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NOTE: Should you have landed here as a result of a search engine (or other) link, be advised that these files contain material that is copyrighted by the American Medical Association. You are forbidden to download the files unless you read, agree to, and abide by the provisions of the copyright statement. Read the copyright statement now and you will be linked back to here. 2014 CODING UPDATE January 2014 Special Ediiton Latest Medicare News for J11 Part B What’s Inside... Annual HCPCS/CPT Coding Update ..................................................................................1 2014 HCPCS Update: Effective January 1, 2014 ................................................................2 2014 HCPCS Modifier Addition ..........................................................................................3 2014 HCPCS, CDT, CPT Code Additions ..................................................................... 4-19 2014 HCPCS, CDT, CPT Code Changes ..................................................................... 20-33 2014 HCPCS, CDT, CPT Code Deletes ...................................................................... 34-39 Bilateral Modifiers: Use of CPT Modifier 50 & HCPCS Modifiers RT & LT............. 40-41 Bilateral Indicator 3 Procedures: Coding Instructions................................................. 42-43 2014 Endoscopy CPT Codes & Families..................................................................... 44-46 Technical & Professional Modifiers: HCPCS Modifier TC & CPT Modifier 26 ........ 47-65 Services Not Reimbursed by Medicare Part B ..................................................................66 Bundled Codes: Status B Indicator ...................................................................................66 Invalid Codes for Medicare: Status Indicator I............................................................ 67-73 Bundled/Excluded Codes: Status P Indicator ...................................................................74 Non-covered Services: Status N Indicator .................................................................. 75-78 Services Same Day/Provider: Status T Indicator ...............................................................79 Annual HCPCS/ CPT Coding Update Effective January 1, 2014, providers must use the HCPCS/CPT codes that are valid at the time the service is rendered. If claims are submitted with discontinued codes, they will be rejected. To ensure prompt and timely payment of claims, use the new HCPCS/CPT codes for 2014 beginning with services rendered on or after January 1, 2014. Each year thereafter, be sure to adopt the new codes. palmettogba.com/part b The J11 Part B Medicare Advisory contains coverage, billing and other information for Jurisdiction 11 Part B. This information is not intended to constitute legal advice. It is our ofϐicial notice to those we serve concerning their responsibilities and obligations as mandated by Medicare regulations and guidelines. This information is readily available at no cost on the Palmetto GBA website. It is the responsibility of each facility to obtain this information and to follow the guidelines. The J11 Part B Medicare Advisory includes information provided by the Centers for Medicare & Medicaid Services (CMS) and is current at the time of publication. The information is subject to change at any time. This bulletin should be shared with all health care practitioners and managerial members of the provider staff. Bulletins are available at no-cost from our website at http://www.PalmettoGBA.com/Medicare. CPT only copyright 2012 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, and are not part of CPT®, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature is published in Current Dental Terminology (CDT), Copyright © 2012 American Dental Association (ADA). All rights reserved. CMS no longer allows a 90-day grace period for discontinued codes. This also applies to any mid-year HCPCS/CPT deletions. 2014 HCPCS Update: Effective January 1, 2014 Recently, Medicare Administrative Contractors (MAC) received the year 2014 additions, changes and deletions to the Centers for Medicare & Medicaid Services (CMS) Common Procedure Coding System (HCPCS). The HCPCS codes are effective for dates of service on or after January 1, 2014. HCPCS is a collection of codes and descriptors that represent procedure, supplies, products and services which may be provided to Medicare beneficiaries and individuals enrolled in private health insurance programs. HCPCS also contains modifiers, which are two-position codes and descriptors used to indicate that a service or procedure has been altered by some specific circumstance, but not changed in its definition or code. The codes and modifiers are divided into three levels: LEVEL I – Codes and descriptors copyrighted by the American Medical Association’s Current Procedure Terminology (CPT), Standard Edition. These are five-position numeric codes ranging from CPT codes 00000 to 99999, primarily representing physician services. Level I modifiers are two-position numeric codes. LEVEL II – Five-position alphanumeric codes, ranging from HCPCS codes A0000 to V9999, representing primarily items and nonphysician services that are not represented in the Level I category. These codes and descriptors, with the exception of the D series, are approved and maintained by the Alphanumeric Editorial Panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association) and are listed in the HCPCS Level II code book. The D series includes codes copyrighted by the American Dental Association’s Current Dental Terminology, Second Edition (CDT-2). Level II modifiers are two-position alphanumeric codes. LEVEL III – Codes and descriptors developed by Medicare MACs for use at the local level. These are five-position alphanumeric codes in the W, X, Y or Z series (ranging from HCPCS codes W0000 to Z9999) representing physician and nonphysician services that are not represented in the Level I or Level II codes. Level III modifiers are two-position alphanumeric codes in the W, X, Y or Z series. The year 2014 additions, changes and deletions for the HCPCS codes are listed on the following pages. Please use this information to supplement your current materials. Note that the codes listed as changes previously may have had different descriptions of service. It is important that the most current HCPCS codes are submitted on all claims, so please be sure to use the year 2014 versions of the respective code books. Special Instructions • The additions and deletions for the 2014 HCPCS Update are effective by date of service instead of implementation date. • The procedure codes listed as additions are valid for services performed on or after January 1, 2014. If these procedure codes are used for dates of service prior to January 1, 2014, the services will be rejected. • The procedure codes listed as deletions are valid for dates of service up to and including December 31, 2013. CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 2 01/14 2014 HCPCS Modifier Addition HCPCS Modifier Description PM Post mortem CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 3 01/14 2014 HCPCS, CDT, CPT Code Additions HCPCS Code Description A4555 Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only A7047 Oral interface used with respiratory suction pump, each A9520 Technetium tc-99m, tilmanocept, diagnostic, up to 0.5 millicuries A9575 Injection, gadoterate meglumine, 0.1 ml A9599 Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (pet) imaging, per study dose C1841 Retinal prosthesis, includes all internal and external components C5271 Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area C5272 Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) C5273 Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children C5274 Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) C5275 Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area C5276 Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) C5277 Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children C5278 Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) C9132 Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 4 01/14 HCPCS Code Description C9133 Factor ix (antihemophilic factor, recombinant), rixibus, per i.u. C9441 Injection, ferric carboxymaltose, 1 mg C9497 Loxapine, inhalation powder, 10 mg C9735 Anoscopy; with directed submucosal injection(s), any substance C9737 Laparoscopy, surgical, esophageal sphincter augmentation with device (e.g., magnetic band) E0766 Electrical stimulation device used for cancer treatment, includes all accessories, any type E1352 Oxygen accessory, flow regulator capable of positive inspiratory pressure G0461 Immunohistochemistry or immunocytochemistry, per specimen; first single or multiplex antibody stain G0462 Immunohistochemistry or immunocytochemistry, per specimen; each additional single or multiplex antibody stain (list separately in addition to code for primary procedure) G0463 Hospital outpatient clinic visit for assessment and management of a patient G9187 Bundled payments for care improvement initiative home visit for patient assessment performed by a qualified health care professional for individuals not considered homebound including, but not limited to, assessment of safety, falls, clinical status, fluid status, medication reconciliation/ management, patient compliance with orders/plan of care, performance of activities of daily living, appropriateness of care setting; (for use only in the Medicare-approved bundled payments for care improvement initiative); may not be billed for a 30-day period covered by a transitional care management code G9188 Beta-blocker therapy not prescribed, reason not given G9189 Beta-blocker therapy prescribed or currently being taken G9190 Documentation of medical reason(s) for not prescribing beta-blocker therapy (e.g., allergy, intolerance, other medical reasons) G9191 Documentation of patient reason(s) for not prescribing beta-blocker therapy (e.g., patient declined, other patient reasons) G9192 Documentation of system reason(s) for not prescribing beta-blocker therapy (e.g., other reasons attributable to the health care system) G9193 Clinician documented that patient with a diagnosis of major depression was not an eligible candidate for antidepressant medication treatment or patient did not have a diagnosis of major depression G9194 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 180 day (6 month) continuation treatment phase G9195 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 180 day (6 months) continuation treatment phase G9196 Documentation of medical reason(s) for not ordering first or second generation cephalosporin for antimicrobial prophylaxis Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 5 01/14 HCPCS Code Description G9197 Documentation of order for first or second generation cephalosporin for antimicrobial prophylaxis G9198 Order for first or second generation cephalosporin for antimicrobial prophylaxis was not documented, reason not given G9199 Venous thromboembolism (VTE) prophylaxis not administered the day of or the day after hospital admission for documented reasons (e.g., patient is ambulatory, patient expired during inpatient stay, patient already on warfarin or another anticoagulant, other medical reason(s) or eg, patient left against medical advice, other patient reason(s)) G9200 Venous thromboembolism (VTE) prophylaxis was not administered the day of or the day after hospital admission, reason not given G9201 Venous thromboembolism (VTE) prophylaxis administered the day of or the day after hospital admission G9202 Patients with a positive hepatitis c antibody test G9203 Rna testing for hepatitis c documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c G9204 Rna testing for hepatitis c was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given G9205 Patient starting antiviral treatment for hepatitis c during the measurement period G9206 Patient starting antiviral treatment for hepatitis c during the measurement period G9207 Hepatitis c genotype testing documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c G9208 Hepatitis c genotype testing was not documented as performed within 12 months prior to initiation of antiviral treatment for hepatitis c, reason not given G9209 Hepatitis c quantitative RNA testing documented as performed between 4-12 weeks after the initiation of antiviral treatment G9210 Hepatitis c quantitative RNA testing not performed between 4-12 weeks after the initiation of antiviral treatment for reasons documented by clinician (e.g., patients whose treatment was discontinued during the testing period prior to testing, other medical reasons, patient declined, other patient reasons) G9211 Hepatitis c quantitative RNA testing was not documented as performed between 4-12 weeks after the initiation of antiviral treatment, reason not given G9212 Dsm-ivtm criteria for major depressive disorder documented at the initial evaluation G9213 Dsm-iv-tr criteria for major depressive disorder not documented at the initial evaluation, reason not otherwise specified G9214 Cd4+ cell count or cd4+ cell percentage results documented G9215 Cd4+ cell count or percentage not documented as performed, reason not given G9216 Pcp prophylaxis was not prescribed at time of diagnosis of hiv, reason not given Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 6 01/14 HCPCS Code Description G9217 Pcp prophylaxis was not prescribed within 3 months of low cd4+ cell count below 200 cells/ mm3, reason not given G9218 Pcp prophylaxis was not prescribed within 3 months of flow cd4+ cell count below 500 cells/ mm3 or a cd4 percentage below 15%, reason not given G9219 Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 for medical reason (i.e., patient’s cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient’s cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) G9220 Pneumocystis jiroveci pneumonia prophylaxis not prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% for medical reason (i.e., patient’s cd4+ cell count above threshold within 3 months after cd4+ cell count below threshold, indicating that the patient’s cd4+ levels are within an acceptable range and the patient does not require pcp prophylaxis) G9221 Pneumocystis jiroveci pneumonia prophlaxis prescribed G9222 Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 200 cells/mm3 G9223 Pneumocystis jiroveci pneumonia prophylaxis prescribed within 3 months of low cd4+ cell count below 500 cells/mm3 or a cd4 percentage below 15% G9224 Documentation of medical reason for not performing foot exam (e.g., patient with bilateral foot/ leg amputation) G9225 Foot exam was not performed, reason not given G9226 Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam - report when all of the 3 components are completed) G9227 Functional outcome assessment documented, care plan not documented, documentation the patient is not eligible for a care plan G9228 Chlamydia, gonorrhea and syphilis screening results documented (report when results are present for all of the 3 screenings) G9229 Chlamydia, gonorrhea, and syphilis not screened, due to documented reason (patient refusal is the only allowed exclusion) G9230 Chlamydia, gonorrhea, and syphilis not screened, reason not given G9231 Documentation of end stage renal disease (esrd), dialysis, renal transplant or pregnancy G9232 Clinician treating major depressive disorder did not communicate to clinician treating comorbid condition for specified patient reason G9233 All quality actions for the applicable measures in the total knee replacement measures group have been performed for this patient G9234 I intend to report the total knee replacement measures group Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 7 01/14 HCPCS Code Description G9235 All quality actions for the applicable measures in the general surgery measures group have been performed for this patient G9236 All quality actions for the applicable measures in the optimizing patient exposure to ionizing radiation measures group have been performed for this patient G9237 I intend to report the general surgery measures group G9238 I intend to report the optimizing patient exposure to ionizing radiation measures group G9239 Documentation of reasons for patient initiating maintenance hemodialysis with a catheter as the mode of vascular access (e.g., patient has a maturing avf/avg, time-limited trial of hemodialysis, patients undergoing palliative dialysis, other medical reasons, patient declined avf/avg, other patient reasons, patient followed by reporting nephrologist for fewer than 90 days, other system reasons) G9240 Patient whose mode of vascular access is a catheter at the time maintenance hemodialysis is initiated G9241 Patient whose mode of vascular access is not a catheter at the time maintenance hemodialysis is initiated G9242 Documentation of viral load equal to or greater than 200 copies/ml G9243 Documentation of viral load less than 200 copies/ml G9244 Antiretroviral therapy not prescribed G9245 Antiretroviral therapy prescribed G9246 Patient did not have at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits G9247 Patient had at least one medical visit in each 6 month period of the 24 month measurement period, with a minimum of 60 days between medical visits G9248 Patient did not have a medical visit in the last 6 months G9249 Patient had a medical visit in the last 6 months G9250 Documentation of patient pain brought to a comfortable level within 48 hours from initial assessment G9251 Documentation of patient with pain not brought to a comfortable level within 48 hours from initial assessment G9252 Adenoma(s) or other neoplasm detected during screening colonoscopy G9253 Adenoma(s) or other neoplasm not detected during screening colonoscopy G9254 Documentation of patient discharged to home later than post-operative day 2 following CAS G9255 Documentation of patient discharged to home no later than post operative day 2 following CAS G9256 Documentation of patient death following CAS G9257 Documentation of patient stroke following CAS Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 8 01/14 HCPCS Code Description G9258 Documentation of patient stroke following CEA G9259 Documentation of patient survival and absence of stroke following CAS G9260 Documentation of patient death following CEA G9261 Documentation of patient survival and absence of stroke following CEA G9262 Documentation of patient death in the hospital following endovascular AAA repair G9263 Documentation of patient survival in the hospital following endovascular AAA repair G9264 Documentation of patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter for documented reasons (e.g., patient is undergoing palliative dialysis with a catheter, patient approved by a qualified transplant program and scheduled to receive a living donor kidney transplant, other medical reasons, patient declined avf/avg, other patient reasons) G9265 Patient receiving maintenance hemodialysis for greater than or equal to 90 days with a catheter as the mode of vascular access G9266 Patient receiving maintenance hemodialysis for greater than or equal to 90 days without a catheter as the mode of vascular access G9267 Documentation of patient with one or more complications or mortality within 30 days G9268 Documentation of patient with one or more complications within 90 days G9269 Documentation of patient without one or more complications and without mortality within 30 days G9270 Documentation of patient without one or more complications within 90 days G9271 LDL value < 100 G9272 LDL value >= 100 G9273 Blood pressure has a systolic value of < 140 and a diastolic value of < 90 G9274 Blood pressure has a systolic value of =140 and a diastolic value of = 90 or systolic value < 140 and diastolic value = 90 or systolic value = 140 and diastolic value < 90 G9275 Documentation that patient is a current non-tobacco user G9276 Documentation that patient is a current tobacco user G9277 Documentation that the patient is on daily aspirin or has documentation of a valid contraindication to aspirin automatic contraindications include anti-coagulant use, allergy, and history of gastrointestinal bleed; additionally, any reason documented by the physician as a reason for not taking daily aspirin is acceptable (examples include non-steroidal antiinflammatory agents, risk for drug interaction, or uncontrolled hypertension defined as > 180 systolic or > 110 diastolic) G9278 Documentation that the patient is not on daily aspirin regimen G9279 Pneumococcal screening performed and documentation of vaccination received prior to discharge Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 9 01/14 HCPCS Code Description G9280 Pneumococcal vaccination not administered prior to discharge, reason not specified G9281 Screening performed and documentation that vaccination not indicated/patient refusal G9282 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., biopsy taken for other purposes in a patient with a history of non-small cell lung cancer or other documented medical reasons) G9283 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation G9284 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation G9285 Specimen site other than anatomic location of lung or is not classified as non small cell lung cancer G9286 Documentation of antibiotic regimen prescribed within 7 days of diagnosis or within 10 days after onset of symptoms G9287 No antibiotic regimen prescribed within 7 days of diagnosis or within 10 days after onset of symptoms G9288 Documentation of medical reason(s) for not reporting the histological type or nsclc-nos classification with an explanation (e.g., a solitary fibrous tumor in a person with a history of non-small cell carcinoma or other documented medical reasons ) G9289 Non small cell lung cancer biopsy and cytology specimen report documents classification into specific histologic type or classified as nsclc-nos with an explanation G9290 Non small cell lung cancer biopsy and cytology specimen report does not document classification into specific histologic type or classified as nsclc-nos with an explanation G9291 Specimen site other than anatomic location of lung, is not classified as non small cell lung cancer or classified as nsclc-nos G9292 Documentation of medical reason(s) for not reporting pt category and a statement on thickness and ulceration and for pt1, mitotic rate (e.g., negative skin biopsies in a patient with a history of melanoma or other documented medical reasons) G9293 Pathology report does not include the pt category and a statement on thickness and ulceration and for pt1, mitotic rate G9294 Pathology report includes the pt category and a statement on thickness and ulceration and for pt1, mitotic rate G9295 Specimen site other than anatomic cutaneous location G9296 Patients with documented shared decision-making including discussion of conservative (nonsurgical) therapy prior to the procedure G9297 Shared decision-making including discussion of conservative (non-surgical) therapy prior to the procedure not documented, reason not given Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 10 01/14 HCPCS Code Description G9298 Patients who are evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including history of dvt, pe, mi, arrhythmia and stroke G9299 Patients who are not evaluated for venous thromboembolic and cardiovascular risk factors within 30 days prior to the procedure including history of dvt, pe, mi, arrhythmia and stroke, reason not given G9300 Documentation of medical reason(s) for not completely infusing the prophylactic antibiotic prior to the inflation of the proximal tourniquet (e.g., a tourniquet was not used) G9301 Patients who had the prophylactic antibiotic completely infused prior to the inflation of the proximal tourniquet G9302 Prophylactic antibiotic not completely infused prior to the inflation of the proximal tourniquet, reason not given G9303 Operative report does not identify the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of the prosthetic implant, reason not given G9304 Operative report identifies the prosthetic implant specifications including the prosthetic implant manufacturer, the brand name of the prosthetic implant and the size of the prosthetic implant G9305 Intervention for presence of leak of endoluminal contents through an anastomosis not required G9306 Intervention for presence of leak of endoluminal contents through an anastomosis required G9307 No return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure G9308 Unplanned return to the operating room for a surgical procedure, for any reason, within 30 days of the principal operative procedure G9309 No unplanned hospital readmission within 30 days of principal procedure G9310 Unplanned hospital readmission within 30 days of principal procedure G9311 No surgical site infection G9312 Surgical site infection G9313 Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis for documented reason (e.g., cystic fibrosis, immotile cilia disorders, ciliary dyskinesia, immune deficiency, prior history of sinus surgery within the past 12 months, and anatomic abnormalities, such as deviated nasal septum, resistant organisms, allergy to medication, recurrent sinusitis, chronic sinusitis, or other reasons) G9314 Amoxicillin, with or without clavulanate, not prescribed as first line antibiotic at the time of diagnosis, reason not given G9315 Documentation amoxicillin, with or without clavulanate, prescribed as a first line antibiotic at the time of diagnosis Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 11 01/14 HCPCS Code Description G9316 Documentation of patient-specific risk assessment with a risk calculator based on multiinstitutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family G9317 Documentation of patient-specific risk assessment with a risk calculator based on multiinstitutional clinical data, the specific risk calculator used, and communication of risk assessment from risk calculator with the patient or family not completed G9318 Imaging study named according to standardized nomenclature G9319 Imaging study not named according to standardized nomenclature, reason not given G9320 Documentation of medical reason(s) for not naming CT studies according to a standardized nomenclature provided (e.g., CT studies performed for radiation treatment planning or imageguided radiation treatment delivery) G9321 Count of previous CT (any type of ct) and cardiac nuclear medicine (myocardial perfusion) studies documented in the 12-month period prior to the current study G9322 Count of previous CT and cardiac nuclear medicine (myocardial perfusion) studies not documented in the 12-month period prior to the current study, reason not given G9323 Documentation of medical reason(s) for not counting previous CT and cardiac nuclear medicine (myocardial perfusion) studies (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) G9324 All necessary data elements not included, reason not given G9325 Ct studies not reported to a radiation dose index registry due to medical reasons (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) G9326 Ct studies performed not reported to a radiation dose index registry, reason not given G9327 Ct studies performed reported to a radiation dose index registry with all necessary data elements G9328 Dicom format image data availability not documented in final report due to medical reasons (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) G9329 Dicom format image data available to non-affiliated external entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study not documented in final report, reason not given G9340 Final report documented that dicom format image data available to non-affiliated external entities on a secure, media free, reciprocally searchable basis with patient authorization for at least a 12-month period after the study G9341 Search conducted for prior patient CT imaging studies completed at non-affiliated external entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 12 01/14 HCPCS Code Description G9342 Search conducted for prior patient imaging studies completed at non-affiliated external entities within the past 12-months and are available through a secure, authorized, media-free, shared archive prior to an imaging study being performed not completed, reason not given G9343 Search for prior patient completed dicom format images not completed due to medical reasons (e.g., CT studies performed for radiation treatment planning or image-guided radiation treatment delivery) G9344 Search for prior patient completed dicom format images not completed due to system reasons (i.e., facility does not have archival abilities through a shared archival system) G9345 Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules (e.g., follow-up CT imaging studies needed or that no follow-up is needed) based at a minimum on nodule size and patient risk factors documented G9346 Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules not documented due to medical reasons (e.g., patients with known malignant disease, patients with unexplained fever, CT studied performed for radiation treatment planning or image-guided radiation treatment delivery) G9347 Follow-up recommendations according to recommended guidelines for incidentally detected pulmonary nodules not documented, reason not given G9348 Ct scan of the paranasal sinuses ordered at the time of diagnosis for documented reasons (e.g., persons with sinusitis symptoms lasting at least 7 to 10 days, antibiotic resistance, immunocompromised, recurrent sinusitis, acute frontal sinusitis, acute sphenoid sinusitis, periorbital cellulitis, or other medical) G9349 Documentation of a CT scan of the paranasal sinuses ordered at the time of diagnosis or received within 28 days after date of diagnosis G9350 Ct scan of the paranasal sinuses not ordered at the time of diagnosis or received within 28 days after date of diagnosis G9351 More than one CT scan of the paranasal sinuses ordered or received within 90 days after diagnosis G9352 More than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis, reason not given G9353 More than one CT scan of the paranasal sinuses ordered or received within 90 days after the date of diagnosis for documented reasons (e.g., patients with complications, second CT obtained prior to surgery, other medical reasons) G9354 More than one CT scan of the paranasal sinuses not ordered within 90 days after the date of diagnosis G9355 Elective delivery or early induction not performed G9356 Elective delivery or early induction performed G9357 Post-partum screenings, evaluations and education performed Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 13 01/14 HCPCS Code Description G9358 Post-partum screenings, evaluations and education not performed G9359 Documentation of negative or managed positive TB screen with further evidence that TB is not active G9360 No documentation of negative or managed positive TB screen J0151 Injection, adenosine for diagnostic use, 1 mg (not to be used to report any adenosine phosphate compounds, instead use a9270) J0401 Injection, aripiprazole, extended release, 1 mg J0717 Injection, certolizumab pegol, 1 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) J1442 Injection, filgrastim (g-csf), 1 microgram J1446 Injection, tbo-filgrastim, 5 micrograms J1556 Injection, immune globulin (bivigam), 500 mg J1602 Injection, golimumab, 1 mg, for intravenous use J3060 Injection, taliglucerace alfa, 10 units J3489 Injection, zoledronic acid, 1 mg J7301 Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg J7316 Injection, ocriplasmin, 0.125 mg J7508 Tacrolimus, extended release, oral, 0.1 mg J9047 Injection, carfilzomib, 1 mg J9262 Injection, omacetaxine mepesuccinate, 0.01 mg J9306 Injection, pertuzumab, 1 mg J9354 Injection, ado-trastuzumab emtansine, 1 mg J9371 Injection, vincristine sulfate liposome, 1 mg J9400 Injection, ziv-aflibercept, 1 mg K0008 Custom manual wheelchair/base K0013 Custom motorized/power wheelchair base K0900 Customized durable medical equipment, other than wheelchair L0455 TLSO, flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 14 01/14 HCPCS Code Description L0457 TLSO, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated, off-the-shelf L0467 TLSO, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf L0469 TLSO, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated, off-the-shelf L0641 Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0642 Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0643 Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0648 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0649 Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0650 Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/ panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panel(s), produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 15 01/14 HCPCS Code Description L0651 Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated, off-the-shelf L1812 Knee orthosis, elastic with joints, prefabricated, off-the-shelf L1833 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated, off-the shelf L1848 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated, off-the-shelf L3678 Shoulder orthosis, shoulder joint design, without joints, may include soft interface, straps, prefabricated, off-the-shelf L3809 Wrist hand finger orthosis, without joint(s), prefabricated, off-the-shelf, any type L3916 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, may include soft interface, straps, prefabricated, off-the-shelf L3918 Hand orthosis, metacarpal fracture orthosis, prefabricated, off-the-shelf L3924 Hand finger orthosis, without joints, may include soft interface, straps, prefabricated, off-theshelf L3930 Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/ springs, may include soft interface material, straps, prefabricated, off-the-shelf L4361 Walking boot, pneumatic and/or vacuum, with or without joints, with or without interface material, prefabricated, off-the-shelf L4387 Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated, off-the-shelf L4397 Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated, off-the-shelf L5969 Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) L8679 Implantable neurostimulator, pulse generator, any type Q0161 Chlorpromazine hydrochloride, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0507 Miscellaneous supply or accessory for use with an external ventricular assist device Q0508 Miscellaneous supply or accessory for use with an implanted ventricular assist device Q0509 Miscellaneous supply or accessory for use with any implanted ventricular assist device for which payment was not made under Medicare part a Q2028 Injection, sculptra, 0.5 mg Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 16 01/14 HCPCS Code Description Q2050 Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10mg Q2052 Services, supplies and accessories used in the home under the Medicare intravenous immune globulin (ivig) demonstration Q3027 Injection, interferon beta-1a, 1 mcg for intramuscular use Q3028 Injection, interferon beta-1a, 1 mcg for subcutaneous use Q4137 Amnioexcel or biodexcel, per square centimeter Q4138 Biodfence dryflex, per square centimeter Q4139 Amniomatrix or biodmatrix, injectable, 1 cc Q4140 Biodfence, per square centimeter Q4141 Alloskin ac, per square centimeter Q4142 Xcm biologic tissue matrix, per square centimeter Q4143 Repriza, per square centimeter Q4145 Epifix, injectable, 1 mg Q4146 Tensix, per square centimeter Q4147 Architect extracellular matrix, per square centimeter Q4148 Neox 1k, per square centimeter Q4149 Excellagen, 0.1 cc S9960 Ambulance service, conventional air services, nonemergency transport, one way (fixed wing) S9961 Ambulance service, conventional air service, nonemergency transport, one way (rotary wing) T4544 Adult sized disposable incontinence product, protective underwear/pull-on, above extra-large, each CDT Code Description D0393 Treatment simulation using 3d image volume D0394 Digital subtraction of two or more images or image volumes of the same modality D0395 Fusion of two or more 3d image volumes of one or more modalities D0601 Caries risk assessment and documentation, with a finding of low risk D0602 Caries risk assessment and documentation, with a finding of moderate risk D0603 Caries risk assessment and documentation, with a finding of high risk D1999 Unspecified preventive procedure, by report D2921 Reattachment of tooth fragment, incisal edge or cusp D2941 Interim therapeutic restoration - primary dentition Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 17 01/14 CDT Code Description D2949 Restorative foundation for an indirect restoration D3355 Pulpal regeneration - initial visit D3356 Pulpal regeneration - interim medication replacement D3357 Pulpal regeneration - completion of treatment D3427 Periradicular surgery without apicoectomy D3428 Bone graft in conjunction with periradicular surgery - per tooth, single site D3429 Bone graft in conjunction with periradicular surgery - each additional contiguous tooth in the same surgical site D3431 Biologic materials to aid in soft and osseous tissue regeneration in conjunction with periradicular surgery D3432 Guided tissue regeneration, resorbable barrier, per site, in conjunction with periradicular surgery D4921 Gingival irrigation - per quadrant D5863 Overdenture - complete maxillary D5864 Overdenture - partial maxillary D5865 Overdenture - complete mandibular D5866 Overdenture - partial mandibular D5994 Peridontal medicament carrier with peripheral seal - laboratory processed D6011 Second stage implant surgery D6013 Surgical placement of mini implant D6052 Semi-precision attachment abutment D8694 Repair of fixed retainers, includes reattachment D9985 Sales tax Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 18 01/14 CPT Code CPT Code CPT Code CPT Code 10030 37241 64617 97610 19081 37242 64642 99446 19082 37243 64643 99447 19083 37244 64644 99448 19084 43191 64645 99449 19085 43192 64646 99481 19086 43193 64647 99482 19281 43194 66183 9001F 19282 43195 77293 9002F 19283 43196 80155 9003F 19284 43197 80159 9004F 19285 43198 80169 9005F 19286 43211 80171 9006F 19287 43212 80175 9007F 19288 43213 80177 0329T 23333 43214 80180 0330T 23334 43229 80183 0031T 23335 43233 80199 0332T 33366 43253 80203 0333T 34841 43254 81287 0334T 34842 43266 81504 0335T 34843 43270 81507 0336T 34844 43274 87661 0337T 34845 43275 88343 0338T 34846 43276 90673 0339T 34847 43277 92521 0340T 34848 43278 92522 0341T 37217 49405 92523 0342T 37236 49406 92524 0343T 37237 49407 93582 0344T 37238 53256 93583 0345T 37239 64616 94669 0346T CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 19 01/14 2014 HCPCS, CDT, CPT Code Changes HCPCS Description Code A5081 Stoma plug or seal, any type A9272 Wound suction, disposable, includes dressing, all accessories and components, any type, each C2618 Probe/needle, cryoablation C9734 Focused ultrasound ablation/therapeutic intervention, other than uterine leiomyomata, with magnetic resonance (mr) guidance E0601 Continuous positive airway pressure (CPAP) device E2300 Wheelchair accessory, power seat elevation system, any type E2301 Wheelchair accessory, power standing system, any type G0416 Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method, 10-20 specimens G0417 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 21-40 specimens G0418 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, 41-60 specimens G0419 Surgical pathology, gross and microscopic examination, for prostate needle biopsy, any method, >60 specimens G8126 Patient with a diagnosis of major depression documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase G8127 Patient with a diagnosis of major depression not documented as being treated with antidepressant medication during the entire 84 day (12 week) acute treatment phase G8417 BMI is documented above normal parameters and a follow-up plan is documented G8418 BMI is documented below normal parameters and a follow-up plan is documented G8419 BMI documented outside normal parameters, no follow-up plan documented, no reason given G8420 BMI is documented within normal parameters and no follow-up plan is required G8421 BMI not documented and no reason is given G8422 BMI not documented, documentation the patient is not eligible for BMI calculation G8427 Eligible professional attests to documenting in the medical record they obtained, updated, or reviewed the patient’s current medications Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 20 01/14 HCPCS Description Code G8428 Current list of medications not documented as obtained, updated, or reviewed by the eligible professional, reason not given G8430 Eligible professional attests to documenting in the medical record the patient is not eligible for a current list of medications being obtained, updated, or reviewed by the eligible professional G8431 Screening for clinical depression is documented as being positive and a follow-up plan is documented G8433 Screening for clinical depression not documented, documentation stating the patient is not eligible G8442 Pain assessment not documented as being performed, documentation the patient is not eligible for a pain assessment using a standardized tool G8451 Beta-blocker therapy for LVEF < 40% not prescribed for reasons documented by the clinician (e.g., low blood pressure, fluid overload, asthma, patients recently treated with an intravenous positive inotropic agent, allergy, intolerance, other medical reasons, patient declined, other patient reasons, or other reasons attributable to the healthcare system) G8509 Pain assessment documented as positive using a standardized tool, follow-up plan not documented, reason not given G8510 Screening for clinical depression is documented as negative, a follow-up plan is not required G8511 Screening for clinical depression documented as positive, follow up plan not documented, reason not given G8535 Elder maltreatment screen not documented; documentation that patient not eligible for the elder maltreatment screen G8539 Functional outcome assessment documented as positive using a standardized tool and a care plan based on identified deficiencies on the date of functional outcome assessment, is documented G8540 Functional outcome assessment not documented as being performed, documentation the patient is not eligible for a functional outcome assessment using a standardized tool G8542 Functional outcome assessment using a standardized tool is documented; no functional deficiencies identified, care plan not required G8543 Documentation of a positive functional outcome assessment using a standardized tool; care plan not documented, reason not given G8569 Prolonged postoperative intubation (> 24 hrs) required G8570 Prolonged postoperative intubation (> 24 hrs) not required Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 21 01/14 HCPCS Description Code G8682 LVF testing documented as being performed prior to discharge or in the previous 12 months G8683 LVF testing not performed prior to discharge or in the previous 12 months for a medical or patient documented reason G8685 LVF testing not documented as being performed prior to discharge or in the previous 12 months, reason not given G8709 Patient prescribed or dispensed antibiotic for documented medical reason(s) (e.g. intestinal infection, pertussis, bacterial infection, lyme disease, otitis media, acute sinusitis, acute pharyngitis, acute tonsillitis, chronic sinusitis, infection of the pharynx/larynx/tonsils/ adenoids, prostatitis, cellulitis, mastoiditis, or bone infections, acute lymphadenitis, impetigo, skin staph infections, pneumonia/gonococcal infections, venereal disease (syphilis, chlamydia, inflammatory diseases (female reproductive organs)), infections of the kidney, cystitis or uti, and acne) G8722 Documentation of medical reason(s) for not including the pt category, the pn category or the histologic grade in the pathology report (e.g., re-excision without residual tumor; noncarcinomasanal canal) G8730 Pain assessment documented as positive using a standardized tool and a follow-up plan is documented G8731 Pain assessment using a standardized tool is documented as negative, no follow-up plan required G8733 Elder maltreatment screen documented as positive and a follow-up plan is documented G8768 Documentation of medical reason(s) for not performing lipid profile (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8772 Documentation of medical reason(s) for not performing urine protein test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8775 Documentation of medical reason(s) for not performing serum creatinine test (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8778 Documentation of medical reason(s) for not performing diabetes screening test (e.g., patients with a diagnosis of diabetes, or with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8781 Documentation of medical reason(s) for patient not receiving counseling for diet and physical activity (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 22 01/14 HCPCS Description Code G8784 Blood pressure reading not documented, documentation the patient is not eligible G8808 Performance of trans-abdominal or trans-vaginal ultrasound not ordered, reason not given (e.g., patient has visited the ed multiple times with no documentation of a trans-abdominal or trans-vaginal ultrasound within ed or from referring eligible professional) G8810 Rh-immunoglobulin (rhogam) not ordered for reasons documented by clinician (e.g., patient had prior documented receipt of rhogam within 12 weeks, patient refusal) G8880 Documentation of reason(s) sentinel lymph node biopsy not performed (e.g., reasons could include but not limited to; non-invasive cancer, incidental discovery of breast cancer on prophylactic mastectomy, incidental discovery of breast cancer on reduction mammoplasty, pre-operative biopsy proven lymph node (ln) metastases, inflammatory carcinoma, stage 3 locally advanced cancer, recurrent invasive breast cancer, patient refusal after informed consent) G8882 Sentinel lymph node biopsy procedure not performed, reason not given G8887 Documentation of medical reason(s) for most recent blood pressure not being under control (e.g., patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8891 Documentation of medical reason(s) for most recent LDL-C not under control (e.g., patients with palliative goals for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8892 Documentation of medical reason(s) for not performing LDL-C test (e.g. patients with palliative goals or for whom treatment of hypertension with standard treatment goals is not clinically appropriate) G8928 Adjuvant chemotherapy not prescribed or previously received for documented reasons (e.g., medical co-morbidities, diagnosis date more than 5 years prior to the current visit date, patient’s cancer has metastasized, medical contraindication/allergy, poor performance status, other medical reasons, patient refusal, other patient reasons, patient is currently enrolled in a clinical trial that precludes prescription of chemotherapy, other system reasons) G8929 Adjuvant chemotherapy not prescribed or previously received, reason not specified G8938 BMI is documented as being outside of normal limits, follow-up plan is not documented, documentation the patient is not eligible G8939 Pain assessment documented as positive, follow-up plan not documented, documentation the patient is not eligible G8940 Screening for clinical depression documented as positive, a follow-up plan not documented, documentation stating the patient is not eligible Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 23 01/14 HCPCS Description Code G8941 Elder maltreatment screen documented as positive, follow-up plan not documented, documentation the patient is not eligible G8942 Functional outcomes assessment using a standardized tool is documented within the previous 30 days and care plan, based on identified deficiencies on the date of the functional outcome assessment, is documented G8946 Minimally invasive biopsy method attempted but not diagnostic of breast cancer (e.g., high risk lesion of breast such as atypical ductal hyperplasia, lobular neoplasia, atypical lobular hyperplasia, lobular carcinoma in situ, atypical columnar hyperplasica, flat epithelial atypia, radial scar, complex sclerosing lesion, papillary lesion, or any lesion with spindle cells) G8950 Pre-hypertensive or hypertensive blood pressure reading documented, and the indicated follow-up is documented G8951 Pre-hypertensive or hypertensive blood pressure reading documented, indicated follow-up not documented, documentation the patient is not eligible G8968 Documentation of medical reason(s) for not prescribing warfarin or another oral anticoagulant that is FDA approved for the prevention of thromboembolism (e.g. patients with mitral stenosis or prosthetic heart valves, patients with transient or reversible causes of AF (e.g., pneumonia or hyperthyroidism), postoperative patients, patients who are pregnant, allergy, risk of bleeding, other medical reasons) G8969 Documentation of patient reason(s) for not prescribing warfarin or another oral anticoagulant that is FDA approved (e.g., economic, social, and/or religious impediments, noncompliance patient refusal, other patient reasons) G8985 Carrying, moving and handling objects, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8990 Other physical or occupational therapy primary functional limitation, current status, at therapy episode outset and at reporting intervals G8991 Other physical or occupational therapy primary functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8992 Other physical or occupational therapy primary functional limitation, discharge status, at discharge from therapy or to end reporting G8993 Other physical or occupational therapy subsequent functional limitation, current status, at therapy episode outset and at reporting intervals G8994 Other physical or occupational therapy subsequent functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 24 01/14 HCPCS Description Code G8995 Other physical or occupational therapy subsequent functional limitation, discharge status, at discharge from therapy or to end reporting G8996 Swallowing functional limitation, current status at therapy episode outset and at reporting intervals G8997 Swallowing functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting G8998 Swallowing functional limitation, discharge status, at discharge from therapy or to end reporting G8999 Motor speech functional limitation, current status at therapy episode outset and at reporting intervals G9158 Motor speech functional limitation, discharge status, at discharge from therapy or to end reporting G9159 Spoken language comprehension functional limitation, current status at therapy episode outset and at reporting intervals G9160 Spoken language comprehension functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting G9161 Spoken language comprehension functional limitation, discharge status, at discharge from therapy or to end reporting G9162 Spoken language expression functional limitation, current status at therapy episode outset and at reporting intervals G9163 Spoken language expression functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting G9164 Spoken language expression functional limitation, discharge status at discharge from therapy or to end reporting G9165 Attention functional limitation, current status at therapy episode outset and at reporting intervals G9166 Attention functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting G9167 Attention functional limitation, discharge status at discharge from therapy or to end reporting G9168 Memory functional limitation, current status at therapy episode outset and at reporting intervals G9169 Memory functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 25 01/14 HCPCS Description Code G9170 Memory functional limitation, discharge status at discharge from therapy or to end reporting G9171 Voice functional limitation, current status at therapy episode outset and at reporting intervals G9172 Voice functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting G9173 Voice functional limitation, discharge status at discharge from therapy or to end reporting G9174 Other speech language pathology functional limitation, current status at therapy episode outset and at reporting intervals G9175 Other speech language pathology functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting G9176 Other speech language pathology functional limitation, discharge status at discharge from therapy or to end reporting G9186 Motor speech functional limitation, projected goal status at therapy episode outset, at reporting intervals, and at discharge from or to end reporting J7507 Tacrolimus, immediate release, oral, 1 mg L0120 Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar) L0160 Cervical, semi-rigid, wire frame occipital/mandibular support, prefabricated, off-the-shelf L0172 Cervical, collar, semi-rigid thermoplastic foam, two-piece, prefabricated, off-the-shelf L0174 Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf L0450 TLSA, flexible, provides trunk support, upper thoracic region, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated, off-the-shelf L0454 TLSA flexible, provides trunk support, extends from sacrococcygeal junction to above t-9 vertebra, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks with rigid stays or panel(s), includes shoulder straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 26 01/14 HCPCS Description Code L0456 TLSA, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, restricts gross trunk motion in the sagittal plane, produces intracavitary pressure to reduce load on the intervertebral disks, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0460 TLSA, triplanar control, modular segmented spinal system, two rigid plastic shells, posterior extends from the sacrococcygeal junction and terminates just inferior to the scapular spine, anterior extends from the symphysis pubis to the sternal notch, soft liner, restricts gross trunk motion in the sagittal, coronal, and transverse planes, lateral strength is provided by overlapping plastic and stabilizing closures, includes straps and closures, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0466 TLSA, sagittal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, restricts gross trunk motion in sagittal plane, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0468 TLSA, sagittal-coronal control, rigid posterior frame and flexible soft anterior apron with straps, closures and padding, extends from sacrococcygeal junction over scapulae, lateral strength provided by pelvic, thoracic, and lateral frame pieces, restricts gross trunk motion in sagittal, and coronal planes, produces intracavitary pressure to reduce load on intervertebral disks, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0621 Sacroiliac orthosis, flexible, provides pelvic-sacral support, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf L0623 Sacroiliac orthosis, provides pelvic-sacral support, with rigid or semi-rigid panels over the sacrum and abdomen, reduces motion about the sacroiliac joint, includes straps, closures, may include pendulous abdomen design, prefabricated, off-the-shelf L0625 Lumbar orthosis, flexible, provides lumbar support, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include pendulous abdomen design, shoulder straps, stays, prefabricated, off-the-shelf Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 27 01/14 HCPCS Description Code L0626 Lumbar orthosis, sagittal control, with rigid posterior panel(s), posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0627 Lumbar orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from l-1 to below l-5 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0628 Lumbar-sacral orthosis, flexible, provides lumbo-sacral support, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include stays, shoulder straps, pendulous abdomen design, prefabricated, off-the-shelf L0630 Lumbar-sacral orthosis, sagittal control, with rigid posterior panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0631 Lumbar-sacral orthosis, sagittal control, with rigid anterior and posterior panels, posterior extends from sacrococcygeal junction to t-9 vertebra, produces intracavitary pressure to reduce load on the intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0633 Lumbar-sacral orthosis, sagittal-coronal control, with rigid posterior frame/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, stays, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 28 01/14 HCPCS Description Code L0637 Lumbar-sacral orthosis, sagittal-coronal control, with rigid anterior and posterior frame/ panels, posterior extends from sacrococcygeal junction to t-9 vertebra, lateral strength provided by rigid lateral frame/panels, produces intracavitary pressure to reduce load on intervertebral discs, includes straps, closures, may include padding, shoulder straps, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0639 Lumbar-sacral orthosis, sagittal-coronal control, rigid shell(s)/panel(s), posterior extends from sacrococcygeal junction to t-9 vertebra, anterior extends from symphysis pubis to xyphoid, produces intracavitary pressure to reduce load on the intervertebral discs, overall strength is provided by overlapping rigid material and stabilizing closures, includes straps, closures, may include soft interface, pendulous abdomen design, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L0980 Peroneal straps, prefabricated, off-the-shelf, pair L0982 Stocking supporter grips, prefabricated, off-the-shelf, set of four (4) L0984 Protective body sock, prefabricated, off-the-shelf, each L1600 Hip orthosis, abduction control of hip joints, flexible, frejka type with cover, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1610 Hip orthosis, abduction control of hip joints, flexible, (frejka cover only), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1620 Hip orthosis, abduction control of hip joints, flexible, (pavlik harness), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1810 Knee orthosis, elastic with joints, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1830 Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf L1832 Knee orthosis, adjustable knee joints (unicentric or polycentric), positional orthosis, rigid support, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1836 Knee orthosis, rigid, without joint(s), includes soft interface material, prefabricated, offthe-shelf Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 29 01/14 HCPCS Description Code L1843 Knee orthosis, single upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/ valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1845 Knee orthosis, double upright, thigh and calf, with adjustable flexion and extension joint (unicentric or polycentric), medial-lateral and rotation control, with or without varus/ valgus adjustment, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1847 Knee orthosis, double upright with adjustable joint, with inflatable air support chamber(s), prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L1850 Knee orthosis, Swedish type, prefabricated, off-the-shelf L1902 Ankle foot orthosis, ankle gauntlet, prefabricated, off-the-shelf L1904 Ankle orthosis, ankle gauntlet, custom-fabricated L1906 Ankle foot orthosis, multiligamentus ankle support, prefabricated, off-the-shelf L1907 Ankle orthosis, supramalleolar with straps, with or without interface/pads, custom fabricated L3100 Hallus-valgus night dynamic splint, prefabricated, off-the-shelf L3170 Foot, plastic, silicone or equal, heel stabilizer, prafabricated, off-the-shelf, each L3650 Shoulder orthosis, figure of eight design abduction restrainer, prefabricated, off-the-shelf L3660 Shoulder orthosis, figure of eight design abduction restrainer, canvas and webbing, prefabricated, off-the-shelf L3670 Shoulder orthosis, acromio/clavicular (canvas and webbing type), prefabricated, off-theshelf L3675 Shoulder orthosis, vest type abduction restrainer, canvas webbing type or equal, prefabricated, off-the-shelf L3677 Shoulder orthosis, shoulder joint design, 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 L3710 Elbow orthosis, elastic with metal joints, prefabricated, off-the-shelf L3762 Elbow orthosis, rigid, without joints, includes soft interface material, prefabricated, off-theshelf Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 30 01/14 HCPCS Description Code 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 L3908 Wrist hand orthosis, wrist extension control cock-up, non molded, prefabricated, off-theshelf L3912 Hand finger orthosis (HFO), flexion glove with elastic finger control, prefabricated, off-theshelf L3915 Wrist hand orthosis, includes one or more nontorsion joint(s), elastic bands, turnbuckles, 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 L3917 Hand orthosis, metacarpal fracture orthosis, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise 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 L3925 Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, off-theshelf L3927 Finger orthosis, proximal interphalangeal (pip)/distal interphalangeal (dip), without joint/ spring, extension/flexion (e.g. static or ring type), may include soft interface material, prefabricated, off-the-shelf L3929 Hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/ springs, may include soft interface material, straps, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L4350 Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf 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 L4370 Pneumatic full leg splint, prefabricated, off-the-shelf L4386 Walking boot, non-pneumatic, 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 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 31 01/14 HCPCS Description Code L4396 Static or dynamic ankle foot orthosis, including soft interface material, adjustable for fit, for positioning, may be used for minimal ambulation, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise L4398 Foot drop splint, recumbent positioning device, prefabricated, off-the-shelf Q5001 Hospice or home health care provided in patient’s home/residence Q5002 Hospice or home health care provided in assisted living facility Q5009 Hospice or home health care provided in place not otherwise specified (NOS) S3870 Comparative genomic hybridization (CGH) microarray testing for developmental delay, autism spectrum disorder and/or intellectual disability T4543 Adult sized disposable incontinence product, protective brief/diaper, above extra large, each CDT Code Description D0350 Oral/facial photographic images obtained intraorally or extraorally D2950 Core build-up, including any pins when required D3351 Apexification/recalcification - initial visit (apical closure/calcific repair of perforations, root resorption, pulp space disinfection, etc.) D3352 Apexification/recalcification - interim medication replacement (apical closure/ calcific repair of perforations, root resorption, pulp space disinfection, etc.) D3410 Apicoectomy - anterior D3421 Apicoectomy - bicuspid (first root) D3425 Apicoectomy - molar (first root) D3426 Apicoectomy (each additional root) D4920 Unscheduled dressing change (by someone other than treating dentist or their staff) D5991 Vesiculobullous disease medicament carrier D6080 Implant maintenance procedures when prostheses are removed and reinserted, including cleansing of prostheses and abutments D8693 Rebonding or recementing of fixed retainers D9210 Local anesthesia not in conjunction with operative or surgical procedures Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 32 01/14 CPT Code CPT Code CPT Code CPT Code 21015 43205 43263 93654 21016 43206 43264 93656 21557 43215 43265 99170 21558 43216 43273 1040F 21935 43217 47552 3016F 21936 43220 65778 22904 43226 65779 22905 43227 69210 23077 43231 72040 23078 43232 77295 24077 43235 81371 24079 43236 81376 24160 43237 81382 24164 43238 81400 25077 43239 81401 25078 43240 81402 26117 43241 81403 26118 43242 81404 27049 43243 81405 27059 43244 81406 27329 43245 81407 27364 43246 81408 27615 43247 84112 27616 43248 87498 28046 43249 87521 28047 43250 87522 33222 43251 87535 33223 43252 87536 43200 43255 87538 43201 43257 87539 43202 43259 91065 43204 43260 93653 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 33 01/14 2014 HCPCS, CDT, CPT Code Deletes HCPCS Code Description C1204 Technetium tc 99m tilmanocept, diagnostic, up to 0.5 millicuries C1879 Tissue marker (implantable) C9130 Injection, immune globulin (bivigam), 500 mg C9131 Injection, ado-trastuzumab emtansine, 1 mg C9292 Injection, pertuzumab, 10 mg C9294 Injection, taliglucerase alfa, 10 units C9295 Injection, carfilzomib, 1 mg C9296 Injection, ziv-aflibercept, 1 mg C9297 Injection, omacetaxine mepesuccinate, 0.01 mg C9298 Injection, ocriplasmin, 0.125 mg C9736 Laparoscopy, surgical, radiofrequency ablations of uterine fibroid(s), including intraoperative guidance and monitoring, when performed G0275 Renal angiography, non-selective, one or both kidneys, performed at the same time as cardiac catheterization and/or coronary angiography, includes positioning or placement of any catheter in the abdominal aorta at or near the origins (ostia) of the renal arteries, injection of dye, flush aortogram, production of permanent images, and radiologic supervision and interpretation (list separately in addition to primary procedure) G8459 Clinician documented that patient is receiving antiviral treatment for hepatitis c G8462 Clinician documented that patient is not an eligible candidate for counseling regarding contraception prior to antiviral treatment; patient not receiving antiviral treatment for hepatitis c G8463 Patient receiving antiviral treatment for hepatitis c documented G8553 Prescription(s) generated and transmitted via a qualified erx system G8556 Referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation G8557 Patient is not eligible for the referral for otologic evaluation measure G8558 Not referred to a physician (preferably a physician with training in disorders of the ear) for an otologic evaluation, reason not given G8588 Most recent systolic blood pressure < 140 mmhg G8589 Most recent systolic blood pressure >= 140 mmhg G8590 Most recent diastolic blood pressure < 90 mmhg G8591 Most recent diastolic blood pressure >= 90 mmhg G8592 No documentation of blood pressure measurement, reason not given Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 34 01/14 HCPCS Code Description G8596 Ldl-c was not performed G8603 Score on the spoken language comprehension functional communication measure at discharge was higher than at admission G8604 Score on the spoken language comprehension functional communication measure at discharge was not higher than at admission, reason not given G8605 Patient treated for spoken language comprehension but not scored on the spoken language comprehension functional communication measure either at admission or at discharge G8606 Score on the attention functional communication measure at discharge was higher than at admission G8607 Score on the attention functional communication measure at discharge was not higher than at admission, reason not given G8608 Patient treated for attention but not scored on the attention functional communication measure either at admission or at discharge G8609 Score on the memory functional communication measure at discharge was higher than at admission G8610 Score on the memory functional communication measure at discharge was not higher than at admission, reason not given G8611 Patient treated for memory but not scored on the memory functional communication measure either at admission or at discharge G8612 Score on the motor speech functional communication measure at discharge was higher than at admission G8613 Score on the motor speech functional communication measure at discharge was not higher than at admission, reason not given G8614 Patient treated for motor speech but not scored on the motor speech comprehension functional communication measure either at admission or at discharge G8615 Score on the reading functional communication measure at discharge was higher than at admission G8616 Score on the reading functional communication measure at discharge was not higher than at admission, reason not given G8617 Patient treated for reading but not scored on the reading functional communication measure either at admission or at discharge G8618 Score on the spoken language expression functional communication measure at discharge was higher than at admission G8619 Score on the spoken language expression functional communication measure at discharge was not higher than at admission, reason not given G8620 Patient treated for spoken language expression but not scored on the spoken language expression functional communication measure either at admission or at discharge Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 35 01/14 HCPCS Code Description G8621 Score on the writing functional communication measure at discharge was higher than at admission G8622 Score on the writing functional communication measure at discharge was not higher than at admission, reason not given G8623 Patient treated for writing but not scored on the writing functional communication measure either at admission or at discharge G8624 Score on the swallowing functional communication measure at discharge was higher than at admission G8625 Score on the swallowing functional communication measure at discharge was not higher than at admission, reason not given G8626 Patient treated for swallowing but not scored on the swallowing functional communication measure at admission or at discharge G8642 The eligible professional practices in a rural area without sufficient high speed internet access and requests a hardship exemption from the application of the payment adjustment under section 1848(a)(5)(a) of the social security act G8643 The eligible professional practices in an area without sufficient available pharmacies for electronic prescribing and requests a hardship exemption for the application of the payment adjustment under section 1848(a)(5)(a) of the social security act G8644 Eligible professional does not have prescribing privileges G8741 Patient not treated for spoken language comprehension disorder G8742 Patient not treated for attention disorder G8743 Patient not treated for memory disorder G8744 Patient not treated for motor speech disorder G8745 Patient not treated for reading disorder G8746 Patient not treated for spoken language expression disorder G8747 Patient not treated for writing disorder G8748 Patient not treated for swallowing disorder G8790 Most recent office visit systolic blood pressure <130 mm hg G8791 Most recent office visit systolic blood pressure, 130 to 139 mm hg G8792 Most recent office visit systolic blood pressure >=140 mm hg G8793 Most recent office visit diastolic blood pressure, <80 mm hg G8794 Most recent office visit diastolic blood pressure, 80 - 89 mm hg G8795 Most recent office visit diastolic blood pressure >=90 mm hg G8796 Blood pressure measurement not documented, reason not given G8799 Anticoagulation ordered Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 36 01/14 HCPCS Code Description G8800 Anticoagulation not ordered for reasons documented by clinician G8801 Anticoagulation was not ordered, reason not given G8812 Patient is not eligible for follow-up cta, duplex, or mra (e.g., patient death, failure to return for scheduled follow-up exam, planned follow-up study which will meet numerator criteria has not yet occurred at the time of reporting) G8813 Follow-up cta, duplex, or mra of the abdomen and pelvis performed G8814 Follow-up cta, duplex, or mra of the abdomen and pelvis not performed G8827 Aneurysm minor diameter <= 5.5 cm for women G8835 Asymptomatic patient with no history of any transient ischemic attack or stroke in any carotid or vertebrobasilar territory G8919 Most recent systolic blood pressure < 140 mmhg G8920 Most recent systolic blood pressure >= 140 mmhg G8921 Most recent diastolic blood pressure < 90 mmhg G8922 Most recent diastolic blood pressure >= 90 mmhg G8945 Aneurysm minor diameter <= 6 cm for men G8954 Complete and appropriate patient data were reported to a qualified clinical database registry J0152 Injection, adenosine for diagnostic use, 30 mg (not to be used to report any adenosine phosphate compounds; instead use a9270) J0718 Injection, certolizumab pegol, 1 mg J1440 Injection, filgrastim (g-csf), 300 mcg J1441 Injection, filgrastim (g-csf), 480 mcg J3487 Injection, zoledronic acid (zometa), 1 mg J3488 Injection, zoledronic acid (reclast), 1 mg J9002 Injection, doxorubicin hydrochloride, liposomal, doxil, 10 mg L0430 Spinal orthosis, anterior-posterior-lateral control, with interface material, custom fitted (dewall posture protector only) Q0090 Levonorgestrel-releasing intrauterine contraceptive system, (skyla), 13.5 mg Q0165 Prochlorperazine maleate, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0168 Dronabinol, 5 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0170 Promethazine hydrochloride, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 37 01/14 HCPCS Code Description Q0171 Chlorpromazine hydrochloride, 10 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0172 Chlorpromazine hydrochloride, 25 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0176 Perphenazine, 8mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0178 Hydroxyzine pamoate, 50 mg, oral, fda approved prescription anti-emetic, for use as a complete therapeutic substitute for an iv anti-emetic at the time of chemotherapy treatment, not to exceed a 48 hour dosage regimen Q0505 Miscellaneous supply or accessory for use with ventricular assist device Q2027 Injection, sculptra, 0.1 ml Q2051 Injection, zoledronic acid, not otherwise specified, 1mg Q3025 Injection, interferon beta-1a, 11 mcg for intramuscular use Q3026 Injection, interferon beta-1a, 11 mcg for subcutaneous use S3625 Maternal serum triple marker screen including alpha-fetoprotein (afp), estriol, and human chorionic gonadotropin (hcg) S3626 Maternal serum quadruple marker screen including alpha-fetoprotein (afp), estriol, human chorionic gonadotropin (hcg) and inhibin a S3833 Complete apc gene sequence analysis for susceptibility to familial adenomatous polyposis (fap) and attenuated fap S3834 Single-mutation analysis (in individual with a known apc mutation in the family) for susceptibility to familial adenomatous polyposis (fap) and attenuated fap CDT Code Description D0363 Cone beam - three-dimensional image reconstruction using existing data, includes multiple images D3354 Pulpal regeneration (completion of regenerative treatment in an immature permanent tooth with a necrotic pulp); does not include final restoration D5860 Overdenture-complete, by report D5861 Overdenture-partial, by report Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 38 01/14 CPT Code CPT Code 13150 49021 19102 49041 19103 49061 19290 50021 19291 58823 19295 64613 23331 64614 23332 75960 32201 77031 37204 77032 37205 92506 37206 0078T 37207 0079T 37208 0080T 37210 0081T 42802 0124T 43219 0183T 43228 0185T 43256 0186T 43258 0192T 43267 0260T 43268 0261T 43269 0318T 43271 43272 43456 43458 44901 47011 48511 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 39 01/14 Bilateral Modifiers: Use of CPT Modifier 50 & HCPCS Modifiers RT & LT Effective for claims processed on or after January 1, 2014, the codes listed in this article cannot be submitted with CPT modifier 50 (Bilateral Procedure) or HCPCS modifiers RT (Right Side) or LT (Left Side), or the services will be rejected. These codes are considered bilateral and /or the code descriptions include possible multiple services. HCPCS Codes CPT Code CPT Code CPT Code CPT Code CPT Code 33881 52300 58720 69210 92004 G0202 33976 52301 58800 70330 92012 G0204 33978 54130 58805 71110 92014 G0268 34803 54135 58900 71111 92020 36221 54430 58920 73050 92025 36252 54901 58925 73520 92060 36254 55041 58940 73565 92065 37185 55200 58950 75716 92072 37186 55250 58951 75733 92081 38562 55300 58952 75743 92082 38571 55450 58953 75803 92083 38572 55815 58954 75807 92100 40701 55845 58956 75822 92132 40702 55865 58957 75833 92133 40843 56632 58958 75842 92134 42507 57109 61000 76102 92136* 42508 57111 61001 76514 92140 42509 57112 61253 76516 92227 42510 57531 63045 76519* 92228 50540 58210 63046 76645 92250 51575 58548 63047 77057 92260 51585 58565 63295 77059 92265 51595 58600 64600 77071 92270 51820 58605 64611 78458 92275 52290 58700 64615 92002 92283 CPT Code 0201T 11010 11011 11012 21193 21194 21195 21196 27158 27392 27395 30801 30802 30905 30906 31231 32853 32854 33880 *= Indicates Global & Technical Component (TC) Only Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 40 01/14 CPT Code CPT Code 92284 92587 92285 92588 92286 92596 92287 92620 92312 92625 92316 92626 92550 92640 92552 93880 95553 93922 92555 93923 92556 93924 92557 93925 92561 93930 92562 93965 92563 93970 92564 95865 92565 95868 92567 95925 92568 95926 92570 95928 92571 95929 92572 95930 92575 95938 92576 95939 92577 96000 92579 96001 92582 96002 92583 96003 92584 96004 92585 92586 *= Indicates Global & Technical Component (TC) Only CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 41 01/14 Bilateral Indicator 3 Procedures Coding Instructions The following procedure codes have a Bilateral Indicator “3” on the Medicare Physician Fee Schedule Database (MPFSDB). This means, when performed bilaterally, the full fee schedule amount is payable for “each” side. The 50% reduction that occurs with Bilateral Indicator “1” procedure codes is not applicable to Bilateral Indicator “3” procedure codes. In order to receive the full fee schedule amount for Bilateral Indicator “3” procedure codes performed bilaterally, the days/units (quantity billed) field must reflect “2” even when submitting CPT Modifier 50 or when submitting HCPCS Modifiers RT and LT on the same detail line. Example 1: CPT Code CPT Modifier Days/Units 92235 50 “2” CPT Code HCPCS Modifier Days/Units 92235 RTLT “2” Example 2: The global, technical, and professional components of the following procedure codes currently have a Bilateral 3 indicator: (Also, applicable when submitted with CPT modifier 26 or HCPCS modifier TC) CPT Code 70030 70120 70130 70190 70332 70554 70555 73000 73010 73020 73030 73040 73060 73070 73080 73085 73090 73092 73100 73110 73115 73120 73130 73140 73200 73201 73202 73218 73219 73220 73221 73222 73223 73701 73702 73706 73718 73719 73720 73721 73722 73723 73725 76510 76511 76512 76513 76529 92235 92240 73525 73530 73550 73560 73562 73564 73580 73590 73592 73600 73610 73615 73620 73630 73650 73660 73700 95885 95886 95887 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 42 01/14 The listed components of the following procedure codes currently have a Bilateral 3 indicator: CPT Code 70336-26 76519-26 92070 92136-26 92225 92226 92230 Important: These instructions apply only to Bilateral Indicator “3” procedure codes. When billing Bilateral Indicator “1” services with CPT Modifier 50, the days/units must be submitted as “1.” The MPFSDB indicators for procedure codes can be viewed by accessing the following website: http://www.cms.hhs.gov/PFSlookup/ (then select the Physician Fee Schedule Search link). CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 43 01/14 2014 Endoscopy CPT Codes & Families Overview: Special rules for multiple endoscopic procedures apply if the procedure is billed with another endoscopy in the same family (i.e., another endoscopy that has the same base procedure). These codes are Status A. Endoscopic Base CPT Code CPT Code 29806 29805 29807 29805 29819 29805 29820 29805 29821 29805 29822 29805 29823 29805 29824 29805 29825 29805 29827 29805 29828 29805 29834 29830 29835 29830 29836 29830 29837 29830 29838 29830 29843 29840 29844 29840 29845 29840 29846 29840 29847 29840 29861 29860 29862 29860 29863 29860 29871 29870 29873 29870 29874 29870 29875 29870 29876 29870 29877 29870 29879 29870 29880 29870 Endoscopic Base CPT Code CPT Code 29881 29870 29882 29870 29883 29870 29884 29870 29885 29870 29886 29870 29887 29870 29914 29860 29915 29860 29916 29860 31510 31505 31511 31505 31512 31505 31513 31505 31527 31525 31528 31525 31529 31525 31530 31525 31531 31526 31535 31525 31536 31526 31540 31525 31541 31526 31545 31526 31546 31526 31560 31525 31561 31526 31570 31525 31571 31526 31576 31575 31577 31575 31578 31575 Endoscopic Base CPT Code CPT Code 31579 31575 31623 31622 31624 31622 31625 31622 31628 31622 31629 31622 31630 31622 31631 31622 31634 31622 31635 31622 31636 31622 31638 31622 31640 31622 31641 31622 31645 31622 31647 31622 31648 31622 31660 31622 31661 31622 38570 49320 43192 43191 43193 43191 43194 43191 43195 43191 43196 43191 43198 43197 43201 43200 43202 43200 43204 43200 43205 43200 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 44 01/14 Endoscopic Base CPT Code CPT Code 43206 43200 43211 43200 43212 43200 43213 43200 43214 43200 43215 43200 43216 43200 43217 43200 43220 43200 43226 43200 43227 43200 43229 43200 43231 43200 43232 43200 43233 43235 43236 43235 43237 43235 43238 43235 43239 43235 43240 43235 43241 43235 43242 43235 43243 43235 43244 43235 43245 43235 43246 43235 43247 43235 43248 43235 43249 43235 43250 43235 43251 43235 43252 43235 43253 43235 43254 43235 43255 43235 43257 43235 43259 43235 Endoscopic Base CPT Code CPT Code 43261 43260 43262 43260 43263 43260 43264 43260 43265 43260 43266 43235 43270 43235 43274 43260 43275 43260 43276 43260 43277 43260 43278 43260 44361 44360 44363 44360 44364 44360 44365 44360 44366 44360 44369 44360 44370 44360 44372 44360 44373 44360 44377 44376 44378 44376 44379 44376 44389 44388 44390 44388 44391 44388 44392 44388 44393 44388 44394 44388 44397 44388 45303 45300 45305 45300 45307 45300 45308 45300 45309 45300 45315 45300 Endoscopic Base CPT Code CPT Code 45317 45300 45320 45300 45321 45300 45327 45300 45331 45330 45332 45330 45333 45330 45334 45330 45335 45330 45337 45330 45338 45330 45339 45330 45340 45330 45345 45330 45379 45378 45380 45378 45381 45378 45382 45378 45383 45378 45384 45378 45385 45378 45386 45378 45387 45378 45391 45378 45392 45378 46604 46600 46606 46600 46608 46600 46610 46600 46611 46600 46612 46600 46614 46600 46615 46600 47553 47552 47554 47552 47555 47552 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 45 01/14 Endoscopic Base CPT Code CPT Code 47556 47552 49321 49320 49322 49320 49323 49320 49324 49320 49325 49320 50555 50551 50557 50551 50561 50551 50572 50570 50574 50570 50575 50570 50576 50570 50580 50570 50953 50951 50955 50951 50957 50951 50961 50951 50974 50970 50976 50970 52001 52000 52005 52000 52007 52000 52010 52000 52204 52000 52214 52000 52224 52000 52234 52000 52235 52000 52240 52000 52250 52000 52260 52000 52265 52000 52270 52000 52275 52000 52276 52000 52277 52000 Endoscopic Base CPT Code CPT Code 52281 52000 52282 52000 52283 52000 52285 52000 52287 52000 52290 52000 52300 52000 52301 52000 52305 52000 52310 52000 52315 52000 52317 52000 52318 52000 52320 52000 52325 52000 52327 52000 52330 52000 52332 52000 52334 52000 52341 52000 52342 52000 52343 52000 52344 52000 52345 52351 52346 52351 52352 52351 52353 52351 52354 52351 52355 52351 52356 52351 52400 52000 52402 52000 57454 57452 57455 57452 57456 57452 57460 57452 57461 57452 Endoscopic Base CPT Code CPT Code 58541 49320 58550 49320 58558 58555 58559 58555 58560 58555 58561 58555 58562 58555 58563 58555 58565 58555 58660 49320 58661 49320 58662 49320 58670 49320 58671 49320 58672 49320 58673 49320 66711 66710 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 46 01/14 Technical & Professional Modifiers: HCPCS Modifier TC & CPT Modifier 26 The following codes listed in this article may be submitted with CPT modifier 26 or HCPCS modifier TC for services rendered in 2014 Claims submitted with an invalid combination of CPT/HCPCS codes and/or CPT modifier 26 or HCPCS modifier TC will be rejected. These services must be resubmitted as new claims with the correct code/modifier combinations. (HCPCS codes and modifiers begin with an alpha character. CPT codes and modifiers begin with a numeric character.) Code Modifier Code Modifier Code Modifier Code Modifier G0106 TC G0389 26 0076T 26 51736 TC G0106 26 G0398 TC 0159T TC 51736 26 G0120 TC G0398 26 0159T 26 51741 TC G0120 26 G0399 TC 0182T TC 51741 26 G0122 TC G0399 26 0182T 26 51784 TC G0122 26 G0400 TC 0240T TC 51784 26 G0130 TC G0400 26 0240T 26 51785 TC G0130 26 G0416 TC 0241T TC 51785 26 G0202 TC G0416 26 0241T 26 51792 TC G0202 26 G0417 TC 0243T TC 51792 26 G0204 TC G0417 26 0243T 26 51797 TC G0204 26 G0418 TC 0244T TC 51797 26 G0206 TC G0418 26 0244T 26 54240 TC G0206 26 G0419 TC 0255T TC 54240 26 G0219 TC G0419 26 0255T 26 54250 TC G0219 26 G0452 26 51725 TC 54250 26 G0235 TC G0461 TC 51725 26 59020 TC G0235 26 G0461 26 51726 TC 59020 26 G0252 TC G0462 TC 51726 26 59025 TC G0252 26 G0462 26 51727 TC 59025 26 G0255 TC Q0035 TC 51727 26 62252 TC G0255 26 Q0035 26 51728 TC 62252 26 G0365 TC 0075T TC 51728 26 70015 TC G0365 26 0075T 26 51729 TC 70015 26 G0389 TC 0076T TC 51729 26 70030 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 47 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 70030 26 70260 26 70450 26 70542 26 70100 TC 70300 TC 70460 TC 70543 TC 70100 26 70300 26 70460 26 70543 26 70110 TC 70310 TC 70470 TC 70544 TC 70110 26 70310 26 70470 26 70544 26 70120 TC 70320 TC 70480 TC 70545 TC 70120 26 70320 26 70480 26 70545 26 70130 TC 70328 TC 70481 TC 70546 TC 70130 26 70328 26 70481 26 70546 26 70134 TC 70330 TC 70482 TC 70547 TC 70134 26 70330 26 70482 26 70547 26 70140 TC 70332 TC 70486 TC 70548 TC 70140 26 70332 26 70486 26 70548 26 70150 TC 70336 TC 70487 TC 70549 TC 70150 26 70336 26 70487 26 70549 26 70160 TC 70350 TC 70488 TC 70551 TC 70160 26 70350 26 70488 26 70551 26 70170 TC 70355 TC 70490 TC 70552 TC 70170 26 70355 26 70490 26 70552 26 70190 TC 70360 TC 70491 TC 70553 TC 70190 26 70360 26 70491 26 70553 26 70200 TC 70370 TC 70492 TC 70554 TC 70200 26 70370 26 70492 26 70554 26 70210 TC 70371 TC 70496 TC 70555 TC 70210 26 70371 26 70496 26 70555 26 70220 TC 70373 TC 70498 TC 70557 TC 70220 26 70373 26 70498 26 70557 26 70240 TC 70380 TC 70540 TC 70558 TC 70240 26 70380 26 70540 26 70558 26 70250 TC 70390 TC 70542 TC 70559 TC 70250 26 70390 26 70260 TC 70450 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 48 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 70559 26 71250 26 72074 26 72141 TC 71010 TC 71260 TC 72080 TC 72141 26 71010 26 71260 26 72080 26 72142 TC 71015 TC 71270 TC 72090 TC 72142 26 71015 26 71270 26 72090 26 72146 TC 71020 TC 71275 TC 72100 TC 72146 26 71020 26 71275 26 72100 26 72147 TC 71021 TC 71550 TC 72110 TC 72147 26 71021 26 71550 26 72110 26 72148 TC 71022 TC 71551 TC 72114 TC 72148 26 71022 26 71551 26 72114 26 72149 TC 71023 TC 71552 TC 72120 TC 72149 26 71023 26 71552 26 72120 26 72156 TC 71030 TC 71555 TC 72125 TC 72156 26 71030 26 71555 26 72125 26 72157 TC 71034 TC 72010 TC 72126 TC 72157 26 71034 26 72010 26 72126 26 72158 TC 71035 TC 72020 TC 72127 TC 72158 26 71035 26 72020 26 72127 26 72159 TC 71100 TC 72040 TC 72128 TC 72159 26 71100 26 72040 26 72128 26 72170 TC 71101 TC 72050 TC 72129 TC 72170 26 71101 26 72050 26 72129 26 72190 TC 71110 TC 72052 TC 72130 TC 72190 26 71110 26 72052 26 72130 26 72191 TC 71111 TC 72069 TC 72131 TC 72191 26 71111 26 72069 26 72131 26 72192 TC 71120 TC 72070 TC 72132 TC 72192 26 71120 26 72070 26 72132 26 72193 TC 71130 TC 72072 TC 72133 TC 72193 26 71130 26 72072 26 72133 26 72194 TC 71250 TC 72074 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 49 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 72194 26 72295 26 73120 26 73520 TC 72195 TC 73000 TC 73130 TC 73520 26 72195 26 73000 26 73130 26 73525 TC 72196 TC 73010 TC 73140 TC 73525 26 72196 26 73010 26 73140 26 73530 TC 72197 TC 73020 TC 73200 TC 73530 26 72197 26 73020 26 73200 26 73540 TC 72198 TC 73030 TC 73201 TC 73540 26 72198 26 73030 26 73201 26 73550 TC 72200 TC 73040 TC 73202 TC 73550 26 72200 26 73040 26 73202 26 73560 TC 72202 TC 73050 TC 73206 TC 73560 26 72202 26 73050 26 73206 26 73562 TC 72220 TC 73060 TC 73218 TC 73562 26 72220 26 73060 26 73218 26 73564 TC 72240 TC 73070 TC 73219 TC 73564 26 72240 26 73070 26 73219 26 73565 TC 72255 TC 73080 TC 73220 TC 73565 26 72255 26 73080 26 73220 26 73580 TC 72265 TC 73085 TC 73221 TC 73580 26 72265 26 73085 26 73221 26 73590 TC 72270 TC 73090 TC 73222 TC 73590 26 72270 26 73090 26 73222 26 73592 TC 72275 TC 73092 TC 73223 TC 73592 26 72275 26 73092 26 73223 26 73600 TC 72285 TC 73100 TC 73225 TC 73600 26 72285 26 73100 26 73225 26 73610 TC 72291 TC 73110 TC 73500 TC 73610 26 72291 26 73110 26 73500 26 73615 TC 72292 TC 73115 TC 73510 TC 73615 26 72292 26 73115 26 73510 26 73620 TC 72295 TC 73120 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 50 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 73620 26 74010 26 74210 26 74270 TC 73630 TC 74020 TC 74220 TC 74270 26 73630 26 74020 26 74220 26 74280 TC 73650 TC 74022 TC 74230 TC 74280 26 73650 26 74022 26 74230 26 74283 TC 73660 TC 74150 TC 74235 TC 74283 26 73660 26 74150 26 74235 26 74290 TC 73700 TC 74160 TC 74240 TC 74290 26 73700 26 74160 26 74240 26 74291 TC 73701 TC 74170 TC 74241 TC 74291 26 73701 26 74170 26 74241 26 74300 TC 73702 TC 74174 TC 74245 TC 74300 26 73702 26 74174 26 74245 26 74301 TC 73706 TC 74175 TC 74246 TC 74301 26 73706 26 74175 26 74246 26 74305 TC 73718 TC 74176 TC 74247 TC 74305 26 73718 26 74176 26 74247 26 74320 TC 73719 TC 74177 TC 74249 TC 74320 26 73719 26 74177 26 74249 26 74327 TC 73720 TC 74178 TC 74250 TC 74327 26 73720 26 74178 26 74250 26 74328 TC 73721 TC 74181 TC 74251 TC 74328 26 73721 26 74181 26 74251 26 74329 TC 73722 TC 74182 TC 74260 TC 74329 26 73722 26 74182 26 74260 26 74330 TC 73723 TC 74183 TC 74261 TC 74330 26 73723 26 74183 26 74261 26 74340 TC 73725 TC 74185 TC 74262 TC 74340 26 73725 26 74185 26 74262 26 74355 TC 74000 TC 74190 TC 74263 TC 74355 26 74000 26 74190 26 74263 26 74360 TC 74010 TC 74210 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 51 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 74360 26 74710 26 75630 26 75801 TC 74363 TC 74740 TC 75635 TC 75801 26 74363 26 74740 26 75635 26 75803 TC 74400 TC 74742 TC 75658 TC 75803 26 74400 26 74742 26 75658 26 75805 TC 74410 TC 74775 TC 75705 TC 75805 26 74410 26 74775 26 75705 26 75807 TC 74415 TC 75557 TC 75710 TC 75807 26 74415 26 75557 26 75710 26 75809 TC 74420 TC 75559 TC 75716 TC 75809 26 74420 26 75559 26 75716 26 75810 TC 74425 TC 75561 TC 75726 TC 75810 26 74425 26 75561 26 75726 26 75820 TC 74430 TC 75563 TC 75731 TC 75820 26 74430 26 75563 26 75731 26 75822 TC 74440 TC 75565 TC 75733 TC 75822 26 74440 26 75565 26 75733 26 75825 TC 74445 TC 75571 TC 75736 TC 75825 26 74445 26 75571 26 75736 26 75827 TC 74450 TC 75572 TC 75741 TC 75827 26 74450 26 75572 26 75741 26 75831 TC 74455 TC 75573 TC 75743 TC 75831 26 74455 26 75573 26 75743 26 75833 TC 74470 TC 75574 TC 75746 TC 75833 26 74470 26 75574 26 75746 26 75840 TC 74475 TC 75600 TC 75756 TC 75840 26 74475 26 75600 26 75756 26 75842 TC 74480 TC 75605 TC 75774 TC 75842 26 74480 26 75605 26 75774 26 75860 TC 74485 TC 75625 TC 75791 TC 75860 26 74485 26 75625 26 75791 26 75870 TC 74710 TC 75630 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 52 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 75870 26 75953 26 76000 26 76498 TC 75872 TC 75954 TC 76001 TC 76498 26 75872 26 75954 26 76001 26 76499 TC 75880 TC 75956 TC 76010 TC 76499 26 75880 26 75956 26 76010 26 76506 TC 75885 TC 75957 TC 76080 TC 76506 26 75885 26 75957 26 76080 26 76510 TC 75887 TC 75958 TC 76098 TC 76510 26 75887 26 75958 26 76098 26 76511 TC 75889 TC 75959 TC 76100 TC 76511 26 75889 26 75959 26 76100 26 76512 TC 75891 TC 75962 TC 76101 TC 76512 26 75891 26 75962 26 76101 26 76513 TC 75893 TC 75964 TC 76102 TC 76513 26 75893 26 75964 26 76102 26 76514 TC 75894 TC 75966 TC 76120 TC 76514 26 75894 26 75966 26 76120 26 76516 TC 75896 TC 75968 TC 76125 TC 76516 26 75896 26 75968 26 76125 26 76519 TC 75898 TC 75970 TC 76376 TC 76519 26 75898 26 75970 26 76376 26 76529 TC 75901 TC 75978 TC 76377 TC 76529 26 75901 26 75978 26 76377 26 76536 TC 75902 TC 75980 TC 76380 TC 76536 26 75902 26 75980 26 76380 26 76604 TC 75945 TC 75982 TC 76390 TC 76604 26 75945 26 75982 26 76390 26 76645 TC 75946 TC 75984 TC 76496 TC 76645 26 75946 26 75984 26 76496 26 76700 TC 75952 TC 75989 TC 76497 TC 76700 26 75952 26 75989 26 76497 26 76705 TC 75953 TC 76000 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 53 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 76705 26 76818 26 76882 26 76975 TC 76770 TC 76819 TC 76885 TC 76975 26 76770 26 76819 26 76885 26 76977 TC 76775 TC 76820 TC 76886 TC 76977 26 76775 26 76820 26 76886 26 76998 TC 76776 TC 76821 TC 76930 TC 76998 26 76776 26 76821 26 76930 26 76999 TC 76800 TC 76825 TC 76932 TC 76999 26 76800 26 76825 26 76932 26 77001 TC 76801 TC 76826 TC 76936 TC 77001 26 76801 26 76826 26 76936 26 77002 TC 76802 TC 76827 TC 76937 TC 77002 26 76802 26 76827 26 76937 26 77003 TC 76805 TC 76828 TC 76940 TC 77003 26 76805 26 76828 26 76940 26 77011 TC 76810 TC 76830 TC 76941 TC 77011 26 76810 26 76830 26 76941 26 77012 TC 76811 TC 76831 TC 76942 TC 77012 26 76811 26 76831 26 76942 26 77013 TC 76812 TC 76856 TC 76945 TC 77013 26 76812 26 76856 26 76945 26 77014 TC 76813 TC 76857 TC 76946 TC 77014 26 76813 26 76857 26 76946 26 77021 TC 76814 TC 76870 TC 76948 TC 77021 26 76814 26 76870 26 76948 26 77022 TC 76815 TC 76872 TC 76950 TC 77022 26 76815 26 76872 26 76950 26 77051 TC 76816 TC 76873 TC 76965 TC 77051 26 76816 26 76873 26 76965 26 77052 TC 76817 TC 76881 TC 76970 TC 77052 26 76817 26 76881 26 76970 26 77053 TC 76818 TC 76882 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 54 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 77053 26 77082 26 77328 26 77761 TC 77054 TC 77084 TC 77331 TC 77761 26 77054 26 77084 26 77331 26 77762 TC 77055 TC 77280 TC 77332 TC 77762 26 77055 26 77280 26 77332 26 77763 TC 77056 TC 77285 TC 77333 TC 77763 26 77056 26 77285 26 77333 26 77776 TC 77057 TC 77290 TC 77334 TC 77776 26 77057 26 77290 26 77334 26 77777 TC 77058 TC 77293 TC 77338 TC 77777 26 77058 26 77293 26 77338 26 77778 TC 77059 TC 77295 TC 77399 TC 77778 26 77059 26 77295 26 77399 26 77785 TC 77072 TC 77299 TC 77421 TC 77785 26 77072 26 77299 26 77421 26 77786 TC 77073 TC 77300 TC 77470 TC 77786 26 77073 26 77300 26 77470 26 77787 TC 77074 TC 77301 TC 77499 TC 77787 26 77074 26 77301 26 77499 26 77789 TC 77075 TC 77305 TC 77600 TC 77789 26 77075 26 77305 26 77600 26 77790 TC 77076 TC 77310 TC 77605 TC 77790 26 77076 26 77310 26 77605 26 77799 TC 77077 TC 77315 TC 77610 TC 77799 26 77077 26 77315 26 77610 26 78012 TC 77078 TC 77321 TC 77615 TC 78012 26 77078 26 77321 26 77615 26 78013 TC 77080 TC 77326 TC 77620 TC 78013 26 77080 26 77326 26 77620 26 78014 TC 77081 TC 77327 TC 77750 TC 78014 26 77081 26 77327 26 77750 26 78015 TC 77082 TC 77328 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 55 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 78015 26 78122 26 78227 26 78300 TC 78016 TC 78130 TC 78230 TC 78300 26 78016 26 78130 26 78230 26 78305 TC 78018 TC 78135 TC 78231 TC 78305 26 78018 26 78135 26 78231 26 78306 TC 78020 TC 78140 TC 78232 TC 78306 26 78020 26 78140 26 78232 26 78315 TC 78070 TC 78185 TC 78258 TC 78315 26 78070 26 78185 26 78258 26 78320 TC 78071 TC 78190 TC 78261 TC 78320 26 78071 26 78190 26 78261 26 78350 TC 78072 TC 78191 TC 78262 TC 78350 26 78072 26 78191 26 78262 26 78399 TC 78075 TC 78195 TC 78264 TC 78399 26 78075 26 78195 26 78264 26 78414 TC 78099 TC 78199 TC 78270 TC 78414 26 78099 26 78199 26 78270 26 78428 TC 78102 TC 78201 TC 78271 TC 78428 26 78102 26 78201 26 78271 26 78445 TC 78103 TC 78202 TC 78272 TC 78445 26 78103 26 78202 26 78272 26 78451 TC 78104 TC 78205 TC 78278 TC 78451 26 78104 26 78205 26 78278 26 78452 TC 78110 TC 78206 TC 78282 TC 78452 26 78110 26 78206 26 78282 26 78453 TC 78111 TC 78215 TC 78290 TC 78453 26 78111 26 78215 26 78290 26 78454 TC 78120 TC 78216 TC 78291 TC 78454 26 78120 26 78216 26 78291 26 78456 TC 78121 TC 78226 TC 78299 TC 78456 26 78121 26 78226 26 78299 26 78457 TC 78122 TC 78227 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 56 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 78457 26 78580 26 78647 26 78801 TC 78458 TC 78582 TC 78650 TC 78801 26 78458 26 78582 26 78650 26 78802 TC 78459 TC 78597 TC 78660 TC 78802 26 78459 26 78597 26 78660 26 78803 TC 78466 TC 78598 TC 78699 TC 78803 26 78466 26 78598 26 78699 26 78804 TC 78468 TC 78599 TC 78700 TC 78804 26 78468 26 78599 26 78700 26 78805 TC 78469 TC 78600 TC 78701 TC 78805 26 78469 26 78600 26 78701 26 78806 TC 78472 TC 78601 TC 78707 TC 78806 26 78472 26 78601 26 78707 26 78807 TC 78473 TC 78605 TC 78708 TC 78807 26 78473 26 78605 26 78708 26 78811 TC 78481 TC 78606 TC 78709 TC 78811 26 78481 26 78606 26 78709 26 78812 TC 78483 TC 78607 TC 78710 TC 78812 26 78483 26 78607 26 78710 26 78813 TC 78491 TC 78608 TC 78725 TC 78813 26 78491 26 78608 26 78725 26 78814 TC 78492 TC 78609 TC 78730 TC 78814 26 78492 26 78609 26 78730 26 78815 TC 78494 TC 78610 TC 78740 TC 78815 26 78494 26 78610 26 78740 26 78816 TC 78496 TC 78630 TC 78761 TC 78816 26 78496 26 78630 26 78761 26 78999 TC 78499 TC 78635 TC 78799 TC 78999 26 78499 26 78635 26 78799 26 79005 TC 78579 TC 78645 TC 78800 TC 79005 26 78579 26 78645 26 78800 26 79101 TC 78580 TC 78647 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 57 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 79101 26 88106 TC 88304 TC 88343 26 79200 TC 88106 26 88304 26 88346 TC 79200 26 88108 TC 88305 TC 88346 26 79300 TC 88108 26 88305 26 88347 TC 79300 26 88112 TC 88307 TC 88347 26 79403 TC 88112 26 88307 26 88348 TC 79403 26 88120 TC 88309 TC 88348 26 79440 TC 88120 26 88309 26 88349 TC 79440 26 88121 TC 88311 TC 88349 26 79445 TC 88121 26 88311 26 88355 TC 79445 26 88125 TC 88312 TC 88355 26 79999 TC 88125 26 88312 26 88356 TC 79999 26 88160 TC 88313 TC 88356 26 83020 26 88160 26 88313 26 88358 TC 84165 26 88161 TC 88314 TC 88358 26 84166 26 88161 26 88314 26 88360 TC 84181 26 88162 TC 88319 TC 88360 26 84182 26 88162 26 88319 26 88361 TC 85390 26 88172 TC 88323 TC 88361 26 85576 26 88172 26 88323 26 88362 TC 86153 26 88173 TC 88331 TC 88362 26 86255 26 88173 26 88331 26 88365 TC 86256 26 88177 TC 88332 TC 88365 26 86320 26 88177 26 88332 26 88367 TC 86325 26 88182 TC 88333 TC 88367 26 86327 26 88182 26 88333 26 88368 TC 86334 26 88199 TC 88334 TC 88368 26 86335 26 88199 26 88334 26 88371 26 87164 26 88300 TC 88342 TC 88372 26 87207 26 88300 26 88342 26 88380 TC 88104 TC 88302 TC 88343 TC 88380 26 88104 26 88302 26 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 58 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 88381 TC 91110 26 92134 26 92541 TC 88381 26 91111 TC 92136 TC 92541 26 88387 TC 91111 26 92136 26 92542 TC 88387 26 91112 TC 92228 TC 92542 26 88388 TC 91112 26 92228 26 92543 TC 88388 26 91120 TC 92235 TC 92543 26 88399 TC 91120 26 92235 26 92544 TC 88399 26 91122 TC 92240 TC 92544 26 89060 26 91122 26 92240 26 92545 TC 91010 TC 91132 TC 92250 TC 92545 26 91010 26 91132 26 92250 26 92546 TC 91013 TC 91133 TC 92265 TC 92546 26 91013 26 91133 26 92265 26 92548 TC 91020 TC 91299 TC 92270 TC 92548 26 91020 26 91299 26 92270 26 92585 TC 91022 TC 92025 TC 92275 TC 92585 26 91022 26 92025 26 92275 26 92587 TC 91030 TC 92060 TC 92283 TC 92587 26 91030 26 92060 26 92283 26 92588 TC 91034 TC 92065 TC 92284 TC 92588 26 91034 26 92065 26 92284 26 92978 TC 91035 TC 92081 TC 92285 TC 92978 26 91035 26 92081 26 92285 26 92979 TC 91037 TC 92082 TC 92286 TC 92979 26 91037 26 92082 26 92286 26 93024 TC 91038 TC 92083 TC 92287 TC 93024 26 91038 26 92083 26 92287 26 93025 TC 91040 TC 92132 TC 92499 TC 93025 26 91040 26 92132 26 92499 26 93278 TC 91065 TC 92133 TC 92540 TC 93278 26 91065 26 92133 26 92540 26 93279 TC 91110 TC 92134 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 59 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 93279 26 93304 26 93453 26 93562 TC 93280 TC 93306 TC 93454 TC 93562 26 93280 26 93306 26 93454 26 93571 TC 93281 TC 93307 TC 93455 TC 93571 26 93281 26 93307 26 93455 26 93572 TC 93282 TC 93308 TC 93456 TC 93572 26 93282 26 93308 26 93456 26 93600 TC 93283 TC 93312 TC 93457 TC 93600 26 93283 26 93312 26 93457 26 93602 TC 93284 TC 93314 TC 93458 TC 93602 26 93284 26 93314 26 93458 26 93603 TC 93285 TC 93315 TC 93459 TC 93603 26 93285 26 93315 26 93459 26 93609 TC 93286 TC 93317 TC 93460 TC 93609 26 93286 26 93317 26 93460 26 93610 TC 93287 TC 93318 TC 93461 TC 93610 26 93287 26 93318 26 93461 26 93612 TC 93288 TC 93320 TC 93464 TC 93612 26 93288 26 93320 26 93464 26 93615 TC 93289 TC 93321 TC 93505 TC 93615 26 93289 26 93321 26 93505 26 93616 TC 93290 TC 93325 TC 93530 TC 93616 26 93290 26 93325 26 93530 26 93618 TC 93291 TC 93350 TC 93531 TC 93618 26 93291 26 93350 26 93531 26 93619 TC 93292 TC 93351 TC 93532 TC 93619 26 93292 26 93351 26 93532 26 93620 TC 93293 TC 93451 TC 93533 TC 93620 26 93293 26 93451 26 93533 26 93621 TC 93303 TC 93452 TC 93561 TC 93621 26 93303 26 93452 26 93561 26 93304 TC 93453 TC Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 60 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 93622 TC 93890 TC 93979 TC 94620 26 93622 26 93890 26 93979 26 94621 TC 93623 TC 93892 TC 93980 TC 94621 26 93623 26 93892 26 93980 26 94680 TC 93624 TC 93893 TC 93981 TC 94680 26 93624 26 93893 26 93981 26 94681 TC 93631 TC 93922 TC 93990 TC 94681 26 93631 26 93922 26 93990 26 94690 TC 93640 TC 93923 TC 94010 TC 94690 26 93640 26 93923 26 94010 26 94726 TC 93641 TC 93924 TC 94060 TC 94726 26 93641 26 93924 26 94060 26 94727 TC 93642 TC 93925 TC 94070 TC 94727 26 93642 26 93925 26 94070 26 94728 TC 93660 TC 93926 TC 94150 TC 94728 26 93660 26 93926 26 94150 26 94729 TC 93662 TC 93930 TC 94200 TC 94729 26 93662 26 93930 26 94200 26 94750 TC 93724 TC 93931 TC 94250 TC 94750 26 93724 26 93931 26 94250 26 94772 TC 93745 TC 93965 TC 94375 TC 94772 26 93745 26 93965 26 94375 26 94799 TC 93799 TC 93970 TC 94400 TC 94799 26 93799 26 93970 26 94400 26 95782 TC 93880 TC 93971 TC 94450 TC 95782 26 93880 26 93971 26 94450 26 95783 TC 93882 TC 93975 TC 94452 TC 95783 26 93882 26 93975 26 94452 26 95800 TC 93886 TC 93976 TC 94453 TC 95800 26 93886 26 93976 26 94453 26 95801 TC 93888 TC 93978 TC 94620 TC 95801 26 93888 26 93978 26 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 61 01/14 Code Modifier Code Modifier Code Modifier Code Modifier 95803 TC 95861 TC 95905 TC 95928 26 95803 26 95861 26 95905 26 95929 TC 95805 TC 95863 TC 95907 TC 95929 26 95805 26 95863 26 95907 26 95930 TC 95806 TC 95864 TC 95908 TC 95930 26 95806 26 95864 26 95908 26 95933 TC 95807 TC 95865 TC 95909 TC 95933 26 95807 26 95865 26 95909 26 95937 TC 95808 TC 95866 TC 95910 TC 95937 26 95808 26 95866 26 95910 26 95938 TC 95810 TC 95867 TC 95911 TC 95938 26 95810 26 95867 26 95911 26 95939 TC 95811 TC 95868 TC 95912 TC 95939 26 95811 26 95868 26 95912 26 95943 TC 95812 TC 95869 TC 95913 TC 95943 26 95812 26 95869 26 95913 26 95950 TC 95813 TC 95870 TC 95921 TC 95950 26 95813 26 95870 26 95921 26 95951 TC 95816 TC 95872 TC 95922 TC 95951 26 95816 26 95872 26 95922 26 95953 TC 95819 TC 95873 TC 95923 TC 95953 26 95819 26 95873 26 95923 26 95954 TC 95822 TC 95874 TC 95924 TC 95954 26 95822 26 95874 26 95924 26 95955 TC 95824 TC 95875 TC 95925 TC 95955 26 95824 26 95875 26 95925 26 95956 TC 95827 TC 95885 TC 95926 TC 95956 26 95827 26 95885 26 95926 26 95957 TC 95829 TC 95886 TC 95927 TC 95957 26 95829 26 95886 26 95927 26 95958 TC 95860 TC 95887 TC 95928 TC 95958 26 95860 26 95887 26 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 62 01/14 Code Modifier 95961 TC 95961 26 95962 TC 95962 26 95965 TC 95965 26 95966 TC 95966 26 95967 TC 95967 26 96020 TC 96020 26 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 63 01/14 MPFSDB Indicator Chart A Active code. These codes are separately paid under the physician fee schedule if covered. There will be RVUs and payment amounts for codes with this status. The presence of an “A” indicator does not mean that Medicare has made a national coverage determination regarding the service; carriers remain responsible for coverage decisions in the absence of a national Medicare policy. B Payment for covered services are always bundled into payment for other services not specified. There will be no RVUs or payment amounts for these codes and no separate payment is ever made. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident (an example is a telephone call from a hospital nurse regarding care of a patient). C Carriers price the code. Carriers will establish RVUs and payment amounts for these services, generally on an individual case basis following review of documentation such as an operative report. D Deleted/discontinued codes. E Excluded from physician fee schedule by regulation. These codes are for items and/or services that CMS chose to exclude from the fee schedule payment by regulation. No RVUs or payment amounts are shown and no payment may be made under the fee schedule for these codes. Payment for them, when covered, continues under reasonable charge procedures. F Deleted/discontinued codes. (Code not subject to a 90 day grace period.) These codes are deleted effective with the beginning of the year and are never subject to a grace period. This indicator is no longer effective beginning with the 2005 fee schedule as of January 1, 2005. G= Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code subject to a 90 day grace period.) This indicator is no longer effective beginning with the 2005 fee schedule as of January 1, 2005. H Deleted modifier. For 2000 and later years, either the TC or PC component shown for the code has been deleted and the deleted component is shown in the data base with the H status. I Not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. (Code NOT subject to a 90 day grace period.) J Anesthesia services (no relative value units or payment amounts for anesthesia codes on the database, only used to facilitate the identification of anesthesia services.) L Local codes. Carriers will apply this status to all local codes in effect on January 1, 1998 or subsequently approved by central office for use. Carriers will complete the RVUs and payment amounts for these codes. M Measurement codes, used for reporting purposes only. Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 64 01/14 N Non-covered service. These codes are carried on the HCPCS tape as noncovered services. P Bundled/excluded codes. There are no RVUs and no payment amounts for these services. No separate payment is made for them under the fee schedule. If the item or service is covered as incident to a physician service and is provided on the same day as a physician service, payment for it is bundled into the payment for the physician service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician service). If the item or service is covered as other than incident to a physician service, it is excluded from the fee schedule (for example, colostomy supplies) and is paid under the other payment provision of the Act. R Restricted coverage. Special coverage instructions apply. T There are RVUs and payment amounts for these services, but they are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider. If any other services payable under the physician fee schedule are billed on the same date by the same provider, these services are bundled into the physician services for which payment is made. X Statutory exclusion. These codes represent an item or service that is not in the statutory definition of “physician services” for fee schedule payment purposes. No RVUs or payment amounts are shown for these codes and no payment may be made under the physician fee schedule. (Examples are ambulances services and clinical diagnostic laboratory services.) CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 65 01/14 Services Not Reimbursed by Medicare Part B When the Medicare Physician Fee Schedule Database is updated, the Centers for Medicare & Medicaid Services (CMS) defines certain services that will not be reimbursed by Medicare Part B. The effective date for these services is January 1, 2014. Bundled Codes: Status B Indicator Payment for covered services is always bundled into payment for other services not specified. When these services are covered, payment for them is subsumed by the payment for the services to which they are incident (an example is a telephone call from a hospital nurse regarding care of a patient). You cannot bill the patient for these services. (The TC modifier is a HCPCS modifier and the 26 modifier is a CPT modifier.) HCPCS Code A4262 A4263 A4270 A4300 A4550 G0269 Q3031 R0076 CPT Code 15850 20930 20936 22841 36000 36416 38204 90885 90887 90889 92352 92353 92354 92355 92358 CPT Code 92371 92531 92532 92533 92534 92605 92606 92618 92921 92925 92929 92934 92938 92944 93740 93770 94005 94150 94150 94150 96040 96902 97010 97602 98960 CPT Code 98961 98962 99000 99001 99002 99024 99050 99051 99053 99056 99058 99060 99070 99071 99078 99080 99090 99091 99100 99116 99135 99140 99288 99339 99340 CPT Code 99358 99359 99363 99364 99366 99367 99368 99374 99377 99379 99380 99446 99447 99448 99449 99485 99486 99487 99488 99489 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 66 01/14 Invalid Codes for Medicare: Status Indicator I Codes with a status indicator of “I” are not valid for Medicare purposes. Medicare uses another code for reporting of, and payment for, these services. HCPCS Code A0021 A0080 A0090 A0100 A0110 A0120 A0130 A0140 A0160 A0170 A0180 A0190 A0200 A0210 A0225 A0380 A0390 A0998 A4232 A4264 A4266 A4267 A4268 A4269 A4466 A4555 A4566 A4570 A4580 A4590 A9152 A9153 HCPCS Code A9180 A9272 A9274 A9279 G8559 G8560 G8561 G8562 G8563 G8564 G8565 G8566 G8567 G8568 G9050 G9051 G9052 G9053 G9054 G9055 G9056 G9057 G9058 G9059 G9060 G9061 G9062 H0001 H0002 H0003 H0004 H0005 HCPCS Code H0006 H0007 H0008 H0009 H0010 H0011 H0012 H0013 H0014 H0015 H0016 H0017 H0018 H0019 H0020 H0021 H0022 H0023 H0024 H0025 H0026 H0027 H0028 H0029 H0030 H0031 H0032 H0033 H0034 H0035 H0036 H0037 HCPCS Code H0038 H0039 H0040 H0041 H0042 H0043 H0044 H0045 H0046 H0047 H0048 H0049 H0050 H1000 H1001 H1002 H1003 H1004 H1005 H1010 H1011 H2000 H2001 H2010 H2011 H2012 H2013 H2014 H2015 H2016 H2017 H2018 HCPCS Code H2019 H2020 H2021 H2022 H2023 H2024 H2025 H2026 H2027 H2028 H2029 H2030 H2031 H2032 H2033 H2034 H2035 H2036 H2037 J1826 J7306 J7307 J8565 P7001 Q3028 S0012 S0014 S0017 S0020 S0021 S0023 HCPCS Code S0028 S0030 S0032 S0034 S0039 S0040 S0073 S0074 S0077 S0078 S0080 S0081 S0088 S0090 S0091 S0092 S0093 S0104 S0106 S0108 S0109 S0117 S0119 S0122 S0126 S0128 S0132 S0136 S0137 S0138 S0139 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 67 01/14 HCPCS Code S0140 S0142 S0145 S0148 S0155 S0156 S0157 S0160 S0164 S0166 S0169 S0170 S0171 S0172 S0174 S0175 S0176 S0177 S0178 S0179 S0182 S0183 S0187 S0189 S0190 S0191 S0194 S0195 S0197 S0199 S0201 S0207 S0208 S0209 S0215 S0220 S0221 HCPCS Code S0250 S0255 S0257 S0260 S0265 S0270 S0271 S0272 S0273 S0274 S0280 S0281 S0302 S0310 S0315 S0316 S0317 S0320 S0340 S0341 S0342 S0353 S0354 S0390 S0395 S0400 S0500 S0504 S0506 S0508 S0510 S0512 S0514 S0515 S0516 S0518 S0580 HCPCS Code S0581 S0590 S0592 S0595 S0596 S0601 S0610 S0612 S0613 S0618 S0620 S0621 S0622 S0630 S0800 S0810 S0812 S1001 S1002 S1015 S1016 S1030 S1031 S1040 S1090 S2053 S2054 S2055 S2060 S2061 S2065 S2066 S2067 S2068 S2070 S2079 S2080 HCPCS Code S2083 S2095 S2102 S2103 S2107 S2112 S2115 S2117 S2118 S2120 S2140 S2142 S2150 S2152 S2202 S2205 S2206 S2207 S2208 S2209 S2225 S2230 S2235 S2260 S2265 S2266 S2267 S2300 S2325 S2340 S2341 S2342 S2348 S2350 S2351 S2360 S2361 HCPCS Code S2400 S2401 S2402 S2403 S2404 S2405 S2409 S2411 S2900 S3000 S3005 S3600 S3601 S3620 S3630 S3645 S3650 S3652 S3655 S3708 S3721 S3722 S3800 S3840 S3841 S3842 S3844 S3845 S3846 S3849 S3850 S3852 S3853 S3854 S3855 S3861 HCPCS Code S3865 S3866 S3870 S3890 S3900 S3902 S3904 S4005 S4011 S4013 S4014 S4015 S4016 S4017 S4018 S4020 S4021 S4022 S4023 S4025 S4026 S4027 S4028 S4030 S4031 S4035 S4037 S4040 S4042 S4981 S4989 S4990 S4991 S4993 S4995 S5000 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 68 01/14 HCPCS Code S5001 S5010 S5011 S5012 S5013 S5014 S5035 S5036 S5100 S5101 S5102 S5105 S5108 S5109 S5110 S5111 S5115 S5116 S5120 S5121 S5125 S5126 S5130 S5131 S5135 S5136 S5140 S5141 S5145 S5146 S5150 S5151 S5160 S5161 S5162 S5165 S5170 HCPCS Code S5175 S5180 S5181 S5185 S5190 S5199 S5497 S5498 S5501 S5502 S5517 S5518 S5520 S5521 S5522 S5523 S5550 S5551 S5552 S5553 S5560 S5561 S5565 S5566 S5570 S5571 S8030 S8035 S8037 S8040 S8042 S8055 S8080 S8085 S8092 S8096 S8097 HCPCS Code S8100 S8101 S8110 S8120 S8121 S8130 S8131 S8185 S8186 S8189 S8210 S8262 S8265 S8270 S8301 S8415 S8420 S8421 S8422 S8423 S8424 S8425 S8426 S8427 S8428 S8429 S8430 S8431 S8450 S8451 S8452 S8460 S8490 S8930 S8940 S8948 S8950 HCPCS Code S8990 S8999 S9001 S9007 S9015 S9024 S9025 S9034 S9055 S9056 S9061 S9083 S9088 S9090 S9097 S9098 S9110 S9117 S9122 S9123 S9124 S9125 S9126 S9127 S9128 S9129 S9131 S9140 S9141 S9145 S9150 S9152 S9208 S9209 S9211 S9212 S9213 HCPCS Code S9214 S9325 S9326 S9327 S9328 S9329 S9330 S9331 S9335 S9336 S9338 S9339 S9340 S9341 S9342 S9343 S9345 S9346 S9347 S9348 S9349 S9351 S9353 S9355 S9357 S9359 S9361 S9363 S9364 S9365 S9366 S9367 S9368 S9370 S9372 S9373 HCPCS Code S9374 S9375 S9376 S9377 S9379 S9381 S9401 S9430 S9433 S9434 S9435 S9436 S9437 S9438 S9439 S9441 S9442 S9443 S9444 S9445 S9446 S9447 S9449 S9451 S9452 S9453 S9454 S9455 S9460 S9465 S9470 S9472 S9473 S9474 S9475 S9476 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 69 01/14 HCPCS Code S9480 S9482 S9484 S9485 S9490 S9494 S9497 S9500 S9501 S9502 S9503 S9504 S9529 S9537 S9538 S9542 S9558 S9559 S9560 S9562 S9590 S9810 S9900 S9960 S9961 S9970 S9975 S9976 S9977 S9981 S9982 S9986 S9988 S9989 S9990 S9991 S9992 HCPCS Code S9994 S9996 S9999 T1000 T1001 T1002 T1003 T1004 T1005 T1006 T1007 T1009 T1010 T1012 T1013 T1014 T1015 T1016 T1017 T1018 T1019 T1020 T1021 T1022 T1023 T1024 T1025 T1026 T1027 T1028 T1029 T1030 T1031 T1502 T1503 T1505 T1999 HCPCS Code T2001 T2002 T2003 T2004 T2005 T2007 T2010 T2011 T2012 T2013 T2014 T2015 T2016 T2017 T2018 T2019 T2020 T2021 T2022 T2023 T2024 T2025 T2026 T2027 T2028 T2029 T2030 T2031 T2032 T2033 T2034 T2035 T2036 T2037 T2038 T2039 T2040 HCPCS Code T2041 T2042 T2043 T2044 T2045 T2046 T2048 T2049 T2101 T4541 T4542 T5001 T5999 CDT Code D0210 D0220 D0230 D0290 D0310 D0320 D0321 D0322 D0330 D0340 D0350 D1352 D3354 D4210 D4211 D4212 D5913 D5914 D5915 CDT Code CDT Code D5916 D6011 D5919 D6040 D5922 D6050 D5923 D6055 D5924 D6080 D5925 D6090 D5926 D6095 D5927 D6100 D5928 D6101 D5929 D6102 D5931 D6103 D5932 D6104 D5933 D6199 D5934 D7251 D5935 D7285 D5936 D7286 D5937 D7287 D5952 D7295 D5953 D7310 D5954 D7320 D5955 D7340 D5958 D7350 D5959 D7410 D5960 D7411 D5982 D7412 D5988 D7413 D5992 D7414 D5993 D7415 D5994 D7440 D5999 D7441 D6010 D7450 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 70 01/14 CDT Code CDT Code CDT Code CDT Code CPT Code CPT Code D7451 D7780 D7948 D9985 1005F 1152F D7460 D7810 D7949 D9999 1008F 1153F D7461 D7820 D7950 CPT Code 1015F 1157F D7465 D7830 D7955 0001F 1018F 1158F D7471 D7840 D7960 0005F 1019F 1159F D7472 D7850 D7970 0012F 1022F 1160F D7473 D7852 D7971 0014F 1026F 1180F D7485 D7854 D7972 0015F 1030F 1182F D7490 D7856 D7980 0501F 1034F 1183F D7510 D7858 D7981 0502F 1035F 1450F D7520 D7860 D7982 0503F 1050F 1451F D7530 D7865 D7983 0505F 1052F 1500F D7540 D7870 D7990 0507F 1055F 1501F D7550 D7872 D7991 0514F 1060F 1502F D7560 D7873 D7995 0516F 1061F 1503F D7610 D7874 D7996 0519F 1065F 1504F D7620 D7875 D7999 0525F 1066F 1505F D7630 D7876 D9210 0535F 1070F 2001F D7640 D7877 D9211 0545F 1071F 2002F D7650 D7880 D9212 0550F 1110F 2004F D7660 D7899 D9215 0551F 1116F 2014F D7670 D7910 D9220 0555F 1118F 2018F D7671 D7911 D9221 0575F 1121F 2020F D7680 D7912 D9241 0580F 1127F 2028F D7710 D7920 D9242 0581F 1128F 2029F D7720 D7921 D9310 0582F 1134F 2030F D7730 D7941 D9410 0583F 1135F 2031F D7740 D7943 D9420 0584F 1136F 2035F D7750 D7944 D9430 1000F 1137F 2044F D7760 D7945 D9440 1002F 1150F 2050F D7770 D7946 D9450 1003F 1151F 2060F D7771 D7947 D9610 1004F Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 71 01/14 CPT Code CPT Code CPT Code CPT Code CPT Code CPT Code 27215 3089F 3293F 3552F 4016F 4145F 27216 3090F 3294F 3555F 4017F 4149F 27217 3091F 3317F 3572F 4018F 4150F 27218 3092F 3318F 3573F 4019F 4153F 3006F 3093F 3324F 3650F 4030F 4155F 3008F 3110F 3325F 3751F 4033F 4157F 3011F 3111F 3330F 3752F 4041F 4158F 3015F 3112F 3331F 3753F 4050F 4159F 3018F 3115F 3351F 3754F 4051F 4163F 3019F 3117F 3352F 3755F 4052F 4165F 3020F 3118F 3353F 3756F 4053F 4167F 3025F 3119F 3354F 3757F 4054F 4168F 3027F 3130F 3450F 3758F 4055F 4169F 3028F 3132F 3451F 3759F 4056F 4174F 3035F 3140F 3452F 3760F 4058F 4176F 3037F 3141F 3490F 3761F 4060F 4178F 3040F 3142F 3491F 3762F 4062F 4180F 3042F 3150F 3492F 3763F 4063F 4181F 3055F 3200F 3493F 38207 4064F 4182F 3056F 3216F 3497F 38208 4065F 4185F 3073F 3218F 3498F 38209 4066F 4186F 3074F 3220F 3500F 38210 4067F 4188F 3075F 3230F 3502F 38211 4069F 4189F 3077F 3266F 3503F 38212 4070F 4190F 3078F 3268F 3511F 38213 4073F 4191F 3079F 3278F 3512F 38214 4077F 4200F 3080F 3279F 3513F 38215 4079F 4201F 3082F 3280F 3514F 4003F 4133F 4210F 3083F 3281F 3515F 4011F 4134F 4220F 3084F 3290F 3520F 4012F 4135F 4221F 3085F 3291F 3550F 4014F 4136F 4230F 3088F 3292F 3551F 4015F Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 72 01/14 CPT Code CPT Code CPT Code CPT Code CPT Code 4240F 4554F 81508 95120 99510 4242F 4555F 81509 95125 99511 4267F 4556F 81510 95130 99512 4268F 4557F 81511 95131 99600 4269F 4558F 81512 95132 99601 4270F 4559F 81599 95133 99602 4271F 4560F 88342 95134 4274F 4561F 88342 95941 4276F 4562F 88342 97005 4279F 4563F 88343 97006 4280F 5005F 88343 97014 4290F 5020F 88343 99241 4293F 5060F 88375 99242 4300F 5062F 9001F 99243 4301F 5100F 9002F 99244 4305F 5200F 9005F 99245 4306F 5250F 90281 99251 4324F 6005F 90283 99252 4326F 6040F 90287 99253 4330F 6070F 90288 99254 4350F 6080F 90291 99255 4450F 6090F 90384 99375 4470F 6100F 90386 99378 44705 7020F 90389 99500 4480F 76140 90399 99501 4481F 80055 90658 99502 4540F 80100 90723 99503 4541F 80101 90738 99504 4550F 80104 90748 99505 4551F 81500 90863 99506 4552F 81503 92630 99507 4553F 81506 92633 99509 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 73 01/14 Bundled/Excluded Codes: Status P Indicator Codes with a status indicator of “P” are bundled/excluded codes. If the item or service is covered as incident to a physician service and is provided on the same day as a physician service, payment for it is bundled into the payment for the physician service to which it is incident (an example is an elastic bandage furnished by a physician incident to a physician service). If the item or service is covered as other than incident to a physician service, it is excluded from the fee schedule (for example, colostomy supplies) and is paid under the other payment provision of the Act. No separate payment will be made for them under the Medicare Physician Fee Schedule. HCPCS Code HCPCS Code HCPCS Code HCPCS Code HCPCS Code HCPCS Code A4211 A4335 A4470 A5114 A6217 A6247 A4212 A4338 A4480 A5121 A6218 A6248 A4220 A4340 A4556 A5122 A6219 A6250 A4253 A4344 A4557 A5126 A6220 A6251 A4256 A4346 A4558 A5131 A6221 A6252 A4258 A4351 A4649 A6154 A6222 A6253 A4259 A4352 A5051 A6196 A6223 A6254 A4265 A4354 A5052 A6197 A6224 A6255 A4301 A4355 A5053 A6198 A6228 A6256 A4305 A4356 A5054 A6199 A6229 A6257 A4306 A4357 A5055 A6203 A6230 A6258 A4310 A4358 A5061 A6204 A6234 A6259 A4311 A4361 A5062 A6205 A6235 A6260 A4312 A4362 A5063 A6206 A6236 A6261 A4313 A4364 A5071 A6207 A6237 A6262 A4314 A4367 A5072 A6208 A6238 A6266 A4315 A4397 A5073 A6209 A6239 A6402 A4316 A4398 A5081 A6210 A6240 A6403 A4320 A4399 A5082 A6211 A6241 A6404 A4322 A4400 A5093 A6212 A6242 V2520 A4326 A4402 A5102 A6213 A6243 A4327 A4404 A5105 A6214 A6244 A4328 A4455 A5112 A6215 A6245 A4330 A4465 A5113 A6216 A6246 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 74 01/14 Non-covered Services: Status N Indicator These are non-covered services and will not be paid by Medicare Part B. (The TC modifier is a HCPCS modifier and the 26 modifier is a CPT modifier.) HCPCS Code HCPCS Code HCPCS Code HCPCS Code HCPCS Code HCPCS Code A0888 A6549 G0255 T4523 V5014 V5243 A4210 A9270 G0282 T4524 V5020 V5244 A4250 A9273 G0295 T4525 V5030 V5245 A4252 A9275 G0428 T4526 V5040 V5246 A4261 A9276 G9013 T4527 V5050 V5247 A4490 A9277 G9014 T4528 V5060 V5248 A4495 A9278 G9016 T4529 V5070 V5249 A4500 A9280 G9147 T4530 V5080 V5250 A4510 A9281 J3520 T4531 V5090 V5251 A4520 A9282 J3535 T4532 V5095 V5252 A4554 A9283 J3570 T4533 V5100 V5253 A4575 A9300 J7300 T4534 V5110 V5254 A4627 A9586 J7301 T4535 V5120 V5255 A4670 G0122 J7302 T4536 V5130 V5256 A6000 G0122 J7303 T4537 V5140 V5257 A6413 G0122 J7304 T4538 V5150 V5258 A6530 G0219 J8499 T4539 V5160 V5259 A6533 G0219 J8515 T4540 V5170 V5260 A6534 G0219 M0075 T4543 V5180 V5261 A6535 G0235 M0076 T4544 V5190 V5262 A6536 G0235 M0100 V2025 V5200 V5263 A6537 G0235 M0300 V2702 V5210 V5264 A6538 G0252 M0301 V2787 V5220 V5265 A6539 G0252 P2031 V2788 V5230 V5266 A6540 G0252 Q0144 V5008 V5240 V5267 A6541 G0255 T4521 V5010 V5241 V5268 A6544 G0255 T4522 V5011 V5242 V5269 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 75 01/14 HCPCS Code CDT Code CDT Code CDT Code CDT Code CDT Code D0273 D1320 D2650 D2933 D3330 V5270 D0363 D1330 D2651 D2934 D3331 V5271 D0364 D1351 D2652 D2940 D3332 V5272 D0365 D1555 D2662 D2941 D3333 V5273 D0366 D2140 D2663 D2949 D3346 V5274 D0367 D2150 D2664 D2950 D3347 V5275 D0368 D2160 D2710 D2951 D3348 V5281 D0369 D2161 D2712 D2952 D3351 V5282 D0370 D2330 D2720 D2953 D3352 V5283 D0371 D2331 D2721 D2954 D3353 V5284 D0380 D2332 D2722 D2955 D3355 V5285 D0381 D2335 D2740 D2957 D3356 V5286 D0382 D2390 D2750 D2960 D3357 V5287 D0383 D2391 D2751 D2961 D3410 V5288 D0384 D2392 D2752 D2962 D3421 V5289 D0385 D2393 D2780 D2971 D3425 V5290 D0386 D2394 D2781 D2975 D3426 V5298 D0391 D2410 D2782 D2980 D3427 V5336 D0393 D2420 D2783 D2981 D3428 V5362 D0394 D2430 D2790 D2982 D3429 V5363 D0395 D2510 D2791 D2983 D3430 V5364 D0415 D2520 D2792 D2990 D3431 D0417 D2530 D2794 D3110 D3432 D0418 D2542 D2799 D3120 D3450 D0425 D2543 D2910 D3220 D3470 D0470 D2544 D2915 D3221 D3910 D0486 D2610 D2920 D3222 D3920 D1110 D2620 D2921 D3230 D3950 D1120 D2630 D2929 D3240 D4230 D1206 D2642 D2930 D3310 D4231 D1208 D2643 D2931 D3320 D4240 D1310 D2644 D2932 CDT Code D0120 D0140 D0145 D0160 D0170 D0180 D0190 D0191 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 76 01/14 CDT Code CDT Code CDT Code CDT Code CDT Code CDT Code D4241 D5422 D5863 D6074 D6605 D6940 D4245 D5510 D5864 D6075 D6606 D6950 D4249 D5520 D5865 D6076 D6607 D6975 D4261 D5610 D5866 D6077 D6608 D6980 D4265 D5620 D5867 D6078 D6609 D6985 D4266 D5630 D5875 D6079 D6610 D6999 D4267 D5640 D5899 D6091 D6611 D7270 D4274 D5650 D5986 D6092 D6612 D7272 D4275 D5660 D5991 D6093 D6613 D7280 D4276 D5670 D6012 D6094 D6614 D7282 D4320 D5671 D6013 D6190 D6615 D7290 D4321 D5710 D6051 D6194 D6624 D7292 D4341 D5711 D6053 D6205 D6634 D7293 D4342 D5720 D6054 D6210 D6710 D7294 D4910 D5721 D6056 D6211 D6720 D7311 D4920 D5730 D6057 D6212 D6721 D7871 D4921 D5731 D6058 D6214 D6722 D7951 D4999 D5740 D6059 D6240 D6740 D7952 D5110 D5741 D6060 D6241 D6750 D7953 D5120 D5750 D6061 D6242 D6751 D7963 D5130 D5751 D6062 D6245 D6752 D7997 D5140 D5760 D6063 D6250 D6780 D7998 D5211 D5761 D6064 D6251 D6781 D8010 D5212 D5810 D6065 D6252 D6782 D8020 D5213 D5811 D6066 D6253 D6783 D8030 D5214 D5820 D6067 D6545 D6790 D8040 D5225 D5821 D6068 D6548 D6791 D8050 D5226 D5850 D6069 D6600 D6792 D8060 D5281 D5851 D6070 D6601 D6793 D8070 D5410 D5860 D6071 D6602 D6794 D8080 D5411 D5861 D6072 D6603 D6930 D8090 D5421 D5862 D6073 D6604 Continued on next page CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 77 01/14 CDT Code CPT Code CPT Code CPT Code CPT Code D8210 43842 88007 92595 99397 D8220 48160 88012 93668 99401 D8660 55970 88014 96110 99402 D8670 55980 88016 96155 99403 D8680 58300 88020 97810 99404 D8690 61640 88025 97811 99408 D8691 61641 88027 97813 99409 D8692 61642 88028 97814 99411 D8693 65760 88029 98943 99412 D8694 65765 88036 98966 99420 D8999 65767 88037 98967 99429 D9120 65771 88040 98968 99441 D9612 69090 88045 98969 99442 D9910 69710 88099 99026 99443 D9911 74263 90875 99027 99444 D9920 74263 90876 99075 99450 D9941 74263 90882 99172 D9942 76390 92015 99173 D9970 76390 92310 99174 D9971 76390 92314 99381 D9972 78350 92340 99382 D9973 78350 92341 99383 D9974 78350 92342 99384 D9975 78351 92370 99385 78609 92551 99386 CPT Code 78609 92559 99387 0085T 78609 92560 99391 0188T 80050 92590 99392 0189T 86910 92591 99393 22526 86911 92592 99394 22527 88000 92593 99395 37216 88005 92594 99396 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 78 01/14 Services Same Day/Provider: Status T Indicator These services are only paid if there are no other services payable under the physician fee schedule billed on the same date by the same provider if the same provider submits any other services payable under the physician fee schedule on the same date, these services are bundled into the physician service(s) for which payment is made. HCPCS Code G0117 G0118 CPT Code 36591 36592 36598 94760 94761 96523 CPT codes, descriptors and other data only are copyright 1999 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS apply. Current Dental Terminology, fourth edition (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. ©2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply. 79 01/14 CMS Offers FREE Medicare Training for Providers CMS Web Training The Centers for Medicare & Medicaid Services (CMS) has launched a series of education and training programs designed to leverage emerging Internet and satellite technologies to offer just-in-time training to Medicare providers and suppliers throughout the United States. Many of these programs include free, downloadable computer/Web based training courses. These courses are also available on CD-ROM. http://www.cms.gov/MLNGenInfo Palmetto GBA Medicare Customer Information and Outreach Training Available Important Telephone Numbers Provider Contact Center 1-866-830-3043 (Toll-Free) To request a Medicare Education meeting/seminar at no cost to you, complete and fax the form located on the http://www.PalmettoGBA.com/J11B/forms. Electronic Data Interchange (EDI) Technical Support (866) 749-4301 http://www.PalmettoGBA.com/Medicare Important Sources For You Medicare Beneficiary Call Center 1-800-MEDICARE (1-800-633-4227) • • • http://www.cms.gov http://www.cms.gov/MLNGenInfo http://www.cms.gov/CMSforms/CMSforms/list.asp TTY 1-877-486-2048 Attention: Billing Manager 80 01/14