radiology compendium as of 12.28 - munson · pdf fileradiology compendium as of 12.28.16 sim...

RADIOLOGY COMPENDIUM As of 12.28.16

SIM Orderable Notes63 ABDOMEN 1 V 74000572 ABDOMEN COMPLETE 2 V 74020812 ABDOMEN COMPLETE W/ 1 V CHEST 740222459 ABSCESS DRAIN PERITONEAL/RETROP 494062458 ABSCESS DRAINAGE ORGAN 494052460 ABSCESS DRAINAGE SOFT TISSUE 100301213 ABSCESSOGRAM THRU EXISTING CATHETER 76080 494242544 ABSCESSOGRAM W/SCLEROSING AGNT 4918536 AC JOINTS BILAT 730508528 ALIGNMENT STUDY/BONE LENGTH 73550502545 ANGIO US GUIDED BIOPSY 769422196 ANGIO VERT NON‐SELECTED COMP 36225236 ANGIOGRAM ARCH 3622119 ANGIOGRAM BRACHIAL ART S&I 75658182 ANGIOGRAM CAROTID CEREBRAL BILAT 36223253 ANGIOGRAM CAROTID CEREBRAL UNI LT 36223254 ANGIOGRAM CAROTID CEREBRAL UNI RT 36223181 ANGIOGRAM CAROTID CERVICAL BILAT 36222219 ANGIOGRAM CAROTID CERVICAL UNI LT 36222220 ANGIOGRAM CAROTID CERVICAL UNI RT 36222189 ANGIOGRAM EXTERNAL CAROTID BILAT ADDL 36227194 ANGIOGRAM EXTERNAL CAROTID LT ADDL 36227196 ANGIOGRAM EXTERNAL CAROTID RT ADDL 36227694 ANGIOGRAM EXTREMITY BILAT 75716276 ANGIOGRAM EXTREMITY UNI LT 75710278 ANGIOGRAM EXTREMITY UNI RT 75710203 ANGIOGRAM INTERNAL CAROTID LT COMP 36224213 ANGIOGRAM INTERNAL CAROTID RT COMP 36224207 ANGIOGRAM PELVIC SELECTIVE 75736211 ANGIOGRAM PULMONARY BILAT 75743214 ANGIOGRAM PULMONARY NON SELECTIVE CATH 757466207 ANGIOGRAM PULMONARY UNI LT 757416272 ANGIOGRAM PULMONARY UNI RT 75741159 ANGIOGRAM SPINAL SELECTIVE 75705570 ANGIOGRAM THRU EXIST CATHETER F/U STUDY 75898184 ANGIOGRAM VERTEBRAL CERVICAL/INTRACRAN 36225261 ANGIOGRAM VISCERAL SELECTIVE 757265333 ANKLE 2 V LT 736005334 ANKLE 2 V RT 736005339 ANKLE COMPLETE MIN 3 V LT 736105340 ANKLE COMPLETE MIN 3 V RT 736108543 ANKLES MIN 3 V EA BILAT 7361050

CPT(s)


SIM Orderable NotesCPT(s)239 AORTOGRAM ABD + BIL ILIOFEMORAL EXTREM 7563020 AORTOGRAM ABDOMINAL 7562521 AORTOGRAM THORACIC 75605872 ARTERIAL CATH/CANNULATION FOR MONITORING 366202631 ARTERIAL PTA 372462632 ARTERIAL PTA ADDITIONAL SITE 372472450 ARTERIAL STENT ABOVE ILIACS 372366111 ARTHROCENTESIS INTERMEDIATE JOINT 20605 770026109 ARTHROCENTESIS MAJOR JOINT 20610 770026113 ARTHROCENTESIS SMALL JOINT 20600 770025131 ARTHROGRAM ELBOW LT 24220 730855133 ARTHROGRAM ELBOW RT 24220 730855288 ARTHROGRAM HIP LT 27093 735255290 ARTHROGRAM HIP RT 27093 735255323 ARTHROGRAM KNEE LT 27370 735805325 ARTHROGRAM KNEE RT 27370 735805107 ARTHROGRAM SHOULDER LT 23350 730405109 ARTHROGRAM SHOULDER RT 23350 730405159 ARTHROGRAM WRIST LT 25246 731155161 ARTHROGRAM WRIST RT 25246 731152628 AV CENTRAL DIALYSIS + PTA 369072629 AV CENTRAL DIALYSIS + STENT/PTA 369082627 AV DIALYSIS + DECLOT/PTA/STENT 369062630 AV DIALYSIS EMBOLIZATION 369092625 AV DIALYSIS PLUS DECLOT 369042626 AV DIALYSIS PLUS DECLOT/PTA 369052623 AV DIALYSIS PLUS PTA 369022624 AV DIALYSIS PLUS PTA/STENT 369032622 AV DIALYSIS SHUNT 3690174 BARIUM ENEMA ADULT 74270417 BARIUM ENEMA PEDS 0‐2 YRS 74270434 BARIUM ENEMA PEDS 2‐6 YRS 74270435 BARIUM ENEMA PEDS 6‐16 YRS 74270139 BARIUM ENEMA W/ AIR COLON 74280607 BARIUM ENEMA W/ AIR PEDS 742802382 BD NO CHARGE None, no charge2522 BILI STNT PLC S/P PTC W EXT TUBE 475382524 BILI STNT PLCMNT NEW PTC W EX TUB 475402527 BILIARY BRUSH BIOPSY ADDL 475431577 BILIARY ENDOSCOPY W/ DILATION + STENT 47556


SIM Orderable NotesCPT(s)2523 BILIARY STENT PLCMNT NEW PTC 475392518 BILIARY STONE REMOVAL ADDL 475442188 BIOPSY NECK/THORAX 215506 BONE AGE STUDY 77072

2366 BONE CRYOABLATION 20983887 BONE DENSITY AXIAL SKELETON 770802305 BONE DENSITY AXIAL W/VERTEBRAL FX ASSESS 770857909 BONE DENSITY PERIPHERAL SKELETON 770812112 BONE DENSITY VERTEBRAL FX ASSESS 77086891 BONE LENGTH STUDY 77073226 BONE SURVEY METABOLIC 77075413 BONE SURVEY METASTATIC 77075287 C ARM OR FLUORO None, no charge1876 C ARM/FLUORO NEURO None, no charge7694 C ARM/FLUORO VASCULAR None, no charge149 CHAIN CYSTOURTHROGRAM 74430 516052536 CHANGE NEPHROSTOMY TUBE LT COMP 504352537 CHANGE NEPHROSTOMY TUBE RT COMP 504352520 CHANGE OF INT/EXT BILIARY TUBE 475362902 CHANGE URETEROSTOMY STENT/ILEAL CONDUIT 50688 757848510 CHEMOEMBOLIZATION 965491781 CHEMOTHERAPY ADMIN INTO CNS +SPINAL PUNC 964506231 CHEMOTHERAPY ADMIN INTRA‐ARTERIAL 9642080 CHEST 1 V 710107703 CHEST 1 V W/ABDOMEN (INFANT ONLY) 710108719 CHEST 1 V W/SPECIAL VIEW(S) 71010 7103582 CHEST 2 V 71020440 CHEST 2 V W/ABDOMEN (INFANT ONLY) 710206204 CHEST DECUBITUS LT 710356269 CHEST DECUBITUS RT 71035736 CHEST TUBE INSERTION W/O FLUORO 3255684 CHEST W/ FLUORO 710237208 CHEST W/ OBLIQUES 71022565 CHEST W/LORDOTIC PROCEDURE 710212521 CHOLANGI POST BILIARY STNT PLCMNT 475372514 CHOLANGIOGRAPHY INTRAOPERATIVE 475315085 CLAVICLE COMPLETE LT 730005086 CLAVICLE COMPLETE RT 73000859 COLON STUDY W/ GASTROGRAFIN 742706430 CONTRAST INJECTION FOR FEEDING TUBE 494652519 CONV EXT BILIARY TUBE TO INT EXT 475356432 CONVERSION G TUBE TO GJ TUBE 49446


SIM Orderable NotesCPT(s)7838 CR FOREIGN IMAGES None, no charge7817 CR OUTSIDE IMAGES FOR COMPARISON None, no charge7626 CR OUTSIDE IMAGES FOR CONSULTATION None, no charge3062 CT ABD + PELVIS W/+W/O CONTR (ORAL+IV) 741783060 CT ABD + PELVIS W/IV CONT (NO ORAL) 741773063 CT ABD + PELVIS W/O CONT (NO ORAL‐NO IV) 741763064 CT ABD + PELVIS W/O IV CONT (ORAL ONLY) 741763061 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) 741772512 CT ABDOMEN LIMITED W/+W/O CONT 7417052 Physician offices would not order, but may get a report/result2513 CT ABDOMEN LIMITED W/IV CONT 7416052 Physician offices would not order, but may get a report/result2511 CT ABDOMEN LIMITED W/O CONTRAST 7415052 Physician offices would not order, but may get a report/result3054 CT ABDOMEN W/ + W/O CONTRAST (ORAL + IV) 741702304 CT ABDOMEN W/ CONTRAST PANCREAS PROTOCOL 741603050 CT ABDOMEN W/ CONTRAST (ORAL + IV) 741602275 CT ABDOMEN W/+W/O CONT (NO ORAL) 741703051 CT ABDOMEN W/IV CONTRAST (NO ORAL CONT) 741603052 CT ABDOMEN W/O CONTRAST (NO ORAL‐NO IV) 741503053 CT ABDOMEN W/O IV CONTRAST (ORAL ONLY) 74150819 CT ABSCESS DRAINAGE 759892132 CT ADDITIONAL VIEWS None, no charge2554 CT BRACHYTHERAPY None, no charge Radiology use only7608 CT CALCIUM SCORING 755717859 CT CERVICAL SPINE W + W/O 72127135 CT CERVICAL SPINE W/O CONTRAST 721253065 CT CHEST + ABD W/O CONT (NO ORAL‐NO IV) 71250 741503069 CT CHEST + ABDOMEN W/ CONT (ORAL + IV) 71260 741603071 CT CHEST + ABDOMEN W/ IV CONT (NO ORAL) 71260 741603067 CT CHEST + ABDOMEN W/O IV (ORAL ONLY) 71250 741503077 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) 74177 712603073 CT CHEST ABD PELVIS W/O (NO ORAL‐NO IV) 71250 741763075 CT CHEST ABD PELVIS W/O IV (ORAL ONLY) 71250 741763079 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) 74177 712602509 CT CHEST LIMITED W/ CONTRAST 7126052 Physician offices would not order, but may get a report/result2510 CT CHEST LIMITED W/O CONTRAST 7125052 Physician offices would not order, but may get a report/result2939 CT CHEST PE PROTOCOL 71260123 CT CHEST W/ + W/O CONTRAST 71270122 CT CHEST W/ CONTRAST 71260121 CT CHEST W/O CONTRAST 712507617 CT CORONARY ARTERIES W/ CALCIUM SCORING 75574398 CT CYST ASP 770121208 CT FACIAL BONES FOR IMPLANTS 763807240 CT FACIAL BONES W/ + W/O CONTRAST 70488


SIM Orderable NotesCPT(s)562 CT FACIAL BONES W/ CONTRAST 70487129 CT FACIAL BONES W/O CONTRAST 704867839 CT FOREIGN IMAGES None, no charge399 CT GUIDANCE BIOPSY/NEEDLE PLACEMENT 770126482 CT GUIDANCE FOR RF BONE ABLATION 209827906 CT GUIDANCE FOR TISSUE ABLATION 770136205 CT GUIDANCE THORACENTESIS 325557907 CT GUIDED CHEST TUBE PLACEMENT 3255171 CT HEAD W/ + W/O CONTRAST 7047070 CT HEAD W/ CONTRAST 7046069 CT HEAD W/O CONTRAST 704502949 CT HEMATURIA PROTOCOL 74178711 CT LIMITED F/U LUNG 71250525192 CT LOWER EXTREM W/ + W/O CONTRAST LT 737025193 CT LOWER EXTREM W/ + W/O CONTRAST RT 737025190 CT LOWER EXTREM W/ CONTRAST LT 737015191 CT LOWER EXTREM W/ CONTRAST RT 737016297 CT LOWER EXTREM W/O CONTRAST LIMITED LT 73700526298 CT LOWER EXTREM W/O CONTRAST LIMITED RT 73700525186 CT LOWER EXTREM W/O CONTRAST LT 737005187 CT LOWER EXTREM W/O CONTRAST RT 73700120 CT LUMBAR SPINE W/ + W/O CONTRAST 72133119 CT LUMBAR SPINE W/ CONTRAST 72132118 CT LUMBAR SPINE W/O CONTRAST 721317695 CT LUNG CANCER SCREENING ANNUAL EXAM G0297

2562CT LUNG CANCER SCREENING INTERVAL F/U

71250Billed at facilitiy's charge for CT Chest w/o to Medicare, Medicaid, Private Insurance, etc.

854 CT LUNGS HIGH RESOLUTION 71250134 CT NECK SOFT TISSUE W/ + W/O CONTRAST 70492133 CT NECK SOFT TISSUE W/ CONTRAST 70491132 CT NECK SOFT TISSUE W/O CONTRAST 704902385 CT NO CHARGE None, no charge1742 CT ORBITS W/ + W/O CONTRAST 70482110 CT ORBITS w/ CONTRAST 7048173 CT ORBITS W/O CONTRAST 704807818 CT OUTSIDE IMAGES FOR COMPARISON None, no charge7649 CT OUTSIDE IMAGES FOR CONSULTATION None, no charge3059 CT PELVIS W/ + W/O CONTRAST (ORAL + IV) 721943057 CT PELVIS W/ CONTRAST (ORAL + IV) 721933058 CT PELVIS W/IV CONTRAST (NO ORAL CONT) 721933055 CT PELVIS W/O CONTRAST (NO ORAL‐NO IV) 721923056 CT PELVIS W/O IV CONTRAST (ORAL ONLY) 72192


SIM Orderable NotesCPT(s)5060 CT PELVIS/KIDNEY STONE PROTOCOL 74176402 CT PITUITARY W/ + W/O CONTRAST 70482395 CT PITUITARY W/ CONTRAST 70481401 CT PITUITARY W/O CONTRAST 704804873 CT ROTATION STUDY 73700RT52 73700LT52407 CT SCANOGRAM 770731151 CT SINUSES W/ + W/O CONTRAST 704881581 CT SINUSES W/ CONTRAST 70487561 CT SINUSES W/O CONTRAST 704862435 CT STEALTH HEAD W + W/O CONTRAST 704702434 CT STEALTH HEAD W/CONTRAST 704602433 CT STEALTH SPINE C SPINE W/O 721252274 CT STEREOTACTIC HEAD W/O 70450406 CT STEREOTATIC LOC 77011404 CT TEMPORAL BONES W/ + W/O CONTRAST 70482403 CT TEMPORAL BONES W/ CONTRAST 70481396 CT TEMPORAL BONES W/O CONTRAST 70480137 CT THORACIC SPINE W/ CONTRAST 72129138 CT THORACIC SPINE W/O CONTRAST 721287251 CT UPPER EXTREM W/ + W/O CONTRAST LT 732027252 CT UPPER EXTREM W/ + W/O CONTRAST RT 732025274 CT UPPER EXTREM W/ CONTRAST LT 732015275 CT UPPER EXTREM W/ CONTRAST RT 732015270 CT UPPER EXTREM W/O CONTRAST LT 732005271 CT UPPER EXTREM W/O CONTRAST RT 732002550 CT VENOGRAM.HEAD W/ + W/O CONTRAST 704702549 CT VENOGRAM/HEAD W/ CONTRAST 704605394 CTA ABD AORTA/RUNOFF 756352406 CTA ABDOMEN + PELVIS W/ IMAGE POST PROC 741742358 CTA ABDOMEN DISSECTION PROTOCOL 741755393 CTA ABDOMEN W/ IMAGE POST PROCESSING 741753046 CTA CARDIAC PULMONARY VEIN MAPPING 755722438 CTA CARDIAC TAVI W/ CONTRAST 755722439 CTA CARDIAC TAVI W/O CONTRAST 75572522429 CTA CHEST ABD PELV TAVI W/CON 71275 741742431 CTA CHEST ABD PELV TAVI W/O CON 71275 741742929 CTA CHEST DISSECTION PROTOCOL 712752401 CTA CHEST THORACIC AORTA 712752200 CTA CHEST/ABD DISSECTION PROTOCOL 71275 741758452 CTA CORONARY ARTERIES 755745385 CTA HEAD W/ IMAGE POST PROCESSING 704962484 CTA LOWER EXT BIL W/IMAGE POST 7370650


SIM Orderable NotesCPT(s)5392 CTA LOWER EXTREM LT W/IMAGE POST PROCESS 737065391 CTA LOWER EXTREM RT W/IMAGE POST PROCESS 737062437 CTA MESENTERIC ABDOMEN 741745386 CTA NECK W/ IMAGE POST PROCESSING 704985388 CTA PELVIS W/ IMAGE POST PROCESSING 721915389 CTA UPPER EXTREM RT W/IMAGE POST PROCESS 732065390 CTA UPPER EXTREM LT W/IMAGE POST PROCESS 732062829 CTA VENOGRAM LOWER EXT LT 737062828 CTA VENOGRAM LOWER EXT RT 737062827 CTA VENOGRAM UPPER EXT LT 732062826 CTA VENOGRAM UPPER EXT RT 732066333 CV CATH CNTEL INS NON TUNN W/O 365561502 CV CATH CNTRL INSERTION NON TUNNEL FLUO 36556 770011506 CV CATH CNTRL INSERTION TUNNELED FLUORO 36558 770011510 CV CATH CNTRL INSERTION TUNNELED W/PORT 36561 770011514 CV CATH PERIPHERALLY INSERT < 5 Y/O FLUO 36568 770011518 CV CATH PERIPHERALLY INSERT > 5 Y/O FLUO 36569 770017892 CV CATH REMOVAL NURSING E & M 992111534 CV CATH REMOVAL W/ PORT FLUORO 36590 770017891 CV CATH REMOVAL W/ PORT W/O FL 365901532 CV CATH REMOVAL W/O PORT FLUORO 36589 770017890 CV CATH REMOVAL W/O PORT W/O FL 365891520 CV CATH REPAIR W/O PORT FLUORO 36575 770011522 CV CATH REPAIR W/ PORT FLUORO 36576 770011530 CV CATH REPLACEMENT PICC FLUORO 36584 770011528 CV CATH REPLACEMENT TUNNELED W/ PORT FL 36582 770011526 CV CATH REPLACEMENT TUNNELED W/O PORT FL 36581 770011524 CV CATH REPLACEMENT W/O PORT FLUORO 36580 770011536 CV CATH REPOSITION/PREVIOUSLY PLACED FL 36597161 CYSTOGRAM 51600 744307878 CYSTOSTOMY TUBE CHANGE 75984 517057089 CYSTOURETHROSCOPY INSER URETERAL STEN LT 523327087 CYSTOURETHROSCOPY INSER URETERAL STEN RT 523322722 CYSTOURETHROSCOPY INSERT URETERAL WIRE 523346230 CYSTOURETHROSCOPY URETERAL BRUSH BX LT 523546295 CYSTOURETHROSCOPY URETERAL BRUSH BX RT 523547097 CYSTOURETHROSCOPY URETERAL STENT REM LT 523107095 CYSTOURETHROSCOPY URETERAL STENT REM RT 523101452 DECLOTTING IMPLANTED VASC DEVICE 36593894 DEFECOGRAPHY 742702526 DILATATION OF BILIARY TREE ADDL 475422542 DILATATION OF URETER LT ADDL 50706


SIM Orderable NotesCPT(s)2543 DILATATION OF URETER RT ADDL 50706373 DILATION OF BILIARY TRACT 74360375 DILATION OF NEPHROSTOMY 74485 503957117 DILATION OF URETER LT 74485 505537115 DILATION OF URETER RT 74485 50553563 DISCOGRAPHY CERVICAL EACH LEVEL 62291 72285564 DISCOGRAPHY LUMBAR EACH LEVEL 72295 622905121 ELBOW 2 V LT 730705122 ELBOW 2 V RT 730705127 ELBOW COMP MIN 3 V LT 730805128 ELBOW COMP MIN 3 V RT 730802455 EMBOLIZATION ARTERIAL 372422457 EMBOLIZATION HEMORRHAGE 372442456 EMBOLIZATION TUMOR/ORGAN 372432454 EMBOLIZATION VENOUS 37241168 ERCP BILIARY + PANCREATIC DUCTAL SYS 743305487 ERCP BILIARY DUCTAL SYSTEM 74328380 ERCP W/ SPINCTOEROTOMY 43262 7432865 ESOPHAGRAM 74246588 ESOPHAGRAM ‐ PEDIATRIC 742202133 ESOPHAGRAM POST LAP BAND 742202296 EVALUATION OF GASTRIC TUBE 49465 Physician offices would not order, but may get a report/result7900 EVALUATION OF PEG TUBE 494658522 EXCH/MANIP EXIST CATH FOR THROMBOLYSIS 372131217 EXCHANGE OF ABSCESS OR CYST DRAIN CATH 49423266 EXCISION/UNROOFING CYST OF KIDNEY LT 50280267 EXCISION/UNROOFING CYST OF KIDNEY RT 502805063 FACIAL BONES < 3 V 701408442 FACIAL BONES COMPLETE MIN 3 V^ 701508738 FEM/POP ATHERECTOMY COMPLETE 372258737 FEM/POP PTA COMPLETE 372248739 FEM/POP STENT COMPLETE 377265298 FEMUR 2 V LT 735525299 FEMUR 2 V RT 735522004 FINGER(S) MIN 2 V LT 731402011 FINGER(S) MIN 2 V RT 73140571 FISTULA OR SINUS TRACT STUDY W/INJECTION 20501 760809 FISTULA TRACT STUDY 76080 20501

2819 FIXED OR FLUORO None, no charge7690 FLUOR GU NEEDLE PLACEMENT W/BONE BIOPSY 77002 202257740 FLUORO FOR INJECTION PAIN CLINIC 770037705 FLUORO GU TRIGGER POINT/NERVE BLOCK 77002


SIM Orderable NotesCPT(s)6384 FLUORO GUIDANCE FOR INJECTION 61070 77003695 FLUORO GUIDANCE FOR NEEDLE PLACEMENT 770021564 FLUORO GUIDANCE FOR VAD/IN OR 770011874 FLUOROSCOPY FOR BRONCHOSCOPY None, no charge5345 FOOT 2 V LT 736205169 FOOT 2 V RT 736208531 FOOT COMPLETE MIN 3 V EA BILAT 73630505174 FOOT COMPLETE MIN 3 V LT 736305175 FOOT COMPLETE MIN 3 V RT 736305135 FOREARM 2 V LT 730905136 FOREARM 2 V RT 73090584 FOREIGN BODY SCAN CHILD 760102184 GD ADDITIONAL VIEWS None, no charge Inpatient ONLY2381 GD NO CHARGE None, no charge710 GI MOTILITY STUDY 74250178 GUIDANCE FOR PERCUTANEOUS DRAINAGE 759897956 HAND 2 V EACH BIL 73120LT 7312RT5164 HAND 2 V LT 731205165 HAND 2 V RT 731208533 HAND MIN 3 V BILAT 73130505264 HAND MIN 3 V LT 731305265 HAND MIN 3 V RT 731305180 HEEL MIN 2 V LT 736505181 HEEL MIN 2 V RT 736505276 HIP 1 V UNI LT 735015277 HIP 1 V UNI RT 735017652 HIP ASPIRATION LT 77002 206107654 HIP ASPIRATION RT 77002 206102220 HIP COMP 1V LT W/PELVIS 1 V 735012222 HIP COMP 1V RT W/PELVIS 1 V 735012224 HIP COMP 2V LT W/PELVIS 1 V 735022226 HIP COMP 2V RT W/PELVIS 1 V 735025282 HIP COMPLETE MIN 2 V LT 735025283 HIP COMPLETE MIN 2 V RT 735022315 HIP INJECTION FLUORO LT 20610 770022317 HIP INJECTION FLUORO RT 20610 770025292 HIP PERFORMED IN OR LT 735015293 HIP PERFORMED IN OR RT 735015294 HIP/PELVIS INFANT OR CHILD MIN 2 V 7350251 HIPS MIN 2 V BILAT 735215115 HUMERUS MIN 2 V LT 730605116 HUMERUS MIN 2 V RT 73060


SIM Orderable NotesCPT(s)163 HYSTEROSALPINGOGRAPHY 58340 747407614 I‐131 TOTAL BODY SCAN 780188746 ILIAC 2ND KISSING STENT COMPLETE 37221598735 ILIAC ADDL PTA ISPILATERAL COMPLETE 372228736 ILIAC ADDL STENT ISPLATERAL COMPLETE 372233083 ILIAC ANEURYSM ENDOGRAFT 34900 759548733 ILIAC PTA COMPLETE 372208734 ILIAC STENT COMPLETE 372217449 INJECTION OF CONTRAST PERITONEAL CAVITY 494007641 INJECTION W/ FLUORO EVAL CV DEVICE 365988423 INS INDWELL TUNNEL PERITONEAL CATH W/CUF 494181800 INSERT INDWELL TUNNEL PLEURAL CATH W/CUF 32550 759897904 INSERT PERCUTANEOUS DUODENOSTOMRY/J TUBE 494411799 INSERTION OF TIPS 37182671 INTRODUCTION OF CATHETER AORTA 36200920 IR CLINIC CONSULTATION based on time 2393 IR CLINIC FOLLOW UP based on time 2415 IVC FILTER INSERT COMPLETE 371912416 IVC FILTER REMOVAL COMPLETE 37193146 IVP 74400145 IVP ADULT W/TOMOGRAPHY 74415415 IVP PEDS 0‐2 YRS 74415432 IVP PEDS 2‐6 YRS 74415433 IVP PEDS 6‐16 YRS 74415595 IVP W/O TOMOGRAPHY 744105303 KNEE 1 ‐ 2 V LT 735605304 KNEE 1 ‐ 2 V RT 735605309 KNEE 3 V LT 735625310 KNEE 3 V RT 735625315 KNEE COMPLETE MIN 4 V LT 735645316 KNEE COMPLETE MIN 4 V RT 735648529 KNEES BILATERAL 2 V EACH 73560506227 KNEES BILATERAL 3 V EACH 73562LT 73562RT8535 KNEES BILATERAL 4 V EACH 73564505321 KNEES STANDING AP ONLY BILAT 735652374 KYPHOPLASTY EA ADD THOR OR LUMB VERT 225152373 KYPHOPLASTY LUMBAR FIRST VERT 225142372 KYPHOPLASTY THORACIC FIRST VERT 225137701 LOOPOGRAM (GENERAL DX) 50690 74425378 LOOPOGRAM (SPECIALS) 74425 506907215 LOWER EXTREM INFANT MIN 2 V LT 735927216 LOWER EXTREM INFANT MIN 2 V RT 73592


SIM Orderable NotesCPT(s)2039 LUMBAR PUNCTURE W/FLUORO 622707218 MA BREAST CYST ASP UNI LT 190007219 MA BREAST CYST ASP UNI RT 190002971 MA BREAST SPECIMEN UNI LT FROM OR 760982972 MA BREAST SPECIMEN UNI RT FROM OR 760987921 MA DIAGNOSTIC CONSULTATION LETTER None, no charge2477 MA FFD DX FOLLOW PROCEDURE BIL G02042478 MA FFD DX FOLLOW PROCEDURE LT G02062479 MA FFD DX FOLLOW PROCEDURE RT G02068459 MA FFD MAMM DIAGNOSTIC BILAT G02042169 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL G0204GG2170 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT G0206GG2171 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT G0206GG8469 MA FFD MAMM DIAGNOSTIC UNI LT G02068472 MA FFD MAMM DIAGNOSTIC UNI RT G02062569 MA FFD MAMM DX LT ICAD G02062568 MA FFD MAMM DX BILAT ICAD G02042570 MA FFD MAMM DX RT ICAD G02062571 MA FFD MAMM SCREEN BIL ICAD G02022572 MA FFD MAMM SCREEN LT ICAD G0202522573 MA FFD MAMM SCREEN RT ICAD G0202527842 MA FOREIGN IMAGES None, no charge2975 MA GUIDED BREAST DUCTOGRAM W/MULT LT 77054 190302976 MA GUIDED BREAST DUCTOGRAM W/MULT RT 77054 190302977 MA GUIDED BREAST DUCTOGRAM W/SINGLE LT 77053 190302978 MA GUIDED BREAST DUCTOGRAM W/SINGLE RT 77053 190302979 MA GUIDED BREAST NEEDLE LOC WIRE LT 192812980 MA GUIDED BREAST NEEDLE LOC WIRE RT 192812983 MA GUIDED BREAST STEREOTACTIC LT 190812984 MA GUIDED BREAST STEREOTACTIC RT 190817609 MA MAMMOGRAM MISCELLANEOUS NONE Used to order for inpatient only,2383 MA NO CHARGE None, no charge7829 MA OUTSIDE IMAGES FOR COMPARISON None, no charge1248 MA OUTSIDE IMAGES FOR CONSULTATION None, no charge7560 MA PRETREATMENT REVIEW None, no charge2859 MA RADIOLOGY PATHOLOGY F/U REPORT None, no charge3 MANDIBLE COMPLETE MIN 4 V 70110

2185 MANDIBLE LESS THEN 4 V 701002185 MANDIBLE LESS THEN 4 V 701008524 MECH REMOVAL FIBRIN SHEATH VENOUS ACCESS 36595 759016118 MISC DSA/ANGIO PROCEDURE None, no charge


SIM Orderable NotesCPT(s)7844 MR FOREIGN IMAGES None, no charge7837 MR OUTSIDE IMAGES FOR COMPARISON None, no charge7648 MR OUTSIDE IMAGES FOR CONSULTATION None, no charge6357 MRA ABDOMEN W/ + W/O CONTRAST C8902 6355 MRA ABDOMEN W/ CONTRAST C89006356 MRA ABDOMEN W/O CONTRAST C89016351 MRA CHEST W/ + W/O CONTRAST C89116349 MRA CHEST W/ CONTRAST C89096350 MRA CHEST W/O CONTRAST C89105365 MRA HEAD W/ + W/O CONTRAST 705465363 MRA HEAD W/ CONTRAST 705455361 MRA HEAD W/O CONTRAST 705447928 MRA INCOMPLETE ABDOMEN C8901527931 MRA INCOMPLETE CHEST C89010527929 MRA INCOMPLETE HEAD 70544527933 MRA INCOMPLETE LOWER EXTREMITY C8913527932 MRA INCOMPLETE NECK 70547527930 MRA INCOMPLETE PELVIS C8920527934 MRA INCOMPLETE UPPER EXTREMITY C8935521357 MRA LOWER EXTREM W/ + W/O CONTRAST LT C89141358 MRA LOWER EXTREM W/ + W/O CONTRAST RT C89142921 MRA LOWER EXTREM W/ OUTFLOW C8912505371 MRA NECK W/ + W/O CONTRAST 705495369 MRA NECK W/ CONTRAST 705485367 MRA NECK W/O CONTRAST 70547865 MRA PELVIS W/ + W/O CONTRAST C89201367 MRA RENAL W/ + W/O CONTRAST C89021366 MRA RENAL W/ CONTRAST C89001365 MRA RENAL W/O CONTRAST C89017553 MRA UPPER EXTREM W/ + W/O CONTRAST LT C89367554 MRA UPPER EXTREM W/ + W/O CONTRAST RT C89361360 MRA UPPER EXTREM W/ CONTRAST LT C89341363 MRA UPPER EXTREM W/ CONTRAST RT C89341359 MRA UPPER EXTREM W/O CONTRAST LT C89351362 MRA UPPER EXTREM W/O CONTRAST RT C89354088 MRI ABDOMEN (MRCP) W/ + W/O CONTRAST 741834087 MRI ABDOMEN (MRCP) W/O CONTRAST 741815383 MRI ABDOMEN W/ + W/O CONTRAST 741835381 MRI ABDOMEN W/ CONTRAST 74182527 MRI ABDOMEN W/O CONTRAST 74181860 MRI ADDL V None, no charge7574 MRI ANKLE W/ + W/O CONTRAST LT 73723


SIM Orderable NotesCPT(s)7575 MRI ANKLE W/ + W/O CONTRAST RT 737237572 MRI ANKLE W/ CONTRAST LT 737227573 MRI ANKLE W/ CONTRAST RT 737227576 MRI ANKLE W/O CONTRAST LT 737217577 MRI ANKLE W/O CONTRAST RT 737216160 MRI BONE MARROW BLOOD STUDY 770842498 MRI BRACHIAL PLEXUS W + W/O 73220667 MRI BRAIN W/ + W/O CONTRAST 70553546 MRI BRAIN W/ CONTRAST 70552519 MRI BRAIN W/O CONTRAST 705512556 MRI BRAIN W/O VENTRICLES MEASUREMENT 7055152 Use for pediatric patients6348 MRI BREAST W/ + W/O CONTRAST BILAT C89086342 MRI BREAST W/ + W/O CONTRAST LT C89056345 MRI BREAST W/ + W/O CONTRAST RT C89056346 MRI BREAST W/ CONTRAST BILAT C89066340 MRI BREAST W/ CONTRAST LT C89036343 MRI BREAST W/ CONTRAST RT C89036347 MRI BREAST W/O CONTRAST BILAT C89076341 MRI BREAST W/O CONTRAST LT C89046344 MRI BREAST W/O CONTRAST RT C8904668 MRI CERVICAL SPINE W/ + W/O CONTRAST 72156545 MRI CERVICAL SPINE W/ CONTRAST 72142521 MRI CERVICAL SPINE W/O CONTRAST 721415360 MRI CHEST W/ + W/O CONTRAST 715525358 MRI CHEST W/ CONTRAST 71551520 MRI CHEST W/O CONTRAST 715507584 MRI ELBOW W/ CONTRAST LT 732227585 MRI ELBOW W/ CONTRAST RT 732227586 MRI ELBOW W/+W/O CONTRAST LT 732237587 MRI ELBOW W/+W/O CONTRAST RT 732237588 MRI ELBOW W/O CONTRAST LT 732217590 MRI ELBOW W/O CONTRAST RT 732212388 MRI ENTEROGRAPHY ABD/PEL W/O W/GLUCAGON 74181 72195 J1610 Q99542387 MRI ENTEROGRAPHY ABD/PEL W+WO W/GLUCAGON 74183 72197 J1610 Q99545413 MRI FACE W/ & W/O CONTRAST 705435410 MRI FACE W/ CONTRAST 70542535 MRI FACE W/O CONTRAST 705402503 MRI FOOT W + W/O CONTRAST LT 737202504 MRI FOOT W + W/O CONTRAST RT 737202501 MRI FOOT W/ CONTRAST LT 737192502 MRI FOOT W/ CONTRAST RT 737192499 MRI FOOT W/O CONTRAST LT 73718


SIM Orderable NotesCPT(s)2500 MRI FOOT W/O CONTRAST RT 737182442 MRI GUIDED BREAST BIOPSY LT 190852443 MRI GUIDED BREAST BIOPSY RT 190852441 MRI GUIDED BREAST NEEDLE LOC LT 192872440 MRI GUIDED BREAST NEEDLE LOC RT 192872496 MRI HAND W + W/O CONTRAST LT 732202497 MRI HAND W + W/O CONTRAST RT 732202494 MRI HAND W/ CONTRAST LT 732192495 MRI HAND W/ CONTRAST RT 732192492 MRI HAND W/O CONTRAST LT 732182493 MRI HAND W/O CONTRAST RT 732186163 MRI HEART W/ CONTRAST 75561526166 MRI HEART FOR VELOCITY FLOW MAPPING 755656415 MRI HEART W/ + W/O CONTRAST 75561528 MRI HEART W/O CONTRAST 755572952 MRI HIP LIMITED W/O CONTRAST LT 73721522953 MRI HIP LIMITED W/O CONTRAST RT 73721527568 MRI HIP W/ + W/O CONTRAST LT 737237569 MRI HIP W/ + W/O CONTRAST RT 737237564 MRI HIP W/ CONTRAST LT 737227567 MRI HIP W/ CONTRAST RT 737227570 MRI HIP W/O CONTRAST LT 737217571 MRI HIP W/O CONTRAST RT 737218537 MRI HIPS BIL W/ + W/O CONTRAST 73723508539 MRI HIPS BILATERAL W/ CONTRAST 73722508541 MRI HIPS BILATERAL W/O CONTRAST 73721507862 MRI INCOMPLETE ABDOMEN 74181527863 MRI INCOMPLETE BRAIN 70551527875 MRI INCOMPLETE BREAST C8904527864 MRI INCOMPLETE CERVICAL SPINE 72141527865 MRI INCOMPLETE CHEST 71550527870 MRI INCOMPLETE FACE NECK ORBIT 70540527866 MRI INCOMPLETE JOINT LOWER EXTREM 73721527867 MRI INCOMPLETE JOINT UPPER EXTREM 73221527868 MRI INCOMPLETE LOWER EXTREMITY 73718527869 MRI INCOMPLETE LUMBAR SPINE 72148527871 MRI INCOMPLETE PELVIS 72195527872 MRI INCOMPLETE THORACIC SPINE 72146527873 MRI INCOMPLETE TMJ 70336527874 MRI INCOMPLETE UPPER EXTREMITY 73218522160 MRI KNEE W/ + W/O CONTRAST LT 737232161 MRI KNEE W/ + W/O CONTRAST RT 73723


SIM Orderable NotesCPT(s)2158 MRI KNEE W/ CONTRAST LT 737222159 MRI KNEE W/ CONTRAST RT 737222164 MRI KNEE W/O CONTR LT 737217563 MRI KNEE W/O CONTRAST RT 737216217 MRI LOWER EXTREM W/ + W/O CONTRAST LT 737206282 MRI LOWER EXTREM W/ + W/O CONTRAST RT 737206253 MRI LOWER EXTREM W/ CONTRAST LT 737196318 MRI LOWER EXTREM W/ CONTRAST RT 737196251 MRI LOWER EXTREM W/O CONTRAST LT 737186316 MRI LOWER EXTREM W/O CONTRAST RT 73718670 MRI LUMBAR SPINE W/ + W/O CONTRAST 72158544 MRI LUMBAR SPINE W/ CONTRAST 72149523 MRI LUMBAR SPINE W/O CONTRAST 721485412 MRI NECK W/ + W/O CONTRAST 705435409 MRI NECK W/ CONTRAST 70542534 MRI NECK W/O CONTRAST 70540861 MRI NO CHARGE None, no charge5411 MRI ORBITS W/ + W/O CONTRAST 705435408 MRI ORBITS W/ CONTRAST 705421368 MRI ORBITS W/O CONTRAST 705403487 MRI PELVIS ‐ FIBROID PROTOCOL 721975398 MRI PELVIS W/ + W/O CONTRAST 72197524 MRI PELVIS W/ CONTRAST 721965396 MRI PELVIS W/O CONTRAST 721952547 MRI PROSTATE W/ & W/O CONTRAST 72197 only done at MMC7578 MRI SHOULDER W/ CONTRAST LT 732227579 MRI SHOULDER W/ CONTRAST RT 732227580 MRI SHOULDER W/+W/O CONTRAST LT 732237581 MRI SHOULDER W/+W/O CONTRAST RT 732237582 MRI SHOULDER W/O CONTRAST LT 732217583 MRI SHOULDER W/O CONTRAST RT 732212491 MRI STEALTH 70552669 MRI THORACIC SPINE W/ + W/O CONTRAST 72157543 MRI THORACIC SPINE W/ CONTRAST 72147522 MRI THORACIC SPINE W/O CONTRAST 72146585 MRI TMJ 703366216 MRI UPPER EXTREM W/ + W/O CONTRAST LT 732206281 MRI UPPER EXTREM W/ + W/O CONTRAST RT 732206261 MRI UPPER EXTREM W/ CONTRAST LT 732196326 MRI UPPER EXTREM W/ CONTRAST RT 732196259 MRI UPPER EXTREM W/O CONTRAST LT 732186324 MRI UPPER EXTREM W/O CONTRAST RT 73218


SIM Orderable NotesCPT(s)2950 MRI WRIST LIMITED W/O CONTRAST LT 73221522951 MRI WRIST LIMITED W/O CONTRAST RT 73221527591 MRI WRIST W/ CONTRAST LT 732227592 MRI WRIST W/ CONTRAST RT 732227593 MRI WRIST W/+W/O CONTRAST LT 732237594 MRI WRIST W/+W/O CONTRAST RT 732237595 MRI WRIST W/O CONTRAST LT 732217596 MRI WRIST W/O CONTRAST RT 732212490 MRV HEAD W/O CONTRAST 705442505 MRV LOWER EXTREM W/O CONTR LT C89132506 MRV LOWER EXTREM W/O CONTR RT C89132507 MRV UPPER EXTREM W/O CONTR LT C89352508 MRV UPPER EXTREM W/O CONTR RT C89352319 MYELOGRAM CERVICAL SPINE 623022321 MYELOGRAM LUMBAR SPINE 623042322 MYELOGRAM SPINE TWO OR MORE REGIONS 623052320 MYELOGRAM THORACIC SPINE 623038443 NASAL BONES COMPLETE MIN 3 V 7016078 NECK SOFT TISSUE 703602535 NEPH TUBE CONVER TO NEPHROURETE 504342530 NEPHROSTOGRAM LT THRU CATHETER 504312528 NEPHROSTOGRAM LT THRU NEEDLE 504302531 NEPHROSTOGRAM RT THRU CATHETER 504312529 NEPHROSTOGRAM RT THRU NEEDLE 504306434 NG TUBE PLACEMENT (GEN DX) 437522183 NM ADDITIONAL VIEWS None, no charge6386 NM BACLOFEN PUMP EVAL A9548 758097850 NM BLOOD POOL STUDY (LEFT) W/RVEF 78472 78496 A95601599 NM BONE MARROW LIMITED 78102 A9541358 NM BONE SCAN THREE PHASE 78315 A95031478 NM BONE WHOLE BODY 78306 A9503834 NM BONE WHOLE BODY W/SPECT 78320 A95037715 NM BONE/JOINT IMAGING 78300 A9503332 NM BOWEL IMAGING MECKELS 78290 A95121584 NM BRAIN SCAN W/ SPECT 78607 A9521885 NM CARDIAC BLD POOL 1ST PASS 78472 A9560906 NM CARDIAC BLD POOL MUGA/REST 78472 A9560341 NM CARDIAC MEDIASTINAL 78466 A9512363 NM CARDIAC SHUNT 78428 A9560368 NM CEREBRAL VASCULAR FLOW A9539 786101788 NM CEREBROSPINAL FLUID FLOW FOR PATENCY 78630 A9539 623111784 NM CISTERNOGRAM A9548 78630 77003 62311


SIM Orderable NotesCPT(s)7843 NM FOREIGN IMAGES None, no charge334 NM GALLBLADDER IMAGING 78226 A9537582 NM GALLBLADDER W/STIMULATION 78227 A9537 J2805742 NM GASTRIC EMPTYING LIQUID 78264 A9572743 NM GASTRIC EMPTYING LIQUID + SOLID 78264 A9572 A9540367 NM GASTRIC EMPTYING SOLID 78264 A9541874 NM GASTROESOPHAGEAL REFLUX STUDY 78262 A9541566 NM GI BLEED TAGGED RBC 78278 A9560578 NM I‐131 ABLATION/RECUR THYROID CA 79005905 NM I‐131 ABLATION/THYROID CA 79005430 NM I‐131 HYPERTHYROID TREATMENT 790057860 NM I‐131 TOTAL BODY RESTAGING 78018 780207711 NM I‐131 TOTAL BODY SCAN FOLLOW UP 780185421 NM LAVEEN SHUNT PATENCY A9512 49427 78291338 NM LIVER + SPLEEN IMAGING 78215 A9541337 NM LIVER IMAGING 78205 A9541820 NM LIVER IMAGING W/ SPECT 78205 A9560903 NM LIVER IMAGING W/ SPECT + VASC FLOW 78206 A9560873 NM LYMPH GLAND IMAGING 78195 A95417857 NM LYMPHATIC IMAGING 78195 A95412551 NM MIBG SCAN 78804 A95166232 NM MYO MLT SPECT THALLIUM STR/ADENOSINE 78452 A95056235 NM MYO MLT SPECT THALLIUM STR/DOBUTAMINE 78452 A95056240 NM MYO MLT SPECT THALLIUM STR/PERSANTINE 78452 A95057884 NM MYOC MULTI SPECT PERF W /DOBUTAMINE 78452 A95007845 NM MYOC MULTI SPECT PERF W/ADENOSINE 78452 A95002866 NM MYOC MULTI SPECT PERF W/LEXISCAN 78452 A95001487 NM MYOC MULTI SPECT PERF W/PERSANTINE 78452 A95027180 NM MYOC MULTI SPECT W/ THALLIUM STRESS 78452 A95057174 NM MYOC PERF PLANAR MULTI SESTAMIBI 78454 A95001749 NM MYOC PERF PLANAR SINGLE SESTAMIBI 78453 A95001747 NM MYOC PERF PLANAR SINGLE THALLIUM 78453 A95057168 NM MYOC SINGLE W/ SPECT THALLIUM REST 78451 A95051499 NM MYOCARDIAL MULTI SPECT W/ STRESS 78452 A95002386 NM NO CHARGE None, no charge869 NM OCTREOSCAN WH BODY W/SPECT SINGLE A9572 788047833 NM OUTSIDE IMAGES FOR COMPARISON None, no charge7853 NM OUTSIDE IMAGES FOR CONSULTATION None, no charge1480 NM PARATHYROID IMAGING 78070 A95002191 NM PARATHYROID PLANAR W/SPECT CT 78012 A95002808 NM PERFUSION + AEROSOL LUNG SCAN 78582 A9539343 NM PERFUSION IMAGING 78580 A9540


SIM Orderable NotesCPT(s)583 NM PERFUSION/VENT REBREAT + WASHOUT 78582 A9558 A9540587 NM PERFUSION/VENTILATION QUANTITATIVE 78598 A9558 A95402135 NM PET MYOCARDIAL VIABILITY 78459 A95522911 NM PET/CT BRAIN PI 78608PI A95522912 NM PET/CT BRAIN PS 76808PS A95526243 NM PET/CT LIMITED AREA PI 78814PI A95526250 NM PET/CT LIMITED AREA PS 78814PS A95526420 NM PET/CT OUTSIDE IMAGES FOR CONS None, no charge6267 NM PET/CT SKULL TO MID THIGH PI 78815PI A95526270 NM PET/CT SKULL TO MID THIGH PS 78815PS A95526274 NM PET/CT WHOLE BODY PI 78816PI A95526276 NM PET/CT WHOLE BODY PS 78816PS A95527170 NM PULM PERFUSION W/VENTILATION IMAGING 78582 A9540 A9558345 NM PULM VENTILATION W/REBREAT+WASHOUT 78582 A95582411 NM PULMONARY VENTILATION (ONLY) IMAGING 78579 A95582413 NM PULMONARY VENTILATION (ONLY) IMAGING 78580 A9540907 NM RENAL W/ FLOW + DIURETIC A9562 78708429 NM RENAL W/ VASCULAR FLOW A9562 78701909 NM RENAL W/FLOW MULTIPLEW/ ACE INHIBIT A9562 78709908 NM RENAL W/FLOW SINGLE W/ACE INHIBIT A9562 787082149 NM SALIVARY GLAND IMAGING 78230 A9512346 NM SPLEEN IMAGING 78185 A95412190 NM TB W/ABLATION PLANNING 78012340 NM THYROID + UPTAKE 78014 A9516347 NM THYROID IMAGING 78013 A9512359 NM THYROID UPTAKE ONLY 78012 A95166169 NM TRIPLE TRACER BONE SCAN A9503 A9507 A9541 78315 78805 781031495 NM TUMOR LOCALIZATION W/ SPECT 78804 A9572365 NM URETERAL REFLUX STUDY A9541 78740 787301485 NM VENTRICULAR FUNCTION W/O STRESS 78472 A95601330 NM WHITE BLOOD CELLS 78804 A9521904 NM WHITE BLOOD CELLS W/ SPECT A9521 788072198 NM WHOLE BODY W SPECT/CT 78306 A9503 78320 783992323 NM XOFIGO INJ THERAPY 791012444 NM Y90 LIVER/LUNG SCAN 78205 78580 A9540 785801565 NM ZEVALIN SCAN A9542 788041568 NM ZEVALIN THERAPY ADMIN 794032848 O ARM/FLUORO NEURO None, no charge2199 OR CASE ‐ PERCUTANEOUS NEPHROSTOGRAM None, no charge8444 ORBITS COMPLETE MIN 4 V 702002363 PARACENTESIS W/ GUIDANCE 490832362 PARACENTESIS W/O GUIDANCE 49082


SIM Orderable NotesCPT(s)102 PELVIS 1 V 72170802 PELVIS COMPLETE MIN 3 V 721902517 PERC BILIARY DRAIN INT/EXT COMPLETE 475342516 PERC BILIARY DRAINAGE EXT COMPLETE 475332532 PERC DRAINAGE KIDNEY LT COMP 504322533 PERC DRAINAGE KIDNEY RT COMP 504327708 PERC GASTROSTOMY TUBE EXCHANGE 43760 75984293 PERC INTRODUCTION OF NEPHROSTOMY LT 50396 74425294 PERC INTRODUCTION OF NEPHROSTOMY RT 50396 744257905 PERC RAD FREQ ABLATION LIVER 47382155 PERC TRANSHEPATIC PORTOGRAM W/ HEMO EVAL 75885 36481727 PERC TRANSHEPATIC PORTOGRAM W/O HEMO EV 75887 36481884 PERCUT TRANSCATH PERMANENT EMBOLIZATION 75894 61626828 PERCUTANEOUS ANTERGRADE PYELOGRAM 50390 744254875 PERCUTANEOUS CHOLECYSTOSTOMY 47490 75989381 PERCUTANEOUS PLACEMENT GASTROSTOMY TUBE 49440 432467132 PERCUTANEOUS STONE REMOVAL LT 500807131 PERCUTANEOUS STONE REMOVAL RT 500808521 PERITONEAL PERM DRAINAGE CATH REMOVAL 494228526 PERITONEAL PERM DRAINAGE CATH REMOVAL 329997450 PERITONEOGRAM AFTER INJ AIR OR CONTRAST 741902189 PICC INSERTION W/ PORT >5Y 365712189 PICC INSERTION W/ PORT >5Y 365712534 PLCMNT NEPHROURETERAL NEW ACC 504332540 PLCMNT URETER STNT NEW ACC ‐ CATH 506952539 PLCMNT URETERAL STENT NEW ACCESS 506942538 PLCMNT URETERAL STENT OLD ACCESS 506932931 PLEURAL DRAINAGE CATH REMOVAL 355521336 PORTOCAVAL VENOUS ANASTOMOSIS OPEN 37140879 POSTURAL STUDY 721002367 PULMONARY CRYOABLATION 0340T7658 REMOVAL NEPHROSTOMY TUBE ‐ FLUORO 503892541 REMOVAL/REPLACE NEPHROURETERAL CATH COMP 503877621 REMOVAL/URETERAL STENT/PERC 503846431 REMOVE OBSTRUCTIVE MATERIAL/FEEDING TUBE 494602419 RENAL ANGIO 1ST BILAT COMP 362522417 RENAL ANGIO 1ST UNILAT COMP 362512418 RENAL ANGIO 2ND UNILAT COMP 36253705 RENAL BIOPSY 502006388 RENAL CYST CONTRAST STUDY W/ INJECTION 74470 503905490 RENAL VENOUS CATHETERIZATION/BLOOD SAMP 75893 365007662 REPLACE URETER STENT INDWELLING 50382


SIM Orderable NotesCPT(s)2896 REPLACMENT OF G TUBE PERCUTANEOUS 4945027 REPLACMENT OF G‐J TUBE PERCUTANEOUS 494523488 REPLACMENT OF J TUBE PERCUTANEOUS 494516203 REPOSITION GASTR FEEDING TUBE (GEN DX) 43761830 RESERVOIR SHUNT PUNCTURE 61070 758097618 REVISION OF TIPS 371835168 RIBS 2 V UNI LT 711005073 RIBS 2 V UNI RT 71100809 RIBS MIN 3 V BILAT 711105075 RIBS MIN 3 V LT W/ 1 V CHEST 711015076 RIBS MIN 3 V RT W/ 1 V CHEST 7110186 RIBS MIN 4 V BILAT W/ 1 V CHEST 71111103 SACROILIAC JOINTS 3 OR MORE VIEWS 72202104 SACRUM/COCCYX MIN 2 V 7222079 SALIVARY GLAND 703805091 SCAPULA COMPLETE LT 730105092 SCAPULA COMPLETE RT 73010101 SCOLIOSIS SURVEY 7208216 SELLA TURCICA 702402289 SHOULDER 1 V BILATERAL 73020505095 SHOULDER 1 V LT 730205096 SHOULDER 1 V RT 730202291 SHOULDER COMP MIN 2 V BILATERAL 73030505101 SHOULDER COMPLETE MIN 2 V LT 730305102 SHOULDER COMPLETE MIN 2 V RT 73030153 SIALOGRAM 70390 425508445 SINUSES < 3 V 702102032 SINUSES 1 V WATER VIEW 7021015 SINUSES COMPLETE MIN 3 V 70220227 SKELETAL SURVEY PEDIATRIC FOR TRAUMA 77076730 SKELETAL SURVEY PEDS FOR CONGEN ANAM 7707617 SKULL < 4 V 7025018 SKULL COMPLETE MIN 4 V 7026068 SMALL BOWEL 74250608 SMALL BOWEL PNEUMOCOLON 74250422 SMALL BOWEL VIA ENTEROCLYSIS TUBE 742512395 SP NO CHARGE None, no charge90 SPINE CERVICAL 1 V 7202091 SPINE CERVICAL 2 OR 3 V 720405488 SPINE CERVICAL 2 V W/ FLEX + EXT 7205092 SPINE CERVICAL 4 OR 5 V 7205093 SPINE CERVICAL COMP W/ FLEX + EXT 72052


SIM Orderable NotesCPT(s)8446 SPINE CERVICAL LAT W/ FLEX + EXT 7204089 SPINE COMPLETE AP + LAT 7208296 SPINE LUMBAR 1 V 7202097 SPINE LUMBAR 2 V 721007543 SPINE LUMBAR AP + LAT W/ FLEX + EXT 72110590 SPINE LUMBAR LAT W/ FLEX + EXT 7212099 SPINE LUMBAR MIN 4 V 721105350 SPINE LUMBAR W/ FLEX + EXT 721147266 SPINE THORACIC 1 V 7202094 SPINE THORACIC 2 V 720707211 SPINE THORACIC 2 V W/ SWIMMERS 7207295 SPINE THORACOLUMBAR 2 V 720806210 STERNOCLAVICULAR JOINTS BILAT MIN 3 V 7113087 STERNUM MIN 2 V 711208451 T TUBE CHOLANGIOGRAM INTRAOPERATIVE 743002303 THERASPHERE ADMINISTATION 79445 77790 C2612 77370 774702720 THORACENTESIS W/ INSERTION OF TUBE 325572360 THORACENTESIS W/FLUORO GUIDANCE 325552359 THORACENTESIS W/O GUIDE 325542364 THORACENTESIS W/US GUIDANCE 325552193 THORACENTESIS WITH TUBE W/O IMAGE 325561879 THROMBECTOMY MECH PERC ARTERIAL INIT 371841880 THROMBECTOMY MECH PERC ARTERIAL SUBSQU 371851878 THROMBECTOMY MECH PERC VEINS REPEAT 371887893 THROMBECTOMY MECH PERCUT VEIN 371875021 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT 368752194 THROMBOLYSIS ARTERIAL INI 372112192 THROMBOLYSIS FINAL DAY COMPLETE 372142195 THROMBOLYSIS VENOUS INI 37212706 THYROID BIOPSY 601005327 TIBIA/FIBULA 2 V LT 735905328 TIBIA/FIBULA 2 V RT 735908745 TIBIAL/PERONEAL ADDL PTA COMPLETE 372328742 TIBIAL/PERONEAL ATHERECTOMY COMPLETE 372298741 TIBIAL/PERONEAL PTA COMPLETE 372288743 TIBIAL/PERONEAL PTA COMPLETE 372308744 TIBIAL/PERONEAL STENT COMPLETE 3723177 TMJ BILAT 703302002 TOE(S) MIN 2 V LT 736602003 TOE(S) MIN 2 V RT 73660151 TOMOGRAM KIDNEY 744157610 TRANSCATH INS EXTRACRANIAL STENT INITIAL 0075T


SIM Orderable NotesCPT(s)7612 TRANSCATH INS INTRAVASC STENT W/EMBOLIC 372152197 TRANSCATH RETRIEVAL PERCUT 371976140 TRANSCATHETER BIOPSY 75970 372007105 TRANSCERVICAL INTRO FALLOPIAN TU CATH LT 74742 583457103 TRANSCERVICAL INTRO FALLOPIAN TU CATH RT 74742 583452525 TRANSHEP PERC PLCMNT FOR ERCP 475412515 TRANSHEPATIC PERC CHOLANGIOGRAM 475321449 UGI/ESOPHAGRAM/SM BOWEL/AIR CONSTR 742467213 UPPER EXTREM INFANT MIN 2 V LT 730927214 UPPER EXTREM INFANT MIN 2 V RT 7309266 UPPER GI ADULT 74240416 UPPER GI PEDS 0‐2 YRS 74240431 UPPER GI PEDS 2‐16 YRS 74240596 UPPER GI W/ AIR CONTRAST 742465465 UPPER GI W/ ESOPHAGRAM 7424067 UPPER GI W/ SMALL BOWEL 742451447 UPPER GI/ESOPHAGRAM W/ SMALL BOWEL 74245810 UPPER GI/SMALL BOWEL W/AIR CONTRAST 74249735 URETERAL BRUSH BIOPSY 50606150 URETHROCYSTOGRAM 74450 516107704 UROGRAPHY RETROGRADE 744202957 US ABDOMEN APPENDIX 767052958 US ABDOMEN ASCITES 76705303 US ABDOMEN COMPLETE 767002961 US ABDOMEN HERNIA 767052909 US ABDOMEN INTUSSUSCEPTION 767052959 US ABDOMEN LUQ 767052400 US ABDOMEN PYLORIC STENOSIS 767052960 US ABDOMEN RUQ 767052182 US ADDITIONAL VIEWS None, no charge6400 US AORTA ABDOMINAL 767757849 US AORTA SCREENING 76706302 US AORTA/RENAL COMPLETE 767702962 US BLADDER 768572314 US BREAST AXILLA BIL 76882502312 US BREAST AXILLA LT 76882LT2313 US BREAST AXILLA RT 76882RT2309 US BREAST LIMITED BIL 76642502310 US BREAST LIMITED LT 76642LT2311 US BREAST LIMITED RT 76642RT2306 US BREAST WHOLE BIL 76641502307 US BREAST WHOLE LT 76641LT


SIM Orderable NotesCPT(s)2308 US BREAST WHOLE RT 76641RT6208 US CHEST LT 766046273 US CHEST RT 766047889 US CHEST WALL UPPER BACK SOFT TISSUE 76604319 US CRANIAL NEONATAL 765062987 US EX NON VASCULAR TENSON/MUSCLE LT 768812988 US EX NON VASCULAR TENSON/MUSCLE RT 768815218 US EXT NON VASC LT 768825219 US EXT NON VASC RT 768827598 US FETAL BIOPHYSICAL W/O NONSTR ADDL FETUS 7681959313 US FOLLICULAR 768577854 US FOREIGN IMAGES None, no charge1875 US GUIDANCE 769428527 US GUIDANCE FOR VASCULAR ACCESS 76937328 US GUIDANCE INTRAOPERATIVE 769982375 US GUIDANCE VASC ACC NO CHARGE NONE Physician offices would not order, but may get a report/result318 US GUIDED AMNIOCENTESIS 59000 769462727 US GUIDED ASPIRATION ABSCESS/CYST 76942 101602402 US GUIDED BIOPSY (CT) 76942 Physician offices would not order, but may get a report/result2965 US GUIDED BREAST CORE BIOPSY LT 190832966 US GUIDED BREAST CORE BIOPSY RT 190832967 US GUIDED BREAST CYST ASPIRATION LT 190002968 US GUIDED BREAST CYST ASPIRATION RT 190002969 US GUIDED BREAST FINE NEEDLE ASP LT 100222970 US GUIDED BREAST FINE NEEDLE ASP RT 100222963 US GUIDED BREAST NEEDLE LOC LT 192852964 US GUIDED BREAST NEEDLE LOC RT 192855436 US GUIDED BX SOFT TISSUE NECK/THORAX 76942 202062325 US GUIDED ELBOW TENDON ASP – LAVAGE 206062128 US GUIDED FINE NEEDLE ASP 76942 100222156 US GUIDED GOLD SEED PROSTATE 55876 769427606 US GUIDED GOLD SEED RECTAL WALL 55876 768722326 US GUIDED HIP JOINT ASP/INJECTION 206112327 US GUIDED HIP TENDON INJECTION 206115061 US GUIDED HYSTEROSONOGRAM 76831 5834023 US GUIDED INJECTION TENDON SHEATH 76942 205502328 US GUIDED KNEE JOINT ASP/INJECTION 206115428 US GUIDED LIVER BX 76942 470002408 US GUIDED PARACENTESIS 490835470 US GUIDED PROSTATE BX 55700 76942 768723004 US GUIDED PROSTATE BX W/SEDATION 55700 76942 768721394 US GUIDED PSEUDO INJECTION 36002


SIM Orderable NotesCPT(s)5454 US GUIDED RENAL ASP 50390 769422329 US GUIDED SHOULDER TENDON ASP – LAVAGE 206115426 US GUIDED SPLEEN ASP 38999 769425460 US GUIDED THORACENTESIS 325551369 US GUIDED THORACENTESIS W/ TUBE INSERT 325575452 US GUIDED THYROID CYST ASP 60300 769423008 US GUIDED THYROID FNA 10022 769422955 US HEAD SOFT TISSUE 765367232 US HIPS INFANT 768852954 US NECK SOFT TISSUE 765362384 US NO CHARGE None, no charge2076 US OB 1ST TRIMESTER 768017677 US OB 1ST TRIMESTER QUADS 76801 76802 76802 768027674 US OB 1ST TRIMESTER TRIPLETS 76802 76802 768017672 US OB 1ST TRIMESTER TWINS 76801 768023012 US OB BIOPHYSICIAL PROFILE TRIPLETS 76819 7681959 76819593010 US OB BIOPHYSICIAL PROFILE TWINS 76819 76819592080 US OB COMPLETE 768057876 US OB COMPLETE ‐ HIGH RISK 768117668 US OB COMPLETE QUADS 76811 76812 76812 768127665 US OB COMPLETE TRIPLETS 76811 76812 768127663 US OB COMPLETE TWINS 76811 76812858 US OB CORD DOPPLER 76820317 US OB FETAL BIOPHYSICAL 768197231 US OB FETAL BIOPHYSICAL WITH NON STRESS 768182422 US OB FETAL ECHO 768252423 US OB FETAL ECHO F/U 768262272 US OB FETAL ECHO F/U QUADS 76826 7682659 7682659 76826592270 US OB FETAL ECHO F/U TRIPLETS 76826 7682659 76826592268 US OB FETAL ECHO F/U TWINS 76826 76826592266 US OB FETAL ECHO QUADS 76825 7682559 7682559 76825592264 US OB FETAL ECHO TRIPLETS 76825 7682559 76825592262 US OB FETAL ECHO TWINS 76825 7682559883 US OB FOLLOW UP 768167686 US OB FOLLOW UP QUADS 76816 7681659 7681659 76816597683 US OB FOLLOW UP TRIPLETS 76816 7681659 7681597681 US OB FOLLOW UP TWINS 76816 7681592426 US OB HIGH RISK TRIPLETS 76811 76812 768122424 US OB HIGH RISK TWINS 76811 768124097 US OB LIMITED 768152261 US OB MCA DOPPLER 768212086 US OB TRANSVAGINAL 76817


SIM Orderable NotesCPT(s)2410 US OUTSIDE IMAGES FOR COMPARISON None, no charge2405 US OUTSIDE IMAGES FOR CONSULTATION None, no charge304 US PELVIS 768562903 US RADIOLOGY PATHOLOGY F/U REPORT None, no charge305 US RENAL 767757723 US RENAL/BLADDER 767705214 US SHOULDER LT 768815215 US SHOULDER RT 76881888 US SPINE AND CONTENTS 76800314 US TESTICULAR/SCROTUM 768702956 US THYROID 76536330 US TRANSRECTAL 76872329 US TRANSVAGINAL NON OB 768307855 US TRUNK/ABDOMEN SOFT TISSUE 767056226 USV AORTA FEM BYPASS LT 939796291 USV AORTA FEM BYPASS RT 93979641 USV AORTA ILIAC BYPASS 93978647 USV AORTA ILIAC BYPASS LIMITED 93979640 USV AORTA‐FEM BYPASS 939785220 USV BYPASS GRAFT LT 939265221 USV BYPASS GRAFT RT 93926652 USV BYPASS GRAFTS BIL 939251372 USV CALF REFLUX STUDY BILAT 939705624 USV CALF REFLUX STUDY LT 939715625 USV CALF REFLUX STUDY RT 93971311 USV CAROTID 938802031 USV CAROTID LT 938822029 USV CAROTID RT 938822989 USV DIALYSIS FISTULA 939904084 USV DIALYSIS GRAFT 939902990 USV GROIN BIL/PSEUDO 939252991 USV GROIN LT/PSEUDO 939262992 USV GROIN RT/PSEUDO 939266200 USV GUIDED PSEUDO INJECTION 76936 96373638 USV ILIAC ARTERY BILAT 939786224 USV ILIAC ARTERY LT 939796289 USV ILIAC ARTERY RT 939796225 USV ILIAC VEIN LT 939796290 USV ILIAC VEIN RT 93979639 USV ILIAC VEINS BILATERAL 93978637 USV INFERIOR VENA CAVA 939782030 USV KIDNEY TRANSPLANT 76776


SIM Orderable NotesCPT(s)612 USV LIVER DOPPLER 93975624 USV LIVER DOPPLER WITH TIPPS 939766199 USV LOWER ART NON EXERCISE UNI 939222218 USV LOWER ARTERIAL ABI ONLY 939227835 USV LOWER ARTERIAL EXERCISE UNI 939227830 USV LOWER ARTERIAL W/ ABI EXERCISE 93923555 USV LOWER ARTERIAL W/ABI NON EXERCISE 939232993 USV LOWER EXT ARTERY BIL 939252994 USV LOWER EXT ARTERY LT 939262995 USV LOWER EXT ARTERY RT 93926580 USV LOWER EXT VEIN BILAT 939705238 USV LOWER EXT VEIN LT 939715239 USV LOWER EXT VEIN RT 93971614 USV MESENTERIC DOPPLER 93975618 USV MESENTERIC VEIN 939752996 USV PALMAR ARCH 93930613 USV RENAL ARTERY DOPPLER 93975625 USV RENAL DOPPLER LIMITED 93976617 USV RENAL VEIN 93975615 USV SPLENIC ARTERY DOPPLER 93975619 USV SPLENIC VEIN 939752997 USV SUBCLAVIAN ARTERIES BILAT 939302998 USV SUBCLAVIAN ARTERY LT 939312999 USV SUBCLAVIAN ARTERY RT 939317834 USV UPPER ARTERIAL EXERCISE SINGLE 939227752 USV UPPER ARTERIAL NON‐EXERCISE UNI 939237831 USV UPPER ARTERIAL W/ WBI EXERCISE 93923556 USV UPPER ARTERIAL W/WBI NON EXERCISE 93923660 USV UPPER EXT ARTERY BIL 939304158 USV UPPER EXT ARTERY LT 939314159 USV UPPER EXT ARTERY RT 93931717 USV UPPER EXT VEIN BILAT 939705236 USV UPPER EXT VEIN LT 939715237 USV UPPER EXT VEIN RT 939713025 USV VEIN MAPPING BILAT ARMS 939702816 USV VEIN MAPPING BILAT LEGS 939702818 USV VEIN MAPPING HEMODIALYSIS ACCESS G03653023 USV VEIN MAPPING LT ARM 939713022 USV VEIN MAPPING LT LEG 939713024 USV VEIN MAPPING RT ARM 939713021 USV VEIN MAPPING RT LEG 939711790 VAGINOGRAM 74775


SIM Orderable NotesCPT(s)270 VENOGRAM CAVAL INFERIOR 75825209 VENOGRAM EXTREMITY BILAT 758227128 VENOGRAM EXTREMITY UNI LT 36005 758207127 VENOGRAM EXTREMITY UNI RT 36005 75820720 VENOGRAM HEPATIC W/ HEMODYNAMIC EVAL 75889726 VENOGRAM HEPATIC W/O HEMODYNAMIC EVAL 75891 36011197 VENOGRAM RENAL SELECTIVE BILAT 75833274 VENOGRAM RENAL SELECTIVE UNI LT 75831275 VENOGRAM RENAL SELECTIVE UNI RT 75831216 VENOGRAM VENOUS SINUS OR JUGULAR LT 75860218 VENOGRAM VENOUS SINUS OR JUGULAR RT 75860271 VENOGRAPHY CAVAL SUPERIOR + SERIALOGRAM 758271572 VENOUS PORT CHECK FOR PATENCY 365982633 VENOUS PTA 372482634 VENOUS PTA ADDITIONAL SITE 372492452 VENOUS STENT 372382369 VERTEBROPLASTY CERVICOTHORA 225102370 VERTEBROPLASTY LUMBOSACRAL 225112371 VERTEBROPLSTY EA ADD CERVTH OR LUMBSAC 22512878 VIDEO FLUOROSCOPY W/ SPEECH PATH 74230162 VOIDING CYSTOURETHROGRAM 74455 516008078 WHITAKER TEST 50396 744255141 WRIST 2 V LT 731005142 WRIST 2 V RT 731005147 WRIST COMP MIN 3 V LT 731105148 WRIST COMP MIN 3 V RT 73110

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