Procedure
Code

Procedure Code Description

Prior
Authorization
Rule

0600U

Infectious disease (wound infection), identification of 65 organisms and 30 antibiotic resistance genes, wound swab, real-time PCR, reported as positive or negative for each organism

Yes

0601U

Infectious disease (periprosthetic joint infection), analysis of 11 biomarkers (alpha defensins 1-3, C-reactive protein, microbial antigens for Staphylococcus [SPA, SPB], Enterococcus, Candida, and C. acnes, total nucleated cell count, percent neutrophils

Yes

0602U

Endocrinology (diabetes), insulin (INS) gene methylation using digital droplet PCR, insulin, and C-peptide immunoassay, serum, Hemoglobin A1c immunoassay, whole blood, algorithm reported as diabetes-risk score

Yes

0603U

Drug assay, presumptive, 77 drugs or metabolites, urine, liquid chromatography with tandem mass spectrometry (LC-MS/MS), results reported as positive or negative

Yes

0604U

Allergy and immunology (chronic recurrent angioedema), 4 bradykinin peptides, liquid chromatography and tandem mass spectrometry (LC-MS/MS), whole blood, quantitative

Yes

0605U

Allergy and immunology (hereditary alpha tryptasemia), DNA, analysis of TPSAB1 gene copy number variation using digital PCR, whole blood, results reported with genotype-specific interpretation of alpha-tryptase copy number and algorithmic classification a

Yes

0606U

Hematology (red cell membrane disorders), RBCs, osmotic gradient ektacytometry, whole blood, quantitative

Yes

0607U

Reproductive medicine (endometrial microbiome assessment), real-time PCR analysis for 31 bacterial DNA targets from endometrial biopsy, reported with quantified levels of bacterial presence and targeted treatment recommendations

Yes

0608U

Reproductive medicine (endometrial microbiome assessment), real-time PCR analysis for 10 bacterial DNA targets from endometrial biopsy, reported with quantified levels of bacterial presence and targeted treatment recommendations

Yes

0609U

Oncology (prostate), immunoassay for total prostate-specific antigen (PSA) and free PSA, serum or plasma, combined with clinical features, algorithm reported as a probability score for clinically significant prostate cancer

Yes

0610U

Infectious disease (antimicrobial susceptibility), phenotypic antimicrobial susceptibility testing of positive blood culture using microfluidic sensor technology to quantify bacterial growth response to multiple antibiotic types, reporting categorical sus

Yes

0611U

Oncology (liver), analysis of over 1,000 methylated regions, cell-free DNA from plasma, algorithm reported as a quantitative result

Yes

0612U

Oncology (liver), analysis of over 1,000 methylated regions, cell-free DNA from plasma, algorithm reported as a quantitative result

Yes

0613U

Oncology (urothelial carcinoma), DNA methylation and mutation analysis of 6 biomarkers (TWIST1, OTX1, ONECUT2, FGFR3, HRAS, TERT promoter region), methylation-specific PCR and targeted next-generation sequencing, urine, algorithm reported as a probability

Yes

0988T

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 t

Yes

0989T

Revision or removal of integrated neurostimulation system for bladder dysfunction, including analysis, programming, and imaging, when performed, posterior tibial nerve; subcutaneous and subfascial

No

0990T

Transcervical instillation of biodegradable hydrogel materials, intrauterine

Yes

0991T

Cystourethroscopy, with low-energy lithotripsy and acoustically actuated microspheres, including imaging

No

0992T

Noninvasive assessment of cardiac risk derived from augmentative software analysis of perivascular fat without concurrent computed tomography (CT) scan of the heart, including patient-specific clinical factors, with interpretation and report by a physicia

Yes

0993T

Noninvasive assessment of cardiac risk derived from augmentative software analysis of perivascular fat with concurrent computed tomography scan of the heart, including patient-specific clinical factors, with interpretation and report by a physician or oth

Yes

0994T

Endovascular delivery of aortic wall stabilization drug therapy through a sheath positioned within an abdominal aortic aneurysm, with aortic roadmapping, balloon occlusion, imaging guidance, and radiological supervision and interpretation; percutaneous

No

0995T

Endovascular delivery of aortic wall stabilization drug therapy through a sheath positioned within an abdominal aortic aneurysm, with aortic roadmapping, balloon occlusion, imaging guidance, and radiological supervision and interpretation; open

No

0996T

Insertion and scleral fixation of a capsular bag prosthesis containing an intraocular lens prosthesis, with vitrectomy, including removal of crystalline lens or dislocated intraocular lens prosthesis, when performed

Yes

0997T

Precuneus magnetic stimulation; treatment planning using magnetic resonance imaging-guided neuronavigation to determine optimal location, dose, and intensity for magnetic stimulation therapy, derived from evoked potentials from single pulses of electromag

Yes

0998T

Precuneus magnetic stimulation; personalized treatment delivery of magnetic stimulation therapy to a prespecified target area derived from analysis of evoked potentials within the precuneus, utilizing magnetic resonance imaging-based neuronavigation, with

Yes

0999T

Autologous muscle cell therapy, harvesting of muscle progenitor cells, including ultrasound guidance, when performed

Yes

1000T

Autologous muscle cell therapy, administration of muscle progenitor cells into the urethral sphincter, including cystoscopy and post-void residual ultrasound, when performed

Yes

1001T

Autologous muscle cell therapy, injection of muscle progenitor cells into the external anal sphincter, including ultrasound guidance, when performed

Yes

1002T

Air displacement plethysmography, whole-body composition assessment, with interpretation and report

No

1003T

Arthroplasty, first carpometacarpal joint, with distal trapezial and proximal first metacarpal prosthetic replacement (eg, first carpometacarpal total joint)

No

1004T

Electronic analysis of implanted sub-scalp continuous bilateral electroencephalography monitoring system (eg, contact group[s], gain, bandpass filters) by physician or other qualified health care professional; without programming

No

1005T

Electronic analysis of implanted sub-scalp continuous bilateral electroencephalography monitoring system (eg, contact group[s], gain, bandpass filters) by physician or other qualified health care professional; with programming, first 15 minutes face-to-fa

No

1006T

Electronic analysis of implanted sub-scalp continuous bilateral electroencephalography monitoring system (eg, contact group[s], gain, bandpass filters) by physician or other qualified health care professional; with programming, each additional 15 minutes

No

1007T

Electroencephalogram from implanted sub-scalp continuous bilateral electroencephalography monitoring system, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and repo

No

1008T

Remote monitoring of sub-scalp implanted continuous bilateral electroencephalography monitoring system, device fitting, initial set-up, and patient education in wearing of system and use of equipment

No

1009T

Remote monitoring of a sub-scalp implanted continuous bilateral electroencephalography monitoring system, physician or other qualified health care professional review of recorded events, analysis of spike and seizure detection, interpretation, and report,

No

1010T

Computerized ophthalmic analysis of monocular eye movements using retinal-based eye-tracking without spatial calibration, including fixation, microsaccades, drift, and horizontal saccades, when performed, unilateral or bilateral, with interpretation and r

No

1011T

Photobiomodulation (PBM) therapy of oral cavity, including placement of an oral device, monitoring of patient tolerance to treatment, and removal of the oral device

No

1012T

Motorized ab interno trephination of sclera (sclerostomy), or trabecular meshwork (trabeculostomy), 1 or more, including injection of antifibrotic agents, when performed

No

1013T

Laparoscopy, surgical, implantation or replacement of lower esophageal sphincter neurostimulator electrode array and neurostimulator pulse generator or receiver, requiring pocket creation and connection between electrode array and pulse generator or recei

Yes

1014T

Laparoscopic revision or removal, lower esophageal sphincter neurostimulator electrodes

No

1015T

Revision or removal, lower esophageal sphincter neurostimulator pulse generator or receiver

No

1016T

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements), lower eso

No

1017T

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements), lower eso

No

1018T

Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of waveform, battery status, electrode selectability, output modulation, cycling, impedance and patient measurements), lower eso

No

1019T

Lymphovenous bypass, including robotic assistance, when performed, per extremity

Yes

1020T

Raman spectroscopy of 1 or more skin lesions, with probability score for malignant risk derived by algorithmic analysis of data from each lesion

Yes

1021T

Active thoracic irrigation (separate procedure)

Yes

1022T

Percutaneous tissue displacement, any method, including imaging guidance; intra-abdominal/pelvic structures (List separately in addition to code for primary procedure)

No

1023T

Percutaneous tissue displacement, any method, including imaging guidance; intrathoracic structures (List separately in addition to code for primary procedure)

No

1024T

Percutaneous tissue displacement, any method, including imaging guidance; soft tissue (List separately in addition to code for primary procedure)

No

27458

Osteotomy(ies), femur, unilateral, with insertion of an externally controlled intramedullary lengthening device, including iliotibial band release when performed, imaging, alignment assessments, computations of adjustment schedules, and management of the

No

27713

Osteotomy(ies), tibia, including fibula when performed, unilateral, with insertion of an externally controlled intramedullary lengthening device, including imaging, alignment assessments, computations of adjustment schedules, and management of the intrame

No

33882

Endovascular repair of the thoracic aorta by deployment of a branched endograft multipiece system involving an aorto-aortic tube device with a fenestration for the left subclavian artery stent graft(s) and all aortic tube endograft extension(s) placed fro

No

35602

Bypass graft, with other than vein; carotid-contralateral carotid

No

37254

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidanc

No

37255

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidanc

No

37256

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidanc

No

37257

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imaging guidanc

No

37258

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery

No

37259

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery

No

37260

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery

No

37261

Revascularization, endovascular, open or percutaneous, iliac vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing the artery

No

37262

Intravascular lithotripsy(ies), iliac vascular territory, including all imaging guidance and radiological supervision and interpretation necessary to perform the intravascular lithotripsy(ies) within the same artery (List separately in addition to code fo

No

37263

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all

No

37264

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all

No

37265

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all

No

37266

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all

No

37267

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheter

No

37268

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheter

No

37269

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheter

No

37270

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheter

No

37271

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizin

No

37272

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizin

No

37273

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizin

No

37274

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizin

No

37275

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acc

No

37276

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acc

No

37277

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acc

No

37278

Revascularization, endovascular, open or percutaneous, femoral and popliteal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acc

No

37279

Intravascular lithotripsy(ies), femoral and popliteal vascular territory, including all imaging guidance and radiological supervision and interpretation necessary to perform the intravascular lithotripsy(ies) within the same artery (List separately in add

No

37280

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all i

No

37281

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all i

No

37282

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all i

No

37283

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all i

No

37284

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheteriz

No

37285

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheteriz

No

37286

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheteriz

No

37287

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheteriz

No

37288

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing

No

37289

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing

No

37290

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing

No

37291

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for accessing and selectively catheterizing

No

37292

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acces

No

37293

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acces

No

37294

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acces

No

37295

Revascularization, endovascular, open or percutaneous, tibial and peroneal vascular territory, with transluminal stent placement, with transluminal atherectomy, including transluminal angioplasty when performed, including all maneuvers necessary for acces

No

37296

Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imagin

No

37297

Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imagin

No

37298

Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imagin

No

37299

Revascularization, endovascular, open or percutaneous, inframalleolar vascular territory, with transluminal angioplasty, including all maneuvers necessary for accessing and selectively catheterizing the artery and crossing the lesion, including all imagin

No

43889

Gastric restrictive procedure, transoral, endoscopic sleeve gastroplasty (ESG), including argon plasma coagulation, when performed

Yes

47384

Ablation, irreversible electroporation, liver, 1 or more tumors, including imaging guidance, percutaneous

No

52443

Cystourethroscopy with initial transurethral anterior prostate commissurotomy with a nondrug-coated balloon catheter followed by therapeutic drug delivery into the prostate by a drug-coated balloon catheter, including transrectal ultrasound and fluoroscop

No

52597

Transurethral robotic-assisted waterjet resection of prostate, including intraoperative planning, ultrasound guidance, control of postoperative bleeding, complete, including vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, an

No

55707

Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])

No

55708

Biopsy, prostate, transrectal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance, first targeted lesion

No

55709

Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant, ultrasound-localized discrete lesion[s])

No

55710

Biopsy, prostate, transperineal, ultrasound-guided (ie, sextant) with MRI-fusion-guidance biopsy, first targeted lesion

No

55711

Biopsy, prostate, transrectal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion

No

55712

Biopsy, prostate, transperineal, MRI-ultrasound-fusion guided, targeted lesion(s) only, first targeted lesion

No

55713

Biopsy, prostate, in-bore CT- or MRI-guided (ie, sextant), with biopsy of additional targeted lesion(s), first targeted lesion

No

55714

Biopsy, prostate, in-bore CT- or MRI-guided targeted lesion(s) only, first targeted lesion

No

55715

Biopsy, prostate, each additional, MRI-ultrasound fusion or in-bore CT- or MRI-guided targeted lesion (List separately in addition to code for primary procedure)

No

55868

Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with lymph node biopsy(ies) (limited pelvic lymphadenectomy)

No

55869

Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes

No

55877

Ablation, irreversible electroporation, prostate, 1 or more tumors, including imaging guidance, percutaneous

No

62330

Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (ie, CT or fluoroscopy), bilateral; one interspace, lumbar

No

62331

Decompression, percutaneous, with partial removal of the ligamentum flavum, including laminotomy for access, epidurography, and imaging guidance (ie, CT or fluoroscopy), bilateral; additional interspace(s), lumbar (List separately in addition to code for

No

63032

Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; with repair of annular defect by implantation of bone-anchored annular closure device, includi

Yes

64567

Percutaneous electrical nerve field stimulation, cranial nerves, without implantation

Yes

64654

Initial open implantation of baroreflex activation therapy (BAT) modulation system, including lead placement onto the carotid sinus, lead tunnelling, connection to a pulse generator placed in a distant subcutaneous pocket (ie, total system), and intraoper

Yes

64655

Revision or replacement of baroreflex activation therapy (BAT) modulation system, with intraoperative interrogation and programming; lead only

Yes

64656

Revision or replacement of baroreflex activation therapy (BAT) modulation system, with intraoperative interrogation and programming; pulse generator only

Yes

64657

Removal of baroreflex activation therapy (BAT) modulation system; total system, including lead and pulse generator

No

64658

Removal of baroreflex activation therapy (BAT) modulation system; lead only

No

64659

Removal of baroreflex activation therapy (BAT) modulation system; pulse generator only

No

64728

Decompression; median nerve at the carpal tunnel, percutaneous, with intracarpal tunnel balloon dilation, including ultrasound guidance

No

70471

Computed tomographic angiography (CTA), head and neck, with contrast material(s), including noncontrast images, when performed, and image postprocessing

Evolent

70472

Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed with concurrent CT or CT angiography of the same anatomy (List separately in addition to code for primary procedure)

Evolent

70473

Computed tomographic (CT) cerebral perfusion analysis with contrast material(s), including image postprocessing performed without concurrent CT or CT angiography of the same anatomy

Yes

75577

Quantification and characterization of coronary atherosclerotic plaque to assess severity of coronary disease, derived from augmentative software analysis of the data set from a coronary computed tomographic angiography, with interpretation and report by

Yes

77436

Surface radiation therapy; superficial or orthovoltage, treatment planning and simulation-aided field setting

No

77437

Surface radiation therapy; superficial, delivery, Γëñ150 kV, per fraction (eg, electronic brachytherapy)

No

77438

Surface radiation therapy; orthovoltage, delivery, >150-500 kV, per fraction

No

77439

Surface radiation therapy; superficial or orthovoltage, image guidance, ultrasound for placement of radiation therapy fields for treatment of cutaneous tumors, per course of treatment (List separately in addition to code for primary procedure)

No

81354

Cytogenomic (genome-wide) analysis for constitutional chromosomal abnormalities; interrogation of structural and copy number variants, optical genome mapping (OGM)

Yes auth

81524

Oncology (central nervous system tumor), DNA methylation analysis of at least 10,000 methylation sites, utilizing DNA extracted from formalin-fixed tumor tissue, algorithm(s) reported as probability of matching a reference tumor family and class, and MGMT

Yes auth

87182

Susceptibility studies, antimicrobial agent; carbapenemase enzyme detection (eg, Klebsiella pneumoniae carbapenemase [KPC], New Delhi metallo-beta-lactamase [NDM], Verona integron-encoded metallo-beta-lactamase [VIM]), multiplex immunoassay, qualitative,

No

87183

Susceptibility studies, antimicrobial agent; carbapenem resistance genes (eg, blaKPC, blaNDM, blaVIM, blaOXA-48, blaIMP), amplified probe technique, per isolate

No

87494

Infectious agent detection by nucleic acid (DNA or RNA); Chlamydia trachomatis and Neisseria gonorrhoeae, multiplex amplified probe technique

No

87627

Infectious agent detection by nucleic acid (DNA or RNA); joint space pathogens and drug resistance genes, multiplex amplified probe technique, 26 or more targets

No

87812

Infectious agent antigen detection by immunoassay with direct optical (ie, visual) observation; severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (coronavirus disease [COVID-19]) and influenza virus types A and B

No

90481

Immunization administration by intramuscular injection, severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) (coronavirus disease [COVID-19]) vaccine; each additional component administered (List separately in addition to code for primary procedure

No

90482

Immunization counseling by physician or other qualified health care professional when immunization(s) is not administered by provider on the same date of service; 3 minutes up to 10 minutes

No

90483

Immunization counseling by physician or other qualified health care professional when immunization(s) is not administered by provider on the same date of service; greater than 10 minutes up to 20 minutes

No

90484

Immunization counseling by physician or other qualified health care professional when immunization(s) is not administered by provider on the same date of service; greater than 20 minutes

No

91124

Rectal sensation, tone, and compliance study (eg, barostat)

No

91125

Anorectal manometry, with rectal sensation and rectal balloon expulsion test, when performed

No

92288

Screening dark adaptation measurement (eg, rod recovery intercept time), with interpretation and report

No

92628

Evaluation for hearing aid candidacy, unilateral or bilateral, including review and integration of audiologic function tests, assessment, and interpretation of hearing needs (eg, speech-in-noise, suprathreshold hearing measures), discussion of candidacy r

No

92629

Evaluation for hearing aid candidacy, unilateral or bilateral, including review and integration of audiologic function tests, assessment, and interpretation of hearing needs (eg, speech-in-noise, suprathreshold hearing measures), discussion of candidacy r

No

92631

Hearing aid selection services, unilateral or bilateral, including review of audiologic function tests and hearing aid candidacy evaluation, assessment of visual and dexterity limitations, and psychosocial factors, establishment of device type, output req

No

92632

Hearing aid selection services, unilateral or bilateral, including review of audiologic function tests and hearing aid candidacy evaluation, assessment of visual and dexterity limitations, and psychosocial factors, establishment of device type, output req

No

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

No

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

No

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 connec

No

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 connec

No

92638

Behavioral verification of amplification including aided thresholds, functional gain, speech-in-noise, when performed (List separately in addition to code for primary procedure)

No

92639

Hearing-aid measurement, verification with probe-microphone (List separately in addition to code for primary procedure)

No

92641

Hearing device verification, electroacoustic analysis

No

92642

Hearing assistive device, supplemental technology fitting services (eg, personal frequency modulation [FM]/digital modulation [DM] system, remote microphone, alerting devices)

No

92930

Percutaneous transcatheter placement of intracoronary stent(s), with coronary angioplasty when performed, single major coronary artery and/or its branch(es); 2 or more distinct coronary lesions with 2 or more coronary stents deployed in 2 or more coronary

No

92945

Percutaneous transluminal revascularization of chronic total occlusion, single coronary artery, coronary artery branch, or coronary artery bypass graft, and/or subtended major coronary artery branches of the bypass graft, any combination of intracoronary

No

93145

Interrogation device evaluation (in person), carotid sinus baroreflex activation therapy (BAT) modulation system including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with int

No

93146

Interrogation device evaluation (in person), carotid sinus baroreflex activation therapy (BAT) modulation system including telemetric iterative communication with the implantable device to monitor device diagnostics and programmed therapy values, with int

No

97007

Mechanical scalp cooling, including individual cap supply with head measurement, fitting, and patient education

No

97008

Mechanical scalp cooling; including hair preparation, individual cap placement, therapy initiation, and precooling period

No

97009

Mechanical scalp cooling; provided after discontinuation of chemotherapy, each 30 minutes (List separately in addition to code for primary procedure)

No

98979

Remote therapeutic monitoring treatment management services, physician or other qualified health care professional time in a calendar month requiring at least 1 real-time interactive communication with the patient or caregiver during the calendar month; f

No

98984

Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of respiratory system, 2-15 days in a 30-day period

No

98985

Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of musculoskeletal system, 2-15 days in a 30-day period

No

98986

Remote therapeutic monitoring (eg, therapy adherence, therapy response, digital therapeutic intervention); device(s) supply for data access or data transmissions to support monitoring of cognitive behavioral therapy, 2-15 days in a 30-day period

No

99445

Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate); device(s) supply with daily recording(s) or programmed alert(s) transmission, 2-15 days in a 30-day period

No

99470

Remote physiologic monitoring treatment management services, clinical staff/physician/other qualified health care professional time in a calendar month requiring 1 real-time interactive communication with the patient/caregiver during the calendar month; f

No

A4295

Intermittent urinary catheter; straight tip, hydrophilic coating, each

No

A4296

Intermittent urinary catheter; Coude (curved) tip, hydrophilic coating, each

No

A4297

Intermittent urinary catheter; hydrophilic coating, with insertion supplies

No

C1607

Neurostimulator, integrated (implantable), rechargeable with all implantable and external components including charging system

No

C1608

Prosthesis, total, dual mobility, first carpometacarpal joint (implantable)

No

C7566

Arthrodesis, interphalangeal joints, with or without internal fixation, with autografts (includes obtaining grafts)

No

C7567

Bronchoscopy, rigid or flexible, including fluoroscopic guidance when performed, with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i), with computer-assisted image-guided navigation

No

C7568

Catheter placement in coronary artery(ies) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation, with intravascular doppler velocity and/or pressure derived coronary flow reserve

No

C7569

Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with endoluminal imaging of initial coronary vessel or graft using intravascular ultrasound (IVUS) or optical coherence tomography (OCT) during diagnostic evaluation an

No

C7570

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation with intraprocedural coronary fractional flow reserve (FFR) with 3D functional mappi

No

C7571

Percutaneous transluminal coronary angioplasty, single major coronary artery or branch with percutaneous transluminal coronary lithotripsy

No

C9176

Tc-99m from domestically produced non-HEU-MO-99, [minimum 50 percent], full cost recovery add-on, per study dose

No

C9810

Water circulating motorized cold therapy device (e.g., iceman) including all system components (e.g., pads, console, disposable parts), non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in acc

No

C9811

Electronic ambulatory infusion pump (e.g., Sapphire pump), including all pump components, including disposable components , non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with

No

C9812

Echogenic nerve block needles (e.g., SonoPlex, SonoBlock, SonoTAP), non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with Section 4135 of the CAA, 2023)

No

C9813

Perforated continuous infusion catheter set (e.g., InfiltraLong), including all components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with Section 4135 of the CAA, 2023)

No

C9814

Continuous anesthesia echogenic conduction catheter set (e.g., SonoLong), non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with Section 4135 of the CAA, 2023)

No

C9815

Linear peristaltic pain management infusion pump (e.g., CADD-Solis ambulatory infusion pump), and all disposable system components, non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accorda

No

C9816

Rotary peristaltic infusion pump (e.g., reusable ambIT pump) including all disposable system components, reusable non-opioid medical device (must be a qualifying Medicare non-opioid medical device for post-surgical pain relief in accordance with Section 4

No

C9817

Electronic cryo-pneumatic compression, pain management system (e.g., Game Ready GRPro 2.1 system), including control unit, anatomically correct wrap(s), and other system component(s), non-opioid medical device (must be a qualifying Medicare non-opioid med

No

G0568

Initial psychiatric collaborative care management, in the first calendar 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,

No

G0569

Subsequent psychiatric collaborative care management, in a subsequent 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, wi

No

G0570

Care management services for behavioral health conditions, directed by a physician or other qualified health care professional, per calendar month, with the following required elements: initial assessment or follow-up monitoring, including the use of appl

No

G0571

Intraoperative nerve(s) cryoablation for post-surgical pain relief (list separately in addition to code for primary service)

No

G0660

TEAM remote E/M new patient, 10 mins

No

G0661

TEAM remote E/M new patient, 20 mins

No

G0662

TEAM remote E/M new patient, 30 mins

No

G0663

TEAM remote E/M new patient, 45 mins

No

G0664

TEAM remote E/M new patient, 60 mins

No

G0665

TEAM remote E/M established patient, 10 mins

No

G0666

TEAM remote E/M established patient, 15 mins

No

G0667

TEAM remote E/M established patient, 25 mins

No

G0668

TEAM remote E/M established patient, 40 mins

No

G9871

Behavioral counseling for diabetes prevention, online, 60 minutes

No

M1426

Encounters conducted via telehealth

No

M1427

Documentation of medical reason(s) for performing a bone scan (including documented pain related to prostate cancer, salvage therapy, other medical reasons)

No

M1428

Patients who have bilateral absence of eyes any time during the patient's history through the end of the measurement period

No

M1429

Retinal exam finding with evidence of retinopathy in left, right or both eyes with severity level documented

No

M1430

Retinal exam finding without evidence of retinopathy in both eyes with severity level documented (in measurement year or in the prior year)

No

M1431

Encounters conducted via telehealth

No

M1432

Encounters conducted via telehealth

No

M1433

Patient on oral chemotherapy on or within 30 days before denominator eligible encounter

No

M1434

Patient on oral chemotherapy on or within 30 days after denominator eligible encounter

No

M1435

Patient on oral chemotherapy during the performance period

No

M1436

Encounters conducted via telehealth

No

M1437

Encounters conducted via telehealth

No

M1438

Time last known well to hospital arrival less than or equal to 3.5 hours (<= 210 minutes)

No

M1439

Significant ocular conditions that impact the visual outcome of surgery

No

M1440

Encounters conducted via telehealth

No

M1441

Encounter corresponds to initial diagnosis of sleep apnea or first contact with sleep apnea diagnosed patient

No

M1442

Encounters conducted via telehealth

No

M1443

Encounters conducted via telehealth

No

M1444

Delivery at < 39 weeks of gestation

No

M1445

Postpartum care visit before or at 12 weeks of giving birth

No

M1446

Patients who died any time prior to the end of the measure assessment period

No

M1447

Patients with an active diagnosis of bipolar disorder any time prior to the end of the measure assessment period

No

M1448

Patients with an active diagnosis of personality disorder any time prior to the end of the measure assessment period

No

M1449

Patients with an active diagnosis of schizophrenia or psychotic disorder any time prior to the end of the measure assessment period

No

M1450

Patients who received hospice or palliative care service any time during denominator identification period or the measure assessment period

No

M1451

Patients with an active diagnosis of pervasive developmental disorder any time prior to the end of the measure assessment period

No

M1452

Patient ever had a diagnosis of dementia

No

M1453

Patients with a pre-operative visual acuity better than 20/40

No

M1454

New CIED

No

M1455

Replaced or revised CIED

No

M1456

Patient had a heart transplant

No

M1457

Patient had a diagnosis of asthma with any contact during the current or prior performance period or had asthma present on an active problem list any time during the performance period

No

M1458

Patient died prior to the end of the performance period

No

M1459

Patient was in hospice or receiving palliative care services at any time during the performance period

No

M1460

Diagnosis for chronic obstructive pulmonary disease, emphysema, cystic fibrosis, or acute respiratory failure

No

M1461

Patient diagnosis for chronic hepatitis C

No

M1462

Patients with clinical indications for imaging of the head

No

M1463

Documentation of at least two attempts to follow up with patient within 180 days of treatment

No

M1464

No documentation of at least two attempts to follow up with patient within 180 days of treatment

No

M1465

Patient follow up more than 180 days after treatment

No

M1466

Patient had a lumbar fusion on the same date as the discectomy/laminectomy procedure

No

M1467

Patients with an existing diagnosis of Lynch syndrome

No

M1468

Patient received recommended doses of hepatitis B vaccination based on age

No

M1469

Patient has a history of hepatitis B illness or received a hepatitis B surface antigen, hepatitis B surface antibody, or total antibody to hepatitis B core antigen test with a positive result any time before or during the measurement period

No

M1470

Documentation of medical reason(s) for not administering hepatitis B vaccine (e.g., prior anaphylaxis due to the hepatitis B vaccine)

No

M1471

Documentation that patient is a Medicare fee-for-service beneficiary and without additional supplementary insurance coverage for whom hepatitis B vaccination is not reimbursable under current Medicare Part B coverage rules

No

M1472

Patient did not receive recommended doses of hepatitis B vaccination based on age

No

M1473

Patient situations, at any point during the denominator identification period, where the patient's functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools, such as delirium, dementia, intellectu

No

M1474

Patients with diagnosis of dementia

No

M1475

Patients with diagnosis of Huntington's disease

No

M1476

Patients with diagnosis of cognitive impairment or Alzheimer's disease

No

M1477

Diagnosis of delirium

No

M1478

Psychoactive substance abuse

No

M1479

Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders

No

M1480

Patients whose functional capacity or motivation (or lack thereof) to improve may impact the accuracy of results of validated tools such as delirium, dementia, intellectual disabilities, and pervasive and specific development disorders

No

M1481

Patients receiving hospice or palliative care or who died during the measurement period

No

M1482

Positive/detectable hepatitis C virus quantitative or qualitative RNA test result during the denominator identification period

No

M1483

Patients who achieve sustained virological response as identified by an HCV RNA test (CPT 87522) or (CPT 87521) with a negative/undetectable HCV RNA result that occurred 20 weeks to 12 months after the first positive/detectable HCV RNA test result within

No

M1484

Patients who did not have a repeat HCV RNA labs performed for medical reasons documented by clinician (e.g., patient with limited life expectancy, delay in treatment of HCV related to treatment of HIV, HBV, hepatocellular carcinoma, decompensated cirrhosi

No

M1485

Patients who did not achieve sustained virological response as identified by an HCV RNA test (CPT 87522) or (CPT 87521) with a negative/undetectable HCV RNA result that occurred 20 weeks to 12 months after the first positive/detectable HCV RNA test result

No

M1486

Patients admitted to a skilled nursing facility (SNF) during the period of evaluation

No

M1487

Patients in hospice in the year before or during the period of evaluation

No

M1488

Patients with a diagnosis for dementia in the year before or during the period of evaluation

No

M1489

Patient status documented

No

M1490

Patient status not documented

No

M1491

Receiving ESRD MCP dialysis services by the provider during the performance period

No

M1492

Patients who did not report a fall

No

M1493

Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, Tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury [MTBI], cervical dystonia, or epilepsy)

No

M1494

Patients that reported a fall since the last visit

No

M1495

Patients that reported a fall occurred who had a plan of care for falls documented or patients that did not report a fall

No

M1496

Patients that had a fall who did not have a plan of care for falls documented or do not have documentation of being assessed for falls

No

M1497

Documentation of falls not performed due to medical reasons (e.g., syncope, vertigo and related disorders, restless leg syndrome, Tourette syndrome/tic disorder, back pain, concussion/mild traumatic brain injury [MTBI], cervical dystonia, or epilepsy)

No

M1498

Diagnostic Radiology MIPS value pathway

No

M1499

Interventional Radiology MIPS value pathway

No

M1500

Neuropsychology MIPS value pathway

No

M1501

Pathology MIPS value pathway

No

M1502

Podiatry MIPS value pathway

No

M1503

Vascular Surgery MIPS value pathway

No

Q4398

Summit AC, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4399

Summit FX, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4400

Polygon3 Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4401

Absolv3 Membrane, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4402

XWRAP 2.0, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4403

XWRAP Dual Plus, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4404

XWRAP Hydro Plus, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4405

XWRAP Fenestra Plus, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4406

XWRAP Fenestra, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4407

XWRAP Tribus, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4408

XWRAP Hydro, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4409

AmniomatrixF3X, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4410

AmchoMatrixDL, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4411

AmniomatrixF4X, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4412

CHORIOFIX, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4413

Cygnus Solo, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4414

SimpliChor, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4415

AlexiGuard SL-T, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4416

AlexiGuard TL-T, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4417

AlexiGuard DL-T, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4420

NuForm, per sq cm (add-on, list separately in addition to primary procedure)

Yes

Q4431

PMA skin substitute product, not otherwise specified (list in addition to primary procedure)

Yes

Q4432

510(k) skin substitute product, not otherwise specified (list in addition to primary procedure)

Yes

Q4433

361 HCT/P skin substitute product, not otherwise specified (list in addition to primary procedure)

Yes

Q5160

Injection, bevacizumab-nwgd (Jobevne), biosimilar, 10 mg

Yes

C9307

Injection, linvoseltamab-gcpt, 1 mg

Yes

C9308

Injection, carboplatin (Avyxa), 1 mg

No

J0013

Esketamine, nasal spray, 1 mg

Yes

J0162

Injection, epinephrine (Fresenius Kabi), not therapeutically equivalent to J0165, 0.1 mg

No

J0654

Injection, liothyronine, 1 mcg

No

J1073

Testosterone pellet, implant, 75 mg

Yes

J1736

Injection, meloxicam (Delova), 1 mg

No

J1737

Injection, meloxicam (Azurity), 1 mg

No

J1837

Injection, posaconazole, 1 mg

No

J2516

Injection, pentamidine isethionate, 1 mg

No

J2596

Injection, vasopressin (Long Grove), not therapeutically equivalent to J2598, 1 unit

Yes

J2711

Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg

No

J3291

Injection, tranexamic acid in sodium chloride, 5 mg

No

J3376

Injection, vancomycin HCl (Hikma), not therapeutically equivalent to J3373, 10 mg

No

J3379

Injection, valproate sodium, 5 mg

No

J3387

Injection, elivaldogene autotemcel, per treatment

Yes

J3389

Topical administration, prademagene zamikeracel, per treatment

Yes

J7299

Intrauterine copper contraceptive (Miudella)

No

J7528

Mycophenolate mofetil, for suspension, oral, 100 mg

Yes

J9184

Injection, gemcitabine HCl (Avyxa), 200 mg

No

J9256

Injection, nipocalimab-aahu, 3 mg

Yes

J9282

Mitomycin, intravesical instillation, 1 mg

Yes

J9326

Injection, telisotuzumab vedotin-tllv, 1 mg

Yes