Revision 19-0; Effective July 1, 2019

 

 

Evaluation and Management  
99201 Office Visit. New Individual. Problem focused history/exam. Straightforward decision-making.
99202 Office Visit. New Individual. Expanded problem focused history/exam. Straightforward medical decision-making.
99203 Office Visit. New Individual. Detailed history/exam. Low complexity decision-making.
99204 Office Visit. New Individual. Comprehensive history/exam. Moderate complexity decision-making.
99205 Office Visit. New Individual. Comprehensive history/exam. High complexity decision-making.
99211 Office Visit. Established Individual. Minor problem focus. Straightforward decision-making.
99212 Office Visit. Established Individual. Problem focused history/exam. Straightforward decision-making.
99213 Office Visit. Established Individual. Expanded problem focused history/exam. Low complexity decision-making.
99214 Office Visit. Established Individual. Detailed history/exam. Moderate complexity decision-making.
99215 Office Visit. Established Individual. Comprehensive history/exam. High complexity decision-making.
99241 Office Consultation. New or Established Individual. Problem focused history/exam. Straightforward decision-making.
99242 Office Consultation. New or Established Individual. Expanded problem focused history/exam. Straightforward decision-making.
99243 Office Consultation. New or Established Individual. Detailed history/exam. Low complexity decision-making.
99244 Office Consultation. New or Established Individual. Comprehensive history/exam. Moderate complexity decision-making.
99384 Preventive Visit. New Individual. Age 12 – 17.
99385 Preventive Visit. New Individual. Age 18 – 39.
99386 Preventive Visit. New Individual. Age 40 – 64.
99394 Preventive Visit. Established Individual. Age 12 – 17.
99395 Preventive Visit. Established Individual. Age 18 – 39.
99396 Preventive Visit. Established Individual. Age 40 – 64.
59430 Postpartum visit
Radiology  
71010 Chest x-ray one view frontal
71020 Chest x-ray two view frontal and lateral
73060 Radiologic examination x-ray, humerus, minimum of two views
74000 X-ray, abdomen, single a/p view
74010 X-ray, abdomen, a/p and additional views
74740 Hysterosalpingogram
76098 Radiological exam, surgical specimen
76641 Ultrasound, complete examination of breast including axilla, unilateral
76642 Ultrasound, limited examination of the breast including axilla, unilateral
76700 US exam, abdominal, complete
76705 US exam, abdominal, limited
76770 US exam abdominal back wall, comp
76801 OB US less than 14 weeks, single fetus
76802 OB US less than 14 weeks, additional fetus
76805 Ultrasound pregnant uterus, greater than or equal to 14 weeks’ gestation, single or first gestation
76810 US exam, pregnant uterus, multiple gestation
76811 OB US, detailed, single fetus
76813 OB US, nuchal measure, one gestation
76815 Ultrasound of pregnant uterus, limited
76816 Ultrasound of pregnant uterus as follow-up of abnormal previous scan
76817 Transvaginal US, obstetric
76818 Fetal biophysical profile with W/NST
76819 Fetal biophysical profile with/out NST
76820 Umbilical artery echo
59025 Fetal non-stress test
76830 Ultrasound, transvaginal
76856 Ultrasound, pelvic, non-obstetric
76857 Ultrasound, pelvic, non-obstetric, limited or follow-up
76881 Ultrasound, extremity, nonvascular, real-time with image documentation, complete
76882 Ultrasound, extremity, nonvascular, real-time with image documentation, limited, anatomic specific
76942 Echo guide for biopsy
76998 Ultrasound guidance, intraoperative
77051 Computer dx mammogram add-on
77053 Mammary ductogram or galactogram, single duct, global fee
77065 Mammogram, one breast
77066 Mammogram, both breasts
77067 Mammogram, screening, appropriate for male and female
77058 Magnetic resonance imaging, breast, with and/or without contrast, unilateral, global fee
77059 Magnetic resonance imaging, breast, with and/or without contrast, bilateral, global fee
G0202 Screening Mammography digital
G0204 Diagnostic mammography, (producing direct 2-d digital image, bilateral, all views)
G0206 Diagnostic mammography, (producing direct 2-d digital image, unilateral, all views)
Medications, Immunizations and Vaccines  
90460 IM admin first/only component
90471 Immunization admin
90472 Immunization admin, any route, each additional vaccine (single or combination)
90632 Hep A vaccine, adult, IM
90633 Hep A vaccine, ped/adol, 2 dose, IM
90636 Hep A/Hep B vaccine, adult, IM
90649 HPV vaccine 4 valent, IM
90650 HPV vaccine 2 valent, IM
90651 HPV vaccine 9 valent, IM
90654 Flu vaccine, split virus, preservative-free, for intradermal use
90656 Flu vaccine no preservative 3 years and older
90658 Flu vaccine 3 years and older, IM
90660 Flu vaccine, live, no preservative, trivalent, IM
90670 Pneumococcal vaccine, 13 Val IM
90673 Flu vaccine, no preservative, trivalent, IM
90686 Flu vaccine, no preservative, quadrivalent, 3 years and older
90688 Flu vaccine, quadrivalent, split virus
90707 MMR vaccine, live, SC
90710 MMRV vaccine, live, SC
90714 Td vaccine, no preservative, age 7 and older, IM
90715 Tdap vaccine, age 7 and older, IM
90716 Chicken pox vaccine, IM
90723 Diphtheria, pertussis, tetanus, Hepatitis B, IMPV
90732 Pneumococcal vaccine, SC or IM
90733 Meningococcal vaccine, SC
90734 Meningococcal vaccine, IM
90736 Zoster vaccine, SC
90743 Hep B vaccine, adolescent, 2 dose, IM
90744 Hep B vaccine, birth – 19 years, 3 dose, IM
90746 Hep B vaccine, 20+ years, 3 dose, IM
96372 Non-neoplastic hormonal therapy injection
A9150 Non-Rx drugs
J0558 Penicillin G benzathine/procaine injection
J0561 Penicillin G benzathine injection
J0690 Cefazolin sodium injection
J0696 Ceftriaxone sodium injection
J0702 Betamethasone sodium phosphate and acetate
J1100 Dexamethasone sodium phosphate
J1725 Hydroxyprogesterone caproate injection
J2010 Lincomycin injection
J2790 Rho D immune globulin injection
J3490 Injection Medication for STD or G/U infection
S5000 Oral prescription medication, generic
Contraceptive Method  
H1010 Instruction, NFP
A4261 Cervical cap
A4266 Diaphragm
A4267 Condom, male, each
A4268 Condom, female, each
A4269 Spermicide (e.g., foam, gel) each, six suppositories or film are quantity of one
S4993 Oral contraceptive pills, one cycle
J7297 Lilleta IUD (52mg levonorgestrel-releasing intrauterine contraceptive)
J7298 Mirena IUD (52mg levonorgestrel-releasing intrauterine contraceptive)
Q9984 Kyleena IUD (19.5 mg levonorgestrel -releasing intrauterine contraceptive)
J7300 Copper intrauterine contraceptive
J7301 Skyla IUD (13.5 mg levonorgestrol intrauterine contraceptive)
J7303 Vaginal ring, each
J7304 Contraceptive patch, each
J7307 Implantable contraceptive capsule
Contraceptive Method-Related Services  
57170 Diaphragm or cervical cap fitting with instructions
58300 Insertion of intrauterine device
58301 Removal of intrauterine device
11982 Removal nonbiodegradable drug delivery implant
11983 Removal with reinsertion, nonbiodegradable drug delivery implant
58562 Hysteroscopy, surgical; with removal of impacted foreign body
J1050 Medroxyprogesterone acetate for contraceptive use, injection
96372 Injection fee, Medroxyprogesterone acetate
11976 Removal, implantable contraceptive
11981 Nonbiodegradable drug delivery implant insertion
Counseling and Education  
90791 Psychiatric diagnostic interview without medical services
90792 Psychiatric diagnostic interview for provider of medical services
97802 Medical nutrition therapy, initial assessment, individual, face to face, every 15 minutes
97803 Medical nutrition therapy, reassessment, individual, face to face, every 15 minutes
97804 Medical nutrition therapy, group (two or more), every 30 minutes
99078 Group health education
99406 Behavior change, smoking 3-10 minutes
99407 Behavior change, smoking greater than 10 minutes
Pathology and Laboratory  
80061 Lipid profile with cholesterol
80300 Drug screen, qualitative/multiple
80301 Drug screen, single
81000 Urinalysis, by dipstick or tablet, nonautomated, with microscopy
81001 Urinalysis, by dipstick or tablet, automated, with microscopy
81002 Urinalysis, dipstick or tablet, nonautomated, without microscopy
81003 Urinalysis, by dipstick or tablet, automated, without microscopy
81005 Urinalysis, qualitative or semiquantitative
81015 Urinalysis, microscopic only
81025 Urine pregnancy test, visual comparison methods
82947 Glucose, blood, except reagent strip
82948 Glucose, blood, reagent strip
83036 Hemoglobin A1c
84443 Thyroid stimulating hormone
84702 Chorionic gonadotropin, quantitative (pregnancy test)
84703 Chorionic gonadotropin, qualitative (pregnancy test)
85013 Microhematocrit, spun
85014 Hematocrit
85018 Hemoglobin
85025 CBC with differential, automated
85027 CBC, automated
86318 Immunoassay, infection agent
86580 Tb skin test, intradermal
86592 Syphilis
86689 HTLV/HIV confirmatory test
86695 Herpes simplex, type 1
86696 Herpes simplex, type 2
86701 HIV-1 antibody
86702 HIV-2 antibody
86703 HIV-1 and HIV-2, single assay
86762 Rubella antibody
86803 Hepatitis C antibody
86900 Blood typing, ABO
86901 Blood typing, Rh
87070 Culture, bacterial; any source other than blood or stool; with presumptive identification of isolates
87086 Urine culture, bacterial, quantitative
87088 Urine culture, bacterial, with presumptive identification of isolates
87102 Culture, fungi, with presumptive identification of isolates, source other than blood, skin, hair or nail
87110 Chlamydia culture
87205 Smear with interpretation, routine stain for bacteria, fungi or cell types
87210 Wet mount for infectious agents (e.g., saline, India ink, KOH preps)
87220 Tissue examination by KOH slide of samples from skin, hair or nails for fungi, ectoparasite ova, mites
87252 Virus isolation, tissue culture inoculation and presumptive identification (herpes)
87389 HIV-1 AG w/ HIV-1 & HIV 2 AB
87480 Candida species, direct probe technique
87490 Chlamydia, direct probe technique
87491 Chlamydia, amplified probe technique
87510 Gardnerella vaginalis, direct probe technique
87535 HIV-1 probe and reverse transcription
87590 Gonorrhea, direct probe technique
87591 Gonorrhea, amplified probe technique
87624 HPV, high-risk types
87625 HPV, types 16 and 18 only
87660 Trichomonas vaginalis, direct probe technique
87797 Infectious agent, NOS, direct probe
87800 Infectious agent, multiple organisms, direct probe technique
87801 Infectious agent, multiple organisms, amplified probe technique
87810 Chlamydia, immunoassay with direct optical observation
87850 Gonorrhea, immunoassay with direct optical observation
88142 Cytopathology, cervical/vaginal, liquid based, automated
88150 Cytopathology, cervical/vaginal, slides, manual
88164 Cytopathology, cervical/vaginal, slides, manual, the Bethesda System
88175 Cytopathology, cervical/vaginal, any reporting system, fluid based, automated screening with manual rescreening or review.
80048 Basic metabolic panel
80053 Comprehensive metabolic panel
85730 Thromboplastin time, partial
88305 Tissue exam by pathologist
88307 Tissue exam by pathologist
93000 Electrocardiogram, complete
88141 Cytopath, cervical or vaginal (C/V), interpret
88143 Cytopath, C/V thin layer, redo
88173 Cytopath evaluation, FNA, report
88174 Cytopath, C/V auto, in fluid
80050 General health panel
80051 Electrolyte panel
80053 Comprehensive metabolic panel
80069 Renal function panel
80074 Acute hepatitis panel
80076 Hepatic function panel
82270 Occult blood, feces
82465 Total cholesterol
82950 Glucose test
83020 Hemoglobin electrophoresis
83021 Hemoglobin chromatography
83036 Glycosylated hemoglobin test
84450 Transferase (AST) (SGOT)
84460 Alanine amino (ALT) (SGPT)
84478 Assay of Triglycerides
84479 Assay of thyroid (T3 or T4)
85007 Differential WBC count
85610 Prothrombin time (PT)
85660 RBC sickle cell test
85730 Thromboplastin time, partial (PTT)
86631 Chlamydia trachomatis, immunofluorescent technique
86677 Helicobacter pylori antibody
86704 Hepatitis B core antibody, total
86706 Hepatitis B surface antibody
86780 Treponema pallidum
86885 Coombs test, indirect, qualitative
87270 Chlamydia trachomatis, immunofluorescent technique
87512 Gardnerella vaginalis, quantification
87529 HSV, DNA, amplified probe
87530 HSV, DNA, quantitative
87661 Trichomonas vaginalis, amplified
88155 Cytopath, C/V, index add-on
88160 Cytopath smear, other source
88161 Cytopath smear, other source
88165 Cyopath, bethesda system, w/manual screen/rescreen
88167 Cytopathology, Bethesda system, cervical/vaginal, select
88172 Cytopathology, evaluation of fine needle aspirate
80055 Obstetric panel
80300 Drug screen, single
82105 Alpha-fetoprotein, serum
82677 Estriol (UE3)
82951 Glucose tolerance test (GTT)
84436 T4
84479 Assay of thyroid (T3 or T4)
85384 Fibrinogen
85610 Prothrombin time
86336 Inhibin A
86777 Toxoplasmosis, IgG IFA
86778 Toxoplasmosis, IgM
86850 Blood, antibody screen
86900 Blood group type
86901 Rh type
87081 GBS culture
87184 Susceptibility test
87340 Hepatitis B surface antigen, by enzyme immunoassay
94760 Non-invasive pulse oximetry for oxygen saturation
99000 Specimen handling or conveyance
Anesthesia  
00851 Anesthesia for sterilization, lower abdomen
00400 Anesthesia for procedures on the integumentary system, anterior trunk
00940 Anesthesia for vaginal procedures (including biopsy of cervix), NOS
Surgical Procedures  
55250 Male sterilization, vasectomy
58340 Catheter for hysterography
58565 Female sterilization, hysteroscopy with bilateral fallopian tube cannulation and placement of permanent implants to occlude the fallopian tubes
58600 Female sterilization, fallopian tube transection, blocking or other procedure
58611 Female sterilization, fallopian tube transection performed at time of cesarean delivery
58615 Female sterilization, occlusion of fallopian tubes by device, vaginal approach
58670 Female sterilization, laparoscopy with fulguration of oviducts
58671 Female sterilization, laparoscopy with occlusion of oviducts by device
10022 FNA with image
19000 Drainage of breast lesion
19081 Breast biopsy first lesion, includes stereotactic guidance
19082 Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous, stereotactic guidance, each additional lesion
19083 Breast biopsy, first lesion, US imaging
19084 Breast biopsy, with placement of localization device and imaging of biopsy specimen, percutaneous, US guidance, each additional lesion
19100 Breast biopsy, percutaneous, needle core, not using imaging guidance, one or more lesion
19101 Incisional breast biopsy, one or more lesions
19120 Removal of breast lesion
19125 Excision of abnormal breast tissue, duct, nipple or areolar lesion, single lesion; identified by preoperative placement of radiological marker (physician in facility)
19126 Excision of abnormal breast tissue, duct, nipple or areolar lesion, each additional lesion (physician in facility)
19281 Preoperative placement of breast localization device, percutaneous: mammographic guidance, first lesion (physician in office)
19282 Preoperative placement of breast localization device, percutaneous: mammographic guidance, each additional lesion (physician in office)
19283 Preoperative placement of breast localization device, percutaneous: stereotactic guidance, first lesion (physician in office)
19284 Preoperative placement of breast localization device, percutaneous: stereotactic guidance, each additional lesion (physician in office)
19285 Preoperative placement of breast localization device, percutaneous: ultrasound guidance, first lesion (physician in office)
19286 Preoperative placement of breast localization device, percutaneous: ultrasound guidance, each additional lesion (physician in office)
56405 I & D of vulva/perineum
56420 Drainage of gland abscess
56501 Destroy, vulva lesions, simple
56515 Destroy vulva lesions, complex
56605 Biopsy of vulva/perineum
56606 Biopsy of vulva/perineum
56820 Exam of vulva w/scope
57023 I & D vaginal hematoma, non-ob
57061 Destroy vaginal lesions, simple
57100 Biopsy of vagina
57421 Exam/biopsy of vagina w/scope
57511 Cryocautery of cervix
58100 Biopsy of uterine lining
Cervical Cancer Screening Services  
57452 Examination of vagina – colposcopy
57454 Vagina examination and biopsy
57455 Biopsy of cervix with scope
57456 Endocervical curettage with scope
57460 Cervix excision
57461 Conization of cervix with scope, leep
57500 Biopsy of cervix
57505 Endocervical curettage
57520 Conization of cervix, cold knife or laser
57522 Conization of cervix, leep
58110 Biopsy done w/colposcopy add-on
Supplies  
A4253 Blood glucose/reagent strips
A4258 Springload device for lancet
A4259 Lancets per box (100 count)
A4264 Intratubal occlusion device