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PCP Services NOT Requiring Prior Authorization

Most services performed by a PCP in the office setting can be reimbursed without obtaining Prior Authorization.

The following office-based services do not require prior authorization. If you plan to offer a service not found on this list you will need to submit a Prior Authorization request to HCP for review.

10060

INCISION AND DRAINAGE OF SINGLE FURUNCLE

10021

FINE NEEDLE ASPIRATION OF FIRST LESION

10040

MARSUPIALIZATION OF MULTIPLE COMEDONES

10061

COMPLICATED INCISION AND DRAINAGE OF PARONYCHIA

10080

SIMPLE INCISION AND DRAINAGE OF PILONIDAL CYST

10081

COMPLICATED INCISION AND DRAINAGE OF PILONIDAL CYST

10120

INCISION OF SUBCUTANEOUS TISSUE WITH REMOVAL OF FOREIGN BODY

10121

COMPLICATED INCISION OF SUBCUTANEOUS TISSUE WITH REMOVAL OF FOREIGN BODY

10160

PUNCTURE ASPIRATION OF HEMATOMA

11000

DEBRIDEMENT OF INFECTED SKIN

11042

DEBRIDEMENT OF SUBCUTANEOUS TISSUE

11043

DEBRIDEMENT OF MUSCLE AND FASCIA

11045

DEBRIDEMENT OF SUBCUTANEOUS TISSUE, INCLUDING EPIDERMIS AND DERMIS, EACH ADDITIONAL 20 SQUARE CMS OR LESS

11046

DEBRIDEMENT OF MUSCLE AND FASCIA, INCLUDING EPIDERMIS, DERMIS, AND SUBCUTANEOUS TISSUE, EACH ADDITIONAL 20 SQUARE CMS OR LESS

11055

CUTTING OF SINGLE BENIGN HYPERKERATOTIC LESION

11056

CUTTING OF 2-4 CORNS

11057

PARING OF MORE THAN 4 CALLUSES

11200

REMOVAL OF FIBROCUTANEOUS TAG

11201

REMOVAL OF FIBROCUTANEOUS TAG

11300

SHAVING OF DERMAL LESION OF LOWER LIMB

11301

SHAVING OF DERMAL LESION OF LOWER LIMB

11302

SHAVING OF DERMAL LESION OF UPPER LIMB

11303

SHAVING OF DERMAL LESION OF UPPER LIMB

11305

SHAVING OF EPIDERMAL LESION OF FOOT

11306

SHAVING OF DERMAL LESION OF HAND

11307

SHAVING OF EPIDERMAL LESION OF FOOT

11308

SHAVING OF DERMAL LESION OF GENITALIA

11310

SHAVING OF DERMAL LESION OF MUCOUS MEMBRANE

11311

SHAVING OF DERMAL LESION OF NOSE

11312

SHAVING OF DERMAL LESION OF NOSE

11313

SHAVING OF DERMAL LESION OF EAR

11400

EXCISION OF BENIGN LESION OF LOWER LIMB, INCLUDING MARGINS, EXCISED DIAMETER 0.5 CM OR LESS

11401

EXCISION OF BENIGN LESION OF UPPER LIMB

11402

EXCISION OF BENIGN LESION OF UPPER LIMB, INCLUDING MARGINS, EXCISED DIAMETER 1.1 TO 2.0 CM

11403

EXCISION OF BENIGN LESION OF TRUNK, INCLUDING MARGINS, EXCISED DIAMETER 2.1 TO 3.0 CM

11404

EXCISION OF BENIGN LESION OF LOWER LIMB, INCLUDING MARGINS, EXCISED DIAMETER 3.1 TO 4.0 CM

11406

EXCISION OF BENIGN LESION OF LOWER LIMB, INCLUDING MARGINS, EXCISED DIAMETER OVER 4.0 CM

11420

EXCISION OF BENIGN LESION OF NECK, INCLUDING MARGINS, EXCISED DIAMETER 0.5 CM OR LESS

11421

EXCISION OF BENIGN LESION OF GENITALIA

11422

EXCISION OF BENIGN LESION OF FOOT, INCLUDING MARGINS, EXCISED DIAMETER 1.1 TO 2.0 CM

11423

EXCISION OF BENIGN LESION OF FOOT, INCLUDING MARGINS, EXCISED DIAMETER 2.1 TO 3.0 CM

11424

EXCISION OF BENIGN LESION OF GENITALIA

11426

EXCISION OF BENIGN LESION OF FOOT, INCLUDING MARGINS, EXCISED DIAMETER OVER 4.0 CM

11440

EXCISION OF BENIGN LESION OF EAR, INCLUDING MARGINS, EXCISED DIAMETER 0.5 CM OR LESS

11441

EXCISION OF BENIGN LESION OF EAR, INCLUDING MARGINS, EXCISED DIAMETER 0.6 TO 1.0 CM

11442

EXCISION OF BENIGN LESION OF LIP, INCLUDING MARGINS, EXCISED DIAMETER 1.1 TO 2.0 CM

11443

EXCISION OF BENIGN LESION OF LIP

11444

EXCISION OF BENIGN LESION OF EAR

11446

EXCISION OF BENIGN LESION OF MUCOUS MEMBRANE

11600

EXCISION OF MALIGNANT LESION OF LOWER LIMB

11601

EXCISION OF MALIGNANT LESION OF UPPER LIMB

11602

EXCISION OF MALIGNANT LESION OF UPPER LIMB

11603

EXCISION OF MALIGNANT LESION OF LOWER LIMB, INCLUDING MARGINS, EXCISED DIAMETER 2.1 TO 3.0 CM

11604

EXCISION OF MALIGNANT LESION OF LOWER LIMB, INCLUDING MARGINS, EXCISED DIAMETER 3.1 TO 4.0 CM

11606

EXCISION OF MALIGNANT LESION OF TRUNK

11620

EXCISION OF MALIGNANT LESION OF GENITALIA, INCLUDING MARGINS, EXCISED DIAMETER 0.5 CM OR LESS

11621

EXCISION OF MALIGNANT LESION OF SCALP

11622

EXCISION OF MALIGNANT LESION OF HAND

11623

EXCISION OF MALIGNANT LESION OF FOOT

11624

EXCISION OF MALIGNANT LESION OF NECK

11626

EXCISION OF MALIGNANT LESION OF GENITALIA

11719

TRIMMING OF NONDYSTROPHIC NAILS

11720

DEBRIDEMENT OF 1-5 NAILS

11721

DEBRIDEMENT OF 6 OR MORE NAILS

11730

PARTIAL AVULSION OF NAIL PLATE

11732

COMPLETE AVULSION OF NAIL PLATE

11740

EVACUATION OF SUBUNGUAL HEMATOMA

11750

PARTIAL EXCISION OF NAIL AND NAIL MATRIX FOR PERMANENT REMOVAL OF DEFORMED NAIL

11765

WEDGE EXCISION OF SKIN OF NAIL FOLD

11770

SIMPLE EXCISION OF PILONIDAL SINUS

11900

INTRALESIONAL INJECTION OF 1 TO 7 LESIONS

11901

INTRALESIONAL INJECTION

12001

REPAIR OF WOUND OF AXILLA

12002

REPAIR OF WOUND OF NECK

12004

SIMPLE REPAIR OF SUPERFICIAL WOUND OF TRUNK, 7.6 CM TO 12.5 CM

12005

SIMPLE REPAIR OF SUPERFICIAL WOUND OF SCALP, 12.6 CM TO 20.0 CM

12006

REPAIR OF WOUND OF EXTERNAL GENITALIA

12007

SIMPLE REPAIR OF SUPERFICIAL WOUND OF TRUNK, OVER 30.0 CM

12011

REPAIR OF WOUND OF EYELID

12013

REPAIR OF WOUND OF EYELID

12014

REPAIR OF WOUND OF EYELID

12015

REPAIR OF WOUND OF EAR

12016

REPAIR OF WOUND OF NOSE

12017

REPAIR OF WOUND OF FACE

12018

REPAIR OF WOUND OF MUCOUS MEMBRANE

16000

INITIAL LOCAL TREATMENT OF FIRST DEGREE BURN

16020

DEBRIDEMENT OF PARTIAL THICKNESS BURN

17000

CHEMOSURGERY OF PREMALIGNANT LESION, FIRST LESION

17003

DESTRUCTION OF ACTINIC KERATOSES, SECOND THROUGH 14 LESIONS

17004

LASER SURGERY OF PREMALIGNANT LESIONS, 15 OR MORE

17106

LASER SURGERY OF CUTANEOUS VASCULAR PROLIFERATIVE LESION, LESS THAN 10.0 SQ CM

17107

LASER SURGERY OF CUTANEOUS VASCULAR PROLIFERATIVE LESION, 10.0 TO 50.0 SQ CM

17108

LASER DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESION, OVER 50 SQ CM

17110

LASER SURGERY OF BENIGN LESION

17111

CHEMOSURGERY OF BENIGN LESION

17250

CHEMICAL CAUTERIZATION OF GRANULATION TISSUE

17340

CRYOTHERAPY FOR ACNE USING LIQUID N2

20520

REMOVAL OF FOREIGN BODY FROM TENDON SHEATH

20526

THERAPEUTIC INJECTION OF CARPAL TUNNEL

20550

INJECTION OF APONEUROSIS OF TENDON SHEATH

20551

INJECTION OF SINGLE TENDON INSERTION

20552

INJECTION OF MULTIPLE TRIGGER POINTS OF 1 MUSCLE

20553

INJECTION OF MULTIPLE TRIGGER POINTS OF 3 OR MORE MUSCLES

20600

ARTHROCENTESIS AND INJECTION OF JOINT OF FINGER

20605

ARTHROCENTESIS AND INJECTION OF INTERMEDIATE JOINT

20610

ARTHROCENTESIS OF KNEE JOINT

20612

INJECTION OF GANGLION CYST

29130

APPLICATION OF STATIC TYPE FINGER SPLINT

29131

APPLICATION OF DYNAMIC TYPE FINGER SPLINT

29580

STRAPPING OF UNNA BOOT

30300

REMOVAL OF INTRANASAL FOREIGN BODY

30901

CONTROL OF ANTERIOR NASAL HEMORRHAGE

31600

TRACHEOSTOMY

45300

DIAGNOSTIC RIGID PROCTOSIGMOIDOSCOPY

45305

RIGID PROCTOSIGMOIDOSCOPY WITH BIOPSY

45307

RIGID PROCTOSIGMOIDOSCOPY WITH REMOVAL OF FOREIGN BODY

45308

RIGID PROCTOSIGMOIDOSCOPY WITH REMOVAL OF POLYP USING HOT BIOPSY FORCEPS

45309

RIGID PROCTOSIGMOIDOSCOPY WITH REMOVAL OF POLYP USING SNARE

45315

RIGID PROCTOSIGMOIDOSCOPY WITH REMOVAL OF LESION USING BIPOLAR CAUTERY

45320

RIGID PROCTOSIGMOIDOSCOPY WITH ABLATION OF LESION

45330

DIAGNOSTIC FLEXIBLE SIGMOIDOSCOPY WITH COLLECTION OF SPECIMEN BY WASHING

45331

FLEXIBLE SIGMOIDOSCOPY WITH BIOPSY

45332

FLEXIBLE SIGMOIDOSCOPY WITH REMOVAL OF FOREIGN BODY

45333

FLEXIBLE SIGMOIDOSCOPY WITH REMOVAL OF POLYP USING BIPOLAR CAUTERY

45334

FLEXIBLE SIGMOIDOSCOPY WITH CONTROL OF BLEEDING

45335

FLEXIBLE SIGMOIDOSCOPY WITH DIRECTED SUBMUCOSAL INJECTION

45337

FLEXIBLE SIGMOIDOSCOPY WITH DECOMPRESSION OF VOLVULUS

45338

FLEXIBLE SIGMOIDOSCOPY WITH REMOVAL OF LESION USING SNARE

46600

DIAGNOSTIC ANOSCOPY

46900

CHEMICAL DESTRUCTION OF LESION OF ANUS

46910

ELECTRODESICCATION OF LESION OF ANUS

46916

CRYOSURGICAL DESTRUCTION OF LESION OF ANUS

46917

LASER SURGICAL DESTRUCTION OF LESION OF ANUS

51701

INSERTION OF NON-INDWELLING BLADDER CATHETER

51702

INSERTION OF FOLEY CATHETER INTO BLADDER

54050

SIMPLE CHEMICAL DESTRUCTION OF HERPETIC VESICLE OF PENIS

54055

ELECTRODESICCATION OF PAPILLOMA OF PENIS

54056

SIMPLE CRYOSURGERY OF CONDYLOMA OF PENIS

54057

LASER SURGERY OF PAPILLOMA OF PENIS

54060

EXCISION OF PAPILLOMA OF PENIS

54150

CIRCUMCISION USING CLAMP WITH REGIONAL DORSAL PENILE BLOCK

54160

CIRCUMCISION BY SURGICAL EXCISION IN NEONATE

64400

INJECTION OF ANESTHETIC AGENT INTO TRIGEMINAL NERVE

64402

INJECTION OF ANESTHETIC AGENT INTO FACIAL NERVE

64405

INJECTION OF ANESTHETIC AGENT INTO GREATER OCCIPITAL NERVE

64408

INJECTION OF ANESTHETIC AGENT INTO VAGUS NERVE

64410

INJECTION OF ANESTHETIC AGENT INTO PHRENIC NERVE

64413

INJECTION OF ANESTHETIC AGENT INTO CERVICAL PLEXUS

64415

SINGLE INJECTION OF ANESTHETIC AGENT INTO BRACHIAL PLEXUS

64417

INJECTION OF ANESTHETIC AGENT INTO AXILLARY NERVE

64418

INJECTION OF ANESTHETIC AGENT INTO SUPRASCAPULAR NERVE

64420

INJECTION OF ANESTHETIC AGENT INTO INTERCOSTAL NERVE

64445

INJECTION OF ANESTHETIC AGENT INTO SCIATIC NERVE

64447

INJECTION OF ANESTHETIC AGENT INTO FEMORAL NERVE

64450

INJECTION OF ANESTHETIC AGENT INTO PERIPHERAL NERVE

64455

INJECTION OF ANESTHETIC AGENT AND STEROID INTO PLANTAR COMMON DIGITAL NERVE

70030

X-RAY FOR DETECTION OF FOREIGN BODY OF EYE

70100

PARTIAL X-RAY OF MANDIBLE

70110

COMPLETE X-RAY OF MANDIBLE, POSTEROANTERIOR, OBLIQUE, AND LATERAL VIEWS

70120

X-RAY OF MASTOIDS, FRONTAL VIEW

70130

COMPLETE X-RAY OF MASTOIDS WITH MINIMUM OF 3 VIEWS PER SIDE

70134

X-RAY OF INTERNAL AUDITORY MEATI

70140

X-RAY OF FACIAL BONES, WATERS VIEW

70150

COMPLETE X-RAY OF FACIAL BONES

70160

COMPLETE X-RAY OF NASAL BONES

70170

RADIOLOGIC SUPERVISION AND INTERPRETATION FOR DACRYOCYSTOGRAPHY OF NASOLACRIMAL DUCT

70190

X-RAY OF OPTIC FORAMINA

70200

X-RAY OF ORBITS

70210

X-RAY OF PARANASAL SINUSES, FEWER THAN 3 VIEWS

70220

COMPLETE X-RAY OF PARANASAL SINUSES, WITH WATERS, CALDWELL, AND SUBMENTAL VERTICAL VIEWS

70240

X-RAY OF SELLA TURCICA

70250

X-RAY OF SKULL, POSTEROANTERIOR, LATERAL, AND TOWNES VIEWS

70260

COMPLETE X-RAY OF SKULL WITH MINIMUM OF 4 VIEWS

70328

UNILATERAL X-RAY OF TEMPOROMANDIBULAR JOINT WITH OPEN AND CLOSED MOUTH VIEWS

70330

BILATERAL X-RAY OF TEMPOROMANDIBULAR JOINT

70360

X-RAY OF SOFT TISSUE OF NECK

71045

X-RAY OF CHEST, SINGLE VIEW

71046

X-RAY OF CHEST, 2 VIEWS

71047

X-RAY OF CHEST, 3 VIEWS

71048

X-RAY OF CHEST, MINIMUM OF 4 VIEWS

71100

UNILATERAL X-RAY OF RIBS

71101

UNILATERAL X-RAY OF RIBS AND POSTEROANTERIOR CHEST

71110

BILATERAL X-RAY OF RIBS, ANTEROPOSTERIOR AND RIGHT AND LEFT POSTERIOR OBLIQUE VIEWS

71111

BILATERAL X-RAY OF RIBS, POSTEROANTERIOR AND RIGHT AND LEFT ANTEROPOSTERIOR OBLIQUE VIEWS, AND X-RAY OF CHEST, POSTEROANTERIOR VIEW

71120

X-RAY OF STERNUM

71130

X-RAY OF STERNOCLAVICULAR JOINTS, POSTEROANTERIOR AND LEFT AND RIGHT ANTERIOR OBLIQUE VIEWS

72020

X-RAY OF SPINE, ANTEROPOSTERIOR VIEW AT LUMBAR LEVEL

72040

X-RAY OF CERVICAL SPINE

72050

X-RAY OF CERVICAL SPINE, 5 VIEWS

72052

X-RAY OF CERVICAL SPINE, ANTEROPOSTERIOR, LATERAL, ODONTOID, SWIMMER, AND CROSS-TABLE LATERAL VIEWS, INCLUDING FLEXION AND EXTENSION STUDY

72070

X-RAY OF THORACIC SPINE

72072

X-RAY OF THORACIC SPINE, 3 VIEWS

72074

X-RAY OF THORACIC SPINE, MINIMUM OF 4 VIEWS

72080

X-RAY OF THORACOLUMBAR SPINE

72081

X-RAY OF THORACOLUMBAR SPINE WITH SKULL, CERVICAL AND SACRAL SPINE, SINGLE VIEW

72082

X-RAY OF THORACOLUMBAR SPINE, 2 VIEWS

72083

X-RAY OF THORACOLUMBAR SPINE, 4 OR 5 VIEWS

72084

X-RAY OF THORACOLUMBAR SPINE, MINIMUM OF 6 VIEWS

72100

X-RAY OF LUMBOSACRAL SPINE, ANTEROPOSTERIOR, LATERAL, AND OBLIQUE VIEWS

72110

X-RAY OF LUMBOSACRAL SPINE, ANTEROPOSTERIOR, LATERAL, OBLIQUE, AND CONED-DOWN LATERAL SPOT LUMBOSACRAL JUNCTION VIEWS

72114

COMPLETE X-RAY OF LUMBOSACRAL SPINE WITH ANTEROPOSTERIOR, LATERAL, RIGHT AND LEFT OBLIQUE, AND RIGHT AND LEFT BENDING VIEWS

72120

X-RAY OF LUMBOSACRAL SPINE, 2 BENDING VIEWS

72170

X-RAY OF PELVIS, ANTEROPOSTERIOR AND FROG-LEG LATERAL VIEW

72190

X-RAY OF PELVIS

72200

X-RAY OF SACROILIAC JOINTS

72202

X-RAY OF SACROILIAC JOINTS

72220

X-RAY OF SACRUM AND COCCYX, ANTEROPOSTERIOR AND LATERAL VIEWS

73000

X-RAY OF CLAVICLE

73010

COMPLETE X-RAY OF SCAPULA, SUPINE ANTEROPOSTERIOR AND STANDING LATERAL VIEWS

73020

X-RAY OF SHOULDER, GRASHEY ANTEROPOSTERIOR VIEW

73030

X-RAY OF SHOULDER, ANTEROPOSTERIOR AND LATERAL Y VIEWS

73050

BILATERAL X-RAY OF ACROMIOCLAVICULAR JOINTS

73060

X-RAY OF HUMERUS

73070

X-RAY OF ELBOW, 2 VIEWS

73080

X-RAY OF ELBOW

73090

X-RAY OF FOREARM

73092

X-RAY OF UPPER EXTREMITY OF INFANT, MINIMUM OF 2 VIEWS

73100

X-RAY OF WRIST

73110

X-RAY OF WRIST

73120

X-RAY OF HAND, 2 VIEWS

73130

X-RAY OF HAND, MINIMUM OF 3 VIEWS

73140

X-RAY OF FINGERS, POSTEROANTERIOR AND OBLIQUE VIEWS

73501

UNILATERAL X-RAY OF HIPS WITH PELVIS, SINGLE VIEW

73502

BILATERAL X-RAY OF HIPS, 2 – 3 VIEWS

73503

BILATERAL X-RAY OF HIPS, MINIMUM OF 4 VIEWS

73521

BILATERAL X-RAY OF HIPS WITH PELVIS, 2 VIEWS

73522

BILATERAL X-RAY OF HIPS, 4 VIEWS

73523

BILATERAL X-RAY OF HIPS, MINIMUM OF 5 VIEWS

73551

X-RAY OF FEMUR, SINGLE VIEW

73552

X-RAY OF FEMUR, MINIMUM OF 2 VIEWS

73560

X-RAY OF KNEE, SUNRISE VIEW

73562

X-RAY OF KNEE

73564

COMPLETE X-RAY OF KNEE, ANTEROPOSTERIOR, LATERAL, MEDIAL OBLIQUE, AND SUNRISE VIEWS

73565

BILATERAL X-RAY OF KNEES, STANDING ANTEROPOSTERIOR VIEW

73590

X-RAY OF TIBIA AND FIBULA

73592

X-RAY OF LOWER EXTREMITY OF INFANT

73600

X-RAY OF ANKLE, ANTEROPOSTERIOR AND LATERAL OBLIQUE VIEWS

73610

COMPLETE X-RAY OF ANKLE, ANTEROPOSTERIOR, MEDIAL OBLIQUE, AND LATERAL OBLIQUE VIEWS

73620

X-RAY OF FOOT, ANTEROPOSTERIOR AND OBLIQUE VIEWS

73630

X-RAY OF FOOT

73650

X-RAY OF CALCANEUS, MINIMUM OF 2 VIEWS

73660

X-RAY OF TOE, ANTEROPOSTERIOR AND LATERAL VIEWS

74022

COMPLETE ACUTE ABDOMEN X-RAY SERIES, SUPINE, ERECT, DECUBITUS VIEWS, AND SINGLE CHEST VIEW

74190

RADIOLOGIC SUPERVISION AND INTERPRETATION FOR PERITONEOGRAM

74210

X-RAY OF PHARYNX

74220

X-RAY OF ESOPHAGUS

74240

X-RAY OF UPPER GASTROINTESTINAL TRACT WITH DELAYED FILMS, WITHOUT KIDNEY, URETER AND BLADDER (KUB) X-RAY

74241

X-RAY OF UPPER GASTROINTESTINAL TRACT WITHOUT DELAYED FILMS, WITH KIDNEY, URETER AND BLADDER (KUB) X-RAY

74245

X-RAY OF UPPER GASTROINTESTINAL TRACT WITH SMALL INTESTINE, WITH MULTIPLE SERIAL FILMS

74250

X-RAY OF SMALL INTESTINE WITH MULTIPLE SERIAL FILMS

77080*

DUAL-ENERGY X-RAY ABSORPTIOMETRY BONE DENSITY STUDY OF PELVIS

77081*

DUAL-ENERGY X-RAY ABSORPTIOMETRY BONE DENSITY STUDY OF HEEL

81000

MANUAL URINALYSIS USING TABLET REAGENT AND MICROSCOPY OF URINE

81001

AUTOMATED URINALYSIS USING DIP STICK AND MICROSCOPY OF URINE

81002

MANUAL URINALYSIS USING DIP STICK

81003

AUTOMATED URINALYSIS USING DIP STICK

81005

SEMIQUANTITATIVE URINALYSIS

81025

URINE PREGNANCY TEST USING VISUAL COLOR COMPARISON METHOD

82270*

QUALITATIVE ANALYSIS OF OCCULT BLOOD IN FECES BY PEROXIDASE ACTIVITY

82272*

QUALITATIVE ANALYSIS OF OCCULT BLOOD IN FECES BY PEROXIDASE ACTIVITY

82274*

QUALITATIVE IMMUNOASSAY FOR HEMOGLOBIN IN FECES

82947

MEASUREMENT OF GLUCOSE IN BLOOD

82948

MEASUREMENT OF GLUCOSE IN BLOOD USING REAGENT STRIP

82950

MEASUREMENT OF GLUCOSE AFTER GLUCOSE DOSE

82962

MEASUREMENT OF BLOOD GLUCOSE USING FDA-APPROVED HOME GLUCOSE MONITORING DEVICE

83036

MEASUREMENT OF GLYCOSYLATED HEMOGLOBIN (HBA1C)

83037

MEASUREMENT OF GLYCOSYLATED HEMOGLOBIN BY FDA-APPROVED HOME DEVICE

85013

MEASUREMENT OF SPUN MICROHEMATOCRIT

85014

MEASUREMENT OF HEMATOCRIT (HCT)

85018

MEASUREMENT OF HEMOGLOBIN (HGB)

85610

PROTHROMBIN TIME TEST

86580*

INTRADERMAL TUBERCULOSIS SKIN TEST

87210

WET MOUNT SMEAR FROM PRIMARY SOURCE WITH INTERPRETATION

87804

INFLUENZA ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION

87806*

HIV-1 ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION

87810

CHLAMYDIA TRACHOMATIS ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION

87880

GROUP A STREPTOCOCCUS ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION

90371*

HUMAN HEPATITIS B IMMUNE GLOBULIN

90389*

HUMAN TETANUS IMMUNE GLOBULIN

90396*

HUMAN VARICELLA-ZOSTER IMMUNE GLOBULIN

90460*

ADMINISTRATION OF FIRST OR ONLY COMPONENT OF EACH VACCINE VIA ANY ROUTE WITH COUNSELING BY NON-PHYSICIAN QUALIFIED HEALTH CARE PROFESSIONAL

90461*

ADMINISTRATION OF EACH ADDITIONAL TOXOID COMPONENT VIA ANY ROUTE WITH COUNSELING BY NON-PHYSICIAN QUALIFIED HEALTH CARE PROFESSIONAL

90471*

INTRADERMAL ADMINISTRATION OF A SINGLE VACCINE

90472*

INTRADERMAL ADMINISTRATION OF EACH ADDITIONAL COMBINATION VACCINE

90473*

INTRANASAL ADMINISTRATION OF SINGLE VACCINE

90474*

INTRANASAL ADMINISTRATION OF SINGLE TOXOID

90620*

MENINGOCOCCAL RECOMBINANT VACCINE, FOR INTRAMUSCULAR USE

90621*

MENINGOCOCCAL RECOMBINANT LIPOPROTEIN VACCINE, FOR INTRAMUSCULAR USE

90625*

CHOLERA VACCINE

90630*

SPLIT VIRUS, PRESERVATIVE-FREE INFLUENZA VIRUS VACCINE

90632*

HEPATITIS A VACCINE, ADULT DOSAGE

90633*

HEPATITIS A VACCINE, ADOLESCENT DOSAGE

90634*

HEPATITIS A VACCINE, ADOLESCENT DOSAGE

90636*

HEPATITIS A AND HEPATITIS B VACCINE

90644*

MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS C & Y AND HEMOPHILUS INFLUENZA B VACCINE

90647*

HEMOPHILUS INFLUENZA B VACCINE, PRP-OMP CONJUGATE

90648*

HEMOPHILUS INFLUENZA B VACCINE, PRP-T CONJUGATE

90649*

HPV VACCINE, TYPE 6 (QUADRIVALENT)

90650*

HPV VACCINE, TYPE 18, BIVALENT

90651*

HUMAN PAPILLOMAVIRUS (HPV) VACCINE TYPE 6 (NONAVALENT)

90653*

INFLUENZA VIRUS VACCINE, INACTIVATED

90654*

SPLIT VIRUS, PRESERVATIVE-FREE INFLUENZA VIRUS VACCINE

90655*

SPLIT VIRUS, PRESERVATIVE-FREE INFLUENZA VIRUS VACCINE, TRIVALENT, FOR INTRAMUSCULAR USE

90656*

SPLIT VIRUS, PRESERVATIVE-FREE INFLUENZA VIRUS VACCINE, TRIVALENT, FOR INTRAMUSCULAR USE

90657*

SPLIT VIRUS INFLUENZA VIRUS VACCINE, TRIVALENT, FOR INTRAMUSCULAR USE

90658*

SPLIT VIRUS INFLUENZA VIRUS VACCINE, TRIVALENT, FOR INTRAMUSCULAR USE

90660*

LIVE INFLUENZA VIRUS VACCINE

90661*

INFLUENZA VIRUS VACCINE, DERIVED FROM CELL CULTURES, SUBUNIT, PRESERVATIVE AND ANTIBIOTIC FREE, TRIVALENT, FOR INTRAMUSCULAR USE

90662*

SPLIT VIRUS, PRESERVATIVE FREE INFLUENZA VIRUS VACCINE, ENHANCED IMMUNOGENICITY VIA INCREASED ANTIGEN CONTENT

90664*

LIVE INFLUENZA VIRUS VACCINE, PANDEMIC FORMULATION

90670*

PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT

90672*

INFLUENZA VIRUS VACCINE, LIVE, QUADRIVALENT

90673*

LIVE VIRUS, TRIVALENT PRESERVATIVE-FREE INFLUENZA VIRUS VACCINE

90674*

QUADRIVALENT INFLUENZA VIRUS VACCINE, DERIVED FROM CELL CULTURES, SUBUNIT, PRESERVATIVE AND ANTIBIOTIC FREE, FOR INTRAMUSCULAR USE

90675*

RABIES VACCINE

90676*

RABIES VACCINE

90680*

LIVE ROTAVIRUS VACCINE, PENTAVALENT

90681*

LIVE ROTAVIRUS VACCINE, HUMAN, ATTENUATED

90682*

INFLUENZA VIRUS VACCINE, QUADRIVALENT (RIV4), DERIVED FROM RECOMBINANT DNA, HEMAGGLUTININ (HA) PROTEIN ONLY, PRESERVATIVE AND ANTIBIOTIC FREE, FOR INTRAMUSCULAR USE

90685*

SPLIT VIRUS, PRESERVATIVE FREE INFLUENZA VIRUS VACCINE, QUADRIVALENT, FOR INTRAMUSCULAR USE

90686*

SPLIT VIRUS, PRESERVATIVE FREE INFLUENZA VIRUS VACCINE, QUADRIVALENT, FOR INTRAMUSCULAR USE

90687*

SPLIT VIRUS INFLUENZA VIRUS VACCINE QUADRIVALENT, 0.25 ML DOSAGE, FOR INTRAMUSCULAR USE

90688*

SPLIT VIRUS INFLUENZA VIRUS VACCINE, QUADRIVALENT, 0.5 ML DOSAGE, FOR INTRAMUSCULAR USE

90690*

LIVE TYPHOID VACCINE

90691*

TYPHOID VACCINE, VI CAPSULAR POLYSACCHARIDE

90696*

DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE AND POLIOVIRUS VACCINE, INACTIVATED

90697*

DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEMOPHILUS INFLUENZA B, HEPATITIS B, AND POLIOVIRUS VACCINE

90698*

INACTIVATED DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HAEMOPHILUS INFLUENZA TYPE B, AND POLIOVIRUS VACCINE

90700*

DIPHTHERIA, TETANUS TOXOIDS, AND ACELLULAR PERTUSSIS VACCINE

90702*

DIPHTHERIA AND TETANUS TOXOIDS ADSORBED

90707*

LIVE MEASLES, MUMPS AND RUBELLA VIRUS VACCINE

90710*

LIVE MEASLES, MUMPS, RUBELLA, AND VARICELLA VACCINE

90713*

INACTIVATED POLIOVIRUS VACCINE

90714*

PRESERVATIVE FREE TETANUS AND DIPHTHERIA ADSORBED TOXOIDS

90715*

TETANUS, DIPHTHERIA TOXOIDS AND ACELLULAR PERTUSSIS VACCINE

90716*

LIVE VARICELLA VIRUS VACCINE

90717*

LIVE YELLOW VIRUS VACCINE

90723*

INACTIVATED DIPHTHERIA, TETANUS TOXOIDS, ACELLULAR PERTUSSIS VACCINE, HEPATITIS B, AND POLIOVIRUS VACCINE

90732*

PNEUMOCOCCAL POLYSACCHARIDE VACCINE, 23-VALENT

90733*

MENINGOCOCCAL POLYSACCHARIDE VACCINE

90734*

MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS A, C, Y AND W-135 (QUADRIVALENT), FOR INTRAMUSCULAR USE

90736*

LIVE ZOSTER (SHINGLES) VACCINE

90738*

INACTIVATED JAPANESE ENCEPHALITIS VIRUS VACCINE

90739*

HEPATITIS B VACCINE

90740*

HEPATITIS B VACCINE

90743*

HEPATITIS B VACCINE

90744*

HEPATITIS B VACCINE

90746*

HEPATITIS B VACCINE

90747*

HEPATITIS B VACCINE

90748*

HEPATITIS B AND HEMOPHILUS INFLUENZA B VACCINE

90750*

ZOSTER (SHINGLES) VACCINE (HZV), RECOMBINANT, SUBUNIT, ADJUVANTED, FOR INTRAMUSCULAR USE

90751*

Initial History And Examination Related To The Healthy Individual, Including Anticipatory Guidance; Adolescent (age 12 Through 17 Years)

90752*

Initial History And Examination Related To The Healthy Individual, Including Anticipatory Guidance; Late Childhood (age 5 Through 11 Years)

90753*

nitial History And Examination Related To The Healthy Individual, Including Anticipatory Guidance; Early Childhood (age 1 Through 4 Years)

90754*

Initial History And Examination Related To The Healthy Individual, Including Anticipatory Guidance; Infant (age Under 1 Year)

90755*

Newborn Care, In Other Than Hospital Setting, Including Physical Examination Of Baby And Conference(s) With Parent(s)

90756*

INFLUENZA VIRUS VACCINE, QUADRIVALENT (CCIIV4), DERIVED FROM CELL CULTURES, SUBUNIT, ANTIBIOTIC FREE, 0.5 ML DOSAGE, FOR INTRAMUSCULAR USE

93000

ROUTINE ECG WITH AT LEAST 12 LEADS WITH INTERPRETATION AND REPORT

93005

TRACING OF ROUTINE ECG WITH AT LEAST 12 LEADS

93010

INTERPRETATION AND REPORT OF ROUTINE ECG WITH AT LEAST 12 LEADS

93040

RHYTHM ECG, 1-3 LEADS WITH INTERPRETATION AND REPORT

93041

TRACING OF RHYTHM ECG, 1-3 LEADS

93042

INTERPRETATION AND REPORT OF RHYTHM ECG, 1-3 LEADS

93970

BILATERAL DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS

93971

UNILATERAL DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSES TO COMPRESSION AND OTHER MANEUVERS

94010

SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENTS WITH MAXIMAL VOLUNTARY VENTILATION

94060

BRONCHODILATION RESPONSIVENESS, SPIROMETRY, PRE- AND POST-BRONCHODILATOR ADMINISTRATION

94150

VITAL CAPACITY

94375

RESPIRATORY FLOW VOLUME LOOP

94617

EXERCISE TEST FOR BRONCHOSPASM

94618

PULMONARY STRESS TESTING BY 6-MINUTE WALK

94640

PRESSURIZED OR NONPRESSURIZED INHALATION DIAGNOSTIC TREATMENT

96360

INTRAVENOUS HYDRATION INFUSION

96361

INTRAVENOUS HYDRATION INFUSION

97597

DEBRIDEMENT OF OPEN WOUND INCLUDING TOPICAL APPLICATIONS, WOUND ASSESSMENT AND INSTRUCTIONS FOR ONGOING CARE

97602

NON-SELECTIVE DEBRIDEMENT OF DEVITALIZED TISSUE FROM WOUND, INCLUDING TOPICAL APPLICATIONS, WOUND ASSESSMENT, AND INSTRUCTIONS FOR ONGOING CARE

98925

OSTEOPATHIC MANIPULATIVE TREATMENT

98926

OSTEOPATHIC MANIPULATIVE TREATMENT

98927

OSTEOPATHIC MANIPULATIVE TREATMENT

98928

OSTEOPATHIC MANIPULATIVE TREATMENT

98929

OSTEOPATHIC MANIPULATIVE TREATMENT

99201

LEVEL 1 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH SELF-LIMITED AND/OR MINOR PROBLEM, INCLUDING PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION-MAKING – TYPICAL TIME WITH PATIENT AND/OR FAMILY 10 MINUTES OR LESS

99202

LEVEL 2 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF LOW TO MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION-MAKING – TYPICAL TIME WITH PATIENT AND/OR FAMILY 20 MINUTES

99203

LEVEL 3 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 30 MINUTES

99204

LEVEL 4 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 45 MINUTES

99205

LEVEL 5 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 60 MINUTES

99211

LEVEL 1 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH MINIMAL PRESENTING PROBLEM, WITHOUT HISTORY, PHYSICAL EXAMINATION, OR MEDICAL DECISION MAKING – TYPICAL TIME LESS THAN 5 MINUTES

99212

LEVEL 2 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH SELF-LIMITED AND/OR MINOR PROBLEM, INCLUDING PROBLEM-FOCUSED PHYSICAL EXAMINATION AND STRAIGHTFORWARD MEDICAL DECISION-MAKING- TYPICAL TIME WITH PATIENT AND/OR FAMILY 10 MINUTES OR LESS

99213

LEVEL 3 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF LOW TO MODERATE SEVERITY, INCLUDING EXPANDED HISTORY AND PHYSICAL EXAMINATION – TYPICAL TIME WITH PATIENT AND/OR FAMILY 15 MINUTES

99214

LEVEL 4 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED PHYSICAL EXAMINATION AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 25 MINUTES

99215

LEVEL 5 OUTPATIENT VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING COMPREHENSIVE PHYSICAL EXAMINATION AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 40 MINUTES

99217

OBSERVATION CARE DISCHARGE DAY MANAGEMENT, DISCHARGE DAY SUBSEQUENT TO INITIAL OBSERVATION DAY

99218

LEVEL 1 INITIAL OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION MAKING – TYPICAL TIME 30 MINUTES

99219

LEVEL 2 INITIAL OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 50 MINUTES

99220

LEVEL 3 INITIAL OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME 70 MINUTES

99221

LEVEL 1 INITIAL HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION MAKING – TYPICAL TIME 30 MINUTES

99222

LEVEL 2 INITIAL HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 50 MINUTES

99223

LEVEL 3 INITIAL HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF HIGH COMPLEXITY – TYPICAL TIME 70 MINUTES

99224

LEVEL 1 SUBSEQUENT OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING PROBLEM FOCUSED INTERVAL HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME 15 MINUTES

99225

LEVEL 2 SUBSEQUENT OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING EXPANDED PROBLEM FOCUSED INTERVAL HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY- TYPICAL TIME 25 MINUTES

99226

LEVEL 3 SUBSEQUENT OBSERVATION CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING DETAILED INTERVAL HISTORY AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY- TYPICAL TIME 35 MINUTES

99231

LEVEL 1 SUBSEQUENT HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME 15 MINUTES

99232

LEVEL 2 SUBSEQUENT HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING EXPANDED PROBLEM FOCUSED INTERVAL HISTORY AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 25 MINUTES

99233

LEVEL 3 SUBSEQUENT HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING DETAILED INTERVAL HISTORY AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 35 MINUTES

99234

OBSERVATION CARE WITH ADMISSION AND DISCHARGE ON SAME DATE, FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION MAKING

99235

OBSERVATION CARE WITH ADMISSION AND DISCHARGE ON SAME DATE, FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY

99236

OBSERVATION CARE WITH ADMISSION AND DISCHARGE ON SAME DATE, FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY

99238

HOSPITAL DISCHARGE DAY MANAGEMENT, 30 MINUTES OR LESS

99239

HOSPITAL DISCHARGE DAY MANAGEMENT, MORE THAN 30 MINUTES

99281

LEVEL 1 EMERGENCY DEPARTMENT VISIT FOR EVALUATION AND MANAGEMENT OF PATIENT WITH SELF-LIMITED AND/OR MINOR PROBLEM, INCLUDING PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION-MAKING

99282

LEVEL 2 EMERGENCY DEPARTMENT VISIT FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF LOW TO MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF LOW COMPLEXITY

99283

LEVEL 3 EMERGENCY DEPARTMENT VISIT FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY

99284

LEVEL 4 EMERGENCY DEPARTMENT VISIT FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY

99285

LEVEL 5 EMERGENCY DEPARTMENT VISIT FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM IMMEDIATELY THREATENING PHYSIOLOGIC FUNCTION, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF HIGH COMPLEXITY

99291

CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF CRITICALLY ILL PATIENT, FIRST 30-74 MIN

99292

CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF CRITICALLY INJURED PATIENT, EACH ADDITIONAL 30 MINUTES

99304

LEVEL 1 INITIAL NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION MAKING – TYPICAL TIME 25 MINUTES

99305

LEVEL 2 INITIAL NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 35 MINUTES

99306

LEVEL 3 INITIAL NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME 45 MINUTES

99307

LEVEL 1 SUBSEQUENT NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING PROBLEM FOCUSED INTERVAL HISTORY AND PHYSICAL EXAMINATION – TYPICAL TIME 10 MINUTES

99308

LEVEL 2 SUBSEQUENT NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING EXPANDED PROBLEM FOCUSED PHYSICAL EXAMINATION AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME 15 MINUTES

99309

LEVEL 3 SUBSEQUENT NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING DETAILED INTERVAL HISTORY AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 25 MINUTES

99310

LEVEL 4 SUBSEQUENT NURSING FACILITY CARE FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING COMPREHENSIVE PHYSICAL EXAMINATION AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME 35 MINUTES

99315

NURSING FACILITY DISCHARGE DAY MANAGEMENT, 30 MINUTES OR LESS

99316

NURSING FACILITY DAY MANAGEMENT, MORE THAN 30 MINUTES

99318

ANNUAL NURSING FACILITY ASSESSMENT FOR EVALUATION AND MANAGEMENT OF PATIENT, INCLUDING DETAILED INTERVAL HISTORY, COMPREHENSIVE PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF LOW TO MODERATE COMPLEXITY – TYPICAL TIME 30 MINUTES

99324

LEVEL 1 REST CUSTODIAL VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND STRAIGHTFORWARD MEDICAL DECISION-MAKING – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 20 MINUTES

99325

LEVEL 2 DOMICILIARY VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM-FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF LOW COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 30 MINUTES

99326

LEVEL 3 REST HOME VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 45 MINUTES

99327

LEVEL 4 REST HOME VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 60 MINUTES

99328

LEVEL 5 DOMICILIARY VISIT FOR EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION-MAKING OF HIGH COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 75 MINUTES

99334

LEVEL 1 REST HOME VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH MINOR AND/OR SELF-LIMITED PROBLEM, INCLUDING PROBLEM-FOCUSED PHYSICAL EXAMINATION AND STRAIGHTFORWARD MEDICAL DECISION-MAKING – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 15 MINUTES

99335

LEVEL 2 CUSTODIAL CARE VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF LOW TO MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM-FOCUSED INTERVAL HISTORY AND MEDICAL DECISION-MAKING OF LOW COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 25 MINUTES

99336

LEVEL 3 CUSTODIAL CARE VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED INTERVAL HISTORY AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 40 MINUTES

99337

LEVEL 4 DOMICILIARY VISIT FOR EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED COMPREHENSIVE PHYSICAL EXAMINATION AND MEDICAL DECISION-MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT, FAMILY, AND/OR CAREGIVER 40 MINUTES

99341

LEVEL 1 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF LOW SEVERITY, INCLUDING PROBLEM FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 20 MINUTES

99342

LEVEL 2 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM FOCUSED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 30 MINUTES

99343

LEVEL 3 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 45 MINUTES

99344

LEVEL 4 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME 60 MINUTES

99345

LEVEL 5 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF NEW PATIENT WITH PROBLEM OF HIGH SEVERITY, INCLUDING COMPREHENSIVE HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF HIGH COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 75 MINUTES

99347

LEVEL 1 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH MINOR AND/OR SELF LIMITED PROBLEM, INCLUDING PROBLEM FOCUSED INTERVAL HISTORY AND PHYSICAL EXAMINATION – TYPICAL TIME WITH PATIENT AND/OR FAMILY 15 MINUTES

99348

LEVEL 2 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF LOW TO MODERATE SEVERITY, INCLUDING EXPANDED PROBLEM FOCUSED PHYSICAL EXAMINATION AND MEDICAL DECISION MAKING OF LOW COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 25 MINUTES

99349

LEVEL 3 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING DETAILED INTERVAL HISTORY AND PHYSICAL EXAMINATION, AND MEDICAL DECISION MAKING OF MODERATE COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 40 MINUTES

99350

LEVEL 4 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT WITH PROBLEM OF MODERATE TO HIGH SEVERITY, INCLUDING COMPREHENSIVE INTERVAL HISTORY AND MEDICAL DECISION MAKING OF MODERATE TO HIGH COMPLEXITY – TYPICAL TIME WITH PATIENT AND/OR FAMILY 60 MINUTES

99381

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT LESS THAN 1 YEAR IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99382

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 1-4 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99383

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 5-11 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99384

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 12-17 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99385

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 18-39 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99386

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 40-64 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99387

INITIAL COMPREHENSIVE PREVENTIVE MEDICINE EVALUATION AND MANAGEMENT OF NEW PATIENT 65 YEARS IN AGE OR OLDER, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99391

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT LESS THAN 1 YEAR IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99392

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 1-4 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99393

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 5-11 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99394

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 12-17 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99395

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 18-39 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99396

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 40-64 YEARS IN AGE, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99397

PERIODIC COMPREHENSIVE PREVENTIVE MEDICINE REEVALUATION AND MANAGEMENT OF ESTABLISHED PATIENT 65 YEARS IN AGE OR OLDER, INCLUDING AGE AND GENDER APPROPRIATE HISTORY, PHYSICAL EXAMINATION; COUNSELING, ANTICIPATORY GUIDANCE, AND/OR RISK FACTOR REDUCTION INTERVENTIONS; AND ORDERING OF LABORATORY AND/OR DIAGNOSTIC PROCEDURES

99460

INITIAL BIRTHING CENTER CARE FOR EVALUATION AND MANAGEMENT OF NORMAL NEWBORN – EACH 24 HOURS

99461

INITIAL OUTPATIENT CARE FOR EVALUATION AND MANAGEMENT OF NORMAL NEWBORN, EACH 24 HOURS

99462

SUBSEQUENT HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF NORMAL NEWBORN – EACH 24 HOURS

99463

INITIAL BIRTHING CENTER CARE FOR EVALUATION AND MANAGEMENT OF NORMAL NEWBORN WITH ADMISSION AND DISCHARGE ON SAME DATE

99471

INITIAL INPATIENT PEDIATRIC CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT 29 DAYS-24 MONTHS IN AGE

99472

SUBSEQUENT INPATIENT PEDIATRIC CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT 29 DAYS-24 MONTHS IN AGE

99475

INITIAL INPATIENT PEDIATRIC CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT 2-5 YEARS IN AGE

99476

SUBSEQUENT INPATIENT PEDIATRIC CRITICAL CARE FOR EVALUATION AND MANAGEMENT OF PATIENT 2-5 YEARS IN AGE

99477

INITIAL HOSPITAL CARE FOR EVALUATION AND MANAGEMENT OF NEONATE 0-28 DAYS IN AGE REQUIRING INTENSIVE OBSERVATION AND FREQUENT INTERVENTIONS

99478

SUBSEQUENT INTENSIVE CARE FOR EVALUATION AND MANAGEMENT OF RECOVERING INFANT WITH PRESENT BODY WEIGHT OF LESS THAN 1500 GRAMS

99479

SUBSEQUENT INTENSIVE CARE FOR EVALUATION AND MANAGEMENT OF RECOVERING INFANT WITH PRESENT BODY WEIGHT OF 1500-2500 GRAMS

99480

SUBSEQUENT INTENSIVE CARE FOR EVALUATION AND MANAGEMENT OF RECOVERING INFANT WITH PRESENT BODY WEIGHT OF 2501-5000 GRAMS

G0104

COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY

G0105

COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL AT HIGH RISK

G0130

SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITY STUDY, ONE OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (E.G., RADIUS, WRIST, HEEL)

G0328*

COLORECTAL CANCER SCREENING; FECAL OCCULT BLOOD TEST, IMMUNOASSAY, 1-3 SIMULTANEOUS

G0337

HOSPICE EVALUATION AND COUNSELING SERVICES, PRE-ELECTION

G0378

HOSPITAL OBSERVATION SERVICE, PER HOUR

G0379

DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE

G0380

LEVEL 1 HOSPITAL EMERGENCY DEPARTMENT VISIT PROVIDED IN A TYPE B EMERGENCY DEPARTMENT; (THE ED MUST MEET AT LEAST ONE OF THE FOLLOWING REQUIREMENTS: (1) IT IS LICENSED BY THE STATE IN WHICH IT IS LOCATED UNDER APPLICABLE STATE LAW AS AN EMERGENCY ROOM OR

G0381

LEVEL 2 HOSPITAL EMERGENCY DEPARTMENT VISIT PROVIDED IN A TYPE B EMERGENCY DEPARTMENT; (THE ED MUST MEET AT LEAST ONE OF THE FOLLOWING REQUIREMENTS: (1) IT IS LICENSED BY THE STATE IN WHICH IT IS LOCATED UNDER APPLICABLE STATE LAW AS AN EMERGENCY ROOM OR

G0382

LEVEL 3 HOSPITAL EMERGENCY DEPARTMENT VISIT PROVIDED IN A TYPE B EMERGENCY DEPARTMENT; (THE ED MUST MEET AT LEAST ONE OF THE FOLLOWING REQUIREMENTS: (1) IT IS LICENSED BY THE STATE IN WHICH IT IS LOCATED UNDER APPLICABLE STATE LAW AS AN EMERGENCY ROOM OR

G0383

LEVEL 4 HOSPITAL EMERGENCY DEPARTMENT VISIT PROVIDED IN A TYPE B EMERGENCY DEPARTMENT; (THE ED MUST MEET AT LEAST ONE OF THE FOLLOWING REQUIREMENTS: (1) IT IS LICENSED BY THE STATE IN WHICH IT IS LOCATED UNDER APPLICABLE STATE LAW AS AN EMERGENCY ROOM OR

G0384

LEVEL 5 HOSPITAL EMERGENCY DEPARTMENT VISIT PROVIDED IN A TYPE B EMERGENCY DEPARTMENT; (THE ED MUST MEET AT LEAST ONE OF THE FOLLOWING REQUIREMENTS: (1) IT IS LICENSED BY THE STATE IN WHICH IT IS LOCATED UNDER APPLICABLE STATE LAW AS AN EMERGENCY ROOM OR

G0402

POSTIMMUNIZATION ACUTE DISSEMINATED ENCEPHALITIS, MYELITIS AND ENCEPHALOMYELITIS

G0403

ELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; PERFORMED AS A SCREENING FOR THE INITIAL PREVENTIVE PHYSICAL EXAMINATION WITH INTERPRETATION AND REPORT

G0404

ELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; TRACING ONLY, WITHOUT INTERPRETATION AND REPORT, PERFORMED AS A SCREENING FOR THE INITIAL PREVENTIVE PHYSICAL EXAMINATION

G0405

ELECTROCARDIOGRAM, ROUTINE ECG WITH 12 LEADS; INTERPRETATION AND REPORT ONLY, PERFORMED AS A SCREENING FOR THE INITIAL PREVENTIVE PHYSICAL EXAMINATION

G0433*

INFECTIOUS AGENT ANTIBODY DETECTION BY ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA) TECHNIQUE, HIV-1 AND/OR HIV-2, SCREENING

G0438

ANNUAL WELLNESS VISIT; INCLUDES A PERSONALIZED PREVENTION PLAN OF SERVICE (PPS), INITIAL VISIT

G0439

OTHER ACUTE NECROTIZING HEMORRHAGIC ENCEPHALOPATHY

G0463

HOSPITAL OUTPATIENT CLINIC VISIT FOR ASSESSMENT AND MANAGEMENT OF A PATIENT

G0466

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, NEW PATIENT; A MEDICALLY-NECESSARY, FACE-TO-FACE ENCOUNTER (ONE-ON-ONE) BETWEEN A NEW PATIENT AND A FQHC PRACTITIONER DURING WHICH TIME ONE OR MORE FQHC SERVICES ARE RENDERED AND INCLUDES A TYPICAL BUNDLE OF

G0467

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, ESTABLISHED PATIENT; A MEDICALLY-NECESSARY, FACE-TO-FACE ENCOUNTER (ONE-ON-ONE) BETWEEN AN ESTABLISHED PATIENT AND A FQHC PRACTITIONER DURING WHICH TIME ONE OR MORE FQHC SERVICES ARE RENDERED AND INCLUDES A

G0468

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, IPPE OR AWV; A FQHC VISIT THAT INCLUDES AN INITIAL PREVENTIVE PHYSICAL EXAMINATION (IPPE) OR ANNUAL WELLNESS VISIT (AWV) AND INCLUDES A TYPICAL BUNDLE OF MEDICARE-COVERED SERVICES THAT WOULD BE FURNISHED PER

G0469

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, MENTAL HEALTH, NEW PATIENT; A MEDICALLY-NECESSARY, FACE-TO-FACE MENTAL HEALTH ENCOUNTER (ONE-ON-ONE) BETWEEN A NEW PATIENT AND A FQHC PRACTITIONER DURING WHICH TIME ONE OR MORE FQHC SERVICES ARE RENDERED AND

G0470

FEDERALLY QUALIFIED HEALTH CENTER (FQHC) VISIT, MENTAL HEALTH, ESTABLISHED PATIENT; A MEDICALLY-NECESSARY, FACE-TO-FACE MENTAL HEALTH ENCOUNTER (ONE-ON-ONE) BETWEEN AN ESTABLISHED PATIENT AND A FQHC PRACTITIONER DURING WHICH TIME ONE OR MORE FQHC SERVICES

J0120

INJECTION, TETRACYCLINE, UP TO 250 MG

J0171

INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG

J0280

INJECTION, AMINOPHYLLIN, UP TO 250 MG

J0558

INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 100,000 UNITS

J0561

INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS

J0670

INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML

J0690

INJECTION, CEFAZOLIN SODIUM, 500 MG

J0696

INJECTION, CEFTRIAXONE SODIUM, PER 250 MG

J0702

INJECTION, BETAMETHASONE ACETATE 3 MG AND BETAMETHASONE SODIUM PHOSPHATE 3 MG

J0780

INJECTION, PROCHLORPERAZINE, UP TO 10 MG

J1000

INFLUENZA DUE TO OTHER IDENTIFIED INFLUENZA VIRUS WITH UNSPECIFIED TYPE OF PNEUMONIA

J1020

INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG

J1030

INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG

J1040

INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG

J1050

INJECTION, MEDROXYPROGESTERONE ACETATE, 1 MG

J1071

INJECTION, TESTOSTERONE CYPIONATE, 1 MG

J1094

INJECTION, DEXAMETHASONE ACETATE, 1 MG

J1100

INJECTION, DEXAMETHASONE SODIUM PHOSPHATE, 1 MG

J1200

INJECTION, DIPHENHYDRAMINE HCL, UP TO 50 MG

J1580

INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG

J1630

INJECTION, HALOPERIDOL, UP TO 5 MG

J1642

INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10 UNITS

J1670

INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS

J1720

INJECTION, HYDROCORTISONE SODIUM SUCCINATE, UP TO 100 MG

J1815

INJECTION, INSULIN, PER 5 UNITS

J1817

INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS

J1885

INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG

J1940

INJECTION, FUROSEMIDE, UP TO 20 MG

J2010

INJECTION, LINCOMYCIN HCL, UP TO 300 MG

J2175

INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG

J2405

INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG

J2510

INJECTION, PENICILLIN G PROCAINE, AQUEOUS, UP TO 600,000 UNITS

J2550

INJECTION, PROMETHAZINE HCL, UP TO 50 MG

J2765

INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG

J3121

INJECTION, TESTOSTERONE ENANTHATE, 1 MG

J3230

INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG

J3250

INJECTION, TRIMETHOBENZAMIDE HCL, UP TO 200 MG

J3300

INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE, 1 MG

J3303

INJECTION, TRIAMCINOLONE HEXACETONIDE, PER 5 MG

J3420

INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000 MCG

J7030

INFUSION, NORMAL SALINE SOLUTION , 1000 CC

J7040

INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML = 1 UNIT)

J7050

INFUSION, NORMAL SALINE SOLUTION, 250 CC

J7608

ACETYLCYSTEINE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER GRAM

J7609

ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG

J7611

ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 1 MG

J7612

LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG

J7613

ALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG

J7614

LEVALBUTEROL, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE, 0.5 MG

J7620

ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME

J7626

BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 0.5 MG

J7644

IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM

Q0111

WET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL, CERVICAL OR SKIN SPECIMENS

Q2034*

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, FOR INTRAMUSCULAR USE (AGRIFLU)

Q2035*

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE (AFLURIA)

Q2036*

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE (FLULAVAL)

Q2037*

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE (FLUVIRIN)

Q2038*

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FOR INTRAMUSCULAR USE (FLUZONE)

Q2039*

INFLUENZA VIRUS VACCINE, NOT OTHERWISE SPECIFIED

Q4003

CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), PLASTER

Q4004

CAST SUPPLIES, SHOULDER CAST, ADULT (11 YEARS +), FIBERGLASS

Q4005

CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), PLASTER

Q4006

CAST SUPPLIES, LONG ARM CAST, ADULT (11 YEARS +), FIBERGLASS

Q4007

CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER

Q4008

CAST SUPPLIES, LONG ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4009

CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), PLASTER

Q4010

CAST SUPPLIES, SHORT ARM CAST, ADULT (11 YEARS +), FIBERGLASS

Q4011

CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), PLASTER

Q4012

CAST SUPPLIES, SHORT ARM CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4013

CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), PLASTER

Q4014

CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), ADULT (11 YEARS +), FIBERGLASS

Q4015

CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 YEARS), PLASTER

Q4016

CAST SUPPLIES, GAUNTLET CAST (INCLUDES LOWER FOREARM AND HAND), PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4017

CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), PLASTER

Q4018

CAST SUPPLIES, LONG ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS

Q4019

CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER

Q4020

CAST SUPPLIES, LONG ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4021

CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), PLASTER

Q4022

CAST SUPPLIES, SHORT ARM SPLINT, ADULT (11 YEARS +), FIBERGLASS

Q4023

CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), PLASTER

Q4024

CAST SUPPLIES, SHORT ARM SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4025

CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), PLASTER

Q4026

CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), ADULT (11 YEARS +), FIBERGLASS

Q4027

CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), PLASTER

Q4028

CAST SUPPLIES, HIP SPICA (ONE OR BOTH LEGS), PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4029

CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), PLASTER

Q4030

CAST SUPPLIES, LONG LEG CAST, ADULT (11 YEARS +), FIBERGLASS

Q4031

CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER

Q4032

CAST SUPPLIES, LONG LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4033

CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), PLASTER

Q4034

CAST SUPPLIES, LONG LEG CYLINDER CAST, ADULT (11 YEARS +), FIBERGLASS

Q4035

CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), PLASTER

Q4036

CAST SUPPLIES, LONG LEG CYLINDER CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4037

CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), PLASTER

Q4038

CAST SUPPLIES, SHORT LEG CAST, ADULT (11 YEARS +), FIBERGLASS

Q4039

CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), PLASTER

Q4040

CAST SUPPLIES, SHORT LEG CAST, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4041

CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), PLASTER

Q4042

CAST SUPPLIES, LONG LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS

Q4043

CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER

Q4044

CAST SUPPLIES, LONG LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4045

CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), PLASTER

Q4046

CAST SUPPLIES, SHORT LEG SPLINT, ADULT (11 YEARS +), FIBERGLASS

Q4047

CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), PLASTER

Q4048

CAST SUPPLIES, SHORT LEG SPLINT, PEDIATRIC (0-10 YEARS), FIBERGLASS

Q4049

FINGER SPLINT, STATIC

Q4050

CAST SUPPLIES, FOR UNLISTED TYPES AND MATERIALS OF CASTS

Q4051

SPLINT SUPPLIES, MISCELLANEOUS (INCLUDES THERMOPLASTICS, STRAPPING, FASTENERS, PADDING AND OTHER SUPPLIES)

86701*

ASSAY FOR HUMAN IMMUNODEFICIENCY VIRUS 1 (HIV-1) ANTIBODY

G0475*

HIV ANTIGEN/ANTIBODY, COMBINATION ASSAY, SCREENING

 

* Where applicable, service reimbursed in addition to capitation.