41.92X4 |
O41.92X5 |
O41.92X9 |
O41.93X0 |
O41.93X1 |
O41.93X2 |
O41.93X3 |
O41.93X4 |
O41.93X5 |
O41.93X9 |
O42.00 |
O42.011 |
O42.012 |
O42.013 |
O42.02 |
O42.10 |
O42.111 |
O42.112 |
O42.113 |
O42.12 |
O42.90 |
O42.911 |
O42.912 |
O42.913 |
O42.92 |
O43.011 |
O43.012 |
O43.013 |
O43.021 |
O43.022 |
O43.023 |
O43.101 |
O43.102 |
O43.103 |
O43.111 |
O43.112 |
O43.113 |
O43.121 |
O43.122 |
O43.123 |
O43.191 |
O43.192 |
O43.193 |
O43.211 |
O43.212 |
O43.213 |
O43.221 |
O43.222 |
O43.223 |
O43.231 |
O43.232 |
O43.233 |
O43.811 |
O43.812 |
O43.813 |
O43.891 |
O43.892 |
O43.893 |
O43.91 |
O43.92 |
O43.93 |
O44.01 |
O44.02 |
O44.03 |
O44.11 |
O44.12 |
O44.13 |
O44.21 |
O44.22 |
O44.23 |
O44.31 |
O44.32 |
O44.33 |
O44.41 |
O44.42 |
O44.43 |
O44.51 |
O44.52 |
O44.53 |
O45.001 |
O45.002 |
O45.003 |
O45.011 |
O45.012 |
O45.013 |
O45.021 |
O45.022 |
O45.023 |
O45.091 |
O45.092 |
O45.093 |
O45.8X1 |
O45.8X2 |
O45.8X3 |
O46.001 |
O46.002 |
O46.003 |
O46.011 |
O46.012 |
O46.013 |
O46.021 |
O46.022 |
O46.023 |
O46.091 |
O46.092 |
O46.093 |
O46.8X1 |
O46.8X2 |
O46.8X3 |
O46.91 |
O46.92 |
O46.93 |
O47.00 |
O47.02 |
O47.03 |
O47.1 |
O47.9 |
O48.0 |
O48.1 |
O60.02 |
O60.03 |
O71.00 |
O71.02 |
O71.03 |
O71.1 |
O71.2 |
O71.3 |
O71.4 |
O71.5 |
O71.6 |
O71.7 |
O71.81 |
O71.82 |
O71.89 |
O71.9 |
O88.011 |
O88.012 |
O88.013 |
O88.111 |
O88.112 |
O88.113 |
O88.211 |
O88.212 |
O88.213 |
O88.311 |
O88.312 |
O88.313 |
O88.811 |
O88.812 |
O88.813 |
O91.011 |
O91.012 |
O91.013 |
O91.03 |
O91.111 |
O91.112 |
O91.113 |
O91.13 |
O91.211 |
O91.212 |
O91.213 |
O91.23 |
O92.011 |
O92.012 |
O92.013 |
O92.03 |
O92.111 |
O92.112 |
O92.113 |
O92.13 |
O92.3 |
O92.4 |
O92.5 |
O92.6 |
O92.79 |
O98.011 |
O98.012 |
O98.013 |
O98.111 |
O98.112 |
O98.113 |
O98.211 |
O98.212 |
O98.213 |
O98.311 |
O98.312 |
O98.313 |
O98.411 |
O98.412 |
O98.413 |
O98.511 |
O98.512 |
O98.513 |
O98.611 |
O98.612 |
O98.613 |
O98.711 |
O98.712 |
O98.713 |
O98.811 |
O98.812 |
O98.813 |
O98.911 |
O98.912 |
O98.913 |
O99.011 |
O99.012 |
O99.013 |
O99.111 |
O99.112 |
O99.113 |
O99.211 |
O99.212 |
O99.213 |
O99.281 |
O99.282 |
O99.283 |
O99.311 |
O99.312 |
O99.313 |
O99.321 |
O99.322 |
O99.323 |
O99.331 |
O99.332 |
O99.333 |
O99.341 |
O99.342 |
O99.343 |
O99.351 |
O99.352 |
O99.353 |
O99.411 |
O99.412 |
O99.413 |
O99.511 |
O99.512 |
O99.513 |
O99.611 |
O99.612 |
O99.613 |
O99.711 |
O99.712 |
O99.713 |
O99.810 |
O99.820 |
O99.830 |
O99.841 |
O99.842 |
O99.843 |
O99.891 |
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O9A.112 |
O9A.113 |
O9A.211 |
O9A.212 |
O9A.213 |
O9A.311 |
O9A.312 |
O9A.313 |
O9A.411 |
O9A.412 |
O9A.413 |
O9A.511 |
O9A.512 |
O9A.513 |
T15.01XA |
T15.01XD |
T15.01XS |
T15.02XA |
T15.02XD |
T15.02XS |
T15.11XA |
T15.11XD |
T15.11XS |
T15.12XA |
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T15.81XA |
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T15.82XA |
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T16.1XXA |
T16.1XXD |
T16.1XXS |
T16.2XXA |
T16.2XXD |
T16.2XXS |
T17.0XXA |
T17.0XXD |
T17.0XXS |
T17.1XXA |
T17.1XXD |
T17.1XXS |
T17.200A |
T17.200D |
T17.200S |
T17.208A |
T17.208D |
T17.208S |
T17.210A |
T17.210D |
T17.210S |
T17.218A |
T17.218D |
T17.218S |
T17.220A |
T17.220D |
T17.220S |
T17.228A |
T17.228D |
T17.228S |
T17.290A |
T17.290D |
T17.290S |
T17.298A |
T17.298D |
T17.298S |
T17.300A |
T17.300D |
T17.300S |
T17.308A |
T17.308D |
T17.308S |
T17.310A |
T17.310D |
T17.310S |
T17.318A |
T17.318D |
T17.318S |
T17.320A |
T17.320D |
T17.320S |
T17.328A |
T17.328D |
T17.328S |
T17.390A |
T17.390D |
T17.390S |
T17.398A |
T17.398D |
T17.398S |
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T17.400S |
T17.408A |
T17.408D |
T17.408S |
T17.410A |
T17.410D |
T17.410S |
T17.418A |
T17.418D |
T17.418S |
T17.420A |
T17.420D |
T17.420S |
T17.428A |
T17.428D |
T17.428S |
T17.490A |
T17.490D |
T17.490S |
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T17.498S |
T17.500A |
T17.500D |
T17.500S |
T17.508A |
T17.508D |
T17.508S |
T17.510A |
T17.510D |
T17.510S |
T17.518A |
T17.518D |
T17.518S |
T17.520A |
T17.520D |
T17.520S |
T17.528A |
T17.528D |
T17.528S |
T17.590A |
T17.590D |
T17.590S |
T17.598A |
T17.598D |
T17.598S |
T17.800A |
T17.800D |
T17.800S |
T17.808A |
T17.808D |
T17.808S |
T17.810A |
T17.810D |
T17.810S |
T17.818A |
T17.818D |
T17.818S |
T17.820A |
T17.820D |
T17.820S |
T17.828A |
T17.828D |
T17.828S |
T17.890A |
T17.890D |
T17.890S |
T17.898A |
T17.898D |
T17.898S |
T17.900A |
T17.900D |
T17.900S |
T17.908A |
T17.908D |
T17.908S |
T17.910A |
T17.910D |
T17.910S |
T17.918A |
T17.918D |
T17.918S |
T17.920A |
T17.920D |
T17.920S |
T17.928A |
T17.928D |
T17.928S |
T17.990A |
T17.990D |
T17.990S |
T17.998A |
T17.998D |
T17.998S |
T18.0XXA |
T18.0XXD |
T18.0XXS |
T18.100A |
T18.100D |
T18.100S |
T18.108A |
T18.108D |
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T18.118A |
T18.118D |
T18.118S |
T18.120A |
T18.120D |
T18.120S |
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T18.2XXA |
T18.2XXD |
T18.2XXS |
T18.3XXA |
T18.3XXD |
T18.3XXS |
T18.4XXA |
T18.4XXD |
T18.4XXS |
T18.5XXA |
T18.5XXD |
T18.5XXS |
T18.8XXA |
T18.8XXD |
T18.8XXS |
T18.9XXA |
T18.9XXD |
T18.9XXS |
T19.0XXA |
T19.0XXD |
T19.0XXS |
T19.1XXA |
T19.1XXD |
T19.1XXS |
T19.2XXA |
T19.2XXD |
T19.2XXS |
T19.3XXA |
T19.3XXD |
T19.3XXS |
T19.4XXA |
T19.4XXD |
T19.4XXS |
T19.8XXA |
T19.8XXD |
T19.8XXS |
T19.9XXA |
T19.9XXD |
T19.9XXS |
T88.4XXA |
T88.4XXD |
T88.4XXS |
T88.59XA |
T88.59XD |
T88.59XS |
Z00.111 |
Z00.121 |
Z00.129 |
Z01.83 |
Z03.71 |
Z03.72 |
Z03.73 |
Z03.74 |
Z03.75 |
Z03.79 |
Z13.0 |
Z13.6 |
Z18.89 |
Z18.9 |
Z32.01 |
Z34.01 |
Z34.02 |
Z34.03 |
Z34.81 |
Z34.82 |
Z34.83 |
Z36.0 |
Z36.1 |
Z36.2 |
Z36.3 |
Z36.4 |
Z36.5 |
Z36.81 |
Z36.82 |
Z36.83 |
Z36.84 |
Z36.85 |
Z36.86 |
Z36.87 |
Z36.88 |
Z36.89 |
Z36.8A |
Z53.09 |
Z74.09 |
Z86.73 |
Z86.74 |
Z91.89 |
Z92.83 |
Z92.84 |
Z95.5 |
Z95.810 |
Z95.811 |
Z95.818 |
Z95.820 |
Z95.828 |
Z95.9 |
Z98.61 |
Z99.11 |
Z99.12 |
Z99.2 |
Z99.2 |
Z99.81 |
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Site of care is typically an outpatient procedure which is only eligible for coverage as an inpatient procedure in special circumstances, including, but not limited to, the presence of a co-morbid condition that would require monitoring in a more controlled environment such as the inpatient setting.
Evidence-based guidelines support the choice of site of care.
This policy is designed to address medical guidelines that are appropriate for the majority of individuals with a particular disease, illness, or condition. Each person's unique clinical or other circumstances may warrant individual consideration, based on review of applicable medical records, as well as other regulatory, contractual and/or legal requirements.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect Highmark's reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract, and subject to the applicable laws of your state.
Highmark retains the right to review and update its medical policy guidelines at its sole discretion. These guidelines are the proprietary information of Highmark. Any sale, copying or dissemination of the medical policies is prohibited; however, limited copying of medical policies is permitted for individual use.
Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:
· Provides free aids and services to people with disabilities to communicate effectively with us, such as:
o Qualified sign language interpreters
o Written information in other formats (large print, audio, accessible electronic formats, other formats)
· Provides free language services to people whose primary language is not English, such as:
o Qualified interpreters
o Information written in other languages
If you need these services, contact the Civil Rights Coordinator.
If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
This information is issued by Highmark Blue Shield on behalf of its affiliated Blue companies, which are independent licensees of the Blue Cross Blue Shield Association. Highmark Inc. d/b/a Highmark Blue Shield and certain of its affiliated Blue companies serve Blue Shield members in the 21 counties of central Pennsylvania. As a partner in joint operating agreements, Highmark Blue Shield also provides services in conjunction with a separate health plan in southeastern Pennsylvania. Highmark Inc. or certain of its affiliated Blue companies also serve Blue Cross Blue Shield members in 29 counties in western Pennsylvania, 13 counties in northeastern Pennsylvania, the state of West Virginia plus Washington County, Ohio, the state of Delaware[ and [8] counties in western New York and Blue Shield members in [13] counties in northeastern New York]. All references to Highmark in this document are references to Highmark Inc. d/b/a Highmark Blue Shield and/or to one or more of its affiliated Blue companies.
Medical policies do not constitute medical advice, nor are they intended to govern the practice of medicine. They are intended to reflect reimbursement and coverage guidelines. Coverage for services may vary for individual members, based on the terms of the benefit contract.
Discrimination is Against the Law
The Claims Administrator/Insurer complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. The Claims Administrator/Insurer does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex. The Claims Administrator/ Insurer:
If you believe that the Claims Administrator/Insurer has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Civil Rights Coordinator, P.O. Box 22492, Pittsburgh, PA 15222, Phone: 1-866-286-8295, TTY: 711, Fax: 412-544-2475, email: CivilRightsCoordinator@highmarkhealth.org. You can file a grievance in person or by mail, fax, or email. If you need help filing a grievance, the Civil Rights Coordinator is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
