Crosswalk to CPT/HCPCS Codes and Associated Coverage Determinations

The following table lists the Coverage Determinations that WPS Medicare currently has available and the CPT/HCPCS codes that can be found within each document. This list assists you with determining whether a procedure code has local coverage limits. All codes are also subject to National Coverage rules, medical necessity and other regulations such as CCI, MUE, ASC, National Lab restrictions, documentation/ signature requirements and other provisions. If a code is available on this list, the Coverage Determination that is associated with the code will present guidance on coverage. This listing is intended to be a helpful tool for search and document retrieval.

If you are unable to find the code(s) you are specifically looking for, please review the CMS Coverage Center Website(external link) to research additional resources they have available.

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LCD Title CMS ID# Coverage Determination Type Associated CPT/HCPCS Codes
3D Interpretation and Reporting of Imaging Studies L30729 Local 76376, 76377
Ablative Therapy L30312 Local 19105, 19499, 32999, 0071T, 0072T,20982, 20999, 47370, 47371, 47380, 47381, 47382, 50250, 50542, 50592, 50593, 76940, 77013, 77022
Allergy Testing and Allergy Immunotherapy L30471 Local 82785, 86003, 86005, 95004, 95010, 95015, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95075, 95078, 95115, 95117, 95120, 95125, 95130, 95131, 95132, 95133, 95134, 95144, 95145, 95146, 95147, 95148, 95149, 95165, 95170, 95180, 95199
Application of Bioengineered Skin Substitutes L30135 Local 11042, 11043, 11044, 11045, 11046, 11047, 15002, 15003, 15004, 15005, 15271, 15272, 15273, 15274, 15275, 15276, 15277, 15278, 97602, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4119, Q4120, Q4121, Q4122, Q4123, Q4124, Q4125, Q4126, Q4127, Q4128, Q4129, Q4130
Automatic Implantable Cardioverter Defibrillator (AICD or ICD)Adobe Portable Document Format NA National 33202, 33203, 33216, 33217, 33223, 33224, 33225, 33240, 33241, 33242, 33243, 33244, 33245, 33246, 33249, 93640, 93641, 93642, 93741, 93742, 93743, 93744, G0297, G0298, G0299, G0300
Bariatric Surgery for Morbid ObesityAdobe Portable Document Format NA National 43644, 43645, 43770, 43775, 43842, 43845, 43846, 43847, 43999, 49320
Biofeedback L31070 Local 51784, 51785, 90875, 90876, 90901, 90911, 95860, 95861, 95863, 95864, 95870, 95872, 97014, 97112
Biofeedback Therapy for the Treatment of Urinary IncontinenceAdobe Portable Document Format NA National 90901, 90911
Bisphosphonate Drug Therapy L30139 Local J1436, J1740, J2430, J3487, J3488
Blepharoplasty, Blepharoptosis and Brow Lift L29973 Local 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908
Bone Marrow or Stem Cell TransplantationAdobe Portable Document Format NA National 38205, 38206, 38230, 38240, 38241,
Bone Mass Measurement L31620 Local 76977, 77078, 77080, 77081, 77083, 78350, 78351, G0130
Botulinum Toxin Type A & Type B L28555 Local 31513, 31570, 31571, 31513, 31570, 31571, 43201, 43236, 43241, 53899, 64611, 64612, 64613, 64614, 64640, 64650, 64999, 67345, 92265, 95860, 95861, 95863, 95865, 95866, 95867, 95868, 95869, 95870, 95873, 95874, J0585, J0586, J0587, J0588, Q2040
Brachytherapy L30320 Local 19296, 19297, 19298, 31626, 31643, 32553, 49327, 49411, 49412, 55859, 55860, 55875, 55876, 55920, 57155, 57156, 58346, 76000, 76001, 76872, 76873, 76950, 76965, 77012, 77014, 77261, 77262, 77263, 77280, 77285, 77290, 77295, 77326, 77327, 77328, 77331, 77336, 77370, 77470, 77750, 77761, 77762, 77763, 77776, 77777, 77778, 77781, 77782, 77783, 77784, 77785, 77786, 77787, 77789, 77790, 77799, A9527, C1716, C1717, C1719, C2616, C2634, C2635, C2636, C2638, C2639, C2640, C2641, C2642, C2643, C2698, C2699, C9725, C9726, C9728, Q3001
Capsule Endoscopy L30141 Local 91110, 91111, 91299
Cardiac Catheterization and Coronary Angiography L30719 Local 33967, 35201, 35206, 35226, 35261, 35266, 35286, 93451, 93452, 93453, 93454, 93455, 93456, 93457, 93458, 93459, 93460, 93461, 93462, 93463, 93503, 93505, 93530, 93531, 93532, 93533, 93563, 93564, 93565, 93566, 93567, 93568
Cardiovascular Stress Testing L28563 Local 90765, 90768, 90772, 90774, 93015, 93016, 93017, 93018, 93799, J0152, J0395, J1245, J1250, J2785
Cataract Surgery and Complex Cataract Surgery L30159 Local 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984
Chemotherapy Drugs and their Adjuncts L28576 Local C9287, C9399, J0640, J0641, J0894, J2353, J3490, J3590, J9000, J9001, J9010, J9015, J9017, J9020, J9025, J9031, J9033, J9035, J9040, J9041, J9043, J9045, J9050, J9055, J9060, J9065, J9070, J9098, J9100, J9120, J9130, J9150, J9151, J9160, J9165, J9171, J9178, J9179, J9181, J9185, J9190, J9200, J9201, J9206, J9207, J9208, J9209, J9211, J9213, J9214, J9215, J9228, J9230, J9245, J9250, J9260, J9261, J9263, J9264, J9265, J9266, J9268, J9270, J9280, J9293, J9300, J9302, J9303, J9305, J9307, J9310, J9315, J9320, J9330, J9340, J9351, J9355, J9357, J9360, J9370, J9390, J9395, J9600, J9999, Q2043
Chiropractic Services L30328 Local 98940, 98941, 98942
Circulating Tumor Cell Marker Assays L32218 Local 0279T, 0280T
Clinical Psychologist ServicesAdobe Portable Document Format NA National 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90846, 90847, 90849, 90853, 90857, 90880, 96101, 96102, 96103, 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96150, 96151, 96152, 96153, 96154, 96155, 97532, 97533
Clinical Social Worker ServicesAdobe Portable Document Format NA National Not Applicable
Colonoscopy and Sigmoidoscopy-Diagnostic L30304 Local 44388, 44389, 44390, 44391, 44392, 44393, 44394, 44397, 45330, 45331, 45332, 45333, 45334, 45335, 45337, 45338, 45339, 45340, 45341, 45342, 45345, 45355, 45378, 45379, 45380, 45381, 45382, 45383, 45384, 45385, 45386, 45387, 45391, 45392
Computed Coronary Tomography Angiography L30288 Local 75571, 75572, 75573, 75574
Computerized Corneal Topography L31064 Local 65710, 65730, 65750 ,65755, 65756, 65757, 65760, 65765, 65767, 65770, 65771, 92025
Computerized Tomography (CAT Scans) L28544 Local 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 75635
Corneal Pachymetry L30485 Local 76514
Cosmetic and Reconstructive Surgery L30733 Local 11920, 11921, 11922, 11950, 11951, 11952, 11954, 15775, 15776, 15781, 15782, 15783, 15788, 15789, 15792, 15793, 15819, 15824, 15825, 15826, 15828, 15829, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15876, 15877, 15878, 15879, 17340, 17360, 17380, 19300, 19316, 19318, 19324, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19357, 19361, 19364, 19366, 19367, 19368, 19369, 19370, 19371, 19380, 19396, 30400, 30410, 30420, 30430, 30435, 30450, 69300, C9800, G0429, Q2026, Q2027
Cranial Stereotactic Radiosurgery (SRS) and Cranial Stereotactic Radiotherapy (SRT) L30318 Local 61796, 61797, 61798, 61799, 61800, 63620, 63621, 77371, 77372, 77373, 77432, 77435, G0173, G0251, G0339, G0340
CT Colonography (Virtual Colonoscopy [VC]) L30300 Local 72192, 72193, 72194, 74150, 74160, 74170, 74261, 74262, 74263, 76376, 76377
Cytogenetic Studies L30487 Local 88230, 88233, 88235, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299
Diagnostic Pap Tests L31080 Local 88141, 88142, 88143, 88147, 88148, 88150, 88152, 88153, 88154, 88155, 88164, 88165, 88166, 88167, 88174 88175, 88199, G0143
Dental ServicesAdobe Portable Document Format NA National 21031, 21032, 21076, 21077, 21079, 21080, 21081, 21082, 21083, 21084, 21085, 21086, 21087, 21088, 21089, 21245, 21246, 21248, 21249, 21299, 41800, 41820, 99231, 99232, 99233, 99251, 99252, 99253, 99254, 99255, L8040, L8041, L8042, L8043, L8044, L8045, L8046, L8047, L8048, L8049
Dialysis Shunt Maintenance L32009 Local 35475, 35476, 35512, 35522, 35523, 35903, 36005, 36010, 36120, 36140, 36147, 36148, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248, 36593, 36831, 36832, 36833, 36834, 36838, 36860, 36861, 36870, 37201, 37205, 37206, 37607, 37618, 75710, 75790, 75791, 75820, 75822, 75825, 75827, 75896, 75962, 75964, 75978, 76000, 90940, 90995, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971, 93990, J0350, J2993, J2997
Drugs and Biologics (Non-chemotherapy) L32013 Local 96401, C9257, C9399, J0129, J0180, J0256, J0257, J0364, J1300, J1642, J1745, J1931, J2001, J2323, J2357, J2503, J2562, J2778, J2796, J3396, J3490, J3590, J9999
Electrical Stimulation (ES) and Electromagnetic Therapy for the Treatment of WoundsAdobe Portable Document Format NA National G0281, G0295, G0329
Electrocardiographic (EKG or ECG) Monitoring (Holter or Real-Time Monitoring) L29584 Local 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272, 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272
Electroconvulsive Therapy (ECT) L30493 Local 00104, 90870
Electromagnetic Navigation Bronchoscopy (ENB) L30510 Local 31627
Emergency Department ServicesAdobe Portable Document Format NA National 99221, 99222, 99223, 99281, 99282, 99283, 99284, 99285, 99286, 99287, 99288, 99291, 99292
Endoscopic Treatment of GERD L30473 Local 43257, 43499, 43999, 49999, C9724
Epidural and Transforaminal Epidural Injections L30481 Local 01996, 62281, 62282, 62310, 62311, 62318, 62319, 64479, 64480, 64483, 64484, 77003, 77012, 72275
Erythropoiesis Stimulating Agents L31074 Local A4657, J0881, J0882, J0885, J0886, G0257, Q4081, 99211
Erythropoiesis Stimulating Agents (ESAs) in Cancer and Related Neoplastic ConditionsAdobe Portable Document Format NA National J0881, J0885
Flow Cytometry L30161 Local 88182, 88184, 88185, 88187, 88188, 88189
Fluorescein or Indocyanine Green Angiography L30727 Local 92235, 92240
Health and Behavior Assessment/Intervention L30514 Local 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90846, 90847, 90849, 90853, 90857, 90862, 90865, 90867, 90868, 90870, 90875, 90876, 90880, 90882, 90885, 90887, 90889, 90899, 96150, 96151, 96152, 96153, 96154, 99401, 99402, 99403, 99404, 99411, 99412 G0375, G0376
Heavy Metal Testing L31067 Local 80178, 82108, 82175, 82300, 82495, 82525, 83015, 83018, 83540, 83655, 83785, 83825, 83885, 84255, 84285, 84630, 84999
Helicobacter Pylori Testing L30163 Local 78267, 78268, 83009, 83013, 83014, 86677, 87338, 87339
Hemophilia Clotting Factors L31078 Local J7180, J7183, J7184, J7185, J7186, J7187, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7198, J7199
Home and Domiciliary Services L31613 Local 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350
Human Granulocyte/Macrophage Colony Stimulating Factors L30306 Local J1440, J1441, J2505, J2820
Hyperbaric Oxygen Therapy (HBO)Adobe Portable Document Format NA National 99183
ICD-9 Coding in Relation to Billing for Positron Emission Tomography (PET) Imaging for Oncologic PurposesAdobe Portable Document Format NA National 78608, 78811, 78812, 78813, 78814, 78815, 78816
Immune Globulins L30147 Local 90371, 90375, 90376, 90393, 90396, 96365, 96366, 96372, J0840, J0850, J1459, J1460, J1557, J1560, J1561, J1566, J1568, J1569, J1571, J1572, J1573, J1599, J1670
Immunizations L31084 Local 90296, 90476, 90477, 90581, 90585, 90586, 90632, 90633, 90634, 90636, 90644, 90645, 90646, 90647, 90648, 90649, 90650, 90675, 70676, 90680, 90681, 90690, 90691, 90692, 90693, 90696, 90698, 90700, 90701, 90702, 90703, 90704, 90705, 90706, 90707, 90708, 90710, 90712, 90713, 90714, 90715, 90716, 90717, 90718, 90719, 90720, 90721, 90723, 90725, 90727, 90732, 90733, 90734, 90735, 90736, 90738, 90749
Incident to a Physician's Professional Service in the Office or ClinicAdobe Portable Document Format NA National Not Applicable
Independent Diagnostic Testing Facilities (IDTFs) L31626 Local 70010, 70015, 70030, 70100, 70110, 70120, 70130, 70134, 70140, 70150, 70160, 70170, 70190, 70200, 70210, 70220, 70240, 70250, 70260, 70300, 70310, 70320, 70328, 70330, 70332, 70336, 70350 70355, 70360, 70370, 070371, 70373, 70380, 70390, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 70554, 70555, 70557, 70558, 70559, 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, 71035, 71040, 71060, 71100, 71101, 71110 71111, 72010, 72020, 72040, 72050, 72052, 72069, 72070, 72072, 72074, 72080, 72090, 72100, 72114, 72120, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72170, 72190, 72191, 72192, 72193, 72194, 72195, 72196, 72197, 72198, 72200, 72202, 72220, 72240, 72255, 72265, 72270, 72275, 72285, 72295, 73000, 73010, 73020, 73030, 73040, 73050, 73060, 73070, 73080, 73085, 73090, 73092, 73100, 73110, 73115, 73120, 73130, 73144 ,73200, 73201, 73202, 73206, 73218, 73219, 73220, 73221, 73222, 73223, 73500, 73510 ,73520, 73525, 73530 73540, 73550, 73560, 73562, 73564, 73565, 73580, 73590 ,73592, 73600, 73610 73615, 73620, 73630, 73650, 73660, 73700 73701, 73702, 73706, 73718, 73719, 73720 ,73721, 73722, 73723, 73725, 74000, 74010, 74020, 74022, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74181, 74182, 74183, 74185, 74190, 74210, 74220, 74230, 74240 74241, 74245, 74246, 74247, 74249, 74250 ,74251, 74260, 74261, 74262, 74263, 74280, 74283 74290 74291, 74300, 74301, 74305, 74320 ,74327, 74328, 74329, 74330, 74400, 74415, 74420 ,74425, 74430, 74440, 74445, 74450, 74455, 74470, 74710, 74740, 74742, 74775, 75557, 75559, 75561, 75563, 75565, 75571, 75572, 75573, 75574, 75600, 75605, 75625, 75630, 75635, 75650, 75658, 75660, 75662, 75665, 75671, 75676, 75680, 75685, 75705, 75710, 75716, 75726, 75731, 75733, 75736, 75741, 75743, 75743, 75756, 75774, 75791, 75801, 75803, 75805, 75807, 75809, 75810, 75820, 75822, 75825, 75827, 75831, 75833, 75840, 75842, 75860, 75870, 75872, 75880, 75885, 75887, 75889, 75891, 75893, 75898, 75900, 75945, 75946, 76000, 76001, 76010, 76080, 76098, 76100, 76101, 76102, 76120, 76125, 76376, 76377, 76380, 76506, 76510, 76511, 76512, 76513, 76514, 76516, 76519, 76529, 76536, 76604, 76645, 76700, 76705, 76770, 76775, 76776, 76800, 76801, 76802, 76805, 76810, 76811, 76812, 76813, 76814, 76815, 76816, 76817, 76818, 76819, 76820, 76821, 76825, 76826, 76827, 76828, 76830, 76831, 76856, 76857, 76870, 76872, 76873, 76881, 76882, 76885, 76886, 76930, 76932, 76937, 76940, 76945, 76946, 76970, 76975, 76977, 77002, 77003, 77011, 77012, 77021, 77031, 77032, 77051, 77052, 77053, 77054, 77055, 77056, 77057, 77058, 77059, 77071, 77072, 77073, 77074, 77075, 77076, 77077, 77078, 77080, 77081, 77082, 77084, 78000, 78001, 78003, 78006, 78007, 78010, 78011, 78015, 78016, 78018, 78020, 78070, 78075, 78102, 78103, 78104, 78110, 78111, 78120, 78121, 78122, 78130, 78135, 78140, 78185, 78190, 78191, 78195, 78201, 78202, 78205, 78206, 78215, 78216, 78226, 78227, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78270 ,78271, 78272, 78278, 78282, 78290, 78291, 78300, 78305, 78306, 78315, 78320, 78414, 78428, 78445, 78451, 78452, 78453, 78454, 78456, 78457, 78458, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, 78579, 78580, 78582, 78597, 97598, 78600, 78601, 78605, 78606, 78607, 78608, 78609, 78610, 78630, 78635, 78645, 78647, 78650, 78660, 78700, 78701, 78707, 78708, 78709, 78710, 78725, 78730, 78740, 78761, 78800, 78801, 78802, 78803, 78804, 78805, 78806, 78807, 78811, 78812, 78813, 78814, 8815, 78816, 78891, 91010, 91013, 91020, 91022, 91030, 91034, 91035, 91037, 91038, 91040, 91065, 91110, 91117, 91120, 91122, 91132, 91133, 92081, 92082, 92083, 92100, 92132, 92133, 92134, 92136, 92140, 92225, 92226, 92227, 92228, 92230, 92235, 92240, 92250, 92260, 92265, 92270, 92275, 92283, 92284, 92285, 92286, 92287, 92541, 92542, 92543, 92544, 92545, 92546, 92547, 92548, 92550, 92552, 92553, 92555, 92556, 92557, 92558, 92561, 92562, 92563, 92564, 92565, 92567, 92568, 92570, 92571, 92572, 92575, 92576, 92577, 92579, 92582, 92583, 92584, 92585, 92586, 92587, 92588, 92596, 93000, 93005, 93010, 93015, 93016, 93017, 903018, 90324, 90325, 93040, 93041, 903042, 93224, 93225, 93226, 93227, 93228, 93229, 93268, 93270, 93271, 93272, 93278, 93279, 93280, 93281, 93282, 93283, 93284, 93285, 93288, 93289, 93290, 93291, 93292, 93293, 93294, 93295, 93296, 93297, 93298, 93299, 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, 93350, 93351, 93352, 93600, 93602, 93603, 93609, 93610, 96312, 96613, 93615, 93616, 93618, 93619, 93620, 93621, 93622, 93623, 93624, 93631, 93640, 93641, 93642, 93660, 93662, 93701, 93724, 93740, 93745, 93750, 93770, 93784, 93786, 93788, 93790, 93880, 93882, 93886, 93888, 93890, 93892, 93893, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971, 93975, 93976, 93978, 93979, 93980, 93981, 93990, 94010, 94014, 94015, 94016, 94060, 94070, 94150, 94200, 94250, 94375, 94400, 94450, 94452, 94453, 94620, 94621, 94680, 94681, 94690, 94726, 94727, 94728, 94729, 94750, 94760, 94761, 94762, 94770, 94772, 95004, 95024, 95027, 95028, 95044, 95052, 95056, 95060, 95065, 95070, 95071, 95075, 95078, 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, 95812, 95813, 95816, 95819, 95822, 95824, 95827, 95830, 95860, 95861, 95863, 95864, 95867, 95868, 95868, 95869, 95870, 95872, 95875, 95885, 95886, 95887, 95900, 95903, 95904, 95921, 95922, 95923, 95925, 95926, 95927, 95928, 95929, 95930, 95933, 95934, 95936, 95937, 95938, 95939, 95950, 95951, 95953, 59554, 95956, 95957, 95958, 96000, 96001, 96002, 96003, 96004, G0389, G0398, G0399, G0400
Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma L30153 Local 20526, 20527, 20550, 20551, 20612, 26341, 28899, 64450, 64455, 64632, 64640, J0775
Intra-articular Injections of Hyaluronan L30149 Local 20610, J7321, J7323, J7324, J7325, J7326
Intra-operative Neurophysiological Testing L30721 Local 95920
Intravenous Iron TherapyAdobe Portable Document Format NA National 90765, 90766, J2915, J2916, J1755, J1756
Low Vision Services L32007 Local 92081, 92082, 92083, 92250, 97003, 97004, 97110, 97112, 97530, 97532, 97533, 97535, 97537, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99354
Luteinizing Hormone-Releasing Hormone (LHRH) Analogs L30479 Local 11981, 11982, 11983, 96402, J1675, J1950, J3315, J9202, J9217, J9218, J9219, J9225, J9226
Magnetic Resonance Angiography L31355 Local 70544, 70545, 70546, 70547, 70548, 70549, 71555, 72198, 73725, 74185, C8900, C8901, C8902, C8909, C8910, C28911, C8912, C8913, C8914, C8914, C8918, C8919, C8920
Magnetic Resonance Imaging L28723 Local 70336, 70540, 70542, 70543, 70549, 70551, 70552, 70553, 70559, 71550, 71551, 71552, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73718, 73719, 73720, 73721, 73722, 73723, 74181, 74182, 74183, 75557, 75558, 75559, 75560, 75561, 75562, 75563, 75564, 77058, 77059, A4643, A9579, A9585, C8903, C8904, C8905, C8906, C8907, C8908, Q9952
Moderate (Conscious) Sedation L29582 Local 99143, 99144, 99145, 99148, 99149, 99150
Mohs Micrographic Surgery L30713 Local 11100, 11101, 17311, 17312, 17313, 17314, 17315, 88300, 88302, 88304, 88305, 88307, 88309, 88331, 88332, 88342
Myocardial Perfusion Imaging and Cardiac Blood Pool Studies L31072 Local 78451, 78452, 78453, 78454, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78494, 78496, 93015, 93016, 93017, 93018, A4641, A9500, A9502, A9505, A9512, A9539, A9560, C9898, J0152, J1250, J2785
Nerve Conduction Studies and Electromyography L31346 Local 51785, 92265, 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95869, 95870, 95872, 95873, 95874, 95885, 95886, 95887, 95900, 95903, 95904, 95905, 95933, 95934, 95936, 95937, 95999, G0255
Non-coronary Vascular Stents L30798 Local 33880, 33881, 33883, 33884, 33886, 33889, 33891, 34800, 34802, 34803, 34804, 34805, 34808, 34812, 34813, 34820, 34825, 34826, 34830, 34831, 34832, 34833, 34834, 34900, 35450, 35452, 35458, 35460, 35471, 35472, 35475, 35476, 35480, 35495, 36000, 36002, 36005, 36010, 36011, 36012, 36013, 36014, 36015, 36100, 36120, 36140, 36145, 36200, 36215, 36216, 36217, 36218, 36245, 36246, 36247, 36248, 37201, 37205, 37206, 37207, 37208, 37799, 75600, 75605, 75625, 75630, 75635, 75650, 75658, 75660, 75662, 75665, 75671, 75676, 75680, 75685, 75705, 75710, 75716, 75722, 75724, 75726, 75731, 75733, 75736, 75741, 75743, 75746, 75756, 75774, 75790, 75820, 75822, 75825, 75827, 75831, 75833, 75896, 75952, 75953, 75954, 75956, 75957, 75958, 75959, 75960, 75962, 75964, 75966, 75968, 75778, G0288
Noninvasive Vascular Testing (N.I.V.T.) L28586 Local 55899, 76936, 90940, 93875, 93880, 93882, 93886, 93888, 93890, 93892, 93893, 93922, 93923, 93924, 93925, 93926, 93930, 93931, 93965, 93970, 93971, 93975, 93976, 93978, 93979, 93980, 93981, 93990, G0365
Nursing Facility Services (Codes 99304 - 99318)Adobe Portable Document Format NA National 99305, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99354, 99355, 99356, 99357
Nutrition Training BenefitsAdobe Portable Document Format NA National 97802, 97803, 97804, G0108, G0109, G0270, G0271
Ophthalmic Biometry L31624 Local 76516, 76519, 92136
Optical Coherence Tomography (OCT) L29971 Local 92133, 92134
Optometrist Services L30157 Local 15820, 15821, 15822, 15823, 65205, 65210, 65220, 65222, 65272, 65275, 65286, 65400, 65420, 65426, 65430, 65435, 65436, 65600, 65710, 65730, 65750, 65755, 65756, 65771, 65772, 65775, 65815, 65820, 65850, 65855, 65875, 65930, 66170, 66180, 66761, 66820, 66821, 66825, 66840, 66850, 66852, 66920, 66930, 66940, 66982, 66983, 66984, 66985, 66986, 67005, 67010, 67015, 67025, 67027, 67030, 67031, 67036, 67039, 67040, 67041, 67042, 67043, 67101, 67105, 67107, 67108, 67110, 67112, 67113, 67115, 67120, 67121, 67141, 67145, 67208, 67210, 67218, 67220, 67227, 67228, 67229, 67311, 67312, 67314, 67316, 67348, 67343, 67345, 67800, 67801, 67805, 67808, 67820, 67825, 67850, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67912, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67938, 68020, 68040, 68530, 68761, 68801, 68810, 68840, 76510, 76511, 76512, 76513, 76514, 76516, 75619, 76529, 82785, 82962, 83516, 83520, 87070, 87081, 87025, 87809, 92002, 92004, 92012, 92014, 92015, 92018, 92019, 92020, 92025, 92060, 92065, 92071, 92072, 92081, 92082, 92083, 92100, 92120, 92130, 92133, 92134, 92136, 92140, 92225, 92226, 92235, 92250, 92260, 92270, 92283, 92284, 92285, 92286, 92287, 92310, 92311, 92312, 92313, 92315, 92316, 92317, 92325, 92326, 92340, 92341, 92342, 92352, 92353, 92354, 92355, 92358, 92370, 92371, 92390, 92391, 92392, 92393, 92395, 92396, 92499, 92541, 92542, 92544, 97112, 97530, 99201, 99202, 92203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99221, 99222, 99223, 99231, 99232, 99233, 99281, 99282, 99283, 99307, 99308, 99309, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99347, 99348, 99349, 99354, 99355, 99356, 99357, 99499, G0117, G0118
Outpatient Rehabilitation Therapy Services billed to Medicare Part B L28531 Local 90911, 96999, 97001, 97002, 97003, 97004, 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97532, 97533, 97535, 97537, 97542, 97545, 97546, 97597, 97598, 97605, 97606, 97750, 97755, 97760, 97761, 97762, 97799, G0281, G0283, G0329
Paravertebral Facet Joint Block and Facet Joint Denervation L30483 Local 64490, 64491, 64492, 64493, 64494, 64495, 64633, 64634, 64635, 64636
Percutaneous Coronary Interventions (PCI) L28478 Local 92973, 92974, 92975, 92978, 92979, 92980, 92981, 92982, 92984, 92995, 92996, G0290, G0291
Percutaneous Transluminal Angioplasty (PTA) (Carotid and Intracranial Stents)Adobe Portable Document Format NA National 0075T, 0076T, 37215, 37216, 37799, 61630, 61635, 75671, 75680, 75960
Polysomnography and Other Sleep Studies L31082 Local 95800, 95801, 95805, 95806, 95807, 95808, 95810, 95811, G0398, G0399, G0400
Posterior Tibial Nerve Stimulation PTNS L28457 Local 64566, 97014, 97032
Proton Beam Therapy L31617 Local 77520, 77522, 77523, 77524, 77525
Psychiatric Partial Hospitalization Program (PHP) L30491 Local 90801, 90802, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90846, 90847, 96101, 96102, 96103, 96116, 96118, 96119, 96120, G0129, G0176, G0177, G0410, G0411
Psychiatry and Psychology Services L30489 Local 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90846, 90847, 90849, 90853, 90857, 90862, 90865, 90880, 90885, 90887, 90889, 90899, 96101, 96102, 96103, 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96125, 99212, 99241, 99242, 99243, 99244, 99245, 99251, 99252, 99253, 99254, 99255, M0064
Psychological and Neuropsychological Testing L31990 Local 96101, 96102, 96103, 96105, 96110, 96111, 96116, 96118, 96119, 96120, 96125
Psychological Services under the "Incident to" Provision L30715 Local 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90810, 90811, 90812, 90813, 90814, 90815, 90816, 90817, 90818, 90819, 90821, 90822, 90823, 90824, 90826, 90827, 90828, 90829, 90845, 90846, 90847, 90849, 90853, 90857, 90862, 90865, 90867, 90868, 90870, 90875, 90876, 90880, 90882, 90885, 90887, 90889, 90899
Radiation Oncology Including Intensity Modulated Radiation Therapy (IMRT) L30316 Local 0073T, 0197T, 11920, 11921, 11922, 16000, 16010, 16015, 16020, 16025, 16030, 36425, 53670, 53675, 76950, 76376, 77014, 77261, 77262, 77263, 77280, 77285, 77290, 77295, 77299, 77300, 77301, 77305, 77310, 77315, 77321, 77326, 77327, 77328, 77331, 77332, 77333, 77334, 77336, 77338, 77370, 77371, 77372, 77373, 77399, 77401, 77402, 77403, 77404, 77406, 77407, 77408, 77409, 77411, 77412, 77413, 77414, 77416, 77417, 77418, 77421, 77422, 77423, 77427, 77431, 77435, 77470, 77499, 77520, 77522, 77523, 77525, 99211, 99212, 99213, 99214, 99215, 99238, 99281, 99282, 99283, 99284, 99285, 90780, 90781, 90841, 90843, 90844, 90847, 99050, 99052, 99054, 99058, 99071, 99090, 99150, 99151, 99180, 99182, 99185, 99371, 99372, 99373
Radiofrequency Treatment for Urinary Incontinence L31615 Local 53860
Radiopharmaceutical Agents L31361 Local 77781, 77782, 77783, 77784, 78000, 78001, 78003, 78006, 78007, 78010, 78011, 78015, 78016, 78018, 78020, 78070, 78075, 78099, 78102, 78103, 78104, 78110, 78111, 78120, 78121, 78122, 78130, 78135, 78140, 78185, 78190, 78191, 78195, 78199, 78201, 78202, 78205, 78206, 78215, 78216, 78226, 78227, 78230, 78231, 78232, 78258, 78261, 78262, 78264, 78267, 78270, 78271, 78272, 78278, 78282, 78290, 78291, 78299, 78300, 78305, 78306, 78315, 78320, 78350, 78351, 78399, 78414, 78428, 78445, 78451, 78452, 78453, 78454, 78456, 78457, 78458, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78496, 78499, 78580, 78584, 78585, 78586, 78587, 78588, 78591, 78593, 78594, 78596, 78599, 78600, 78601, 78605, 78606, 78607, 78608, 78609, 78610, 78603, 78635, 78645, 78647, 78650, 78660, 78699, 78700, 78701, 78707, 78708, 78709, 78710, 78725, 78730, 78740, 78761, 78799, 78800, 78801, 78802, 78803, 78804, 78805, 78806, 78807, 78808, 78811, 78812, 78813, 78814, 78815, 78816, 78999, 79005, 79101, 79200, 79300, 79403, 79440, 79445, 79900, 79999, A4641, A4642, A4643, A4644, A4645, A4646, A4647, A9500, A9501, A9502, A9503, A9504, A9505, A9507, A9508, A9510, A9512, A9516, A9517, A9521, A9524, A9526, A9527, A9528, A9529, A9530, A9531, A9532, A9536, A9537, A9538, A9539, A9540, A9541, A9542, A9543, A9544, A9545, A9546, A9547, A9548, A9550, A9551, A9552, A9553, A9554, A9555, A9556, A9557, A9558, A9559, A9560, A9561, A9562, A9563, A9564, A9566, A9567, A9568, A9569, A9570, A9571, A9572, A9582, A9584, A9600, A9604, A9699, C9898, J1245
Removal of Benign Skin Lesions L30330 Local 11200, 11201, 11300, 11301, 11302, 11303, 11305, 11306, 11307, 11308, 11310, 11311, 11312, 11313, 11400, 11401, 11402, 11403, 11404, 11406, 11420, 11421, 11422, 11423, 11424, 11426, 11440, 11441, 11442, 11443, 11444, 11446, 11450, 11451, 11462, 11463, 12031, 12032, 13034, 12035, 12036, 12037, 12041, 12042, 12044, 12045, 12046, 12047, 12051, 12052, 12053, 12054, 12055, 12056, 12057, 13100, 13101, 13102, 13120, 13121, 13122, 13131, 13132, 13133, 13150, 13151, 13152, 13153, 14000, 14001, 14020, 14021, 14040, 14041, 14060, 14061, 15002, 15003, 15004, 15005, 15040, 15050, 15100, 15101, 15110, 15111, 15115, 15116, 15120, 15121, 15130, 15131, 15135, 15136, 15150, 15151, 15152, 15155, 15156, 15157, 15170, 15171, 15175, 15176, 15200, 15201, 15220 15221, 15240, 15241, 15260, 15261, 15570, 15572, 15574, 15576, 15600, 15610, 15620 15630, 15650 15731, 15732, 15734, 15736, 15738, 15740, 15750, 15756, 15757, 15758, 15760, 15770, 17000, 17003, 17004, 17106, 17107, 17108, 17110, 17111
Routine Foot Care L30322 Local 11055, 11056, 11057, 11719, 11720, 11721, G0127
Sacroiliac Joint Injections L31359 Local 20610, 27096, 64999, G0260
Screening Pap Smears and Pelvic Examinations for Early Detection of Cervical or Vaginal CancerAdobe Portable Document Format NA National G0101, G0123, G0124, G0141, G0143, G0144, G0145, G0147, G0148, P3000, P3001, Q0091
Selective Internal Radiation Therapy (SIRT) for Primary and Secondary Hepatic Malignancy (90YMicrosphere Hepatic Brachytherapy) L30137 Local 37204, 77263, 77290, 77300, 77370, 77470, 75894, 77399, 77778, 77790, C2616
Sentinel Lymph Node Biopsy L30475 Local 38500, 38505, 38510, 38520, 38525, 38530, 38542, 38792, 78195
Stereotactic Body Radiation Therapy L28366 Local 31626, 32553, 49411, 55876, 77373, 77435, C9728, G0251, G0339, G0340
Stereotactic Computer Assisted Volumetric and/or Navigational Procedure L29586 Local 0054T, 0055T, 20985, 61781, 61782, 61783
Surgical Treatment of Obstructive Sleep Apnea (OSA) L30731 Local 21110, 21141, 21145, 21196, 21199, 21685, 30140, 30802, 31600, 31610, 41512, 41530, 42145, 42299
Thrombopoietic Growth factor - Oprelvekin L30151 Local 96372, J2355
Transcranial Magnetic Stimulation (TMS) L32220 Local 90867, 90868
Transesophageal Echocardiography (Including Intraoperative TEE) L28574 Local 36000, 90760, 90761, 90765, 90766, 90773, 90774, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93320, 93321, 93325, 93799, A9700, C8925, C8926, C8927, Q9955, Q9956, Q9957
Transthoracic Echocardiography (TTE) L28565 Local 93014, 93041, 93303, 93304, 93306, 93307, 93308, 93320, 93321, 93325, 93350, 93351, 93352, A9700, C8921, C8922, C8923, C8924, C8928, C8929, C8930, Q9955, Q9956, Q9957
Treatment of Varicose Veins of the Lower Extremities L30143 Local 36468, 36470, 36471, 36475, 36476, 36478, 36479, 37500, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, 37799, 93968, 93970, 93971
Trigger Points, Local Injections L30155 Local 20552, 20553
Vagus Nerve Stimulation (VNS)Adobe Portable Document Format NA National 61885, 64553, 64570, 64590, 64595, 95970, 95971, 95972, 95973, 95974, 95975, 95978, 95979
Venous Angioplasty with or without Stent Placement for the Treatment of Chronic Cerebrospinal Venous Insufficiency L32452 Local 35460, 35476, 75978
Vertebroplasty (Percutaneous) and Vertebral Augmentation including cavity creation L30516 Local 20225, 20250, 20251, 22325, 22326, 22327, 22328, 22520, 22521, 22522, 22523, 22524, 22525, 22899, 62292, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 630510, 63051, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 72291, 72292
Visual Fields L31348 Local 92081, 92082, 92083
Vitamin B 12 Injections L30145 Local J3420
Vitamin D Assay Testing L31076 Local 82306, 82652
Wound Care L28572 Local 11042, 11043, 11044, 11045, 11046, 11047, 97597, 97598, 97602, 97605, 97606, G0281, G0329, Q4104, Q4105, Q4107, Q4108, Q4110, Q4111, Q4112, Q4113, Q4114, Q4115, Q4116, Q4117, Q4118, Q4119, Q4120, Q4121

Page Last Updated: Tuesday, 22-May-2012 11:49:24 CDT