IN FULL TRANSPARENCY
STAR ER has always practiced full transparency in billing. Accordingly, we support HB2041 and are pleased to share our full chargemaster list below.
We know that the cost of healthcare is complicated and often a stressful part of a patient’s experience. We encourage you to understand your insurance policy, including deductibles and co-pays, and ask any questions that arise at the time of your visit or at any point in the billing process by contacting our financial office at (806) 701- 4141.
- Prices below are based on the most current chargemaster as of 1/1/19 and many times are adjusted to reflect lower allowed amounts by insurance or in relation to self-pay rates.
- Existing Network contracts determine final charges and often result in substantially lower billing and total prices. STAR ER does not balance bill and never charges more than any insurance plan allows after processing the claims. That does not negate your deductible or out-of-pocket expenses pre-determined by you and your insurance company.
- Emergency Physician fees are not included in the rates below; however, STAR ER does not have added consulting fees or fees for other specialty services outside STAR emergency Physicians.
| Charge Code | Description | Fee ($) |
|---|---|---|
| 10040 | Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules) | 885.8 |
| 10060 | Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or single | 972.88 |
| 10061 | Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple | 1808.15 |
| 10080 | Incision and drainage of pilonidal cyst; simple | 1849 |
| 10081 | Incision and drainage of pilonidal cyst; complicated | 1739.35 |
| 10120 | Incision and removal of foreign body, subcutaneous tissues; simple | 1047.05 |
| 10121 | Incision and removal of foreign body, subcutaneous tissues; complicated | 1879.1 |
| 10140 | Incision and drainage of hematoma, seroma or fluid collection | 3762.5 |
| 10160 | Puncture aspiration of abscess, hematoma, bulla, or cyst | 1075 |
| 11000 | Debridement of extensive eczematous or infected skin; up to 10% of body surface | 215 |
| 11042 | Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less | 1075 |
| 11043 | Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less | 1147.03 |
| 11055 | Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesion | 196.73 |
| 11200 | Removal of skin tags, multiple fibrocutaneous tags, any area; up to and including 15 lesions | 342.93 |
| 11305 | Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or less | 282.73 |
| 11400 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less | 479.45 |
| 11401 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm | 585.88 |
| 11402 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cm | 654.68 |
| 11403 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cm | 754.65 |
| 11404 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm | 857.85 |
| 11406 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm | 1231.95 |
| 11420 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less | 479.45 |
| 11421 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cm | 621.35 |
| 11422 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cm | 693.38 |
| 11423 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cm | 811.63 |
| 11424 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cm | 937.4 |
| 11426 | Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm | 1349.13 |
| 11440 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or less | 524.6 |
| 11441 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cm | 670.8 |
| 11442 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cm | 752.5 |
| 11443 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cm | 900.85 |
| 11444 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cm | 1141.65 |
| 11446 | Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cm | 1570.58 |
| 11601 | Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cm | 909.45 |
| 11720 | Debridement of nail(s) by any method(s); 1 to 5 | 125.78 |
| 11730 | Avulsion of nail plate, partial or complete, simple; single | 548.25 |
| 11732 | Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure) | 180.6 |
| 11740 | Evacuation of subungual hematoma | 332.18 |
| 11750 | Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal | 1766.23 |
| 11760 | Repair of nail bed | 1574.88 |
| 11765 | Wedge excision of skin of nail fold (eg, for ingrown toenail) | 999.75 |
| 11770 | Excision of pilonidal cyst or sinus; simple | 767.55 |
| 12001 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or less | 548.25 |
| 12002 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cm | 600.93 |
| 12004 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm | 747.13 |
| 12005 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cm | 1011.58 |
| 12006 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cm | 1227.65 |
| 12007 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cm | 1524.35 |
| 12011 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | 567.6 |
| 12013 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm | 635.33 |
| 12014 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm | 807.33 |
| 12015 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm | 1005.13 |
| 12016 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm | 1364.18 |
| 12017 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm | 1557.68 |
| 12018 | Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cm | 1761.93 |
| 12031 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or less | 1543.7 |
| 12032 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cm | 1961.88 |
| 12034 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm | 2085.5 |
| 12035 | Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cm | 2446.7 |
| 12041 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less | 1579.18 |
| 12042 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm | 2016.7 |
| 12044 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm | 2177.95 |
| 12045 | Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm | 2732.65 |
| 12051 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less | 1732.9 |
| 12052 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm | 2053.25 |
| 12053 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm | 2200.53 |
| 12055 | Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm | 3076.65 |
| 13100 | Repair, complex, trunk; 1.1 cm to 2.5 cm | 1290 |
| 13101 | Repair, complex, trunk; 2.6 cm to 7.5 cm | 1631.85 |
| 13102 | Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure) | 445.05 |
| 13120 | Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm | 2388.65 |
| 13121 | Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm | 2704.7 |
| 13122 | Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure) | 869.68 |
| 13131 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm | 1482.43 |
| 13132 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm | 2400.48 |
| 13133 | Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure) | 704.13 |
| 13151 | Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm | 1681.3 |
| 13152 | Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm | 2322 |
| 15850 | Removal of sutures under anesthesia (other than local), same surgeon | 364.43 |
| 15851 | Removal of sutures under anesthesia (other than local), other surgeon | 384.85 |
| 16000 | Initial treatment, first degree burn, when no more than local treatment is required | 287.03 |
| 16020 | Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area) | 552.55 |
| 16025 | Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area) | 612.75 |
| 16030 | Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area) | 733.15 |
| 16036 | Escharotomy; each additional incision (List separately in addition to code for primary procedure) | 365.5 |
| 17000 | Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesion | 327.88 |
| 17003 | Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion) | 33.33 |
| 17004 | Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesions | 720.25 |
| 17110 | Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions | 445.05 |
| 17250 | Chemical cauterization of granulation tissue (ie, proud flesh) | 303.15 |
| 20103 | Exploration of penetrating wound (separate procedure); extremity | 2308.03 |
| 20520 | Removal of foreign body in muscle or tendon sheath; simple | 787.98 |
| 20550 | Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia") | 239.73 |
| 20552 | Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s) | 790.13 |
| 20553 | Injection(s); single or multiple trigger point(s), 3 or more muscles | 250.48 |
| 20600 | Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidance | 225.75 |
| 20605 | Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidance | 244.03 |
| 20610 | Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidance | 790.13 |
| 21310 | Closed treatment of nasal bone fracture without manipulation | 790.13 |
| 21315 | Closed treatment of nasal bone fracture; without stabilization | 1077.15 |
| 21320 | Closed treatment of nasal bone fracture; with stabilization | 1026.63 |
| 21400 | Closed treatment of fracture of orbit, except blowout; without manipulation | 1359.88 |
| 21480 | Closed treatment of temporomandibular dislocation; initial or subsequent | 639.63 |
| 21800 | Closed treatment of rib fracture, uncomplicated, each | 494.5 |
| 23500 | Closed treatment of clavicular fracture; without manipulation | 857.85 |
| 23505 | Closed treatment of clavicular fracture; with manipulation | 1397.5 |
| 23540 | Closed treatment of acromioclavicular dislocation; without manipulation | 1316.45 |
| 23570 | Closed treatment of scapular fracture; without manipulation | 911.6 |
| 23600 | Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation | 1271.73 |
| 23605 | Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction | 3291.65 |
| 23650 | Closed treatment of shoulder dislocation, with manipulation; without anesthesia | 2900.35 |
| 23655 | Closed treatment of shoulder dislocation, with manipulation; requiring anesthesia | 1584.55 |
| 23930 | Incision and drainage, upper arm or elbow area; deep abscess or hematoma | 1430.83 |
| 24200 | Removal of foreign body, upper arm or elbow area; subcutaneous | 552.55 |
| 24500 | Closed treatment of humeral shaft fracture; without manipulation | 1391.05 |
| 24530 | Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation | 1492.1 |
| 24560 | Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation | 1250.23 |
| 24565 | Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation | 3762.5 |
| 24576 | Closed treatment of humeral condylar fracture, medial or lateral; without manipulation | 1313.65 |
| 24600 | Treatment of closed elbow dislocation; without anesthesia | 1465.23 |
| 24605 | Treatment of closed elbow dislocation; requiring anesthesia | 2743.4 |
| 24640 | Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulation | 953.53 |
| 24650 | Closed treatment of radial head or neck fracture; without manipulation | 1012.65 |
| 24655 | Closed treatment of radial head or neck fracture; with manipulation | 2805.75 |
| 24670 | Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulation | 1134.13 |
| 24800 | Arthrodesis, elbow joint; local | 3377.65 |
| 25028 | Incision and drainage, forearm and/or wrist; deep abscess or hematoma | 2112.38 |
| 25500 | Closed treatment of radial shaft fracture; without manipulation | 1041.68 |
| 25505 | Closed treatment of radial shaft fracture; with manipulation | 4353.23 |
| 25530 | Closed treatment of ulnar shaft fracture; without manipulation | 1007.28 |
| 25560 | Closed treatment of radial and ulnar shaft fractures; without manipulation | 1059.95 |
| 25565 | Closed treatment of radial and ulnar shaft fractures; with manipulation | 4353.75 |
| 25600 | Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulation | 1039.53 |
| 25605 | Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulation | 2281.15 |
| 25622 | Closed treatment of carpal scaphoid (navicular) fracture; without manipulation | 1180.35 |
| 25630 | Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each bone | 1201.85 |
| 25650 | Closed treatment of ulnar styloid fracture | 1255.6 |
| 26010 | Drainage of finger abscess; simple | 1012.65 |
| 26011 | Drainage of finger abscess; complicated (eg, felon) | 1529.73 |
| 26415 | Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rod | 2915.4 |
| 26600 | Closed treatment of metacarpal fracture, single; without manipulation, each bone | 1114.78 |
| 26605 | Closed treatment of metacarpal fracture, single; with manipulation, each bone | 1256.68 |
| 26607 | Closed treatment of metacarpal fracture, with manipulation, with external fixation, each bone | 1813.53 |
| 26670 | Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesia | 1323.33 |
| 26700 | Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesia | 1266.35 |
| 26720 | Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, each | 1859.75 |
| 26725 | Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, each | 3060.53 |
| 26742 | Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, each | 1475.98 |
| 26750 | Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, each | 1864.05 |
| 26755 | Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, each | 2757.38 |
| 26770 | Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesia | 2581.08 |
| 26775 | Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesia | 1512.53 |
| 27301 | Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee region | 2703.63 |
| 27501 | Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulation | 2076.9 |
| 27508 | Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulation | 2132.8 |
| 27520 | Closed treatment of patellar fracture, without manipulation | 1264.2 |
| 27560 | Closed treatment of patellar dislocation; without anesthesia | 1497.48 |
| 27620 | Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign body | 1923.18 |
| 27650 | Repair, primary, open or percutaneous, ruptured Achilles tendon; | 2810.05 |
| 27750 | Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation | 1364.18 |
| 27752 | Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction | 2186.55 |
| 27760 | Closed treatment of medial malleolus fracture; without manipulation | 1313.65 |
| 27780 | Closed treatment of proximal fibula or shaft fracture; without manipulation | 1183.58 |
| 27786 | Closed treatment of distal fibular fracture (lateral malleolus); without manipulation | 1248.08 |
| 27808 | Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation | 1307.2 |
| 27810 | Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation | 1914.58 |
| 27818 | Closed treatment of trimalleolar ankle fracture; with manipulation | 1972.63 |
| 27824 | Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulation | 1245.93 |
| 27840 | Closed treatment of ankle dislocation; without anesthesia | 1475.98 |
| 28190 | Removal of foreign body, foot; subcutaneous | 983.63 |
| 28192 | Removal of foreign body, foot; deep | 1875.88 |
| 28400 | Closed treatment of calcaneal fracture; without manipulation | 982.55 |
| 28430 | Closed treatment of talus fracture; without manipulation | 926.65 |
| 28470 | Closed treatment of metatarsal fracture; without manipulation, each | 2094.1 |
| 28490 | Closed treatment of fracture great toe, phalanx or phalanges; without manipulation | 639.63 |
| 28495 | Closed treatment of fracture great toe, phalanx or phalanges; with manipulation | 689.08 |
| 28510 | Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, each | 639.63 |
| 28515 | Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, each | 639.63 |
| 28540 | Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesia | 201.32 |
| 28630 | Closed treatment of metatarsophalangeal joint dislocation; without anesthesia | 606.3 |
| 28660 | Closed treatment of interphalangeal joint dislocation; without anesthesia | 449.35 |
| 29049 | Application, cast; figure-of-eight | 561.13 |
| 29085 | Application, cast; hand and lower forearm (gauntlet) | 316.8 |
| 29105 | Application of long arm splint (shoulder to hand) | 604.15 |
| 29125 | Application of short arm splint (forearm to hand); static | 325.73 |
| 29126 | Application of short arm splint (forearm to hand); dynamic | 405.5 |
| 29130 | Application of finger splint; static (foam) | 325.73 |
| 29131 | Application of finger splint; dynamic | 372.24 |
| 29240 | Strapping; shoulder (eg, Velpeau) | 237.58 |
| 29260 | Strapping; elbow or wrist | 363.03 |
| 29280 | Strapping; hand or finger | 190.08 |
| 29505 | Application of long leg splint (thigh to ankle or toes) | 440.75 |
| 29515 | Application of short leg splint (calf to foot) | 508.48 |
| 29530 | Strapping; knee | 211.78 |
| 29540 | Strapping; ankle and/or foot (Do not report 29540 in conjunction with 29581) | 163.15 |
| 29550 | Strapping; toes | 146.2 |
| 29580 | Strapping; Unna boot | 39.6 |
| 29700 | Removal or bivalving; gauntlet, boot or body cast | 258 |
| 29799 | Unlisted procedure, casting or strapping | 409.85 |
| 30300 | Removal foreign body, intranasal; office type procedure | 906.23 |
| 30901 | Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any method | 434.3 |
| 30903 | Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any method | 794.43 |
| 30905 | Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initial | 985.78 |
| 31500 | Intubation, endotracheal, emergency procedure | 624.58 |
| 31505 | Laryngoscopy, indirect; diagnostic (separate procedure) | 342.93 |
| 31525 | Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn | 1646.9 |
| 31575 | Laryngoscopy, flexible; diagnostic | 342.93 |
| 31720 | Catheter aspiration (separate procedure); nasotracheal | 228.98 |
| 32551 | Tube thoracostomy, includes connection to drainage system (eg, water seal), when performed, open (separate procedure) | 3171.25 |
| 36000 | Introduction of needle or intracatheter, vein | 119.33 |
| 36410 | Venipuncture, age 3 years or older, necessitating the skill of a physician or other qualified health care professional (separate procedure), for diagnostic or therapeutic purposes (not to be used for routine venipuncture) | 87.08 |
| 36415 | Collection of venous blood by venipuncture | 58.05 |
| 36416 | Collection of capillary blood specimen (eg, finger, heel, ear stick) | 65.58 |
| 36556 | Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older | 3171.25 |
| 36569 | Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older | 1114.78 |
| 36575 | Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site | 675.1 |
| 36591 | Collection of blood specimen from a completely implantable venous access device | 96.75 |
| 36592 | Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified | 106.43 |
| 37195 | Thrombolysis, cerebral, by intravenous infusion | 591.25 |
| 40650 | Repair lip, full thickness; vermilion only | 1701.73 |
| 40652 | Repair lip, full thickness; up to half vertical height | 1994.13 |
| 40654 | Repair lip, full thickness; over one-half vertical height, or complex | 2348.88 |
| 40830 | Closure of laceration, vestibule of mouth; 2.5 cm or less | 997.6 |
| 40831 | Closure of laceration, vestibule of mouth; over 2.5 cm or complex | 1151.33 |
| 41250 | Repair of laceration 2.5 cm or less; floor of mouth and/or anterior two-thirds of tongue | 959.98 |
| 41800 | Drainage of abscess, cyst, hematoma from dentoalveolar structures | 949.23 |
| 42330 | Sialolithotomy; submandibular (submaxillary), sublingual or parotid, uncomplicated, intraoral | 1151.33 |
| 42700 | Incision and drainage abscess; peritonsillar | 1536.18 |
| 42809 | Removal of foreign body from pharynx | 708.43 |
| 43752 | Naso- or oro-gastric tube placement, requiring physician's skill and fluoroscopic guidance (includes fluoroscopy, image documentation and report) | 187.05 |
| 43753 | Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (eg, for gastrointestinal hemorrhage), including lavage if performed | 225.75 |
| 43760 | Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance | 1505 |
| 43999 | Unlisted procedure, stomach | 704.13 |
| 45005 | Incision and drainage of submucosal abscess, rectum | 1028.78 |
| 46040 | Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) | 3020.75 |
| 46050 | Incision and drainage, perianal abscess, superficial | 992.23 |
| 46083 | Incision of thrombosed hemorrhoid, external | 741.75 |
| 46230 | Excision of multiple external papillae or tags, anus | 1056.73 |
| 46320 | Excision of thrombosed hemorrhoid, external | 559 |
| 46500 | Injection of sclerosing solution, hemorrhoids | 422.48 |
| 46600 | Anoscopy; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) | 334.33 |
| 46608 | Anoscopy; with removal of foreign body | 884.73 |
| 49580 | Repair umbilical hernia, younger than age 5 years; reducible | 1380.3 |
| 49585 | Repair umbilical hernia, age 5 years or older; reducible | 1835.03 |
| 51700 | Bladder irrigation, simple, lavage and/or instillation | 334.33 |
| 51701 | Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine) | 338.63 |
| 51702 | Insertion of temporary indwelling bladder catheter; simple (eg, Foley) | 338.63 |
| 51703 | Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon) | 617.05 |
| 51798 | Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging | 89.23 |
| 54700 | Incision and drainage of epididymis, testis and/or scrotal space (eg, abscess or hematoma) | 1224.43 |
| 55100 | Drainage of scrotal wall abscess | 1224.43 |
| 56405 | Incision and drainage of vulva or perineal abscess | 470.85 |
| 56420 | Incision and drainage of Bartholin's gland abscess | 534.28 |
| 57415 | Removal of impacted vaginal foreign body (separate procedure) under anesthesia (other than local) | 690.15 |
| 62270 | Spinal puncture, lumbar, diagnostic | 1757.63 |
| 64400 | Injection, anesthetic agent; trigeminal nerve, any division or branch | 790.13 |
| 64402 | Injection, anesthetic agent; facial nerve | 470.85 |
| 64405 | Injection, anesthetic agent; greater occipital nerve | 352.6 |
| 64450 | Injection, anesthetic agent; other peripheral nerve or branch | 1757.63 |
| 65205 | Removal of foreign body, external eye; conjunctival superficial | 463.33 |
| 65210 | Removal of foreign body, external eye; conjunctival embedded (includes concretions), subconjunctival, or scleral nonperforating | 557.93 |
| 65220 | Removal of foreign body, external eye; corneal, without slit lamp | 1064.25 |
| 65222 | Removal of foreign body, external eye; corneal, with slit lamp | 309.6 |
| 67700 | Blepharotomy, drainage of abscess, eyelid | 1027.7 |
| 68040 | Expression of conjunctival follicles (eg, for trachoma) | 268.75 |
| 69000 | Drainage external ear, abscess or hematoma; simple | 742.83 |
| 69020 | Drainage external auditory canal, abscess | 941.7 |
| 69200 | Removal foreign body from external auditory canal; without general anesthesia | 497.73 |
| 69205 | Removal foreign body from external auditory canal; with general anesthesia | 426.78 |
| 69209 | Removal impacted cerumen using irrigation/lavage, unilateral | 334.33 |
| 69210 | Removal impacted cerumen requiring instrumentation, unilateral | 251.55 |
| 70030 | Radiologic examination, eye, for detection of foreign body | 121.48 |
| 70100 | Radiologic examination, mandible; partial, less than 4 views | 261.23 |
| 70110 | Radiologic examination, mandible; complete, minimum of 4 views | 387 |
| 70130 | Radiologic examination, mastoids; complete, minimum of 3 views per side | 234.35 |
| 70140 | Radiologic examination, facial bones; less than 3 views | 204.25 |
| 70150 | Radiologic examination, facial bones; complete, minimum of 3 views | 1404.1 |
| 70160 | Radiologic examination, nasal bones, complete, minimum of 3 views | 734.45 |
| 70200 | Radiologic examination; orbits, complete, minimum of 4 views | 306.38 |
| 70210 | Radiologic examination, sinuses, paranasal, less than 3 views | 127.93 |
| 70220 | Radiologic examination, sinuses, paranasal, complete, minimum of 3 views | 734.45 |
| 70250 | Radiologic examination, skull; less than 4 views | 1404.1 |
| 70260 | Radiologic examination, skull; complete, minimum of 4 views | 313.9 |
| 70320 | Radiologic examination, teeth; complete, full mouth | 187.05 |
| 70330 | Radiologic examination, temporomandibular joint, open and closed mouth; bilateral | 374.1 |
| 70360 | Radiologic examination; neck, soft tissue | 734.45 |
| 70450 | Computed tomography, head or brain; without contrast material | 1404.1 |
| 70460 | Computed tomography, head or brain; with contrast material(s) | 2988.41 |
| 70470 | Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further sections | 2988.41 |
| 70480 | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material | 1591 |
| 70481 | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) | 2988.41 |
| 70482 | Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, followed by contrast material(s) and further sections | 3180.93 |
| 70486 | Computed tomography, maxillofacial area; without contrast material | 1591 |
| 70487 | Computed tomography, maxillofacial area; with contrast material(s) | 2988.41 |
| 70488 | Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further sections | 2897.13 |
| 70490 | Computed tomography, soft tissue neck; without contrast material | 1591 |
| 70491 | Computed tomography, soft tissue neck; with contrast material(s) | 2988.41 |
| 70492 | Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further sections | 2988.41 |
| 70496 | Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 2988.41 |
| 70498 | Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 3672.2 |
| 71010 | Radiologic examination, chest; single view, frontal | 146.2 |
| 71020 | Radiologic examination, chest, 2 views, frontal and lateral; | 201.03 |
| 71022 | Radiologic examination, chest, 2 views, frontal and lateral; with oblique projections | 197.8 |
| 71030 | Radiologic examination, chest, complete, minimum of 4 views; | 197.8 |
| 71035 | Radiologic examination, chest, special views (eg, lateral decubitus, Bucky studies) | 150.5 |
| 71045 | Radiologic examination, chest; single view | 734.45 |
| 71046 | Radiologic examination, chest; 2 views | 734.45 |
| 71047 | Radiologic examination, chest; 3 views | 233.28 |
| 71048 | Radiologic examination, chest; 4 or more views | 271.98 |
| 71100 | Radiologic examination, ribs, unilateral; 2 views | 734.45 |
| 71101 | Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views | 1404.1 |
| 71110 | Radiologic examination, ribs, bilateral; 3 views | 387 |
| 71111 | Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views | 222.53 |
| 71120 | Radiologic examination; sternum, minimum of 2 views | 734.45 |
| 71130 | Radiologic examination; sternoclavicular joint or joints, minimum of 3 views | 161.25 |
| 71250 | Computed tomography, thorax; without contrast material | 1591 |
| 71260 | Computed tomography, thorax; with contrast material(s) | 2988.41 |
| 71270 | Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections | 2988.41 |
| 71275 | Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing | 3516.33 |
| 72020 | Radiologic examination, spine, single view, specify level | 204.25 |
| 72040 | Radiologic examination, spine, cervical; 2 or 3 views | 734.45 |
| 72050 | Radiologic examination, spine, cervical; 4 or 5 views | 1404.1 |
| 72052 | Radiologic examination, spine, cervical; 6 or more views | 387 |
| 72070 | Radiologic examination, spine; thoracic, 2 views | 1404.1 |
| 72072 | Radiologic examination, spine; thoracic, 3 views | 387 |
| 72074 | Radiologic examination, spine; thoracic, minimum of 4 views | 387 |
| 72080 | Radiologic examination, spine; thoracolumbar junction, minimum of 2 views | 153.73 |
| 72100 | Radiologic examination, spine, lumbosacral; 2 or 3 views | 1404.1 |
| 72110 | Radiologic examination, spine, lumbosacral; minimum of 4 views | 387 |
| 72114 | Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views | 308.53 |
| 72120 | Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views | 387 |
| 72125 | Computed tomography, cervical spine; without contrast material | 1591 |
| 72126 | Computed tomography, cervical spine; with contrast material | 5396.22 |
| 72127 | Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further sections | 1942.53 |
| 72128 | Computed tomography, thoracic spine; without contrast material | 1591 |
| 72129 | Computed tomography, thoracic spine; with contrast material | 2257.5 |
| 72130 | Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further sections | 2847.68 |
| 72131 | Computed tomography, lumbar spine; without contrast material | 1591 |
| 72132 | Computed tomography, lumbar spine; with contrast material | 5396.22 |
| 72133 | Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further sections | 2811.13 |
| 72170 | Radiologic examination, pelvis; 1 or 2 views | 1404.1 |
| 72190 | Radiologic examination, pelvis; complete, minimum of 3 views | 173.08 |
| 72191 | Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 3672.2 |
| 72192 | Computed tomography, pelvis; without contrast material | 1404.1 |
| 72193 | Computed tomography, pelvis; with contrast material(s) | 2988.41 |
| 72194 | Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections | 2721.9 |
| 72202 | Radiologic examination, sacroiliac joints; 3 or more views | 359.05 |
| 72220 | Radiologic examination, sacrum and coccyx, minimum of 2 views | 734.45 |
| 73000 | Radiologic examination; clavicle, complete | 734.45 |
| 73010 | Radiologic examination; scapula, complete | 1404.1 |
| 73020 | Radiologic examination, shoulder; 1 view | 734.45 |
| 73030 | Radiologic examination, shoulder; complete, minimum of 2 views | 734.45 |
| 73050 | Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction | 156.95 |
| 73060 | Radiologic examination; humerus, minimum of 2 views | 734.45 |
| 73070 | Radiologic examination, elbow; 2 views | 734.45 |
| 73080 | Radiologic examination, elbow; complete, minimum of 3 views | 734.45 |
| 73090 | Radiologic examination; forearm, 2 views | 734.45 |
| 73092 | Radiologic examination; upper extremity, infant, minimum of 2 views | 121.48 |
| 73100 | Radiologic examination, wrist; 2 views | 734.45 |
| 73110 | Radiologic examination, wrist; complete, minimum of 3 views | 734.45 |
| 73120 | Radiologic examination, hand; 2 views | 1404.1 |
| 73130 | Radiologic examination, hand; minimum of 3 views | 734.45 |
| 73140 | Radiologic examination, finger(s), minimum of 2 views | 734.45 |
| 73200 | Computed tomography, upper extremity; without contrast material | 1591 |
| 73201 | Computed tomography, upper extremity; with contrast material(s) | 1536.18 |
| 73202 | Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further sections | 1959.73 |
| 73502 | Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views | 734.45 |
| 73510 | Radiologic examination, hip, unilateral; complete, minimum of 2 views | 405.28 |
| 73520 | Radiologic examination, hips, bilateral, minimum of 2 views of each hip, including anteroposterior view of pelvis | 169.85 |
| 73550 | Radiologic examination, femur, 2 views | 197.8 |
| 73552 | Radiologic examination, femur; minimum 2 views | 734.45 |
| 73560 | Radiologic examination, knee; 1 or 2 views | 734.45 |
| 73562 | Radiologic examination, knee; 3 views | 734.45 |
| 73564 | Radiologic examination, knee; complete, 4 or more views | 1404.1 |
| 73590 | Radiologic examination; tibia and fibula, 2 views | 734.45 |
| 73592 | Radiologic examination; lower extremity, infant, minimum of 2 views | 124.7 |
| 73600 | Radiologic examination, ankle; 2 views | 734.45 |
| 73610 | Radiologic examination, ankle; complete, minimum of 3 views | 734.45 |
| 73620 | Radiologic examination, foot; 2 views | 734.45 |
| 73630 | Radiologic examination, foot; complete, minimum of 3 views | 734.45 |
| 73650 | Radiologic examination; calcaneus, minimum of 2 views | 734.45 |
| 73660 | Radiologic examination; toe(s), minimum of 2 views | 734.45 |
| 73700 | Computed tomography, lower extremity; without contrast material | 1591 |
| 73701 | Computed tomography, lower extremity; with contrast material(s) | 2988.41 |
| 73702 | Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further sections | 1964.03 |
| 73706 | Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 2988.41 |
| 74000 | Radiologic examination, abdomen; single anteroposterior view | 158.03 |
| 74010 | Radiologic examination, abdomen; anteroposterior and additional oblique and cone views | 648.23 |
| 74018 | Radiologic examination, abdomen; 1 view | 734.45 |
| 74019 | Radiologic examination, abdomen; 2 views | 1404.1 |
| 74020 | Radiologic examination, abdomen; complete, including decubitus and/or erect views | 281.65 |
| 74021 | Radiologic examination, abdomen; 3 or more views | 1404.1 |
| 74022 | Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus views, single view chest | 1404.1 |
| 74150 | Computed tomography, abdomen; without contrast material | 1404.1 |
| 74160 | Computed tomography, abdomen; with contrast material(s) | 2233.85 |
| 74170 | Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections | 2627.3 |
| 74174 | Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 3535.68 |
| 74175 | Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing | 3672.2 |
| 74176 | Computed tomography, abdomen and pelvis; without contrast material | 2899.73 |
| 74177 | Computed tomography, abdomen and pelvis; with contrast material(s) | 2988.41 |
| 74178 | Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions | 3504.5 |
| 74190 | Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation | 380.55 |
| 74410 | Urography, infusion, drip technique and/or bolus technique; | 483.75 |
| 75574 | Computed tomographic angiography, heart, coronary arteries and bypass grafts (when present), with contrast material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, assessment of cardiac function, and evaluatio | 3230.38 |
| 76010 | Radiologic examination from nose to rectum for foreign body, single view, child | 121.48 |
| 76376 | 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent works | 496.65 |
| 76512 | Ophthalmic ultrasound, diagnostic; B-scan (with or without superimposed non-quantitative A-scan) | 1404.1 |
| 76536 | Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation | 955.68 |
| 76645 | Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation | 724.55 |
| 76700 | Ultrasound, abdominal, real time with image documentation; complete | 1404.1 |
| 76705 | Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) | 1404.1 |
| 76770 | Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete | 977.18 |
| 76775 | Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited | 369.8 |
| 76801 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; single or first gestation | 1404.1 |
| 76802 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary procedure) | 756.8 |
| 76805 | Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester (> or = 14 weeks 0 days), transabdominal approach; single or first gestation | 983.63 |
| 76815 | Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses | 1404.1 |
| 76817 | Ultrasound, pregnant uterus, real time with image documentation, transvaginal | 1404.1 |
| 76830 | Ultrasound, transvaginal | 1404.1 |
| 76856 | Ultrasound, pelvic (nonobstetric), real time with image documentation; complete | 1404.1 |
| 76857 | Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) | 1404.1 |
| 76870 | Ultrasound, scrotum and contents | 1404.1 |
| 76882 | Ultrasound, limited, joint or other nonvascular extremity structure(s) (eg, joint space, peri-articular tendon[s], muscle[s], nerve[s], other soft tissue structure[s], or soft tissue mass[es]), real-time with image documentation | 1404.1 |
| 76942 | Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging supervision and interpretation | 2702.61 |
| 77777 | Interstitial radiation source application; intermediate | 2543.45 |
| 78630 | Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography | 1360.95 |
| 80047 | Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea Nitrogen (BUN) (84520) | 258 |
| 80048 | Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310) Carbon dioxide (bicarbonate) (82374) Chloride (82435) Creatinine (82565) Glucose (82947) Potassium (84132) Sodium (84295) Urea nitrogen (BUN) (84520) | 123.45 |
| 80050 | General health panel This panel must include the following: Comprehensive metabolic panel (80053) Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004) OR Blood count, complete (CBC), automated (85027) and | 388.08 |
| 80051 | Electrolyte panel This panel must include the following: Carbon dioxide (bicarbonate) (82374) Chloride (82435) Potassium (84132) Sodium (84295) | 102.4 |
| 80053 | Comprehensive metabolic panel | 154.2 |
| 80061 | Lipid panel This panel must include the following: Cholesterol, serum, total (82465) Lipoprotein, direct measurement, high density cholesterol (HDL cholesterol) (83718) Triglycerides (84478) | 195.47 |
| 80074 | Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709) Hepatitis B core antibody (HBcAb), IgM antibody (86705) Hepatitis B surface antigen (HBsAg) (87340) Hepatitis C antibody (86803) | 695.43 |
| 80076 | Hepatic function panel This panel must include the following: Albumin (82040) Bilirubin, total (82247) Bilirubin, direct (82248) Phosphatase, alkaline (84075) Protein, total (84155) Transferase, alanine amino (ALT) (SGPT) (84460) Transferase, aspartate am | 110.73 |
| 80100 | Drug screen, qualitative; multiple drug classes chromatographic method, each procedure | 95.68 |
| 80101 | Drug screen, qualitative; single drug class method (eg, immunoassay, enzyme assay), each drug class | 89.23 |
| 80104 | Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure | 95.68 |
| 80156 | Carbamazepine; total | 197.8 |
| 80158 | Cyclosporine | 74.18 |
| 80160 | Desipramine | 93.53 |
| 80162 | Digoxin; total | 193.81 |
| 80164 | Valproic acid (dipropylacetic acid); total | 184.9 |
| 80166 | Doxepin | 98.9 |
| 80174 | Imipramine | 93.53 |
| 80178 | Lithium | 89.23 |
| 80182 | Nortriptyline | 87.08 |
| 80184 | Phenobarbital | 74.18 |
| 80185 | Phenytoin; total | 193.46 |
| 80194 | Quinidine | 74.18 |
| 80196 | Salicylate | 46.23 |
| 80198 | Theophylline | 206.46 |
| 80202 | Vancomycin | 184.9 |
| 80299 | Acetaminophen Level | 87.08 |
| 80305 | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; capable of being read by direct optical observation only (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when p | 213.93 |
| 80306 | Drug test(s), presumptive, any number of drug classes, any number of devices or procedures; read by instrument assisted direct optical observation (eg, utilizing immunoassay [eg, dipsticks, cups, cards, or cartridges]), includes sample validation when per | 212.38 |
| 80320 | Alcohols | 199.95 |
| 80329 | Analgesics, non-opioid; 1 or 2 | 225.75 |
| 81000 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy | 16.13 |
| 81001 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, with microscopy | 16.13 |
| 81002 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, without microscopy | 41.15 |
| 81003 | Urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; automated, without microscopy | 32.76 |
| 81005 | Urinalysis; qualitative or semiquantitative, except immunoassays | 12.9 |
| 81025 | Urine pregnancy test, by visual color comparison methods | 101.81 |
| 81050 | Volume measurement for timed collection, each | 11.83 |
| 82003 | Acetaminophen | 130.08 |
| 82009 | Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); qualitative | 25.8 |
| 82010 | Ketone body(s) (eg, acetone, acetoacetic acid, beta-hydroxybutyrate); quantitative | 119.31 |
| 82040 | Albumin; serum, plasma or whole blood | 72.25 |
| 82043 | Albumin; urine (eg, microalbumin), quantitative | 39.78 |
| 82055 | Alcohol (ethanol); any specimen except breath | 59.13 |
| 82075 | Alcohol (ethanol), breath | 70.95 |
| 82085 | Aldolase | 65.58 |
| 82103 | Alpha-1-antitrypsin; total | 87.08 |
| 82105 | Alpha-fetoprotein (AFP); serum | 74.18 |
| 82108 | Aluminum | 164.48 |
| 82128 | Amino acids; multiple, qualitative, each specimen | 89.23 |
| 82131 | Amino acids; single, quantitative, each specimen | 110.73 |
| 82150 | Amylase | 94.6 |
| 82164 | Angiotensin I - converting enzyme (ACE) | 95.68 |
| 82232 | Beta-2 microglobulin | 106.43 |
| 82247 | Bilirubin; total | 73.2 |
| 82248 | Bilirubin; direct | 68.8 |
| 82270 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative; feces, consecutive collected specimens with single determination, for colorectal neoplasm screening (ie, patient was provided 3 cards or single triple card for consecutive collection) | 22.58 |
| 82272 | Blood, occult, by peroxidase activity (eg, guaiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasm screening | 50.02 |
| 82274 | Blood, occult, by fecal hemoglobin determination by immunoassay, qualitative, feces, 1-3 simultaneous determinations | 104.28 |
| 82306 | Vitamin D; 25 hydroxy, includes fraction(s), if performed | 368.73 |
| 82310 | Calcium; total | 34.4 |
| 82330 | Calcium; ionized | 87.08 |
| 82360 | Calculus; quantitative analysis, chemical | 82.78 |
| 82374 | Carbon dioxide (bicarbonate) | 33.33 |
| 82378 | Carcinoembryonic antigen (CEA) | 124.7 |
| 82390 | Ceruloplasmin | 70.95 |
| 82397 | Chemiluminescent assay | 191.35 |
| 82435 | Chloride; blood | 30.1 |
| 82465 | Cholesterol, serum or whole blood, total | 27.95 |
| 82480 | Cholinesterase; serum | 50.53 |
| 82482 | Cholinesterase; RBC | 50.53 |
| 82491 | Chromatography, quantitative, column (eg, gas liquid or HPLC); single analyte not elsewhere specified, single stationary and mobile phase | 245.1 |
| 82533 | Cortisol; total | 237.92 |
| 82540 | Creatine | 30.1 |
| 82550 | Creatine kinase (CK), (CPK); total | 95.07 |
| 82553 | Creatine kinase (CK), (CPK); MB fraction only | 168.62 |
| 82565 | Creatinine; blood | 74.85 |
| 82570 | Creatinine; other source | 34.4 |
| 82575 | Creatinine; clearance | 61.28 |
| 82607 | Cyanocobalamin (Vitamin B-12); | 74.18 |
| 82626 | Dehydroepiandrosterone (DHEA) | 164.48 |
| 82670 | Estradiol | 378.4 |
| 82671 | Estrogens; fractionated | 208.55 |
| 82672 | Estrogens; total | 139.75 |
| 82677 | Estriol | 156.95 |
| 82690 | Ethchlorvynol | 89.23 |
| 82728 | Ferritin | 185.98 |
| 82746 | Folic acid; serum | 74.18 |
| 82747 | Folic acid; RBC | 112.88 |
| 82784 | Gammaglobulin (immunoglobulin); IgA, IgD, IgG, IgM, each | 59.13 |
| 82800 | Gases, blood, pH only | 183.83 |
| 82803 | Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); | 308.28 |
| 82805 | Gases, blood, any combination of pH, pCO2, pO2, CO2, HCO3 (including calculated O2 saturation); with O2 saturation, by direct measurement, except pulse oximetry | 931.46 |
| 82810 | Gases, blood, O2 saturation only, by direct measurement, except pulse oximetry | 204.25 |
| 82945 | Glucose, body fluid, other than blood | 57.35 |
| 82947 | Glucose; quantitative, blood (except reagent strip) | 57.35 |
| 82948 | Glucose; blood, reagent strip | 59.6 |
| 82962 | Glucose, blood by glucose monitoring device(s) cleared by the FDA specifically for home use | 38.79 |
| 82977 | Glutamyltransferase, gamma (GGT) | 105.12 |
| 83001 | Gonadotropin; follicle stimulating hormone (FSH) | 251.55 |
| 83002 | Gonadotropin; luteinizing hormone (LH) | 250.48 |
| 83015 | Heavy metal (eg, arsenic, barium, beryllium, bismuth, antimony, mercury); qualitative, any number of analytes | 120.4 |
| 83036 | Hemoglobin; glycosylated (A1C) | 141.78 |
| 83090 | Homocysteine | 110.73 |
| 83516 | Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; qualitative or semiquantitative, multiple step method | 75.25 |
| 83540 | Iron | 87.08 |
| 83550 | Iron binding capacity | 118.25 |
| 83605 | Lactate (lactic acid) | 155.97 |
| 83615 | Lactate dehydrogenase (LD), (LDH); | 88.1 |
| 83630 | Lactoferrin, fecal; qualitative | 126.85 |
| 83655 | Lead | 79.55 |
| 83690 | Lipase | 100.63 |
| 83718 | Lipoprotein, direct measurement; high density cholesterol (HDL cholesterol) | 39.78 |
| 83719 | Lipoprotein, direct measurement; VLDL cholesterol | 75.25 |
| 83721 | Lipoprotein, direct measurement; LDL cholesterol | 129 |
| 83735 | Magnesium | 97.79 |
| 83835 | Metanephrines | 37.63 |
| 83872 | Mucin, synovial fluid (Ropes test) | 26.88 |
| 83874 | Myoglobin | 188.61 |
| 83880 | Natriuretic peptide | 495.47 |
| 83970 | Parathormone (parathyroid hormone) | 266.6 |
| 84035 | Phenylketones, qualitative | 80.63 |
| 84075 | Phosphatase, alkaline; | 75.56 |
| 84100 | Phosphorus inorganic (phosphate); | 65.58 |
| 84119 | Porphyrins, urine; qualitative | 37.63 |
| 84132 | Potassium; serum, plasma or whole blood | 62.35 |
| 84144 | Progesterone | 283.8 |
| 84146 | Prolactin | 125.78 |
| 84152 | Prostate specific antigen (PSA); complexed (direct measurement) | 249.4 |
| 84153 | Prostate specific antigen (PSA); total | 120.4 |
| 84155 | Protein, total, except by refractometry; serum, plasma or whole blood | 53.57 |
| 84156 | Protein, total, except by refractometry; urine | 68.8 |
| 84157 | Protein, total, except by refractometry; other source (eg, synovial fluid, cerebrospinal fluid) | 49.45 |
| 84166 | Protein; electrophoretic fractionation and quantitation, other fluids with concentration (eg, urine, CSF) | 260.27 |
| 84295 | Sodium; serum, plasma or whole blood | 65.58 |
| 84402 | Testosterone; free | 164.48 |
| 84403 | Testosterone; total | 351.53 |
| 84425 | Thiamine (Vitamin B-1) | 137.6 |
| 84436 | Thyroxine; total | 46.23 |
| 84439 | Thyroxine; free | 131.61 |
| 84443 | Thyroid stimulating hormone (TSH) | 245.37 |
| 84450 | Transferase; aspartate amino (AST) (SGOT) | 75.56 |
| 84460 | Transferase; alanine amino (ALT) (SGPT) | 77.34 |
| 84466 | Transferrin | 79.55 |
| 84478 | Triglycerides | 37.63 |
| 84479 | Thyroid hormone (T3 or T4) uptake or thyroid hormone binding ratio (THBR) | 94.36 |
| 84480 | Triiodothyronine T3; total (TT-3) | 207.06 |
| 84481 | Triiodothyronine T3; free | 247.38 |
| 84484 | Troponin, quantitative | 147.46 |
| 84520 | Urea nitrogen; quantitative | 57.71 |
| 84550 | Uric acid; blood | 65.98 |
| 84681 | C-peptide | 303.9 |
| 84702 | Gonadotropin, chorionic (hCG); quantitative | 219.83 |
| 84703 | Gonadotropin, chorionic (hCG); qualitative | 109.85 |
| 84999 | Unlisted chemistry procedure | 176.3 |
| 85007 | Blood count; blood smear, microscopic examination with manual differential WBC count | 12.9 |
| 85009 | Blood count; manual differential WBC count, buffy coat | 50.53 |
| 85014 | Blood count; hematocrit (Hct) | 34.65 |
| 85018 | Blood count; hemoglobin (Hgb) | 34.65 |
| 85025 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) and automated differential WBC count | 113.4 |
| 85027 | Blood count; complete (CBC), automated (Hgb, Hct, RBC, WBC and platelet count) | 94.36 |
| 85032 | Blood count; manual cell count (erythrocyte, leukocyte, or platelet) each | 232.2 |
| 85044 | Blood count; reticulocyte, manual | 25.8 |
| 85045 | Blood count; reticulocyte, automated | 58.3 |
| 85049 | Blood count; platelet, automated | 23.65 |
| 85240 | Clotting; factor VIII (AHG), 1-stage | 74.18 |
| 85250 | Clotting; factor IX (PTC or Christmas) | 74.18 |
| 85300 | Clotting inhibitors or anticoagulants; antithrombin III, activity | 78.48 |
| 85348 | Coagulation time; other methods | 13.98 |
| 85378 | Fibrin degradation products, D-dimer; qualitative or semiquantitative | 47.3 |
| 85379 | Fibrin degradation products, D-dimer; quantitative | 148.52 |
| 85380 | Fibrin degradation products, D-dimer; ultrasensitive (eg, for evaluation for venous thromboembolism), qualitative or semiquantitative | 47.3 |
| 85384 | Fibrinogen; activity | 54.83 |
| 85610 | Prothrombin time; | 57.35 |
| 85651 | Sedimentation rate, erythrocyte; non-automated | 23.65 |
| 85652 | Sedimentation rate, erythrocyte; automated | 39.38 |
| 85730 | Thromboplastin time, partial (PTT); plasma or whole blood | 81.7 |
| 86000 | Agglutinins, febrile (eg, Brucella, Francisella, Murine typhus, Q fever, Rocky Mountain spotted fever, scrub typhus), each antigen | 23.65 |
| 86003 | Allergen specific IgE; quantitative or semiquantitative, crude allergen extract, each | 33.33 |
| 86038 | Antinuclear antibodies (ANA); | 55.9 |
| 86039 | Antinuclear antibodies (ANA); titer | 72.03 |
| 86060 | Antistreptolysin 0; titer | 47.3 |
| 86140 | C-reactive protein; | 75.56 |
| 86141 | C-reactive protein; high sensitivity (hsCRP) | 83.85 |
| 86147 | Cardiolipin (phospholipid) antibody, each Ig class | 137.6 |
| 86156 | Cold agglutinin; screen | 44.08 |
| 86157 | Cold agglutinin; titer | 53.75 |
| 86277 | Growth hormone, human (HGH), antibody | 103.2 |
| 86308 | Heterophile antibodies; screening | 75.56 |
| 86309 | Heterophile antibodies; titer | 43 |
| 86316 | Immunoassay for tumor antigen, other antigen, quantitative (eg, CA 50, 72-4, 549), each | 133.3 |
| 86318 | Immunoassay for infectious agent antibody, qualitative or semiquantitative, single step method (eg, reagent strip) | 213.91 |
| 86325 | Immunoelectrophoresis; other fluids (eg, urine, cerebrospinal fluid) with concentration | 70.95 |
| 86376 | Microsomal antibodies (eg, thyroid or liver-kidney), each | 197.8 |
| 86403 | Particle agglutination; screen, each antibody | 137.6 |
| 86430 | Rheumatoid factor; qualitative | 77.4 |
| 86431 | Rheumatoid factor; quantitative | 25.8 |
| 86480 | Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon | 91.38 |
| 86490 | Skin test; coccidioidomycosis | 27.95 |
| 86510 | Skin test; histoplasmosis | 27.95 |
| 86580 | Skin test; tuberculosis, intradermal | 78.48 |
| 86592 | Syphilis test, non-treponemal antibody; qualitative (eg, VDRL, RPR, ART) | 62.32 |
| 86609 | Antibody; bacterium, not elsewhere specified | 83.85 |
| 86611 | Antibody; Bartonella | 33.33 |
| 86617 | Antibody; Borrelia burgdorferi (Lyme disease) confirmatory test (eg, Western Blot or immunoblot) | 209.63 |
| 86618 | Antibody; Borrelia burgdorferi (Lyme disease) | 232.2 |
| 86631 | Antibody; Chlamydia | 172.65 |
| 86635 | Antibody; Coccidioides | 33.33 |
| 86644 | Antibody; cytomegalovirus (CMV) | 93.53 |
| 86658 | Antibody; enterovirus (eg, coxsackie, echo, polio) | 113.95 |
| 86663 | Antibody; Epstein-Barr (EB) virus, early antigen (EA) | 83.85 |
| 86664 | Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA) | 207.48 |
| 86674 | Antibody; Giardia lamblia | 199.95 |
| 86677 | Antibody; Helicobacter pylori | 211.79 |
| 86694 | Antibody; herpes simplex, non-specific type test | 93.53 |
| 86695 | Antibody; herpes simplex, type 1 | 178.45 |
| 86696 | Antibody; herpes simplex, type 2 | 261.23 |
| 86701 | Antibody; HIV-1 | 120.4 |
| 86703 | Antibody; HIV-1 and HIV-2, single result | 66.65 |
| 86704 | Hepatitis B core antibody (HBcAb); total | 164.48 |
| 86705 | Hepatitis B core antibody (HBcAb); IgM antibody | 161.25 |
| 86706 | Hepatitis B surface antibody (HBsAb) | 70.95 |
| 86708 | Hepatitis A antibody (HAAb) | 167.7 |
| 86709 | Hepatitis A antibody (HAAb), IgM antibody | 152.65 |
| 86710 | Antibody; influenza virus | 87.08 |
| 86713 | Antibody; Legionella | 93.53 |
| 86735 | Antibody; mumps | 116.1 |
| 86747 | Antibody; parvovirus | 96.75 |
| 86756 | Antibody; respiratory syncytial virus | 188.14 |
| 86759 | Antibody; rotavirus | 215.57 |
| 86762 | Antibody; rubella | 93.53 |
| 86765 | Antibody; rubeola | 83.85 |
| 86777 | Antibody; Toxoplasma | 93.53 |
| 86778 | Antibody; Toxoplasma, IgM | 173.08 |
| 86787 | Antibody; varicella-zoster | 110.73 |
| 86788 | Antibody; West Nile virus, IgM | 110.73 |
| 86789 | Antibody; West Nile virus | 63.43 |
| 86800 | Thyroglobulin antibody | 215 |
| 86803 | Hepatitis C antibody; | 193.5 |
| 86804 | Hepatitis C antibody; confirmatory test (eg, immunoblot) | 98.9 |
| 86812 | HLA typing; A, B, or C (eg, A10, B7, B27), single antigen | 148.35 |
| 86900 | Blood typing, serologic; ABO | 41.93 |
| 86901 | Blood typing, serologic; Rh (D) | 107.5 |
| 86906 | Blood typing, serologic; Rh phenotyping, complete | 376.04 |
| 87040 | Culture, bacterial; blood, aerobic, with isolation and presumptive identification of isolates (includes anaerobic culture, if appropriate) | 150.65 |
| 87045 | Culture, bacterial; stool, aerobic, with isolation and preliminary examination (eg, KIA, LIA), Salmonella and Shigella species | 127.93 |
| 87046 | Culture, bacterial; stool, aerobic, additional pathogens, isolation and presumptive identification of isolates, each plate | 137.88 |
| 87070 | Culture, bacterial; any other source except urine, blood or stool, aerobic, with isolation and presumptive identification of isolates | 125.82 |
| 87073 | Culture, bacterial; quantitative, anaerobic with isolation and presumptive identification of isolates, any source except urine, blood or stool | 25.8 |
| 87075 | Culture, bacterial; any source, except blood, anaerobic with isolation and presumptive identification of isolates | 138.23 |
| 87076 | Culture, bacterial; anaerobic isolate, additional methods required for definitive identification, each isolate | 109.65 |
| 87077 | Culture, bacterial; aerobic isolate, additional methods required for definitive identification, each isolate | 61.28 |
| 87081 | Culture, presumptive, pathogenic organisms, screening only; | 96.73 |
| 87086 | Culture, bacterial; quantitative colony count, urine | 117.78 |
| 87088 | Culture, bacterial; with isolation and presumptive identification of each isolate, urine | 109.65 |
| 87102 | Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; other source (except blood) | 27.95 |
| 87103 | Culture, fungi (mold or yeast) isolation, with presumptive identification of isolates; blood | 56.98 |
| 87110 | Culture, chlamydia, any source | 286.05 |
| 87116 | Culture, tubercle or other acid-fast bacilli (eg, TB, AFB, mycobacteria) any source, with isolation and presumptive identification of isolates | 78.48 |
| 87177 | Ova and parasites, direct smears, concentration and identification | 148.35 |
| 87186 | Susceptibility studies, antimicrobial agent; microdilution or agar dilution (minimum inhibitory concentration [MIC] or breakpoint), each multi-antimicrobial, per plate | 117.18 |
| 87205 | Smear, primary source with interpretation; Gram or Giemsa stain for bacteria, fungi, or cell types | 62.32 |
| 87206 | Smear, primary source with interpretation; fluorescent and/or acid fast stain for bacteria, fungi, parasites, viruses or cell types | 27.95 |
| 87207 | Smear, primary source with interpretation; special stain for inclusion bodies or parasites (eg, malaria, coccidia, microsporidia, trypanosomes, herpes viruses) | 55.9 |
| 87209 | Smear, primary source with interpretation; complex special stain (eg, trichrome, iron hemotoxylin) for ova and parasites | 262.4 |
| 87210 | Smear, primary source with interpretation; wet mount for infectious agents (eg, saline, India ink, KOH preps) | 68.82 |
| 87220 | Tissue examination by KOH slide of samples from skin, hair, or nails for fungi or ectoparasite ova or mites (eg, scabies) | 58.05 |
| 87230 | Toxin or antitoxin assay, tissue culture (eg, Clostridium difficile toxin) | 288.18 |
| 87252 | Virus isolation; tissue culture inoculation, observation, and presumptive identification by cytopathic effect | 185.98 |
| 87255 | Virus isolation; including identification by non-immunologic method, other than by cytopathic effect (eg, virus specific enzymatic activity) | 459.03 |
| 87265 | Infectious agent antigen detection by immunofluorescent technique; Bordetella pertussis/parapertussis | 163.4 |
| 87274 | Infectious agent antigen detection by immunofluorescent technique; Herpes simplex virus type 1 | 163.4 |
| 87275 | Infectious agent antigen detection by immunofluorescent technique; influenza B virus | 78.48 |
| 87276 | Infectious agent antigen detection by immunofluorescent technique; influenza A virus | 78.48 |
| 87280 | Infectious agent antigen detection by immunofluorescent technique; respiratory syncytial virus | 163.4 |
| 87299 | Infectious agent antigen detection by immunofluorescent technique; not otherwise specified, each organism | 224.68 |
| 87324 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Clostridium difficile toxin | 78.48 |
| 87328 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; cryptosporidium | 163.4 |
| 87339 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Helicobacter pylori | 78.48 |
| 87340 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; hepatitis B surface antigen | 68.8 |
| 87400 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Influenza, A or B, each | 78.48 |
| 87400 | Infectious agent antigen detection by enzyme immunoassay technique, Influenza A | 78.48 |
| 87400 | Infectious agent antigen detection by enzyme immunoassay technique, Influenza B | 78.48 |
| 87420 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; respiratory syncytial virus | 78.48 |
| 87425 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; rotavirus | 224.68 |
| 87430 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]) qualitative or semiquantitative, multiple-step method; Streptococcus, group A | 163.4 |
| 87450 | Infectious agent antigen detection by immunoassay technique, (eg, enzyme immunoassay [EIA], enzyme-linked immunosorbent assay [ELISA], immunochemiluminometric assay [IMCA]), qualitative or semiquantitative; single step method, not otherwise specified, eac | 61.28 |
| 87490 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, direct probe technique | 292.79 |
| 87491 | Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis, amplified probe technique | 512.38 |
| 87522 | Infectious agent detection by nucleic acid (DNA or RNA); hepatitis C, quantification, includes reverse transcription when performed | 275.2 |
| 87529 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, amplified probe technique | 476.23 |
| 87530 | Infectious agent detection by nucleic acid (DNA or RNA); Herpes simplex virus, quantification | 384.85 |
| 87590 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, direct probe technique | 271.98 |
| 87591 | Infectious agent detection by nucleic acid (DNA or RNA); Neisseria gonorrhoeae, amplified probe technique | 512.38 |
| 87621 | Infectious agent detection by nucleic acid (DNA or RNA); papillomavirus, human, amplified probe technique | 226.83 |
| 87798 | Infectious agent detection by nucleic acid (DNA or RNA), not otherwise specified; amplified probe technique, each organism | 476.23 |
| 87804 | Infectious agent antigen detection by immunoassay with direct optical observation; Influenza | 195.7 |
| 87807 | Infectious agent antigen detection by immunoassay with direct optical observation; respiratory syncytial virus | 175.01 |
| 87808 | Infectious agent antigen detection by immunoassay with direct optical observation; Trichomonas vaginalis | 180.8 |
| 87850 | Infectious agent antigen detection by immunoassay with direct optical observation; Neisseria gonorrhoeae | 290.42 |
| 87880 | Infectious agent antigen detection by immunoassay with direct optical observation; Streptococcus, group A | 195.47 |
| 89050 | Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood | 68.94 |
| 89051 | Cell count, miscellaneous body fluids (eg, cerebrospinal fluid, joint fluid), except blood; with differential count | 74.18 |
| 89055 | Leukocyte assessment, fecal, qualitative or semiquantitative | 62.32 |
| 89060 | Crystal identification by light microscopy with or without polarizing lens analysis, tissue or any body fluid (except urine) | 104.41 |
| 90471 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); 1 vaccine (single or combination vaccine/toxoid) | 251.55 |
| 90472 | Immunization administration (includes percutaneous, intradermal, subcutaneous, or intramuscular injections); each additional vaccine (single or combination vaccine/toxoid) (List separately in addition to code for primary procedure) | 125.78 |
| 90655 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.25 mL dosage, for intramuscular use | 139.75 |
| 90656 | Influenza virus vaccine, trivalent (IIV3), split virus, preservative free, 0.5 mL dosage, for intramuscular use | 44.08 |
| 90658 | Influenza virus vaccine, trivalent (IIV3), split virus, 0.5 mL dosage, for intramuscular use | 44.08 |
| 90700 | Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use | 184.9 |
| 90703 | Tetanus toxoid adsorbed, for intramuscular use | 84.93 |
| 90714 | Tetanus and diphtheria toxoids adsorbed (Td), preservative free, when administered to individuals 7 years or older, for intramuscular use | 106.43 |
| 90715 | Tetanus, diphtheria toxoids and acellular pertussis vaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use | 144.05 |
| 90732 | Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use | 116.1 |
| 92002 | Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; intermediate, new patient | 314.98 |
| 92081 | Visual field examination, unilateral or bilateral, with interpretation and report; limited examination (eg, tangent screen, Autoplot, arc perimeter, or single stimulus level automated test, such as Octopus 3 or 7 equivalent) | 224.68 |
| 92551 | Screening test, pure tone, air only | 47.3 |
| 92552 | Pure tone audiometry (threshold); air only | 96.75 |
| 92950 | Cardiopulmonary resuscitation (eg, in cardiac arrest) | 1884.48 |
| 93000 | Electrocardiogram, routine ECG with at least 12 leads; with interpretation and report | 106.43 |
| 93005 | Electrocardiogram, routine ECG with at least 12 leads; tracing only, without interpretation and report | 81.7 |
| 93010 | Electrocardiogram, routine ECG with at least 12 leads; interpretation and report only | 49.45 |
| 93040 | Rhythm ECG, 1-3 leads; with interpretation and report | 72.03 |
| 93041 | Rhythm ECG, 1-3 leads; tracing only without interpretation and report | 182.75 |
| 93042 | Rhythm ECG, 1-3 leads; interpretation and report only | 37.63 |
| 93880 | Duplex scan of extracranial arteries; complete bilateral study | 819.15 |
| 93922 | Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler waveform recording | 516 |
| 93926 | Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study | 524.6 |
| 93965 | Noninvasive physiologic studies of extremity veins, complete bilateral study (eg, Doppler waveform analysis with responses to compression and other maneuvers, phleborheography, impedance plethysmography) | 523.53 |
| 93970 | Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study | 840.65 |
| 93971 | Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited study | 923.43 |
| 93975 | Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study | 704.13 |
| 93976 | Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study | 462.25 |
| 94010 | Spirometry, including graphic record, total and timed vital capacity, expiratory flow rate measurement(s), with or without maximal voluntary ventilation | 145.13 |
| 94060 | Bronchodilation responsiveness, spirometry as in 94010, pre- and post-bronchodilator administration | 553.63 |
| 94150 | Vital capacity, total (separate procedure) | 103.2 |
| 94375 | Respiratory flow volume loop | 380.55 |
| 94640 | Pressurized or nonpressurized inhalation treatment for acute airway obstruction for therapeutic purposes and/or for diagnostic purposes such as sputum induction with an aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure b | 602 |
| 94644 | Continuous inhalation treatment with aerosol medication for acute airway obstruction; first hour | 602 |
| 94645 | Continuous inhalation treatment with aerosol medication for acute airway obstruction; each additional hour (List separately in addition to code for primary procedure) | 125.78 |
| 94664 | Demonstration and/or evaluation of patient utilization of an aerosol generator, nebulizer, metered dose inhaler or IPPB device | 65.58 |
| 94750 | Pulmonary compliance study (eg, plethysmography, volume and pressure measurements) | 313.9 |
| 94760 | Noninvasive ear or pulse oximetry for oxygen saturation; single determination | 33.33 |
| 94761 | Noninvasive ear or pulse oximetry for oxygen saturation; multiple determinations (eg, during exercise) | 51.6 |
| 95115 | Professional services for allergen immunotherapy not including provision of allergenic extracts; single injection | 44.08 |
| 95117 | Professional services for allergen immunotherapy not including provision of allergenic extracts; 2 or more injections | 53.75 |
| 96360 | Intravenous infusion, hydration; initial, 31 minutes to 1 hour | 618.13 |
| 96361 | Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) | 150.5 |
| 96365 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour | 690.15 |
| 96366 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | 187.05 |
| 96367 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); additional sequential infusion of a new drug/substance, up to 1 hour (List separately in addition to code for primary procedure) | 167.7 |
| 96368 | Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) | 176.3 |
| 96370 | Subcutaneous infusion for therapy or prophylaxis (specify substance or drug); each additional hour (List separately in addition to code for primary procedure) | 68.8 |
| 96372 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular | 251.55 |
| 96374 | Therapeutic, prophylactic, or diagnostic injection; intravenous push, single or initial substance/drug | 564.38 |
| 96375 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of a new substance/drug (List separately in addition to code for primary procedure) | 222.53 |
| 96376 | Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); each additional sequential intravenous push of the same substance/drug provided in a facility (List separately in addition to code for primary procedure) | 87.08 |
| 97124 | Therapeutic procedure, 1 or more areas, each 15 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) | 104.28 |
| 97597 | Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound | 274.13 |
| 97598 | Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, debris, biofilm), including topical application(s), wound | 338.63 |
| 97802 | Medical nutrition therapy; initial assessment and intervention, individual, face-to-face with the patient, each 15 minutes | 130.08 |
| 98925 | Osteopathic manipulative treatment (OMT); 1-2 body regions involved | 126.85 |
| 99000 | Handling and/or conveyance of specimen for transfer from the office to a laboratory | 36.55 |
| 99001 | Handling and/or conveyance of specimen for transfer from the patient in other than an office to a laboratory (distance may be indicated) | 36.55 |
| 99050 | Services provided in the office at times other than regularly scheduled office hours, or days when the office is normally closed (eg, holidays, Saturday or Sunday), in addition to basic service | 56.98 |
| 99051 | Service(s) provided in the office during regularly scheduled evening, weekend, or holiday office hours, in addition to basic service | 36.55 |
| 99053 | After hours service | 226.83 |
| 99058 | Service(s) provided on an emergency basis in the office, which disrupts other scheduled office services, in addition to basic service | 106.43 |
| 99070 | Supplies and materials (except spectacles), provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies, or materials provided) | 264.45 |
| 99080 | Special reports such as insurance forms, more than the information conveyed in the usual medical communications or standard reporting form | 53.75 |
| 99143 | Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the pre | 793.35 |
| 99144 | Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the pre | 793.35 |
| 99145 | Moderate sedation services (other than those services described by codes 00100-01999) provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the pre | 439.68 |
| 99148 | Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the se | 793.35 |
| 99149 | Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the se | 168.78 |
| 99150 | Moderate sedation services (other than those services described by codes 00100-01999), provided by a physician or other qualified health care professional other than the health care professional performing the diagnostic or therapeutic service that the se | 65.58 |
| 99151 | Moderate sedation services provided by the same physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports, requiring the presence of an independent trained observer to assist in the m | 860 |
| 99155 | Moderate sedation services provided by a physician or other qualified health care professional other than the physician or other qualified health care professional performing the diagnostic or therapeutic service that the sedation supports; initial 15 min | 168.78 |
| 99173 | Screening test of visual acuity, quantitative, bilateral | 22.58 |
| 99201 | Office visit for new patient, straightforward | 210.7 |
| 99202 | Office visit for new patient, straightforward | 299.93 |
| 99203 | Office visit for new patient, low complexity. | 435.38 |
| 99204 | Office visit new patient, comprehensive examination | 675.1 |
| 99205 | Office visit new patient, comprehensive examination | 849.25 |
| 99211 | Office visit established patient, minimal. | 210.7 |
| 99212 | Office visit established patient, problem focused | 210.7 |
| 99213 | Office visit established patient, expanded problem | 293.48 |
| 99214 | Office visit established patient, detailed history | 437.53 |
| 99215 | Office visit established patient, comprehensive | 591.25 |
| 99217 | Observation care discharge day management (This code is to be utilized to report all services provided to a patient on discharge from outpatient hospital "observation status" if the discharge is on other than the initial date of "observation status." To r | 303.15 |
| 99241 | Office consultation new or established patient, problem focused | 215 |
| 99242 | Office consultation new or established patient, problem focused | 409.58 |
| 99243 | Office consultation new or established patient, detailed | 556.85 |
| 99244 | Office consultation new or established patient, comprehensive | 823.45 |
| 99245 | Office consultation new or established patient, complex | 1007.28 |
| 99281 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or coordination of care | 317.13 |
| 99282 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/o | 779.38 |
| 99283 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of moderate complexity. Counseling | 1402.88 |
| 99284 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with o | 2520.88 |
| 99285 | Emergency department visit for the evaluation and management of a patient, which requires these 3 key components within the constraints imposed by the urgency of the patient's clinical condition and/or mental status: A comprehensive history; A comprehensi | 3450.75 |
| 99291 | Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes | 5122.38 |
| 99292 | Critical care, evaluation and management of the critically ill or critically injured patient; each additional 30 minutes (List separately in addition to code for primary service) | 1242.7 |
| 99354 | Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; first hour (List separately in | 416.03 |
| 99355 | Prolonged evaluation and management or psychotherapy service(s) (beyond the typical service time of the primary procedure) in the office or other outpatient setting requiring direct patient contact beyond the usual service; each additional 30 minutes (Lis | 416.03 |
| 99381 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 402.05 |
| 99382 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 440.75 |
| 99383 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 439.68 |
| 99384 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 477.3 |
| 99385 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 477.3 |
| 99386 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 557.93 |
| 99387 | Initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnos | 613.83 |
| 99391 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 338.63 |
| 99392 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 378.4 |
| 99393 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 377.33 |
| 99394 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 416.03 |
| 99395 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 417.1 |
| 99396 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 455.8 |
| 99397 | Periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diag | 514.93 |
| 99406 | Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes | 107.5 |
| 99407 | Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes | 115.03 |
| A0396 | Als specialized service disposable supplies; esophageal intubation | 25.8 |
| A4206 | Syringe with needle, sterile, 1 cc or less, each | 33.33 |
| A4209 | Syringe with needle, sterile 5 cc or greater, each | 12.9 |
| A4212 | Non-coring needle or stylet with or without catheter | 18.28 |
| A4213 | Syringe, sterile, 20 cc or greater, each | 18.28 |
| A4215 | Needle, sterile, any size, each | 38.7 |
| A4216 | Sterile water, saline and/or dextrose, diluent/flush, 10 ml | 7.53 |
| A4217 | Sterile water/saline, 500 ml | 12.9 |
| A4222 | Infusion supplies for external drug infusion pump, per cassette or bag (list drugs separately) | 367.39 |
| A4248 | Chlorhexidine containing antiseptic, 1 ml | 33.33 |
| A4314 | Insertion tray with drainage bag with indwelling catheter, foley type, two-way latex with coating (teflon, silicone, silicone elastomer or hydrophilic, etc.) | 44.08 |
| A4316 | Insertion tray with drainage bag with indwelling catheter, foley type, three-way, for continuous irrigation | 87.08 |
| A4320 | Irrigation tray with bulb or piston syringe, any purpose | 10.75 |
| A4322 | Irrigation syringe, bulb or piston, each | 7.53 |
| A4338 | Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each | 70.95 |
| A4344 | Indwelling catheter, foley type, two-way, all silicone, each | 82.78 |
| A4351 | Intermittent urinary catheter; straight tip, with or without coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each | 4.3 |
| A4353 | Intermittent urinary catheter, with insertion supplies | 26.88 |
| A4358 | Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each | 16.13 |
| A4364 | Adhesive, liquid or equal, any type, per oz - Dermabond | 47.3 |
| A4390 | Ostomy pouch, drainable, with extended wear barrier attached, with built-in convexity (1 piece), each | 2.15 |
| A4450 | Tape, non-waterproof, per 18 square inches | 11.83 |
| A4495 | Surgical stockings thigh length, each | 50 |
| A4550 | Surgical trays | 87.08 |
| A4556 | Electrodes, (e.g., apnea monitor), per pair | 97.51 |
| A4565 | Slings | 33.33 |
| A4570 | Splint | 87.08 |
| A4590 | Special casting material (e.g., fiberglass) | 127.93 |
| A4615 | Cannula, nasal | 2.15 |
| A4616 | Tubing (oxygen), per foot | 11.83 |
| A4617 | Mouth piece | 12.9 |
| A4627 | Spacer, bag or reservoir, with or without mask, for use with metered dose inhaler | 46.23 |
| A4649 | Surgical supply; miscellaneous | 26.88 |
| A4673 | Extension line with easy lock connectors, used with dialysis | 18.37 |
| A4927 | Gloves, non-sterile, per 100 | 1.08 |
| A4930 | Gloves, sterile, per pair | 8.6 |
| A6203 | Composite dressing, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 13.98 |
| A6204 | Composite dressing, sterile, pad size more than 16 sq. in. but less than or equal to 48 sq. in., with any size adhesive border, each dressing | 11.83 |
| A6212 | Foam dressing, wound cover, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 4.3 |
| A6216 | Gauze, non-impregnated, non-sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 4.3 |
| A6219 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, with any size adhesive border, each dressing | 13.98 |
| A6222 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 3.23 |
| A6223 | Gauze, impregnated with other than water, normal saline, or hydrogel, sterile, pad size more than 16 sq. in., but less than or equal to 48 sq. in., without adhesive border, each dressing | 8.6 |
| A6250 | Skin sealants, protectants, moisturizers, ointments, any type, any size | 36.55 |
| A6260 | Wound cleansers, any type, any size | 133.3 |
| A6402 | Gauze, non-impregnated, sterile, pad size 16 sq. in. or less, without adhesive border, each dressing | 3.23 |
| A6407 | Packing strips, non-impregnated, sterile, up to 2 inches in width, per linear yard | 3.23 |
| A6413 | Adhesive bandage, first-aid type, any size, each | 8.6 |
| A6445 | Conforming bandage, non-elastic, knitted/woven, sterile, width less than three inches, per yard | 3.24 |
| A6448 | Light compression bandage, elastic, knitted/woven, width less than three inches, per yard | 10.75 |
| A6449 | Light compression bandage, elastic, knitted/woven, width greater than or equal to three inches and less than five inches, per yard | 10.75 |
| A6450 | Light compression bandage, elastic, knitted/woven, width greater than or equal to five inches, per yard | 32.25 |
| A6453 | Self-adherent bandage, elastic, non-knitted/non-woven, width less than three inches, per yard | 7.53 |
| A6454 | Self-adherent bandage, elastic, non-knitted/non-woven, width greater than or equal to three inches and less than five inches, per yard | 16.13 |
| A6457 | Tubular dressing with or without elastic, any width, per linear yard | 8.6 |
| A7000 | Canister, disposable, used with suction pump, each | 18.28 |
| A7002 | Tubing, used with suction pump, each | 18.28 |
| A7003 | Administration set, with small volume nonfiltered pneumatic nebulizer, disposable | 8.6 |
| A7015 | Aerosol mask, used with dme nebulizer | 76.33 |
| A7016 | Dome and mouthpiece, used with small volume ultrasonic nebulizer | 168.78 |
| A7040 | One way chest drain valve | 25.8 |
| A7041 | Water seal drainage container and tubing for use with implanted chest tube | 18.28 |
| A9150 | Non-prescription drugs | 26.88 |
| A9273 | Hot water bottle, ice cap or collar, heat and/or cold wrap, any type | 49.45 |
| A9284 | Spirometer, non-electronic, includes all accessories | 294.55 |
| A9900 | Miscellaneous dme supply, accessory, and/or service component of another hcpcs code | 13.98 |
| A9150 | Neosporin Antibiotic Ointment foil packs | 26.88 |
| J8499 | Acet/Tylenol #3 with Codeine, 300mg, Oral | 8.6 |
| A9150 | Acet/Tylenol, 120mg, Suppository | 26.88 |
| A9150 | Acet/Tylenol, 325 mg, PO | 26.88 |
| A9150 | Acetaminophen/Tylenol, 500 mg tablet | 26.88 |
| J3490 | Acetaminophen Childrens Oral Suspension | 44.08 |
| A9150 | Acetaminophen/Tylenol Elixir, 160mg | 26.88 |
| J8499 | Acet/Tylenol w/ Codeine, 12.5mg, Elixer | 8.6 |
| J3490 | Acetaminophen Suppository | 44.08 |
| A9150 | Activated Charcoal, 25mg with Sorbital, Suspension | 26.88 |
| J3490 | Acyclovir 800 mg tablet (Zovirax) PO | 44.08 |
| J3490 | Advil Children's Suspension | 44.08 |
| J3490 | Advil Infant Drops, 15 ml | 44.08 |
| A9150 | Afrin Nasal Spray (Oxymetazoline) | 26.88 |
| 99070 | Alligator Clamp | 264.45 |
| 99070 | Alligator Forceps | 264.45 |
| J8499 | Alprazolam/Xanax 0.5 mg tab (PO Med) | 8.6 |
| J3490 | Ambien 10 mg | 44.08 |
| 99070 | Ambu / Resuscitation Bag for child | 264.45 |
| J3490 | Amidate / Etomidate 2mg, IV | 44.08 |
| J3490 | Amlodipine besylate 5 mg tabs | 44.08 |
| 99070 | Ammonia Capsule | 264.45 |
| J3490 | Amoxicillin 125 mg | 44.08 |
| 99070 | Arm board, for IV stabilization | 264.45 |
| A9150 | Aspirin, 325mg, PO | 26.88 |
| A9150 | Aspirin Tablet, 81mg PO | 26.88 |
| J3490 | Atenolol 25 mg | 44.08 |
| J8499 | Ativan/Lorazepam .0.5 mg. PO | 8.6 |
| J3490 | Atorvastatin 10mg PO | 44.08 |
| J8499 | Augmentin 875 mg tab | 8.6 |
| J3490 | Auralgan/ Antipyrine/ Benzocaine Otic Drops | 44.08 |
| B4081 | NG TUBING WITH STYLET | 33.33 |
| J3490 | Bactrim DS/ Sulfamethoxazole and trimethoprim 800mg/160mg Tablet | 44.08 |
| J3490 | Bactroban/ Mupirocin | 44.08 |
| 99070 | Basin | 264.45 |
| J3490 | Benadryl/Diphenhydramine, 25 mg, PO | 44.08 |
| J3490 | Benadryl / Diphenhydramine Elixir | 44.08 |
| J3490 | Dicyclomine/ Bentyl 10mg (PO Med) | 44.08 |
| 99070 | Zinc Benzoin | 264.45 |
| J3490 | Bicarbonate, 2 ml | 44.08 |
| 99070 | Surgical Blade - Sterile | 264.45 |
| J3490 | Brevital, 500mg, IV | 44.08 |
| 99070 | Buretrol Tubing | 264.45 |
| 99070 | Opthalmic / Eye Burr | 264.45 |
| C1751 | Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis) | 65.58 |
| J3490 | Carafate/Sucralfate 1gm tablet | 44.08 |
| J3490 | Cardene, PGBCK IV PREMIX SOD CHLORIDE 20 MG/200ML | 44.08 |
| 99070 | Cardiac Monitoring/Telemetry | 264.45 |
| J3490 | Cardizem/Diltiazem 5mg per vial, IV | 44.08 |
| J3490 | Cardizem / Diltiazem 25mg/5ml vial, IV | 44.08 |
| J3490 | Carvedilol 25 mg PO | 44.08 |
| 99070 | Cautery, Micro-temp Fine Tip / Bovie | 264.45 |
| J3490 | Cephalexin / Keflex 500MG PO | 44.08 |
| J3490 | Cerumenex Ear Wax Remover | 44.08 |
| J3490 | Cetacaine Spray | 44.08 |
| 99070 | Chromic sutures (Gut) | 264.45 |
| 99070 | Chux, Blue Pad | 264.45 |
| J3490 | Cipro 500mg | 44.08 |
| J3490 | Cipro Ophthalmic Drops | 44.08 |
| J3490 | Clindamycin/Cleocin phosphate, 150 mg, IV/IM | 44.08 |
| J3490 | Clindamycin/Cleocin phosphate, 200mg, IV/IM | 44.08 |
| J8499 | Clindamycin PO 300 MG | 16.77 |
| J3490 | Catapres/Clonidine, 0.1mg PO | 44.08 |
| J3490 | Clopidogrel Bisulfate 75 mg | 44.08 |
| 99070 | Coban/ Co-Flex Bandage | 264.45 |
| J3490 | Colace/Docusate | 44.08 |
| J3490 | Cortisporin-TC Otic Suspension | 44.08 |
| 99070 | CT Injector Kit | 264.45 |
| J3490 | Cyclogel Ophthalmic Drops | 44.08 |
| J3490 | Cyclogyl opthamalgic drops, 1% | 44.08 |
| J3490 | Cyclopentolate HCl Ophthalmic Drops, 1% | 44.08 |
| J3490 | Debrox, Earwax Removal Kit | 44.08 |
| J8540 | Dexamethasone .25 mg PO | 7.53 |
| J3490 | Dextrose 50%, 50 ml | 44.08 |
| J3490 | Diltiazem 20 mg | 44.08 |
| J3490 | Donnatal Elixir, 16.2mg | 44.08 |
| 99070 | Dressing Change Tray, Sterile | 264.45 |
| E0114 | Crutches, underarm, pair, with pads, tips and handgrips | 124.7 |
| E0116 | Crutch, underarm, other than wood, adjustable or fixed, with pad, tip, handgrip, with or without shock absorber, each | 53.75 |
| E0487 | Spirometer, electronic, includes all accessories | 27.95 |
| E0585 | Nebulizer, with compressor and heater | 36.55 |
| E1812 | Dynamic knee, extension/flexion device with active resistance control | 110.73 |
| 99070 | Ear Curette | 264.45 |
| 99070 | Ear Wick | 264.45 |
| 99070 | Electrodes for EKG | 264.45 |
| 99070 | Emesis Basin | 264.45 |
| 99070 | Epistat Balloon | 264.45 |
| J3490 | Erythromycin Eye Ointment | 44.08 |
| 99070 | Ethilon 3.0 sutures | 264.45 |
| 99070 | Ethilon 4.0 sutures | 264.45 |
| 99070 | Ethilon 5.0 sutures | 264.45 |
| 99070 | Ethilon 6.0 sutures | 264.45 |
| J3490 | Eye Wash | 44.08 |
| J3490 | Fentanyl, 50mg, IV | 44.08 |
| J3490 | Fentanyl, 25 mg, IV | 44.08 |
| 99070 | Intranasal Fentanyl Kit | 264.45 |
| J3490 | Flagyl / Metronidazole, 500mg, PO | 44.08 |
| J3490 | Adult-Fleet Enema | 44.08 |
| J3490 | Flexerill/Cyclobenzaprine HCI, 10 mg PO | 44.08 |
| J3490 | Flomax/Tamsulosin cap 0.5-0.4 mg | 44.08 |
| J3490 | Fluconazole 150 MG | 44.08 |
| J3490 | Fluor-I-Strip, 9mg, for dialation of the eye | 44.08 |
| J3490 | Folic Acid IV | 44.08 |
| G0008 | Administration of influenza virus vaccine | 53.75 |
| G0009 | Administration of pneumococcal vaccine | 110.73 |
| G0010 | Administration of hepatitis b vaccine | 43 |
| G0101 | Cervical or vaginal cancer screening; pelvic and clinical breast examination | 120.4 |
| G0102 | Prostate cancer screening; digital rectal examination | 27.95 |
| G0105 | Colorectal cancer screening; colonoscopy on individual at high risk | 180.6 |
| G0106 | Colorectal cancer screening; alternative to g0104, screening sigmoidoscopy, barium enema | 153.73 |
| G0117 | Glaucoma screening for high risk patients furnished by an optometrist or ophthalmologist | 155.88 |
| G0120 | Colorectal cancer screening; alternative to g0105, screening colonoscopy, barium enema. | 389.15 |
| G0121 | Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk | 638.55 |
| G0124 | Screening cytopathology, cervical or vaginal (any reporting system), collected in preservative fluid, automated thin layer preparation, requiring interpretation by physician | 79.55 |
| G0130 | Single energy x-ray absorptiometry (sexa) bone density study, one or more sites; appendicular skeleton (peripheral) (e.g., radius, wrist, heel) | 34.4 |
| G0148 | Screening cytopathology smears, cervical or vaginal, performed by automated system with manual rescreening | 210.7 |
| G0168 | Wound closure utilizing tissue adhesive(s) only | 250.48 |
| G0180 | Physician certification for medicare-covered home health services under a home health plan of care (patient not present), including contacts with home health agency and review of reports of patient status required by physicians to affirm the initial imple | 179.53 |
| G0202 | Screening mammography, producing direct digital image, bilateral, all views | 402.05 |
| G0204 | Diagnostic mammography, producing direct digital image, bilateral, all views | 455.8 |
| G0206 | Diagnostic mammography, producing direct digital image, unilateral, all views | 365.5 |
| G0245 | Initial physician evaluation and management of a diabetic patient with diabetic sensory neuropathy resulting in a loss of protective sensation (lops) which must include: (1) the diagnosis of lops, (2) a patient history, (3) a physical examination that con | 210.7 |
| G0268 | Removal of impacted cerumen (one or both ears) by physician on same date of service as audiologic function testing | 142.98 |
| G0341 | Percutaneous islet cell transplant, includes portal vein catheterization and infusion | 1124.45 |
| G0364 | Bone marrow aspiration performed with bone marrow biopsy through the same incision on the same date of service | 30.1 |
| G0365 | Vessel mapping of vessels for hemodialysis access (services for preoperative vessel mapping prior to creation of hemodialysis access using an autogenous hemodialysis conduit, including arterial inflow and venous outflow) | 39.78 |
| G0378 | Hospital Observation Service, per 1 hour | 1864.05 |
| G0380 | Level 1 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or | 87.08 |
| G0381 | Level 2 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or | 176.3 |
| G0382 | Level 3 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or | 308.53 |
| G0383 | Level 4 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or | 394.53 |
| G0384 | Level 5 hospital emergency department visit provided in a type b emergency department; (the ed must meet at least one of the following requirements: (1) it is licensed by the state in which it is located under applicable state law as an emergency room or | 570.83 |
| G0389 | Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening | 349.38 |
| G0434 | Drug screen, other than chromatographic; any number of drug classes, by clia waived test or moderate complexity test, per patient encounter | 95.68 |
| J3490 | Gentamycin Sulfate Ointment | 44.08 |
| J3490 | Gentamycin Opth Drops | 44.08 |
| J3490 | Hyoscyamine Sulfate/Anaspas .125mg/5ml, PO | 44.08 |
| J3490 | Ibuprofen 10 mg PO Peds | 44.08 |
| 99070 | Ice/Cold Pack | 264.45 |
| J3490 | Imodium/ Loperamide PO | 44.08 |
| 99070 | Infant Sensor - Pedi Sensor | 264.45 |
| J3490 | Integrilin / Eptifibatide, 2mg/ml, 10ml vial | 44.08 |
| 99070 | IV Pump | 264.45 |
| J0131 | Injection, acetaminophen, 10 mg | 9.68 |
| J0150 | Injection, adenosine for therapeutic use, 6 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) | 220.38 |
| J0171 | Injection, adrenalin, epinephrine, 0.1 mg | 33.33 |
| J0282 | Injection, amiodarone hydrochloride, 30 mg | 106.43 |
| J0290 | Injection, ampicillin sodium, 500 mg | 50.53 |
| J0295 | Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm | 13.98 |
| J0330 | Injection, succinylcholine chloride, up to 20 mg | 36.55 |
| J0360 | Injection, hydralazine hcl, up to 20 mg | 49.45 |
| J0456 | Injection, azithromycin, 500 mg | 120.4 |
| J0461 | Injection, atropine sulfate, 0.01 mg | 24.73 |
| J0475 | Injection, baclofen, 10 mg | 25 |
| J0500 | Injection, dicyclomine hcl, up to 20 mg | 241.88 |
| J0561 | Injection, penicillin g benzathine, 100,000 units | 53.75 |
| J0570 | Buprenorphine implant, 74.2 mg | 210.7 |
| J0610 | Injection, calcium gluconate, per 10 ml | 131.15 |
| J0690 | Injection, cefazolin sodium, 500 mg | 70.95 |
| J0692 | Injection, cefepime hydrochloride, 500 mg | 86 |
| J0696 | Injection, ceftriaxone sodium, per 250 mg | 68.8 |
| J0698 | Injection, cefotaxime sodium, per gm | 53.75 |
| J0702 | Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg | 22.58 |
| J0735 | Injection, clonidine hydrochloride, 1 mg | 160.18 |
| J0744 | Injection, ciprofloxacin for intravenous infusion, 200 mg | 79.55 |
| J0780 | Injection, prochlorperazine, up to 10 mg, Compazine | 37.63 |
| J1020 | Injection, methylprednisolone acetate, 20 mg | 26.88 |
| J1030 | Injection, methylprednisolone acetate, 40 mg | 53.75 |
| J1040 | Injection, methylprednisolone acetate, 80 mg | 46.23 |
| J1070 | Injection, testosterone cypionate, up to 100 mg | 36.55 |
| J1094 | Injection, dexamethasone acetate, 1 mg | 34.4 |
| J1100 | Injection, dexamethasone sodium phosphate, 1 mg | 11.83 |
| J1170 | Injection, hydromorphone, up to 4 mg | 155.88 |
| J1200 | Injection, diphenhydramine hcl, up to 50 mg | 36.55 |
| J1265 | Injection, dopamine hcl, 40 mg | 53.75 |
| J1580 | Injection, garamycin, gentamicin, up to 80 mg | 26.88 |
| J1610 | Injection, glucagon hydrochloride, per 1 mg | 662.9 |
| J1630 | Injection, haloperidol, up to 5 mg | 10.75 |
| J1631 | Injection, haloperidol decanoate, per 50 mg | 59.13 |
| J1642 | Injection, heparin sodium, (heparin lock flush), per 10 units | 11.83 |
| J1644 | Injection, heparin sodium, per 1000 units | 44.08 |
| J1650 | Injection, enoxaparin sodium, 10 mg | 53.75 |
| J1670 | Injection, tetanus immune globulin, human, up to 250 units | 79.55 |
| J1720 | Injection, hydrocortisone sodium succinate, up to 100 mg | 43 |
| J1815 | Injection, insulin, per 5 units | 44.08 |
| J1885 | Injection, ketorolac tromethamine, per 15 mg | 44.08 |
| J1940 | Injection, furosemide, up to 20 mg | 36.55 |
| J1956 | Injection, levofloxacin, 250 mg (Levaquin) | 131.15 |
| J1980 | Injection, hyoscyamine sulfate, up to 0.25 mg (Levsin) | 87.08 |
| J1990 | Injection, chlordiazepoxide hcl, up to 100 mg | 15 |
| J2001 | Injection, lidocaine hcl for intravenous infusion, 10 mg | 36.55 |
| J2060 | Injection, lorazepam/Ativan, 2 mg | 36.55 |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 131.15 |
| J2180 | Injection, meperidine and promethazine hcl, up to 50 mg | 4.3 |
| J2250 | Injection, Versed/midazolam hydrochloride, per 1 mg | 16.13 |
| J2270 | Injection, morphine sulfate, up to 10 mg | 131.15 |
| J2300 | Injection, nalbuphine hydrochloride, per 10 mg | 10.75 |
| J2310 | Injection, Narcan/naloxone hydrochloride, per 1 mg | 80.63 |
| J2360 | Injection, Norflex/Orphenadrine citrate, up to 60 mg | 36.55 |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 50.53 |
| J2543 | Injection,Zosyn/Piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 22.58 |
| J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | 56.98 |
| J2550 | Injection, Phenergan/Promethazine hcl, up to 50 mg | 70.95 |
| J2690 | Injection, procainamide hcl, up to 1 gm | 3.23 |
| J2704 | Injection, propofol, 10 mg | 23.65 |
| J2765 | Injection, Metoclopramide hcl, up to 10 mg (Reglan) | 44.08 |
| J2780 | Injection, Zantac/Ranitidine hydrochloride, 25 mg | 36.55 |
| J2920 | Injection, methylprednisolone sodium succinate, up to 40 mg | 16.13 |
| J2930 | Injection, methylprednisolone sodium succinate, up to 125 mg | 87.08 |
| J2997 | Injection, alteplase recombinant, 1 mg | 118.25 |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 139.75 |
| J3030 | Injection,Imitrex/Sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered) | 247.25 |
| J3105 | Injection, terbutaline sulfate, up to 1 mg | 50.53 |
| J3250 | Injection, trimethobenzamide hcl, up to 200 mg | 15.05 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg (Kenalog) | 10.75 |
| J3360 | Injection, Valium/Diazepam, up to 5 mg | 44.08 |
| J3370 | Injection, Vancomycin hcl, 500 mg | 43 |
| J3410 | Injection, Atarax/Hydroxyzine hcl, up to 25 mg | 21.5 |
| J3411 | Injection, thiamine hcl, 100 mg | 87.08 |
| J3475 | Injection, magnesium sulfate, per 500 mg | 36.55 |
| J3480 | Injection, potassium chloride, per 2 meq | 3.23 |
| J3490 | Unclassified drugs | 44.08 |
| J7030 | Infusion, normal saline solution , 1000 cc | 62.35 |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 41.93 |
| J7042 | 5% dextrose/normal saline (500 ml = 1 unit) | 70.95 |
| J7050 | Infusion, normal saline solution, 250 cc | 39.78 |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | 70.95 |
| J7070 | Infusion, d5w, 1000 cc | 16.13 |
| J7120 | Ringers lactate infusion, up to 1000 cc | 36.55 |
| J7506 | Prednisone, oral, per 5mg | 3.23 |
| J7510 | Prednisolone oral, per 5 mg | 4.3 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 3.23 |
| J7609 | Albuterol, inhalation solution, compounded product, administered through dme, unit dose, 1 mg | 22.58 |
| J7610 | Albuterol, inhalation solution, compounded product, administered through dme, concentrated form, 1 mg | 44.08 |
| J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | 16.13 |
| J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | 16.13 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 44.08 |
| J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | 44.08 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | 7.53 |
| J7638 | Dexamethasone, inhalation solution, compounded product, administered through dme, unit dose form, per milligram | 10.75 |
| J7644 | Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | 16.13 |
| J7699 | Noc drugs, inhalation solution administered through dme | 38.7 |
| J8499 | Prescription drug, oral, non chemotherapeutic, nos | 13.55 |
| J8540 | Dexamethasone, oral, 0.25 mg | 7.53 |
| 99070 | Katz Extractor (i.e. for Nasal foreign body) | 264.45 |
| J3490 | Kayexalate / Sodium Polystyrene, Susp 15g/6m | 44.08 |
| J3490 | KDur / Potassium, 40 meq, oral | 44.08 |
| J3490 | Ketamine 10 mg IV/IM | 44.08 |
| J3490 | Ketamine, 100 mg/ml, IV/IM | 44.08 |
| J3490 | Ketamine, 20 mg, for sedation, IV/IM | 44.08 |
| J3490 | Ketamine, 40 mg, IV/IM | 44.08 |
| J3490 | Ketamine 5 mg IV/IM | 44.08 |
| J3490 | Ketamine, 50 mg, IV/IM | 44.08 |
| J3490 | Kexalate, Kionex PO | 44.08 |
| L0120 | Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) | 36.55 |
| L0174 | Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf | 41.93 |
| L1830 | KO; Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf | 139.75 |
| L1902 | Ankle orthosis, ankle gauntlet or similar, with or without joints, prefabricated, off-the-shelf | 519.17 |
| L3260 | Surgical boot/shoe, each | 44.08 |
| L3650 | Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf | 36.55 |
| L3660 | Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf | 23.65 |
| L3807 | Wrist hand finger orthosis, without joint(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | 65.58 |
| L3908 | Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-the-shelf | 44.08 |
| L3913 | Hand finger orthosis, without joints, may include soft interface, straps, custom fabricated, includes fitting and adjustment | 36.55 |
| L3923 | Hand finger orthosis, without joints, may include soft interface, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | 729.93 |
| L3980 | Upper extremity fracture orthosis, humeral, prefabricated, includes fitting and adjustment | 729.93 |
| L3982 | Upper extremity fracture orthosis, radius/ulnar, prefabricated, includes fitting and adjustment | 507.4 |
| L3984 | Upper extremity fracture orthosis, wrist, prefabricated, includes fitting and adjustment | 507.4 |
| L3999 | Upper limb orthosis, not otherwise specified | 36.55 |
| L4350 | Ankle Brace; Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf (AIR SPLINT) | 566.53 |
| L4360 | Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise | 331.1 |
| L4361 | Walking boot, pneumatic and/or vacuum, with or without joints | 167.7 |
| L4386 | Walking boot, non-pneumatic, with or without joints | 180.6 |
| J3490 | Labetalol HCI, 5mg/ml, IV | 44.08 |
| J3490 | Lactulose 10mg/15ml | 44.08 |
| J3490 | Lasix/Furosemide, 20mg, PO | 44.08 |
| J3490 | Levaquin/Levofloxacin, 250 mg tablet (oral) | 44.08 |
| J3490 | Levaquin/Levofloxacin, 500mg tablet (oral) | 44.08 |
| J3490 | Levaquin 750mg PO | 44.08 |
| J3490 | Levophed/Norepinephrine 1MG/ML | 28.8 |
| J8499 | Hyoscyamine Sulfate 0.125 mg tablet | 8.6 |
| J3490 | Lidocaine 1% with EPI, 20ml, IV | 44.08 |
| J3490 | Lidocaine HCL, MDV 1%, 10ml | 44.08 |
| J3490 | Lidocaine 2%, 10ml, IV | 44.08 |
| J3490 | Lidocaine 2%, 20ml | 44.08 |
| J3490 | Lidocaine 2% with EPI | 44.08 |
| J3490 | Lidocaine 4%, 250ml, IV | 44.08 |
| J3490 | Lidocaine 4%, 50ml, topical solution | 44.08 |
| J3490 | Lisinopril 10 mg tab PO | 44.08 |
| J3490 | Lomotil, 2.5 mg, oral | 44.08 |
| J3490 | Lopressor/Metoprolol Tartrate 25 mg oral | 44.08 |
| J3490 | Lopressor/Metoprolol Tartrate 50 mg oral | 44.08 |
| S5001 | Lortab 10mg/500mg PO | 6.45 |
| S5000 | Loratadine (Claritin) 10 mg PO | 3.23 |
| J3490 | Lortab, 7.5/500 mg (oral) | 44.08 |
| J3490 | Losartan 50 mg PO | 44.08 |
| J3490 | Mylanta/Maalox (oral) | 44.08 |
| J3490 | Macrobid 100 mg | 44.08 |
| J3490 | Magnesium citrate, 1 bottle | 44.08 |
| J3490 | Marcaine/Bupivacaine EPI INJ SDV 10ML .5% | 37 |
| 99070 | Marcaine / Bupivicaine 0.25% 10 ml SDV | 264.45 |
| 99070 | Marcaine 0.5%, 50 ml, single vial | 264.45 |
| 99070 | Mastisol 2/3cc | 264.45 |
| J3490 | Meclizine / Dramamine / Antivert, 25 mg, oral | 44.08 |
| 99070 | Merocel | 264.45 |
| J3490 | Metoprolol 50 mg tabs PO | 44.08 |
| J3490 | Metoprolol Tartrate / Lopressor, 1mg/ml, IV | 44.08 |
| J3490 | Midazolam (Versed) 3mg intranasal | 36 |
| 99070 | Miller Blade | 264.45 |
| 99070 | Morgan Lens Delivery Set | 264.45 |
| 99070 | Morgan Lens Medi Flow | 264.45 |
| J3490 | Motrin/Ibuprofen tablet, 200mg, coated (oral) | 44.08 |
| J3490 | Motrin / Ibuprofen, Children's Elixir | 44.08 |
| J3490 | Mucinex 600 mg | 44.08 |
| J3490 | Mucomyst | 44.08 |
| J3490 | MVI | 44.08 |
| 99070 | Nasal Speculum Currette | 264.45 |
| J3490 | Neosporin eye drops | 44.08 |
| J3490 | Neomycin Hydrocortisone Otic Drops | 44.08 |
| J3490 | Neo-Synephrine | 44.08 |
| 99070 | Nitro Tubing | 264.45 |
| J3490 | Nitro-Bid, ointment 2%, 1gm | 44.08 |
| J3490 | Nitroglycerin, 0.2mg/250ml, IV | 44.08 |
| J3490 | Nitroglycerin paste, 1" strip | 44.08 |
| J3490 | Nitroquick SL, 0.4mg tablet | 44.08 |
| J3490 | Norco 5/325 mg | 44.08 |
| J3490 | Norvasc 5 mg tab | 44.08 |
| 99070 | Nonrebreather oxygen mask | 264.45 |
| J3490 | Normal saline solution / Sodium Chloride, 100 ml | 44.08 |
| J3490 | Normal saline 0.9%, 250 ml bottle, for irrigation | 44.08 |
| 99070 | Oxygen each additional hour | 264.45 |
| 99070 | Oxygen First Hour | 264.45 |
| J3490 | Orapred / Oral Prednisone, for kids | 44.08 |
| 99070 | Paper tape | 264.45 |
| 99070 | Pedialyte | 264.45 |
| J3490 | Pedi-Fleet Enema, 2.2oz | 44.08 |
| 99070 | Pelvic Tray (for Female Pelvic Exams) | 264.45 |
| J3490 | Famotidine/Pepcid, 10 mg, oral | 44.08 |
| J3490 | Famotidine/Pepcid, 20 mg, oral | 44.08 |
| A9150 | Pepto Bismol Caplets PO | 26.88 |
| A9150 | Pepto Bismol caps PO | 26.88 |
| J3490 | Phenegan/Promethazine HCI Rectal Suppository, 12.5 mg | 44.08 |
| J3490 | Phenegan/Promethazine HCI Rectal Suppository, 25 mg | 44.08 |
| J3490 | Phenergan/Promethazine Suppository 50 mg each | 44.08 |
| J3490 | Phenegan/Promethazine HCI, 25 mg, oral | 44.08 |
| J3490 | Phenergan/Promethazine HCI, 50 mg, oral | 44.08 |
| 99070 | Nitrazine ( PH ) test strips | 264.45 |
| J3490 | Plavix / Clopidogrel, 75mg, oral | 44.08 |
| 99070 | Pleur-Evac System Adult Single Use Sterile | 264.45 |
| J3490 | Polytrim Opthalmic, Polymyxin | 44.08 |
| POSTOP | Postoperative Recheck (Suture Removal, Wound Recheck, etc) | 0 |
| J3490 | Potassium 60mg PO | 44.08 |
| J3490 | Potassium Chloride, 10 meq, oral | 44.08 |
| J3490 | Potassium Chloride ER, 20 mg, oral | 44.08 |
| J3490 | Prelone syrup, less than 1 tsp, oral | 44.08 |
| 99070 | Primary tubing for IV | 264.45 |
| 99070 | Prolene 3.0 sutures | 264.45 |
| 99070 | Prolene 4.0 sutures | 264.45 |
| 99070 | Prolene 5.0 sutures | 264.45 |
| 99070 | Prolene 6.0 sutures | 264.45 |
| J3490 | Proparacaine HCl / Alcaine Opth Drops | 44.08 |
| J3490 | Protonix / Pantoprazole Sodium 40 mg, oral | 44.08 |
| J3490 | Proventil Tabs 10 MG oral | 44.08 |
| J8499 | Provera Tablet up to 10 mg | 8.6 |
| 99070 | Pump tubing for IV | 264.45 |
| J3490 | Pyridium/Phenazopyridine, 200MG PO | 44.08 |
| Q0035 | Cardiokymography | 66.65 |
| Q0091 | Screening papanicolaou smear; obtaining, preparing and conveyance of cervical or vaginal smear to laboratory | 124.7 |
| Q0111 | Wet mounts, including preparations of vaginal, cervical or skin specimens | 77.4 |
| Q0144 | Azithromycin dihydrate, oral, capsules/powder, 1 gram | 189.2 |
| Q0163 | Diphenhydramine hydrochloride, 50 mg, oral, | 7.53 |
| Q2009 | Injection, fosphenytoin, 50 mg phenytoin equivalent | 80.63 |
| Q4005 | Cast supplies, long arm cast, adult (11 years +), plaster | 176.3 |
| Q4006 | Cast supplies, long arm cast, adult (11 years +), fiberglass | 176.3 |
| Q4007 | Cast supplies, long arm cast, pediatric (0-10 years), plaster | 176.3 |
| Q4008 | Cast supplies, long arm cast, pediatric (0-10 years), fiberglass | 176.3 |
| Q4009 | Cast supplies, short arm cast, adult (11 years +), plaster | 176.3 |
| Q4010 | Cast supplies, short arm cast, adult (11 years +), fiberglass | 176.3 |
| Q4011 | Cast supplies, short arm cast, pediatric (0-10 years), plaster | 176.3 |
| Q4012 | Cast supplies, short arm cast, pediatric (0-10 years), fiberglass | 176.3 |
| Q4014 | Cast supplies, gauntlet cast (includes lower forearm and hand), adult (11 years +), fiberglass | 87.08 |
| Q4016 | Cast supplies, gauntlet cast (includes lower forearm and hand), pediatric (0-10 years), fiberglass | 87.08 |
| Q4017 | Cast supplies, long arm splint, adult (11 years +), plaster | 176.3 |
| Q4018 | Cast supplies, long arm splint, adult (11 years +), fiberglass | 176.3 |
| Q4019 | Cast supplies, long arm splint, pediatric (0-10 years), plaster | 176.3 |
| Q4020 | Cast supplies, long arm splint, pediatric (0-10 years), fiberglass | 176.3 |
| Q4022 | Cast supplies, short arm splint, adult (11 years +), fiberglass | 118.25 |
| Q4024 | Cast supplies, short arm splint, pediatric (0-10 years), fiberglass | 61.28 |
| Q4029 | Cast supplies, long leg cast, adult (11 years +), plaster | 176.3 |
| Q4031 | Cast supplies, long leg cast, pediatric (0-10 years), plaster | 176.3 |
| Q4032 | Cast supplies, long leg cast, pediatric (0-10 years), fiberglass | 255.85 |
| Q4037 | Cast supplies, short leg cast, adult (11 years +), plaster | 176.3 |
| Q4038 | Cast supplies, short leg cast, adult (11 years +), fiberglass | 127.93 |
| Q4039 | Cast supplies, short leg cast, pediatric (0-10 years), plaster | 176.3 |
| Q4040 | Cast supplies, short leg cast, pediatric (0-10 years), fiberglass | 137.6 |
| Q4046 | Cast supplies, short leg splint, adult (11 years +), fiberglass | 115.03 |
| Q4048 | Cast supplies, short leg splint, pediatric (0-10 years), fiberglass | 176.3 |
| Q4049 | Finger splint, static | 44.08 |
| Q9954 | Oral magnetic resonance contrast agent, per 100 ml | 612.75 |
| Q9963 | High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml | 7.53 |
| Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml | 7.53 |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 7.53 |
| 99070 | Quick Clot | 264.45 |
| J3490 | Racemic EPI, 2.25%, inhalation | 44.08 |
| J8499 | Reglan up to 10 mg PO | 8.6 |
| 99070 | Nasal rapid rhino rocket (supplies) | 264.45 |
| J3490 | Robaxin | 44.08 |
| J3490 | Robitussin | 44.08 |
| J3490 | Romazicon/Flumazenil, 0.1mg, IV | 44.08 |
| S0020 | Injection, bupivicaine hydrochloride, 30 ml | 36.55 |
| S0028 | Injection, famotidine, 20 mg | 106.43 |
| S0030 | Injection, metronidazole, 500 mg (Flagyl) | 87.08 |
| S0039 | Injection, sulfamethoxazole and trimethoprim, 10 ml | 36.55 |
| S0077 | Injection, clindamycin phosphate, 300 mg | 87.08 |
| S0119 | Ondansetron, oral, 4 mg (for circumstances falling under the medicare statute, use hcpcs q code) | 49.45 |
| S0164 | Injection, pantoprazole sodium, 40 mg | 292.4 |
| S0630 | Removal of sutures; by a physician other than the physician who originally closed the wound | 176.3 |
| S2083 | Adjustment of gastric band diameter via subcutaneous port by injection or aspiration of saline | 704.13 |
| S5000 | Prescription drug, generic | 3.23 |
| S5001 | Prescription drug, brand name | 6.45 |
| S5011 | 5% dextrose in lactated ringer's, 1000 ml | 4.3 |
| S8120 | Oxygen contents, gaseous, 1 unit equals 1 cubic foot | 38.7 |
| S8450 | Splint, prefabricated, digit (specify digit by use of modifier) | 41.93 |
| S8451 | Splint, prefabricated, wrist or ankle | 79.55 |
| S9088 | Services provided in an urgent care center (list in addition to code for service) | 439.68 |
| 99070 | Saline locks for IV | 264.45 |
| 99070 | Schuknecht Foreign Body Remover | 264.45 |
| 99070 | Secondary Tubing for IV | 264.45 |
| 99070 | Silk 0 for sutures | 264.45 |
| J3490 | Silvadene Cream 1%, 20gm | 44.08 |
| J3490 | Silver Nitrate | 44.08 |
| J3490 | Silver Sulfadiazine 1% cream | 44.08 |
| J8499 | Skelaxin 800mg PO | 5.81 |
| J3490 | Sodium Bicarbonate, 8.4%, 50 ml, 1meq/mL | 44.08 |
| 99070 | Staples | 264.45 |
| 99070 | Defibrillator Pad / Stat Pad, F/Zoll PD 1200 ADLT | 264.45 |
| 99070 | Steri Strips 1/2" | 264.45 |
| 99070 | Urine strain cup | 264.45 |
| J3490 | Succsodonate | 44.08 |
| 99070 | Surgicel | 264.45 |
| 99070 | Swab, sterile | 264.45 |
| J3490 | Tamiflu | 44.08 |
| J3490 | Artificial Tears | 44.08 |
| 99070 | Tegaderm | 264.45 |
| J3490 | Tessalon Perles 20 mg PO | 44.08 |
| J3490 | Tetracaine opthalmic drops 5% | 44.08 |
| J8499 | Tigan, 100mg suppository | 8.6 |
| J3490 | Tobramycin Sulfate Opth Drops | 44.08 |
| J3490 | Tobrex | 44.08 |
| 99070 | Tono Pen Tip | 264.45 |
| J3490 | Tranexamic Acid 100mg PO | 18.21 |
| 99070 | Transpore Tape | 264.45 |
| 99070 | Trocar Catheter | 264.45 |
| 99070 | Urine Specimen Cup | 264.45 |
| J8499 | Ultram 50 mg PO | 8.6 |
| 99070 | Urine Collection Hat | 264.45 |
| V2797 | Vision supply, accessory and/or service component of another hcpcs vision code | 44.08 |
| J8499 | Valium/Diazepam, 10mg tablet (oral) | 8.6 |
| J8499 | Valium/Diazepam, 5mg tablet (oral) | 8.6 |
| J3490 | Valsartan 80 mg PO | 44.08 |
| J3490 | Vasopressin, Mdv 20u/ml 1ml | 44.08 |
| J3490 | Enalapril, Vasotec IV med 1 ml | 44.08 |
| J8499 | VazoTuss, 10cc, oral | 8.6 |
| J3490 | Verapamil 2.5 mg/ml | 44.08 |
| J3490 | Vecuronium Bromide, 10mg, IV | 44.08 |
| 99070 | Vicryl 4.0 for sutures | 264.45 |
| 99070 | Vicryl 5.0 for sutures | 264.45 |
| 99070 | Vicryl 6.0 for sutures | 264.45 |
| J8499 | Vicodin/Hydrocodone 5/500mg (oral) | 8.6 |
| A9150 | Viscous Lidocaine, for topical use | 26.88 |
| A9150 | Viscous Lidocaine, 10 ml, PO | 26.88 |
| 99070 | Word Bartholin Catheter | 264.45 |
| 99070 | Yankaur Suction | 264.45 |
| J3490 | Zantac ( RANITIDINE) 150 mg PO | 44.08 |
| J8499 | Zithromax / Azithromycin dihydrate, oral, up to 500 mg | 8.6 |
| A9150 | Zyrtec, Oral, 10mg tablet | 26.88 |