Surgery – Claim Documentation Requirements

Code Description Documentation Required
0377T Anoscopy with directed submucosal injection of bulking agent for fecal incontinence Clinical notes
0406T Clinical Notes Nasal Endoscopy, Surgical, Ethmoid Sinus, Placement Of Drug Eluting Implant Clinical notes
0407T Clinical Notes Nasal Endoscopy, Surgical, Ethmoid Sinus, Placement Of Drug Eluting Implant; With Biopsy, Polypectomy Or Debridement Clinical notes
0438T Transperineal placement of biodegradable material, peri-prostatic (via needle), single or multiple, includes image guidance Diagnostic/imaging report
0510T Removal of sinus tarsi implant Clinical notes
0511T Removal and reinsertion of sinus tarsi implant Clinical notes
0523T Intraprocedural coronary fractional flow reserve (FFR) with 3d functional mapping of color-coded FFR values for the coronary tree, derived from coronary angiogram data, for real-time review and interpretation of possible atherosclerotic stenosis(es) intervention (list separately in addition to code for primary procedure) Diagnostic/imaging report
0594T OSTEOTOMY, HUMERUS, WITH INSERTION OF AN EXTERNALLY CONTROLLED INTRAMEDULLARY LENGTHENING DEVICE Clinical notes
0614T REMOVAL AND REPLACEMENT OF SUBSTERNAL IMPLANTABLE DEFIBRILLATOR PULSE GENERATOR Clinical notes
0620T Endovascular venous arterialization, tibial or peroneal vein, with transcatheter placement of intravascular stent graft(s) and closure by any method, including percutaneous or open vascular access, ultrasound guidance for vascular access when performed, all catheterization(s) and intraprocedural roadmapping and imaging guidance necessary to complete the intervention, all associated radiological supervision and interpretation, when performed 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
0643T Transcatheter left ventricular restoration device implantation including right and left heart catheterization and left ventriculography when performed, arterial approach Clinical notes
0644T Transcatheter removal or debulking of intracardiac mass (eg, vegetations, thrombus) via suction (eg, vacuum, aspiration) device, percutaneous approach, with intraoperative reinfusion of aspirated blood, including imaging guidance, when performed Clinical notes
0645T Transcatheter implantation of coronary sinus reduction device including vascular access and closure, right heart catheterization, venous angiography, coronary sinus angiography, imaging guidance, and supervision and interpretation, when performed Clinical notes
0651T Magnetically controlled capsule endoscopy, esophagus through stomach, including intraprocedural positioning of capsule, with interpretation and report Clinical notes
0652T Esophagogastroduodenoscopy, flexible, transnasal; diagnostic, including collection of specimen(s) by brushing or washing, when performed (separate procedure) Clinical notes
0653T Esophagogastroduodenoscopy, flexible, transnasal; with biopsy, single or multiple Clinical notes
0654T Esophagogastroduodenoscopy, flexible, transnasal; with insertion of intraluminal tube or catheter Clinical notes
0655T Transperineal focal laser ablation of malignant prostate tissue, including transrectal imaging guidance, with mr-fused images or other enhanced ultrasound imaging Clinical notes
0656T Vertebral body tethering, anterior; up to 7 vertebral segments Consult Report, Diagnostic/Imaging Report, and History & Physical
0657T Vertebral body tethering, anterior; 8 or more vertebral segments Consult Report, Diagnostic/Imaging Report, and History & Physical
0659T Transcatheter intracoronary infusion of supersaturated oxygen in conjunction with percutaneous coronary revascularization during acute myocardial infarction, including catheter placement, imaging guidance (eg, fluoroscopy), angiography, and radiologic supervision and interpretation Clinical notes
0660T Implantation of anterior segment intraocular nonbiodegradable drug-eluting system, internal approach Clinical notes
0661T Removal and reimplantation of anterior segment intraocular nonbiodegradable drug-eluting implant History & Physical
0735T Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (iort) concurrent with primary craniotomy (list separately in addition to code for primary procedure) Clinical notes
0736T Colonic lavage, 35 or more liters of water, gravity-fed, with induced defecation, including insertion of rectal catheter Clinical notes
0790T REVISION (EG, AUGMENTATION, DIVISION OF TETHER), REPLACEMENT, OR REMOVAL OF THORACOLUMBAR OR LUMBAR VERTEBRAL BODY TETHERING, INCLUDING THORACOSCOPY, WHEN PERFORMED Diagnostic/Imaging Report
0809T Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, placement of transfixing device(s) and intra- articular implant(s), including allograft or synthetic device(s) Clinical notes
0869T Injection(s), bone-substitute material for bone and/or soft tissue hardware fixation augmentation, including intraoperative imaging guidance, when performed Clinical notes
0913T Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (e.g., drug-coated, drug-eluting), including mechanical dilation by nondrug-delivery balloon angioplasty, endoluminal imaging using intravascular ultrasound (IVUS) Clinical Notes
0914T Percutaneous transcatheter therapeutic drug delivery by intracoronary drug-delivery balloon (e.g., drug-coated, drug-eluting) performed on a separate target lesion from the target lesion treated with balloon angioplasty, coronary stent placement or coronary Clinical Notes
13100 Repair, complex, trunk; 1.1 cm to 2.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13101 Repair, complex, trunk; 2.6 cm to 7.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13102 Repair, complex, trunk; each additional 5 cm or less Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13120 Repair, complex, scalp, arms, and/or legs; 1.1 to 2.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13121 Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13122 Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13131 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13132 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13133 Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13150 Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or less Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13151 Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13152 Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cm Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13153 Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
13160 Secondary closure of surgical wound or dehiscence, extensive or complicated Operative report with documentation of the layered closure, the layers involved, the number of sutures used in each layer, the total length of the repair in centimeters and any debridement or reconfiguration performed.
15011 Harvest of skin for skin cell suspension autograft; first 25 sq cm or less Clinical Notes
15012 Harvest of skin for skin cell suspension autograft; each additional 25 sq cm or part thereof (list separately in addition to code for primary procedure) Clinical Notes
15013 Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; first 25 sq cm or less of harvested skin Clinical Notes
15014 Preparation of skin cell suspension autograft, requiring enzymatic processing, manual mechanical disaggregation of skin cells, and filtration; each additional 25 sq cm of harvested skin or part thereof (list separately in addition to code for primary procedure) Clinical Notes
15015 Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; first 480 sq cm or less Clinical Notes
15016 Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, trunk, arms, legs; each additional 480 sq cm or part thereof (list separately in addition to code for primary procedure) Clinical Notes
15017 Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 480 sq cm or less Clinical Notes
15018 Application of skin cell suspension autograft to wound and donor sites, including application of primary dressing, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 480 sq cm or part thereof (list separately in addition to code for primary procedure) Clinical Notes
15271 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Clinical notes
15272 Application of skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary procedure) Clinical notes
15273 Application of skin substitute graft to trunk, arms, legs, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children Clinical notes
15275 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area Clinical notes
15277 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; first 100 sq cm wound surface area, or 1% of body area of infants and children Clinical notes
15278 Application of skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area greater than or equal to 100 sq cm; each additional 100 sq cm wound surface area, or part thereof, or each additional 1% of body area of infants and children, or part thereof (list separately in addition to code for primary procedure) Clinical notes
15771 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; 50 cc or less injectate Clinical notes
15772 Grafting of autologous fat harvested by liposuction technique to trunk, breasts, scalp, arms, and/or legs; each additional 50 cc injectate, or part thereof (list separately in addition to code for primary procedure) Clinical notes
15773 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; 25 cc or less injectate Clinical notes
15774 Grafting of autologous fat harvested by liposuction technique to face, eyelids, mouth, neck, ears, orbits, genitalia, hands, and/or feet; each additional 25 cc injectate, or part thereof (list separately in addition to code for primary procedure) Clinical notes
15777 Implantation of biologic implant (e.g., acellular dermal matrix) for soft tissue reinforcement (e.g., breast, trunk) (List separately in addition to code for primary procedure)
22836 ANTERIOR THORACIC VERTEBRAL BODY TETHERING, INCLUDING THORACOSCOPY, WHEN PERFORMED; UP TO 7 VERTEBRAL SEGMENTS Diagnostic/Imaging Report
22837 ANTERIOR THORACIC VERTEBRAL BODY TETHERING, INCLUDING THORACOSCOPY, WHEN PERFORMED; 8 OR MORE VERTEBRAL SEGMENTS Diagnostic/Imaging Report
22838 REVISION (EG, AUGMENTATION, DIVISION OF TETHER), REPLACEMENT, OR REMOVAL OF THORACIC VERTEBRAL BODY TETHERING, INCLUDING THORACOSCOPY, WHEN PERFORMED Diagnostic/Imaging Report
27415 Osteochondral allograft, knee, open Clinical notes
27416 Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s]) Clinical notes
28446 Open osteochondral autograft, talus (includes obtaining graft[s]) Clinical notes
29867 Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty) Clinical notes
31647 Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, when performed, assessment of air leak, airway sizing, and insertion of bronchial valve(s), initial lobe Clinical notes
31648 Bronchoscopy with the removal of a previously placed bronchial valve(s) Clinical notes
31649 Removal of bronchial valves in additional lobes of the lung during a bronchoscopy procedure, following the removal of bronchial valves from the initial lobe Clinical notes
31651 Endobronchial Valve, additional insertion Clinical notes
32672 Thoracoscopy, surgical; with resection-plication for emphysematous lung (bullous or non-bullous) for lung volume reduction (LVRS), unilateral includes any pleural procedure, when performed Clinical notes
33272 Clinical Notes Removal Of Subcutaneous Implantable Defibrillator Electrode Clinical notes
33273 Clinical Notes Repositioning Of Previously Implanted Subcutaneous Implantable Defibrillator Electrode Clinical notes
33927 Implantation of a total replacement heart system (artificial heart) with recipient cardiectomy Clinical notes
33928 Removal and replacement of total replacement heart system (artificial heart) Clinical notes
33929 Removal of a total replacement heart system (artificial heart) for heart transplantation (list separately in addition to code for primary procedure) Clinical notes
37218 Clinical Notes Transcatheter Placement Of Intravascular Stent(S), Intrathoracic Common Carotid Artery Or Innominate Artery, Open Or Percutaneous Antegrade Approach, Including Angioplasty, When Performed, And Radiological Supervision And Interpretation Clinical notes
41512 Tongue Base Suspension Operative report, history and physical report, diagnostic imaging report, and sleep study report
41530 Submucosal Ablation of the Tongue Base Operative report, history and physical report, diagnostic imaging report, and sleep study report
41826 Excision of lesion or tumor, dentoalveolar structures; with simple repair Operative report
41827 Excision of lesion or tumor; dentoalveolar structures; with complex repair Operative report
41850 Destruction of lesion (except excision), dentoalveolar structures Operative report
42975 Drug-Induced Sleep Endoscopy, With Dynamic Evaluation Of Velum, Pharynx, Tongue Base, And Larynx For Evaluation Of Sleep-Disordered Breathing, Flexible, Diagnostic Clinical notes; Submit hypoglossal nerve stimulator checklist including BMI, date of last sleep study, and documentation of CPAP failure
51721 Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed Consult Report
53865 Cystourethroscopy with insertion of temporary device for ischemic remodeling (i.e., pressure necrosis) of bladder neck and prostate Consult Report
53866 Catheterization with removal of temporary device for ischemic remodeling (i.e., pressure necrosis) of bladder neck and prostate Consult Report
55706 Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance Operative report
55881 Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; Consult Report
55882 Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed Clinical Notes
58580 Transcervical ablation of uterine fibroid(s), including intraoperative ultrasound guidance and monitoring, radiofrequency Clinical Notes
61715 Magnetic resonance image guided high intensity focused ultrasound (MRGFUS), stereotactic ablation of target, intracranial, including stereotactic navigation and frame placement, when performed Clinical Notes
61889 INSERTION OF SKULL-MOUNTED CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, INCLUDING CRANIECTOMY OR CRANIOTOMY, WHEN PERFORMED, WITH DIRECT OR INDUCTIVE COUPLING, WITH CONNECTION TO DEPTH AND/OR CORTICAL STRIP ELECTRODE ARRAY(S) Clinical notes
61891 REVISION OR REPLACEMENT OF SKULL-MOUNTED CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER WITH CONNECTION TO DEPTH AND/OR CORTICAL STRIP ELECTRODE ARRAY(S) Clinical notes
61892 REMOVAL OF SKULL-MOUNTED CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER WITH CRANIOPLASTY, WHEN PERFORMED Clinical notes
62324 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; without imaging guidance Clinical notes
62325 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, cervical or thoracic; with imaging guidance (ie, fluoroscopy or CT) Clinical notes
62326 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); without imaging guidance Clinical notes
62327 Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic or therapeutic substance(s) (eg, anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, interlaminar epidural or subarachnoid, lumbar or sacral (caudal); with imaging guidance (ie, fluoroscopy or CT) Clinical notes
63052 Clinical Notes Laminectomy, Facetectomy, Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord, Cauda Equina And/Or Nerve Root[S] [Eg, Spinal Or Lateral Recess Stenosis]), During Posterior Interbody Arthrodesis, Lumbar; Single Vertebral Segment (List Separately In Addition To Code For Primary Procedure) Clinical notes
63053 Laminectomy, Facetectomy, Or Foraminotomy (Unilateral Or Bilateral With Decompression Of Spinal Cord, Cauda Equina And/Or Nerve Root[S] [Eg, Spinal Or Lateral Recess Stenosis]), During Posterior Interbody Arthrodesis, Lumbar; Each Additional Segment (List Separately In Addition To Code For Primary Procedure) Clinical notes
64568 Incision for implantation of cranial nerve (eg, vagnus nerve) neurostimulator electrode array and pulse generator History and physical
64569 Revision or replacement of cranial nerve (eg, vagnus nerve) neurostimulator electrode array, including connection to existing pulse generator History and physical
64570 Removal of cranial nerve (eg, vagnus nerve) neurostimulator electrode array and pulse generator History and physical
64582 Open Implantation Of Hypoglossal Nerve Neurostimulator Array, Pulse Generator, And Distal Respiratory Sensor Electrode Or Electrode Array Clinical notes
64584 Removal Of Hypoglossal Nerve Neurostimulator Array, Pulse Generator, And Distal Respiratory Sensor Electrode Or Electrode Array Clinical notes
64583 Revision Or Replacement Of Hypoglossal Nerve Neurostimulator Array And Distal Respiratory Sensor Electrode Or Electrode Array, Including Connection To Existing Pulse Generator Clinical notes
64596 INSERTION OR REPLACEMENT OF PERCUTANEOUS ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED; INITIAL ELECTRODE ARRAY Clinical notes
64597 INSERTION OR REPLACEMENT OF PERCUTANEOUS ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED; EACH ADDITIONAL ELECTRODE ARRAY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) Clinical notes
64598 REVISION OR REMOVAL OF NEUROSTIMULATOR ELECTRODE ARRAY, PERIPHERAL NERVE, WITH INTEGRATED NEUROSTIMULATOR Clinical notes
64625 Clinical Notes Radiofrequency Ablation, Nerves Innervating The Sacroiliac Joint, With Image Guidance (Ie, Fluoroscopy Or Computed Tomography) Clinical notes
64628 Clinical Notes Thermal Destruction Of Intraosseous Basivertebral Nerve, Including All Imaging Guidance; First 2 Vertebral Bodies, Lumbar Or Sacral  
64629 Thermal Destruction Of Intraosseous Basivertebral Nerve, Including All Imaging Guidance; Each Additional Vertebral Body, Lumbar Or Sacral (List Separately In Addition To Code For Primary Procedure) Clinical notes
66179 Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft Clinical notes
66184 Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft Clinical notes
66683 Implantation of iris prosthesis, including suture fixation and repair or removal of iris, when performed Clinical Notes
69716 Implantation, Osseointegrated Implant, Skull; With Magnetic Transcutaneous Attachment To External Speech Processor Clinical notes
69719 Revision Or Replacement (Including Removal Of Existing Device), Osseointegrated Implant, Skull; With Magnetic Transcutaneous Attachment To External Speech Processor Clinical notes
69726 Removal, Osseointegrated Implant, Skull; With Percutaneous Attachment To External Speech Processor Clinical notes
69727 Clinical Notes Removal, Osseointegrated Implant, Skull; With Magnetic Transcutaneous Attachment To External Speech Processor Clinical notes
69728 Removal, entire osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex Clinical notes
69729 Implantation, osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside of the mastoid and resulting in removal of greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex Clinical notes
69730 Replacement (including removal of existing device), osseointegrated implant, skull; with magnetic transcutaneous attachment to external speech processor, outside the mastoid and involving a bony defect greater than or equal to 100 sq mm surface area of bone deep to the outer cranial cortex Clinical notes
0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach Clinical notes
0192T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, external approach Clinical notes
0253T Insertion of anterior segment aqueous drainage device, without extraocular reservoir, internal approach, in to the suprachoroidal space Clinical notes
0256T Implantation of catheter-delivered prosthetic aortic heart valve; endovascular approach Operative report
0257T Implantation of catheter-delivered prosthetic aortic heart valve; open thoracic approach (eg, transapical, transventricular) Operative report
0258T Transthoracic cardiac exposure (i.e., sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; without cardiopulmonary bypass Operative report
0259T Transthoracic cardiac exposure (i.e., sternotomy, thoracotomy, subxiphoid) for catheter-delivered aortic valve replacement; with cardiopulmonary bypass Operative report
0331T Myocardial sympathetic innervation imaging, planar qualitative and quantitive assessment Clinical notes and diagnostic/imaging report
0332T Myocardial sympathetic innervation imaging, planar qualitative and quantitative assessment; with tomographic SPECT Clinical notes and diagnostic/imaging report
0483T Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; Percutaneous approach, including transseptal puncture, when performed Clinical notes
0484T Transcatheter mitral valve implantation/replacement (tmvi) with prosthetic valve; Transthoracic exposure (eg, thoracotomy, transapical) Clinical notes
0673T Ablation, Benign Thyroid Nodule(S), Percutaneous, Laser, Including Imaging Guidance Clinical notes
A4341 Scalp cooling, mechanical; placement of device, monitoring, and removal of device (list separately in addition to code for primary procedure) Clinical notes
A4342 Accessories for patient inserted indwelling intraurethral drainage device with valve, replacement only, each Clinical notes
A4544 Electrode for external lower extremity nerve stimulator for restless legs syndrome Clinical notes
A6515 Gradient compression wrap with adjustable straps, full leg, each, custom Clinical Notes
A6516 Gradient compression wrap with adjustable straps, foot, each, custom Clinical Notes
A6517 Gradient compression wrap with adjustable straps, below knee, each, custom Clinical Notes
A6518 Gradient compression wrap with adjustable straps, arm, each, custom Clinical Notes
A6519 Gradient compression garment, not otherwise specified, for nighttime use, each Clinical Notes
A6611 Gradient compression wrap with adjustable straps, above knee, each, custom Clinical Notes
A6590 External urinary catheters; disposable, with wicking material, for use with suction pump, per month Clinical notes
G0440 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; first 25 sq cm or less Clinical notes
G0441 Application of tissue cultured allogeneic skin substitute or dermal substitute; for use on lower limb, includes the site preparation and debridement if performed; each additional 25 sq cm. Clinical notes
G0564 Creation of subcutaneous pocket with insertion of 365 day implantable interstitial glucose sensor, including system activation and patient training Clinical Notes
G0565 Removal of implantable interstitial glucose sensor with creation of subcutaneous pocket at different anatomic site and insertion of new 365 day implantable sensor, including system activation Clinical Notes
Q4176 Neopatch, per square centimeter Clinical notes
Q4177 Floweramnioflo, 0.1 cc Clinical notes
Q4178 Floweramniopatch, per square centimeter Clinical notes
Q4179 Flowerderm, per square centimeter Clinical notes
Q4180 Revita, per square centimeter Clinical notes
Q4181 Amnio wound, per square centimeter Clinical notes
Q4182 Transcyte, per square centimeter Clinical notes
By Report Procedures
Complex Wound Repairs and Complicated Incisions
Cosmetic procedures, see Cosmetic Procedures – Claim Documentation Requirements
Debridement
Oral Surgery and Interdental Fixation Services – Claim Documentation Requirements

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.