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Provider Manual

Approved Outpatient Procedures

Last Updated on October 29, 2018

The following is a list of approved outpatient procedures.

CPT Description ASC Group
10021 Fine needle aspiration; without imaging guidance 1
10022 Fine needle aspiration; with imaging guidance 1
11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less 2
11404 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cm 1
11406 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cm 2
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 2
11426 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cm 2
11646 Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cm 2
11770 Excision of pilonidal cyst or sinus; simple 3
11771 Excision of pilonidal cyst or sinus; extensive 3
11772 Excision of pilonidal cyst or sinus; complicated 3
11970 Replacement of tissue expander with permanent prosthesis 3
12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cm 2
13100 Repair, complex, trunk; 1.1 cm to 2.5 cm 2
13101 Repair, complex, trunk; 2.6 cm to 7.5 cm 3
13120 Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cm 2
13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm 3
13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm 2
13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm 3
13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm 3
13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm 3
13160 Secondary closure of surgical wound or dehiscence, extensive or complicated 2
14000 Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or less 2
14040 Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or less 2
14060 Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or less 3
15002 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and children. 2
15004 Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and children. 2
15050 Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameter 2
15100 Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 2
15120 Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050) 2
15240 Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or less 3
15260 Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or less 2
15574 Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, or feet 3
15576 Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoral 3
15620 Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feet 4
15820 Blepharoplasty, lower eyelid 3
15821 Blepharoplasty, with extensive herniated fat pad 3
15822 Blepharoplasty, upper eyelid 3
15823 Blepharoplasty, with excessive skin weighting down lid 3
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) 2
19081 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidance 3
19083 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidance 3
19085 Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidance 3
19100 Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure) 3
19112 Excision of lactiferous duct fistula 3
19120 Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesions 3
19125 Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesion 3
19300 Mastectomy for gynecomastia 4
19301 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy) 3
19302 Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomy 7
19303 Mastectomy, simple, complete 4
19307 Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscle 4
19328 Removal of intact mammary implant 1
19330 Removal of mammary implant material 1
19340 Immediate insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 2
19342 Delayed insertion of breast prosthesis following mastopexy, mastectomy or in reconstruction 3
19350 Nipple/areola reconstruction 4
19357 Breast reconstruction, immediate or delayed, with tissue expander, including subsequent expansion 5
19370 Open periprosthetic capsulotomy, breast 4
19371 Periprosthetic capsulectomy, breast 4
19380 Revision of reconstructed breast 5
20205 Biopsy, muscle; deep 3
20245 Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft) 3
20525 Removal of foreign body in muscle or tendon sheath; deep or complicated 3
20680 Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate) 3
20690 Application of a uniplane (pins or wires in one plane), unilateral, external fixation system 2
20694 Removal, under anesthesia, of external fixation system 1
20900 Bone graft, any donor area; minor or small (eg, dowel or button) 3
20902 Bone graft, any donor area; major or large 4
21040 Excision of benign tumor or cyst of mandible, by enucleation and/or curettage 2
21210 Graft, bone; nasal, maxillary or malar areas (includes obtaining graft) 5
21235 Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft) 7
21242 Arthroplasty, temporomandibular joint, with allograft 5
21315 Closed treatment of nasal bone fracture; without stabilization 2
21320 Closed treatment of nasal bone fracture; with stabilization 2
21390 Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implant 7
21407 Open treatment of fracture of orbit, except blowout; with implant 3
21480 Closed treatment of temporomandibular dislocation; initial or subsequent 1
21555 Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cm 2
21556 Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cm 2
21600 Excision of rib, partial 2
21930 Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cm 2
22900 Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cm 4
23075 Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cm 2
23076 Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cm 2
23120 Claviculectomy; partial 5
23140 Excision or curettage of bone cyst or benign tumor of clavicle or scapula 4
23200 Radical resection for tumor, clavicle 4
23600 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulation 1
23605 Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal traction 2
23620 Closed treatment of greater humeral tuberosity fracture; without manipulation 1
23625 Closed treatment of greater humeral tuberosity fracture; with manipulation 2
23630 Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performed 5
24075 Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cm 2
24076 Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cm 2
24102 Arthrotomy, elbow; with synovectomy 3
24105 Excision, olecranon bursa 3
24357 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneous 1
24358 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open 1
24359 Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachment 1
24360 Arthroplasty, elbow; with membrane (eg, fascial) 5
24361 Arthroplasty, elbow; with distal humeral prosthetic replacement 5
24362 Arthroplasty, elbow; with implant and fascia lata ligament reconstruction 5
24363 Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow) 7
24500 Closed treatment of humeral shaft fracture; without manipulation 1
24505 Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal traction 1
24530 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulation 1
24535 Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal traction 1
24538 Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extension 2
24546 Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extension 5
24560 Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulation 1
24565 Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulation 2
24566 Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulation 2
24575 Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performed 3
24576 Closed treatment of humeral condylar fracture, medial or lateral; without manipulation 1
24577 Closed treatment of humeral condylar fracture, medial or lateral; with manipulation 1
24579 Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performed 3
25000 Incision, extensor tendon sheath, wrist (eg, deQuervains disease) 3
25075 Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cm 2
25105 Arthrotomy, wrist joint; with synovectomy 4
25110 Excision, lesion of tendon sheath, forearm and/or wrist 3
25111 Excision of ganglion, wrist (dorsal or volar); primary 3
25112 Excision of ganglion, wrist (dorsal or volar); recurrent 4
25115 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors 4
25116 Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculum 4
25118 Synovectomy, extensor tendon sheath, wrist, single compartment; 2
25210 Carpectomy; one bone 3
25215 Carpectomy; all bones of proximal row 4
25248 Exploration with removal of deep foreign body, forearm or wrist 2
25270 Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscle 4
25310 Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendon 3
25320 Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instability 3
25332 Arthroplasty, wrist, with or without interposition, with or without external or internal fixation 5
25447 Arthroplasty, interposition, intercarpal or carpometacarpal joints 5
25505 Closed treatment of radial shaft fracture; with manipulation 1
25515 Open treatment of radial shaft fracture, includes internal fixation, when performed 3
25520 Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation) 1
25526 Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complex 5
25535 Closed treatment of ulnar shaft fracture; with manipulation 1
25565 Closed treatment of radial and ulnar shaft fractures; with manipulation 2
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 3
25606 Percutaneous skeletal fixation of distal radial fracture or epiphyseal separation 3
25607 Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixation 5
25608 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragments 5
25609 Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragments 5
25800 Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints) 4
25820 Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal) 4
25825 Arthrodesis, wrist; with autograft (includes obtaining graft) 5
26045 Fasciotomy, palmar (eg, Dupuytren's contracture); open, partial 3
26055 Tendon sheath incision (eg, for trigger finger) 2
26115 Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cm 2
26116 Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cm 2
26121 Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft) 4
26123 Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft) 4
26135 Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digit 4
26145 Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendon 3
26160 Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or finger 3
26210 Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; 2
26236 Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of finger 3
26370 Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendon 4
26410 Repair, extensor tendon, hand, primary or secondary; without free graft, each tendon 3
26418 Repair, extensor tendon, finger, primary or secondary; without free graft, each tendon 4
26445 Tenolysis, extensor tendon, hand OR finger; each tendon 3
26460 Tenotomy, extensor, hand or finger, open, each tendon 3
26471 Tenodesis; of proximal interphalangeal joint, each joint 2
26480 Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendon 3
26520 Capsulectomy or capsulotomy; metacarpophalangeal joint, each joint 3
26525 Capsulectomy or capsulotomy; interphalangeal joint, each joint 3
26531 Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each joint 7
26536 Arthroplasty, interphalangeal joint; with prosthetic implant, each joint 5
26540 Repair of collateral ligament, metacarpophalangeal or interphalangeal joint 4
26541 Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft) 7
26545 Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each joint 4
26608 Percutaneous skeletal fixation of metacarpal fracture, each bone 3
26615 Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each bone 4
26735 Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with or without internal or external fixation, each 4
26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each 5
26765 Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, each 4
26841 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation 4
26842 Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft) 4
26843 Arthrodesis, carpometacarpal joint, digit, other than thumb, each; 3
26844 Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft) 3
26850 Arthrodesis, metacarpophalangeal joint, with or without internal fixation; 4
26860 Arthrodesis, interphalangeal joint, with or without internal fixation; 3
26910 Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transfer 3
26951 Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closure 2
27047 Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cm 2
27062 Excision; trochanteric bursa or calcification 5
27275 Manipulation, hip joint, requiring general anesthesia 2
27305 Fasciotomy, iliotibial (tenotomy), open 2
27323 Biopsy, soft tissue of thigh or knee area; superficial 1
27327 Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cm 2
27328 Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cm 3
27340 Excision, prepatellar bursa 3
27360 Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess) 5
27422 Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure) 7
27425 Lateral retinacular release, open 7
27475 Arrest, epiphyseal, any method (eg, epiphysiodesis); distal femur 4
27532 Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal traction 1
27550 Closed treatment of knee dislocation; without anesthesia 1
27552 Closed treatment of knee dislocation; requiring anesthesia 1
27570 Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices) 1
27612 Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengthening 3
27630 Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankle 3
27635 Excision or curettage of bone cyst or benign tumor, tibia or fibula 3
27685 Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure) 3
27686 Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), each 3
27687 Gastrocnemius recession (eg, Strayer procedure) 3
27691 Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot) 3
27695 Repair, primary, disrupted ligament, ankle; collateral 2
27750 Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulation 1
27752 Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal traction 1
27780 Closed treatment of proximal fibula or shaft fracture; without manipulation 1
27781 Closed treatment of proximal fibula or shaft fracture; with manipulation 1
28043 Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cm 2
28045 Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cm 3
28080 Excision, interdigital (Morton) neuroma, single, each 3
28090 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); foot 3
28092 Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), each 2
28104 Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus 2
28110 Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure) 3
28116 Ostectomy, excision of tarsal coalition 3
28119 Ostectomy, calcaneus; for spur, with or without plantar fascial release 4
28120 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneus 4
28124 Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toe 4
28150 Phalangectomy, toe, each toe 3
28160 Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, each 3
28192 Removal of foreign body, foot; deep 2
28232 Tenotomy, open, tendon flexor; toe, single tendon (separate procedure) 3
28238 Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure) 3
28280 Syndactylization, toes (eg, webbing or Kelikian type procedure) 2
28285 Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy) 3
28288 Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal head 3
28291 Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implant 3
28292 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method 2
28296 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any method 3
28297 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method 3
28298 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any method 3
28299 Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any method 5
28300 Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixation 2
28308 Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, each 2
28313 Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes) 2
28615 Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performed 3
28750 Arthrodesis, great toe; metatarsophalangeal joint 4
28805 Amputation, foot; transmetatarsal 3
28810 Amputation, metatarsal, with toe, single 3
28820 Amputation, toe; metatarsophalangeal joint 3
28825 Amputation, toe; interphalangeal joint 2
29822 Arthroscopy, shoulder, surgical; debridement, limited 3
29823 Arthroscopy, shoulder, surgical; debridement, extensive 3
29837 Arthroscopy, elbow, surgical; debridement, limited 3
29870 Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure) 3
29873 Arthroscopy, knee, surgical, with lateral release 3
29874 Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation) 3
29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure) 4
29876 Arthroscopy, knee, surgical; synovectomy, major, two or more compartments (eg, medial or lateral) 4
29877 Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty) 4
29879 Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfracture 3
29880 Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 4
29881 Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performed 4
29882 Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral) 3
29887 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation 3
29894 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign body 3
29895 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partial 3
29897 Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limited 3
30115 Excision, nasal polyp(s), extensive 2
30117 Excision or destruction (eg, laser), intranasal lesion; internal approach 3
30130 Excision turbinate, partial or complete, any method 3
30140 Submucous resection turbinate, partial or complete, any method 2
30310 Removal foreign body, intranasal; requiring general anesthesia 1
30420 Rhinoplasty, primary; including major septal repair 5
30460 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip only 6
30462 Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomies 6
30520 Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graft 4
30560 Lysis intranasal synechia 2
30630 Repair nasal septal perforations 7
30930 Fracture nasal turbinate(s), therapeutic 1
31000 Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium) 1
31020 Sinusotomy, maxillary (antrotomy); intranasal 2
31030 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polyps 3
31032 Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polyps 4
31200 Ethmoidectomy; intranasal, anterior 2
31201 Ethmoidectomy; intranasal, total 5
31237 Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure) 2
31239 Nasal/sinus endoscopy, surgical; with dacryocystorhinostomy 4
31240 Nasal/sinus endoscopy, surgical; with concha bullosa resection 2
31254 Nasal/sinus endoscopy, surgical; with ethmoidectomy, partial (anterior) 3
31255 Nasal/sinus endoscopy, surgical; with ethmoidectomy, total (anterior and posterior) 5
31256 Nasal/sinus endoscopy, surgical, with maxillary antrostomy 3
31525 Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newborn 1
31536 Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescope 3
31540 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis 4
31541 Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescope 4
31611 Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis) 3
31622 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure) 2
31623 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushings 2
31624 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavage 2
31629 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i) 2
31830 Revision of tracheostomy scar 2
36555 Insertion of non-tunneled centrally inserted central venous catheter; younger than 5 years of age 1
36556 Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older 1
36557 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; younger than 5 years of age 3
36558 Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older 3
36560 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; younger than 5 years of age 3
36561 Insertion of tunneled centrally inserted central venous access device, with subcutaneous port; age 5 years or older 3
36565 Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; without subcutaneous port or pump (eg, Tesio type catheter) 3
36566 Insertion of tunneled centrally inserted central venous access device, requiring 2 catheters via 2 separate venous access sites; with subcutaneous port(s) 3
36568 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; younger than 5 years of age 1
36569 Insertion of peripherally inserted central venous catheter (PICC), without subcutaneous port or pump; age 5 years or older 1
36570 Insertion of peripherally inserted central venous access device, with subcutaneous port; younger than 5 years of age 3
36571 Insertion of peripherally inserted central venous access device, with subcutaneous port; age 5 years or older 3
36575 Repair of tunneled or non-tunneled central venous access catheter, without subcutaneous port or pump, central or peripheral insertion site 2
36576 Repair of central venous access device, with subcutaneous port or pump, central or peripheral insertion site 2
36578 Replacement, catheter only, of central venous access device, with subcutaneous port or pump, central or peripheral insertion site 2
36580 Replacement, complete, of a non-tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access 1
36581 Replacement, complete, of a tunneled centrally inserted central venous catheter, without subcutaneous port or pump, through same venous access 2
36582 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access 2
36583 Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous pump, through same venous access 2
36584 Replacement, complete, of a peripherally inserted central venous catheter (PICC), without subcutaneous port or pump, through same venous access 1
36585 Replacement, complete, of a peripherally inserted central venous access device, with subcutaneous port, through same venous access 2
36589 Removal of tunneled central venous catheter, without subcutaneous port or pump 1
36590 Removal of tunneled central venous access device, with subcutaneous port or pump, central or peripheral insertion 1
36825 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); autogenous graft 4
36830 Creation of arteriovenous fistula by other than direct arteriovenous anastomosis (separate procedure); nonautogenous graft; (eg, biological collagen, thermoplastic graft) 4
37700 Ligation and division of long saphenous vein at saphenofemoral junction, or distal interruptions 2
37718 Ligation, division and stripping, short saphenous vein 3
37722 Ligation, division, and stripping long (greater) saphenous veins from saphenofemoral junction to knee or below 3
37780 Ligation and division of short saphenous vein at saphenopopliteal junction (separate procedure) 3
37785 Ligation, division, and/or excision of varicose vein cluster(s), 1 leg 3
38220 Bone marrow aspiration 1
38221 Bone marrow; biopsy, needle or trocar 1
38500 Biopsy or excision of lymph node(s); open, superficial 2
38510 Biopsy or excision of lymph node(s); open, deep cervical node(s) 2
38520 Biopsy or excision of lymph node(s); open, deep cervical node(s) with excision scalene fat pad 2
38525 Biopsy or excision of lymph node(s); open, deep axillary node(s) 2
38745 Axillary lymphadenectomy; complete 4
38792 Injection procedure; for identification of sentinel node 2
40500 Vermilionectomy (lip shave), with mucosal advancement 2
40510 Excision of lip; transverse wedge excision with primary closure 2
40525 Excision of lip; full thickness, reconstruction with local flap (eg, Estlander or fan) 2
40812 Excision of lesion of mucosa and submucosa, vestibule of mouth; with simple repair 1
40814 Excision of lesion of mucosa and submucosa, vestibule of mouth; with complex repair 2
40818 Excision of mucosa of vestibule of mouth as donor graft 1
40819 Excision of frenum, labial or buccal (frenumectomy, frenulectomy, frenectomy) 1
41112 Excision of lesion of tongue with closure; anterior two-thirds 2
42145 Palatopharyngoplasty (eg, uvulopalatopharyngoplasty, uvulopharyngoplasty) 5
42340 Sialolithotomy; parotid, extraoral or complicated intraoral 2
42400 Biopsy of salivary gland; needle 2
42405 Biopsy of salivary gland; incisional 2
42410 Excision of parotid tumor or parotid gland; lateral lobe, without nerve dissection 3
42420 Excision of parotid tumor or parotid gland; total, with dissection and preservation of facial nerve 7
42425 Excision of parotid tumor or parotid gland; total, en bloc removal with sacrifice of facial nerve 7
42440 Excision of submandibular (submaxillary) gland 3
42804 Biopsy; nasopharynx, visible lesion, simple 1
42808 Excision or destruction of lesion of pharynx, any method 2
42810 Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues 3
42820 Tonsillectomy and adenoidectomy; younger than age 12 5
42821 Tonsillectomy and adenoidectomy; age 12 or over 5
42825 Tonsillectomy, primary or secondary; younger than age 12 4
42826 Tonsillectomy, primary or secondary; age 12 or over 4
42830 Adenoidectomy, primary; younger than age 12 3
42831 Adenoidectomy, primary; age 12 or over 4
43200 Esophagoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 1
43201 Esophagoscopy, flexible, transoral; with directed submucosal injection(s), any substance 1
43202 Esophagoscopy, flexible, transoral; with biopsy, single or multiple 1
43204 Esophagoscopy, flexible, transoral; with injection sclerosis of esophageal varices 1
43205 Esophagoscopy, flexible, transoral; with band ligation of esophageal varices 1
43212 Esophagoscopy, flexible, transoral; with placement of endoscopic stent (includes pre- and post-dilation and guide wire passage, when performed) 1
43215 Esophagoscopy, flexible, transoral; with removal of foreign body(s) 1
43216 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 1
43217 Esophagoscopy, flexible, transoral; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 1
43220 Esophagoscopy, flexible, transoral; with transendoscopic balloon dilation (less than 30 mm diameter) 1
43235 Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 1
43236 Esophagogastroduodenoscopy, flexible, transoral; with directed submucosal injection(s), any substance 2
43239 Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple 2
43248 Esophagogastroduodenoscopy, flexible, transoral; with insertion of guide wire followed by passage of dilator(s) through esophagus over guide wire 2
43249 Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter) 2
43260 Endoscopic retrograde cholangiopancreatography (ERCP); diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 2
43261 Endoscopic retrograde cholangiopancreatography (ERCP); with biopsy, single or multiple 2
43262 Endoscopic retrograde cholangiopancreatography (ERCP); with sphincterotomy/papillotomy 2
43264 Endoscopic retrograde cholangiopancreatography (ERCP); with removal of calculi/debris from biliary/pancreatic duct(s) 2
43265 Endoscopic retrograde cholangiopancreatography (ERCP); with destruction of calculi, any method (eg, mechanical, electrohydraulic, lithotripsy) 2
43270 Esophagogastroduodenoscopy, flexible, transoral; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 2
43870 Closure of gastrostomy, surgical 1
44340 Revision of colostomy; simple (release of superficial scar) (separate procedure) 3
44360 Small intestinal endoscopy, enteroscopy beyond second portion of duodenum, not including ileum; diagnostic with or without collection of specimen(s) by brushing or washing (separate procedure) 2
44388 Colonoscopy through stoma; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 2
45330 Sigmoidoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 2
45331 Sigmoidoscopy, flexible; with biopsy, single or multiple 2
45333 Sigmoidoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 2
45378 Colonoscopy, flexible; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) 2
45380 Colonoscopy, flexible; with biopsy, single or multiple 2
45381 Colonoscopy, flexible; with directed submucosal injection(s), any substance 2
45382 Colonoscopy, flexible; with control of bleeding, any method 2
45384 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps 2
45385 Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by snare technique 2
45386 Colonoscopy, flexible; with transendoscopic balloon dilation 2
45388 Colonoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed) 2
46040 Incision and drainage of ischiorectal and/or perirectal abscess (separate procedure) 3
46060 Incision and drainage of ischiorectal or intramural abscess, with fistulectomy or fistulotomy, submuscular, with or without placement of seton 2
46080 Sphincterotomy, anal, division of sphincter (separate procedure) 3
46200 Fissurectomy, including sphincterotomy, when performed 2
46250 Hemorrhoidectomy, external, 2 or more columns/groups 3
46255 Hemorrhoidectomy, internal and external, single column/group 3
46260 Hemorrhoidectomy, internal and external, 2 or more columns/groups 3
46270 Surgical treatment of anal fistula (fistulectomy/fistulotomy); subcutaneous 3
46275 Surgical treatment of anal fistula (fistulectomy/fistulotomy); intersphincteric 3
46280 Surgical treatment of anal fistula (fistulectomy/fistulotomy); transsphincteric, suprasphincteric, extrasphincteric or multiple, including placement of seton, when performed 4
46922 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), simple; surgical excision 1
46924 Destruction of lesion(s), anus (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 1
47000 Biopsy of liver, needle; percutaneous 1
47562 Laparoscopy, surgical; cholecystectomy 6
47563 Laparoscopy, surgical; cholecystectomy with cholangiography 6
49082 Abdominal paracentesis (diagnostic or therapeutic); without imaging guidance 2
49083 Abdominal paracentesis (diagnostic or therapeutic); with imaging guidance 2
49084 Peritoneal lavage, including imaging guidance, when performed 2
49320 Laparoscopy, abdomen, peritoneum, and omentum, diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) 3
49321 Laparoscopy, surgical; with biopsy (single or multiple) 3
49322 Laparoscopy, surgical; with aspiration of cavity or cyst (eg, ovarian cyst) (single or multiple) 3
49323 Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity 3
49495 Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; reducible 4
49496 Repair, initial inguinal hernia, full term infant younger than age 6 months, or preterm infant older than 50 weeks postconception age and younger than age 6 months at the time of surgery, with or without hydrocelectomy; incarcerated or strangulated 5
49500 Repair initial inguinal hernia, age 6 months to younger than 5 years, with or without hydrocelectomy; reducible 4
49505 Repair initial inguinal hernia, age 5 years or older; reducible 4
49507 Repair initial inguinal hernia, age 5 years or older; incarcerated or strangulated 5
49520 Repair recurrent inguinal hernia, any age; reducible 7
49525 Repair inguinal hernia, sliding, any age 4
49550 Repair initial femoral hernia, any age; reducible 5
49560 Repair initial incisional or ventral hernia; reducible 4
49565 Repair recurrent incisional or ventral hernia; reducible 4
49570 Repair epigastric hernia (eg, preperitoneal fat); reducible (separate procedure) 4
49572 Repair epigastric hernia (eg, preperitoneal fat); incarcerated or strangulated 5
49580 Repair umbilical hernia, younger than age 5 years; reducible 4
49585 Repair umbilical hernia, age 5 years or older; reducible 4
50200 Renal biopsy; percutaneous, by trocar or needle 1
50430 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access 2
50431 Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access 2
50432 Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation 2
50435 Exchange nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and interpretation 1
50590 Lithotripsy, extracorporeal shock wave 8
52000 Cystourethroscopy (separate procedure) 1
52204 Cystourethroscopy, with biopsy(s) 2
52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 to 2.0 cm) 2
52260 Cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction (spinal) anesthesia 2
52276 Cystourethroscopy with direct vision internal urethrotomy 3
52281 Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female 2
52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple 2
52320 Cystourethroscopy (including ureteral catheterization); with removal of ureteral calculus 2
52332 Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type 4
52351 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic 3
52352 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included) 4
52353 Cystourethroscopy, with uteroscopy and/or pyeloscopy; with lithotripsy (urethral catheterization is included) 4
52356 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (eg, Gibbons or double-J type) 4
53020 Meatotomy, cutting of meatus (separate procedure); except infant 1
53230 Excision of urethral diverticulum (separate procedure); female 2
53235 Excision of urethral diverticulum (separate procedure); male 3
53270 Excision of fulguration; Skene's glands 2
53400 Urethroplasty; first stage, for fistula, diverticulum, or stricture (eg, Johannsen type) 3
53405 Urethroplasty; second stage (formation of urethra), including urinary diversion 2
53410 Urethroplasty, 1-stage reconstruction of male anterior urethra 2
53460 Urethromeatoplasty, with partial excision of distal urethral segment (Richardson type procedure) 1
54065 Destruction of lesion(s), penis (eg, condyloma, papilloma, molluscum contagiosum, herpetic vesicle), extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 1
54100 Biopsy of penis; (separate procedure) 1
54161 Circumcision, surgical excision other than clamp, device, or dorsal slit; older than 28 days of age 2
54304 Plastic operation on penis for correction of chordee or for first stage hypospadias repair with or without transplantation of prepuce or skin flaps 4
54344 Repair of hypospadias complications (ie, fistula, stricture, diverticula); requiring mobilization of skin flaps and urethroplasty with flap or patch graft 5
54360 Plastic operation on penis to correct angulation 3
54560 Exploration for undescended testis with abdominal exploration 2
54620 Fixation of contralateral testis (separate procedure) 3
54640 Orchiopexy, inguinal approach, with or without hernia repair 4
54840 Excision of spermatocele, with or without epididymectomy 4
54860 Epididymectomy; unilateral 3
54861 Epididymectomy; bilateral 4
55040 Excision of hydrocele; unilateral 3
55041 Excision of hydrocele; bilateral 3
55060 Repair of tunica vaginalis hydrocele (Bottle type) 4
55500 Excision of hydrocele of spermatic cord, unilateral (separate procedure) 3
55535 Excision of varicocele or ligation of spermatic veins for varicocele; abdominal approach 4
55705 Biopsy, prostate; incisional, any approach 2
56515 Destruction of lesion(s), vulva; extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 3
56605 Biopsy of vulva or perineum; 1 lesion 3
56620 Vulvectomy simple; partial 5
56740 Excision of Bartholin's gland or cyst 3
57000 Colpotomy; with exploration 1
57065 Destruction of vaginal lesion(s); extensive (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery) 1
57135 Excision of vaginal cyst or tumor 3
57513 Cautery of cervix; laser ablation 2
57520 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; cold knife or laser 2
57522 Conization of cervix, with or without fulguration, with or without dilation and curettage, with or without repair; and loop electrode excision 2
58120 Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) 2
58145 Myomectomy, excision of fibroid tumor(s) of uterus, 1 to 4 intramural myoma(s) with total weight of 250 g or less and/or removal of surface myomas; vaginal approach 5
58555 Hysteroscopy, diagnostic (separate procedure) 2
58558 Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D&C 3
58565 Hysteroscopy, surgical; with bilateral fallopian tube cannulation to induce occlusion by placement of permanent implants 6
58600 Ligation or transection of fallopian tube(s), abdominal or vaginal approach, unilateral or bilateral 2
58661 Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy) 4
58662 Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method 4
58670 Laparoscopy, surgical; with fulguration of oviducts (with or without transection) 2
58740 Lysis of adhesions (salpingolysis, ovariolysis) 3
58940 Oophorectomy, partial or total, unilateral or bilateral 6
59320 Cerclage of cervix, during pregnancy, vaginal 2
59812 Treatment of incomplete abortion, any trimester, completed surgically 2
59820 Treatment of missed abortion, completed surgically, first trimester 2
59840 Induce abortion, by dilation and curettage 2
60100 Biopsy thyroid, percutaneous core needle 2
60200 Excision of cyst or adenoma of thyroid, or transection of isthmus 2
60210 Partial thyroid lobectomy, unilateral; with or without isthmusectomy 2
60220 Total thyroid lobectomy, unilateral; with or without isthmusectomy 2
60225 Total thyroid lobectomy, unilateral; with contralateral subtotal lobectomy, including isthmusectomy 3
60280 Excision of thyroglossal duct cyst or sinus 4
61070 Puncture of shunt tubing or reservoir for aspiration or injection procedure 1
64708 Neuroplasty, major peripheral nerve, arm or leg; other than specified 2
64718 Neuroplasty and/or transposition; ulnar nerve at elbow 2
64721 Neuroplasty and/or transposition; median nerve at carpal tunnel 2
64772 Transection or avulsion of other spinal nerve, extradural 2
64788 Excision of neurofibroma or neurolemmoma; cutaneous nerve 3
64790 Excision of neurofibroma or neurolemmoma; major peripheral nerve 3
64795 Biopsy of nerve 2
64831 Suture of digital nerve, hand or foot; 1 nerve 4
65155 Reinsertion of ocular implant; with use of foreign material for reinforcement and/or attachment of muscles to implant 3
65175 Removal of ocular implant 1
65420 Excision or transposition of pterygium; without graft 3
65426 Excision or transposition of pterygium; with graft 5
65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) 7
65755 Keratoplasty (corneal transplant); penetrating (in pseudophakia) 7
65850 Trabeculotomy ab externo 4
66170 Fistulization of sclera for glaucoma; trabeculectomy ab externo in absence of previous surgery 4
66172 Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents) 4
66180 Aqueous shunt to extraocular equatorial plate reservoir, external approach; with graft 5
66185 Revision of aqueous shunt to extraocular equatorial plate reservoir; with graft 2
66250 Revision or repair of operative wound of anterior segment, any type, early or late, major or minor procedure 2
66720 Ciliary body destruction; cryotherapy 2
66840 Removal of lens material; aspiration technique, 1 or more stages 4
66982 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage 8
66983 Intracapsular cataract extraction with insertion of intraocular lens prosthesis (1 stage procedure) 8
66984 Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification) 8
66985 Insertion of intraocular lens prosthesis (secondary implant), not associated with concurrent cataract removal 6
66986 Exchange of intraocular lens 6
67005 Removal of vitreous, anterior approach (open sky technique or limbal incision); partial removal 4
67311 Strabismus surgery, recession or resection procedure; 1 horizontal muscle 3
67312 Strabismus surgery, recession or resection procedure; 2 horizontal muscles 4
67314 Strabismus surgery, recession or resection procedure; 1 vertical muscle (excluding superior oblique) 4
67715 Canthotomy (separate procedure) 1
67808 Excision of chalazion; under general anesthesia and/or requiring hospitalization, single or multiple 2
67880 Construction of intermarginal adhesions, median tarsorrhaphy, or canthorrhaphy 3
67900 Repair of brow ptosis (supraciliary, mid-forehead or coronal approach) 5
67901 Repair of blepharoptosis; frontalis muscle technique with suture or other material (eg, banked fascia) 5
67904 Repair of blepharoptosis; (tarso) levator resection or advancement, external approach 4
67911 Correction of lid retraction 3
67916 Repair of ectropion; excision tarsal wedge 4
67917 Repair of ectropion; extensive (eg, tarsal strip operations) 4
67924 Repair of entropion; extensive (eg, tarsal strip or capsulopalpebral fascia repairs operation) 4
67961 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; up to one-fourth of lid margin 3
67966 Excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus, or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement; over one-fourth of lid margin 3
68110 Excision of lesion, conjunctiva; up to 1 cm 2
68320 Conjunctivoplasty; with conjunctival graft or extensive rearrangement 4
68705 Correction of everted punctum, cautery 2
68720 Dacryocystorhinostomy (fistulization of lacrimal sac to nasal cavity) 4
68810 Probing of nasolacrimal duct, with or without irrigation 1
69145 Excision soft tissue lesion, external auditory canal 2
69205 Removal foreign body from external auditory canal; with general anesthesia 1
69222 Debridement, mastoidectomy cavity, complex (eg, with anesthesia or more than routine cleaning) 1
69310 Reconstruction of external auditory canal (meatoplasty) (eg, for stenosis due to injury, infection) (separate procedure) 3
69421 Myringotomy including aspiration and/or eustachian tube inflation requiring general anesthesia 3
69424 Ventilating tube removal requiring general anesthesia 1
69436 Tympanostomy (requiring insertion of ventilating tube), general anesthesia 3
69440 Middle ear exploration through postauricular or ear canal incision 3
69610 Tympanic membrane repair, with or without site preparation of perforation for closure, with or without patch 2
69631 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; without ossicular chain reconstruction 5
69632 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction (eg, postfenestration) 5
69633 Tympanoplasty without mastoidectomy (including canalplasty, atticotomy and/or middle ear surgery), initial or revision; with ossicular chain reconstruction and synthetic prosthesis (eg, partial ossicular replacement prosthesis (PORP), total ossicular replacement prosthesis (TORP)) 5
69635 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); without ossicular chain reconstruction 7
69636 Tympanoplasty with antrotomy or mastoidotomy (including canalplasty, atticotomy, middle ear surgery, and/or tympanic membrane repair); with ossicular chain reconstruction 7
69641 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); without ossicular chain reconstruction 7
69642 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with ossicular chain reconstruction 7
69643 Tympanoplasty with mastoidectomy (including canalplasty, middle ear surgery, tympanic membrane repair); with intact or reconstructed wall, without ossicular chain reconstruction 7
69660 Stapedectomy or stapedotomy with reestablishment of ossicular continuity, with or without use of foreign material 5
69662 Revision of stapedectomy or stapedotomy 5
69666 Repair oval window fistula 4
69801 Labyrinthotomy, with perfusion of vestibuloactive drug(s), transcanal 5
69930 Cochlear device implantation, with or without mastoidectomy 7
HCPCS Code Description ASC Group
G0104 Colorectal cancer screening; flexible sigmoidoscopy 2
G0105 Colorectal cancer screening; colonoscopy on individual at high risk 2
G0120 Colorectal cancer screening; alternative to G0105, screening colonoscopy, barium enema 2
G0121 Colorectal cancer screening; colonoscopy on individual not meeting criteria for high risk 2