New York Codes, Rules and Regulations
Title 18 - DEPARTMENT OF SOCIAL SERVICES
Chapter II - Regulations of the Department of Social Services
Subchapter E - Medical Care
Article 4 - Fees and Reimbursement
Part 533 - State Reimbursement For Payment To Physicians
Section 533.5 - Anesthesia and surgery
Universal Citation: 18 NY Comp Codes Rules and Regs ยง 533.5
Current through Register Vol. 46, No. 39, September 25, 2024
All fees billed must be in accordance with the provisions of Part 505 of this Subchapter.
(a) Anesthesia.
(1) The conversion
factor for the anesthesia services and procedures listed in this section shall
be $5.
(2) Anesthesia values.
(i) The total values for anesthesia services
include pre- and post-operative visits, the administration of the anesthesia
and the administration of fluids and/or blood incident to the anesthesia or
surgery.
(ii) Calculated values for
anesthesia services shall be used only when the anesthesia is personally
administered by a licensed physician who remains in constant attendance during
the procedure for the sole purpose of rendering such anesthesia
services.
(iii) For anesthesia
procedures, the same item number as the related surgical procedure shall be
used with the suffix "a" added.
(iv) When hypothermia and/or pump oxygenator
are employed in conjunction with an anesthesia, the anesthesia "basic" value
shall be 20 units instead of the "basic" value presently listed and the suffix
"y" shall be substituted for "a".
(v) If the general or regional anesthetic is
administered by the attending surgeon, the value shall be 50 percent of the
calculated value and the suffix "p" shall be substituted for "a".
(vi) In procedures where no value is listed,
the basic portion of the calculated value shall be the same as listed for a
comparable procedure.
(vii)
Necessary drugs and materials provided by the physician anesthetist may be
charged for separately.
(viii)
Where unusual detention with the patient is essential for the safety and
welfare of such patient, the necessary time shall be valued on the same basis
as indicated below for anesthesia time.
(ix) No fee shall be allowed for local
infiltration or digital block anesthesia administered by the operating
surgeon.
(3) Calculation
of total anesthesia values.
Calculation of total anesthesia value shall be determined by adding the listed basic value and time units. The time units shall be computed by allowing one unit for each 15 minutes of anesthesia time. Anesthesia time shall start with the beginning of the administration of the anesthetic agents and shall end when the physician anesthetist is no longer in personal attendance.
(b) Surgery.
(1) The conversion factor for the surgical
services and procedures listed in this section shall be $4.
(2) The values hereinafter listed for
surgical procedures include the surgery and follow-up care for the period
indicated. In cases in which follow-up care beyond the required period is
necessary, reimbursement shall be available for additional payments made by the
social services district to the physician on a fee-for-service basis.
(3) Where an asterisk (*) precedes a
procedure number and its listed value, reimbursement shall be determined on the
basis of the following factors:
(i) the listed
value is for the surgical procedure only;
(ii) reimbursement for all post-operative
care shall be available for payments made to the physician on a fee-for-service
basis;
(iii) when such procedure
requires admission to a hospital, an additional two units shall be added to its
listed value in lieu of any hospital visit fee;
(iv) when such procedure is carired out at
the time of the initial visit, one additional unit shall be added to the value
of the procedure in lieu of any office visit fee.
(4) When the notation "Sv" follows a listed
surgical procedure, the maximum reimbursable allowance therefor shall be the
sum of the values of the various respective services rendered, such as for a
hospital visit, application of cast or splint, detention with the patient, or
office visit, multiplied by the respective appropriate conversion
factor.
(5) In the event of
complications or other circumstances requiring additional and unusual services
concurrent with the procedure or during the established period of follow-up
care, reimbursement shall be available for payment to a physician on a
fee-for-service basis in addition to the reimbursement for the
procedure.
(6)
(i) When multiple or bilateral surgical
procedures are performed at the same operative session, the total value shall
be the value of the major procedure plus 50 percent of the value of the lesser
procedure(s) after the conversion factor ($4) has been applied to all fee
items, unless otherwise specified.
(ii) When an incidental procedure, such as an
incidental appendectomy, lysis of adhesions, excision of a previous scar, or
puncture of an ovary cyst, is performed through the same incision, the value of
such procedure shall be that of the major procedure only, unless otherwise
specified.
(7) When the
skills of two surgeons are required in the management of a specific surgical
procedure, by prior agreement, the total value may be apportioned in relation
to the responsibility and work done, provided the patient is made aware of the
fee distribution according to medical ethics. The value of such procedure may
be increased by 25 percent.
(8)
When an additional surgical procedure is carried out within the established
period of follow-up care for a previous surgery, the follow-up periods for each
shall be deemed to run concurrently.
(9) When the value of a surgical procedure is
to be determined "by report", the social services district shall require the
physician to submit the following information:
(i) postoperative diagnosis;
(ii) size, location and number of lesions on
procedures where appropriate;
(iii)
major surgical procedure and supplementary procedures;
(iv) where possible, a list of similar
procedures, by item number, as set forth in this section;
(v) an estimate of the follow-up
period;
(vi) operative
time;
(vii) such other information
as may be required.
(10)
In the case of a kidney transplant, procedure item 3850, if the recipient of a
kidney transplant is eligible for medical assistance, all costs attributable to
medical services provided to a live donor of a kidney shall be reimbursable.
If, however, the recipient of a kidney transplant is not eligible for medical
assistance, payments for neither the transplant nor the costs incured for the
live donor shall be reimbursable even though the live donor may be eligible for
medical assistance.
(11) Surgical
fees.
The maximum reimbursable allowance for the numbered and described items of surgical procedures listed in this section shall be computed on the basis of the respective listed value multiplied by the conversion factor of $4.
(12) The maximum
reimbursable allowance to an individual physician for a single operation shall
be $800.
(c) Maximum reimbursable anesthesia and surgery fee schedules:
SURGICAL ASSISTANTS
| 6993 | Assist at surgery, 20% of listed unit value(s) of surgical procedure(s)- |
Integumitary System
Skin, Mucous Membrane, Subcutaneous and Areolar Tissues
| Unitr or Dollar Value | Follow-up Days | Anes.§ | ||
| Incision | ||||
| *0101 | Incision and drainage of infected or non-infected sebaceous cyst ........................ | *2.0 | 0 | 3.0+T |
| (2nd lesion 50%; each additional lesion 25%) | ||||
| *0102 | Incision and drainage of furuncle..................................... | *2.0 | 0 | 3.0+T |
| *0103 | Acne surgery; marsupialization, opening, or removal of multiple milia, comedones, cysts, pustules, etc............................................ | *1.5 | 0 | 3.0+T |
| *0108 | Incision and drainage of carbuncle, suppurative hidradenitis and other cutaneous or subcutaneous abscesses, simple................................. | *2.0 | 0 | 3.0+T |
| 0109 | extensive................................ | by report | 3.0+T | |
| *0115 | Drainage of pilonidal cyst.................................... | *2.0 | 0 | 3.0+T |
| *0125 | Drainage of onychia or paronychia.............................. | *2.0 | 0 | 3.0+T |
| 0126 | multiple or complicated | by report | 3.0+T | |
| *0130 | Incision and removal of foreign body, subcutaneous tissues, simple.................... | *2.0 | 0 | 3.0+T |
| 0131 | complicated........................... | by report | 0 | 3.0+T |
| *0140 | Drainage of hematoma simple..................................... | *2.0 | 0 | 3.0+T |
| 0141 | complicated............................... | by report | 0 | 3.0+T |
| *0145 | Puncture aspiration of abscess or hematoma ........................................... | *1.0 | 0 | 3.0+T |
| Excision | ||||
| Debridement (for abrasions and burns see 0164, 0330-0334, 0351-0356.) | ||||
| *0160 | Debridement of extensively eczematized or infected skin up to 10% of the body surface | *2.0 | 0 | 3.0+T |
| *0161 | for each additional 10% of body surface, add | *1.0 | 0 | 3.0+T |
| *0162 | Debridement of nails, any method, five or less | *2.0 | 0 | 3.0+T |
| *0163 | for each additional five or major portion thereof | *1.0 | 0 | 3.0+T |
| 0164 | Debridement of abrasions | by report | ||
| Excision and Simple Closure-(Not reconstructive surgery; for reconstructive surgery see "Repair-Complex.") | ||||
| (For electro-surgical methods see 0401, et seq.) | ||||
| 0171 | Biopsy; excision of skin, subcutaneous tissue or mucous membrane for biopsy (including simple closure) independent procedure) | 3.0 | 15 | 3.0+T |
| Excision (including simple closure) of BENIGN cicatricial, fibrous, inflammatory, congenital, cystic, etc., lesions of skin, subcutaneous tissue or mucous membrane; one (see appropriate size below.) | ||||
| (For multiple lesions see Surgical Rule 9.) | ||||
| 0175 | lesion diameter up to 1/4 inch | 4.0 | 30 | 3.0+T |
| 0176 | lesion diameter 1/4 to 1/2 inch | 5.0 | 30 | 3.0+T |
| 0177 | lesion diameter 1/2 to 3/4 inch | 6.0 | 30 | 3.0+T |
| 0178 | lesion diameter more than 3/4 inch or complicated | by report | 3.0+T | |
| Excision (including simple closure) or treatment by any other method (except radiation) of MALIGNANT lesions of skin or mucous membrane (except melanoma) to include local anesthesia. | ||||
| Trunk, arms or legs: | ||||
| 0188 | lesion diameter up to 1/4 inch | 6.0 | 90 | 3.0+T |
| 0189 | lesion diameter 1/4 to 1/2 inch | 8.0 | 90 | 3.0+T |
| 0190 | lesion diameter 1/2 to 3/4 inch | 10.0 | 90 | 3.0+T |
| Face, scalp, ears, neck, hands, feet, genitalia: | ||||
| 0191 | lesion diameter up to 1/4 inch | 10.0 | 90 | 3.0+T |
| 0192 | lesion diameter up to 1/2 inch | 15.0 | 90 | 3.0+T |
| 0193 | lesion diameter 1/2 to 3/4 inch | 20.0 | 90 | 3.0+T |
| Eyelids, nose, lips, mucous membrane: | ||||
| 0194 | lesion diameter up to 1/4 inch | 15.0 | 90 | 3.0+T |
| 0195 | lesion diameter 1/4 to 1/2 inch | 20.0 | 90 | 3.0+T |
| 0196 | lesion diameter 1/2 to 3/4 inch | 25.0 | 90 | 3.0+T |
| 0197 | Lesions over 3/4 inch, complicated or unusually located | by report | 3.0+T | |
| 0225 | Avulsion, nail, partial, or complete, simple | *2.0 | 0 | 3.0+T |
| 0228 | Excision of nail or nail matrix, partial or complete, e.g., ingrown or deformed nail for permanent removal | 10.0 | 30 | 3.0+T |
| 0238 | Excision of pilonidal cyst or sinus | 30.0 | 60 | 3.0+T |
| Miscellaneous lesions (use appropriate procedure number and state diagnosis.) | ||||
| Hermangioma (see 0175-0178, 0260-0324.) | ||||
| Hidradenitis (see 0106, 0175-0178, 0260-0324.) | ||||
| Lipoma (see 0175-0178, 0260-0324.) | ||||
| Lymph node dissection (see 2651-2672.) | ||||
| Melanoma (see 0188-0197, 0260-0324.) | ||||
| Ulcer-vascular or inflammatory (see 0175-0178, 0260-0324.) | ||||
| Introduction | ||||
| *0242 | Injection, intralesional (up to and including seven lesions) | *2.0 | 0 | 3.0+T |
| *0243 | more than seven | *3.0 | 0 | 3.0+T |
| Repair-Simple | ||||
| *0251 | Wounds, recent, up to 2 1/2 inches | *2.0 | 0 | 3.0+T |
| *0252 | for each additional inch add | *1.0 | 0 | 3.0+T |
| (For multiple wounds, see Surgical Rule 9.) | ||||
| REPAIR-COMPLEX (e.g., reconstructive surgery, complicated wound closure, skin grafts, etc.). | ||||
| The following values (0260-0324) are to be applied in situations requiring unusual and time-consuming techniques of repair to obtain the maximum functional and cosmetic result. Unless otherwise noted, the stated values include the creation of the defect and necessary preparation for repair, or the debridement and repair of complicated lacerations (excluding 0251, 0252.) | ||||
| Excision and/or repair by direct closure of lesion or laceration resulting in a LINEAR REPAIR: | ||||
| 0260 | up to 1/2 inch, forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 8.0 | 30 | 3.0+T |
| 0261 | eyelids, nose, ears and lips (See also 0290-0294, 2737-2746.) | 10.0 | 30 | 3.0+T |
| (For other areas see 0175-0178, 0188-0197, 0251-0252.) | ||||
| 0262 | 1/2 inch to 1 inch, trunk | 7.0 | 30 | 3.0+T |
| 0263 | scalp, arms and legs | 10.0 | 30 | 3.0+T |
| 0264 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 14.0 | 30 | 3.0+T |
| 0265 | eyelids, nose, ears and lips | 17.0 | 30 | 3.0+T |
| (See also 0290-0294, 2737-2746.) | ||||
| 0266 | 1 inch to 3 inches, trunk | 15.0 | 30 | 3.0+T |
| 0267 | scalp, arms and legs | 22.0 | 30 | 3.0+T |
| 0268 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 30.0 | 30 | 3.0+T |
| 0269 | eyelids, nose, ears and lips (See also 0290-0294, 2737-2746.) | 40.0 | 30 | 3.0+T |
| 0270 | Unusual, complicated or over 3 inch linear repair | by report | 3.0+T | |
| Excision and/or repair by adjacent tissue transfer or rearrangement (e.g., Z-plasty, rotation flap, advanced flap, double pedicle flap, etc.): | ||||
| 0275 | for defect up to 1 square inch, trunk | 20.0 | 60 | 3.0+T |
| 0276 | scalp, arms and legs | 30.0 | 60 | 3.0+T |
| 0277 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 40.0 | 60 | 3.0+T |
| 0278 | eyelids, nose, ears and lips | 50.0 | 60 | 3.0+T |
| 0279 | defect size between 1 square inch and 3 square inches, trunk | 30.0 | 60 | 3.0+T |
| 0280 | scalp, arms and legs | 40.0 | 60 | 3.0+T |
| 0281 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 50.0 | 60 | 3.0+T |
| 0282 | eyelids, nose, ears and lips | 60.0 | 60 | 3.0+T |
| 0283 | more than 3 square inches, unusual or complicated | by report | 3.0+T | |
| Eyelid, full thickness, excision and repair: | ||||
| 0290 | by advancement flaps, up to 1/4 eyelid margin | 37.0 | 60 | 3.0+T |
| 0291 | over 1/4 of eyelid margin | 50.0 | 60 | 3.0+T |
| 0292 | by transfer flaps of tarsoconjunctivea from opposing eyelid, up to 2/3 of eyelid | 50.0 | 60 | 3.0+T |
| 0293 | total eyelid, one or more stages, lower lid | 75.0 | 60 | 3.0+T |
| 0294 | upper lid | 85.0 | 60 | 3.0+T |
| SKIN GRAFTS-The value is to be determined on the basis of size and location of defect (recipient area) and type of graft. Unless otherwise noted, these values include creation and/or surgical preparation of the defect, obtaining and placing of the graft, and the care of the donor site. For repair of the donor site requiring skin graft or local flaps, see section 533.5(b)(6)(i). | ||||
| *0300 | Pinch, split or full thickness skin to cover small ulcer, tip of digit or other minimal open area (except on face, use 0301-0304) up to defect size 3/4 inch diameter | *5.0 | 0 | |
| (Values for items 0301-0304 include simple debridement of granulations or recent avulsions. When the recipient area for grafting is created by surgical excision of essentially intact skin, scar or other lesion (including subcutaneous tissue) add 50% to the calculated value for the graft. This includes primary or delayed application of the graft.) | ||||
| 0301 | Split skin graft, up to 16 square inches (except 0300), trunk, scalp, arms, legs, hands and feet (except multiple digits) | 25.0 | 45 | |
| 0302 | each additional 16 square inches or part thereof | 5.0 | 45 | |
| 0303 | face, neck, ears, genitalia or multiple digits | 38.0 | 45 | |
| 0304 | each additional 16 square inches or part thereof | 7.0 | 45 | |
| 0308 | Full thickness, free, up to 3 square inches, including direct closure of donor site, trunk | 20.0 | 45 | |
| 0309 | scalp, arms and legs | 30.0 | 45 | |
| 0310 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 40.0 | 45 | |
| 0311 | eyelids, nose, ears and lips | 50.0 | 45 | |
| (For each additional 3 square inches in the above procedures, add 50% of area value.) | ||||
| (For repair of donor site requiring skin graft or local flaps, see section 533.5(b)(6)(i)). | ||||
| Values for following items (0312-0323) do NOT include extensive immobilizing; for plaster casts see 1851-1890 for values for these services. | ||||
| 0312 | Pedicle flap, direct or tubed, (including direct closure of donor site) trunk | 20.0 | 45 | |
| 0313 | scalp, arms and legs | 30.0 | 45 | |
| 0314 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 40.0 | 45 | |
| 0315 | eyelids, nose, ears and lips | 50.0 | 45 | |
| (For repair of donor site requiring skin graft or local flaps, see section 533.5(b)(6)(i)). | ||||
| 0316 | delay, intermediate transfer or sectioning of pedicle of tubed or direct flap, trunk | 15.0 | 45 | |
| 0317 | scalp, arms and legs | 22.0 | 45 | |
| 0318 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 30.0 | 45 | |
| 0319 | eyelids, nose, ears and lips | 37.0 | 45 | |
| 0320 | excision of lesion and/or preparation of recipient site and attachment of direct or tubed pedicle flap, trunk | 30.0 | 45 | |
| 0321 | scalp, arms and legs | 45.0 | 45 | |
| 0322 | forehead, cheeks, chin, mouth, neck, axilla, genitalia, hands and feet | 60.0 | 45 | |
| 0323 | eyelids, nose, ears and lips | 75.0 | 45 | |
| (Revision, defatting or rearranging of transferred pedicle or flap skin graft, see 0260-0283 inclusive.) | ||||
| 0324 | Composite graft (full thickness of external ear or nasal ala) | 25.0 | 45 | 3.0+T |
| 0325 | Derma-fat-fascia-graft (except to breast-0484) | 45.0 | 60 | 3.0+T |
| 0330 | Abrasion of skin, total face, for removal of scars, tattoos, etc., primary | 60.0 | 90 | 3.0+T |
| 0331 | secondary, total face | 30.0 | 45 | 3.0+T |
| 0333 | regional ( 1/4 face, cheeks, chin, forehead or elsewhere) primary | 15.0 | 60 | 3.0+T |
| 0334 | secondary, regional | 7.5 | 30 | 3.0+T |
| 0335 | Rhytidectomy, lower eyelids | 60.0 | 30 | 3.0+T |
| 0336 | upper eyelids | 40.0 | 30 | 3.0+T |
| 0337 | forehead | 50.0 | 30 | 3.0+T |
| 0338 | glabellar frown | 40.0 | 30 | 3.0+T |
| 0339 | cheeks, chin and neck | 150.0 | 45 | 4.0+T |
| 0340 | Facial nerve paralysis, free fascia grafts | 100.0 | 100 | 4.0+T |
| 0341 | reanimation-muscle transfers | 120.0 | 120 | 4.0+T |
| (For nerve transfers, decompression or suture, see 5350, 6002, 6003.) | ||||
| BURNS-List percentage of body surface involved and depth of burn. Does not include skin grafts. | ||||
| *0351 | Initial treatment, first degree, where no more than local treatment necessary | *1.5 | 0 | |
| *0352 | Dressings, initial or subsequent under anesthesia, small | *4.0 | 0 | 3.0+T |
| *0353 | under anesthesia, large or with major debridement, per hour | *10.0 | 0 | 3.0+T |
| *0354 | without anesthesia, small, office or hospital | *2.0 | 0 | |
| *0355 | without anesthesia, medium (whole face or whole extremity, etc.) | *3.0 | 0 | |
| *0356 | without anesthesia, large (more than one extremity, etc.) | *4.0 | 0 | |
| Destruction | ||||
| *0401 | Electro-surgical destruction with or without surgical curettement of facial nevi, leukoplakia, actinic or senile keratoses, or keratoacanthomas, to include local anesthesia, one lesion | *3.0 | 0 | 3.0+T |
| (50% for each additional lesion up to a total of three; over three, each additional lesion 25%.) | ||||
| 0402 | complicated lesion(s) | by report | ||
| *0403 | Electro-surgical destruction (except 0401 and 0402) or chemocautery (Mono-, Bi-, Trichloracetic acid, phenol, etc.) or cryocautery (liquid N2, CO2, etc.) of benign or premalignant lesions of skin or mucous membrane (except 0405 and 0406) with or without curettement, one lesion | *2.0 | 0 | |
| (50% for second lesion; over two, each additional lesion 25%.) | ||||
| 0404 | complicated lesion(s) | by report | ||
| *0405 | flat (plane, juvenile) warts, up to fifteen | *2.0 | 0 | |
| (Retreatment same as routine office visit.) | ||||
| *0406 | Electro-surgical destruction of multiple fibro-cutaneous tags, up to fifteen | *2.0 | 0 | |
| 0408 | Chemosurgery, (Mohs type technique), malignancies of skin, includes removal of growth and microscopic delineation of margins and base, first stage -fulguration and application of chemicals | 20.0 | 30 | |
| 0409 | each subsequent treatment, up to five sections | 5.0 | 30 | |
| 0410 | each additional section over five | 1.0 | 30 | |
| *0411 | Cryotherapy-(CO2 slush, liquid N2) | *1.5 | 0 | |
| *0412 | Electrolysis epilation, each 1/2 hour | *3.0 | 0 | |
| (For actinotherapy and galvanic iontophoresis, see 9425-9427.) | ||||
| Breast | ||||
| Incision | ||||
| *0430 | Puncture aspiration of cyst | *2.0 | 0 | |
| 0431 | Mastotomy with exploration or drainage of abscess, deep | 10.0 | 14 | 3.0+T |
| Excision | ||||
| 0441 | Biopsy of breast | 15.0 | 30 | 3.0+T |
| 0444 | Excision of cyst, fibro-adenoma or other benign tumor, aberrant breast tissue, duct lesion (including gyneco-mastia) or nipple lesion (including any other partial mastectomy) male or female, unilateral | 15.0 | 30 | 3.0+T |
| 0445 | bilateral | 25.0 | 30 | 3.0+T |
| 0446 | Excision of chest wall tumor involving ribs | 70.0 | 60 | 9.0+T |
| 0447 | Excision of chest wall tumor involving ribs plus plastic reconstruction | 100.0 | 60 | 9.0+T |
| 0457 | Complete (simple) mastectomy | 30.0 | 45 | 3.0+T |
| 0470 | Radical mastectomy, including breast, pectoral muscles and axillary lymph nodes | 70.0 | 60 | 3.0+T |
| 0481 | Mammoplasty, plastic operation on breasts, reduction or repositioning, bilateral, one stage | 150.0 | 90 | 3.0+T |
| 0482 | two stage | by report | 3.0+T | |
| 0483 | augmentation, prosthetic, unilateral | 75.0 | 90 | 3.0+T |
| 0484 | bilateral | 100.0 | 90 | 3.0+T |
| 0485 | derma-fat fascia, unilateral | 100.0 | 90 | 3.0+T |
| MUSCULOSKELETAL SYSTEM | ||||
| Listed values include the application of first cast or traction device only. Values for major replacement casts and traction devices necessarily applied during listed period of aftercare to be added. | ||||
| Incision | ||||
| 0501 | Aspiration or curette biopsy of bone marrow | 3.0 | 7 | 3.0+T |
| (For sternal or iliac puncture, see L116) | ||||
| 0502 | Needle (Trocar) biopsy, vertebra | 10.0 | 7 | 4.0+T |
| *0506 | Incision of superficial soft tissue abscess secondary to osteomyelitis | *2.0 | 0 | 3.0+T |
| 0507 | deep or complicated | by report | 3.0+T | |
| 0513 | Sequestrectomy for osteomyelitis or bone abscess | by report | 30 | 3.0+T |
| 0516 | Removal of metal band, plate, screw or nail (independent procedure) | 15.0 | 15 | 3.0+T |
| (For pins, etc., see 0596, 0599.) | ||||
| OSTEOTOMY-Cutting, division or transection of bone, with or without internal fixation. | ||||
| 0526 | Clavicle | 40.0 | 90 | 3.0+T |
| 0527 | Humerus | 50.0 | 150 | 3.0+T |
| 0529 | Radius | 40.0 | 120 | 3.0+T |
| 0530 | Ulna | 40.0 | 120 | 3.0+T |
| 0531 | Femur, neck, under age 8 | 80.0 | 180 | 3.0+T |
| 0532 | over age 8 | 100.0 | 180 | 3.0+T |
| 0533 | subtrochanteric | 80.0 | 180 | 3.0+T |
| 0534 | supracondylar | 70.0 | 180 | 3.0+T |
| 0536 | Tibia | 55.0 | 150 | 3.0+T |
| 0537 | Smaller bones (fibula, metacarpals, metatarsals, etc.) | 30.0 | 120 | 3.0+T |
| 0538 | Correction of bowlegs or knock-knees, unilateral | 50.0 | 150 | 3.0+T |
| 0539 | bilateral | 75.0 | 150 | 3.0+T |
| (For iliac osteotomy, see 1341, 1342.) | ||||
| 0540 | Multiple osteotomies, single bones for realignment on intrameduallary rod, Scofield type procedure, humerous. | 50.00 | 150 | 3.0+T |
| 0541 | radius or ulna | 50.0 | 120 | 3.0+T |
| 0542 | femur | 100.0 | 180 | 3.0+T |
| 0543 | tibia | 75.0 | 150 | 3.0+T |
| Excision | ||||
| 0549 | Biopsy bone, radius, ulna, fibula, skull, sternum | 10.0 | 15 | 3.0+T |
| 0550 | humerus, pelvis, femur, tibia | 20.0 | 15 | 3.0+T |
| 0551 | vertebra | 40.0 | 45 | 3.0+T |
| (For needle biopsy, see 0502.) | ||||
| (Value of biopsy done preceding definitive surgery is 50 percent of listed value.) | ||||
| 0552 | Claviculectomy, partial | 35.0 | 60 | 3.0+T |
| 0553 | total | 65.0 | 60 | 3.0+T |
| 0554 | Astragalectomy | 55.0 | 120 | 3.0+T |
| 0556 | Excision of head of radius | 35.0 | 90 | 3.0+T |
| 0557 | Carpectomy | 30.0 | 90 | 3.0+T |
| 0560 | Coccygectomy | 30.0 | 90 | 4.0+T |
| 0561 | Patelectomy or hemipatellectomy | 50.0 | 120 | 3.0+T |
| 0563 | Metatarsectomy | 25.0 | 60 | 3.0+T |
| 0566 | Excision of chondroma, osteochondroma, or exostosis; humerus, pelvis, femur, tibia, radius, fibula, ulna | 40.0 | 150 | 3.0+T |
| 0567 | small bones | 25.00 | 90 | 3.0+T |
| 0568 | Excision of bone cyst, simple, large bones | 40.0 | 120 | 3.0+T |
| 0569 | small bones | 25.00 | 90 | 3.0+T |
| (With autogenous bone graft, add 10.0 units to 0568, 0569.) | ||||
| 0576 | Partial ostectomy; partial excision of bone, craterization, guttering or saucerization of bone; diaphysectomy; humerus, pelvis, femur, tibia, fibula, radius, ulna | 50.0 | 150 | 3.0+T |
| 0577 | small bones | 25.0 | 90 | 3.0+T |
| 0578 | Excision of tumor of mandible without replacement | 75.00 | 90 | 6.0+T |
| (For replacement see 0619.) | ||||
| 0580 | Radical resection of bones for tumor with bone graft; scapula, humerus, pelvis, femur, tibia | 100.0 | 120 | 5.0+T |
| 0581 | other bones | 65.0 | 90 | 3.0+T |
| Introduction | ||||
| (For associated procedures, see Fractures.) | ||||
| (For injection procedure for intraosseus venography, see radiology.) | ||||
| *0591 | Insertion of wire, pin, caliper or tongs (independent procedure) | *5.0 | 0 | 3.0+T |
| *0598 | Removal buried wire or pin (independent procedure) | *2.0 | 0 | 3.0+T |
| *0599 | Removal of caliper or tongs (independent procedure) | *1.0 | 0 | 3.0+T |
| Repair | ||||
| 0611 | Osteoplasty; shortening of bone, femur, tibia, humerus | 100.0 | 180 | 3.0+T |
| 0612 | radius, ulna | 65.0 | 120 | 3.0+T |
| 0613 | other bones | 45.0 | 90 | 3.0+T |
| 0614 | lengthening of bone | 100.0 | 365 | 3.0+T |
| 0616 | mandible for prognathism or micrognathism, one or two stages | 100.0 | 90 | 5.0+T |
| BONE OR CARTILAGE GRAFT-Osteoperiosteal graft, periosteal graft, or cartilage graft. Includes otbaining and placing of graft. Unless otherwise indicated, values are for autogenous graft. When non-autogenous material is used, reduce value by 5.0 units. | ||||
| 0617 | Bone graft; femur, tibia, humerus | 100.0 | 180 | 3.0+T |
| 0618 | radius, ulna | 65.0 | 150 | 3.0+T |
| 0619 | skull or significant portion of mandible | 100.0 | 180 | 7.0+T |
| 0620 | other bones, including chin, nose, malar prominences | 45.0 | 120 | 3.0+T |
| 0621 | Cartilage graft, autogenous, to face, nose, ear or skull | 70.0 | 120 | 7.0+T |
| Spinal Fusion (For fusion of childhood scoliosis, see 0643, 0644, 0645.) | ||||
| (Items 0634-0642 refer to spinal procedures at one interspace; for each additional interspace, add 10%.) (If two surgeons are involved, see sections 533.3(c) and 533.5(b)(7).) | ||||
| 0634 | Spinal fusion, cervical region, posterior technique | 90.0 | 180 | 7.0+T |
| 0635 | anterior technique | 80.0 | 180 | 7.0+T |
| 0636 | thoracic region, posterior or posterior-lateral technique | 90.0 | 180 | 7.0+T |
| 0637 | interbody technique, anterior, lateral or posterior | 100.0 | 270 | 7.0+T |
| 0638 | lumbar region, posterior or posterior-lateral technique | 90.0 | 270 | 7.0+T |
| (For interbody technique, anterior see 0642.) | ||||
| 0639 | Spinal fusion with removal of intervertebral disc, cervical region, posterior, technique | 120.0 | 180 | 7.0+T |
| 0640 | anterior interbody technique | 80.00 | 180 | 7.0+T |
| 0641 | lumbar or thoracic region, posterior, posterior-lateral, or posterior interbody technique | 120.0 | 270 | 7.0+T |
| 0642 | anterior interbody technique | 100.0 | 270 | 7.0+T |
| 0643 | Spinal fusion for scoliosis, child or young adult (less than 18 years of age), up to and including five interspaces | 120.0 | 270 | 7.0+T |
| 0644 | Harrington rod technique | 150.0 | 270 | 7.0+T |
| 0645 | Halo technique | 150.0 | 270 | 9.0+T |
| (For adult scoliotic fusion see 0634-0642.) | ||||
| 0647 | Scapulopexy | 65.0 | 90 | 6.0+T |
| 0648 | Patellapexy | 50.0 | 90 | 3.0+T |
| 0649 | Pectus excavatum, infants, plastic repair | 25.0 | 60 | 3.0+T |
| 0650 | Pectus excavatum (major) plastic repair | 90.0 | 90 | 9.0+T |
| 0654 | Epiphyseal-diaphyseal fusion; epiphyseal arrest; epiphysiodesis or stapling; femur | 55.0 | 90 | 3.0+T |
| 0655 | tibia and fibula, proximal or distal | 55.0 | 90 | 3.0+T |
| 0656 | combined distal femur and proximal tibia and fibula (knee) | 75.0 | 90 | 3.0+T |
| 0657 | combined proximal and distal, tibia and fibula | 75.0 | 90 | 3.0+T |
| 0658 | combined distal femur and proximal and distal tibia and fibula | 100.0 | 120 | 3.0+T |
| 0660 | Hemi-epiphyseal arrest (e.g. for genu varus or genu valgus) distal femur | 45.0 | 180 | 3.0+T |
| (For removal and reinsertion of staples at same operation, use values listed above.) | ||||
| (For removal of staples only, 50% of listed values.) | ||||
| (Freeing of bone adhesions, callus or synostosis, independent procedure, see Ostectomy.) | ||||
| FRACTURES | ||||
| Skull | ||||
| 0681 | Skull, non-operative | Sv. ¶ | ||
| (Depressed with operation, see 5018, 5020.) | ||||
| Facial Bones | ||||
| 0685 | Nasal, simple or compound, no reduction | Sv. ¶ | ||
| *0686 | uncomplicated (digital) closed reduction | *5.0 | 0 | |
| 0687 | complicated (instrumental) closed reduction | 10.0 | 30 | 4.0+T |
| 0688 | open reduction, uncomplicated | 25.0 | 30 | 4.0+T |
| 0689 | complicated with either internal and/or external skeletal fixation | 40.0 | 45 | 4.0+T |
| 0690 | with concomitant open reduction of fractured septum | 60.0 | 45 | |
| 0691 | Malar, simple or compound, no reduction | Sv. ¶ | ||
| *0692 | closed reduction (including towel clip technique) | *5.0 | 0 | 4.0+T |
| 0693 | depressed, open reduction | 30.0 | 60 | 4.0+T |
| 0694 | complicated, depressed, open reduction with internal skeletal fixation and multiple surgical approaches | 65.0 | 90 | 5.0+T |
| 0698 | Maxilla, simple or compound, no reduction | Sv. ¶ | ||
| 0699 | closed reduction, with wiring of teeth | 30.0 | 90 | 4.0+T |
| 0701 | open reduction, with wiring of teeth and/or local fixation | 50.0 | 90 | 4.0+T |
| 0702 | complicated, open reduction, fixation by head cap, multiple surgical approaches, internal fixation, wiring teeth, etc. | by report | 90 | 6.0+T |
| (For antral approach, see 1988.) | ||||
| 0703 | Mandible, simple or compound, no reduction | Sv. ¶ | ||
| 0704 | closed reduction and wiring of teeth | 30.0 | 90 | 4.0+T |
| 0705 | open reduction with or without wiring of teeth | 50.0 | 90 | 4.0+T |
| 0706 | skeletal pinning with external fixation | 40.0 | 90 | 4.0+T |
| Spine and Trunk | ||||
| 0720 | Vertebral process, one or more | Sv. ¶ | ||
| 0721 | Vertebral body, one or more not requiring reduction | Sv. ¶ | ||
| 0722 | requiring reduction | 30.0 | 180 | 3.0+T |
| 0732 | Sacrum, simple, not requiring reduction | Sv. ¶ | ||
| 0733 | compound or complex | by report | ||
| 0735 | Coccyx, simple, not requiring reduction | Sv. ¶ | ||
| 0736 | compound or complicated | by report | ||
| 0740 | Clavicle, simple, no reduction | Sv. ¶ | ||
| 0741 | simple, closed reduction | 15.0 | 90 | 3.0+T |
| 0742 | compound, including uncomplicated soft tissue closure | 20.0 | 90 | 3.0+T |
| 0743 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0747 | Scapula, simple, no reduction | Sv. ¶ | ||
| 0748 | simple or compound, open reduction | 55.0 | 90 | 3.0+T |
| 0756 | Sternum, simple | Sv. ¶ | ||
| 0757 | compound or complicated | by report | 3.0+T | |
| 0761 | Ribs, simple | Sv. ¶ | ||
| 0762 | compound or complicated | by report | 3.0+T | |
| Pelvis (Ilium, Ischium, Pubis) | ||||
| 0767 | Fracture, simple, no reduction | Sv. ¶ | ||
| 0768 | complicated, closed reduction | by report | 3.0+T | |
| 0771 | compound, open reduction | 75.0 | 120 | 3.0+T |
| 0772 | Acetabulum, with or without other fractures of pelvis, simple, no reduction | Sv. ¶ | ||
| 0773 | central, with displacement, requiring closed reduction | 55.0 | 180 | 3.0+T |
| 0775 | simple or compound, open reduction | 75.0 | 180 | 3.0+T |
| Upper Extremity | ||||
| 0778 | Humerus, surgical neck, simple, not requiring reduction | Sv. ¶ | ||
| 0780 | requiring manipulative reduction | 30.0 | 120 | 3.0+T |
| 0781 | compound, with uncomplicated soft tissue closure | 35.0 | 120 | 3.0+T |
| 0782 | simple or compound, open reduction | 50.0 | 120 | 3.0+T |
| 0783 | shaft, simple, not requiring reduction | Sv. ¶ | ||
| 0784 | simple, closed reduction | 25.0 | 120 | 3.0+T |
| 0785 | compound, with uncomplicated soft tissue closure | 30.0 | 120 | 3.0+T |
| 0786 | simple or compound, open reduction | 45.0 | 120 | 3.0+T |
| 0787 | simple or compound, open reduction, skeletal pinning with external fixation | 40.0 | 120 | 3.0+T |
| 0788 | supracondylar or dicondylar, nor requiring reduction | Sv. ¶ | ||
| 0789 | closed reduction | 25.0 | 120 | 3.0+T |
| 0790 | compound with uncomplicated soft tissue closure | 30.0 | 120 | 3.0+T |
| 0791 | simple or compound, open reduction | 50.0 | 120 | 3.0+T |
| 0792 | medial or lateral condyle, simple not requiring reduction | Sv. ¶ | ||
| 0793 | closed reduction | 20.0 | 120 | 3.0+T |
| 0794 | compound with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0795 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0796 | Elbow, proximal end of ulna with dislocation of radial head, simple, (Monteggia, fracture) closed reduction | 20.0 | 90 | 3.0+T |
| 0797 | simple or compound, open reduction | 55.0 | 120 | 3.0+T |
| (see also 1292.) | ||||
| 0798 | Radius, head, simple, no reduction | Sv. ¶ | ||
| 0799 | closed reduction | 15.0 | 60 | 3.0+T |
| 0800 | compound with uncomplicated soft tissue closure | 20.0 | 60 | 3.0+T |
| 0801 | simple or compound, open reduction or excision (See also 0556.) | 35.0 | 90 | 3.0+T |
| 0802 | shaft, simple, no reduction | Sv. ¶ | ||
| 0803 | simple, closed reduction | 20.0 | 120 | 3.0+T |
| 0804 | compound, with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0805 | simple or compound, open reduction | 40.0 | 150 | 3.0+T |
| 0806 | distal end (e.g. Colle's type), simple, no reduction | Sv. ¶ | ||
| 0807 | closed reduction | 15.0 | 120 | 3.0+T |
| 0808 | with severe comminution and impaction, closed reduction | 20.0 | 120 | 3.0+T |
| 0809 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0810 | skeletal pinning, with external fixation | 30.0 | 120 | 3.0+T |
| 0811 | Ulna, proximal end, olecranon process, simple, no reduction | Sv. ¶ | ||
| 0812 | compound with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0813 | simple or compound, open reduction and/or resection | 40.0 | 120 | 3.0+T |
| 0814 | shaft, simple, no reduction | Sv. ¶ | ||
| 0815 | closed reduction | 20.0 | 120 | 3.0+T |
| 0816 | compound, with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0817 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0818 | skeletal pinning with external fixation | 30.0 | 120 | 3.0+T |
| 0820 | Radius and ulna shaft, simple, no reduction | Sv. ¶ | ||
| 0821 | simple, closed reduction | 25.0 | 120 | 3.0+T |
| 0822 | compound, with uncomplicated soft tissue closure | 30.0 | 120 | 3.0+T |
| 0823 | simple or compound, open reduction | 50.0 | 150 | 3.0+T |
| 0824 | skeletal pinning with eterxnal fixation | 40.0 | 150 | 3.0+T |
| (For Colle's fracture see 0806-0810.) | ||||
| 0827 | Carpal bones, one or more, simple reduction | Sv. ¶ | ||
| 0830 | simple or compound, open reduction | 35.0 | 120 | 3.0+T |
| 0840 | Metacarpal, simple, no reduction | Sv. ¶ | ||
| 0842 | one, simple or compound, closed reduction with uncomplicated soft tissue closure | 10.0 | 45 | 3.0+T |
| 0843 | more than one, simple or compound, closed reduction, with uncomplicated soft tissue closure | 12.5 | 60 | 3.0+T |
| 0844 | one or more, simple or compound, open reduction | 30.0 | 90 | 3.0+T |
| 0848 | skeletal pinning with external fixation | 25.0 | 90 | 3.0+T |
| 0852 | Phalanx or phalanges, finger, proximal, middle or thumb, simple, no reduction | Sv. ¶ | ||
| 0853 | closed reduction | 7.5 | 45 | 3.0+T |
| 0854 | compound, with uncomplicated soft tissue closure | 10.0 | 45 | 3.0+T |
| 0855 | simple or compound, open reduction | 20.0 | 60 | 3.0+T |
| 0856 | Phalanx or phalanges, distal, simple, no reduction | Sv. ¶ | ||
| 0857 | simple or compound, closed reduction with uncomplicated soft tissue closure | 5.0 | 30 | 3.0+T |
| 0858 | simple or compound, open reduction | 12.5 | 45 | 3.0+T |
| LOWER EXTREMITY | ||||
| 0865 | Femur, neck, simple, no reduction | Sv. ¶ | ||
| 0866 | with fixation or traction | 50.0 | 180 | 3.0+T |
| 0867 | simple or compound, open reduction | 80.0 | 180 | 5.0+T |
| 0868 | multiple pinning, with or without external fixation | 80.0 | 180 | 5.0+T |
| 0869 | treatment with replacement prosthesis | 80.0 | 180 | 6.0+T |
| 0872 | intertrochanteric, simple, no reduction | Sv. ¶ | ||
| 0873 | with fixation or traction | 45.0 | 180 | 3.0+T |
| 0874 | simple or compound, open reduction | 80.0 | 180 | 5.0+T |
| 0877 | slipped epiphysis, no reduction, treatment by traction, bed rest or cast application | Sv. ¶ | ||
| 0878 | open reduction, single or multiple pinning or bone graft | 80.0 | 180 | 5.0+T |
| 0879 | reconstruction | 100.0 | 180 | 5.0+T |
| 0880 | shaft, including supracondylar, simple, no reduction | Sv. ¶ | ||
| 0881 | simple, closed reduction | 40.0 | 180 | 3.0+T |
| 0882 | compound, with uncomplicated soft tissue closure | 45.0 | 180 | 3.0+T |
| 0883 | simple or compound, open reduction | 80.0 | 180 | 3.0+T |
| 0884 | skeletal pinning with external fixation | 60.0 | 180 | 3.0+T |
| 0885 | distal end, medial or lateral condyle, simple, no reduction | Sv. ¶ | ||
| 0886 | condyle or condyles, simple, closed reduction | 35.0 | 120 | 3.0+T |
| 0887 | simple or compound, open reduction | 60.0 | 150 | 3.0+T |
| 0889 | Patella, simple, no reduction | Sv. ¶ | ||
| 0890 | compound, with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0891 | simple or compound, open reduction | 50.0 | 120 | 3.0+T |
| 0893 | Tibia, proximal end, tibial plateaus, condyle, condyles or intercondylar spines, simple, no reduction | Sv. ¶ | ||
| 0894 | close reduction | 25.0 | 120 | 3.0+T |
| 0895 | compound with uncomplicated soft tissue closure | 30.0 | 120 | 3.0+T |
| 0896 | simple or compound, open reduction | 55.0 | 150 | 3.0+T |
| 0901 | shaft, simple, no reduction | Sv. ¶ | ||
| 0902 | closed reduction | 25.0 | 180 | 3.0+T |
| 0903 | compound with uncomplicated soft tissue closure | 30.0 | 180 | 3.0+T |
| 0904 | simple or compound, open reduction | 50.0 | 180 | 3.0+T |
| 0905 | simple or compound, open or "lind"insertion of intramedullary rod (e.g. Lottes nail) | 50.0 | 180 | 3.0+T |
| 0907 | distal end, malleolus, simple, no reduction | Sv. ¶ | ||
| 0908 | simple, closed reduction | 15.0 | 120 | 3.0+T |
| 0909 | compound with uncomplicated soft tissue closure | 20.0 | 120 | 3.0+T |
| 0910 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0914 | Fibula, shaft, simple, no reduction | Sv. ¶ | ||
| 0915 | compound, with uncomplicated soft tissue closure | 20.0 | 60 | 3.0+T |
| 0916 | simple or compound, open reduction | 30.0 | 60 | 3.0+T |
| 0920 | distal end, malleolus, simple, no reduction | Sv. ¶ | ||
| 0921 | closed reduction | 15.0 | 75 | 3.0+T |
| 0922 | compound with uncomplicated soft tissue closure | 20.0 | 120 | 3.0+T |
| 0923 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 0925 | Tibia and fibula, shafts, simple, no reduction | Sv. ¶ | ||
| 0926 | closed reduction | 30.0 | 180 | 3.0+T |
| 0927 | compound with uncomplicated soft tissue closure | 35.0 | 180 | 3.0+T |
| 0928 | simple or compound, open reduction | 60.0 | 180 | 3.0+T |
| 0930 | skeletal pinning with external fixation | 40.0 | 180 | 3.0+T |
| 0932 | Ankle, bimalleolar (including Potts) simple, no reduction | Sv. ¶ | ||
| 0933 | simple, closed reduction | 25.0 | 150 | 3.0+T |
| 0934 | compound with uncomplicated soft tissue closure | 30.0 | 150 | 3.0+T |
| 0935 | simple or compound, open reduction | 50.0 | 150 | 3.0+T |
| 0937 | trimalleolar, simple, no reduction | Sv. ¶ | ||
| 0938 | closed reduction | 30.0 | 150 | 3.0+T |
| 0940 | compound with uncomplicated soft tissue closure | 35.0 | 150 | 3.0+T |
| 0941 | simple or compound, open reduction | 60.0 | 150 | 3.0+T |
| 0943 | Tarsal (except astragalus and os calcis) one or more, simple, no reduction | Sv. ¶ | ||
| 0944 | closed reduction | 10.0 | 90 | 3.0+T |
| 0945 | compound with uncomplicated soft tissue closure | 15.0 | 90 | 3.0+T |
| 0946 | simple or compound, open reduction | 30.0 | 90 | 3.0+T |
| 0954 | Astragalus, simple, no reduction | Sv. ¶ | ||
| 0955 | simple, closed reduction | 20.0 | 120 | 3.0+T |
| 0956 | compound with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 0957 | simple or compound, open reduction | 55.0 | 120 | 3.0+T |
| 0960 | Os calcis, simple, no reduction | Sv. ¶ | ||
| 0961 | closed reduction | 20.0 | 120 | 3.0+T |
| 0962 | compound, with uncomplicated soft tissue closure | 25.0 | 270 | 3.0+T |
| 0963 | simple or compound, open reduction | 50.0 | 270 | 3.0+T |
| 0964 | skeletal pinning with external fixation | 40.0 | 270 | 3.0+T |
| 0966 | Metatarsal, simple, no reduction | Sv. ¶ | ||
| 0967 | closed reduction | 10.0 | 90 | 3.0+T |
| 0968 | compound with uncomplicated soft tissue closure | 15.0 | 90 | 3.0+T |
| 0970 | simple or compound, open reduction | 25.0 | 90 | 3.0+T |
| 0975 | Phalanx or phalanges, great toe, simple, no reduction | Sv. ¶ | ||
| 0976 | simple, closed reduction | 5.0 | 60 | 3.0+T |
| 0977 | simple or compound, open reduction | 15.0 | 60 | 3.0+T |
| 0979 | other than great toe, simple, no reduction | Sv. ¶ | ||
| 0981 | closed reduction | 5.0 | 60 | 3.0+T |
| 0982 | simple or compound, open reduction | 12.5 | 60 | 3.0+T |
| Joints | ||||
| Incision | ||||
| ARTHROTOMY or capsulotomy with exploration, drainage, or removal of loose body, e.g., osteochondritis or foreign body. | ||||
| 1001 | Shoulder | 50.0 | 90 | 3.0+T |
| 1002 | Elbow | 50.0 | 60 | 3.0+T |
| 1003 | Wrist | 40.0 | 60 | 3.0+T |
| 1005 | Other joints of upper extremity | 30.0 | 60 | 3.0+T |
| 1006 | Finger, one | 15.0 | 60 | 3.0+T |
| 1007 | Hip | 70.0 | 90 | 3.0+T |
| 1008 | Knee | 50.0 | 90 | 3.0+T |
| (For meniscectomy, see 1082.) | ||||
| 1010 | Ankle | 50.0 | 90 | 3.0+T |
| 1013 | Other joints of lower extremity | 30.0 | 90 | 3.0+T |
| 1020 | Toe great toe | 15.0 | 60 | 3.0+T |
| 1026 | other | 10.0 | 60 | 3.0+T |
| *1044 | Arthrocentesis; puncture for aspiration of hemarthrosis, initial | *3.0 | 0 | 3.0+T |
| *1045 | subsequent | *2.0 | 0 | 3.0+T |
| *1046 | puncture for aspiration of joint effusion (not traumatic), or injection of medication, initial or subsequent | *2.0 | 0 | 3.0+T |
| 1050 | Sesamoid bone, excision, one or more, unilateral | 15.0 | 60 | 3.0+T |
| Excision | ||||
| ARTHRECTOMY-Excision of joint (See also Arthrodesis.) | ||||
| 1065 | Temporomandibular Joint, unilateral | 75.0 | 90 | 5.0+T |
| 1074 | Excision of intervertebral disc | 90.0 | 90 | 7.0+T |
| (See also 5208-5211.) | ||||
| (With spinal fusion, see 0639-0642.) | ||||
| (For laminectomy for spondylolisthesis, see 5225.) | ||||
| 1082 | Menisectomy: excision of semilunar cartilage of knee joint | 50.0 | 90 | 3.0+T |
| 1085 | temporomandibular joint | 75.0 | 90 | 5.0+T |
| 1093 | Synovectomy elbow | 70.0 | 120 | 3.0+T |
| 1101 | hip | 80.0 | 120 | 4.0+T |
| 1102 | knee | 70.0 | 120 | 3.0+T |
| 1103 | ankle | 50.0 | 120 | 3.0+T |
| Introduction | ||||
| *1131 | Injection procedure for arthrography | *3.0 | 0 | 3.0+T |
| Repair | ||||
| ARTHROPLASTY-Plastic or reconstructive operation on Joint, any type unless otherwise specified. | ||||
| 1141 | Shoulder (See also 1200, 1201.) | 80.0 | 120 | 3.0+T |
| 1142 | Elbow | 80.0 | 120 | 3.0+T |
| 1143 | Wrist | 80.0 | 120 | 3.0+T |
| 1144 | Finger, one joint | 30.0 | 90 | 3.0+T |
| 1148 | Hip, cup | 100.0 | 270 | 5.0+T |
| 1149 | replacement prosthesis, primary for fracture | 80.0 | 270 | 5.0+T |
| 1150 | secondary reconstruction | 100.0 | 270 | 5.0+T |
| (For acetabuloplasty, either 1148 or 1150, add 25% to listed values.) | ||||
| 1151 | Knee | 100.0 | 270 | 3.0+T |
| 1152 | Ankle | 75.0 | 180 | 3.0+T |
| 1154 | Toe, one joint | 20.0 | 60 | 3.0+T |
| 1159 | Metatarsal-phalangeal joint; bunion operation, Silver type | 20.0 | 60 | 3.0+T |
| 1160 | Keller, McBride, etc., types | 30.0 | 120 | 3.0+T |
| 1162 | Joplin type | 35.0 | 150 | 3.0+T |
| 1163 | Club foot corrective procedure, medial release, Brockman type | 30.0 | 120 | 3.0+T |
| ARTHRODESIS- Fusion of joint (For spine see 0634-0645.) | ||||
| 1166 | Shoulder | 90.0 | 150 | 3.0+T |
| 1167 | Elbow | 70.0 | 150 | 3.0+T |
| 1168 | Wrist | 60.0 | 120 | 3.0+T |
| 1170 | Finger, thumb, one joint | 20.0 | 120 | 3.0+T |
| 1175 | Hip | 100.0 | 365 | 5.0+T |
| 1176 | Knee | 80.0 | 180 | 3.0+T |
| 1177 | Ankle | 70.0 | 180 | 3.0+T |
| 1178 | Toe, one or more joints | 15.0 | 120 | 3.0+T |
| 1179 | Hammer toe operation, one toe (e.g., inter-phalangeal fusion, filleting, phalangectomy) | 20.0 | 120 | 3.0+T |
| (More than one toe, see section 533.5(b)(6)(i).) | ||||
| 1183 | Tarsal joints, one or more (e.g. Grice procedure) | 50.0 | 120 | 3.0+T |
| 1184 | Other joints, lower extremity | 40.0 | 120 | 3.0+T |
| 1185 | Foot, triple arthrodesis, unilateral under age 14 years | 50.0 | 180 | 3.0+T |
| 1186 | over age 14 years | 60.0 | 180 | 3.0+T |
| (With tendon transplantation see 1585, 1586, and see section 533.5(b)(6)(i).) | ||||
| Suture | ||||
| CAPSULORRAPHY OR RECONSTRUCTION | ||||
| 1200 | Shoulder, suture or repair of joint capsule for recurrent dislocation (independent procedure), Putti-Platt, Mag-nusen types | 70.0 | 90 | 3.0+T |
| 1201 | Bankart type | 80.0 | 90 | 3.0+T |
| 1206 | Patella (See also 0561, 1352, 1632.) | 60.0 | 120 | 3.0+T |
| 1211 | Knee, suture of a torn, ruptured or severed collateral ligament | 55.0 | 120 | 3.0+T |
| 1212 | suture of a torn, ruptured, or severed cruciate ligament | 55.0 | 120 | 3.0+T |
| 1213 | suture of torn, ruptured or severed collateral and cruciate ligaments | 75.0 | 180 | 3.0+T |
| 1214 | reconstruction of a collateral or cruiate ligament | 65.0 | 180 | 3.0+T |
| 1215 | both collateral or cruciate ligaments | 85.0 | 180 | 3.0+T |
| 1216 | Ankle, reconstruction of a collateral ligament, ankle | 45.0 | 180 | 3.0+T |
| 1217 | both ligaments | 60.0 | 180 | 3.0+T |
| 1218 | Hand, reconstruction, metacarpophalangeal or interphalangeal ligaments | 35.0 | 90 | 3.0+T |
| Manipulation | ||||
| Manipulation of joint under general anesthesia, including application of fixation apparatus (dislocation excluded). | ||||
| (For club feet and turnbuckle casts, see section on casts.) | ||||
| *1221 | Shoulder | *5.0 | 0 | 3.0+T |
| *1222 | Elbow | *4.0 | 0 | 3.0+T |
| *1223 | Wrist | *4.0 | 0 | 3.0+T |
| *1224 | Digits, one or more, under anesthesia, where no other surgical procedure is performed | *2.5 | 0 | 3.0+T |
| *1226 | Hip | *6.0 | 0 | 3.0+T |
| *1227 | Knee | *5.0 | 0 | 3.0+T |
| *1228 | Ankle | *4.0 | 0 | 3.0+T |
| *1232 | Spine | 6.0 | 0 | 3.0+T |
| Dislocations | ||||
| *1251 | Temporomandibular, simple closed reduction, initial | *5.0 | 0 | 3.0+T |
| *1252 | subsequent | *1.0 | 0 | |
| 1255 | Vertebra, cervical, simple, closed reduction, using traction | Sv. ¶ | ||
| 1256 | closed reduction with anesthesia | 55.0 | 180 | 3.0+T |
| 1262 | thoracic, simple, closed reduction with anesthesia.... | 55.0 | 180 | 3.0+T |
| 1264 | simple or compound, open reduction | 100.0 | 180 | 6.0+T |
| 1267 | lumbar, simple, closed reduction with anesthesia | 55.0 | 180 | 3.0+T |
| 1270 | simple or compound, open reduction | 100.0 | 180 | 6.0+T |
| 1273 | Clavicle, sternoclavicular, simple, no reduction | Sv. ¶ | ||
| 1274 | closed reduction with anesthesia | 10.0 | 45 | 3.0+T |
| 1275 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 1278 | acromioclavicular, simple, no reduction | Sv. ¶ | ||
| 1279 | closed reduction with anesthesia | 10.0 | 45 | 3.0+T |
| 1281 | simple or compound, open reduction | 40.0 | 120 | 3.0+T |
| 1284 | Shoulder (humerus), simple, closed reduction, without anesthesia | Sv. ¶ | ||
| *1285 | with anesthesia | *5.0 | 0 | 3.0+T |
| 1286 | simple or compound, open reduction | 55.0 | 120 | 3.0+T |
| *1290 | Elbow, simple, closed reduction | *5.0 | 0 | 3.0+T |
| 1291 | compound with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 1292 | simple or compound, open reduction | 55.0 | 120 | 3.0+T |
| *1295 | Wrist, carpal, one bone, simple, closed reduction | *5.0 | 0 | 3.0+T |
| 1296 | compound, with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 1297 | simple or compound, open reduction | 45.0 | 120 | 3.0+T |
| *1298 | more than one bone, simple, closed reduction | *7.0 | 0 | 3.0+T |
| 1300 | compound, with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 1301 | simple or compound. open reduction | 45.0 | 120 | 3.0+T |
| *1304 | Metacarpal, one bone, simple, closed reduction | *3.0 | 0 | 3.0+T |
| 1305 | compound with uncomplicated soft tissue closure | 10.0 | 90 | 3.0+T |
| 1306 | simple or compound, open reduction | 20.0 | 90 | 3.0+T |
| *1315 | Finger, one, one or more joints, simple, closed reduction | *3.0 | 0 | 3.0+T |
| 1316 | compound, with uncomplicated soft tissue closure | 7.5 | 75 | 3.0+T |
| 1317 | simple or compound. open reduction | 15.0 | 75 | 3.0+T |
| *1326 | Thumb, simple, closed reduction | *4.0 | 0 | 3.0+T |
| 1327 | compound with uncomplicated soft tissue closure | 10.0 | 75 | 3.0+T |
| 1328 | simple or compound, open reduction | 20.0 | 75 | 3.0+T |
| 1332 | Hip (femur), simple, closed reduction | 20.0 | 180 | 3.0+T |
| 1334 | simple or compound. open reduction | 60.0 | 180 | 5.0+T |
| 1338 | congenital, abduction splinting or traction in any form | Sv. ¶ | ||
| 1339 | congenital, closed reduction with anesthesia | 20.0 | 45 | 3.0+T |
| 1340 | congenital, open reduction and replacement of fe-moral head in acetabulum | 60.0 | 180 | 4.0+T |
| 1341 | iliac or acetabular osteotomy, (e.g., Pemberton or Salter type), under age 8 | 80.0 | 180 | 4.0+T |
| 1342 | over age 8 | 100.0 | 180 | 5.0+T |
| (For dislocated or slipped femoral head epiphyses, see 0877-0879.) | ||||
| 1344 | Knee (femoral-tibial joint), simple, closed reduction | 20.0 | 90 | 3.0+T |
| 1345 | compound with uncomplicated soft tissue closure | 25.0 | 120 | 3.0+T |
| 1346 | simple or compound, open reduction | 60.0 | 120 | 3.0+T |
| *1350 | Patella, simple, closed reduction | *3.0 | 0 | |
| 1351 | compound with uncomplicated soft tissue closure | 15.0 | 120 | 3.0+T |
| 1352 | simple or compound, open reduction (with or without partial or total patellectomy) | 50.0 | 120 | 3.0+T |
| (See also 0561, 1206 and 1632.) | ||||
| 1354 | Distal tibial-fibular joint (ankle mortise), open reduction and fixation | 45.0 | 90 | 3.0+T |
| 1355 | Ankle, simple, closed reduction | 10.0 | 90 | 3.0+T |
| 1356 | compound, with uncomplicated soft tissue closure | 25.0 | 90 | 3.0+T |
| 1357 | simple or compound, open reduction | 50.0 | 90 | 3.0+T |
| 1361 | Tarsal, simple, closed reduction | 10.0 | 90 | 3.0+T |
| 1362 | compound, with uncomplicated soft tissue closure | 17.5 | 90 | 3.0+T |
| 1363 | simple or compound, open reduction | 45.0 | 120 | 3.0+T |
| 1371 | Astragalo-tarsal, simple, closed reduction | 10.0 | 90 | 3.0+T |
| 1372 | compound with uncomplicated soft tissue closure | 17.5 | 180 | 3.0+T |
| 1373 | simple or compound, open reduction | 45.0 | 180 | 3.0+T |
| 1376 | Metatarsal, one bone, simple, closed reduction | 7.0 | 45 | 3.0+T |
| 1377 | compound with uncomplicated soft tissue closure | 12.0 | 60 | 3.0+T |
| 1378 | simple or compound, open reduction | 25.0 | 60 | 3.0+T |
| *1385 | Toe, one, simple, closed reduction | *2.0 | 0 | |
| 1386 | compound with uncomplicated soft tissue closure | 7.0 | 15 | 3.0+T |
| 1387 | simple or compound, open reduction | 15.0 | 45 | 3.0+T |
| 1391 | multiple joints and/or toes, simple, closed reduction | 7.0 | 30 | 3.0+T |
| 1392 | compound with uncomplicated soft tissue closure | 12.0 | 45 | 3.0+T |
| 1393 | simple or compound, open reduction | 20.0 | 45 | 3.0+T |
| Bursae | ||||
| Incision | ||||
| *1401 | Drainage of infected bursa | *3.0 | 0 | 3.0+T |
| 1406 | Removal of subdeltoid calcium deposits | 25.0 | 60 | 3.0+T |
| 1410 | Removal of subtrochanteric calcium deposits | 30.0 | 60 | 3.0+T |
| *1413 | Needle puncture of bursa, with or without aspiration, injection or irrigation, initial or subsequent | *2.0 | 0 | |
| Excision | ||||
| 1430 | Radical excision of bursa, hand, wrist or forearm, (i.e., tenosynovitis fungosa, Tbc., and other granulomas) | 50.0 | 60 | 3.0+T |
| 1431 | Excision of bursa, olecranon | 20.0 | 60 | 3.0+T |
| 1433 | prepatellar | 20.0 | 60 | 3.0+T |
| 1435 | subacromial (subdeltoid) | 25.0 | 90 | 3.0+T |
| 1436 | peritrochanteric, femur | 30.0 | 90 | 3.0+T |
| (For popliteal see 1562.) | ||||
| Muscles | ||||
| Incision | ||||
| 1450 | Removal of foreign body in muscle, with anesthesia | by report | ||
| 1454 | Division of scalenus anticus, without resection of cervical rib | 35.0 | 60 | 3.0+T |
| 1456 | with resection of cervical rib | 50.0 | 60 | 5.0+T |
| 1458 | Division of sternocleidomastoid for torticollis, open operation | 35.0 | 60 | 3.0+T |
| 1460 | Muscle biopsy, superficial | 5.0 | 15 | 3.0+T |
| 1462 | deep | 10.0 | 15 | 3.0+T |
| Suture | ||||
| 1495 | Suture of ruptured diaphragm, chronic, transabdominal | 70.0 | 60 | 5.0+T |
| 1496 | transthoracic or combined | 80.0 | 60 | 11.0+T |
| 1497 | acute, traumatic | by report | 60 | 13.0+T |
| (For other specific muscles, see 1683, 1640, 1654.) | ||||
| Tendons, Tendon Sheaths and Fascia | ||||
| Incision | ||||
| *1511 | Drainage of tendon sheath, acute suppurative tenosynovitis, one digit | *3.0 | 0 | 3.0+T |
| 1514 | single palmar and/or ulnar or radial bursa | 30.0 | 60 | 3.0+T |
| 1515 | multiple or complicated | by report | 60 | 3.0+T |
| *1517 | Injection of medication, tendon sheath | *2.0 | 0 | |
| 1519 | Incision of fibrous sheath of tendon for stenosing tenosynovitis, including freeing of tendons or removal of foreign body | 20.0 | 30 | 3.0+T |
| 1531 | Division of iliotibial band, open operation | 30.0 | 45 | 3.0+T |
| 1534 | Stripping of ilium (Soutter operation) | 40.0 | 90 | 3.0+T |
| Tenotomy | ||||
| *1535 | Tenotomy, subcutaneous, corrective, single digit | *5.0 | 0 | 3.0+T |
| *1536 | multiple digits | *7.5 | 0 | 3.0+T |
| 1537 | adductor, hip | 10.0 | 15 | 3.0+T |
| 1538 | open, elbow to shoulder, single | 20.0 | 30 | 3.0+T |
| 1539 | multiple | 25.0 | 30 | 3.0+T |
| 1540 | elbow to wrist, single | 15.0 | 30 | 3.0+T |
| 1541 | multiple | 25.0 | 30 | 3.0+T |
| 1542 | knee to hip, single | 30.0 | 45 | 3.0+T |
| 1543 | multiple | 40.0 | 45 | 3.0+T |
| 1544 | knee to thigh, single | 15.0 | 45 | 3.0+T |
| 1545 | multiple | 30.0 | 45 | 3.0+T |
| Exclusion | ||||
| 1550 | Excision of lesion of tendon or fibrous sheath, or ganglion, digits only | 10.0 | 30 | 3.0+T |
| 1553 | in other locations | 15.0 | 30 | 3.0+T |
| (For radical excision of bursa, forearm, i.e., tenosynovitis fungosa, Tbc., and other granuiomas, see 1430.) | ||||
| 1562 | Excision of synovial cyst of popliteal space (Baker's cyst) | 30.0 | 60 | 5.0+T |
| 1570 | Fasciotomy, palmar or plantar, subcutaneous | 10.0 | 60 | 3.0+T |
| 1573 | Fasciectomy, for Dupuytren's contracture, partial | 30.0 | 60 | 3.0+T |
| 1574 | radical, including finger extensions and vertical bands | 50.0 | 90 | 3.0+T |
| Repair | ||||
| Includes necessary initial dressing (including cast and/or splint application). | ||||
| (For multiple structures unless otherwise specified see 1593 or section 533.5(a)(6)(i).) | ||||
| 1580 | Repair or suture of an extensor tendon, primary or late, hand or foot, distal to wrist or ankle | 12.0 | 60 | 3.0+T |
| 1582 | forearm or leg | 18.0 | 60 | 3.0+T |
| 1583 | Repair or suture of a flexor tendon, primary or late, finger, hand or forearm, foot or leg | 30.0 | 120 | 3.0+T |
| 1585 | Transfer, transplant or free tendon graft, distal to elbow, or distal to knee, single | 40.0 | 120 | 3.0+T |
| 1586 | multiple | 50.0 | 120 | 3.0+T |
| 1587 | elbow to shoulder or knee to hip, single | 50.0 | 120 | 3.0+T |
| 1588 | multiple | 60.0 | 120 | 3.0+T |
| 1589 | Tenolysis, single | 25.0 | 60 | 3.0+T |
| 1590 | multiple (any number through same incision) | 30.0 | 60 | 3.0+T |
| 1591 | Lengthening or shortening of tendon, (e.g. Achilles' tendon) | 30.0 | 60 | 3.0+T |
| (Retrieve or reroute tendon through separate incision, add 25 percent of appropriate fee.) | ||||
| 1593 | Multiple tendons and/or other structures through same incision or wound | by report | 3.0+T | |
| 1612 | Free fascial graft for reconstruction of tendon pulley or gliding surface, etc | 15.0 | 90 | 3.0+T |
| 1616 | Abdominal fascial transplants, bilateral (Lowman type procedure) | 75.0 | 90 | 3.0+T |
| (For free fascial graft to face see 0340.) | ||||
| 1618 | Fascia lata transplants, other | by report | 3.0+T | |
| 1632 | Patellar (extensor mechanism) advancement, with or without patellectomy | 60.0 | 90 | 3.0+T |
| 1633 | Rutured quadriceps insertion | 45.0 | 90 | 3.0+T |
| 1635 | Ruptured Achilles tendon from insertion at heel | 45.0 | 120 | 3.0+T |
| 1639 | Ruptured long head of biceps, proximal | 35.0 | 90 | 3.0+T |
| 1640 | Ruptured biceps tendon from insertion at elbow | 45.0 | 90 | 3.0+T |
| 1641 | Flexor-plasty, elbow (e.g. (e.g. Steindler type advancement or extensor release) | 30.0 | 90 | 3.0+T |
| 1654 | Repair ruptured supraspinatus tendon or musculotendinous cuff shoulder, acute | 50.0 | 120 | 3.0+T |
| 1655 | Repair of complete shoulder cuff avulsion, chronic | 70.0 | 150 | 3.0+T |
| EXTREMITIES | ||||
| Incision | ||||
| *1681 | Drainage of felon, superficial | *2.0 | 0 | 3.0+T |
| *1682 | in hospital | *5.0 | 0 | 3.0+T |
| (For drainage of single or multiple infected spaces of hand, lumbrical, hypothenar, thenar, middle palmar, etc. with or without tendon sheath involvement, see 1514, 1515.) | ||||
| Amputation | ||||
| UPPER EXTREMITIY: | ||||
| 1701 | Interthoracoscapular | 100.0 | 90 | 11.0+T |
| 1703 | Disarticulation of shoulder | 75.0 | 90 | 5.0+T |
| 1705 | Arm through humerus | 40.0 | 90 | 3.0+T |
| 1708 | Forearm, through radius and ulna | 40.0 | 90 | 3.0+T |
| 1709 | Open (Guillotine) arm | 35.0 | 90 | 3.0+T |
| *1710 | secondary closure or minor scar revision | *5.0 | 0 | 3.0+T |
| 1711 | re-amputation | 40.0 | 90 | 3.0+T |
| 1713 | Cineplasty, complete procedure | 75.0 | 150 | 3.0+T |
| 1718 | Disarticulation through wrist or amputation of hand through metacarpal bones | 40.0 | 90 | 3.0+T |
| 1725 | Metacarpal, with finger or thumb, one, with or without split or Wolff graft, or skin-plasty and/or tenodesis, with or without resection of digital nerves | 30.0 | 60 | 3.0+T |
| 1737 | Digit (finger or thumb), any joint or phalanx, one, with or without split or Wolff graft, or skin-plasty and/or tenodesis, with or without resection of digital nerves | 15.0 | 45 | 3.0+T |
| LOWER EXTREMITY: | ||||
| 1745 | Interpelviabdominal | by report | 11.0+T | |
| 1748 | Disarticulation of hip | 80.0 | 180 | 8.0+T |
| 1750 | Disarticulation of knee | 40.0 | 120 | 3.0+T |
| 1752 | Thigh, through femur, including supracondylar | 60.0 | 120 | 3.0+T |
| 1760 | open (Guillotine) | 50.0 | 180 | 3.0+T |
| *1761 | secondary closure or minor revision | *5.0 | 0 | 3.0+T |
| 1763 | reamputation | 60.0 | 120 | 3.0+T |
| 1767 | Leg, through tibia and fibula | 50.0 | 90 | 3.0+T |
| 1771 | open (Guillotine) | 40.0 | 120 | 3.0+T |
| *1772 | secondary closure or minor revision | *5.0 | 0 | 3.0+T |
| 1774 | reamputation | 50.0 | 90 | 3.0+T |
| 1778 | Ankle (Syme, Pirogoff types), with skin-plasty and resection of nerves | 50.0 | 90 | 3.0+T |
| 1782 | Midtarsal | 35.0 | 90 | 3.0+T |
| 1785 | Foot, transmetatarsal | 35.0 | 90 | 3.0+T |
| 1788 | Metatarsal with toe, with or without split or Wolff graft, or skin-plasty and/or tenodesis, with or without resection of digital nerves | 25.0 | 90 | 3.0+T |
| 1802 | Toe, one, with or without split or Wolff graft, or skin-plasty and/or tenodesis, with or without resection of digital nerves | 10.0 | 45 | 3.0+T |
| 1803 | more than one | 15.0 | 60 | 3.0+T |
| Repair | ||||
| 1811 | Freeing of web fingers, with flaps | 35.0 | 60 | 3.0+T |
| 1815 | with skin graft | 45.0 | 60 | 3.0+T |
| 1816 | complex | by report | ||
| Plaster Casts (Independent Procedure Only) | ||||
| (Excluding Cost of Materials) | ||||
| 1840 | Club-foot cast with molding or manipulation, long or short leg, under age of 24 months, single | 2.0 | 2 | 3.0+T |
| 1841 | bilateral | 3.5 | 2 | 3.0+T |
| (If over age 24 months, see casts, general.) | ||||
| 1842 | Wedging club-foot cast single | 1.0 | 2 | 3.0+T |
| 1843 | bilateral | 1.5 | 2 | 3.0+T |
| (For children 10 years of age or under, reduce listed values 1851-1890 by 30%.) | ||||
| 1851 | Molded plaster to forearm (splint) | 2.0 | 2 | 3.0+T |
| 1854 | Elbow to fingers (short arm) | 2.0 | 2 | 3.0+T |
| 1856 | Hand and wrist (gauntlet) | 2.0 | 2 | 3.0+T |
| 1860 | Shoulder to hand (full arm) | 3.0 | 2 | 3.0+T |
| 1862 | Shoulder spica | 6.0 | 2 | 3.0+T |
| 1863 | Thigh-foot, molded splint | 3.0 | 2 | 3.0+T |
| 1864 | Leg-foot, molded splint | 2.0 | 2 | 3.0+T |
| 1865 | Ankle (foot to midleg) (short leg) | 3.0 | 2 | 3.0+T |
| 1867 | Knee (foot to thigh) (long leg) | 4.0 | 2 | 3.0+T |
| 1871 | Ambulatory leg cast (walking boot cast) | 3.5 | 2 | 3.0+T |
| 1878 | Hip spica, unilateral | 7.0 | 2 | 3.0+T |
| 1882 | bilateral | 8.0 | 2 | 3.0+T |
| 1884 | Body, sboulder to hips | 8.0 | 2 | 3.0+T |
| 1885 | including head | 10.0 | 2 | 3.0+T |
| 1886 | Risser jacket, localizer, body only | 12.5 | 2 | 3.0+T |
| 1887 | including head | 15.0 | 2 | 3.0+T |
| 1888 | Turnbuckle jacket, body only, for scoliosis | 12.5 | 2 | 3.0+T |
| 1889 | including head | 15.0 | 2 | 3.0+T |
| 1890 | "alo"type fixation and cast | 20.0 | 2 | 3.0+T |
| 1891 | Unna boot | 2.0 | 2 | |
| 1892 | Wedging cast, any age (except 1842-1843) | 1.0 | 3.0+T | |
| 1894 | Windowing a cast | 1.0 | 3.0+T | |
| 1895 | Removal or bivalving of cast applied by another physician small, (e.g., gauntlet, boot, body, full arm) | 1.5 | ||
| 1896 | large, (e.g., long leg, shoulder or hip spica, Minerva, Calot jacket, turnbuckle, etc.) | 2.0 | ||
| 1897 | Repair of spica, body cast or jacket | 3.0 | ||
| (For change of cast, unit value will be that of application only.) | ||||
| RESPIRATORY SYSTEM | ||||
| Nose | ||||
| Incision | ||||
| *1901 | Drainage of nasal abscess or hematoma | *2.0 | 0 | 3.0+T |
| *1905 | Drainage of septal abscess or hematoma | *2.5 | 0 | 3.0+T |
| Excision | ||||
| 1911 | Biopsy, soft tissue, nose | 3.0 | 7 | 3.0+T |
| 1916 | Excision of nasal polyp(s) one or more, unilateral or bilateral, one or more stages, office | 7.0 | 15 | 3.0+T |
| 1917 | complicated, requiring hospitalization | 20.0 | 30 | 3.0+T |
| (For excision of nasopharyngeal fibroma, see 3005.) | ||||
| 1924 | Excision or surgical planing of skin of nose for rhinophyma | 35.0 | 60 | 3.0+T |
| 1928 | Submucous resection, classic, nasal septum | 30.0 | 90 | 3.0+T |
| (For septoplasty, see 1952.) | ||||
| 1935 | Resection of inferior turbinate (submucous) complete or partial, unilateral or bilateral (independent procedure) | 15.0 | 90 | 3.0+T |
| Endoscopy | ||||
| *1941 | Removal of intranasal foreign body by rhinoscopy | *2.0 | 0 | 3.0+T |
| 1942 | by lateral rhinotomy | by report | 3.0+T | |
| Repair | ||||
| (See also Repair-Complex 0260-0324, and 0620, 0621.) | ||||
| 1950 | Rhinoplasty, lateral and alar cartilages and/or elevation of nasal tip | 40.0 | 180 | 3.0+T |
| 1951 | complete, external parts including bony pyramid, lateral and alar cartilages, and/or elevation of nasal tip | 80.0 | 180 | 3.0+T |
| 1952 | including major septal repair | 90.0 | 180 | 3.0+T |
| 1953 | secondary minor revision | 15.0 | 45 | 3.0+T |
| (For total or major partial reconstruction, see 0260-0324, 0620, 0621.) | ||||
| (For nasal bridge collapse, bone or cartilage graft, see 0620, 0621.) | ||||
| 1954 | Septoplasty, (not 1928) independent procedure | 40.0 | 90 | 3.0+T |
| 1959 | Repair, choanal atresia, intranasal | 10.0 | 60 | 3.0+T |
| 1960 | transpalatine | 60.0 | 365 | 3.0+T |
| *1961 | Lysis of synechia | *2.0 | 0 | 3.0+T |
| 1962 | Repair of oromaxillary fistula | by report | 3.0+T | |
| 1963 | with radical antrotomy | 50.0 | 90 | 3.0+T |
| 1964 | Repair oronasal fistula | 20.0 | 30 | 3.0+T |
| 1965 | Reconstruction, functional, of the internal nose | 40.0 | 90 | 3.0+T |
| Destruction | ||||
| *1966 | Cauterization of turbinates, unilateral or bilateral (independent procedure) | *2.0 | 0 | |
| Manipulation | ||||
| (For reduction of fracture, see 0685-0690.) | ||||
| *1971 | Nasal hemorrhage, anterior, control of, unilateral or bilateral, with or without cauterization or anterior packs | *2.0 | 0 | |
| *1973 | posterior, with cauterization or posterior nasal packs, with or without anterior pack, initial | *10.0 | 0 | 3.0+T |
| *1974 | subsequent | *2.0 | 0 | 3.0+T |
| 1978 | by ligation of anterior ethmoidal artery | 30.0 | 30 | 3.0+T |
| ACCESSORY SINUSES | ||||
| Incision | ||||
| *1981 | Antrum lavage, puncture or natural ostium, unilateral | *2.0 | 0 | 3.0+T |
| *1982 | bilateral | *3.0 | 0 | 3.0+T |
| 1983 | Antroscopy | *4.0 | 0 | 3.0+T |
| 1985 | Antrotomy, intranasal, unilateral | 15.0 | 90 | 3.0+T |
| 1986 | bilateral | 25.0 | 90 | 3.0+T |
| 1988 | Radical (Caldwell-Luc), unilateral | 50.0 | 90 | 3.0+T |
| 1989 | bilateral | 65.0 | 90 | 3.0+T |
| 1991 | Sphenoid sinusotomy | 30.0 | 90 | 3.0+T |
| 1992 | Frontal sinusotomy, external, simple (trephine operation) | 20.0 | 30 | 3.0+T |
| 1993 | transorbital, unilateral | 40.0 | 180 | 3.0+T |
| 1994 | radical, obliterative | 60.0 | 180 | 3.0+T |
| 1995 | Combined external frontal, ethmoidal and sphenoidal sinusotomy, unilateral | 80.0 | 180 | 3.0+T |
| Excision | ||||
| 2006 | Ethmoidectomy, intranasal or external, unilateral | 30.0 | 90 | 3.0+T |
| 2017 | Maxillectomy, unilateral, with or without orbital exenteration and/or lateral rhinotomy | 100.0 | 365 | 3.0+T |
| 2019 | Hypophysectomy, transeptal | 70.0 | 90 | 4.0+T |
| (See also 5130.) | ||||
| LARYNX | ||||
| Incision | ||||
| 2041 | Laryngofissure with removal of tumor or laryngocele | 60.0 | 365 | 6.0+T |
| 2042 | Thyrotomy, diagnostic | 35.0 | 60 | 6.0+T |
| 2043 | for laryngeal web, two stage, with Keel insertion, (McNaught type) | 90.0 | 365 | 6.0+T |
| 2044 | for laryngeal stenosis with graft or core mold, including tracheotomy | by report | 6.0+T | |
| Excision | ||||
| 2051 | Laryngectomy, without neck dissection | 100.0 | 365 | 6.0+T |
| 2054 | with neck dissection | 140.0 | 365 | 6.0+T |
| 2055 | Hemilaryngectomy | 60.0 | 365 | 6.0+T |
| 2056 | Arytenoidectomy, external approach (See also 2084.) | 70.0 | 180 | 6.0+T |
| 2057 | Epiglottidectomy, external approach | 60.0 | 365 | 6.0+T |
| 2058 | endoral approach | 25.0 | 90 | 4.0+T |
| Introduction | ||||
| *2060 | Injection procedure for bronchography, indirect method | *3.0 | 0 | 4.0+T |
| *2061 | with insertion of catheter, (independent procedure) | *4.0 | 0 | 4.0+T |
| *2062 | Endotracheal intubation, emergency procedure | *5.0 | 0 | |
| Endoscopy | ||||
| 2070 | Laryngoscopy, indirect with biopsy | 4.0 | 7 | |
| 2071 | direct, diagnostic (independent procedure) | 10.0 | 30 | 4.0+T |
| 2072 | operative, including foreign body removal | 30.0 | 30 | 4.0+T |
| 2073 | with biopsy | 15.0 | 30 | 4.0+T |
| 2074 | including excision of tumor | 25.0 | 180 | 4.0+T |
| 2075 | with Lynch suspension | 30.0 | 180 | 4.0+T |
| 2084 | Endoscopic arytenoidectomy | 50.0 | 180 | 4.0+T |
| TRACHEA AND BRONCHI | ||||
| Incision | ||||
| 2101 | Tracheotomy (independent procedure) | 20.0 | 15 | 4.0+T |
| 2102 | Tracheal fenestration | 50.0 | 180 | 4.0+T |
| Endoscopy | ||||
| 2111 | Bronchoscopy, diagnostic | 15.0 | 30 | 4.0+T |
| 2113 | with biopsy | 20.0 | 30 | 4.0+T |
| 2117 | with removal of foreign body | 25.0 | 30 | 4.0+T |
| 2120 | with excision of tumor | 25.0 | 30 | 4.0+T |
| 2121 | with therapeutic aspiration of bronchus | 15.0 | 30 | 4.0+T |
| 2122 | with drainage of lung abscess or cavity, initial | 15.0 | 30 | 4.0+T |
| 2123 | with injection of contrast media | 15.0 | 30 | 4.0+T |
| 2124 | subsequent | 10.0 | 30 | 4.0+T |
| 2126 | Catheterization for bronchospirometry (independent procedure) (exclusive of gas analysis) (See also 9201- 9206.) | 10.0 | 30 | 4.0+T |
| 2127 | Tracheal aspiration (independent procedure) under direct vision | 10.0 | 30 | 4.0+T |
| *2128 | indirect | *1.0 | 0 | |
| Repair | ||||
| 2131 | Tracheoplasty: plastic operation on trachea. cervical | by report | 6.0+T | |
| 2132 | intrathoracic | by report | 11.0+T | |
| 2133 | Bronchoplasty, graft repair | by report | 11.0+T | |
| 2134 | excision of stenosis and anastomosis | by report | 11.0+T | |
| 2135 | with lobectomy and anastomosis | by report | 11.0+T | |
| Suture | ||||
| 2141 | Tracheorrhaphy: suture of external tracheal wound or injury, depending on structure and extent of injury, cervial | by report | 5.0+T | |
| 2142 | intrathoracic | by report | 11.0+T | |
| 2144 | Closure of tracheostomy or tracheal fistula | 25.0 | 30 | 4.0+T |
| 2147 | Closure of traeheo-esophageal fistula | 90.0 | 90 | 11.0+T |
| 2148 | complicated | by report | 90 | 11.0+T |
| Incision | ||||
| 2151 | Thoracotomy, exploratory, including biopsy | 50.0 | 90 | 11.0+T |
| 2152 | including control of hemorrhage and/or repair of lung fistula | 75.0 | 90 | 11.0+T |
| 2153 | for post-operative complications | 75.0 | 90 | 11.0+T |
| 2154 | with open drainage of empyema cavity by rib resection (independent procedure) | 40.0 | 90 | 11.0+T |
| 2155 | with cyst removal | 75.0 | 90 | 11.0+T |
| *2157 | with closed drainage of empyema cavity; tube drainage with negative pressure (independent procedure), in hospital | *5.0 | 0 | 3.0+T |
| 2160 | with removal of intra-pleural foreign body or fibrin body | 70.0 | 90 | 11.0+T |
| 2161 | with cardiac massage | by report | 12.0+T | |
| 2163 | with open intrapleural pneumonolysis (See also 2207.) | 75.0 | 90 | 11.0+T |
| 2170 | Pneumonotomy, with open drainage of pulmonary abscess or cyst | 60.0 | 120 | 11.0+T |
| 2173 | with removal of foreign body from lung | 75.0 | 90 | 11.0+T |
| 2177 | Decortication, pulmonary, total | 100.0 | 90 | 11.0+T |
| *2180 | Pneumonocentesis: puncture of lung for aspiration biopsy | *5.0 | 0 | |
| *2183 | Thoracentesis: puncture of pleural cavity for aspiration, initial or subsequent | *3.0 | 0 | |
| Excision | ||||
| 2191 | Pneumonectomy, total | 100.0 | 90 | 11.0+T |
| 2193 | Lobectomy, total, subtotal or segmental | 100.0 | 90 | 11.0+T |
| 2194 | with concomitant decortication | 125.0 | 90 | 11.0+T |
| 2195 | Wedge resection, single or multiple | 80.0 | 90 | 11.0+T |
| 2196 | Pulmonary resection with concomitant thoracoplasty | 150.0 | 180 | 11.0+T |
| 2197 | Pleurectomy, any type (independent procedure) | 50.0 | 90 | 11.0+T |
| Endoscopy | ||||
| 2201 | Thoracoscopy, exploratory (independent procedure) | 20.0 | 30 | 4.0+T |
| 2204 | with biopsy | 20.0 | 30 | 4.0+T |
| 2207 | Closed intrapleural pneumonolysis | 30.0 | 30 | 4.0+T |
| Surgical Collapse Therapy | ||||
| Thoracoplasty | ||||
| 2211 | Extrapleural resection of ribs, any type, first stage | 60.0 | 90 | 6.0+T |
| 2212 | second stage | 30.0 | 90 | 5.0+T |
| 2213 | third stage | 30.0 | 90 | 5.0+T |
| 2217 | Extrapleural pneumonolysis, including associated filling or packing procedures | 60.0 | 90 | 6.0+T |
| 2218 | Extraperiosteal pneumonolysis, including associated filling or packing procedures | 70.0 | 90 | 6.0+T |
| *2221 | Pneumothorax: intrapleural injection of air, initial | *5.0 | 0 | |
| *2222 | subsequent | *2.0 | 0 | |
| CARDIOVASCULAR SYSTEM | ||||
| Heart and Pericardium | ||||
| Values for principal surgeon only. For monitoring, operation of pump and other nonsurgical services, see 9195, 9196, etc. | ||||
| Incision | ||||
| 2301 | Cardiotomy, exploratory (includes removal of foreign body) | 100.0 | 90 | 15.0+T |
| 2305 | Periocardiotomy with exploration, drainage or removal of foreign body | 100.0 | 90 | 13.0+T |
| *2309 | Pericardiocentesis, initial | *5.0 | 0 | |
| *2310 | subsequent | *4.0 | 0 | |
| 2311 | Blalock-Hanlon procedure (creation of atrial-septal defect) (closed) | 150.0 | 90 | 15.0+T |
| Excision | ||||
| 2316 | Pericardiectomy, extensive | 120.0 | 90 | 15.0+T |
| 2317 | Excision intracardiac tumor | 200.0 | 90 | 15.0+T |
| 2319 | Infundibular stenosis | by report | 15.0+T | |
| Introduction | ||||
| Listed values include usual preassessment of clinical problem and recording of intracardiac pressures. (For consultation services, see 9028-9031.) | ||||
| 2330 | Catheterization of heart, including recording of intracardiac pressures where indicated (independent procedure) right | 35.0 | 7 | |
| 2331 | left, percutaneous | 15.0 | 7 | |
| 2332 | trans-septal | 20.0 | 7 | |
| 2333 | retrograde | 20.0 | 7 | |
| 2334 | combined left and right | 45.0 | 7 | |
| 2335 | final evaluation and report only | 5.0 | ||
| (For injection procedures see radiology.) | ||||
| Suture | ||||
| 2337 | Cardiorrhaphy: suture of heart wound or injury | 100.0 | 90 | 15.0+T |
| Repair | ||||
| 2340 | Aortic valve, valvotomy (commissurotomy (closed) | 150.0 | 90 | 15.0+T |
| 2341 | valvuloplasty for stenosis or insufficiency (open) | 200.0 | 90 | 15.0+T |
| 2342 | replacement (open) | 200.0 | 90 | 15.0+T |
| 2343 | Pulmonic valve, valvotomy (commissurotomy) (closed) | 150.0 | 90 | 15.0+T |
| 2344 | valvotomy; infundibular stenosis (open) | 200.0 | 90 | 15.0+T |
| 2345 | Mitral valve, valvotomy (commissurotomy) (closed) | 140.0 | 90 | 15.0+T |
| 2346 | valvuloplasty for stenosis or insufficiency (open) | 200.0 | 90 | 15.0+T |
| 2347 | replacement (open) | 200.0 | 90 | 15.0+T |
| 2348 | Tricuspid valve | by report | 90 | 15.0+T |
| 2349 | Coronary endarterectomy, myocardial revascularization by implantation or anastomosis | 100.0 | 90 | 15.0+T |
| 2350 | Myocardial aneurysm | 200.0 | 90 | 15.0+T |
| 2351 | Atrial septal defect (secundum type; endocardial cushion defect) (open) | 180.0 | 90 | 15.0+T |
| 2352 | Ventricular septal defect (open) | 180.0 | 90 | 15.0+T |
| 2353 | Tetralogy of Fallot (with or without previous shunt) (open) | 200.0 | 90 | 15.0+T |
| 2354 | Aortic sinus of Valsalva fistula (open) | 200.0 | 90 | 15.0+T |
| 2355 | Repair anomalous pulmonary venous connection, total (open) | 200.0 | 90 | 15.0+T |
| 2356 | Insert internal pacemaker with myocardial electrodes, initial | 100.0 | 90 | 15.0T |
| 2357 | replacement or repair | 30.0 | 30 | 3.0+T |
| 2358 | Pervenous or transvenous insertion of a pacemaker and subcutaneous implantation of a battery | 50.0 | 30 | 3.0+T |
| 2359 | Subcutaneous implantation of a battery (used with code 2330, right heart catheterization, currently in fee schedule) | 18.75 | 7 | 3.0+T |
| Arteries and Veins | ||||
| Incision | ||||
| ARTERIOTOMY-With removal of embolus: | ||||
| 2373 | Trunk | 80.0 | 60 | 6.0+T |
| 2374 | Neck | 60.0 | 60 | 6.0+T |
| 2375 | Extremity | 60.0 | 60 | 5.0+T |
| PHLEBOTOMY-With removal of thrombus: | ||||
| 2380 | Trunk | 70.0 | 60 | 5.0+T |
| 2381 | Extremity | 45.0 | 60 | 4.0+T |
| Excision | ||||
| 2390 | Thromboendarterectomy, abdominal aorta and iliac arteries and/or femoral arteries | 150.0 | 90 | 13.0+T |
| 2392 | femoral and/or popliteal arteries | 120.0 | 90 | 5.0+T |
| 2394 | carotid artery | 120.0 | 90 | 6.0+T |
| 2400 | Excision and graft or bypass graft of arch of aorta | by report | 90 | 15.0+T |
| 2404 | Excision and graft, thoracic aorta | 150.0 | 90 | 15.0+T |
| 2408 | abdominal aorta | 150.0 | 90 | 13.0+T |
| 2412 | extremity | 120.0 | 90 | 5.0+T |
| 2420 | Excision of arteriovenous fistula (See also 2474.) | by report | ||
| Introduction | ||||
| (For injection procedures see radiology.) | ||||
| 2441 | Venopuncture, withdrawal of venous blood, intravenous injection (femoral, internal or external juglar or sagittal sinus) for diagnostic study or introduction of intravenous therapy, up to three years of age | 2.0 | ||
| 2442 | scalp vein, for fluid therapy or indirect transfusion, up to three year of age | 3.0 | ||
| 2443 | Exposure of and incision into vein ("utdown" for fluid therapy or indirect transfusion, under one year of age | 4.0 | ||
| 2444 | over one year of age | 3.0 | ||
| 2445 | Blood transfusion, indirect method | 2.0 | 0 | |
| 2446 | replacement type, infant, initial or subsequent | 30.0 | 15 | |
| 2448 | direct method | 5.0 | 7 | |
| 2450 | "ush"transfusion, given under two years of age | 5.0 | 0 | |
| *2454 | Injection of sclerosing solution into vein of leg, one | *1.0 | 0 | |
| *2455 | two or more injections, same leg | *2.0 | 0 | |
| Repair | ||||
| 2460 | Repair aneurysm of aorta, lateral repair | 150.0 | 90 | 13.0+T |
| 2464 | dissecting ("indow"operation) | 150.0 | 90 | 13.0+T |
| 2466 | Banding of pulmonary artery | 100.0 | 90 | 13.0+T |
| 2472 | Repair of aortic arch anomalies (vascular ring) | 120.0 | 90 | 15.0+T |
| 2473 | Repair of atrial septal defect | 200.0 | 90 | 15.0+T |
| 2474 | Repair arterio-venous fistula, plastic procedure | by report | ||
| 2475 | Excision of corarctation of aorta with primary anastomosis (See also 2400-2408.) | 150.0 | 90 | 15.0+T |
| (For aortic anastomosis, see also 2400-2408, 2472.) | ||||
| 2478 | Pulmonary-subclavian anastomosis, Potts | 150.0 | 90 | 15.0+T |
| 2482 | Blalock | 120.0 | 90 | 15.0+T |
| 2486 | Pulmonary-superiorcaval anastomosis, Glenn | 150.0 | 90 | 15.0+T |
| 2487 | Baffes procedure: inferior cava to left atrium-right pulmonary vein to right antrium | 150.0 | 90 | 15.0+T |
| 2490 | Portocaval anastomosis | 100.0 | 90 | 9.0+T |
| 2496 | Splenorenal anastomosis | 100.0 | 90 | 9.0+T |
| Suture | ||||
| Abdominal | ||||
| 2511 | Arteriorrhaphy: suture of wound or injury of artery | 6.0+T | ||
| (independent procedure), trunk | or Thoracic | |||
| 60.0 | 60 | 12.0+T | ||
| 2512 | extremity | 60.0 | 60 | 4.0+T |
| Abdominal | ||||
| 2515 | Phleborrhaphy: suture of wound or injury of vein | 4.0+T | ||
| (independent procedure), trunk | or Thoracic | |||
| 60.0 | 60 | 12.0+T | ||
| 2516 | extremity, | 60.0 | 60 | 4.0+T |
| 2520 | Ligation and division of ductus arteriosus | 100.0 | 90 | 13.0+T |
| 2522 | Ligation of carotid artery | 40.00 | 30 | 4.0+T |
| 2525 | Ligation and division of inferior vena cava | 60.0 | 90 | 5.0+T |
| 2526 | Ligation of femoral vein | 25.0 | 30 | 3.0+T |
| 2530 | Ligation and division of common iliac vein | 50.0 | 90 | 3.0+T |
| 2558 | Ligation and division of long saphenous vein at saph-enofemoral junction, with or without retrograde injection or distal interruptions | 20.0 | 30 | 3.0+T |
| 2561 | Ligation and division and complete stripping of long or short saphenous veins, unilateral | 30.0 | 30 | 3.0+T |
| 2562 | bilateral | 50.0 | 30 | 3.0+T |
| 2563 | long and short saphanous veins, unilateral | 40.0 | 30 | 3.0+T |
| 2565 | bilateral | 60.0 | 30 | 3.0+T |
| 2576 | Ligation and division of short saphenous vein at saphenopopliteal junction (independent procedure) | 12.5 | 30 | 3.0+T |
| 2581 | minor varicose vein of leg, initial | 5.0 | 15 | |
| 2585 | subsequent | 3.0 | 15 | |
| HEMODIALYSIS-RELATED SURGICAL PROCEDURES | ||||
| 2590 | Insertion of initial arteriovenous shunt (Including revisions during 21 follow-up days) | 50.0 | 21 | by report |
| 2591 | Revision of either arterial or venous cannula | 31.25 | 21 | by report |
| 2592 | Construction of arterio-venous fistula | 50.0 | 21 | by report |
| HEMIC AND LYMPHATIC SYSTEMS | ||||
| Spleen | ||||
| Excision | ||||
| 2601 | Splenectomy | 60.0 | 45 | 6.0+T |
| Introduction | ||||
| 2610 | Injection procedure for splenoportography | 10.0 | 7 | 3.0+T |
| Lymph Nodes and Lymphatic Channels | ||||
| Incision | ||||
| *2631 | Drainage of lymph node abscess or lymphadenitis, simple | *3.0 | 0 | |
| 2632 | extensive | by report | 3.0+T | |
| Excision | ||||
| 2641 | Biopsy or excision of lymph node (independent procedure) (except 2642) | 5.0 | 30 | 3.0+T |
| 2642 | anterior scalene | 15.0 | 30 | 3.0+T |
| RADICAL LYMPHADENECTOMY | ||||
| (Radical resection of lymph nodes): | ||||
| 2651 | Supra-hyoid, unilateral | 50.0 | 60 | 4.0+T |
| 2652 | bilateral | 60.0 | 60 | 4.0+T |
| 2655 | Cervical (complete), unilateral | 80.0 | 60 | 4.0+T |
| 2658 | Axilla | 50.0 | 60 | 3.0+T |
| 2671 | Groin, superficial | 50.0 | 60 | 3.0+T |
| 2672 | deep, with common iliac dissection | 80.0 | 60 | 3.0+T |
| 2673 | Retroperitoneal, extensive, including pelvic, aortic and renal dissection | 100.0 | 90 | 5.0+T |
| Introduction | ||||
| 2676 | Injection procedure for lymphangiography, unilateral | 10.0 | 14 | |
| 2677 | bilateral | 15.0 | 14 | |
| MEDIASTINUM | ||||
| Incision | ||||
| 2680 | Mediastinotomy with exploration or drainage, cervical approach | 40.0 | 90 | 12.0+T |
| 2681 | transthoracic | 80.0 | 90 | 12.0+T |
| 2683 | Foreign body removal, cervical approach | 70.0 | 90 | 12.0+T |
| 2684 | transthoracic | 80.0 | 90 | 12.0+T |
| Excision | ||||
| 2691 | Excision of mediastinal cyst | 80.0 | 90 | 12.0+T |
| 2693 | Excision of mediastinal tumor | 100.0 | 90 | 12.0+T |
| 2696 | Ligation or repair, thoracic duct | 75.0 | 90 | 12.0+T |
| DIGESTIVE SYSTEM | ||||
| Mouth | ||||
| Incision | ||||
| *2701 | Drainage of sublingual abscess | *2.0 | 0 | 3.0+T |
| 2705 | Drainage of Ludwig's angina | 8.0 | 7 | 4.0+T |
| LIPS | ||||
| Excision | ||||
| (For excision of mucocele see 0175-0178 or 0260-0269.) | ||||
| (For excision of small lesion of lip see 0175-0178 or 0260-0269.) | ||||
| 2737 | Vermilionectomy ("ip peel" | 40.0 | 120 | 3.0+T |
| 2739 | Transverse wedge excision, lip | 25.0 | 120 | 3.0+T |
| 2743 | V-excision of large lesion of lip up to one-half lip | 25.0 | 120 | 3.0+T |
| 2746 | Resection of more than one-half lip without plastic closure | 25.0 | 120 | 3.0+T |
| (With plastic closure, primary or secondary see 0260-0324.) | ||||
| Repair (Cheiloplasty) | ||||
| 2754 | Plastic repair of cleft lip, primary, unilateral | 70.0 | 90 | 6.0+T |
| 2758 | bilateral, one stage | 90.0 | 90 | 6.0+T |
| 2759 | bilateral, two stages, per stage | 60.0 | 90 | 6.0+T |
| (For secondary, local revision, unilateral or bilateral see 0260-03234.) | ||||
| 2762 | Plastic repair (secondary) of unilateral cleft lip by recreation of defect and reclosure | 70.0 | 90 | 6.0+T |
| 2765 | Plastic repair (secondary) of bilateral harelip by recreation of defect and reclosure-per major stage | 60.0 | 90 | 6.0+T |
| (For plastic or reconstruction operation on lip see also 0260-0324.) | ||||
| TONGUE | ||||
| Incision (Glossotomy) | ||||
| *2771 | Drainage of lingual abscess | *2.0 | 0 | 3.0+T |
| Excision (Glossectomy) | ||||
| 2781 | Biopsy of tongue, anterior third | 3.0 | 30 | 3.0+T |
| 2782 | posterior two-thirds | 5.0 | 30 | 3.0+T |
| 2785 | Partial glossectomy or hemiglossectomy | 40.0 | 120 | 6.0+T |
| 2787 | Complete or total glossectomy | 70.0 | 120 | 6.0+T |
| Repair (Glossoplasty) | ||||
| (For plastic repair of tongue see 0260-0324.) | ||||
| Suture (Glossorrhaphy) | ||||
| (For suture of injury see 0251, 0260-0270.) | ||||
| TEETH AND GUMS | ||||
| Incision | ||||
| *2815 | Drainage of alveolar abscess, acute with cellulitus, intraoral | *2.0 | 0 | 3.0+T |
| 2820a | General anesthesia for multiple extractions in hospital | 3.0+T | ||
| PALATE AND UVULA | ||||
| Incision | ||||
| *2871 | Incision and drainage of abscess of palate | *2.0 | 0 | 3.0+T |
| Excision | ||||
| 2881 | Biopsy of palate | 3.0 | 30 | 3.0+T |
| (For excision of local lesion of palate see 0175-0196, 0260-0270.) | ||||
| (For graft or flap closure see 0275-0283, 0300-0304.) | ||||
| 2885 | Resection of palate or extensive excision of lesion of palate | 40.0 | 90 | 6.0+T |
| (For resection of palate with reconstruction see 0277- 0283, 0312-0323.) | ||||
| 2887 | Uvulectomy: excision of uvula | 3.0 | 30 | 3.0+T |
| Repair | ||||
| 2890 | Palatoplasty: plastic operation for cleft palate, partial | 60.0 | 90 | 6.0+T |
| 2890 | complete, including alveolar ridge | 80.0 | 90 | 6.0+T |
| 2895 | major revision | 60.0 | 90 | 6.0+T |
| 2897 | secondary lengthening procedure | 70.0 | 90 | 6.0+T |
| 2898 | attachment pharyngeal flap | 60.0 | 90 | 6.0+T |
| 2899 | alveolar ridge, anterior palate defect | 30.0 | 90 | 6.0+T |
| (For secondary minor revision see 0260-0270, 0277-0283.) | ||||
| Suture | ||||
| (For suture of palate injury see 0260-0270, 0277-0283.) | ||||
| Salivary Glands and Ducts | ||||
| Incision | ||||
| *2911 | Drainage of parotid abscess | *5.0 | 0 | 3.0+T |
| *2912 | Drainage of submaxillary abscess | *5.0 | 0 | 3.0+T |
| *2914 | Sialolithotomy, submaxillary or parotid, uncomplicated | *3.0 | 0 | 3.0+T |
| 2915 | Sialolithotomy, submaxillary, complicated | 10.0 | 30 | 3.0+T |
| 2916 | Sialolithotomy, parotid, extraoral | 25.0 | 30 | 3.0+T |
| Excision | ||||
| 2921 | Biopsy of salivary gland | 5.0 | 30 | 3.0+T |
| 2927 | Excision of parotid tumor or gland, superficial, without nerve dissection | 20.0 | 60 | 3.0+T |
| 2928 | with nerve dissection | 60.0 | 60 | 3.0+T |
| 2934 | Excision of parotid gland, total, with dissection of facial nerve | 70.0 | 60 | 3.0+T |
| 2937 | with sacrifice of facial nerve | 60.0 | 60 | 3.0+T |
| 2938 | Excision of submaxillary tumor and/or gland | 40.0 | 60 | 3.0+T |
| Repair (Slalodochoplasty) | ||||
| 2941 | Plastic repair of salivary duct, simple | 35.0 | 60 | 3.0+T |
| 2942 | complicated | by report | 3.0+T | |
| Introduction | ||||
| *2945 | Injection procedure for sialography | *1.0 | 0 | 3.0+T |
| Suture | ||||
| 2951 | Closure of salivary fistula | 40.0 | 60 | 3.0+T |
| Unit or Dollar Value | Follow-up Days | Anes.§ | ||
| Manipulation | ||||
| *2961 | Dilation of salivary duct; ptyalectasis | *1.0 | 0 | |
| Pharynx, Adenoids and Tonsils | ||||
| Incision | ||||
| *2970 | Drainage of peritonsillar abscess | *3.0 | 0 | 4.0+T |
| 2971 | Drainage of retropharyngeal or parapharyngeal abscess, intraoral | 10.0 | 15 | 4.0+T |
| 2973 | external approach | by report | 4.0+T | |
| Excision | ||||
| 2981 | Biopsy of oropharynx | 3.0 | 15 | 3.0+T |
| 2982 | hypopharynx | 5.0 | 15 | 3.0+T |
| 2983 | nasopharynx | 5.0 | 15 | 3.0+T |
| (For larynx, see 2070 or 2073.) | ||||
| 2984 | Excision of pharyngoesophageal diverticulum, single stage | 50.0 | 60 | 3.0+T |
| 2985 | multiple stages | 60.0 | 60 | 4.0+T |
| 2989 | Excision branchial cleft cyst or vestige, confined to skin and subcutaneous tissues | 15.0 | 30 | 3.0+T |
| 2990 | extending beneath subcutaneous tissues | 50.0 | 30 | 3.0+T |
| 2992 | Tonsillectomy, with or without adenoidectomy, under age 18 years | 15.0 | 30 | 3.0+T |
| 2993 | 18 years or over | 20.0 | 30 | 3.0+T |
| 2994 | Adenoidectomy (independent procedure), primary or secondary | 10.0 | 30 | 3.0+T |
| 3000 | Excision of tonsil tag(s), hospital | 10.0 | 30 | 3.0+T |
| 3002 | office | 6.0 | 30 | 3.0+T |
| 3004 | Excision of lingual tonsil (independent procedure) | 10.0 | 30 | 3.0+T |
| 3005 | Excision of nasopharyngeal fibroma | by report | 3.0+T | |
| Suture | ||||
| 3006 | Suture of wound or injury of pharynx | by report | 3.0+T | |
| Repair | ||||
| 3011 | Pharyngoplasty: plastic or reconstructive operation on pharynx | by report | 4.0+T | |
| (For pharyngeal flap, see 2898.) | ||||
| Esophagus | ||||
| Incision | ||||
| 3031 | Esophagotomy, cervical | 60.0 | 90 | 6.0+T |
| 3032 | for removal of foreign body, cervical | 60.0 | 90 | 6.0+T |
| 3033 | thoracic | 80.0 | 90 | 12.0+T |
| Excision | ||||
| 3043 | Esophagectomy: resection of esophagus, transpleural or extrapleural (upper two-thirds) | 120.0 | 90 | 12.0+T |
| 3045 | Esophagogastrectomy, combined thoraco-abdominal | 120.0 | 90 | 12.0+T |
| 3046 | Local excision, end-to-end anastomosis | 90.0 | 90 | 12.0+T |
| Endoscopy | ||||
| 3051 | Esophagoscopy, diagnostic | 15.0 | 15 | 4.0+T |
| 3053 | with insertion of radioactive substance | 20.0 | 30 | 4.0+T |
| 3055 | with biopsy | 20.0 | 15 | 4.0+T |
| 3057 | with foreign body removal | 25.0 | 15 | 4.0+T |
| 3061 | with dilation, direct | 20.0 | 15 | 4.0+T |
| 3063 | subsequent dilation | 15.0 | 15 | 4.0+T |
| (See also 3092, 3095.) | ||||
| Repair | ||||
| 3071 | Esophagoplasty: plastic repair or reconstruction of esophagus | by report | 12.0+T | |
| 3072 | Esophagogastrostomy (cardioplasty) | 80.0 | 90 | 12.0+T |
| 3073 | Esophagomyotomy (Heller type) | 80.0 | 90 | 12.0+T |
| 3074 | Esophagoduodenostomy (including total gastrectomy) | 100.0 | 90 | 11.0+T |
| 3075 | Esophagojejunostomy, including total gastrectomy | 100.0 | 90 | 11.0+T |
| 3076 | Esophagostomy; fistulization of esophagus, external | 60.0 | 90 | 6.0+T |
| Suture | ||||
| 3077 | Direct ligation of esophageal varices | 80.0 | 90 | 12.0+T |
| 3081 | Suture of esophageal wound, injury or rupture, cervical approach | by report | 7.0+T | |
| 3083 | transthoracic | 70.0 | 90 | 12.0+T |
| 3086 | Closure of esophagostomy or other external esophageal fistula, cervical | 45.0 | 90 | 7.0+T |
| 3087 | thoracic | 70.0 | 90 | 12.0+T |
| Manipulation | ||||
| *3092 | Dilation of esophagus by sound, bougie or bag, indirect, initial | *5.0 | 0 | |
| *3095 | subsequent | *3.0 | 0 | |
| (For direct see 3061 and 3063.) | ||||
| STOMACH | ||||
| Incision | ||||
| 3101 | Gastrotomy with exploration or foreign body removal | 50.0 | 45 | 5.0+T |
| 3105 | Pyloromyotomy: cutting of pyloric muscle (Fredet-Ramstedt type operation) | 50.0 | 45 | 6.0+T |
| Excision | ||||
| 3111 | Biopsy by laparotomy | 50.0 | 45 | 5.0+T |
| 3112 | Local excision of ulcer or tumor | 60.0 | 45 | 5.0+T |
| 3114 | Total gastrectomy | 100.0 | 90 | 6.0+T |
| 3115 | Subtotal or hemi-gastrectomy, without vagotomy | 80.0 | 60 | 6.0+T |
| 3116 | with vagotomy | 90.0 | 60 | 6.0+T |
| 3117 | Vagotomy and pyloroplasty | 70.0 | 60 | 6.0+T |
| (See also 3131.) | ||||
| Endoscopy (independent procedure) | ||||
| 3121 | Gastroscopy, diagnostic | 15.0 | 7 | 4.0+T |
| 3123 | with biopsy | 15.0 | 7 | 4.0+T |
| Suture | ||||
| 3131 | Pyloroplasty | 50.0 | 45 | 5.0+T |
| 3133 | Gastroduodenostomy | 60.0 | 45 | 5.0+T |
| 3135 | Gastrojejunostomy | 60.0 | 45 | 5.0+T |
| 3136 | with vagotomy | 75.0 | 45 | 6.0+T |
| 3137 | Gastrostomy | 40.0 | 45 | 5.0+T |
| 3141 | Gastrorrhaphy: suture of perforated duodeal or gutric ulcer, wound or injury | 50.0 | 45 | 6.0+T |
| 3144 | Revision of gastroduodenal anastomosis (gastroduodenostomy) with reconstruction without vagotomy | 90.0 | 60 | 6.0+T |
| 3145 | with vagotomy | 100.0 | 60 | 6.0+T |
| 3146 | Revision of gastrojejunal anastomosis (gastrojejunostomy) with reconstruction, without vagatomy | 90.0 | 60 | 6.0+T |
| 3147 | with vagotomy | 100.0 | 60 | 6.0+T |
| 3153 | Closure of gastrostomy, surgical | 40.0 | 45 | 5.0+T |
| INTESTINES (EXCEPT RECTUM) | ||||
| Incision | ||||
| 3161 | Enterotomy with exploration or foreign body removal, small bowel | 60.0 | 60 | 4.0+T |
| 3162 | large bowel | 65.0 | 60 | 4.0+T |
| 3166 | Exteriorization of intestine (Mikulicz resection of colon, with or without crushing of spur) | 70.0 | 60 | 4.0+T |
| Excision | ||||
| 3171 | Excision of one or more lesions of small or large bowel not requiring anastomosis, exteriorization or fistulization, single enterotomy | 60.0 | 60 | 4.0+T |
| 3172 | multiple enterotomies | 70.0 | 60 | 4.0+T |
| 3174 | Enterectomy: resection of small intestine with anastomosis | 70.0 | 60 | 4.0+T |
| 3176 | with enterostomy | 70.0 | 60 | 4.0+T |
| 3178 | Colectomy, partial resection of large intestine in two stages, including first stage colostomy or cecostomy | 100.0 | 90 | 5.0+T |
| 3179 | Colectomy, partial, with anastomosis, with or without concomitant proximal colostomy | 80.0 | 90 | 5.0+T |
| 3180 | total, with ileostomy or ilioproctostomy | 110.0 | 90 | 6.0+T |
| 3181 | with proctectomy and ileostomy | 120.0 | 90 | 6.0+T |
| 3191 | Enteroenterostomy; anastomosis of intestine | 60.0 | 90 | 5.0+T |
| ENTEROSTOMY-External fistulization of intestines (independent procedure): | ||||
| 3193 | small bowel (ileostomy or jejunostomy) | 50.0 | 90 | 4.0+T |
| 3195 | large bowel (colostomy or cecostomy) | 50.0 | 90 | 4.0+T |
| 3197 | small or large bowel, for ulcerative colitis | 75.0 | 90 | 6.0+T |
| 3200 | Reduction of volvulus, intussusception, internal hernia, by laparotomy | 60.0 | 90 | 5.0+T |
| 3203 | Revision of colostomy, simple, (release of superficial scar) | 5.0 | 90 | |
| 3204 | complicated (reconstruction in depth) | 25.0 | 60 | 4.0+T |
| Destruction | ||||
| 3211 | Enterolysis (freeing of intestinal adhesion) | 40.0 | 45 | 4.0+T |
| 3212 | with acute bowel obstruction | 60.0 | 45 | 5.0+T |
| 3213 | Intestinal plication (Noble type) | 60.0 | 90 | 4.0+T |
| Suture | ||||
| 3220 | Suture of intestine (enterorrhaphy), large or small, for perforated ulcer, wound, injury or rupture, single | 60.0 | 45 | 5.0+T |
| 3221 | multiple | by report | 6.0+T | |
| 3222 | Suture of intestine with colostomy | 70.0 | 90 | 5.0+T |
| 3225 | Closure of enterostomy large or small intestine | 40.0 | 90 | 5.0+T |
| 3227 | Closure of fecal fistula | by report | 5.0+T | |
| Meckel's Diverticulum and the Mesentery | ||||
| Excision | ||||
| 3231 | Excision of Meckel's diverticulum (diverticulectomy) | 50.0 | 45 | 4.0+T |
| 3235 | Excision of lesion of mesentery | 50.0 | 45 | 4.0+T |
| (With bowel resection, see 3174.) | ||||
| Suture | ||||
| 3241 | Suture of mesentery | 40.0 | 45 | 4.0+T |
| Appendix | ||||
| Incision | ||||
| 3251 | Incision and drainage of appendicular abscess, trans-abdominal | 30.0 | 45 | 4.0+T |
| Excision | ||||
| 3261 | Appendectomy | 40.0 | 45 | 4.0+T |
| Rectum | ||||
| Incision | ||||
| 3282 | Transrectal drainage of pelvic abscess | 15.0 | 15 | 3.0+T |
| 3283 | Incision and drainage of deep supralevator, pelvirectal or retrorectal abscess | 20.0 | 30 | 3.0+T |
| (See also 3357, 3358.) | ||||
| Excision | ||||
| 3291 | Complete proctectomy, combined abdomino-perineal, one or two stages | 100.0 | 90 | 6.0+T |
| 3292 | Complete proctectomy for congenital megacolon (Swenson type procedure) | 100.0 | 90 | 7.0+T |
| 3294 | Excision of rectal procidentia, with anastomosis, perineal approach | 60.0 | 90 | 4.0+T |
| 3295 | abdominal and perineal approach | 100.0 | 90 | 6.0+T |
| 3296 | Division of stricture in rectum | 20.0 | 90 | 4.0+T |
| 3298 | Perineal excision of primary or recurrent malignant tumor (Kraske type) | 80.0 | 90 | 4.0+T |
| 3299 | Local excision of extensive villous papilloma of rectum | 40.0 | 90 | 4.0+T |
| Endoscopy (Independent procedure) | ||||
| 3310 | Proctosigmoidoscopy, diagnostic, initial | 3.0 | 15 | 3.0+T |
| 3311 | subsequent | 2.0 | 15 | 3.0+T |
| 3312 | with biopsy, initial | 5.0 | 15 | 3.0+T |
| 3313 | subsequent for same lesion | 3.0 | 15 | 3.0+T |
| 3314 | with removal of papilloma or polyp, initial | 7.0 | 15 | 3.0+T |
| 3315 | subsequent for same lesion | 5.0 | 15 | 3.0+T |
| 3316 | with removal of multiple papillomas or polyps | 9.0 | 15 | 3.0+T |
| 3317 | complicated | by report | 3.0+T | |
| 3318 | Endoscopic control of hemorrhage | by report | 3.0+T | |
| 3319 | Endoscopic removal of foreign body, anus or rectum | by report | 3.0+T | |
| Repair | ||||
| 3320 | Proctoplasty, for stenosis | 40.0 | 90 | 3.0+T |
| 3321 | for prolapse of mucous membrane | 40.0 | 90 | 3.0+T |
| 3322 | Perirectal injection of sclerosing solution for prolapse, in hospital | 10.0 | 30 | |
| 3323 | Proctopexy for prolapse, abdominal approach | 60.0 | 90 | 5.0+T |
| 3325 | Proctopexy combined with sigmoid resection, abdominal approach | 90.0 | 90 | 5.0+T |
| Suture | ||||
| 3331 | Closure of rectovesical fistula | 60.0 | 90 | 5.0+T |
| (See also 3965.) | ||||
| 3333 | Closure of rectourethral fistula | 70.0 | 90 | 5.0+T |
| (See also 4026.) | ||||
| 3335 | Closure of rectovaginal fistula | 60.0 | 90 | 5.0+T |
| (When a colostomy is part of the above procedures, add 10 units.) | ||||
| Manipulation | ||||
| *3341 | Reduction of procidentia (independent procedure) | *2.0 | 0 | |
| Anus | ||||
| Incision | ||||
| 3351 | Fistulotomy or fistulectomy, subcutaneous | 10.0 | 30 | 3.0+T |
| 3352 | submuscular | 40.0 | 90 | 3.0+T |
| 3353 | complex or multiple | by report | 3.0+T | |
| 3354 | second stage | 10.0 | 60 | 3.0+T |
| 3355 | Remove seton, office | 2.0 | 15 | |
| 3356 | Incision and drainage of ischiorectal abscess (independent procedure) | 10.0 | 15 | 3.0+T |
| *3357 | Incision and drainage, perianal abscess (See also 3283.) | *2.0 | 0 | 3.0+T |
| 3358 | Incision and drainage of ischiorectal abscess with fistulotomy or fistulectomy, submuscular (See also 3283.) | 40.0 | 90 | 3.0+T |
| *3364 | Sphincterotomy, anal: division of anal sphincter (indedependent procedure) | *5.0 | 0 | 3.0+T |
| Excision | ||||
| 3371 | Fissurectomy, with or without sphincterotomy | 20.0 | 90 | 3.0+T |
| 3372 | Cryptectomy, single, office | 5.0 | 30 | |
| 3373 | multiple, hospital procedure | 30.0 | 90 | 3.0+T |
| 3374 | Papillectomy or excision of single tab (independent procedure), office | 3.0 | 15 | |
| 3375 | Excision of external hemorrhoidal tags and/or multiple papillae, office | 5.0 | 15 | |
| 3377 | Hemorrhoidectomy, external, complete | 20.0 | 90 | 3.0+T |
| 3380 | internal and external | 30.0 | 90 | 3.0+T |
| 3381 | radical (Buie or amputative type) | 40.0 | 90 | 3.0+T |
| 3382 | Fistulotomy or fistulectomy, submuscular, and hemorrhoidectomy | 40.0 | 90 | 3.0+T |
| 3386 | Fissurectomy and hemorrhoidectomy | 30.0 | 90 | 3.0+T |
| *3392 | Enucleation or excision of external thrombotic hemorrhoid | *3.0 | 0 | 3.0+T |
| Introduction | ||||
| *3401 | Hemorrhoids, injection of sclerosing solution | *2.0 | 0 | 3.0+T |
| Endoscopy (independent procedure) | ||||
| *3411 | Anoscopy, diagnostic with or without biopsy | *1.0 | 0 | |
| (For with removal of foreign body, see 3319.) | ||||
| (For control of hemorrhage, endoscopic, see 3318.) | ||||
| Repair | ||||
| 3420 | Anoplasty: plastic operation for stricture | 40.0 | 90 | 5.0+T |
| 3421 | infant, minor thin septum | 5.0 | 30 | 3.0+T |
| 3422 | Construction of anus for congenital absence, perineal approach | 50.0 | 90 | 5.0+T |
| 3423 | combined abdominal and perineal approach | 80.0 | 90 | 7.0+T |
| 3425 | Sphincteroplasty, anal, for incontinence | 40.0 | 90 | 4.0+T |
| 3426 | muscle transplant | by report | 4.0+T | |
| 3427 | Theiersch procedure for incontinence and/or prolapse | 25.0 | 30 | 4.0+T |
| Destruction | ||||
| 3433 | Condyloma, single or multiple, internal and external, in hospital | 20.0 | 30 | 3.0+T |
| *3434 | external, electrodesiccation, initial | *3.0 | 0 | |
| *3435 | subsequent | *2.0 | 0 | |
| LIVER | ||||
| Incision | ||||
| *3456 | Aspiration biopsy of liver | *5.0 | 0 | 3.0+T |
| Excision | ||||
| 3464 | Hepatectomy, partial: resection of liver | 80.0 | 45 | 9.0+T |
| Repair | ||||
| 3471 | Marsupialization of cyst or abscess of liver | 70.0 | 60 | 6.0+T |
| Suture | ||||
| 3481 | Hepatorrhaphy: suture of liver wound or injury | 60.0 | 45 | 9.0+T |
| BILIARY TRACT | ||||
| Incision | ||||
| 3491 | Hepaticotomy or hepaticostomy with exploration, drainage or removal of calculus | 70.0 | 45 | 6.0+T |
| 3495 | Choledochotomy or choledochostomy with exploration, drainage or removal of calculus, with or without cholecystotomy | 70.0 | 45 | 6.0+T |
| 3500 | Duodenocholedochotomy: transduodenal choledocholithomy | 80.0 | 60 | 6.0+T |
| 3501 | Transduodenal spincterotomy | 80.0 | 60 | 6.0+T |
| 3504 | Cholecystotomy or cholecystostomy with exploration, drainage or removal of calculus | 50.0 | 45 | 5.0+T |
| Introduction | ||||
| 3509 | Injection procedure for percutaneous trans-hepatic cholangiography (independent procedure) | 10.0 | 7 | 3.0+T |
| Excision | ||||
| 3515 | Cholecystectomy | 60.0 | 45 | 5.0+T |
| 3517 | with open exploration of common duct | 70.0 | 45 | 5.0+T |
| Repair | ||||
| 3518 | Exploration for congenital atresia of bile ducts | 50.0 | 60 | 7.0+T |
| 3519 | Direct anastomosis of gallbladder and gastrointestinal tract | 60.0 | 60 | 5.0+T |
| 3520 | Roux-en-y anastomosis of gallbladder and gastro-intestinal tract | 65.0 | 60 | 5.0+T |
| 3521 | Direct anastomosis of extrahepatic biliary ducts and gastrointestinal tract | 75.0 | 90 | 5.0+T |
| 3522 | Roux-en-y anastomosis of extrahepatic biliary ducts and gastrointestinal tract | 85.0 | 90 | 5.0+T |
| 3523 | Plastic reconstruction of extrahepatic biliary ducts with end-to-end anastomosis | 80.0 | 90 | 5.0+T |
| PANCREAS | ||||
| Incision | ||||
| 3541 | Abdominal drainage of pancreatitis | 50.0 | 60 | 6.0+T |
| 3544 | Removal of calculus | 70.0 | 60 | 6.0+T |
| Excision | ||||
| 3550 | Pancreatectomy, subtotal | 80.0 | 90 | 6.0+T |
| 3551 | subtotal (Whipple type) | 140.0 | 90 | 6.0+T |
| 3552 | total | 140.0 | 90 | 6.0+T |
| 3553 | Pancreatico-jejunostomy | 80.0 | 90 | 6.0+T |
| Repair | ||||
| 3565 | Marsupialization of cyst of pancreas | 60.0 | 60 | 6.0+T |
| 3566 | Internal direct anastomosis of cyst to gastrointestinal tract | 70.0 | 60 | 6.0+T |
| 3567 | Roux-en-y internal anastomosis, cyst to gastro-intestinal tract | 80.0 | 60 | 6.0+T |
| ABDOMEN, PERITONEUM AND OMENTUM | ||||
| Incision | ||||
| 3571 | Exploratory laparotomy: exploratory celiotomy | 40.0 | 45 | 4.0+T |
| 3573 | Drainage of peritoneal abscess or localized peritonitis exclusive of appendicular abscess | 40.0 | 45 | 4.0+T |
| 3575 | Subdiaphragmatic or subphrenic abscess | 50.0 | 45 | 5.0+T |
| 3578 | Retroperitoneal abscess | 40.0 | 45 | 5.0+T |
| *3588 | Peritoneocentesis: abdominal paracentesis, initial | *4.0 | 0 | |
| *3590 | subsequent | *3.0 | 0 | |
| Excision | ||||
| 3591 | Trans-peritoneal excision of intra-abdominal or retroperitoneal tumors or cysts | 70.0 | 60 | 5.0+T |
| Endoscopy | ||||
| 3595 | Peritoneoscopy | 15.0 | 15 | |
| Introduction | ||||
| *3611 | Pneumoperitoneum: intraperitoneal injection of air, initial | *4.0 | 0 | |
| *3612 | subsequent | *2.0 | 0 | |
| *3614 | Injection procedure for retroperitoneal pneumography, unilateral or bilateral (independent procedure) | *5.0 | ||
| *3615 | Injection procedure for pelvic pneumography (independent procedure) | *4.0 | ||
| (See also 4462.) | ||||
| Repair | ||||
| Hernioplasty, Herniorrhaphy, Herniotomy: | ||||
| (For bilateral herniorrhaphy see Rule 11.) | ||||
| 3631 | Inguinal, unilateral | 35.0 | 45 | 3.0+T |
| 3633 | with orchiectomy | 40.0 | 45 | 3.0+T |
| 3634 | with excision of hydrocele | 40.0 | 45 | 3.0+T |
| 3635 | recurrent | 40.0 | 45 | 3.0+T |
| 3646 | Femoral, unilateral | 35.0 | 45 | 3.0+T |
| 3651 | recurrent | 45.0 | 45 | 3.0+T |
| 3661 | Ventral, incisional | 45.0 | 45 | 3.0+T |
| 3662 | recurrent | 50.0 | 45 | 3.0+T |
| 3663 | Epigastric | 35.0 | 45 | 3.0+T |
| 3664 | recurrent | 45.0 | 45 | 3.0+T |
| 3665 | Umbilical, under age five years | 30.0 | 45 | 3.0+T |
| 3666 | over age five years | 35.0 | 45 | 3.0+T |
| 3667 | Omphalocele, in newborn, one stage | 40.0 | 60 | 6.0+T |
| 3668 | Gross type procedure, first stage | 50.0 | 60 | 6.0+T |
| 3669 | second stage | 50.0 | 60 | 6.0+T |
| (For diaphragmatic hernia, see 1495, 1496.) | ||||
| Suture | ||||
| 3734 | Secondary suture of abdominal wall for evisceration or disruption | 20.0 | 30 | 4.0+T |
| (For suture of ruptured diaphragm, see 1495, 1496.) | ||||
| URINARY SYSTEM | ||||
| Kidney | ||||
| Incision | ||||
| 3802 | Drainage of perirenal abscess (independent procedure) | 50.0 | 90 | 5.0+T |
| 3808 | Nephrotomy with drainage; nephrostomy | 80.0 | 90 | 5.0+T |
| 3811 | Nephrolithotomy, removal of calculus | 80.0 | 90 | 5.0+T |
| 3812 | large (staghorn) calculus | 90.0 | 90 | 5.0+T |
| 3813 | Division or transection of aberrant renal vessels (indedependent procedure) | 70.0 | 90 | 5.0+T |
| Pyelotomy with exploration | 70.0 | 90 | 5.0+T | |
| 3816 | Pyelotomy with drainage, pyelostomy | 70.0 | 90 | 5.0+T |
| 3817 | Pyelotomy with removal of calculus; pyelolithotomy; pelviolithotomy | 70.0 | 90 | 5.0+T |
| Excision | ||||
| *3820 | Renal biopsy, trochar or needle | *5.0 | 0 | |
| 3821 | Nephrectomy, including partial ureterectomy | 80.0 | 90 | 5.0+T |
| 3822 | with total ureterectomy through same or separate incision | 100.0 | 90 | 5.0+T |
| 3824 | Heminephrectomy | 100.0 | 90 | 5.0+T |
| 3827 | Excision of cyst of kidney | 70.0 | 90 | 5.0+T |
| *3829 | Aspiration or injection of renal cyst or renal pelvis | *5.0 | 0 | |
| Introduction | ||||
| (For perirenal insufflation, unilateral or bilateral, see 3614.) | ||||
| Repair | ||||
| 3831 | Pycloplasty: plastic operation on renal pelvis with or without plastic operation on ureter or nephropexy | 80.0 | 90 | 5.0+T |
| 3835 | Nephropexy: fixation or suspension of kidney (independent procedure) | 70.0 | 90 | 5.0+T |
| Suture | ||||
| 3841 | Nephrorrhaphy: suture of kidney wound or injury | 80.0 | 90 | 8.0+T |
| 3845 | Closure of nephrostomy, pyelostomy or other renal fistula (e.g., renocolic fistula) | 80.0 | 90 | 5.0+T |
| 3846 | Symphysiotomy for horseshoe kidney | 100.0 | 90 | 6.0+T |
| Transplant | ||||
| 3850 | Kidney transplant | 125.0 | 90 | 5.0+T |
| URETER | ||||
| Incision | ||||
| 3851 | Ureterotomy with exploration or drainage (independent procedure) | 70.0 | 90 | 5.0+T |
| 3857 | Ureterolithotomy, upper three quarters of ureter | 70.0 | 90 | 5.0+T |
| 3858 | lower one quarter | 80.0 | 90 | 5.0+T |
| Excision | ||||
| 3861 | Ureterectomy, with bladder cuff (independent procedure) | 80.0 | 90 | 5.0+T |
| Repair | ||||
| 3871 | Ureteroplasty: plastic operation on ureter (stricture) | 80.0 | 90 | 5.0+T |
| 3872 | Ureterolysis, with or without repositioning of ureter, unilateral | 70.0 | 90 | 5.0+T |
| 3873 | bilateral | 90.0 | 90 | 5.0+T |
| 3874 | Ureteropyclostomy: anastomosis of ureter and renal pelvis | 80.0 | 90 | 5.0+T |
| 3875 | Ureteroureterostomy | 80.0 | 90 | 5.0+T |
| 3876 | Ureteroneocystostomy: anastomosis of ureter to bladder, unilateral | 80.0 | 90 | 5.0+T |
| 3877 | bilateral | 100.0 | 90 | 5.0+T |
| 3880 | Ureteroenterostomy: anastomosis of ureter to intestine, unilateral | 80.0 | 90 | 5.0+T |
| 3881 | bilateral | 100.0 | 90 | 5.0+T |
| 3884 | Ureterostomy: transplantation of ureter to skin, unilateral | 70.0 | 90 | 5.0+T |
| 3885 | bilateral | 90.0 | 90 | 5.0+T |
| Suture | ||||
| 3891 | Ureterorrhaphy: suture of ureter (independent procedure) | 80.0 | 90 | 5.0+T |
| 3895 | Closure of fistula of ureter | by report | 5.0+T | |
| BLADDER | ||||
| Incision | ||||
| *3900 | Aspiration of bladder by needle or trochar | *5.0 | 0 | |
| 3902 | with insertion of suprapubic catheter | 10.0 | 30 | |
| 3904 | Cystotomy or cystostomy with fulguration | 60.0 | 90 | 5.0+T |
| 3906 | Cystotomy with drainage; cystostomy | 50.0 | 90 | 5.0+T |
| 3907 | Cystotomy with removal of calculus (cystolithotomy) without vesical neck resection | 50.0 | 90 | 5.0+T |
| 3908 | Drainage of perivesical or prevesical space abscess | 50.0 | 90 | 5.0+T |
| Excision | ||||
| 3911 | Cystectomy, partial | 70.0 | 90 | 6.0+T |
| 3912 | with re-implantation of ureter into bladder (ureteroneocystostomy) | 80.0 | 90 | 6.0+T |
| 3913 | complete | 100.0 | 90 | 6.0+T |
| 3914 | radical with ureteral transplants | 120.0 | 180 | 7.0+T |
| 3915 | with ureteral-ileo conduit | 140.0 | 180 | 7.0+T |
| 3918 | Transurethral resection, vesical neck, female or child (See also 4321.) | 50.0 | 90 | 4.0+T |
| 3919 | Cystotomy for excision of vesical neck (independent procedure) | 60.0 | 90 | 5.0+T |
| 3920 | Excision of bladder diverticulum (independent procedure) | 70.0 | 90 | 5.0+T |
| 3922 | Excision of bladder tumor (See also 3904.) | 60.0 | 90 | 5.0+T |
| 3924 | Transurethral resection of bladder tumors, large (For small tumors, see 3936, 3937.) | 60.0 | 90 | 5.0+T |
| Introduction | ||||
| *3926 | Bladder irrigation, simple, lavage and/or instillation | *1.0 | 0 | |
| *3927 | Injection procedure for cystography or urethro-cystography | *1.0 | 0 | |
| CYSTOSCOPY (independent procedure): | ||||
| 3930 | Diagnostic, office, initial | 5.0 | 7 | |
| 3931 | subsequent within 30 days | 3.0 | 7 | |
| 3932 | with ureteral catheterization | 8.0 | 7 | |
| 3933 | hospital | 8.0 | 7 | 3.0+T |
| 3934 | with ureteral catheterization | 15.0 | 7 | 3.0+T |
| (For Howard or Stamey type renal function test see 3948.) | ||||
| 3935 | With biopsy | 10.0 | 7 | |
| 3936 | With fulguration or treatment of minor (less than 0.5 cm.) lesion, with or without biopsy | 10.0 | 7 | |
| 3937 | With fulguration of small bladder tumors (0.5 cm. to 2 cm.) (For larger tumors, see 3924.) | 25.0 | 30 | 3.0+T |
| 3938 | With subsequent fulguration of bladder tumor | 10.0 | 7 | 3.0+T |
| 3939 | With insertion of radioactive substance, with or without biopsy or fulguration | 30.0 | 30 | 3.0+T |
| 3940 | With dilation of bladder, for interstitial cystitis, general anesthesia | 15.0 | 30 | 3.0+T |
| 3942 | With ureteral meatotomy | 20.0 | 30 | 3.0+T |
| 3943 | With resection or fulguration of ureterocele | 20.0 | 30 | 3.0+T |
| 3944 | With removal of foreign body from urethra or bladder | 20.0 | 30 | 3.0+T |
| 3945 | With removal of calculus from ureter | 30.0 | 30 | 3.0+T |
| 3946 | With manipulation of ureteral calculus, primary | 20.0 | 7 | 3.0+T |
| 3947 | subsequent | 10.0 | 7 | 3.0+T |
| 3948 | Differential quantitative and chemical renal function test (e.g., Howard or Stamey type), see 3932 or 3934, and add detention time beyond that required for usual catheterization, see 9071. | |||
| Destruction | ||||
| 3951 | Litholapaxy: crushing of calculus in bladder and removal of fragments | 50.0 | 90 | 3.0+T |
| Repair | ||||
| 3952 | Cystoplasty: plastic operation on bladder (anterior Y-plasty, vesical fundus resection, etc.) any procedure | 80.0 | 90 | 5.0+T |
| Suture | ||||
| 3961 | Cystorrhaphy: suture of bladder wound, injury or rupture | 60.0 | 90 | 6.0+T |
| 3963 | Closure of cystostomy (independent procedure) | 30.0 | 90 | 3.0+T |
| 3965 | Closure of vesicovaginal, vesicouterine, or vesicoenteric fistula (See also 3331.) | 60.0 | 90 | 5.0+T |
| Urethra | ||||
| Incision | ||||
| 3971 | Urethotomy, external (independent procedure) anterior | 10.0 | 15 | 3.0+T |
| 3973 | perineal, external | 25.0 | 15 | 3.0+T |
| 3977 | Meatotomy: cutting of meatus (independent procedure) | 3.0 | 7 | 3.0+T |
| 3978 | Drainage of deep periurethral abscess, hospital | 10.0 | 30 | 3.0+T |
| 3979 | Drainage of simple perineal urinary extravasation (independent procedure), uncomplicated | 15.0 | 15 | 3.0+T |
| 3980 | complicated, with or without diversion of urinary stream | 50.0 | 60 | 5.0+T |
| (See also 3908.) | ||||
| Excision | ||||
| (For excision or fulguration of urethral caruncle, see 4437.) | ||||
| 3987 | Excision or fulguration of carcinoma of urethra | by report | 3.0+T | |
| 3991 | Excision of diverticulum of urethra (independent procedure) | 50.0 | 60 | 3.0+T |
| 3994 | Excision or fulguration of urethral polyps, distal 3/4 inch of urethra | 5.0 | 15 | 3.0+T |
| (For posterior urethra, see 4006.) | ||||
| Endoscopy | ||||
| 4000 | Urethroscopy, diagnostic | 5.0 | 15 | 3.0+T |
| 4001 | with removal of calculus or foreign body | 20.0 | 45 | 3.0+T |
| 4004 | with internal urethrotomy | 20.0 | 45 | 3.0+T |
| 4006 | with fulguration of posterior urethra | 10.0 | 15 | 3.0+T |
| 4008 | subsequent, within 30 days | 5.0 | 15 | 3.0+T |
| Repair | ||||
| 4011 | Urethroplasty: plastic operation on urethra (except 4132 and 4135) | by report | 3.0+T | |
| Suture | ||||
| 4021 | Urethrorrhaphy: suture of urethral wound or injury | by report | 4.0+T | |
| 4023 | Closure of urethrostomy or fistual of urethra (independent procedure) | 30.0 | 60 | 4.0+T |
| 4025 | Closure of urethrovaginal fistula | 50.0 | 60 | 4.0+T |
| 4026 | Closure of urethrorectal fistula (See also 3333.) | 70.0 | 90 | 5.0+T |
| Manipulation | ||||
| *4031 | Dilation of urethral stricture by passage of sound, initial, male | *3.0 | 0 | |
| *4032 | subsequent within 30 days | *1.5 | 0 | |
| *4033 | Dilation of urethral stricture by passage of filiform and follower, male | *5.0 | 0 | |
| *4034 | subsequent within 30 days | *2.5 | 0 | |
| *4035 | Passage of filiform and follower for acute vesical retention, male | *5.0 | 0 | |
| *4036 | Dilation of female urethra including suppository and/or installation | *2.0 | 0 | |
| *4037 | subsequent within 30 days | *1.0 | 0 | |
| MALE GENITAL SYSTEM | ||||
| PENIS | ||||
| Incision | ||||
| *4101 | Dorsal or lateral "slit"of prepuce (independent procedure) | *3.0 | 0 | |
| Excision | ||||
| 4111 | Biopsy of penis (independent procedure) | 3.0 | 15 | |
| 4114 | Amputation of penis, partial | 40.0 | 60 | 3.0+T |
| 4115 | complete | 60.0 | 60 | 3.0+T |
| 4116 | radical | 100.0 | 90 | 4.0+T |
| (For local excision of lesion of penis, see Integumentary System.) | ||||
| 4122 | Circumcision, clamp procedure, newborn | 3.0 | 15 | |
| 4123 | except newborn | 5.0 | 15 | 3.0+T |
| 4124 | surgical excision other than clamp or dorsal slit, any age (except newborn) | 10.0 | 30 | 3.0+T |
| (For excision or fulguration of warts, see 0403, 0405.) | ||||
| Repair | ||||
| 4131 | Plastic operation on penis for hypospadias, straightening of chordee | 30.0 | 30 | 3.0+T |
| (For urethroplasty for hypospadias, see 0260 to 0324.) | ||||
| 4134 | Plastic operation on penis for injury | by report | 4.0+T | |
| 4135 | Plastic operation on penis for epispadias with extrophy of bladder | by report | 4.0+T | |
| 4136 | Plastic operation for penile epispadias distal to external sphincter | 50.0 | 30 | 4.0+T |
| TESTIS | ||||
| Excision | ||||
| 4140 | Biopsy, needle (independent procedure) | 2.0 | 15 | |
| 4141 | incisional (independent procedure) | 10.0 | 15 | 3.0+T |
| 4143 | Orchiectomy, simple unilateral | 20.0 | 30 | 3.0+T |
| 4144 | bilateral | 30.0 | 30 | 3.0+T |
| 4145 | with superficial inguinal node dissection, unilateral | 50.0 | 90 | 3.0+T |
| (For radical retroperitoneal node dissection, see 2673.) | ||||
| Repair | ||||
| 4152 | Reduction of torsion of testis by surgical means | 30.0 | 30 | 3.0+T |
| 4153 | with fixation of contralateral testis | 45.0 | 30 | 3.0+T |
| 4154 | Fixation of contralateral testis (independent procedure) | 20.0 | 30 | 3.0+T |
| 4156 | Orchiopexy, any type, with or without hernia repair | 50.0 | 60 | 3.0+T |
| 4157 | second stage (Torek type) | 10.0 | 30 | 3.0+T |
| (For orchiectomy with repair of hernia, see 3633.) | ||||
| EPIDIDYMIS | ||||
| Incision | ||||
| *4161 | Drainage of abscess of epididymis | *3.0 | 0 | 3.0+T |
| Excision | ||||
| 4171 | Biopsy of epididymis, needle | 2.0 | 15 | 3.0+T |
| 4172 | Exploration of epididymis with or without biopsy | 10.0 | 30 | 3.0+T |
| 4174 | Excision of spermatocele with or without epididymectomy | 30.0 | 90 | 3.0+T |
| 4176 | Epididymectomy, unilateral | 30.0 | 90 | 3.0+T |
| Repair | ||||
| 4181 | Epididymovasostomy (anastomosis of epididymis to vas deferens), unilateral | 40.0 | 90 | 3.0+T |
| 4182 | bilateral | 50.0 | 90 | 3.0+T |
| TUNICA VAGINALIS | ||||
| Incision | ||||
| *4191 | Puncture aspiration of hydrocele with or without injection of medication | *2.0 | 0 | |
| 4200 | Repair of hydrocele (Bottle type) | 20.0 | 90 | 3.0+T |
| 4201 | Excision of hydrocele, unilateral | 30.0 | 90 | 3.0+T |
| 4202 | with hernia repair | 40.0 | 45 | 3.0+T |
| SCROTUM | ||||
| Incision | ||||
| *4211 | Drainage of scrotal abscess | *2.0 | 0 | 3.0+T |
| 4215 | Removal of foreign body in scrotum | by report | 3.0+T | |
| Excision | ||||
| (For local excision of lesion of skin of scrotum, see 0175-0197, 0260-0270.) | ||||
| 4224 | Resection of scrotum | by report | 3.0+T | |
| 4227 | Scrotoplasty; plastic operation on scrotum | by report | 3.0+T | |
| Vas Deferens | ||||
| Incision | ||||
| 4231 | Vasotomy: incision or transection of vas, unilateral or bilateral (independent procedure) | 15.0 | 30 | 3.0+T |
| Excision | ||||
| 4241 | Vasectomy, unilateral or bilateral (independent procedure) | 15.0 | 30 | 3.0+T |
| Repair | ||||
| 4251 | Vasovasostomy, unilateral | 30.0 | 30 | 3.0+T |
| 4252 | bilateral | 40.0 | 30 | 3.0+T |
| Suture | ||||
| 4261 | Ligation (percutaneous) of vas deferens (independent procedure) | 5.0 | 30 | 3.0+T |
| Spermatic Cord | ||||
| Excision | ||||
| 4271 | Excision of hydrocele of spermatic cord (independent procedure), unilateral | 30.0 | 90 | 3.0+T |
| 4275 | Excision of varicocele (independent procedure), unilateral | 30.0 | 45 | 3.0+T |
| 4278 | with hernia repair | 40.0 | 45 | 3.0+T |
| Seminal Vesicles | ||||
| Incision | ||||
| 4281 | Vesiculotomy, unilateral | by report | ||
| Excision | ||||
| 4291 | Vesiculectomy | 80.0 | 90 | 3.0+T |
| Prostate | ||||
| Incision | ||||
| 4300 | Biopsy, prostate, needle, single or multiple | 5.0 | 15 | |
| 4301 | incisional, perineal approach | 30.0 | 30 | 4.0+T |
| 4302 | transrectal | 20.0 | 30 | 3.0+T |
| 4303 | Prostatotomy: external drainage of prostatic abscess | 30.0 | 60 | 4.0+T |
| 4304 | Prostatolithotomy: removal of prostatic calculus (independent procedure) | 70.0 | 60 | 4.0+T |
| Excision | ||||
| 4311 | Prostatectomy, perineal, subtotal | 80.0 | 90 | 6.0+T |
| 4313 | radical | 100.0 | 90 | 6.0+T |
| 4316 | suprapubic, one or two stages | 80.0 | 90 | 5.0+T |
| 4318 | retropubic | 80.0 | 90 | 5.0+T |
| 4319 | radical | 100.0 | 90 | 6.0+T |
| Endoscopy | ||||
| 4321 | Transurethral resection of prostate, including control of postoperative bleeding, complete (See also 3918.) | 80.0 | 90 | 5.0+T |
| FEMALE GENITAL SYSTEM Vulva and Introitus | ||||
| Incision | ||||
| 4403 | Incision and drainage, abscess of vulva | 5.0 | 15 | 3.0+T |
| 4405 | Incision and drainage of Bartholin's gland abscess, unilateral | 5.0 | 15 | 3.0+T |
| Excision | ||||
| 4421 | Biopsy of vulva (independent procedure) | 3.0 | 15 | 3.0+T |
| (For local excision or fulgration of lesion(s) of external genitalia, see 0175-0197, 0260-0324, 0401-0406.) | ||||
| 4423 | Vulvectomy, complete, bilateral | 55.0 | 60 | 3.0+T |
| 4424 | partial, less than 80% of vulvar area | 40.0 | 60 | 3.0+T |
| 4425 | radical, including unilateral regional lymph nodes | 100.0 | 90 | 5.0+T |
| 4426 | including bilateral regional lymph nodes | 150.0 | 90 | 5.0+T |
| 4428 | Clitoridotomy: circumcision, female | 7.5 | 30 | 3.0+T |
| 4429 | Clitoridectomy | 10.0 | 30 | 3.0+T |
| 4431 | Hymenectomy, partial excision of hymen | 10.0 | 30 | 3.0+T |
| 4433 | Excision of Bartholin's gland or cyst | 20.0 | 30 | 3.0+T |
| 4434 | Marsupialization or cautery destruction of Bartholin's gland or cyst | 15.0 | 30 | 3.0+T |
| 4436 | Excision or fulguration of Skene's glands | 7.0 | 30 | 3.0+T |
| 4437 | Excision or fulguration of unrethral caruncle | 7.0 | 30 | 3.0+T |
| (For excision of unrethral diverticulum see 3991.) | ||||
| (For excision or fulguration of unrethal carcinoma see 3987.) | ||||
| Repair | ||||
| 4441 | Episioplasty: plastic repair of vulva (non obstetrical) | 20.0 | 30 | 3.0+T |
| 4443 | Plastic operation on unrethral sphincter, vaginal approach | 30.0 | 60 | 3.0+T |
| 4445 | Plastic repair of urethra for mucosal prolapse (independent procedure) | by report | 60 | 3.0+T |
| 4447 | Plastic repair of unrethocele (independent procedure).. | 30.0 | 60 | 3.0+T |
| Suture | ||||
| (For episiorrhaphy or episiperineorrhapy: for recent injury of vulva and/or perineum (nonobstetrical), see 4480.) | ||||
| Vagina | ||||
| Incision | ||||
| 4461 | Colpotomy with exploration or drainage of pelvic abscess | 15.0 | 30 | 3.0+T |
| *4462 | Colpocentsis (independent procedure) | *4.0 | 0 | 3.0+T |
| *4463 | Puncture and aspiration of cul de sac | *3.0 | 0 | 3.0+T |
| 4471 | Biopsy of vaginal mucosa (independent procedure) | 3.0 | 15 | 3.0+T |
| (For excision and/or fulguration of local lesion(s) see 0175-0197, 0401-0406.) | ||||
| 4473 | Colpocleisis, complete obliteration of vagina | 50.0 | 60 | 3.0+T |
| 4475 | Le Fort type | 35.0 | 60 | 3.0+T |
| 4477 | Excision of vaginal septum | by report | 30 | 3.0+T |
| Introduction | ||||
| *4478 | Irrigation and/or application of any medicament for treatment of bacterial, parasitic or fungoid disease... | *1.0 | 0 | |
| Repair | ||||
| 4479 | Colporrhaphy: suture of injury of vagina (non-obsterical) | by report | 60 | 3.0+T |
| 4480 | Colpoperineorrhaphy: suture of injury of vagina and/or perineum (nonobstetrical) | by report | 60 | 3.0+T |
| 4481 | Anterior colporrhaphy, repair of cystocele with or without repair of urethocele (independent procedure) | 35.0 | 60 | 3.0+T |
| 4484 | Posterior colporrhaphy, repair of rectocele (independent procedure) | 30.0 | 60 | 3.0+T |
| 4485 | with perineoplasty or perineorrhaphy | 35.0 | 60 | 3.0+T |
| 4488 | Combined anterior-posterior colporrhaphy | 50.0 | 60 | 3.0+T |
| 4492 | Urethral suspension, abdominal approach (Marshall-Marchetti type) | 40.0 | 45 | 4.0+T |
| 4493 | Repair of enterocele (independent procedure) abdominal approach | 45.0 | 60 | 4.0+T |
| 4494 | vaginal approach | 45.0 | 60 | 4.0+T |
| 4495 | Colpopexy, abdominal approach | 45.0 | 60 | 4.0+T |
| 4497 | Construction of artificial vagina (vaginal atresia or absence) with or without graft | by report | 60 | 3.0+T |
| (For closure of vaginal fistulae, see 3335, 3965, 4025.) | ||||
| Manipulation | ||||
| *4511 | Dilation of vagina under anesthesia | *2.0 | 0 | 3.0+T |
| *4512 | Pelvic examination under anesthesia | *2.0 | 0 | 3.0+T |
| Endoscopy | ||||
| 4521 | Culdoscopy (independent procedure) | 15.0 | 15 | 3.0+T |
| Oviduct | ||||
| Incision | ||||
| 4531 | Transection of Fallopian tube, unilateral or bilateral, abdominal or vaginal approach | 40.0 | 45 | 4.0+T |
| 4532 | post-partum, during same hospitalization | 30.0 | 45 | 4.0+T |
| Excision | ||||
| 4541 | Salpingectomy, complete or partial, unilateral or bi-lateral (independent procedure) | 45.0 | 45 | 4.0+T |
| 4545 | Salpingo-oophorectomy, complete or partial, unilateral or bilateral (independent procedure) | 45.0 | 45 | 4.0+T |
| 4551 | Salpingoplasty, unilateral or bilateral (independent procedure) | 50.0 | 45 | 4.0+T |
| Ovary | ||||
| Incision | ||||
| 4561 | Drainage of ovarian cyst, vaginal approach, unilateral or bilateral | 25.0 | 60 | 4.0+T |
| 4562 | abdominal approach, unilateral or bilateral | 40.0 | 60 | 4.0+T |
| 4564 | Drainage of ovarian abscess, vaginal approach | 20.0 | 60 | 4.0+T |
| 4565 | abdominal approach | 40.0 | 60 | 4.0+T |
| Excision | ||||
| 4566 | Biopsy of ovary, unilateral or bilateral (independent procedure) | 45.0 | 60 | 4.0+T |
| 4568 | Partial oophorectomy, bilateral or unilateral | 45.0 | 60 | 4.0+T |
| Cervix Uteri | ||||
| Excision | ||||
| (For radical surgical procedures, see 4620, 4626.) | ||||
| 4571 | Biopsy or local excision of lesion, with or without fulguration, quadrant biopsy (independent procedure) | 3.0 | 15 | 3.0+T |
| *4572 | Cauterization of cervix, office | *3.0 | 0 | |
| 4573 | Biopsy of cervix, circumferential (cone) with or without dilation and curettage, with or without Sturmdorff type repair | 20.0 | 45 | 3.0+T |
| 4574 | Cryocautery of the cervix | 5.0 | 0 | |
| 4575 | Trachelectomy: cervicectomy: amputation of cervix (independent procedure) | 20.0 | 45 | 3.0+T |
| 4577 | total excision of cervical stump, with or without pelvic floor repair, abdominal approach | 50.0 | 45 | 4.0+T |
| 4578 | vaginal approach | 60.0 | 45 | 3.0+T |
| Introduction | ||||
| *4581 | Insertion of any hemostatic agent for control of hemorrhage (independent procedure) | *3.0 | 0 | 3.0+T |
| (For Insertion of any radioactive materials, see 7615.) | ||||
| *4583 | Insertion of intracervical or intrauterine device | *3.0 | 0 | 3.0+T |
| Repair | ||||
| *4585 | Tracheloplasty: surgical repair of incompetent cervix, loop type | *8.0 | 0 | 3.0+T |
| 4586 | Shirodkar type | 20.0 | 45 | 3.0+T |
| 4587 | Trachelorrhaphy, plastic repair of uterine cervix, vaginal approach | by report | 60 | 3.0+T |
| Manipulation | ||||
| *4588 | Dilation of cervical canal, instrumental (independent procedure) | *3.0 | 0 | 3.0+T |
| 4589 | Dilation and curettement of cervical canal | 15.0 | 15 | 3.0+T |
| Corpus Uteri | ||||
| Excision | ||||
| 4610 | Endometrial biopsy (independent procedure) | 3.0 | 15 | 3.0+T |
| 4612 | Dilation and curettage, diagnostic and/or therapeutic (nonobstetrical) | 15.0 | 15 | 3.0+T |
| 4613 | Myomectomy: excision of fibroid tumor of uterus (independent procedure, nonobstetrical) | 50.0 | 45 | 4.0+T |
| 4614 | Total hysterectomy (corpus and cervix) with or without tubes, and/or ovaries, one or both | 60.0 | 45 | 4.0+T |
| 4618 | Supracervical hysterectomy: subtotal hysterectomy, with or without tubes, and/or ovaries, one or both | 55.0 | 45 | 4.0+T |
| 4620 | Radical hysterectomy for cancer including regional lymph nodes | 100.0 | 90 | 6.0+T |
| 4626 | plus removal of bladder and ureteral transplantations and/or abdomino-perineal resection of rectum and colon and colostomy or any combination thereof | by report | 90 | 7.0+T |
| 4631 | Vaginal hysterectomy | 60.0 | 45 | 4.0 +T |
| 4632 | with plastic repair of vagina, anterior and/or posterior coloporrhaphy | 70.0 | 45 | 4.0+T |
| 4634 | with repair of enterocele | 75.0 | 45 | 4.0+T |
| Introduction | ||||
| (For insertion of radioactive substance into corpus with or without dilation and curettage, see 7615.) | ||||
| *4675 | Insuffiation of uterus and tubes with air or CO2 | *3.0 | 0 | 3.0+T |
| *4676 | Injection procedure for hystero-salpingography | *3.0 | 0 | 3.0+T |
| Repair | ||||
| 4683 | Uterine suspension with or without shortening of round ligaments (independent procedure) | 40.0 | 45 | 4.0+T |
| 4684 | with presacral sympathectomy | 45.0 | 45 | 4.0+T |
| 4685 | with interposition operation, with or without pelvic floor repair | 50.0 | 45 | 4.0+T |
| 4690 | with shortening of endopelvic fascia: parametrial fixation with or without pelvic floor repair (Manchester type) | 50.0 | 45 | 4.0+T |
| 4692 | with shortening of sacro-uterine ligaments | 50.0 | 45 | 4.0+T |
| 4694 | Hysterosalpingostomy: anastomosic of tubes of uterus.. | 50.0 | 45 | 4.0+T |
| 4695 | Hysterorrhaphy: repair of ruptured uterus (non-obstetrical) | 40.0 | 45 | 4.0+T |
| Perineum | ||||
| Excision | ||||
| 4710 | Biopsy of perineum (independent procedure) | 3.0 | 15 | 3.0+T |
| (For excision of local lesion see 0175-0178, 0260-0324.) | ||||
| Incision | ||||
| *4720 | Incision and drainage of perineal abscess (non-obsterical) | *3.0 | 0 | 3.0+T |
| Repair | ||||
| 4731 | Perineoplasty: repair of perineum (independent procedure) | 15.0 | 45 | 3.0+T |
| 4735 | third degree laceration, old (independent procedure).. | 40.0 | 45 | 3.0+T |
| (Also see 4441, 4480.) | ||||
| 4742 | Perineorrhaphy, postpartum, by other than delivering physician | 20.0 | 45 | 3.0+T |
| 4745 | Repair of perineal fistula | 25.0 | 45 | 3.0+T |
| (For repair of recent injury of perineum, non-obstetrical, see 4480.) | ||||
| MATERNITY | ||||
| Nonspecialist in Obstetrics | ||||
| (For medical or surgical complications during maternity care, see section 533.5(a) (2) (vii). Fees for all maternity procedures include prenatal and postpartum care unless otherwise specified.) | ||||
| Incision | ||||
| 4801 | Classic cesarean section | 50.0 | 45 | 5.0+T |
| 4802 | Low cervical (lower uterine segment) cesarean section.. | 50.0 | 45 | 5.0+T |
| 4803 | Cesarean section and hysterectomy, total or subtotal | 60.0 | 45 | 5.0+T |
| 4804 | Extraperitoneal cesarean section | 60.0 | 45 | 5.0+T |
| Excision | ||||
| 4809 | Hysterotomy induced abortion | 50.0 | 45 | 5.0+T |
| 4811 | Ectopic pregnancy, tubal, requiring salpingectomy and/or oophorectorny, abdominal or vaginal approach | 50.0 | 60 | 5.0+T |
| 4812 | ovarian, requiring oophorectomy | by report | 60 | 5.0+T |
| 4815 | Hysterotomy, abdominal, for removal of hydatidiform mole | 45.0 | 90 | 5.0+T |
| Manipulation | ||||
| (For value of anesthesia service rendered by attending physician, see Anesthesia sections 533.5(a)(2)(v) and 533.5(a)(2)(ix)) | ||||
| 4821 | Total obstetrical care including antepartum care, obstetrical delivery and postpartum care (with or without low forceps, and/or episiotomy) | 35.0 | 45 | 3.0+T |
| 4822 | Obstetrical delivery (with or without low forceps, and/or episiotomy) and including hospital postpartum care | 20.0 | 45 | 3.0+T |
| 4823 | Antepartum care only (independent procedure) | Sv[Phi] | ||
| 4824 | Postpartum care only (independent procedure) | Sv[Phi] | ||
| 4843 | Dilation and curettage, and/or suction, induced abortion | 20.0 | 45 | 3.0+T |
| 4850 | Abortion, first trimester, completed medically | Sv[Phi] | ||
| 4851 | (incomplete) completed surgically, (dilatation and curettage) | 15.0 | 45 | 3.0+T |
| 4853 | second trimester, completed medically | Sv[Phi] | ||
| 4854 | (incomplete) completed surgically, (dilatation and curettage) | 15.0 | 45 | 3.0+T |
| 4856 | missed, first or second trimester, completed medically or surgically | by report | 45 | 3.0+T |
| 4858 | incomplete, septic, requiring dilatation and curettage and additional care | by report | 45 | 3.0+T |
| 4870 | Dilatation and curettage of uterus for postpartum bleeding | 15.0 | 45 | 3.0+T |
| MATERNITY | ||||
| Specialist in Obstetrics | ||||
| (For medical or surgical complications during maternity care, see Surgery Rule 6. Fees for all maternity procedures include prenatal and postpartum care unless otherwise specified.) | ||||
| Incision (Obstetrician) | ||||
| 4805 | Classic caesarean section | 68.75 | 45 | 5.0+T |
| 4806 | Low cervical (lower uterine segment) caesarean section | 68.75 | 45 | 5.0+T |
| 4807 | Caesarean section & hysterectomy, total or subtotal | 81.25 | 45 | 5.0+T |
| 4808 | Extraperitoneal caesarean section | 75.0 | 45 | 5.0+T |
| Excision (Obstetrician) | ||||
| 4810 | Hysterotomy, induced abortion | 68.75 | 45 | 5.0+T |
| 4811 | Ectopic pregnancy, tubal, requiring salpingectomy and/or oophorectomy, abdominal or vaginal approach | 50.0 | 60 | 5.0+T |
| 4812 | ovarian, requiring oophorectomy | by report | 60 | 5.0+T |
| 4815 | Hysterotomy, abdominal, for removal of hydatidiform mole | 45.0 | 90 | 5.0+T |
| Manipulation (Obstetrician) | ||||
| 4825 | Total obstetrical care (with or without low forceps, and/or episiotomy) | 50.0 | 45 | 3.0+T |
| 4826 | Obstetrical delivery (with or without low forcepts, and/or episiotomy) & including hospital postpartum care (excludes prenatal care) | 27.5 | 45 | 3.0+T |
| 4827 | Antepartum care only (independent procedure) | Sv[Phi] | ||
| 4828 | Postpartum care only (independent procedure) | Sv[Phi] | ||
| 4830 | Abortion, first trimester, completed medically | Sv[Phi] | ||
| 4831 | (incomplete) completed surgically, (dilatation and curettage) | 18.75 | 45 | 3.0+T |
| 4833 | second trimester, completed medically | Sv[Phi] | ||
| 4834 | (incomplete) completed surgically, (dilatation and curettage) | 18.75 | 45 | 3.0+T |
| 4836 | missed, first or second trimester, completed medically or surgically | by report | 45 | 3.0+T |
| 4838 | incomplete, septic, requiring dilatation and curettage and additional care | by report | 45 | 3.0+T |
| 4841 | Amniocentesis, diagnostic | 5.0 | 7 | 3.0+T |
| 4842 | Amniocentesis with hypertonic solution including terminal curettage, induced abortion | 40.0 | 45 | 4.0+T |
| 4844 | Dilatation and curettage, and/or suction, induced abortion | 25.0 | 45 | 3.0+T |
| 4845 | Dilatation and curettage of uterus for postpartum bleeding | 18.75 | 45 | 3.0+T |
| (For medical complications of pregnancies, e.g. toxemia, cardiac, neurological, etc., or problems requiring additional and unusual services, see Medicine or other appropriate sections of these studies.) | ||||
| ENDOCRINE SYSTEM | ||||
| Thyroid Gland | ||||
| Incision | ||||
| *4904 | Incision and drainage of thyroglossal cyst (infected) | *3.0 | 0 | 3.0+T |
| Excision | ||||
| 4911 | Local excision of small cyst or adenoma of thyroid | 40.0 | 45 | 5.0+T |
| 4912 | Total thyroid lobectomy, unilateral | 50.00 | 45 | 5.0+T |
| 4914 | Thyroidectomy, total or complete | 70.0 | 45 | 5.0+T |
| 4917 | subtotal or partial | 60.0 | 45 | 5.0+T |
| 4924 | total or subtotal for malignancy with radical neck dissection | 100.0 | 45 | 6.0+T |
| 4925 | total or subtotal for malignancy with limited neck dissection | 80.0 | 45 | 5.0+T |
| 4937 | secondary, unilateral | 60.0 | 45 | 5.0+T |
| 4938 | bilateral | 70.0 | 45 | 5.0+T |
| 4941 | Excision of thyroglossal duct, cyst or sinus | 45.0 | 45 | 4.0+T |
| Parathyroid, Thymus, Pituitary, Pineal Adrenal Glands and Carotid Body | ||||
| (For hypophysectomy, see 2019 and 5130.) | ||||
| Excision | ||||
| 4971 | Parathyroidectomy or exploration of parathyroid | 70.0 | 45 | 5.0+T |
| 4972 | with mediastinal exploration with or without splitting of sternum | 90.0 | 60 | 12.0+T |
| 4985 | Adrenalectomy, transabdominal, lumbar or dorsal, unilateral | 80.0 | 90 | 9.0+T |
| 4986 | bilateral, one stage | 100.0 | 90 | 9.0+T |
| 4987 | two stages | 120.0 | 90 | 9.0+T |
| 4989 | Biopsy adrenal, unilateral | 60.0 | 45 | 9.0+T |
| 4990 | bilateral | 70.0 | 45 | 9.0+T |
| 4993 | Excision of carotid body tumor, with excision of carotid artery | 100.0 | 60 | 8.0+T |
| 4994 | without excision of carotid artery | 70.0 | 60 | 8.0+T |
| NERVOUS SYSTEM | ||||
| Skull, Meninges and Brain | ||||
| CRANIOTOMY FOLLOWING TRAUMA: | ||||
| Incision | ||||
| 5001 | Burr holes, unilateral, exploratory for subdural puncture, not followed by surgery | 30.0 | 60 | 8.0+T |
| 5002 | multiple, bilateral, not followed by surgery | 50.0 | 60 | 8.0+T |
| 5003 | Evacuation of hematoma, subdural, extradural, or introcerebral by burr holes only | 90.0 | 60 | 9.0+T |
| 5004 | requiring craniotomy | 100.0 | 60 | 9.0+T |
| 5012 | Removal of foreign body from brain | 100.0 | 60 | 9.0+T |
| Excision | ||||
| 5015 | Removal of brain scar | by report | 9.0+T | |
| Repair | ||||
| 5018 | Elevation of depressed skull fracture, simple | 75.0 | 60 | 9.0+T |
| 5020 | with debridement of brain and repair of dura | 100.0 | 60 | 9.0+T |
| 5022 | Cranioplasty for skull defect, bone, metal or plastic | 100.0 | 60 | 9.0+Y |
| 5024 | Repair of dura by graft, including repair for cerebrospinal rhinorrhea | 100.0 | 60 | 9.0+T |
| CRANIOTOMY FOR NONTRAUMATIC CAUSES: | ||||
| Incision | ||||
| 5101 | Burr holes, exploratory or ventricular puncture, not followed by surgery | 30.0 | 30 | 7.0+T |
| 5102 | Ventricular puncture through previous burr holes or fontanelle | 5.0 | 7 | |
| 5106 | Craniotomy for drainage of brain abscess | 75.0 | 90 | 11.0+T |
| 5108 | Subsequent tapping (aspiration) abscess in operating room | 10.0 | 7 | 4.0+T |
| 5110 | at bedside | 5.0 | 7 | |
| 5112 | Suboccipital craniectomy for tractotomy or section of 5th, 8th, 9th or other cranial nerves | 125.0 | 90 | 9.0+T |
| 5113 | Intratemporal (mastoid) craniectomy for decompression, neurolysis or excision of acoustic nerve tumor | 100.0 | 90 | 9.0+T |
| 5114 | Craniotomy for surgery of sensory root of gasserian ganglion | 100.0 | 90 | 9.0+T |
| 5116 | Craniotomy for lobotomy, unilateral | 40.0 | 90 | 9.0+T |
| 5117 | bilateral | 60.0 | 90 | 9.0+T |
| 5119 | Craniotomy for orbital decompression, unilateral | 100.0 | 90 | 9.0+T |
| *5121 | Cisternal puncture (independent procedure) | *3.0 | 0 | |
| *5122 | Subdural tap through fontanelle (infant) | *3.0 | 0 | |
| Excision | ||||
| (For trans-septal hypophsectomy see 2019.) | ||||
| 5130 | Osteoplastic craniotomy for excision of brain tumor, abscess, or cyst, supratentorial | 125.0 | 90 | 9.0+T |
| 5132 | Suboccipital craniectomy for brain tumor | 150.0 | 90 | 11.0+T |
| 5134 | Osteoplastic craniotomy for arteriovenous malformation | by report | 11.0+T | |
| 5136 | Osteoplastic craniotomy for obliteration of aneurysm | 150.0 | 90 | 11.0+T |
| 5140 | Craniotomy for pallidectomy, any method, including localizing techniques, single or multiple stages | 100.0 | 90 | 9.0+T |
| 5144 | for topectomy | 100.0 | 90 | 11.0+T |
| 5146 | for excision of choroid plexus | 50.0 | 90 | 11.0+T |
| 5148 | Craniectomy for osteomyelitis of skull | by report | 8.0+T | |
| Introduction | ||||
| (For cerebral angiography, see radiology.) | ||||
| 5152 | Burr holes with ventriculography, not followed by surgery | 30.0 | 30 | 7.0+T |
| 5153 | followed by surgery | 20.0 | 30 | |
| 5154 | Ventriculography through fontanelle or previous burr holes | 10.0 | 7 | 7.0+T |
| 5155 | Ventricular puncture with introduction of dye and recovery by spinal puncture | 12.0 | 7 | 7.0+T |
| 5159 | Injection procedure for pneumo-encephalography | 10.0 | 7 | 5.0+T |
| Repair | ||||
| 5160 | Ventriculocisternostomy | 100.0 | 90 | 11.0+T |
| 5162 | Repair of encephalocele | by report | 9.0+T | |
| 5166 | Ventriculoauricular shunt | 100.0 | 90 | 11.0+T |
| 5167 | replacement or irrigation of obstructed valve | 90.0 | 90 | 11.0+T |
| 5168 | replacement or irrigation of ventricular catheter | 30.0 | 30 | 5.0+T |
| 5169 | removal of shunt in toto without replacement | 30.0 | 30 | 11.0+T |
| 5170 | Ventriculo-auricular-peritoneal-pleural-ureteral shunt | 100.0 | 90 | 11.0+T |
| 5171 | co-surgeon | 80.0 | 90 | |
| 5174 | Craniectomy for crantostenosis, single suture | 75.0 | 90 | 9.0+T |
| 5175 | multiple sutures | 100.0 | 90 | 9.0+T |
| Spine and Spinal Cord | ||||
| Incision | ||||
| 5190 | Laminectomy for decompression of the spinal cord and nerve roots (See also 5208-5210, 5225.) | 100.0 | 90 | 7.0+T |
| 5192 | Cordotomy, cervico-dorsal | 100.0 | 90 | 8.0+T |
| 5194 | Rhizotomy | 75.0 | 60 | 8.0+T |
| *5198 | Spinal puncture, lumbar, simple (independent procedure) | *2.0 | 0 | |
| *5199 | diagnostic, initial, with study of hydrodynamics | *4.0 | 0 | |
| (Add one unit to value assigned to 5198 and 5199 if patient is under 4 years.) | ||||
| Excision | ||||
| 5206 | Laminectomy for lesion of spinal cord or meninges | 100.0 | 90 | 7.0+T |
| 5208 | Laminotomy for removal of intervertebral discs, cervical | 90.0 | 90 | 8.0+T |
| 5209 | thoracic | 90.0 | 90 | 7.0+T |
| 5210 | lumbar | 90.0 | 90 | 7.0+T |
| 5211 | Excision of intervertebral discs, anterior approach, cervical | 80.0 | 90 | 7.0+T |
| (Also see 0634-0642.) | ||||
| Introduction | ||||
| 5214 | Injection procedure for myelography | 10.0 | 7 | 3.0+T |
| 5216 | for discography | 10.0 | 7 | 3.0+T |
| Repair | ||||
| 5225 | Laminectomy for spondylolisthesis (See also 5190) | 100.0 | 90 | 7.0+T |
| 5227 | Repair of meningocele | 75.0 | 90 | 9.0+T |
| 5229 | Repair of meningomyelocele | 90.0 | 90 | 9.0+T |
| 5231 | Lumbar subarachnoid-peritoneal-ureteral shunt | 80.0 | 90 | 9.0+T |
| 5232 | co-surgeon | 75.0 | 90 | |
| *5233 | Application crutchfield tongs or other skeletal traction device | *5.0 | 0 | |
| Peripheral Nerves, Other Extracranial nerves, and Ganglia | ||||
| Incision | ||||
| (For transection of trigeminal or glossopharyngeal nerves, see 5112, 5114.) | ||||
| 5252 | Phrenic nerve transection or avulsion | 15.0 | 30 | 3.0+T |
| 5255 | Transection, spinal nerve | 40.0 | 60 | 3.0+T |
| 5257 | Transection occipital nerve | 40.0 | 60 | 4.0+T |
| Excision | ||||
| (For excision of tender scar, skin and subcutaneous tissues with or without tiny neuroma, see 0175, 0178, 0265, 0266.) | ||||
| 5273 | Excision of surgical identifiable neuroma of cutaneous nerve | 8.0 | 60 | 3.0+T |
| 5274 | digital nerve, one or both, same digit | 10.0 | 60 | 3.0+T |
| 5275 | hand or foot, one (add 10 percent each additional) | 15.0 | 60 | 3.0+T |
| 5276 | arm or leg | 25.0 | 60 | 3.0+T |
| 5277 | Avulsion infraorbital nerve | 20.0 | 60 | 3.0+T |
| 5280 | Stoefel's neurectomy | 40.0 | 60 | 3.0+T |
| 5282 | Obturator neurectomy | 40.0 | 60 | 3.0+T |
| Introduction | ||||
| *5290 | Alcohol injection, subarachnoid | *5.0 | 0 | |
| 5294 | 2nd or 3rd branch of trigeminal nerve | 7.5 | 30 | |
| 5295 | under x-ray control (excluding x-ray charge) | 10.0 | 30 | |
| Nerve Block | ||||
| 5298 | Paravertebral block, lumbar or thoracic | 5.0 | 7 | |
| 5300 | Sympathetic block (cervical) | 5.0 | 7 | |
| 5302 | Stellate ganglion | 5.0 | 7 | |
| 5311 | Brachial plexus block | 5.0 | 7 | |
| 5312 | Intercostal nerves | 3.0 | 7 | |
| 5313 | Lumbar, sacral and coccygeal nerves | 5.0 | 7 | |
| 5314 | Pudendal nerve | 5.0 | 7 | |
| 5315 | Splanchnic nerves | 5.0 | 7 | |
| 5316 | Ilioinguinal and iliohypogastric nerves | 5.0 | 7 | |
| 5317 | Sciatic nerve | 3.0 | 7 | |
| 5318 | Phrenic nerve | 3.0 | 7 | |
| 5319 | Other peripheral nerves | 3.0 | 7 | |
| Repair | ||||
| NEURORRHAPHY - suture of nerve. | ||||
| Primary | ||||
| 5320 | Digital, one (add 25% each additional nerve) | 15.0 | 90 | 3.0+T |
| 5322 | Hand or foot (except motor thenar or ulnar motor) | 20.0 | 90 | 3.0+T |
| 5323 | Motor thenar or ulnar motor | 30.0 | 90 | 3.0+T |
| 5325 | Arm or leg (except sciatic) | 40.0 | 90 | 3.0+T |
| 5326 | Sciatic | by report | 3.0+T | |
| 5328 | Brachial or lumbar plexus | by report | 3.0+T | |
| 5330 | Cranial, extra-cranial | 75.0 | 90 | 5.0+T |
| (For facial nerve, see 6002, 6003.) | ||||
| Secondary or delayed anastomosis or reanastomosis including local advancement to overcome gap. (Add 25 percent to primary repair.) | ||||
| Secondary or delayed anastomosis involving additional procedures such as nerve graft and/or rerouting of nerve to overcome gap | by report | |||
| (See 6003 for facial nerve.) | ||||
| NEUROPLASTIES; plastic procedure on intact nerve. | ||||
| 5335 | Freeing nerve from scar, including internal and external lysis and transposition away from scarred area, digital, one or both | 15.0 | 90 | 3.0+T |
| 5337 | hand or foot | 20.0 | 90 | 3.0+T |
| 5339 | arm or leg (except sciatic) | 40.0 | 90 | 3.0+T |
| 5340 | sciatic | by report | ||
| 5341 | brachial or lumbar plexus | by report | ||
| 5343 | cranial, extra-cranial | 75.0 | 90 | 5.0+T |
| (For facial nerve, see 6002, 6003.) | ||||
| 5345 | Transplantation ulnar nerve, elbow (independent procedure) (includes neurolysis) | 25.0 | 90 | 3.0+T |
| 5347 | Median nerve decompression at carpal tunnel, simple | 30.0 | 45 | 3.0+T |
| (If complex, see also 1550, 1553.) | ||||
| NEURO-ANASTOMOSIS to establish other than normal anatomical continuity. | ||||
| 5350 | Spinal accessory-facial, hypoglossal-facial, spinal accessory-hypoglossal, etc | 75.0 | 90 | 6.0+T |
| Vegetative Nervous System | ||||
| Excision | ||||
| Sympathectomies: | ||||
| 5371 | Cervical, unilateral | 60.0 | 60 | 6.0+T |
| 5372 | bilateral | 80.0 | 60 | 6.0+T |
| 5375 | Cervico-thoracic (Smithwicke type, supra- and infra-diaphragmatic), unilateral | 70.0 | 60 | 6.0+T |
| 5376 | bilateral, concomitant or delaved | 100.0 | 60 | 8.0+T |
| 5381 | Lumbar, unilateral | 55.0 | 60 | 4.0+T |
| 5382 | bilateral | 75.0 | 60 | 6.0+T |
| 5385 | Splanchnicectomy (Peet Type) unilateral | 65.0 | 60 | 5.0+T |
| 5386 | bilateral | 80.0 | 60 | 8.0+T |
| 5390 | Presacral neurectomy, hypogastric plexus | 50.0 | 60 | 4.0+T |
| EYE | ||||
| Diagnostic and Manipulative Procedures | ||||
| 5400 | Eye examination to include refraction, ophthalmoscopy, tonometry, gross visual field and muscle balance examination and medical diagnosis | $20.00 | ||
| 5401 | with complete visual fields included | $28.00 | ||
| *5402 | Gonioscopy, diagnostic, adult | *2.0 | 0 | 3.0+T |
| 5403 | infant | 4.0 | 7 | 3.0+T |
| *5404 | Refraction without cycloplegic or mydriatic | *$12.00 | 0 | |
| *5405 | with cycloplegic or mydriatic, including post-cycle-plegic visit | *$16.00 | 0 | |
| 5406 | Orthoptic evaluation | 2.0 | 0 | |
| 5407 | training each 30 minutes | 1.0 | 0 | |
| *5408 | Visual fields, complete | *2.0 | 0 | |
| *5409 | Tonography (recording tonometer method or perilimbal suction device) | *2.0 | 0 | |
| *5410 | Provocative test(s) for glaucoma including water drinking and/or mydriatic | *2.0 | ||
| 5411 | Funduscopic under anesthesia | 4.0 | 7 | 3.0+T |
| 5412 | Fitting contact lenses | Sv[Phi] | ||
| Ophthalmologist | ||||
| Office Visits | ||||
| 5414 | **External eye examination (medical treatment of minor external eye diseases, e.g., conjunctivitis, chalazion, hordeolum, blepharitis) | $10.00 | ||
| 5416 | Follow-up visit to external eye examination | $7.20 | ||
| **Not to be added to codes 5400 or 5401. | ||||
| Hospital Visits | ||||
| 5417 | Initial visit | 2.5 | ||
| 5418 | Follow-up visit, including treatment | 1.5 | ||
| Eyeball | ||||
| Incision | ||||
| 5420 | Goniotomy | 50.0 | 30 | 4.0+T |
| Excision | ||||
| 5421 | Enucleation of eyeball with or without sphere implant | 40.0 | 30 | 4.0+T |
| 5422 | with integrated implant | 50.0 | 30 | 4.0+T |
| 5424 | Secondary implantation of integrated implant | 60.0 | 30 | 4.0+T |
| 5427 | Evisceration of eyeball | 40.0 | 30 | 4.0+T |
| 5428 | with implantation in scleral shell | 50.0 | 30 | 4.0+T |
| 5431 | Suture of eyeball for wound or injury | by report | 4.0+T | |
| Cornea | ||||
| Incision | ||||
| 5441 | Keratotomy, any type | 10.0 | 14 | 4.0+T |
| 5443 | Paracentesis of cornea | 10.0 | 14 | 4.0+T |
| *5445 | Removal of foreign body from surface of cornea | *2.0 | 0 | |
| *5448 | under slit lamp | *3.0 | 0 | |
| Excision | ||||
| 5451 | Keratectomy, partial | 30.0 | 30 | 6.0+T |
| 5452 | complete | 40.0 | 30 | 6.0+T |
| 5457 | Pterygium | 25.0 | 30 | 4.0+T |
| Introduction | ||||
| 5461 | Tattoo of cornea, mechanical or chemical | 30.0 | 30 | 4.0+T |
| *5465 | Curettage and cauterization of corneal ulcer | *5.0 | 0 | |
| *5466 | Iontophoresis of corneal ulcer | *5.0 | 0 | |
| Repair | ||||
| 5471 | Keratoplasty, (corneal transplant) lamellar | 100.0 | 90 | 8.0+T |
| 5472 | partial or complete, penetrating | 110.0 | 90 | 8.0+T |
| Suture | ||||
| 5481 | Suture of perforated cornea | by report | 6.0+T | |
| Sclera | ||||
| Incision | ||||
| 5491 | Sclerotomy, operative incision, with removal of intraocular foreign body (with or without magnet) | 50.0 | 45 | 6.0+T |
| 5492 | with removal of foreign body from anterior chamber (with or without magnet) | 50.0 | 45 | 6.0+T |
| 5495 | Sclerotomy, posterior | 30.0 | 15 | 4.0+T |
| *5496 | Aspiration of anterior chamber, diagnostic | *4.0 | 0 | |
| Excision | ||||
| 5501 | Sclerectomy for glaucoma, with scissors, punch or trephination | 60.0 | 45 | 6.0+T |
| 5503 | Scleral resection | 100.0 | 90 | 6.0+T |
| Introduction | ||||
| 5511 | Irrigation and/or air injection into anterior chamber | 15.0 | 15 | 4.0+T |
| Suture | ||||
| 5521 | Suture of sclera for wound or injury | by report | 8.0+T | |
| Iris and Ciliary Body | ||||
| Incision | ||||
| 5531 | Iridotomy | 20.0 | 30 | 4.0+T |
| 5532 | with transfixion of iris; iris bombe | 20.0 | 30 | 4.0+T |
| 5534 | Iridotomy-performed with photocoagulator | 10.0 | 30 | 4.0+T |
| Excision | ||||
| 5541 | Excision of lesion of iris | 60.0 | 45 | 4.0+T |
| 5542 | and/or ciliary body (iridocyclectomy) | 80.0 | 45 | 4.0+T |
| 5544 | Iridectomy; basal, optical or preliminary | 50.0 | 45 | 4.0+T |
| 5546 | peripheral | 50.0 | 45 | 4.0+T |
| Repair | ||||
| 5552 | Iridodialysis | 40.0 | 45 | 4.0+T |
| 5561 | Repair of prolapsed iris with suture of perforated sclera or cornea | by report | 8.0+T | |
| Manipulation | ||||
| 5571 | Iridencleisis or comparable procedure | 50.0 | 45 | 4.0+T |
| Destruction | ||||
| 5580 | Diathermy of the ciliary body; cyclodiathermy | 30.0 | 30 | 4.0+T |
| 5582 | Cyclodialysis | 50.0 | 45 | 4.0+T |
| Crystalline Lens | ||||
| Incision | ||||
| 5601 | Discission (needling of lens), initial | 20.0 | 45 | 4.0+T |
| 5602 | subsequent | 10.0 | 45 | 4.0+T |
| 5603 | Aspiration of lens material for congenital cataract, one or more stages | 60.0 | 30 | 4.0+T |
| Excision | ||||
| 5611 | Extraction of lens, intracapsular, extracapsular or linear, unilateral | 80.0 | 90 | 8.0+T |
| 5616 | Removal of dislocated lens | 80.0 | 90 | 8.0+T |
| Vitreous | ||||
| Introduction | ||||
| 5622 | Transplantation of vitreous | 50.0 | 60 | 8.0+T |
| Retina | ||||
| Repair | ||||
| 5630 | Reattachment of retina, electrocoagulation, scleral resection, buckling or partial tubing | 100.0 | 90 | 7.0+T |
| 5631 | encircling tube, initial | 100.0 | 90 | 7.0+T |
| 5632 | subsequent | by report | 30 | 7.0+T |
| 5633 | Removal of encircling tube | 40.0 | 30 | 4.0+T |
| 5634 | Reattachnent of retina, light coagulation of retinal break(s), one or more stages during same period of hospitalization | 40.0 | 30 | 7.0+T |
| 5635 | with drainage of subretinal fluid | 50.0 | 60 | 7.0+T |
| 5636 | Light coagulation of retina for tumor, Eales disease, etc., initial | 40.0 | 30 | 4.0+T |
| 5637 | subsequent | 20.0 | 30 | 4.0+T |
| Examination | ||||
| 5638 | Comprehensive retinal examination prior to or in anticipation of surgery, to include the following | 10.0 | 0 | |
| 1. Code 5400 - Eye examination to include refraction, opthalmoscopy, tonometry, gross visual field and muscle balance examination and medical diagnosis. | ||||
| 2. Complete visual fields and records. | ||||
| 3. Study of the vitreous cavities and the fundi of both eyes including contact lens examination and binocular indirect ophthalmoscopy. | ||||
| 4. Gonioscopy. | ||||
| 5. Complete retinal drawings of both eyes. | ||||
| Ocular Muscles | ||||
| Incision, Excision and Repair | ||||
| 5641 | Any type of muscle operation involving one or more muscles in one or both eyes done in one stage | 60.0 | 30 | 4.0+T |
| 5647 | Muscle transplant (Hummelscheim type, etc.) | 70.0 | 30 | 4.0+T |
| Orbit | ||||
| Incision | ||||
| 5651 | Orbitotomy with exploration | 60.0 | 30 | 7.0+T |
| 5652 | with drainage of intraorbital abscess | 60.0 | 30 | 7.0+T |
| 5653 | with removal of intraorbital foreign body | 60.0 | 30 | 7.0+T |
| 5662 | Excision of benign lesion of orbit, requiring bone flap | 90.0 | 30 | 7.0+T |
| 5864 | Exenteration or evisceration of orbital contents with or without graft | 60.0 | 60 | 7.0+T |
| 5665 | including orbital bone | by report | ||
| Introduction | ||||
| 5671 | Orbital injection of alcohol for hemorrhagic glaucoma or intractable pain | 10.0 | 15 | |
| Repair | ||||
| (For plastic repair of orbit, see 0260-0324, 0619-0621.) | ||||
| Eyelids | ||||
| Incision | ||||
| *5691 | Blepharotomy with drainage of abscess of eyelid | *2.0 | 0 | |
| *5692 | with drainage of Meibomian glands; hordeolum (stye) | *2.0 | 0 | |
| Excision | ||||
| (For blepharectomy, see 0175-0197, 0260-0324.) | ||||
| 5702 | Excision or incision of Meibomian gland (chalazion), single | 5.0 | 15 | 3.0+T |
| 5703 | multiple, same lid | 6.0 | 15 | 3.0+T |
| 5704 | multiple, different lids | 7.0 | 15 | 3.0+T |
| (For excision of lesion of eyelid, malignant, see 0194-0197, 0260-0324.) | ||||
| 5712 | Epilation, electrolysis | 4.0 | 15 | 3.0+T |
| (For excision of xantholasma, 0175-0178, 0260-0324.) | ||||
| Repair | ||||
| (Blepharoplasty; plastic repair of eyelid with or without graft, any type, see 0251, 0252, 0260-0324.) | ||||
| (Canthoplasty: plastic repair of canthus, see 0251, 0252, 0260-0324.) | ||||
| (Plastic restoration of eyebrow, by graft, see 0308-0324.) | ||||
| (Tarsoplasty: plastic repair of tarsal cartilage, see 0261-0275.) | ||||
| (Reposition of ciliary base, see 0260-0324.) | ||||
| 5727 | Blepharoptosis repair, superior rectus, levator, or frontalis methods, unilateral | 60.0 | 60 | 4.0+T |
| 5728 | fascia sling method | 40.0 | 60 | 4.0+T |
| 5729 | lid suture method | 25.0 | 60 | 3.0+T |
| 5730 | Cautery puncture for entropion or ectropian | 5.0 | 15 | |
| 5731 | Ectropion repair (e.g., Kuhnt-Szymanowski type) | 40.0 | 30 | 4.0+T |
| 5732 | Entropion repair (e.g., Wheeler type) | 40.0 | 30 | 4.0+T |
| Suture | ||||
| (Blepharorrhaphy: suture of eyelid, see 0251, 0261-0269.) | ||||
| (Tarsorrhaphy: suture of tarsal cartilage see 0251, 0261-0269.) | ||||
| (Canthorrhaphy: suture of palpebral fissure of canthus, see 0251, 0261-0269.) | ||||
| Conjunctiva | ||||
| Incision | ||||
| *5741 | Removal of foreign body from surface of conjunctiva | *1.0 | 0 | |
| *5742 | embedded in conjunctiva | *2.0 | 0 | |
| 5743 | Suture of conjunctiva | 5.0 | 15 | 4.0+T |
| Excision | ||||
| 5751 | Biopsy of conjunctiva | 5.0 | 15 | 4.0+T |
| 5753 | Excision of lesion of conjunctiva, e.g., cyst | 5.0 | 15 | 4.0+T |
| (For epithelioma, see 0175-0196, 0261-0269.) | ||||
| (For nevus, see 0175-0196, 0261-0269.) | ||||
| Repair | ||||
| 5760 | Conjunctivoplasty, free graft using conjunctiva | 50.0 | 30 | 5.0+T |
| 5762 | using buccal mucous membrane | 60.0 | 30 | 5.0+T |
| 5774 | Flap operation of corneal ulcer | 20.0 | 30 | 4.0+T |
| 5775 | Flap operation: "flapping"of conjunctiva for perforating injuries or operative wound | 20.0 | 30 | 5.0+T |
| (For repair of symblepharon without graft see 0175-0178, 0260-0276.) | ||||
| Lacrimal Tract | ||||
| Incision | ||||
| 5801 | Drainage of lacrimal gland (abscess) | 10.0 | 15 | 4.0+T |
| 5803 | Drainage of lacrimal sac, dacryocystotomy or dacryo-cystostomy) | 7.5 | 15 | 4.0+T |
| Excision | ||||
| 5811 | Excision of lacrimal gland (dacryoadenectomy) | 50.0 | 45 | 4.0+T |
| 5813 | Excision of lacrimal sac (dacryocystectomy) | 50.0 | 45 | 4.0+T |
| 5815 | Excision of lacrimal gland tumor | 60.0 | 45 | 4.0+T |
| Introduction | ||||
| 5821 | Catheterization of nasolacrimal duct with implantation of tube or stent | 10.0 | 15 | 3.0+T |
| *5823 | Injection procedure for dacryocystography | *3.0 | 0 | |
| Repair | ||||
| 5831 | Plastic operation on canaliculi | by report | 4.0+T | |
| 5833 | Dacryocystorrhinostomy: fistulization of lacrimal sac into nasal cavity, with or without anterior ethmoliidectomy | 70.0 | 60 | 5.0+T |
| 5835 | Closure of punctum by cautery | 4.0 | 15 | 3.0+T |
| Manipulation | ||||
| *5841 | Dilation of punctum | *2.0 | 0 | 3.0+T |
| *5843 | Probing of nasolacrimal duct | *3.0 | 0 | 3.0+T |
| *5846 | Probing and/or irrigation of canaliculus | *2.0 | 0 | 3.0+T |
| EAR | ||||
| External Ear | ||||
| (For audiometric, vestibular and speech tests, see 9340-9342.) | ||||
| Incision | ||||
| *5901 | Drainage of abscess or hematoma of auricle, simple | *2.0 | 0 | 3.0+T |
| 5902 | complicated, including suppurative chondritis | by report | 3.0+T | |
| *5905 | Drainage of abscess of external auditory canal | *2.0 | 0 | 3.0+T |
| Excision | ||||
| 5911 | Biopsy of ear | 3.0 | 15 | |
| (For local destruction or excision of lesion of ear, see 0175-0197.) | ||||
| (For plastic closure, see 0260-0324.) | ||||
| 5916 | Excision ear, partial, simple repair | 10.0 | 30 | 3.0+T |
| 5917 | Complete amputation, auricle | 20.0 | 90 | 3.0+T |
| *5920 | Excision osteoma, external canal, simple | *5.0 | 0 | |
| 5923 | Excision of exostois of external auditory canal, end-aural or post-aural approach, complicated | 50.0 | 90 | 3.0+T |
| 5924 | Radical excision of malignant lesion of external auditory canal | by report | 4.0+T | |
| 5926 | with neck dissection | by report | 6.0+T | |
| Endoscopy | ||||
| *5931 | Otoscopy with removal foreign body in external auditory canal | *2.0 | 0 | 3.0+T |
| Repair | ||||
| (Otoplasty: plastic operation on ear, see 0260-0324.) | ||||
| (Reconstruction of ear with graft of skin plus cartilage, bone or other implant, see 0260-0324, 0620, 0621.) | ||||
| 5947 | Otoplasty, of cartilage ("lop-ear")with or without reduction in size, unilateral | 50.0 | 180 | 3.0+T |
| 5948 | bilateral | 70.0 | 180 | 3.0+T |
| 5949 | Reconstruct external auditory canal for congenital atresia, single stage | 100.0 | 180 | 3.0+T |
| Suture | ||||
| (For suture of wound or injury of ear, see 0251, 0252, 0260-0270.) | ||||
| Middle Ear | ||||
| Introduction | ||||
| 5955 | Eustachian tube catheterization and insufflation, unilateral or bilateral | 1.5 | 0 | |
| Incision | ||||
| *5961 | Myringotomy; tympanotomy; plicotomy, with or without Eustachian inflation and/or aspiration | *3.0 | 0 | 3.0+T |
| 5962 | Tympanotomy, diagnostic, exploratory for middle ear exposure | 50.0 | 30 | 3.0+T |
| 5963 | with insertion of tube for serous otitis media, unilateral | 5.0 | 7 | 3.0+T |
| 5964 | with insertion of collar-button tube for muco-serous otitis media, unilateral or bilateral | 25.0 | 45 | 3.0+T |
| 5968 | Tympanolysis, transtympanic | 80.0 | 180 | 3.0+T |
| Excision | ||||
| 5971 | Mastoidectomy, simple | 50.0 | 180 | 4.0+T |
| 5972 | Mastoidectomy, modified radical or radical, without skin graft | 80.0 | 180 | 4.0+T |
| 5975 | with skin graft | 90.0 | 180 | 4.0+T |
| 5980 | Petrous apicectomy, including radical mastoidectomy | by report | 4.0+T | |
| 5982 | Removal of middle ear polyp | 10.0 | 30 | 3.0+T |
| Repair | ||||
| 5990 | Revision of radical mastoidectomy, with or without skin graft | 90.0 | 180 | 4.0+T |
| *5991 | Patching tympanic membrane, with or without cauterization | *2.0 | 0 | |
| 5992 | Myringoplasty, uncomplicated | 80.0 | 180 | 4.0+T |
| 5993 | Tympanoplasty without mastoidectomy (may include change in contours of external auditory canal and be combined with middle ear, including ossicular chain constuction and/or attic surgery), post-auricular or endaural approach | 100.0 | 180 | 4.0+T |
| 5994 | Tympanoplasty with mastoidectomy | 120.0 | 180 | 4.0+T |
| 5996 | Incudo-stapedial arthrodesis, with or without graft | 70.0 | 90 | 4.0+T |
| 5997 | Stapes mobiliation, primary or secondary | 70.0 | 90 | 4.0+T |
| 5998 | Stapedectomy with insertion of prosthetic stapes with fenestration of the oval window | 100.0 | 90 | 4.0+T |
| 5999 | Mastoid obliteration | 80.0 | 90 | 4.0+T |
| Suture | ||||
| 6001 | Closure of fistula, mastoid (independent procedure) | 25.0 | 60 | 4.0+T |
| 6002 | Decompression, intratemporal, facial nerve, with or without neurolysis | 100.0 | 180 | 9.0+T |
| (see also 5330) | ||||
| 6003 | Suture and/or graft, facial nerve, intratemporal | 120.0 | 180 | 9.0+T |
| Internal Ear | ||||
| Incision | ||||
| 6011 | Labyrinthotomy, any type | 100.0 | 180 | 6.0+T |
| 6012 | Fenestration of semicircular canal | 100.0 | 180 | 6.0+T |
| 6014 | Revision of fenestration operation | 60.0 | 180 | 6.0+T |
| Excision | ||||
| 6021 | Labyrinthectomy | 100.0 | 180 | 6.0+T |
Disclaimer: These regulations may not be the most recent version. New York may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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