modifiers - aapc...transnasal diagnostic specimen collection 43197 with biopsy 43198 transoral...
TRANSCRIPT
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
An
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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
471CPT® is a registered trademark of the American Medical Association. All rights reserved.
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
CPT® is a registered trademark of the American Medical Association. All rights reserved.474
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
493CPT® is a registered trademark of the American Medical Association. All rights reserved.
Surg
ery/Integ
um
enta
ry SyStem10030 - 10081
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
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
rger
y/In
teg
um
enta
ry S
ySte
m10120 - 11008
1012
0 - 1
1008
CPT® is a registered trademark of the American Medical Association. All rights reserved.494
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
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
671CPT® is a registered trademark of the American Medical Association. All rights reserved.
Surg
ery/reSpirato
ry SyStem30000 - 30160
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
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
rger
y/re
Spir
ato
ry S
ySte
m30200 - 30462
3020
0 - 3
0462
CPT® is a registered trademark of the American Medical Association. All rights reserved.672
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
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
973CPT® is a registered trademark of the American Medical Association. All rights reserved.
Ra
dio
log
y PRoced
uRes
70010 - 70220
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
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
CPT® is a registered trademark of the American Medical Association. All rights reserved.974
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, 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®
Hepatitis A (HepA)VAQTA®
90634Havrix®
Hepatitis A (HepA)VAQTA®
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
Afluria® Quadrivalent
Influenza virusFluarix® Quadrivalent
FluLaval® Quadrivalent
Fluzone® Quadrivalent
90687Afluria® Quadrivalent
Influenza virusFluzone® Quadrivalent
90688
Afluria® Quadrivalent
Influenza virusFluLaval® Quadrivalent
Fluzone® 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