2015 facility scoring methodology for blue select · 2017. 6. 21. · 2015 facility scoring...

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2015 Facility Scoring Methodology for Blue Select

In keeping with its goal of providing members with high-quality, lower-cost health care, Blue Cross Blue Shield of North Carolina (BCBSNC) developed the following methodology to best evaluate the quality and efficiency of partner facilities. Based on evaluation results, BCBSNC will designate in-network facilities as Tier 1 or Tier 2 for its 2015 Blue Select plan. This document describes the methodology used by BCBSNC for the Tiered Network product (Blue Select) for 2015 and is provided for informational purposes only. Physician designation ratings are a guide to choosing a physician, practice or medical group. Because ratings have a risk of error, they should not be the sole basis for selecting a doctor. Patients should confer with their physician before making a decision.

Designation Overview Tier designation is made at the facility level and only includes In-network Facilities contracted with BCBSNC. In-network Facilities are designated as Tier 1 or Tier 2. BCBSNC will base its Tier 1 designation on quality and efficiency. To be designated as Tier 1, a Facility must first meet the quality criteria. Facilities that are unable to meet the quality criteria (described below) for the network are automatically designated with a Tier 2 status. Facilities that potentially qualify for Tier 1 based on their quality evaluation will then be evaluated against BCBSNC’s efficiency criteria (described below) to determine if the Facility meets the standards for Tier 1 status. Facilities that meet both the quality and efficiency standards are designated with a Tier 1 status. Facilities that meet the quality standard, but do not attain the efficiency standard, are designated with a Tier 2 status (with exceptions for Critical Access facilities as defined by CMS).

Tiered Network Product Quality Thresholds for Facilities For facilities, BCBSNC has introduced a methodology that utilizes Hospital Compare, a database administered by the Centers for Medicare and Medicaid Services (CMS). Leveraging data downloaded on March 13, 2014 from the CMS website (http://medicare.gov/hospitalcompare/), each facility was examined for their quality performance on twelve measures, listed below, as reported in the database.

Measure Reporting Period

1 Hospital 30-day mortality rate for heart attack. 7/1/09 – 6/30/12

2 Hospital 30-day readmission rate for heart attack. 7/1/09 – 6/30/12

3 Hospital 30-day mortality rate for heart failure. 7/1/09 – 6/30/12

4 Hospital 30-day readmission rate for heart failure. 7/1/09 – 6/30/12

5 Hospital 30-day mortality rate for pneumonia. 7/1/09 – 6/30/12

6 Hospital 30-day readmission rate for pneumonia. 7/1/09 – 6/30/12

7 Heart failure patients given discharge instructions. 4/1/12 – 3/31/13

8 Heart attack patients given PCI within 90 minutes of arrival. 4/1/12 – 3/31/13

9 Heart attack patients given a prescription for a statin at discharge. 4/1/12 – 3/31/13

http://medicare.gov/hospitalcompare/

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Measure Reporting Period

10 Pneumonia patients whose initial emergency room blood culture was performed prior to the administration of the first hospital dose of antibiotics.

4/1/12 – 3/31/13

11 Pneumonia patients given the most appropriate initial antibiotic(s). 4/1/12 – 3/31/13

12 Weighted measure representing HCAHPS question "How do patients rate the hospital, overall?" Response scale 1 (poor) to 10 (excellent). Weighted score calculated by summing the products of (1*Percent rating 6 or lower), (2*Percent rating 7 or 8), and (3*Percent rating 9 or 10). Resulting score falls between 100 and 300, higher value is better.

4/1/12 – 3/31/13

Facilities were awarded one point for each measure on which they reported data and performed above the 25th percentile. Percentile distributions were calculated using data for all BCBSNC-contracted, non-government acute care facilities in North Carolina, plus two in Virginia that are considered eligible for the Tiered product. Each facility’s earned points were summed and divided by the number of potential points; if data were not reported for a measure due to low volume, the earned and potential points were both reduced accordingly. Final scores ranged from 0 to 100% and represent the percent of measures for which the facility meets the minimum quality standard. Facilities were required to score at or above 67% across measures to be deemed quality eligible allowing them to be assessed on efficiency criteria to determine tier designation; those scoring below 67% were automatically designated Tier 2 and were not given the opportunity to bid into Tier 1. Please note that BCBSNC will examine quality scores on an annual basis to determine if a facility’s tier designation should be reclassified based on updated quality information. Tiered Network Product Efficiency Threshold for Facilities With the quality standards in place, BCBSNC then analyzed claims to stratify facilities on the basis of efficiency performance. The objective of this analysis was to identify “automatic” Tier 1 (no proposal required) and proposal-eligible Tier 2 Facilities. Facilities were assigned to categories based on bed size, total volume, transfers and the provision of certain types of services including burns, trauma, transplants, maternity, hip and knee arthroplasty, spine surgery, oncology, complex cardiology, and complex neurology. Bed size was obtained from the NC Division of Health Services Regulation and service volume was determined from claims for calendar year 2013. Peer cohorts were established using Cohort Analysis, which identifies patterns of similarity in the selected characteristics and then classifies Facilities into groups, called “Peer Cohorts” here forward.

Cohort Variable Defined as DRGs/MDCs defining service line

Hospital Beds Total hospital beds (Source: NC Division of Health Services Regulation, downloaded 1/30/2013 from www.ncdhhs.gov/dhsr/reports.htm)

N/A

Total Volume Total volume All

Transfer Dichotomous indicator if volume of cases as a result of a transfer from another facility designated by discharge status => 10

All

Maternity Volume of maternity cases / total volume MDC 14

Hip & Knee Arthroplasty

Volume of hip and knee arthroplasty cases/total volume

DRGs 209, 558, 471, 789, 818, 558, 471, 817

Spine Surgery Dichotomous indicator if volume of spinal surgery cases => 10

DRGs 756, 755, 558, 807, 884, 806, 865, 864

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Cohort Variable Defined as DRGs/MDCs defining service line

Oncology Dichotomous indicator if volume of oncology cases >= 10

MDC 17, DRGs 010, 011, 146, 147, 172, 173, 203, 257, 258, 259, 260, 274, 303, 306, 307, 318, 319, 336, 337, 338, 346, 354, 355, 357, 363, 366, 367

Complex Cardiology

Dichotomous indicator if volume of complex cardiology cases >= 10

DRGs 104, 105, 106, 107, 108, 109, 115, 545, 546, 547, 548, 549, 850, 851, 852

Complex Neurology

Dichotomous indicator if volume of craniotomy cases >= 10

DRGs 001, 002, 530, 738, 739, 879

Burns or Trauma Dichotomous indicator if total volume of trauma or burns => 10

Burns=MDC 22; Trauma=MDC 25

Transplants Dichotomous indicator if total volume of transplants => 10

DRGs 103, 302, 480, 795, 803, 804, 805

Next, two metrics of efficiency performance were constructed based on inpatient and outpatient claims for Facilities within each Peer Cohort. Data preparation and analytical approaches for the evaluation are described below.

Inpatient Costs Analyses were conducted on inpatient case data for services performed between January 2013 – December 2013.

Includes Inpatient allowed facility costs only (i.e. no professional or ancillary costs)

Lines of business: Blue Options (Group Underwritten, ASO, State Health Plan, CDHP), Blue Advantage (Individual, CDHP), Blue Select, Blue Value.

Excludes denials, Medicare crossovers, COB, and State Health Plan retirees.

To reduce the effect of outliers, allowed costs were truncated at the 95th percentile by AP-DRG. Analysis is limited to those AP-DRGs performed at least 30 times at a minimum of two facilities statewide.

Two inpatient cost metrics were computed for “facility specific allowed costs” and the “average costs”. o Average costs were calculated for each AP-DRG within a Peer Cohort if there were at least 30 cases in a

minimum of 2 facilities; if there was insufficient volume within a Peer Cohort, the costs reflect the average cost for Facilities statewide.

o Your facility specific allowed costs and the average costs were summed separately for all cases with sufficient AP-DRG / CPT volume.

Both Inpatient and Outpatient costs were forward-adjusted to reflect each facility’s new fee schedule increases for the next calendar year once the final summary amounts were tabulated.

All DRGs were evaluated. If DRGs are missing, there was not enough volume to be evaluated. In the following table, "Cohort" refers to the DRG analysis within the cohort only. "Statewide" refers to the DRG analysis done statewide due to the low volume.

AP DRG Code Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

001 CRANIOTOMY AGE >17 W CC statewide statewide cohort statewide

002 CRANIOTOMY AGE >17 W/O CC cohort cohort cohort

010 NERVOUS SYSTEM NEOPLASMS W CC statewide statewide statewide cohort statewide

011 NERVOUS SYSTEM NEOPLASMS W/O CC statewide statewide statewide

012 DEGENERATIVE NERVOUS SYSTEM DISORDERS statewide statewide statewide statewide statewide

013 MULTIPLE SCLEROSIS & CEREBELLAR ATAXIA statewide statewide statewide statewide cohort

014 STROKE W INFARCT statewide cohort cohort cohort cohort

018 CRANIAL & PERIPHERAL NERVE DISORDERS W CC statewide statewide statewide statewide statewide

020 NERVOUS SYSTEM INFECTION EXCEPT VIRAL statewide statewide statewide statewide statewide

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MENINGITIS

021 VIRAL MENINGITIS statewide statewide statewide statewide cohort

024 SEIZURE & HEADACHE AGE >17 W CC statewide statewide statewide cohort cohort

025 SEIZURE & HEADACHE AGE >17 W/O CC statewide cohort statewide cohort cohort

034 OTHER DISORDERS OF NERVOUS SYSTEM W CC statewide statewide statewide statewide statewide

035 OTHER DISORDERS OF NERVOUS SYSTEM W/O CC statewide statewide statewide statewide statewide

063 OTHER EAR, NOSE, MOUTH & THROAT O.R. PROCEDURES statewide statewide cohort statewide

065 DYSEQUILIBRIUM statewide statewide statewide statewide statewide

068 OTITIS MEDIA & URI AGE >17 W CC statewide statewide statewide statewide statewide

069 OTITIS MEDIA & URI AGE >17 W/O CC statewide statewide statewide statewide statewide

070 OTITIS MEDIA & URI AGE <18 statewide statewide statewide statewide statewide

073 OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES AGE >17 statewide statewide statewide statewide statewide

075 MAJOR CHEST PROCEDURES statewide statewide cohort cohort cohort

076 OTHER RESP SYSTEM O.R. PROCEDURES W CC statewide statewide statewide statewide statewide

078 PULMONARY EMBOLISM statewide cohort cohort cohort cohort

079 RESPIRATORY INFECTIONS & INFLAMMATIONS EXC SIMPLE PNEUMONIA AGE >17 W CC statewide statewide statewide statewide statewide

082 RESPIRATORY NEOPLASMS statewide statewide statewide statewide cohort

087 PULMONARY EDEMA & RESPIRATORY FAILURE statewide cohort statewide statewide cohort

088 CHRONIC OBSTRUCTIVE PULMONARY DISEASE statewide cohort cohort statewide cohort

089 SIMPLE PNEUMONIA & PLEURISY AGE >17 W CC statewide cohort cohort cohort cohort

090 SIMPLE PNEUMONIA & PLEURISY AGE >17 W/O CC statewide cohort statewide statewide cohort

094 PNEUMOTHORAX W CC statewide statewide statewide statewide

095 PNEUMOTHORAX W/O CC statewide statewide statewide statewide

096 BRONCHITIS & ASTHMA AGE >17 W CC statewide cohort statewide statewide cohort

097 BRONCHITIS & ASTHMA AGE >17 W/O CC statewide cohort statewide statewide statewide

101 OTHER RESPIRATORY SYSTEM DIAGNOSES W CC statewide statewide statewide statewide statewide

105 CARDIAC VALVE & OTHER MAJOR CARDIOTHORACIC PROC W/O CARDIAC CATH statewide cohort cohort

107 CORONARY BYPASS W/O PTCA W CARDIAC CATH statewide cohort statewide cohort

108 OTHER CARDIOTHORACIC PROC W/O PDX CONGENITAL ANOMALY statewide statewide statewide

109 CORONARY BYPASS W/O PTCA W/O CARDIAC CATH statewide statewide cohort cohort

110 MAJOR CARDIOVASCULAR PROCEDURES W CC statewide statewide cohort cohort

111 MAJOR CARDIOVASCULAR PROCEDURES W/O CC statewide statewide statewide

112 PERCUTANEOUS CARDIOVASCULAR PROC W/O AMI,HEART FAILURE OR SHOCK statewide statewide cohort cohort

116 OTHER PERMANENT CARDIAC PACEMAKER IMPLANT statewide statewide statewide statewide statewide

121 CIRCULATORY DISORDERS W AMI & MAJOR COMP, DISCHARGED ALIVE statewide cohort statewide statewide cohort

122 CIRCULATORY DISORDERS W AMI W/O MAJOR COMP, DISCHARGED ALIVE statewide cohort cohort cohort cohort

124 CIRCULATORY DISORD EXCEPT AMI, W CARD CATH & COMPLEX DIAG statewide statewide cohort cohort cohort

125 CIRCULATORY DISORD EXCEPT AMI, W CARD CATH W/O COMPLEX DIAG statewide cohort cohort cohort

127 HEART FAILURE & SHOCK statewide cohort cohort cohort cohort

130 PERIPHERAL VASCULAR DISORDERS W CC statewide statewide statewide statewide cohort

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

131 PERIPHERAL VASCULAR DISORDERS W/O CC statewide statewide statewide statewide statewide

134 HYPERTENSION statewide cohort cohort statewide cohort

138 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC statewide cohort cohort cohort cohort

139 CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC statewide cohort cohort cohort cohort

140 ANGINA PECTORIS statewide statewide statewide statewide statewide

141 SYNCOPE & COLLAPSE W CC statewide statewide statewide statewide statewide

142 SYNCOPE & COLLAPSE W/O CC statewide statewide statewide statewide statewide

143 CHEST PAIN statewide cohort statewide statewide cohort

144 OTHER CIRCULATORY SYSTEM DIAGNOSES W CC statewide statewide statewide statewide statewide statewide

145 OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC statewide statewide statewide statewide

146 RECTAL RESECTION W CC statewide statewide statewide statewide statewide

147 RECTAL RESECTION W/O CC statewide statewide statewide statewide statewide

148 MAJOR SMALL & LARGE BOWEL PROCEDURES W CC statewide cohort cohort cohort cohort

149 MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC statewide cohort cohort cohort cohort statewide

150 PERITONEAL ADHESIOLYSIS W CC statewide statewide statewide statewide cohort

151 PERITONEAL ADHESIOLYSIS W/O CC statewide cohort statewide statewide cohort

152 MINOR SMALL & LARGE BOWEL PROCEDURES W CC statewide statewide statewide statewide statewide

153 MINOR SMALL & LARGE BOWEL PROCEDURES W/O CC statewide statewide statewide cohort statewide

154 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W CC statewide statewide statewide statewide cohort

155 STOMACH, ESOPHAGEAL & DUODENAL PROCEDURES AGE >17 W/O CC statewide statewide statewide cohort cohort

157 ANAL & STOMAL PROCEDURES W CC statewide statewide statewide statewide

158 ANAL & STOMAL PROCEDURES W/O CC statewide statewide statewide statewide statewide

159 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W CC statewide statewide statewide statewide statewide statewide

160 HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL AGE >17 W/O CC statewide statewide statewide cohort cohort

165 APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC statewide statewide statewide statewide

167 APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC statewide statewide statewide statewide statewide

170 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC statewide statewide statewide statewide

171 OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W/O CC statewide statewide statewide statewide

172 DIGESTIVE MALIGNANCY W CC statewide statewide statewide statewide statewide

174 G.I. HEMORRHAGE W CC statewide cohort cohort cohort cohort

175 G.I. HEMORRHAGE W/O CC statewide cohort cohort cohort cohort

176 COMPLICATED PEPTIC ULCER statewide statewide statewide statewide statewide

179 INFLAMMATORY BOWEL DISEASE statewide cohort statewide cohort cohort

180 G.I. OBSTRUCTION W CC statewide cohort statewide cohort cohort

181 G.I. OBSTRUCTION W/O CC statewide cohort cohort cohort cohort

182 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORD AGE >17 W CC statewide cohort cohort cohort cohort statewide

183 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORD AGE >17 W/O CC statewide cohort cohort cohort cohort statewide

188 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W CC statewide cohort cohort cohort cohort

189 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC statewide statewide statewide statewide cohort

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

191 PANCREAS, LIVER & SHUNT PROCEDURES W CC statewide cohort statewide

192 PANCREAS, LIVER & SHUNT PROCEDURES W/O CC statewide statewide statewide

198 CHOLECYSTECTOMY W/O C.D.E. W/O CC statewide statewide statewide statewide statewide

202 CIRRHOSIS & ALCOHOLIC HEPATITIS statewide statewide statewide statewide statewide

203 MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS statewide statewide statewide statewide

204 DISORDERS OF PANCREAS EXCEPT MALIGNANCY statewide cohort cohort cohort cohort

205 DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC statewide statewide statewide cohort statewide

207 DISORDERS OF THE BILIARY TRACT W CC statewide statewide statewide statewide statewide statewide

208 DISORDERS OF THE BILIARY TRACT W/O CC statewide statewide statewide statewide statewide

209 MAJ JOINT & LIMB REATTACH PROC OF LOW EXT, EXC HIP, EXC FOR COMP cohort cohort cohort cohort cohort cohort

210 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W CC statewide statewide statewide statewide statewide

211 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE >17 W/O CC statewide statewide statewide cohort cohort statewide

212 HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT AGE <18 statewide statewide cohort statewide

218 LOWER EXTREM & HUMER PROC EXC HIP,FOOT,FEMUR AGE >17 W CC statewide statewide statewide cohort cohort statewide

219 LOWER EXTREM & HUMER PROC EXC HIP,FOOT,FEMUR AGE >17 W/O CC statewide cohort cohort cohort cohort statewide

220 LOWER EXTREM & HUMER PROC EXC HIP,FOOT,FEMUR AGE <18 statewide statewide statewide statewide statewide

224 SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC, W/O CC statewide statewide statewide statewide

225 FOOT PROCEDURES statewide statewide statewide statewide statewide

226 SOFT TISSUE PROCEDURES W CC statewide statewide statewide statewide statewide statewide

227 SOFT TISSUE PROCEDURES W/O CC statewide statewide statewide statewide statewide

234 OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC statewide cohort statewide statewide

239 PATHOLOGICAL FRACTURES & MUSCSKELET & CONN TISS MALIGNANCY statewide statewide statewide statewide statewide

240 CONNECTIVE TISSUE DISORDERS W CC statewide statewide statewide statewide statewide statewide

243 MEDICAL BACK PROBLEMS statewide statewide statewide cohort cohort

247 SIGNS & SYMPTOMS OF MUSCULOSKELETAL SYSTEM & CONN TISSUE statewide statewide statewide statewide statewide

248 TENDONITIS, MYOSITIS & BURSITIS statewide statewide statewide statewide statewide

257 TOTAL MASTECTOMY FOR MALIGNANCY W CC statewide statewide statewide statewide statewide

258 TOTAL MASTECTOMY FOR MALIGNANCY W/O CC statewide statewide statewide cohort cohort

261 BREAST PROC FOR NON-MALIGNANCY EXCEPT BIOPSY & LOCAL EXCISION statewide statewide statewide statewide

269 OTHER SKIN, SUBCUT TISS & BREAST PROC W CC statewide statewide statewide statewide statewide

270 OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC statewide statewide statewide statewide statewide

276 NON-MALIGNANT BREAST DISORDERS statewide statewide statewide statewide statewide

277 CELLULITIS AGE >17 W CC statewide cohort cohort cohort cohort

278 CELLULITIS AGE >17 W/O CC statewide cohort cohort cohort cohort statewide 279 CELLULITIS AGE <18 statewide statewide statewide statewide cohort statewide

285 AMPUTAT OF LOW LIMB FOR ENDOCRINE,NUTRIT,& METABOL DISORDERS statewide statewide statewide statewide statewide

286 ADRENAL & PITUITARY PROCEDURES statewide cohort statewide

288 GASTRIC PROCEDURES FOR OBESITY cohort cohort cohort cohort cohort

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

290 THYROID PROCEDURES statewide statewide cohort statewide statewide

294 DIABETES AGE >35 statewide cohort cohort cohort cohort

295 DIABETES AGE <36 statewide cohort cohort cohort cohort

296 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W CC statewide cohort cohort cohort cohort

297 NUTRITIONAL & MISC METABOLIC DISORDERS AGE >17 W/O CC statewide statewide statewide statewide cohort statewide

298 NUTRITIONAL & MISC METABOLIC DISORDERS AGE <18 statewide statewide statewide cohort cohort

300 ENDOCRINE DISORDERS W CC statewide statewide statewide statewide statewide

301 ENDOCRINE DISORDERS W/O CC statewide statewide statewide statewide

302 KIDNEY TRANSPLANT statewide

303 KIDNEY,URETER & MAJ BLADDER PROC FOR NEOPLASM statewide statewide statewide cohort cohort

304 KIDNEY,URETER & MAJ BLADDER PROC FOR NON-NEOPLASM W CC statewide statewide statewide statewide

305 KIDNEY,URETER & MAJ BLADDER PROC FOR NON-NEOPLASM W/O CC statewide statewide statewide cohort statewide

310 TRANSURETHRAL PROCEDURES W CC statewide statewide statewide statewide statewide

311 TRANSURETHRAL PROCEDURES W/O CC statewide statewide statewide statewide statewide

315 OTHER KIDNEY & URINARY TRACT PROCEDURES statewide statewide statewide statewide

316 RENAL FAILURE statewide cohort cohort cohort cohort statewide

320 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W CC statewide cohort statewide statewide cohort

321 KIDNEY & URINARY TRACT INFECTIONS AGE >17 W/O CC statewide statewide statewide statewide cohort

322 KIDNEY & URINARY TRACT INFECTIONS AGE <18 statewide statewide statewide statewide statewide

323 URINARY STONES W CC, &/OR ESW LITHOTRIPSY statewide statewide statewide statewide cohort

324 URINARY STONES W/O CC statewide statewide statewide statewide

331 OTHER KIDNEY & URINARY TRACT DIAGNOSES AGE >17 W CC statewide statewide statewide statewide statewide

334 MAJOR MALE PELVIC PROCEDURES W CC statewide statewide statewide statewide

335 MAJOR MALE PELVIC PROCEDURES W/O CC statewide statewide cohort cohort cohort

350 INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM statewide statewide statewide statewide statewide

357 UTERINE & ADNEXA PROC FOR OVARIAN OR ADNEXAL MALIGNANCY statewide statewide statewide statewide statewide

358 UTERINE & ADNEXA PROC FOR CA IN SITU & NON-MALIGNANCY W CC statewide cohort statewide cohort cohort

359 UTERINE & ADNEXA PROC FOR CA IN SITU & NON-MALIGNANCY W/O CC statewide cohort cohort cohort cohort

361 LAPAROSCOPY OR INCISIONAL TUBAL INTERRUPTION statewide statewide statewide statewide statewide

368 INFECTIONS, FEMALE REPRODUCTIVE SYSTEM statewide statewide statewide statewide statewide

369 MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS statewide statewide statewide statewide

370 CESAREAN SECTION W CC statewide cohort cohort cohort cohort

371 CESAREAN SECTION W/O CC statewide cohort cohort cohort cohort

372 VAGINAL DELIVERY W COMPLICATING DIAGNOSES statewide cohort cohort cohort cohort

373 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES statewide cohort cohort cohort cohort

374 VAGINAL DELIVERY W STERILIZATION &/OR D&C cohort cohort statewide cohort

375 VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C statewide statewide statewide statewide

376 POSTPARTUM & POST ABORTION DIAGNOSES cohort statewide cohort cohort

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

W/O O.R. PROCEDURE

377 POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE statewide statewide statewide statewide

378 ECTOPIC PREGNANCY statewide statewide statewide statewide statewide

379 THREATENED ABORTION statewide statewide cohort cohort

380 ABORTION W/O D&C statewide statewide statewide statewide

395 RED BLOOD CELL DISORDERS AGE >17 statewide cohort cohort cohort cohort

397 COAGULATION DISORDERS statewide statewide statewide cohort statewide

398 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC statewide statewide statewide cohort cohort

399 RETICULOENDOTHELIAL & IMMUNITY DISORDERS W/O CC statewide statewide statewide statewide statewide

403 LYMPHOMA & NON-ACUTE LEUKEMIA W CC statewide statewide statewide statewide

410 CHEMOTHERAPY statewide statewide cohort cohort

415 O.R. PROCEDURE FOR INFECTIOUS & PARASITIC DISEASES statewide statewide statewide cohort cohort statewide

416 SEPTICEMIA AGE >17 statewide cohort cohort cohort cohort

418 POSTOPERATIVE & POST-TRAUMATIC INFECTIONS statewide statewide statewide cohort cohort

419 FEVER OF UNKNOWN ORIGIN AGE >17 W CC statewide statewide statewide statewide statewide

420 FEVER OF UNKNOWN ORIGIN AGE >17 W/O CC statewide statewide statewide statewide

421 VIRAL ILLNESS AGE >17 statewide statewide statewide statewide statewide

422 VIRAL ILLNESS & FEVER OF UNKNOWN ORIGIN AGE <18 statewide statewide cohort statewide

423 OTHER INFECTIOUS & PARASITIC DISEASES DIAGNOSES statewide statewide statewide statewide statewide

425 ACUTE ADJUSTMENT REACTION & PSYCHOSOCIAL DYSFUNCTION statewide statewide statewide cohort cohort

426 DEPRESSIVE NEUROSES statewide cohort cohort cohort cohort

427 NEUROSES EXCEPT DEPRESSIVE statewide statewide statewide statewide statewide

430 PSYCHOSES cohort cohort cohort cohort cohort

442 OTHER O.R. PROCEDURES FOR INJURIES W CC statewide statewide statewide statewide statewide

443 OTHER O.R. PROCEDURES FOR INJURIES W/O CC statewide statewide statewide cohort cohort statewide

447 ALLERGIC REACTIONS AGE >17 statewide statewide statewide statewide statewide

449 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W CC statewide cohort statewide cohort cohort

450 POISONING & TOXIC EFFECTS OF DRUGS AGE >17 W/O CC statewide cohort cohort statewide statewide

451 POISONING & TOXIC EFFECTS OF DRUGS AGE <18 statewide statewide statewide cohort

452 COMPLICATIONS OF TREATMENT W CC statewide statewide statewide cohort statewide

453 COMPLICATIONS OF TREATMENT W/O CC statewide statewide statewide statewide statewide

461 O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES statewide statewide statewide statewide statewide

462 REHABILITATION statewide cohort statewide statewide cohort

463 SIGNS & SYMPTOMS W CC statewide statewide statewide cohort cohort

464 SIGNS & SYMPTOMS W/O CC statewide statewide statewide statewide

468 EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS statewide statewide cohort cohort cohort statewide

469 PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS statewide cohort cohort statewide cohort

470 UNGROUPABLE

471 BILATERAL OR MULTIPLE MAJOR JOINT PROCS OF LOWER EXTREMITY statewide statewide statewide statewide cohort statewide

477 NON-EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS statewide statewide statewide statewide cohort

478 OTHER VASCULAR PROCEDURES W CC statewide statewide statewide statewide statewide

9


Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

479 OTHER VASCULAR PROCEDURES W/O CC statewide statewide statewide

482 TRACHEOSTOMY FOR FACE,MOUTH & NECK DIAGNOSES statewide statewide

491 MAJOR JOINT & LIMB REATTACHMENT PROCEDURES OF UPPER EXTREMITY statewide statewide statewide cohort cohort statewide

493 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC statewide cohort cohort statewide cohort

494 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC statewide cohort cohort cohort cohort

530 CRANIOTOMY W MAJOR CC statewide cohort statewide

531 NERVOUS SYSTEM PROCEDURES EXCEPT CRANIOTOMY W MAJOR CC statewide statewide statewide statewide statewide

532 TIA, PRECEREBRAL OCCLUSIONS, SEIZURE & HEADACHE W MAJOR CC statewide statewide cohort cohort

533 OTHER NERVOUS SYSTEM DISORD EXCEPT TIA, SEIZURE & HEADACHE W MAJOR CC statewide cohort cohort cohort cohort

538 MAJOR CHEST PROCEDURES W MAJOR CC statewide statewide statewide cohort cohort

539 RESPIRATORY PROCEDURES EXCEPT MAJOR CHEST W MAJOR CC statewide statewide statewide statewide statewide

540 RESPIRATORY INFECTIONS & INFLAMMATIONS EXC SIMPLE PNEUMONIA W MAJOR CC statewide statewide statewide statewide statewide

541

SIMPLE PNEUMONIA & OTH RESPIRATORY DISORD EXC BRONCHITIS, ASTHMA W MAJOR CC cohort cohort cohort cohort cohort

543 CIRC DISORDERS EXCEPT AMI, ENDOCARDITIS, CHF & ARRHYTHMIA W MAJOR CC statewide cohort cohort cohort cohort

544 CHF & CARDIAC ARRHYTHMIA W MAJOR CC statewide cohort cohort cohort cohort

545 CARDIAC VALVE PROCEDURE W MAJOR CC statewide cohort cohort

546 CORONARY BYPASS W MAJOR CC statewide statewide cohort cohort

547 OTHER CARDIOTHORACIC PROCEDURES W MAJOR CC statewide statewide

549 MAJOR CARDIOVASCULAR PROCEDURES W MAJOR CC statewide statewide statewide cohort cohort

550 OTHER VASCULAR PROCEDURES W MAJOR CC statewide statewide cohort cohort cohort

551 ESOPHAGITIS, GASTROENTERITIS & UNCOMPLICATED ULCERS W MAJOR CC statewide cohort cohort cohort cohort

552

DIGEST SYST DISORD EXCEPT ESOPH,GASTROENT & UNCOMPL ULCERS W MAJOR CC statewide cohort cohort cohort cohort

553 DIGEST SYST PROC EXC HERNIA & MAJOR STOMACH OR BOWEL PROC W MAJOR CC statewide statewide statewide cohort cohort

555 PANCREAS,LIVER & OTH BIL TRACT PROC EXCEPT LIVER TRANSPLNT W MAJOR CC statewide statewide

556 CHOLECYSTECTOMY AND OTHER HEPATOBILIARY PROCEDURES W MAJOR CC statewide statewide statewide statewide statewide

557 HEPATOBILIARY AND PANCREAS DISORDERS W MAJOR CC statewide cohort cohort cohort cohort

558 MAJOR MUSCULOSKELETAL PROCEDURES W MAJOR CC statewide statewide cohort cohort cohort statewide

559 NON-MAJOR MUSCULOSKELETAL PROCEDURES W MAJOR CC statewide statewide statewide cohort cohort

560 MUSCULOSKEL DISORD EXC OSTEO,SEPTIC ARTH & CONN TISSUE DIS W MAJOR CC statewide statewide statewide cohort statewide

561 OSTEOMYELITIS, SEPTIC ARTHRITIS & CONN TISSUE DISORDER W MAJOR CC statewide statewide statewide cohort statewide

563 OTHER SKIN DISORDERS W MAJOR CC statewide statewide statewide statewide cohort

564 SKIN & BREAST PROCEDURES W MAJOR CC statewide statewide statewide statewide statewide

565 ENDOCRINE, NUTRIT & METAB PROC EXCEPT LOWER LIMB AMPUTAT W MAJOR CC statewide statewide statewide statewide statewide

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Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

566 ENDOCRINE, NUTRIT & METAB DISORD EXC EATING DISORDER OR CF W MAJOR CC statewide cohort cohort cohort cohort

567 KIDNEY & URINARY TRACT PROCEDURES EXCEPT KIDNEY TRANSPLANT W MAJOR CC statewide statewide statewide cohort statewide

568 RENAL FAILURE W MAJOR CC statewide cohort cohort cohort cohort

569 KIDNEY & URINARY TRACT DISORDERS EXCEPT RENAL FAILURE W MAJOR CC statewide cohort cohort cohort cohort

573 NON-RADICAL FEMALE REPRODUCTIVE PROCEDURES W MAJOR CC statewide statewide statewide statewide

574 BLOOD, BLOOD FORMING ORGANS & IMMUNOLOGICAL DISORDERS W MAJOR CC statewide statewide statewide cohort cohort

576 ACUTE LEUKEMIA W MAJOR CC statewide statewide statewide

577 MYELOPROLIF DISORDERS & POORLY DIFFERENTIATED NEOPLASMS W MAJOR CC statewide statewide statewide cohort statewide

580 SYSTEMIC INFECTIONS & PARASITIC DISORD EXCEPT SEPTICEMIA W MAJOR CC statewide statewide statewide cohort cohort

581 SYSTEMIC INFECTIONS & PARASITIC DISORDER PROCEDURES W MAJOR CC statewide cohort cohort cohort cohort

582 INJURIES, POISONINGS & TOXIC EFFECTS OF DRUGS EXC MULTIPLE TRAUMA W MAJOR CC statewide cohort cohort cohort cohort

583 PROCEDURES FOR INJURIES EXCEPT MULTIPLE TRAUMA W MAJOR CC statewide statewide statewide statewide statewide

584 SEPTICEMIA W MAJOR CC statewide cohort cohort cohort cohort

585

MAJOR STOMACH,ESOPHAGEAL,DUODENAL,SMALL & LARGE BOWEL PROC W MAJOR CC statewide cohort cohort cohort cohort

586 ENT & MOUTH DISORDERS AGE >17 W MAJOR CC statewide statewide statewide statewide statewide

588 BRONCHITIS & ASTHMA AGE >17 W MAJOR CC statewide statewide statewide statewide statewide

607 NEONATE, BIRTHWT 1000-1499G, W/O SIGNIF O.R. PROC, DISCHARGED ALIVE statewide statewide cohort cohort

611 NEONATE, BWT 1500-1999G, W/O SIGN O.R. PROC,W MULT MAJ PROB OR MV 96+ HRS statewide statewide statewide statewide

612 NEONATE, BIRTHWT 1500-1999G, W/O SIGNIF O.R. PROC, W MAJOR PROB statewide statewide statewide cohort

613 NEONATE, BIRTHWT 1500-1999G, W/O SIGNIF O.R. PROC, W MINOR PROB statewide statewide statewide statewide

614 NEONATE, BIRTHWT 1500-1999G, W/O SIGNIF O.R. PROC, W OTHER PROB statewide statewide statewide cohort

618 NEONATE, BIRTHWT 2000-2499G, W/O SIGNIF O.R. PROC, W MAJOR PROB statewide statewide statewide cohort

619 NEONATE, BIRTHWT 2000-2499G, W/O SIGNIF O.R. PROC, W MINOR PROB statewide statewide statewide statewide

620 NEONATE, BWT 2000-2499G, W/O SIGNIF O.R. PROC, W NORM NEWBORN DIAG statewide cohort statewide cohort cohort

621 NEONATE, BIRTHWT 2000-2499G, W/O SIGNIF O.R. PROC, W OTHER PROB statewide statewide statewide cohort

626 NEONATE, BWT >2499G, W/O SIGN O.R. PROC,W MULT MAJ PROB OR MV 96+ HRS statewide statewide cohort cohort

627 NEONATE, BIRTHWT >2499G, W/O SIGNIF O.R. PROC, W MAJOR PROB cohort cohort cohort cohort

628 NEONATE, BIRTHWT >2499G, W/O SIGNIF O.R. PROC, W MINOR PROB cohort cohort cohort cohort

629 NEONATE, BWT >2499G, W/O SIGNIF O.R. PROC, W NORMAL NEWBORN DIAG statewide cohort cohort cohort cohort

630 NEONATE, BIRTHWT >2499G, W/O SIGNIF O.R. PROC, W OTHER PROB cohort cohort statewide cohort

639 NEONATE, TRANSFERRED <5 DAYS OLD, BORN HERE cohort statewide statewide cohort

650 HIGH RISK CESAREAN SECTION W CC cohort cohort cohort cohort

11


Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

651 HIGH RISK CESAREAN SECTION W/O CC cohort cohort cohort cohort

652 HIGH RISK VAGINAL DELIVERY W STERILIZATION AND/OR D&C statewide statewide statewide cohort

714 HIV W SIGNIFICANT RELATED DIAGNOSIS statewide statewide statewide statewide

731 SPINE, HIP, FEMUR OR LIMB PROC FOR MULTIPLE SIGNIFICANT TRAUMA statewide statewide

732 OTHER O.R. PROCEDURE FOR MULTIPLE SIGNIFICANT TRAUMA statewide cohort statewide

733 HEAD, CHEST AND LOWER LIMB DIAGNOSES OF MULTIPLE SIGNIFICANT TRAUMA statewide statewide statewide statewide

739 CRANIOTOMY AGE <18 W/O CC cohort statewide

740 CYSTIC FIBROSIS statewide statewide cohort statewide

744 OPIOID ABUSE OR DEPENDENCE W CC statewide statewide statewide statewide statewide

745 OPIOID ABUSE OR DEPENDENCE W/O CC statewide cohort cohort statewide cohort

748 COCAINE OR OTHER DRUG ABUSE OR DEPENDENCE W/O CC statewide statewide statewide statewide statewide

750 ALCOHOL ABUSE OR DEPENDENCE, W CC statewide cohort cohort statewide cohort

751 ALCOHOL ABUSE OR DEPENDENCE, W/O CC cohort cohort cohort statewide cohort

755 SPINAL FUSION W CC statewide statewide statewide cohort cohort statewide 756 SPINAL FUSION W/O CC statewide statewide cohort cohort cohort statewide

757 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W CC statewide statewide statewide statewide statewide

758 BACK & NECK PROCEDURES EXCEPT SPINAL FUSION W/O CC statewide statewide statewide cohort cohort statewide

761 TRAUMATIC STUPOR & COMA, COMA >1 HR statewide statewide statewide

763 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE <18 statewide statewide statewide

767 TRAUMATIC STUPOR & COMA, COMA <1 HR AGE >17 W/O CC statewide statewide statewide statewide

768 SEIZURE & HEADACHE AGE <18 W CC statewide statewide statewide

769 SEIZURE & HEADACHE AGE <18 W/O CC statewide statewide statewide cohort cohort

772 SIMPLE PNEUMONIA & PLEURISY AGE <18 W CC statewide statewide statewide statewide cohort

773 SIMPLE PNEUMONIA & PLEURISY AGE <18 W/O CC statewide statewide statewide cohort

774 BRONCHITIS & ASTHMA AGE <18 W CC statewide statewide statewide cohort

775 BRONCHITIS & ASTHMA AGE <18 W/O CC statewide cohort statewide cohort cohort

777 ESOPHAGITIS, GASTROENT & MISC DIGEST DISORD AGE <18 W/O CC statewide statewide cohort statewide

784 ACQUIRED HEMOLYTIC ANEMIA OR SICKLE CELL CRISIS AGE <18 statewide statewide statewide statewide

786 MAJOR HEAD & NECK PROCEDURES FOR MALIGNANCY statewide cohort statewide statewide

789

KNEE REVISION OR MAJ JOINT & LIMB REATTACH PROC OF LOW EXT, EXC HIP,FOR COMP statewide statewide statewide statewide cohort statewide

793 PROC FOR MUL SIG TRAUMA EXC CRANIOTOMY W NON-TRAUMATIC MAJOR CC statewide statewide cohort statewide

796 LOWER EXTREMITY REVASCULARIZATION W CC statewide statewide statewide statewide statewide

797 LOWER EXTREMITY REVASCULARIZATION W/O CC statewide statewide statewide statewide statewide

804 AUTOLOGOUS BONE MARROW TRANSPLANT statewide

807 COMBINED ANTERIOR/POSTERIOR SPINAL FUSION W/O CC statewide statewide statewide statewide statewide

808 PERCUTANEOUS CARDIOVASCULAR PROC W AMI,HEART FAILURE OR SHOCK statewide cohort cohort cohort

810 INTRACRANIAL HEMORRHAGE statewide statewide cohort cohort

813 NONBACTERIAL GASTROENTERITIS & ABDOMINAL PAIN AGE >17 W CC statewide cohort cohort cohort cohort

814 NONBACTERIAL GASTROENTERITIS & statewide cohort cohort cohort cohort

12


Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ABDOMINAL PAIN AGE >17 W/O CC

816 NONBACTERIAL GASTROENTERITIS & ABDOMINAL PAIN AGE <18 W/O CC statewide statewide statewide statewide statewide

817 HIP REVISION OR HIP REPLACEMENT FOR COMPLICATIONS statewide statewide statewide statewide cohort statewide

818 HIP REPLACEMENT EXCEPT FOR COMPLICATIONS cohort cohort cohort cohort cohort cohort

820 MALFUNCTIONS, REACTIONS & COMP OF GU DEVICE/GRAFT/TRANSPLANT statewide statewide statewide statewide statewide

828 NON-EXTENSIVE BURNS W/O INHAL INJ, CC OR SIGNIFICANT TRAUMA statewide

832 TRANSIENT ISCHEMIA statewide cohort statewide statewide cohort

836 SPINAL PROCEDURES W CC statewide statewide statewide statewide statewide

837 SPINAL PROCEDURES W/O CC statewide statewide cohort statewide statewide

838 EXTRACRANIAL PROCEDURES W CC statewide statewide statewide statewide cohort

839 EXTRACRANIAL PROCEDURES W/O CC statewide statewide statewide statewide

853 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W DRUG-ELUTING STENT W AMI statewide statewide cohort cohort cohort

854 PERCUTANEOUS CARDIOVASCULAR PROCEDURE W DRUG-ELUTING STENT W/O AMI statewide statewide cohort cohort cohort

864 CERVICAL SPINAL FUSION W CC statewide statewide statewide cohort cohort statewide 865 CERVICAL SPINAL FUSION W/O CC statewide statewide cohort cohort cohort statewide

867 LOCAL EXCISION & REMOVAL OF INT FIX DEVICES EXCEPT HIP & FEMUR W/O CC statewide statewide statewide statewide statewide

876 CHEMO W ACUTE LEUKEMIA AS SDX OR W USE OF HIGH DOSE CHEMO AGENT statewide statewide cohort cohort

877 ECMO OR TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W MAJ O.R. statewide statewide statewide cohort statewide

878 TRACH W MV 96+ HRS OR PDX EXC FACE, MOUTH & NECK W/O MAJ O.R. statewide statewide statewide statewide

880 ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT statewide statewide statewide statewide

881 RESPIRATORY SYSTEM DIAGNOSIS W MV 96+ HRS statewide statewide statewide statewide cohort

882 RESPIRATORY SYSTEM DIAGNOSIS W MV <96 HRS statewide cohort statewide cohort cohort

883 LAPAROSCOPIC APPENDECTOMY statewide cohort cohort cohort cohort

884 SPINAL FUSION EXC CERV W CURVATURE OF THE SPINE OR MALIGNANCY cohort cohort statewide

885 OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE statewide statewide statewide statewide

886 OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE cohort cohort cohort cohort

Outpatient Costs Includes Outpatient allowed facility costs (POS=22, POS=23) only (i.e. no professional or ancillary costs)

Dates of Service: January 2013 - December 2013

Lines of business: Blue Options (Group Underwritten, ASO, State Health Plan, CDHP), Blue Advantage (Individual, CDHP), Blue Select, Blue Value.

Excludes denials, Medicare crossovers, COB, and State Health Plan retirees.

To reduce the effect of outliers, claims with allowed costs below the 5th percentile by CPT were dropped and allowed costs were truncated at the 95th percentile by CPT.

CPTs were limited to those CPTs performed at least 30 times in at least 2 facilities statewide.

13

CPTs were further limited to those CPTs where CPT code is required according to BCBSNC policy titled “Provider Update: Effective April 10, 2012 – BCBSNC Requires CPT and HCPCS Codes to be Included on UB-04 Claim Submissions”.

Analysis excludes CPTs associated with the following revenue code groupings: o Pharmacy o IV Therapy o Laboratory o Pathology o Blood and Blood Components o Administration, Processing, and Storage for Blood and Blood Components o Physical Therapy o Occupational Therapy o Speech Therapy - Language Pathology o Free-Standing Clinic o Hemodialysis - Outpatient or Home o Peritoneal Dialysis - Outpatient or Home o Continuous Ambulatory Peritoneal Dialysis (CAPD) - Outpatient or Home o Continuous Cycling Peritioneal Dialysis (CCPD) - Outpatient or Home o Miscellaneous Dialysis o Other Therapeutic Services.

Your “facility specific allowed costs” and the “average costs” were also calculated for each facility’s outpatient costs.

o Average costs were calculated for each AP-DRG within a Peer Cohort if there were at least 30 cases in a minimum of 2 facilities; if there was insufficient volume within a Peer Cohort, the costs reflect the average cost for Facilities statewide.

o Your facility specific allowed costs and the average costs were summed separately for all cases with sufficient AP-DRG / CPT volume.

Both Inpatient and Outpatient costs were forward-adjusted to reflect each facility’s new fee schedule increases for the next calendar year once the final summary amounts were tabulated.

For example, if a facility had a $100,000 inpatient facility specific cost based on calendar year 2012 data, and had a 4% fee schedule increase effective 4/1/2013, then the Inpatient facility specific cost for that facility would be increased to $104,000 for comparison purposes. Note: Increases are prorated to reflect when the increase went into effect during the calendar year. To forward-adjust the average cost metrics, the Peer Cohort weighted average increase was blended with the statewide weighted average increase by facility based on how much each group contributed to the development of that facility’s average costs. Once the facility specific allowed costs and the average cost metrics were forward-adjusted, the facility specific cost metric was divided by the average cost metric for both inpatient and outpatient to create efficiency ratios. The efficiency ratios were normalized to ensure that the weighted average for both inpatient and outpatient in any given Peer Cohort was 1.0. Finally, each facility’s inpatient and outpatient normalized efficiency factors were blended using the aggregate allowed Inpatient and Outpatient charges for their Peer Cohort. For example, if Peer Cohort six had 60% of allowed charges associated with inpatient and 40% associated with outpatient the inpatient normalized efficiency factor blend would be 60% inpatient/ 40% outpatient. Note: If the normalized efficiency factor for a facility is 1.10 that would imply the facility is 10% less efficient than the Peer Cohort average.

14

Next, all facilities were categorized into seven macro regions made up of various combinations of the 16 regions as defined by the DOI per the Affordable Care Act. Facilities were categorized based where the majority of its claims dollars originated from based on patient address. A crosswalk of these regional definitions by county is provided below. Facilities that fell at or below the lowest 20th percentile of normalized efficiency factor within their given macro region were deemed automatic Tier 1 and all other facilities were deemed to be request for proposal-eligible Tier 2. CMS defined Critical Access facilities were excluded from this process and were also given automatic Tier 1 status.

County ACA

Region Macro Region

ALAMANCE Region 11 Triangle

ALEXANDER Region 2 Asheville

ALLEGHANY Region 3 Asheville

ANSON Region 4 Charlotte

ASHE Region 3 Asheville

AVERY Region 1 Asheville

BEAUFORT Region 16 Eastern

BERTIE Region 12 Eastern

BLADEN Region 9 Fayetteville

BRUNSWICK Region 15 Wilmington

BUNCOMBE Region 1 Asheville

BURKE Region 2 Asheville

CABARRUS Region 4 Charlotte

CALDWELL Region 2 Asheville

Camden Region 12 Eastern

CARTERET Region 16 Eastern

CASWELL Region 11 Triangle

CATAWBA Region 2 Asheville

CHATHAM Region 11 Triangle

CHEROKEE Region 1 Asheville

CHOWAN Region 12 Eastern

CLAY Region 1 Asheville

CLEVELAND Region 5 Charlotte

COLUMBUS Region 15 Wilmington

CRAVEN Region 16 Eastern

CUMBERLAND Region 9 Fayetteville

CURRITUCK Region 12 Eastern

DARE Region 16 Eastern

DAVIDSON Region 6 Triad

DAVIE Region 6 Triad

DUPLIN Region 15 Wilmington

DURHAM Region 11 Triangle

EDGECOMBE Region 14 Eastern

FORSYTH Region 6 Triad

FRANKLIN Region 13 Triangle

County ACA

Region Macro Region

GASTON Region 5 Charlotte

Gates Region 12 Eastern

Graham Region 1 Asheville

GRANVILLE Region 10 Triangle

Greene Region 14 Eastern

GUILFORD Region 7 Triad

HALIFAX Region 12 Eastern

HARNETT Region 9 Fayetteville

HAYWOOD Region 1 Asheville

HENDERSON Region 1 Asheville

HERTFORD Region 12 Eastern

HOKE Region 9 Fayetteville

HYDE Region 16 Eastern

IREDELL Region 2 Asheville

JACKSON Region 1 Asheville

JOHNSTON Region 13 Triangle

Jones Region 16 Eastern

LEE Region 11 Triangle

LENOIR Region 16 Eastern

LINCOLN Region 5 Charlotte

MACON Region 1 Asheville

MADISON Region 1 Asheville

MARTIN Region 12 Eastern

MCDOWELL Region 1 Asheville

MECKLENBURG Region 4 Charlotte

MITCHELL Region 1 Asheville

MONTGOMERY Region 8 Fayetteville

MOORE Region 8 Fayetteville

NASH Region 14 Eastern

NEW HANOVER Region 15 Wilmington

NORTHAMPTON Region 12 Eastern

ONSLOW Region 15 Wilmington

ORANGE Region 11 Triangle

Pamlico Region 16 Eastern

PASQUOTANK Region 12 Eastern

15

County ACA

Region Macro Region

PENDER Region 15 Wilmington

PERQUIMANS Region 12 Eastern

PERSON Region 11 Triangle

PITT Region 14 Eastern

POLK Region 1 Asheville

RANDOLPH Region 7 Triad

RICHMOND Region 9 Fayetteville

ROBESON Region 9 Fayetteville

ROCKINGHAM Region 7 Triad

ROWAN Region 4 Charlotte

RUTHERFORD Region 1 Asheville

SAMPSON Region 9 Fayetteville

SCOTLAND Region 9 Fayetteville

STANLY Region 4 Charlotte

STOKES Region 6 Triad

County ACA

Region Macro Region

SURRY Region 6 Triad

SWAIN Region 1 Asheville

TRANSYLVANIA Region 1 Asheville

Tyrrell Region 16 Eastern

UNION Region 4 Charlotte

VANCE Region 10 Triangle

WAKE Region 13 Triangle

WARREN Region 10 Triangle

WASHINGTON Region 16 Eastern

WATAUGA Region 3 Asheville

WAYNE Region 14 Eastern

WILKES Region 3 Asheville

WILSON Region 14 Eastern

YADKIN Region 6 Triad

YANCEY Region 1 Asheville

All CPTs were evaluated. In the following table, "Cohort" refers to the CPT analysis within the cohort only. "Statewide" refers to the DRG analysis done statewide due to the low volume. Outpatient CPT information was not used to determine Peer Cohorts.

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

00100 Anesthesia for procedures on salivary glands, including biopsy cohort cohort cohort cohort

00102

ANESTHESIA FOR PROCEDURES ON INTEGUMENTARY SYSTEM OF HEADAND/OR SALIVARY GLANDS, INCLUDING BIOPSY; PLASTIC REPAIR OF CLEFT LIP statewide

00103 BLEPHAROPLASTY cohort cohort cohort cohort cohort

00104 ANESTHESIA FOR ELECTROCONVULSIVE THERAPY cohort cohort

00120 ANESTHESIA FOR PROCEDURES ON EXTERNAL, MIDDLE, ANDINNER EARINCLUDING BIOPSY; NOT OTHERWISE SPECIFIE D cohort cohort cohort cohort

00124 OTOSCOPY statewide

00126 TYMPANOTOMY cohort cohort cohort cohort

00140 ANESTHESIA FOR PROCEDURES ON EYE; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00142 LENS SURGERY cohort cohort cohort cohort cohort

00144 CORNEAL TRANSPLANT cohort cohort cohort

00145 VITRECTOMY cohort cohort cohort

00148 OPHTHALMOSCOPY statewide

00160 ANESTHESIA FOR PROCEDURES ON NOSE AND ACCESSORY SINUSES; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00162 RADICAL SURGERY statewide

00164 BIOPSY, SOFT TISSUE statewide

00170 ANESTHESIA FOR INTRAORAL PROCEDURES, INCLUDING BIOPSY; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00172 REPAIR OF CLEFT PALATE cohort cohort

00174 EXCISION OF RETROPHARYNGEAL TUMOR cohort cohort

00176 RADICAL SURGERY statewide

00190 ANESTHESIA FOR PROCEDURES ON FACIAL BONES; NOT cohort cohort cohort cohort cohort

16

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OTHERWISE SPECIFIED

00192 RADICAL SURGERY (INCLUDING PROGNATHISM) statewide

00210 ANESTHESIA FOR INTRACRANIAL PROCEDURES, NOT OTHERWISE SPECIFIED cohort cohort

00211 Anesthesia for intracranial procedures; craniotomyor craniectomy for evacuation of hematoma statewide

00215 ELEVATION OF DEPRESSED SKULL FRACTURE, EXTRADURAL (SIMPLE OR COMPOUND) statewide

00220 SPINAL FLUID SHUNTING PROCEDURES statewide

00300 ANESTHESIA FOR ALL PROCEDURES ON INTEGUMENTARY SYSTEM OF NECK, INCLUDING SUBCUTANEOUS TISSUE cohort cohort cohort cohort cohort

00320

ANESTHESIA FOR ALL PROCEDURES ON ESOPHAGUS, THYROID, LARYNX, TRACHEA AND LYMPHATIC SYSTEM OF NECK; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00322 NEEDLE BIOPSY OF THYROID (FOR PROCEDURES ON CERVICAL SPINE AND CORD, SEE 00600, 00604, 00670) statewide

00326 ANESTHESIA, LARYNX & TRACHEA PROC; CHILDREN <1 YR cohort cohort

00350 ANESTHESIA FOR PROCEDURES ON MAJOR VESSELS OF NECK; NOT OTHERWISE SPECIFIED cohort cohort

00352 SIMPLE LIGATION (FOR ARTERIOGRAPHY, SEE 01916) statewide

00400

ANESTHESIA FOR PROCEDURES ON ANTERIOR INTEGUMENTARY SYSTEM OF CHEST, INCLUDING SUBCUTANEOUS TISSUE; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00402 RECONSTRUCTIVE PROCEDURES ON BREAST (EG. REDUCTIONOR AUGMENTATION MAMOPLASTY, MUSCLE FLAPS) cohort cohort cohort cohort cohort

00404 RADICAL OR MODIFIED RADICAL PROCEDURES ON BREAST cohort cohort cohort cohort cohort

00406 RADICAL OR MODIFIED RADICAL PROCEDURES ON BREAST WITH INTERNAL MAMMARY NODE DISSECTION cohort cohort cohort

00410 ELECTRICAL CONVERSION OF ARRHYTHMIAS cohort cohort cohort cohort

0042T

CEREBRAL PERFUSION ANALYSIS USING COMPUTED TOMOGRAWITH CONTRAST ADMIN. INCLUDING POST-PROCESSING OF PARAMETRIC MAPS WITH DETERM. OF CEREBRAL BLOOD VOLAND MEAN TRANSIT TIME statewide

00450 ANESTHESIA FOR PROCEDURES ON CLAVICLE AND SCAPULA; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort cohort

00454 BIOPSY OF CLAVICLE statewide

00470 ANESTHESIA FOR PARTIAL RIB RESECTION; NOT OTHERWISE SPECIFIED statewide

00474 RADICAL PROCEDURES (EG. PECTUS EXCAVATUM) statewide

00520

ANESTHESIA FOR CLOSED CHEST PROCEDURES (INCLUDING ESOPHAGOSCOPY, BRONCHOSCOPY, DIAGNOSTIC THORACOSCOPY); NOT OTHERWISE SPECIFIED cohort cohort cohort cohort

00524 PNEUMOCENTESIS statewide

00528

ANESTHESIA FOR CLOSED CHEST PROCEDURES; MEDIASTINOSCOPY AND DIAGNOSTIC THORACOSCOPY NOT UTILIZING 1 LUNG VENTILATION cohort cohort cohort cohort

00530 ANESTHESIA FOR TRANSVENOUS PACEMAKER INSERTION cohort cohort cohort

00532 ANESTHESIA FOR ACCESS TO CENTRAL VENOUS CIRCULATION cohort cohort cohort cohort cohort

00534

ANESTHESIA FOR TRANSVENOUS INSERTION OR REPLACEMENT OF CARDIOVERTER/DEFIBRILLATOR (FOR TRANSTHORACIC APPROACH, USE 00560) cohort cohort cohort cohort

00537 ANESTHESIA FOR CARDIAC ELECTROPHYSIOLOGIC PROCEDURES INCLUDING RADIOFREQUENCY ABLATION cohort cohort cohort

00540

ANESTHESIA FOR THORACOTOMY PROCEDURES INVOLVING LUNGS, PLEURA, DIAPHRAGM, AND MEDIASTINUM (INCLUDING SURGICAL THORACOSCOPY); NOT OTHERWISE SPECIFIED cohort cohort

00548 INTRATHORACIC PROCEDURES ON THE TRACHEA AND BRONCHI statewide

00600 ANESTHESIA FOR PROCEDURES ON CERVICAL SPINE AND CORD; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort

00604 POSTERIOR CERVICAL LAMINECTOMY IN SITTING POSITION cohort cohort

17

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

00620 ANESTHESIA FOR PROCEDURES ON THORACIC SPINE AND CORD; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort

00625

ANESTHESIA FOR PROCEDURES ON THE THORACIC SPINE AND CORD, VIA AN ANTERIOR TRANSTHORACIC APPROACH; NOT UTILIZING 1 LUNG VENTILATION statewide

00630 ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00635 ANESTHESIA FOR PROCEDURES IN LUMBAR REGION; DIAGNOSTIC OR THERAPEUTIC LUMBAR PUNCTURE. cohort cohort cohort

00640

ANESTHESIA FOR MANIPULATION OF THE SPINE OR FOR CLOSED PROCEDURES ON THE CERVICAL, THORACIC OR LUMBAR SPINE statewide

00670 ANESTHESIA FOR EXTENSIVE SPINE AND SPINAL CORD PROCEDURES (EG, HARRINGTON ROD TECHNIQUE) cohort cohort cohort cohort

00700 ANESTHESIA FOR PROCEDURES ON UPPER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIFIED cohort cohort cohort

00702 PERCUTANEOUS LIVER BIOPSY statewide

00730 ANESTHESIA FOR PROCEDURES ON UPPER POSTERIOR ABDOMINAL WALL cohort cohort

0073T

COMPENSATOR-BASED BEAM MODULATION TREATMENT DELIVERY OF INVERSE PLANNED TREATMENT USING THREE OR MORE HIGH RESOLUTION (MILLED OR CAST) COMPENSATOR CONVERGENT BEAM MODULATED FIELDS, PER statewide

00740 ANESTHESIA FOR UPPER GASTROINTESTINAL ENDOSCOPIC PROCEDURES cohort cohort cohort cohort cohort

00750 ANESTHESIA FOR HERNIA REPAIRS IN UPPDER ABDOMEN; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00752 LUMBAR AND VENTRAL (INCISIONAL)HERNIAS AND/OR WOUND DEHISCENCE cohort cohort cohort

00754 OMPHALOCELE statewide

00770 ANESTHESIA FOR ALL PROCEDURES ON MAJOR ABDOMINAL BLOOD VESSELS statewide

00790

ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN UPPERABDOMEN INCLUDING LAPAROSCOPY, NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00792 PARTIAL HEPATECTOMY (EXCLUDING LIVER BIOPSY) statewide

00797 ANESTHESIA, INTRAPERITONEAL PROC, UPPER ABDOMEN W/LAPAROSCOPY; GASTRIC RESTRICT MORBIID OBESITY cohort cohort cohort cohort

00800 ANESTHESIA FOR PROCEDURES ON LOWER ANTERIOR ABDOMINAL WALL; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort

00810 ANESTHESIA FOR INTESTINAL ENDOSCOPIC PROCEDURES cohort cohort cohort cohort cohort cohort

00820 ANESTHESIA FOR PROCEDURES ON LOWER POSTERIOR ABDOMINAL WALL cohort cohort cohort

00830 ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00832 VENTRAL AND INCISIONAL HERNIAS cohort cohort cohort cohort

00834 ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN NOT OTHERWISE SPECIFIED, UNDER 1 YEAR OF AGE cohort cohort cohort cohort

00836

ANESTHESIA FOR HERNIA REPAIRS IN LOWER ABDOMEN NOT OTHERWISE SPECIFIED, INFANTS LESS THAN 37 WEEKGESTATIONAL AGE AT BIRTH AND LESS THAN 50 WEEKS GESTATIONAL AGE AT TIME OF SURGERY statewide

00840

ANESTHESIA FOR INTRAPERITONEAL PROCEDURES IN LOWERABDOMEN INCLUDING LAPAROSCOPY; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00846 RADICAL HYSTERECTOMY cohort cohort cohort

00851 ANESTHESIA, INTRAPERITONEAL PROC, LOWER ABDOMEN W/LAPAROSCOPY; TUBAL LIGATION/TRANSECTION cohort cohort cohort cohort

00860

ANESTHESIA FOR EXTRAPERITONEAL PROCEDURES IN LOWERABDOMEN, INCLUDING URINARY TRACT; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00862 RENAL PROCEDURES, INCLUDING UPPER 1/3 OF URETER, OR cohort cohort cohort cohort

18

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

DONOR NEPHRECTOMY

00865 RADICAL PROSTATECTOMY (SUPRAPUBIC, RETROPUBIC cohort cohort cohort cohort

00866 ADRENALECTOMY statewide

00870 CYSTOLITHOTOMY cohort cohort cohort

00872 ANESTHESIA FOR LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE; WITH WATER BATH cohort cohort

00873 WITHOUT WATER BATH cohort cohort cohort

00880 ANESTHESIA FOR PROCEDURES ON MAJOR LOWER ABDOMINALVESSELS; NOT OTHERWISE SPECIFIED statewide

00902 ANORECTAL PROCEDURE (INCLUDING ENDOSCOPY AND/OR BIOPSY cohort cohort cohort cohort cohort

00904 RADICAL PERINEAL PROCEDURE cohort cohort

00906 VULVECTOMY cohort cohort cohort

00908 PERINEAL PROSTATECTOMY cohort cohort cohort

00910

ANESTHESIA FOR TRANSURETHRAL PROCEDURES (INCLUDINGURETHROCYSTOSCOPY); NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00912 TRANSURETHRAL RESECTION OF BLADDER TUMOR(S) cohort cohort cohort cohort cohort

00914 TRANSURETHRAL RESECTION OF PROSTATE cohort cohort cohort cohort cohort

00918 WITH FRAGMENTATION AND/OR REMOVAL OF URETERAL CALCULUS cohort cohort cohort cohort cohort

00920 ANESTHESIA FOR PROCEDURES ON MALE EXTERNAL GENITALIA; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00921 VASECTOMY, UNILATERAL/BILATERAL cohort cohort cohort cohort

00922 SEMINAL VESICLES statewide

00924 UNDESCENDED TESTIS, UNILATERAL OR BILATERAL statewide

00926 RADICAL ORCHIECTOMY, INGUINAL cohort cohort cohort cohort

00928 RADICAL ORCHIECTOMY, ABDOMINAL cohort cohort

00930 ORCHIOPEXY, UNILATERAL OR BILATERAL cohort cohort cohort cohort

00938 INSERTION OF PENILE PROSTHESIS (PERINEAL APPROACH) cohort cohort cohort cohort

00940

ANESTHESIA FOR VAGINAL PROCEDURES (INCLUDING BIOPSY OF LABIA, VAGINA, CERVIX OR ENDOMETRIUM); NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

00942 COLPOTOMY, COLPECTOMY, COLPORRHAPHY cohort cohort cohort cohort cohort

00944 VAGINAL HYSTERECTOMY cohort cohort cohort cohort cohort

00948 CERVICAL CERCLAGE cohort cohort cohort cohort

00952 HYSTEROSCOPY cohort cohort cohort cohort cohort

01112 ANESTHESIA FOR BONE MARROW ASPIRATION AND/OR BIOPSY, ANTERIOR OR POSTERIOR ILIAC CREST cohort cohort cohort

01120 ANESTHESIA FOR PROCEDURES ON BONY PELVIS statewide

01130 ANESTHESIA FOR BODY CAST APPLICATION OR REVISION statewide

01170 ANESTHESIA FOR OPEN PROCEDURES INVOLVING SYMPHYSIS PUBIS OR SACROILIAC JOINT cohort cohort cohort

01190 INTRAPELVIC statewide

01200 ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING HIP JOINT cohort cohort cohort cohort

01202 ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF HIP JOINT cohort cohort cohort cohort

01210 ANESTHESIA FOR OPEN PROCEDURES INVOLVING HIP JOINT; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort

01214 TOTAL HIP REPLACEMENT OR REVISION cohort cohort

01220 ANESTHESIA FOR ALL CLOSED PROCEDURES INVOLVING UPPER 2/3 OF FEMUR statewide

01230 ANESTHESIA FOR OPEN PROCEDURES INVOLVING UPPER 2/3 OF FEMUR; NOT OTHERWISE SPECIFIED cohort cohort

01232 AMPUTATION statewide

01250 ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES cohort cohort cohort cohort cohort

19

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

TENDONS, FASCIA, AND BURSAE OF UPPER LEG

01260 ANESTHESIA FOR ALL PROCEDURES ON INVOLVING VEINS OF UPPER LEG, INCLUDING EXPLORATION cohort cohort cohort cohort

01270

ANESTHESIA FOR PROCEDURES INVOLVING ARTERIES OF UPPER LEG, INCLUDING BYPASS GRAFT; NOT OTHERWISE SPECIFIED statewide

01320

ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF KNEE AND/OR POPLITEAL AREA cohort cohort cohort cohort cohort

01340 ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER 1/3 OF FEMUR statewide

01360 ANESTHESIA FOR ALL OPEN PROCEDURES ON LOWER 1/3 OF FEMUR cohort cohort cohort

01380 ANESTHESIA FOR ALL CLOSED PROCEDURES ON KNEE JOINT cohort cohort cohort cohort cohort

01382 ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF KNEE JOINT cohort cohort cohort cohort cohort

01390 ANESTHESIA FOR ALL CLOSED PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATELLA statewide

01392 ANESTHESIA FOR ALL OPEN PROCEDURES ON UPPER ENDS OF TIBIA, FIBULA, AND/OR PATELLA cohort cohort cohort cohort cohort

01400 ANESTHESIA FOR OPEN PROCEDURES ON KNEE JOINT; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

01402 TOTAL KNEE REPLACEMENT cohort cohort cohort cohort

01420 ANESTHESIA FOR ALL CAST APPLICATIONS, REMOVAL, OR REPAIR INVOLVING KNEE JOINT cohort cohort

01430 ANESTHESIA FOR PROCEDURES ON VEINS OF KNEE AND POPLITEAL AREA; NOT OTHERWISE SPECIFIED cohort cohort

01462 ANESTHESIA FOR ALL CLOSED PROCEDURES ON LOWER LEG, ANKLE, AND FOOT cohort cohort cohort cohort cohort

01464 ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ANKLE JOINT cohort cohort cohort cohort

01470

ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, AND FASCIA OF LOWER LEG, ANKLE, AND FOOT;NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

01472 REPAIR OF RUPTURED ACHILLES TENDON, WITH OR WITHOUT GRAFT cohort cohort cohort cohort cohort

01474 GASTROCNEMIUS RECESSION (EG. STRAYER PROCEDURE) statewide

01480 ANESTHESIA FOR OPEN PROCEDURES ON BONES OF LOWE LEG, ANKLE, AND FOOT; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

01482 RADICAL RESECTION cohort cohort cohort

01484 ODTEOTOMY OR OSTEOPLASTY OF TIBIA AND/OR FIBULA cohort cohort cohort

01490 ANESTHESIA FOR LOWER LEG CAST APPLICATION, REMOVAL, OR REPAIR statewide

01500 ANESTHESIA FOR PROCEDURES ON ARTERIES OF LOWER LEGINCLUDING BYPASS GRAFT; NOT OTHERWISE SPECIFIED. statewide

01520 ANESTHESIA FOR PROCEDURES ON VEINS OF LOWER LEG; NOT OTHERWISE SPECIFIED statewide

01522 VENOUS THROMBECTOMY,DIRECT OR WITH CATHETER statewide

0159T

Computer aided detection, including computer algorithm analysis of MRI image data for lesion detection/ characterization, pharmacokinetic analysis, with further physician review for interpretation, br statewide

01610 ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF SHOULDER AND AXILLA cohort cohort cohort cohort cohort

01620

ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERAL HEAD ABD NECK, STERNOCLAVICULAR JOINT, ACROMIOCLAVICULAR JOINT, AND SHOULDER JOINT cohort cohort cohort cohort

01622 ANESTHESIA FOR ARTROSCOPIC PROCEDURES OF SHOULDER JOINT cohort cohort cohort cohort

01630

ANESTHESIA FOR OPEN PROCEDURES ON HUMERAL HEAD ANDNECK, STERNOCLAVICULAR JOINT, ACROMIOCLAVICULAR JOINT, AND SHOULDER JOINT; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

20

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

01650 ANESTHESIA FOR PROCEDURES ON ARTERIES OF SHOULDER AND AXILLA; NOT OTHERWISE SPECIFIED statewide

01680 ANESTHESIA FOR SHOULDER CAST APPLICATION, REMOVAL OR REPAIR; NOT OTHERWISE SPECIFIED statewide

01710

ANESTHESIA FOR PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF UPPER ARM AND ELBOW; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

01712 TENOTOMY, ELBOW TO SHOULDER, OPEN cohort cohort

01714 TENOPLASTY, ELBOW TO SHOULDER statewide

01716 TENODESIS, RUPTURE OF LONG TENDON OF BICEPS cohort cohort cohort cohort

01730 ANESTHESIA FOR ALL CLOSED PROCEDURES ON HUMERUS AND ELBOW cohort cohort cohort cohort

01732 ANESTHESIA FOR ARTHROSCOPIC PROCEDURES OF ELBOW JOINT statewide

01740 ANESTHESIA FOR OPEN PROCEDURES ON HUMERUS AND ELBOW; NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

01742 OSTEOTOMY OF HUMERUS statewide

01744 REPAIR OF NONUNION OR MALUNION OF HUMERUS cohort cohort cohort cohort

01756 RADICAL PROCEDURES cohort cohort

01758 EXCISION OF CYST OR TUMOR OF HUMERUS statewide

01760 TOTAL ELBOW REPLACEMENT statewide

01770 ANESTHESIA FOR PROCEDURES ON ARTERIES OF UPPER ARMAND ELBOW; NOT OTHERWISE SPECIFIED cohort cohort cohort

01780 ANESTHESIA FOR PROCEDURES ON VEINS OF UPPER ARM AND ELBOW; NOT OTHERWISE SPECIFIED statewide

01810

ANESTHESIA FOR ALL PROCEDURES ON NERVES, MUSCLES, TENDONS, FASCIA, AND BURSAE OF FOREARM, WRIST, ANDHAND cohort cohort cohort cohort cohort

01820 ANESTHESIA FOR ALL CLOSED PROCEDURES ON RADIUS, ULNA, WRIST, OR HAND BONES HAND cohort cohort cohort cohort cohort

01830 ANESTHESIA FOR OPEN PROCEDURES ON RADIUS, ULNA, WRIST, OR HAND BONES; NOT OTHERWISE SPECIFIED HAND cohort cohort cohort cohort cohort

01832 TOTAL WRIST REPLACEMENT cohort cohort

01840 ANESTHESIA FOR PROCEDURES ON ARTERIES OF FOREARM, WRIST, AND HAND; NOT OTHERWISE SPECIFIED cohort cohort

01844 ANESTHESIA FOR VASCULAR SHUNT, OR SHUNT REVISION, ANY TYPE (EG. DIALYSIS) cohort cohort cohort cohort

0184T Excision of rectal tumor, transanal endoscopic microsurgical approach (i.e., TEMS), including muscularis propria (i.e., full thickness) cohort cohort cohort

01850 ANESTHESIA FOR PROCEDURES ON VEINS OF FOREARM, WRIST, AND HAND; NOT OTHERWISE SPECIFIED statewide

01916 ANESTHESIA FOR ARTERIOGRAMS, NEEDLE; CAROTID OR VERTEBRAL cohort cohort cohort

0191T Insertion of anterior segment aqueous drainage device, without extraocular reservoir; internal approach, into the trabecular meshwork cohort cohort

01920

ANESTHESIA FOR CARDIAC CATHETERIZATION INCLUDING CORONARY ARTERIOGRAPHY AND VENTRICULOGRAPHY (NOT TO INCLUDE SWAN-GANZ CATHETER) statewide

01922 ANESTHESIA FOR NON-INVASIVE IMAGING OR RADIATION THERAPY cohort cohort cohort cohort cohort

01924 ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL, ARTERIAL SYSTEM NOS cohort cohort cohort

01925 ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL ARTERIAL SYSTEM; CAROTID/CORONARY statewide

01926 ANESTHESIA THERAPEUTIC INTERVENTIONAL RADIOL ARTERIAL SYSTEM; INTRACRANIAL/INTRACARDIAC/AORTIC cohort cohort

0192T INSERTION OF ANTERIOR SEGMENT AQUEOUS DRAINAGE cohort cohort cohort

01930 ANES, THERAPEUTIC INTERVEN RADIOL, VENOUS/LYMPHATISYSTEM W/O CENTRAL CIRC ACCESS; NOS cohort cohort cohort cohort

01931 ANESTHESIA FOR THERAPEUTIC INTERVENTIONAL statewide

21

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

RADIOLOGICAL PROCEDURES INVOLVING THE VENOUS/LYMPHATIC SYSTEM (NOT TO INCLUDE ACCESS TO THE CENTRAL CIRCULATION); INTRAHEPATIC OR PORTAL CIRCULATION (E.G., TR

01936 Anesthesia for percutaneous image guided procedures on the spine and spinal cord; therapeutic cohort cohort

01951

ANESTHESIA FOR SECOND AND THIRD DEGREE BURN EX- CISION OR DEBRIDEMENT WITH OR WITHOUT SKIN GRAFT- ING, ANY SITE, FOR TOTAL BODY SURFACE AREA (TBSA) TREATED DURING ANESTHESIA AND SURGERY; LESS 1% TOT statewide

01960 ANESTHESIA FOR; VAGINAL DELIVERY ONLY statewide

01962 ANESTHESIA FOR; URGENT HYSTERECTOMY FOLLOWING DELIVERY statewide

01965 ANESTHESIA FOR INCOMPLETE OR MISSED ABORTION PROCEDURES cohort cohort cohort cohort

01966 ANESTHESIA FOR INDUCED ABORTION PROCEDURES cohort cohort

01968 CESAREAN DELIVERY FOLLOWING NEURAXIAL LABOR ANALGEANESTHESIA ADD'L ANESTHESIA statewide

01991

ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION IS PERFORMED BY A DIFFERENT PHYSICIAN OR OTHER QUALIFIEDHEALTH CARE PROFESSIONAL); OTHER THAN THE PRONE P statewide

01992

ANESTHESIA FOR DIAGNOSTIC OR THERAPEUTIC NERVE BLOCKS AND INJECTIONS (WHEN BLOCK OR INJECTION IS PERFORMED BY A DIFFERENT PHYSICIAN OR OTHER QUALIFIEDHEALTH CARE PROFESSIONAL); PRONE POSITION cohort cohort cohort cohort

0227T Anoscopy, high resolution (HRA) (with magnificaiton and chemical agent enhancement); with biopsy(ies) statewide

0238T Transluminal peripheral atherectomy, including radiological supervision and interpretation; iiac artery, each vessel statewide

0240T

ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY WITH INTERPRETATION AND REPORT; WITH HIGH RESOLUTION ESOPHAGEAL PRESSURE TOPOGRAPHY cohort cohort

0249T Ligation, hemorrhoidal vascular bundle(s), including ultrasound guidance statewide

0275T

Percutaneous laminotomy/laminectomy (intralaminar approach) for decompression of neural elements, (with or without ligamentous resection, discectomy, facetectomy and/or foraminotomy) and method under statewide

0291T

Intravascular optical coherence tomography (coronary native vessel or graft) during diagnostic evaluation and/or therapeutic intervention, including imaging supervision, interpretation, and report; in statewide

0296T

External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; recording (includes connection and initial recording) cohort cohort

0297T

External electrocardiographic recording for more than 48 hours up to 21 days by continuous rhythm recording and storage; scanning analysis with report cohort cohort

0334T

Sacroiliac joint stabilization for arthrodesis, percutaneous or minimally invasive (indirect visualization), includes obtaining and applying autograftor allograft (structural or morselized), when per statewide

0360 OR SERVICES statewide

0402 ULTRASOUND statewide

10021 FINE NEEDLE ASPIRATION; W/OUT IMAGING GUIDANCE cohort cohort cohort cohort

10022 FINE NEEDLE ASPIRATION; W/IMAGING GUIDANCE cohort cohort cohort cohort cohort

10040 *ACNE SURGERY (EG, MARSUPIALIZATION, OPENING OR REMOVAL OFMULTIPLE MILIA, COMEDONES, CYSTS, PUSTULES) statewide

10060

*INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE,SUPPURATIVE HIDRADENITIS, CUTANEOUS OR SUBCUTANEOUSABSCESS, CYST, FURUNCLE, OR PARONYCHIA); SIMPLE OR SINGLE cohort cohort cohort cohort cohort cohort

22

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

10061

INCISION AND DRAINAGE OF ABSCESS (EG, CARBUNCLE, SUPPURATIVEHIDRADENITIS, CUTANEOUS OR SUBCUTANEOUS ABSCESS, CYST, FURUNCLE, OR PARONYCHIA); COMPLICATED OR MULTIPLE cohort cohort cohort cohort cohort

10080 *INCISION AND DRAINAGE OF PILONIDAL CYST; SIMPLE cohort cohort cohort cohort cohort cohort

10081 INCISION AND DRAINAGE OF PILONIDAL CYST; COMPLICATED cohort cohort cohort cohort cohort

10120

*INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUS TISSUES;SIMPLE *INCISION AND REMOVAL OF FOREIGNBODY, SUBCUTANEOUS TISSUES; cohort cohort cohort cohort cohort cohort

10121

INCISION AND REMOVAL OF FOREIGN BODY, SUBCUTANEOUSTISSUES; COMPLICATED INCISION AND REMOVAL OF FOR EIGN BODY, SUBCUTANEOUS TISSUES; cohort cohort cohort cohort

10140 *INCISION AND DRAINAGE OF HEMATOMA, SEROMA OR FLUIDCOLLECTION cohort cohort cohort cohort cohort

10160

*PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST*PUNCTURE ASPIRATION OF ABSCESS, HEMATOMA, BULLA, OR CYST cohort cohort cohort cohort cohort

10180 INCISION AND DRAINAGE, COMPLEX, POSTOPERATIVE WOUNDINFECTION cohort cohort cohort cohort

11000 *DEBRIDEMENT OF EXTENSIVE ECZEMATOUS OR INFECTED SKIN; UP TO10% OF BODY SURFACE cohort cohort cohort cohort cohort

11005

DEBRIDEMENT OF SKIN, SUBCUTANEOUS TISSUE, MUSCLE AND FASCIA FOR NECROTIZING SOFT TISSUE INFECTION ABDOMINAL WALL WITH OR WITHOUT FASCIAL CLOSURE cohort cohort cohort

11008

Removal of prosthetic material or mesh, abdominal wall for infection (e.g., for chronic or recurrentmesh infection or necrotizing soft tissue infecti on) statewide

11010

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin and subcutaneous tissues cohort cohort cohort cohort

11011

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, and muscle statewide

11012

Debridement including removal of foreign material at the site of an open fracture and/or an open dislocation (eg, excisional debridement); skin, subcutaneous tissue, muscle fascia, muscle, and bone cohort cohort cohort cohort cohort

11042 Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); first 20 sq cm or less cohort cohort cohort cohort cohort cohort

11043 Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); first 20 sq cm or less cohort cohort cohort cohort cohort cohort

11044 Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); first 20 sq cm or less cohort cohort cohort cohort cohort cohort

11045

Debridement, subcutaneous tissue (includes epidermis and dermis, if performed); each additional 20 sq cm, or part thereof (List separately in additionto code for primary procedure) cohort cohort cohort cohort cohort cohort

11046

Debridement, muscle and/or fascia (includes epidermis, dermis, and subcutaneous tissue, if performed); each additional 20 sq cm, or part thereof (Listseparately in addition to code for primary proced cohort cohort cohort cohort cohort

11047

Debridement, bone (includes epidermis, dermis, subcutaneous tissue, muscle and/or fascia, if performed); each additional 20 sq cm, or part thereof (List separately in addition to code for primary proc cohort cohort cohort

11055

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); SINGLE LESION PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN cohort cohort cohort cohort cohort cohort

11056

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); TWO TO FOUR LESIONS PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN cohort cohort cohort cohort cohort

11057

PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG, CORN OR CALLUS); MORE THAN FOUR LESIONS PARING OR CUTTING OF BENIGN HYPERKERATOTIC LESION (EG,CORN statewide

11100

BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS MEMBRANE(INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED (SEPARATE PROCEDURE); SINGLE LESION cohort cohort cohort cohort cohort cohort

11101 BIOPSY OF SKIN, SUBCUTANEOUS TISSUE AND/OR MUCOUS cohort cohort cohort cohort

23

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MEMBRANE(INCLUDING SIMPLE CLOSURE), UNLESS OTHERWISE LISTED (SEPARATE PROCEDURE); EACH SEPARATE/ADDITIONAL LESION (LIST

11200

*REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANYAREA; UP TO AND INCLUDING 15 LESIONS *REMOVAL OF SKIN TAGS, MULTIPLE FIBROCUTANEOUS TAGS, ANY cohort cohort cohort cohort cohort

11201

Removal of skin tags, multiple fibrocutaneous tags, any area; each additional 10 lesions, or part thereof (List separately in addition to code for primary procedure) cohort cohort cohort

11300

*SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION,TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM ORLESS cohort cohort cohort

11301 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK,ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0CM cohort cohort cohort

11302 SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, TRUNK,ARMS OR LEGS; LESION DIAMETER 1.1 TO 2.0CM cohort cohort

11306

SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP,NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM cohort cohort cohort

11308

SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, SCALP,NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 2.0 CM statewide

11310

*SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE,EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; 0.5 CM OR LESS cohort cohort cohort cohort

11311

SHAVING OF EPIDERMAL OR DERMAL LESION, SINGLE LESION, FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM statewide

11400

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.5 CM OR LESS cohort cohort cohort cohort cohort

11401

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER 0.6 TO 1.0 CM cohort cohort cohort cohort cohort cohort

11402


11403


11404


11406

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), TRUNK, ARMS OR LEGS; LESION DIAMETER OVER 4.0 CM cohort cohort cohort cohort cohort cohort

11420

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS cohort cohort cohort cohort cohort cohort

11421

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM cohort cohort cohort cohort cohort cohort

11422


11423


11424


11426

EXCISION, BENIGN LESION, EXCEPT SKIN TAG (UNLESS LISTEDELSEWHERE), SCALP, NECK, HANDS, FEET, GENITALIA; LESION DIAMETER OVER 4.0 CM cohort cohort cohort cohort cohort cohort

11440 EXCISION, OTHER BENIGN LESION (UNLESS LISTED cohort cohort cohort cohort cohort

24

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS

11441

EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.6 TO 1.0 CM cohort cohort cohort cohort cohort

11442

EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 1.1 TO 2.0 CM cohort cohort cohort cohort cohort

11443

EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 2.1 TO 3.0 CM cohort cohort cohort cohort

11444

EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 3.1 TO 4.0 CM cohort cohort cohort cohort

11446

EXCISION, OTHER BENIGN LESION (UNLESS LISTED ELSEWHERE),FACE, EARS, EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER OVER 4.0 CM cohort cohort cohort cohort

11450

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,AXILLARY; WITH SIMPLE OR INTERMEDIATE REPAIR cohort cohort cohort cohort cohort

11451 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,AXILLARY; WITH COMPLEX REPAIR cohort cohort cohort

11462

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,INGUINAL; WITH SIMPLE OR INTERMEDIATE REPAIR cohort cohort cohort cohort

11463 EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,INGUINAL; WITH COMPLEX REPAIR statewide

11470

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,PERIANAL, PERINEAL, OR UMBILICAL; WITH SIMPLE OR INTERMEDIATE REPAIR cohort cohort cohort cohort cohort

11471

EXCISION OF SKIN AND SUBCUTANEOUS TISSUE FOR HIDRADENITIS,PERIANAL, PERINEAL, OR UMBILICAL; WITH COMPLEX REPAIR cohort cohort

11600 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER 0.5 CM OR LESS cohort cohort cohort

11601 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER 0.6 TO 1.0 CM cohort cohort cohort cohort

11602 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER 1.1 TO 2.0 CM cohort cohort cohort cohort cohort

11603 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER 2.1 TO 3.0 CM cohort cohort cohort cohort cohort

11604 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER 3.1 TO 4.0 CM cohort cohort cohort cohort

11606 EXCISION, MALIGNANT LESION, TRUNK, ARMS, OR LEGS; LESIONDIAMETER OVER 4.0 CM cohort cohort cohort cohort cohort

11620

EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET,GENITALIA; LESION DIAMETER 0.5 CM OR LESS EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, cohort cohort cohort cohort

11621

EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET,GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, cohort cohort cohort cohort

11622

EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET,GENITALIA; LESION DIAMETER 1.1 TO 2.0 CM EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, cohort cohort cohort

11623


11624


11626

EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET,GENITALIA; LESION DIAMETER OVER 4.0 CM EXCISION, MALIGNANT LESION, SCALP, NECK, HANDS, FEET, cohort cohort cohort cohort

11640 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, cohort cohort cohort

25

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

LIPS;LESION DIAMETER 0.5 CM OR LESS

11641 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS;LESION DIAMETER 0.6 TO 1.0 CM cohort cohort cohort cohort

11642 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS;LESION DIAMETER 1.1 TO 2.0 CM cohort cohort cohort cohort cohort

11643 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS;LESION DIAMETER 2.1 TO 3.0 CM cohort cohort cohort cohort

11644 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS;LESION DIAMETER 3.1 TO 4.0 CM cohort cohort cohort

11646 EXCISION, MALIGNANT LESION, FACE, EARS, EYELIDS, NOSE, LIPS;LESION DIAMETER OVER 4.0 CM cohort cohort cohort cohort

11719 TRIMMING OF NONDYSTROPHIC NAILS, ANY NUMBER cohort cohort

11720 DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVEDEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); ONE TO FIVE cohort cohort cohort cohort

11721

DEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MOREDEBRIDEMENT OF NAIL(S) BY ANY METHOD(S); SIX OR MORE cohort cohort cohort

11730 *AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; SINGLE cohort cohort cohort cohort cohort cohort

11732

AVULSION OF NAIL PLATE, PARTIAL OR COMPLETE, SIMPLE; EACHADDITIONAL NAIL PLATE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

11740 EVACUATION OF SUBUNGUAL HEMATOMAEVACUATION OF SUBUNGUAL HEMATOMA cohort cohort cohort cohort cohort

11750

EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANENT REMOVAL; EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, cohort cohort cohort cohort cohort

11752

EXCISION OF NAIL AND NAIL MATRIX, PARTIAL OR COMPLETE, (EG, INGROWN OR DEFORMED NAIL) FOR PERMANENT REMOVAL; WITH AMPUTATION OF TUFT OF DISTAL PHALANX cohort cohort cohort

11755

BIOPSY OF NAIL UNIT, ANY METHOD (EG, PLATE, BED, MATRIX,HYPONYCHIUM, PROXIMAL AND LATERAL NAIL FOLDS) (SEPARATE PROCEDURE) cohort cohort

11760 REPAIR OF NAIL BEDREPAIR OF NAIL BED cohort cohort cohort cohort cohort

11762 RECONSTRUCTION OF NAIL BED WITH GRAFTRECONSTRUCTION OF NAIL BED WITH GRAFT statewide

11765

WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWNTOENAIL) WEDGE EXCISION OF SKIN OF NAIL FOLD (EG, FOR INGROWN cohort cohort cohort cohort cohort

11770 EXCISION OF PILONIDAL CYST OR SINUS; SIMPLE cohort cohort cohort cohort cohort cohort

11771 EXCISION OF PILONIDAL CYST OR SINUS; EXTENSIVE cohort cohort cohort cohort cohort cohort

11772 EXCISION OF PILONIDAL CYST OR SINUS; COMPLICATED cohort cohort cohort cohort cohort cohort

11900 *INJECTION, INTRALESIONAL; UP TO AND INCLUDING SEVEN LESIONS cohort cohort

11901 *INJECTION, INTRALESIONAL; MORE THAN SEVEN LESIONS statewide

11921

TATTOOING, INTRADERMAL INTRODUCTION OF INSOLUBLE OPAQUEPIGMENTS TO CORRECT COLOR DEFECTS OF SKIN, INCLUDING MICROPIGMENTATION; 6.1 TO 20.0 SQ CM statewide

11950

SUBCUTANEOUS INJECTION OF FILLING MATERIAL (EG, COLLAGEN); 1CC OR LESS SUBCUTANEOUS INJECTION OF FILLING MATERIAL (EG, COLLAGEN); 1 statewide

11951

SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG, COLLAGEN);1.1 TO 5.0 CC SUBCUTANEOUS INJECTION OF"FILLING" MATERIAL (EG, COLLAGEN); statewide

11952

SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG, COLLAGEN);5.1 TO 10.0 CC SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG, COLLAGEN); statewide

11954

SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG, COLLAGEN);OVER 10.0 CC SUBCUTANEOUS INJECTION OF "FILLING" MATERIAL (EG, COLLAGEN); statewide

11960 INSERTION OF TISSUE EXPANDER(S) FOR OTHER THAN cohort cohort

26

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

BREAST,INCLUDING SUBSEQUENT EXPANSION

11970 REPLACEMENT OF TISSUE EXPANDER WITH PERMANENT PROSTHESIS cohort cohort cohort cohort cohort cohort

11971 REMOVAL OF TISSUE EXPANDER(S) WITHOUT INSERTION OFPROSTHESIS cohort cohort cohort cohort cohort

11980

SUBCUTANEOUS HORMONE PELLET IMPLANTATION(IMPLANTATION OF ESTRADIOL AND/OR TESTOSTERONE PELLETS BENEATH THE SKIN cohort cohort cohort

11981 INSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT cohort cohort cohort cohort cohort

11982 REMOVAL, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT cohort cohort cohort cohort

11983 REMOVAL W/REINSERTION, NON-BIODEGRADABLE DRUG DELIVERY IMPLANT cohort cohort

12001

*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK,AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.5 CM OR LESS cohort cohort cohort cohort cohort cohort

12002

*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK,AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 2.6 CM TO 7.5 CM cohort cohort cohort cohort cohort cohort

12004

*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK,AXILLAE, EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 7.6 CM TO 12.5 CM cohort cohort cohort cohort cohort cohort

12005

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE,EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 12.6 CM TO 20.0 CM cohort cohort cohort cohort cohort

12006

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE,EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); 20.1 CM TO 30.0 CM cohort cohort cohort cohort

12007

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF SCALP, NECK, AXILLAE,EXTERNAL GENITALIA, TRUNK AND/OR EXTREMITIES (INCLUDING HANDS AND FEET); OVER 30.0 CM cohort cohort

12011

*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS,NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.5 CM OR LESS cohort cohort cohort cohort cohort cohort

12013

*SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS, EYELIDS,NOSE, LIPS AND/OR MUCOUS MEMBRANES; 2.6 CM TO 5.0 CM cohort cohort cohort cohort cohort

12014

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS,EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 5.1 CM TO 7.5 CM cohort cohort cohort cohort cohort

12015

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS,EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 7.6 CM TO 12.5 CM cohort cohort cohort cohort cohort

12016

SIMPLE REPAIR OF SUPERFICIAL WOUNDS OF FACE, EARS,EYELIDS, NOSE, LIPS AND/OR MUCOUS MEMBRANES; 12.6 CM TO 20.0 CM cohort cohort cohort cohort

12020 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; SIMPLE CLOSURE cohort cohort cohort cohort cohort

12021 TREATMENT OF SUPERFICIAL WOUND DEHISCENCE; WITH PACKING cohort cohort

12031 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);2.5 cm or less cohort cohort cohort cohort cohort

12032 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);2.6 cm to 7.5 cm cohort cohort cohort cohort cohort cohort

12034 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);7.6 cm to 12.5 cm cohort cohort cohort cohort cohort cohort

12035 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);12.6 cm to 20.0 cm cohort cohort cohort cohort cohort

12036 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);20.1 cm to 30.0 cm cohort cohort cohort cohort

12037 Repair, intermediate, wounds of scalp, axillae, trunk and/or extremities (excluding hands and feet);over 30.0 cm cohort cohort cohort

12041 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.5 cm or less cohort cohort cohort cohort cohort

27

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

12042 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 2.6 cm to 7.5 cm cohort cohort cohort cohort cohort

12044 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 7.6 cm to 12.5 cm cohort cohort cohort cohort cohort cohort

12045 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 12.6 cm to 20.0 cm cohort cohort cohort

12046 Repair, intermediate, wounds of neck, hands, feet and/or external genitalia; 20.1 cm to 30.0 cm statewide

12051 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.5 cm or less cohort cohort cohort cohort cohort cohort

12052 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 2.6 cm to 5.0 cm cohort cohort cohort cohort cohort cohort

12053 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 5.1 cm to 7.5 cm cohort cohort cohort cohort

12054 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 7.6 cm to 12.5 cm cohort cohort cohort cohort cohort

12055 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 12.6 cm to 20.0 cm cohort cohort cohort

12056 Repair, intermediate, wounds of face, ears, eyelids, nose, lips and/or mucous membranes; 20.1 cm to 30.0 cm statewide

13101 REPAIR, COMPLEX, TRUNK; 2.6 CM TO 7.5 CM cohort cohort cohort cohort

13102

REPAIR, COMPLEX, TRUNK; EACH ADDITIONAL 5 CM OR LESS (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

13120 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 1.1 CM TO 2.5 CM cohort cohort cohort

13121 REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS; 2.6 CM TO 7.5 CM cohort cohort cohort cohort cohort

13122

REPAIR, COMPLEX, SCALP, ARMS, AND/OR LEGS;EACH ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITIOTO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

13131

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET; 1.1 CM TO 2.5 CM REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN,MOUTH, NECK, cohort cohort cohort cohort cohort

13132

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET; 2.6 CM TO 7.5 CM REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN,MOUTH, NECK, cohort cohort cohort cohort cohort

13133

REPAIR, COMPLEX, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK,AXILLAE, GENITALIA, HANDS AND/OR FEET;EACH ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITON TO PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

13150 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.0 CM OR LESS cohort cohort cohort

13151 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 1.1 CM TO 2.5 CM cohort cohort cohort cohort

13152 REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; 2.6 CM TO 7.5 CM cohort cohort cohort cohort cohort

13153

REPAIR, COMPLEX, EYELIDS, NOSE, EARS AND/OR LIPS; EACH ADDITIONAL 5 CM OR LESS(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

13160 SECONDARY CLOSURE OF SURGICAL WOUND OR DEHISCENCE,EXTENSIVEOR COMPLICATED cohort cohort cohort cohort cohort

14000

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 SQ CM OR LESS ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT 10 cohort cohort cohort cohort

14001

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, TRUNK; DEFECT cohort cohort cohort cohort

14020

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMSAND/OR LEGS; DEFECT 10 SQ CM OR LESS ADJACENTTISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS cohort cohort cohort cohort

28

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

14021

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMSAND/OR LEGS; DEFECT 10.1 SQ CM TO 30.0 SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, SCALP, ARMS cohort cohort cohort cohort

14040

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS,CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10 SQ CM OR LESS cohort cohort cohort cohort cohort

14041

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, FOREHEAD, CHEEKS,CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS AND/OR FEET; DEFECT 10.1 SQ CM TO 30.0 SQ CM cohort cohort cohort cohort

14060

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE,EARS AND/OR LIPS; DEFECT 10 SQ CM OR LESS ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, cohort cohort cohort cohort cohort

14061

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE,EARS AND/OR LIPS; DEFECT 10.1 SQ CM TO 30.0SQ CM ADJACENT TISSUE TRANSFER OR REARRANGEMENT, EYELIDS, NOSE, cohort cohort cohort cohort

14301 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM cohort cohort cohort cohort

14302

ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

14350 FILLETED FINGER OR TOE FLAP, INCLUDING PREPARATIONOFRECIPIENT SITE statewide

15002

SURGICAL PREPARATION OR CREATION OF RECIPIENT SITEBY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, TRUNK, ARMS, LEGS; FIRS cohort cohort cohort cohort

15003

Surgical preparation or creation of recipient siteby excision of open wounds, burn eschar, or scar (including subcutaneous tissues), or incisional release of scar contracture, trunk, arms, legs; each cohort cohort

15004

SURGICAL PREPARATION OR CREATION OF RECIPIENT SITEBY EXCISION OF OPEN WOUNDS, BURN ESCHAR, OR SCAR (INCLUDING SUBCUTANEOUS TISSUES), OR INCISIONAL RELEASE OF SCAR CONTRACTURE, FACE, SCALP, EYELIDS, M cohort cohort cohort cohort cohort

15100

SPLIT GRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM ORLESS, OR ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN (EXCEPT 15050) cohort cohort cohort cohort cohort cohort

15101

SPLIT GRAFT, TRUNK, ARMS, LEGS; EACH ADDITIONAL 100 SQ CM,OR EACH ADDITIONAL ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO cohort cohort

15115

EPIDERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/ORMULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN statewide

15120

SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS,ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTS cohort cohort cohort cohort

15121

SPLIT GRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS,ORBITS, GENITALIA, HANDS, FEET AND/OR MULTIPLE DIGITS; EACH ADDITIONAL 100 SQ CM, OR EACH ADDITIONAL ONE PERCENT OF BODY statewide

15130

DERMAL AUTOGRAFT, TRUNK, ARMS, LEGS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTSAND CHILDREN statewide

15135

DERMAL AUTOGRAFT, FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS; FIRST 100 SQ CM OR LESS, OR ONE PERCENT OF BODY AREA OF INFANTS AND CHILDREN cohort cohort cohort cohort

15200

FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OFDONOR SITE, TRUNK; 20 SQ CM OR LESS FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF cohort cohort cohort

15220 FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE cohort cohort cohort cohort

29

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OFDONOR SITE, SCALP, ARMS, AND/OR LEGS; 20 SQ CM OR LESS FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OF

15221

Full thickness graft, free, including direct closure of donor site, scalp, arms, and/or legs; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedure) statewide

15240

FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OFDONOR SITE, FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS, AND/OR FEET; 20 SQCM OR LESS cohort cohort cohort cohort cohort cohort

15260

FULL THICKNESS GRAFT, FREE, INCLUDING DIRECT CLOSURE OFDONOR SITE, NOSE, EARS, EYELIDS, AND/OR LIPS;20 SQ CM OR LESS cohort cohort cohort cohort cohort

15261

Full thickness graft, free, including direct closure of donor site, nose, ears, eyelids, and/or lips; each additional 20 sq cm, or part thereof (List separately in addition to code for primary procedu statewide

15271

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM;FIRST 25 SQ CM OR LESS WOUND SURFACE AREA cohort cohort cohort cohort cohort

15272

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM;EACH ADDITIONAL 25 SQ CM WOUND SURFACE AREA, OR P ART THEREOF (LIST SEPARATELY IN ADDITION TO CODE F cohort cohort cohort cohort

15273

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; FIRST 100 SQ CM WOUND SURFACE AREA, OR 1% OF BODY AREA OF INFANTS AND CHILDREN cohort cohort cohort cohort

15274

APPLICATION OF SKIN SUBSTITUTE GRAFT TO TRUNK, ARMS, LEGS, TOTAL WOUND SURFACE AREA GREATER THAN OR EQUAL TO 100 SQ CM; EACH ADDITIONAL 100 SQ CM WOUND SURFACE AREA, OR PART THEREOF, OR EACH ADDITIONA cohort cohort cohort cohort

15275

APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; FIRST 25 SQ CM OR LES cohort cohort cohort cohort cohort

15276

APPLICATION OF SKIN SUBSTITUTE GRAFT TO FACE, SCALP, EYELIDS, MOUTH, NECK, EARS, ORBITS, GENITALIA, HANDS, FEET, AND/OR MULTIPLE DIGITS, TOTAL WOUND SURFACE AREA UP TO 100 SQ CM; EACH ADDITIONAL 25 SQ statewide

15574

FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUTTRANSFER; FOREHEAD, CHEEKS, CHIN, MOUTH, NECK, AXILLAE, GENITALIA, HANDS OR FEET cohort cohort

15576

FORMATION OF DIRECT OR TUBED PEDICLE, WITH OR WITHOUTTRANSFER; EYELIDS, NOSE, EARS, LIPS, OR INTRAORAL cohort cohort

15600 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); ATTRUNK cohort cohort

15610 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); ATSCALP, ARMS, OR LEGS statewide

15620

DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); ATFOREHEAD, CHEEKS, CHIN, NECK, AXILLAE, GENITALIA, HANDS (EXCEPT 15625), OR FEET cohort cohort cohort

15630 DELAY OF FLAP OR SECTIONING OF FLAP (DIVISION AND INSET); ATEYELIDS, NOSE, EARS, OR LIPS cohort cohort

15650 TRANSFER, INTERMEDIATE, OF ANY PEDICLE FLAP (EG, ABDOMEN TO WRIST, "WALKING" TUBE), ANY LOCATION cohort cohort

15731 FOREHEAD FLAP WITH PRESERVATION OF VASCULAR PEDICLE (EG, AXIAL PATTERN FLAP, PARAMEDIAN FOREHEAD FLAP) cohort cohort

15732

MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; HEAD AND NECK(EG, TEMPORALIS, MASSETER, STERNOCLEIDOMASTOID, LEVATOR SCAPULAE) cohort cohort cohort cohort cohort

15734 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; TRUNK cohort cohort cohort

15736 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; UPPEREXTREMITY cohort cohort cohort

15738 MUSCLE, MYOCUTANEOUS, OR FASCIOCUTANEOUS FLAP; cohort cohort

30

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

LOWEREXTREMITY

15740 FLAP; ISLAND PEDICLE REQUIRING IDENTIFICATION AND DISSECTION OF AN ANATOMICALLY NAMED AXIAL VESSEL statewide

15760 GRAFT; COMPOSITE (EG, FULL THICKNESS OF EXTERNAL EAR ORNASAL ALA), INCLUDING PRIMARY CLOSURE, DONOR AREA cohort cohort cohort

15770 GRAFT; DERMA-FAT-FASCIA statewide

15776

PUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN 15 PUNCH GRAFTSPUNCH GRAFT FOR HAIR TRANSPLANT; MORE THAN15 PUNCH GRAFTS statewide

15777

IMPLANTATION OF BIOLOGIC IMPLANT (EG, ACELLULAR DERMAL MATRIX) FOR SOFT TISSUE REINFORCEMENT (EG, BREAST, TRUNK) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

15781 Dermabrasion; segmental, face cohort cohort cohort

15821 BLEPHAROPLASTY, LOWER EYELID; WITH EXTENSIVE HERNIATED FATPAD statewide

15822 BLEPHAROPLASTY, UPPER EYELID; cohort cohort cohort

15823 BLEPHAROPLASTY, UPPER EYELID; WITH EXCESSIVE SKIN WEIGHTING DOWN LID cohort cohort cohort cohort cohort cohort

15829 RHYTIDECTOMY; SUPERFICIAL MUSCULOAPONEUROTIC SYSTEM (SMAS)FLAP statewide

15830

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY); ABDOMEN, INFRAUMBILICAL PANNICULECTOMY cohort cohort cohort cohort

15839 EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDING LIPECTOMY); OTHER AREA cohort cohort

15847

EXCISION, EXCESSIVE SKIN AND SUBCUTANEOUS TISSUE (INCLUDES LIPECTOMY), ABDOMEN (EG, ABDOMINOPLASTY) (INCLUDES UMBILICAL TRANSPOSITION AND FASCIAL PLICATION) (LIST SEPARATELY IN ADDITION TO CODE FOR PR statewide

15850 REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL), SAMESURGEON cohort cohort cohort cohort

15851 REMOVAL OF SUTURES UNDER ANESTHESIA (OTHER THAN LOCAL),OTHER SURGEON cohort cohort

15852 DRESSING CHANGE (FOR OTHER THAN BURNS) UNDER ANESTHESIA(OTHER THAN LOCAL) cohort cohort cohort

15876 SUCTION ASSISTED LIPECTOMY; HEAD AND NECK statewide

15877 SUCTION ASSISTED LIPECTOMY; TRUNK cohort cohort cohort

15878 SUCTION ASSISTED LIPECTOMY; UPPER EXTREMITY statewide

15879 SUCTION ASSISTED LIPECTOMY; LOWER EXTREMITY statewide

15931

EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE;EXCISION, SACRAL PRESSURE ULCER, WITH PRIMARY SUTURE; statewide

15946

EXCISION, ISCHIAL PRESSURE ULCER, WITH OSTECTOMY, INPREPARATION FOR MUSCLE OR MYOCUTANEOUS FLAP OR SKIN GRAFT CLOSURE statewide

16000 INITIAL TREATMENT, FIRST DEGREE BURN, WHEN NO MORETHANLOCAL TREATMENT cohort cohort cohort cohort cohort

16020

*DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT;WITHOUT ANESTHESIA, OFFICE OR HOSPITAL, SMALL *DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT; cohort cohort cohort cohort cohort

16025

*DRESSINGS AND/OR DEBRIDEMENT, INITIAL OR SUBSEQUENT;WITHOUT ANESTHESIA, MEDIUM (EG, WHOLE FACE OR WHOLE EXTREMITY) cohort cohort cohort cohort

16030

DRESSINGS AND/OR DEBRIDEMENT OF PARTIAL-THICKNESS BURNS, INITIAL OR SUBSEQUENT; LARGE (EG, MORE THAN1 EXTREMITY, OR GREATER THAN 10% TOTAL BODY SURFA CE AREA) cohort cohort cohort

17000

Destruction (eg, laser surgery, electrosurgery, cryosurgery chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratosis) first lesion cohort cohort

31

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

17003

DESTRUCTION BY ANY METHOD, INCLUDING LASER, WITH OR WITHOUT SURGICAL CURETTEMENT, ALL BENIGN OR PREMALIGNANT LESIONS (EG, ACTINIC KERATOSES) OTHER THAN SKIN TAGS OR CUTANEOUS statewide

17004

Destruction (eg, laser surgery, electrosurgery, cryosurgery chemosurgery, surgical curettement), premalignant lesions (eg, actinic keratosis) 15 or more lesions statewide

17106

DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG,LASER TECHNIQUE); LESS THAN 10 SQ CM DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, cohort cohort cohort

17107

DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG,LASER TECHNIQUE); 10.0 - 50.0 SQ CM DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG, cohort cohort

17108

DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS (EG,LASER TECHNIQUE); OVER 50.0 SQ CM DESTRUCTION OF CUTANEOUS VASCULAR PROLIFERATIVE LESIONS(EG, statewide

17110

Destruction (e.g., laser surgery, electrosurgery, cryosurgery, chemosurgery, surgical curettement), of benign lesions other than skin tags or cutaneous vascular proliferative lesions; up to 14 lesions cohort cohort cohort cohort cohort

17111 DESTRUCTION BY ANY METHOD OF FLAT WARTS, MOLLUSCUMCONTAGIOSUM, OR MILIA; 15 OR MORE LESIONS cohort cohort cohort

17250 *CHEMICAL CAUTERIZATION OF GRANULATION TISSUE (PROUD FLESH, SINUS OR FISTULA) cohort cohort cohort cohort cohort cohort

17260

*DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK,ARMS ORLEGS; LESION DIAMETER 0.5 CM OR LESS *DES TRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR statewide

17261

DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS ORLEGS; LESION DIAMETER 0.6 TO 1.0 CM DESTRUCTION, MALIGNANT LESION, ANY METHOD, TRUNK, ARMS OR statewide

17270

*DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP,NECK,HANDS, FEET, GENITALIA; LESION DIAMETER 0.5 CM OR LESS *DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, statewide

17271

DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK,HANDS, FEET, GENITALIA; LESION DIAMETER 0.6 TO 1.0 CM DESTRUCTION, MALIGNANT LESION, ANY METHOD, SCALP, NECK, statewide

17280

*DESTRUCTION, MALIGNANT LESION, ANY METHOD, FACE, EARS,EYELIDS, NOSE, LIPS, MUCOUS MEMBRANE; LESION DIAMETER 0.5 CM OR LESS statewide

17311

MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND H statewide

17312

MOHS MICROGRAPHIC TECHNIQUE, INCLUDING REMOVAL OF ALL GROSS TUMOR, SURGICAL EXCISION OF TISSUE SPECIMENS, MAPPING, COLOR CODING OF SPECIMENS, MICROSCOPIC EXAMINATION OF SPECIMENS BY THE SURGEON, AND H statewide

17340 *CRYOTHERAPY (CO2 SLUSH, LIQUID N2) FOR ACNE statewide

17999

UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUSTISSUE UNLISTED PROCEDURE, SKIN, MUCOUS MEMBRANE AND SUBCUTANEOUS cohort cohort cohort cohort cohort cohort

19000 *PUNCTURE ASPIRATION OF CYST OF BREAST; cohort cohort cohort cohort cohort

19001

PUNCTURE ASPIRATION OF CYST OF BREAST; EACH ADDITIONAL CYST (LIST SEPARATELY IN ADDITION TO CODE FORPRIMARY PROCEDURE) cohort cohort cohort cohort

19020 MASTOTOMY WITH EXPLORATION OR DRAINAGE OF ABSCESS,DEEP cohort cohort cohort cohort cohort cohort

19030 INJECTION PROCEDURE ONLY FOR MAMMARY DUCTOGRAM ORGALACTOGRAM cohort cohort cohort

32

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

19100 *BIOPSY OF BREAST; NEEDLE CORE (SEPARATE PROCEDURE) cohort cohort cohort cohort

19101 BIOPSY OF BREAST; INCISIONAL cohort cohort cohort cohort cohort

19102 BIOPSY OF BREAST; PERCUTANEOUS, NEEDLE CORE, USINGIMAGING GUIDANCE cohort cohort cohort cohort cohort cohort

19103

BIOPSY OF BREAST; PERCUTANEOUS, AUTOMATED VACUUM ASSISTED OR ROTATING BIOPSY DEVICE, USING IMAGING GUIDANCE cohort cohort cohort cohort cohort

19110

NIPPLE EXPLORATION, WITH OR WITHOUT EXCISION OF A SOLITARYLACTIFEROUS DUCT OR A PAPILLOMA LACTIFEROUS DUCT cohort cohort cohort cohort cohort

19112 EXCISION OF LACTIFEROUS DUCT FISTULA statewide

19120

EXCISION OF CYST, FIBROADENOMA, OR OTHER BENIGN ORMALIGNANT TUMOR, ABERRANT BREAST TISSUE, DUCT LES ION, NIPPLE OR AREOLAR LESION (EXCEPT 19300), OPEN, MALE OR FEMALE, 1 OR MORE LESIONS cohort cohort cohort cohort cohort cohort

19125

EXCISION OF BREAST LESION IDENTIFIED BY PRE-OPERATIVEPLACEMENT OF RADIOLOGICAL MARKER; SINGLE LESION cohort cohort cohort cohort cohort

19126

EXCISION OF BREAST LESION IDENTIFIED BY PREOPERATIVEPLACEMENT OF RADIOLOGICAL MARKER; EACH ADDITIONAL LESION SEPARATELY IDENTIFIED BY A RADIOLOGICAL MARKER (LIST cohort cohort cohort cohort

19260 EXCISION OF CHEST WALL TUMOR INCLUDING RIBS cohort cohort

19290 PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; cohort cohort cohort cohort cohort cohort

19291

PREOPERATIVE PLACEMENT OF NEEDLE LOCALIZATION WIRE, BREAST; EACH ADDITIONAL LESION (LIST SEPARATELY IN ADDITION TO CODE cohort cohort cohort cohort

19295

IMAGE GUIDED PLACEMENT, METALLIC LOCALIZATION CLIP, PERCUTANEOUS, DURING BREAST BIOPSY/ASPIRATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort cohort

19297

Placement of radiotherapy afterloading expandable catheter (single or multichannel) into the breast for interstitial radioelement application following partial mastectomy, includes imaging guidance; c statewide

19298

PLACEMENT OF RADIOTHERAPY AFTERLOADING BRACHYTHERAPY CATHETERS INTO BREAST FOR INTERSTITIAL RADIOELEMENT APPLICATION FOLLOWING PARTIAL MASTECTOMY, INCL IMAGING GUIDANCE statewide

19300 MASTECTOMY FOR GYNECOMASTIA cohort cohort cohort cohort

19301 MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); cohort cohort cohort cohort cohort cohort

19302

MASTECTOMY, PARTIAL (EG, LUMPECTOMY, TYLECTOMY, QUADRANTECTOMY, SEGMENTECTOMY); WITH AXILLARY LYMPHADENECTOMY cohort cohort cohort cohort

19303 MASTECTOMY, SIMPLE, COMPLETE cohort cohort cohort cohort cohort

19304 MASTECTOMY, SUBCUTANEOUS cohort cohort cohort cohort cohort

19305 MASTECTOMY, RADICAL, INCLUDING PECTORAL MUSCLES, AXILLARY LYMPH NODES cohort cohort

19307

MASTECTOMY, MODIFIED RADICAL, INCLUDING AXILLARY LYMPH NODES, WITH OR WITHOUT PECTORALIS MINOR MUSCLE, BUT EXCLUDING PECTORALIS MAJOR MUSCLE cohort cohort cohort cohort cohort

19316 MASTOPEXY cohort cohort cohort cohort cohort cohort

19318 REDUCTION MAMMAPLASTY cohort cohort cohort cohort cohort cohort

19324

MAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANTMAMMAPLASTY, AUGMENTATION; WITHOUT PROSTHETIC IMPLANT statewide

19325

MAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANTMAMMAPLASTY, AUGMENTATION; WITH PROSTHETIC IMPLANT cohort cohort cohort

19328 REMOVAL OF INTACT MAMMARY IMPLANTREMOVAL OF INTACTMAMMARY IMPLANT cohort cohort cohort cohort cohort

19330 REMOVAL OF MAMMARY IMPLANT MATERIALREMOVAL OF cohort cohort cohort

33

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MAMMARY IMPLANT MATERIAL

19340

IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWINGMASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION IMMEDIATE INSERTION OF BREAST PROSTHESIS FOLLOWING cohort cohort cohort cohort cohort cohort

19342

DELAYED INSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEXY, MASTECTOMY OR IN RECONSTRUCTION DELAYEDINSERTION OF BREAST PROSTHESIS FOLLOWING MASTOPEX Y, cohort cohort cohort cohort cohort cohort

19350 NIPPLE/AREOLA RECONSTRUCTION cohort cohort cohort cohort

19355 CORRECTION OF INVERTED NIPPLES statewide

19357 BREAST RECONSTRUCTION, IMMEDIATE OR DELAYED, WITH TISSUEEXPANDER, INCLUDING SUBSEQUENT EXPANSION cohort cohort cohort cohort cohort cohort

19361 Breast reconstruction with latissimus dorsi flap, without prosthetic implant cohort cohort cohort

19364 BREAST RECONSTRUCTION WITH FREE FLAP statewide

19366 BREAST RECONSTRUCTION WITH OTHER TECHNIQUE cohort cohort cohort cohort cohort

19367

BREAST RECONSTRUCTION WITH TRANSVERSE RECTUS ABDOMINISMYOCUTANEOUS FLAP(TRAM), SINGLE PEDICLE, INCLUDING CLOSURE OF DONOR SITE; statewide

19370 OPEN PERIPROSTHETIC CAPSULOTOMY, BREAST cohort cohort cohort cohort

19371 PERIPROSTHETIC CAPSULECTOMY, BREAST cohort cohort cohort cohort cohort

19380 REVISION OF RECONSTRUCTED BREAST cohort cohort cohort cohort cohort cohort

19396 PREPARATION OF MOULAGE FOR CUSTOM BREAST IMPLANT statewide

19499 UNLISTED PROCEDURE, BREAST cohort cohort

20005 Incision and drainage of soft tissue abscess, subfascial (ie, involves the soft tissue below the deep fascia) cohort cohort cohort

20101 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE); CHEST cohort cohort

20102 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE);ABDOMEN/FLANK/BACK cohort cohort

20103 EXPLORATION OF PENETRATING WOUND (SEPARATE PROCEDURE);EXTREMITY cohort cohort cohort cohort cohort

20200 BIOPSY, MUSCLE; SUPERFICIAL cohort cohort cohort

20205 BIOPSY, MUSCLE; DEEP cohort cohort cohort cohort

20206 *BIOPSY, MUSCLE, PERCUTANEOUS NEEDLE cohort cohort cohort cohort

20220

BIOPSY, BONE, TROCAR OR NEEDLE; SUPERFICIAL (EG, ILIUM,STERNUM, SPINOUS PROCESS, RIBS) BIOPSY, BONE, TROCAR OR NEEDLE; SUPERFICIAL (EG, ILIUM, cohort cohort cohort cohort

20225

BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (VERTEBRAL BODY,FEMUR) BIOPSY, BONE, TROCAR, OR NEEDLE; DEEP (VERTEBRAL BODY, cohort cohort cohort cohort cohort

20240

BIOPSY, BONE, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM,SPINOUS PROCESS, RIBS, TROCHANTER OF FEMUR) BIOPSY, BONE, EXCISIONAL; SUPERFICIAL (EG, ILIUM, STERNUM, cohort cohort cohort cohort cohort

20245 BIOPSY, BONE, EXCISIONAL; DEEP (EG, HUMERUS, ISCHIUM, FEMUR) cohort cohort cohort

2028F

Foot examination performed (includes examination through visual inspection, sensory exam with monofilament, and pulse exam - report when any of the 3 components are completed) (DM) statewide

20500 *INJECTION OF SINUS TRACT; THERAPEUTIC (SEPARATE PROCEDURE) cohort cohort

20501 *INJECTION OF SINUS TRACT; DIAGNOSTIC (SINOGRAM) cohort cohort cohort cohort

20520

*REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE *REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; SIMPLE cohort cohort cohort cohort cohort

20525

REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR COMPLICATED REMOVAL OF FOREIGN BODY IN MUSCLE OR TENDON SHEATH; DEEP OR cohort cohort cohort cohort

20526 INJECTION, THERAPEUTIC (LOCAL ANESTHETIC CORTICOSTEROID); CARPAL CANAL cohort cohort cohort cohort cohort

34

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

20550 *INJECTION, TENDON SHEATH, LIGAMENT, TRIGGER POINTS ORGANGLION CYST cohort cohort cohort cohort cohort

20551 INJECTION; TENDON ORIGIN/INSERTION cohort cohort

20552 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S);1 OR 2 MUSCLE(S) cohort cohort cohort cohort cohort cohort

20553 INJECTION(S); SINGLE OR MULTIPLE TRIGGER POINT(S);3 OR MORE MUSCLE(S) cohort cohort cohort cohort cohort cohort

20600

*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SMALL JOINT,BURSA OR GANGLION CYST (EG, FINGERS, TOES)*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; SM ALL JOINT, cohort cohort cohort cohort cohort cohort

20605

*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; INTERMEDIATEJOINT, BURSA OR GANGLION CYST (EG, TEMPOROMANDIBULAR, ACROMIOCLAVICULAR, WRIST, ELBOW OR ANKLE, OLECRANON BURSA) cohort cohort cohort cohort cohort cohort

20610

*ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT ORBURSA (EG, SHOULDER, HIP, KNEE JOINT, SUBACROMIAL BURSA) *ARTHROCENTESIS, ASPIRATION AND/OR INJECTION; MAJOR JOINT OR cohort cohort cohort cohort cohort cohort

20612 ASPIRATION &/OR INJECTION, GANGLION CYST(S) ANY LOCATION cohort cohort cohort cohort cohort

20615 ASPIRATION AND INJECTION FOR TREATMENT OF BONE CYST cohort cohort cohort

20650

*INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETALTRACTION, INCLUDING REMOVAL (SEPARATE PROCEDURE) *INSERTION OF WIRE OR PIN WITH APPLICATION OF SKELETAL statewide

20660 Application of cranial tongs, caliper, or stereotactic frame, including removal (separate procedure) cohort cohort

20661 APPLICATION OF HALO, INCLUDING REMOVAL; CRANIALAPPLICATION OF HALO, INCLUDING REMOVAL; CRANIAL cohort cohort

20665 REMOVAL OF TONGS OR HALO APPLIED BY ANOTHER INDIVIDUAL statewide

20670

*REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN ORROD) (SEPARATE PROCEDURE) *REMOVAL OF IMPLANT; SUPERFICIAL, (EG, BURIED WIRE, PIN OR cohort cohort cohort cohort

20680

REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METALBAND, NAIL, ROD OR PLATE) REMOVAL OF IMPLANT; DEEP (EG, BURIED WIRE, PIN, SCREW, METAL cohort cohort cohort cohort cohort cohort

20690 APPLICATION OF A UNIPLANE (PINS OR WIRES IN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYSTEM cohort cohort cohort

20692

APPLICATION OF A MULTIPLANE (PINS OR WIRES IN MORETHAN 1 PLANE), UNILATERAL, EXTERNAL FIXATION SYST EM (EG, ILIZAROV, MONTICELLI TYPE) cohort cohort cohort cohort

20693

ADJUSTMENT OR REVISION OF EXTERNAL FIXATION SYSTEMREQUIRINGANESTHESIA (EG, NEW PIN(S) OR WIRE(S) AN D/OR NEW RING(S) OR BAR(S)) cohort cohort

20694 REMOVAL, UNDER ANESTHESIA, OF EXTERNAL FIXATION SYSTEM cohort cohort cohort cohort cohort

20696

APPLICATION OF MULTIPLANE (PINS OR WIRES IN MORE THAN 1 PLANE), UNILATERAL, EXTERNAL FIXATION WITH STEREOTACTIC COMPUTER-ASSISTED ADJUSTMENT (EG, SPATIAL FRAME), INCLUDING IMAGING; INITIAL AND SUBSEQU statewide

20822 REPLANTATION, DIGIT, EXCLUDING THUMB (INCLUDES DISTAL TIP TOSUBLIMIS TENDON INSERTION); COMPLETE AMPUTATION cohort cohort

20900 Bone graft, any donor area; minor or small (e.g., dowel or button) cohort cohort cohort cohort cohort

20902 Bone graft, any donor area; major or large cohort cohort cohort

20912 Cartilage graft; nasal septum cohort cohort cohort cohort cohort

20924 Tendon graft, from a distance (e.g., palmaris, toeextensor, plantaris) cohort cohort cohort cohort cohort

20926 Tissue grafts, other (e.g., paratenon, far, dermis) cohort cohort cohort cohort cohort

20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) cohort cohort cohort cohort cohort cohort

20931 Allograft, structural, for spine surgery only (List separately in addition to cohort cohort cohort cohort

35

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

code for primary procedure)

20936

Autograft for spine surgery only (includes harvesting the graft); local (e.g. ribs, spinous process,or laminar fragments) obtained from the same inci sion cohort cohort cohort cohort cohort

20937 Autograft for spine surgery only (includes harvesting the graft); morselized (through separate skin or fascial incision) cohort cohort cohort

20938

Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) cohort cohort cohort cohort

20982

ABLATION, BONE TUMOR(S) (EG, OSTEOID OSTEOMA, METASTASIS) RADIOFREQUENCY, PERCUTANEOUS, INCLUDING COMPUTED TOMOGRAPHIC GUIDANCE cohort cohort cohort

20999 UNLISTED PROCEDURE, MUSCULOSKELETAL SYSTEM, GENERAL cohort cohort cohort cohort cohort

21011 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM statewide

21012 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER cohort cohort cohort cohort

21013

EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN2 CM cohort cohort

21014

EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER cohort cohort cohort cohort

21015 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP; LESS THAN 2 CM statewide

21016 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER cohort cohort cohort cohort

21025 EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS);MANDIBLE cohort cohort

21026 EXCISION OF BONE (EG, FOR OSTEOMYELITIS OR BONE ABSCESS);FACIAL BONE(S) statewide

21030 EXCISION OF BENIGN TUMOR OR CYST OF FACIAL BONE OTHER THANMANDIBLE statewide

21032 EXCISION OF MAXILLARY TORUS PALATINUS statewide

21034 EXCISION OF MALIGNANT TUMOR OF FACIAL BONE OTHER THANMANDIBLE statewide

21040

EXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; SIMPLEEXCISION OF BENIGN CYST OR TUMOR OF MANDIBLE; SIMPLE cohort cohort

21046 EXCISION, BENIGN TUMOR/CYST, MANDIBL; INTRA-ORAL OSTEOTOMY & PARTIAL MANDIBULECTOMY cohort cohort cohort

21047 EXCISION, BENIGN TUMOR/CYST, MANDIBLE: EXTRA-ORAL OSTEOMOTY & PARTIAL MANDIBULECTOMY statewide

21048 EXCISION, BENIGN TUMOR/CYST, MAXILLA; INTRA-ORAL OSTEOTOMY statewide

21060

MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT(SEPARATE PROCEDURE) MENISCECTOMY, PARTIAL OR COMPLETE, TEMPOROMANDIBULAR JOINT statewide

21070 CORONOIDECTOMY (SEPARATE PROCEDURE) statewide

21085

IMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINTIMPRESSION AND CUSTOM PREPARATION; ORAL SURGICAL SPLINT statewide

21089 UNLISTED MAXILLOFACIAL PROSTHETIC PROCEDUREUNLISTED MAXILLOFACIAL PROSTHETIC PROCEDURE statewide

21110

APPLICATION OF INTERDENTAL FIXATION DEVICE FOR CONDITIONSOTHER THAN FRACTURE OR DISLOCATION, INCLUDES REMOVAL cohort cohort

21120

GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC MATERIAL) GENIOPLASTY; AUGMENTATION (AUTOGRAFT, ALLOGRAFT, PROSTHETIC cohort cohort

21121 GENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECEGENIOPLASTY; SLIDING OSTEOTOMY, SINGLE PIECE statewide

36

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

21122

GENIOPLASTY; SLIDING OSTEOTOMIES, TWO OR MORE OSTEOTOMIES(EG, WEDGE EXCISION OR BONE WEDGE REVERSAL FOR ASYMMETRICAL CHIN) statewide

21123

GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONEGRAFTS (INCLUDES OBTAINING AUTOGRAFTS) GENIOPLASTY; SLIDING, AUGMENTATION WITH INTERPOSITIONAL BONE statewide

21141

RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENTMOVEMENT IN ANY DIRECTION (EG, FOR LONG FACE SYNDROME), WITHOUT BONE GRAFT statewide

21142

RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENTMOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT RECONSTRUCTION MIDFACE, LEFORT I; TWO PIECES, SEGMENT statewide

21143

RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES,SEGMENT MOVEMENT IN ANY DIRECTION, WITHOUT BONE GRAFT RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES, statewide

21145

RECONSTRUCTION MIDFACE, LEFORT I; SINGLE PIECE, SEGMENTMOVEMENT IN ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) cohort cohort cohort

21147

RECONSTRUCTION MIDFACE, LEFORT I; THREE OR MORE PIECES,SEGMENT MOVEMENT IN ANY DIRECTION, REQUIRING BONE GRAFTS (INCLUDES OBTAINING AUTOGRAFTS) (EG, UNGRAFTED BILATERAL cohort cohort

21181 RECONSTRUCTION BY CONTOURING OF BENIGN TUMOR OF CRANIALBONES (EG, FIBROUS DYSPLASIA), EXTRACRANIAL cohort cohort

21196

RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTALSPLIT; WITH INTERNAL RIGID FIXATION RECONSTRUCTION OF MANDIBULAR RAMI AND/OR BODY, SAGITTAL cohort cohort cohort cohort

21198 OSTEOTOMY, MANDIBLE, SEGMENTALOSTEOTOMY, MANDIBLE,SEGMENTAL statewide

21210 GRAFT, BONE; NASAL, MAXILLARY OR MALAR AREAS (INCLUDESOBTAINING GRAFT) statewide

21215 GRAFT, BONE; MANDIBLE (INCLUDES OBTAINING GRAFT) cohort cohort

21230 GRAFT; RIB CARTILAGE, AUTOGENOUS, TO FACE, CHIN, NOSE OR EAR(INCLUDES OBTAINING GRAFT) cohort cohort

21235 GRAFT; EAR CARTILAGE, AUTOGENOUS, TO NOSE OR EAR (INCLUDESOBTAINING GRAFT) cohort cohort cohort cohort

21240

ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUTAUTOGRAFT (INCLUDES OBTAINING GRAFT) ARTHROPLASTY, TEMPOROMANDIBULAR JOINT, WITH OR WITHOUT cohort cohort cohort

21244

RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRANSOSTEAL BONEPLATE (EG, MANDIBULAR STAPLE BONE PLATE)RECONSTRUCTION OF MANDIBLE, EXTRAORAL, WITH TRAN SOSTEAL BONE statewide

21246

RECONSTRUCTION OF MANDIBLE OR MAXILLA, SUBPERIOSTEALIMPLANT; COMPLETE RECONSTRUCTION OF MANDIBLE ORMAXILLA, SUBPERIOSTEAL statewide

21282 LATERAL CANTHOPEXY cohort cohort

21299

UNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDUREUNLISTED CRANIOFACIAL AND MAXILLOFACIAL PROCEDURE statewide

21315

*CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUTSTABILIZATION *CLOSED TREATMENT OF NASAL BONE FRACTURE; WITHOUT cohort cohort cohort cohort

21320

CLOSED TREATMENT OF NASAL BONE FRACTURE; WITH STABILIZATION CLOSED TREATMENT OF NASAL BONE FRACTURE;WITH STABILIZATION cohort cohort cohort cohort cohort

21325

OPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATEDOPEN TREATMENT OF NASAL FRACTURE; UNCOMPLICATED cohort cohort cohort

21330 OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH statewide

37

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

INTERNALAND/OR EXTERNAL SKELETAL FIXATION OPEN TREATMENT OF NASAL FRACTURE; COMPLICATED, WITH INTERNAL

21335

OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANTOPENTREATMENT OF FRACTURED SEPTUM OPEN TREATMENT OF NASAL FRACTURE; WITH CONCOMITANT OPEN cohort cohort cohort

21336

OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUTSTABILIZATION OPEN TREATMENT OF NASAL SEPTAL FRACTURE, WITH OR WITHOUT cohort cohort cohort

21337

CLOSED TREATMENT OF NASAL SEPTAL FRACTURE, WITH ORWITHOUTSTABILIZATION CLOSED TREATMENT OF NASAL S EPTAL FRACTURE, WITH OR WITHOUT cohort cohort cohort cohort cohort

21343

OPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTUREOPEN TREATMENT OF DEPRESSED FRONTAL SINUS FRACTURE statewide

21346

OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); WITH WIRING AND/OR LOCAL FIXATIONOPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II statewide

21347

OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II TYPE); REQUIRING MULTIPLE OPEN APPROACHES OPEN TREATMENT OF NASOMAXILLARY COMPLEX FRACTURE (LEFORT II statewide

21355

*PERCUTANEOUS TREATMENT OF FRACTURE OF MALAR AREA,INCLUDINGZYGOMATIC ARCH AND MALAR TRIPOD, WITH MA NIPULATION *PERCUTANEOUS TREATMENT OF FRACTURE OFMALAR AREA, INCLUDING statewide

21356

OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG,GILLIES APPROACH) OPEN TREATMENT OF DEPRESSED ZYGOMATIC ARCH FRACTURE (EG, cohort cohort cohort cohort

21360

OPEN TREATMENT OF DEPRESSED MALAR FRACTURE, INCLUDINGZYGOMATIC ARCH AND MALAR TRIPOD OPEN TREATMENTOF DEPRESSED MALAR FRACTURE, INCLUDING cohort cohort

21365

OPEN TREATMENT OF COMPLICATED (EG, COMMINUTED OR INVOLVINGCRANIAL NERVE FORAMINA) FRACTURE(S) OF MALAR AREA, INCLUDING ZYGOMATIC ARCH AND MALAR TRIPOD; WITH INTERNAL FIXATION AND cohort cohort cohort cohort

21386

OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE;PERIORBITAL APPROACH OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; cohort cohort cohort

21390

OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE;PERIORBITAL APPROACH, WITH ALLOPLASTIC OR OTHER IMPLANT OPEN TREATMENT OF ORBITAL FLOOR "BLOWOUT" FRACTURE; cohort cohort cohort

21406

OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUTIMPLANT OPEN TREATMENT OF FRACTURE OF ORBIT, EXCEPT BLOWOUT; WITHOUT cohort cohort

21421

CLOSED TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I TYPE), WITH INTERDENTAL WIRE FIXATION ORFIXATION OF DENTURE OR SPLINT statewide

21422

OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT ITYPE); OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT I cohort cohort

21423

OPEN TREATMENT OF PALATAL OR MAXILLARY FRACTURE (LEFORT ITYPE); COMPLICATED (COMMINUTED OR INVOLVINGCRANIAL NERVE FORAMINA), MULTIPLE APPROACHES cohort cohort

21440

CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGEFRACTURE (SEPARATE PROCEDURE) CLOSED TREATMENT OF MANDIBULAR OR MAXILLARY ALVEOLAR RIDGE statewide

21451

CLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATIONCLOSED TREATMENT OF MANDIBULAR FRACTURE; WITH MANIPULATION cohort cohort cohort

21452 PERCUTANEOUS TREATMENT OF MANDIBULAR FRACTURE, WITH EXTERNALFIXATION PERCUTANEOUS TREATMENT OF statewide

38

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MANDIBULAR FRACTURE, WITH EXTERNAL

21453

CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTALFIXATION CLOSED TREATMENT OF MANDIBULAR FRACTURE WITH INTERDENTAL cohort cohort cohort

21461

OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTALFIXATION OPEN TREATMENT OF MANDIBULAR FRACTURE; WITHOUT INTERDENTAL statewide

21462

OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTALFIXATION OPEN TREATMENT OF MANDIBULAR FRACTURE; WITH INTERDENTAL cohort cohort cohort

21465

OPEN TREATMENT OF MANDIBULAR CONDYLAR FRACTUREOPENTREATMENT OF MANDIBULAR CONDYLAR FRACTURE cohort cohort

21470

OPEN TREATMENT OF COMPLICATED MANDIBULAR FRACTURE BYMULTIPLE SURGICAL APPROACHES INCLUDING INTERNAL FIXATION, INTERDENTAL FIXATION, AND/OR WIRING OF DENTURES OR SPLINTS cohort cohort

21480

CLOSED TREATMENT OF TEMPOROMANDIBULAR DISLOCATION;INITIALOR SUBSEQUENT CLOSED TREATMENT OF TEMPORO MANDIBULAR DISLOCATION; INITIAL cohort cohort cohort cohort

21497 INTERDENTAL WIRING, FOR CONDITION OTHER THAN FRACTURE statewide

21499 UNLISTED MUSCULOSKELETAL PROCEDURE, HEAD statewide

21501

INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFTTISSUES OF NECK OR THORAX; INCISION AND DRAINAGE, DEEP ABSCESS OR HEMATOMA, SOFT cohort cohort cohort

21550 BIOPSY, SOFT TISSUE OF NECK OR THORAX cohort cohort cohort cohort

21552 EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort cohort

21554

EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort cohort cohort cohort

21555 EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort cohort cohort

21556 EXCISION, TUMOR, SOFT TISSUE OF NECK OR ANTERIOR THORAX, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5CM cohort cohort cohort cohort

21557 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR ANTERIOR THORAX; LESS THAN 5 CM cohort cohort

21600 EXCISION OF RIB, PARTIAL statewide

21627 STERNAL DEBRIDEMENT statewide

21685 HYOID MYOTOMY AND SUSPENSION statewide

21720 DIVISION OF STERNOCLEIDOMASTOID FOR TORTICOLLIS, OPENOPERATION; WITHOUT CAST APPLICATION statewide

21800

CLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACHCLOSED TREATMENT OF RIB FRACTURE, UNCOMPLICATED, EACH cohort cohort

21899 UNLISTED PROCEDURE, NECK OR THORAX cohort cohort cohort

21920 BIOPSY, SOFT TISSUE OF BACK OR FLANK; SUPERFICIAL cohort cohort

21925 BIOPSY, SOFT TISSUE OF BACK OR FLANK; DEEP statewide

21930 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort

21931 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort

21932 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort cohort

21933 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort cohort cohort

21936 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER statewide

22102

PARTIAL EXCISION OF POSTERIOR VERTEBRAL COMPONENT (EG,SPINOUS PROCESS, LAMINA OR FACET) FOR INTRINSIC BONY LESION, SINGLE VERTEBRAL SEGMENT; LUMBAR cohort cohort

39

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

22114

PARTIAL EXCISION OF VERTEBRAL BODY, FOR INTRINSIC BONYLESION, WITHOUT DECOMPRESSION OF SPINAL CORD OR NERVE ROOT(S), SINGLE VERTEBRAL SEGMENT; LUMBAR statewide

22318

OPEN TREATMENT AND/OR REDUCTION OF ODONTOID FRACTURE(S) AND OR DISLOCATION(S) (INCLUDING OS ODONTOIDEUM), ANTERIOR APPROACH, INCLUDING PLACEMENT OF INTERNAL FIXATION; WITHOUT GRAFTING statewide

22520

PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; THORACIC cohort cohort cohort

22521

PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; LUMBAR cohort cohort

22522

PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY INCLUDED WHEN PERFORMED), 1 VERTEBRAL BODY, UNILATERAL OR BILATERAL INJECTION; EACH ADDITIONAL THORACIC OR LUMBAR VERTEBRAL BODY (LIST SEPARATELY IN ADDITION T cohort cohort

22523

PERCUTANEOUS VERTEBRAL AUGMENTATION, INCLUDING CAVITY CREATION (FRACTURE REDUCTION AND BONE BIOPSY INCLUDED WHEN PERFORMED) USING MECHANICAL DEVICE, 1VERTEBRAL BODY, UNILATERAL OR BILATERAL CANNULATI cohort cohort cohort cohort

22524


22525


22548

ARTHRODESIS, ANTERIOR TRANSORAL OR EXTRAORAL TECHNIQUE,CLIVUS-C1-C2 (ATLAS-AXIS), WITH OR WITHOUT EXCISION OF ODONTOID PROCESS statewide

22551

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 cohort cohort cohort cohort cohort cohort

22552

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List cohort cohort cohort cohort cohort

22554

ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMALDISKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); CERVICAL BELOW C2 cohort cohort cohort cohort cohort

22558

ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMALDISKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); LUMBAR cohort cohort

22565 ADDED DURING FEE SCHEDULE LOAD PROCESS statewide

22585

ARTHRODESIS, ANTERIOR INTERBODY TECHNIQUE, INCLUDING MINIMALDISKECTOMY TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION); EACH ADDITIONAL INTERSPACE (LIST SEPARATELY cohort cohort

22600 ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLELEVEL; CERVICAL BELOW C2 SEGMENT cohort cohort cohort cohort

22612

ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLE LEVEL; LUMBAR (WITH LATERAL TRANSVERSE TECHNIQUE, WHEN PERFORMED) cohort cohort

22614

ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE, SINGLELEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

22630 ARTHRODESIS, POSTERIOR INTERBODY TECHNIQUE, SINGLEINTERSPACE; LUMBAR cohort cohort cohort

22633

ARTHRODESIS, COMBINED POSTERIOR OR POSTEROLATERAL TECHNIQUE WITH POSTERIOR INTERBODY TECHNIQUE INCLUDING LAMINECTOMY AND/OR DISCECTOMY SUFFICIENT TO PREPARE INTERSPACE (OTHER THAN FOR DECOMPRESSION), cohort cohort

22830 EXPLORATION OF SPINAL FUSION cohort cohort

40

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

22840

POSTERIOR NON-SEGMENTAL INSTRUMENTATION (EG, HARRINGTON ROD TECHNIQUE, PEDICLE FIXATION ACROSS 1 INTERSPACE, ATLANTOAXIAL TRANSARTICULAR SCREW FIXATION, SUBLAMINAR WIRING AT C1, FACET SCREW FIXATION) cohort cohort cohort cohort

22842 Posterior segmental instrumentation (e.g., pediclefixation, dual rods with multiple hooks and subla minar wires); 3 to 6 vertebral segments cohort cohort

22845 Anterior instrumentation; 2 to 3 vertebral segments cohort cohort cohort cohort cohort

22846 Anterior instrumentation; 4 to 7 vertebral segments cohort cohort cohort

22849 REINSERTION OF SPINAL FIXATION DEVICEREINSERTION OF SPINAL FIXATION DEVICE statewide

22850

REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG,HARRINGTON ROD) REMOVAL OF POSTERIOR NONSEGMENTAL INSTRUMENTATION (EG, cohort cohort

22851

Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methylmethacrylate) tovertebral defect or interspace (List separately i n addition to code for primary procedure) cohort cohort cohort cohort cohort cohort

22852

REMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATIONREMOVAL OF POSTERIOR SEGMENTAL INSTRUMENTATION cohort cohort

22855 REMOVAL OF ANTERIOR INSTRUMENTATIONREMOVAL OF ANTERIOR INSTRUMENTATION cohort cohort

22899 UNLISTED PROCEDURE, SPINEUNLISTED PROCEDURE, SPINE cohort cohort cohort

22900 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort cohort

22901 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort

22902 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort

22903 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort

22905 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER cohort cohort

22999 UNLISTED PROCEDURE, ABDOMEN, MUSCULOSKELETAL SYSTEM cohort cohort cohort cohort cohort

23000 REMOVAL OF SUBDELTOID (OR INTRATENDINOUS) CALCAREOUSDEPOSITS, ANY METHOD cohort cohort

23020 CAPSULAR CONTRACTURE RELEASE (EG, SEVER TYPE PROCEDURE) cohort cohort

23030 INCISION AND DRAINAGE, SHOULDER AREA; DEEP ABSCESSORHEMATOMA cohort cohort

23044

ARTHROTOMY, ACROMIOCLAVICULAR, STERNOCLAVICULAR JOINT,INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OFFOREIGN BODY ARTHROTOMY, ACROMIOCLAVICULAR, STE RNOCLAVICULAR JOINT, cohort cohort

23065 BIOPSY, SOFT TISSUE OF SHOULDER AREA; SUPERFICIAL statewide

23071 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort cohort

23073 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort cohort cohort cohort

23075 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort

23076 EXCISION, TUMOR, SOFT TISSUE OF SHOULDER AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort cohort

23120 CLAVICULECTOMY; PARTIAL cohort cohort cohort cohort cohort cohort

23130 ACROMIOPLASTY OR ACROMIONECTOMY, PARTIAL, WITH OR WITHOUTCORACOACROMIAL LIGAMENT RELEASE cohort cohort cohort cohort cohort

23140 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFCLAVICLE OR SCAPULA; cohort cohort

23150 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFPROXIMAL HUMERUS; statewide

23156 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFPROXIMAL HUMERUS; WITH ALLOGRAFT statewide

41

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

23200 RADICAL RESECTION OF TUMOR; CLAVICLE statewide

23330

REMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUSREMOVAL OF FOREIGN BODY, SHOULDER; SUBCUTANEOUS statewide

23331

REMOVAL OF FOREIGN BODY, SHOULDER; DEEP (EG, NEERHEMIARTHROPLASTY REMOVAL) REMOVAL OF FOREIGN BODY,SHOULDER; DEEP (EG, NEER statewide

23350 INJECTION PROCEDURE FOR SHOULDER ARTHROGRAPHY cohort cohort cohort cohort cohort cohort

23395 MUSCLE TRANSFER, ANY TYPE, SHOULDER OR UPPER ARM; SINGLE cohort cohort cohort

23405 TENOTOMY, SHOULDER AREA; SINGLE TENDON cohort cohort cohort cohort

23410 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF);ACUTE cohort cohort cohort cohort cohort cohort

23412 REPAIR OF RUPTURED MUSCULOTENDINOUS CUFF (EG, ROTATOR CUFF);CHRONIC cohort cohort cohort cohort cohort

23415 CORACOACROMIAL LIGAMENT RELEASE, WITH OR WITHOUTACROMIOPLASTY cohort cohort cohort

23420 RECONSTRUCTION OF COMPLETE SHOULDER (ROTATOR) CUFFAVULSION,CHRONIC (INCLUDES ACROMIOPLASTY) cohort cohort cohort cohort cohort

23430 TENODESIS OF LONG TENDON OF BICEPS cohort cohort cohort cohort cohort cohort

23440 RESECTION OR TRANSPLANTATION OF LONG TENDON OF BICEPS statewide

23450 CAPSULORRHAPHY, ANTERIOR; PUTTI-PLATT PROCEDURE ORMAGNUSON TYPE OPERATION cohort cohort

23455 CAPSULORRHAPHY, ANTERIOR; WITH LABRAL REPAIR (EG, BANKARTPROCEDURE) cohort cohort cohort cohort

23460 CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH BONE BLOCK cohort cohort

23462 CAPSULORRHAPHY, ANTERIOR, ANY TYPE; WITH CORACOID PROCESSTRANSFER cohort cohort cohort cohort cohort

23465 CAPSULORRHAPHY, GLENOHUMERAL JOINT, POSTERIOR, WITH ORWITHOUT BONE BLOCK cohort cohort

23466 CAPSULORRHAPHY, GLENOHUMERAL JOINT, ANY TYPEMULTI-DIRECTIONAL INSTABILITY cohort cohort

23470

ARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTYARTHROPLASTY, GLENOHUMERAL JOINT; HEMIARTHROPLASTY cohort cohort cohort

23472

ARTHROPLASTY, GLENOHUMERAL JOINT; TOTAL SHOULDER (GLENOIDAND PROXIMAL HUMERAL REPLACEMENT (EG, TOTALSHOULDER)) ARTHROPLASTY, GLENOHUMERAL JOINT; TOT AL SHOULDER (GLENOID cohort cohort cohort

23474

REVISION OF TOTAL SHOULDER ARTHROPLASTY, INCLUDINGALLOGRAFT WHEN PERFORMED; HUMERAL AND GLENOID COM PONENT cohort cohort cohort

23480 OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; cohort cohort

23485

OSTEOTOMY, CLAVICLE, WITH OR WITHOUT INTERNAL FIXATION; WITHBONE GRAFT FOR NONUNION OR MALUNION (INCLUDES OBTAINING GRAFT AND/OR NECESSARY FIXATION) cohort cohort cohort cohort cohort

23500

CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITHOUT cohort cohort cohort

23505

CLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATIONCLOSED TREATMENT OF CLAVICULAR FRACTURE; WITH MANIPULATION statewide

23515 Open treatment of clavicular fracture, includes internal fixation when performed cohort cohort cohort cohort cohort cohort

23525

CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITHMANIPULATION CLOSED TREATMENT OF STERNOCLAVICULAR DISLOCATION; WITH cohort cohort

23530

OPEN TREATMENT OF STERNOCLAVICULAR DISLOCATION, ACUTE ORCHRONIC; OPEN TREATMENT OF STERNOCLAVICULARDISLOCATION, ACUTE OR cohort cohort

42

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

23540

CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION;WITHOUTMANIPULATION CLOSED TREATMENT OF ACROMIOC LAVICULAR DISLOCATION; WITHOUT statewide

23545

CLOSED TREATMENT OF ACROMIOCLAVICULAR DISLOCATION;WITHMANIPULATION CLOSED TREATMENT OF ACROMIOCLAV ICULAR DISLOCATION; WITH cohort cohort

23550

OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE ORCHRONIC; OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR cohort cohort cohort cohort cohort cohort

23552

OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE ORCHRONIC; WITH FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) OPEN TREATMENT OF ACROMIOCLAVICULAR DISLOCATION, ACUTE OR cohort cohort cohort cohort cohort

23585 Open treatment of scapular fracture (body, glenoidor acromion) includes internal fixation, when per formed cohort cohort

23600

CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICALNECK) FRACTURE; WITHOUT MANIPULATION CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICAL cohort cohort

23605

CLOSED TREATMENT OF PROXIMAL HUMERAL (SURGICAL OR ANATOMICALNECK) FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION cohort cohort cohort cohort

23615

Open treatment of proximal humeral (surgical or anatomical neck) fracture, includes internal fixation when performed, includes repair of tuberosity(s)when performed; cohort cohort cohort cohort cohort

23630 Open treatment of greater humeral tuberosity fracture, includes internal fixation when performed cohort cohort cohort cohort cohort

23650

CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION;WITHOUT ANESTHESIA CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; cohort cohort cohort cohort cohort

23655

CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION;REQUIRING ANESTHESIA CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH MANIPULATION; cohort cohort cohort cohort cohort

23660 OPEN TREATMENT OF ACUTE SHOULDER DISLOCATIONOPEN TREATMENT OF ACUTE SHOULDER DISLOCATION statewide

23665

CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OFGREATER HUMERAL TUBEROSITY, WITH MANIPULATION CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH FRACTURE OF cohort cohort cohort cohort

23670 Open treatment of shoulder dislocation, with fracture of greater humeral tuberosity, includes internal fixation when performed cohort cohort cohort cohort

23675

CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL ORANATOMICAL NECK FRACTURE, WITH MANIPULATION CLOSED TREATMENT OF SHOULDER DISLOCATION, WITH SURGICAL OR cohort cohort

23680 Open treatment of shoulder dislocation, with surgical or anatomical neck fracture, includes internalfixation when performed statewide

23700

*MANIPULATION UNDER ANESTHESIA, SHOULDER JOINT, INCLUDINGAPPLICATION OF FIXATION APPARATUS (DISLOCATION EXCLUDED) cohort cohort cohort cohort cohort cohort

23929 UNLISTED PROCEDURE, SHOULDER cohort cohort cohort cohort cohort

23930 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; DEEP ABSCESSOR HEMATOMA statewide

23931 INCISION AND DRAINAGE, UPPER ARM OR ELBOW AREA; BURSA cohort cohort

24000

ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, ORREMOVAL OF FOREIGN BODY ARTHROTOMY, ELBOW, INCLUDING EXPLORATION, DRAINAGE, OR statewide

24006 ARTHROTOMY OF THE ELBOW, WITH CAPSULAR EXCISION FOR CAPSULARRELEASE (SEPARATE PROCEDURE) cohort cohort cohort cohort

24065 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; SUPERFICIAL statewide

24071 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOWAREA, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort cohort cohort

24073 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR cohort cohort cohort

43

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ELBOWAREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GRE ATER

24075 EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOWAREA, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort

24076

EXCISION, TUMOR, SOFT TISSUE OF UPPER ARM OR ELBOWAREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort

24079

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM ORGREATER statewide

24101

ARTHROTOMY, ELBOW; WITH JOINT EXPLORATION, WITH ORWITHOUTBIOPSY, WITH OR WITHOUT REMOVAL ARTHROTOM Y, ELBOW; WITH JOINT EXPLORATION, WITH OR WITHOUT cohort cohort cohort cohort cohort

24102 ARTHROTOMY, ELBOW; WITH SYNOVECTOMY cohort cohort

24105 EXCISION, OLECRANON BURSA cohort cohort cohort cohort cohort cohort

24110 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, HUMERUS; statewide

24120 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF HEADOR NECK OF RADIUS OR OLECRANON PROCESS; cohort cohort cohort

24130 EXCISION, RADIAL HEAD cohort cohort

24140 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), HUMERUS cohort cohort cohort cohort cohort

24147

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS), OLECRANONPROCESS cohort cohort cohort

24149

RADICAL RESECTION OF CAPSULE, SOFT TISSUE, AND HETEROTOPICBONE, ELBOW, WITH CONTRACTURE RELEASE (SEPARATE PROCEDURE) cohort cohort cohort cohort

24155 RESECTION OF ELBOW JOINT (ARTHRECTOMY) statewide

24200

REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA;SUBCUTANEOUS REMOVAL OF FOREIGN BODY, UPPER ARM ORELBOW AREA; statewide

24201

REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP(SUBFASCIAL OR INTRAMUSCULAR) REMOVAL OF FOREIGN BODY, UPPER ARM OR ELBOW AREA; DEEP statewide

24220 INJECTION PROCEDURE FOR ELBOW ARTHROGRAPHY cohort cohort cohort cohort cohort

24300 MANIPULATION, ELBOW, UNDER ANESTHESIA cohort cohort cohort cohort

24301 MUSCLE OR TENDON TRANSFER, ANY TYPE, UPPER ARM OR ELBOW,SINGLE (EXCLUDING 24320-24331) statewide

24305 TENDON LENGTHENING, UPPER ARM OR ELBOW, EACH TENDON statewide

24310

TENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDONTENOTOMY, OPEN, ELBOW TO SHOULDER, EACH TENDON cohort cohort

24320

TENOPLASTY, WITH MUSCLE TRANSFER, WITH OR WITHOUT FREEGRAFT, ELBOW TO SHOULDER, SINGLE (SEDDON-BROOKES TYPE PROCEDURE) statewide

24331 FLEXOR-PLASTY, ELBOW (EG, STEINDLER TYPE ADVANCEMENT); WITH EXTENSOR ADVANCEMENT statewide

24340 TENODESIS OF BICEPS TENDON AT ELBOW (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

24341

REPAIR, TENDON OR MUSCLE, UPPER ARM OR ELBOW, EACHTENDON ORMUSCLE, PRIMARY OR SECONDARY (EXCLUDES R OTATOR CUFF) cohort cohort cohort cohort cohort cohort

24342 REINSERTION OF RUPTURED BICEPS OR TRICEPS TENDON, DISTAL,WITH OR WITHOUT TENDON GRAFT cohort cohort cohort cohort cohort cohort

24343 REPAIR LATERAL COLLATERAL LIGAMENT, ELBOW, W/LOCALTISSUE cohort cohort cohort cohort

24344 RECONSTRUCTION LATERAL COLLATERAL LIGAMENT ELBOW, W/TENDON GRAFT W/HARVESTING, GRAFT cohort cohort cohort

24345 REPAIR MEDIAL COLLATERAL LIGAMENT, ELBOW, W/LOCAL TISSUE cohort cohort

24346 RECONSTRUCTION MEDIAL COLLATERAL LIGAMENT ELBOW, cohort cohort cohort cohort cohort

44

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

W/TENDON GRAFT W/HARVESTING, GRAFT

24357 Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow, golfer's elbow); percutaneous statewide

24358 Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow, golfer's elbow); debridement,soft tissue and/or bone, open cohort cohort cohort cohort cohort

24359

Tenotomy, elbow, lateral or medial (e.g., epicondylitis, tennis elbow, golfer's elbow); debridement,soft tissue and/or bone, open with tendon repair or reattachment cohort cohort cohort cohort cohort cohort

24360 ARTHROPLASTY, ELBOW; WITH MEMBRANE (EG, FASCIAL) cohort cohort

24363

ARTHROPLASTY, ELBOW; WITH DISTAL HUMERUS AND PROXIMAL ULNAR PROSTHETIC REPLACEMENT (EG, TOTAL ELBOW) statewide

24365 ARTHROPLASTY, RADIAL HEAD; cohort cohort cohort

24366 ARTHROPLASTY, RADIAL HEAD; WITH IMPLANT cohort cohort cohort cohort cohort

24400 OSTEOTOMY, HUMERUS, WITH OR WITHOUT INTERNAL FIXATION statewide

24430 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITHOUT GRAFT (EG, COMPRESSION TECHNIQUE) cohort cohort cohort

24435 REPAIR OF NONUNION OR MALUNION, HUMERUS; WITH ILIAC OR OTHERAUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort

24500

CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHOUT statewide

24505

CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITHMANIPULATION, WITH OR WITHOUT SKELETAL TRACTION CLOSED TREATMENT OF HUMERAL SHAFT FRACTURE; WITH cohort cohort cohort cohort

24515

OPEN TREATMENT OF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE OPEN TREATMENTOF HUMERAL SHAFT FRACTURE WITH PLATE/SCREWS, cohort cohort cohort cohort cohort

24516

OPEN TREATMENT OF HUMERAL SHAFT FRACTURE, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/OR LOCKING SCREWS cohort cohort

24530

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLARHUMERALFRACTURE, WITH OR WITHOUT INTERCONDYLAR EX TENSION; WITHOUT MANIPULATION cohort cohort cohort

24535

CLOSED TREATMENT OF SUPRACONDYLAR OR TRANSCONDYLARHUMERALFRACTURE, WITH OR WITHOUT INTERCONDYLAR EX TENSION; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION statewide

24538

PERCUTANEOUS SKELETAL FIXATION OF SUPRACONDYLAR ORTRANSCONDYLAR HUMERAL FRACTURE, WITH OR WITHOUT INTERCONDYLAR EXTENSION cohort cohort cohort cohort cohort

24545

Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation when performed; without intercondylar extension cohort cohort cohort cohort

24546 Open treatment of humeral supracondylar or transcondylar fracture, includes internal fixation when performed; with intercondylar extension cohort cohort cohort

24560

CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITHOUT MANIPULATION CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR cohort cohort

24565

CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR LATERAL; WITH MANIPULATION CLOSED TREATMENT OF HUMERAL EPICONDYLAR FRACTURE, MEDIAL OR statewide

24575 Open treatment of humeral epicondylar fracture, medial or lateral, includes internal fixation when performed cohort cohort cohort cohort

24576

CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL ORLATERAL; WITHOUT MANIPULATION CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL OR cohort cohort cohort

24577

CLOSED TREATMENT OF HUMERAL CONDYLAR FRACTURE, MEDIAL ORLATERAL; WITH MANIPULATION CLOSED TREATMENTOF HUMERAL CONDYLAR FRACTURE, MEDIAL OR statewide

24579 Open treatment of humeral condylar fracture, medial, or lateral, includes cohort cohort cohort cohort cohort

45

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

internal fixation when performed

24582

PERCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLARFRACTURE,MEDIAL OR LATERAL, WITH MANIPULATION PE RCUTANEOUS SKELETAL FIXATION OF HUMERAL CONDYLAR FRACTURE, cohort cohort

24586

OPEN TREATMENT OF PERIARTICULAR FRACTURE AND/OR DISLOCATION OF THE ELBOW (FRACTURE DISTAL HUMERUS AND PROXIMAL ULNA AND/ OR PROXIMAL RADIUS); cohort cohort cohort cohort

24600

TREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIATREATMENT OF CLOSED ELBOW DISLOCATION; WITHOUT ANESTHESIA cohort cohort cohort cohort cohort

24605

TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA TREATMENT OF CLOSED ELBOW DISLOCATION; REQUIRING ANESTHESIA cohort cohort cohort cohort cohort

24620

CLOSED TREATMENT OF MONTEGGIA TYPE OF FRACTURE DISLOCATIONAT ELBOW (FRACTURE PROXIMAL END OF ULNA WITH DISLOCATION OF RADIAL HEAD), WITH MANIPULATION cohort cohort cohort

24635

Open treatment of Monteggia type of fracture dislocation at elbow (fracture proximal end of ulna with dislocation of radial head), includes internal fixation when performed cohort cohort cohort cohort

24640

*CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD,"NURSEMAID ELBOW", WITH MANIPULATION *CLOSED TREATMENT OF RADIAL HEAD SUBLUXATION IN CHILD, cohort cohort cohort cohort cohort

24650

CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHOUT cohort cohort cohort

24655

CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITHMANIPULATION CLOSED TREATMENT OF RADIAL HEAD OR NECK FRACTURE; WITH cohort cohort cohort cohort cohort

24665 Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; cohort cohort cohort cohort cohort

24666

Open treatment of radial head or neck fracture, includes internal fixation or radial head excision, when performed; with radial head prosthetic replacement cohort cohort cohort

24670 Closed treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process[es]); without manipulation cohort cohort

24675 Closed treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process[es]); with manipulation cohort cohort cohort cohort

24685 Open treatment of ulnar fracture, proximal end (e.g., olecranon or coronoid process[es]), includes internal fixation when performed cohort cohort cohort cohort cohort cohort

24999 UNLISTED PROCEDURE, HUMERUS OR ELBOW cohort cohort cohort cohort cohort

25000 INCISION, EXTENSOR TENDON SHEATH, WRIST (EG, DEQUERVAIN'SDISEASE) cohort cohort cohort cohort cohort cohort

25001 INCISION, FLEXOR TENDON SHEATH, WRIST (FLEXOR CARPI RADIALIS) statewide

25020 DECOMPRESSION FASCIOTOMY, FOREARM AND/OR WRIST; FLEXOR OREXTENSOR COMPARTMENT statewide

25024 DECOMPRES FASCIOTOMY, FOREARM &/OR WRIST, FLEXOR & EXTENSOR COMPART; W/O DEBRIDE NONV MUSCLE/NERV statewide

25028 INCISION AND DRAINAGE, FOREARM AND/OR WRIST; DEEP ABSCESS ORHEMATOMA statewide

25035 INCISION, DEEP, BONE CORTEX, FOREARM AND/OR WRIST (EG,OSTEOMYELITIS OR BONE ABSCESS) statewide

25040

ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITHEXPLORATION, DRAINAGE, ARTHROTOMY, RADIOCARPAL OR MIDCARPAL JOINT, WITH statewide

25071 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort

25073 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 3 CM OR GREATER cohort cohort

25075 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST AREA, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort

25076 EXCISION, TUMOR, SOFT TISSUE OF FOREARM AND/OR WRIST cohort cohort

46

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN3 CM

25077

RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA; LESS THAN 3 CM statewide

25085 CAPSULOTOMY, WRIST (EG, CONTRACTURE) cohort cohort

25100 ARTHROTOMY, WRIST JOINT; WITH BIOPSY cohort cohort

25101 ARTHROTOMY, WRIST JOINT; WITH JOINT EXPLORATION, WITH ORWITHOUT BIOPSY, WITH OR WITHOUT REMOVAL BODY cohort cohort cohort

25105 ARTHROTOMY, WRIST JOINT; WITH SYNOVECTOMY cohort cohort

25107 ARTHROTOMY, DISTAL RADIOULNAR JOINT INCLUDING REPAIR OFTRIANGULAR CARTILAGE, COMPLEX cohort cohort cohort

25110 EXCISION, LESION OF TENDON SHEATH, FOREARM AND/OR WRIST cohort cohort cohort cohort cohort

25111 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); PRIMARY cohort cohort cohort cohort cohort cohort

25112 EXCISION OF GANGLION, WRIST (DORSAL OR VOLAR); RECURRENT cohort cohort cohort cohort

25115

RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARMTENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); FLEXORS cohort cohort cohort cohort cohort cohort

25116

RADICAL EXCISION OF BURSA, SYNOVIA OF WRIST, OR FOREARMTENDON SHEATHS (EG, TENOSYNOVITIS, FUNGUS, TBC, OR OTHER GRANULOMAS, RHEUMATOID ARTHRITIS); EXTENSORS, WITH OR cohort cohort cohort cohort

25118 SYNOVECTOMY, EXTENSOR TENDON SHEATH, WRIST, SINGLECOMPARTMENT; cohort cohort cohort cohort cohort cohort

25120

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF RADIUSOR ULNA (EXCLUDING HEAD OR NECK OF RADIU S AND OLECRANON PROCESS); cohort cohort

25126

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF RADIUSOR ULNA (EXCLUDING HEAD OR NECK OF RADIU S AND OLECRANON PROCESS); WITH ALLOGRAFT statewide

25130 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF CARPALBONES; cohort cohort cohort

25135

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF CARPALBONES; WITH AUTOGRAFT (INCLUDES OBTAININ G GRAFT) statewide

25150 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION ORDIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); ULNA statewide

25151

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION ORDIAPHYSECTOMY) OF BONE (EG, FOR OSTEOMYELITIS); RADIUS cohort cohort

25210 CARPECTOMY; 1 BONE cohort cohort cohort

25215 CARPECTOMY; ALL BONES OF PROXIMAL ROW cohort cohort cohort cohort cohort

25230 RADIAL STYLOIDECTOMY (SEPARATE PROCEDURE) cohort cohort cohort

25240 EXCISION DISTAL ULNA PARTIAL OR COMPLETE (EG, DARRACH TYPEOR MATCHED RESECTION) cohort cohort cohort

25246 INJECTION PROCEDURE FOR WRIST ARTHROGRAPHY cohort cohort cohort cohort cohort

25248

EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM ORWRIST EXPLORATION WITH REMOVAL OF DEEP FOREIGN BODY, FOREARM OR statewide

25259 MANIPULATION, WRIST, UNDER ANESTHESIA cohort cohort

25260 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST;PRIMARY, SINGLE, EACH TENDON OR MUSCLE cohort cohort cohort cohort cohort

25263 REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST;SECONDARY, SINGLE, EACH TENDON OR MUSCLE statewide

25265

REPAIR, TENDON OR MUSCLE, FLEXOR, FOREARM AND/OR WRIST;SECONDARY, WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON OR MUSCLE statewide

25270 REPAIR, TENDON OR MUSCLE, EXTENSOR, FOREARM AND/ORWRIST;PRIMARY, SINGLE, EACH TENDON OR MUSCLE cohort cohort cohort cohort

47

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

25275 REPAIR, TENDON SHEATH, EXTENSOR FOREARM &/OR WRISTW/FREE GRAFT cohort cohort cohort cohort

25280 LENGTHENING OR SHORTENING OF FLEXOR OR EXTENSOR TENDON,FOREARM AND/OR WRIST, SINGLE, EACH TENDON cohort cohort cohort

25290

TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARMAND/ORWRIST, SINGLE, EACH TENDON TENOTOMY, OPEN, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR cohort cohort cohort cohort cohort

25295 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, FOREARM AND/OR WRIST, SINGLE, EACH TENDON cohort cohort cohort

25310 TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR,FOREARM AND/OR WRIST, SINGLE; EACH TENDON cohort cohort cohort cohort cohort cohort

25312

TENDON TRANSPLANTATION OR TRANSFER, FLEXOR OR EXTENSOR,FOREARM AND/OR WRIST, SINGLE; WITH TENDON GRAFT(S) (INCLUDES OBTAINING GRAFT), EACH TENDON cohort cohort cohort

25316

FLEXOR ORIGIN SLIDE (EG, FOR CEREBRAL PALSY, VOLKMANNCONTRACTURE), FOREARM AND/OR WRIST; WITH TENDON(S) TRANSFER cohort cohort

25320

CAPSULORRHAPHY OR RECONSTRUCTION, WRIST, ANY METHOD (EG,CAPSULODESIS, LIGAMENT REPAIR, TENDON TRANSFER OR GRAFT) (INCLUDES SYNOVECTOMY, CAPSULOTOMY AND OPEN REDUCTION) FOR cohort cohort cohort cohort cohort

25332 ARTHROPLASTY, WRIST, WITH OR WITHOUT INTERPOSITION, WITH OR WITHOUT EXTERNAL OR INTERNAL FIXATION cohort cohort cohort cohort

25337

RECONSTRUCTION FOR STABILIZATION OF UNSTABLE DISTAL ULNA OR DISTAL RADIOULNAR JOINT, SECONDARY BY SOFT TISSUE STABILIZATION (EG, TENDON TRANSFER, TENDON GRAFT OR WEAVE, cohort cohort cohort

25360 OSTEOTOMY; ULNA statewide

25365 OSTEOTOMY; RADIUS AND ULNA statewide

25390 OSTEOPLASTY, RADIUS OR ULNA; SHORTENING cohort cohort cohort cohort

25391 OSTEOPLASTY, RADIUS OR ULNA; LENGTHENING WITH AUTOGRAFT statewide

25400 REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITHOUTGRAFT (EG, COMPRESSION TECHNIQUE) cohort cohort cohort cohort cohort

25405 REPAIR OF NONUNION OR MALUNION, RADIUS OR ULNA; WITH ILIACOR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort cohort cohort

25415 REPAIR OF NONUNION OR MALUNION, RADIUS AND ULNA; WITHOUTGRAFT (EG, COMPRESSION TECHNIQUE) cohort cohort cohort

25425 REPAIR OF DEFECT WITH AUTOGRAFT; RADIUS OR ULNA statewide

25431 REPAIR, NONUNION, CARPAL BONE (EXCLUDING CARPAL SCAPHOID) W/GRAFT, EACH BONE cohort cohort cohort cohort

25440

REPAIR OF NONUNION, SCAPHOID (NAVICULAR) BONE, WITH ORWITHOUT RADIAL STYLOIDECTOMY (INCLUDES OBTAINING GRAFT AND NECESSARY FIXATION) cohort cohort cohort cohort cohort cohort

25445 ARTHROPLASTY WITH PROSTHETIC REPLACEMENT; TRAPEZIUM statewide

25447 ARTHROPLASTY, INTERPOSITION, INTERCARPAL OR CARPOMETACARPAL JOINTS cohort cohort cohort cohort cohort cohort

25500

CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITHOUT statewide

25505

CLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATIONCLOSED TREATMENT OF RADIAL SHAFT FRACTURE; WITH MANIPULATION cohort cohort cohort cohort

25515 Open treatment of radial shaft fracture, includes internal fixation when performed cohort cohort cohort cohort

25525

Open treatment of radial shaft fracture, includes internal fixation when performed, and closed treatment of distal radioulnar joint dislocation (Galeazzi fracture/ dislocation), includes percutaneous cohort cohort

25526

Open treatment of radial shaft fracture, includes internal fixation when performed and open treatment of distal radioulnar joint dislocation (Galeazzifracture/ dislocation), includes internal fixatio cohort cohort cohort

25530 CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF ULNAR SHAFT cohort cohort

48

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

FRACTURE; WITHOUT

25535

CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION CLOSED TREATMENT OF ULNAR SHAFT FRACTURE; WITH MANIPULATION cohort cohort cohort cohort

25545 Open treatment of ulnar shaft fracture, includes internal fixation when performed cohort cohort cohort

25560

CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES;WITHOUT MANIPULATION CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; cohort cohort cohort

25565

CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITHMANIPULATION CLOSED TREATMENT OF RADIAL AND ULNAR SHAFT FRACTURES; WITH cohort cohort cohort cohort cohort

25574 Open treatment of radial AND ulnar shaft fractures, with internal fixation when performed; of radiusOR ulna cohort cohort cohort cohort

25575 Open treatment of radial AND ulnar shaft fractures, with internal fixation when performed; of radiusAND ulna cohort cohort cohort cohort cohort

25600

Closed treatment of distal radial fracture (eg, Colles or Smith type) or epiphyseal separation includes closed treatment of fracture of ulnar styloid when performed; without manipulation cohort cohort cohort cohort cohort

25605

CLOSED TREATMENT OF DISTAL RADIAL FRACTURE (EG, COLLES ORSMITH TYPE) OR EPIPHYSEAL SEPARATION, WITH OR WITHOUT FRACTURE OF ULNAR STYLOID; WITH MANIPULATION cohort cohort cohort cohort cohort

25606 PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIAL FRACTURE OR EPIPHYSEAL SEPARATION cohort cohort cohort cohort cohort

25607

OPEN TREATMENT OF DISTAL RADIAL EXTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION, WITH INTERNAL FIXATION cohort cohort cohort cohort cohort cohort

25608

OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 2 FRAGMENTS cohort cohort cohort cohort cohort cohort

25609

OPEN TREATMENT OF DISTAL RADIAL INTRA-ARTICULAR FRACTURE OR EPIPHYSEAL SEPARATION; WITH INTERNAL FIXATION OF 3 OR MORE FRAGMENTS cohort cohort cohort cohort cohort cohort

25622

CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE;WITHOUT MANIPULATION CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; cohort cohort

25624

CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE;WITH MANIPULATION CLOSED TREATMENT OF CARPAL SCAPHOID (NAVICULAR) FRACTURE; statewide

25628 Open treatment of carpal scaphoid (navicular) fracture, includes internal fixation when performed cohort cohort cohort cohort cohort

25635

CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPALSCAPHOID (NAVICULAR)); WITH MANIPULATION, EACH BONE CLOSED TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL cohort cohort cohort cohort

25645

OPEN TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPALSCAPHOID (NAVICULAR)), EACH BONE OPEN TREATMENT OF CARPAL BONE FRACTURE (EXCLUDING CARPAL cohort cohort cohort cohort cohort

25650 CLOSED TREATMENT OF ULNAR STYLOID FRACTURECLOSED TREATMENT OF ULNAR STYLOID FRACTURE cohort cohort cohort

25651 PERCUTANEOUS SKELETAL FIXATION OF ULNAR STYLOID FRACTURE cohort cohort cohort

25652 OPEN TREATMENT OF ULNAR STYLOID FRACTURE cohort cohort cohort cohort cohort

25660 CLOSED TREATMENT OF RADIOCARPAL OR INTERCARPAL DISLOCATION, 1 OR MORE BONES, WITH MANIPULATION cohort cohort

25671 PERCUTANEOUS SKELETAL FIXATION OF DISTAL RADIOULNAR DISLOCATION statewide

25675

CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITHMANIPULATION CLOSED TREATMENT OF DISTAL RADIOULNAR DISLOCATION WITH cohort cohort

25690

CLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATIONCLOSED TREATMENT OF LUNATE DISLOCATION, WITH MANIPULATION statewide

25800 ARTHRODESIS, WRIST; COMPLETE, WITHOUT BONE GRAFT statewide

49

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(INCLUDESRADIOCARPAL AND/OR INTERCARPAL AND/OR CARPOMETACARPAL JOINTS)

25805 ARTHRODESIS, WRIST; WITH SLIDING GRAFT statewide

25810 ARTHRODESIS, WRIST; WITH ILIAC OR OTHER AUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort cohort

25820 ARTHRODESIS, WRIST; LIMITED, WITHOUT BONE GRAFT (EG,INTERCARPAL OR RADIOCARPAL) cohort cohort

25825 ARTHRODESIS, WRIST; WITH AUTOGRAFT (INCLUDES OBTAININGGRAFT) cohort cohort cohort cohort

25999 UNLISTED PROCEDURE, FOREARM OR WRIST cohort cohort cohort cohort

26010 *DRAINAGE OF FINGER ABSCESS; SIMPLE cohort cohort cohort cohort cohort

26011 *DRAINAGE OF FINGER ABSCESS; COMPLICATED (EG, FELON) cohort cohort cohort cohort

26020 DRAINAGE OF TENDON SHEATH, DIGIT AND/OR PALM, EACH cohort cohort cohort

26025 DRAINAGE OF PALMAR BURSA; SINGLE, BURSA statewide

26034 INCISION, BONE CORTEX, HAND OR FINGER (EG, OSTEOMYELITIS OR BONE ABSCESS) cohort cohort cohort

26035 DECOMPRESSION FINGERS AND/OR HAND, INJECTION INJURY (EG,GREASE GUN) statewide

26040 FASCIOTOMY, PALMAR (EG, DUPUYTRENS CONTRACTURE);PERCUTANEOUS cohort cohort cohort

26045 FASCIOTOMY, PALMAR (EG, DUPUYTRENS CONTRACTURE); OPEN,PARTIAL cohort cohort cohort cohort

26055 TENDON SHEATH INCISION (EG, FOR TRIGGER FINGER) cohort cohort cohort cohort cohort cohort

26075

ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVALOF LOOSE OR FOREIGN BODY; METACARPOPHALANGEAL JOI NT, EACH cohort cohort

26080

ARTHROTOMY, WITH EXPLORATION, DRAINAGE, OR REMOVALOF LOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT, EACH cohort cohort

26110 ARTHROTOMY WITH BIOPSY; INTERPHALANGEAL JOINT, EACH statewide

26111 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; 1.5 CM OR GREATER cohort cohort cohort cohort cohort

26113

EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER cohort cohort

26115 EXCISION, TUMOR OR VASCULAR MALFORMATION, SOFT TISSUE OF HAND OR FINGER, SUBCUTANEOUS; LESS THAN 1.5CM cohort cohort cohort cohort cohort cohort

26116

EXCISION, TUMOR, SOFT TISSUE, OR VASCULAR MALFORMATION, OF HAND OR FINGER, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 1.5 CM cohort cohort cohort cohort

26117 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER; LESS THAN 3 CM statewide

26118 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER statewide

26121

FASCIECTOMY, PALM ONLY, WITH OR WITHOUT Z-PLASTY, OTHERLOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING (INCLUDES OBTAINING GRAFT) cohort cohort

26123

FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLEDIGITINCLUDING PROXIMAL INTERPHALANGEAL JOINT, WI TH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING cohort cohort cohort cohort

26125

FASCIECTOMY, PARTIAL PALMAR WITH RELEASE OF SINGLEDIGITINCLUDING PROXIMAL INTERPHALANGEAL JOINT, WI TH OR WITHOUT Z-PLASTY, OTHER LOCAL TISSUE REARRANGEMENT, OR SKIN GRAFTING cohort cohort cohort cohort

26130 SYNOVECTOMY, CARPOMETACARPAL JOINTSYNOVECTOMY, CARPOMETACARPAL JOINT statewide

26140

SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDINGEXTENSOR RECONSTRUCTION, EACH INTERPHALANGEAL JOINT SYNOVECTOMY, PROXIMAL INTERPHALANGEAL JOINT, INCLUDING cohort cohort

26145 SYNOVECTOMY, TENDON SHEATH, RADICAL cohort cohort cohort cohort

50

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(TENOSYNOVECTOMY),FLEXOR TENDON, PALM AND/OR FINGER, EACH TENDONSYNOVECTOMY, TENDON SHEATH, RADICAL (TENOSYNOVEC TOMY),

26160 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST,MUCOUS CYST, OR GANGLION), HAND OR FINGER cohort cohort cohort cohort cohort cohort

26170 Excision of tendon, palm, flexor or extensor, single, each tendon statewide

26180 Excision of tendon, finger, flexor or extensor, each tendon cohort cohort

26185 SESAMOIDECTOMY, THUMB OR FINGER (SEPARATE PROCEDURE) statewide

26200 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFMETACARPAL; cohort cohort cohort cohort cohort

26210 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFPROXIMAL, MIDDLE OR DISTAL PHALANX OF FINGER; cohort cohort cohort cohort cohort

26215

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROFPROXIMAL, MIDDLE, OR DISTAL PHALANX OF FINGER; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort

26230 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); METACARPAL statewide

26235

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); PROXIMAL OR MIDDLE PHALANX OF FINGER statewide

26236

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS); DISTAL PHALANX OF FINGER cohort cohort cohort cohort

26262 RADICAL RESECTION OF TUMOR, DISTAL PHALANX OF FINGER statewide

26320 REMOVAL OF IMPLANT FROM FINGER OR HAND statewide

26340 MANIPULATION, FINGER JOINT, UNDER ANESTHESIA, EACH JOINT statewide

26350

REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); PRIMARY OR SECONDARY WITHOUT FREE GRAFT, EACH TENDON cohort cohort cohort cohort

26352

REPAIR OR ADVANCEMENT, FLEXOR TENDON, NOT IN DIGITAL FLEXOR TENDON SHEATH (EG, NO MAN'S LAND); SECONDARY WITH FREE GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON statewide

26356

REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN DIGITAL FLEXORTENDON SHEATH (EG, NO MAN'S LAND); PRIMARY, EACH TENDON cohort cohort cohort cohort

26357

REPAIR OR ADVANCEMENT, FLEXOR TENDON, IN DIGITAL FLEXORTENDON SHEATH (EG, NO MAN'S LAND); SECONDARY,EACH TENDON cohort cohort cohort cohort

26370 REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACTSUPERFICIALIS TENDON; PRIMARY, EACH TENDON cohort cohort cohort cohort cohort cohort

26373

REPAIR OR ADVANCEMENT OF PROFUNDUS TENDON, WITH INTACTSUPERFICIALIS TENDON; SECONDARY WITHOUT FREE GRAFT, EACH TENDON cohort cohort cohort

26410 REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHOUTFREE GRAFT, EACH TENDON cohort cohort cohort cohort

26412 REPAIR, EXTENSOR TENDON, HAND, PRIMARY OR SECONDARY; WITHFREE GRAFT (INCLUDES OBTAINING GRAFT), EACHTENDON cohort cohort

26415

EXCISION OF EXTENSOR TENDON, IMPLANTATION OF PROSTHETIC ROD FOR DELAYED TENDON GRAFT, HAND OR FINGER statewide

26418 REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY;WITHOUT FREE GRAFT, EACH TENDON cohort cohort cohort cohort cohort

26420

REPAIR, EXTENSOR TENDON, FINGER, PRIMARY OR SECONDARY; WITH FREE GRAFT (INCLUDES OBTAINING GRAFT) EACH TENDON cohort cohort cohort

26426

REPAIR OF EXTENSOR TENDON, CENTRAL SLIP, SECONDARY(EG,BOUTONNIERE DEFORMITY); USING LOCAL TISSUE(S) , INCLUDING LATERAL BAND(S), EACH TENDON cohort cohort cohort cohort

26432 CLOSED TREATMENT OF DISTAL EXTENSOR TENDON INSERTION, WITHOR WITHOUT PERCUTANEOUS PINNING (EG, cohort cohort cohort

51

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MALLET FINGER)

26433 REPAIR OF EXTENSOR TENDON, DISTAL INSERTION, PRIMARY ORSECONDARY; WITHOUT GRAFT (EG, MALLET FINGER) cohort cohort cohort

26437 REALIGNMENT OF EXTENSOR TENDON, HAND, EACH TENDON cohort cohort cohort cohort cohort

26440 TENOLYSIS, FLEXOR TENDON; PALM OR FINGER; EACH TENDON cohort cohort cohort cohort

26442 TENOLYSIS, FLEXOR TENDON; PALM AND FINGER, EACH TENDON statewide

26445 TENOLYSIS, EXTENSOR TENDON, HAND OR FINGER; EACH TENDON cohort cohort cohort cohort

26450 TENOTOMY, FLEXOR, PALM, OPEN, EACH TENDONTENOTOMY,FLEXOR, PALM, OPEN, EACH TENDON statewide

26455 TENOTOMY, FLEXOR, FINGER, OPEN, EACH TENDON cohort cohort

26460

TENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH TENDONTENOTOMY, EXTENSOR, HAND OR FINGER, OPEN, EACH TENDON cohort cohort

26471 TENODESIS; OF PROXIMAL INTERPHALANGEAL JOINT, EACHJOINT cohort cohort cohort cohort

26474 TENODESIS; OF DISTAL JOINT, EACH JOINT statewide

26479 SHORTENING OF TENDON, FLEXOR, HAND OR FINGER, EACHTENDON statewide

26480

TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA ORDORSUM OF HAND; WITHOUT FREE GRAFT, EACH TENDON cohort cohort cohort cohort cohort cohort

26483

TRANSFER OR TRANSPLANT OF TENDON, CARPOMETACARPAL AREA ORDORSUM OF HAND; WITH FREE TENDON GRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON cohort cohort cohort

26485 TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITHOUT FREETENDON GRAFT, EACH TENDON statewide

26489 TRANSFER OR TRANSPLANT OF TENDON, PALMAR; WITH FREE TENDONGRAFT (INCLUDES OBTAINING GRAFT), EACH TENDON statewide

26492 OPPONENSPLASTY; TENDON TRANSFER WITH GRAFT (INCLUDESOBTAINING GRAFT), EACH TENDON cohort cohort cohort

26497 TRANSFER OF TENDON TO RESTORE INTRINSIC FUNCTION; RING ANDSMALL FINGER statewide

26500 RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITHLOCALTISSUES (SEPARATE PROCEDURE) statewide

26502

RECONSTRUCTION OF TENDON PULLEY, EACH TENDON; WITHTENDON ORFASCIAL GRAFT (INCLUDES OBTAINING GRAFT) (SEPARATE PROCEDURE) statewide

26510 CROSS INTRINSIC TRANSFER statewide

26516 CAPSULODESIS, METACARPOPHALANGEAL JOINT; SINGLE DIGIT cohort cohort

26520 CAPSULECTOMY OR CAPSULOTOMY; METACARPOPHALANGEAL JOINT, EACHJOINT cohort cohort cohort cohort cohort

26525 CAPSULECTOMY OR CAPSULOTOMY; INTERPHALANGEAL JOINT, EACHJOINT cohort cohort cohort

26530 ARTHROPLASTY, METACARPOPHALANGEAL JOINT; EACH JOINT cohort cohort cohort cohort

26531 ARTHROPLASTY, METACARPOPHALANGEAL JOINT; WITH PROSTHETICIMPLANT, EACH JOINT statewide

26535 ARTHROPLASTY, INTERPHALANGEAL JOINT; EACH JOINT cohort cohort cohort cohort

26536 ARTHROPLASTY, INTERPHALANGEAL JOINT; WITH PROSTHETICIMPLANT, EACH JOINT cohort cohort

26540 REPAIR OF COLLATERAL LIGAMENT, METACARPOPHALANGEALORINTERPHALANGEAL JOINT cohort cohort cohort cohort cohort

26541

RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEALJOINT, SINGLE; WITH TENDON OR FASCIAL GRAFT (INCLUDES OBTAINING GRAFT) cohort cohort

26542

RECONSTRUCTION, COLLATERAL LIGAMENT, METACARPOPHALANGEALJOINT, SINGLE; WITH LOCAL TISSUE (EG, ADDUCTOR ADVANCEMENT) statewide

26545 RECONSTRUCTION, COLLATERAL LIGAMENT, INTERPHALANGEAL JOINT, SINGLE, INCLUDING GRAFT, EACH cohort cohort

52

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

JOINT

26546

REPAIR NON-UNION, METACARPAL OR PHALANX, (INCLUDESOBTAININGBONE GRAFT WITH OR WITHOUT EXTERNAL OR I NTERNAL FIXATION) cohort cohort cohort

26548 REPAIR AND RECONSTRUCTION, FINGER, VOLAR PLATE,INTERPHALANGEAL JOINT cohort cohort

26560 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS statewide

26561 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; WITH SKIN FLAPS AND GRAFTS statewide

26562 REPAIR OF SYNDACTYLY (WEB FINGER) EACH WEB SPACE; COMPLEX(EG, INVOLVING BONE, NAILS) cohort cohort

26565 OSTEOTOMY; METACARPAL, EACH cohort cohort

26567 OSTEOTOMY; PHALANX OF FINGER, EACH statewide

26568 OSTEOPLASTY, LENGTHENING, METACARPAL OR PHALANX statewide

26580 REPAIR CLEFT HAND statewide

26587 RECONSTRUCTION OF SUPERNUMERARY DIGIT, SOFT TISSUEAND BONE statewide

26600

CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHOUTMANIPULATION, EACH BONE CLOSED TREATMENT OFMETACARPAL FRACTURE, SINGLE; WITHOUT cohort cohort cohort cohort

26605

CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITHMANIPULATION, EACH BONE CLOSED TREATMENT OF METACARPAL FRACTURE, SINGLE; WITH cohort cohort cohort cohort

26608

PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH BONE PERCUTANEOUS SKELETAL FIXATION OF METACARPAL FRACTURE, EACH cohort cohort cohort cohort cohort

26615 Open treatment of metacarpal fracture, single, includes internal fixation when performed, each bone cohort cohort cohort cohort cohort cohort

26641

CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITHMANIPULATION CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, THUMB, WITH statewide

26645

CLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DISLOCATION,THUMB (BENNETT FRACTURE), WITH MANIPULATIONCLOSED TREATMENT OF CARPOMETACARPAL FRACTURE DIS LOCATION, cohort cohort

26650 Percutaneous skeletal fixation of carpometacarpal fracture dislocation, thumb (Bennett fracture), with manipulation cohort cohort cohort cohort

26665 Open treatment of carpometacarpal fracture dislocation, thumb (Bennett fracture), includes internal fixation when performed cohort cohort cohort

26670

CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA cohort cohort

26675

CLOSED TREATMENT OF CARPOMETACARPAL DISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA statewide

26676

PERCUTANEOUS SKELETAL FIXATION OF CARPOMETACARPALDISLOCATION, OTHER THAN THUMB (BENNETT FRACTURE), SINGLE, WITH MANIPULATION cohort cohort

26685 Open treatment of carpometacarpal dislocation, other than thumb; includes internal fixation, when performed, each joint statewide

26700

CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE,WITH MANIPULATION; WITHOUT ANESTHESIA CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE, cohort cohort cohort cohort cohort

26705

CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATION, SINGLE,WITH MANIPULATION; REQUIRING ANESTHESIA CLOSED TREATMENT OF METACARPOPHALANGEAL DISLOCATI ON, SINGLE, cohort cohort cohort

26720

CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL ORMIDDLE PHALANX, FINGER OR THUMB; WITHOUT MANIPULATION, EACH CLOSED TREATMENT OF PHALANGEALSHAFT FRACTURE, PROXIMAL OR cohort cohort cohort

53

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

26725

CLOSED TREATMENT OF PHALANGEAL SHAFT FRACTURE, PROXIMAL ORMIDDLE PHALANX, FINGER OR THUMB; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION, EACH cohort cohort cohort cohort cohort

26727

PERCUTANEOUS SKELETAL FIXATION OF UNSTABLE PHALANGEAL SHAFT FRACTURE, PROXIMAL OR MIDDLE PHALANX, FINGER OR THUMB, WITH MANIPULATION, EACH cohort cohort cohort cohort cohort cohort

26735

Open treatment of phalangeal shaft fracture, proximal or middle phalanx, finger or thumb, includes internal fixation when performed, each cohort cohort cohort cohort cohort cohort

26742

CLOSED TREATMENT OF ARTICULAR FRACTURE, INVOLVINGMETACARPOPHALANGEAL OR INTERPHALANGEAL JOINT; WITH MANIPULATION, EACH cohort cohort cohort cohort

26746 Open treatment of articular fracture, involving metacarpophalangeal or interphalangeal joint, includes internal fixation, when performed, each cohort cohort cohort cohort cohort cohort

26750

CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER ORTHUMB; WITHOUT MANIPULATION, EACH CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR cohort cohort cohort cohort

26755

CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER ORTHUMB; WITH MANIPULATION, EACH CLOSED TREATMENT OF DISTAL PHALANGEAL FRACTURE, FINGER OR cohort cohort cohort cohort cohort

26756

PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEALFRACTURE, FINGER OR THUMB, EACH PERCUTANEOUS SKELETAL FIXATION OF DISTAL PHALANGEAL cohort cohort cohort cohort

26765 Open treatment of distal phalangeal fracture, finger or thumb, includes internal fixation when performed, each cohort cohort cohort cohort cohort cohort

26770

CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION,SINGLE, WITH MANIPULATION; WITHOUT ANESTHESIA CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCA TION, cohort cohort cohort cohort cohort

26775

CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION,SINGLE, WITH MANIPULATION; REQUIRING ANESTHESIA CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION, cohort cohort cohort cohort

26785 Open treatment of interphalangeal joint dislocation, includes internal fixation when performed, single cohort cohort cohort cohort

26841 ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH ORWITHOUTINTERNAL FIXATION; cohort cohort

26842

ARTHRODESIS, CARPOMETACARPAL JOINT, THUMB, WITH ORWITHOUTINTERNAL FIXATION; WITH AUTOGRAFT (INCLUDE S OBTAINING GRAFT) statewide

26843 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THANTHUMB; statewide

26844 ARTHRODESIS, CARPOMETACARPAL JOINT, DIGITS, OTHER THANTHUMB; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) statewide

26850 ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUTINTERNAL FIXATION; cohort cohort cohort

26852

ARTHRODESIS, METACARPOPHALANGEAL JOINT, WITH OR WITHOUTINTERNAL FIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) statewide

26860 ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNALFIXATION; cohort cohort cohort cohort cohort cohort

26861

ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNALFIXATION; EACH ADDITIONAL INTERPHALANGEAL JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

26862

ARTHRODESIS, INTERPHALANGEAL JOINT, WITH OR WITHOUT INTERNALFIXATION; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) statewide

26910

AMPUTATION, METACARPAL, WITH FINGER OR THUMB (RAYAMPUTATION), SINGLE, WITH OR WITHOUT INTEROSSEOUS TRANSFER cohort cohort

26951

AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY,ANY JOINTOR PHALANX, SINGLE, INCLUDING NEURECTOMI ES; WITH DIRECT CLOSURE cohort cohort cohort cohort cohort

54

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

26952

AMPUTATION, FINGER OR THUMB, PRIMARY OR SECONDARY,ANY JOINTOR PHALANX, SINGLE, INCLUDING NEURECTOMI ES; WITH LOCAL ADVANCEMENT FLAPS (V-Y, HOOD) cohort cohort cohort cohort

26989 UNLISTED PROCEDURE, HANDS OR FINGERS cohort cohort cohort cohort cohort cohort

26990 INCISION AND DRAINAGE, PELVIS OR HIP JOINT AREA; DEEPABSCESS OR HEMATOMA statewide

26992 INCISION, BONE CORTEX, PELVIS AND/OR HIP JOINT (EG,OSTEOMYELITIS OR BONE ABSCESS) statewide

27000 TENOTOMY, ADDUCTOR OF HIP, PERCUTANEOUS (SEPARATE PROCEDURE) statewide

27001 TENOTOMY, ADDUCTOR OF HIP, OPEN cohort cohort

27006 TENOTOMY, ABDUCTORS AND/OR EXTENSOR(S) OF HIP, OPEN(SEPARATE PROCEDURE) statewide

27025 FASCIOTOMY, HIP OR THIGH, ANY TYPE statewide

27033

ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSEOR FOREIGN BODY ARTHROTOMY, HIP, INCLUDING EXPLORATION OR REMOVAL OF LOOSE statewide

27036

CAPSULECTOMY OR CAPSULOTOMY, HIP, WITH OR WITHOUT EXCISIONOF HETEROTOPIC BONE, WITH RELEASE OF HIP FLEXOR MUSCLES (IE, GLUTEUS MEDIUS, GLUTEUS MINIMUS, TENSOR FASCIA LATAE, RECTUS statewide

27040 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; SUPERFICIAL statewide

27043 EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort

27045 EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort

27047 EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBCUTANEOUS; LESS THAN 3 CM statewide

27048 EXCISION, TUMOR, SOFT TISSUE OF PELVIS AND HIP AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM statewide

27059 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER statewide

27062 EXCISION; TROCHANTERIC BURSA OR CALCIFICATION cohort cohort cohort cohort cohort cohort

27066

Excision of bone cyst or benign tumor, wing of ilium, symphysis pubis, or greater trochanter of femur; deep (subfascial), includes autograft, when performed cohort cohort

27080 COCCYGECTOMY, PRIMARY cohort cohort

27086

*REMOVAL OF FOREIGN BODY, PELVIS OR HIP; SUBCUTANEOUS TISSUE*REMOVAL OF FOREIGN BODY, PELVIS OR HIP;SUBCUTANEOUS TISSUE statewide

27093 INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITHOUT ANESTHESIA cohort cohort cohort cohort cohort cohort

27095 INJECTION PROCEDURE FOR HIP ARTHROGRAPHY; WITH ANESTHESIA cohort cohort cohort cohort cohort

27096

INJECTION PROCEDURE FOR SACROILIAC JOINT, ANESTHETIC/STEROID, WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT) INCLUDING ARTHROGRAPHY WHEN PERFORMED cohort cohort cohort cohort cohort cohort

27130

ARTHROPLASTY, ACETABULAR AND PROXIMAL FEMORAL PROSTHETICREPLACEMENT (TOTAL HIP REPLACEMENT), WITH ORWITHOUT AUTOGRAFT OR ALLOGRAFT cohort cohort cohort

27146 OSTEOTOMY, ILIAC, ACETABULAR OR INNOMINATE BONE; statewide

27176 TREATMENT OF SLIPPED FEMORAL EPIPHYSIS; BY SINGLE ORMULTIPLE PINNING, IN SITU cohort cohort

27187

PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, FEMORAL NECK AND PROXIMAL FEMUR statewide

27193

CLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOCATION,DIASTASIS OR SUBLUXATION; WITHOUT MANIPULATIONCLOSED TREATMENT OF PELVIC RING FRACTURE, DISLOC ATION, statewide

27216 Percutaneous skeletal fixation of posterior pelvicbone fracture and/or dislocation, for fracture pa tterns that disrupt the pelvic ring, unilateral statewide

55

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(includes ipsilateral ilium, sacroiliac joint and/or

27227

OPEN TREATMENT OF ACETABULAR FRACTURE(S) INVOLVINGANTERIOR OR POSTERIOR (ONE) COLUMN, OR A FRACTURE RUNNING TRANSVERSELY ACROSS THE ACETABULUM, WITH INTERNAL FIXATION statewide

27230

CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK;WITHOUT MANIPULATION CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK; statewide

27232

CLOSED TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK;WITH MANIPULATION, WITH OR WITHOUT SKELETALTRACTION CLOSED TREATMENT OF FEMORAL FRACTURE, P ROXIMAL END, NECK; statewide

27235

PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, PROXIMALEND, NECK, UNDISPLACED, MILDLY DISPLACED, OR IMPACTED FRACTURE cohort cohort

27236

OPEN TREATMENT OF FEMORAL FRACTURE, PROXIMAL END, NECK,INTERNAL FIXATION OR PROSTHETIC REPLACEMENT (DIRECT FRACTURE EXPOSURE) cohort cohort cohort

27240

CLOSED TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC, ORSUBTROCHANTERIC FEMORAL FRACTURE; WITH MANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION statewide

27245

OPEN TREATMENT OF INTERTROCHANTERIC, PERTROCHANTERIC ORSUBTROCHANTERIC FEMORAL FRACTURE; WITH INTRAMEDULLARY IMPLANT, WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCLAGE statewide

27250

CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUTANESTHESIA CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; WITHOUT cohort cohort cohort

27252

CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRINGANESTHESIA CLOSED TREATMENT OF HIP DISLOCATION, TRAUMATIC; REQUIRING cohort cohort

27256

*TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL,INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITHOUT ANESTHESIA, WITHOUT MANIPULATION statewide

27257

*TREATMENT OF SPONTANEOUS HIP DISLOCATION (DEVELOPMENTAL,INCLUDING CONGENITAL OR PATHOLOGICAL), BY ABDUCTION, SPLINT OR TRACTION; WITH MANIPULATION,REQUIRING ANESTHESIA statewide

27258

OPEN TREATMENT OF SPONTANEOUS HIP DISLOCATION(DEVELOPMENTAL, INCLUDING CONGENITAL OR PATHOLOGICAL), REPLACEMENT OF FEMORAL HEAD IN ACETABULUM (INCLUD ING statewide

27265

CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION;WITHOUT ANESTHESIA CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; cohort cohort cohort cohort

27266

CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION;REQUIRING REGIONAL OR GENERAL ANESTHESIA CLOSED TREATMENT OF POST HIP ARTHROPLASTY DISLOCATION; cohort cohort cohort cohort

27275 *MANIPULATION, HIP JOINT, REQUIRING GENERAL ANESTHESIA cohort cohort

27280 ARTHRODESIS, SACROILIAC JOINT (INCLUDING OBTAININGGRAFT) cohort cohort

27299 UNLISTED PROCEDURE, PELVIS OR HIP JOINT cohort cohort cohort cohort

27301 INCISION AND DRAINAGE, DEEP ABSCESS, BURSA, OR HEMATOMA,THIGH OR KNEE REGION cohort cohort cohort cohort

27303 INCISION, DEEP, WITH OPENING OF BONE CORTEX, FEMUROR KNEE(EG, OSTEOMYELITIS OR BONE ABSCESS) statewide

27305 FASCIOTOMY, ILIOTIBIAL (TENOTOMY), OPEN cohort cohort cohort cohort cohort

27310

ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF FOREIGN BODY (EG, INFECTION) ARTHROTOMY, KNEE, WITH EXPLORATION, DRAINAGE, OR REMOVAL OF cohort cohort cohort cohort cohort

27323 BIOPSY, SOFT TISSUE OF THIGH OR KNEE AREA; SUPERFICIAL statewide

56

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

27327 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort

27328 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort cohort cohort

27331

ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, ORREMOVAL OF LOOSE OR FOREIGN BODIES ARTHROTOMY, KNEE; INCLUDING JOINT EXPLORATION, BIOPSY, OR cohort cohort cohort

27332 ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE(MENISCECTOMY) KNEE; MEDIAL OR LATERAL cohort cohort cohort cohort

27333 ARTHROTOMY, WITH EXCISION OF SEMILUNAR CARTILAGE(MENISCECTOMY) KNEE; MEDIAL AND LATERAL statewide

27334 ARTHROTOMY, WITH SYNOVECTOMY KNEE; ANTERIOR OR POSTERIOR statewide

27337 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort cohort

27339 EXCISION, TUMOR, SOFT TISSUE OF THIGH OR KNEE AREA, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER cohort cohort cohort

27340 EXCISION, PREPATELLAR BURSA cohort cohort cohort cohort cohort

27345 EXCISION OF SYNOVIAL CYST OF POPLITEAL SPACE (EG, BAKERSCYST) cohort cohort cohort cohort

27347 EXCISION OF LESION OF MENISCUS OR CAPSULE (EG, CYST,GANGLION), KNEE cohort cohort cohort cohort

27350 PATELLECTOMY OR HEMIPATELLECTOMY cohort cohort cohort

27355 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF FEMUR; cohort cohort cohort

27356 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOROF FEMUR;WITH ALLOGRAFT statewide

27360

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/OR FIBULA (EG, OSTEOMYELITIS OR BONE ABSCESS) statewide

27364 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF THIGH OR KNEE AREA; 5 CM OR GREATER statewide

27370 INJECTION PROCEDURE FOR KNEE ARTHROGRAPHY cohort cohort cohort cohort

27372 REMOVAL OF FOREIGN BODY, DEEP, THIGH REGION OR KNEE AREA cohort cohort cohort

27380 SUTURE OF INFRAPATELLAR TENDON; PRIMARY cohort cohort cohort cohort cohort

27381 SUTURE OF INFRAPATELLAR TENDON; SECONDARY RECONSTRUCTION,INCLUDING FASCIAL OR TENDON GRAFT cohort cohort

27385 SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; PRIMARY cohort cohort cohort cohort

27386

SUTURE OF QUADRICEPS OR HAMSTRING MUSCLE RUPTURE; SECONDARY RECONSTRUCTION, INCLUDING FASCIAL OR TENDON GRAFT statewide

27394 LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS,1 LEG statewide

27395 LENGTHENING OF HAMSTRING TENDON; MULTIPLE TENDONS,BILATERAL statewide

27396 Transplant or transfer (with muscle redirection orrerouting), high (e.g., extensor to flexor); sing le tendon statewide

27403 ARTHROTOMY WITH MENISCUS REPAIR, KNEE cohort cohort cohort

27405 REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE;COLLATERAL cohort cohort cohort cohort cohort cohort

27407 REPAIR, PRIMARY, TORN LIGAMENT AND/OR CAPSULE, KNEE;CRUCIATE cohort cohort cohort cohort

27412 AUTOLOGOUS CHONDROCYTE IMPLANTATION, KNEE statewide

27415 OSTEOCHONDRAL ALLOGRAFT, KNEE, OPEN cohort cohort cohort cohort

27418 ANTERIOR TIBIAL TUBERCLEPLASTY (EG, MAQUET TYPE PROCEDURE) cohort cohort cohort cohort

27420 RECONSTRUCTION OF DISLOCATING PATELLA; (EG, HAUSERTYPEPROCEDURE) cohort cohort cohort cohort cohort

27422 RECONSTRUCTION OF DISLOCATING PATELLA; WITH cohort cohort cohort cohort cohort cohort

57

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

EXTENSORREALIGNMENT AND/OR MUSCLE ADVANCEMENT OR RELEASE(EG, CAMPBELL, GOLDWAITE TYPE PROCEDURE)

27424 RECONSTRUCTION OF DISLOCATING PATELLA; WITH PATELLECTOMY statewide

27425 LATERAL RETINACULAR RELEASE (ANY METHOD) cohort cohort cohort cohort cohort

27427 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE;EXTRA-ARTICULAR cohort cohort cohort cohort cohort cohort

27428 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE;INTRA-ARTICULAR (OPEN) cohort cohort cohort cohort cohort

27429 LIGAMENTOUS RECONSTRUCTION (AUGMENTATION), KNEE;INTRA-ARTICULAR (OPEN) AND EXTRA-ARTICULAR cohort cohort

27430 QUADRICEPSPLASTY (EG, BENNETT OR THOMPSON TYPE) cohort cohort cohort cohort cohort

27435 CAPSULOTOMY, POSTERIOR CAPSULAR RELEASE, KNEE cohort cohort cohort

27437 ARTHROPLASTY, PATELLA; WITHOUT PROSTHESIS cohort cohort cohort

27438 ARTHROPLASTY, PATELLA; WITH PROSTHESIS statewide

27440 ARTHROPLASTY, KNEE, TIBIAL PLATEAU; statewide

27442 ARTHROPLASTY, FEMORAL CONDYLES OR TIBIAL PLATEAU(S), KNEE; cohort cohort

27445 ARTHROPLASTY, KNEE, HINGE PROSTHESIS (EG, WALLDIUSTYPE) statewide

27446 ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL ORLATERALCOMPARTMENT cohort cohort cohort cohort

27447

ARTHROPLASTY, KNEE, CONDYLE AND PLATEAU; MEDIAL AND LATERAL COMPARTMENTS WITH OR WITHOUT PATELLA RESURFACING (TOTAL KNEE REPLACEMENT) cohort cohort

27448 OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITHOUT FIXATION statewide

27450 OSTEOTOMY, FEMUR, SHAFT OR SUPRACONDYLAR; WITH FIXATION statewide

27457

OSTEOTOMY, PROXIMAL TIBIA, INCLUDING FIBULAR EXCISION OROSTEOTOMY (INCLUDES CORRECTION OF GENU VARUS(BOWLEG) OR GENU VALGUS (KNOCK-KNEE)); AFTER EPI PHYSEAL CLOSURE statewide

27472

REPAIR, NONUNION OR MALUNION, FEMUR, DISTAL TO HEAD ANDNECK; WITH ILIAC OR OTHER AUTOGENOUS BONE GRAFT (INCLUDES OBTAINING GRAFT) statewide

27475 ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS); DISTAL FEMUR cohort cohort

27477 ARREST, EPIPHYSEAL, ANY METHOD (EG, EPIPHYDIODESIS); TIBIAAND FIBULA, PROXIMAL statewide

27485 ARREST, HEMIEPIPHYSEAL, DISTAL FEMUR OR PROXIMAL TIBIA ORFIBULA (EG, GENU VARUS OR VALGUS) cohort cohort cohort

27486 REVISION OF TOTAL KNEE ARTHROPLASTY, WITH OR WITHOUT ALLOGRAFT; 1 COMPONENT statewide

27488

REMOVAL OF PROSTHESIS, INCLUDING TOTAL KNEE PROSTHESIS,METHYLMETHACRYLATE WITH OR WITHOUT INSERTION OF SPACER, KNEE statewide

27495 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, FEMUR statewide

27500

CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUTMANIPULATION CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHOUT cohort cohort

27502

CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITHMANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION CLOSED TREATMENT OF FEMORAL SHAFT FRACTURE, WITH cohort cohort cohort

27506

OPEN TREATMENT OF FEMORAL SHAFT FRACTURE, WITH OR WITHOUTEXTERNAL FIXATION, WITH INSERTION OF INTRAMEDULLARY IMPLANT, WITH OR WITHOUT CERCLAGE AND/ORLOCKING SCREWS statewide

27508 CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR LATERAL CONDYLE, WITHOUT MANIPULATION statewide

58

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

CLOSED TREATMENT OF FEMORAL FRACTURE, DISTAL END, MEDIAL OR

27509

PERCUTANEOUS SKELETAL FIXATION OF FEMORAL FRACTURE, DISTALEND, MEDIAL OR LATERAL CONDYLE, OR SUPRACONDYLAR OR TRANSCONDYLAR, WITH OR WITHOUT INTERCONDYLAR EXTENSION, OR statewide

27514 Open treatment of femoral fracture, distal end, medial or lateral condyle, includes internal fixation when performed cohort cohort cohort

27516

CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION;WITHOUT MANIPULATION CLOSED TREATMENT OF DISTAL FEMORAL EPIPHYSEAL SEPARATION; statewide

27524

OPEN TREATMENT OF PATELLAR FRACTURE, WITH INTERNALFIXATION AND/OR PARTIAL OR COMPLETE PATELLECTOMY AND SOFT TISSUE REPAIR cohort cohort cohort cohort

27530

CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU);WITHOUT MANIPULATION CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); cohort cohort

27532

CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU);WITH OR WITHOUT MANIPULATION, WITH SKELETAL TRACTION CLOSED TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU); cohort cohort cohort

27535 Open treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation when performed cohort cohort cohort cohort

27536

OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLATEAU);BICONDYLAR, WITH OR WITHOUT INTERNAL FIXATION OPEN TREATMENT OF TIBIAL FRACTURE, PROXIMAL (PLAT EAU); cohort cohort cohort

27540 Open treatment of intercondylar spine(s) and/or tuberosity fracture(s) of the knee, includes internal fixation when performed cohort cohort

27550

CLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIACLOSED TREATMENT OF KNEE DISLOCATION; WITHOUT ANESTHESIA statewide

27552

CLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIACLOSED TREATMENT OF KNEE DISLOCATION; REQUIRING ANESTHESIA cohort cohort cohort

27560

CLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIACLOSED TREATMENT OF PATELLAR DISLOCATION; WITHOUT ANESTHESIA cohort cohort cohort cohort cohort

27562

CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRINGANESTHESIA CLOSED TREATMENT OF PATELLAR DISLOCATION; REQUIRING cohort cohort cohort

27566

OPEN TREATMENT OF PATELLAR DISLOCATION, WITH OR WITHOUTPARTIAL OR TOTAL PATELLECTOMY OPEN TREATMENTOF PATELLAR DISLOCATION, WITH OR WITHOUT cohort cohort cohort

27570

*MANIPULATION OF KNEE JOINT UNDER GENERAL ANESTHESIA(INCLUDES APPLICATION OF TRACTION OR OTHER FIXATION DEVICES) cohort cohort cohort cohort cohort cohort

27590 AMPUTATION, THIGH, THROUGH FEMUR, ANY LEVEL; statewide

27599 UNLISTED PROCEDURE, FEMUR OR KNEE cohort cohort cohort cohort cohort

27600 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERALCOMPARTMENTS ONLY cohort cohort cohort cohort

27601 DECOMPRESSION FASCIOTOMY, LEG; POSTERIOR COMPARTMENT(S) ONLY cohort cohort

27602 DECOMPRESSION FASCIOTOMY, LEG; ANTERIOR AND/OR LATERAL, AND POSTERIOR COMPARTMENT(S) cohort cohort cohort

27603 INCISION AND DRAINAGE, LEG OR ANKLE; DEEP ABSCESS ORHEMATOMA cohort cohort cohort cohort

27606 TENOTOMY, PERCUTANEOUS, ACHILLES TENDON (SEPARATEPROCEDURE); GENERAL ANESTHESIA cohort cohort cohort cohort

27610

ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, ORREMOVAL OF FOREIGN BODY ARTHROTOMY, ANKLE, INCLUDING EXPLORATION, DRAINAGE, OR cohort cohort cohort

27612 ARTHROTOMY, POSTERIOR CAPSULAR RELEASE, ANKLE, WITH ORWITHOUT ACHILLES TENDON LENGTHENING cohort cohort

27614 BIOPSY, SOFT TISSUE OF LEG OR ANKLE AREA; DEEP cohort cohort cohort

59

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(SUBFASCIALOR INTRAMUSCULAR)

27616 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER statewide

27618 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA,SUBCUTANEOUS; LESS THAN 3 CM cohort cohort cohort cohort cohort

27619 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA,SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM cohort cohort cohort cohort cohort

27620

ARTHROTOMY, ANKLE, WITH JOINT EXPLORATION, WITH ORWITHOUTBIOPSY, WITH ARTHROTOMY, ANKLE, WITH JOIN T EXPLORATION, WITH OR WITHOUT cohort cohort cohort cohort

27625 ARTHROTOMY, WITH SYNOVECTOMY, ANKLE; cohort cohort cohort cohort

27626 ARTHROTOMY, WITH SYNOVECTOMY, ANKLE; INCLUDINGTENOSYNOVECTOMY cohort cohort cohort cohort

27630 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE cohort cohort cohort cohort cohort

27632 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA,SUBCUTANEOUS; 3 CM OR GREATER cohort cohort cohort cohort

27634 EXCISION, TUMOR, SOFT TISSUE OF LEG OR ANKLE AREA,SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER statewide

27635 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA ORFIBULA; cohort cohort cohort cohort cohort

27637

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA ORFIBULA; WITH AUTOGRAFT (INCLUDES OBTAINING GRAFT) statewide

27638 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TIBIA ORFIBULA; WITH ALLOGRAFT cohort cohort cohort cohort

27640 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); TIBIA cohort cohort cohort cohort

27641 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, ORDIAPHYSECTOMY), BONE (EG, OSTEOMYELITIS); FIBULA cohort cohort cohort

27645 RADICAL RESECTION OF TUMOR; TIBIA cohort cohort

27646 RADICAL RESECTION OF TUMOR; FIBULA statewide

27647 RADICAL RESECTION OF TUMOR; TALUS OR CALCANEUS statewide

27648 INJECTION PROCEDURE FOR ANKLE ARTHROGRAPHY statewide

27650 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLESTENDON; cohort cohort cohort cohort cohort cohort

27652 REPAIR, PRIMARY, OPEN OR PERCUTANEOUS, RUPTURED ACHILLESTENDON; WITH GRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort cohort

27654 REPAIR, SECONDARY, ACHILLES TENDON, WITH OR WITHOUT GRAFT cohort cohort cohort cohort cohort

27658 REPAIR, FLEXOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACHTENDON cohort cohort cohort cohort cohort cohort

27659 REPAIR, FLEXOR TENDON, LEG; SECONDARY, WITH OR WITHOUTGRAFT, EACH TENDON cohort cohort cohort cohort cohort

27664 REPAIR, EXTENSOR TENDON, LEG; PRIMARY, WITHOUT GRAFT, EACHTENDON cohort cohort cohort cohort cohort

27665 REPAIR, EXTENSOR TENDON, LEG; SECONDARY, WITH OR WITHOUTGRAFT, EACH TENDON cohort cohort

27675 REPAIR, DISLOCATING PERONEAL TENDONS; WITHOUT FIBULAROSTEOTOMY cohort cohort cohort cohort

27676 REPAIR, DISLOCATING PERONEAL TENDONS; WITH FIBULAROSTEOTOMY cohort cohort cohort cohort

27680 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE;SINGLE, EACH TENDON cohort cohort cohort

27681 TENOLYSIS, FLEXOR OR EXTENSOR TENDON, LEG AND/OR ANKLE;MULTIPLE TENDONS (THROUGH SEPARATE INCISION(S)) cohort cohort

27685 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE;SINGLETENDON (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

27686 LENGTHENING OR SHORTENING OF TENDON, LEG OR ANKLE;MULTIPLE TENDONS (THROUGH SAME INCISION), EACH statewide

27687 GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE) cohort cohort cohort cohort cohort

60

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

27690

TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLEREDIRECTION OR REROUTING); SUPERFICIAL (EG, ANTERIOR TIBIAL EXTENSORS INTO MIDFOOT) cohort cohort cohort

27691

TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLEREDIRECTION OR REROUTING); DEEP (EG, ANTERIOR TIBIAL OR POSTERIOR TIBIAL THROUGH INTEROSSEOUS SPACE, FLEXOR cohort cohort cohort cohort cohort cohort

27692

TRANSFER OR TRANSPLANT OF SINGLE TENDON (WITH MUSCLEREDIRECTION OR REROUTING); EACH ADDITIONAL TENDON (LIST IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

27695 REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; COLLATERAL cohort cohort cohort cohort cohort cohort

27696 REPAIR, PRIMARY, DISRUPTED LIGAMENT, ANKLE; BOTH COLLATERAL LIGAMENTS cohort cohort cohort cohort

27698 REPAIR, SECONDARY DISRUPTED LIGAMENT, ANKLE, COLLATERAL (EG,WATSON-JONES PROCEDURE) cohort cohort cohort cohort cohort

27700 ARTHROPLASTY, ANKLE; cohort cohort cohort

27702 Arthroplasty, ankle, with implant (total ankle) cohort cohort

27705 OSTEOTOMY; TIBIA cohort cohort cohort cohort cohort

27707 OSTEOTOMY; FIBULA cohort cohort

27709 OSTEOTOMY; TIBIA AND FIBULA statewide

27720 REPAIR OF NONUNION OR MALUNION, TIBIA; WITHOUT GRAFT, (EG,COMPRESSION TECHNIQUE) cohort cohort cohort cohort cohort

27722 REPAIR OF NONUNION OR MALUNION, TIBIA; WITH SLIDING GRAFT statewide

27724 REPAIR OF NONUNION OR MALUNION, TIBIA; WITH ILIAC OR OTHERAUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort cohort cohort

27726 Repair of fibula nonunion and/or malunion with internal fixation cohort cohort

27730 ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD; DISTALTIBIA statewide

27732 ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD; DISTALFIBULA statewide

27734 ARREST, EPIPHYSEAL (EPIPHYSIODESIS), ANY METHOD; DISTALTIBIA AND FIBULA cohort cohort

27745 PROPHYLACTIC TREATMENT (NAILING, PINNING, PLATING OR WIRING)WITH OR WITHOUT METHYLMETHACRYLATE, TIBIA statewide

27750

CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH ORWITHOUTFIBULAR FRACTURE); WITHOUT MANIPULATION C LOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUT cohort cohort cohort cohort

27752

CLOSED TREATMENT OF TIBIAL SHAFT FRACTURE (WITH ORWITHOUTFIBULAR FRACTURE); WITH MANIPULATION, WITH OR WITHOUT SKELETAL TRACTION cohort cohort cohort cohort

27756

PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE(WITH OR WITHOUT FIBULAR FRACTURE) (EG, PINS OR SCREWS) PERCUTANEOUS SKELETAL FIXATION OF TIBIAL SHAFT FRACTURE cohort cohort

27758

OPEN TREATMENT OF TIBIAL SHAFT FRACTURE, (WITH OR WITHOUTFIBULAR FRACTURE) WITH PLATE/SCREWS, WITH OR WITHOUT CERCLAGE cohort cohort cohort cohort cohort

27759

OPEN TREATMENT OF TIBIAL SHAFT FRACTURE (WITH OR WITHOUTFIBULAR FRACTURE) BY INTRAMEDULLARY IMPLANT,WITH OR WITHOUT INTERLOCKING SCREWS AND/OR CERCL AGE cohort cohort cohort cohort

27760

CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHOUT statewide

27762

CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITHMANIPULATION, WITH OR WITHOUT SKIN OR SKELETAL TRACTION CLOSED TREATMENT OF MEDIAL MALLEOLUS FRACTURE; WITH cohort cohort cohort cohort cohort

27766 Open treatment of medial malleolus fracture, includes internal fixation when performed cohort cohort cohort cohort cohort cohort

61

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

27767 Closed treatment of posterior malleolus fracture; without manipulation statewide

27768 Closed treatment of posterior malleolus fracture; with manipulation cohort cohort cohort

27769 Open treatment of posterior malleolus fracture, includes internal fixation when performed cohort cohort cohort

27780

CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE;WITHOUT MANIPULATION CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; cohort cohort

27781

CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH MANIPULATION CLOSED TREATMENT OF PROXIMAL FIBULA OR SHAFT FRACTURE; WITH cohort cohort

27784 Open treatment of proximal fibula or shaft fracture, includes internal fixation when performed cohort cohort cohort cohort

27786

CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERALMALLEOLUS); WITHOUT MANIPULATION CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL cohort cohort cohort cohort

27788

CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERALMALLEOLUS); WITH MANIPULATION CLOSED TREATMENT OF DISTAL FIBULAR FRACTURE (LATERAL cohort cohort cohort cohort cohort

27792 Open treatment of distal fibular fracture (lateralmalleolus), includes internal fixation when perfo rmed cohort cohort cohort cohort cohort cohort

27808

Closed treatment of bimalleolar ankle fracture, e.g., lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); without manipulation cohort cohort cohort cohort

27810

Closed treatment of bimalleolar ankle fracture, e.g., lateral and medial malleoli, or lateral and posterior malleoli or medial and posterior malleoli); with manipulation cohort cohort cohort cohort cohort

27814

Open treatment of bimalleolar ankle fracture (e.g., lateral and medial malleoli, or lateral and posterior malleoli, or medial and posterior malleoli),includes internal fixation when performed cohort cohort cohort cohort cohort cohort

27816

CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUTMANIPULATION CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHOUT statewide

27818

CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITHMANIPULATION CLOSED TREATMENT OF TRIMALLEOLAR ANKLE FRACTURE; WITH cohort cohort cohort cohort cohort

27822

Open treatment of trimalleolar ankle fracture, includes internal fixation when performed, medial and/or lateral malleolus; without fixation of posterior lip cohort cohort cohort cohort cohort cohort

27823

Open treatment of trimalleolar ankle fracture, includes internal fixation when performed, medial and/or lateral malleolus; with fixation of posterior lip cohort cohort cohort cohort

27824

CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULARPORTION OF DISTAL TIBIA (EG, PILON OR TIBIALPLAFOND), WITH OR WITHOUT ANESTHESIA; WITHOUT MANIPULATION cohort cohort

27825

CLOSED TREATMENT OF FRACTURE OF WEIGHT BEARING ARTICULARPORTION OF DISTAL TIBIA (EG, PILON OR TIBIALPLAFOND), WITH OR WITHOUT ANESTHESIA; WITH SKE LETAL TRACTION AND/OR cohort cohort cohort cohort cohort

27827

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), with internal fixation when performed; of tibia only cohort cohort cohort cohort cohort cohort

27828

Open treatment of fracture of weight bearing articular surface/portion of distal tibia (e.g., pilon or tibial plafond), with internal fixation when performed; of both tibia and fibula cohort cohort cohort cohort cohort

27829 Open treatment of distal tibiofibular joint (syndesmosis) disruption, includes internal fixation when performed cohort cohort cohort cohort cohort cohort

27831 CLOSED TREATMENT OF PROXIMAL TIBIOFIBULAR JOINT DISLOCATION;REQUIRING ANESTHESIA statewide

27840

CLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIACLOSED TREATMENT OF ANKLE DISLOCATION; WITHOUT ANESTHESIA cohort cohort cohort cohort

27842

CLOSED TREATMENT OF ANKLE DISLOCATION; REQUIRING ANESTHESIA,WITH OR WITHOUT PERCUTANEOUS SKELETAL FIXATION CLOSED TREATMENT OF ANKLE DISLOCATION; cohort cohort

62

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

REQUIRING ANESTHESIA,

27870 ARTHRODESIS, ANKLE, ANY METHOD cohort cohort cohort cohort cohort

27871 ARTHRODESIS, TIBIOFIBULAR JOINT, PROXIMAL OR DISTAL statewide

27886 AMPUTATION LEG, THROUGH TIBIA AND FIBULA; RE-AMPUTATION statewide

27899 UNLISTED PROCEDURE, LEG OR ANKLE cohort cohort cohort cohort cohort cohort

28002 *INCISION AND DRAINAGE BELOW FASCIA, WITH OR WITHOUT TENDON SHEATH INVOLVEMENT, FOOT; SINGLE BURSAL SPACE statewide

28005 INCISION, BONE CORTEX (EG, OSTEOMYELITIS OR BONE ABSCESS),FOOT cohort cohort

28008 FASCIOTOMY, FOOT AND/OR TOE cohort cohort cohort cohort cohort

28010 TENOTOMY, PERCUTANEOUS, TOE; SINGLE TENDON cohort cohort cohort

28011 TENOTOMY, PERCUTANEOUS, TOE; MULTIPLE TENDONS cohort cohort cohort cohort cohort

28020

ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OFLOOSE OR FOREIGN BODY; INTERTARSAL OR TARSOMETATARSAL JOINT ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF cohort cohort cohort cohort

28022

ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OFLOOSE OR FOREIGN BODY; METATARSOPHALANGEALJOINT ARTHROTOMY, INCLUDING EXPLORATION, DRAINAG E, OR REMOVAL OF cohort cohort cohort cohort

28024

ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OFLOOSE OR FOREIGN BODY; INTERPHALANGEAL JOINT ARTHROTOMY, INCLUDING EXPLORATION, DRAINAGE, OR REMOVAL OF cohort cohort

28035 RELEASE, TARSAL TUNNEL (POSTERIOR TIBIAL NERVEDECOMPRESSION) cohort cohort cohort cohort cohort

28039 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; 1.5 CM OR GREATER cohort cohort cohort cohort cohort

28041 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); 1.5 CM OR GREATER cohort cohort cohort cohort

28043 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBCUTANEOUS; LESS THAN 1.5 CM cohort cohort cohort

28045 EXCISION, TUMOR, SOFT TISSUE OF FOOT OR TOE, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 1.5 CM cohort cohort

28047 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER statewide

28060 FASCIECTOMY, PLANTAR FASCIA; PARTIAL (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

28062 FASCIECTOMY, PLANTAR FASCIA; RADICAL (SEPARATE PROCEDURE) cohort cohort

28070

SYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL JOINT,EACHSYNOVECTOMY; INTERTARSAL OR TARSOMETATARSAL J OINT, EACH cohort cohort cohort

28072 SYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACHSYNOVECTOMY; METATARSOPHALANGEAL JOINT, EACH cohort cohort cohort

28080 EXCISION, INTERDIGITAL (MORTON) NEUROMA, SINGLE, EACH cohort cohort cohort cohort cohort cohort

28086 SYNOVECTOMY, TENDON SHEATH, FOOT; FLEXORSYNOVECTOMY, TENDON SHEATH, FOOT; FLEXOR cohort cohort

28088 SYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSORSYNOVECTOMY, TENDON SHEATH, FOOT; EXTENSOR statewide

28090

EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE(INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION);FOOT EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE cohort cohort cohort cohort cohort cohort

28092

EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE(INCLUDING SYNOVECTOMY) (EG, CYST OR GANGLION);TOE(S), EACH EXCISION OF LESION, TENDON, TENDON SHEATH, OR CAPSULE cohort cohort cohort cohort cohort

28100 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TALUS ORCALCANEUS; cohort cohort cohort cohort

28103 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, statewide

63

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

TALUS ORCALCANEUS; WITH ALLOGRAFT

28104

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSALOR METATARSAL BONES, EXCEPT TALUS OR CALCANEUS; cohort cohort cohort cohort cohort

28107

EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR, TARSALOR METATARSAL BONES, EXCEPT TALUS OR CALCANEUS; WITH ALLOGRAFT statewide

28108 EXCISION OR CURETTAGE OF BONE CYST OR BENIGN TUMOR,PHALANGES OF FOOT cohort cohort cohort cohort cohort

28110 OSTECTOMY, PARTIAL EXCISION, FIFTH METATARSAL HEAD(BUNIONETTE) (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

28111 OSTECTOMY, COMPLETE EXCISION; FIRST METATARSAL HEAD cohort cohort

28112 OSTECTOMY, COMPLETE EXCISION; OTHER METATARSAL HEAD (SECOND,THIRD OR FOURTH) cohort cohort cohort cohort

28113 OSTECTOMY, COMPLETE EXCISION; FIFTH METATARSAL HEAD cohort cohort cohort cohort cohort

28114

OSTECTOMY, COMPLETE EXCISION; ALL METATARSAL HEADS, WITHPARTIAL PROXIMAL PHALANGECTOMY, EXCLUDING FIRST METATARSAL (EG, CLAYTON TYPE PROCEDURE) cohort cohort

28116 OSTECTOMY, EXCISION OF TARSAL COALITION cohort cohort cohort cohort

28118 OSTECTOMY, CALCANEUS; cohort cohort cohort cohort

28119 OSTECTOMY, CALCANEUS; FOR SPUR, WITH OR WITHOUT PLANTARFASCIAL RELEASE cohort cohort cohort cohort cohort cohort

28120

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION,SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TALUS OR CALCANEUS cohort cohort cohort cohort cohort

28122

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION,SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); TARSAL OR METATARSAL BONE, EXCEPT TALUS OR cohort cohort cohort cohort

28124

PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION,SEQUESTRECTOMY, OR DIAPHYSECTOMY) BONE (EG, OSTEOMYELITIS OR BOSSING); PHALANX OF TOE cohort cohort cohort cohort

28126 RESECTION, PARTIAL OR COMPLETE, PHALANGEAL BASE, EACH TOE cohort cohort

28140 METATARSECTOMY cohort cohort

28150 PHALANGECTOMY, TOE, EACH TOE statewide

28153 RESECTION, CONDYLE(S), DISTAL END OF PHALANX, EACHTOE cohort cohort cohort

28160 HEMIPHALANGECTOMY OR INTERPHALANGEAL JOINT EXCISION, TOE,PROXIMAL END OF PHALANX, EACH cohort cohort cohort cohort

28173 RADICAL RESECTION OF TUMOR; METATARSAL cohort cohort

28175 RADICAL RESECTION OF TUMOR; PHALANX OF TOE statewide

28190

*REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS*REMOVAL OF FOREIGN BODY, FOOT; SUBCUTANEOUS cohort cohort cohort cohort cohort

28192 REMOVAL OF FOREIGN BODY, FOOT; DEEPREMOVAL OF FOREIGN BODY, FOOT; DEEP cohort cohort cohort cohort cohort cohort

28193 REMOVAL OF FOREIGN BODY, FOOT; COMPLICATEDREMOVAL OF FOREIGN BODY, FOOT; COMPLICATED statewide

28200 REPAIR, TENDON, FLEXOR, FOOT; PRIMARY OR SECONDARY, WITHOUT FREE GRAFT, EACH TENDON cohort cohort cohort cohort cohort

28202 REPAIR, TENDON, FLEXOR, FOOT; SECONDARY WITH FREE GRAFT,EACH TENDON (INCLUDES OBTAINING GRAFT) cohort cohort cohort

28208 REPAIR, TENDON, EXTENSOR, FOOT; PRIMARY OR SECONDARY, EACHTENDON cohort cohort cohort cohort

28220 TENOLYSIS, FLEXOR, FOOT; SINGLE TENDON statewide

28225 TENOLYSIS, EXTENSOR, FOOT; SINGLE TENDON statewide

28230 TENOTOMY, OPEN, TENDON FLEXOR; FOOT, SINGLE OR MULTIPLETENDON(S) (SEPARATE PROCEDURE) statewide

28232 TENOTOMY, OPEN, TENDON FLEXOR; TOE, SINGLE TENDON (SEPARATE PROCEDURE) cohort cohort cohort cohort

64

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

28234 TENOTOMY, OPEN, EXTENSOR, FOOT OR TOE, EACH TENDON cohort cohort cohort cohort

28238

RECONSTRUCTION (ADVANCEMENT), POSTERIOR TIBIAL TENDON WITHEXCISION OF ACCESSORY NAVICULAR BONE (EG, KIDNER TYPE PROCEDURE) cohort cohort cohort cohort cohort

28240 TENOTOMY, LENGTHENING, OR RELEASE, ABDUCTOR HALLUCIS MUSCLE statewide

28250 DIVISION OF PLANTAR FASCIA AND MUSCLE (EG, STEINDLERSTRIPPING) (SEPARATE PROCEDURE) cohort cohort cohort

28260 CAPSULOTOMY, MIDFOOT; MEDIAL RELEASE ONLY (SEPARATEPROCEDURE) cohort cohort

28261 CAPSULOTOMY, MIDFOOT; WITH TENDON LENGTHENING statewide

28262

CAPSULOTOMY, MIDFOOT; EXTENSIVE, INCLUDING POSTERIORTALOTIBIAL CAPSULOTOMY AND TENDON(S) LENGTHENING(EG, RESISTANT CLUBFOOT DEFORMITY) cohort cohort cohort

28270 CAPSULOTOMY; METATARSOPHALANGEAL JOINT, WITH OR WITHOUTTENORRHAPHY, EACH JOINT (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

28272 CAPSULOTOMY; INTERPHALANGEAL JOINT, EACH JOINT (SEPARATEPROCEDURE) cohort cohort cohort cohort

28280 SYNDACTYLIZATION, TOES (EG, WEBBING OR KELIKIAN TYPEPROCEDURE) cohort cohort

28285 CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION,PARTIALOR TOTAL PHALANGECTOMY) cohort cohort cohort cohort cohort cohort

28286 CORRECTION, COCK-UP FIFTH TOE, WITH PLASTIC SKIN CLOSURE(EG, RUIZ-MORA TYPE PROCEDURE) statewide

28288 OSTECTOMY, PARTIAL, EXOSTECTOMY OR CONDYLECTOMY, METATARSAL HEAD, EACH METATARSAL HEAD cohort cohort cohort cohort

28289

HALLUX RIGIDUS CORRECTION WITH CHEILECTOMY, DEBRIDEMENT AND CAPSULAR RELEASE OF THE FIRST METATARSOPHALANGEAL JOINT cohort cohort cohort cohort cohort cohort

28290

CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; SIMPLE EXOSTECTOMY (EG, SILVER TYPE PROCEDURE) cohort cohort cohort cohort

28292

CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; KELLER, MCBRIDE, OR MAYO TYPE PROCEDURE cohort cohort cohort cohort cohort cohort

28293

CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; RESECTION OF JOINT WITH IMPLANT cohort cohort cohort cohort

28296

CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; WITH METATARSAL OSTEOTOMY (EG, MITCHELL, CHEVRON, OR CONCENTRIC TYPE PROCEDURES) cohort cohort cohort cohort cohort cohort

28297 CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; LAPIDUS TYPE PROCEDURE cohort cohort cohort cohort cohort cohort

28298 CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; BY PHALANX OSTEOTOMY cohort cohort cohort cohort cohort cohort

28299

CORRECTION, HALLUX VALGUS (BUNION), WITH OR WITHOUTSESAMOIDECTOMY; BY OTHER METHODS (EG, DOUBLE OSTEOTOMY) cohort cohort cohort cohort cohort cohort

28300 OSTEOTOMY; CALCANEUS (EG, DWYER OR CHAMBERS TYPE PROCEDURE),WITH OR WITHOUT INTERNAL FIXATION cohort cohort cohort cohort cohort cohort

28302 OSTEOTOMY; TALUS cohort cohort cohort

28304 OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; cohort cohort cohort cohort cohort

28305

OSTEOTOMY, TARSAL BONES, OTHER THAN CALCANEUS OR TALUS; WITHAUTOGRAFT (INCLUDES OBTAINING GRAFT) (EG, FOWLER TYPE) cohort cohort

28306

OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENINGORANGULAR CORRECTION, METATARSAL; FIRST METATARSA L cohort cohort cohort cohort cohort

28307

OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENINGORANGULAR CORRECTION, METATARSAL; FIRST METATARSA L WITH AUTOGRAFT (OTHER THAN FIRST TOE) statewide

65

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

28308

OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENINGORANGULAR CORRECTION, METATARSAL; OTHER THAN FIRS T METATARSAL, EACH cohort cohort cohort cohort cohort cohort

28309

OSTEOTOMY, WITH OR WITHOUT LENGTHENING, SHORTENINGORANGULAR CORRECTION, METATARSAL; MULTIPLE (EG, S WANSON TYPE CAVUS FOOT PROCEDURE) cohort cohort cohort

28310

OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION;PROXIMAL PHALANX, FIRST TOE (SEPARATE PROCEDURE) cohort cohort cohort

28312 OSTEOTOMY, SHORTENING, ANGULAR OR ROTATIONAL CORRECTION;OTHER PHALANGES, ANY TOE cohort cohort

28313

RECONSTRUCTION, ANGULAR DEFORMITY OF TOE, SOFT TISSUEPROCEDURES ONLY (EG, OVERLAPPING SECOND TOE, FIFTH TOE, CURLY TOES) cohort cohort cohort cohort cohort

28315 SESAMOIDECTOMY, FIRST TOE (SEPARATE PROCEDURE) cohort cohort cohort cohort

28320 REPAIR, NONUNION OR MALUNION; TARSAL BONES cohort cohort cohort

28322 REPAIR, NONUNION OR MALUNION; METATARSAL, WITH OR WITHOUTBONE GRAFT (INCLUDES OBTAINING GRAFT) cohort cohort cohort cohort cohort cohort

28341 RECONSTRUCTION, TOE, MACRODACTYLY; REQUIRING BONE RESECTION statewide

28344 RECONSTRUCTION, TOE(S); POLYDACTYLY statewide

28345 RECONSTRUCTION, TOE(S); SYNDACTYLY, WITH OR WITHOUT SKINGRAFT(S), EACH WEB cohort cohort cohort cohort

28360 RECONSTRUCTION, CLEFT FOOT statewide

28400

CLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATIONCLOSED TREATMENT OF CALCANEAL FRACTURE; WITHOUT MANIPULATION cohort cohort cohort cohort

28415 Open treatment of calcaneal fracture, includes internal fixation when performed; cohort cohort cohort cohort

28420

Open treatment of calcaneal fracture, includes internal fixation when performed; with primary iliac or other autogenous bone graft (includes obtaininggraft) statewide

28435

CLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATIONCLOSED TREATMENT OF TALUS FRACTURE; WITH MANIPULATION cohort cohort cohort cohort

28445 Open treatment of talus fracture, includes internal fixation when performed cohort cohort cohort cohort

28465 Open treatment of tarsal bone fracture (except talus and calcaneus), includes internal fixation whenperformed, each cohort cohort cohort

28470

CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUTMANIPULATION, EACH CLOSED TREATMENT OF METATARSAL FRACTURE; WITHOUT cohort cohort cohort cohort

28475

CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, EACH CLOSED TREATMENT OF METATARSAL FRACTURE; WITH MANIPULATION, cohort cohort cohort cohort cohort

28476

PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH MANIPULATION, EACH PERCUTANEOUS SKELETAL FIXATION OF METATARSAL FRACTURE, WITH cohort cohort cohort

28485 Open treatment of metatarsal fracture, includes internal fixation when performed, each cohort cohort cohort cohort cohort cohort

28490

CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX ORPHALANGES; WITHOUT MANIPULATION CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR cohort cohort cohort

28495

CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX ORPHALANGES; WITH MANIPULATION CLOSED TREATMENT OF FRACTURE GREAT TOE, PHALANX OR cohort cohort cohort

28496

PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE,PHALANX OR PHALANGES, WITH MANIPULATION PERCUTANEOUS SKELETAL FIXATION OF FRACTURE GREAT TOE, cohort cohort

28505 Open treatment of fracture, great toe, phalanx or phalanges, includes internal fixation when performed cohort cohort cohort

28510 CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, cohort cohort

66

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OTHERTHAN GREAT TOE; WITHOUT MANIPULATION, EACH CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGE S, OTHER

28515

CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHERTHAN GREAT TOE; WITH MANIPULATION, EACH CLOSED TREATMENT OF FRACTURE, PHALANX OR PHALANGES, OTHER cohort cohort cohort cohort

28525 Open treatment of fracture, phalanx or phalanges, other than great toe, includes internal fixation when performed, each cohort cohort cohort

28530 CLOSED TREATMENT OF SESAMOID FRACTURECLOSED TREATMENT OF SESAMOID FRACTURE statewide

28531

OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUTINTERNAL FIXATION OPEN TREATMENT OF SESAMOID FRACTURE, WITH OR WITHOUT statewide

28540

CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHERTHANTALOTARSAL; WITHOUT ANESTHESIA CLOSED TREATM ENT OF TARSAL BONE DISLOCATION, OTHER THAN statewide

28545

CLOSED TREATMENT OF TARSAL BONE DISLOCATION, OTHERTHANTALOTARSAL; REQUIRING ANESTHESIA CLOSED TREA TMENT OF TARSAL BONE DISLOCATION, OTHER THAN statewide

28555 Open treatment of tarsal bone dislocation, includes internal fixation when performed statewide

28585 Open treatment of talotarsal joint dislocation, includes internal fixation when performed cohort cohort

28605

CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION;REQUIRING ANESTHESIA CLOSED TREATMENT OF TARSOMETATARSAL JOINT DISLOCATION; statewide

28606

PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINTDISLOCATION, WITH MANIPULATION PERCUTANEOUS SKELETAL FIXATION OF TARSOMETATARSAL JOINT statewide

28615 Open treatment of tarsometatarsal joint dislocation, includes internal fixation when performed cohort cohort cohort cohort cohort

28630

*CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; WITHOUT ANESTHESIA *CLOSED TREATMENT OFMETATARSOPHALANGEAL JOINT DISLOCATION; cohort cohort cohort cohort

28635

*CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; REQUIRING ANESTHESIA *CLOSED TREATMENT OF METATARSOPHALANGEAL JOINT DISLOCATION; statewide

28636

PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT DISLOCATION, WITH MANIPULATION PERCUTANEOUS SKELETAL FIXATION OF METATARSOPHALANGEAL JOINT cohort cohort

28645 Open treatment of metatarsophalangeal joint dislocation includes internal fixation when performed cohort cohort

28660

*CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION;WITHOUT ANESTHESIA *CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; cohort cohort cohort cohort cohort

28665

*CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION;REQUIRING ANESTHESIA *CLOSED TREATMENT OF INTERPHALANGEAL JOINT DISLOCATION; statewide

28715 ARTHRODESIS; TRIPLEARTHRODESIS; TRIPLE cohort cohort cohort cohort cohort

28725 ARTHRODESIS; SUBTALARARTHRODESIS; SUBTALAR cohort cohort cohort cohort cohort cohort

28730 ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE ORTRANSVERSE; cohort cohort cohort cohort cohort

28735

ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, MULTIPLE ORTRANSVERSE; WITH OSTEOTOMY (EG, FLATFOOT CORRECTION) cohort cohort cohort cohort cohort

28737

ARTHRODESIS, WITH TENDON LENGTHENING AND ADVANCEMENT,MIDTARSAL NAVICULAR-CUNEIFORM (EG, MILLER TYPE PROCEDURE) cohort cohort

28740 ARTHRODESIS, MIDTARSAL OR TARSOMETATARSAL, SINGLE JOINT cohort cohort cohort cohort cohort cohort

28750 ARTHRODESIS, GREAT TOE; METATARSOPHALANGEAL JOINT cohort cohort cohort cohort cohort

28755 ARTHRODESIS, GREAT TOE; INTERPHALANGEAL JOINT cohort cohort cohort cohort cohort

67

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

28760

ARTHRODESIS, WITH EXTENSOR HALLUCIS LONGUS TRANSFER TO FIRSTMETATARSAL NECK, GREAT TOE, INTERPHALANGEAL JOINT (EG, JONES TYPE PROCEDURE) cohort cohort cohort

28800 AMPUTATION, FOOT; MIDTARSAL (EG, CHOPART TYPE PROCEDURE) statewide

28805 AMPUTATION, FOOT; TRANSMETATARSAL cohort cohort cohort

28810 AMPUTATION, METATARSAL, WITH TOE, SINGLE cohort cohort cohort cohort cohort

28820 AMPUTATION, TOE; METATARSOPHALANGEAL JOINT cohort cohort cohort cohort cohort

28825 AMPUTATION, TOE; INTERPHALANGEAL JOINT cohort cohort cohort cohort cohort

28899 UNLISTED PROCEDURE, FOOT OR TOES cohort cohort cohort cohort cohort

29010 APPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLYAPPLICATION OF RISSER JACKET, LOCALIZER, BODY; ONLY statewide

29065 APPLICATION; SHOULDER TO HAND (LONG ARM)APPLICATION; SHOULDER TO HAND (LONG ARM) cohort cohort

29075 APPLICATION; ELBOW TO FINGER (SHORT ARM)APPLICATION; ELBOW TO FINGER (SHORT ARM) cohort cohort cohort cohort

29085

APPLICATION; HAND AND LOWER FOREARM (GAUNTLET)APPLICATION; HAND AND LOWER FOREARM (GAUNTLET) cohort cohort cohort

29086 APPLICATION, CAST; FINGER (CONTRACTURE) statewide

29105

APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND)APPLICATION OF LONG ARM SPLINT (SHOULDER TO HAND) cohort cohort cohort cohort cohort cohort

29125

APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND);STATICAPPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND); STATIC cohort cohort cohort cohort cohort cohort

29126

APPLICATION OF SHORT ARM SPLINT (FOREARM TO HAND);DYNAMICAPPLICATION OF SHORT ARM SPLINT (FOREARM T O HAND); DYNAMIC cohort cohort cohort cohort

29130 APPLICATION OF FINGER SPLINT; STATICAPPLICATION OFFINGER SPLINT; STATIC cohort cohort cohort cohort cohort

29131 APPLICATION OF FINGER SPLINT; DYNAMICAPPLICATION OF FINGER SPLINT; DYNAMIC cohort cohort cohort

29200 STRAPPING; THORAX statewide

29240 STRAPPING; SHOULDER (EG, VELPEAU) cohort cohort cohort cohort cohort

29260 STRAPPING; ELBOW OR WRIST cohort cohort cohort cohort cohort

29280 STRAPPING; HAND OR FINGER cohort cohort cohort cohort cohort

29305 APPLICATION OF HIP SPICA CAST; 1 LEG statewide

29325 APPLICATION OF HIP SPICA CAST; 1 AND ONE-HALF SPICA OR BOTH LEGS cohort cohort

29345 APPLICATION OF LONG LEG CAST (THIGH TO TOES);APPLICATION OF LONG LEG CAST (THIGH TO TOES); cohort cohort

29355

APPLICATION OF LONG LEG CAST (THIGH TO TOES); WALKER ORAMBULATORY TYPE APPLICATION OF LONG LEG CAST(THIGH TO TOES); WALKER OR statewide

29405

APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES);APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); cohort cohort cohort cohort

29425

APPLICATION OF SHORT LEG CAST (BELOW KNEE TO TOES); WALKING OR AMBULATORY TYPE APPLICATION OF SHORTLEG CAST (BELOW KNEE TO TOES); WALKING cohort cohort cohort cohort

29440 ADDING WALKER TO PREVIOUSLY APPLIED CASTADDING WALKER TO PREVIOUSLY APPLIED CAST statewide

29445 APPLICATION OF RIGID TOTAL CONTACT LEG CASTAPPLICATION OF RIGID TOTAL CONTACT LEG CAST cohort cohort cohort cohort cohort cohort

29450

APPLICATION OF CLUBFOOT CAST WITH MOLDING OR MANIPULATION,LONG OR SHORT LEG APPLICATION OF CLUBFOOTCAST WITH MOLDING OR MANIPULATION, statewide

29505

APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES)APPLICATION OF LONG LEG SPLINT (THIGH TO ANKLE OR TOES) cohort cohort cohort cohort cohort cohort

68

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

29515 APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT)APPLICATION OF SHORT LEG SPLINT (CALF TO FOOT) cohort cohort cohort cohort cohort cohort

29520 STRAPPING; HIP statewide

29530 STRAPPING; KNEE cohort cohort cohort cohort cohort

29540 STRAPPING; ANKLE cohort cohort cohort cohort cohort

29550 STRAPPING; TOES cohort cohort cohort cohort

29580 STRAPPING; UNNA BOOT cohort cohort cohort cohort

29581 APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; LEG(BELOW KNEE), INCLUDING ANKLE AND FOOT cohort cohort cohort cohort cohort cohort

29582 APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; THIGH AND LEG, INCLUDING ANKLE AND FOOT, WHEN PERFORMED statewide

29584 APPLICATION OF MULTI-LAYER COMPRESSION SYSTEM; UPPER ARM, FOREARM, HAND, AND FINGERS statewide

29705 REMOVAL OR BIVALVING; FULL ARM OR FULL LEG CASTREMOVAL OR BIVALVING; FULL ARM OR FULL LEG CAST cohort cohort cohort

29740 WEDGING OF CAST (EXCEPT CLUBFOOT CASTS)WEDGING OF CAST (EXCEPT CLUBFOOT CASTS) statewide

29799 UNLISTED PROCEDURE, CASTING OR STRAPPINGUNLISTED PROCEDURE, CASTING OR STRAPPING cohort cohort cohort cohort cohort

29804

ARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICALARTHROSCOPY, TEMPOROMANDIBULAR JOINT, SURGICAL statewide

29805 ARTHROSCOPY, SHOULDER, DX, W/WO SYNOVIAL BIOPSY (SEP PROC) cohort cohort cohort cohort cohort

29806 ARTHROSCOPY, SHOULDER, SURGICAL; CAPSULORRHAPY cohort cohort cohort cohort cohort cohort

29807 REPAIR, SLAP LESION cohort cohort cohort cohort cohort cohort

29819

ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ARTHROSCOPY, SHOULDER, SURGICAL; WITH REMOVAL OF LOOSE BODY cohort cohort cohort cohort cohort cohort

29820 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, PARTIAL cohort cohort cohort cohort cohort

29821 ARTHROSCOPY, SHOULDER, SURGICAL; SYNOVECTOMY, COMPLETE cohort cohort cohort cohort

29822 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, LIMITED cohort cohort cohort cohort cohort cohort

29823 ARTHROSCOPY, SHOULDER, SURGICAL; DEBRIDEMENT, EXTENSIVE cohort cohort cohort cohort cohort cohort

29824 ARTHROSCOPY, SHOULDER, SURGICAL; DISTAL CLAVICULECTOMY W/ARTICULAR SURFACE cohort cohort cohort cohort cohort cohort

29825 ARTHROSCOPY, SHOULDER, SURGICAL; WITH LYSIS AND RESECTION OFADHESIONS, WITH OR WITHOUT MANIPULATION cohort cohort cohort cohort cohort cohort

29826

ARTHROSCOPY, SHOULDER, SURGICAL; DECOMPRESSION OF SUBACROMIAL SPACE WITH PARTIAL ACROMIOPLASTY, WITHCORACOACROMIAL LIGAMENT (IE, ARCH) RELEASE, WHEN PERFORMED (LIST SEPARATELY IN ADDITION TO CODE FOR cohort cohort cohort cohort cohort cohort

29827 ARTHROSCOPY, SHOULDER, SURGICAL; W/ROTATOR CUFF REPAIR cohort cohort cohort cohort cohort cohort

29828 Arthroscopy, shoulder, surgical; biceps tenodesis cohort cohort cohort cohort cohort cohort

29834

ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ARTHROSCOPY, ELBOW, SURGICAL; WITH REMOVAL OF LOOSE BODY OR cohort cohort cohort cohort cohort cohort

29835 ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, PARTIAL cohort cohort cohort cohort cohort

29836 ARTHROSCOPY, ELBOW, SURGICAL; SYNOVECTOMY, COMPLETE cohort cohort

29837 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, LIMITED cohort cohort cohort

29838 ARTHROSCOPY, ELBOW, SURGICAL; DEBRIDEMENT, EXTENSIVE cohort cohort cohort cohort cohort

29840 ARTHROSCOPY, WRIST, DIAGNOSTIC, WITH OR WITHOUT SYNOVIALBIOPSY (SEPARATE PROCEDURE) cohort cohort

29844 ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, PARTIAL cohort cohort cohort cohort cohort

29845 ARTHROSCOPY, WRIST, SURGICAL; SYNOVECTOMY, COMPLETE cohort cohort

29846 ARTHROSCOPY, WRIST, SURGICAL; EXCISION AND/OR REPAIR cohort cohort cohort cohort cohort cohort

69

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OFTRIANGULAR FIBROCARTILAGE AND/OR JOINT DEBRIDEMENT

29847 ARTHROSCOPY, WRIST, SURGICAL; INTERNAL FIXATION FOR FRACTUREOR INSTABILITY statewide

29848 ENDOSCOPY, WRIST, SURGICAL, WITH RELEASE OF TRANSVERSECARPAL LIGAMENT cohort cohort cohort cohort cohort cohort

29851

ARTHROSCOPICALLY AIDED TREATMENT OF INTERCONDYLAR SPINE(S)AND/OR TUBEROSITY FRACTURE(S) OF THE KNEE,WITH OR WITHOUT MANIPULATION; WITH INTERNAL OR E XTERNAL FIXATION (INCLUDES cohort cohort cohort cohort cohort

29855

Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation when performed (includes arthroscopy) cohort cohort

29860 ARTHROSCOPY, HIP, DIAGNOSTIC WITH OR WITHOUT SYNOVIAL BIOPSY(SEPARATE PROCEDURE) statewide

29861

ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY ORFOREIGN BODY ARTHROSCOPY, HIP, SURGICAL; WITH REMOVAL OF LOOSE BODY OR cohort cohort cohort

29862

ARTHROSCOPY, HIP, SURGICAL; WITH DEBRIDEMENT/SHAVING OFARTICULAR CARTILAGE (CHONDROPLASTY), ABRASIONARTHROPLASTY, AND/OR RESECTION OF LABRUM cohort cohort cohort cohort cohort cohort

29863 ARTHROSCOPY, HIP, SURGICAL; WITH SYNOVECTOMY cohort cohort cohort cohort

29866 Arthroscopy, knee, surgical; osteochondral autograft(s) (e.g., mosaicplasty) (includes harvesting ofthe autograft[s]) cohort cohort

29867 ARTHROSCOPY, KNEE, SURGICAL;OSTEOCHONDRAL ALLOGRAFT IMPLANT W/SCOPE statewide

29868 ARTHROSCOPY, KNEE, SURGICAL; MENISCAL TRANSPLANTION, MEDIAL OR LATERAL W/SCOPE cohort cohort

29870 ARTHROSCOPY, KNEE, DIAGNOSTIC, WITH OR WITHOUT SYNOVIALBIOPSY (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

29871 ARTHROSCOPY, KNEE, SURGICAL; FOR INFECTION, LAVAGEANDDRAINAGE cohort cohort cohort

29873 ARTHROSCOPY, KNEE, SURGICAL; W/LATERAL RELEASE cohort cohort cohort cohort cohort cohort

29874

ARTHROSCOPY, KNEE, SURGICAL; FOR REMOVAL OF LOOSE BODY ORFOREIGN BODY (EG, OSTEOCHONDRITIS DISSECANSFRAGMENTATION, CHONDRAL FRAGMENTATION) cohort cohort cohort cohort cohort cohort

29875 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, LIMITED (EG, PLICAOR SHELF RESECTION) (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

29876 ARTHROSCOPY, KNEE, SURGICAL; SYNOVECTOMY, MAJOR, 2OR MORE COMPARTMENTS (EG, MEDIAL OR LATERAL) cohort cohort cohort cohort cohort cohort

29877 ARTHROSCOPY, KNEE, SURGICAL; DEBRIDEMENT/SHAVING OFARTICULAR CARTILAGE (CHONDROPLASTY) cohort cohort cohort cohort cohort cohort

29879

ARTHROSCOPY, KNEE, SURGICAL; ABRASION ARTHROPLASTY(INCLUDESCHONDROPLASTY WHERE NECESSARY) OR MULTIP LE DRILLING cohort cohort cohort cohort cohort cohort

29880

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL AND LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S cohort cohort cohort cohort cohort cohort

29881

ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCECTOMY (MEDIAL OR LATERAL, INCLUDING ANY MENISCAL SHAVING) INCLUDING DEBRIDEMENT/SHAVING OF ARTICULAR CARTILAGE (CHONDROPLASTY), SAME OR SEPARATE COMPARTMENT(S) cohort cohort cohort cohort cohort cohort

29882 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIAL ORLATERAL) cohort cohort cohort cohort cohort

29883 ARTHROSCOPY, KNEE, SURGICAL; WITH MENISCUS REPAIR (MEDIALAND LATERAL) cohort cohort cohort cohort cohort

29884 ARTHROSCOPY, KNEE, SURGICAL; WITH LYSIS OF ADHESIONS, WITHOR WITHOUT MANIPULATION (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

29886 ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACTOSTEOCHONDRITIS DISSECANS LESION cohort cohort cohort cohort

29887

ARTHROSCOPY, KNEE, SURGICAL; DRILLING FOR INTACTOSTEOCHONDRITIS DISSECANS LESION WITH INTERNAL FIXATION cohort cohort cohort cohort

70

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

29888 ARTHROSCOPICALLY AIDED ANTERIOR CRUCIATE LIGAMENTREPAIR/AUGMENTATION OR RECONSTRUCTION cohort cohort cohort cohort cohort cohort

29889 ARTHROSCOPICALLY AIDED POSTERIOR CRUCIATE LIGAMENTREPAIR/AUGMENTATION OR RECONSTRUCTION cohort cohort cohort cohort

29891

ARTHROSCOPY, ANKLE, SURGICAL; EXCISION OF OSTEOCHONDRALDEFECT OF TALUS AND/OR TIBIA, INCLUDING DRILLING OF THE DEFECT cohort cohort cohort cohort cohort

29892

ARTHROSCOPICALLY AIDED REPAIR OF LARGE OSTEOCHONDRITISDISSECANS LESION, TALAR DOME FRACTURE, OR TIBIAL PLAFOND FRACTURE, WITH OR WITHOUT INTERNAL FIXATION (INCLUDES cohort cohort cohort cohort

29893 ENDOSCOPIC PLANTAR FASCIOTOMY cohort cohort cohort cohort

29894

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS),SURGICAL; WITH REMOVAL OF LOOSE BODY OR FOREIGN BODY ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), cohort cohort cohort cohort

29895

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS),SURGICAL; SYNOVECTOMY, PARTIAL ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), cohort cohort cohort cohort cohort

29897

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS),SURGICAL; DEBRIDEMENT, LIMITED ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), cohort cohort cohort cohort cohort

29898

ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS),SURGICAL; DEBRIDEMENT, EXTENSIVE ARTHROSCOPY, ANKLE (TIBIOTALAR AND FIBULOTALAR JOINTS), cohort cohort cohort cohort cohort cohort

29899 ARTHROSCOPY, ANKLE, SURGICAL; W/ANKLE ARTHRODESIS cohort cohort cohort cohort

29906 Arthroscopy, subtalar joint, surgical; with debridement statewide

29907 Arthroscopy, subtalar joint, surgical; with subtalar arthrodesis statewide

29914 Arthroscopy, hip, surgical; with femoroplasty (ie,treatment of cam lesion) cohort cohort cohort cohort cohort

29915 Arthroscopy, subtalar joint, surgical; with acetabuloplasty (ie, treatment of pincer lesion) cohort cohort cohort cohort cohort

29916 Arthroscopy, subtalar joint, surgical; with labralrepair cohort cohort cohort cohort cohort cohort

29999 UNLISTED PROC, ARTHROSCOPY cohort cohort cohort cohort cohort cohort

30000 *DRAINAGE ABSCESS OR HEMATOMA, NASAL, INTERNAL APPROACH cohort cohort

30020 *DRAINAGE ABSCESS OR HEMATOMA, NASAL SEPTUM statewide

30100 BIOPSY, INTRANASAL cohort cohort cohort

30110 EXCISION, NASAL POLYP(S), SIMPLEEXCISION, NASAL POLYP(S), SIMPLE statewide

30115 EXCISION, NASAL POLYP(S), EXTENSIVEEXCISION, NASALPOLYP(S), EXTENSIVE cohort cohort cohort

30117 EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING LASER),INTRANASAL LESION; INTERNAL APPROACH cohort cohort cohort cohort

30118

EXCISION OR DESTRUCTION, ANY METHOD (INCLUDING LASER),INTRANASAL LESION; EXTERNAL APPROACH (LATERAL RHINOTOMY) cohort cohort

30125 EXCISION DERMOID CYST, NOSE; COMPLEX, UNDER BONE ORCARTILAGE cohort cohort

30130 EXCISION TURBINATE, PARTIAL OR COMPLETE, ANY METHOD cohort cohort cohort cohort cohort cohort

30140 SUBMUCOUS RESECTION TURBINATE, PARTIAL OR COMPLETE, ANYMETHOD cohort cohort cohort cohort cohort cohort

30150 RHINECTOMY; PARTIAL statewide

30300

*REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE*REMOVAL FOREIGN BODY, INTRANASAL; OFFICE TYPE PROCEDURE cohort cohort cohort cohort cohort

30310

REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERALANESTHESIA REMOVAL FOREIGN BODY, INTRANASAL; REQUIRING GENERAL cohort cohort cohort

30400 RHINOPLASTY, PRIMARY; LATERAL AND ALAR CARTILAGES AND/ORELEVATION OF NASAL TIP statewide

30420 RHINOPLASTY, PRIMARY; INCLUDING MAJOR SEPTAL REPAIR cohort cohort

71

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

30430 RHINOPLASTY, SECONDARY; MINOR REVISION (SMALL AMOUNT OFNASAL TIP WORK) statewide

30450 RHINOPLASTY, SECONDARY; MAJOR REVISION (NASAL TIP WORK ANDOSTEOTOMIES) statewide

30460

RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITALCLEFT LIP AND/OR PALATE, INCLUDING COLUMELLARLENGTHENING; TIP ONLY cohort cohort

30462

RHINOPLASTY FOR NASAL DEFORMITY SECONDARY TO CONGENITALCLEFT LIP AND/OR PALATE, INCLUDING COLUMELLARLENGTHENING; TIP, SEPTUM, OSTEOTOMIES cohort cohort

30465 REPAIR OF NASAL VESTIBULAR STENOSIS (EG, SPREADER GRAFTING, LATERAL NASAL WALL RECONSTRUCTION) cohort cohort cohort cohort cohort

30520

SEPTOPLASTY OR SUBMUCOUS RESECTION, WITH OR WITHOUTCARTILAGE SCORING, CONTOURING OR REPLACEMENT WITHGRAFT cohort cohort cohort cohort cohort cohort

30540 REPAIR CHOANAL ATRESIA; INTRANASAL statewide

30545 REPAIR CHOANAL ATRESIA; TRANSPALATINE statewide

30560 *LYSIS INTRANASAL SYNECHIA cohort cohort cohort cohort

30580 REPAIR FISTULA; OROMAXILLARY (COMBINE WITH 31030 IFANTROTOMY IS INCLUDED) cohort cohort

30600 REPAIR FISTULA; ORONASAL cohort cohort

30620 SEPTAL OR OTHER INTRANASAL DERMATOPLASTY (DOES NOTINCLUDEOBTAINING GRAFT) statewide

30630 REPAIR NASAL SEPTAL PERFORATIONS cohort cohort cohort cohort

30801

ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL cohort cohort cohort cohort cohort

30802

ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL) cohort cohort cohort cohort cohort

30901 *CONTROL NASAL HEMORRHAGE, ANTERIOR, SIMPLE (LIMITED CAUTERYAND/OR PACKING) ANY METHOD cohort cohort cohort cohort cohort cohort

30903 *CONTROL NASAL HEMORRHAGE, ANTERIOR, COMPLEX (EXTENSIVECAUTERY AND/OR PACKING) ANY METHOD cohort cohort cohort

30905

*CONTROL NASAL HEMORRHAGE, POSTERIOR, WITH POSTERIOR NASALPACKS AND/OR CAUTERIZATION, ANY METHOD; INITIAL cohort cohort cohort cohort cohort

30915 LIGATION ARTERIES; ETHMOIDAL statewide

30920 LIGATION ARTERIES; INTERNAL MAXILLARY ARTERY, TRANSANTRAL statewide

30930 FRACTURE NASAL TURBINATE(S), THERAPEUTIC cohort cohort cohort cohort cohort cohort

30999 UNLISTED PROCEDURE, NOSE cohort cohort cohort cohort cohort

31000 *LAVAGE BY CANNULATION; MAXILLARY SINUS (ANTRUM PUNCTURE OR NATURAL OSTIUM) cohort cohort cohort

31002 *LAVAGE BY CANNULATION; SPHENOID SINUS statewide

31020

SINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASALSINUSOTOMY, MAXILLARY (ANTROTOMY); INTRANASAL cohort cohort cohort cohort cohort

31030

SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC)WITHOUT REMOVAL OF ANTROCHOANAL POLYPS SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) cohort cohort cohort

31032

SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC)WITH REMOVAL OF ANTROCHOANAL POLYPS SINUSOTOMY, MAXILLARY (ANTROTOMY); RADICAL (CALDWELL-LUC) cohort cohort

31040 PTERYGOMAXILLARY FOSSA SURGERY, ANY APPROACH statewide

31050 SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY;SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; cohort cohort

31051 SINUSOTOMY, SPHENOID, WITH OR WITHOUT BIOPSY; WITHMUCOSALSTRIPPING OR REMOVAL OF POLYP(S) statewide

72

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

31070

SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION)SINUSOTOMY FRONTAL; EXTERNAL, SIMPLE (TREPHINE OPERATION) statewide

31080

SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, BROW INCISION (INCLUDES ABLATION) SINUSOTOMY FRONTAL; OBLITERATIVE WITHOUT OSTEOPLASTIC FLAP, statewide

31085

SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP,CORONAL INCISION SINUSOTOMY FRONTAL; OBLITERATIVE, WITH OSTEOPLASTIC FLAP, statewide

31200 ETHMOIDECTOMY; INTRANASAL, ANTERIOR cohort cohort cohort cohort

31201 ETHMOIDECTOMY; INTRANASAL, TOTAL statewide

31205 ETHMOIDECTOMY; EXTRANASAL, TOTAL statewide

3120F 12-Lead ECG Performed (EM) statewide

31225 MAXILLECTOMY; WITHOUT ORBITAL EXENTERATION cohort cohort

31231 NASAL ENDOSCOPY, DIAGNOSTIC, UNILATERAL OR BILATERAL(SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

31233

NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH MAXILLARY SINUSOSCOPY(VIA INFERIOR MEATUS OR CANINE FOSSA PUNCTURE) statewide

31235

NASAL/SINUS ENDOSCOPY, DIAGNOSTIC WITH SPHENOID SINUSOSCOPY (VIA PUNCTURE OF SPHENOIDAL FACE OR CANNULATION OF OSTIUM) statewide

31237 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY ORDEBRIDEMENT (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

31238 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF EPISTAXIS cohort cohort cohort cohort

31239 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH DACRYOCYSTORHINOSTOMY cohort cohort cohort

31240 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSARESECTION cohort cohort cohort cohort cohort

31254 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, PARTIAL(ANTERIOR) cohort cohort cohort cohort cohort cohort

31255 NASAL/SINUS ENDOSCOPY, SURGICAL; WITH ETHMOIDECTOMY, TOTAL(ANTERIOR AND POSTERIOR) cohort cohort cohort cohort cohort cohort

31256 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; cohort cohort cohort cohort cohort cohort

31267

NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS cohort cohort cohort cohort cohort cohort

31276 NASAL/SINUS ENDOSCOPY, SURGICAL WITH FRONTAL SINUSEXPLORATION, WITH OR SINUS cohort cohort cohort cohort cohort cohort

31287 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; cohort cohort cohort cohort cohort cohort

31288 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH SPHENOIDOTOMY; WITHREMOVAL OF TISSUE FROM THE SPHENOID SINUS cohort cohort cohort cohort cohort

31290 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OFCEREBROSPINAL FLUID LEAK; ETHMOID REGION cohort cohort

31291 NASAL/SINUS ENDOSCOPY, SURGICAL, WITH REPAIR OFCEREBROSPINAL FLUID LEAK; SPHENOID REGION statewide

31295 Nasal/sinus endoscopy, surgical; with dilation of maxillary sinus ostium (eg, balloon dilation), transnasal or via canine fossa statewide

31296 Nasal/sinus endoscopy, surgical; with dilation of frontal sinus ostium (eg, balloon dilation) cohort cohort

31297 Nasal/sinus endoscopy, surgical; with dilation of sphenoid sinus ostium (eg, balloon dilation) statewide

31299 UNLISTED PROCEDURE, ACCESSORY SINUSES statewide

31300 LARYNGOTOMY (THYROTOMY, LARYNGOFISSURE); WITH REMOVAL OFTUMOR OR LARYNGOCELE, CORDECTOMY cohort cohort

31500 INTUBATION, ENDOTRACHEAL, EMERGENCY PROCEDURE cohort cohort cohort cohort cohort

31502 TRACHEOTOMY TUBE CHANGE PRIOR TO ESTABLISHMENT OF FISTULATRACT cohort cohort

73

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

31505 LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); DIAGNOSTIC cohort cohort

31511

LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OFFOREIGN BODY LARYNGOSCOPY, INDIRECT (SEPARATE PROCEDURE); WITH REMOVAL OF statewide

31525 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY;DIAGNOSTIC, EXCEPT NEWBORN cohort cohort cohort cohort cohort

31526 LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY;DIAGNOSTIC, WITH OPERATING MICROSCOPE cohort cohort cohort cohort

31528

LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY;WITHDILATATION, INITIAL LARYNGOSCOPY DIRECT, WIT H OR WITHOUT TRACHEOSCOPY; WITH cohort cohort cohort cohort

31529

LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY;WITHDILATATION, SUBSEQUENT LARYNGOSCOPY DIRECT, WITH OR WITHOUT TRACHEOSCOPY; WITH cohort cohort cohort

31530

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODYREMOVAL; LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FO REIGN BODY REMOVAL; cohort cohort cohort cohort

31531

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODYREMOVAL; WITH OPERATING MICROSCOPE LARYNGOSCOPY, DIRECT, OPERATIVE, WITH FOREIGN BODY REMOVAL; statewide

31535 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; cohort cohort cohort cohort cohort cohort

31536 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH BIOPSY; WITHOPERATINGMICROSCOPE cohort cohort cohort cohort cohort

31540 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMORAND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; cohort cohort cohort cohort cohort cohort

31541

LARYNGOSCOPY, DIRECT, OPERATIVE, WITH EXCISION OF TUMORAND/OR STRIPPING OF VOCAL CORDS OR EPIGLOTTIS; WITH OPERATING MICROSCOPE cohort cohort cohort cohort

31545

LARNGOSCOPY, DIRECT, OPERATIVE, W/OPERATING MICRO-SCOPE OR TELESCOPE, W/SUBMUCOSAL REMOVAL OF NON- NEOPLASTIC LESION(S) OF VOCAL CORD; RECONSTRUCTIONW/LOCAL TISSUE FLAPS(S) cohort cohort cohort

31560 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; statewide

31561 LARYNGOSCOPY, DIRECT, OPERATIVE, WITH ARYTENOIDECTOMY; WITH OPERATING MICROSCOPE statewide

31570 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S),THERAPEUTIC; cohort cohort cohort cohort

31571 LARYNGOSCOPY, DIRECT, WITH INJECTION INTO VOCAL CORD(S),THERAPEUTIC; WITH OPERATING MICROSCOPE cohort cohort cohort cohort

31575 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; DIAGNOSTIC cohort cohort cohort cohort cohort

31576 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH BIOPSY cohort cohort cohort

31577

LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OFFOREIGNBODY LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; W ITH REMOVAL OF FOREIGN statewide

31578 LARYNGOSCOPY, FLEXIBLE FIBEROPTIC; WITH REMOVAL OFLESION cohort cohort

31579 LARYNGOSCOPY, FLEXIBLE OR RIGID FIBEROPTIC, WITH STROBOSCOPY cohort cohort

31588 LARYNGOPLASTY, NOT OTHERWISE SPECIFIED (EG, FOR BURNS,RECONSTRUCTION AFTER PARTIAL LARYNGECTOMY) cohort cohort cohort

31599 UNLISTED PROCEDURE, LARYNX cohort cohort cohort

31611

CONSTRUCTION OF TRACHEOESOPHAGEAL FISTULA AND SUBSEQUENTINSERTION OF AN ALARYNGEAL SPEECH PROSTHESIS(EG, VOICE BUTTON, BLOM-SINGER PROSTHESIS) statewide

31612 TRACHEAL PUNCTURE, PERCUTANEOUS WITH TRANSTRACHEALASPIRATION AND/OR INJECTION statewide

31613 TRACHEOSTOMA REVISION; SIMPLE, WITHOUT FLAP ROTATION statewide

31615 TRACHEOBRONCHOSCOPY THROUGH ESTABLISHED TRACHEOSTOMYINCISION statewide

74

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

31620

ENDOBRONCHIAL ULTRASOUND (EBUS) DURING BRONCHOSCOPIC DIAGNOSTIC OR THERAPEUTIC INTERVENTION(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE(S)) cohort cohort cohort cohort

31622

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; DIAGNOSTIC, WITH CELL WASHING, WHEN PERFORMED (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

31623

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRUSHING OR PROTECTED BRUSHINGS cohort cohort cohort cohort cohort

31624

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL ALVEOLAR LAVAGE cohort cohort cohort cohort cohort

31625

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH BRONCHIAL OR ENDOBRONCHIAL BIOPSY(S), SINGLE OR MULTIPLE SITES cohort cohort cohort cohort cohort

31627

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE[S]) statewide

31628

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), SINGLE LOBE cohort cohort cohort cohort cohort

31629

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), TRACHEA, MAIN STEM AND/OR LOBAR BRONCHUS(I) cohort cohort cohort cohort cohort

31630

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRACHEAL/BRONCHIAL DILATION OR CLOSED REDUCTION OF FRACTURE cohort cohort

31631

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF TRACHEAL STENT(S) (INCLUDES TRACHEAL/BRONCHIAL DILATION AS REQUIRED) statewide

31632

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL LUNG BIOPSY(S), EACH ADDITIONAL LOBE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

31633

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH TRANSBRONCHIAL NEEDLE ASPIRATION BIOPSY(S), EACH ADDITIONAL LOBE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY cohort cohort cohort

31635

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH REMOVAL OF FOREIGN BODY cohort cohort cohort

31636

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF BRONCHIAL STENT(S) (INCLUDES TRACHEAL/BRONCHIAL DILATION AS REQUIRED), INITIAL BRONCHUS cohort cohort

31640

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH EXCISION OF TUMOR cohort cohort

31641

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH DESTRUCTION OF TUMOR OR RELIEF OF STENOSIS BY ANY METHOD OTHER THAN EXCISION (EG, LASER THERAPY, CRYOTHERAPY) statewide

31645

BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH THERAPEUTIC ASPIRATION OF TRACHEOBRONCHIAL TREE, cohort cohort cohort

75

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

INITIAL (EG, DRAINAGE OF LUNG ABSCESS)

31720 CATHETER ASPIRATION (SEPARATE PROCEDURE); NASOTRACHEAL cohort cohort cohort cohort cohort

31800 SUTURE OF TRACHEAL WOUND OR INJURY; CERVICAL statewide

31820 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITHOUT PLASTICREPAIR statewide

31825 SURGICAL CLOSURE TRACHEOSTOMY OR FISTULA; WITH PLASTICREPAIR statewide

31830 REVISION OF TRACHEOSTOMY SCAR statewide

31899 UNLISTED PROCEDURE, TRACHEA, BRONCHI cohort cohort

32400 *BIOPSY, PLEURA; PERCUTANEOUS NEEDLE cohort cohort cohort

32405 BIOPSY, LUNG OR MEDIASTINUM, PERCUTANEOUS NEEDLE cohort cohort cohort cohort cohort

32550 Insertion of indwelling tunneled pleural catheter with cuff cohort cohort cohort cohort cohort

32551

TUBE THORACOSTOMY, INCLUDES CONNECTION TO DRAINAGESYSTEM (EG, WATER SEAL), WHEN PERFORMED, OPEN (SE PARATE PROCEDURE) cohort cohort cohort cohort cohort

32552 REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF cohort cohort

32553

PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-THORACIC, SINGLE OR MULTIPLE cohort cohort

32554 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITHOUT IMAGING GUIDANCE cohort cohort cohort cohort cohort

32555 THORACENTESIS, NEEDLE OR CATHETER, ASPIRATION OF THE PLEURAL SPACE; WITH IMAGING GUIDANCE cohort cohort cohort cohort cohort

32556 PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITHOUT IMAGING GUIDANCE cohort cohort

32557 PLEURAL DRAINAGE, PERCUTANEOUS, WITH INSERTION OF INDWELLING CATHETER; WITH IMAGING GUIDANCE cohort cohort cohort

32561

INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); INITIAL DAY statewide

32562

INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); SUBSEQUENT DAY statewide

32606 THORACOSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE); MEDIASTINALSPACE, WITH BIOPSY statewide

32609 THORACOSCOPY; WITH BIOPSY(IES) OF PLEURA cohort cohort

32655

THORACOSCOPY, SURGICAL; WITH RESECTION-PLICATION OF BULLAE, INCLUDES ANY PLEURAL PROCEDURE WHEN PERFORMED statewide

32663 THORACOSCOPY, SURGICAL; WITH LOBECTOMY (SINGLE LOBE) statewide

32664

THORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMYTHORACOSCOPY, SURGICAL; WITH THORACIC SYMPATHECTOMY cohort cohort cohort

32666 THORACOSCOPY, SURGICAL; WITH THERAPEUTIC WEDGE RESECTION (EG, MASS, NODULE), INITIAL UNILATERAL statewide

32997 TOTAL LUNG LAVAGE (UNILATERAL) statewide

32998

ABLATION THERAPY FOR REDUCTION OR ERADICATION OF 1OR MORE PULMONARY TUMOR(S) INCLUDING PLEURA OR CH EST WALL WHEN INVOLVED BY TUMOR EXTENSION, PERCUTANEOUS, RADIOFREQUENCY, UNILATERAL statewide

32999 UNLISTED PROCEDURE, LUNGS AND PLEURA statewide

33010 *PERICARDIOCENTESIS; INITIAL statewide

33202

INSERTION OF EPICARDIAL ELECTRODE(S); OPEN INCISION (EG, THORACOTOMY, MEDIAN STERNOTOMY, SUBXIPHOID APPROACH) statewide

33206 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL statewide

33207 INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); cohort cohort cohort

76

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

VENTRICULAR

33208

INSERTION OF NEW OR REPLACEMENT OF PERMANENT PACEMAKER WITH TRANSVENOUS ELECTRODE(S); ATRIAL AND VENTRICULAR cohort cohort cohort cohort

33210

INSERTION OR REPLACEMENT OF TEMPORARY TRANSVENOUS SINGLECHAMBER CARDIAC ELECTRODE OR PACEMAKER CATHETER (SEPARATE PROCEDURE) cohort cohort cohort cohort

33213 INSERTION OF PACEMAKER PULSE GENERATOR ONLY; WITH EXISTING DUAL LEADS cohort cohort

33215 REPOSITIONING, PREVIOUSLY IMPLANTED TRANSVENOUS ELECTRODE/PACING CARDIOVERT-DEFIB ELECTRODE cohort cohort

33216 INSERTION OF A SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR statewide

33217 INSERTION OF 2 TRANSVENOUS ELECTRODES, PERMANENT PACEMAKER OR CARDIOVERTER-DEFIBRILLATOR statewide

33218 REPAIR OF SINGLE TRANSVENOUS ELECTRODE, PERMANENT PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR statewide

33222 REVISION OR RELOCATION OF SKIN POCKET FOR PACEMAKER statewide

33223 REVISION OF SKIN POCKET FOR CARDIOVERTER-DEFIBRILLATOR cohort cohort

33224

INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, WITH ATTACHMENT TO PREVIOUSLY PLACED PACEMAKER OR PACING CARDIOVERTER-DEFIBRILLATOR PULSE GENERATOR (INCLUDING REVISI statewide

33225

INSERTION OF PACING ELECTRODE, CARDIAC VENOUS SYSTEM, FOR LEFT VENTRICULAR PACING, AT TIME OF INSERTION OF PACING CARDIOVERTER-DEFIBRILLATOR OR PACEMAKER PULSE GENERATOR (EG, FOR UPGRADE TO DUAL CHAMB cohort cohort cohort cohort

33227

REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; SINGLELEAD SYSTEM statewide

33228

REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; DUAL LEAD SYSTEM cohort cohort cohort cohort

33229

REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR WITH REPLACEMENT OF PACEMAKER PULSE GENERATOR; MULTIPLE LEAD SYSTEM statewide

33233 REMOVAL OF PERMANENT PACEMAKER PULSE GENERATOR ONLY cohort cohort

33235 REMOVAL OF TRANSVENOUS PACEMAKER ELECTRODE(S); DUAL LEADSYSTEM cohort cohort

33241 REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSEGENERATOR ONLY cohort cohort

33244

REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSEGENERATOR AND/OR LEAD SYSTEM; BY OTHER THAN THORACOTOMY REMOVAL OF IMPLANTABLE CARDIOVERTER-DEFIBRILLATOR PULSE cohort cohort

33249

INSERTION OR REPLACEMENT OF PERMANENT PACING CARDIOVERTER-DEFIBRILLATOR SYSTEM WITH TRANSVENOUS LEAD(S), SINGLE OR DUAL CHAMBER cohort cohort cohort cohort

33262

REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSEGENERATOR WITH REPLACEMENT OF PACING CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR; SINGLE LEAD SYSTEM cohort cohort cohort

33263

REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSEGENERATOR WITH REPLACEMENT OF PACING CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR; DUAL LEAD SYSTEM cohort cohort cohort cohort

33264

REMOVAL OF PACING CARDIOVERTER-DEFIBRILLATOR PULSEGENERATOR WITH REPLACEMENT OF PACING CARDIOVERTER -DEFIBRILLATOR PULSE GENERATOR; MULTIPLE LEAD SYSTEM cohort cohort cohort cohort

33282 IMPLANTATION OF PATIENT-ACTIVATED CARDIAC EVENT RECORDER cohort cohort cohort cohort

77

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

33284 REMOVAL OF AN IMPLANTABLE, PATIENT-ACTIVATED CARDIAC EVENT RECORDER cohort cohort cohort

34111

EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER;RADIAL OR ULNAR ARTERY, BY ARM INCISION EMBOLECTOMY OR THROMBECTOMY, WITH OR WITHOUT CATHETER; cohort cohort

34520 CROSS-OVER VEIN GRAFT TO VENOUS SYSTEM statewide

35045

DIRECT REPAIR OF ANEURYSM, FALSE ANEURYSM, OR EXCISION(PARTIAL OR TOTAL) AND GRAFT INSERTION, WITH OR WITHOUT PATCH GRAFT; FOR ANEURYSM, FALSE ANEURYSM, AND ASSOCIATED statewide

35190 REPAIR, ACQUIRED OR TRAUMATIC ARTERIOVENOUS FISTULA;EXTREMITIES statewide

35201 REPAIR BLOOD VESSEL, DIRECT; NECK cohort cohort

35206 REPAIR BLOOD VESSEL, DIRECT; UPPER EXTREMITY cohort cohort

35207 REPAIR BLOOD VESSEL, DIRECT; HAND, FINGER cohort cohort cohort cohort

35221 REPAIR BLOOD VESSEL, DIRECT; INTRA-ABDOMINAL statewide

35226 REPAIR BLOOD VESSEL, DIRECT; LOWER EXTREMITY cohort cohort cohort cohort

35301 Thromboendarterectomy, including patch graft, if performed; carotid, vertebral, subclavian, by neck incision cohort cohort

35302 THROMBOENDARTERECTOMY, INCLUDING PATCH GRAFT, IF PERFORMED; SUPERFICIAL FEMORAL ARTERY statewide

35390

REOPERATION, CAROTID, THROMBOENDARTERECTOMY, MORE THAN 1 MONTH AFTER ORIGINAL OPERATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

35471 Transluminal balloon angioplasty, percutaneous; renal or visceral artery cohort cohort cohort

35472 TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; AORTIC cohort cohort

35475

TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS;BRACHIOCEPHALIC TRUNK OR BRANCHES, EACH VESSEL cohort cohort cohort cohort cohort

35476 TRANSLUMINAL BALLOON ANGIOPLASTY, PERCUTANEOUS; VENOUS cohort cohort cohort cohort cohort

35761 EXPLORATION (NOT FOLLOWED BY SURGICAL REPAIR), WITH ORWITHOUT LYSIS OF ARTERY; OTHER VESSELS cohort cohort

35800 EXPLORATION FOR POSTOPERATIVE HEMORRHAGE, THROMBOSIS ORINFECTION; NECK cohort cohort

35876

THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT (OTHER THANHEMODIALYSIS GRAFT OR FISTULA); WITH REVISION OFARTERIAL OR VENOUS GRAFT statewide

35903 EXCISION OF INFECTED GRAFT; EXTREMITY statewide

36000 *INTRODUCTION OF NEEDLE OR INTRACATHETER, VEIN cohort cohort cohort cohort cohort

36002 INJECTION (THROMBIN) PERCUTANEOUS TREATMENT EXTREMITY PSEUDOANEURYSM cohort cohort

36005 INJECTION PROCEDURE FOR CONTRAST VENOGRAPHY (INCLUDINGINTRODUCTION OF NEEDLE OR INTRACATHETER) cohort cohort cohort cohort cohort

36010 INTRODUCTION OF CATHETER, SUPERIOR OR INFERIOR VENA CAVA cohort cohort cohort cohort

36011 Selective Catheter placement cohort cohort cohort cohort

36012

SELECTIVE CATHETER PLACEMENT, VENOUS SYSTEM; SECOND ORDER,OR MORE SELECTIVE, BRANCH (EG, LEFT ADRENAL VEIN, PETROSAL SINUS) cohort cohort

36014 SELECTIVE CATHETER PLACEMENT, LEFT OR RIGHT PULMONARY ARTERY statewide

36015 SELECTIVE CATHETER PLACEMENT, SEGMENTAL OR SUBSEGMENTALPULMONARY ARTERY cohort cohort

36140 INTRODUCTION OF NEEDLE OR INTRACATHETER; EXTREMITYARTERY cohort cohort cohort cohort

36147

INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); INITIAL ACCESS WITH COMPLETE cohort cohort cohort cohort cohort

78

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

RADIOLOGICAL EVALUATIONOF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE

36148

INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); ADDITIONAL ACCESS FOR THERAPEUTIC INTERVENTION (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCED cohort cohort cohort cohort cohort

36200 INTRODUCTION OF CATHETER, AORTA cohort cohort cohort cohort

36215

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRSTORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort cohort

36216

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIALSECOND ORDER THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort

36217

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRDORDER OR MORE SELECTIVE THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort cohort

36218

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONALSECOND ORDER, THIRD ORDER, AND BEYOND, THORACIC OR BRACHIOCEPHALIC BRANCH, WITHIN A VASCULARFAMILY (LIST IN cohort cohort

36221

NON-SELECTIVE CATHETER PLACEMENT, THORACIC AORTA, WITH ANGIOGRAPHY OF THE EXTRACRANIAL CAROTID, VERTEBRAL, AND/OR INTRACRANIAL VESSELS, UNILATERAL OR BILATERAL, AND ALL ASSOCIATED RADIOLOGICAL SUPERVI cohort cohort cohort

36222

SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH ANGIOGRAPHY OF THE IPSILATERAL EXTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERV cohort cohort cohort cohort

36223

SELECTIVE CATHETER PLACEMENT, COMMON CAROTID OR INNOMINATE ARTERY, UNILATERAL, ANY APPROACH, WITH ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERV cohort cohort cohort cohort

36224

SELECTIVE CATHETER PLACEMENT, INTERNAL CAROTID ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL INTRACRANIAL CAROTID CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, cohort cohort cohort

36225

SELECTIVE CATHETER PLACEMENT, SUBCLAVIAN OR INNOMINATE ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INC cohort cohort cohort

36226

SELECTIVE CATHETER PLACEMENT, VERTEBRAL ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL VERTEBRAL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SUPERVISION AND INTERPRETATION, INCLUDES ANGIOGRAP cohort cohort cohort cohort

36227

SELECTIVE CATHETER PLACEMENT, EXTERNAL CAROTID ARTERY, UNILATERAL, WITH ANGIOGRAPHY OF THE IPSILATERAL EXTERNAL CAROTID CIRCULATION AND ALL ASSOCIATEDRADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST cohort cohort cohort cohort

36228

SELECTIVE CATHETER PLACEMENT, EACH INTRACRANIAL BRANCH OF THE INTERNAL CAROTID OR VERTEBRAL ARTERIES, UNILATERAL, WITH ANGIOGRAPHY OF THE SELECTED VESSEL CIRCULATION AND ALL ASSOCIATED RADIOLOGICAL SU cohort cohort

36245

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; EACH FIRST ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort cohort

36246

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL SECOND ORDER ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort cohort

36247

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; INITIAL THIRD ORDER OR MORE SELECTIVE ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY cohort cohort cohort cohort

79

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

36248

SELECTIVE CATHETER PLACEMENT, ARTERIAL SYSTEM; ADDITIONAL SECOND ORDER, THIRD ORDER, AND BEYOND, ABDOMINAL, PELVIC, OR LOWER EXTREMITY ARTERY BRANCH, WITHIN A VASCULAR FAMILY (LIST IN ADDITION TO CODE cohort cohort cohort

36251

SELECTIVE CATHETER PLACEMENT (FIRST-ORDER), MAIN RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE ANDCATHETER PLACEMENT(S), FLUOROSCOPY, CONTRAST INJE cohort cohort cohort cohort

36252

SELECTIVE CATHETER PLACEMENT (FIRST-ORDER), MAIN RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE ANDCATHETER PLACEMENT(S), FLUOROSCOPY, CONTRAST INJE cohort cohort cohort cohort

36253

SUPERSELECTIVE CATHETER PLACEMENT (ONE OR MORE SECOND ORDER OR HIGHER RENAL ARTERY BRANCHES) RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE, CATHETER cohort cohort cohort

36254

SUPERSELECTIVE CATHETER PLACEMENT (ONE OR MORE SECOND ORDER OR HIGHER RENAL ARTERY BRANCHES) RENAL ARTERY AND ANY ACCESSORY RENAL ARTERY(S) FOR RENAL ANGIOGRAPHY, INCLUDING ARTERIAL PUNCTURE, CATHETER statewide

36262 REMOVAL OF IMPLANTED INTRA-ARTERIAL INFUSION PUMP statewide

36299 UNLISTED PROCEDURE, VASCULAR INJECTION statewide

36406

VENIPUNCTURE, YOUNGER THAN AGE 3 YEARS, NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL, NOT TO BE USED FOR ROUTINEVENIPUNCTURE; OTHER VEIN statewide

36410

VENIPUNCTURE, AGE 3 YEARS OR OLDER, NECESSITATING THE SKILL OF A PHYSICIAN OR OTHER QUALIFIED HEALTHCARE PROFESSIONAL (SEPARATE PROCEDURE), FOR DIAGN OSTIC OR THERAPEUTIC PURPOSES (NOT TO BE USED FOR cohort cohort cohort cohort

36415

*ROUTINE VENIPUNCTURE OR FINGER/HEEL/EAR STICK FORCOLLECTION OF SPECIMEN(S) *ROUTINE VENIPUNCTURE OR FINGER/HEEL/EAR STICK FOR cohort cohort cohort cohort cohort

36416 COLLECTION OF CAPILLARY BLOOD SPECIMEN (EG, FINGER, HEEL, EAR STICK) cohort cohort cohort cohort

36430 TRANSFUSION, BLOOD OR BLOOD COMPONENTSTRANSFUSION,BLOOD OR BLOOD COMPONENTS cohort cohort cohort cohort cohort

36470 *INJECTION OF SCLEROSING SOLUTION; SINGLE VEIN statewide

36471 *INJECTION OF SCLEROSING SOLUTION; MULTIPLE VEINS,SAME LEG cohort cohort

36475

ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE AND MONITORING, PERCUTANEOUS, RADIOFREQUENCY; FIRST VEIN TREATED cohort cohort

36478

ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE & MONITORING, PERCUTANEOUS, LASER; FIRST VEIN TREATED cohort cohort cohort cohort

36479

ENDOVENOUS ABLATION THERAPY OF INCOMPETENT VEIN, EXTREMITY, INCLUSIVE OF ALL IMAGING GUIDANCE & MONITORING, PERCUTANEOUS, LASER;2ND & SEBSEQUENT VEINS TREATED IN A SINGLE EXTREMITY, EACH SEPARATE SIT statewide

36481 PERCUTANEOUS PORTAL VEIN CATHETERIZATION BY ANY METHOD statewide

36500 VENOUS CATHETERIZATION FOR SELECTIVE ORGAN BLOOD SAMPLING cohort cohort

36511 THERAPEUTIC APHERESIS; WHITE BLOOD CELLS statewide

36512 THERAPEUTIC APHERESIS; RED BLOOD CELLS statewide

36513 THERAPEUTIC APHERESIS; PLATELETS cohort cohort

36514 THERAPEUTIC APHERESIS; PLASMA PHERESIS cohort cohort

36516 THERAPEUTIC APHERESIS, W/EXTRACOPPRL SELECTVE FILTRATION & PLASMA REINFUSION statewide

36522 PHOTOPHERESIS, EXTRACORPOREAL statewide

36555 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL statewide

80

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

VENOUS CATHETER; UNDER 5 YEARS OF AGE

36556 INSERTION OF NON-TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER; AGE 5 YEARS OR OLDER cohort cohort cohort cohort cohort

36557

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP;UNDER 5 YEARS OF AGE statewide

36558

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP;AGE 5 YEARS OR OLDER cohort cohort cohort cohort cohort cohort

36560

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; UNDER 5 YEARS OF AGE statewide

36561

INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARS OR OLDER cohort cohort cohort cohort cohort cohort

36563 INSERTION OF TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH SUBCUTANEOUS PUMP cohort cohort

36568

INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP; UNDER 5 YEARS OF AGE cohort cohort

36569

INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC), WITHOUT SUBCUTANEOUS PORT OR PUMP; AGE 5 YEARS OR OLDER cohort cohort cohort cohort cohort cohort

36571

INSERTION OF PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT; AGE 5 YEARSOR OLDER cohort cohort cohort cohort cohort cohort

36575

REPAIR OF TUNNELED OR NON-TUNNELED CENTRAL VENOUS ACCESS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE statewide

36576

REPAIR OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRAL OR PERIPHERAL INSERTION SITE cohort cohort

36578

REPLACEMENT, CATHETER ONLY, OF CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT OR PUMP, CENTRALOR PERIPHERAL INSERTION SITE cohort cohort cohort

36580

REPLACEMENT, COMPLETE, OF A NON-TUNNELED CENTRALLYINSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTA NEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS cohort cohort

36581

REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS CATHETER, WITHOUT SUBCUTANEOUS PORT OR PUMP, THROUGH SAME VENOUS ACCESS cohort cohort cohort cohort cohort

36582

REPLACEMENT, COMPLETE, OF A TUNNELED CENTRALLY INSERTED CENTRAL VENOUS ACCESS DEVICE, WITH SUBCUTANEOUS PORT, THROUGH SAME VENOUS ACCESS cohort cohort cohort

36584

REPLACEMENT COMPLETE OF A PERIPHERALLY INSERTED CENTRAL VENOUS CATHETER (PICC) WITHOUT SUBCUTANEOUS PORT OR PUMP THROUGH SAME VENOUS ACCESS cohort cohort cohort cohort cohort

36585

REPLACEMENT COMPLETE OF A PERIPHERALLY INSERTED CENTRAL VENOUS ACCESS DEVICE WITH SUBCUTANEOUS PORT THROUGH SAME VENOUS ACCESS statewide

36589 REMOVAL OF TUNNELED CENTRAL VENOUS CATHETER WITHOUT SUBCUTANEOUS PORT OR PUMP cohort cohort cohort cohort cohort cohort

36590

REMOVAL OF TUNNELED CENTRAL VENOUS ACCESS DEVICE WITH SUBCUTANEOUS PORT OR PUMP CENTRAL OR PERIPHERAL INSERTION cohort cohort cohort cohort cohort cohort

36591 Collection of blood specimen from a completely implantable venous access device cohort cohort cohort cohort cohort

36592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwisespecified cohort cohort cohort cohort

36593 Declotting by thrombolytic agent of implanted vascular access device or catheter cohort cohort cohort cohort cohort

36595 MECHANICAL REMOVAL OF PERICATHETER OBSTRUCTIVE MATERIAL (EG FIBRIN SHEATH) FROM CENTRAL VENOUS DEVICE cohort cohort cohort

81

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

VIA SEPARATE VENOUS ACCESS

36596

MECHANICAL REMOVAL OF INTRALUMINAL (INTRACATHETER)OBSTRUCTIVE MATERIAL FROM CENTRAL VENOUS DEVICE THROUGH DEVICE LUMEN statewide

36597 REPOSITIONING OF PREVIOUSLY PLACED CENTRAL VENOUS CATHETER UNDER FLUOROSCOPIC GUIDANCE statewide

36598

CONTRAST INJECTION(S) FOR RADIOLOGIC EVALUATION OFEXISTING CENTRAL VENOUS ACCESS DEVICE, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT cohort cohort cohort cohort cohort

36600 *ARTERIAL PUNCTURE, WITHDRAWAL OF BLOOD FOR DIAGNOSIS cohort cohort cohort cohort cohort

36620

ARTERIAL CATHETERIZATION OR CANNULATION FOR SAMPLING,MONITORING OR TRANSFUSION (SEPARATE PROCEDURE);PERCUTANEOUS ARTERIAL CATHETERIZATION OR CANNULA TION FOR SAMPLING, cohort cohort cohort cohort

36680 PLACEMENT OF NEEDLE FOR INTRAOSSEOUS INFUSION cohort cohort cohort cohort

36815

INSERTION OF CANNULA FOR HEMODIALYSIS, OTHER PURPOSE(SEPARATE PROCEDURE); ARTERIOVENOUS, EXTERNAL REVISION, OR CLOSURE statewide

36818 ARTERIOVENOUS ANASTOMOSIS, OPEN; BY UPPER ARM CEPHALIC VEIN TRANSPOSITION cohort cohort cohort cohort cohort

36819 ARTERIOVENOUS ANASTOMOSIS, OPEN; BY BASILIC VEIN TRANSPOSITION cohort cohort cohort

36820 ARTERIOVENOUS ANASTOMOSIS, OPEN; FOREARM VEIN TRANSPOSITION cohort cohort

36821

ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (EG, CIMINOTYPE) (SEPARATE ARTERIOVENOUS ANASTOMOSIS, DIRECT, ANY SITE (EG, CIMINO cohort cohort cohort cohort cohort

36825

CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECTARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); AUTOGENOUS GRAFT cohort cohort

36830

CREATION OF ARTERIOVENOUS FISTULA BY OTHER THAN DIRECTARTERIOVENOUS ANASTOMOSIS (SEPARATE PROCEDURE); NONAUTOGENOUS GRAFT cohort cohort cohort cohort cohort

36831

THROMBECTOMY, ARTERIOVENOUS FISTULA WITHOUT REVISION,AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE) statewide

36832

REVISION, ARTERIOVENOUS FISTULA; WITHOUT THROMBECTOMY,AUTOGENOUS OR NONAUTOGENOUS, DIALYSIS GRAFT (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

36833

REVISION, ARTERIOVENOUS FISTULA; WITH THROMBECTOMY,AUTOGENOUS OR NONAUTOGENOUS DIALYSIS GRAFT (SEPARATE PROCEDURE) cohort cohort cohort

36838 DISTAL REVASCULARIZATION AND INTERVAL LIGATION (DRIL) UPPER EXTREMITY HEMODIALYSIS ACCESS (STEAL SYNDROME) cohort cohort cohort

36860

EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUTBALLOON CATHETER EXTERNAL CANNULA DECLOTTING (SEPARATE PROCEDURE); WITHOUT statewide

36870

THROMBECTOMY, PERCUTANOUS, ARTERIOVENOUS FISTULA, AUTOGENOUS OR NONAUTOGENOUS GRAFT (INCLUDES MECHANICAL THROMBUS EXTRACTION AND INTRA-GRAFT THROMBOLYSIS) cohort cohort cohort cohort cohort

37182 INSERTION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) statewide

37183 REVISION, TRANSVENOUS INTRAHEPATIC PORTOSYSTEMIC SHUNT(S) statewide

37184

PRIMARY PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY, NONCORONARY, ARTERIAL OR ARTERIAL BYPASS GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRAPROCEDURAL PHARMACOLOGICAL THROMBOLYTIC INJECTION(S) statewide

37186

SECONDARY PERCUTANEOUS TRANSLUMINAL THROMBECTOMY (EG, NONPRIMARY MECHANICAL, SNARE BASKET, SUCTION TECHNIQUE), NONCORONARY, ARTERIAL OR ARTERIAL BYPASS cohort cohort cohort

82

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

GRAFT, INCLUDING FLUOROSCOPIC GUIDANCE AND INTRA

37187

PERCUTANEOUS TRANSLUMINAL MECHANICAL THROMBECTOMY,VEIN(S), INCLUDING INTRAPROCEDURAL PHARMACOLOGICA L THROMBOLYTIC INJECTIONS AND FLUOROSCOPIC GUIDANCE cohort cohort

37191

INSERTION OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSELSELECTION, AND RADIOLOGICAL SUPERVISION AND INTER PRETATION, INTRAPROCEDURAL ROADMAPPING, AND IMAGIN cohort cohort cohort cohort

37193

RETRIEVAL (REMOVAL) OF INTRAVASCULAR VENA CAVA FILTER, ENDOVASCULAR APPROACH INCLUDING VASCULAR ACCESS, VESSEL SELECTION, AND RADIOLOGICAL SUPERVISIONAND INTERPRETATION, INTRAPROCEDURAL ROADMAPPING, cohort cohort cohort cohort

37195 THROMBOLYSIS, CEREBRAL, BY INTRAVENOUS INFUSION statewide

37197

TRANSCATHETER RETRIEVAL, PERCUTANEOUS, OF INTRAVASCULAR FOREIGN BODY (EG, FRACTURED VENOUS OR ARTERIAL CATHETER), INCLUDES RADIOLOGICAL SUPERVISION AND INTERPRETATION, AND IMAGING GUIDANCE (ULTRASOUND cohort cohort cohort

37200 TRANSCATHETER BIOPSY cohort cohort cohort

37202

TRANSCATHETER THERAPY, INFUSION OTHER THAN FOR THROMBOLYSIS,ANY TYPE (EG, SPASMOLYTIC, VASOCONSTRICTIVE) statewide

37204

TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMORDESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDEA VASCULAR MALFORMATION), PERCUTANEOUS, ANY METH OD, NON-CENTRAL NERVOUS cohort cohort cohort

37205

Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; initialvessel cohort cohort cohort cohort

37206

Transcatheter placement of an intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity arteries), percutaneous; each additional vessel (List separately in addition to co cohort cohort cohort

37210

UTERINE FIBROID EMBOLIZATION (UFE, EMBOLIZATION OFTHE UTERINE ARTERIES TO TREAT UTERINE FIBROIDS, L EIOMYOMATA), PERCUTANEOUS APPROACH INCLUSIVE OF VASCULAR ACCESS, VESSEL SELECTION, EMBOLIZATION, AND cohort cohort cohort cohort cohort

37215 Transcatheter placement of intravascular stent(s),cervical carotid artery, percutaneous with distal embolic protection statewide

37220 Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal angioplasty cohort cohort cohort cohort

37221

Revascularization, endovascular, open or percutaneous, iliac artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed cohort cohort cohort cohort cohort

37222

Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal angioplasty (List separately in addition to code for primary procedure) statewide

37223

Revascularization, endovascular, open or percutaneous, iliac artery, each additional ipsilateral iliac vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when p cohort cohort cohort cohort

37224 Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal angioplasty cohort cohort cohort cohort cohort

37225

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with atherectomy, includes angioplasty within the same vessel, when performed cohort cohort cohort cohort

37226

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s), includes angioplasty within the same vessel, when performed cohort cohort cohort cohort cohort

37227

Revascularization, endovascular, open or percutaneous, femoral, popliteal artery(s), unilateral; with transluminal stent placement(s) and atherectomy,includes angioplasty within the same vessel, when cohort cohort cohort cohort

37228 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal angioplasty cohort cohort cohort cohort

37229 Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with atherectomy, includes angioplasty cohort cohort

83

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

within the same vessel, when performed

37230

Revascularization, endovascular, open or percutaneous, tibial, peroneal artery, unilateral, initial vessel; with transluminal stent placement(s), includes angioplasty within the same vessel, when perf statewide

37232

Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with transluminal angioplasty (Listseparately in addition to code for primary proced cohort cohort

37233

Revascularization, endovascular, open or percutaneous, tibial/peroneal artery, unilateral, each additional vessel; with atherectomy, includes angioplasty within the same vessel, when performed (List s statewide

37250

INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL) DURINGTHERAPEUTIC INTERVENTION; INITIAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

37607 LIGATION OR BANDING OF ANGIOACCESS ARTERIOVENOUS FISTULA cohort cohort cohort cohort cohort

37609 LIGATION OR BIOPSY, TEMPORAL ARTERY cohort cohort cohort cohort

37617 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE);ABDOMEN cohort cohort

37618 LIGATION, MAJOR ARTERY (EG, POST-TRAUMATIC, RUPTURE);EXTREMITY statewide

37700

LIGATION AND DIVISION OF LONG SAPHENOUS VEIN ATSAPHENOFEMORAL JUNCTION, OR DISTAL INTERRUPTIONS LIGATION AND DIVISION OF LONG SAPHENOUS VEIN AT cohort cohort

37718 LIGATION, DIVISION, AND STRIPPING, SHORT SAPHENOUSVEIN cohort cohort

37722

LIGATION, DIVISION, AND STRIPPING, LONG (GREATER) SAPHENOUS VEINS FROM SAPHENOFEMORAL JUNCTION TO KNEE OR BELOW cohort cohort

37761 LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG statewide

37765 STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; 10-20 STAB INCISIONS cohort cohort cohort

37766 STAB PHLEBECTOMY OF VARICOSE VEINS, 1 EXTREMITY; MORE THAN 20 INCISIONS cohort cohort cohort

37785 LIGATION, DIVISION, AND/OR EXCISION OF VARICOSE VEIN COHORT(S), 1 LEG statewide

37790 PENILE VENOUS OCCLUSIVE PROCEDURE statewide

37799 UNLISTED PROCEDURE, VASCULAR SURGERYUNLISTED PROCEDURE, VASCULAR SURGERY cohort cohort cohort cohort cohort

38100 SPLENECTOMY; TOTAL (SEPARATE PROCEDURE) cohort cohort

38101 SPLENECTOMY; PARTIAL statewide

38115 REPAIR OF RUPTURED SPLEEN (SPLENORRHAPHY) WITH OR WITHOUTPARTIAL SPLENECTOMY statewide

38120 LAPAROSCOPY, SURGICAL, SPLENECTOMY cohort cohort cohort

38129 UNLISTED LAPAROSCOPY PROCEDURE, SPLEEN statewide

38205

BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING FOR TRANSPLANTATION, PER COLLECTION; ALLOGENEIC statewide

38206 BLOOD-DERIVED HEMATOPOIETIC PROGENITOR CELL HARVESTING, TRANSPLANTATION/COLLECTION; AUTOLOGOUS statewide

38207 TRANSPLANT PREPARATION, HEMATOPIETIC PROGENITOR CELLS, CRYOPRESERVATION AND STORAGE statewide

38208

TRANSPLANT PREPARATION OF HEMATOPOIETIC PROGENITORCELLS; THAWING OF PREVIOUSLY FROZEN HARVEST, WITH OUT WASHING, PER DONOR statewide

38214 TRANSPLANT PREPARATION, HEMATOPIETIC PROGENITOR CELLS, PLASMA VOLUME DEPLETION statewide

38215 TRANSPLANT PREPARATION, HEMATOPIETIC PROGENITOR CELLS, CELL CONC, PLASMA/MONONUCLEAR/ BUFFY COAT statewide

38220 BONE MARROW ASPIRATION cohort cohort cohort cohort cohort cohort

38221 BONE MARROW BX. NEEDLE/TROCAR cohort cohort cohort cohort cohort

38232 BONE MARROW HARVESTING FOR TRANSPLANTATION; cohort cohort

84

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

AUTOLOGOUS

38241 HEMATOPOIETIC PROGENITOR CELL (HPC); AUTOLOGOUS TRANSPLANTATION statewide

38242 ALLOGENEIC LYMPHOCYTE INFUSIONS statewide

38500 BIOPSY OR EXCISION OF LYMPH NODE(S); SUPERFICIAL (SEPARATEPROCEDURE) cohort cohort cohort cohort cohort cohort

38505 BIOPSY OR EXCISION OF LYMPH NODE(S); BY NEEDLE, SUPERFICIAL (EG, CERVICAL, INGUINAL, AXILLARY) cohort cohort cohort cohort cohort

38510 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP CERVICALNODE(S) cohort cohort cohort cohort cohort cohort

38520 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP CERVICALNODE(S)WITH EXCISION SCALENE FAT PAD statewide

38525 BIOPSY OR EXCISION OF LYMPH NODE(S); DEEP AXILLARYNODE(S) cohort cohort cohort cohort cohort cohort

38530 BIOPSY OR EXCISION OF LYMPH NODE(S); INTERNAL MAMMARYNODE(S) statewide

38542 DISSECTION, DEEP JUGULAR NODE(S) statewide

38562 LIMITED LYMPHADENECTOMY FOR STAGING (SEPARATE PROCEDURE);PELVIC AND PARA-AORTIC cohort cohort cohort

38570 LAPAROSCOPY, SURGICAL;WITH RETROPERITONEAL LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE cohort cohort cohort cohort

38571 LAPAROSCOPY, SURGICAL;WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY cohort cohort cohort

38572

LAPAROSCOPY, SURGICAL;WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PERI-AORTIC LYMPH NODE SAMPLING (BIOPSY), SINGLE OR MULTIPLE cohort cohort cohort

38589 UNLISTED LAPAROSCOPY PROCEDURE, LYMPHATIC SYSTEM cohort cohort

38700 SUPRAHYOID LYMPHADENECTOMYSUPRAHYOID LYMPHADENECTOMY cohort cohort

38720 CERVICAL LYMPHADENECTOMY (COMPLETE)CERVICAL LYMPHADENECTOMY (COMPLETE) cohort cohort

38724

CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION) CERVICAL LYMPHADENECTOMY (MODIFIED RADICAL NECK DISSECTION) cohort cohort cohort cohort

38740 AXILLARY LYMPHADENECTOMY; SUPERFICIALAXILLARY LYMPHADENECTOMY; SUPERFICIAL statewide

38745 AXILLARY LYMPHADENECTOMY; COMPLETEAXILLARY LYMPHADENECTOMY; COMPLETE cohort cohort cohort cohort

38760

INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDINGCLOQUET'S NODE (SEPARATE PROCEDURE) INGUINOFEMORAL LYMPHADENECTOMY, SUPERFICIAL, INCLUDING cohort cohort cohort

38770

PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC,HYPOGASTRIC, AND OBTURATOR NODES (SEPARATE PROCEDURE) PELVIC LYMPHADENECTOMY, INCLUDING EXTERNAL ILIAC, cohort cohort

38790 INJECTION PROCEDURE; LYMPHANGIOGRAPHY statewide

38792 INJECTION PROCEDURE; RADIOACTIVE TRACER FOR IDENTIFICATION OF SENTINEL NODE cohort cohort cohort cohort cohort

38900

Intraoperative identification (eg, mapping) of sentinel lymph node(s) includes injection of non-radioactive dye, when performed (List separately in addition to code for primary procedure) cohort cohort cohort cohort cohort

38999 UNLISTED PROCEDURE, HEMIC OR LYMPHATIC SYSTEM cohort cohort cohort cohort

39010

MEDIASTINOTOMY WITH EXPLORATION, DRAINAGE, REMOVALOFFOREIGN BODY, OR BIOPSY; TRANSTHORACIC APPROACH , INCLUDING EITHER TRANSTHORACIC OR MEDIAN STERNOTOMY statewide

39220 RESECTION OF MEDIASTINAL TUMOR cohort cohort

39400 MEDIASTINOSCOPY, INCLUDES BIOPSY(IES), WHEN PERFORMED cohort cohort cohort cohort cohort

39599 UNLISTED PROCEDURE, DIAPHRAGM statewide

4048F Documentation that administration of prophylactic parenteral antibiotic was initiated within one hour (if fluoroquinolone or vancomycin, two statewide

85

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

hours) prior to surgical incision (or start of procedure wh

40490 BIOPSY OF LIP statewide

40510 EXCISION OF LIP; TRANSVERSE WEDGE EXCISION WITH PRIMARYCLOSURE cohort cohort

40525 EXCISION OF LIP; FULL THICKNESS, RECONSTRUCTION WITH LOCALFLAP (EG, ESTLANDER OR FAN) statewide

40530 RESECTION OF LIP, MORE THAN ONE-FOURTH, WITHOUTRECONSTRUCTION statewide

40650 REPAIR LIP, FULL THICKNESS; VERMILION ONLY cohort cohort cohort cohort

40652 REPAIR LIP, FULL THICKNESS; UP TO HALF VERTICAL HEIGHT statewide

40654 REPAIR LIP, FULL THICKNESS; OVER ONE-HALF VERTICALHEIGHT,OR COMPLEX statewide

40700 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY,PARTIAL OR COMPLETE, UNILATERAL cohort cohort

40701 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; PRIMARY BILATERAL, 1-STAGE PROCEDURE statewide

40720 PLASTIC REPAIR OF CLEFT LIP/NASAL DEFORMITY; SECONDARY, BYRECREATION OF DEFECT AND RECLOSURE cohort cohort cohort

40799 UNLISTED PROCEDURE, LIPS cohort cohort cohort

40800

*DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OFMOUTH;SIMPLE *DRAINAGE OF ABSCESS, CYST, HEMATOM A, VESTIBULE OF MOUTH; cohort cohort cohort cohort

40801

DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH;COMPLICATED DRAINAGE OF ABSCESS, CYST, HEMATOMA, VESTIBULE OF MOUTH; statewide

40804

*REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH;SIMPLE *REMOVAL OF EMBEDDED FOREIGN BODY, VESTIBULE OF MOUTH; statewide

40806 INCISION OF LABIAL FRENUM (FRENOTOMY) cohort cohort cohort

40810 EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OFMOUTH; WITHOUT REPAIR cohort cohort

40812 EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OFMOUTH; WITH SIMPLE REPAIR cohort cohort cohort cohort

40814 EXCISION OF LESION OF MUCOSA AND SUBMUCOSA, VESTIBULE OFMOUTH; WITH COMPLEX REPAIR cohort cohort

40819 EXCISION OF FRENUM, LABIAL OR BUCCAL (FRENUMECTOMY,FRENULECTOMY, FRENECTOMY) cohort cohort

40820

DESTRUCTION OF LESION OR SCAR OF VESTIBULE OF MOUTH BYPHYSICAL METHODS (EG, LASER, THERMAL, CRYO, CHEMICAL) cohort cohort

40830

CLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESSCLOSURE OF LACERATION, VESTIBULE OF MOUTH; 2.5 CM OR LESS cohort cohort cohort

40831

CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM ORCOMPLEX CLOSURE OF LACERATION, VESTIBULE OF MOUTH; OVER 2.5 CM OR cohort cohort

40840 VESTIBULOPLASTY; ANTERIORVESTIBULOPLASTY; ANTERIOR statewide

41008

INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, ORHEMATOMA OF TONGUE INTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR statewide

41010 INCISION OF LINGUAL FRENUM (FRENOTOMY) cohort cohort cohort cohort

41016

EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, ORHEMATOMA OF FLOOR OF MOUTH; SUBMENTAL EXTRAORALINCISION AND DRAINAGE OF ABSCESS, CYST, OR statewide

41017

EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, ORHEMATOMA OF FLOOR OF MOUTH; SUBMANDIBULAR EXTRAORAL INCISION AND DRAINAGE OF ABSCESS, CYST, OR statewide

41100 BIOPSY OF TONGUE; ANTERIOR TWO-THIRDSBIOPSY OF TONGUE; ANTERIOR TWO-THIRDS cohort cohort cohort

41105 BIOPSY OF TONGUE; POSTERIOR ONE-THIRDBIOPSY OF TONGUE; POSTERIOR ONE-THIRD cohort cohort

86

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

41108 BIOPSY OF FLOOR OF MOUTHBIOPSY OF FLOOR OF MOUTH statewide

41110 EXCISION OF LESION OF TONGUE WITHOUT CLOSURE cohort cohort

41112 EXCISION OF LESION OF TONGUE WITH CLOSURE; ANTERIORTWO-THIRDS cohort cohort cohort cohort

41113 EXCISION OF LESION OF TONGUE WITH CLOSURE; POSTERIORONE-THIRD cohort cohort

41114 EXCISION OF LESION OF TONGUE WITH CLOSURE; WITH LOCAL TONGUEFLAP statewide

41115 EXCISION OF LINGUAL FRENUM (FRENECTOMY) cohort cohort cohort

41116 EXCISION, LESION OF FLOOR OF MOUTH cohort cohort cohort

41120 GLOSSECTOMY; LESS THAN ONE-HALF TONGUE cohort cohort cohort

41135 GLOSSECTOMY; PARTIAL, WITH UNILATERAL RADICAL NECKDISSECTION cohort cohort

41250

*REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR ANTERIOR TWO-THIRDS OF TONGUE *REPAIR OF LACERATION 2.5 CM OR LESS; FLOOR OF MOUTH AND/OR cohort cohort cohort cohort

41251 *REPAIR OF LACERATION 2.5 CM OR LESS; POSTERIOR ONE-THIRD OFTONGUE statewide

41252

*REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CMOR COMPLEX *REPAIR OF LACERATION OF TONGUE, FLOOR OF MOUTH, OVER 2.6 CM statewide

41512 Tongue base suspension, permanent suture technique statewide

41520 FRENOPLASTY (SURGICAL REVISION OF FRENUM, EG, WITHZ-PLASTY) cohort cohort cohort cohort cohort

41599 UNLISTED PROCEDURE, TONGUE, FLOOR OF MOUTH cohort cohort cohort

41800 *DRAINAGE OF ABSCESS, CYST, HEMATOMA FROM DENTOALVEOLARSTRUCTURES cohort cohort cohort cohort cohort

41820 GINGIVECTOMY, EXCISION GINGIVA, EACH QUADRANT statewide

41821 OPERCULECTOMY, EXCISION PERICORONAL TISSUES statewide

41825 EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE),DENTOALVEOLAR STRUCTURES; WITHOUT REPAIR statewide

41826 EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE),DENTOALVEOLAR STRUCTURES; WITH SIMPLE REPAIR cohort cohort cohort

41827

EXCISION OF LESION OR TUMOR (EXCEPT LISTED ABOVE),DENTOALVEOLAR STRUCTURES; WITH COMPLEX REPAIR statewide

41874 ALVEOLOPLASTY, EACH QUADRANT (SPECIFY) cohort cohort cohort

41899 UNLISTED PROCEDURE, DENTOALVEOLAR STRUCTURES cohort cohort cohort cohort cohort cohort

42000 *DRAINAGE OF ABSCESS OF PALATE, UVULA statewide

42100 BIOPSY OF PALATE, UVULA statewide

42104 EXCISION, LESION OF PALATE, UVULA; WITHOUT CLOSURE cohort cohort cohort cohort

42106 EXCISION, LESION OF PALATE, UVULA; WITH SIMPLE PRIMARYCLOSURE cohort cohort cohort

42107 EXCISION, LESION OF PALATE, UVULA; WITH LOCAL FLAPCLOSURE statewide

42120 RESECTION OF PALATE OR EXTENSIVE RESECTION OF LESION statewide

42140 UVULECTOMY, EXCISION OF UVULA cohort cohort cohort cohort cohort

42145 PALATOPHARYNGOPLASTY (EG, UVULOPALATOPHARYNGOPLASTY,UVULOPHARYNGOPLASTY) cohort cohort cohort cohort

42160 DESTRUCTION OF LESION, PALATE OR UVULA (THERMAL, CRYO ORCHEMICAL) statewide

42180 REPAIR, LACERATION OF PALATE; UP TO 2 CMREPAIR, LACERATION OF PALATE; UP TO 2 CM statewide

42182

REPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEXREPAIR, LACERATION OF PALATE; OVER 2 CM OR COMPLEX cohort cohort

42200 PALATOPLASTY FOR CLEFT PALATE, SOFT AND/OR HARD PALATE ONLY statewide

42205 PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF statewide

87

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ALVEOLARRIDGE; SOFT TISSUE ONLY

42210

PALATOPLASTY FOR CLEFT PALATE, WITH CLOSURE OF ALVEOLARRIDGE; WITH BONE GRAFT TO ALVEOLAR RIDGE (INCLUDES OBTAINING GRAFT) statewide

42220 PALATOPLASTY FOR CLEFT PALATE; SECONDARY LENGTHENINGPROCEDURE statewide

42225 PALATOPLASTY FOR CLEFT PALATE; ATTACHMENT PHARYNGEAL FLAP statewide

42226 LENGTHENING OF PALATE, AND PHARYNGEAL FLAP statewide

42235 REPAIR OF ANTERIOR PALATE, INCLUDING VOMER FLAP statewide

42299 UNLISTED PROCEDURE, PALATE, UVULA statewide

42300 *DRAINAGE OF ABSCESS; PAROTID, SIMPLE statewide

42330

SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR PAROTID, UNCOMPLICATED, INTRAORAL SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), SUBLINGUAL OR cohort cohort cohort cohort

42335

SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED,INTRAORAL SIALOLITHOTOMY; SUBMANDIBULAR (SUBMAXILLARY), COMPLICATED, statewide

42400 *BIOPSY OF SALIVARY GLAND; NEEDLE statewide

42405 BIOPSY OF SALIVARY GLAND; INCISIONAL cohort cohort

42408 EXCISION OF SUBLINGUAL SALIVARY CYST (RANULA) statewide

42409 MARSUPIALIZATION OF SUBLINGUAL SALIVARY CYST (RANULA) statewide

42410 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE,WITHOUT NERVE DISSECTION cohort cohort cohort cohort

42415 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; LATERAL LOBE,WITH DISSECTION AND PRESERVATION OF FACIAL NERVE cohort cohort cohort cohort

42420 EXCISION OF PAROTID TUMOR OR PAROTID GLAND; TOTAL,WITHDISSECTION AND PRESERVATION OF FACIAL NERVE cohort cohort cohort cohort

42440 EXCISION OF SUBMANDIBULAR (SUBMAXILLARY) GLAND cohort cohort cohort cohort cohort

42450 EXCISION OF SUBLINGUAL GLAND cohort cohort

42500

PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY;PRIMARYOR SIMPLE PLASTIC REPAIR OF SALIVARY DUCT , SIALODOCHOPLASTY; PRIMARY cohort cohort

42505

PLASTIC REPAIR OF SALIVARY DUCT, SIALODOCHOPLASTY;SECONDARYOR COMPLICATED PLASTIC REPAIR OF SALIVA RY DUCT, SIALODOCHOPLASTY; SECONDARY statewide

42550 INJECTION PROCEDURE FOR SIALOGRAPHY statewide

42650 *DILATION SALIVARY DUCT*DILATION SALIVARY DUCT cohort cohort

42699 UNLISTED PROCEDURE, SALIVARY GLANDS OR DUCTS cohort cohort cohort

42700 *INCISION AND DRAINAGE ABSCESS; PERITONSILLAR cohort cohort cohort cohort cohort

42720 INCISION AND DRAINAGE ABSCESS; RETROPHARYNGEAL ORPARAPHARYNGEAL, INTRAORAL APPROACH cohort cohort

42800 BIOPSY; OROPHARYNX cohort cohort cohort cohort

42804 BIOPSY; NASOPHARYNX, VISIBLE LESION, SIMPLE statewide

42806 BIOPSY; NASOPHARYNX, SURVEY FOR UNKNOWN PRIMARY LESION cohort cohort

42808 EXCISION OR DESTRUCTION OF LESION OF PHARYNX, ANY METHOD cohort cohort cohort

42809 REMOVAL OF FOREIGN BODY FROM PHARYNX cohort cohort cohort

42810 EXCISION BRANCHIAL CLEFT CYST OR VESTIGE, CONFINEDTO SKINAND SUBCUTANEOUS TISSUES cohort cohort cohort cohort cohort

42815

EXCISION BRANCHIAL CLEFT CYST, VESTIGE, OR FISTULA,EXTENDING BENEATH SUBCUTANEOUS TISSUES AND/OR INTO PHARYNX cohort cohort cohort cohort

42820 TONSILLECTOMY AND ADENOIDECTOMY; UNDER AGE 12 cohort cohort cohort cohort cohort cohort

42821 TONSILLECTOMY AND ADENOIDECTOMY; AGE 12 OR OVER cohort cohort cohort cohort cohort cohort

42825 TONSILLECTOMY, PRIMARY OR SECONDARY; UNDER AGE 12 cohort cohort cohort cohort cohort cohort

88

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

42826 TONSILLECTOMY, PRIMARY OR SECONDARY; AGE 12 OR OVER cohort cohort cohort cohort cohort cohort

42830 ADENOIDECTOMY, PRIMARY; UNDER AGE 12 cohort cohort cohort cohort cohort cohort

42831 ADENOIDECTOMY, PRIMARY; AGE 12 OR OVER cohort cohort cohort cohort cohort

42835 ADENOIDECTOMY, SECONDARY; UNDER AGE 12 cohort cohort cohort

42836 ADENOIDECTOMY, SECONDARY; AGE 12 OR OVER cohort cohort

42842 RADICAL RESECTION OF TONSIL, TONSILLAR PILLARS, AND/ORRETROMOLAR TRIGONE; WITHOUT CLOSURE statewide

42860 EXCISION OF TONSIL TAGS statewide

42870 EXCISION OR DESTRUCTION LINGUAL TONSIL, ANY METHOD(SEPARATEPROCEDURE) cohort cohort

42892

RESECTION OF LATERAL PHARYNGEAL WALL OR PYRIFORM SINUS,DIRECT CLOSURE BY ADVANCEMENT OF LATERAL AND POSTERIOR PHARYNGEAL WALLS statewide

42950 PHARYNGOPLASTY (PLASTIC OR RECONSTRUCTIVE OPERATION ONPHARYNX) cohort cohort cohort

42960

CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); SIMPLE CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, cohort cohort cohort cohort

42961

CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); COMPLICATED, REQUIRING HOSPITALIZATION CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, cohort cohort cohort

42962

CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, POSTTONSILLECTOMY); WITH SECONDARY SURGICAL INTERVENTION CONTROL OROPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY (EG, cohort cohort cohort cohort

42970

CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY(EG, POSTADENOIDECTOMY); SIMPLE, WITH POSTERIOR NASAL PACKS, WITH OR WITHOUT ANTERIOR PACKSAND/OR CAUTERIZATION cohort cohort

42971

CONTROL OF NASOPHARYNGEAL HEMORRHAGE, PRIMARY OR SECONDARY(EG, POSTADENOIDECTOMY); COMPLICATED, REQUIRING HOSPITALIZATION statewide

42999 UNLISTED PROCEDURE, PHARYNX, ADENOIDS, OR TONSILS cohort cohort cohort cohort cohort

43030 CRICOPHARYNGEAL MYOTOMYCRICOPHARYNGEAL MYOTOMY statewide

43130 DIVERTICULECTOMY OF HYPOPHARYNX OR ESOPHAGUS, WITHORWITHOUT MYOTOMY; CERVICAL APPROACH statewide

43200

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC, WITHORWITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING O R WASHING (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

43201 ESOPHAGOSCOPY, RIGID/FLEXIBLE; W/DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE cohort cohort cohort

43202 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BIOPSY, SINGLE ORMULTIPLE cohort cohort cohort cohort

43204 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INJECTION SCLEROSISOF ESOPHAGEAL VARICES statewide

43215

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGNBODY ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH REMOVAL OF FOREIGN cohort cohort cohort cohort cohort

43219 ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF PLASTIC TUBE OR STENT statewide

43220

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION(LESS THAN 30 MM DIAMETER) ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH BALLOON DILATION cohort cohort cohort

43226

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDEWIRE FOLLOWED BY DILATION OVER GUIDE WIRE ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH INSERTION OF GUIDE cohort cohort

43228

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH ABLATION OFTUMOR(S),POLYP(S), OR OTHER LESION(S), NOT AMENAB LE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE cohort cohort cohort

89

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

43231

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; DIAGNOSTIC WITH OR WITHOUT COLLECTION OF SPECIMENS BY BRUSHING OR WASHING (SEPARATE PROCEDURE) WITH ENDOSCOPIC ULTRASOUND EXAMINATION. cohort cohort cohort

43232

ESOPHAGOSCOPY, RIGID OR FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR TRANSMURAL FINE NEEDLE ASPIRATION/BIOPSY(S) cohort cohort

43235

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; DIAGNOSTIC, WITH OR WITHOUT COLL ECTION OF cohort cohort cohort cohort cohort

43236 UPPER GI ENDOSCOPY; W/DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE cohort cohort cohort cohort cohort

43237

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS STOMACH AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAM LIMITED TO THE ESOPHAGUS cohort cohort

43238

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS STOMACH AND EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND-GUIDED INTRAMURAL OR FINE NEEDLE ASPIRATION BIOPSY statewide

43239

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH BIOPSY, SINGLE OR MULTIPLE cohort cohort cohort cohort cohort cohort

43240

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH TRANSMURAL DRAINAGE OF PSEU DOCYST. cohort cohort

43242

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH TRANSENDOSCOPIC ULTRASOUND- GUIDED INTRAMURAL FINE NEEDLE ASPIRATION/BIOPSY(S) cohort cohort cohort

43243

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH INJECTION SCLEROSIS OF ESOP HAGEAL AND/OR cohort cohort cohort

43244

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH BAND LIGATION OF ESOPHAGEAL AND/OR GASTRIC cohort cohort cohort cohort cohort

43245

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH DILATION OF GASTRIC OUTLET FOR cohort cohort cohort cohort cohort

43246

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH DIRECTED PLACEMENT OF PERCU TANEOUS cohort cohort cohort cohort cohort

43247

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH REMOVAL OF FOREIGN BODY cohort cohort cohort cohort cohort

43248

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH INSERTION OF GUIDE WIRE FOL LOWED BY cohort cohort cohort cohort cohort

43249

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH BALLOON DILATION OF ESOPHAG US (LESS THAN cohort cohort cohort cohort cohort

43250

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP( S), OR OTHER cohort cohort cohort cohort cohort

43251 UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR cohort cohort cohort cohort cohort

90

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

JEJUNUMAS APPROPRIATE; WITH REMOVAL OF TUMOR(S), POLYP( S), OR OTHER

43255

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH CONTROL OF BLEEDING, ANY ME THOD cohort cohort cohort cohort cohort

43256

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH TRANSENDOSCOPIC STENT PLACE MENT (INCLUDES PREDILATION) statewide

43257

UPPER GASTROINTESTINAL ENDOSCOPY INCL ESOPHAGUS, STOMACH, & EITHER THE DUODENUM AND/OR JEJUNUM AS APPROPRIATE; WITH DELIVERY OF THERMAL ENERGY TO THE MUSCLE OF LOWER ESOPHAGEAL SPHINCTER / GASTRIC statewide

43258

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH ABLATION OF TUMOR(S), POLYP (S), OR OTHER cohort cohort cohort cohort cohort

43259

UPPER GASTROINTESTINAL ENDOSCOPY INCLUDING ESOPHAGUS,STOMACH, AND EITHER THE DUODENUM AND/OR JEJUNUMAS APPROPRIATE; WITH ENDOSCOPIC ULTRASOUND EXAMI NATION cohort cohort cohort cohort

43260

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP);DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S), BY BRUSHING OR WASHING (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

43261 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH BIOPSY, SINGLE OR MULTIPLE cohort cohort cohort cohort cohort

43262 ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH SPHINCTEROTOMY/PAPILLOTOMY cohort cohort cohort cohort

43263

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH PRESSURE MEASUREMENT OF SPHINCTER OF ODDI (PANCREATIC DUCT OR COMMON BILE DUCT) statewide

43264

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF STONE(S) FROM BILIARY AND/OR PANCREATIC DUCTS cohort cohort cohort cohort cohort

43265

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE DESTRUCTION, LITHOTRIPSY OF STONE(S), ANY METHOD cohort cohort cohort

43267

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF NASOBILIARY OR NASOPANCREATIC DRAINAGE TUBE statewide

43268

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE INSERTION OF TUBE OR STENT INTO BILE OR PANCREATIC DUCT cohort cohort cohort cohort

43269

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE REMOVAL OF FOREIGNBODY AND/OR CHANGE cohort cohort cohort cohort cohort

43271

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ENDOSCOPIC RETROGRADE BALLOON DILATION OF AMPULLA, BILIARY AND/OR PANCREATIC DUCT(S) cohort cohort cohort cohort

43272

ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP); WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHERLESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY statewide

43273

Endoscopic cannulation of papilla with direct visualization of common bile duct(s) and/or pancreaticduct(s) (List separately in addition to code(s) f or primary procedure) cohort cohort cohort cohort cohort

43279 Laparoscopy, surgical esophagomyotomy (Heller type), with fundoplasty, when performed cohort cohort cohort cohort

43280 LAPAROSCOPY, SURGICAL, ESOPHAGOGASTRIC FUNDOPLASTY(EG, NISSEN, TOUPET PROCEDURES) cohort cohort cohort cohort cohort

43281

LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH cohort cohort cohort cohort cohort

91

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

43282

LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH cohort cohort cohort cohort cohort

43283

Laparoscopy, surgical, esophageal lengthening procedure (eg, Collis gastroplasty or wedge gastroplasty) (List separately in addition to code for primary procedure) statewide

43333

Repair, paraesophageal hiatal hernia (including fundoplication), via laparotomy, except neonatal; with implantation of mesh or other prosthesis statewide

43450

*DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE OR MULTIPLE PASSES *DILATION OF ESOPHAGUS, BY UNGUIDED SOUND OR BOUGIE, SINGLE cohort cohort cohort cohort cohort

43453 DILATION OF ESOPHAGUS, OVER GUIDE WIREDILATION OF ESOPHAGUS, OVER GUIDE WIRE statewide

43456

DILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADEDILATION OF ESOPHAGUS, BY BALLOON OR DILATOR, RETROGRADE cohort cohort cohort

43458

DILATION OF ESOPHAGUS WITH BALLOON (30 MM DIAMETERORLARGER) FOR ACHALASIA DILATION OF ESOPHAGUS WI TH BALLOON (30 MM DIAMETER OR cohort cohort cohort

43499 UNLISTED PROCEDURE, ESOPHAGUS cohort cohort cohort cohort

43520 PYLOROMYOTOMY, CUTTING OF PYLORIC MUSCLE (FREDET-RAMSTEDTTYPE OPERATION) statewide

43631 GASTRECTOMY, PARTIAL, DISTAL; WITH GASTRODUODENOSTOMY statewide

43644

LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCED-URE; WITH GASTRIC BYPASS AND ROUX-EN-Y GASTROENTEROSTOMY (RUOX LIMB 150 CM OR LESS) cohort cohort

43653

LAPAROSCOPY, SURGICAL;GASTOSTOMY, WITHOUT CONSTRUCTION OF GASTRIC TUBE (EG. STAMM PROCEDURE (SEPARATE PROCEDURE) cohort cohort

43659 LAPAROSCOPY, SURGICAL;UNLISTED LAPAROSCOPY PROCEDURE , STOMACH cohort cohort cohort

43752 Naso or oro gastric tube placement, necessitating physician's skill cohort cohort

43753

Gastric intubation and aspiration(s) therapeutic, necessitating physician's skill (eg, for gastrointestinal hemorrhage), including lavage if performed cohort cohort cohort cohort cohort

43760 Change of gastrostomy tube, percutaneous, without imaging or endoscopic guidance cohort cohort cohort cohort cohort

43761 REPOSITIONING OF A NASO- OR ORO-GASTRIC FEEDING TUBE, THROUGH THE DUODENUM FOR ENTERIC NUTRITION cohort cohort

43770

Laparoscopy, surgical, gastric restrictive procedure; placement of adjustable gastric restrictive device (e.g., gastric band and subcutaneous port components) cohort cohort cohort cohort

43771 Laparoscopy, surgical, gastric restrictive procedure; revision of adjustable gastric restrictive device component only cohort cohort cohort cohort cohort

43772 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device component only statewide

43773 Laparoscopy, surgical, gastric restrictive procedure; removal and replacement of adjustable gastric restrictive device component only cohort cohort cohort

43774 Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components cohort cohort cohort cohort

43775

LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) cohort cohort cohort

43800 PYLOROPLASTY statewide

43830 GASTROSTOMY, TEMPORARY (TUBE, RUBBER OR PLASTIC) (SEPARATEPROCEDURE); statewide

43870 CLOSURE OF GASTROSTOMY, SURGICAL cohort cohort cohort

43880 CLOSURE OF GASTROCOLIC FISTULA statewide

43886 GASTRIC RESTRICTIVE PROCEDURE, OPEN; REVISION OF SUBCUTANEOUS PORT COMPONENT ONLY cohort cohort

92

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

43887 GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL OF SUBCUTANEOUS PORT COMPONENT ONLY statewide

43888 GASTRIC RESTRICTIVE PROCEDURE, OPEN; REMOVAL AND REPLACEMENT OF SUBCUTANEOUS PORT COMPONENT ONLY cohort cohort

43999 UNLISTED PROCEDURE, STOMACH cohort cohort cohort

44005 ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATEPROCEDURE) cohort cohort cohort

44055

CORRECTION OF MALROTATION BY LYSIS OF DUODENAL BANDS AND/OR REDUCTION OF MIDGUT VOLVULUS (EG, LADD PROCEDURE) statewide

44120 ENTERECTOMY, RESECTION OF SMALL INTESTINE; SINGLE RESECTION AND ANASTOMOSIS statewide

44140 COLECTOMY, PARTIAL; WITH ANASTOMOSIS statewide

44180 LAPAROSCOPY, SURGICAL, ENTEROLYSIS (FREEING OF INTESTINAL ADHESION) (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

44186 LAPAROSCOPY, SURGICAL; JEJUNOSTOMY (EG, FOR DECOMPRESSION OR FEEDING) statewide

44187 LAPAROSCOPY, SURGICAL; ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE cohort cohort

44188 LAPAROSCOPY, SURGICAL, COLOSTOMY OR SKIN LEVEL CECOSTOMY statewide

44202 LAPAROSCOPY, SURGICAL; INTESTINAL RESECTION, WITH ANASTOMOSIS (INTRA OR EXTRACORPOREAL) cohort cohort

44204 LAPAROSCOPY, SURGICAL;COLECTOMY, PARTIAL, W/ ANASTOMOSIS cohort cohort cohort

44205 LAPAROSCOPY, SURGICAL;COLECTOMY, PARTIAL, W/ REMOVAL TERMINAL ILEUM W/ ILEOCOLOSTOMY cohort cohort

44213

LAPAROSCOPY, SURGICAL, MOBILIZATION (TAKE-DOWN) OFSPLENIC FLEXURE PERFORMED IN CONJUNCTION WITH PAR TIAL COLECTOMY (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) statewide

44238 UNLISTED LAPAROSCOPY PROCEDURE, INTESTINE (EXCEPT RECTUM) cohort cohort cohort cohort

44300 Placement, enterostomy or cecostomy, tube open (e.g., for feeding or decompression) (separate procedure) statewide

44310 ILEOSTOMY OR JEJUNOSTOMY, NON-TUBE (SEPARATE PROCEDURE) statewide

44312 REVISION OF ILEOSTOMY; SIMPLE (RELEASE OF SUPERFICIAL SCAR) (SEPARATE PROCEDURE) statewide

44346 REVISION OF COLOSTOMY; WITH REPAIR OF PARACOLOSTOMY HERNIA(SEPARATE PROCEDURE) statewide

44360

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING cohort cohort cohort cohort

44361

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH BIOPSY, SINGLE OR MULTIPLE cohort cohort cohort

44366

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH CONTROL OF BLEEDING, ANY METHOD cohort cohort

44369

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO cohort cohort cohort

44372

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, NOT INCLUDING ILEUM; WITH PLACEMENT OF PERCUTANEOUS JEJUNOSTOMY TUBE statewide

44376

SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, INCLUDING ILEUM; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING cohort cohort cohort cohort cohort

44377 SMALL INTESTINAL ENDOSCOPY, ENTEROSCOPY BEYOND SECONDPORTION OF DUODENUM, INCLUDING ILEUM; WITH statewide

93

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

BIOPSY, SINGLE OR MULTIPLE

44380

ILEOSCOPY, THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) statewide

44382 ILEOSCOPY, THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE statewide

44385

ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL ORPELVIC) POUCH; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING(SEPARATE PROCEDURE) cohort cohort

44386 ENDOSCOPIC EVALUATION OF SMALL INTESTINAL (ABDOMINAL ORPELVIC) POUCH; WITH BIOPSY, SINGLE OR MULTIPLE statewide

44388

COLONOSCOPY THROUGH STOMA; DIAGNOSTIC, WITH OR WITHOUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) cohort cohort cohort cohort

44389

COLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLECOLONOSCOPY THROUGH STOMA; WITH BIOPSY, SINGLE OR MULTIPLE cohort cohort

44392

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S),POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY statewide

44394

COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S),POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR( S), statewide

44500 INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG,MILLER-ABBOTT) (SEPARATE PROCEDURE) cohort cohort cohort

44602

SUTURE OF SMALL INTESTINE (ENTERORRHAPHY) FOR PERFORATEDULCER, DIVERTICULUM, WOUND, INJURY OR RUPTURE; SINGLE PERFORATION cohort cohort

44604

SUTURE OF LARGE INTESTINE (COLORRHAPHY) FOR PERFORATEDULCER, DIVERTICULUM, WOUND, INJURY OR RUPTURE (SINGLE OR MULTIPLE PERFORATIONS); WITHOUT COLOSTOMY cohort cohort cohort

44615

INTESTINAL STRICTUROPLASTY (ENTEROTOMY AND ENTERORRHAPHY)WITH OR WITHOUT DILATION, FOR INTESTINAL OBSTRUCTION statewide

44620 CLOSURE OF ENTEROSTOMY, LARGE OR SMALL INTESTINE; statewide

44680 INTESTINAL PLICATION (SEPARATE PROCEDURE) statewide

44705 PREPARATION OF FECAL MICROBIOTA FOR INSTILLATION, INCLUDING ASSESSMENT OF DONOR SPECIMEN statewide

44799 UNLISTED PROCEDURE, INTESTINE cohort cohort cohort cohort

44800 EXCISION OF MECKEL'S DIVERTICULUM (DIVERTICULECTOMY) OROMPHALOMESENTERIC DUCT cohort cohort cohort

44899 UNLISTED PROCEDURE, MECKEL'S DIVERTICULUM AND THE MESENTERY cohort cohort cohort

44950 APPENDECTOMY; cohort cohort cohort cohort

44955

APPENDECTOMY; WHEN DONE FOR INDICATED PURPOSE AT TIME OFOTHER MAJOR PROCEDURE (NOT AS SEPARATE PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

44960 APPENDECTOMY; FOR RUPTURED APPENDIX WITH ABSCESS ORGENERALIZED PERITONITIS statewide

44970 LAPAROSCOPY, SURGICAL; APPENDECTOMY cohort cohort cohort cohort cohort

44979 UNLISTED LAPAROSCOPY PROCEDURE, APPENDIX cohort cohort cohort cohort

45005 INCISION AND DRAINAGE OF SUBMUCOSAL ABSCESS, RECTUM cohort cohort cohort

45100 BIOPSY OF ANORECTAL WALL, ANAL APPROACH (EG, CONGENITALMEGACOLON) cohort cohort cohort cohort cohort

45120

PROCTECTOMY, COMPLETE (FOR CONGENITAL MEGACOLON), ABDOMINAL AND PERINEAL APPROACH; WITH PULL-THROUGHPROCEDURE AND ANASTOMOSIS (EG, SWENSON, DUHAMEL, OR SOAVE TYPE OPERATION) statewide

94

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

45123 PROCTECTOMY, PARTIAL, WITHOUT ANASTOMOSIS, PERINEAL APPROACH statewide

45130 EXCISION OF RECTAL PROCIDENTIA, WITH ANASTOMOSIS; PERINEALAPPROACH statewide

45171 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PARTIAL THICKNESS) cohort cohort cohort cohort cohort

45172 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE, FULL THICKNESS) cohort cohort cohort

45190 DESTRUCTION OF RECTAL TUMOR, ANY METHOD (EG,ELECTRODESICCATION) TRANSANAL APPROACH cohort cohort cohort

45300

PROCTOSIGMOIDOSCOPY, RIGID; DIAGNOSTIC, WITH OR WITHOUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) cohort cohort cohort cohort

45303 PROCTOSIGMOIDOSCOPY, RIGID; WITH DILATION, ANY METHOD statewide

45305 PROCTOSIGMOIDOSCOPY, RIGID; WITH BIOPSY, SINGLE ORMULTIPLE cohort cohort cohort cohort

45307 PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF FOREIGN BODY statewide

45308

PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLETUMOR,POLYP, OR OTHER LESION BY HOT BIOPSY FORCEP S OR BIPOLAR CAUTERY statewide

45309

PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLETUMOR,POLYP, OR OTHER LESION BY SNARE TECHNIQUE PROCTOSIGMOIDOSCOPY, RIGID; WITH REMOVAL OF SINGLETUMOR, cohort cohort

45317 PROCTOSIGMOIDOSCOPY, RIGID; WITH CONTROL OF BLEEDING, ANYMETHOD statewide

45320

PROCTOSIGMOIDOSCOPY, RIGID; WITH ABLATION OF TUMOR(S),POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE(EG, cohort cohort cohort

45330

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR WITHOUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING(SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

45331

SIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLE OR MULTIPLESIGMOIDOSCOPY, FLEXIBLE; WITH BIOPSY, SINGLEOR MULTIPLE cohort cohort cohort cohort cohort

45332

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODYSIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF FOREIGN BODY cohort cohort cohort

45333

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S),POLYP(S),OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY SIGMOIDOSCOPY, FLEXIBLE; WIT H REMOVAL OF TUMOR(S), POLYP(S), cohort cohort

45334

SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING,ANYMETHOD SIGMOIDOSCOPY, FLEXIBLE; WITH CONTROL OF BLEEDING, ANY cohort cohort cohort cohort

45335 SIGMOIDOSCOPY, FLEXIBLE; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE cohort cohort cohort cohort

45338

SIGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S),POLYP(S),OR OTHER LESION(S) BY SNARE TECHNIQUE S IGMOIDOSCOPY, FLEXIBLE; WITH REMOVAL OF TUMOR(S), POLYP(S), cohort cohort cohort

45339

SIGMOIDOSCOPY, FLEXIBLE; WITH ABLATION OF TUMOR(S),POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO BIOPSY FORCEPS, BIPOLAR CAUTERY OR SNARE TECHNIQUE cohort cohort cohort cohort cohort

45340 SIGMOIDSCOPY, FLEXIBLE; W/DILATION, BALLOON, 1/>STRJUCTURES cohort cohort cohort cohort

45341

SIGMOIDOSCOPY, FLEXIBLE; DIAGNOSTIC, WITH OR W/OUTCOLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) WITH ENDOSCOPIC ULTRASOUND EXAMINATION. cohort cohort cohort cohort cohort

45342 SIGMOIDOSCOPY, FLEXIBLE; WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRANSMURAL FINE cohort cohort cohort

95

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

NEEDLEASPIRATION/BIOPSY(S)

45378

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE;DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WITH OR WITHOUT COLON DECOMPRESSION cohort cohort cohort cohort cohort cohort

45379

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHREMOVAL OF FOREIGN BODY COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH cohort cohort

45380

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHBIOPSY, SINGLE OR MULTIPLE COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH cohort cohort cohort cohort cohort

45381 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; W/DIRECTED SUBMUCOSA INJECTION(S), ANY SUBSTANCE cohort cohort cohort cohort cohort

45382

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHCONTROL OF BLEEDING, ANY METHOD COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH cohort cohort cohort cohort cohort

45383

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) NOT AMENABLE TO REMOVAL BY HOT BIOPSY FORCEPS, BIPOLAR CAUTERY cohort cohort cohort cohort cohort

45384

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHREMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY cohort cohort cohort cohort cohort

45385

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITHREMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE cohort cohort cohort cohort cohort

45386 COLONOSCPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE;W/DILATION, BALLOON, 1/>STRICTURES cohort cohort cohort cohort

45387

COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE; WITH TRANSENDOSCOPIC STENT PLACEMENT (INCLUDES PREDILATION) statewide

45391 COLONOSCOPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXUREWITH ENDOSCOPIC ULTRASOUND EXAMINATION cohort cohort cohort cohort

45392

COLONOSPY, FLEXIBLE, PROXIMAL TO SPLENIC FLEXURE WITH TRANSENDOSCOPIC ULTRASOUND GUIDED INTRAMURAL OR TRASMURAL FINE NEEDLE ASPIRATION/BIOSPY(S) cohort cohort

45400 LAPAROSCOPY, SURGICAL; PROCTOPEXY (FOR PROLAPSE) statewide

45499 UNLISTED LAPAROSCOPY PROCEDURE, RECTUM statewide

45505 PROCTOPLASTY; FOR PROLAPSE OF MUCOUS MEMBRANE cohort cohort

45541 PROCTOPEXY FOR PROLAPSE; PERINEAL APPROACH statewide

45560 REPAIR OF RECTOCELE (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

45905 *DILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE) UNDERANESTHESIA OTHER THAN LOCAL cohort cohort cohort cohort

45910 DILATION OF RECTAL STRICTURE (SEPARATE PROCEDURE) UNDERANESTHESIA OTHER THAN LOCAL cohort cohort

45915 *REMOVAL OF FECAL IMPACTION OR FOREIGN BODY (SEPARATEPROCEDURE) UNDER ANESTHESIA cohort cohort cohort cohort

45990 ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC cohort cohort cohort cohort

45999 UNLISTED PROCEDURE, RECTUM cohort cohort cohort cohort

46020 PLACEMENT, SETON cohort cohort cohort cohort cohort cohort

46030 *REMOVAL OF ANAL SETON, OTHER MARKER cohort cohort cohort cohort cohort

46040 INCISION AND DRAINAGE OF ISCHIORECTAL AND/OR PERIRECTALABSCESS (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

46045

INCISION AND DRAINAGE OF INTRAMURAL, INTRAMUSCULARORSUBMUCOSAL ABSCESS, TRANSANAL, UNDER ANESTHESIA cohort cohort

46050 *INCISION AND DRAINAGE, PERIANAL ABSCESS, SUPERFICIAL cohort cohort cohort cohort cohort

46060

INCISION AND DRAINAGE OF ISCHIORECTAL OR INTRAMURAL ABSCESS,WITH FISTULECTOMY OR FISTULOTOMY, SUBMUSCULAR, WITH OR WITHOUT PLACEMENT OF SETON cohort cohort cohort

46080 *SPHINCTEROTOMY, ANAL, DIVISION OF SPHINCTER cohort cohort cohort cohort cohort

96

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(SEPARATEPROCEDURE)

46083 INCISION OF THROMBOSED HEMORRHOID, EXTERNAL cohort cohort cohort cohort cohort

46200 FISSURECTOMY, INCLUDING SPHINCTEROTOMY, WHEN PERFORMED cohort cohort cohort cohort cohort

46220 EXCISION OF SINGLE EXTERNAL PAPILLA OR TAG, ANUS cohort cohort cohort cohort cohort

46221 HEMORRHOIDECTOMY, INTERNAL, BY RUBBER BAND LIGATION(S) cohort cohort cohort cohort cohort

46230 EXCISION OF MULTIPLE EXTERNAL PAPILLAE OR TAGS, ANUS cohort cohort cohort cohort cohort

46250 HEMORRHOIDECTOMY, EXTERNAL, 2 OR MORE COLUMNS/GROUPS cohort cohort cohort cohort

46255 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; cohort cohort cohort cohort cohort

46257 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISSURECTOMY cohort cohort cohort cohort

46258

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, SINGLE COLUMN/GROUP; WITH FISTULECTOMY, INCLUDING FISSURECTOMY, WHEN PERFORMED cohort cohort cohort cohort

46260 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORECOLUMNS/GROUPS; cohort cohort cohort cohort cohort

46261 HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORECOLUMNS/GROUPS; WITH FISSURECTOMY cohort cohort cohort

46262

HEMORRHOIDECTOMY, INTERNAL AND EXTERNAL, 2 OR MORECOLUMNS/GROUPS; WITH FISTULECTOMY, INCLUDING FISS URECTOMY, WHEN PERFORMED cohort cohort

46270 SURGICAL TREATMENT OF ANAL FISTULA(FISTULECTOMY/FISTULOTOMY); SUBCUTANEOUS cohort cohort cohort cohort cohort cohort

46275 SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); INTERSPHINCTERIC cohort cohort cohort cohort cohort

46280

SURGICAL TREATMENT OF ANAL FISTULA (FISTULECTOMY/FISTULOTOMY); TRANSSPHINCTERIC, SUPRASPHINCTERIC, EXTRASPHINCTERIC OR MULTIPLE, INCLUDING PLACEMENT OF SETON, WHEN PERFORMED cohort cohort cohort cohort cohort

46285 SURGICAL TREATMENT OF ANAL FISTULA(FISTULECTOMY/FISTULOTOMY); SECOND STAGE cohort cohort cohort

46288 CLOSURE OF ANAL FISTULA WITH RECTAL ADVANCEMENT FLAP cohort cohort cohort cohort

46320 EXCISION OF THROMBOSED HEMORRHOID, EXTERNAL cohort cohort cohort cohort

46500 *INJECTION OF SCLEROSING SOLUTION, HEMORRHOIDS cohort cohort cohort

46505 CHEMODENERVATION OF INTERNAL ANAL SPHINCTER cohort cohort cohort

46600

ANOSCOPY; DIAGNOSTIC, WITH OR WITHOUT COLLECTION OFSPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

46604 ANOSCOPY; WITH DILATION, ANY METHOD cohort cohort cohort

46606 ANOSCOPY; WITH BIOPSY, SINGLE OR MULTIPLE cohort cohort cohort

46608 ANOSCOPY; WITH REMOVAL OF FOREIGN BODY statewide

46610 ANOSCOPY; WITH REMOVAL OF SINGLE TUMOR, POLYP, OR OTHERLESION BY HOT BIOPSY FORCEPS OR BIPOLAR CAUTERY cohort cohort

46612 ANOSCOPY; WITH REMOVAL OF MULTIPLE TUMORS, POLYPS,OR OTHER LESIONS BY HOT BIOPSY TECHNIQUE cohort cohort cohort

46614 ANOSCOPY; WITH CONTROL OF BLEEDING, ANY METHOD cohort cohort

46615

ANOSCOPY; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHERLESION(S) NOT AMENABLE TO BIPOLAR CAUTERY ORSNARE TECHNIQUE cohort cohort cohort

46700 ANOPLASTY, PLASTIC OPERATION FOR STRICTURE; ADULT cohort cohort cohort

46706 REPAIR OF ANAL FISTULA W/FIBRIN GLUE cohort cohort

46750 SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE OR PROLAPSE; ADULT cohort cohort cohort

46761

SPHINCTEROPLASTY, ANAL, FOR INCONTINENCE, ADULT; LEVATORMUSCLE IMBRICATION (PARK POSTERIOR ANAL REPAIR) statewide

46910 *DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, cohort cohort cohort cohort cohort

97

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION

46917

DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY cohort cohort

46922

DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION cohort cohort cohort cohort cohort cohort

46924

DESTRUCTION OF LESION(S), ANUS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE, ANY METHOD cohort cohort cohort cohort

46930 Destruction of internal hemorrhoid(s) by thermal energy (e.g., infrared coagulation, cautery, radiofrequency) cohort cohort cohort

46940

CURETTAGE OR CAUTERIZATION OF ANAL FISSURE, INCLUDINGDILATION OF ANAL SPHINCTER (SEPARATE PROCEDURE); INITIAL cohort cohort

46945 HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THANRUBBER BAND; SINGLE HEMORRHOID COLUMN/GROUP cohort cohort cohort

46946

HEMORRHOIDECTOMY, INTERNAL, BY LIGATION OTHER THANRUBBER BAND; 2 OR MORE HEMORRHOID COLUMNS/GROUPS cohort cohort cohort cohort

46947 HEMORRHOIDOPEXY (EG,FOR PROLAPSING INTERNAL HEMORRHOIDS) BY STAPLING cohort cohort cohort cohort cohort

46999 UNLISTED PROCEDURE, ANUS cohort cohort cohort cohort cohort cohort

47000 *BIOPSY OF LIVER, NEEDLE; PERCUTANEOUS cohort cohort cohort cohort cohort

47001

BIOPSY OF LIVER, NEEDLE; WHEN DONE FOR INDICATED PURPOSE AT TIME OF OTHER MAJOR PROCEDURE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

47011 HEPATOTOMY; FOR PERCUTANEOUS DRAINAGE OF ABSCESS OR CYST, 1 OR 2 STAGES cohort cohort

47100 BIOPSY OF LIVER, WEDGE cohort cohort cohort

47120 HEPATECTOMY, RESECTION OF LIVER; PARTIAL LOBECTOMY statewide

47300 MARSUPIALIZATION OF CYST OR ABSCESS OF LIVER statewide

47350 MANAGEMENT OF LIVER HEMORRHAGE; SIMPLE SUTURE OF LIVER WOUNDOR INJURY statewide

47379 UNLISTED LAPAROSCOPIC PROCEDURE, LIVER cohort cohort cohort cohort cohort

47382 ABLATION, 1 OR MORE LIVER TUMOR(S), PERCUTANEOUS, RADIOFREQUENCY cohort cohort

47399 UNLISTED PROCEDURE, LIVER cohort cohort

47490

Cholecystostomy, percutaneous, complete procedure,including imaging guidance, catheter placement, c holecystogram when performed, and radiological supervision and interpretation statewide

47500

INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATICCHOLANGIOGRAPHY INJECTION PROCEDURE FOR PERCUTANEOUS TRANSHEPATIC cohort cohort

47505

INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH ANEXISTING CATHETER (EG, PERCUTANEOUS TRANSHEPATIC OR T-TUBE) INJECTION PROCEDURE FOR CHOLANGIOGRAPHY THROUGH AN EXISTING cohort cohort cohort cohort cohort

47510 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC CATHETERFORBILIARY DRAINAGE statewide

47511 INTRODUCTION OF PERCUTANEOUS TRANSHEPATIC STENT FOR INTERNALAND EXTERNAL BILIARY DRAINAGE statewide

47525 CHANGE OF PERCUTANEOUS BILIARY DRAINAGE CATHETER cohort cohort cohort

47550

BILIARY ENDOSCOPY, INTRAOPERATIVE (CHOLEDOCHOSCOPY) (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

47553 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT;WITH BIOPSY, SINGLE OR MULTIPLE statewide

47554 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT;WITH REMOVAL OF STONE(S) statewide

47555 BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER cohort cohort

98

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

TRACT;WITH DILATION OF BILIARY DUCT STRICTURE(S)WITHOUT STENT BILIARY ENDOSCOPY, PERCUTANEOUS VI A T-TUBE OR OTHER TRACT;

47556

BILIARY ENDOSCOPY, PERCUTANEOUS VIA T-TUBE OR OTHER TRACT;WITH DILATION OF BILIARY DUCT STRICTURE(S)WITH STENT BILIARY ENDOSCOPY, PERCUTANEOUS VIA T -TUBE OR OTHER TRACT; statewide

47562 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY cohort cohort cohort cohort cohort cohort

47563 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY cohort cohort cohort cohort cohort

47564 LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT cohort cohort cohort cohort

47579 UNLISTED LAPAROSCOPY PROCEDURE, BILIARY TRACT cohort cohort cohort

47600 CHOLECYSTECTOMY; cohort cohort cohort cohort

47605 CHOLECYSTECTOMY; WITH CHOLANGIOGRAPHY cohort cohort

47610 CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT; statewide

47630 BILIARY DUCT STONE EXTRACTION, PERCUTANEOUS VIA T-TUBETRACT, BASKET OR SNARE (EG, BURHENNE TECHNIQUE) statewide

47765 ANASTOMOSIS, OF INTRAHEPATIC DUCTS AND GASTROINTESTINALTRACT statewide

47801 PLACEMENT OF CHOLEDOCHAL STENT statewide

47999 UNLISTED PROCEDURE, BILIARY TRACT cohort cohort

48102 *BIOPSY OF PANCREAS, PERCUTANEOUS NEEDLE cohort cohort cohort cohort

48999 UNLISTED PROCEDURE, PANCREAS cohort cohort cohort

49000

EXPLORATORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITHORWITHOUT BIOPSY(S) (SEPARATE PROCEDURE) EXPLORA TORY LAPAROTOMY, EXPLORATORY CELIOTOMY WITH OR cohort cohort cohort cohort

49002 REOPENING OF RECENT LAPAROTOMY cohort cohort

49010

EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) (SEPARATE PROCEDURE) EXPLORATION, RETROPERITONEAL AREA WITH OR WITHOUT BIOPSY(S) statewide

49020 DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS,EXCLUSIVE OF APPENDICEAL ABSCESS; OPEN cohort cohort

49021

DRAINAGE OF PERITONEAL ABSCESS OR LOCALIZED PERITONITIS,EXCLUSIVE OF APPENDICEAL ABSCESS; PERCUTANEOUS cohort cohort cohort cohort

49061 DRAINAGE OF RETROPERITONEAL ABSCESS; PERCUTANEOUS cohort cohort cohort cohort

49082 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITHOUT IMAGING GUIDANCE cohort cohort cohort cohort cohort

49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC OR THERAPEUTIC); WITH IMAGING GUIDANCE cohort cohort cohort cohort cohort

49084 PERITONEAL LAVAGE, INCLUDING IMAGING GUIDANCE, WHEN PERFORMED cohort cohort cohort

49180 *BIOPSY, ABDOMINAL OR RETROPERITONEAL MASS, PERCUTANEOUSNEEDLE cohort cohort cohort cohort cohort

49203

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal,mesenteric, or retroperitoneal primary or seconda ry tumors; largest tumor 5 cm diameter or less cohort cohort cohort

49204

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal,mesenteric, or retroperitoneal primary or seconda ry tumors; largest tumor 5.1-10.0 cm diameter cohort cohort cohort

49205

Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal,mesenteric, or retroperitoneal primary or seconda ry tumors; largest tumor greater than 10.0 diamete cohort cohort cohort

49215 EXCISION OF PRESACRAL OR SACROCOCCYGEAL TUMOR statewide

49250 UMBILECTOMY, OMPHALECTOMY, EXCISION OF UMBILICUS (SEPARATEPROCEDURE) cohort cohort cohort cohort

49255 OMENTECTOMY, EPIPLOECTOMY, RESECTION OF OMENTUM (SEPARATEPROCEDURE) cohort cohort cohort cohort

49320 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND cohort cohort cohort cohort cohort

99

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OMENTUM; DIAGNOSTIC , WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

49321 LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH BIOPSY (SINGLE OR MULTIPLE) cohort cohort cohort cohort cohort

49322

LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE) cohort cohort cohort cohort cohort

49324 Laparoscopy, surgical; with insertion of tunneled intraperitoneal catheter cohort cohort cohort cohort cohort

49325

LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLYPLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED cohort cohort cohort cohort

49326

LAPAROSCOPY, SURGICAL; WITH OMENTOPEXY (OMENTAL TACKING PROCEDURE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

49329

LAPAROSCOPY, SURGICAL, ABDOMEN, PERITONEUM, AND OMENTUM; UNLISTED LAPAROSCOPY PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM cohort cohort cohort cohort cohort cohort

49402 REMOVAL OF PERITONEAL FOREIGN BODY FROM PERITONEALCAVITY cohort cohort cohort

49411

PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR M cohort cohort

49418

Insertion of tunneled intraperitoneal catheter (eg, dialysis, intraperitoneal chemotherapy instillation, management of ascites), complete procedure, including imaging guidance, catheter placement, con cohort cohort cohort cohort

49419 Insertion of tunneled intraperitoneal catheter, with subcutaneous port (ie, totally implantable) cohort cohort

49421 Insertion of tunneled intraperitoneal catheter fordialysis, open cohort cohort cohort

49422 Removal of tunneled intraperitoneal catheter cohort cohort cohort cohort cohort

49423

EXCHANGE OF PREVIOUSLY PLACED ABSCESS OR CYST DRAINAGECATHETER UNDER RADIOLOGICAL GUIDANCE (SEPARATEPROCEDURE) cohort cohort cohort cohort

49424 CONTRAST INJECTION FOR ASSESSMENT OF ABSCESS OR CYST VIAPREVIOUSLY PLACED CATHETER (SEPARATE PROCEDURE) cohort cohort cohort cohort

49425 INSERTION OF PERITONEAL-VENOUS SHUNT statewide

49426 REVISION OF PERITONEAL-VENOUS SHUNT statewide

49427

INJECTION PROCEDURE (EG, CONTRAST MEDIA) FOR EVALUATION OFPREVIOUSLY PLACED PERITONEAL-VENOUS SHUNT statewide

49435

INSERTION OF SUBCUTANEOUS EXTENSION TO INTRAPERITONEAL CANNULA OR CATHETER WITH REMOTE CHEST EXIT SITE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

49440

Insertion of gastrostomy tube, percutaneous, underfluoroscopic guidance including contrast injectio n(s), image documentation and report cohort cohort cohort cohort

49441

Insertion of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report statewide

49446

Conversion of gastrostomy tube to gastro-jejunostomy tube, percutaneous, under fluoroscopic guidanceincluding contrast injection(s), image documentat ion and report cohort cohort

49450

Replacement of gastrostomy or cecostomy (or other colonic) tube, percutaneous, under fluoroscopic guidance including contrast injection(s), image documentation and report cohort cohort

49451

Replacement of duodenostomy or jejunostomy tube, percutaneous, under fluoroscopic guidance includingcontrast injection(s), image documentation and re port cohort cohort cohort

49452 Replacement of gastro-jejunostomy tube, percutaneous, under fluoroscopic guidance including contrastinjection(s), image cohort cohort

100

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

documentation and report

49460

Mechanical removal of obstructive material from gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic ) tube, anymethod, under fluoroscopic guidance including con statewide

49465

Contrast injection(s) for radiological evaluation of existing gastrostomy, duodenostomy, jejunostomy, gastro-jejunostomy, or cecostomy (or other colonic) tube, from a percutaneous approach including i cohort cohort cohort cohort cohort

49491 REPAIR INIT INGUINAL HERNIA, PRETERM INFANT (BIRTH50 WKS POSTCONCEPT)W/WO HYDROCELECT; REDUCIBLE cohort cohort

49495 REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE cohort cohort cohort

49496

REPAIR INITIAL INGUINAL HERNIA, UNDER AGE 6 MONTHS, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR STRANGULATED statewide

49500 REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5YEARS, WITH OR WITHOUT HYDROCELECTOMY; REDUCIBLE cohort cohort cohort cohort

49501

REPAIR INITIAL INGUINAL HERNIA, AGE 6 MONTHS TO UNDER 5YEARS, WITH OR WITHOUT HYDROCELECTOMY; INCARCERATED OR STRANGULATED cohort cohort cohort

49505 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER;REDUCIBLE cohort cohort cohort cohort cohort cohort

49507 REPAIR INITIAL INGUINAL HERNIA, AGE 5 YEARS OR OVER;INCARCERATED OR STRANGULATED cohort cohort cohort cohort cohort cohort

49520 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; REDUCIBLE cohort cohort cohort cohort cohort cohort

49521 REPAIR RECURRENT INGUINAL HERNIA, ANY AGE; INCARCERATED ORSTRANGULATED cohort cohort cohort cohort cohort

49525 REPAIR INGUINAL HERNIA, SLIDING, ANY AGE cohort cohort cohort cohort cohort

49540 REPAIR LUMBAR HERNIA statewide

49550 REPAIR INITIAL FEMORAL HERNIA, ANY AGE, REDUCIBLE; cohort cohort cohort cohort cohort cohort

49553 REPAIR INITIAL FEMORAL HERNIA, ANY AGE; INCARCERATED ORSTRANGULATED cohort cohort

49560 REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; REDUCIBLE cohort cohort cohort cohort cohort cohort

49561 REPAIR INITIAL INCISIONAL OR VENTRAL HERNIA; INCARCERATED ORSTRANGULATED cohort cohort cohort cohort cohort cohort

49565 REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; REDUCIBLE cohort cohort cohort cohort cohort

49566 REPAIR RECURRENT INCISIONAL OR VENTRAL HERNIA; INCARCERATED OR STRANGULATED cohort cohort cohort cohort

49568

Implantation of mesh or other prosthesis for open incisional or ventral hernia repari or mesh for closure of debridement for necrotizing soft tissue infection (List separately in addition to code for cohort cohort cohort cohort cohort cohort

49570 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT); REDUCIBLE (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

49572 REPAIR EPIGASTRIC HERNIA (EG, PREPERITONEAL FAT);INCARCERATED OR STRANGULATED cohort cohort cohort cohort cohort

49580 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; REDUCIBLE cohort cohort cohort cohort

49582 REPAIR UMBILICAL HERNIA, UNDER AGE 5 YEARS; INCARCERATED OR STRANGULATED statewide

49585 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; REDUCIBLE cohort cohort cohort cohort cohort cohort

49587 REPAIR UMBILICAL HERNIA, AGE 5 YEARS OR OVER; INCARCERATEDOR STRANGULATED cohort cohort cohort cohort cohort cohort

49590 REPAIR SPIGELIAN HERNIA cohort cohort

49650 LAPAROSCOPY, SURGICAL; REPAIR INTIAL INQUINAL HERNIA cohort cohort cohort cohort cohort

49651 LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INQUINAL HERNIA cohort cohort cohort cohort cohort cohort

49652 Laparoscopy, surgical repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); reducible cohort cohort cohort cohort cohort cohort

49653

Laparoscopy, surgical repair, ventral, umbilical, spigelian or epigastric hernia (includes mesh insertion, when performed); incarcerated or strangulated cohort cohort cohort cohort cohort cohort

101

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

49654 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); reducible cohort cohort cohort cohort

49655 Laparoscopy, surgical, repair, incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated cohort cohort cohort cohort cohort cohort

49656 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible cohort cohort cohort cohort

49657 Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); incarcerated or strangulated cohort cohort cohort cohort cohort

49659 UNLISTED LAPAROSCOPY PROCEDURE, HERNIOPLASTY, HERNIORRHAPHY, HERNIOTOMY cohort cohort cohort cohort cohort

49999 UNLISTED PROCEDURE, ABDOMEN, PERITONEUM AND OMENTUM cohort cohort cohort cohort cohort cohort

50021 DRAINAGE OF PERIRENAL OR RENAL ABSCESS; PERCUTANEOUS cohort cohort

50040 NEPHROSTOMY, NEPHROTOMY WITH DRAINAGE cohort cohort

50060 NEPHROLITHOTOMY; REMOVAL OF CALCULUS cohort cohort

50075

NEPHROLITHOTOMY; REMOVAL OF LARGE STAGHORN CALCULUS FILLING RENAL PELVIS AND CALYCES (INCLUDING ANATROPHIC PYELOLITHOTOMY) statewide

50080

PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITHOR WITHOUT DILATION, ENDOSCOPY, LITHOTRIPSY, STENTING OR BASKET EXTRACTION; UP TO 2 CM cohort cohort cohort cohort

50081

PERCUTANEOUS NEPHROSTOLITHOTOMY OR PYELOSTOLITHOTOMY, WITHOR WITHOUT DILATION, ENDOSCOPY, LITHOTRIPSY, STENTING OR BASKET EXTRACTION; OVER 2 CM cohort cohort cohort cohort cohort

50200 *RENAL BIOPSY; PERCUTANEOUS, BY TROCAR OR NEEDLE cohort cohort cohort cohort cohort

50220 NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACHINCLUDING RIB RESECTION; statewide

50225

NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACHINCLUDING RIB RESECTION; COMPLICATED BECAUSE OF PREVIOUS SURGERY ON SAME KIDNEY statewide

50230

NEPHRECTOMY, INCLUDING PARTIAL URETERECTOMY, ANY APPROACHINCLUDING RIB RESECTION; RADICAL, WITH REGIONAL LYMPHADENECTOMY AND/OR VENA CAVAL THROMBECTOMY statewide

50240 NEPHRECTOMY, PARTIAL statewide

50382

REMOVAL (VIA SNARE/CAPTURE) AND REPLACEMENT OF INTERNALLY DWELLING URETERAL STENT VIA PERCUTANEOUS APPROACH, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

50384

REMOVAL (VIA SNARE/CAPTURE) OF INTERNALLY DWELLINGURETERAL STENT VIA PERCUTANEOUS APPROACH, INCLUDI NG RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

50385

Removal (via snare/capture) and replacement of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation cohort cohort cohort

50386

Removal (via snare/capture) of internally dwellingureteral stent via transurethral approach, withou t use of cystoscopy, including radiological supervision and interpretation cohort cohort

50387

REMOVAL AND REPLACEMENT OF EXTERNALLY ACCESSIBLE TRANSNEPHRIC URETERAL STENT (EG, EXTERNAL/INTERNAL STENT) REQUIRING FLUOROSCOPIC GUIDANCE, INCLUDING RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

50389

REMOVAL OF NEPHROSTOMY TUBE, REQUIRING FLUOROSCOPIC GUIDANCE (EG, WITH CONCURRENT INDWELLING URETERAL STENT) cohort cohort cohort

50390 *ASPIRATION AND/OR INJECTION OF RENAL CYST OR PELVIS BYNEEDLE, PERCUTANEOUS cohort cohort cohort cohort

50392 INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS cohort cohort cohort cohort cohort

102

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

50393

INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETERTHROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS cohort cohort cohort cohort cohort

50394

INJECTION PROCEDURE FOR PYELOGRAPHY (AS NEPHROSTOGRAM,PYELOSTOGRAM, ANTEGRADE PYELOURETEROGRAMS) THROUGH NEPHROSTOMY OR PYELOSTOMY TUBE, OR INDWELLING URETERAL cohort cohort cohort cohort

50395

INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITHDILATION TO ESTABLISH NEPHROSTOMY TRACT, PERCUTANEOUS INTRODUCTION OF GUIDE INTO RENAL PELVIS AND/OR URETER WITH cohort cohort cohort cohort

50398 *CHANGE OF NEPHROSTOMY OR PYELOSTOMY TUBE cohort cohort cohort cohort cohort

50400

PYELOPLASTY (FOLEY Y-PYELOPLASTY), PLASTIC OPERATION ONRENAL PELVIS, WITH OR WITHOUT PLASTIC OPERATION ON URETER, NEPHROPEXY, NEPHROSTOMY, PYELOSTOMY, OR URETERAL SPLINTING; cohort cohort

50542 Laparoscopy, surgical; ablation of renal mass lesion(s), including intraoperative ultrasound guidance and monitoring, when performed cohort cohort

50543 LAPAROSCOPY, SURGICAL; PARTIAL NEPHRECTOMY cohort cohort cohort

50544 LAPAROSCOPY, SURGICAL; PYELOPLASTY statewide

50546 LAPAROSCOPY, SURGICAL; NEPHRECTOMY statewide

50548 LAPAROSCOPICALLY ASSISTED NEPHROURETERECTOMY statewide

50549 UNLISTED LAPAROSCOPY PROCEDURE, RENAL statewide

50551

RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY ORPYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; statewide

50561

RENAL ENDOSCOPY THROUGH ESTABLISHED NEPHROSTOMY ORPYELOSTOMY, WITH OR WITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH statewide

50570

RENAL ENDOSCOPY THROUGH NEPHROTOMY OR PYELOTOMY, WITH ORWITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; statewide

50590 LITHOTRIPSY, EXTRACORPOREAL SHOCK WAVE cohort cohort cohort cohort cohort

50592 Ablation, one or more renal tumor(s), percutaneous, unilateral, radiofrequency cohort cohort cohort

50593 Ablation, renal tumor(s) unilateral, percutaneous,cryotherapy cohort cohort

50600 URETEROTOMY WITH EXPLORATION OR DRAINAGE (SEPARATEPROCEDURE) cohort cohort

50605 URETEROTOMY FOR INSERTION OF INDWELLING STENT, ALLTYPES statewide

50610 URETEROLITHOTOMY; UPPER ONE-THIRD OF URETER statewide

50684

INJECTION PROCEDURE FOR URETEROGRAPHY OR URETEROPYELOGRAPHY THROUGH URETEROSTOMY OR INDWELLING URETERAL CATHETER statewide

50688 *CHANGE OF URETEROSTOMY TUBE cohort cohort

50690

INJECTION PROCEDURE FOR VISUALIZATION OF ILEAL CONDUITAND/OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE cohort cohort cohort cohort

50700 URETEROPLASTY, PLASTIC OPERATION ON URETER (EG, STRICTURE) statewide

50715 URETEROLYSIS, WITH OR WITHOUT REPOSITIONING OF URETER FORRETROPERITONEAL FIBROSIS cohort cohort

50727 REVISION OF URINARY-CUTANEOUS ANASTOMOSIS (ANY TYPEUROSTOMY); statewide

50780 URETERONEOCYSTOSTOMY; ANASTOMOSIS OF SINGLE URETERTOBLADDER cohort cohort cohort

50782 URETERONEOCYSTOSTOMY; ANASTOMOSIS OF DUPLICATED URETER TOBLADDER cohort cohort

50900 URETERORRHAPHY, SUTURE OF URETER (SEPARATE PROCEDURE) statewide

103

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

50949 UNLISTED LAPAROSCOPY PROCEDURE, URETER cohort cohort cohort cohort cohort

50951

URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH ORWITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; statewide

50961

URETERAL ENDOSCOPY THROUGH ESTABLISHED URETEROSTOMY, WITH ORWITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE;WITH REMOVAL OF FOREIGN cohort cohort cohort

51040 CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE cohort cohort cohort cohort cohort

51050 CYSTOLITHOTOMY, CYSTOTOMY WITH REMOVAL OF CALCULUS, WITHOUT VESICAL NECK RESECTION cohort cohort cohort cohort cohort

51102 Aspiration of bladder; with insertion of suprapubic catheter cohort cohort cohort cohort

51520 CYSTOTOMY; FOR SIMPLE EXCISION OF VESICAL NECK (SEPARATEPROCEDURE) statewide

51525 CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM, SINGLE ORMULTIPLE (SEPARATE PROCEDURE) statewide

51550 CYSTECTOMY, PARTIAL; SIMPLE cohort cohort

51570 CYSTECTOMY, COMPLETE; (SEPARATE PROCEDURE) statewide

51600 *INJECTION PROCEDURE FOR CYSTOGRAPHY OR VOIDINGURETHROCYSTOGRAPHY cohort cohort cohort cohort cohort

51605 INJECTION PROCEDURE AND PLACEMENT OF CHAIN FOR CONTRAST AND/OR CHAIN URETHROCYSTOGRAPHY statewide

51610 INJECTION PROCEDURE FOR RETROGRADE URETHROCYSTOGRAPHY cohort cohort cohort cohort cohort

51700 *BLADDER IRRIGATION, SIMPLE, LAVAGE AND/OR INSTILLATION cohort cohort cohort cohort cohort

51701 INSERTION, NON-INDWELLING BLADDER CATHETER cohort cohort cohort cohort cohort

51702 INSERTION, TEMPORARY INDWELLING BLADDER CATHETER; SIMPLE cohort cohort cohort cohort cohort

51703 INSERTION, TEMPORARY INDWELLING BLADDER CATHETER; COMPLICATED cohort cohort cohort cohort cohort

51705 *CHANGE OF CYSTOSTOMY TUBE; SIMPLE statewide

51710 *CHANGE OF CYSTOSTOMY TUBE; COMPLICATED statewide

51715

ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSALTISSUES OF THE URETHRA AND/OR BLADDER NECK ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL cohort cohort cohort cohort

51720 Bladder instillation of anticarcinogenic agent (including retention time) cohort cohort cohort cohort cohort

51726 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); cohort cohort

51727

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL PRESSURE PROFILE STUDIES(IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECH NIQUE cohort cohort

51728

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE cohort cohort

51729

COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE) cohort cohort

51736 SIMPLE UROFLOWMETRY (UFR) (EG, STOP-WATCH FLOW RATE,MECHANICAL UROFLOWMETER) statewide

51741 COMPLEX UROFLOWMETRY (EG, CALIBRATED ELECTRONIC EQUIPMENT) cohort cohort cohort

51784 ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRALSPHINCTER, OTHER THAN NEEDLE, ANY TECHNIQUE cohort cohort

51785 NEEDLE ELECTROMYOGRAPHY STUDIES (EMG) OF ANAL OR URETHRALSPHINCTER, ANY TECHNIQUE statewide

51797

VOIDING PRESSURE STUDIES, INTRA-ABDOMINAL (IE, RECTAL, GASTRIC, INTRAPERITONEAL) (LIST SEPARATELY INADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

104

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

51798 MEASUREMENT, POST-VOIDING RESIDUAL URINE &/OR BLADDER CAPACITY, US, NON-IMAGING cohort cohort cohort cohort cohort

51840

ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG,MARSHALL-MARCHETTI- KRANTZ, BURCH); SIMPLE ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG, cohort cohort cohort cohort

51841

ANTERIOR VESICOURETHROPEXY, OR URETHROPEXY (EG,MARSHALL-MARCHETTI-KRANTZ, BURCH); COMPLICATED (EG, SECONDARY REPAIR) statewide

51845

ABDOMINO-VAGINAL VESICAL NECK SUSPENSION, WITH OR WITHOUTENDOSCOPIC CONTROL (EG, STAMEY, RAZ, MODIFIED PEREYRA) cohort cohort

51860 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE;SIMPLE cohort cohort cohort cohort

51865 CYSTORRHAPHY, SUTURE OF BLADDER WOUND, INJURY OR RUPTURE;COMPLICATED cohort cohort

51980 CUTANEOUS VESICOSTOMY statewide

51990 LAPAROSCOPY, SURGICAL; URETHRAL SUSPENSION FOR STRESS INCONTINENCE statewide

51992 LAPAROSCOPY, SURGICAL; SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) cohort cohort cohort cohort cohort

51999 UNLISTED LAPAROSCOPY PROCEDURE, BLADDER cohort cohort

52000 CYSTOURETHROSCOPY (SEPARATE PROCEDURE)CYSTOURETHROSCOPY (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

52001 CYSTOURETHROSCOPY W/IRRIGATON & EVACUATON CLOTS cohort cohort cohort

52005

CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH ORWITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; cohort cohort cohort cohort cohort

52007

CYSTOURETHROSCOPY, WITH URETERAL CATHETERIZATION, WITH ORWITHOUT IRRIGATION, INSTILLATION, OR URETEROPYELOGRAPHY, EXCLUSIVE OF RADIOLOGIC SERVICE; WITH BRUSH BIOPSY OF URETER cohort cohort

52204 Cystourethroscopy, with biopsy(s) cohort cohort cohort cohort cohort

52214

CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERYOR LASER SURGERY) OF TRIGONE, BLADDER NECK, PROSTATIC FOSSA, URETHRA, OR PERIURETHRAL GLANDS cohort cohort cohort cohort

52224

CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERYOR LASER SURGERY) OR TREATMENT OF MINOR (LESS THAN 0.5 CM) LESION(S) WITH OR WITHOUT BIOPSY cohort cohort cohort cohort cohort

52234

CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERYOR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 TO 2.0 CM) cohort cohort cohort cohort cohort

52235

CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERYOR LASER SURGERY) AND/OR RESECTION OF; MEDIUM BLADDER TUMOR(S) (2.0 TO 5.0 CM) cohort cohort cohort cohort cohort

52240

CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERYOR LASER SURGERY) AND/OR RESECTION OF; LARGE BLADDER TUMOR(S) cohort cohort cohort cohort

52250

CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE,WITH OR WITHOUT BIOPSY OR FULGURATION CYSTOURETHROSCOPY WITH INSERTION OF RADIOACTIVE SUBSTANCE, cohort cohort

52260

CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIALCYSTITIS; GENERAL OR CONDUCTION (SPINAL)ANESTHESIA CYSTOURETHROSCOPY, WITH DILATION OF B LADDER FOR INTERSTITIAL cohort cohort cohort cohort cohort

52265

CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIALCYSTITIS; LOCAL ANESTHESIA CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL cohort cohort

52270

CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALECYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; FEMALE statewide

52275 CYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; cohort cohort cohort

105

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MALECYSTOURETHROSCOPY, WITH INTERNAL URETHROTOMY; MALE

52276

CYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMYCYSTOURETHROSCOPY WITH DIRECT VISION INTERNAL URETHROTOMY cohort cohort cohort cohort cohort

52281

CYSTOURETHROSCOPY, WITH CALIBRATION AND/OR DILATION OFURETHRAL STRICTURE OR STENOSIS, WITH OR WITHOUT MEATOTOMY, WITH OR WITHOUT INJECTION PROCEDURE FOR CYSTOGRAPHY, MALE OR cohort cohort cohort cohort cohort

52282 CYSTOURETHROSCOPY, WITH INSERTION OF PERMANENT URETHRAL STENT cohort cohort cohort cohort

52283

CYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURECYSTOURETHROSCOPY, WITH STEROID INJECTION INTO STRICTURE statewide

52287 CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER cohort cohort cohort cohort

52290

CYSTOURETHROSCOPY; WITH URETERAL MEATOTOMY, UNILATERAL ORBILATERAL CYSTOURETHROSCOPY; WITH URETERALMEATOTOMY, UNILATERAL OR cohort cohort cohort

52300

CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OFORTHOTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF statewide

52301

CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC URETEROCELE(S), UNILATERAL OR BILATERAL CYSTOURETHROSCOPY; WITH RESECTION OR FULGURATION OF ECTOPIC cohort cohort

52305 CYSTOURETHROSCOPY; WITH INCISION OR RESECTION OF ORIFICE OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE statewide

52310

CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS,OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); SIMPLE cohort cohort cohort cohort cohort

52315

CYSTOURETHROSCOPY, WITH REMOVAL OF FOREIGN BODY, CALCULUS,OR URETERAL STENT FROM URETHRA OR BLADDER (SEPARATE PROCEDURE); COMPLICATED cohort cohort cohort cohort

52317

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUSBY ANYMEANS IN BLADDER AND REMOVAL OF FRAGMENTS; SIMPLE OR SMALL (LESS THAN 2.5 CM) cohort cohort cohort cohort cohort

52318

LITHOLAPAXY: CRUSHING OR FRAGMENTATION OF CALCULUSBY ANYMEANS IN BLADDER AND REMOVAL OF FRAGMENTS; COMPLICATED OR LARGE (OVER 2.5 CM) cohort cohort cohort cohort

52320

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITHREMOVAL OF URETERAL CALCULUS CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH cohort cohort cohort cohort cohort

52325

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITHFRAGMENTATION OF URETERAL CALCULUS (EG, ULTRASONIC OR ELECTRO-HYDRAULIC TECHNIQUE) cohort cohort cohort cohort

52327

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITHSUBURETERIC INJECTION OF IMPLANT MATERIAL CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH cohort cohort cohort cohort

52330

CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITHMANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH cohort cohort cohort cohort cohort

52332

CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERALSTENT (EG, GIBBONS OR DOUBLE-J TYPE) CYSTOURETHROSCOPY, WITH INSERTION OF INDWELLING URETERAL cohort cohort cohort cohort cohort

52334

CYSTOURETHROSCOPY WITH INSERTION OF URETERAL GUIDEWIRETHROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS NE PHROSTOMY, RETROGRADE statewide

52341 CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, cohort cohort cohort cohort cohort

106

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ELECTROCAUTERY, AND INCISION)

52342

CYSTOURETHROSCOPY; WITH TREATMENT OF URETEROPELVICJUNCTION STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION) cohort cohort

52344

CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER ELECTROCAUTERY, AND INCISION) cohort cohort cohort cohort cohort

52345

CYSTOURETHROSCOPY WITH URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTURE STRICTURE (EG, BALLOONDILATER ELECTROCAUTERY, AND INCISION) cohort cohort cohort cohort

52351 CYSTOURETHROSCOPY WITH URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC cohort cohort cohort cohort cohort

52352

CYSTOURETHROSCOPY WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH REMOVAL OR MANIPULATION OR CALCULUS (URETERAL CATHETERIZATION IS INCLUDED) cohort cohort cohort cohort cohort

52353

CYSTOURETHROSCOPY WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH LITHROTIPSY (URETERAL CATHETERIZATION ISINCLUDED) cohort cohort cohort cohort cohort

52354 CYSTOURETHROSCOPY WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH BIOPSY AND/OR FULGURATION OF LESION cohort cohort cohort cohort

52450 TRANSURETHRAL INCISION OF PROSTATETRANSURETHRAL INCISION OF PROSTATE cohort cohort cohort

52500

TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE)TRANSURETHRAL RESECTION OF BLADDER NECK (SEPARATE PROCEDURE) cohort cohort cohort cohort

52601

TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE,INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL cohort cohort cohort cohort cohort

52630

Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/o cohort cohort cohort cohort

52640

TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECKCONTRACTURE TRANSURETHRAL RESECTION; OF POSTOPERATIVE BLADDER NECK cohort cohort cohort cohort

52648

CONTACT LASER VAPORIZATION WITH OR WITHOUT TRANSURETHRALRESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, cohort cohort cohort cohort cohort

52649

Laser enucleation of the prostate with morcellation, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal uret cohort cohort cohort

53010 URETHROTOMY OR URETHROSTOMY, EXTERNAL (SEPARATE PROCEDURE); PERINEAL URETHRA, EXTERNAL statewide

53020 MEATOTOMY, CUTTING OF MEATUS (SEPARATE PROCEDURE);EXCEPTINFANT cohort cohort cohort

53060 DRAINAGE OF SKENE'S GLAND ABSCESS OR CYST statewide

53200 BIOPSY OF URETHRA cohort cohort

53210 URETHRECTOMY, TOTAL, INCLUDING CYSTOSTOMY; FEMALE statewide

53230 EXCISION OF URETHRAL DIVERTICULUM (SEPARATE PROCEDURE);FEMALE cohort cohort cohort cohort

53260 EXCISION OR FULGURATION; URETHRAL POLYP(S), DISTALURETHRA statewide

53265 EXCISION OR FULGURATION; URETHRAL CARUNCLE statewide

53270 EXCISION OR FULGURATION; SKENE'S GLANDS statewide

53400 URETHROPLASTY; FIRST STAGE, FOR FISTULA, DIVERTICULUM, ORSTRICTURE (EG, JOHANNSEN TYPE) statewide

53410 URETHROPLASTY, ONE-STAGE RECONSTRUCTION OF MALE ANTERIORURETHRA cohort cohort cohort

53420 URETHROPLASTY, TWO-STAGE RECONSTRUCTION OR REPAIR OFPROSTATIC OR MEMBRANOUS URETHRA; FIRST STAGE statewide

53430 URETHROPLASTY, RECONSTRUCTION OF FEMALE URETHRA cohort cohort

107

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

53440

OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH OR WITHOUT INTRODUCTION OF PROSTHESIS OPERATION FOR CORRECTION OF MALE URINARY INCONTINENCE, WITH cohort cohort cohort cohort cohort

53445

OPERATION FOR CORRECTION OF URINARY INCONTINENCE WITHPLACEMENT OF INFLATABLE URETHRAL OR BLADDER NECK SPHINCTER, INCLUDING PLACEMENT OF PUMP AND/OR RESERVOIR cohort cohort cohort

53446 REMOVAL, INFLATABLE URETHRAL/BLADDER NECK SPHINCTER W/PUMP/RESERVOIR/CUFF cohort cohort

53447

REMOVAL, REPAIR OR REPLACEMENT OF INFLATABLE SPHINCTERINCLUDING PUMP AND/OR RESERVOIR AND/OR CUFF REMOVAL, REPAIR OR REPLACEMENT OF INFLATABLE SPHINCTER cohort cohort

53450 URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT cohort cohort cohort

53460 URETHROMEATOPLASTY, WITH PARTIAL EXCISION OF DISTAL URETHRALSEGMENT (RICHARDSON TYPE PROCEDURE) cohort cohort

53500

URETHROLYSIS TRANSVAGINAL SECONDARY OPEN INCLUDINGCYSTOURETHROSCOPY (EG POSTSURGICAL OBSTRUCTION SCARRING) cohort cohort cohort cohort cohort

53502 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY, FEMALE statewide

53505 URETHRORRHAPHY, SUTURE OF URETHRAL WOUND OR INJURY; PENILE statewide

53520 CLOSURE OF URETHROSTOMY OR URETHROCUTANEOUS FISTULA, MALE(SEPARATE PROCEDURE) cohort cohort cohort

53600

*DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND ORURETHRAL DILATOR, MALE; INITIAL *DILATION OF URETHRAL STRICTURE BY PASSAGE OF SOUND OR cohort cohort

53605

DILATION OF URETHRAL STRICTURE OR VESICAL NECK BY PASSAGE OFSOUND OR URETHRAL DILATOR, MALE, GENERALOR CONDUCTION (SPINAL) ANESTHESIA statewide

53620

*DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM ANDFOLLOWER, MALE; INITIAL *DILATION OF URETHRAL STRICTURE BY PASSAGE OF FILIFORM AND statewide

53665

DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL)ANESTHESIA DILATION OF FEMALE URETHRA, GENERAL OR CONDUCTION (SPINAL) statewide

53855 INSERTION OF A TEMPORARY PROSTATIC URETHRAL STENT,INCLUDING URETHRAL MEASUREMENT statewide

53899 UNLISTED PROCEDURE, URINARY SYSTEMUNLISTED PROCEDURE, URINARY SYSTEM cohort cohort cohort cohort cohort

54000 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE);NEWBORN statewide

54001 SLITTING OF PREPUCE, DORSAL OR LATERAL (SEPARATE PROCEDURE);EXCEPT NEWBORN cohort cohort

54050

*DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; CHEMICAL *DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, statewide

54055

*DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA, MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; ELECTRODESICCATION statewide

54057

DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; LASER SURGERY cohort cohort cohort cohort

54060

DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), SIMPLE; SURGICAL EXCISION cohort cohort

54065

DESTRUCTION OF LESION(S), PENIS (EG, CONDYLOMA, PAPILLOMA,MOLLUSCUM CONTAGIOSUM, HERPETIC VESICLE), EXTENSIVE, ANY METHOD cohort cohort cohort

54100 BIOPSY OF PENIS; CUTANEOUS (SEPARATE PROCEDURE) cohort cohort cohort

54111 EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITHGRAFT statewide

108

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

TO 5 CM IN LENGTH EXCISION OF PENILE PLAQU E (PEYRONIE DISEASE); WITH GRAFT TO

54112

EXCISION OF PENILE PLAQUE (PEYRONIE DISEASE); WITHGRAFTGREATER THAN 5 CM IN LENGTH EXCISION OF PEN ILE PLAQUE (PEYRONIE DISEASE); WITH GRAFT statewide

54120 AMPUTATION OF PENIS; PARTIAL statewide

54125 AMPUTATION OF PENIS; COMPLETE statewide

54150 Circumcision, using clamp or other device with regional dorsal penile or ring block cohort cohort cohort cohort

54160 Circumcision, surgical excision other than clamp, device, or dorsal slit; neonate (28 days or less) cohort cohort

54161 CIRCUMCISION, SURGICAL EXCISION OTHER THAN CLAMP, DEVICE OR DORSAL SLIT; OLDER THAN 28 DAYS OF AGE cohort cohort cohort cohort cohort

54162 LYSIS/EXCISION, PENILE POSTCIRCUMCISION ADHESIONS cohort cohort cohort cohort cohort

54163 REPAIR, INCOMPLETE CIRCUMCISION cohort cohort cohort cohort cohort

54164 FRENULOTOMY, PENIS cohort cohort

54200 *INJECTION PROCEDURE FOR PEYRONIE DISEASE; cohort cohort

54220 IRRIGATION OF CORPORA CAVERNOSA FOR PRIAPISM cohort cohort cohort cohort

54235 INJECTION OF CORPORA CAVERNOSA WITH PHARMACOLOGIC AGENT(S)(EG, PAPAVERINE, PHENTOLAMINE) cohort cohort

54300

PLASTIC OPERATION OF PENIS FOR STRAIGHTENING OF CHORDEE (EG,HYPOSPADIAS), WITH OR WITHOUT MOBILIZATION OF URETHRA cohort cohort cohort

54304

PLASTIC OPERATION ON PENIS FOR CORRECTION OF CHORDEE OR FOR FIRST STAGE HYPOSPADIAS REPAIR WITH OR WITHOUT TRANSPLANTATION OF PREPUCE AND/OR SKIN FLAPS cohort cohort cohort

54308 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDINGURINARY DIVERSION); LESS THAN 3 CM statewide

54312 URETHROPLASTY FOR SECOND STAGE HYPOSPADIAS REPAIR (INCLUDINGURINARY DIVERSION); GREATER THAN 3 CM statewide

54322

1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUTCHORDEE OR CIRCUMCISION); WITH SIMPLE MEATAL ADVA NCEMENT (EG, MAGPI, V-FLAP) cohort cohort cohort

54324

1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUTCHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY L OCAL SKIN FLAPS (EG, FLIP-FLAP, PREPUCIAL FLAP) cohort cohort cohort

54326

1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUTCHORDEE OR CIRCUMCISION); WITH URETHROPLASTY BY L OCAL SKIN FLAPS AND MOBILIZATION OF URETHRA statewide

54328

1-STAGE DISTAL HYPOSPADIAS REPAIR (WITH OR WITHOUTCHORDEE OR CIRCUMCISION); WITH EXTENSIVE DISSECTI ON TO CORRECT CHORDEE AND URETHROPLASTY WITH LOCALSKIN FLAPS, SKIN GRAFT PATCH, AND/OR ISLAND FLAP cohort cohort

54332

1-STAGE PROXIMAL PENILE OR PENOSCROTAL HYPOSPADIASREPAIR REQUIRING EXTENSIVE DISSECTION TO CORRECT CHORDEE AND URETHROPLASTY BY USE OF SKIN GRAFT TUBE AND/OR ISLAND FLAP cohort cohort cohort

54340

REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE,DIVERTICULA); BY CLOSURE, INCISION, OR EXCISION, SIMPLE statewide

54344

REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE,DIVERTICULA); REQUIRING MOBILIZATION OF SKIN FLAPS AND URETHROPLASTY WITH FLAP OR PATCH GRAFT statewide

54348

REPAIR OF HYPOSPADIAS COMPLICATIONS (IE, FISTULA, STRICTURE,DIVERTICULA); REQUIRING EXTENSIVE DISSECTION AND URETHROPLASTY WITH FLAP, PATCH OR TUBED GRAFT (INCLUDES statewide

54360 PLASTIC OPERATION ON PENIS TO CORRECT ANGULATION cohort cohort

54380 PLASTIC OPERATION ON PENIS FOR EPISPADIAS DISTAL TO EXTERNALSPHINCTER; statewide

54401 INSERTION OF PENILE PROSTHESIS; INFLATABLE (SELF- cohort cohort cohort cohort cohort

109

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

CONTAINED)

54405

INSERTION OF INFLATABLE (MULTI-COMPONENT) PENILE PROSTHESIS,INCLUDING PLACEMENT OF PUMP, CYLINDERS, AND/OR RESERVOIR cohort cohort cohort cohort

54408 REPAIR COMPONENTS(S) MULTICOMPONENT, INFLATABLE PENILE PROSTHESIS statewide

54410 REMOVAL & REPLACEMENT, MULTICOMPONENT INFLATABLE PENILE PROSTHESIS, SAME SESSION statewide

54411 REMOVAL & REPLACEMENT, MULTICOMPONENT INFLATABLE PENILE PROSTHESIS, INFECTED, W/IRRIG & DEBRIDE cohort cohort

54416 REMOVAL & REPLACEMENT, NONINFLATABLE (SEMI-RIGID)/INFLATABLE (SELF-CONTAINED) PENILE PROSTHESIS statewide

54440 PLASTIC OPERATION OF PENIS FOR INJURY cohort cohort

54450 FORESKIN MANIPULATION INCLUDING LYSIS OF PREPUTIALADHESIONSAND STRETCHING cohort cohort cohort

54500 BIOPSY OF TESTIS, NEEDLE (SEPARATE PROCEDURE) statewide

54505 BIOPSY OF TESTIS, INCISIONAL (SEPARATE PROCEDURE) cohort cohort cohort

54512 EXCISION OF EXTRAPARENCHYMAL LESION OF TESTIS cohort cohort cohort cohort

54520

ORCHIECTOMY, SIMPLE (INCLUDING SUBCAPSULAR), WITH OR WITHOUTTESTICULAR PROSTHESIS, SCROTAL OR INGUINAL APPROACH cohort cohort cohort cohort cohort

54522 ORCHIECTOMY, PARTIAL cohort cohort

54530 ORCHIECTOMY, RADICAL, FOR TUMOR; INGUINAL APPROACH cohort cohort cohort cohort cohort

54550 EXPLORATION FOR UNDESCENDED TESTIS (INGUINAL OR SCROTALAREA) statewide

54600 REDUCTION OF TORSION OF TESTIS, SURGICAL, WITH OR WITHOUTFIXATION OF CONTRALATERAL TESTIS cohort cohort cohort cohort cohort

54620 FIXATION OF CONTRALATERAL TESTIS (SEPARATE PROCEDURE) cohort cohort cohort

54640 ORCHIOPEXY, INGUINAL APPROACH, WITH OR WITHOUT HERNIA REPAIR cohort cohort cohort cohort cohort

54650 ORCHIOPEXY, ABDOMINAL APPROACH, FOR INTRA-ABDOMINAL TESTIS(EG, FOWLER-STEPHENS) statewide

54660 INSERTION OF TESTICULAR PROSTHESIS (SEPARATE PROCEDURE) statewide

54670 SUTURE OR REPAIR OF TESTICULAR INJURY cohort cohort cohort

54690 LAPAROSCOPY, SURGICAL;ORCHIECTOMY cohort cohort

54692 LAPAROSCOPY, SURGICAL;ORCHIOPEXY FOR INTRA- ABDOMINAL TESTIS statewide

54700 INCISION AND DRAINAGE OF EPIDIDYMIS, TESTIS AND/ORSCROTALSPACE (EG, ABSCESS OR HEMATOMA) cohort cohort cohort cohort cohort

54830 EXCISION OF LOCAL LESION OF EPIDIDYMIS cohort cohort cohort cohort cohort

54840 EXCISION OF SPERMATOCELE, WITH OR WITHOUT EPIDIDYMECTOMY cohort cohort cohort cohort cohort

54860 EPIDIDYMECTOMY; UNILATERAL cohort cohort cohort cohort

55000 *PUNCTURE ASPIRATION OF HYDROCELE, TUNICA VAGINALIS, WITH ORWITHOUT INJECTION OF MEDICATION cohort cohort cohort cohort

55040 EXCISION OF HYDROCELE; UNILATERAL cohort cohort cohort cohort cohort

55041 EXCISION OF HYDROCELE; BILATERAL cohort cohort cohort cohort

55060 REPAIR OF TUNICA VAGINALIS HYDROCELE (BOTTLE TYPE) cohort cohort cohort cohort

55100 *DRAINAGE OF SCROTAL WALL ABSCESS cohort cohort cohort cohort

55110 SCROTAL EXPLORATION statewide

55120 REMOVAL OF FOREIGN BODY IN SCROTUM statewide

55150 RESECTION OF SCROTUM cohort cohort

55175 SCROTOPLASTY; SIMPLE cohort cohort cohort cohort

55180 SCROTOPLASTY; COMPLICATED cohort cohort

55250

VASECTOMY, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE),INCLUDING POSTOPERATIVE SEMEN EXAMINATION(S) cohort cohort cohort cohort cohort

110

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

55400 VASOVASOSTOMY, VASOVASORRHAPHY statewide

55500 EXCISION OF HYDROCELE OF SPERMATIC CORD, UNILATERAL(SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

55520 EXCISION OF LESION OF SPERMATIC CORD (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort cohort

55530 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FORVARICOCELE; (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

55535 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FORVARICOCELE; ABDOMINAL APPROACH cohort cohort cohort cohort

55540 EXCISION OF VARICOCELE OR LIGATION OF SPERMATIC VEINS FORVARICOCELE; WITH HERNIA REPAIR statewide

55550 LAPAROSCOPY, SURGICAL, WITH LIGATION OF SPERMATIC VEINS FOR VARICOCELE cohort cohort cohort cohort

55559 UNLISTED LAPAROSCOPY PROCEDURE, SPERMATIC CORD cohort cohort cohort

55700 BIOPSY, PROSTATE; NEEDLE OR PUNCH, SINGLE OR MULTIPLE, ANYAPPROACH cohort cohort cohort cohort cohort

55706 Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance statewide

55840 PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUTNERVESPARING; statewide

55842

PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUTNERVESPARING; WITH LYMPH NODE BIOPSY(S) (LIMITED PELVIC LYMPHADENECTOMY) cohort cohort

55845

PROSTATECTOMY, RETROPUBIC RADICAL, WITH OR WITHOUTNERVESPARING; WITH BILATERAL PELVIC LYMPHADENECTO MY, INCLUDING EXTERNAL ILIAC, HYPOGASTRIC AND OBTURATOR NODES cohort cohort

55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed cohort cohort cohort cohort

55873 CRYOSURGICAL ABLATION OF THE PROSTATE (INCLUDES ULTRASONIC GUIDANCE AND MONITORING) cohort cohort cohort

55875

TRANSPERINEAL PLACEMENT OF NEEDLES OR CATHETERS INTO PROSTATE FOR INTERSTITIAL RADIOELEMENT APPLICATION, WITH OR WITHOUT CYSTOSCOPY cohort cohort cohort cohort

55876

Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple cohort cohort cohort cohort

55899 UNLISTED PROCEDURE, MALE GENITAL SYSTEM cohort cohort cohort cohort

55920 Placement of needles or catheters into pelvic organs and/or genitalia (except prostate) for subsequent interstitial radioelement application statewide

56405 *INCISION AND DRAINAGE OF VULVA OR PERINEAL ABSCESS cohort cohort cohort cohort cohort

56420 *INCISION AND DRAINAGE OF BARTHOLIN'S GLAND ABSCESS cohort cohort cohort cohort cohort

56440 MARSUPIALIZATION OF BARTHOLIN'S GLAND CYST cohort cohort cohort cohort

56441 LYSIS OF LABIAL ADHESIONS cohort cohort cohort

56442 HYMENOTOMY, SIMPLE INCISION statewide

56501

DESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY METHODDESTRUCTION OF LESION(S), VULVA; SIMPLE, ANY METHOD cohort cohort cohort cohort

56515

DESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY METHODDESTRUCTION OF LESION(S), VULVA; EXTENSIVE, ANY METHOD cohort cohort cohort cohort

56605 BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE); 1 LESION cohort cohort cohort cohort cohort

56606

*BIOPSY OF VULVA OR PERINEUM (SEPARATE PROCEDURE);EACHSEPARATE ADDITIONAL LESION (LIST SEPARATELY I N ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

56620 VULVECTOMY SIMPLE; PARTIAL cohort cohort cohort cohort cohort

56625 VULVECTOMY SIMPLE; COMPLETE cohort cohort cohort

56630 VULVECTOMY, RADICAL, PARTIAL; cohort cohort

56700 PARTIAL HYMENECTOMY OR REVISION OF HYMENAL RING cohort cohort cohort cohort

111

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

56740 EXCISION OF BARTHOLIN'S GLAND OR CYST cohort cohort cohort cohort

56800 PLASTIC REPAIR OF INTROITUS cohort cohort cohort

56810 PERINEOPLASTY, REPAIR OF PERINEUM, NON-OBSTETRICAL(SEPARATEPROCEDURE) cohort cohort cohort cohort

56820 COLPOSCOPY, VULVA cohort cohort cohort

56821 COLPOSCOPY, VULVA; W/BIOPSY(S) cohort cohort cohort

57000 COLPOTOMY; WITH EXPLORATION cohort cohort cohort cohort cohort

57010 COLPOTOMY; WITH DRAINAGE OF PELVIC ABSCESS statewide

57023 INCISION AND DRAINAGE OF VAGINAL HEMATOMA; NON-OBSTETRICAL (EG, POST-TRAUMA, SPONTANEOUS BLEEDING) cohort cohort

57061

DESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY METHODDESTRUCTION OF VAGINAL LESION(S); SIMPLE, ANY METHOD cohort cohort cohort cohort cohort

57065

DESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY METHODDESTRUCTION OF VAGINAL LESION(S); EXTENSIVE, ANY METHOD cohort cohort cohort cohort

57100 *BIOPSY OF VAGINAL MUCOSA; SIMPLE (SEPARATE PROCEDURE) cohort cohort cohort cohort

57105 BIOPSY OF VAGINAL MUCOSA; EXTENSIVE, REQUIRING SUTURE(INCLUDING CYSTS) statewide

57106 VAGINECTOMY, PARTIAL REMOVAL OF VAGINAL WALL; cohort cohort cohort

57120 COLPOCLEISIS (LE FORT TYPE) cohort cohort

57130 EXCISION OF VAGINAL SEPTUM cohort cohort cohort

57135 EXCISION OF VAGINAL CYST OR TUMOR cohort cohort cohort cohort cohort

57155 Insertion of uterine tandem and/or vaginal ovoids for clinical brachytherapy cohort cohort

57156 Insertion of a vaginal radiation afterloading apparatus for clinical brachytherapy cohort cohort

57160 *FITTING AND INSERTION OF PESSARY OR OTHER INTRAVAGINALSUPPORT DEVICE cohort cohort

57180

INTRODUCTION OF ANY HEMOSTATIC AGENT OR PACK FOR SPONTANEOUSOR TRAUMATIC NONOBSTETRICAL VAGINAL HEMORRHAGE (SEPARATE PROCEDURE) statewide

57200

COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL)COLPORRHAPHY, SUTURE OF INJURY OF VAGINA (NONOBSTETRICAL) cohort cohort cohort cohort cohort

57210

COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/ORPERINEUM (NONOBSTETRICAL) COLPOPERINEORRHAPHY, SUTURE OF INJURY OF VAGINA AND/OR cohort cohort cohort

57220

PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH(EG, KELLY URETHRAL PLICATION) PLASTIC OPERATION ON URETHRAL SPHINCTER, VAGINAL APPROACH cohort cohort

57240

ANTERIOR COLPORRHAPHY, REPAIR OF CYSTOCELE WITH ORWITHOUTREPAIR OF URETHROCELE ANTERIOR COLPORRHAP HY, REPAIR OF CYSTOCELE WITH OR WITHOUT cohort cohort cohort cohort cohort

57250

POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT PERINEORRHAPHY POSTERIOR COLPORRHAPHY, REPAIR OF RECTOCELE WITH OR WITHOUT cohort cohort cohort cohort cohort

57260 COMBINED ANTEROPOSTERIOR COLPORRHAPHY;COMBINED ANTEROPOSTERIOR COLPORRHAPHY; cohort cohort cohort cohort cohort

57265

COMBINED ANTEROPOSTERIOR COLPORRHAPHY; WITH ENTEROCELEREPAIR COMBINED ANTEROPOSTERIOR COLPORRHAPHY;WITH ENTEROCELE cohort cohort cohort cohort

57267 INSERT MESH/PELVIC FLR ADDON cohort cohort cohort cohort cohort

57268 REPAIR OF ENTEROCELE, VAGINAL APPROACH (SEPARATE PROCEDURE) cohort cohort cohort cohort

57270 REPAIR OF ENTEROCELE, ABDOMINAL APPROACH (SEPARATEPROCEDURE) cohort cohort

57280 COLPOPEXY, ABDOMINAL APPROACHCOLPOPEXY, ABDOMINAL APPROACH cohort cohort cohort

112

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

57282 SACROSPINOUS LIGAMENT FIXATION FOR PROLAPSE OF VAGINA cohort cohort cohort cohort cohort

57283 COLPOPEXY, INTRAPERITONEAL cohort cohort cohort cohort cohort

57284 Paravaginal defect repair (including repair of cystocele, if performed); open abdominal approach statewide

57285 Paravaginal defect repair (including repair of cystocele, if performed); vaginal approach cohort cohort cohort

57287 REMOVAL OR REVISION OF SLING FOR STRESS INCONTINENCE (EG, FASCIA OR SYNTHETIC) cohort cohort cohort cohort cohort

57288

SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA ORSYNTHETIC) SLING OPERATION FOR STRESS INCONTINENCE (EG, FASCIA OR cohort cohort cohort cohort cohort

57289

PEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHYPEREYRA PROCEDURE, INCLUDING ANTERIOR COLPORRHAPHY statewide

57295 REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINALGRAFT, VAGINAL APPROACH cohort cohort cohort cohort cohort

57300 CLOSURE OF RECTOVAGINAL FISTULA; VAGINAL OR TRANSANALAPPROACH cohort cohort cohort cohort cohort

57308

CLOSURE OF RECTOVAGINAL FISTULA; TRANSPERINEAL APPROACH,WITH PERINEAL BODY RECONSTRUCTION, WITH OR WITHOUT LEVATOR PLICATION statewide

57310 CLOSURE OF URETHROVAGINAL FISTULA; statewide

57320 CLOSURE OF VESICOVAGINAL FISTULA; VAGINAL APPROACH cohort cohort

57330 CLOSURE OF VESICOVAGINAL FISTULA; TRANSVESICAL ANDVAGINALAPPROACH statewide

57400 Dilation of vagina under anesthesia (other than local) cohort cohort

57410 Pelvic examination under anesthesia (other than local) cohort cohort cohort cohort

57415 Removal of impacted vaginal foreign body (separateprocedure) under anesthesia (other than local) cohort cohort cohort

57420 COLPOSCOPY ENTIRE VAGINA, W/CERVIX IF PRESENT cohort cohort cohort

57421 COLPOSCOPY ENTIRE VAGINA W/CERVIX IF PRESENT; W/BIOPSY (S) cohort cohort cohort cohort

57425 LAPAROSCOPY SURGICAL COLPOPEXY (SUSPENSION OF VAGINAL APEX) cohort cohort cohort cohort cohort

57426 REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINALGRAFT, LAPAROSCOPIC APPROACH statewide

57452 *COLPOSCOPY (VAGINOSCOPY); (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

57454 *COLPOSCOPY (VAGINOSCOPY); WITH BIOPSY(S) OF THE CERVIXAND/OR ENDOCERVICAL CURETTAGE cohort cohort cohort cohort cohort

57455 COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/BIOPSY (S), CERVIX cohort cohort cohort

57456 COLPOSCOPY, CERVIX W/UPPER ADJACENT VAGINA; W/ENDOCERVICAL CURETTAGE cohort cohort cohort cohort

57460 COLPOSCOPY (VAGINOSCOPY); WITH LOOP ELECTRODE EXCISIONPROCEDURE OF THE CERVIX cohort cohort cohort cohort cohort

57461 COLPOSCOPY CERVIX W/UPPER ADJACENT VAGINA; W/LOOP ELECTRODE CONIZATION CERVIX cohort cohort cohort cohort cohort

57500 Biopsy of cervix, single or multiple, or local excision of lesion, with or without fulguration (separate procedure) cohort cohort cohort cohort cohort

57505 ENDOCERVICAL CURETTAGE (NOT DONE AS PART OF A DILATION ANDCURETTAGE) cohort cohort cohort cohort cohort

57510 CAUTERIZATION OF CERVIX; ELECTRO OR THERMAL cohort cohort

57511 *CAUTERIZATION OF CERVIX; CRYOCAUTERY, INITIAL OR REPEAT statewide

57513 CAUTERIZATION OF CERVIX; LASER ABLATION cohort cohort cohort

57520

CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION,WITH ORWITHOUT DILATION AND CURETTAGE, WITH OR WI THOUT REPAIR; COLD KNIFE OR LASER cohort cohort cohort cohort

57522 CONIZATION OF CERVIX, WITH OR WITHOUT FULGURATION,WITH ORWITHOUT DILATION AND CURETTAGE, WITH OR WI THOUT cohort cohort cohort cohort

113

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

REPAIR; LOOP ELECTRODE EXCISION

57530 TRACHELECTOMY (CERVICECTOMY), AMPUTATION OF CERVIX(SEPARATEPROCEDURE) cohort cohort cohort cohort

57531

RADICAL TRACHELECTOMY, WITH BILATERAL TOTAL PELVICLYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE SAMPLING BIOPSY, WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL statewide

57550 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; statewide

57556 EXCISION OF CERVICAL STUMP, VAGINAL APPROACH; WITHREPAIR OFENTEROCELE statewide

57700 CERCLAGE OF UTERINE CERVIX, NONOBSTETRICAL cohort cohort

57720 TRACHELORRHAPHY, PLASTIC REPAIR OF UTERINE CERVIX,VAGINALAPPROACH cohort cohort cohort cohort

57800 *DILATION OF CERVICAL CANAL, INSTRUMENTAL (SEPARATEPROCEDURE) cohort cohort cohort cohort

58100

*ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

58110

ENDOMETRIAL SAMPLING (BIOPSY) PERFORMED IN CONJUNCTION WITH COLPOSCOPY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

58120 DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC(NONOBSTETRICAL) cohort cohort cohort cohort cohort

58140

MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS, SINGLE ORMULTIPLE (SEPARATE PROCEDURE); ABDOMINAL APPROACH cohort cohort cohort cohort cohort

58145

MYOMECTOMY, EXCISION OF FIBROID TUMOR OF UTERUS, SINGLE ORMULTIPLE (SEPARATE PROCEDURE); VAGINAL APPROACH cohort cohort cohort cohort

58146 MYOMECTOMY 5/>INTRAMURAL MYOMAS &/OR TOTAL WT>250 GMS,ABDOMINAL APPROACH cohort cohort cohort cohort

58150

TOTAL ABDOMINAL HYSTERECTOMY (CORPUS AND CERVIX), WITH ORWITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUTREMOVAL OF OVARY(S); cohort cohort cohort cohort

58180

SUPRACERVICAL ABDOMINAL HYSTERECTOMY (SUBTOTALHYSTERECTOMY), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR WITHOUT REMOVAL OF OVARY(S) cohort cohort cohort

58200

TOTAL ABDOMINAL HYSTERECTOMY, INCLUDING PARTIAL VAGINECTOMY,WITH PARA-AORTIC AND PELVIC LYMPH NODE SAMPLING, WITH OR WITHOUT REMOVAL OF TUBE(S), WITHOR WITHOUT REMOVAL OF statewide

58210

RADICAL ABDOMINAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY), WITH OR WITHOUT REMOVAL OF TUBE(S), WITH OR statewide

58260 VAGINAL HYSTERECTOMY; cohort cohort cohort cohort cohort

58262 VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S), AND/OROVARY(S) cohort cohort cohort cohort cohort

58263 VAGINAL HYSTERECTOMY; WITH REMOVAL OF TUBE(S), AND/OROVARY(S), WITH REPAIR OF ENTEROCELE cohort cohort cohort cohort

58267

VAGINAL HYSTERECTOMY; WITH COLPO-URETHROCYSTOPEXY(MARSHALL-MARCHETTI-KRANTZ TYPE, PEREYRA TYPE, WITHOR WITHOUT ENDOSCOPIC CONTROL) cohort cohort

58270 VAGINAL HYSTERECTOMY; WITH REPAIR OF ENTEROCELE cohort cohort cohort cohort

58275 VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL COLPECTOMY; statewide

58280 VAGINAL HYSTERECTOMY, WITH TOTAL OR PARTIAL COLPECTOMY; WITHREPAIR OF ENTEROCELE cohort cohort

58290 VAGINAL HYSTERECTOMY, UTERUS >250GMS; cohort cohort cohort cohort

58291 VAGINAL HYSTERECTOMY UTERUS >250 GMS; W/REMOVAL, TUBE(S) &/OR OVARY(S) cohort cohort cohort

58292 VAGINAL HYSTERECTOMY UTERUS >250GMS; W/REMOVAL, TUBE(S) &/OR OVARY(S) W/REPAIR OF ENTEROCELE statewide

114

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

58294 VAGINAL HYSTERECTOMY UTERUS >250 GMS; W/REPAIR OF ENTEROCELE cohort cohort cohort

58300 *INSERTION OF INTRAUTERINE DEVICE (IUD)*INSERTION OF INTRAUTERINE DEVICE (IUD) cohort cohort cohort cohort

58301 REMOVAL OF INTRAUTERINE DEVICE (IUD)REMOVAL OF INTRAUTERINE DEVICE (IUD) cohort cohort cohort cohort cohort

58340

*CATHETERIZATION AND INTRODUCTION OF SALINE OR CONTRASTMATERIAL FOR HYSTEROSONOGRAPHY OR HYSTEROSALPINGOGRAPHY cohort cohort cohort cohort cohort

58345

TRANSCERVICAL INTRODUCTION OF FALLOPIAN TUBE CATHETER FORDIAGNOSIS AND/OR RE-ESTABLISHING PATENCY (ANY METHOD), WITH OR WITHOUT HYSTEROSALPINGOGRAPHY cohort cohort

58350 *CHROMOTUBATION OF OVIDUCT, INCLUDING MATERIALS cohort cohort cohort cohort

58353 ENDOMETRIAL ABLATION, THERMAL, WITHOUT HYSTEROSCOPIC GUIDANCE. cohort cohort cohort cohort

58356 ENDOMETRIAL CRYOABLATION statewide

58400 UTERINE SUSPENSION, WITH OR WITHOUT SHORTENING OF ROUNDLIGAMENTS, WITH LIGAMENTS; (SEPARATE PROCEDURE) cohort cohort

58520 HYSTERORRHAPHY, REPAIR OF RUPTURED UTERUS (NONOBSTETRICAL) cohort cohort

58540 HYSTEROPLASTY, REPAIR OF UTERINE ANOMALY (STRASSMAN TYPE) statewide

58541 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY,FOR UTERUS 250 G OR LESS; cohort cohort cohort cohort cohort

58542

LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY,FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S) cohort cohort cohort cohort cohort

58543 LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY,FOR UTERUS GREATER THAN 250 G; cohort cohort cohort cohort cohort

58544

LAPAROSCOPY, SURGICAL, SUPRACERVICAL HYSTERECTOMY,FOR UTERUS GREATER THAN 250 G; WITH REMOVAL OF TU BE(S) AND/OR OVARY(S) cohort cohort cohort cohort cohort

58545 LAPAROSCOPY, SURG, MYOMECTOMY; 1-4 INTRAMURAL MYOMAS, TOTAL WT 250 GMS, &/OR REMOVE SURFACE MYOMAS cohort cohort cohort cohort cohort

58546 LAPARPSCOPY, SURG, MYOMECTOMY; 5/> INTRAMURAL MYOMAS &/OR TOTAL WT>250 GMS cohort cohort cohort cohort

58548

LAPAROSCOPY, SURGICAL, WITH RADICAL HYSTERECTOMY, WITH BILATERAL TOTAL PELVIC LYMPHADENECTOMY AND PARA-AORTIC LYMPH NODE SAMPLING (BIOPSY), WITH REMOVAL OF TUBE(S) AND OVARY(S), IF PERFORMED cohort cohort cohort

58550

LAPAROSCOPY, SURGICAL; WITH VAGINAL HYSTERECTOMY WITH OR WITHOUT REMOVAL OF TUBE(S),WITH OR WITHOUTREMOVAL OF OVARY(S) (LAPAROSCOPIC ASSISTED VAGINALHYSTERECTOMY) cohort cohort cohort cohort cohort

58552 LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS 250 GMS/<; W/REMOVAL TUBE(S) &/OR OVARY(S) cohort cohort cohort cohort cohort

58553 LAPAROSCOPY, SURG, W/VAGINAL HYSTERECTOMY, UTERUS >250 GMS cohort cohort cohort cohort

58554 LAPAROSCOPY SURG W/VAGINAL HYSTERECTOMY, UTERUS >250 GMS; W/REMOVE TUBE(S) &/OR OVARY(S) cohort cohort cohort cohort

58555 HYSTEROSCOPY, DIAGNOSTIC (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

58558

HYSTEROSCOPY, SURGICAL; WITH SAMPLING (BIOPSY) OF ENDOMETRIUM AND/OR POLYPECTOMY, WITH OR WITHOUT D & C cohort cohort cohort cohort cohort

58559 HYSTEROSCOPY, SURGICAL; WITH LYSIS OF INTRAUTERINEADHESIONS (ANY METHOD) cohort cohort cohort cohort

58560 HYSTEROSCOPY, SURGICAL; WITH DIVISION OR RESECTIONOF INTRAUTERINE SEPTUM (ANY METHOD) cohort cohort

58561 HYSTEROSCOPY, SURGICAL;WITH REMOVAL OF LEIOMYOMATA cohort cohort cohort cohort

58562 HYSTEROSCOPY, SURGICAL;WITH REMOVAL OF IMPACTED FOREIGN BODY cohort cohort cohort cohort

58563 HYSTEROSCOPY, SURGICAL; WITH ENDOMETRIAL ABLATION cohort cohort cohort cohort cohort

115

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

(ANY METHOD)

58565 HYSTEROSCOPY, STERILIZATION cohort cohort cohort cohort

58570 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; cohort cohort cohort cohort cohort

58571 Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s) cohort cohort cohort cohort cohort

58572 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; cohort cohort cohort cohort

58573 Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s) cohort cohort cohort cohort cohort

58578 UNLISTED LAPAROSCOPY PROCEDURE, UTERUS cohort cohort cohort cohort

58579 UNLISTED HYSTEROSCOPY PROCEDURE, UTERUS cohort cohort cohort cohort

58600

LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S), ABDOMINAL ORVAGINAL APPROACH, UNILATERAL OR BILATERAL cohort cohort cohort

58615

OCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BAND, CLIP,FALOPE RING) VAGINAL OR SUPRAPUBIC APPROACHOCCLUSION OF FALLOPIAN TUBE(S) BY DEVICE (EG, BA ND, CLIP, cohort cohort cohort cohort

58660 LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE) cohort cohort cohort cohort

58661

LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY) cohort cohort cohort cohort cohort

58662

LAPAROSCOPY, SURGICAL;WITH FULGURATION OR EXCISIONOF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD cohort cohort cohort cohort cohort

58670 LAPAROSCOPY, SURGICAL;WITH FULGURATION OF OVIDUCTS(WITH OR WITHOUT TRANSECTION) cohort cohort cohort cohort cohort

58671 LAPAROSCOPY, SURGICAL; WITH OCCLUSION OF OVIDUCTS BY DEVICE (EG. BAND, CLIP, OR FALOPE RING) cohort cohort cohort cohort cohort

58672 LAPAROSCOPY, SURGICAL; WITH FIMBRIOPLASTY statewide

58673 LAPAROSCOPY, SURGICAL; WITH SALPINGOSTOMY (SALPINGONEOSTOMY) cohort cohort

58679 UNLISTED LAPAROSCOPY PROCEDURE, OVIDUCT, OVARY (SALPINGONEOSTOMY) cohort cohort cohort cohort

58700 SALPINGECTOMY, COMPLETE OR PARTIAL, UNILATERAL OR BILATERAL (SEPARATE PROCEDURE) cohort cohort cohort cohort

58720 SALPINGO-OOPHORECTOMY, COMPLETE OR PARTIAL, UNILATERAL ORBILATERAL (SEPARATE PROCEDURE) cohort cohort cohort cohort

58740 LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) cohort cohort

58750 TUBOTUBAL ANASTOMOSIS statewide

58770 SALPINGOSTOMY (SALPINGONEOSTOMY) statewide

58800 DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL,(SEPARATE PROCEDURE); VAGINAL APPROACH cohort cohort cohort

58805 DRAINAGE OF OVARIAN CYST(S), UNILATERAL OR BILATERAL,(SEPARATE PROCEDURE); ABDOMINAL APPROACH statewide

58823

DRAINAGE OF PELVIC ABSCESS, TRANSVAGINAL OR TRANSRECTALAPPROACH, PERCUTANEOUS (EG, OVARIAN, PERICOLIC) statewide

58900 BIOPSY OF OVARY, UNILATERAL OR BILATERAL (SEPARATEPROCEDURE) statewide

58925 OVARIAN CYSTECTOMY, UNILATERAL OR BILATERAL cohort cohort cohort cohort

58940 OOPHORECTOMY, PARTIAL OR TOTAL, UNILATERAL OR BILATERAL; cohort cohort

58950 Resection (initial) of ovarian, tubal or primary preitoneal malignancy with bilateral salpingo-oophorectomy and omentectomy statewide

58970 FOLLICLE PUNCTURE FOR OOCYTE RETRIEVAL, ANY METHOD statewide

58999 Unlisted procedure, female genital system (nonobstetrical) cohort cohort cohort cohort

59000 *AMNIOCENTESIS, ANY METHOD cohort cohort cohort cohort

59001 AMNIOCENTESIS; THERAPEUTIC AMNIOTIC FLUID statewide

116

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

REDUCTIOW/US

59015 CHORIONIC VILLUS SAMPLING, ANY METHOD cohort cohort

59020 *FETAL CONTRACTION STRESS TEST cohort cohort cohort

59025 FETAL NON-STRESS TESTFETAL NON-STRESS TEST cohort cohort cohort cohort cohort

59050

FETAL MONITORING DURING LABOR BY CONSULTING PHYSICIAN (IE,NON-ATTENDING PHYSICIAN) WITH WRITTEN REPORT; SUPERVISION AND INTERPRETATION statewide

59074

FETAL FLUID DRAINAGE (EG VESICOCENTESIS THORACOCENTESIS PARACENTESIS) INCLUDING ULTRA- SOUND GUIDANCE statewide

59076 FETAL SHUNT PLACEMENT INCLUDING ULTRASOUND GUIDANCE statewide

59120

SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN,REQUIRING SALPINGECTOMY AND/OR OOPHORECTOMY, ABDOMINAL OR VAGINAL APPROACH cohort cohort cohort

59121 SURGICAL TREATMENT OF ECTOPIC PREGNANCY; TUBAL OR OVARIAN,WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY statewide

59150 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHOUTSALPINGECTOMY AND/OR OOPHORECTOMY cohort cohort cohort cohort

59151 LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITHSALPINGECTOMY AND/OR OOPHORECTOMY cohort cohort cohort cohort

59160 CURETTAGE, POSTPARTUM cohort cohort cohort cohort

59200 INSERTION OF CERVICAL DILATOR (EG, LAMINARIA, PROSTAGLANDIN)(SEPARATE PROCEDURE) cohort cohort

59300 EPISIOTOMY OR VAGINAL REPAIR, BY OTHER THAN ATTENDING cohort cohort cohort

59320 CERCLAGE OF CERVIX, DURING PREGNANCY; VAGINAL cohort cohort cohort cohort

59325 CERCLAGE OF CERVIX, DURING PREGNANCY; ABDOMINAL statewide

59409 VAGINAL DELIVERY ONLY (WITH OR WITHOUT EPISIOTOMY AND/ORFORCEPS); statewide

59412 EXTERNAL CEPHALIC VERSION, WITH OR WITHOUT TOCOLYSIS (LISTIN ADDITION TO CODE(S) FOR DELIVERY) cohort cohort cohort cohort

59414 DELIVERY OF PLACENTA (SEPARATE PROCEDURE) statewide

59514 CESAREAN DELIVERY ONLY; statewide

59812 TREATMENT OF INCOMPLETE ABORTION, ANY TRIMESTER, COMPLETEDSURGICALLY cohort cohort cohort cohort cohort

59820

TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRSTTRIMESTER TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; FIRST cohort cohort cohort cohort

59821

TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECONDTRIMESTER TREATMENT OF MISSED ABORTION, COMPLETED SURGICALLY; SECOND cohort cohort cohort cohort

59840 INDUCED ABORTION, BY DILATION AND CURETTAGE cohort cohort

59841 INDUCED ABORTION, BY DILATION AND EVACUATION cohort cohort

59856

INDUCED ABORTION, BY 1 OR MORE VAGINAL SUPPOSITORIES (EG, PROSTAGLANDIN) WITH OR WITHOUT CERVICAL DILATION (EG, LAMINARIA), INCLUDING HOSPITAL ADMISSION AND VISITS, DELIVERY OF FETUS AND SECUNDINES; W cohort cohort

59866 MULTIFETAL PREGNANCY REDUCTION(S) (MPR) statewide

59870 UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE cohort cohort cohort cohort

59871 REMOVAL OF CERCLAGE SUTURE UNDER ANESTHESIA (OTHERTHANLOCAL) statewide

59899 UNLISTED PROCEDURE, MATERNITY CARE AND DELIVERY cohort cohort cohort

60000 *INCISION AND DRAINAGE OF THYROGLOSSAL CYST, INFECTED statewide

60100 *BIOPSY THYROID, PERCUTANEOUS CORE NEEDLE cohort cohort cohort cohort cohort

60200 EXCISION OF CYST OR ADENOMA OF THYROID, OR TRANSECTION OFISTHMUS cohort cohort cohort cohort

60210 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUTISTHMUSECTOMY cohort cohort cohort cohort cohort cohort

60212 PARTIAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERALSUBTOTAL LOBECTOMY, INCLUDING cohort cohort cohort

117

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ISTHMUSECTOMY

60220 TOTAL THYROID LOBECTOMY, UNILATERAL; WITH OR WITHOUTISTHMUSECTOMY cohort cohort cohort cohort cohort cohort

60225

TOTAL THYROID LOBECTOMY, UNILATERAL; WITH CONTRALATERALSUBTOTAL LOBECTOMY, INCLUDING ISTHMUSECTOMY cohort cohort cohort cohort cohort cohort

60240 THYROIDECTOMY, TOTAL OR COMPLETE cohort cohort cohort cohort cohort

60252 THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITHLIMITED NECK DISSECTION cohort cohort cohort cohort

60254 THYROIDECTOMY, TOTAL OR SUBTOTAL FOR MALIGNANCY; WITHRADICAL NECK DISSECTION cohort cohort

60260

THYROIDECTOMY, REMOVAL OF ALL REMAINING THYROID TISSUEFOLLOWING PREVIOUS REMOVAL OF A PORTION OF THYROID cohort cohort cohort cohort

60271 THYROIDECTOMY, INCLUDING SUBSTERNAL THYROID GLAND;CERVICAL APPROACH cohort cohort cohort

60280 EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; cohort cohort cohort cohort

60281 EXCISION OF THYROGLOSSAL DUCT CYST OR SINUS; RECURRENT statewide

60300 Aspiration and/or injection, thyroid cyst cohort cohort cohort

60500 PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); cohort cohort cohort cohort

60502 PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S);RE-EXPLORATION cohort cohort

60505

PARATHYROIDECTOMY OR EXPLORATION OF PARATHYROID(S); WITHMEDIASTINAL EXPLORATION, STERNAL SPLIT OR TRANSTHORACIC APPROACH cohort cohort

60512 PARATHYROID AUTOTRANSPLANTATION (LIST SEPARATELY IN ADDITIONTO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

60520 THYMECTOMY, PARTIAL OR TOTAL; TRANSCERVICAL APPROACH(SEPARATE PROCEDURE) cohort cohort cohort

60521

THYMECTOMY, PARTIAL OR TOTAL; STERNAL SPLIT OR TRANSTHORACICAPPROACH, WITHOUT RADICAL MEDIASTINAL DISSECTION (SEPARATE PROCEDURE) cohort cohort

60600 EXCISION OF CAROTID BODY TUMOR; WITHOUT EXCISION OF CAROTID ARTERY statewide

60650

LAPAROSCOPY, SURGICAL, WITH ADRENALECTOMY, PARTIALOR COMPLETE, OR EXPLORATION OF ADRENAL GLAND WITH OR WITHOUT BIOPSY, TRANSABDOMINAL, LUMBAR OR DORSAL cohort cohort cohort cohort

61055

*CISTERNAL OR LATERAL CERVICAL (C1-C2) PUNCTURE; WITHINJECTION OF DRUG OR OTHER SUBSTANCE FOR DIAGNOSIS OR TREATMENT (EG, C1-C2) cohort cohort

61070

*PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION ORINJECTION PROCEDURE *PUNCTURE OF SHUNT TUBING OR RESERVOIR FOR ASPIRATION OR cohort cohort

61210

Burr hole(s); for implanting ventricular catheter,reservoir, EEG electrode(s), pressure recording d evice, or other cerebral monitoring device (separate procedure) statewide

61304

CRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIALCRANIECTOMY OR CRANIOTOMY, EXPLORATORY; SUPRATENTORIAL statewide

61343

CRANIECTOMY, SUBOCCIPITAL WITH CERVICAL LAMINECTOMY FORDECOMPRESSION OF MEDULLA AND SPINAL CORD, WITH OR WITHOUT DURAL GRAFT (EG, ARNOLD-CHIARI MALFORMATION) statewide

61500

CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF SKULL CRANIECTOMY; WITH EXCISION OF TUMOR OR OTHER BONE LESION OF cohort cohort cohort

61544

CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION ORCOAGULATION OF CHOROID PLEXUS CRANIOTOMY WITH ELEVATION OF BONE FLAP; FOR EXCISION OR statewide

61550 CRANIECTOMY FOR CRANIOSYNOSTOSIS; SINGLE CRANIAL SUTURE statewide

61563 EXCISION, INTRA AND EXTRACRANIAL, BENIGN TUMOR OF cohort cohort

118

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

CRANIALBONE (EG, FIBROUS DYSPLASIA); WITHOUT OPTICNERVE DECOMPRESSION

61591

INFRATEMPORAL POST-AURICULAR APPROACH TO MIDDLE CRANIALFOSSA (INTERNAL AUDITORY MEATUS, PETROUS APEX, TENTORIUM, CAVERNOUS SINUS, PARASELLAR AREA, INFRATEMPORAL FOSSA) statewide

61605

RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF INFRATEMPORAL FOSSA, PARAPHARYNGEAL SPACE, PETROUS APEX; EXTRADURAL statewide

61607

RESECTION OR EXCISION OF NEOPLASTIC, VASCULAR OR INFECTIOUS LESION OF PARASELLAR AREA, CAVERNOUS SINUS, CLIVUS OR MIDLINE SKULL BASE; EXTRADURAL statewide

61613

OBLITERATION OF CAROTID ANEURYSM, ARTERIOVENOUSMALFORMATION, OR CAROTID-CAVERNOUS FISTULA BY DISSECTION WITHIN CAVERNOUS SINUS statewide

61623 ENDOVASC TEMP OCCLUSION HEAD/NCK W/VESSEL CATH BALLOON POSITIONING/INFLATION NEUR MONIT, S&I statewide

61624

TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMORDESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDEA VASCULAR MALFORMATION), PERCUTANEOUS, ANY METH OD; CENTRAL NERVOUS cohort cohort

61626

TRANSCATHETER OCCLUSION OR EMBOLIZATION (EG, FOR TUMORDESTRUCTION, TO ACHIEVE HEMOSTASIS, TO OCCLUDEA VASCULAR MALFORMATION), PERCUTANEOUS, ANY METH OD; NON-CENTRAL NERVOUS cohort cohort

61750 STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURRHOLE(S), FOR INTRACRANIAL LESION; cohort cohort

61751

STEREOTACTIC BIOPSY, ASPIRATION, OR EXCISION, INCLUDING BURRHOLE(S), FOR INTRACRANIAL LESION; WITH COMPUTERIZED AXIAL TOMOGRAPHY statewide

61781 Stereotactic computer-assisted (navigational) procedure; cranial, intradural (List separately in addition to code for primary procedure) cohort cohort

61782 Stereotactic computer-assisted (navigational) procedure; cranial, extradural (List separately in addition to code for primary procedure) cohort cohort cohort cohort

61867

TWIST DRILL, BURR HOLE, CRANIOTOMY, OR CRANIECTOMYWITH STEREOTACTIC IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY IN SUBCORTICAL SITE (EG, THALAMUS , GLOBUS PALLIDUS, SUBTHALAMIC NUCLEUS, PERIVENTRI statewide

61885

INCISION AND SUBCUTANEOUS PLACEMENT OF CRANIALNEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT ORINDUCTIVE COUPLING cohort cohort

61886

INSERTION OR REPLACEMENT OF CRANIAL NEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVECOUPLING; WITH CONNECTION TO 2 OR MORE ELECTRODE ARRAYS cohort cohort

61888 REVISION OR REMOVAL OF CRANIAL NEUROSTIMULATOR PULSEGENERATOR OR RECEIVER cohort cohort

62000

ELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE, EXTRADURALELEVATION OF DEPRESSED SKULL FRACTURE; SIMPLE, EXTRADURAL statewide

62140 CRANIOPLASTY FOR SKULL DEFECT; UP TO 5 CM DIAMETER statewide

62142 REMOVAL OF BONE FLAP OR PROSTHETIC PLATE OF SKULL statewide

62145 CRANIOPLASTY FOR SKULL DEFECT WITH REPARATIVE BRAIN SURGERY statewide

62146 CRANIOPLASTY WITH AUTOGRAFT (INCLUDES OBTAINING BONEGRAFTS); UP TO 5 CM DIAMETER statewide

62148 INCISION & RETRIEVAL SUBQ CRANIAL BONE GRAFT FOR CRANIOPLASTY statewide

62160 NEUROENDOSCOPY, INTRACRANIAL PLACE/REPLACE VENTRICULAR CATH, SHUNT SYS/ENT DRAINAGE statewide

62201

VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTICMETHOD VENTRICULOCISTERNOSTOMY, THIRD VENTRICLE; STEREOTACTIC statewide

119

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

62220

CREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AURICULARCREATION OF SHUNT; VENTRICULO-ATRIAL, -JUGULAR, -AURICULAR statewide

62223

CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL, OTHERTERMINUS CREATION OF SHUNT; VENTRICULO-PERITONEAL, -PLEURAL, OTHER statewide

62225

REPLACEMENT OR IRRIGATION, VENTRICULAR CATHETERREPLACEMENT OR IRRIGATION, VENTRICULAR CATHETER statewide

62230

REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, ORDISTAL CATHETER IN SHUNT SYSTEM REPLACEMENT OR REVISION OF CSF SHUNT, OBSTRUCTED VALVE, OR statewide

62252 REPROGRAMMING OF PROGRAMMABLE CSF SHUNT. statewide

62256

REMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITHOUT REPLACEMENTREMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITHOUT REPLACEMENT statewide

62258

REMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITH REPLACEMENT BYSIMILAR OR OTHER SHUNT AT SAME OPERATION REMOVAL OF COMPLETE CSF SHUNT SYSTEM; WITH REPLACEMENT BY statewide

62264 LYSIS PERQ EPIDURAL ADHESIONS SOLUTION INJECTION/ MECHANICAL W/RADIOLOGIC LOCALIZATION; 1 DAY statewide

62267 Percutaneous aspiration within the nucleus pulposus, intervertebral disc, or paravertebral tissue for diagnostic purposes statewide

62268 *PERCUTANEOUS ASPIRATION, SPINAL CORD CYST OR SYRINX cohort cohort

62269 *BIOPSY OF SPINAL CORD, PERCUTANEOUS NEEDLE cohort cohort

62270 *SPINAL PUNCTURE, LUMBAR, DIAGNOSTIC cohort cohort cohort cohort cohort

62272 *SPINAL PUNCTURE, THERAPEUTIC, FOR DRAINAGE OF SPINAL FLUID (BY NEEDLE OR CATHETER) cohort cohort cohort cohort

62273

*INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH*INJECTION, LUMBAR EPIDURAL, OF BLOOD OR CLOT PATCH cohort cohort cohort cohort cohort cohort

62281

*INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL,ICED SALINE SOLUTIONS); EPIDURAL, CERVICAL OR THORACIC *INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, statewide

62282

*INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL,ICED SALINE SOLUTIONS); EPIDURAL, LUMBAR OR CAUDAL *INJECTION OF NEUROLYTIC SUBSTANCE (EG, ALCOHOL, PHENOL, statewide

62284 Injection procedure for myelography and/or computed tomography, spinal (other than C1-C2 and posterior fossa) cohort cohort cohort cohort cohort

62287

DECOMPRESSION PROCEDURE, PERCUTANEOUS, OF NUCLEUS PULPOSUS OF INTERVERTEBRAL DISC, ANY METHOD UTILIZING NEEDLE BASED TECHNIQUE TO REMOVE DISC MATERIALUNDER FLUOROSCOPIC IMAGING OR OTHER FORM OF INDIR statewide

62290 *INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; LUMBAR cohort cohort cohort cohort cohort

62291 *INJECTION PROCEDURE FOR DISKOGRAPHY, EACH LEVEL; CERVICAL cohort cohort

62310

INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEM cohort cohort cohort cohort cohort cohort

62311

INJECTION(S), OF DIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER SOLUTION), NOT INCLUDING NEUROLYTIC SUBSTANCES, INCLUDING NEEDLE OR CATHETER PLACEM cohort cohort cohort cohort cohort cohort

62318

INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OFDIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER cohort cohort

62319

INJECTION(S), INCLUDING INDWELLING CATHETER PLACEMENT, CONTINUOUS INFUSION OR INTERMITTENT BOLUS, OFDIAGNOSTIC OR THERAPEUTIC SUBSTANCE(S) (INCLUDING cohort cohort cohort

120

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ANESTHETIC, ANTISPASMODIC, OPIOID, STEROID, OTHER

62350

IMPLANTATION, REVISION OR REPOSITIONING OF INTRATHECAL OREPIDURAL CATHETER, FOR IMPLANTABLE RESERVOIR OR IMPLANTABLE INFUSION PUMP; WITHOUT LAMINECTOMY cohort cohort cohort cohort

62362

IMPLANTATION OR REPLACEMENT OF DEVICE FOR INTRATHECAL OREPIDURAL DRUG INFUSION; PROGRAMMABLE PUMP, INCLUDING PREPARATION OF PUMP, WITH OR WITHOUT PROGRAMMING cohort cohort cohort cohort

62367

ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITHOUT REPROGRAMMING O statewide

62368

ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FORINTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION cohort cohort cohort cohort

62369

ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITH REPROGRAMMING AND cohort cohort cohort cohort cohort

62370

ELECTRONIC ANALYSIS OF PROGRAMMABLE, IMPLANTED PUMP FOR INTRATHECAL OR EPIDURAL DRUG INFUSION (INCLUDES EVALUATION OF RESERVOIR STATUS, ALARM STATUS, DRUG PRESCRIPTION STATUS); WITH REPROGRAMMING AND cohort cohort

63001

LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT FACETECTOMY, FORAMINOTOMY OR DISKECTOMY, (EG, SPINAL STENOSIS), ONE OR TWO VERTEBRAL statewide

63005

LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT FACETECTOMY, FORAMINOTOMY OR DISKECTOMY, (EG, SPINAL STENOSIS), ONE OR TWO VERTEBRAL cohort cohort cohort

63012

LAMINECTOMY WITH REMOVAL OF ABNORMAL FACETS AND/ORPARSINTER-ARTICULARIS WITH DECOMPRESSION OF CAUDA EQUINA AND NERVE ROOTS FOR SPONDYLOLISTHESIS, LU MBAR (GILL TYPE statewide

63015

LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT FACETECTOMY, FORAMINOTOMY OR DISKECTOMY, (EG, SPINAL STENOSIS), MORE THAN 2 VERTEBRAL statewide

63017

LAMINECTOMY WITH EXPLORATION AND/OR DECOMPRESSION OF SPINAL CORD AND/OR CAUDA EQUINA, WITHOUT FACETECTOMY, FORAMINOTOMY OR DISKECTOMY, (EG, SPINAL STENOSIS), MORE THAN 2 VERTEBRAL cohort cohort

63020

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, CERVICAL cohort cohort cohort

63030

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; 1 INTERSPACE, LUMBAR cohort cohort cohort cohort cohort cohort

63035

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE, CERVICAL OR cohort cohort cohort cohort cohort

63040

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVEROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK, RE-EXPLORATION; statewide

63042

LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVEROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK, RE-EXPLORATION; cohort cohort cohort cohort

63044 LAMINOTOMY (HEMILAMINECTOMY),WITH DECOMPRESSION OFNERVEROOT(S),INCLUDING PARTIAL statewide

121

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

FACETECTOMY,FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISK,RE-EXPLORATION;EACH ADDT'L LUMBAR INTERSPACE

63045

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL ORBILATERAL WITH DECOMPRESSION OF SPINAL CORD,CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL O R LATERAL RECESS cohort cohort cohort

63046

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL ORBILATERAL WITH DECOMPRESSION OF SPINAL CORD,CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL O R LATERAL RECESS cohort cohort

63047

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL ORBILATERAL WITH DECOMPRESSION OF SPINAL CORD,CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL O R LATERAL RECESS cohort cohort cohort cohort cohort cohort

63048

LAMINECTOMY, FACETECTOMY AND FORAMINOTOMY (UNILATERAL ORBILATERAL WITH DECOMPRESSION OF SPINAL CORD,CAUDA EQUINA AND/OR NERVE ROOT(S), (EG, SPINAL O R LATERAL RECESS cohort cohort cohort cohort cohort cohort

63051

LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, 2 OR MORE VERTEBRAL SEGMENTS; WITH RECONSTRUCTION OF THE POSTERIOR BONY ELEMENTS (INCLUDING THE APPLICATION OF BRIDGING BONE GRAFT AND NO statewide

63055

TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD,EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT; THORACIC statewide

63056

TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD,EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT; LUMBAR cohort cohort cohort cohort

63057

TRANSPEDICULAR APPROACH WITH DECOMPRESSION OF SPINAL CORD,EQUINA AND/OR NERVE ROOT(S) (EG, HERNIATEDINTERVERTEBRAL DISK), SINGLE SEGMENT; EACH ADDIT IONAL SEGMENT, THORACIC OR cohort cohort cohort

63075

DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINALCORD AND/OR NERVE ROOT(S), INCLUDING OSTEOPHYTECT OMY; CERVICAL, SINGLE INTERSPACE cohort cohort cohort

63076

DISKECTOMY, ANTERIOR, WITH DECOMPRESSION OF SPINALCORD AND/OR NERVE ROOT(S), INCLUDING OSTEOPHYTECT OMY; CERVICAL, EACH ADDITIONAL INTERSPACE (LIST SEPARATELY IN ADDITION TO CODE cohort cohort

63081

VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, SINGLE SEGMENT cohort cohort cohort cohort

63082

VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, ANTERIOR APPROACH WITH DECOMPRESSION OF SPINAL CORD AND/OR NERVE ROOT(S); CERVICAL, EACH ADDITIONAL SEGMENT cohort cohort cohort cohort

63200 LAMINECTOMY, WITH RELEASE OF TETHERED SPINAL CORD,LUMBAR statewide


63252

LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUSMALFORMATION OF SPINAL CORD; THORACOLUMBAR LAMINECTOMY FOR EXCISION OR OCCLUSION OF ARTERIOVENOUS statewide

63267 LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESIONOTHER THAN NEOPLASM, EXTRADURAL; LUMBAR cohort cohort cohort cohort

63273 LAMINECTOMY FOR EXCISION OF INTRASPINAL LESION OTHER THANNEOPLASM, INTRADURAL; SACRAL statewide

63276 LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM;EXTRADURAL, THORACIC statewide

63277 LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL NEOPLASM;EXTRADURAL, LUMBAR statewide

63281 LAMINECTOMY FOR BIOPSY/EXCISION OF INTRASPINAL statewide

122

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

NEOPLASM;INTRADURAL, EXTRAMEDULLARY, THORACIC

63302

VERTEBRAL CORPECTOMY (VERTEBRAL BODY RESECTION), PARTIAL OR COMPLETE, FOR EXCISION OF INTRASPINAL LESION, SINGLE SEGMENT; EXTRADURAL, THORACIC BY THORACOLUMBAR APPROACH statewide

63650

PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODEARRAY, EPIDURAL PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE cohort cohort cohort cohort cohort

63655

LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, PLATE/PADDLE, EPIDURAL LAMINECTOMY FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODES, cohort cohort cohort cohort

63661

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED cohort cohort

63662

REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED cohort cohort cohort cohort

63663

REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OFSPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARR AY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED cohort cohort cohort cohort

63685

INCISION AND SUBCUTANEOUS PLACEMENT OF SPINALNEUROSTIMULATOR PULSE GENERATOR OR RECEIVER, DIRECT OR INDUCTIVE COUPLING cohort cohort cohort cohort cohort

63688 REVISION OR REMOVAL OF IMPLANTED SPINAL NEUROSTIMULATORPULSE GENERATOR cohort cohort cohort cohort cohort cohort

63707 REPAIR OF DURAL/CSF LEAK, NOT REQUIRING LAMINECTOMY statewide

63709 REPAIR OF DURAL/CSF LEAK OR PSEUDOMENINGOCELE, WITHLAMINECTOMY statewide

63710 DURAL GRAFT, SPINAL statewide

63740 CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL,-PLEURAL, OR OTHER; INCLUDING LAMINECTOMY statewide

63741

CREATION OF SHUNT, LUMBAR, SUBARACHNOID-PERITONEAL,-PLEURAL, OR OTHER; PERCUTANEOUS, NOT REQUIRING LAMINECTOMY statewide

63744 REPLACEMENT, IRRIGATION OR REVISION OF LUMBOSUBARACHNOIDSHUNT statewide

64400 *INJECTION, ANESTHETIC AGENT; TRIGEMINAL NERVE, ANY DIVISIONOR BRANCH cohort cohort cohort cohort cohort

64402 *INJECTION, ANESTHETIC AGENT; FACIAL NERVE cohort cohort cohort cohort cohort

64405 *INJECTION, ANESTHETIC AGENT; GREATER OCCIPITAL NERVE cohort cohort cohort cohort cohort

64410 *INJECTION, ANESTHETIC AGENT; PHRENIC NERVE statewide

64412 *INJECTION, ANESTHETIC AGENT; SPINAL ACCESSORY NERVE statewide

64413 *INJECTION, ANESTHETIC AGENT; CERVICAL PLEXUS cohort cohort cohort cohort

64415 *INJECTION, ANESTHETIC AGENT; BRACHIAL PLEXUS cohort cohort cohort cohort cohort

64416 Injection, anesthetic agent; brachialplexus, continuous infusion by catheter (including catheter placement) cohort cohort cohort cohort cohort

64417 *INJECTION, ANESTHETIC AGENT; AXILLARY NERVE cohort cohort cohort cohort cohort

64418 *INJECTION, ANESTHETIC AGENT; SUPRASCAPULAR NERVE cohort cohort cohort cohort

64420 *INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVE, SINGLE cohort cohort cohort cohort

64421

*INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, REGIONAL BLOCK *INJECTION, ANESTHETIC AGENT; INTERCOSTAL NERVES, MULTIPLE, cohort cohort cohort cohort

64425 *INJECTION, ANESTHETIC AGENT; ILIOINGUINAL, ILIOHYPOGASTRIC NERVES cohort cohort cohort cohort cohort

64430 *INJECTION, ANESTHETIC AGENT; PUDENDAL NERVE cohort cohort

64435 *INJECTION, ANESTHETIC AGENT; PARACERVICAL (UTERINE) NERVE cohort cohort

64445 *INJECTION, ANESTHETIC AGENT; SCIATIC NERVE cohort cohort cohort cohort cohort

64446 Injection, anesthetic agent; sciatic nerve, continuous infusion by catheter (including catheter placement) cohort cohort

123

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

64447 INJECTION ANESTHETIC AGENT; FEMORAL NERVE SINGLE cohort cohort cohort cohort cohort

64448 Injection, anesthetic agent; femoral nerve, continuous infusion by catheter (including catheter placement) cohort cohort cohort cohort

64449 Injection, anesthetic agent; lumbar plexus, posterior approach, continuous infusion by catheter (including catheter placement) cohort cohort

64450 *INJECTION, ANESTHETIC AGENT; OTHER PERIPHERAL NERVE ORBRANCH cohort cohort cohort cohort cohort

64455 Injection(s), anesthetic agent and/or steriod, plantar common digital nerve(s) (e.g., Morton's neuroma) cohort cohort

64479

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level cohort cohort cohort cohort cohort cohort

64480

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for cohort cohort cohort cohort cohort

64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level cohort cohort cohort cohort cohort cohort

64484

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level (List separately in addition to code for prim cohort cohort cohort cohort cohort cohort

64490

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL cohort cohort cohort cohort cohort cohort

64491

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL cohort cohort cohort cohort cohort cohort

64492

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY cohort cohort cohort cohort cohort cohort

64493

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL cohort cohort cohort cohort cohort cohort

64494

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIS cohort cohort cohort cohort cohort cohort

64495

INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADD cohort cohort cohort cohort cohort cohort

64505 *INJECTION, ANESTHETIC AGENT; SPHENOPALATINE GANGLION cohort cohort

64510 *INJECTION, ANESTHETIC AGENT; STELLATE GANGLION (CERVICALSYMPATHETIC) cohort cohort cohort cohort cohort cohort

64517 INJECTION, ANESTHETIC AGENT; SUPERIOR HYPOGASTRIC PLEXUS cohort cohort cohort

64520 *INJECTION, ANESTHETIC AGENT; LUMBAR OR THORACIC(PARAVERTEBRAL SYMPATHETIC) cohort cohort cohort cohort cohort cohort

64530 *INJECTION, ANESTHETIC AGENT; CELIAC PLEXUS, WITH OR WITHOUTRADIOLOGIC MONITORING cohort cohort cohort cohort

64555

PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; PERIPHERAL NERVE (EXCLUDES SACRAL NERVE) cohort cohort

64561

PERCUTANEOUS IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) INCLUDING IMAGE GUIDANCE, IF PERFORMED cohort cohort cohort cohort

64568 Incision for implantation of cranial nerve (eg, vagus nerve) cohort cohort cohort

124

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

neurostimulator electrode array and pulse generator

64570 Removal of cranial nerve (eg, vagus nerve) neurostimulator electrode array and pulse generator statewide

64581

INCISION FOR IMPLANTATION OF NEUROSTIMULATOR ELECTRODE ARRAY; SACRAL NERVE (TRANSFORAMINAL PLACEMENT) cohort cohort cohort cohort cohort

64585 REVISION OR REMOVAL OF PERIPHERAL NEUROSTIMULATOR ELECTRODE ARRAY cohort cohort cohort cohort cohort

64590 Insertion or replacement of peripheral or gastric neurostimulator pulse generator or receiver, direct or inductive coupling cohort cohort cohort cohort cohort

64595 Revision or removal of peripheral or gastric neurostimulator pulse generator or receiver cohort cohort cohort cohort cohort

64600

DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE;SUPRAORBITAL, INFRAORBITAL, MENTAL, OR INFERIOR ALVEOLAR BRANCH cohort cohort

64605

DESTRUCTION BY NEUROLYTIC AGENT, TRIGEMINAL NERVE;SECONDAND THIRD DIVISION BRANCHES AT FORAMEN OVAL E statewide

64611 Chemodenervation of parotid and submandibular salivary glands, bilateral statewide

64612

CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL NERVE, UNILATERAL (EG, FOR BLEPHAROSPASM, HEMIFACIAL SPASM) cohort cohort cohort

64613

DESTRUCTION BY NEUROLYTIC AGENT (CHEMODENERVATION OF MUSCLE ENDPLATE); CERVICAL SPINAL MUSCLES (EG, FOR SPASMODIC TORTICOLLIS) cohort cohort cohort cohort

64614

CHEMODENERVATION OF MUSCLE(S); EXTREMITY AND/OR TRUNK MUSCLE(S) (EG, FOR DYSTONIA, CEREBRAL PALSY, MULTIPLE SCLEROSIS) cohort cohort cohort

64615

CHEMODENERVATION OF MUSCLE(S); MUSCLE(S) INNERVATED BY FACIAL, TRIGEMINAL, CERVICAL SPINAL AND ACCESSORY NERVES, BILATERAL (EG, FOR CHRONIC MIGRAINE) cohort cohort

64620 DESTRUCTION BY NEUROLYTIC AGENT; INTERCOSTAL NERVE cohort cohort cohort

64630 DESTRUCTION BY NEUROLYTIC AGENT; PUDENDAL NERVE statewide

64633

DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, SINGLE FACET JOINT cohort cohort cohort cohort cohort

64634

DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); CERVICAL OR THORACIC, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE F cohort cohort cohort cohort cohort

64635

DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, SINGLE FACET JOINT cohort cohort cohort cohort cohort cohort

64636

DESTRUCTION BY NEUROLYTIC AGENT, PARAVERTEBRAL FACET JOINT NERVE(S), WITH IMAGING GUIDANCE (FLUOROSCOPY OR CT); LUMBAR OR SACRAL, EACH ADDITIONAL FACET JOINT (LIST SEPARATELY IN ADDITION TO CODE FOR P cohort cohort cohort cohort cohort cohort

64640 DESTRUCTION BY NEUROLYTIC AGENT; OTHER PERIPHERAL NERVE ORBRANCH cohort cohort cohort cohort cohort

64680 DESTRUCTION BY NEUROLYTIC AGENT, CELIAC PLEXUS, WITH ORWITHOUT RADIOLOGIC MONITORING cohort cohort cohort cohort cohort

64681 DESTRUCTION BY NEUROLYTIC AGENT, WITH OR WITHOUT RADIOLOGIC MONITORING; SUPERIOR HYPOGASTRIC PLEXUS statewide

64702 NEUROPLASTY; DIGITAL, ONE OR BOTH, SAME DIGIT cohort cohort cohort cohort

64704 NEUROPLASTY; NERVE OF HAND OR FOOT cohort cohort cohort cohort

64708 Neuroplasty, major peripheral nerve, arm or leg, open; other than specified cohort cohort cohort cohort cohort cohort

64713 Neuroplasty, major peripheral nerve, arm or leg, open; brachial plexus cohort cohort

125

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

64716 NEUROPLASTY AND/OR TRANSPOSITION; CRANIAL NERVE (SPECIFY) statewide

64718

NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOWNEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT ELBOW cohort cohort cohort cohort cohort cohort

64719

NEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRISTNEUROPLASTY AND/OR TRANSPOSITION; ULNAR NERVE AT WRIST cohort cohort cohort cohort cohort cohort

64721 NEUROPLASTY AND/OR TRANSPOSITION; MEDIAN NERVE AT CARPALTUNNEL cohort cohort cohort cohort cohort cohort

64722 DECOMPRESSION; UNSPECIFIED NERVE(S) (SPECIFY) cohort cohort cohort

64727

INTERNAL NEUROLYSIS, REQUIRING USE OF OPERATING MICROSCOPE(LIST SEPARATELY IN ADDITION TO CODE FOR NEUROPLASTY) (NEUROPLASTY INCLUDES EXTERNAL NEUROLYSIS) cohort cohort cohort cohort cohort

64732 TRANSECTION OR AVULSION OF; SUPRAORBITAL NERVE statewide

64771 TRANSECTION OR AVULSION OF OTHER CRANIAL NERVE, EXTRADURAL cohort cohort

64772 TRANSECTION OR AVULSION OF OTHER SPINAL NERVE, EXTRADURAL cohort cohort cohort

64774 EXCISION OF NEUROMA; CUTANEOUS NERVE, SURGICALLYIDENTIFIABLE cohort cohort cohort

64776 EXCISION OF NEUROMA; DIGITAL NERVE, ONE OR BOTH, SAME DIGIT cohort cohort

64782 EXCISION OF NEUROMA; HAND OR FOOT, EXCEPT DIGITAL NERVE cohort cohort cohort

64783

EXCISION OF NEUROMA; HAND OR FOOT, EACH ADDITIONALNERVE,EXCEPT SAME DIGIT (LIST SEPARATELY IN ADDIT ION TO CODE FOR PRIMARY PROCEDURE) statewide

64784 EXCISION OF NEUROMA; MAJOR PERIPHERAL NERVE, EXCEPT SCIATIC cohort cohort

64788

EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVEEXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; CUTANEOUS NERVE cohort cohort

64790

EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERALNERVE EXCISION OF NEUROFIBROMA OR NEUROLEMMOMA; MAJOR PERIPHERAL statewide

64795 BIOPSY OF NERVE cohort cohort cohort cohort

64820 SYMPATHECTOMY, DIGITAL ARTERIES, WITH MAGNIFICATION, EACHDIGIT cohort cohort

64821 SYMPATHECTOMY; RADIAL ARTERY statewide

64822 SYMPATHECTOMY; ULNAR ARTERY statewide

64823 SYMPATHECTOMY; SUPERFICIAL PALMAR ARCH cohort cohort

64831 SUTURE OF DIGITAL NERVE, HAND OR FOOT; ONE NERVE cohort cohort cohort cohort cohort

64832

SUTURE OF DIGITAL NERVE, HAND OR FOOT; EACH ADDITIONALDIGITAL NERVE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

64834 SUTURE OF 1 NERVE; HAND OR FOOT, COMMON SENSORY NERVE cohort cohort

64835 SUTURE OF 1 NERVE; MEDIAN MOTOR THENAR cohort cohort cohort

64836 SUTURE OF 1 NERVE; ULNAR MOTOR cohort cohort

64837

SUTURE OF EACH ADDITIONAL NERVE, HAND OR FOOT (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

64856 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPTSCIATIC; INCLUDING TRANSPOSITION statewide

64857 SUTURE OF MAJOR PERIPHERAL NERVE, ARM OR LEG, EXCEPTSCIATIC; WITHOUT TRANSPOSITION cohort cohort

64859

SUTURE OF EACH ADDITIONAL MAJOR PERIPHERAL NERVE (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

126

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

64864 SUTURE OF FACIAL NERVE; EXTRACRANIAL statewide

64868 ANASTOMOSIS; FACIAL-HYPOGLOSSAL statewide

64885

NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO 4 CM IN LENGTH NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; UP TO statewide

64886

NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORETHAN 4 CM LENGTH NERVE GRAFT (INCLUDES OBTAINING GRAFT), HEAD OR NECK; MORE statewide

64892

NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARMOR LEG; UP TO 4 CM LENGTH NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM statewide

64893

NERVE GRAFT (INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARMOR LEG; MORE THAN 4 CM LENGTH NERVE GRAFT(INCLUDES OBTAINING GRAFT), SINGLE STRAND, ARM statewide

64897 NERVE GRAFT (INCLUDES OBTAINING GRAFT), MULTIPLE STRANDS(CABLE), ARM OR LEG; UP TO 4 CM LENGTH statewide

64902

NERVE GRAFT, EACH ADDITIONAL NERVE; MULTIPLE STRANDS (CABLE)(LIST SEPARATELY IN ADDITION TO CODE FORPRIMARY PROCEDURE) statewide

64905 NERVE PEDICLE TRANSFER; FIRST STAGENERVE PEDICLE TRANSFER; FIRST STAGE statewide

64910 NERVE REPAIR; WITH SYNTHETIC CONDUIT OR VEIN ALLOGRAFT (EG, NERVE TUBE), EACH NERVE cohort cohort cohort cohort

64911 NERVE REPAIR; WITH AUTOGENOUS VEIN GRAFT (INCLUDESHARVEST OF VEIN GRAFT), EACH NERVE cohort cohort cohort

64999 UNLISTED PROCEDURE, NERVOUS SYSTEM cohort cohort cohort cohort cohort

65091 EVISCERATION OF OCULAR CONTENTS; WITHOUT IMPLANT statewide

65105 ENUCLEATION OF EYE; WITH IMPLANT, MUSCLES ATTACHEDTOIMPLANT cohort cohort cohort

65140

INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION,MUSCLES ATTACHED TO IMPLANT INSERTION OF OCULAR IMPLANT SECONDARY; AFTER ENUCLEATION, statewide

65205

*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVALSUPERFICIAL *REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVAL cohort cohort cohort cohort cohort

65210

*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CONJUNCTIVALEMBEDDED (INCLUDES CONCRETIONS), SUBCONJUNCTIVAL, OR SCLERAL NONPERFORATING cohort cohort cohort cohort

65220

*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUTSLIT LAMP *REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITHOUT cohort cohort cohort cohort cohort cohort

65222

*REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLITLAMP *REMOVAL OF FOREIGN BODY, EXTERNAL EYE; CORNEAL, WITH SLIT cohort cohort cohort cohort cohort

65235

REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER OR LENS REMOVAL OF FOREIGN BODY, INTRAOCULAR; FROM ANTERIOR CHAMBER cohort cohort

65270

*REPAIR OF LACERATION; CONJUNCTIVA, WITH OR WITHOUTNONPERFORATING LACERATION SCLERA, DIRECT CLOSURE cohort cohort

65275 REPAIR OF LACERATION; CORNEA, NONPERFORATING, WITHORWITHOUT REMOVAL FOREIGN BODY cohort cohort

65280 REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING, NOTINVOLVING UVEAL TISSUE cohort cohort

65285

REPAIR OF LACERATION; CORNEA AND/OR SCLERA, PERFORATING,WITH REPOSITION OR RESECTION OF UVEAL TISSUE cohort cohort

65400 EXCISION OF LESION, CORNEA (KERATECTOMY, LAMELLAR,PARTIAL),EXCEPT PTERYGIUM cohort cohort cohort

65420 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITHOUT GRAFT cohort cohort

65426 EXCISION OR TRANSPOSITION OF PTERYGIUM; WITH GRAFT cohort cohort cohort cohort cohort

65435 *REMOVAL OF CORNEAL EPITHELIUM; WITH OR WITHOUTCHEMOCAUTERIZATION (ABRASION, CURETTAGE) statewide

127

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

65436 REMOVAL OF CORNEAL EPITHELIUM; WITH APPLICATION OFCHELATINGAGENT (EG, EDTA) statewide

65450

DESTRUCTION OF LESION OF CORNEA BY CRYOTHERAPY,PHOTOCOAGULATION OR THERMOCAUTERIZATION statewide

65710 Keratoplasty (corneal transplant); anterior lamellar statewide

65730 Keratoplasty (corneal transplant); penetrating (except in aphakia or pseudophakia) cohort cohort cohort cohort

65750 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (INAPHAKIA) statewide

65755 KERATOPLASTY (CORNEAL TRANSPLANT); PENETRATING (INPSEUDOPHAKIA) statewide

65756 Keratoplasty (corneal transplant); endothelial cohort cohort cohort cohort cohort cohort

65757

Backbench preparation of corneal endothelial allograft prior to transplantation (List separately in addition to code for primary procedure) cohort cohort cohort

65771 RADIAL KERATOTOMY statewide

65772 CORNEAL RELAXING INCISION FOR CORRECTION OF SURGICALLYINDUCED ASTIGMATISM cohort cohort cohort

65775 CORNEAL WEDGE RESECTION FOR CORRECTION OF SURGICALLY INDUCEDASTIGMATISM statewide

65778 Placement of amniotic membrane on the ocular surface for wound healing; self-retaining statewide

65779 Placement of amniotic membrane on the ocular surface for wound healing; single layer, sutured statewide

65780 Ocular surface reconstruction; amniotic membrane transplantation, multiple layers cohort cohort

65782 OCULAR SURFACE RECONSTRUCTION; LIMBAL CONJUNCTIVALAUTOGRAFT (INCLUDES OBTAINING GRAFT) cohort cohort

65800 PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATE PROCEDURE); WITH REMOVAL OF AQUEOUS statewide

65815

PARACENTESIS OF ANTERIOR CHAMBER OF EYE (SEPARATEPROCEDURE); WITH REMOVAL OF BLOOD, WITH OR WITHOUT IRRIGATION AND/OR AIR INJECTION statewide

65850 TRABECULOTOMY AB EXTERNO cohort cohort

65855 TRABECULOPLASTY BY LASER SURGERY, ONE OR MORE SESSIONS(DEFINED TREATMENT SERIES) cohort cohort cohort cohort

65865

SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONALTECHNIQUE (WITH OR WITHOUT INJECTION OF AIROR LIQUID) (SEPARATE PROCEDURE); GONIOSYNECHIAE statewide

65870

SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONALTECHNIQUE (WITH OR WITHOUT INJECTION OF AIROR LIQUID) (SEPARATE PROCEDURE); ANTERIOR SYNECH IAE, EXCEPT cohort cohort

65875

SEVERING ADHESIONS OF ANTERIOR SEGMENT OF EYE, INCISIONALTECHNIQUE (WITH OR WITHOUT INJECTION OF AIROR LIQUID) (SEPARATE PROCEDURE); POSTERIOR SYNEC HIAE cohort cohort

65920

REMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT EYEREMOVAL OF IMPLANTED MATERIAL, ANTERIOR SEGMENT EYE cohort cohort cohort cohort

66020 INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE); AIR ORLIQUID statewide

66030 *INJECTION, ANTERIOR CHAMBER (SEPARATE PROCEDURE);MEDICATION cohort cohort

66130 EXCISION OF LESION, SCLERA statewide

66170 FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY ABEXTERNO IN ABSENCE OF PREVIOUS SURGERY cohort cohort cohort cohort cohort

66172

FISTULIZATION OF SCLERA FOR GLAUCOMA; TRABECULECTOMY ABEXTERNO WITH SCARRING FROM PREVIOUS OCULAR SURGERY OR TRAUMA (INCLUDES INJECTION OF ANTIFIBROTIC AGENTS) cohort cohort

128

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

66175 Transluminal dilation of aqueous outflow canal; with retention of device or stent statewide

66180 AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR, (EG, MOLTENO,SCHOCKET, DENVER-KRUPIN) cohort cohort cohort cohort

66185 REVISION OF AQUEOUS SHUNT TO EXTRAOCULAR RESERVOIR cohort cohort

66250

REVISION OR REPAIR OF OPERATIVE WOUND OF ANTERIOR SEGMENT,ANY TYPE, EARLY OR LATE, MAJOR OR MINOR PROCEDURE cohort cohort cohort cohort

66500 IRIDOTOMY BY STAB INCISION (SEPARATE PROCEDURE); EXCEPTTRANSFIXION statewide

66600 IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION;FORREMOVAL OF LESION statewide

66625

IRIDECTOMY, WITH CORNEOSCLERAL OR CORNEAL SECTION;PERIPHERAL FOR GLAUCOMA (SEPARATE PROCEDURE) cohort cohort

66680 REPAIR OF IRIS, CILIARY BODY (AS FOR IRIDODIALYSIS) statewide

66682

SUTURE OF IRIS, CILIARY BODY (SEPARATE PROCEDURE) WITHRETRIEVAL OF SUTURE THROUGH SMALL INCISION (EG, MCCANNEL SUTURE) cohort cohort cohort cohort

66710 CILIARY BODY DESTRUCTION; CYCLOPHOTOCOAGULATION cohort cohort cohort

66711 CILIARY ENDOSCOPIC ABLATION cohort cohort

66761 Iridotomy/iridectomy by laser surgery (eg, for glaucoma) (per session) cohort cohort cohort cohort cohort

66762

IRIDOPLASTY BY PHOTOCOAGULATION (ONE OR MORE SESSIONS) (EG, FOR IMPROVEMENT OF VISION, FOR WIDENING OF ANTERIOR CHAMBER ANGLE) cohort cohort

66820

DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIEDPOSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); STAB INCISION TECHNIQUE (ZIEGLER OR WHEELER KNIFE) statewide

66821

DISCISSION OF SECONDARY MEMBRANOUS CATARACT (OPACIFIEDPOSTERIOR LENS CAPSULE AND/OR ANTERIOR HYALOID); LASER SURGERY (EG, YAG LASER) (ONE OR MORE STAGES) cohort cohort cohort cohort

66825 REPOSITIONING OF INTRAOCULAR LENS PROSTHESIS, REQUIRING ANINCISION (SEPARATE PROCEDURE) cohort cohort cohort

66840 REMOVAL OF LENS MATERIAL; ASPIRATION TECHNIQUE, ONE OR MORE STAGES statewide

66850

REMOVAL OF LENS MATERIAL; PHACOFRAGMENTATION TECHNIQUE(MECHANICAL OR ULTRASONIC) (EG, PHACOEMULSIFICATION), WITH ASPIRATION cohort cohort cohort cohort cohort

66852 REMOVAL OF LENS MATERIAL; PARS PLANA APPROACH, WITH ORWITHOUT VITRECTOMY cohort cohort cohort cohort

66920 REMOVAL OF LENS MATERIAL; INTRACAPSULAR cohort cohort

66930 REMOVAL OF LENS MATERIAL; INTRACAPSULAR, FOR DISLOCATED LENS statewide

66940 REMOVAL OF LENS MATERIAL; EXTRACAPSULAR (OTHER THAN 66840,66850, 66852) cohort cohort

66982

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULAR LENS PROSTHESIS (1-STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR PHACOEMULSIFICATION), COMPLEX, REQUIR cohort cohort cohort cohort cohort cohort

66983 INTRACAPSULAR CATARACT EXTRACTION WITH INSERTION OFINTRAOCULAR LENS PROSTHESIS (ONE STAGE PROCEDURE) statewide

66984

EXTRACAPSULAR CATARACT REMOVAL WITH INSERTION OF INTRAOCULARLENS PROSTHESIS (ONE STAGE PROCEDURE), MANUAL OR MECHANICAL TECHNIQUE (EG, IRRIGATION AND ASPIRATION OR cohort cohort cohort cohort cohort cohort

66985

INSERTION OF INTRAOCULAR LENS PROSTHESIS (SECONDARYIMPLANT), NOT ASSOCIATED WITH CONCURRENT CATARACTREMOVAL cohort cohort cohort cohort cohort

66986 EXCHANGE OF INTRAOCULAR LENS cohort cohort cohort cohort

66990 OPHTHALMIC ENDOSCOPE USE cohort cohort cohort

129

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

66999 UNLISTED PROCEDURE, ANTERIOR SEGMENT OF EYE cohort cohort cohort

67005 REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUEOR LIMBAL INCISION); PARTIAL REMOVAL cohort cohort cohort

67010

REMOVAL OF VITREOUS, ANTERIOR APPROACH (OPEN SKY TECHNIQUEOR LIMBAL INCISION); SUBTOTAL REMOVAL WITHMECHANICAL VITRECTOMY cohort cohort cohort

67015

ASPIRATION OR RELEASE OF VITREOUS, SUBRETINAL OR CHOROIDALFLUID, PARS PLANA APPROACH (POSTERIOR SCLEROTOMY) cohort cohort

67025

INJECTION OF VITREOUS SUBSTITUTE, PARS PLANA OR LIMBALAPPROACH, (FLUID-GAS EXCHANGE), WITH OR WITHOUT ASPIRATION (SEPARATE PROCEDURE) cohort cohort cohort cohort

67027

IMPLANTATION OF INTRAVITREAL DRUG DELIVERY SYSTEM (EG,GANCICLOVIR IMPLANT), INCLUDES CONCOMITANT REMOVAL OF VITREOUS statewide

67028 INTRAVITREAL INJECTION OF A PHARMACOLOGIC AGENT (SEPARATEPROCEDURE) cohort cohort cohort

67036 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; cohort cohort cohort cohort cohort

67039 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH FOCALENDOLASER PHOTOCOAGULATION cohort cohort cohort

67040 VITRECTOMY, MECHANICAL, PARS PLANA APPROACH; WITH ENDOLASER PANRETINAL PHOTOCOAGULATION cohort cohort cohort cohort

67041 Vitrectomy, mechanical, pars plana approach; with removal of preretinal cellular membrane (e.g., macular pucker) cohort cohort cohort cohort cohort cohort

67042

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (e.g., for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tampon cohort cohort cohort cohort cohort cohort

67043

Vitrectomy, mechanical, pars plana approach; with removal of subretinal membrane (e.g., choroidal neovascularization), includes, if performed, intraocular tamponade i.e., air, gas or silicone oil) and cohort cohort cohort

67101

REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS;CRYOTHERAPY OR DIATHERMY, WITH OR WITHOUT DRAINAGE OF SUBRETINAL FLUID cohort cohort cohort

67105

REPAIR OF RETINAL DETACHMENT, ONE OR MORE SESSIONS;PHOTOCOAGULATION, WITH OR WITHOUT DRAINAGE OF SUBRETINAL FLUID cohort cohort cohort cohort

67107

REPAIR OF RETINAL DETACHMENT; SCLERAL BUCKLING (SUCH ASLAMELLAR SCLERAL DISSECTION, IMBRICATION OR ENCIRCLING PROCEDURE), WITH OR WITHOUT IMPLANT, WITH OR WITHOUT cohort cohort cohort cohort cohort

67108

REPAIR OF RETINAL DETACHMENT; WITH VITRECTOMY, ANYMETHOD,WITH OR WITHOUT AIR OR GAS TAMPONADE, FOCA L ENDOLASER PHOTOCOAGULATION, CRYOTHERAPY, DRAINAGE OF SUBRETINAL FLUID, cohort cohort cohort cohort cohort cohort

67110 REPAIR OF RETINAL DETACHMENT; BY INJECTION OF AIR OR OTHERGAS (EG, PNEUMATIC RETINOPEXY) cohort cohort

67112

REPAIR OF RETINAL DETACHMENT; BY SCLERAL BUCKLING ORVITRECTOMY, ON PATIENT HAVING PREVIOUS IPSILATERAL RETINAL DETACHMENT REPAIR(S) USING SCLERAL BUCKLING OR VITRECTOMY cohort cohort cohort

67113

Repair of complex retinal detachment (e.g., proliferative vitreoretinopathy, stage C-1 or greater, diabetic traction retinal detachment, retinopathy of prematurity, retinal tear of greater than 90 deg cohort cohort cohort cohort cohort cohort

67120

REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT;EXTRAOCULAR REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; cohort cohort

67121

REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT;INTRAOCULAR REMOVAL OF IMPLANTED MATERIAL, POSTERIOR SEGMENT; cohort cohort cohort

67141

PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK,LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY statewide

67145 PROPHYLAXIS OF RETINAL DETACHMENT (EG, RETINAL BREAK,LATTICE DEGENERATION) WITHOUT DRAINAGE, ONE OR cohort cohort cohort cohort

130

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MORE SESSIONS; PHOTOCOAGULATION (LASER OR XENON ARC)

67208

DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAREDEMA, TUMORS), ONE OR MORE SESSIONS; CRYOTHERAPY, DIATHERMY cohort cohort

67210

DESTRUCTION OF LOCALIZED LESION OF RETINA (EG, MACULAREDEMA, TUMORS), ONE OR MORE SESSIONS; PHOTOCOAGULATION cohort cohort

67220

DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDALNEOVASCULARIZATION), ONE OR MORE SESSION, PHOTOCOAGULATION (LASER) statewide

67221

DESTRUCTION OF LOCALIZED LESION OF CHOROID (EG, CHOROIDALNEOVASCULARIZATION);PHOTODYNAMIC THERAPY (INCLUDES INTRAVENOUS INFUSION) statewide

67227 Destruction of extensive or progressive retinopathy (e.g., diabetic retinopathy), one or more sessions, cryotherapy, diathermy cohort cohort

67228 Treatment of extensive or progressive retinopathy,one or more sessions; (e.g., diabetic retinopathy ), photocoagulation cohort cohort cohort cohort

67250 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITHOUT GRAFT statewide

67255 SCLERAL REINFORCEMENT (SEPARATE PROCEDURE); WITH GRAFT cohort cohort cohort cohort

67311 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONEHORIZONTAL MUSCLE cohort cohort cohort cohort cohort

67312 STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWOHORIZONTAL MUSCLES cohort cohort cohort

67314

STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; ONEVERTICAL MUSCLE (EXCLUDING SUPERIOR OBLIQUE) cohort cohort cohort cohort

67316

STRABISMUS SURGERY, RECESSION OR RESECTION PROCEDURE; TWO ORMORE VERTICAL MUSCLES (EXCLUDING SUPERIOR OBLIQUE) statewide

67318 STRABISMUS SURGERY, ANY PROCEDURE, SUPERIOR OBLIQUE MUSCLE cohort cohort cohort

67320

TRANSPOSITION PROCEDURE (EG, FOR PARETIC EXTRAOCULARMUSCLE), ANY EXTRAOCULAR MUSCLE (SPECIFY) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

67331

STRABISMUS SURGERY ON PATIENT WITH PREVIOUS EYE SURGERY ORINJURY THAT DID NOT INVOLVE THE EXTRAOCULAR MUSCLES (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

67332

STRABISMUS SURGERY ON PATIENT WITH SCARRING OF EXTRAOCULARMUSCLES (EG, PRIOR OCULAR INJURY, STRABISMUS OR RETINAL DETACHMENT SURGERY) OR RESTRICTIVE MYOPATHY (EG, DYSTHYROID cohort cohort

67334

STRABISMUS SURGERY BY POSTERIOR FIXATION SUTURE TECHNIQUE,WITH OR WITHOUT MUSCLE RECESSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

67335

PLACEMENT OF ADJUSTABLE SUTURE(S) DURING STRABISMUS SURGERY,INCLUDING POSTOPERATIVE ADJUSTMENT(S) OFSUTURE(S) (LIST SEPARATELY IN ADDITION TO CODE F OR SPECIFIC STRABISMUS cohort cohort

67340

STRABISMUS SURGERY INVOLVING EXPLORATION AND/OR REPAIR OFDETACHED EXTRAOCULAR MUSCLE(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

67346 BIOPSY OF EXTRAOCULAR MUSCLE statewide

67400

ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVALAPPROACH); FOR EXPLORATION, WITH OR WITHOUT BIOPSY cohort cohort cohort

67405 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVALAPPROACH); WITH DRAINAGE ONLY cohort cohort

67412 ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF LESION cohort cohort cohort cohort

131

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

67413

ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF FOREIGN BODY ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVAL statewide

67414

ORBITOTOMY WITHOUT BONE FLAP (FRONTAL OR TRANSCONJUNCTIVALAPPROACH); WITH REMOVAL OF BONE FOR DECOMPRESSION statewide

67420 ORBITOTOMY WITH BONE FLAP OR WINDOW, LATERAL APPROACH (EG,KROENLEIN); WITH REMOVAL OF LESION cohort cohort

67500 *RETROBULBAR INJECTION; MEDICATION (SEPARATE PROCEDURE, DOESNOT INCLUDE SUPPLY OF MEDICATION) statewide

67515 *INJECTION OF THERAPEUTIC AGENT INTO TENON'S CAPSULE statewide

67550 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); INSERTION statewide

67560 ORBITAL IMPLANT (IMPLANT OUTSIDE MUSCLE CONE); REMOVAL ORREVISION statewide

67570 OPTIC NERVE DECOMPRESSION (EG, INCISION OR FENESTRATION OFOPTIC NERVE SHEATH) cohort cohort

67599 UNLISTED PROCEDURE, ORBIT statewide

67700 *BLEPHAROTOMY, DRAINAGE OF ABSCESS, EYELID cohort cohort cohort

67710 *SEVERING OF TARSORRHAPHY statewide

67715 *CANTHOTOMY (SEPARATE PROCEDURE) statewide

67800 EXCISION OF CHALAZION; SINGLE cohort cohort cohort cohort

67801 EXCISION OF CHALAZION; MULTIPLE, SAME LIDEXCISION OF CHALAZION; MULTIPLE, SAME LID statewide

67805 EXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDSEXCISION OF CHALAZION; MULTIPLE, DIFFERENT LIDS cohort cohort

67808

EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA AND/ORREQUIRING HOSPITALIZATION, SINGLE OR MULTIPLE EXCISION OF CHALAZION; UNDER GENERAL ANESTHESIA A ND/OR cohort cohort cohort

67825

*CORRECTION OF TRICHIASIS; EPILATION BY OTHER THANFORCEPS(EG, BY ELECTROSURGERY, CRYOTHERAPY, LASER SURGERY) cohort cohort

67840 *EXCISION OF LESION OF EYELID (EXCEPT CHALAZION) WITHOUTCLOSURE OR WITH SIMPLE DIRECT CLOSURE cohort cohort cohort cohort

67850 *DESTRUCTION OF LESION OF LID MARGIN (UP TO 1 CM) statewide

67875 TEMPORARY CLOSURE OF EYELIDS BY SUTURE (EG, FROST SUTURE) cohort cohort cohort cohort

67880 CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIANTARSORRHAPHY, OR CANTHORRHAPHY; cohort cohort cohort

67882

CONSTRUCTION OF INTERMARGINAL ADHESIONS, MEDIANTARSORRHAPHY, OR CANTHORRHAPHY; WITH TRANSPOSITION OFTARSAL PLATE statewide

67900 REPAIR OF BROW PTOSIS (SUPRACILIARY, MID-FOREHEAD OR CORONALAPPROACH) cohort cohort cohort cohort

67901 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITHSUTURE OR OTHER MATERIAL cohort cohort cohort

67902 REPAIR OF BLEPHAROPTOSIS; FRONTALIS MUSCLE TECHNIQUE WITHFASCIAL SLING (INCLUDES OBTAINING FASCIA) cohort cohort

67903 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTIONORADVANCEMENT, INTERNAL APPROACH statewide

67904 REPAIR OF BLEPHAROPTOSIS; (TARSO)LEVATOR RESECTIONORADVANCEMENT, EXTERNAL APPROACH cohort cohort cohort cohort cohort cohort

67908

REPAIR OF BLEPHAROPTOSIS; CONJUNCTIVO-TARSO-MULLER'SMUSCLE-LEVATOR RESECTION (EG, FASANELLA-SERVAT TYPE) cohort cohort

67911 CORRECTION OF LID RETRACTION cohort cohort cohort

67912 CORRECTION OF LAGOPHTHALMOS, WITH IMPLANTATION OF UPPER EYELID LID LOAD (EG, GOLD WEIGHT) cohort cohort

67914 REPAIR OF ECTROPION; SUTURE statewide

132

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

67917 REPAIR OF ECTROPION; BLEPHAROPLASTY, EXTENSIVE (EG,KUHNT-SZYMANOWSKI OR TARSAL STRIP OPERATIONS) cohort cohort cohort

67921 REPAIR OF ENTROPION; SUTURE statewide

67923 REPAIR OF ENTROPION; EXCISION TARSAL WEDGE statewide

67924 REPAIR OF ENTROPION; BLEPHAROPLASTY, EXTENSIVE (EG, WHEELER OPERATION) statewide

67930

SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN,TARSUS, AND/OR PALPEBRAL CONJUNCTIVA DIRECT CLOSURE; PARTIAL THICKNESS statewide

67935

SUTURE OF RECENT WOUND, EYELID, INVOLVING LID MARGIN,TARSUS, AND/OR PALPEBRAL CONJUNCTIVA) DIRECT CLOSURE; FULL THICKNESS cohort cohort cohort cohort

67938 REMOVAL OF EMBEDDED FOREIGN BODY, EYELID cohort cohort cohort

67950 CANTHOPLASTY (RECONSTRUCTION OF CANTHUS) cohort cohort cohort

67961

EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS,CONJUNCTIVA, CANTHUS, OR FULL THICKNESS,MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICL E FLAP WITH ADJACENT cohort cohort cohort cohort

67966

EXCISION AND REPAIR OF EYELID, INVOLVING LID MARGIN, TARSUS,CONJUNCTIVA, CANTHUS, OR FULL THICKNESS,MAY INCLUDE PREPARATION FOR SKIN GRAFT OR PEDICL E FLAP WITH ADJACENT cohort cohort cohort cohort cohort

67971

RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OFTARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; UP TO TWO-THIRDS OF EYELID, ONE STAGE OR FIRST STAGE cohort cohort

67973

RECONSTRUCTION OF EYELID, FULL THICKNESS BY TRANSFER OFTARSOCONJUNCTIVAL FLAP FROM OPPOSING EYELID; TOTAL EYELID, LOWER, ONE STAGE OR FIRST STAGE statewide

67999 UNLISTED PROCEDURE, EYELIDS cohort cohort

68100 BIOPSY OF CONJUNCTIVA statewide

68110 EXCISION OF LESION, CONJUNCTIVA; UP TO 1 CM cohort cohort cohort cohort

68115 EXCISION OF LESION, CONJUNCTIVA; OVER 1 CM cohort cohort cohort cohort cohort

68130 EXCISION OF LESION, CONJUNCTIVA; WITH ADJACENT SCLERA statewide

68135 *DESTRUCTION OF LESION, CONJUNCTIVA statewide

68200 *SUBCONJUNCTIVAL INJECTION cohort cohort

68320 CONJUNCTIVOPLASTY; WITH CONJUNCTIVAL GRAFT OR EXTENSIVEREARRANGEMENT cohort cohort

68325 CONJUNCTIVOPLASTY; WITH BUCCAL MUCOUS MEMBRANE GRAFT(INCLUDES OBTAINING GRAFT) statewide

68335 REPAIR OF SYMBLEPHARON; WITH FREE GRAFT CONJUNCTIVA ORBUCCAL MUCOUS MEMBRANE (INCLUDES OBTAINING GRAFT) statewide

68360 CONJUNCTIVAL FLAP; BRIDGE OR PARTIAL (SEPARATE PROCEDURE) cohort cohort

68399 UNLISTED PROCEDURE, CONJUNCTIVA statewide

68440 *SNIP INCISION OF LACRIMAL PUNCTUM cohort cohort

68510 BIOPSY OF LACRIMAL GLAND cohort cohort

68530 REMOVAL OF FOREIGN BODY OR DACRYOLITH, LACRIMAL PASSAGES statewide

68700 PLASTIC REPAIR OF CANALICULI cohort cohort

68720 DACRYOCYSTORHINOSTOMY (FISTULIZATION OF LACRIMAL SAC TONASAL CAVITY) cohort cohort cohort cohort cohort

68750 CONJUNCTIVORHINOSTOMY (FISTULIZATION OF CONJUNCTIVA TO NASALCAVITY); WITH INSERTION OF TUBE OR STENT statewide

68760 CLOSURE OF THE LACRIMAL PUNCTUM; BY THERMOCAUTERIZATION,LIGATION, OR LASER SURGERY statewide

68801 *DILATION OF LACRIMAL PUNCTUM, WITH OR WITHOUT IRRIGATION statewide

68810 *PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION; cohort cohort

68811 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT cohort cohort cohort cohort cohort

133

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

IRRIGATION;REQUIRING GENERAL ANESTHESIA

68815 PROBING OF NASOLACRIMAL DUCT, WITH OR WITHOUT IRRIGATION;WITH INSERTION OF TUBE OR STENT cohort cohort cohort cohort cohort

68816 Probing of nasolacrimal duct, with or without irrigation; with transluminal balloon catheter dilation cohort cohort cohort cohort cohort

68840 *PROBING OF LACRIMAL CANALICULI, WITH OR WITHOUT IRRIGATION cohort cohort

68850 *INJECTION OF CONTRAST MEDIUM FOR DACRYOCYSTOGRAPHY statewide

68899 UNLISTED PROCEDURE, LACRIMAL SYSTEM statewide

69000 *DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; SIMPLE cohort cohort cohort cohort cohort

69005 DRAINAGE EXTERNAL EAR, ABSCESS OR HEMATOMA; COMPLICATED statewide

69020 *DRAINAGE EXTERNAL AUDITORY CANAL, ABSCESS cohort cohort

69100 BIOPSY EXTERNAL EAR cohort cohort cohort

69110 EXCISION EXTERNAL EAR; PARTIAL, SIMPLE REPAIR cohort cohort cohort

69120 EXCISION EXTERNAL EAR; COMPLETE AMPUTATION statewide

69145 EXCISION SOFT TISSUE LESION, EXTERNAL AUDITORY CANAL cohort cohort cohort cohort cohort cohort

69200 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL;WITHOUTGENERAL ANESTHESIA cohort cohort cohort cohort cohort

69205 REMOVAL FOREIGN BODY FROM EXTERNAL AUDITORY CANAL;WITHGENERAL ANESTHESIA cohort cohort cohort cohort cohort

69210 REMOVAL IMPACTED CERUMEN (SEPARATE PROCEDURE), ONEOR BOTHEARS cohort cohort cohort cohort cohort cohort

69220 DEBRIDEMENT, MASTOIDECTOMY CAVITY, SIMPLE (EG, ROUTINECLEANING) cohort cohort

69300 OTOPLASTY, PROTRUDING EAR, WITH OR WITHOUT SIZE REDUCTION statewide

69310

RECONSTRUCTION OF EXTERNAL AUDITORY CANAL (MEATOPLASTY) (EG,FOR STENOSIS DUE TO TRAUMA, INFECTION), (SEPARATE PROCEDURE) cohort cohort cohort

69399 UNLISTED PROCEDURE, EXTERNAL EAR cohort cohort

69420 *MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBEINFLATION cohort cohort cohort cohort

69421 *MYRINGOTOMY INCLUDING ASPIRATION AND/OR EUSTACHIAN TUBEINFLATION REQUIRING GENERAL ANESTHESIA cohort cohort cohort cohort cohort

69424 VENTILATING TUBE REMOVAL WHEN ORIGINALLY INSERTED BY ANOTHERPHYSICIAN cohort cohort cohort cohort cohort cohort

69433 *TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE),LOCAL OR TOPICAL ANESTHESIA cohort cohort cohort

69436 TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE),GENERAL ANESTHESIA cohort cohort cohort cohort cohort cohort

69450 TYMPANOLYSIS, TRANSCANAL cohort cohort

69501 TRANSMASTOID ANTROTOMY ("SIMPLE" MASTOIDECTOMY) statewide

69502 MASTOIDECTOMY; COMPLETE statewide

69511 MASTOIDECTOMY; RADICAL statewide

69535 RESECTION TEMPORAL BONE, EXTERNAL APPROACH statewide

69540 EXCISION AURAL POLYP statewide

69552 EXCISION AURAL GLOMUS TUMOR; TRANSMASTOID statewide

69601 REVISION MASTOIDECTOMY; RESULTING IN COMPLETE MASTOIDECTOMY statewide

69603 REVISION MASTOIDECTOMY; RESULTING IN RADICAL MASTOIDECTOMY statewide

69604 REVISION MASTOIDECTOMY; RESULTING IN TYMPANOPLASTY statewide

69610

TYMPANIC MEMBRANE REPAIR, WITH OR WITHOUT SITE PREPARATIONOR PERFORATION FOR CLOSURE, WITH OR WITHOUT PATCH cohort cohort cohort cohort cohort cohort

69620 MYRINGOPLASTY (SURGERY CONFINED TO DRUMHEAD AND cohort cohort cohort cohort cohort

134

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

DONOR AREA)

69631

TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITHOUT OSSICULAR CHAIN RECONSTRUCTION cohort cohort cohort cohort cohort

69632

TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION (EG, POSTFENESTRATION) cohort cohort cohort cohort

69633

TYMPANOPLASTY WITHOUT MASTOIDECTOMY (INCLUDING CANALPLASTY, ATTICOTOMY AND/OR MIDDLE EAR SURGERY), INITIAL OR REVISION; WITH OSSICULAR CHAIN RECONSTRUCTION AND SYNTHETIC PROSTHESIS cohort cohort cohort cohort cohort

69635

TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDINGCANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION statewide

69637

TYMPANOPLASTY WITH ANTROTOMY OR MASTOIDOTOMY (INCLUDINGCANALPLASTY, ATTICOTOMY, MIDDLE EAR SURGERY, AND/OR TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION AND cohort cohort

69641

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITHOUT OSSICULAR CHAIN RECONSTRUCTION cohort cohort cohort cohort

69642

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH OSSICULAR CHAIN RECONSTRUCTION cohort cohort cohort

69643

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED WALL, WITHOUT OSSICULAR CHAIN cohort cohort cohort

69644

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); WITH INTACT OR RECONSTRUCTED CANAL WALL, WITH OSSICULAR CHAIN cohort cohort cohort cohort

69645

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITHOUT OSSICULAR CHAIN RECONSTRUCTION cohort cohort

69646

TYMPANOPLASTY WITH MASTOIDECTOMY (INCLUDING CANALPLASTY,MIDDLE EAR SURGERY, TYMPANIC MEMBRANE REPAIR); RADICAL OR COMPLETE, WITH OSSICULAR CHAIN RECONSTRUCTION statewide

69650 STAPES MOBILIZATION statewide

69660

STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OFOSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL; cohort cohort cohort cohort

69661

STAPEDECTOMY OR STAPEDOTOMY WITH REESTABLISHMENT OFOSSICULAR CONTINUITY, WITH OR WITHOUT USE OF FOREIGN MATERIAL; WITH FOOTPLATE DRILL OUT cohort cohort

69662 REVISION OF STAPEDECTOMY OR STAPEDOTOMY cohort cohort cohort

69700 CLOSURE POSTAURICULAR FISTULA, MASTOID (SEPARATE PROCEDURE) statewide

69710 IMPLANTATION OR REPLACEMENT OF ELECTROMAGNETIC BONECONDUCTION HEARING DEVICE IN TEMPORAL BONE cohort cohort cohort

69711 REMOVAL OR REPAIR OF ELECTROMAGNETIC BONE CONDUCTION HEARINGDEVICE IN TEMPORAL BONE statewide

69714

IMPLANTATION OSSEOINTEGRATED IMPLANT TEMPORAL BONEW/ PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR, WITHOUT MASTIODECTOMY cohort cohort cohort

69717

REPLACEMENT (INCLUDING REMOVAL OF EXISTING DEVICE)OSSEOINTERGRATED IMPLANT, TEMPORAL BONE W/ PERCUTANEOUS ATTACHMENT TO EXTERNAL SPEECH PROCESSOR/COCHLEAR STIMULATOR W/OUT MASTOIDECTOMY statewide

135

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

69720 DECOMPRESSION FACIAL NERVE, INTRATEMPORAL; LATERALTOGENICULATE GANGLION statewide

69799 UNLISTED PROCEDURE, MIDDLE EAR cohort cohort cohort cohort cohort

69801 Labyrinthotomy, with perfusion of vestibuloactive drug(s); transcanal cohort cohort cohort

69805 ENDOLYMPHATIC SAC OPERATION; WITHOUT SHUNT cohort cohort

69806 ENDOLYMPHATIC SAC OPERATION; WITH SHUNT cohort cohort

69820 FENESTRATION SEMICIRCULAR CANAL statewide

69930 COCHLEAR DEVICE IMPLANTATION, WITH OR WITHOUT MASTOIDECTOMY cohort cohort cohort

69949 UNLISTED PROCEDURE, INNER EAR cohort cohort

69990 USE OF OPERATING MICROSCOPE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

70015 CISTERNOGRAPHY, POSITIVE CONTRAST, RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

70030 RADIOLOGIC EXAMINATION, EYE, FOR DETECTION OF FOREIGN BODY cohort cohort cohort cohort cohort cohort

70100 RADIOLOGIC EXAMINATION, MANDIBLE; PARTIAL, LESS THAN FOURVIEWS cohort cohort cohort cohort cohort cohort

70110 RADIOLOGIC EXAMINATION, MANDIBLE; COMPLETE, MINIMUM OF FOUR VIEWS cohort cohort cohort cohort cohort

70140

RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS RADIOLOGIC EXAMINATION, FACIAL BONES; LESS THAN THREE VIEWS cohort cohort cohort cohort

70150

RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OFTHREE VIEWS RADIOLOGIC EXAMINATION, FACIAL BONES; COMPLETE, MINIMUM OF cohort cohort cohort cohort cohort

70160 RADIOLOGIC EXAMINATION, NASAL BONES, COMPLETE, MINIMUM OF 3 VIEWS cohort cohort cohort cohort cohort

70170 DACRYOCYSTOGRAPHY, NASOLACRIMAL DUCT, RADIOLOGICALSUPERVISION AND INTERPRETATION statewide

70200 RADIOLOGIC EXAMINATION; ORBITS, COMPLETE, MINIMUM OF FOURVIEWS cohort cohort cohort cohort cohort

70210 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, LESS THAN THREE VIEWS cohort cohort cohort cohort

70220 RADIOLOGIC EXAMINATION, SINUSES, PARANASAL, COMPLETE,MINIMUM OF THREE VIEWS cohort cohort cohort cohort cohort

70250

RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS, WITH ORWITHOUT STEREO RADIOLOGIC EXAMINATION, SKULL; LESS THAN FOUR VIEWS, WITH OR cohort cohort cohort cohort cohort

70260

RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOURVIEWS, WITH OR WITHOUT STEREO RADIOLOGIC EXAMINATION, SKULL; COMPLETE, MINIMUM OF FOUR cohort cohort cohort cohort cohort

70300 RADIOLOGIC EXAMINATION, TEETH; SINGLE VIEWRADIOLOGIC EXAMINATION, TEETH; SINGLE VIEW statewide

70310

RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESSTHAN FULL MOUTH RADIOLOGIC EXAMINATION, TEETH; PARTIAL EXAMINATION, LESS cohort cohort

70320

RADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTHRADIOLOGIC EXAMINATION, TEETH; COMPLETE, FULL MOUTH cohort cohort

70328

RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN ANDCLOSED MOUTH; UNILATERAL RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND statewide

70330

RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN ANDCLOSED MOUTH; BILATERAL RADIOLOGIC EXAMINATION, TEMPOROMANDIBULAR JOINT, OPEN AND cohort cohort cohort cohort cohort

70336 MAGNETIC RESONANCE (EG, PROTON) IMAGING, TEMPOROMANDIBULARJOINT cohort cohort cohort cohort cohort

70355 ORTHOPANTOGRAM (EG, PANORAMIC X-RAY) cohort cohort cohort cohort

70360 RADIOLOGIC EXAMINATION; NECK, SOFT TISSUE cohort cohort cohort cohort cohort

70371 COMPLEX DYNAMIC PHARYNGEAL AND SPEECH EVALUATION BY cohort cohort cohort

136

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

CINE OR VIDEO RECORDING

70390 SIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

70450 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

70460 COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

70470

COMPUTERIZED AXIAL TOMOGRAPHY, HEAD OR BRAIN; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort cohort

70480

COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort

70481

COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

70482

COMPUTERIZED AXIAL TOMOGRAPHY, ORBIT, SELLA, OR POSTERIORFOSSA OR OUTER, MIDDLE, OR INNER EAR; WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER cohort cohort cohort cohort cohort

70486 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA;WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

70487 COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA;WITHCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

70488

COMPUTERIZED AXIAL TOMOGRAPHY, MAXILLOFACIAL AREA;WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MA TERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort

70490 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort

70491 COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort cohort

70492

COMPUTERIZED AXIAL TOMOGRAPHY, SOFT TISSUE NECK; WITHOUTCONTRAST MATERIAL FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort

70496 Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed and image postprocessing cohort cohort cohort cohort cohort

70498 Computed tomographic angiography, neck, with contrast material(s), including noncontrast image, if performed, and image postprocessing cohort cohort cohort cohort cohort

70540 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) cohort cohort cohort cohort cohort

70542 MAGNETIC RESONANCE (EG, PROTON) IMAGING; ORBIT, FACE, AND NECK; WITH CONTRAST MATERIAL(S) cohort cohort

70543

MAGNETIC RESONANCE (EG, PROTON) IMAGING; ORBIT, FACE, AND NECK; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

70544 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CON-TRAST MATERIAL(S) cohort cohort cohort cohort cohort

70545 MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITH CON- TRAST MATERIAL(S) statewide

70546

MAGNETIC RESONANCE ANGIOGRAPHY, HEAD; WITHOUT CON-TRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

70547 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CON-TRAST MATERIAL(S) cohort cohort cohort cohort cohort

70548 MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITH CON- TRAST MATERIAL(S) cohort cohort cohort cohort

70549

MAGNETIC RESONANCE ANGIOGRAPHY, NECK; WITHOUT CON-TRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

70551 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDINGBRAIN STEM); WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

70552 MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDINGBRAIN STEM); WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

137

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

70553

MAGNETIC RESONANCE (EG, PROTON) IMAGING, BRAIN (INCLUDINGBRAIN STEM); WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort cohort

70554

MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI;INCLUDING TEST SELECTION AND ADMINISTRATION OF RE PETITIVE BODY PART MOVEMENT AND/OR VISUAL STIMULATION, NOT REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMIN statewide

70555

MAGNETIC RESONANCE IMAGING, BRAIN, FUNCTIONAL MRI;REQUIRING PHYSICIAN OR PSYCHOLOGIST ADMINISTRATIO N OF ENTIRE NEUROFUNCTIONAL TESTING statewide

71010 RADIOLOGIC EXAMINATION, CHEST; SINGLE VIEW, FRONTAL cohort cohort cohort cohort cohort cohort

71020 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL ANDLATERAL; cohort cohort cohort cohort cohort cohort

71021 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL ANDLATERAL; WITH APICAL LORDOTIC PROCEDURE cohort cohort cohort cohort cohort

71022 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL ANDLATERAL; WITH OBLIQUE PROJECTIONS cohort cohort cohort cohort

71023 RADIOLOGIC EXAMINATION, CHEST, TWO VIEWS, FRONTAL ANDLATERAL; WITH FLUOROSCOPY cohort cohort cohort cohort

71030 RADIOLOGIC EXAMINATION, CHEST, COMPLETE, MINIMUM OF FOURVIEWS; cohort cohort cohort cohort

71035 RADIOLOGIC EXAMINATION, CHEST, SPECIAL VIEWS (EG, LATERALDECUBITUS, BUCKY STUDIES) cohort cohort cohort cohort

71100 RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; TWO VIEWS cohort cohort cohort cohort cohort cohort

71101

RADIOLOGIC EXAMINATION, RIBS, UNILATERAL; INCLUDINGPOSTEROANTERIOR CHEST, MINIMUM OF THREE VIEWS cohort cohort cohort cohort cohort cohort

71110 RADIOLOGIC EXAMINATION, RIBS, BILATERAL; THREE VIEWS cohort cohort cohort cohort cohort

71111

RADIOLOGIC EXAMINATION, RIBS, BILATERAL; INCLUDINGPOSTEROANTERIOR CHEST, MINIMUM OF FOUR VIEWS cohort cohort cohort cohort cohort

71120 RADIOLOGIC EXAMINATION; STERNUM, MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort cohort

71130 RADIOLOGIC EXAMINATION; STERNOCLAVICULAR JOINT OR JOINTS,MINIMUM OF THREE VIEWS cohort cohort cohort cohort

71250 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRASTMATERIAL cohort cohort cohort cohort cohort cohort

71260 COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITH CONTRASTMATERIAL(S) cohort cohort cohort cohort cohort cohort

71270

COMPUTERIZED AXIAL TOMOGRAPHY, THORAX; WITHOUT CONTRASTMATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort

71275

Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, if performed, and image postprocessing cohort cohort cohort cohort cohort cohort

71550

MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOREVALUATION OF HILAR AND MEDIASTINAL LYMPHADENOPATHY) cohort cohort cohort cohort

71552

MAGNETIC RESONANCE (EG, PROTON) IMAGING, CHEST (EG, FOR EVALUATION OF HILAR AND MEDIASTINAL LYMPHA- DENOPATHY); WITHOUT CONTRAST MATERIAL(S) FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

71555

MAGNETIC RESONANCE ANGIOGRAPHY, CHEST (EXCLUDINGMYOCARDIUM), WITH OR WITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort

72010 RADIOLOGIC EXAMINATION, SPINE, ENTIRE, SURVEY STUDY,ANTEROPOSTERIOR AND LATERAL cohort cohort

72020 RADIOLOGIC EXAMINATION, SPINE, SINGLE VIEW, SPECIFY LEVEL cohort cohort cohort cohort cohort cohort

72040 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 3 VIEWS OR LESS cohort cohort cohort cohort cohort cohort

72050 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 4 OR 5 VIEWS cohort cohort cohort cohort cohort cohort

72052 RADIOLOGIC EXAMINATION, SPINE, CERVICAL; 6 OR MOREVIEWS cohort cohort cohort cohort cohort cohort

138

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

72069 RADIOLOGIC EXAMINATION, SPINE, THORACOLUMBAR, STANDING(SCOLIOSIS) cohort cohort cohort cohort cohort

72070 RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR ANDLATERAL cohort cohort cohort cohort cohort cohort

72072

RADIOLOGIC EXAMINATION, SPINE; THORACIC, ANTEROPOSTERIOR ANDLATERAL, INCLUDING SWIMMER'S VIEW OF THECERVICOTHORACIC JUNCTION cohort cohort cohort cohort cohort cohort

72074 RADIOLOGIC EXAMINATION, SPINE; THORACIC, COMPLETE,INCLUDINGOBLIQUES, MINIMUM OF FOUR VIEWS cohort cohort cohort cohort cohort

72080 RADIOLOGIC EXAMINATION, SPINE; THORACOLUMBAR,ANTEROPOSTERIOR AND LATERAL cohort cohort cohort cohort cohort

72090 RADIOLOGIC EXAMINATION, SPINE; SCOLIOSIS STUDY, INCLUDINGSUPINE AND ERECT STUDIES cohort cohort cohort cohort cohort

72100 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; ANTEROPOSTERIOR AND LATERAL cohort cohort cohort cohort cohort cohort

72110 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, WITHOBLIQUE VIEWS cohort cohort cohort cohort cohort cohort

72114 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; COMPLETE, INCLUDING BENDING VIEWS, MINIMUM OF 6 VIEWS cohort cohort cohort cohort cohort

72120 RADIOLOGIC EXAMINATION, SPINE, LUMBOSACRAL; BENDING VIEWS ONLY, 2 OR 3 VIEWS cohort cohort cohort cohort cohort

72125 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

72126 COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITH CONTRASTMATERIAL cohort cohort cohort cohort cohort

72127

COMPUTERIZED AXIAL TOMOGRAPHY, CERVICAL SPINE; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort

72128 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort

72129 COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITH CONTRASTMATERIAL cohort cohort cohort cohort cohort

72130

COMPUTERIZED AXIAL TOMOGRAPHY, THORACIC SPINE; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort

72131 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort

72132 COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITH CONTRASTMATERIAL cohort cohort cohort cohort cohort cohort

72133

COMPUTERIZED AXIAL TOMOGRAPHY, LUMBAR SPINE; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort

72141 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, CERVICAL; WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

72142 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, CERVICAL; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

72146 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, THORACIC; WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort

72147 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, THORACIC; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

72148 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, LUMBAR; WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

72149 MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, LUMBAR; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

72156

MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; CERVICAL cohort cohort cohort cohort cohort

72157

MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; THORACIC cohort cohort cohort cohort cohort

72158

MAGNETIC RESONANCE (EG, PROTON) IMAGING, SPINAL CANAL ANDCONTENTS, WITHOUT CONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; LUMBAR cohort cohort cohort cohort cohort cohort

139

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

72170 RADIOLOGIC EXAMINATION, PELVIS; ANTEROPOSTERIOR ONLY cohort cohort cohort cohort cohort cohort

72190 RADIOLOGIC EXAMINATION, PELVIS; COMPLETE, MINIMUM OF THREEVIEWS cohort cohort cohort cohort cohort

72191 Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, and image postprocessing cohort cohort cohort cohort cohort

72192 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRASTMATERIAL cohort cohort cohort cohort cohort cohort

72193 COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITH CONTRASTMATERIAL(S) cohort cohort cohort cohort cohort

72194

COMPUTERIZED AXIAL TOMOGRAPHY, PELVIS; WITHOUT CONTRASTMATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort cohort cohort

72195 MAGNETIC RESONANCE (EG, PROTON) IMAGING; PELVIS; WITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

72196 MAGNETIC RESONANCE (EG, PROTON) IMAGING, PELVIS cohort cohort cohort

72197

MAGNETIC RESONANCE (EG, PROTON) IMAGING; PELVIS; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRASTMATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

72198 MAGNETIC RESONANCE ANGIOGRAPHY, PELVIS, WITH OR WITHOUTCONTRAST MATERIAL(S) cohort cohort cohort

72200 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; LESS THAN THREEVIEWS cohort cohort cohort cohort

72202 RADIOLOGIC EXAMINATION, SACROILIAC JOINTS; THREE OR MOREVIEWS cohort cohort cohort cohort cohort

72220 RADIOLOGIC EXAMINATION, SACRUM AND COCCYX, MINIMUMOF TWOVIEWS cohort cohort cohort cohort cohort cohort

72240 MYELOGRAPHY, CERVICAL, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort cohort

72255 MYELOGRAPHY, THORACIC, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort

72265 MYELOGRAPHY, LUMBOSACRAL, RADIOLOGICAL SUPERVISIONANDINTERPRETATION cohort cohort cohort cohort cohort cohort

72270 MYELOGRAPHY, ENTIRE SPINAL CANAL, RADIOLOGICAL SUPERVISIONAND INTERPRETATION cohort cohort cohort cohort cohort

72275 EPIDUROGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

72291

RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, ORSACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVI TY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER F cohort cohort cohort

72292

RADIOLOGICAL SUPERVISION AND INTERPRETATION, PERCUTANEOUS VERTEBROPLASTY, VERTEBRAL AUGMENTATION, ORSACRAL AUGMENTATION (SACROPLASTY), INCLUDING CAVI TY CREATION, PER VERTEBRAL BODY OR SACRUM; UNDER C statewide

72295 DISKOGRAPHY, LUMBAR, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort

73000 RADIOLOGIC EXAMINATION; CLAVICLE, COMPLETE cohort cohort cohort cohort cohort cohort

73010 RADIOLOGIC EXAMINATION; SCAPULA, COMPLETE cohort cohort cohort cohort cohort cohort

73020 RADIOLOGIC EXAMINATION, SHOULDER; ONE VIEW cohort cohort cohort cohort cohort

73030 RADIOLOGIC EXAMINATION, SHOULDER; COMPLETE, MINIMUM OF TWOVIEWS cohort cohort cohort cohort cohort cohort

73040 RADIOLOGIC EXAMINATION, SHOULDER, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

73050 RADIOLOGIC EXAMINATION; ACROMIOCLAVICULAR JOINTS, BILATERAL,WITH OR WITHOUT WEIGHTED DISTRACTION cohort cohort cohort cohort cohort

73060 RADIOLOGIC EXAMINATION; HUMERUS, MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort cohort

73070 RADIOLOGIC EXAMINATION, ELBOW; ANTEROPOSTERIOR ANDLATERALVIEWS cohort cohort cohort cohort cohort

73080 RADIOLOGIC EXAMINATION, ELBOW; COMPLETE, MINIMUM OF THREEVIEWS cohort cohort cohort cohort cohort cohort

140

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

73085 RADIOLOGIC EXAMINATION, ELBOW, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort

73090

RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR AND LATERALVIEWS RADIOLOGIC EXAMINATION; FOREARM, ANTEROPOSTERIOR AND LATERAL cohort cohort cohort cohort cohort cohort

73092 RADIOLOGIC EXAMINATION; UPPER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort

73100 RADIOLOGIC EXAMINATION, WRIST; ANTEROPOSTERIOR ANDLATERALVIEWS cohort cohort cohort cohort cohort cohort

73110 RADIOLOGIC EXAMINATION, WRIST; COMPLETE, MINIMUM OF THREEVIEWS cohort cohort cohort cohort cohort cohort

73115 RADIOLOGIC EXAMINATION, WRIST, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

73120 RADIOLOGIC EXAMINATION, HAND; TWO VIEWS cohort cohort cohort cohort cohort

73130 RADIOLOGIC EXAMINATION, HAND; MINIMUM OF THREE VIEWS cohort cohort cohort cohort cohort cohort

73140 RADIOLOGIC EXAMINATION, FINGER(S), MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort cohort

73200 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

73201 COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

73202

COMPUTERIZED AXIAL TOMOGRAPHY, UPPER EXTREMITY; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort

73206

Computed tomographic angiography, upper extremity,with contrast material(s), including noncontrast images, if performed, and image postprocessing cohort cohort cohort cohort

73218

MAGNETIC RESONANCE (EG, PROTON) IMAGING; UPPER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

73219 MAGNETIC RESONANCE (EG, PROTON) IMAGING; UPPER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort

73220 MAGNETIC RESONANCE (EG, PROTON) IMAGING, UPPER EXTREMITY,OTHER THAN JOINT cohort cohort cohort cohort

73221 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF UPPER EXTREMITY cohort cohort cohort cohort cohort cohort

73222 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF UPPER EXTREMITY; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort cohort

73223

MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF UPPER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

73225 MAGNETIC RESONANCE ANGIOGRAPHY, UPPER EXTREMITY, WITH ORWITHOUT CONTRAST MATERIAL(S) cohort cohort cohort

73500 RADIOLOGIC EXAMINATION, HIP; UNILATERAL, ONE VIEW cohort cohort cohort cohort cohort

73510 RADIOLOGIC EXAMINATION, HIP, UNILATERAL; COMPLETE,MINIMUMOF TWO VIEWS cohort cohort cohort cohort cohort cohort

73520

RADIOLOGIC EXAMINATION, HIPS, BILATERAL, MINIMUM OF TWOVIEWS OF EACH HIP, INCLUDING ANTEROPOSTERIOR VIEW OF PELVIS cohort cohort cohort cohort cohort cohort

73525 RADIOLOGIC EXAMINATION, HIP, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort cohort

73530 RADIOLOGIC EXAMINATION, HIP, DURING OPERATIVE PROCEDURE cohort cohort cohort cohort

73540 RADIOLOGIC EXAMINATION, PELVIS AND HIPS, INFANT ORCHILD,MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort

73550 RADIOLOGIC EXAMINATION, FEMUR, ANTEROPOSTERIOR ANDLATERALVIEWS cohort cohort cohort cohort cohort cohort

73560 RADIOLOGIC EXAMINATION, KNEE; ONE OR TWO VIEWS cohort cohort cohort cohort cohort cohort

73562 RADIOLOGIC EXAMINATION, KNEE; THREE VIEWS cohort cohort cohort cohort cohort

73564 RADIOLOGIC EXAMINATION, KNEE; COMPLETE, FOUR OR MORE VIEWS cohort cohort cohort cohort cohort cohort

141

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

73565 RADIOLOGIC EXAMINATION, KNEE; BOTH KNEES, STANDING,ANTEROPOSTERIOR cohort cohort cohort cohort cohort

73580 RADIOLOGIC EXAMINATION, KNEE, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort

73590 RADIOLOGIC EXAMINATION; TIBIA AND FIBULA, ANTEROPOSTERIORAND LATERAL VIEWS cohort cohort cohort cohort cohort cohort

73592 RADIOLOGIC EXAMINATION; LOWER EXTREMITY, INFANT, MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort

73600 RADIOLOGIC EXAMINATION, ANKLE; ANTEROPOSTERIOR ANDLATERALVIEWS cohort cohort cohort cohort cohort cohort

73610 RADIOLOGIC EXAMINATION, ANKLE; COMPLETE, MINIMUM OF THREEVIEWS cohort cohort cohort cohort cohort cohort

73615 RADIOLOGIC EXAMINATION, ANKLE, ARTHROGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort

73620 RADIOLOGIC EXAMINATION, FOOT; ANTEROPOSTERIOR AND LATERALVIEWS cohort cohort cohort cohort cohort cohort

73630 RADIOLOGIC EXAMINATION, FOOT; COMPLETE, MINIMUM OFTHREEVIEWS cohort cohort cohort cohort cohort cohort

73650 RADIOLOGIC EXAMINATION; CALCANEUS, MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort

73660 RADIOLOGIC EXAMINATION; TOE(S), MINIMUM OF TWO VIEWS cohort cohort cohort cohort cohort cohort

73700 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUTCONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

73701 COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

73702

COMPUTERIZED AXIAL TOMOGRAPHY, LOWER EXTREMITY; WITHOUTCONTRAST MATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS cohort cohort cohort

73706

Computed tomographic angiography, lower extremity,with contrast material(s), including noncontrast images, if performed, and image postprocessing cohort cohort cohort cohort cohort

73718

MAGNETIC RESONANCE (EG, PROTON) IMAGING; LOWER EXTREMITY, OTHER THAN JOINT; WITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort cohort

73719 MAGNETIC RESONANCE (EG, PROTON) IMAGING; LOWER EXTREMITY, OTHER THAN JOINT; WITH CONTRAST MATERIAL(S) cohort cohort cohort

73720 MAGNETIC RESONANCE (EG, PROTON) IMAGING, LOWER EXTREMITY,OTHER THAN JOINT cohort cohort cohort cohort cohort

73721 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL cohort cohort cohort cohort cohort cohort

73722 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF LOWER EXTREMITY; WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

73723

MAGNETIC RESONANCE (EG, PROTON) IMAGING, ANY JOINTOF LOWER EXTREMITY; WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

73725 MAGNETIC RESONANCE ANGIOGRAPHY, LOWER EXTREMITY, WITH ORWITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort

74000 RADIOLOGIC EXAMINATION, ABDOMEN; SINGLE ANTEROPOSTERIOR VIEW cohort cohort cohort cohort cohort cohort

74010 RADIOLOGIC EXAMINATION, ABDOMEN; ANTEROPOSTERIOR ANDADDITIONAL OBLIQUE AND CONE VIEWS cohort cohort cohort cohort cohort

74020 RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE, INCLUDINGDECUBITUS AND/OR ERECT VIEWS cohort cohort cohort cohort cohort cohort

74022

RADIOLOGIC EXAMINATION, ABDOMEN; COMPLETE ACUTE ABDOMENSERIES, INCLUDING SUPINE, ERECT, AND/OR DECUBITUS VIEWS, UPRIGHT PA CHEST cohort cohort cohort cohort cohort cohort

74150 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRASTMATERIAL cohort cohort cohort cohort cohort

74160 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITH CONTRASTMATERIAL(S) cohort cohort cohort cohort cohort cohort

74170 COMPUTERIZED AXIAL TOMOGRAPHY, ABDOMEN; WITHOUT CONTRASTMATERIAL, FOLLOWED BY CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

142

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

AND FURTHER SECTIONS

74174

COMPUTED TOMOGRAPHIC ANGIOGRAPHY, ABDOMEN AND PELVIS, WITH CONTRAST MATERIAL(S), INCLUDING NONCONTRAST IMAGES, IF PERFORMED, AND IMAGE POSTPROCESSING cohort cohort cohort cohort cohort

74175

Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if performed, and image postprocessing cohort cohort cohort cohort cohort

74176 Computed tomography, abdomen and pelvis; without contrast material cohort cohort cohort cohort cohort cohort

74177 Computed tomography, abdomen and pelvis; with contrast material(s) cohort cohort cohort cohort cohort cohort

74178

Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by contrast material(s) and further sections in one or both body regions cohort cohort cohort cohort cohort cohort

74181 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN WITHOUT CONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

74182 MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN WITH CONTRAST MATERIAL(S) cohort cohort cohort cohort

74183

MAGNETIC RESONANCE (EG, PROTON) IMAGING, ABDOMEN WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY WITH CONTRAST MATERIAL(S) AND FURTHER SEQUENCES cohort cohort cohort cohort cohort

74185 MAGNETIC RESONANCE ANGIOGRAPHY, ABDOMEN, WITH OR WITHOUTCONTRAST MATERIAL(S) cohort cohort cohort cohort cohort

74210 RADIOLOGIC EXAMINATION; PHARYNX AND/OR CERVICAL ESOPHAGUS cohort cohort cohort

74220 RADIOLOGIC EXAMINATION; ESOPHAGUS cohort cohort cohort cohort cohort cohort

74230 SWALLOWING FUNCTION, PHARYNX AND/OR ESOPHAGUS, WITHCINERADIOGRAPHY AND/OR VIDEO cohort cohort cohort cohort cohort

74240 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITHOUT KUB cohort cohort cohort cohort cohort

74241 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH OR WITHOUT DELAYED FILMS, WITH KUB cohort cohort cohort cohort cohort

74245 RADIOLOGIC EXAMINATION, GASTROINTESTINAL TRACT, UPPER; WITH SMALL BOWEL, INCLUDES MULTIPLE SERIAL FILMS cohort cohort cohort cohort cohort

74246

RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIRCONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED cohort cohort cohort cohort cohort cohort

74247

RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIRCONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH OR WITHOUT DELAYED cohort cohort cohort cohort cohort

74249

RADIOLOGICAL EXAMINATION, GASTROINTESTINAL TRACT, UPPER, AIRCONTRAST, WITH SPECIFIC HIGH DENSITY BARIUM, EFFERVESCENT AGENT, WITH OR WITHOUT GLUCAGON; WITH SMALL BOWEL cohort cohort cohort cohort cohort

74250 RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLESERIAL FILMS cohort cohort cohort cohort cohort

74251 RADIOLOGIC EXAMINATION, SMALL BOWEL, INCLUDES MULTIPLESERIAL FILMS; VIA ENTEROCLYSIS TUBE statewide

74261

COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRASTMATERIAL cohort cohort cohort cohort cohort

74263 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING,INCLUDING IMAGE POSTPROCESSING cohort cohort cohort

74270 Radiologic examination, colon; contrast (e.g., barium) enema, with or without KUB cohort cohort cohort cohort cohort

74280 RADIOLOGIC EXAMINATION, COLON; AIR CONTRAST WITH SPECIFICHIGH DENSITY BARIUM, WITH OR WITHOUT GLUCAGON cohort cohort cohort cohort cohort

74283

THERAPEUTIC ENEMA, CONTRAST OR AIR, FOR REDUCTION OFINTUSSUSCEPTION OR OTHER INTRALUMINAL OBSTRUCTION (EG, MECONIUM ILEUS) cohort cohort cohort

74290 CHOLECYSTOGRAPHY, ORAL CONTRAST; statewide

74300 CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; cohort cohort cohort cohort cohort

143

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

INTRAOPERATIVE,RADIOLOGICAL SUPERVISION AND INTERPRETATION

74301

CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; ADDITIONALSETINTRAOPERATIVE, RADIOLOGICAL SUPERVISION AND I NTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

74305

CHOLANGIOGRAPHY AND/OR PANCREATOGRAPHY; POSTOPERATIVE,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

74320 CHOLANGIOGRAPHY, PERCUTANEOUS, TRANSHEPATIC, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort

74327

POSTOPERATIVE BILIARY DUCT STONE REMOVAL, PERCUTANEOUS VIAT-TUBE TRACT, BASKET OR SNARE (EG, BURHENNE TECHNIQUE), RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

74328

ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM,RADIOLOGICAL SUPERVISION AND INTERPRETATION ENDOSCOPIC CATHETERIZATION OF THE BILIARY DUCTAL SYSTEM, cohort cohort cohort cohort cohort

74329

ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, RADIOLOGICAL SUPERVISION AND INTERPRETATION ENDOSCOPIC CATHETERIZATION OF THE PANCREATIC DUCTAL SYSTEM, cohort cohort cohort

74330

COMBINED ENDOSCOPIC CATHETERIZATION OF THE BILIARYANDPANCREATIC DUCTAL SYSTEMS, RADIOLOGICAL SUPERV ISION AND INTERPRETATION cohort cohort cohort cohort cohort

74340

INTRODUCTION OF LONG GASTROINTESTINAL TUBE (EG,MILLER-ABBOTT), INCLUDING MULTIPLE FLUOROSCOPIES AND FILMS, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

74360

INTRALUMINAL DILATION OF STRICTURES AND/OR OBSTRUCTIONS (EG,ESOPHAGUS), RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort

74363

PERCUTANEOUS TRANSHEPATIC DILATATION OF BILIARY DUCTSTRICTURE WITH OR WITHOUT PLACEMENT OF STENT, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

74400

UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB,WITH OR WITHOUT TOMOGRAPHY; UROGRAPHY (PYELOGRAPHY), INTRAVENOUS, WITH OR WITHOUT KUB, cohort cohort cohort cohort cohort

74410

UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; cohort cohort cohort

74415

UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; WITH NEPHROTOMOGRAPHY UROGRAPHY, INFUSION, DRIP TECHNIQUE AND/OR BOLUS TECHNIQUE; cohort cohort cohort cohort

74420 UROGRAPHY, RETROGRADE, WITH OR WITHOUT KUB cohort cohort cohort cohort cohort

74425

UROGRAPHY, ANTEGRADE, (PYELOSTOGRAM, NEPHROSTOGRAM,LOOPOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

74430 CYSTOGRAPHY, MINIMUM OF THREE VIEWS, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

74450 URETHROCYSTOGRAPHY, RETROGRADE, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort cohort

74455 URETHROCYSTOGRAPHY, VOIDING, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort cohort

74475

INTRODUCTION OF INTRACATHETER OR CATHETER INTO RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

74480

INTRODUCTION OF URETERAL CATHETER OR STENT INTO URETERTHROUGH RENAL PELVIS FOR DRAINAGE AND/OR INJECTION, PERCUTANEOUS, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

74485 DILATION OF NEPHROSTOMY, URETERS, OR URETHRA, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort

74710 PELVIMETRY, WITH OR WITHOUT PLACENTAL LOCALIZATION statewide

144

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

74740 HYSTEROSALPINGOGRAPHY, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort cohort cohort

74742 TRANSCERVICAL CATHETERIZATION OF FALLOPIAN TUBE,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

74775 PERINEOGRAM (EG, VAGINOGRAM, FOR SEX DETERMINATIONOR EXTENTOF ANOMALIES) statewide

75557 Cardiac magnetic resonance imaging for morphology and function without contrast material; cohort cohort cohort

75561

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; cohort cohort cohort

75563

Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast material(s) and further sequences; with stress imaging statewide

75565

CARDIAC MAGNETIC RESONANCE IMAGING FOR VELOCITY FLOW MAPPING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

75571

COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE EVALUATION OF CORONARY CALCIUM cohort cohort cohort cohort

75572

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRU cohort cohort cohort

75573

COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV C cohort cohort

75574

COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING(INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MO cohort cohort cohort cohort cohort

75600 AORTOGRAPHY, THORACIC, WITHOUT SERIALOGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort

75605 AORTOGRAPHY, THORACIC, BY SERIALOGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75625 AORTOGRAPHY, ABDOMINAL, BY SERIALOGRAPHY, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

75630

AORTOGRAPHY, ABDOMINAL PLUS BILATERAL ILIOFEMORAL LOWEREXTREMITY, CATHETER, BY SERIALOGRAPHY, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75635

Computed tomographic angiography, abdominal aorta and bilateral iliofemoral lower extremity runoff, with contrast material(s), including noncontrast images, if performed, and image postprocessing. cohort cohort cohort cohort cohort

75705 ANGIOGRAPHY, SPINAL, SELECTIVE, RADIOLOGICAL SUPERVISION ANDINTERPRETATION statewide

75710 ANGIOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISIONAND INTERPRETATION cohort cohort cohort cohort cohort

75716 ANGIOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

75726

ANGIOGRAPHY, VISCERAL, SELECTIVE OR SUPRASELECTIVE, (WITH ORWITHOUT FLUSH AORTOGRAM), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

75733 ANGIOGRAPHY, ADRENAL, BILATERAL, SELECTIVE, RADIOLOGICALSUPERVISION AND INTERPRETATION statewide

75736

ANGIOGRAPHY, PELVIC, SELECTIVE OR SUPRASELECTIVE,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

75741 ANGIOGRAPHY, PULMONARY, UNILATERAL, SELECTIVE, RADIOLOGICAL SUPERVISION cohort cohort

75743 ANGIOGRAPHY, PULMONARY, BILATERAL, SELECTIVE, RADIOLOGICALSUPERVISION AND INTERPRETATION statewide

75756 ANGIOGRAPHY, INTERNAL MAMMARY, RADIOLOGICAL statewide

145

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

SUPERVISION AND INTERPRETATION

75774

ANGIOGRAPHY, SELECTIVE, EACH ADDITIONAL VESSEL STUDIED AFTERBASIC EXAMINATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR cohort cohort cohort cohort

75791

ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT FISTULA/GRAFT), COMPLETE EVALUATION OF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT (INCLUDES INJECTIONS OF CONTRAST AN statewide

75809

SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLINGNONVASCULAR SHUNT (EG, LEVEEN SHUNT, VENTRICULOPERITONEAL SHUNT), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

75820 VENOGRAPHY, EXTREMITY, UNILATERAL, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75822 VENOGRAPHY, EXTREMITY, BILATERAL, RADIOLOGICAL SUPERVISIONAND INTERPRETATION cohort cohort cohort cohort

75825

VENOGRAPHY, CAVAL, INFERIOR, WITH SERIALOGRAPHY,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75827

VENOGRAPHY, CAVAL, SUPERIOR, WITH SERIALOGRAPHY,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75831 VENOGRAPHY, RENAL, UNILATERAL, SELECTIVE, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort

75833 VENOGRAPHY, RENAL, BILATERAL, SELECTIVE, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort

75860 VENOGRAPHY, SINUS OR JUGULAR, CATHETER, RADIOLOGICALSUPERVISION AND INTERPRETATION statewide

75870 VENOGRAPHY, SUPERIOR SAGITTAL SINUS, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort

75885

PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITH HEMODYNAMICEVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

75887

PERCUTANEOUS TRANSHEPATIC PORTOGRAPHY WITHOUT HEMODYNAMICEVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

75889

HEPATIC VENOGRAPHY, WEDGED OR FREE, WITH HEMODYNAMICEVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

75891

HEPATIC VENOGRAPHY, WEDGED OR FREE, WITHOUT HEMODYNAMICEVALUATION, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

75893

VENOUS SAMPLING THROUGH CATHETER, WITH OR WITHOUTANGIOGRAPHY (EG, FOR PARATHYROID HORMONE, RENIN), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

75894 TRANSCATHETER THERAPY, EMBOLIZATION, ANY METHOD,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort

75896

TRANSCATHETER THERAPY, INFUSION, OTHER THAN FOR THROMBOLYSIS, RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

75898

ANGIOGRAPHY THROUGH EXISTING CATHETER FOR FOLLOW-UP STUDY FOR TRANSCATHETER THERAPY, EMBOLIZATION ORINFUSION, OTHER THAN FOR THROMBOLYSIS cohort cohort cohort

75901 MECHANICAL REMOVE, PERICATHETER OBSTRUCTIVE MATL FROM CVA DEVICE VIA SEP VENOUS ACCESS S&I cohort cohort cohort

75945

INTRAVASCULAR ULTRASOUND (NON-CORONARY VESSEL), RADIOLOGICALSUPERVISION AND INTERPRETATION; INITIAL VESSEL statewide

75960

Transcatheter introduction of intravascular stent(s) (except coronary, carotid, vertebral, iliac, and lower extremity artery), percutaneous and/or open, radiological supervision and interpretation, ea cohort cohort cohort cohort cohort

75962

TRANSLUMINAL BALLOON ANGIOPLASTY, PERIPHERAL ARTERY OTHER THAN RENAL, OR OTHER VISCERAL ARTERY, ILIAC OR LOWER EXTREMITY, RADIOLOGICAL SUPERVISION cohort cohort cohort cohort cohort

146

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ANDINTERPRETATION

75966

TRANSLUMINAL BALLOON ANGIOPLASTY, RENAL OR OTHER VISCERALARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

75968

TRANSLUMINAL BALLOON ANGIOPLASTY, EACH ADDITIONAL VISCERALARTERY, RADIOLOGICAL SUPERVISION AND INTERPRETATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

75970 TRANSCATHETER BIOPSY, RADIOLOGICAL SUPERVISION ANDINTERPRETATION cohort cohort cohort

75978

TRANSLUMINAL BALLOON ANGIOPLASTY, VENOUS (EG, SUBCLAVIANSTENOSIS), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

75982

PERCUTANEOUS PLACEMENT OF DRAINAGE CATHETER FOR COMBINEDINTERNAL AND EXTERNAL BILIARY DRAINAGE OR OFA DRAINAGE STENT FOR INTERNAL BILIARY DRAINAGE I N PATIENTS WITH AN cohort cohort

75984

Change of percutaneous tube or drainage catheter with contrast monitoring (e.g., genitourinary system, abscess), radiological supervision and interpretation cohort cohort cohort cohort cohort

75989

RADIOLOGICAL GUIDANCE FOR PERCUTANEOUS DRAINAGE OFABSCESS, OR SPECIMEN COLLECTION (IE, FLUOROSCOPY, ULTRASOUND, OR COMPUTED TOMOGRAPHY), WITH PLACEM ENT OF INDWELLING CATHETER, cohort cohort cohort cohort

76000

FLUOROSCOPY (SEPARATE PROCEDURE), UP TO 1 HOUR PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONALTIME, OTHER THAN 71023 OR 71034 (EG, CARDIAC FLUO ROSCOPY) cohort cohort cohort cohort cohort cohort

76001

FLUOROSCOPY, PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL TIME MORE THAN 1 HOUR, ASSISTING A NONRADIOLOGIC PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (EG, NEPHROSTOLITHOTOMY, ERCP, cohort cohort cohort cohort cohort cohort

76010 RADIOLOGIC EXAMINATION FROM NOSE TO RECTUM FOR FOREIGN BODY,SINGLE FILM, CHILD cohort cohort cohort cohort

76080

RADIOLOGIC EXAMINATION, ABSCESS, FISTULA OR SINUS TRACTSTUDY, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

76098 RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN cohort cohort cohort cohort cohort

76100 RADIOLOGIC EXAMINATION, SINGLE PLANE BODY SECTION (EG,TOMOGRAPHY), OTHER THAN WITH UROGRAPHY cohort cohort

76120 CINERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED statewide

76125

CINERADIOGRAPHY TO COMPLEMENT ROUTINE EXAMINATION (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

76140 CONSULTATION ON X-RAY EXAMINATION MADE ELSEWHERE, WRITTENREPORT statewide

76365

COMPUTERIZED TOMOGRAPHY GUIDANCE FOR CYST ASPIRATION,RADIOLOGICAL SUPERVISION AND INTERPRETATION statewide

76376

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; NOT cohort cohort cohort cohort

76377

3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY WITH IMAGE POSTPROCESSING UNDER CONCURRENT SUPERVISION; REQ cohort cohort cohort cohort cohort

76380 COMPUTERIZED TOMOGRAPHY, LIMITED OR LOCALIZED FOLLOW-UPSTUDY cohort cohort cohort cohort cohort

76390 MAGNETIC RESONANCE SPECTROSCOPY statewide

76496 UNLISTED FLUOROSCOPIC PROCEDURE cohort cohort

76497 UNLISTED COMPUTED TOMOGRAPHY PROCEDURE cohort cohort

147

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

76498 UNLISTED MAGNETIC RESONANCE PROCEDURE cohort cohort

76499 UNLISTED DIAGNOSTIC RADIOLOGIC PROCEDUREUNLISTED DIAGNOSTIC RADIOLOGIC PROCEDURE cohort cohort cohort

76506

Echoencephalography, real time with image documentation (gray sale) (for determination of ventricular size, delineation of cerebral contents, and detection of fluid masses or other intracranial abnorm cohort cohort cohort cohort

76512 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CONTACTB-SCAN (WITH OR WITHOUT SIMULTANEOUS A-SCAN) statewide

76513 OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; IMMERSION(WATER BATH) B-SCAN statewide

76514

OPHTHALMIC ULTRASOUND, ECHOGRAPHY, DIAGNOSTIC; CORNEAL PACHYMETRY, UNILATERAL OR BILATERAL (DETERMINATION OF CORNEAL THICKNESS) statewide

76519 OPHTHALMIC BIOMETRY BY ULTRASOUND ECHOGRAPHY, A-SCAN; WITHINTRAOCULAR LENS POWER CALCULATION statewide

76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid) real time with image documentation cohort cohort cohort cohort cohort cohort

76604 Ultrasound, chest (includes mediastinum), real time with image documentation cohort cohort cohort cohort cohort

76645 Ultrasound, breast(s) (unilateral or bilateral), real time with image documentation cohort cohort cohort cohort cohort cohort

76700 Ultrasound, abdominal, real time with image documentation; complete cohort cohort cohort cohort cohort cohort

76705

ECHOGRAPHY, ABDOMINAL, B-SCAN AND/OR REAL TIME WITH IMAGEDOCUMENTATION; LIMITED (EG, SINGLE ORGAN, QUADRANT, FOLLOW-UP) cohort cohort cohort cohort cohort cohort

76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete cohort cohort cohort cohort cohort cohort

76775

ECHOGRAPHY, RETROPERITONEAL (EG, RENAL, AORTA, NODES),B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; LIMITED cohort cohort cohort cohort cohort

76776 ULTRASOUND, TRANSPLANTED KIDNEY, REAL TIME AND DUPLEX DOPPLER WITH IMAGE DOCUMENTATION cohort cohort cohort cohort

76800 ECHOGRAPHY, SPINAL CANAL AND CONTENTS cohort cohort cohort cohort cohort

76801 US,PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL & MATERNAL, 1ST TRIMEST, TRANSABDOM SINGL/1ST GEST cohort cohort cohort cohort cohort

76802 US,PREG UTER, REAL TIME W/IMAGE DOCUMENT, FETAL & MATERNAL, 1ST TRIMEST, TRANSABDOM;EA ADD'L GEST cohort cohort cohort

76805

ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITHIMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL AND MATERNAL EVALUATION) cohort cohort cohort cohort cohort

76810

ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITHIMAGE DOCUMENTATION; COMPLETE (COMPLETE FETAL AND MATERNAL EVALUATION), MULTIPLE GESTATION, AFTER THE FIRST TRIMESTER cohort cohort cohort cohort cohort

76811 US,PREG UTER, REAL TIME W/IMAGE DOC FETL & MATRNL + DETL FETL EXM, TRANSABD; SINGL/1ST ADD'L GEST cohort cohort cohort cohort

76812 US,PREG UTER, REAL TIME W/IMAGE DOC FETAL & MATERNAL,+ DETAIL FETAL EXAM TRANSABD; EA ADD'L GEST cohort cohort cohort cohort

76813

ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINALAPPROACH; SINGLE OR FIRST GESTATION cohort cohort cohort cohort

76814

ULTRASOUND, PREGNANT UTERUS, REAL TIME WITH IMAGE DOCUMENTATION, FIRST TRIMESTER FETAL NUCHAL TRANSLUCENCY MEASUREMENT, TRANSABDOMINAL OR TRANSVAGINALAPPROACH; EACH ADDITIONAL GESTATION (LIST SEPARAT cohort cohort cohort cohort

76815

ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITHIMAGE DOCUMENTATION; LIMITED (FETAL SIZE, HEART BEAT, PLACENTAL LOCATION, FETAL POSITION, OREMERGENCY IN THE cohort cohort cohort cohort cohort

76816 ECHOGRAPHY, PREGNANT UTERUS, B-SCAN AND/OR REAL TIME WITHIMAGE DOCUMENTATION; FOLLOW-UP OR REPEAT cohort cohort cohort cohort cohort

148

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

76817 US,PREGNANT UTERUS,REAL TIME W/IMAGE DOCUMENT TRANSVAGINAL cohort cohort cohort cohort cohort

76818 FETAL BIOPHYSICAL PROFILE cohort cohort cohort cohort

76819 FETAL BIOPHYSICAL PROFILE : WITH NON-STRESS TESTING cohort cohort cohort cohort

76820 UMBILICAL ARTERY ECHO cohort cohort cohort

76821 MIDDLE CEREBRAL ARTERY ECHO cohort cohort cohort

76825

ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIMEWITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; cohort cohort

76826

ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM, REAL TIMEWITH IMAGE DOCUMENTATION (2D) WITH OR WITHOUT M-MODE RECORDING; FOLLOW-UP OR REPEAT STUDY cohort cohort

76827

DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM,PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; COMPLETE cohort cohort cohort

76828

DOPPLER ECHOCARDIOGRAPHY, FETAL, CARDIOVASCULAR SYSTEM,PULSED WAVE AND/OR CONTINUOUS WAVE WITH SPECTRAL DISPLAY; FOLLOW-UP OR REPEAT STUDY cohort cohort

76830 ECHOGRAPHY, TRANSVAGINAL cohort cohort cohort cohort cohort cohort

76831 HYSTEROSONOGRAPHY, WITH OR WITHOUT COLOR FLOW DOPPLER cohort cohort cohort

76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete cohort cohort cohort cohort cohort cohort

76857

ECHOGRAPHY, PELVIC (NONOBSTETRIC), B-SCAN AND/OR REAL TIMEWITH IMAGE DOCUMENTATION; LIMITED OR FOLLOW-UP (EG, FOR FOLLICLES) cohort cohort cohort cohort cohort

76870 ECHOGRAPHY, SCROTUM AND CONTENTS cohort cohort cohort cohort cohort cohort

76872 ECHOGRAPHY, TRANSRECTAL cohort cohort cohort cohort cohort

76873

ECHOGRAPHY, PROSTATE VOLUME STUDAY FOR BRACHYTHERAPY TREATMENT PLANNIN (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

76881 Ultrasound, extremity, nonvascular, real-time withimage documentation; complete cohort cohort cohort cohort cohort cohort

76882 Ultrasound, extremity, nonvascular, real-time withimage documentation; limited, anatomic specific cohort cohort cohort cohort cohort

76885

ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; DYNAMIC (REQUIRING PHYSICIAN OR OTHERQUALIFIED HEALTH CARE PROFESSIONAL MANIPULATION) cohort cohort cohort cohort

76886

ULTRASOUND, INFANT HIPS, REAL TIME WITH IMAGING DOCUMENTATION; LIMITED, STATIC (NOT REQUIRING PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL MANIPULATION) cohort cohort cohort cohort

76932 ULTRASONIC GUIDANCE FOR ENDOMYOCARDIAL BIOPSY, RADIOLOGICAL SUPERVISION statewide

76936

ULTRASOUND GUIDED COMPRESSION REPAIR OF ARTERIALPSEUDO-ANEURYSM OR ARTERIOVENOUS FISTULAE (INCLUDES DIAGNOSTIC ULTRASOUND EVALUATION, COMPRESSION OF LESION AND cohort cohort cohort

76937

ULTRASOUND GUIDANCE FOR VASCULAR ACCESS REQUIRING ULTRASOUND EVALUATION OF POTENTIAL ACCESS SITES, DOCUMENTATION OF SELECTED VESSEL PATENCY, CONCURRENT REALTIME ULTRASOUND VISUALIZATION OF VASCULAR NE cohort cohort cohort cohort cohort cohort

76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation statewide

76941

ULTRASONIC GUIDANCE FOR INTRAUTERINE FETAL TRANSFUSION ORCORDOCENTESIS, RADIOLOGICAL SUPERVISION ANDINTERPRETATION statewide

76942

ULTRASONIC GUIDANCE FOR NEEDLE PLACEMENT(EG,BIOPSYASPIRATION, INJECTION,LOCALIZATION DEVICE) IMAGINGSUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort cohort

76945 ULTRASONIC GUIDANCE FOR CHORIONIC VILLUS SAMPLING,RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

149

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

76946 ULTRASONIC GUIDANCE FOR AMNIOCENTESIS, RADIOLOGICALSUPERVISION AND INTERPRETATION cohort cohort cohort cohort

76950 ECHOGRAPHY FOR PLACEMENT OF RADIATION THERAPY FIELDS, B-SCAN statewide

76965

ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENTAPPLICATION ULTRASONIC GUIDANCE FOR INTERSTITIAL RADIOELEMENT cohort cohort cohort cohort

76970 ULTRASOUND STUDY FOLLOW-UP (SPECIFY) cohort cohort

76998 ULTRASONIC GUIDANCE, INTRAOPERATIVE cohort cohort cohort cohort cohort

76999 UNLISTED ULTRASOUND PROCEDURE cohort cohort cohort cohort cohort

77001

FLUOROSCOPIC GUIDANCE FOR CENTRAL VENOUS ACCESS DEVICE PLACEMENT, REPLACEMENT (CATHETER ONLY OR COMPLETE), OR REMOVAL (INCLUDES FLUOROSCOPIC GUIDANCE FOR VASCULAR ACCESS AND CATHETER MANIPULATION, ANY cohort cohort cohort cohort cohort cohort

77002 FLUOROSCOPIC GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE) cohort cohort cohort cohort cohort cohort

77003

FLUOROSCOPIC GUIDANCE AND LOCALIZATION OF NEEDLE OR CATHETER TIP FOR SPINE OR PARASPINOUS DIAGNOSTICOR THERAPEUTIC INJECTION PROCEDURES (EPIDURAL OR SUBARACHNOID) cohort cohort cohort cohort cohort cohort

77011 COMPUTED TOMOGRAPHY GUIDANCE FOR STEREOTACTIC LOCALIZATION cohort cohort

77012

COMPUTED TOMOGRAPHY GUIDANCE FOR NEEDLE PLACEMENT (EG, BIOPSY, ASPIRATION, INJECTION, LOCALIZATION DEVICE), RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

77013 COMPUTERIZED TOMOGRAPHY GUIDANCE FOR, AND MONITORING OF, PARENCHYMAL TISSUE ABLATION cohort cohort cohort

77014 COMPUTED TOMOGRAPHY GUIDANCE FOR PLACEMENT OF RADIATION THERAPY FIELDS cohort cohort cohort cohort cohort

77021

MAGNETIC RESONANCE GUIDANCE FOR NEEDLE PLACEMENT (EG, FOR BIOPSY, NEEDLE ASPIRATION, INJECTION, OR PLACEMENT OF LOCALIZATION DEVICE) RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

77031

STEREOTACTIC LOCALIZATION GUIDANCE FOR BREAST BIOPSY OR NEEDLE PLACEMENT (EG, FOR WIRE LOCALIZATION OR FOR INJECTION), EACH LESION, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

77032

MAMMOGRAPHIC GUIDANCE FOR NEEDLE PLACEMENT, BREAST(EG, FOR WIRE LOCALIZATION OR FOR INJECTION), EAC H LESION, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort cohort

77051

COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR LESION DETECTION) WITH FURTHER REVIEW FOR INTERPRETATION, WITH OR WITHOUT DIGITIZATION OF FILM RADIOGRAPHIC IMAGES; DIAG cohort cohort cohort cohort cohort

77052

COMPUTER-AIDED DETECTION (COMPUTER ALGORITHM ANALYSIS OF DIGITAL IMAGE DATA FOR LESION DETECTION) WITH FURTHER REVIEW FOR INTERPRETATION, WITH OR WITHOUT DIGITIZATION OF FILM RADIOGRAPHIC IMAGES; SCRE cohort cohort cohort cohort cohort

77053 MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort cohort cohort

77054 MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS, RADIOLOGICAL SUPERVISION AND INTERPRETATION cohort cohort

77055 MAMMOGRAPHY; UNILATERAL cohort cohort cohort cohort cohort

77056 MAMMOGRAPHY; BILATERAL cohort cohort cohort cohort cohort

77057 SCREENING MAMMOGRAPHY, BILATERAL (2-VIEW FILM STUDY OF EACH BREAST) cohort cohort cohort cohort cohort

77058 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/ORWITH CONTRAST MATERIAL(S); UNILATERAL cohort cohort cohort cohort

77059 MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/ORWITH CONTRAST MATERIAL(S); BILATERAL cohort cohort cohort cohort cohort

77072 BONE AGE STUDIES cohort cohort cohort cohort cohort

77073 BONE LENGTH STUDIES (ORTHOROENTGENOGRAM, cohort cohort cohort cohort

150

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

SCANOGRAM)

77074 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; LIMITED (EG, FOR METASTASES) cohort cohort cohort cohort

77075 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY; COMPLETE (AXIAL AND APPENDICULAR SKELETON) cohort cohort cohort cohort cohort

77076 RADIOLOGIC EXAMINATION, OSSEOUS SURVEY, INFANT cohort cohort

77077 JOINT SURVEY, SINGLE VIEW, 2 OR MORE JOINTS (SPECIFY) cohort cohort cohort cohort

77078 COMPUTED TOMOGRAPHY, BONE MINERAL DENSITY STUDY, 1OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE) cohort cohort

77080

DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; AXIAL SKELETON (EG, HIPS, PELVIS, SPINE) cohort cohort cohort cohort cohort cohort

77081

DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) cohort cohort cohort cohort

77082

DUAL-ENERGY X-RAY ABSORPTIOMETRY (DXA), BONE DENSITY STUDY, 1 OR MORE SITES; VERTEBRAL FRACTURE ASSESSMENT cohort cohort

77280 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING; SIMPLE cohort cohort cohort cohort cohort

77285 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING;INTERMEDIATE cohort cohort cohort

77290 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING;COMPLEX cohort cohort cohort cohort cohort

77295 THERAPEUTIC RADIOLOGY SIMULATION-AIDED FIELD SETTING;THREE-DIMENSIONAL cohort cohort cohort cohort cohort

77300

BASIC RADIATION DOSIMETRY CALCULATION, CENTRAL AXIS DEPTHDOSE, TDF, NSD, GAP CALCULATION, OFF AXIS FACTOR, TISSUE INHOMOGENEITY FACTORS, AS REQUIREDDURING COURSE OF cohort cohort cohort cohort cohort

77301 INTENSITY MODULATED RADIOTHERAPY PLAN W/DOSE VOLUME HISTOGRAMS cohort cohort cohort cohort cohort

77305

TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTERCALCULATED); SIMPLE (ONE OR TWO PARALLEL OPPOSED UNMODIFIED PORTS DIRECTED TO A SINGLE AREA OF INTEREST) cohort cohort cohort cohort

77310

TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTERCALCULATED); INTERMEDIATE (THREE OR MORE TREATMENT PORTS DIRECTED TO A SINGLE AREA OF INTEREST) cohort cohort cohort

77315

TELETHERAPY, ISODOSE PLAN (WHETHER HAND OR COMPUTERCALCULATED); COMPLEX (MANTLE OR INVERTED Y, TANGENTIAL PORTS, THE USE OF WEDGES, COMPENSATORS, COMPLEX BLOCKING, cohort cohort cohort cohort cohort

77321 SPECIAL TELETHERAPY PORT PLAN, PARTICLES, HEMI-BODY, TOTALBODY cohort cohort cohort cohort cohort

77326

BRACHYTHERAPY ISODOSE CALCULATION; SIMPLE (CALCULATION MADE FROM SINGLE PLANE, ONE TO FOUR SOURCES/RIBBON APPLICATION, REMOTE AFTERLOADING BRACHYTHERAPY, 1 TO 8 SOURCES) cohort cohort cohort

77327

BRACHYTHERAPY ISODOSE CALCULATION; INTERMEDIATE (MULTIPLANE DOSAGE CALCULATIONS, APPLICATION INVOLVING 5 TO 10 SOURCES/RIBBONS, REMOTE AFTERLOADING BRACHYTHERAPY, 9 TO 12 cohort cohort

77328

BRACHYTHERAPY ISODOSE CALCULATION; COMPLEX (MULTIPLANEISODOSE PLAN, VOLUME IMPLANT CALCULATIONS, OVER 10 SOURCES/RIBBONS USED, SPECIAL SPATIAL RECONSTRUCTION, REMOTE cohort cohort cohort cohort

77331

SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY WHEN PRESCRIBED BY THE TREATING PHYSICIAN SPECIAL DOSIMETRY (EG, TLD, MICRODOSIMETRY) (SPECIFY), ONLY cohort cohort cohort cohort cohort

77332 TREATMENT DEVICES, DESIGN AND CONSTRUCTION; SIMPLE(SIMPLEBLOCK, SIMPLE BOLUS) cohort cohort cohort cohort cohort

151

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

77333

TREATMENT DEVICES, DESIGN AND CONSTRUCTION; INTERMEDIATE(MULTIPLE BLOCKS, STENTS, BITE BLOCKS, SPECIAL BOLUS) cohort cohort cohort cohort cohort

77334

TREATMENT DEVICES, DESIGN AND CONSTRUCTION; COMPLEX(IRREGULAR BLOCKS, SPECIAL SHIELDS, COMPENSATORS,WEDGES, MOLDS OR CASTS) cohort cohort cohort cohort cohort

77336

CONTINUING MEDICAL PHYSICS CONSULTATION, INCLUDINGASSESSMENT OF TREATMENT PARAMETERS, QUALITY ASSURANCE OF DOSE DELIVERY, AND REVIEW OF PATIENT TREATMENT DOCUMENTATION cohort cohort cohort cohort cohort

77338

MULTI-LEAF COLLIMATOR(MLC) DEVICE(S) FOR INTENSITYMODULATED RADIATION THERAPY (IMRT),DESIGN AND CONSTRUCTION PER IMRT PLAN cohort cohort cohort cohort cohort

77370 SPECIAL MEDICAL RADIATION PHYSICS CONSULTATION cohort cohort cohort cohort cohort

77371

Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of 1 session; multi-sourceCobalt 60 based statewide

77373

STEREOTACTIC BODY RADIATION THERAPY, TREATMENT DELIVERY, PER FRACTION TO 1 OR MORE LESIONS, INCLUDING IMAGE GUIDANCE, ENTIRE COURSE NOT TO EXCEED 5 FRACTIONS statewide

77399 UNLISTED PROCEDURE, MEDICAL RADIATION PHYSICS, DOSIMETRY ANDTREATMENT DEVICES, AND SPECIAL SERVICES cohort cohort cohort

77401 RADIATION TREATMENT DELIVERY, SUPERFICIAL AND/OR ORTHOVOLTAGE statewide

77402

RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; UP TO 5 MEV statewide

77403

RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; 6-10 MEV cohort cohort cohort cohort

77404

RADIATION TREATMENT DELIVERY, SINGLE TREATMENT AREA, SINGLE PORT OR PARALLEL OPPOSED PORTS, SIMPLE BLOCKS OR NO BLOCKS; 11-19 MEV cohort cohort cohort cohort

77408

RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 6-10 MEV cohort cohort

77409

RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 11-19 MEV cohort cohort cohort cohort

77411

RADIATION TREATMENT DELIVERY, TWO SEPARATE TREATMENT AREAS, THREE OR MORE PORTS ON A SINGLE TREATMENT AREA, USE OF MULTIPLE BLOCKS; 20 MEV OR GREATER statewide

77412

RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATETREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, cohort cohort cohort

77413

RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATETREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, cohort cohort cohort cohort cohort

77414

RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATETREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, cohort cohort cohort cohort cohort

77416

RADIATION TREATMENT DELIVERY, THREE OR MORE SEPARATETREATMENT AREAS, CUSTOM BLOCKING, TANGENTIAL PORTS, WEDGES, ROTATIONAL BEAM, COMPENSATORS, SPECIAL PARTICLE BEAM (EG, cohort cohort cohort

77417 THERAPEUTIC RADIOLOGY PORT FILM(S) cohort cohort cohort cohort cohort

77418 INTENSITY MODULATED RADIOTHERAPY PLAN, SINGLE/ MULTIPLE FIELDS/ARCS, PER SESSION cohort cohort cohort cohort cohort

77421 STEREOSCOPIC X-RAY GUIDANCE FOR LOCALIZATION OF TARGET VOLUME FOR THE DELIVERY OF RADIATION THERAPY cohort cohort cohort cohort cohort

77470 SPECIAL TREATMENT PROCEDURE (EG, TOTAL BODY cohort cohort cohort cohort cohort

152

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

IRRADIATION, HEMIBODY RADIATION, PER ORAL OR ENDOCAVITARY IRRADIATION)

77750 INFUSION OR INSTILLATION OF RADIOELEMENT SOLUTION statewide

77761 INTRACAVITARY RADIOELEMENT APPLICATION; SIMPLE statewide

77762 INTRACAVITARY RADIOELEMENT APPLICATION; INTERMEDIATE statewide

77763 INTRACAVITARY RADIOELEMENT APPLICATION; COMPLEX statewide

77777

INTERSTITIAL RADIOELEMENT APPLICATION; INTERMEDIATEINTERSTITIAL RADIOELEMENT APPLICATION; INTERMEDIATE cohort cohort

77778

INTERSTITIAL RADIOELEMENT APPLICATION; COMPLEXINTERSTITIAL RADIOELEMENT APPLICATION; COMPLEX cohort cohort cohort cohort

77785 Remote afterloading high dose rate radionuclide brachytherapy; 1 channel cohort cohort cohort

77786 Remote afterloading high dose rate radionuclide brachytherapy; 2-12 channels cohort cohort cohort

77787 Remote afterloading high dose rate radionuclide brachytherapy; over 12 channels cohort cohort

77790 SUPERVISION, HANDLING, LOADING OF RADIOELEMENT cohort cohort cohort cohort

77799 UNLISTED PROCEDURE, CLINICAL BRACHYTHERAPY cohort cohort

78012

THYROID UPTAKE, SINGLE OR MULTIPLE QUANTITATIVE MEASUREMENT(S) (INCLUDING STIMULATION, SUPPRESSION, OR DISCHARGE, WHEN PERFORMED) cohort cohort cohort cohort cohort

78013 THYROID IMAGING (INCLUDING VASCULAR FLOW, WHEN PERFORMED); cohort cohort cohort cohort cohort

78014

THYROID IMAGING (INCLUDING VASCULAR FLOW, WHEN PERFORMED); WITH SINGLE OR MULTIPLE UPTAKE(S) QUANTITATIVE MEASUREMENT(S) (INCLUDING STIMULATION, SUPPRESSION, OR DISCHARGE, WHEN PERFORMED) cohort cohort cohort cohort cohort

78015 THYROID CARCINOMA METASTASES IMAGING; LIMITED AREA(EG, NECKAND CHEST ONLY) cohort cohort

78018 THYROID CARCINOMA METASTASES IMAGING; WHOLE BODY cohort cohort cohort cohort

78020 THYROID CARCINOMA METASTASES UPTAKE (LIST SEPARATELY INADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

78070 PARATHYROID PLANAR IMAGING (INCLUDING SUBTRACTION,WHEN PERFORMED); cohort cohort cohort cohort cohort

78071

PARATHYROID PLANAR IMAGING (INCLUDING SUBTRACTION,WHEN PERFORMED); WITH TOMOGRAPHIC (SPECT) cohort cohort cohort cohort

78072

PARATHYROID PLANAR IMAGING (INCLUDING SUBTRACTION,WHEN PERFORMED); WITH TOMOGRAPHIC (SPECT), AND CO NCURRENTLY ACQUIRED COMPUTED TOMOGRAPHY (CT) FOR ANATOMICAL LOCALIZATION cohort cohort cohort

78075 ADRENAL IMAGING, CORTEX AND/OR MEDULLA statewide

78102 BONE MARROW IMAGING; LIMITED AREA statewide

78104 BONE MARROW IMAGING; WHOLE BODY statewide

78122

WHOLE BLOOD VOLUME DETERMINATION, INCLUDING SEPARATEMEASUREMENT OF PLASMA VOLUME AND RED CELL VOLUME(RADIOPHARMACEUTICAL VOLUME-DILUTION TECHNIQUE) statewide

78195 LYMPHATICS AND LYMPH GLANDS IMAGING cohort cohort cohort cohort

78201 LIVER IMAGING; STATIC ONLY statewide

78202 LIVER IMAGING; WITH VASCULAR FLOW statewide

78205 LIVER IMAGING (SPECT) cohort cohort cohort cohort

78215 LIVER AND SPLEEN IMAGING; STATIC ONLY cohort cohort cohort cohort cohort

78216 LIVER AND SPLEEN IMAGING; WITH VASCULAR FLOW cohort cohort

78226 HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER WHEN PRESENT; cohort cohort cohort cohort cohort

78227 HEPATOBILIARY SYSTEM IMAGING, INCLUDING GALLBLADDER WHEN PRESENT; WITH PHARMACOLOGIC INTERVENTION, cohort cohort cohort cohort cohort cohort

153

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

INCLUDING QUANTITATIVE MEASUREMENT(S) WHEN PERFORMED

78264 GASTRIC EMPTYING STUDY cohort cohort cohort cohort cohort

78267 UREA BREATH TEST, C-14; ACQUISITION FOR ANALYSIS cohort cohort

78268 UREA BREATH TEST, C-14; ANALYSIS statewide

78278 ACUTE GASTROINTESTINAL BLOOD LOSS IMAGING cohort cohort cohort cohort

78290 BOWEL IMAGING (EG, ECTOPIC GASTRIC MUCOSA, MECKEL'SLOCALIZATION, VOLVULUS) cohort cohort cohort cohort

78300 BONE AND/OR JOINT IMAGING; LIMITED AREA cohort cohort cohort cohort cohort

78305 BONE AND/OR JOINT IMAGING; MULTIPLE AREAS cohort cohort cohort

78306 BONE AND/OR JOINT IMAGING; WHOLE BODY cohort cohort cohort cohort cohort cohort

78315 BONE AND/OR JOINT IMAGING; THREE PHASE STUDY cohort cohort cohort cohort cohort cohort

78320 BONE AND/OR JOINT IMAGING; TOMOGRAPHIC (SPECT) cohort cohort cohort cohort cohort cohort

78428 CARDIAC SHUNT DETECTION statewide

78445 NON-CARDIAC VASCULAR FLOW IMAGING (IE, ANGIOGRAPHY,VENOGRAPHY) statewide

78451

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICAT cohort cohort cohort cohort cohort

78452

MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICAT cohort cohort cohort cohort cohort

78454

MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIE statewide

78459 MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),METABOLIC EVALUATION statewide

78472

CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; PLANAR,SINGLE STUDY AT REST OR STRESS (EXERCISE AND/OR PHARMACOLOGIC), WALL MOTION STUDY PLUS EJECTIONFRACTION, cohort cohort cohort cohort cohort

78473

CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM; MULTIPLESTUDIES, WALL MOTION STUDY PLUS EJECTION FRACTION, AT REST AND STRESS (EXERCISE AND/OR PHARMACOLOGIC), WITH OR WITHOUT cohort cohort

78492

MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET),PERFUSION; MULTIPLE STUDIES AT REST AND/OR STRESS MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), statewide

78494

CARDIAC BLOOD POOL IMAGING, GATED EQUILIBRIUM, SPECT, ATREST, WALL MOTION STUDY PLUS EJECTION FRACTION, WITH OR WITHOUT QUANTITATIVE PROCESSING cohort cohort

78579 PULMONARY VENTILATION IMAGING (EG, AEROSOL OR GAS) cohort cohort cohort cohort

78580 PULMONARY PERFUSION IMAGING (EG, PARTICULATE) cohort cohort cohort cohort

78582 PULMONARY VENTILATION (EG, AEROSOL OR GAS) AND PERFUSION IMAGING cohort cohort cohort cohort cohort

78597 QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION, INCLUDING IMAGING WHEN PERFORMED cohort cohort cohort cohort

78598

QUANTITATIVE DIFFERENTIAL PULMONARY PERFUSION AND VENTILATION (EG, AEROSOL OR GAS), INCLUDING IMAGING WHEN PERFORMED cohort cohort cohort

78606 Brain imaging, minimum 4 static views; with vascular flow statewide

78607 Brain imaging, tomographic (SPECT) cohort cohort

78608

BRAIN IMAGING, POSITRON EMISSION TOMOGRAPHY (PET);METABOLICEVALUATION BRAIN IMAGING, POSITRON EMIS SION TOMOGRAPHY (PET); METABOLIC cohort cohort cohort

78630 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDINGINTRODUCTION OF MATERIAL); CISTERNOGRAPHY cohort cohort

154

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

78645 CEREBROSPINAL FLUID FLOW, IMAGING (NOT INCLUDINGINTRODUCTION OF MATERIAL); SHUNT EVALUATION cohort cohort

78650 CSF LEAKAGE DETECTION AND LOCALIZATION statewide

78660

RADIOPHARMACEUTICAL DACRYOCYSTOGRAPHYRADIOPHARMACEUTICAL DACRYOCYSTOGRAPHY cohort cohort

78700 Kidney imaging morphology cohort cohort cohort

78701 KIDNEY IMAGING; WITH VASCULAR FLOW cohort cohort

78707 with vascular flow and function, single study without pharmocological intervention cohort cohort cohort cohort cohort

78708

with vascular flow and function, single study, with pharmacological intervention (eg, angiotension converting enzyme inhibitor and/or diuretic) cohort cohort cohort cohort cohort

78709

with vascular flow and function, multiple studies,with and without pharmacological intervention (eg , angiotension converting enzyme inhibitor and/or diuretic) cohort cohort cohort

78710 Tomographic (SPECT) cohort cohort

78725 KIDNEY FUNCTION STUDY, NON-IMAGING RADIOISOTOPIC STUDY statewide

78740

URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDINGCYSTOGRAM) URETERAL REFLUX STUDY (RADIOPHARMACEUTICAL VOIDING cohort cohort cohort

78800

RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; LIMITEDAREARADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; LI MITED AREA cohort cohort cohort cohort

78801 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; MULTIPLE AREAS cohort cohort

78802 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; WHOLE BODY cohort cohort cohort

78803 RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR; TOMOGRAPHIC(SPECT) cohort cohort cohort cohort

78804

RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); WHOLE BODY, REQUIRING TWO OR MORE DAYS IMAGING cohort cohort cohort cohort

78805

RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; LIMITED AREARADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; LIMITED AREA cohort cohort cohort cohort

78806 RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; WHOLEBODY cohort cohort cohort cohort

78807 RADIOPHARMACEUTICAL LOCALIZATION OF ABSCESS; TOMOGRAPHIC(SPECT) statewide

78808 Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (e.g., parathyroid adenoma) cohort cohort

78812 Positron emission tomography (PET) imaging; skull base to mid-thigh statewide

78813 Positron emission tomography (PET) imaging; whole body statewide

78814

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging;limited area (e.g., chest, head/neck) cohort cohort

78815

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging;skull base to mid-thigh cohort cohort cohort cohort cohort

78816

Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation correction and anatomical localization imaging;whole body cohort cohort cohort cohort cohort

78999 UNLISTED MISCELLANEOUS PROCEDURE, DIAGNOSTIC NUCLEARMEDICINE statewide

79005 NUCLEAR RX, ORAL ADMIN cohort cohort cohort cohort

79101 NUCLEAR RX, IV ADMIN cohort cohort cohort

79403 RADIOPHARMACEUTICAL THERAPY, RADIOLABELED MONOCLONAL ANTIBODY BY INTRAVENOUS INFUSION cohort cohort

79440 INTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPYINTRA-ARTICULAR RADIOPHARMACEUTICAL THERAPY statewide

155

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

79445 NUCLEAR RX, INTRA-ARTERIAL statewide

80047

Basic metabolic panel (Calcium, ionized) This panel must include the following: Calcium, ionized (82330), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (8413 statewide

80048

Basic metabolic panel (Calcium, total) This panel must include the following: Calcium, total (82310), Carbon dioxide (82374), Chloride (82435), Creatinine (82565), Glucose (82947), Potassium (84132), cohort cohort

80050

General health panel This panel must include the following: Comprehensive metabolic panel (80053), Blood count, complete (CBC), automated and automated differential WBC count (85025 or 85027 and 85004 statewide

80053

Comprehensive metabolic panel This panel must include the following: Albumin (82040), Bilirubin, total (82247), Calcium, total (82310), Carbon dioxide(bicarbonate) (82374), Chloride (82435), Creatini cohort cohort cohort cohort

80061

Lipid panel This panel must include the following:Cholesterol, serum, total (82465), Lipoprotein, d irect measurement, high density cholesterol (HDL cholesterol) (83718), Triglycerides (84478) cohort cohort

80069

Renal function panel This panel must include the following: Albumin (82040), Calcium, total (82310),Carbon dioxide (bicarbonate) (82374), Chloride (8 2435), Creatinine (82565), Glucose (82947), Phosph statewide

80074

Acute hepatitis panel This panel must include the following: Hepatitis A antibody (HAAb), IgM antibody (86709), Hepatitis B core antibody (HBcAb), IgMantibody (86705), Hepatitis B surface antigen (HB cohort cohort

80076

Hepatic function panel This panel must include thefollowing: Albumin (82040), Bilirubin, total (822 47), Bilirubin, direct (82248), Phosphatase, alkaline (84075), Protein, total (84155), Transferase, statewide

80104 Drug screen, qualitative; multiple drug classes other than chromatographic method, each procedure statewide

80156 CARBAMAZEPINE(CLOSEST CLINICALLY EQUIVALENT CODE(S) DELETED IN 1993: 82372) statewide

80202 VANCOMYCIN statewide

80299 QUANTITATION OF DRUG, NOT ELSEWHERE SPECIFIED statewide

81000

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN,GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE cohort cohort cohort cohort

81001

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN,GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE cohort cohort cohort cohort cohort cohort

81002

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN,GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE cohort cohort cohort cohort cohort

81003

URINALYSIS, BY DIP STICK OR TABLET REAGENT FOR BILIRUBIN,GLUCOSE, HEMOGLOBIN, KETONES, LEUKOCYTES, NITRITE, PH, PROTEIN, SPECIFIC GRAVITY, UROBILINOGEN, ANY NUMBER OF THESE cohort cohort cohort cohort cohort cohort

81005

URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPTIMMUNOASSAYS URINALYSIS; QUALITATIVE OR SEMIQUANTITATIVE, EXCEPT cohort cohort cohort cohort

81015 URINALYSIS; MICROSCOPIC ONLYURINALYSIS; MICROSCOPIC ONLY cohort cohort cohort cohort cohort

81025

URINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODSURINE PREGNANCY TEST, BY VISUAL COLOR COMPARISON METHODS cohort cohort cohort cohort cohort cohort

81050 VOLUME MEASUREMENT FOR TIMED COLLECTION, EACHVOLUME MEASUREMENT FOR TIMED COLLECTION, EACH cohort cohort cohort cohort cohort

81201 APC (adenomatous polyposis coli) (e.g., familial adenomatosis polyposis [FAP], attenuated FAP) gene analysis; full gene sequence statewide

81205

BCKDHB (BRANCHED-CHAIN KETO ACID DEHYDROGENASE E1,BETA POLYPEPTIDE) (EG, MAPLE SYRUP URINE DISEASE) GENE ANALYSIS, COMMON VARIANTS (EG, R183P, G278S, E422X) statewide

81206 BCR/ABL1 (T(9;22)) (EG, CHRONIC MYELOGENOUS LEUKEMIA) TRANSLOCATION ANALYSIS; MAJOR BREAKPOINT, QUALITATIVE statewide

156

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OR QUANTITATIVE

81207

BCR/ABL1 (T(9;22)) (EG, CHRONIC MYELOGENOUS LEUKEMIA) TRANSLOCATION ANALYSIS; MINOR BREAKPOINT, QUALITATIVE OR QUANTITATIVE statewide

81210 BRAF (V-RAF MURINE SARCOMA VIRAL ONCOGENE HOMOLOG B1) (EG, COLON CANCER), GENE ANALYSIS, V600E VARIANT statewide

81220

CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; COMMON VARIANTS (EG, ACMG/ACOG GUIDELINES) statewide

81223

CFTR (CYSTIC FIBROSIS TRANSMEMBRANE CONDUCTANCE REGULATOR) (EG, CYSTIC FIBROSIS) GENE ANALYSIS; FULLGENE SEQUENCE statewide

81225

CYP2C19 (CYTOCHROME P450, FAMILY 2, SUBFAMILY C, POLYPEPTIDE 19) (EG, DRUG METABOLISM), GENE ANALYSIS, COMMON VARIANTS (EG, *2, *3, *4, *8, *17) statewide

81229

CYTOGENOMIC CONSTITUTIONAL (GENOME-WIDE) MICROARRAY ANALYSIS; INTERROGATION OF GENOMIC REGIONS FOR COPY NUMBER AND SINGLE NUCLEOTIDE POLYMORPHISM (SNP) VARIANTS FOR CHROMOSOMAL ABNORMALITIES statewide

81240 F2 (PROTHROMBIN, COAGULATION FACTOR II) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, 20210G>A VARIANT statewide

81241 F5 (COAGULATION FACTOR V) (EG, HEREDITARY HYPERCOAGULABILITY) GENE ANALYSIS, LEIDEN VARIANT statewide

81243

FMR1 (FRAGILE X MENTAL RETARDATION 1) (EG, FRAGILEX MENTAL RETARDATION) GENE ANALYSIS; EVALUATION T O DETECT ABNORMAL (EG, EXPANDED) ALLELES statewide

81264

IGK@ (IMMUNOGLOBULIN KAPPA LIGHT CHAIN LOCUS) (EG,LEUKEMIA AND LYMPHOMA, B-CELL), GENE REARRANGEMEN T ANALYSIS, EVALUATION TO DETECT ABNORMAL CLONAL POPULATION(S) statewide

81265

COMPARATIVE ANALYSIS USING SHORT TANDEM REPEAT (STR) MARKERS; PATIENT AND COMPARATIVE SPECIMEN (EG, PRE-TRANSPLANT RECIPIENT AND DONOR GERMLINE TESTING, POST-TRANSPLANT NON-HEMATOPOIETIC RECIPIENT GER statewide

81267

CHIMERISM (ENGRAFTMENT) ANALYSIS, POST TRANSPLANTATION SPECIMEN (EG, HEMATOPOIETIC STEM CELL), INCLUDES COMPARISON TO PREVIOUSLY PERFORMED BASELINE ANALYSES; WITHOUT CELL SELECTION statewide

81268

CHIMERISM (ENGRAFTMENT) ANALYSIS, POST TRANSPLANTATION SPECIMEN (EG, HEMATOPOIETIC STEM CELL), INCLUDES COMPARISON TO PREVIOUSLY PERFORMED BASELINE ANALYSES; WITH CELL SELECTION (EG, CD3, CD33), EACH statewide

81270 JAK2 (JANUS KINASE 2) (EG, MYELOPROLIFERATIVE DISORDER) GENE ANALYSIS, P.VAL617PHE (V617F) VARIANT statewide

81275

KRAS (V-KI-RAS2 KIRSTEN RAT SARCOMA VIRAL ONCOGENE) (EG, CARCINOMA) GENE ANALYSIS, VARIANTS IN CODONS 12 AND 13 statewide

81331

SNRPN/UBE3A (SMALL NUCLEAR RIBONUCLEOPROTEIN POLYPEPTIDE N AND UBIQUITIN PROTEIN LIGASE E3A) (EG, PRADER-WILLI SYNDROME AND/OR ANGELMAN SYNDROME), METHYLATION ANALYSIS statewide

81370 HLA CLASS I AND II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); HLA-A, -B, -C, -DRB1/3/4/5, AND-DQB1 statewide

81376

HLA CLASS II TYPING, LOW RESOLUTION (EG, ANTIGEN EQUIVALENTS); ONE LOCUS (EG, HLA-DRB1/3/4/5, -DQB1,-DQA1, -DPB1, OR -DPA1), EACH statewide

81378 HLA CLASS I AND II TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS), HLA-A, -B, -C, AND -DRB1 statewide

81379 HLA CLASS I TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); COMPLETE (IE, HLA-A, -B, AND -C) statewide

81382

HLA CLASS II TYPING, HIGH RESOLUTION (IE, ALLELES OR ALLELE GROUPS); ONE LOCUS (EG, HLA-DRB1, -DRB3,-DRB4, -DRB5, -DQB1, -DQA1, -DPB1, OR -DPA1), EAC H statewide

81401 MOLECULAR PATHOLOGY PROCEDURE, LEVEL 2 (EG, 2-10 SNPS, statewide

157

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

1 METHYLATED VARIANT, OR 1 SOMATIC VARIANT [TYPICALLY USING NONSEQUENCING TARGET VARIANT ANALYSIS], OR DETECTION OF A DYNAMIC MUTATION DISORDER/T

81404

MOLECULAR PATHOLOGY PROCEDURE, LEVEL 5 (EG, ANALYSIS OF 2-5 EXONS BY DNA SEQUENCE ANALYSIS, MUTATIONSCANNING OR DUPLICATION/DELETION VARIANTS OF 6-10 EXONS, OR CHARACTERIZATION OF A DYNAMIC MUTATION statewide

81408

MOLECULAR PATHOLOGY PROCEDURE, LEVEL 9 (EG, ANALYSIS OF >50 EXONS IN A SINGLE GENE BY DNA SEQUENCE ANALYSIS) ATM (ATAXIA TELANGIECTASIA MUTATED) (EG, ATAXIA TELANGIECTASIA), FULL GENE SEQUENCE CDH23 ( statewide

81479 UNLISTED MOLECULAR PATHOLOGY PROCEDURE statewide

82003 ACETAMINOPHEN statewide

82010 KETONE BODY(S) (EG, ACETONE, ACETOACETIC ACID, BETA-HYDROXYBUTYRATE); QUANTITATIVE statewide

82017 ACYLCARNITINES; QUANTITATIVE, EACH SPECIMEN (FOR CARNITINE, SEE 82379) statewide

82040 Albumin serum, plasma or whole blood cohort cohort

82043 ALBUMIN; URINE, MICROALBUMIN, QUANTITATIVE statewide

82055 ALCOHOL (ETHANOL); ANY SPECIMEN EXCEPT BREATH statewide

82103 ALPHA-1-ANTITRYPSIN; TOTAL(CLOSEST CLINICALLY EQUIVALENT CODE(S), DELETED IN 1993: 86064, 86067) statewide

82120 AMINES, VAGINAL FLUID, QUALITATIVE statewide

82136 AMINO ACIDS, 2 TO 5 AMINO ACIDS, QUANTITATIVE, EACH SPECIMEN statewide

82139 AMINO ACIDS, 6 OR MORE AMINO ACIDS, QUANTITATIVE, EACHSPECIMEN statewide

82140 AMMONIA statewide

82150 AMYLASE cohort cohort

82157 ANDROSTENEDIONE statewide

82172 APOLIPOPROTEIN, EACH statewide

82247 BILIRUBIN; TOTAL statewide

82248 BILIRUBIN; DIRECT statewide

82270 BLOOD, OCCULT; FECES, 1-3 SIMULTANEOUS DETERMINATIONS cohort cohort cohort

82271 BLOOD, OCCULT, BY PEROXIDASE ACTIVITY (EG, GUAIAC), QUALITATIVE; OTHER SOURCES statewide

82272

Blood, occult, by peroxidase activity (e.g., guiac), qualitative, feces, 1-3 simultaneous determinations, performed for other than colorectal neoplasmscreening cohort cohort

82300 CADMIUM cohort cohort

82310 CALCIUM; TOTALCALCIUM; TOTAL statewide

82360 CALCULUS (STONE); QUANTITATIVE ANALYSIS, CHEMICAL statewide

82373 CARBOHYDRATE DEFICIENT TRANSFERRIN statewide

82379 CARNITINE (TOTAL AND FREE), QUANTITATIVE, EACH SPECIMEN statewide

82380 CAROTENE statewide

82390 CERULOPLASMIN statewide

82397 CHEMILUMINESCENT ASSAY statewide

82438 CHLORIDE; OTHER SOURCE statewide

82465 CHOLESTEROL, SERUM, TOTALCHOLESTEROL, SERUM, TOTAL statewide

82491

CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID ORHPLC); SINGLE ANALYTE NOT ELSEWHERE SPECIFIED, SINGLE STATIONARY AND MOBILE PHASE statewide

82492

CHROMATOGRAPHY, QUANTITATIVE, COLUMN (EG, GAS LIQUID ORHPLC); MULTIPLE ANALYTES, SINGLE STATIONARY AND MOBILE PHASE cohort cohort

82495 CHROMIUM statewide

82533 CORTISOL; TOTAL statewide

158

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

82544

COLUMN CHROMATOGRAPHY/MASS SPECTOMETRY (EG, GC/MS,ORHPLC/MS), ANALYTE NOT ELSEWHERE SPECIFIED; STAB LE ISOTOPE DILUTION, MULTIPLE ANALYTES, QUANTITATIVE, SINGLE STATIONARY statewide

82550 CREATINE KINASE (CK), (CPK); TOTAL statewide

82565 CREATININE; BLOOD statewide

82570 CREATININE; OTHER SOURCE statewide

82607 CYANOCOBALAMIN (VITAMIN B-12);CYANOCOBALAMIN (VITAMIN B-12); statewide

82626 DEHYDROEPIANDROSTERONE (DHEA) statewide

82633 DESOXYCORTICOSTERONE, 11- statewide

82634 DEOXYCORTISOL, 11- statewide

82651 DIHYDROTESTOSTERONE (DHT) cohort cohort

82652 VITAMIN D; 1, 25 DIHYDROXY, INCLUDES FRACTION(S), IF PERFORMED statewide

82656 PANCREATIC ELASTASE, FECAL statewide

82657

ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, ORTISSUE,NOT ELSEWHERE SPECIFIED; NONRADIOACTIVE SU BSTRATE, EACH SPECIMEN statewide

82658

ENZYME ACTIVITY IN BLOOD CELLS, CULTURED CELLS, ORTISSUE,NOT ELSEWHERE SPECIFIED; RADIOACTIVE SUBST RATE, EACH SPECIMEN statewide

82670 ESTRADIOL statewide

82705 FAT OR LIPIDS, FECES; QUALITATIVE statewide

82728 FERRITIN statewide

82731 FETAL FIBRONECTIN, CERVICOVAGINAL SECRETIONS,SEMI-QUANTITATIVE statewide

82746 FOLIC ACID; SERUM statewide

82784 GAMMAGLOBULIN (IMMUNOGLOBULIN); IGA, IGD, IGG, IGM, EACH statewide

82785 GAMMAGLOBULIN (IMMUNOGLOBULIN); IGE statewide

82787 GAMMAGLOBULIN (IMMUNOGLOBULIN); IMMUNOGLOBULIN SUBCLASSES (EG, IGG1, 2, 3, OR 4), EACH statewide

82800 GASES, BLOOD, PH ONLYGASES, BLOOD, PH ONLY statewide

82947 GLUCOSE; QUANTITATIVEGLUCOSE; QUANTITATIVE cohort cohort

82948 GLUCOSE; BLOOD, REAGENT STRIPGLUCOSE; BLOOD, REAGENT STRIP statewide

82955 GLUCOSE-6-PHOSPHATE DEHYDROGENASE (G6PD); QUANTITATIVE statewide

82962

GLUCOSE, BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BYTHE FDA SPECIFICALLY FOR HOME USE GLUCOSE,BLOOD BY GLUCOSE MONITORING DEVICE(S) CLEARED BY cohort cohort

82977 GLUTAMYLTRANSFERASE, GAMMA (GGT) statewide

82978 GLUTATHIONE statewide

83001 GONADOTROPIN; FOLLICLE STIMULATING HORMONE (FSH) statewide

83002 GONADOTROPIN; LUTEINIZING HORMONE (LH) statewide


83010 HAPTOGLOBIN; QUANTITATIVE statewide

83021 HEMOGLOBIN FRACTIONATION AND QUANTITATION; CHROMATOGRAPHY(EG, A2, S, C, AND/OR F) statewide

83036 HEMOGLOBIN; GLYCATEDHEMOGLOBIN; GLYCATED statewide

83090 HOMOCYSTINE statewide

83498 HYDROXYPROGESTERONE, 17-D statewide

83516

IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD statewide

83519 IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATIVE, BY statewide

159

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

RADIOIMMUNOASSAY (EG, RIA)

83520

IMMUNOASSAY FOR ANALYTE OTHER THAN INFECTIOUS AGENT ANTIBODY OR INFECTIOUS AGENT ANTIGEN; QUANTITATIVE, NOT OTHERWISE SPECIFIED statewide

83525 INSULIN; TOTALINSULIN; TOTAL statewide

83540 IRON statewide

83615 LACTATE DEHYDROGENASE (LD), (LDH); statewide

83655 LEADLEAD cohort cohort

83690 LIPASE cohort cohort

83718

LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL(HDL CHOLESTEROL) LIPOPROTEIN, DIRECT MEASUREMENT; HIGH DENSITY CHOLESTEROL statewide

83721

LIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROLLIPOPROTEIN, DIRECT MEASUREMENT; LDL CHOLESTEROL statewide

83735 MAGNESIUM cohort cohort

83789

MASS SPECTROMETRY AND TANDEM MASS SPECTROMETRY (MS, MS/MS), ANALYTE NOT ELSEWHERE SPECIFIED; QUANTITATIVE, EACH SPECIMEN statewide

83840 METHADONE statewide

83880 NATRIURETIC PEPTIDE cohort cohort

83883 NEPHELOMETRY, EACH ANALYTE NOT ELSEWHERE SPECIFIED statewide

83919 ORGANIC ACIDS; QUALITATIVE, EACH SPECIMEN statewide

83921 ORGANIC ACID, SINGLE, QUANTITATIVE statewide

83970 PARATHORMONE (PARATHYROID HORMONE) statewide

83986 PH; BODY FLUID, NOT OTHERWISE SPECIFIED statewide

83993 Calprotectin, fecal statewide

84075 PHOSPHATASE, ALKALINE; statewide

84087 PHOSPHOHEXOSE ISOMERASE statewide

84100 PHOSPHORUS INORGANIC (PHOSPHATE); cohort cohort

84132 Potassium; serum, plasma or whole blood statewide

84143 17-HYDROXYPREGNENOLONE statewide

84144 PROGESTERONE statewide

84146 PROLACTIN statewide

84153 PROSTATE SPECIFIC ANTIGEN (PSA); TOTAL (CLOSEST CLINICALLYEQUIVALENT CODE(S), DELETED IN 1993: 80080) statewide

84155 Protein, total, except by refractometry; serum, plasma or whole blood statewide

84156 PROTEIN, TOTAL, EXCEPT BY REFRACTOMETRY; URINE cohort cohort

84165 PROTEIN; ELECTROPHORETIC FRACTIONATION AND QUANTITATION statewide

84166 PROTEIN E-PHORESIS/URINE/CSF statewide


84207 PYRIDOXAL PHOSPHATE (VITAMIN B-6) statewide

84220 PYRUVATE KINASE statewide

84244 RENIN statewide

84295 Sodium; serum, plasma or whole blood statewide

84376 SUGARS (MONO, DI, AND OLIGOSACCHARIDES); SINGLE QUALITATIVE,EACH SPECIMEN cohort cohort

84378 SUGARS (MONO, DI, AND OLIGOSACCHARIDES); SINGLEQUANTITATIVE, EACH SPECIMEN statewide

84403 TESTOSTERONE; TOTALTESTOSTERONE; TOTAL statewide

84425 THIAMINE (VITAMIN B-1) statewide

84432 THYROGLOBULIN statewide

84436 THYROXINE; TOTALTHYROXINE; TOTAL statewide

84439 THYROXINE; FREETHYROXINE; FREE statewide

160

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

84443 THYROID STIMULATING HORMONE (TSH) cohort cohort

84446 TOCOPHEROL ALPHA (VITAMIN E) statewide

84450 TRANSFERASE; ASPARTATE AMINO (AST) (SGOT) statewide

84460 TRANSFERASE; ALANINE AMINO (ALT) (SGPT) statewide

84466 TRANSFERRIN statewide

84478 TRIGLYCERIDES statewide

84480 TRIIODOTHYRONINE (T-3); TOTAL (TT-3) statewide

84484 TROPONIN, QUANTITATIVE cohort cohort cohort cohort

84550 URIC ACID; BLOOD statewide

84590 VITAMIN A statewide

84681 C-PEPTIDE statewide

84702 GONADOTROPIN, CHORIONIC (HCG); QUANTITATIVE statewide

84703 GONADOTROPIN, CHORIONIC (HCG); QUALITATIVE statewide

85007 BLOOD COUNT; MANUAL DIFFERENTIAL WBC COUNT (INCLUDES RBCMORPHOLOGY AND PLATELET ESTIMATION) cohort cohort

85014 BLOOD COUNT; OTHER THAN SPUN HEMATOCRIT cohort cohort

85018 BLOOD COUNT; HEMOGLOBINBLOOD COUNT; HEMOGLOBIN statewide

85025

BLOOD COUNT; HEMOGRAM AND PLATELET COUNT, AUTOMATED, ANDAUTOMATED COMPLETE DIFFERENTIAL WBC COUNT (CBC) cohort cohort cohort

85027 BLOOD COUNT; HEMOGRAM AND PLATELET COUNT, AUTOMATED cohort cohort cohort cohort cohort

85097 BONE MARROW; SMEAR INTERPRETATION ONLY, WITH OR WITHOUTDIFFERENTIAL CELL COUNT statewide

85210 CLOTTING; FACTOR II, PROTHROMBIN, SPECIFIC statewide

85260 CLOTTING; FACTOR X (STUART-PROWER) statewide

85280 CLOTTING; FACTOR XII (HAGEMAN) statewide

85300 CLOTTING INHIBITORS OR ANTICOAGULANTS; ANTITHROMBIN III,ACTIVITY statewide

85303 CLOTTING INHIBITORS OR ANTICOAGULANTS; PROTEIN C, ACTIVITY statewide

85347 COAGULATION TIME; ACTIVATED statewide

85379 FIBRIN DEGRADATION PRODUCTS, D-DIMER; QUANTITATIVE cohort cohort

85598 Phospholipid neutralization; hexagonal phospholipid statewide

85610 PROTHROMBIN TIME; cohort cohort cohort cohort

85613 RUSSELL VIPER VENOM TIME (INCLUDES VENOM); DILUTED statewide

85651 SEDIMENTATION RATE, ERYTHROCYTE; NON-AUTOMATED statewide

85652 SEDIMENTATION RATE, ERYTHROCYTE; AUTOMATED statewide

85660 SICKLING OF RBC, REDUCTIONSICKLING OF RBC, REDUCTION cohort cohort

85730 THROMBOPLASTIN TIME, PARTIAL (PTT); PLASMA OR WHOLE BLOOD cohort cohort cohort

86000

AGGLUTININS, FEBRILE (EG, BRUCELLA, FRANCISELLA, MURINETYPHUS, Q FEVER, ROCKY MOUNTAIN SPOTTED FEVER, SCRUB TYPHUS), EACH ANTIGEN statewide

86003 ALLERGEN SPECIFIC IGE; QUANTITATIVE OR SEMIQUANTITATIVE,EACH ALLERGEN statewide

86038 ANTINUCLEAR ANTIBODIES (ANA);ANTINUCLEAR ANTIBODIES (ANA); statewide

86039 ANTINUCLEAR ANTIBODIES (ANA); TITERANTINUCLEAR ANTIBODIES (ANA); TITER statewide

86060 ANTISTREPTOLYSIN 0; TITERANTISTREPTOLYSIN 0; TITER cohort cohort

86063 ANTISTREPTOLYSIN 0; SCREENANTISTREPTOLYSIN 0; SCREEN statewide

86140 C-REACTIVE PROTEIN cohort cohort

86146 BETA 2 GLYCOPROTEIN I ANTIBODY, EACH statewide

86147 CARDIOLIPIN (PHOSPHOLIPID) ANTIBODYCARDIOLIPIN (PHOSPHOLIPID) ANTIBODY statewide

161

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

86160

COMPLEMENT; ANTIGEN, EACH COMPONENT (CLOSEST CLINICALLYEQUIVALENT CODE(S), DELETED IN 1993: 86159, 86163, 86164) statewide

86225

DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLESTRANDED DEOXYRIBONUCLEIC ACID (DNA) ANTIBODY; NATIVE OR DOUBLE statewide

86235 EXTRACTABLE NUCLEAR ANTIGEN, ANTIBODY TO, ANY METHOD (EG,NRNP, SS-A, SS-B, SM, RNP, SC170, J01), EACH ANTIBODY cohort cohort

86255

FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACHANTIBODY FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; SCREEN, EACH statewide

86256

FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACHANTIBODY FLUORESCENT NONINFECTIOUS AGENT ANTIBODY; TITER, EACH statewide

86317 IMMUNOASSAY FOR INFECTIOUS AGENT ANTIBODY, QUANTITATIVE, NOTOTHERWISE SPECIFIED statewide

86331 IMMUNODIFFUSION; GEL DIFFUSION, QUALITATIVE (OUCHTERLONY),EACH ANTIGEN OR ANTIBODY statewide

86334 IMMUNOFIXATION ELECTROPHORESIS statewide

86335 IMMUNFIX E-PHORSIS/URINE/CSF statewide

86341 ISLET CELL ANTIBODY statewide

86355 B CELLS, TOTAL COUNT statewide

86356 Mononuclear cell antigen, quantitative (e.g., flowcytometry), not otherwise specified, each antigen statewide

86357 NATURAL KILLER (NK) CELLS, TOTAL COUNT statewide

86359 T CELLS; TOTAL COUNT statewide

86361 T CELLS; ABSOLUTE CD4 COUNT statewide

86403 PARTICLE AGGLUTINATION; SCREEN, EACH ANTIBODY cohort cohort cohort

86431 RHEUMATOID FACTOR; QUANTITATIVE statewide

86480 Tuberculosis test, cell mediated immunity antigen response measurement; gamma interferon cohort cohort

86580 SKIN TEST; TUBERCULOSIS, INTRADERMAL statewide

86592 SYPHILIS TEST, NON-TREPONEMAL ANTIBODY; QUALITATIVE (EG, VDRL, RPR, ART) cohort cohort

86618 ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE)ANTIBODY; BORRELIA BURGDORFERI (LYME DISEASE) cohort cohort

86619 ANTIBODY; BORRELIA (RELAPSING FEVER) statewide

86644 ANTIBODY; CYTOMEGALOVIRUS (CMV)ANTIBODY; CYTOMEGALOVIRUS (CMV) statewide

86645 ANTIBODY; CYTOMEGALOVIRUS (CMV), IGMANTIBODY; CYTOMEGALOVIRUS (CMV), IGM statewide

86663 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, EARLY ANTIGEN (EA) statewide

86664

ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN(EBNA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLEAR ANTIGEN (EBNA) statewide

86665 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID (VCA)ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL CAPSID(VCA) statewide

86666 ANTIBODY; EHRLICHIA statewide

86682 ANTIBODY; HELMINTH, NOT ELSEWHERE SPECIFIED statewide

86684 ANTIBODY; HEMOPHILUS INFLUENZA statewide

86687 ANTIBODY; HTLV I statewide

86692 ANTIBODY; HEPATITIS, DELTA AGENTANTIBODY; HEPATITIS, DELTA AGENT statewide

86694 ANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TESTANTIBODY; HERPES SIMPLEX, NON-SPECIFIC TYPE TEST statewide

86695 ANTIBODY; HERPES SIMPLEX, TYPE 1 cohort cohort cohort

86696 ANTIBODY; HERPES SIMPLEX, TYPE 2 cohort cohort cohort cohort

86703 ANTIBODY; HIV-1 AND HIV-2, SINGLE RESULT cohort cohort cohort

162

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

86704 HEPATITIS B CORE ANTIBODY (HBCAB); IGG AND IGMHEPATITIS B CORE ANTIBODY (HBCAB); IGG AND IGM statewide

86706 HEPATITIS B SURFACE ANTIBODY (HBSAB)HEPATITIS B SURFACE ANTIBODY (HBSAB) cohort cohort

86708 HEPATITIS A ANTIBODY (HAAB); IGG AND IGMHEPATITIS A ANTIBODY (HAAB); IGG AND IGM statewide

86709 HEPATITIS A ANTIBODY (HAAB); IGM ANTIBODYHEPATITISA ANTIBODY (HAAB); IGM ANTIBODY statewide

86735 ANTIBODY; MUMPS (CLOSEST CLINICALLY EQUIVALENT CODE(S),DELETED IN 1993: 86540) statewide

86747 ANTIBODY; PARVOVIRUS statewide

86753 ANTIBODY; PROTOZOA, NOT ELSEWHERE SPECIFIED statewide

86757 RICKETTSIA statewide

86762 ANTIBODY; RUBELLA statewide

86765 ANTIBODY; RUBEOLA statewide

86777 ANTIBODY; TOXOPLASMAANTIBODY; TOXOPLASMA statewide

86778 ANTIBODY; TOXOPLASMA, IGMANTIBODY; TOXOPLASMA, IGM statewide

86780 ANTIBODY; TREPONEMA PALLIDUM statewide

86787 ANTIBODY; VARICELLA-ZOSTER cohort cohort

86790 ANTIBODY; VIRUS, NOT ELSEWHERE SPECIFIED statewide

86800 THYROGLOBULIN ANTIBODY statewide

86803 HEPATITIS C ANTIBODY;HEPATITIS C ANTIBODY; cohort cohort

86825

HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM SAMPLE OR DILUTION statewide

86829

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); QUALITATIVE ASSESSMENT OF THE PRESENCE OR ABSENCE OF ANTIBODY(IES) TO HLA CLASS I OR statewide

86832

ANTIBODY TO HUMAN LEUKOCYTE ANTIGENS (HLA), SOLID PHASE ASSAYS (EG, MICROSPHERES OR BEADS, ELISA, FLOW CYTOMETRY); HIGH DEFINITION QUALITATIVE PANEL FOR IDENTIFICATION OF ANTIBODY SPECIFICITIES (EG, I statewide

86850

ANTIBODY SCREEN, RBC, EACH SERUM TECHNIQUE (CLOSESTCLINICALLY EQUIVALENT CODE(S), DELETED IN 1993: 86016, 86031, 86083) cohort cohort

86885 Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell statewide

86900 BLOOD TYPING; ABO (CLOSEST CLINICALLY EQUIVALENT CODE(S),DELETED IN 1993: 86080, 86082) cohort cohort

86901 BLOOD TYPING; RH (D)(CLOSEST CLINICALLY EQUIVALENTCODE(S), DELETED IN 1993: 86082, 86083, 86100) cohort cohort

87015 CONCENTRATION (ANY TYPE), FOR PARASITES, OVA, OR TUBERCLEBACILLUS (TB, AFB) cohort cohort cohort cohort cohort

87040 CULTURE, BACTERIAL, DEFINITIVE; BLOOD (INCLUDES ANAEROBICSCREEN) cohort cohort cohort cohort cohort cohort

87045 CULTURE, BACTERIAL, DEFINITIVE; STOOL cohort cohort cohort cohort cohort cohort

87046

CULTURE, BACTERIAL; STOOL, ADDITIONAL PATHOGENS, ISOLATION AND PRELIMINARY EXAMINATION (EG, CAMPYLOBACTER, YERSINIA, VIBRO, E. COLI O157),EACH PLATE cohort cohort cohort cohort cohort

87070 CULTURE, BACTERIAL, DEFINITIVE; ANY OTHER SOURCE cohort cohort cohort cohort cohort cohort

87071

CULTURE, BACTERIAL; QUANTITATIVE, AEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL cohort cohort cohort cohort cohort

87073

CULTURE, BACTERIAL; QUANTITATIVE, ANAEROBIC WITH ISOLATION AND PRESUMPTIVE IDENTIFICATION OF ISOLATES, ANY SOURCE EXCEPT URINE, BLOOD OR STOOL statewide

87075 CULTURE, BACTERIAL, ANY SOURCE; ANAEROBIC (ISOLATION) cohort cohort cohort cohort cohort cohort

87076 CULTURE, BACTERIAL, ANY SOURCE; DEFINITIVE IDENTIFICATION,EACH ANAEROBIC ORGANISM, INCLUDING GAS cohort cohort cohort cohort cohort

163

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

CHROMATOGRAPHY

87077

CULTURE, BACTERIAL, ANY SOURCE; AEROBIC ISOLATE, ADDITIONAL METHODS REQUIRED FOR DEFINITIVE IDENTI FICATION, EACH ISOLATE cohort cohort cohort cohort cohort cohort

87081 CULTURE, BACTERIAL, SCREENING ONLY, FOR SINGLE ORGANISMS cohort cohort cohort cohort cohort

87085

CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, BY COMMERCIAL KIT (SPECIFY TYPE); WITH COLONY COUNT CULTURE, PRESUMPTIVE, PATHOGENIC ORGANISMS, SCREENING ONLY, statewide

87086 CULTURE, BACTERIAL, URINE; QUANTITATIVE, COLONY COUNT cohort cohort cohort cohort cohort cohort

87088

CULTURE, BACTERIAL, URINE; IDENTIFICATION, IN ADDITION TOQUANTITATIVE OR COMMERCIAL KIT CULTURE, BACTERIAL, URINE; IDENTIFICATION, IN ADDITION TO cohort cohort cohort cohort cohort cohort

87101 CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT PRESUMPTIVEIDENTIFICATION); SKIN cohort cohort cohort cohort

87102

CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT PRESUMPTIVEIDENTIFICATION); OTHER SOURCE (EXCEPT BLOOD) cohort cohort cohort cohort cohort

87103 CULTURE, FUNGI, ISOLATION (WITH OR WITHOUT PRESUMPTIVEIDENTIFICATION); BLOOD cohort cohort cohort

87106

CULTURE, FUNGI, DEFINITIVE IDENTIFICATION,EACH ORGANISM; YEAST (USE 87106 IN ADDITIONAL TO CODES 87101, 87102, OR 87103 WHEN APPROPRIATE) cohort cohort cohort cohort

87107

CULTURE, FUNGI, DEFINITIVE IDENTIFICATION,EACH ORGANISM; MOLD (USE 87106 IN ADDITIONAL TO CODES 87101, 87102, OR 87103 WHEN APPROPRIATE) cohort cohort cohort cohort

87109 CULTURE, MYCOPLASMA, ANY SOURCE cohort cohort cohort cohort

87110 CULTURE, CHLAMYDIA cohort cohort cohort

87116 CULTURE, TUBERCLE OR OTHER ACID-FAST BACILLI (EG, TB, AFB,MYCOBACTERIA); ANY SOURCE, ISOLATION ONLY cohort cohort cohort cohort cohort

87118 CULTURE, MYCOBACTERIA, DEFINITIVE IDENTIFICATION OF EACHORGANISM cohort cohort

87140 CULTURE, TYPING; FLUORESCENT METHOD, EACH ANTISERUM cohort cohort cohort cohort

87147 CULTURE, TYPING; SEROLOGIC METHOD, AGGLUTINATION GROUPING,PER ANTISERUM cohort cohort cohort cohort cohort

87149

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, DIRECT PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED cohort cohort cohort

87153

CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF THE 16S RRNA GENE) statewide

87168 MACROSCOPIC EXAMINATION; ARTHROPOD cohort cohort

87169 MACROSCOPIC EXAMINATION; PARASITE statewide

87172 PINWORM EXAM (EG, CELLOPHANE TAPE PREP) cohort cohort

87176 ENDOTOXIN, BACTERIAL (PYROGENS); HOMOGENIZATION, TISSUE, FORCULTURE cohort cohort cohort cohort cohort

87177 OVA AND PARASITES, DIRECT SMEARS, CONCENTRATION ANDIDENTIFICATION cohort cohort cohort cohort cohort cohort

87181 SENSITIVITY STUDIES, ANTIBIOTIC; AGAR DIFFUSION METHOD, PER ANTIBIOTIC cohort cohort cohort cohort cohort

87184 SENSITIVITY STUDIES, ANTIBIOTIC; DISK METHOD, PER PLATE (12 OR FEWER DISKS) cohort cohort cohort cohort cohort

87185 SUSCEPTIBILITY STUDIES, ANTIMICROBIAL AGENT; ENZYME DETECTION (EG, BETA LACTAMASE), PER ENZYME cohort cohort cohort cohort cohort

87186

SENSITIVITY STUDIES, ANTIBIOTIC; MICROTITER, MINIMUMINHIBITORY CONCENTRATION (MIC), ANY NUMBER OF ANTIBIOTICS cohort cohort cohort cohort cohort cohort

87188 SENSITIVITY STUDIES, ANTIBIOTIC; MACROTUBE DILUTION METHOD, EACH ANTIBIOTIC statewide

87190 SENSITIVITY STUDIES, ANTIBIOTIC; TUBERCLE BACILLUS(TB,AFB), EACH DRUG statewide

164

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

87205 SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; ROUTINE STAINFOR BACTERIA, FUNGI, OR CELL TYPES cohort cohort cohort cohort cohort cohort

87206

SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; FLUORESCENTAND/OR ACID FAST STAIN FOR BACTERIA, FUNGI, OR CELL TYPES cohort cohort cohort cohort cohort

87207

SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; SPECIAL STAINFOR INCLUSION BODIES OR INTRACELLULAR PARASITES (EG, MALARIA, KALA AZAR, HERPES) cohort cohort cohort cohort cohort

87209

SMEAR, PRIMARY SOURCE WITH INTERPRETATION; COMPLEXSPECIAL STAIN (EG, TRICHROME, IRON HEMOTOXYLIN) F OR OVA AND PARASITES cohort cohort cohort cohort cohort

87210

SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; WET MOUNT WITHSIMPLE STAIN, FOR BACTERIA, FUNGI, OVA, AND/OR PARASITES SMEAR, PRIMARY SOURCE, WITH INTERPRETATION; WET MOUNT WITH cohort cohort cohort cohort cohort

87220 TISSUE EXAMINATION FOR FUNGI (EG, KOH SLIDE)TISSUEEXAMINATION FOR FUNGI (EG, KOH SLIDE) cohort cohort cohort

87230 TOXIN OR ANTITOXIN ASSAY, TISSUE CULTURE (EG, CLOSTRIDIUMDIFFICILE TOXIN) cohort cohort cohort

87252 VIRUS IDENTIFICATION; TISSUE CULTURE INOCULATION ANDOBSERVATION cohort cohort cohort cohort cohort

87253

VIRUS IDENTIFICATION; TISSUE CULTURE, ADDITIONAL STUDIES(EG, HEMABSORPTION, NEUTRALIZATION) EACH ISOLATE cohort cohort

87254 VIRUS ISOLATION; SHELL VIAL, INCLUDES IDENTIFICATION WITH IMMUNOFLUORESCENCE STAIN, EACH VIRUS cohort cohort cohort cohort

87255 VIRUS ISOLATION; ID, NON-IMMUNOLOGIC METHOD, OTHER THAN CYTOPATHIC EFFECT cohort cohort cohort cohort

87260

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; ADENOVIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT statewide

87265

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; BORDETELLA PERTUSSIS/PARAPERTUSSIS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT cohort cohort

87269 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; GIARDIA statewide

87272

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT ANTIBODY TECHNIQUE; CRYPTOSPORIDIUM/GIARDIA cohort cohort cohort

87273

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; HERPES SIMPLEX VIRUS TYPE 2 statewide

87274

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; HERPES SIMPLEX VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT cohort cohort

87275 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; INFLUENZA B VIRUS cohort cohort

87276

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; INFLUENZA A VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT cohort cohort cohort

87278

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; LEGIONELLA PNEUMOPHILA INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT statewide

87279

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PARAINFLUENZA VIRUS, EACH TYPE statewide

87280

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; RESPIRATORY SYNCYTIAL VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT cohort cohort

165

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

87281 INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE; PNEUMOCYSTIS CARINII cohort cohort

87290

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE; VARICELLA ZOSTER VIRUS INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENT statewide

87299

INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUORESCENTANTIBODY TECHNIQUE, NOT OTHERWISE SPECIFIED INFECTIOUS AGENT ANTIGEN DETECTION BY DIRECT FLUO RESCENT statewide

87300

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOFLUORESCENT TECHNIQUE, POLYVALENT FOR MULTIPLE ORGANISMS, EACH POLYVALENT ANTISERUM cohort cohort cohort

87305

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE-STEP METHOD; ASPERGILLUS cohort cohort

87320

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CHLAMYDIA TRACHOMATIS statewide

87324

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CLOSTRIDIUM DIFFICILE TOXINA cohort cohort cohort cohort cohort cohort

87327

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; CRYPTOCOCCUS NEOFORMANS statewide

87328

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; CRYPTOSPORIDIUM/GIARDIA cohort cohort cohort cohort cohort

87329

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; GIARDIA cohort cohort cohort cohort cohort cohort

87336

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA DISPAR GROUP cohort cohort

87337

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; ENTAMOEBA HISTOLYTICA GROUP statewide

87338

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMI- QUANTITATIVE, MULTIPLE STEP METHOD; HELICOBACTER PYLORI, STOOL cohort cohort cohort cohort cohort

87339 HELICOBACTER PYLORI cohort cohort

87340

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN(HBSAG) cohort cohort cohort cohort cohort cohort

87341

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; HEPATITIS B SURFACE ANTIGEN(HBSAG) NEUTRALIZATION cohort cohort cohort cohort

87350

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HEPATITIS BE ANTIGEN (HBEAG) cohort cohort cohort cohort cohort

87385

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HISTOPLASMA CAPSULATUM cohort cohort cohort

87389

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE-STEP METHOD; HIV-1 ANTIGEN(S), cohort cohort cohort cohort cohort

166

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

WITH HIV- 1 AND HIV-2 ANTIBODIES, SINGLE RESULT

87390

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; HIV-1 statewide

87400

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; INFLUENZA, A OR B, EACH cohort cohort cohort cohort

87420

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; RESPIRATORY SYNCYTIAL VIRUS cohort cohort cohort cohort

87425

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; ROTAVIRUS cohort cohort cohort cohort

87427

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE,MULTIPLE STEP METHOD; SHIGA-LIKE TOXIN cohort cohort cohort cohort

87430

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE, QUALITATIVE OR SEMIQUANTITATIVE, MULTIPLE STEP METHOD; STREPTOCOCCUS, GROUP A cohort cohort cohort cohort cohort

87449

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; MULTIPLE STEP METHOD, NOT OTHERWISE SPECIFIED cohort cohort cohort cohort cohort

87450

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAYTECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; SINGLE STEP METHOD, NOT OTHERWISE SPECIFIED cohort cohort

87451

INFECTIOUS AGENT ANTIGEN DETECTION BY ENZYME IMMUNOASSAY TECHNIQUE QUALITATIVE OR SEMIQUANTITATIVE; MULTIPLE STEP METHOD,EACH POLYVALENT ANTISERUM statewide

87471

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);BARTONELLA HENSELAE AND BARTONELLA QUINTANA, AMPLIFIED PROBE TECHNIQUE statewide

87476

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);BORRELIA BURGDORFERI, AMPLIFIED PROBE TECHNI QUE cohort cohort cohort cohort

87481 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CANDIDA SPECIES, AMPLIFIED PROBE TECHNIQUE statewide

87486

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CHLAMYDIA PNEUMONIAE, AMPLIFIED PROBE TECHNI QUE statewide

87490

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CHLAMYDIA TRACHOMATIS, DIRECT PROBE TECHNIQU E INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNAOR RNA); cohort cohort cohort cohort

87491

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CHLAMYDIA TRACHOMATIS, AMPLIFIED PROBE TECHN IQUE cohort cohort cohort cohort cohort

87493

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLI FIED PROBE TECHNIQUE cohort cohort cohort cohort cohort

87496

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CYTOMEGALOVIRUS, AMPLIFIED PROBE TECHNIQUE INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); cohort cohort cohort cohort

87497

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);CYTOMEGALOVIRUS, QUANTIFICATION INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); cohort cohort cohort cohort

87498

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); ENTEROVIRUS, REVERSE TRANSCRIPTION AND AMPL IFIED PROBE TECHNIQUE cohort cohort cohort

87500 Infectious agent detection by nucleic acid (DNA orRNA); vancomycin statewide

167

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

resistance (e.g., enterococcus s pecies van A, van B), amplified probe technique

87501

Infectious agent detection by nucleic acid (DNA orRNA); influenza virus, reverse transcription and amplified probe technique, each type or subtype statewide

87502

Infectious agent detection by nucleic acid (DNA orRNA); influenza virus, for multiple types or sub- types, reverse transcription and amplified probe technique, first 2 types or sub-types cohort cohort cohort

87503

Infectious agent detection by nucleic acid (DNA orRNA); influenza virus, for multiple types or sub- types, multiplex reverse transcription and amplified probe technique, each additional influenza viru cohort cohort cohort

87516

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);HEPATITIS B VIRUS, AMPLIFIED PROBE TECHNIQUE INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); statewide

87517

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);HEPATITIS B VIRUS, QUANTIFICATION INFECTIOU S AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); cohort cohort cohort cohort cohort

87521

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); HEPATITIS C, REVERSE TRANSCRIPTION AND AMPL IFIED PROBE TECHNIQUE cohort cohort cohort

87522

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); HEPATITIS C, REVERSE TRANSCRIPTION AND QUAN TIFICATION cohort cohort cohort cohort cohort cohort

87529

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);HERPES SIMPLEX VIRUS, AMPLIFIED PROBE TECHNI QUE cohort cohort cohort cohort cohort

87532 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);HERPES VIRUS-6, AMPLIFIED PROBE TECHNIQUE statewide

87533

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);HERPES VIRUS-6, QUANTIFICATION INFECTIOUS A GENT DETECTION BY NUCLEIC ACID (DNA OR RNA); statewide

87535

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); HIV-1, REVERSE TRANSCRIPTION AND AMPLIFIED PROBE TECHNIQUE cohort cohort

87536

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); HIV-1, REVERSE TRANSCRIPTION AND QUANTIFICA TION cohort cohort cohort cohort cohort

87556

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);MYCOBACTERIA TUBERCULOSIS, AMPLIFIED PROBE T ECHNIQUE cohort cohort

87581

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);MYCOPLASMA PNEUMONIAE, AMPLIFIED PROBE TECHN IQUE statewide

87590

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);NEISSERIA GONORRHOEAE, DIRECT PROBE TECHNIQU E INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNAOR RNA); cohort cohort cohort

87591

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);NEISSERIA GONORRHOEAE, AMPLIFIED PROBE TECHN IQUE cohort cohort cohort cohort cohort

87621

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA);PAPILLOMAVIRUS, HUMAN, AMPLIFIED PROBE TECHN IQUE cohort cohort cohort cohort

87631

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); RESPIRATORY VIRUS (EG, ADENOVIRUS, INFLUENZ A VIRUS, CORONAVIRUS, METAPNEUMOVIRUS, PARAINFLUENZA VIRUS, RESPIRATORY SYNCYTIAL VIRUS, RHINOVIRUS) cohort cohort

87632


87633


168

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

87640

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); STAPHYLOCOCCUS AUREUS, AMPLIFIED PROBE TECH NIQUE statewide

87641

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); STAPHYLOCOCCUS AUREUS, METHICILLIN RESISTAN T, AMPLIFIED PROBE TECHNIQUE cohort cohort cohort cohort cohort

87653

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); STREPTOCOCCUS, GROUP B, AMPLIFIED PROBE TEC HNIQUE cohort cohort

87798

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); NOTOTHERWISE SPECIFIED, AMPLIFIED PROBE TEC HNIQUE INFECTIOUS AGENT DETECTION BY NUCLEIC ACID(DNA OR RNA); NOT cohort cohort cohort cohort cohort

87799

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA); NOTOTHERWISE SPECIFIED, QUANTIFICATION INF ECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); NOT cohort cohort cohort cohort

87800 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA),MULTIPLE ORGANISMS; DIRECT PROBE(S) TECHNIQUE statewide

87801

INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA ORRNA),MULTIPLE ORGANISMS; AMPLIFIED PROBE(S) TECHNIQUE cohort cohort cohort cohort cohort

87802 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;STREPTOCOCCUC GROUP B cohort cohort cohort

87803 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;CLOSTRIDIUM DIFFICILE TOXIN A statewide

87804 INFECTIOUS AGENT, IMMUNOASSAY, DIRECT OBSERVATION;INFLUENZA cohort cohort cohort cohort cohort

87807 RSV ASSAY W/OPTIC cohort cohort cohort cohort cohort

87808

INFECTIOUS AGENT ANTIGEN DETECTION BY IMMUNOASSAY WITH DIRECT OPTICAL OBSERVATION; TRICHOMONAS VAGINALIS statewide

87810 Chlamydia trachomatis statewide

87880

INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECTOPTICAL OBSERVATION; STREPTOCOCCUS, GROUP A INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT cohort cohort cohort cohort cohort cohort

87899

INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECTOPTICAL OBSERVATION; NOT OTHERWISE SPECIFIED INFECTIOUS AGENT DETECTION BY IMMUNOASSAY WITH DIRECT cohort cohort cohort cohort

87900

INFECTIOUS AGENT DRUG SUSCEPTIBILITY PHENOTYPE PREDICTION USING REGULARLY UPDATED GENOTYPIC BIOINFORMATICS statewide

87901 Infectious agent genotype analysis by nucleic acid(DNA or RNA); HIV-1, reverse transcriptase and pr otease regions cohort cohort

87902 INFECTIOUS AGENT, GENOTYPE ANALYSIS, NUCLEIC ACID (DNA/RNA); HEPATITIS C VIRUS cohort cohort cohort cohort

87903

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID (DNA OR RNA) WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS, HIV 1; UP TO 10 DRUGS statewide

87904

INFECTIOUS AGENT PHENOTYPE ANALYSIS BY NUCLEIC ACID(DNA OR RNA)WITH DRUG RESISTANCE TISSUE CULTURE ANALYSIS,HIV1;EACH ADDITIONAL DRUG, UP TO 5 DRUGS(LIST SEPARATELY IN ADDITION TO CODE PRIM PROCDUR statewide

87999 UNLISTED MICROBIOLOGY PROCEDURE statewide

88112

CYTOPATHOLOGY, SELECTIVE CELLULAR ENHANCEMENT TECHNIQUE WITH INTERPRETATION (EG, LIQUID BASED SLIDE PREPARATION METHOD), EXCEPT CERVICAL OR VAGINAL statewide

88142

CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM),COLLECTED IN PRESERVATIVE FLUID, AUTOMATEDTHIN LAYER PREPARATION; MANUAL SCREENING UNDER P HYSICIAN SUPERVISION cohort cohort cohort cohort

88173 EVALUATION OF FINE NEEDLE ASPIRATE WITH OR WITHOUTPREPARATION OF SMEARS; INTERPRETATION AND cohort cohort

169

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

REPORT

88174 CYTOPATHOLOGY, CERVICAL/VAGINAL, AUTO THIN LAYER PREP; AUTO SCREEN, WITH PHYSICIAN SUPERVISION statewide

88175

CYTOPATHOLOGY, CERVICAL/VAGINAL,AUTO THIN LAYER PREP; AUTO SCREEN & MANUAL RESCREEN, WITH PHYSICIAN INTERPRETATION cohort cohort

88184 FLOWCYTOMETRY/ TC, 1 MARKER statewide

88185 FLOWCYTOMETRY/TC, ADD-ON statewide

88230 TISSUE CULTURE FOR NON-NEOPLASTIC DISORDERS; LYMPHOCYTE statewide

88237 TISSUE CULTURE FOR NEOPLASTIC DISORDERS; BONE MARROW, BLOOD CELLS statewide

88261 CHROMOSOME ANALYSIS; COUNT 5 CELLS, 1 KARYOTYPE, WITHBANDING statewide

88262 CHROMOSOME ANALYSIS; COUNT 15-20 CELLS, 2 KARYOTYPES, WITHBANDING statewide

88264 CHROMOSOME ANALYSIS; ANALYZE 20-25 CELLS statewide

88271 MOLECULAR CYTOGENETICS; DNA PROBE, EACH (EG, FISH) statewide

88275 MOLECULAR CYTOGENETICS; INTERPHASE IN SITU HYBRIDIZATION,ANALYZE 100-300 CELLS statewide

88280 CHROMOSOME ANALYSIS; ADDITIONAL KARYOTYPES, EACH STUDY statewide

88283 CHROMOSOME ANALYSIS; ADDITIONAL SPECIALIZED BANDINGTECHNIQUE (EG, NOR, C-BANDING) statewide

88285 CHROMOSOME ANALYSIS; ADDITIONAL CELLS COUNTED, EACH STUDY statewide

88304 LEVEL III - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION statewide statewide

88305 LEVEL IV - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION cohort cohort cohort

88307 LEVEL V - SURGICAL PATHOLOGY, GROSS AND MICROSCOPIC EXAMINATION cohort cohort cohort

88311 DECALCIFICATION PROCEDURE (LIST SEPARATELY IN ADDITION TOCODE FOR SURGICAL PATHOLOGY EXAMINATION) cohort cohort

88312

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT;GROUP I FOR MICROORGANISMS (EG, ACID FAST, METHEN AMINE SILVER) statewide

88313

SPECIAL STAIN INCLUDING INTERPRETATION AND REPORT;GROUP II, ALL OTHER (EG, IRON, TRICHROME), EXCEPT STAIN FOR MICROORGANISMS, STAINS FOR ENZYME CONST ITUENTS, OR IMMUNOCYTOCHEMISTRY AND IMMUNOHISTOCHE cohort cohort cohort

88331 PATHOLOGY CONSULTATION DURING SURGERY; WITH FROZENSECTION(S), SINGLE SPECIMEN statewide

88334

Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site (List separately in addition to code for primary procedure) cohort cohort

88342 IMMUNOCYTOCHEMISTRY (INCLUDING TISSUE IMMUNOPEROXIDASE),EACH ANTIBODY cohort cohort cohort cohort

88346 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; DIRECT METHOD statewide

88347 IMMUNOFLUORESCENT STUDY, EACH ANTIBODY; INDIRECT METHOD statewide

88348 ELECTRON MICROSCOPY; DIAGNOSTIC statewide

88361

MORPHOMETRIC ANALYSIS; TUMOR IMMUNOHISTOCHEMISTRY (EG, HER-2/NEU, ESTROGEN RECEPTOR/PROGESTERONE RECEPTOR), QUANTITATIVE OR SEMIQUANTITATIVE statewide

89051 CELL COUNT, MISCELLANEOUS BODY FLUIDS (EG, CSF, JOINTFLUID), EXCEPT BLOOD; WITH DIFFERENTIAL COUNT statewide

89055 LEUKOCYTE COUNT, FECAL cohort cohort

89060 Crystal identification by light microscopy with orwithout polarizing lens analysis, tissue or any b ody fluid (except urine) statewide

170

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

89220 SPUTUM, OBTAINING SPECIMEN, AEROSOL INDUCED TECHNIQUE (SEPARATE PROCEDURE) statewide

89230 SWEAT COLLECTION BY IONTOPHORESIS statewide

90287 Botulinum antitoxin, equine, any route statewide

90371 Hepatitis B immune globulin (HBIg), human, for intramuscular use statewide

90375 Rabies immune globulin (RIg), human, for intramuscular and/or subcutaneous use cohort cohort cohort cohort cohort

90376 Rabies immune globulin, heat-treated (Rig-HT), human, for intramuscular and/or subcutaneous use statewide

90460

IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, WITH COUNSELINGBY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFE SSIONAL; FIRST OR ONLY COMPONENT OF EACH VACCINE O cohort cohort

90461

IMMUNIZATION ADMINISTRATION THROUGH 18 YEARS OF AGE VIA ANY ROUTE OF ADMINISTRATION, WITH COUNSELINGBY PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFE SSIONAL; EACH ADDITIONAL VACCINE OR TOXOID COMPONE cohort cohort

90471

IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS, INTRADERMAL, SUBCUTANEOUS, OR INTRAMUSCULAR INJECTIONS); 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) cohort cohort cohort cohort cohort cohort

90472

IMMUNIZATION ADMINISTRATION (INCLUDES PERCUTANEOUS,INTRADERMAL, SUBCUTANEOUS, INTRAMUSCULAR AND JET INJECTIONS AND/OR INTRANASAL OR ORAL ADMINISTRATION); TWO OR MORE cohort cohort cohort cohort cohort

90473 IMMUNIZATION ADMINISTRATION BY INTRANASAL OR ORAL ROUTE; 1 VACCINE (SINGLE OR COMBINATION VACCINE/TOXOID) statewide

90474 IMMUNIZATION ADMINISTRATION,INTRANASAL/ORAL; EA ADD'L SINGLE/COMBINATION VACCINE/TOXOID cohort cohort

90585 Bacillus Calmette-Guerin vaccine (BCG) for tuberculosis, live, for percutaneous use statewide

90586 Bacillus Calmette-Guerin vaccine (BCG) for bladdercancer, live, for intravesical use statewide

90632 Hepatitis A vaccine, adult dosage, for intramuscular use statewide

90633 Hepatitis A vaccine, pediatric/adolescent dosage-2dose schedule, for intramuscular use cohort cohort

90636 Hepatitis A and hepatitis B vaccine (HepA-HepB), adult dosage, for intramuscular use statewide

90645 Hemophilus influenza b vaccine (Hib), HbOC conjugate (4 dose schedule), for intramuscular use cohort cohort

90646 Hemophilus influenza b vaccine (Hib), PRP-D conjugate, for booster use only, intramuscular use statewide

90647 Hemophilus influenza b vaccine (Hib), PRP-OMP conjugate (3 dose schedule), for intramuscular use statewide

90648 Hemophilus influenza b vaccine (Hib), PRP-T conjugate (4 dose schedule), for intramuscular use statewide

90649 Human Papilloma virus (HPV) vaccine, types 6, 11, 16, 18 (quadrivalent), 3 dose schedule, for intramuscular use cohort cohort

90655 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to children 6-35 months of age, for intramuscular use cohort cohort

90656 Influenza virus vaccine, trivalent, split virus, preservative free, when administered to individuals3 years and older, for intramuscular use cohort cohort cohort cohort

90657 Influenza virus vaccine, trivalent, split virus, when administered to children 6-35 months of age, for intramuscular use statewide

90658 Influenza virus vaccine, trivalent, split virus, when administered to individuals 3 years of age andolder, for intramuscular use cohort cohort cohort

90660 Influenza virus vaccine, trivalent, live, for intranasal use statewide

90662 Influenza virus vaccine, split virus, preservationfree, enhanced immunogenicity via increased antig en content, for intramuscular use cohort cohort

90669 PNEUMOCOCCAL CONJUGATE VACCINE, 7 VALENT, FOR INTRAMUSCULAR USE statewide

90670 Pneumococcal conjugate vaccine, 13 valent, for intramuscular use cohort cohort

171

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

90675 Rabies vaccine, for intramuscular use cohort cohort cohort cohort cohort

90680 Rotavirus vaccine, pentavalent, 3 dose schedule, live, for oral use statewide

90681 Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use statewide

90686

Influenza virus vaccine, quadrivalent, split virus, preservative free, when administered to individuals 3 years of age and older, for intramuscular use statewide

90696

Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 years through6 years of age, for intramuscular use cohort cohort cohort

90700

Diphtheria, tetanus toxoids, and acellular pertussis vaccine (DTaP), when administered to individuals younger than 7 years, for intramuscular use cohort cohort

90702 Diphtheria and tetanus toxoids (DT) absorbed when administered to individuals younger than 7 years, for intramuscular use statewide

90703 Tetanus toxoid absorbed, for intramuscular use cohort cohort

90707 MEASLES, MUMPS AND RUBELLA VIRUS VACCINE (MMR), LIVE, FORSUBCUTANEOUS USE statewide

90710 Measles, mumps, rubella, and varicella vaccine (MMRV), live for subcutaneous use cohort cohort

90713 POLIOVIRUS VACCINE, INACTIVATED, (IPV), FOR SUBCUTANEOUS OR INTRAVMUSCULAR USE cohort cohort

90714 Tetanus and diphtheria toxoids (Td) absorbed, preservative free, when administered to individuals 7years or older, for intramuscular use cohort cohort cohort cohort

90715 Tetanus diphtheria toxoids and acellular pertussisvaccine (Tdap), when administered to individuals 7 years or older, for intramuscular use cohort cohort cohort cohort cohort

90716 Varicella virus vaccine, live, for subcutaneous use statewide

90723 Diphtheria, tetanus toxoids, acellular pertussis vaccine, Hepatitis B, and poliovirus vaccine, inactivated (DtaP-HepB-IPV), for intramuscular use cohort cohort cohort

90732

Pneumococcal polysaccharide vaccine, 23-valent, adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use cohort cohort cohort cohort

90733 Meningococcal polysaccharide vaccine (any group(s)), for subcutaneous use cohort cohort cohort

90734 Meningococcal conjugate vaccine, serogroups A, C, Y and W-135 (tetravalent), for intramuscular use cohort cohort

90736 Zoster (shingles) vaccine, live, for subcutaneous injection cohort cohort

90740 Hepatitis B vaccine, dialysis or immunosuppressed patient dosage (3 dose schedule), for intramuscular use cohort cohort


90743 Hepatitis B vaccine, adolescent (2 dose schedule),for intramuscular use statewide

90744 Hepatitis B vaccine, pediatric/adolescent dosage (3 dose schedule), for intramuscular use cohort cohort

90746 Hepatitis B vaccine, adult dosage (3 dose schedule), for intramuscular use cohort cohort

90791 PSYCHIATRIC DIAGNOSTIC EVALUATION cohort cohort cohort cohort

90792 PSYCHIATRIC DIAGNOSTIC EVALUATION WITH MEDICAL SERVICES statewide

90832 PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER cohort cohort cohort

90833

PSYCHOTHERAPY, 30 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) statewide

90834 PSYCHOTHERAPY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER cohort cohort

90836

PSYCHOTHERAPY, 45 MINUTES WITH PATIENT AND/OR FAMILY MEMBER WHEN PERFORMED WITH AN EVALUATION AND MANAGEMENT SERVICE (LIST SEPARATELY IN ADDITION TO THE CODE FOR PRIMARY PROCEDURE) statewide

90837 PSYCHOTHERAPY, 60 MINUTES WITH PATIENT AND/OR FAMILY cohort cohort

172

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MEMBER

90839 PSYCHOTHERAPY FOR CRISIS; FIRST 60 MINUTES statewide

90847

FAMILY PSYCHOTHERAPY (CONJOINT PSYCHOTHERAPY) (WITH PATIENT PRESENT) FAMILY PSYCHOTHERAPY (CONJOINTPSYCHOTHERAPY) (WITH PATIENT statewide

90853

GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) GROUP PSYCHOTHERAPY (OTHER THAN OF A MULTIPLE-FAMILY GROUP) cohort cohort cohort

90870

ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING);SINGLE SEIZURE ELECTROCONVULSIVE THERAPY (INCLUDES NECESSARY MONITORING); cohort cohort cohort cohort cohort

90901 BIOFEEDBACK TRAINING BY ANY MODALITY statewide

90911

BIOFEEDBACK TRAINING, PERINEAL MUSCLES, ANORECTAL ORURETHRAL SPHINCTER, INCLUDING EMG AND/OR MANOMETRY statewide

90935

HEMODIALYSIS PROCEDURE WITH SINGLE EVALUATION BY APHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI ONAL cohort cohort

90945

DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTHER CONTINUOUS RENAL REPLACEMENT THERAPIES), WITH SINGLE EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED HEALTH C statewide

90947

DIALYSIS PROCEDURE OTHER THAN HEMODIALYSIS (EG, PERITONEAL DIALYSIS, HEMOFILTRATION, OR OTHER CONTINUOUS RENAL REPLACEMENT THERAPIES) REQUIRING REPEATED EVALUATION BY A PHYSICIAN OR OTHER QUALIFIED HE statewide

90999

UNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENTUNLISTED DIALYSIS PROCEDURE, INPATIENT OR OUTPATIENT cohort

91010

ESOPHAGEAL MOTILITY (MANOMETRIC STUDY OF THE ESOPHAGUS AND/OR GASTROESOPHAGEAL JUNCTION) STUDY WITH INTERPRETATION AND REPORT; cohort cohort cohort cohort cohort

91020 GASTRIC MOTILITY (MANOMETRIC) STUDIES statewide

91034 GASTROESOPHAGEAL REFLUX TEST cohort cohort cohort cohort

91035 ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST, WITH ELECTRODE cohort cohort cohort cohort cohort

91037

ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER INTRALUMINAL IMPEDANCE ELECTRODE(S) PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION cohort cohort cohort

91038 ESOPHAGEAL FUNCTION TEST, GASTROESOPHAGEAL REFLUX TEST WITH NASAL CATHETER INTRALUMINAL, > 1 HR cohort cohort cohort

91065 BREATH HYDROGEN TEST (EG, FOR DETECTION OF LACTASEDEFICIENCY) cohort cohort cohort

91110

GASTROINTESTINAL TRACT IMAGING, INTRALUMINAL (EG, CAPSULE ENDOSCOPY), ESOPHAGUS THROUGH ILEUM, WITH INTERPRETATION AND REPORT cohort cohort cohort cohort

91112

GASTROINTESTINAL TRANSIT AND PRESSURE MEASUREMENT,STOMACH THROUGH COLON, WIRELESS CAPSULE, WITH INT ERPRETATION AND REPORT statewide

91117

Colon motility (manometric) study, minimum 6 hourscontinuous recording (including provocation tests , eg, meal, intracolonic balloon distension, pharmacologic agents, if performed), with interpretatio statewide

91120 RECTAL SENSATION TEST statewide

91122 ANORECTAL MANOMETRY cohort cohort

91299 UNLISTED DIAGNOSTIC GASTROENTEROLOGY PROCEDURE cohort cohort

92015 DETERMINATION OF REFRACTIVE STATEDETERMINATION OF REFRACTIVE STATE statewide

92018

OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDERGENERALANESTHESIA, WITH OR WITHOUT MANIPULATION O F GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE cohort cohort

173

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

92019

OPHTHALMOLOGICAL EXAMINATION AND EVALUATION, UNDERGENERALANESTHESIA, WITH OR WITHOUT MANIPULATION O F GLOBE FOR PASSIVE RANGE OF MOTION OR OTHER MANIPULATION TO FACILITATE statewide

92025 COMPUTERIZED CORNEAL TOPOGRAPHY, UNILATERAL OR BILATERAL, WITH INTERPRETATION AND REPORT statewide

92081

VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL,WITHINTERPRETATION AND REPORT; LIMITED EXAMINATIO N (EG, TANGENT SCREEN, AUTOPLOT, ARC PERIMETER, OR SINGLE STIMULUS LEVEL statewide

92082

VISUAL FIELD EXAMINATION, UNILATERAL OR BILATERAL,WITHINTERPRETATION AND REPORT; INTERMEDIATE EXAMI NATION (EG, AT LEAST 2 ISOPTERS ON GOLDMANN PERIMETER, OR SEMIQUANTITATIVE, statewide

92083

Visual field examination, unilateral or bilateral,with interpretation and report; extended examinat ion (eg, Goldmann visual fields with at least 3 isopters plotted and static determination within the statewide

92133

Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; optic nerve statewide

92134 Scanning computerized ophthalmic diagnostic imaging, posterior segment, with interpretation and report, unilateral or bilateral; retina statewide

92136 OPTHALMIC BIOMETRY BY PARTIAL COHERENCE INTERFEROMETRY W/ INTRAOCULAR LENS CALCULATION statewide

92140

PROVOCATIVE TESTS FOR GLAUCOMA, WITH INTERPRETATION ANDREPORT, WITHOUT TONOGRAPHY PROVOCATIVE TESTSFOR GLAUCOMA, WITH INTERPRETATION AND statewide

92235

FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITHINTERPRETATION AND REPORT FLUORESCEIN ANGIOGRAPHY (INCLUDES MULTIFRAME IMAGING) WITH statewide

92240 INDOCYANINE-GREEN ANGIOGRAPHY (INCLUDES MULTIFRAMEIMAGING) WITH INTERPRETATION AND REPORT statewide

92250

FUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORTFUNDUS PHOTOGRAPHY WITH INTERPRETATION AND REPORT statewide

92270

ELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORTELECTRO-OCULOGRAPHY WITH INTERPRETATION AND REPORT cohort cohort

92275

ELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORTELECTRORETINOGRAPHY WITH INTERPRETATION AND REPORT statewide

92285

EXTERNAL OCULAR PHOTOGRAPHY WITH INTERPRETATION AND REPORTFOR DOCUMENTATION OF MEDICAL PROGRESS (EG,CLOSE-UP PHOTOGRAPHY, SLIT LAMP PHOTOGRAPHY, GON IOPHOTOGRAPHY, cohort cohort

92499

UNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDUREUNLISTED OPHTHALMOLOGICAL SERVICE OR PROCEDURE cohort cohort

92502 OTOLARYNGOLOGIC EXAMINATION UNDER GENERAL ANESTHESIA cohort cohort

92504 BINOCULAR MICROSCOPY (SEPARATE DIAGNOSTIC PROCEDURE) statewide

92506

EVALUATION OF SPEECH, LANGUAGE, VOICE, COMMUNICATION,AUDITORY PROCESSING, AND/OR AURAL REHABILITATION STATUS statewide

92511 NASOPHARYNGOSCOPY WITH ENDOSCOPE (SEPARATE PROCEDURE) cohort cohort cohort cohort

92540

BASIC VESTIBULAR EVALUATION, INCLUDES SPONTANEOUS NYSTAGMUS TEST WITH ECCENTRIC GAZE FIXATION NYSTAGMUS, WITH RECORDING, POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING, OPTOKINETIC cohort cohort cohort

92542

POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS,WITHRECORDING POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH statewide

174

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

92543

CALORIC VESTIBULAR TEST, EACH IRRIGATION (BINAURAL, BITHERMAL STIMULATION CONSTITUTES 4 TESTS), WITHRECORDING cohort cohort cohort

92546 SINUSOIDAL VERTICAL AXIS ROTATIONAL TESTINGSINUSOIDAL VERTICAL AXIS ROTATIONAL TESTING statewide

92547

USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TOCODE FOR PRIMARY PROCEDURE) USE OF VERTICAL ELECTRODES (LIST SEPARATELY IN ADDITION TO statewide

92550 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS cohort cohort cohort cohort

92551 SCREENING TEST, PURE TONE, AIR ONLY cohort cohort cohort cohort

92552 PURE TONE AUDIOMETRY (THRESHOLD); AIR ONLY cohort cohort cohort cohort

92553 PURE TONE AUDIOMETRY (THRESHOLD); AIR AND BONE cohort cohort

92555 SPEECH AUDIOMETRY THRESHOLD; cohort cohort cohort cohort

92556 SPEECH AUDIOMETRY THRESHOLD; WITH SPEECH RECOGNITION cohort cohort cohort cohort

92557 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECHRECOGNITION (92553 AND 92556 COMBINED) cohort cohort cohort cohort

92558

EVOKED OTOACOUSTIC EMISSIONS, SCREENING (QUALITATIVE MEASUREMENT OF DISTORTION PRODUCT OR TRANSIENT EVOKED OTOACOUSTIC EMISSIONS), AUTOMATED ANALYSIS cohort cohort

92563 TONE DECAY TEST statewide

92565 STENGER TEST, PURE TONE cohort cohort

92567 TYMPANOMETRY (IMPEDANCE TESTING) cohort cohort cohort cohort

92568 ACOUSTIC REFLEX TESTING, THRESHOLD cohort cohort cohort cohort

92570

ACOUSTIC IMMITTANCE TESTING, INCLUDES TYMPANOMETRY(IMPEDANCE TESTING), ACOUSTIC REFLEX THRESHOLD TE STING, AND ACOUSTIC REFLEX DECAY TESTING cohort cohort cohort

92572 STAGGERED SPONDAIC WORD TEST statewide

92577 STENGER TEST, SPEECH statewide

92579 VISUAL REINFORCEMENT AUDIOMETRY (VRA) cohort cohort cohort cohort

92582 CONDITIONING PLAY AUDIOMETRY cohort cohort cohort

92583 SELECT PICTURE AUDIOMETRY statewide

92584 ELECTROCOCHLEOGRAPHY cohort cohort

92585

AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRYAND/OR TESTING OF THE CENTRAL NERVOUS SYSTEM cohort cohort cohort cohort

92586

AUDITORY EVOKED POTENTIALS FOR EVOKED RESPONSE AUDIOMETRY AND/OR TESTING OF THE CENTRAL NERVOUS SYSTEM; LIMITED cohort cohort cohort cohort

92587

DISTORTION PRODUCT EVOKED OTOACOUSTIC EMISSIONS; LIMITED EVALUATION (TO CONFIRM THE PRESENCE OR ABSENCE OF HEARING DISORDER, 3-6 FREQUENCIES) OR TRANSIENT EVOKED OTOACOUSTIC EMISSIONS, WITH INTERPRETA cohort cohort cohort cohort

92588

DISTORTION PRODUCT EVOKED OTOACOUSTIC EMISSIONS; COMPREHENSIVE DIAGNOSTIC EVALUATION (QUANTITATIVE ANALYSIS OF OUTER HAIR CELL FUNCTION BY COCHLEAR MAPPING, MINIMUM OF 12 FREQUENCIES), WITH INTERPRETA cohort cohort cohort cohort

92590 HEARING AID EXAMINATION AND SELECTION; MONAURAL statewide

92591 HEARING AID EXAMINATION AND SELECTION; BINAURAL statewide

92592 HEARING AID CHECK; MONAURALHEARING AID CHECK; MONAURAL cohort cohort

92593 HEARING AID CHECK; BINAURALHEARING AID CHECK; BINAURAL cohort cohort

92594 ELECTROACOUSTIC EVALUATION FOR HEARING AID; MONAURAL cohort cohort

92595 ELECTROACOUSTIC EVALUATION FOR HEARING AID; BINAURAL cohort cohort

92601 DX ANALYSIS COCHLEAR IMPLANT, PATIENT <7 YRS. W/PROGRAMMING statewide

92602 DX ANALYSIS COCHLEAR IMPLANT, PATIENT <7 YRS. REPROGRAMMING statewide

175

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

92603 DX ANALYSIS COCHLEAR IMPLANT, PATIENT >7 YRS. W/PROGRAMMING statewide

92604 DX ANALYSIS COCHLEAR IMPLANT, PATIENT >7 YRS. REPROGRAMMING statewide

92610 EVAL ORAL & PHARYNGEAL SWALLOW FUNCTION statewide

92611 MOTION FLUOROSCOPIC EVAL SWALLOW FUNCTION CINE/ VIDEO RECORD statewide

92612 FLEXIBLE FIBEROPTIC ENDOSCOPIC EVAL SWALLOW CINE/ VIDEO RECORD statewide

92620 AUDITORY FUNCTION, 60 MIN cohort cohort cohort cohort

92621

EVALUATION OF CENTRAL AUDITORY FUNCTION, WITH REPORT; EACH ADDITIONAL 15 MINUTES (LIST SEPARATELY INADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

92625 TINNITUS ASSESSMENT statewide

92626 EVALUATION OF AUDITORY REHABILITATION STATUS; FIRST HOUR cohort cohort

92627

EVALUATION OF AUDITORY REHABILITATION STATUS; EACHADDITIONAL 15 MINUTES (LIST SEPARATELY IN ADDITIO N TO CODE FOR PRIMARY PROCEDURE) statewide

92700 UNLISTED OTORHINOLARYNGOLOGICAL SERVICE OR PROCEDURE statewide

92920 PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY; SINGLE MAJOR CORONARY ARTERY OR BRANCH cohort cohort cohort cohort cohort

92921

PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY; EACH ADDITIONAL BRANCH OF A MAJOR CORONARY ARTERY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

92924

PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH statewide

92928

PERCUTANEOUS TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH cohort cohort cohort cohort

92929

PERCUTANEOUS TRANSCATHETER PLACEMENT OF INTRACORONARY STENT(S), WITH CORONARY ANGIOPLASTY WHEN PERFORMED; EACH ADDITIONAL BRANCH OF A MAJOR CORONARY ARTERY (LIST SEPARATELY IN ADDITION TO CODE FOR PRI cohort cohort cohort cohort

92933

PERCUTANEOUS TRANSLUMINAL CORONARY ATHERECTOMY, WITH INTRACORONARY STENT, WITH CORONARY ANGIOPLASTY WHEN PERFORMED; SINGLE MAJOR CORONARY ARTERY OR BRANCH cohort cohort cohort

92937

PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR THROUGH CORONARY ARTERY BYPASS GRAFT (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS), ANY COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AND ANGIOPLASTY, I cohort cohort cohort

92938

PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF OR THROUGH CORONARY ARTERY BYPASS GRAFT (INTERNAL MAMMARY, FREE ARTERIAL, VENOUS), ANY COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AND ANGIOPLASTY, I statewide

92941

PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF ACUTE TOTAL/SUBTOTAL OCCLUSION DURING ACUTE MYOCARDIAL INFARCTION, CORONARY ARTERY OR CORONARY ARTERY BYPASS GRAFT, ANY COMBINATION OF INTRACORONARY STEN cohort cohort

92943

PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF CHRONIC TOTAL OCCLUSION, CORONARY ARTERY, CORONARY ARTERY BRANCH, OR CORONARY ARTERY BYPASS GRAFT, ANY COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AN cohort cohort cohort cohort

92944

PERCUTANEOUS TRANSLUMINAL REVASCULARIZATION OF CHRONIC TOTAL OCCLUSION, CORONARY ARTERY, CORONARY ARTERY BRANCH, OR CORONARY ARTERY BYPASS GRAFT, ANY COMBINATION OF INTRACORONARY STENT, ATHERECTOMY AN statewide

92950 CARDIOPULMONARY RESUSCITATION (EG, IN CARDIAC ARREST) cohort cohort cohort cohort cohort

176

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

92953 TEMPORARY TRANSCUTANEOUS PACING cohort cohort

92960 CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OFARRHYTHMIA, EXTERNAL cohort cohort cohort cohort cohort

92961 CARDIOVERSION, ELECTIVE, ELECTRICAL CONVERSION OF ARRHYTHMIA; INTERNAL (SEPARATE PROCEDURE) statewide

92971 Cardioassist-method of circulatory assist; external statewide

92973

PERCUTANEOUS TRANSLUMINAL CORONARY THROMBECTOMY MECHANICAL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

92974 TRANSCATHETER PLACEMENT, RADIATION DELIVERY DEVICECORONARY INTRAVASCULAR BRACHYTHERAPY statewide

92977 THROMBOLYSIS, CORONARY; BY INTRAVENOUS INFUSION cohort cohort

92978

INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURINGTHERAPEUTIC INTERVENTION INCLUDING IMAGINGSUPERVISION, INTERPRETATION AND REPORT; INITIAL VESSEL (LIST SEPARATELY cohort cohort cohort cohort cohort

92979

INTRAVASCULAR ULTRASOUND (CORONARY VESSEL OR GRAFT) DURINGTHERAPEUTIC INTERVENTION INCLUDING IMAGINGSUPERVISION, INTERPRETATION AND REPORT; EACH ADD ITIONAL VESSEL (LIST cohort cohort cohort

92986 PERCUTANEOUS BALLOON VALVULOPLASTY; AORTIC VALVE statewide

92987 PERCUTANEOUS BALLOON VALVULOPLASTY; MITRAL VALVE statewide

92990 PERCUTANEOUS BALLOON VALVULOPLASTY; PULMONARY VALVE statewide

92997 PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOONANGIOPLASTY; SINGLE VESSEL statewide

92998

PERCUTANEOUS TRANSLUMINAL PULMONARY ARTERY BALLOONANGIOPLASTY; EACH ADDITIONAL VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) statewide

93000

ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH INTERPRETATION AND REPORT ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; WITH cohort cohort cohort cohort cohort

93005

ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS;TRACING ONLY, WITHOUT INTERPRETATION AND REPORT ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12LEADS; cohort cohort cohort cohort cohort cohort

93010

ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS;INTERPRETATION AND REPORT ONLY ELECTROCARDIOGRAM, ROUTINE ECG WITH AT LEAST 12 LEADS; cohort cohort cohort

93015

CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMAL TREADMILL OR BICYCLE EXERCISE, CONTINUOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL STRESS; WITH SUPERVISION, INTERPRETATION AND RE statewide

93017

CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMALTREADMILL OR BICYCLE EXERCISE, CONTINOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL cohort cohort cohort cohort cohort

93018

CARDIOVASCULAR STRESS TEST USING MAXIMAL OR SUBMAXIMALTREADMILL OR BICYCLE EXERCISE, CONTINOUS ELECTROCARDIOGRAPHIC MONITORING, AND/OR PHARMACOLOGICAL statewide

93040 RHYTHM ECG, ONE TO THREE LEADS; WITH INTERPRETATION ANDREPORT statewide

93041 RHYTHM ECG, ONE TO THREE LEADS; TRACING ONLY WITHOUTINTERPRETATION AND REPORT cohort cohort cohort cohort cohort

93225

External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; recording (includes connection, recording, and disconnection) cohort cohort cohort cohort cohort cohort

93226 External electrocardiographic recording up to 48 hours by continuous rhythm recording and storage; scanning analysis with report cohort cohort cohort cohort cohort

93229 EXTERNAL MOBILE CARDIOVASCULAR TELEMETRY WITH cohort cohort

177

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

ELECTROCARDIOGRAPHIC RECORDING, CONCURRENT COMPUTERIZED REAL TIME DATA ANALYSIS AND GREATER THAN 24 HOURS OF ACCESSIBLE ECG DATA STORAGE (RETRIEVABLE WITH

93270

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attende cohort cohort cohort cohort cohort

93271

External patient and, when performed, auto activated electrocardiographic rhythm derived event recording with symptom-related memory loop with remote download capability up to 30 days, 24-hour attende cohort cohort cohort cohort

93272

EXTERNAL PATIENT AND, WHEN PERFORMED, AUTO ACTIVATED ELECTROCARDIOGRAPHIC RHYTHM DERIVED EVENT RECORDING WITH SYMPTOM-RELATED MEMORY LOOP WITH REMOTE DOWNLOAD CAPABILITY UP TO 30 DAYS, 24-HOUR ATTENDE statewide

93278 SIGNAL-AVERAGED ELECTROCARDIOGRAPHY (SAECG), WITH OR WITHOUTECG statewide

93279

PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AN cohort cohort

93280

PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AN cohort cohort cohort

93281

PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AN statewide

93282


93283

PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AN cohort cohort cohort

93284

PROGRAMMING DEVICE EVALUATION (IN PERSON) WITH ITERATIVE ADJUSTMENT OF THE IMPLANTABLE DEVICE TO TEST THE FUNCTION OF THE DEVICE AND SELECT OPTIMAL PERMANENT PROGRAMMED VALUES WITH ANALYSIS, REVIEW AN cohort cohort

93285


93286

PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND PROGRAMMING OF DEVICE SYSTEM PARAMETERS BEFORE OR AFTER A SURGERY, PROCEDURE, OR TEST WITH ANALYSIS,REVIEW AND REPORT BY A PHYSICIAN OR OTHER QUALIFI statewide

93287

PERI-PROCEDURAL DEVICE EVALUATION (IN PERSON) AND PROGRAMMING OF DEVICE SYSTEM PARAMETERS BEFORE OR AFTER A SURGERY, PROCEDURE, OR TEST WITH ANALYSIS,REVIEW AND REPORT BY A PHYSICIAN OR OTHER QUALIFI statewide

93288

INTERROGATION DEVICE EVALUATION (IN PERSON) WITH ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR OTHERQUALIFIED HEALTH CARE PROFESSIONAL, INCLUDES CONN ECTION, RECORDING AND DISCONNECTION PER PATIENT cohort cohort cohort

178

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

EN

93289

INTERROGATION DEVICE EVALUATION (IN PERSON) WITH ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR OTHERQUALIFIED HEALTH CARE PROFESSIONAL, INCLUDES CONN ECTION, RECORDING AND DISCONNECTION PER PATIENT EN cohort cohort cohort

93290

INTERROGATION DEVICE EVALUATION (IN PERSON) WITH ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR OTHERQUALIFIED HEALTH CARE PROFESSIONAL, INCLUDES CONN ECTION, RECORDING AND DISCONNECTION PER PATIENT EN statewide

93291

INTERROGATION DEVICE EVALUATION (IN PERSON) WITH ANALYSIS, REVIEW AND REPORT BY A PHYSICIAN OR OTHERQUALIFIED HEALTH CARE PROFESSIONAL, INCLUDES CONN ECTION, RECORDING AND DISCONNECTION PER PATIENT EN cohort cohort

93293

TRANSTELEPHONIC RHYTHM STRIP PACEMAKER EVALUATION(S) SINGLE, DUAL, OR MULTIPLE LEAD PACEMAKER SYSTEM, INCLUDES RECORDING WITH AND WITHOUT MAGNET APPLICATION WITH ANALYSIS, REVIEW AND REPORT(S) BY A PH cohort cohort cohort

93296

Interrogation device evaluation(s) (remote), up to90 days; single, dual, or multiple lead pacemaker system or implantable cardioverter-defibrillator system, remote data acquisition(s), receipt of tra cohort cohort cohort

93299

Interrogation device evaluation(s), (remote) up to30 days; implantable cardiovascular monitor syste m or implantable loop recorded system, remote dataacquisition(s), receipt of transmissions and tech statewide

93303 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIACANOMALIES; COMPLETE cohort cohort cohort cohort

93304 TRANSTHORACIC ECHOCARDIOGRAPHY FOR CONGENITAL CARDIACANOMALIES; FOLLOW-UP OR LIMITED STUDY cohort cohort

93305 ADDED DURING FEE SCHEDULE LOAD PROCESS cohort cohort cohort cohort

93306

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,when performed, complete with spectral Doppler ec hocardiography, and with color flow Doppler echoca cohort cohort cohort cohort cohort cohort

93307

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,when performed, complete, without spectral or col or Doppler echocardiography cohort cohort cohort cohort cohort

93308

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,when performed, follow-up or limited study cohort cohort cohort cohort cohort

93312

ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGEDOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION cohort cohort cohort cohort cohort

93313

ECHOCARDIOGRAPHY, TRANSESOPHAGEAL, REAL TIME WITH IMAGEDOCUMENTATION (2D) (WITH OR WITHOUT M-MODE RECORDING); PLACEMENT OF TRANSESOPHAGEAL PROBE ONLY cohort cohort

93315

TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR CONGENITAL CARDIACANOMALIES; INCLUDING PROBE PLACEMENT, IMAGE ACQUISITION, INTERPRETATION AND REPORT statewide

93318

ECHOCARDIOGRAPHY, TEE FOR MONITORING PURPOSES, INCLUDING PROBE PLACEMENT, REAT TIME 2 DIMENSIONALIMAGE ACQUISITION AND INTERPRETATION LEADING TO ONGOING ASSESSMENT OF CARDIAC PUMPING FUNCTION cohort cohort cohort

93320

DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVEWITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); COMPLETE cohort cohort cohort cohort cohort

93321

DOPPLER ECHOCARDIOGRAPHY, PULSED WAVE AND/OR CONTINUOUS WAVEWITH SPECTRAL DISPLAY (LIST SEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHIC IMAGING); FOLLOW-UP OR LIMITED STUDY cohort cohort cohort cohort cohort

93325 DOPPLER ECHOCARDIOGRAPHY COLOR FLOW VELOCITY cohort cohort cohort cohort cohort

179

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MAPPING (LISTSEPARATELY IN ADDITION TO CODES FOR ECHOCARDIOGRAPHY)

93350

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording,when performed, during rest and cardiovascular st ress test using treadmill, bicycle exercise and/or cohort cohort cohort cohort cohort

93351

ECHOCARDIOGRAPHY, TRANSTHORACIC, REAL-TIME WITH IMAGE DOCUMENTATION (2D), INCLUDES M-MODE RECORDING,WHEN PERFORMED, DURING REST AND CARDIOVASCULAR ST RESS TEST USING TREADMILL, BICYCLE EXERCISE AND/OR cohort cohort cohort cohort cohort

93352

Use of echocardiographic contrast agent during stress echocardiography (List separately in addition to code for primary procedure) cohort cohort

93451 Right heart catheterization including measurement(s) of oxygen saturation and cardiac output, when performed cohort cohort cohort cohort

93452

Left heart catheterization including intraprocedural injection(s) for left ventriculography, imagingsupervision and interpretation, when performed cohort cohort cohort cohort

93453

Combined right and left heart catheterization including intraprocedural injection(s) for left ventriculography, imaging supervision and interpretation, when performed cohort cohort cohort

93454

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; cohort cohort cohort cohort

93455

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) i cohort cohort cohort cohort

93456

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right heart catheteriza cohort cohort cohort cohort

93457

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with catheter placement(s) i cohort cohort

93458

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterizat cohort cohort cohort cohort cohort

93459

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with left heart catheterizat cohort cohort cohort cohort cohort

93460

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart ca cohort cohort cohort cohort cohort

93461

Catheter placement in coronary artery(s) for coronary angiography, including intraprocedural injection(s) for coronary angiography, imaging supervision and interpretation; with right and left heart ca cohort cohort cohort cohort cohort

93462

Left heart catheterization by transseptal puncturethrough intact septum or by transapical puncture (List separately in addition to code for primary procedure) cohort cohort cohort

93463

Pharmacologic agent administration (eg, inhaled nitric oxide, intravenous infusion of nitroprusside,dobutamine, milrinone, or other agent) including assessing hemodynamic measurements before, during, cohort cohort cohort

93464

Physiologic exercise study (eg, bicycle or arm ergometry) including assessing hemodynamic measurements before and after (List separately in addition to code for primary procedure) cohort cohort cohort

93503 INSERTION AND PLACEMENT OF FLOW DIRECTED CATHETER (EG,SWAN-GANZ) FOR MONITORING PURPOSES statewide

93505 Endomyocardial biopsy statewide

93530 Right heart catheterization, for congenital cardiac anomalies statewide

93531 Combined right heart catheterization and retrograde left heart catheterization, for congenital cardiac anomalies cohort cohort cohort

93533

Combined right heart catheterization and transseptal left heart catheterization through existing septal opening, with or without retrograde left heartcatheterization, for congenital cardiac anomalies statewide

93563 Injection procedure during cardiac catheterizationincluding imaging supervision, interpretation, an d report; for selective coronary cohort cohort

180

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

angiography during congenital heart catheterization (List separatel

93565

Injection procedure during cardiac catheterizationincluding imaging supervision, interpretation, an d report; for selective left ventricular or left atrial angiography (List separately in addition to cohort cohort

93566

Injection procedure during cardiac catheterizationincluding imaging supervision, interpretation, an d report; for selective right ventricular or rightatrial angiography (List separately in addition t cohort cohort

93567

Injection procedure during cardiac catheterizationincluding imaging supervision, interpretation, an d report; for supravalvular aortography (List separately in addition to code for primary procedure) cohort cohort cohort cohort

93568

Injection procedure during cardiac catheterizationincluding imaging supervision, interpretation, an d report; for pulmonary angiography (List separately in addition to code for primary procedure) statewide

93571

INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVEDCORONARY FLOW RESERVE MEASUREMENT (CORONARY VESSEL OR GRAFT) DURING CORONARY ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY cohort cohort cohort cohort cohort

93572

INTRAVASCULAR DOPPLER VELOCITY AND/OR PRESSURE DERIVEDCORONARY FLOW RESERVE MEASUREMENT (CORONARY VESSEL OR GRAFT) DURING CORONARY ANGIOGRAPHY INCLUDING PHARMACOLOGICALLY cohort cohort cohort cohort

93580 PERC TRANSCATHETER CLOSURE CONGENITAL INTERATRIAL COMMUNICATION W/IMPLANT cohort cohort

93581 PERC TRANSCATHETER CLOSURE CONGENITAL VENTRICULAR SEPTAL DEFECT W/IMPLANT statewide

93603 RIGHT VENTRICULAR RECORDING statewide

93609

INTRAVENTRICULAR AND/OR INTRA-ATRIAL MAPPING OF TACHYCARDIA SITE(S) WITH CATHETER MANIPULATION TO RECORD FROM MULTIPLE SITES TO IDENTIFY ORIGIN OF TACHYCARDIA cohort cohort cohort

93612 INTRAVENTRICULAR PACING statewide

93613 INTRACARDIAC ELECTROPHYSIOLOGIC 3- DIMENSIONAL MAPPING cohort cohort cohort

93616 ESOPHAGEAL RECORDING OF ATRIAL ELECTROGRAM WITH ORWITHOUTVENTRICULAR ELECTROGRAM(S); WITH PACING statewide

93618 INDUCTION OF ARRHYTHMIA BY ELECTRICAL PACING statewide

93619

Comprehensive electrophysiologic evaluation with right atrial pacing and recording, right ventricular pacing and recording, His bundle recording, including insertion and repositioning of multiple elec cohort cohort

93620

Comprehensive electrophysiologic evaluation including insertion and repositioning of multiple electrode catheters with induction or attempted induction of arrhythmia; with right atrial pacing and reco cohort cohort cohort

93621

COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHTATRIAL PACING AND RECORDING, RIGHT VENTRICULARPACING AND RECORDING, HIS BUNDLE RECORDING, INCL UDING INSERTION AND cohort cohort cohort

93622

COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION WITH RIGHTATRIAL PACING AND RECORDING, RIGHT VENTRICULARPACING AND RECORDING, HIS BUNDLE RECORDING, INCL UDING INSERTION AND cohort cohort cohort

93623

PROGRAMMED STIMULATION AND PACING AFTER INTRAVENOUS DRUGINFUSION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

93624

Electrophysiologic follow-up study with pacing andrecording to test effectiveness of therapy, inclu ding induction or attempted induction of arrhythmia statewide

93631

INTRA-OPERATIVE EPICARDIAL AND ENDOCARDIAL PACING ANDMAPPING TO LOCALIZE THE SITE OF TACHYCARDIA OR ZONE OF SLOW CONDUCTION FOR SURGICAL CORRECTION statewide

93640

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold evaluation (induction of arrhythmia, evaluation of sensing and pacing statewide

93641 Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator leads including defibrillation threshold cohort cohort cohort

181

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

evaluation (induction of arrhythmia, evaluation of sensing and pacing

93642

Electrophysiologic evaluation of single or dual chamber pacing cardioverter-defibrillator (includes defibrillation threshold evaluation, induction of arrhythmia, evaluation of sensing and pacing for a cohort cohort cohort

93650

Intracardiac catheter ablation of atrioventricularnode function, atrioventricular conduction for cr eation of complete heart block, with or without temporary pacemaker placement cohort cohort

93653

COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED INDUCTION OF AN ARRHYTHMIA WITH RIGHT ATRIAL PACING AND RE cohort cohort cohort

93654

COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED INDUCTION OF AN ARRHYTHMIA WITH RIGHT ATRIAL PACING AND RE cohort cohort cohort

93655

INTRACARDIAC CATHETER ABLATION OF A DISCRETE MECHANISM OF ARRHYTHMIA WHICH IS DISTINCT FROM THE PRIMARY ABLATED MECHANISM, INCLUDING REPEAT DIAGNOSTICMANEUVERS, TO TREAT A SPONTANEOUS OR INDUCED ARRH cohort cohort cohort

93656

COMPREHENSIVE ELECTROPHYSIOLOGIC EVALUATION INCLUDING TRANSSEPTAL CATHETERIZATIONS, INSERTION AND REPOSITIONING OF MULTIPLE ELECTRODE CATHETERS WITH INDUCTION OR ATTEMPTED INDUCTION OF AN ARRHYTHMIA W cohort cohort cohort

93657

ADDITIONAL LINEAR OR FOCAL INTRACARDIAC CATHETER ABLATION OF THE LEFT OR RIGHT ATRIUM FOR TREATMENT OF ATRIAL FIBRILLATION REMAINING AFTER COMPLETION OF PULMONARY VEIN ISOLATION (LIST SEPARATELY IN AD cohort cohort cohort

93660

Evaluation of cardiovascular function with tilt table evaluation, with continuous ECG monitoring andintermittent blood pressure monitoring, with or w ithout pharmacological intervention cohort cohort cohort cohort cohort

93662

INTRACARDIAC ECHOCARDIOGRAPHY DURING THERAPEUTIC/ DIAGNOSTIC INTERVENTION, INCLUDING IMAGING SUPERVISION AND INTERPRETATION (LIST SEPARATELY INADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort

93750

INTERROGATION OF VENTRICULAR ASSIST DEVICE (VAD), IN PERSON, WITH PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ANALYSIS OF DEVICE PARAMETERS (EG, DRIVELINES, ALARMS, POWER SURGES), REVIEW OF statewide

93786

AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEMSUCH AS MAGNETIC TAPE AND/OR COMPUTER DISK, FOR 24 HOURS OR LONGER; RECORDING ONLY cohort cohort

93788

AMBULATORY BLOOD PRESSURE MONITORING, UTILIZING A SYSTEMSUCH AS MAGNETIC TAPE AND/OR COMPUTER DISK, FOR 24 HOURS OR LONGER; SCANNING ANALYSIS WITH REPORT cohort cohort

93797

PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL SERVICES FOR OUTPATIENT CARDIAC REHABILITATION; WITHOUT CONTINUOUS ECG MONITORING (PER SESSION) statewide

93799 UNLISTED CARDIOVASCULAR SERVICE OR PROCEDURE cohort cohort cohort

93880 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; COMPLETE BILATERALSTUDY cohort cohort cohort cohort cohort cohort

93882 DUPLEX SCAN OF EXTRACRANIAL ARTERIES; UNILATERAL OR LIMITED STUDY cohort cohort cohort

93886 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES;COMPLETE STUDY cohort cohort cohort cohort

93888 TRANSCRANIAL DOPPLER STUDY OF THE INTRACRANIAL ARTERIES;LIMITED STUDY cohort cohort cohort

93892 TCD, EMOLIDETECT W/O INJ statewide

93893 TCD, EMOLI DETECT W/INJ statewide

93922

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis a cohort cohort cohort cohort cohort cohort

93923 Complete bilateral noninvasive physiologic studiesof upper or lower cohort cohort cohort cohort cohort

182

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

extremity arteries, 3 or more l evels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibia

93924

Noninvasive physiologic studies of lower extremityarteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler waveform or volume plethysmography recording and analysis at res cohort cohort cohort cohort

93925 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASSGRAFTS; COMPLETE BILATERAL STUDY cohort cohort cohort cohort cohort

93926 DUPLEX SCAN OF LOWER EXTREMITY ARTERIES OR ARTERIAL BYPASSGRAFTS; UNILATERAL OR LIMITED STUDY cohort cohort cohort cohort cohort

93930 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASSGRAFTS; COMPLETE BILATERAL STUDY cohort cohort cohort cohort cohort

93931 DUPLEX SCAN OF UPPER EXTREMITY ARTERIES OR ARTERIAL BYPASSGRAFTS; UNILATERAL OR LIMITED STUDY cohort cohort cohort cohort

93965

NON-INVASIVE PHYSIOLOGIC STUDIES OF EXTREMITY VEINS,COMPLETE BILATERAL STUDY(EG, DOPPLER WAVEFORM ANALYSIS WITH RESPONSES TO COMPRESSION AND OTHER MANEUVERS, cohort cohort cohort

93970

DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSESTOCOMPRESSION AND OTHER MANEUVERS; COMPLETE BILAT ERAL STUDY cohort cohort cohort cohort cohort cohort

93971

DUPLEX SCAN OF EXTREMITY VEINS INCLUDING RESPONSESTOCOMPRESSION AND OTHER MANEUVERS; UNILATERAL OR LIMITED STUDY cohort cohort cohort cohort cohort cohort

93975

DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OFABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; COMPLETE STUDY cohort cohort cohort cohort cohort

93976

DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OFABDOMINAL, PELVIC, SCROTAL CONTENTS AND/OR RETROPERITONEAL ORGANS; LIMITED STUDY cohort cohort cohort cohort cohort

93978 DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE,OR BYPASS GRAFTS; COMPLETE STUDY cohort cohort cohort cohort cohort

93979

DUPLEX SCAN OF AORTA, INFERIOR VENA CAVA, ILIAC VASCULATURE,OR BYPASS GRAFTS; UNILATERAL OR LIMITED STUDY cohort cohort cohort

93980 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; COMPLETE STUDY cohort cohort cohort

93981 DUPLEX SCAN OF ARTERIAL INFLOW AND VENOUS OUTFLOW OF PENILE VESSELS; FOLLOW-UP OR LIMITED STUDY statewide

93990 DUPLEX SCAN OF HEMODIALYSIS ACCESS (INCLUDING ARTERIALINFLOW, BODY OF ACCESS AND VENOUS OUTFLOW) cohort cohort cohort

93998 UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY statewide

94002

VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED OR CONTROLLED BREATHING; HOSPITAL INPATIENT/OBSERVATION, INITIAL DAY cohort cohort cohort cohort cohort

94003

VENTILATION ASSIST AND MANAGEMENT, INITIATION OF PRESSURE OR VOLUME PRESET VENTILATORS FOR ASSISTED OR CONTROLLED BREATHING; HOSPITAL INPATIENT/OBSERVATION, EACH SUBSEQUENT DAY cohort cohort cohort

94010

SPIROMETRY, INCLUDING GRAPHIC RECORD, TOTAL AND TIMED VITAL CAPACITY, EXPIRATORY FLOW RATE MEASUREMENT(S), WITH OR WITHOUT MAXIMAL VOLUNTARY VENTILATION cohort cohort cohort cohort cohort

94011 MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWSIN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE statewide

94012

MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWS, BEFORE AND AFTER BRONCHODILATOR, IN AN INFANT ORCHILD THROUGH 2 YEARS OF AGE statewide

94013

MEASUREMENT OF LUNG VOLUMES (IE, FUNCTIONAL RESIDUAL CAPACITY ¢FRC!, FORCED VITAL CAPACITY ¢FVC!, AND EXPIRATORY RESERVE VOLUME ¢ERV!) IN AN INFANT ORCHILD THROUGH 2 YEARS OF AGE statewide

94060

BRONCHOSPASM EVALUATION: SPIROMETRY AS IN 94010, BEFORE AND AFTER BRONCHODILATOR (AEROSOL OR PARENTERAL) cohort cohort cohort cohort cohort cohort

183

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

94070

PROLONGED POSTEXPOSURE EVALUATION OF BRONCHOSPASM WITHMULTIPLE SPIROMETRIC DETERMINATIONS AFTER ANTIGEN, COLD AIR, METHACHOLINE OR OTHER CHEMICAL AGENT, WITH SUBSEQUENT cohort cohort cohort cohort cohort

94150 VITAL CAPACITY, TOTAL (SEPARATE PROCEDURE) cohort cohort cohort cohort

94200 MAXIMUM BREATHING CAPACITY, MAXIMAL VOLUNTARY VENTILATION cohort cohort cohort cohort cohort

94250 EXPIRED GAS COLLECTION, QUANTITATIVE, SINGLE PROCEDURE(SEPARATE PROCEDURE) statewide

94375 RESPIRATORY FLOW VOLUME LOOP cohort cohort cohort cohort cohort

94452

HIGH ALTITUDE SIMULATION TEST (HAST), WITH INTERPRETATION AND REPORT BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL; statewide

94620

Pulmonary stress testing; simple (eg, 6-minute walk test, prolonged exercise test for bronchospasm with pre- and post-spirometry and oximetry cohort cohort cohort cohort cohort

94621

PULMONARY STRESS TESTING; COMPLEX (INCLUDING MEASUREMENTS OFCO2 PRODUCTION, O2 UPTAKE, AND ELECTROCARDIOGRAPHIC RECORDINGS) cohort cohort cohort cohort

94640

NONPRESSURIZED INHALATION TREATMENT FOR ACUTE AIRWAYOBSTRUCTION NONPRESSURIZED INHALATION TREATMENTFOR ACUTE AIRWAY cohort cohort cohort cohort cohort cohort

94642

AEROSOL INHALATION OF PENTAMIDINE FOR PNEUMOCYSTISCARINIIPNEUMONIA TREATMENT OR PROPHYLAXIS cohort cohort

94644 CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; FIRST HOUR cohort cohort cohort cohort cohort

94645

CONTINUOUS INHALATION TREATMENT WITH AEROSOL MEDICATION FOR ACUTE AIRWAY OBSTRUCTION; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

94660 CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP),INITIATION AND MANAGEMENT cohort cohort cohort cohort cohort

94664

AEROSOL OR VAPOR INHALATIONS FOR SPUTUM MOBILIZATION,BRONCHODILATION, OR SPUTUM INDUCTION FOR DIAGNOSTIC PURPOSES; INITIAL DEMONSTRATION AND/OR EVALUATION cohort cohort cohort cohort cohort

94667

MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, ANDVIBRATION TO FACILITATE LUNG FUNCTION; INITIAL DEMONSTRATION AND/OR EVALUATION cohort cohort cohort cohort cohort

94668 MANIPULATION CHEST WALL, SUCH AS CUPPING, PERCUSSING, ANDVIBRATION TO FACILITATE LUNG FUNCTION; SUBSEQUENT cohort cohort cohort cohort

94680

OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE,DIRECT, SIMPLE OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST AND EXERCISE, statewide

94690

OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT(SEPARATE PROCEDURE) OXYGEN UPTAKE, EXPIRED GAS ANALYSIS; REST, INDIRECT cohort cohort cohort

94726 PLETHYSMOGRAPHY FOR DETERMINATION OF LUNG VOLUMES AND, WHEN PERFORMED, AIRWAY RESISTANCE cohort cohort cohort cohort cohort

94727

GAS DILUTION OR WASHOUT FOR DETERMINATION OF LUNG VOLUMES AND, WHEN PERFORMED, DISTRIBUTION OF VENTILATION AND CLOSING VOLUMES cohort cohort cohort cohort

94728 AIRWAY RESISTANCE BY IMPULSE OSCILLOMETRY cohort cohort cohort

94729

DIFFUSING CAPACITY (EG, CARBON MONOXIDE, MEMBRANE)(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

94750 PULMONARY COMPLIANCE STUDY, ANY METHOD cohort cohort cohort

94760 NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION;SINGLE DETERMINATION cohort cohort cohort cohort cohort cohort

94761

NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION;MULTIPLE DETERMINATIONS (EG, DURING EXERCISE) cohort cohort cohort cohort cohort cohort

184

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

94762

NONINVASIVE EAR OR PULSE OXIMETRY FOR OXYGEN SATURATION; BY CONTINUOUS OVERNIGHT MONITORING (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

94770 CARBON DIOXIDE, EXPIRED GAS DETERMINATION BY INFRAREDANALYZER cohort cohort cohort cohort cohort

94799 UNLISTED PULMONARY SERVICE OR PROCEDURE cohort cohort cohort cohort cohort

95004

PERCUTANEOUS TESTS (SCRATCH, PUNCTURE, PRICK) WITHALLERGENIC EXTRACTS, IMMEDIATE TYPE REACTION, INC LUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TESTS cohort cohort

95012 NITRIC OXIDE EXPIRED GAS DETERMINATION statewide

95018

ALLERGY TESTING, ANY COMBINATION OF PERCUTANEOUS (SCRATCH, PUNCTURE, PRICK) AND INTRACUTANEOUS (INTRADERMAL), SEQUENTIAL AND INCREMENTAL, WITH DRUGS OR BIOLOGICALS, IMMEDIATE TYPE REACTION, INCLUDING statewide

95024

INTRACUTANEOUS (INTRADERMAL) TESTS WITH ALLERGENICEXTRACTS, IMMEDIATE TYPE REACTION, INCLUDING TEST INTERPRETATION AND REPORT, SPECIFY NUMBER OF TEST S statewide

95044

PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS)PATCH OR APPLICATION TEST(S) (SPECIFY NUMBER OF TESTS) statewide

95070

INHALATION BRONCHIAL CHALLENGE TESTING (NOT INCLUDINGNECESSARY PULMONARY FUNCTION TESTS); WITH HISTAMINE, METHACHOLINE, OR SIMILAR COMPOUNDS cohort cohort cohort

95076

INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); INITIAL 120 MINUTES OF TESTING statewide

95079

INGESTION CHALLENGE TEST (SEQUENTIAL AND INCREMENTAL INGESTION OF TEST ITEMS, EG, FOOD, DRUG OR OTHER SUBSTANCE); EACH ADDITIONAL 60 MINUTES OF TESTING (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY statewide

95115

PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOTINCLUDING PROVISION OF ALLERGENIC EXTRACTS; SINGLE INJECTION cohort cohort cohort

95117

PROFESSIONAL SERVICES FOR ALLERGEN IMMUNOTHERAPY NOTINCLUDING PROVISION OF ALLERGENIC EXTRACTS; TWO OR MORE INJECTIONS cohort cohort cohort

95165

PROFESSIONAL SERVICES FOR THE SUPERVISION AND PROVISION OFANTIGENS FOR ALLERGEN IMMUNOTHERAPY; SINGLE OR MULTIPLE ANTIGENS (SPECIFY NUMBER OF DOSES) statewide

95250

Ambulatory continuous glucose monitoring of interstitial tissue fluid via a subcutaneous sensor for a minimum of 72 hours; sensor placement, hook-up, calibration of monitor, patient training, removal cohort cohort cohort cohort

95782

POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST cohort cohort

95783

POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY OR BI-LEVEL VENTILATION, ATTENDED BY statewide

95800

Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis(eg, by airflow or peripheral arterial tone), and sleep time statewide

95805

MULTIPLE SLEEP LATENCY OR MAINTENANCE OF WAKEFULNESSTESTING, RECORDING, ANALYSIS AND INTERPRETATION OF PHYSIOLOGICAL MEASUREMENTS OF SLEEP DURING MULTIPLE TRIALS cohort cohort cohort cohort cohort

95806

SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING OF, HEART RATE, OXYGEN SATURATION, RESPIRATORY AIRFLOW, AND RESPIRATORY EFFORT (EG, THORACOABDOMINAL MOVEMENT) cohort cohort cohort cohort

95807

SLEEP STUDY, SIMULTANEOUS RECORDING OF VENTILATION,RESPIRATORY EFFORT, ECG OR HEART RATE, AND OXYGENSATURATION, ATTENDED BY A TECHNOLOGIST cohort cohort

185

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

95808

POLYSOMNOGRAPHY; ANY AGE, SLEEP STAGING WITH 1-3 ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST statewide

95810

POLYSOMNOGRAPHY; AGE 6 YEARS OR OLDER, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST cohort cohort cohort cohort cohort cohort

95811

POLYSOMNOGRAPHY; AGE 6 YEARS OR OLDER, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY OR BILEVEL VENTILATION, ATTENDED BY A cohort cohort cohort cohort cohort cohort

95812 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; UPTO ONEHOUR cohort cohort cohort cohort

95813 ELECTROENCEPHALOGRAM (EEG) EXTENDED MONITORING; GREATER THANONE HOUR cohort cohort cohort cohort

95816

ELECTROENCEPHALOGRAM (EEG) INCLUDING RECORDING AWAKE ANDDROWSY, WITH HYPERVENTILATION AND/OR PHOTIC STIMULATION cohort cohort cohort cohort cohort

95819

ELECTROENCEPHALOGRAM (EEG) INCLUDING RECORDING AWAKE ANDASLEEP, WITH HYPERVENTILATION AND/OR PHOTIC STIMULATION cohort cohort cohort cohort cohort

95831 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); EXTREMITY(EXCLUDING HAND) OR TRUNK, WITH REPORT statewide

95834 MUSCLE TESTING, MANUAL (SEPARATE PROCEDURE); TOTALEVALUATION OF BODY, INCLUDING HANDS statewide

95851

RANGE OF MOTION MEASUREMENTS AND REPORT (SEPARATEPROCEDURE); EACH EXTREMITY (EXCLUDING HAND) OR EACHTRUNK SECTION (SPINE) statewide

95860 NEEDLE ELECTROMYOGRAPHY; 1 EXTREMITY WITH OR WITHOUT RELATED PARASPINAL AREAS cohort cohort cohort cohort cohort

95861 NEEDLE ELECTROMYOGRAPHY, TWO EXTREMITIES WITH OR WITHOUTRELATED PARASPINAL AREAS cohort cohort cohort cohort

95865 NEEDLE ELECTROMYOGRAPHY; LARYNX cohort cohort

95867 NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES,UNILATERAL cohort cohort

95868 NEEDLE ELECTROMYOGRAPHY, CRANIAL NERVE SUPPLIED MUSCLES,BILATERAL cohort cohort cohort cohort

95869 NEEDLE ELECTROMYOGRAPHY; THORACIC PARASPINAL MUSCLES statewide

95870

NEEDLE ELECTROMYOGRAPHY; LIMITED STUDY OF MUSCLES IN 1 EXTREMITY OR NON-LIMB (AXIAL) MUSCLES (UNILATERAL OR BILATERAL), OTHER THAN THORACIC PARASPINAL, CRANIAL NERVE SUPPLIED MUSCLES, OR SPHINCTERS cohort cohort cohort

95872

NEEDLE ELECTROMYOGRAPHY USING SINGLE FIBER ELECTRODE, WITHQUANTITATIVE MEASUREMENT OF JITTER, BLOCKING AND/OR FIBER DENSITY, ANY/ALL SITES OF EACH MUSCLE STUDIED cohort cohort

95873

ELECTRICAL STIMULATION FOR GUIDANCE IN CONJUNCTIONWITH CHEMODENERVATION (LIST SEPARATELY IN ADDITIO N TO CODE FOR PRIMARY PROCEDURE) cohort cohort

95874

NEEDLE ELECTROMYOGRAPHY FOR GUIDANCE IN CONJUNCTION WITH CHEMODENERVATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort

95875 ISCHEMIC LIMB EXERCISE WITH NEEDLE ELECTROMYOGRAPHY, WITHLACTIC ACID DETERMINATION statewide

95885

NEEDLE ELECTROMYOGRAPHY, EACH EXTREMITY, WITH RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE WITH NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY; LIMITED (LIST SEPARATELY IN ADDITION TO CODE F cohort cohort cohort cohort

95886

NEEDLE ELECTROMYOGRAPHY, EACH EXTREMITY, WITH RELATED PARASPINAL AREAS, WHEN PERFORMED, DONE WITH NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY; COMPLETE, FIVE OR MORE MUSCLES STUDIED, INNERV cohort cohort cohort cohort

95887

NEEDLE ELECTROMYOGRAPHY, NON-EXTREMITY (CRANIAL NERVE SUPPLIED OR AXIAL) MUSCLE(S) DONE WITH NERVE CONDUCTION, AMPLITUDE AND LATENCY/VELOCITY STUDY (LIST cohort cohort

186

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

SEPARATELY IN ADDITION TO CODE FOR PRIMARY PRO

95907 NERVE CONDUCTION STUDIES; 1-2 STUDIES cohort cohort cohort

95908 NERVE CONDUCTION STUDIES; 3-4 STUDIES cohort cohort cohort cohort cohort

95909 NERVE CONDUCTION STUDIES; 5-6 STUDIES cohort cohort cohort cohort cohort

95910 NERVE CONDUCTION STUDIES; 7-8 STUDIES cohort cohort cohort cohort



95913 NERVE CONDUCTION STUDIES; 13 OR MORE STUDIES cohort cohort cohort

95921

TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; CARDIOVAGAL INNERVATION (PARASYMPATHETIC FUNCTION), INCLUDING 2 OR MORE OF THE FOLLOWING: HEART RATE RESPONSE TO DEEP BREATHING WITH RECORDED R-R INTERVAL statewide

95922

TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; VASOMOTORADRENERGIC INNERVATION (SYMPATHETIC ADRENERGIC FUNCTION), INCLUDING BEAT-TO-BEAT BLOOD PRESSURE AND R-R INTERVAL statewide

95923

TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; SUDOMOTOR, INCLUDING 1 OR MORE OF THE FOLLOWING: QUANTITATIVE SUDOMOTOR AXON REFLEX TEST (QSART), SILASTIC SWEAT IMPRINT, THERMOREGULATORY SWEAT TEST, AND statewide

95924

TESTING OF AUTONOMIC NERVOUS SYSTEM FUNCTION; COMBINED PARASYMPATHETIC AND SYMPATHETIC ADRENERGIC FUNCTION TESTING WITH AT LEAST 5 MINUTES OF PASSIVE TILT statewide

95925

SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY,STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM;IN UPPER LIMBS cohort cohort cohort

95926

SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY,STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM;IN LOWER LIMBS cohort cohort cohort

95927

SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY,STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKIN SITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM;IN THE TRUNK OR statewide

95928 C MONTOR EVOKED, UPPER LIMBS statewide

95929 C MONTOR EVOKED, LOWER LIMBS cohort cohort

95930 VISUAL EVOKED POTENTIAL (VEP) TESTING CENTRAL NERVOUSSYSTEM, CHECKERBOARD OR FLASH cohort cohort cohort cohort

95933 ORBICULARIS OCULI (BLINK) REFLEX, BY ELECTRODIAGNOSTICTESTING statewide

95937 NEUROMUSCULAR JUNCTION TESTING (REPETITIVE STIMULATION, PAIRED STIMULI), EACH NERVE, ANY 1 METHOD cohort cohort

95938

SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKINSITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER AND LOWER LIMBS cohort cohort cohort

95939

SHORT-LATENCY SOMATOSENSORY EVOKED POTENTIAL STUDY, STIMULATION OF ANY/ALL PERIPHERAL NERVES OR SKINSITES, RECORDING FROM THE CENTRAL NERVOUS SYSTEM; IN UPPER AND LOWER LIMBS cohort cohort cohort

95940

CONTINUOUS INTRAOPERATIVE NEUROPHYSIOLOGY MONITORING IN THE OPERATING ROOM, ONE ON ONE MONITORING REQUIRING PERSONAL ATTENDANCE, EACH 15 MINUTES (LISTSEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCED cohort cohort cohort cohort cohort

95950

MONITORING FOR IDENTIFICATION AND LATERALIZATION OF CEREBRALSEIZURE FOCUS, ELECTROENCEPHALOGRAPHIC (EG, 8 CHANNEL EEG) RECORDING AND INTERPRETATION, EACH 24 HOURS cohort cohort cohort

187

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

95951

MONITORING FOR LOCALIZATION OF CEREBRAL SEIZURE FOCUS BYCABLE OR RADIO, 16 OR MORE CHANNEL TELEMETRY, COMBINED ELECTROENCEPHALOGRAPHIC (EEG) AND VIDEO RECORDING AND cohort cohort cohort

95953

Monitoring for localization of cerebral seizure focus by computerized portable 16 or more channel EEG, electroencephalographic (EEG) recording and interpretation, each 24 hours, unattended cohort cohort cohort cohort cohort

95955 ELECTROENCEPHALOGRAM (EEG) DURING NONINTRACRANIAL SURGERY(EG, CAROTID SURGERY) statewide

95956

Monitoring for localization of cerebral seizure focus by cable or radio, 16 or more channel telemetry, electroencephalographic (EEG) recording and interpretation, each 24 hours, attended by a technolo cohort cohort

95957 DIGITAL ANALYSIS OF ELECTROENCEPHALOGRAM (EEG) (EG, FOREPILEPTIC SPIKE ANALYSIS) cohort cohort

95958 WADA ACTIVATION TEST FOR HEMISPHERIC FUNCTION, INCLUDINGELECTROENCEPHALOGRAPHIC (EEG) MONITORING statewide

95965 MAGNETOENCEPHALOGRAPHY (MEG), RECORD & ANALYSIS; FOR SPONTANEOUS BRAIN MAGNETIC ACTIVITY statewide

95966 MAGNETOENCEPHALOGRAPHY (MEG), RECORD & ANALYSIS; FOR EVOKED MAGNETIC FIELDS, SINGLE MODALITY statewide

95967 MAGNETOENCEPHALOGRAPHY (MEG), RECORD & ANALYSIS; FOR EVOKED MAGNETIC FIELDS, EA ADD'L MODALITY statewide

95970

ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE, PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI statewide

95971

ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE, PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI cohort cohort cohort cohort cohort

95972

ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE, PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI cohort cohort cohort cohort cohort

95973

ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE, PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI statewide

95974

ELECTRONIC ANALYSIS OF IMPLANTED NEUROSTIMULATOR PULSE GENERATOR SYSTEM (EG, RATE, PULSE AMPLITUDE, PULSE DURATION, CONFIGURATION OF WAVE FORM, BATTERY STATUS, ELECTRODE SELECTABILITY, OUTPUT MODULATI cohort cohort

95978 ANALYZE NEUROSTIM BRAIN / 1 HOUR statewide

95990

REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SPINAL (INTRATHECAL, EPIDURAL) OR BRAIN (INTRAVENTRICULAR), INCLUDES ELECTRONIC ANALYSIS OF PUMP, WHEN PERFORMED; cohort cohort

95991

REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SPINAL (INTRATHECAL, EPIDURAL) OR BRAIN (INTRAVENTRICULAR), INCLUDES ELECTRONIC ANALYSIS OF PUMP, WHEN PERFORMED; REQUIRIN statewide

95999 UNLISTED NEUROLOGICAL OR NEUROMUSCULAR DIAGNOSTIC PROCEDURE statewide

96020

NEUROFUNCTIONAL TESTING SELECTION AND ADMINISTRATION DURING NONINVASIVE IMAGING FUNCTIONAL BRAIN MAPPING, WITH TEST ADMINISTERED ENTIRELY BY A PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL (IE statewide

96101

Psychological testing (includes psychodiagnostic assessment of emotionality, intellectual abilities,personality and psychopathology, e.g., MMPI, Rors chach, WAIS), per hour of the psychologist's or ph cohort cohort

96102

PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES,PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI AND WAI S), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERP statewide

188

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

96103

PSYCHOLOGICAL TESTING (INCLUDES PSYCHODIAGNOSTIC ASSESSMENT OF EMOTIONALITY, INTELLECTUAL ABILITIES,PERSONALITY AND PSYCHOPATHOLOGY, EG, MMPI), ADMIN ISTERED BY A COMPUTER, WITH QUALIFIED HEALTH CARE statewide

96110 DEVELOPMENTAL SCREENING, WITH INTERPRETATION AND REPORT, PER STANDARDIZED INSTRUMENT FORM statewide

96111

DEVELOPMENTAL TESTING, (INCLUDES ASSESSMENT OF MOTOR, LANGUAGE, SOCIAL, ADAPTIVE, AND/OR COGNITIVE FUNCTIONING BY STANDARDIZED DEVELOPMENTAL INSTRUMENTS) WITH INTERPRETATION AND REPORT statewide

96116

NEUROBEHAVIORAL STATUS EXAM (CLINICAL ASSESSMENT OF THINKING, REASONING AND JUDGMENT, EG, ACQUIRED KNOWLEDGE, ATTENTION, LANGUAGE, MEMORY, PLANNING AND PROBLEM SOLVING, AND VISUAL SPATIAL ABILITIES), statewide

96118

Neuropsychological testing (e.g., Halstead-Reitan Neuropsychological Battery, Wechsler Memory Scalesand Wisconsin Card Sorting Test), per hour of the psychologist's or physician's time, both face-to- statewide

96119

NEUROPSYCHOLOGICAL TESTING (EG, HALSTEAD-REITAN NEUROPSYCHOLOGICAL BATTERY, WECHSLER MEMORY SCALES AND WISCONSIN CARD SORTING TEST), WITH QUALIFIED HEALTH CARE PROFESSIONAL INTERPRETATION AND REPORT, statewide

96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour cohort cohort cohort cohort cohort

96361 Intravenous infusion, hydration; each additional hour (List separately in addition to code for primary procedure) cohort cohort cohort cohort cohort

96365 Intravenous infusion, for therapy, prophylaxis, ordiagnosis (specify substance or drug); initial, u p to 1 hour cohort cohort cohort cohort cohort

96366

Intravenous infusion, for therapy, prophylaxis, ordiagnosis (specify substance or drug); each addit ional hour (List separately in addition to code for primary procedure) cohort cohort cohort cohort cohort

96367

INTRAVENOUS INFUSION, FOR THERAPY, PROPHYLAXIS, ORDIAGNOSIS (SPECIFY SUBSTANCE OR DRUG); ADDITIONAL SEQUENTIAL INFUSION OF A NEW DRUG/SUBSTANCE, UP T O 1 HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR cohort cohort cohort cohort cohort

96368

Intravenous infusion, for therapy, prophylaxis, ordiagnosis (specify substance or drug); concurrent infusion (List separately in addition to code for primary procedure) cohort cohort cohort cohort cohort

96372 Therapeutic, prophylactic, or diagnostic injection(specify substance or drug); subcutaneous or intr amuscular cohort cohort cohort cohort cohort

96373 Therapeutic, prophylactic, or diagnostic injection(specify substance or drug); intra-arterial cohort cohort cohort

96374 Therapeutic, prophylactic, or diagnostic injection(specify substance or drug); intravenous push, si ngle or initial substance/drug cohort cohort cohort cohort cohort

96375

Therapeutic, prophylactic, or diagnostic injection(specify substance or drug); each additional sequ ential intravenous push of a new substance/drug (List separately in addition to code for primary pro cohort cohort cohort cohort cohort

96376

Therapeutic, prophylactic, or diagnostic injection(specify substance or drug); each additional sequ ential intraveous push of the same substance/drug provided in a facility (List separately in additio cohort cohort cohort cohort cohort

96379 Unlisted therapeutic, prophylactic, or diagnostic intravenous or intra-arterial injection or infusion cohort cohort cohort

96401 CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; NON-HORMONAL ANTI-NEOPLASTIC cohort cohort cohort cohort cohort

96402 CHEMOTHERAPY ADMINISTRATION, SUBCUTANEOUS OR INTRAMUSCULAR; HORMONAL ANTI-NEOPLASTIC cohort cohort cohort cohort cohort

96409 CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, SINGLE OR INITIAL SUBSTANCE/DRUG cohort cohort cohort cohort cohort

96411

CHEMOTHERAPY ADMINISTRATION; INTRAVENOUS, PUSH TECHNIQUE, EACH ADDITIONAL SUBSTANCE/DRUG (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

96413

CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; UP TO 1 HOUR, SINGLE OR INITIAL SUBSTANCE/DRUG cohort cohort cohort cohort cohort

189

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

96415

CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

96416

CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; INITIATION OF PROLONGED CHEMOTHERAPY INFUSION (MORE THAN 8 HOURS), REQUIRING USE OF A PORTABLE OR IMPLANTABLE PUMP cohort cohort cohort cohort cohort

96417

CHEMOTHERAPY ADMINISTRATION, INTRAVENOUS INFUSION TECHNIQUE; EACH ADDITIONAL SEQUENTIAL INFUSION (DIFFERENT SUBSTANCE/DRUG), UP TO 1 HOUR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort cohort

96420

CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE CHEMOTHERAPY ADMINISTRATION, INTRA-ARTERIAL; PUSH TECHNIQUE statewide

96446 Chemotherapy administration into the peritoneal cavity via indwelling port or catheter cohort cohort cohort

96450

CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL),REQUIRING AND INCLUDING LUMBAR PUNCTURE CHEMOTHERAPY ADMINISTRATION, INTO CNS (EG, INTRATHECAL), cohort cohort cohort

96521 REFILLING AND MAINTENANCE OF PORTABLE PUMP cohort cohort cohort cohort cohort

96522

REFILLING AND MAINTENANCE OF IMPLANTABLE PUMP OR RESERVOIR FOR DRUG DELIVERY, SYSTEMIC (EG, INTRAVENOUS, INTRA-ARTERIAL) cohort cohort

96523 IRRIGATION OF IMPLANTED VENOUS ACCESS DEVICE FOR DRUG DELIVERY SYSTEMS cohort cohort cohort cohort cohort


96542

CHEMOTHERAPY INJECTION, SUBARACHNOID OR INTRAVENTRICULAR VIASUBCUTANEOUS RESERVOIR, SINGLE OR MULTIPLE AGENTS cohort cohort

96549 UNLISTED CHEMOTHERAPY PROCEDURE cohort cohort

97001 PHYSICAL THERAPY EVALUATION statewide

97028

APPLICATION OF A MODALITY TO ONE OR MORE AREAS; ULTRAVIOLET APPLICATION OF A MODALITY TO ONE OR MOREAREAS; ULTRAVIOLET statewide

97116 THERAPEUTIC PROCEDURE, 1 OR MORE AREAS, EACH 15 MINUTES; GAIT TRAINING (INCLUDES STAIR CLIMBING) statewide

97150

THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS)THERAPEUTIC PROCEDURE(S), GROUP (2 OR MORE INDIVIDUALS) cohort cohort cohort cohort cohort

97250 (CODE DELETED IN 1999. TO REPORT, SEE 97140) MYOFA statewide

97530

THERAPEUTIC ACTIVITIES, DIRECT (ONE-ON-ONE) PATIENT CONTACT (USE OF DYNAMIC ACTIVITIES TO IMPROVE FUNCTIONAL PERFORMANCE), EACH 15 MINUTES cohort cohort

97532

DEVELOPMENT OF COGNITIVE SKILLS TO IMPROVE ATTENTION, MEMORY, PROBLEM SOLVING (INCLUDES COMPENSATORYTRAINING), DIRECT (ONE-ON-ONE) PATIENT CONTACT, E ACH 15 MINUTES statewide

97535

SELF-CARE/HOME MANAGEMENT TRAINING (EG, ACTIVITIESOF DAILY LIVING (ADL) AND COMPENSATORY TRAINING, MEAL PREPARATION, SAFETY PROCEDURES, AND INSTRUCTIONS IN USE OF ASSISTIVE TECHNOLOGY DEVICES/ADAPTIV cohort cohort

97597

Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, de cohort cohort cohort cohort cohort cohort

97598

Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound, (eg, fibrin, devitalized epidermis and/or dermis, exudate, de cohort cohort cohort cohort cohort

97602

REMOVAL OF DEVITALIZED TISSUE FROM WOUND;NONSELECTIVE DEBRIDEMENT, WITHOUT ANESTHESIA, WOUND ASSESS-MENT, AND INSTUCTION FOR ONGING CARE, PER SESSION cohort cohort cohort cohort cohort

97605 NEG PRESSURE WOUND THERAPY, < 50 CM cohort cohort cohort cohort

97606 NEG PRESSURE WOUND THERAPY, > 50 CM cohort cohort

190

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

97802

MEDICAL NUTRITION THERAPY; INITIAL ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE TO FACE WITH THE PATIENT, EACH 15 MINUTES statewide

97803

MEDICAL NUTRITION THERAPY; RE-ASSESSMENT AND INTERVENTION, INDIVIDUAL, FACE TO FACE WITH THE PATIENT, EACH 15 MINUTES statewide

97804 MEDICAL NUTRITION THERAPY; GROUP (2 OR MORE INDIVIDUALS),EACH 30 MINUTES statewide

98926

OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); THREE TOFOUR BODYREGIONS INVOLVED OSTEOPATHIC MANIPULATI VE TREATMENT (OMT); THREE TO FOUR BODY statewide

98929

OSTEOPATHIC MANIPULATIVE TREATMENT (OMT); NINE TO TEN BODYREGIONS INVOLVED OSTEOPATHIC MANIPULATIVETREATMENT (OMT); NINE TO TEN BODY statewide

98960

EDUCATION AND TRAINING FOR PATIENT SELF-MANAGEMENTBY A QUALIFIED, NONPHYSICIAN HEALTH CARE PROFESSI ONAL USING A STANDARDIZED CURRICULUM, FACE-TO-FACEWITH THE PATIENT (COULD INCLUDE CAREGIVER/FAMILY) statewide

99005

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION ANDMANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE THREE KEY COMPONENTS: statewide

99070

SUPPLIES AND MATERIALS (EXCEPT SPECTACLES), PROVIDED BY THE PHYSICIAN OR OTHER QUALIFIED HEALTH CAREPROFESSIONAL OVER AND ABOVE THOSE USUALLY INCLUDE D WITH THE OFFICE VISIT OR OTHER SERVICES RENDERED cohort cohort cohort

99100

ANESTHESIA FOR PATIENT OF EXTREME AGE, UNDER ONE YEAR ANDOVER SEVENTY (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY ANESTHESIA PROCEDURE) statewide

99140

ANESTHESIA COMPLICATED BY EMERGENCY CONDITIONS (SPECIFY)(LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY ANESTHESIA PROCEDURE) statewide

99143

MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999) PROVIDED BY THE SAME PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL PERFORMING THE DIAGNOSTIC OR THERAPEUTI cohort cohort cohort cohort cohort

99144


99145


99148

MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999), PROVIDED BY APHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI ONAL OTHER THAN THE HEALTH CARE PROFESSIONAL PERFO cohort cohort cohort cohort

99149

MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999), PROVIDED BY APHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI ONAL OTHER THAN THE HEALTH CARE PROFESSIONAL PERFO cohort cohort cohort cohort cohort

99150

MODERATE SEDATION SERVICES (OTHER THAN THOSE SERVICES DESCRIBED BY CODES 00100-01999), PROVIDED BY APHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSI ONAL OTHER THAN THE HEALTH CARE PROFESSIONAL PERFO cohort cohort cohort

99173 SCREENING TEST OF VISUAL ACUITY, QUANTITATIVE, BILATERAL statewide

99183

PHYSICIAN OR OTHER QUALIFIED HEALTH CARE PROFESSIONAL ATTENDANCE AND SUPERVISION OF HYPERBARIC OXYGEN THERAPY, PER SESSION cohort cohort cohort cohort cohort

99195 PHLEBOTOMY, THERAPEUTIC (SEPARATE PROCEDURE) cohort cohort cohort cohort cohort

99201 OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION cohort cohort cohort cohort cohort

191

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY;A PROBLEM FOCUSED EXAMINATION; STRAIGHTFORWARD ME

99202

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION cohort cohort cohort cohort cohort cohort

99203

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL DECISION MAKING OF LOW C cohort cohort cohort cohort cohort cohort

99204

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; ACOMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKIN cohort cohort cohort cohort cohort cohort

99205

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; ACOMPREHENSIVE EXAMINATION; MEDICAL DECISION MAKIN cohort cohort cohort cohort cohort cohort

99211

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, THAT MAY NOT REQUIRE THE PRESENCE OF A PHYSICIAN. USUALLY, THE PRESENTING PROBLEM(S) ARE MINIMAL. TYPICALL cohort cohort cohort cohort cohort cohort

99212

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINAT cohort cohort cohort cohort cohort cohort

99213

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROB cohort cohort cohort cohort cohort cohort

99214

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; MEDICAL D cohort cohort cohort cohort cohort

99215

OFFICE OR OTHER OUTPATIENT VISIT FOR THE EVALUATION AND MANAGEMENT OF AN ESTABLISHED PATIENT, WHICH REQUIRES AT LEAST 2 OF THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; cohort cohort cohort cohort cohort

99217

OBSERVATION CARE DISCHARGE DAY MANAGEMENT (THIS CODE IS TO BE UTILIZED TO REPORT ALL SERVICES PROVIDED TO A PATIENT ON DISCHARGE FROM "OBSERVATION STATUS" IF THE DISCHARGE IS ON OTHER THAN THE INITIAL cohort cohort cohort cohort cohort

99218

INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED OR COMPREHENSIVE HISTORY; A DETAILED OR COMPREHENSIVE EXAMINATION; A cohort cohort cohort cohort cohort cohort

99219

INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAK cohort cohort cohort cohort

99220

INITIAL OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAK statewide

99224

SUBSEQUENT OBSERVATION CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRESAT LEAST 2 OF THESE 3 KEY COMPONENTS: PROBLEM FOC USED INTERVAL HISTORY; PROBLEM FOCUSED EXAMINATION cohort cohort cohort

99231

SUBSEQUENT HOSPITAL CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES ATLEAST 2 OF THESE 3 KEY COMPONENTS: A PROBLEM FOCU SED INTERVAL HISTORY; A PROBLEM FOCUSED EXAMINATIO statewide

99234

OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT INCLUDING ADMISSION AND DISCHARGE ON THE SAME DATE, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED OR cohort cohort cohort

192

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

COMPREHE

99235

OBSERVATION OR INPATIENT HOSPITAL CARE, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT INCLUDING ADMISSION AND DISCHARGE ON THE SAME DATE, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTOR statewide

99241

OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION;AND STRAIGHTFORWARD MEDICAL DECISION MAKING. COUN cohort cohort

99242

OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL D statewide

99243

OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF LOW COMPLEXITY. COUNSELING AND/O cohort cohort

99244

OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; ANDMEDICAL DECISION MAKING OF MODERATE COMPLEXITY. C cohort cohort cohort

99245

OFFICE CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; ANDMEDICAL DECISION MAKING OF HIGH COMPLEXITY. COUNS cohort cohort

99252

INPATIENT CONSULTATION FOR A NEW OR ESTABLISHED PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY; AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICA statewide

99281

EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A PROBLEM FOCUSED HISTORY; A PROBLEMFOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL cohort cohort cohort cohort cohort cohort

99282

EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY;AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDI cohort cohort cohort cohort cohort cohort

99283

EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: AN EXPANDED PROBLEM FOCUSED HISTORY;AN EXPANDED PROBLEM FOCUSED EXAMINATION; AND MEDI cohort cohort cohort cohort cohort cohort

99284

EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A DETAILED HISTORY; A DETAILED EXAMINATION; AND MEDICAL DECISION MAKING OF MODERATE CO cohort cohort cohort cohort cohort cohort

99285

EMERGENCY DEPARTMENT VISIT FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS WITHIN THE CONSTRAINTS IMPOSED BY THEURGENCY OF THE PATIENT'S CLINICAL CONDITION AND/O cohort cohort cohort cohort cohort cohort

99291

CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE UNSTABLECRITICALLY ILL OR UNSTABLE CRITICALLY INJURED PATIENT, REQUIRING THE CONSTANT ATTENDANCE OF THE PHYSICIAN; FIRST cohort cohort cohort cohort cohort

99292

CRITICAL CARE, EVALUATION AND MANAGEMENT OF THE CRITICALLYILL OR CRITICALLY INJURED PATIENT, REQUIRING THE CONSTANT ATTENDANCE OF THE PHYSICIAN; EACHADDITIONAL 30 MINUTES cohort cohort cohort cohort cohort

99306

INITIAL NURSING FACILITY CARE, PER DAY, FOR THE EVALUATION AND MANAGEMENT OF A PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISIO cohort cohort cohort

99341 HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A statewide

193

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

PROBLEM FOCUSED HISTORY; A PROBLEM FOCUSED EXAMINATION; AND STRAIGHTFORWARD MEDICAL DECISION MAK

99345

HOME VISIT FOR THE EVALUATION AND MANAGEMENT OF A NEW PATIENT, WHICH REQUIRES THESE 3 KEY COMPONENTS: A COMPREHENSIVE HISTORY; A COMPREHENSIVE EXAMINATION; AND MEDICAL DECISION MAKING OF HIGH COMPLEXI statewide


99366

Medical team conference with interdisciplinary team of health care professionals, face-to-face with patient and/or family, 30 minutes or more, participation by nonphysician qualified health care profe statewide

99374

SUPERVISION OF A PATIENT UNDER CARE OF HOME HEALTHAGENCY (PATIENT NOT PRESENT) IN HOME, DOMICILIARY OR EQUIVALENT ENVIRONMENT (EG, ALZHEIMER'S FACILI TY) REQUIRING COMPLEX AND MULTIDISCIPLINARY CARE M statewide

99395

Periodic comprehensive preventive medicine reevaluation and management of an individual including anage and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduc statewide

99396

Periodic comprehensive preventive medicine reevaluation and management of an individual including anage and gender appropriate history, examination, counseling/anticipatory guidance/risk factor reduc cohort cohort

99401

PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO AN INDIVIDUAL (SEPARATE PROCEDURE); APPROXIMATELY 15 MINUTES statewide

99402


99403


99404

PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO AN INDIVIDUAL (SEPARATE PROCEDURE); APPROXIMATELY 60 MINUTES cohort cohort

99406 Smoking and tobacco use cessation counseling visit; intermediate, greater than 3 minutes up to 10 minutes cohort cohort

99407 Smoking and tobacco use cessation counseling visit; intensive, greater than 10 minutes statewide

99412

PREVENTIVE MEDICINE COUNSELING AND/OR RISK FACTOR REDUCTION INTERVENTION(S) PROVIDED TO INDIVIDUALS IN A GROUP SETTING (SEPARATE PROCEDURE); APPROXIMATELY 60 MINUTES statewide

99460 Initial hospital or birthing center care, per day,for evaluation and management of normal newborn i nfant statewide

A0398 ALS ROUTINE DISPOSABLE SUPPLIES statewide

A0422 AMBULANCE (ALS OR BLS) OXYGEN AND OXYGEN SUPPLIES,LIFESUSTAINING SITUATION statewide

A0425 GROUND MILEAGE , PER STATUTE MILE cohort cohort cohort cohort

A0426 AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, NON- EMERGENCY TRANSPORT, LEVEL 1 (ALS 1) cohort cohort cohort cohort

A0427 AMBULANCE SERVICE, ADVANCED LIFE SUPPORT, EMERGENCY TRANSPORT LEVEL 1 cohort cohort cohort cohort

A0428 AMBULANCE SERVICE, BASIC LIFE SUPPORT, NON- EMERGENCY TRANSPORT (BLS) cohort cohort cohort cohort

A0429 AMBULANCE SERVICE, BASIC LIFE SUPPORT, EMERGENCY TRANSPORT (BLS- EMERGENCY cohort cohort cohort

A0430 AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (FIXED WING) statewide

A0431 AMBULANCE SERVICE, CONVENTIONAL AIR SERVICES, TRANSPORT, ONE WAY (ROTARY WING) statewide

A0433 ADVANCED LIFE SUPPORT, LEVEL 2 (ALS 2) cohort cohort cohort cohort

A0434 SPECIALTY CARE TRANSPORT (SCT) cohort cohort

A0435 FIXED WING AIR MILEAGE, PER STATUTE MILE statewide

194

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

A0436 ROTARY WING AIR MILEAGE, PER STATUTE MILE statewide

A0888 NONCOVERED AMBULANCE MILEAGE, PER MILE (E.G., FOR MILESTRAVELED BEYOND CLOSEST APPROPRIATE FACILITY) statewide

A0998 AMBULANCE RESPONSE AND TREATMENT, NO TRANSPORT statewide

A4206 Syringe with needle, sterile, 1 cc or less, each statewide

A4208 SYRINGE WITH NEEDLE, STERILE 3CC, EACH statewide

A4212 NON-CORING NEEDLE OR STYLET WITH OR WITHOUT CATHETER cohort cohort cohort

A4216 STERILE WATER, SALINE AND/OR DEXTROSE, DILUENT/FLUSH, 10 ML cohort cohort cohort cohort cohort

A4217 STERILE WATER/SALINE, 500 ML cohort cohort cohort cohort

A4218 STERILE SALINE OR WATER, METERED DOSE DISPENSER, 10 ML statewide

A4220 REFILL KIT FOR IMPLANTABLE INFUSION PUMP statewide

A4222 SUPPLIES FOR EXTERNAL DRUG INFUSION PUMP, PER CASSETTE ORBAG (LIST DRUG SEPARATELY) statewide

A4248 CHLORHEXIDINE CONTAINING ANTISEPTIC, 1 ML cohort cohort

A4264 PERMANENT IMPLANTABLE CONTRACEPTIVE INTRATUBAL OCCLUSION DEVICE(S) AND DELIVERY SYSTEM cohort cohort cohort cohort

A4270 DISPOSABLE ENDOSCOPE SHEATH, EACH cohort cohort cohort

A4300 IMPLANTABLE ACCESS CATHETER (VENOUS, ARTERIAL, EPIDURAL ORPERITONEAL), EXTERNAL ACCESS cohort cohort

A4301

IMPLANTABLE ACCESS TOTAL SYSTEM; CATHETER, PORT/RESERVOIR(VENOUS, ARTERIAL OR EPIDURAL), PERCUTANEOUS ACCESS cohort cohort

A4306 DISPOSABLE DRUG DELIVERY SYSTEM, FLOW RATE OF LESSTHAN 50 ML PER HOUR statewide

A4310 INSERTION TRAY WITHOUT DRAINAGE BAG AND WITHOUT CATHETER(ACCESSORIES ONLY) statewide

A4314

INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER,FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER OR HYDROPHILIC, ETC.) statewide

A4316

INSERTION TRAY WITH DRAINAGE BAG WITH INDWELLING CATHETER,FOLEY TYPE, THREE-WAY, FOR CONTINUOUS IRRIGATION statewide

A4320 IRRIGATION TRAY WITH BULB OR PISTON SYRINGE, ANY PURPOSE statewide

A4322 IRRIGATION SYRINGE, BULB OR PISTON, EACH statewide

A4334 URINARY CATHETER ANCHORING DEVICE, LEG STRAP, EACH statewide

A4335 INCONTINENCE SUPPLY; MISCELLANEOUS statewide

A4338

INDWELLING CATHETER; FOLEY TYPE, TWO-WAY LATEX WITH COATING (TEFLON, SILICONE, SILICONE ELASTOMER, OR HYDROPHILIC, ETC.), EACH cohort cohort cohort

A4340 INDWELLING CATHETER; SPECIALTY TYPE, EG; COUDE, MUSHROOM,WING, ETC.), EACH cohort cohort cohort cohort

A4344 INDWELLING CATHETER, FOLEY TYPE, TWO-WAY, ALL SILICONE, EACH cohort cohort cohort cohort

A4346 INDWELLING CATHETER; FOLEY TYPE, THREE WAY FOR CONTINUOUSIRRIGATION, EACH cohort cohort

A4349 DISPOSABLE MALE EXTERNAL CATHETER statewide

A4351 INTERMITTENT URINARY CATHETER; STRAIGHT TIP, EACH statewide

A4353 INTERMITTENT URINARY CATHETER, WITH INSERTION SUPPLIES cohort cohort

A4355

IRRIGATION TUBING SET FOR CONTINUOUS BLADDER IRRIGATIONTHROUGH A THREE-WAY INDWELLING FOLEY CATHETER, EACH statewide

A4357 BEDSIDE DRAINAGE BAG, DAY OR NIGHT, WITH OR WITHOUTANTI-REFLUX DEVICE, WITH OR WITHOUT TUBE, EACH statewide

A4358 URINARY LEG BAG; VINYL, WITH OR WITHOUT TUBE, EACH cohort cohort

A4364 ADHESIVE FOR OSTOMY OR CATHETER; LIQUID (SPRAY, BRUSH,ETC.), CEMENT, POWDER OR PASTE; ANY COMPOSITION statewide

195

CPT Description

Peer Cohort 1

Peer Cohort 2

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Peer Cohort 6

(E.G. SILICONE, LATEX, ETC.); PER OZ.

A4373

OSTOMY SKIN BARRIER, WITH FLANGE (SOLID, FLEXIBLE,OR ACCORDION), STANDARD WEAR, WITH BUILT-IN CONVEXITY, ANY SIZE, EACH statewide

A4421 OSTOMY SUPPLY; MISCELLANEOUS statewide

A4463 SURGICAL DRESSING HOLDER, REUSABLE, EACH statewide

A4465 NON-ELASTIC BINDER FOR EXTREMITY statewide

A4466 GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR SIMILAR STRETCHABLE MATERIAL, ANY TYPE, EACH statewide

A4495 SURGICAL STOCKINGS THIGH LENGTH, EACH statewide

A4550 SURGICAL TRAYS statewide

A4562 PESSARY, NON RUBBER, ANY TYPE statewide

A4565 SLINGS cohort cohort cohort

A4570 SPLINT cohort cohort

A4614 PEAK EXPIRATORY FLOW RATE METER, HAND HELD statewide

A4615 CANNULA, NASAL cohort cohort cohort

A4616 TUBING (OXYGEN), PER FOOT statewide

A4628 OROPHARYNGEAL SUCTION CATHETER, EACH statewide

A4641 RADIOPHARMACEUTICAL, DIAGNOSTIC, NOT OTHERWISE CLASSIFIED cohort cohort cohort cohort

A4648 Tissue marker, implantable, any type, each cohort cohort cohort cohort cohort

A4649 SURGICAL SUPPLY; MISCELLANEOUS cohort cohort cohort cohort

A4719 "Y SET" TUBNG FOR PERITONEAL DIALYSIS statewide

A4722

DIALYSATE SOLUTION ANY CONCENTRATION OF DEXTROSE FLUID VOLUME GREATER THAN 1999CC BUT LESS THAN OR EQUAL TO 2999CC FOR PERITONEAL DIALYSIS statewide

A4725

DIALYSATE SOLUTION ANY CONCENTRATION OF DEXTROSE FLUID VOLUME GREATER THAN 4999CC BUT LESS THAN OR EQUAL TO 5999CC FOR PERITONEAL DIALYSIS statewide

A5500

FOR DIABETICS ONLY, FITTING (INCLUDING FOLLOW-UP),CUSTOMPREPARATION AND SUPPLY OF OFF-THE-SHELF DEP TH-INLAY SHOE MANUFACTURED TO ACCOMMODATE MULTI- DENSITY INSERT(S), PER statewide

A5512

FOR DIABETICS ONLY, MULTIPLE DENSITY INSERT, DIRECT FORMED, MOLDED TO FOOT AFTER EXTERNAL HEAT SOURCE OF 230 DEGREES FAHRENHEIT OR HIGHER, TOTAL CONTACT WITH PATIENT'S FOOT, INCLUDING ARCH, BASE LAYE statewide

A6021 Collagen dressing, sterile, size 16 sq. In. Or less, each cohort cohort cohort

A6022 Collagen dressing, sterile, size more than 16 sq. In. But less than or equal to 48 sq. In. , each statewide

A6196 ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ.IN. OR LESS, EACH DRESSING cohort cohort cohort cohort

A6197

ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING cohort cohort cohort cohort

A6199 ALGINATE OR OTHER FIBER GELLING DRESSING, WOUND FILLER, STERILE, PER 6 INCHES statewide

A6207 CONTACT LAYER, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING cohort cohort cohort

A6209 FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING cohort cohort cohort cohort

A6210

FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORETHAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DRESSING cohort cohort cohort cohort cohort

A6211

FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORETHAN 48 SQ. IN., WITHOUT ADHESIVE BORDER, EACH DR ESSING statewide

A6212 FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING cohort cohort cohort cohort

196

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

A6213

FOAM DRESSING, WOUND COVER, STERILE, PAD SIZE MORETHAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., WITH ANY SIZE ADHESIVE BORDER, EACH DRESSING cohort cohort cohort

A6215 FOAM DRESSING, WOUND FILLER, STERILE, PER GRAM statewide

A6222

GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH cohort cohort cohort cohort

A6223

GAUZE, IMPREGNATED WITH OTHER THAN WATER, NORMAL SALINE, OR HYDROGEL, STERILE, PAD SIZE MORE THAN 16SQ INCHES, WITHOUT ADHESIVE BORDER, EACH DRESSING cohort cohort cohort

A6234

HYDROCOLLOID DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING cohort cohort cohort

A6240 HYDROCOLLOID DRESSING, WOUND FILLER, PASTE, STERILE, PER OUNCE cohort cohort cohort

A6242 HYDROGEL DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING statewide

A6248 HYDROGEL DRESSING, WOUND FILLER, GEL, PER FLUID OUNCE cohort cohort cohort cohort cohort

A6250 SKIN SEALANTS, PROTECTANTS, MOISTURIZERS, OINTMENTS, ANYTYPE, ANY SIZE cohort cohort

A6251

SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE 16 SQ. IN. OR LESS, WITHOUT ADHESIVE BORDER, EACH DRESSING statewide

A6252

SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 16 SQ. IN., BUT LESS THAN OREQUAL TO 48 SQ. IN., WITHOUT ADHESIVE BORDER, EAC H DRESSING cohort cohort

A6253

SPECIALTY ABSORPTIVE DRESSING, WOUND COVER, STERILE, PAD SIZE MORE THAN 48 SQ. IN., WITHOUT ADHESIVEBORDER, EACH DRESSING statewide

A6257 TRANSPARENT FILM, STERILE, 16 SQ. IN. OR LESS, EACH DRESSING cohort cohort

A6258 TRANSPARENT FILM, STERILE, MORE THAN 16 SQ. IN. BUT LESS THAN OR EQUAL TO 48 SQ. IN., EACH DRESSING cohort cohort cohort

A6259 TRANSPARENT FILM, STERILE, MORE THAN 48 SQ. IN., EACH DRESSING statewide

A6260 WOUND CLEANSERS, ANY TYPE, ANY SIZE statewide

A6266 GAUZE, IMPREGNATED, OTHER THAN WATER, NORMAL SALINE, OR ZINC PASTE, STERILE, ANY WIDTH, PER LINEAR YARD statewide

A6402 GAUZE, NON-IMPREGNATED, STERILE, PAD SIZE 16 SQ. IN. ORLESS, WITHOUT ADHESIVE BORDER, EACH DRESSING cohort cohort cohort

A6407 PACKING STRIPS, NON-IMPREGNATED, STERILE, UP TO 2 INCHES IN WIDTH, PER LINEAR YARD statewide

A6413 Adhesive bandage, first-aid type, any size, each statewide

A6443 CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN cohort cohort

A6444 CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, NON-STERILE, WIDTH GREATER THAN statewide

A6445 CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH LESS THAN THREE cohort cohort

A6446 CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR cohort cohort cohort

A6447 CONFORMING BANDAGE, NON-ELASTIC, KNITTED/WOVEN, STERILE, WIDTH GREATER THAN OR statewide

A6448 LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,WIDTH LESS THAN THREE statewide

A6449 LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,WIDTH GREATER THAN OR EQUAL cohort cohort cohort

A6450 LIGHT COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN,WIDTH GREATER THAN OR EQUAL statewide

A6451 MODERATE COMPRESSION BANDAGE, ELASTIC, KNITTED/WOVEN, LOAD RESISTANCE OF 1.25 statewide

A6453 SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON- cohort cohort

197

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

WOVEN, WIDTH LESS THAN THREE

A6454 SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR cohort cohort

A6455 SELF-ADHERENT BANDAGE, ELASTIC, NON-KNITTED/NON-WOVEN, WIDTH GREATER THAN OR statewide

A6456

ZINC PASTE IMPREGNATED BANDAGE, NON-ELASTIC, KNITTED/WOVEN, WIDTH GREATER THAN OR EQUAL TO THREE INCHES AND LESS THAN FIVE INCHES, PER YARD cohort cohort cohort

A6457 TUBULAR DRESSING WITH OR WITHOUT ELASTIC, ANY WIDTH, PER LINEAR YARD statewide

A6534 GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 30-40MMHG, EACH statewide

A6535 GRADIENT COMPRESSION STOCKING, THIGH LENGTH, 40-50MMHG, EACH statewide

A6538 GRADIENT COMPRESSION STOCKING, FULL LENGTH/CHAP STYLE, 40-50 MMHG, EACH statewide

A6550

WOUND CARE SET, FOR NEGATIVE PRESSURE WOUND THERAPY ELECTRICAL PUMP, INCLUDES ALL SUPPLIES AND ACCESSORIES statewide

A7000 CANISTER, DISPOSABLE, USED WITH SUCTION PUMP, EACH cohort cohort

A7002 TUBING, USED WITH SUCTION PUMP, EACH statewide

A7003 ADMINISTRATION SET, WITH SMALL VOLUME NONFILTERED PNEUMATIC NEBULIZER, DISPOSABLE statewide

A7030 FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH statewide

A7042 IMPLANTED PLEURAL CATHETER, EACH cohort cohort

A7043 VACUUM DRAINAGE BOTTLE AND TUBING FOR USE WITH IMPLANTED CATHETER cohort cohort cohort cohort

A7501 TRACHEOSTOMA VALVE, INCLUDING DIAPHRAGM, EACH statewide

A7503 FILTER HOLDER OR FILTER CAP, REUSABLE, FOR USE IN A TRACHEOSTOMA HEAT statewide

A7504 FILTER FOR USE IN A TRACHEOSTOMA HEAT AND MOISTURE EXCHANGE SYSTEM, EACH statewide

A7506 ADHESIVE DISC FOR USE IN A HEAT AND MOISTURE EXCHANGE SYSTEM AND/OR WITH statewide

A7521 TRACHEOSTOMY/LARYNGECTOMY TUBE, CUFFED, POLYVINYLCHLORIDE (PVC), SILICONE OR statewide

A9150 NON-PRESCRIPTION DRUGS cohort cohort cohort cohort cohort

A9152 SINGLE VITAMIN NOS statewide

A9153 MULTI-VITAMIN NOS cohort cohort

A9270 NON-COVERED ITEM OR SERVICE cohort cohort cohort cohort cohort

A9280 ALERT OR ALARM DEVICE, NOT OTHERWISE CLASSIFIED statewide

A9500 TECHNETIUM TC-99M SESTAMIBI, DIAGNOSTIC, PER STUDYDOSE cohort cohort cohort cohort cohort

A9502 TECHNETIUM TC-99M TETROFOSMIN, DIAGNOSTIC, PER STUDY DOSE cohort cohort cohort cohort cohort

A9503 TECHNETIUM TC-99M MEDRONATE, DIAGNOSTIC, PER STUDYDOSE, UP TO 30 MILLICURIES cohort cohort cohort cohort cohort cohort

A9505 THALLIUM TL-201 THALLOUS CHLORIDE, DIAGNOSTIC, PERMILLICURIE cohort cohort

A9508 IODINE I-131 IOBENGUANE SULFATE, DIAGNOSTIC, PER 0.5 MILLICURIE cohort cohort

A9509 Iodine I-123 Sodium Iodide, diagnostic, per millicurie cohort cohort

A9510 TECHNETIUM TC-99M DISOFENIN, DIAGNOSTIC, PER STUDYDOSE, UP TO 15 MILLICURIES cohort cohort cohort

A9512 TECHNETIUM TC-99M PERTECHNETATE, DIAGNOSTIC, PER MILLICURIE cohort cohort cohort cohort cohort

A9516 Iodine I-123 Sodium Iodide, diagnostic, per 100 microcuries, up to 999 microcuries cohort cohort cohort cohort cohort

A9517 IODINE I-131 SODIUM IODIDE CAPSULE(S), THERAPEUTIC, PER cohort cohort cohort cohort

198

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

MILLICURIE

A9521 TECHNETIUM TC-99M EXAMETAZIME, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES cohort cohort cohort cohort

A9524 IODINE I-131 IODINATED SERUM ALBUMIN, DIAGNOSTIC, PER 5 MICROCURIES statewide

A9526 NITROGEN N-13 AMMONIA, DIAGNOSTIC, PER STUDY DOSE,UP TO 40 MILLICURIES statewide

A9527 IODINE I-125, SODIUM IODIDE SOLUTION, THERAPEUTIC,PER MILLICURIE statewide

A9528 IODINE I-131 SODIUM IODIDE CAPSULE(S), DIAGNOSTIC,PER MILLICURIE cohort cohort cohort cohort

A9529 IODINE I-131 SODIUM IODIDE SOLUTION, DIAGNOSTIC, PER MILLICURIE cohort cohort

A9530 IODINE I-131 SODIUM IODIDE SOLUTION, THERAPEUTIC, PER MILLICURIE cohort cohort

A9531 IODINE I-131 SODIUM IODIDE, DIAGNOSTIC, PER MICROCURIE (UP TO 100 MICROCURIES) cohort cohort cohort cohort cohort

A9537 TECHNETIUM TC-99M MEBROFENIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES cohort cohort cohort cohort cohort cohort

A9538 TECHNETIUM TC-99M PYROPHOSPHATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES cohort cohort cohort

A9539 TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, PER STUDYDOSE, UP TO 25 MILLICURIES cohort cohort cohort cohort cohort

A9540 TECHNETIUM TC-99M MACROAGGREGATED ALBUMIN, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES cohort cohort cohort cohort cohort

A9541 TECHNETIUM TC-99M SULFUR COLLOID, DIAGNOSTIC, PER STUDY DOSE, UP TO 20 MILLICURIES cohort cohort cohort cohort cohort

A9543 YTTRIUM Y-90 IBRITUMOMAB TIUXETAN, THERAPEUTIC, PER TREATMENT DOSE, UP TO 40 MILLICURIES cohort cohort

A9547 INDIUM IN-111 OXYQUINOLINE, DIAGNOSTIC, PER 0.5 MILLICURIE cohort cohort cohort

A9548 INDIUM IN-111 PENTETATE, DIAGNOSTIC, PER 0.5 MILLICURIE cohort cohort cohort

A9550 TECHNETIUM TC-99M SODIUM GLUCEPTATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIE statewide

A9551 TECHNETIUM TC-99M SUCCIMER, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MILLICURIES cohort cohort cohort

A9552 FLUORODEOXYGLUCOSE F-18 FDG, DIAGNOSTIC, PER STUDYDOSE, UP TO 45 MILLICURIES cohort cohort cohort cohort cohort

A9554 IODINE I-125 SODIUM IOTHALAMATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 10 MICROCURIES statewide

A9555 RUBIDIUM RB-82, DIAGNOSTIC, PER STUDY DOSE, UP TO 60 MILLICURIES statewide

A9556 GALLIUM GA-67 CITRATE, DIAGNOSTIC, PER MILLICURIE cohort cohort

A9557 TECHNETIUM TC-99M BICISATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 25 MILLICURIES statewide

A9558 XENON XE-133 GAS, DIAGNOSTIC, PER 10 MILLICURIES cohort cohort cohort cohort cohort

A9560 TECHNETIUM TC-99M LABELED RED BLOOD CELLS, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES cohort cohort cohort cohort cohort

A9561 TECHNETIUM TC-99M OXIDRONATE, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES cohort cohort cohort cohort

A9562 TECHNETIUM TC-99M MERTIATIDE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES cohort cohort cohort cohort cohort

A9564 CHROMIC PHOSPHATE P-32 SUSPENSION, THERAPEUTIC, PER MILLICURIE statewide

A9567 TECHNETIUM TC-99M PENTETATE, DIAGNOSTIC, AEROSOL, PER STUDY DOSE, UP TO 75 MILLICURIES cohort cohort cohort cohort

A9569 Technetium TC-99M Exametazime labeled autologous white blood cells, diagnostic, per study dose cohort cohort

A9570 Indium IN-111 labeled autologous white blood cells, diagnostic, per study dose cohort cohort cohort cohort

A9572 Indium IN-111 Pentetreotide, diagnostic, per studydose up to 6 millicuries cohort cohort cohort cohort

199

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

A9577 Injection, Gadobenate Dimeglumine (Multihance), per ml cohort cohort

A9579 Injection, Gadolinium-based magnetic resonance contrast agent, not other wise specified (NOS), per ml cohort cohort cohort cohort

A9580 SODIUM FLUORIDE F-18, DIAGNOSTIC, PER STUDY DOSE, UP TO 30 MILLICURIES cohort cohort cohort

A9581 INJECTION, GADOXETATE DISODIUM, 1 ML cohort cohort

A9582 IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES cohort cohort

A9583 INJECTION, GADOFOSVESET TRISODIUM, 1 ML statewide

A9584 IODINE 1-123 IOFLUPANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 5 MILLICURIES statewide

A9585 INJECTION, GADOBUTROL, 0.1 ML cohort cohort cohort

A9604 SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER TREATMENT DOSE, UP TO 150 MILLICURIES statewide

A9699 RADIOPHARMACEUTICAL, THERAPEUTIC, NOT OTHERWISE CLASSIFIED statewide

A9999 MISCELLANEOUS DME SUPPLY OR ACCESSORY, NOT OTHERWISE SPECIFIED statewide

ADJUS CLAIM WAITING REFUND statewide

B4087 Gastrostomy/jejunostomy tube, standard, any material, any type, each cohort cohort cohort

B4088 Gastrostomy/jejunostomy tube, low-profile, any material, any type, each statewide

C1204 Technetium Tc 99m tilmanocept, diagnostic, up to 0.5 millicuries statewide

C1300 C code valid for UB claims only cohort cohort cohort cohort cohort

C1713 C code valid for UB claims only cohort cohort cohort cohort cohort cohort

C1714 C code valid for UB claims only cohort cohort cohort cohort

C1715 C code valid for UB claims only cohort cohort cohort








C1728 C code valid for UB claims only cohort cohort







C1751 C CODE VALID FOR UB CLAIMS ONLY cohort cohort cohort cohort cohort




C1756 C code valid for UB claims only statewide









200

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Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6













C1780 LENS, INTRAOCULAR (NEW TECHNOLOGY) [C CODES FOR FACILITY CLAIMS ONLY] cohort cohort cohort cohort cohort











C1814 C CODES VALID FOR UB ONLY cohort cohort cohort cohort








C1830 Powered bone marrow biopsy needle cohort cohort cohort cohort













C1886 CATHETER, EXTRAVASCULAR TISSUE ABLATION, ANY MODALITY (INSERTABLE) [C codes used by facilities only] cohort cohort cohort

C1887 C CODES VALID FOR UB CLAIMS ONLY cohort cohort cohort cohort cohort




201

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6













C2626 C code valid for UB claims only cohort statewide






C2634 C CODE VALID FOR UB CLAIMS ONLY statewide

























C8929 C Code valid for UB claims only cohort cohort cohort cohort cohort

C8930 C Code valid for UB claims only cohort cohort cohort cohort

C8936 Magnetic resonance angiography without contrast followed by with contrast, upper extremity statewide


C9113 C CODE VALID FOR UB CLAIMS ONLY cohort cohort


C9285 Lidocaine 70 mg/tetracaine 70 mg, per patch [C codes should be used statewide

202

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

by facilities only]

C9290 Injection, bupivacaine liposome, 1 mg [C codes valid with facility claims only] cohort cohort

C9292 INJECTION, PERTUZUMAB, 10 MG C CODES CAN ONLY BE USED ON UB FACILITY CLAIMS statewide


C9359 C codes valid for UB claims only cohort cohort cohort cohort cohort

C9362 C Code valid for UB claims only cohort cohort


C9600

Percutaneous transcatheter placement of drug eluting intracoronary stent(s), with coronary angioplasty when performed; single major coronary artery orbranch [C code for facility claims only] cohort cohort cohort cohort cohort

C9601

Percutaneous transcatheter placement of drug-eluting intracoronary stent(s), with coronary angioplasty when performed; each additional branch of a major coronary artery (list separately in addition to cohort cohort cohort cohort

C9602

Percutaneous transluminal coronary atherectomy, with drug eluting intracoronary stent, with coronaryangioplasty when performed; single major coronary artery or branch [C code for facility claims only cohort cohort

C9604

Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and a cohort cohort cohort cohort

C9606

Percutaneous transluminal revascularization of acute total/subtotal occlusion during acute myocardial infarction, coronary artery or coronary artery bypass graft, any combination of drug-eluting intr statewide

C9607

Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of drug-eluting intracoronary stent, a cohort cohort cohort

C9724

Endoscopic full-thickness plication in the gastriccardia using endoscopic plication system (eps); i ncludes endoscopy [C codes used for facility claims only] statewide



C9736 Laparoscopy, surgical, radiofrequency ablation of uterine fibroid(s), including intraoperative guidance and monitoring, when performed statewide

C9898 C codes valid for UB claims only cohort cohort

D0150 COMPREHENSIVE ORAL EVALUATION statewide

D0210 Intraoral - complete series of radiographic images cohort cohort

D0220 Intraoral - periapical first radiographic image cohort cohort

D0230 Intraoral - periapical each additional radiographic image cohort cohort

D0240 Intraoral - 0cclusal radiographic image statewide

D0272 Bitewings - two radiographic images statewide

D0274 Bitewings - four radiographic images statewide

D0470 DIAGNOSTIC CASTS statewide

D1110 PROPHYLAXIS-ADULT statewide

D1120 PROPHYLAXIS-CHILD cohort cohort cohort cohort

D1206 Topical application of fluoride varnish cohort cohort cohort cohort

D1208 Topical application of fluoride cohort cohort cohort

D1351 SEALANT-PER TOOTH cohort cohort cohort

D1510 SPACE MAINTAINER-FIXED UNILATERAL statewide

D2140 AMALGAM RESTORATIONS - ONE SURFACE, PERMANENT statewide

D2330 RESIN RESTORATIONS - ONE SURFACE, ANTERIOR cohort cohort

D2331 RESIN RESTORATIONS - TWO SURFACES, ANTERIOR cohort cohort

D2332 RESIN RESTORATIONS - THREE SURFACES, ANTERIOR statewide

D2335 RESIN RESTORATIONS - FOUR OR MORE SURFACES OR INVOLVINGINCISAL ANGLE (ANTERIOR) cohort cohort

D2390 RESIN-BASED COMPOSITE CROWN, ANTERIOR cohort cohort

D2391 RESIN-BASED COMPOSITE - ONE SURFACE, cohort cohort cohort

203

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

D2392 RESIN-BASED COMPOSITE - TWO SURFACES, cohort cohort

D2393 RESIN-BASED COMPOSITE - THREE SURFACES, cohort cohort

D2394 RESIN-BASED COMPOSITE - FOUR OR MORE SURFACES, statewide

D2650 INLAY RESTORATIONS, COMPOSITE/RESIN-ONE SURFACE (LABORATORY PROCESSED) statewide

D2662 ONLAY - COMPOSITE/RESIN - TWO SURFACES (LABORATORYPROCESSED statewide

D2710 CROWN RESTORATIONS-RESIN (LABORATORY) statewide

D2740 CROWN RESTORATIONS-PORCELAIN/CERAMIC SUBSTRATE statewide

D2930 PREFABRICATED STAINLESS STEEL CROWN-PRIMARY TOOTH cohort cohort cohort

D2932 PREFABRICATED RESIN CROWN statewide

D2934 PREFABRICATED ESTHETIC COATED STAINLESS STEEL statewide

D2940 PROTECTIVE RESTORATION cohort cohort

D2980 Crown repair necessitated by restorative material failure statewide

D2999 UNSPECIFIED RESTORATIVE PROCEDURE, BY REPORT statewide

D3120 PULP CAP-INDIRECT statewide

D3220 THERAPEUTIC PULPOTOMY (EXCLUDING FINAL RESTORATION) cohort cohort

D3221 GROSS PULPAL DEBRIDEMENT, PRIMARY AND PERMANENT statewide

D3230 PULPAL THERAPY (RESORBABLE FILLING)-ANTERIOR, PRIMARY TOOTH (EXCLUDING FINAL RESTORATION) cohort cohort

D3310 ENDODONTIC THERAPY, ANTERIOR TOOTH (EXCLUDING FINAL RESTORATION) statewide

D3320 ENDODONTIC THERAPY, BICUSPID TOOTH (EXCLUDING FINAL RESTORATION) statewide

D3330 ENDODONTIC THERAPY, MOLAR (EXCLUDING FINAL RESTORATION) cohort cohort

D4341 PERIODONTAL SCALING AND ROOT PLANING-PER QUADRANT statewide

D7140 EXTRACTION, ERUPTED TOOTH OR EXPOSED ROOT (ELEVATION AND/OR FORCEPS REMOVAL) cohort cohort cohort

D7241 REMOVAL OF IMPACTED TOOTH-COMPLETELY BONY, WITH UNUSUALSURGICAL COMPLICATIONS statewide

D7250 SURGICAL REMOVAL OF RESIDUAL TOOTH ROOTS (CUTTING PROCEDURE) statewide

D7310 ALVEOLOPLASTY IN CONJUNCTION WITH EXTRACTIONS - FOUR OR MORE TEETH OR TOOTH statewide

E0105 CANE, QUAD OR THREE PRONG, INCLUDES CANES OF ALL MATERIALS, ADJUSTABLE OR FIXED, WITH TIPS statewide

E0110

CRUTCHES, FOREARM, INCLUDES CRUTCHES OF VARIOUS MATERIALS,ADJUSTABLE OR FIXED, PAIR, COMPLETE WITH TIPS AND HANDGRIPS cohort cohort

E0112 CRUTCHES, UNDERARM, WOOD, ADJUSTABLE OR FIXED, PAIR, WITHPADS, TIPS AND HANDGRIPS cohort cohort cohort cohort

E0114 CRUTCHES UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED,PAIR, WITH PADS, TIPS AND HANDGRIPS cohort cohort cohort cohort cohort

E0116

CRUTCH, UNDERARM, OTHER THAN WOOD, ADJUSTABLE OR FIXED, WITH PAD, TIP, HANDGRIP, WITH OR WITHOUT SHOCK ABSORBER, EACH statewide

E0117 CRUTCH, UNDERARM, ARTICULATING, SPRING ASSISTED, EACH statewide

E0135 WALKER, FOLDING (PICKUP), ADJUSTABLE OR FIXED HEIGHT cohort cohort

E0160 SITZ TYPE BATH OR EQUIPMENT, PORTABLE, USED WITH OR WITHOUT COMMODE cohort cohort

E0218 WATER CIRCULATING COLD PAD WITH PUMP cohort cohort cohort cohort

E0603 BREAST PUMP ELECTRIC (AC AND/OR DC), ANY TYPE cohort cohort

E0607 HOME BLOOD GLUCOSE MONITOR cohort cohort

E0621 SLING OR SEAT, PATIENT LIFT, CANVAS OR NYLON statewide

E0781

AMBULATORY INFUSION PUMP, SINGLE OR MULTIPLE CHANNELS, WITH ADMINISTRATIVE EQUIPMENT, WORN BY PATIENT statewide

204

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

E0782 INFUSION PUMP, IMPLANTABLE, NON-PROGRAMMABLE statewide

E0870 TRACTION FRAME, ATTACHED TO FOOTBOARD, EXTREMITY TRACTION,(E.G. BUCK'S) statewide

E0910 TRAPEZE BARS, A/K/A PATIENT HELPER, ATTACHED TO BED, WITHGRAB BAR statewide

E1700 JAW MOTION REHABILITATION SYSTEM statewide

G0008 ADMINISTRATION OF INFLUENZA VIRUS VACCINE cohort cohort cohort cohort cohort

G0009 ADMINISTRATION OF PNEUMOCOCCAL VACCINE cohort cohort cohort cohort cohort

G0010 ADMINISTRATION OF HEPATITIS B VACCINE cohort cohort

G0027 SEMEN ANALYSIS; PRESENCE AND/OR MOTILITY OF SPERM EXCLUDING HUHNER statewide

G0101 CERVICAL OR VAGINAL CANCER SCREENING; PELVIC AND CLINICAL BREAST EXAMINATION cohort cohort

G0102 PROSTATE CANCER SCREENING; DIGITAL RECTAL EXAM cohort cohort

G0103 PROSTATE CANCER SCREENING; PROSTATE SPECIFIC ANTIGEN TEST (PSA) statewide

G0104 COLORECTAL CANCER SCREENING; FLEXIBLE SIGMOIDOSCOPY cohort cohort

G0105 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL ATHIGH RISK cohort cohort cohort cohort cohort

G0108 DIABETES OUTPATIENT SELF-MANAGEMENT TRAINING SERVICES,INDIVIDUAL, PER SESSION cohort cohort cohort

G0109 DIABETES SELF-MANAGEMENT TRAINING SERVICES, GROUP SESSION,PER INDIVIDUAL statewide

G0121 COLORECTAL CANCER SCREENING; COLONOSCOPY ON INDIVIDUAL NOTMEETING CRITERIA FOR HIGH RISK cohort cohort cohort cohort cohort

G0127 TRIMMING OF DYSTROPHIC NAILS, ANY NUMBER cohort cohort

G0130

SINGLE ENERGY X-RAY ABSORPTIOMETRY (SEXA) BONE DENSITYSTUDY, ONE OR MORE SITES; APPENDICULAR SKELETON (PERIPHERAL) (EG, RADIUS, WRIST, HEEL) statewide

G0145

SCREENING CYTOPATHOLOGY, CERVICAL OR VAGINAL (ANY REPORTING SYSTEM), COLLECTED IN PRESERVATIVE FLUID, AUTOMATED THIN LAYER PREPARATION, WITH MANUAL SCREENING AND statewide

G0168 WOUND CLOSURE UTILIZING TISSUE ADHESIVE(S) ONLY cohort cohort cohort cohort cohort

G0173 STEREOTACTIC RADIOSURGERY, COMPLETE COURSE OF THERAPY IN ONE SESSION statewide

G0176

ACTIVITY THERAPY, SUCH AS MUSIC, DANCE,ART, OR PLAY THERAPY NOT FOR RECREATION RELATED TO CARE AND TREATMENT OF PATIENTS DISABLING MENTAL HEALTH PROBLEMS, PER SESSION (45 MINUTES OR MORE) statewide

G0202 SCREENING MAMOGRAPHY PRODUCING DIRECT DIGITAL IMAGE, BILATERAL ALL VIEWS. cohort cohort cohort cohort cohort cohort

G0204 DIAGNOSTIC MAMMOGRAPHY, DIRECT DIGITAL IMAGE, BILATERAL ALL VIEWS. cohort cohort cohort cohort cohort cohort

G0206 DIAGNOSTIC MAMMOGRAPHY, DIRECT DIGITAL IMAGE, UNILATERAL ALL VIEWS. cohort cohort cohort cohort cohort cohort

G0237

THERAPEUTIC PROCEDURES TO INCREASE STRENGTH OR ENDURANCE OF RESPIRATORY MUSCLES, FACE TO FACE ONE ON ONE EACH 15 MINUTES (INCLUDES MONITORING) cohort cohort cohort cohort cohort

G0238

THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION, OTHER THAN DESCRIBED BY G0237 ONE ON ONEFACE TO FACE PER 15 MINUTES (INCLUDES MONITORING) cohort cohort cohort cohort cohort

G0239

THERAPEUTIC PROCEDURES TO IMPROVE RESPIRATORY FUNCTION, OTHER THAN SERVICES DESCRIBED BY G0237 TWO OR MORE (INCLUDING MONITORING) cohort cohort cohort cohort cohort

G0251

LINEAR ACCELERATOR BASED STERIOTACTIC RADIOSURGERYDELIVERY INCLUDING COLLIMATOR CAHNGE AND CUSTOM PLUGGING FRACTIONED TREATMENT, ALL LESIONS, PER SESSION, MAX 5 SESSIONS PER COURSE statewide

G0257 UNSCHEDULED OR EMERGENCY DIALYSIS TREATMENT FOR AN ESRD PATIENT IN A HOSPITAL cohort cohort cohort cohort

205

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

G0259 INJECTION PROCEDURE FOR SACROILIAC JOINT; ARTHROGRAPY statewide

G0260 INJECTION PROCEDURE FOR SACROILIAC JOINT; PROVISION OF ANESTHETIC, STEROID cohort cohort cohort cohort cohort

G0269 PLACEMENT OF OCCLUSIVE DEVICE INTO EITHER A VENOUS OR ARTIERIAL ACCESS SITE cohort cohort cohort cohort cohort

G0275

RENAL ARTERY ANGIOGRAPHY (UNILATERAL OR BILATERAL)PERFORMED AT THE TIME OF CARDIAC CATHETERIZATION, INCLUDES CATHETER PLACEMENT, INJECTION OF DYE, cohort cohort cohort

G0278 ILIAC ARTERY ANGIOGRAPHY PERFORMED AT THE SAME TIME OF CARDIAC CATHETERIZATION cohort cohort

G0288 RECONSTRUCTION, COMPUTED TOMOGRAPHIC ANGIOGRAPHY OF AORTA FOR SURGICAL PLANNING statewide

G0289 ARTHROSCOPY, KNEE, SURGICAL, FOR REMOVAL OF LOOSE BODY, FOREIGN BODY cohort cohort cohort cohort

G0339

IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASE STEREOTACTIC RADIOSURGERY COMPLETE COURSE OF THERAPY INONE SESSION OR FIRST SESSION OF FRACTIONATED TREA TMENT cohort cohort

G0340

IMAGE GUIDED ROBOTIC LINEAR ACCELERATOR BASED STEREOTACTIC RADIOSURGERY DELIVERY INCLUDING COLLIMATOR CHANGES AND CUSTOM PLUGGING FRACTIONATED TREATMENT ALL LESIONS PER SESSION MAX 5 SESSIONS PER TREA cohort cohort

G0364 BONE MARROR ASPIRATE & BIOPSY cohort cohort cohort cohort

G0365 VESSEL MAPPING HEMO ACCESS cohort cohort cohort

G0378 HOSPITAL OBSERVATION SERVICE, PER HOUR cohort cohort cohort cohort cohort cohort

G0379 DIRECT ADMISSION OF PATIENT FOR HOSPITAL OBSERVATION CARE cohort cohort cohort cohort cohort

G0380

Level I hospital emergency department visit provided in a type B emergency department; (The ED must meet at least one of the following requirements: (1) it is licensed by the state in which it is loc cohort cohort cohort

G0381

Level 2 hospital emergency department visit provided in a type B emergency department; (The ED must meet at least one of the following requirements: cohort cohort cohort

G0382


G0383


G0384


G0389

ULTRASOUND B-SCAN AND/OR REAL TIME WITH IMAGE DOCUMENTATION; FOR ABDOMINAL AORTIC ANEURYSM (AAA) SCREENING cohort cohort cohort cohort cohort

G0390 TRAUMA RESPONSE TEAM ASSOCIATED WITH HOSPITAL CRITICAL CARE SERVICE cohort cohort cohort cohort

G0399

HOME SLEEP STUDY TEST (HST) WITH TYPE III PROTABLEMONITOR, UNATTENDED; MINIMUM OF 4 CHANNELS: 2 RESPIRATORY MOVEMENT/AIR FLOW, 1 ECG/HEART RATE, AND 1 OXYGEN SATURATION statewide

G0402

INITIAL PREVENTIVE PHYSICAL EXAMINATION; FACE-TO-FACE VISIT, SERVICES LIMITED TO NEW BENEFICIARY DURING THE FIRST 12 MO OF MEDICARE ENROLLMENT statewide

G0410

GROUP PSYCHOTHERAPY OTHER THAN OF A MULTIPLE-FAMILY GROUP, IN A PARTIAL HOSPITALIZATION SETTING, APPROXIMATELY 45 TO 50 MINUTES cohort cohort

G0424 PULMONARY REHABILITATION, INCLUDING EXERCISE (INCLUDES MONITORING), ONE HOUR, PER SESSION, cohort cohort cohort cohort cohort

G0431 DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES BYHIGH COMPLEXITY TEST METHOD (E.G., IMMUNOASSAY, E statewide

206

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

NZYME ASSAY), PER PATIENT ENCOUNTER

G0435 Infectious agent antigen detection by rapid antibody test of oral mucosa transudate, HIV-1 or HIV-2,screening statewide

G0436

SMOKING AND TOBACCO CESSATION COUNSELING VISIT FORTHE ASYMPTOMATIC PATIENT; INTERMEDIATE, GREATER T HAN 3 MINUTES, UP TO 10 MINUTES statewide

G8553 PRESCRIPTION(S) GENERATED AND TRANSMITTED VIA A QUALIFIED ERX SYSTEM OR A CERTIFIED EHR SYSTEM statewide

G9019 OSELTAMIVIR PHOSPHATE, ORAL statewide

H0015 ALCOHOL AND/OR DRUG SERVICES; INTENSIVE OUTPATIENTTREATMENT PROGRAM statewide

H0035 MENTAL HEALTH PARTIAL HOSPITALIZATION, TREATMENT, LESS THAN 24 HOURS cohort cohort

H075 MAJOR CHEST PROCEDURES statewide

H181 G.I. OBSTRUCTION W/O CC statewide

H189 OTHER DIGESTIVE SYSTEM DIAGNOSES AGE >17 W/O CC statewide

H209 MAJ JOINT & LIMB REATTACH PROC OF LOW EXT, EXC HIPEXC FOR COMP cohort cohort

H359 UTERINE + ADNEXA PROC FOR CA IN SITU + NON-MALIGNA statewide

H373 VAGINAL DELIVERY W/O COMPLICATING DIAGNOSES statewide

H493 LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E W CC statewide

H813 NONBACTERIAL GASTROENTERITIS & ABDOMINAL PAIN AGE >17 W/CC statewide

H876 CHEMO W ACUTE LEUKEMIA AS SDX OR WITH USE OF HIGH DOSE CHEMO AGENT statewide

J0110 ADDED DURING FEE SCHEDULE LOAD PROCESS statewide

J0129

INJECTION, ABATACEPT, 10 MG (CODE MAY BE USED FOR MEDICARE WHEN DRUG ADMINISTERED UNDER THE DIRECT SUPERVISION OF A PHYSICIAN, NOT FOR USE WHEN DRUG IS SELF ADMINISTERED) statewide

J0130 INJECTION ABCIXIMAB, 10 MG statewide

J0131 INJECTION, ACETAMINOPHEN, 10 MG cohort cohort cohort cohort

J0132 INJECTION, ACETYLCYSTEINE, 100 MG statewide

J0133 INJECTION, ACYCLOVIR, 5 MG statewide

J0150

INJECTION, ADENOSINE, 6 MG (NOT TO BE USED TO REPORT ANYADENOSINE PHOSPHATE COMPOUNDS, INSTEAD USE A9270) cohort cohort cohort

J0152 INJECTION ADENOSINE 30MG (NOT TO BE USED TO REPORTANY ADENOSINE PHOSPHATE) cohort cohort cohort

J0171 INJECTION, ADRENALIN, EPINEPHRINE, 0.1 MG cohort cohort cohort cohort cohort

J0178 Injection, aflibercept, 1 mg statewide

J0180 AGALSIDASE BETA INJECTION, 1MG statewide

J0221 INJECTION, ALGLUCOSIDASE ALFA, (LUMIZYME), 10 MG statewide

J0278 INJECTION, AMIKACIN SULFATE, 100 MG cohort cohort

J0280 INJECTION, AMINOPHYLLIN, UP TO 250 MG cohort cohort cohort

J0282 INJECTION, AMIODARONE HYDROCHLORINE, 30 MG cohort cohort

J0289 INJECTION, AMPHOTERICIN B LIPOSOME, 10 MG statewide

J0290 INJECTION, AMPICILLIN SODIUM, cohort cohort cohort

J0295 INJECTION, AMPICILLIN SODIUM/SULBACTAM SODIUM, PER1.5 GM cohort cohort cohort cohort cohort

J0330 INJECTION, SUCCINYLCHOLINE CHLORIDE, UP TO 20 MG cohort cohort cohort cohort cohort

J0360 INJECTION, HYDRALAZINE HCL, UP TO 20 MG cohort cohort cohort cohort

J0456 AZITHROMYCIN- INJECTION, AZITHROMYCIN, 500 MG cohort cohort cohort

J0461 INJECTION, ATROPINE SULFATE, 0.01 MG cohort cohort cohort cohort

J0475 INJECTION, BACLOFEN, 10 MG statewide

J0490 INJECTION, BELIMUMAB, 10 MG [Benlysta] statewide

207

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J0500 INJECTION, DICYCLOMINE HCL, UP TO 20 MG cohort cohort cohort cohort

J0561 INJECTION, PENICILLIN G BENZATHINE, 100,000 UNITS cohort cohort cohort

J0583 INJECTION BIVALIRUDIN 1MG cohort cohort cohort cohort

J0585 INJECTION, ONABOTULINUMTOXINA, 1 UNIT statewide

J0595 INJECTION BUTORPHANOL TARTRATE 1 MG cohort cohort cohort

J0597 INJECTION, C-1 ESTERASE INHIBITOR (HUMAN), BERINERT, 10 UNITS statewide

J0610 INJECTION, CALCIUM GLUCONATE, PER 10 ML cohort cohort cohort

J0630 INJECTION, CALCITONIN SALMON, UP TO 400 UNITS statewide

J0640 INJECTION, LEUCOVORIN CALCIUM, PER 50 MG cohort cohort cohort cohort


J0670 INJECTION, MEPIVACAINE HYDROCHLORIDE, PER 10 ML cohort cohort cohort cohort

J0690 INJECTION, CEFAZOLIN SODIUM, cohort cohort cohort cohort cohort cohort

J0692 INJECTION, CEFEPIME HYDROCHLORIDE, 500MG. cohort cohort cohort

J0694 INJECTION, CEFOXITIN SODIUM, 1 GM cohort cohort cohort cohort cohort

J0696 INJECTION, CEFTRIAXONE SODIUM, PER 250 MG cohort cohort cohort cohort cohort

J0697 INJECTION, STERILE CEFUROXIME SODIUM, PER 750 MG cohort cohort cohort

J0698 CEFOTAXIME SODIUM, PER GM cohort cohort

J0702 Injection, Betamethasone Acetate 3 mg and Betamethasone Sodium Phosphate 3 mg cohort cohort cohort

J0706 NJECTION CAFFEINE CITRATE 5MG statewide

J0713 INJECTION, CEFTAZIDIME, PER 500 MG cohort cohort

J0725 INJECTION, CHORIONIC GONADOTROPIN, PER 1,000 USP UNITS statewide

J0735 INJECTION, CLONIDINE HYDROCHLORIDE, 1 MG statewide

J0740 INJECTION CIDOFOVIR, 375 MG statewide

J0743 INJECTION, CILASTATIN SODIUM; IMIPENEM, PER 250 MG statewide

J0744 INJECTION CIPROFLOXACIN FOR INTRAVENOUS INFUSION 200MG cohort cohort cohort cohort cohort

J0760 INJECTION, COLCHICINE, PER 1MG statewide

J0780 INJECTION, PROCHLORPERAZINE, UP TO 10 MG cohort cohort cohort cohort cohort

J0833 INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25 MG statewide

J0834 INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG cohort cohort cohort

J0840 INJECTION, CROTALIDAE POLYVALENT IMMUNE FAB (OVINE), UP TO 1 GRAM statewide

J0850 INJECTION, CYTOMEGALOVIRUS IMMUNE GLOBULIN INTRAVENOUS(HUMAN), PER VIAL statewide

J0878 DAPTOMYCIN INJECTION 1MG statewide

J0881 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (NON-ESRDUSE) cohort cohort cohort

J0882 INJECTION, DARBEPOETIN ALFA, 1 MICROGRAM (FOR ESRDON DIALYSIS) statewide

J0885 INJECTION, EPOETIN ALFA, (FOR NON-ESRD USE), 1000 UNITS cohort cohort

J0886 INJECTION, EPOETIN ALFA, 1000 UNITS (FOR ESRD ON DIALYSIS) statewide

J0894 INJECTION, DECITABINE, 1 MG statewide

J0895 INJECTION, DEFEROXAMINE MESYLATE, 500 MG PER 5 CC statewide

J0897 INJECTION, DENOSUMAB, 1 MG [Prolia] [XGEVA] cohort cohort

J1020 INJECTION, METHYLPREDNISOLONE ACETATE, 20 MG statewide

J1030 INJECTION, METHYLPREDNISOLONE ACETATE, 40 MG cohort cohort cohort cohort

J1040 INJECTION, METHYLPREDNISOLONE ACETATE, 80 MG cohort cohort cohort

J1050 Injection, medroxyprogesterone acetate, 1 mg cohort cohort cohort cohort

J1070 INJECTION, TESTOSTERONE CYPIONATE, UP TO 100 MG statewide

J1080 INJECTION, TESTOSTERONE CYPIONATE, 1 CC, 200 MG statewide

J1100 INJECTION, DEXAMETHOSONE SODIUM PHOSPHATE, UP TO 4MG/ML cohort cohort cohort cohort cohort

208

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J1110 INJECTION, DIHYDROERGOTAMINE MESYLATE, PER 1 MG cohort cohort cohort

J1120 INJECTION, ACETAZOLAMIDE SODIUM, UP TO 500 MG cohort cohort cohort

J1160 INJECTION, DIGOXIN, UP TO 0.5 MG cohort cohort

J1165 INJECTION, PHENYTOIN SODIUM, PER 50 MG cohort cohort cohort

J1170 INJECTION, HYDROMORPHONE, UP TO 4 MG cohort cohort cohort cohort

J1200 INJECTION, DIPHENHYDRAMINE HCL, cohort cohort cohort cohort cohort

J1212 INJECTION, DMSO, DIMETHYL SULFOXIDE, 50%, 50 ML statewide

J1245 INJECTION, DIPYRIDAMOLE, PER 10 MG statewide

J1250 INJECTION, DOBUTAMINE HYDROCHLORIDE, PER 250 MG cohort cohort cohort

J1260 INJECTION, DOLASETRON MESYLATE, 1 MG statewide

J1265 INJECTION, DOPAMINE HCL, 40 MG cohort cohort

J1300 Injection, Eculizumab, 10 mg statewide

J1327 EPTIFIBATIDE INJECTION, 500 MG cohort cohort cohort

J1335 INJECTION ERTAPENEM SODIUM 500MG cohort cohort cohort cohort cohort

J1364 INJECTION, ERYTHROMYCIN LACTOBIONATE, PER 500 MG statewide

J1410 INJECTION, ESTROGEN cohort cohort

J1440 INJECTION, FILGRASTIM (G-CSF), 300 MCG cohort cohort

J1441 INJECTION, FILGRASTIM (G-CSF), 480 MCG cohort cohort cohort

J1450 INJECTION FLUCONAZOLE, 200 MG cohort cohort cohort

J1453 INJECTION, FOSAPREPITANT, 1 MG cohort cohort cohort

J1455 INJECTION, FOSCARNET SODIUM, PER 1000 MG statewide

J1459 INJECTION, IMMUNE GLOBULIN (PRIVIGEN), INTRAVENOUS, NON-LYOPHILIZED (E.G. LIQUID), 500 MG statewide

J1559 INJECTION, IMMUNE GLOBULIN (HIZENTRA), 100 MG statewide

J1561 Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e. g. Liquid), 500 mg cohort cohort

J1566 Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg statewide

J1569 Injection, immune globulin, (gammagard liquid), non-lyophilized, (e. g. Liquid), 500 mg statewide

J1570 INJECTION, GANCICLOVIR SODIUM, 500 MG statewide

J1580 INJECTION, GARAMYCIN, GENTAMICIN, UP TO 80 MG cohort cohort cohort

J1610 INJECTION, GLUCAGON HYDROCHLORIDE, PER 1 MG cohort cohort cohort

J1630 INJECTION, HALOPERIDOL, UP TO 5 MG cohort cohort cohort

J1642 INJECTION, HEPARIN SODIUM, (HEPARIN LOCK FLUSH), PER 10UNITS cohort cohort cohort cohort

J1644 INJECTION, HEPARIN SODIUM, PER 1000 UNITS cohort cohort cohort cohort cohort

J1645 INJECTION, DALTEPARIN SODIUM, PER 2500 IU statewide

J1650 INJECTION, ENOXAPARIN SODIUM, 10 MG cohort cohort cohort cohort

J1652 INJECTION FONDAPARINUX SODIUM 0.5 MG. cohort cohort

J1670 INJECTION, TETANUS IMMUNE GLOBULIN, HUMAN, UP TO 250 UNITS cohort cohort

J1720 INJECTION, HYDROCORTISONE cohort cohort cohort

J1725 INJECTION, HYDROXYPROGESTERONE CAPROATE, 1 MG [Makena] statewide

J1740 INJECTION, IBANDRONATE SODIUM, 1 MG statewide

J1742 INJECTION, IBUTILIDE FUMARATE, 1 MG cohort cohort

J1745 INJECTION INFLIXIMAB, 10MG cohort cohort cohort

J1750 INJECTION, IRON DEXTRAN, 50MG cohort cohort

J1756 INJECTION IRON SUCROSE 1 MG. cohort cohort cohort

J1790 INJECTION, DROPERIDOL, UP TO 5 MG cohort cohort cohort cohort

J1800 INJECTION, PROPRANOLOL HCL, UP TO 1 MG cohort cohort cohort

J1815 INJECTION INSULIN PER 5 UNITS cohort cohort cohort cohort cohort

209

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J1817 INSULIN FOR ADMINISTRATION THROUGH DME (I.E., INSULIN PUMP) PER 50 UNITS statewide

J1885 INJECTION, KETOROLAC TROMETHAMINE, PER 15 MG cohort cohort cohort cohort cohort

J1940 INJECTION, FUROSEMIDE, UP TO 20 MG cohort cohort cohort cohort

J1950 INJECTION, LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), PER3.75 MG cohort cohort

J1953 INJECTION, LEVETIRACETAM, 10 MG cohort cohort cohort

J1956 INJECTION, LEVOFLOXACIN, 250 MG cohort cohort cohort cohort cohort cohort

J1980 INJECTION, HYOSCYAMINE SULFATE, UP TO 0.25 MG statewide

J2001 INJECTION LIDOCAINE HCL FOR INTRAVENOUS INFUSION 10 MG cohort cohort cohort cohort cohort

J2060 INJECTION, LORAZEPAM, 2 MG cohort cohort cohort cohort cohort cohort

J2150 INJECTION, MANNITOL, 25% IN 50 ML cohort cohort cohort

J2175 INJECTION, MEPERIDINE HYDROCHLORIDE, PER 100 MG cohort cohort cohort cohort cohort cohort

J2185 INJECTION MEROPENEM 100MG cohort cohort cohort

J2210 INJECTION, METHYLERGONOVINE MALEATE, UP TO 0.2 MG cohort cohort cohort

J2248 INJECTION, MICAFUNGIN SODIUM, 1 MG statewide

J2250 INJECTION, MIDAZOLAM HYDROCHLORIDE, PER 1 MG cohort cohort cohort cohort cohort cohort

J2270 INJECTION, MORPHINE SULFATE, UP TO 10 MG cohort cohort cohort cohort cohort cohort

J2271 INJECTION, MORPHINE SULFATE, 100MG statewide

J2275 INJECTION, MORPHINE SULFATE (PRESERVATIVE-FREE STERILESOLUTION), PER 10 MG cohort cohort cohort

J2280 INJECTION MOXIFLOXACIN 100MG cohort cohort cohort

J2300 INJECTION, NALBUPHINE HYDROCHLORIDE, PER 10 MG cohort cohort cohort

J2310 INJECTION, NALOXONE HYDROCHLORIDE, PER 1 MG cohort cohort cohort

J2323 Injection, Natalizumab, 1 mg statewide

J2353 INJECTION OCTREOTIDE DEPOT FORM FOR INTRAMUSCULAR INJECTION 1 MG cohort cohort cohort

J2354 INJECTION OCTREOTIDE NON-DEPOT FORM FOR SUBCUTAN- EOUS OR INTRAVENOUS cohort cohort cohort cohort

J2357 OMALIZUMAB INJECTION, 5MG cohort cohort

J2360 INJECTION, ORPHENADRINE CITRATE, UP TO 60 MG statewide

J2370 INJECTION, PHENYLEPHRINE HCL, UP TO 1 ML cohort cohort cohort cohort

J2400 INJECTION, CHLOROPROCAINE HYDROCHLORIDE, PER 30 ML cohort cohort

J2405 INJECTION, ONDANSETRON HYDROCHLORIDE, PER 1 MG cohort cohort cohort cohort cohort

J2425 INJECTION, PALIFERMIN, 50 MICROGRAMS statewide

J2430 INJECTION, PAMIDRONATE DISODIUM, PER 30 MG statewide

J2440 INJECTION, PAPAVERINE HCL, UP TO 60 MG cohort cohort

J2469 PALONOSETRON HCL INJECTION, 25MCG cohort cohort cohort

J2501 INJECTION PARICALCITOL 1 MCG. statewide

J2505 INJECTION PEGFILGRASTIM 6 MG cohort cohort cohort

J2507 INJECTION, PEGLOTICASE, 1 MG [Krystexxa] statewide

J2515 INJECTION, PENTOBARBITAL SODIUM, PER 50 MG statewide

J2540 INJECTION, PENICILLIN G POTASSIUM, UP TO 600,000 UNITS cohort cohort cohort

J2543 INJECTION, PIPERACILLIN SODIUM/TAZOBACTAM SODIUM, 1 GRAM0.125 GRAMS (1.125 GRAMS) cohort cohort cohort cohort cohort

J2545

Pentamidine Isethionate, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per 300 mg statewide

J2550 INJECTION, PROMETHAZINE HCL, UP TO 50 MG cohort cohort cohort cohort cohort

J2560 INJECTION, PHENOBARBITAL SODIUM, UP TO 120 MG statewide

J2562 INJECTION, PLERIXAFOR, 1 MG statewide

J2590 INJECTION, OXYTOCIN, UP TO 10 UNITS cohort cohort cohort cohort

J2597 INJECTION, DESMOPRESSIN ACETATE, PER 1 MCG cohort cohort cohort

J2690 INJECTION, PROCAINAMIDE HCL, UP TO 1 GM statewide

210

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Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J2710 INJECTION, NEOSTIGMINE METHYLSULFATE, UP TO 0.5 MG cohort cohort cohort cohort cohort

J2720 INJECTION, PROTAMINE SULFATE, PER 10 MG cohort cohort

J2730 INJECTION, PRALIDOXIME CHLORIDE, UP TO 1 GM cohort cohort

J2765 INJECTION, METOCLOPRAMIDE HCL, UP TO 10 MG cohort cohort cohort cohort cohort cohort

J2778 Injection, Ranibizumab, 0.1 mg statewide

J2780 INJECTION, RANITIDINE HYDROCHLORIDE, 25 MG cohort cohort cohort cohort

J2785 INJECTION, REGADENOSON, 0.1 MG cohort cohort cohort cohort cohort

J2788 INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, MINIDOSE,50 MICROGRAMS (250 I.U.) cohort cohort

J2790 INJECTION, RHO D IMMUNE GLOBULIN, HUMAN, FULL DOSE, 300 MICROGRAMS (1500 I.U.) cohort cohort cohort cohort

J2791 Injection, RHO (D) immune globulin (human), (Rhophylac), intramuscular or intravenous, 100 IU statewide

J2792 INJECTION, RHO D IMMUNE GLOBULIN, INTRAVENOUS, HUMAN,SOLVENT DETERGENT, 100 IU statewide

J2795 INJECTION, ROPIVACAINE HYDROCHLORIDE, 1 MG cohort cohort cohort cohort

J2800 INJECTION, METHOCARBAMOL, UP TO 10 ML cohort cohort

J2805 INJECTION, SINCALIDE, 5 MICROGRAMS cohort cohort cohort

J2916 INJECTION SODIUM FERRIC GLUCONATE COMPLEX IN SUCROSE INJECTION 12.5 MG cohort cohort cohort

J2920 INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UPTO 40 MG cohort cohort cohort cohort cohort cohort

J2930 INJECTION, METHYLPREDNISOLONE SODIUM SUCCINATE, UPTO 125 MG cohort cohort cohort cohort cohort

J2997 INJECTION, ALTEPLASE RECOMBINANT, 1 MG cohort cohort cohort

J3010 INJECTION, FENTANYL CITRATE, UP TO 2 ML cohort cohort cohort cohort cohort cohort

J3030

INJECTION, SUMATRIPTAN SUCCINATE, 6 MG, ADMINISTERED UNDERDIRECT PHYSICIAN SUPERVISION, EXCLUDES SELF ADMINISTRATION cohort cohort cohort

J3101 INJECTION, TENECTEPLASE, 1 MG statewide

J3105 INJECTION, TERBUTALINE SULFATE, UP TO 1 MG. cohort cohort


J3230 INJECTION, CHLORPROMAZINE HCL, UP TO 50 MG statewide

J3240 INJECTION, THYROTROPIN, UP TO 10 I.U. cohort cohort cohort cohort

J3243 INJECTION, TIGECYCLINE, 1 MG statewide

J3260 INJECTION, TOBRAMYCIN SULFATE, UP TO 80 MG cohort cohort

J3262 INJECTION, TOCILIZUMAB, 1 MG statewide

J3300 INJECTION, TRIAMCINOLONE ACETONIDE, PRESERVATIVE FREE, 1MG statewide

J3301 INJECTION, TRIAMCINOLONE ACETONIDE, NOT OTHERWISESPECIFIED, 10 MG cohort cohort cohort cohort cohort

J3303 INJECTION TRIAMCINOLONE HEXACETONIDE, PER 5MG statewide

J3315 INJECTION TRIPTORELIN PAMOATE 3.75 MG. statewide

J3360 INJECTION, DIAZEPAM, UP TO 5 MG cohort cohort cohort cohort cohort cohort

J3370 INJECTION, VANCOMYCIN HCL, UP TO 500 MG cohort cohort cohort cohort cohort

J3396 VERTEPORFIN INJECTION,0.1 MG statewide

J3410 INJECTION, HYDROXYZINE HCL, UP TO 25 MG cohort cohort cohort

J3411 INJECTION THIAMINE HCL 100MG cohort cohort cohort

J3415 INJECTION PYRIDOXINE HCL 100MG statewide

J3420 INJECTION, VITAMIN B-12 CYANOCOBALAMIN, UP TO 1000MCG cohort cohort cohort

J3430 INJECTION, PHYTONADIONE (VITAMIN K), PER 1 MG cohort cohort cohort

J3465 INJECTION VORICONAZOLE 10 MG statewide

J3470 INJECTION, HYALURONIDASE, UP TO 150 UNITS cohort cohort

J3471 INJECTION, HYALURONIDASE, OVINE, PRESERVATIVE FREE, PER 1 USP UNIT (UP TO 999 USP UNITS) cohort cohort

211

CPT Description

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Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J3473 INJECTION, HYALURONIDASE, RECOMBINANT, 1 USP UNIT statewide

J3475 INJECTION, MAGNESIUM SULFATE, PER 500 MG cohort cohort cohort cohort cohort

J3480 INJECTION, POTASSIUM CHLORIDE, PER 2 MEQ cohort cohort cohort cohort cohort cohort

J3486 INJECTION ZIPRASIDONE MESYLATE 10MG cohort cohort

J3487 Injection, Zoledronic acid (Zometa), 1 mg cohort cohort cohort

J3488 Injection, Zoledronic Acid (Reclast), 1 mg cohort cohort cohort cohort

J3490 UNCLASSIFIED DRUGS cohort cohort cohort cohort cohort cohort

J3535 DRUG ADMINISTERED THROUGH A METERED DOSE INHALER statewide

J3590 UNCLASSIFIED BIOLOGICS cohort cohort


J7030 INFUSION, NORMAL SALINE SOLUTION, 1000 CC cohort cohort cohort cohort cohort cohort

J7040 INFUSION, NORMAL SALINE SOLUTION, STERILE (500 ML=1 UNIT) cohort cohort cohort cohort cohort cohort

J7042 5% DEXTROSE/NORMAL SALINE (500 ML = 1 UNIT) cohort cohort cohort cohort cohort cohort

J7050 INFUSION, NORMAL SALINE SOLUTION, 250 CC cohort cohort cohort cohort cohort cohort

J7060 5% DEXTROSE/WATER (500 ML = 1 UNIT) cohort cohort cohort cohort cohort

J7070 INFUSION, D5W, 1000 CC cohort cohort cohort cohort

J7100 INFUSION, DEXTRAN 40, 500 ML statewide

J7120 RINGERS LACTATE INFUSION, UP TO 1000 CC cohort cohort cohort cohort cohort cohort

J7187 Injection, Von Willebrand factor complex (Humate-P), per IU VWF:RCO statewide

J7192 FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) PER I.U., NOT OTHERWISE SPECIFIED statewide

J7194 FACTOR IX, COMPLEX, PER I.U. statewide

J7195 FACTOR IX (ANTIHEMOPHILIAC FACTOR, RECOMBINANT) PER IU statewide

J7300 INTRAUTERINE COPPER CONTRACEPTIVE statewide

J7302 LEVONORGESTREL-RELEASING INTRAUTERINE CONTRACEPTIVSYSTEM 52 MG cohort cohort

J7307 Etonogestrel (contraceptive) Implant System, including implant and supplies cohort cohort cohort

J7311 FLUOCINOLONE ACETONIDE, INTRAVITREAL IMPLANT statewide

J7315 Mitomycin, opthalmic, 0. 2 mg statewide

J7324 Hyaluronan or derivative, Orthovisc, for intra-articular injection, per dose statewide

J7330 Autologous cultured chondrocytes, implant statewide

J7500 AZATHIOPRINE - ORAL, TAB, 50 MG, 100S EA cohort cohort cohort

J7502 CYCLOSPORINE, ORAL, 100 MG. statewide

J7506 PREDNISONE, ORAL, PER 5 MG cohort cohort cohort cohort cohort

J7507 TACROLIMUS, ORAL, PER 1 MG statewide

J7509 METHYLPREDNISOLONE ORAL, PER 4 MG cohort cohort cohort

J7510 PREDNISOLONE ORAL, PER 5 MG cohort cohort cohort cohort cohort

J7517 MYCOPHENOLATE MOFETIL, ORAL, 250 MG cohort cohort

J7518 MYCOPHENOLIC ACID, ORAL, 180 MG statewide

J7520 SIROLIMUS, ORAL, 1 MG statewide

J7525 TACROLIMUS, PARENTERAL, 5 MG statewide

J7605

Arformoterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, 15 micrograms statewide

J7607

LEVALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, CONCENTRATED FORM, 0.5 MG statewide

J7608 Acetylcysteine, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose form, per gram cohort cohort

J7609 ALBUTEROL, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE, 1 MG statewide

J7611 Albuterol, inhalation solution, FDA-approved finalproduct, non-compounded, administered through DME , concentrated form, 1 mg cohort cohort cohort cohort

212

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J7612 Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 1 mg cohort cohort cohort cohort

J7613 Albuterol, inhalation solution, FDA-approved finalproduct, non-compounded, administered through DME , unit dose, 1 mg cohort cohort cohort cohort cohort

J7614 Levalbuterol, inhalation solution, FDA-approved final product, non-compounded, administered through DME, unit dose, 0.5 mg cohort cohort cohort cohort

J7620 ALBUTEROL, UP TO 2.5 MG AND IPRATROPIUM BROMIDE, UP TO 0.5 MG, FDA-APPROVED cohort cohort cohort cohort

J7622 BECLOMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH statewide

J7626 BUDESONIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, cohort cohort cohort cohort cohort

J7627 BUDESONIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, statewide

J7638 DEXAMETHASONE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH statewide

J7642 GLYCOPYRROLATE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH statewide

J7644 IPRATROPIUM BROMIDE, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, cohort cohort cohort cohort cohort

J7645

IPRATROPIUM BROMIDE, INHALATION SOLUTION, COMPOUNDED PRODUCT, ADMINISTERED THROUGH DME, UNIT DOSE FORM, PER MILLIGRAM statewide

J7674 METHACHOLINE CHLORIDE ADM AS INHALATION SOLUTION THROUGH A NEBULIZER, PER 1MG cohort cohort

J7676 Pentamidine Isethionate, inhalation solution, compounded product, administered through DME, unit dose form, per 300 mg statewide

J7799 NOC DRUGS, OTHER THAN INHALATION DRUGS, ADMINISTERED THROUGHDME cohort cohort

J8498 ANTIEMETIC DRUG, RECTAL/SUPPOSITORY, NOT OTHERWISESPECIFIED cohort cohort

J8499 PRESCRIPTION DRUG, ORAL, NON CHEMOTHERAPEUTIC, NOS cohort cohort cohort

J8501 APREPITANT, ORAL, 5MG cohort cohort cohort

J8530 CYCLOPHOSPHAMIDE; ORAL, 25 MG statewide

J8540 DEXAMETHASONE, ORAL, 0.25 MG cohort cohort cohort

J8597 ANTIEMETIC DRUG, ORAL, NOT OTHERWISE SPECIFIED statewide

J8700 TEMOZOLMIDE, ORAL, 5 MG statewide

J8999 PRESCRIPTION DRUG, ORAL, CHEMOTHERAPEUTIC, NOS statewide

J9000 INJECTION, DOXORUBICIN HYDROCHLORIDE, 10 MG cohort cohort cohort

J9002 Injection, Doxorubicin Hydrochloride, Liposomal, Doxil, 10 mg cohort cohort

J9010 INJECTION, ALEMTUZUMAB, 10 MG statewide

J9017 INJECTION, ARSENIC TRIOXIDE, 1 MG statewide

J9025 INJECTION, AZACITIDINE, 1 MG statewide

J9033 INJECTION, BENDAMUSTINE HCL, 1 MG cohort cohort

J9035 BEVACIZUMAB INJECTION, 10MG cohort cohort cohort

J9040 INJECTION, BLEOMYCIN SULFATE, 15 UNITS cohort cohort

J9041 BORTEZOMIB INJECTION, 0.1 MG cohort cohort cohort

J9045 INJECTION, CARBOPLATIN, 50 MG cohort cohort cohort

J9055 CETUXIMAB INJECTION, 10MG cohort cohort

J9060 INJECTION, CISPLATIN, POWDER OR S0LUTION, 10 MG cohort cohort cohort

J9070 CYCLOPHOSPHAMIDE, 100 MG cohort cohort cohort

J9098 INJECTION, CYTARABINE LIPOSOME, 10 MG statewide

J9100 INJECTION, CYTARABINE, 100 MG statewide

J9120 INJECTION, DACTINOMYCIN, 0.5 MG statewide

J9130 DACARBAZINE, 100 MG cohort cohort

J9155 INJECTION, DEGARELIX, 1 MG statewide

213

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

J9171 INJECTION, DOCETAXEL, 1 MG cohort cohort cohort

J9175 INJECTION, ELLIOTTS' B SOLUTION, 1 ML statewide

J9178 INJECTION EPIRUBICIN HCL 2MG cohort cohort

J9179 INJECTION, ERIBULIN MESYLATE, 0.1 MG statewide

J9181 INJECTION, ETOPOSIDE, 10 MG cohort cohort cohort

J9185 INJECTION, FLUDARABINE PHOSPHATE, 50 MG cohort cohort

J9190 INJECTION, FLUOROURACIL, 500 MG cohort cohort cohort

J9201 INJECTION, GEMCITABINE HYDROCHLORIDE, 200 MG cohort cohort cohort

J9202 GOSERELIN ACETATE IMPLANT, PER 3.6 MG cohort cohort

J9206 INJECTION, IRINOTECAN, 20 MG cohort cohort cohort

J9207 INJECTION, IXABEPILONE, 1 MG statewide

J9208 INJECTION, IFOSFAMIDE, 1 GRAM cohort cohort

J9209 INJECTION, MESNA, 200 MG cohort cohort

J9217 LEUPROLIDE ACETATE (FOR DEPOT SUSPENSION), 7.5 MG cohort cohort

J9218 LEUPROLIDE ACETATE, PER 1 MG statewide

J9226 Histrelin implant (Supprelin LA), 50 mg cohort cohort

J9228 INJECTION, IPILIMUMAB, 1 MG [Yervoy] statewide

J9245 INJECTION, MELPHALAN HYDROCHLORIDE, 50 MG statewide

J9250 METHOTREXATE SODIUM, 5 MG cohort cohort

J9260 METHOTREXATE SODIUM, 50 MG statewide

J9261 INJECTION, NELARABINE, 50 MG statewide

J9263 INJECTION OXALIPLATIN 0.5 MG cohort cohort cohort

J9264 INJECTION, PACLITAXEL PROTEIN-BOUND PARTICLES, 1 MG cohort cohort

J9265 INJECTION, PACLITAXEL, 30 MG cohort cohort cohort

J9266 INJECTION, PEGASPARGASE, PER SINGLE DOSE VIAL statewide

J9270 INJECTION, PLICAMYCIN, 2.5 MG cohort cohort

J9280 Injection, mitomycin, 5 mg cohort cohort cohort

J9303 Injection, Panitumumab, 10 mg statewide

J9305 PEMETREXED INJECTION, 10MG cohort cohort

J9307 INJECTION, PRALATREXATE, 1 MG statewide

J9310 INJECTION, RITUXIMAB, 100 MG cohort cohort cohort

J9315 INJECTION, ROMIDEPSIN, 1 MG statewide

J9328 INJECTION, TEMOZOLOMIDE, 1 MG statewide

J9330 INJECTION, TEMSIROLIMUS, 1 MG statewide

J9351 INJECTION, TOPOTECAN, 0.1 MG statewide

J9355 INJECTION, TRASTUZUMAB, 10 MG cohort cohort cohort

J9360 INJECTION, VINBLASTINE SULFATE, 1 MG cohort cohort

J9370 VINCRISTINE SULFATE, 1 MG statewide

J9390 INJECTION, VINORELBINE TARTRATE, 10 MG cohort cohort

J9395 INJECTION, FULVESTRANT, 25 MG cohort cohort

J9999 NOT OTHERWISE CLASSIFIED, ANTINEOPLASTIC DRUGS statewide

L0120 CERVICAL, FLEXIBLE, NON-ADJUSTABLE (FOAM COLLAR) cohort cohort cohort cohort cohort

L0130 CERVICAL, FLEXIBLE, THERMOPLASTIC COLLAR, MOLDED TO PATIENT statewide

L0140 CERVICAL, SEMI-RIGID, ADJUSTABLE (PLASTIC COLLAR) cohort cohort cohort

L0150 CERVICAL, SEMI-RIGID, ADJUSTABLE MOLDED CHIN CUP (PLASTICCOLLAR WITH MANDIBULAR/OCCIPITAL PIECE) cohort cohort

L0172 CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE cohort cohort cohort cohort cohort

L0174 CERVICAL, COLLAR, SEMI-RIGID, THERMOPLASTIC FOAM, TWO PIECE WITH THORACIC EXTENSION cohort cohort

L0180 CERVICAL, MULTIPLE POST COLLAR, statewide

214

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

OCCIPITAL/MANDIBULARSUPPORTS, ADJUSTABLE

L0458

TLSO TRIPLANAR CONTROL MODULAR SEGMENTED SPINAL SYSTEM TWO RIGID PLASTIC SHELLS POSTERIOR EXTENDS FROM THE SACROCOCCYGEAL JUNCTION AND TERMINATES JUST INFERIOR TO THE SCAPULAR SPINE statewide

L0484 TLSO TRIPLANAR CONTROL TWO PIECE RIGID PLASTIC SHELL WITHOUT INTERFACE LINER statewide

L0486 TLSO TRIPLANAR CONTROL TWO PIECE RIGID PLASTIC SHELL WITH INTERFACE LINER statewide

L0625

LUMBAR ORTHOSIS, FLEXIBLE, PROVIDES LUMBAR SUPPORT, POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISCS, INCLUDES STRAPS, CLOSU cohort cohort cohort

L0627

LUMBAR ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR PANELS, POSTERIOR EXTENDS FROM L-1 TO BELOW L-5 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DISC cohort cohort cohort

L0628

LUMBAR-SACRAL ORTHOSIS, FLEXIBLE, PROVIDES LUMBO-SACRAL SUPPORT, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO T-9 VERTEBRA, PRODUCES INTRACAVITARY PRESSURE TO REDUCE LOAD ON THE INTERVERTEBRAL DI cohort cohort

L0631 LUMBAR-SACRAL ORTHOSIS, SAGITTAL CONTROL, WITH RIGID ANTERIOR AND POSTERIOR cohort cohort

L0636

LUMBAR SACRAL ORTHOSIS, SAGITTAL-CORONAL CONTROL, LUMBAR FLEXION, RIGID POSTERIOR FRAME/PANELS, LATERAL ARTICULATING DESIGN TO FLEX THE LUMBAR SPINE, POSTERIOR EXTENDS FROM SACROCOCCYGEAL JUNCTION TO statewide

L0999 ADDITION TO SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED statewide

L1020 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, KYPHOSIS PAD statewide

L1030 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR BOLSTER PAD statewide

L1040 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, LUMBAR ORLUMBARRIB PAD statewide

L1050 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, STERNAL PAD statewide

L1060 ADDITION TO CTLSO OR SCOLIOSIS ORTHOSIS, THORACIC PAD statewide

L1200 THORACIC-LUMBAR-SACRAL-ORTHOSIS (TLSO), INCLUSIVE OFFURNISHING INITIAL ORTHOSIS ONLY statewide

L1499 SPINAL ORTHOSIS, NOT OTHERWISE SPECIFIED cohort cohort cohort

L1620 HO, ABDUCTION CONTROL OF HIP JOINTS, FLEXIBLE, PAVLIKHARNESS statewide

L1652 HIP ORTHOSIS BILATERAL THIGH CUFFS WITH ADJUSTABLEABDUCTOR SPREADER BAR statewide

L1810 KO, ELASTIC WITH JOINTS cohort cohort

L1820 KO, ELASTIC WITH CONDYLAR PADS AND JOINTS statewide

L1830 KO, IMMOBILIZER, CANVAS LONGITUDINAL cohort cohort cohort cohort cohort

L1832

KNEE ORTHOSIS, ADJUSTABLE KNEE JOINTS (UNICENTRIC OR POLYCENTRIC), POSITIONAL ORTHOSIS, RIGID SUPPORT, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort cohort

L1845

KNEE ORTHOSIS, DOUBLE UPRIGHT, THIGH AND CALF, WITH ADJUSTABLE FLEXION AND EXTENSION JOINT (UNICENTRIC OR POLYCENTRIC), MEDIAL-LATERAL AND ROTATION CONTROL, WITH OR WITHOUT VARUS/VALGUS ADJUSTMENT, PR statewide

L1902 AFO, ANKLE GAUNTLET cohort cohort

L1930 AFO, PLASTIC cohort cohort cohort

L1940 AFO, MOLDED TO PATIENT MODEL, PLASTIC statewide

L1970 AFO, PLASTIC MOLDED TO PATIENT MODEL, WITH ANKLE JOINT statewide

L1990 AFO, DOUBLE UPRIGHT FREE PLANTAR DORSIFLEXION, SOLIDSTIRRUP, CALF BAND/CUFF (DOUBLE BAR "BK" ORTHOSIS) statewide

L2112 AFO, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SOFT statewide

L2114 AFO, FRACTURE ORTHOSIS, TIBIAL FRACTURE ORTHOSIS, SEMI- cohort cohort

215

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

RIGID

L2275 ADDITION TO LOWER EXTREMITY, VARUS/VALGUS CORRECTION,PLASTIC MODIFICATION, PADDED/LINED statewide

L2999 LOWER EXTREMITY ORTHOSES, NOT OTHERWISE SPECIFIED cohort cohort

L3000 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL, "UCB"TYPE, BERKELEY SHELL, EACH statewide

L3010 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL,LONGITUDINAL ARCH SUPPORT, EACH statewide

L3020 FOOT, INSERT, REMOVABLE, MOLDED TO PATIENT MODEL,LONGITUDINAL/METATARSAL SUPPORT, EACH cohort cohort

L3031 FOOT, INSERT/PLATE, REMOVABLE, ADDITION TO LOWER EXTREMITY ORTHOSIS, HIGH statewide

L3160 FOOT, ADJUSTABLE SHOE-STYLED POSITIONING DEVICE statewide

L3204 ORTHOPEDIC SHOE, HIGHTOP WITH SUPINATOR OR PRONATOR, INFANT statewide

L3224 ORTHOPEDIC FOOTWEAR, WOMAN'S SHOE, OXFORD, USED ASANINTEGRAL PART OF A BRACE (ORTHOSIS) statewide

L3260 AMBULATORY SURGICAL BOOT, EACH cohort cohort

L3265 PLASTAZOTE SANDAL, EACH cohort cohort

L3300 LIFT, ELEVATION, HEEL, TAPERED TO METATARSALS, PERINCH statewide

L3334 LIFT, ELEVATION, HEEL, PER INCH statewide

L3610 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, CALIPERPLATE, NEW statewide

L3630 TRANSFER OF AN ORTHOSIS FROM ONE SHOE TO ANOTHER, SOLIDSTIRRUP, NEW statewide

L3650 SHOULDER ORTHOSIS, (SO), FIGURE OF "8" DESIGN ABDUCTION RE- STRAINER cohort cohort cohort cohort cohort

L3660 SO, FIGURE OF "8" DESIGN ABDUCTION RESTRAINER, CANVAS ANDWEBBING cohort cohort cohort

L3670 SO, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE) cohort cohort cohort cohort

L3702

ELBOW ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT statewide

L3720 EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, FREE MOTION cohort cohort

L3730 EO, DOUBLE UPRIGHT WITH FOREARM/ARM CUFFS, EXTENSION/FLEXION ASSIST statewide

L3763

ELBOW WRIST HAND ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT statewide

L3764

ELBOW WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT statewide

L3765

ELBOW WRIST HAND FINGER ORTHOSIS, RIGID, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT statewide

L3806

Wrist hand finger orthosis, includes one or more nontorsion joint(s), turnbuckles, elastic bands/springs, may include soft interface material, straps,custom fabricated, includes fitting and adjustmen statewide

L3807 WHFO, EXTENSION ASSIST, WITH INFLATABLE PALMER AIRSUPPORT, WITH OR WITHOUT THUMB EXTENSION cohort cohort

L3808

WRIST HAND FINGER ORTHOSIS, RIGID WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE MATERIAL; STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort cohort cohort cohort

L3900

WHFO, DYNAMIC FLEXOR HINGE, RECIPROCAL WRIST EXTENSION/FLEXION, FINGER FLEXION/EXTENSION, WRIST OR FINGER DRIVEN statewide

L3905

WRIST HAND ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDESOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUD ES FITTING AND ADJUSTMENT statewide

216

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

L3906

WRIST HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDESFITTING AND ADJUSTMENT cohort cohort cohort

L3908 WHO, WRIST EXTENSION CONTROL COCK-UP, NON MOLDED cohort cohort cohort cohort cohort cohort

L3913

HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort cohort

L3919

HAND ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort

L3921

HAND FINGER ORTHOSIS, INCLUDES ONE OR MORE NONTORSION JOINTS, ELASTIC BANDS, TURNBUCKLES, MAY INCLUDE SOFT INTERFACE, STRAPS, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT statewide

L3923

HAND FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, STRAPS, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort

L3925

Finger orthosis, proximal interphalangeal (PIP)/distal interphalangeal (DIP), non torsion joint/spring, extension/flexion, may include soft interface material, prefabricated, includes fitting and adju cohort cohort cohort cohort

L3929

Hand finger orthosis, includes one or more nontorsion joints(s), turnbuckles, elastic bands/springs,may include soft interface material, straps, pref abricated, includes fitting and adjustment statewide

L3933

FINGER ORTHOSIS, WITHOUT JOINTS, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING ANDADJUSTMENT cohort cohort cohort cohort cohort

L3935

FINGER ORTHOSIS, NONTORSION JOINT, MAY INCLUDE SOFT INTERFACE, CUSTOM FABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort

L3962 SEWHO, ABDUCTION POSITIONING, ERBS PALSEY DESIGN statewide

L3982 UPPER EXTREMITY FRACTURE ORTHOSIS, RADIUS/ULNAR statewide

L3984 UPPER EXTREMITY FRACTURE ORTHOSIS, WRIST statewide

L3999 UPPER LIMB ORTHOSIS, NOT OTHERWISE SPECIFIED cohort cohort

L4205 REPAIR OF ORTHOTIC DEVICE, LABOR COMPONENT, PER 15MINUTES statewide

L4210 REPAIR OF ORTHOTIC DEVICE, REPAIR OR REPLACE MINORPARTS statewide

L4350 PNEUMATIC ANKLE CONTROL SPLINT (E.G., AIRCAST) cohort cohort cohort cohort

L4360

WALKING BOOT, PNEUMATIC AND/OR VACUUM, WITH OR WITHOUT JOINTS, WITH OR WITHOUT INTERFACE MATERIAL, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort

L4386 NON-PNEUMATIC WALKING SPLINT WITH OR WITHOUT JOINTS PREFABRICATED INCLUDES FITTING AND ADJUSTMENTS cohort cohort cohort cohort cohort

L4396

STATIC OR DYNAMIC ANKLE FOOT ORTHOSIS, INCLUDING SOFT INTERFACE MATERIAL, ADJUSTABLE FOR FIT, FOR POSITIONING, MAY BE USED FOR MINIMAL AMBULATION, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT cohort cohort cohort

L8000 Breast prosthesis, mastectomy bra, without integrated breast prosthesis form, any size, any type statewide

L8015 EXTERNAL BREAST PROSTHESIS GARMENT, WITH MASTECTOMY FORM,POST MASTECTOMY statewide

L8020 BREAST PROSTHESIS, MASTECTOMY FORM statewide

L8030 BREAST PROSTHESIS, SILICONE OR EQUAL, WITHOUT INTEGRAL ADHESIVE statewide

L8460 PROSTHETIC SHRINKER, ABOVE KNEE, EACH statewide

L8509 TRACHEO-ESOPHAGEAL VOICE PROSTHESIS INSERTED BY A LICENSED HEALTH CARE PROVIDER ANY TYPE statewide

L8600 IMPLANTABLE BREAST PROSTHESIS, SILICONE OR EQUAL cohort cohort cohort cohort

L8603 COLLAGEN IMPLANT, URINARY TRACT, PER 2.5 CC SYRINGE,INCLUDES SHIPPING AND NECESSARY SUPPLIES cohort cohort cohort cohort

L8604 INJECTABLE BULKING AGENT, DEXTRANOMER/HYALURONIC ACID COPOLYMER IMPLANT, URINARY TRACT, 1 ML, INCLUDES cohort cohort cohort cohort

217

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

SHIPPING AND NECESSARY SUPPLIES

L8606 INJECTABLE BULKING AGENT, SYNTHETIC IMPLANT, URINARY TRACT, 1 ML SYRINGE cohort cohort cohort

L8610 OCULAR IMPLANT cohort cohort cohort

L8612 AQUEOUS SHUNT cohort cohort

L8613 OSSICULA IMPLANT cohort cohort cohort

L8614 COCHLEAR DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS statewide

L8627 COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR, COMPONENT, REPLACEMENT statewide

L8670 VASCULAR GRAFT MATERIAL, SYNTHETIC, IMPLANT statewide

L8680 IMPLANTABLE NEUROSTIMULATOR ELECTRODE (WITH ANY NUMBER OF CONTACT POINTS), EACH cohort cohort cohort

L8681

PATIENT PROGRAMMER (EXTERNAL) FOR USE WITH IMPLANTABLE PROGRAMMABLE NEUROSTIMULATOR PULSE GENERATOR,REPLACEMENT ONLY cohort cohort

L8686 IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, SINGLE ARRAY, NON-RECHARGEABLE, INCLUDES EXTENSION statewide

L8687 IMPLANTABLE NEUROSTIMULATOR PULSE GENERATOR, DUAL ARRAY, RECHARGEABLE, INCLUDES EXTENSION cohort cohort

L8689

EXTERNAL RECHARGING SYSTEM FOR BATTERY (INTERNAL) FOR USE WITH IMPLANTABLE NEUROSTIMULATOR REPLACEMENT ONLY statewide

L8690 AUDITORY OSSEOINTEGRATED DEVICE, INCLUDES ALL INTERNAL AND EXTERNAL COMPONENTS cohort cohort cohort

L8693 AUDITORY OSSEOINTEGRATED DEVICE ABUTMENT, ANY LENGTH, REPLACEMENT ONLY cohort cohort

L8699 PROSTHETIC IMPLANT, NOT OTHERWISE SPECIFIED cohort cohort cohort

P9041 INFUSION, ALBUMIN (HUMAN), 5%, 50 ML statewide

P9045 INFUSION ALBUMIN (HUMAN), 5%, 250 ML. statewide

P9047 INFUSION ALBUMIN (HUMAN) 25%, 50ML. cohort cohort

P9612 CATHETERIZATION FOR COLLECTION OF SPECIMEN, SINGLEPATIENT, ALL PLACES OF SERVICE cohort cohort cohort cohort cohort

Q0081 INFUSION THERAPY, USING OTHER THAN CHEMOTHERAPEUTIC DRUGS,PER VISIT statewide

Q0091

SCREENING PAPANICOLAOU SMEAR; OBTAINING, PREPARINGANDCONVEYANCE OF CERVICAL OR VAGINAL SMEAR TO LAB ORATORY cohort cohort cohort cohort

Q0092 SET-UP PORTABLE X-RAY EQUIPMENT statewide

Q0111 WET MOUNTS, INCLUDING PREPARATIONS OF VAGINAL, CERVICAL, OR SKIN SPECIMENS cohort cohort

Q0112 ALL POTASSIUM HYDROXIDE (KOH) PREPARATIONS cohort cohort

Q0114 FERN TEST cohort cohort cohort cohort

Q0138 INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (FOR NON-ESRD ON DIALYSIS) statewide

Q0144 AZITHROMYCIN DIHYDRATE, ORAL, CAPSULES/POWDER, 1 GRAM cohort cohort cohort cohort

Q0162

ONDANSETRON 1 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT NOT TO EXCEED A 48 HOUR DOSAGE R cohort cohort cohort cohort cohort

Q0163

DIPHENHYDRAMINE HYDROCHLORIDE, 50 MG, ORAL, FDA APPROVEDPRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETICAT TIME OF CHEMOTHERAPY cohort cohort cohort cohort

Q0164

PROCHLORPERAZINE MALEATE, 5PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY cohort cohort

Q0165 PROCHLORPERAZINE MALEATE, 10PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC cohort cohort cohort

218

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

Q0167

DRONABINOL, 2.5 MG, ORAL, FDA APPROVED PRESCRIPTIONANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, statewide

Q0168

DRONABINOL, 5 MG, ORAL, FDA APPROVED PRESCRIPTIONANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, statewide

Q0169

PROMETHAZINE HYDROCHLORIDE, 12.5 MG, ORAL, FDA APPROVEDPRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY cohort cohort

Q0170 PROMETHAZINE HYDROCHLORIDE, 25PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC cohort cohort cohort cohort

Q0171 CHLORPROMAZINE HYDROCHLORIDE, 10PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC statewide

Q0172

CHLORPROMAZINE HYDROCHLORIDE, 25 MG, ORAL, FDA APPROVEDPRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC cohort cohort cohort

Q0177

HYDROXYZINE PAMOATE, 25 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, cohort cohort

Q0178

HYDROXYZINE PAMOATE, 50 MG, ORAL, FDA APPROVED PRESCRIPTION ANTI-EMETIC, FOR USE AS A COMPLETE THERAPEUTIC SUBSTITUTE FOR AN IV ANTI-EMETIC AT THE TIME OF CHEMOTHERAPY TREATMENT, statewide

Q0496

BATTERY, OTHER THAN LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY statewide

Q0498 HOLSTER FOR USE statewide

Q0499

BELT/VEST/BAG FOR USE TO CARRY EXTERNAL PERIPHERALCOMPONENTS OF ANY TYPE VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY statewide

Q0501

SHOWER COVER FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY statewide

Q0508 Miscellaneous supply or accessory for use with an implanted ventricular assist device (VAD) statewide

Q2009 INJECTION, FOSPHENYTOIN, 50 MG PHENYTOIN EQUIVALENT statewide

Q2026 Injection, Radiesse, 0.1 ml statewide

Q2035

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FORINTRAMUSCULAR USE (AFLURIA) cohort cohort cohort

Q2036

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FORINTRAMUSCULAR USE (Flulaval) statewide

Q2037

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND OLDER, FORINTRAMUSCULAR USE (FLUVIRIN) statewide

Q2038

INFLUENZA VIRUS VACCINE, SPLIT VIRUS, WHEN ADMINISTERED TO INDIVIDUALS 3 YEARS OF AGE AND ODER, FOR INTRAMUSCULAR USE (FLUZONE) statewide

Q2043

Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion statewide

Q2050 Injection, doxorubicin Hydrochloride, Liposomal, not otherwise specified, 10 mg statewide

Q2051 Injection, Zoledronic Acid, not otherwise specified, 1 mg cohort cohort

Q3001 RADIOELEMENTS FOR BRACHYTHERAPY, ANY TYPE, EACH statewide

Q3014 TELEHEALTH ORIGINATING SITE FACILITY FEE cohort cohort

Q4021 CAST SUPPLIES SHORT ARM SPLINT ADULT (11 YEARS+) PLASTER statewide

219

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

Q4041 CAST SUPPLIES LONG LEG SPLINT ADULT (11 YEARS+) PLASTER statewide

Q4042 CAST SUPPLIES LONG LEG SPLINT ADULT (11 YEARS+) FIBERGLASS statewide

Q4045 CAST SUPPLIES SHORT LEG SPLINT ADULT (11 YEARS+) PLASTER cohort cohort

Q4046 CAST SUPPLIES SHORT LEG SPLINT ADULT (11 YEARS+) FIBERGLASS statewide

Q4049 FINGER SPLINT STATIC statewide

Q4081 INJECTION, EPOETIN ALFA, 100 UNITS (FOR ESRD ON DIALYSIS) cohort cohort cohort

Q4100 SKIN SUBSTITUTE, NOT OTHERWISE SPECIFIED statewide

Q4101 APLIGRAF, PER SQUARE CENTIMETER cohort cohort cohort cohort

Q4102 OASIS WOUND MATRIX, PER SQUARE CENTIMETER statewide

Q4112 CYMETRA, INJECTABLE, 1CC statewide

Q4116 ALLODERM, PER SQUARE CENTIMETER cohort cohort cohort cohort cohort

Q4119 Matristem wound matrix, psmx, rs, or psm, per square centimeter cohort cohort

Q9954 ORAL MAGNETIC RESONANCE CONTRAST AGENT, PER ML cohort cohort

Q9957 INJECTION, PERFLUTREN LIPID MICROSPHERES, PER ML cohort cohort cohort

Q9958 HIGH OSMOLAR CONTRAST MATERIAL, UP TO 149 MG/ML IODINE CONCENTRATION PER ML cohort cohort

Q9959 HIGH OSMOLAR CONTRAST MATERIAL, 150-199 MG/ML IODINE CONCENTRATION PER ML statewide



Q9963 HIGH OSMOLAR CONTRAST MATERIAL, 350-399 MG/ML IODINE CONCENTRATION PER ML cohort cohort

Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml cohort cohort cohort

Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml cohort cohort

Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml cohort cohort cohort cohort

Q9968 INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG cohort cohort cohort

S0020 INJECTION, BUPIVICAINE HYDROCHLORIDE, 30 ML cohort cohort cohort cohort

S0028 INJECTION FAMOTIDINE 20 MG. cohort cohort cohort cohort

S0030 INJECTION METRONIDAZOLE, 500MG statewide

S0073 INJECTION, AZTREONAM, 500 MG statewide

S0077 INJECTON CLINDAMYCIN PHOSPHATE 300MG. cohort cohort cohort

S0106 BUPROPION HCI SUSTAINED RELEASE TABLET 150 MG PER BOTTLE OF 60 TABLETS cohort cohort

S0109 METHADONE, ORAL, 5MG cohort cohort

S0119 ONDANSETRON, ORAL, 4 MG (FOR CIRCUMSTANCES FALLINGUNDER THE MEDICARE STATUTE, USE HCPCS Q CODE) cohort cohort

S0138 FINASTERIDE, 5 MG. statewide

S0164 INJECTION, PANTOPRAZOLE SODIUM, 40 MG cohort cohort cohort

S0179 MEGESTROL ACETATE ORAL 20 MG. statewide

S0183

PROCHLORPERAZINE MALEATE ORAL 5MG. (FOR CIRCUM- STANCES FALLING UNDER THE MEDICARE STATUTE USE Q0164-Q0165 statewide

S0187 TAMOXIFEN CITRATE ORAL 10MG. cohort cohort

S0191 MISOPROSTOL, ORAL 200 MCG. statewide

S0390

ROUTINE FOOT CARE; REMOVAL AND/OR TRIMMING OF CORNS, CALLUSES AND/OR NAILS AND PREVENTATIVE MAINTENANCE PER VISIT statewide

S1015 IV TUBING EXTENSION SET statewide

220

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

S1040 CRANIAL REMOLDING ORTHOSIS, PEDIATRIC, RIGID, WITHSOFT INTERFACE MATERIAL, statewide

S1090 Mometasone Furoae sinus implant, 370 micrograms cohort cohort

S2070

CYSTOURETHROSCOPY, WITH URETEROSCOPY AND/OR PYELOSCOPY; WITH ENDOSCOPIC LASER TREATMENT OF URETERAL CALCULI ( INCLUDES URETEREAL CATHERIZATION) cohort cohort cohort cohort

S2083 ADJUSTMENT OF GASTRIC BAND DIAMETER VIA SUBCUT- ANEOUS PORT BY INJECTION OR ASPIRATION OF SALINE cohort cohort cohort cohort

S2117 ARTHROEREISIS, SUBTALAR statewide

S2140 CORD BLOOD HARVESTING FOR TRANSPLANTATION ALLOGENIC statewide

S2325 HIP CORE DECOMPRESSION statewide

S2900

SURGICAL TECHNIQUES REQUIRING USE OF ROBOTICS SURGICAL SYSTEM (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) cohort cohort cohort cohort

S4991 NICOTINE PATCHES, NON-LEGEND cohort cohort

S5010 5% DEXTROSE AND 0.45% NORMAL SALINE 1000ML. statewide

S5011 5% DEXTROSE IN LACTATED RINGER'S 1000 ML. cohort cohort cohort

S8096 PORTABLE PEAK FLOW METER cohort cohort

S8101 HOLDING CHAMBER OR SPACER FOR USE WITH AN INHALER OR NEBULIZER; WITH MASK statewide

S9443 LACTATION CLASSES, NON-PHYSICIAN PROVIDER PER SESSION cohort cohort

S9470 NUTRITIONAL COUNSELING, DIETITIAN VISIT statewide

S9480 INTENSIVE OUTPATIENT PSYCHIATRIC SERVICES, PER DIEM cohort cohort

T001 INPATIENT MEDICAL statewide

T5001 POSITIONING SEAT FOR PERSONS WITH SPECIAL ORTHOPEDIC NEEDS statewide

T5999 SUPPLY, NOT OTHERWISE SPECIFIED statewide

V2627 SCLERAL COVER SHELL statewide

V2630 ANTERIOR CHAMBER INTRAOCULAR LENS cohort cohort

V2632 POSTERIOR CHAMBER INTRAOCULAR LENS cohort cohort cohort cohort cohort

V2785 PROCESSING, PRESERVING AND TRANSPORTING CORNEAL TISSUE cohort cohort cohort cohort cohort

V2787 Astigmatism correcting function of intraocular lens cohort cohort cohort cohort cohort

V2788 PRESBYOPIA CORRECTING FUNCTION OF INTRAOCULAR LENS cohort cohort cohort cohort cohort cohort

V2790 AMNIOTIC MEMBRANE FOR SURGICAL RECONSTRUCTION PER PROCEDURE cohort cohort cohort cohort cohort

V2797 VISION SUPPLY, ACCESSORY AND/OR SERVICE COMPONENT OF ANOTHER HCPCS VISION CODE statewide

V5011 FITTING/ORIENTATION/CHECKING OF HEARING AID statewide

V5014 REPAIR/MODIFICATION OF A HEARING AID statewide

V5020 CONFORMITY EVALUATION statewide

V5050 HEARING AID, MONAURAL, IN THE EAR statewide

V5090 DISPENSING FEE, UNSPECIFIED HEARING AID cohort cohort

V5110 DISPENSING FEE, BILATERAL cohort cohort

V5130 BINAURAL, IN THE EAR statewide

V5160 DISPENSING FEE, BINAURAL statewide

V5241 DISPENSING FEE MONAURAL HEARING AID ANY TYPE cohort cohort

V5256 HEARING AID DIGITAL MONAURAL ITE statewide

V5257 HEARING AID DIGITAL MONAURAL BTE cohort cohort

V5261 HEARING AID DIGITAL BINAURAL BTE cohort cohort

V5264 EAR MOLD/INSERT NOT DISPOSABLE ANY TYPE cohort cohort

V5266 BATTERY FOR USE IN HEARING DEVICE cohort cohort

V5267 Hearing aid supplies / accessories cohort cohort

V5274 ASSISTANT LEARNING DEVICE NOT OTHERWISE SPECIFIED cohort cohort

V5275 EAR IMPRESSION EACH statewide

221

CPT Description

Peer Cohort 1

Peer Cohort 2

Peer Cohort 3

Peer Cohort 4

Peer Cohort 5

Peer Cohort 6

V5290 Assistive listening device, transmitter microphone, any type statewide

V5299 HEARING SERVICE, MISCELLANEOUS cohort cohort

2015 facility scoring methodology for blue select · 2017. 6. 21. · 2015 facility scoring...

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