Upload
dangbao
View
215
Download
2
Embed Size (px)
Citation preview
1
Table of Contents
Introduction:
• Features �����������������������������������������������������������������������������������������������������������������������������������������������������������������������2
• Symbols and Conventions �����������������������������������������������������������������������������������������������������������������������������������3
Instructions for Using This Manual ���������������������������������������������������������������������������������������������� 4
HCPCS Coding Procedures ������������������������������������������������������������������������������������������������������������ 5
New/Revised/Deleted Codes for 2016 ��������������������������������������������������������������������������������������� 11
Deleted Codes Crosswalk ������������������������������������������������������������������������������������������������������������ 20
Anatomical Illustrations �������������������������������������������������������������������������������������������������������������� 21
Index to Services, Supplies, Equipment, and Drugs ����������������������������������������������������������������� 53
Tabular List ����������������������������������������������������������������������������������������������������������������������������������� 89
Index to Dental Services and Procedures ��������������������������������������������������������������������������������295
Tabular List of Dental Codes �����������������������������������������������������������������������������������������������������303
Appendixes:
• Appendix A: Table of Drugs and Biologicals ���������������������������������������������������������������������������������������������333
• Appendix B: HCPCS Level II Modifiers ���������������������������������������������������������������������������������������������������������369
• Appendix C: Ambulance Modifiers ��������������������������������������������������������������������������������������������������������������375
• Appendix D: Ambulatory Modifiers �������������������������������������������������������������������������������������������������������������376
• Appendix E: List of Abbreviations ����������������������������������������������������������������������������������������������������������������378
• Appendix F: Place of Service ��������������������������������������������������������������������������������������������������������������������������381
• Appendix G: Type of Service ���������������������������������������������������������������������������������������������������������������������������384
• Appendix H: Medically Unlikely Edits (MUEs) �������������������������������������������������������������������������������������������385
• Appendix I: Payment Status Indicators �������������������������������������������������������������������������������������������������������407
• Appendix J: ASC Payment Indicators ����������������������������������������������������������������������������������������������������������408
• Appendix K: PQRS Table with HCPCS Code Numerator and Corresponding Denominator �������409
• Appendix L: Column 1 and Column 2 Correct Coding Edits ���������������������������������������������������������������412
• Appendix M: General Correct Coding Policies �����������������������������������������������������������������������������������������418
• Appendix N: Pub 100 References������������������������������������������������������������������������������������������������������������������425
0_HCPCS_FM.indd 1 25/11/15 5:50 pm
2
Introduction
This Healthcare Common Procedure Coding System (HCPCS) Level II manual goes beyond the basics to help you to code accurately and efficiently. In addition to including the official Alphabetic Index and Tabular List for services, supplies, durable medical equipment, and drugs which the Centers for Medicare and Medicaid Services (CMS) developed, we also included the Alphabetic Index and Tabular List for Current Dental Terminology (CDT® codes) from the American Dental Association.
FeaturesWe’ve crafted a select set of bonus features based on requests from coders in the field as well as the recommendations of our core group of veteran coding educators. Features that you’ll benefit from page after page include:
• HCPCS Coding Procedures guide from CMS to help you to better understand HCPCS codes• Comprehensive list of new/revised/deleted codes for 2016• Deleted Codes Crosswalk• Symbols showing which codes have restrictions based on age or sex of the patient • Medicare and carrier coverage and reimbursement alerts• APC status indicators• HCPCS code modifiers• Full illustrations of body systems at the front of the book so you don’t have to search the manual for these large color
images of body systems • Highlighted coding instructional and informational notes help you recognize important code usage guidance for specific
sections • Intuitive color-coded symbols and alerts identify critical coding and reimbursement issues quickly• A user-friendly page design, including dictionary-style headers, color bleed tabs, and legend keys
Additionally, our dedicated team drew on their years of experience using coding manuals to develop this manual’s user friendly symbols, highlighting, color coding, and tabs, all designed to help you find the information you need quickly.
Let Us Know What You ThinkOur goal for this manual is to support those involved in the business side of healthcare, helping them to do their jobs and do them well. We’d appreciate your feedback, including your suggestions for what you’ll need in a HCPCS resource, so we can be sure our manuals serve your needs.
0_HCPCS_FM.indd 2 25/11/15 5:50 pm
21
AN
ATOM
ICA
L ILLUSTR
ATION
S
Anatomical Illustrations
BRAIN ANATOMY
4_Anatomical Illustrations.indd 21 25/11/15 5:50 pm
22
AnAtomicAl illustrAtionsA
NAT
OM
ICA
L IL
LUST
RAT
ION
S
BREAST ANATOMY
4_Anatomical Illustrations.indd 22 25/11/15 5:50 pm
53
Ind
ex to
ServIceS, Su
pplIeS, equ
Ipmen
t, dru
gS
A-H
ydr
oc
or
t® - A
dH
esive
AA-Hydrocort® J1710Abatacept J0129Abciximab J0130Abdominal pad, tLso L1270Abduction
Control, hip orthosis, hip jointDynamic, adjustable L1680Flexible
Frejka type L1600, L1610Pavlik harness L1620
Semi-flexible, Van Rosen type L1630Static
Adjustable, Ilfeld type, prefabricated L1650Pelvic band or spreader bar L1640Plastic, prefabricated L1660
Control, lower extremity orthosis, hip joint L2624Pillow (miscellaneous durable medical equipment) E1399Restrainer, shoulder L3650
Canvas and webbing L3660Vest type L3675
Rotation barFoot L3150
Adjustable shoe-styled positioning device L3160Including shoes L3140Prefabricated, off-the-shelf, each L3170
Lower extremityHip involvement, jointed, adjustable L2300Straight L2310
Ablation catheterElectrophysiological
3D or vector mapping C1732Other than 3D or vector mapping or cool-tip C1733
Endovascular, noncardiac C1888Extravascular, any modality C1886Tissue, extravascular C1886Ultrasound, focused C9734
Abobotulinumtoxin type A J0586Abortion, induced
17 to 24 weeks S226025 to 28 weeks S226529 to 31 weeks S226632 or greater S2267Drug induced, with other services S0199
Absorption dressing A6251-A6256Access system A4301Accessories
Ambulation devices E0153-E0159Artificial kidney, see also Dialysis
Machines E1510-E1699Beds E0271-E0280, E0300-E0316Wheelchairs E0950-E1030, E2201-E2397, E2626-E2633,
K0001-K0108, K0669Accu-chek® or similar product
Blood glucose meter E0607Test strips, box of 50 A4253
Acetaminophen J0131Acetate concentrate for hemodialysis A4708Acetazolamide sodium J1120Acetylcysteine
Inhalation solution J7604, J7608Injection J0132
Acid concentrate for hemodialysis A4709
Activated carbon filter for hemodialysis A4680Activity therapy
45 minutes or more G0176Per 15 minutes H2032
Acyclovir J0133Adalimumab J0135Adapter
Breast pump A4282Electric/pneumatic ventricular assist device Q0478Neurostimulator C1883Oxygen accessory E1358Pacing lead C1883Pneumatic ventricular assist device Q0504
Addition, see also orthotic device by typeCushion socket
Above knee L5648Below knee L5646
Harness upper extremityDual cable L6676Single cable L6675
Interface replacement for halo procedure L0861Orthotic components, lower extremity K0672, L2750,
L2760, L2780-L2861Prosthesis components
Adjustable heel height L5990SACH foot L5970
Torsion mechanism, upper extremity joint orthotic L3891Wrist unit, flexion, extension L6620
Adenoma detection G9496Adenosine J0153Adhesive
Bandage A6413Conforming A6442-A6447Padding A6441Self-adherent A6453, A6454, A6455Zinc paste impregnated A6456
Barrier C1765Disc or foam pad A5126Dressing
Composite16 sq. in. or less A6203More than 16 sq. in. but less than or equal to 48 sq.
in. A6204More than 48 sq. in A6205
Foam A6214Gauze
16 sq. in. or less A6219More than 16 sq. in. but less than or equal to 48 sq.
in. A6220More than 48 sq. in. A6221
Hydrocolloid16 sq. in. or less A6234More than 16 sq. in. but less than or equal to 48 sq.
in. A6238More than 48 sq. in. A6239
Hydrogel16 sq. in. or less A6245More than 16 sq. in. but less than or equal to 48 sq.
in. A6246More than 48 sq. in. A6247
Specialty16 sq. in. or less A6254More than 16 sq. in. but less than or equal to 48 sq.
in. A6255
Index to Services, Supplies, equipment, drugs
5_Index to Services, Supplies, Equipment, Drugs.indd 53 25/11/15 5:50 pm
54Ind
ex t
o S
erv
IceS
, Su
pplI
eS, e
qu
Ipm
ent,
dru
gS
Adjustment, gastric band - Amphotericin B injection
Ad
just
men
t, g
Ast
ric
BA
nd
- A
mpH
ote
ric
in B
inje
cti
on
Index to Services, Supplies, Equipment, Drugs
More than 48 sq. in. A6256Liquid A4364Remover A4455, A4456Support for breast prosthesis A4280Tape
Nonwaterproof A4450Waterproof A4452
Tissue (wound closure) G0168Adjustment, gastric band S2083Administration
Aerosolized drug therapy S9061Medication
Direct observation H0033Oral, intramuscular and/or subcutaneous medication
T1502Other than oral and/or injectable T1503
Tositumomab G3001Vaccine
Hepatitis B G0010Influenza virus G0008Pneumococcal G0009
Administrative, miscellaneous and investigational A9150-A9999
Adoptive immunotherapy S2107Ado-trastuzumab J9354Adrenal tissue transplant S2103Adrenalin J0171Advance directive S0257Advanced brain imaging G9534, G9535, G9536, G9537,
G9538Aerosol
Compressor E0572Compressor filter A7013, A7014Mask A7015
Aflibercept J0178AFo (ankle foot orthosis) L1900-L1990
Dynamic adjustable E1815, E1830, L4397Fracture L2106-L2116Replace L4392, L4396Walking boot L4631
Agalsidase beta J0180Aggrastat J3246Air bubble detector, dialysis E1530Air fluidized bed E0194Air pressure pad/mattress E0186, E0197Air travel and nonemergency transportation A0140Alarm, pressure, dialysis E1540Alatrofloxacin mesylate J0200Albumin, human
5%, 50 mL P90415%, 250 mL P904525%, 20 mL P904625%, 50 mL P9047
Albuterol, all formulations, inhalation solutionConcentrated
Compounded J7610Noncompounded J7611
Unit doseCompounded J7609Noncompounded J7613, J7620
Alcohol (and drug)Abuse and prevention services G0443, H0001-H2037,
T1006-T1012Not otherwise specified (NOS) H0047Screening G9621, G9622, G9623, G9624Structured, with intervention
15-20 minutes G0396Greater than 30 minutes G0397
Per pint A4244Testing collection and handling only H0048Wipes A4245
Aldesleukin (iL2) J9015Alefacept J0215Alemtuzumab J0202Alert device A9280Alginate dressing A6196, A6197, A6198, A6199Alglucerase J0205Alglucosidase J0220Alglucosidase alfa J0221Alkaline battery
Blood glucose monitorJ cell A4234Other than J cell A4233
Cochlear implant device replacement L8622External infusion pump owned by patient, alkaline K0603
Alloderm® Q4116Allogeneic cord blood harvest S2140Allograft, small intestine and liver S2053Alloskin™ Q4115Alpha-1-proteinase inhibitor, human J0256, J0257Alphanate J7186Alprostadil
Injection J0270Urethral suppository J0275
ALs (advanced life support)Disposable supplies service
Esophageal intubation A0396IV drug therapy A0394
Level 2 A0433Mileage A0390Routine disposable supplies A0398
Alteplase recombinant J2997Alternating pressure mattress/pad replacement pad A4640
Air mattress E0277Powered pressure reducing mattress overlay/pad E0181Replacement only E0182
Alternative communication device board E1902Ambulance A0021-A0999
Air A0430, A0431, A0435, A0436Basic life support (BLS) A0428Disposable supplies A0382-A0398Fixed wing S9960Mileage A0425Nonemergency transport A0080-A0160, A0180-A0200,
A0426, A0428, S0215Oxygen A0422Response and treatment A0998Rotary wing S9961Unlisted service A0999
Ambulation device E0100-E0159Amifostine J0207Amikacin sulfate J0278Aminocaproic acid S0017Aminolevulinate J7309Aminolevulinic acid Hcl J7308Aminophylline J0280Amiodarone Hcl J0282Amitriptyline Hci J1320Ammonia n-13 A9526Ammonia test paper A4774Amniogen® Q4162, Q4163Amniopro® Q4162, Q4163Amniotic membrane V2790Amobarbital J0300Amphotericin B J0285Amphotericin B injection
5_Index to Services, Supplies, Equipment, Drugs.indd 54 25/11/15 5:50 pm
89
Male only Female only Age A2 - Z3 = ASC Payment Indicator A - Y = APC Status IndicatorASC = ASC Approved Procedure Paid under the DME fee schedule Physician Quality Reporting System
Tra
nspo
rTaTion
services in
clud
ing
am
bu
lan
ce (a0021- a
0999) a
0021 - a0396
Transportation Services Including Ambulance (A0021- A0999)
a0021 - a0396
TRANSPORTATION SERVICES INCLUDING
AMBULANCE (A0021- A0999)
HCPCS Level II codes for ambulance services (A0021-A0999)
must be reported with modifiers indicating pick-up origins
and destinations. The modifier describing the arrangement
(QM, QN) is listed first. The modifiers describing the origin
and destination are listed second. Origin and destination
modifiers are created by combining two alpha characters from
the following list. Each alpha character, with the exception
of X, represents either an origin or destination. Each pair of
the alpha characters creates one modifier. The first position
represents the origin and the second the destination. The
modifiers most commonly used are:
D Diagnostic or therapeutic site other than P or H when
these are used as origin codes
E Residential, domiciliary, custodial facility (other than
1819 facility)
G Hospital-based dialysis facility
H Hospital
I Site of transfer (e.g., airport or helicopter pad)
between modes of ambulance transport
J Free standing ESRD facility
N Skilled nursing facility (SNF)
P Physician's office
R Residence
S Scene of accident or acute event
X Intermediate stop at physician's office on way to
hospital (destination code only)
AMBULANCE AND OTHER TRANSPORT SERVICES AND
SUPPLIES (A0021-A0999)
I A0021 Ambulance service, outside state per mile,
transport (Medicaid only) E
Service not separately priced by Part B
I A0080 Non-emergency transportation, per mile -
vehicle provided by volunteer (individual or
organization), with no vested interest E
Service not separately priced by Part B
I A0090 Non-emergency transportation, per mile
- vehicle provided by individual (family
member, self, neighbor) with vested interest E
Service not separately priced by Part B
I A0100 Non-emergency transportation; taxi E
Service not separately priced by Part B
I A0110 Non-emergency transportation and bus, intra
or inter state carrier E
Service not separately priced by Part B
I A0120 Non-emergency transportation: mini-
bus, mountain area transports, or other
transportation systems E
Service not separately priced by Part B
I A0130 Non-emergency transportation: wheel-chair
van E
Service not separately priced by Part B
I A0140 Non-emergency transportation and air travel
(private or commercial) intra or inter state E
Service not separately priced by Part B
I A0160 Non-emergency transportation: per mile -
case worker or social worker E
Service not separately priced by Part B
I A0170 Transportation ancillary: parking fees, tolls,
other E
Service not separately priced by Part B
I A0180 Non-emergency transportation: ancillary:
lodging-recipient E
Service not separately priced by Part B
I A0190 Non-emergency transportation: ancillary:
meals-recipient E
Service not separately priced by Part B
I A0200 Non-emergency transportation: ancillary:
lodging escort E
Service not separately priced by Part B
I A0210 Non-emergency transportation: ancillary:
meals-escort E
Service not separately priced by Part B
I A0225 Ambulance service, neonatal transport, base
rate, emergency transport, one way E
Service not separately priced by Part B
I A0380 BLS mileage (per mile) E
Service not separately priced by Part B
Pub: 100-4, Chap. 15, 20.2; 100-4, Chap. 15,
30.2
I A0382 BLS routine disposable supplies E
Service not separately priced by Part B
Pub: 100-2, Chap. 10, 30.1.1
I A0384 BLS specialized service disposable supplies;
defibrillation (used by ALS ambulances
and BLS ambulances in jurisdictions where
defibrillation is permitted in BLS
ambulances) E
Service not separately priced by Part B
I A0390 ALS mileage (per mile) E
Service not separately priced by Part B
Pub: 100-4, Chap. 15, 20.2; 100-4, Chap. 15,
30.2
I A0392 ALS specialized service disposable supplies;
defibrillation (to be used only in jurisdictions
where defibrillation cannot be performed in
BLS ambulances) E
Service not separately priced by Part B
Pub: 100-2, Chap. 10, 30.1.1
I A0394 ALS specialized service disposable supplies;
IV drug therapy E
Service not separately priced by Part B
I A0396 ALS specialized service disposable supplies;
esophageal intubation E
Service not separately priced by Part B
6_HCPCS_tabular.indd 89 25/11/15 10:03 pm
91
med
ica
l an
d su
rgic
al su
pplies (a4206-a
8004) a
4206 - a4255
Medical and Surgical Supplies (A4206-A8004)
a4206 - a4255
Male only Female only Age A2 - Z3 = ASC Payment Indicator A - Y = APC Status IndicatorASC = ASC Approved Procedure Paid under the DME fee schedule Physician Quality Reporting System
MEDICAL AND SURGICAL SUPPLIES (A4206-A8004)
INJECTION AND INFUSION SUPPLIES (A4206-A4232)
C A4206 Syringe with needle, sterile, 1 cc or less,
each N
Service not separately priced by Part B
C A4207 Syringe with needle, sterile 2 cc, each N
Service not separately priced by Part B
C A4208 Syringe with needle, sterile 3 cc, each N
Service not separately priced by Part B
C A4209 Syringe with needle, sterile 5 cc or greater,
each N
Service not separately priced by Part B
M A4210 Needle-free injection device, each E
Service not separately priced by Part B
D A4211 Supplies for self-administered injections N
Service not separately priced by Part B
C A4212 Non-coring needle or stylet with or without
catheter N
Other carrier priced
C A4213 Syringe, sterile, 20 cc or greater, each N
Service not separately priced by Part B
C A4215 Needle, sterile, any size, each N
Service not separately priced by Part B
D A4216 Sterile water, saline and/or dextrose,
diluent/flush, 10 ml N
D A4217 Sterile water/saline, 500 ml N
DME Modifier: AU
D A4218 Sterile saline or water, metered dose
dispenser, 10 ml N1 N
D A4220 Refill kit for implantable infusion pump N1 N
Other carrier priced
C A4221 Supplies for maintenance of drug infusion
catheter, per week (list drug separately) N
C A4222 Infusion supplies for external drug infusion
pump, per cassette or bag (list drugs
separately) N
C A4223 Infusion supplies not used with external
infusion pump, per cassette or bag (list drugs
separately) N
Service not separately priced by Part B
D A4230 Infusion set for external insulin pump, non
needle cannula type N
Insulin Pump
D A4231 Infusion set for external insulin pump, needle
type N
I A4232 Syringe with needle for external insulin
pump, sterile, 3 cc E
Service not separately priced by Part B
REPLACEMENT BATTERIES (A4233-A4236)
C A4233 Replacement battery, alkaline (other than J
cell), for use with medically necessary home
blood glucose monitor owned by patient,
each E
DME Modifier: NU, KL
Pub: 100-4, Chap. 23, 60.3
C A4234 Replacement battery, alkaline, J cell,
for use with medically necessary home
blood glucose monitor owned by patient,
each E
DME Modifier: NU, KL
C A4235 Replacement battery, lithium, for use with
medically necessary home blood glucose
monitor owned by patient, each E
DME Modifier: NU, KL
C A4236 Replacement battery, silver oxide,
for use with medically necessary home
blood glucose monitor owned by patient,
each E
DME Modifier: NU, KL
OTHER SUPPLIES INCLUDING DIABETES SUPPLIES AND
CONTRACEPTIVES (A4244-A4290)
C A4244 Alcohol or peroxide, per pint N
Service not separately priced by Part B
C A4245 Alcohol wipes, per box N
Service not separately priced by Part B
C A4246 Betadine or pHisoHex solution, per pint N
Service not separately priced by Part B
C A4247 Betadine or iodine swabs/wipes, per box N
Service not separately priced by Part B
C A4248 Chlorhexidine containing antiseptic,
1 ml N1 N
Service not separately priced by Part B
M A4250 Urine test or reagent strips or tablets (100
tablets or strips) E
Service not separately priced by Part B
Pub: 100-2, Chap. 15, 110
S A4252 Blood ketone test or reagent strip, each E
Service not separately priced by Part B
Statute: 1861(n)
D A4253 Blood glucose test or reagent strips for home
blood glucose monitor, per 50 strips N
DME Modifier: NU, KL
Pub: 100-4, Chap. 23, 60.3
D A4255 Platforms for home blood glucose monitor,
50 per box N
6_HCPCS_tabular.indd 91 25/11/15 10:04 pm
107
a9150 - a
9509Administrative, Miscellaneous and Investigational (A9150-A9999)
ad
min
isTraTiv
e, miscella
neo
us a
nd
inv
esTigaTio
na
l (a9150-a
9999)
a9150 - a9509
Male only Female only Age A2 - Z3 = ASC Payment Indicator A - Y = APC Status IndicatorASC = ASC Approved Procedure Paid under the DME fee schedule Physician Quality Reporting System
ADMINISTRATIVE, MISCELLANEOUS AND
INVESTIGATIONAL (A9150-A9999)
MISCELLANEOUS SUPPLIES AND EQUIPMENT (A9150-A9300)
D A9150 Non-prescription drugs B
Other carrier priced
I A9152 Single vitamin/mineral/trace element, oral,
per dose, not otherwise specified E
Service not separately priced by Part B
I A9153 Multiple vitamins, with or without minerals
and trace elements, oral, per dose, not
otherwise specified E
Service not separately priced by Part B
C A9155 Artificial saliva, 30 ml B
Other carrier priced
I A9180 Pediculosis (lice infestation) treatment,
topical, for administration by patient/
caretaker E
Service not separately priced by Part B
M A9270 Non-covered item or service E
Service not separately priced by Part B
Pub: 100-4, Chap. 11, 100.1
S A9272 Wound suction, disposable, includes
dressing, all accessories and components,
any type, each E
Service not separately priced by Part B
Statute: 1861(n)
M A9273 Hot water bottle, ice cap or collar, heat and/
or cold wrap, any type E
Service not separately priced by Part B
S A9274 External ambulatory insulin delivery system,
disposable, each, includes all supplies and
accessories E
Service not separately priced by Part B
Statute: 1861(n)
M A9275 Home glucose disposable monitor, includes
test strips E
Service not separately priced by Part B
S A9276 Sensor; invasive (e.g., subcutaneous),
disposable, for use with interstitial
continuous glucose monitoring system, one
unit = 1 day supply E
Service not separately priced by Part B
Statute: 1861(n)
S A9277 Transmitter; external, for use with interstitial
continuous glucose monitoring system E
Service not separately priced by Part B
Statute: 1861(n)
S A9278 Receiver (monitor); external, for use with
interstitial continuous glucose monitoring
system E
Service not separately priced by Part B
Statute: 1861(n)
S A9279 Monitoring feature/device, stand-alone
or integrated, any type, includes all
accessories, components and electronics,
not otherwise classified E
Service not separately priced by Part B
Statute: 1861(n)
S A9280 Alert or alarm device, not otherwise classified E
Service not separately priced by Part B
Statute: 1861
S A9281 Reaching/grabbing device, any type, any
length, each E
Service not separately priced by Part B
Statute: 1862 SSA
S A9282 Wig, any type, each E
Service not separately priced by Part B
Statute: 1861SSA
S A9283 Foot pressure off loading/supportive device,
any type, each E
Service not separately priced by Part B
Statute: 1862a(i)13
D A9284 Spirometer, non-electronic, includes all
accessories N
Service not separately priced by Part B
M A9300 Exercise equipment E
Service not separately priced by Part B
DIAGNOSTIC AND THERAPEUTIC RADIOPHARMACEUTICALS
(A9500-A9700), SEE ALSO DIAGNOSTIC
RADIOPHARMACEUTICALS (A4641-A4642)
C A9500 Technetium Tc-99m sestamibi, diagnostic,
per study dose N1 N
Other carrier priced
Coding Clinic 2006, Q2, P5
C A9501 Technetium Tc-99m teboroxime, diagnostic,
per study dose N1 N
Other carrier priced
C A9502 Technetium Tc-99m tetrofosmin, diagnostic,
per study dose N1 N
Other carrier priced
Coding Clinic 2006, Q2, P5
C A9503 Technetium Tc-99m medronate, diagnostic,
per study dose, up to 30 millicuries N1 N
Other carrier priced
C A9504 Technetium Tc-99m apcitide, diagnostic, per
study dose, up to 20 millicuries N1 N
Other carrier priced
C A9505 Thallium Tl-201 thallous chloride, diagnostic,
per millicurie N1 N
Other carrier priced
C A9507 Indium In-111 capromab pendetide,
diagnostic, per study dose, up to 10
millicuries N1 N
Other carrier priced
C A9508 Iodine I-131 iobenguane sulfate, diagnostic,
per 0.5 millicurie N1 N
C A9509 Iodine I-123 sodium iodide, diagnostic, per
millicurie N1 N
Other carrier priced
6_HCPCS_tabular.indd 107 25/11/15 10:04 pm
111
b4034 - b4162Enteral and Parenteral Therapy (B4034-B9999)
enTer
al a
nd
paren
Tera
l Ther
apy (b4034-b9999)
b4034 - b4162
Male only Female only Age A2 - Z3 = ASC Payment Indicator A - Y = APC Status IndicatorASC = ASC Approved Procedure Paid under the DME fee schedule Physician Quality Reporting System
ENTERAL AND PARENTERAL THERAPY
(B4034-B9999)
ENTERAL FEEDING SUPPLIES AND EQUIPMENT
(B4034-B4088)
D B4034 Enteral feeding supply kit; syringe fed, per
day, includes but not limited to feeding/
flushing syringe, administration set tubing,
dressings, tape Y
Pub: 100-4, Chap. 23, 60.3
D B4035 Enteral feeding supply kit; pump fed, per day,
includes but not limited to feeding/flushing
syringe, administration set tubing, dressings,
tape Y
D B4036 Enteral feeding supply kit; gravity fed, per
day, includes but not limited to feeding/
flushing syringe, administration set tubing,
dressings, tape Y
D B4081 Nasogastric tubing with stylet Y
Pub: 100-4, Chap. 23, 60.3
D B4082 Nasogastric tubing without stylet Y
D B4083 Stomach tube - Levine type Y
C B4087 Gastrostomy/jejunostomy tube, standard,
any material, any type, each A
C B4088 Gastrostomy/jejunostomy tube, low-profile,
any material, any type, each A
ENTERAL FORMULAS AND ADDITIVES (B4100-B4162)
M B4100 Food thickener, administered orally, per
ounce E
Service not separately priced by Part B
D B4102 Enteral formula, for adults, used to replace
fluids and electrolytes (e.g., clear liquids),
500 ml = 1 unit Y
D B4103 Enteral formula, for pediatrics, used to
replace fluids and electrolytes (e.g., clear
liquids), 500 ml = 1 unit Y
D B4104 Additive for enteral formula (e.g., fiber) E
Service not separately priced by Part B
D B4149 Enteral formula, manufactured blenderized
natural foods with intact nutrients, includes
proteins, fats, carbohydrates, vitamins and
minerals, may include fiber, administered
through an enteral feeding tube, 100 calories
= 1 unit Y
Pub: 100-4, Chap. 23, 60.3
D B4150 Enteral formula, nutritionally complete with
intact nutrients, includes proteins, fats,
carbohydrates, vitamins and minerals, may
include fiber, administered through an enteral
feeding tube, 100 calories = 1 unit Y
D B4152 Enteral formula, nutritionally complete,
calorically dense (equal to or greater than
1.5 kcal/ml) with intact nutrients, includes
proteins, fats, carbohydrates, vitamins and
minerals, may include fiber, administered
through an enteral feeding tube,
100 calories = 1 unit Y
D B4153 Enteral formula, nutritionally complete,
hydrolyzed proteins (amino acids and
peptide chain), includes fats, carbohydrates,
vitamins and minerals, may include fiber,
administered through an enteral feeding
tube, 100 calories = 1 unit Y
D B4154 Enteral formula, nutritionally complete, for
special metabolic needs, excludes inherited
disease of metabolism, includes altered
composition of proteins, fats, carbohydrates,
vitamins and/or minerals, may include fiber,
administered through an enteral feeding
tube, 100 calories = 1 unit Y
D B4155 Enteral formula, nutritionally incomplete/
modular nutrients, includes specific
nutrients, carbohydrates (e.g., glucose
polymers), proteins/amino acids (e.g.,
glutamine, arginine), fat (e.g., medium chain
triglycerides) or combination, administered
through an enteral feeding tube, 100 calories
= 1 unit Y
D B4157 Enteral formula, nutritionally complete, for
special metabolic needs for inherited disease
of metabolism, includes proteins, fats,
carbohydrates, vitamins and minerals, may
include fiber, administered through an enteral
feeding tube, 100 calories = 1 unit Y
D B4158 Enteral formula, for pediatrics, nutritionally
complete with intact nutrients, includes
proteins, fats, carbohydrates, vitamins and
minerals, may include fiber and/or iron,
administered through an enteral feeding
tube, 100 calories = 1 unit Y
D B4159 Enteral formula, for pediatrics, nutritionally
complete soy based with intact nutrients,
includes proteins, fats, carbohydrates,
vitamins and minerals, may include fiber
and/or iron, administered through an enteral
feeding tube, 100 calories = 1 unit Y
D B4160 Enteral formula, for pediatrics, nutritionally
complete calorically dense (equal to or
greater than 0.7 kcal/ml) with intact nutrients,
includes proteins, fats, carbohydrates,
vitamins and minerals, may include fiber,
administered through an enteral feeding
tube, 100 calories = 1 unit Y
D B4161 Enteral formula, for pediatrics, hydrolyzed/
amino acids and peptide chain proteins,
includes fats, carbohydrates, vitamins and
minerals, may include fiber, administered
through an enteral feeding tube, 100 calories
= 1 unit Y
D B4162 Enteral formula, for pediatrics, special
metabolic needs for inherited disease
of metabolism, includes proteins, fats,
carbohydrates, vitamins and minerals, may
include fiber, administered through an enteral
feeding tube, 100 calories = 1 unit Y
6_HCPCS_tabular.indd 111 25/11/15 10:04 pm
295
Ind
ex to
den
tal Serv
IceS an
d Pro
cedu
reSA
bsc
ess - cr
evicu
lAr
An
timic
ro
biA
l Ag
ents
CDT® copyright 2015 American Dental Association. All rights reserved.
AAbscess
Complicated D7520Complicated D7521
Intraoral soft tissue D7510Complicated D7511
AccessionExfoliative cytologic smears D0480Tissue D0472 – D0474Transepithelial cytologic sample D0486
Adjunctive general servicesAnesthesia D9210-D9248Miscellaneous services D9910-D9999Other drugs D9630Professional visit D9310-D9450Therapeutic parenteral drug D9610-D9612
Allograft, soft tissue D7955Alveoloplasty
In conjunctionFour or more teeth D7310One to three teeth D7311
Without conjunctionFour or more teeth D7321One to three teeth D7320
Alveolus, fractureClosed reduction D7670Closed reduction stabilization D7771Open reduction D7671Open reduction stabilization D7770
Amalgam restorations D2140 – D2161Analgesia D9230Anchorage device, temporary
Requiring flap D7293Screw retained plate requiring flap D7292Without flap D7294
AnesthesiaGeneral D9219Local D9210, D9215Regional D9211Trigeminal division block D9212
Apically positioned flap D4245Apicoectomy D3410 – D3426
Anterior D3410Bicuspid (first root) D3421Molar (first root) D3425
Appliance removal D7997Appointment
Cancelled D9986Missed D9987
Arthrocentesis D7870Arthrogram, temporomandibular joint D0320Arthroplasty D7865Arthroscopy D7872 – D7877Arthrotomy D7860Assessment of a patient D0191Athletic mouthguard D9941Autologous blood concentrate D7921
Bbehavior management D9920biologic materials D4265
In conjunction with periradicular surgery D3431biopsy
Brush D7288Oral tissue-hard D7285Oral tissue-soft D7286
bitewingFour images D0274Single image D0270Three images D0273Two images D0272
bleachingExternal, for home application D9975External, per arch D9972External, per tooth D9973Internal, per tooth D9974
bone fragment D9930bone harvest D7295bone tissue, excision D7471 – D7490bridge, See Fixed partial denturesbruxism appliance D9940
Ccancelled appointment D9986caries
Arresting medicament application D1354Risk assessment D0601 – D0603Susceptibility test D0425
carrierFluoride gel D5986Periodontal medicament D5994Radiation D5983Vesiculobullous medicament D5991
case presentation D945cast post and core D2952-D2953casts, diagnostic (study models) D0470cephalometric image, 2-D D0340collection and application of autologous blood
concentrate D7921combined connective tissue and double pedicle graft
D4276complications, post-surgical D9930comprehensive orthodontics D8070 – D8090condylectomy D7840cone beam – ct
Image capture and interpretation D0364 – D0368Image capture only D0380 – D0384Interpretation and report only D0391Post-processing image or image sets D0393 – D0395
connector barDental implant supported D6055Fixed partial denture D6920
conscious sedation D9248consultation D9310coping D2975core buildup D2950coronectomy D7251coronoidectomy D7991counseling
Nutritional D1310Oral hygiene D1330Tobacco D1320
crevicular antimicrobial agents D4381
Index to dental Services and Procedures
7_Index to Dental Services and Procedures.indd 295 25/11/15 5:51 pm
333
Appen
dix
A: TA
ble o
f dru
gs A
nd
bio
log
icA
lsA
.P.L. - AER
OLATE JR
®
Appendix A: Table of drugs and biologicals
DRUG NAME UNIT PER ROUTE CODEA.P.L., SEE CHORIONIC GONADOTROPINABATACEPT 10 mg IV J0129ABBOKINASE OPEN CATH® 250, 000
IU vial IV J3365
ABBOKINASE OPEN-CATH® 5, 000 IU vial
IV J3364
ABBOKINASE® 5, 000 IU vial
IV J3364
ABBOKINASE® 250, 000 IU vial
IV J3365
ABBOKINASE, OPEN CATH, SEE UROKINASEABBOKINASE, SEE UROKINASEABCIXIMAB 10 mg IV J0130ABELCET® 10 mg IV J0287ABELCET, SEE AMPHOTERICIN B LIPID COMPLEXABILIFY DISCMELT® 1 mg INJ J0401ABILIFY DISCMELT® 0.25 mg IM J0400ABILIFY MAINTENA® 0.25 mg IM J0400ABILIFY MAINTENA® 1 mg INJ J0401ABILIFY® 0.25 mg IM J0400ABILIFY® 1 mg INJ J0401ABLC, SEE AMPHOTERICIN BABOBOTULINUMTOXINTYPEA 5 units IM J0586ACCUNEB® 1 mg INH J7611ACCUNEB® 1 mg INH J7613ACEPHEN® 10 mg IV J0131ACETADOTE® 100 mg IV J0132ACETADOTE® per gram INH J7608ACETAMINOPHEN 10 mg IV J0131ACETAZOLAMIDE SODIUM up to 500
mgIM, IV J1120
ACETYLCYSTEINE, INJECTION 100 mg IV J0132ACETYLCYSTEINE, UNIT DOSE FORM per gram INH J7604,
J7608ACHROMYCIN, SEE TETRACYCLINEACLASTA® 1 mg IV J3489ACTAMIN® 10 mg IV J0131ACTEMRA® 1 mg IV J3262ACTEMRA, SEE TOCILIZUMABACTH GEL® up to 40
unitsIV, IM, SC J0800
ACTH, SEE CORTICOTROPINACTH-40 HP® up to 40
unitsIV, IM, SC J0800
ACTH-80® up to 40 units
IV, IM, SC J0800
DRUG NAME UNIT PER ROUTE CODE
ACTHAR GEL® up to 40 units
IV, IM, SC J0800
ACTHAR® up to 40 units
IV, IM, SC J0800
ACTHAR, SEE CORTICOTROPIN
ACTHREL® 1 mcg J0795
ACTIMMUNE® 3 million units
SC J9216
ACTIMMUNE, SEE INTERFERON GAMMA 1-B
ACTIVASE® 1 mg IV J2997
ACTIVASE, SEE ALTEPLASE RECOMBINANT
ACYCLOVIR 5 mg J0133
ACYS-5® 100 mg IV J0132
ACYS-5® per gram INH J7608
ADAGEN® 25 iu J2504
ADALIMUMAB 20 mg SC J0135
ADBEON® per 3 mg IM J0702
ADCETIS, SEE BRENTUXIMAB VEDOTIN
ADCETRIS® 1 mg IV J9042
ADENOCARD® 1 mg IV J0153
ADENOCARD, SEE ADENOSINE
ADENOSCAN® 1 mg IV J0153
ADENOSCAN, SEE ADENOSINE
ADENOSINE 1 mg IV J0153
ADO-TRASTUZUMAB EMTANSINE 1 mg IV J9354
ADRENACLICK TWO-PACK® 0.1 mg SC, IM J0171
ADRENALIN CHLORIDE, SEE ADRENALIN, EPINEPHRINE
ADRENALIN® 0.1 mg SC, IM J0171
ADRENALIN, EPINEPHRINE 0.1 mg SC, IM J0171
ADRIAMYCIN PFS® 10 mg IV J9000
ADRIAMYCIN PFS, SEE DOXORUBICIN HCL
ADRIAMYCIN RDF® 10 mg IV J9000
ADRIAMYCIN RDF, SEE DOXORUBICIN HCL
ADRIAMYCIN® 10 mg IV J9000
ADRUCIL® 500 mg IV J9190
ADRUCIL, SEE FLUOROURACIL
ADVATE® per IU IV J7185
ADVATE® per IU IV J7192
AEROLATE III® per 40 mg IV J2810
AEROLATE JR® per 40 mg IV J2810
Appendix A Table of Drugs and Biologicals.indd 333 26/11/15 2:29 pm
334
App
end
ix A
: TA
ble
of
dru
gs
An
d b
iolo
gic
Als
Aer
olA
Te s
r® -
An
Ad
ulA
fun
gin
AerolATe sr® - AnAdulAfungin Appendix A: Table of Drugs and Biologicals
DRUG NAME UNIT PER ROUTE CODE
AEROLATE SR® per 40 mg IV J2810
AFLIBERCEPT 1 mg OTH J0178
AGALSIDASE BETA 1 mg IV J0180
AGGRASTAT® 0.25 mg IM, IV J3246
AGGRASTAT, SEE TIROFIBAN HYDROCHLORIDE
A-HYDROCORT, SEE HYDROCORTISONE SODIUM PHOSPHATE
AKINETON HCL® per 5 mg IM, IV J0190
AKINETON, SEE BIPERIDEN
ALA-HIST AC® per 30 mg IM, IV, SC J0745
ALA-TET® up to 250 mg
IM, IV J0120
ALATROFLOXACIN MESYLATE, INJECTION
100 mg IV J0200
ALBUTEROL 0.5 mg INH J7620
ALBUTEROL, CONCENTRATED FORM 1 mg INH J7610, J7611
ALBUTEROL, UNIT DOSE FORM 1 mg INH J7609, J7613
ALDESLEUKIN per single use vial
IM, IV J9015
ALDOMET, SEE METHYLDOPATE HCL
ALDURAZYME® 0.1 mg IV J1931
ALEFACEPT 0.5 mg IM, IV J0215
ALFERON N® 250, 000 IU
IM J9215
ALFERON N, SEE INTERFERON ALFA-N3
ALGLUCERASE per 10 units
IV J0205
ALGLUCOSIDASE ALFA 10 mg IV J0220, J0221
ALIMTA® 10 mg IV J9305
ALKABAN-AQ, SEE VINBLASTINE SULFATE
ALKERAN® 2 mg ORAL J8600
ALKERAN® 50 mg IV J9245
ALKERAN, SEE MELPHALAN, ORAL
ALLERMAX® 50 mg ORAL Q0163
ALLERMAX® 50 mg ORAL Q0163
ALOXI® 25 mcg IV J2469
ALPHA 1-PROTEINASE INHIBITOR, HUMAN
10 mg IV J0256, J0257
ALPHANATE J7186
ALPHANATE® J7186
ALPHANINE SD per IU IV J7194
ALPROLIX per IU IV J7201
ALPROSTADIL, INJECTION 1.25 mcg OTH J0270
DRUG NAME UNIT PER ROUTE CODE
ALPROSTADIL, URETHRAL SUPPOSITORY
OTH J0275
ALSUMA® 6 mg SC J3030
ALTEPLASE RECOMBINANT 1 mg IV J2997
ALUPENT® J7668
ALUPENT® J7669
ALUPENT, SEE METAPROTERENOL SULFATE OR METAPROTERENOL, COMPOUNDED
AMBISOME® 10 mg IV J0289
AMCORT, SEE TRIAMCINOLONE DIACETATE
A-METHAPRED, SEE METHYLPREDNISOLONE SODIUM SUCCINATE
AMEVIVE® 0.5 mg IM, IV J0215
AMGEN, SEE INTERFERON ALPHACON-1
AMIFOSTINE 500 mg IV J0207
AMIKACIN SULFATE 100 mg J0278
AMIKIN PEDIATRIC® 100 mg J0278
AMIKIN® 100 mg J0278
AMINOLEVALINIC ACID HCL unit dose (354 mg)
OTH J7308
AMINOLEVULINATE 1 gm OTH J7309
AMINOPHYLLINE/AMINOPHYLLIN up to 250 mg
IV J0280
AMIODARONE HCL 30 mg IV J0282
AMITRIPTYLINE HCL up to 20 mg
IM J1320
AMOBARBITAL up to 125 mg
IM, IV J0300
AMPHADASE® up to 150 units
SC, IV J3470
AMPHOCIN® 50 mg IV J0285
AMPHOCIN, SEE AMPHOTERICIN B
AMPHOTEC® J0288
AMPHOTERICIN B 50 mg IV J0285
AMPHOTERICIN B, LIPID COMPLEX 10 mg IV J0287, J0289
AMPICILLIN SODIUM up to 500 mg
IM, IV J0290
AMPICILLIN SODIUM/SULBACTAM SODIUM
per 1.5 gm
IM, IV J0295
AMYGDALIN, SEE LAETRILE, AMYGDALIN, VITAMIN B-17
AMYTAL® up to 125 mg
IM, IV J0300
AMYTAL, SEE AMOBARBITAL
ANABOLIN LA 100, SEE NANDROLONE DECANOATE
ANADULAFUNGIN 1 mg IV J0348
Appendix A Table of Drugs and Biologicals.indd 334 26/11/15 2:29 pm