The following procedures may be safely and effectively performed in a physician's office. These services are eligible for benefit coverage under HMSA plans when performed in the physician's office or other outpatient setting which is not designated as a hospital based or free-standing ambulatory surgical center or an acute inpatient facility. If the physician feels that a higher level of care is required, precertification is required.
To pre-certify, complete HMSA’s Precertification Request Form and fax it to 808-944-5611 or mail to:
HMSA
Attn: Medical Management
P.O. Box 2001
Honolulu, HI 96805-2001
Table 1 - Integumentary System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 10021 | Fine needle aspiration; without imaging guidance |
| 10040 | Extraction (e.g., marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) |
| 10060 | Incision and drainage of abscess (e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single |
| 10061 | complicated or multiple (See Incisions - Complicated) |
| 10080 | Incision and drainage of pilonidal cyst; simple |
| 10120 | Incision and removal of foreign body, subcutaneous tissues; simple |
| 10121 | complicated (See Incisions - Complicated) |
| 10140 | Incision and drainage of hematoma, seroma or fluid collection |
| 10160 | Puncture aspiration of abscess, hematoma, bulla, or cyst |
| 11000 | Debridement of extensive eczematous or infected skin; up to 10 percent of body surface |
| 11042 | skin, and subcutaneous tissue |
| 11055 | Paring or cutting of benign hyperkeratotic lesion (e.g., corn or callus); single lesion |
| 11056 | two to four lesions |
| 11057 | more than four lesions |
| 11102 | Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesion |
| 11104 | Punch biopsy of skin (including simple closure, when performed); single lesion |
| 11106 | Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesion |
| 11200 | Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions |
| 11300 | Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or less |
| 11301 | lesion diameter 0.6 to 1.0 cm |
| 11302 | lesion diameter 1.1 to 2.0 cm |
| 11303 | lesion diameter over 2.0 cm |
| 11305 | Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less |
| 11306 | lesion diameter 0.6 to 1.0 cm |
| 11307 | lesion diameter 1.1 to 2.0 cm |
| 11308 | lesion diameter over 2.0 cm |
| 11310 | Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or less |
| 11311 | lesion diameter 0.6 to 1.0 cm |
| 11312 | lesion diameter 1.1 to 2.0 cm |
| 11313 | lesion diameter over 2.0 cm |
| 11400 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms, or legs; excised diameter 0.5 cm or less |
| 11401 | excised diameter 0.6 to 1.0 cm |
| 11402 | excised diameter 1.1 to 2.0 cm |
| 11403 | excised diameter 2.1 to 3.0 cm |
| 11404 | excised diameter 3.1 to 4.0 cm |
| 11420 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less |
| 11421 | excised diameter 0.6 to 1.0 cm |
| 11422 | excised diameter 1.1 to 2.0 cm |
| 11423 | excised diameter 2.1 to 3.0 cm |
| 11424 | excised diameter 3.1 to 4.0 cm |
| 11440 | Excision, other benign lesion including margins (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less |
| 11441 | excised diameter 0.6 to 1.0 cm |
| 11442 | Excision, other benign lesion, face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm |
| 11443 | excised diameter 2.1 to 3.0 cm |
| 11444 | excised diameter 3.1 to 4.0 cm |
| 11600 | Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or less |
| 11601 | excised diameter 0.6 to 1.0 cm |
| 11602 | excised diameter 1.1 to 2.0 cm |
| 11603 | excised diameter 2.1 to 3.0 cm |
| 11620 | Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less |
| 11621 | excised diameter 0.6 to 1.0 cm |
| 11622 | excised diameter 1.1 to 2.0 cm |
| 11640 | Excision, malignant lesion including margins, face, ears, eyelids, nose, lips, excised diameter 0.5 cm or less |
| 11641 | excised diameter 0.6 to 1.0 cm |
| 11642 | excised diameter 1.1 to 2.0 cm |
| 11643 | excised diameter 2.1 to 3.0 cm |
| 11719 | Trimming of nondystrophic nails, any number |
| 11720 | Debridement of nail(s) by any method(s); one to five |
| 11721 | six or more |
| 11730 | Avulsion of nail plate, partial or complete, simple; single |
| 11740 | Evacuation of subungual hematoma |
| 11750 | Excision of nail and nail matrix, partial or complete, (e.g., ingrown or deformed nail) for permanent removal |
| 11755 | Biopsy of nail unit, any method (e.g., plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure) |
| 11765 | Wedge excision of skin of nail fold (eg, for ingrown toenail) |
| 11900 | Injection, intralesional; up to and including seven lesions |
| 11901 | more than seven lesions |
| 11920 |
Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or less. (When submitting claims for this service, enclose an operative report or other documentation with the claim.) (See Cosmetic and Reconstructive Surgery and Services) |
| 11950 | Subcutaneous injection of filling material (e.g., collagen); 1 cc or less. |
| 11951 | 1.1 to 5.0 cc |
| 11976 | Removal, implantable contraceptive capsules |
| 11981 | Insertion, non-biodegradable drug delivery implant |
| 11982 | Removal, non-biodegradable drug delivery implant |
| 11983 | Removal with reinsertion, non-biodegradable drug delivery implant |
| 12001 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less |
| 12002 | 2.6 cm to 7.5 cm |
| 12005 | 12.6 cm to 30.0 cm |
| 12006 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/extremeties (including hands and feet); 20.1 cm to 30.0 cm |
| 12007 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/extremeties (including hands and feet); 20.1 cm to 30.0 cm |
| 12011 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less |
| 12013 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm |
| 12016 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips &/or mucous membranes; 12.6 cm to 20.0 cm |
| 12020 | Treatment of superficial wound dehiscence; simple closure |
| 12021 | with packing |
| 12031 | Layer closure of wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) |
| 12032 | 2.6 cm to 7.5 cm. (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) |
| 12034 | Layer closure of wounds of scalp, axillae, trunk and/or extremities; 7.6 cm to 12.5 cm |
| 12035 | Layer closure of wounds of scalp, axillae, trunk and/or extremities 12.6 cm to 20 cm |
| 12036 | Layer closure of wounds of scalp, axillae, trunk and/or extremities 20.1 cm to 30 cm |
| 12037 | Layer closure of wounds of scalp, axillae, trunk and/or extremities over 30 cm |
| 12041 | Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) |
| 12042 | Layer closure of wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm |
| 12044 | Layer closure of wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm |
| 12045 | Layer closure of wounds of neck, hands, feet and/or external genitalia; 12.6 to 20.0 cm |
| 12046 | Layer closure of wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm |
| 12051 | Layer closure of wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) |
| 12052 | 2.6 cm to 5.0 cm |
| 12053 | 5.1 cm to 7.5 cm |
| 12054 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and / or mucous membranes; 7.6 cm to 12.6 cm |
| 12055 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and / or mucous membranes; 12.6 cm to 20.0 cm |
| 12056 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and / or mucous membranes; 20.1 cm to 30.0 cm |
| 12057 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and / or mucous membranes; over 30.0 cm |
| 13100 | Repair, complex, trunk; 1.1 cm to 2.5 cm (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) (See Incisions - Complicated) |
| 13101 | 2.6 cm to 7.5 cm |
| 13120 | Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm (When submitting claims for layered closures and complex repairs, include an operative report with the claim.) (See Incisions - Complicated) |
| 13121 | 2.6 cm to 7.5 cm |
| 13131 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet, 1.1 cm to 2.5 cm |
| 13132 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm (See Incisions - Complicated) |
| 13151 | Repair complex, eyelids, nose ears, and/or lips; 1.1 cm to 2.5 cm |
| 13152 | 2.6 cm to 7.5 cm |
| 15050 | Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter |
| 15786 | Abrasion; single lesion (e.g., keratosis, scar) |
| 15788 | Chemical peel, facial; epidermal (See Cosmetic and Reconstructive Surgery and Services) |
| 15789 | dermal |
| 15792 | Chemical peel, nonfacial; epidermal (See Cosmetic and Reconstructive Surgery and Services) |
| 15793 | dermal |
| 16000 | Initial treatment, first degree burn, when no more than local treatment is required |
| 16020 | Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) |
| 17000 | Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement premalignant lesions (e.g., actinic keratoses); first lesion |
| 17004 | 15 or more lesions |
| 17106 | Destruction of cutaneous vascular proliferative lesions (e.g., laser technique); less than 10 sq cm |
| 17107 | 10.0 - 50.0 sq cm |
| 17110 | Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular lesions; up to 14 lesions |
| 17111 | 15 or more lesions |
| 17250 | Chemical cauterization of granulation tissue (proud flesh, sinus or fistula) |
| 17260 | Destruction, malignant lesion (e.g., laser surgery electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or less |
| 17261 | lesion diameter 0.6 to 1.0 cm |
| 17262 | lesion diameter 1.1 to 2.0 cm |
| 17263 | lesion diameter 2.1 to 3.0 cm |
| 17264 | lesion diameter 3.1 to 4.0 cm |
| 17270 | Destruction, malignant lesion (e.g. laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement) scalp, neck, hands, feet, genitalia, lesion diameter 0.5 cm or less |
| 17271 | lesion diameter 0.6 to 1.0 cm |
| 17272 | lesion diameter 1.1 to 2.0 cm |
| 17280 | Destruction, malignant lesion (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement); scalp, neck, hands, feet, genitalia, lesion diameter 0.5 cm or less |
| 17281 | lesion diameter 0.6 to 1.0 cm |
| 17311 | Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stan(s) (e.g., hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocks |
| 17313 | Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (e.g., hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocks |
| 17340 | Cryotherapy (CO2 slush, liquid N2) for acne |
| 17360 | Chemical exfoliation for acne (e.g., acne paste, acid) |
| 19000 | Puncture aspiration of cyst of breast |
| 19100 | Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) |
Table 2 - Musculoskeletal System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 20500 | Injection of sinus tract; therapeutic (separate procedure) |
| 20501 | diagnostic (sinogram) (for radiological supervision and interpretation, use 76080) |
| 20550 | Injection(s), single tendon sheath, or ligament, aponeurosis (e.g., plantar "fascia") |
| 20551 | Injection(s), single tendon origin/insertion |
| 20552 | Injection(s), single or multiple trigger point(s), one or two muscles |
| 20553 | Injection(s), single or multiple trigger point(s), three or more muscles |
| 20600 | Arthrocentesis, aspiration and/or injection; small joint or bursa (e.g., fingers, toes) |
| 20605 | intermediate joint or bursa (e.g., temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa) |
| 20612 | Aspiration and/or injection of ganglion cyst(s) any location |
| 20615 | Aspiration and injection for treatment of bone cyst |
| 21011 | Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cm |
| 21013 | Excision, tumor, soft tissue of face and scalp, subfascial; less than 2 cm |
| 21030 | Excision of benign tumor or cyst of maxilla or zygoma by enucleation of curettage |
| 21040 | Excision of benign cyst or tumor of mandible; by enucleation and/or curettage |
| 21116 | Injection procedure for temporomandibular joint arthrography |
| 21315 | Closed treatment of nasal bone fracture; without stabilization |
| 21550 | Biopsy, soft tissue of neck or thorax |
| 21555 | Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm |
| 21920 | Biopsy, soft tissue of back or flank; superficial |
| 23065 | Biopsy, soft tissue of shoulder area; superficial |
| 23075 | Excision, soft tumor, shoulder area; subcutaneous |
| 23330 | Removal of foreign body, shoulder; subcutaneous |
| 23500 | Closed treatment of clavicular fracture; without manipulation |
| 23520 | Closed treatment of sternoclavicular dislocation; without manipulation |
| 23540 | Closed treatment of acromioclavicular dislocation; without manipulation |
| 23650 | Closed treatment of shoulder dislocation, with manipulation; without anesthesia |
| 24065 | Biopsy, soft tissue of upper arm or elbow area; superficial |
| 24200 | Removal of foreign body; upper arm or elbow area; subcutaneous |
| 24530 | Closed treatment of supracondylar or transcondylar humeral fracture, with or without manipulation |
| 24560 | Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation |
| 24650 | Closed treatment of radial head or neck fracture; without manipulation |
| 25500 | Closed treatment of radial shaft fracture; without manipulation |
| 25505 | Closed treatment of radial shaft fracture; with manipulation |
| 25600 | Closed treatment of distal radial fracture (e.g., Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed without manipulation |
| 25622 | Closed treatment of carpal scaphoid (navicular) fracture; without manipulation |
| 25630 | Closed treatment of carpal bone fracture (excluding carpal scaphoid (navicular); without manipulation, each bone |
| 25635 | with manipulation, each bone |
| 26010 | Drainage of finger abscess; simple |
| 26600 | Closed treatment of metacarpal fracture, single; without manipulation, each bone |
| 26605 | with manipulation, each bone |
| 26670 | Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia |
| 26720 | Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each |
| 26725 | with manipulation, with or without skin or skeletal traction, each |
| 26740 | Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, each |
| 26742 | with manipulation, each |
| 26750 | Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each |
| 26755 | with manipulation, each |
| 26770 | Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia |
| 27040 | Biopsy, soft tissue of pelvis and hip area; superficial |
| 27086 | Removal of foreign body, pelvis or hip; subcutaneous tissue |
| 27323 | Biopsy, soft tissue of thigh or knee area; superficial |
| 27613 | Biopsy, soft tissue of leg or ankle area; superficial |
| 27618 | Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cm |
| 27648 | Injection procedure for ankle arthrography |
| 27760 | Closed treatment of medial malleolus fracture; without manipulation |
| 27808 | Closed treatment of bimalleolar ankle fracture, (including potts); without manipulation |
| 28043 | Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm |
| 28190 | Removal of foreign body, foot; subcutaneous |
| 28400 | Closed treatment of calcaneal fracture; without manipulation |
| 28430 | Closed treatment of talus fracture; without manipulation |
| 28470 | Closed treatment of metatarsal fracture; without manipulation, each |
| 28475 | with manipulation, each |
| 28490 | Closed treatment of fracture great toe; phalanx or phalanges; without manipulation |
| 28495 | with manipulation |
| 28510 | Closed treatment of fracture; phalanx or phalanges, other than great toe; without manipulation, each |
| 28515 | with manipulation, each |
| 28540 | Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia |
| 28570 | Closed treatment of talotarsal joint dislocation; without anesthesia |
| 28600 | Closed treatment of tarsometatarsal joint dislocation; without anesthesia |
| 28630 | Closed treatment of metatarsophalangeal joint dislocation; without anesthesia |
| 28660 | Closed treatment of interphalangeal joint dislocation; without anesthesia |
| 29049 | Application; cast figure-of-eight |
| 29055 | shoulder spica |
| 29058 | plaster Velpeau |
| 29065 | shoulder to hand (long arm) |
| 29075 | elbow to finger (short arm) |
| 29085 | hand and lower forearm (gauntlet) |
| 29105 | Application of long arm splint (shoulder to hand) |
| 29125 | Application of short arm splint (forearm to hand); static |
| 29126 | dynamic |
| 29130 | Application of finger splint; static |
| 29131 | dynamic |
| 29345 | Application of long leg cast (thigh to toes); |
| 29355 | walker or ambulatory type |
| 29358 | Application of long leg cast brace |
| 29365 | Application of cylinder cast (thigh to ankle) |
| 29405 | Application of short leg cast (below knee to toes); |
| 29425 | walking or ambulatory type |
| 29435 | Application of patellar tendon bearing (PTB) cast |
| 29440 | Adding walker to previously applied cast |
| 29445 | Application of rigid total contact leg cast |
| 29450 | Application of clubfoot cast with molding or manipulation, long or short leg |
| 29505 | Application of long leg splint (thigh to ankle or toes) |
| 29515 | Application of short leg splint (calf to foot) |
| 29700 | Removal or bivalving; gauntlet, boot or body cast |
| 29705 | Removal or bivalving; full arm or full leg cast |
| 29710 | Removal of bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc. |
| 29720 | Repair of spica, body cast or jacket |
| 29730 | Windowing of cast |
| 29740 | Wedging of cast (except clubfoot casts) |
| 29750 | Wedging of clubfoot cast |
| 29799 | Unlisted procedure, casting or strapping |
Table 3 - Respiratory System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 30000 | Drainage abscess or hematoma, nasal, internal approach |
| 30020 | Drainage abscess or hematoma, nasal septum |
| 30100 | Biopsy, intranasal |
| 30110 | Excision, nasal polyp(s), simple |
| 30124 | Excision dermoid cyst, nose; simple, skin, subcutaneous |
| 30200 | Injection into turbinate(s), therapeutic |
| 30300 | Removal foreign body, intranasal; office type procedure |
| 30560 | Lysis intranasal synechia |
| 30801 | Cautery and/or ablation, mucosa of inferior turbinates, unilateral or bilateral, any method (separate procedure); superficial |
| 30901 | Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method |
| 30903 | Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing ) any method |
| 31000 | Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium) |
| 31002 | sphenoid sinus |
| 31231 | Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure) |
| 31505 | Laryngoscopy, indirect; diagnostic (separate procedure) |
| 31520 | Laryngoscopy direct, with or without tracheoscopy; for aspiration, diagnostic, newborn |
| 31525 | diagnostic, except newborn (Do not report modifier 63 in conjunction with 31520) |
| 31526 | diagnostic, with operating microscope or telescope |
| 31575 | Laryngoscopy, flexible fiberoptic; diagnostic |
Table 4 - Cardiovascular, Hemic and Lymphatic Systems
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 36465 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; single incompetent extremity truncal vein (eg, great saphenous vein, accessory saphenous vein) |
| 36466 | Injection of non-compounded foam sclerosant with ultrasound compression maneuvers to guide dispersion of the injectate, inclusive of all imaging guidance and monitoring; multiple incompetent truncal veins (eg, great saphenous vein, accessory saphenous vein), same leg |
| 38300 | Drainage of lymph node abscess or lymphadenitis; simple |
| 38505 | Biopsy or excision of lymph node(s); by needle, superficial (e.g., cervical, inguinal, axillary) |
Table 5 - Digestive System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 40490 | Biopsy of lip |
| 40510 | Excision of lip; transverse wedge excision with primary closure |
| 40520 | V-excision with primary direct linear closure |
| 40800 | Drainage of abscess, cyst, hematoma, vestibule of mouth; simple |
| 40804 | Removal of embedded foreign body, vestibule of mouth; simple |
| 40812 | Excision of lesion of mucosa and submucosa, vestibule of mouth, with simple repair |
| 42100 | Biopsy of palate, uvula |
| 42300 | Drainage of abscess; parotid, simple |
| 42650 | Dilation salivary duct |
| 42800 | Biopsy; oropharynx |
| 42804 | nasopharynx, visible lesion, simple |
| 42808 | Excision or destruction of lesion of pharynx, any method |
| 43762 | Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; not requiring revision of gastrostomy tract |
| 43763 | Replacement of gastrostomy tube, percutaneous, includes removal, when performed, without imaging or endoscopic guidance; requiring revision of gastrostomy tract |
| 45300 | Proctosigmoidoscopy, rigid; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) |
| 45303 | with dilation (e.g., balloon, guide wire, bougie) |
| 45305 | with biopsy, single or multiple |
| 46050 | Incision and drainage, perianal abscess, superficial |
| 46220 | Papillectomy or excision of single tag, anus (separate procedure) |
| 46221 | Hemorrhoidectomy, by simple ligature (e.g., rubber band) |
| 46230 | Excision of external hemorrhoid tags and/or multiple papillae |
| 46320 | Enucleation or excision of external thrombotic hemorrhoid |
| 46500 | Injection of sclerosing solution, hemorrhoids |
| 46600 | Anoscopy; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) |
| 46604 | with dilation (e.g., balloon, guide wire, bougie) |
| 46606 | with biopsy, single or multiple |
| 46610 | with removal of single tumor, polyp, or other lesion by hot biopsy forceps or bipolar cautery |
| 46900 | Destruction of lesion(s), anus, (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical |
| 46910 | electrodessication |
| 46916 | cryosurgery |
| 46917 | laser surgery |
| 46945 | Ligation of internal hemorrhoids; single procedure |
| 46946 | multiple procedures |
| G0104 | Colorectal cancer screening; flexible sigmoidoscopy |
Table 6 - Urinary System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 51701 | Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) |
| 51702 | Insertion of temporary indwelling bladder catheter; simple (eg, Foley) |
| 51725 | Simple cystometrogram (cmg) (eg, spinal manometer) |
| 51736 | Simple uroflowmetry (ufr) (eg, stop-watch flow rate, mechanical uroflowmeter) |
| 51792 | Stimulus evoked response (eg, measurement of bulbocavernosus reflex latency time) |
| 53600 | Dilation of urethral stricture by passage of sound or urethral dilator, male; initial |
| 53601 | subsequent |
| 53660 | Dilation of female urethra including suppository and/or instillation; initial |
| 53661 | subsequent |
Table 7 - Male Genital System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 54050 | Destruction of lesion(s), penis (e.g., condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; chemical |
| 54055 | electrodesiccation |
| 54056 | cryosurgery |
| 54060 | surgical excision |
| 54100 | Biopsy of penis, cutaneous (separate procedure) |
| 55100 | Drainage of scrotal wall abscess |
| 55250 | Vasectomy, unilateral or bilateral (separate procedure), including postoperative semen examination(s) |
Table 8 - Female Genital System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 56405 | Incision and drainage of vulva or perineal abscess |
| 56420 | Incision and drainage of Bartholin's gland abscess |
| 56501 | Destruction of lesion(s), vulva; simple (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery) |
| 56605 | Biopsy of vulva or perineum (separate procedure); one lesion |
| 56820 | Colposcopy of the vulva; |
| 56821 | Colposcopy of the vulva; with biopsy(s) |
| 57100 | Biopsy of vaginal mucosa; simple (separate procedure) |
| 57150 | Irrigation of vagina and/or application of medicament for treatment of bacterial, parasitic, or fungoid disease |
| 57160 | Fitting and insertion of pessary or other intravaginal support device |
| 57170 | Diaphragm or cervical cap fitting with instructions |
| 57180 | Introduction of any hemostatic agent or pack for spontaneous or traumatic nonobstetrical vaginal hemorrhage (separate procedure) |
| 57452 | Colposcopy of the cervix including upper/adjacent vagina |
| 57454 | with biopsy(s) of the cervix and/or endocervical curettage |
| 57455 | Colposcopy of the cervix including upper/adjacent vagina; with biopsy(s) of the cervix |
| 57456 | Colposcopy of the cervix including upper/adjacent vagina; with endocervical curettage |
| 57500 | Biopsy, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) |
| 57510 | Cautery of cervix; electro or thermal |
| 57511 | cryocautery, initial or repeat |
| 57800 | Dilation of cervical canal, instrumental (separate procedure) |
| 58100 | Endometrial sampling (biopsy), with or without endocervical sampling (biopsy), without cervical dilation, any method (separate procedure) |
| 58300 | Insertion of intrauterine device (IUD) |
| 58301 | Removal of intrauterine device (IUD) |
| 59200 | Insertion of cervical dilator (eg, laminaria, prostaglandin) (separate procedure) |
Table 9 - Nervous System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 64405 | Injection, anesthetic agent; greater occipital nerve |
| 64418 | Injection, anesthetic agent; suprascapular nerve |
| 64420 | intercostal nerve, single |
| 64421 | intercostal nerves, multiple, regional block |
| 64425 | ilioinguinal, iliohypogastric nerves |
| 64435 | paracervical (uterine) nerve |
| 64612 | Chemodenervation of muscle(s); muscle(s) innervated by facial nerve (e.g., for blepharospasm, hemifacial spasm) |
| 64615 | Chemodenervation of muscle(s); muscle(s) innervated by facial, trigeminal, cervical spinal and accessory nerves, bilateral (eg, for chronic migraine) |
Table 10 - Eye and Ocular Adnexa
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 65205 | Removal of foreign body, external eye; conjunctival superficial |
| 65220 | corneal, without slit lamp |
| 65430 | Scraping of cornea, diagnostic, for smear and/or culture |
| 66700 | Ciliary body destruction; diathermy |
| 67028 | Intravitreal injection of a pharmacologic agent (separate procedure) |
| 67500 | Retrobulbar injection; medication (separate procedure, does not include supply of medication) |
| 67700 | Blepharotomy, drainage of abscess, eyelid |
| 67800 | Excision of chalazion; single |
| 67801 | multiple, same lid |
| 67805 | multiple, different lids |
| 67810 | Biopsy of eyelid |
| 67820 | Correction of trichiasis; epilation, by forceps only |
| 67825 | epilation by other than forceps, (e.g., by electrosurgery or cryotherapy, laser surgery) |
| 67840 | Excision of lesion of eyelid (except chalazion) without closure or with simple direct closure |
| 68020 | Incision of conjunctiva, drainage of cyst |
| 68040 | Expression of conjunctival follicles (e.g., for trachoma) |
| 68371 | Harvesting conjunctival allograft, living donor |
| 68440 | Snip incision of lacrimal punctum |
| 68840 | Probing of lacrimal canaliculi, with or without irrigation |
Table 11 - Auditory System
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 69000 | Drainage external ear, abscess or hematoma; simple |
| 69005 | complicated |
| 69020 | Drainage external auditory canal, abscess |
| 69100 | Biopsy external ear |
| 69105 | Biopsy external auditory canal |
| 69110 | Excision external ear; partial, simple repair |
| 69145 | Excision soft tissue lesion, external auditory canal |
| 69200 | Removal foreign body from external auditory canal; without general anesthesia |
| 69209 | Removal impacted cerumen using irrigation/lavage, unilateral |
| 69210 | Removal impacted cerumen (separate procedure), one or both ears |
| 69220 | Debridement, mastoidectomy cavity, simple (e.g., routine cleaning) |
| 69420 | Myringotomy including aspiration and/or eustachian tube inflation |
| 69433 | Tympanostomy (requiring insertion of ventilating tube), local or topical anesthesia |
Table 12 - Audiologic Function Test
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 92558 | Evoked otoacoustic emissions, screening (qualitative measurement of distortion product or transient evoked otoacoustic emissions), automated analysis |
Table 13 - Evaluative and Therapeutic Services
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 93308 | Echocardiography, transthoracic, real-time with image documentation (2D) includes M-Mode recording; when performed, follow-up or limited study |
Table 14 - Pulmonary Diagnostic Therapies
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 94727 | Gas dilution or washout for determination of lung volumes and, when performed, distribution of ventilation and closing volumes |
| 94728 | Airway resistance by impulse oscillometry |
| 94780 | Car seat/bed testing for airway integrity, neonate, with continual nursing observation and continuous recording of pulse oximetry, heart rate and respiratory rate, with interpretation and report; 60 minutes |
Table 15 - Electromyography
| CPT Procedure Code | Office Procedures - Description |
|---|---|
Table 16 - Evoked Potentials and Reflex Tests
| CPT Procedure Code | Office Procedures - Description |
|---|---|
| 95938 | Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs |
| 95939 | Short-latency somatosensory evoked potential study, stimulation of any/all peripheral nerves or skin sites, recording from the central nervous system; in upper and lower limbs |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |