cpt & ICD-9 2015 ARTHROGRAM - Non - Conventional w CT

cpt & ICD-9 2015 The following codes are being provided as a quick reference guide only. Please be sure to consult your office AMA CPT code book to confirm all codes. Breast Procedures CPT Code CTA CPT Code US GUIDED BREAST BIOPSY 19083 ABDOMEN 74175 + EACH ADDITIONAL LESION (USE WITH 19083) 19084 ABDOMEN/PELVIS 74174 BREAST CYST ASPIRATION 76942, 19000 RUN- OFF STUDY (ABDOMINAL AORTA & BILATERAL LWR EXTREMITIES) 75635 + EACH ADDITIONAL CYST (USE WITH 19000) 19001 CHEST (NONCORONARY) 71275 ULTRASOUND GUIDED FNA x # OF LESIONS 76942, 10022 CORONARY ARTERIES 75574 US PLACEMENT OF LOCALIZATION DEVICE HEAD 70496 PLACEMENT OF CLIP, METALLIC PELLET, WIRE/NEEDLE, 19285 LOWER EXTREMITY 73706 RADIOACTIVE SEEDS NECK (CAROTID) 70498 + EACH ADDITIONAL LESION (USE WITH 19285) 19286 PELVIS 72191 STEREOTACTIC GUIDED BIOPSY 19081 UPPER EXTREMITY 73206 + EACH ADDITIONAL LESION (USE WITH 19081) 19082 MYELOGRAM BREAST CYST ASPIRATION 77031, 19000 CERVICAL SPINE 62302, 72126 + EACH ADDITIONAL CYST (USE WITH 19000) 19001 STEREOTACTIC PLACEMENT OF LOCALIZATION WIRE CERVICAL C- 1- C2 62302, 72126 PLACEMENT OF CLIP, METALLIC PELLET, WIRE/NEEDLE, 19283 RADIOACTIVE SEEDS THORACIC SPINE 62303, 72129 + EACH ADDITIONAL LESION (USE WITH 19283) 19284 MR GUIDED BREAST BIOPSY 19085 LUMBAR 62304, 72132 + EACH ADDITIONAL LESION (USE WITH 19085) 19086 BREAST CYST ASPIRATION 77021, 19000 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, 62305 & + EACH ADDITIONAL CYST (USE WITH 19000) 19001 THORACIC/CERVICAL, LUMBAR/CERVICAL) 2 CT Codes based on region MR PLACEMENT OF LOCALIZATION DEVICE POSTERIOR FOSSA 70460, 70010, 77003 & PLACEMENT OF CLIP, METALLIC PELLET, WIRE/NEEDLE, 19287 61055 or 62284 RADIOACTIVE SEEDS CISTERNOGRAPHY 70460, 70015, 77003 & + EACH ADDITIONAL LESION (USE WITH 19287) 19288 61055 or 62284 CT GUIDED BIOPSY ARTHROGRAM - Conventional (RAD) w CT BREAST BIOPSY PER LESION 77012, 19499 ELBOW 73201, 24220, 73085 BREAST CYST ASPIRATION 77012, 19000 HIP 73701, 27093, 73525 + EACH ADDITIONAL CYST (USE WITH 19000) 19001 SHOULDER 73201, 23350, 73040 MAMMOGRAPHIC GUIDED BIOPSY KNEE 73701, 27370, 73580 BREAST CYST ASPIRATION 77032, 19000, 19001 WRIST 73201, 25246, 73115 MAMMOGRAPHIC PLACEMENT OF LOCALIZATION WIRE WRIST 3 JOINT 73201, 25246,73115 PLACEMENT OF CLIP, METALLIC PELLET, WIRE/NEEDLE, 19281 ANKLE 73701, 27648, 73615 RADIOACTIVE SEEDS SACROILIAC (SI) JOINT 27096, 72193 + EACH ADDITIONAL LESION (USE WITH 19281) 19282 TMJ 70487, 21116, 70332 POST BIOPSY MAMMOGRAM ARTHROGRAM - Non - Conventional w CT BILATERAL G0204, 77051 ELBOW 73201, 24220, 77002 UNILATERAL G0206, 77051 HIP 73701, 27093, 77002 MAMMOGRAPHY SHOULDER 73201, 23350, 77002 DIAGNOSTIC BILATERAL TOMOSYNTHESIS 77062 KNEE 73701, 27370, 77002 DIAGNOSTIC UNILATERAL TOMOSYNTHESIS 77061 WRIST 73201, 25246, 77002 DIGITAL DIAGNOSTIC BILATERAL G0204, 77051 WRIST 3 JOINT 73201, 25246, 77002 DIGITAL DIAGNOSTIC UNILATERAL G0206, 77051 ANKLE 73701, 27648, 77002 DIGITAL SCREENING BILATERAL G0202, 77052 SACROILIAC (SI) JOINT 27096, 72193 DIGITAL SCREENING BILATERAL WITH TOMOSYNTHESIS G0202, 77052, 77063 DIGITAL SCREENING UNILATERAL G0202-52, 77052 TMJ 21116, 70487, 77002 DUCTOGRAM MULTI DUCT 19030, 77054 NEEDLE GUIDED BIOPSY DUCTOGRAM SINGLE DUCT 19030, 77053 LIVER 47000, 77012 LYMPH NODES 38505, 77012 THIGH 20206, 77012 SURGICAL SPECIMEN 76098 KIDNEY - RENAL MASS 50200, 77012 ULTRASOUND SOFT TISSUE MASS 20206, 77012 BREAST(S) 76641 or 76642 UNLISTED CT PROCEDURE 76497 MRI BREAST UNILATERAL 77058 BREASTS BILATERAL 77059

CT CPT Code CT CPT Code 3D RECONSTRUCITON W/O POSTPROCESSING 76376 LUMBAR SPINE WITHOUT CONTRAST 72131 3D RECONSTRUCTION WITH POSPROCESSING 76377 LUMBAR SPINE WITH CONTRAST 72132 ABDOMEN/PELVIS WITHOUT CONTRAST 74176 LUMBAR SPINE W- W/O CONTRAST 72133 ABDOMEN/PELVIS WITH CONTRAST 74177 LUNG SCREENING 71250 ABDOMEN/PELVIS W- W/O CONTRAST 74178 LOWER EXTREMITY WITHOUT CONTRAST 73700 ABDOMEN WITHOUT CONTRAST 74150 LOWER EXTREMITY WITH CONTRAST 73701 ABDOMEN WITH CONTRAST 74160 LOWER EXTREMITY W- W/O CONTRAST 73702 ABDOMEN W- W/O CONTRAST 74170 MAXILLOFACIAL WITHOUT CONTRAST 70486 BRAIN WITHOUT CONTRAST 70450 MAXILLOFACIAL WITH CONTRAST 70487 BRAIN WITH CONTRAST 70460 MAXILLOFACIAL W- W/O CONTRAST 70488 BRAIN W- W/O CONTRAST 70470 NECK SOFT TISSUE WITHOUT CONTRAST 70490 CARDIAC CALCIUM SCORING WITHOUT CONTRAST 75571 NECK SOFT TISSUE WITH CONTRAST 70491 CARDIAC STRUCTURE AND MORPHOLOGY W/ CONTRAST 75572 NECK SOFT TISSUE W- W/OUT CONTRAST 70492 CARDIAC STRUCTURE AND MORPHOLOGY - IN THE SETTING 75573 ORBITS WITHOUT CONTRAST 70480 OF CONGENITAL HEART DISEASE W/ CONTRAST ORBITS WITH CONTRAST 70481 CERVICAL SPINE WITHOUT CONTRAST 72125 ORBITS W- W/O CONTRAST 70482 CERVICAL SPINE WITH CONTRAST 72126 PELVIS WITHOUT CONTRAST 72192 CERVICAL SPINE W- W/O CONTRAST 72127 PELVIS WITH CONTRAST 72193 CHEST WITHOUT CONTRAST 71250 PELVIS W- W/O CONTRAST 72194 CHEST WITH CONTRAST 71260 PITUITARY- SELLA WITHOUT CONTRAST 70480 CHEST W- W/OUT CONTRAST 71270 PITUITARY- SELLA WITH CONTRAST 70481 COCCYX WITH CONTRAST 72193 PITUITARY- SELLA W- W/O CONTRAST 70482 COCCYX WITHOUT CONTRAST 72192 POSTERIOR FOSSA WITHOUT CONTRAST 70480 COCCYX W/WO CONTRAST 72194 POSTERIOR FOSSA WITH CONTRAST 70481 DENTAL IMPLANTS WO CONT 70486 POSTERIOR FOSSA W- W/O CONTRAST 70482 DENTAL SCAN ONLY CASH PAY ONLY SACRUM WITHOUT CONTRAST 72192 DENTAL SCAN W PROCESS BOTH CASH PAY ONLY SACRUM WITH CONTRAST 72193 DENTAL SCAN WITH PROCESSING CASH PAY ONLY SACRUM W- W/O CONTRAST 72194 DNTL SCAN ONLY BOTH TOP AND BOTTOM CASH PAY ONLY SCANOGRAM 77073 ELBOW WITHOUT CONTRAST 73200 SHOULDER WITHOUT CONTRAST 73200 ELBOW WITH CONTRAST 73201 SHOULDER WITH CONTRAST 73201 ELBOW W- W/O CONTRAST 73202 SHOULDER W- W/O CONTRAST 73202 ENTEROGRAPHY (ABD & PEL W CONTRAST) 74177, 76376 or 76377 SINUS LTD WITHOUT CONTRAST 70486 FACIAL BONES WITHOUT CONTRAST 70486 SINUS WITHOUT CONTRAST 70486 FACIAL BONES WITH CONTRAST 70487 SINUS WITH CONTRAST 70487 FACIAL BONES W- W/O CONTRAST 70488 SINUS W- W/O CONTRAST 70488 FOLLOW- UP STUDY LIMITED OR LOCALIZED 76380 TEMPORAL BONES WITHOUT CONTRAST 70480 FOOT- ANKLE WITHOUT CONTRAST 73700 TEMPORAL BONES WITH CONTRAST 70481 FOOT- ANKLE WITH CONTRAST 73701 TEMPORAL BONES W- W/O CONTRAST 70482 FOOT- ANKLE W- W/O CONTRAST 73702 THIGH- FEMUR WITHOUT CONTRAST 73700 FOREARM WITHOUT CONTRAST 73200 THIGH- FEMUR WITH CONTRAST 73701 FOREARM WITH CONTRAST 73201 THIGH- FEMUR W- W/O CONTRAST 73702 FOREARM W- W/O CONTRAST 73202 THORACIC SPINE - WITHOUT CONTRAST 72128 HAND WITHOUT CONTRAST 73200 THORACIC SPINE - WITH CONTRAST 72129 HAND WITH CONTRAST 73201 THORACIC SPINE - W- W/O CONTRAST 72130 HAND W- W/O CONTRAST 73202 TIB- FIB WITHOUT CONTRAST 73700 HIP WITHOUT CONTRAST 73700 TIB- FIB WITH CONTRAST 73701 HIP WITH CONTRAST 73701 TIB- FIB W- W/O CONTRAST 73702 HIP W- W/O CONTRAST 73702 TMJS WITHOUT CONTRAST 70486 HUMERUS WITHOUT CONTRAST 73200 TMJS WITH CONTRAST 70487 HUMERUS WITH CONTRAST 73201 TMJS W- W/O CONTRAST 70488 HUMERUS W- W/O CONTRAST 73202 UPPER EXTREMITY WITHOUT CONTRAST 73200 IACS, ORBIT, SELLA OR POSTERIOR FOSSA W/O CONTRAST 70480 UPPER EXTREMITY WITH CONTRAST 73201 IACS, ORBIT, SELLA OR POSTERIOR FOSSA W/ CONTRAST 70481 UPPER EXTREMITY W- W/O CONTRAST 73202 IACS, ORBIT, SELLA OR POSTERIOR FOSSA 70482 UROGRAM (ABD PEL W/WO) 74178 & W & W/O CONTRAST 76376 or 76377 KNEE WITHOUT CONTRAST 73700 VIRTUAL COLONOSCOPY W/O CONTRAST, DIAGNOSTIC 74261 KNEE WITH CONTRAST 73701 VIRTUAL COLONOSCOPY WITH CONTRAST, DIAGNOSTIC 74262 KNEE W- W/O CONTRAST 73702 VIRTUAL COLONOSCOPY W/O CONTRAST, SCREENING 74263 KUB ABD/PEL W/O 74176 WRIST WITHOUT CONTRAST 73200 LARYNX WITHOUT CONTRAST 70490 WRIST WITH CONTRAST 73201 LARYNX WITH CONTRAST 70491 WRITST W- W/O CONTRAST 73202 LARYNX W- W/O CONTRAST 70492 RADIATION THERAPY PLANNING 77014

Fluoroscopy CPT Code Fluoroscopy CPT Code FISTULA SINUS TRACT STUDY 76080, 20501 UGI - W- W/O DELAYED FILMS, WITHOUT KUB 74240 FLUORO GUID LOC NEEDLE, SPINE 77003 SMALL BOWEL STUDY 74250 FLUORO GUIDE BX, INJ, ASP 77002 UGI - DOUBLE CONTRAST, W- W/OUT DELAYED FILMS, 74246 GUIDED BX, INJ, ASPIRATION 77002 W/OUT KUB - ADULTS LARGE JOINT (EG, SHOULDER, HIP KNEE) 20610, 77002 UGI - DOUBLE CONTRAST, W- W/OUT DELAYED FILMS, 74246 INTERMEDIATE JOINT (EG, TMJ, WRIST, ELBOW, ANKLE) 20605, 77002 W/OUT KUB - INFANTS/CHILDREN SMALL JOINT (EG, FINGERS, TOES) 20600, 77002 UGI - DOUBLE CONTRAST, W- W/OUT DELAYED FILMS 74247 LOOPOGRAM 74425, 50690 W/ KUB - ADULTS INDEPENDENT STUDY 76000 UGI - DOUBLE CONTRAST, W- W/OUT DELAYED FILMS, 74249 SNIFF TEST 76000 W/ KUB & SMALL BOWEL FOLLOW THROUGH - FLUORO UP TO ONE HOUR 76000 INFANTS/CHILDREN FLUORO MORE THAN ONE HOUR 76001 UGI - DOUBLE CONTRAST, W- W/OUT DELAYED FILMS W/ 74249 FLUORO EVAL OF EXISTING CENTRAL VENOUS ACCESS 36598, 75820 & KUB & SMALL BOWEL FOLLOW THROUHG - ADULTS DEVICE 75825 or 75827 UGI - W- W/O DELAYED FILMS, WITH KUB 74241 LUMBAR PUNCTURE (Diagnostic) 62270, 77003 UGI - W/SMALL BOWEL FOLLOW THROUGH 74245 LUMBAR PUNCTURE (Therapeutic) 62272, 77003 GYNECOLOGICAL AND OBSTETRICAL NOSE TO RECTUM EXAMINATION FOR DETECTION OF 76010 HYSTERSALPINGOGRAM (AKA HSG) 74740, 58340 FOREIGN BODY - CHILD VAGINOGRAM (PERINEOGRAM) 74775 BLOOD PATCH 62273, 77003 URINARY TRACT PROCEDURE UNLISTED 76496 CYSTOGRAPHY 74430 & TOMOGRAPHY TO COMPLETE EXAM 76100 51600 or 51605 GANGLION CYST ASPIRATION INJECTION 20612, 77002 IVP - INTRAVENOUS, WITH OR WITHOUT KUB, 74400 INJ SINGLE TENDON SHEATH, LIGAMENT 20550, 77002 WITH OR WITHOUT TOMOGRAPHY INJ SINUS TRACT - SINOGRAM 76080, 20501 IVP ROUTINE - DRIP AND/OR BOLUS TECHNIQUE, 18 YEARS 74410 INJECTION VENOGRAM 36005, 75820, 75822 OR UNDER SIALOGRAM 70390, 42550 IVP - DRIP AND/OR BOLUS TECHNIQUE 74415 PERITONEOGRAM 74190, 49400 WITH TOMOGRAPHY (ALWAYS W TOMOS IF 18 +) MYELOGRAM - Conventional (RAD) LOOPOGRAM (ANTEGRADE PYELOGRAM) 74425, 50690 & POSTERIOR FOSSA 70010, 77003 & 50394 or 50390 61055 or 62284 NEPHROSTOGRAM 74425, 50390 & CISTERNOGRAPHY 70015, 77003 & 50394 or 50690 61055 or 62284 RETROGRADE PYELOGRAM 74420 CERVICAL MYELOGRAM 62302 URETHROCYSTOGRAPHY - RETROGRADE 74450, 51610 URETHROCYSTOGRAPHY - VOIDING (AKA VCUG) 74455, 51600 THORACIC MYELOGRAM 62303 MEASUREMENT OF POST- VOID RESIDUAL URINE AND/OR 51798 BLADDER CAPACITY BY US (USE WITH URINARY TRACT LUMBAR MYELOGRAM 62304 CODES IF PERFORMED) THORACENTESIS/PARACENTESIS MYELOGRAM 2 OR MORE REGIONS 62305 CHEST TUBE EXTENDED USE 32551 PARACENTESIS 49083 ARTHROGRAM - Conventional (RAD) THORACENTESIS 32555 ANKLE 73615, 27648 THORACENTESIS WITH TUBE 32557 ELBOW 73085, 24220 GASTROINTESTINAL TRACT HIP 73525, 27093 BE (BARIUM ENEMA) 74270 KNEE 73580, 27370 BE AC (BARIUM ENEMA, DOUBLE CONTRAST W/AIR) 74280 TMJ ARTHROGRAM 70332, 21116 THERAPEUTIC ENEMA 74283 WRIST ARTHROGRAM 73115, 25246 CHOLANGIOGRAM THROUGH EXISTING T- TUBE 74305, 47505 WRIST ARTHROGRAM 3 JOINT 73115, 25246 x3 ENTEROCLYSIS SMALL BOWEL 74251, 44500, 74340 SACROILIAC (SI) JOINT 27096 PHARYNX AND/OR CERVICAL ESOPHAGUS 74210 SHOULDER 73040, 23350 BARIUM SWALLOW - ESOPHAGUS 74220 BARIUM SWALLOW - ESOPHAGUS - MODIFIED 74230 FOREIGN BODY REMOVAL - ESOPHAGEAL 74235 & 43215 or 43247 GB - CHOLECYSTOGRAPHY, ORAL CONTRAST 74290 GB DD - CHOLECYSTOGRAPHY, ADDITIONAL OR REPEAT 74291 EXAM OR MULTIPLE DAY EXAM

MRI CPT Code MRI CPT Code ABDOMEN WITHOUT CONTRAST 74181 ORBIT, FACE AND/OR NECK WITHOUT CONTRAST 70540 ABDOMEN WITH CONTRAST 74182 ORBIT, FACE AND/OR NECK WITH CONTRAST 70542 ABDOMEN W- W/O CONTRAST 74183 ORBIT, FACE AND OR/NECK W- W/O CONTRAST 70543 BRACHIAL PLEXUS WITHOUT CONTRAST 71550 PELVIS - WITHOUT CONTRAST 72195 - TO IDENTIFY APICAL LUNG CANCERS PELVIS - WITH CONTRAST 72196 BRACHIAL PLEXUS WITH CONTRAST 71551 PELVIS - W- W/O CONTRAST 72197 - TO IDENTIFY APICAL LUNG CANCERS PELVIS W- W/O PROTOCOL STUDY 72197 BRACHIAL PLEXUS W- W/O CONTRAST 71552 PITUITARY WITHOUT CONTRAST 70551 - TO IDENTIFY APICAL LUNG CANCERS PITUITARY WITH CONTRAST 70552 BRACHIAL PLEXUS WITHOUT CONTRAST 73218 PITUITARY W- W/O CONTRAST 70553 - EVALUATION OF TUMOR IN AXILLA PROSTATE WITHOUT CONTRAST 72195 BRACHIAL PLEXUS WITH CONTRAST 73219 PROSTATE WITH CONTRAST 72196 - EVALUATION OF TUMOR IN AXILLA PROSTATE W- W/O CONTRAST 72197 BRACHIAL PLEXUS W- W/O CONTRAST 73220 SACRUM WITHOUT CONTRAST 72195 - EVALUATION OF TUMOR IN AXILLA SACRUM WITH CONTRAST 72196 BRACHIAL PLEXUS WITHOUT CONTRAST 73221 SACRUM W- W/O CONTRAST 72197 - EVALUATION OF TUMOR IN SHOULDER GIRDLE SINUS WITHOUT CONTRAST 70540 BRACHIAL PLEXUS WITH CONTRAST 73222 SINUS WITH CONTRAST 70542 - EVALUATION OF TUMOR IN SHOULDER GIRDLE SINUS W- W/O CONTRAST 70543 BRACHIAL PLEXUS W- W/O CONTRAST 73223 TEMPORAL/MASTOID (BRAIN) WITHOUT CONTRAST 70551 - EVALUATION OF TUMOR IN SHOULDER GIRDLE TEMPORAL/MASTOID (BRAIN) WITH CONTRAST 70552 BRACHIAL PLEXUS WITHOUT CONTRAST - EVALUATION TO 70540 TEMPORAL/MASTOID (BRAIN) W/WO CONTRAST 70553 IDENTIFY HEAD/NECK CA TO LEVEL OF THYROID THIGH FEMUR WITHOUT CONTRAST 73718 BRACHIAL PLEXUS WITH CONTRAST - EVALUATION TO 70542 THIGH FEMUR WITH CONTRAST 73719 IDENTIFY HEAD/NECK CA TO LEVEL OF THYROID THIGH FEMUR W- W/O CONTRAST 73720 BRACHIAL PLEXUS W- W/O CONTRAST - EVALUATION TO 70543 THORACIC SPINE WITHOUT CONTRAST 72146 IDENTIFY HEAD/NECK CA TO LEVEL OF THYROID THORACIC SPINE WITH CONTRAST 72147 BRAIN - WITHOUT CONTRAST 70551 THORACIC SPINE W- W/O CONTRAST 72157 BRAIN - WITH CONTRAST 70552 TMJ WITHOUT CONTRAST 70336 BRAIN - W- W/O CONTRAST 70553 UNLISTED PROCEDURE 76498 BREAST BILATERAL 77059 UPPER EXTREMITY (NON- JOINT) BREAST UNILATERAL 77058 FOREARM WITHOUT CONTRAST 73218 CARDIAC FOR MORPHOLOGY & FUNCTION 75557 FOREARM WITH CONTRAST 73219 - W/O CONTRAST FOREARM W- W/O CONTRAST 73220 CARDIAC FOR MORPHOLOGY AND FUNCTION 75559 HAND WITHOUT CONTRAST 73218 - WITHOUT CONTRAST, WITH STRESS IMAGING HAND WITH CONTRAST 73219 + VELOCITY FLOW MAPPING (USE WITH 75557, 75559) 75565 HAND W- W/O CONTRAST 73220 CARDIAC FOR MORPHOLOGY AND FUNCTION 75561 HUMERUS WITHOUT CONTRAST 73218 W - W/O CONTRAST HUMERUS WITH CONTRAST 73219 CARDIAC FOR MORPHOLOGY AND FUNCTION 75563 HUMERUS W- W/O CONTRAST 73220 - W- W/O CONTRAST, WITH STRESS IMAGING SCAPULA WITHOUT CONTRAST 73218 + VELOCITY FLOW MAPPING (USE WITH 75561, 75563) 75565 SCAPULA WITH CONTRAST 73219 CERVICAL SPINE WITHOUT CONTRAST 72141 SCAPULA W- W/O CONTRAST 73220 CERVICAL SPINE WITH CONTRAST 72142 UPPER EXTREMITY NON JOINT WITHOUT CONTRAST 73218 CERVICAL SPINE W- W/O CONTRAST 72156 UPPER EXTREMITY NON JOINT WITH CONTRAST 73219 CHEST - WITHOUT CONTRAST 71550 UPPER EXTREMITY NON JOINT W- W/O CONTRAST 73220 CHEST - WITH CONTRAST 71551 UPPER EXTREMITY (JOINT) CHEST - W- W/O CONTRAST 71552 ELBOW WITHOUT CONTRAST 73221 ENTEROGRAPHY WITHOUT CONTRAST 74181, 72195 & ELBOW WITH CONTRAST 73222 76376 or 76377 ELBOW W- W/O CONTRAST 73223 ENTEROGRAPHY WITH CONTRAST 74182, 72196 & FINGER WITHOUT CONTRAST 73221 76376 or 76377 FINGER WITH CONTRAST 73222 ENTEROGRAPHY W- W/O CONTRAST 74183, 72197 & FINGER W- W/O CONTRAST 73223 76376 or 76377 SHOULDER WITHOUT CONTRAST 73221 FETUS WITHOUT CONTRAST 72195 SHOULDER WITH CONTRAST 73222 FETUS WITH CONTRAST 72196 SHOULDER W- W/O CONTRAST 73223 FETUS W- W/O CONTRAST 72197 WRITS WITHOUT CONTRAST 73221 IACS WITHOUT CONTRAST 70551 WRIST WITH CONTRAST 73222 IACS WITH CONTRAST 70552 WRIST W- W/O CONTRAST 73223 IACS WITH- W/O CONTRAST 70553 WRIST W- W/O PFIZER PROTOCOL 73223 LUMBAR SPINE WITHOUT CONTRAST 72148 LUMBAR SPINE WITH CONTRAST 72149 LUMBAR SPINE W- W/O CONTRAST 72158 MRCP 74181 & 76376 or 76377

MRI CPT Code MRI CPT Code LOWER EXTREMITY (NON- JOINT) MRA FOOT WITHOUT CONTRAST 73718 ABDOMEN 74185 FOOT WITH CONTRAST 73719 CHEST 71555 FOOT W- W/O CONTRAST 73720 HEAD WITHOUT CONTRAST 70544 LOWER EXTREMITY WITHOUT CONTRAST 73718 HEAD WITH CONTRAST 70545 LOWER EXTREMITY WITH CONTRAST 73719 HEAD W- W/O CONTRAST 70546 LOWER EXTREMITY W- W/O CONTRAST 73720 LOWER EXTREMITY 73725 THIGH/FEMUR WITHOUT CONTRAST 73718 NECK WITHOUT CONTRAST 70547 THIGH/FEMUR WITH CONTRAST 73719 NECK WITH CONTRAST 70548 THIGH/FEMUR W- W/O CONTRAST 73720 NECK W- W/O CONTRAST 70549 TIB FIB WITHOUT CONTRAST 73718 PELVIS 72198 TIB FIB WITH CONTRAST 73719 RUN- OFF STUDY (ABDOMINAL AORTA & BILATERAL LWR EXTREMITIES) 74185, 73725 x 2 TIB FIB W- W/O CONTRAST 73720 SPINAL CANAL AND CONTENTS 72159 LOWER EXTREMITY (JOINT) UPPER EXTREMITY 73225 ANKLE POST ARTHROGRAM 73722 MRV ANKLE WITHOUT CONTRAST 73721 MRV HEAD WITHOUT CONTRAST 70544 ANKLE WITH CONTRAST 73722 MRV HEAD WITH CONTRAST 70545 ANKLE W- W/O CONTRAST 73723 MRV HEAD WITH W/O CONTRAST 70546 HIP WITHOUT CONTRAST 73721 OTHER HIP WITH CONTRAST 73722 SPECTROSCOPY (ANY AREA OF THE BODY) 76390 HIP W- W/O CONTRAST 73723 ULISTED MRI PROCEDURE 76498 KNEE WITHOUT CONTRAST 73721 MYELOGRAM KNEE WITH CONTRAST 73722 POSTERIOR FOSSA 70552, 70010, 77003 & KNEE W- W/O CONTRAST 73723 61055 or 62284 LOWER EXTREMITY JOINT WITHOUT CONTRAST 73721 CISTERNOGRAPHY 70552, 70015, 77003 & LOWER EXTREMITY JOINT WITH CONTRAST 73722 61055 or 62284 LOWER EXTREMITY JOINT W- W/O CONTRAST 73723 CERVICAL SPINE 62302, 72142 ARTHROGRAM - Conventional (RAD) W MRI ANKLE 73722, 27648, 73615 CERVICAL C- 1- C2 62302, 72142 ELBOW 73222, 24220, 73085 HIP 73722, 27093, 73525 THORACIC SPINE 62303, 72147 KNEE 73722, 27370, 73580 SHOULDER 73222, 23350, 73040 LUMBAR 62304, 72149 WRIST 73222, 25246, 73115 WRIST 3 JOINT 73222, 25246, 73115 2 OR MORE REGIONS (EG, LUMBAR/THORACIC, 62305 SACROILIAC (SI) JOINT 27096, 72196 THORACIC/CERVICAL, LUMBAR/CERVICAL) TMJ 70336, 21116, 70332 +and APPROPRIATE 2 MR CODES, BASED ON REGIONS ARTHROGRAM - Non- Conventional W MRI ANKLE 73722, 27648, 77002 ELBOW 73222, 24220, 77002 HIP 73722, 27093, 77002 KNEE 73722, 27370, 77002 SHOULDER 73222, 23350, 77002 WRIST 73222, 25246, 73115 WRIST 3 JOINT 73222, 25246, 77002 SACROILIAC (SI) JOINT 27096, 72196 TMJ 70336, 21116, 77002

Ultrasound CPT Code Ultrasound CPT Code ABDOMEN 76700 VASCULAR ABDOMEN LTD 76705 ABI SINGLE LEVEL - BILATERAL/UNILATERAL 93922 LOWER BACK 76705 ABI 2 LEVELS - BILATERAL/UNILATERAL 93922 AORTA ABDOMINAL (AORTA BACKWALL) 76775 ABI 3 LEVELS - UNILATERAL 93922 AAA SCREENING FOR NON- MEDICARE PATIENTS 76775 ABI COMPLETE - 3 LEVELS, BILATERAL 93923 AAA SCREENING FOR MEDICARE PATIENTS G0389 AORTA AND/OR IVC DUPLEX LIMITED 93979 BONE DENSITY MEASUREMENT/INTERPRETATION, 76977 AORTA IVC DUPLEX COMPLETE 93978 PERIPHERAL BREAST UNILATERAL INCL AXILLA IF PERFORMED 76641 ART BILAT LOWER EXTREMITY 93925 BREAST UNILATERAL, LIMITED 76642 ART BILAT UPPER EXTREMITY 93930 CHEST/MEDIASTINUM 76604 ART HEMODIALYSIS ACCESS ** AV FISTULA 93990 UPPER BACK 76604 ART REST STRESS LOWER EXTREMITY 93924 EXTREMITY NON VASCULAR COMPLETE 76881 ART UNILAT LOWER EXTREMITY 93926 EXTREMITY NON VASCULAR LTD 76882 ART UNILAT UPPER EXTREMITY 93931 AXILLA - INDICATIONS RELATING TO ARM/ARM PIT 76882 CAROTID DUPLEX - COMPLETE 93880 GROIN 76882 CAROTID DUPLEX - LIMITED 93882 GALLBLADDER 76705 DUPLEX SCAN OF ABDOMINAL, PELVIC, SCROTAL AND/OR 93975 INFANT HIPS 76885 RETROPERITONEAL ORGANS - COMPLETE INFANT HIPS LIMITED 76886 DUPLEX SCAN OF ABDOMINAL, PELVIC, SCROTAL AND/OR 93976 HYSTEROSONOGRAPHY (SONOHYSTERGRAPHY) 76831, 58340 RETROPERITONEAL ORGANS - LTD KIDNEY DOPPLER 93975 PENILE DOPPLER 93980 LIVER 76705 PENILE DOPPLER FOLLOW UP OR LIMITED 93981 NECK/HEAD SOFT TISSUE 76536 TRANSCRANIAL DOPPLER - COMPLETE 93886 NEONATAL BRAIN 76506 TRANSCRANIAL DOPPLER - LIMITED 93888 PELVIS LTD - NON OB 76857 VENOUS DOPPLER EXT BILATERAL 93970 BUTTOCK 76857 VENOUS DOPPLER EXT UNILATERAL 93971 PENIS 76857 THORACENTESIS/PARACENTESIS PERINEUM 76857 CHEST TUBE EXTENDED USE 32551 PELVIS COMPLETE - NON OB 76856 PARACENTESIS 49083 PROSTATE VOLUME STUDY 76873 THORACENTESIS 32555 RENAL COMPLETE 76770 THORACENTESIS WITH TUBE 32557 RENAL LTD 76775 GUIDED BIOPSY RENAL TRANSPLANT 76776 THIGH CORE 76942, 20206 RETROPERITONEAL COMPLETE 76770 THIGH FNA 76942, 10022 RETROPERITONEAL LTD 76775 THYROID FNA (x # OF NODULES) 76942, 10022 SPINAL CANAL 76800 THYROID CORE (x # OF NODULES) 76942, 60100 SPINAL CANAL INFANTS 76800 THYROID CYST ASPIRATION 76942, 60300 TRANSVAGINAL APPROACH - NON OB 76830 OTHER TESTICULAR/SCROTUM 76870 FOLLOW UP STUDY (SPECIFY) 76970 THYROID 76536 UNLISTED PROCEDURE 76999 TRANSRECTAL 76872 MEASUREMENT OF POST- VOIDING RESIDUAL URINE 51798 URINARY BLADDER 76775 AND/OR URINARY BLADDER (NON- IMAGING) OBSTETRICAL VESSEL MAPPING FOR HEMODIALYSIS ACCESS G0365 OB BIOPHYSICAL PROFILE WITH NON- STRESS TESTING 76818 - MEDICARE PATIENTS OB BIOPHYSICAL PROFILE W/OUT NON- STRESS TESTING 76819 MUSCLE INJ OB FOLLOW UP EXAM, PER FETUS 76816 SINGLE OR MULTIPLE - 1 OR 2 MUSCLE(S) 20552, 76942 OB GREATER THAN 14 WEEKS - SINGLE FETUS 76805 SINGLE OR MULTIPLE - 3 OR MORE MUSCLE(S) 20553, 76942 + EACH ADDITIONAL FETUS (USE IN ADDITION TO 76805) 76810 OB LESS THAN 14 WEEKS - SINGLE FETUS 76801 + EACH ADDITIONAL FETUS (USE IN ADDITION TO 76801) 76802 OB FETAL AND MATERNAL EVALUATION PLUS DETAILED 76811 FETAL ANATOMIC EXAM, TRANSABDOMINAL + EACH ADDITIONAL FETUS (USE IN ADDITION TO 76811) 76812 FETAL ECHOCARDIOGRAPHY 76825 FETAL ECHOCARDIOGRAPHY FOLLOWUP / REPEAT STUDY 76826 FETAL DOPPLER 76827 FETAL DOPPLER FOLLOW UP OR REPEAT STUDY 76828

X- ray CPT Code X- ray CPT Code ABDOMNEN - SINGLE VIEW 74000 LUMBAR SPINE FLEX EXT ONLY - 2 OR 3 VIEWS 72120 SITZMARKS STUDY 74000 PER DAY LUMBAR SPINE COMPLETE INCLUDING 72114 FLEXION/EXTENSION - MIN 6 VIEWS ABDOMEN - AP PLUS OBLIQUE AND CONE VIEWS 74010 MANDIBLE COMPLETE - MIN 4 VIEWS 70110 ABDOMEN - COMPLETE INCLUDING DECUBITUS AND/OR 74020 MANDIBLE LIMITED - LESS THAN 4 VIEWS 70100 ERECT VIEWS ABDOMEN - COMPLETE ACUTE SERIES, INCLUDING 74022 MASTOID COMPLETE - MIN 3 VIEWS PER SIDE 70130 SUPINE, ERECT, AND/OR DECUBITUS VIEWS + 1 VIEW CHEST AC JOINTS - WITH OR WITHOUT WEIGHTED DISTRACTION 73050 MASTOIDS LIMITED - LESS THAN 3 VIEWS PER SIDE 70120 ANKLE COMPLETE - MIN 3 VIEWS 73610 NASAL BONES COMPLETE MIN 3 VIEWS 70160 ANKLE LTD - 2 VIEWS 73600 NECK SOFT TISSUE 70360 BONE AGE 77072 OPTIC FORAMINA 70190 BONE LENGTH - SCANOGRAM 77073 ORBITS COMPLETE - MIN 4 VIEWS 70200 BONE SKELETON SURVEY COMPLETE 77075 ORTHOPANTOGRAM AKA "PANORAMIC X- RAY" 70355 BONE SKELETON SURVEY LTD 77074 PELVIS LTD - 1 OR 2 VIEWS 72170 BONE SURVEY INFANT 77076 PELVIS COMPLETE - MIN 3 VIEWS 72190 CERVICAL SPINE - 2 OR 3 VIEWS 72040 PHARYNX OR LARYNX INCLUDING FLOURO AND/OR MAGNIFICATION TECHNIQUE AKA "NASOPHARYNGOGRAM" 70370 CERVICAL SPINE - 4 OR 5 VIEWS 72050 RIBS BILATERAL - 3 VIEWS 71110 CERVICAL SPINE - 6 OR MORE VIEWS 72052 RIBS BILATERAL W/PA CHEST - 4 VIEWS 71111 CHEST COMPLETE - MIN 4 VIEWS 71030 RIBS UNILATERAL - 2 VIEWS 71100 CHEST COMPLETE W/FLUOROSCOPY 71034 RIBS UNILATERAL W/PA CHEST - MIN 3 VIEWS 71101 CHEST SPECIAL VIEWS ( EG, LATERAL, DECUBITUS, BUCKY STUDIES) 71035 SACRUM & COCCYX - MIN 2 VIEWS 72220 CHEST - SINGLE VIEW - PA 71010 SALIVARY GLAND FOR CALCULUS 70380 CHEST - 2 VIEWS - PA/LAT 71020 SCAPULA 73010 CHEST STEREO - FRONTAL 71015 SCOLIOSIS STUDY 72090 CHEST - 2 VIEWS WITH LORDOTIC PROCEDURE 71021 SELLA TURCICA AKA "TURKISH SADDLE" 70240 CHEST - 2 VIEWS WITH OBLIQUES 71022 SHOULDER LTD - 1 VIEW 73020 CHEST - 2 VIEWS WITH FLOUROSCOPY 71023 SHOULDER COMPLETE - MIN 2 VIEWS 73030 CLAVICLE 73000 SI JOINTS COMPLETE - MIN 3 VIEWS 72202 ELBOW LTD - 2 VIEWS 73070 SI JOINTS LTD - LESS THAN 3 VIEWS 72200 ELBOW COMPLETE - MIN 3 VIEWS 73080 SINUS/PARANASAL LTD - LESS THAN 3 VIEWS 70210 EYE - FOR DETECTION OF FOREIGN BODY 70030 SINUS/PARANASAL COMPLETE - MIN 3 VIEWS 70220 FACIAL BONES LTD - LESS THAN 3 VIEWS 70140 SKULL LTD - LESS THAN 4 VIEWS 70250 FACIAL BONES COMPLETE - MIN 3 VIEWS 70150 SKULL COMPLETE - MIN 4 VIEWS 70260 FEMUR 73550 SPINE - 1 VIEW (SPECIFY LEVEL) 72020 FINGER 73140 SPINE - ENTIRE SURVEY STUDY 72010 FOOT LTD - 2 VIEWS 73620 STERNOCLAVICULAR JOINT OR JOINTS - MIN 3 VIEWS 71130 FOOT COMPLETE - MIN 3 VIEWS 73630 STERNUM - MIN 2 VIEWS 71120 FOREARM 73090 TEETH - SINGLE VIEW 70300 HAND LTD - 2 VIEWS 73120 TEETH - PARTIAL EXAMINATION, LESS THAN FULL MOUTH 70310 HAND COMPLETE - MIN 3 VIEWS 73130 TEETH - COMPLETE - FULL MOUTH 70320 HEEL (CALCANEUS) 73650 THORACIC SPINE - 3 VIEWS 72072 HIP BILATERAL - MIN 2 VIEWS EACH WITH AP VIEW OF 73520 THORACIC SPINE - MIN 4 VIEWS 72074 PELVIS HIP UNILATERAL LTD - 1 VIEW 73500 THORACIC SPINE - 2VIEWS - AP/LAT 72070 HIP UNILATERAL COMPLETE - MIN 2 VIEWS 73510 THORACOLUMBAR SPINE - 2 VIEWS 72080 HUMERUS 73060 THORACOLUMBAR SPINE - STANDING (SCOLIOSIS) 72069 INFANT OR CHILD HIPS AND PELVIS 73540 TIBIA FIBULA 73590 INFANT - LOWER EXTREMITY 73592 TMJ - BILATERAL 70330 INFANT - UPPER EXTREMITY 73092 TMJ - UNILATERAL 70328 INTERNAL AUDITORY MEATI COMPLETE 70134 TOE(S) 73660 JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS 77077 WRIST LTD - 2 VIEWS 73100 KNEE - 1 OR 2 VIEWS 73560 WRIST COMPLETE - MIN 3 VIEWS 73110 KNEE - 3 VIEWS 73562 OTHER KNEE AP STANDING - BILATERAL 73565 UNLISTED DIAGNOSTIC RADIOGRAPHIC PROCEDURE 76499 KNEE COMPLETE - 4 OR MORE VIEWS 73564 DEXA KUB 74000 SCAN BODY FAT ASSESSMENT 76499 LUMBAR SPINE - 2 OR 3 VIEWS 72100 BONE DENSITY; AXIAL SKELETON (HIPS, SPINE, PELVIS) 77080 LUMBAR SPINE - 4 OR MORE VIEWS 72110 BONE DENSITY, AXIAL SKELETON, INCLUDING VERTEBRAL 77085 FRACTURE ASSESSMENT LUMBAR SPINE FLEX EXT ONLY - 2 OR 3 VIEWS 72120 BONE DENSITY; APPENDICULAR SKELETON (RADIUS, WRIST, 77081 HEEL) LUMBAR SPINE COMPLETE INCLUDING FLEXION/EXTENSION - MIN 6 VIEWS 72114 DEXA SCAN; VERTEBRAL FRACTURE ASSESSMENT ONLY 77086

Nuclear Medicine CPT Code Nuclear Medicine CPT Code ABSCESS LOCALIZATION LIMITED 78805, A9569, A9556 * TUMOR LOCALIZATION - MULTIPLE AREAS 78801, A9560, A9572, ABSCESS LOCALIZATION WHOLE BODY 78806, A9569, A9556 * TUMOR LOCALIZATION - WHOLE BODY, SINGLE DAY 78802, A9560, A9572, ABSCESS LOCALIZATION SPECT 78807, A9560, A9572, TUMOR LOCALIZATION - WHOLE BODY SPECT, SINGLE DAY 78803, A9560, A9572, ABSCESS LOCALIZATION SPECT WHOLE BODY 78806, 78807, A9560, A9572, A9569, A9500, A9556 * TUMOR LOCALIZATOIN - WHOLE BODY, 2 OR MORE DAYS 78804, A9560, A9572, ADRENAL IMAGING, CORTEX AND/OR MEDULLA 78075, A9508, A9582 or A9548 * TUMOR LOCALIZATION - WHOLE BODY SPECT, 2 OR MORE DAYS 78803, 78804, A9560, A9572, A9569, A9500, A9556 * BONE MARROW IMAGING LTD AREA 78102, A9541 GASTRIC EMPTYING SCAN xs 2 78264, A9541 BONE MARROW IMAGING MULTIPLE AREAS 78103, A9541 ACUTE GI BLOOD LOSS IMAGING 78278, A9560 or A9541 * BONE MARROW IMAGING WHOLE BODY 78104, A9541 HIDA SCAN 78226, A9537 BONE SCAN 3 PHASE 78315, A9561 or A9503 * HIDA SCAN WITH PHARMACOLOGIC INTERVENTION (CCK) 78227, A9537, J2805 (kinevac/cck) or J2275 (morphine) BONE OR JOINT IMAGING; LIMITED AREA 78300, A9561 or A9503 * I 131 BODY SCAN 78018, A9528 BONE OR JOINT IMAGING; MULTIPLE AREAS 78305, A9561 or A9503 * LIVER SCAN STATIC ONLY 78201, A9541 BONE SCAN SPECT STUDY 78320 LIVER SCAN WITH VASCULAR FLOW 78202, A9541 BONE OR JOINT IMAGING; WHOLE BODY 78306, A9561 or A9503 * LIVER IMAGING SPECT (3D) 78205, A9541 BONE OR JOINT IMAGING; WHOLE BODY WITH SPECT 78306, 78320, A9561 or A9503 * LIVER SPECT SCAN WITH VASCULAR FLOW 78206, A9541 BRAIN IMAGING LESS THAN 4 STATIC VIEWS 78600, A9569 LIVER & SPLEEN IMAGING STATIC ONLY 78215, A9541 BRAIN IMAGING LESS THAN 4 STATIC VIEWS WITH VASCULAR FLOW 78601, A9569 LIVER & SPLEEN IMAGING WITH VASCULAR FLOW 78216, A9541 BRAIN IMAGING MINIMUM 4 STATIC VIEWS 78605, A9569 LYMPHATICS AND LYMPH NODE IMAGING 78195, A9541 BRAIN IMAGING MINIMUM 4 STATIC VIEWS WITH VASCULAR FLOW 78606, A9569 MECKELS SCAN 78290, A9512 BRAIN SPECT SCAN 78607, A9569 MIBG SPECT SCAN I 123 78803, 78804, A9582 BRAIN IMAGING VASCULAR FLOW ONLY 78610, A9569 MIBG SPECT SCAN 1 131 78803, 78804, A9508 CARDIAC SHUNT IMAGING/DETECTION 78428, A9540 MUGA; PLANAR, SINGLE STUDY AT REST OR STRESS 78472, A9560, A9512, A9538 * CEA SPECT SCAN CEA WHOLE BODY SCAN MULTI DAY CEA WHOLE BODY SCAN SINGLE DAY 78803, A9560, A9572, + RIGHT VENTRICULAR EJECTION FRACTION (USE WITH 78472) 78496 78804, A9560, A9572, MUGA; MULTIPLE STUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS 78802, A9560, A9572, MUGA SPECT 78473, A9560, A9512, A9538 * 78494, A9560, A9512, A9538 CEA WHOLE BODY MULTI DAY SPECT 78803, 78804, A9560, A9572, A9569, A9500, A9556 * OCTREOSCAN SPECT 78803, A9572 CISTERNOGRAM 78630, 62311, 77003, A9548, 62310 OCTREOSCAN WHOLE BODY MULTI DAY 78804, A9572 CSF LEAKAGE DETECTION AND LOCALIZATION 78650 OCTRESCAN WHOLE BODY MULTI DAY W/SPECT 78803, 78804, A9572 GALLIUM SCAN LTD AREA - TUMOR LOCALIZATION 78800, A9560, A9572, OCTREOSCAN WHOLE BODY SINGLE DAY 78802, A9572 GALLIUM SCAN WHOLE BODY MULTI DAY - TUMOR LOCALIZATION GALLIUM SCAN WHOLE BODY SINGLE DAY - TUMOR LOCALIZATION 78804, A9560, A9572, 78802, 78803, A9560, A9572, A9569, A9500, A9556 * PARATHYROID IMAGING WITHOUT SPECT PARATHYROID IMAGING WITH SPECT PARATHYROID IMAGING WITH SPECT AND CT FOR ANATOMICAL LOCALIZATION 78070, A9500 78071, A9500 78072, A9500

Nuclear Medicine CPT Code Nuclear Medicine CPT Code PET CT LIMITED AREA 78814, A9552 SALIVARY GLAND IMAGING 78230, A9512 PET CT SKULL BASE TO MID THIGH 78815, A9552 SERIAL SALIVARY IMAGING 78231, A9512 PET CT WHOLE BODY 78816, A9552 SESTAMIBI SCAN 78803, A9500 PET MYOCARDIAL IMAGING METABOLIC EVALUATION 78459 TESTICULAR IMAGING WITH VASCULAR FLOW 78761, A9512 PET MYOCARDIAL PERFUSION; SINGLE STUDY AT REST OR STRESS 78491 THYROID UPTAKE SINGLE OR MULTIPLE 78012, A9516 PET MYOCARDIAL PERFUSION; MULTIPLE STUDIES AT REST OR STRESS 78492 THYROID IMAGING INCLUDING VASCULAR FLOW, IF PERFORMED 78013, A9516 PET BRAIN METABOLIC EVALUATION 78608, A9552 THYROID IMAGING WITH SINGLE OR MULTIPLE UPTAKES 78014, A9516 PROSTASCINT MULTI DAY SPECT NEEDS ABD/PEL W/WO TOO 78803, 78804, A9507 THYROID CARCINOMA METASTASES LTD 78015, A9528 PROSTASCINT WHOLE BODY SINGLE 78802, A9507 THYROID CARCINOMA METASTASES WITH ADDITIONAL STUDIES 78016, A9528 PROSTASCINT WHOLE BODY MULTI W OUT SPECT 78804, A9507 THYROID CARCINOMA METASTASES WHOLE BODY SCAN 78018, A9528 PULMONARY PERFUSION PARTICULATE ONLY 78580, A9540 + THYROID CARCINOMA METASTASES UPTAKE (USE WITH 78018) 78020 PULMONARY VENTILATION AND PERFUSION SCAN (AKA VQ SCAN) 78582, A9540, A9567 URETAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING CYSTOGRAM) 78740 PULMONARY PERUSION AND VENTILATION WITH QUANTITATIVE DIFFERENTIAL 78598, A9540, A9567 + URINARY BLADDER RESIDUAL STUDY (USE WITH 78740) 78730 QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION, INCLUDING IMAGING WHEN PERFORMED 78597 OTHER RA I 131 THYROID ABLATION THERAPY (#1) 79005, A9517 UNLISTED ENDOCRINE PROCEDURE 78099 RENAL FUNCTION STUDY 78725, A9539 UNLISTED HEMATOPOIETIC, RETICULOENDOTHELIAL AND LYMPHATIC PROCEDURE 78199 RENAL SCAN W/CAPTOPRIL MULTIPLE STUDIES 78709, A9562, J1940 UNLISTED GASTROINTESTINAL PROCEDURE 78299 RENAL SCAN W/CAPTOPRIL SINGLE STUDY 78708, A9562, J1940 UNLISTED MUSCOSKELETAL PROCEDURE 78399 RENAL SCAN W/LASIX MULTIPLE STUDIES 78709, A9562, J1940 UNLISTED CARDIOVASCULAR PROCEDURE 78499 RENAL SCAN W/LASIX SINGLE STUDY 78708, A9562, J1940 UNLISTED RESPIRATORY PROCEDURE 78599 RENAL SCAN MORPHOLOGY 78700 UNLISTED NERVOUS SYSTEM PROCEDURE 78699 RENAL SCAN WITH VASCULAR FLOW 78701, A9562, A9551, A9539 * UNLISTED GENITOURINARY PROCEDURE 78799 RENAL SCAN WITH VASCULAR FLOW AND FUNCTION, SINGLE STUDY W/OUT PHARM INTERVENTION 78707 UNLISTED MISCELLANEOUS PROCEDURE 78999 RENAL SPECT SCAN 78710 UNLISTED RADIOPHARMACEUTICAL THERAPY PROCEDURE 79999 SALIVARY GLAND FUNTION STUDY 78232, A9512 INJECTION PROCEDURE FOR RADIOPHARMACEUTICAL LOCALIZATION BY NON- IMAGING PROBE STUDY, INTRAVENOUS 78808

Biopsy, Drainge & Aspiration CPT Code Biopsy, Drainage & Aspiration CPT Code Muscle/Soft Tissue 20206 with either 76942 Bone Superficial (eg, sternum, ilium, rib) Bone Deep (eg, femur, vertebral body) 20220 with either 76942 Paracentesis 49083 20225 with either 76942 Thoracentesis 32555 Pleura 32400 with either 76942 Aspiration of Hematoma, Bulla, ABSCES or Cyst 10160 with either 76942 Lung or Mediastinum 32405 with either 76942 Aspiration; renal cyst or pelvis 50390 with either 76942 Bone Marrow 38221 with either 76942 Aspiration; thyroid cyst 60300 with either 76942 BONE MARROW - ASPIRATION ONLY 38220 with either 76942 Incision and Drainage of Hematoma, Seroma or Fluid Collection 10140 with either 76942 BONE MARROW BIOPSY AND ASPRITATION - MEDICARE PATIENTS Lymph Nodes; superficial 38221, G0364 with either 76942 (US), 77012 (CT), 77002 (FL) or 77021 (MR) FLUID COLLECTION DRAINAGE, WITH IMAGING GUIDANCE, SOFT TISSUE (EG, ABSCESS, SEROMA, LYMPHOCELE, CYST) 38505 with either 76942 FLUID COLLECTION DRAINAGE, WITH IMAGING GUIDANCE, VISCERAL (EG, LIVER, KIDNEY, SPLEEN, LUNG) 10030 49405 Liver 47000 with either 76942 FLUID COLLECTION DRAINAGE, WITH IMAGING GUIDANCE, PERITONEAL OR RETROERITONEAL THROUH ABDOMINAL WALL OR FLANK 49406 Pancreas 48102 with either 76942 FLUID COLLECTION DRAINAGE, WITH IMAGING GUIDANCE, PERITONEAL OR RETROERITONEAL, T- VAG OR T- RECTAL APPROACH 49407 Abdominal or Retroperitoneal Mass Kidney Prostate Thyroid; Core Thyroid; FNA (fine needle aspiration) FNA on any area of the body; can be done alone or in addition to a core biopsy 49180 with either 76942 INTERVERTEBRAL DISC ASPIRATION 62267, 77003 50200 with either 76942 CHEST TUBE PLACEMENT AND DRAINAGE 32557 55700 with either 76942 TUNNELED PLEUARAL CATHETER PLACEMENT 32550, 75989 60100 with either 76942 TUNNELED PLEURAL CATHETER REMOVAL 32552 10022 (per lesion) 76942 10022 w/either 76942 Insertion of Tunneled Intraperitoneal Catheter 49418 Insertion of Tunneled Intraperitoneal Catheter with Subcutaneous Port 49419

Biopsy, Drainge & Aspiration CPT Code Biopsy, Drainage & Aspiration CPT Code Removal of Tunneled Intraperitoneal Catheter 49422 REPAIR OF PERIPHERALLY INSERTED CVC W/OUT PORT OR PUMP 36575, 76937, 77001 Contrast Injection for Assessment of Abscess or Cyst Via 49424, 76080 Previously Placed Drainage Cath/Tube REPAIR OF PERIPHERALLY INSERTED CVC WITH PORT 36576, 76937, 77001 Exchange of Previously Placed Abscess or Drainage 49423, 75984 REPLACEMENT (COMPLETE) OF PERIPHERALLY INSERTED Catheter CVC W/OUT PORT OR PUMP 36584, 76937, 77001 Injection of Sinus Tract DIAGNOSTIC (Sinogram, 20501, 76080 REPLACEMENT OF PERIPHERALLY INSERTED CVC WITH PORT Fistulogram) (CATH ONLY) 36578, 76937, 77001 INJECTION OF SINUS TRACT, THERAPEUTIC (NON- 20500, 76080 REPLACEMENT (COMPLETE) OF PERIPHERALLY INSERTED VASCULAR SCLEROTHERAPY) CVC WITH PORT 36585, 76937, 77001 PICCS & PORTS REPAIR OF TUNNELED CVC W/OUT PORT OR PUMP 36575, 76937, 77001 NON- TUNNELED CENTRALLY INSERTED < 5 YEARS OLD 36555, 76937, 77001 REPAIR OF TUNNELED CVC WITH PORT 36576, 76937, 77001 NON- TUNNELED CENTRALLY INSERTED 5 YEARS OLD 36556, 76937, 77001 REPLACEMENT OF TUNNELED CVC W/OUT PORT OR PUMP THROUGH SAME VENOUS ACCESS 36581, 76937, 77001 REPAIR OF NON- TUNNELED CVC 36575, 76937, 77001 REPLACEMENT OF TUNNELED CVC WITH PORT THROUGH SAME VENOUS ACCESS 36582, 76937, 77001 REPLACEMENT OF NON- TUNNELED CVC THROUGH SAME VENOUS ACCESS 36580, 76937, 77001 REMOVAL OF TUNNELED CVC W/OUT PORT OR PUMP 36589, 76937, 77001 TUNNELED CENTRALLY INSERTED W/OUT PORT OR PUMP < 5 YEARS OLD 36557, 76937, 77001 REMOVAL OF TUNNELED CVC WITH PORT 36590, 76937, 77001 TUNNELED CENTRALLY INSERTED W/OUT PORT OR PUMP 5 YEARS OLD 36558, 76937, 77001 REMOVAL OF TUNNELED CVC WITH PUMP 36590, 76937, 77001 ^^^ REQUIRING 2 CATHETERS VIA 2 SEPARTE ACCESS SITES 36565, 76937, 77001 REMOVAL OF PERIPHERALLY INSERTED CVC 36590, 76937, 77001 TUNNELED CENTRALLY INSERTED WITH PORT < 5 YEARS OLD 36560, 76937, 77001 DECLOTTING BY THROMBOLYTIC AGENT OF CVC 36593 TUNNELED CENTRALLY INSTERTED WITH PORT 5 YEARS OLD 36561, 76937, 77001 ^^^ REQUIRING 2 CATHETERS VIA 2 SEPARTE ACCESS SITES 36566, 76937, 77001 MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL 36595, 75901 MECHANICAL REMOVAL OF INTRACATHETER OBSTRUCTIVE MATERIAL 36596, 75902 TUNNELED CENTRALLY INSERTED WITH PUMP 5 YEARLS OLD 36563, 76937, 77001 REPOSITIONING OF CVC 36597, 76000 REPLACEMENT OF TUNNELED CVC WITH PUMP (CATH ONLY) 36578, 76937, 77001 CVC CONTRAST INJECTION 36598, 75825 or 75827 REPLACEMENT OF TUNNELED CVC WITH PUMP (COMPLETE) THROUGH SAME VENOUS ACCESS 36583, 76937, 77001 IVC FILTER PERIPHERALLY INSERTED W/OUT PORT OR PUMP (PICC) < 5 YEARS OLD 36568, 76937, 77001 IVC FILTER INSERTION 37191 PERIPHERALLY INSERTED W/OUT PORT OR PUMP (PICC) 5 YEARS OLD 36569, 76937, 77001 IVC FILTER REPOSITIONING 37192 PERIPHERALLY INSERTED WITH PORT < 5 YEARS OLD 36570, 76937, 77001 IVC FILTER REMOVAL 37193 PERIPHERALLY INSERTED WITH PORT 5 YEARS OLD 36571, 76937, 77001

ICD- 9 Abdomen & Pelvic Head & Neck Abdomen Pain RUQ 789.01 Aphasia 784.3 Abdomen Pain LUQ 789.02 Convulsions 780.39 Abdomen Pain RLQ 789.03 CVA NOS 434.91 Abdomen Pain LLQ 789.04 Dizziness Giddiness 780.4 Ascites, Other 789.59 Headaches 784.0 Ascites, Malignant 789.51 Lack of Coordination 781.3 Constipation 564.00 Mass/Lump Neck/Head 784.2 Diarrhea 787.91 Migraine 346.90 Flatulence Gas Pain 787.3 MS 340 Hematuria 599.70 Parkinson s Disease 332.0 Hepatitis NOS 573.3 Speech Disturbance 784.59 Hepatomegaly 789.10 Stenosis of Carotid 433.10 Malaise/Fatigue 780.79 Subdural Hemorrhage 432.1 Malignant Neo Abd Intra 195.2 Syncope 780.2 Malignant Neo Biliary Tract 156.9 TIA 435.9 Malignant Neo Colon 153.9 Malignant Neo Liver Not Spec as Primay or Secondary 155.2 Orbit, Face & Neck Nausea w/vomit 787.01 Chronic Sinusitis 473.9 Nausea w/o vomiting 787.02 Diplopia 368.2 Splenomegaly 789.2 Goiter NOS 240.9 UTI 599.0 Hearing Loss 389.9 Ventral Hernia 553.20 Orbital Disorder 376.9 Weight Loss, Abnormal 783.21 Thyroid Dysfunction 246.9 Thyroid Nodule 241.9 Breast Tinnitus 388.3 Breast Cancer 174.9 Visual Disturbance 368.9 Fibrocystic Disease 610.1 Visual Loss, Both Eyes 369 Lump or Mass 611.72 Nipple Discharge 611.79 Spine Pain Breast 611.71 Cervical Radiculopathy 723.4 Screening Mammography V76.12 Cervical Pain 723.1 Screening Mammography, high- risk V76.11 Cervical Spondylosis 721.0 Cervical Disc Displacement 722.0 Female Disorders Cervical Stenosis 723.0 Amenorrhea 626.0 Degen of Cervical 722.4 Bleeding Unrelated to Menstrual Cycle 626.6 Degen of Thoracic 722.51 Dysfunctional Uterine Bleed 626.8 Degen of Lumbar 722.52 Irregular Menstrual Cycle 626.4 Lumbar Pain 724.2 Menorrhagia 626.2 Lumbar Spondylosis 721.3 Menstrual Disorder Unspecified 626.9 Lumbar Disc Displacement 722.10 Oligomenorrhea 626.1 Lumbar Stenosis 724.02 OB Size & Date V22.1 Thoracic & Lumbar Radiculopathy 724.4 Pelvic Pain 625.9 Thoracic Pain 724.1 Extremities & Joints Thoracic Spondylosis 721.2 Bursitis, Elbow 726.33 Thoracic Disc Displacement 722.11 Ganglion Cyst of Joint 727.41 Thoracic Stenosis 724.01 Joint Disorder NOS 719.90 Sciatica 724.3 Joint Effusion, Ankle 719.07 Joint Effusion, site unspecified 719.00 Additional Diagnosis Joint Effusion, Hand 719.04 Cellulitis, Arms 682.3 Joint Effusion, Shoulder 719.01 Chest Pain 786.50 Joint Stiffness NEC 719.5 Cough 786.2 Medial Meniscus Tear 836.0 Numbness 782.0 Pain Forearm, Wrist 719.43 Osteoporosis 733.00 Pain Hand 719.44 Osteopenia 733.90 Pain Multi Joint 719.49 Pain in Limb 729.5 Pain Shoulder 719.41 Superficial Swelling 782.2 Pain Upper Arm 719.42 Swelling of Limb 729.81 Pain Ankle, Foot 719.47 Pain Knee 719.46 Pain Hip, Pelvic 719.45 Rotator Cuff Syndrome 726.10 Shoulder Stiffness 719.51 Sprain, Strain Rotator Cuff 840.4