bluecross blueshield of tennessee commercial code bundling ... · print date: 3/2/2015 bluecross...
TRANSCRIPT
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Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00100 0178T NCCI
00100 0179T NCCI
00100 0180T NCCI
00100 01996 NCCI
00100 0213T NCCI
00100 0216T NCCI
00100 0228T NCCI
00100 0230T NCCI
00100 0282T NCCI
00100 0283T NCCI
00100 0311T NCCI
00100 31505 NCCI
00100 31515 NCCI
00100 31527 NCCI
00100 31622 NCCI
00100 31634 NCCI
00100 31645 NCCI
00100 31647 NCCI
00100 36000 NCCI
00100 36010 NCCI
00100 36011 NCCI
00100 36012 NCCI
00100 36013 NCCI
00100 36014 NCCI
00100 36015 NCCI
00100 36400 NCCI
00100 36405 NCCI
00100 36406 NCCI
00100 36410 NCCI
00100 36420 NCCI
00100 36425 NCCI
00100 36430 NCCI
00100 36440 NCCI
00100 36600 NCCI
00100 36640 NCCI
00100 43752 NCCI
00100 43753 NCCI
00100 43754 NCCI
00100 61026 NCCI
00100 61055 NCCI
00100 62280 NCCI
00100 62281 NCCI
00100 62282 NCCI
00100 62284 NCCI
00100 62310 NCCI
00100 62311 NCCI
00100 62318 NCCI
Comprehensive ComponentCode Code Source
00100 62319 NCCI
00100 64400 NCCI
00100 64402 NCCI
00100 64405 NCCI
00100 64408 NCCI
00100 64410 NCCI
00100 64412 NCCI
00100 64413 NCCI
00100 64415 NCCI
00100 64416 NCCI
00100 64417 NCCI
00100 64418 NCCI
00100 64420 NCCI
00100 64421 NCCI
00100 64425 NCCI
00100 64430 NCCI
00100 64435 NCCI
00100 64445 NCCI
00100 64446 NCCI
00100 64447 NCCI
00100 64448 NCCI
00100 64449 NCCI
00100 64450 NCCI
00100 64479 NCCI
00100 64483 NCCI
00100 64486 NCCI
00100 64487 NCCI
00100 64488 NCCI
00100 64489 NCCI
00100 64490 NCCI
00100 64493 NCCI
00100 64505 NCCI
00100 64508 NCCI
00100 64510 NCCI
00100 64517 NCCI
00100 64520 NCCI
00100 64530 NCCI
00100 64550 NCCI
00100 64553 NCCI
00100 64555 NCCI
00100 64565 NCCI
00100 67500 NCCI
00100 76000 NCCI
00100 76001 NCCI
00100 76998 NCCI
00100 77002 NCCI
00100 81000 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 1 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00100 81002 NCCI
00100 81003 NCCI
00100 81005 NCCI
00100 81015 NCCI
00100 82013 NCCI
00100 90865 NCCI
00100 92511 NCCI
00100 92512 NCCI
00100 92516 NCCI
00100 92520 NCCI
00100 92543 NCCI
00100 92950 NCCI
00100 92953 NCCI
00100 92960 NCCI
00100 92961 NCCI
00100 93000 NCCI
00100 93005 NCCI
00100 93010 NCCI
00100 93040 NCCI
00100 93041 NCCI
00100 93042 NCCI
00100 93303 NCCI
00100 93304 NCCI
00100 93306 NCCI
00100 93307 NCCI
00100 93308 NCCI
00100 93312 NCCI
00100 93313 NCCI
00100 93314 NCCI
00100 93315 NCCI
00100 93316 NCCI
00100 93317 NCCI
00100 93318 NCCI
00100 93351 NCCI
00100 93355 NCCI
00100 93451 NCCI
00100 93456 NCCI
00100 93457 NCCI
00100 93561 NCCI
00100 93562 NCCI
00100 93701 NCCI
00100 93922 NCCI
00100 93923 NCCI
00100 93924 NCCI
00100 93925 NCCI
00100 93926 NCCI
00100 93930 NCCI
Comprehensive ComponentCode Code Source
00100 93931 NCCI
00100 93965 NCCI
00100 93970 NCCI
00100 93971 NCCI
00100 93975 NCCI
00100 93976 NCCI
00100 93978 NCCI
00100 93979 NCCI
00100 93980 NCCI
00100 93981 NCCI
00100 94002 NCCI
00100 94004 NCCI
00100 94200 NCCI
00100 94250 NCCI
00100 94640 NCCI
00100 94644 NCCI
00100 94660 NCCI
00100 94662 NCCI
00100 94680 NCCI
00100 94681 NCCI
00100 94690 NCCI
00100 94760 NCCI
00100 94761 NCCI
00100 94762 NCCI
00100 94770 NCCI
00100 95812 NCCI
00100 95813 NCCI
00100 95816 NCCI
00100 95819 NCCI
00100 95822 NCCI
00100 95829 NCCI
00100 95955 NCCI
00100 95956 NCCI
00100 95957 NCCI
00100 96360 NCCI
00100 96365 NCCI
00100 96372 NCCI
00100 96373 NCCI
00100 96374 NCCI
00100 96375 NCCI
00100 96376 NCCI
00100 99143 NCCI
00100 99144 NCCI
00100 99145 NCCI
00100 99148 NCCI
00100 99149 NCCI
00100 99150 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 2 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00100 99201 NCCI
00100 99202 NCCI
00100 99203 NCCI
00100 99204 NCCI
00100 99205 NCCI
00100 99211 NCCI
00100 99212 NCCI
00100 99213 NCCI
00100 99214 NCCI
00100 99215 NCCI
00100 99217 NCCI
00100 99218 NCCI
00100 99219 NCCI
00100 99220 NCCI
00100 99221 NCCI
00100 99222 NCCI
00100 99223 NCCI
00100 99224 NCCI
00100 99225 NCCI
00100 99226 NCCI
00100 99231 NCCI
00100 99232 NCCI
00100 99233 NCCI
00100 99234 NCCI
00100 99235 NCCI
00100 99236 NCCI
00100 99238 NCCI
00100 99239 NCCI
00100 99241 Retained NCCI
00100 99242 Retained NCCI
00100 99243 Retained NCCI
00100 99244 Retained NCCI
00100 99245 Retained NCCI
00100 99251 Retained NCCI
00100 99252 Retained NCCI
00100 99253 Retained NCCI
00100 99254 Retained NCCI
00100 99255 Retained NCCI
00100 99281 NCCI
00100 99282 NCCI
00100 99283 NCCI
00100 99284 NCCI
00100 99285 NCCI
00100 99304 NCCI
00100 99305 NCCI
00100 99306 NCCI
00100 99307 NCCI
Comprehensive ComponentCode Code Source
00100 99308 NCCI
00100 99309 NCCI
00100 99310 NCCI
00100 99315 NCCI
00100 99318 NCCI
00100 99324 NCCI
00100 99325 NCCI
00100 99326 NCCI
00100 99327 NCCI
00100 99328 NCCI
00100 99334 NCCI
00100 99335 NCCI
00100 99336 NCCI
00100 99337 NCCI
00100 99341 NCCI
00100 99342 NCCI
00100 99343 NCCI
00100 99347 NCCI
00100 99348 NCCI
00100 99349 NCCI
00100 99354 NCCI
00100 99355 NCCI
00100 99356 NCCI
00100 99357 NCCI
00100 99446 NCCI
00100 99447 NCCI
00100 99448 NCCI
00100 99449 NCCI
00100 99466 NCCI
00100 99468 NCCI
00100 99469 NCCI
00100 99471 NCCI
00100 99472 NCCI
00100 99475 NCCI
00100 99476 NCCI
00100 99477 NCCI
00100 99478 NCCI
00100 99479 NCCI
00100 99480 NCCI
00100 99485 NCCI
00100 99497 NCCI
00100 C8921 NCCI
00100 C8922 NCCI
00100 C8923 NCCI
00100 C8924 NCCI
00100 C8925 NCCI
00100 C8926 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 3 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00100 C8927 NCCI
00100 C8929 NCCI
00100 C8930 NCCI
00100 G0380 NCCI
00100 G0381 NCCI
00100 G0382 NCCI
00100 G0383 NCCI
00100 G0384 NCCI
00100 G0406 NCCI
00100 G0407 NCCI
00100 G0408 NCCI
00100 G0425 NCCI
00100 G0426 NCCI
00100 G0427 NCCI
00100 G0463 NCCI
00100 G6043 NCCI
00102 0178T NCCI
00102 0179T NCCI
00102 0180T NCCI
00102 01996 NCCI
00102 0213T NCCI
00102 0216T NCCI
00102 0228T NCCI
00102 0230T NCCI
00102 0282T NCCI
00102 0283T NCCI
00102 0311T NCCI
00102 31505 NCCI
00102 31515 NCCI
00102 31527 NCCI
00102 31622 NCCI
00102 31634 NCCI
00102 31645 NCCI
00102 31647 NCCI
00102 36000 NCCI
00102 36010 NCCI
00102 36011 NCCI
00102 36012 NCCI
00102 36013 NCCI
00102 36014 NCCI
00102 36015 NCCI
00102 36400 NCCI
00102 36405 NCCI
00102 36406 NCCI
00102 36410 NCCI
00102 36420 NCCI
00102 36425 NCCI
Comprehensive ComponentCode Code Source
00102 36430 NCCI
00102 36440 NCCI
00102 36600 NCCI
00102 36640 NCCI
00102 43752 NCCI
00102 43753 NCCI
00102 43754 NCCI
00102 61026 NCCI
00102 61055 NCCI
00102 62280 NCCI
00102 62281 NCCI
00102 62282 NCCI
00102 62284 NCCI
00102 62310 NCCI
00102 62311 NCCI
00102 62318 NCCI
00102 62319 NCCI
00102 64400 NCCI
00102 64402 NCCI
00102 64405 NCCI
00102 64408 NCCI
00102 64410 NCCI
00102 64412 NCCI
00102 64413 NCCI
00102 64415 NCCI
00102 64416 NCCI
00102 64417 NCCI
00102 64418 NCCI
00102 64420 NCCI
00102 64421 NCCI
00102 64425 NCCI
00102 64430 NCCI
00102 64435 NCCI
00102 64445 NCCI
00102 64446 NCCI
00102 64447 NCCI
00102 64448 NCCI
00102 64449 NCCI
00102 64450 NCCI
00102 64479 NCCI
00102 64483 NCCI
00102 64486 NCCI
00102 64487 NCCI
00102 64488 NCCI
00102 64489 NCCI
00102 64490 NCCI
00102 64493 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 4 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00102 64505 NCCI
00102 64508 NCCI
00102 64510 NCCI
00102 64517 NCCI
00102 64520 NCCI
00102 64530 NCCI
00102 64550 NCCI
00102 64553 NCCI
00102 64555 NCCI
00102 64565 NCCI
00102 67500 NCCI
00102 76000 NCCI
00102 76001 NCCI
00102 76998 NCCI
00102 77002 NCCI
00102 81000 NCCI
00102 81002 NCCI
00102 81003 NCCI
00102 81005 NCCI
00102 81015 NCCI
00102 82013 NCCI
00102 90865 NCCI
00102 92511 NCCI
00102 92512 NCCI
00102 92516 NCCI
00102 92520 NCCI
00102 92543 NCCI
00102 92950 NCCI
00102 92953 NCCI
00102 92960 NCCI
00102 92961 NCCI
00102 93000 NCCI
00102 93005 NCCI
00102 93010 NCCI
00102 93040 NCCI
00102 93041 NCCI
00102 93042 NCCI
00102 93303 NCCI
00102 93304 NCCI
00102 93306 NCCI
00102 93307 NCCI
00102 93308 NCCI
00102 93312 NCCI
00102 93313 NCCI
00102 93314 NCCI
00102 93315 NCCI
00102 93316 NCCI
Comprehensive ComponentCode Code Source
00102 93317 NCCI
00102 93318 NCCI
00102 93351 NCCI
00102 93355 NCCI
00102 93451 NCCI
00102 93456 NCCI
00102 93457 NCCI
00102 93561 NCCI
00102 93562 NCCI
00102 93701 NCCI
00102 93922 NCCI
00102 93923 NCCI
00102 93924 NCCI
00102 93925 NCCI
00102 93926 NCCI
00102 93930 NCCI
00102 93931 NCCI
00102 93965 NCCI
00102 93970 NCCI
00102 93971 NCCI
00102 93975 NCCI
00102 93976 NCCI
00102 93978 NCCI
00102 93979 NCCI
00102 93980 NCCI
00102 93981 NCCI
00102 94002 NCCI
00102 94004 NCCI
00102 94200 NCCI
00102 94250 NCCI
00102 94640 NCCI
00102 94644 NCCI
00102 94660 NCCI
00102 94662 NCCI
00102 94680 NCCI
00102 94681 NCCI
00102 94690 NCCI
00102 94760 NCCI
00102 94761 NCCI
00102 94762 NCCI
00102 94770 NCCI
00102 95812 NCCI
00102 95813 NCCI
00102 95816 NCCI
00102 95819 NCCI
00102 95822 NCCI
00102 95829 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 5 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00102 95955 NCCI
00102 95956 NCCI
00102 95957 NCCI
00102 96360 NCCI
00102 96365 NCCI
00102 96372 NCCI
00102 96373 NCCI
00102 96374 NCCI
00102 96375 NCCI
00102 96376 NCCI
00102 99143 NCCI
00102 99144 NCCI
00102 99145 NCCI
00102 99148 NCCI
00102 99149 NCCI
00102 99150 NCCI
00102 99201 NCCI
00102 99202 NCCI
00102 99203 NCCI
00102 99204 NCCI
00102 99205 NCCI
00102 99211 NCCI
00102 99212 NCCI
00102 99213 NCCI
00102 99214 NCCI
00102 99215 NCCI
00102 99217 NCCI
00102 99218 NCCI
00102 99219 NCCI
00102 99220 NCCI
00102 99221 NCCI
00102 99222 NCCI
00102 99223 NCCI
00102 99224 NCCI
00102 99225 NCCI
00102 99226 NCCI
00102 99231 NCCI
00102 99232 NCCI
00102 99233 NCCI
00102 99234 NCCI
00102 99235 NCCI
00102 99236 NCCI
00102 99238 NCCI
00102 99239 NCCI
00102 99241 Retained NCCI
00102 99242 Retained NCCI
00102 99243 Retained NCCI
Comprehensive ComponentCode Code Source
00102 99244 Retained NCCI
00102 99245 Retained NCCI
00102 99251 Retained NCCI
00102 99252 Retained NCCI
00102 99253 Retained NCCI
00102 99254 Retained NCCI
00102 99255 Retained NCCI
00102 99281 NCCI
00102 99282 NCCI
00102 99283 NCCI
00102 99284 NCCI
00102 99285 NCCI
00102 99304 NCCI
00102 99305 NCCI
00102 99306 NCCI
00102 99307 NCCI
00102 99308 NCCI
00102 99309 NCCI
00102 99310 NCCI
00102 99315 NCCI
00102 99318 NCCI
00102 99324 NCCI
00102 99325 NCCI
00102 99326 NCCI
00102 99327 NCCI
00102 99328 NCCI
00102 99334 NCCI
00102 99335 NCCI
00102 99336 NCCI
00102 99337 NCCI
00102 99341 NCCI
00102 99342 NCCI
00102 99343 NCCI
00102 99347 NCCI
00102 99348 NCCI
00102 99349 NCCI
00102 99354 NCCI
00102 99355 NCCI
00102 99356 NCCI
00102 99357 NCCI
00102 99446 NCCI
00102 99447 NCCI
00102 99448 NCCI
00102 99449 NCCI
00102 99466 NCCI
00102 99468 NCCI
00102 99469 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 6 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00102 99471 NCCI
00102 99472 NCCI
00102 99475 NCCI
00102 99476 NCCI
00102 99477 NCCI
00102 99478 NCCI
00102 99479 NCCI
00102 99480 NCCI
00102 99485 NCCI
00102 99497 NCCI
00102 C8921 NCCI
00102 C8922 NCCI
00102 C8923 NCCI
00102 C8924 NCCI
00102 C8925 NCCI
00102 C8926 NCCI
00102 C8927 NCCI
00102 C8929 NCCI
00102 C8930 NCCI
00102 G0380 NCCI
00102 G0381 NCCI
00102 G0382 NCCI
00102 G0383 NCCI
00102 G0384 NCCI
00102 G0406 NCCI
00102 G0407 NCCI
00102 G0408 NCCI
00102 G0425 NCCI
00102 G0426 NCCI
00102 G0427 NCCI
00102 G0463 NCCI
00102 G6043 NCCI
00103 0178T NCCI
00103 0179T NCCI
00103 0180T NCCI
00103 01996 NCCI
00103 0213T NCCI
00103 0216T NCCI
00103 0228T NCCI
00103 0230T NCCI
00103 0282T NCCI
00103 0283T NCCI
00103 0311T NCCI
00103 31505 NCCI
00103 31515 NCCI
00103 31527 NCCI
00103 31622 NCCI
Comprehensive ComponentCode Code Source
00103 31634 NCCI
00103 31645 NCCI
00103 31647 NCCI
00103 36000 NCCI
00103 36010 NCCI
00103 36011 NCCI
00103 36012 NCCI
00103 36013 NCCI
00103 36014 NCCI
00103 36015 NCCI
00103 36400 NCCI
00103 36405 NCCI
00103 36406 NCCI
00103 36410 NCCI
00103 36420 NCCI
00103 36425 NCCI
00103 36430 NCCI
00103 36440 NCCI
00103 36600 NCCI
00103 36640 NCCI
00103 43752 NCCI
00103 43753 NCCI
00103 43754 NCCI
00103 61026 NCCI
00103 61055 NCCI
00103 62280 NCCI
00103 62281 NCCI
00103 62282 NCCI
00103 62284 NCCI
00103 62310 NCCI
00103 62311 NCCI
00103 62318 NCCI
00103 62319 NCCI
00103 64400 NCCI
00103 64402 NCCI
00103 64405 NCCI
00103 64408 NCCI
00103 64410 NCCI
00103 64412 NCCI
00103 64413 NCCI
00103 64415 NCCI
00103 64416 NCCI
00103 64417 NCCI
00103 64418 NCCI
00103 64420 NCCI
00103 64421 NCCI
00103 64425 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 7 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00103 64430 NCCI
00103 64435 NCCI
00103 64445 NCCI
00103 64446 NCCI
00103 64447 NCCI
00103 64448 NCCI
00103 64449 NCCI
00103 64450 NCCI
00103 64479 NCCI
00103 64483 NCCI
00103 64486 NCCI
00103 64487 NCCI
00103 64488 NCCI
00103 64489 NCCI
00103 64490 NCCI
00103 64493 NCCI
00103 64505 NCCI
00103 64508 NCCI
00103 64510 NCCI
00103 64517 NCCI
00103 64520 NCCI
00103 64530 NCCI
00103 64550 NCCI
00103 64553 NCCI
00103 64555 NCCI
00103 64565 NCCI
00103 67500 NCCI
00103 76000 NCCI
00103 76001 NCCI
00103 76998 NCCI
00103 77002 NCCI
00103 81000 NCCI
00103 81002 NCCI
00103 81003 NCCI
00103 81005 NCCI
00103 81015 NCCI
00103 82013 NCCI
00103 90865 NCCI
00103 92511 NCCI
00103 92512 NCCI
00103 92516 NCCI
00103 92520 NCCI
00103 92543 NCCI
00103 92950 NCCI
00103 92953 NCCI
00103 92960 NCCI
00103 92961 NCCI
Comprehensive ComponentCode Code Source
00103 93000 NCCI
00103 93005 NCCI
00103 93010 NCCI
00103 93040 NCCI
00103 93041 NCCI
00103 93042 NCCI
00103 93303 NCCI
00103 93304 NCCI
00103 93306 NCCI
00103 93307 NCCI
00103 93308 NCCI
00103 93312 NCCI
00103 93313 NCCI
00103 93314 NCCI
00103 93315 NCCI
00103 93316 NCCI
00103 93317 NCCI
00103 93318 NCCI
00103 93351 NCCI
00103 93355 NCCI
00103 93451 NCCI
00103 93456 NCCI
00103 93457 NCCI
00103 93561 NCCI
00103 93562 NCCI
00103 93701 NCCI
00103 93922 NCCI
00103 93923 NCCI
00103 93924 NCCI
00103 93925 NCCI
00103 93926 NCCI
00103 93930 NCCI
00103 93931 NCCI
00103 93965 NCCI
00103 93970 NCCI
00103 93971 NCCI
00103 93975 NCCI
00103 93976 NCCI
00103 93978 NCCI
00103 93979 NCCI
00103 93980 NCCI
00103 93981 NCCI
00103 94002 NCCI
00103 94004 NCCI
00103 94200 NCCI
00103 94250 NCCI
00103 94640 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 8 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00103 94644 NCCI
00103 94660 NCCI
00103 94662 NCCI
00103 94680 NCCI
00103 94681 NCCI
00103 94690 NCCI
00103 94760 NCCI
00103 94761 NCCI
00103 94762 NCCI
00103 94770 NCCI
00103 95812 NCCI
00103 95813 NCCI
00103 95816 NCCI
00103 95819 NCCI
00103 95822 NCCI
00103 95829 NCCI
00103 95955 NCCI
00103 95956 NCCI
00103 95957 NCCI
00103 96360 NCCI
00103 96365 NCCI
00103 96372 NCCI
00103 96373 NCCI
00103 96374 NCCI
00103 96375 NCCI
00103 96376 NCCI
00103 99143 NCCI
00103 99144 NCCI
00103 99145 NCCI
00103 99148 NCCI
00103 99149 NCCI
00103 99150 NCCI
00103 99201 NCCI
00103 99202 NCCI
00103 99203 NCCI
00103 99204 NCCI
00103 99205 NCCI
00103 99211 NCCI
00103 99212 NCCI
00103 99213 NCCI
00103 99214 NCCI
00103 99215 NCCI
00103 99217 NCCI
00103 99218 NCCI
00103 99219 NCCI
00103 99220 NCCI
00103 99221 NCCI
Comprehensive ComponentCode Code Source
00103 99222 NCCI
00103 99223 NCCI
00103 99224 NCCI
00103 99225 NCCI
00103 99226 NCCI
00103 99231 NCCI
00103 99232 NCCI
00103 99233 NCCI
00103 99234 NCCI
00103 99235 NCCI
00103 99236 NCCI
00103 99238 NCCI
00103 99239 NCCI
00103 99241 Retained NCCI
00103 99242 Retained NCCI
00103 99243 Retained NCCI
00103 99244 Retained NCCI
00103 99245 Retained NCCI
00103 99251 Retained NCCI
00103 99252 Retained NCCI
00103 99253 Retained NCCI
00103 99254 Retained NCCI
00103 99255 Retained NCCI
00103 99281 NCCI
00103 99282 NCCI
00103 99283 NCCI
00103 99284 NCCI
00103 99285 NCCI
00103 99304 NCCI
00103 99305 NCCI
00103 99306 NCCI
00103 99307 NCCI
00103 99308 NCCI
00103 99309 NCCI
00103 99310 NCCI
00103 99315 NCCI
00103 99318 NCCI
00103 99324 NCCI
00103 99325 NCCI
00103 99326 NCCI
00103 99327 NCCI
00103 99328 NCCI
00103 99334 NCCI
00103 99335 NCCI
00103 99336 NCCI
00103 99337 NCCI
00103 99341 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 9 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00103 99342 NCCI
00103 99343 NCCI
00103 99347 NCCI
00103 99348 NCCI
00103 99349 NCCI
00103 99354 NCCI
00103 99355 NCCI
00103 99356 NCCI
00103 99357 NCCI
00103 99446 NCCI
00103 99447 NCCI
00103 99448 NCCI
00103 99449 NCCI
00103 99466 NCCI
00103 99468 NCCI
00103 99469 NCCI
00103 99471 NCCI
00103 99472 NCCI
00103 99475 NCCI
00103 99476 NCCI
00103 99477 NCCI
00103 99478 NCCI
00103 99479 NCCI
00103 99480 NCCI
00103 99485 NCCI
00103 99497 NCCI
00103 C8921 NCCI
00103 C8922 NCCI
00103 C8923 NCCI
00103 C8924 NCCI
00103 C8925 NCCI
00103 C8926 NCCI
00103 C8927 NCCI
00103 C8929 NCCI
00103 C8930 NCCI
00103 G0380 NCCI
00103 G0381 NCCI
00103 G0382 NCCI
00103 G0383 NCCI
00103 G0384 NCCI
00103 G0406 NCCI
00103 G0407 NCCI
00103 G0408 NCCI
00103 G0425 NCCI
00103 G0426 NCCI
00103 G0427 NCCI
00103 G0463 NCCI
Comprehensive ComponentCode Code Source
00103 G6043 NCCI
00104 0178T NCCI
00104 0179T NCCI
00104 0180T NCCI
00104 01996 NCCI
00104 0213T NCCI
00104 0216T NCCI
00104 0228T NCCI
00104 0230T NCCI
00104 0282T NCCI
00104 0283T NCCI
00104 0311T NCCI
00104 0333T NCCI
00104 31505 NCCI
00104 31515 NCCI
00104 31527 NCCI
00104 31622 NCCI
00104 31634 NCCI
00104 31645 NCCI
00104 31647 NCCI
00104 36000 NCCI
00104 36010 NCCI
00104 36011 NCCI
00104 36012 NCCI
00104 36013 NCCI
00104 36014 NCCI
00104 36015 NCCI
00104 36400 NCCI
00104 36405 NCCI
00104 36406 NCCI
00104 36410 NCCI
00104 36420 NCCI
00104 36425 NCCI
00104 36430 NCCI
00104 36440 NCCI
00104 36600 NCCI
00104 36640 NCCI
00104 43752 NCCI
00104 43753 NCCI
00104 43754 NCCI
00104 61026 NCCI
00104 61055 NCCI
00104 62280 NCCI
00104 62281 NCCI
00104 62282 NCCI
00104 62284 NCCI
00104 62310 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 10 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00104 62311 NCCI
00104 62318 NCCI
00104 62319 NCCI
00104 64400 NCCI
00104 64402 NCCI
00104 64405 NCCI
00104 64408 NCCI
00104 64410 NCCI
00104 64412 NCCI
00104 64413 NCCI
00104 64415 NCCI
00104 64416 NCCI
00104 64417 NCCI
00104 64418 NCCI
00104 64420 NCCI
00104 64421 NCCI
00104 64425 NCCI
00104 64430 NCCI
00104 64435 NCCI
00104 64445 NCCI
00104 64446 NCCI
00104 64447 NCCI
00104 64448 NCCI
00104 64449 NCCI
00104 64450 NCCI
00104 64479 NCCI
00104 64483 NCCI
00104 64486 NCCI
00104 64487 NCCI
00104 64488 NCCI
00104 64489 NCCI
00104 64490 NCCI
00104 64493 NCCI
00104 64505 NCCI
00104 64508 NCCI
00104 64510 NCCI
00104 64517 NCCI
00104 64520 NCCI
00104 64530 NCCI
00104 64550 NCCI
00104 64553 NCCI
00104 64555 NCCI
00104 64565 NCCI
00104 67500 NCCI
00104 76000 NCCI
00104 76001 NCCI
00104 76998 NCCI
Comprehensive ComponentCode Code Source
00104 77002 NCCI
00104 81000 NCCI
00104 81002 NCCI
00104 81003 NCCI
00104 81005 NCCI
00104 81015 NCCI
00104 82013 NCCI
00104 90865 NCCI
00104 92511 NCCI
00104 92512 NCCI
00104 92516 NCCI
00104 92520 NCCI
00104 92543 NCCI
00104 92585 NCCI
00104 92950 NCCI
00104 92953 NCCI
00104 92960 NCCI
00104 92961 NCCI
00104 93000 NCCI
00104 93005 NCCI
00104 93010 NCCI
00104 93040 NCCI
00104 93041 NCCI
00104 93042 NCCI
00104 93303 NCCI
00104 93304 NCCI
00104 93306 NCCI
00104 93307 NCCI
00104 93308 NCCI
00104 93312 NCCI
00104 93313 NCCI
00104 93314 NCCI
00104 93315 NCCI
00104 93316 NCCI
00104 93317 NCCI
00104 93318 NCCI
00104 93351 NCCI
00104 93355 NCCI
00104 93451 NCCI
00104 93456 NCCI
00104 93457 NCCI
00104 93561 NCCI
00104 93562 NCCI
00104 93701 NCCI
00104 93922 NCCI
00104 93923 NCCI
00104 93924 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 11 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00104 93925 NCCI
00104 93926 NCCI
00104 93930 NCCI
00104 93931 NCCI
00104 93965 NCCI
00104 93970 NCCI
00104 93971 NCCI
00104 93975 NCCI
00104 93976 NCCI
00104 93978 NCCI
00104 93979 NCCI
00104 93980 NCCI
00104 93981 NCCI
00104 94002 NCCI
00104 94004 NCCI
00104 94200 NCCI
00104 94250 NCCI
00104 94640 NCCI
00104 94644 NCCI
00104 94660 NCCI
00104 94662 NCCI
00104 94680 NCCI
00104 94681 NCCI
00104 94690 NCCI
00104 94760 NCCI
00104 94761 NCCI
00104 94762 NCCI
00104 94770 NCCI
00104 95812 NCCI
00104 95813 NCCI
00104 95816 NCCI
00104 95819 NCCI
00104 95822 NCCI
00104 95829 NCCI
00104 95860 NCCI
00104 95861 NCCI
00104 95863 NCCI
00104 95864 NCCI
00104 95865 NCCI
00104 95866 NCCI
00104 95867 NCCI
00104 95868 NCCI
00104 95869 NCCI
00104 95870 NCCI
00104 95907 NCCI
00104 95908 NCCI
00104 95909 NCCI
Comprehensive ComponentCode Code Source
00104 95910 NCCI
00104 95911 NCCI
00104 95912 NCCI
00104 95913 NCCI
00104 95925 NCCI
00104 95926 NCCI
00104 95927 NCCI
00104 95928 NCCI
00104 95929 NCCI
00104 95930 NCCI
00104 95933 NCCI
00104 95937 NCCI
00104 95938 NCCI
00104 95939 NCCI
00104 95940 NCCI
00104 95955 NCCI
00104 95956 NCCI
00104 95957 NCCI
00104 96360 NCCI
00104 96365 NCCI
00104 96372 NCCI
00104 96373 NCCI
00104 96374 NCCI
00104 96375 NCCI
00104 96376 NCCI
00104 99143 NCCI
00104 99144 NCCI
00104 99145 NCCI
00104 99148 NCCI
00104 99149 NCCI
00104 99150 NCCI
00104 99201 NCCI
00104 99202 NCCI
00104 99203 NCCI
00104 99204 NCCI
00104 99205 NCCI
00104 99211 NCCI
00104 99212 NCCI
00104 99213 NCCI
00104 99214 NCCI
00104 99215 NCCI
00104 99217 NCCI
00104 99218 NCCI
00104 99219 NCCI
00104 99220 NCCI
00104 99221 NCCI
00104 99222 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 12 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00104 99223 NCCI
00104 99224 NCCI
00104 99225 NCCI
00104 99226 NCCI
00104 99231 NCCI
00104 99232 NCCI
00104 99233 NCCI
00104 99234 NCCI
00104 99235 NCCI
00104 99236 NCCI
00104 99238 NCCI
00104 99239 NCCI
00104 99241 Retained NCCI
00104 99242 Retained NCCI
00104 99243 Retained NCCI
00104 99244 Retained NCCI
00104 99245 Retained NCCI
00104 99251 Retained NCCI
00104 99252 Retained NCCI
00104 99253 Retained NCCI
00104 99254 Retained NCCI
00104 99255 Retained NCCI
00104 99281 NCCI
00104 99282 NCCI
00104 99283 NCCI
00104 99284 NCCI
00104 99285 NCCI
00104 99304 NCCI
00104 99305 NCCI
00104 99306 NCCI
00104 99307 NCCI
00104 99308 NCCI
00104 99309 NCCI
00104 99310 NCCI
00104 99315 NCCI
00104 99318 NCCI
00104 99324 NCCI
00104 99325 NCCI
00104 99326 NCCI
00104 99327 NCCI
00104 99328 NCCI
00104 99334 NCCI
00104 99335 NCCI
00104 99336 NCCI
00104 99337 NCCI
00104 99341 NCCI
00104 99342 NCCI
Comprehensive ComponentCode Code Source
00104 99343 NCCI
00104 99347 NCCI
00104 99348 NCCI
00104 99349 NCCI
00104 99354 NCCI
00104 99355 NCCI
00104 99356 NCCI
00104 99357 NCCI
00104 99446 NCCI
00104 99447 NCCI
00104 99448 NCCI
00104 99449 NCCI
00104 99466 NCCI
00104 99468 NCCI
00104 99469 NCCI
00104 99471 NCCI
00104 99472 NCCI
00104 99475 NCCI
00104 99476 NCCI
00104 99477 NCCI
00104 99478 NCCI
00104 99479 NCCI
00104 99480 NCCI
00104 99485 NCCI
00104 99497 NCCI
00104 C8921 NCCI
00104 C8922 NCCI
00104 C8923 NCCI
00104 C8924 NCCI
00104 C8925 NCCI
00104 C8926 NCCI
00104 C8927 NCCI
00104 C8929 NCCI
00104 C8930 NCCI
00104 G0380 NCCI
00104 G0381 NCCI
00104 G0382 NCCI
00104 G0383 NCCI
00104 G0384 NCCI
00104 G0406 NCCI
00104 G0407 NCCI
00104 G0408 NCCI
00104 G0425 NCCI
00104 G0426 NCCI
00104 G0427 NCCI
00104 G0453 NCCI
00104 G0463 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 13 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00104 G6043 NCCI
00120 0178T NCCI
00120 0179T NCCI
00120 0180T NCCI
00120 01996 NCCI
00120 0213T NCCI
00120 0216T NCCI
00120 0228T NCCI
00120 0230T NCCI
00120 0282T NCCI
00120 0283T NCCI
00120 0311T NCCI
00120 31505 NCCI
00120 31515 NCCI
00120 31527 NCCI
00120 31622 NCCI
00120 31634 NCCI
00120 31645 NCCI
00120 31647 NCCI
00120 36000 NCCI
00120 36010 NCCI
00120 36011 NCCI
00120 36012 NCCI
00120 36013 NCCI
00120 36014 NCCI
00120 36015 NCCI
00120 36400 NCCI
00120 36405 NCCI
00120 36406 NCCI
00120 36410 NCCI
00120 36420 NCCI
00120 36425 NCCI
00120 36430 NCCI
00120 36440 NCCI
00120 36600 NCCI
00120 36640 NCCI
00120 43752 NCCI
00120 43753 NCCI
00120 43754 NCCI
00120 61026 NCCI
00120 61055 NCCI
00120 62280 NCCI
00120 62281 NCCI
00120 62282 NCCI
00120 62284 NCCI
00120 62310 NCCI
00120 62311 NCCI
Comprehensive ComponentCode Code Source
00120 62318 NCCI
00120 62319 NCCI
00120 64400 NCCI
00120 64402 NCCI
00120 64405 NCCI
00120 64408 NCCI
00120 64410 NCCI
00120 64412 NCCI
00120 64413 NCCI
00120 64415 NCCI
00120 64416 NCCI
00120 64417 NCCI
00120 64418 NCCI
00120 64420 NCCI
00120 64421 NCCI
00120 64425 NCCI
00120 64430 NCCI
00120 64435 NCCI
00120 64445 NCCI
00120 64446 NCCI
00120 64447 NCCI
00120 64448 NCCI
00120 64449 NCCI
00120 64450 NCCI
00120 64479 NCCI
00120 64483 NCCI
00120 64486 NCCI
00120 64487 NCCI
00120 64488 NCCI
00120 64489 NCCI
00120 64490 NCCI
00120 64493 NCCI
00120 64505 NCCI
00120 64508 NCCI
00120 64510 NCCI
00120 64517 NCCI
00120 64520 NCCI
00120 64530 NCCI
00120 64550 NCCI
00120 64553 NCCI
00120 64555 NCCI
00120 64565 NCCI
00120 67500 NCCI
00120 76000 NCCI
00120 76001 NCCI
00120 76998 NCCI
00120 77002 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 14 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00120 81000 NCCI
00120 81002 NCCI
00120 81003 NCCI
00120 81005 NCCI
00120 81015 NCCI
00120 82013 NCCI
00120 90865 NCCI
00120 92511 NCCI
00120 92512 NCCI
00120 92516 NCCI
00120 92520 NCCI
00120 92543 NCCI
00120 92950 NCCI
00120 92953 NCCI
00120 92960 NCCI
00120 92961 NCCI
00120 93000 NCCI
00120 93005 NCCI
00120 93010 NCCI
00120 93040 NCCI
00120 93041 NCCI
00120 93042 NCCI
00120 93303 NCCI
00120 93304 NCCI
00120 93306 NCCI
00120 93307 NCCI
00120 93308 NCCI
00120 93312 NCCI
00120 93313 NCCI
00120 93314 NCCI
00120 93315 NCCI
00120 93316 NCCI
00120 93317 NCCI
00120 93318 NCCI
00120 93351 NCCI
00120 93355 NCCI
00120 93451 NCCI
00120 93456 NCCI
00120 93457 NCCI
00120 93561 NCCI
00120 93562 NCCI
00120 93701 NCCI
00120 93922 NCCI
00120 93923 NCCI
00120 93924 NCCI
00120 93925 NCCI
00120 93926 NCCI
Comprehensive ComponentCode Code Source
00120 93930 NCCI
00120 93931 NCCI
00120 93965 NCCI
00120 93970 NCCI
00120 93971 NCCI
00120 93975 NCCI
00120 93976 NCCI
00120 93978 NCCI
00120 93979 NCCI
00120 93980 NCCI
00120 93981 NCCI
00120 94002 NCCI
00120 94004 NCCI
00120 94200 NCCI
00120 94250 NCCI
00120 94640 NCCI
00120 94644 NCCI
00120 94660 NCCI
00120 94662 NCCI
00120 94680 NCCI
00120 94681 NCCI
00120 94690 NCCI
00120 94760 NCCI
00120 94761 NCCI
00120 94762 NCCI
00120 94770 NCCI
00120 95812 NCCI
00120 95813 NCCI
00120 95816 NCCI
00120 95819 NCCI
00120 95822 NCCI
00120 95829 NCCI
00120 95955 NCCI
00120 95956 NCCI
00120 95957 NCCI
00120 96360 NCCI
00120 96365 NCCI
00120 96372 NCCI
00120 96373 NCCI
00120 96374 NCCI
00120 96375 NCCI
00120 96376 NCCI
00120 99143 NCCI
00120 99144 NCCI
00120 99145 NCCI
00120 99148 NCCI
00120 99149 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 15 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00120 99150 NCCI
00120 99201 NCCI
00120 99202 NCCI
00120 99203 NCCI
00120 99204 NCCI
00120 99205 NCCI
00120 99211 NCCI
00120 99212 NCCI
00120 99213 NCCI
00120 99214 NCCI
00120 99215 NCCI
00120 99217 NCCI
00120 99218 NCCI
00120 99219 NCCI
00120 99220 NCCI
00120 99221 NCCI
00120 99222 NCCI
00120 99223 NCCI
00120 99224 NCCI
00120 99225 NCCI
00120 99226 NCCI
00120 99231 NCCI
00120 99232 NCCI
00120 99233 NCCI
00120 99234 NCCI
00120 99235 NCCI
00120 99236 NCCI
00120 99238 NCCI
00120 99239 NCCI
00120 99241 Retained NCCI
00120 99242 Retained NCCI
00120 99243 Retained NCCI
00120 99244 Retained NCCI
00120 99245 Retained NCCI
00120 99251 Retained NCCI
00120 99252 Retained NCCI
00120 99253 Retained NCCI
00120 99254 Retained NCCI
00120 99255 Retained NCCI
00120 99281 NCCI
00120 99282 NCCI
00120 99283 NCCI
00120 99284 NCCI
00120 99285 NCCI
00120 99304 NCCI
00120 99305 NCCI
00120 99306 NCCI
Comprehensive ComponentCode Code Source
00120 99307 NCCI
00120 99308 NCCI
00120 99309 NCCI
00120 99310 NCCI
00120 99315 NCCI
00120 99318 NCCI
00120 99324 NCCI
00120 99325 NCCI
00120 99326 NCCI
00120 99327 NCCI
00120 99328 NCCI
00120 99334 NCCI
00120 99335 NCCI
00120 99336 NCCI
00120 99337 NCCI
00120 99341 NCCI
00120 99342 NCCI
00120 99343 NCCI
00120 99347 NCCI
00120 99348 NCCI
00120 99349 NCCI
00120 99354 NCCI
00120 99355 NCCI
00120 99356 NCCI
00120 99357 NCCI
00120 99446 NCCI
00120 99447 NCCI
00120 99448 NCCI
00120 99449 NCCI
00120 99466 NCCI
00120 99468 NCCI
00120 99469 NCCI
00120 99471 NCCI
00120 99472 NCCI
00120 99475 NCCI
00120 99476 NCCI
00120 99477 NCCI
00120 99478 NCCI
00120 99479 NCCI
00120 99480 NCCI
00120 99485 NCCI
00120 99497 NCCI
00120 C8921 NCCI
00120 C8922 NCCI
00120 C8923 NCCI
00120 C8924 NCCI
00120 C8925 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 16 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00120 C8926 NCCI
00120 C8927 NCCI
00120 C8929 NCCI
00120 C8930 NCCI
00120 G0380 NCCI
00120 G0381 NCCI
00120 G0382 NCCI
00120 G0383 NCCI
00120 G0384 NCCI
00120 G0406 NCCI
00120 G0407 NCCI
00120 G0408 NCCI
00120 G0425 NCCI
00120 G0426 NCCI
00120 G0427 NCCI
00120 G0463 NCCI
00120 G6043 NCCI
00124 0178T NCCI
00124 0179T NCCI
00124 0180T NCCI
00124 01996 NCCI
00124 0213T NCCI
00124 0216T NCCI
00124 0228T NCCI
00124 0230T NCCI
00124 0282T NCCI
00124 0283T NCCI
00124 0311T NCCI
00124 31505 NCCI
00124 31515 NCCI
00124 31527 NCCI
00124 31622 NCCI
00124 31634 NCCI
00124 31645 NCCI
00124 31647 NCCI
00124 36000 NCCI
00124 36010 NCCI
00124 36011 NCCI
00124 36012 NCCI
00124 36013 NCCI
00124 36014 NCCI
00124 36015 NCCI
00124 36400 NCCI
00124 36405 NCCI
00124 36406 NCCI
00124 36410 NCCI
00124 36420 NCCI
Comprehensive ComponentCode Code Source
00124 36425 NCCI
00124 36430 NCCI
00124 36440 NCCI
00124 36600 NCCI
00124 36640 NCCI
00124 43752 NCCI
00124 43753 NCCI
00124 43754 NCCI
00124 61026 NCCI
00124 61055 NCCI
00124 62280 NCCI
00124 62281 NCCI
00124 62282 NCCI
00124 62284 NCCI
00124 62310 NCCI
00124 62311 NCCI
00124 62318 NCCI
00124 62319 NCCI
00124 64400 NCCI
00124 64402 NCCI
00124 64405 NCCI
00124 64408 NCCI
00124 64410 NCCI
00124 64412 NCCI
00124 64413 NCCI
00124 64415 NCCI
00124 64416 NCCI
00124 64417 NCCI
00124 64418 NCCI
00124 64420 NCCI
00124 64421 NCCI
00124 64425 NCCI
00124 64430 NCCI
00124 64435 NCCI
00124 64445 NCCI
00124 64446 NCCI
00124 64447 NCCI
00124 64448 NCCI
00124 64449 NCCI
00124 64450 NCCI
00124 64479 NCCI
00124 64483 NCCI
00124 64486 NCCI
00124 64487 NCCI
00124 64488 NCCI
00124 64489 NCCI
00124 64490 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 17 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00124 64493 NCCI
00124 64505 NCCI
00124 64508 NCCI
00124 64510 NCCI
00124 64517 NCCI
00124 64520 NCCI
00124 64530 NCCI
00124 64550 NCCI
00124 64553 NCCI
00124 64555 NCCI
00124 64565 NCCI
00124 67500 NCCI
00124 76000 NCCI
00124 76001 NCCI
00124 76100 NCCI
00124 76998 NCCI
00124 77002 NCCI
00124 81000 NCCI
00124 81002 NCCI
00124 81003 NCCI
00124 81005 NCCI
00124 81015 NCCI
00124 82013 NCCI
00124 90865 NCCI
00124 92511 NCCI
00124 92512 NCCI
00124 92516 NCCI
00124 92520 NCCI
00124 92543 NCCI
00124 92950 NCCI
00124 92953 NCCI
00124 92960 NCCI
00124 92961 NCCI
00124 93000 NCCI
00124 93005 NCCI
00124 93010 NCCI
00124 93040 NCCI
00124 93041 NCCI
00124 93042 NCCI
00124 93303 NCCI
00124 93304 NCCI
00124 93306 NCCI
00124 93307 NCCI
00124 93308 NCCI
00124 93312 NCCI
00124 93313 NCCI
00124 93314 NCCI
Comprehensive ComponentCode Code Source
00124 93315 NCCI
00124 93316 NCCI
00124 93317 NCCI
00124 93318 NCCI
00124 93351 NCCI
00124 93355 NCCI
00124 93451 NCCI
00124 93456 NCCI
00124 93457 NCCI
00124 93561 NCCI
00124 93562 NCCI
00124 93701 NCCI
00124 93922 NCCI
00124 93923 NCCI
00124 93924 NCCI
00124 93925 NCCI
00124 93926 NCCI
00124 93930 NCCI
00124 93931 NCCI
00124 93965 NCCI
00124 93970 NCCI
00124 93971 NCCI
00124 93975 NCCI
00124 93976 NCCI
00124 93978 NCCI
00124 93979 NCCI
00124 93980 NCCI
00124 93981 NCCI
00124 94002 NCCI
00124 94004 NCCI
00124 94200 NCCI
00124 94250 NCCI
00124 94640 NCCI
00124 94644 NCCI
00124 94660 NCCI
00124 94662 NCCI
00124 94680 NCCI
00124 94681 NCCI
00124 94690 NCCI
00124 94760 NCCI
00124 94761 NCCI
00124 94762 NCCI
00124 94770 NCCI
00124 95812 NCCI
00124 95813 NCCI
00124 95816 NCCI
00124 95819 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 18 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00124 95822 NCCI
00124 95829 NCCI
00124 95955 NCCI
00124 95956 NCCI
00124 95957 NCCI
00124 96360 NCCI
00124 96365 NCCI
00124 96372 NCCI
00124 96373 NCCI
00124 96374 NCCI
00124 96375 NCCI
00124 96376 NCCI
00124 99143 NCCI
00124 99144 NCCI
00124 99145 NCCI
00124 99148 NCCI
00124 99149 NCCI
00124 99150 NCCI
00124 99201 NCCI
00124 99202 NCCI
00124 99203 NCCI
00124 99204 NCCI
00124 99205 NCCI
00124 99211 NCCI
00124 99212 NCCI
00124 99213 NCCI
00124 99214 NCCI
00124 99215 NCCI
00124 99217 NCCI
00124 99218 NCCI
00124 99219 NCCI
00124 99220 NCCI
00124 99221 NCCI
00124 99222 NCCI
00124 99223 NCCI
00124 99224 NCCI
00124 99225 NCCI
00124 99226 NCCI
00124 99231 NCCI
00124 99232 NCCI
00124 99233 NCCI
00124 99234 NCCI
00124 99235 NCCI
00124 99236 NCCI
00124 99238 NCCI
00124 99239 NCCI
00124 99241 Retained NCCI
Comprehensive ComponentCode Code Source
00124 99242 Retained NCCI
00124 99243 Retained NCCI
00124 99244 Retained NCCI
00124 99245 Retained NCCI
00124 99251 Retained NCCI
00124 99252 Retained NCCI
00124 99253 Retained NCCI
00124 99254 Retained NCCI
00124 99255 Retained NCCI
00124 99281 NCCI
00124 99282 NCCI
00124 99283 NCCI
00124 99284 NCCI
00124 99285 NCCI
00124 99304 NCCI
00124 99305 NCCI
00124 99306 NCCI
00124 99307 NCCI
00124 99308 NCCI
00124 99309 NCCI
00124 99310 NCCI
00124 99315 NCCI
00124 99318 NCCI
00124 99324 NCCI
00124 99325 NCCI
00124 99326 NCCI
00124 99327 NCCI
00124 99328 NCCI
00124 99334 NCCI
00124 99335 NCCI
00124 99336 NCCI
00124 99337 NCCI
00124 99341 NCCI
00124 99342 NCCI
00124 99343 NCCI
00124 99347 NCCI
00124 99348 NCCI
00124 99349 NCCI
00124 99354 NCCI
00124 99355 NCCI
00124 99356 NCCI
00124 99357 NCCI
00124 99446 NCCI
00124 99447 NCCI
00124 99448 NCCI
00124 99449 NCCI
00124 99466 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 19 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00124 99468 NCCI
00124 99469 NCCI
00124 99471 NCCI
00124 99472 NCCI
00124 99475 NCCI
00124 99476 NCCI
00124 99477 NCCI
00124 99478 NCCI
00124 99479 NCCI
00124 99480 NCCI
00124 99485 NCCI
00124 99497 NCCI
00124 C8921 NCCI
00124 C8922 NCCI
00124 C8923 NCCI
00124 C8924 NCCI
00124 C8925 NCCI
00124 C8926 NCCI
00124 C8927 NCCI
00124 C8929 NCCI
00124 C8930 NCCI
00124 G0380 NCCI
00124 G0381 NCCI
00124 G0382 NCCI
00124 G0383 NCCI
00124 G0384 NCCI
00124 G0406 NCCI
00124 G0407 NCCI
00124 G0408 NCCI
00124 G0425 NCCI
00124 G0426 NCCI
00124 G0427 NCCI
00124 G0463 NCCI
00124 G6043 NCCI
00126 0178T NCCI
00126 0179T NCCI
00126 0180T NCCI
00126 01996 NCCI
00126 0213T NCCI
00126 0216T NCCI
00126 0228T NCCI
00126 0230T NCCI
00126 0282T NCCI
00126 0283T NCCI
00126 0311T NCCI
00126 31505 NCCI
00126 31515 NCCI
Comprehensive ComponentCode Code Source
00126 31527 NCCI
00126 31622 NCCI
00126 31634 NCCI
00126 31645 NCCI
00126 31647 NCCI
00126 36000 NCCI
00126 36010 NCCI
00126 36011 NCCI
00126 36012 NCCI
00126 36013 NCCI
00126 36014 NCCI
00126 36015 NCCI
00126 36400 NCCI
00126 36405 NCCI
00126 36406 NCCI
00126 36410 NCCI
00126 36420 NCCI
00126 36425 NCCI
00126 36430 NCCI
00126 36440 NCCI
00126 36600 NCCI
00126 36640 NCCI
00126 43752 NCCI
00126 43753 NCCI
00126 43754 NCCI
00126 61026 NCCI
00126 61055 NCCI
00126 62280 NCCI
00126 62281 NCCI
00126 62282 NCCI
00126 62284 NCCI
00126 62310 NCCI
00126 62311 NCCI
00126 62318 NCCI
00126 62319 NCCI
00126 64400 NCCI
00126 64402 NCCI
00126 64405 NCCI
00126 64408 NCCI
00126 64410 NCCI
00126 64412 NCCI
00126 64413 NCCI
00126 64415 NCCI
00126 64416 NCCI
00126 64417 NCCI
00126 64418 NCCI
00126 64420 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 20 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00126 64421 NCCI
00126 64425 NCCI
00126 64430 NCCI
00126 64435 NCCI
00126 64445 NCCI
00126 64446 NCCI
00126 64447 NCCI
00126 64448 NCCI
00126 64449 NCCI
00126 64450 NCCI
00126 64479 NCCI
00126 64483 NCCI
00126 64486 NCCI
00126 64487 NCCI
00126 64488 NCCI
00126 64489 NCCI
00126 64490 NCCI
00126 64493 NCCI
00126 64505 NCCI
00126 64508 NCCI
00126 64510 NCCI
00126 64517 NCCI
00126 64520 NCCI
00126 64530 NCCI
00126 64550 NCCI
00126 64553 NCCI
00126 64555 NCCI
00126 64565 NCCI
00126 67500 NCCI
00126 76000 NCCI
00126 76001 NCCI
00126 76998 NCCI
00126 77002 NCCI
00126 81000 NCCI
00126 81002 NCCI
00126 81003 NCCI
00126 81005 NCCI
00126 81015 NCCI
00126 82013 NCCI
00126 90865 NCCI
00126 92511 NCCI
00126 92512 NCCI
00126 92516 NCCI
00126 92520 NCCI
00126 92543 NCCI
00126 92950 NCCI
00126 92953 NCCI
Comprehensive ComponentCode Code Source
00126 92960 NCCI
00126 92961 NCCI
00126 93000 NCCI
00126 93005 NCCI
00126 93010 NCCI
00126 93040 NCCI
00126 93041 NCCI
00126 93042 NCCI
00126 93303 NCCI
00126 93304 NCCI
00126 93306 NCCI
00126 93307 NCCI
00126 93308 NCCI
00126 93312 NCCI
00126 93313 NCCI
00126 93314 NCCI
00126 93315 NCCI
00126 93316 NCCI
00126 93317 NCCI
00126 93318 NCCI
00126 93351 NCCI
00126 93355 NCCI
00126 93451 NCCI
00126 93456 NCCI
00126 93457 NCCI
00126 93561 NCCI
00126 93562 NCCI
00126 93701 NCCI
00126 93922 NCCI
00126 93923 NCCI
00126 93924 NCCI
00126 93925 NCCI
00126 93926 NCCI
00126 93930 NCCI
00126 93931 NCCI
00126 93965 NCCI
00126 93970 NCCI
00126 93971 NCCI
00126 93975 NCCI
00126 93976 NCCI
00126 93978 NCCI
00126 93979 NCCI
00126 93980 NCCI
00126 93981 NCCI
00126 94002 NCCI
00126 94004 NCCI
00126 94200 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 21 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00126 94250 NCCI
00126 94640 NCCI
00126 94644 NCCI
00126 94660 NCCI
00126 94662 NCCI
00126 94680 NCCI
00126 94681 NCCI
00126 94690 NCCI
00126 94760 NCCI
00126 94761 NCCI
00126 94762 NCCI
00126 94770 NCCI
00126 95812 NCCI
00126 95813 NCCI
00126 95816 NCCI
00126 95819 NCCI
00126 95822 NCCI
00126 95829 NCCI
00126 95955 NCCI
00126 95956 NCCI
00126 95957 NCCI
00126 96360 NCCI
00126 96365 NCCI
00126 96372 NCCI
00126 96373 NCCI
00126 96374 NCCI
00126 96375 NCCI
00126 96376 NCCI
00126 99143 NCCI
00126 99144 NCCI
00126 99145 NCCI
00126 99148 NCCI
00126 99149 NCCI
00126 99150 NCCI
00126 99201 NCCI
00126 99202 NCCI
00126 99203 NCCI
00126 99204 NCCI
00126 99205 NCCI
00126 99211 NCCI
00126 99212 NCCI
00126 99213 NCCI
00126 99214 NCCI
00126 99215 NCCI
00126 99217 NCCI
00126 99218 NCCI
00126 99219 NCCI
Comprehensive ComponentCode Code Source
00126 99220 NCCI
00126 99221 NCCI
00126 99222 NCCI
00126 99223 NCCI
00126 99224 NCCI
00126 99225 NCCI
00126 99226 NCCI
00126 99231 NCCI
00126 99232 NCCI
00126 99233 NCCI
00126 99234 NCCI
00126 99235 NCCI
00126 99236 NCCI
00126 99238 NCCI
00126 99239 NCCI
00126 99241 Retained NCCI
00126 99242 Retained NCCI
00126 99243 Retained NCCI
00126 99244 Retained NCCI
00126 99245 Retained NCCI
00126 99251 Retained NCCI
00126 99252 Retained NCCI
00126 99253 Retained NCCI
00126 99254 Retained NCCI
00126 99255 Retained NCCI
00126 99281 NCCI
00126 99282 NCCI
00126 99283 NCCI
00126 99284 NCCI
00126 99285 NCCI
00126 99304 NCCI
00126 99305 NCCI
00126 99306 NCCI
00126 99307 NCCI
00126 99308 NCCI
00126 99309 NCCI
00126 99310 NCCI
00126 99315 NCCI
00126 99318 NCCI
00126 99324 NCCI
00126 99325 NCCI
00126 99326 NCCI
00126 99327 NCCI
00126 99328 NCCI
00126 99334 NCCI
00126 99335 NCCI
00126 99336 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 22 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00126 99337 NCCI
00126 99341 NCCI
00126 99342 NCCI
00126 99343 NCCI
00126 99347 NCCI
00126 99348 NCCI
00126 99349 NCCI
00126 99354 NCCI
00126 99355 NCCI
00126 99356 NCCI
00126 99357 NCCI
00126 99446 NCCI
00126 99447 NCCI
00126 99448 NCCI
00126 99449 NCCI
00126 99466 NCCI
00126 99468 NCCI
00126 99469 NCCI
00126 99471 NCCI
00126 99472 NCCI
00126 99475 NCCI
00126 99476 NCCI
00126 99477 NCCI
00126 99478 NCCI
00126 99479 NCCI
00126 99480 NCCI
00126 99485 NCCI
00126 99497 NCCI
00126 C8921 NCCI
00126 C8922 NCCI
00126 C8923 NCCI
00126 C8924 NCCI
00126 C8925 NCCI
00126 C8926 NCCI
00126 C8927 NCCI
00126 C8929 NCCI
00126 C8930 NCCI
00126 G0380 NCCI
00126 G0381 NCCI
00126 G0382 NCCI
00126 G0383 NCCI
00126 G0384 NCCI
00126 G0406 NCCI
00126 G0407 NCCI
00126 G0408 NCCI
00126 G0425 NCCI
00126 G0426 NCCI
Comprehensive ComponentCode Code Source
00126 G0427 NCCI
00126 G0463 NCCI
00126 G6043 NCCI
00140 0178T NCCI
00140 0179T NCCI
00140 0180T NCCI
00140 01996 NCCI
00140 0213T NCCI
00140 0216T NCCI
00140 0228T NCCI
00140 0230T NCCI
00140 0282T NCCI
00140 0283T NCCI
00140 0311T NCCI
00140 0329T NCCI
00140 31505 NCCI
00140 31515 NCCI
00140 31527 NCCI
00140 31622 NCCI
00140 31634 NCCI
00140 31645 NCCI
00140 31647 NCCI
00140 36000 NCCI
00140 36010 NCCI
00140 36011 NCCI
00140 36012 NCCI
00140 36013 NCCI
00140 36014 NCCI
00140 36015 NCCI
00140 36400 NCCI
00140 36405 NCCI
00140 36406 NCCI
00140 36410 NCCI
00140 36420 NCCI
00140 36425 NCCI
00140 36430 NCCI
00140 36440 NCCI
00140 36600 NCCI
00140 36640 NCCI
00140 43752 NCCI
00140 43753 NCCI
00140 43754 NCCI
00140 61026 NCCI
00140 61055 NCCI
00140 62280 NCCI
00140 62281 NCCI
00140 62282 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 23 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00140 62284 NCCI
00140 62310 NCCI
00140 62311 NCCI
00140 62318 NCCI
00140 62319 NCCI
00140 64400 NCCI
00140 64402 NCCI
00140 64405 NCCI
00140 64408 NCCI
00140 64410 NCCI
00140 64412 NCCI
00140 64413 NCCI
00140 64415 NCCI
00140 64416 NCCI
00140 64417 NCCI
00140 64418 NCCI
00140 64420 NCCI
00140 64421 NCCI
00140 64425 NCCI
00140 64430 NCCI
00140 64435 NCCI
00140 64445 NCCI
00140 64446 NCCI
00140 64447 NCCI
00140 64448 NCCI
00140 64449 NCCI
00140 64450 NCCI
00140 64479 NCCI
00140 64483 NCCI
00140 64486 NCCI
00140 64487 NCCI
00140 64488 NCCI
00140 64489 NCCI
00140 64490 NCCI
00140 64493 NCCI
00140 64505 NCCI
00140 64508 NCCI
00140 64510 NCCI
00140 64517 NCCI
00140 64520 NCCI
00140 64530 NCCI
00140 64550 NCCI
00140 64553 NCCI
00140 64555 NCCI
00140 64565 NCCI
00140 67500 NCCI
00140 76000 NCCI
Comprehensive ComponentCode Code Source
00140 76001 NCCI
00140 76998 NCCI
00140 77002 NCCI
00140 81000 NCCI
00140 81002 NCCI
00140 81003 NCCI
00140 81005 NCCI
00140 81015 NCCI
00140 82013 NCCI
00140 90865 NCCI
00140 92100 NCCI
00140 92511 NCCI
00140 92512 NCCI
00140 92516 NCCI
00140 92520 NCCI
00140 92543 NCCI
00140 92950 NCCI
00140 92953 NCCI
00140 92960 NCCI
00140 92961 NCCI
00140 93000 NCCI
00140 93005 NCCI
00140 93010 NCCI
00140 93040 NCCI
00140 93041 NCCI
00140 93042 NCCI
00140 93303 NCCI
00140 93304 NCCI
00140 93306 NCCI
00140 93307 NCCI
00140 93308 NCCI
00140 93312 NCCI
00140 93313 NCCI
00140 93314 NCCI
00140 93315 NCCI
00140 93316 NCCI
00140 93317 NCCI
00140 93318 NCCI
00140 93351 NCCI
00140 93355 NCCI
00140 93451 NCCI
00140 93456 NCCI
00140 93457 NCCI
00140 93561 NCCI
00140 93562 NCCI
00140 93701 NCCI
00140 93922 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 24 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00140 93923 NCCI
00140 93924 NCCI
00140 93925 NCCI
00140 93926 NCCI
00140 93930 NCCI
00140 93931 NCCI
00140 93965 NCCI
00140 93970 NCCI
00140 93971 NCCI
00140 93975 NCCI
00140 93976 NCCI
00140 93978 NCCI
00140 93979 NCCI
00140 93980 NCCI
00140 93981 NCCI
00140 94002 NCCI
00140 94004 NCCI
00140 94200 NCCI
00140 94250 NCCI
00140 94640 NCCI
00140 94644 NCCI
00140 94660 NCCI
00140 94662 NCCI
00140 94680 NCCI
00140 94681 NCCI
00140 94690 NCCI
00140 94760 NCCI
00140 94761 NCCI
00140 94762 NCCI
00140 94770 NCCI
00140 95812 NCCI
00140 95813 NCCI
00140 95816 NCCI
00140 95819 NCCI
00140 95822 NCCI
00140 95829 NCCI
00140 95955 NCCI
00140 95956 NCCI
00140 95957 NCCI
00140 96360 NCCI
00140 96365 NCCI
00140 96372 NCCI
00140 96373 NCCI
00140 96374 NCCI
00140 96375 NCCI
00140 96376 NCCI
00140 99143 NCCI
Comprehensive ComponentCode Code Source
00140 99144 NCCI
00140 99145 NCCI
00140 99148 NCCI
00140 99149 NCCI
00140 99150 NCCI
00140 99201 NCCI
00140 99202 NCCI
00140 99203 NCCI
00140 99204 NCCI
00140 99205 NCCI
00140 99211 NCCI
00140 99212 NCCI
00140 99213 NCCI
00140 99214 NCCI
00140 99215 NCCI
00140 99217 NCCI
00140 99218 NCCI
00140 99219 NCCI
00140 99220 NCCI
00140 99221 NCCI
00140 99222 NCCI
00140 99223 NCCI
00140 99224 NCCI
00140 99225 NCCI
00140 99226 NCCI
00140 99231 NCCI
00140 99232 NCCI
00140 99233 NCCI
00140 99234 NCCI
00140 99235 NCCI
00140 99236 NCCI
00140 99238 NCCI
00140 99239 NCCI
00140 99241 Retained NCCI
00140 99242 Retained NCCI
00140 99243 Retained NCCI
00140 99244 Retained NCCI
00140 99245 Retained NCCI
00140 99251 Retained NCCI
00140 99252 Retained NCCI
00140 99253 Retained NCCI
00140 99254 Retained NCCI
00140 99255 Retained NCCI
00140 99281 NCCI
00140 99282 NCCI
00140 99283 NCCI
00140 99284 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 25 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00140 99285 NCCI
00140 99304 NCCI
00140 99305 NCCI
00140 99306 NCCI
00140 99307 NCCI
00140 99308 NCCI
00140 99309 NCCI
00140 99310 NCCI
00140 99315 NCCI
00140 99318 NCCI
00140 99324 NCCI
00140 99325 NCCI
00140 99326 NCCI
00140 99327 NCCI
00140 99328 NCCI
00140 99334 NCCI
00140 99335 NCCI
00140 99336 NCCI
00140 99337 NCCI
00140 99341 NCCI
00140 99342 NCCI
00140 99343 NCCI
00140 99347 NCCI
00140 99348 NCCI
00140 99349 NCCI
00140 99354 NCCI
00140 99355 NCCI
00140 99356 NCCI
00140 99357 NCCI
00140 99446 NCCI
00140 99447 NCCI
00140 99448 NCCI
00140 99449 NCCI
00140 99466 NCCI
00140 99468 NCCI
00140 99469 NCCI
00140 99471 NCCI
00140 99472 NCCI
00140 99475 NCCI
00140 99476 NCCI
00140 99477 NCCI
00140 99478 NCCI
00140 99479 NCCI
00140 99480 NCCI
00140 99485 NCCI
00140 99497 NCCI
00140 C8921 NCCI
Comprehensive ComponentCode Code Source
00140 C8922 NCCI
00140 C8923 NCCI
00140 C8924 NCCI
00140 C8925 NCCI
00140 C8926 NCCI
00140 C8927 NCCI
00140 C8929 NCCI
00140 C8930 NCCI
00140 G0380 NCCI
00140 G0381 NCCI
00140 G0382 NCCI
00140 G0383 NCCI
00140 G0384 NCCI
00140 G0406 NCCI
00140 G0407 NCCI
00140 G0408 NCCI
00140 G0425 NCCI
00140 G0426 NCCI
00140 G0427 NCCI
00140 G0463 NCCI
00140 G6043 NCCI
00142 0178T NCCI
00142 0179T NCCI
00142 0180T NCCI
00142 01996 NCCI
00142 0213T NCCI
00142 0216T NCCI
00142 0228T NCCI
00142 0230T NCCI
00142 0282T NCCI
00142 0283T NCCI
00142 0311T NCCI
00142 0329T NCCI
00142 31505 NCCI
00142 31515 NCCI
00142 31527 NCCI
00142 31622 NCCI
00142 31634 NCCI
00142 31645 NCCI
00142 31647 NCCI
00142 36000 NCCI
00142 36010 NCCI
00142 36011 NCCI
00142 36012 NCCI
00142 36013 NCCI
00142 36014 NCCI
00142 36015 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 26 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00142 36400 NCCI
00142 36405 NCCI
00142 36406 NCCI
00142 36410 NCCI
00142 36420 NCCI
00142 36425 NCCI
00142 36430 NCCI
00142 36440 NCCI
00142 36600 NCCI
00142 36640 NCCI
00142 43752 NCCI
00142 43753 NCCI
00142 43754 NCCI
00142 61026 NCCI
00142 61055 NCCI
00142 62280 NCCI
00142 62281 NCCI
00142 62282 NCCI
00142 62284 NCCI
00142 62310 NCCI
00142 62311 NCCI
00142 62318 NCCI
00142 62319 NCCI
00142 64402 NCCI
00142 64405 NCCI
00142 64408 NCCI
00142 64410 NCCI
00142 64412 NCCI
00142 64413 NCCI
00142 64415 NCCI
00142 64416 NCCI
00142 64417 NCCI
00142 64418 NCCI
00142 64420 NCCI
00142 64421 NCCI
00142 64425 NCCI
00142 64430 NCCI
00142 64435 NCCI
00142 64445 NCCI
00142 64446 NCCI
00142 64447 NCCI
00142 64448 NCCI
00142 64449 NCCI
00142 64450 NCCI
00142 64479 NCCI
00142 64483 NCCI
00142 64486 NCCI
Comprehensive ComponentCode Code Source
00142 64487 NCCI
00142 64488 NCCI
00142 64489 NCCI
00142 64490 NCCI
00142 64493 NCCI
00142 64505 NCCI
00142 64508 NCCI
00142 64510 NCCI
00142 64517 NCCI
00142 64520 NCCI
00142 64530 NCCI
00142 64550 NCCI
00142 64553 NCCI
00142 64555 NCCI
00142 64565 NCCI
00142 67500 NCCI
00142 76000 NCCI
00142 76001 NCCI
00142 76998 NCCI
00142 77002 NCCI
00142 81000 NCCI
00142 81002 NCCI
00142 81003 NCCI
00142 81005 NCCI
00142 81015 NCCI
00142 82013 NCCI
00142 90865 NCCI
00142 92100 NCCI
00142 92511 NCCI
00142 92512 NCCI
00142 92516 NCCI
00142 92520 NCCI
00142 92543 NCCI
00142 92950 NCCI
00142 92953 NCCI
00142 92960 NCCI
00142 92961 NCCI
00142 93000 NCCI
00142 93005 NCCI
00142 93010 NCCI
00142 93040 NCCI
00142 93041 NCCI
00142 93042 NCCI
00142 93303 NCCI
00142 93304 NCCI
00142 93306 NCCI
00142 93307 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 27 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00142 93308 NCCI
00142 93312 NCCI
00142 93313 NCCI
00142 93314 NCCI
00142 93315 NCCI
00142 93316 NCCI
00142 93317 NCCI
00142 93318 NCCI
00142 93351 NCCI
00142 93355 NCCI
00142 93451 NCCI
00142 93456 NCCI
00142 93457 NCCI
00142 93561 NCCI
00142 93562 NCCI
00142 93701 NCCI
00142 93922 NCCI
00142 93923 NCCI
00142 93924 NCCI
00142 93925 NCCI
00142 93926 NCCI
00142 93930 NCCI
00142 93931 NCCI
00142 93965 NCCI
00142 93970 NCCI
00142 93971 NCCI
00142 93975 NCCI
00142 93976 NCCI
00142 93978 NCCI
00142 93979 NCCI
00142 93980 NCCI
00142 93981 NCCI
00142 94002 NCCI
00142 94004 NCCI
00142 94200 NCCI
00142 94250 NCCI
00142 94640 NCCI
00142 94644 NCCI
00142 94660 NCCI
00142 94662 NCCI
00142 94680 NCCI
00142 94681 NCCI
00142 94690 NCCI
00142 94760 NCCI
00142 94761 NCCI
00142 94762 NCCI
00142 94770 NCCI
Comprehensive ComponentCode Code Source
00142 95812 NCCI
00142 95813 NCCI
00142 95816 NCCI
00142 95819 NCCI
00142 95822 NCCI
00142 95829 NCCI
00142 95955 NCCI
00142 95956 NCCI
00142 95957 NCCI
00142 96360 NCCI
00142 96365 NCCI
00142 96372 NCCI
00142 96373 NCCI
00142 96374 NCCI
00142 96375 NCCI
00142 96376 NCCI
00142 99143 NCCI
00142 99144 NCCI
00142 99145 NCCI
00142 99148 NCCI
00142 99149 NCCI
00142 99150 NCCI
00142 99201 NCCI
00142 99202 NCCI
00142 99203 NCCI
00142 99204 NCCI
00142 99205 NCCI
00142 99211 NCCI
00142 99212 NCCI
00142 99213 NCCI
00142 99214 NCCI
00142 99215 NCCI
00142 99217 NCCI
00142 99218 NCCI
00142 99219 NCCI
00142 99220 NCCI
00142 99221 NCCI
00142 99222 NCCI
00142 99223 NCCI
00142 99224 NCCI
00142 99225 NCCI
00142 99226 NCCI
00142 99231 NCCI
00142 99232 NCCI
00142 99233 NCCI
00142 99234 NCCI
00142 99235 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 28 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00142 99236 NCCI
00142 99238 NCCI
00142 99239 NCCI
00142 99241 Retained NCCI
00142 99242 Retained NCCI
00142 99243 Retained NCCI
00142 99244 Retained NCCI
00142 99245 Retained NCCI
00142 99251 Retained NCCI
00142 99252 Retained NCCI
00142 99253 Retained NCCI
00142 99254 Retained NCCI
00142 99255 Retained NCCI
00142 99281 NCCI
00142 99282 NCCI
00142 99283 NCCI
00142 99284 NCCI
00142 99285 NCCI
00142 99304 NCCI
00142 99305 NCCI
00142 99306 NCCI
00142 99307 NCCI
00142 99308 NCCI
00142 99309 NCCI
00142 99310 NCCI
00142 99315 NCCI
00142 99318 NCCI
00142 99324 NCCI
00142 99325 NCCI
00142 99326 NCCI
00142 99327 NCCI
00142 99328 NCCI
00142 99334 NCCI
00142 99335 NCCI
00142 99336 NCCI
00142 99337 NCCI
00142 99341 NCCI
00142 99342 NCCI
00142 99343 NCCI
00142 99347 NCCI
00142 99348 NCCI
00142 99349 NCCI
00142 99354 NCCI
00142 99355 NCCI
00142 99356 NCCI
00142 99357 NCCI
00142 99446 NCCI
Comprehensive ComponentCode Code Source
00142 99447 NCCI
00142 99448 NCCI
00142 99449 NCCI
00142 99466 NCCI
00142 99468 NCCI
00142 99469 NCCI
00142 99471 NCCI
00142 99472 NCCI
00142 99475 NCCI
00142 99476 NCCI
00142 99477 NCCI
00142 99478 NCCI
00142 99479 NCCI
00142 99480 NCCI
00142 99485 NCCI
00142 99497 NCCI
00142 C8921 NCCI
00142 C8922 NCCI
00142 C8923 NCCI
00142 C8924 NCCI
00142 C8925 NCCI
00142 C8926 NCCI
00142 C8927 NCCI
00142 C8929 NCCI
00142 C8930 NCCI
00142 G0380 NCCI
00142 G0381 NCCI
00142 G0382 NCCI
00142 G0383 NCCI
00142 G0384 NCCI
00142 G0406 NCCI
00142 G0407 NCCI
00142 G0408 NCCI
00142 G0425 NCCI
00142 G0426 NCCI
00142 G0427 NCCI
00142 G0463 NCCI
00142 G6043 NCCI
00144 0178T NCCI
00144 0179T NCCI
00144 0180T NCCI
00144 01996 NCCI
00144 0213T NCCI
00144 0216T NCCI
00144 0228T NCCI
00144 0230T NCCI
00144 0282T NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 29 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00144 0283T NCCI
00144 0311T NCCI
00144 31505 NCCI
00144 31515 NCCI
00144 31527 NCCI
00144 31622 NCCI
00144 31634 NCCI
00144 31645 NCCI
00144 31647 NCCI
00144 36000 NCCI
00144 36010 NCCI
00144 36011 NCCI
00144 36012 NCCI
00144 36013 NCCI
00144 36014 NCCI
00144 36015 NCCI
00144 36400 NCCI
00144 36405 NCCI
00144 36406 NCCI
00144 36410 NCCI
00144 36420 NCCI
00144 36425 NCCI
00144 36430 NCCI
00144 36440 NCCI
00144 36600 NCCI
00144 36640 NCCI
00144 43752 NCCI
00144 43753 NCCI
00144 43754 NCCI
00144 61026 NCCI
00144 61055 NCCI
00144 62280 NCCI
00144 62281 NCCI
00144 62282 NCCI
00144 62284 NCCI
00144 62310 NCCI
00144 62311 NCCI
00144 62318 NCCI
00144 62319 NCCI
00144 64400 NCCI
00144 64402 NCCI
00144 64405 NCCI
00144 64408 NCCI
00144 64410 NCCI
00144 64412 NCCI
00144 64413 NCCI
00144 64415 NCCI
Comprehensive ComponentCode Code Source
00144 64416 NCCI
00144 64417 NCCI
00144 64418 NCCI
00144 64420 NCCI
00144 64421 NCCI
00144 64425 NCCI
00144 64430 NCCI
00144 64435 NCCI
00144 64445 NCCI
00144 64446 NCCI
00144 64447 NCCI
00144 64448 NCCI
00144 64449 NCCI
00144 64450 NCCI
00144 64479 NCCI
00144 64483 NCCI
00144 64486 NCCI
00144 64487 NCCI
00144 64488 NCCI
00144 64489 NCCI
00144 64490 NCCI
00144 64493 NCCI
00144 64505 NCCI
00144 64508 NCCI
00144 64510 NCCI
00144 64517 NCCI
00144 64520 NCCI
00144 64530 NCCI
00144 64550 NCCI
00144 64553 NCCI
00144 64555 NCCI
00144 64565 NCCI
00144 67500 NCCI
00144 76000 NCCI
00144 76001 NCCI
00144 76998 NCCI
00144 77002 NCCI
00144 81000 NCCI
00144 81002 NCCI
00144 81003 NCCI
00144 81005 NCCI
00144 81015 NCCI
00144 82013 NCCI
00144 90865 NCCI
00144 92511 NCCI
00144 92512 NCCI
00144 92516 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 30 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00144 92520 NCCI
00144 92543 NCCI
00144 92950 NCCI
00144 92953 NCCI
00144 92960 NCCI
00144 92961 NCCI
00144 93000 NCCI
00144 93005 NCCI
00144 93010 NCCI
00144 93040 NCCI
00144 93041 NCCI
00144 93042 NCCI
00144 93303 NCCI
00144 93304 NCCI
00144 93306 NCCI
00144 93307 NCCI
00144 93308 NCCI
00144 93312 NCCI
00144 93313 NCCI
00144 93314 NCCI
00144 93315 NCCI
00144 93316 NCCI
00144 93317 NCCI
00144 93318 NCCI
00144 93351 NCCI
00144 93355 NCCI
00144 93451 NCCI
00144 93456 NCCI
00144 93457 NCCI
00144 93561 NCCI
00144 93562 NCCI
00144 93701 NCCI
00144 93922 NCCI
00144 93923 NCCI
00144 93924 NCCI
00144 93925 NCCI
00144 93926 NCCI
00144 93930 NCCI
00144 93931 NCCI
00144 93965 NCCI
00144 93970 NCCI
00144 93971 NCCI
00144 93975 NCCI
00144 93976 NCCI
00144 93978 NCCI
00144 93979 NCCI
00144 93980 NCCI
Comprehensive ComponentCode Code Source
00144 93981 NCCI
00144 94002 NCCI
00144 94004 NCCI
00144 94200 NCCI
00144 94250 NCCI
00144 94640 NCCI
00144 94644 NCCI
00144 94660 NCCI
00144 94662 NCCI
00144 94680 NCCI
00144 94681 NCCI
00144 94690 NCCI
00144 94760 NCCI
00144 94761 NCCI
00144 94762 NCCI
00144 94770 NCCI
00144 95812 NCCI
00144 95813 NCCI
00144 95816 NCCI
00144 95819 NCCI
00144 95822 NCCI
00144 95829 NCCI
00144 95955 NCCI
00144 95956 NCCI
00144 95957 NCCI
00144 96360 NCCI
00144 96365 NCCI
00144 96372 NCCI
00144 96373 NCCI
00144 96374 NCCI
00144 96375 NCCI
00144 96376 NCCI
00144 99143 NCCI
00144 99144 NCCI
00144 99145 NCCI
00144 99148 NCCI
00144 99149 NCCI
00144 99150 NCCI
00144 99201 NCCI
00144 99202 NCCI
00144 99203 NCCI
00144 99204 NCCI
00144 99205 NCCI
00144 99211 NCCI
00144 99212 NCCI
00144 99213 NCCI
00144 99214 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 31 of 976
-
Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00144 99215 NCCI
00144 99217 NCCI
00144 99218 NCCI
00144 99219 NCCI
00144 99220 NCCI
00144 99221 NCCI
00144 99222 NCCI
00144 99223 NCCI
00144 99224 NCCI
00144 99225 NCCI
00144 99226 NCCI
00144 99231 NCCI
00144 99232 NCCI
00144 99233 NCCI
00144 99234 NCCI
00144 99235 NCCI
00144 99236 NCCI
00144 99238 NCCI
00144 99239 NCCI
00144 99241 Retained NCCI
00144 99242 Retained NCCI
00144 99243 Retained NCCI
00144 99244 Retained NCCI
00144 99245 Retained NCCI
00144 99251 Retained NCCI
00144 99252 Retained NCCI
00144 99253 Retained NCCI
00144 99254 Retained NCCI
00144 99255 Retained NCCI
00144 99281 NCCI
00144 99282 NCCI
00144 99283 NCCI
00144 99284 NCCI
00144 99285 NCCI
00144 99304 NCCI
00144 99305 NCCI
00144 99306 NCCI
00144 99307 NCCI
00144 99308 NCCI
00144 99309 NCCI
00144 99310 NCCI
00144 99315 NCCI
00144 99318 NCCI
00144 99324 NCCI
00144 99325 NCCI
00144 99326 NCCI
00144 99327 NCCI
Comprehensive ComponentCode Code Source
00144 99328 NCCI
00144 99334 NCCI
00144 99335 NCCI
00144 99336 NCCI
00144 99337 NCCI
00144 99341 NCCI
00144 99342 NCCI
00144 99343 NCCI
00144 99347 NCCI
00144 99348 NCCI
00144 99349 NCCI
00144 99354 NCCI
00144 99355 NCCI
00144 99356 NCCI
00144 99357 NCCI
00144 99446 NCCI
00144 99447 NCCI
00144 99448 NCCI
00144 99449 NCCI
00144 99466 NCCI
00144 99468 NCCI
00144 99469 NCCI
00144 99471 NCCI
00144 99472 NCCI
00144 99475 NCCI
00144 99476 NCCI
00144 99477 NCCI
00144 99478 NCCI
00144 99479 NCCI
00144 99480 NCCI
00144 99485 NCCI
00144 99497 NCCI
00144 C8921 NCCI
00144 C8922 NCCI
00144 C8923 NCCI
00144 C8924 NCCI
00144 C8925 NCCI
00144 C8926 NCCI
00144 C8927 NCCI
00144 C8929 NCCI
00144 C8930 NCCI
00144 G0380 NCCI
00144 G0381 NCCI
00144 G0382 NCCI
00144 G0383 NCCI
00144 G0384 NCCI
00144 G0406 NCCI
CPT® is a registered trademark of the American Medical AssociationCurrent Dental Terminology © 2004 American Dental Association
Code bundling rules subject to additions, deletions, and/or revisions on a quarterly basis.
Print Date: 3/2/2015 BlueCross BlueShield of Tennessee-Coding Bundling Rules Page 32 of 976
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Effective Date of Service: 4/1/2015
BlueCross BlueShield of TennesseeCommercial Code Bundling Rules
Comprehensive ComponentCode Code Source
00144 G0407 NCCI
00144 G0408 NCCI
00144 G0425 NCCI
00144 G0426 NCCI
00144 G0427 NCCI
00144 G0463 NCCI
00144 G6043 NCCI
00145 0178T NCCI
00145 0179T NCCI
00145 0180T NCCI
00145 01996 NCCI
00145 0213T NCCI
00145 0216T NCCI
00145 0228T NCCI
00145 0230T NCCI
00145 0282T NCCI
00145 0283T NCCI
00145 0311T NCCI
00145 31505 NCCI
00145 31515 NCCI
00145 31527 NCCI
00145 31622 NCCI
00145 31634 NCCI
00145 31645 NCCI
00145 31647 NCCI
00145 36000 NCCI
00145 36010 NCCI
00145 36011 NCCI
00145 36012 NCCI
00145 36013 NCCI
00145 36014 NCCI
00145 36015 NCCI
00145 36400 NCCI
00145 36405 NCCI
00145 36406 NCCI
00145 36410 NCCI
00145 36420 NCCI
00145 36425 NCCI
00145 36430 NCCI
00145 36440 NCCI
00145 36600 NCCI
00145 36640 NCCI
00145 43752 NCCI
00145 43753 NCCI
00145 43754 NCCI
00145 61026 NCCI
00145 61055 NCCI
Comprehensive ComponentCode Code Source
00145 62280 NCCI
00145 62281 NCCI
00145 62282 NCCI
00145 62284 NCCI
00145 62310 NCCI
00145 62311 NCCI
00145 62318 NCCI
00145 62319 NCCI
00145 64400 NCCI
00145 64402 NCCI
00145 64405 NCCI
00145 64408 NCCI
00145 64410 NCCI
00145 64412 NCCI
00145 64413 NCCI
00145 64415 NCCI
00145 64416 NCCI
00145 64417 NCCI
00145 64418 NCCI
00145 64420 NCCI
00145 64421 NCCI
00145 64425 NCCI
00145 64430 NCCI
00145 64435 NCCI
00145 64445 NCCI
00145 64446 NCCI
00145 64447 NCCI
00145 64448 NCCI
00145 64449 NCCI
00145 64450 NCCI
00145 64479 NCCI
00145 64483 NCCI
00145 64486 NCCI
00145 64487 NCCI
00145 64488 NCCI
00145 64489 NCCI
00145 64490 NCCI
00145 64493 NCCI
00145 64505 NCCI
00145 64508 NCCI
00145 64510 NCCI
00145 64517 NCCI