hcpcs - aapc · 2. introduction. this healthcare common procedure coding system (hcpcs) level ii...

HCPCSLevel II Expert

2016

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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

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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.

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21

AN

ATOM

ICA

L ILLUSTR

ATION

S

Anatomical Illustrations

BRAIN ANATOMY

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22

AnAtomicAl illustrAtionsA

NAT

OM

ICA

L IL

LUST

RAT

ION

S

BREAST ANATOMY

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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.


Hydrogel16 sq. in. or less A6245More than 16 sq. in. but less than or equal to 48 sq.


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

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54Ind

ex t

o S

erv

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, Su

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Adjustment, gastric band - Amphotericin B injection

Ad

just

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Ast

ric

BA

nd

- A

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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


I A0090 Non-emergency transportation, per mile

- vehicle provided by individual (family

member, self, neighbor) with vested interest E


I A0100 Non-emergency transportation; taxi E


I A0110 Non-emergency transportation and bus, intra

or inter state carrier E


I A0120 Non-emergency transportation: mini-

bus, mountain area transports, or other

transportation systems E


I A0130 Non-emergency transportation: wheel-chair

van E


I A0140 Non-emergency transportation and air travel

(private or commercial) intra or inter state E


I A0160 Non-emergency transportation: per mile -

case worker or social worker E


I A0170 Transportation ancillary: parking fees, tolls,

other E


I A0180 Non-emergency transportation: ancillary:

lodging-recipient E



meals-recipient E



lodging escort E



meals-escort E


I A0225 Ambulance service, neonatal transport, base

rate, emergency transport, one way E


I A0380 BLS mileage (per mile) E


Pub: 100-4, Chap. 15, 20.2; 100-4, Chap. 15,

30.2

I A0382 BLS routine disposable supplies E


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


I A0390 ALS mileage (per mile) E


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


Pub: 100-2, Chap. 10, 30.1.1


IV drug therapy E



esophageal intubation E


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


MEDICAL AND SURGICAL SUPPLIES (A4206-A8004)

INJECTION AND INFUSION SUPPLIES (A4206-A4232)

C A4206 Syringe with needle, sterile, 1 cc or less,

each N


C A4207 Syringe with needle, sterile 2 cc, each N


C A4208 Syringe with needle, sterile 3 cc, each N


C A4209 Syringe with needle, sterile 5 cc or greater,

each N


M A4210 Needle-free injection device, each E


D A4211 Supplies for self-administered injections N


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


C A4215 Needle, sterile, any size, each N


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


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


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


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


each E


C A4235 Replacement battery, lithium, for use with

medically necessary home blood glucose

monitor owned by patient, each E


C A4236 Replacement battery, silver oxide,

for use with medically necessary home


each E


OTHER SUPPLIES INCLUDING DIABETES SUPPLIES AND

CONTRACEPTIVES (A4244-A4290)

C A4244 Alcohol or peroxide, per pint N


C A4245 Alcohol wipes, per box N


C A4246 Betadine or pHisoHex solution, per pint N


C A4247 Betadine or iodine swabs/wipes, per box N


C A4248 Chlorhexidine containing antiseptic,

1 ml N1 N


M A4250 Urine test or reagent strips or tablets (100

tablets or strips) E


Pub: 100-2, Chap. 15, 110

S A4252 Blood ketone test or reagent strip, each E


Statute: 1861(n)

D A4253 Blood glucose test or reagent strips for home

blood glucose monitor, per 50 strips N


Pub: 100-4, Chap. 23, 60.3

D A4255 Platforms for home blood glucose monitor,

50 per box N


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


ADMINISTRATIVE, MISCELLANEOUS AND

INVESTIGATIONAL (A9150-A9999)

MISCELLANEOUS SUPPLIES AND EQUIPMENT (A9150-A9300)

D A9150 Non-prescription drugs B


I A9152 Single vitamin/mineral/trace element, oral,

per dose, not otherwise specified E


I A9153 Multiple vitamins, with or without minerals

and trace elements, oral, per dose, not

otherwise specified E


C A9155 Artificial saliva, 30 ml B


I A9180 Pediculosis (lice infestation) treatment,

topical, for administration by patient/

caretaker E


M A9270 Non-covered item or service E


Pub: 100-4, Chap. 11, 100.1

S A9272 Wound suction, disposable, includes

dressing, all accessories and components,

any type, each E


Statute: 1861(n)

M A9273 Hot water bottle, ice cap or collar, heat and/

or cold wrap, any type E


S A9274 External ambulatory insulin delivery system,

disposable, each, includes all supplies and

accessories E


Statute: 1861(n)

M A9275 Home glucose disposable monitor, includes

test strips E


S A9276 Sensor; invasive (e.g., subcutaneous),

disposable, for use with interstitial

continuous glucose monitoring system, one

unit = 1 day supply E


Statute: 1861(n)

S A9277 Transmitter; external, for use with interstitial

continuous glucose monitoring system E


Statute: 1861(n)

S A9278 Receiver (monitor); external, for use with

interstitial continuous glucose monitoring

system E


Statute: 1861(n)

S A9279 Monitoring feature/device, stand-alone

or integrated, any type, includes all

accessories, components and electronics,

not otherwise classified E


Statute: 1861(n)

S A9280 Alert or alarm device, not otherwise classified E


Statute: 1861

S A9281 Reaching/grabbing device, any type, any

length, each E


Statute: 1862 SSA

S A9282 Wig, any type, each E


Statute: 1861SSA

S A9283 Foot pressure off loading/supportive device,

any type, each E


Statute: 1862a(i)13

D A9284 Spirometer, non-electronic, includes all

accessories N


M A9300 Exercise equipment E


DIAGNOSTIC AND THERAPEUTIC RADIOPHARMACEUTICALS

(A9500-A9700), SEE ALSO DIAGNOSTIC

RADIOPHARMACEUTICALS (A4641-A4642)

C A9500 Technetium Tc-99m sestamibi, diagnostic,

per study dose N1 N


Coding Clinic 2006, Q2, P5

C A9501 Technetium Tc-99m teboroxime, diagnostic,

per study dose N1 N


C A9502 Technetium Tc-99m tetrofosmin, diagnostic,

per study dose N1 N


Coding Clinic 2006, Q2, P5

C A9503 Technetium Tc-99m medronate, diagnostic,

per study dose, up to 30 millicuries N1 N


C A9504 Technetium Tc-99m apcitide, diagnostic, per

study dose, up to 20 millicuries N1 N


C A9505 Thallium Tl-201 thallous chloride, diagnostic,

per millicurie N1 N


C A9507 Indium In-111 capromab pendetide,

diagnostic, per study dose, up to 10

millicuries N1 N


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



111

b4034 - b4162Enteral and Parenteral Therapy (B4034-B9999)

enTer

al a

nd

paren

Tera

l Ther

apy (b4034-b9999)

b4034 - b4162


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


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


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



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,



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


= 1 unit Y

D B4157 Enteral formula, nutritionally complete, for

special metabolic needs for inherited disease

of metabolism, includes proteins, fats,




D B4158 Enteral formula, for pediatrics, nutritionally

complete with intact nutrients, includes


minerals, may include fiber and/or iron,




complete soy based with intact nutrients,

includes proteins, fats, carbohydrates,

vitamins and minerals, may include fiber

and/or iron, administered through an enteral



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,



D B4161 Enteral formula, for pediatrics, hydrolyzed/

amino acids and peptide chain proteins,

includes fats, carbohydrates, vitamins and



= 1 unit Y

D B4162 Enteral formula, for pediatrics, special

metabolic needs for inherited disease

of metabolism, includes proteins, fats,





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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

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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

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AerolATe sr® - AnAdulAfungin Appendix A: Table of Drugs and Biologicals


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


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

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