The following table lists the codes for services that do not meet payment determination criteria. If criteria for the use of modifier code GA are met, GA should be appended when billing for the services listed. See Modifier Code GA.
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Table I. CPT Codes
| CPT Codes | Description |
|---|---|
| 0010M | Oncology (high-grade prostate cancer), biochemical assay of four proteins (total PSA, free PSA, intact PSAand human kallikrein 2 [hk2]) plus patient age, digital rectal examination status, and no history of positive prostate biopsy, utilizing plasma, prognostic algorithm reported as a probability score |
| 0011M | Oncology, prostate cancer, mrna expression assay of 12 genes (10 content and 2 housekeeping), rt-pcr test utilizing blood plasma and/or urine, algorithms to predict high-grade prostate cancer risk |
| 0012M | Oncology (urothelial), mrna, gene expression profiling by real-time quantitative pcr of five genes (mdk, hoxa13, cdc2 [cdk1], igfbp5, and xcr2), utilizing urine, algorithm reported as a risk score for having urothelial carcinoma |
| 0013M | Oncology (urothelial), mrna, gene expression profiling by real-time quantitative pcr of five genes (mdk, hoxa13, cdc2 [cdk1], igfbp5, and cxcr2), utilizing urine, algorithm reported as a risk score for having recurrent urothelial carcinoma |
| 0019M | Cardiovascular disease, plasma, analysis of protein biomarkers by aptamer-based microarray and algorithm reported as 4-year likelihood of coronary event in high-risk populations |
| 0351T | Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen; real time intraoperative |
| 0352T | Optical coherence tomography of breast or axillary lymph node, excised tissue, each specimen, interpretation and report, real time or referred |
| 0353T | Optical coherence tomography of breast, surgical cavity; real time intraoperative |
| 0354T | Optical coherence tomography of breast, surgical cavity; interpretation and report, real time intraoperative |
| 0355T | Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report |
| 0356T | Insertion of drug-eluting implant (including puntal dilation and implant removal when performed) into lacrimal canaliculus, each |
| 0358T | Biolectrical impedance analysis whole body composition assessment, supine position, with interpretation and report |
| 0359T | Behavior identification assessment, by the physician or other qualified health care professional, face-to-face with patient and caregiver(s), includes administration of standardization and non-standardization tests, detailed behavioral history, patient observational |
| 0360T | Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; first 30 minutes of technician time, face-to-face with the patient |
| 0361T | Observational behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by one technician; each additional 30 minutes of technician time, face-to-face with the patient |
| 0363T | Exposure behavioral follow-up assessment, includes physician or other qualified health care professional direction with interpretation and report, administered by physician or other qualified health care professional with the assistance of one or more tec |
| 0509T | Electroretinography (erg) with interpretation and report, pattern (perg) |
| 0512T, 0513T | Extracorporeal shock wave for integumentary wound healing, high energy, including topical application and dressing care; initial wound |
| 0514T | Intraoperative visual axis identification using patient fixation (list separately in addition to code for primary procedure) |
| 0621T | Trabeculostomy ab interno by laser |
| 0622T | Trabeculostomy ab interno by laser; with use of ophthalmic endoscope |
| 0632T | Percutaneous transcatheter ultrasound ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance |
| 0634T | Computed tomography, breast, including 3D rendering, when performed, unilateral; with contrast material(s) |
| 0635T | Computed tomography, breast, including 3D rendering, when performed, unilateral; without contrast, followed by contrast material(s) |
| 0636T | Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast material(s) |
| 0637T | Computed tomography, breast, including 3D rendering, when performed, bilateral; with contrast material(s) |
| 0638T | Computed tomography, breast, including 3D rendering, when performed, bilateral; without contrast, followed by contrast material(s) |
| 0639T | Wireless skin sensor thermal anisotropy measurement(s) and assessment of flow in cerebrospinal fluid shunt, including ultrasound guidance, when performed |
| 0887T | End-tidal control of inhaled anesthetic agents and oxygen to assist anesthesia care delivery (list separately in addition to code for primary procedure) |
| 0867T | Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume greater or equal to 50 ml |
| 0868T | High-resolution gastric electrophysiology mapping with simultaneous patient- symptom profiling, with interpretation and report |
| 0870T | Implantation of subcutaneous peritoneal ascites pump system, percutaneous, including pump-pocket creation, insertion of tunneled indwelling bladder and peritoneal catheters with pump connections, including all imaging and initial programming, when performed |
| 0871T | Replacement of a subcutaneous peritoneal ascites pump, including reconnection between pump and indwelling bladder and peritoneal catheters, including initial programming and imaging, when performed |
| 0872T | Replacement of indwelling bladder and peritoneal catheters, including tunneling of catheter(s) and connection with previously implanted peritoneal ascites pump, including imaging and programming, when performed |
| 0873T | Revision of a subcutaneously implanted peritoneal ascites pump system, any component (ascites pump, associated peritoneal catheter, associated bladder catheter), including imaging and programming, when performed |
| 0874T | Removal of a peritoneal ascites pump system, including implanted peritoneal ascites pump and indwelling bladder and peritoneal catheters |
| 0875T | Programming of subcutaneously implanted peritoneal ascites pump system by physician or other qualified health care professional |
| 0876T | Duplex scan of hemodialysis fistula, computer-aided, limited (volume flow, diameter, and depth, including only body of fistula) |
| 0881T | Cryotherapy of the oral cavity using temperature regulated fluid cooling system, including placement of an oral device, monitoring of patient tolerance to treatment, and removal of the oral device |
| 0882T | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (list separately in addition to code for primary procedure) |
| 0883T | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve (list separately in addition to code for primary procedure |
| 0884T | Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when performed |
| 0885T | Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed |
| 0886T | Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed |
| 0888T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance |
| 0893T | Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or other qualified health care professional interpretation and report |
| 0894T | Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion |
| 0895T | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory assessments (eg, perfusate temperature, perfusate ph, hemodynamic parameters, bile production, bile ph, bile glucose, biliary bicarbonate, lactate levels, macroscopic assessment) |
| 0896T | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour, including physiological and laboratory assessments (eg, perfusate temperature, perfusate ph, hemodynamic parameters, bile production, bile ph, bile glucose, biliary bicarbonate, lactate levels, macroscopic assessment) (list separately in addition to code for primary procedure) |
| 0897T | Noninvasive augmentative arrhythmia analysis derived from quantitative computational cardiac arrhythmia simulations, based on selected intervals of interest from 12-lead electrocardiogram and uploaded clinical parameters, including uploading clinical parameters with interpretation and report |
| 0018U | Oncology (thyroid), microRNA profiling by RT-PCR of 10 microRNA sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy |
| 0031U | CYP1A2 (cytochrome P450 family 1, subfamily A, member 2)(eg, drug metabolism), gene analysis, common variants (ie, *1F, *1K, *6, *7) |
| 0036U | Neurology (prion disease), cerebrospinal fluid, detection of prion protein by quaking- induced conformational conversion, qualitative |
| 0041U | Borrelia burgdorferi, antibody detection of 5 recombinant protein groups, by immunoblot, igm |
| 0045U | Oncology (breast ductal carcinoma in situ), mrna, gene expression profiling by real- time rt-pcr of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence score |
| 0051U | Prescription drug monitoring, evaluation of drugs present by lc-ms/ms, urine, 31 drug panel, reported as quantitative results, detected or not detected, per date of service |
| 0052U | Lipoprotein, blood, high resolution fractionation and quantitation of lipoproteins, including all five major lipoprotein classes and subclasses of hdl, ldl, and vldl by vertical auto profile ultracentrifugation |
| 0054U | Prescription drug monitoring, 14 or more classes of drugs and substances, definitive tandem mass spectrometry with chromatography, capillary blood, quantitative report with therapeutic and toxic ranges, including steady-state range for the prescribed dose when detected, per date of service |
| 0061U | Transcutaneous measurement of five biomarkers (tissue oxygenation [sto2], oxyhemoglobin [cthbo2], deoxyhemoglobin [cthbr], papillary and reticular dermal hemoglobin concentrations [cthb1 and cthb2]), using spatial frequency domain imaging (sfdi) and multi-spectral analysis |
| 0067U | Oncology (breast), immunohistochemistry, protein expression profiling of 4 biomarkers (matrix metalloproteinase-1 [mmp-1], carcinoembryonic antigen-related cell adhesion molecule 6 [ceacam6], hyaluronoglucosaminidase [hyal1], highly expressed in cancer protein [hec1]), formalin-fixed paraffin-embedded precancerous breast tissue, algorithm reported as carcinoma risk score |
| 0068U | Candida species panel (c. Albicans, c. Glabrata, c. Parapsilosis, c. Kruseii, c tropicalis, and c. Auris), amplified probe technique with qualitative report of the presence or absence of each species |
| 0078U | Pain management (opioid-use disorder) genotyping panel, 16 common variants (ie, ABCB1, COMT, DAT1, DBH, DOR, DRD1, DRD2, DRD4, GABA, GAL, HTR2A, HTTLPR, MTHFR, MUOR, OPRK1, OPRM1), buccal swab or other germline tissue sample, algorithm reported as positive or negative risk of opioid-use disorder |
| 0087U | Cardiology (heart transplant), mrna gene expression profiling by microarray of 1283 genes, transplant biopsy tissue, allograft rejection and injury algorithm reported as a probability score |
| 0088U | Transplantation medicine (kidney allograft rejection), microarray gene expression profiling of 1494 genes, utilizing transplant biopsy tissue, algorithm reported as a probability score for rejection |
| 0090U | Oncology (cutaneous melanoma), mrna gene expression profiling by rt-pcr of 23 genes (14 content and 9 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a categorical result (ie, benign, indeterminate, malignant) |
| 0094U | Genome (eg, unexplained constitutional or heritable disorder or syndrome), rapid sequence analysis |
| 0097U | Gastrointestinal pathogen, multiplex reverse transcription and multiplex amplified probe technique, multiple types or subtypes, 22 targets (campylobacter [c. Jejuni/c. Coli/c. Upsaliensis], clostridium difficile [c. Difficile] toxin a/b, plesiomonas shigelloides, salmonella, vibrio [v. Parahaemolyticus/v. Vulnificus/v. Cholerae], including specific identification of vibrio cholerae, yersinia enterocolitica, enteroaggregative escherichia coli [eaec], enteropathogenic escherichia coli [epec], enterotoxigenic escherichia coli [etec] lt/st, shiga-like toxin-producing escherichia coli [stec] stx1/stx2 [including specific identification of the e. Coli o157 serogroup within stec], shigella/enteroinvasive escherichia coli [eiec], cryptosporidium, cyclospora cayetanensis, entamoeba histolytica, giardia lamblia [also known as g. Intestinalis and g. Duodenalis], adenovirus f 40/41, astrovirus, norovirus gi/gii, rotavirus a, sapovirus [genogroups i, ii, iv, and v]) |
| 0105U | Nephrology (chronic kidney disease), multiplex electrochemiluminescent immunoassay (eclia) of tumor necrosis factor receptor 1a, receptor superfamily 2 (tnfr1, tnfr2), and kidney injury molecule-1 (kim-1) combined with longitudinal clinical data, including apol1 genotype if available, and plasma (isolated fresh or frozen), algorithm reported as probability score for rapid kidney function decline (RKFD) |
| 0108U | Gastroenterology (Barrett’s esophagus), whole slide–digital imaging, including morphometric analysis, computer-assisted quantitative immunolabeling of 9 protein biomarkers (p16, AMACR, p53, cd68, cox-2, cd45ro, hif1a, her-2, k20) and morphology, formalin-fixed paraffin-embedded tissue, algorithm reported as risk of progression to high-grade dysplasia or cancer |
| 0109U | Infectious disease (aspergillus species), real-time PCR for detection of DNA from 4 species (a. Fumigatus, a. Terreus, a. Niger, and a. Flavus), blood, lavage fluid, or tissue, qualitative reporting of presence or absence of each species |
| 0110U | Prescription drug monitoring, one or more oral oncology drug(s) and substances, definitive tandem mass spectrometry with chromatography, serum or plasma from capillary blood or venous blood, quantitative report with steady-state range for the prescribed drug(s) when detected |
| 0112U | Infectious agent detection and identification, targeted sequence analysis (16s and 18s rRNA genes) with drug-resistance gene |
| 0113U | Oncology (prostate), measurement of pca3 and tmprss2-erg in urine and PSA in serum following prostatic massage, by RNA amplification and fluorescence-based detection, algorithm reported as risk score |
| 0114U | Gastroenterology (Barrett’s esophagus), vim and ccna1 methylation analysis, esophageal cells, algorithm reported as likelihood for Barrett’s esophagus |
| 0116U | Prescription drug monitoring, enzyme immunoassay of 35 or more drugs confirmed with lc-ms/ms, oral fluid, algorithm results reported as a patient-compliance measurement with risk of drug to drug interactions for prescribed medications |
| 0117U | Pain management, analysis of 11 endogenous analytes (methylmalonic acid, xanthurenic acid, homocysteine, pyroglutamic acid, vanilmandelate, 5-hydroxyindoleacetic acid, hydroxymethylglutarate, ethylmalonate, 3-hydroxypropyl mercapturic acid (3-hpma), quinolinic acid, kynurenic acid), lc-ms/ms, urine, algorithm reported as a pain-index score with likelihood of atypical biochemical function associated with pain |
| 0119U | Cardiology, ceramides by liquid chromatography–tandem mass spectrometry, plasma, quantitative report with risk score for major cardiovascular events |
| 0120U | Oncology (b-cell lymphoma classification), mRNA, gene expression profiling by fluorescent probe hybridization of 58 genes (45 content and 13 housekeeping genes), formalin-fixed paraffin-embedded tissue, algorithm reported as likelihood for primary mediastinal b-cell lymphoma (PMBCL) and diffuse large b-cell lymphoma (DLBCL) with cell of origin subtyping in the latter |
| 0123U | Mechanical fragility, RBC, shear stress and spectral analysis profiling |
| 0130U | Hereditary colon cancer disorders (eg, Lynch syndrome, PTEN hamartoma syndrome, Cowden syndrome, familial adenomatosis polyposis), targeted mRNA sequence analysis panel (APC, CDH1, CHEK2, MLH1, MSH2, MSH6, MUTYH, PMS2, PTEN, and, TP53) (List separately in addition to code for primary procedure) |
| 0136U | ATM (ataxia telangiectasia mutated) (eg, ataxia telangiectasia) mRNA sequence analysis (List separately in addition to code for primary procedure) |
| 0138U | BRCA1 (BRCA1, DNA repair associated), BRCA2 (BRCA2, DNA repair associated) (eg, hereditary breast and ovarian cancer) mRNA sequence analysis (List separately in, addition to code for primary procedure) |
| 0143U | Drug assay, definitive, 120 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0144U | Drug assay, definitive, 160 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0145U | Drug assay, definitive, 65 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0146U | Drug assay, definitive, 80 or more drugs or metabolites, urine, by quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0147U | Drug assay, definitive, 85 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0148U | Drug assay, definitive, 100 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0149U | Drug assay, definitive, 60 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0150U | Drug assay, definitive, 120 or more drugs or metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (LC-MS/MS) using multiple reaction monitoring (MRM), with drug or metabolite description, comments including sample validation, per date of service |
| 0163U | ONCOLOGY (COLORECTAL) SCREENING, BIOCHEMICAL ENZYME-LINKED IMMUNOSORBENT ASSAY (ELISA) OF 3 PLASMA OR SERUM PROTEINS (TERATOCARCINOMA DERIVED GROWTH FACTOR-1 [TDGF-1, CRIPTO- 1], CARCINOEMBRYONIC ANTIGEN [CEA], EXTRACELLULAR MATRIX PROTEIN [ECM]), WITH DEMOGRAPHIC DATA (AGE, GENDER, CRC- SCREENING COMPLIANCE) USING A PROPRIETARY ALGORITHM AND REPORTED AS LIKELIHOOD OF CRC OR ADVANCED ADENOMAS |
| 0164U | GASTROENTEROLOGY (IRRITABLE BOWEL SYNDROME [IBS]), IMMUNOASSAY FOR ANTI- CDTB AND ANTI-VINCULIN ANTIBODIES, UTILIZING PLASMA, ALGORITHM FOR ELEVATED OR NOT ELEVATED QUALITATIVE RESULTS |
| 0166U | LIVER DISEASE, 10 BIOCHEMICAL ASSAYS (A2- MACROGLOBULIN, HAPTOGLOBIN, APOLIPOPROTEIN A1, BILIRUBIN, GGT, ALT, AST, TRIGLYCERIDES, CHOLESTEROL, FASTING GLUCOSE) AND BIOMETRIC AND DEMOGRAPHIC DATA, UTILIZING SERUM, ALGORITHM REPORTED AS SCORES FOR FIBROSIS, NECROINFLAMMATORY ACTIVITY, AND STEATOSIS WITH A SUMMARY INTERPRETATION |
| 0167U | GONADOTROPIN, CHORIONIC (HCG), IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION, BLOOD |
| 0170U | NEUROLOGY (AUTISM SPECTRUM DISORDER [ASD]), RNA, NEXT-GENERATION SEQUENCING, SALIVA, ALGORITHMIC ANALYSIS, AND RESULTS REPORTED AS PREDICTIVE PROBABILITY OF ASD DIAGNOSIS |
| 0202U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected |
| 0223U | INFECTIOUS DISEASE (BACTERIAL OR VIRAL RESPIRATORY TRACT INFECTION), PATHOGEN-SPECIFIC NUCLEIC ACID (DNA OR RNA), 22 TARGETS INCLUDING SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2), QUALITATIVE RT-PCR, NASOPHARYNGEAL SWAB, EACH PATHOGEN REPORTED DETECTED OR NOT DETECTED |
| 0224U | Antibody, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (Coronavirus disease [COVID-19]), includes titer(s), when performed (Do not report 0224U in conjunction with 86769) At this time deny, unclear if quantitative IgG medically useful at this time |
| 0225U | Infectious disease (bacterial or viral respiratory tract infection) pathogen-specific DNA and RNA, 21 targets, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), amplified probe technique, including multiplex reverse transcription for RNA targets, each analyte reported as detected or not detected |
| 0226U | SURROGATE VIRAL NEUTRALIZATION TEST (SVNT), SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) (CORONAVIRUS DISEASE [COVID-19]), ELISA, PLASMA, SERUM |
| 0248U | Oncology (brain), spheroid cell culture in a 3d microenvironment, 12 drug panel, tumor-response prediction for each drug 0249U Oncology (breast), semiquantitative analysis of 32 phosphoproteins and protein analytes, includes laser capture microdissection, with algorithmic analysis and interpretative report |
| 0251U | Hepcidin-25, enzyme-linked immunosorbent assay (elisa), serum or plasma |
| 0253U | Reproductive medicine (endometrial receptivity analysis), rna gene expression profile, 238 genes by next-generation sequencing, endometrial tissue, predictive algorithm reported as endometrial window of implantation (eg, pre-receptive, receptive, post-receptive) |
| 0254U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using embryonic dna genomic sequence analysis for aneuploidy, and a mitochondrial dna score in euploid embryos, results reported as normal (euploidy),monosomy, trisomy, or partial deletion/duplications, mosaicism, and segmental aneuploidy, per embryo tested |
| 0255U | Andrology (infertility), sperm-capacitation assessment of ganglioside gm1 distribution patterns, fluorescence microscopy, fresh or frozen specimen, reported as percentage of capacitated sperm and probability of generating a pregnancy score |
| 0257U | Very long chain acyl-coenzyme a (coa) dehydrogenase (vlcad), leukocyte enzyme activity, whole blood |
| 0258U | Autoimmune (psoriasis), mrna, next- generation sequencing, gene expression profiling of 50-100 genes, skin-surface collection using adhesive patch, algorithm reported as likelihood of response to psoriasis biologics |
| 0259U | Nephrology (chronic kidney disease), nuclear magnetic resonance spectroscopy measurement of myo-inositol, valine, and creatinine, algorithmically combined with cystatin c (by immunoassay) and demographic data to determine estimated glomerular filtration rate (gfr), serum, quantitative |
| 0260U | Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping |
| 0261U | Oncology (colorectal cancer), image analysis with artificial intelligence assessment of 4 histologic and immunohistochemical features (cd3 and cd8 within tumor-stroma border and tumor core), tissue, reported as immune response and recurrence-risk score |
| 0262U | Oncology (solid tumor), gene expression profiling by real-time rt-pcr of 7 gene pathways (er, ar, pi3k, mapk, hh, tgfb, notch), formalin-fixed paraffin- embedded (ffpe), algorithm reported as gene pathway activity score |
| 0263U | Neurology (autism spectrum disorder [asd]), quantitative measurements of 16 central carbon metabolites (ie, a- ketoglutarate, alanine, lactate, phenylalanine, pyruvate, succinate, carnitine, citrate, fumarate, hypoxanthine, inosine, malate, s-sulfocysteine, taurine, urate, and xanthine), liquid chromatography tandem mass spectrometry (lc-ms/ms), plasma, algorithmic analysis with result reported as negative or positive (with metabolic subtypes of asd) |
| 0264U | Rare diseases (constitutional/heritable disorders), identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping |
| 0265U | Rare constitutional and other heritable disorders, whole genome and mitochondrial dna sequence analysis, blood, frozen and formalin-fixed paraffin- embedded (ffpe) tissue, saliva, buccal swabs or cell lines, identification of single nucleotide and copy number variants |
| 0267U | Rare constitutional and other heritable disorders, identification of copy number variations, inversions, insertions, translocations, and other structural variants by optical genome mapping and whole genome sequencing |
| 0275U | Hematology (heparin-induced thrombocytopenia), platelet antibody reactivity by flow cytometry, serum |
| 0278U | Hematology (genetic thrombosis), genomic sequence analysis of 12 genes, blood, buccal swab, or amniotic fluid |
| 0285U | Oncology, response to radiation, cell-free dna, quantitative branched chain dna amplification, plasma, reported as a radiation toxicity score |
| 0286U | Cep72 (centrosomal protein, 72-kda), nudt15 (nudix hydrolase 15) and tpmt (thiopurine s-methyltransferase) (eg, drug metabolism) gene analysis, common variants |
| 0288U | Oncology (lung), mrna, quantitative pcr analysis of 11 genes (bag1, brca1, cdc6, cdk2ap1, erbb3, fut3, il11, lck, rnd3, sh3bgr, wnt3a) and 3 reference genes (esd, tbp, yap1), formalin-fixed paraffin-embedded (ffpe) tumor tissue, algorithmic interpretation reported as a recurrence risk score |
| 0289U | Neurology (alzheimer disease), mrna, gene expression profiling by rna sequencing of 24 genes, whole blood, algorithm reported as predictive risk score |
| 0290U | Pain management, mrna, gene expression profiling by rna sequencing of 36 genes, whole blood, algorithm reported as predictive risk score |
| 0291U | Psychiatry (mood disorders), mrna, gene expression profiling by rna sequencing of 144 genes, whole blood, algorithm reported as predictive risk score |
| 0292U | Psychiatry (stress disorders), mrna, gene expression profiling by rna sequencing of 72 genes, whole blood, algorithm reported as predictive risk score |
| 0293U | Psychiatry (suicidal ideation), mrna, gene expression profiling by rna sequencing of 54 genes, whole blood, algorithm reported as predictive risk score |
| 0294U | Longevity and mortality risk, mrna, gene expression profiling by rna sequencing of 18 genes, whole blood, algorithm reported as predictive risk score |
| 0295U | Oncology (breast ductal carcinoma in situ), protein expression profiling by immunohistochemistry of 7 proteins (cox2, foxa1, her2, ki-67, p16, pr, siah2), with 4 clinicopathologic factors (size, age, margin status, palpability), utilizing formalin-fixed paraffin-embedded (ffpe) tissue, algorithm reported as a recurrence risk score |
| 0296U | Oncology (oral and/or oropharyngeal cancer), gene expression profiling by rna sequencing at least 20 molecular features (eg, human and/or microbial mrna), saliva, algorithm reported as positive or negative for signature associated with malignancy |
| 0297U | Oncology (pan tumor), whole genome sequencing of paired malignant and normal dna specimens, fresh or formalin-fixed paraffin-embedded (ffpe) tissue, blood or bone marrow, comparative sequence analyses and variant identification |
| 0298U | Oncology (pan tumor), whole transcriptome sequencing of paired malignant and normal rna specimens, fresh or formalin-fixed paraffin-embedded (ffpe) tissue, blood or bone marrow, comparative sequence analyses and expression level and chimeric transcript identification |
| 0299U | Oncology (pan tumor), whole genome optical genome mapping of paired malignant and normal DNA specimens, fresh frozen tissue, blood, or bone marrow, comparative structural variant identification |
| 0300U | Oncology (pan tumor), whole genome sequencing and optical genome mapping of paired malignant and normal DNA specimens, fresh tissue, blood, or bone marrow, comparative sequence analyses and variant identification |
| 0303U | Hematology, red blood cell (rbc) adhesion to endothelial/subendothelial adhesion molecules, functional assessment, whole blood, with algorithmic analysis and result reported as an rbc adhesion index; hypoxic |
| 0304U | Hematology, red blood cell (rbc) adhesion to endothelial/subendothelial adhesion molecules, functional assessment, whole blood, with algorithmic analysis and result reported as an rbc adhesion index; normoxic |
| 0305U | Hematology, red blood cell (rbc) functionality and deformity as a function of shear stress, whole blood, reported as a maximum elongation index |
| 0310U | Pediatrics (vasculitis, kawasaki disease [kd]), analysis of 3 biomarkers (nt- probnp, c-reactive protein, and t-uptake), plasma, algorithm reported as a risk score for kd |
| 0312U | Autoimmune diseases (eg, systemic lupus erythematosus [sle]), analysis of 8 igg autoantibodies and 2 cell-bound complement activation products using enzyme-linked immunosorbent immunoassay (elisa), flow cytometry and indirect immunofluorescence, serum, or plasma and whole blood, individual components reported along with an algorithmic sle-likelihood assessment |
| 0313U | Oncology (pancreas), dna and mrna next-generation sequencing analysis of 74 genes and analysis of cea (ceacam5) gene expression, pancreatic cyst fluid, algorithm reported as a categorical result (ie, negative, low probability of neoplasia or positive, high probability of neoplasia) |
| 0314U | Oncology (cutaneous melanoma), mrna gene expression profiling by rt-pcr of 35 genes (32 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded (ffpe) tissue, algorithm reported as a categorical result (ie, benign, intermediate, malignant) |
| 0315U | Oncology (cutaneous squamous cell carcinoma), mrna gene expression profiling by rt-pcr of 40 genes (34 content and 6 housekeeping), utilizing formalin-fixed paraffin-embedded (ffpe) tissue, algorithm reported as a categorical risk result (ie, class 1, class 2a, class 2b) |
| 0316U | Borrelia burgdorferi (lyme disease), ospa protein evaluation, urine |
| 0317U | Oncology (lung cancer), four-probe fish (3q29, 3p22.1, 10q22.3, 10cen) assay, whole blood, predictive algorithm- generated evaluation reported as decreased or increased risk for lung cancer |
| 0319U | Nephrology (renal transplant), rna expression by select transcriptome sequencing, using pretransplant peripheral blood, algorithm reported as a risk score for early acute rejection |
| 0320U | Nephrology (renal transplant), rna expression by select transcriptome sequencing, using posttransplant peripheral blood, algorithm reported as a risk score for acute cellular rejection |
| 0322U | Neurology (autism spectrum disorder [asd]), quantitative measurements of 14 acyl carnitines and microbiome-derived metabolites, liquid chromatography with tandem mass spectrometry (lc-ms/ms), plasma, results reported as negative or positive for risk of metabolic subtypes associated with asd |
| 0323U | Infectious agent detection by nucleic acid (dna and rna), central nervous system pathogen, metagenomic next-generation sequencing, cerebrospinal fluid (csf), identification of pathogenic bacteria, viruses, parasites, or fungi |
| 0324U | Oncology (ovarian), spheroid cell culture, 4-drug panel (carboplatin, doxorubicin, gemcitabine, paclitaxel), tumor chemotherapy response prediction for each drug |
| 0325U | Oncology (ovarian), spheroid cell culture, poly (adp-ribose) polymerase (parp) inhibitors (niraparib, olaparib, rucaparib, velparib), tumor response prediction for each drug |
| 0327U | Fetal aneuploidy (trisomy 13, 18, and 21), DNA sequence analysis of selected regions using maternal plasma, algorithm reported as a risk score for each trisomy, includes sex reporting, if performed |
| 0328U | Drug assay, definitive, 120 or more drugs and metabolites, urine, quantitative liquid chromatography with tandem mass spectrometry (lc-ms/ms), includes specimen validity and algorithmic analysis describing drug or metabolite and presence or absence of risks for a significant patient-adverse event, per date of service |
| 0329U | Oncology (neoplasia), exome and transcriptome sequence analysis for sequence variants, gene copy number amplifications and deletions, gene rearrangements, microsatellite instability and tumor mutational burden utilizing dna and rna from tumor with dna from normal blood or saliva for subtraction, report of clinically significant mutation(s) with therapy associations |
| 0331U | Oncology (hematolymphoid neoplasia), optical genome mapping for copy number alterations and gene rearrangements utilizing dna from blood or bone marrow, report of clinically significant alternations |
| 0333U | Oncology (liver), surveillance for hepatocellular carcinoma (HCC) in high- risk patients, analysis of methylation patterns on circulating cell-free DNA (cfDNA) plus measurement of serum of afp/afp-l3 and oncoprotein des-gamma-carboxy-prothrombin (DCP), algorithm reported as normal or abnormal result |
| 0337U | Oncology (plasma cell disorders and myeloma), circulating plasma cell immunologic selection, identification, morphological characterization, and enumeration of plasma cells based on differential cd138, cd38, cd19, and cd45 protein biomarker expression, peripheral blood |
| 0338U | Oncology (solid tumor), circulating tumor cell selection, identification, morphological characterization, detection and enumeration based on differential epcam, cytokeratins 8, 18, and 19, and cd45 protein biomarkers, and quantification of her2 protein biomarker-expressing cells, peripheral blood |
| 0339U | Oncology (prostate), mRNA expression profiling of hoxc6 and dlx1, reverse transcription polymerase chain reaction (rt-PCR), first-void urine following digital rectal examination, algorithm reported as probability of high-grade cancer |
| 0342U | Oncology (pancreatic cancer), multiplex immunoassay of c5, c4, cystatin c, factor b, osteoprotegerin (OPG), gelsolin, igfbp3, ca125 and multiplex electrochemiluminescent immunoassay (ECLIA) for ca19-9, serum, diagnostic algorithm reported qualitatively as positive, negative, or borderline |
| 0343U | Oncology (prostate), exosome-based analysis of 442 small noncoding RNAs (sncRNAs) by quantitative reverse transcription polymerase chain reaction (rt-qPCR), urine, reported as molecular evidence of no-, low-, intermediate- or high-risk of prostate cancer |
| 0345U | Psychiatry (eg, depression, anxiety, attention deficit hyperactivity disorder [ADHD]), genomic analysis panel, variant analysis of 15 genes, including deletion/duplication analysis of cyp2d6 |
| 0346U | Beta amyloid, ab40 and ab42 by liquid chromatography with tandem mass spectrometry (lc-ms/ms), ratio, plasma |
| 0347U | Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 16 gene report, with variant analysis and reported phenotypes |
| 0348U | Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 25 gene report, with variant analysis and reported phenotypes |
| 0349U | Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 27 gene report, with variant analysis, including reported phenotypes and impacted gene-drug interactions |
| 0350U | Drug metabolism or processing (multiple conditions), whole blood or buccal specimen, DNA analysis, 27 gene report, with variant analysis and reported phenotypes |
| 0351U | Infectious disease (bacterial or viral), biochemical assays, tumor necrosis factor- related apoptosis-inducing ligand (trail), interferon gamma-induced protein-10 (ip- 10), and c-reactive protein, serum, algorithm reported as likelihood of bacterial infection |
| 0352U | Infectious disease (bacterial vaginosis and vaginitis), multiplex amplified probe technique, for detection of bacterial vaginosis-associated bacteria (bvab-2, atopobium vaginae, and megasphera type 1), algorithm reported as detected or not detected and separate detection of candida species (c. albicans, c. tropicalis, c. parapsilosis, c. dubliniensis), candida glabrata/candida krusei, and trichomonas vaginalis, vaginal-fluid specimen, each result reported as detected or not detected |
| 0353U | Infectious agent detection by nucleic acid (DNA), chlamydia trachomatis and neisseria gonorrhoeae, multiplex amplified probe technique, urine, vaginal, pharyngeal, or rectal, each pathogen reported as detected or not detected |
| 0354U | Human papilloma virus (HPV), high-risk types (ie, 16, 18, 31, 33, 45, 52 and 58) qualitative mRNA expression of e6/e7 by quantitative polymerase chain reaction (qPCR) |
| 0365U | Oncology (bladder), analysis of 10 protein biomarkers (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 and VEGFA) by immunoassays, urine, algorithm reported, as a probability of bladder cancer |
| 0366U | Oncology (bladder), analysis of 10 protein biomarkers (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 and VEGFA) by immunoassays, urine, algorithm reported, as a probability of recurrent bladder cancer |
| 0367U | Oncology (bladder), analysis of 10 protein biomarkers (A1AT, ANG, APOE, CA9, IL8, MMP9, MMP10, PAI1, SDC1 and VEGFA) by immunoassays, urine, diagnostic algorithm reported as a risk score for probability of rapid recurrence of recurrent or persistent cancer following transurethral resection |
| 0368U | Oncology (colorectal cancer), evaluation for mutations of APC, BRAF, CTNNB1, KRAS, NRAS, PIK3CA, SMAD4, and TP53, and methylation markers (MYO1G, KCNQ5, C9ORF50, FLI1, CLIP4, ZNF132 and TWIST1), multiplex quantitative polymerase chain reaction (qPCR), circulating cell-free DNA (cfDNA), plasma, report of risk score for, advanced adenoma or colorectal cancer |
| 0369U | Infectious agent detection by nucleic acid (DNA and RNA), gastrointestinal pathogens, 31 bacterial, viral, and parasitic organisms and identification of 21 associated antibiotic-resistance genes, multiplex amplified probe technique |
| 0370U | Infectious agent detection by nucleic acid (DNA and RNA), surgical wound pathogens, 34 microorganisms and identification of 21 associated antibiotic-resistance genes,, multiplex amplified probe technique, wound swab |
| 0371U | Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogen, semiquantitative identification, DNA from 16 bacterial organisms and 1 fungal organism, multiplex amplified probe technique via quantitative polymerase chain reaction (qPCR), urine |
| 0372U | Infectious disease (genitourinary pathogens), antibiotic-resistance gene detection, multiplex amplified probe technique, urine, reported as an antimicrobial stewardship, risk score |
| 0373U | Infectious agent detection by nucleic acid (DNA and RNA), respiratory tract infection, 17 bacteria, 8 fungus, 13 virus, and 16 antibiotic-resistance genes, multiplex amplified probe technique, upper or lower respiratory specimen |
| 0374U | Infectious agent detection by nucleic acid (DNA or RNA), genitourinary pathogens, identification of 21 bacterial and fungal organisms and identification of 21 associated, antibiotic-resistance genes, multiplex amplified probe technique, urine |
| 0375U | Oncology (ovarian), biochemical assays of 7 proteins (follicle stimulating hormone, human epididymis protein 4, apolipoprotein A-1, transferrin, beta-2 macroglobulin, prealbumin [ie, transthyretin], and cancer antigen 125), algorithm reported as ovarian, cancer risk score |
| 0376U | Oncology (prostate cancer), image analysis of at least 128 histologic features and clinical factors, prognostic algorithm determining the risk of distant metastases, and prostate cancer-specific mortality, includes predictive algorithm to androgen, deprivation-therapy response, if appropriate |
| 0377U | Cardiovascular disease, quantification of advanced serum or plasma lipoprotein profile, by nuclear magnetic resonance (NMR) spectrometry with report of a, lipoprotein profile (including 23 variables) |
| 0378U | RFC1 (replication factor C subunit 1), repeat expansion variant analysis by traditional and repeat-primed PCR, blood, saliva, or buccal swab |
| 0380U | Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis, 20 gene variants and CYP2D6 deletion or duplication analysis with reported, genotype and phenotype |
| 0381U | Maple syrup urine disease monitoring by patient-collected blood card sample, quantitative measurement of allo-isoleucine, leucine, isoleucine, and valine, liquid chromatography with tandem mass spectrometry (LC-MS/MS) |
| 0382U | Hyperphenylalaninemia monitoring by patient-collected blood card sample, quantitative measurement of phenylalanine and tyrosine, liquid chromatography with, tandem mass spectrometry (LC-MS/MS) |
| 0383U | Tyrosinemia type I monitoring by patient-collected blood card sample, quantitative measurement of tyrosine, phenylalanine, methionine, succinylacetone, nitisinone, liquid chromatography with tandem mass spectrometry (LC-MS/MS) |
| 0384U | Nephrology (chronic kidney disease), carboxymethyllysine, methylglyoxal hydroimidazolone, and carboxyethyl lysine by liquid chromatography with tandem mass spectrometry (LC-MS/MS) and HbA1c and estimated glomerular filtration rate, (GFR), with risk score reported for predictive progression to high-stage kidney disease |
| 0385U | Nephrology (chronic kidney disease), apolipoprotein A4 (ApoA4), CD5 antigen-like (CD5L), and insulin-like growth factor binding protein 3 (IGFBP3) by enzyme-linked immunoassay (ELISA), plasma, algorithm combining results with HDL, estimated glomerular filtration rate (GFR) and clinical data reported as a risk score for developing, diabetic kidney disease |
| 0386U | Gastroenterology (Barrett's esophagus), P16, RUNX3, HPP1, and FBN1 methylation analysis, prognostic and predictive algorithm reported as a risk score for progression to high-grade dysplasia or esophageal cancer |
| 0387U | Oncology (melanoma), autophagy and beclin 1 regulator 1 (AMBRA1) and loricrin (AMLo) by immunohistochemistry, formalin-fixed paraffin-embedded (FFPE) tissue, report for risk of progression |
| 0389U | Pediatric febrile illness (Kawasaki disease [KD]), interferon alpha-inducible protein 27 (IFI27) and mast cell-expressed membrane protein 1 (MCEMP1), RNA, using reverse transcription polymerase chain reaction (RT-qPCR), blood, reported as a risk score for KD |
| 0390U | Obstetrics (preeclampsia), kinase insert domain receptor (KDR), Endoglin (ENG), and retinol-binding protein 4 (RBP4), by immunoassay, serum, algorithm reported as a risk score |
| 0392U | Drug metabolism (depression, anxiety, attention deficit hyperactivity disorder [ADHD]), gene-drug interactions, variant analysis of 16 genes, including deletion/duplication analysis of CYP2D6, reported as impact of gene-drug interaction for each drug |
| 0393U | Neurology (eg, Parkinson disease, dementia with Lewy bodies), cerebrospinal fluid (CSF), detection of misfolded α-synuclein protein by seed amplification assay, qualitative |
| 0394U | Perfluoroalkyl substances (PFAS) (eg, perfluorooctanoic acid, perfluorooctane sulfonic acid), 16 PFAS compounds by liquid chromatography with tandem mass spectrometry (LC-MS/MS), plasma or serum, quantitative |
| 0395U | Oncology (lung), multi-omics (microbial DNA by shotgun next-generation sequencing and carcinoembryonic antigen and osteopontin by immunoassay), plasma, algorithm reported as malignancy risk for lung nodules in early-stage disease |
| 0398U | Gastroenterology (Barrett esophagus), P16, RUNX3, HPP1, and FBN1 DNA methylation analysis using PCR, formalin-fixed paraffin-embedded (FFPE) tissue, algorithm reported as risk score for progression to high-grade dysplasia or cancer |
| 0399U | Neurology (cerebral folate deficiency), serum, detection of anti-human folate receptor IgG-binding antibody and blocking autoantibodies by enzyme-linked immunoassay (ELISA), qualitative, and blocking autoantibodies, using a functional blocking assay for IgG or IgM, quantitative, reported as positive or not detected |
| 0401U | Cardiology (coronary heart disease [CAD]), 9 genes (12 variants), targeted variant genotyping, blood, saliva, or buccal swab, algorithm reported as a genetic risk score for a coronary event |
| 0402U | Infectious agent (sexually transmitted infection), Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis, Mycoplasma genitalium, multiplex amplified probe technique, vaginal, endocervical, or male urine, each pathogen reported as detected or not detected |
| 0403U | Oncology (prostate), mRNA, gene expression profiling of 18 genes, first-catch post-digital rectal examination urine (or processed first-catch urine), algorithm reported as percentage of likelihood of detecting clinically significant prostate cancer |
| 0404U | Oncology (breast), semiquantitative measurement of thymidine kinase activity by immunoassay, serum, results reported as risk of disease progression |
| 0406U | Oncology (lung), flow cytometry, sputum, 5 markers (meso-tetra [4-carboxyphenyl] porphyrin [TCPP], CD206, CD66b, CD3, CD19), algorithm reported as likelihood of lung cancer |
| 0407U | Nephrology (diabetic chronic kidney disease [CKD]), multiplex electrochemiluminescent immunoassay (ECLIA) of soluble tumor necrosis factor receptor 1 (sTNFR1), soluble tumor necrosis receptor 2 (sTNFR2), and kidney injury molecule 1 (KIM-1) combined with clinical data, plasma, algorithm reported as risk for progressive decline in kidney function |
| 0410U | Oncology (pancreatic), DNA, whole genome sequencing with 5-hydroxymethylcytosine enrichment, whole blood or plasma, algorithm reported as cancer detected or not detected |
| 0411U | Psychiatry (eg, depression, anxiety, attention deficit hyperactivity disorder [ADHD]), genomic analysis panel, variant analysis of 15 genes, including deletion/duplication analysis of CYP2D6 |
| 0412U | Beta amyloid, Aβ42/40 ratio, immunoprecipitation with quantitation by liquid chromatography with tandem mass spectrometry (LC-MS/MS) and qualitative ApoE isoform-specific proteotyping, plasma combined with age, algorithm reported as presence or absence of brain amyloid pathology |
| 0413U | Oncology (hematolymphoid neoplasm), optical genome mapping for copy number alterations, aneuploidy, and balanced/complex structural rearrangements, DNA from blood or bone marrow, report of clinically significant alterations |
| 0415U | Cardiovascular disease (acute coronary syndrome [ACS]), IL-16, FAS, FASLigand, HGF, CTACK, EOTAXIN, and MCP-3 by immunoassay combined with age, sex, family history, and personal history of diabetes, blood, algorithm reported as a 5-year (deleted risk) score for ACS |
| 0416U | Infectious agent detection by nucleic acid (DNA), genitourinary pathogens, identification of 20 bacterial and fungal organisms, including identification of 20 associated antibiotic-resistance genes, if performed, multiplex amplified probe technique, urine |
| 0417U | Rare diseases (constitutional/heritable disorders), whole mitochondrial genome sequence with heteroplasmy detection and deletion analysis, nuclear-encoded mitochondrial gene analysis of 335 nuclear genes, including sequence changes, deletions, insertions, and copy number variants analysis, blood or saliva, identification and categorization of mitochondrial disorder–associated genetic variants |
| 0418U | Oncology (breast), augmentative algorithmic analysis of digitized whole slide imaging of 8 histologic and immunohistochemical features, reported as a recurrence score |
| 0419U | Neuropsychiatry (eg, depression, anxiety), genomic sequence analysis panel, variant analysis of 13 genes, saliva or buccal swab, report of each gene phenotype |
| 0420U | ONCOLOGY (UROTHELIAL), MRNA EXPRESSION PROFILING BY REAL-TIME QUANTITATIVE PCR OF MDK, HOXA13, CDC2, IGFBP5, AND CXCR2 IN COMBINATION WITH DROPLET DIGITAL PCR (DDPCR) ANALYSIS OF 6 SINGLE-NUCLEOTIDE POLYMORPHISMS (SNPS) GENES TERT AND FGFR3, URINE, ALGORI |
| 0421U | ONCOLOGY (COLORECTAL) SCREENING, QUANTITATIVE REAL-TIME TARGET AND SIGNAL AMPLIFICATION OF 8 RNA MARKERS (GAPDH, SMAD4, ACY1, AREG, CDH1, KRAS, TNFRSF10B, EGLN2) AND FECAL HEMOGLOBIN, ALGORITHM REPORTED AS A POSITIVE OR NEGATIVE FOR COLORECTAL CANCER RISK |
| 0423U | PSYCHIATRY (EG, DEPRESSION, ANXIETY), GENOMIC ANALYSIS PANEL, INCLUDING VARIANT ANALYSIS OF 26 GENES, BUCCAL SWAB, REPORT INCLUDING METABOLIZER STATUS AND RISK OF DRUG TOXICITY BY CONDITION |
| 0424U | ONCOLOGY (PROSTATE), EXOSOME- BASED ANALYSIS OF 53 SMALL NONCODING RNAS (SNCRNAS) BY QUANTITATIVE REVERSE TRANSCRIPTION POLYMERASE CHAIN REACTION (RT- QPCR), URINE, REPORTED AS NO MOLECULAR EVIDENCE, LOW-, MODERATE- OR ELEVATED-RISK OF PROSTATE CANCER |
| 0425U | GENOME (EG, UNEXPLAINED CONSTITUTIONAL OR HERITABLE DISORDER OR SYNDROME), RAPID SEQUENCE ANALYSIS, EACH COMPARATOR GENOME (EG, PARENTS, SIBLINGS) |
| 0426U | GENOME (EG, UNEXPLAINED CONSTITUTIONAL OR HERITABLE DISORDER OR SYNDROME), ULTRA-RAPID SEQUENCE ANALYSIS |
| 0427U | MONOCYTE DISTRIBUTION WIDTH, WHOLE BLOOD (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0429U | HUMAN PAPILLOMAVIRUS (HPV), OROPHARYNGEAL SWAB, 14 HIGH-RISK TYPES (IE, 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66, AND 68) |
| 0430U | GASTROENTEROLOGY, MALABSORPTION EVALUATION OF ALPHA-1-ANTITRYPSIN, CALPROTECTIN, PANCREATIC ELASTASE AND REDUCING SUBSTANCES, FECES, QUANTITATIVE |
| 0431U | GLYCINE RECEPTOR ALPHA1 IGG, SERUM OR CEREBROSPINAL FLUID (CSF), LIVE CELL-BINDING ASSAY (LCBA), QUALITATIVE |
| 0432U | KELCH-LIKE PROTEIN 11 (KLHL11) ANTIBODY, SERUM OR CEREBROSPINAL FLUID (CSF), CELL-BINDING ASSAY, QUALITATIVE |
| 0433U | ONCOLOGY (PROSTATE), 5 DNA REGULATORY MARKERS BY QUANTITATIVE PCR, WHOLE BLOOD, ALGORITHM, INCLUDING PROSTATE-SPECIFIC ANTIGEN, REPORTED AS LIKELIHOOD OF CANCER |
| 0434U | DRUG METABOLISM (ADVERSE DRUG REACTIONS AND DRUG RESPONSE), GENOMIC ANALYSIS PANEL, VARIANT ANALYSIS OF 25 GENES WITH REPORTED PHENOTYPES |
| 0435U | ONCOLOGY, CHEMOTHERAPEUTIC DRUG CYTOTOXICITY ASSAY OF CANCER STEM CELLS (CSCS), FROM CULTURED CSCS AND PRIMARY TUMOR CELLS, CATEGORICAL DRUG RESPONSE REPORTED BASED ON CYTOTOXICITY PERCENTAGE OBSERVED, MINIMUM OF 14 DRUGS OR DRUG COMBINATIONS |
| 0436U | ONCOLOGY (LUNG), PLASMA ANALYSIS OF 388 PROTEINS, USING APTAMER- BASED PROTEOMICS TECHNOLOGY, PREDICTIVE ALGORITHM REPORTED AS CLINICAL BENEFIT FROM IMMUNE CHECKPOINT INHIBITOR THERAPY |
| 0437U | PSYCHIATRY (ANXIETY DISORDERS), MRNA, GENE EXPRESSION PROFILING BY RNA SEQUENCING OF 15 BIOMARKERS, WHOLE BLOOD, ALGORITHM REPORTED AS PREDICTIVE RISK SCORE |
| 0438U | DRUG METABOLISM (ADVERSE DRUG REACTIONS AND DRUG RESPONSE), BUCCAL SPECIMEN, GENE-DRUG INTERACTIONS, VARIANT ANALYSIS OF 33 GENES, INCLUDING DELETION/DUPLICATION ANALYSIS OF CYP2D6, INCLUDING REPORTED PHENOTYPES AND IMPACTED GENE- DRUG INTERACTIONS |
| 0439U | Cardiology (coronary heart disease [CHD]), DNA, analysis of 5 single-nucleotide polymorphisms (SNPs) (rs11716050 [LOC105376934], rs6560711 [WDR37], rs3735222 [SCIN/LOC107986769], rs6820447 [intergenic], and rs9638144 [ESYT2]) and 3 DNA methylation markers (cg00300879 [transcription start site {TSS200} of CNKSR1], cg09552548 [intergenic], and cg14789911 [body of SPATC1L]), qPCR and digital PCR, whole blood, algorithm reported as a 4-tiered risk score for a 3-year risk of symptomatic CHD |
| 0440U | Cardiology (coronary heart disease [CHD]), DNA, analysis of 10 single-nucleotide polymorphisms (SNPs) (rs710987 [LINC010019], rs1333048 [CDKN2B-AS1], rs12129789 [KCND3], rs942317 [KTN1-AS1], rs1441433 [PPP3CA], rs2869675 [PREX1], rs4639796 [ZBTB41], rs4376434 [LINC00972], rs12714414 [TMEM18], and rs7585056 [TMEM18]) and 6 DNA methylation markers (cg03725309 [SARS1], cg12586707 [CXCL1, cg04988978 [MPO], cg17901584 [DHCR24-DT], cg21161138 [AHRR], and cg12655112 [EHD4]), qPCR and digital PCR, whole blood, algorithm reported as detected or not detected for CHD |
| 0441U | Infectious disease (bacterial, fungal, or viral infection), semiquantitative biomechanical assessment (via deformability cytometry), whole blood, with algorithmic analysis and result reported as an index |
| 0442U | Infectious disease (respiratory infection), Myxovirus resistance protein A (MxA) and C-reactive protein (CRP), fingerstick whole blood specimen, each biomarker reported as present or absent |
| 0443U | Neurofilament light chain (NfL), ultra-sensitive immunoassay, serum or cerebrospinal fluid |
| 0444U | Oncology (solid organ neoplasia), targeted genomic sequence analysis panel of 361 genes, interrogation for gene fusions, translocations, or other rearrangements, using DNA from formalin-fixed paraffin-embedded (FFPE) tumor tissue, report of clinically significant variant(s) |
| 0445U | B-amyloid (Abeta42) and phospho tau (181P) (pTau181), electrochemiluminescent immunoassay (ECLIA), cerebral spinal fluid, ratio reported as positive or negative for amyloid pathology |
| 0446U | Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 10 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic risk score for current disease activity |
| 0447U | Autoimmune diseases (systemic lupus erythematosus [SLE]), analysis of 11 cytokine soluble mediator biomarkers by immunoassay, plasma, individual components reported with an algorithmic prognostic risk score for developing a clinical flare |
| 0449U | Carrier screening for severe inherited conditions (eg, cystic fibrosis, spinal muscular atrophy, beta hemoglobinopathies [including sickle cell disease], alpha thalassemia), regardless of race or self-identified ancestry, genomic sequence analysis panel, must include analysis of 5 genes (CFTR, SMN1, HBB, HBA1, HBA2) |
| 0531U | Infectious disease (acid-fast bacteria and invasive fungi), DNA (673 organisms), nextgeneration sequencing, plasma |
| 0532U | Rare diseases (constitutional disease/hereditary disorders), rapid whole genome and mitochondrial DNA sequencing for single nucleotide variants, insertions/deletions, copy number variations, peripheral blood, buffy coat, saliva, buccal or tissue sample, r |
| 0533U | Drug metabolism (adverse drug reactions and drug response), genotyping of 16 genes (i.e., ABCG2, CYP2B6, CYP2C9, CYP2C19, CYP2C, CYP2D6, CYP3A5, CYP4F2, DPYD, G6PD, GGCX, NUDT15, SLCO1B1, TPMT, UGT1A1, VKORC1), reported as metabolizer status and transporter |
| 0534U | Oncology (prostate), microRNA, single-nucleotide polymorphisms (SNPs) analysis by rt-PCR of 32 variants, using buccal swab, algorithm reported as a risk score |
| 0535U | Perfluoroalkyl substances (pfas) (e.g., perfluorooctanoic acid, perfluorooctane sulfonic acid), by liquid chromatography with tandem mass spectrometry (LCMS/MS), plasma or serum, quantitative |
| 0537U | Oncology (colorectal cancer), analysis of cell-free DNA for epigenomic patterns, next generation sequencing, >2500 differentially methylated regions (DMRs), plasma, algorithm reported as positive or negative |
| 0541U | Cardiovascular disease (HDL reverse cholesterol transport), cholesterol efflux capacity, LC-MS/MS, quantitative measurement of 5 distinct HDL-bound apolipoproteins (apolipoproteins A1, C1, C2, C3, AND C4), serum, algorithm reported as prediction of corona |
| 0542U | Nephrology (renal transplant), urine, nuclear magnetic resonance (NMR) spectroscopy measurement of 84 urinary metabolites, combined with patient data, quantification of bk virus (human polyomavirus 1) using real-time PCR and serum creatinine, algorithm r |
| 0545U | Acetylcholine receptor (ACHR), antibody identification by immunofluorescence, using live cells, reported as positive or negative |
| 0546U | Low-density lipoprotein receptor-related protein 4 (LRP4), antibody identification by immunofluorescence, using live cells, reported as positive or negative |
| 0547U | Neurofilament light chain(NFL), chemiluminescent enzyme immunoassay, plasma, quantitative |
| 0548U | Glial fibrillary acidic protein (GFAP), chemiluminescent enzyme immunoassay, using plasma |
| 0549U | Oncology (urothelial), DNA, quantitative methylated real time PCR of TRNA-Cys, SIM2, and NKX1-1, using urine, diagnostic algorithm reported as a probability index for bladder cancer and/or upper tract urothelial carcinoma (UTUC) |
| 0550U | Oncology (prostate), enzyme linked immunosorbent assays (ELISA) for total prostate specific antigen (PSA) and free PSA, serum, combined with age, previous negative prostate biopsy status, digital rectal examination findings, prostate volume, and image and |
| 0551U | Tau, phosphorylated, ptau217, by single-molecule array (ultrasensitive digital protein detection), using plasma |
| 0553U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial DNA score, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, or mosaic, per embryo tested |
| 0554U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from trophectoderm biopsy for aneuploidy, ploidy, a mitochondrial DNA score, and embryo quality control, results reported as normal (euploidy), monosomy, trisomy, segmental aneuploidy, triploid, haploid, or mosaic, with quality control results reported as contamination detected or inconsistent cohort when applicable, per embryo tested |
| 0555U | Reproductive medicine (preimplantation genetic assessment), analysis of 24 chromosomes using DNA genomic sequence analysis from embryonic trophectoderm for structural rearrangements, aneuploidy, and a mitochondrial DNA score, results reported as normal/balanced (euploidy/balanced), unbalanced structural rearrangement, monosomy, trisomy, segmental aneuploidy, or mosaic, per embryo tested |
| 0556U | Infectious Disease (Bacterial Or Viral Respiratory Tract Infection), Pathogen-Specific DNA And RNA By Real-Time PCR, 12 Targets, Nasopharyngeal Or Oropharyngeal Swab, Including Multiplex Reverse Transcription For RNA Targets, Each Analyte Reported As Detected |
| 0558U | Oncology (Colorectal), Quantitative Enzyme-Linked Immunosorbent Assay (Elisa) For Secreted Colorectal Cancer Protein Marker (Bf7 Antigen), Using Serum, Result Reported As Indicative Of Response/No Response To Therapy Or Disease Progression/Regression |
| 0559U | Oncology (Breast), Quantitative Enzyme-Linked Immunosorbent Assay (Elisa) For Secreted Breast Cancer Protein Marker (Bf9 Antigen), Serum, Result Reported As Indicative Of Response/No Response To Therapy Or Disease Progression/Regression |
| 0560U | Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood and tumor tissue, baseline assessment for design and construction of a personalized variant panel to evaluate current MRD and for comparison to subsequent MRD assessments |
| 0561U | Oncology (minimal residual disease [MRD]), genomic sequence analysis, cell-free DNA, whole blood, subsequent assessment with comparison to initial assessment to evaluate for MRD |
| 0562U | Oncology (solid tumor), targeted genomic sequence analysis, 33 genes, detection of single-nucleotide variants (SNVs), insertions and deletions, copy-number amplifications, and translocations in human genomic circulating cell-free DNA, plasma, reported as presence of actionable variants |
| 0563U | Infectious Disease (Bacterial And/Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (DNA Or RNA), 11 Viral Targets And 4 Bacterial Targets, Qualitative RT-PCR, Upper Respiratory Specimen, Each Pathogen Reported As Positive Or Negative |
| 0564U | Infectious Disease (Bacterial And/Or Viral Respiratory Tract Infection), Pathogen-Specific Nucleic Acid (DNA Or RNA), 10 Viral Targets And 4 Bacterial Targets, Qualitative RT-PCR, Upper Respiratory Specimen, Each Pathogen Reported As Positive Or Negative |
| 0565U | Oncology (hepatocellular carcinoma), next-generation sequencing methylation pattern assay to detect 6626 epigenetic alterations, cell free DNA, plasma, algorithm reported as cancer signal detected or not detected |
| 0566U | Oncology (lung), qPCR based analysis of 13 differentially methylated regions (CCDC181, HOXA7, LRRC8A, MARCHF11, MIR129-2, NCOR2, PANTR1, PRKCB, SLC9A3, TBR1_2, TRAP1, VWC2, ZNF781), pleural fluid, algorithm reported as a qualitative result |
| 0567U | Rare diseases (constitutional/heritable disorders), whole-genome sequence analysis combination of short and long reads, for single-nucleotide variants, insertions/deletions and characterized intronic variants, copy-number variants, duplications/deletions, mobile element insertions, runs of homozygosity, aneuploidy, and inversions, mitochondrial DNA sequence and deletions, short tandem repeat genes, methylation status of selected regions, blood, saliva, amniocentesis, chorionic villus sample or tissue, identification and categorization of genetic variants |
| 0569U | Oncology (solid tumor), next generation sequencing analysis of tumor methylation markers (>20000 differentially methylated regions) present in cell-free circulating tumor DNA (ctDNA), whole blood, algorithm reported as presence or absence of ctDNA with tumor fraction, if appropriate |
| 0572U | Oncology (Prostate), High-Throughput Telomere Length Quantification By Fish, Whole Blood, Diagnostic Algorithm Reported As Risk Of Prostate Cancer |
| 0573U | Oncology (Pancreas), 3 Biomarkers (Glucose, Carcinoembryonic Antigen, And Gastricsin), Pancreatic Cyst Lesion Fluid, Algorithm Reported As Categorical Mucinous Or Non-Mucinous |
| 0574U | Mycobacterium Tuberculosis, Culture Filtrate Protein–10-KDA (CFP-10), Serum Or Plasma, Liquid Chromatography Mass Spectrometry (LC-MS) |
| 0614U | Inborn error of metabolism (primary mitochondrial disease), mitochondrial analysis of 4 enzyme complexes by stained blue native polyacrylamide gel electrophoresis (page), frozen tissue (muscle, liver, heart, cultured skin fibroblasts), diagnostic qualitative result |
| 0615U | Borrelia burgdorferi (lyme disease), antibody detection of 26 recombinant protein groups, by immunoassay, igm |
| 0629U | Infectious disease (tuberculosis), dna, analysis of 1 target by pcr with clustered regularly interspaced short palindromic repeat (crispr)-based probe detection, plasma or serum, qualitative report as detected or not detected |
| 15775 | Punch graft for hair transplant; 1 to 15 punch grafts |
| 15776 | more than 15 punch grafts |
| 15879 | Suction assisted lipectomy; lower extremity |
| 17360 | Chemical exfoliation for acne (eg, acne paste, acid) |
| 19105 | Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenoma |
| 20932 | Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (list separately in addition to code for primary procedure) |
| 20933 | Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (list separately in addition to code for primary procedure) |
| 20939 | Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (list separately in addition to code for primary procedure) |
| 20983 | Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; cryoablation |
| 22505 | Manipulation of spine requiring anesthesia, any region, effective 5/1/11 |
| 22586 | Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, l5-s1 interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 22857 | Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 22860 | Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression); second interspace, lumbar (list separately in addition to code for primary procedure) |
| 22862 | Revision including replacement of total disc arthroplasty (artificial disc) anterior approach, lumbar, single interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 22865 | Removal of total disc arthroplasty (artificial disc), anterior approach, lumbar, single interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 22867 | Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; single level |
| 22868 | Insertion of interlaminar/interspinous process stabilization/distraction device, without fusion, including image guidance when performed, with open decompression, lumbar; second level (List separately in addition to code for primary procedure) |
| 22869 | Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; single level |
| 22870 | Insertion of interlaminar/interspinous process stabilization/distraction device, without open decompression or fusion, including image guidance when performed, lumbar; second level (List separately in addition to code for primary procedure) |
| 24370 | Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar component |
| 24371 | Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar component |
| 27278 | Arthrodesis, sacroiliac joint, percutaneous or minimally invasive, with image guidance, includes obtaining bone graft when performed, unilateral; placement of intra-articular device(s), without cortical piercing |
| 28890 | Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fascia |
| 33265 | Endoscopy, surgical; operative tissue ablation and reconstruction of atria, limited (eg, modified maze procedure), without cardiopulmonary bypass |
| 33266 | Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass |
| 33276 | INSERTION OF PHRENIC NERVE STIMULATOR SYSTEM (PULSE GENERATOR AND STIMULATING LEAD[S]), INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND PULSE GENERATOR INITIAL ANALYSIS WITH DIAGNOSTIC MODE ACTIVATION, WHEN PERFORMED |
| 33277 | INSERTION OF PHRENIC NERVE STIMULATOR TRANSVENOUS SENSING LEAD (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 33278 | REMOVAL OF PHRENIC NERVE STIMULATOR, INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND INTERROGATION AND PROGRAMMING, WHEN PERFORMED; SYSTEM, INCLUDING PULSE GENERATOR AND LEAD(S) |
| 33279 | REMOVAL OF PHRENIC NERVE STIMULATOR, INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND INTERROGATION AND PROGRAMMING, WHEN PERFORMED; TRANSVENOUS STIMULATION OR SENSING LEAD(S) ONLY |
| 33280 | REMOVAL OF PHRENIC NERVE STIMULATOR, INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND INTERROGATION AND PROGRAMMING, WHEN PERFORMED; PULSE GENERATOR ONLY |
| 33281 | REPOSITIONING OF PHRENIC NERVE STIMULATOR TRANSVENOUS LEAD(S) |
| 33287 | REMOVAL AND REPLACEMENT OF PHRENIC NERVE STIMULATOR, INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND INTERROGATION AND PROGRAMMING, WHEN PERFORMED; PULSE GENERATOR |
| 33288 | REMOVAL AND REPLACEMENT OF PHRENIC NERVE STIMULATOR, INCLUDING VESSEL CATHETERIZATION, ALL IMAGING GUIDANCE, AND INTERROGATION AND PROGRAMMING, WHEN PERFORMED; TRANSVENOUS STIMULATION OR SENSING LEAD(S) |
| 33289 | Transcatheter implantation of wireless pulmonary artery pressure sensor for long-term hemodynamic monitoring. |
| 37788 | Penile revascularization, artery, with or without vein graft For more detailed information, please see associated medical policy Erectile Dysfunction |
| 37790 | Penile venous occlusive procedure For more detailed information, please see associated medical policy Erectile Dysfunction |
| 43197 | Flexible transnasal esophagoscopy |
| 43198 | Flexible transnasal esophagoscopy |
| 43210 | Esophagogastroduodenoscopy, flexible, transoral; with esophagogastric fundoplasty, partial or complete, includes duodenoscopy when performed |
| 43257 | Upper gastrointestinal endoscopy including esophagus, stomach, and either the duodenum and/or jejunum as appropriate; with delivery of thermal energy to the muscle of lower esophageal sphincter and/or gastric cardia, for treatment of gastroesophageal reflux disease |
| 43284 | Laparoscopy, surgical, esophageal sphincter augmentation procedure, placement of sphincter augmentation device (ie. Magnetic band), including curoplasty when performed |
| 43285 | Removal of esophageal sphincter augmentation device |
| 43290 | Esophagogastroduodenoscopy, flexible, transoral; with deployment of intragastric bariatric balloon |
| 43291 | Esophagogastroduodenoscopy, flexible, transoral; with removal of intragastric bariatric balloon(s) |
| 43497 | Lower esophageal myotomy, transoral (ie, peroral endoscopic myotomy [poem]) |
| 46707 | Repair of anorectal fistula with plug (e.g., porcine small intestine submucosa (SIS). Note: this code replaces 0170T |
| 47383 | Ablation, 1 or more liver tumor(s), percutaneous, cryoablation |
| 52284 | CYSTOURETHROSCOPY, WITH MECHANICAL URETHRAL DILATION AND URETHRAL THERAPEUTIC DRUG DELIVERY BY DRUG-COATED BALLOON CATHETER FOR URETHRAL STRICTURE OR STENOSIS, MALE, INCLUDING FLUOROSCOPY, WHEN PERFORMED |
| 53451 | Periurethral transperineal adjustable balloon continence device; bilateral insertion, including cystourethroscopy and imaging guidance |
| 53452 | Periurethral transperineal adjustable balloon continence device; unilateral insertion, including cystourethroscopy and imaging guidance |
| 53453 | Periurethral transperineal adjustable balloon continence device; removal, each balloon |
| 53454 | Periurethral transperineal adjustable balloon continence device; percutaneous adjustment of balloon(s) fluid volume |
| 53855 | Insertion of a temporary prostatic urethral stent, including urethral measurement Note: this code replaces 0084T |
| 53860 | Transurethral radiofrequency micro-remodeling of the female bladder neck and proximal urethra for stress urinary incontinence |
| 57465 | Computer-aided mapping of cervix uteri during colposcopy, including optical dynamic spectral imaging and algorithmic quantification of the acetowhitening effect (List separately in addition to code for primary procedure) |
| 60660 | Ablation of 1 or more thyroid nodule(s), one lobe or the isthmus, percutaneous, including imaging guidance, radiofrequency |
| 60661 | Ablation of 1 or more thyroid nodule(s), additional lobe, percutaneous, including imaging guidance, radiofrequency (list separately in addition to code for primary procedure) |
| 61736 | Laser interstitial thermal therapy (litt) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; single trajectory for 1 simple lesion |
| 61737 | Laser interstitial thermal therapy (litt) of lesion, intracranial, including burr hole(s), with magnetic resonance imaging guidance, when performed; multiple trajectories for multiple or complex lesion(s) |
| 61870 | Craniectomy for implantation of neurostimulator electrodes, cerebellar; cortical |
| 62287 | Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar |
| 64580 | Incision for implantation of neurostimulator electrodes; neuromuscular |
| 64555 | Percutaneous implantation of neurostimulator electrodes; peripheral nerve [excludes sacral nerve] |
| 67516 | SUPRACHOROIDAL SPACE INJECTION OF PHARMACOLOGIC AGENT (SEPARATE PROCEDURE) |
| 68841 | Insertion of drug-eluting implant, including punctal dilation when performed, into lacrimal canaliculus, each |
| 76014 | MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (e.g., surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging), analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; initial 15 minutes |
| 76015 | MR safety implant and/or foreign body assessment by trained clinical staff, including identification and verification of implant components from appropriate sources (e.g., surgical reports, imaging reports, medical device databases, device vendors, review of prior imaging), analyzing current MR conditional status of individual components and systems, and consulting published professional guidance with written report; each additional 30 minutes (list separately in addition to code for primary procedure) |
| 76016 | MR safety determination by a physician or other qualified health care professional responsible for the safety of the MR procedure, including review of implant MR conditions for indicated MR examination, analysis of risk vs clinical benefit of performing MR examination, and determination of MR equipment, accessory equipment, and expertise required to perform examination, with written report |
| 76017 | MR safety medical physics examination customization, planning and performance monitoring by medical physicist or MR safety expert, with review and analysis by physician or other qualified health care professional to prioritize and select views and imaging sequences, to tailor MR acquisition specific to restrictive requirements or artifacts associated with MR conditional implants or to mitigate risk of non-conditional implants or foreign bodies, with written report |
| 76018 | MR safety implant electronics preparation under supervision of physician or other qualified health care professional, including MR -specific programming of pulse generator and/or transmitter to verify device integrity, protection of device internal circuitry from MR electromagnetic fields, and protection of patient from risks of unintended stimulation or heating while in the MR room, with written report |
| 76019 | MR safety implant positioning and/or immobilization under supervision of physician or other qualified health care professional, including application of physical protections to secure implanted medical device from MR-induced translational or vibrational forces, magnetically induced functional changes, and/or prevention of radiofrequency burns from inadvertent tissue contact while in the MR room, with written report |
| 77089 | Trabecular bone score (tbs), structural condition of the bone microarchitecture; using dual x-ray absorptiometry (dxa) or other imaging data on gray-scale variogram, calculation, with interpretation and report on fracture-risk |
| 77090 | Trabecular bone score (tbs), structural condition of the bone microarchitecture; technical preparation and transmission of data for analysis to be performed elsewhere |
| 77091 | Trabecular bone score (tbs), structural condition of the bone microarchitecture; technical calculation only |
| 77092 | Trabecular bone score (tbs), structural condition of the bone microarchitecture; interpretation and report on fracture-risk only by other qualified health care professional |
| 80235 | LACOSAMIDE |
| 80280 | VEDOLIZUMAB |
| 81230 | CYP3A4 (cytochrome P450 family 3 subfamily A member 4) (eg, drug metabolism), gene analysis, common variant(s) (eg, *2, *22) |
| 81283 | IFNL3 (Interferon, lambda 3) (eg, drug response), gene analysis, RS12979860 variant |
| 81291 | MTHFR (5, 10-methylenetetrahydrofolate reductase) (e.g., hereditary hypercoagulability) gene analysis, common variants (e.g., 677T, 1298C) |
| 81313 | PCA3/KLK3 (prostate cancer antigen 3 [non-protein coding]/kallikrein-related, peptidase 3 [prostate specific antigen]) ratio (eg, prostate cancer) |
| 81327 | SEPT9 (Septin9) (eg, colorectal cancer) methylation analysis |
| 81328 | SLCO1B1 (Solute carrier organic anion transporter family, member 1B1) (eg, adverse drug reaction), gene analysis, common variant(s) (EG, *5) |
| 81346 | TYMS (Thymidylate Synthetase) (eg, 5-Fluorouracil/5-FU drug metabolism), gene analysis, common variant(s) (eg, tandem repeat variant) |
| 81410 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); genomic sequence analysis panel, must include sequencing of at least 9 genes, including FBN1, TGFBR1, TGFBR2,, COL3A1, MYH11, ACTA2, SLC2A10, SMAD3, and MYLK |
| 81411 | Aortic dysfunction or dilation (eg, Marfan syndrome, Loeys Dietz syndrome, Ehler Danlos syndrome type IV, arterial tortuosity syndrome); duplication/deletion analysis panel, must include analyses for TGFBR1, TGFBR2, MYH11, and COL3A1 |
| 81418 | Drug metabolism (eg, pharmacogenomics) genomic sequence analysis panel, must include testing of at least 6 genes, including cyp2c19, cyp2d6, and cyp2d6 duplication/deletion analysis |
| 81422 | Fetal chromosomal microdeletion(s) genomic sequence analysis (eg, DiGeorge syndrome, Cri-du-chat syndrome), circulating cell-free fetal DNA in maternal blood |
| 81425 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence, analysis |
| 81426 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); sequence analysis, each comparator genome (eg, parents, siblings) (List separately in addition to code for primary procedure) |
| 81427 | Genome (eg, unexplained constitutional or heritable disorder or syndrome); re- evaluation of previously obtained genome sequence (eg, updated knowledge or, unrelated condition/syndrome) |
| 81440 | Nuclear encoded mitochondrial genes (eg, neurologic or myopathic phenotypes), genomic sequence panel, must include analysis of at least 100 genes, including BCS1L, C10orf2, COQ2, COX10, DGUOK, MPV17, OPA1, PDSS2, POLG, POLG2, RRM2B, SCO1, SCO2, SLC25A4, SUCLA2, SUCLG1, TAZ, TK2, and TYMP |
| 81449 | Targeted genomic sequence analysis panel, solid organ neoplasm, 5-50 genes (eg, alk, braf, cdkn2a, egfr, erbb2, kit, kras, met, nras, pdgfra, pdgfrb, pgr, pik3ca, pten, ret), interrogation for sequence variants and copy number variants or rearrangements, if performed; rna analysis |
| 81451 | Targeted genomic sequence analysis panel, hematolymphoid neoplasm or disorder, 5-50 genes (eg, braf, cebpa, dnmt3a, ezh2, flt3, idh1, idh2, jak2, kit, kras, mll, notch1, npm1, nras), interrogation for sequence variants, and copy number variants or rearrangements, or isoform expression or mrna expression levels, if performed; rna analysis |
| 81456 | Targeted genomic sequence analysis panel, solid organ or hematolymphoid neoplasm or disorder, 51 or greater genes (eg, alk, braf, cdkn2a, cebpa, dnmt3a, egfr, erbb2, ezh2, flt3, idh1, idh2, jak2, kit, kras, met, mll, notch1, npm1, nras, pdgfra, pdgfrb, pgr, pik3ca, pten, ret), interrogation for sequence variants and copy number variants or rearrangements, or isoform expression or mrna expression levels, if performed; rna analysis |
| 81470 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); genomic sequence analysis panel, must include sequencing of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1,, OCRL, RPS6KA3, and SLC16A2 |
| 81471 | X-linked intellectual disability (XLID) (eg, syndromic and non-syndromic XLID); duplication/deletion gene analysis, must include analysis of at least 60 genes, including ARX, ATRX, CDKL5, FGD1, FMR1, HUWE1, IL1RAPL, KDM5C, L1CAM, MECP2, MED12, MID1, OCRL, RPS6KA3, and SLC16A2 |
| 81490 | Autoimmune (rheumatoid arthritis), analysis of 12 biomarkers using immunoassays, utilizing serum, prognostic algorithm reported as a disease activity score |
| 81493 | Coronary artery disease, mrna, gene expression profiling by real-time rt-pcr of 23 genes, utilizing whole peripheral blood, algorithm reported as a risk score |
| 81500 | Oncology (ovarian), biochemical assays of two proteins (CA-125 and HE4), utilizing serum, with menopausal status, algorithm reported as a risk score |
| 81503 | Oncology (ovarian), biochemical assays of five proteins (CA-125, apolipoprotein A1, beta-2 microglobulin, transferrin, and pre-albumin), utilizing serum, algorithm reported as a risk score |
| 81504 | Oncology (tissue of origin), microarray gene expression profiling of > 2000 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as tissue similarity scores |
| 81506 | Endocrinology (type 2 diabetes), biochemical assays of seven analytes (glucose, hba1c, insulin, hs-crp, adoponectin, ferritin, interleukin 2-receptor alpha), utilizing serum or plasma, algorithm reporting a risk score |
| 81514 | Infectious disease, bacterial vaginosis and vaginitis, quantitative real-time amplification of DNA markers for Gardnerella vaginalis, Atopobium vaginae, Megasphaera type 1, Bacterial Vaginosis Associated Bacteria-2 (BVAB-2), and Lactobacillus species (L. crispatus and L. jensenii), utilizing vaginal-fluid specimens, algorithm reported as a positive or negative for high likelihood of bacterial vaginosis, includes separate detection of Trichomonas vaginalis and/or Candida species (C. albicans, C. tropicalis, C. parapsilosis, C. dubliniensis), Candida glabrata, Candida krusei, when reported |
| 81525 | Oncology (colon), mrna, gene expression profiling by real-time rt-pcr of 12 genes (7 content and 5 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a recurrence score |
| 81529 | Oncology (cutaneous melanoma), mRNA, gene expression profiling by real-time RT-PCR of 31 genes (28 content and 3 housekeeping), utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as recurrence risk, including likelihood of sentinel lymph node metastasis |
| 81535 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by dapi stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination |
| 81536 | Oncology (gynecologic), live tumor cell culture and chemotherapeutic response by dapi stain and morphology, predictive algorithm reported as a drug response score; first single drug or drug combination; each additional single drug or drug combination (list separately in addition to code for primary procedure) |
| 81538 | Oncology (lung), mass spectrometric 8-protein signature, including amyloid a, utilizing serum, prognostic and predictive algorithm reported as good versus poor overall survival |
| 81539 | Oncology (high-grade prostate cancer), biochemical assay of four proteins (Total PSA, Free PSA, Intact PSA, and human kallikrein-2 [hK2]), utilizing plasma or serum, prognostic algorithm reported as a probability score |
| 81540 | Oncology (tumor of unknown origin), mrna, gene expression profiling by real-time rt-pcr of 92 genes (87 content and 5 housekeeping) to classify tumor into main cancer type and subtype, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a probability of a predicted main cancer type and subtype |
| 81551 | Oncology (prostate), promoter methylation profiling by real-time PCR of 3 genes (GSTP1, APC, RASSF1), utilizing formalin-fixed paraffin-embedded tissue, algorithm, reported as a likelihood of prostate cancer detection on repeat biopsy |
| 81554 | Pulmonary disease (idiopathic pulmonary fibrosis [IPF]), mRNA, gene expression analysis of 190 genes, utilizing transbronchial biopsies, diagnostic algorithm reported as categorical result (eg, positive or negative for high probability of usual interstitial pneumonia [UIP]) |
| 81558 | Transplantation medicine (allograft rejection, kidney), MRNA, gene expression profiling by quantitative polymerase chain reaction (QPCR) of 139 genes, utilizing whole blood, algorithm reported as a binary categorization as transplant excellence, which indicates immune quiescence, or not transplant excellence, indicating subclinical rejection |
| 81560 | Transplantation Medicine (Allograft Rejection, Pediatric Liver And Small Bowel), Measurement Of Donor And Third-Party-Induced Cd154+T-Cytotoxic Memory Cells, Utilizing Whole Peripheral Blood, Algorithm Reported As A Rejection Risk Score |
| 82172 | Apolipoprotein, each (except when billed for hepatitis C) |
| 83006 | Growth stimulation expressed gene 2 (ST2, Interleukin 1 receptor like-1) |
| 83695 | Lipoprotein (a) |
| 83698 | Lipoprotein-associated phospholipase A2 (Lp-PLA2) For more detailed information, please see associated medical policy Measurement of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk |
| 83700 | Lipoprotein, blood; electrophoretic separation and quantitation |
| 83701 | high resolution fractionation and quantitation of lipoproteins including lipoprotein subclasses when performed (e.g., electrophoresis, ultracentrifugation) |
| 83704 | quantitation of lipoprotein particle numbers and lipoprotein particle subclasses (e.g., nuclear magnetic resonance spectroscopy) |
| 83722 | Lipoprotein, direct measurement; small dense ldl cholesterol |
| 83876 | Meyloperoxidase (MPO) |
| 83884 | Assay neurofilament light chain (NFL) |
| 83951 | Des-Gamma-Carboxy-Prothrombin (DCP) |
| 83987 | PH; exhaled breath condensate |
| 84431 | Thromboxane metabolite(s), including thromboxane if performed, urine |
| 84393 | Tau, phosphorylated (e.g., pTau 181, pTau 217), each |
| 84394 | Tau, total (tTau) |
| 86141 | C-reactive protein; high sensitivity (HSCRP) |
| 86152 | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); For more detailed information, please see associated medical policy Genetic Testing of Inherited Cancer Predisposition |
| 86153 | Cell enumeration using immunologic selection and identification in fluid specimen (eg, circulating tumor cells in blood); physician interpretation and report, when required For more detailed information, please see associated medical policy Genetic Testing of Inherited Cancer Predisposition |
| 86305 | Human epididymis protein 4 (HE4) |
| 86343 | Leukocyte histamine release test (LHR) |
| 86352 | Cellular function assay involving stimulation (e.g., mitogen or antigen) and detection of biomarker (e.g., ATP) |
| 86408 | NEUTRALIZING ANTIBODY, SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) (CORONAVIRUS DISEASE [COVID-19]); SCREEN |
| 86409 | NEUTRALIZING ANTIBODY, SEVERE ACUTE RESPIRATORY SYNDROME CORONAVIRUS 2 (SARS-COV-2) (CORONAVIRUS DISEASE [COVID-19]); TITER |
| 86413 | Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Coronavirus disease [COVID-19]) antibody, quantitative |
| 86490 | Skin test; coccidioidomycosis |
| 86510 | histoplasmosis |
| 86581 | Streptococcus pneumoniae antibody (IgG), serotypes, multiplex immunoassay, quantitative |
| 87483 | Infectious agent detection by nucleic acid (DNA or RNA); central nervous system pathogen (eg, Neisseria meningitidis, Streptococcus pneumoniae, Listeria, Haemophilus influenzae, E. coli, Streptococcus agalactiae, enterovirus, human parechovirus, herpes simplex virus type 1 and 2, human herpesvirus 6, cytomegalovirus, varicella zoster virus, Cryptococcus), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
| 87513 | Infectious agent detection by nucleic acid (DNA or RNA); Helicobacter Pylori (H. pylori), clarithromycin resistance, amplified probe technique |
| 87505 | Infectious agent detection by nucleic acid (dna or rna); gastrointestinal pathogen (eg, clostridium difficile, e. Coli, salmonella, shigella, norovirus, giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 3-5 targets |
| 87506 | Infectious agent detection by nucleic acid (dna or rna); gastrointestinal pathogen (eg, clostridium difficile, e. Coli, salmonella, shigella, norovirus, giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 6-11 targets |
| 87507 | Infectious agent detection by nucleic acid (dna or rna); gastrointestinal pathogen (eg, clostridium difficile, e. Coli, salmonella, shigella, norovirus, giardia), includes multiplex reverse transcription, when performed, and multiplex amplified probe technique, multiple types or subtypes, 12-25 targets |
| 87623 | Infectious agent detection by nucleic acid (dna or rna); human papillomavirus (hpv), low-risk types (eg, 6, 11, 42, 43, 44) |
| 87900 | Infectious agent drug susceptibility phenotype prediction using regularly updated genotypic bioinformatics |
| 88104 | Cytopathology, fluids, washings or brushings, except cervical or vaginal; smears with, interpretation |
| 89290 | Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-, implantation genetic diagnosis); less than or equal to 5 embryos |
| 89291 | Biopsy, oocyte polar body or embryo blastomere, microtechnique (for pre-, implantation genetic diagnosis); greater than 5 embryos |
| 89329 | Sperm evaluation; hamster penetration test |
| 91111 | Gastrointestinal tract imaging, intraluminal (e.g., capsule endoscopy), esophagus with physician interpretation and report (effective 9/1/11) |
| 91112 | Gastrointestinal transit and pressure measurement, stomach through colon, wireless capsule, with interpretation and report |
| 91113 | Gastrointestinal tract imaging, intraluminal (eg, capsule endoscopy), colon, with interpretation and report |
| 92066 | Orthoptic training; under supervision of a physician or other qualified health care professional |
| 92132 | Scanning computerized ophthalmic diagnostic imaging, anterior segment, with interpretation and report, unilateral |
| 92145 | Corneal hysteresis determination, by air impulse stimulation, unilateral or bilateral, with interpretation and report |
| 92512 | Nasal function studies (e.g., rhinomanometry) |
| 92517 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) |
| 92518 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; ocular (oVEMP) |
| 92519 | Vestibular evoked myogenic potential (VEMP) testing, with interpretation and report; cervical (cVEMP) and ocular (oVEMP) |
| 92548 | Computerized dynamic posturography |
| 92634 | Hearing aid fitting services, unilateral or bilateral, including device analysis, programming, verification, counseling, orientation, and training, and, when performed, hearing assistive device, supplemental technology fitting services; first 60 minutes This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92635 | Hearing aid fitting services, unilateral or bilateral, including device analysis, programming, verification, counseling, orientation, and training, and, when performed, hearing assistive device, supplemental technology fitting services; each additional 15 minutes (list separately in addition to code for primary procedure) This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92636 | Hearing aid post-fitting follow-up services, unilateral or bilateral, including confirmation of physical fit, validation of patient benefit and performance, sound quality of device, adjustment(s) (eg, verification, programming adjustment[s], device connection[s], and device training), as indicated, and, when performed, hearing assistive device, supplemental technology fitting services; first 30 minutes This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92637 | Hearing aid post-fitting follow-up services, unilateral or bilateral, including confirmation of physical fit, validation of patient benefit and performance, sound quality of device, adjustment(s) (eg, verification, programming adjustment[s], device connection[s], and device training), as indicated, and, when performed, hearing assistive device, supplemental technology fitting services; each additional 15 minutes (list separately in addition to code for primary procedure) This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92638 | Behavioral verification of amplification including aided thresholds, functional gain, speech-in-noise, when performed (list separately in addition to code for primary procedure) This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92642 | Hearing assistive device, supplemental technology fitting services (eg, personal frequency modulation [fm]/digital modulation [dm] system, remote microphone, alerting devices) This code Does Not Meet Payment Determination Criteria for Commercial but will pay for QUEST |
| 92971 | Cardioassist-method of circulatory assist |
| 92972 | PERCUTANEOUS TRANSLUMINAL CORONARY LITHOTRIPSY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 93025 | Microvolt T-wave alternans for assessment of ventricular arrhythmias |
| 93050 | Arterial pressure waveform analysis for assessment of central arterial pressures, includes obtaining waveform(s), digitization and application of nonlinear mathematical transformations to determine central arterial pressures and augmentation index, with interpretation and report, upper extremity artery, non-invasive |
| 93150 | THERAPY ACTIVATION OF IMPLANTED PHRENIC NERVE STIMULATOR SYSTEM, INCLUDING ALL INTERROGATION AND PROGRAMMING |
| 93151 | INTERROGATION AND PROGRAMMING (MINIMUM ONE PARAMETER) OF IMPLANTED PHRENIC NERVE STIMULATOR SYSTEM |
| 93152 | INTERROGATION AND PROGRAMMING OF IMPLANTED PHRENIC NERVE STIMULATOR SYSTEM DURING POLYSOMNOGRAPHY |
| 93153 | INTERROGATION WITHOUT PROGRAMMING OF IMPLANTED PHRENIC NERVE STIMULATOR SYSTEM |
| 93228 | External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional |
| 93229 | External mobile cardiovascular telemetry with electrocardiographic recording, concurrent computerized real time data analysis and greater than 24 hours of accessible ECG data storage (retrievable with query) with ECG triggered and patient selected events transmitted to a remote attended surveillance center for up to 30 days; technical support for connection and patient instructions for use, attended surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional |
| 93264 | Remote monitoring of a wireless pulmonary artery pressure sensor. |
| 93278 | Signal-averaged electrocardiography (SAECG), with or without ECG |
| 93702 | Bioimpedance spectroscopy (BIS), extracellular fluid analysis for lymphedema assessment(s) |
| 93895 | Quantitative carotid intima media thickness and carotid atheroma evaluation, bilateral |
| 94400 | Breathing response to CO2 (CO2 response curve) |
| 95012 | Nitric oxide expired gas determination |
| 95803 | Actigraphy testing, recording, analysis, interpretation, and report (minimum of 72 hours to 14 consecutive days of recording) |
| 95919 | Quantitative pupillometry with physician or other qualified health care professional interpretation and report, unilateral or bilateral |
| 95924 | Testing of an autonomic nervous system function; combined parasympathetic and sympathetic adrenergic function testing with at least 5 minutes of passive tilt. |
| 95905 | Motor and/or sensory nerve conduction, using preconfigured electrode array(s), amplitude and latency/velocity study, each limb, includes F-wave study when performed with interpretation and report |
| 95961 | Functional cortical and subcortical mapping by stimulation and/or recording of electrodes on brain surface, or of depth electrodes, to provoke seizures or identify vital brain structures; initial hour of physician attendance |
| 95962 | each additional hour of physician attendance |
| 95980 | Electronic analysis of implanted neurostimulator pulse generator system (e.g., rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements) gastric neurostimulator pulse generator/transmitter; intraoperative, with programming |
| 95981 | subsequent, without programming |
| 95982 | subsequent, with reprogramming |
| 96000 | Comprehensive computer-based motion analysis by video-taping and 3D kinematics |
| 96001 | with dynamic plantar pressure measurements during walking |
| 96002 | Dynamic surface electromyography, during walking or other functional activities, 1 to 12 muscles |
| 96003 | Dynamic fine wire electromyography, during walking or other functional activities, 1 muscle |
| 96004 | Physician review & interpretation of comprehensive computer-based motion analysis, dynamic plantar pressure measurements, dynamic surface electromyography during walking or other functional activities, and dynamic fine wire electromyography, with written report |
| 96156 | Health behavior assessment, or re-assessment (ie, health-focused clinical interview, behavioral observations, clinical decision making) |
| 96158 | Health behavior intervention, individual, face-to-face; initial 30 minutes |
| 96159 | Health behavior intervention, individual, face-to-face; each additional 15 minutes (list separately in addition to code for primary service) |
| 96164 | Health behavior intervention, group (2 or more patients), face-to-face; initial 30 minutes |
| 96165 | Health behavior intervention, group (2 or more patients), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) |
| 96167 | Health behavior intervention, family (with the patient present), face-to-face; initial 30 minutes |
| 96168 | Health behavior intervention, family (with the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) |
| 96170 | Health behavior intervention, family (without the patient present), face-to-face; initial 30 minutes |
| 96171 | Health behavior intervention, family (without the patient present), face-to-face; each additional 15 minutes (list separately in addition to code for primary service) |
| 96202 | Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); initial 60 minutes |
| 96203 | Multiple-family group behavior management/modification training for parent(s)/guardian(s)/caregiver(s) of patients with a mental or physical health diagnosis, administered by physician or other qualified health care professional (without the patient present), face-to-face with multiple sets of parent(s)/guardian(s)/caregiver(s); each additional 15 minutes (list separately in addition to code for primary service) |
| 96931 | Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, first lesion |
| 96932 | Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, first lesion |
| 96934 | Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition and interpretation and report, each additional lesion (list separately in addition to code for primary procedure) |
| 96935 | Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; image acquisition only, each additional lesion (list separately in addition to code for primary procedure) |
| 96936 | Reflectance confocal microscopy (rcm) for cellular and sub-cellular imaging of skin; interpretation and report only, each additional lesion (list separately in addition to code for primary procedure) |
| 97037 | APPLICATION OF A MODALITY TO 1 OR MORE AREAS; LOW-LEVEL LASER THERAPY (IE, NONTHERMAL AND NON-ABLATIVE) FOR POST-OPERATIVE PAIN REDUCTION |
| 97610 | Topical wound treatment with low frequency, non-contact, non-thermal ultrasound with wound assessment and instructions |
| 99177 | Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with on-site analysis |
| G2168 | SERVICES PERFORMED BY A PHYSICAL THERAPIST ASSISTANT IN THE HOME HEALTH SETTING IN THE DELIVIERY OF A SAFE AND EFFECTIVE PHYSICAL THERAPY MAINTENANCE PROGRAM, EACH 15 MINUTES |
| G2169 | SERVICES PERFORMED BY A OCCUPATIONAL THERAPIST ASSISTANT IN THE HOME HEALTH SETTING IN THE DELIVIERY OF A SAFE AND EFFECTIVE OCCUPATIONAL THERAPY MAINTENANCE PROGRAM, EACH 15 MINUTES |
Table II. HCPCS Codes
| HCPCS Codes | Description |
|---|---|
| A2001 | Hcpcs: innovamatrix ac, per square centimeter (effective 1/1/2022); irf pps: miscellaneous with motor >49.15.,without comorbidities |
| A2002 | Hcpcs: mirragen advanced wound matrix, per square centimeter (effective 1/1/2022); irf pps: miscellaneous with motor >38.75 & motor <49.15.,without comorbidities |
| A2004 | Hcpcs: xcellistem, per square centimeter (effective 1/1/2022); irf pps: miscellaneous with motor <27.85, without comorbidities |
| A2005 | Hcpcs: microlyte matrix, per square centimeter (effective 1/1/2022); irf pps: miscellaneous m <46.50 and a <77.50.,without comorbidities |
| A2006 | Novosorb synpath dermal matrix, per square centimeter |
| A2007 | Restrata, per square centimeter |
| A2008 | Theragenesis, per sq cm |
| A2009 | Symphony, per sq cm |
| A2010 | Apis, per square centimeter |
| A2011 | Supra sdrm, per square centimeter |
| A2012 | Suprathel, per square centimeter |
| A2013 | Innovamatrix fs, per square centimeter |
| A2019 | Kerecis omega3 marigen shield, per square centimeter |
| A2020 | Ac5 advanced wound system (ac5) |
| A2021 | Neomatrix, per square centimeter |
| A2026 | Restrata minimatrix, 5 mg |
| A2027 | Matriderm, per square centimeter |
| A2028 | Micromatrix flex, per mg |
| A2029 | Mirotract wound matrix sheet, per cubic centimeter |
| A2030 | Miro3d fibers, per milligram |
| A2031 | Mirodry wound matrix, per square centimeter |
| A2032 | Myriad matrix, per square centimeter |
| A2033 | Myriad morcells, 4 milligrams |
| A2034 | Foundation drs solo, per square centimeter |
| A2035 | Corplex p or Theracor p or Allacor p, per milligram |
| A2040 | Microlyte painguard, per square centimeter |
| A2041 | Foundation drs+ duo, per square centimeter |
| A2042 | Foundation drs+ solo, per square centimeter |
| A4543 | Supplies for transcutaneous electrical nerve stimulator, for nerves in the auricular region, per month |
| A7021 | Supplies and accessories for lung expansion airway clearance, continuous high frequency oscillation, and nebulization device (e.g., handset, nebulizer kit, biofilter) |
| A4100 | Skin substitute, fda cleared as a device, not otherwise specified |
| A4467 | Belt, strap, sleeve, garment, or covering, any type​ |
| A4540 | DISTAL TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR, STIMULATES PERIPHERAL NERVES OF THE UPPER ARM |
| A4541 | MONTHLY SUPPLIES FOR USE OF DEVICE CODED AT E0733 |
| A4542 | SUPPLIES AND ACCESSORIES FOR EXTERNAL UPPER LIMB TREMOR STIMULATOR OF THE PERIPHERAL NERVES OF THE WRIST |
| A2043 | Biobrane, per square centimeter |
| A2044 | Biobrane glove, each |
| A2045 | Novashield or novogen wound matrix, per square centimeter |
| A4318 | Female external urinary collection cup, with or without ring attachment, per day |
| A4560 | Neuromuscular electrical stimulator (nmes), disposable, replacement only |
| A4555 | Electrode/transducer for use with electrical stimulation device used for cancer treatment, replacement only |
| A4593 | Neuromodulation stimulator system, adjunct to rehabilitation therapy regime |
| A4594 | Neuromodulation stimulator system, adjunct to rehabilitation therapy regime, mouthpiece each |
| A4670 | Automatic blood pressure monitor |
| A6460 | Synthetic resorbable wound dressing, sterile, pad size 16 sq. In. Or less, without adhesive border, each dressing |
| A6461 | Synthetic resorbable wound dressing, sterile, pad size more than 16 sq. In. But less than or equal to 48 sq. In., without adhesive border, each dressing |
| A6591 | External urinary catheter; non-disposable, for use with suction pump, per month |
| A7023 | MECHANICAL ALLERGEN PARTICLE BARRIER/INHALATION FILTER, CREAM, NASAL, TOPICAL |
| A7047 | Oral interface used with respiratory suction pump, each For more detailed information, please see associated medical policy Positive Airway Pressure and Oral Devices for the Treatment of Obstructive Sleep Apnea |
| A7049 | Expiratory positive airway pressure intranasal resistance valve |
| A9154 | Artificial saliva, 1 ml |
| A9284 | Spirometer, non-electronic, includes all accessories |
| A9291 | Prescription digital behavioral therapy, fda cleared, per course of treatment |
| A9586 | Florbetapir F18, diagnostic, per study dose, up to 10 millicuries |
| A9599 | Radiopharmaceutical, diagnostic, for beta-amyloid positron emission tomography (PET) imaging, per study dose |
| B4105 | In-line cartridge containing digestive enzyme(s) for enteral feeding, each |
| C1602 | ORTHOPEDIC/DEVICE/DRUG MATRIX/ABSORBABLE BONE VOID FILLER, ANTIMICROBIAL-ELUTING (IMPLANTABLE) |
| C1604 | GRAFT, TRANSMURAL TRANSVENOUS ARTERIAL BYPASS (IMPLANTABLE), WITH ALL DELIVERY SYSTEM COMPONENTS |
| C1605 | PACEMAKER, LEADLESS, DUAL CHAMBER (RIGHT ATRIAL AND RIGHT VENTRICULAR IMPLANTABLE COMPONENTS), RATE-RESPONSIVE, INCLUDING ALL NECESSARY COMPONENTS FOR IMPLANTATION |
| C1833 | Monitor, cardiac, including intracardiac lead and all system components (implantable) |
| C8000 | Support device, extravascular, for arteriovenous fistula (implantable) |
| C9354 | Acellular pericardial tissue matrix of nonhuman origin (Veritas), per square centimeter |
| C9356 | Tendon, porous matrix of cross-linked collagen and glycosaminoglycan matrix (TenoGlide Tendon Protector Sheet), per square centimeter |
| C9358 | Dermal substitute, native, non-denatured collagen, fetal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters |
| C9360 | Dermal substitute, native, non-denatured collagen, neonatal bovine origin (SurgiMend Collagen Matrix), per 0.5 square centimeters |
| C9363 | Skin substitute, Integra Meshed Bilayer Wound Matrix, per square centimeter |
| C9364 | Porcine implant, Permacol, per square centimeter |
| E0152 | Walker, battery powered, wheeled, folding, adjustable or fixed height |
| E0201 | Penile contracture device, manual, greater than 3 lbs traction force |
| E0231 | Noncontact wound warming device (temperature control unit, ac adapter and power cord) for use with warming card and wound cover |
| E0232 | Warming card for use with the noncontact wound warming device and noncontact wound warming cover |
| E0446 | Topical oxygen delivery system, not otherwise specified, includes all supplies and accessories |
| E0469 | Lung expansion airway clearance, continuous high frequency oscillation, and nebulization device |
| E0487 | Spirometer, electronic, includes all accessories |
| E0492 | POWER SOURCE AND CONTROL ELECTRONICS UNIT FOR ORAL DEVICE/APPLIANCE FOR NEUROMUSCULAR ELECTRICAL STIMULATION OF THE TONGUE MUSCLE, CONTROLLED BY PHONE APPLICATION |
| E0493 | ORAL DEVICE/APPLIANCE FOR NEUROMUSCULAR ELECTRICAL STIMULATION OF THE TONGUE MUSCLE, USED IN CONJUNCTION WITH THE POWER SOURCE AND CONTROL ELECTRONICS UNIT, CONTROLLED BY PHONE APPLICATION, 90-DAY SUPPLY |
| E0530 | ELECTRONIC POSITIONAL OBSTRUCTIVE SLEEP APNEA TREATMENT, WITH SENSOR, INCLUDES ALL COMPONENTS AND ACCESSORIES, ANY TYPE |
| E0670 | Segmental pneumatic appliance for use with pneumatic compressor, integrated, 2 full legs and trunk |
| E0676 | Intermittent limb compression device (includes all accessories) not otherwise specified |
| E0677 | Non-pneumatic sequential compression garment, trunk |
| E0711 | Upper extremity medical tubing/lines enclosure or covering device, restricts elbow range of motion |
| E0715 | Intravaginal device intended to strengthen pelvic floor muscles during kegel exercises |
| E0716 | Supplies and accessories for intravaginal device intended to strengthen pelvic floor muscles during kegel exercises |
| E0721 | Transcutaneous electrical nerve stimulatory, stimulates nerves in the auricular region |
| E0732 | CRANIAL ELECTROTHERAPY STIMULATION (CES) SYSTEM, ANY TYPE |
| E0733 | TRANSCUTANEOUS ELECTRICAL NERVE STIMULATOR FOR ELECTRICAL STIMULATION OF THE TRIGEMINAL NERVE |
| E0734 | EXTERNAL UPPER LIMB TREMOR STIMULATOR OF THE PERIPHERAL NERVES OF THE WRIST |
| E0735 | NON-INVASIVE VAGUS NERVE STIMULATOR |
| E0830 | Ambulatory traction device, all types, each |
| E1800 | Dynamic adjustable elbow extension/flexion device, includes soft interface material |
| E1801 | Static progressive stretch elbow device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1802 | Dynamic adjustable forearm pronation/supination device, includes soft interface material |
| E1803 | Dynamic adjustable elbow extension only device, includes soft interface material |
| E1804 | Dynamic adjustable elbow flexion only device, includes soft interface material |
| E1805 | Dynamic adjustable wrist extension/flexion device, includes soft interface material |
| E1806 | Static progressive stretch wrist device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
| E1807 | Dynamic adjustable wrist extension only device, includes soft interface material |
| E1808 | Dynamic adjustable wrist flexion only device, includes soft interface material |
| E1810 | Dynamic adjustable knee extension/flexion device, includes soft interface material |
| E1811 | Static progressive stretch knee device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1812 | Dynamic knee extension/flexion device with active resistance control |
| E1813 | Dynamic adjustable knee extension only device, includes soft interface material |
| E1814 | Dynamic adjustable knee flexion only device, includes soft interface material |
| E1815 | Dynamic adjustable ankle extension/flexion device, includes soft interface material |
| E1816 | Static progressive stretch ankle device, flexion and/or extension, with or without range of motion adjustment, includes all components and accessories |
| E1818 | Static progressive stretch forearm pronation/supination device, with or without range of motion adjustment, includes all components and accessories |
| E1820 | Replacement soft interface material, dynamic adjustable extension/flexion device |
| E1821 | Replacement soft interface material/cuffs for bi-directional static progressive stretch device |
| E1822 | Dynamic adjustable ankle extension only device, includes soft interface material |
| E1823 | Dynamic adjustable ankle flexion only device, includes soft interface material |
| E1825 | Dynamic adjustable finger extension/flexion device, includes soft interface material |
| E1826 | Dynamic adjustable finger extension only device, includes soft interface material |
| E1827 | Dynamic adjustable finger flexion only device, includes soft interface material |
| E1828 | Dynamic adjustable toe extension only device, includes soft interface material |
| E1829 | Dynamic adjustable toe flexion only device, includes soft interface material |
| E1830 | Dynamic adjustable toe extension/flexion device, includes soft interface material |
| E1831 | Static progressive stretch toe device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1832 | Static progressive stretch finger device, extension and/or flexion, with or without range of motion adjustment, includes all components and accessories |
| E1840 | Dynamic adjustable shoulder flexion/abduction/rotation device, includes soft interface material |
| E1841 | Static progressive stretch shoulder device, with or without range of motion adjustment, includes all components and accessories |
| E1905 | Virtual reality cognitive behavioral therapy device (cbt), including pre-programmed therapy software |
| E2001 | SUCTION PUMP, HOME MODEL, PORTABLE OR STATIONARY, ELECTRIC, ANY TYPE, FOR USE WITH EXTERNAL URINE MANAGEMENT SYSTEM |
| E2358 | Power wheelchair accessory, group 34 nonsealed lead acid battery, each |
| E2360 | Power wheelchair accessory, 22 NF nonsealed lead acid battery, each |
| E2362 | Power wheelchair accessory, group 24 nonsealed lead acid battery, each |
| E2364 | Power wheelchair accessory, U-1 nonsealed lead acid battery, each |
| E2372 | Power wheelchair accessory, hand or chin control interface, standard remote joystick (not including controller), proportional, including all related electronics and fixed mounting hardware, replacement only |
| E2513 | Accessory for speech generating device, electromyographic sensor |
| E3000 | SPEECH VOLUME MODULATION SYSTEM, ANY TYPE, INCLUDING ALL COMPONENTS AND ACCESSORIES |
| E3200 | Gait modulation system, rhythmic auditory stimulation, including restricted therapy software, all components and accessories, prescription only |
| G0183 | Quantitative software measurements of cardiac volume, cardiac chambers volumes and left ventricular wall mass derived from CT scan(s) data of the chest/heart (with or without contrast) |
| G0250 | Physician review, interpretation and patient management of home INR testing |
| G0259 | Injection procedure for sacroiliac joint; arthrography |
| G0276 | Blinded procedure for lumbar stenosis, percutaneous image-guided lumbar decompression (pild) or placebo-control, performed in an approved coverage with evidence development (ced) clinical trial |
| G0281 | Electrical stimulation, (unattended), to one or more areas, for chronic stage III & stage IV pressure ulcers, arterial ulcers, diabetic ulcers, & venous stasis ulcers not demonstrating measurable signs of healing after 30 days of conventional care, as part of a therapy plan of care |
| G0282 | Electrical stimulation, (unattended), to one or more areas, for wound care other than described in G0281 |
| G0295 | Electromagnetic therapy, to one or more areas, for wound care other than described in G0329, or for other uses |
| G0327 | Colorectal cancer screening; blood-based biomarker. |
| G0329 | Electromagnetic therapy, to one or more areas for chronic stage III and stage IV pressure ulcers, arterial ulcers, diabetic ulcers and venous stasis ulcers not demonstrating measurable signs of healing after 30 days on conventional care as part of a therapy plan of care |
| G0409 | Social work and psychological services, directly relating to and/or furthering the patient's rehabilitation goals, each 15 minutes, face-to-face; individual (services provided by a CORF qualified social worker or psychologist in a CORF) |
| G0428 | Collagen Meniscus Implant procedure for filling meniscal defects (e.g., CMI, collagen scaffold, Menaflex) |
| G0465 | Autologous platelet rich plasma (prp) for diabetic chronic wounds/ulcers, using an fda-cleared device (includes administration, dressings, phlebotomy, centrifugation, and all other preparatory procedures, per treatment) |
| G0537 | Administration of a standardized, evidence-based atherosclerotic cardiovascular disease (ASCVD) risk assessment, 5-15 minutes, not more often than every 12 months |
| G0538 | Atherosclerotic cardiovascular disease (ASCVD) risk management services; clinical staff time; per calendar month |
| G0552 | Supply of digital mental health treatment device and initial education and onboarding, per course of treatment that augments a behavioral therapy plan |
| G0553 | First 20 minutes of monthly treatment management services directly related to the patient’s therapeutic use of the digital mental health treatment (dmht) device that augments a behavioral therapy plan, physician/other qualified health care professional ti |
| G0554 | Each additional 20 minutes of monthly treatment management services directly related to the patient’s therapeutic use of the digital mental health treatment (DMHT) device that augments a behavioral therapy plan, physician/other qualified health care professional |
| G0555 | Provision of replacement patient electronics system (e.g., system pillow, handheld reader) for home pulmonary artery pressure monitoring |
| G0566 | 3D radiodensity-value bone imaging, algorithm derived, from previous magnetic resonance examination of the same anatomy |
| G0680 | Detection and quantification of coronary artery calcium and/or aortic valve calcification from algorithmic analysis of computed tomography of the chest with report |
| G2000 | Blinded administration of convulsive therapy procedure, either electroconvulsive therapy (ect, current covered gold standard) or magnetic seizure therapy (mst, non-covered experimental therapy), performed in an approved ide-based clinical trial, per treatment session |
| G2214 | Initial or subsequent psychiatric collaborative care management, first 30 minutes in a month of behavioral health care manager activities, in consultation with a psychiatric consultant, and directed by the treating physician or other qualified health care professional |
| G2250 | Remote assessment of recorded video and/or images submitted by an established patient (e.g., store and forward), including interpretation with follow-up with the patient within 24 business hours, not originating from a related service provided within the previous 7 days nor leading to a service or procedure within the next 24 hours or soonest available appointment |
| G9147 | Outpatient Intravenous Insulin Treatment (OIVIT) either pulsatile or continuous, by any means, guided by the results of measurements for: respiratory quotient; and/or, urine urea nitrogen (UUN); and/or, arterial, venous or capillary glucose; and/or potassium concentration |
| H2038 | Skills training and development, per diem |
| J0591 | Injection, deoxycholic acid, 1 mg |
| J0691 | Injection, lefamulin, 1 mg |
| J1072 | Injection, testosterone cypionate (Azmiro), 1 mg |
| J1938 | Injection, furosemide, 1 mg |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg |
| J3530 | Nasal vaccine inhalation |
| J3570 | Laetrile, amygdalin, vitamin B-17 |
| K1002 | Cranial electrotherapy stimulation (CES) system with supplies access |
| K1004 | Low frequency ultrasonic diathermy treatment device for home use |
| K1005 | Disposable collection and storage bag for breast milk, any size, any type |
| K1023 | Distal transcutaneous electrical nerve stimulator, stimulates peripheral nerves of the upper arm |
| K1026 | Mechanical allergen particle barrier/inhalation filter, cream, nasal, topical |
| K1028 | Power source and control electronics unit for oral device/appliance for neuromuscular electrical stimulation of the tongue muscle for the reduction of snoring and obstructive sleep apnea, controlled by phone application |
| K1029 | Oral device/appliance for neuromuscular electrical stimulation of the tongue muscle, used in conjunction with the power source and control electronics unit, controlled by phone application, 90-day supply |
| K1030 | External recharging system for battery (internal) for use with implanted cardiac contractility modulation generator, replacement only |
| K1037 | Docking station for use with oral device/appliance used to reduce upper airway collapsibility |
| J1072 | Injection, testosterone cypionate (Azmiro), 1 mg |
| J1938 | Injection, furosemide, 1 mg |
| L0720 | Cervical-thoracic-lumbar-sacral-orthoses (CTLSO), anterior-posterior-lateral control, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual with expertise |
| L0984 | Protective body sock, prefabricated, off-the-shelf, each |
| L2221 | Addition to lower extremity orthosis, ankle system, microprocessor-controlled feature plantarflexion and/or dorsiflexion, includes power source |
| L3161 | FOOT, ADDUCTUS POSITIONING DEVICE, ADJUSTABLE |
| L5827 | Endoskeletal knee-shin system, single axis, electromechanical swing and stance phase control, with or without shock absorption and stance extension damping |
| L5969 | Addition, endoskeletal ankle-foot or ankle system, power assist, includes any type motor(s) |
| L5973 | Endoskeletal ankle foot system, microprocessor controlled feature, dorsiflexion and/or plantar flexion control, includes power source |
| L6700 | Upper extremity addition, external powered feature, myoelectronic control module, additional EMG inputs, pattern-recognition decoding intent movement |
| L8608 | Miscellaneous external component, supply or accessory for use with the argus ii retinal prosthesis system |
| L8678 | Electrical stimulator supplies (external) for use with implantable neurostimulator, per month |
| L8701 | Powered upper extremity range of motion assist device, elbow, wrist, hand with single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated |
| L8702 | Powered upper extremity range of motion assist device, elbow, wrist, hand, finger, single or double upright(s), includes microprocessor, sensors, all components and accessories, custom fabricated |
| M0075 | Cellular therapy |
| M0076 | Prolotherapy |
| M0100 | Intragastric hypothermia using gastric freezing |
| P9027 | Red blood cells, leukocytes reduced, oxygen/ carbon dioxide reduced, each unit |
| Q2058 | Obecabtagene autoleucel, 10 up to 400 million CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures, per infusion |
| Q4103 | Oasis Burn Matrix, per square centimeter |
| Q4104 | Integra Bilayer Matrix Wound Dressing (BMWD), per square centimeter |
| Q4108 | Integra Matrix, per square centimeter |
| Q4110 | PriMatrix, per square centimeter |
| Q4111 | GammaGraft, per square centimeter |
| Q4112 | Cymetra, injectable, 1 cc |
| Q4113 | Graftjacket Xpress, injectable, 1 cc |
| Q4115 | AlloSkin, per square centimeter |
| Q4117 | Hyalomatrix, per square centimeter |
| Q4118 | Matristem micromatrix, per square centimeter |
| Q4121 | Theraskin, per square centimeter |
| Q4123 | Alloskin RT, per square centimeter |
| Q4125 | Arthroflex, per square centimeter |
| Q4126 | Memoderm, Dermaspan, Transgraft or Integuply, per square centimeter |
| Q4127 | Talymed, per square centimeter |
| Q4128 | Flex HD, Allopatch HD or Matrix HD, per square centimeter [when used for Allopatch HD or Matrix HD] |
| Q4134 | hMatrix, per square centimeter |
| Q4135 | Mediskin, per square centimeter |
| Q4136 | EZ-derm, per square centimeter |
| 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 |
| Q4146 | TenSIX, per square centimeter |
| Q4147 | Architect, Architect PX, or Architect FX, extracellular matrix, per square |
| Q4148 | Neox 1k, per square centimeter |
| Q4149 | Excellagen, 0.1 cc |
| Q4150 | Allowrap DS or dry, per square centimeter |
| Q4152 | Dermapure, per square centimeter |
| Q4153 | Dermavest and Plurivest, per square centimeter |
| Q4155 | Neox Flo or Clarix Flo, 1 mg |
| Q4156 | Neox 100, per square centimeter |
| Q4157 | Revitalon, per square centimeter |
| Q4158 | MariGen, per square centimeter |
| Q4160 | NuShield, per square centimeter |
| Q4161 | Bio-connekt wound matrix, per square centimeter |
| Q4162 | Amniopro flow, bioskin flow, biorenew flow, woundex flow, amniogen-a, amniogen-c, 0.5 cc |
| Q4163 | Amniopro, bioskin, biorenew, woundex, amniogen-45, amniogen-200, per square centimeter |
| Q4164 | Helicoll, per square centimeter |
| Q4165 | Keramatrix, per square centimeter |
| Q4166 | Cytal, per square centimeter |
| Q4167 | Truskin, per square centimeter |
| Q4169 | Artacent wound, per square centimeter |
| Q4170 | Cygnus, per square centimeter |
| Q4171 | Interfyl, 1 mg |
| Q4173 | Palingen or palingen xplus, per square centimeter |
| Q4174 | Palingen or promatrx, 0.36 mg per 0.25 cc |
| Q4175 | Miroderm, per square centimeter |
| Q4183 | Surgigraft, per square centimeter |
| Q4184 | Cellesta, per square centimeter |
| Q4185 | Cellesta flowable amnion (25 mg per cc); per 0.5 cc |
| Q4187 | Epicord, per square centimeter |
| Q4188 | Amnioarmor, per square centimeter |
| Q4189 | Artacent ac, 1 mg |
| Q4190 | Artacent ac, per square centimeter |
| Q4191 | Restorigin, per square centimeter |
| Q4192 | Restorigin, 1 cc |
| Q4193 | Coll-e-derm, per square centimeter |
| Q4194 | Novachor, per square centimeter |
| Q4195 | Puraply, per square centimeter |
| Q4196 | Puraply am, per square centimeter |
| Q4197 | Puraply xt, per square centimeter |
| Q4198 | Genesis amniotic membrane, per square centimeter |
| Q4199 | Cygnus matrix, per square centimeter |
| Q4200 | Skin te, per square centimeter |
| Q4201 | Matrion, per square centimeter |
| Q4202 | Keroxx (2.5g/cc), 1cc |
| Q4203 | Derma-gide, per square centimeter |
| Q4204 | Xwrap, per square centimeter |
| Q4205 | Membrane graft or membrane wrap, per square centimeter |
| Q4206 | Fluid flow or fluid gf, 1 cc |
| Q4208 | Novafix, per square cenitmeter |
| Q4209 | Surgraft, per square centimeter |
| Q4210 | Axolotl graft or axolotl dualgraft, per square centimeter |
| Q4211 | Amnion bio or axobiomembrane, per square centimeter |
| Q4212 | Allogen, per cc |
| Q4213 | Ascent, 0.5 mg |
| Q4214 | Cellesta cord, per square centimeter |
| Q4215 | Axolotl ambient or axolotl cryo, 0.1 mg |
| Q4216 | Artacent cord, per square centimeter |
| Q4217 | Woundfix, biowound, woundfix plus, biowound plus, woundfix xplus or biowound xplus, per square centimeter |
| Q4218 | Surgicord, per square centimeter |
| Q4219 | Surgigraft-dual, per square centimeter |
| Q4220 | Bellacell hd or surederm, per square centimeter |
| Q4221 | Amniowrap2, per square centimeter |
| Q4222 | Progenamatrix, per square centimeter |
| Q4224 | Human health factor 10 amniotic patch (hhf10-p), per square centimeter |
| Q4225 | Amniobind, per square centimeter |
| Q4226 | Myown skin, includes harvesting and preparation procedures, per square centimeter |
| Q4234 | Xcellerate, per square centimeter |
| Q4235 | Amniorepair or altiply, per square centimeter |
| Q4236 | Carepatch, per square centimeter |
| Q4237 | Cryo-cord, per square centimeter |
| Q4238 | Derm-maxx, per square centimeter |
| Q4239 | Amnio-maxx or amnio-maxx lite, per square centimeter |
| Q4240 | Corecyte, for topical use only, per 0.5 cc |
| Q4241 | Polycyte, for topical use only, per 0.5 cc |
| Q4242 | Amniocyte plus, per 0.5 cc |
| Q4244 | Procenta, per 200 mg |
| Q4245 | Amniotext, per cc |
| Q4246 | Coretext or protext, per cc |
| Q4247 | Amniotext patch, per square centimeter |
| Q4248 | Dermacyte amniotic membrane allograft, per square centimeter |
| Q4251 | Vim, per square centimeter |
| Q4252 | Vendaje, per square centimeter |
| Q4253 | Zenith amniotic membrane, per square centimeter |
| Q4256 | Mlg-complete, per square centimeter |
| Q4257 | Relese, per square centimeter |
| Q4258 | Enverse, per square centimeter |
| Q4259 | Celera dual layer or celera dual membrane, per square centimeter |
| Q4260 | Signature apatch, per square centimeter |
| Q4262 | Dual layer impax membrane, per square centimeter |
| Q4263 | Surgraft tl, per square centimeter |
| Q4264 | Cocoon membrane, per square centimeter |
| Q4265 | Neostim tl, per square centimeter |
| Q4266 | Neostim membrane, per square centimeter |
| Q4267 | Neostim dl, per square centimeter |
| Q4268 | Surgraft ft, per square centimeter |
| Q4269 | Surgraft xt, per square centimeter |
| Q4270 | Complete sl, per square centimeter |
| Q4271 | Complete ft, per square centimeter |
| Q4272 | Esano a, per square centimeter |
| Q4273 | Esano aaa, per square centimeter |
| Q4274 | Esano ac, per square centimeter |
| Q4275 | Esano aca, per square centimeter |
| Q4276 | Orion, per square centimeter |
| Q4277 | Woundplus membrane or e-graft, per square centimeter |
| Q4278 | Epieffect, per square centimeter |
| Q4279 | VENDAJE AC, PER SQUARE CENTIMETER |
| Q4280 | Xcell amino matrix, per square centimeter |
| Q4281 | Barrera sl or barrera dl, per square centimeter |
| Q4282 | Cygnus dual, per square centimeter |
| Q4283 | Biovance tri-layer or biovance 3L, per square centimeter |
| Q4284 | Dermabind sl, per square centimeter |
| Q4287 | DERMABIND DL, PER SQUARE CENTIMETER |
| Q4288 | DERMABIND CH, PER SQUARE CENTIMETER |
| Q4289 | REVOSHIELD + AMNIOTIC BARRIER, PER SQUARE CENTIMETER |
| Q4290 | MEMBRANE WRAP-HYDRO, PER SQUARE CENTIMETER |
| Q4291 | LAMELLAS XT, PER SQUARE CENTIMETER |
| Q4292 | LAMELLAS, PER SQUARE CENTIMETER |
| Q4293 | ACESSO DL, PER SQUARE CENTIMETER |
| Q4294 | AMNIO QUAD-CORE, PER SQUARE CENTIMETER |
| Q4295 | AMNIO TRI-CORE AMNIOTIC, PER SQUARE CENTIMETER |
| Q4296 | REBOUND MATRIX, PER SQUARE CENTIMETER |
| Q4297 | EMERGE MATRIX, PER SQUARE CENTIMETER |
| Q4298 | AMNICORE PRO, PER SQUARE CENTIMETER |
| Q4299 | AMNICORE PRO+, PER SQUARE CENTIMETER |
| Q4300 | ACESSO TL, PER SQUARE CENTIMETER |
| Q4301 | ACTIVATE MATRIX, PER SQUARE CENTIMETER |
| Q4302 | COMPLETE ACA, PER SQUARE CENTIMETER |
| Q4303 | COMPLETE AA, PER SQUARE CENTIMETER |
| Q4304 | GRAFIX PLUS, PER SQUARE CENTIMETER |
| Q4305 | American amnion ac tri-layer, per square centimeter |
| Q4306 | American amnion ac, per square centimeter |
| Q4307 | American amnion, per square centimeter |
| Q4308 | Sanopellis, per square centimeter |
| Q4309 | Via matrix, per square centimeter |
| Q4310 | Procenta, per 100 mg |
| Q4311 | ACESSO, PER SQUARE CENTIMETER |
| Q4312 | ACESSO AC, PER SQUARE CENTIMETER |
| Q4313 | DERMABIND FM, PER SQUARE CENTIMETER |
| Q4314 | REEVA FT, PER SQUARE CENITMETER |
| Q4315 | REGENELINK AMNIOTIC MEMBRANE ALLOGRAFT, PER SQUARE CENTIMETER |
| Q4316 | AMCHOPLAST, PER SQUARE CENTIMETER |
| Q4317 | VITOGRAFT, PER SQUARE CENTIMETER |
| Q4318 | E-GRAFT, PER SQUARE CENTIMETER |
| Q4319 | SANOGRAFT, PER SQUARE CENTIMETER |
| Q4320 | PELLOGRAFT, PER SQUARE CENTIMETER |
| Q4321 | RENOGRAFT, PER SQUARE CENTIMETER |
| Q4322 | CAREGRAFT, PER SQUARE CENTIMETER |
| Q4323 | ALLOPLY, PER SQUARE CENTIMETER |
| Q4324 | AMNIOTX, PER SQUARE CENTIMETER |
| Q4325 | ACAPATCH, PER SQUARE CENTIMETER |
| Q4327 | DUOAMNION, PER SQUARE CENTIMETER |
| Q4328 | MOST, PER SQUARE CENTIMETER |
| Q4329 | SINGLAY, PER SQUARE CENTIMETER |
| Q4330 | TOTAL, PER SQUARE CENTIMETER |
| Q4331 | AXOLOTL GRAFT, PER SQUARE CENTIMETER |
| Q4332 | AXOLOTL DUALGRAFT, PER SQUARE CENTIMETER |
| Q4333 | ARDEOGRAFT, PER SQUARE CENTIMETER |
| Q4334 | Amnioplast 1, per square centimeter |
| Q4335 | Amnioplast 2, per square centimeter |
| Q4336 | Artacent c, per square centimeter |
| Q4337 | Artacent trident, per square centimeter |
| Q4338 | Artacent velos, per square centimeter |
| Q4339 | Artacent vericlen, per square centimeter |
| Q4340 | Simpligraft, per square centimeter |
| Q4341 | Simplimax, per square centimeter |
| Q4342 | Theramend, per square centimeter |
| Q4343 | Dermacyte ac matrix amniotic membrane allograft, per square centimeter |
| Q4344 | Tri-membrane wrap, per square centimeter |
| Q4345 | Matrix hd allograft dermis, per square centimeter |
| Q4346 | Shelter dm matrix, per square centimeter |
| Q4347 | Rampart dl matrix, per square centimeter |
| Q4348 | Sentry sl matrix, per square centimeter |
| Q4349 | Mantle dl matrix, per square centimeter |
| Q4350 | Palisade dm matrix, per square centimeter |
| Q4351 | Enclose tl matrix, per square centimeter |
| Q4352 | Overlay sl matrix, per square centimeter |
| Q4353 | Xceed tl matrix, per square centimeter |
| Q4354 | Palingen dual-layer membrane, per square centimeter |
| Q4355 | Abiomend Xplus membrane and Abiomend Xplus hydromembrane, per square centimeter |
| Q4356 | Abiomend membrane and Abiomend hydromembrane, per square centimeter |
| Q4357 | Xwrap plus, per square centimeter |
| Q4358 | Xwrap dual, per square centimeter |
| Q4359 | Choriply, per square centimeter |
| Q4360 | Amchoplast fd, per square centimeter |
| Q4361 | Epixpress, per square centimeter |
| Q4362 | Cygnus disk, per square centimeter |
| Q4363 | Amnio burgeon membrane and hydromembrane, per square centimeter |
| Q4364 | Amnio burgeon Xplus membrane and xplus hydromembrane, per square centimeter |
| Q4365 | Amnio burgeon dual-layer membrane, per square centimeter |
| Q4366 | Dual layer amnio burgeon x-membrane, per square centimeter |
| Q4367 | Amniocore sl, per square centimeter |
| Q4368 | Amchothick, per square centimeter |
| Q4369 | Amnioplast 3, per square centimeter |
| Q4370 | Aeroguard, per square centimeter |
| Q4371 | Neoguard, per square centimeter |
| Q4372 | Amchoplast excel, per square centimeter |
| Q4373 | Membrane wrap lite, per square centimeter |
| Q4375 | Duograft ac, per square centimeter |
| Q4376 | Duograft aa, per square centimeter |
| Q4377 | Trigraft ft, per square centimeter |
| Q4378 | Renew ft matrix, per square centimeter |
| Q4379 | Amniodefend ft matrix, per square centimeter |
| Q4380 | Advograft one, per square centimeter |
| Q4382 | Advograft dual, per square centimeter |
| Q4418 | Biolab membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4419 | Biolab membrane wrap lite flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4421 | Biolab membrane wrap solo, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4422 | A/c wrap, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4423 | Biolab tri-membrane wrap flow, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4424 | Revive ft, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4425 | Revive tl, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4426 | Dermabind tl + or dermabind tl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4427 | Dermabind dl n or dermabind dl + or dermabind dl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4428 | Dermabind sl n or dermabind sl + or dermabind sl x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4429 | Dermabind ch n or dermabind ch x, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4435 | Renati membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4436 | Renati ac membrane, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4437 | Revival ac, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4438 | Pretect, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4439 | Instagraft, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q4440 | Curamatrix, per square centimeter (add-on, list separately in addition to primary procedure) |
| Q9982 | Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries |
| Q9983 | Florbetaben F18, diagnostic, per study dose, up to 8.1 millicuries |
| S1091 | Stent, noncoronary, temporary, with delivery system (Propel) |
| S2080 | Laser-assisted uvuolopalatoplasty (LAUP) |
| S2103 | Adrenal tissue transplant to brain (effective 09/01/2014) |
| S2205 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, under direct vision; using arterial graft(s), 2 coronary arterial grafts |
| S2206 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using arterial grafts |
| S2207 | Minimally invasive direct coronary artery bypass surgery involving mini-toracotomy or mini-sternotomy surgery, performed under direct vision; using venous graft only, single coronary venous graft |
| S2208 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using single arterial and venous graft(s), single venous graft |
| S2209 | Minimally invasive direct coronary artery bypass surgery involving mini-thoracotomy or mini-sternotomy surgery, performed under direct vision; using 2 arterial grafts and single venous graft |
| S3650 | Saliva test, hormone level; during menopause |
| S3652 | to assess preterm labor risk |
| S3852 | DNA analysis for APOE epsilon 4 allele for susceptibility to Alzheimer’s disease |
| S3902 | Ballistocardiogram |
| S3904 | Masters two step |
| S4988 | Penile contracture device, manual, greater than 3 lbs traction force |
| S8080 | Scintimammography (radioimmunoscintigraphy of the breast), unilateral, including supply of radiopharmaceutical |
| S9002 | Intra-vaginal motion sensor system, provides biofeedback for pelvic floor muscle rehabilitation device |
| S9025 | Omnicardiogram/cardiointegram |
| S9432 | Medical foods for non-inborn errors of metabolism |
| T1505 | Electronic medication compliance management device, includes all components and accessories, not otherwise classified |
| T2050 | Financial management, self-directed, waiver; per diem |
| T2051 | Supports brokerage, self-directed, waiver; per diem |
| T4545 | Incontinence product, disposable, penile wrap, each |
| V2525 | Contact lens, hydrophilic, dual focus, per lens |
| 0202U | nfectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected. |
| 0017M | Oncology (diffuse large b-cell lymphoma [dlbcl]), mrna, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin |
Table III. CPT Category III Codes
| CPT Procedure Codes | Description |
|---|---|
| 0202U | Infectious disease (bacterial or viral respiratory tract infection), pathogen-specific nucleic acid (DNA or RNA), 22 targets including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), qualitative RT-PCR, nasopharyngeal swab, each pathogen reported as detected or not detected. |
| 0017M | Oncology (diffuse large b-cell lymphoma [dlbcl]), mrna, gene expression profiling by fluorescent probe hybridization of 20 genes, formalin-fixed paraffin-embedded tissue, algorithm reported as cell of origin |
| 0085T | Breath test for heart transplant rejection |
| 0095T | Removal of total disc arthroplasty (artificial disc), interior approach, each additional interspace, cervical For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0098T | Revision, including replacement of total disc arthroplasty (artificial disc), anterior approach, each additional interspace, cervical For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0100T | Placement of a subconjunctival retinal prosthesis receiver and pulse generator, and implantation of intra-ocular retinal electrode array, with vitrectomy |
| 0101T | Extracorporeal shock wave involving musculoskeletal system, not otherwise specified; high energy |
| 0102T | Extracorporeal shock wave, high energy, performed by a physician, requiring anesthesia other than local, involving lateral humeral epicondyle |
| 0111T | Long-chain (C20-22) omega-3 fatty acids in red blood cell (RBC) membranes |
| 0126T | Common carotid intima-media thickness (IMT) study for evaluation of atherosclerotic burden or coronary heart disease risk factor assessment |
| 0159T | Computer-aided detection, including computer algorithm analysis of MRI image data for lesion detection/characterization, pharmacokinetic analysis with further physician review for interpretation, breast MRI |
| 0163T | Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), lumbar, each additional interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0164T | Removal of total disc arthroplasty (artificial disc), anterior approach, lumbar, each additional interspace |
| 0165T | Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, lumbar, each additional interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0190T | Placement of intraocular radiation source applicator |
| 0195T | Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L5-S1 interspace For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0196T | Arthrodesis, pre-sacral interbody technique, disc space preparation, discectomy, without instrumentation, with image guidance, includes bone graft when performed; L4-L5 interspace (List separately in addition to code for primary procedure) For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0198T | Measurement of ocular blood flow by repetitive intraocular pressure sampling, with interpretation and report |
| 0200T | Percutaneous sacral augmentation (sacroplasty), unilateral injection(s), including the use of a balloon or mechanical device, when used, one or more needles |
| 0201T | Percutaneous sacral augmentation (sacroplasty), bilateral injections, including the use of a balloon or mechanical device, when used, two or more needles |
| 0202T | Posterior vertebral joint(s) arthroplasty (e.g., facet joint(s) replacement) including facetectomy, laminectomy, foraminotomy, and vertebral column fixation, injection of bone cement, when performed, including fluoroscopy, single level, lumbar spine |
| 0206T | Algorithmic analysis, remote, of electrocardiographic-derived data with computer probability assessment, including report |
| 0207T | Evacuation of meibomian glands, automated, using heat and intermittent pressure, unilateral |
| 0219T | Placement of a posterior intrafacet implant(s), unilateral or bilateral, including imaging and placement of bone graft(s) or synthetic device(s), single level; cervical (Do not report 0219T-0221T with any radiological service) |
| 0220T | thoracic (Do not report 0219T-0221T with any radiological service) |
| 0221T | lumbar (Do not report 0219T-0221T with any radiological service) For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0222T | each additional vertebral segment (List separately in addition to code for primary procedure) (Use 0222T in conjunction with 0219T-0221T) For more detailed information, please see associated medical policy Spinal Interventional Pain Management and Spine Surgery |
| 0232T | Injection(s), platelet rich plasma, any tissue, including image guidance, harvesting and preparation when performed |
| 0263T | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections, one leg, including ultrasound guidance, if performed; complete procedure including unilateral or bilateral bone marrow harvest (effective 7/1/11) |
| 0264T | complete procedure excluding bone marrow harvest |
| 0265T | unilateral or bilateral bone marrow harvest only for intramuscular autologous bone marrow cell therapy |
| 0266T | Implantation or replacement of carotid sinus baroreflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0267T | lead only, unilateral (includes intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0268T | pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0269T | Revision or removal of carotid sinus baroflex activation device; total system (includes generator placement, unilateral or bilateral lead placement, intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0270T | lead only, unilateral (includes intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0271T | pulse generator only (includes intra-operative interrogation, programming, and repositioning, when performed) (effective 7/1/11) |
| 0272T | Interrogation device evaluation (in person), carotid sinus baroreflex activation system, including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with interpretation and report (eg, battery status, lead impedance, pulse amplitude, pulse width, therapy frequency, pathway mode, burst mode, therapy start/stop times each day) (effective 7/1/11) |
| 0273T | with programming (effective 7/1/11) |
| 0274T | Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) any method under indirect image guidance (eg, fluoroscopic, CT), with or without the use of an endoscope, single or multiple levels, unilateral or bilateral; cervical or thoracic (effective 7/1/11) |
| 0275T | lumbar |
| 0278T | Transcutaneous electrical modulation pain reprocessing (eg, scrambler therapy), each treatment session (includes placement of electrodes) |
| 0312T | Vagus nerve blocking therapy (morbid obesity); laparoscopic implantation of neurostimulator electrode array, anterior and posterior vagal trunks adjacent to esophagogastric junction (EGJ), with implantation of pulse generator, includes programming |
| 0313T | Vagus nerve blocking therapy (morbid obesity); laparoscopic revision or replacement of vagal trunk neurostimulator electrode array, including connection to existing pulse generator |
| 0314T | Vagus nerve blocking therapy (morbid obesity); laparoscopic removal of vagal trunk neurostimulator electrode array and pulse generator |
| 0315T | Vagus nerve blocking therapy (morbid obesity); removal of pulse generator |
| 0316T | Vagus nerve blocking therapy (morbid obesity); replacement of pulse generator |
| 0317T | Vagus nerve blocking therapy (morbid obesity); neurostimulator pulse generator electronic analysis, includes reprogramming when performed |
| 0330T | Tear film imaging, unilateral or bilateral, with interpretation and report |
| 0333T | Visual evoked potential, screening of visual acuity, automated |
| 0335T | Extra-osseous subtalar joint implant for talotarsal stabilization |
| 0337T | Endothelial function assessment, using peripheral vascular response to reactive hyperemia, non-invasive (eg, brachial artery ultrasound, peripheral artery tonometry), unilateral or bilateral |
| 0338T | Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; unilateral |
| 0339T | Transcatheter renal sympathetic denervation, percutaneous approach including arterial puncture, selective catheter placement(s) renal artery(ies), fluoroscopy, contrast injection(s), intraprocedural roadmapping and radiological supervision and interpretation, including pressure gradient measurements, flush aortogram and diagnostic renal angiography when performed; bilateral |
| 0340T | Ablation, pulmonary tumor(s), including pleura or chest wall when involved by tumor extension, percutaneous, cryoablation, unilateral, includes imaging guidance |
| 0341T | Quantitative pupillometry with interpretation and report, unilateral or bilateral |
| 0342T | Therapeutic apheresis with selective hdl delipidation and plasma reinfusion |
| 0346T | Ultrasound, elastography (list separately in addition to code for primary procedure) (except when billed for hepatitis C) |
| 0356T | Insertion of drug-eluting implant (including punctual dilation and implant removal when performed) into lacrimal canaliculus, each |
| 0358T | Bioelectrical impedance analysis whole body composition assessment, supine position, with interpretation and report |
| 0378T | Visual field assessment, with concurrent real time data analysis and accessible data storage with patient initiated data transmitted to a remote surveillance center for up to 30 days; review and interpretation with report by a physician or other qualified health care professional |
| 0379T | Technical support and patient instructions, surveillance, analysis and transmission of daily and emergent data reports as prescribed by a physician or other qualified health care professional |
| 0380T | Computer-aided animation and analysis of time series retinal images for the monitoring of disease progression, unilateral or bilateral, with interpretation and report |
| 0381T | External heart rate and 3-axis accelerometer data recording up to 14 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional |
| 0382T | External heart rate and 3-axis accelerometer data recording up to 14 days to assess changes in heart rate and to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only |
| 0383T | External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional |
| 0384T | External heart rate and 3-axis accelerometer data recording from 15 to 30 days to assess changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only |
| 0385T | External heart rate and 3-axis accelerometer data recording more than 30 days to assess changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; includes report, scanning analysis with report, review and interpretation by a physician or other qualified health care professional |
| 0386T | External heart rate and 3-axis accelerometer data recording more than 30 days to assess changes in heart rate to monitor motion analysis for the purposes of diagnosing nocturnal epilepsy seizure events; review and interpretation only |
| 0387T | Transcatheter insertion or replacement of permanent leadless pacemaker, ventricular |
| 0388T | Transcatheter removal of permanent leadless pacemaker, ventricular |
| 0389T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report, leadless pacemaker system |
| 0390T | Peri-procedural device evaluation (in person) and programming of device system parameters before or after a surgery, procedure or test with analysis, review and report, leadless pacemaker system |
| 0391T | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, leadless pacemaker system |
| 0397T | Endoscopic retrograde cholangiopancreatography (ercp), with optical endomicroscopy (list separately in addition to code for primary procedure) |
| 0398T | Magnetic resonance image guided high intensity focused ultrasound (mrgfus), stereotactic ablation lesion, intracranial for movement disorder including stereotactic navigation and frame placement when performed |
| 0404T | Transcervical uterine fibroid(s) ablation with ultrasound guidance, radiofrequency |
| 0408T | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator with transvenous electrodes |
| 0409T | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator only |
| 0410T | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; atrial electrode only |
| 0411T | Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; ventricular electrode only |
| 0412T | Removal of permanent cardiac contractility modulation system; pulse generator only |
| 0413T | Removal of permanent cardiac contractility modulation system; transvenous electrode (atrial or ventricular) |
| 0414T | Removal and replacement of permanent cardiac contractility modulation system pulse generator only |
| 0415T | Repositioning of previously implanted cardiac contractility modulation transvenous electrode, (atrial or ventricular lead) |
| 0416T | Relocation of skin pocket for implanted cardiac contractility modulation pulse generator |
| 0417T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility m |
| 0418T | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter; implantable cardiac contractility modulation system |
| 0421T | Transurethral waterjet ablation of prostate, including control of post-operative bleeding, including ultrasound guidance, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included when performed) |
| 0423T | Secretory type ii phospholipase a2 (spla2-iia) |
| 0424T | Insertion or replacement of neurostimulator system for treatment of central sleep apnea; complete system (transvenous placement of right or left stimulation lead, sensing lead, implantable pulse generator) |
| 0425T | Insertion or replacement of neurostimulator system for treatment of central sleep apnea; sensing lead only |
| 0426T | Insertion or replacement of neurostimulator system for treatment of central sleep apnea; stimulation lead only |
| 0427T | Insertion or replacement of neurostimulator system for treatment of central sleep apnea; pulse generator only |
| 0428T | Removal of neurostimulator system for treatment of central sleep apnea; pulse generator only |
| 0429T | Removal of neurostimulator system for treatment of central sleep apnea; sensing lead only |
| 0430T | Removal of neurostimulator system for treatment of central sleep apnea; stimulation lead only |
| 0431T | Removal and replacement of neurostimulator system for treatment of central sleep apnea, pulse generator only |
| 0432T | Repositioning of neurostimulator system for treatment of central sleep apnea; stimulation lead only |
| 0433T | Repositioning of neurostimulator system for treatment of central sleep apnea; sensing lead only |
| 0434T | Interrogation device evaluation implanted neurostimulator pulse generator system for central sleep apnea |
| 0435T | Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; single session |
| 0436T | Programming device evaluation of implanted neurostimulator pulse generator system for central sleep apnea; during sleep study |
| 0437T | Implantation of non-biologic or synthetic implant (eg, polypropylene) for fascial reinforcement of the abdominal wall (list separately in addition to primary procedure) |
| 0439T | Myocardial contrast perfusion echocardiography; at rest or with stress, for assessment of myocardial ischemia or viability (list separately in addition to primary procedure) |
| 0440T | Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve |
| 0441T | Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve; lower extremity distal/peripheral nerve |
| 0442T | Ablation, percutaneous, cryoablation, includes imaging guidance; upper extremity distal/peripheral nerve; nerve plexus or other truncal nerve (eg, brachial plexus, pudendal nerve) |
| 0443T | Real time spectral analysis of prostate tissue by fluorescence spectroscopy |
| 0444T | Initial placement of a drug-eluting ocular insert under one or more eyelids, including fitting, training, and insertion, unilateral or bilateral |
| 0445T | Subsequent placement of a drug-eluting ocular insert under one or more eyelids, including re-training, and removal of existing insert, unilateral or bilateral |
| 0450T | Insertion of aqueous drainage device, without extraocular reservoir, internal approach, into the subconjunctival space; initial device; each additional device (list separately in addition to code for primary procedure) |
| 0451T | Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; complete system (counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface and subcutaneous electrodes) |
| 0452T | Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; complete system (counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface and subcutaneous electrodes); aortic counterpulsation device and vascular hemostatic seal |
| 0453T | Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; complete system (counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface and subcutaneous electrodes); mechano-electrical skin interface |
| 0454T | Insertion or replacement of a permanently implantable aortic counterpulsation ventricular assist system, endovascular approach, and programming of sensing and therapeutic parameters; complete system (counterpulsation device, vascular graft, implantable vascular hemostatic seal, mechano-electrical skin interface and subcutaneous electrodes); subcutaneous electrode |
| 0455T | Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes) |
| 0456T | Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes); aortic counterpulsation device and vascular |
| 0457T | Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes); mechano-electrical skin interface |
| 0458T | Removal of permanently implantable aortic counterpulsation ventricular assist system; complete system (aortic counterpulsation device, vascular hemostatic seal, mechano-electrical skin interface and electrodes); subcutaneous electrode |
| 0459T | Relocation of skin pocket with replacement of implanted aortic counterpulsation ventricular assist device,mechano- electrical skin interface and electrodes |
| 0460T | Repositioning of previously implanted aortic counterpulsation ventricular assist device, subcutaneous electrode |
| 0461T | Repositioning of previously implanted aortic counterpulsation ventricular assist device, subcutaneous electrode; aortic counterpulsation device |
| 0462T | Programming device evaluation (in person) with iterative adjustment of the implantable mechano-electrical skin interface and/or external driver to test the function of the device and select optimal permanent programmed values with analysis, including review |
| 0463T | Interrogation device evaluation (in person) with analysis, review and report, includes connection, recording and disconnection per patient encounter, implantable aortic counterpulsation ventricular assist system, per day |
| 0464T | Visual evoked potential, testing for glaucoma, with interpretation and report |
| 0465T | Suprachoroidal injection of a pharmacologic agent (does not include supply of medication) |
| 0466T | Insertion of chest wall respiratory sensor electrode or electrode array, including connection to pulse generator (list separately in addition to code for primary procedure) |
| 0467T | Revision or replacement of chest wall respiratory sensor electrode or electrode array, including connection to existing pulse generator |
| 0468T | Removal of chest wall respiratory sensor electrode or electrode array |
| 0470T | Optical coherence tomography (oct) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; first lesion |
| 0474T | Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space​ |
| 0471T | Optical coherence tomography (oct) for microstructural and morphological imaging of skin, image acquisition, interpretation, and report; each additional lesion (list separately in additional to code for primary procedure) |
| 0472T | Device evaluation, interrogation, and initial programming of intra-ocular retinal electrode array (eg, retinal prosthesis), in person, with iterative adjustment of the implantable device to test functionality, select optimal permanent programmed values with analysis, including visual training, with review and report by a qualified health care professional |
| 0473T | Device evaluation and interrogation of intra-ocular retinal electrode array (eg, retinal prosthesis), in person, including reprogramming and visual training, when performed, with review and report by a qualified health care professional |
| 0497T | External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring; in-office connection For more detailed information, please see associated medical policy Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry. |
| 0498T | External patient-activated, physician- or other qualified health care professional-prescribed, electrocardiographic rhythm derived event recorder without 24 hour attended monitoring; review and interpretation by a physician or other qualified health care professional per 30 days with at least one patient-generated triggered event For more detailed information, please see associated medical policy Ambulatory Event Monitors and Mobile Cardiac Outpatient Telemetry. |
| 0541T | Myocardial imaging by magnetocardiography (mcg) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning- derived clinical scoring, and automated report generation, single study |
| 0542T | Myocardial imaging by magnetocardiography (mcg) for detection of cardiac ischemia, by signal acquisition using minimum 36 channel grid, generation of magnetic-field time-series images, quantitative analysis of magnetic dipoles, machine learning- derived clinical scoring, and automated report generation, single study; interpretation and report |
| 0525T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; complete system (electrode and implantable monitor) |
| 0526T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; electrode only |
| 0527T | Insertion or replacement of intracardiac ischemia monitoring system, including testing of the lead and monitor, initial system programming, and imaging supervision and interpretation; implantable monitor only |
| 0528T | Programming device evaluation (in person) of intracardiac ischemia monitoring system with iterative adjustment of programmed values, with analysis, review, and report |
| 0529T | Interrogation device evaluation (in person) of intracardiac ischemia monitoring system with analysis, review, and report |
| 0530T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; complete system (electrode and implantable monitor) |
| 0531T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; electrode only |
| 0532T | Removal of intracardiac ischemia monitoring system, including all imaging supervision and interpretation; implantable monitor only |
| 0533T | Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; includes set-up, patient training, configuration of monitor, data upload, analysis and initial report configuration, download review, interpretation and report |
| 0534T | Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; set-up, patient training, configuration of monitor |
| 0535T | Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; data upload, analysis and initial report configuration |
| 0536T | Continuous recording of movement disorder symptoms, including bradykinesia, dyskinesia, and tremor for 6 days up to 10 days; download review, interpretation and report |
| 0546T | Radiofrequency spectroscopy, real time, intraoperative margin assessment, at the time of partial mastectomy, with report |
| 0547T | Bone-material quality testing by microindentation(s) of the tibia(s), with results reported as a score |
| 0548T | Transperineal periurethral balloon continence device; bilateral placement, including cystoscopy and fluoroscopy |
| 0549T | Transperineal periurethral balloon continence device; unilateral placement, including cystoscopy and fluoroscopy |
| 0550T | Transperineal periurethral balloon continence device; removal, each balloon |
| 0551T | Transperineal periurethral balloon continence device; adjustment of balloon(s) fluid volume |
| 0552T | Low-level laser therapy, dynamic photonic and dynamic thermokinetic energies, provided by a physician or other qualified health care professional |
| 0553T | Percutaneous transcatheter placement of iliac arteriovenous anastomosis implant, inclusive of all radiological supervision and interpretation, intraprocedural roadmapping, and imaging guidance necessary to complete the intervention |
| 0554T | Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data, assessment of bone strength and fracture risk and bone mineral density, interpretation and report |
| 0555T | Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; retrieval and transmission of the scan data |
| 0556T | Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; assessment of bone strength and fracture risk and bone mineral density |
| 0557T | Bone strength and fracture risk using finite element analysis of functional data, and bone-mineral density, utilizing data from a computed tomography scan; interpretation and report |
| 0558T | Computed tomography scan taken for the purpose of biomechanical computed tomography analysis |
| 0559T | Anatomic model 3d-printed from image data set(s); first individually prepared and processed component of an anatomic structure |
| 0560T | Anatomic model 3d-printed from image data set(s); each additional individually prepared and processed component of an anatomic structure (list separately in addition to code for primary procedure) |
| 0561T | Anatomic guide 3d-printed and designed from image data set(s); first anatomic guide |
| 0562T | Anatomic guide 3d-printed and designed from image data set(s); each additional anatomic guide (list separately in addition to code for primary procedure) |
| 0565T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; tissue harvesting and cellular implant creation |
| 0566T | Autologous cellular implant derived from adipose tissue for the treatment of osteoarthritis of the knees; injection of cellular implant into knee joint including ultrasound guidance, unilateral |
| 0567T | Permanent fallopian tube occlusion with degradable biopolymer implant, transcervical approach, including transvaginal ultrasound |
| 0568T | Introduction of mixture of saline and air for sonosalpingography to confirm occlusion of fallopian tubes, transcervical approach, including transvaginal ultrasound and pelvic ultrasound |
| 0571T | Insertion or replacement of implantable cardioverter-defibrillator system with substernal electrode(s), including all imaging guidance and electrophysiological evaluation (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters), when performed |
| 0572T | Insertion of substernal implantable defibrillator electrode |
| 0573T | Removal of substernal implantable defibrillator electrode |
| 0574T | Repositioning of previously implanted substernal implantable defibrillator-pacing electrode |
| 0575T | Programming device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional |
| 0576T | Interrogation device evaluation (in person) of implantable cardioverter-defibrillator system with substernal electrode, with analysis, review and report by a physician or other qualified health care professional, includes connection, recording and disconnection per patient encounter |
| 0577T | Electrophysiological evaluation of implantable cardioverter- defibrillator system with substernal electrode (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing for arrhythmia termination, and programming or reprogramming of sensing or therapeutic parameters) |
| 0578T | Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system with interim analysis, review(s) and report(s) by a physician or other qualified health care professional |
| 0579T | Interrogation device evaluation(s) (remote), up to 90 days, substernal lead implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of transmissions and technician review, technical support and distribution of results |
| 0580T | Removal of substernal implantable defibrillator pulse generator only |
| 0596T | Temporary female intraurethral valve-pump (ie, voiding prosthesis); initial insertion, including urethral measurement |
| 0597T | Temporary female intraurethral valve-pump (ie, voiding prosthesis); replacement |
| 0598T | Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and measure wound size, per session; first anatomic site (e.g., lower extremity, right leg) |
| 0599T; | Real-time fluorescence wound imaging with clinical darkness, to identify location of bacterial wound pathogens and measure wound size, per session; each additional anatomic site (e.g., upper extremity, left leg) (list separately in addition to code for primary procedure) |
| 0600T | Ablation, irreversible electroporation; 1 or more tumors per organ, other than liver or prostate, including imaging guidance, when performed, percutaneous |
| 0601T | Ablation, irreversible electroporation; 1 or more tumors, including fluoroscopic and ultrasound guidance, when performed, open |
| 0602T | Glomerular filtration rate (GFR) measurement(s), transdermal |
| 0603T | Glomerular filtration rate (GFR) monitoring, transdermal, including sensor placement and administration of more than one dose of fluorescent pyrazine agent, each 24 hours |
| 0607T | Remote monitoring of an external continuous pulmonary fluid monitoring system |
| 0608T | Remote monitoring of an external continuous pulmonary fluid monitoring system, including measurement of radiofrequency- derived pulmonary fluid levels, heart rate, respiration rate, activity, posture, and cardiovascular rhythm |
| 0609T | Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); acquisition of single voxel data, per disc, on biomarkers |
| 0610T | Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); transmission of biomarker data for software analysis |
| 0611T | Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); |
| 0612T | Magnetic resonance spectroscopy, determination and localization of discogenic pain (cervical, thoracic, or lumbar); interpretation and report |
| 0615T | Eye-movement analysis without spatial calibration, with interpretation and report |
| 0616T | Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; without removal of crystalline lens or intraocular lens, without insertion of intraocular lens |
| 0617T | Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with removal of crystalline lens and insertion of intraocular lens |
| 0618T | Insertion of iris prosthesis, including suture fixation and repair or removal of iris, when performed; with secondary intraocular lens placement or intraocular lens exchange |
| 0619T | Cystourethroscopy with transurethral anterior prostate commissurotomy and drug delivery, including transrectal ultrasound and fluoroscopy, when performed |
| 0640T | Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [sto2]); image acquisition, interpretation and report, each flap or wound |
| 0641T | Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [sto2]); image acquisition only, each flap or wound |
| 0642T | Noncontact near-infrared spectroscopy studies of flap or wound (eg, for measurement of deoxyhemoglobin, oxyhemoglobin, and ratio of tissue oxygenation [sto2]); interpretation and report only, each flap or wound |
| 0662T | Scalp cooling, mechanical; initial measurement and calibration of cap |
| 0663T | Scalp cooling, mechanical; placement of device, monitoring, and removal of device (list separately in addition to code for primary procedure) |
| 0672T | Endovaginal cryogen-cooled, monopolar radiofrequency remodeling of the tissues surrounding the female bladder neck and proximal urethra for urinary incontinence |
| 0674T | Laparoscopic insertion of new or replacement of permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including an implantable pulse generator and diaphragmatic lead(s) |
| 0675T | Laparoscopic insertion of new or replacement of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first lead |
| 0676T | Laparoscopic insertion of new or replacement of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional lead (list separately in addition to code for primary procedure) |
| 0677T | Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; first repositioned lead |
| 0678T | Laparoscopic repositioning of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, including connection to an existing pulse generator; each additional repositioned lead (list separately in addition to code for primary procedure) repositioned lead |
| 0679T | Laparoscopic removal of diaphragmatic lead(s), permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function |
| 0680T | Insertion or replacement of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing lead(s) |
| 0681T | Relocation of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function, with connection to existing dual leads |
| 0682T | Removal of pulse generator only, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function |
| 0683T | Programming device evaluation (in-person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, review and report by a physician or other qualified health care professional, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function |
| 0684T | Peri-procedural device evaluation (in-person) and programming of device system parameters before or after a surgery, procedure, or test with analysis, review, and report by a physician or other qualified health care professional, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function |
| 0685T | Interrogation device evaluation (in-person) with analysis, review and report by a physician or other qualified health care professional, including connection, recording and disconnection per patient encounter, permanent implantable synchronized diaphragmatic stimulation system for augmentation of cardiac function |
| 0691T | Automated analysis of an existing computed tomography study for vertebral fracture(s), including assessment of bone density when performed, data preparation, interpretation, and report |
| 0692T | Therapeutic ultrafiltration |
| 0693T | Comprehensive full body computer-based markerless 3d kinematic and kinetic motion analysis and report |
| 0695T | Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of implant or replacement |
| 0696T | Body surface–activation mapping of pacemaker or pacing cardioverter-defibrillator lead(s) to optimize electrical synchrony, cardiac resynchronization therapy device, including connection, recording, disconnection, review, and report; at time of follow-up interrogation or programming device evaluation |
| 0700T | Molecular fluorescent imaging of suspicious nevus; first lesion |
| 0701T | Molecular fluorescent imaging of suspicious nevus; each additional lesion (list separately in addition to code for primary procedure) |
| 0704T | Remote treatment of amblyopia using an eye tracking device; device supply with initial set-up and patient education on use of equipment |
| 0705T | Remote treatment of amblyopia using an eye tracking device; surveillance center technical support including data transmission with analysis, with a minimum of 18 training hours, each 30 days |
| 0706T | Remote treatment of amblyopia using an eye tracking device; interpretation and report by physician or other qualified health care professional, per calendar month |
| 0707T | Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect (ie, bone marrow lesion, bone bruise, stress injury, microtrabecular fracture), including imaging guidance and arthroscopic assistance for joint visualization |
| 0708T | Intradermal cancer immunotherapy; preparation and initial injection |
| 0709T | Intradermal cancer immunotherapy; each additional injection (list separately in addition to code for primary procedure) |
| 0710T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; including data preparation and transmission, quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability, data review, interpretation and report |
| 0711T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data preparation and transmission |
| 0712T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; quantification of the structure and composition of the vessel wall and assessment for lipid-rich necrotic core plaque to assess atherosclerotic plaque stability |
| 0713T | Noninvasive arterial plaque analysis using software processing of data from non-coronary computerized tomography angiography; data review, interpretation and report |
| 0714T | Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance |
| 0715T | Percutaneous transluminal coronary lithotripsy (list separately in addition to code for primary procedure) |
| 0716T | Cardiac acoustic waveform recording with automated analysis and generation of coronary artery disease risk score |
| 0717T | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; adipose tissue harvesting, isolation and preparation of harvested cells, including incubation with cell dissociation enzymes, filtration, washing and concentration of ADRCS |
| 0718T | Autologous adipose-derived regenerative cell (ADRC) therapy for partial thickness rotator cuff tear; injection into supraspinatus tendon including ultrasound guidance, unilateral |
| 0719T | Posterior vertebral joint replacement, including bilateral facetectomy, laminectomy, and radical discectomy, including imaging guidance, lumbar spine, single segment |
| 0720T | Percutaneous electrical nerve field stimulation, cranial nerves, without implantation |
| 0725T | Vestibular device implantation, unilateral |
| 0726T | Removal of implanted vestibular device, unilateral |
| 0727T | Removal and replacement of implanted vestibular device, unilateral |
| 0728T | Diagnostic analysis of vestibular implant, unilateral; with initial programming |
| 0729T | Diagnostic analysis of vestibular implant, unilateral; with subsequent programming |
| 0730T | Trabeculotomy by laser, including optical coherence tomography (OCT) guidance |
| 0731T | Augmentative AI-based facial phenotype analysis with report |
| 0732T | Immunotherapy administration with electroporation, intramuscular |
| 0733T | Remote body and limb kinematic measurement-based therapy ordered by a physician or other qualified health care professional; supply and technical support, per 30 days |
| 0734T | Remote body and limb kinematic measurement-based therapy ordered by a physician or other qualified health care professional; treatment management services by a physician or other qualified health care professional, per calendar month |
| 0737T | Xenograft implantation into the articular surface |
| 0779T | Gastrointestinal myoelectrical activity study, stomach through colon, with interpretation and report |
| 0792T | Application of silver diamine fluoride 38%, by a physician or other qualified health care professional |
| 0793T | Percutaneous transcatheter thermal ablation of nerves innervating the pulmonary arteries, including right heart catheterization, pulmonary artery angiography, and all imaging guidance |
| 0794T | Patient-specific, assistive, rules-based algorithm for ranking pharmaco-oncologic treatment options based on the patient's tumor-specific cancer marker information obtained from prior molecular pathology, immunohistochemical, or other pathology results which have been previously interpreted and reported separately |
| 0805T | Transcatheter superior and inferior vena cava prosthetic valve implantation (ie, caval valve implantation [cavi]); percutaneous femoral vein approach |
| 0806T | Transcatheter superior and inferior vena cava prosthetic valve implantation (ie, caval valve implantation [cavi]); open femoral vein approach |
| 0807T | Pulmonary tissue ventilation analysis using software-based processing of data from separately captured cinefluorograph images; in combination with previously acquired computed tomography (ct) images, including data preparation and transmission, quantification of pulmonary tissue ventilation, data review, interpretation and report |
| 0808T | Pulmonary tissue ventilation analysis using software-based processing of data from separately captured cinefluorograph images;in combination with computed tomography (ct) images taken for the purpose of pulmonary tissue ventilation analysis, including data preparation and transmission, quantification of pulmonary tissue ventilation, data review, interpretation and report |
| 0810T | Subretinal injection of a pharmacologic agent, including vitrectomy and 1 or more retinotomies |
| 0813T | ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL, WITH VOLUME ADJUSTMENT OF INTRAGASTRIC BARIATRIC BALLOON |
| 0814T | PERCUTANEOUS INJECTION OF CALCIUM-BASED BIODEGRADABLE OSTEOCONDUCTIVE MATERIAL, PROXIMAL FEMUR, INCLUDING IMAGING GUIDANCE, UNILATERAL |
| 0816T | OPEN INSERTION OR REPLACEMENT OF INTEGRATED NEUROSTIMULATION SYSTEM FOR BLADDER DYSFUNCTION INCLUDING ELECTRODE(S) (EG, ARRAY OR LEADLESS), AND PULSE GENERATOR OR RECEIVER, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING GUIDANCE, WHEN PERFORMED, POSTERIOR TIBIAL NERVE; SUBCUTANEOUS |
| 0817T | OPEN INSERTION OR REPLACEMENT OF INTEGRATED NEUROSTIMULATION SYSTEM FOR BLADDER DYSFUNCTION INCLUDING ELECTRODE(S) (EG, ARRAY OR LEADLESS), AND PULSE GENERATOR OR RECEIVER, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING GUIDANCE, WHEN PERFORMED, POSTERIOR TIBIAL NERVE; SUBFASCIAL |
| 0818T | REVISION OR REMOVAL OF INTEGRATED NEUROSTIMULATION SYSTEM FOR BLADDER DYSFUNCTION, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING, WHEN PERFORMED, POSTERIOR TIBIAL NERVE; SUBCUTANEOUS |
| 0819T | REVISION OR REMOVAL OF INTEGRATED NEUROSTIMULATION SYSTEM FOR BLADDER DYSFUNCTION, INCLUDING ANALYSIS, PROGRAMMING, AND IMAGING, WHEN PERFORMED, POSTERIOR TIBIAL NERVE; SUBFASCIAL |
| 0823T | TRANSCATHETER INSERTION OF PERMANENT SINGLE-CHAMBER LEADLESS PACEMAKER, RIGHT ATRIAL, INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY, VENOUS ULTRASOUND, RIGHT ATRIAL ANGIOGRAPHY AND/OR RIGHT VENTRICULOGRAPHY, FEMORAL VENOGRAPHY, CAVOGRAPHY) AND DEVICE EVALUATION (EG INTERROGATION OR PRORAMMING), WHEN PERFORMED |
| 0824T | TRANSCATHETER REMOVAL OF PERMANENT SINGLE-CHAMBER LEADLESS PACEMAKER, RIGHT ATRIAL, INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY, VENOUS ULTRASOUND, RIGHT ATRIAL ANGIOGRAPHY AND/OR RIGHT VENTRICULOGRAPHY, FEMORAL VENOGRAPHY, CAVOGRAPHY), WHEN PERFORMED |
| 0825T | TRANSCATHETER REMOVAL AND REPLACEMENT OF PERMANENT SINGLE-CHAMBER LEADLESS PACEMAKER, RIGHT ATRIAL, INCLUDING IMAGING GUIDANCE (EG, FLUOROSCOPY, VENOUS ULTRASOUND, RIGHT ATRIAL ANGIOGRAPHY AND/OR RIGHT VENTRICULOGRAPHY, FEMORAL VENOGRAPHY, CAVOGRAPHY) AND DEVICE EVALUATION (EG, INTERROGATION OR PROGRAMMING), WHEN PERFORMED |
| 0826T | PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, LEADLESS PACEMAKER SYSTEM IN SINGLE-CARDIAC CHAMBER |
| 0827T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, FLUIDS, WASHINGS, OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SMEARS WITH INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0828T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, FLUIDS, WASHINGS, OR BRUSHINGS, EXCEPT CERVICAL OR VAGINAL; SIMPLE FILTER METHOD WITH INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0829T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, CONCENTRATION TECHNIQUE, SMEARS, AND INTERPRETATION (EG, SACCOMANNO TECHNIQUE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0830T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, SELECTIVE-CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID-BASED SLIDE PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0831T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), REQUIRING INTERPRETATION BY PHYSICIAN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0832T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; SCREENING AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0833T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; PREPARATION, SCREENING AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0834T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, SMEARS, ANY OTHER SOURCE; EXTENDED STUDY INVOLVING OVER 5 SLIDES AND/OR MULTIPLE STAINS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0835T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC STUDY TO DETERMINE ADEQUACY FOR DIAGNOSIS, FIRST EVALUATION EPISODE, EACH SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDU |
| 0836T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; IMMEDIATE CYTOHISTOLOGIC STUDY TO DETERMINE ADEQUACY FOR DIAGNOSIS, EACH SEPARATE ADDITIONAL EVALUATION EPISODE, SAME SITE (LIST SEPARATELY IN ADDITION TO CODE |
| 0837T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CYTOPATHOLOGY, EVALUATION OF FINE NEEDLE ASPIRATE; INTERPRETATION AND REPORT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0838T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CONSULTATION AND REPORT ON REFERRED SLIDES PREPARED ELSEWHERE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0839T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CONSULTATION AND REPORT ON REFERRED MATERIAL REQUIRING PREPARATION OF SLIDES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0840T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR CONSULTATION, COMPREHENSIVE, WITH REVIEW OF RECORDS AND SPECIMENS, WITH REPORT ON REFERRED MATERIAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0841T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR PATHOLOGY CONSULTATION DURING SURGERY; FIRST TISSUE BLOCK, WITH FROZEN SECTION(S), SINGLE SPECIMEN (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0842T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR PATHOLOGY CONSULTATION DURING SURGERY; EACH ADDITIONAL TISSUE BLOCK WITH FROZEN SECTION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0843T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREPARATION, SQUASH PREPARATION), INITIAL SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0844T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR PATHOLOGY CONSULTATION DURING SURGERY; CYTOLOGIC EXAMINATION (EG, TOUCH PREPARATION, SQUASH PREPARATION), EACH ADDITIONAL SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0845T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR IMMUNOFLUORESCENCE, PER SPECIMEN; INITIAL SINGLE ANTIBODY STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0846T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR IMMUNOFLUORESCENCE, PER SPECIMEN; EACH ADDITIONAL SINGLE ANTIBODY STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0847T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR EXAMINATION AND SELECTION OF RETRIEVED ARCHIVAL (IE, PREVIOUSLY DIAGNOSED) TISSUE(S) FOR MOLECULAR ANALYSIS (EG, KRAS MUTATIONAL ANALYSIS) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0848T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR IN SITU HYBRIDIZATION (EG, FISH), PER SPECIMEN; INITIAL SINGLE PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0849T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR IN SITU HYBRIDIZATION (EG, FISH), PER SPECIMEN; EACH ADDITIONAL SINGLE PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0850T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR IN SITU HYBRIDIZATION (EG, FISH), PER SPECIMEN; EACH MULTIPLEX PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0851T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION (QUANTITATIVE OR SEMIQUANTITATIVE), MANUAL, PER SPECIMEN; INITIAL SINGLE PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0852T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION (QUANTITATIVE OR SEMIQUANTITATIVE), MANUAL, PER SPECIMEN; EACH ADDITIONAL SINGLE PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0853T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR MORPHOMETRIC ANALYSIS, IN SITU HYBRIDIZATION (QUANTITATIVE OR SEMIQUANTITATIVE), MANUAL, PER SPECIMEN; EACH MULTIPLEX PROBE STAIN PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0854T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR BLOOD SMEAR, PERIPHERAL, INTERPRETATION BY PHYSICIAN WITH WRITTEN REPORT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0855T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR BONE MARROW, SMEAR INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0856T | DIGITIZATION OF GLASS MICROSCOPE SLIDES FOR ELECTRON MICROSCOPY, DIAGNOSTIC (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0857T | OPTO-ACOUSTIC IMAGING, BREAST, UNILATERAL, INCLUDING AXILLA WHEN PERFORMED, REAL-TIME WITH IMAGE DOCUMENTATION, AUGMENTATIVE ANALYSIS AND REPORT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) |
| 0858T | EXTERNALLY APPLIED TRANSCRANIAL MAGNETIC STIMULATION WITH CONCOMITANT MEASUREMENT OF EVOKED CORTICAL POTENTIALS WITH AUTOMATED REPORT |
| 0859T | NONCONTACT NEAR-INFRARED SPECTROSCOPY (EG, FOR MEASUREMENT OF DEOXYHEMOGLOBIN, OXYHEMOGLOBIN, AND RATIO OF TISSUE OXYGENATION), OTHER THAN FOR SCREENING FOR PERIPHERAL ARTERIAL DISEASE, IMAGE ACQUISITION, INTERPRETATION, AND REPORT; EACH ADDITIONAL ANATOMIC SITE |
| 0860T | NONCONTACT NEAR-INFRARED SPECTROSCOPY (EG, FOR MEASUREMENT OF DEOXYHEMOGLOBIN, OXYHEMOGLOBIN, AND RATIO OF TISSUE OXYGENATION), FOR SCREENING FOR PERIPHERAL ARTERIAL DISEASE, INCLUDING PROVOCATIVE MANEUVERS, IMAGE ACQUISITION, INTERPRETATION, AND REPORT, ONE OR BOTH LOWER EXTREMITIES |
| 0861T | REMOVAL OF PULSE GENERATOR FOR WIRELESS CARDIAC STIMULATOR FOR LEFT VENTRICULAR PACING; BOTH COMPONENTS (BATTERY AND TRANSMITTER) |
| 0862T | RELOCATION OF PULSE GENERATOR FOR WIRELESS CARDIAC STIMULATOR FOR LEFT VENTRICULAR PACING, INCLUDING DEVICE INTERROGATION AND PROGRAMMING; BATTERY COMPONENT ONLY |
| 0863T | RELOCATION OF PULSE GENERATOR FOR WIRELESS CARDIAC STIMULATOR FOR LEFT VENTRICULAR PACING, INCLUDING DEVICE INTERROGATION AND PROGRAMMING; TRANSMITTER COMPONENT ONLY |
| 0864T | LOW-INTENSITY EXTRACORPOREAL SHOCK WAVE THERAPY INVOLVING CORPUS CAVERNOSUM, LOW ENERGY |
| 0867T | Transperineal laser ablation of benign prostatic hyperplasia, including imaging guidance; prostate volume greater or equal to 50 ml |
| 0868T | High-resolution gastric electrophysiology mapping with simultaneous patient- symptom profiling, with interpretation and report |
| 0870T | Implantation of subcutaneous peritoneal ascites pump system, percutaneous, including pump-pocket creation, insertion of tunneled indwelling bladder and peritoneal catheters with pump connections, including all imaging and initial programming, when performed |
| 0871T | Replacement of a subcutaneous peritoneal ascites pump, including reconnection between pump and indwelling bladder and peritoneal catheters, including initial programming and imaging, when performed |
| 0872T | Replacement of indwelling bladder and peritoneal catheters, including tunneling of catheter(s) and connection with previously implanted peritoneal ascites pump, including imaging and programming, when performed |
| 0873T | Revision of a subcutaneously implanted peritoneal ascites pump system, any component (ascites pump, associated peritoneal catheter, associated bladder catheter), including imaging and programming, when performed |
| 0874T | Removal of a peritoneal ascites pump system, including implanted peritoneal ascites pump and indwelling bladder and peritoneal catheters |
| 0875T | Programming of subcutaneously implanted peritoneal ascites pump system by physician or other qualified health care professional |
| 0876T | Duplex scan of hemodialysis fistula, computer-aided, limited (volume flow, diameter, and depth, including only body of fistula) |
| 0881T | Cryotherapy of the oral cavity using temperature regulated fluid cooling system, including placement of an oral device, monitoring of patient tolerance to treatment, and removal of the oral device |
| 0882T | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; initial nerve (list separately in addition to code for primary procedure) |
| 0883T | Intraoperative therapeutic electrical stimulation of peripheral nerve to promote nerve regeneration, including lead placement and removal, upper extremity, minimum of 10 minutes; each additional nerve (list separately in addition to code for primary procedure |
| 0884T | Esophagoscopy, flexible, transoral, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for esophageal stricture, including fluoroscopic guidance, when performed |
| 0885T | Colonoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed |
| 0886T | Sigmoidoscopy, flexible, with initial transendoscopic mechanical dilation (eg, nondrug-coated balloon) followed by therapeutic drug delivery by drug-coated balloon catheter for colonic stricture, including fluoroscopic guidance, when performed |
| 0887T | End-tidal control of inhaled anesthetic agents and oxygen to assist anesthesia care delivery (list separately in addition to code for primary procedure) |
| 0888T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant renal tissue, including imaging guidance |
| 0893T | Noninvasive assessment of blood oxygenation, gas exchange efficiency, and cardiorespiratory status, with physician or other qualified health care professional interpretation and report |
| 0894T | Cannulation of the liver allograft in preparation for connection to the normothermic perfusion device and decannulation of the liver allograft following normothermic perfusion |
| 0895T | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; initial 4 hours of monitoring time, including hourly physiological and laboratory assessments (eg, perfusate temperature, perfusate ph, hemodynamic parameters, bile production, bile ph, bile glucose, biliary bicarbonate, lactate levels, macroscopic assessment) |
| 0896T | Connection of liver allograft to normothermic machine perfusion device, hemostasis control; each additional hour, including physiological and laboratory assessments (eg, perfusate temperature, perfusate ph, hemodynamic parameters, bile production, bile ph, bile glucose, biliary bicarbonate, lactate levels, macroscopic assessment) (list separately in addition to code for primary procedure) |
| 0897T | Noninvasive augmentative arrhythmia analysis derived from quantitative computational cardiac arrhythmia simulations, based on selected intervals of interest from 12-lead electrocardiogram and uploaded clinical parameters, including uploading clinical parameters with interpretation and report |
| 0901T | Placement of bone marrow sampling port, including imaging guidance when performed |
| 0902T | QTC interval derived by augmentative algorithmic analysis of input from an external, patient-activated mobile ECG device |
| 0915T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator and dual transvenous electrodes/leads |
| 0916T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; pulse generator only |
| 0917T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; single transvenous lead (pacing or defibrillation) only |
| 0918T | Insertion of permanent cardiac contractility modulation-defibrillation system component(s), including fluoroscopic guidance, and evaluation and programming of sensing and therapeutic parameters; dual transvenous leads (pacing and defibrillation) only |
| 0919T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); pulse generator only |
| 0920T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous pacing lead only |
| 0921T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); single transvenous defibrillation lead only |
| 0922T | Removal of a permanent cardiac contractility modulation-defibrillation system component(s); dual (pacing and defibrillation) transvenous leads only |
| 0923T | Removal and replacement of permanent cardiac contractility modulation-defibrillation pulse generator only |
| 0924T | Repositioning of previously implanted cardiac contractility modulation-defibrillation transvenous electrode(s)/lead(s), including fluoroscopic guidance and programming of sensing and therapeutic parameters |
| 0925T | Relocation of skin pocket for implanted cardiac contractility modulation-defibrillation pulse generator |
| 0926T | Programming device evaluation (in person) with iterative adjustment of the implantable device to test the function of the device and select optimal permanent programmed values with analysis, including review and report, implantable cardiac contractility modulation-defibrillation system |
| 0927T | Interrogation device evaluation (in person) with analysis, review, and report, including connection, recording, and disconnection, per patient encounter, implantable cardiac contractility modulation-defibrillation system |
| 0928T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system with interim analysis and report(s) by a physician or other qualified health care professional |
| 0929T | Interrogation device evaluation (remote), up to 90 days, cardiac contractility modulation-defibrillation system, remote data acquisition(s), receipt of transmissions, technician review, technical support, and distribution of results |
| 0930T | Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), at time of initial implantation or replacement with testing of cardiac contractility modulation-defibrillator pulse generator |
| 0931T | Electrophysiologic evaluation of cardiac contractility modulation-defibrillator leads, including defibrillation-threshold evaluation (induction of arrhythmia, evaluation of sensing and therapy for arrhythmia termination), separate from initial implantation or replacement with testing of cardiac contractility modulation-defibrillator pulse generator |
| 0932T | Noninvasive detection of heart failure derived from augmentative analysis of an echocardiogram that demonstrated preserved ejection fraction, with interpretation and report by a physician or other qualified health care professional |
| 0933T | Transcatheter implantation of wireless left atrial pressure sensor for long-term left atrial pressure monitoring, including sensor calibration and deployment, right heart catheterization, transseptal puncture, imaging guidance, and radiological supervision and interpretation |
| 0934T | Remote monitoring of a wireless left atrial pressure sensor for up to 30 days, including data from daily uploads of left atrial pressure recordings, interpretation(s) and trend analysis, with adjustments to the diuretics plan, treatment paradigm thresholds, medications or lifestyle modifications, when performed, and report(s) by a physician or other qualified health care professional |
| 0935T | Cystourethroscopy with renal pelvic sympathetic denervation, radiofrequency ablation, retrograde ureteral approach, including insertion of guide wire, selective placement of ureteral sheath(s) and multiple conformable electrodes, contrast injection(s), and fluoroscopy, bilateral |
| 0936T | Photobiomodulation therapy of retina, single session |
| 0937T | External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; including recording, scanning analysis with report, review and interpretation by a physician or other qualified health care professional |
| 0938T | External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; recording (including connection and initial recording) |
| 0939T | External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; scanning analysis with report |
| 0940T | External electrocardiographic recording for greater than 15 days up to 30 days by continuous rhythm recording and storage; review and interpretation by a physician or other qualified health care professional |
| 0941T | Cystourethroscopy, flexible; with insertion and expansion of prostatic urethral scaffold using integrated cystoscopic visualization |
| 0942T | Cystourethroscopy, flexible; with removal and replacement of prostatic urethral scaffold |
| 0943T | Cystourethroscopy, flexible; with removal of prostatic urethral scaffold |
| 0944T | 3d contour simulation of target liver lesion(s) and margin(s) for image-guided percutaneous microwave ablation |
| 0945T | Intraoperative assessment for abnormal (tumor) tissue, in-vivo, following partial mastectomy (e.g., lumpectomy) using computer-aided fluorescence imaging (list separately in addition to code for primary procedure) |
| 0946T | Orthopedic implant movement analysis using paired computed tomography (CT) examination of the target structure, including data acquisition, data preparation and transmission, interpretation and report (including CT scan of the joint or extremity performed with paired views) |
| 0947T | Magnetic resonance image guided low intensity focused ultrasound (MRGFUS), stereotactic blood-brain barrier disruption using microbubble resonators to increase the concentration of blood-based biomarkers of target, intracranial, including stereotactic nav |
| 0002U | Oncology (colorectal), quantitative assessment of three urine metabolites (ascorbic acid, succinic acid and carnitine) by liquid chromatography with tandem mass spectrometry (lc-ms/ms) using multiple reaction monitoring acquisition, algorithm reported as likelihood of adenomatous polyps |
| 0003U | Oncology (ovarian) biochemical assays of five proteins (apolipoprotein a-1, ca 125 ii, follicle stimulating hormone, human epididymis protein 4, transferrin), utilizing serum, algorithm reported as a likelihood score |
| 0007U | Drug test(s), presumptive, with definitive confirmation of positive results, any number of drug classes, urine, includes specimen verification including dna authentication in comparison to buccal dna, per date of service |
| 0008U | Helicobacter pylori detection and antibiotic resistance, dna, 16s and 23s rrna, gyra, pbp1, rdxa and rpob, next generation sequencing, formalin-fixed paraffin embedded or fresh tissue, predictive, reported as positive or negative for resistance to clarithromycin, fluoroquinolones, metronidazole, amoxicillin, tetracycline and rifabutin |
| 0009U | Oncology (breast cancer), erbb2 (her2) copy number by fish, tumor cells from formalin fixed paraffin embedded tissue isolated using image-based dielectrophoresis (dep) sorting, reported as erbb2 gene amplified or non-amplified |
| 0010U | Infectious disease (bacterial), strain typing by whole genome sequencing, phylogenetic-based report of strain relatedness, per submitted isolate |
| 0011U | Prescription drug monitoring, evaluation of drugs present by lc- ms/ms, using oral fluid, reported as a comparison to an estimated steady-state range, per date of service including all drug compounds and metabolites |
| 0018U | Oncology (thyroid), microrna profiling by rt-pcr of 10 microrna sequences, utilizing fine needle aspirate, algorithm reported as a positive or negative result for moderate to high risk of malignancy |
| 0019U | Oncology, rna, gene expression by whole transcriptome sequencing, formalin-fixed paraffin embedded tissue or fresh frozen tissue, predictive algorithm reported as potential targets for therapeutic agents |
| 0021U | Oncology (prostate), detection of 8 autoantibodies (arf 6, nkx3-1, 5’- utr-bmi1, cep 164, 3’-utr-ropporin, desmocollin, aurkaip- 1, csnk2a2), multiplexed immunoassay and flow cytometry serum, algorithm reported as risk score |
| 0022U | Targeted genomic sequence analysis panel, non-small cell lung neoplasia, dna and rna analysis, 23 genes, interrogation for sequence variants and rearrangements, reported as presence/absence of variants and associated therapy(ies) to consider |
| 0024U | Glycosylated acute phase proteins (glyca), nuclear magnetic resonance spectroscopy, quantitative |
| 0025U | Tenofovir, by liquid chromatography with tandem mass spectrometry (lc-ms/ms), urine, quantitative |
| 0029U | Drug metabolism (adverse drug reactions and drug response), targeted sequence analysis (ie, cyp1a2, cyp2c19, cyp2c9, cyp2d6, cyp3a4, cyp3a5, cyp4f2, slco1b1, vkorc1 and rs12777823) |
| 0032U | Comt (catechol-o-methyltransferase)(drug metabolism) gene analysis, c.472g>a (rs4680) variant |
| 0033U | Htr2a (5-hydroxytryptamine receptor 2a), htr2c (5-hydroxytryptamine receptor 2c) (eg, citalopram metabolism) gene analysis, common variants (ie, htr2a rs7997012 [c.614-2211t>c], htr2c rs3813929 [c.- 759c>t] and rs1414334 [c.551-3008c>g]) |
| 0039U | Deoxyribonucleic acid (dna) antibody, double stranded, high avidity |
| 0050U | Targeted genomic sequence analysis panel, acute myelogenous leukemia, DNA analysis, 194 genes, interrogation for sequence variants, copy number variants or rearrangements |
| 0053U | Oncology (prostate cancer), fish analysis of 4 genes (asap1, hdac9, chd1 and pten), needle biopsy specimen, algorithm reported as probability of higher tumor grade |
| 0055U | Cardiology (heart transplant), cell-free DNA, PCR assay of 96 DNA target sequences (94 single nucleotide polymorphism targets and two control targets), plasma |
| 0056U | Hematology (acute myelogenous leukemia), DNA, whole genome next- generation sequencing to detect gene rearrangement(s), blood or bone marrow, report of specific gene rearrangement(s) |
| 0058U | Oncology (merkel cell carcinoma), detection of antibodies to the merkel cell polyoma virus oncoprotein (small t antigen), serum, quantitative |
| 0059U | Oncology (merkel cell carcinoma), detection of antibodies to the merkel cell polyoma virus capsid protein (vp1), serum, reported as positive or negative |
| 0060U | TWIN ZYGOSITY, GENOMIC TARGETED SEQUENCE ANALYSIS OF CHROMOSOME 2, USING CIRCULATING CELL-FREE FETAL DNA IN MATERNAL BLOOD |
| 0062U | Autoimmune (systemic lupus erythematosus), igg and igm analysis of 80 biomarkers, utilizing serum, algorithm reported with a risk score |
| 0063U | Neurology (autism), 32 amines by lc-ms/ms, using plasma, algorithm reported as metabolic signature associated with autism spectrum disorder |
| 0070U | CYP2D6 (Cytochrome P450, family 2, subfamily D, Polypeptide 6) (eg, drug metabolism) gene analysis, common and select rare variants (IE, *2, *3, *4, *4N, *5, *6, *7, *8, *9, *10, *11, *12, *13, *14A, *14B, *15, *17, *29, *35, *36, *41, *57, *61, *63, *68, *83, *XN) |
| 0071U | CYP2D6 (Cytochrome P450, family 2, subfamily d, polypeptide 6) (eg, drug metabolism) gene analysis, full gene sequence (list separately in addition to code for primary procedure) |
| 0072U | CYP2D6 (Cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, CYP2D6-2D7 hybrid gene) (list separately in addition to code for primary procedure) |
| 0073U | CYP2D6 (Cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, CYP2D7-2D6 hybrid gene) (list separately in addition to code for primary procedure) |
| 0074U | CYP2D6 (Cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, non-duplicated gene when duplication/multiplication is trans) (list separately in addition to code for primary procedure) |
| 0075U | CYP2D6 (Cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 5' gene duplication/multiplication) (list separately in addition to code for primary procedure) |
| 0076U | CYP2D6 (Cytochrome P450, family 2, subfamily D, polypeptide 6) (eg, drug metabolism) gene analysis, targeted sequence analysis (ie, 3' gene duplication/ multiplication) (list separately in addition to code for primary procedure) |
| 0153U | Oncology (breast), MRNA, gene expression profiling by next-generation sequencing of 101 genes, utilizing formalin-fixed paraffin-embedded tissue, algorithm reported as a triple negative breast cancer clinical subtype(s) with information on immune cell involvement |
| 0173U | Psychiatry (ie, depression, anxiety), genomic analysis panel, includes variant analysis of 14 genes |
| 0174U | Oncology (solid tumor), mass spectrometric 30 protein targets, formalin- fixed paraffin-embedded tissue, |
| 0175U | Psychiatry (eg, depression, anxiety), genomic analysis panel, variant analysis of 15 genes |
| 0355U | Apol1 (apolipoprotein l1) (eg, chronic kidney disease), risk variants (g1, g2) |
| 0356U | Oncology (oropharyngeal), evaluation of 17 dna biomarkers using droplet digital pcr (ddpcr), cell-free dna, algorithm reported as a prognostic risk score for cancer recurrence |
| 0357U | Oncology (melanoma), artificial intelligence (ai)-enabled quantitative mass spectrometry analysis of 142 unique pairs of glycopeptide and product fragments, plasma, prognostic, and predictive algorithm reported as likely, unlikely, or uncertain benefit from immunotherapy agents |
| 0358U | Neurology (mild cognitive impairment), analysis of ?-amyloid 1-42 and 1-40, chemiluminescence enzyme immunoassay, cerebral spinal fluid, reported as positive, likely positive, or negative |
| 0359U | Oncology (prostate cancer), analysis of all prostate-specific antigen (psa) structural isoforms by phase separation and immunoassay, plasma, algorithm reports risk of cancer |
| 0360U | Oncology (lung), enzyme-linked immunosorbent assay (elisa) of 7 autoantibodies (p53, ny-eso-1, cage, gbu4-5, sox2, mage a4, and hud), plasma, algorithm reported as a categorical result for risk of malignancy |
| 0361U | Neurofilament light chain, digital immunoassay, plasma, quantitative |
| 0362U | Oncology (papillary thyroid cancer), gene-expression profiling via targeted hybrid capture-enrichment rna sequencing of 82 content genes and 10 housekeeping genes, formalin-fixed paraffin embedded (ffpe) tissue, algorithm reported as one of three molecular subtypes |
| 0363U | Oncology (urothelial), mrna, gene- expression profiling by real-time quantitative pcr of 5 genes (mdk, hoxa13, cdc2 [cdk1], igfbp5, and cxcr2), utilizing urine, algorithm incorporates age, sex, smoking history, and macrohematuria frequency, reported as a risk score for having urothelial carcinoma |
| 0522U | Carbonic anhydrase VI, parotid specific/secretory protein and salivary protein 1 (SP1), IgG, IgM, and IgA antibodies, chemiluminescence, semiqualitative, blood |
| 0524U | Obstetrics (preeclampsia), sFlt1/PlGF ratio, immunoassay, utilizing serum or plasma, reported as a value |
| 0525U | Oncology, spheroid cell culture, 11-drug panel (carboplatin, docetaxel, doxorubicin, etoposide, gemcitabine, niraparib, olaparib, paclitaxel, rucaparib, topotecan, veliparib) ovarian, fallopian, or peritoneal response prediction for each drug |
| 0526U | Nephrology (renal transplant), quantification of CXCL10 chemokines, flow cytometry, urine, reported as pg/mL creatinine baseline and monitoring over time |
| 0527U | Herpes simplex virus (HSV) types 1 and 2 and Varicella zoster virus (VZV), amplified probe technique, each pathogen reported as detected or not detected |
| 0528U | Lower respiratory tract infectious agent detection, 18 bacteria, 8 viruses, and 7 antimicrobial resistance genes, amplified probe technique, including reverse transcription for RNA targets, each analyte reported as detected or not detected with semiquantitative results for 15 bacteria |
| 0529U | Hematology (venous thromboembolism [VTE]), genome-wide single-nucleotide polymorphism variants, including F2 and F5 gene analysis, and Leiden variant, by microarray analysis, saliva, report as risk score for VTE |
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform.
|
| 09/11/2026 | Added code L0984. |