Appendix A.2 OUTPATIENT IMAGING

Transcription

1 CPT Code MR spectroscopy Appendix A.2 OUTPATIENT IMAGING Effective January 1, 2015 All outpatient imaging services on this list require pre-certification Description Magnetic resonance imaging, brain (including brain stem) without contrast material Magnetic resonance imaging, brain (including brain stem) MRI Brain without contrast matierial, followed by contrast material and further sequences MRI, Brain, functional MRI including rest selection and administration of repetitive body part movement and /or visual stimulation, requiring physician or psychologist adminstration Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire neurofunctional testing MRI chest w/o dye MRI chest w/dye MRI chest w/o dye & w/dye MRI angio chest w/ or w/o dye Cardiac MRI w/ morph Cardiac MRI w/ stress img Cardiac MRI for morph w/dye Card MRI w/ stress img & dye Card MRI veloc flow mapping Magnetic resonance imaging, spinal canal and contents, cervical; without contrast material Magnetic resonance imaging, apinal canal and contents, thoracic; without contrast material (s) Magnetic resonance imaging, spinal canal and contents, lumbar, without contrast material Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; cervical Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; Thoracic Magnetic resonance imagaing, spinal canal and contents, without contrast material, followed by contrast material and further sequesnces; Lumbar MRI angiography, spinal canal and contents, with or without contrast material Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the

2 MRI, upper extremity, other than joint, without contrast material MRI upper extremity w/o & w/dye Magnetic resonance imaging, any joint of upper extremity; without contrast materials without contrast material, followed by contrast material and further sections MR angio ur extr w/o & w/dye MRI, lower extremity other than joint;without contrast material without contrast material, followed by contrast material and further sequences Magnetic resonance imaging; any joint of lower extremity; without contrat material without contrast material, followed by contrast material and further sections MRI, lower extremity, with or without contrast material Magnetic image bone marrow MRI, pelvis, without contrast material without contrast material, followed by contrast material and further sections MRI angiography, pelvis, with or without contrast material Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; without contrast material Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; with contrast material Magnetic Resonance Imaging (including brain stem and skull base), during open intracranial procedure; without contrast material, followed by contrast material & further sequences Magnetic Image jaw joint MRI orbit/face/neck w/o dye MRI orbit/face/neck w/dye MRI orbit/face/neck w/o & w/dye MR angiography head w/o dye MR angiogrphy head w/dye MR angiography head w/o dye & w/dye MR angiograhy neck w/o dye MR angiography neck w/dye MR angiography neck w/o & w/ dye MRI abdomen w/o dye MRI abdomen w/ dye MRI abdomen w/o & w/dye MRI angio abdom w/ or w/o dye MRI procedure MR guidance for needle place MRI, breast without and/or, unilateral MRI, breast without and/or, bilateral Magnetic Resonance guidance for, and monitoring of, parenchymal tissue ablation Liver imaging (SPECT) Liver imaging (SPECT); with vascular flow Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the

3 78710 Kidney imaging morphology; tomographic (SPECT) HT muscle image spect sing HT muscle image spect mult Heart muscle imaging (PET) Heart infarct image Heart infarct image (EF) Heart infarct image (3D) Heart image (PET) image single Heart image (PET) image multiple Heart image spect Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, add'l quantification, when performed); single study, at rest or stress (exercise or pharmacologic) Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass or gated technique, add'l quantification, when performed); multiple studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection Brain imaging; tomographic (SPECT) PET, brain, metabolic evaluation PET, brain, perfusion evaluation CParathyroid b i planar l fl id imaging fl i (including i ( t isubtraction, l di i t when d ti performed); f t iwith l) ttomographic (SPECT) (SPECT) Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently acquired computed tomography (CT) for anatomical localization Bone and/or joint imaging; tomographic (SPECT) PET image w/ CT full body Radiopharmaceutical localization of tumor or distribution of radiopharmaceutical agent; tomographic (SPECT) Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) PET, limited area (eg. Chest, head, neck) PET, Skull base to mid-thigh PET, whole body PET image w/ct Lmtd PET image w/ct skull-thigh D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; not requiring image postprocessing on an independent workstation D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, or other tomographic modality with image postprocessing under concurrent supervision; requiring image postprocessing on an independent workstation Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the

4 Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the

5 Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the

6 Current Procedural Terminology (CPT ) is a copyright of American Medical Association All rights reserved. CPT is a registered trademark of the