SCCB - CPT CODE LIST

Transcription

1 SCCB - CPT CODE LIST CPT CODE DESCRIPTION OF SERVICE FEE EYEBALL REMOVAL OF EYE EVISCREATION OF EYE, WITHOUT IMPLANT EVISCERATION OF EYE WITH IMPLANT ENUCLEATION WITHOUT IMPLANT ENUCLEATION W/IMPLANT, MUSCLES NOT ATTACHED ENUCLEATION W/IMPLANT, MUSCLES ATTACHED TO IMPLANT EXENTERATION OF ORBIT W/O SKIN GRAFT REM ORBIT CONTENT EXENTERATION, W/THERAPEUTIC REMOVALOF BONE EXENTERATION, WITH MUSCLE OR MYOCULANEOUS FLAP SECONDARY IMPLANT(S) PROCEDURES MODIFICATION, OCULAR IMPLANT (SEPARATE PROCEDURE) EVISCREATION, EYE IMPLANTATION IN SCLERAL SHELL AFTER ENUCLEATION, MUSCLES NOT ATTAHCED TO IMPLANT

2 65140 AFTER ENUCLEATION, MUSCLES ATTACHED TO IMPLANT REINSERTION/OCULAR IMPLANT W/WO CONJUNCTIVAL GRAFT REINSERTION, IMPLANT W/FOREING MAT F/REIN ATT MUSC REMOVAL OCULAR IMPLANT REMOVAL OF FOREIGN BODY REMOVAL FOREING BODY EXTERNAL EYE CONJUNCTIVA REMOVAL EMBEDDED CONJENCTIVA/SCLERAL NONPERFORATIIN CPT CODE DESCRIPTION OF SERVICE FEE REMOVAL OF FOREIGN BODY REMOVAL, CORNEAL WITHOUT SLIT SLAMP REMOVAL, CORNEAL WITH SLIT LAMP REMOVAL, INTRAOCULAR, ANTERIOR CHAMBER OR LENS REMOVAL, POSTERIOR SEGMENT MAGNETIC EXTRACTION REMOVAL, POSTERIOR SEGMENT NONMAGNETIC EXTRACTION

3 REPAIR OF LACERATION REPAIR LACERATION CONJUNCTIVA W-W/O DIRECT CLOSURE REPAIR CONJUNCTIVA MOBILE & REARRANGE W/O HOSPITAL REPAIR CONJUNCTIVA MOBILE & RERRANGE W/HOSPITAL REPAIR CORNEA NONPERFORATING W-W/O REM FORGN BODY REMOVAL OF EPITHELIAL DOWNBROTH, ANTERIOR CHAMBER CORNEA/SCLERA, PERFOORATING W/REPOS OR RESEC UVEAL APPLICATION, TISSUE GLUE, WOUNDS CORNEA/SCLERA REPAIR WOUND, EXTRAOCULAR MUSCLE TENDON - CAPSULE CORNEA EXCISION LESION, CORNEA NON PTERYGIUM BIOPSY, CORNEA PTERYGIUM EXCISION OR TRANSPOSITION WITHOUT GRAFT

4 654 PTERYGIUM EXCISION WITH GRAFT SCRAPING CORNEA, DIAGNOSTIC F/SMAR/CULTURE REMOVAL CORNEAL EPITHELIUM W-W/O CHEMOCAUTHERIZATIO CPT CODE DESCRIPTION OF SERVICE FEE CORNEA REMOVAL WITH APPLICATION CHELATING AGENT (EDTA) DESTRUCTION LESION CORNEA (CRYTO/PHOTO/THERMO) MULTIPLE PUNCTURES OF ANTERIOR CORNEA KERATOPLASTY (Corneal Transplant) KERATOPLASTY (CORN. TRANS), LAMELLAR KERATOPLASTY, PENETRATING (NON-AHAKIA) KERATOPLASTY PENETRATING (IN APHAKIA) KERATOPLASTY, PENETRATING (IN PSEUDOPHAKIA) KERTOPLASTY ENDOTHELIAL

5 65757 BACKBENCH PREPARATION OF CORNEAL ENDOTHELIAL ALLOGRAFT PRIOR TO TRANSPLANTATION (USE IN CONJUCTION WITH 65756) M KERATOMILEUSIS KERATOPHAKIA EPIKERATOPLASTY KERATOPROSTHESIS CORNEAL RELAXING ENCISION (BR) SURGICALLY IND. AST CORNEAL WEDGE RESECTION (BR) SURGICALLY ASTI ANTERIOR CHAMBER - INCISION PARACENTESIS, ANTERIOR CHAMPER W/DIAGNOSTIC ASP PARACENTESIS, W-W/O AIR INJECTION PARACENTESIS, W/REML BLOOD W-W/O IRRIGATION/AIR CPT CODE DESCRIPTION OF SERVICE FEE ANTERIOR CHAMBER GONIOTOMY TRABECULTOMY AB EXTERNO

6 65855 LASER TRABECULOPLASTY; ONE OR MORE SESSIONS SEVERING ADHESIONS OF ANTERIOR SEGMENT, LASER SEVERING ADESIONS OF ANTERIOR SEGMENT OF EYE POSTERIOR SYNCHEIAE SEVERING POSTERIOR SYNECHIAE SEVERING CORNEOVITREAL ADHESIONS (BR) ANTERIOR CHAMBER - REMOVAL REMOVAL OF EPITHELIAL DOWNBROWTH, ANTERIOR CHAMBER OF EYE REMOVAL OF IMPLANTED MARTERIAL, ANTERIOR CHAMBER REMOVAL OF BLOOD CLOT, ANTERIOR SEGMENT INJECTION, ANTERIOR CHAMBER, AIR/LIQUID, SEP PROC INJECTION, ANTERIOR CHAMBER, MEDICATION ANTERIOR SCLERA - EXCISION EXCISION OFLESION, SCLERA FISTUIZATION OF SCLERA F/GLAUCOMA; TREPHINATION 5.38

7 66155 THERMOCAUTERIZATION WITH IRIDECTOMY SCLERECTOMY WITH PUNCH OR SCISSORS, WITH IDECTOMY SCLEROTOMY W/PUNC OR SCISSORS, W/IRIDECTOMY CPT CODE DESCRIPTION OF SERVICES FEE ANTERIOR SCLERA - EXCISION TRABECLECTOMY (SURGICAL FILTERING) TRABECULECTOMY (INCLUED INJECTION OF ANTIFIBROTIC AGNT) TRANSLUMINAL DILATION OF AQUEOUS OUTFLOW CANAL; WITHOUT RETENTION OF DEVICE OR STENT WITH RETENTION OF DEVICE OR STENT AQUEOUS SHUNT AQUEOUS SHUNT TO EXTRAOCULAR RESERVIOR (MOLTENO) REVISION OF AQUEOUS SHUNT EXTRAOCULAR RESERVIOR REPAIR OR REVISION REPAIR OF SCLERAL STAPHYLOMA; WITHOUT GRAFT REPAIR OF SCLERAL STAPHYLOMA; WITH GRAFT REVISION, REPAIR OPERATIVE WOUND OF ANTERIOR SEGM

8 IRIS, CILIARY BODY IRIDOTOMY BY STAB INCISION, EXCEPT TRANSFIXION IRIDOTOMY WITH TRANSFIXION AS FOR IRIS BOMBE EXCISION IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION; FOR REMOVAL OF LESION IRIDECTOMY; WITH CYCLECTOMY IRIDECTOMY; PERIPHERAL FOR GLAUCOMA IRIDECTOMY; SECTOR FOR GLAUCOMA IRIDECTOMY; OPTICAL REPAIR REPAIR OF IRIS, CILIARY BODY (IRIDODIALYSIS) SUTURE OF IRIS CILIARY BODY (SEPERATE PROCEDURE) CPT CODE DESCRIPTION OF SERVICES FEE DESTRUCTION CILIARY BODY DESTRUCTION; DIATHERMY CYCLOPHOTOCOAGULATION; TRANSSCLERAL CYCOLPHOTOCOAGULATION, ENDOSCOPIC CILIARY BODY DESTRUCTION; CRYOTHERAPY

9 66740 CILIARY BODY DESTRUCTION; CYCLODIALYSIS IRIDOTOMY/IRIDECTOMY BY LASER SURGERY (FOR GLAUCOMA PER SESSION) IRIDOPLASTY, PHOTOCOAGULATION (1 OR MORE SESSIONS) DESTRUCTION OF CYST ORLESION IRIS OR CILIARY BODY LENS INCISION DISCUSSION SECONDARY MEMBRANOUS CATARACT (KNIFE) LASER SURGRY (YAG LASER) (1 OR MORE STAGES) REPOSITIONING OF INTRAOCULAR LENS PROTHESIS, REQUIRING AN INCISION (SEPARATE PROCEDURE) LENS - REMOVAL REMOVAL SECONDARY MEMBRANOUS CATARACT REMOVAL OF LENS; ASPIRATION (ONE OR MORE SESSIONS) REMOVALOF LENS; PHACOFRAGMENTATION, W/ASPIRATION REMOVAL OF LENS; PARS PLANA W-W/P VITRECTOMY REMOVAL OF LENS; INTRACAPSULAR

10 66930 REMOVAL OF LENS; INTRACAPSULAR F/DISLOCATED LENS REMOVAL OF LENS; EXTRACAPSULAR CPT CODE DESCRIPTION OF SERVICES FEE INTRAOCULAR LEN PROCEDURES EXTRACAPULAR CATARACT EXTRACTION W/IOL INTRACAPSULAR CATARACT EXTRACTION W/IOL EXTRACAPSULAR CATARACT EXTRACTION W/IOL INSERTION OF I.O.L., (SECONDARY IMPLANT) NOT ASSOCIATED WITH CONCURRENT CATARACT REMOVAL EXCHANGE OF INTRAOCULAR LENS USE OF OPHTHALMIC ENDOSCOPE (LIST SEPARETLY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) VITREOUS REMOVAL VITREOUS, ANTERIO APPROCAH (SKY/LIMBAL) REMOVAL VITREOUS, SUBTOTAL/MECHANICAL VITRECTOMY ASPIRATION OR RELEASE OF VITREOUS PARS PLANA INJECTION, VITREOUS SUBSTITUTE, PARS PLANA/LIMBAL

11 67027 IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM INCLUDES CONCOMITANT REMOVAL OF VITREOUS INTRAVITREALM INJECTION OF PHARMACOLOGIC AGENT DISCUSSION, VITREOUS STRANDS W/O REML PARS PLANA SEVERING OF VITREOUS STRANDS VITRECTOMY, MECHANICAL, PARS PLANA APPROACH VITRECTOMY, WITH FOCAL ENDOLASER PHOTOCOAGULATION VITRECTOMY; WITH ENDOLASER, PANRETINAL PHOTOCOAGULATI VITRECTOMY; WITH REMOVAL OF PRERETINAL CELLULAR MEMB CPT CODE DESCRIPTION OF SERVICES FEE VITREOUS VITRECTOMY; WITH REMOVAL OF INTERNAL LIMITING MEMBR VITRECTOMY; WITH REMOVAL OF SUBRETINAL MEMBRANE RETINA OR CHOROID - REPAIR REPAIR RETINAL DETACHMENT (ONE OR MORE SESSIONS)

12 67105 PHOTOCOAGULATION W-W/O DRAINAGE SUBRETINAL REPAIR OF RETINA DETACHMENT, SCLERAL BUCKLING REPAIR, SCLERAL BUDKLING W/VITRECTOMY BY INJECTION AIR/OTHER GAS (PNEUMORETINOPEXY) REPAIR BY SCLERAL BUCKLING OR VITRECTOMY, ON PATIENT HAVING HAD PREVIOUS DETACHMENT REPAIR REPAIR OF COMPLEX RETINAL DETACHMENT 1, RELEASE ENCIRCLING MATERIAL (POSTERIOR SEGMENT; EXTRAOCULAR) REMOVAL OF IMPLANTED MATERIAL, EXTRAOCULAR REMOVAL OF IMPLANTED MATERIAL, INTRAOCULAR PROPHYLAXIS PROPHYLAXIS RETINAL DETACHMENT DIATHERMY/ CRYOTHERAP PROPHYSAXIS PHOTOCOAGULATION LASER DESTRUCTION DESTRUCTION OF LOCALIZED LESION OF RETINA 1 SESSION

13 67210 PHOTOCOAGULATION, LASER OR SENON ARC FOCAL LASER RADIATION BY IMPLANTATIONOF SOURCE (INC. REMOVAL) DESTRUCTION OF LOCALIZED LESION OF CHOROID CPT CODE DESCRIPTION OF SERVICES FEE DESTRUCTION PHOTODYNAMIC THERAPY (INCLUDES INTRAVENOUS INFUSION) PHTODYNAMIC THERAPY, (SECOND EYE) LIST SEPERATELY IN ADDITION TO PRIMARY CODE (USE IN CONJUNCTION WITH 67221) DESTRUCTION, EXTENSIVE/PROGRESSIVE RETINOPATHY PHOTOCOAGULATION PAN RETINAL (SAME EYE 6 MONTHS) POSTERIOR SCLERA - REPAIR SCLERAL REINFORCEMENT; WITHOUT GRAFT SCLERAL REINFORCEMENT; WITH GRAFT ORBIT EXPLORATION, EXCISION, DECOMPRESSION ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNTIVAL APPROACH); FOR EXPLORATION, WITH OR WITHOUT BIOPSY

14 67405 ORBITOTOMY WITH DRAINAGE ONLY ORBITOTOMY WITH REMOVAL OF LESION ORBITOTOMY W/REMOVAL OF FOREIGN BODY ORBITOTOMY WITH REMOVAL OF BONE FOR DECOMPRESSION FINE NEEDLE ASPIRATION OF ORBITAL CONTENTS ORBITOTOMY W/BONE FLAP/WINDOW LATERIAL APP W/ LESION 1, OBITOTOMY WITH REMOVALOF FOREIGN BODY ORBITOTOMY WITH DRAINAGE ORBITOTOMY WITH REMOVALOF BONE FOR DECOMPRESSION ORBITOTOMY FOR EXPLORATION, WITH OR WITHOUT BIOPSY RETROBULBAR INJECTIONS; MEDICATION CPT CODE DESCRIPTION OF SERVICES FEE ORBIT OTHER PROCEDURES RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOES NOT INCLUDE SUPPLY OF MEDICATION) 57.20

15 67505 RETROBUBAR INJECTIONS; ALCOHOL INJECTION OF THERAPEUTIC ANGENT INTO TENON CAPSULE ORBITAL IMPLANT (OUTSIDE MUSCLE CONE); INSERTION REMOVAL OF REVISION OPTIC NERVE DECOMPRESSION (INCISION/FENESTRATION EYELIDS EXCISION, DESTRUCTION EXCISION OF CHALAZION; SINGLE EXCISION OF CHALAZION; MULTIPLE, SAME LID EXCISION OF CHALAZION; MULTIPLE, DIFFERENCE LIDS EXCISION, GEN ANESTHESIA, REQD HOSP SINGLE/MULTI EYELIDS EXCISION, DESTRUCTION BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID SEVERING OF TARSORRHPHY CANTHOTOMY (SEPARATE PROCEDURE) BIOPSY EYELID

16 67820 CORRECTION OF TRICHIASIS; EPILATION BY FORCEPS EPILATION, BY ELECTROSURGERY OR CRYOTHERPHY INCISION OF LID MARGIN FOR TRICHIASIS INCISION OF LID MARGIN, WITH MUCOUS MEMBRANE GRAFT CPT CODE DESCRIPTION OF SERVICES FEE EYELIDS EXCISION, DESTRUCTION EXCISION OF LESION EYELID (EXCEPT CHALZAION) DESTRUCTION OF LESIONOFLID MARGIN (UP TO 1 CM) TARSORRHAPHY TEMPORARY CLOSURE OF EYELIDS BY SUTURE (FROST) CONSTRUCTION, INTERMARGINAL ADHESIONS, MEDIAN WITH TRANSPOSITION OF TRASAL PLATE REPAIR (BROW PTOSIS, BLEPHAROPTOSIS, LID RETRACTION, ECTROPION, ENTROPION) REPAIR OF BROW PTOSIS REPAIR OF BLEPHAROPTOSIS; FRONTAL MUSCLE TECHNIQUE

17 67902 REPAIR; FRONTAL MUSCLE TECHNIQUE W/FASCIAL SLING (TARSO) LEVATOR RESECTION OR ADVANCEMENT, EXTERNAL APPROCAH CONJUNCTIVA INCISION AND DRAINAGE INCISION OF CONJUNCTIVA, DRAINAGE OF CYST EXPRESSION CONJUNCTIVAL FOLLICLES F/TRACHOMA EXCISION AND/OR DESTRUCTION BIOPSY OF CONJUNCTIVA EXISION OF LESION OF CONJUNCTIVA UP TO 1 CM EXCISION OF LESIONOF CONJUNCTIVA OVER 1 CM EXCISION OF LESION/CONJUNCTIVA W/ ADJACENT SCLERA DESTRUCTION OF LESION, CONJUNCTIVA INJECTION SUBCONJUCTIVAL INJECTIONS CPT CODE DESCRIPTION OF SERVICES FEE CONJUNCTIVOPLASTY CONJUNCTIVOPLASTY W/GRAFT OR REARRANGEMENT CONJUNCTIVOPLASTY W/BUCCAL MUCOUS MEMBRANE GRAFT

18 683 CONJUNCTIVOPLASTY/ RECONSTRUCTION CUL-DE-SAC W/ G-R REPAIR SYMBLEMPHARON, CONJUNCTIOPLASTY, NO GRAFT REPAIR SYBLEPHARON; W/FREE GRAFT CONJ/BUCCAL MUCO DIVISION OF SYMBLEPHARON, WITH OR WITHOUT INSERTION OF CONFORMER OF CONTACT LENS OTHER PROCEDURES CONJUNCTIAL FLAP; BRIDGE OR PARTIAL CONJUNCTIVAL FLAP; TOTAL LACRIMAL SYSTEM - INCISION INCISION DRAINAGE LACRIMAL GLAND INCISION, DRAINAGE LACRIMAL SAC SNIP INCLSION OF LACRIMAL PUNCTUM EXCISION, LACRIMAL BLAND; TOTAL EXCEPT FOR TUMOR EXCISION, LACRIMAL GLAND; PARTICAL EXCEPT FOR TUMOR BIOPSY OF LACRIMAL GLAND

19 68520 EXCISION OF LACRIMAL SAC BIOPSY OF LACRIMAL SAC REMOVAL FOREIGN BOYD OF DACRYOLITH, LACRIMAL PATH EXCISION OF LACRIMAL GLAND TUMOR, FRONTAL APPROCAH EXCISION OF LACRIMAL GLAND TUMOR, W/OSTEOTOMY CPT CODE DESCRIPTION OF SERVICES FEE LACRIMAL SYSTEM -REPAIR PLASTIC REPAIR OF CANALICULI CORRECTION OF EVERTED PUNCTUM CAUTERY DACRYOCYSTORHINOSTOMY (FISTULIZATION LACRIMAL SAC) CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVAL) W/O TUBE CONJUNCTIVORHINOSTOMY (FIST CONJUNCTIVA) W/TUBE CLOSURE OF LACRIMAL PUNCTUM CLOSURE OF LACRIMAL PUNCTUM BY PLUG CLOSURE OF LACRIMAL FISTULA (SEPARATE PROCEDURE)

20 68840 PROVING CANALICULUS W-W/O IRRIGATION INJECTION CONTAST MEDIUM F/DARCRYOCYSTOPRAPHY DIAGNOSTIC ULTRASOUND - SCANS OPHTHALMIC ULTRASOUND, DIAGNOSTIC; B-SCAN AND QUANTITATIVE A-SCAN PERFGORMED DURING THE SAME PATIENT ENCOUNTER QUANTITATIVE A-SCAN ONLY B-SCAN (W-W/O SIMUTANEOUD A-SCAN) ANTERIOR SEGMENT ULTRASOUND, B-SCAN OR HIGHER RESOLUTION CORNEAL PACHYMETRY, UNILATERIAL OR BILATERAL CPT CODE DESCRIPTION OF SERVICES FEE DIAGNOSTIC ULTRASOUND - SCANS OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A- SCAN

21 76519 OPTHALMIC BIOMETRY ULTRASD E GRAPHY A-SCAN W/ LENS OPHTHALMOLOGY NEW PATIENT INTERMEDIATE EYE EXAM NEW PATIENT COMPREHENSIVE EYE EXAM NEW PATIENT LOW VISION EXAM LOW VISION EXAMINATION (SCCB CLINIC) ESTABLISHED PATIENT INTERMEDIATE/RE-EXAM ESTABLISHED PATIENT DILATED/INTERMEDIATE EXAM ESTABLISHED PATIENT 76. SPECIAL OPHTHALMOLOGICAL SERVICES DETERMINATION OF REFRACTIVE STATE GONIOSCOPY, NOT PART OF COMPLETE EYE EXAM COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, INTERPRETATION AND REPORT VISUAL FIELDS EXAMINATION, UNILATERAL OR BILATERIAL HUMPHREY VISUAL FIELDS EXAMINATION, INTERMEDIATE

22 GOLDMANN VISUAL FIELDS EXTENDED EXAM SERIAL TONOMETRY (SEPARATE PROCEDURE) WITH MULTIPLE MEASUREMENTS OF INTRAOCULAR PRESSURE SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC IMAGING INTERPRETATION CPT CODE DESCRIPTION OF SERVICE FEE SPECIAL OPHTHALMOLOGICAL SERVICES SCANNING COMPUTERIZED OPHTHALMIC DIAGNOSTIC (OCT) SCANNING COMPUTERIZED OPHTHALMIC (OCT) OPHTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY WITH IOL POWER CALCULATION PROVOCATIVE TESTS FOR GLAUCOMA, WITH AND REPORT, WITHOUT TONOGRAPHY OPHTHALMOSCOPY OPHTHALMOSCOPY, EXTENDED W/RETINAL DRAWING OPHTHALMOSCOPY - SUBSEQUENT REMOTE IMAGING FOR DETECTION OF RETINAL DISEASE 6.79

23 92228 REMOTE IMAGING FOR MONITORING AND MANAGEMENT OF ACTIVE RETINAL DISEASE FLRORESCEIN ANGIOSCOPY W/INTERPRETATION AND REPORT FLUROESCEIN ANGIOGRAPHY FUNDUS PHTOTS WITH INTERPRETATION AND REPORT EXTERNAL OCULAR PHOTOGRAPHY INTERPRETATION ANTERIOR SEGMENT IMAGING INTERPRETATION CONTACT LENS FITTING FITTING OF CONTACT LENS FOR TREATMENT OF OCULAR SURFACE DISEASE CPT CODE DESCRIPTION OF SERVICE FEE CONTACT LENS FITTING INITIAL FITTING OF CONTACT LENS FOR MANAGEMENT OF KERATOCONUS; INITIAL FITTING PRESCRIPTION OF OPTICAL AND PHYSICAL CHARACTERISTICS OF AND FITTING OF CONTACT LENS CORNEAL LENS FOR APHAKIA, 1 EYE CORNEAL LENS FOR APHAKIA, BOTH EYES 72.25

24 92313 CORNEOSCLERAL LENS FITTING FOR GLASSES FITTING, SPECTACLES EXCEPT FOR APHAKIA, MONOFOCAL.53 CONTACT LENS SERVICES (for treatment of eye disease only) LENS SOFT ONE EYE LENS HARD ONE EYE OFFICE VISIT - MEDICAL INITIAL OFFICE VISIT EXAM INITIAL OFFICE VISIT - EXAM INITIAL OFFICE VISIT - EXAM LEVEL IV MEDICAL EXAM; NEW PATIENT GENERAL MEDICAL HEMOGLOBIN & URINALYSIS OFFICE VISIT ESTABLISHED PATIENT LEVEL I FOLLOW UP; ESTABLISHED PATIENT 13.52

25 99212 LEVEL II FOLLOWUP; ESTABLSHED PATIENT CPT CODE DESCRIPTION OF SERVICE FEE LEVEL III FOLLOWUP; ESTABLISHED PATIENT LEVEL V FOLLOWUP; ESTABLSIHED PATIENT LEVEL V FOLLOWUP; ESTABLISHED PATIENT INITIAL CONSULTANTION INITIAL OFFICE CONSULTATION INITIAL OFFICE CONSULTATION INITIAL OFFICE CONSULTATION INITIAL OFFICE CONSULTATION INITIAL OFFICE CONSULTATION AUDIOLOGICAL EVALUATION TYMPANOMETRY AND RELFEX THRESHOLD MEASUREMENTS SCREENING TEST, PURE TONE, AIR ONLY PURE TONE AUDIOMETRY (THRESHOLD) AIR ONLY 14.52

26 92553 AIR AND BONE SPEECH AUDIOMETRY THRESHOLD COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION HEARING AID CHECK, MONAURAL HEARING AIDS CONSULT JERRY FRANCIS ANESTHESIA ANESTHEISA ESTIMATION ONLY (once invoice has been received actual amount will be calculated) CORNEA TISSUE V2785 CORNEA TISSUE 2, CPT CODE DESCRIPTION OF SERVICE FEE INJECTION J9035 AVASTIN USE IN CONJUNCTION WITH PSYCHIATRIC DIAGNOSTIC EVALUATION PSYCHIATRIC SERVICES PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES

27 PSYCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER PSYSCHOTHERAPHY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE OF PRIMARY PROCEDURE) PSYCHOTHERAPHY, 45 MINTUES WITH PATIENT AND/OR FAMILY MEMBER PSYCHOTHERAPHY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT OF SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER PSYCHOTHERAPHY, 60 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPERATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE)