Prior Authorization Requirements
Nebraska Total Care needs pre-approval (PA) for some services. This notice has info about such PA needs. This applies to Medicaid offered by Nebraska Total Care.
Nebraska Total Care is committed to delivering cost-effective care to our members. Our members receive treatment that is medically needed. This is based on standards of practice. PA is a step started by the provider. We check the medical need of health care. We use medical criteria and/or in-network utilization.
It is the provider’s duty to find out which codes need pre-approval.
Providers check member status and benefits before giving services. Payment depends on the member’s status at the time of service. Non-par providers and facilities need pre-approval for all HMO services. There are a few exceptions.
Providers: Please see our Pre-Auth Check Tool for a current list.
THESE CODES NEEDED PRE-APPROVAL AS OF 12/31/2025:
Service Category | Service | Procedure Codes |
|---|---|---|
Administrative & Quality | Quality Reporting & Performance Measures | G9473, G9474, G9475, G9476, G9477, G9478, G9479, G9490 |
Anesthesia Services | Interventional Pain Management (Nerve Blocks) | 62263, 62264, 62280, 62281, 62282, 62287, 64400, 64405, 64408, 64415, 64416, 64417, 64418, 64420, 64421, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64451, 64461, 64462, 64463, 64466, 64467, 64468, 64469, 64473, 64474, 64479, 64480, 64483, 64484, 64486, 64487, 64488, 64489, 64490, 64491, 64492, 64493, 64494, 64495, 64505, 64510, 64517, 64520, 64600, 64620, 64622, 64625, 64630, 64632, 64633, 64634, 64635, 64636, 64640, 64650, 64680, 64681 |
Behavioral Health & Substance Use | Alcohol and drug management, treatment, and rehabilitation Applied Behavioral Analysis (ABA) Behavioral Health Management, Treatment, and Rehab Intensive Behavioral Health & Crisis Services (PHP/IOP/Crisis) Neuropsychological and Psychological Testing Psychological and psychiatric evaluation and therapy | G0552, H0010, H0012, H0014, H0015, H0018, H0019, H0045, H2014, H2034 97151, 97152, 97153, 97154, 97155, 97156, 97158 1001, 1002, A9291, H0036, H0040, H0045, H0046, H2000, H2013, H2015, H2017, H2018, H2020, H2027, H2033, T2048 H2012, S9480, S9485 96105, 96110, 96130, 96131, 96132, 96133, 96136, 96137, 96138, 96139 0889T, 0890T, 0891T, 0892T, 90870 |
Cardiovascular & Thoracic Procedures | Coronary artery bypass graft (CABG) | 33542, 33548 |
Cardiovascular & Thoracic Procedures | Heart valve procedures | 33406, 33410, 33411, 33412, 33413, 33930, 33933, 33935, 33940, 33944, 33945 |
Cardiovascular & Thoracic Procedures | Insertion, revision, replacement, removal of cardiac pacemaker/Defibrillator | 0698T, 33254, 33255, 33256, 33257, 33258, 33259, 33265, 33266, C1605 |
Cardiovascular & Thoracic Procedures | Lobectomy, Pneumonectomy, and Mediastinal Procedures | 32491, 32672, 32850, 32851, 32852, 32853, 32854, 32855, 32856, S2060, S2061 |
Cardiovascular & Thoracic Procedures | Peripheral vascular bypass | 37220, 37221, 37224, 37225, 37226, 37227, 37228, 37229, 37230, 37231, 37243, C9782, C9783 |
Cardiovascular & Thoracic Procedures | Varicose vein stripping, lower limb | 36465, 36466, 36468, 36470, 36471, 36475, 36476, 36478, 36479, 36482, 36483, 37500, 37700, 37718, 37722, 37735, 37760, 37761, 37765, 37766, 37780, 37785, S2202 |
Consultation & Evaluation Services | Consultation, evaluation, and preventative care | 0794T, 0893T, 99183, 99341, 99342, 99344, 99345, 99347, 99348, 99349, 99350, 99375, 99377, 99378, A9293, G0182, G0248, G0302, G0303, G0304, G0305, G0378, G0379, G3002, S0255, S0270, S0271, S0272, S0273, S0280, S0281, S9976, S9988, S9990, S9991, S9992, S9994, S9996 |
Dental Services | Oral and Dental Services | D0120, D0140, D0145, D0150, D0160, D0170, D0171, D0180, D0190, D0191, D0210, D0220, D0230, D0240, D0250, D0260, D0270, D0272, D0273, D0274, D0277, D0290, D0310, D0320, D0321, D0322, D0330, D0340, D0350, D0351, D0360, D0362, D0363, D0364, D0365, D0366, D0367, D0368, D0369, D0370, D0371, D0380, D0381, D0382, D0383, D0384, D0385, D0386, D0391, D0415, D0416, D0417, D0418, D0421, D0425, D0431, D0460, D0470, D0472, D0473, D0474, D0475, D0476, D0477, D0478, D0479, D0480, D0481, D0482, D0483, D0484, D0485, D0486, D0999, D1110, D1120, D1203, D1204, D1206, D1208, D1310, D1320, D1330, D1351, D1352, D1353, D1510, D1515, D1520, D1525, D1550, D1555, D1708, D1709, D1710, D1711, D1712, D1713, D1714, D2140, D2150, D2160, D2161, D2330, D2331, D2332, D2335, D2390, D2391, D2392, D2393, D2394, D2410, D2420, D2430, D2510, D2520, D2530, D2542, D2543, D2544, D2610, D2620, D2630, D2642, D2643, D2644, D2650, D2651, D2652, D2662, D2663, D2664, D2710, D2712, D2720, D2721, D2722, D2740, D2750, D2751, D2752, D2780, D2781, D2782, D2783, D2790, D2791, D2792, D2794, D2799, D2910, D2915, D2920, D2929, D2930, D2931, D2932, D2933, D2934, D2940, D2950, D2951, D2952, D2953, D2954, D2955, D2957, D2960, D2961, D2962, D2970, D2971, D2975, D2980, D2981, D2982, D2983, D2990, D2999, D3110, D3120, D3220, D3221, D3222, D3230, D3240, D3310, D3320, D3330, D3331, D3332, D3333, D3346, D3347, D3348, D3351, D3352, D3353, D3354, D3410, D3421, D3425, D3426, D3430, D3450, D3460, D3470, D3910, D3920, D3950, D3999, D4210, D4211, D4212, D4230, D4231, D4240, D4241, D4245, D4249, D4260, D4261, D4263, D4264, D4265, D4266, D4267, D4268, D4270, D4271, D4273, D4274, D4275, D4276, D4277, D4278, D4320, D4321, D4341, D4342, D4355, D4381, D4910, D4920, D4999, D5110, D5120, D5130, D5140, D5211, D5212, D5213, D5214, D5225, D5226, D5281, D5410, D5411, D5421, D5422, D5510, D5520, D5610, D5620, D5630, D5640, D5650, D5660, D5670, D5671, D5710, D5711, D5720, D5721, D5730, D5731, D5740, D5741, D5750, D5751, D5760, D5761, D5810, D5811, D5820, D5821, D5850, D5851, D5860, D5861, D5862, D5867, D5875, D5899, D5911, D5912, D5913, D5914, D5915, D5916, D5919, D5922, D5923, D5924, D5925, D5926, D5927, D5928, D5929, D5931, D5932, D5933, D5934, D5935, D5936, D5937, D5951, D5952, D5953, D5954, D5955, D5958, D5959, D5960, D5982, D5983, D5984, D5985, D5986, D5987, D5988, D5991, D5992, D5993, D5999, D6010, D6012, D6040, D6050, D6051, D6053, D6054, D6055, D6056, D6057, D6058, D6059, D6060, D6061, D6062, D6063, D6064, D6065, D6066, D6067, D6068, D6069, D6070, D6071, D6072, D6073, D6074, D6075, D6076, D6077, D6078, D6079, D6080, D6090, D6091, D6092, D6093, D6094, D6095, D6100, D6101, D6102, D6103, D6104, D6110, D6111, D6112, D6113, D6114, D6115, D6116, D6117, D6190, D6194, D6199, D6205, D6210, D6211, D6212, D6214, D6240, D6241, D6242, D6245, D6250, D6251, D6252, D6253, D6254, D6545, D6548, D6549, D6600, D6601, D6602, D6603, D6604, D6605, D6606, D6607, D6608, D6609, D6610, D6611, D6612, D6613, D6614, D6615, D6624, D6634, D6710, D6720, D6721, D6722, D6740, D6750, D6751, D6752, D6780, D6781, D6782, D6783, D6790, D6791, D6792, D6793, D6794, D6795, D6920, D6930, D6940, D6950, D6970, D6972, D6973, D6975, D6976, D6977, D6980, D6985, D6999, D7111, D7140, D7210, D7220, D7230, D7240, D7241, D7250, D7251, D7260, D7261, D7270, D7272, D7280, D7282, D7283, D7285, D7286, D7287, D7288, D7290, D7291, D7292, D7293, D7294, D7295, D7310, D7311, D7320, D7321, D7340, D7350, D7410, D7411, D7412, D7413, D7414, D7415, D7440, D7441, D7450, D7451, D7460, D7461, D7465, D7471, D7472, D7473, D7485, D7490, D7510, D7511, D7520, D7521, D7530, D7540, D7550, D7560, D7610, D7620, D7630, D7640, D7650, D7660, D7670, D7671, D7680, D7710, D7720, D7730, D7740, D7750, D7760, D7770, D7771, D7780, D7810, D7820, D7830, D7840, D7850, D7852, D7854, D7856, D7858, D7860, D7865, D7870, D7871, D7872, D7873, D7874, D7875, D7876, D7877, D7880, D7899, D7910, D7911, D7912, D7920, D7921, D7940, D7941, D7943, D7944, D7945, D7946, D7947, D7948, D7949, D7950, D7951, D7952, D7953, D7955, D7960, D7963, D7970, D7971, D7972, D7980, D7981, D7982, D7983, D7990, D7991, D7995, D7996, D7997, D7998, D7999, D8010, D8020, D8030, D8040, D8050, D8060, D8070, D8080, D8090, D8210, D8220, D8660, D8670, D8680, D8690, D8691, D8692, D8693, D8999, D9110, D9120, D9210, D9211, D9212, D9215, D9219, D9220, D9221, D9230, D9241, D9242, D9248, D9310, D9410, D9420, D9430, D9440, D9450, D9610, D9612, D9630, D9910, D9911, D9920, D9930, D9931, D9940, D9941, D9942, D9950, D9951, D9952, D9970, D9971, D9972, D9973, D9974, D9975, D9986, D9987, D9999 |
Diagnostic Cardiology | Diagnostic ultrasound of heart (echocardiogram) | 93303, 93304, 93306, 93307, 93308, 93312, 93313, 93314, 93315, 93316, 93317, 93318, 93350, 93351, 93356 |
Diagnostic Cardiology | Electrographic cardiac monitoring | 0695T, 0696T, 0897T, G0429 |
Diagnostic Neurology | Electroencephalogram (EEG), Sleep Studies, and Neurodiagnostics | 95805, 95807, 95808, 95810, 95811, 95851, 95852, 95782, 95783, 95872, G0400 |
Diagnostic Radiology & Imaging | Computerized axial tomography (CT) Imaging | 0042T, 0691T, 0710T, 0711T, 0712T, 0713T, 0722T, 0877T, 0878T, 0879T, 0880T, 70450, 70460, 70470, 70480, 70481, 70482, 70486, 70487, 70488, 70490, 70491, 70492, 70496, 70498, 71250, 71260, 71270, 71271, 71275, 72125, 72126, 72127, 72128, 72129, 72130, 72131, 72132, 72133, 72191, 72192, 72193, 72194, 72198, 73200, 73201, 73202, 73206, 73700, 73701, 73702, 73706, 73718, 73719, 73720, 73721, 73722, 73723, 73725, 74150, 74160, 74170, 74174, 74175, 74176, 74177, 74178, 74261, 74262, 75572, 75573, 75574, 75635, 76380, 76497, 77078, G0288, S8032 |
Diagnostic Radiology & Imaging | Magnetic resonance imaging (MRI/MRA) | 0697T, 0724T, 0898T, 0899T, 0900T, 70336, 70540, 70542, 70543, 70544, 70545, 70546, 70547, 70548, 70549, 70551, 70552, 70553, 71550, 71551, 71552, 71555, 72141, 72142, 72146, 72147, 72148, 72149, 72156, 72157, 72158, 72159, 72195, 72196, 72197, 73218, 73219, 73220, 73221, 73222, 73223, 73225, 74181, 74182, 74183, 74185, 74712, 74713, 75557, 75559, 75561, 75563, 75565, 76498, 77046, 77047, 77048, 77049, 77084, C8900, C8901, C8902, C8903, C8905, C8906, C8908, C8909, C8910, C8911, C8912, C8913, C8914, C8918, C8919, S8037, S8042 |
Diagnostic Radiology & Imaging | Mammography | 0694T |
Diagnostic Radiology & Imaging | Other diagnostic ultrasound | 0689T, 0690T, 0876T |
Diagnostic Radiology & Imaging | Radioisotope scan, PET, and Nuclear Medicine | 78429, 78430, 78431, 78432, 78433, 78434, 78451, 78452, 78453, 78454, 78459, 78466, 78468, 78469, 78472, 78473, 78481, 78483, 78491, 78492, 78494, 78499, 78608, 78609, 78811, 78812, 78813, 78814, 78815, 78816 |
Dialysis & Nephrology Services | Hemodialysis and Peritoneal Dialysis | 0692T, C8000 |
Durable Medical Equipment (DME) | DME and supplies | A4100, A4210, A4239, A4341, A4342, A4560, A4593, A4594, A6501, A6507, A6511, A6590, A6591, A7049, A8003, A9156, A9900, A9999, E0152, E0170, E0172, E0190, E0193, E0194, E0221, E0236, E0240, E0250, E0255, E0256, E0260, E0261, E0265, E0266, E0290, E0292, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0316, E0328, E0329, E0371, E0372, E0373, E0450, E0453, E0455, E0460, E0461, E0463, E0464, E0465, E0466, E0467, E0468, E0469, E0470, E0480, E0481, E0482, E0483, E0490, E0491, E0492, E0493, E0500, E0530, E0550, E0575, E0605, E0606, E0607, E0610, E0616, E0617, E0619, E0620, E0625, E0630, E0635, E0636, E0637, E0638, E0639, E0640, E0641, E0642, E0650, E0651, E0652, E0656, E0658, E0659, E0670, E0675, E0676, E0677, E0678, E0679, E0680, E0681, E0682, E0683, E0691, E0692, E0693, E0694, E0711, E0715, E0721, E0732, E0733, E0734, E0735, E0736, E0737, E0738, E0739, E0743, E0745, E0747, E0748, E0749, E0760, E0764, E0766, E0767, E0770, E0781, E0782, E0783, E0784, E0785, E0786, E0791, E0912, E0954, E0983, E0984, E0986, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1010, E1011, E1012, E1030, E1031, E1032, E1033, E1034, E1035, E1037, E1050, E1060, E1070, E1083, E1084, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1220, E1223, E1224, E1229, E1230, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, E1301, E1310, E1399, E1406, E1800, E1801, E1802, E1803, E1804, E1805, E1806, E1807, E1808, E1810, E1811, E1812, E1813, E1814, E1815, E1816, E1818, E1822, E1823, E1825, E1826, E1827, E1828, E1829, E1830, E1832, E1840, E1841, E1905, E2102, E2103, E2204, E2227, E2228, E2291, E2292, E2293, E2294, E2295, E2298, E2310, E2311, E2312, E2313, E2321, E2322, E2325, E2327, E2328, E2329, E2330, E2331, E2343, E2351, E2370, E2375, E2376, E2378, E2402, E2502, E2504, E2506, E2508, E2510, E2512, E2599, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2613, E2614, E2615, E2616, E2617, E2620, E2621, E2622, E2624, E2628, E3000, E8000, E8001, E8002, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0008, K0009, K0010, K0011, K0012, K0014, K0108, K0455, K0606, K0609, K0730, K0742, K0800, K0801, K0802, K0806, K0807, K0808, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0877, K0884, K0885, K0886, K0890, K0891, K0898, K0899, K1035, K1036, Q3025, Q3026, Q3031, S4030, S4031, S4035, S4037, S4040, S4042, S5035, S5036, S8092, S8262, T1999 |
Durable Medical Equipment (DME) | Enteral & Parenteral Therapy (Formula/Pumps) | B4105, B9002 |
Durable Medical Equipment (DME) | Orthotics, Prosthetics, and OPPS Devices | C1735, C1736, C1737, C1742, C1826, C1827, C1832, L0112, L0456, L0457, L0458, L0460, L0462, L0464, L0469, L0480, L0482, L0484, L0486, L0488, L0631, L0635, L0636, L0637, L0638, L0639, L0640, L0648, L0650, L0651, L0700, L0710, L0720, L0810, L0820, L0830, L0859, L0999, L1000, L1001, L1005, L1006, L1007, L1200, L1300, L1310, L1320, L1499, L1653, L1680, L1681, L1685, L1686, L1690, L1700, L1710, L1720, L1730, L1755, L1840, L1843, L1844, L1845, L1846, L1860, L1932, L1933, L1945, L1951, L1952, L1970, L2000, L2005, L2010, L2020, L2030, L2034, L2036, L2037, L2038, L2108, L2112, L2126, L2128, L2134, L2136, L2350, L2525, L2627, L2628, L2999, L3230, L3671, L3674, L3730, L3740, L3765, L3766, L3900, L3901, L3904, L3905, L3916, L3961, L3967, L3971, L3973, L3975, L3976, L3977, L3978, L3981, L3999, L4000, L4020, L4631, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5160, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5312, L5321, L5331, L5341, L5400, L5410, L5420, L5430, L5450, L5460, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5585, L5590, L5595, L5600, L5610, L5611, L5613, L5614, L5615, L5616, L5639, L5643, L5645, L5647, L5649, L5651, L5657, L5681, L5683, L5700, L5701, L5702, L5703, L5705, L5706, L5707, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5781, L5782, L5783, L5795, L5814, L5816, L5818, L5822, L5824, L5826, L5827, L5828, L5830, L5840, L5841, L5845, L5848, L5859, L5926, L5930, L5950, L5960, L5961, L5964, L5966, L5968, L5969, L5979, L5980, L5981, L5987, L5988, L5990, L5991, L5999, L6000, L6010, L6020, L6026, L6028, L6029, L6031, L6032, L6033, L6034, L6035, L6036, L6038, L6039, L6050, L6055, L6100, L6110, L6120, L6130, L6200, L6205, L6250, L6300, L6310, L6320, L6350, L6360, L6370, L6380, L6382, L6384, L6400, L6450, L6500, L6550, L6570, L6580, L6582, L6584, L6586, L6588, L6590, L6621, L6624, L6638, L6646, L6648, L6693, L6696, L6697, L6700, L6707, L6708, L6709, L6712, L6713, L6714, L6715, L6721, L6722, L6880, L6881, L6883, L6884, L6885, L6900, L6905, L6910, L6915, L6920, L6925, L6930, L6935, L6940, L6945, L6950, L6955, L6960, L6965, L6970, L6975, L7007, L7008, L7009, L7040, L7045, L7170, L7185, L7186, L7190, L7191, L7259, L7364, L7366, L7368, L7406, L7499, L7900, L8035, L8039, L8040, L8041, L8042, L8043, L8044, L8045, L8046, L8047, L8499, L8600, L8605, L8609, L8610, L8612, L8614, L8619, L8627, L8628, L8629, L8631, L8659, L8670, L8678, L8679, L8680, L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689, L8690, L8691, L8692, L8693, L8694, L8720 |
Ear, Nose & Throat (ENT) Surgery | Diagnostic procedures on nose, mouth, pharynx, and ear | 0881T, 30120, 30520, 30620, 30630, 31276, 42145, 42831, 42835, 42836, 69300, 69716 |
Gastroenterology Procedures | Gastrointestinal endoscopy (and Diagnostics) | 0884T, 0886T, 91110, 91111, 91112, A9268, A9269, S2140, S2142 |
General & Abdominal Surgery | Exploratory laparotomy (and Major Open Abdominal) | 0600T, 0601T, 0673T, 0686T, 0868T, 0870T, 0871T, 0873T, 0874T, 47133, 47135, 47140, 47141, 47142, 47143, 47144, 47145, 47146, 47147, 47370, 47371, 47380, 47381, 48160, 48550, 48551, 48552, 48554, 48556, S2102 |
General & Abdominal Surgery | Gastric bypass and volume reduction (Bariatric) | 43290, 43291, 43328, 43644, 43645, 43647, 43648, 43770, 43771, 43772, 43773, 43774, 43775, 43842, 43843, 43845, 43846, 43847, 43848, C9784, C9785 |
General & Abdominal Surgery | Gastric, Esophageal, and Bariatric Structural Surgery | 43881, 43882, 43886, 43887, 43888, 43999 |
General & Abdominal Surgery | Laparoscopy | C9736, S2103 |
General & Abdominal Surgery | Other hernia repair | 49595 |
General & Abdominal Surgery | Small bowel resection/ Resection & Stoma | 44132, 44133, 44135, 44136, 44137, 44715, 44720, 44721 |
Gynecological Surgery | Hysterectomy, abdominal and vaginal | 58150, 58260, 58262, 58290, 58291, 58541, 58542, 58543, 58550, 58552, 58553, 58554, 58570, 58571, 58572, 58573 |
Gynecological Surgery | Minor Gyn, Non-Hysterectomy & Maternity | 56625, 56800, 56805, 57110, 57291, 57292, 58350, 59840, 59841, 59850, 59851, 59852, 59855, 59856, 59857, 59866, 59871, 59897, 59898, 59899, S4011, S4013, S4014, S4015, S4016, S4017, S4018, S4020, S4021, S4022, S4023, S4025, S4026, S4027, S4028, S9001, S9002, S9208, S9209, S9211, S9212, S9213, S9214 |
Gynecological Surgery | Other gynecological surgery (Ovary/Tubal) | 58661, 58720, 58760, 58770, 58920, 58940 |
Hematology & Oncology Procedures | Blood and blood product transfusion | P9051 |
Hematology & Oncology Procedures | Bone marrow transplant | 0584T, 0585T, 0586T, 38204, 38205, 38206, 38207, 38208, 38209, 38210, 38211, 38212, 38213, 38214, 38215, 38220, 38221, 38230, 38232, 38240, 38241, 38242, S2150, S2152 |
Hematology & Oncology Procedures | Therapeutic radiology (Radiation Oncology) | 77371, 77372, 77373, 77385, 77386, 77423, C2623, G0293, G0294, G0339, G0340 |
Home Health & Community Services | Home Infusion Services | S5497, S5498, S5501, S5502, S5517, S5518, S5520, S5521, S5522, S5523, S9098, S9325, S9326, S9327, S9328, S9329, S9330, S9331, S9335, S9336, S9338, S9339, S9345, S9346, S9347, S9348, S9349, S9351, S9353, S9355, S9357, S9359, S9361, S9363, S9364, S9365, S9366, S9367, S9368, S9370, S9372, S9373, S9374, S9375, S9376, S9377, S9379, S9490, S9494, S9497, S9500, S9501, S9502, S9503, S9504, S9538, S9542, S9560, S9590, S9810 |
Home Health & Community Services | Home Nursing Services | G0299, G0300, T1002, T1003, T1021, T1022, T1024, T1027, T1028, T1029, T1030, T1031 |
Home Health & Community Services | Nonhospital-based care (e.g., home health care, hospice) | 99500, 99501, 99502, 99503, 99504, 99505, 99506, 99507, 99509, 99510, 99511, G0128, G0151, G0152, G0153, G0154, G0156, G0162, G0529, G0530, G0531, G9187, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, Q5010, Q5098, Q5099, Q5100, S9122, S9123, S9124, S9125, S9126, S9127, S9128, S9129, S9131 |
Home Health & Community Services | Supplemental & State-Waiver Services | S5108, S5109, S5110, S5111, S5115, S5116, S5165, S5180, S5181, T2013, T2027, T2028, T2029, T2035, T2043, T2044, T2045, T2046, T5001 |
Integumentary Procedures | Blepharoplasty and Brow Procedures | 15820, 15821, 15822, 15823, 67900, 67901, 67902, 67903, 67904, 67906, 67908, 67909, 67911, 67914, 67915, 67916, 67917, 67921, 67922, 67923, 67924, 67938, 67950 |
Integumentary Procedures | Breast Reconstruction and Mastectomy | 19300, 19303, 19316, 19318, 19325, 19328, 19330, 19340, 19342, 19350, 19355, 19370, 19371, 19396, 19499, S2053, S2054, S2055 |
Integumentary Procedures | Complex Reconstruction & Grafts (Skin Substitutes) | Q4199, Q4224, Q4225, Q4236, Q4256, Q4257, Q4258, Q4259, Q4260, Q4261, Q4262, Q4263, Q4264, Q4265, Q4266, Q4267, Q4268, Q4269, Q4270, Q4271, Q4272, Q4273, Q4274, Q4275, Q4276, Q4277, Q4278, Q4279, Q4280, Q4281, Q4282, Q4283, Q4284, Q4285, Q4286, Q4287, Q4288, Q4289, Q4290, Q4291, Q4292, Q4293, Q4294, Q4295, Q4296, Q4297, Q4298, Q4299, Q4300, Q4301, Q4302, Q4303, Q4304, Q4309, Q4311, Q4312, Q4313, Q4314, Q4315, Q4316, Q4317, Q4318, Q4319, Q4320, Q4321, Q4322, Q4323, Q4324, Q4325, Q4326, Q4327, Q4328, Q4329, Q4330, Q4331, Q4332, Q4333, Q4346, Q4347, Q4348, Q4349, Q4350, Q4351, Q4352, Q4353, Q4354, Q4355, Q4356, Q4357, Q4358, Q4359, Q4360, Q4361, Q4362, Q4363, Q4364, Q4365, Q4366, Q4367, Q4368, Q4369, Q4370, Q4371, Q4372, Q4373, Q4375, Q4376, Q4377, Q4378, Q4379, Q4380, Q4381, Q4382, Q4383, Q4384, Q4385, Q4386, Q4387, Q4388, Q4389, Q4390, Q4391, Q4392, Q4393, Q4394, Q4395, Q4396, Q4397 |
Integumentary Procedures | Debridement of wound, infection or burn | 97602, 97605 |
Integumentary Procedures | Skin graft | 15734, 15736, 15738, 15769, 15771, 15772, 15773, 15774, 15776, A2001, A2002, A2003, A2004, A2005, A2006, A2007, A2008, A2009, A2010, A2011, A2012, A2013, A2014, A2015, A2016, A2017, A2018, A2019, A2020, A2021, A2022, A2023, A2024, A2025, A2026, A2027, A2028, A2029, A2030, A2031, A2032, A2033, A2034, A2035, A2036, A2037, A2038, A2039 |
Integumentary Procedures | Wound Repair & Destruction of Lesions | 13100, 13101, 13102, 13120, 13121, 13122, 13131, 13132, 13133, 13150, 13151, 13152, 13153, 13160, 17340, 17360, 17999 |
Laboratory & Pathology Services | Genetic and Molecular Testing | 0006M, 0012M, 0013M, 0019M, 0020M, 81105, 81106, 81161, 81162, 81163, 81164, 81165, 81166, 81167, 81171, 81172, 81173, 81174, 81175, 81177, 81178, 81179, 81180, 81181, 81182, 81183, 81184, 81185, 81186, 81187, 81188, 81189, 81190, 81195, 81200, 81204, 81205, 81206, 81207, 81208, 81209, 81210, 81212, 81215, 81216, 81217, 81218, 81219, 81222, 81223, 81225, 81226, 81227, 81229, 81233, 81234, 81235, 81236, 81237, 81239, 81241, 81242, 81243, 81244, 81250, 81251, 81252, 81253, 81255, 81256, 81260, 81261, 81268, 81270, 81271, 81274, 81275, 81276, 81277, 81284, 81285, 81286, 81289, 81290, 81292, 81293, 81294, 81295, 81296, 81297, 81298, 81299, 81300, 81301, 81302, 81304, 81305, 81306, 81307, 81308, 81309, 81312, 81314, 81315, 81317, 81318, 81319, 81320, 81327, 81329, 81330, 81331, 81332, 81333, 81336, 81337, 81342, 81343, 81344, 81345, 81349, 81350, 81355, 81370, 81371, 81372, 81373, 81374, 81375, 81376, 81377, 81378, 81379, 81380, 81381, 81382, 81383, 81400, 81401, 81402, 81403, 81404, 81405, 81406, 81407, 81408, 81418, 81441, 81443, 81449, 81451, 81456, 81457, 81458, 81459, 81462, 81463, 81464, 81479, 81506, 81517, 81518, 81522, 81523, 81542, 81552, 81558, S3713, S3818, S3819, S3820, S3822, S3823, S3828, S3829, S3830, S3831, S3833, S3834, S3835, S3837, S3840, S3843, S3847, S3848, S3851, S3855, S3860, S3862, S3870, S3890 |
Laboratory & Pathology Services | Immunology | 86812, 86813, 86816, 86817, 86821, 86825, 86826, 86828, 86829, 86830, 86831, 86832, 86833, 86834, 86835 |
Laboratory & Pathology Services | Laboratory - Chemistry, Hematology, and Blood Bank | 80184, 80220, 83890, 83891, 83892, 83893, 83894, 83896, 83897, 83898, 83900, 83901, 83902, 83903, 83904, 83905, 83906, 83907, 83908, 83909, 83912, 83913, 83914, 83992, 88720, 88738, 89050, 89055, 89060, 89125, 89190, 89398 |
Laboratory & Pathology Services | Microscopic examination (bacterial, toxicology, COVID-19) | 80324, 80325, 80345, 80347, 80350, 80351, 80352, 80356, 80362, 80363, 87484, 87593, G0482, G0483, G6053 |
Laboratory & Pathology Services | Pathology | 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, 88350, 88384, 88385, 88386 |
Laboratory & Pathology Services | Proprietary Lab Analyses (PLA Codes) | 0002U, 0003U, 0045U, 0046U, 0047U, 0048U, 0049U, 0050U, 0051U, 0054U, 0055U, 0056U, 0060U, 0062U, 0063U, 0067U, 0069U, 0070U, 0071U, 0073U, 0074U, 0075U, 0076U, 0078U, 0079U, 0080U, 0082U, 0083U, 0084U, 0087U, 0088U, 0089U, 0090U, 0092U, 0094U, 0101U, 0102U, 0103U, 0105U, 0108U, 0111U, 0112U, 0113U, 0114U, 0117U, 0118U, 0120U, 0126U, 0128U, 0129U, 0130U, 0131U, 0132U, 0133U, 0134U, 0135U, 0136U, 0137U, 0138U, 0139U, 0153U, 0154U, 0155U, 0156U, 0157U, 0158U, 0159U, 0160U, 0161U, 0162U, 0163U, 0168U, 0169U, 0170U, 0171U, 0172U, 0173U, 0174U, 0175U, 0177U, 0179U, 0180U, 0181U, 0182U, 0183U, 0184U, 0185U, 0186U, 0187U, 0188U, 0189U, 0190U, 0191U, 0192U, 0193U, 0194U, 0195U, 0196U, 0197U, 0198U, 0199U, 0200U, 0201U, 0242U, 0243U, 0244U, 0245U, 0246U, 0247U, 0285U, 0286U, 0287U, 0288U, 0289U, 0290U, 0291U, 0292U, 0293U, 0294U, 0295U, 0296U, 0297U, 0298U, 0299U, 0300U, 0306U, 0307U, 0308U, 0309U, 0310U, 0313U, 0314U, 0315U, 0317U, 0318U, 0319U, 0320U, 0322U, 0327U, 0328U, 0329U, 0331U, 0333U, 0334U, 0335U, 0336U, 0339U, 0340U, 0341U, 0343U, 0345U, 0347U, 0348U, 0349U, 0350U, 0353U, 0355U, 0356U, 0357U, 0358U, 0359U, 0360U, 0361U, 0362U, 0363U, 0364U, 0365U, 0366U, 0367U, 0368U, 0369U, 0370U, 0371U, 0372U, 0373U, 0374U, 0375U, 0376U, 0377U, 0378U, 0379U, 0384U, 0385U, 0386U, 0387U, 0388U, 0389U, 0390U, 0391U, 0392U, 0393U, 0395U, 0396U, 0397U, 0398U, 0400U, 0401U, 0403U, 0405U, 0406U, 0407U, 0409U, 0410U, 0411U, 0412U, 0413U, 0414U, 0415U, 0417U, 0418U, 0419U, 0420U, 0421U, 0422U, 0423U, 0424U, 0425U, 0426U, 0433U, 0434U, 0436U, 0437U, 0438U, 0439U, 0440U, 0443U, 0444U, 0449U, 0450U, 0451U, 0452U, 0453U, 0454U, 0457U, 0458U, 0459U, 0460U, 0461U, 0462U, 0463U, 0465U, 0466U, 0467U, 0468U, 0469U, 0470U, 0472U, 0473U, 0474U, 0475U, 0476U, 0477U, 0478U, 0479U, 0480U, 0481U, 0485U, 0486U, 0487U, 0488U, 0489U, 0493U, 0494U, 0495U, 0496U, 0497U, 0498U, 0499U, 0500U, 0501U, 0502U, 0503U, 0506U, 0507U, 0508U, 0509U, 0510U, 0511U, 0516U, 0523U, 0529U, 0530U, 0531U, 0532U, 0533U, 0534U, 0536U, 0537U, 0538U, 0539U, 0540U, 0543U, 0544U, 0549U, 0552U, 0553U, 0554U, 0555U, 0560U, 0561U, 0562U, 0565U, 0566U, 0567U, 0568U, 0569U, 0571U, 0575U, 0576U, 0578U, 0582U, 0583U, 0585U, 0586U, 0592U, 0597U |
Medication & Pharmacy | Medications (Injections, infusions and other forms) | 0708T, 0709T, A9274, A9277, A9278, A9513, A9542, A9607, C9021, C9022, C9025, C9026, C9027, C9034, C9035, C9036, C9037, C9038, C9040, C9044, C9045, C9048, C9049, C9050, C9051, C9052, C9053, C9054, C9055, C9056, C9057, C9058, C9061, C9063, C9065, C9071, C9072, C9073, C9075, C9076, C9079, C9080, C9081, C9082, C9083, C9088, C9089, C9094, C9095, C9096, C9097, C9098, C9121, C9122, C9130, C9131, C9132, C9133, C9134, C9135, C9136, C9151, C9166, C9167, C9168, C9173, C9174, C9175, C9255, C9256, C9257, C9259, C9260, C9261, C9263, C9264, C9265, C9266, C9267, C9269, C9270, C9271, C9272, C9273, C9276, C9277, C9278, C9280, C9281, C9284, C9286, C9287, C9289, C9291, C9292, C9293, C9294, C9295, C9296, C9297, C9298, C9301, C9302, C9303, C9304, C9305, C9306, C9399, C9442, C9445, C9448, C9449, C9450, C9451, C9452, C9453, C9454, C9455, C9456, J0121, J0129, J0139, J0172, J0174, J0175, J0177, J0178, J0179, J0180, J0184, J0202, J0205, J0208, J0215, J0217, J0218, J0219, J0220, J0221, J0222, J0223, J0224, J0225, J0256, J0257, J0291, J0364, J0480, J0485, J0490, J0491, J0517, J0565, J0567, J0577, J0578, J0584, J0585, J0586, J0587, J0588, J0589, J0591, J0593, J0594, J0596, J0597, J0598, J0599, J0601, J0602, J0603, J0604, J0605, J0606, J0607, J0608, J0609, J0614, J0638, J0642, J0668, J0691, J0717, J0718, J0738, J0739, J0741, J0751, J0752, J0775, J0791, J0799, J0800, J0801, J0802, J0850, J0870, J0879, J0881, J0882, J0885, J0887, J0888, J0889, J0890, J0893, J0894, J0896, J0897, J0901, J1072, J1190, J1202, J1203, J1290, J1299, J1301, J1302, J1303, J1304, J1305, J1306, J1307, J1322, J1323, J1324, J1325, J1326, J1411, J1412, J1413, J1414, J1426, J1429, J1434, J1439, J1440, J1441, J1442, J1447, J1448, J1449, J1454, J1456, J1458, J1459, J1460, J1470, J1480, J1490, J1500, J1510, J1520, J1530, J1540, J1550, J1551, J1552, J1555, J1556, J1557, J1558, J1559, J1560, J1561, J1562, J1566, J1568, J1569, J1572, J1575, J1576, J1595, J1599, J1602, J1628, J1632, J1640, J1652, J1655, J1680, J1729, J1740, J1743, J1744, J1745, J1746, J1747, J1748, J1785, J1786, J1809, J1823, J1825, J1826, J1930, J1931, J1932, J1950, J1951, J1952, J1954, J1961, J2170, J2182, J2212, J2267, J2277, J2278, J2311, J2313, J2323, J2325, J2326, J2327, J2329, J2350, J2351, J2353, J2354, J2355, J2356, J2357, J2403, J2425, J2427, J2428, J2468, J2501, J2502, J2503, J2504, J2505, J2506, J2507, J2508, J2562, J2724, J2777, J2778, J2779, J2781, J2782, J2786, J2792, J2793, J2795, J2797, J2801, J2802, J2820, J2840, J2860, J2941, J2998, J3031, J3032, J3055, J3060, J3095, J3110, J3111, J3240, J3241, J3245, J3247, J3262, J3263, J3285, J3299, J3304, J3315, J3316, J3357, J3358, J3380, J3385, J3391, J3392, J3393, J3394, J3396, J3397, J3398, J3399, J3401, J3402, J3403, J3487, J3488, J3490, J3590, J3591, J7169, J7171, J7172, J7173, J7174, J7177, J7178, J7179, J7181, J7184, J7188, J7190, J7191, J7193, J7194, J7196, J7197, J7198, J7199, J7200, J7201, J7202, J7203, J7204, J7205, J7207, J7210, J7211, J7212, J7213, J7214, J7294, J7310, J7311, J7312, J7313, J7314, J7315, J7316, J7318, J7320, J7321, J7323, J7324, J7325, J7326, J7327, J7329, J7330, J7331, J7332, J7333, J7335, J7351, J7352, J7353, J7355, J7356, J7401, J7504, J7508, J7511, J7513, J7514, J7516, J7518, J7521, J7525, J7527, J7599, J7601, J7639, J7682, J7686, J7699, J8499, J8522, J8541, J8561, J8562, J8565, J8611, J8612, J8705, J8999, J9000, J9001, J9002, J9010, J9011, J9015, J9017, J9019, J9020, J9021, J9022, J9023, J9024, J9025, J9026, J9027, J9028, J9029, J9032, J9033, J9034, J9035, J9038, J9039, J9040, J9041, J9042, J9043, J9045, J9046, J9047, J9048, J9049, J9050, J9051, J9052, J9054, J9055, J9056, J9057, J9060, J9061, J9062, J9063, J9064, J9065, J9071, J9072, J9073, J9074, J9075, J9076, J9090, J9091, J9092, J9093, J9094, J9097, J9098, J9100, J9110, J9118, J9119, J9120, J9130, J9140, J9144, J9145, J9150, J9151, J9153, J9155, J9161, J9171, J9172, J9173, J9174, J9175, J9176, J9177, J9178, J9179, J9181, J9185, J9190, J9196, J9198, J9199, J9200, J9201, J9202, J9204, J9205, J9206, J9207, J9208, J9209, J9210, J9211, J9212, J9213, J9214, J9215, J9216, J9217, J9218, J9219, J9223, J9225, J9226, J9227, J9228, J9229, J9230, J9245, J9246, J9248, J9249, J9258, J9261, J9262, J9263, J9264, J9265, J9266, J9267, J9268, J9269, J9271, J9272, J9273, J9274, J9275, J9276, J9280, J9281, J9286, J9289, J9290, J9291, J9292, J9294, J9295, J9296, J9297, J9298, J9299, J9301, J9302, J9303, J9304, J9305, J9306, J9307, J9308, J9309, J9311, J9312, J9313, J9314, J9315, J9316, J9317, J9318, J9319, J9320, J9321, J9322, J9323, J9324, J9328, J9329, J9330, J9331, J9332, J9333, J9334, J9340, J9341, J9342, J9345, J9347, J9348, J9350, J9351, J9352, J9353, J9354, J9355, J9357, J9358, J9359, J9360, J9361, J9370, J9371, J9375, J9376, J9380, J9381, J9382, J9390, J9393, J9394, J9395, J9400, J9600, J9999, M0224, Q0155, Q0224, Q2017, Q2025, Q2026, Q2027, Q2028, Q2042, Q2043, Q2044, Q2045, Q2046, Q2047, Q2048, Q2049, Q2050, Q2051, Q2052, Q2053, Q2054, Q2055, Q2056, Q2057, Q2058, Q3027, Q3028, Q4074, Q4082, Q5101, Q5103, Q5104, Q5105, Q5106, Q5107, Q5108, Q5109, Q5110, Q5111, Q5113, Q5115, Q5116, Q5117, Q5118, Q5119, Q5120, Q5121, Q5122, Q5123, Q5124, Q5125, Q5126, Q5127, Q5128, Q5129, Q5130, Q5133, Q5134, Q5135, Q5136, Q5137, Q5138, Q5140, Q5141, Q5142, Q5143, Q5144, Q5145, Q5146, Q5147, Q5148, Q5149, Q5150, Q5151, Q5152, Q5153, Q5154, Q5155, Q5156, Q5157, Q5158, Q5159, Q9972, Q9973, Q9975, Q9976, Q9977, Q9978, Q9979, Q9996, Q9997, Q9998, Q9999, S0013, S0088, S0122, S0126, S0128, S0132, S0145, S0148, S0190 |
Medication & Pharmacy | Radiopharmaceuticals | C7901, C7902 |
Neurosurgery | Incision and excision of CNS | 61796, 61797, 61798, 61799, 63620, 63621 |
Neurosurgery | Insertion of catheter or spinal stimulator | 0587T, 0588T, 0589T, 0590T, 0674T, 0675T, 0676T, 0677T, 0678T, 0680T, 62320, 62321, 62322, 62323, 62324, 62325, 62326, 62327, 62350, 62351, 62355, 62360, 62361, 62362, 62365, 62367, 62369, 62370, 63650, 63655, 63661, 63662, 63685, 63688, 64553, 64555, 64560, 64561, 64566, 64568, 64590, 64595, 95980, 95981, 95982 |
Ophthalmology & Vision Care | General Eye Exams & Diagnostics | 0563T, 0687T, 0688T, 0704T, 0705T, 0706T |
Ophthalmology & Vision Care | Glaucoma & Eyeball Procedures | 0671T, 66020, 67715 |
Ophthalmology & Vision Care | Visual aids and other optical supplies | S0500, S0504, S0506, S0508, S0510, S0512, S0514, S0515, S0516, S0518, S0580, S0581, S0590, S0592, S0595, V2020, V2100, V2101, V2102, V2103, V2104, V2105, V2106, V2107, V2108, V2109, V2110, V2111, V2112, V2113, V2114, V2115, V2118, V2121, V2199, V2200, V2201, V2202, V2203, V2204, V2205, V2206, V2207, V2208, V2209, V2210, V2211, V2212, V2213, V2214, V2215, V2218, V2219, V2220, V2221, V2299, V2300, V2301, V2302, V2303, V2304, V2305, V2306, V2307, V2308, V2309, V2310, V2311, V2312, V2313, V2314, V2315, V2318, V2319, V2320, V2321, V2399, V2410, V2430, V2499, V2500, V2501, V2502, V2503, V2510, V2511, V2512, V2513, V2520, V2521, V2522, V2523, V2525, V2526, V2530, V2531, V2599, V2600, V2610, V2615, V2623, V2624, V2625, V2626, V2627, V2628, V2629, V2700, V2702, V2710, V2715, V2718, V2730, V2744, V2745, V2750, V2755, V2756, V2760, V2761, V2762, V2770, V2780, V2781, V2782, V2783, V2784, V2786, V2787, V2788, V2790, V2797, V2799 |
Orthopedic & Spine Surgery | General Orthopedics, Trauma, & Fracture Treatment | 0707T, 0869T, 20939, 21120, 21121, 21122, 21123, 21125, 21127, 21137, 21138, 21139, 21141, 21142, 21143, 21145, 21146, 21147, 21150, 21151, 21154, 21155, 21159, 21160, 21172, 21175, 21179, 21180, 21181, 21182, 21183, 21184, 21188, 21193, 21194, 21195, 21196, 21198, 21199, 21206, 21208, 21209, 21210, 21215, 21230, 21235, 21240, 21242, 21243, 21244, 21247, 21248, 21249, 21255, 21256, 21260, 21261, 21263, 21267, 21268, 21270, 21275, 21280, 21282, 21295, 21296, 21299, 22101, 22102, 22103, 22110, 22112, 22114, 22116, 22206, 22207, 22208, 22210, 22212, 22214, 22216, 22220, 22222, 22224, 22226, 22510, 22511, 22512, 22513, 22514, 22515, 22521, 22522, 22523, 22524, 22532, 22856, 22857, 22858, 22860, 22861, 22862, 22864, 22865, 24360, 24361, 24362, 24363, 24366, 24370, 24371, 25332, 25441, 25442, 25443, 25444, 25445, 25446, 25447, 25449, 26530, 26531, 26535, 26536, 27096, 27125, 27278, 27279, 27437, 27438, 27702, 27703, 27704 |
Orthopedic & Spine Surgery | Major Joint Reconstruction & Arthroscopy | 23470, 23472, 23473, 23474, 27130, 27132, 27134, 27137, 27138, 27440, 27441, 27442, 27443, 27445, 27446, 27447, 27486, 27487 |
Orthopedic & Spine Surgery | Spine Surgery (Fusion, Laminectomy, & Deformity) | 0719T, 0790T, 22533, 22534, 22548, 22551, 22552, 22554, 22556, 22558, 22585, 22586, 22590, 22595, 22600, 22610, 22612, 22614, 22630, 22632, 22633, 22634, 22800, 22802, 22804, 22808, 22810, 22812, 22818, 22819, 22830, 22836, 22837, 22838, 22840, 22841, 22842, 22843, 22844, 22845, 22846, 22847, 22848, 22849, 22850, 22852, 22853, 22855, 63001, 63003, 63005, 63011, 63012, 63015, 63016, 63017, 63020, 63030, 63035, 63040, 63042, 63043, 63044, 63045, 63046, 63047, 63048, 63050, 63051, 63052, 63053, 63055, 63056, 63057, 63064, 63066, 63075, 63076, 63077, 63078, 63081, 63082, 63085, 63086, 63087, 63088, 63090, 63091, 63101, 63102, 63103, 63170, 63172, 63173, 63185, 63190, 63191, 63194, 63195, 63196, 63197, 63198, 63199, 63200, 63250, 63251, 63252, 63265, 63266, 63267, 63268, 63270, 63271, 63272, 63273, 63275, 63276, 63277, 63278, 63280, 63281, 63282, 63283, 63285, 63286, 63287, 63290, 63295, 63300, 63301, 63302, 63303, 63304, 63305, 63306, 63307, 63308, C7504, C7505, C7507, C7508, C9757, G0276, G0277, S2350, S2351, S2360, S2361 |
Physical, Occupational, and Speech Therapy | PT/OT/Speech therapy | 0693T, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97161, 97162, 97163, 97165, 97166, 97167, 97530, 97542, G0129, S8948 |
Physical, Occupational, and Speech Therapy | Therapy Modalities (Ultrasound, Traction, Stim) | 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97750, 97755, 97760, 97761, 97763 |
Plastic & Reconstructive Surgery | Cosmetic & Functional Reconstructive Surgery | 11950, 11951, 11952, 11954, 11960, 15780, 15781, 15782, 15783, 15786, 15787, 15788, 15789, 15792, 15793, 15824, 15825, 15826, 15828, 15829, 15830, 15832, 15833, 15834, 15835, 15836, 15837, 15838, 15839, 15840, 15841, 15842, 15845, 15847, 15876, 15877, 15878, 15879 |
Plastic & Reconstructive Surgery | Plastic procedures on nose (Rhinoplasty) | 30400, 30410, 30420, 30430, 30435, 30450, 30460, 30462, 30465 |
Respiratory Services | Pulmonary Function Tests (PFTs) & Diagnostics | 94005, 94774, 94777 |
Speech, Language, and Hearing Services | Hearing and Speech Evaluations | 92507, 92508, 92521, 92522, 92523, 92524, 92526, 92551, 92597, 92605, 92606, 92607, 92608, 92609, 92610, 92612, 92613, 92614, 92615, 92616, 92617 |
Speech, Language, and Hearing Services | Hearing devices and audiology supplies | V5030, V5040, V5050, V5060, V5070, V5080, V5095, V5100, V5110, V5120, V5130, V5140, V5150, V5171, V5172, V5181, V5190, V5211, V5212, V5213, V5214, V5215, V5221, V5230, V5244, V5245, V5246, V5247, V5250, V5251, V5252, V5253, V5254, V5255, V5256, V5257, V5258, V5259, V5260, V5261, V5262, V5263, V5265, V5268, V5269, V5270, V5271, V5272, V5273, V5274, V5281, V5282, V5283, V5284, V5285, V5286, V5287, V5288, V5289, V5290, V5298, V5336 |
Telehealth Services | Telehealth (calls, online communication, remote monitoring) | G0406 |
Therapeutic Injections & Infusions | Injections: muscles, tendons, bursa, joints, soft tissue | 20552, 20553 |
Therapeutic Injections & Infusions | Vaccine and Immune Globulin Products | 90281, 90283, 90284, 90291, 90378, 90741, 91305, 91306 |
Transportation Services | Transportation - patient, provider, equipment | A0430, A0435 |
Urological & Kidney Surgery | Diagnostic procedures, male genital (includes minor surgery) | 54125, 54520, 54660, 54680, 54690, 55175, 55180 |
Urological & Kidney Surgery | Kidney transplant | 50300, 50320, 50323, 50325, 50327, 50328, 50329, 50340, 50360, 50365, 50370, 50380, S2065 |
Urological & Kidney Surgery | Nephrectomy and Major Urinary Tract Reconstruction | 0672T, 0888T, 50547, 50548, 53430 |
Urological & Kidney Surgery | Procedures of urinary tract | 0872T |
Urological & Kidney Surgery | Transurethral resection of prostate (TURP) | 0867T |