LIST OF CPT1/HCPCS CODES USED TO DEFINE CERTAIN DESIGNATED HEALTH SERVICE CATEGORIES2 UNDER SECTION 1877 OF THE SOCIAL SECURITY ACT																																				
This code list is effective January 1, 2014 																																				
CLINICAL LABORATORY SERVICES																																				
INCLUDE CPT codes for all clinical laboratory services in the 80000 series, except EXCLUDE CPT codes for the following blood component collection services:																																				
																																				
86152	Cell enumeration &id																																			
86153	Cell enumeration phys interp																																			
86890	Autologous blood process																																			
86891	Autologous blood op salvage																																			
86927	Plasma fresh frozen																																			
86930	Frozen blood prep																																			
86931	Frozen blood thaw																																			
86932	Frozen blood freeze/thaw																																			
86945	Blood product/irradiation																																			
86950	Leukacyte transfusion																																			
86960	Vol reduction of blood/prod																																			
86965	Pooling blood platelets																																			
86985	Split blood or products																																			
																																				
INCLUDE the following CPT and HCPCS Level 2 codes for other clinical laboratory services:																																				
																																				
0058T	Cryopreservation ovary tiss																																			
0059T	Cryopreservation oocyte																																			
0103T	Holotranscobalamin																																			
0111T	RBC membranes fatty acids																																			
36415	Routine venipuncture																																			
78110	Plasma volume single																																			
78111	Plasma volume multiple																																			
78120	Red cell mass single																																			
78121	Red cell mass multiple																																			
78122	Blood volume																																			
78130	Red cell survival study																																			
78191	Platelet survival																																			
78267	Breath tst attain/anal c-14																																			
78268	Breath test analysis c-14																																			
78270	Vit B-12 absorption exam																																			
78271	Vit B-12 absrp exam int fac																																			
78272	Vit B-12 absorp combined																																			
78725	Kidney function study																																			
G0027	Semen analysis 																																			
G0103	Psa screening																																			
G0123	Screen cerv/vag thin layer																																			
G0124	Screen c/v thin layer by MD																																			
G0141	Scr c/v cyto,autosys and md																																			
G0143	Scr c/v cyto,thinlayer,rescr																																			
G0144	Scr c/v cyto,thinlayer,rescr																																			
G0145 	Scr c/v cyto,thinlayer,rescr																																			
G0147	Scr c/v cyto, automated sys																																			
G0148	Scr c/v cyto, autosys, rescr																																			
G0306	CBC/diffwbc w/o platelet																																			
G0307	CBC without platelet																																			
G0328	Fecal blood scrn immunoassay																																			
G0416	Sat biopsy prostate 1-20 spc																																			
G0417	Sat biopsy prostate 21-40																																			
G0418	Sat biopsy prostate 41-60																																			
G0419	Sat biopsy prostate: >60																																			
G0431	Drug screen single class																																			
G0432	EIA HIV-1/HIV-2 screen																																			
G0433	ELISA HIV-1/HIV-2 screen																																			
G0434	Drug screen multi drug clas																																			
G0435	Oral HIV-1/HIV-2 screen																																			
G9143	Warfarin respon genetic test																																			
P2028	Cephalin floculation test																																			
P2029	Congo red blood test																																			
P2033	Blood thymol turbidity 																																			
P2038	Blood mucoprotein																																			
P3000	Screen pap by tech w md supv																																			
P3001	Screening pap smear by phys																																			
P9612	Catheterize for urine spec																																			
P9615	Urine specimen collect mult 																																			
Q0111	Wet mounts/ w preparations																																			
Q0112	Potassium hydroxide preps																																			
Q0113	Pinworm examinations																																			
Q0114	Fern test																																			
Q0115	Post-coital mucous exam																																			
																																				
PHYSICAL THERAPY, OCCUPATIONAL THERAPY, AND OUTPATIENT SPEECH-LANGUAGE PATHOLOGY SERVICES																																				
																																				
INCLUDE the following CPT and HCPCS codes for physical therapy/occupational therapy/outpatient speech-language pathology services:																																				
																																				
0019T	Extracorp shock wv tx ms nos																																			
64550	Apply neurostimulator																																			
90901	Biofeedback train any meth																																			
90911	Biofeedback peri/uro/rectal																																			
92507	Speech/hearing therapy																																			
92508	Speech/hearing therapy																																			
92520	Laryngeal function studies																																			
92521	Evaluation of speech fluency																																			
92522	Evaluate speech production																																			
92523	Speech sound lang comprehen																																			
92524	Behavral qualit analys voice																																			
92526	Oral function therapy																																			
92597	Oral speech device eval																																			
92607	Ex for speech device rx 1hr																																			
92608	Ex for speech device rx addl																																			
92609	Use of speech device service																																			
92610	Evaluate swallowing function																																			
92611	Motion fluoroscopy/swallow																																			
92612	Endoscopy swallow tst (fees)																																			
92614	Laryngoscopic sensory test																																			
92616	Fees w/laryngeal sense test																																			
93797	Cardiac rehab																																			
93798	Cardiac rehab/monitor																																			
95831	Limb muscle testing manual																																			
95832	Hand muscle testing manual																																			
95833	Body muscle testing manual																																			
95834	Body muscle testing manual																																			
95851	Range of motion measurements																																			
95852	Range of motion measurements																																			
95992	Canalith repositioning proc																																			
96000	Motion analysis video/3d																																			
96001	Motion test w/ft press meas																																			
96002	Dynamic surface emg																																			
96003	Dynamic fine wire emg																																			
96105	Assessment of aphasia 																																			
96111	Developmental testing																																			
96125	Cognitive test by HC pro																																			
97001	Pt evaluation																																			
97002	Pt re-evaluation																																			
97003	Ot evaluation																																			
97004	Ot re-evaluation																																			
97010	Hot or cold packs therapy																																			
97012	Mechanical traction therapy																																			
97016	Vasopneumatic device therapy																																			
97018	Paraffin bath therapy																																			
97022	Whirlpool therapy																																			
97024	Diathermy eg microwave																																			
97026	Infrared therapy																																			
97028	Ultraviolet therapy																																			
97032	Electrical stimulation																																			
97033	Electric current therapy																																			
97034	Contrast bath therapy																																			
97035	Ultrasound therapy																																			
97036	Hydrotherapy																																			
97039	Physical therapy treatment																																			
97110	Therapeutic exercises																																			
97112	Neuromuscular reeducation																																			
97113	Aquatic therapy/exercises																																			
97116	Gait training therapy																																			
97124	Massage therapy																																			
97139	Physical medicine procedure																																			
97140	Manual therapy																																			
97150	Group therapeutic procedures																																			
97530	Therapeutic activities																																			
97532	Cognitive skills development																																			
97533	Sensory integration																																			
97535	Self care mngment training																																			
97537	Community/work reintegration																																			
97542	Wheelchair mngment training																																			
97545	Work hardening																																			
97546	Work hardening add-on																																			
97597	RMVL devital tis 20cm/<																																			
97598	RMVL devital tis addl 20 cm<																																			
97602	Wound(s) care non-selective																																			
97605	Neg press wound tx < 50 cm																																			
97606	Neg press wound tx > 50 cm																																			
97610	Low frequency non-thermal US																																			
97750	Physical performance test																																			
97755	Assistive technology assess																																			
97760	Orthotic mgmt and training																																			
97761	Prosthetic training																																			
97762	C/O for orthotic/prosth use																																			
97799	Physical medicine procedure																																			
G0281	Elec stim unattend for press																																			
G0283	Elec stim other than wound																																			
G0329	Electromagntic tx for ulcers																																			
G0451	Development test interp & rep																																			
G0460	Autologous PRP for ulcers																																			
																																				
RADIOLOGY AND CERTAIN OTHER IMAGING SERVICES																																				
																																				
INCLUDE the following CPT and HCPCS codes:																																				
																																				
0042T	Ct perfusion w/contrast cbf																																			
0159T	Cad breast mri																																			
0174T	Cad cxr with interp																																			
0175T	Cad cxr remote																																			
0330T	Tear film img uni/bi w/i&r																																			
0331T	Heart symp image plnr																																			
0332T	Heart symp image plnr spect																																			
0346T+	Ultrasound elastography																																			
51798	Us urine capacity measure																																			
70100	X-ray exam of jaw																																			
70110	X-ray exam of jaw																																			
70120	X-ray exam of mastoids																																			
70130	X-ray exam of mastoids																																			
70134	X-ray exam of middle ear																																			
70140	X-ray exam of facial bones																																			
70150	X-ray exam of facial bones																																			
70160	X-ray exam of nasal bones																																			
70190	X-ray exam of eye sockets																																			
70200	X-ray exam of eye sockets																																			
70210	X-ray exam of sinuses																																			
70220	X-ray exam of sinuses																																			
70240	X-ray exam pituitary saddle																																			
70250	X-ray exam of skull																																			
70260	X-ray exam of skull																																			
70300	X-ray exam of teeth																																			
70310	X-ray exam of teeth																																			
70320	Full mouth x-ray of teeth																																			
70328	X-ray exam of jaw joint																																			
70330	X-ray exam of jaw joints																																			
70336	Magnetic image jaw joint																																			
70350	X-ray head for orthodontia																																			
70355	Panoramic x-ray of jaws																																			
70360	X-ray exam of neck																																			
70370	Throat x-ray & fluoroscopy																																			
70371	Speech evaluation complex																																			
70380	X-ray exam of salivary gland																																			
70450	Ct head/brain w/o dye																																			
70460	Ct head/brain w/dye																																			
70470	Ct head/brain w/o & w/dye																																			
70480	Ct orbit/ear/fossa w/o dye																																			
70481	Ct orbit/ear/fossa w/dye 																																			
70482	Ct orbit/ear/fossa w/o&w/dye																																			
70486	Ct maxillofacial w/o dye																																			
70487	Ct maxillofacial w/dye																																			
70488	Ct maxillofacial w/o & w/dye																																			
70490	Ct soft tissue neck w/o dye																																			
70491	Ct soft tissue neck w/dye																																			
70492	Ct sft tsue nck w/o & w/dye																																			
70496	Ct angiography head																																			
70498	Ct angiography neck																																			
70540	Mri orbit/face/neck w/o dye																																			
70542	Mri orbit/face/neck w/dye																																			
70543	Mri orbt/fac/nck w/o & w/dye																																			
70544	Mr angiography head w/o dye																																			
70545	Mr angiography head w/dye																																			
70546	Mr angiograph head w/o&w/dye																																			
70547	Mr angiography neck w/o dye																																			
70548	Mr angiography neck w/dye																																			
70549	Mr angiograph neck w/o&w/dye																																			
70551	Mri brain w/o dye																																			
70552	Mri brain w/dye																																			
70553	Mri brain w/o & w/dye 																																			
70554	Fmri brain by tech																																			
70555	Fmri brain by phys/psych																																			
71010	Chest x-ray																																			
71015	Chest x-ray																																			
71020	Chest x-ray																																			
71021	Chest x-ray																																			
71022	Chest x-ray																																			
71023	Chest x-ray and fluoroscopy																																			
71030	Chest x-ray																																			
71034	Chest x-ray and fluoroscopy																																			
71035	Chest x-ray																																			
71100	X-ray exam of ribs																																			
71101	X-ray exam of ribs/chest																																			
71110	X-ray exam of ribs																																			
71111	X-ray exam of ribs/chest																																			
71120	X-ray exam of breastbone																																			
71130	X-ray exam of breastbone																																			
71250	Ct thorax w/o dye																																			
71260	Ct thorax w/dye																																			
71270	Ct thorax w/o & w/dye																																			
71275	Ct angiography chest																																			
71550	Mri chest w/o dye																																			
71551	Mri chest w/dye																																			
71552	Mri chest w/o & w/dye																																			
71555	Mri angio chest w or w/o dye																																			
72010	X-ray exam of spine																																			
72020	X-ray exam of spine																																			
72040	X-ray exam neck spine 3/<vws																																			
72050	X-ray exam of neck spine																																			
72052	X-ray exam of neck spine																																			
72069	X-ray exam of trunk spine																																			
72070	X-ray exam of thoracic spine																																			
72072	X-ray exam of thoracic spine																																			
72074	X-ray exam of thoracic spine																																			
72080	X-ray exam of trunk spine																																			
72090	X-ray exam of trunk spine																																			
72100	X-ray exam of lower spine																																			
72110	X-ray exam of lower spine																																			
72114	X-ray exam of lower spine																																			
72120	X-ray exam of lower spine																																			
72125	Ct neck spine w/o dye																																			
72126	Ct neck spine w/dye																																			
72127	Ct neck spine w/o & w/dye																																			
72128	Ct chest spine w/o dye																																			
72129	Ct chest spine w/dye																																			
72130	Ct chest spine w/o & w/dye																																			
72131	Ct lumbar spine w/o dye																																			
72132	Ct lumbar spine w/dye																																			
72133	Ct lumbar spine w/o & w/dye																																			
72141	Mri neck spine w/o dye																																			
72142	Mri neck spine w/dye																																			
72146	Mri chest spine w/o dye																																			
72147	Mri chest spine w/dye																																			
72148	Mri lumbar spine w/o dye																																			
72149	Mri lumbar spine w/dye																																			
72156	Mri neck spine w/o & w/dye																																			
72157	Mri chest spine w/o & w/dye																																			
72158	Mri lumbar spine w/o & w/dye																																			
72159	Mr angio spine w/o&w/dye																																			
72170	X-ray exam of pelvis																																			
72190	X-ray exam of pelvis																																			
72191	Ct angiograph pelv w/o&w/dye																																			
72192	Ct pelvis w/o dye																																			
72193	Ct pelvis w/dye																																			
72194	Ct pelvis w/o & w/dye																																			
72195	Mri pelvis w/o dye																																			
72196	Mri pelvis w/dye																																			
72197	Mri pelvis w/o & w/dye																																			
72198	Mr angio pelvis w/o & w/dye																																			
72200	X-ray exam sacroiliac joints																																			
72202	X-ray exam sacroiliac joints																																			
72220	X-ray exam of tailbone																																			
73000	X-ray exam of collar bone																																			
73010	X-ray exam of shoulder blade																																			
73020	X-ray exam of shoulder																																			
73030	X-ray exam of shoulder																																			
73050	X-ray exam of shoulders																																			
73060	X-ray exam of humerus																																			
73070	X-ray exam of elbow																																			
73080	X-ray exam of elbow																																			
73090	X-ray exam of forearm																																			
73092	X-ray exam of arm infant																																			
73100	X-ray exam of wrist																																			
73110	X-ray exam of wrist																																			
73120	X-ray exam of hand																																			
73130	X-ray exam of hand																																			
73140	X-ray exam of finger(s)																																			
73200	Ct upper extremity w/o dye																																			
73201	Ct upper extremity w/dye																																			
73202	Ct uppr extremity w/o&w/dye																																			
73206	Ct angio upr extrm w/o&w/dye																																			
73218	Mri upper extremity w/o dye																																			
73219	Mri upper extremity w/dye																																			
73220	Mri uppr extremity w/o&w/dye																																			
73221	Mri joint upr extrem w/o dye																																			
73222	Mri joint upr extrem w/dye																																			
73223	Mri joint upr extr w/o&w/dye																																			
73225	Mr angio upr extr w/o&w/dye																																			
73500	X-ray exam of hip																																			
73510	X-ray exam of hip																																			
73520	X-ray exam of hips																																			
73540	X-ray exam of pelvis & hips																																			
73550	X-ray exam of thigh																																			
73560	X-ray exam of knee 1 or 2																																			
73562	X-ray exam of knee 3																																			
73564	X-ray exam knee 4 or more																																			
73565	X-ray exam of knees																																			
73590	X-ray exam of lower leg																																			
73592	X-ray exam of leg infant																																			
73600	X-ray exam of ankle																																			
73610	X-ray exam of ankle																																			
73620	X-ray exam of foot																																			
73630	X-ray exam of foot																																			
73650	X-ray exam of heel																																			
73660	X-ray exam of toe(s)																																			
73700	Ct lower extremity w/o dye																																			
73701	Ct lower extremity w/dye																																			
73702	Ct lwr extremity w/o&w/dye																																			
73706	Ct angio lwr extr w/o&w/dye																																			
73718	Mri lower extremity w/o dye																																			
73719	Mri lower extremity w/dye																																			
73720	Mri lwr extremity w/o&w/dye																																			
73721	Mri jnt of lwr extre w/o dye																																			
73722	Mri joint of lwr extr w/dye																																			
73723	Mri joint lwr extr w/o&w/dye																																			
73725	Mr ang lwr ext w or w/o dye																																			
74000	X-ray exam of abdomen																																			
74010	X-ray exam of abdomen																																			
74020	X-ray exam of abdomen																																			
74022	X-ray exam series abdomen																																			
74150	Ct abdomen w/o dye																																			
74160	Ct abdomen w/dye																																			
74170	Ct abdomen w/o & w/dye																																			
74174	Ct angio abd&pelv w/o&w/dye																																			
74175	Ct angio abdom w/o & w/dye																																			
74176	Ct abd & pelvis																																			
74177	Ct abd & pelv w/contrast																																			
74178	Ct abd & pelv 1/>regns																																			
74181	Mri abdomen w/o dye																																			
74182	Mri abdomen w/dye																																			
74183	Mri abdomen w/o & w/dye																																			
74185	Mri angio abdom w orw/o dye																																			
74210	Contrst x-ray exam of throat																																			
74220	Contrast x-ray esophagus																																			
74230	Cine/vid x-ray throat/esoph																																			
74240	X-ray exam upper gi tract																																			
74241	X-ray exam upper gi tract																																			
74245	X-ray exam upper gi tract																																			
74246	Contrst x-ray uppr gi tract																																			
74247	Contrst x-ray uppr gi tract																																			
74249	Contrst x-ray uppr gi tract																																			
74250	X-ray exam of small bowel																																			
74261	Ct colonography dx																																			
74262	Ct colonography dx w/dye																																			
74290	Contrast x-ray gallbladder																																			
74291	Contrast x-rays gallbladder																																			
74710	X-ray measurement of pelvis																																			
75557	Cardiac MRI for morph																																			
75559	Cardiac MRI w/stress img																																			
75561	Cardiac MRI for morph w/dye																																			
75563	Card MRI w/stress img & dye																																			
75565	Card MRI veloc flow mapping																																			
75571	Ct hrt w/o dye w/ca test																																			
75572	Ct hrt w/3d image																																			
75573	Ct hrt w/3d image congen																																			
75574	Ct angio hrt w/3d image																																			
75635	Ct angio abdominal arteries																																			
76000	Fluoroscope examination																																			
76010	X-ray nose to rectum																																			
76100	X-ray exam of body section																																			
76101	Complex body section x-ray																																			
76102	Complex body section x-rays																																			
76120	Cine/video x-rays																																			
76125	Cine/video x-rays add-on																																			
76376	3d render w/o postprocess																																			
76377	3d rendering w/postprocess																																			
76380	CAT scan follow-up study																																			
76499	Radiographic procedure																																			
76506	Echo exam of head																																			
76510	Ophth us b & quant a																																			
76511	Ophth us quant a only																																			
76512	Ophth us b w/non-quant a																																			
76513	Echo exam of eye water bath																																			
76514	Echo exam of eye thickness																																			
76516	Echo exam of eye																																			
76519	Echo exam of eye																																			
76536	Us exam of head and neck																																			
76604	Us exam chest																																			
76645	Us exam breast(s)																																			
76700	Us exam abdom complete																																			
76705	Echo exam of abdomen																																			
76770	Us exam abdo back wall comp																																			
76775	Us exam abdo back wall lim																																			
76776	Us exam k transpl w/Doppler																																			
76800	Us exam spinal canal																																			
76801	Ob us < 14 wks single fetus																																			
76802	Ob us < 14 wks addl fetus																																			
76805	Ob us >/= 14 wks sngl fetus																																			
76810	Ob us >/= 14 wks addl fetus																																			
76811	Ob us detailed sngl fetus																																			
76812	Ob us detailed addl fetus																																			
76815	Ob us limited fetus(s)																																			
76816	Ob us follow-up per fetus																																			
76818	Fetal biophys profile w/nst																																			
76819	Fetal biophys profil w/o nst																																			
76820	Umbilical artery echo																																			
76821	Middle cerebral artery echo																																			
76825	Echo exam of fetal heart																																			
76826	Echo exam of fetal heart																																			
76827	Echo exam of fetal heart																																			
76828	Echo exam of fetal heart																																			
76856	Us exam pelvic complete																																			
76857	Us exam pelvic limited																																			
76870	Us exam scrotum																																			
76881	Us xtr non-vasc complete																																			
76882	Us xtr non-vasc lmtd																																			
76885	Us exam infant hips dynamic																																			
76886	Us exam infant hips static																																			
76970	Ultrasound exam follow-up																																			
76977	Us bone density measure																																			
76999	Echo examination procedure																																			
77051	Computer dx mammogram add-on																																			
77052	Comp screen mammogram add-on																																			
77055	Mammogram one breast																																			
77056	Mammogram both breasts																																			
77057	Mammogram screening																																			
77058	Mri one breast																																			
77059	Mri both breasts																																			
77071	X-ray stress view																																			
77072	X-rays for bone age																																			
77073	X-rays bone length studies																																			
77074	X-rays bone survey limited																																			
77075	X-rays bone survey complete																																			
77076	X-rays bone survey infant																																			
77077	Joint survey single view																																			
77078	Ct bone density axial																																			
77080	Dxa bone density axial																																			
77081	Dxa bone density/peripheral																																			
77082	Dxa bone density vert fx																																			
77084	Magnetic image bone marrow																																			
78012	Thyroid uptake measurement 																																			
78013	Thyroid imaging w/blood flow																																			
78014	Thyroid imaging w/blood flow																																			
78015	Thyroid met imaging																																			
78016	Thyroid met imaging/studies																																			
78018	Thyroid met imaging body																																			
78020	Thyroid met uptake																																			
78070	Parathyroid nuclear imaging																																			
78071	Parathyrd planar w/wo subtrj																																			
78072	Parathyrd planar w/spect&ct																																			
78075	Adrenal nuclear imaging																																			
78099	Endocrine nuclear procedure																																			
78102	Bone marrow imaging ltd																																			
78103	Bone marrow imaging mult																																			
78104	Bone marrow imaging body																																			
78135	Red cell survival kinetics																																			
78140	Red cell sequestration																																			
78185	Spleen imaging																																			
78190	Platelet survival kinetics																																			
78195	Lymph system imaging																																			
78199	Blood/lymph nuclear exam																																			
78201	Liver imaging																																			
78202	Liver imaging with flow																																			
78205	Liver imaging (3D)																																			
78206	Liver image (3d) with flow																																			
78215	Liver and spleen imaging																																			
78216	Liver & spleen image/flow																																			
78226	Hepatobiliary system imaging																																			
78227	Hepatobil syst image w/drug																																			
78230	Salivary gland imaging																																			
78231	Serial salivary imaging																																			
78232	Salivary gland function exam																																			
78258	Esophageal motility study																																			
78261	Gastric mucosa imaging																																			
78262	Gastroesophageal reflux exam																																			
78264	Gastric emptying study																																			
78278	Acute GI blood loss imaging																																			
78282	GI protein loss exam																																			
78290	Meckels divert exam																																			
78291	Leveen/shunt patency exam																																			
78299	GI nuclear procedure																																			
78300	Bone imaging limited area																																			
78305	Bone imaging multiple areas																																			
78306	Bone imaging whole body																																			
78315	Bone imaging 3 phase																																			
78320	Bone imaging (3D)																																			
78399	Musculoskeletal nuclear exam																																			
78428	Cardiac shunt imaging																																			
78445	Vascular flow imaging																																			
78451	Ht muscle image spect sing																																			
78452	Ht muscle image spect mult																																			
78453	Ht muscle image planar sing																																			
78454	Ht musc image planar mult																																			
78456	Acute venous thrombus image																																			
78457	Venous thrombosis imaging																																			
78458	Ven thrombosis images bilat																																			
78459	Heart muscle imaging (PET)																																			
78466	Heart infarct image																																			
78468	Heart infarct image (ef)																																			
78469	Heart infarct image (3D)																																			
78472	Gated heart planar single																																			
78473	Gated heart multiple																																			
78481	Heart first pass single																																			
78483	Heart first pass multiple																																			
78491	Heart image (pet) single																																			
78492	Heart image (pet) multiple																																			
78494	Heart image spect																																			
78496	Heart first pass add-on																																			
78499	Cardiovascular nuclear exam																																			
78579	Lung ventilation imaging																																			
78580	Lung perfusion imaging																																			
78582	Lung ventilat&perfus imaging																																			
78597	Lung perfusion differential																																			
78598	Lung perf&ventilat diferentl																																			
78599	Respiratory nuclear exam																																			
78600	Brain image < 4 views																																			
78601	Brain image w/flow < 4 views																																			
78605	Brain image 4+ views																																			
78606	Brain image w/flow 4 + views																																			
78607	Brain imaging (3D)																																			
78608	Brain imaging (PET)																																			
78610	Brain flow imaging only																																			
78630	Cerebrospinal fluid scan																																			
78635	CSF ventriculography																																			
78645	CSF shunt evaluation																																			
78647	Cerebrospinal fluid scan																																			
78650	CSF leakage imaging																																			
78660	Nuclear exam of tear flow																																			
78699	Nervous system nuclear exam																																			
78700	Kidney imaging morphol																																			
78701	Kidney imaging with flow																																			
78707	K flow/funct image w/o drug																																			
78708	K flow/funct image w/drug																																			
78709	K flow/funct image multiple																																			
78710	Kidney imaging (3D)																																			
78730	Urinary bladder retention																																			
78740	Ureteral reflux study																																			
78761	Testicular imaging w/flow																																			
78799	Genitourinary nuclear exam																																			
78800	Tumor imaging limited area																																			
78801	Tumor imaging mult areas																																			
78802	Tumor imaging whole body																																			
78803	Tumor imaging (3D)																																			
78804	Tumor imaging whole body																																			
78805	Abscess imaging ltd area																																			
78806	Abscess imaging whole body																																			
78807	Nuclear localization/abscess																																			
78811	PET image ltd area																																			
78812	PET image skull-thigh																																			
78813	PET image full body																																			
78814	PET image w/ct lmtd																																			
78815	PET image w/ct skull-thigh																																			
78816	PET image w/ct full body																																			
78999	Nuclear diagnostic exam																																			
91110	Gi tract capsule endoscopy																																			
91111	Esophageal capsule endoscopy																																			
92132	Cpmtr ophth dx img ant segmt																																			
92133	Cmptr ophth img optic nerve																																			
92134	Cptr ophth dx img post segmt																																			
92227	Remote dx retinal imaging																																			
92228	Remote retinal imaging mgmt																																			
93303	Echo transthoracic																																			
93304	Echo transthoracic																																			
93306	TTE w/Doppler complete																																			
93307	TTE w/o Doppler complete																																			
93308	TTE f-up or lmtd																																			
93320	Doppler echo exam heart [if used in conjunction with 93303-93304]																																			
93321	Doppler echo exam heart [if used in conjunction with 93303, 93304, 93308]																																			
93325	Doppler color flow add-on [if used in conjunction with 76825, 76826, 76827,76828, 93303, 93304, 93308]																																			
93875	Extracranial study																																			
93880	Extracranial study																																			
93882	Extracranial study																																			
93886	Intracranial study																																			
93888	Intracranial study																																			
93890	Tcd vasoreactivity study																																			
93892	Tcd emboli detect w/o inj																																			
93922	Upr/l xtremity art 2 levels																																			
93923	Upr/lxtr art stdy 3+ lvls																																			
93924	Lwr xtr vasc stdy bilat 																																			
93925	Lower extremity study																																			
93926	Lower extremity study																																			
93930	Upper extremity study																																			
93931	Upper extremity study																																			
93965	Extremity study																																			
93970	Extremity study																																			
93971	Extremity study																																			
93975	Vascular study																																			
93976	Vascular study																																			
93978	Vascular study																																			
93979	Vascular study																																			
93980	Penile vascular study																																			
93981	Penile vascular study																																			
93990	Doppler flow testing																																			
93998	Noninvas vasc dx study proc																																			
97610	Low frequency non-thermal US																																			
A4641	Radiopharm dx agent noc																																			
A4642	In111 satumomab																																			
A9500	Tc99m sestamibi																																			
A9501	Technetium TC-99m teboroxime																																			
A9502	Tc99m tetrofosmin																																			
A9503	Tc99m medronate																																			
A9504	Tc99m apcitide																																			
A9505	TL201 thallium																																			
A9507	In111 capromab																																			
A9508	I131 iodobenguate, dx																																			
A9509	Iodine I-123 sod iodide mil																																			
A9510	Tc99m disofenin																																			
A9512	Tc99m pertechnetate																																			
A9516	Iodine I-123 sod iodide mic																																			
A9521	Tc99m exametazime																																			
A9524	I131 serum albumin, dx																																			
A9526	Nitrogen N-13 ammonia																																			
A9528	Iodine I-131 iodide cap, dx																																			
A9529	I131 iodide sol, dx 																																			
A9531	I131 max 100uCi																																			
A9532	I125 serum albumin, dx																																			
A9536	TC99m depreotide																																			
A9537	Tc99m mebrofenin																																			
A9538	Tc99m pyrophosphate 																																			
A9539    	Tc99m pentetate																																			
A9540	Tc99m MAA																																			
A9541     	Tc99m sulfur colloid																																			
A9542    	In111 ibritumomab, dx																																			
A9544    	I131 tositumomab, dx																																			
A9546    	CO57/58																																			
A9547   	In111 oxyquinoline																																			
A9548    	In111 pentetate																																			
A9550   	Tc99m gluceptate   																																			
A9551	Tc99m succimer																																			
A9552	F18 fdg																																			
A9553	Cr51 chromate																																			
A9554	I125 iothalamate, dx																																			
A9555	Rb82 rubidium																																			
A9556	Ga67 gallium																																			
A9557	Tc99m bicisate																																			
A9558	Xe133 xenon 10mci																																			
A9559	Co57 cyano																																			
A9560	Tc99m labeled rbc																																			
A9561	Tc99m oxidronate																																			
A9562	Tc99m mertiatide																																			
A9566	Tc99m fanolesomab																																			
A9567	Technetium TC-99m aerosol																																			
A9568	Technetium tc99m arcitumomab																																			
A9569	Technetium TC-99m auto WBC																																			
A9570	Indium In-111 auto WBC																																			
A9571	Indium In-111 auto platelet																																			
A9572	Indium In-111 pentetreotide																																			
A9576	Inj prohance multipack																																			
A9577	Inj multihance																																			
A9578	Inj multihance multipack																																			
A9579	Gad-base MR contrast NOS,1ml  																																			
A9580	Sodium fluoride F-18																																			
A9584	Iodine I-123 ioflupane																																			
A9586	Florbetapir F18																																			
A9700	Echocardiography contrast																																			
A9520	Tc99 Tilmanocept diag 0.5mci																																			
C9734	U/S trtmt, not leiomyomata																																			
G0130	Single energy x-ray study																																			
G0202	Screeningmammographydigital																																			
G0204	Diagnosticmammographydigital																																			
G0206	Diagnosticmammographydigital																																			
G0288	Recon, CTA for surg plan																																			
G0389	Ultrasound exam AAA screen																																			
Q0092	Set up port xray equipment 																																			
Q9951	LOCM>=400 mg/ml iodine,1ml																																			
Q9953	Inj Fe-based MR contrast,1ml																																			
Q9954	Oral MR contrast, 100ml																																			
Q9955	Inj perflexane lip micros,ml																																			
Q9956	Inj octafluoropropane mic,ml																																			
Q9957	Inj perflutren lip micros,ml																																			
Q9958	HOCM <=149 mg/ml iodine, 1ml																																			
Q9959	HOCM 150-199mg/ml iodine,1ml																																			
Q9960	HOCM 200-249mg/ml iodine,1ml																																			
Q9961	HOCM 250-299mg/ml iodine,1ml																																			
Q9962	HOCM 300-349mg/ml iodine,1ml																																			
Q9963	HOCM 350-399mg/ml iodine,1ml																																			
Q9964	HOCM>= 400mg/ml iodine, 1ml																																			
Q9965	LOCM 100-199mg/ml iodine,1ml																																			
Q9966	LOCM 200-299mg/ml iodine,1ml																																			
Q9967	LOCM 300-399mg/ml iodine,1ml																																			
R0070	Transport portable x-ray																																			
R0075	Transport port x-ray multipl																																			
																																				
RADIATION THERAPY SERVICES AND SUPPLIES																																				
																																				
INCLUDE the following CPT and HCPCS codes:																																				
																																				
0073T	Delivery comp imrt																																			
0182T	HDR elect brachytherapy																																			
0190T	Place intraoc radiation src																																			
0197T	Intrafraction track motion  																																			
19296	Place po breast cath for rad																																			
19297	Place breast cath for rad																																			
19298	Place breast rad tube/caths																																			
20555	Place ndl musc/tis for rt																																			
31643	Diag bronchoscope/catheter																																			
32553	Ins mark thor for rt perq																																			
32701	Thorax stereo rad targetw/tx																																			
41019	Place needles h&n for rt																																			
49327	Lap ins device for rt																																			
49411	Ins mark abd/pel for rt perq																																			
49412	Ins device for rt guide open																																			
55875	Transperi needle place pros																																			
55876	Place rt device/marker pros																																			
55920	Place needles pelvic for rt																																			
57155	Insert uteri tandems/ovoids																																			
57156	Ins vag brachytx device																																			
58346	Insert heyman uteri capsule																																			
61770	Incise skull for treatment																																			
61796	SRS cranial lesion simple																																			
61797	SRS cran les simple addl																																			
61798	SRS cranial lesion complex																																			
61799	SRS cran les complex addl																																			
61800	Apply SRS headframe add-on																																			
63620	SRS spinal lesion																																			
63621	SRS spinal lesion addl																																			
77261	Radiation therapy planning																																			
77262	Radiation therapy planning																																			
77263	Radiation therapy planning																																			
77280	Set radiation therapy field																																			
77285	Set radiation therapy field																																			
77290	Set radiation therapy field																																			
77295	Set radiation therapy field																																			
77299	Radiation therapy planning																																			
77300	Radiation therapy dose plan																																			
77301	Radiotherapy dose plan imrt																																			
77305	Teletx isodose plan simple																																			
77310	Teletx isodose plan intermed																																			
77315	Teletx isodose plan complex																																			
77321	Special teletx port plan																																			
77326	Brachytx isodose calc simp																																			
77327	Brachytx isodose calc interm																																			
77328	Brachytx isodose plan compl																																			
77331	Special radiation dosimetry																																			
77332	Radiation treatment aid(s)																																			
77333	Radiation treatment aid(s)																																			
77334	Radiation treatment aid(s)																																			
77336	Radiation physics consult																																			
77338	Design mlc device for imrt																																			
77370	Radiation physics consult																																			
77371	Srs multisource																																			
77372	Srs linear based																																			
77373	Sbrt delivery																																			
77399	External radiation dosimetry																																			
77401	Radiation treatment delivery																																			
77402	Radiation treatment delivery																																			
77403	Radiation treatment delivery																																			
77404	Radiation treatment delivery																																			
77406	Radiation treatment delivery																																			
77407	Radiation treatment delivery																																			
77408	Radiation treatment delivery																																			
77409	Radiation treatment delivery																																			
77411	Radiation treatment delivery																																			
77412	Radiation treatment delivery																																			
77413	Radiation treatment delivery																																			
77414	Radiation treatment delivery																																			
77416	Radiation treatment delivery																																			
77417	Radiology port film(s)																																			
77418	Radiation tx delivery imrt																																			
77421	Stereoscopic x-ray guidance																																			
77422	Neutron beam tx simple																																			
77423	Neutron beam tx complex																																			
77427	Radiation tx management x5																																			
77431	Radiation therapy management																																			
77432	Stereotactic radiation trmt																																			
77435	Sbrt management																																			
77470	Special radiation treatment																																			
77499	Radiation therapy management																																			
77520	Proton trmt simple w/o comp																																			
77522	Proton trmt simple w/comp																																			
77523	Proton trmt intermediate																																			
77525	Proton treatment complex																																			
77600	Hyperthermia treatment																																			
77605	Hyperthermia treatment																																			
77610	Hyperthermia treatment																																			
77615	Hyperthermia treatment																																			
77620	Hyperthermia treatment																																			
77750	Infuse radioactive materials																																			
77761	Apply intrcav radiat simple																																			
77762	Apply intrcav radiat interm																																			
77763	Apply intrcav radiat compl																																			
77776	Apply interstit radiat simpl																																			
77777	Apply interstit radiat inter																																			
77778	Apply interstit radiat compl																																			
77785	HDR brachytx 1 channel																																			
77786	HDR brachytx 2-12 channel																																			
77787	HDR brachytx over 12 chan																																			
77789	Apply surface radiation																																			
77790	Radiation handling																																			
77799	Radium/radioisotope therapy																																			
79005	Nuclear rx oral admin																																			
79101	Nuclear rx iv admin																																			
79200	Nuclear rx intracav admin																																			
79300	Nuclr rx interstit colloid																																			
79403	Hematopoietic nuclear tx																																			
79440	Nuclear rx intra-articular																																			
79445	Nuclear rx intra-arterial																																			
79999	Nuclear medicine therapy																																			
92974	Cath place cardio brachytx																																			
A4650	Implant radiation dosimeter																																			
A9517	I131 iodide cap, rx																																			
A9527	Iodine I-125 sodium iodide																																			
A9530	I131 iodide sol, rx																																			
A9543	Y90 ibritumomab, rx																																			
A9545	I131 tositumomab, rx																																			
A9563	P32 Na phosphate																																			
A9564	P32 chromic phosphate																																			
A9600	Sr89 strontium																																			
A9604	Sm 153 lexidronam																																			
A9699	Radiopharm rx agent noc																																			
C1716	Brachytx, non-str, Gold-198																																			
C1717	Brachytx, non-str,HDR Ir-192																																			
C1719	Brachytx, NS, Non-HDRIr-192																																			
C2616	Brachytx, non-str,Yttrium-90																																			
C2634	Brachytx, non-str, HA, I-125																																			
C2635	Brachytx, non-str, HA, P-103																																			
C2636	Brachy linear, non-str,P-103																																			
C2638	Brachytx, stranded, I-125																																			
C2639	Brachytx,non-stranded,I-125																																			
C2640	Brachytx, stranded, P-103																																			
C2641	Brachytx, non-stranded,P-103																																			
C2642	Brachytx, stranded, C-131																																			
C2643	Brachytx, non-stranded,C-131																																			
C2698	Brachytx, stranded, NOS																																			
C2699	Brachytx, non-stranded, NOS																																			
C9734	U/S trtmt, not leiomyomata																																			
G0173	Linear acc stereo radsur com																																			
G0251	Linear acc based stero radio																																			
G0339	Robot lin-radsurg com, first																																			
G0340	Robt lin-radsurg fractx 2-5																																			
Q3001	Brachytherapy Radioelements																																			
																																				
EPO AND OTHER DIALYSIS-RELATED DRUGS																																				
																																				
The physician self-referral prohibition does not apply to the following codes for dialysis-related drugs furnished in or by an ESRD facility if the conditions in §411.355(g) are satisfied:																																				
																																				
No codes reported at this time.																																				
																																				
PREVENTIVE SCREENING TESTS, IMMUNIZATIONS AND VACCINES																																				
																																				
The physician self-referral prohibition does not apply to the following tests if they are performed for screening purposes and satisfy the conditions in §411.355(h):																																				
																																				
77052	Comp screen mammogram add-on																																			
77057	Mammogram screening																																			
80061	Lipid panel [only when billed with one of the following ICD-9-CM codes:  V81.0, V81.1, or V81.2] 																																			
82270	Occult blood feces																																			
82465	Assay bld/serum cholesterol [only when billed with one of the following ICD-9-CM codes:  V81.0, V81.1, or V81.2] 																																			
82947	Assay glucose blood quant [only when billed with ICD-9-CM code V77.1]																																			
82950	Glucose test [only when billed with ICD-9-CM code V77.1]																																			
82951	Glucose tolerance test (GTT) [only when billed with ICD-9-CM code V77.1]																																			
83718	Assay of lipoprotein [only when billed with one of the following ICD-9-CM codes:  V81.0, V81.1, or V81.2] 																																			
84478	Assay of triglycerides [only when billed with one of the following ICD-9-CM codes:  V81.0, V81.1, or V81.2] 																																			
G0103	PSA screening																																			
G0106	Colon CA screen;barium enema																																			
G0118	Glaucoma scrn hgh risk direc																																			
G0120	Colon ca scrn; barium enema																																			
G0123	Screen cerv/vag thin layer																																			
G0124	Screen c/v thin layer by MD																																			
G0141	Scr c/v cyto,autosys and md																																			
G0143	Scr c/v cyto,thinlayer,rescr																																			
G0144	Scr c/v cyto,thinlayer,rescr																																			
G0145 	Scr c/v cyto,thinlayer,rescr																																			
G0147	Scr c/v cyto, automated sys																																			
G0148	Scr c/v cyto, autosys, rescr																																			
G0202	Screeningmammographydigital																																			
G0328	Fecal blood scrn immunoassay																																			
G0389	Ultrasound exam AAA screen																																			
P3000	Screen pap by tech w md supv																																			
P3001	Screening pap smear by phys																																			
																																				
The physician self-referral prohibition does not apply to the following immunization and vaccine codes if they satisfy the conditions in §411.355(h):																																				
																																				
90654	Flu vaccine no preserv, ID																																			
90655	Flu vaccine no preserv 6-35m																																			
90656	Flu vaccine no preserv 3 & >																																			
90657	Flu vaccine 3 yrs im																																			
90660	Flu vaccine nasal																																			
90661	Flu vacc cell cult prsv free																																			
90662	Flu vacc prsv free inc antig																																			
90669	Pneumococcal vacc 7 val im																																			
90670	Pneumococcal vacc 13 val im																																			
90672	Flu vaccine 4 valent nasal																																			
90673	Flu vacc RIV3 no preserv																																			
90685	Flu vac no prsv 4 val 6-35 m																																			
90686	Flu vac no prsv 4 val 3 yrs+																																			
90688	Flu vacc 4 val 3 yrs plus im  																																			
90732	Pneumococcal vaccine																																			
90740	Hepb vacc ill pat 3 dose im																																			
90743	Hep b vacc adol 2 dose im																																			
90744	Hepb vacc ped/adol 3 dose im																																			
90746	Hep b vaccine adult im																																			
90747	Hepb vacc ill pat 4 dose im																																			
G0432	EIA HIV-1/HIV-2 screen																																			
G0433	ELISA HIV-1/HIV-2 screen																																			
G0435	Oral HIV-1/HIV-2 screen																																			
Q2034	Agriflu vaccine																																			
Q2035	Afluria vacc, 3 yrs & >, im																																			
Q2036	Flulaval vacc, 3 yrs & >, im																																			
Q2037	Fluvirin vacc, 3 yrs & >, im																																			
Q2038	Fluzone vacc, 3 yrs & >, im																																			
Q2039	NOS flu vacc, 3 yrs & >, im																																			
																																				
1CPT codes and descriptions only are copyright 2013 American Medical Association.  All rights are reserved and applicable FARS/DFARS clauses apply.																																				
																																				
2This list does not include codes for the following designated health service (DHS) categories: durable medical equipment and supplies; parenteral and enteral nutrients, equipment and supplies; prosthetics, orthotics, and prosthetic devices and supplies; home health services; outpatient prescription drugs; and inpatient and outpatient hospital services.  For the definitions of these DHS categories, refer to §411.351.  For more information, refer to the CMS Web site at http://www.cms.gov/Medicare/Fraud-and-Abuse/PhysicianSelfReferral/List_of_Codes.html.																																				
