Version 1
An episode of care, also known as an episode, groups all relevant services provided to a patient for a particular condition within a confined time range. An episode of care serves as a unit of accounting as well as a unit of accountability for providers who take on financial risk for the episode. Defining an episode in such a manner helps to identify sources of variation and to standardize care.
An episode of care for Esophagogastroduodenoscopy Upper GI-Endoscopy, sometimes abbreviated EGD, is a procedural episode. The Esophagogastroduodenoscopy Upper GI-Endoscopy episode includes services related to the procedure such as a facility stay, anesthesia services, as well as services within the 3-day pre- and 14-day post-operative care time window, such as diagnostic services, (imaging, labs etc.), office visits, and ancillary services.
Episode Components
| Triggers | An EGD episode is triggered by an outpatient facility or a professional claim with a procedure trigger code (in any position) and a qualifying diagnosis code (in any position) on the same claim. (Table 1) |
| Typical Diagnosis | Typical diagnosis codes (ICD 10 DX codes) indicate typical care. Claims with typical diagnosis codes usually associated with an episode help steer services into this episode. However, a relevant procedure code is required on the same claim/claim line for the indicated diagnosis code to be incorporated into the episode. (Table 2) |
| Actionable adverse events (AAE) | Actionable adverse events (AAE) are events that are recognized by diagnosis codes (ICD 10 DX codes) and their timing to indicate potential complications of care. They require a relevant procedure code (ICD 10 PX codes; CPT/HCPCS codes) on the same claim/claim line to assign the claim to the episode. Additional rules are used to identify AAEs in addition to the presence of AAE diagnosis codes. For example, relevant acute inpatient readmission claims are flagged as actionable adverse events regardless of the presence of AAE codes. (Table 3) |
| Relevant Procedure Codes | All relevant services within the timeframe of an episode are included within an episode. These include office visits, emergency room visits, inpatient professional or facility services, labs, radiology or ancillary services. Relevant diagnosis and procedure codes help identify which services are included. Some procedure codes are sufficient to stand alone, while others require typical or actionable adverse event (AAE) diagnosis codes on the same claim/claim line to steer services into the episode. (Tables 4 and 5) |
| Relevant Pharmacy | All relevant pharmacy services are included within an episode. These are identified by National Drug Codes (NDC) on a pharmacy claim and are grouped using the RxNorm grouping classification for ease of assigning them into episodes. (Table 6) |
| SubTypes | Episode subtypes are used to adjust the target price and/or to subset episode type for reporting purposes. They are specific to the episode and identified from the trigger claim or from claims during the look-back period. Examples of Subtype Groups: Achalasia, Esophageal Spasm, Stricture, DysphagiaAcute Gastroduodenal UlcerBarrett’s EsophagusEsophageal LacerationEsophageal Reflux and Other Esophagitis |
Code Tables
Table 1: Trigger Codes
| Trigger Type | Code Value |
CPT / HCPCS Triggers | 43200, 43201, 43202, 43204, 43205, 43206, 43211, 43212, 43213, 43214, 43215, 43216, 43217, 43219, 43220, 43226, 43227, 43228, 43229, 43231, 43232, 43233, 43234, 43235, 43236, 43237, 43238, 43239, 43240, 43241, 43242, 43243, 43244, 43245, 43246, 43247, 43248, 43249, 43250, 43251, 43252, 43253, 43254, 43255, 43256, 43257, 43258, 43259, 43266, 43270 |
ICD-10-CM (DX) Qualifying Diagnosis | A050, A051, A052, A053, A058, A059, A070, A071, A5279, B3781, B9681, C153, C154, C155, C158, C159, C160, C161, C162, C163, C164, C165, C166, C168, C169, C170, C171, C172, C178, C179, C269, C451, C457, C459, C463, C464, C467, C469, C480, C481, C482, C488, C49A0, C49A1, C49A2, C49A3, C49A9, C758, C759, C762, C768, C772, C778, C779, C781, C784, C786, C787, C7880, C7889, C7989, C799, C7A00, C7A010, C7A011, C7A012, C7A019, C7A092, C7A094, C7A095, C7A096, C7A098, C7A1, C7A8, C7B00, C7B01, C7B02, C7B04, C7B09, C7B8, C800, C801, C960, C962, C96A, D001, D002, D0140, D0149, D017, D019, D093, D098, D099, D130, D131, D132, D1330, D1339, D371, D372, D373, D374, D375, D376, D378, D379, D440, D442, D449, D483, D484, D487, D489, D490, D4989, D499, D500, D501, D508, D509, D638, D644, D6489, D649, E0843, E0943, E1043, E1143, E1343, E860, E861, E869, F458, I8500, I8501, I8510, I8511, J690, J691, J698, J860, K200, K208, K209, K210, K219, K220, K2210, K2211, K222, K223, K224, K225, K226, K2270, K22710, K22711, K22719, K228, K229, K23, K250, K251, K252, K253, K254, K255, K256, K257, K259, K260, K261, K262, K263, K264, K265, K266, K267, K269, K270, K271, K272, K273, K274, K275, K276, K277, K279, K280, K281, K282, K283, K284, K285, K286, K287, K289, K2900, K2901, K2920, K2930, K2931, K2940, K2941, K2950, K2951, K2960, K2961, K2970, K2971, K2980, K2981, K2990, K2991, K30, K310, K311, K312, K313, K314, K315, K316, K317, K31811, K31819, K3182, K3183, K3184, K3189, K319, K440, K441, K449, K469, K50013, K50113, K50813, K50913, K520, K521, K522, K5221, K5222, K5229, K523, K5281, K52831, K52832, K52838, K52839, K5289, K529, K550, K55011, K55012, K55019, K55021, K55022, K55029, K55032, K55039, K55042, K55049, K55051, K55052, K55059, K55061, K55062, K55069, K551, K5521, K5530, K5531, K5532, K5533, K558, K559, K560, K561, K562, K5660, K567, K5711, K5751, K580, K581, K582, K588, K589, K5900, K591, K592, K598, K599, K625, K632, K633, K634, K6381, K6389, K639, K900, K901, K902, K904, K9041, K9049, K9089, K909, K910, K911, K912, K913, K9161, K9162, K9171, K9172, K9181, K91840, K91841, K91850, K91858, K9189, K920, K921, K922, K9281, K9289, K929, K9410, K9411, K9412, K9413, K9419, K9420, K9421, K9422, K9423, K9429, K9430, K9431, K9433, K9439, Q390, Q391, Q392, Q393, Q394, Q395, Q396, Q398, Q399, Q400, Q401, Q402, Q403, Q408, Q409, Q410, Q411, Q412, Q418, Q419, Q433, Q434, Q438, Q439, Q450, Q451, Q452, Q453, Q458, Q459, R100, R1010, R1011, R1013, R102, R1030, R1031, R1033, R10811, R10813, R10815, R10816, R10817, R10819, R10821, R10823, R10825, R10826, R10827, R10829, R1084, R109, R110, R1110, R1111, R1112, R1113, R1114, R112, R12, R130, R1310, R1311, R1312, R1313, R1314, R1319, R140, R141, R142, R143, R180, R1900, R1901, R1903, R1905, R1906, R1907, R1909, R1911, R1912, R1915, R192, R1930, R1931, R1933, R1935, R1936, R1937, R194, R197, R198, R634, R6889, R933, R935, T18100A, T18108A, T18110A, T18118A, T18120A, T18128A, T18190A, T18198A, Z0389, Z431, Z434, Z4651, Z4659, Z800, Z8500, Z8501, Z85020, Z85028, Z85030, Z85038, Z85040, Z85060, Z85068, Z8507, Z8509, Z85110, Z85230, Z85520, Z85821, Z85831, Z8589, Z859, Z86010, Z8719, Z87738, Z931, Z932, Z934, Z980 |
ICD-10-PCS (PX) Triggers | 0D774DZ, 0D778DZ, 0D778ZZ, 0D914ZX, 0D918ZX, 0D924ZX, 0D927ZX, 0D928ZX, 0D934ZX, 0D937ZX, 0D938ZX, 0D944ZX, 0D947ZX, 0D948ZX, 0D954ZX, 0D957ZX, 0D958ZX, 0D968ZX, 0D978ZX, 0D994ZX, 0D997ZX, 0D998ZX, 0D9A4ZX, 0D9A7ZX, 0D9A8ZX, 0DB14ZX, 0DB17ZX, 0DB18ZX, 0DB24ZX, 0DB27ZX, 0DB28ZX, 0DB34ZX, 0DB37ZX, 0DB38ZX, 0DB44ZX, 0DB47ZX, 0DB48ZX, 0DB54ZX, 0DB57ZX, 0DB58ZX, 0DB68ZX, 0DB78ZX, 0DB94ZX, 0DB97ZX, 0DB98ZX, 0DBA4ZX, 0DBA7ZX, 0DBA8ZX, 0DJ04ZZ, 0DJ07ZZ, 0DJ08ZZ, 0DQ94ZZ, 0DQ97ZZ, 0DQ98ZZ, 0W3P8ZZ |
Table 2: ICD-10 Typical Diagnosis
| Group ID | Group Name | Code Value |
| DXX03119 | Resp – laryngitis – chronic | J370, J371 |
| DXX03129 | Resp – voice disturbance | R498 |
| DXX04100 | Resp – painful breathing | R071, R0781 |
| DXX04127 | empyema, lung abscess | J860 |
| DXX04155 | laryngeal problems | J384 |
| DXX0496 | Resp – cough | R05 |
| DXX0498 | Resp – wheezing | R062 |
| DXX05282 | Unstable angina | R072, R0782, R0789, R079 |
| DXX05345 | Orthostatic Hypotension / Dizziness | I951, R42 |
| DXX06160 | Gastroenteritis | K5289, K529 |
| DXX06162 | GI – diarrhea | R197 |
| DXX06204 | GI – constipation | R150 |
| DXX06206 | GI – abdominal pain | R1012, R1032 |
| DXX06207 | GI – flatulence / gas pain | R140, R141, R142, R143 |
| DXX06208 | GI – symptoms – nec / nos | R194, R198 |
| DXX06211 | GI – abnormal bowel sounds | R1911, R1912, R1915 |
| DXX06212 | GI – visible peristalsis | R192 |
| DXX06214 | GI – abdominal tenderness | R10812, R10822 |
| DXX06216 | GI – abdominal mass | R1902, R1904 |
| DXX06218 | GI – abnormal abdominal imaging study | R935 |
| DXX06219 | GI – abnormal gi imaging study | R933 |
| DXX06221 | GI – personal hx of GI disease | Z8719 |
| DXX06267 | Nausea, vomiting | R110, R1110, R1111, R1112, R1114, R112 |
| DXX06268 | Complicated Hiatal Hernia | K440, K441 |
| DXX06274 | Intestinal infection | A050, A051, A052, A053, A058, A059, A070 |
| DXX06277 | Irritable Bowel and other functional GI disor | K580, K581, K582, K588, K589, K5900, K5901, K5902, K5903, K5904, K591, K598, K599, K634, K6389, K639, K9289, K929 |
| DXX06281 | Diverticulitis, colitis | K5221, K5222, K5712, K5752 |
| DXX06283 | Intestinal Malabsorption, Celiac Disease | K900, K901, K902, K904, K9041, K9049, K9089, K909 |
| DXX06285 | Previous bowel surgery, ostomy status | Z431, Z434, Z4651, Z4659, Z931, Z932, Z934, Z980 |
| DXX06286 | Personal history of GI cancer | Z8500, Z8501, Z85028, Z85038, Z85048, Z85068, Z8507, Z8509 |
| DXX06287 | Hx of colon polyps, family Hx of colon cancer | Z800, Z8371, Z86010 |
| DXX06290 | Cancer of other GI organs; peritoneum | C269, C451, C480, C481, C482, C488, D0140, D0149, D017, D019 |
| DXX06295 | Digestive congenital anomalies | Q408, Q409, Q434, Q438, Q439, Q458, Q459, Z87738 |
| DXX06301 | Marginal Ulcer | K287, K289 |
| DXX06306 | GI Bleed | K2901, K2931, K2941, K2951, K2961, K2971, K2981, K2991, K625, K920, K921, K922 |
| DXX06307 | Intestinal Obstruction | K312, K315, K565, K5660, K5669, R1113 |
| DXX06308 | Other disorders of stomach and duodenum | K311, K313, K314, K31811, K31819, K3182, K3183, K3189, K319 |
| DXX06311 | Vascular Insufficiency of intestine | K550, K55011, K55012, K55019, K55021, K55022, K55029, K55031, K55032, K55039, K55041, K55042, K55049, K55051, K55052, K55059, K55061, K55062, K55069, K551, K5530, K5531, K5532, K5533, K558, K559 |
| DXX06313 | Esophageal Complications | K226 |
| DXX06314 | Digestive system complications | K592 |
| DXX06315 | Fistula GI tract | K316, K632 |
| DXX06316 | Achalasia, Esophageal Spasm, Stricture, Dysphagia | K220, K2210, K222, K224, R1310 |
| DXX06317 | Acute esophagitis, acute gastritis, duodenitis | K2900, K2930, K2940, K2950, K2960, K2970, K2980, K2990 |
| DXX06318 | Acute Gastroduodenal Ulcer w Perforation / Obstruction | K251, K261, K271 |
| DXX06319 | Barrett’s Esophagus | K2270, K22710, K22711, K22719 |
| DXX06320 | Cancer in situ, Esophagus | D001 |
| DXX06321 | Cancer in situ, Stomach | D002 |
| DXX06322 | Cancer of esophagus | C153, C154, C155, C158, C159 |
| DXX06323 | Cancer of stomach | C160, C161, C162, C163, C164, C165, C166, C168, C169, C7A092 |
| DXX06324 | Cancer small bowel | C170, C171, C172, C178, C179, C7A010, C7A011, C7A012, C7A019, C7A094, C7A095 |
| DXX06325 | Diaphragmatic Hernia | K449 |
| DXX06326 | Diverticulosis, Meckel’s diverticulum, Angiodysplasia | K5711, K5731, K5751, K5791 |
| DXX06327 | Gastroduodenal Ulcer | K257, K259, K267, K269, K277, K279 |
| DXX06328 | Gastroduodenal Ulcer w Perforation / Obstruction | K255, K265, K275 |
| DXX06331 | Other Esophageal conditions | A5279, K225, K228, K229, K23, T18100A, T18108A, T18110A, T18118A, T18120A, T18128A, T18190A, T18198A |
| DXX06332 | Dysphagia | R130, R1311, R1312, R1313, R1314, R1319 |
| DXX06336 | Diverticulitis with hemorrhage | K5701, K5713, K5741, K5753 |
| DXX06337 | Toxic Gastroenteritis | K521 |
| DXX06340 | GI inflammation from chemotherapy | K9281 |
| DXX06341 | Crohn’s Disease | K5000, K5080, K5090 |
| DXX06342 | Ulcerative Colitis | K5180 |
| DXX06343 | Acute Peptic Ulcer with Bleed | K250, K252, K260, K262, K270, K272 |
| DXX06344 | Chronic Peptic Ulcer with Bleed | K254, K256, K264, K266, K274, K276 |
| DXX06345 | Acute Gastroduodenal Ulcer | K253, K263, K273 |
| DXX06346 | Dyspepsia | K30 |
| DXX06347 | Alcoholic Gastritis | K2920, K2921 |
| DXX06348 | Ulceration of Intestine | K633 |
| DXX06349 | Angiodysplasia of intestine | K5521, K6381 |
| DXX06350 | Gastroparesis | K3184 |
| DXX06353 | Perforation, Peritonitis, Abd Abscess | R1930, R1931, R1932, R1933, R1934, R1935, R1936, R1937 |
| DXX06356 | Nonspecific Gastroenteritis | K523, K52831, K52832, K52838, K52839 |
| DXX06364 | Heartburn | R12 |
| DXX06365 | Abdominal pain | R100, R1010, R1011, R1013, R102, R1030, R1031, R1033, R1084, R109 |
| DXX06366 | Abdominal mass | R1900, R1901, R1903, R1905, R1906, R1907, R1909 |
| DXX06367 | Abdominal tenderness | R10811, R10813, R10814, R10815, R10816, R10817, R10819, R10821, R10823, R10824, R10825, R10826, R10827, R10829 |
| DXX06368 | Benign Carcinoid Tumor of the GI tract | D120, D121, D122, D123, D124, D125, D126, K635 |
| DXX06369 | Esophageal Reflux and Other Esophagitis | K200, K208, K209, K210 |
| DXX06370 | Crohn’s Disease w Fistula | K50013, K50113, K50813, K50913 |
| DXX06371 | Crohn’s Disease w Abscess | K50014, K50814, K50914 |
| DXX06372 | Ulc Colitis w Obstruction | K51012, K51212, K51312, K51412, K51512, K51812, K51912 |
| DXX06375 | Allergic, Dietetic, Eosinophilic Gastroenteritis | K522, K5229, K5281 |
| DXX06376 | Diverticulitis w Perf, Abscess | K5700, K5740 |
| DXX06380 | Abdominal Hernia w/out Gangrene/Obstruction | K469 |
| DXX06383 | Crohn’s disease w rectal bleeding | K50011, K50811, K50911 |
| DXX06384 | Crohn’s disease w other complications | K50018, K50019, K50818, K50819, K50918, K50919 |
| DXX06389 | Esophageal Varices | I8500, I8501, I8510, I8511 |
| DXX06390 | GERD, Hiatal Hernia, Other Upper GI Disorders | K2211, K310 |
| DXX06393 | Marginal Ulcer w hmg / obstr / perf | K280, K281, K282, K283, K284, K285, K286 |
| DXX06395 | Post GI Surgery Syndromes | K911 |
| DXX06396 | Crohn’s disease w intestinal obstruction | K50012, K50112, K50812, K50912 |
| DXX0641 | Neoplsm – benign neoplsm – esophagus | D130 |
| DXX0642 | Neoplsm – benign neoplsm – stomach | D131, K317 |
| DXX0643 | Neoplsm – benign neoplsm – small intestine | D132, D1330, D1339 |
| DXX0671 | GI – esophagitis | K219 |
| DXX07106 | Other abn of GB, pancreas, liver | Q450, Q451, Q452, Q453 |
| DXX0804 | Neoplsm – malignant neoplsm – gi – nos | C49A0, C49A1, C49A2, C49A3, C49A9 |
| DXX10101 | diabetes mellitus with neurologic manifestations | E0843, E0943, E1043, E1143, E1343 |
| DXX10120 | Thyroid Cancer | D093, D440 |
| DXX10121 | Vitamin, Mineral & Other Nutrl Deficiency | D81818, D81819, E508, E509, E5111, E5112, E512, E518, E519, E52, E530, E531, E538, E539, E54, E559, E560, E561, E568, E569, E58, E59, E60, E610, E611, E612, E613, E614, E615, E616, E617, E618, E619, E630, E631, E638, E639, E641, E642, E648, E649 |
| DXX1067 | Endo – other metabolic ds | E700, E701, E7020, E7021, E7029, E7030, E70310, E70311, E70318, E70319, E70320, E70321, E70328, E70329, E70330, E70331, E70338, E70339, E7039, E7040, E7041, E7049, E705, E708, E709, E710, E71110, E71111, E71118, E71120, E71121, E71128, E7119, E712, E7200, E7201, E7202, E7203, E7204, E7209, E7210, E7211, E7212, E7219, E7220, E7221, E7222, E7223, E7229, E723, E724, E7250, E7251, E7252, E7253, E7259, E728, E729, E7400, E7401, E7402, E7403, E7404, E7409, E7420, E7421, E7429, E744, E748, E749, E771, E786 |
| DXX1583 | Congenital GI Problems in NB | Q390, Q391, Q392, Q393, Q394, Q395, Q396, Q398, Q399, Q400, Q401, Q402, Q403, Q410, Q411, Q412, Q418, Q419, Q433 |
| DXX16289 | Prvn – screening – other | Z130 |
| DXX16293 | Iron deficiency and other anemias | D500, D501, D508, D509, D510, D511, D512, D513, D518, D519, D520, D521, D528, D529, D530, D531, D532, D538, D539, D638, D644, D6489, D649 |
| DXX1767 | Cancer; other and unspecified primary | C457, C459, C762, C768, C7A00, C7A096, C7A098, C7B00, C7B09, C7B8, C801 |
| DXX1768 | Secondary malignancies | C772, C778, C779, C786, C787, C7880, C7889, C7989, C799, C7B01, C7B02, C7B04, R180 |
| DXX1771 | Metastatic Cancer and Acute Leukemia | C781, C784 |
| DXX1772 | Neoplasms of unspecified nature or uncertain behavior | D098, D099, D371, D372, D373, D374, D375, D376, D378, D379, D442, D449, D483, D484, D487, D489, D490, D4989, D499, Q8500, Q8501, Q8502, Q8503, Q8509 |
| DXX1773 | Disseminated Metastatic Cancer | C800 |
| DXX1774 | Neuroendocrine, Myeloproliferative Cancers | C463, C464, C467, C469, C758, C759, C7A1, C7A8, C960, C962, C96A |
| DXX1846 | Opportunistic Infections | B3781 |
| DXX1849 | Other bacterial infections | B9681 |
| DXX1854 | Parasitic Infections: Amebiasis, Giardiasis | A071 |
| DXX19104 | Other somatoform disorders | F458 |
| DXX1923 | BH – other ds | F9821 |
| DXX1963 | Anxiety Disorders | F064 |
| DXX2104 | NS – acute pain – post op | G8918 |
| DXX2159 | Toxic Effects of Radiation | K520 |
| DXX2332 | Sxs – symptoms -other | R6889 |
| DXX2361 | complications of surgical procedures | K910 |
| DXX2369 | Abnormal weight loss | R634 |
| DXX2370 | Fever & Chills | R5081, R509, R6883 |
| DXX2377 | Personal history of blood, endocrine, nutritional disorders | Z8639 |
| DXX2379 | Observation/Examination | Z0389 |
| DXX2385 | Personal history of cancer | Z85020, Z85030, Z85040, Z85060, Z85110, Z85230, Z85520, Z85821, Z85831, Z8589, Z859 |
Table 3: ICD-10 Actionable Adverse Events
| Group ID | Group Name | Code Value |
| DXX01384 | Hemorrhagic Stroke | I60, I600, I6000, I6001, I6002, I601, I6010, I6011, I6012, I602, I6020, I6021, I6022, I603, I6030, I6031, I6032, I604, I605, I6050, I6051, I6052, I606, I607, I608, I609, I610, I611, I612, I613, I614, I615, I616, I618, I619, I6200, I6201, I6202, I6203, I621, I629 |
| DXX01385 | Thromboembolic Stroke | I6300, I63011, I63012, I63013, I63019, I6302, I63031, I63032, I63033, I63039, I6309, I6310, I63111, I63112, I63113, I63119, I6312, I63131, I63132, I63133, I63139, I6319, I6320, I63211, I63212, I63213, I63219, I6322, I63231, I63232, I63233, I63239, I6329, I6330, I63311, I63312, I63313, I63319, I63321, I63322, I63323, I63329, I63331, I63332, I63333, I63339, I63341, I63342, I63343, I63349, I6339, I6340, I63411, I63412, I63413, I63419, I63421, I63422, I63423, I63429, I63431, I63432, I63433, I63439, I63441, I63442, I63443, I63449, I6349, I6350, I63511, I63512, I63513, I63519, I63521, I63522, I63523, I63529, I63531, I63532, I63533, I63539, I63541, I63542, I63543, I63549, I6359, I636, I638, I639 |
| DXX01388 | Transient cerebral ischemia, TIA | G450, G451, G452, G458, G459, G460, G461, G462, I67841, I67848 |
| DXX01391 | Meningitis / Encephalitis | G038 |
| DXX04126 | other lung complications | J90, J940, J941, J942, J949, J954, J955, J95859, J9588, R091 |
| DXX04127 | empyema, lung abscess | J869 |
| DXX04130 | Aspiration Pneumonia | J690, J698 |
| DXX04138 | Viral Pneumonia | B012, J120, J122, J123, J1289, J129 |
| DXX04142 | Respiratory Failure | J80, J9584, J9600, J9601, J9602, J9610, J9611, J9612, J9620, J9621, J9622, J9690, J9691, J9692, R092 |
| DXX04154 | Respiratory Insufficiency | R0681, R0901, R0902, Y654, Z9981 |
| DXX04164 | Chronic Fungal and Other Pneumonias | A70, B390, B391, B392, B440, B7781 |
| DXX04170 | Ventilator Associated Pneumonia | J95851 |
| DXX04172 | Gram Negative Pneumonia | J155, J156 |
| DXX04173 | MRSA Pneumonia | J15212 |
| DXX04174 | Other Staph Pneumonia | J1520, J15211, J1529 |
| DXX04176 | Resp Failure following trauma / surgery | J951, J952, J953, J95821, J95822 |
| DXX04177 | Ventilator Dependence | Z9911, Z9912 |
| DXX04187 | Other lung problems | J918, J9811, J9819, R063 |
| DXX04188 | Other Bacterial Pneumonia | J158, J159, J17, J188, J189 |
| DXX04189 | Debilitating Viral Pneumonia | J09X1 |
| DXX04190 | Influenza with Pneumonia | J1000, J1001, J1008, J1100, J1108 |
| DXX05272 | dic, coagulation, hemorrhagic disorders | D65, D7582 |
| DXX05275 | Phlebitis, Deep vein thrombosis (DVT) | I8000, I8001, I8002, I8003, I8010, I8011, I8012, I8013, I80201, I80202, I80203, I80209, I80211, I80212, I80213, I80219, I80221, I80222, I80223, I80229, I80231, I80232, I80233, I80239, I80291, I80292, I80293, I80299, I803, I809, I821, I82401, I82402, I82403, I82409, I82411, I82412, I82413, I82419, I82421, I82422, I82423, I82429, I82431, I82432, I82433, I82439, I82441, I82442, I82443, I82449, I82491, I82492, I82493, I82499, I824Y1, I824Y2, I824Y3, I824Y9, I824Z1, I824Z2, I824Z3, I824Z9, I82811, I82812, I82813, I82819, I82890, I8290, I87001, I87002, I87003, I87009, I87011, I87012, I87013, I87019, I87021, I87022, I87023, I87029, I87031, I87032, I87033, I87039, I87091, I87092, I87093, I87099 |
| DXX05281 | STEMI | I2101, I2102, I2109, I2111, I2119, I2121, I2129, I213 |
| DXX05289 | Subendocardial infarct | I214 |
| DXX05291 | Recent AMI | I220, I221, I222, I228, I229 |
| DXX05297 | Hypotension / Syncope | I952, I9581, I959, R55 |
| DXX05298 | Fluid Electrolyte Acid Base Problems | E8330, E8339, E8340, E8341, E8342, E8349, E870, E871, E872, E873, E874, E875, E876, E8770, E8779, E878 |
| DXX05299 | Shock / Cardiac Arrest | I462, I468, I469, I4901, I4902, R570, R571, R578, R579, T782XXA, T882XXA, T886XXA |
| DXX05311 | Other Phlebitis, Lymphangitis, varices | I808, I891 |
| DXX05335 | Sinus Node Dysfunction | I498, R001 |
| DXX05336 | Supraventricular Tachyarrhythmias | I471, I492 |
| DXX05339 | Ventricular Arrhythmias | I470, I472 |
| DXX05340 | Other cardiac arrhythmias | I479, I499, R000, R002 |
| DXX05372 | Shock during or following cardiac surgery | I97120, I97121, I97710, I97790 |
| DXX05373 | Shock during or post-procedure | I97711, I97791, I9788 |
| DXX05375 | Dehydration | E860, E861, E869 |
| DXX06160 | Gastroenteritis | A080, A0811, A0819, A082, A0831, A0832, A0839, A084, A088, A09 |
| DXX06305 | C-Difficile Infection | A047 |
| DXX06307 | Intestinal Obstruction | K560, K561, K562, K567 |
| DXX06313 | Esophageal Complications | K223 |
| DXX06314 | Digestive system complications | K913, K9181, K9182, K9183 |
| DXX06335 | Retroperitoneal Abscess | K6812, K6819, K689 |
| DXX06338 | Complications of colostomy, enterostomy | K9400, K9401, K9402, K9403, K9409, K9410, K9411, K9412, K9413, K9419, K9420, K9421, K9422, K9423, K9429, K9430, K9431, K9433, K9439 |
| DXX06352 | Hemoperitoneum | K661 |
| DXX06353 | Perforation, Peritonitis, Abd Abscess | K630, K631, K650, K651, K658, K659, N733, R188 |
| DXX09192 | Dermatitis, Urticaria | T7841XA |
| DXX11143 | Urinary Tract Infection | N10, N110, N111, N118, N119, N12, N136, N151, N159, N16, N2884, N2885, N2886, N3000, N3001, N3010, N3011, N3020, N3021, N3030, N3031, N3080, N3081, N3090, N3091, N340, N341, N342, N343, N35111, N35112, N35113, N35114, N35119, N3512, N37, N390, R309 |
| DXX11167 | Acute Kidney Failure | N170, N171, N172, N178, N179, N19, N990 |
| DXX16296 | Hemorrhage | R58 |
| DXX1846 | Opportunistic Infections | B395, B399, B488 |
| DXX1849 | Other bacterial infections | R899 |
| DXX1850 | MRSA, Drug Resistant Infections | A4902, B9562, Z1610, Z1611, Z1612, Z1619, Z1620, Z1621, Z1622, Z1623, Z1624, Z1629, Z1630, Z1631, Z1632, Z1633, Z16341, Z16342, Z1635, Z1639 |
| DXX1851 | Sepsis | A400, A401, A403, A408, A409, A4101, A4102, A411, A412, A413, A414, A4150, A4151, A4152, A4153, A4159, A4181, A4189, A419, A5486, B377 |
| DXX1852 | Severe Sepsis | A483, R6511, R6520, R6521 |
| DXX1853 | Bacteremia, SIRS, no organ dysfunction | R6510, R7881 |
| DXX2161 | Complications from Central Line | T80218A, T80219A, T8022XA |
| DXX2171 | Adverse effects of drugs | G4440, G4441, K1232, R502, T360X5A, T360X5D, T361X5A, T361X5D, T362X5A, T362X5D, T363X5A, T363X5D, T364X5A, T364X5D, T365X5A, T365X5D, T366X5A, T366X5D, T367X5A, T367X5D, T368X5A, T368X5D, T3695XA, T3695XD, T370X5A, T370X5D, T371X5A, T371X5D, T372X5A, T372X5D, T373X5A, T373X5D, T374X5A, T374X5D, T375X5A, T375X5D, T378X5A, T378X5D, T3795XA, T3795XD, T380X5A, T380X5D, T381X5A, T381X5D, T382X5A, T382X5D, T383X5A, T383X5D, T384X5A, T384X5D, T385X5A, T385X5D, T386X5A, T386X5D, T387X5A, T387X5D, T38805A, T38805D, T38815A, T38815D, T38895A, T38895D, T38905A, T38905D, T38995A, T38995D, T39015A, T39015D, T39095A, T39095D, T391X5A, T391X5D, T392X5A, T392X5D, T39315A, T39315D, T39395A, T39395D, T394X5A, T394X5D, T398X5A, T398X5D, T3995XA, T3995XD, T400X5A, T400X5D, T402X5A, T402X5D, T403X5A, T403X5D, T404X5A, T404X5D, T40605A, T40605D, T40695A, T40695D, T407X5A, T407X5D, T40905A, T40905D, T40995A, T40995D, T415X5A, T415X5D, T420X5A, T420X5D, T421X5A, T421X5D, T422X5A, T422X5D, T423X5A, T423X5D, T424X5A, T424X5D, T425X5A, T425X5D, T426X5A, T426X5D, T4275XA, T4275XD, T428X5A, T428X5D, T43015A, T43015D, T43025A, T43025D, T431X5A, T431X5D, T43205A, T43205D, T43215A, T43215D, T43225A, T43225D, T43295A, T43295D, T433X5A, T433X5D, T434X5A, T434X5D, T43505A, T43505D, T43595A, T43595D, T43605A, T43605D, T43615A, T43615D, T43625A, T43625D, T43635A, T43635D, T43695A, T43695D, T438X5A, T438X5D, T4395XA, T4395XD, T440X5A, T440X5D, T441X5A, T441X5D, T442X5A, T442X5D, T443X5A, T443X5D, T444X5A, T444X5D, T445X5A, T445X5D, T446X5A, T446X5D, T447X5A, T447X5D, T448X5A, T448X5D, T44905A, T44905D, T44995A, T44995D, T450X5A, T450X5D, T451X5A, T451X5D, T452X5A, T452X5D, T453X5A, T453X5D, T454X5A, T454X5D, T45515A, T45515D, T45525A, T45525D, T45605A, T45605D, T45615A, T45615D, T45625A, T45625D, T45695A, T45695D, T457X5A, T457X5D, T458X5A, T458X5D, T4595XA, T4595XD, T460X5A, T460X5D, T461X5A, T461X5D, T462X5A, T462X5D, T463X5A, T463X5D, T464X5A, T464X5D, T465X5A, T465X5D, T466X5A, T466X5D, T467X5A, T467X5D, T468X5A, T468X5D, T46905A, T46905D, T46995A, T46995D, T470X5A, T470X5D, T471X5A, T471X5D, T472X5A, T472X5D, T473X5A, T473X5D, T474X5A, T474X5D, T475X5A, T475X5D, T476X5A, T476X5D, T477X5A, T477X5D, T478X5A, T478X5D, T4795XA, T4795XD, T480X5A, T480X5D, T481X5A, T481X5D, T48205A, T48205D, T48295A, T48295D, T483X5A, T483X5D, T484X5A, T484X5D, T485X5A, T485X5D, T486X5A, T486X5D, T48905A, T48905D, T48995A, T48995D, T490X5A, T490X5D, T491X5A, T491X5D, T492X5A, T492X5D, T493X5A, T493X5D, T494X5A, T494X5D, T495X5A, T495X5D, T496X5A, T496X5D, T497X5A, T497X5D, T498X5A, T498X5D, T4995XA, T4995XD, T500X5A, T500X5D, T501X5A, T501X5D, T502X5A, T502X5D, T503X5A, T503X5D, T504X5A, T504X5D, T505X5A, T505X5D, T506X5A, T506X5D, T507X5A, T507X5D, T508X5A, T508X5D, T50905A, T50905D, T50995A, T50995D, T50A15A, T50A25A, T50A95A, T50B15A, T50B15D, T50B95A, T50B95D, T50Z15A, T50Z15D, T50Z95A, T50Z95D |
| DXX2175 | Complications of anesthesia | T410X5A, T411X5A, T41205A, T41295A, T413X5A, T4145XA, T883XXA, T884XXA, T8852XA, T8853XA, T8859XA, Y653, Y700, Y701, Y702, Y703, Y708 |
| DXX2361 | complications of surgical procedures | D7801, D7802, D7811, D7812, D7821, D7822, D7831, D7832, D7833, D7834, E3601, E3602, E3611, E3612, E89810, E89811, E89820, E89821, E89822, E89823, G970, G9731, G9732, G9748, G9749, G9751, G9752, G9761, G9762, G9763, G9764, G9781, G9782, I97131, I97191, I97410, I97411, I97418, I9742, I9751, I9752, I97610, I97611, I97618, I9762, I97620, I97621, I97622, I97630, I97631, I97638, I97640, I97641, I97648, I9789, J9561, J9562, J9571, J9572, J95830, J95831, J95860, J95861, J95862, J95863, J9589, K912, K9161, K9162, K9171, K9172, K91840, K91841, K91850, K91858, K91870, K91871, K91872, K91873, K9189, L7601, L7602, L7611, L7612, L7621, L7622, L7631, L7632, L7633, L7634, M96810, M96811, M96820, M96821, M96830, M96831, M96840, M96841, M96842, M96843, N9961, N9962, N9971, N9972, N99820, N99821, N99840, N99841, N99842, N99843, R5082, T81718A, T81719A, T8172XA, T8182XA, T8189XA, T819XXA, T888XXA, Y624, Y626, Y628, Y629, Y652, Y6551, Y6552, Y710, Y711, Y712, Y713, Y718, Y720, Y721, Y722, Y723, Y728, Y730, Y731, Y732, Y733, Y738, Y740, Y741, Y742, Y743, Y748, Y750, Y751, Y752, Y753, Y758, Y760, Y761, Y762, Y763, Y768, Y770, Y771, Y772, Y773, Y778, Y780, Y781, Y782, Y783, Y788, Y790, Y791, Y792, Y793, Y798, Y800, Y801, Y802, Y803, Y808, Y810, Y811, Y812, Y813, Y818, Y828, Y829, Y848 |
| DXX2362 | complications of medical care | D7881, D7889, E368, E8989, I973, J95850, L7681, L7682, M9689, R680, T7841XD, T801XXA, T8181XA, T880XXA, T881XXA, T887XXA, T889XXA, Y633, Y634, Y635, Y636, Y638, Y639, Y641, Y648, Y649, Y658, Y66, Y69, Y844, Y846, Y847 |
| DXX2395 | Foreign body left during procedure | T81500A, T81501A, T81502A, T81503A, T81504A, T81505A, T81506A, T81507A, T81508A, T81509A, T81510A, T81511A, T81512A, T81513A, T81514A, T81515A, T81516A, T81517A, T81518A, T81519A, T81520A, T81521A, T81522A, T81523A, T81524A, T81525A, T81526A, T81527A, T81528A, T81529A, T81530A, T81531A, T81532A, T81533A, T81534A, T81535A, T81536A, T81537A, T81538A, T81539A, T81590A, T81591A, T81592A, T81593A, T81594A, T81595A, T81596A, T81597A, T81598A, T81599A, T8160XA, T8161XA, T8169XA |
| DXX9910 | HAC 02: Air Embolism | T800XXA |
Table 4: ICD-10 Relevant Procedure Codes
| Group ID | Group Name | Code Value |
| PXX0108 | Other non-OR or closed therapeutic nervous system procedures – 008 | 3C1ZX8Z |
| PXX03229 | Nonoperative removal of foreign body – 229 | 0DC17ZZ, 0DC18ZZ, 0DC27ZZ, 0DC28ZZ, 0DC37ZZ, 0DC38ZZ, 0DC57ZZ, 0DC58ZZ |
| PXX03231 | Other therapeutic procedures – 231 | 0WQFXZZ, 3E0G8TZ |
| PXX04178 | CT scan chest – 178 | BW2400Z, BW240ZZ, BW2410Z, BW241ZZ, BW24Y0Z, BW24YZZ, BW24ZZZ |
| PXX05226 | Other diagnostic radiology and related techniques – 226 | BD14ZZZ |
| PXX0561 | Other OR procedures on vessels other than head and neck – 061 | 06L30CZ, 06L30DZ, 06L30ZZ, 06L33ZZ, 06L34CZ, 06L34DZ, 06L34ZZ, 06L43ZZ |
| PXX06179 | CT scan abdomen – 179 | B52F00Z, B52F0ZZ, B52F10Z, B52F1ZZ, B52FY0Z, B52FYZZ, B52FZZZ, B52G00Z, B52G0ZZ, B52G10Z, B52G1ZZ, B52GY0Z, B52GYZZ, B52GZZZ, B52H00Z, B52H0ZZ, B52H10Z, B52H1ZZ, B52HY0Z, B52HYZZ, B52HZZZ, BD2400Z, BD240ZZ, BD2410Z, BD241ZZ, BD24Y0Z, BD24YZZ, BD24ZZZ, BF2500Z, BF250ZZ, BF2510Z, BF251ZZ, BF25Y0Z, BF25YZZ, BF25ZZZ, BF2600Z, BF260ZZ, BF2610Z, BF261ZZ, BF26Y0Z, BF26YZZ, BF26ZZZ, BF2700Z, BF270ZZ, BF2710Z, BF271ZZ, BF27Y0Z, BF27YZZ, BF27ZZZ, BF2C00Z, BF2C0ZZ, BF2C10Z, BF2C1ZZ, BF2CY0Z, BF2CYZZ, BF2CZZZ, BW2000Z, BW200ZZ, BW2010Z, BW201ZZ, BW20Y0Z, BW20YZZ, BW20ZZZ, BW2G00Z, BW2G0ZZ, BW2G10Z, BW2G1ZZ, BW2GY0Z, BW2GYZZ, BW2GZZZ |
| PXX06185 | Upper gastrointestinal X-ray – 185 | BD11YZZ, BD15YZZ, BD15ZZZ |
| PXX06186 | Lower gastrointestinal X-ray – 186 | BD14YZZ |
| PXX06194 | Diagnostic ultrasound of gastrointestinal tract – 194 | BD41ZZZ, BD42ZZZ, BD47ZZZ, BD48ZZZ, BD49ZZZ, BD4CZZZ, BF40ZZZ, BF42ZZZ, BF43ZZZ, BF45ZZZ, BF46ZZZ, BF47ZZZ, BF4CZZZ |
| PXX06196 | Diagnostic ultrasound of abdomen or retroperitoneum – 196 | BW40ZZZ |
| PXX06238 | Adjust / Revise Lap Adjustable Gastric Band | 3E0G3GC |
| PXX0668 | Injection or ligation of esophageal varices – 068 | 06L33CZ, 06L33DZ |
| PXX0669 | Esophageal dilatation – 069 | 0D717DZ, 0D717ZZ, 0D718DZ, 0D718ZZ, 0D727DZ, 0D727ZZ, 0D728DZ, 0D728ZZ, 0D737DZ, 0D737ZZ, 0D738DZ, 0D738ZZ, 0D747DZ, 0D747ZZ, 0D748DZ, 0D748ZZ, 0D757DZ, 0D757ZZ, 0D758DZ, 0D758ZZ |
| PXX0670 | Upper gastrointestinal endoscopy, biopsy – 070 | 0D913ZX, 0D914ZX, 0D917ZX, 0D918ZX, 0D923ZX, 0D924ZX, 0D927ZX, 0D928ZX, 0D933ZX, 0D934ZX, 0D937ZX, 0D938ZX, 0D943ZX, 0D944ZX, 0D947ZX, 0D948ZX, 0D953ZX, 0D954ZX, 0D957ZX, 0D958ZX, 0D963ZX, 0D964ZX, 0D967ZX, 0D968ZX, 0D973ZX, 0D974ZX, 0D977ZX, 0D978ZX, 0D983ZX, 0D984ZX, 0D987ZX, 0D988ZX, 0D993ZX, 0D994ZX, 0D997ZX, 0D998ZX, 0D9A3ZX, 0D9A4ZX, 0D9A7ZX, 0D9A8ZX, 0D9B3ZX, 0D9B4ZX, 0D9B7ZX, 0D9B8ZX, 0D9C3ZX, 0D9C4ZX, 0D9C7ZX, 0D9C8ZX, 0DB13ZX, 0DB14ZX, 0DB17ZX, 0DB18ZX, 0DB23ZX, 0DB24ZX, 0DB27ZX, 0DB28ZX, 0DB33ZX, 0DB34ZX, 0DB37ZX, 0DB38ZX, 0DB43ZX, 0DB44ZX, 0DB47ZX, 0DB48ZX, 0DB53ZX, 0DB54ZX, 0DB57ZX, 0DB58ZX, 0DB63ZX, 0DB64ZX, 0DB67ZX, 0DB68ZX, 0DB73ZX, 0DB74ZX, 0DB77ZX, 0DB78ZX, 0DB83ZX, 0DB84ZX, 0DB87ZX, 0DB88ZX, 0DB93ZX, 0DB94ZX, 0DB97ZX, 0DB98ZX, 0DBA3ZX, 0DBA4ZX, 0DBA7ZX, 0DBA8ZX, 0DBB3ZX, 0DBB4ZX, 0DBB7ZX, 0DBB8ZX, 0DBC3ZX, 0DBC4ZX, 0DBC7ZX, 0DBC8ZX, 0DJ08ZZ, 0DJ68ZZ |
| PXX0692 | Other bowel diagnostic procedures – 092 | 0D960ZX, 0D970ZX, 0D980ZX, 0D990ZX, 0D9A0ZX, 0D9B0ZX, 0D9C0ZX, 0DB60ZX, 0DB70ZX, 0DB80ZX, 0DB90ZX, 0DBA0ZX, 0DBB0ZX, 0DBC0ZX, 0DJ63ZZ, 0DJ64ZZ, 0DJ67ZZ |
| PXX0693 | Other non-OR upper GI therapeutic procedures – 093 | 04L23DZ, 06L13DZ, 06L43CZ, 06L43DZ, 06L53DZ, 0D20X0Z, 0D20XUZ, 0D20XYZ, 0D514ZZ, 0D518ZZ, 0D524ZZ, 0D528ZZ, 0D534ZZ, 0D538ZZ, 0D544ZZ, 0D548ZZ, 0D554ZZ, 0D558ZZ, 0D564ZZ, 0D568ZZ, 0D574ZZ, 0D578ZZ, 0D774DZ, 0D778DZ, 0D778ZZ, 0DB14ZZ, 0DB18ZZ, 0DB24ZZ, 0DB28ZZ, 0DB34ZZ, 0DB38ZZ, 0DB48ZZ, 0DB54ZZ, 0DB58ZZ, 0DB74ZZ, 0DB78ZZ, 0DH50DZ, 0DH50UZ, 0DH53DZ, 0DH53UZ, 0DH54DZ, 0DH54UZ, 0DH57DZ, 0DH57UZ, 0DH58DZ, 0DH58UZ, 0DL57DZ, 0DL58DZ, 0DP67DZ, 0DP68DZ, 0DP6X0Z, 0DP6XUZ, 0DQ90ZZ, 0DQ93ZZ, 0DQ94ZZ, 0DQ97ZZ, 0DQ98ZZ, 0W3G0ZZ, 0W3G3ZZ, 0W3G4ZZ, 0W3P8ZZ, 0WQFXZ2, 3E0G76Z, 3E0G7GC, 3E0G86Z, 3E0G8GC, 3E1G38X, 3E1G38Z, 3E1G78X, 3E1G78Z, 3E1G88X, 3E1G88Z, 3E1H38X, 3E1H38Z, 3E1H88X, 3E1H88Z |
| PXX0694 | Other OR upper GI therapeutic procedures – 094 | 0DB10ZZ, 0DB13ZZ, 0DB17ZZ, 0DB20ZZ, 0DB23ZZ, 0DB27ZZ, 0DB30ZZ, 0DB33ZZ, 0DB37ZZ, 0DB50ZZ, 0DB53ZZ, 0DB57ZZ |
| PXX0695 | Other non-OR lower GI therapeutic procedures – 095 | 0D594ZZ, 0D598ZZ, 0D787ZZ, 0D788ZZ, 0D797ZZ, 0D798ZZ, 0D7A7ZZ, 0D7A8ZZ, 0D7B7ZZ, 0D7B8ZZ, 0D7E7ZZ, 0D7E8ZZ, 0D7F7ZZ, 0D7F8ZZ, 0D7G7ZZ, 0D7G8ZZ, 0D7H7ZZ, 0D7H8ZZ, 0D7K7ZZ, 0D7K8ZZ, 0D7L7ZZ, 0D7L8ZZ, 0D7M7ZZ, 0D7M8ZZ, 0D7N7ZZ, 0D7N8ZZ, 0DB94ZZ, 0DB98ZZ, 3E1H78Z |
| PXX0696 | Other OR lower GI therapeutic procedures – 096 | 0D9870Z, 0D9880Z, 0D9E70Z, 0D9E80Z, 0DNP7ZZ, 0DNP8ZZ |
| PXX0697 | Other gastrointestinal diagnostic procedures – 097 | 0D910ZX, 0D920ZX, 0D930ZX, 0D940ZX, 0D950ZX, 0DB10ZX, 0DB20ZX, 0DB30ZX, 0DB40ZX, 0DB50ZX, 0DJ00ZZ, 0DJ03ZZ, 0DJ04ZZ, 0DJ07ZZ, 0DJ0XZZ |
| PXX0698 | Other non-OR gastrointestinal therapeutic procedures – 098 | 07PPX0Z, 07PPX3Z, 0D9970Z, 0D9980Z, 0D9A70Z, 0D9A80Z, 0D9B70Z, 0D9B80Z, 0D9F70Z, 0D9F80Z, 0D9G70Z, 0D9G80Z, 0D9H70Z, 0D9H80Z, 0D9K70Z, 0D9K80Z, 0D9L70Z, 0D9L80Z, 0D9M70Z, 0D9M80Z, 0D9N70Z, 0D9N80Z, 0DN87ZZ, 0DN88ZZ, 0DN97ZZ, 0DN98ZZ, 0DNA7ZZ, 0DNA8ZZ, 0DNB7ZZ, 0DNB8ZZ, 0DNE7ZZ, 0DNE8ZZ, 0DNF7ZZ, 0DNF8ZZ, 0DNG7ZZ, 0DNG8ZZ, 0DNH7ZZ, 0DNH8ZZ, 0DNK7ZZ, 0DNK8ZZ, 0DNL7ZZ, 0DNL8ZZ, 0DNM7ZZ, 0DNM8ZZ, 0DNN7ZZ, 0DNN8ZZ, 0DP0X2Z, 0DP0X3Z, 0DP0XDZ, 0DP571Z, 0DP581Z, 0DP5X1Z, 0DP5X2Z, 0DP5X3Z, 0DP5XUZ, 0DP6X2Z, 0DP6X3Z, 0DP6XDZ, 0DPDX2Z, 0DPDX3Z, 0DPDXDZ, 0DPP71Z, 0DPP81Z, 0DPPX1Z, 0F757DZ, 0F758DZ, 0F767DZ, 0F768DZ, 0F787DZ, 0F788DZ, 0F797DZ, 0F798DZ, 0F7D7DZ, 0F7D8DZ, 0FHB7DZ, 0FHB8DZ, 0FP0X0Z, 0FP0X2Z, 0FP0X3Z, 0FP4X0Z, 0FP4X2Z, 0FP4X3Z, 0FP4XDZ, 0FPB7DZ, 0FPB8DZ, 0FPBX0Z, 0FPBX1Z, 0FPBX2Z, 0FPBX3Z, 0FPBXDZ, 0FPD7DZ, 0FPD8DZ, 0FPDX0Z, 0FPDX1Z, 0FPDX2Z, 0FPDX3Z, 0FPDXDZ, 0FPGX0Z, 0FPGX2Z, 0FPGX3Z, 0WPFX0Z, 0WPFX1Z, 0WPFX3Z, 0WPFX7Z, 0WPFXJZ, 0WPFXKZ, 0WPFXYZ, 0WPGX0Z, 0WPGX1Z, 0WPGX3Z, 0WPJ00Z, 0WPJ01Z, 0WPJ03Z, 0WPJ0JZ, 0WPJ0YZ, 0WPJ30Z, 0WPJ31Z, 0WPJ33Z, 0WPJ3JZ, 0WPJ3YZ, 0WPJ40Z, 0WPJ41Z, 0WPJ43Z, 0WPJ4JZ, 0WPJ4YZ, 0WPPX1Z, 0WPPX3Z, 0WPPXYZ, 2W53X0Z, 2W53X4Z, 2W53X5Z, 2W53X6Z, 2W53X7Z, 2W53XYZ, 2Y53X5Z, 3E1H78X, 3E1J78X, 3E1J78Z, 3E1J88X, 3E1J88Z |
Table 5: Relevant Procedure Codes CPT/HCPCS
| Group ID | Group Name | Code Value |
| CT0025 | Preventive Medicine, Care Coordination | 98960, 98961, 98962, 98966, 98967, 98968, 99078, 99361, 99362, 99366, 99367, 99368, 99371, 99372, 99373, 99382, 99383, 99384, 99385, 99386, 99387, 99392, 99393, 99394, 99395, 99396, 99397, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99441, 99442, 99443, 99446, 99447, 99448, 99449, 99499, G0175, G0406, G0407, G0408, G0425, G0426, G0427, G8686, G8688, G8690, G8692, H0034, H0039, H0040, S0220, S0221, S0315, S0316, S0317, S0320 |
| CT0026 | Pain medicines | J0400, J0780, J1630, J1631, J1960, J2270, J2310, J2358, J2426, J2680, J2794, J3010, J3070, J3230, J3486, S0012, S0092, S0093, S0136, S0166 |
| CT0043 | Counseling Services | G0396, G0397 |
| CT0062 | Flexible Esophagoscopy | 43200, 43206, 43231, 43232 |
| CT0063 | Esophagoscopy w additional procedures | 43201, 43211, 43212, 43215, 43216, 43217, 43219, 43227, 43229 |
| CT0064 | Upper GI endoscopy w additional procedures | 43236, 43240, 43241, 43246, 43247, 43250, 43251, 43253, 43254, 43255, 43256, 43258, 43259, 43266, 43270 |
| CT0065 | Esophagoscopy w treatment of varices | 43204, 43205, 43243, 43244 |
| CT0066 | Esophagoscopy w Dilatation | 43213, 43214, 43220, 43226, 43249 |
| CT0067 | Flexible Esophagoscopy w biopsy | 43202 |
| CT0068 | EGD w biopsy | 43238, 43239, 43242 |
| CT0069 | EGD w Dilation | 43233, 43245, 43248 |
| CT0070 | Upper GI endoscopy | 43234, 43235, 43237, 43252 |
| CT0080 | Imaging Abdomen | 74000, 74010, 74020, 74022, 74150, 74160, 74170, 74175, 74181, 74182, 74183, 74185, 76700, 76705, 76975, 76999, C8900, C8901, C8902 |
| CT0082 | Opioid Administration / Dispensing (OTP) | 96372, H0033, J0592, J1230, J2315 |
| CT0083 | Blood Type, Coomb’s test | 86077, 86880, 86900, 86901 |
| CT0088 | Hepatitis B vaccine | 90744, G0010 |
| CT0089 | Metabolic Renal Hepatic Chemistry Panel | 80047, 80048, 80050, 80051, 80053, 80069, 80074, 80076, 82040, 82247, 82248, 82310, 82330, 82374, 82435, 82565, 82575, 82947, 84132, 84155, 84295, 84450, 84460, 84520, 84550 |
| CT0090 | Physical Therapy / Rehab | 97755, S9129, S9131 |
| CT0091 | Physician Services – Outpatient | 99050, 99051, 99053, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99354, 99355, 99381, 99391, T1015 |
| CT0092 | Physician Services – Inpatient | 99221, 99222, 99223, 99238, 99239, 99252, 99253, 99254, 99255 |
| CT0093 | Routine Immunizations | 90471 |
| CT0094 | Screen for amino acid disorders | 84030 |
| CT0097 | Vitamin K administration | J3430 |
| CT0098 | Colonoscopy/Sigmoidoscopy ColorectalCa Screen | 82270 |
| CT0114 | Procedure – spinal canal – catheter | C1755, E0785 |
| CT0122 | Procedure – peripheral nerve repair / graft – graft / guide | C9355 |
| CT0132 | Rx – central nervous system – parkinson’s rx | J0190, J0515, J8515 |
| CT0133 | Rx – central nervous system – sympatholytic rx | J1110 |
| CT0135 | Rx – central nervous system – anticonvulsants | C9254, J1165, J1953, J3475, Q2009, S0078 |
| CT0136 | Rx – central nervous system – antidepressants | J1320, S0106 |
| CT0137 | Rx – central nervous system – tranq/antipsychotics | J1790, J2950, J3310, J3400 |
| CT0138 | Rx – central nervous system – amphetamines | S0160 |
| CT0139 | Rx – central nervous system – non-amphetamine stimulants | J0706 |
| CT01394 | Medications (Injections, infusions and other forms) | C9270, C9272, C9275, C9276, C9277, C9279, C9281, C9282, C9283, C9285, J0171, J0558, J0561, J0597, J0638, J0775, J1290, J1559, J1599, J1680, J1786, J1826, J2793, J3095, J3357, J3385, J7184, J7309, J7312, J7335, J7686, J8562, Q2026, Q2027, Q2040, Q2041, Q2042, Q2044, S0148, S0169 |
| CT01395 | DME and supplies | A4466, A9273, C9362, C9365, C9367, C9406, C9800, E0433, E0446, E1036, E2622, E2623, E2624, E2625, K0740, K0741, K0742, K0743, K0744, K0745, K0746, Q4117, Q4118, Q4119, Q4120, Q4121, T1505 |
| CT0140 | Rx – central nervous system – barbiturates | J0300, J2515, J2560 |
| CT0141 | Rx – central nervous system – benzodiazepines | J1990, J2060, J2250, J3360 |
| CT0142 | Rx – central nervous system – anxiolytic/sedative/hypnot nec | J3410 |
| CT0324 | Procedure – nasopharyngoscopy – dx | 92511 |
| CT0351 | Therapy – habilitation | T2012 |
| CT0354 | Rx – eent – topical – eye/ear/nose/throat misc | J3396 |
| CT0378 | Tests – ent – swallowing evaluation | 92611, 92612, 92613, 92614, 92615, 92616, 92617 |
| CT0424 | Rx – respiratory – beta agonists | J7606 |
| CT0425 | Rx – respiratory – phenylephrine | J2370 |
| CT0426 | Rx – respiratory – mucolytics/cold comb | J0132 |
| CT0427 | Rx – respiratory – methylxanthines | J0280, J1180, J2810 |
| CT04280 | Lung Function Tests | 94010 |
| CT04281 | Blood Gases, Pulse Oximetry | 82800, 82803, 82805, 82810, 94760, 94761, 94762 |
| CT04282 | Chest X-Ray | 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, 71035 |
| CT0429 | Other care – respiratory therapy | S5180, S5181 |
| CT0434 | Other care – respiratory – oxygen / oxygen concentrator | E0424, E0425, E0430, E0431, E0434, E0435, E0439, E0440, E0441, E0442, E0443, E0444, E1390, E1391, E1392, K0738 |
| CT0438 | Other care – respiratory – equipment / supplies – nebulizer | E0555, E1405, E1406 |
| CT0439 | Other care – respiratory – equipment / supplies – peak flow meter | S8096 |
| CT0440 | Other care – respiratory – equipment / supplies – spirometer | A9284 |
| CT0441 | Other care – respiratory – equipment / supplies – apnea monitor | A4556, A4557 |
| CT0442 | Other care – respiratory – equipment / supplies | E0445, E0455, E0457, E0459, E0487, E0605, E0606, E1353, E1354, E1355, E1356, E1357, E1358, E1399, K0195 |
| CT0444 | Other care – prevention – smoking cessation | S9453 |
| CT0446 | Imaging – cta – chest | 71275 |
| CT0448 | Imaging – mra – chest | 71555, C8909, C8910, C8911 |
| CT0449 | Imaging – nuclear – lung scan | A9536, A9558 |
| CT0453 | Tests – pulmonary – peak flow | S8110 |
| CT05167 | Procedure – vascular – related supplies – occlusion catheter | C2628 |
| CT05171 | Procedure – central venous catheter – insertion | S5522, S5523 |
| CT05184 | Procedure – vascular access – port / pump – insertion | C1772, C2626, E0782, E0783, E0786 |
| CT05193 | Rx – cardiovascular system – cardiac drugs | J1742, J2260 |
| CT05194 | Rx – cardiovascular system – cardiac glycosides | J1160 |
| CT05195 | Rx – cardiovascular system – antiarrhythmic rx | J0150, J0152, J0282, J2690 |
| CT05196 | Rx – cardiovascular system – beta blockers | J1800 |
| CT05197 | Rx – cardiovascular system – hypotensive rx | J0210, J0360, J0735, J1730, J2760, S0139 |
| CT05198 | Rx – cardiovascular system – vasodilating agents, nec | S9347 |
| CT05199 | Rx – cardiovascular system – vasodilating rx | J1325, J2440, J2670, J3285, K0455, S0155 |
| CT05201 | Rx – cardiovascular system – natriuretic peptides | J2325 |
| CT05202 | Rx – diuretics, loop diuretics | J1940, J3265, S0171, S9361 |
| CT05203 | Rx – diuretics, osmotic | J2150, J3350 |
| CT05204 | Rx – diuretics, thiazides / related | J1205 |
| CT05205 | Rx – diuretics – diuretic, carb anhydrase inhib | J1120 |
| CT05218 | Imaging – nuclear – venous thrombosis – radiopharmaceutical | A9504 |
| CT05233 | Tests – cardiac – ecg – ecg – 12 lead | R0076 |
| CT05240 | Tests – cardiac – echo – contrast agent | Q9955, Q9956 |
| CT05256 | Tests – cardiac – radiopharmaceuticals | A9500, A9501, A9502, A9505, A9526, A9555 |
| CT0608 | Procedure – ugi endoscopy – small bowel endoscopy | 44360, 44361, 44363, 44364, 44365, 44369, 44370, 44372, 44376, 44377, 44378, 44379, 44380, 44382 |
| CT0609 | Procedure – ugi endoscopy – other | 43600, 44383, 44385, 44386 |
| CT0610 | Procedure – dilation – esophagus | 43450, 43453, 43456, 43458, 43460, 74360 |
| CT06106 | Imaging – nuclear – gi blood loss | 78278 |
| CT06107 | Imaging – nuclear – other gi | 78261, 78264, 78267, 78268, 78282, 78290, 78291, 78299 |
| CT0611 | Procedure – injection / ligation – esophageal varices | 43400 |
| CT06110 | Imaging – x-ray – upper gi – esophagus – contrast | 74220, 74230 |
| CT06112 | Imaging – x-ray – upper gi – small bowel – contrast | 74250, 74251, 74355 |
| CT06113 | Imaging – x-ray – upper gi – duodenogram | 74260 |
| CT06114 | Imaging – x-ray – upper gi – other | 74340 |
| CT06118 | Tests – gi – esophageal balloon distension test | 91040 |
| CT06119 | Tests – gi – gastric motility study | 91020 |
| CT0612 | Procedure – esophageal / gastric intubation | 91000, 91105 |
| CT06120 | Tests – gi – duodeneal motility study | 91022 |
| CT06121 | Tests – gi – other dx | 82930, 91052, 91055, 91065, 91110, 91111, 91132, 91133, 91299 |
| CT06122 | Lab – gi – fat absorption | S3708 |
| CT06127 | Barrett’s ablation | 43228, 43257 |
| CT0617 | Procedure – other procedures – esophagus | 43045, 43499, 74235 |
| CT0619 | Procedure – gastrostomy | 44373, 74350 |
| CT0623 | Procedure – obesity procedure – restriction | C9724 |
| CT06304 | Esophageal Motility and Diagnostic Workup | 74240, 74241, 74245, 74246, 74247, 74249, 78258, 78262, 91010, 91011, 91012, 91030, 91034, 91035, 91037, 91038 |
| CT06372 | Upper gastrointestinal endoscopy, biopsy | 0133T |
| CT0657 | Procedure – other lower gi procedures – other bowel dx | 44010, 44020, 44100 |
| CT0659 | Procedure – other lower gi procedures – other non – or rx | 91100, 99175 |
| CT0690 | Procedure – anesthesia | 00700, 00730, 00740, 00790, 00800, 00820 |
| CT0692 | Therapy – neurostimulator – nausea / vomiting | E0765 |
| CT0693 | Rx – gi – antichol/antispasmodics | J0500, J1980 |
| CT0694 | Rx – gi – antiemetics | J1240, J1626, J2405, J2469, J2550, J2765, J3250, J3280, J8501, S0091, S0174, S0181, S0183, S9351, S9370 |
| CT0695 | Rx – gi – h2 antagonists | J2780, S0023, S0028 |
| CT0696 | Rx – gi drug misc,nec | S0191 |
| CT0697 | Rx – gi – ppis | C9113, S0164 |
| CT0698 | Rx – diagnostic rx – gastric function | J2805, J2850 |
| CT0732 | Imaging – nuclear – hepatobiliary ductal scan – radiopharmaceutical | A9510, A9537 |
| CT0745 | Other gastrointestinal diagnostic procedures | 0241T, 0242T |
| CT08106 | Imaging – x-ray – other – joint survey | R0070 |
| CT08113 | DME – heat/cold application | E0200, E0205, E0210, E0215, E0217, E0218, E0221, E0225, E0231, E0232, E0235, E0236, E0239 |
| CT08116 | DME – rehabilitation | E2000 |
| CT0847 | Procedure – related supplies – graft – tendon repair | C9356 |
| CT0857 | Rx – muscle relaxants – muscle relax, skeletal central | J0475, J0476, J2800, S9363 |
| CT0858 | Rx – muscle relaxants – muscle relax, skeletal, misc | J2360 |
| CT0859 | Rx – muscle relaxants – muscle relax, neuromusc block | J0330 |
| CT0950 | Procedure – graft – skin – graft material | C9358, Q4100, Q4101, Q4102, Q4103, Q4104, Q4105, Q4106, Q4107, Q4108, Q4110, Q4111 |
| CT0963 | Rx – skin / mucous membrane – antiinflam s/mm agnts / comb nec | J7311 |
| CT0964 | Rx – skin / mucous membrane – s/mm miscellaneous | J7308, S0157 |
| CT0969 | Other care – chronic edema – surgical stockings | A4490, A4495, A4500, A4510 |
| CT0972 | Other care – chronic edema – appliance – segmental | E0656, E0657 |
| CT1003 | Procedure – thyroid ablation – radionucleotide | A9527, A9530 |
| CT1011 | Rx – antidiabetic rx – insulins | J1815 |
| CT1012 | Rx – antidiabetic rx, misc | J1610 |
| CT1013 | Rx – endocrine – other – parathyroid hormones | J0630 |
| CT1017 | Rx – vitamins – vitamin b / b complex | J3411, J3415, J3420 |
| CT1019 | Rx – vitamins – vitamin d | J0636, J1270, J2501 |
| CT1021 | Rx – vitamins – multivit prep | A9152, A9153, S0194 |
| CT1022 | Rx – diagnostic rx – thyroid function | J2725, J3240 |
| CT1023 | Rx – diagnostic rx, misc | J7674 |
| CT1025 | Other care – diabetes care – glucose monitoring – other supplies | A4250, A4256, A4257 |
| CT1026 | Other care – diabetes care – glucose monitoring – lancet | A4258, A4259, E0620 |
| CT1027 | Other care – diabetes care – glucose monitoring | A9279, A9280 |
| CT10295 | Thyroid Function Tests | 84432, 84436, 84437, 84439, 84442, 84443, 84445, 84479, 84480, 84481, 84482 |
| CT10296 | Low dose steroids | J0702, J1020, J1094, J1100, J1700, J1710, J1720, J2650, J3300, J3301, J3302, J3303, J7506, J7509, J7510, J8540, S9490 |
| CT10297 | High dose steroids | J1030, J1040, J2920, J2930, Q0138 |
| CT1036 | Other care – nutrition – assessment | 97802, 97803, G0270, G0271 |
| CT1037 | Other care – nutrition – enteral – administration | S9340, S9341, S9342, S9343 |
| CT1038 | Other care – nutrition – enteral | B4034, B4035, B4036, B4081, B4100, B4104, B9998 |
| CT1039 | Other care – nutrition – enteral – tubing | B4082, B4083, B4087, B4088 |
| CT1040 | Other care – nutrition – enteral – formula | B4102, B4103, B4149, B4150, B4152, B4153, B4154, B4155, B4157, B4158, B4159, B4160, B4161, B4162, B9000 |
| CT1041 | Other care – nutrition – enteral – pump | B9002 |
| CT1042 | Other care – nutrition – parenteral – nutrition solution | B4164, B4168, B4172, B4176, B4178, B4180, B4185, B4189, B4193, B4197, B4199, B5000, B5100, B5200 |
| CT1043 | Other care – nutrition – parenteral | B4216, B4220, B4222, B4224, B9999 |
| CT1044 | Other care – nutrition – parenteral – pump | B9004, B9006, E0791 |
| CT1045 | Other care – nutrition – parenteral – all – inclusive | S9364, S9365, S9366, S9367, S9368 |
| CT1046 | Other care – nutrition – education | S9452 |
| CT1047 | Other care – nutrition – medical food | S9433, S9434, S9435 |
| CT1048 | Other care – nutrition – counseling – dietician | S9470 |
| CT1049 | Other care – other – weight management | S9449 |
| CT1052 | Imaging – nuclear – thyroid – radiopharmaceutical | A9509, A9516, A9528, A9529, A9531 |
| CT1062 | Lab – endocrine | S3650, S3652 |
| CT1146 | Therapy – dialysis – supplies | A4932 |
| CT1148 | Rx – gu – other – bladder rx | J0520 |
| CT1166 | Lab – urinalysis | 81007, 81015, 81020, 81050, 81099 |
| CT1167 | Lab – specimen collection – urine | P9612, P9615 |
| CT1502 | Other care – newborn – jaundice – phototherapy | E0202, S9098 |
| CT1616 | Therapy – transfusion – blood | P9010, P9011, P9016, P9021, P9022, P9038, P9039, P9040, P9051, P9054, P9056, P9057, P9058, S9538 |
| CT1617 | Therapy – transfusion – plasma | P9017, P9023, P9043, P9044, P9048, P9059, P9060 |
| CT1618 | Therapy – transfusion – granulocytes | P9050 |
| CT1619 | Therapy – transfusion – platelets | P9019, P9020, P9031, P9032, P9033, P9034, P9035, P9036, P9037, P9052, P9053, P9055 |
| CT1620 | Therapy – phlebotomy | 99195 |
| CT1622 | Rx – immune system – interferons | J1830, Q3025, Q3026, S0145, S9559 |
| CT1623 | Rx – immune system – gold compounds | J1600, J2910 |
| CT1624 | Rx – immune system – immunosuppressants | J0215, J2357, J7507, J7517, J7518, J7520, J7525 |
| CT1626 | Rx – blood derivatives | P9041, P9045, P9046, P9047 |
| CT1627 | Rx – hematopoietic system – other | J1640 |
| CT1628 | Rx – hematopoietic system – iron / related | J1750, J1756, J2916 |
| CT1629 | Rx – hematopoietic system – hematopoietic growth factors | J0881, J0885, J2355, J2796, J2820, Q4081, S9537 |
| CT16293 | Azathioprine / Mercaptopurine | J7500, J7501 |
| CT16295 | Cyclosporin | J7502, J7515, J7516 |
| CT16296 | Lipid Level Monitoring | 80061, 82465, 83695, 83698, 83700, 83701, 83704, 83718, 83719, 83721, 84478 |
| CT16297 | Blood Count | 82728, 83540, 83550, 85004, 85007, 85008, 85009, 85013, 85014, 85018, 85025, 85027, 85032, 85041, 85044, 85045, 85046, 85048, 85049, 85060, G0306, G0307 |
| CT16298 | NewBorn Blood Tests | 82948, 88720 |
| CT16299 | Bleeding Status | 85002, 85345, 85347, 85348, 85610, 85611, 85670, 85675, 85705, 85730, 85732, 99363, 99364, S9401 |
| CT1630 | Rx – coagulation system – anticoagulants | C9121, J0583, J1644, J1645, J1650, J1652, J1655, J1945, J7197, S9336, S9372 |
| CT1631 | Rx – coagulation system – antiheparin agnt | J2720 |
| CT16316 | Blood transfusion | P9070, P9071, P9072 |
| CT1632 | Rx – coagulation system – hemostatics | J0365, J7185, J7186, J7189, J7190, J7191, J7192, J7193, J7194, J7195, J7196, J7198, J7199, P9012, S0017 |
| CT1633 | Rx – coagulation system – thrombolytic rx | J0350, J2993, J2995, J2997, J3101, J3364, J3365 |
| CT1634 | Rx – coagulation system – antiplatelet rx | J0130, J1245, J1327, J3246 |
| CT1635 | Rx – serums, toxoids, vaccines – serums | 90281, 90283, 90291, 90296, 90371, 90375, 90376, 90384, 90385, 90386, 90389, 90396, 90399, J0850, J1162, J1459, J1460, J1560, J1561, J1562, J1566, J1568, J1569, J1571, J1572, J1573, J1670, J2788, J2790, J2791, J2792, J7504 |
| CT1636 | Rx – serums, toxoids, vaccines – toxins | J0585, J0586, J0587 |
| CT1638 | Rx – administration – injection | 90772, 90773, 90774, 90775, 96373, 96374, 96375, 96376, 99506 |
| CT1639 | Rx – administration – infusion | 90765, 90766, 90767, 90768, 90779, 96361, 96365, 96366, 96367, 96368, 96369, 96370, 96371, 96379, 99601, 99602, A4220, A4221, A4222, A4223, A4305, A4306, C8957, E0776, E0779, E0780, E0781, K0552, K0601, K0602, K0603, K0604, K0605, S1015, S1016, S5035, S5036, S5497, S5498, S5501, S5502, S5517, S5518, S5520, S5521, S9379, S9542, S9810 |
| CT1645 | Lab – blood gases | 82820 |
| CT1646 | Lab – hematology – coagulation | 85170, 85175, 85210, 85220, 85230, 85240, 85244, 85245, 85246, 85247, 85250, 85260, 85270, 85280, 85290, 85291, 85292, 85293, 85300, 85301, 85302, 85303, 85305, 85306, 85307, 85335, 85337, 85360, 85362, 85366, 85370, 85378, 85379, 85380, 85384, 85385, 85390, 85396, 85397, 85400, 85410, 85415, 85420, 85421, 85612, 85613, 85635 |
| CT1647 | Lab – hematology – blood count | 85055 |
| CT1648 | Lab – hematology – blood count – eosinophil count | S3630 |
| CT1649 | Lab – other hematology | 85130, 85441, 85445, 85460, 85461, 85475, 85520, 85525, 85530, 85536, 85540, 85547, 85549, 85555, 85557, 85576, 85597, 85660, 85810, 85999, 88738, 88740, 88741 |
| CT1651 | Lab – immunology | 86000, 86001, 86003, 86005, 86021, 86022, 86023, 86038, 86039, 86060, 86063, 86078, 86079, 86146, 86147, 86148, 86155, 86156, 86157, 86160, 86161, 86162, 86171, 86185, 86200, 86215, 86225, 86226, 86235, 86243, 86255, 86256, 86277, 86280, 86294, 86300, 86301, 86304, 86305, 86308, 86309, 86310, 86316, 86320, 86325, 86327, 86329, 86331, 86332, 86334, 86335, 86336, 86337, 86340, 86341, 86343, 86344, 86352, 86353, 86355, 86356, 86357, 86359, 86360, 86361, 86367, 86376, 86378, 86382, 86384, 86403, 86406, 86430, 86431, 86480, 86485, 86486, 86490, 86510, 86580, 86586, 86590, 86592, 86593 |
| CT1652 | Lab – transfusion medicine | 86850, 86860, 86870, 86885, 86886, 86890, 86891, 86903, 86904, 86905, 86906, 86910, 86911, 86920, 86921, 86922, 86923, 86927, 86930, 86931, 86932, 86940, 86941, 86945, 86950, 86960, 86965, 86970, 86971, 86972, 86975, 86976, 86977, 86978, 86985, 86999 |
| CT1797 | Lab – tumor marker | S3711 |
| CT1805 | Rx – antibiotics / antivirals / antifungals – infusion | S9345, S9494, S9497, S9500, S9501, S9502, S9503, S9504 |
| CT1806 | Rx – antibiotics – aminoglycosides | J0278, J1580, J1840, J1850, J3000, J3260 |
| CT1807 | Rx – antibiotics – cephalosporins | J0690, J0692, J0694, J0696, J0697, J0698, J0710, J0713, J0715, J1890 |
| CT1808 | Rx – b-lactam antibiotics | J0743, J1335, J2185, S0073 |
| CT1809 | Rx – antibiotics – chloramphenicol / comb | J0720 |
| CT1810 | Rx – antibiotics – macrolides | J0456, J1364, Q0144 |
| CT1811 | Rx – antibiotics – penicillins | J0290, J0295, J2510, J2540, J2543, J2700, S0032, S0040, S0081 |
| CT1812 | Rx – antibiotics – tetracyclines | J0120, J2460 |
| CT1813 | Rx – antibiotics, misc | J0770, J2010, J2020, J2770, J3320, J3370, S0021, S0074, S0077, S0142 |
| CT1814 | Rx – antibiotics – quinolones | J0744, J1590, J1956, J2280, S0034 |
| CT1815 | Rx – antibiotics – sulfonamides / comb | S0039 |
| CT1816 | Rx – antibiotics – anti-infectives, misc | J3305, S0030, S0080 |
| CT1817 | Rx – antivirals | 90378, 90379, G9034, J0133, J1324, J1452, J1455, J1570, J3465, J3485, J7310, S0104, S0137, S0140, S9562 |
| CT1818 | Rx – antifungals | J0285, J0287, J0288, J0289, J0637, J1450, J1835 |
| CT1819 | Rx – other anti-infectives – antimalarials | J0200, J0390 |
| CT1820 | Other care – other – infection control | S8301 |
| CT1821 | Lab – infectious agent antigen | 87260, 87265, 87267, 87269, 87271, 87272, 87273, 87274, 87275, 87276, 87277, 87278, 87279, 87280, 87281, 87283, 87285, 87290, 87299, 87300, 87301, 87305, 87324, 87327, 87328, 87329, 87332, 87335, 87336, 87337, 87338, 87339, 87340, 87341, 87350, 87380, 87385, 87390, 87391, 87400, 87420, 87425, 87427, 87430, 87449, 87450, 87451 |
| CT1822 | Lab – infectious agent antibody | 86317, 86318, 86602, 86603, 86606, 86609, 86611, 86612, 86615, 86617, 86618, 86619, 86622, 86625, 86628, 86635, 86638, 86641, 86644, 86645, 86648, 86651, 86652, 86653, 86654, 86658, 86663, 86664, 86665, 86666, 86668, 86671, 86674, 86677, 86682, 86684, 86687, 86688, 86689, 86692, 86694, 86695, 86696, 86698, 86701, 86702, 86703, 86704, 86705, 86706, 86707, 86708, 86709, 86710, 86713, 86717, 86720, 86723, 86727, 86729, 86732, 86735, 86738, 86741, 86744, 86747, 86750, 86753, 86756, 86757, 86759, 86762, 86765, 86768, 86771, 86774, 86777, 86778, 86780, 86781, 86784, 86787, 86788, 86789, 86790, 86793, 86800, 86803, 86804, S3645 |
| CT1823 | Lab – infectious agent dna | 87470, 87471, 87472, 87475, 87476, 87477, 87480, 87481, 87482, 87493, 87495, 87496, 87497, 87498, 87500, 87510, 87511, 87512, 87515, 87516, 87517, 87520, 87521, 87522, 87525, 87526, 87527, 87528, 87529, 87530, 87531, 87532, 87533, 87534, 87535, 87536, 87537, 87538, 87539, 87540, 87541, 87542, 87550, 87551, 87552, 87555, 87556, 87557, 87560, 87561, 87562, 87580, 87581, 87582, 87590, 87591, 87592, 87620, 87621, 87622, 87640, 87641, 87650, 87651, 87652, 87653, 87660, 87797, 87798, 87799, 87800, 87801, 87802, 87803, 87804, 87807, 87808, 87809, 87850, 87880, 87899, 87900, 87901, 87902, 87903, 87904 |
| CT1824 | Lab – microbiology – other | 87015, 87164, 87166, 87168, 87169, 87172, 87176, 87177, 87230, 87905, 87999 |
| CT1825 | Lab – microbiology – c & s | 87040, 87045, 87046, 87070, 87071, 87073, 87075, 87076, 87077, 87081, 87084, 87086, 87088, 87101, 87102, 87103, 87106, 87107, 87109, 87116, 87118, 87140, 87143, 87147, 87149, 87150, 87152, 87153, 87158, 87181, 87184, 87185, 87186, 87187, 87188, 87190, 87197 |
| CT1826 | Lab – microbiology – microscopic exam | 87205, 87206, 87207, 87209, 87210, 87220 |
| CT1827 | Lab – microbiology – viral culture | 87250, 87252, 87253, 87254, 87255 |
| CT1828 | Lab – microbiology | P7001 |
| CT18302 | CHLAMYDIA SCREENING | 86631, 86632, 87110, 87270, 87320, 87485, 87486, 87487, 87490, 87491, 87492, 87810 |
| CT1901 | Therapy – behavior – evaluation and therapy | 96150, 96151, 96152, 96153, 96154, 96155 |
| CT1905 | Therapy – behavior – partial hospilization | S0201 |
| CT1907 | Tests – neuro – sleep studies | 95803, 95805, 95806, 95807, 95808, 95810, 95811 |
| CT19303 | Psychiatry Evaluations | T1023 |
| CT19304 | Psychiatry Services | H0031, H2010, H2015, H2016, H2021, H2022, S3005, S9454, S9482, T2034 |
| CT19378 | Laboratory – Chemistry and Hematology | 83987, G0435 |
| CT19381 | Smoking / Tobacco Cessation | 99406, 99407 |
| CT19384 | Peer Services | H0038 |
| CT2006 | Alcohol / Drug Use Management | H0045, H0048 |
| CT2009 | Alcohol / Drug Use Screening | 80100, 80101, 80102, 80103, 82009, 82010, 99408, 99409, G0431, G0432, G0433, H0001, H0003, H0049, H0050 |
| CT20376 | Other Laboratory | G9143, S3713, S3865, S3866, S3870 |
| CT2101 | Lab – therapeutic drug assay | 80150, 80152, 80154, 80156, 80157, 80158, 80160, 80162, 80164, 80166, 80168, 80170, 80172, 80173, 80174, 80176, 80178, 80182, 80184, 80185, 80186, 80188, 80190, 80192, 80194, 80195, 80196, 80197, 80198, 80200, 80201, 80202, 80299 |
| CT2302 | Therapy – behavior – other | H2000, H2033, T2036, T2037 |
| CT2309 | Therapy – activity therapy | H2032 |
| CT2311 | Therapy – vaccination – mmr / related | 90704, 90705, 90706, 90707, 90708, 90710 |
| CT2312 | Therapy – vaccination – dtp / related | 90696, 90698, 90700, 90701, 90702, 90703, 90718, 90719, 90720, 90721, 90723, 90749 |
| CT2313 | Therapy – vaccination – hib vaccine | 90645, 90646, 90647, 90648 |
| CT2314 | Therapy – vaccination – hepatitis a vaccine | 90632, 90633, 90634, 90636 |
| CT2315 | Therapy – vaccination – hepatitis b | 90740, 90743, 90746, 90747, 90748 |
| CT2316 | Therapy – vaccination – poliovirus vaccine | 90712, 90713 |
| CT2317 | Therapy – vaccination – chicken pox | 90716 |
| CT2319 | Therapy – vaccination – other vaccine | 90476, 90477, 90581, 90585, 90665, 90675, 90676, 90680, 90690, 90691, 90692, 90693, 90714, 90715, 90717, 90725, 90727, 90733, 90734, 90735, 90736 |
| CT2320 | Therapy – vaccination – vaccine administration | 90465, 90466, 90467, 90468, 90472, 90473, 90474 |
| CT2326 | Other care – bladder / bowel care – other supplies | A4310, A4320, A4321, A4322, A4330, A4331, A4332, A4333, A4334, A4335, A4336, A4354, A4355, A4356, A5113, A5114 |
| CT2327 | Other care – bladder / bowel care – catheter | A4311, A4312, A4313, A4314, A4315, A4316, A4326, A4327, A4328, A4338, A4340, A4344, A4346, A4349, A4351, A4352, A4353 |
| CT2328 | Other care – bladder / bowel care – drainage bag | A4357, A4358, A5102, A5105, A5112 |
| CT2329 | Other care – bladder / bowel care – other supplies – diaper / related | A4360, A4520, A4554, T4521, T4522, T4523, T4524, T4525, T4526, T4527, T4528, T4529, T4530, T4531, T4532, T4533, T4534, T4535, T4536, T4537, T4538, T4539, T4540, T4541, T4542, T4543 |
| CT2330 | Other care – bladder / bowel care – other supplies – skin barrier | A5120, A5121, A5122, A5126, A5131, A5200 |
| CT23307 | Vaccine for flu or Pneumonia | 90655, 90656, 90657, 90658, 90660, 90661, 90662, 90663, 90669, 90670, 90732, G0008, G0009, G9141, G9142, Q2035, Q2036, Q2037, Q2038, Q2039, S0195 |
| CT23309 | Markers for Inflammation | 85651, 85652, 86140, 86141 |
| CT2331 | Other care – observation | G0379 |
| CT2334 | Other care – child care – specialized | T2026, T2027 |
| CT2337 | Other care – special needs children | T1024, T1025, T1026, T1027, T1028 |
| CT2338 | Other care – other – education | S9445, S9446 |
| CT23393 | Prophylactic vaccinations and inoculations | 90681, 90738 |
| CT23398 | Ancillary Services | 99415, 99416, G9474 |
| CT23400 | HPV VACCINE | 90649, 90650 |
| CT2341 | Other care – other – exercise classes | S9451 |
| CT2353 | DME – patient lifts | E0621, E0625, E0627, E0628, E0629, E0630, E0635, E0636, E0637, E0638, E0639, E0640, E0641, E0642 |
| CT9902 | E & M – consultation | Q3014, T1014 |
| CT9903 | E & M – hospital | 99217, 99218, 99219, 99220, 99231, 99232, 99233, 99234, 99235, 99236, 99291, 99292, 99293, 99294, 99466, 99475, 99481, 99482, G0378, G0390, S0310 |
| CT9904 | E & M – emergency care | 99058, 99281, 99282, 99283, 99284, 99285, G0380, G0381, G0382, G0383, G0384, S9083, S9088 |
| CT9905 | E & M – home visit | 99224, 99225, 99226, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, S0273 |
| CT9906 | E & M – nursing home | 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99318, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337 |
| CT9907 | E & M – prevention | 99420, S0302 |
| CT9908 | E & M – other | 96040, 99026, 99027, 99056, 99060, 99150, 99288, 99289, 99290, 99360, 99450, 99455, 99456, 99485, 99486, 99488, S0260 |
| CT99101 | Other care – other – lead assessment | T1029 |
| CT99102 | Other care – other | H0043, H0044, S1001, S1002, S9988, S9989, S9990, S9991, S9999, T2025, T2035, T2038, T2040, T2041 |
| CT99103 | Imaging – ct – follow – up | 76380 |
| CT99104 | Imaging – ct – other | 76497 |
| CT99105 | Imaging – ct – guidance | 77012 |
| CT99106 | Imaging – cta – other | 72191 |
| CT99107 | Imaging – mri – other | 76498, C1770, S8042 |
| CT99108 | Imaging – mri – guidance | 77021 |
| CT99109 | Imaging – mri – contrast agent | A9576, A9577, A9578, A9579, A9581, A9583, Q9953, Q9954 |
| CT9911 | Procedure – sedation | 99143, 99144, 99145, 99148, 99149 |
| CT99113 | Imaging – us – guide – biopsy | 76942 |
| CT99114 | Imaging – us – guide – other | 76936, 76937, 76940, 76998 |
| CT99115 | Imaging – us – other | 76970 |
| CT99122 | Imaging – nuclear – csf – radiopharmaceutical | A9548 |
| CT99123 | Imaging – nuclear – kidney – radiopharmaceutical | A9539, A9551, A9554, A9562, A9567 |
| CT99124 | Imaging – nuclear – tumor localization | 78800, 78801, 78802, 78803, 78804 |
| CT99125 | Imaging – nuclear – localization of inflammation | 78805, 78806, 78807 |
| CT99126 | Imaging – nuclear – lymphoma – radiolabeled antibody | A9542, A9544 |
| CT99127 | Imaging – nuclear – other – automated data add – on | 78890, 78891 |
| CT99128 | Imaging – nuclear – other | 78660, 78699, 78799, 78808, 78999 |
| CT99129 | Imaging – nuclear – radiopharmaceutical – radiopharmaceutical – other | A4641, A4642, A9507, A9512, A9521, A9538, A9540, A9541, A9547, A9550, A9553, A9556, A9560, A9566, A9568, A9569, A9570, A9571, A9572, A9582 |
| CT99130 | Imaging – pet – other | A9552, A9580, G0235, S8085 |
| CT99133 | Imaging – other imaging – fluoroscopy | 76000, 76001, 76496 |
| CT99134 | Imaging – other imaging – fluoroscopy – guidance | 77002, 77003 |
| CT99136 | Imaging – other imaging | 74210, 75809, 75900, 76100, 76101, 76102, 76120, 76125, 76140, 76150, 76350, 76376, 76377, 76390, 76499, Q0092, R0075 |
| CT99139 | Imaging – supplies – contrast agent – low osmolar | Q9951, Q9965, Q9966, Q9967 |
| CT99140 | Imaging – supplies – contrast agent – high osmolar | A9698, Q9958, Q9959, Q9960, Q9961, Q9962, Q9963, Q9964 |
| CT99141 | Imaging – supplies – ultrasound related | A4559 |
| CT99142 | Lab – pathology consultation | 80500, 80502 |
| CT99143 | Lab – chemistry | 82000, 82003, 82013, 82016, 82017, 82024, 82030, 82045, 82085, 82088, 82101, 82103, 82104, 82108, 82127, 82128, 82131, 82135, 82136, 82139, 82140, 82143, 82145, 82150, 82154, 82157, 82160, 82163, 82164, 82172, 82175, 82180, 82190, 82205, 82232, 82239, 82240, 82252, 82261, 82271, 82272, 82274, 82286, 82300, 82306, 82307, 82308, 82331, 82340, 82355, 82360, 82365, 82370, 82373, 82375, 82376, 82378, 82379, 82380, 82382, 82383, 82384, 82387, 82390, 82397, 82415, 82436, 82438, 82441, 82480, 82482, 82485, 82486, 82487, 82488, 82489, 82491, 82492, 82495, 82507, 82520, 82523, 82525, 82528, 82530, 82533, 82540, 82541, 82542, 82543, 82544, 82550, 82552, 82553, 82554, 82570, 82585, 82595, 82600, 82607, 82608, 82610, 82615, 82626, 82627, 82633, 82634, 82638, 82646, 82649, 82651, 82652, 82654, 82656, 82657, 82658, 82664, 82666, 82668, 82670, 82671, 82672, 82677, 82679, 82690, 82693, 82696, 82705, 82710, 82715, 82725, 82726, 82735, 82742, 82746, 82747, 82759, 82760, 82775, 82776, 82784, 82785, 82787, 82926, 82928, 82938, 82941, 82943, 82945, 82946, 82950, 82951, 82952, 82953, 82955, 82960, 82962, 82963, 82965, 82975, 82977, 82978, 82979, 82980, 82985, 83003, 83008, 83009, 83010, 83012, 83013, 83014, 83015, 83018, 83020, 83021, 83026, 83045, 83050, 83051, 83055, 83060, 83065, 83068, 83069, 83070, 83071, 83080, 83088, 83090, 83150, 83491, 83497, 83498, 83499, 83500, 83505, 83516, 83518, 83519, 83520, 83525, 83527, 83528, 83570, 83582, 83586, 83593, 83605, 83615, 83625, 83630, 83631, 83632, 83633, 83634, 83670, 83690, 83727, 83735, 83775, 83785, 83788, 83789, 83805, 83825, 83835, 83840, 83857, 83858, 83864, 83866, 83872, 83873, 83874, 83876, 83880, 83883, 83885, 83887, 83890, 83891, 83892, 83893, 83894, 83896, 83897, 83898, 83900, 83901, 83902, 83903, 83904, 83905, 83906, 83907, 83908, 83909, 83912, 83913, 83914, 83915, 83916, 83918, 83919, 83921, 83925, 83930, 83935, 83937, 83945, 83950, 83951, 83970, 83986, 83992, 83993, 84022, 84035, 84060, 84061, 84066, 84075, 84078, 84080, 84081, 84085, 84087, 84100, 84105, 84106, 84110, 84119, 84120, 84126, 84127, 84133, 84134, 84135, 84138, 84140, 84143, 84144, 84145, 84146, 84150, 84152, 84153, 84154, 84156, 84157, 84160, 84165, 84166, 84181, 84182, 84202, 84203, 84206, 84207, 84210, 84220, 84228, 84233, 84234, 84235, 84238, 84244, 84252, 84255, 84260, 84270, 84275, 84285, 84300, 84302, 84305, 84307, 84311, 84315, 84375, 84376, 84377, 84378, 84379, 84392, 84402, 84403, 84425, 84430, 84431, 84446, 84449, 84466, 84484, 84485, 84488, 84490, 84510, 84512, 84525, 84540, 84545, 84560, 84577, 84578, 84580, 84583, 84585, 84586, 84588, 84590, 84591, 84597, 84600, 84620, 84630, 84681, 84999 |
| CT99146 | Lab – cytology | 88104, 88106, 88107, 88108, 88112, 88160, 88161, 88162, 88172, 88173, 88182, 88184, 88185, 88187, 88188, 88189, 88199 |
| CT99147 | Lab – cytogenetics | 88230, 88233, 88237, 88239, 88240, 88241, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88267, 88269, 88271, 88272, 88273, 88274, 88275, 88280, 88283, 88285, 88289, 88291, 88299 |
| CT99148 | Lab – surgical pathology | 88300, 88302, 88304, 88305, 88307, 88309, 88312, 88313, 88314, 88318, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88342, 88346, 88347, 88348, 88349, 88355, 88356, 88358, 88360, 88361, 88362, 88365, 88367, 88368, 88371, 88372, 88380, 88381, 88384, 88385, 88386, 88387, 88388, 88399 |
| CT99149 | Lab – other clinical lab | 88400, 89050, 89051, 89055, 89060, 89100, 89105, 89125, 89130, 89132, 89135, 89136, 89140, 89141, 89160, 89190, 89220, 89225, 89230, 89235, 89240 |
| CT99166 | Lab – genetic testing – cardiac ion channel syndrome | S3860, S3862 |
| CT99167 | Lab – genetic testing – brugada syndrome | S3861 |
| CT99168 | Lab – chemistry and toxicology tests | P2028, P2029, P2031, P2033, P2038 |
| CT99169 | Lab – specimen collection – blood – venous – venipuncture | 36415, S9529 |
| CT9917 | Procedure – related supplies – access catheter | A4301 |
| CT99173 | Lab – specimen collection – specimen handling | 99000 |
| CT99174 | Lab – microscopic – wet mount | Q0111 |
| CT99175 | Lab – microscopic – koh prep | Q0112 |
| CT99176 | Lab – stat request | S3600, S3601 |
| CT9918 | Procedure – related supplies – ablation – catheter | Q4116 |
| CT99182 | Transportation – paramedic | S0207, S0208 |
| CT99183 | Transportation – other transportation | A0021, A0080, A0090, A0100, A0110, A0120, A0130, A0140, A0160, A0170, A0180, A0190, A0200, A0210, A0225, A0380, A0382, A0384, A0390, A0392, A0394, A0396, A0398, A0420, A0422, A0424, A0425, A0426, A0427, A0428, A0429, A0430, A0431, A0432, A0433, A0434, A0435, A0436, A0888, A0998, A0999, P9603, P9604, S0209, S0215, S9992, T2001, T2002, T2003, T2004, T2005, T2007, T2049 |
| CT99191 | Supplies | A4206, A4207, A4208, A4209, A4210, A4211, A4212, A4213, A4215, A4216, A4217, A4218, A4244, A4245, A4246, A4247, A4265, A4450, A4452, A4455, A4456, A4458, A4461, A4463, A4465, A4470, A4480, A4550, A4601, A4649, A6000, A6010, A6011, A6021, A6022, A6023, A6024, A6025, A6154, A6196, A6197, A6198, A6199, A6203, A6204, A6205, A6206, A6207, A6208, A6209, A6210, A6211, A6212, A6213, A6214, A6215, A6216, A6217, A6218, A6219, A6220, A6221, A6222, A6223, A6224, A6228, A6229, A6230, A6231, A6232, A6233, A6234, A6235, A6236, A6237, A6238, A6239, A6240, A6241, A6242, A6243, A6244, A6245, A6246, A6247, A6248, A6250, A6251, A6252, A6253, A6254, A6255, A6256, A6257, A6258, A6259, A6260, A6261, A6262, A6266, A6402, A6403, A6404, A6407, A6413, A6441, A6442, A6443, A6444, A6445, A6446, A6447, A6448, A6449, A6450, A6451, A6452, A6453, A6454, A6455, A6456, A6457, A6550, A7000, A7001, A7002, A9155, C1751, C1769, C9898, J1642, T2028 |
| CT99195 | Prosthetics – other | K0462 |
| CT99197 | Other – non – covered | A9270, G0293, G0294, S9986 |
| CT99198 | PQRI | G8427, G8428, G8430, G8440, G8441, G8442, G8447, G8448, G8476, G8477, G8478, G8508, G8509, G8524, G8525, G8526, G8530, G8531, G8532, G8534, G8535, G8536, G8537, G8538, G8539, G8540, G8541, G8542, G8543, G9016, G9019, G9020, G9033, G9035, G9036, G9140 |
| CT9920 | Procedure – related supplies – catheter | C1758, C2627 |
| CT9922 | Procedure – related supplies – drainage | C1729 |
| CT9924 | Procedure – related supplies – implant | C9899 |
| CT9925 | Procedure – related supplies – resection – morcellator | C1782 |
| CT9926 | Procedure – related supplies – retrieval – device | C1773 |
| CT9927 | Procedure – related supplies – other | C1765, C9250, C9359, C9360, C9361, C9363, C9364, Q9968 |
| CT9928 | Therapy – accupuncture | 97810, 97811, 97813, 97814 |
| CT9930 | Therapy – habilitation | T2013, T2014, T2015, T2016, T2017, T2018, T2019, T2020, T2021 |
| CT99309 | Physician Services | 99251 |
| CT9931 | Therapy – rehabilitation – other | 92526, G0409 |
| CT99311 | Urine Protein | 81000, 81001, 81002, 81003, 81005, 82042, 82043, 82044 |
| CT99312 | HbA1C | 83036, 83037 |
| CT99316 | Physician Services – Inpatient | 99356, 99357 |
| CT9934 | Therapy – ultraviolet light therapy | A4633, A4634, E0691, E0692, E0693, E0694 |
| CT9935 | Therapy – hyperbaric oxygen | 99183, C1300 |
| CT9936 | Therapy – neurostimulator – tens – device | E0720, E0730, E0731 |
| CT9937 | Therapy – neurostimulator – tens – leads | A4595 |
| CT9938 | Therapy – neurostimulator – tens – supplies | A4558 |
| CT9939 | Therapy – neurostimulator – other | A4630, E0745 |
| CT99392 | Other diagnostic procedures (interview, evaluation, consultation) | C1749, G0436, G0437, G0438, G0439, Q5010 |
| CT9940 | Therapy – other | 99024, E0761, M0075, M0100, M0300, S9355 |
| CT99400 | Advance care planning | S0255, S0257 |
| CT99401 | Bundled Payment / Medical Home | S0280, S0281 |
| CT99402 | Care Plan Oversight | 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380 |
| CT99403 | Case Management Services | G0162, G9012, S0250, T1001, T1016, T1017, T2022, T2023, T2024 |
| CT99405 | Case Management Services – Educational | T1018 |
| CT99408 | Chronic Care Management | 99487, 99489 |
| CT99409 | Home Health / Hospice | G0179, G0180, G0181, G0182 |
| CT9941 | Rx – allergy – antihistamines / comb | J0945, J1200 |
| CT99410 | Coordinated Care Fees/Services | G9001, G9002, G9003, G9004, G9005, G9006, G9007, G9008, G9009, G9010, G9011 |
| CT99411 | Medication Therapy Management Services | 99605, 99606, 99607 |
| CT99412 | Online Management | 98969, 99444 |
| CT99413 | Personal Care Services | T1019, T1020 |
| CT99415 | Physician Services – Outpatient | 99358, 99359 |
| CT99416 | Procedures and Reporting | 99080, 99090, 99091 |
| CT99419 | Wellness Assessment | S5190 |
| CT9942 | Rx – gi – antichol/antispasmodics | J0461 |
| CT99420 | LEAD SCREENING | 83655 |
| CT9943 | Rx – autonomic rx – parasympathomimetics | J2710, S0014 |
| CT9944 | Rx – autonomic rx – sympathomimetic rx | J0380, J0395, J1250, J1265, J3105, S9348 |
| CT9945 | Rx – autonomic rx – nicotine preps | S4990, S4991, S4995 |
| CT9946 | Rx – analg/antipy/nsaids – nsaids | J1885 |
| CT9947 | Rx – analg/antipy/nsaids – narcotics | J0364, J0595, J0745, J1170, J1810, J2175, J2180, J2271, J2275, J2300, J2410, S0109 |
| CT9949 | Rx – electrolytic, caloric, water – calcium supplements | J0610, J0620 |
| CT9950 | Rx – electrolytic, caloric, water – potassium supp | J3480, S5012 |
| CT9951 | Rx – electrolytic, caloric, water – multi-mineral prep | J7120, S5014 |
| CT9952 | Rx – electrolytic, caloric, water – sodium chlor preps | J7030, J7040, J7050, J7130 |
| CT9953 | Rx – electrolytic, caloric, water – replacement preparations, misc | J7100, J7110 |
| CT9954 | Rx – electrolytic, caloric, water – caloric rx, amino acid prep | J1955 |
| CT9955 | Rx – electrolytic, caloric, water – caloric rx dextrose / rel | J7042, J7060, J7070, S5010, S5011, S5013 |
| CT9956 | Rx – electrolytic, caloric, water – hydration – unspecfied | 90760, 90761, Q0081, S9373, S9374, S9375, S9376, S9377 |
| CT9957 | Rx – miscellaneous rx | 90287, 90288, 90393, A9150, C9248, C9399, J0348, J0795, J0878, J0894, J1212, J1267, J1436, J1453, J1457, J1458, J1595, J1740, J1743, J1930, J2248, J2278, J2323, J2425, J2503, J2513, J2724, J2730, J2778, J2785, J3110, J3243, J3490, J3530, J3535, J3570, J3590, J7187, J7321, J7323, J7324, J7325, J7505, J7599, J7799, J8499, J8650, Q2004, Q4074, Q4082, S0190, S5000, S5001, T1502 |
| CT9958 | Rx – miscellaneous rx – enzymes | J0180, J0205, J0220, J1931, J2504, J3470, J3471, J3472, J3473, S9357 |
| CT9959 | Rx – miscellaneous rx – heavy metal antagonists | J0470, J0600, J0895, J1190, J3520 |
| CT9960 | Rx – miscellaneous rx – anesthetics, local | J0670, J2001, J2400, J2795, S0020 |
| CT9961 | Rx – diagnostic rx – roentgenography | Q9957 |
| CT9962 | Rx – other | J0598, S9346, T1503 |
| CT9963 | Rx – pharmacy fee | Q0513, Q0514, S9430 |
| CT9964 | Other care – home care – specialized visit | 99507, 99509, 99510, 99511, 99600 |
| CT9965 | Other care – home care – physician supervision | G0372, S0270, S0272 |
| CT9966 | Other care – home care – nursing care | G0128, T1000, T1002, T1003, T1004 |
| CT9967 | Other care – home care – nursing care – rn | G0154, S9123, T1030 |
| CT9968 | Other care – home care – nursing care – lpn | S9124, T1031 |
| CT9969 | Other care – home care – nursing care – np | S0274 |
| CT9970 | Other care – home care – rehabilitation – physical therapy | G0151, G0157, G0158 |
| CT9971 | Other care – home care – rehabilitation – occupational therapy | G0152 |
| CT9972 | Other care – home care – rehabilitation – speech therapy | S9128 |
| CT9973 | Other care – home care – social worker | G0155, S9127 |
| CT9974 | Other care – home care – home health aide | G0156, S9122, T1021 |
| CT9975 | Other care – home care – other care – day care | S5100, S5101, S5102, S5105 |
| CT9976 | Other care – home care – other care – chore care | S5120, S5121 |
| CT9977 | Other care – home care – other care – attendant care | S5125, S5126 |
| CT9978 | Other care – home care – other care – homemaker | S5130, S5131 |
| CT9979 | Other care – home care – other care – companion care | S5135, S5136 |
| CT9980 | Other care – home care – other care – respite care | S5150, S5151, S9125, T1005 |
| CT9981 | Other care – home care – other care | S5165, S5175, S5185, S5199, T1022 |
| CT9982 | Other care – home care – training | S5108, S5109, S5110, S5111, S5115, S5116 |
| CT9983 | Other care – home care – emergency response system | S5160, S5161, S5162 |
| CT9984 | Other care – home care – meals | S5170 |
| CT9985 | Other care – pain management – pca / related | S9325, S9326, S9327, S9328 |
| CT9986 | Other care – hospice | G0337, Q5001, Q5002, Q5003, Q5004, Q5005, Q5006, Q5007, Q5008, Q5009, S0271, S9126, T2042, T2043, T2044, T2045, T2046 |
| CT9987 | Other care – long term care – residential care | T2010, T2011, T2032, T2033 |
| CT9988 | Other care – long term care – assisted living | T2030, T2031 |
| CT9990 | Other care – other – ancillary services | 97804, 99001, 99002, 99070, 99071, 99075, 99082, 99199 |
| CT9991 | Other care – other – lightbox | E0203 |
| CT9995 | Other care – other – irrigation | S9590 |
| CT9996 | Other care – other – lodging | S9976, S9994 |
| CT9997 | Other care – other – meals | S9977, S9996 |
| CT9998 | Other care – other – medical records | S9981, S9982 |
| XX0000 | Ungrouped Codes | 0240T, 3125F, 33952, 33954, 33958, 33962, 33966, 33984, 37191, 37192, 37193, 37619, 6030F, 7010F, 90769, 90770, 90771, 90776, 96360, A4459, A5056, A5057, C9443, C9444, C9446, C9737, G0434, G0472, G0473, G8155, G8156, G8157, G8214, G8217, G8219, G8220, G8221, G8234, G8569, G8570, G8571, G8572, G8575, G8576, G8577, G8578, G8579, G8580, G8581, G8582, G8583, G8584, G8585, G8586, G8587, G8588, G8589, G8590, G8591, G8592, G8593, G8594, G8595, G8596, G8597, G8598, G8599, G8600, G8601, G8602, G8603, G8604, G8605, G8606, G8607, G8608, G8609, G8610, G8611, G8612, G8613, G8614, G8615, G8616, G8617, G8618, G8619, G8620, G8621, G8622, G8623, G8624, G8625, G8626, G8627, G8628, G8629, G8630, G8631, G8632, G8633, G8634, G8635, G8636, G8637, G8638, G8639, G8640, G8641, G8642, G8643, G8644, G8675, G8676, G8677, G8678, G8679, G8680, G8687, G8689, G8691, G8693, G8696, G8697, G8698, G8748, G8967, G8968, G8969, G8970, G8971, G8972, G9199, G9200, G9201, G9298, G9299, G9362, G9363, G9497, G9500, G9501, G9637, G9638, G9642, G9644, G9645, G9654, G9655, G9656, G9657, G9658, J2274, J2704, Q9974, S0144 |
Table 6: Relevant Typical Drug Groups
| Group ID | Group Name |
| RX001 | contrast media |
| RX002 | diagnostic agents |
| RX0111 | parasympathomimetics |
| RX017 | hypnotics and sedatives |
| RX0320 | cough and cold preparations |
| RX0321 | decongestants and other nasal preparations for topical use |
| RX0324 | throat preparations |
| RX0426 | Bronchodilators: adrenergics for systemic use |
| RX0427 | drugs for obstructive airway diseases – inhalants |
| RX0429 | other systemic drugs for obstructive airway diseases |
| RX0538 | diuretics |
| RX0539 | i.v. solutions & additives |
| RX0540 | Nitrates and other antianginals |
| RX0541 | other antihypertensives |
| RX0546 | Antiplatelet agents, thrombin inhibitors |
| RX0645 | antacids |
| RX0646 | antidiarrheals intestinal adsorbents |
| RX0647 | antiemetics and antinauseants |
| RX0648 | digestives incl. enzymes |
| RX0649 | drugs for constipation |
| RX0650 | drugs for functional gastrointestinal disorders |
| RX0651 | drugs for peptic ulcer and gerd |
| RX0652 | intestinal antiinfectives |
| RX0653 | intestinal antiinflammatory agents |
| RX0654 | stomatological preparations |
| RX0755 | bile and liver therapy |
| RX0857 | antiinflammatory and antirheumatic products |
| RX0861 | opioids |
| RX0862 | other analgesics and antipyretics |
| RX0970 | antipruritics incl. antihistamines anesthetics etc. |
| RX1086 | corticosteroids for systemic use |
| RX16106 | iron preparations |
| RX16109 | vitamin b12 and folic acid |
| RX18114 | agents against amoebiasis and other protozoal diseases |
| RX18115 | agents against leishmaniasis and trypanosomiasis |
| RX18116 | anthelmintics |
| RX18117 | antibacterials for systemic use |
| RX18118 | antifungals for systemic use |
| RX18119 | antiinfectives |
| RX19125 | anxiolytics |
| RX19126 | drugs used in addictive disorders |
| RX23129 | immune sera and immunoglobulins |
| RX23131 | mineral supplements |
| RX23133 | other nutrients |
| RX23134 | vaccines |
| RX23135 | vitamins |
| RX99136 | anesthetics general |
| RX99137 | anesthetics local |
| RX99138 | medical gas |
| RX99139 | Other Therapeutic Agents |