0500F 0501F 1034F 1035F Initial prenatal care visit Prenatal flow sheet Current tobacco smoker Smokeless tobacco user 10061 Drainage of skin abscess 20552 20553 20660 CPT CODES initial prenatal care visit (report at first prenatal encounter with health care professional providing obstetrical care. Report also date of visit and, in a separate field, the date of the last menstrual period [LMP]) (Prenatal) 12/15/2009 prenatal flow sheet documented in medical record by first prenatal visit (documentation includes at minimum blood pressure, weight, urine protein, uterine size, fetal heart tones, and estimated date of delivery). Report also: date of visit and, in a separate field, the date of the last menstrual period [LMP] (Note: If reporting 0501F Prenatal flow sheet, it is not necessary to report 0500F Initial prenatal care visit) (Prenatal) 12/15/2009 current tobacco smoker (CAD, CAP, COPD, PV) (DM) 12/15/2009 current smokeless tobacco user (eg, chew, snuff) (PV) 12/15/2009 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia); complicated or multiple 04/01/2011 Therapeutic injections: Tendons, trigger points single or multiple trigger points; 1 or 2 muscles 02/01/2010 Therapeutic injections: Tendons, trigger points Apply, removal fixation device single or multiple trigger points; 3 or more muscles 02/01/2010 application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) 05/01/2010 20661 Application of head brace application of halo, including removal; cranial 05/01/2010 20662 Application of pelvis brace application of halo, including removal; pelvic 05/01/2010 20664 Halo brace application application of halo, including removal, cranial, 6 or more pins placed, for thin skull osteology (eg, pediatric patients, hydrocephalus, osteogenesis imperfecta), requiring general anesthesia 05/01/2010 Revised 12/2010 Page 1 of 33 All Codes
20665 Removal of fixation device removal of tongs or halo applied by another physician 05/01/2010 20912 Remove cartilage for graft cartilage graft; nasal septum 05/01/2010 20982 Ablate, bone tumor(s), percutaneous ablation, bone tumor(s) (eg, osteoid osteoma, metastasis) radiofrequency, percutaneous, including computed tomographic guidance 05/01/2010 21010 Incision of jaw joint arthrotomy, temporomandibular joint 05/01/2010 21050 Removal of jaw joint 21060 Remove jaw joint cartilage condylectomy, temporomandibular joint (separate procedure) 05/01/2010 meniscectomy, partial or complete, temporomandibular joint (separate procedure) 05/01/2010 21070 Remove coronoid process coronoidectomy (separate procedure) 05/01/2010 21073 Manip of tmj w/anes 21076 21079 21080 21081 21082 21083 21084 21087 21088 Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis Prepare face/oral prosthesis 21100 Maxillofacial fixation manipulation of temporomandibular joint(s) (TMJ), therapeutic, requiring an anesthesia service (ie, general or monitored anesthesia care) 07/01/2010 impression and custom preparation; surgical obturator prosthesis 07/01/2010 impression and custom preparation; interim obturator prosthesis 07/01/2010 impression and custom preparation; definitive obturator prosthesis 07/01/2010 impression and custom preparation; mandibular resection prosthesis 07/01/2010 impression and custom preparation; palatal augmentation prosthesis 07/01/2010 impression and custom preparation; palatal lift prosthesis 07/01/2010 impression and custom preparation; speech aid prosthesis 07/01/2010 impression and custom preparation; nasal prosthesis 09/01/2010 impression and custom preparation; facial prosthesis 09/01/2010 application of halo type appliance for maxillofacial fixation, includes removal (separate procedure) 09/01/2010 Revised 12/2010 Page 2 of 33 All Codes
21120 Reconstruction of chin genioplasty; augmentation (autograft, allograft, prosthetic material) 09/01/2010 21121 Reconstruction of chin Genioplasty; sliding osteotomy, single piece 09/01/2010 21122 Reconstruction of chin 21123 Reconstruction of chin genioplasty; sliding osteotomies, 2 or more osteotomies (eg, wedge excision or bone wedge reversal for asymmetrical chin) 09/01/2010 genioplasty; sliding, augmentation with interpositional bone grafts (includes obtaining 09/01/2010 autografts) 21137 Reduction of forehead reduction forehead; contouring only 09/01/2010 21138 Reduction of forehead 21139 Reduction of forehead reduction forehead; contouring and application of prosthetic material or bone graft (includes obtaining autograft) 09/01/2010 reduction forehead; contouring and setback of anterior frontal sinus wall 09/01/2010 59425 Antepartum care only antepartum care only; 4-6 visits 09/01/2006 59426 Antepartum care only antepartum care only; 7 or more visits 09/01/2006 77427 90470 90801 90804 90806 Radiation tx management, x5 radiation treatment management, 5 treatments 10/01/2005 Immune admin H1N1 im/nasal H1N1 immunization administration (intramuscular, intranasal), including counseling when performed 10/01/2009 Psychiatric diagnostic interview examination 02/01/2010 Individual outpatient psychotherapy Individual outpatient psychotherapy individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 20-30 minutes face to face with patient individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 45-50 minutes face to face with patient 02/01/2010 02/01/2010 Revised 12/2010 Page 3 of 33 All Codes
90808 90810 90812 90814 90816 90818 90821 Individual outpatient psychotherapy Individual outpatient interactive psychotherapy Individual outpatient interactive psychotherapy Individual outpatient interactive psychotherapy Individual inpatient psychotherapy Individual inpatient psychotherapy Individual inpatient psychotherapy individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an office or outpatient facility, approximately 75-80 minutes face to face with patient 02/01/2010 individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 20 to 30 minutes face-to-face with the patient 02/01/2010 individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 45 to 50 minutes face-to-face with the patient 02/01/2010 individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an office or outpatient facility, approximately 75 to 80 minutes face-to-face with the patient 02/01/2010 individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient individual psychotherapy, insight oriented, behavior modifying and/or supportive, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient 02/01/2010 02/01/2010 02/01/2010 Revised 12/2010 Page 4 of 33 All Codes
90823 90826 90828 Inpatient individual psychotherapy: Interactive Inpatient individual psychotherapy: Interactive Inpatient individual psychotherapy: Interactive 92506 Speech/hearing evaluation 92507 Speech/hearing therapy 92508 Speech/hearing therapy 92526 92609 Special procedures of the ears/nose/throat Services related to hearing and speech devices individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 20 to 30 minutes face-to-face with the patient 02/01/2010 individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 45 to 50 minutes face-to-face with the patient 02/01/2010 individual psychotherapy, interactive, using play equipment, physical devices, language interpreter, or other mechanisms of non-verbal communication, in an inpatient hospital, partial hospital or residential care setting, approximately 75 to 80 minutes face-to-face with the patient 02/01/2010 evaluation of speech, language, voice, communication, and/or auditory processing treatment of speech, language, voice, communication, and/or auditory processing disorder; individual treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals 10/01/2009 10/01/2009 10/01/2009 treatment of swallowing dysfunction and/or oral function of feeding 02/01/2010 therapeutic services for the use of speechgenerating device, including programming and modification 02/01/2010 Revised 12/2010 Page 5 of 33 All Codes
92610 Swallowing evaluations 92612 Swallowing evaluations 93012 Transmission of ecg 93014 Report on transmitted ecg 93268 ECG record/review 93270 ECG recording 93271 ECG/monitoring and analysis 93272 ECG/review, interpret only evaluation of oral and pharyngeal swallowing function 02/01/2010 flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording 02/01/2010 telephonic transmission of post-symptom electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day period of time; tracing only telephonic transmission of post-symptom electrocardiogram rhythm strip(s), 24-hour attended monitoring, per 30 day period of time; physician review with interpretation and report only 02/01/2008 05/15/2008 wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; includes transmission, physician review and interpretation 05/15/2008 wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; recording (includes connection, recording, and disconnection) 05/15/2008 wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; monitoring, receipt of transmissions, and analysis 05/15/2008 wearable patient activated electrocardiographic rhythm derived event recording with presymptom memory loop, 24-hour attended monitoring, per 30 day period of time; physician review and interpretation 05/15/2008 Revised 12/2010 Page 6 of 33 All Codes
94014 94015 Patient recorded spirometry Patient recorded spirometry 94016 Review patient spirometry 94774 94775 94776 94777 Ped home apnea rec, compl Ped home apnea rec, hkup Ped home apnea rec, downld Ped home apnea rec, report patient-initiated spirometric recording per 30- day period of time; includes reinforced education, transmission of spirometric tracing, data capture, analysis of transmitted data, periodic recalibration and physician review and interpretation 05/15/2008 patient-initiated spirometric recording per 30- day period of time; recording (includes hookup, reinforced education, data transmission, data capture, trend analysis, and periodic recalibration) patient-initiated spirometric recording per 30- day period of time; physician review and interpretation only 05/15/2008 05/15/2008 pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; includes monitor attachment, download of data, physician review, interpretation, and preparation of a report 05/15/2008 pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitor attachment only (includes hook-up, initiation of recording and disconnection) 05/15/2008 pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; monitoring, download of information, receipt of transmission(s) and analyses by computer only 05/15/2008 pediatric home apnea monitoring event recording including respiratory rate, pattern and heart rate per 30-day period of time; physician review, interpretation and preparation of report only 05/15/2008 Revised 12/2010 Page 7 of 33 All Codes
95117 Allergy immunotherapy 2 or more injections 02/01/2010 95120 Immunotherapy, one injection 95125 Immunotherapy, many antigens 95808 Polysomnography, 1-3 95810 Polysomnography, 4 or more 95811 Polysomnography w/cpap 96110 96111 Cognitive capability assessments Cognitive capability assessments professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; single injection professional services for allergen immunotherapy in prescribing physicians office or institution, including provision of allergenic extract; 2 or more injections polysomnography; sleep staging with 1-3 additional parameters of sleep, attended by a technologist polysomnography; sleep staging with 4 or more additional parameters of sleep, attended by a technologist polysomnography; sleep staging with 4 or more additional parameters of sleep, with initiation of continuous positive airway pressure therapy or bilevel ventilation, attended by a technologist developmental testing; limited (eg. Developmental Screening Test II, Early Language Milestone Screen), with interpretation and report extended (includes assessment of motor, language, social, adaptive and/or cognitive functioning by standardized developmental instruments) with interpretation and report 04/01/2011 04/01/2011 10/01/2009 10/01/2009 10/01/2009 02/01/2010 12/15/2010 02/01/2010 12/15/2010 97001 97003 Physical medicine assessments physical therapy evaluation 02/01/2010 Physical medicine assessments occupational therapy evaluation 02/01/2010 Revised 12/2010 Page 8 of 33 All Codes
99201 Outpatient and other visits 99202 Outpatient and other visits office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; Straightforward medical decision making. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 02/01/2010 office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; Straightforward medical decision making. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 9 of 33 All Codes
99203 Outpatient and other visits 99204 Outpatient and other visits office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; Medical decision making of low complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 02/01/2010 office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-toface with the patient and/or family. 02/01/2010 Revised 12/2010 Page 10 of 33 All Codes
99205 Outpatient and other visits 99211 Outpatient and other visits 99212 Outpatient and other visits office or other outpatient visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; Medical decision making of high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 02/01/2010 office or other outpatient visit for the evaluation and management of an established patient, that may not require the presence of a physician. Usually, the presenting problem(s) are minimal. Typically, 5 minutes are spent performing or supervising these services. 02/01/2010 office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused history; a problem focused examination; Straightforward medical decision making. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 10 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 11 of 33 All Codes
99213 Outpatient and other visits 99214 Outpatient and other visits office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; an expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 02/01/2010 office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed history; a detailed examination; Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 25 minutes face-toface with the patient and/or family. 02/01/2010 Revised 12/2010 Page 12 of 33 All Codes
99215 Outpatient and other visits 99238 Inpatient hospital discharge services office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive history; a comprehensive examination; Medical decision making of high complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes face-toface with the patient and/or family. 02/01/2010 hospital discharge day management: 30 minutes or less 02/01/2010 99239 Inpatient hospital discharge services more than 30 minutes 02/01/2010 99241 Consultations office consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 13 of 33 All Codes
99242 Consultations 99243 Consultations 99244 Consultations office consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 30 minutes face-to-face with the patient and/or family. 02/01/2010 office consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 40 minutes face-toface with the patient and/or family. 02/01/2010 office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 14 of 33 All Codes
99245 Consultations 99251 Consultations 99252 Consultations office consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes face-to-face with the patient and/or family. 02/01/2010 inpatient consultation for a new or established patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 20 minutes at the bedside and on the patient's hospital floor or unit. 02/01/2010 inpatient consultation for a new or established patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Straightforward medical decision making. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 40 minutes at the bedside and on the patient's hospital floor or unit. 02/01/2010 Revised 12/2010 Page 15 of 33 All Codes
99253 Consultations 99254 Consultations 99255 Consultations inpatient consultation for a new or established patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of low complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 55 minutes at the bedside and on the patient's hospital floor or unit. 02/01/2010 inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 80 minutes at the bedside and on the patient's hospital floor or unit. 02/01/2010 inpatient consultation for a new or established patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 110 minutes at the bedside and on the patient's hospital floor or unit. 02/01/2010 Revised 12/2010 Page 16 of 33 All Codes
99291 Critical care visits: Patients 25 months of age and older 99304 Nursing facility visits 99305 Nursing facility visits Critical care, evaluation and management of the critically ill or critically injured patient: first 30-74 minutes initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A detailed or comprehensive history; A detailed or comprehensive examination; and Medical decision making that is straightforward or of low complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the problem(s) requiring admission are of low severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. 02/01/2010 initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the problem(s) requiring admission are of moderate severity. Physicians typically spend 35 minutes with the patient and/or family or caregiver. 02/01/2010 02/01/2010 11/19/2010 Revised 12/2010 Page 17 of 33 All Codes
99306 Nursing facility visits 99307 Nursing facility visits initial nursing facility care, per day, for the evaluation and management of a patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the problem(s) requiring admission are of high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver. 02/01/2010 subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A problem focused interval history; A problem focused examination; Straightforward medical decision. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is stable, recovering, or improving. Physicians typically spend 10 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 18 of 33 All Codes
99308 Nursing facility visits 99309 Nursing facility visits subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is responding inadequately to therapy or has developed a minor complication. Physicians typically spend 15 minutes with the patient and/or family or caregiver. 02/01/2010 subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the patient has developed a significant complication or a significant new problem. Physicians typically spend 25 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 19 of 33 All Codes
99310 Nursing facility visits 99324 Domiciliary care, rest home, assisted living visits subsequent nursing facility care, per day, for the evaluation and management of a patient, which requires at least 2 of these 3 key components. A comprehensive interval history; A comprehensive examination; Medical decision making of high complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 35 minutes with the patient and/or family or caregiver. 02/01/2010 domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 20 of 33 All Codes
99325 99326 99327 Domiciliary care, rest home, assisted living visits Domiciliary care, rest home, assisted living visits Domiciliary care, rest home, assisted living visits domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes with the patient and/or family or caregiver. 02/01/2010 domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes with the patient and/or family or caregiver. 02/01/2010 domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 21 of 33 All Codes
99328 99334 Domiciliary care, rest home, assisted living visits Domiciliary care, rest home, assisted living visits domiciliary or rest home visit for the evaluation and management of a new patient, which requires these 3 key components: : A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physican attention. Physicians typically spend 75 minutes with the patient and/or family or caregiver. 02/01/2010 domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused internal history; A problem focused examination; Straightforward medical decision making. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 22 of 33 All Codes
99335 99336 Domiciliary care, rest home, assisted living visits Domiciliary care, rest home, assisted living visits domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused internal history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes with the patient and/or family or caregiver. 02/01/2010 domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 40 minutes with the patient and/or family or caregiver. 02/01/2010 Revised 12/2010 Page 23 of 33 All Codes
99337 99341 Home visits Domiciliary care, rest home, assisted living visits domiciliary or rest home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physical attention. Physicians typically spend 60 minutes with the patient and/or family or caregiver. 02/01/2010 home visit for the evaluation and management of a new patient, which requires these 3 key components: A problem focused history; A problem focused examination; and Straightforward medical decision making. consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low severity. Physicians typically spend 20 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 24 of 33 All Codes
99342 Home visits 99343 Home visits home visit for the evaluation and management of a new patient, which requires these 3 key components: An expanded problem focused history; An expanded problem focused examination; and Medical decision making of low complexity. Counseling and/or agencies are provided consistent wit the and/or family's needs. Usually, the presenting problem(s) are of moderate severity. Physicians typically spend 30 minutes face-toface with the patient and/or family. 02/01/2010 home visit for the evaluation and management of a new patient, which requires these 3 key components: A detailed history; A detailed examination; and Medical decision making of moderate complexity. Counseling and/or agencies are provided consistent wit the and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. Physicians typically spend 45 minutes face-toface with the patient and/or family. 02/01/2010 Revised 12/2010 Page 25 of 33 All Codes
99344 Home visits 99345 Home visits 99347 Home visits home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of moderate complexity. consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of high severity. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 02/01/2010 home visit for the evaluation and management of a new patient, which requires these 3 key components: A comprehensive history; A comprehensive examination; and Medical decision making of high complexity. consistent wit the nature of the problem(s) and the patient's and/or family's needs. Usually, the patient is unstable or has developed a significant new problem requiring immediate physician attention. Physicians typically spend 75 minutes face-to-face with the patient and/or family. 02/01/2010 home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A problem focused internal history; A problem focused examination; and Straightforward medical decision making. Counseling and/or agencies are provided consistent with the and/or family's needs. Usually, the presenting problem(s) are self limited or minor. Physicians typically spend 15 minutes face-toface with the patient and/or family. 02/01/2010 Revised 12/2010 Page 26 of 33 All Codes
99348 Home visits 99349 Home visits home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused interval history; An expanded problem focused examination; Medical decision making of low complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Physicians typically spend 25 minutes face-to-face with the patient and/or family. 02/01/2010 home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A detailed interval history; A detailed examination; Medical decision making of moderate complexity. Counseling and/or coordination of care with other providers or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are moderate to high severity. Physicians typically spend 40 minutes face-to-face with the patient and/or family. 02/01/2010 Revised 12/2010 Page 27 of 33 All Codes
99350 Home visits 99354 Prolonged services outside customary services home visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: A comprehensive interval history; A comprehensive examination; Medical decision making of moderate to high complexity. consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of moderate to high severity. The patient may be unstable or may have developed a significant new problem requiring immediate physician attention. Physicians typically spend 60 minutes face-to-face with the patient and/or family. 02/01/2010 prolonged physician service in the office or other outpatient setting requiring direct (faceto-face) patient contact beyond the usual service. First hour list separately in addition to code the office or other outpatient Evaluation and Management service. 02/01/2010 99381 Init pm e/m, new pat, inf initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; infant (age younger than 1 year) 02/01/2011 Revised 12/2010 Page 28 of 33 All Codes
99382 Init pm e/m, new pat 1-4 yrs 99383 Prev visit, new, age 5-11 99384 Prev visit, new, age 12-17 99385 Prev visit, new, age 18-39 initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; early childhood (age 1 through 4 years) 02/01/2011 initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; late childhood (age 5 through 11 years) 02/01/2011 initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; adolescent (age 12 through 17 years) 02/01/2011 initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 18-39 years 02/01/2011 Revised 12/2010 Page 29 of 33 All Codes
99386 Prev visit, new, age 40-64 99387 Init pm e/m, new pat 65+ yrs 99391 Per pm reeval, est pat, inf 99392 Prev visit, est, age 1-4 yrs initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 40-64 years 02/01/2011 initial comprehensive preventive medicine evaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, new patient; 65 years and older 02/01/2011 periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; infant (age younger than 1 year) 02/01/2011 periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; early childhood (age 1 through 4 years) 02/01/2011 Revised 12/2010 Page 30 of 33 All Codes
99393 Prev visit, est, age 5-11 99394 Prev visit, est, age 12-17 periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; late childhood (age 5 through 11 years) 02/01/2011 periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; adolescent (age 12 through 17 years) 02/01/2011 99395 Preventive medicine visits 18-39 years 02/01/2010 99396 Prev visit, est, age 40-64 99397 Per pm reeval est pat 65+ yrs periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 40-64 years 02/01/2011 periodic comprehensive preventive medicine reevaluation and management of an individual including an age and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduction interventions, and the ordering of laboratory/diagnostic procedures, established patient; 65 years and older 02/01/2011 Revised 12/2010 Page 31 of 33 All Codes
99401 Counseling services: Risk factor and behavioral change modification preventive medicine counseling and/or risk factor reduction intervention(s) provided to an individual (separate procedure), approximately 15 minutes 02/01/2010 99402 99403 99404 99411 99412 99466 Counseling services: Risk factor and behavioral change modification approximately 30 minutes 02/01/2010 Counseling services: Risk factor and behavioral change modification approximately 45 minutes 02/01/2010 Counseling services: Risk factor and behavioral change modification approximately 60 minutes 02/01/2010 Counseling services: Risk factor and behavioral change modification preventive medicine counseling and/or risk factor reduction intervention(s) provided to individuals in a group setting (separate procedure), approximately 30 minutes 02/01/2010 Counseling services: Risk factor and behavioral change modification approximately 60 minutes 02/01/2010 Critical care transport age 24 months or younger critical care services delivered by a physician, face-to-face, during an interfacility transport of critically ill or critically injured pediatric patient, 24 months of age or less, first 30-74 minutes of hands-on care during transport. 02/01/2010 Revised 12/2010 Page 32 of 33 All Codes
E0424 Stationary compressed gas 02 E0431 Portable gaseous 02 E0434 Portable liquid 02 E0439 Stationary liquid 02 G9141 Influenza A H1N1,admin w counsel HCPCS CODES stationary compressed, gaseous oxygen, rental; incl. container, contents, 01/01/2005 portable gaseous oxygen system, rental; portable container, regulator 01/01/2005 portable liquid oxygen system, includes container, flowmeter, etc. 01/01/2005 stationary liquid oxygen system, rental; includes container, contents, regulator 01/01/2005 influenza A (H1N1) immunization administration (includes the physician counseling the patient/family) 09/15/2009 J2505 Injection, pegfilgrastim 6mg injection pegfilgrastim 6mg 05/15/2008 Q0513 S0270 S0271 S0272 S4040 Disp fee inhal drugs/30 days Home std case rate 30 days Home hospice case 30 days Home episodic case 30 days Monit store cryo embryo 30 days pharmacy dispensing fee for inhalation drug(s); per 30 days 05/15/2008 physician management of patient home care, standard monthly case rate (per 30 days) 05/15/2008 physician management of patient home care, hospice monthly case rate (per 30 days) 05/15/2008 physician management of patient home care, episodic care monthly case rate (per 30 days) 05/15/2008 monitoring and storage of cryopreserved embryos, per 30 days 05/15/2008 Revised 12/2010 Page 33 of 33 All Codes