Prior Authorization Reference Guide – Exchange

  • The purpose of these guides (below, by line of business) is to inform you of services that require prior authorization.
  • If you do not find a specific service listed on these guides, it may be that the service is a non-covered benefit. If you need information related to covered services, please refer to our Billing Guidelines and Coverage Summaries or call Neighborhood Provider Services at 1-800-963-1001.
  • All Acute and Post-Acute admissions require authorization.
  • Neighborhood Health Plan of RI utilizes the following criteria to make medical review decisions:
    • InterQual
    • Clinical Medical Policies
  • Access Prior Authorization Forms here.  Forms can be completed online or submitted to the 24/7 fax line at 401-459-6023.If you have any questions about the authorization process, please call Utilization Management at 401-459-6060.
  • For the following areas: Radiology, Oncology and Durable Medical Equipment please see our partnered vendor information below regarding authorization requirements

 

Radiology Authorization Information

Radiology Authorizations

Neighborhood has partnered with eviCore Healthcare for prior authorization of outpatient elective CT, MR, PET, CT Cardiac, MR Cardiac, PET Cardiac, Nuclear Cardiology and 3D Rendering Procedures.  Out of Network Providers: Please see NHPRI auth guide for additional radiology codes that may require auth

Please note: Neighborhood and eviCore will accept authorizations from either the ordering or rendering provider prior to the service being rendered.

Additional resources:

For more information visit eviCore.

Oncology Authorization Information

Oncology Authorizations

Neighborhood has partnered with New Century Health – Program for oncology-related drugs and/or treatment.

ICD-10, CPT and HCPC code list for Genomic and Radiation Oncology as of 4-1-2021.pdf

 

Durable Medical Equipment (DME) Authorization Information

DME Authorizations

Neighborhood has partnered with DMEnsion Benefit Manager- processes claims and manages the DME vendor network for DME delivered in the home. Please see NHPRI auth guide for DME HCPC codes rendered in POS other than 12(home).

 

Code Code DescriptionAuthorization Required CommentsForm Link
10004Fine needle aspiration biopsy, without imaging guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10005Fine needle aspiration biopsy, including ultrasound guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10006Fine needle aspiration biopsy, including ultrasound guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10007Fine needle aspiration biopsy, including fluoroscopic guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10008Fine needle aspiration biopsy, including fluoroscopic guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10009Fine needle aspiration biopsy, including CT guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10010Fine needle aspiration biopsy, including CT guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10011Fine needle aspiration biopsy, including MR guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10012Fine needle aspiration biopsy, including MR guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10021Fine needle aspiration biopsy, without imaging guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10030Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst), soft tissue (eg, extremity, abdominal wall, neck), percutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10035Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10036Placement of soft tissue localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous, including imaging guidance; each additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10040Acne surgery (eg, marsupialization, opening or removal of multiple milia, comedones, cysts, pustules)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10060Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); simple or singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10061Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multipleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10080Incision and drainage of pilonidal cyst; simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10081Incision and drainage of pilonidal cyst; complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10120Incision and removal of foreign body, subcutaneous tissues; simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10121Incision and removal of foreign body, subcutaneous tissues; complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10140Incision and drainage of hematoma, seroma or fluid collectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10160Puncture aspiration of abscess, hematoma, bulla, or cystSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
10180Incision and drainage, complex, postoperative wound infectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11000Debridement of extensive eczematous or infected skin; up to 10% of body surfaceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11001Debridement of extensive eczematous or infected skin; each additional 10% of the body surface, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11004Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia and perineumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11005Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; abdominal wall, with or without fascial closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11006Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft tissue infection; external genitalia, perineum and abdominal wall, with or without fascial closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11008Removal of prosthetic material or mesh, abdominal wall for infection (eg, for chronic or recurrent mesh infection or necrotizing soft tissue infection) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11010Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissuesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11011Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11012Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11042Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11043Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11044Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11045Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11046Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11047Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11055Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); single lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11056Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); 2 to 4 lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11057Paring or cutting of benign hyperkeratotic lesion (eg, corn or callus); more than 4 lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11102Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); single lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11103Tangential biopsy of skin (eg, shave, scoop, saucerize, curette); each separate/additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11104Punch biopsy of skin (including simple closure, when performed); single lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11105Punch biopsy of skin (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11106Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); single lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11107Incisional biopsy of skin (eg, wedge) (including simple closure, when performed); each separate/additional lesion (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11300Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.5 cm or lessYesOutpatient Surgery e-form
11301Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 0.6 to 1.0 cmYesOutpatient Surgery e-form
11302Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11303Shaving of epidermal or dermal lesion, single lesion, trunk, arms or legs; lesion diameter over 2.0 cmYesOutpatient Surgery e-form
11305Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or lessYesOutpatient Surgery e-form
11306Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cmYesOutpatient Surgery e-form
11307 Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11308Shaving of epidermal or dermal lesion, single lesion, scalp, neck, hands, feet, genitalia; lesion diameter over 2.0 cmYesOutpatient Surgery e-form
11310Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or lessYesOutpatient Surgery e-form
11311Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cmYesOutpatient Surgery e-form
11312Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11313Shaving of epidermal or dermal lesion, single lesion, face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 2.0 cmYesOutpatient Surgery e-form
11400Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.5 cm or less. (Complex or layered closure is reported separately, if required. Each lesion removed is reported separately.) YesOutpatient Surgery e-form
11401Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 0.6 to 1.0 cm. (Complex or layered closure is reported separately, if required. Each lesion removed is reported separately.)YesOutpatient Surgery e-form
11402 Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11403Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 2.1 to 3.0 cmYesOutpatient Surgery e-form
11404Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter 3.1 to 4.0 cmYesOutpatient Surgery e-form
11406Excision, benign lesion including margins, except skin tag (unless listed elsewhere), trunk, arms or legs; excised diameter over 4.0 cmYesOutpatient Surgery e-form
11420Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or lessYesOutpatient Surgery e-form
11421Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cmYesOutpatient Surgery e-form
11422Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11423Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cmYesOutpatient Surgery e-form
11424Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cmYesOutpatient Surgery e-form
11426Excision, benign lesion including margins, except skin tag (unless listed elsewhere), scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cmYesOutpatient Surgery e-form
11440 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.5 cm or lessYesOutpatient Surgery e-form
11441 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 0.6 to 1.0 cmYesOutpatient Surgery e-form
11442 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 1.1 to 2.0 cmYesOutpatient Surgery e-form
11443 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 2.1 to 3.0 cmYesOutpatient Surgery e-form
11444 Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter 3.1 to 4.0 cmYesOutpatient Surgery e-form
11446Excision, other benign lesion including margins, except skin tag (unless listed elsewhere), face, ears, eyelids, nose, lips, mucous membrane; excised diameter over 4.0 cmYesOutpatient Surgery e-form
11450Excision of skin and subcutaneous tissue for hidradenitis, axillary; with simple or intermediate repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11451Excision of skin and subcutaneous tissue for hidradenitis, axillary; with complex repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11462Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with simple or intermediate repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11463Excision of skin and subcutaneous tissue for hidradenitis, inguinal; with complex repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11470Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with simple or intermediate repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11471Excision of skin and subcutaneous tissue for hidradenitis, perianal, perineal, or umbilical; with complex repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11600Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11601Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11602Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11603Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11604Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11606Excision, malignant lesion including margins, trunk, arms, or legs; excised diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11620Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11621Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11622Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11623Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11624Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11626Excision, malignant lesion including margins, scalp, neck, hands, feet, genitalia; excised diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11640Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11641Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11642Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11643Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11644Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11646Excision, malignant lesion including margins, face, ears, eyelids, nose, lips; excised diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11730Avulsion of nail plate, partial or complete, simple; singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11732Avulsion of nail plate, partial or complete, simple; each additional nail plate (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11740Evacuation of subungual hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11750Excision of nail and nail matrix, partial or complete (eg, ingrown or deformed nail), for permanent removal;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11755Biopsy of nail unit (eg, plate, bed, matrix, hyponychium, proximal and lateral nail folds) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11760Repair of nail bedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11762Reconstruction of nail bed with graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11765Wedge excision of skin of nail fold (eg, for ingrown toenail)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11770Excision of pilonidal cyst or sinus; simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11771Excision of pilonidal cyst or sinus; extensiveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11772Excision of pilonidal cyst or sinus; complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11900Injection, intralesional; up to and including 7 lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11901Injection, intralesional; more than 7 lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11920Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.0 sq cm or lessYesOutpatient Surgery e-form
11921Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; 6.1 to 20.0 sq cmYesOutpatient Surgery e-form
11922Tattooing, intradermal introduction of insoluble opaque pigments to correct color defects of skin, including micropigmentation; each additional 20.0 sq cm, or part thereof (List separately in addition to code for primary procedure)YesOutpatient Surgery e-form
11950Subcutaneous injection of filling material (eg, collagen); 1 cc or lessYesOutpatient Surgery e-form
11951Subcutaneous injection of filling material (eg, collagen); 1.1 to 5.0 ccYesOutpatient Surgery e-form
11952Subcutaneous injection of filling material (eg, collagen); 5.1 to 10.0 ccYesOutpatient Surgery e-form
11954Subcutaneous injection of filling material (eg, collagen); over 10.0 ccYesOutpatient Surgery e-form
11960Insertion of tissue expander(s) for other than breast, including subsequent expansionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11970Replacement of tissue expander with permanent prosthesisYesOutpatient Surgery e-form
11971Removal of tissue expander(s) without insertion of prosthesisYesOutpatient Surgery e-form
11976Removal, implantable contraceptive capsulesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11980Subcutaneous hormone pellet implantation (implantation of estradiol and/or testosterone pellets beneath the skin)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11981Insertion, non-biodegradable drug delivery implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11982Removal, non-biodegradable drug delivery implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
11983Removal with reinsertion, non-biodegradable drug delivery implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12001Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12002Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12004Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12005Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 12.6 cm to 20.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12006Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 20.1 cm to 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12007Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); over 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12011Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12013Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12014Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12015Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12016Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12017Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12018Simple repair of superficial wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12020Treatment of superficial wound dehiscence; simple closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12021Treatment of superficial wound dehiscence; with packingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12031Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12032Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12034Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 7.6 cm to 12.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12035Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 12.6 cm to 20.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12036Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); 20.1 cm to 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12037Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet); over 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12041Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12042Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12044Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12045Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12046Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12047Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; over 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12051Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12052Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12053Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12054Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12055Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12056Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
12057Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; over 30.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13100Repair, complex, trunk; 1.1 cm to 2.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13101Repair, complex, trunk; 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13102Repair, complex, trunk; each additional 5 cm or less (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13120Repair, complex, scalp, arms, and/or legs; 1.1 cm to 2.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13121Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13122Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13131Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 1.1 cm to 2.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13132Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13133Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; each additional 5 cm or less (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13150Repair, complex, eyelids, nose, ears and/or lips; 1.0 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13151Repair, complex, eyelids, nose, ears and/or lips; 1.1 cm to 2.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13152Repair, complex, eyelids, nose, ears and/or lips; 2.6 cm to 7.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13153Repair, complex, eyelids, nose, ears and/or lips; each additional 5 cm or less (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
13160Secondary closure of surgical wound or dehiscence, extensive or complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14000Adjacent tissue transfer or rearrangement, trunk; defect 10 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14001Adjacent tissue transfer or rearrangement, trunk; defect 10.1 sq cm to 30.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14020Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14021Adjacent tissue transfer or rearrangement, scalp, arms and/or legs; defect 10.1 sq cm to 30.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14040Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14041Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/or feet; defect 10.1 sq cm to 30.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14060Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14061Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10.1 sq cm to 30.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14300Adjacent tissue transfer or rearrangement, more than 30 sq cm, unusual or complicated, any areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14301Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14302Adjacent tissue transfer or rearrangement, any area; each additional 30.0 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
14350Filleted finger or toe flap, including preparation of recipient siteSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15002Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; first 100 sq cm or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15003Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15004Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; first 100 sq cm or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15005Surgical preparation or creation of recipient site by excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet and/or multiple digits; each additional 100 sq cm, or part thereof, or each additional 1% of body area of infants and children (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15040Harvest of skin for tissue cultured skin autograft, 100 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15050Pinch graft, single or multiple, to cover small ulcer, tip of digit, or other minimal open area (except on face), up to defect size 2 cm diameterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15100Split-thickness autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15101Split-thickness autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15110Epidermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15111Epidermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15115Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15116Epidermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15120Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and children (except 15050)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15121Split-thickness autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15130Dermal autograft, trunk, arms, legs; first 100 sq cm or less, or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15131Dermal autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15135Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 100 sq cm or less, or 1% of body area of infants and childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15136Dermal autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15150Tissue cultured skin autograft, trunk, arms, legs; first 25 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15151Tissue cultured skin autograft, trunk, arms, legs; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15152Tissue cultured skin autograft, trunk, arms, legs; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15155Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; first 25 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15156Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; additional 1 sq cm to 75 sq cm (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15157Tissue cultured skin autograft, face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits; each additional 100 sq cm, or each additional 1% of body area of infants and children, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15200Full thickness graft, free, including direct closure of donor site, trunk; 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15201Full thickness graft, free, including direct closure of donor site, trunk; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15220Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15221Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15240Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15241Full thickness graft, free, including direct closure of donor site, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands, and/or feet; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15260Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; 20 sq cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15261Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15271Application 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 areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15272Application 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)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15273Application 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 childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15274Application of skin substitute graft to trunk, arms, legs, 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)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15275Application 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 areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15276Application 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; each additional 25 sq cm wound surface area, or part thereof (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15277Application 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 childrenSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15278Application 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)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15570Formation of direct or tubed pedicle, with or without transfer; trunkSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15572Formation of direct or tubed pedicle, with or without transfer; scalp, arms, or legsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15574Formation of direct or tubed pedicle, with or without transfer; forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands or feetSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15576Formation of direct or tubed pedicle, with or without transfer; eyelids, nose, ears, lips, or intraoralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15600Delay of flap or sectioning of flap (division and inset); at trunkSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15610Delay of flap or sectioning of flap (division and inset); at scalp, arms, or legsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15620Delay of flap or sectioning of flap (division and inset); at forehead, cheeks, chin, neck, axillae, genitalia, hands, or feetSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15630Delay of flap or sectioning of flap (division and inset); at eyelids, nose, ears, or lipsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15650Transfer, intermediate, of any pedicle flap (eg, abdomen to wrist, Walking tube), any locationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15730Midface flap (ie, zygomaticofacial flap) with preservation of vascular pedicle(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15731Forehead flap with preservation of vascular pedicle (eg, axial pattern flap, paramedian forehead flap)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15733Muscle, myocutaneous, or fasciocutaneous flap; head and neck with named vascular pedicle (ie, buccinators, genioglossus, temporalis, masseter, sternocleidomastoid, levator scapulae)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15734Muscle, myocutaneous, or fasciocutaneous flap; trunkSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15736Muscle, myocutaneous, or fasciocutaneous flap; upper extremitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15738Muscle, myocutaneous, or fasciocutaneous flap; lower extremitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15740Flap; island pedicle requiring identification and dissection of an anatomically named axial vesselSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15750Flap; neurovascular pedicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15756Free muscle or myocutaneous flap with microvascular anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15757Free skin flap with microvascular anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15758Free fascial flap with microvascular anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15760Graft; composite (eg, full thickness of external ear or nasal ala), including primary closure, donor areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15770Graft; derma-fat-fasciaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15777Implantation of biologic implant (eg, acellular dermal matrix) for soft tissue reinforcement (ie, breast, trunk) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15786Abrasion; single lesion (eg, keratosis, scar)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15787Abrasion; each additional 4 lesions or less (List separately in addition to code for primary procedure)YesOutpatient Surgery e-form
15819CervicoplastySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15820Blepharoplasty, lower eyelidYesOutpatient Surgery e-form
15821Blepharoplasty, lower eyelid; with extensive herniated fat padYesOutpatient Surgery e-form
15822Blepharoplasty, upper eyelid;YesOutpatient Surgery e-form
15823Blepharoplasty, upper eyelid; with excessive skin weighting down lidYesOutpatient Surgery e-form
15830Excision, excessive skin and subcutaneous tissue (includes lipectomy); abdomen, infraumbilical panniculectomyYesOutpatient Surgery e-form
15840Graft for facial nerve paralysis; free fascia graft (including obtaining fascia)YesOutpatient Surgery e-form
15841Graft for facial nerve paralysis; free muscle graft (including obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15842Graft for facial nerve paralysis; free muscle flap by microsurgical techniqueSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15845Graft for facial nerve paralysis; regional muscle transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15850Removal of sutures under anesthesia (other than local), same surgeonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15851Removal of sutures under anesthesia (other than local), other surgeonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15852Dressing change (for other than burns) under anesthesia (other than local)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15860Intravenous injection of agent (eg, fluorescein) to test vascular flow in flap or graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15920Excision, coccygeal pressure ulcer, with coccygectomy; with primary sutureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15922Excision, coccygeal pressure ulcer, with coccygectomy; with flap closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15931Excision, sacral pressure ulcer, with primary suture;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15933Excision, sacral pressure ulcer, with primary suture; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15934Excision, sacral pressure ulcer, with skin flap closure;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15935Excision, sacral pressure ulcer, with skin flap closure; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15936Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15937Excision, sacral pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15940Excision, ischial pressure ulcer, with primary suture;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15941Excision, ischial pressure ulcer, with primary suture; with ostectomy (ischiectomy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15944Excision, ischial pressure ulcer, with skin flap closure;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15945Excision, ischial pressure ulcer, with skin flap closure; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15946Excision, ischial pressure ulcer, with ostectomy, in preparation for muscle or myocutaneous flap or skin graft closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15950Excision, trochanteric pressure ulcer, with primary suture;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15951Excision, trochanteric pressure ulcer, with primary suture; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15952Excision, trochanteric pressure ulcer, with skin flap closure;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15953Excision, trochanteric pressure ulcer, with skin flap closure; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15956Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15958Excision, trochanteric pressure ulcer, in preparation for muscle or myocutaneous flap or skin graft closure; with ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
15999Unlisted procedure, excision pressure ulcerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16000Initial treatment, first degree burn, when no more than local treatment is requiredSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16020Dressings and/or debridement of partial-thickness burns, initial or subsequent; small (less than 5% total body surface area)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16025Dressings and/or debridement of partial-thickness burns, initial or subsequent; medium (eg, whole face or whole extremity, or 5% to 10% total body surface area)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16030Dressings and/or debridement of partial-thickness burns, initial or subsequent; large (eg, more than 1 extremity, or greater than 10% total body surface area)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16035Escharotomy; initial incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
16036Escharotomy; each additional incision (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17000Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); first lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17003Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses); second through 14 lesions, each (List separately in addition to code for first lesion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17004Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratoses), 15 or more lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17106Destruction of cutaneous vascular proliferative lesions (eg, laser technique); less than 10 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17107Destruction of cutaneous vascular proliferative lesions (eg, laser technique); 10.0 to 50.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17108Destruction of cutaneous vascular proliferative lesions (eg, laser technique); over 50.0 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17110Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17111Destruction (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; 15 or more lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17250Chemical cauterization of granulation tissue (ie, proud flesh)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17260Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17261Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17262Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17263Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17264Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17266Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), trunk, arms or legs; lesion diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17270Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17271Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17272Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17273Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17274Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17276Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), scalp, neck, hands, feet, genitalia; lesion diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17280Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.5 cm or lessSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17281Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 0.6 to 1.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17282Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 1.1 to 2.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17283Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 2.1 to 3.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17284Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter 3.1 to 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17286Destruction, malignant lesion (eg, laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), face, ears, eyelids, nose, lips, mucous membrane; lesion diameter over 4.0 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17311Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; first stage, up to 5 tissue blocksSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17312Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), head, neck, hands, feet, genitalia, or any location with surgery directly involving muscle, cartilage, bone, tendon, major nerves, or vessels; each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17313Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; first stage, up to 5 tissue blocksSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17314Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), of the trunk, arms, or legs; each additional stage after the first stage, up to 5 tissue blocks (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
17315Mohs micrographic technique, including removal of all gross tumor, surgical excision of tissue specimens, mapping, color coding of specimens, microscopic examination of specimens by the surgeon, and histopathologic preparation including routine stain(s) (eg, hematoxylin and eosin, toluidine blue), each additional block after the first 5 tissue blocks, any stage (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19000Puncture aspiration of cyst of breast;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19001Puncture aspiration of cyst of breast; each additional cyst (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19020Mastotomy with exploration or drainage of abscess, deepSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19030Injection procedure only for mammary ductogram or galactogramSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19081Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including stereotactic guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19082Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19083Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including ultrasound guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19084Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19085Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; first lesion, including magnetic resonance guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19086Biopsy, breast, with placement of breast localization device(s) (eg, clip, metallic pellet), when performed, and imaging of the biopsy specimen, when performed, percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19100Biopsy of breast; percutaneous, needle core, not using imaging guidance (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19101Biopsy of breast; open, incisionalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19105Ablation, cryosurgical, of fibroadenoma, including ultrasound guidance, each fibroadenomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19110Nipple exploration, with or without excision of a solitary lactiferous duct or a papilloma lactiferous ductSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19112Excision of lactiferous duct fistulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19120Excision of cyst, fibroadenoma, or other benign or malignant tumor, aberrant breast tissue, duct lesion, nipple or areolar lesion (except 19300), open, male or female, 1 or more lesionsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19125Excision of breast lesion identified by preoperative placement of radiological marker, open; single lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19126Excision of breast lesion identified by preoperative placement of radiological marker, open; each additional lesion separately identified by a preoperative radiological marker (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19281Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19282Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19283Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including stereotactic guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19284Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including stereotactic guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19285Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including ultrasound guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19286Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including ultrasound guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19287Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including magnetic resonance guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19288Placement of breast localization device(s) (eg clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including magnetic resonance guidance (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19294Preparation of tumor cavity, with placement of a radiation therapy applicator for intraoperative radiation therapy (IORT) concurrent with partial mastectomy (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19296Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; on date separate from partial mastectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19297Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; concurrent with partial mastectomy (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19298Placement of radiotherapy after loading brachytherapy catheters (multiple tube and button type) into the breast for interstitial radioelement application following (at the time of or subsequent to) partial mastectomy, includes imaging guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
19301Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy);YesBreast Reduction e-form
19302Mastectomy, partial (eg, lumpectomy, tylectomy, quadrantectomy, segmentectomy); with axillary lymphadenectomyYesBreast Reduction e-form
19303Mastectomy, simple, completeYesBreast Reduction e-form
19305Mastectomy, radical, including pectoral muscles, axillary lymph nodesYesBreast Reduction e-form
19306Mastectomy, radical, including pectoral muscles, axillary and internal mammary lymph nodes (Urban type operation)YesBreast Reduction e-form
19307Mastectomy, modified radical, including axillary lymph nodes, with or without pectoralis minor muscle, but excluding pectoralis major muscleYesBreast Reduction e-form
19316MastopexyYesBreast Reduction e-form
19318Breast reductionYesBreast Reduction e-form
19325Breast augmentation with implantYesBreast Reduction e-form
19328Removal of intact breast implantYesBreast Reduction e-form
19330Removal of ruptured breast implant, including implant contents (eg, saline, silicone gel)YesBreast Reduction e-form
19340Insertion of breast implant on same day of mastectomy (ie, immediate)YesBreast Reduction e-form
19342Insertion or replacement of breast implant on separate day from mastectomyYesBreast Reduction e-form
19350Nipple/areola reconstructionYesBreast Reduction e-form
19355Correction of inverted nipplesYesBreast Reduction e-form
19357Tissue expander placement in breast reconstruction, including subsequent expansion(s)YesBreast Reduction e-form
19361Breast reconstruction; with latissimus dorsi flapYesBreast Reduction e-form
19364Breast reconstruction; with free flap (eg, fTRAM, DIEP, SIEA, GAP flap)YesBreast Reduction e-form
19367Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flapYesBreast Reduction e-form
19368Breast reconstruction; with single-pedicled transverse rectus abdominis myocutaneous (TRAM) flap, requiring separate microvascular anastomosis (supercharging)YesBreast Reduction e-form
19369Breast reconstruction; with bipedicled transverse rectus abdominis myocutaneous (TRAM) flapYesBreast Reduction e-form
19370Revision of peri-implant capsule, breast, including capsulotomy, capsulorrhaphy, and/or partial capsulectomyYesBreast Reduction e-form
19371Peri-implant capsulectomy, breast, complete, including removal of all intracapsular contentsYesBreast Reduction e-form
19380Revision of reconstructed breast (eg, significant removal of tissue, re-advancement and/or re-inset of flaps in autologous reconstruction or significant capsular revision combined with soft tissue excision in implant-based reconstruction)YesBreast Reduction e-form
19396Preparation of moulage for custom breast implantYesBreast Reduction e-form
19499Unlisted procedure, breastYesBreast Reduction e-form
20100Exploration of penetrating wound (separate procedure); neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20101Exploration of penetrating wound (separate procedure); chestSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20102Exploration of penetrating wound (separate procedure); abdomen/flank/backSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20103Exploration of penetrating wound (separate procedure); extremitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20150Excision of epiphyseal bar, with or without autogenous soft tissue graft obtained through same fascial incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20200Biopsy, muscle; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20205Biopsy, muscle; deepSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20206Biopsy, muscle, percutaneous needleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20220Biopsy, bone, trocar, or needle; superficial (eg, ilium, sternum, spinous process, ribs)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20240Biopsy, bone, open; superficial (eg, sternum, spinous process, rib, patella, olecranon process, calcaneus, tarsal, metatarsal, carpal, metacarpal, phalanx)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20245Biopsy, bone, open; deep (eg, humeral shaft, ischium, femoral shaft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20250Biopsy, vertebral body, open; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20251Biopsy, vertebral body, open; lumbar or cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20500Injection of sinus tract; therapeutic (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20501Injection of sinus tract; diagnostic (sinogram)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20520Removal of foreign body in muscle or tendon sheath; simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20525Removal of foreign body in muscle or tendon sheath; deep or complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20526Injection, therapeutic (eg, local anesthetic, corticosteroid), carpal tunnelSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20527Injection, enzyme (eg, collagenase), palmar fascial cord (ie, Dupuytren's contracture)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20550Injection(s); single tendon sheath, or ligament, aponeurosis (eg, plantar "fascia")See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20551Injection(s); single tendon origin/insertionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20552Injection(s); single or multiple trigger point(s), 1 or 2 muscle(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20553Injection(s); single or multiple trigger point(s), 3 or more musclesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20555Placement of needles or catheters into muscle and/or soft tissue for subsequent interstitial radioelement application (at the time of or subsequent to the procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20600Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); without ultrasound guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20604Arthrocentesis, aspiration and/or injection, small joint or bursa (eg, fingers, toes); with ultrasound guidance, with permanent recording and reportingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20605Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); without ultrasound guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20606Arthrocentesis, aspiration and/or injection, intermediate joint or bursa (eg, temporomandibular, acromioclavicular, wrist, elbow or ankle, olecranon bursa); with ultrasound guidance, with permanent recording and reportingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20610Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); without ultrasound guidanceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20611Arthrocentesis, aspiration and/or injection, major joint or bursa (eg, shoulder, hip, knee, subacromial bursa); with ultrasound guidance, with permanent recording and reportingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20612Aspiration and/or injection of ganglion cyst(s) any locationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20615Aspiration and injection for treatment of bone cystSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20650Insertion of wire or pin with application of skeletal traction, including removal (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20660Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20661Application of halo, including removal; cranialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20662Application of halo, including removal; pelvicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20663Application of halo, including removal; femoralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20664Application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20665Removal of tongs or halo applied by another individualSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20670Removal of implant; superficial (eg, buried wire, pin or rod) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20680Removal of implant; deep (eg, buried wire, pin, screw, metal band, nail, rod or plate)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20690Application of a uniplane (pins or wires in 1 plane), unilateral, external fixation systemSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20692Application of a multiplane (pins or wires in more than 1 plane), unilateral, external fixation system (eg, Ilizarov, Monticelli type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20693Adjustment or revision of external fixation system requiring anesthesia (eg, new pin[s] or wire[s] and/or new ring[s] or bar[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20694Removal, under anesthesia, of external fixation systemSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20696Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; initial and subsequent alignment(s), assessment(s), and computation(s) of adjustment schedule(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20697Application of multiplane (pins or wires in more than 1 plane), unilateral, external fixation with stereotactic computer-assisted adjustment (eg, spatial frame), including imaging; exchange (ie, removal and replacement) of strut, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20700Manual preparation and insertion of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20701Removal of drug-delivery device(s), deep (eg, subfascial) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20702Manual preparation and insertion of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20703Removal of drug-delivery device(s), intramedullary (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20704Manual preparation and insertion of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20705Removal of drug-delivery device(s), intra-articular (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20802Replantation, arm (includes surgical neck of humerus through elbow joint), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20805Replantation, forearm (includes radius and ulna to radial carpal joint), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20808Replantation, hand (includes hand through metacarpophalangeal joints), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20816Replantation, digit, excluding thumb (includes metacarpophalangeal joint to insertion of flexor sublimis tendon), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20822Replantation, digit, excluding thumb (includes distal tip to sublimis tendon insertion), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20824Replantation, thumb (includes carpometacarpal joint to MP joint), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20827Replantation, thumb (includes distal tip to MP joint), complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20838Replantation, foot, complete amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20900Bone graft, any donor area; minor or small (eg, dowel or button)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20902Bone graft, any donor area; major or largeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20910Cartilage graft; costochondralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20912Cartilage graft; nasal septumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20920Fascia lata graft; by stripperSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20922Fascia lata graft; by incision and area exposure, complex or sheetSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20924Tendon graft, from a distance (eg, palmaris, toe extensor, plantaris)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20930Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20931Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20932Allograft, includes templating, cutting, placement and internal fixation, when performed; osteoarticular, including articular surface and contiguous bone (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20933Allograft, includes templating, cutting, placement and internal fixation, when performed; hemicortical intercalary, partial (ie, hemicylindrical) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20934Allograft, includes templating, cutting, placement and internal fixation, when performed; intercalary, complete (ie, cylindrical) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20936Autograft for spine surgery only (includes harvesting the graft); local (eg, ribs, spinous process, or laminar fragments) obtained from same incision (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20937Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20938Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20939Bone marrow aspiration for bone grafting, spine surgery only, through separate skin or fascial incision (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20950Monitoring of interstitial fluid pressure (includes insertion of device, eg, wick catheter technique, needle manometer technique) in detection of muscle compartment syndromeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20955Bone graft with microvascular anastomosis; fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20956Bone graft with microvascular anastomosis; iliac crestSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20957Bone graft with microvascular anastomosis; metatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20962Bone graft with microvascular anastomosis; other than fibula, iliac crest, or metatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20969Free osteocutaneous flap with microvascular anastomosis; other than iliac crest, metatarsal, or great toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20970Free osteocutaneous flap with microvascular anastomosis; iliac crestSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20972Free osteocutaneous flap with microvascular anastomosis; metatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20973Free osteocutaneous flap with microvascular anastomosis; great toe with web spaceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20974Electrical stimulation to aid bone healing; noninvasive (nonoperative)YesOutpatient Surgery e-form
20975Electrical stimulation to aid bone healing; invasive (operative)YesOutpatient Surgery e-form
20979Low intensity ultrasound stimulation to aid bone healing, noninvasive (nonoperative)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20982Ablation therapy for reduction or eradication of 1 or more bone tumors (eg, metastasis) including adjacent soft tissue when involved by tumor extension, percutaneous, including imaging guidance when performed; radiofrequencySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
20999Unlisted procedure, musculoskeletal system, generalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21010Arthrotomy, temporomandibular jointYesOutpatient Surgery e-form
21011Excision, tumor, soft tissue of face or scalp, subcutaneous; less than 2 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21012Excision, tumor, soft tissue of face or scalp, subcutaneous; 2 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21013Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); less than 2 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21014Excision, tumor, soft tissue of face and scalp, subfascial (eg, subgaleal, intramuscular); 2 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21015Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; less than 2 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21016Radical resection of tumor (eg, sarcoma), soft tissue of face or scalp; 2 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21025Excision of bone (eg, for osteomyelitis or bone abscess); mandibleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21026Excision of bone (eg, for osteomyelitis or bone abscess); facial bone(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21029Removal by contouring of benign tumor of facial bone (eg, fibrous dysplasia)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21030Excision of benign tumor or cyst of maxilla or zygoma by enucleation and curettageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21031Excision of torus mandibularisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21032Excision of maxillary torus palatinusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21034Excision of malignant tumor of maxilla or zygomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21040Excision of benign tumor or cyst of mandible, by enucleation and/or curettageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21044Excision of malignant tumor of mandibleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21045Excision of malignant tumor of mandible; radical resectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21046Excision of benign tumor or cyst of mandible; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21047Excision of benign tumor or cyst of mandible; requiring extra-oral osteotomy and partial mandibulectomy (eg, locally aggressive or destructive lesion[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21048Excision of benign tumor or cyst of maxilla; requiring intra-oral osteotomy (eg, locally aggressive or destructive lesion[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21049Excision of benign tumor or cyst of maxilla; requiring extra-oral osteotomy and partial maxillectomy (eg, locally aggressive or destructive lesion[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21050Condylectomy, temporomandibular joint (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21060Meniscectomy, partial or complete, temporomandibular joint (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21070Coronoidectomy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21073Manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21076Impression and custom preparation; surgical obturator prosthesisYesOutpatient Surgery e-form
21077Impression and custom preparation; orbital prosthesisYesOutpatient Surgery e-form
21078Impression and custom preparation; interim obturator prosthesisYesOutpatient Surgery e-form
21079Impression and custom preparation; definitive obturator prosthesisYesOutpatient Surgery e-form
21080Impression and custom preparation; mandibular resection prosthesisYesOutpatient Surgery e-form
21081Impression and custom preparation; palatal augmentation prosthesisYesOutpatient Surgery e-form
21082Impression and custom preparation; palatal lift prosthesisYesOutpatient Surgery e-form
21083Impression and custom preparation; speech aid prosthesisYesOutpatient Surgery e-form
21084Impression and custom preparation; oral surgical splintYesOutpatient Surgery e-form
21085Impression and custom preparation; oral surgical splintSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21086Impression and custom preparation; auricular prosthesisYesOutpatient Surgery e-form
21087Impression and custom preparation; nasal prosthesisYesOutpatient Surgery e-form
21088Impression and custom preparation; facial prosthesisYesOutpatient Surgery e-form
21089Unlisted maxillofacial prosthetic procedureYesOutpatient Surgery e-form
21100Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21110Application of interdental fixation device for conditions other than fracture or dislocation, includes removalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21116Injection procedure for temporomandibular joint arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21120Genioplasty; augmentation (autograft, allograft, prosthetic material)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21121Genioplasty; sliding osteotomy, single pieceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21122Genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21123Genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21125Augmentation, mandibular body or angle; prosthetic materialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21127Augmentation, mandibular body or angle; with bone graft, onlay or interpositional (includes obtaining autograft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21137Reduction forehead; contouring onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21138Reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21139Reduction forehead; contouring and setback of anterior frontal sinus wallSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21141Reconstruction midface, LeFort I; single piece, segment movement in any direction (eg, for Long Face Syndrome), without bone graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21142Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, without bone graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21143Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, without bone graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21145Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21146Reconstruction midface, LeFort I; 2 pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted unilateral alveolar cleft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21147Reconstruction midface, LeFort I; 3 or more pieces, segment movement in any direction, requiring bone grafts (includes obtaining autografts) (eg, ungrafted bilateral alveolar cleft or multiple osteotomies)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21150Reconstruction midface, LeFort II; anterior intrusion (eg, Treacher-Collins Syndrome)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21151Reconstruction midface, LeFort II; any direction, requiring bone grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21154Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); without LeFort ISee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21155Reconstruction midface, LeFort III (extracranial), any type, requiring bone grafts (includes obtaining autografts); with LeFort ISee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21159Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); without LeFort ISee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21160Reconstruction midface, LeFort III (extra and intracranial) with forehead advancement (eg, mono bloc), requiring bone grafts (includes obtaining autografts); with LeFort ISee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21172Reconstruction superior-lateral orbital rim and lower forehead, advancement or alteration, with or without grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21175Reconstruction, bifrontal, superior-lateral orbital rims and lower forehead, advancement or alteration (eg, plagiocephaly, trigonocephaly, brachycephaly), with or without grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21179Reconstruction, entire or majority of forehead and/or supraorbital rims; with grafts (allograft or prosthetic material)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21180Reconstruction, entire or majority of forehead and/or supraorbital rims; with autograft (includes obtaining grafts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21181Reconstruction by contouring of benign tumor of cranial bones (eg, fibrous dysplasia), extracranialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21182Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting less than 40 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21183Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 40 sq cm but less than 80 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21184Reconstruction of orbital walls, rims, forehead, nasoethmoid complex following intra- and extracranial excision of benign tumor of cranial bone (eg, fibrous dysplasia), with multiple autografts (includes obtaining grafts); total area of bone grafting greater than 80 sq cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21188Reconstruction midface, osteotomies (other than LeFort type) and bone grafts (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21193Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; without bone graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21194Reconstruction of mandibular rami, horizontal, vertical, C, or L osteotomy; with bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21195Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21196Reconstruction of mandibular rami and/or body, sagittal split; with internal rigid fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21198Osteotomy, mandible, segmental;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21199Osteotomy, mandible, segmental; with genioglossus advancementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21206Osteotomy, maxilla, segmental (eg, Wassmund or Schuchard)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21208Osteoplasty, facial bones; augmentation (autograft, allograft, or prosthetic implant)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21209Osteoplasty, facial bones; reductionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21210Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21215Graft, bone; mandible (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21230Graft; rib cartilage, autogenous, to face, chin, nose or ear (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21235Graft; ear cartilage, autogenous, to nose or ear (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21240Arthroplasty, temporomandibular joint, with or without autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21242Arthroplasty, temporomandibular joint, with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21243Arthroplasty, temporomandibular joint, with prosthetic joint replacementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21244Reconstruction of mandible, extraoral, with transosteal bone plate (eg, mandibular staple bone plate)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21245Reconstruction of mandible or maxilla, subperiosteal implant; partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21246Reconstruction of mandible or maxilla, subperiosteal implant; completeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21247Reconstruction of mandibular condyle with bone and cartilage autografts (includes obtaining grafts) (eg, for hemifacial microsomia)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21248Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21249Reconstruction of mandible or maxilla, endosteal implant (eg, blade, cylinder); completeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21255Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21256Reconstruction of orbit with osteotomies (extracranial) and with bone grafts (includes obtaining autografts) (eg, micro-ophthalmia)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21260Periorbital osteotomies for orbital hypertelorism, with bone grafts; extracranial approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21261Periorbital osteotomies for orbital hypertelorism, with bone grafts; combined intra- and extracranial approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21263Periorbital osteotomies for orbital hypertelorism, with bone grafts; with forehead advancementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21267Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; extracranial approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21268Orbital repositioning, periorbital osteotomies, unilateral, with bone grafts; combined intra- and extracranial approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21270Malar augmentation, prosthetic materialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21275Secondary revision of orbitocraniofacial reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21280Medial canthopexy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21282Lateral canthopexySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21295Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); extraoral approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21296Reduction of masseter muscle and bone (eg, for treatment of benign masseteric hypertrophy); intraoral approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21299Unlisted craniofacial and maxillofacial procedureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21310Closed treatment of nasal bone fracture without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21315Closed treatment of nasal bone fracture; without stabilizationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21320Closed treatment of nasal bone fracture; with stabilizationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21325Open treatment of nasal fracture; uncomplicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21330Open treatment of nasal fracture; complicated, with internal and/or external skeletal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21335Open treatment of nasal fracture; with concomitant open treatment of fractured septumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21336Open treatment of nasal septal fracture, with or without stabilizationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21337Closed treatment of nasal septal fracture, with or without stabilizationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21338Open treatment of nasoethmoid fracture; without external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21339Open treatment of nasoethmoid fracture; with external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21340Percutaneous treatment of nasoethmoid complex fracture, with splint, wire or headcap fixation, including repair of canthal ligaments and/or the nasolacrimal apparatusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21343Open treatment of depressed frontal sinus fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21344Open treatment of complicated (eg, comminuted or involving posterior wall) frontal sinus fracture, via coronal or multiple approachesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21345Closed treatment of nasomaxillary complex fracture (LeFort II type), with interdental wire fixation or fixation of denture or splintSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21346Open treatment of nasomaxillary complex fracture (LeFort II type); with wiring and/or local fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21347Open treatment of nasomaxillary complex fracture (LeFort II type); requiring multiple open approachesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21348Open treatment of nasomaxillary complex fracture (LeFort II type); with bone grafting (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21355Percutaneous treatment of fracture of malar area, including zygomatic arch and malar tripod, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21356Open treatment of depressed zygomatic arch fracture (eg, Gillies approach)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21360Open treatment of depressed malar fracture, including zygomatic arch and malar tripodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21365Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with internal fixation and multiple surgical approachesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21366Open treatment of complicated (eg, comminuted or involving cranial nerve foramina) fracture(s) of malar area, including zygomatic arch and malar tripod; with bone grafting (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21385Open treatment of orbital floor blowout fracture; transantral approach (Caldwell-Luc type operation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21386Open treatment of orbital floor blowout fracture; periorbital approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21387Open treatment of orbital floor blowout fracture; combined approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21390Open treatment of orbital floor blowout fracture; periorbital approach, with alloplastic or other implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21395Open treatment of orbital floor blowout fracture; periorbital approach with bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21400Closed treatment of fracture of orbit, except blowout; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21401Closed treatment of fracture of orbit, except blowout; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21406Open treatment of fracture of orbit, except blowout; without implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21407Open treatment of fracture of orbit, except blowout; with implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21408Open treatment of fracture of orbit, except blowout; with bone grafting (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21421Closed treatment of palatal or maxillary fracture (LeFort I type), with interdental wire fixation or fixation of denture or splintSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21422Open treatment of palatal or maxillary fracture (LeFort I type);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21423Open treatment of palatal or maxillary fracture (LeFort I type); complicated (comminuted or involving cranial nerve foramina), multiple approachesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21431Closed treatment of craniofacial separation (LeFort III type) using interdental wire fixation of denture or splintSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21432Open treatment of craniofacial separation (LeFort III type); with wiring and/or internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21433Open treatment of craniofacial separation (LeFort III type); complicated (eg, comminuted or involving cranial nerve foramina), multiple surgical approachesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21435Open treatment of craniofacial separation (LeFort III type); complicated, utilizing internal and/or external fixation techniques (eg, head cap, halo device, and/or intermaxillary fixation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21436Open treatment of craniofacial separation (LeFort III type); complicated, multiple surgical approaches, internal fixation, with bone grafting (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21440Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21445Open treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21450Closed treatment of mandibular fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21451Closed treatment of mandibular fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21452Percutaneous treatment of mandibular fracture, with external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21453Closed treatment of mandibular fracture with interdental fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21454Open treatment of mandibular fracture with external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21462Open treatment of mandibular fracture; with interdental fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21465Open treatment of mandibular condylar fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21470Open treatment of complicated mandibular fracture by multiple surgical approaches including internal fixation, interdental fixation, and/or wiring of dentures or splintsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21480Closed treatment of temporomandibular dislocation; initial or subsequentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21485Closed treatment of temporomandibular dislocation; complicated (eg, recurrent requiring intermaxillary fixation or splinting), initial or subsequentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21497Interdental wiring, for condition other than fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21499Unlisted musculoskeletal procedure, headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21501Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21502Incision and drainage, deep abscess or hematoma, soft tissues of neck or thorax; with partial rib ostectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21510Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), thoraxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21550Biopsy, soft tissue of neck or thoraxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21552Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21554Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21555Excision, tumor, soft tissue of neck or anterior thorax, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21556Excision, tumor, soft tissue of neck or anterior thorax, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21557Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21558Radical resection of tumor (eg, sarcoma), soft tissue of neck or anterior thorax; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21600Excision of rib, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21601Excision of chest wall tumor including rib(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21602Excision of chest wall tumor involving rib(s), with plastic reconstruction; without mediastinal lymphadenectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21603Excision of chest wall tumor involving rib(s), with plastic reconstruction; with mediastinal lymphadenectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21610Costotransversectomy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21615Excision first and/or cervical rib;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21616Excision first and/or cervical rib; with sympathectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21620Ostectomy of sternum, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21627Sternal debridementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21630Radical resection of sternum;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21632Radical resection of sternum; with mediastinal lymphadenectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21685Hyoid myotomy and suspensionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21700Division of scalenus anticus; without resection of cervical ribSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21705Division of scalenus anticus; with resection of cervical ribSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21720Division of sternocleidomastoid for torticollis, open operation; without cast applicationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21725Division of sternocleidomastoid for torticollis, open operation; with cast applicationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21740Reconstructive repair of pectus excavatum or carinatum; openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21742Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), without thoracoscopySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21743Reconstructive repair of pectus excavatum or carinatum; minimally invasive approach (Nuss procedure), with thoracoscopySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21750Closure of median sternotomy separation with or without debridement (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21811Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 1-3 ribsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21812Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 4-6 ribsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21813Open treatment of rib fracture(s) with internal fixation, includes thoracoscopic visualization when performed, unilateral; 7 or more ribsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21820Closed treatment of sternum fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21825Open treatment of sternum fracture with or without skeletal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21899Unlisted procedure, neck or thoraxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21920Biopsy, soft tissue of back or flank; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21925Biopsy, soft tissue of back or flank; deepSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21930Excision, tumor, soft tissue of back or flank, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21931Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21932Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21933Excision, tumor, soft tissue of back or flank, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21935Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
21936Radical resection of tumor (eg, sarcoma), soft tissue of back or flank; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22010Incision and drainage, open, of deep abscess (subfascial), posterior spine; cervical, thoracic, or cervicothoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22015Incision and drainage, open, of deep abscess (subfascial), posterior spine; lumbar, sacral, or lumbosacralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22100Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22101Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22102Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22103Partial excision of posterior vertebral component (eg, spinous process, lamina or facet) for intrinsic bony lesion, single vertebral segment; each additional segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22110Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22112Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22114Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22116Partial excision of vertebral body, for intrinsic bony lesion, without decompression of spinal cord or nerve root(s), single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22206Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22207Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22208Osteotomy of spine, posterior or posterolateral approach, 3 columns, 1 vertebral segment (eg, pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22210Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22212Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22214Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22216Osteotomy of spine, posterior or posterolateral approach, 1 vertebral segment; each additional vertebral segment (List separately in addition to primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22220Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22222Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22224Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22226Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22310Closed treatment of vertebral body fracture(s), without manipulation, requiring and including casting or bracingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22315Closed treatment of vertebral fracture(s) and/or dislocation(s) requiring casting or bracing, with and including casting and/or bracing by manipulation or tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22318Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; without graftingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22319Open treatment and/or reduction of odontoid fracture(s) and or dislocation(s) (including os odontoideum), anterior approach, including placement of internal fixation; with graftingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22325Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22326Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22327Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22328Open treatment and/or reduction of vertebral fracture(s) and/or dislocation(s), posterior approach, 1 fractured vertebra or dislocated segment; each additional fractured vertebra or dislocated segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22510Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22511Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22512Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22513Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; thoracicYesOutpatient Surgery e-form
22514Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; lumbarYesOutpatient Surgery e-form
22515Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inclusive of all imaging guidance; each additional thoracic or lumbar vertebral body (List separately in addition to code for primary procedure)YesOutpatient Surgery e-form
22526Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single levelSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22527Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; 1 or more additional levels (List separately in addition to code for primary procedure)YesOutpatient Surgery e-form
22532Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22533Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22534Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22548Arthrodesis, anterior transoral or extraoral technique, clivus-C1-C2 (atlas-axis), with or without excision of odontoid processSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22551Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22552Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22554Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22556Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22558Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22585Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); each additional interspace (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22590Arthrodesis, posterior technique, craniocervical (occiput-C2)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22595Arthrodesis, posterior technique, atlas-axis (C1-C2)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22600Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segmentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22610Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22612Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22614Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22630Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22632Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22633Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbarYesOutpatient Surgery e-form
22634Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; each additional interspace and segment (List separately in addition to code for primary procedure)YesOutpatient Surgery e-form
22800Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22802Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 12 vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22804Arthrodesis, posterior, for spinal deformity, with or without cast; 13 or more vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22808Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22810Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22812Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22818Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22819Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22830Exploration of spinal fusionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22840Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across 1 interspace, atlantoaxial transarticular screw fixation, sublaminar wiring at C1, facet screw fixation) (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22841Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22842Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22843Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 12 vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22844Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 13 or more vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22845Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22846Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22847Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22848Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22849Reinsertion of spinal fixation deviceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22850Removal of posterior nonsegmental instrumentation (eg, Harrington rod)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22852Removal of posterior segmental instrumentationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22853Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with interbody arthrodesis, each interspace (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22854Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to vertebral corpectomy(ies) (vertebral body resection, partial or complete) defect, in conjunction with interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22855Removal of anterior instrumentationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22856Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22857Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22858Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22859Insertion of intervertebral biomechanical device(s) (eg, synthetic cage, mesh, methylmethacrylate) to intervertebral disc space or vertebral body defect without interbody arthrodesis, each contiguous defect (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22861Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22862Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22864Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22865Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22899Unlisted procedure, spineSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22900Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22901Excision, tumor, soft tissue of abdominal wall, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22902Excision, tumor, soft tissue of abdominal wall, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22903Excision, tumor, soft tissue of abdominal wall, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22904Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22905Radical resection of tumor (eg, sarcoma), soft tissue of abdominal wall; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
22999Unlisted procedure, abdomen, musculoskeletal systemSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23000Removal of subdeltoid calcareous deposits, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23020Capsular contracture release (eg, Sever type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23030Incision and drainage, shoulder area; deep abscess or hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23031Incision and drainage, shoulder area; infected bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23035Incision, bone cortex (eg, osteomyelitis or bone abscess), shoulder areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23040Arthrotomy, glenohumeral joint, including exploration, drainage, or removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23044Arthrotomy, acromioclavicular, sternoclavicular joint, including exploration, drainage, or removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23065Biopsy, soft tissue of shoulder area; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23066Biopsy, soft tissue of shoulder area; deepSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23071Excision, tumor, soft tissue of shoulder area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23073Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23075Excision, tumor, soft tissue of shoulder area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23076Excision, tumor, soft tissue of shoulder area, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23077Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23078Radical resection of tumor (eg, sarcoma), soft tissue of shoulder area; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23100Arthrotomy, glenohumeral joint, including biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23101Arthrotomy, acromioclavicular joint or sternoclavicular joint, including biopsy and/or excision of torn cartilageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23105Arthrotomy; glenohumeral joint, with synovectomy, with or without biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23106Arthrotomy; sternoclavicular joint, with synovectomy, with or without biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23107Arthrotomy, glenohumeral joint, with joint exploration, with or without removal of loose or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23120Claviculectomy; partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23125Claviculectomy; totalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23130Acromioplasty or acromionectomy, partial, with or without coracoacromial ligament releaseSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23140Excision or curettage of bone cyst or benign tumor of clavicle or scapula;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23145Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23146Excision or curettage of bone cyst or benign tumor of clavicle or scapula; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23150Excision or curettage of bone cyst or benign tumor of proximal humerus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23155Excision or curettage of bone cyst or benign tumor of proximal humerus; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23156Excision or curettage of bone cyst or benign tumor of proximal humerus; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23170Sequestrectomy (eg, for osteomyelitis or bone abscess), clavicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23172Sequestrectomy (eg, for osteomyelitis or bone abscess), scapulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23174Sequestrectomy (eg, for osteomyelitis or bone abscess), humeral head to surgical neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23180Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), clavicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23182Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), scapulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23184Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), proximal humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23190Ostectomy of scapula, partial (eg, superior medial angle)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23195Resection, humeral headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23200Radical resection of tumor; clavicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23210Radical resection of tumor; scapulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23220Radical resection of tumor, proximal humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23330Removal of foreign body, shoulder; subcutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23333Removal of foreign body, shoulder; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23334Removal of prosthesis, includes debridement and synovectomy when performed; humeral or glenoid componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23335Removal of prosthesis, includes debridement and synovectomy when performed; humeral and glenoid components (eg, total shoulder)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23350Injection procedure for shoulder arthrography or enhanced CT/MRI shoulder arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23395Muscle transfer, any type, shoulder or upper arm; singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23397Muscle transfer, any type, shoulder or upper arm; multipleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23400Scapulopexy (eg, Sprengels deformity or for paralysis)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23405Tenotomy, shoulder area; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23406Tenotomy, shoulder area; multiple tendons through same incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23410Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; acuteSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23412Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23415Coracoacromial ligament release, with or without acromioplastySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23420Reconstruction of complete shoulder (rotator) cuff avulsion, chronic (includes acromioplasty)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23430Tenodesis of long tendon of bicepsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23440Resection or transplantation of long tendon of bicepsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23450Capsulorrhaphy, anterior; Putti-Platt procedure or Magnuson type operationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23455Capsulorrhaphy, anterior; with labral repair (eg, Bankart procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23460Capsulorrhaphy, anterior, any type; with bone blockSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23462Capsulorrhaphy, anterior, any type; with coracoid process transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23465Capsulorrhaphy, glenohumeral joint, posterior, with or without bone blockSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23466Capsulorrhaphy, glenohumeral joint, any type multi-directional instabilitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23470Arthroplasty, glenohumeral joint; hemiarthroplastySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23472Arthroplasty, glenohumeral joint; total shoulder (glenoid and proximal humeral replacement (eg, total shoulder))See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23473Revision of total shoulder arthroplasty, including allograft when performed; humeral or glenoid componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23474Revision of total shoulder arthroplasty, including allograft when performed; humeral and glenoid componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23480Osteotomy, clavicle, with or without internal fixation;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23485Osteotomy, clavicle, with or without internal fixation; with bone graft for nonunion or malunion (includes obtaining graft and/or necessary fixation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23490Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; clavicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23491Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; proximal humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23500Closed treatment of clavicular fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23505Closed treatment of clavicular fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23515Open treatment of clavicular fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23520Closed treatment of sternoclavicular dislocation; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23525Closed treatment of sternoclavicular dislocation; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23530Open treatment of sternoclavicular dislocation, acute or chronic;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23532Open treatment of sternoclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23540Closed treatment of acromioclavicular dislocation; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23545Closed treatment of acromioclavicular dislocation; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23550Open treatment of acromioclavicular dislocation, acute or chronic;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23552Open treatment of acromioclavicular dislocation, acute or chronic; with fascial graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23570Closed treatment of scapular fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23575Closed treatment of scapular fracture; with manipulation, with or without skeletal traction (with or without shoulder joint involvement)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23585Open treatment of scapular fracture (body, glenoid or acromion) includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23600Closed treatment of proximal humeral (surgical or anatomical neck) fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23605Closed treatment of proximal humeral (surgical or anatomical neck) fracture; with manipulation, with or without skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23615Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23616Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation, when performed, includes repair of tuberosity(s), when performed; with proximal humeral prosthetic replacementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23620Closed treatment of greater humeral tuberosity fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23625Closed treatment of greater humeral tuberosity fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23630Open treatment of greater humeral tuberosity fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23650Closed treatment of shoulder dislocation, with manipulation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23655Closed treatment of shoulder dislocation, with manipulation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23660Open treatment of acute shoulder dislocationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23665Closed treatment of shoulder dislocation, with fracture of greater humeral tuberosity, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23670Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23675Closed treatment of shoulder dislocation, with surgical or anatomical neck fracture, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23680Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23700Manipulation under anesthesia, shoulder joint, including application of fixation apparatus (dislocation excluded)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23800Arthrodesis, glenohumeral joint;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23802Arthrodesis, glenohumeral joint; with autogenous graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23900Interthoracoscapular amputation (forequarter)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23920Disarticulation of shoulder;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23921Disarticulation of shoulder; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23929Unlisted procedure, shoulderSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23930Incision and drainage, upper arm or elbow area; deep abscess or hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23931Incision and drainage, upper arm or elbow area; bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
23935Incision, deep, with opening of bone cortex (eg, for osteomyelitis or bone abscess), humerus or elbowSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24000Arthrotomy, elbow, including exploration, drainage, or removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24006Arthrotomy of the elbow, with capsular excision for capsular release (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24065Biopsy, soft tissue of upper arm or elbow area; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24066Biopsy, soft tissue of upper arm or elbow area; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24071Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24073Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24075Excision, tumor, soft tissue of upper arm or elbow area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24076Excision, tumor, soft tissue of upper arm or elbow area, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24077Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24079Radical resection of tumor (eg, sarcoma), soft tissue of upper arm or elbow area; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24100Arthrotomy, elbow; with synovial biopsy onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24101Arthrotomy, elbow; with joint exploration, with or without biopsy, with or without removal of loose or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24102Arthrotomy, elbow; with synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24105Excision, olecranon bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24110Excision or curettage of bone cyst or benign tumor, humerus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24115Excision or curettage of bone cyst or benign tumor, humerus; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24116Excision or curettage of bone cyst or benign tumor, humerus; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24120Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24125Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24126Excision or curettage of bone cyst or benign tumor of head or neck of radius or olecranon process; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24130Excision, radial headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24134Sequestrectomy (eg, for osteomyelitis or bone abscess), shaft or distal humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24136Sequestrectomy (eg, for osteomyelitis or bone abscess), radial head or neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24138Sequestrectomy (eg, for osteomyelitis or bone abscess), olecranon processSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24140Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24145Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), radial head or neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24147Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis), olecranon processSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24149Radical resection of capsule, soft tissue, and heterotopic bone, elbow, with contracture release (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24150Radical resection of tumor, shaft or distal humerusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24152Radical resection of tumor, radial head or neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24155Resection of elbow joint (arthrectomy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24160Removal of prosthesis, includes debridement and synovectomy when performed; humeral and ulnar componentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24164Removal of prosthesis, includes debridement and synovectomy when performed; radial headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24200Removal of foreign body, upper arm or elbow area; subcutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24201Removal of foreign body, upper arm or elbow area; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24220Injection procedure for elbow arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24300Manipulation, elbow, under anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24301Muscle or tendon transfer, any type, upper arm or elbow, single (excluding 24320-24331)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24305Tendon lengthening, upper arm or elbow, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24310Tenotomy, open, elbow to shoulder, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24320Tenoplasty, with muscle transfer, with or without free graft, elbow to shoulder, single (Seddon-Brookes type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24330Flexor-plasty, elbow (eg, Steindler type advancement);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24331Flexor-plasty, elbow (eg, Steindler type advancement); with extensor advancementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24332Tenolysis, tricepsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24340Tenodesis of biceps tendon at elbow (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24341Repair, tendon or muscle, upper arm or elbow, each tendon or muscle, primary or secondary (excludes rotator cuff)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24342Reinsertion of ruptured biceps or triceps tendon, distal, with or without tendon graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24343Repair lateral collateral ligament, elbow, with local tissueSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24344Reconstruction lateral collateral ligament, elbow, with tendon graft (includes harvesting of graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24345Repair medial collateral ligament, elbow, with local tissueSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24346Reconstruction medial collateral ligament, elbow, with tendon graft (includes harvesting of graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24357Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); percutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24358Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24359Tenotomy, elbow, lateral or medial (eg, epicondylitis, tennis elbow, golfer's elbow); debridement, soft tissue and/or bone, open with tendon repair or reattachmentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24360Arthroplasty, elbow; with membrane (eg, fascial)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24361Arthroplasty, elbow; with distal humeral prosthetic replacementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24362Arthroplasty, elbow; with implant and fascia lata ligament reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24363Arthroplasty, elbow; with distal humerus and proximal ulnar prosthetic replacement (eg, total elbow)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24365Arthroplasty, radial head;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24366Arthroplasty, radial head; with implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24370Revision of total elbow arthroplasty, including allograft when performed; humeral or ulnar componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24371Revision of total elbow arthroplasty, including allograft when performed; humeral and ulnar componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24400Osteotomy, humerus, with or without internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24410Multiple osteotomies with realignment on intramedullary rod, humeral shaft (Sofield type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24420Osteoplasty, humerus (eg, shortening or lengthening) (excluding 64876)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24430Repair of nonunion or malunion, humerus; without graft (eg, compression technique)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24435Repair of nonunion or malunion, humerus; with iliac or other autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24470Hemiepiphyseal arrest (eg, cubitus varus or valgus, distal humerus)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24495Decompression fasciotomy, forearm, with brachial artery explorationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24498Prophylactic treatment (nailing, pinning, plating or wiring), with or without methylmethacrylate, humeral shaftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24500Closed treatment of humeral shaft fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24505Closed treatment of humeral shaft fracture; with manipulation, with or without skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24515Open treatment of humeral shaft fracture with plate/screws, with or without cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24516Treatment of humeral shaft fracture, with insertion of intramedullary implant, with or without cerclage and/or locking screwsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24530Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24535Closed treatment of supracondylar or transcondylar humeral fracture, with or without intercondylar extension; with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24538Percutaneous skeletal fixation of supracondylar or transcondylar humeral fracture, with or without intercondylar extensionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24545Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; without intercondylar extensionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24546Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation, when performed; with intercondylar extensionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24560Closed treatment of humeral epicondylar fracture, medial or lateral; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24565Closed treatment of humeral epicondylar fracture, medial or lateral; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24566Percutaneous skeletal fixation of humeral epicondylar fracture, medial or lateral, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24575Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24576Closed treatment of humeral condylar fracture, medial or lateral; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24577Closed treatment of humeral condylar fracture, medial or lateral; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24579Open treatment of humeral condylar fracture, medial or lateral, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24582Percutaneous skeletal fixation of humeral condylar fracture, medial or lateral, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24586Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24587Open treatment of periarticular fracture and/or dislocation of the elbow (fracture distal humerus and proximal ulna and/or proximal radius); with implant arthroplastySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24600Treatment of closed elbow dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24605Treatment of closed elbow dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24615Open treatment of acute or chronic elbow dislocationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24620Closed treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24635Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24640Closed treatment of radial head subluxation in child, nursemaid elbow, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24650Closed treatment of radial head or neck fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24655Closed treatment of radial head or neck fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24665Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24666Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24670Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24675Closed treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]); with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24685Open treatment of ulnar fracture, proximal end (eg, olecranon or coronoid process[es]), includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24800Arthrodesis, elbow joint; localSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24802Arthrodesis, elbow joint; with autogenous graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24900Amputation, arm through humerus; with primary closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24920Amputation, arm through humerus; open, circular (guillotine)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24925Amputation, arm through humerus; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24930Amputation, arm through humerus; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24931Amputation, arm through humerus; with implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24935Stump elongation, upper extremitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24940Cineplasty, upper extremity, complete procedureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
24999Unlisted procedure, humerus or elbowSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25000Incision, extensor tendon sheath, wrist (eg, deQuervains disease)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25001Incision, flexor tendon sheath, wrist (eg, flexor carpi radialis)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25020Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; without debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25023Decompression fasciotomy, forearm and/or wrist, flexor OR extensor compartment; with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25024Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; without debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25025Decompression fasciotomy, forearm and/or wrist, flexor AND extensor compartment; with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25028Incision and drainage, forearm and/or wrist; deep abscess or hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25031Incision and drainage, forearm and/or wrist; bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25035Incision, deep, bone cortex, forearm and/or wrist (eg, osteomyelitis or bone abscess)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25040Arthrotomy, radiocarpal or midcarpal joint, with exploration, drainage, or removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25065Biopsy, soft tissue of forearm and/or wrist; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25066Biopsy, soft tissue of forearm and/or wrist; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25071Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25073Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25075Excision, tumor, soft tissue of forearm and/or wrist area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25076Excision, tumor, soft tissue of forearm and/or wrist area, subfascial (eg, intramuscular); less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25077Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25078Radical resection of tumor (eg, sarcoma), soft tissue of forearm and/or wrist area; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25085Capsulotomy, wrist (eg, contracture)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25100Arthrotomy, wrist joint; with biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25101Arthrotomy, wrist joint; with joint exploration, with or without biopsy, with or without removal of loose or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25105Arthrotomy, wrist joint; with synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25107Arthrotomy, distal radioulnar joint including repair of triangular cartilage, complexSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25109Excision of tendon, forearm and/or wrist, flexor or extensor, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25110Excision, lesion of tendon sheath, forearm and/or wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25111Excision of ganglion, wrist (dorsal or volar); primarySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25112Excision of ganglion, wrist (dorsal or volar); recurrentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25115Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexorsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25116Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); extensors, with or without transposition of dorsal retinaculumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25118Synovectomy, extensor tendon sheath, wrist, single compartment;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25119Synovectomy, extensor tendon sheath, wrist, single compartment; with resection of distal ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25120Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25125Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25126Excision or curettage of bone cyst or benign tumor of radius or ulna (excluding head or neck of radius and olecranon process); with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25130Excision or curettage of bone cyst or benign tumor of carpal bones;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25135Excision or curettage of bone cyst or benign tumor of carpal bones; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25136Excision or curettage of bone cyst or benign tumor of carpal bones; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25145Sequestrectomy (eg, for osteomyelitis or bone abscess), forearm and/or wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25150Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25151Partial excision (craterization, saucerization, or diaphysectomy) of bone (eg, for osteomyelitis); radiusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25170Radical resection of tumor, radius or ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25210Carpectomy; 1 boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25215Carpectomy; all bones of proximal rowSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25230Radial styloidectomy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25240Excision distal ulna partial or complete (eg, Darrach type or matched resection)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25246Injection procedure for wrist arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25248Exploration with removal of deep foreign body, forearm or wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25250Removal of wrist prosthesis; (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25251Removal of wrist prosthesis; complicated, including total wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25259Manipulation, wrist, under anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25260Repair, tendon or muscle, flexor, forearm and/or wrist; primary, single, each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25263Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, single, each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25265Repair, tendon or muscle, flexor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25270Repair, tendon or muscle, extensor, forearm and/or wrist; primary, single, each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25272Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, single, each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25274Repair, tendon or muscle, extensor, forearm and/or wrist; secondary, with free graft (includes obtaining graft), each tendon or muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25275Repair, tendon sheath, extensor, forearm and/or wrist, with free graft (includes obtaining graft) (eg, for extensor carpi ulnaris subluxation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25280Lengthening or shortening of flexor or extensor tendon, forearm and/or wrist, single, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25290Tenotomy, open, flexor or extensor tendon, forearm and/or wrist, single, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25295Tenolysis, flexor or extensor tendon, forearm and/or wrist, single, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25300Tenodesis at wrist; flexors of fingersSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25301Tenodesis at wrist; extensors of fingersSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25310Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25312Tendon transplantation or transfer, flexor or extensor, forearm and/or wrist, single; with tendon graft(s) (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25315Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25316Flexor origin slide (eg, for cerebral palsy, Volkmann contracture), forearm and/or wrist; with tendon(s) transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25320Capsulorrhaphy or reconstruction, wrist, open (eg, capsulodesis, ligament repair, tendon transfer or graft) (includes synovectomy, capsulotomy and open reduction) for carpal instabilitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25332Arthroplasty, wrist, with or without interposition, with or without external or internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25335Centralization of wrist on ulna (eg, radial club hand)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25337Reconstruction for stabilization of unstable distal ulna or distal radioulnar joint, secondary by soft tissue stabilization (eg, tendon transfer, tendon graft or weave, or tenodesis) with or without open reduction of distal radioulnar jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25350Osteotomy, radius; distal thirdSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25355Osteotomy, radius; middle or proximal thirdSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25360Osteotomy; ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25365Osteotomy; radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25370Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius OR ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25375Multiple osteotomies, with realignment on intramedullary rod (Sofield type procedure); radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25390Osteoplasty, radius OR ulna; shorteningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25391Osteoplasty, radius OR ulna; lengthening with autograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25392Osteoplasty, radius AND ulna; shortening (excluding 64876)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25393Osteoplasty, radius AND ulna; lengthening with autograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25394Osteoplasty, carpal bone, shorteningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25400Repair of nonunion or malunion, radius OR ulna; without graft (eg, compression technique)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25405Repair of nonunion or malunion, radius OR ulna; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25415Repair of nonunion or malunion, radius AND ulna; without graft (eg, compression technique)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25420Repair of nonunion or malunion, radius AND ulna; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25425Repair of defect with autograft; radius OR ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25426Repair of defect with autograft; radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25430Insertion of vascular pedicle into carpal bone (eg, Hori procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25431Repair of nonunion of carpal bone (excluding carpal scaphoid (navicular)) (includes obtaining graft and necessary fixation), each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25440Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25441Arthroplasty with prosthetic replacement; distal radiusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25442Arthroplasty with prosthetic replacement; distal ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25443Arthroplasty with prosthetic replacement; scaphoid carpal (navicular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25444Arthroplasty with prosthetic replacement; lunateSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25445Arthroplasty with prosthetic replacement; trapeziumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25446Arthroplasty with prosthetic replacement; distal radius and partial or entire carpus (total wrist)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25447Arthroplasty, interposition, intercarpal or carpometacarpal jointsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25449Revision of arthroplasty, including removal of implant, wrist jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25450Epiphyseal arrest by epiphysiodesis or stapling; distal radius OR ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25455Epiphyseal arrest by epiphysiodesis or stapling; distal radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25490Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radiusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25491Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25492Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate; radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25500Closed treatment of radial shaft fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25505Closed treatment of radial shaft fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25515Open treatment of radial shaft fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25520Closed treatment of radial shaft fracture and closed treatment of dislocation of distal radioulnar joint (Galeazzi fracture/dislocation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25525Open treatment of radial shaft fracture, includes internal fixation, when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous skeletal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25526Open treatment of radial shaft fracture, includes internal fixation, when performed, and open treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes internal fixation, when performed, includes repair of triangular fibrocartilage complexSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25530Closed treatment of ulnar shaft fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25535Closed treatment of ulnar shaft fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25545Open treatment of ulnar shaft fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25560Closed treatment of radial and ulnar shaft fractures; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25565Closed treatment of radial and ulnar shaft fractures; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25574Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius OR ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25575Open treatment of radial AND ulnar shaft fractures, with internal fixation, when performed; of radius AND ulnaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25600Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25605Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation, includes closed treatment of fracture of ulnar styloid, when performed; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25606Percutaneous skeletal fixation of distal radial fracture or epiphyseal separationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25607Open treatment of distal radial extra-articular fracture or epiphyseal separation, with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25608Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 2 fragmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25609Open treatment of distal radial intra-articular fracture or epiphyseal separation; with internal fixation of 3 or more fragmentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25622Closed treatment of carpal scaphoid (navicular) fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25624Closed treatment of carpal scaphoid (navicular) fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25628Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25630Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); without manipulation, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25635Closed treatment of carpal bone fracture (excluding carpal scaphoid [navicular]); with manipulation, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25645Open treatment of carpal bone fracture (other than carpal scaphoid [navicular]), each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25650Closed treatment of ulnar styloid fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25651Percutaneous skeletal fixation of ulnar styloid fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25652Open treatment of ulnar styloid fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25660Closed treatment of radiocarpal or intercarpal dislocation, 1 or more bones, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25670Open treatment of radiocarpal or intercarpal dislocation, 1 or more bonesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25671Percutaneous skeletal fixation of distal radioulnar dislocationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25675Closed treatment of distal radioulnar dislocation with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25676Open treatment of distal radioulnar dislocation, acute or chronicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25680Closed treatment of trans-scaphoperilunar type of fracture dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25685Open treatment of trans-scaphoperilunar type of fracture dislocationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25690Closed treatment of lunate dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25695Open treatment of lunate dislocationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25800Arthrodesis, wrist; complete, without bone graft (includes radiocarpal and/or intercarpal and/or carpometacarpal joints)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25805Arthrodesis, wrist; with sliding graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25810Arthrodesis, wrist; with iliac or other autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25820Arthrodesis, wrist; limited, without bone graft (eg, intercarpal or radiocarpal)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25825Arthrodesis, wrist; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25830Arthrodesis, distal radioulnar joint with segmental resection of ulna, with or without bone graft (eg, Sauve-Kapandji procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25900Amputation, forearm, through radius and ulna;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25905Amputation, forearm, through radius and ulna; open, circular (guillotine)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25907Amputation, forearm, through radius and ulna; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25909Amputation, forearm, through radius and ulna; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25915Krukenberg procedureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25920Disarticulation through wrist;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25922Disarticulation through wrist; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25924Disarticulation through wrist; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25927Transmetacarpal amputation;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25929Transmetacarpal amputation; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25931Transmetacarpal amputation; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
25999Unlisted procedure, forearm or wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26010Drainage of finger abscess; simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26011Drainage of finger abscess; complicated (eg, felon)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26020Drainage of tendon sheath, digit and/or palm, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26025Drainage of palmar bursa; single, bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26030Drainage of palmar bursa; multiple bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26034Incision, bone cortex, hand or finger (eg, osteomyelitis or bone abscess)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26035Decompression fingers and/or hand, injection injury (eg, grease gun)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26037Decompressive fasciotomy, hand (excludes 26035)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26040Fasciotomy, palmar (eg, Dupuytren's contracture); percutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26045Fasciotomy, palmar (eg, Dupuytren's contracture); open, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26055Tendon sheath incision (eg, for trigger finger)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26060Tenotomy, percutaneous, single, each digitSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26070Arthrotomy, with exploration, drainage, or removal of loose or foreign body; carpometacarpal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26075Arthrotomy, with exploration, drainage, or removal of loose or foreign body; metacarpophalangeal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26080Arthrotomy, with exploration, drainage, or removal of loose or foreign body; interphalangeal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26100Arthrotomy with biopsy; carpometacarpal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26105Arthrotomy with biopsy; metacarpophalangeal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26110Arthrotomy with biopsy; interphalangeal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26111Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; 1.5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26113Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); 1.5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26115Excision, tumor or vascular malformation, soft tissue of hand or finger, subcutaneous; less than 1.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26116Excision, tumor, soft tissue, or vascular malformation, of hand or finger, subfascial (eg, intramuscular); less than 1.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26117Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26118Radical resection of tumor (eg, sarcoma), soft tissue of hand or finger; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26121Fasciectomy, palm only, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26123Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26125Fasciectomy, partial palmar with release of single digit including proximal interphalangeal joint, with or without Z-plasty, other local tissue rearrangement, or skin grafting (includes obtaining graft); each additional digit (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26130Synovectomy, carpometacarpal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26135Synovectomy, metacarpophalangeal joint including intrinsic release and extensor hood reconstruction, each digitSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26140Synovectomy, proximal interphalangeal joint, including extensor reconstruction, each interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26145Synovectomy, tendon sheath, radical (tenosynovectomy), flexor tendon, palm and/or finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26160Excision of lesion of tendon sheath or joint capsule (eg, cyst, mucous cyst, or ganglion), hand or fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26170Excision of tendon, palm, flexor or extensor, single, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26180Excision of tendon, finger, flexor or extensor, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26185Sesamoidectomy, thumb or finger (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26200Excision or curettage of bone cyst or benign tumor of metacarpal;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26205Excision or curettage of bone cyst or benign tumor of metacarpal; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26210Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26215Excision or curettage of bone cyst or benign tumor of proximal, middle, or distal phalanx of finger; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26230Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); metacarpalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26235Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); proximal or middle phalanx of fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26236Partial excision (craterization, saucerization, or diaphysectomy) bone (eg, osteomyelitis); distal phalanx of fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26250Radical resection of tumor, metacarpalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26260Radical resection of tumor, proximal or middle phalanx of fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26262Radical resection of tumor, distal phalanx of fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26320Removal of implant from finger or handSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26340Manipulation, finger joint, under anesthesia, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26341Manipulation, palmar fascial cord (ie, Dupuytren's cord), post enzyme injection (eg, collagenase), single cordSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26350Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); primary or secondary without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26352Repair or advancement, flexor tendon, not in zone 2 digital flexor tendon sheath (eg, no man's land); secondary with free graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26356Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); primary, without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26357Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26358Repair or advancement, flexor tendon, in zone 2 digital flexor tendon sheath (eg, no man's land); secondary, with free graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26370Repair or advancement of profundus tendon, with intact superficialis tendon; primary, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26372Repair or advancement of profundus tendon, with intact superficialis tendon; secondary with free graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26373Repair or advancement of profundus tendon, with intact superficialis tendon; secondary without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26390Excision flexor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26392Removal of synthetic rod and insertion of flexor tendon graft, hand or finger (includes obtaining graft), each rodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26410Repair, extensor tendon, hand, primary or secondary; without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26412Repair, extensor tendon, hand, primary or secondary; with free graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26415Excision of extensor tendon, with implantation of synthetic rod for delayed tendon graft, hand or finger, each rodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26416Removal of synthetic rod and insertion of extensor tendon graft (includes obtaining graft), hand or finger, each rodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26418Repair, extensor tendon, finger, primary or secondary; without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26420Repair, extensor tendon, finger, primary or secondary; with free graft (includes obtaining graft) each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26426Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); using local tissue(s), including lateral band(s), each fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26428Repair of extensor tendon, central slip, secondary (eg, boutonniere deformity); with free graft (includes obtaining graft), each fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26432Closed treatment of distal extensor tendon insertion, with or without percutaneous pinning (eg, mallet finger)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26433Repair of extensor tendon, distal insertion, primary or secondary; without graft (eg, mallet finger)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26434Repair of extensor tendon, distal insertion, primary or secondary; with free graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26437Realignment of extensor tendon, hand, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26440Tenolysis, flexor tendon; palm OR finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26442Tenolysis, flexor tendon; palm AND finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26445Tenolysis, extensor tendon, hand OR finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26449Tenolysis, complex, extensor tendon, finger, including forearm, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26450Tenotomy, flexor, palm, open, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26455Tenotomy, flexor, finger, open, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26460Tenotomy, extensor, hand or finger, open, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26471Tenodesis; of proximal interphalangeal joint, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26474Tenodesis; of distal joint, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26476Lengthening of tendon, extensor, hand or finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26477Shortening of tendon, extensor, hand or finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26478Lengthening of tendon, flexor, hand or finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26479Shortening of tendon, flexor, hand or finger, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26480Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26483Transfer or transplant of tendon, carpometacarpal area or dorsum of hand; with free tendon graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26485Transfer or transplant of tendon, palmar; without free tendon graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26489Transfer or transplant of tendon, palmar; with free tendon graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26490Opponensplasty; superficialis tendon transfer type, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26492Opponensplasty; tendon transfer with graft (includes obtaining graft), each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26494Opponensplasty; hypothenar muscle transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26496Opponensplasty; other methodsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26497Transfer of tendon to restore intrinsic function; ring and small fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26498Transfer of tendon to restore intrinsic function; all 4 fingersSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26499Correction claw finger, other methodsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26500Reconstruction of tendon pulley, each tendon; with local tissues (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26502Reconstruction of tendon pulley, each tendon; with tendon or fascial graft (includes obtaining graft) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26508Release of thenar muscle(s) (eg, thumb contracture)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26510Cross intrinsic transfer, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26516Capsulodesis, metacarpophalangeal joint; single digitSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26517Capsulodesis, metacarpophalangeal joint; 2 digitsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26518Capsulodesis, metacarpophalangeal joint; 3 or 4 digitsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26520Capsulectomy or capsulotomy; metacarpophalangeal joint, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26525Capsulectomy or capsulotomy; interphalangeal joint, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26530Arthroplasty, metacarpophalangeal joint; each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26531Arthroplasty, metacarpophalangeal joint; with prosthetic implant, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26535Arthroplasty, interphalangeal joint; each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26536Arthroplasty, interphalangeal joint; with prosthetic implant, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26540Repair of collateral ligament, metacarpophalangeal or interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26541Reconstruction, collateral ligament, metacarpophalangeal joint, single; with tendon or fascial graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26542Reconstruction, collateral ligament, metacarpophalangeal joint, single; with local tissue (eg, adductor advancement)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26545Reconstruction, collateral ligament, interphalangeal joint, single, including graft, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26546Repair non-union, metacarpal or phalanx (includes obtaining bone graft with or without external or internal fixation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26548Repair and reconstruction, finger, volar plate, interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26550Pollicization of a digitSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26551Transfer, toe-to-hand with microvascular anastomosis; great toe wrap-around with bone graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26553Transfer, toe-to-hand with microvascular anastomosis; other than great toe, singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26554Transfer, toe-to-hand with microvascular anastomosis; other than great toe, doubleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26555Transfer, finger to another position without microvascular anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26556Transfer, free toe joint, with microvascular anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26560Repair of syndactyly (web finger) each web space; with skin flapsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26561Repair of syndactyly (web finger) each web space; with skin flaps and graftsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26562Repair of syndactyly (web finger) each web space; complex (eg, involving bone, nails)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26565Osteotomy; metacarpal, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26567Osteotomy; phalanx of finger, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26568Osteoplasty, lengthening, metacarpal or phalanxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26580Repair cleft handSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26587Reconstruction of polydactylous digit, soft tissue and boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26590Repair macrodactylia, each digitSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26591Repair, intrinsic muscles of hand, each muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26593Release, intrinsic muscles of hand, each muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26596Excision of constricting ring of finger, with multiple Z-plastiesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26600Closed treatment of metacarpal fracture, single; without manipulation, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26605Closed treatment of metacarpal fracture, single; with manipulation, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26607Closed treatment of metacarpal fracture, with manipulation, with external fixation, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26608Percutaneous skeletal fixation of metacarpal fracture, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26615Open treatment of metacarpal fracture, single, includes internal fixation, when performed, each boneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26641Closed treatment of carpometacarpal dislocation, thumb, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26645Closed treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26650Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26665Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26670Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26675Closed treatment of carpometacarpal dislocation, other than thumb, with manipulation, each joint; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26676Percutaneous skeletal fixation of carpometacarpal dislocation, other than thumb, with manipulation, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26685Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26686Open treatment of carpometacarpal dislocation, other than thumb; complex, multiple, or delayed reductionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26700Closed treatment of metacarpophalangeal dislocation, single, with manipulation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26705Closed treatment of metacarpophalangeal dislocation, single, with manipulation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26706Percutaneous skeletal fixation of metacarpophalangeal dislocation, single, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26715Open treatment of metacarpophalangeal dislocation, single, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26720Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26725Closed treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb; with manipulation, with or without skin or skeletal traction, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26727Percutaneous skeletal fixation of unstable phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26735Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26740Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26742Closed treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint; with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26746Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26750Closed treatment of distal phalangeal fracture, finger or thumb; without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26755Closed treatment of distal phalangeal fracture, finger or thumb; with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26756Percutaneous skeletal fixation of distal phalangeal fracture, finger or thumb, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26765Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26770Closed treatment of interphalangeal joint dislocation, single, with manipulation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26775Closed treatment of interphalangeal joint dislocation, single, with manipulation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26776Percutaneous skeletal fixation of interphalangeal joint dislocation, single, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26785Open treatment of interphalangeal joint dislocation, includes internal fixation, when performed, singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26820Fusion in opposition, thumb, with autogenous graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26841Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26842Arthrodesis, carpometacarpal joint, thumb, with or without internal fixation; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26843Arthrodesis, carpometacarpal joint, digit, other than thumb, each;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26844Arthrodesis, carpometacarpal joint, digit, other than thumb, each; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26850Arthrodesis, metacarpophalangeal joint, with or without internal fixation;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26852Arthrodesis, metacarpophalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26860Arthrodesis, interphalangeal joint, with or without internal fixation;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26861Arthrodesis, interphalangeal joint, with or without internal fixation; each additional interphalangeal joint (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26862Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26863Arthrodesis, interphalangeal joint, with or without internal fixation; with autograft (includes obtaining graft), each additional joint (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26910Amputation, metacarpal, with finger or thumb (ray amputation), single, with or without interosseous transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26951Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with direct closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26952Amputation, finger or thumb, primary or secondary, any joint or phalanx, single, including neurectomies; with local advancement flaps (V-Y, hood)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26989Unlisted procedure, hands or fingersSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26990Incision and drainage, pelvis or hip joint area; deep abscess or hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26991Incision and drainage, pelvis or hip joint area; infected bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
26992Incision, bone cortex, pelvis and/or hip joint (eg, osteomyelitis or bone abscess)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27000Tenotomy, adductor of hip, percutaneous (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27001Tenotomy, adductor of hip, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27003Tenotomy, adductor, subcutaneous, open, with obturator neurectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27005Tenotomy, hip flexor(s), open (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27006Tenotomy, abductors and/or extensor(s) of hip, open (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27025Fasciotomy, hip or thigh, any typeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27027Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle), unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27030Arthrotomy, hip, with drainage (eg, infection)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27033Arthrotomy, hip, including exploration or removal of loose or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27035Denervation, hip joint, intrapelvic or extrapelvic intra-articular branches of sciatic, femoral, or obturator nervesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27036Capsulectomy or capsulotomy, hip, with or without excision of heterotopic bone, with release of hip flexor muscles (ie, gluteus medius, gluteus minimus, tensor fascia latae, rectus femoris, sartorius, iliopsoas)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27040Biopsy, soft tissue of pelvis and hip area; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27041Biopsy, soft tissue of pelvis and hip area; deep, subfascial or intramuscularSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27043Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27045Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27047Excision, tumor, soft tissue of pelvis and hip area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27048Excision, tumor, soft tissue of pelvis and hip area, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27049Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27050Arthrotomy, with biopsy; sacroiliac jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27052Arthrotomy, with biopsy; hip jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27054Arthrotomy with synovectomy, hip jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27057Decompression fasciotomy(ies), pelvic (buttock) compartment(s) (eg, gluteus medius-minimus, gluteus maximus, iliopsoas, and/or tensor fascia lata muscle) with debridement of nonviable muscle, unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27059Radical resection of tumor (eg, sarcoma), soft tissue of pelvis and hip area; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27060Excision; ischial bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27062Excision; trochanteric bursa or calcificationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27065Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; superficial, includes autograft, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27066Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27067Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; with autograft requiring separate incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27070Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27071Partial excision, wing of ilium, symphysis pubis, or greater trochanter of femur, (craterization, saucerization) (eg, osteomyelitis or bone abscess); deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27075Radical resection of tumor; wing of ilium, 1 pubic or ischial ramus or symphysis pubisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27076Radical resection of tumor; ilium, including acetabulum, both pubic rami, or ischium and acetabulumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27077Radical resection of tumor; innominate bone, totalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27078Radical resection of tumor; ischial tuberosity and greater trochanter of femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27080Coccygectomy, primarySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27086Removal of foreign body, pelvis or hip; subcutaneous tissueSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27087Removal of foreign body, pelvis or hip; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27090Removal of hip prosthesis; (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27091Removal of hip prosthesis; complicated, including total hip prosthesis, methylmethacrylate with or without insertion of spacerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27093Injection procedure for hip arthrography; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27095Injection procedure for hip arthrography; with anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27096Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including arthrography when performedYesPain Managament Request e-form
27097Release or recession, hamstring, proximalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27098Transfer, adductor to ischiumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27100Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27105Transfer paraspinal muscle to hip (includes fascial or tendon extension graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27110Transfer iliopsoas; to greater trochanter of femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27111Transfer iliopsoas; to femoral neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27120Acetabuloplasty; (eg, Whitman, Colonna, Haygroves, or cup type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27122Acetabuloplasty; resection, femoral head (eg, Girdlestone procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27125Hemiarthroplasty, hip, partial (eg, femoral stem prosthesis, bipolar arthroplasty)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27130Arthroplasty, acetabular and proximal femoral prosthetic replacement (total hip arthroplasty), with or without autograft or allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27132Conversion of previous hip surgery to total hip arthroplasty, with or without autograft or allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27134Revision of total hip arthroplasty; both components, with or without autograft or allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27137Revision of total hip arthroplasty; acetabular component only, with or without autograft or allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27138Revision of total hip arthroplasty; femoral component only, with or without allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27140Osteotomy and transfer of greater trochanter of femur (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27146Osteotomy, iliac, acetabular or innominate bone;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27147Osteotomy, iliac, acetabular or innominate bone; with open reduction of hipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27151Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27156Osteotomy, iliac, acetabular or innominate bone; with femoral osteotomy and with open reduction of hipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27158Osteotomy, pelvis, bilateral (eg, congenital malformation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27161Osteotomy, femoral neck (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27165Osteotomy, intertrochanteric or subtrochanteric including internal or external fixation and/or castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27170Bone graft, femoral head, neck, intertrochanteric or subtrochanteric area (includes obtaining bone graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27175Treatment of slipped femoral epiphysis; by traction, without reductionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27176Treatment of slipped femoral epiphysis; by single or multiple pinning, in situSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27177Open treatment of slipped femoral epiphysis; single or multiple pinning or bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27178Open treatment of slipped femoral epiphysis; closed manipulation with single or multiple pinningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27179Open treatment of slipped femoral epiphysis; osteoplasty of femoral neck (Heyman type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27181Open treatment of slipped femoral epiphysis; osteotomy and internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27185Epiphyseal arrest by epiphysiodesis or stapling, greater trochanter of femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27187Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, femoral neck and proximal femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27197Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27198Closed treatment of posterior pelvic ring fracture(s), dislocation(s), diastasis or subluxation of the ilium, sacroiliac joint, and/or sacrum, with or without anterior pelvic ring fracture(s) and/or dislocation(s) of the pubic symphysis and/or superior/inferior rami, unilateral or bilateral; with manipulation, requiring more than local anesthesia (ie, general anesthesia, moderate sedation, spinal/epidural)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27200Closed treatment of coccygeal fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27202Open treatment of coccygeal fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27215Open treatment of iliac spine(s), tuberosity avulsion, or iliac wing fracture(s), unilateral, for pelvic bone fracture patterns that do not disrupt the pelvic ring, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27216Percutaneous skeletal fixation of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral (includes ipsilateral ilium, sacroiliac joint and/or sacrum)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27217Open treatment of anterior pelvic bone fracture and/or dislocation for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes pubic symphysis and/or ipsilateral superior/inferior rami)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27218Open treatment of posterior pelvic bone fracture and/or dislocation, for fracture patterns that disrupt the pelvic ring, unilateral, includes internal fixation, when performed (includes ipsilateral ilium, sacroiliac joint and/or sacrum)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27220Closed treatment of acetabulum (hip socket) fracture(s); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27222Closed treatment of acetabulum (hip socket) fracture(s); with manipulation, with or without skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27226Open treatment of posterior or anterior acetabular wall fracture, with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27227Open treatment of acetabular fracture(s) involving anterior or posterior (one) column, or a fracture running transversely across the acetabulum, with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27228Open treatment of acetabular fracture(s) involving anterior and posterior (two) columns, includes T-fracture and both column fracture with complete articular detachment, or single column or transverse fracture with associated acetabular wall fracture, with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27230Closed treatment of femoral fracture, proximal end, neck; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27232Closed treatment of femoral fracture, proximal end, neck; with manipulation, with or without skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27235Percutaneous skeletal fixation of femoral fracture, proximal end, neckSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27236Open treatment of femoral fracture, proximal end, neck, internal fixation or prosthetic replacementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27238Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27240Closed treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27244Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with plate/screw type implant, with or without cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27245Treatment of intertrochanteric, peritrochanteric, or subtrochanteric femoral fracture; with intramedullary implant, with or without interlocking screws and/or cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27246Closed treatment of greater trochanteric fracture, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27248Open treatment of greater trochanteric fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27250Closed treatment of hip dislocation, traumatic; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27252Closed treatment of hip dislocation, traumatic; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27253Open treatment of hip dislocation, traumatic, without internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27254Open treatment of hip dislocation, traumatic, with acetabular wall and femoral head fracture, with or without internal or external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27256Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; without anesthesia, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27257Treatment of spontaneous hip dislocation (developmental, including congenital or pathological), by abduction, splint or traction; with manipulation, requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27258Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27259Open treatment of spontaneous hip dislocation (developmental, including congenital or pathological), replacement of femoral head in acetabulum (including tenotomy, etc); with femoral shaft shorteningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27265Closed treatment of post hip arthroplasty dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27266Closed treatment of post hip arthroplasty dislocation; requiring regional or general anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27267Closed treatment of femoral fracture, proximal end, head; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27268Closed treatment of femoral fracture, proximal end, head; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27269Open treatment of femoral fracture, proximal end, head, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27275Manipulation, hip joint, requiring general anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27279Arthrodesis, sacroiliac joint, percutaneous or minimally invasive (indirect visualization), with image guidance, includes obtaining bone graft when performed, and placement of transfixing deviceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27280Arthrodesis, open, sacroiliac joint, including obtaining bone graft, including instrumentation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27282Arthrodesis, symphysis pubis (including obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27284Arthrodesis, hip joint (including obtaining graft);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27286Arthrodesis, hip joint (including obtaining graft); with subtrochanteric osteotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27290Interpelviabdominal amputation (hindquarter amputation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27295Disarticulation of hipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27299Unlisted procedure, pelvis or hip jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27301Incision and drainage, deep abscess, bursa, or hematoma, thigh or knee regionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27303Incision, deep, with opening of bone cortex, femur or knee (eg, osteomyelitis or bone abscess)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27305Fasciotomy, iliotibial (tenotomy), openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27306Tenotomy, percutaneous, adductor or hamstring; single tendon (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27307Tenotomy, percutaneous, adductor or hamstring; multiple tendonsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27310Arthrotomy, knee, with exploration, drainage, or removal of foreign body (eg, infection)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27323Biopsy, soft tissue of thigh or knee area; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27324Biopsy, soft tissue of thigh or knee area; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27325Neurectomy, hamstring muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27326Neurectomy, popliteal (gastrocnemius)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27327Excision, tumor, soft tissue of thigh or knee area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27328Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27329Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27330Arthrotomy, knee; with synovial biopsy onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27331Arthrotomy, knee; including joint exploration, biopsy, or removal of loose or foreign bodiesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27332Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial OR lateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27333Arthrotomy, with excision of semilunar cartilage (meniscectomy) knee; medial AND lateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27334Arthrotomy, with synovectomy, knee; anterior OR posteriorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27335Arthrotomy, with synovectomy, knee; anterior AND posterior including popliteal areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27337Excision, tumor, soft tissue of thigh or knee area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27339Excision, tumor, soft tissue of thigh or knee area, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27340Excision, prepatellar bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27345Excision of synovial cyst of popliteal space (eg, Baker's cyst)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27347Excision of lesion of meniscus or capsule (eg, cyst, ganglion), kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27350Patellectomy or hemipatellectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27355Excision or curettage of bone cyst or benign tumor of femur;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27356Excision or curettage of bone cyst or benign tumor of femur; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27357Excision or curettage of bone cyst or benign tumor of femur; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27358Excision or curettage of bone cyst or benign tumor of femur; with internal fixation (List in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27360Partial excision (craterization, saucerization, or diaphysectomy) bone, femur, proximal tibia and/or fibula (eg, osteomyelitis or bone abscess)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27364Radical resection of tumor (eg, sarcoma), soft tissue of thigh or knee area; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27365Radical resection of tumor, femur or kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27369Injection procedure for contrast knee arthrography or contrast enhanced CT/MRI knee arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27372Removal of foreign body, deep, thigh region or knee areaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27380Suture of infrapatellar tendon; primarySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27381Suture of infrapatellar tendon; secondary reconstruction, including fascial or tendon graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27385Suture of quadriceps or hamstring muscle rupture; primarySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27386Suture of quadriceps or hamstring muscle rupture; secondary reconstruction, including fascial or tendon graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27390Tenotomy, open, hamstring, knee to hip; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27391Tenotomy, open, hamstring, knee to hip; multiple tendons, 1 legSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27392Tenotomy, open, hamstring, knee to hip; multiple tendons, bilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27393Lengthening of hamstring tendon; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27394Lengthening of hamstring tendon; multiple tendons, 1 legSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27395Lengthening of hamstring tendon; multiple tendons, bilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27396Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27397Transplant or transfer (with muscle redirection or rerouting), thigh (eg, extensor to flexor); multiple tendonsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27400Transfer, tendon or muscle, hamstrings to femur (eg, Egger's type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27403Arthrotomy with meniscus repair, kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27405Repair, primary, torn ligament and/or capsule, knee; collateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27407Repair, primary, torn ligament and/or capsule, knee; cruciateSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27409Repair, primary, torn ligament and/or capsule, knee; collateral and cruciate ligamentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27412Autologous chondrocyte implantation, kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27415Osteochondral allograft, knee, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27416Osteochondral autograft(s), knee, open (eg, mosaicplasty) (includes harvesting of autograft[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27418Anterior tibial tubercleplasty (eg, Maquet type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27420Reconstruction of dislocating patella; (eg, Hauser type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27422Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27424Reconstruction of dislocating patella; with patellectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27425Lateral retinacular release, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27427Ligamentous reconstruction (augmentation), knee; extra-articularSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27428Ligamentous reconstruction (augmentation), knee; intra-articular (open)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27429Ligamentous reconstruction (augmentation), knee; intra-articular (open) and extra-articularSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27430Quadricepsplasty (eg, Bennett or Thompson type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27435Capsulotomy, posterior capsular release, kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27437Arthroplasty, patella; without prosthesisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27438Arthroplasty, patella; with prosthesisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27440Arthroplasty, knee, tibial plateau;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27441Arthroplasty, knee, tibial plateau; with debridement and partial synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27442Arthroplasty, femoral condyles or tibial plateau(s), knee;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27443Arthroplasty, femoral condyles or tibial plateau(s), knee; with debridement and partial synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27445Arthroplasty, knee, hinge prosthesis (eg, Walldius type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27446Arthroplasty, knee, condyle and plateau; medial OR lateral compartmentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27447Arthroplasty, knee, condyle and plateau; medial AND lateral compartments with or without patella resurfacing (total knee arthroplasty)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27448Osteotomy, femur, shaft or supracondylar; without fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27450Osteotomy, femur, shaft or supracondylar; with fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27454Osteotomy, multiple, with realignment on intramedullary rod, femoral shaft (eg, Sofield type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27455Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); before epiphyseal closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27457Osteotomy, proximal tibia, including fibular excision or osteotomy (includes correction of genu varus [bowleg] or genu valgus [knock-knee]); after epiphyseal closureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27465Osteoplasty, femur; shortening (excluding 64876)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27466Osteoplasty, femur; lengtheningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27468Osteoplasty, femur; combined, lengthening and shortening with femoral segment transferSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27470Repair, nonunion or malunion, femur, distal to head and neck; without graft (eg, compression technique)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27472Repair, nonunion or malunion, femur, distal to head and neck; with iliac or other autogenous bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27475Arrest, epiphyseal, any method (eg, epiphysiodesis); distal femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27477Arrest, epiphyseal, any method (eg, epiphysiodesis); tibia and fibula, proximalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27479Arrest, epiphyseal, any method (eg, epiphysiodesis); combined distal femur, proximal tibia and fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27485Arrest, hemiepiphyseal, distal femur or proximal tibia or fibula (eg, genu varus or valgus)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27486Revision of total knee arthroplasty, with or without allograft; 1 componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27487Revision of total knee arthroplasty, with or without allograft; femoral and entire tibial componentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27488Removal of prosthesis, including total knee prosthesis, methylmethacrylate with or without insertion of spacer, kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27495Prophylactic treatment (nailing, pinning, plating, or wiring) with or without methylmethacrylate, femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27496Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27497Decompression fasciotomy, thigh and/or knee, 1 compartment (flexor or extensor or adductor); with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27498Decompression fasciotomy, thigh and/or knee, multiple compartments;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27499Decompression fasciotomy, thigh and/or knee, multiple compartments; with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27500Closed treatment of femoral shaft fracture, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27501Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27502Closed treatment of femoral shaft fracture, with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27503Closed treatment of supracondylar or transcondylar femoral fracture with or without intercondylar extension, with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27506Open treatment of femoral shaft fracture, with or without external fixation, with insertion of intramedullary implant, with or without cerclage and/or locking screwsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27507Open treatment of femoral shaft fracture with plate/screws, with or without cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27508Closed treatment of femoral fracture, distal end, medial or lateral condyle, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27509Percutaneous skeletal fixation of femoral fracture, distal end, medial or lateral condyle, or supracondylar or transcondylar, with or without intercondylar extension, or distal femoral epiphyseal separationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27510Closed treatment of femoral fracture, distal end, medial or lateral condyle, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27511Open treatment of femoral supracondylar or transcondylar fracture without intercondylar extension, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27513Open treatment of femoral supracondylar or transcondylar fracture with intercondylar extension, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27514Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27516Closed treatment of distal femoral epiphyseal separation; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27517Closed treatment of distal femoral epiphyseal separation; with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27519Open treatment of distal femoral epiphyseal separation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27520Closed treatment of patellar fracture, without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27524Open treatment of patellar fracture, with internal fixation and/or partial or complete patellectomy and soft tissue repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27530Closed treatment of tibial fracture, proximal (plateau); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27532Closed treatment of tibial fracture, proximal (plateau); with or without manipulation, with skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27535Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27536Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27538Closed treatment of intercondylar spine(s) and/or tuberosity fracture(s) of knee, with or without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27540Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27550Closed treatment of knee dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27552Closed treatment of knee dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27556Open treatment of knee dislocation, includes internal fixation, when performed; without primary ligamentous repair or augmentation/reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27557Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27558Open treatment of knee dislocation, includes internal fixation, when performed; with primary ligamentous repair, with augmentation/reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27560Closed treatment of patellar dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27562Closed treatment of patellar dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27566Open treatment of patellar dislocation, with or without partial or total patellectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27570Manipulation of knee joint under general anesthesia (includes application of traction or other fixation devices)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27580Arthrodesis, knee, any techniqueSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27590Amputation, thigh, through femur, any level;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27591Amputation, thigh, through femur, any level; immediate fitting technique including first castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27592Amputation, thigh, through femur, any level; open, circular (guillotine)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27594Amputation, thigh, through femur, any level; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27596Amputation, thigh, through femur, any level; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27598Disarticulation at kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27599Unlisted procedure, femur or kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27600Decompression fasciotomy, leg; anterior and/or lateral compartments onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27601Decompression fasciotomy, leg; posterior compartment(s) onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27602Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27603Incision and drainage, leg or ankle; deep abscess or hematomaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27604Incision and drainage, leg or ankle; infected bursaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27605Tenotomy, percutaneous, Achilles tendon (separate procedure); local anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27606Tenotomy, percutaneous, Achilles tendon (separate procedure); general anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27607Incision (eg, osteomyelitis or bone abscess), leg or ankleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27610Arthrotomy, ankle, including exploration, drainage, or removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27612Arthrotomy, posterior capsular release, ankle, with or without Achilles tendon lengtheningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27613Biopsy, soft tissue of leg or ankle area; superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27614Biopsy, soft tissue of leg or ankle area; deep (subfascial or intramuscular)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27615Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27616Radical resection of tumor (eg, sarcoma), soft tissue of leg or ankle area; 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27618Excision, tumor, soft tissue of leg or ankle area, subcutaneous; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27619Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); less than 5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27620Arthrotomy, ankle, with joint exploration, with or without biopsy, with or without removal of loose or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27625Arthrotomy, with synovectomy, ankle;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27626Arthrotomy, with synovectomy, ankle; including tenosynovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27630Excision of lesion of tendon sheath or capsule (eg, cyst or ganglion), leg and/or ankleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27632Excision, tumor, soft tissue of leg or ankle area, subcutaneous; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27634Excision, tumor, soft tissue of leg or ankle area, subfascial (eg, intramuscular); 5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27635Excision or curettage of bone cyst or benign tumor, tibia or fibula;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27637Excision or curettage of bone cyst or benign tumor, tibia or fibula; with autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27638Excision or curettage of bone cyst or benign tumor, tibia or fibula; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27640Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27641Partial excision (craterization, saucerization, or diaphysectomy), bone (eg, osteomyelitis); fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27645Radical resection of tumor; tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27646Radical resection of tumor; fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27647Radical resection of tumor; talus or calcaneusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27648Injection procedure for ankle arthrographySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27650Repair, primary, open or percutaneous, ruptured Achilles tendon;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27652Repair, primary, open or percutaneous, ruptured Achilles tendon; with graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27654Repair, secondary, Achilles tendon, with or without graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27656Repair, fascial defect of legSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27658Repair, flexor tendon, leg; primary, without graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27659Repair, flexor tendon, leg; secondary, with or without graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27664Repair, extensor tendon, leg; primary, without graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27665Repair, extensor tendon, leg; secondary, with or without graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27675Repair, dislocating peroneal tendons; without fibular osteotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27676Repair, dislocating peroneal tendons; with fibular osteotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27680Tenolysis, flexor or extensor tendon, leg and/or ankle; single, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27681Tenolysis, flexor or extensor tendon, leg and/or ankle; multiple tendons (through separate incision[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27685Lengthening or shortening of tendon, leg or ankle; single tendon (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27686Lengthening or shortening of tendon, leg or ankle; multiple tendons (through same incision), eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27687Gastrocnemius recession (eg, Strayer procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27690Transfer or transplant of single tendon (with muscle redirection or rerouting); superficial (eg, anterior tibial extensors into midfoot)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27691Transfer or transplant of single tendon (with muscle redirection or rerouting); deep (eg, anterior tibial or posterior tibial through interosseous space, flexor digitorum longus, flexor hallucis longus, or peroneal tendon to midfoot or hindfoot)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27692Transfer or transplant of single tendon (with muscle redirection or rerouting); each additional tendon (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27695Repair, primary, disrupted ligament, ankle; collateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27696Repair, primary, disrupted ligament, ankle; both collateral ligamentsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27698Repair, secondary, disrupted ligament, ankle, collateral (eg, Watson-Jones procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27700Arthroplasty, ankle;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27702Arthroplasty, ankle; with implant (total ankle)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27703Arthroplasty, ankle; revision, total ankleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27704Removal of ankle implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27705Osteotomy; tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27707Osteotomy; fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27709Osteotomy; tibia and fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27712Osteotomy; multiple, with realignment on intramedullary rod (eg, Sofield type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27715Osteoplasty, tibia and fibula, lengthening or shorteningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27720Repair of nonunion or malunion, tibia; without graft, (eg, compression technique)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27722Repair of nonunion or malunion, tibia; with sliding graftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27724Repair of nonunion or malunion, tibia; with iliac or other autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27725Repair of nonunion or malunion, tibia; by synostosis, with fibula, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27726Repair of fibula nonunion and/or malunion with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27727Repair of congenital pseudarthrosis, tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27730Arrest, epiphyseal (epiphysiodesis), open; distal tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27732Arrest, epiphyseal (epiphysiodesis), open; distal fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27734Arrest, epiphyseal (epiphysiodesis), open; distal tibia and fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27740Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27742Arrest, epiphyseal (epiphysiodesis), any method, combined, proximal and distal tibia and fibula; and distal femurSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27745Prophylactic treatment (nailing, pinning, plating or wiring) with or without methylmethacrylate, tibiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27750Closed treatment of tibial shaft fracture (with or without fibular fracture); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27752Closed treatment of tibial shaft fracture (with or without fibular fracture); with manipulation, with or without skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27756Percutaneous skeletal fixation of tibial shaft fracture (with or without fibular fracture) (eg, pins or screws)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27758Open treatment of tibial shaft fracture (with or without fibular fracture), with plate/screws, with or without cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27759Treatment of tibial shaft fracture (with or without fibular fracture) by intramedullary implant, with or without interlocking screws and/or cerclageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27760Closed treatment of medial malleolus fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27762Closed treatment of medial malleolus fracture; with manipulation, with or without skin or skeletal tractionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27766Open treatment of medial malleolus fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27767Closed treatment of posterior malleolus fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27768Closed treatment of posterior malleolus fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27769Open treatment of posterior malleolus fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27780Closed treatment of proximal fibula or shaft fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27781Closed treatment of proximal fibula or shaft fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27784Open treatment of proximal fibula or shaft fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27786Closed treatment of distal fibular fracture (lateral malleolus); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27788Closed treatment of distal fibular fracture (lateral malleolus); with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27792Open treatment of distal fibular fracture (lateral malleolus), includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27808Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27810Closed treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27814Open treatment of bimalleolar ankle fracture (eg, lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli), includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27816Closed treatment of trimalleolar ankle fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27818Closed treatment of trimalleolar ankle fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27822Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; without fixation of posterior lipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27823Open treatment of trimalleolar ankle fracture, includes internal fixation, when performed, medial and/or lateral malleolus; with fixation of posterior lipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27824Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27825Closed treatment of fracture of weight bearing articular portion of distal tibia (eg, pilon or tibial plafond), with or without anesthesia; with skeletal traction and/or requiring manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27826Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of fibula onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27827Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of tibia onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27828Open treatment of fracture of weight bearing articular surface/portion of distal tibia (eg, pilon or tibial plafond), with internal fixation, when performed; of both tibia and fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27829Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27830Closed treatment of proximal tibiofibular joint dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27831Closed treatment of proximal tibiofibular joint dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27832Open treatment of proximal tibiofibular joint dislocation, includes internal fixation, when performed, or with excision of proximal fibulaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27840Closed treatment of ankle dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27842Closed treatment of ankle dislocation; requiring anesthesia, with or without percutaneous skeletal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27846Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; without repair or internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27848Open treatment of ankle dislocation, with or without percutaneous skeletal fixation; with repair or internal or external fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27860Manipulation of ankle under general anesthesia (includes application of traction or other fixation apparatus)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27870Arthrodesis, ankle, openSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27871Arthrodesis, tibiofibular joint, proximal or distalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27880Amputation, leg, through tibia and fibula;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27881Amputation, leg, through tibia and fibula; with immediate fitting technique including application of first castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27882Amputation, leg, through tibia and fibula; open, circular (guillotine)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27884Amputation, leg, through tibia and fibula; secondary closure or scar revisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27886Amputation, leg, through tibia and fibula; re-amputationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27888Amputation, ankle, through malleoli of tibia and fibula (eg, Syme, Pirogoff type procedures), with plastic closure and resection of nervesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27889Ankle disarticulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27892Decompression fasciotomy, leg; anterior and/or lateral compartments only, with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27893Decompression fasciotomy, leg; posterior compartment(s) only, with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27894Decompression fasciotomy, leg; anterior and/or lateral, and posterior compartment(s), with debridement of nonviable muscle and/or nerveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
27899Unlisted procedure, leg or ankleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28001Incision and drainage, bursa, footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28002Incision and drainage below fascia, with or without tendon sheath involvement, foot; single bursal spaceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28003Incision and drainage below fascia, with or without tendon sheath involvement, foot; multiple areasSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28005Incision, bone cortex (eg, osteomyelitis or bone abscess), footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28008Fasciotomy, foot and/or toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28010Tenotomy, percutaneous, toe; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28011Tenotomy, percutaneous, toe; multiple tendonsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28020Arthrotomy, including exploration, drainage, or removal of loose or foreign body; intertarsal or tarsometatarsal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28022Arthrotomy, including exploration, drainage, or removal of loose or foreign body; metatarsophalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28024Arthrotomy, including exploration, drainage, or removal of loose or foreign body; interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28035Release, tarsal tunnel (posterior tibial nerve decompression)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28039Excision, tumor, soft tissue of foot or toe, subcutaneous; 1.5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28041Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); 1.5 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28043Excision, tumor, soft tissue of foot or toe, subcutaneous; less than 1.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28045Excision, tumor, soft tissue of foot or toe, subfascial (eg, intramuscular); less than 1.5 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28046Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; less than 3 cmSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28047Radical resection of tumor (eg, sarcoma), soft tissue of foot or toe; 3 cm or greaterSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28050Arthrotomy with biopsy; intertarsal or tarsometatarsal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28052Arthrotomy with biopsy; metatarsophalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28054Arthrotomy with biopsy; interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28055Neurectomy, intrinsic musculature of footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28060Fasciectomy, plantar fascia; partial (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28062Fasciectomy, plantar fascia; radical (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28070Synovectomy; intertarsal or tarsometatarsal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28072Synovectomy; metatarsophalangeal joint, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28080Excision, interdigital (Morton) neuroma, single, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28086Synovectomy, tendon sheath, foot; flexorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28088Synovectomy, tendon sheath, foot; extensorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28090Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28092Excision of lesion, tendon, tendon sheath, or capsule (including synovectomy) (eg, cyst or ganglion); toe(s), eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28100Excision or curettage of bone cyst or benign tumor, talus or calcaneus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28102Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28103Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28104Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28106Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with iliac or other autograft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28107Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus; with allograftSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28108Excision or curettage of bone cyst or benign tumor, phalanges of footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28110Ostectomy, partial excision, fifth metatarsal head (bunionette) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28111Ostectomy, complete excision; first metatarsal headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28112Ostectomy, complete excision; other metatarsal head (second, third or fourth)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28113Ostectomy, complete excision; fifth metatarsal headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28114Ostectomy, complete excision; all metatarsal heads, with partial proximal phalangectomy, excluding first metatarsal (eg, Clayton type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28116Ostectomy, excision of tarsal coalitionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28118Ostectomy, calcaneus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28119Ostectomy, calcaneus; for spur, with or without plantar fascial releaseSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28120Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); talus or calcaneusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28122Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28124Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); phalanx of toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28126Resection, partial or complete, phalangeal base, each toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28130Talectomy (astragalectomy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28140MetatarsectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28150Phalangectomy, toe, each toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28153Resection, condyle(s), distal end of phalanx, each toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28160Hemiphalangectomy or interphalangeal joint excision, toe, proximal end of phalanx, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28171Radical resection of tumor; tarsal (except talus or calcaneus)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28173Radical resection of tumor; metatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28175Radical resection of tumor; phalanx of toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28190Removal of foreign body, foot; subcutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28192Removal of foreign body, foot; deepSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28193Removal of foreign body, foot; complicatedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28200Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28202Repair, tendon, flexor, foot; secondary with free graft, each tendon (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28208Repair, tendon, extensor, foot; primary or secondary, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28210Repair, tendon, extensor, foot; secondary with free graft, each tendon (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28220Tenolysis, flexor, foot; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28222Tenolysis, flexor, foot; multiple tendonsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28225Tenolysis, extensor, foot; single tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28226Tenolysis, extensor, foot; multiple tendonsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28230Tenotomy, open, tendon flexor; foot, single or multiple tendon(s) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28232Tenotomy, open, tendon flexor; toe, single tendon (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28234Tenotomy, open, extensor, foot or toe, each tendonSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28238Reconstruction (advancement), posterior tibial tendon with excision of accessory tarsal navicular bone (eg, Kidner type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28240Tenotomy, lengthening, or release, abductor hallucis muscleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28250Division of plantar fascia and muscle (eg, Steindler stripping) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28260Capsulotomy, midfoot; medial release only (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28261Capsulotomy, midfoot; with tendon lengtheningSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28262Capsulotomy, midfoot; extensive, including posterior talotibial capsulotomy and tendon(s) lengthening (eg, resistant clubfoot deformity)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28264Capsulotomy, midtarsal (eg, Heyman type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28270Capsulotomy; metatarsophalangeal joint, with or without tenorrhaphy, each joint (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28272Capsulotomy; interphalangeal joint, each joint (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28280Syndactylization, toes (eg, webbing or Kelikian type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28285Correction, hammertoe (eg, interphalangeal fusion, partial or total phalangectomy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28286Correction, cock-up fifth toe, with plastic skin closure (eg, Ruiz-Mora type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28288Ostectomy, partial, exostectomy or condylectomy, metatarsal head, each metatarsal headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28289Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; without implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28291Hallux rigidus correction with cheilectomy, debridement and capsular release of the first metatarsophalangeal joint; with implantSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28292Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28295Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal metatarsal osteotomy, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28296Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with distal metatarsal osteotomy, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28297Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28298Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with proximal phalanx osteotomy, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28299Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with double osteotomy, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28300Osteotomy; calcaneus (eg, Dwyer or Chambers type procedure), with or without internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28302Osteotomy; talusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28304Osteotomy, tarsal bones, other than calcaneus or talus;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28305Osteotomy, tarsal bones, other than calcaneus or talus; with autograft (includes obtaining graft) (eg, Fowler type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28306Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28307Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; first metatarsal with autograft (other than first toe)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28308Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; other than first metatarsal, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28309Osteotomy, with or without lengthening, shortening or angular correction, metatarsal; multiple (eg, Swanson type cavus foot procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28310Osteotomy, shortening, angular or rotational correction; proximal phalanx, first toe (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28312Osteotomy, shortening, angular or rotational correction; other phalanges, any toeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28313Reconstruction, angular deformity of toe, soft tissue procedures only (eg, overlapping second toe, fifth toe, curly toes)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28315Sesamoidectomy, first toe (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28320Repair, nonunion or malunion; tarsal bonesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28322Repair, nonunion or malunion; metatarsal, with or without bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28340Reconstruction, toe, macrodactyly; soft tissue resectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28341Reconstruction, toe, macrodactyly; requiring bone resectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28344Reconstruction, toe(s); polydactylySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28345Reconstruction, toe(s); syndactyly, with or without skin graft(s), each webSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28360Reconstruction, cleft footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28400Closed treatment of calcaneal fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28405Closed treatment of calcaneal fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28406Percutaneous skeletal fixation of calcaneal fracture, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28415Open treatment of calcaneal fracture, includes internal fixation, when performed;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28420Open treatment of calcaneal fracture, includes internal fixation, when performed; with primary iliac or other autogenous bone graft (includes obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28430Closed treatment of talus fracture; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28435Closed treatment of talus fracture; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28436Percutaneous skeletal fixation of talus fracture, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28445Open treatment of talus fracture, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28446Open osteochondral autograft, talus (includes obtaining graft[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28450Treatment of tarsal bone fracture (except talus and calcaneus); without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28455Treatment of tarsal bone fracture (except talus and calcaneus); with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28456Percutaneous skeletal fixation of tarsal bone fracture (except talus and calcaneus), with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28465Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28470Closed treatment of metatarsal fracture; without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28475Closed treatment of metatarsal fracture; with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28476Percutaneous skeletal fixation of metatarsal fracture, with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28485Open treatment of metatarsal fracture, includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28490Closed treatment of fracture great toe, phalanx or phalanges; without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28495Closed treatment of fracture great toe, phalanx or phalanges; with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28496Percutaneous skeletal fixation of fracture great toe, phalanx or phalanges, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28505Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28510Closed treatment of fracture, phalanx or phalanges, other than great toe; without manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28515Closed treatment of fracture, phalanx or phalanges, other than great toe; with manipulation, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28525Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation, when performed, eachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28530Closed treatment of sesamoid fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28531Open treatment of sesamoid fracture, with or without internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28540Closed treatment of tarsal bone dislocation, other than talotarsal; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28545Closed treatment of tarsal bone dislocation, other than talotarsal; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28546Percutaneous skeletal fixation of tarsal bone dislocation, other than talotarsal, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28555Open treatment of tarsal bone dislocation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28570Closed treatment of talotarsal joint dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28575Closed treatment of talotarsal joint dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28576Percutaneous skeletal fixation of talotarsal joint dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28585Open treatment of talotarsal joint dislocation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28600Closed treatment of tarsometatarsal joint dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28605Closed treatment of tarsometatarsal joint dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28606Percutaneous skeletal fixation of tarsometatarsal joint dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28615Open treatment of tarsometatarsal joint dislocation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28630Closed treatment of metatarsophalangeal joint dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28635Closed treatment of metatarsophalangeal joint dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28636Percutaneous skeletal fixation of metatarsophalangeal joint dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28645Open treatment of metatarsophalangeal joint dislocation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28660Closed treatment of interphalangeal joint dislocation; without anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28665Closed treatment of interphalangeal joint dislocation; requiring anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28666Percutaneous skeletal fixation of interphalangeal joint dislocation, with manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28675Open treatment of interphalangeal joint dislocation, includes internal fixation, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28705Arthrodesis; pantalarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28715Arthrodesis; tripleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28725Arthrodesis; subtalarSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28730Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28735Arthrodesis, midtarsal or tarsometatarsal, multiple or transverse; with osteotomy (eg, flatfoot correction)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28737Arthrodesis, with tendon lengthening and advancement, midtarsal, tarsal navicular-cuneiform (eg, Miller type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28740Arthrodesis, midtarsal or tarsometatarsal, single jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28750Arthrodesis, great toe; metatarsophalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28755Arthrodesis, great toe; interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28760Arthrodesis, with extensor hallucis longus transfer to first metatarsal neck, great toe, interphalangeal joint (eg, Jones type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28800Amputation, foot; midtarsal (eg, Chopart type procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28805Amputation, foot; transmetatarsalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28810Amputation, metatarsal, with toe, singleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28820Amputation, toe; metatarsophalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28825Amputation, toe; interphalangeal jointSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28890Extracorporeal shock wave, high energy, performed by a physician or other qualified health care professional, requiring anesthesia other than local, including ultrasound guidance, involving the plantar fasciaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
28899Unlisted procedure, foot or toesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29000Application of halo type body cast (see 20661-20663 for insertion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29010Application of Risser jacket, localizer, body; onlySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29015Application of Risser jacket, localizer, body; including headSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29035Application of body cast, shoulder to hips;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29040Application of body cast, shoulder to hips; including head, Minerva typeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29044Application of body cast, shoulder to hips; including 1 thighSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29046Application of body cast, shoulder to hips; including both thighsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29049Application, cast; figure-of-eightSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29055Application, cast; shoulder spicaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29058Application, cast; plaster VelpeauSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29065Application, cast; shoulder to hand (long arm)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29075Application, cast; elbow to finger (short arm)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29085Application, cast; hand and lower forearm (gauntlet)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29086Application, cast; finger (eg, contracture)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29105Application of long arm splint (shoulder to hand)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29125Application of short arm splint (forearm to hand); staticSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29126Application of short arm splint (forearm to hand); dynamicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29130Application of finger splint; staticSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29131Application of finger splint; dynamicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29200Strapping; thoraxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29240Strapping; shoulder (eg, Velpeau)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29260Strapping; elbow or wristSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29280Strapping; hand or fingerSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29305Application of hip spica cast; 1 legSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29325Application of hip spica cast; 1 and one-half spica or both legsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29345Application of long leg cast (thigh to toes);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29355Application of long leg cast (thigh to toes); walker or ambulatory typeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29358Application of long leg cast braceSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29365Application of cylinder cast (thigh to ankle)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29405Application of short leg cast (below knee to toes);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29425Application of short leg cast (below knee to toes); walking or ambulatory typeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29435Application of patellar tendon bearing (PTB) castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29440Adding walker to previously applied castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29445Application of rigid total contact leg castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29450Application of clubfoot cast with molding or manipulation, long or short legSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29505Application of long leg splint (thigh to ankle or toes)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29515Application of short leg splint (calf to foot)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29520Strapping; hipSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29530Strapping; kneeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29540Strapping; ankle and/or footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29550Strapping; toesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29580Strapping; Unna bootSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29581Application of multi-layer compression system; leg (below knee), including ankle and footSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29584Application of multi-layer compression system; upper arm, forearm, hand, and fingersSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29700Removal or bivalving; gauntlet, boot or body castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29705Removal or bivalving; full arm or full leg castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29710Removal or bivalving; shoulder or hip spica, Minerva, or Risser jacket, etc.See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29720Repair of spica, body cast or jacketSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29730Windowing of castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29740Wedging of cast (except clubfoot casts)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29750Wedging of clubfoot castSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29799Unlisted procedure, casting or strappingSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29800Arthroscopy, temporomandibular joint, diagnostic, with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29804Arthroscopy, temporomandibular joint, surgicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29805Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29806Arthroscopy, shoulder, surgical; capsulorrhaphySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29807Arthroscopy, shoulder, surgical; repair of SLAP lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29819Arthroscopy, shoulder, surgical; with removal of loose body or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29820Arthroscopy, shoulder, surgical; synovectomy, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29821Arthroscopy, shoulder, surgical; synovectomy, completeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29822Arthroscopy, shoulder, surgical; debridement, limited, 1 or 2 discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29823Arthroscopy, shoulder, surgical; debridement, extensive, 3 or more discrete structures (eg, humeral bone, humeral articular cartilage, glenoid bone, glenoid articular cartilage, biceps tendon, biceps anchor complex, labrum, articular capsule, articular side of the rotator cuff, bursal side of the rotator cuff, subacromial bursa, foreign body[ies])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29824Arthroscopy, shoulder, surgical; distal claviculectomy including distal articular surface (Mumford procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29825Arthroscopy, shoulder, surgical; with lysis and resection of adhesions, with or without manipulationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29826Arthroscopy, shoulder, surgical; decompression of subacromial space with partial acromioplasty, with coracoacromial ligament (ie, arch) release, when performed (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29827Arthroscopy, shoulder, surgical; with rotator cuff repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29828Arthroscopy, shoulder, surgical; biceps tenodesisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29830Arthroscopy, elbow, diagnostic, with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29834Arthroscopy, elbow, surgical; with removal of loose body or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29835Arthroscopy, elbow, surgical; synovectomy, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29836Arthroscopy, elbow, surgical; synovectomy, completeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29837Arthroscopy, elbow, surgical; debridement, limitedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29838Arthroscopy, elbow, surgical; debridement, extensiveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29840Arthroscopy, wrist, diagnostic, with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29843Arthroscopy, wrist, surgical; for infection, lavage and drainageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29844Arthroscopy, wrist, surgical; synovectomy, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29845Arthroscopy, wrist, surgical; synovectomy, completeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29846Arthroscopy, wrist, surgical; excision and/or repair of triangular fibrocartilage and/or joint debridementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29847Arthroscopy, wrist, surgical; internal fixation for fracture or instabilitySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29848Endoscopy, wrist, surgical, with release of transverse carpal ligamentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29850Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; without internal or external fixation (includes arthroscopy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29851Arthroscopically aided treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, with or without manipulation; with internal or external fixation (includes arthroscopy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29855Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29856Arthroscopically aided treatment of tibial fracture, proximal (plateau); bicondylar, includes internal fixation, when performed (includes arthroscopy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29860Arthroscopy, hip, diagnostic with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29861Arthroscopy, hip, surgical; with removal of loose body or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29862Arthroscopy, hip, surgical; with debridement/shaving of articular cartilage (chondroplasty), abrasion arthroplasty, and/or resection of labrumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29863Arthroscopy, hip, surgical; with synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29866Arthroscopy, knee, surgical; osteochondral autograft(s) (eg, mosaicplasty) (includes harvesting of the autograft[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29867Arthroscopy, knee, surgical; osteochondral allograft (eg, mosaicplasty)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29868Arthroscopy, knee, surgical; meniscal transplantation (includes arthrotomy for meniscal insertion), medial or lateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29870Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29871Arthroscopy, knee, surgical; for infection, lavage and drainageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29873Arthroscopy, knee, surgical; with lateral releaseSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29874Arthroscopy, knee, surgical; for removal of loose body or foreign body (eg, osteochondritis dissecans fragmentation, chondral fragmentation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29875Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29876Arthroscopy, knee, surgical; synovectomy, major, 2 or more compartments (eg, medial or lateral)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29877Arthroscopy, knee, surgical; debridement/shaving of articular cartilage (chondroplasty)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29879Arthroscopy, knee, surgical; abrasion arthroplasty (includes chondroplasty where necessary) or multiple drilling or microfractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29880Arthroscopy, knee, surgical; with meniscectomy (medial AND lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29881Arthroscopy, knee, surgical; with meniscectomy (medial OR lateral, including any meniscal shaving) including debridement/shaving of articular cartilage (chondroplasty), same or separate compartment(s), when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29882Arthroscopy, knee, surgical; with meniscus repair (medial OR lateral)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29883Arthroscopy, knee, surgical; with meniscus repair (medial AND lateral)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29884Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29885Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of lesion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29886Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29887Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29888Arthroscopically aided anterior cruciate ligament repair/augmentation or reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29889Arthroscopically aided posterior cruciate ligament repair/augmentation or reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29891Arthroscopy, ankle, surgical, excision of osteochondral defect of talus and/or tibia, including drilling of the defectSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29892Arthroscopically aided repair of large osteochondritis dissecans lesion, talar dome fracture, or tibial plafond fracture, with or without internal fixation (includes arthroscopy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29893Endoscopic plantar fasciotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29894Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with removal of loose body or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29895Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; synovectomy, partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29897Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, limitedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29898Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; debridement, extensiveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29899Arthroscopy, ankle (tibiotalar and fibulotalar joints), surgical; with ankle arthrodesisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29900Arthroscopy, metacarpophalangeal joint, diagnostic, includes synovial biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29901Arthroscopy, metacarpophalangeal joint, surgical; with debridementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29902Arthroscopy, metacarpophalangeal joint, surgical; with reduction of displaced ulnar collateral ligament (eg, Stenar lesion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29904Arthroscopy, subtalar joint, surgical; with removal of loose body or foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29905Arthroscopy, subtalar joint, surgical; with synovectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29906Arthroscopy, subtalar joint, surgical; with debridementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29907Arthroscopy, subtalar joint, surgical; with subtalar arthrodesisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29914Arthroscopy, hip, surgical; with femoroplasty (ie, treatment of cam lesion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29915Arthroscopy, hip, surgical; with acetabuloplasty (ie, treatment of pincer lesion)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29916Arthroscopy, hip, surgical; with labral repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
29999Unlisted procedure, arthroscopySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30000Drainage abscess or hematoma, nasal, internal approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30020Drainage abscess or hematoma, nasal septumSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30100Biopsy, intranasalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30110Excision, nasal polyp(s), simpleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30115Excision, nasal polyp(s), extensiveSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30117Excision or destruction (eg, laser), intranasal lesion; internal approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30118Excision or destruction (eg, laser), intranasal lesion; external approach (lateral rhinotomy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30120Excision or surgical planing of skin of nose for rhinophymaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30124Excision dermoid cyst, nose; simple, skin, subcutaneousSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30125Excision dermoid cyst, nose; complex, under bone or cartilageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30130Excision inferior turbinate, partial or complete, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30140Submucous resection inferior turbinate, partial or complete, any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30150Rhinectomy; partialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30160Rhinectomy; totalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30200Injection into turbinate(s), therapeuticSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30210Displacement therapy (Proetz type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30220Insertion, nasal septal prosthesis (button)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30300Removal foreign body, intranasal; office type procedureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30310Removal foreign body, intranasal; requiring general anesthesiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30320Removal foreign body, intranasal; by lateral rhinotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30400Rhinoplasty, primary; lateral and alar cartilages and/or elevation of nasal tipYesOutpatient Surgery e-form
30410Rhinoplasty, primary; complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tipYesOutpatient Surgery e-form
30420Rhinoplasty, primary; including major septal repairYesOutpatient Surgery e-form
30435Rhinoplasty, secondary; intermediate revision (bony work with osteotomies)YesOutpatient Surgery e-form
30450Rhinoplasty, secondary; major revision (nasal tip work and osteotomies)YesOutpatient Surgery e-form
30460Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip onlyYesOutpatient Surgery e-form
30462Rhinoplasty for nasal deformity secondary to congenital cleft lip and/or palate, including columellar lengthening; tip, septum, osteotomiesYesOutpatient Surgery e-form
30465Repair of nasal vestibular stenosis (eg, spreader grafting, lateral nasal wall reconstruction)YesOutpatient Surgery e-form
30468Repair of nasal valve collapse with subcutaneous/submucosal lateral wall implant(s)YesOutpatient Surgery e-form
30520Septoplasty or submucous resection, with or without cartilage scoring, contouring or replacement with graftYesOutpatient Surgery e-form
30540Repair choanal atresia; intranasalYesOutpatient Surgery e-form
30545Repair choanal atresia; transpalatineYesOutpatient Surgery e-form
30560Lysis intranasal synechiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30580Repair fistula; oromaxillary (combine with 31030 if antrotomy is included)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30600Repair fistula; oronasalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30620Septal or other intranasal dermatoplasty (does not include obtaining graft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30630Repair nasal septal perforationsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30801Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); superficialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30802Ablation, soft tissue of inferior turbinates, unilateral or bilateral, any method (eg, electrocautery, radiofrequency ablation, or tissue volume reduction); intramural (ie, submucosal)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30901Control nasal hemorrhage, anterior, simple (limited cautery and/or packing) any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30903Control nasal hemorrhage, anterior, complex (extensive cautery and/or packing) any methodSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30905Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; initialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30906Control nasal hemorrhage, posterior, with posterior nasal packs and/or cautery, any method; subsequentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30915Ligation arteries; ethmoidalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30920Ligation arteries; internal maxillary artery, transantralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30930Fracture nasal inferior turbinate(s), therapeuticSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
30999Unlisted procedure, noseSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31000Lavage by cannulation; maxillary sinus (antrum puncture or natural ostium)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31002Lavage by cannulation; sphenoid sinusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31020Sinusotomy, maxillary (antrotomy); intranasalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31030Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) without removal of antrochoanal polypsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31032Sinusotomy, maxillary (antrotomy); radical (Caldwell-Luc) with removal of antrochoanal polypsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31050Sinusotomy, sphenoid, with or without biopsy;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31051Sinusotomy, sphenoid, with or without biopsy; with mucosal stripping or removal of polyp(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31070Sinusotomy frontal; external, simple (trephine operation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31075Sinusotomy frontal; transorbital, unilateral (for mucocele or osteoma, Lynch type)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31080Sinusotomy frontal; obliterative without osteoplastic flap, brow incision (includes ablation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31081Sinusotomy frontal; obliterative, without osteoplastic flap, coronal incision (includes ablation)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31084Sinusotomy frontal; obliterative, with osteoplastic flap, brow incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31085Sinusotomy frontal; obliterative, with osteoplastic flap, coronal incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31086Sinusotomy frontal; nonobliterative, with osteoplastic flap, brow incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31087Sinusotomy frontal; nonobliterative, with osteoplastic flap, coronal incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31090Sinusotomy, unilateral, 3 or more paranasal sinuses (frontal, maxillary, ethmoid, sphenoid)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31200Ethmoidectomy; intranasal, anteriorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31201Ethmoidectomy; intranasal, totalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31205Ethmoidectomy; extranasal, totalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31225Maxillectomy; without orbital exenterationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31230Maxillectomy; with orbital exenteration (en bloc)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31231Nasal endoscopy, diagnostic, unilateral or bilateral (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31233Nasal/sinus endoscopy, diagnostic; with maxillary sinusoscopy (via inferior meatus or canine fossa puncture)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31235Nasal/sinus endoscopy, diagnostic; with sphenoid sinusoscopy (via puncture of sphenoidal face or cannulation of ostium)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31237Nasal/sinus endoscopy, surgical; with biopsy, polypectomy or debridement (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31238Nasal/sinus endoscopy, surgical; with control of nasal hemorrhageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31239Nasal/sinus endoscopy, surgical; with dacryocystorhinostomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31240Nasal/sinus endoscopy, surgical; with concha bullosa resectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31241Nasal/sinus endoscopy, surgical; with ligation of sphenopalatine arterySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31253Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including frontal sinus exploration, with removal of tissue from frontal sinus, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31254Nasal/sinus endoscopy, surgical with ethmoidectomy; partial (anterior)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31255Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31256Nasal/sinus endoscopy, surgical, with maxillary antrostomy;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31257Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31259Nasal/sinus endoscopy, surgical with ethmoidectomy; total (anterior and posterior), including sphenoidotomy, with removal of tissue from the sphenoid sinusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31267Nasal/sinus endoscopy, surgical, with maxillary antrostomy; with removal of tissue from maxillary sinusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31276Nasal/sinus endoscopy, surgical, with frontal sinus exploration, including removal of tissue from frontal sinus, when performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31287Nasal/sinus endoscopy, surgical, with sphenoidotomy;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31288Nasal/sinus endoscopy, surgical, with sphenoidotomy; with removal of tissue from the sphenoid sinusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31290Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; ethmoid regionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31291Nasal/sinus endoscopy, surgical, with repair of cerebrospinal fluid leak; sphenoid regionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31292Nasal/sinus endoscopy, surgical, with orbital decompression; medial or inferior wallSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31293Nasal/sinus endoscopy, surgical, with orbital decompression; medial and inferior wallSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31294Nasal/sinus endoscopy, surgical, with optic nerve decompressionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31298Nasal/sinus endoscopy, surgical, with dilation (eg, balloon dilation); frontal and sphenoid sinus ostiaSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31299Unlisted procedure, accessory sinusesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31300Laryngotomy (thyrotomy, laryngofissure), with removal of tumor or laryngocele, cordectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31360Laryngectomy; total, without radical neck dissectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31365Laryngectomy; total, with radical neck dissectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31367Laryngectomy; subtotal supraglottic, without radical neck dissectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31368Laryngectomy; subtotal supraglottic, with radical neck dissectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31370Partial laryngectomy (hemilaryngectomy); horizontalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31375Partial laryngectomy (hemilaryngectomy); lateroverticalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31380Partial laryngectomy (hemilaryngectomy); anteroverticalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31382Partial laryngectomy (hemilaryngectomy); antero-latero-verticalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31390Pharyngolaryngectomy, with radical neck dissection; without reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31395Pharyngolaryngectomy, with radical neck dissection; with reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31400Arytenoidectomy or arytenoidopexy, external approachSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31420EpiglottidectomySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31500Intubation, endotracheal, emergency procedureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31502Tracheotomy tube change prior to establishment of fistula tractSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31505Laryngoscopy, indirect; diagnostic (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31510Laryngoscopy, indirect; with biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31511Laryngoscopy, indirect; with removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31512Laryngoscopy, indirect; with removal of lesionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31513Laryngoscopy, indirect; with vocal cord injectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31515Laryngoscopy direct, with or without tracheoscopy; for aspirationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31520Laryngoscopy direct, with or without tracheoscopy; diagnostic, newbornSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31525Laryngoscopy direct, with or without tracheoscopy; diagnostic, except newbornSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31526Laryngoscopy direct, with or without tracheoscopy; diagnostic, with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31527Laryngoscopy direct, with or without tracheoscopy; with insertion of obturatorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31528Laryngoscopy direct, with or without tracheoscopy; with dilation, initialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31529Laryngoscopy direct, with or without tracheoscopy; with dilation, subsequentSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31530Laryngoscopy, direct, operative, with foreign body removal;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31531Laryngoscopy, direct, operative, with foreign body removal; with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31535Laryngoscopy, direct, operative, with biopsy;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31536Laryngoscopy, direct, operative, with biopsy; with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31540Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31541Laryngoscopy, direct, operative, with excision of tumor and/or stripping of vocal cords or epiglottis; with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31545Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with local tissue flap(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31546Laryngoscopy, direct, operative, with operating microscope or telescope, with submucosal removal of non-neoplastic lesion(s) of vocal cord; reconstruction with graft(s) (includes obtaining autograft)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31551Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, younger than 12 years of ageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31552Laryngoplasty; for laryngeal stenosis, with graft, without indwelling stent placement, age 12 years or olderSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31553Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, younger than 12 years of ageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31554Laryngoplasty; for laryngeal stenosis, with graft, with indwelling stent placement, age 12 years or olderSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31560Laryngoscopy, direct, operative, with arytenoidectomy;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31561Laryngoscopy, direct, operative, with arytenoidectomy; with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31570Laryngoscopy, direct, with injection into vocal cord(s), therapeutic;See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31571Laryngoscopy, direct, with injection into vocal cord(s), therapeutic; with operating microscope or telescopeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31572Laryngoscopy, flexible; with ablation or destruction of lesion(s) with laser, unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31573Laryngoscopy, flexible; with therapeutic injection(s) (eg, chemodenervation agent or corticosteroid, injected percutaneous, transoral, or via endoscope channel), unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31574Laryngoscopy, flexible; with injection(s) for augmentation (eg, percutaneous, transoral), unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31575Laryngoscopy, flexible; diagnosticSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31576Laryngoscopy, flexible; with biopsy(ies)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31577Laryngoscopy, flexible; with removal of foreign body(s)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31578Laryngoscopy, flexible; with removal of lesion(s), non-laserSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31579Laryngoscopy, flexible or rigid telescopic, with stroboscopySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31580Laryngoplasty; for laryngeal web, with indwelling keel or stent insertionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31584Laryngoplasty; with open reduction and fixation of (eg, plating) fracture, includes tracheostomy, if performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31587Laryngoplasty, cricoid split, without graft placementSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31590Laryngeal reinnervation by neuromuscular pedicleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31591Laryngoplasty, medialization, unilateralSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31592Cricotracheal resectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31599Unlisted procedure, larynxSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31600Tracheostomy, planned (separate procedure);See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31601Tracheostomy, planned (separate procedure); younger than 2 yearsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31603Tracheostomy, emergency procedure; transtrachealSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31605Tracheostomy, emergency procedure; cricothyroid membraneSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31610Tracheostomy, fenestration procedure with skin flapsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31611Construction of tracheoesophageal fistula and subsequent insertion of an alaryngeal speech prosthesis (eg, voice button, Blom-Singer prosthesis)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31612Tracheal puncture, percutaneous with transtracheal aspiration and/or injectionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31613Tracheostoma revision; simple, without flap rotationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31614Tracheostoma revision; complex, with flap rotationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31615Tracheobronchoscopy through established tracheostomy incisionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31622Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; diagnostic, with cell washing, when performed (separate procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31623Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with brushing or protected brushingsSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31624Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial alveolar lavageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31625Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with bronchial or endobronchial biopsy(s), single or multiple sitesSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31626Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of fiducial markers, single or multipleSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31627Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with computer-assisted, image-guided navigation (List separately in addition to code for primary procedure[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31628Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), single lobeSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31629Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), trachea, main stem and/or lobar bronchus(i)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31630Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with tracheal/bronchial dilation or closed reduction of fractureSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31631Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of tracheal stent(s) (includes tracheal/bronchial dilation as required)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31632Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial lung biopsy(s), each additional lobe (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31633Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transbronchial needle aspiration biopsy(s), each additional lobe (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31634Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with balloon occlusion, with assessment of air leak, with administration of occlusive substance (eg, fibrin glue), if performedSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31635Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with removal of foreign bodySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31636Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of bronchial stent(s) (includes tracheal/bronchial dilation as required), initial bronchusSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31637Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; each additional major bronchus stented (List separately in addition to code for primary procedure)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31638Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with revision of tracheal or bronchial stent inserted at previous session (includes tracheal/bronchial dilation as required)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31640Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with excision of tumorSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31641Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with destruction of tumor or relief of stenosis by any method other than excision (eg, laser therapy, cryotherapy)See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31643Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with placement of catheter(s) for intracavitary radioelement applicationSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31645Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, initialSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31646Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with therapeutic aspiration of tracheobronchial tree, subsequent, same hospital staySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31652Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), one or two mediastinal and/or hilar lymph node stations or structuresSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31653Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with endobronchial ultrasound (EBUS) guided transtracheal and/or transbronchial sampling (eg, aspiration[s]/biopsy[ies]), 3 or more mediastinal and/or hilar lymph node stations or structuresSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31654Bronchoscopy, rigid or flexible, including fluoroscopic guidance, when performed; with transendoscopic endobronchial ultrasound (EBUS) during bronchoscopic diagnostic or therapeutic intervention(s) for peripheral lesion(s) (List separately in addition to code for primary procedure[s])See CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31717Catheterization with bronchial brush biopsySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31720Catheter aspiration (separate procedure); nasotrachealSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31725Catheter aspiration (separate procedure); tracheobronchial with fiberscope, bedsideSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31730Transtracheal (percutaneous) introduction of needle wire dilator/stent or indwelling tube for oxygen therapySee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31750Tracheoplasty; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31755Tracheoplasty; tracheopharyngeal fistulization, each stageSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31760Tracheoplasty; intrathoracicSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31766Carinal reconstructionSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31770Bronchoplasty; graft repairSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31775Bronchoplasty; excision stenosis and anastomosisSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.
Out of Network e-form
31780Excision tracheal stenosis and anastomosis; cervicalSee CommentIn Network: No authorization required.
Out of Network:Authorization is required.