New / Changed in 2020: |
|
Service Description: |
Skilled Nursing Facility |
Restricted to Preferred Facilities: |
|
Service Code: |
0022 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Skilled Nursing Facility |
0022 |
New / Changed in 2020: |
|
Service Description: |
Room and Board, Subacute Pediatric (Private Hospital) |
Restricted to Preferred Facilities: |
|
Service Code: |
0190 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Room and Board, Subacute Pediatric (Private Hospital) |
0190 |
New / Changed in 2020: |
|
Service Description: |
Subacute Care - Level I |
Restricted to Preferred Facilities: |
|
Service Code: |
0191 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Subacute Care - Level I |
0191 |
New / Changed in 2020: |
|
Service Description: |
Subacute Care - Level II |
Restricted to Preferred Facilities: |
|
Service Code: |
0192 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Subacute Care - Level II |
0192 |
New / Changed in 2020: |
|
Service Description: |
Subacute Care - Level III |
Restricted to Preferred Facilities: |
|
Service Code: |
0193 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Subacute Care - Level III |
0193 |
New / Changed in 2020: |
|
Service Description: |
Subacute Care - Level IV |
Restricted to Preferred Facilities: |
|
Service Code: |
0194 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Subacute Care - Level IV |
0194 |
New / Changed in 2020: |
|
Service Description: |
Room and Board, Subacute Adult (Private Hospital) |
Restricted to Preferred Facilities: |
|
Service Code: |
0199 |
Service Code Type: |
REV |
Effective Date: |
1/1/1996 12:00:00 AM |
|
Admission to an Intermediate Care Facility (ICF) or a Skilled Nursing Facility (SNF) |
Room and Board, Subacute Adult (Private Hospital) |
0199 |
New / Changed in 2020: |
|
Service Description: |
Electroshock Behavioral Health Treatments/Services |
Restricted to Preferred Facilities: |
|
Service Code: |
0901 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Outpatient electro-convulsive treatment |
Electroshock Behavioral Health Treatments/Services |
0901 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION INTERNAL ANAL SPHINCTER |
Restricted to Preferred Facilities: |
|
Service Code: |
46505 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION INTERNAL ANAL SPHINCTER |
46505 |
New / Changed in 2020: |
|
Service Description: |
CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER |
Restricted to Preferred Facilities: |
|
Service Code: |
52287 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CYSTOURETHROSCOPY INJ CHEMODENERVATION BLADDER |
52287 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS |
Restricted to Preferred Facilities: |
|
Service Code: |
64611 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERV PAROTID&SUBMANDIBL SALIVARY GLNDS |
64611 |
New / Changed in 2020: |
|
Service Description: |
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL |
Restricted to Preferred Facilities: |
|
Service Code: |
64612 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV UNIL |
64612 |
New / Changed in 2020: |
|
Service Description: |
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE |
Restricted to Preferred Facilities: |
|
Service Code: |
64615 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODERVATE FACIAL/TRIGEM/CERV MUSC MIGRAINE |
64615 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA |
Restricted to Preferred Facilities: |
|
Service Code: |
64616 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION MUSCLE NECK UNILAT FOR DYSTONIA |
64616 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG |
Restricted to Preferred Facilities: |
|
Service Code: |
64617 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION MUSCLE LARYNX UNILAT W/EMG |
64617 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE |
Restricted to Preferred Facilities: |
|
Service Code: |
64642 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION ONE EXTREMITY 1-4 MUSCLE |
64642 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE |
Restricted to Preferred Facilities: |
|
Service Code: |
64643 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION 1 EXTREMITY EA ADDL 1-4 MUSCLE |
64643 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES |
Restricted to Preferred Facilities: |
|
Service Code: |
64644 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION 1 EXTREMITY 5 OR MORE MUSCLES |
64644 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES |
Restricted to Preferred Facilities: |
|
Service Code: |
64645 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION 1 EXTREMITY EA ADDL 5/> MUSCLES |
64645 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES |
Restricted to Preferred Facilities: |
|
Service Code: |
64646 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION OF TRUNK MUSCLE 1-5 MUSCLES |
64646 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES |
Restricted to Preferred Facilities: |
|
Service Code: |
64647 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION OF TRUNK 6 OR MORE MUSCLES |
64647 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE |
Restricted to Preferred Facilities: |
|
Service Code: |
64650 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION ECCRINE GLANDS BOTH AXILLAE |
64650 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY |
Restricted to Preferred Facilities: |
|
Service Code: |
64653 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION ECCRINE GLANDS OTH AREA PER DAY |
64653 |
New / Changed in 2020: |
|
Service Description: |
CHEMODENERVATION EXTRAOCULAR MUSCLE |
Restricted to Preferred Facilities: |
|
Service Code: |
67345 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2000 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
CHEMODENERVATION EXTRAOCULAR MUSCLE |
67345 |
New / Changed in 2020: |
|
Service Description: |
Unlisted procedure, therapeutic radiology clinical treatment planning |
Restricted to Preferred Facilities: |
|
Service Code: |
77299 |
Service Code Type: |
CPT |
Effective Date: |
8/15/2016 12:00:00 AM |
|
Radiation Oncology- Prep for Treatment |
Unlisted procedure, therapeutic radiology clinical treatment planning |
77299 |
New / Changed in 2020: |
|
Service Description: |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence |
Restricted to Preferred Facilities: |
|
Service Code: |
81201 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence |
81201 |
New / Changed in 2020: |
|
Service Description: |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants |
Restricted to Preferred Facilities: |
|
Service Code: |
81202 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; known familial variants |
81202 |
New / Changed in 2020: |
|
Service Description: |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion varian |
Restricted to Preferred Facilities: |
|
Service Code: |
81203 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; duplication/deletion varian |
81203 |
New / Changed in 2020: |
|
Service Description: |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81288 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81288 |
New / Changed in 2020: |
|
Service Description: |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81292 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81292 |
New / Changed in 2020: |
|
Service Description: |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81293 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81293 |
New / Changed in 2020: |
|
Service Description: |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81294 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81294 |
New / Changed in 2020: |
|
Service Description: |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81295 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81295 |
New / Changed in 2020: |
|
Service Description: |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81296 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81296 |
New / Changed in 2020: |
|
Service Description: |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
Restricted to Preferred Facilities: |
|
Service Code: |
81297 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH2 (mutS homolog 2, colon cancer, nonpolyposis type 1) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysis; |
81297 |
New / Changed in 2020: |
|
Service Description: |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
Restricted to Preferred Facilities: |
|
Service Code: |
81298 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; full sequence analysis |
81298 |
New / Changed in 2020: |
|
Service Description: |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
Restricted to Preferred Facilities: |
|
Service Code: |
81299 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; known familial variants |
81299 |
New / Changed in 2020: |
|
Service Description: |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion va |
Restricted to Preferred Facilities: |
|
Service Code: |
81300 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
MSH6 (mutS homolog 6 [E. coli]) (e.g., hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; duplication/deletion va |
81300 |
New / Changed in 2020: |
|
Service Description: |
Microsatellite instability analysis of markers for mismatch repair deficiency, includes comparison of neoplastic and normal tissue |
Restricted to Preferred Facilities: |
|
Service Code: |
81301 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
Microsatellite instability analysis of markers for mismatch repair deficiency, includes comparison of neoplastic and normal tissue |
81301 |
New / Changed in 2020: |
|
Service Description: |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
Restricted to Preferred Facilities: |
|
Service Code: |
81317 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
81317 |
New / Changed in 2020: |
|
Service Description: |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
Restricted to Preferred Facilities: |
|
Service Code: |
81318 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
81318 |
New / Changed in 2020: |
|
Service Description: |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
Restricted to Preferred Facilities: |
|
Service Code: |
81319 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
PMS2 (postmeiotic segregation increased 2 [S. cerevisiae]) (e.g., hereditary nonpolyposis colorectal cancer, Lynch syndrome) gene analysi |
81319 |
New / Changed in 2020: |
|
Service Description: |
Hereditary colon cancer syndromes (e.g., Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2 |
Restricted to Preferred Facilities: |
|
Service Code: |
81435 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
Hereditary colon cancer syndromes (e.g., Lynch syndrome, familial adenomatosis polyposis); genomic sequence analysis panel, must include analysis of at least 7 genes, including APC, CHEK2, MLH1, MSH2, MSH6, MUTYH, and PMS2 |
81435 |
New / Changed in 2020: |
|
Service Description: |
Hereditary colon cancer syndromes (e.g., Lynch syndrome, familial adenomatosis polyposis); duplication/deletion gene analysis panel, must include analysis of at least 8 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYH |
Restricted to Preferred Facilities: |
|
Service Code: |
81436 |
Service Code Type: |
CPT |
Effective Date: |
4/1/2011 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
Hereditary colon cancer syndromes (e.g., Lynch syndrome, familial adenomatosis polyposis); duplication/deletion gene analysis panel, must include analysis of at least 8 genes, including APC, MLH1, MSH2, MSH6, PMS2, EPCAM, CHEK2, and MUTYH |
81436 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, al |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
81519 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Genetic Testing - Breast or Ovarian Cancer |
Oncology (breast), mRNA, gene expression profiling by real-time RT-PCR of 21 genes, utilizing formalin-fixed paraffin embedded tissue, al |
81519 |
New / Changed in 2020: |
|
Service Description: |
ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES |
Restricted to Preferred Facilities: |
|
Service Code: |
81525 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Genetic Testing - Colorectal Cancer |
ONCOLOGY COLON MRNA GENE EXPRESSION 12 GENES |
81525 |
New / Changed in 2020: |
|
Service Description: |
Electroconvulsive therapy; includes necessary monitoring |
Restricted to Preferred Facilities: |
|
Service Code: |
90870 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Outpatient electro-convulsive treatment |
Electroconvulsive therapy; includes necessary monitoring |
90870 |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0537T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Kymriah (tisagenleclencel) |
Kymriah or Yescarta |
0537T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0537T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Yescarta (axicabtagene ciloleucel) |
Kymriah or Yescarta |
0537T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0538T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Kymriah (tisagenleclencel) |
Kymriah or Yescarta |
0538T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0538T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Yescarta (axicabtagene ciloleucel) |
Kymriah or Yescarta |
0538T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0539T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Kymriah (tisagenleclencel) |
Kymriah or Yescarta |
0539T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0539T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Yescarta (axicabtagene ciloleucel) |
Kymriah or Yescarta |
0539T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0540T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Kymriah (tisagenleclencel) |
Kymriah or Yescarta |
0540T |
New / Changed in 2020: |
|
Service Description: |
Kymriah or Yescarta |
Restricted to Preferred Facilities: |
|
Service Code: |
0540T |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Yescarta (axicabtagene ciloleucel) |
Kymriah or Yescarta |
0540T |
New / Changed in 2020: |
|
Service Description: |
Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
Restricted to Preferred Facilities: |
|
Service Code: |
A4555 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Radiation Oncology-Tumor Treatment Fields |
Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
A4555 |
New / Changed in 2020: |
|
Service Description: |
Lutetium lu 177, dotatate, therapeutic, 1 millicurie |
Restricted to Preferred Facilities: |
|
Service Code: |
A9513 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Lutathera (luteum Lu 177 dotate) |
Lutetium lu 177, dotatate, therapeutic, 1 millicurie |
A9513 |
New / Changed in 2020: |
|
Service Description: |
Unclassified drugs or biologicals |
Restricted to Preferred Facilities: |
|
Service Code: |
C9399 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Cosentyx® (secukinumab) vials |
Unclassified drugs or biologicals |
C9399 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Cranial prosthesis |
Restricted to Preferred Facilities: |
|
Service Code: |
D5924 |
Service Code Type: |
HCPCS |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Cranial Orthotics – helmets/remolding bands for Infants |
Cranial prosthesis |
D5924 |
New / Changed in 2020: |
|
Service Description: |
Electrical stimulation device used for cancer treatment, includes all accessories, any type |
Restricted to Preferred Facilities: |
|
Service Code: |
E0766 |
Service Code Type: |
HCPCS |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Radiation Oncology-Tumor Treatment Fields |
Electrical stimulation device used for cancer treatment, includes all accessories, any type |
E0766 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
Injection, benralizumab, 1 mg |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
J0517 |
Service Code Type: |
HCPCS |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Fasenra (benralizumab) |
Injection, benralizumab, 1 mg |
J0517 |
New / Changed in 2020: |
|
Service Description: |
Injection, bezlotoxumab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J0565 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Zinplava (bezlotoxumab) |
Injection, bezlotoxumab, 10 mg |
J0565 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
Injection, onabotulinumtoxina, 1 unit |
Restricted to Preferred Facilities: |
|
Service Code: |
J0585 |
Service Code Type: |
HCPCS |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Chemodenervation-Botox® (Botulinum toxin Type A) |
Injection, onabotulinumtoxina, 1 unit |
J0585 |
New / Changed in 2020: |
|
Service Description: |
Injection, etelcalcetide, 0.1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J0606 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Parsabiv (etelcalcetide) |
Injection, etelcalcetide, 0.1 mg |
J0606 |
New / Changed in 2020: |
|
Service Description: |
Injection, edaravone, 1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J1301 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Radicava (edaravone) |
Injection, edaravone, 1 mg |
J1301 |
New / Changed in 2020: |
|
Service Description: |
Inj, granisetron, xr, 0.1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J1627 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Sustol (granisetron extended release) |
Inj, granisetron, xr, 0.1 mg |
J1627 |
New / Changed in 2020: |
|
Service Description: |
Injection, meropenem and vaborbactam, 10mg/10mg (20mg) |
Restricted to Preferred Facilities: |
|
Service Code: |
J2186 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Vabomere (meropenem/vaborbactam) |
Injection, meropenem and vaborbactam, 10mg/10mg (20mg) |
J2186 |
New / Changed in 2020: |
|
Service Description: |
Injection, ocrelizumab, 1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J2350 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ocrevus (ocrelizumab) |
Injection, ocrelizumab, 1 mg |
J2350 |
New / Changed in 2020: |
|
Service Description: |
Injection, olanzapine, long-acting, 1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J2358 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Zyprexa Relprevv® (olanzapine) |
Injection, olanzapine, long-acting, 1 mg |
J2358 |
New / Changed in 2020: |
|
Service Description: |
Injection, Durvalumab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J3304 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Zilretta (triamcinolone acetonide ER injection) |
Injection, Durvalumab, 10 mg |
J3304 |
New / Changed in 2020: |
|
Service Description: |
Ustekinumab, for intravenous injection, 1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J3358 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stelara™ (ustekinumab) |
Ustekinumab, for intravenous injection, 1 mg |
J3358 |
New / Changed in 2020: |
|
Service Description: |
Inj., vestronidase alfa-vjbk |
Restricted to Preferred Facilities: |
|
Service Code: |
J3397 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Mepsevii (vestronidase alfa-vjbk) |
Inj., vestronidase alfa-vjbk |
J3397 |
New / Changed in 2020: |
|
Service Description: |
Inj luxturna 1 billion vec g |
Restricted to Preferred Facilities: |
|
Service Code: |
J3398 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Luxturna (voretigeneneparvovec-rzyl) |
Inj luxturna 1 billion vec g |
J3398 |
New / Changed in 2020: |
|
Service Description: |
Unclassified drugs |
Restricted to Preferred Facilities: |
|
Service Code: |
J3490 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Cosentyx® (secukinumab) vials |
Unclassified drugs |
J3490 |
New / Changed in 2020: |
|
Service Description: |
Unclassified drugs |
Restricted to Preferred Facilities: |
|
Service Code: |
J3490 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Unituxin (dinutuximab) |
Unclassified drugs |
J3490 |
New / Changed in 2020: |
|
Service Description: |
Unclassified biologics |
Restricted to Preferred Facilities: |
|
Service Code: |
J3590 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Unituxin (dinutuximab) |
Unclassified biologics |
J3590 |
New / Changed in 2020: |
|
Service Description: |
Injection, atezolizumab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9022 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Tecentriq™ (atezolizumab) |
Injection, atezolizumab, 10 mg |
J9022 |
New / Changed in 2020: |
|
Service Description: |
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine |
Restricted to Preferred Facilities: |
|
Service Code: |
J9153 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Vyxeos (daunorubicin/cytarabine liposomal) |
Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine |
J9153 |
New / Changed in 2020: |
|
Service Description: |
Injection, durvalumab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9173 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Imfinzi (durvalumab) |
Injection, durvalumab, 10 mg |
J9173 |
New / Changed in 2020: |
|
Service Description: |
Gemtuzumab ozogamicin 0.1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9203 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Mylotarg (gemfuzumab ozogamicin) |
Gemtuzumab ozogamicin 0.1 mg |
J9203 |
New / Changed in 2020: |
|
Service Description: |
Inj, olaratumab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9285 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Lartruvo (olaratumab) |
Inj, olaratumab, 10 mg |
J9285 |
New / Changed in 2020: |
|
Service Description: |
Injection, rituximab 10 mg and hyaluronidase |
Restricted to Preferred Facilities: |
|
Service Code: |
J9311 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Rituxin Hycela (rituximab/hyaluronidase) |
Injection, rituximab 10 mg and hyaluronidase |
J9311 |
New / Changed in 2020: |
|
Service Description: |
Injection, rituximab, 10 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9312 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Rituxan® (rituximab) Rituxan for Non-Hodgkin’s Lymphoma does not require prior authorization. |
Injection, rituximab, 10 mg |
J9312 |
New / Changed in 2020: |
|
Service Description: |
Injection, thiotepa, 15 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
J9340 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Tepadina (thiotepa) |
Injection, thiotepa, 15 mg |
J9340 |
New / Changed in 2020: |
|
Service Description: |
Not otherwise classified, antineoplastic drugs |
Restricted to Preferred Facilities: |
|
Service Code: |
J9999 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Unituxin (dinutuximab) |
Not otherwise classified, antineoplastic drugs |
J9999 |
New / Changed in 2020: |
|
Service Description: |
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated |
Restricted to Preferred Facilities: |
|
Service Code: |
L0112 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Cranial Orthotics – helmets/remolding bands for Infants |
Cranial cervical orthosis, congenital torticollis type, with or without soft interface material, adjustable range of motion joint, custom fabricated |
L0112 |
New / Changed in 2020: |
|
Service Description: |
Cranial cervical orthotic, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment |
Restricted to Preferred Facilities: |
|
Service Code: |
L0113 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Cranial Orthotics – helmets/remolding bands for Infants |
Cranial cervical orthotic, torticollis type, with or without joint, with or without soft interface material, prefabricated, includes fitting and adjustment |
L0113 |
New / Changed in 2020: |
|
Service Description: |
Durable Medical Equipment (Outpatient - see Comments) |
Restricted to Preferred Facilities: |
|
Service Code: |
N/A |
Service Code Type: |
|
Effective Date: |
1/1/2020 12:00:00 AM |
|
Durable Medical Equipment (Outpatient - see Comments) |
Durable Medical Equipment (Outpatient - see Comments) |
N/A |
New / Changed in 2020: |
|
Service Description: |
|
Restricted to Preferred Facilities: |
|
Service Code: |
N/A |
Service Code Type: |
|
Effective Date: |
1/1/2020 12:00:00 AM |
|
Health Care Services associated with Non-covered Services (including but not limited to deep sedation and general anesthesia) |
|
N/A |
New / Changed in 2020: |
|
Service Description: |
Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco |
Restricted to Preferred Facilities: |
|
Service Code: |
Q2041 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Yescarta (axicabtagene ciloleucel) |
Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco |
Q2041 |
New / Changed in 2020: |
|
Service Description: |
Injection, hydroxyprogesterone caproate, 1 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
Q2042 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Kymriah (tisagenleclencel) |
Injection, hydroxyprogesterone caproate, 1 mg |
Q2042 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
Q5103 |
Service Code Type: |
HCPCS |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inflectra (infliximab-dyyb) |
Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg |
Q5103 |
New / Changed in 2020: |
|
Service Description: |
Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
Q9991 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Sublocade (buprenorphine ER injection for subcutaneous use ) |
Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg |
Q9991 |
New / Changed in 2020: |
|
Service Description: |
Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
Restricted to Preferred Facilities: |
|
Service Code: |
Q9992 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Sublocade (buprenorphine ER injection for subcutaneous use ) |
Injection, buprenorphine extended-release (sublocade), greater than 100 mg |
Q9992 |
New / Changed in 2020: |
|
Service Description: |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
Restricted to Preferred Facilities: |
|
Service Code: |
S1040 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Cranial Orthotics – helmets/remolding bands for Infants |
Cranial remolding orthosis, pediatric, rigid, with soft interface material, custom fabricated, includes fitting and adjustment(s) |
S1040 |
New / Changed in 2020: |
|
Service Description: |
Ambulatory setting substance abuse treatment or detoxification services, per diem |
Restricted to Preferred Facilities: |
|
Service Code: |
S9475 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Outpatient treatment of Opioid dependence |
Ambulatory setting substance abuse treatment or detoxification services, per diem |
S9475 |
New / Changed in 2020: |
|
Service Description: |
Private duty/independent nursing service(s), licensed, up to 15 minutes |
Restricted to Preferred Facilities: |
|
Service Code: |
T1000 |
Service Code Type: |
HCPCS |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Hospice |
Private duty/independent nursing service(s), licensed, up to 15 minutes |
T1000 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Medical/Surgical/Gynecological |
Restricted to Preferred Facilities: |
|
Service Code: |
0111 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Medical/Surgical/Gynecological |
0111 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, OB |
Restricted to Preferred Facilities: |
|
Service Code: |
0112 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, OB |
0112 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Pediatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0113 |
Service Code Type: |
REV |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Pediatric |
0113 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0114 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Room and Board – Private, Psychiatric |
0114 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0114 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Psychiatric |
0114 |
New / Changed in 2020: |
|
Service Description: |
Detoxification Room and Board Private (one bed) |
Restricted to Preferred Facilities: |
|
Service Code: |
0116 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Detoxification Room and Board Private (one bed) |
0116 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Oncology |
Restricted to Preferred Facilities: |
|
Service Code: |
0117 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Oncology |
0117 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Rehabilitation |
Restricted to Preferred Facilities: |
|
Service Code: |
0118 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Rehabilitation |
0118 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Private, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0119 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Private, Other |
0119 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Medical/Surgical/Gynecological |
Restricted to Preferred Facilities: |
|
Service Code: |
0121 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Medical/Surgical/Gynecological |
0121 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Obstetric |
Restricted to Preferred Facilities: |
|
Service Code: |
0122 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Obstetric |
0122 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Pediatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0123 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Pediatric |
0123 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0124 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Room and Board – Semiprivate 2 Bed, Psychiatric |
0124 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0124 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Psychiatric |
0124 |
New / Changed in 2020: |
|
Service Description: |
Detoxification Room and Board Semiprivate (two beds) |
Restricted to Preferred Facilities: |
|
Service Code: |
0126 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Detoxification Room and Board Semiprivate (two beds) |
0126 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Oncology |
Restricted to Preferred Facilities: |
|
Service Code: |
0127 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Oncology |
0127 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 2 Bed, Rehabilitation |
Restricted to Preferred Facilities: |
|
Service Code: |
0128 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 2 Bed, Rehabilitation |
0128 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate, 2 Beds, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0129 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate, 2 Beds, Other |
0129 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Medical/Surgical/Gynecological |
Restricted to Preferred Facilities: |
|
Service Code: |
0131 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Medical/Surgical/Gynecological |
0131 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Obstetric |
Restricted to Preferred Facilities: |
|
Service Code: |
0132 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Obstetric |
0132 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Pediatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0133 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Pediatric |
0133 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0134 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Room and Board – Semiprivate 3 or 4 Bed, Psychiatric |
0134 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0134 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Psychiatric |
0134 |
New / Changed in 2020: |
|
Service Description: |
Detoxification Room and Board (3 and 4 beds) |
Restricted to Preferred Facilities: |
|
Service Code: |
0136 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Detoxification Room and Board (3 and 4 beds) |
0136 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Oncology |
Restricted to Preferred Facilities: |
|
Service Code: |
0137 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Oncology |
0137 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate 3 or 4 Bed, Rehabilitation |
Restricted to Preferred Facilities: |
|
Service Code: |
0138 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate 3 or 4 Bed, Rehabilitation |
0138 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Semiprivate, 3 and 4 Beds, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0139 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Semiprivate, 3 and 4 Beds, Other |
0139 |
New / Changed in 2020: |
|
Service Description: |
Psychiatric Room and Board Deluxe Private |
Restricted to Preferred Facilities: |
|
Service Code: |
0144 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Psychiatric Room and Board Deluxe Private |
0144 |
New / Changed in 2020: |
|
Service Description: |
Detoxification Room and Board Deluxe Private |
Restricted to Preferred Facilities: |
|
Service Code: |
0146 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Detoxification Room and Board Deluxe Private |
0146 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Medical/Surgical/Gynecological |
Restricted to Preferred Facilities: |
|
Service Code: |
0151 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Medical/Surgical/Gynecological |
0151 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Obstetric |
Restricted to Preferred Facilities: |
|
Service Code: |
0152 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Obstetric |
0152 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Pediatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0153 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Pediatric |
0153 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0154 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Room and Board – Ward (Medical or General), Psychiatric |
0154 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0154 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Psychiatric |
0154 |
New / Changed in 2020: |
|
Service Description: |
Detoxification Room and Board Ward |
Restricted to Preferred Facilities: |
|
Service Code: |
0156 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Detoxification Room and Board Ward |
0156 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Oncology |
Restricted to Preferred Facilities: |
|
Service Code: |
0157 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Oncology |
0157 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward (Medical or General), Rehabilitation |
Restricted to Preferred Facilities: |
|
Service Code: |
0158 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward (Medical or General), Rehabilitation |
0158 |
New / Changed in 2020: |
|
Service Description: |
Room and Board – Ward, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0159 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board – Ward, Other |
0159 |
New / Changed in 2020: |
|
Service Description: |
Room and Board, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0169 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board, Other |
0169 |
New / Changed in 2020: |
|
Service Description: |
Nursery, General Classification |
Restricted to Preferred Facilities: |
|
Service Code: |
0170 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Nursery, General Classification |
0170 |
New / Changed in 2020: |
|
Service Description: |
Nursery, Newborn, Level I |
Restricted to Preferred Facilities: |
|
Service Code: |
0171 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Nursery, Newborn, Level I |
0171 |
New / Changed in 2020: |
|
Service Description: |
Nursery, Newborn, Level II |
Restricted to Preferred Facilities: |
|
Service Code: |
0172 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Nursery, Newborn, Level II |
0172 |
New / Changed in 2020: |
|
Service Description: |
Nursery, Newborn, Level III |
Restricted to Preferred Facilities: |
|
Service Code: |
0173 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Nursery, Newborn, Level III |
0173 |
New / Changed in 2020: |
|
Service Description: |
Nursery, Newborn, Level IV |
Restricted to Preferred Facilities: |
|
Service Code: |
0174 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Nursery, Newborn, Level IV |
0174 |
New / Changed in 2020: |
|
Service Description: |
Room and Board, Subacute Pediatric (Private Hospital) |
Restricted to Preferred Facilities: |
|
Service Code: |
0190 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board, Subacute Pediatric (Private Hospital) |
0190 |
New / Changed in 2020: |
|
Service Description: |
Room and Board, Subacute Adult (Private Hospital) |
Restricted to Preferred Facilities: |
|
Service Code: |
0199 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Room and Board, Subacute Adult (Private Hospital) |
0199 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, General Classification |
Restricted to Preferred Facilities: |
|
Service Code: |
0200 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, General Classification |
0200 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Surgical |
Restricted to Preferred Facilities: |
|
Service Code: |
0201 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Surgical |
0201 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Medical |
Restricted to Preferred Facilities: |
|
Service Code: |
0202 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Medical |
0202 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Pediatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0203 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Pediatric |
0203 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0204 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Intensive Care, Psychiatric |
0204 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Psychiatric |
Restricted to Preferred Facilities: |
|
Service Code: |
0204 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Psychiatric |
0204 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Intermediate ICU |
Restricted to Preferred Facilities: |
|
Service Code: |
0206 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Intermediate ICU |
0206 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Burn Care |
Restricted to Preferred Facilities: |
|
Service Code: |
0207 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Burn Care |
0207 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Trauma |
Restricted to Preferred Facilities: |
|
Service Code: |
0208 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Trauma |
0208 |
New / Changed in 2020: |
|
Service Description: |
Intensive Care, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0209 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Intensive Care, Other |
0209 |
New / Changed in 2020: |
|
Service Description: |
Coronary Care, General Classification |
Restricted to Preferred Facilities: |
|
Service Code: |
0210 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Coronary Care, General Classification |
0210 |
New / Changed in 2020: |
|
Service Description: |
Coronary Care, Myocardial Infarction |
Restricted to Preferred Facilities: |
|
Service Code: |
0211 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Coronary Care, Myocardial Infarction |
0211 |
New / Changed in 2020: |
|
Service Description: |
Coronary Care, Pulmonary Care |
Restricted to Preferred Facilities: |
|
Service Code: |
0212 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Coronary Care, Pulmonary Care |
0212 |
New / Changed in 2020: |
|
Service Description: |
Coronary Care, Intermediate CCU |
Restricted to Preferred Facilities: |
|
Service Code: |
0214 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Coronary Care, Intermediate CCU |
0214 |
New / Changed in 2020: |
|
Service Description: |
Coronary Care, Other |
Restricted to Preferred Facilities: |
|
Service Code: |
0219 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Coronary Care, Other |
0219 |
New / Changed in 2020: |
|
Service Description: |
Inpatient respite care |
Restricted to Preferred Facilities: |
|
Service Code: |
0655 |
Service Code Type: |
REV |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Hospice |
Inpatient respite care |
0655 |
New / Changed in 2020: |
|
Service Description: |
General inpatient care (nonrespite) |
Restricted to Preferred Facilities: |
|
Service Code: |
0656 |
Service Code Type: |
REV |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Hospice |
General inpatient care (nonrespite) |
0656 |
New / Changed in 2020: |
|
Service Description: |
Lithotripsy, General Classification |
Restricted to Preferred Facilities: |
|
Service Code: |
0790 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Inpatient Facility Admission - Planned |
Lithotripsy, General Classification |
0790 |
New / Changed in 2020: |
|
Service Description: |
Behavioral Health Treatments/Services Partial hospitalization - less intensive |
Restricted to Preferred Facilities: |
|
Service Code: |
0912 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Behavioral Health Treatments/Services Partial hospitalization - less intensive |
0912 |
New / Changed in 2020: |
|
Service Description: |
Behavioral Health Treatments/Services Partial hospitalization - intensive |
Restricted to Preferred Facilities: |
|
Service Code: |
0913 |
Service Code Type: |
REV |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Behavioral Health (Mental Health) and Substance Abuse: Planned Inpatient services |
Behavioral Health Treatments/Services Partial hospitalization - intensive |
0913 |
New / Changed in 2020: |
|
Service Description: |
SUBCUTANEOUS HORMONE PELLET IMPLANTATION |
Restricted to Preferred Facilities: |
|
Service Code: |
11980 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
SUBCUTANEOUS HORMONE PELLET IMPLANTATION |
11980 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq. cm or less of wound surface area |
Restricted to Preferred Facilities: |
|
Service Code: |
15271 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq. cm or less of wound surface area |
15271 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Each additional 25 sq. cm wound surface area, or part thereof) (List separately in addition to code for primary procedure |
Restricted to Preferred Facilities: |
|
Service Code: |
15272 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Each additional 25 sq. cm wound surface area, or part thereof) (List separately in addition to code for primary procedure |
15272 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Application of skin substitute graft to trunk, arms, legs, total wound surface greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children |
Restricted to Preferred Facilities: |
|
Service Code: |
15273 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Application of skin substitute graft to trunk, arms, legs, total wound surface greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children |
15273 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof) (List separately in addition to code for primary procedure |
Restricted to Preferred Facilities: |
|
Service Code: |
15274 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof) (List separately in addition to code for primary procedure |
15274 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area up to 100 sq. cm; first 25 sq. cm or less |
Restricted to Preferred Facilities: |
|
Service Code: |
15275 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area up to 100 sq. cm; first 25 sq. cm or less |
15275 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
each additional 25 sq. cm wound surface area, or part thereof) (List separately in addition to code for primary procedure |
Restricted to Preferred Facilities: |
|
Service Code: |
15276 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
each additional 25 sq. cm wound surface area, or part thereof) (List separately in addition to code for primary procedure |
15276 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children |
Restricted to Preferred Facilities: |
|
Service Code: |
15277 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Application of skin substitute graft to face, scalp, feet, etc., total wound surface area greater than or equal to 100 sq. cm; first 100 sq. cm wound surface area, or 1% of body area of infants and children |
15277 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children) (List separately in addition to code for primary procedure |
Restricted to Preferred Facilities: |
|
Service Code: |
15278 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bioengineered Skin Equivalents (including but not limited to Dermagraft and Apligraf (Graftskin) - a type of skin graft) |
Each additional 100 sq. cm wound surface area, or part thereof, or each additional 1% of body area of infants and children) (List separately in addition to code for primary procedure |
15278 |
New / Changed in 2020: |
|
Service Description: |
BLEPHAROPLASTY LOWER EYELID |
Restricted to Preferred Facilities: |
|
Service Code: |
15820 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Blepharoplasty (plastic surgery of the eyelids) |
BLEPHAROPLASTY LOWER EYELID |
15820 |
New / Changed in 2020: |
|
Service Description: |
BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD |
Restricted to Preferred Facilities: |
|
Service Code: |
15821 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Blepharoplasty (plastic surgery of the eyelids) |
BLEPHAROPLASTY LOWER EYELID HERNIATED FAT PAD |
15821 |
New / Changed in 2020: |
|
Service Description: |
BLEPHAROPLASTY UPPER EYELID |
Restricted to Preferred Facilities: |
|
Service Code: |
15822 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Blepharoplasty (plastic surgery of the eyelids) |
BLEPHAROPLASTY UPPER EYELID |
15822 |
New / Changed in 2020: |
|
Service Description: |
BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN |
Restricted to Preferred Facilities: |
|
Service Code: |
15823 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Blepharoplasty (plastic surgery of the eyelids) |
BLEPHAROPLASTY UPPER EYELID W/EXCESSIVE SKIN |
15823 |
New / Changed in 2020: |
|
Service Description: |
MASTECTOMY PARTIAL |
Restricted to Preferred Facilities: |
|
Service Code: |
19301 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
MASTECTOMY PARTIAL |
19301 |
New / Changed in 2020: |
|
Service Description: |
MASTECTOMY SIMPLE COMPLETE |
Restricted to Preferred Facilities: |
|
Service Code: |
19303 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
MASTECTOMY SIMPLE COMPLETE |
19303 |
New / Changed in 2020: |
|
Service Description: |
MASTECTOMY SUBCUTANEOUS |
Restricted to Preferred Facilities: |
|
Service Code: |
19304 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
MASTECTOMY SUBCUTANEOUS |
19304 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
MASTOPEXY |
Restricted to Preferred Facilities: |
|
Service Code: |
19316 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
MASTOPEXY |
19316 |
New / Changed in 2020: |
|
Service Description: |
REDUCTION MAMMAPLASTY |
Restricted to Preferred Facilities: |
|
Service Code: |
19318 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
REDUCTION MAMMAPLASTY |
19318 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
MAMMAPLASTY, AUGMENTATION; W/O PROSTHETIC IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19324 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
MAMMAPLASTY, AUGMENTATION; W/O PROSTHETIC IMPLANT |
19324 |
New / Changed in 2020: |
|
Service Description: |
MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19324 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
MAMMAPLASTY AUGMENTATION W/O PROSTHETIC IMPLANT |
19324 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
MAMMAPLASTY, AUGMENTATION; W/PROSTHETIC IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19325 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
MAMMAPLASTY, AUGMENTATION; W/PROSTHETIC IMPLANT |
19325 |
New / Changed in 2020: |
|
Service Description: |
MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19325 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
MAMMAPLASTY AUGMENTATION W/PROSTHETIC IMPLANT |
19325 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
REMOVAL, INTACT MAMMARY IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19328 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
REMOVAL, INTACT MAMMARY IMPLANT |
19328 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
REMOVAL, MAMMARY IMPLANT MATL |
Restricted to Preferred Facilities: |
|
Service Code: |
19330 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
REMOVAL, MAMMARY IMPLANT MATL |
19330 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION |
Restricted to Preferred Facilities: |
|
Service Code: |
19340 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION |
19340 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION |
Restricted to Preferred Facilities: |
|
Service Code: |
19342 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION |
19342 |
New / Changed in 2020: |
|
Service Description: |
NIPPLE/AREOLA RECONSTRUCTION |
Restricted to Preferred Facilities: |
|
Service Code: |
19350 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
NIPPLE/AREOLA RECONSTRUCTION |
19350 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
CORRECTION OF INVERTED NIPPLES |
Restricted to Preferred Facilities: |
|
Service Code: |
19355 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
CORRECTION OF INVERTED NIPPLES |
19355 |
New / Changed in 2020: |
|
Service Description: |
BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ |
Restricted to Preferred Facilities: |
|
Service Code: |
19357 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
BRST RCNSTJ IMMT/DLYD W/TISS EXPANDER SBSQ XPNSJ |
19357 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with latissimus dorsi flap, without prosthetic implant |
Restricted to Preferred Facilities: |
|
Service Code: |
19361 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with latissimus dorsi flap, without prosthetic implant |
19361 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with free flap |
Restricted to Preferred Facilities: |
|
Service Code: |
19364 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with free flap |
19364 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with other technique |
Restricted to Preferred Facilities: |
|
Service Code: |
19366 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with other technique |
19366 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site |
Restricted to Preferred Facilities: |
|
Service Code: |
19367 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site |
19367 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) |
Restricted to Preferred Facilities: |
|
Service Code: |
19368 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), single pedicle, including closure of donor site, with microvascular anastomosis (supercharging) |
19368 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site |
Restricted to Preferred Facilities: |
|
Service Code: |
19369 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Breast reconstruction with transverse rectus abdominis myocutaneous flap (TRAM), double pedicle, including closure of donor site |
19369 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST |
Restricted to Preferred Facilities: |
|
Service Code: |
19370 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST |
19370 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
PERIPROSTHETIC CAPSULECTOMY, BREAST |
Restricted to Preferred Facilities: |
|
Service Code: |
19371 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
PERIPROSTHETIC CAPSULECTOMY, BREAST |
19371 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
REVISION OF RECONSTRUCTED BREAST |
Restricted to Preferred Facilities: |
|
Service Code: |
19380 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
REVISION OF RECONSTRUCTED BREAST |
19380 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
REVISION OF RECONSTRUCTED BREAST |
Restricted to Preferred Facilities: |
|
Service Code: |
19380 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
REVISION OF RECONSTRUCTED BREAST |
19380 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
19396 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Breast Reduction or Reconstructive Surgery |
PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT |
19396 |
New / Changed in 2020: |
|
Service Description: |
INJECTION ENZYME PALMAR FASCIAL CORD |
Restricted to Preferred Facilities: |
|
Service Code: |
20527 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Xiaflex® (collagenase clostridium histolyticum) |
INJECTION ENZYME PALMAR FASCIAL CORD |
20527 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Bone graft, any donor area; minor or small (e.g., dowel or button) |
Restricted to Preferred Facilities: |
|
Service Code: |
20900 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Bone graft, any donor area; minor or small (e.g., dowel or button) |
20900 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Bone graft, any donor area; major or large |
Restricted to Preferred Facilities: |
|
Service Code: |
20902 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Bone graft, any donor area; major or large |
20902 |
New / Changed in 2020: |
|
Service Description: |
GENIOPLASTY AUGMENTATION |
Restricted to Preferred Facilities: |
|
Service Code: |
21120 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
GENIOPLASTY AUGMENTATION |
21120 |
New / Changed in 2020: |
|
Service Description: |
GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE |
Restricted to Preferred Facilities: |
|
Service Code: |
21121 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
GENIOPLASTY SLIDING OSTEOTOMY SINGLE PIECE |
21121 |
New / Changed in 2020: |
|
Service Description: |
GENIOPLASTY 2/> SLIDING OSTEOTOMIES |
Restricted to Preferred Facilities: |
|
Service Code: |
21122 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
GENIOPLASTY 2/> SLIDING OSTEOTOMIES |
21122 |
New / Changed in 2020: |
|
Service Description: |
GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS |
Restricted to Preferred Facilities: |
|
Service Code: |
21123 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
GENIOP SLIDING AGMNTJ W/INTERPOSAL BONE GRAFTS |
21123 |
New / Changed in 2020: |
|
Service Description: |
AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL |
Restricted to Preferred Facilities: |
|
Service Code: |
21125 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
AGMNTJ MNDBLR BODY/ANGLE PROSTHETIC MATERIAL |
21125 |
New / Changed in 2020: |
|
Service Description: |
AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL |
Restricted to Preferred Facilities: |
|
Service Code: |
21127 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
AGMNTJ MNDBLR BDY/ANGL W/GRF ONLAY/INTERPOSAL |
21127 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
21141 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 1 PIECE W/O BONE GRAFT |
21141 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
21142 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 2 PIECES W/O BONE GRAFT |
21142 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
21143 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 3/> PIECE W/O BONE GRAFT |
21143 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS |
Restricted to Preferred Facilities: |
|
Service Code: |
21145 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 1 PIECE W/BONE GRAFTS |
21145 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS |
Restricted to Preferred Facilities: |
|
Service Code: |
21146 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 2 PIECES W/BONE GRAFTS |
21146 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS |
Restricted to Preferred Facilities: |
|
Service Code: |
21147 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MIDFACE LEFORT I 3/> PIECE W/BONE GRAFTS |
21147 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF |
Restricted to Preferred Facilities: |
|
Service Code: |
21193 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/O GRF |
21193 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
21194 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MNDBLR RAMI HRZNTL/VER/C/L OSTEOT W/GRAFT |
21194 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD |
Restricted to Preferred Facilities: |
|
Service Code: |
21195 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MNDBLR RAMI&/BODY SGTL SPLT W/O INT RGD |
21195 |
New / Changed in 2020: |
|
Service Description: |
RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI |
Restricted to Preferred Facilities: |
|
Service Code: |
21196 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
RCNSTJ MNDBLR RAMI&/BDY SGTL SPLT W/INT RGD FI |
21196 |
New / Changed in 2020: |
|
Service Description: |
OSTEOTOMY MANDIBLE SEGMENTAL |
Restricted to Preferred Facilities: |
|
Service Code: |
21198 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
OSTEOTOMY MANDIBLE SEGMENTAL |
21198 |
New / Changed in 2020: |
|
Service Description: |
OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT |
Restricted to Preferred Facilities: |
|
Service Code: |
21199 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
OSTEOTOMY MANDIBLE SGMTL W/GENIOGLOSSUS ADVMNT |
21199 |
New / Changed in 2020: |
|
Service Description: |
OSTEOTOMY MAXILLA SEGMENTAL |
Restricted to Preferred Facilities: |
|
Service Code: |
21206 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
OSTEOTOMY MAXILLA SEGMENTAL |
21206 |
New / Changed in 2020: |
|
Service Description: |
HYOID MYOTOMY & SUSPENSION |
Restricted to Preferred Facilities: |
|
Service Code: |
21685 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Orthognathic Surgery (including, but not limited to mandibular and maxillary osteotomies) |
HYOID MYOTOMY & SUSPENSION |
21685 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Reconstructive repair of pectus excavatum or carinatum; open |
Restricted to Preferred Facilities: |
|
Service Code: |
21740 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Reconstructive repair of pectus excavatum or carinatum; open |
21740 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy |
Restricted to Preferred Facilities: |
|
Service Code: |
21742 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopy |
21742 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy |
Restricted to Preferred Facilities: |
|
Service Code: |
21743 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Pectus Excavatum or Carinatum (surgical correction of chest deformity) |
Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopy |
21743 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR |
Restricted to Preferred Facilities: |
|
Service Code: |
22533 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR |
22533 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR |
Restricted to Preferred Facilities: |
|
Service Code: |
22534 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR |
22534 |
New / Changed in 2020: |
|
Service Description: |
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 |
Restricted to Preferred Facilities: |
|
Service Code: |
22551 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2 |
22551 |
New / Changed in 2020: |
|
Service Description: |
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC |
Restricted to Preferred Facilities: |
|
Service Code: |
22552 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC |
22552 |
New / Changed in 2020: |
|
Service Description: |
ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2 |
Restricted to Preferred Facilities: |
|
Service Code: |
22554 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2 |
22554 |
New / Changed in 2020: |
|
Service Description: |
ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC |
Restricted to Preferred Facilities: |
|
Service Code: |
22556 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC |
22556 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
ARTHRODESIS ANTERIOR INTERBODY LUMBAR |
Restricted to Preferred Facilities: |
|
Service Code: |
22558 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS ANTERIOR INTERBODY LUMBAR |
22558 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC |
Restricted to Preferred Facilities: |
|
Service Code: |
22585 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC |
22585 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS POSTERIOR/ POSTEROLATERAL LUMBAR |
Restricted to Preferred Facilities: |
|
Service Code: |
22612 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS POSTERIOR/ POSTEROLATERAL LUMBAR |
22612 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS POSTERIOR/ POSTEROLATERAL EA ADDL |
Restricted to Preferred Facilities: |
|
Service Code: |
22614 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS POSTERIOR/ POSTEROLATERAL EA ADDL |
22614 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS POSTERIOR INTERBODY LUMBAR |
Restricted to Preferred Facilities: |
|
Service Code: |
22630 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS POSTERIOR INTERBODY LUMBAR |
22630 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS POSTERIOR INTERBODY EA ADDL |
Restricted to Preferred Facilities: |
|
Service Code: |
22632 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHRODESIS POSTERIOR INTERBODY EA ADDL |
22632 |
New / Changed in 2020: |
|
Service Description: |
ARTHDSIS POST/ POSTEROLATRL/ POSTINTERBODY LUMBAR |
Restricted to Preferred Facilities: |
|
Service Code: |
22633 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHDSIS POST/ POSTEROLATRL/ POSTINTERBODY LUMBAR |
22633 |
New / Changed in 2020: |
|
Service Description: |
ARTHDSIS POST/ POSTEROLATRL/ POSTINTRBDYADL SPC/ SEG |
Restricted to Preferred Facilities: |
|
Service Code: |
22634 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Spinal Fusion (Elective) |
ARTHDSIS POST/ POSTEROLATRL/ POSTINTRBDYADL SPC/ SEG |
22634 |
New / Changed in 2020: |
|
Service Description: |
INJECT SI JOINT ARTHRGRPHY&/ ANES/ STEROID W/ IMA |
Restricted to Preferred Facilities: |
|
Service Code: |
27096 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Sacroiliac Joint Injection |
INJECT SI JOINT ARTHRGRPHY&/ ANES/ STEROID W/ IMA |
27096 |
New / Changed in 2020: |
|
Service Description: |
ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS |
Restricted to Preferred Facilities: |
|
Service Code: |
27279 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Sacroiliac Joint Fusion |
ARTHRODESIS SACROILIAC JOINT PERCUTANEOUS |
27279 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE |
Restricted to Preferred Facilities: |
|
Service Code: |
27412 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Autologous cultured chondrocyte (MACI) |
AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE |
27412 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia |
Restricted to Preferred Facilities: |
|
Service Code: |
28890 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Extracorporeal Shock Wave Treatment (ESWT) for Musculoskeletal Indications |
Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia |
28890 |
New / Changed in 2020: |
|
Service Description: |
RHINP PRIM LAT&ALAR CRTLGS&/ ELVTN NASAL TI |
Restricted to Preferred Facilities: |
|
Service Code: |
30400 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINP PRIM LAT&ALAR CRTLGS&/ ELVTN NASAL TI |
30400 |
New / Changed in 2020: |
|
Service Description: |
RHINP PRIM LAT&ALAR CRTLGS&/ ELVTN NASAL TI |
Restricted to Preferred Facilities: |
|
Service Code: |
30400 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINP PRIM LAT&ALAR CRTLGS&/ ELVTN NASAL TI |
30400 |
New / Changed in 2020: |
|
Service Description: |
RHINP PRIM COMPLETE XTRNL PARTS |
Restricted to Preferred Facilities: |
|
Service Code: |
30410 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINP PRIM COMPLETE XTRNL PARTS |
30410 |
New / Changed in 2020: |
|
Service Description: |
RHINP PRIM COMPLETE XTRNL PARTS |
Restricted to Preferred Facilities: |
|
Service Code: |
30410 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINP PRIM COMPLETE XTRNL PARTS |
30410 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR |
Restricted to Preferred Facilities: |
|
Service Code: |
30420 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR |
30420 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR |
Restricted to Preferred Facilities: |
|
Service Code: |
30420 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINOPLASTY PRIMARY W/MAJOR SEPTAL REPAIR |
30420 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY MINOR REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30430 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINOPLASTY SECONDARY MINOR REVISION |
30430 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY MINOR REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30430 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINOPLASTY SECONDARY MINOR REVISION |
30430 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY INTERMEDIATE REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30435 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINOPLASTY SECONDARY INTERMEDIATE REVISION |
30435 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY INTERMEDIATE REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30435 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINOPLASTY SECONDARY INTERMEDIATE REVISION |
30435 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY MAJOR REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30450 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty as a standalone procedure or Rhinoplasty, with
or without septal repair, in conjunction with other planned medically necessary surgeries. |
RHINOPLASTY SECONDARY MAJOR REVISION |
30450 |
New / Changed in 2020: |
|
Service Description: |
RHINOPLASTY SECONDARY MAJOR REVISION |
Restricted to Preferred Facilities: |
|
Service Code: |
30450 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
RHINOPLASTY SECONDARY MAJOR REVISION |
30450 |
New / Changed in 2020: |
|
Service Description: |
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF |
Restricted to Preferred Facilities: |
|
Service Code: |
30520 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF |
30520 |
New / Changed in 2020: |
|
Service Description: |
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF |
Restricted to Preferred Facilities: |
|
Service Code: |
30520 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Septoplasty as a standalone procedure or septoplasty in conjunction with other planned medically necessary surgeries |
SEPTOPLASTY/SUBMUCOUS RESECJ W/WO CARTILAGE GRF |
30520 |
New / Changed in 2020: |
|
Service Description: |
SEPTAL/OTHER INTRANASAL DERMATOPLASTY |
Restricted to Preferred Facilities: |
|
Service Code: |
30620 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Rhinoplasty including major septal repair |
SEPTAL/OTHER INTRANASAL DERMATOPLASTY |
30620 |
New / Changed in 2020: |
|
Service Description: |
SEPTAL/OTHER INTRANASAL DERMATOPLASTY |
Restricted to Preferred Facilities: |
|
Service Code: |
30620 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Septoplasty as a standalone procedure or septoplasty in conjunction with other planned medically necessary surgeries |
SEPTAL/OTHER INTRANASAL DERMATOPLASTY |
30620 |
New / Changed in 2020: |
|
Service Description: |
LARYNGOPLASTY CRICOID SPLIT |
Restricted to Preferred Facilities: |
|
Service Code: |
31587 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LARYNGOPLASTY CRICOID SPLIT |
31587 |
New / Changed in 2020: |
|
Service Description: |
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe |
Restricted to Preferred Facilities: |
|
Service Code: |
31660 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Bronchial Thermoplasty |
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 1 lobe |
31660 |
New / Changed in 2020: |
|
Service Description: |
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes |
Restricted to Preferred Facilities: |
|
Service Code: |
31661 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Bronchial Thermoplasty |
Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial thermoplasty, 2 or more lobes |
31661 |
New / Changed in 2020: |
|
Service Description: |
TRACHEOPLASTY CERVICAL |
Restricted to Preferred Facilities: |
|
Service Code: |
31750 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
TRACHEOPLASTY CERVICAL |
31750 |
New / Changed in 2020: |
|
Service Description: |
RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG |
Restricted to Preferred Facilities: |
|
Service Code: |
32491 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Lung Volume Reduction Surgery |
RMVL LUNG OTH/THN PNUMEC RESXN-PLCTJ EMPHY LUNG |
32491 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment |
Restricted to Preferred Facilities: |
|
Service Code: |
32701 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Thoracic target(s) delineation for stereotactic body radiation therapy (SRS/SBRT), (photon or particle beam), entire course of treatment |
32701 |
New / Changed in 2020: |
|
Service Description: |
DONOR PNEUMONECTOMY FROM CADAVER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
32850 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR PNEUMONECTOMY FROM CADAVER DONOR |
32850 |
New / Changed in 2020: |
|
Service Description: |
LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS |
Restricted to Preferred Facilities: |
|
Service Code: |
32851 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LUNG TRANSPLANT 1 W/O CARDIOPULMONARY BYPASS |
32851 |
New / Changed in 2020: |
|
Service Description: |
LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS |
Restricted to Preferred Facilities: |
|
Service Code: |
32852 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LUNG TRANSPLANT 1 W/CARDIOPULMONARY BYPASS |
32852 |
New / Changed in 2020: |
|
Service Description: |
LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS |
Restricted to Preferred Facilities: |
|
Service Code: |
32853 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LUNG TRANSPLANT 2 W/O CARDIOPULMONARY BYPASS |
32853 |
New / Changed in 2020: |
|
Service Description: |
LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS |
Restricted to Preferred Facilities: |
|
Service Code: |
32854 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LUNG TRANSPLANT 2 W/CARDIOPULMONARY BYPASS |
32854 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI |
Restricted to Preferred Facilities: |
|
Service Code: |
32855 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT UNI |
32855 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI |
Restricted to Preferred Facilities: |
|
Service Code: |
32856 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR LUNG ALLOGRAFT BI |
32856 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Transmyocardial laser revascularization, by thoracotomy (separate procedure) |
Restricted to Preferred Facilities: |
|
Service Code: |
33140 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Transmyocardial Laser Revascularization (TMLR) (when performed as a stand-alone procedure–process to increase blood supply to the heart) |
Transmyocardial laser revascularization, by thoracotomy (separate procedure) |
33140 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) |
Restricted to Preferred Facilities: |
|
Service Code: |
33141 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Transmyocardial Laser Revascularization (TMLR) (when performed as a stand-alone procedure–process to increase blood supply to the heart) |
Transmyocardial laser revascularization, by thoracotomy; performed at the time of other open cardiac procedure(s) |
33141 |
New / Changed in 2020: |
|
Service Description: |
DONOR CARDIECTOMY-PNEUMONECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
33930 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR CARDIECTOMY-PNEUMONECTOMY |
33930 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
33933 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR HEART/LUNG ALLOGRAFT |
33933 |
New / Changed in 2020: |
|
Service Description: |
HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC |
Restricted to Preferred Facilities: |
|
Service Code: |
33935 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
HEART-LUNG TRNSPL W/RECIPIENT CARDIECTOMY-PNUMEC |
33935 |
New / Changed in 2020: |
|
Service Description: |
DONOR CARDIECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
33940 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR CARDIECTOMY |
33940 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
33944 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR HEART ALLOGRAFT |
33944 |
New / Changed in 2020: |
|
Service Description: |
HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
33945 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
HEART TRANSPLANT W/WO RECIPIENT CARDIECTOMY |
33945 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Insertion of ventricular assist device; extracorporeal, single ventricle |
Restricted to Preferred Facilities: |
|
Service Code: |
33975 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Insertion of ventricular assist device; extracorporeal, single ventricle |
33975 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Insertion of ventricular assist device; extracorporeal, biventricular |
Restricted to Preferred Facilities: |
|
Service Code: |
33976 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Insertion of ventricular assist device; extracorporeal, biventricular |
33976 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Removal of ventricular assist device; extracorporeal, single ventricle |
Restricted to Preferred Facilities: |
|
Service Code: |
33977 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Removal of ventricular assist device; extracorporeal, single ventricle |
33977 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Removal of ventricular assist device; extracorporeal, biventricular |
Restricted to Preferred Facilities: |
|
Service Code: |
33978 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Removal of ventricular assist device; extracorporeal, biventricular |
33978 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Insertion of ventricular assist device, implantable intracorporeal, single ventricle |
Restricted to Preferred Facilities: |
|
Service Code: |
33979 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Insertion of ventricular assist device, implantable intracorporeal, single ventricle |
33979 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Removal of ventricular assist device, implantable intracorporeal, single ventricular |
Restricted to Preferred Facilities: |
|
Service Code: |
33980 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Removal of ventricular assist device, implantable intracorporeal, single ventricular |
33980 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump |
Restricted to Preferred Facilities: |
|
Service Code: |
33981 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Replacement of extracorporeal ventricular assist device, single or biventricular, pump(s), single or each pump |
33981 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass |
Restricted to Preferred Facilities: |
|
Service Code: |
33982 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, without cardiopulmonary bypass |
33982 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass |
Restricted to Preferred Facilities: |
|
Service Code: |
33983 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Replacement of ventricular assist device pump(s); implantable intracorporeal, single ventricle, with cardiopulmonary bypass |
33983 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only |
Restricted to Preferred Facilities: |
|
Service Code: |
33990 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; arterial access only |
33990 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture |
Restricted to Preferred Facilities: |
|
Service Code: |
33991 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Insertion of ventricular assist device, percutaneous including radiological supervision and interpretation; both arterial and venous access, with transseptal puncture |
33991 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Removal of percutaneous ventricular assist device at separate and distinct session from insertion |
Restricted to Preferred Facilities: |
|
Service Code: |
33992 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Removal of percutaneous ventricular assist device at separate and distinct session from insertion |
33992 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion |
Restricted to Preferred Facilities: |
|
Service Code: |
33993 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Ventricular Assist Device (VAD) |
Repositioning of percutaneous ventricular assist device with imaging guidance at separate and distinct session from insertion |
33993 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
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 (e.g., great saphenous vein, accessory saphenous vein) |
Restricted to Preferred Facilities: |
|
Service Code: |
36465 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
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 (e.g., great saphenous vein, accessory saphenous vein) |
36465 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
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 (e.g., great saphenous vein, accessory saphenous vein), same leg |
Restricted to Preferred Facilities: |
|
Service Code: |
36466 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
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 (e.g., great saphenous vein, accessory saphenous vein), same leg |
36466 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK |
Restricted to Preferred Facilities: |
|
Service Code: |
36468 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
1/MLT NJXS SCLRSG SLNS SPIDER VEINS LIMB/TRUNK |
36468 |
New / Changed in 2020: |
|
Service Description: |
NJX SCLEROSING SOLUTION SINGLE VEIN |
Restricted to Preferred Facilities: |
|
Service Code: |
36470 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
NJX SCLEROSING SOLUTION SINGLE VEIN |
36470 |
New / Changed in 2020: |
|
Service Description: |
NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG |
Restricted to Preferred Facilities: |
|
Service Code: |
36471 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG |
36471 |
New / Changed in 2020: |
|
Service Description: |
NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG |
Restricted to Preferred Facilities: |
|
Service Code: |
36471 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
NJX SCLEROSING SOLUTION MULTIPLE VEINS SAME LEG |
36471 |
New / Changed in 2020: |
|
Service Description: |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, MECHANOCHEMICAL; FIRST VEIN TREATED |
Restricted to Preferred Facilities: |
|
Service Code: |
36473 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, MECHANOCHEMICAL; FIRST VEIN TREATED |
36473 |
New / Changed in 2020: |
|
Service Description: |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, MECHANOCHEMICAL; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
Restricted to Preferred Facilities: |
|
Service Code: |
36474 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, MECHANOCHEMICAL; SUBSEQUENT VEIN(S) TREATED IN A SINGLE EXTREMITY, EACH THROUGH SEPARATE ACCESS SITES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
36474 |
New / Changed in 2020: |
|
Service Description: |
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN |
Restricted to Preferred Facilities: |
|
Service Code: |
36475 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 1ST VEIN |
36475 |
New / Changed in 2020: |
|
Service Description: |
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS |
Restricted to Preferred Facilities: |
|
Service Code: |
36476 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVEN ABLTJ INCMPTNT VEIN XTR RF 2ND+ VEINS |
36476 |
New / Changed in 2020: |
|
Service Description: |
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN |
Restricted to Preferred Facilities: |
|
Service Code: |
36478 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 1ST VEIN |
36478 |
New / Changed in 2020: |
|
Service Description: |
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS |
Restricted to Preferred Facilities: |
|
Service Code: |
36479 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVEN ABLTJ INCMPTNT VEIN XTR LASER 2ND+ VEINS |
36479 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) REMOTE FROM THE ACCESS SITE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS; FIRST VEIN TREATED |
Restricted to Preferred Facilities: |
|
Service Code: |
36482 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) REMOTE FROM THE ACCESS SITE, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS; FIRST VEIN TREATED |
36482 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) 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) |
Restricted to Preferred Facilities: |
|
Service Code: |
36483 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, BY TRANSCATHETER DELIVERY OF A CHEMICAL ADHESIVE (EG, CYANOACRYLATE) 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) |
36483 |
New / Changed in 2020: |
|
Service Description: |
Insertion of tunneled centrally inserted central venous access device with subcutaneous pump |
Restricted to Preferred Facilities: |
|
Service Code: |
36563 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Intrathecal Infusion Pump |
Insertion of tunneled centrally inserted central venous access device with subcutaneous pump |
36563 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX |
Restricted to Preferred Facilities: |
|
Service Code: |
37500 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
VASC ENDOSCOPY SURG W/LIG PERFORATOR VEINS SPX |
37500 |
New / Changed in 2020: |
|
Service Description: |
LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ |
Restricted to Preferred Facilities: |
|
Service Code: |
37700 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIG&DIV LONG SAPH VEIN SAPHFEM JUNCT/INTERRUPJ |
37700 |
New / Changed in 2020: |
|
Service Description: |
LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN |
Restricted to Preferred Facilities: |
|
Service Code: |
37718 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIGJ DIVJ & STRIPPING SHORT SAPHENOUS VEIN |
37718 |
New / Changed in 2020: |
|
Service Description: |
LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW |
Restricted to Preferred Facilities: |
|
Service Code: |
37722 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIGJ DIVJ&STRIP LONG SAPH SAPHFEM JUNCT KNE/BELW |
37722 |
New / Changed in 2020: |
|
Service Description: |
LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS |
Restricted to Preferred Facilities: |
|
Service Code: |
37735 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIGJ & DIVJ RADICAL STRIP LONG/SHORT SAPHENOUS |
37735 |
New / Changed in 2020: |
|
Service Description: |
LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG |
Restricted to Preferred Facilities: |
|
Service Code: |
37760 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIG PRFRATR VEIN SUBFSCAL RAD INCL SKN GRF 1 LEG |
37760 |
New / Changed in 2020: |
|
Service Description: |
LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG |
Restricted to Preferred Facilities: |
|
Service Code: |
37761 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIG PRFRATR VEIN SUBFSCAL OPEN INCL US GID 1 LEG |
37761 |
New / Changed in 2020: |
|
Service Description: |
STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS |
Restricted to Preferred Facilities: |
|
Service Code: |
37765 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
STAB PHLEBT VARICOSE VEINS 1 XTR 10-20 STAB INCS |
37765 |
New / Changed in 2020: |
|
Service Description: |
STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS |
Restricted to Preferred Facilities: |
|
Service Code: |
37766 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
STAB PHLEBT VARICOSE VEINS 1 XTR > 20 INCS |
37766 |
New / Changed in 2020: |
|
Service Description: |
LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX |
Restricted to Preferred Facilities: |
|
Service Code: |
37780 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIGJ & DIV SHORT SAPH VEIN SAPHENOPOP JUNCT SPX |
37780 |
New / Changed in 2020: |
|
Service Description: |
LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG |
Restricted to Preferred Facilities: |
|
Service Code: |
37785 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Varicose Vein Treatments |
LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG |
37785 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
UNLISTED PROCEDURE VASCULAR SURGERY |
Restricted to Preferred Facilities: |
|
Service Code: |
37799 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Varicose Vein Treatments |
UNLISTED PROCEDURE VASCULAR SURGERY |
37799 |
New / Changed in 2020: |
|
Service Description: |
MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ |
Restricted to Preferred Facilities: |
|
Service Code: |
38204 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
MGMT RCP HEMATOP PROGENITOR CELL DONOR &ACQUISJ |
38204 |
New / Changed in 2020: |
|
Service Description: |
BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC |
Restricted to Preferred Facilities: |
|
Service Code: |
38205 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ ALGNC |
38205 |
New / Changed in 2020: |
|
Service Description: |
BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL |
Restricted to Preferred Facilities: |
|
Service Code: |
38206 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BLD-DRV HEMATOP PROGEN CELL HRVG TRNSPLJ AUTOL |
38206 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR |
Restricted to Preferred Facilities: |
|
Service Code: |
38207 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN CELLS CRYOPRSRV STOR |
38207 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR |
Restricted to Preferred Facilities: |
|
Service Code: |
38208 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREP HEMATOP PROGEN THAW PREV HRV PER DNR |
38208 |
New / Changed in 2020: |
|
Service Description: |
TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR |
Restricted to Preferred Facilities: |
|
Service Code: |
38209 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSP PREP HMATOP PROG THAW PREV HRV WSH PER DNR |
38209 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL |
Restricted to Preferred Facilities: |
|
Service Code: |
38210 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN DEPLJ IN HRV T-CELL |
38210 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ |
Restricted to Preferred Facilities: |
|
Service Code: |
38211 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN TUM CELL DEPLJ |
38211 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL |
Restricted to Preferred Facilities: |
|
Service Code: |
38212 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN RED BLD CELL RMVL |
38212 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ |
Restricted to Preferred Facilities: |
|
Service Code: |
38213 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN PLTLT DEPLJ |
38213 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ |
Restricted to Preferred Facilities: |
|
Service Code: |
38214 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN PLSM VOL DEPLJ |
38214 |
New / Changed in 2020: |
|
Service Description: |
TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM |
Restricted to Preferred Facilities: |
|
Service Code: |
38215 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPL PREPJ HEMATOP PROGEN CONCENTRATION PLSM |
38215 |
New / Changed in 2020: |
|
Service Description: |
BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC |
Restricted to Preferred Facilities: |
|
Service Code: |
38230 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC |
38230 |
New / Changed in 2020: |
|
Service Description: |
BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS |
Restricted to Preferred Facilities: |
|
Service Code: |
38232 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BONE MARROW HARVEST TRANSPLANTATION AUTOLOGOUS |
38232 |
New / Changed in 2020: |
|
Service Description: |
TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
38240 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPLJ ALLOGENEIC HEMATOPOIETIC CELLS PER DONOR |
38240 |
New / Changed in 2020: |
|
Service Description: |
TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
38241 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPLJ AUTOLOGOUS HEMATOPOIETIC CELLS PER DONOR |
38241 |
New / Changed in 2020: |
|
Service Description: |
ALLOGENEIC LYMPHOCYTE INFUSIONS |
Restricted to Preferred Facilities: |
|
Service Code: |
38242 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
ALLOGENEIC LYMPHOCYTE INFUSIONS |
38242 |
New / Changed in 2020: |
|
Service Description: |
TRNSPLJ HEMATOPOIETIC CELL BOOST |
Restricted to Preferred Facilities: |
|
Service Code: |
38243 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRNSPLJ HEMATOPOIETIC CELL BOOST |
38243 |
New / Changed in 2020: |
|
Service Description: |
ALVEOLOPLASTY EACH QUADRANT SPECIFY |
Restricted to Preferred Facilities: |
|
Service Code: |
41874 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Extraction of teeth and Alveoloplasty (extractions that are required by traumatic injury, or prior to organ transplantation, cardiac or radiation procedures) |
ALVEOLOPLASTY EACH QUADRANT SPECIFY |
41874 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES |
Restricted to Preferred Facilities: |
|
Service Code: |
41899 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Extraction of teeth and Alveoloplasty (extractions that are required by traumatic injury, or prior to organ transplantation, cardiac or radiation procedures) |
UNLISTED PROCEDURE DENTOALVEOLAR STRUCTURES |
41899 |
New / Changed in 2020: |
|
Service Description: |
Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed |
Restricted to Preferred Facilities: |
|
Service Code: |
43284 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Magnetic Esophageal Sphincter Augmentation (LINX) |
Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie, magnetic band), including cruroplasty when performed |
43284 |
New / Changed in 2020: |
|
Service Description: |
Removal of esophageal sphincter augmentation device |
Restricted to Preferred Facilities: |
|
Service Code: |
43285 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Magnetic Esophageal Sphincter Augmentation (LINX) |
Removal of esophageal sphincter augmentation device |
43285 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43644 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GSTR RSTCV PX W/BYP ROUX-EN-Y LIMB <150 CM |
43644 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43645 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GSTR RSTCV PX W/BYP&SM INT RCNSTJ |
43645 |
New / Changed in 2020: |
|
Service Description: |
LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM |
Restricted to Preferred Facilities: |
|
Service Code: |
43647 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gastric Electrical Stimulation |
LAPS IMPLTJ/RPLCMT GASTRIC NSTIM ELTRD ANTRUM |
43647 |
New / Changed in 2020: |
|
Service Description: |
LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM |
Restricted to Preferred Facilities: |
|
Service Code: |
43648 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gastric Electrical Stimulation |
LAPS REVISION/RMVL GASTRIC NSTIM ELTRD ANTRUM |
43648 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43770 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GASTRIC RESTRICTIVE PROCEDURE PLACE DEVICE |
43770 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43771 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GASTRIC RESTRICTIVE PX REVISION DEVICE |
43771 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43772 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE |
43772 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43773 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GASTRIC RESTRICTIVE PX REMOVE&RPLCMT DEVICE |
43773 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43774 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GASTRIC RESTRICTIVE PX REMOVE DEVICE & PORT |
43774 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43775 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
LAPS GSTRC RSTRICTIV PX LONGITUDINAL GASTRECTOMY |
43775 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43842 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GASTRIC RSTCV W/O BYP VERTICAL-BANDED GASTROPLY |
43842 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43843 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GSTR RSTCV W/O BYP OTH/THN VER-BANDED GSTP |
43843 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43845 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GASTRIC RSTCV W/PRTL GASTRECTOMY 50-100 CM |
43845 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43846 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GASTRIC RSTCV W/BYP W/SHORT LIMB 150 CM/< |
43846 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43847 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GASTRIC RSTCV W/BYP W/SM INT RCNSTJ LIMIT ABSRPJ |
43847 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43848 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
REVISION OPEN GASTRIC RESTRICTIVE PX NOT DEVICE |
43848 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ/RPLCMT GASTRIC NSTIM ELTRDE ANTRUM OPEN |
Restricted to Preferred Facilities: |
|
Service Code: |
43881 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gastric Electrical Stimulation |
IMPLTJ/RPLCMT GASTRIC NSTIM ELTRDE ANTRUM OPEN |
43881 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43886 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GSTR RSTCV PX OPN REVJ SUBQ PORT COMPONENT ONLY |
43886 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43887 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GSTR RSTCV PX OPN RMVL SUBQ PORT COMPONENT ONLY |
43887 |
New / Changed in 2020: |
Changed for 2020 |
Service Description: |
GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT |
Restricted to Preferred Facilities: |
RESTRICTED |
Service Code: |
43888 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2020 12:00:00 AM |
|
Obesity Surgery |
GSTR RSTCV OPN RMVL & RPLCMT SUBQ PORT |
43888 |
New / Changed in 2020: |
|
Service Description: |
INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
44135 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
INTESTINAL ALLOTRANSPLANTATION CADAVER DONOR |
44135 |
New / Changed in 2020: |
|
Service Description: |
INTESTINAL ALLOTRANSPLANTATION LIVING DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
44136 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
INTESTINAL ALLOTRANSPLANTATION LIVING DONOR |
44136 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREP CADAVER/LIVING DONOR INTESTINE |
Restricted to Preferred Facilities: |
|
Service Code: |
44715 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREP CADAVER/LIVING DONOR INTESTINE |
44715 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
44720 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ INT ALGRFT VEN ANAST EA |
44720 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
44721 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ INT ALGRFT ARTL ANAST EA |
44721 |
New / Changed in 2020: |
|
Service Description: |
DONOR HEPATECTOMY CADAVER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
47133 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR HEPATECTOMY CADAVER DONOR |
47133 |
New / Changed in 2020: |
|
Service Description: |
LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE |
Restricted to Preferred Facilities: |
|
Service Code: |
47135 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LVR ALTRNSPLJ ORTHOTOPIC PRTL/WHL DON ANY AGE |
47135 |
New / Changed in 2020: |
|
Service Description: |
DONOR HEPATECTOMY LIVING DONOR SEG II & III |
Restricted to Preferred Facilities: |
|
Service Code: |
47140 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR HEPATECTOMY LIVING DONOR SEG II & III |
47140 |
New / Changed in 2020: |
|
Service Description: |
DONOR HEPATECTOMY LIVING DONOR SEG II III & IV |
Restricted to Preferred Facilities: |
|
Service Code: |
47141 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR HEPATECTOMY LIVING DONOR SEG II III & IV |
47141 |
New / Changed in 2020: |
|
Service Description: |
DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI |
Restricted to Preferred Facilities: |
|
Service Code: |
47142 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR HEPATECTOMY LIVING DONOR SEG V VI VII &VI |
47142 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREP CADAVER DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
47143 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREP CADAVER DONOR |
47143 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER WHOLE LIVER GRF I&IV VII |
Restricted to Preferred Facilities: |
|
Service Code: |
47144 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER WHOLE LIVER GRF I&IV VII |
47144 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VI |
Restricted to Preferred Facilities: |
|
Service Code: |
47145 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR WHL LVR GRF I&V VI |
47145 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
47146 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ LVR GRF VENOUS ANAST EA |
47146 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ LVR GRF ARTL ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
47147 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ LVR GRF ARTL ANAST EA |
47147 |
New / Changed in 2020: |
|
Service Description: |
PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS |
Restricted to Preferred Facilities: |
|
Service Code: |
48160 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
PANCREATECTOMY W/TRNSPLJ PANCREAS/ISLET CELLS |
48160 |
New / Changed in 2020: |
|
Service Description: |
DONOR PANCREATECTOMY DUODENAL SGM TRANSPLANT |
Restricted to Preferred Facilities: |
|
Service Code: |
48550 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR PANCREATECTOMY DUODENAL SGM TRANSPLANT |
48550 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR PANCREAS ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
48551 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR PANCREAS ALLOGRAFT |
48551 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
48552 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ CDVR PNCRS ALGRFT VEN ANAST EA |
48552 |
New / Changed in 2020: |
|
Service Description: |
TRANSPLANTATION PANCREATIC ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
48554 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
TRANSPLANTATION PANCREATIC ALLOGRAFT |
48554 |
New / Changed in 2020: |
|
Service Description: |
RMVL TRANSPLANTED PANCREATIC ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
48556 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RMVL TRANSPLANTED PANCREATIC ALLOGRAFT |
48556 |
New / Changed in 2020: |
|
Service Description: |
DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL |
Restricted to Preferred Facilities: |
|
Service Code: |
50300 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR NEPHRECTOMY CADAVER DONOR UNI/BILATERAL |
50300 |
New / Changed in 2020: |
|
Service Description: |
DONOR NEPHRECTOMY OPEN LIVING DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
50320 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
DONOR NEPHRECTOMY OPEN LIVING DONOR |
50320 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
50323 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ CADAVER DONOR RENAL ALLOGRAFT |
50323 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
50325 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH PREPJ LIVING RENAL DONOR ALLOGRAFT |
50325 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
50327 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ RENAL ALGRFT VENOUS ANAST EA |
50327 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
50328 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ RENAL ALLOGRAFT ARTERIAL ANAST EA |
50328 |
New / Changed in 2020: |
|
Service Description: |
BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA |
Restricted to Preferred Facilities: |
|
Service Code: |
50329 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
BKBENCH RCNSTJ ALGRFT URETERAL ANAST EA |
50329 |
New / Changed in 2020: |
|
Service Description: |
RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE |
Restricted to Preferred Facilities: |
|
Service Code: |
50340 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RECIPIENT NEPHRECTOMY SEPARATE PROCEDURE |
50340 |
New / Changed in 2020: |
|
Service Description: |
RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
50360 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RENAL ALTRNSPLJ IMPLTJ GRF W/O RCP NEPHRECTOMY |
50360 |
New / Changed in 2020: |
|
Service Description: |
RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
50365 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RENAL ALTRNSPLJ IMPLTJ GRF W/RCP NEPHRECTOMY |
50365 |
New / Changed in 2020: |
|
Service Description: |
RMVL TRNSPLED RENAL ALLOGRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
50370 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RMVL TRNSPLED RENAL ALLOGRAFT |
50370 |
New / Changed in 2020: |
|
Service Description: |
RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY |
Restricted to Preferred Facilities: |
|
Service Code: |
50380 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
RENAL AUTOTRNSPLJ REIMPLANTATION KIDNEY |
50380 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR |
Restricted to Preferred Facilities: |
|
Service Code: |
50547 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Transplant evaluation services (pre-transplant services) and surgical tranplantation of organs, bone marrow or stem cells (Solid Organ) |
LAPAROSCOPY DONOR NEPHRECTOMY LIVING DONOR |
50547 |
New / Changed in 2020: |
|
Service Description: |
URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT |
Restricted to Preferred Facilities: |
|
Service Code: |
53415 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
URTP TRANSPUBIC/PRNL 1 STG RCNSTJ/RPR URT |
53415 |
New / Changed in 2020: |
|
Service Description: |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE |
Restricted to Preferred Facilities: |
|
Service Code: |
53420 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 1ST STAGE |
53420 |
New / Changed in 2020: |
|
Service Description: |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE |
Restricted to Preferred Facilities: |
|
Service Code: |
53425 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE |
53425 |
New / Changed in 2020: |
|
Service Description: |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE |
Restricted to Preferred Facilities: |
|
Service Code: |
53425 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
URTP 2-STG RCNSTJ/RPR PROSTAT/URETHRA 2ND STAGE |
53425 |
New / Changed in 2020: |
|
Service Description: |
URETHROPLASTY RCNSTJ FEMALE URETHRA |
Restricted to Preferred Facilities: |
|
Service Code: |
53430 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
URETHROPLASTY RCNSTJ FEMALE URETHRA |
53430 |
New / Changed in 2020: |
|
Service Description: |
AMPUTATION PENIS PARTIAL |
Restricted to Preferred Facilities: |
|
Service Code: |
54120 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
AMPUTATION PENIS PARTIAL |
54120 |
New / Changed in 2020: |
|
Service Description: |
AMPUTATION PENIS COMPLETE |
Restricted to Preferred Facilities: |
|
Service Code: |
54125 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
AMPUTATION PENIS COMPLETE |
54125 |
New / Changed in 2020: |
|
Service Description: |
INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID |
Restricted to Preferred Facilities: |
|
Service Code: |
54400 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INSJ PENILE PROSTHESIS NON-INFLATABLE SEMI-RIGID |
54400 |
New / Changed in 2020: |
|
Service Description: |
INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED |
Restricted to Preferred Facilities: |
|
Service Code: |
54401 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INSJ PENILE PROSTHESOS INFLATABLE SELF-CONTAINED |
54401 |
New / Changed in 2020: |
|
Service Description: |
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH |
Restricted to Preferred Facilities: |
|
Service Code: |
54405 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INSJ MULTI-COMPONENT INFLATABLE PENILE PROSTH |
54405 |
New / Changed in 2020: |
|
Service Description: |
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH |
Restricted to Preferred Facilities: |
|
Service Code: |
54406 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL INFLATABLE PENILE PROSTH W/O RPLCMT PROSTH |
54406 |
New / Changed in 2020: |
|
Service Description: |
RPR COMPONENT INFLATABLE PENILE PROSTHESIS |
Restricted to Preferred Facilities: |
|
Service Code: |
54408 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RPR COMPONENT INFLATABLE PENILE PROSTHESIS |
54408 |
New / Changed in 2020: |
|
Service Description: |
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS |
Restricted to Preferred Facilities: |
|
Service Code: |
54410 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL & RPLCMT INFLATABLE PENILE PROSTH SAME SESS |
54410 |
New / Changed in 2020: |
|
Service Description: |
RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL |
Restricted to Preferred Facilities: |
|
Service Code: |
54411 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL & RPLCMT NFLTBL PENILE PROSTH INFECTED FIEL |
54411 |
New / Changed in 2020: |
|
Service Description: |
RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT |
Restricted to Preferred Facilities: |
|
Service Code: |
54415 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL NON-NFLTBL/NFLTBL PENILE PROSTH W/O RPLCMT |
54415 |
New / Changed in 2020: |
|
Service Description: |
RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI |
Restricted to Preferred Facilities: |
|
Service Code: |
54416 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL & RPLCMT NON-NFLTBL/NFLTBL PENILE PROSTHESI |
54416 |
New / Changed in 2020: |
|
Service Description: |
RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD |
Restricted to Preferred Facilities: |
|
Service Code: |
54417 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
RMVL & RPLCMT PENILE PROSTHESIS INFECTED FIELD |
54417 |
New / Changed in 2020: |
|
Service Description: |
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH |
Restricted to Preferred Facilities: |
|
Service Code: |
54520 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
ORCHIECTOMY SIMPLE SCROTAL/INGUINAL APPROACH |
54520 |
New / Changed in 2020: |
|
Service Description: |
INSJ TESTICULAR PROSTH SEPARATE PROCEDURE |
Restricted to Preferred Facilities: |
|
Service Code: |
54660 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INSJ TESTICULAR PROSTH SEPARATE PROCEDURE |
54660 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY SURGICAL ORCHIECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
54690 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY SURGICAL ORCHIECTOMY |
54690 |
New / Changed in 2020: |
|
Service Description: |
SCROTOPLASTY SIMPLE |
Restricted to Preferred Facilities: |
|
Service Code: |
55175 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
SCROTOPLASTY SIMPLE |
55175 |
New / Changed in 2020: |
|
Service Description: |
SCROTOPLASTY COMPLICATED |
Restricted to Preferred Facilities: |
|
Service Code: |
55180 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
SCROTOPLASTY COMPLICATED |
55180 |
New / Changed in 2020: |
|
Service Description: |
UNLISTED PROCEDURE MALE GENITAL SYSTEM |
Restricted to Preferred Facilities: |
|
Service Code: |
55899 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
UNLISTED PROCEDURE MALE GENITAL SYSTEM |
55899 |
New / Changed in 2020: |
|
Service Description: |
INTERSEX SURG MALE FEMALE |
Restricted to Preferred Facilities: |
|
Service Code: |
55970 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INTERSEX SURG MALE FEMALE |
55970 |
New / Changed in 2020: |
|
Service Description: |
INTERSEX SURG FEMALE MALE |
Restricted to Preferred Facilities: |
|
Service Code: |
55980 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
INTERSEX SURG FEMALE MALE |
55980 |
New / Changed in 2020: |
|
Service Description: |
VULVECTOMY SIMPLE COMPLETE |
Restricted to Preferred Facilities: |
|
Service Code: |
56625 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VULVECTOMY SIMPLE COMPLETE |
56625 |
New / Changed in 2020: |
|
Service Description: |
PLASTIC REPAIR INTROITUS |
Restricted to Preferred Facilities: |
|
Service Code: |
56800 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
PLASTIC REPAIR INTROITUS |
56800 |
New / Changed in 2020: |
|
Service Description: |
CLITOROPLASTY INTERSEX STATE |
Restricted to Preferred Facilities: |
|
Service Code: |
56805 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
CLITOROPLASTY INTERSEX STATE |
56805 |
New / Changed in 2020: |
|
Service Description: |
PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX |
Restricted to Preferred Facilities: |
|
Service Code: |
56810 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
PERINEOPLASTY RPR PERINEUM NONOBSTETRICAL SPX |
56810 |
New / Changed in 2020: |
|
Service Description: |
VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL |
Restricted to Preferred Facilities: |
|
Service Code: |
57106 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINECTOMY PARTIAL REMOVAL VAGINAL WALL |
57106 |
New / Changed in 2020: |
|
Service Description: |
VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T |
Restricted to Preferred Facilities: |
|
Service Code: |
57107 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINECTOMY PRTL RMVL VAG WALL & PARAVAGINAL T |
57107 |
New / Changed in 2020: |
|
Service Description: |
VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL |
Restricted to Preferred Facilities: |
|
Service Code: |
57110 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINECTOMY COMPLETE REMOVAL VAGINAL WALL |
57110 |
New / Changed in 2020: |
|
Service Description: |
VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS |
Restricted to Preferred Facilities: |
|
Service Code: |
57111 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINECTOMY COMPL RMVL VAG WALL & PARAVAG TISS |
57111 |
New / Changed in 2020: |
|
Service Description: |
CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
57291 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
CONSTRUCTION ARTIFICIAL VAGINA W/O GRAFT |
57291 |
New / Changed in 2020: |
|
Service Description: |
CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT |
Restricted to Preferred Facilities: |
|
Service Code: |
57292 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
CONSTRUCTION ARTIFICIAL VAGINA W/GRAFT |
57292 |
New / Changed in 2020: |
|
Service Description: |
REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP |
Restricted to Preferred Facilities: |
|
Service Code: |
57295 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
REVJ/RMVL PROSTHETIC VAGINAL GRAFT VAGINAL APP |
57295 |
New / Changed in 2020: |
|
Service Description: |
REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR |
Restricted to Preferred Facilities: |
|
Service Code: |
57296 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
REVJ W/RMVL PROSTHETIC VAGINAL GRAFT ABDML APPR |
57296 |
New / Changed in 2020: |
|
Service Description: |
VAGINOPLASTY INTERSEX STATE |
Restricted to Preferred Facilities: |
|
Service Code: |
57335 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINOPLASTY INTERSEX STATE |
57335 |
New / Changed in 2020: |
|
Service Description: |
TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58150 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
TOTAL ABDOMINAL HYSTERECT W/WO RMVL TUBE OVARY |
58150 |
New / Changed in 2020: |
|
Service Description: |
SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58180 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
SUPRACERVICAL ABDL HYSTER W/WO RMVL TUBE OVARY |
58180 |
New / Changed in 2020: |
|
Service Description: |
VAGINAL HYSTERECTOMY UTERUS 250 GM/< |
Restricted to Preferred Facilities: |
|
Service Code: |
58260 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINAL HYSTERECTOMY UTERUS 250 GM/< |
58260 |
New / Changed in 2020: |
|
Service Description: |
VAG HYST 250 GM/< W/RMVL TUBE&/OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58262 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAG HYST 250 GM/< W/RMVL TUBE&/OVARY |
58262 |
New / Changed in 2020: |
|
Service Description: |
VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY |
Restricted to Preferred Facilities: |
|
Service Code: |
58275 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINAL HYSTERECTOMY W/TOT/PRTL VAGINECTOMY |
58275 |
New / Changed in 2020: |
|
Service Description: |
VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE |
Restricted to Preferred Facilities: |
|
Service Code: |
58280 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAG HYSTER W/TOT/PRTL VAGINECT W/RPR ENTEROCELE |
58280 |
New / Changed in 2020: |
|
Service Description: |
VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION |
Restricted to Preferred Facilities: |
|
Service Code: |
58285 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINAL HYSTERECTOMY RADICAL SCHAUTA OPERATION |
58285 |
New / Changed in 2020: |
|
Service Description: |
VAGINAL HYSTERECTOMY UTERUS > 250 GM |
Restricted to Preferred Facilities: |
|
Service Code: |
58290 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAGINAL HYSTERECTOMY UTERUS > 250 GM |
58290 |
New / Changed in 2020: |
|
Service Description: |
VAG HYST > 250 GM RMVL TUBE&/OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58291 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
VAG HYST > 250 GM RMVL TUBE&/OVARY |
58291 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< |
Restricted to Preferred Facilities: |
|
Service Code: |
58541 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY SUPRACERVICAL HYSTERECTOMY 250 GM/< |
58541 |
New / Changed in 2020: |
|
Service Description: |
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR |
Restricted to Preferred Facilities: |
|
Service Code: |
58542 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS SUPRACRV HYSTERECT 250 GM/< RMVL TUBE/OVAR |
58542 |
New / Changed in 2020: |
|
Service Description: |
LAPS SUPRACERVICAL HYSTERECTOMY >250 |
Restricted to Preferred Facilities: |
|
Service Code: |
58543 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS SUPRACERVICAL HYSTERECTOMY >250 |
58543 |
New / Changed in 2020: |
|
Service Description: |
LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58544 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS SUPRACRV HYSTEREC >250 G RMVL TUBE/OVARY |
58544 |
New / Changed in 2020: |
|
Service Description: |
LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< |
Restricted to Preferred Facilities: |
|
Service Code: |
58550 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS VAGINAL HYSTERECTOMY UTERUS 250 GM/< |
58550 |
New / Changed in 2020: |
|
Service Description: |
LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES |
Restricted to Preferred Facilities: |
|
Service Code: |
58552 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS W/VAG HYSTERECT 250 GM/&RMVL TUBE&/OVARIES |
58552 |
New / Changed in 2020: |
|
Service Description: |
LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS |
Restricted to Preferred Facilities: |
|
Service Code: |
58553 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS W/VAGINAL HYSTERECTOMY > 250 GRAMS |
58553 |
New / Changed in 2020: |
|
Service Description: |
LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR |
Restricted to Preferred Facilities: |
|
Service Code: |
58554 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS VAGINAL HYSTERECT > 250 GM RMVL TUBE&/OVAR |
58554 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< |
Restricted to Preferred Facilities: |
|
Service Code: |
58570 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY W TOTAL HYSTERECTOMY UTERUS 250 GM/< |
58570 |
New / Changed in 2020: |
|
Service Description: |
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY |
Restricted to Preferred Facilities: |
|
Service Code: |
58571 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPS TOTAL HYSTERECT 250 GM/< W/RMVL TUBE/OVARY |
58571 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM |
Restricted to Preferred Facilities: |
|
Service Code: |
58572 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY TOTAL HYSTERECTOMY UTERUS >250 GM |
58572 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR |
Restricted to Preferred Facilities: |
|
Service Code: |
58573 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY TOT HYSTERECTOMY >250 G W/TUBE/OVAR |
58573 |
New / Changed in 2020: |
|
Service Description: |
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES |
Restricted to Preferred Facilities: |
|
Service Code: |
58661 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
LAPAROSCOPY W/RMVL ADNEXAL STRUCTURES |
58661 |
New / Changed in 2020: |
|
Service Description: |
SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX |
Restricted to Preferred Facilities: |
|
Service Code: |
58720 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
SALPINGO-OOPHORECTOMY COMPL/PRTL UNI/BI SPX |
58720 |
New / Changed in 2020: |
|
Service Description: |
OOPHORECTOMY PARTIAL/TOTAL UNI/BI |
Restricted to Preferred Facilities: |
|
Service Code: |
58940 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Gender Dysphoria and Gender Confirmation Treatment |
OOPHORECTOMY PARTIAL/TOTAL UNI/BI |
58940 |
New / Changed in 2020: |
|
Service Description: |
FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE |
Restricted to Preferred Facilities: |
|
Service Code: |
59072 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Fetal Surgery (surgery on the unborn child) |
FETAL UMBILICAL CORD OCCLUSION W/ULTRSND GUIDNCE |
59072 |
New / Changed in 2020: |
|
Service Description: |
FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE |
Restricted to Preferred Facilities: |
|
Service Code: |
59074 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Fetal Surgery (surgery on the unborn child) |
FETAL FLUID DRAINAGE W/ULTRASOUND GUIDANCE |
59074 |
New / Changed in 2020: |
|
Service Description: |
FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE |
Restricted to Preferred Facilities: |
|
Service Code: |
59076 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Fetal Surgery (surgery on the unborn child) |
FETAL SHUNT PLACEMENT W/ULTRASOUND GUIDANCE |
59076 |
New / Changed in 2020: |
|
Service Description: |
INDUCED ABORTION DILATION AND CURETTAGE |
Restricted to Preferred Facilities: |
|
Service Code: |
59840 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORTION DILATION AND CURETTAGE |
59840 |
New / Changed in 2020: |
|
Service Description: |
INDUCED ABORTION DILATION & EVACUATION |
Restricted to Preferred Facilities: |
|
Service Code: |
59841 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORTION DILATION & EVACUATION |
59841 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ |
Restricted to Preferred Facilities: |
|
Service Code: |
59850 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORTION 1/> AMNIOTIC INJX W/D&C/EVACJ |
59850 |
New / Changed in 2020: |
|
Service Description: |
INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C |
Restricted to Preferred Facilities: |
|
Service Code: |
59851 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS D&C |
59851 |
New / Changed in 2020: |
|
Service Description: |
INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM |
Restricted to Preferred Facilities: |
|
Service Code: |
59852 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCE ABORT 1/> AMNIOT NJXS DLVR FETUS HYSTOTM |
59852 |
New / Changed in 2020: |
|
Service Description: |
INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS |
Restricted to Preferred Facilities: |
|
Service Code: |
59855 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORT 1/> VAG SUPPOSITORIES DLVR FETUS |
59855 |
New / Changed in 2020: |
|
Service Description: |
INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC |
Restricted to Preferred Facilities: |
|
Service Code: |
59856 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORT 1/> VAG SUPP DLVR FETUS D&C &/EVAC |
59856 |
New / Changed in 2020: |
|
Service Description: |
INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT |
Restricted to Preferred Facilities: |
|
Service Code: |
59857 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Termination of Pregnancy (Abortion) |
INDUCED ABORT 1/> VAG SUPPOS DLVR FETUS HYSTOT |
59857 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion |
Restricted to Preferred Facilities: |
|
Service Code: |
61796 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 simple cranial lesion |
61796 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, simple (List separately in addition to code for primary procedure) |
Restricted to Preferred Facilities: |
|
Service Code: |
61797 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, simple (List separately in addition to code for primary procedure) |
61797 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 complex cranial lesion |
Restricted to Preferred Facilities: |
|
Service Code: |
61798 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); 1 complex cranial lesion |
61798 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure) |
Restricted to Preferred Facilities: |
|
Service Code: |
61799 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Stereotactic radiosurgery (particle beam, gamma ray or linear accelerator); each additional cranial lesion, complex (List separately in addition to code for primary procedure) |
61799 |
New / Changed in 2020: |
New for 2020 |
Service Description: |
Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure) |
Restricted to Preferred Facilities: |
|
Service Code: |
61800 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Stereotactic Radiosurgery (including but not limited to Cyberknife, GammaKnife, LINAC, Neuromate, Nerhkoordinaten Manipulator (MKM)) |
Application of stereotactic headframe for stereotactic radiosurgery (List separately in addition to code for primary procedure) |
61800 |
New / Changed in 2020: |
|
Service Description: |
TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL |
Restricted to Preferred Facilities: |
|
Service Code: |
61850 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
TWIST/BURR HOLE IMPLTJ NSTIM ELTRD CORTICAL |
61850 |
New / Changed in 2020: |
|
Service Description: |
CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL |
Restricted to Preferred Facilities: |
|
Service Code: |
61860 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Deep Brain Stimulation |
CRNEC/CRX IMPLTJ NSTIM ELTRD CERE CORTICAL |
61860 |
New / Changed in 2020: |
|
Service Description: |
STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY |
Restricted to Preferred Facilities: |
|
Service Code: |
61863 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD 1ST ARRAY |
61863 |
New / Changed in 2020: |
|
Service Description: |
STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY |
Restricted to Preferred Facilities: |
|
Service Code: |
61864 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
STRTCTC IMPLTJ NSTIM ELTRD W/O RECORD EA ARRAY |
61864 |
New / Changed in 2020: |
|
Service Description: |
STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY |
Restricted to Preferred Facilities: |
|
Service Code: |
61867 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
STRTCTC IMPLTJ NSTIM ELTRD W/RECORD 1ST ARRAY |
61867 |
New / Changed in 2020: |
|
Service Description: |
STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY |
Restricted to Preferred Facilities: |
|
Service Code: |
61868 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
STRTCTC IMPLTJ NSTIM ELTRD W/RECORD EA ARRAY |
61868 |
New / Changed in 2020: |
|
Service Description: |
CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL |
Restricted to Preferred Facilities: |
|
Service Code: |
61870 |
Service Code Type: |
CPT |
Effective Date: |
2/1/2020 12:00:00 AM |
|
Deep Brain Stimulation |
CRNEC IMPLTJ NSTIM ELTRD CEREBELLAR CORTICAL |
61870 |
New / Changed in 2020: |
|
Service Description: |
INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR |
Restricted to Preferred Facilities: |
|
Service Code: |
61885 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR |
61885 |
New / Changed in 2020: |
|
Service Description: |
INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR |
Restricted to Preferred Facilities: |
|
Service Code: |
61885 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Vagal Nerve Stimulation |
INSJ/RPLCMT CRANIAL NEUROSTIM PULSE GENERATOR |
61885 |
New / Changed in 2020: |
|
Service Description: |
INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS |
Restricted to Preferred Facilities: |
|
Service Code: |
61886 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Deep Brain Stimulation |
INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS |
61886 |
New / Changed in 2020: |
|
Service Description: |
INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS |
Restricted to Preferred Facilities: |
|
Service Code: |
61886 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Vagal Nerve Stimulation |
INSJ/RPLCMT CRANIAL NEUROSTIM GENER 2/> ELTRDS |
61886 |
New / Changed in 2020: |
|
Service Description: |
PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS |
Restricted to Preferred Facilities: |
|
Service Code: |
62263 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Lysis of Adhesions |
PRQ LYSIS EPIDURAL ADHESIONS MULT SESS 2/> DAYS |
62263 |
New / Changed in 2020: |
|
Service Description: |
PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY |
Restricted to Preferred Facilities: |
|
Service Code: |
62264 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Lysis of Adhesions |
PRQ LYSIS EPIDURAL ADHESIONS MULT SESSIONS 1 DAY |
62264 |
New / Changed in 2020: |
|
Service Description: |
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 |
Restricted to Preferred Facilities: |
|
Service Code: |
62320 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Injections |
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 |
62320 |
New / Changed in 2020: |
|
Service Description: |
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) |
Restricted to Preferred Facilities: |
|
Service Code: |
62321 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Injections |
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) |
62321 |
New / Changed in 2020: |
|
Service Description: |
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, lumbar or sacral (caudal); without imaging guidance |
Restricted to Preferred Facilities: |
|
Service Code: |
62322 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Injections |
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, lumbar or sacral (caudal); without imaging guidance |
62322 |
New / Changed in 2020: |
|
Service Description: |
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, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) |
Restricted to Preferred Facilities: |
|
Service Code: |
62323 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Epidural Injections |
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, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) |
62323 |
New / Changed in 2020: |
|
Service Description: |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance |
Restricted to Preferred Facilities: |
|
Service Code: |
62324 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance |
62324 |
New / Changed in 2020: |
|
Service Description: |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) |
Restricted to Preferred Facilities: |
|
Service Code: |
62325 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) |
62325 |
New / Changed in 2020: |
|
Service Description: |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance |
Restricted to Preferred Facilities: |
|
Service Code: |
62326 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance |
62326 |
New / Changed in 2020: |
|
Service Description: |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) |
Restricted to Preferred Facilities: |
|
Service Code: |
62327 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) |
62327 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM |
Restricted to Preferred Facilities: |
|
Service Code: |
62350 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM |
62350 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM |
Restricted to Preferred Facilities: |
|
Service Code: |
62351 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM |
62351 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR |
Restricted to Preferred Facilities: |
|
Service Code: |
62360 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS SUBQ RSVR |
62360 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ/RPLCMT FS NON-PRGRBL PUMP |
Restricted to Preferred Facilities: |
|
Service Code: |
62361 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
IMPLTJ/RPLCMT FS NON-PRGRBL PUMP |
62361 |
New / Changed in 2020: |
|
Service Description: |
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP |
Restricted to Preferred Facilities: |
|
Service Code: |
62362 |
Service Code Type: |
CPT |
Effective Date: |
1/1/2018 12:00:00 AM |
|
Intrathecal Infusion Pump |
IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP |