sim orderable cpt cpt cpt cpt cpt remarks 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen...

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SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 ABDOMEN 1 V 74018 572 ABDOMEN COMPLETE 2 V 74019 812 ABDOMEN COMPLETE W/ 1 V CHEST 74022 2459 ABSCESS DRAIN PERITONEAL/RETROP 49406 2458 ABSCESS DRAINAGE ORGAN 49405 2460 ABSCESS DRAINAGE SOFT TISSUE 10030 1213 ABSCESSOGRAM THRU EXISTING CATHETER 76080 49424 2544 ABSCESSOGRAM W/SCLEROSING AGNT 49185 36 AC JOINTS BILAT 73050 8528 ALIGNMENT STUDY/BONE LENGTH 7355150 182 ANGIO CEREBRAL CAROTID BIL COMP 36223 253 ANGIO CEREBRAL CAROTID LT COMP 36223 254 ANGIO CEREBRAL CAROTID RT COMP 36223 181 ANGIO CERVICAL CAROTID BIL COMP 36222 219 ANGIO CERVICAL CAROTID LT COMP 36222 220 ANGIO CERVICAL CAROTID RT COMP 36222 7143 ANGIO FLUOROSCOPY none 2196 ANGIO SELECTED COMP 36226 2545 ANGIO US GUIDED BIOPSY 76942 184 ANGIO VERT NON-SELECTED COMP 36225 236 ANGIOGRAM ARCH COMPLETE 36221 189 ANGIOGRAM EXTERNAL CAROTID BILAT ADDL 36227 194 ANGIOGRAM EXTERNAL CAROTID LT ADDL 36227 196 ANGIOGRAM EXTERNAL CAROTID RT ADDL 36227 694 ANGIOGRAM EXTREMITY BILAT 75716 276 ANGIOGRAM EXTREMITY UNI LT 75710 278 ANGIOGRAM EXTREMITY UNI RT 75710 203 ANGIOGRAM INTERNAL CAROTID LT COMP 36224 213 ANGIOGRAM INTERNAL CAROTID RT COMP 36224 207 ANGIOGRAM PELVIC SELECTIVE 75736 211 ANGIOGRAM PULMONARY BILAT 75743 214 ANGIOGRAM PULMONARY NON SELECTIVE CATH 75746 6207 ANGIOGRAM PULMONARY UNI LT 75741 6272 ANGIOGRAM PULMONARY UNI RT 75741 159 ANGIOGRAM SPINAL SELECTIVE 75705 570 ANGIOGRAM THRU EXIST CATHETER F/U STUDY 75898 261 ANGIOGRAM VISCERAL SELECTIVE 75726 5333 ANKLE 2 V LT 73600 5334 ANKLE 2 V RT 73600 5339 ANKLE COMPLETE MIN 3 V LT 73610 5340 ANKLE COMPLETE MIN 3 V RT 73610 8543 ANKLES MIN 3 V EA BILAT 7361050 239 AORTOGRAM ABD + BIL ILIOFEMORAL EXTREM 75630 20 AORTOGRAM ABDOMINAL 75625 21 AORTOGRAM THORACIC 75605 872 ARTERIAL CATH/CANNULATION FOR MONITORING 36620 2631 ARTERIAL PTA 37246 2632 ARTERIAL PTA ADDITIONAL SITE 37247 2450 ARTERIAL STENT ABOVE ILIACS 37236 5131 ARTHROGRAM ELBOW LT 24220 73085 5133 ARTHROGRAM ELBOW RT 24220 73085 5288 ARTHROGRAM HIP LT 27093 73525 5290 ARTHROGRAM HIP RT 27093 73525 5323 ARTHROGRAM KNEE LT 27369 73580 5325 ARTHROGRAM KNEE RT 27369 73580 5107 ARTHROGRAM SHOULDER LT 23350 73040 5109 ARTHROGRAM SHOULDER RT 23350 73040 5159 ARTHROGRAM WRIST LT 25246 73115 5161 ARTHROGRAM WRIST RT 25246 73115 2628 AV CENTRAL DIALYSIS + PTA 36907 2629 AV CENTRAL DIALYSIS + STENT/PTA 36908 2627 AV DIALYSIS + DECLOT/PTA/STENT 36906

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Page 1: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS

63 ABDOMEN 1 V 74018

572 ABDOMEN COMPLETE 2 V 74019

812 ABDOMEN COMPLETE W/ 1 V CHEST 74022

2459 ABSCESS DRAIN PERITONEAL/RETROP 49406

2458 ABSCESS DRAINAGE ORGAN 49405

2460 ABSCESS DRAINAGE SOFT TISSUE 10030

1213 ABSCESSOGRAM THRU EXISTING CATHETER 76080 49424

2544 ABSCESSOGRAM W/SCLEROSING AGNT 49185

36 AC JOINTS BILAT 73050

8528 ALIGNMENT STUDY/BONE LENGTH 7355150

182 ANGIO CEREBRAL CAROTID BIL COMP 36223

253 ANGIO CEREBRAL CAROTID LT COMP 36223

254 ANGIO CEREBRAL CAROTID RT COMP 36223

181 ANGIO CERVICAL CAROTID BIL COMP 36222

219 ANGIO CERVICAL CAROTID LT COMP 36222

220 ANGIO CERVICAL CAROTID RT COMP 36222

7143 ANGIO FLUOROSCOPY none

2196 ANGIO SELECTED COMP 36226

2545 ANGIO US GUIDED BIOPSY 76942

184 ANGIO VERT NON-SELECTED COMP 36225

236 ANGIOGRAM ARCH COMPLETE 36221

189 ANGIOGRAM EXTERNAL CAROTID BILAT ADDL 36227

194 ANGIOGRAM EXTERNAL CAROTID LT ADDL 36227

196 ANGIOGRAM EXTERNAL CAROTID RT ADDL 36227

694 ANGIOGRAM EXTREMITY BILAT 75716

276 ANGIOGRAM EXTREMITY UNI LT 75710

278 ANGIOGRAM EXTREMITY UNI RT 75710

203 ANGIOGRAM INTERNAL CAROTID LT COMP 36224

213 ANGIOGRAM INTERNAL CAROTID RT COMP 36224

207 ANGIOGRAM PELVIC SELECTIVE 75736

211 ANGIOGRAM PULMONARY BILAT 75743

214 ANGIOGRAM PULMONARY NON SELECTIVE CATH 75746

6207 ANGIOGRAM PULMONARY UNI LT 75741

6272 ANGIOGRAM PULMONARY UNI RT 75741

159 ANGIOGRAM SPINAL SELECTIVE 75705

570 ANGIOGRAM THRU EXIST CATHETER F/U STUDY 75898

261 ANGIOGRAM VISCERAL SELECTIVE 75726

5333 ANKLE 2 V LT 73600

5334 ANKLE 2 V RT 73600

5339 ANKLE COMPLETE MIN 3 V LT 73610

5340 ANKLE COMPLETE MIN 3 V RT 73610

8543 ANKLES MIN 3 V EA BILAT 7361050

239 AORTOGRAM ABD + BIL ILIOFEMORAL EXTREM 75630

20 AORTOGRAM ABDOMINAL 75625

21 AORTOGRAM THORACIC 75605

872 ARTERIAL CATH/CANNULATION FOR MONITORING 36620

2631 ARTERIAL PTA 37246

2632 ARTERIAL PTA ADDITIONAL SITE 37247

2450 ARTERIAL STENT ABOVE ILIACS 37236

5131 ARTHROGRAM ELBOW LT 24220 73085

5133 ARTHROGRAM ELBOW RT 24220 73085

5288 ARTHROGRAM HIP LT 27093 73525

5290 ARTHROGRAM HIP RT 27093 73525

5323 ARTHROGRAM KNEE LT 27369 73580

5325 ARTHROGRAM KNEE RT 27369 73580

5107 ARTHROGRAM SHOULDER LT 23350 73040

5109 ARTHROGRAM SHOULDER RT 23350 73040

5159 ARTHROGRAM WRIST LT 25246 73115

5161 ARTHROGRAM WRIST RT 25246 73115

2628 AV CENTRAL DIALYSIS + PTA 36907

2629 AV CENTRAL DIALYSIS + STENT/PTA 36908

2627 AV DIALYSIS + DECLOT/PTA/STENT 36906

Page 2: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

2630 AV DIALYSIS EMBOLIZATION 36909

2625 AV DIALYSIS PLUS DECLOT 36904

2626 AV DIALYSIS PLUS DECLOT/PTA 36905

2623 AV DIALYSIS PLUS PTA 36902

2624 AV DIALYSIS PLUS PTA/STENT 36903

2622 AV DIALYSIS SHUNT 36901

74 BARIUM ENEMA ADULT 74270

417 BARIUM ENEMA PEDS 0-6 YRS 74270

435 BARIUM ENEMA PEDS 6-16 YRS 74270

139 BARIUM ENEMA W/ AIR COLON 74280

2382 BD NO CHARGE none Provider office would not order

2522 BILI STNT PLC S/P PTC W EXT TUBE 47538

2524 BILI STNT PLCMNT NEW PTC W EX TUB 47540

2527 BILIARY BRUSH BIOPSY ADDL 47543

1577 BILIARY ENDOSCOPY W/ DILATION + STENT 47556

2523 BILIARY STENT PLCMNT NEW PTC 47539

2518 BILIARY STONE REMOVAL ADDL 47544

6 BONE AGE STUDY 77072

887 BONE DENSITY AXIAL SKELETON 77080

2305 BONE DENSITY AXIAL W/VERTEBRAL FX ASSESS 77085

7909 BONE DENSITY PERIPHERAL SKELETON 77081

2112 BONE DENSITY VERTEBRAL FX ASSESS 77086P

891 BONE LENGTH STUDY 77073

226 BONE SURVEY METABOLIC 77075

413 BONE SURVEY METASTATIC 77075

149 CHAIN CYSTOURTHROGRAM 51605 74430

2536 CHANGE NEPHROSTOMY TUBE LT COMP 50435

2537 CHANGE NEPHROSTOMY TUBE RT COMP 50435

2520 CHANGE OF INT/EXT BILIARY TUBE 47536

2902 CHANGE URETEROSTOMY STENT/ILEAL CONDUIT 50688 75984

8510 CHEMOEMBOLIZATION 96549

6231 CHEMOTHERAPY ADMIN INTRA-ARTERIAL 96420

80 CHEST 1 V 71045

7703 CHEST 1 V W/ABDOMEN (INFANT ONLY) 71045

82 CHEST 2 V 71046

440 CHEST 2 V W/ABDOMEN (INFANT ONLY) 71046

3125 CHEST 3 V 71047

83 CHEST 4 V 71048

6204 CHEST DECUBITUS LT 71045

6269 CHEST DECUBITUS RT 71045

736 CHEST TUBE INSERTION W/O FLUORO 32556

2521 CHOLANGI POST BILIARY STNT PLCMNT 47537

142 CHOLANGIOGRAM INTRAOPERATIVE 74300

2514 CHOLANGIOGRAPHY INTRAOPERATIVE 47531

5085 CLAVICLE COMPLETE LT 73000

5086 CLAVICLE COMPLETE RT 73000

859 COLON STUDY W/ GASTROGRAFIN 74270

6430 CONTRAST INJECTION FOR FEEDING TUBE 49465

2519 CONV EXT BILIARY TUBE TO INT EXT 47535

6432 CONVERSION G TUBE TO GJ TUBE 49446

7838 CR FOREIGN IMAGES none Provider office would not order

3060 CT ABD + PELVIS W/IV CONT (NO ORAL) 74177

3063 CT ABD + PELVIS W/O CONT (NO ORAL-NO IV) 74176

3064 CT ABD + PELVIS W/O IV CONT (ORAL ONLY) 74176

3061 CT ABDOMEN + PELVIS W/CONTRAST (ORAL+IV) 74177

3470 CT ABDOMEN W/ + W/O ADRENAL PROTOCOL 74170

2275 CT ABDOMEN W/ + W/O CONT (NO ORAL CONT) 74170

3471 CT ABDOMEN W/ + W/O LIVER TRIPLE PHASE 74170

3054 CT ABDOMEN W/ + W/O CONTRAST (ORAL + IV) 74170

2304 CT ABDOMEN W/ CONTRAST PANCREAS PROTOCOL 74160

3050 CT ABDOMEN W/ CONTRAST (ORAL + IV) 74160

3472 CT ABDOMEN W/CON LIVER DUAL PHASE 74160

3051 CT ABDOMEN W/IV CONTRAST (NO ORAL CONT) 74160

Page 3: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

3052 CT ABDOMEN W/O CONTRAST (NO ORAL-NO IV) 74150

3053 CT ABDOMEN W/O IV CONTRAST (ORAL ONLY) 74150

3469 CT ABDOMEN W+W/O RENAL PROTOCOL 74170

819 CT ABSCESS DRAINAGE 75989

2298 CT ABSCESS DRAINAGE (US) 76942 Provider office would not order

2132 CT ADDITIONAL VIEWS NONE Provider office would not order

2402 CT BIOPSY/US GUIDED 76942 Provider office would not order

2366 CT BONE CRYOABLATION 20983

7608 CT CALCIUM SCORING 75571

136 CT CERVICAL SPINE W/ CONTRAST 72126

135 CT CERVICAL SPINE W/O CONTRAST 72125

3065 CT CHEST + ABD W/O CONT (NO ORAL-NO IV) 71250 74150

3069 CT CHEST + ABDOMEN W/ CONT (ORAL + IV) 71260 74160

3071 CT CHEST + ABDOMEN W/ IV CONT (NO ORAL) 71260 74160

3067 CT CHEST + ABDOMEN W/O IV (ORAL ONLY) 71250 74150

3077 CT CHEST ABD PELVIS W/IV CONT (NO ORAL) 74177 71260

3073 CT CHEST ABD PELVIS W/O (NO ORAL-NO IV) 71250 74176

3075 CT CHEST ABD PELVIS W/O IV (ORAL ONLY) 71250 74176

3079 CT CHEST ABDOMEN PELVIS W/CONT (ORAL+IV) 74177 71260

2939 CT CHEST PE PROTOCOL 71260

123 CT CHEST W/ + W/O CONTRAST 71270

122 CT CHEST W/ CONTRAST 71260

121 CT CHEST W/O CONTRAST 71250

398 CT CYST ASP 77012

3473 CT ENTEROGRAPHY 74177

7240 CT FACIAL BONES W/ + W/O CONTRAST 70488

562 CT FACIAL BONES W/ CONTRAST 70487

129 CT FACIAL BONES W/O CONTRAST 70486

7839 CT FOREIGN IMAGES none Provider office would not order

399 CT GUIDANCE BIOPSY/NEEDLE PLACEMENT 77012 Also include biopy CPT

3479 CT GUIDANCE CRYO ABLATION LIVER 47382 77013

3476 CT GUIDANCE CRYO ABLATION LUNG 32994

6241 CT GUIDANCE CRYO ABLATION RENAL 50593

6482 CT GUIDANCE FOR RF BONE ABLATION 20982

3477 CT GUIDANCE MICROWAVE ABLATION BONE 20982

3481 CT GUIDANCE MICROWAVE ABLATION LIVER 47382 77013

3478 CT GUIDANCE MICROWAVE ABLATION LUNG 32998

3483 CT GUIDANCE MICROWAVE ABLATION RENAL 50592 77013

6205 CT GUIDANCE THORACENTESIS 32555

7907 CT GUIDED CHEST TUBE PLACEMENT 32551

4215 CT GUIDED FINE NEEDLE ASPIRATION 10009

4216 CT GUIDED FINE NEEDLE ASPIRATION (US) 10005 Provider office would not order

71 CT HEAD W/ + W/O CONTRAST 70470

70 CT HEAD W/ CONTRAST 70460

69 CT HEAD W/O CONTRAST 70450

2949 CT HEMATURIA PROTOCOL 74178

5190 CT LOWER EXTREM W/ CONTRAST LT 73701

5191 CT LOWER EXTREM W/ CONTRAST RT 73701

5186 CT LOWER EXTREM W/O CONTRAST LT 73700

5187 CT LOWER EXTREM W/O CONTRAST RT 73700

119 CT LUMBAR SPINE W/ CONTRAST 72132

118 CT LUMBAR SPINE W/O CONTRAST 72131

7695 CT LUNG CANCER SCREENING ANNUAL EXAM G0297

2562 CT LUNG CANCER SCREENING INTERVAL F/U 71250

854 CT LUNGS HIGH RESOLUTION 71250

134 CT NECK SOFT TISSUE W/ + W/O CONTRAST 70492

133 CT NECK SOFT TISSUE W/ CONTRAST 70491

132 CT NECK SOFT TISSUE W/O CONTRAST 70490

2385 CT NO CHARGE none Provider office would not order

1742 CT ORBITS W/ + W/O CONTRAST 70482

110 CT ORBITS w/ CONTRAST 70481

73 CT ORBITS W/O CONTRAST 70480

7649 CT OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

Page 4: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

3057 CT PELVIS W/ CONTRAST (ORAL + IV) 72193

3058 CT PELVIS W/IV CONTRAST (NO ORAL CONT) 72193

3055 CT PELVIS W/O CONTRAST (NO ORAL-NO IV) 72192

3056 CT PELVIS W/O IV CONTRAST (ORAL ONLY) 72192

5060 CT PELVIS/KIDNEY STONE W/O CONTRAST 74176

395 CT PITUITARY W/ CONTRAST 70481

401 CT PITUITARY W/O CONTRAST 70480

4873 CT ROTATION STUDY 73700RT 73700LT

407 CT SCANOGRAM 77073

1581 CT SINUSES W/ CONTRAST 70487

561 CT SINUSES W/O CONTRAST 70486

2349 CT STATISTICAL CHARGE ONLY none

2434 CT STEALTH HEAD W/CONTRAST 70460

3474 CT STEALTH HEAD W/O CONTRAST 70450

403 CT TEMPORAL BONES W/ CONTRAST 70481

396 CT TEMPORAL BONES W/O CONTRAST 70480

137 CT THORACIC SPINE W/ CONTRAST 72129

138 CT THORACIC SPINE W/O CONTRAST 72128

5274 CT UPPER EXTREM W/ CONTRAST LT 73201

5275 CT UPPER EXTREM W/ CONTRAST RT 73201

5270 CT UPPER EXTREM W/O CONTRAST LT 73200

5271 CT UPPER EXTREM W/O CONTRAST RT 73200

2549 CT VENOGRAM/HEAD W/ CONTRAST 70460

2550 CT VENOGRAM/HEAD W/ + W/O CONTRAST 70470

5394 CTA ABD AORTA/RUNOFF 75635

2406 CTA ABDOMEN + PELVIS W/ IMAGE POST PROC 74174

5393 CTA ABDOMEN W/ IMAGE POST PROCESSING 74175

3046 CTA CARDIAC PULMONARY VEIN MAPPING 75572

2438 CTA CARDIAC TAVI W/ CONTRAST 75572

2439 CTA CARDIAC TAVI W/O CONTRAST 7557252

2429 CTA CHEST ABD PELV TAVI W/CON 71275 74174

2431 CTA CHEST ABD PELV TAVI W/O CONTRAST 71275 74174 A9510

2401 CTA CHEST THORACIC AORTA 71275

2200 CTA CHEST/ABD DISSECTION PROTOCOL 71275 74175

8452 CTA CORONARY ARTERIES 75574

7617 CTA CORONARY ARTERIES W/ CALCIUM SCORING 75574

5385 CTA HEAD W/ IMAGE POST PROCESSING 70496

2484 CTA LOWER EXT BIL W/IMAGE POST 7370650

2437 CTA MESENTERIC 74174

5386 CTA NECK W/ IMAGE POST PROCESSING 70498

5388 CTA PELVIS W/ IMAGE POST PROCESSING 72191

5389 CTA UPPER EXTREM RT W/IMAGE POST PROCESS 73206

5390 CTA UPPER EXTREM LT W/IMAGE POST PROCESS 73206

6333 CV CATH CNTEL INS NON TUNN W/O 36556

1502 CV CATH CNTRL INSERTION NON TUNNEL FLUO 36556 77001

1506 CV CATH CNTRL INSERTION TUNNELED FLUORO 36558 77001

1510 CV CATH CNTRL INSERTION TUNNELED W/PORT 36561 77001

4210 CV CATH PERIPH INSERT > 5 INC GUIDANCE 36573

4209 CV CATH PERIPH INSERT< 5 INC GUIDANCE 36572

4211 CV CATH PICC REPLACEMENT 36584

1534 CV CATH REMOVAL W/ PORT FLUORO 36590 77001

7891 CV CATH REMOVAL W/ PORT W/O FL 36590

1532 CV CATH REMOVAL W/O PORT FLUORO 36589 77001

7890 CV CATH REMOVAL W/O PORT W/O FL 36589

1520 CV CATH REPAIR W/O PORT FLUORO 36575 77001

1522 CV CATH REPAIR W/ PORT FLUORO 36576 77001

1528 CV CATH REPLACEMENT TUNNELED W/ PORT FL 36582 77001

1526 CV CATH REPLACEMENT TUNNELED W/O PORT FL 36581 77001

1524 CV CATH REPLACEMENT W/O PORT FLUORO 36580 77001

1536 CV CATH REPOSITION/PREVIOUSLY PLACED FL 36597 76000

161 CYSTOGRAM 51600 74430

7878 CYSTOSTOMY TUBE CHANGE 75984 51705

7089 CYSTOURETHROSCOPY INSER URETERAL STEN LT 52332

Page 5: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

7087 CYSTOURETHROSCOPY INSER URETERAL STEN RT 52322

2722 CYSTOURETHROSCOPY INSERT URETERAL WIRE 52334

6230 CYSTOURETHROSCOPY URETERAL BRUSH BX LT 52354

6295 CYSTOURETHROSCOPY URETERAL BRUSH BX RT 52354

7097 CYSTOURETHROSCOPY URETERAL STENT REM LT 52310

7095 CYSTOURETHROSCOPY URETERAL STENT REM RT 52310

1452 DECLOTTING IMPLANTED VASC DEVICE 36593

894 DEFECOGRAPHY 74270

2526 DILATATION OF BILIARY TREE ADDL 47542

2542 DILATATION OF URETER LT ADDL 50706

2543 DILATATION OF URETER RT ADDL 50706

4200 DILATION NEPHROSTOMY 74485

373 DILATION OF BILIARY TRACT 74360

7117 DILATION OF URETER LT 74485 50553

7115 DILATION OF URETER RT 74485 50553

564 DISCOGRAPHY LUMBAR EACH LEVEL 72295 62290

5121 ELBOW 2 V LT 73070

5122 ELBOW 2 V RT 73070

5127 ELBOW COMP MIN 3 V LT 73080

5128 ELBOW COMP MIN 3 V RT 73080

2455 EMBOLIZATION ARTERIAL 37242

2457 EMBOLIZATION HEMORRHAGE 37244

2456 EMBOLIZATION TUMOR/ORGAN 37243

2454 EMBOLIZATION VENOUS 37241

168 ERCP BILIARY + PANCREATIC DUCTAL SYS 74330

5487 ERCP BILIARY DUCTAL SYSTEM 74328

65 ESOPHAGRAM 74220

3126 ESOPHAGRAM W/ AIR CONTRAST 74246

2296 EVALUATION OF GASTRIC TUBE 49465

1217 EXCHANGE OF ABSCESS OR CYST DRAIN CATH 49423 75984

5063 FACIAL BONES < 3 V 70140

8442 FACIAL BONES COMPLETE MIN 3 V 70150

8738 FEM/POP ATHERECTOMY COMPLETE 37225

8737 FEM/POP PTA COMPLETE 37224

8739 FEM/POP STENT COMPLETE 37226

5298 FEMUR 2 V LT 73552

5299 FEMUR 2 V RT 73552

2004 FINGER MIN 2 V LT 73140

2011 FINGER MIN 2 V RT 73140

571 FISTULA OR SINUS TRACT STUDY W/INJECTION 20501 76080 J2805

2819 FIXED OR FLUORO none

7690 FLUOR GU NEEDLE PLACEMENT W/BONE BIOPSY 77002 20225

7900 FLUORO EVALUATION OF GASTRIC TUBE 49465

7740 FLUORO FOR INJECTION PAIN CLINIC 77003

7705 FLUORO GU TRIGGER POINT/NERVE BLOCK 77002

6384 FLUORO GUIDANCE FOR INJECTION 61070 77003

695 FLUORO GUIDANCE FOR NEEDLE PLACEMENT 77002

5345 FOOT 2 V LT 73620

5169 FOOT 2 V RT 73620

8531 FOOT COMPLETE MIN 3 V EA BILAT 7363050 NONE

5174 FOOT COMPLETE MIN 3 V LT 73630

5175 FOOT COMPLETE MIN 3 V RT 73630

5135 FOREARM 2 V LT 73090

5136 FOREARM 2 V LT 73090

584 FOREIGN BODY SCAN CHILD 76010

2184 GD ADDITIONAL VIEWS none Provider office would not order

2381 GD NO CHARGE none Provider office would not order

7626 GD OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

178 GUIDANCE FOR PERCUTANEOUS DRAINAGE 75989

7956 HAND 2 V EACH BIL 73120LT 73120RT

5164 HAND 2 V LT 73120

5165 HAND 2 V RT 73120

8533 HAND MIN 3 V BILAT 7313050

Page 6: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

5264 HAND MIN 3 V LT 73130

5265 HAND MIN 3 V RT 73130

5180 HEEL MIN 2 V LT 73650

5181 HEEL MIN 2 V RT 73650

5276 HIP 1 V UNI LT 73501

5277 HIP 1 V UNI RT 73501

2220 HIP 1V LT W/PELVIS 1 V 73501

2222 HIP 1V RT W/PELVIS 1 V 73501

5282 HIP COMPLETE MIN 2 V LT 73502

5283 HIP COMPLETE MIN 2 V RT 73502

51 HIPS MIN 2 V BILAT 73521

5115 HUMERUS MIN 2 V LT 73060

5116 HUMERUS MIN 2 V RT 73060

2564 HYDROCELE ASPIRATION 55000

163 HYSTEROSALPINGOGRAPHY 58340 74740

8746 ILIAC 2ND KISSING STENT COMPLETE 3722159

8735 ILIAC ADDL PTA ISPILATERAL COMPLETE 37222

8736 ILIAC ADDL STENT ISPLATERAL COMPLETE 37223

3083 ILIAC ANEURYSM ENDOGRAFT 34900 75954

8733 ILIAC PTA COMPLETE 37220

8734 ILIAC STENT COMPLETE 37221

7449 INJECTION OF CONTRAST PERITONEAL CAVITY 49400

7641 INJECTION W/ FLUORO EVAL CV DEVICE 36598

8423 INS INDWELL TUNNEL PERITONEAL CATH W/CUF 49418

1800 INSERT INDWELL TUNNEL PLEURAL CATH W/CUF 32550 75989

7904 INSERT PERCUTANEOUS DUODENOSTOMRY/J TUBE 49441

1799 INSERTION OF TIPS 37182

920 IR CLINIC CONSULTATION Multiple Based on time

2393 IR CLINIC FOLLOW UP Multiple Based on time

2415 IVC FILTER INSERT COMPLETE 37191

2416 IVC FILTER REMOVAL COMPLETE 37193

146 IVP 74400

3127 JOINT ASPIRATION LT 77002 Also need joint CPT

3128 JOINT ASPIRATION RT 77002 Also need joint CPT

3129 JOINT INJECTION LT 77002 Also need joint CPT

3130 JOINT INJECTION RT 77002 Also need joint CPT

5303 KNEE 1 - 2 V LT 73560

5304 KNEE 1 - 2 V RT 73560

5309 KNEE 3 V LT 73562

5310 KNEE 3 V RT 73562

5315 KNEE COMPLETE MIN 4 V LT 73564

5316 KNEE COMPLETE MIN 4 V RT 73564

8529 KNEES BILATERAL 2 V EACH 7356450

6227 KNEES BILATERAL 3 V EACH 73562LT 73562RT

8535 KNEES BILATERAL 4 V EACH 7356450 NONE

5321 KNEES STANDING AP ONLY BILAT 73565

2374 KYPHOPLASTY EA ADD THOR OR LUMB VERT 22515

2373 KYPHOPLASTY LUMBAR FIRST VERT 22514

2372 KYPHOPLASTY THORACIC FIRST VERT 22513

7701 LOOPOGRAM 50690 74425

2039 LUMBAR PUNCTURE DIAGNOSTIC 62270

7902 LUMBAR PUNCTURE THERAPEUTIC 62272

1781 LUMBAR PUNCTURE W/ CHEMO 96450

2971 MA BREAST SPECIMEN UNI LT FROM OR 76098 Provider office would not order

2972 MA BREAST SPECIMEN UNI RT FROM OR 76098 Provider office would not order

7921 MA DIAGNOSTIC CONSULTATION LETTER none Provider office would not order

2477 MA FFD DX FOLLOW PROCEDURE BIL 77066 Provider office would not order

2478 MA FFD DX FOLLOW PROCEDURE LT 77065 Provider office would not order

2479 MA FFD DX FOLLOW PROCEDURE RT 77065 Provider office would not order

8459 MA FFD MAMM DIAGNOSTIC BILAT 77066

2169 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN BIL 77066GG Provider office would not order

2170 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN LT 77065GG Provider office would not order

2171 MA FFD MAMM DIAGNOSTIC FOLLOW SCRN RT 77065GG Provider office would not order

Page 7: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

8469 MA FFD MAMM DIAGNOSTIC UNI LT 77065

8472 MA FFD MAMM DIAGNOSTIC UNI RT 77065

2593 MA FFD MAMM SCREEN BILATERAL 77067

2594 MA FFD MAMM SCREEN LT UNI 7706752

2595 MA FFD MAMM SCREEN RT UNI 7706752

7842 MA FOREIGN IMAGES none Provider office would not order

7218 MA GUIDED BREAST CYST ASPIRATION LT 19000 19000

7219 MA GUIDED BREAST CYST ASPIRATION RT 19000 19000

2975 MA GUIDED BREAST DUCTOGRAM W/MULT LT 77054 77054

2976 MA GUIDED BREAST DUCTOGRAM W/MULT RT 77054 77054

2977 MA GUIDED BREAST DUCTOGRAM W/SINGLE LT 19030 77053

2978 MA GUIDED BREAST DUCTOGRAM W/SINGLE RT 19030 77053

2979 MA GUIDED BREAST NEEDLE LOC WIRE LT 19281

2980 MA GUIDED BREAST NEEDLE LOC WIRE RT 19281

2983 MA GUIDED BREAST STEREOTACTIC LT 19081

2984 MA GUIDED BREAST STEREOTACTIC RT 19081

2587 MA MAMM 3D DIAGNOSTIC BIL 77066 G0279

2588 MA MAMM 3D DIAGNOSTIC LT 77065 G0279

2589 MA MAMM 3D DIAGNOSTIC RT 77065 G0279

2584 MA MAMM 3D SCREENING BIL 77067 77063

2585 MA MAMM 3D SCREENING LT 7706752 7706352

2586 MA MAMM 3D SCREENING RT 7706752 7706352

7609 MA MAMMOGRAM MISCELLANEOUS none Provider office would not order

2383 MA NO CHARGE none Provider office would not order

1248 MA OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

7560 MA PRETREATMENT REVIEW none Provider office would not order

2859 MA RADIOLOGY PATHOLOGY F/U REPORT none Provider office would not order

3 MANDIBLE COMPLETE MIN 4 V 70110

7748 MANIPULATION OF PERITONEAL DIALYSIS CATH 49999

6118 MISC INTERVENTIONAL RADIOLOGY EXAM none

7844 MR FOREIGN IMAGES none Provider office would not order

7648 MR OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

6357 MRA ABDOMEN W/ + W/O CONTRAST C8902

6355 MRA ABDOMEN W/ CONTRAST C8900

6356 MRA ABDOMEN W/O CONTRAST C8901

6351 MRA CHEST W/ + W/O CONTRAST C8911

6349 MRA CHEST W/ CONTRAST C8909

6350 MRA CHEST W/O CONTRAST C8910

5365 MRA HEAD W/ + W/O CONTRAST 70546

5363 MRA HEAD W/ CONTRAST 70545

5361 MRA HEAD W/O CONTRAST 70544

7928 MRA INCOMPLETE ABDOMEN C890152

7931 MRA INCOMPLETE CHEST C891052

7929 MRA INCOMPLETE HEAD 7054452

7933 MRA INCOMPLETE LOWER EXTREMITY C891352

7932 MRA INCOMPLETE NECK 7054752

7930 MRA INCOMPLETE PELVIS C892052

7934 MRA INCOMPLETE UPPER EXTREMITY C893552

1357 MRA LOWER EXTREM W/ + W/O CONTRAST LT C8914

1358 MRA LOWER EXTREM W/ + W/O CONTRAST RT C8914

2921 MRA LOWER EXTREM W/ OUTFLOW C891250

5371 MRA NECK W/ + W/O CONTRAST 70549

5369 MRA NECK W/ CONTRAST 70548

5367 MRA NECK W/O CONTRAST 70547

865 MRA PELVIS W/ + W/O CONTRAST C8920

1367 MRA RENAL W/ + W/O CONTRAST C8902

1366 MRA RENAL W/ CONTRAST C8900

1365 MRA RENAL W/O CONTRAST C8901

7553 MRA UPPER EXTREM W/ + W/O CONTRAST LT C8936

7554 MRA UPPER EXTREM W/ + W/O CONTRAST RT C8936

1360 MRA UPPER EXTREM W/ CONTRAST LT C8934

1363 MRA UPPER EXTREM W/ CONTRAST RT C8934

1359 MRA UPPER EXTREM W/O CONTRAST LT C8935

Page 8: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

1362 MRA UPPER EXTREM W/O CONTRAST RT C8935

4088 MRI ABDOMEN (MRCP) W/ + W/O CONTRAST 74183

4087 MRI ABDOMEN (MRCP) W/O CONTRAST 74181

5383 MRI ABDOMEN W/ + W/O CONTRAST 74183

5381 MRI ABDOMEN W/ CONTRAST 74182

527 MRI ABDOMEN W/O CONTRAST 74181

860 MRI ADDITION VIEWS none Provider office would not order

7574 MRI ANKLE W/ + W/O CONTRAST LT 73723

7575 MRI ANKLE W/ + W/O CONTRAST RT 73723

7572 MRI ANKLE W/ CONTRAST LT 73722

7573 MRI ANKLE W/ CONTRAST RT 73722

7576 MRI ANKLE W/O CONTRAST LT 73721

7577 MRI ANKLE W/O CONTRAST RT 73721

6160 MRI BONE MARROW BLOOD STUDY 77084

2498 MRI BRACHIAL PLEXUS W + W/O CONTRAST 73220

667 MRI BRAIN W/ + W/O CONTRAST 70553

546 MRI BRAIN W/ CONTRAST 70552

519 MRI BRAIN W/O CONTRAST 70551

2556 MRI BRAIN W/O VENTRICLES MEASUREMENT 7055152

6348 MRI BREAST W/ & W/O CONT BIL 77049

6342 MRI BREAST W/ & W/O CONT LT 77048

6345 MRI BREAST W/ & W/O CONTR RT 77048

6347 MRI BREAST W/O CONTRAST BILAT 77047

6341 MRI BREAST W/O CONTRAST LT 77046

6344 MRI BREAST W/O CONTRAST RT 77046

668 MRI CERVICAL SPINE W/ + W/O CONTRAST 72156

545 MRI CERVICAL SPINE W/ CONTRAST 72142

521 MRI CERVICAL SPINE W/O CONTRAST 72141

5360 MRI CHEST W/ + W/O CONTRAST 71552

5358 MRI CHEST W/ CONTRAST 71551

520 MRI CHEST W/O CONTRAST 71550

7584 MRI ELBOW W/ CONTRAST LT 73222

7585 MRI ELBOW W/ CONTRAST RT 73222

7586 MRI ELBOW W/+W/O CONTRAST LT 73223

7587 MRI ELBOW W/+W/O CONTRAST RT 73223

7588 MRI ELBOW W/O CONTRAST LT 73221

7590 MRI ELBOW W/O CONTRAST RT 73221

2388 MRI ENTEROGRAPHY ABD/PEL W/O W/GLUCAGON 74181 72195 A9954

2387 MRI ENTEROGRAPHY ABD/PEL W+WO W/GLUCAGON 74183 72197 J1610 A9954

5413 MRI FACE W/ & W/O CONTRAST 70543

5410 MRI FACE W/ CONTRAST 70542

535 MRI FACE W/O CONTRAST 70540

2503 MRI FOOT W + W/O CONTRAST LT 73720

2504 MRI FOOT W + W/O CONTRAST RT 73720

2501 MRI FOOT W/ CONTRAST LT 73719

2502 MRI FOOT W/ CONTRAST RT 73719

2499 MRI FOOT W/O CONTRAST LT 73718

2500 MRI FOOT W/O CONTRAST RT 73718

2442 MRI GUIDED BREAST BIOPSY LT 19085

2443 MRI GUIDED BREAST BIOPSY RT 19085

2441 MRI GUIDED BREAST NEEDLE LOC LT 19287

2440 MRI GUIDED BREAST NEEDLE LOC RT 19287

2496 MRI HAND W + W/O CONTRAST LT 73220

2497 MRI HAND W + W/O CONTRAST RT 73220

2494 MRI HAND W/ CONTRAST LT 73219

2495 MRI HAND W/ CONTRAST RT 73219

2492 MRI HAND W/O CONTRAST LT 73218

2493 MRI HAND W/O CONTRAST RT 73218

6166 MRI HEART FOR VELOCITY FLOW MAPPING 75565

6415 MRI HEART W/ + W/O CONTRAST 75561

6163 MRI HEART W/ CONTRAST 7556152

528 MRI HEART W/O CONTRAST 75557

7568 MRI HIP W/ + W/O CONTRAST LT 73723

Page 9: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

7569 MRI HIP W/ + W/O CONTRAST RT 73723

7564 MRI HIP W/ CONTRAST LT 73722

7567 MRI HIP W/ CONTRAST RT 73722

7570 MRI HIP W/O CONTRAST LT 73721

7571 MRI HIP W/O CONTRAST RT 73721

8537 MRI HIPS BIL W/ + W/O CONTRAST 7372350

8539 MRI HIPS BILATERAL W/ CONTRAST 7372250

8541 MRI HIPS BILATERAL W/O CONTRAST 7372150

7862 MRI INCOMPLETE ABDOMEN 7418152 Provider office would not order

7863 MRI INCOMPLETE BRAIN 7055152 Provider office would not order

7875 MRI INCOMPLETE BREAST C890452 Provider office would not order

7864 MRI INCOMPLETE CERVICAL SPINE 7214152 Provider office would not order

7865 MRI INCOMPLETE CHEST 7155052 Provider office would not order

7870 MRI INCOMPLETE FACE NECK ORBIT 7054052 Provider office would not order

7866 MRI INCOMPLETE JOINT LOWER EXTREM 7372152 Provider office would not order

7867 MRI INCOMPLETE JOINT UPPER EXTREM 7322152 Provider office would not order

7868 MRI INCOMPLETE LOWER EXTREMITY 7371852 Provider office would not order

7869 MRI INCOMPLETE LUMBAR SPINE 7214852 Provider office would not order

7871 MRI INCOMPLETE PELVIS 7219552 Provider office would not order

7872 MRI INCOMPLETE THORACIC SPINE 7214652 Provider office would not order

7873 MRI INCOMPLETE TMJ 7033652 Provider office would not order

7874 MRI INCOMPLETE UPPER EXTREMITY 7321852 Provider office would not order

2160 MRI KNEE W/ + W/O CONTRAST LT 73723

2161 MRI KNEE W/ + W/O CONTRAST RT 73723

2158 MRI KNEE W/ CONTRAST LT 73722

2159 MRI KNEE W/ CONTRAST RT 73722

2164 MRI KNEE W/O CONTR LT 73721

7563 MRI KNEE W/O CONTRAST RT 73721

6217 MRI LOWER EXTREM W/ + W/O CONTRAST LT 73720

6282 MRI LOWER EXTREM W/ + W/O CONTRAST RT 73720

6253 MRI LOWER EXTREM W/ CONTRAST LT 73719

6318 MRI LOWER EXTREM W/ CONTRAST RT 73719

6251 MRI LOWER EXTREM W/O CONTRAST LT 73718

6316 MRI LOWER EXTREM W/O CONTRAST RT 73718

670 MRI LUMBAR SPINE W/ + W/O CONTRAST 72158

544 MRI LUMBAR SPINE W/ CONTRAST 72149

523 MRI LUMBAR SPINE W/O CONTRAST 72148

5412 MRI NECK W/ + W/O CONTRAST 70543

5409 MRI NECK W/ CONTRAST 70542

534 MRI NECK W/O CONTRAST 70540

861 MRI NO CHARGE none Provider office would not order

5411 MRI ORBITS W/ + W/O CONTRAST 70543

5408 MRI ORBITS W/ CONTRAST 70542

1368 MRI ORBITS W/O CONTRAST 70540

3487 MRI PELVIS - FIBROID PROTOCOL 72197

5398 MRI PELVIS W/ + W/O CONTRAST 72197

524 MRI PELVIS W/ CONTRAST 72196

5396 MRI PELVIS W/O CONTRAST 72195

2547 MRI PROSTATE W/ & W/O CONTRAST 72197

7578 MRI SHOULDER W/ CONTRAST LT 73222

7579 MRI SHOULDER W/ CONTRAST RT 73222

7580 MRI SHOULDER W/+W/O CONTRAST LT 73223

7581 MRI SHOULDER W/+W/O CONTRAST RT 73223

7583 MRI SHOULDER W/O CONRAST RT 73221

7582 MRI SHOULDER W/O CONTRAST LT 73221

2491 MRI STEALTH 70552

669 MRI THORACIC SPINE W/ + W/O CONTRAST 72157

543 MRI THORACIC SPINE W/ CONTRAST 72147

522 MRI THORACIC SPINE W/O CONTRAST 72146

585 MRI TMJ 70336

6216 MRI UPPER EXTREM W/ + W/O CONTRAST LT 73220

6281 MRI UPPER EXTREM W/ + W/O CONTRAST RT 73220

6261 MRI UPPER EXTREM W/ CONTRAST LT 73219

Page 10: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

6326 MRI UPPER EXTREM W/ CONTRAST RT 73219

6259 MRI UPPER EXTREM W/O CONTRAST LT 73218

6324 MRI UPPER EXTREM W/O CONTRAST RT 73218

7591 MRI WRIST W/ CONTRAST LT 73222

7592 MRI WRIST W/ CONTRAST RT 73222

7593 MRI WRIST W/+W/O CONTRAST LT 73223

7594 MRI WRIST W/+W/O CONTRAST RT 73223

7595 MRI WRIST W/O CONTRAST LT 73221

7596 MRI WRIST W/O CONTRAST RT 73221

2482 MRV HEAD W/ & W/O CONTRAST 70546

2481 MRV HEAD W/ CONTRAST 70545

2490 MRV HEAD W/O CONTRAST 70544

2505 MRV LOWER EXTREM W/O CONTR LT C8913

2506 MRV LOWER EXTREM W/O CONTR RT C8913

2507 MRV UPPER EXTREM W/O CONTR LT C8935

2508 MRV UPPER EXTREM W/O CONTR RT C8935

2319 MYELOGRAM CERVICAL SPINE 62302

2321 MYELOGRAM LUMBAR SPINE 62304

2322 MYELOGRAM SPINE TWO OR MORE REGIONS 62305

2320 MYELOGRAM THORACIC SPINE 62303

8443 NASAL BONES COMPLETE MIN 3 V 70160

78 NECK SOFT TISSUE 70360

2535 NEPH TUBE CONVER TO NEPHROURETE 50434

2530 NEPHROSTOGRAM LT THRU CATHETER 50431

2528 NEPHROSTOGRAM LT THRU NEEDLE 50430

2531 NEPHROSTOGRAM RT THRU CATHETER 50431

2529 NEPHROSTOGRAM RT THRU NEEDLE 50430

6434 NG TUBE PLACEMENT/REPOSITION 43752

2183 NM ADDITIONAL VIEWS none Provider office would not order

6386 NM BACLOFEN PUMP EVAL 75809 A9548

358 NM BONE SCAN THREE PHASE 78315 A9503

1478 NM BONE WHOLE BODY 78306 A9503

2198 NM BONE WHOLE BODY W SPECT/CT 78306 78320 A9503

834 NM BONE WHOLE BODY W/SPECT 78320 A9503

7715 NM BONE/JOINT IMAGING 78300 A9503

332 NM BOWEL IMAGING MECKELS 78290 A9512

1584 NM BRAIN SCAN W/ SPECT 78607 A9584

885 NM CARDIAC BLD POOL 1ST PASS 78472 A9560

906 NM CARDIAC BLD POOL MUGA/REST 78472 A9560

368 NM CEREBRAL VASCULAR FLOW 78610 A9539

1788 NM CEREBROSPINAL FLUID FLOW FOR PATENCY 78630 62322

1784 NM CISTERNOGRAM 78630 A9548 A9539

7843 NM FOREIGN IMAGES none Provider office would not order

334 NM GALLBLADDER IMAGING 78226 A9537

582 NM GALLBLADDER W/STIMULATION 78227 A9537 A9540

742 NM GASTRIC EMPTYING LIQUID 78264 A9572 A9540

743 NM GASTRIC EMPTYING LIQUID + SOLID 78264 A9572

367 NM GASTRIC EMPTYING SOLID 78264 A9541

874 NM GASTROESOPHAGEAL REFLUX STUDY 78262 A9541

566 NM GI BLEED TAGGED RBC 78278 A9560

2597 NM I 131 TOTAL BODY SCAN W/O TREATMENT 78018

2600 NM I-131 THERAPY 79005

7614 NM I-131 TOTAL BODY SCAN 78018

7711 NM I-131 TOTAL BODY SCAN FOLLOW UP 78018

5421 NM LAVEEN SHUNT PATENCY 49427 78291

338 NM LIVER + SPLEEN IMAGING 78215 A9541

337 NM LIVER IMAGING 78205 A9541

820 NM LIVER IMAGING W/ SPECT 78205 A9560

903 NM LIVER IMAGING W/ SPECT + VASC FLOW 78206 A9560

873 NM LYMPH GLAND IMAGING 78195 A9541

2551 NM MIBG SCAN 78804 A9516

2602 NM MYO MULTI SPECT PERF W /PHARMACOLOGIC 78452 A9500

1499 NM MYO MULTI SPECT W/ STRESS 78452 A9500

Page 11: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

2603 NM MYOC MLT SPECT THALLIUM STR/PHARMACOLOGIC 78452 A9500

7174 NM MYOC PERF PLANAR MULTI SESTAMIBI 78454 A9500

1749 NM MYOC PERF PLANAR SINGLE SESTAMIBI 78453 A9500

1747 NM MYOC PERF PLANAR SINGLE THALLIUM 78453 A9505

2646 NM MYOC PYP 78469 A9538

2601 NM MYOC SINGLE W/ SPECT SESTAMIBI REST 78451 A9500

7168 NM MYOC SINGLE W/ SPECT THALLIUM REST 78451 A9505 A9558

2386 NM NO CHARGE none Provider office would not order

869 NM OCTREOSCAN WH BODY W/SPECT SINGLE 78804 A9572

7853 NM OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

1480 NM PARATHYROID IMAGING 78070 A9500

2191 NM PARATHYROID PLANAR W/SPECT CT 78072 A9500 78999

2135 NM PET MYOCARDIAL VIABILITY 78459 A9552

2911 NM PET/CT BRAIN PI 78608PI A9552

2912 NM PET/CT BRAIN PS 78608PS A9552

6243 NM PET/CT LIMITED AREA PI 78814PI A9552

6250 NM PET/CT LIMITED AREA PS 78814PS A9552

6420 NM PET/CT OUTSIDE IMAGES FOR CONS none

6267 NM PET/CT SKULL TO MID THIGH PI 78815PI A9552

6270 NM PET/CT SKULL TO MID THIGH PS 78815PS A9552

6274 NM PET/CT WHOLE BODY PI 78816PI A9552

6276 NM PET/CT WHOLE BODY PS 78816PS A9552

2808 NM PULM PERFUSION + AEROSOL LUNG SCAN 78582 A9567

7170 NM PULM PERFUSION W/VENTILATION IMAGING 78582 A9540

587 NM PULM PERFUSION/VENTILATION QUANTITATIVE 78598 A9558

345 NM PULM VENTILATION W/REBREAT+WASHOUT 78582 A9558

2413 NM PULMONARY PERFUSION (ONLY) IMAGING 78580 A9540

2411 NM PULMONARY VENTILATION (ONLY) IMAGING 78579 A9558

907 NM RENAL W/ FLOW + DIURETIC 78708 A9562

429 NM RENAL W/ VASCULAR FLOW 78701 A9562

909 NM RENAL W/FLOW MULTIPLEW/ ACE INHIBIT 78709 A9562

908 NM RENAL W/FLOW SINGLE W/ACE INHIBIT 78708 A9562

2599 NM THYROGEN I 131 TOTAL BODY SCAN W/O TREATMENT 78018

2598 NM THYROGEN I 131 TOTAL BODY SCAN W/TREATMENT 78018

340 NM THYROID + UPTAKE 78014 A9516

347 NM THYROID IMAGING 78013 A9512

359 NM THYROID UPTAKE ONLY 78012 A9516 A9541

6169 NM TRIPLE TRACER BONE SCAN 78315 78805 A9503 A9570 A9541

1495 NM TUMOR LOCALIZATION W/ SPECT 78804 A9572

365 NM URETERAL REFLUX STUDY 78740 78730

1330 NM WHITE BLOOD CELLS 78804 A9521

904 NM WHITE BLOOD CELLS W/ SPECT 78807 A9521

2323 NM XOFIGO INJ THERAPY 79101

2444 NM Y90 LIVER/LUNG SCAN 78205 78580

2848 O ARM/FLUORO NEURO none Provider office would not order

8444 ORBITS COMPLETE MIN 4 V 70200

2363 PARACENTESIS W/ GUIDANCE 49083

2362 PARACENTESIS W/O GUIDANCE 49082

102 PELVIS 1 - 2 V 72170

802 PELVIS COMPLETE MIN 3 V 72190

2517 PERC BILIARY DRAIN INT/EXT COMPLETE 47534

2516 PERC BILIARY DRAINAGE EXT COMPLETE 47533

2532 PERC DRAINAGE KIDNEY LT COMP 50432

2533 PERC DRAINAGE KIDNEY RT COMP 50432

7708 PERC GASTROSTOMY TUBE EXCHANGE 43760 75984

293 PERC INTRODUCTION OF NEPHROSTOMY LT 50396 74425

294 PERC INTRODUCTION OF NEPHROSTOMY RT 74425 50396

155 PERC TRANSHEPATIC PORTOGRAM W/ HEMO EVAL 75885 36481

727 PERC TRANSHEPATIC PORTOGRAM W/O HEMO EV 75887 36481

884 PERCUT TRANSCATH PERMANENT EMBOLIZATION 75894 61626

828 PERCUTANEOUS ANTERGRADE PYELOGRAM 50390 74425

4875 PERCUTANEOUS CHOLECYSTOSTOMY 47490 75989

7132 PERCUTANEOUS STONE REMOVAL LT 50080

Page 12: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

7131 PERCUTANEOUS STONE REMOVAL RT 50080

8521 PERITONEAL PERM DRAINAGE CATH REMOVAL 49422

7450 PERITONEOGRAM AFTER INJ AIR OR CONTRAST 74190

2189 PICC INSERTION W/ PORT >5Y 36571

2534 PLCMNT NEPHROURETERAL NEW ACC 50433

2540 PLCMNT URETER STNT NEW ACC - CATH 50695

2539 PLCMNT URETERAL STENT NEW ACCESS 50694

2538 PLCMNT URETERAL STENT OLD ACCESS 50693

2931 PLEURAL DRAINAGE CATH REMOVAL 32552

1336 PORTOCAVAL VENOUS ANASTOMOSIS OPEN 37140

879 POSTURAL STUDY 72100

7658 REMOVAL NEPHROSTOMY TUBE/INTERNAL STENT 50389

2541 REMOVAL/REPLACE NEPHROURETERAL CATH COMP 50387

7621 REMOVAL/URETERAL STENT/PERC 50384

6431 REMOVE OBSTRUCTIVE MATERIAL/FEEDING TUBE 49460

2419 RENAL ANGIO 1ST BILAT COMP 36252

2417 RENAL ANGIO 1ST UNILAT COMP 36251

2418 RENAL ANGIO 2ND UNILAT COMP 36253

6388 RENAL CYST CONTRAST STUDY W/ INJECTION 74470 50390

4212 REPLACE G TUBE NO FLUORO 43762

7662 REPLACE URETER STENT INDWELLING 50382

2896 REPLACMENT OF G TUBE PERCUTANEOUS 49450

27 REPLACMENT OF G-J TUBE PERCUTANEOUS 49452

3488 REPLACMENT OF J TUBE PERCUTANEOUS 49451

6203 REPOSITION GASTR FEEDING TUBE 43761

830 RESERVOIR SHUNT PUNCTURE 61070 75809

7618 REVISION OF TIPS INCLUSIVE 37183

5168 RIBS 2 V UNI LT 71100

5073 RIBS 2 V UNI RT 71100

5076 RIBS MIN 2V LT W/ 1 V CHEST 71101

5075 RIBS MIN 2V RT W/ 1 V CHEST 71101

809 RIBS MIN 3 V BILAT 71110

86 RIBS MIN 3 V BILAT W/ 1 V CHEST 71111

103 SACROILIAC JOINTS 3 OR MORE VIEWS 72202

104 SACRUM/COCCYX MIN 2 V 72220

5091 SCAPULA COMPLETE LT 73010

5092 SCAPULA COMPLETE RT 73010

101 SCOLIOSIS SURVEY 72082

2289 SHOULDER 1 V BILATERAL 7302050

5095 SHOULDER 1 V LT 73020

5096 SHOULDER 1 V RT 73020

2291 SHOULDER COMP MIN 2 V BILATERAL 7303050

5101 SHOULDER COMPLETE MIN 2 V LT 73030

5102 SHOULDER COMPLETE MIN 2 V RT 73030

153 SIALOGRAM 70390 42550

2032 SINUSES 1 V WATER VIEW 70210

15 SINUSES COMPLETE MIN 3 V 70220

227 SKELETAL SURVEY PEDIATRIC FOR TRAUMA 77076

730 SKELETAL SURVEY PEDS FOR CONGEN ANAM 77076

17 SKULL < 4 V 70250

18 SKULL COMPLETE MIN 4 V 70260

68 SMALL BOWEL 74250

84 SNIFF TEST 71046

2395 SP NO CHARGE none Provider office would not order

3450 SPECIMEN FROM OR 76098

90 SPINE CERVICAL 1 V 72020

91 SPINE CERVICAL 2 OR 3 V 72040

5488 SPINE CERVICAL 2 V W/ FLEX + EXT 72050

92 SPINE CERVICAL 4 OR 5 V 72050

93 SPINE CERVICAL COMP W/ FLEX + EXT 72052

8446 SPINE CERVICAL LAT W/ FLEX + EXT 72040

89 SPINE COMPLETE AP + LAT 72082

96 SPINE LUMBAR 1 V 72020

Page 13: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

97 SPINE LUMBAR 2 V 72100

7543 SPINE LUMBAR AP + LAT W/ FLEX + EXT 72110

590 SPINE LUMBAR LAT W/ FLEX + EXT 72120

99 SPINE LUMBAR MIN 4 V 72110

5350 SPINE LUMBAR MIN 4 V W/ FLEX + EXT 72114

7266 SPINE THORACIC 1 V 72020

94 SPINE THORACIC 2 V 72070

7211 SPINE THORACIC 2 V W/ SWIMMERS 72072

2575 SPINE THORACIC 2 V W/FLEX + EXT 72074

95 SPINE THORACOLUMBAR 2 V 72080

6210 STERNOCLAVICULAR JOINTS BILAT MIN 3 V 71130

87 STERNUM MIN 2 V 71120

2303 THERASPHERE ADMINISTATION 79445

2720 THORACENTESIS W/ INSERTION OF TUBE none

2360 THORACENTESIS W/FLUORO GUIDANCE 32555

2359 THORACENTESIS W/O GUIDE none

2364 THORACENTESIS W/US GUIDANCE 32555 J1610

2193 THORACENTESIS WITH TUBE W/O IMAGE 32556

2726 THORACOSTOMY W/ RADIOLOGICAL GUIDANCE 32557 75989

1879 THROMBECTOMY MECH PERC ARTERIAL INIT 37184

1880 THROMBECTOMY MECH PERC ARTERIAL SUBSQU 37185

1878 THROMBECTOMY MECH PERC VEINS REPEAT 37188

7893 THROMBECTOMY MECH PERCUT VEIN 37187

5021 THROMBECTOMY OF ARTERIAL OR VENOUS GRAFT 35875

2194 THROMBOLYSIS ARTERIAL INI 37211

2192 THROMBOLYSIS FINAL DAY COMPLETE 37214

8522 THROMBOLYSIS SUBSEQUENT DAY COMP 37213

2195 THROMBOLYSIS VENOUS INI 37212

5327 TIBIA/FIBULA 2 V LT 73590

5328 TIBIA/FIBULA 2 V RT 73590

8745 TIBIAL/PERONEAL ADDL PTA COMPLETE 37232

8742 TIBIAL/PERONEAL ATHERECTOMY COMPLETE 37229

8741 TIBIAL/PERONEAL PTA COMPLETE 37228

8743 TIBIAL/PERONEAL STENT COMPLETE 37230

77 TMJ BILAT 70330

2002 TOE MIN 2 V LT 73660

2003 TOE MIN 2 V RT 73660

7612 TRANSCATH INS INTRAVASC STENT W/EMBOLIC 37215

2197 TRANSCATH RETRIEVAL PERCUTUTANEOUS 37197

6140 TRANSCATHETER BIOPSY 37200 75970 78103

7105 TRANSCERVICAL INTRO FALLOPIAN TU CATH LT 74742 58345

7103 TRANSCERVICAL INTRO FALLOPIAN TU CATH RT 74742 58345

2525 TRANSHEP PERC PLCMNT FOR ERCP 47541

2515 TRANSHEPATIC PERC CHOLANGIOGRAM 47532

1449 UGI/ESOPHAGRAM/SM BOWEL/AIR CONSTR 74249

66 UPPER GI 74240

596 UPPER GI W/ AIR CONTRAST 74246

5465 UPPER GI W/ ESOPHAGRAM 74240 768752

67 UPPER GI W/ SMALL BOWEL 74245

1447 UPPER GI/ESOPHAGRAM W/ SMALL BOWEL 74245

3143 UPPER GI/ESOPHAGRAM W/AIR 74246

810 UPPER GI/SMALL BOWEL W/AIR CONTRAST 74249

735 URETERAL BRUSH BIOPSY 50606

150 URETHROCYSTOGRAM 74450 51610

7704 UROGRAPHY RETROGRADE 74420

2957 US ABDOMEN APPENDIX 76705

2958 US ABDOMEN ASCITES 76705

303 US ABDOMEN COMPLETE 76700

2961 US ABDOMEN HERNIA 76705

2909 US ABDOMEN INTUSSUSCEPTION 76705

2959 US ABDOMEN LUQ 76705

2400 US ABDOMEN PYLORIC STENOSIS 76705

2960 US ABDOMEN RUQ 76705

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2182 US ADDITIONAL VIEWS none Provider office would not order

6400 US AORTA ABDOMINAL 76775

7849 US AORTA SCREENING 76706 One time benefits from Medicare

302 US AORTA/RENAL COMPLETE 76770

2962 US BLADDER 76857

2314 US BREAST AXILLA BIL 7688250

2312 US BREAST AXILLA LT 76882LT

2313 US BREAST AXILLA RT 76882RT

2309 US BREAST LIMITED BIL 7664250

2310 US BREAST LIMITED LT 76642LT

2311 US BREAST LIMITED RT 76642RT

2306 US BREAST WHOLE BIL 7664150

2307 US BREAST WHOLE LT 76641LT

2308 US BREAST WHOLE RT 76641RT

6208 US CHEST LT 76604

6273 US CHEST RT 76604

319 US CRANIAL NEONATAL 76506

5218 US EXT NON VASC LT 76882

5219 US EXT NON VASC RT 76882

2987 US EXT NON VASCULAR TENSON/MUSCLE LT 76882

2988 US EXT NON VASCULAR TENSON/MUSCLE RT 76882

313 US FOLLICULAR 76857

7854 US FOREIGN IMAGES none Provider office would not order

1875 US GUIDANCE 76942 Provider office would not order

8527 US GUIDANCE FOR VASCULAR ACCESS 76937 Provider office would not order

328 US GUIDANCE INTRAOPERATIVE 76998 Provider office would not order

2375 US GUIDANCE VASC ACC NO CHARGE none Provider office would not order

318 US GUIDED AMNIOCENTESIS 76946 59000

2727 US GUIDED ASPIRATION ABSCESS/CYST 76942 10160 A9540

2965 US GUIDED BREAST CORE BIOPSY LT 19083

2966 US GUIDED BREAST CORE BIOPSY RT 19083

2967 US GUIDED BREAST CYST ASPIRATION LT 76942 19000

2968 US GUIDED BREAST CYST ASPIRATION RT 76942 19000

2969 US GUIDED BREAST FINE NEEDLE ASP LT 76942 10022

2970 US GUIDED BREAST FINE NEEDLE ASP RT 76942 10022

2963 US GUIDED BREAST NEEDLE LOC LT 19285

2964 US GUIDED BREAST NEEDLE LOC RT 19285

5436 US GUIDED BX SOFT TISSUE NECK/THORAX 76942 20206

2325 US GUIDED ELBOW TENDON ASP – LAVAGE 20606

4213 US GUIDED FINE NEEDLE ASPIRATION 10005

2156 US GUIDED GOLD SEED PROSTATE 55876 76942

7606 US GUIDED GOLD SEED RECTAL WALL 55876 76872

2326 US GUIDED HIP JOINT ASP/INJECTION 20611

2327 US GUIDED HIP TENDON INJECTION 20611

5061 US GUIDED HYSTEROSONOGRAM 76831 58340

2328 US GUIDED KNEE JOINT ASP/INJECTION 20611

5428 US GUIDED LIVER BX 76942 47000

2408 US GUIDED PARACENTESIS 49083

5470 US GUIDED PROSTATE BX 76942 55700

3004 US GUIDED PROSTATE BX W/SEDATION 55700 76942

1394 US GUIDED PSEUDO INJECTION 36002

5454 US GUIDED RENAL ASP 76942 50390

2329 US GUIDED SHOULDER TENDON ASP – LAVAGE 20611

23 US GUIDED SHOULDER TENDON INJECTION 76942 20550

5426 US GUIDED SPLEEN ASP 76942 38999

5460 US GUIDED THORACENTESIS 32555

1369 US GUIDED THORACENTESIS W/ TUBE INSERT 32557

5452 US GUIDED THYROID CYST ASP 76942 60300

4214 US GUIDED THYROID FINE NEEDLE ASPIRATION 10005

2955 US HEAD SOFT TISSUE 76536

7232 US HIPS INFANT 76885

2577 US INGUINAL HERNIA LT 76882

2578 US INGUINAL HERNIA RT 76882

Page 15: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

2954 US NECK SOFT TISSUE 76536

2384 US NO CHARGE none Provider office would not order

2076 US OB 1ST TRIMESTER 76801

7677 US OB 1ST TRIMESTER QUADS 76801 76802 76802

7674 US OB 1ST TRIMESTER TRIPLETS 76801 76802 76802

7672 US OB 1ST TRIMESTER TWINS 76801 76802 76802

2080 US OB COMPLETE 76805

7876 US OB COMPLETE - HIGH RISK 76811

7668 US OB COMPLETE QUADS 76811 76812 76812

7665 US OB COMPLETE TRIPLETS 76811 76812 76812

7663 US OB COMPLETE TWINS 76811 76812 76812

858 US OB CORD DOPPLER 76820

317 US OB FETAL BIOPHYSICAL PROFILE 76819

3012 US OB FETAL BIOPHYSICAL PROFILE TRIPLETS 76819 7681959

3010 US OB FETAL BIOPHYSICAL PROFILE TWINS 76819 7681959 7681959

7231 US OB FETAL BIOPHYSICAL WITH NON STRESS 76818

2422 US OB FETAL ECHO 76825

2423 US OB FETAL ECHO F/U 76826

2272 US OB FETAL ECHO F/U QUADS 76826 7682659 7682659

2270 US OB FETAL ECHO F/U TRIPLETS 76826 7682659 7682659

2268 US OB FETAL ECHO F/U TWINS 76826 7682659 7682659

2266 US OB FETAL ECHO QUADS 76825 7682559 7682559

2264 US OB FETAL ECHO TRIPLETS 76825 7682559 7682559

2262 US OB FETAL ECHO TWINS 76825 7682559 7682559

883 US OB FOLLOW UP 76816

7686 US OB FOLLOW UP QUADS 76816 7681659 7681659

7683 US OB FOLLOW UP TRIPLETS 76816 7681659 7681659

7681 US OB FOLLOW UP TWINS 76816 7681659 7681659

2426 US OB HIGH RISK TRIPLETS 76811 76812

2424 US OB HIGH RISK TWINS 76811 76812 76812

4097 US OB LIMITED 76815

2261 US OB MCA DOPPLER 76821

2086 US OB TRANSVAGINAL 76817

2410 US OUTSIDE IMAGES FOR COMPARISON none Provider office would not order

2405 US OUTSIDE IMAGES FOR CONSULTATION none Provider office would not order

3020 US PEDIATRIC none Provider office would not order

304 US PELVIS 76856

2576 US PELVIS SOFT TISSUE 76857

2903 US RADIOLOGY PATHOLOGY F/U REPORT none Provider office would not order

305 US RENAL 76775

7723 US RENAL/BLADDER 76770

5214 US SHOULDER LT 76881

5215 US SHOULDER RT 76881

888 US SPINE AND CONTENTS 76800

2354 US STATISTICAL CHARGE ONLY none Provider office would not order

314 US TESTICULAR/SCROTUM 76870

2956 US THYROID 76536

330 US TRANSRECTAL 76872

329 US TRANSVAGINAL NON OB 76830

7855 US TRUNK/ABDOMEN SOFT TISSUE 76705

6226 USV AORTA FEM BYPASS LT 93979

6291 USV AORTA FEM BYPASS RT 93979

641 USV AORTA ILIAC BYPASS 93978

647 USV AORTA ILIAC BYPASS LIMITED 93979

640 USV AORTA-FEM BYPASS 93978

5220 USV BYPASS GRAFT LT 93926

5221 USV BYPASS GRAFT RT 93926

652 USV BYPASS GRAFTS BIL 93925

1372 USV CALF REFLUX STUDY BILAT 93970

5624 USV CALF REFLUX STUDY LT 93971

5625 USV CALF REFLUX STUDY RT 93971

311 USV CAROTID 93880

2031 USV CAROTID LT 93882

Page 16: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

2029 USV CAROTID RT 93882

2989 USV DIALYSIS FISTULA 93990

4084 USV DIALYSIS GRAFT 93990

2990 USV GROIN BIL/PSEUDO 93925

2991 USV GROIN LT/PSEUDO 93926

2992 USV GROIN RT/PSEUDO 93926

6200 USV GUIDED PSEUDO INJECTION 76936 96373

638 USV ILIAC ARTERY BILAT 93978

6224 USV ILIAC ARTERY LT 93979

6289 USV ILIAC ARTERY RT 93979

6225 USV ILIAC VEIN LT 93979

6290 USV ILIAC VEIN RT 93979

639 USV ILIAC VEINS BILATERAL 93978

637 USV INFERIOR VENA CAVA 93978

2030 USV KIDNEY TRANSPLANT 76776

612 USV LIVER DOPPLER 93975

624 USV LIVER DOPPLER WITH TIPPS 93976

6199 USV LOWER ART NON EXERCISE UNI 93922

2218 USV LOWER ARTERIAL ABI ONLY 93922

7835 USV LOWER ARTERIAL EXERCISE UNI 93922

7830 USV LOWER ARTERIAL W/ ABI EXERCISE 93923

555 USV LOWER ARTERIAL W/ABI NON EXERCISE 93923

2993 USV LOWER EXT ARTERY BIL 93925

2994 USV LOWER EXT ARTERY LT 93926

2995 USV LOWER EXT ARTERY RT 93926

580 USV LOWER EXT VEIN BILAT 93970

5238 USV LOWER EXT VEIN LT 93971

5239 USV LOWER EXT VEIN RT 93971

614 USV MESENTERIC DOPPLER 93975

618 USV MESENTERIC VEIN 93975

2996 USV PALMAR ARCH 93930

613 USV RENAL ARTERY DOPPLER 93975

625 USV RENAL DOPPLER LIMITED 93976

617 USV RENAL VEIN 93975

615 USV SPLENIC ARTERY DOPPLER 93975

619 USV SPLENIC VEIN 93975

2997 USV SUBCLAVIAN ARTERIES BILAT 93930

2998 USV SUBCLAVIAN ARTERY LT 93931

2999 USV SUBCLAVIAN ARTERY RT 93931

2590 USV TEMPORAL ARTERY 93882

7834 USV UPPER ARTERIAL EXERCISE UNI 93922

7752 USV UPPER ARTERIAL NON-EXERCISE UNI 93923

7831 USV UPPER ARTERIAL W/ WBI EXERCISE 93923

556 USV UPPER ARTERIAL W/WBI NON EXERCISE 93923

660 USV UPPER EXT ARTERY BIL 93930

4158 USV UPPER EXT ARTERY LT 93931

4159 USV UPPER EXT ARTERY RT 93931

717 USV UPPER EXT VEIN BILAT 93970

5236 USV UPPER EXT VEIN LT 93971

5237 USV UPPER EXT VEIN RT 93971

3025 USV VEIN MAPPING BILAT ARMS 93970

2816 USV VEIN MAPPING BILAT LEGS 93970

2818 USV VEIN MAPPING HEMODIALYSIS ACCESS G0365

3023 USV VEIN MAPPING LT ARM 93971

3022 USV VEIN MAPPING LT LEG 93971

3024 USV VEIN MAPPING RT ARM 93971

3021 USV VEIN MAPPING RT LEG 93971

270 VENOGRAM CAVAL INFERIOR 75825

209 VENOGRAM EXTREMITY BILAT 75822

7128 VENOGRAM EXTREMITY UNI LT 75820 36005

7127 VENOGRAM EXTREMITY UNI RT 75820 36005

720 VENOGRAM HEPATIC W/ HEMODYNAMIC EVAL 75889

726 VENOGRAM HEPATIC W/O HEMODYNAMIC EVAL 72891 36011

Page 17: SIM ORDERABLE CPT CPT CPT CPT CPT REMARKS 63 …...80 chest 1 v 71045 7703 chest 1 v w/abdomen (infant only) 71045 82 chest 2 v 71046 440 chest 2 v w/abdomen (infant only) 71046 3125

197 VENOGRAM RENAL SELECTIVE BILAT 75833

274 VENOGRAM RENAL SELECTIVE UNI LT 75831

275 VENOGRAM RENAL SELECTIVE UNI RT 75831

216 VENOGRAM VENOUS SINUS OR JUGULAR LT 75860

218 VENOGRAM VENOUS SINUS OR JUGULAR RT 75860

271 VENOGRAPHY CAVAL SUPERIOR + SERIALOGRAM 75827

5490 VENOUS CATH FOR BLOOD SAMPLING 75893 36500

1572 VENOUS PORT CHECK FOR PATENCY 36598 76000

2633 VENOUS PTA 37248

2452 VENOUS STENT 37238

2371 VERTEBROPALSTY EA ADD CERVTH OR LUMBSAC 22512

2369 VERTEBROPLASTY CERVICOTHORA 22510

2370 VERTEBROPLASTY LUMBOSACRAL 22511

878 VIDEO FLUOROSCOPY W/ SPEECH PATH 74230

162 VOIDING CYSTOURETHROGRAM 51600 74455

8078 WHITAKER TEST 50396 74425

5141 WRIST 2 V LT 73100

5142 WRIST 2 V RT 73100

5147 WRIST COMP MIN 3 V LT 73110

5148 WRIST COMP MIN 3 V RT 73110