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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 |