| Code | Description | Documentation Required |
|---|---|---|
| 0569T | Transcatheter tricuspid valve repair, percutaneous approach; initial prosthesis | Clinical notes |
| 0570T | Transcatheter tricuspid valve repair, percutaneous approach; each additional prosthesis during same session (list separately in addition to code for primary procedure) | Clinical notes |
| 0584T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; percutaneous | Clinical notes |
| 0585T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; laparoscopic | Clinical notes |
| 0586T | Islet cell transplant, includes portal vein catheterization and infusion, including all imaging, including guidance, and radiological supervision and interpretation, when performed; open | Clinical notes |
| 0627T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; first level | Clinical notes |
| 0628T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with fluoroscopic guidance, lumbar; each additional level (List separately in addition to code for primary procedure) | Clinical notes |
| 0629T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; first level | Clinical notes |
| 0630T | Percutaneous injection of allogeneic cellular and/or tissue-based product, intervertebral disc, unilateral or bilateral injection, with CT guidance, lumbar; each additional level (List separately in addition to code for primary procedure) | Clinical notes |
| 0646T | Transcatheter tricuspid valve implantation (ttvi)/replacement with prosthetic valve, percutaneous approach, including right heart catheterization, temporary pacemaker insertion, and selective right ventricular or right atrial angiography, when performed Medicine – Claim Documentation Requirements | Clinical notes |
| 0647T | Insertion of gastrostomy tube, percutaneous, with magnetic gastropexy, under ultrasound guidance, image documentation and report medicine - claim documentation requirements | Clinical notes |
| 0658T | Electrical impedance spectroscopy of 1 or more skin lesions for automated melanoma risk score | Clinical notes |
| 0673T | Ablation, benign thyroid nodule(s), percutaneous, laser, including imaging guidance | Clinical notes |
| 0686T | Histotripsy (ie, non-thermal ablation via acoustic energy delivery) of malignant hepatocellular tissue, including image guidance | Clinical notes |
| 0687T | Treatment of amblyopia using an online digital program; device supply, educational set-up, and initial session | Clinical notes |
| 0688T | Treatment of amblyopia using an online digital program; assessment of patient performance and program data by physician or other qualified health care professional, with report, per calendar month | Clinical notes |
| 0820T | CONTINUOUS IN-PERSON MONITORING AND INTERVENTION (EG, PSYCHOTHERAPY, CRISIS INTERVENTION), AS NEEDED, DURING PSYCHEDELIC MEDICATION THERAPY; FIRST PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH HOUR | Clinical notes |
| 0821T | CONTINUOUS IN-PERSON MONITORING AND INTERVENTION (EG, PSYCHOTHERAPY, CRISIS INTERVENTION), AS NEEDED, DURING PSYCHEDELIC MEDICATION THERAPY; SECOND PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, CONCURRENT WITH FIRST PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH HOUR | Clinical notes |
| 0822T | ONTINUOUS IN-PERSON MONITORING AND INTERVENTION (EG, PSYCHOTHERAPY, CRISIS INTERVENTION), AS NEEDED, DURING PSYCHEDELIC MEDICATION THERAPY; CLINICAL STAFF UNDER THE DIRECTION OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, CONCURRENT WITH FIRST PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, EACH HOUR | Clinical notes |
| 0889T | Personalized target development for accelerated, repetitive high-dose functional connectivity mri–guided theta-burst stimulation derived from a structural and resting-state functional mri, including data preparation and transmission, generation of the target, motor threshold–starting location, neuronavigation files and target report, review and interpretationincluding data preparation and transmission, generation of the tar | Clinical notes |
| 0890T | Accelerated, repetitive high-dose functional connectivity mri–guided theta-burst stimulation, including target assessment, initial motor threshold determination, neuronavigation, delivery and management, initial treatment day | Clinical notes |
| 0891T | Accelerated, repetitive high-dose functional connectivity mri–guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent treatment day | Clinical notes |
| 0892T | Accelerated, repetitive high-dose functional connectivity mri–guided theta-burst stimulation, including neuronavigation, delivery and management, subsequent motor threshold redetermination with delivery and management, per treatment day | Clinical notes |
| 62328 | Spinal puncture, lumbar, diagnostic; with fluoroscopic or ct guidance | Clinical notes |
| 62329 | Spinal puncture, therapeutic, for drainage of cerebrospinal fluid (by needle or catheter); with fluoroscopic or ct guidance | Clinical notes |
| 66989 | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1-stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification), complex, requiring devices or techniques not generally used in routine cataract surgery (eg, iris expansion device, suture support for intraocular lens, or primary posterior capsulorrhexis) or performed on patients in the amblyogenic developmental stage; with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more | Clinical notes |
| 66991 | Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabecular meshwork, supraciliary, suprachoroidal) anterior segment aqueous drainage device, without extraocular reservoir, internal approach, one or more | Clinical notes |
| 92549 | Computerized dynamic posturography sensory organization test (cdp-sot), 6 conditions (ie, eyes open, eyes closed, visual sway, platform sway, eyes closed platform sway, platform and visual sway), including interpretation and report; with motor control test (mct) and adaptation test (adt) | Clinical notes |
| 93356 | Myocardial strain imaging using speckle tracking-derived assessment of myocardial mechanics (list separately in addition to codes for echocardiography imaging) | Clinical notes |
| 93896 | Vasoreactivity study performed with transcranial doppler study of intracranial arteries, complete (list separately in addition to code for primary procedure) | Clinical notes |
| 93897 | Emboli detection without intravenous microbubble injection performed with transcranial doppler study of intracranial arteries, complete (list separately in addition to code for primary procedure) | Clinical notes |
| 93898 | Venous-arterial shunt detection with intravenous microbubble injection performed with transcranial doppler study of intracranial arteries, complete (list separately in addition to code for primary procedure) | Clinical notes |
| 95705 | Electroencephalogram (eeg), without video, review of data, technical description by eeg technologist, 2-12 hours; unmonitored | Clinical notes |
| 95717 | Electroencephalogram (eeg), continuous recording, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation and report, 2-12 hours of eeg recording; without video | Clinical notes |
| 93895 | Quantitative Carotid Intima Media Thickness And Carotid Atheroma Evaluation, Bilateral | Clinical notes |
| 96547 | INTRAOPERATIVE HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) PROCEDURE, INCLUDING SEPARATE INCISION(S) AND CLOSURE, WHEN PERFORMED; FIRST 60 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) | Diagnostic/Imaging Report |
| 96548 | INTRAOPERATIVE HYPERTHERMIC INTRAPERITONEAL CHEMOTHERAPY (HIPEC) PROCEDURE, INCLUDING SEPARATE INCISION(S) AND CLOSURE, WHEN PERFORMED; EACH ADDITIONAL 30 MINUTES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) | |
| 98976 | Remote Therapeutic Monitoring (Eg, Respiratory System Status, Musculoskeletal System Status, Therapy Adherence, Therapy Response); Device(S) Supply With Scheduled (Eg, Daily) Recording(S) And/Or Programmed Alert(S) Transmission To Monitor Respiratory System, Each 30 Days | Clinical notes |
| 99174 |
Instrument-based ocular screening (eg, photoscreening, automated-refraction), bilateral; with remote analysis and report
** For individuals <5 years, medical necessity review not required. All other ages require documentation. |
Clinical notes |
| A4468 | EXSUFFLATION BELT, INCLUDES ALL SUPPLIES AND ACCESSORIES | Clinical notes |
| A6521 | GRADIENT COMPRESSION GARMENT, GLOVE, PADDED, FOR NIGHTTIME USE, CUSTOM, EACH | Clinical notes |
| A6523 | GRADIENT COMPRESSION GARMENT, ARM, PADDED, FOR NIGHTTIME USE, CUSTOM, EACH | Clinical notes |
| A6525 | GRADIENT COMPRESSION GARMENT, LOWER LEG AND FOOT, PADDED, FOR NIGHTTIME USE, CUSTOM, EACH | Clinical notes |
| A6526 | RADIENT COMPRESSION GARMENT, FULL LEG AND FOOT, PADDED, FOR NIGHTTIME USE, EACH | Clinical notes |
| A6527 | GRADIENT COMPRESSION GARMENT, FULL LEG AND FOOT, PADDED, FOR NIGHTTIME USE, CUSTOM, EACH | Clinical notes |
| A6528 | GRADIENT COMPRESSION GARMENT, BRA, FOR NIGHTTIME USE, EACH | Clinical notes |
| A6529 | GRADIENT COMPRESSION GARMENT, BRA, FOR NIGHTTIME USE, CUSTOM, EACH | Clinical notes |
| A6559 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 18-30 MMHG, CUSTOM, EACH | Clinical notes |
| A6560 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 30-40 MMHG, CUSTOM, EACH | Clinical notes |
| A6561 | GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40 MMHG OR GREATER, CUSTOM, EAC | Clinical notes |
| A6562 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 18-30 MMHG, CUSTOM, EACH | Clinical notes |
| A6563 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 30-40 MMHG, CUSTOM, EACH | Clinical notes |
| A6564 | GRADIENT COMPRESSION STOCKING, WAIST LENGTH, 40 MMHG OR GREATER, CUSTOM, EACH | Clinical notes |
| A6566 | GRADIENT COMPRESSION GARMENT, NECK/HEAD, EACH | Clinical notes |
| A6567 | GRADIENT COMPRESSION GARMENT, NECK/HEAD, CUSTOM, EACH | Clinical notes |
| A6568 | GRADIENT COMPRESSION GARMENT, TORSO AND SHOULDER, EACH | Clinical notes |
| A6569 | GRADIENT COMPRESSION GARMENT, TORSO/SHOULDER, CUSTOM, EACH | Clinical notes |
| A6570 | GRADIENT COMPRESSION GARMENT, GENITAL REGION, EACH | Clinical notes |
| A6571 | GRADIENT COMPRESSION GARMENT, GENITAL REGION, CUSTOM, EACH | Clinical notes |
| A6584 | GRADIENT COMPRESSION WRAP WITH ADJUSTABLE STRAPS, NOT OTHERWISE SPECIFIED | Clinical notes |
| A6586 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, FULL LEG, EACH | Clinical notes |
| A6589 | GRADIENT PRESSURE WRAP WITH ADJUSTABLE STRAPS, BRA, EACH | Clinical notes |
| A6593 | ACCESSORY FOR GRADIENT COMPRESSION GARMENT OR WRAP WITH ADJUSTABLE STRAPS, NON-OTHERWISE SPECIFIED | Clinical notes |
| A6609 | GRADIENT COMPRESSION BANDAGING SUPPLY, NOT OTHERWISE SPECIFIED | Clinical notes |
| A6610 | GRADIENT COMPRESSION STOCKING, BELOW KNEE, 18-30 MMHG, CUSTOM, EACH | Clinical notes |
| A9294 | Prescription digital cognitive and/or behavioral therapy, biofeedback, fda cleared, per course of treatment | Clinical notes |
| A9506 | GRAPHITE CRUCIBLE FOR PREPARATION OF TECHNETIUM TC 99M-LABELED CARBON AEROSOL, EACH | Clinical notes |
| A9593 | Gallium ga-68 psma-11, diagnostic, (ucsf), 1 millicurie | Clinical notes |
| A9609 | FLUDEOXYGLUCOSE F18 UP TO 15 MILLICURIES | Clinical notes |
| A9601 | Flortaucipir f 18 injection, diagnostic, 1 millicurie | Clinical notes |
| C1737 | Joint fusion and fixation device(s), sacroiliac and pelvis, including all system components (implantable) | Clinical notes |
| C1739 | Tissue marker, imaging and non-imaging device (implantable) | Clinical notes |
| G0166 | External counterpulsation, per treatment session | Clinical notes |
| G0545 | Visit complexity inherent to hospital inpatient or observation care associated with a confirmed or suspected infectious disease by an infectious diseases specialist, including disease transmission risk assessment and mitigation, public health investigation | Clinical notes |
| J0174 | Injection, lecanemab-irmb, 1 mg | Clinical notes |
| J0799 | FDA APPROVED PRESCRIPTION DRUG, ONLY FOR USE AS HIV PRE-EXPOSURE PROPHYLAXIS (NOT FOR USE AS TREATMENT OF HIV), NOT OTHERWISE CLASSIFIED | Clinical notes |
| J0879 | Injection, difelikefalin, 0.1 microgram, (for esrd on dialysis) | Clinical notes |
| J1096 | Dexamethasone, Lacrimal Ophthalmic insert, 0.1 mg | Operative Report |
| J1097 | Phenylephrine 10.16 mg/ml and Ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml | Operative Report |
| J1412 | Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 1013 vector genomes | Clinical notes |
| J1413 | Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose | Clinical notes |
| J1440 | Fecal microbiota, live - jslm, 1 ml | Clinical notes |
| J1632 | Injection, brexanolone, 1 mg | Clinical notes |
| J7168 | Prothrombin complex concentrate (human), kcentra, per i.u. Of factor ix activity | Clinical notes |
| J2561 | Injection, phenobarbital sodium (sezaby), 1 mg | Clinical notes |
| J7165 | Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity | Clinical notes |
| J7401 | Mometasone Furoate sinus implant, 10 micrograms | Clinical notes |
| J9029 | Injection, nadofaragene firadenovec-vncg, per therapeutic dose | Clinical notes |
| J9161 | Injection, denileukin diftitox-cxdl, 1 mcg | Clinical notes |
| J9248 | Injection, melphalan (hepzato), 1 mg | Clinical notes |
| J9275 | Injection, cosibelimab-ipdl, 2 mg | Clinical notes, diagnostic/Imaging report, History and Physical, and Pathology Report |
In addition, HMSA may require submission of clinical records before or after payment of claims for the purpose of investigating potential fraudulent, abusive or other inappropriate billing practices, but only as long as there is a reasonable basis for believing such investigation is warranted.
Revision History
| Date | Nature of Revision |
|---|---|
| 08/03/2026 | Migrated to new platform. |