modifiers - aapc...transnasal diagnostic specimen collection 43197 with biopsy 43198 transoral...

CPT® ModifiersModifier Description

22 Increased Procedural Services23 Unusual Anesthesia24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a

Postoperative Period25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care

Professional on the Same Day of the Procedure or Other Service26 Professional Component27 Multiple Outpatient Hospital E/M Encounters on the Same Date32 Mandated Services33 Preventive Services47 Anesthesia by Surgeon50 Bilateral Procedure51 Multiple Procedures52 Reduced Services53 Discontinued Procedure54 Surgical Care Only55 Postoperative Management Only56 Preoperative Management Only57 Decision for Surgery58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period59 Distinct Procedural Service62 Two Surgeons63 Procedure Performed on Infants less than 4 kg66 Surgical Team73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following

Initial Procedure for a Related Procedure During the Postoperative Period79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period80 Assistant Surgeon81 Minimum Assistant Surgeon82 Assistant Surgeon (when qualified resident surgeon not available)90 Reference (Outside) Laboratory91 Repeat Clinical Diagnostic Laboratory Test92 Alternative Laboratory Platform Testing95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System96 Habilitative Services97 Rehabilitative Services99 Multiple Modifiers

Category II ModifiersModifier Description

1P Performance Measure Exclusion Modifier due to Medical Reasons2P Performance Measure Exclusion Modifier due to Patient Reasons3P Performance Measure Exclusion Modifier due to System Reasons8P Performance Measure Reporting Modifier - Action Not Performed, Reason Not Otherwise Specified

HCPCS ModifiersModifier Description

A1 Dressing for one woundA2 Dressing for two woundsA3 Dressing for three woundsA4 Dressing for four woundsA5 Dressing for five woundsA6 Dressing for six woundsA7 Dressing for seven woundsA8 Dressing for eight woundsA9 Dressing for nine or more woundsAA Anesthesia services performed

personally by anesthesiologistAD Medical supervision by a physician:

more than four concurrent anesthesia procedures

Modifier DescriptionAE Registered dieticianAF Specialty physicianAG Primary physicianAH Clinical psychologistAI Principal physician of recordAJ Clinical social workerAK Non participating physicianAM Physician, team member serviceAO Alternate payment method declined

by provider of serviceAP Determination of refractive state

was not performed in the course of diagnostic ophthalmological examination

Modifier DescriptionAQ Physician providing a service in

an unlisted health professional shortage area (HPSA)

AR Physician provider services in a physician scarcity area

AS Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery

AT Acute treatment (this modifier should be used when reporting service 98940, 98941, 98942)

AU Item furnished in conjunction with a urological, ostomy, or tracheostomy supply

Table of ContentsIntroduction

y Features, Symbols, and Conventions �� 3

Instructions for Using This Manual � � � � � �4

Anatomical Illustrations� � � � � � � � � � � � � � � �5

New/Revised/Deleted Codes Advice for 2020 � � � � � � � � � � � � � � � � � � � � � � � � � � � �41

CPT® Modifiers, Definitions, and Tips � � �97

HCPCS Modifiers, Definitions, and Tips� � � � � � � � � � � � � � � � � � � � � � � � � � �109

Index � � � � � � � � � � � � � � � � � � � � � � � � � � � � �177

Code Chapters � � � � � � � � � � � � � � � � � � � � �441

y Evaluation and Management Services �� 441

y Anesthesia�� 471

y Surgery

§ Surgery/General �� 491§ Surgery/Integumentary System �� 493§ Surgery/Musculoskeletal System �� 533§ Surgery/Respiratory System �� 671§ Surgery/Cardiovascular System �� 695§ Surgery/Hemic and Lymphatic

Systems �� 757§ Surgery/Mediastinum and Diaphragm�� 763§ Surgery/Digestive System �� 765§ Surgery/Urinary System �� 829§ Surgery/Male Genital System �� 855§ Surgery/Reproductive System �� 867§ Surgery/Intersex Surgery �� 869§ Surgery/Female Genital System �� 871§ Surgery/Maternity Care and Delivery �� 889§ Surgery/Endocrine System �� 895§ Surgery/Nervous System �� 899

§ Surgery/Eye and Ocular Adnexa �� 939§ Surgery/Auditory System �� 963§ Surgery/Operating Microscope �� 971

y Radiology Procedures �� 973

y Pathology and Laboratory Procedures �� 1021

y Medicine Services and Procedures ��1135

y Category II Codes �� 1223

y Category III Codes �� 1243

y Multianalyte Assays �� 1269

y Proprietary Laboratory Analyses �� 1271

Appendices

y Appendix A: New, Revised, and Deleted Codes for 2020 �� 1283

y Appendix B: Crosswalks for Deleted Codes �� 1285

y Appendix C: Inpatient-Only Procedure Codes �� 1287

y Appendix D: Category II Modifiers�� 1293

y Appendix E: HCPCS Level II Modifiers �� 1295

y Appendix F: Resequenced CPT® Codes �� 1303

y Appendix G: Vascular Families for Interventional Radiology Coding �� 1305

y Appendix H: Modifier 51 Exempt, Modifier 63 Exempt, and Add-On Codes ��1311

y Appendix I: Brand-Name and Generic Vaccinations Associated With CPT® Codes �� 1313

y Appendix J: Place of Service/Type of Service �� 1315

y Appendix K: Drug Class List�� 1319

y Appendix L: APC Status Indicators �� 1337

y Appendix M: ASC Payment Indicators �� 1339

17

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Ation

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Anatomical illustrations

Title: Skin layers.png, Author: Madhero88, Source: Own work, License/Permission: This file is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported license., URL link: https://commons.wikimedia.org/wiki/File:Skin_layers.png

18

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Anatomical illustrations

177CPT® is a registered trademark of the American Medical Association. All rights reserved.

IND

EXA

(Vitamin A

) — A

bdomen or A

bdominal, X-ray

Index

AA (Vitamin A) 84590

A-II (Angiotensin II) 82163

Ab Externo Trabeculectomy (AET) 65850

Abbe-Estlander Reconstruction Procedure

Lip Excision 40527Plastic Repair With Sectioning and

Inserting Pedicle 40761

Abdomen or AbdominalAbscess Incision and Drainage

Peritoneal 49020Retroperitoneal 49060Subphrenic 49040

Anesthesia, See Anesthesia, AbdomenAngiography

CT With Contrast Material 74174, 74175, 75635

Magnetic Resonance (MRA) 74185Aorta

Angiography 75635Aortography 75625, 75630Thromboendarterectomy 35331

Aortic AneurysmEndovascular 34701-34708

Device Placement 34808Open Repair 34832, 34841-34848,

35081-35103Prosthesis or Graft 34813, 34820,

34709-34711Exposure 34812

Infrarenal Repair 34830, 34831, 34832Open Exposure 34833, 34834Screening Ultrasound 76706

Biopsy During Exploratory Laparotomy 49000

Blood Vessel RepairDirect 35221With Graft 35281With Vein Graft 35251

Bypass Graft Removal (Infected) 35907Catheter (Tunneled) Removal 49422Celiotomy, See LaparotomyCesarean Section Delivery

Delivery Only 59514, 59620Delivery With Postpartum Care 59515,

59622Routine Obstetric Care 59510, 59618With Hysterectomy 59525With Tubal Ligation 58611

CT ScanWith Contrast 74160, 74174, 74175,

74177, 75635Without Contrast 74150, 74170, 74176,

74178Drainage

ParacentesisWith Imaging Guidance 49083Without Imaging Guidance 49082

Peripancreatic 48000Skin and Subcutaneous Tissue 10060,

10061Ectopic Pregnancy, Surgical Treatment

59130Excision/Destruction

Cyst5 cm Diameter or Less 492035.1-10.0 cm Diameter 49204Greater Than 10.0 cm Diameter 49205

Endometrioma 49203, 49204, 49205Tumor

Intraabdominal5 cm or Less 492035.1-10.0 cm Diameter 49204Greater Than 10.0 cm 49205

Radical Resection5 cm and Greater 22905Less Than 5 cm 22904

Subcutaneous (Abdominal Wall)3 cm and Greater 22903Less Than 3 cm 22902

Subfascial (Abdominal Wall)5 cm and Greater 22901Less Than 5 cm 22900

ExplorationPost-operative Hemorrhage 35840Preperitoneal Pelvic Packing 49013, 49014Reopening of Recent Laparotomy 49010Staging/Restaging 49220, 58960With or Without Biopsy 49000

Fascia Reinforcement with Nonbiologic or Synthetic Implant 0437T

Hernia RepairEpigastric 49570, 49572Inguinal

5 Years or Older 49505, 49507, 49520, 49521, 49525

Laparoscopic 49650, 496516 Months to Less Than 5 Years 49500,

49501Less Than 6 Months of Age 49491,

49492, 49495, 49496Omphalocele 49600, 49605, 49606,

49610, 49611Spigelian 49590Umbilical

5 Years or Older 49585, 49587Less Than 5 Years 49580, 49582

Ventral or Incisional 49560, 49561, 49565, 49566

With Mesh Implantation 49568Hysterectomy (With or Without Salpingo-

oophorectomy)Radical 58210Supracervical 58180Total (TAH) 58150

Colpourethrocystopexy 58152Omentectomy 58956Partial Vaginectomy 58200

With Resection of Ovarian Malignancy 58951, 58953, 58954, 58956

Incision Procedures, See Also LaparotomyDrainage 49020, 49040, 49060, 49062

Exploration 49000, 49010Paracentesis 49082, 49083Peritoneal Lavage 49084Reopening, Recent 49002Staging/Restaging 49220With or Without Omentectomy 58960

Injection, Air or Contrast Material 49400Intraperitoneal

Tunneled CatheterExit Site 49436Insertion 49418, 49419, 49421, 49435Removal 49422Revision 49325

Venous ShuntInsertion 49425Ligation 49428Removal 49429Revision 49426

LaparoscopySurgical 49321, 49322, 49323, 49324,

49325, 49326, 49327Unlisted Procedure 49329Without Treatment 49320

Laparotomy, See Also Exploratory Laparotomy, Abdomen

Reopening, Recent 49002Staging 49220, 58960

Ligation, Artery 37617Lymphadenectomy (Removal) 49220Lymphangiogram/Lymphangiography

75805, 75807Injection 38790

Magnetic Resonance Imaging (MRI)With Contrast Material 74182Without Contrast Material 74181

Followed With Contrast Material 74183Needle Biopsy (Percutaneous) 49180Nonbiologic or Synthetic Implant 0437TPanniculectomy, Infraumbilical 15830Paracentesis

With Imaging Guidance 49083Without Imaging Guidance 49082

Pelvic Exenteration (Radical Resection) 51597

Peritoneal Venous Shunt Revision 49426Radiation Therapy Guidance Device

Placement 49411, 49412Radiography/Imaging

CT 74150-74178MRI 74181, 74182, 74183, 74185Peritoneogram 74190Ultrasound 76700, 76705X-ray 74018-74022

Removal, Mesh/Prosthetic Material 11008Suture, Secondary 49900Ultrasound

Complete 76700Limited 76705

Unlisted Procedure 49999Wall Debridement for Infection 11005,

11006Wound (Penetrating) Exploration 20102X-ray, Radiologic Exam 74018-74022

Esophagorrhaphy (Suture) Established Patient, Emergency Department ServicesINDEX

CPT® is a registered trademark of the American Medical Association. All rights reserved.248

IND

EXEs

opha

gorr

haph

y (S

utur

e) —

Est

ablis

hed

Pati

ent,

Emer

genc

y D

epar

tmen

t Ser

vice

s Esophagorrhaphy (Suture) 43405, 43410, 43415

EsophagoscopyTransnasal

DiagnosticSpecimen Collection 43197With Biopsy 43198

TransoralAblation Lesion/Polyp/Tumor 43229Band Ligation Varices 43205Biopsy

Needle 43232Single/Multiple 43193, 43198, 43202

Diagnostic 43191, 43200Dilation

Balloon 43195, 43214, 43220, 43233With Ablation, Polyps/Tumors/Other

Lesions 43229With Guidewire Insertion 43196, 43226With Stent Placement 43212

InjectionDirected, Submucosal 43192, 43201Sclerosis, Esophageal Varices 43204

Insertion Guidewire 43196, 43212, 43226, 43229

RemovalForeign Body 43194, 43215Polyp/Tumor/Other Lesions 43216,

43217, 43229Specimen Collection 43191, 43200Stent 43212Ultrasound

Endoscopic Examination 43231Guided Needle Aspiration/Biopsy 43232

With Band Ligation 43205With Control of Bleeding 43277With Cricopharyngeal Myotomy 43180With Diverticulectomy 43180With Mucosal Resection 43211With Optical Endomicroscopy 43206

EsophagostomyClosure

Cervical Approach 43420Transabdominal Approach 43425

External FistulizationCervical Approach 43352Thoracic Approach 43351

With Esophagectomy, Total or Partial 43124

Esophagotomy, With Removal of Foreign Body 43020, 43045

Esophagotracheal Fistula, RepairCervical Approach 43305Thoracic Approach 43312

Congenital Defect 43314

EsophagusAblation, Lesion/Polyp/Tumor 43229Acid Perfusion (Bernstein) Test 91030Acid Reflux Tests

With Mucosal Attached Telemetry pH Electrode Analysis 91035

With Nasal CatheterIntraluminal Impedance Electrode

Analysis 91037, 91038pH Electrode Analysis 91034

BiopsyEndoscopic, Single or Multiple 43198, 43202

Needle 43232

Forceps, For GERD 3150FCricopharyngeal Myotomy 43030, 43180Diagnostic 43200Dilation 43450, 43453

EndoscopicBalloon 43195, 43214, 43220, 43233With Ablation, Polyps/Tumors/Other

Lesions 43229With EGD 43248, 43249With Guidewire Insertion 43196, 43226With Stent Placement 43212

Surgical, With Permanent Insertion, Transluminal Tube 43510

Endoscopy, See Endoscopy, Esophagus; Esophagoscopy

Esophagoscopy, See EsophagoscopyExcision

DiverticulaCervical Approach 43130Thoracic Approach 43135

Partial 43116, 43117, 43118, 43121, 43124

Total 43107, 43108, 43112, 43113, 43124Imaging Studies 91110, 91111

Motility 78258Obstructions/Strictures 74360Radiologic Examination 74210, 74220,

74221Reflux 78262Removal of Foreign Body, via Balloon

Catheter 74235Swallowing Function Cineradiography/

Videoradiography 74230Incision

Muscle, Cricopharyngeal 43030With Removal of Foreign Body 43020,

43045Injection

Sclerosis Agent 43204Submucosal 43192, 43201

InsertionIntraluminal Tube 43510Stent Placement 43212Tamponade, Sengstaken Type 43460

Lengthening Procedure (Collis or Wedge Gastroplasty) 43338

Laparoscopic 43283Lesion, Excision

Cervical Approach 43100Thoracic or Abdominal Approach 43101

Ligation or Stapling 43405Motility Study 78258, 91010

With Perfusion or Stimulation 91013Nuclear Medicine

Imaging (Motility) 78258Reflux Study 78262

Provocation Study, Balloon Distension 91040

Radiology Examination 74220, 74221Reconstruction 43300, 43310, 43313

Esophagostomy (Stoma)Cervical 43352Thoracic 43351

Gastrointestinal 43360, 43361Removal

Foreign BodyCervical 43020Esophageal, With Balloon Catheter

74235

Thoracic 43045Transoral 43194, 43215

Polyp/Tumors/Other LesionsHot Biopsy Forceps 43216Snare Technique 43217

RepairEsophagogastric Fundoplasty

Laparoscopic (Nissen, Toupet Procedures) 43280

Partial or Complete 43327, 43328With Fundic Patch 43325

Esophagogastrostomy, Transabdominal or Transthoracic 43320

EsophagojejunostomyAbdominal Approach 43340Thoracic Approach 43341

Esophagomyotomy (Heller Type), With Fundoplasty 43279

EsophagoplastyCervical Approach 43300, 43305Thoracic Approach 43310, 43312

Fistula 43305, 43312, 43314, 43420, 43425

Muscle (Heller Type Esophagomyotomy)Abdominal Approach 43330Thoracic Approach 43331With Surgical Thoracoscopy 32665

Paraesophageal HerniaLaparoscopic 43281, 43282Through Laparotomy 43332, 43333Through Thoracoabdominal Incision

43336, 43337Through Thoracotomy 43334, 43335

Pre-existing Perforation, Ligation or Stapling 43405

Wound/Injury Suture 43410, 43415Specimen of Collection 43191, 43197,

43200Sphincter

Placement, Augmentation Device 43284Removal, Augmentation Device 43285

Suture 43405Wound/Injury

Cervical Approach 43410Transthoracic Approach 43415

UltrasoundExamination 43231With Needle Aspiration/Biopsy 43232

Unlisted Esophagus Procedure 43499Laparoscopic 43289

Vein, Band Ligation 43205With Control of Bleeding 43227With Mucosal Resection 43211

Esophagus Neoplasm Ablation 43229

Esophagus, Varix, See Esophageal Varices

Established PatientCounseling, See CounselingCritical Care

Each Additional 30 Minutes 99292First 30-74 Minutes 99291

Domiciliary or Rest Home Visit 99334, 99335, 99336, 99337

Complex and Multidisciplinary Care 99339, 99340

Emergency Department Services 99281, 99282, 99283, 99284, 99285


An

esthesiA

00100 - 00162

APC APC Value ASC PI ASC Payment Indicator APC SI APC Status Indicator ASC Sep. Pay ASC Separate Payment CPT Asst CPT® Assistant Article Reference HCPCS CODE DOSAGE Dosage Amount for Drug PAYMENT LIMIT Maximum Reimbursement Amount

2019 PAYMENT WITH CAP Lab Payment for CY 2019 Including Phase-in Reduction Cap WEIGHTED MEDIAN From Market-based Payment Rates by Volume

Anesthesia for Procedures on the Head (00100-00222)00100 Anesthesia for procedures on salivary glands, including

biopsy FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QJ, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8, JUL 2012; Vol 22: Issue 7, JUL 2011; Vol 21: Issue 7, OCT 2011; Vol 21: Issue 10, NOV 2007; Vol 17: Issue 11, FEB 2006; Vol 16: Issue 2, MAR 2006; Vol 16: Issue 3, NOV 2002; Vol 12: Issue 11

00102 Anesthesia for procedures involving plastic repair of cleft lip FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00103 Anesthesia for reconstructive procedures of eyelid (eg, blepharoplasty, ptosis surgery) FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 52, 53, 59, 76, 77, 99, AA, AD, CR, E1, E2, E3, E4, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00104 Anesthesia for electroconvulsive therapy FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, H9, HK, HW, KX, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00120 Anesthesia for procedures on external, middle, and inner ear including biopsy; not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00124 Anesthesia for procedures on external, middle, and inner ear including biopsy; otoscopy G Code Crosswalk G0268FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QJ, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00126 Anesthesia for procedures on external, middle, and inner ear including biopsy; tympanotomy FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QJ, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00140 Anesthesia for procedures on eye; not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, 99, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QJ, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00142 Anesthesia for procedures on eye; lens surgery FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00144 Anesthesia for procedures on eye; corneal transplant FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00145 Anesthesia for procedures on eye; vitreoretinal surgery FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00147 Anesthesia for procedures on eye; iridectomy FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00148 Anesthesia for procedures on eye; ophthalmoscopy FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00160 Anesthesia for procedures on nose and accessory sinuses; not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00162 Anesthesia for procedures on nose and accessory sinuses; radical surgery FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

Anesthesia

AnesthesiaA

nes

thes

iA00470 - 00540

0047

0 - 0

0540


New Code Revised Code Add-On Code # Resequenced Code FDA Approval Pending Modifier 51 Exempt Modifier 63 Exempt Female-only Procedure Male-only Procedure Maternity Merit-based Incentive Payment System Code Telemedicine Code FRVU Facility Total RVU NFRVU Non-facility Total RVU GLOBAL Global Days MUE Medically Unlikely Edit MOD Modifier Crosswalk

MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00470 Anesthesia for partial rib resection; not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00472 Anesthesia for partial rib resection; thoracoplasty (any type) FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00474 Anesthesia for partial rib resection; radical procedures (eg, pectus excavatum) FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, LT, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, RT, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8, NOV 2007; Vol 17: Issue 11

Anesthesia for Intrathoracic Procedures (00500-00580)00500 Anesthesia for all procedures on esophagus

FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8, NOV 2007; Vol 17: Issue 11, MAR 2006; Vol 16: Issue 3

00520 Anesthesia for closed chest procedures; (including bronchoscopy) not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00522 Anesthesia for closed chest procedures; needle biopsy of pleura FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00524 Anesthesia for closed chest procedures; pneumocentesis FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00528 Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy not utilizing 1 lung ventilation FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00529 Anesthesia for closed chest procedures; mediastinoscopy and diagnostic thoracoscopy utilizing 1 lung ventilation FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8, JUN 2004; Vol 14: Issue 6

00530 Anesthesia for permanent transvenous pacemaker insertion FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00532 Anesthesia for access to central venous circulation FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00534 Anesthesia for transvenous insertion or replacement of pacing cardioverter-defibrillator G Code Crosswalk G0448FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00537 Anesthesia for cardiac electrophysiologic procedures including radiofrequency ablation FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00539 Anesthesia for tracheobronchial reconstruction FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8

00540 Anesthesia for thoracotomy procedures involving lungs, pleura, diaphragm, and mediastinum (including surgical thoracoscopy); not otherwise specified FRVU 0.00 NFRVU 0.00 GLOBAL XXX MOD 22, 23, 52, 53, 59, 76, 77, AA, AD, CR, ET, G8, G9, GA, GC, GJ, GR, KX, P1, P2, P3, P4, P5, P6, Q5, Q6, QK, QS, QX, QY, QZ, XE, XP, XS, XUCPT® Asst: DEC 2017; Vol 27: Issue 12, AUG 2014; Vol 24: Issue 8


Surg

ery/Integ

um

enta

ry SyStem10030 - 10081



Surgery/Integumentary SystemSurgical Procedures on the Integumentary System (10030-19499)

Surgical Procedures on the Skin, Subcutaneous and Accessory Structures (10030-11646)

Introduction and Removal (10030-10036)10030 Image-guided fluid collection drainage by catheter (eg,

abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneous FRVU 3.97 NFRVU 16.27 GLOBAL 000 MUE 2 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99, AF, AG, AQ, AR, AS, GA, GC, GZ, KX, PD, Q5, Q6, QJ, SA, XE, XP, XS, XUASC PI: G2 ASC Sep. Pay: Yes APC SI: T APC: 5071CPT® Asst: APR 2019; Vol 29: Issue 4, AUG 2017; Vol 27: Issue 8, MAY 2014; Vol 24: Issue 5, MAY 2014; Vol 24: Issue 5, NOV 2013; Vol 23: Issue 11

10035 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesion FRVU 2.48 NFRVU 13.67 GLOBAL 000 MUE 1 MOD 22, 47, 50, 51, 52, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99, AF, AG, AS, CT, GA, GC, GY, GZ, KX, LT, Q5, Q6, QJ, RT, SA, XE, XP, XS, XUASC PI: N1 ASC Sep. Pay: No APC SI: T APC: 5071CPT® Asst: JUN 2016; Vol 26: Issue 6

10036 Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure) FRVU 1.25 NFRVU 11.79 GLOBAL ZZZ MUE 2 MOD 22, 47, 52, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99, AF, AG, AS, CT, GA, GC, GY, GZ, KX, LT, Q5, Q6, QJ, RT, SA, XE, XP, XS, XUASC PI: N1 ASC Sep. Pay: No CPT® Asst: JUN 2016; Vol 26: Issue 6

Incision and Drainage Procedures on the Skin, Subcutaneous and Accessory Structures (10040-10180)10040 Acne surgery (eg, marsupialization, opening or removal of

multiple milia, comedones, cysts, pustules) FRVU 1.66 NFRVU 3.09 GLOBAL 010 MUE 1 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, CS, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: N1 ASC Sep. Pay: No APC SI: T APC: 5051CPT® Asst: FEB 2008; Vol 18: Issue 2

10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single FRVU 2.81 NFRVU 3.37 GLOBAL 010 MUE 1

MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5051CPT® Asst: SEP 2012; Vol 22: Issue 9, APR 2010; Vol 20: Issue 4, DEC 2006; Vol 16: Issue 12

Incision and Drainage of Abscess

10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple FRVU 5.16 NFRVU 5.87 GLOBAL 010 MUE 1 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5052CPT® Asst: SEP 2012; Vol 22: Issue 9, DEC 2006; Vol 16: Issue 12

10080 Incision and drainage of pilonidal cyst; simple FRVU 2.93 NFRVU 5.23 GLOBAL 010 MUE 1 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5071CPT® Asst: MAY 2007; Vol 17: Issue 5, DEC 2006; Vol 16: Issue 12

10081 Incision and drainage of pilonidal cyst; complicated FRVU 4.87 NFRVU 7.84 GLOBAL 010 MUE 1 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU

Surgery/Integumentary SystemSu

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1012

0 - 1

1008



ASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5071CPT® Asst: MAY 2007; Vol 17: Issue 5, DEC 2006; Vol 16: Issue 12

10120 Incision and removal of foreign body, subcutaneous tissues; simple FRVU 2.96 NFRVU 4.32 GLOBAL 010 MUE 3 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5052CPT® Asst: APR 2013; Vol 23: Issue 4, DEC 2013; Vol 23: Issue 12, SEP 2012; Vol 22: Issue 9, DEC 2006; Vol 16: Issue 12

10121 Incision and removal of foreign body, subcutaneous tissues; complicated FRVU 5.32 NFRVU 7.77 GLOBAL 010 MUE 2 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5072CPT® Asst: DEC 2013; Vol 23: Issue 12, SEP 2012; Vol 22: Issue 9, DEC 2006; Vol 16: Issue 12

10140 Incision and drainage of hematoma, seroma or fluid collection FRVU 3.40 NFRVU 4.77 GLOBAL 010 MUE 2 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: J1 APC: 5072CPT® Asst: NOV 2014; Vol 24: Issue 11, DEC 2006; Vol 16: Issue 12

10160 Puncture aspiration of abscess, hematoma, bulla, or cyst FRVU 2.72 NFRVU 3.70 GLOBAL 010 MUE 3 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5052CPT® Asst: MAY 2017; Vol 27: Issue 5, AUG 2017; Vol 27: Issue 8, APR 2010; Vol 20: Issue 4

10180 Incision and drainage, complex, postoperative wound infection FRVU 5.10 NFRVU 7.12 GLOBAL 010 MUE 2 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5073CPT® Asst: NOV 2014; Vol 24: Issue 11, DEC 2006; Vol 16: Issue 12

Debridement Procedures on the Skin (11000-11047)11000 Debridement of extensive eczematous or infected skin;

up to 10% of body surface FRVU 0.82 NFRVU 1.57 GLOBAL 000 MUE 1 MOD 22, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, ET, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, T1, T2, T3, T4, T5, T6, T7, T8, T9, TA, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5053CPT® Asst: FEB 2018; Vol 28: Issue 2, MAY 2011; Vol 21: Issue 5

11001 Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure) FRVU 0.41 NFRVU 0.62 GLOBAL ZZZ MUE 1 MOD 22, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, ET, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, T1, T2, T3, T4, T5, T6, T7, T8, T9, TA, XE, XP, XS, XUASC PI: N1 ASC Sep. Pay: No CPT® Asst: FEB 2018; Vol 28: Issue 2, MAY 2011; Vol 21: Issue 5

11004 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineum FRVU 16.69 NFRVU 16.69 GLOBAL 000 MUE 1 MOD 22, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUCPT® Asst: FEB 2018; Vol 28: Issue 2, OCT 2013; Vol 23: Issue 10, JAN 2012; Vol 22: Issue 1, MAY 2011; Vol 21: Issue 5

11005 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closure FRVU 22.64 NFRVU 22.64 GLOBAL 000 MUE 1 MOD 22, 52, 53, 58, 59, 76, 77, 78, 79, 80, 81, 82, AQ, AR, AS, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUCPT® Asst: FEB 2018; Vol 28: Issue 2, OCT 2013; Vol 23: Issue 10, JAN 2012; Vol 22: Issue 1, MAY 2011; Vol 21: Issue 5

11006 Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closure FRVU 20.44 NFRVU 20.44 GLOBAL 000 MUE 1 MOD 22, 51, 52, 53, 58, 59, 76, 77, 78, 79, AQ, AR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUCPT® Asst: OCT 2013; Vol 23: Issue 10, JAN 2012; Vol 22: Issue 1, MAY 2011; Vol 21: Issue 5

11008 Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure) FRVU 7.96 NFRVU 7.96 GLOBAL ZZZ MUE 1


Surg

ery/reSpirato

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Surgical Procedures on the Respiratory System (30000-32999)

Surgical Procedures on the Nose (30000-30999)

Incision Procedures on the Nose (30000-30020)30000 Drainage abscess or hematoma, nasal, internal approach

FRVU 3.37 NFRVU 6.83 GLOBAL 010 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: P2 ASC Sep. Pay: Yes APC SI: T APC: 5161

30020 Drainage abscess or hematoma, nasal septum FRVU 3.37 NFRVU 6.90 GLOBAL 010 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5162

Excision Procedures on the Nose (30100-30160)30100 Biopsy, intranasal

FRVU 1.93 NFRVU 4.00 GLOBAL 000 MUE 2 MOD 22, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: J1 APC: 5163CPT® Asst: JAN 2019; Vol 29: Issue 1

30110 Excision, nasal polyp(s), simple FRVU 3.69 NFRVU 6.65 GLOBAL 010 MUE 1 MOD 22, 47, 50, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: J1 APC: 5163

30115 Excision, nasal polyp(s), extensive FRVU 12.47 NFRVU 12.47 GLOBAL 090 MUE 1 MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164

30117 Excision or destruction (eg, laser), intranasal lesion; internal approach FRVU 9.56 NFRVU 25.65 GLOBAL 090 MUE 2 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164CPT® Asst: JUL 2019; Vol 29: Issue 7

30118 Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy) FRVU 22.14 NFRVU 22.14 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164

30120 Excision or surgical planing of skin of nose for rhinophyma FRVU 12.34 NFRVU 14.68 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164CPT® Asst: MAY 2007; Vol 17: Issue 5

30124 Excision dermoid cyst, nose; simple, skin, subcutaneous FRVU 8.19 NFRVU 8.19 GLOBAL 090 MUE 2 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: R2 ASC Sep. Pay: Yes APC SI: J1 APC: 5163

30125 Excision dermoid cyst, nose; complex, under bone or cartilage FRVU 17.57 NFRVU 17.57 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30130 Excision inferior turbinate, partial or complete, any method FRVU 11.02 NFRVU 11.02 GLOBAL 090 MUE 1 MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164CPT® Asst: MAY 2003; Vol 13: Issue 5, SEP 2001; Vol 11: Issue 9

30140 Submucous resection inferior turbinate, partial or complete, any method FRVU 5.12 NFRVU 7.92 GLOBAL 000 MUE 1 MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164CPT® Asst: MAR 2008; Vol 18: Issue 3, DEC 2004; Vol 14: Issue 12, APR 2003; Vol 13: Issue 4, MAY 2003; Vol 13: Issue 5, DEC 2002; Vol 12: Issue 12

30150 Rhinectomy; partial FRVU 22.07 NFRVU 22.07 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30160 Rhinectomy; total FRVU 22.23 NFRVU 22.23 GLOBAL 090 MUE 1 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

Surgery/respiratory System

Surgery/respiratory SystemSu

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3020

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0462



Introduction Procedures on the Nose (30200-30220)30200 Injection into turbinate(s), therapeutic

FRVU 1.66 NFRVU 3.18 GLOBAL 000 MUE 1 MOD 22, 47, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: T APC: 5162CPT® Asst: DEC 2004; Vol 14: Issue 12

30210 Displacement therapy (Proetz type) FRVU 2.82 NFRVU 4.25 GLOBAL 010 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: P3 ASC Sep. Pay: Yes APC SI: J1 APC: 5163CPT® Asst: OCT 2009; Vol 19: Issue 10

30220 Insertion, nasal septal prosthesis (button) FRVU 3.55 NFRVU 8.60 GLOBAL 010 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5163

Removal of Foreign Body Procedures on the Nose (30300-30320)30300 Removal foreign body, intranasal; office type procedure

FRVU 3.14 NFRVU 5.26 GLOBAL 010 MUE 1 MOD 22, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: N1 ASC Sep. Pay: No APC SI: S APC: 5734CPT® Asst: JAN 2012; Vol 22: Issue 1

30310 Removal foreign body, intranasal; requiring general anesthesia FRVU 5.77 NFRVU 5.77 GLOBAL 010 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5164

30320 Removal foreign body, intranasal; by lateral rhinotomy FRVU 13.03 NFRVU 13.03 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5163

Repair Procedures on the Nose (30400-30630)30400 Rhinoplasty, primary; lateral and alar cartilages and/or

elevation of nasal tip FRVU 30.98 NFRVU 30.98 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30410 Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip

FRVU 35.81 NFRVU 35.81 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30420 Rhinoplasty, primary; including major septal repair FRVU 39.42 NFRVU 39.42 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165CPT® Asst: OCT 2017; Vol 27: Issue 10, JUL 2016; Vol 26: Issue 7

30430 Rhinoplasty, secondary; minor revision (small amount of nasal tip work) FRVU 27.25 NFRVU 27.25 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30435 Rhinoplasty, secondary; intermediate revision (bony work with osteotomies) FRVU 33.79 NFRVU 33.79 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30450 Rhinoplasty, secondary; major revision (nasal tip work and osteotomies) FRVU 44.92 NFRVU 44.92 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165

30460 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only FRVU 23.51 NFRVU 23.51 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165CPT® Asst: DEC 2014; Vol 24: Issue 12

30462 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies FRVU 45.19 NFRVU 45.19 GLOBAL 090 MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: A2 ASC Sep. Pay: Yes APC SI: J1 APC: 5165CPT® Asst: DEC 2014; Vol 24: Issue 12


Ra

dio

log

y PRoced

uRes

70010 - 70220



Radiology ProceduresRadiology Procedures (70010-79999)

Diagnostic Radiology (Diagnostic Imaging) Procedures (70010-76499)

Diagnostic Radiology (Diagnostic Imaging) Procedures of the Head and Neck (70010-70559)70010 Myelography, posterior fossa, radiological supervision and

interpretation FRVU 1.73 NFRVU 1.73 GLOBAL XXX MUE 1 MOD 22, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5572CPT® Asst: DEC 2007; Vol 17: Issue 12, MAR 2005; Vol 15: Issue 3

70015 Cisternography, positive contrast, radiological supervision and interpretation FRVU 4.35 NFRVU 4.35 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5573

70030 Radiologic examination, eye, for detection of foreign body FRVU 0.83 NFRVU 0.83 GLOBAL XXX MUE 2 MOD 22, 26, 50, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70100 Radiologic examination, mandible; partial, less than 4 views FRVU 0.97 NFRVU 0.97 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70110 Radiologic examination, mandible; complete, minimum of 4 views FRVU 1.13 NFRVU 1.13 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70120 Radiologic examination, mastoids; less than 3 views per side FRVU 0.97 NFRVU 0.97 GLOBAL XXX MUE 1 MOD 22, 26, 50, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70130 Radiologic examination, mastoids; complete, minimum of 3 views per side FRVU 1.61 NFRVU 1.61 GLOBAL XXX MUE 1 MOD 22, 26, 50, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70134 Radiologic examination, internal auditory meati, complete FRVU 1.51 NFRVU 1.51 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5524

70140 Radiologic examination, facial bones; less than 3 views FRVU 0.86 NFRVU 0.86 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70150 Radiologic examination, facial bones; complete, minimum of 3 views FRVU 1.23 NFRVU 1.23 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70160 Radiologic examination, nasal bones, complete, minimum of 3 views FRVU 0.97 NFRVU 0.97 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70170 Dacryocystography, nasolacrimal duct, radiological supervision and interpretation FRVU 0.00 NFRVU 0.00 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5523

70190 Radiologic examination; optic foramina FRVU 1.03 NFRVU 1.03 GLOBAL XXX MUE 1 MOD 22, 26, 50, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70200 Radiologic examination; orbits, complete, minimum of 4 views FRVU 1.24 NFRVU 1.24 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70210 Radiologic examination, sinuses, paranasal, less than 3 views FRVU 0.89 NFRVU 0.89 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70220 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views FRVU 1.10 NFRVU 1.10 GLOBAL XXX MUE 1

Radiology ProceduresR

ad

iolo

gy

PRo

ced

uRe

s70240 - 70390

7024

0 - 7

0390



MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70240 Radiologic examination, sella turcica FRVU 0.89 NFRVU 0.89 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70250 Radiologic examination, skull; less than 4 views FRVU 1.07 NFRVU 1.07 GLOBAL XXX MUE 2 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70260 Radiologic examination, skull; complete, minimum of 4 views FRVU 1.34 NFRVU 1.34 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5522

70300 Radiologic examination, teeth; single view FRVU 0.40 NFRVU 0.40 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70310 Radiologic examination, teeth; partial examination, less than full mouth FRVU 1.06 NFRVU 1.06 GLOBAL XXX MUE 1 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5523

70320 Radiologic examination, teeth; complete, full mouth FRVU 1.53 NFRVU 1.53 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5523

70328 Radiologic examination, temporomandibular joint, open and closed mouth; unilateral FRVU 0.89 NFRVU 0.89 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70330 Radiologic examination, temporomandibular joint, open and closed mouth; bilateral FRVU 1.39 NFRVU 1.39 GLOBAL XXX MUE 1 MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521CPT® Asst: MAY 2011; Vol 21: Issue 5

70332 Temporomandibular joint arthrography, radiological supervision and interpretation FRVU 2.15 NFRVU 2.15 GLOBAL XXX MUE 2 MOD 22, 26, 50, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XU

ASC PI: N1 APC SI: S APC: 5523CPT® Asst: FEB 2007; Vol 17: Issue 2

70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) FRVU 8.86 NFRVU 8.86 GLOBAL XXX MUE 1 MOD 22, 26, 50, 51, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: Z2 APC SI: S APC: 5523CPT® Asst: AUG 2015; Vol 25: Issue 8, JUL 2001; Vol 11: Issue 7

70350 Cephalogram, orthodontic FRVU 0.53 NFRVU 0.53 GLOBAL XXX MUE 1 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521CPT® Asst: AUG 2012; Vol 22: Issue 8

70355 Orthopantogram (eg, panoramic x-ray) FRVU 0.56 NFRVU 0.56 GLOBAL XXX MUE 1 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70360 Radiologic examination; neck, soft tissue FRVU 0.85 NFRVU 0.85 GLOBAL XXX MUE 2 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70370 Radiologic examination; pharynx or larynx, including fluoroscopy and/or magnification technique FRVU 2.27 NFRVU 2.27 GLOBAL XXX MUE 1 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording FRVU 2.77 NFRVU 2.77 GLOBAL XXX MUE 1 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 96, 97, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5523CPT® Asst: JUL 2014; Vol 24: Issue 7, DEC 2004; Vol 14: Issue 12

70380 Radiologic examination, salivary gland for calculus FRVU 0.95 NFRVU 0.95 GLOBAL XXX MUE 2 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5521

70390 Sialography, radiological supervision and interpretation FRVU 2.90 NFRVU 2.90 GLOBAL XXX MUE 2 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, FX, FY, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XUASC PI: N1 APC SI: S APC: 5523

1313

90393 - 90694A

ppend

ix i Bra

nd

-na

me a

nd

Gen

eric Vaccin

ation

s asso

ciated W

ith cPt® co

des

CPT® Code

Brand-name Drug Generic Drug

90393 ACAM2000® Smallpox (Vaccinia)

90581 BioThrax® Anthrax

90585 TICE® BCGBacillus Calmette-Guerin

(BCG)

90586 TICE® BCGBacillus Calmette-Guerin

(BCG)

90619Pending FDA approval

at time of printing

Meningococcal conjugate vaccine, serogroups A, C, W, Y, quadrivalent, tetanus toxoid carrier

(MenACWY-TT)

90620 Bexsero®

Meningococcal recombinant protein and outer membrane vesicle, serogroup B (MenB-4C)

90621 Trumenba®Meningococcal

recombinant lipoprotein, serogroup B (MenB-FHbp)

90625 Vaxchora® Cholera

90630Fluzone® Intradermal

QuadrivalentInfluenza virus

90632Havrix®

Hepatitis A (HepA)VAQTA®

90633Havrix®


90634Havrix®


90636 Twinrix® Hepatitis B and Hepatitis A (HepA-HepB)

90647 PedvaxHIB® Haemophilus B conjugate (PRP-OMP)

90648ActHIB® Haemophilus B conjugate

(PRP-T)Hiberix®

90649 Gardasil®

Human papillomavirus quadrivalent (types 6,

11,16, and 18), recombinant

90650 Cervarix®Human Papillomavirus, types 16, 18, bivalent

(2vHPV)

90651 Gardasil 9®

Human papillomavirus (types 6, 11, 16, 18, 31,33,

45, 52, 58), nonavalent (9vHPV)

CPT® Code

Brand-name Drug Generic Drug

90653 Fluad® Influenza virus

90656 Afluria® Influenza virus

90657 Fluzone® Influenza virus

90658

Afluria®

Influenza virusFluvirin®

Fluzone®

90660 FluMist® Trivalent Influenza virus

90662 Fluzone® High-Dose Influenza virus

90670 Prevnar 13® Pneumococcal 13-valent conjugate PCV13

90672 FluMist® Quadrivalent Influenza virus

90673 Flublok® Influenza virus

90674 Flucelvax® Quadrivalent Influenza virus

90675Imovax®

Rabies virusRabAvert®

90676Imovax®

Rabies virusRabAvert®

90680 RotaTeq® Rotavirus, pentavalent (RV5)

90681 Rotarix® Rotavirus, attenuated (RV1)

90682 Flublok® Quadrivalent Influenza virus

90685

Afluria® Quadrivalent

Influenza virusFlulaval® Quadrivalent

Fluzone® Quadrivalent

90686


Influenza virusFluarix® Quadrivalent

FluLaval® Quadrivalent


90687Afluria® Quadrivalent

Influenza virusFluzone® Quadrivalent

90688


Influenza virusFluLaval® Quadrivalent


90690 Vivotif® Typhoid

90691 Typhim Vi® Typhoid

90694Brand name not

available at time of printing

Influenza virus, quadrivalent (aIIV4), inactivated,

adjuvanted, preservative free

Appendix iBrand-Name and Generic Vaccinations Associated With CPT® Codes

Modifier DescriptionCPT® Modifiers

25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional on the Same Day of the Procedure or Other Service

27 Multiple Outpatient Hospital E/M Encounters on the Same Date

33 Preventive Services50 Bilateral Procedure52 Reduced Services58 Staged or Related Procedure or

Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

59 Distinct Procedural Service73 Discontinued Out-Patient

Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia

74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia

76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional

77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional

78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following Initial Procedure for a Related Procedure During the Postoperative Period

79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period

91 Repeat Clinical Diagnostic Laboratory Test

Modifier DescriptionLEVEL II (HCPCS/National) ModifiersE1 Upper left, eyelid

E2 Lower left, eyelid

E3 Upper right, eyelid

E4 Lower right, eyelid

F1 Left hand, second digit

F2 Left hand, third digit

F3 Left hand, fourth digit

F4 Left hand, fifth digit

F5 Right hand, thumb

F6 Right hand, second digit

F7 Right hand, third digit

F8 Right hand, fourth digit

F9 Right hand, fifth digit

FA Left hand, thumb

GG Performance and payment of a screening mammogram and diagnostic mammogram on the same patient, same day

GH Diagnostic mammogram converted from screening mammogram on same day

LC Left circumflex coronary artery

LD Left anterior descending coronary artery

LM Left main coronary artery

LT Left side (used to identify procedures performed on the left side of the body)

QM Ambulance service provided under arrangement by a provider of services

QN Ambulance service furnished directly by a provider of services

RC Right coronary artery

RI Ramus intermedius coronary artery

RT Right side (used to identify procedures performed on the right side of the body)

Modifier DescriptionT1 Left foot, second digitT2 Left foot, third digitT3 Left foot, fourth digitT4 Left foot, fifth digitT5 Right foot, great toeT6 Right foot, second digitT7 Right foot, third digitT8 Right foot, fourth digitT9 Right foot, fifth digitTA Left foot, great toe

Anesthesia ModifiersModifier Description

P1 A normal healthy patientP2 A patient with mild systemic

diseaseP3 A patient with severe systemic

diseaseP4 A patient with severe systemic

disease that is a constant threat to life

P5 A moribund patient who is not expected to survive without the operation

P6 A declared brain-dead patient whose organs are being removed for donor purposes

Modifier DescriptionAA Anesthesia services performed

personally by the anesthesiologistAD Medical supervision by a

physician: more than four concurrent anesthesia procedures

G8 Monitored anesthesia care (MAC) for deep complex, complicated, or markedly invasive surgical procedure

G9 Monitored anesthesia care for patient who has history of severe cardio-pulmonary condition

GC This service has been performed in part by a resident under the direction of a teaching physician

Modifier Description

QK Medical direction of two, three, or four concurrent anesthesia procedures involving qualified individuals

QS Monitored anesthesia care service

QX CRNA service: with medical direction by a physician

QY Medical direction of one certified registered nurse anesthetist (CRNA) by an anesthesiologist

QZ CRNA service: without medical direction by a physician

Ambulatory Modifiers

2020 PROCEDURAL CODING EXPERT

ISBN: 978-1-626887-558

modifiers - aapc...transnasal diagnostic specimen collection 43197 with biopsy 43198 transoral...

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