OUTPATIENT SURGICAL PROCEDURES CPT/HCPCS CODES
UnitedHealthcare CommercialNetwork Bulletin AppendixOUTPATIENT SURGICAL PROCEDURES – SITE OF SERVICE:CPT/HCPCS CODESEffective Date: November 1, 2019SITE OF SERVICE REVIEWFor dates of service on or after Nov. 1, 2019, we’re expanding our notification/prior authorization requirements toinclude the procedures/CPT codes listed below. We’ll only require notification/prior authorization if these procedures/CPT codes will be performed in an outpatient hospital setting. This change will take effect on or after Dec. 1, 2019, forCalifornia, Connecticut, New Jersey and New York, on or after Jan. 1, 2020 for Colorado, Maryland and Rhode Island,and on or after March 1, 2020 for Georgia, Iowa, Kansas, Nebraska, New Hampshire, North Carolina, Maine, SouthCarolina and Vermont. States excluded from this requirement are Alaska, Kentucky, Massachusetts, Texas, Utah andWisconsin. Refer to the policy titled Outpatient Surgical Procedures – Site of Service.CPT/HCPCS Code0249TDescriptionLigation hemorrhoid bundle w/us10121Incision & removal foreign body subq tiss compl10180Incision & drainage complex po wound infection11000Dbrdmt extensv eczema/infect skn up 10% bdy surf11010Dbrdmt w/rmvl fm fx&/dislc skin&subq tissus11012Dbrdmt fx&/dislc subq t/m/f bone11440Exc b9 lesion mrgn xcp sk tg f/e/e/n/l/m 0.5cm/ 11441Exc b9 les mrgn xcp sk tg f/e/e/n/l/m 0.6-1.0 cm11443Exc b9 les mrgn xcp sk tg f/e/e/n/l/m 2.1-3.0 cm11444Exc b9 les mrgn xcp sk tg f/e/e/n/l/m 3.1-4.0 cm11446Exc b9 lesion mrgn xcp sk tg f/e/e/n/l/m 4.0cm11450Excision hidradenitis axillary smpl/intrm rpr11451Excision hidradenitis axillary complex repair11462Excision hidradenitis inguinal smpl/intrm rpr11463Excision hidradenitis inguinal complex repair11470Excision h/p/p/u simple/intermediate repair11471Excision h/p/p/u complex repair11601Excision mal lesion trunk/arm/leg 0.6-1.0 cm11602Excision mal lesion trunk/arm/leg 1.1-2.0 cm11603Excision mal lesion trunk/arm/leg 2.1-3.0 cm/ 11604Excision mal lesion trunk/arm/leg 3.1-4.0 cm11620Excision malignant lesion s/n/h/f/g 0.5 cm/ 11621Excision malignant lesion s/n/h/f/g 0.6-1.0 cm11622Excision malignant lesion s/n/h/f/g 1.1-2.0 cm11623Excision malignant lesion s/n/h/f/g 2.1-3.0 cm/ 11624Excision malignant lesion s/n/h/f/g 3.1-4.0 cm11626Excision malignant lesion s/n/h/f/g 4.0 cm11640Excision malignant lesion f/e/e/n/l 0.5 cm/ 11641Excision malignant lesion f/e/e/n/l 0.6-1.0 cm11642Excision malignant lesion f/e/e/n/l 1.1-2.0 cm11643Excision malignant lesion f/e/e/n/l 2.1-3.0 cmOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 1 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code11644DescriptionExcision malignant lesion f/e/e/n/l 3.1-4.0 cm11646Excision malignant lesion f/e/e/n/l 4.0 cm11750Excision nail matrix permanent removal11755Biopsy nail unit separate procedure11760Repair nail bed11770Excision pilonidal cyst/sinus simple11772Excision pilonidal cyst/sinus complicated12031Repair intermediate s/a/t/e 2.5 cm/ 12032Repair intermediate s/a/t/e 2.6-7.5 cm12034Repair intermediate s/a/t/e 7.6-12.5 cm12035Repair intermediate s/a/t/e 12.6-20.0 cm12037Repair intermediate s/a/t/e 30.0 cm12041Repair intermediate n/h/f/xtrnl gent 2.5cm/ 12042Repair intermediate n/h/f/xtrnl gent 2.6-7.5 cm12051Repair intermediate f/e/e/n/l&/muc 2.5 cm/ 12052Repair intermediate f/e/e/n/l&/muc 2.6-5.0 cm13100Repair complex trunk 1.1-2.5 cm13101Repair, complex, trunk; 2.6 cm to 7.5 cm13120Repair complex scalp/arm/leg 1.1-2.5 cm13121Repair complex scalp/arm/leg 2.6-7.5 cm13131Repair complex f/c/c/m/n/ax/g/h/f 1.1-2.5 cm13132Repair, complex, forehead, cheeks, chin, mouth, neck, axillae, genitalia, hands and/orfeet; 2.6 cm to 7.5 cm13151Repair complex eyelid/nose/ear/lip 1.1-2.5 cm13152Repair complex eyelid/nose/ear/lip 2.6-7.5 cm14040Adjacent tissue transfer or rearrangement, forehead, cheeks, chin, mouth, neck, axillae,genitalia, hands and/or feet; defect 10 sq cm or less14060Adjacent tissue transfer or rearrangement, eyelids, nose, ears and/or lips; defect 10 sqcm or less14301Adjacent tissue transfer or rearrangement, any area; defect 30.1 sq cm to 60.0 sq cm15100Split agrft t/a/l 1st 100 cm/&/1% bdy inft/chld15120Split agrft f/s/n/h/f/g/m/d gt 1st 100 cm/ /1 %15220Fth/gft free w/direct closure s/a/l 20 cm/ 15240Fth/gft fr w/dir clsr f/c/c/m/n/ax/g/h/f 20 cm/ 15260Fth/gft free w/direct closure n/e/e/l 20 sq cm/ 15576Frmj direct/tubed pedicle w/wotr e/n/e/l/ntroral15760Graft composite w/primary closure donor area15770GRAFT DERMA-fat-fascia15850Removal sutures under anesthesia same surgeon17000Destruction premalignant lesion 1st17004Destruction premalignant lesion 15/ 17110Destruction benign lesions up to 1417111Destruction benign lesions 15/ 17311Mohs micrographic h/n/h/f/g 1st stage 5 blocks17313Mohs trunk/arm/leg 1st stage 5 blocks19101Biopsy breast open incisional19110Nipple exploration19112Excision lactiferous duct fistulaOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 2 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code19120DescriptionExc cyst/aberrant breast tissue open 1/ lesion19125Exc breast les preop plmt rad marker open 1 les20200Biopsy muscle superficial20205Biopsy muscle deep20220Biopsy bone trocar/needle superficial20225Biopsy bone trocar/needle deep20240Biopsy bone open superficial20245Biopsy bone open deep20520Removal foreign body muscle/tendon sheath simple20525Rmvl foreign body muscle/tendon sheath deep/comp20526Injection therapeutic carpal tunnel20551Injection single tendon origin/insertion20552Injection single/mlt trigger point 1/2 muscles20553Injection single/mlt trigger point 3/ muscles20600Arthrocentesis aspir&/inj small jt/bursa w/o us20604Arthrocnt aspir&/inj small jt/bursaw/us rec rprt20605Arthrocentesis aspir&/inj interm jt/burs w/o us20606Arthrocentesis aspir&/inj interm jt/burs w/us20610Arthrocentesis aspir&/inj major jt/bursa w/o us20611Arthrocentesis aspir&/inj major jt/bursa w/us20612Aspiration&/injection ganglion cyst any locatj20680Removal of implant; deep (e.g., buried wire, pin, screw, metal band, nail, rod or plate)20693Adjustment/revj xtrnl fixation system req anes20694Removal external fixation system under anes20912Cartilage graft nasal septum21011Excision tumor soft tiss face/scalp subq 2cm21012Excision tumor soft tiss face/scalp subq 2 cm/ 21013Exc tumor soft tiss face&scalp subfascial 2cm21014Exc tumor soft tiss face&scalp subfascial 2 cm/ 21030Exc benign tumor/cyst maxl/zygoma encl & curtg21031Excision torus mandibularis21040Excision benign tumor/cyst mandible encl & curt21046Exc benign tumor/cyst mndbl intra-oral osteot21048Exc benign tumor/cyst maxl intra-oral osteot21315Closed tx nasal fracture w/o stabilization21320Closed treatment of nasal bone fracture; with stabilization21325Open treatment nasal fracture uncomplicated21330Open tx nasal fx comp w/int&/xtrnl skeletal fi21335Open tx nasal fx w/concomitant optx fxd septum21336Open tx nasal septal fracture w/wo stabilization21337Closed tx nasal septal fract w/wo stabilization21356Open tx depressed zygomatic arch fracture21365Open tx comp fx malar w/internal fx&mult surg21385Open tx orbital floor blowout fx transantral21390Optx orb floor blwt fx pri/bital appr w/allplstc21407Open tx fx orbit except blowout w/implant21550Biopsy soft tissue neck/thoraxOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 3 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code21552DescriptionExcision, tumor, soft tissue of neck or anterior thorax, subcutaneous; 3 cm or greater21554Exc tumor soft tissue neck/thorax subfasc 5 cm/ 21555Exc tumor soft tissue neck/ant thorax subq 3cm21556Exc tumor soft tiss neck/thorax subfascial 5cm21557Rad resect tumor soft tiss neck/ant thorax 5cm21920Biopsy soft tissue back/flank superficial21930Excision tumor soft tissue back/flank subq 3cm21931Excision, tumor, soft tissue of back or flank, subcutaneous; 3 cm or greater21932Exc tumor soft tiss back/flank subfascial 5cm21933Exc tumor soft tiss back/flank subfascial 5 cm/ 22900Exc tumor soft tissue abdl wall subfascial 5cm22901Exc tumor soft tissue abdl wall subfascial 5cm/ 22902Exc tumor soft tissue abdominal wall subq 3cm22903Exc tumor soft tissue abdominal wall subq 3 cm/ 23071Excision tumor soft tissue shoulder subq 3 cm/ 23075Excision tumor soft tissue shoulder subq 3cm23076Exc tumor soft tiss shoulder subfasc 5cm23140Exc/curtg bone cyst/benign tumor clav/scapula23150Exc/curtg bone cyst/benign tumor prox humerus23405Tenotomy shoulder area 1 tendon23415Coracoacromial ligament releas w/woacromioplasty23430Tenodesis long tendon biceps23480Osteotomy clavicle w/wo internal fixation23615Open treatment proximal humeral fracture23630Open treatment grter humeral tuberosity fracture23700Manj w/anes shoulder joint w/fixation apparatus24000Arthrt elbow w/exploration drainage/removal fb24006Arthrt elbow capsular excision capsular rls spx24065Biopsy soft tissue upper arm/elbow superficial24066Biopsy soft tissue upper arm/elbow area deep24071Exc tumor soft tissue upper arm/elbow subq 3cm/ 24073Exc tumor soft tiss upper arm/elbw subfasc 5cm/ 24075Exc tumor soft tiss upper arm/elbow subq 3cm24076Exc tumor soft tiss upr arm/elbow subfasc 5cm24101Arthrt elbow w/jnt expl w/wobx w/wormvl loose/fb24102Arthrotomy elbow w/synovectomy24105Excision olecranon bursa24110Excision/curtg bone cyst/benign tumor humerus24120Exc/curtg bone cyst/benign tumor h/n rds/olecrn24130Excision radial head24147Partial excision bone olecranon process24200Rmvl foreign body upper arm/elbow subcutaneous24201Removal foreign body upper arm/elbow deep24300Manipulation elbow under anesthesia24310Tenotomy open elbow to shoulder each tendon24340Tenodesis biceps tendon elbow separate procedure24357Tenotomy elbow lateral/medial percutaneousOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 4 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code24358DescriptionTnot elbow lateral/medial debride open24366Arthroplasty radial head w/implant24515Optx humeral shft fx w/plate/screws w/wocerclage24516Tx humral shaft fx w/insj imed implt w/w cerclge24586Optx periarticular fracture &/dislocation elbo24615Open tx acute/chronic elbow dislocation24665Open tx radial head/neck fracture24666Open tx radial head/neck fracture prosthetic25000Incision extensor tendon sheath wrist25071Exc tumor soft tiss forearm and/wrist subq 3cm/ 25073Exc tumor sft tiss forearm&/wrist subfasc 3cm/ 25075Exc tumor soft tissue forearm &/wrist subq 3cm25076Exc tumor soft tiss forearm&/wrist subfasc 3cm25085Capsulotomy wrist25105Arthrotomy wrist joint with synovectomy25107Arthrotomy dstl radioulnar joint rpr cartilage25109Exc tendon forearm&/wrist flexor/extensor ea25110Excision lesion tendon sheath forearm&/wrist25111Excision ganglion wrist dorsal/volar primary25112Excision ganglion wrist dorsal/volar recurrent25118Synovectomy extensor tendon shth wrist 1 cmprt25120Excision/curettage cyst/tumor radius/ulna25130Excision/curettage cyst/tumor carpal bones25151Partial excision bone radius25210Carpectomy 1 bone25215Carpectomy all bones proximal row25230Radical styloidectomy separate procedure25240Excision distal ulna partial/complete25260Rpr tdn/musc flxr f/arm&/wrst prim 1 ea tdn/mu25270Rpr tdn/musc xtnsr f/arm&/wrist prim 1 ea tdn25275Rpr tendon sheath extensor f/arm&/wrist w/graft25280Lngth/shrt flxr/xtnsr tdn f/arm&/wrist 1 ea tdn25290Tnot flxr/xtnsr tendon forearm&/wrist 1 ea25295Tnols flxr/xtnsr tendon forearm&/wrist 1 ea25350Osteotomy radius distal third25445Arthroplasty w/prosthetic replacement trapezium25545Open treatment of ulnar shaft fracture25605Cltx dstl rdl fx/epiphysl sep w/manj when perf25606Perq skel fixj distal radial fx/epiphysl sep25607Optx dstl radl x-artic fx/epiphysl sep25608Optx dstl radl i-artic fx/epiphysl sep 2 frag25609Optx dstl radl i-artic fx/epiphysl sep 3 frag25624Closed tx carpal scaphoid fracture w/manj25628Open tx carpal scaphoid navicular fracture25645Open tx carpal bone fracture oth/thn scaphoid ea25652Open treatment ulnar styloid fracture25810Arthrodesis wrist w/iliac/other autograftOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 5 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code25825Arthrodesis wrist limited w/autograftDescription26011Drainage finger abscess complicated26020Drainage tendon sheath digit&/palm each26045Fasciotomy palmar open partial26055Tendon sheath incision26070Arthrt expl drg/rmvl loose/fb carp/mtcrpl jt26075Arthrt expl drg/rmvl loose/fb mtcarphlngl jt ea26080Arthrt expl drg/rmvl loose/fb iphal jt ea26105Arthrotomy biopsy mtcarphlngl joint each26110Arthrotomy biopsy interphalangeal joint each26111Ex tum/vasc malf sft tiss hand/fngr subq 1.5cm/ 26113Ex tum/vasc mal sft tis hand/fngr subfsc 1.5cm/ 26115Exc tum/vasc mal sft tiss hand/fngr subq 1.5cm26116Exc tum/vas mal sft tis hand/fngr subfasc 1.5cm26121Fasct palm w/wo z-plasty tissue reargmt/skn grft26123Fasct prtl palmar 1 dgt prox iphal jt w/wo rpr26160Exc lesion tdn shth/jt capsl hand/fngr26180Excision tendon finger flexor/extensor each26200Excision/curettage cyst/tumor metacarpal26210Excision/curettage cyst/tumor phalanx finger26215Exc/curettage cyst/tumor phalanx finger w/agraft26236Partial excision distal phalanx finger26320Removal implant from finger/hand26356Rpr/advmnt flxr tdn zone 2 w/o fr grft ea tendon26357Rpr/advmnt flxr tdn zone 2 w/o fr grft ea tendon26392Rmvl synth rod & insj flxr tdn grf h/f ea rod26410Repair extensor tendon hand w/o graft each26418Repair extensor tendon finger w/o graft each26420Repair extensor tendon finger w/graft each26426Rpr xtnsr tdn cntrl slip tiss w/lat band ea fngr26432Cltx dstl xtnsr tdn insj w/wo percutan pinning26433Repair extensor tendon distal insertion w/o grf26437Realignment extensor tendon hand each tendon26440Tenolysis flexor tendon palm/finger each tendon26442Tenolysis flexor tendon palm&finger each tendo26445Tenolysis extensor tendon hand/finger each26455Tenotomy flexor finger open each tendon26480Tr/trnspl tdn carp/mtcrpl hand w/o fr grf ea tdn26500Rcnstj tendon pulley each w/local tissues spx26502Rcnstj tdn pulley ea tdn w/tdn/fscal grf spx26516Capsulodesis mtcarphlngl joint single digit26520Capsulectomy/capsulotomy mtcarphlngl joint each26525Capsulectomy/capsulotomy iphal joint each26530Arthroplasty metacarpophalangeal joint each26535Arthroplasty interphalangeal joint each26540Rpr coltrl ligm mtcarphlngl/iphal jt26541Rcnstj coltrl ligm mtcarphlngl 1 w/tdn/fscal grfOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 6 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code26542DescriptionRcnstj coltrl ligm mtcarphlngl 1 w/local tiss26546Rpr non-union mtcrpl/phalanx26567Osteotomy phalanx finger each26608Prq skeletal fixj metacarpal fx each bone26615Open tx metacarpal fracture single ea bone26650Prq skeletal fix carpo/metacarpal fx dislc thumb26665Open tx carpometacarpal fracture dislocate thumb26676Prq skel fixj carpo/mtcrpl dislc thmb manj ea jt26715Open treatment metacarpophalangeal dislocation26727Prq skel fixj phlngl shft fx prox/middle px/f/t26735Open tx phalangeal shaft fracture prox/middle ea26742Cltx artclr fx invg mtcarphlngl/iphal jt w/manj26746Open tx articular fracture mcp/ip joint ea26756Prq skel fixj dstl phlngl fx fngr/thmb ea26765Open tx distal phalangeal fracture each26841Arthrd carpo/metacarpal jt thumb w/wo int fixj26842Arthrd crp/mtacrpl jt thmb w/wo int fixj w/agrft26850Arthrodesis metacarpophalangeal jt w/wo int fixj26860Arthrodesis interphalangeal jt w/wo int fixj26862Arthrodesis iphal jt w/wo int fixj w/autograft26910Amp mtcrpl w/finger/thumb w/wo inteross transfer26951Amp f/th 1/2 jt/phalanx w/neurect w/dir clsr26952Amp f/th 1/2 jt/phalanx w/neurect local flap27006Tenotomy abductors&/extensor hip open spx27043Excision tumor soft tissue pelvis&hip subq 3cm/ 27045Exc tumor soft tissue pelvis & hip subfasc 5cm/ 27047Exc tumor soft tissue pelvis & hip subq 3cm27048Exc tumor soft tissue pelvis & hip subfasc 5cm27062Excision trochanteric bursa/calcification27093Injection hip arthrography w/o anesthesia27095Injection hip arthrography w/anesthesia27310Arthrt kne w/expl drg/rmvl fb27323Biopsy soft tissue thigh/knee area superficial27324Biopsy soft tissue thigh/knee area deep27327Excision tumor soft tissue thigh/knee subq 3cm27328Exc tumor soft tissue thigh/knee subfasc 5cm27329Rad resect tumor soft tissue thigh/knee 5cm27331Arthrt kne w/jt expl bx/rmvl loose/fb27332Arthrt w/exc semilunar crtlg knee medial/lat27334Arthrotomy w/synovectomy knee anterior/posterior27335Arthrt w/synvct kne ant&post w/pop areaOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 7 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code27337DescriptionExcison tumor soft tissue thigh/knee subq 3 cm/ 27339Exc tumor soft tissue thigh/knee subfasc 5 cm/ 27340Excision prepatellar bursa27345Excision synovial cyst popliteal space27347Excision lesion meniscus/capsule knee27372Removal foreign body deep thigh/knee27403Arthrotomy w/meniscus repair knee27407Repair primary torn ligm&/capsule knee cruciat27418Anterior tibial tubercleplasty27570Manipulation knee joint under general anesthesia27613Biopsy soft tissue leg/ankle area superficial27614Biopsy soft tissue leg/ankle area deep27618Exc tumor soft tissue leg/ankle subq 3cm27619Exc tumor soft tissue leg/ankle subfascial 5cm27620Arthrt ankle w/expl w/wo bx w/wo rmvl loose/fb27626Arthrotomy w/synovectomy ankle tenosynovectomy27632Excision tumor soft tissue leg/ankle subq 3 cm/ 27634Exc tumor soft tissue leg/ankle subfasc 5 cm/ 27638Exc/curettage cyst/tumor tibia/fibula w/algraft27640Partial excision bone tibia27658Repair flexor tendon leg primary w/o graft each27665Rpr extensor tendon leg secondry w/wo graft each27685Lngth/shrt tendon leg/ankle 1 tendon spx27705Osteotomy tibia27720Repair nonunion/malunion tibia w/o graft27756Prq skeletal fixation tibial shaft fracture27788Cltx dstl fibular fx lat malls w/manj28005Incision bone cortex foot28010Tenotomy percutaneous toe single tendon28011Tenotomy percutaneous toe multiple tendon28020Arthrt w/expl drg/rmvl loose/fb ntrtrsl/tars jt28022Arthrt w/expl drg/rmvl loose/fb mttarphlngl jt28035Release tarsal tunnel28039Excision tumor soft tis foot/toe subq 1.5 cm/ 28041Exc tumor soft tissue foot/toe subfasc 1.5 cm/ 28043Excision tumor soft tissue foot/toe subq 1.5cm28045Exc tumor soft tissue foot/toe subfasc 1.5cm28047Rad resection tumor soft tissue foot/toe 3 cm/ 28055Neurectomy intrinsic musculature of foot28060Fasciectomy plantar fascia partial spx28080Excision interdigital morton neuroma single each28086Synovectomy tendon sheath foot flexor28088Synovectomy tendon sheath foot extensor28090Exc lesion tendon sheath/capsule w/synvct foot28092Exc lesion tendon sheath/capsule w/synvct toe ea28100Excision/curettage cyst/tumor talus/calcaneus28103Exc/curettage cyst/tumor talus/calcaneus algrftOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 8 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code28104DescriptionExc/curtg bone cyst/b9 tumortarsal/metatarsal28108Exc/curtg cst/b9 tum phalanges foot28110Ostectomy prtl 5th metar head spx28111Ostectomy complete 1st metatarsal head28112Ostectomy complete other metatarsal head 2/3/428113Ostectomy complete 5th metatarsal head28118Ostectomy calcaneus28119Ostectomy calcaneus spur w/wo plntar fascial rls28120Partial excision bone talus/calcaneus28124Partical excision bone phalanx toe28126Resection partial/complete phalangeal base each28153Resection condyle distal end phalanx each toe28160Hemiphalangectomy/interphalangeal joint exc toe28190Removal foreign body foot subcutaneous28192Removal foreign body foot deep28193Removal foreign body foot complicated28208Repair tendon extensor foot 1/2 each tendon28225Tenolysis extensor foot single tendon28234Tenotomy open extensor foot/toe each tendon28250Division plantar fascia & muscle spx28272Capsulotomy iphal joint each joint spx28280Syndactylization toes28286Correction cock-up 5th toe w/plastic closure28288Ostc prtl exostc/condylc metar head28295Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; withproximal metatarsal osteotomy, any method28306Osteot w/wo lngth shrt/corrj 1st metar28310Osteot shrt corrj prox phalanx 1st toe28312Osteot shrt corrj oth phalanges any toe28313Rcnstj angular dfrm toe soft tiss px only28315Sesamoidectomy first toe spx28475Cltx metar fx w/manj28476Prq skel fixj metar fx w/manj28496Prq skel fixj fx grt toe phlx/phlg w/manj28515Cltx fx phlx/phlg oth/thn grt toe w/manj28525Open tx fracture phalanx/phalanges not great toe28645Open tx metatarsophalangeal joint dislocation28666Prq skel fixj interphalangeal joint dislc w/manj28675Open treatment interphalangeal joint dislocation28755Arthrodesis great toe interphalangeal joint28760Arthrd w/xtnsr hallucis longus tr 1st metar nck28825Amputation toe interphalangeal joint29800Arthrs temporomandibulr jt dx w/wo synval bx spx29804Arthroscopy temporomandibular joint surgical29906Arthroscopy subtalar joint with debridement30000Drainage abscess/hematoma nasal int approach30020Drainage abscess/hematoma nasal septumOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 9 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code30100DescriptionBiopsy intranasal30110Excision nasal polyp simple30115Excision nasal polyp extensive30117Excision/destruction intranasal lesion int appr30118Excision/destruction intranasal lesion xtrnl30130Excision inferior turbinate partial/complete30140Submucous resection inferior turbinate, partial or complete, any method30220Insertion nasal septal prosthesis button30310Removal foreign body intranasal general anes30520Septoplasty or submucous resection, with or without cartilage scoring, contouring orreplacement with graft30580Repair fistula oromaxillary30630Repair nasal septal perforations30801Abltj soft tis inferior turbinates uni/bi supfc30802Abltj sof tiss inf turbs uni/bi supfc intramural30930Fracture nasal inferior turbinate therapeutic31020Sinusotomy maxillary antrotomy intranasal31030Sinusotomy maxillary rad w/o rmvl antroch polyps31032Sinusot max antrt rad w/rmvl antroch polyps31200Ethmoidectomy intranasal anterior31205Ethmoidectomy extranasal total31525Laryngoscopy w/wo tracheoscopy dx except newborn31526Laryngoscopy w/wo tracheoscopy w/micro/telescope31528Laryngoscopy w/wo tracheoscopy w/dilation in31529Laryngoscopy w/wo tracheoscopy dilation subsq31530Laryngoscopy w/foreign body removal31535Laryngoscopy direct operative w/biopsy31536Laryngoscopy w/biopsy microscope/telescope31540Laryngoscopy exc tum&/stripping cords/epiglott31541Largsc exc tum&/strpg cords/epigl mcrscp/tlscp31545Largsc micro/telescope rmvl les vocal cord flap31570Laryngoscope injection vocal cord therapeutic31571Largsc w/njx vocal cord ther w/micro/telescope31574Laryngoscopy flexible w/injection agmntj uni31575Laryngoscopy flexible fiberoptic diagnostic31576Laryngoscopy flexible fiberoptic w/biopsy31578Laryngoscopy flexible fiberoptic removal lesion31591Laryngoplasty medialization unliateral31611Constj tracheoesophgl fstl&insj sp prosth31622Brnchsc incl fluor gdnce dx w/cell washg spx31623Brnchsc brushing/protected brushings31624Brnchsc w/brncl alveolar lavage31625Bronchoscopy bronchial/endobrncl bx 1 sites31628Bronchoscopy w/transbronchial lung bx 1 lobe31652Brnchsc ebus guided sampl 1/2 node station/strux32405Biopsy lung/mediastinum percutaneous needle32555Thoracentesis needle/cath pleura w/imagingOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 10 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code32557DescriptionPerq drainage pleura insert cath w/imaging33215Rpsg prev implted pm/dfb r atr/r ventr electrode33216Insj 1 transvns eltrd perm pacemaker/impltbl dfb33241Removal implantable defib pulse generator only35045Dir rpr ruptd aneurysm radial/ulnar artery36000Introduction needle/intracatheter vein36010Intro catheter superior/inferior vena cava36012Slctv cath plmt ven sys 2nd order/ slctv branc36215Slctv cathj ea 1st ord thrc/brch/cphlc brnch36246Slctv cathj 2nd order abdl pel/lxtr art brnch36471Njx sclerosing solution multiple veins same leg36556Insj non-tunneled central venous cath age 5 yr/ 36569Insj prph cvc w/o subq port/pmp age 5 yr/ 36571Insj prph ctr vad w/subq port age 5 yr/ 36581Rplcmt compl tun cvc w/o subq port/pmp36582Rplcmt compl tun ctr vad w/subq port36589Rmvl tun cvc w/o subq port/pmp36590Rmvl tun ctr vad w/subq port/pmp ctr/prph insj36821Arteriovenous anastomosis open direct36901Intro cath dialysis circuit dx angrph fluor s&i36902Intro cath dialysis circuit w/trluml balo angiop37242Vascular embolization or occlusion arterial rs&i37248Trlml balo angiop open/perq w/img s&i 1st vein37607Lig/banding angioaccess arteriovenous fistula37609Ligation/biopsy temporal artery37761Lig prfratr vein subfscal open incl us gid 1 leg37765Stab phlebt varicose veins 1 xtr 10-20 stab incs37766Stab phlebt varicose veins 1 xtr 20 incs37785Ligj divj &/excj varicose vein cluster 1 leg38221Bone marrow biopsy needle/trocar38222Diagnostic bone marrow biopsies & aspirations38500Bx/exc lymph node open superficial38505Bx/exc lymph node needle superficial38510Bx/exc lymph node open deep cervical node38520Bx/exc lymph node opn dp crv node w/exc fat pad38525Bx/exc lymph node open deep axillary node38740Axillary lymphadenectomy superficial38760Inguinofem lmphadec supfc w/cloquets node spx40520Exc lip v-exc w/prim dir linr clsr40525Exc lip full thkns rcnstj w/local flap40530Rescj lip one-foruth w/o rcnstj40810Exc les mucosa & sbmcsl vestibule mouth w/o rpr40812Exc lesion mucosa & sbmcsl vestibule smpl rpr40814Exc lesion mucosa & sbmcsl vestibule cplx rpr40816Exc lesion mucosa&sbmcsl vestibule cplx exc musc41105Biopsy tongue posterior one-thirdOutpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 11 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS CodeDescription41110Excision lesion tongue w/o closure41112Exc lesion tongue w/clsr anterior two-thirds41113Exc lesion tongue w/clsr posterior one-third41116Excision lesion floor mouth41520Frenoplasty surg revj frenum eg w/z-plasty41825Exc lesion/tumor dentoalveolar strux w/o rpr42100Biopsy palate uvula42104Exc lesion palate uvula w/o closure42106Exc lesion palate uvula w/smpl prim closure42107Exc lesion palate uvula w/local flap closure42140Uvulectomy excision uvula42330Sialot submndblr sublngl/prtd uncomp intraoral42335Sialolithotomy submndblr submax comp intraoral42405Biopsy salivary gland incisional42408Exc sublingual salivary cyst ranula42410Exc prtd tum/prtd glnd lat lobe w/o nrv dsj42415Exc prtd tum/prtd glnd lat dsj&prsrv facial nr42420Exc prtd tum/prtd glnd tot dsj&prsrv facial nr42425Excision parotid tumor/gland total en bloc rmvl42440Excision submandibular submaxillary gland42450Exision of sublingual gland42500Plstc rpr salivary dux sialodochoplasty prim42650Dilation salivary duct42800Biopsy oropharynx42804Biopsy nasopharynx visible lesion simple42808Excision/destruction lesion pharynx any method42810Exc branchial cleft cyst confined skn&subq tis42820Tonsillectomy and adenoidectomy; younger than age 1242821Tonsillectomy and adenoidectomy; age 12 or over42825Tonsillectomy, primary or secondary; younger than age 1242826Tonsillectomy, primary or secondary; age 12 or over42830Adenoidectomy, primary; younger than age 1242831Adenoidectomy primary age 12/ 42870Exc/dstrj lingual tonsil any method spx43191Esophagoscopy rigid transoral diagnostic brush43195Esophagoscopy rigid transoral balloon dilation43197Esophagoscopy flexible transnasal diagnostic43200Esophagoscopy flexible transoral diagnostic43202Esophagoscopy flexible transoral with biopsy43214Esophagoscopy dilate esophagus balloon 30 mm43220Esophagoscopy flex balloon dilat 30 mm diam43226Esophagoscopy flexible guide wire dilation43229Esophagoscopy flex transoral lesion ablation43233Egd esophagus balloon dilation 30 mm or larger43235Esophagogastroduodenoscopy, flexible, transoral; diagnostic, including collection ofspecimen(s) by brushing or washing, when performed (separate procedure)Outpatient Surgical Procedures – Site of Service: CPT/HCPCS CodesPage 12 of 26UnitedHealthcare Network Bulletin AppendixEffective 11/01/2019Proprietary Information of UnitedHealthcare. Copyright 2019 United HealthCare Services, Inc.
CPT/HCPCS Code43236DescriptionEsophagogastroduodenoscopy submucosal injection43237Esophagogastroduodenoscopy us scope w/adj strxrs43238Egd intrmural us needle aspirate/biopsy esophags43239Esophagogastroduodenoscopy, flexible, transoral; with biopsy, single or multiple43240Egd transoral transmural drainage pseudocyst43
11750 Excision nail matrix permanent removal 11755 Biopsy nail unit separate procedure 11760 Repair nail bed 11770 Excision pilonidal cyst/sinus simple 11772 Excision pilonidal cyst/sinus complicated 12031 Repair intermediate s/a/t/e 2.5 cm/ 12032 Repair intermediate s/a/t/e
cpt code:11740-2 94.14 cpt code:11750-2 541.06 cpt code:11755-2 123.03 cpt code:11760-2 128.26 cpt code:11762-2 571.07 cpt code:11765-2 581.10 cpt code:11770-2 861.67 cpt code:11771-2 1,092.11 cpt code:11772-2 1,703.29 cpt code:11900-2 56.09 cpt code:11901-2 162.31 cpt code:11920-2 116.23 cpt code
cpt code:11740-2 88.80 cpt code:11750-2 510.36 cpt code:11755-2 116.05 cpt code:11760-2 120.98 cpt code:11762-2 538.68 cpt code:11765-2 548.14 cpt code:11770-2 812.78 cpt code:11771-2 1,030.15 cpt code:11772-2 1,606.65 cpt code:11900-2 52.91 cpt code:11901-2 153.10 cpt code:11920-2 109.63 cpt code
Pain Management CPT/ HCPCS Code . Specialty Medication* CPT/ HCPCS Code Speech Therapy - (My Care Family (MVACO) members (ONLY) CPT Code (Only 1 code is required) Example 92507 Surgical (Use for SDC) CPT Code . Note: For a list of Surgical Procedures that
caputo nicholas j cpt sf carr franklin brent cpt lg . dederich david j cpt sf deep alex john cpt sf delew christopher y cpt mi dell jonathan m cpt ar delp jeffrey l cpt lg delre amanda l cpt ad dembeck michael r cpt lg . hefti michael lee
Table of RVU & Conversion Factor values by CPT/HCPCS Codes: CPT/HCPCS: NON-FACILITY; FACILITY ADA: PAY WORK: PE PE: MPE GLOBAL: CONVERSION TERM: SHORT DESCRIPTION HCPCS: MODIFIER STATUS: RVU RVU: RVU RVU: PERIOD FACTOR: DATE (ADA, HCPCS & OWCP codes only; Refer to AMA CPT) 00100 C: 0.00 0.00: 0.00 0.00: XXX 0.00: Anesth Salivary Gland 00102:
Hospital inpatient 11 Hospital outpatient, asc, physician 11 HCPCS supply code 15 Peripheral venous 16 Hospital inpatient 16 Hospital outpatient, asc, physician 16 HCPCS supply code 18 AV fistula – dialysis circuit 19 Hospital inpatient 19 Hospital outpatient, asc, physician 19 HCPCS supply code 21 Lead extraction and cardiac rhythm management 22
Table of RVU & Conversion Factor values by CPT/HCPCS Codes: CPT; NON-FACILITY FACILITY: ADA PAY: WORK PE: PE MPE: GLOBAL CONVERSION: SHORT DESCRIPTION HCPCS: MODIFIER STATUS: RVU RVU: RVU RVU: PERIOD FACTOR: END DATE (ADA, HCPCS & OWCP codes only; Refer to AMA CPT) 00100 C: 0.00 0.00: 0.00 0.00: XXX 0.00: Anesth Salivary Gland 00102:
2. What is the difference between outpatient and inpatient coding? Answer: Outpatient coders will focus on learning CPT , HCPCS Level II, and ICD-9-CM codes volumes 1 and 2. They will work in physician offices, outpatient clinics, and facility outpatient departments. Outpatient facility coders will also work with Ambu-
