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QUEST - Place of Treatment - Outpatient Procedures List

 

Many inpatient procedures may be safely and effectively performed in an ASC or other outpatient setting without compromising the quality of patient care. HMSA encourages providers to review the attached list of recommended outpatient procedures. These services are eligible for benefit coverage under HMSA's Plan for QUEST Members only when performed in an ASC or lower level setting such as a physician's office, unless the physician has contacted HMSA to pre-certify benefit coverage in a more acute setting (e.g., inpatient hospital).

 

It is understood that common standard of care practices will be followed, and equipment, instruments and facilities should be properly maintained and periodically inspected to ensure the safety of HMSA members.

 

Pre-certification of Inpatient Services

If a physician is recommending that an outpatient procedure be done in an inpatient setting, the physician should submit a request for pre-certification outlining his or her concerns about the member's comorbidities, complex problems, extreme age (younger than 1 year or older than 70), etc.

 

HMSA will evaluate pre-certification requests and respond to the physician within 14 calendar days of receipt of all necessary information. Determinations on requests that meet the definition of "urgent" as described in Benefit Information and which clearly are marked as urgent will be made within three business days.

 

To pre-certify benefits for procedures performed in an inpatient setting, please submit a written request to HMSA's Pre-authorization Unit at the address or fax number below. Urgent and emergent requests must be labeled accordingly to ensure prompt handling.

 

Pre-certification Request, 6th Floor
HMSA - Medical Management Department
P.O. Box 2001
Honolulu, HI 96805

- or -

Fax: (808) 944-5611

 

If the request for inpatient benefits is denied, the physician may appeal the decision by calling the Pre-authorization Unit at 948-6464 on Oahu or 1 (800) 344-6122 from the Neighbor Islands. The Pre-authorization Unit's hours are 8 a.m. to 4 p.m., Monday through Friday. If you call after hours, please leave a message on the voice mail at these numbers.

 

HMSA physician reviewers are available to discuss utilization management decisions with the treating physician.

 

Exceptions

Pre-certification is not required if:

 

Financial Responsibility

If pre-certification is not obtained the member is not responsible for charges. If pre-certification is denied, the physician must advise the member that QUEST will not cover the procedure done on an inpatient basis, and that he/she will be responsible for all charges associated with the procedure. If the patient still wishes to proceed knowing it will not be covered, the patient must sign a statement agreeing to the financial responsibility before services are done. Patients may not be billed without a signed financial responsibility statement.

 

CPT Procedure Code Outpatient Procedures - Description
11406 Excision, benign lesion, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter over 4.0 cm
11446 Excision, other benign lesion including margins (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm
11450 Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repair
11462 Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repair
11770 Excision of pilonidal cyst or sinus; simple
11971 Removal of tissue expander(s) without insertion of prosthesis (See Cosmetic and Reconstructive Surgery and Services)
14001 Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cm
14021 Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cm
14041 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cm
14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less
15100 Split graft, trunk arms, legs; first 100 sq cm or less, or one percent of body area of infants and children
15120 Split graft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or less, or one percent of body area of infants and children
15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral
15600 Delay of flap or sectioning of flap (division and inset); at trunk
15620

at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet

15630

at eyelids, nose, ears, or lips

15823 Blepharoplasty, upper eyelid; with excessive skin weighting down lid. (See Blepharoplasty)
15850 Removal of sutures under anesthesia (other than local), same surgeon
19101 Biopsy of breast; open, incisional
19110 Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous duct
19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion
19290 Preoperative placement of needle localization wire, breast
19370 Open periprosthetic capsulotomy, breast. (See Cosmetic and Reconstructive Surgery and Services)
20200 Biopsy, muscle; superficial
20205

deep

20220 Biopsy, bone, trocar or needle; superficial (e.g., ilium, sternum, spinous process, ribs)
20225

deep (e.g., vertebral body, femur)

20240 Biopsy, bone, excisional; superficial (e.g., ilium, sternum, spinous process, ribs, trochanter of femur)
20245

deep (e.g., humerus, ischium, femur)

20525 Removal of foreign body in muscle or tendon sheath; deep or complicated
20670 Removal of implant; superficial (e.g. buried wire, pin or rod) (separate procedure) (eff 02/01/12)
20680 Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)
20693 Adjustment or revision of external fixation system requiring anesthesia (e.g., new pin(s) or wire(s) and/or new ring(s) or bar(s))
20694 Removal, under anesthesia, of external fixation system
21320 Closed treatment of nasal bone fracture; with stabilization
21336 Open treatment of nasal septal fracture, with or without stabilization
21400 Closed treatment of fracture of orbit, except blowout; without manipulation
21453 Closed treatment of mandibular fracture with interdental fixation
21925 Biopsy, soft tissue of back or flank; deep
21930 Excision, tumor, soft tissue of back or flank
22900 Excision, abdominal wall tumor, subfascial (e.g., desmoid)
23350 Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrography
23655 Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia
23700 Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)
23930 Incision and drainage, upper arm or elbow area; deep abscess or hematoma
24075 Excision, tumor, soft tissue of upper arm or elbow area; subcutaneous
24105 Excision, olecranon bursa
24350 Fasciotomy, lateral or medial (e.g., tennis elbow or epicondylitis)
24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation
24650 Closed treatment of radial head or neck fracture; without manipulation
25000 Incision, extensor tendon sheath, wrist (e.g., deQuervains disease)
25076 Excision, tumor, soft tissue of forearm and/or wrist area; deep (subfascial or intramuscular)
25101 Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign body
25110 Excision, lesion of tendon sheath, forearm and/or wrist
25111 Excision of ganglion, wrist (dorsal or volar); primary
25112

recurrent

25116 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (e.g., tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum
25118 Synovectomy, extensor tendon sheath, wrist, single compartment
25120 Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process)
25210 Carpectomy; one bone
25246 Injection procedure for wrist arthrography
25248 Exploration with removal of deep foreign body, forearm or wrist
25270 Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle
25295 Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendon
25310 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon
25500 Closed treatment of radial shaft fracture; without manipulation
25535 Closed treatment of ulnar shaft fracture; with manipulation
25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation
25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation
25608 Open treatment of distal radial intra-articular fracture or epiphyseal separation, with internal fixation of 2 fragments
25609

with internal fixation of 3 or more fragments

26020 Drainage of tendon sheath, digit and/or palm, each
26040 Fasciotomy, palmar (e.g., Dupuytren's contracture); percutaneous
26045

open, partial

26055 Tendon sheath incision (e.g., for trigger finger)
26070 Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal joint
26075

metacarpophalangeal joint, each

26080

interphalangeal joint, each

26100 Arthrotomy with biopsy; carpometacarpal joint, each
26105

metacarpophalangeal joint, each

26110

interphalangeal joint, each

26115 Excision, tumor or vascular malformation, soft tissue of hand or finger; subcutaneous
26116

deep (subfascial, intramuscular)

26121 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)
26130 Synovectomy, carpometacarpal joint
26135 Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit
26145 Synovectomy tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon
26160 Excision of lesion of tendon sheath or joint capsule (e.g., cyst, mucous cyst, or ganglion), hand or finger
26210 Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger
26410 Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon
26418 Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon
26426 Repair of extensor tendon, central slip, secondary (e.g., boutonniere deformity); using local tissue(s), including lateral band(s), each tendon
26432 Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (e.g., mallet finger)
26433 Repair of extensor tendon, distal insertion, primary or secondary; without graft (e.g., mallet finger)
26440 Tenolysis, flexor tendon; palm or finger, each tendon
26442

palm and finger, each tendon

26445 Tenolysis, extensor tendon, hand or finger, each tendon
26449 Tenolysis, complex, extensor tendon, finger, including forearm, each tendon
26450 Tenotomy, flexor, palm, open, each tendon
26455 Tenotomy, flexor, finger, open, each tendon
26460 Tenotomy, extensor, hand or finger, open, each tendon
26540 Repair of collateral ligament, metacarpophalangeal or interphalangeal joint
26608 Percutaneous skeletal fixation of metacarpal fracture, each bone
26650 Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation, with or without external fixation
26676 Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each joint
26735 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each
26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, with or without internal or external fixation, each
26765 Open treatment of distal phalangeal fracture, finger or thumb, with or without internal or external fixation, each
26785 Open treatment of interphalangeal joint dislocation, with or without internal or external fixation, single
26850 Arthrodesis, metacarpophalangeal joint, with or without internal fixation
27041 Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscular
27327 Excision, tumor, thigh or knee area; subcutaneous
27328

deep, subfascial, or intramuscular

27333 Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial and lateral
27340 Excision, prepatellar bursa
27350 Patellectomy or hemipatellectomy
27355 Excision or curettage of bone cyst or benign tumor of femur
27370 Injection procedure for knee arthrography
27372 Removal of foreign body, deep, thigh region or knee area
27570 Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)
27610 Arthrotomy, ankle, including exploration, drainage, or removal of foreign body
27612 Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening
27614 Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)
27619 Excision, tumor, leg or ankle area; deep (subfascial or intramuscular)
27635 Excision or curettage of bone cyst or benign tumor, tibia or fibula
27762 Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal traction
28008 Fasciotomy, foot and/or toe
28035 Release, tarsal tunnel (posterior tibial nerve decompression)
28046 Radical resection of tumor (e.g., malignant neoplasm), soft tissue of foot
28080 Excision, interdigital (Morton) neuroma, single, each
28090 Excision of lesion, tendon sheath, or capsule (including synovectomy) (e.g., cyst or ganglion); foot
28092

toe(s), each

28108 Excision or curettage of bone cyst or benign tumor, phalanges of foot
28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)
28111 Ostectomy, complete excision; first metatarsal head
28119 Ostectomy, calcaneus; for spur, with or without plantar fascial release
28122 Partial excision (craterization, saucerization, sequestrectomy or diaphysectomy) bone (e.g., osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus
28193 Removal of foreign body, foot; complicated
28200 Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon
28208 Repair, tendon, extensor, foot; primary or secondary, each tendon
28250 Division of plantar fascia and muscle (e.g., Steindler stripping) (separate procedure)
28272 Capsulotomy; interphalangeal joint, each joint (separate procedures)
28285 Correction, hammertoe (e.g., interphalangeal fusion, partial or total phalangectomy)
28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head
28289 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint
28290 Correction, hallux valgus (bunion), with or without sesamoidectomy; simple exostectomy (e.g., Silver type procedure)
28292 Keller, McBride or Mayo type procedure
28293

resection of joint with implant

28296

with metatarsal osteotomy (e.g., Mitchell, Chevron, or concentric type procedures)

28297

Lapidus type procedure

28315 Sesamoidectomy, first toe (separate procedure)
28341 Reconstruction, toe, macrodactyly; requiring bone resection
28476 Percutaneous skeletal fixation of metatarsal fracture, with manipulation, each
28505 Open treatment of fracture great toe, phalanx or phalanges, with or without internal or external fixation
29805 Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
29819 Arthroscopy, shoulder, surgical; capsulorrhaphy; with removal of loose body or foreign body
29822

debridement, limited

29823

debridement, extensive

29825

with lysis and resection of adhesions, with or without manipulation

29826

decompression of subacromial space with partial acromioplasty, with or without coracoacromial release

29830 Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)
29834 Arthroscopy, elbow, surgical; with removal of loose body or foreign body
29837

debridement, limited

29838

debridement, extensive

29848 Endoscopy, wrist, surgical, with release of transverse carpal ligament
29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
29871 Arthroscopy, knee, surgical; for infection, lavage and drainage
29874

for removal of loose body or foreign body (e.g., osteochondritis dissecans fragmentation, chondral fragmentation)

29877

debridement/shaving of articular cartilage (chondroplasty)

29881

with meniscectomy (medical or lateral, including any meniscal shaving)

29884

with lysis of adhesions, with or without manipulation (separate procedure)

29894 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body
29895

synovectomy, partial

29897

debridement, limited

29898

debridement, extensive

29999 Unlisted procedure, arthroscopy
30130 Excision inferior turbinate, partial or complete, any method
30140 Submucous resection inferior turbinate, partial or complete, any method
30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft
30930 Fracture nasal inferior turbinate(s), therapeutic
31020 Sinusotomy, maxillary (antrotomy); intranasal
31051 Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)
31090 Sinusotomy, unilateral, three or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)
31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy
31256 Nasal/sinus endoscopy, surgical; with maxillary antrostomy
31530 Laryngoscopy, direct, operative, with foreign body removal
31577 Laryngoscopy, flexible fiberoptic; with removal of foreign body
31622 Bronchoscopy, rigid or flexible; with or without fluoroscopic guidance; diagnostic, with or without cell washing (separate procedure)
31623

with brushing or protected brushings

31625

with bronchial or endobronchial biopsy(s), single or multiple sites

31629

with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)

31635

with removal of foreign body

31641 Bronchoscopy, (rigid or flexible); with destruction of tumor or relief of stenosis by any method other than excision (e.g., laser therapy, cryotherapy)
32405 Biopsy, lung or mediastinum, percutaneous needle
32664 Thoracoscopy, surgical; with thoracic sympathectomy
36005 Injection procedure for extremity venography (including introduction of needle or intracatheter)
36012 Selective catheter placement, venous system; second order, or more selective, branch (e.g., left adrenal vein, petrosal sinus)
36246 Selective catheter placement, arterial system; initial second order abdominal, pelvic or lower extremity artery branch, within a vascular family
37609 Ligation or biopsy, temporal artery
37785 Ligation, division, and/or excision of varicose veins cluster(s), one leg
38500 Biopsy or excision of lymph node(s); open, superficial
38510

open, deep cervical node(s)

38550 Excision of cystic hygroma, axillary or cervical; without deep neurovascular dissection
40525 Excision of lip; full thickness, reconstruction with local flap (e.g., Estlander or fan)
40720 Plastic repair of cleft lip/nasal deformity; secondary, by recreation of defect and reclosure
40810 Excision of lesion of mucosa and submucosa, vestibule of mouth; without repair
40819 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy)
41010 Incision of lingual frenum (frenotomy)
41115 Excision of lingual frenum (frenectomy)
41850 Destruction of lesion (except excision), dentoalveolar structures
42409 Marsupialization of sublingual salivary cyst (ranula)
42700 Incision and drainage abscess; peritonsillar
42802 Biopsy; hypopharynx
42815 Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx
42830 Adenoidectomy, primary; younger than 12
42860 Excision of tonsil tags
43200 Esophagoscopy, rigid or flexible; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
43202

with biopsy, single or multiple

43215

with removal of foreign body

43220

with balloon dilation (less than 30 mm diameter)

43226

with insertion of guide wire followed by dilation over guide wire

43234 Upper gastrointestinal endoscopy, simple primary examination (e.g., with small diameter flexible endoscope) (separate procedure)
43235 Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
43239

with biopsy, single or multiple

43244

with band ligation of esophageal and/or gastric varices

43245

with dilation of gastric outlet for obstruction (e.g., balloon, guide wire, bougie)

43246

with directed placement of percutaneous gastrostomy tube

43247

with removal of foreign body

43248

with insertion of guide wire followed by dilation of esophagus over guide wire

43249

with balloon dilation of esophagus (less than 30 mm diameter)

43250

with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

43251

with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

43258

with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, with or without collection of specimen(s) by brushing or washing
43261

with biopsy, single or multiple

43450 Dilation of esophagus, by unguided sound or bougie, single or multiple passes
43453 Dilation of esophagus, over guide wire
43456 Dilation of esophagus, by balloon or dilator; retrograde
44377 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, including ileum; with biopsy, single or multiple
44380 Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure)
44382

with biopsy, single or multiple

44389 Colonoscopy through stoma; with biopsy, single or multiple
44392 Colonoscopy through stoma; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
45100 Biopsy of anorectal wall, anal approach (e.g., congenital megacolon)
45170 Excision of rectal tumor, transanal approach
45308 Protosigmoidoscopy, rigid; with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery
45309

with removal of single tumor, polyp, or other lesion by snare technique

45315

with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique

45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery
45339

with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery, or snare technique

45378 Colonoscopy, flexible, proximal to splenic flexure; diagnostic, with or without collection of specimen(s) by brushing or washing, with or without colon decompression (separate procedure)
45379

with removal of foreign body

45380

with biopsy, single or multiple

45383

with ablation of tumor(s), polyp(s), or other lesion(s) not amenable to removal by hot biopsy forceps, bipolar cautery or snare technique

45384

with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps or bipolar cautery

45385

with removal of tumor(s), polyp(s), or other lesion(s) by snare technique

45505 Proctoplasty; for prolapse of mucous membrane
45905 Dilation of anal sphincter (separate procedure) under anesthesia other than local
45990 Anorectal exam, surgical, requiring anesthesia (general, spinal or epidural), diagnostic
46045 Incision and drainage of intramural, intramuscular or submucosal abscess, transanal, under anesthesia
46060 Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton
46080 Sphincterotomy, anal, division of sphincter
46200 Fissurectomy, with or without sphincterotomy
46612 Anoscopy; with removal of multiple tumors, polyps, or other lesions by hot biopsy forceps, bipolar cautery or snare technique
46700 Anoplasty, plastic operation for stricture; adult
46924 Destruction of lesion(s), anus (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery)
47000 Biopsy of liver, needle; percutaneous
47505 Injection procedure for cholangiography through an existing catheter (e.g., percutaneous transhepatic or T-tube)
48102 Biopsy of pancreas, percutaneous needle
49080 Peritoneocentesis, abdominal paracentesis, or peritoneal lavage (diagnostic or therapeutic); initial
49081

subsequent

49180 Biopsy, abdominal or retroperitoneal mass, percutaneous needle
49250 Umbilectomy, omphalectomy, excision of umbilicus (separate procedure)
50200 Renal biopsy; percutaneous, by trocar or needle
50394 Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral catheter
50398 Change of nephrostomy or pyelostomy tube
51600 Injection procedure for cystography or voiding urethrocystography
51726 Complex cystometrogram (e.g., calibrated electronic equipment)
51741 Complex uroflowmetry (UFR) (e.g., stop-watch flow rate, mechanical uroflowmeter)
51772 Urethral pressure profile studies (UPP) (urethral closure pressure profile), any technique
51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique
51785 Needle electromyography studies (EMG) of anal or urethral sphincter, any technique
52005 Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service
52204 Cystourethroscopy, with biopsy
52214 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
52224 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy
52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 to 2.0 cm)
52235

MEDIUM bladder tumor(s) (2.0 to 5.0 cm)

52240

LARGE bladder tumor(s)

52250 Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration
52260 Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia
52270 Cystourethroscopy, with internal urethrotomy; female
52275

male

52276 Cystourethroscopy with direct vision internal urethrotomy
52285 Cystourethroscopy for treatment of the female urethral syndrome with any or all of the following: urethral meatotomy, urethral dilation, internal urethrotomy, lysis of urethrovaginal septal fibrosis, lateral incisions of the bladder neck, and fulguration of polyp(s) of urethra, bladder neck, and/or trigone
52290 Cystourethroscopy; with ureteral meatotomy, unilateral or bilateral
52300

with resection or fulguration of orthotopic ureterocele(s), unilateral or bilateral

52315 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated
53450 Urethromeatoplasty, with mucosal advancement
54001 Slitting of prepuce, dorsal or lateral (separate procedure); except newborn
54152 Circumcision, using clamp or other device; except newborn
54161 Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn
54360 Plastic operation on penis to correct angulation
54450 Foreskin manipulation including lysis of preputial adhesions and stretching
54700 Incision and drainage of epididymis, testis and/or scrotal space (e.g., abscess or hematoma)
54840 Excision of spermatocele, with or without epididymectomy
55060 Repair of tunica vaginalis hydrocele (Bottle type)
55500 Excision of hydrocele of spermatic cord, unilateral (separate procedure)
55535 Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach
55700 Biopsy, prostate; needle or punch, single or multiple, any approach
56440 Marsupialization of Bartholin's gland cyst
56441 Lysis of labial adhesions
56620 Vulvectomy simple; partial
56740 Excision of Bartholin's gland or cyst
57000 Colpotomy; with exploration
57105 Biopsy of vaginal mucosa; extensive, requiring suture (including cysts)
57200 Colporrhaphy, suture of injury of vagina (nonobstetrical)
57410 Pelvic examination under anesthesia
57513 Cautery of cervix; laser ablation
57520 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser
57522

loop electrode excision

57700 Cerclage of uterine cervix, nonobstetrical
58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical)
58340 Catheterization and introduction of saline or contrast material for saline infusion sonohysterography (SIS) or hysterosalpingography
58345 Transcervical introduction of fallopian tube catheter for diagnosis and/or re-establishing patency (any method), with or without hysterosalpingography
58545 Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas
58555 Hysteroscopy, diagnostic
58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
58559 Hysterectomy, surgical; with lysis of intrauterine adhesions
58560 Hysterectomy, surgical; with division or resection of intrauterine septum
58561 Hysterectomy, surgical;p with removal of leiomyomata
58562 Hysterectomy, surgical; with removal of impacted foreign body
58563 Hysterectomy, surgical; with endometrial ablation
58565

with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants

58660 Laparoscopy, surgical; with lysis of adhesions
58661 Laparoscopy, surgical; with removal of adnexal structures
58662 Laparoscopy, surgical; with fulguration of excision of lesions of the ovary, pelvic viscera, or peritoneal surface
58670 Laparoscopy, surgical; with fulguration of oviducts
58671 Laparoscopy, surgical; with occlusion of oviducts by device
58673 Laparoscopy, surgical; with salpingostomy (salpingoneostomy)
59840 Induced abortion, by dilation and curettage
59841 Induced abortion, by dilation and evacuation
60200 Excision of cyst or adenoma of thyroid, or transection of isthmus
60210 Partial thyroid lobectomy, unilateral; with or without isthmusectomy
60220 Total thyroid lobectomy, unilateral; with or without isthmusectomy
60225 Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy
62270 Spinal puncture, lumbar, diagnostic
62272 Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter)
62273 Injection, epidural, of blood or clot patch
62281 Injection/infusion of neurolytic substance (e.g., alcohol, phenol, iced saline solutions); with or without other therapeutic substance; epidural, cervical or thoracic
62282

epidural, lumbar, sacral (caudal)

62284 Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa)
62290 Injection procedure for diskography, each level; lumbar
62291

cervical or thoracic

62311 Injection, single (not via indwelling catheter), not including neurolytic substances, with our without contrast (for either localization or epidurography), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), epidural or subarachnoid; lumbar, sacral (caudal)
64402 Injection, anesthetic agent; facial nerve
64405

greater occipital nerve

64476 Injection, anesthetic agent and/or steroid, paravertebral facet joint or facet joint nerve; lumbar or sacral, each additional level
64479 Injection, anesthetic agent and/or steroid, transforaminal epidural; cervical or thoracic, single level
64483

lumbar or sacral, single level

64510 Injection, anesthetic agent; stellate ganglion (cervical sympathetic)
64530

celiac plexus, with or without radiologic monitoring

64680 Destruction by neurolytic agent, with or without radiologic monitoring; celiac plexus
64719 Neuroplasty and/or transposition; ulnar nerve at wrist
64721

median nerve at carpal tunnel

65103 Enucleation of eye; with implant, muscles not attached to implant
65125 Modification of ocular implant with placement or replacement of pegs (e.g., drilling receptacle for prosthesis appendage) (separate procedure)
65140 Insertion of ocular implant secondary; after enucleation, muscles attached to implant
65290 Repair of wound, extraocular muscle, tendon and/or Tenon's capsule
65426 Excision or transposition of pterygium; with graft
65450 Destruction of lesion of cornea by cryotherapy, photocoagulation or thermocauterization
65600 Multiple punctures of anterior cornea (e.g., for corneal erosion, tattoo)
65820 Goniotomy
65855 Trabeculoplasty by laser surgery, one or more sessions (defined treatment series)
66170 Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery
66180 Aqueous shunt to extraocular reservoir, (e.g., Molteno, Schocket, Denver-Krupin)
66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure
66720 Ciliary body destruction; cryotherapy
66761 Iridotomy/iridectomy by laser surgery (e.g., for glaucoma) (one or more sessions)
66762 Iridoplasty by photocoagulation (one or more sessions) (e.g., for improvement of vision, for widening of anterior chamber angle)
66821 Discission of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid); laser surgery (e.g., Yag laser) (one or more stages)
66825 Repositioning of intraocular lens prosthesis, requiring an incision (separate procedure)
66830 Removal of secondary membranous cataract (opacified posterior lens capsule and/or anterior hyaloid) with corneo-scleral section, with or without iridectomy (iridocapsulotomy, iridocapsulectomy)
66840 Removal of lens material; aspiration technique, one or more stages
66850

phacofragmentation technique (mechanical or ultrasonic) (e.g., phacoemulsification), with aspiration

66852

pars plana approach, with or without vitrectomy

66920

intracapsular

66930

intracapsular, for dislocated lens

66940

extracapsular (other than 66840, 66850, 66852)

66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage
66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (one stage procedure)
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (one stage procedure), manual or mechanical technique (e.g., irrigation and aspiration or phacoemulsification)
66985 Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal
67031 Severing of vitreous strands, vitreous face adhesions, sheets, membranes or opacities, laser surgery (one or more stages)
67101 Repair of retinal detachment, one or more sessions; cryotherapy or diathermy, with or without drainage of subretinal fluid
67105

photocoagulation, with or without drainage of subretinal fluid

67121 Removal of implanted material, posterior segment; intraocular
67141 Prophylaxis of retinal detachment (e.g., retinal break, lattice degeneration) without drainage, one or more sessions; cryotherapy, diathermy
67145

photocoagulation (laser or xenon arc)

67208 Destruction of localized lesion of retina (e.g., macular edema, tumors) one or more sessions; cryotherapy, diathermy
67210

photocoagulation

67227 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions; cryotherapy, diathermy
67228

photocoagulation (laser or xenon arc)

67311 Strabismus surgery, recession or resection procedure; one horizontal muscle
67312

two horizontal muscles

67331 Strabismus surgery on patient with previous eye surgery or injury that did not involve the extraocular muscles (List separately in addition to code for primary procedure)
67332 Strabismus surgery on patient with scarring of extraocular muscles (e.g., prior ocular injury, strabismus or retinal detachment surgery) or restrictive myopathy (e.g., dysthyroid ophthalmopathy) (List separately in addition to code for primary procedure)
67334 Strabismus surgery by posterior fixation suture technique, with or without muscle recession
67400 Orbitotomy without bone flap (frontal or transconjunctival approach); for exploration, with or without biopsy
67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material. (When submitting claims, submit an operative report or other documentation)
67902

frontalis muscle technique with fascial sling (includes obtaining fascia). (When submitting claims, submit an operative report or other documentation)

67903

(tarso) levator resection or advancement, internal approach. (When submitting claims, submit an operative report or other documentation)

67904

(tarso) levator resection or advancement, external approach. (When submitting claims, submit an operative report or other documentation) (See Cosmetic and Reconstructive Surgery and Services)

67906

superior rectus technique with fascial sling (includes obtaining fascia)

67908

conjunctivo-tarso-Muller's muscle-levator resection (e.g., Fasanella-Servat type)

67914 Repair of ectropion; suture
67915

thermocauterization

67916

excision tarsal wedge

67917

extensive (e.g., tarsal strip operations)

67921 Repair of entropion; suture
67922

thermocauterization

67923

excision tarsal wedge

67924 Repair of entropion; extensive (e.g., tarsal strip or capsulopalpebral fascia repairs operation). (When submitting claims, submit an operative report or other documentation.) (See Cosmetic and Reconstructive Surgery and Services)
67950 Canthoplasty (reconstruction of canthus)
67973 Reconstruction of eyelid, full thickness by transfer of tarsoconjunctival flap from opposing eyelid; total eyelid, lower, one stage or first stage
68115 Excision of lesion, conjunctiva; over 1 cm
68135 Destruction of lesion, conjunctiva
68320 Conjunctivoplasty; with conjunctival graft or extensive rearrangement
68326 Conjunctivoplasty, reconstruction cul-de-sac; with conjunctival graft or extensive rearrangement
68700 Plastic repair of canaliculi
68811 Probing of nasolacrimal duct, with or without irrigation; requiring general anesthesia
68815

with insertion of tube or stent

69205 Removal foreign body from external auditory canal; with general anesthesia
69421 Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia
69424 Ventilating tube removal requiring general anesthesia
69440 Middle ear exploration through postauricular or ear canal incision
69540 Excision aural polyp
69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction
69660 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material
93651* Intracardiac catheter ablation of arrhythmogenic focus; for treatment of supraventricular tachycardia by ablation of fast or slow atrioventricular pathways, accessory atrioventricular connections or other atrial foci, singly or in combination

 

*Pulmonary Vein Isolation (PVI) ablation, which currently does not have its own code, is billed under CPT 93651 and is considered an outpatient procedure.

 


First Published:11/26/2008
Latest Revision:12/07/2011

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