Programs:, Cardiology, Radiation Therapy, and Sleep Management MRI 70336 MRI TMJ Tempomandibular joint/jaw CT SCANS 70450 CT Head/Brain w/o Contrast CT SCANS 70470 CT Head/Brain w/o & w/ Contrast CT SCANS 70480 CT Orbit w/o Contrast Temporal Bone/Mastoid/Ears CT SCANS 70481 CT Orbit w/ Contrast Temporal Bone/Mastoid/Ears CT SCANS 70482 CT Orbit w/o & w/ Contrast Temporal Bone/Mastoid/Ears CT SCANS 70486 CT Maxllfcl w/o Contrast Sinus/Denta Scan/TMJ CT SCANS 70487 CT Maxllfcl w/ Contrast Sinus/Denta Scan/TMJ CT SCANS 70488 CT Maxllfcl w/o & w/ Contrast Sinus/Denta Scan/TMJ CT SCANS 70490 CT Soft Tissue Neck w/o Contrast Parotid; Not used for Cervical Bone CT SCANS 70491 CT Soft Tissue Neck w/ Contrast Parotid; Not used for Cervical Bone CT SCANS 70492 CT Soft Tissue Neck w/o & w/ Contrast Parotid; Not used for Cervical Bone CT SCANS 70496 Ct Angiography Head CT SCANS 70498 Ct Angiography Neck MRI MRI Face, Orbit, Neck w/o Contrast Sinus/3 areas (soft tissue neck) 70540 eyes/temporal MRI 70542 MRI Face, Orbit, Neck w/ Contrast Gadolinium MRI 70543 MRI Face, Orbit, Neck w & w/o Contrast Gadolinium MRA 70544 MRA Head w/o Contrast Also known as MRV MRA 70545 MRA Head w/ Contrast Gadolinium/ Also known as MRV MRA 70546 MRA Head w & w/o Contrast Gadolinium/ Also known as MRV MRA 70547 MRA Neck w/o Contrast Also known as MRV MRA 70548 MRA Neck w/ Contrast Gadolinium/ Also known as MRV MRA 70549 MRA Neck w & w/o Contrast Gadolinium/ Also known as MRV MRI 70551 MRI Head w/o Contrast IACs (Internal Auditory Canal) MRI 70552 MRI Head w/ Contrast IACs (Internal Auditory Canal) MRI 70553 MRI Head w/ & w/o Contrast IACs (Internal Auditory Canal) Page 1 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management MRI MRI 70554 70555 MRI, Brain, Functional MRI; Including Test Selection and Administration of Repetitive Body Part Movement and/or Visual Stimulation, Not Requiring Physician or Psychologist Administration MRI, Brain, Functional MRI; Requiring Physician or Psychologist Administration of Entire Neurofunctional Testing CT SCANS 71250 CT Thorax w/o Contrast Can be CT Chest or a Ultrafast CT/EBT/EBCT CT SCANS 71260 CT Thorax w/ Contrast Chest/Ultrafast CT/EBT/EBCT CT SCANS 71270 CT Thorax w/o & w/ Contrast Chest/Ultrafast CT/EBT/EBCT CT SCANS 71275 Ct Angiography Chest MRI 71550 MRI Chest w/o Contrast Brachial Plexus MRI 71551 MRI Chest w/ Contrast MRI 71552 MRI Chest w/ & w/o Contrast Gadolinium MRA MRA Chest (Emc Myocardium) w/ or w/o Gadolinium/ Also known as MRV 71555 Contrast CT SCANS 72126 CT C Spine w/ Contrast CT SCANS 72127 CT C Spine w/o & w/ Contrast CT SCANS 72128 CT T Spine w/o Contrast CT SCANS 72129 CT T Spine w/ Contrast CT SCANS 72130 CT T Spine w/o & w/ Contrast CT SCANS 72132 CT L Spine w/ Contrast Includes Sacrum CT SCANS 72133 CT L Spine w/o & w/ Contrast Includes Sacrum MRI 72141 MRI Cervical Spine w/o Contrast Vertebrae of the Neck MRI 72142 MRI Cervical Spine w/ Contrast Gadolinium MRI 72146 MRI Thoracic Spine w/o Contrast MRI 72147 MRI Thoracic Spine w/ Contrast Gadolinium MRI 72148 MRI Lumbar Spine w/o Contrast Includes Sacrum Page 2 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management MRI 72149 MRI Lumbar Spine w/ Contrast Gadolinium Includes Sacrum MRI 72156 MRI C Spine w/ & w/o Contrast Gadolinium MRI 72157 MRI T Spine w/ & w/o Contrast Gadolinium MRI 72158 MRI L Spine w/ & w/o Contrast Gadolinium Includes Sacrum MRA 72159 MRA Spinal Canal w/ or w/o Contrast Gadolinium/ Also known as MRV CT SCANS 72191 CT Angiography Pelvis Aortic Aneurysm CT SCANS 72192 CT Pelvis w/o Contrast Below Belly Button/Coccyx CT SCANS 72193 CT Pelvis w/ Contrast Below Belly Button/Coccyx CT SCANS 72194 CT Pelvis w/o & w/ Contrast Below Belly Button/Coccyx MRI 72195 MRI Pelvis w/o Contrast Coccyx MRI 72196 MRI Pelvis w/ Contrast Gadolinium/coccyx MRI 72197 MRI Pelvis w & w/o Contrast Gadolinium/coccyx MRA 72198 MRA Pelvis w/ or w/o Contrast Gadolinium/ Also known as MRV CT SCANS 73200 CT Upper Extremity w/o Contrast Hand/Arm/Shoulder/ Elbow/Wrist CT SCANS 73201 CT Upper Extremity w/ Contrast Hand/Arm/Shoulder/ Elbow/Wrist CT SCANS 73202 CT Upper Extremity w/o & w/ Contrast Hand/Arm/Shoulder/ Elbow/Wrist CT SCANS 73206 CT Angiography Upper Extremity Hand/Arm/Shoulder/ Elbow/Wrist MRI 73218 MRI Upper Extremity w/o Contrast Hand/Arm/Axilla MRI 73219 MRI Upper Extremity w/ Contrast Hand/Arm/Axilla Gadolinium MRI 73220 MRI Upper Extremity w & w/o Contrast Hand/Arm/Axilla Gadolinium MRI 73221 MRI Upper Extremity w/o Contrast Shoulder/Elbow/Wrist MRI 73222 MRI Upper Extremity w/ Contrast Arthrogram Shoulder/Elbow/Wrist Gadolinium MRI 73223 MRI Upper Extremity Joint w & w/o Contrast Shoulder/Elbow/Wrist Gadolinium MRA 73225 MRA Upper Extremity w/ or w/o Contrast Gadolinium/ Also known as MRV CT SCANS 73700 CT Lower Extremity w/o Contrast Hip/Leg/Knee/Ankle/ Foot CT SCANS 73701 CT Lower Extremity w/ Contrast Hip/Leg/Knee/Ankle/ Foot Page 3 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management CT SCANS 73702 CT Lower Extremity w/o & w/ Contrast Hip/Leg/Knee/Ankle/ Foot CT SCANS 73706 CT Angiography Lower Extremity Hip/Leg/Knee/Ankle/ Foot MRI 73718 MRI Lower Extremity w/o Contrast Foot/Leg MRI 73719 MRI Lower Extremity w/ Contrast Foot/Leg Gadolinium MRI 73720 MRI Lower Extremity w/ & w/o Contrast Foot/Leg Gadolinium MRI 73721 MRI Lower Extremity w/o Contrast Hip/Knee/Ankle MRI 73722 MRI Lower Extremity w/ Contrast Arthrogram Hip/Knee/Ankle Gadolinium MRI 73723 MRI Lower Extremity Joint w/ & w/o Contrast Hip/Knee/Ankle Gadolinium MRA 73725 MRA Lower Extremity w/ or w/o Contrast Gadolinium/ Also known as MRV CT SCANS 74150 CT Abdomen w/o Contrast Diaphragm to Belly Button CT SCANS 74160 CT Abdomen w/ Contrast Aneurysm/Diaphragm to Belly Button CT SCANS 74170 CT Abdomen w/o & w/ Contrast Diaphragm to Belly Button CT SCANS 74174 Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing CT SCANS 74175 Ct Angiography Abdomen Diaphragm to Belly Button MRI 74181 MRI Abdomen w/o Contrast MRCP MR Cholangiogram MRI 74182 MRI Abdomen w/ Contrast MRCP MR Cholangiogram Gadolinium MRI 74183 MRI Abdomen w/ & w/o Contrast MRCP MR Cholangiogram Gadolinium MRA 74185 MRA Abdomen w/ or w/o Contrast Also known as MRV MRI MRI 75557 75559 Cardiac MRI For Morphology And Function Without Contrast Material Cardiac MRI For Morphology And Function Without Contrast Material; With Stress Imaging MRI 75561 Cardiac MRI For Morphology And Function Without Contrast Material(s), Followed By Contrast Material(s) And Further Sequences Page 4 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management MRI 75563 Cardiac MRI For Morphology And Function Without Contrast Material(s), Followed By Contrast Material(s) And Further Sequences; With Stress Imaging CT SCANS 76380 CT Limited or Localized Follow Up Study MRI 76390 MRI Spectroscopy MRS CT SCANS 76497 Unlisted Computed Tomography Procedure MRI 76498 Unlisted MRI Procedure Redirect to valid code MRI 76499 Unlisted Radiologic Procedure ULTRASOUND U/S OB Pelvis, Pregnant Uterus, First Trimester <14 Weeks Single Or First Gestation 76801 ULTRASOUND 76802 U/S OB Pelvis, Pregnant Uterus, First Trimester <14 Weeks Each Additional Gestation Multiple Gestation only ULTRASOUND ULTRASOUND 76805 76810 U/S OB Pelvis, Pregnant Uterus, B Scan (Allowed Once Per Gestation) U/S OB Pelvis Complete, Multiple Gestation after 1st Trimester (Allowed Once For Each Additional Fetus per Gestation; Must Be Billed With 76805) Level 1 Multiple Gestation only ULTRASOUND 76811 Cardiology CARDIAC IMPLANTABLES 33206 Cardiology CARDIAC IMPLANTABLES 33207 Cardiology CARDIAC IMPLANTABLES 33208 US Pregnant Uterus Fetal & Maternal Eval Plus Fetal Anatomic Eval Transabdominal Single or First Gestation (Allowed Once Per Gestation; Second Study Allowed If Performed By A Different Physician) Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrode(s); Atrial Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrode(s); Ventricular Insertion Of New Or Replacement Of Permanent Pacemaker With Transvenous Electrode(s); Atrial And Ventricular Level 2 Page 5 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology CARDIAC IMPLANTABLES 33212 ULTRASOUND 76812 Insertion or Replacement of Permanent Pacemaker Pulse Generator Only; Single Chamber, Atrial or Ventricular US Pregnant Uterus Fetal & Maternal Eval Plus Fetal Anatomic Eval Transabdominal Each Additional Gestation (Allowed Once For Each Additional Fetus Per Gestation; Must Be Billed With 76811; Second Study Allowed If Performed By A Different Physician) ULTRASOUND Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; single or first gestation. (Allowed once per gestation) 76813 Multiple Gestation only ULTRASOUND 76814 Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to code for primary procedure) (Allowed once for each additional fetus per gestation) ULTRASOUND 76815 U/S Pregnant Uterus, Real Time w/ Image Documentation, Limited (E.G. Fetal Heart Beat, Placental Location, Fetal Position and/or Qualitative Amniotic Fluid Volume), 1 or More Fetuses One CPT code per DOS regardless the # of fetuses ULTRASOUND 76816 U/S OB Pelvis Follow Up or Repeat One exam per fetus ULTRASOUND US Pregnant Uterus Transvaginal One CPT code per DOS regardless the # of 76817 fetuses ULTRASOUND 76818 Fetal Biophysical Profile One exam per fetus Page 6 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management ULTRASOUND 76819 Fetal Biophysical Profile w/o Stress Non Stress One exam per fetus ULTRASOUND 76820 Doppler Velocimetry, Fetal; Umbilical Artery One exam per fetus ULTRASOUND Doppler Velocimetry, Fetal; Middle Cerebral One exam per fetus 76821 Artery ULTRASOUND U/S OB Echocardiography, Fetal, Cardiovascular Fetal Echo 76825 System One exam per fetus ULTRASOUND 76826 Follow Up or Repeat Study One exam per fetus ULTRASOUND 76827 Doppler Echocardiography Fetal Complete One exam per fetus ULTRASOUND 76828 Follow Up or Repeat Study One exam per fetus Rdil ULTRASOUND 76975 U/S Gastrointestinal, i CT SCANS 77011 CT Guidance Sterotactic Localization CT SCANS 77012 CT Guidance Needle BX RAD S & I CT Guidance for and Monitoring of Tissue CT SCANS 77013 Ablation CT SCANS CT Guidance for Placement of Radiation Therapy 77014 Fields MRI 77021 MRI Guidance for Needle Placement MRI MRI Guidance for and Monitoring of Tissue 77022 Ablation MRI 77058 MRI Breast w/ and/or w/o Contrast; Unilateral Unilateral One Gadolinium MRI 77059 MRI Breast Bilateral Both CT SCANS 77078 CT Bone Density Study, Axial Skeleton CT SCANS 77079 CT Bone Density Study, Appendicular Skeleton MRI 77084 MRI Bone Marrow Blood Supply 78000 Thyroid uptake; single determination Redirect to valid code 78001 Thyroid uptake; multiple determinations Redirect to valid code 78003 Thyroid uptake stimulation, suppression or discharge (not including initial uptake studies) Redirect to valid code Page 7 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Thyroid imaging, with uptake; single 78006 Redirect to valid code determination 78007 Thyroid imaging, multiple determinations Redirect to valid code 78010 Thyroid imaging; only Redirect to valid code 78011 Thyroid imaging; with vascular flow Redirect to valid code 78012 Thyroid Uptake, Single or Multiple Quantitative Measurements(s) (Including Stimulation, Suppression, or Discharge, When Performed) Thyroid Imaging (Including Vascular Flow, When 78013 Performed) 78014 Thyroid Imaging (Including Vascular Flow, When Performed); With Single or Multiple Uptake(s) Quantitative Measurement(s) (Including Stimulation, Suppression, or Discharge, When Performed) 78015 Thyroid Met Imaging 78016 Thyroid Met Imaging with Additional Studies 78018 Thyroid Scan Whole Body For CA thyroid (I 31 scan) 78020 Thyroid Carcinoma Metastases Uptake 78070 Parathyroid Planar Imaging (Including Subtraction, When Performed) 78075 Adrenal Nuclear Imaging MIBG 78099 Unlisted Endocrine Procedure 78102 Bone Marrow Imaging, Limited 78103 Bone Marrow Imaging, Multiple 78104 Bone Marrow Imaging, Whole Body 78135 Differential Organ/Tissues Kinetic 78140 Labeled Red Cell Sequestration Page 8 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management 78185 Spleen Imaging w & w/o Vascular Flow 78190 Platelet Survival, Kinetics 78191 Platelet Survival 78195 Lymph System Imaging MIBG 78199 Unlisted Hematopoetic Procedure 78201 Liver Imaging 78202 Liver Imaging w/ Flow 78205 Liver Imaging Spect 78206 Liver Imaging Spect w/ Vascular Flow 78215 Liver and Spleen Imaging Red Cell Tagging 78216 Liver and Spleen Imaging w/ Flow 78226 78227 Hepatobiliary system imaging, including gallbladder when present; Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including quantitative measurement(s) when performed 78230 Salivary Gland Imaging 78231 Serial Salivary Gland 78232 Salivary Gland Function Test 78258 Esophagus Motility Study 78261 Gastric Mucosa Imaging 78262 Gastroesophagael Reflum Emam 78264 Gastric Emptying Study 78278 GI Bleeder Scan 78282 GI Protein Loss Exam 78290 Meckel's Diverticulum Imaging 78291 Leveen Shunt Patency Exam Page 9 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management 78299 Unlisted Gastroinestinal Procedure 78300 Bone or Joint Imaging Ltd One Bone 78305 Bone or Joint Imaging Multiple More than one Bone 78306 Bone Scan Whole Body Used Often with CA studies/all bones Bone and/or Joint Imaging; 3 Phase Study Osteomyelitis 78315 Technesium 99 78320 Bone Joint Imaging Tomo Test Spect 78399 Unlisted Musculoskeletal Procedure 78414 Non Imaging Heart Function 78428 Cardiac Shunt Imaging 78445 Radionuclide Venogram Non Cardiac 78456 Acute Venous Thrombosis Imaging 78457 Venous Thrombosis Imaging Unilateral 78458 Venous Thrombosis Imaging Bilateral PET SCANS Myocardial Imaging, Positron Emission 78459 Tomography (PET) Metabolic Eval. 78466 Myocardial Infarction Scan 78468 Heart Infarct Image Ef 78469 Heart Infarct Image Spect 78472 Gated Heart, Rest or Stress 78473 Cardiac Blood Pool Muga Scan 78481 Heart First Pass Single 78483 Cardiac Blood Pool Imaging, Multi PET SCANS PET SCANS 78491 78492 Myocardial Imaging, Positron Emission Tomography (PET), Perfusion; Single Study At Rest Or Stress Myocardial Imaging, Positron Emission Tomography (PET), Perfusion; Multiple Studies At Rest Or Stress Page 10 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management 78494 Cardiac Blood Pool Imaging, Spect 78496 Cardiac Blood Pool Imaging, Single at Rest Insertion Of Pacemaker Pulse Generator Only; Cardiology CARDIAC IMPLANTABLES 33213 With Existing Dual Leads 78499 Unlisted Cardiovascular Procedure Cardiology CARDIAC IMPLANTABLES 33214 78579 Upgrade Of Implanted Pacemaker System, Conversion Of Single Chamber System To Dual Chamber System (Includes Removal Of Previously Placed Pulse Generator, Testing Of Existing Lead, Insertion Of New Lead, Insertion Of New Generator) Pulmonary ventilation imaging (eg, aerosol or gas) 78580 Pulmonary perfusion imaging (eg, particulate); 78582 78597 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging Quantitative differential pulmonary perfusion, including imaging when performed Quantitative differential pulmonary perfusion 78598 and ventilation (eg, aerosol or gas), including imaging when performed 78599 Unlisted Respiratory Procedure 78600 Brain Imaging Ltd Static 78601 Brain Ltd Imaging and Flow 78605 Brain Imaging Complete 78606 Brain Imaging Complete w/ Flow 78607 Brain Imaging Spect SPECT PET SCANS 78608 Brain Imaging, Positron Emission Tomography (PET) Metabolic Evaluation Page 11 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management PET SCANS Brain Imaging, Positron Emission Tomography 78609 (PET) Perfusion Evaluation 78610 Brain Flow Imaging Only 78630 Cisternogram (Cerebrospinal Fluid Flow) 78635 Cerebrospinal Ventriculography 78645 CSF Shunt Evaluation 78647 Cerebrospinal Fluid Scan Spect 78650 CSF Leakage Detection and Localization 78660 Radiopharmaceutical Dacryocystorgraphy 78699 Unlisted Nuclear Medicine Procedure 78700 Kidney Imaging Morphology 78701 Kidney Imaging Morphology w/ Vascular Flow 78707 78708 Kidney Imaging Morphology w/ Vascular Flow and Function Study Kidney Imaging Morphology w/ Vascular Flow and Function, Single w/ Pharm Intervention Renal Scan Kidney Imaging Morphology w/ Vascular Flow, Captorpril/Renal Scan/MAG 3 78709 Multi, w/o and w/ Pharm Intervention 78710 Kidney Imaging, Spect 78725 Kidney Function Study, Non Image Radioisotropic 78730 Urinary Bladder Residual Study 78740 Ureteral Reflum Study VCUG/Cystogram 78761 Testicular Imaging w/ Vascular Flow 78799 Unlisted Genitourinary Procedure 78800 Radiopharm Localization of Tumor, Limited Area 78801 Radiopharm Localization of Tumor, Multi Areas Gallium Scan/Mammo Scintogram/OctreoScan Page 12 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management 78802 Radiopharm Localization of Tumor, Whole Body Gallium Scan/Octreo Scan 78803 Radiopharm Localization of Tumor, Spect Gallium Scan/FUO 78804 Radiopharmaceutical Localization of Tumor or Distribution of Radiopharmaceutical Agent(s); Whole Body, Requiring 2 or More Days Imaging 78805 Radiopharm Localization of Abscess, Limited Area Gallium Scan/Indium Scan/WBC Scan/MBIG 78806 Radiopharm Localization of Abscess, Whole Body Gallium Scan/Indium Scan/WBC Scan/MBIG 78807 Radiopharm Localization of Abscess, Spect Galliium Scan/Indium Scan/WBC Scan/MBIG PET SCANS Positron Emission Tomography (PET) Imaging; Limited Area (Eg, Chest, Head/Neck) 78811 PET SCANS PET SCANS PET SCANS PET SCANS 78812 78813 78814 78815 Positron Emission Tomography (PET) Imaging; Skull Base To Mid Thigh Positron Emission Tomography (PET) Imaging; Whole Body Positron Emission Tomography (PET) with Concurrently Acquired Computer Tomography (CT) for Attenuation Correction and Anatomical Localization Imaging; Limited Area (Eg Chest, Head/Neck) Positron Emission Tomography (PET) with Concurrently Acquired Computer Tomography (CT) for Attenuation Correction and Anatomical Localization Imaging; Skull Base to Mid Thigh PET with CT PET with CT PET SCANS 78816 Positron Emission Tomography (PET) with Concurrently Acquired Computer Tomography (CT) for Attenuation Correction and Anatomical Localization Imaging; Whole Body PET with CT 78999 Unlisted Misc. Procedeure Diagnostic Nuclear Med Page 13 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management T CODES T CODES 0042T 0159T CT Perfusion Brain Investigational Computer Aided Detection, Including Computer Algorithm Analysis of MRI Image Data For Lesion Detection/Characterization, Pharmacokinetic Analysis, with Further Physician Review for Interpretation, Breast MRI (List Separately In Addition To Code For Primary Procedure) Not Covered CT SCANS 70460 CT Head/Brain w/ Contrast CT SCANS 72125 CT C Spine w/o Contrast CT SCANS 72131 CT L Spine w/o Contrast Computed Tomography, Abdomen and Pelvis; CT SCANS 74176 without Contrast Material Computed Tomography, Abdomen and Pelvis; CT SCANS 74177 with Contrast Material(s) CT SCANS 74178 Computed Tomography, Abdomen And Pelvis; Without Contrast Material In One Or Both Body Regions, Followed By Contrast Material(s) And Further Sections In One Or Both Body Regions CT SCANS 74261 CT SCANS 74262 CT SCANS MRI CT SCANS 74263 75565 75571 Computed Tomographic (CT) Colonography, Diagnostic, Including Image Postprocessing; Without Contrast Material Computed Tomographic (CT) Colonography, Diagnostic, Including Image Postprocessing; With Contrast Material(s) Including Non Contrast Images, If Performed Computed Tomographic (CT) Colonography, Screening, Including Image Postprocessing Cardiac MRI For Velocity Flow Mapping (List Separately In Addition To Code For Primary Procedure) CT Heart Without Contrast Material, With Quantitive Evaluation Of Coronary Calcium Page 14 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management CT SCANS 75572 Cardiac CT For Morphology CT SCANS 75573 Cardiac CT For Congenital HD CT SCANS 75574 CT Angio Coronary Artery CT SCANS 75635 CT Angiography Abdominal Aorta Aortic Aneurysm 3DI 76376 3D 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 3DI 76377 3D 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 78071 78072 Parathyroid Planar Imaging (Including Subtraction, When Performed); With Tomographic (Spect) Parathyroid Planar Imaging (Including Subtraction, When Performed); With Tomographic (Spect), And Concurrently Acquired Computed Tomography (CT) For Anatomical Localization 78451 MPI, Spect, Single Rest or Stress 78452 MPI, Spect, Multiple Rest or Stress 78453 MPI, Planar, Single Rest or Stress 78454 MPI, Planar, Multiple Rest or Stress C CODES C8900 MRA with Contrast, Abdomen Page 15 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management C CODES C8901 MRA without Contrast, Abdomen C CODES C8902 MRA with and without Contrast, Abdomen C CODES C8903 MRI with Contrast, Breast; Unilateral C CODES C8904 MRI without Contrast, Breast; Unilateral C CODES MRI with and without Contrast, Breast; Unilateral C8905 C CODES C8906 MRI with Contrast, Breast; Bilateral C CODES C8907 MRI without Contrast, Breast; Bilateral C CODES MRI with and without Contrast, Breast; Bilateral C8908 C CODES MRA with Contrast, Chest (Excluding C8909 Myocardium) C CODES MRA without Contrast, Chest (Excluding C8910 Myocardium) C CODES MRA with and Without Contrast, Chest C8911 (Excluding Myocardium) C CODES C8912 MRA with Contrast, Lower Extremity C CODES C8913 MRA without Contrast, Lower Extremity C CODES MRA with and Without Contrast, Lower C8914 Extremity C CODES C8918 MRA with Contrast, Pelvis C CODES C8919 MRA without Contrast, Pelvis C CODES C8920 MRA with and without Contrast, Pelvis Page 16 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management C CODES Transthoracic Echocardiography w/contrast For Congenital Cardiac Anomalies; Complete C8921 C CODES C CODES C CODES C8922 C8923 C8924 Transthoracic Echocardiography w/contrast for Congenital Cardiac Anomalies; F/U or Limited Study Transthoracic Echocardiography w/contrast, Real Time w/image Documentation (2D), w or w/o M Mode Recording; Complete Transthoracic Echocardiography w/contrast, Real Time w/image Documentation (2D), w or w/o M Mode Recording; F/U Or Limited Study C CODES C8928 Transthoracic Echocardiography with Contrast, Real Time w/image Documentation (2D), w/ or w/o M Mode Recording, During Rest And Cardiovascular Stress Test, w/interpretation and Report (Crosswalked To Either 93350 Or 93351) RADIOLOGY C CODES C8929 Transthoracic Echocardiography with Contrast, or without Contrast Followed By with Contrast, Real Time with Image Documentation (2D), Includes M Mode Recording, When Performed, Complete, with Spectral Doppler Echocardiography, and with Color Flow Doppler Echocardiography Page 17 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management RADIOLOGY C CODES C8930 Transthoracic Echocardiography, with Contrast, or without Contrast Followed By with Contrast, Real Time With Image Documentation (2D), Includes M Mode Recording, When Performed, During Rest And Cardiovascular Stress Test Using Treadmill, Bicycle Exercise and/or Pharmacologically Induced Stress, with Interpretation and Report; Including Performance of Continuous Electrocardiographic Monitoring, with Physician Supervision RADIOLOGY RADIOLOGY RADIOLOGY RADIOLOGY RADIOLOGY RADIOLOGY C CODES C CODES C CODES C CODES C CODES C CODES G CODES C8931 C8932 C8933 C8934 C8935 C8936 G0219 Magnetic Resonance Angiography with Contrast, Spinal Canal and Contents Magnetic Resonance Angiography without Contrast, Spinal Canal and Contents Magnetic Resonance Angiography without Contrast Followed by with Contrast, Spinal Canal and Contents Magnetic Resonance Angiography with Contrast, Upper Extremity Magnetic Resonance Angiography without Contrast, Upper Extremity Magnetic Resonance Angiography without Contrast Followed by with Contrast, Upper Extremity Pet Imaging Whole Body; Melanoma for Non Covered Indications Investigational G CODES G0235 Pet Imaging, Any Site, Not Otherwise Specified Redirect to valid code G CODES G0252 Pet Imaging, Full and Partial Ring Pet Scanners Only for Initial Diagnosis of Breast Cancer and/or Surgical Planning for Breast Cancer Redirect to valid code Cardiology CARDIAC IMPLANTABLES 33221 Insertion Of Pacemaker Pulse Generator Only; With Existing Multiple Leads Page 18 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology CARDIAC IMPLANTABLES 33224 Insertion Of Pacing Electrode, Cardiac Venous System, For Left Ventricular Pacing, With Attachment To Previously Placed Pacemaker Or Implantable Defibrillator Pulse Generator (Including Revision Of Pocket, Removal, Insertion, And/Or Replacement Of Existing Generator) Cardiology CARDIAC IMPLANTABLES 33225 Insertion Of Pacing Electrode, Cardiac Venous System, For Left Ventricular Pacing, At Time Of Insertion Of Implantable Defibrillator Or Pacemaker Pulse Generator (Eg, For Upgrade To DualChamber System) (List Separately In Addition To Code For Primary Procedure) Cardiology CARDIAC IMPLANTABLES 33227 Cardiology CARDIAC IMPLANTABLES 33228 Cardiology CARDIAC IMPLANTABLES 33229 Cardiology CARDIAC IMPLANTABLES 33230 Cardiology CARDIAC IMPLANTABLES 33231 Cardiology CARDIAC IMPLANTABLES 33240 Cardiology CARDIAC IMPLANTABLES 33249 Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Single Lead System Removal of Permanent Pacemaker Pulse Generator with Replacement of Pacemaker Pulse Generator; Dual Lead System Removal Of Permanent Pacemaker Pulse Generator With Replacement Of Pacemaker Pulse Generator; Multiple Lead System Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Dual Leads Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Multiple Leads Insertion Of Implantable Defibrillator Pulse Generator Only; With Existing Single Lead Insertion Or Replacement Of Permanent Implantable Defibrillator System With Transvenous Lead(s), Single Or Dual Chamber Cardiology CARDIAC IMPLANTABLES 33262 Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implantable Defibrillator Pulse Generator; Single Lead System Page 19 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology CARDIAC IMPLANTABLES 33263 Removal Of Implantable Defibrillator Pulse Generator With Replacement Of Implantable Defibrillator Pulse Generator; Dual Lead System Cardiology CARDIAC IMPLANTABLES 33264 Cardiology CARDIAC IMPLANTABLES 33270 Removal of Implantable Defibrillator Pulse Generator with Replacement of Pacing Cardioverter Defibrillator Pulse Generator; Multiple Lead System Insertion Or Replacement Of Permanent Subcutaneous Implantable Defibrillator System, with Subcutaneous Electrode, Including Defibrillation Threshold Evaluation, Indication of Arrythmia,Evaluation Of Sensing For Arrythmia Termination, and Programming Or Reprogramming Of Sensing Or Therapeutic Parameters When Performed Cardiology MRI 75557 Cardiology MRI 75559 Cardiology MRI 75561 Cardiology MRI 75563 Cardiac Magnetic Resonance Imaging For Morphology And Function Without Contrast Material Cardiac Magnetic Resonance Imaging For Morphology And Function Without Contrast Material; With Stress Imaging Cardiac Magnetic Resonance Imaging For Morphology And Function Without Contrast Material(S), Followed By Contrast Material(S) And Further Sequences Cardiac Magnetic Resonance Imaging For Morphology And Function Without Contrast Material(S), Followed By Contrast Material(S) And Further Sequences; With Stress Imaging Cardiology MRI 75565 Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary procedure) Page 20 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology CT SCANS 75571 Cardiology CT SCANS 75572 Computed Tomography, Heart, Without Contrast Material, With Quantitative Evaluation Of Coronary Calcium Computed Tomography, Heart, With Contrast Material, For Evaluation Of Cardiac Structure And Morphology (Including 3D Image Post processing, Assessment Of Cardiac Function, And Evaluation Of Venous Structures, If Performed) (Managed Under ) (Managed Under ) Cardiology CT SCANS 75573 Computed Tomography, Heart, With Contrast Material, For Evaluation Of Cardiac Structure And Morphology In The Setting Of Congenital Heart Disease (Including 3D Image Post processing, Assessment Of LV Cardiac Function, RV Structure And Function And Evaluation Of Venous Structures, If Performed) (Managed Under ) CT SCANS S8032 Low Dose Computed Tomography for Lung Cancer Screening Cardiology CT SCANS 75574 Computed Tomographic Angiography, Heart, Coronary Arteries And Bypass Grafts (When Present), With Contrast Material, Including 3D Image Post processing (Including Evaluation Of Cardiac Structure And Morphology, Assessment Of Cardiac Function, And Evaluation Of Venous Structures, If Performed) (Managed Under ) S CODES S CODES S8037 S8042 Magnetic Resonance Cholangiopancreatography (MRCP) Magnetic Resonance Imaging (MRI), Low Field Redirect Redirect to valid code to valid code Page 21 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology NUCLEAR STRESS 78451 Myocardial Perfusion Imaging, Tomographic (SPECT) Including Attenuation Correction, Qualitative Or Quantitative Wall Motion, Ejection Fraction By First Pass Or Gated Technique, Additional Quantification, When Performed); Single Study, At Rest Or Stress (Exercise Or Pharmacologic) (Managed Under ) S CODES Scintimammography (Radioimmunoscintigraphy of the Breast), Unilateral, Including Supply of Radiopharmaceutical S8080 p g Cardiology NUCLEAR STRESS 78452 S CODES S8085 Myocardial Perfusion Imaging, Tomographic (SPECT) (Including Attenuation Correction, Qualitative Or Quantitative Wall Motion, Ejection Fraction By First Pass Or Gated Technique, Additional Quantification, When Performed); Multiple Studies, At Rest and/or Stress (Exercise Or Pharmacologic) and/or Redistribution and/or Rest Reinjection Fluorine 18 Fluorodeomyglucose (F 18 Fdg) Imaging Using Dual Head Coincidence Detection System. (Non Dedicated PET Scan) (Managed Under ) Investigational Page 22 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology NUCLEAR STRESS 78453 S CODES Myocardial Perfusion Imaging, Planar (Including Qualitative Or Quantitative Wall Motion, Ejection Fraction By First Pass Or Gated Technique, Additional Quantification, When Performed); Single Study, At Rest Or Stress (Exercise Or Pharmacologic) Electron Beam Computed Tomography (Also Known as Ultrafast CT, Cinet) (Managed Under ) S8092 Cardiology NUCLEAR STRESS 78454 Myocardial Perfusion Imaging, Planar (Including Qualitative Or Quantitative Wall Motion, Ejection Fraction By First Pass Or Gated Technique, Additional Quantification, When Performed); Multiple Studies, At Rest and/or Stress (Exercise Or Pharmacologic) and/or Redistribution and/or Rest Reinjection (Managed Under ) Cardiology PET 78459 PET Myocardial Imaging; Positron Emission Tomography (PET) Metabolic Evaluation (Managed Under ) Cardiology 78472 Gated Cardiac Radionuclide Angiography Cardiology 78473 Gated Multiple Cardiac Radionuclide Angiography Cardiology 78481 Cardiology 78483 Cardiology PET 78491 Cardiology PET 78492 Planar First Pass Cardiac Radionuclide Angiography Planar First Pass Multiple Cardiac Radionuclide Angiography Myocardial Perfusion Imaging, Positron Emission Tomography (PET) Single Study, Rest or Stress Myocardial Perfusion Imaging, Positron Emission Tomography (PET) Multiple Studies, Rest and/or Stress (Managed Under ) (Managed Under ) (Managed Under ) (Managed Under ) Page 23 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology 78494 Cardiology 78496 Cardiology ECHOCARDIOGRAPHY 93303 Cardiology ECHOCARDIOGRAPHY 93304 SPECT Equilbrium Cardiac Radionuclide Angiography SPECT EquilbriumMultiple Radionuclide Angiography Transthoracic Echocardiography For Congenital Cardiac Anomalies; Complete Transthoracic Echocardiography For Congenital Cardiac Anomalies; Follow Up Or Limited Study (Managed Under ) (Managed Under ) Cardiology ECHOCARDIOGRAPHY 93306 Echocardiography, Transthoracic, Real Time With Image Documentation (2D), Includes M Mode Recording, When Performed, Complete, With Spectral Doppler Echocardiography, And With Color Flow Doppler Echocardiography Excluded dfrom program Cardiology ECHOCARDIOGRAPHY 93307 Cardiology ECHOCARDIOGRAPHY 93308 Echocardiography, Transthoracic, Real Time With Image Documentation (2D) With Or Without M Mode Recording; Complete Echocardiography, Transthoracic, Real Time With Image Documentation (2D) With Or Without M Mode Recording; Follow Up Or Limited Study Cardiology ECHOCARDIOGRAPHY 93320 Cardiology ECHOCARDIOGRAPHY 93321 Cardiology ECHOCARDIOGRAPHY 93325 Cardiology ECHO STRESS 93350 Doppler Echocardiography, Pulsed Wave and/or Continuous Wave With Spectral Display; Complete Doppler Echocardiography, Pulsed Wave and/or Continuous Wave With Spectral Display; Follow Up Or Limited Study Doppler Echocardiography Color Flow Velocity Mapping Echocardiography, Transthoracic, Real Time With Image Documentation (2D), With Or Without M Mode Recording, During Rest And Cardiovascular Stress Test, With Interpretation And Report Page 24 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology ECHO STRESS 93351 Echocardiography, Transthoracic, Real Time With Image Documentation (2D), Includes M Mode Recording, When Performed, During Rest And Cardiovascular Stress Test Using Treadmill, Bicycle Exercise and/or Pharmacologically Induced Stress, With Interpretation And Report; Including Performance Of Continuous Electrocardiographic Monitoring, With Supervision By A Physician Or Other Qualified Health Care Professional. Cardiology ECHO STRESS 93352 Useof echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) Cardiology CARDIAC CATH 93452 Cardiology CARDIAC CATH 93453 Left Heart Catheterization Including Intraprocedural Injection(s) For Left Ventriculography, Imaging Supervision And Interpretation, When Performed Combined Right And Left Heart Catheterization Including Intraprocedural Injection(s) For Left Ventriculography, Imaging Supervision And Interpretation, When Performed Cardiology CARDIAC CATH 93454 Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation Cardiology CARDIAC CATH 93455 Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Catheter Placement(s) In Bypass Graft(s) (Internal Mammary FreeArterialVenous Grafts) Including Page 25 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology CARDIAC CATH 93456 Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Right Heart Catheterization Cardiology CARDIAC CATH 93457 Cardiology CARDIAC CATH 93458 Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Catheter Placement(s) In Bypass Graft(s) (Internal Mammary, Free Arterial, Venous Grafts) Including Intraprocedural Injection(s) For Bypass Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Left Heart Catheterization Including Intraprocedural Injection(s) For Left Ventriculography, When Performed Cardiology CARDIAC CATH 93459 Cardiology CARDIAC CATH 93460 Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Left Heart Catheterization Including Intraprocedural Injection(s) For Left Ventriculography, When Performed, Catheter Placement(s) In Bypass G Catheter ft( )(I Placement t l M In Coronary F Artery(s) At il For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Supervision And Interpretation; With Right And Left Heart Catheterization Including Page 26 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Catheter Placement In Coronary Artery(s) For Coronary Angiography, Including Intraprocedural Injection(s) For Coronary Angiography, Imaging Cardiology CARDIAC CATH 93461 Supervision And Interpretation; With Right And Left Heart Catheterization Including Radiation Therapy CPT Intraprocedural Injection(s) For Left Ventriculography, When Performed, Catheter Placement(s) In Bypass Graft(s) (Internal High Dose Rate Electronic Brachytherapy, Per 0182T Fraction Radiation Therapy CPT Placement Of Intraocular Radiation Source 0190T Applicator Radiation Therapy REV Code 0330 /Therapeutic General Classification Radiation Therapy REV Code 0333 /Therapeutic Radiation Therapy Radiation Therapy REV Code 0339 /Therapeutic Other Radiation Therapy REV Code 0344 Therapeutic Radiopharmaceuticals Radiation Therapy REV Code 0973 Professional Fees /Therapeutic Radiation Therapy CPT 19296 Radiation Therapy CPT 19297 Radiation Therapy CPT 19298 Radiation Therapy CPT 31643 Placement Of Radiation Therapy After loading Expandable Catheter Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy On Date Separate From Partial Mastectomy Placement Of Radiation Therapy After loading Expandable Catheter Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy, Concurrent With Partial Mastectomy) Placement Of Radiation Therapy After loading Brachytherapy Catheter Into The Breast For Interstitial Radioelement Application Following Partial Mastectomy Bronchoscopy (Rigid Or Flexible), With Placement Of Catheter For Intracavitary Radioelement Application Page 27 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 32553 Radiation Therapy CPT 41019 Radiation Therapy CPT 43241 Radiation Therapy CPT 49411 Placement Of Interstitial Device For Radiation Therapy Guidance, Percutaneous, Intra Thoracic, Single Or Multiple Placement Of Needles, Catheters, And Other Devices Into The Head and/or Neck Region Upper Gastrointestinal Endoscopy Including Esophagus, Stomach And Either The Duodenum and/or Jejunum As Appropriate; W/ Transendoscopic Intraluminal Tube Or Catheter Placement Placement Of Interstitial Device(s) For Radiation Therapy Guidance, Open, Intra Abdominal, Intra Pelvic and/or Retroperitoneum, Including Image Guidance, Single Or Multiple Radiation Therapy CPT 49412 Placement Of Interstitial Device(s) For Radiation Therapy Guidance (Eg, Fiducial Markers, Dosimeter), Open, Intra Abdominal, Intrapelvic, and/or Retroperitoneum, Including Image Guidance, If Performed, Single Or Multiple (List Separately In Addition To Code For Primary Procedure) Radiation Therapy CPT 55875 Transperineal Placement Of Needles Or Catheters Into Prostate For Interstitial Radioelement Application, With Or Out Cytosocopy Radiation Therapy CPT 55876 Fiducial Marker Placement In The Prostate Radiation Therapy CPT 55920 Placement Of Needles, Catheters, Or Other Device(s) Into The Head and/or Neck Region (Percutaneous, Transoral, Or Transnasal) For Subsequent Interstitial Radioelement Application Radiation Therapy CPT 57155 Insertion Of Uterine Tandem and/or Vaginal Ovoids For Clinical Brachytherapy Page 28 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 57156 Insertion Of A Vaginal Radiation After Loading Apparatus For Clinical Brachytherapy Radiation Therapy CPT Insertion Of Heyman Capsulesfor Clinical 58346 Brachytherapy Radiation Therapy CPT US Transrectal Prostate Volume Study For 76873 Brachytherapy Radiation Therapy CPT Ultrasound Guidance For Interstitial 76965 Radioelement Application Radiation Therapy CPT Computed Tomography Guidance For 77011 Stereotactic Localization Rditi CT Guidance For Placement Of Radiation Therapy Radiation Therapy CPT 77014 Fields PA Mdi Medical lnecessity Review Therapeutic Treatment Planning; Radiation Therapy CPT 77261 Simple Therapeutic Treatment Planning; Radiation Therapy CPT 77262 Intermediate Therapeutic Treatment Planning; Radiation Therapy CPT 77263 Complex Radiation Therapy CPT 77280 Therapeutic Simulation; Simple Radiation Therapy CPT 77285 Therapeutic Simulation; Intermediate Radiation Therapy CPT 77290 Therapeutic Simulation; Complex Radiation Therapy CPT 77293 Respiratory Motion Management Simulation (List Separately In Addition To Code For Primary Procedure) Radiation Therapy CPT 3 Dimensional Radiotherapy Plan, Including Dose 77295 Volume Histograms Radiation Therapy CPT Unlisted Procedure; Therapeutic 77299 Treatment Planning Radiation Therapy CPT 77300 Basic Radiation Dosimetry Radiation Therapy CPT 77301 IMRT Planning Radiation Therapy CPT 77306 Teletherapy Isodose Plan; Simple (1 Or 2 Unmodified Ports Directed To A Single Area Of Interest), Includes Basic Dosimetry Calculation(s) Page 29 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 77307 Radiation Therapy CPT 77316 Radiation Therapy CPT 77317 Radiation Therapy CPT 77318 Teletherapy Isodose Plan; Complex (Multiple Treatment Areas, Tangential Ports, The Use Of Wedges, Blocking, Rotational Beam, Or Special Beam Considerations), Includes Basic Dosimetry Calculation(s) Brachytherapy Isodose Plan; Simple (Calculation(s) Made From 1 To 4 Sources, Or Remote Afterloading Brachytherapy, 1 Channel), Includes Basic Dosimetry Calculation(S) Brachytherapy Isodose Plan; Intermediate (Calculation(s) ( Made From 5 To 10 Sources, Or Remote Afterloading Brachytherapy, 2 12 Channels), Includes Basic Dosimetry Calculation(S) Brachytherapy Isodose Plan; Complex (Calculation(s) Made From Over 10 Sources, Or Remote Afterloading Brachytherapy, 12 Channels), Includes Basic Dosimetry Calculation(s) Radiation Therapy CPT Special Teletherapy Port Plan, Particles, 77321 Hemibody, Total Body Radiation Therapy CPT 77331 Special Radiation Dosimetry Radiation Therapy CPT 77332 Treatment Devices; Simple Radiation Therapy CPT 77333 Treatment Devices; Intermediate Radiation Therapy CPT 77334 Treatment Devices; Complex Radiation Therapy CPT 77336 Continuing Medical Physics Consultation Radiation Therapy CPT 77338 Multi Leaf Collimator (MLC) Device(s) For IMRT, Design And Construction Per IMRT Plan Radiation Therapy CPT 77370 Special Medical Physics Consultation Radiation Therapy CPT 77371 Stereotactic Radiosurgery Treatment Delivery, Complete Course Of Treatment Of Cerebral Lesion(s) 1 Session, Multi Source Cobalt 60 Based Page 30 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 77372 Radiation Therapy CPT 77373 Radiation Therapy CPT 77385 Radiation Therapy CPT 77386 Radiation Therapy CPT 77387 Stereotactic Radiosurgery Treatment Delivery, Complete Course Of Treatment Of Cerebral Lesion(s) 1 Session, Linac Based Stereotactic Body Radiation Therapy Delivery Per Fraction 1 Or More Lesions; Including Image Guidance Not To Exceed 5 Fractions Intensity Modulated Radiation Treatment Delivery (IMRT), Includes Guidance And Tracking, When Performed; Simple Intensity Modulated Radiation Treatment Delivery (IMRT), Includes Guidance And Tracking, When Performed; Complex Guidance For Localization Of Target Volume For Delivery Of Radiation Treatment Delivery, Includes Intrafraction Tracking, When Performed Radiation Therapy CPT 77399 Unlisted Procedure, Medical Radiation Physics Radiation Therapy CPT 77401 Radiation Therapy CPT 77402 Radiation Therapy CPT 77407 Radiation Therapy CPT 77412 Radiation Treatment Delivery, Superficial and/or Ortho Voltage, Per Day Radiation Treatment Delivery; Single Treatment Area, One Or Two Ports; And Two Or Fewer Simple Blocks; >1 MEV; Simple Radiation Treatment Delivery; Two Separate Treatment Areas; Three Or More Ports On A Single Treatment Area; Or Three Or More Simple Blocks; >1 MEV; Intermediate Radiation Treatment Delivery; Three Or More Separate Treatment Areas; Custom Blocking; Tangential Ports; Wedges; Rotational Beam; Field In Field Or Other Tissue Compensation That Does Not Meet IMRT Guidelines; Or Electron Beam; >1 MEV; Complex Radiation Therapy CPT 77417 Therapeutic Port Films Radiation Therapy CPT 77422 Neutron Beam TX, Simple Page 31 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 77423 Neutron Beam TX, Complex Intraoperative Radiation Treatment Delivery, X Radiation Therapy CPT 77424 Ray, Single Treatment Session Intraoperative Radiation Treatment Delivery, Radiation Therapy CPT 77425 Electrons, Single Treatment Session Radiation Treatment Management, Five Radiation Therapy CPT 77427 Treatments Radiation Therapy CPT 77431 Radiation Treatment Management, With Complete Course Of Therapy Consisting Of 1 2 Fractions Stereotactic Radiation Treatment Management Radiation Therapy CPT 77432 Cerebral Lesion(s) Complete Course Of Treatment Consisting Of 1 Session Stereotactic Body Radiation Treatment Management Per Treatment Course; 1 Or More Radiation Therapy CPT 77435 Lesions, Including Image Guidance Entire Course Not To Exceed 5 Fractions Radiation Therapy CPT 77469 Intraoperative Radiation Treatment Management Radiation Therapy CPT 77470 Special Treatment Procedure (Eg. Total Body Radiation, Hemibody Radiation Or Per Oral Endocavity) Radiation Therapy CPT Unlisted Procedure, Therapeutic 77499 Treatment Management Radiation Therapy CPT Proton Treatment Delivery, Simple w/o 77520 Compensation Radiation Therapy CPT Proton Treatment Delivery, Simple w/ 77522 Compensation Radiation Therapy CPT 77523 Proton Treatment Delivery, Intermediate Radiation Therapy CPT 77525 Proton Treatment Delivery, Complex Hyperthermia Treatment; Externally Generated, Radiation Therapy CPT 77600 Deep Hyperthermia Treatment; Externally Generated, Radiation Therapy CPT 77605 Superficial Radiation Therapy CPT Hyperthermia Generated By Interstitial Probe(s); 77610 5 Or Fewer Applicators Page 32 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy CPT 77615 Radiation Therapy CPT 77620 Radiation Therapy CPT 77750 Radiation Therapy CPT 77761 Radiation Therapy CPT 77762 Radiation Therapy CPT 77763 Hyperthermia Generated By Interstitial Probe(s); 5 Or More Applicators Hyperthermia Generated By Intracavitary Probe(s) Infusion Or Instillation Of Radioelement Solution (Includes 3 Month Follow Up Care) Intracavitary Radiation Source Application; Simple Intracavitary Radiation Source Application; Intermediate Intracavitary Radiation Source Application; Complex Radiation Therapy CPT 77776 Interstitial Radiation Source; Simple Radiation Therapy CPT 77777 Interstitial Radiation Source; Intermediate Radiation Therapy CPT 77778 Interstitial Radiation Source; Complex Remote After loading High Dose Rate Radiation Therapy CPT 77785 Radionuclide Brachytherapy; 1 Channel Remote After loading High Dose Rate Radiation Therapy CPT 77786 Radionuclide Brachytherapy; 2 12 Channels Radiation Therapy CPT 77787 Remote After loading High Dose Rate Radionuclide Brachytherapy; Over 12 Channels Radiation Therapy CPT 77789 Apply Surface Radiation Radiation Therapy CPT 77790 Radio Isotope Supervision, Handling, Loading Radiation Therapy CPT 77799 Radium/Radioisotope Therapy Radiation Therapy HCPS A4648 Tissue Marker, Implantable, Any Type Each Radiation Therapy HCPS A4650 Implant Radiation Dosimeter, Each Radiation Therapy HCPS C1715 Brachytherapy Needle Brachytherapy Source, Non Stranded, Gold 198, Radiation Therapy HCPS C1716 Per... Brachytherapy Source, Non Stranded, Gold 198 Radiation Therapy HCPS C1717 Per Page 33 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy HCPS Brachytherapy Source, Non Stranded, Non High C1719 Dose... Radiation Therapy HCPS C1728 Catheter, Brachytherapy Seed Administration Radiation Therapy HCPS C2616 Radiation Therapy HCPS C2634 Radiation Therapy HCPS C2635 Radiation Therapy HCPS C2636 Radiation Therapy HCPS C2637 Radiation Therapy HCPS C2638 Radiation Therapy HCPS C2639 Radiation Therapy HCPS C2640 Radiation Therapy HCPS C2641 Radiation Therapy HCPS C2642 Radiation Therapy HCPS C2643 Radiation Therapy HCPS C2644 Radiation Therapy HCPS C2698 Radiation Therapy HCPS C2699 Radiation Therapy HCPS C9725 Brachytherapy Source, Non Stranded, Yttrium 90, Per Source Brachytherapy Source, Non Stranded, High Activity,... Brachytherapy Source, Non Stranded, High Activity,... Brachytherapy Linear Source, Non Stranded, Paladiu... Brachytherapy Source, Non Stranded, Ytterbium 169,... Brachytherapy Source, Stranded, Iodine 125, Per So... Brachytherapy Source, Non Stranded, Iodine 125, Per... Brachytherapy Source, Stranded, Palladium 103, Per... Brachytherapy Source, Non Stranded, Palladium 103,... Brachytherapy Source, Stranded, Cesium 131, Per So... Brachytherapy Source, Non Stranded, Cesium 131, Per... Brachytherapy Source, Cesium 131 Chloride Solution, Per Millicurie Brachytherapy Source, Stranded, Not Otherwise Spec... Brachytherapy Source, Non Stranded, Not Otherwise Placement Ofÿendorectal Intracavitary Applicator For High Intensity Brachytherapy Page 34 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy HCPS C9726 Radiation Therapy HCPS C9728 Placement And Removal (If Performed) Of Applicator Into Breast For Radiation Therapy (Packaged Into Payment For 77424 And 77425 As Of Jan 1, 2014) Placement Of Interstitial Device(S) For Radiation Therapy/Surgery Guidance( Eg, Fiducial Markers, Dosimeter), Other Than Prostrate (Any Approach), Single Or Multiple Radiation Therapy HCPS G0339 Robotic Stereotactic Surgery 1 Session Robotic Stereotactic Radio Surgery 2 Through 5 Radiation Therapy HCPS G0340 Sessions Ultrasonic Guidance For Placement Of Radiation Radiation Therapy HCPS G6001 Therapy Fields. MPFS Code In Place Of 76950 For 2015 Stereoscopic X Ray Guidance For Localization Of Target Volume For The Delivery Of Radiation Radiation Therapy HCPS G6002 Therapy. MPFS Code In Place Of 77421 For 2015 Radiation Therapy HCPS G6003 Radiation Treatment Delivery, Single Treatment Area, Single Port Or Parallel Opposed Ports, Simple Blocks Or No Blocks; Up To 5 MEV. MPFS Code In Place Of 77402 For 2015 Radiation Therapy HCPS G6004 Radiation Treatment Delivery, Single Treatment Area, Single Port Or Parallel Opposed Ports, Simple Blocks Or No Blocks; 6 10 MEV. MPFS Code In Place Of 77403 For 2015 Radiation Therapy HCPS G6005 Radiation Treatment Delivery, Single Treatment Area, Single Port Or Parallel Opposed Ports, Simple Blocks Or No Blocks; 11 19 MEV. MPFS Code In Place Of 77404 For 2015 Page 35 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy HCPS G6006 Radiation Treatment delivery, Single Treatment Area, Single Port Or Parallel Opposed Ports, Simple Blocks Or No Blocks; 20 MEV Or Greater. MPFS Code In Place Of 77406 For 2015 Radiation Therapy HCPS G6007 Radiation Treatment Delivery, 2 Separate Treatment Areas, 3 Or More Ports On A Single Treatment Area, Use Of Multiple Blocks; Up To 5 MEV. MPFS Code In Place Of 77407 For 2015 Radiation Therapy HCPS G6008 Radiation Treatment Delivery, 2 Separate Treatment Areas, 3 Or More Ports On A Single Treatment Area, Use Of Multiple Blocks; 6 10 MEV. MPFS Code In Place Of 77408 For 2015 Radiation Therapy HCPS G6009 Radiation Treatment Delivery, 2 Separate Treatment Areas, 3 Or More Ports On A Single Treatment Area, Use Of Multiple Blocks; 11 19 MEV. MPFS Code In Place Of 77409 For 2015 Radiation Therapy HCPS G6010 Radiation Therapy HCPS G6011 Radiation Therapy HCPS G6012 Radiation Treatment Delivery, 2 Separate Treatment Areas, 3 Or More Ports On A Single Treatment Area, Use Of Multiple Blocks; 20 MEV Or Greater. MPFS Code In Place Of 77411 For 2015 Radiation Treatment Delivery, 3 Or More Separate Treatment Areas, Custom Blocking, Tangential Ports, Wedges, Rotational Beam, Compensators, Electron Beam; Up To 5 MEV. MPFS Code In Place Of 77412 For 2015 Radiation Treatment Delivery, 3 Or More Separate Treatment Areas, Custom Blocking, Tangential Ports, Wedges, Rotational Beam, Compensators, Electron Beam; 6 10 MEV. MPFS Code In Place Of 77413 For 2015 Page 36 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy HCPS G6013 Radiation Therapy HCPS G6014 Radiation Treatment Delivery, 3 Or More Separate Treatment Areas, Custom Blocking, Tangential Ports, Wedges, Rotational Beam, Compensators, Electron Beam; 11 19 MEV. MPFS Code In Place Of 77414 For 2015 Radiation Treatment Delivery, 3 Or More Separate Treatment Areas, Custom Blocking, Tangential Ports, Wedges, Rotational Beam, Compensators, Electron Beam; 20, MEV Or Greater. MPFS Code In Place Of 77416 For 2015 Radiation Therapy HCPS G6015 Intensity Modulated Treatment Delivery, Single Or Multiple Fields/Arcs,Via Narrow Spatially And Temporally Modulated Beams, Binary, Dynamic MLC, Per Treatment Session. MPFS Code In Place Of 77418 For 2015 Radiation Therapy HCPS G6016 Compensator Based Beam Modulation Treatment Delivery Of Inverse Planned Treatment Using 3 Or More High Resolution (Milled Or Cast) Compensator, Convergent Beam Modulated Fields, Per Treatment Session. MPFS Code In Place Of 0073t For 2015 Radiation Therapy HCPS G6017 Intra Fraction Localization And Tracking Of Target Or Patient Motion During Delivery Of Radiation Therapy (Eg, 3D Positional Tracking, Gating, 3D Surface Tracking), Each Fraction Of Treatment. MPFS Code In Place Of 0197t For 2015 Radiation Therapy HCPS Q3001 Radiation Therapy HCPS S2095 Radioelements For Brachytherapy, Any Type, Each Transcatheter Occlusion Or Embolization For Tumor Destruction, Percutaneous, Any Method, Using Yttrium 90 Microspheres Page 37 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Radiation Therapy HCPS S8030 Scleral Application Of Tantalum Ring(s) For Localization Of Lesions For Proton Beam Therapy Sleep Therapies 94660 Sleep Diagnostics 95782 Continuous Positive Airway Pressure Ventilation (CPAP), Initiation and Management Polysomnography; Younger Than 6 Years, Sleep Staging With 4 Or More Additional Parameters Of Sleep, Attended By A Technologist Sleep Diagnostics 95783 Polysomnography; Younger Than 6 Years, Sleep Staging gwith 4 Or More Additional Parameters Of Sleep, With Initiation Of Continuous Positive Airway Pressure Therapy Or Bi Level Ventilation, Attended By A Technologist Sleep Diagnostics 95800 Sleep Diagnostics 95801 Sleep Diagnostics 95805 Sleep Diagnostics 95806 Sleep Study, Unattended, Simultaneous Recording; Heart Rate, Oxygen Saturation, Respiratory Analysis (E.G., By Airflow or Peripheral Arterial Tone), and Sleep Time Sleep Study, Unattended, Simultaneous Recording; Minimum of Heart Rate, Oxygen Saturation, and Respiratory Analysis (E.G., By Airflow or Peripheral Arterial Tone) Multiple Sleep Latency Test Or Maintenance Of Wakefulness Test Sleep Study, Unattended, Simultaneous Recording Of, Heart Rate, Oxygen Saturation, Respiratory Airflow, And Respiratory Effort (E.G. Thoracoabdominal Movement) Excluded From Program Excluded From Program Sleep Diagnostics 95807 Sleep Study, Simultaneous Recording Of Ventilation, Respiratory Effort, ECG Or Heart Rate, And Oxygen Saturation, Attended By A Technologist Page 38 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Sleep Diagnostics 95808 Sleep Diagnostics 95810 Polysomnography; Any Age, Sleep Staging With 1 3 Additional Parameters of Sleep, Attended By A Technologist Polysomnography; Age 6 Years or Older, Sleep Staging With 4 or More Additional Parameters of Sleep, Attended By A Technologist Sleep Diagnostics 95811 Polysomnography, Age 6 Years Or Older, Sleep Staging With 4 Or More Additional Parameters Of Sleep, With Initiation Of Continuous Positive Airway Pressure Therapy Or Bi Level Ventilation, Attended By A Technologist Diagnostic Split Night Study (Psg And Cpap Titration); Sleep Testing; Age 6 Years Sleep Management of Care A4604 Sleep Diagnostics 95811 Tubing With Integrated Heating Element For Use With Positive Airway Pressure Device Polysomnography, Age 6 Years Or Older, Sleep Staging With 4 Or More Additional Parameters Of Sleep, With Initiation Of Continuous Positive Airway Pressure Therapy Or Bi Level Ventilation, Attended By A Technologist Attended Titration Of Positive Airway Pressure; Sleep Testing; Age 6 Years Sleep Management of Care A7027 Sleep Management of Care A7028 Sleep Management of Care A7029 Sleep Management of Care A7030 Sleep Management of Care A7031 Combination Oral/Nasal Mask, Used With CPAP, Each Oral Cushion For Combination Oral/Nasal Mask, Replacement Only Nasal Pillows For Combination Oral/Nasal Mask, Replacement Only, Pair Full Face Mask Used With Positive Airway Pressure Device, Each Face Mask Interface, Replacement For Full Face Mask, Each Page 39 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Sleep Management of Care Cushion For Use On Nasal Mask Interface, A7032 Replace Only, Each Sleep Management of Care Pillow For Use On Nasal Cannula Type Interface, A7033 Replacement Only, Pair Sleep Management of Care Nasal Interface (Mask Or Cannula Type) Used A7034 With Positive Airway Pressure Device Sleep Management of Care Headgear Used With Positive Airway Pressure A7035 Device Sleep Management of Care Chinstrap Used With Positive Airway Pressure A7036 Device Sleep Management of Care Tubing Used With Positive Airway Pressure A7037 Device Filter, Disposable, Used With Positive Airway Sleep Management of Care A7038 Pressure Device Sleep Management of Care Filter, Non Disposable, Used With Positive Airway A7039 Pressure Device Sleep Management of Care Oral Interface Used With Positive Airway A7044 Pressure Device, Each Exhalation Port With Or Without Swivel Used Sleep Management of Care A7045 With Accessories For Positive Airway Devices, Replacement Only Water Chamber For Humidifier, Used With Sleep Management of Care A7046 Positive Airway Pressure Device, Replacement, Each Respiratory Assist Device, Bi Level Pressure Capability without Backup Rate Feature, Used Sleep Therapies E0470 with Noninvasive Interface, E.G. Nasal or Facial Mask (Intermittent Assist Device with Continuous Positive Airway Pressure Device) Sleep Therapies E0471 Sleep Therapies E0561 Respiratory Assist Device, Bi Level Pressure Capability, with Back Up Rate Feature, Used with Noninvasive Interface, E.G. Nasal or Facial Mask (Intermittent Assist Device with Continuous Positive Airway Pressure Device) Humidifier, Non Heated, Used with Positive Airway Pressure Device Page 40 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Sleep Therapies Humidifier, Heated, Used with Positive Airway E0562 Pressure Device Sleep Therapies E0601 Positive Airway Pressure Therapy Sleep Diagnostics G0398 Sleep Diagnostics G0399 Home Sleep Study Test (HST) With Type II Portable Monitor, Unattended; Minimum Of 7 Channels: EEG, EOG, EMG, ECG/Heart Rate, Airflow, Respiratory Effort And Oxygen Saturation Home Sleep Test (HST) With Type III Portable Monitor, Unattended; Minimum Of 4 Channels: 2 Respiratory Movement/Airflow, 1 ECG/Heart Rate And 1 Oxygen Saturation Sleep Diagnostics G0400 Cardiology C CODES C8921 Cardiology C CODES C8922 Cardiology C CODES C8923 Cardiology C CODES C8924 Sleep Study, Unattended, Simultaneous Recording; Minimum Of Heart Rate, Oxygen Saturation, And Respiratory Transthoracic Echocardiography w/contrast For Congenital Cardiac Anomalies; Complete Transthoracic Echocardiography w/contrast For Congenital Cardiac Anomalies; F/U Or Limited Study Transthoracic Echocardiography w/contrast, Real Time w/image Documentation (2D), w/wo M Mode Recording; Complete Transthoracic Echocardiography w/contrast, Real Time w/image Documentation (2D), w/wo M Mode Recording; F/U Or Limited Study Cardiology C CODES C8928 Transthoracic Echocardiography w/contrast, Real Time w/image Documentation (2D), w/wo M Mode Recording, During Rest And Cardiovascular Stress Test, w/interpretation And Report Page 41 of 42
Programs:, Cardiology, Radiation Therapy, and Sleep Management Cardiology C CODES C8929 Transthoracic Echocardiography With Contrast, Or Without Contrast Followed By With Contrast, Real Time With Image Documentation (2D), Includes M Mode Recording, When Performed, Complete, With Spectral Doppler Echocardiography, And With Color Flow Doppler Echocardiography Cardiology C CODES C8930 Transthoracic Echocardiography, With Contrast, Or Without Contrast Followed By With Contrast, Real Time With Image Documentation (2D), Includes M Mode Recording, When Performed, During Rest And Cardiovascular Stress Test Using Treadmill, Bicycle Exercise and/or Pharmacologically Induced Stress, With Interpretation And Report; Including Performance Of Continuous Electrocardiographic Monitoring, With Physician Supervision Page 42 of 42