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 Low Back Pain, sometimes abbreviated LBP, is a chronic condition episode. There is a 30-day lookback period to capture services rendered prior to the trigger claim, such as diagnostic services, office visits, and ancillary services. The Low Back Pain episode does not have an end date regarding the look-forward period, but can be broken into distinct reporting periods for implementations (e.g., 12 months).
Episode Components
| Triggers | A Low Back Pain episode can be triggered by an inpatient facility claim with a trigger principal diagnosis code for the condition (See Table 1) or an outpatient facility or professional claim with a trigger diagnosis code (in any position) and an E&M procedure code (in any position) on the same claim line. For professional claim triggers a second trigger signal or confirming claim is required that meets the same criteria as any of the initial trigger claims above. The confirming claim must be at least 30 days after the initial trigger claim. |
| Typical Diagnoses | 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, for chronic episodes, relevant acute inpatient admissions claims are flagged as actionable adverse events regardless of the presence of AAE codes.) (Table 3) |
| Typical Procedures | 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 diagnoses 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: Low Back Pain, Radiculopathy Low Back Pain, Radiculopathy, Myelopathy Inflammatory spondylopathies |
Code Tables
Table 1: Trigger Codes
| Trigger Type | Code Value |
| ICD-10-CM (DX) Triggers | A1801, M2578, M4300, M4305, M4306, M4307, M4308, M4309, M438X9, M4600, M4605, M4606, M4607, M4608, M4609, M4640, M4646, M4647, M4648, M4649, M4650, M4655, M4656, M4657, M4658, M4659, M4680, M4685, M4686, M4687, M4688, M4689, M4690, M4695, M4696, M4697, M4698, M4699, M4710, M4716, M4720, M4726, M4727, M4728, M47816, M47817, M47818, M47819, M47896, M47897, M47898, M47899, M479, M4800, M4806, M48061, M48062, M4807, M4808, M4810, M4816, M4817, M4818, M4819, M4820, M4825, M4826, M4827, M4830, M4835, M4836, M4837, M4838, M488X6, M488X7, M488X8, M488X9, M489, M4980, M4985, M4986, M4987, M4988, M4989, M5106, M5116, M5117, M5126, M5127, M5135, M5136, M5137, M5146, M5147, M5186, M5187, M519, M532X6, M532X7, M532X8, M532X9, M533, M5380, M5385, M5386, M5387, M5388, M539, M5400, M5405, M5406, M5407, M5408, M5409, M5410, M5415, M5416, M5417, M5418, M5430, M5431, M5432, M5440, M5441, M5442, M545, M5489, M549, M62830, M961, M9903, M9913, M9914, M9915, M9916, M9919, M9923, M9923, M9924, M9924, M9925, M9925, M9926, M9929, M9933, M9933, M9934, M9934, M9935, M9935, M9936, M9939, M9943, M9943, M9944, M9944, M9945, M9945, M9946, M9949, M9953, M9953, M9954, M9954, M9955, M9955, M9956, M9959, M9963, M9963, M9964, M9964, M9965, M9965, M9966, M9969, M9973, M9973, M9974, M9974, M9975, M9975, M9976, M9979, M9983, M9984, M9985, M9986, M9989, S335XXA, S338XXA, S339XXA |
Table 2: ICD-10 Typical Diagnosis
| Group ID | Group Name | Code Value |
| DXX0012 | Other injuries and conditions due to external | T1490 |
| DXX0104 | ID – other herpes zoster | B020, B0223, B0224, B0229 |
| DXX01130 | NS – autonomic ns ds | G9009, G990 |
| DXX01146 | NS – hereditary polyneuropathy | G600, G602 |
| DXX01147 | NS – idiopathic polyneuropathy | G608, G609 |
| DXX01152 | NS – polyneuropathy – other diseases | A5215 |
| DXX01183 | NS – acute pain – other | G890 |
| DXX01186 | NS – chronic pain – other | G8929, G894 |
| DXX01208 | MS – soft tissue – nos- symptoms / findings | M5410, M5418, M792 |
| DXX01343 | Inj – cauda equina | S343XXA |
| DXX01399 | Major Neurological Deficit | G834 |
| DXX01417 | Neuromuscular Disorders from STDs | A5212, A5219 |
| DXX05345 | Orthostatic Hypotension / Dizziness | I951, R42 |
| DXX06335 | Retroperitoneal Abscess | K6812 |
| DXX081038 | Post Laminectomy Syndrome | M961 |
| DXX081045 | Deformities, lower limb | M9906 |
| DXX081048 | Hip / Pelvis deformities | M9905, M9985 |
| DXX081050 | Inflammatory Arthropathies | M461 |
| DXX081051 | Inflammatory spondylopathies | M4650, M4651, M4652, M4653, M4654, M4655, M4656, M4657, M4658, M4659, M4680, M4681, M4682, M4683, M4684, M4685, M4686, M4687, M4688, M4689, M4690, M4691, M4692, M4693, M4694, M4695, M4696, M4697, M4698, M4699 |
| DXX081054 | Low Back Pain, Radiculopathy | M4646, M4647, M4720, M4726, M4727, M4728, M47816, M47817, M47818, M47819, M47896, M47897, M47898, M47899, M479, M5116, M5117, M5126, M5127, M5134, M5135, M5136, M5137, M5146, M5147, M5186, M5187, M519, M5415, M5416, M5417, M5430, M5431, M5432, M5440, M5441, M5442, M545, M9983, M9984 |
| DXX081055 | Low Back Pain, Radiculopathy, Myelopathy | M4716, M4806, M4807, M5106 |
| DXX081062 | Other arthropathies | M081, M450, M455, M456, M457, M458, M459, M9903, M9904 |
| DXX081063 | Other Back Pain, Radiculopathy, Myelopathy | M4710, M4800, M4808 |
| DXX081064 | Other deformities, limb, other sites | M9986 |
| DXX08107 | MS – pelvis – sprn/strn | S338XXA, S339XXA |
| DXX081070 | Other bone infections | A1801 |
| DXX081082 | Compl of joint prosthesis, orthopedic proced | T84216S, T84226S, T84296S |
| DXX081092 | Backache | M4320, M4321, M4322, M4323, M4324, M4325, M4326, M5403, M5404, M5405, M5406, M5407, M5408, M5409, M5489, M549, M62830 |
| DXX081093 | Sprain Lower Back | S139XXA, S239XXA, S335XXA, S336XXA |
| DXX081094 | Sprains and Strains | S0340XS, S0341XS, S0342XS, S0343XS, S038XXA, S038XXS, S039XXA, S039XXS, S0911XS, S134XXS, S135XXS, S138XXS, S139XXS, S161XXS, S233XXS, S2341XS, S23420S, S23421S, S23428S, S23429S, S238XXS, S239XXS, S29011A, S29011S, S29012A, S29012S, S29019A, S29019S, S334XXS, S335XXS, S336XXS, S338XXS, S339XXS, S39011A, S39011S, S39012A, S39012S, S39013A, S39013S, S43401S, S43402S, S43409S, S43411S, S43412S, S43419S, S43421S, S43422S, S43429S, S43431S, S43432S, S43439S, S43491S, S43492S, S43499S, S4350XS, S4351XS, S4352XS, S4360XS, S4361XS, S4362XS, S4380XS, S4381XS, S4382XS, S4390XS, S4391XS, S4392XS, S46011S, S46012S, S46019S, S46111S, S46112S, S46119S, S46211S, S46212S, S46219S, S46311S, S46312S, S46319S, S46811S, S46812S, S46819S, S46911S, S46912S, S46919S, S5320XS, S5321XS, S5322XS, S5330XS, S5331XS, S5332XS, S53401S, S53402S, S53409S, S53411S, S53412S, S53419S, S53421S, S53422S, S53429S, S53431S, S53432S, S53439S, S53441S, S53442S, S53449S, S53491S, S53492S, S53499S, S56011S, S56012S, S56019S, S56111S, S56112S, S56113S, S56114S, S56115S, S56116S, S56117S, S56118S, S56119S, S56211S, S56212S, S56219S, S56311S, S56312S, S56319S, S56411S, S56412S, S56413S, S56414S, S56415S, S56416S, S56417S, S56418S, S56419S, S56511S, S56512S, S56519S, S56811S, S56812S, S56819S, S56911S, S56912S, S56919S, S63301S, S63302S, S63309S, S63311S, S63312S, S63319S, S63321S, S63322S, S63329S, S63331S, S63332S, S63339S, S63391S, S63392S, S63399S, S63400S, S63401S, S63402S, S63403S, S63404S, S63405S, S63406S, S63407S, S63408S, S63409S, S63410S, S63411S, S63412S, S63413S, S63414S, S63415S, S63416S, S63417S, S63418S, S63419S, S63420S, S63421S, S63422S, S63423S, S63424S, S63425S, S63426S, S63427S, S63428S, S63429S, S63430S, S63431S, S63432S, S63433S, S63434S, S63435S, S63436S, S63437S, S63438S, S63439S, S63490S, S63491S, S63492S, S63493S, S63494S, S63495S, S63496S, S63497S, S63498S, S63499S, S63501S, S63502S, S63509S, S63511S, S63512S, S63519S, S63521S, S63522S, S63529S, S63591S, S63592S, S63599S, S63601S, S63602S, S63609S, S63610S, S63611S, S63612S, S63613S, S63614S, S63615S, S63616S, S63617S, S63618S, S63619S, S63621S, S63622S, S63629S, S63630S, S63631S, S63632S, S63633S, S63634S, S63635S, S63636S, S63637S, S63638S, S63639S, S63641S, S63642S, S63649S, S63650S, S63651S, S63652S, S63653S, S63654S, S63655S, S63656S, S63657S, S63658S, S63659S, S63681S, S63682S, S63689S, S63690S, S63691S, S63692S, S63693S, S63694S, S63695S, S63696S, S63697S, S63698S, S63699S, S638X1S, S638X2S, S638X9S, S6390XS, S6391XS, S6392XS, S66011S, S66012S, S66019S, S66110S, S66111S, S66112S, S66113S, S66114S, S66115S, S66116S, S66117S, S66118S, S66119S, S66211S, S66212S, S66219S, S66310S, S66311S, S66312S, S66313S, S66314S, S66315S, S66316S, S66317S, S66318S, S66319S, S66411S, S66412S, S66419S, S66510S, S66511S, S66512S, S66513S, S66514S, S66515S, S66516S, S66517S, S66518S, S66519S, S66811S, S66812S, S66819S, S66911S, S66912S, S66919S, S73101S, S73102S, S73109S, S73111S, S73112S, S73119S, S73121S, S73122S, S73129S, S73191S, S73192S, S73199S, S76011S, S76012S, S76019S, S76111S, S76112S, S76119S, S76211S, S76212S, S76219S, S76311S, S76312S, S76319S, S76811S, S76812S, S76819S, S76911S, S76912S, S76919S, S8360XS, S8361XS, S8362XS, S838X1S, S838X2S, S838X9S, S8390XS, S8391XS, S8392XS, S86011S, S86012S, S86019S, S86111S, S86112S, S86119S, S86211S, S86212S, S86219S, S86311S, S86312S, S86319S, S86811S, S86812S, S86819S, S86911S, S86912S, S86919S, S93401S, S93402S, S93409S, S93411S, S93412S, S93419S, S93421S, S93422S, S93429S, S93431S, S93432S, S93439S, S93491S, S93492S, S93499S, S93501S, S93502S, S93503S, S93504S, S93505S, S93506S, S93509S, S93511S, S93512S, S93513S, S93514S, S93515S, S93516S, S93519S, S93521S, S93522S, S93523S, S93524S, S93525S, S93526S, S93529S, S93601S, S93602S, S93609S, S93611S, S93612S, S93619S, S93621S, S93622S, S93629S, S93691S, S93692S, S93699S, S96011S, S96012S, S96019S, S96111S, S96112S, S96119S, S96211S, S96212S, S96219S, S96811S, S96812S, S96819S, S96911S, S96912S, S96919S |
| DXX081095 | Stiff Spine | M4810, M4811, M4812, M4813, M4814, M4815, M4816, M4817, M4818, M4819, M4820, M4821, M4822, M4823, M4824, M4825, M4826, M4827 |
| DXX081096 | Other Spine Problems | M2578, M4300, M4305, M4306, M4307, M4308, M4309, M4315, M4316, M4317, M4318, M4319, M4327, M4328, M438X9, M4600, M4601, M4602, M4603, M4604, M4605, M4606, M4607, M4608, M4609, M4640, M4648, M4649, M4830, M4831, M4832, M4833, M4834, M4835, M4836, M4837, M4838, M488X5, M488X6, M488X7, M488X8, M488X9, M489, M4980, M4981, M4982, M4983, M4984, M4985, M4986, M4987, M4988, M4989, M532X6, M532X7, M532X8, M533, M5380, M5384, M5385, M5386, M5387, M5388, M539, M9923, M9923, M9924, M9924, M9925, M9925, M9926, M9929, M9933, M9933, M9934, M9934, M9935, M9935, M9936, M9939, M9943, M9943, M9944, M9944, M9945, M9945, M9946, M9949, M9953, M9953, M9954, M9954, M9955, M9955, M9956, M9959, M9963, M9963, M9964, M9964, M9965, M9965, M9966, M9969, M9973, M9973, M9974, M9974, M9975, M9975, M9976, M9979 |
| DXX081103 | Other osteopathic disorders | M9989 |
| DXX081104 | Other injuries to spine | S129XXA, S22009A, S22009B, S32009A, S32009B, S3210XA, S3210XB, S34109A, S34139A |
| DXX081105 | Spinal cord injury | S14109A, S24109A |
| DXX081115 | Periprosthetic fracture | M978XXS, M979XXS, T84048S, T84049S |
| DXX08179 | MS – spine – lmbr – disloc – closed | M9913 |
| DXX08186 | MS – spine – scrm / ccyx – fx – w/o cord injury – closed | S322XXA |
| DXX08187 | MS – spine – scrm / ccyx – fx – w/o cord injury – open | S322XXB |
| DXX08192 | MS – spine – scrm – disloc – closed | M9914 |
| DXX08202 | MS – spine – other – disloc – closed | M9915 |
| DXX08224 | MS – spine – deformity | M4000, M4003, M4004, M4005, M4010, M4012, M4013, M4014, M4015, M40202, M40203, M40204, M40205, M40209, M40292, M40293, M40294, M40295, M40299, M4030, M4035, M4036, M4037, M41112, M41113, M41114, M41115, M41116, M41117, M41119, M41122, M41123, M41124, M41125, M41126, M41127, M41129, M4120, M4122, M4123, M4124, M4125, M4126, M4127, M963 |
| DXX0873 | MS – head / neck – ossification of ligament | M6788 |
| DXX08897 | MS – joint nos – jnt derangmnt – other | M532X9 |
| DXX08906 | MS – joint nos – disloc – closed | M9916, M9919 |
| DXX08931 | MS – soft tissue – nos- nec / nos | M7080, M70811, M70812, M70819, M70821, M70822, M70829, M70831, M70832, M70839, M70841, M70842, M70849, M70851, M70852, M70859, M70861, M70862, M70869, M70871, M70872, M70879, M7088, M7089, M7989 |
| DXX08948 | MS – muscle – nos – spasm of muscle | M6240, M62411, M62412, M62419, M62421, M62422, M62429, M62431, M62432, M62439, M62441, M62442, M62449, M62451, M62452, M62459, M62461, M62462, M62469, M62471, M62472, M62479, M6248, M6249, M62831, M62838 |
| DXX08949 | MS – muscle – nos – muscle weakness | M6281 |
| DXX08950 | MS – muscle – nos – myalgia | M6080, M60811, M60812, M60819, M60821, M60822, M60829, M60831, M60832, M60839, M60841, M60842, M60849, M60851, M60852, M60859, M60861, M60862, M60869, M60871, M60872, M60879, M6088, M6089, M609, M791, M797 |
| DXX08960 | MS – nos – aftercare | Z4781, Z4782, Z4789 |
| DXX0990 | MS – head / neck – infection | M5400 |
| DXX1554 | Spina Bifida | Q762 |
| DXX1765 | NS – chronic pain – cancer | G893 |
| DXX1923 | BH – other ds | F4541 |
| DXX1963 | Anxiety Disorders | F064 |
| DXX2159 | Toxic Effects of Radiation | M962 |
| DXX2337 | Prvn – routine medical exam | Z0001 |
| DXX2338 | Prvn – routine exam – other | Z005, Z0070, Z0071 |
| DXX2339 | Prvn – admin exam / visit | Z020, Z021, Z022, Z023, Z024, Z025, Z026, Z0271, Z0279, Z0282, Z0289, Z029 |
| DXX2345 | Othr – fitting – other device | Z4582, Z4589, Z459, Z469 |
| DXX2352 | Othr – other | Z723, Z72820 |
| DXX2378 | Pain, unspecified | R52 |
| DXX2379 | Observation/Examination | Z0000, Z008, Z0189, Z049 |
| DXX2381 | Aftercare | Z4689, Z4889, Z5189 |
| DXX2382 | Preventive Screening | Z13828, Z1389 |
| XX0000 | Ungrouped Codes | M48061, M48062, S034XXS |
Table 3: ICD-10 Actionable Adverse Events
| Group ID | Group Name | Code Value |
| DXX01392 | Delirium, Encephalopathy | G92 |
| 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 |
| DXX05308 | Pulmonary Embolism | I2690, I2692, I2699 |
| DXX05375 | Dehydration | E860, E861, E869 |
| DXX06160 | Gastroenteritis | A080, A0811, A0819, A082, A0831, A0832, A0839, A084, A088, A09, K5289, K529 |
| DXX06314 | Digestive system complications | K592 |
| DXX06372 | Ulc Colitis w Obstruction | K51412 |
| DXX081039 | Intraspinal abscess | G061 |
| DXX081082 | Compl of joint prosthesis, orthopedic proced | T84216A, T84216D, T84226A, T84226D, T84296A, T84296D |
| DXX09191 | Decubitus Ulcer | L89000, L89001, L89002, L89009, L89010, L89011, L89012, L89019, L89020, L89021, L89022, L89029, L89100, L89101, L89102, L89109, L89110, L89111, L89112, L89119, L89120, L89121, L89122, L89129, L89130, L89131, L89132, L89139, L89140, L89141, L89142, L89149, L89150, L89151, L89152, L89159, L89200, L89201, L89202, L89209, L89210, L89211, L89212, L89219, L89220, L89221, L89222, L89229, L89300, L89301, L89302, L89309, L89310, L89311, L89312, L89319, L89320, L89321, L89322, L89329, L8940, L8941, L8942, L8945, L89500, L89501, L89502, L89509, L89510, L89511, L89512, L89519, L89520, L89521, L89522, L89529, L89600, L89601, L89602, L89609, L89610, L89611, L89612, L89619, L89620, L89621, L89622, L89629, L89810, L89811, L89812, L89819, L89890, L89891, L89892, L89899, L8990, L8991, L8992, L8995 |
| DXX09192 | Dermatitis, Urticaria | T7841XA |
| DXX09193 | Cellulitis, Skin Infection | L02211, L02212, L02213, L02214, L02215, L02216, L02219, L02811, L02818, L0291, L03311, L03312, L03313, L03314, L03315, L03316, L03319, L03321, L03322, L03323, L03324, L03325, L03326, L03329, L03811, L03818, L03891, L03898, L0390, L0391, L983 |
| 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 |
| DXX11150 | Bladder Dysfunction, hemorrhage | N310, N311, N319 |
| DXX11152 | Urinary Frequency & other symptoms | R300 |
| DXX11153 | Urinary Incontinence | R32 |
| DXX11167 | Acute Kidney Failure | N170, N171, N172, N178, N179, N19, N990 |
| DXX2161 | Complications from Central Line | T80218A, T80219A |
| DXX2164 | Accidental Falls | V00811A, V00811D, V00812A, V00812D, V00818A, V00818D, V00831A, V00831D, W050XXA, W050XXD, W051XXA, W051XXD, W052XXA, W052XXD, W06XXXA, W06XXXD, W07XXXA, W07XXXD, W08XXXA, W08XXXD, W102XXA, W102XXD, W108XXA, W108XXD, W109XXA, W109XXD, W1811XA, W1811XD, W1812XA, W1812XD |
| DXX2171 | Adverse effects of drugs | G4440, G4441, 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, T884XXA, T8853XA, T8859XA |
| DXX2360 | Complication of Implanted device, graft | T836XXA, T85610A, T85612A, T85613A, T85615A, T85618A, T85620A, T85623A, T85625A, T85628A, T85630A, T85635A, T85638A, T85690A, T85695A, T85698A, T8579XA, T85818A, T8581XA, T85828A, T8582XA, T85838A, T8583XA, T85848A, T8584XA, T85858A, T8585XA, T85868A, T8586XA, T85898A, T8589XA, T859XXA |
| DXX2361 | complications of surgical procedures | I9789, T81718A, T8172XA, T8189XA, T888XXA |
| DXX2362 | complications of medical care | D7881, D7889, E368, E8989, I973, L7681, L7682, M9689, T7841XD, T801XXA, T8181XA, T880XXA, T881XXA, T887XXA, T889XXA, Y633, Y635, Y636, Y638, Y639, Y641, Y648, Y649, Y658, Y66, Y69, Y844, Y846, Y847 |
| DXX9912 | HAC 04: Stage III and IV Pressure Ulcers | L89003, L89004, L89013, L89014, L89023, L89024, L89103, L89104, L89113, L89114, L89123, L89124, L89133, L89134, L89143, L89144, L89153, L89154, L89203, L89204, L89213, L89214, L89223, L89224, L89303, L89304, L89313, L89314, L89323, L89324, L8943, L8944, L89503, L89504, L89513, L89514, L89523, L89524, L89603, L89604, L89613, L89614, L89623, L89624, L89813, L89814, L89893, L89894, L8993, L8994 |
Table 4: ICD-10 Relevant Procedure Codes
| Group ID | Group Name | Code Value |
| PXX0101 | Incision and excision of CNS – 001 | 3E0Q03Z, 3E0Q33Z |
| PXX0105 | Insertion of catheter or spinal stimulator and injection into spinal canal – 005 | 3E0R33Z, 3E0R3NZ, 3E0S33Z, 3E0S3NZ |
| PXX0108 | Other non-OR or closed therapeutic nervous system procedures – 008 | 3C1ZX8Z, 3E0T33Z, 3E0X33Z |
| PXX01198 | Magnetic resonance imaging – 198 | 8E0XXBH, 8E0YXBH, B03BY0Z, B03BYZZ, B03BZZZ, BL30Y0Z, BL31Y0Z, BL31YZZ, BL33Y0Z, BL33YZZ, BL33ZZZ, BR30Y0Z, BR30YZZ, BR30ZZZ, BR31Y0Z, BR31YZZ, BR31ZZZ, BR32Y0Z, BR32YZZ, BR32ZZZ, BR33Y0Z, BR33YZZ, BR33ZZZ, BR39Y0Z, BR39YZZ, BR39ZZZ, BR3CY0Z, BR3CYZZ, BR3CZZZ, BR3FY0Z, BR3FYZZ, BR3FZZZ, BT30Y0Z, BT30YZZ, BT30ZZZ, BW33Y0Z, BW33YZZ, BW3GY0Z, BW3GYZZ, BW3GZZZ |
| PXX0219 | Other therapeutic procedures on eyelids, conjunctiva, cornea – 019 | 0JBL0ZZ, 0JBM0ZZ |
| PXX03215 | Other physical therapy and rehabilitation – 215 | 7W03X0Z, 7W03X1Z, 7W03X2Z, 7W03X3Z, 7W03X4Z, 7W03X5Z, 7W03X6Z, 7W03X7Z, 7W03X8Z, 7W03X9Z, 7W04X0Z, 7W04X1Z, 7W04X2Z, 7W04X3Z, 7W04X4Z, 7W04X5Z, 7W04X6Z, 7W04X7Z, 7W04X8Z, 7W04X9Z, 7W05X0Z, 7W05X1Z, 7W05X2Z, 7W05X3Z, 7W05X4Z, 7W05X5Z, 7W05X6Z, 7W05X7Z, 7W05X8Z, 7W05X9Z, 7W06X0Z, 7W06X1Z, 7W06X2Z, 7W06X3Z, 7W06X4Z, 7W06X5Z, 7W06X6Z, 7W06X7Z, 7W06X8Z, 7W06X9Z, 7W09X0Z, 7W09X1Z, 7W09X2Z, 7W09X3Z, 7W09X4Z, 7W09X5Z, 7W09X6Z, 7W09X7Z, 7W09X8Z, 7W09X9Z, F003GKZ, F003GMZ, F003GPZ, F003GYZ, F003GZZ, F00Z01Z, F00Z02Z, F00Z0KZ, F00Z0ZZ, F00Z11Z, F00Z12Z, F00Z19Z, F00Z1KZ, F00Z1ZZ, F00Z21Z, F00Z22Z, F00Z29Z, F00Z2KZ, F00Z2ZZ, F00Z31Z, F00Z32Z, F00Z3KZ, F00Z3ZZ, F00Z41Z, F00Z42Z, F00Z4ZZ, F00Z51Z, F00Z52Z, F00Z59Z, F00Z5KZ, F00Z6KZ, F00Z6MZ, F00Z6PZ, F00Z6YZ, F00Z6ZZ, F00Z7KZ, F00Z7MZ, F00Z7PZ, F00Z7YZ, F00Z7ZZ, F00Z8KZ, F00Z8MZ, F00Z8PZ, F00Z8YZ, F00Z8ZZ, F00Z9KZ, F00Z9PZ, F00Z9QZ, F00Z9YZ, F00Z9ZZ, F00ZBKZ, F00ZBNZ, F00ZBPZ, F00ZBQZ, F00ZBTZ, F00ZBYZ, F00ZBZZ, F00ZCKZ, F00ZCMZ, F00ZCPZ, F00ZCYZ, F00ZCZZ, F00ZDKZ, F00ZDNZ, F00ZDPZ, F00ZDQZ, F00ZDSZ, F00ZDTZ, F00ZDYZ, F00ZDZZ, F00ZFKZ, F00ZFNZ, F00ZFPZ, F00ZFSZ, F00ZFTZ, F00ZFYZ, F00ZFZZ, F00ZGKZ, F00ZGMZ, F00ZGPZ, F00ZGYZ, F00ZGZZ, F00ZQ1Z, F00ZQ2Z, F00ZQKZ, F00ZQZZ, F00ZR1Z, F00ZR2Z, F00ZRKZ, F00ZRZZ, F00ZS1Z, F00ZS2Z, F00ZSKZ, F00ZSZZ, F00ZT1Z, F00ZT2Z, F00ZTKZ, F00ZTZZ, F00ZV1Z, F00ZV2Z, F00ZVKZ, F00ZVZZ, F00ZW1Z, F00ZW2Z, F00ZWKZ, F00ZWZZ, F00ZXZZ, F0636KZ, F0636MZ, F0636PZ, F0636YZ, F0636ZZ, F06Z0KZ, F06Z0MZ, F06Z0PZ, F06Z0YZ, F06Z0ZZ, F06Z1KZ, F06Z1ZZ, F06Z2KZ, F06Z2ZZ, F06Z3KZ, F06Z3MZ, F06Z3PZ, F06Z3YZ, F06Z3ZZ, F06Z4KZ, F06Z4PZ, F06Z4QZ, F06Z4TZ, F06Z4YZ, F06Z4ZZ, F06Z5KZ, F06Z5LZ, F06Z5MZ, F06Z5NZ, F06Z5PZ, F06Z5QZ, F06Z5SZ, F06Z5YZ, F06Z5ZZ, F06Z6KZ, F06Z6MZ, F06Z6PZ, F06Z6YZ, F06Z6ZZ, F06Z74Z, F06Z7KZ, F06Z7NZ, F06Z7QZ, F06Z7SZ, F06Z7TZ, F06Z7YZ, F06Z7ZZ, F06Z8KZ, F06Z8NZ, F06Z8PZ, F06Z8QZ, F06Z8SZ, F06Z8TZ, F06Z8YZ, F06Z8ZZ, F06Z9KZ, F06Z9PZ, F06Z9YZ, F06Z9ZZ, F06ZBKZ, F06ZBLZ, F06ZBMZ, F06ZBPZ, F06ZBYZ, F06ZBZZ, F06ZCKZ, F06ZCNZ, F06ZCPZ, F06ZCSZ, F06ZCTZ, F06ZCVZ, F06ZCYZ, F06ZCZZ, F07H6ZZ, F07J6ZZ, F07K6ZZ, F07L6ZZ, F07M6ZZ, F07Z4DZ, F07Z4EZ, F07Z4FZ, F07Z4UZ, F07Z4YZ, F07Z4ZZ, F07Z5CZ, F07Z5EZ, F07Z5FZ, F07Z5UZ, F07Z5YZ, F07Z5ZZ, F08Z0EZ, F08Z0FZ, F08Z0UZ, F08Z0YZ, F08Z0ZZ, F08Z1EZ, F08Z1FZ, F08Z1UZ, F08Z1YZ, F08Z1ZZ, F08Z2EZ, F08Z2FZ, F08Z2UZ, F08Z2YZ, F08Z2ZZ, F08Z3CZ, F08Z3DZ, F08Z3EZ, F08Z3FZ, F08Z3UZ, F08Z3YZ, F08Z3ZZ, F08Z4DZ, F08Z4EZ, F08Z4FZ, F08Z4UZ, F08Z4YZ, F08Z4ZZ, F08Z6ZZ, F08Z7BZ, F08Z7CZ, F08Z7DZ, F08Z7EZ, F08Z7FZ, F08Z7GZ, F08Z7UZ, F08Z7YZ, F08Z7ZZ, F0DZ3MZ, F0DZ4SZ, F0DZ4VZ, F0FZ0EZ, F0FZ0FZ, F0FZ0UZ, F0FZ0ZZ, F0FZ1EZ, F0FZ1FZ, F0FZ1UZ, F0FZ1ZZ, F0FZ2EZ, F0FZ2FZ, F0FZ2UZ, F0FZ2ZZ, F0FZ3EZ, F0FZ3FZ, F0FZ3UZ, F0FZ3ZZ, F0FZ4EZ, F0FZ4FZ, F0FZ4UZ, F0FZ4ZZ, F0FZ5EZ, F0FZ5FZ, F0FZ5UZ, F0FZ5ZZ, F0FZ6EZ, F0FZ6FZ, F0FZ6UZ, F0FZ6ZZ, F0FZ7EZ, F0FZ7FZ, F0FZ7UZ, F0FZ7ZZ, F0FZ8EZ, F0FZ8FZ, F0FZ8UZ, F0FZ8ZZ, F0FZ9EZ, F0FZ9FZ, F0FZ9UZ, F0FZ9ZZ, F0FZBEZ, F0FZBFZ, F0FZBUZ, F0FZBZZ, F0FZCEZ, F0FZCFZ, F0FZCUZ, F0FZCZZ, F0FZHEZ, F0FZHFZ, F0FZHUZ, F0FZHZZ, F0FZJKZ, F0FZJLZ, F0FZJMZ, F0FZJPZ, F0FZJZZ |
| PXX03235 | Robotic Assisted Procedure | 8E0X0CZ, 8E0X3CZ, 8E0XXCZ, 8E0Y0CZ, 8E0Y3CZ, 8E0YXCZ |
| PXX04183 | Routine chest X-ray – 183 | BW03ZZZ |
| PXX0441 | Other non-OR therapeutic procedures on respiratory system – 041 | 0HQ5XZZ |
| PXX05197 | Other diagnostic ultrasound – 197 | B04BZZZ, B440ZZZ, B444ZZZ, B445ZZZ, B446ZZZ, B447ZZZ, B448ZZZ, B44BZZZ, B44FZZZ, B44GZZZ, B44HZZZ, B44KZZZ, B44LZZZ, B44NZZZ, B549ZZZ, B54BZZZ, B54CZZZ, B54DZZZ, B54JZZZ, B54KZZZ, B54LZZZ, B54MZZZ, B54NZZZ, B54PZZZ, B54TZZZ, BG40ZZZ, BG41ZZZ, BG42ZZZ, BG44ZZZ, BH48ZZZ, BH49ZZZ, BH4BZZZ, BL41ZZZ, BL43ZZZ, BQ40ZZZ, BQ41ZZZ, BQ42ZZZ, BR47ZZZ, BR49ZZZ, BR4FZZZ |
| PXX05226 | Other diagnostic radiology and related techniques – 226 | B00BZZZ, B01BZZZ, B410ZZZ, B412ZZZ, B413ZZZ, B414ZZZ, B415ZZZ, B416ZZZ, B417ZZZ, B418ZZZ, B419ZZZ, B41BZZZ, B41CZZZ, B41DZZZ, B41FZZZ, B41GZZZ, B41JZZZ, B510ZZA, B510ZZZ, B519ZZZ, B51BZZA, B51BZZZ, B51CZZA, B51CZZZ, B51DZZA, B51DZZZ, B51FZZA, B51FZZZ, B51GZZA, B51GZZZ, B51HZZA, B51HZZZ, B51JZZA, B51JZZZ, B51KZZA, B51KZZZ, B51LZZA, B51LZZZ, B7080ZZ, B7081ZZ, B708YZZ, B7090ZZ, B7091ZZ, B709YZZ, B70B0ZZ, B70B1ZZ, B70BYZZ, BQ000ZZ, BQ001ZZ, BQ00YZZ, BQ00ZZ1, BQ00ZZZ, BQ010ZZ, BQ011ZZ, BQ01YZZ, BQ01ZZ1, BQ01ZZZ, BQ03ZZ1, BQ03ZZZ, BQ04ZZ1, BQ04ZZZ, BQ100ZZ, BQ101ZZ, BQ10YZZ, BQ10ZZZ, BQ110ZZ, BQ111ZZ, BQ11YZZ, BQ11ZZZ, BQ13ZZZ, BQ14ZZZ, BR00ZZZ, BR01ZZZ, BR02ZZZ, BR03ZZZ, BR040ZZ, BR041ZZ, BR04YZZ, BR04ZZZ, BR050ZZ, BR051ZZ, BR05YZZ, BR05ZZZ, BR060ZZ, BR061ZZ, BR06YZZ, BR06ZZZ, BR07ZZ1, BR07ZZZ, BR08ZZZ, BR09ZZ1, BR09ZZZ, BR0BZZZ, BR0CZZZ, BR0D0ZZ, BR0D1ZZ, BR0DYZZ, BR0DZZZ, BR0FZZZ, BR0GZZ1, BR0GZZZ, BR10ZZZ, BR11ZZZ, BR12ZZZ, BR13ZZZ, BR140ZZ, BR141ZZ, BR14YZZ, BR14ZZZ, BR150ZZ, BR151ZZ, BR15YZZ, BR15ZZZ, BR160ZZ, BR161ZZ, BR16YZZ, BR16ZZZ, BR170ZZ, BR171ZZ, BR17YZZ, BR17ZZZ, BR180ZZ, BR181ZZ, BR18YZZ, BR18ZZZ, BR190ZZ, BR191ZZ, BR19YZZ, BR19ZZZ, BR1B0ZZ, BR1B1ZZ, BR1BYZZ, BR1BZZZ, BR1C0ZZ, BR1C1ZZ, BR1CYZZ, BR1CZZZ, BR1D0ZZ, BR1D1ZZ, BR1DYZZ, BR1DZZZ, BR1F0ZZ, BR1F1ZZ, BR1FYZZ, BR1FZZZ, BR1G0ZZ, BR1GZZZ, BR1H0ZZ, BR1H1ZZ, BR1HYZZ, BR1HZZZ, BW00ZZZ, BW01ZZZ, BW0BZZZ, BW0CZZZ, BW0KZZZ, BW0LZZZ, BW1C0ZZ, BW1C1ZZ, BW1CYZZ, BW1CZZZ |
| PXX05227 | Other diagnostic procedures (interview, evaluation, consultation) – 227 | 03JYXZZ, 04JYXZZ, 05JYXZZ, 06JYXZZ, 07JNXZZ, 07JPXZZ, 0DJ6XZZ, 0DJUXZZ, 0DJVXZZ, 0DJWXZZ, 0FJ0XZZ, 0FJ4XZZ, 0FJGXZZ, 0JJSXZZ, 0JJTXZZ, 0JJVXZZ, 0JJWXZZ, 0KJXXZZ, 0KJYXZZ, 0LJXXZZ, 0LJYXZZ, 0MJXXZZ, 0MJYXZZ, 0NJ0XZZ, 0NJBXZZ, 0NJWXZZ, 0PJYXZZ, 0QJYXZZ, 0RJ4XZZ, 0RJ5XZZ, 0RJCXZZ, 0RJDXZZ, 0RJEXZZ, 0RJFXZZ, 0RJGXZZ, 0RJHXZZ, 0RJJXZZ, 0RJKXZZ, 0RJLXZZ, 0RJMXZZ, 0RJQXZZ, 0RJRXZZ, 0RJSXZZ, 0RJTXZZ, 0RJUXZZ, 0RJVXZZ, 0SJ0XZZ, 0SJ2XZZ, 0SJ3XZZ, 0SJ4XZZ, 0SJ5XZZ, 0SJ6XZZ, 0SJ7XZZ, 0SJ8XZZ, 0SJ9XZZ, 0SJBXZZ, 0SJMXZZ, 0SJNXZZ, 0SJPXZZ, 0SJQXZZ, 0TJ5XZZ, 0TJ9XZZ, 0TJBXZZ, 0TJDXZZ, 0UJ3XZZ, 0UJ8XZZ, 0UJHXZZ, 0UJMXZZ, 0VJ4XZZ, 0VJ8XZZ, 0VJDXZZ, 0VJMXZZ, 0VJRXZZ, 0VJSXZZ, 0WJ2XZZ, 0WJ3XZZ, 0WJ4XZZ, 0WJ5XZZ, 0WJ6XZZ, 0WJ8XZZ, 0WJFXZZ, 0WJKXZZ, 0WJLXZZ, 0WJMXZZ, 0WJNXZZ, 0XJ2XZZ, 0XJ3XZZ, 0XJ4XZZ, 0XJ5XZZ, 0XJ6XZZ, 0XJ7XZZ, 0XJ8XZZ, 0XJ9XZZ, 0XJBXZZ, 0XJCXZZ, 0XJDXZZ, 0XJFXZZ, 0XJJXZZ, 0XJKXZZ, 0YJ0XZZ, 0YJ1XZZ, 0YJ5XZZ, 0YJ6XZZ, 0YJ7XZZ, 0YJ8XZZ, 0YJ9XZZ, 0YJAXZZ, 0YJBXZZ, 0YJCXZZ, 0YJDXZZ, 0YJEXZZ, 0YJFXZZ, 0YJGXZZ, 0YJHXZZ, 0YJJXZZ, 0YJMXZZ, 0YJNXZZ, 4A0002Z, 4A000BZ, 4A00X2Z, 4A01029, 4A0102B, 4A01329, 4A0132B, 4A01X29, 4A01X2B, 4A0B78Z, 4A0B7GZ, 4A0B88Z, 4A0B8GZ, 4A0Z76Z, 4A0Z7KZ, 4A0ZX6Z, 4A1002Z, 4A100BZ, 4A1B78Z, 4A1B7GZ, 4A1B88Z, 4A1B8GZ, 4A1Z7KZ, 4A1ZXKZ, 4B00XVZ, 4B01XVZ, 4B0FXVZ, 8E01XY7, 8E0KXY7, F01Z77Z, F01Z9JZ |
| PXX0686 | Other muscular repair – 086 | 0JQ70ZZ, 0JQ73ZZ, 0JQC0ZZ, 0JQC3ZZ, 0JQM0ZZ, 0JQM3ZZ, 0JQN0ZZ, 0JQN3ZZ |
| PXX08149 | Arthroscopy – 149 | 0SJ24ZZ, 0SJ44ZZ |
| PXX08156 | Injections and aspirations of muscles, tendons, bursa, joints and soft tis – 156 | 0K9F3ZZ, 0K9G3ZZ, 0M9C30Z, 0M9C3ZZ, 0M9C40Z, 0M9C4ZZ, 0M9D30Z, 0M9D3ZZ, 0M9D40Z, 0M9D4ZZ, 0M9J30Z, 0M9J4ZZ |
| PXX08159 | Other diagnostic procedures on musculoskeletal system – 159 | 0JJT0ZZ, 0JJT3ZZ, 0JJV0ZZ, 0JJV3ZZ, 0JJW0ZZ, 0JJW3ZZ, 0K910ZX, 0K913ZX, 0K914ZX, 0K9F0ZX, 0K9F3ZX, 0K9F4ZX, 0K9G0ZX, 0K9G3ZX, 0K9G4ZX, 0K9K0ZX, 0K9K3ZX, 0K9K4ZX, 0K9L0ZX, 0K9L3ZX, 0K9L4ZX, 0K9M0ZX, 0K9M3ZX, 0K9M4ZX, 0K9N0ZX, 0K9N3ZX, 0K9N4ZX, 0K9P0ZX, 0K9P3ZX, 0K9P4ZX, 0K9Q0ZX, 0K9Q3ZX, 0K9Q4ZX, 0K9R0ZX, 0K9R3ZX, 0K9R4ZX, 0K9S0ZX, 0K9S3ZX, 0K9S4ZX, 0K9T0ZX, 0K9T3ZX, 0K9T4ZX, 0KBF0ZX, 0KBF3ZX, 0KBF4ZX, 0KBG0ZX, 0KBG3ZX, 0KBG4ZX, 0KBK0ZX, 0KBK3ZX, 0KBK4ZX, 0KBL0ZX, 0KBL3ZX, 0KBL4ZX, 0KBM0ZX, 0KBM3ZX, 0KBM4ZX, 0KBN0ZX, 0KBN3ZX, 0KBN4ZX, 0KBP0ZX, 0KBP3ZX, 0KBP4ZX, 0L990ZX, 0L993ZX, 0L994ZX, 0L9B0ZX, 0L9B3ZX, 0L9B4ZX, 0L9F0ZX, 0L9F3ZX, 0L9F4ZX, 0L9G0ZX, 0L9G3ZX, 0L9G4ZX, 0L9H0ZX, 0L9H3ZX, 0L9H4ZX, 0LB90ZX, 0LB93ZX, 0LB94ZX, 0LBB0ZX, 0LBB3ZX, 0LBB4ZX, 0LBF0ZX, 0LBF3ZX, 0LBF4ZX, 0LBG0ZX, 0LBG3ZX, 0LBG4ZX, 0LBH0ZX, 0LBH3ZX, 0LBH4ZX, 0LBJ0ZX, 0LBJ3ZX, 0LBJ4ZX, 0LBK0ZX, 0LBK3ZX, 0LBK4ZX, 0LBL0ZX, 0LBL3ZX, 0LBL4ZX, 0LBM0ZX, 0LBM3ZX, 0LBM4ZX, 0LBN0ZX, 0LBN3ZX, 0LBN4ZX, 0LBP0ZX, 0LBP3ZX, 0LBP4ZX, 0LJX0ZZ, 0LJX3ZZ, 0LJX4ZZ, 0LJY0ZZ, 0LJY3ZZ, 0LJY4ZZ, 0M930ZX, 0M933ZX, 0M934ZX, 0M940ZX, 0M943ZX, 0M944ZX, 0M990ZX, 0M993ZX, 0M994ZX, 0M9B0ZX, 0M9B3ZX, 0M9B4ZX, 0M9C0ZX, 0M9C3ZX, 0M9C4ZX, 0M9D0ZX, 0M9D3ZX, 0M9D4ZX, 0M9H0ZX, 0M9H3ZX, 0M9H4ZX, 0M9J0ZX, 0M9J3ZX, 0M9J4ZX, 0M9K0ZX, 0M9K3ZX, 0M9K4ZX, 0M9L0ZX, 0M9L3ZX, 0M9L4ZX, 0M9M0ZX, 0M9M3ZX, 0M9M4ZX, 0M9V0ZX, 0M9V3ZX, 0M9V4ZX, 0M9W0ZX, 0M9W3ZX, 0M9W4ZX, 0MB30ZX, 0MB33ZX, 0MB34ZX, 0MB40ZX, 0MB43ZX, 0MB44ZX, 0MBC0ZX, 0MBC3ZX, 0MBC4ZX, 0MBD0ZX, 0MBD3ZX, 0MBD4ZX, 0MBH0ZX, 0MBH3ZX, 0MBH4ZX, 0MBJ0ZX, 0MBJ3ZX, 0MBJ4ZX, 0MBK0ZX, 0MBK3ZX, 0MBK4ZX, 0MBL0ZX, 0MBL3ZX, 0MBL4ZX, 0MBM0ZX, 0MBM3ZX, 0MBM4ZX, 0MBV0ZX, 0MBV3ZX, 0MBV4ZX, 0MBW0ZX, 0MBW3ZX, 0MBW4ZX, 0Q900ZX, 0Q903ZX, 0Q904ZX, 0Q910ZX, 0Q913ZX, 0Q914ZX, 0Q920ZX, 0Q923ZX, 0Q924ZX, 0Q930ZX, 0Q933ZX, 0Q934ZX, 0Q940ZX, 0Q943ZX, 0Q944ZX, 0Q950ZX, 0Q953ZX, 0Q954ZX, 0Q9S0ZX, 0Q9S3ZX, 0Q9S4ZX, 0QB20ZX, 0QB23ZX, 0QB24ZX, 0QB30ZX, 0QB33ZX, 0QB34ZX, 0QB40ZX, 0QB43ZX, 0QB44ZX, 0QB50ZX, 0QB53ZX, 0QB54ZX, 0QJY0ZZ, 0QJY3ZZ, 0QJY4ZZ, 0R9A0ZX, 0R9A3ZX, 0R9A4ZX, 0R9B0ZX, 0R9B3ZX, 0R9B4ZX, 0RBA0ZX, 0RBA3ZX, 0RBA4ZX, 0RBB0ZX, 0RBB3ZX, 0RBB4ZX, 0S900ZX, 0S903ZX, 0S904ZX, 0S920ZX, 0S923ZX, 0S924ZX, 0S930ZX, 0S933ZX, 0S934ZX, 0S940ZX, 0S943ZX, 0S944ZX, 0S950ZX, 0S953ZX, 0S954ZX, 0S960ZX, 0S963ZX, 0S964ZX, 0S970ZX, 0S973ZX, 0S974ZX, 0S980ZX, 0S983ZX, 0S984ZX, 0SB00ZX, 0SB03ZX, 0SB04ZX, 0SB20ZX, 0SB23ZX, 0SB24ZX, 0SB30ZX, 0SB33ZX, 0SB34ZX, 0SB40ZX, 0SB43ZX, 0SB44ZX, 0SB50ZX, 0SB53ZX, 0SB54ZX, 0SB60ZX, 0SB63ZX, 0SB64ZX, 0SB70ZX, 0SB73ZX, 0SB74ZX, 0SB80ZX, 0SB83ZX, 0SB84ZX |
| PXX08160 | Other therapeutic procedures on muscles and tendons – 160 | 0J960ZZ, 0J970ZZ, 0J980ZZ, 0J990ZZ, 0J9B0ZZ, 0J9C0ZZ, 0J9L0ZZ, 0J9M0ZZ, 0J9N0ZZ, 0J9P0ZZ, 0JB00ZZ, 0JB60ZZ, 0JB70ZZ, 0JB80ZZ, 0JB90ZZ, 0JBB0ZZ, 0JBC0ZZ, 0JBN0ZZ, 0JBP0ZZ, 0JD00ZZ, 0JD10ZZ, 0JD60ZZ, 0JD70ZZ, 0JD80ZZ, 0JD90ZZ, 0JDB0ZZ, 0JDC0ZZ, 0JDL0ZZ, 0JDM0ZZ, 0JDN0ZZ, 0JDP0ZZ, 0JQ10ZZ, 0JQ13ZZ, 0JQ60ZZ, 0JQ63ZZ, 0JQ80ZZ, 0JQ83ZZ, 0JQ90ZZ, 0JQ93ZZ, 0JQB0ZZ, 0JQB3ZZ, 0JQL0ZZ, 0JQL3ZZ, 0JQP0ZZ, 0JQP3ZZ, 0MJX0ZZ, 0MJY0ZZ |
| PXX08162 | Other OR therapeutic procedures on joints – 162 | 0MJX3ZZ, 0MJX4ZZ, 0MJY3ZZ, 0MJY4ZZ, 0RJA3ZZ, 0RJB3ZZ, 0SJ03ZZ, 0SJ23ZZ, 0SJ33ZZ, 0SJ43ZZ, 0SJ53ZZ, 0SJ63ZZ, 0SJ73ZZ, 0SJ83ZZ, 0SP93JZ, 0SP94JZ, 0SPA0JZ, 0SPA3JZ, 0SPA4JZ, 0SPB3JZ, 0SPB4JZ, 0SPE0JZ, 0SPE3JZ, 0SPE4JZ, 0SPR0JZ, 0SPR3JZ, 0SPR4JZ, 0SPS0JZ, 0SPS3JZ, 0SPS4JZ, 0ST50ZZ, 0ST60ZZ, 0ST70ZZ, 0ST80ZZ |
| PXX08163 | Other non-OR therapeutic procedures on musculoskeletal system – 163 | 0QP2X5Z, 0QP3X5Z, 0SP9X5Z, 0SPBX5Z, 2W03X1Z, 2W03X2Z, 2W03X3Z, 2W05X1Z, 2W05X2Z, 2W05X3Z, 2W53X1Z, 2W53X2Z, 2W53X3Z, 2W55X1Z, 2W55X2Z, 2W55X3Z, 2W5LX1Z, 2W5LX2Z, 2W5LX3Z, 2W5MX1Z, 2W5MX2Z, 2W5MX3Z, 2W5NX1Z, 2W5NX2Z, 2W5NX3Z, 2W5PX1Z, 2W5PX2Z, 2W5PX3Z, 2W5QX1Z, 2W5QX2Z, 2W5QX3Z, 2W5RX1Z, 2W5RX2Z, 2W5RX3Z, 3E0U3GC, F0DZ8EZ, F0DZ8FZ |
| PXX08164 | Other OR therapeutic procedures on musculoskeletal system – 164 | 0HQHXZZ, 0HQJXZZ, 0HQKXZZ, 0HQLXZZ |
| PXX08181 | Myelogram – 181 | B00B0ZZ, B00B1ZZ, B00BYZZ, B01B0ZZ, B01B1ZZ, B01BYZZ, BR030ZZ, BR031ZZ, BR03YZZ, BR130ZZ, BR131ZZ, BR13YZZ, BR1G1ZZ, BR1GYZZ |
| PXX08207 | Radioisotope bone scan – 207 | CP111ZZ, CP11YZZ, CP141ZZ, CP14YZZ, CP151ZZ, CP15YZZ, CP161ZZ, CP16YZZ, CP171ZZ, CP17YZZ, CP181ZZ, CP18YZZ, CP191ZZ, CP19YZZ, CP1B1ZZ, CP1BYZZ, CP1C1ZZ, CP1CYZZ, CP1D1ZZ, CP1DYZZ, CP1F1ZZ, CP1FYZZ, CP1YYZZ, CP1Z1ZZ, CP1ZYZZ, CP211ZZ, CP21YZZ, CP241ZZ, CP24YZZ, CP261ZZ, CP26YZZ, CP271ZZ, CP27YZZ, CP281ZZ, CP28YZZ, CP291ZZ, CP29YZZ, CP2B1ZZ, CP2BYZZ, CP2C1ZZ, CP2CYZZ, CP2D1ZZ, CP2DYZZ, CP2F1ZZ, CP2FYZZ, CP2H1ZZ, CP2HYZZ, CP2J1ZZ, CP2JYZZ, CP2YYZZ |
| PXX08212 | Diagnostic physical therapy – 212 | 4A0F33Z, 4A0FX3Z, F00ZHYZ, F00ZHZZ, F00ZJTZ, F00ZJWZ, F00ZJYZ, F00ZKKZ, F00ZKPZ, F00ZKYZ, F00ZKZZ, F00ZLKZ, F00ZLMZ, F00ZLPZ, F00ZLYZ, F00ZLZZ, F00ZMKZ, F00ZMPZ, F00ZMSZ, F00ZMVZ, F00ZMYZ, F00ZMZZ, F00ZNNZ, F00ZNPZ, F00ZNQZ, F00ZNSZ, F00ZNTZ, F00ZNYZ, F00ZPYZ, F00ZPZZ, F0110EZ, F0110FZ, F0110UZ, F0110YZ, F0110ZZ, F0111ZZ, F0113ZZ, F0114ZZ, F0115YZ, F0115ZZ, F0116YZ, F0116ZZ, F011GZZ, F0120EZ, F0120FZ, F0120UZ, F0120YZ, F0120ZZ, F0121ZZ, F0123ZZ, F0124ZZ, F0125YZ, F0125ZZ, F0126YZ, F0126ZZ, F012GZZ, F0130EZ, F0130FZ, F0130UZ, F0130YZ, F0130ZZ, F0131ZZ, F0133ZZ, F0134ZZ, F0135YZ, F0135ZZ, F0136YZ, F0136ZZ, F013GZZ, F01F0EZ, F01F0FZ, F01F0UZ, F01F0YZ, F01F0ZZ, F01F1ZZ, F01F5YZ, F01F5ZZ, F01F6YZ, F01F6ZZ, F01G0EZ, F01G0FZ, F01G0UZ, F01G0YZ, F01G0ZZ, F01G1ZZ, F01G5YZ, F01G5ZZ, F01G6YZ, F01G6ZZ, F01H0EZ, F01H0FZ, F01H0UZ, F01H0YZ, F01H0ZZ, F01H1ZZ, F01H5YZ, F01H5ZZ, F01H6YZ, F01H6ZZ, F01K0EZ, F01K0FZ, F01K0UZ, F01K0YZ, F01K0ZZ, F01K1ZZ, F01K5YZ, F01K5ZZ, F01K6YZ, F01K6ZZ, F01L0EZ, F01L0FZ, F01L0UZ, F01L0YZ, F01L0ZZ, F01L1ZZ, F01L5YZ, F01L5ZZ, F01L6YZ, F01L6ZZ, F01M0EZ, F01M0FZ, F01M0UZ, F01M0YZ, F01M0ZZ, F01M1ZZ, F01M5YZ, F01M5ZZ, F01M6YZ, F01M6ZZ, F01N0EZ, F01N0FZ, F01N0UZ, F01N0YZ, F01N0ZZ, F01Z2KZ, F01Z2MZ, F01Z2NZ, F01Z2PZ, F01Z2QZ, F01Z2SZ, F01Z2YZ, F01Z2ZZ, F01ZBEZ, F01ZBFZ, F01ZBUZ, F01ZBZZ, F01ZCEZ, F01ZCFZ, F01ZCUZ, F01ZCZZ, F01ZDEZ, F01ZDFZ, F01ZDUZ, F01ZDYZ, F01ZDZZ, F01ZFEZ, F01ZFFZ, F01ZFUZ, F01ZFZZ, F021DYZ, F021DZZ, F022DYZ, F022DZZ, F023DYZ, F023DZZ, F025GCZ, F025GGZ, F025GYZ, F025GZZ, F026GCZ, F026GGZ, F026GYZ, F026GZZ, F0277EZ, F0277GZ, F0277UZ, F0277YZ, F0277ZZ, F027GCZ, F027GGZ, F027GYZ, F027GZZ, F029GCZ, F029GGZ, F029GYZ, F029GZZ, F02BGCZ, F02BGGZ, F02BGYZ, F02BGZZ, F02C7EZ, F02C7GZ, F02C7UZ, F02C7YZ, F02C7ZZ, F02CGCZ, F02CGGZ, F02CGYZ, F02CGZZ, F02Z0EZ, F02Z0FZ, F02Z0UZ, F02Z0ZZ, F02Z1EZ, F02Z1FZ, F02Z1UZ, F02Z1ZZ, F02Z2YZ, F02Z2ZZ, F02Z3EZ, F02Z3FZ, F02Z3UZ, F02Z3ZZ, F02Z4EZ, F02Z4FZ, F02Z4UZ, F02Z4ZZ, F02Z5KZ, F02Z5MZ, F02Z5NZ, F02Z5PZ, F02Z5QZ, F02Z5SZ, F02Z5YZ, F02Z5ZZ, F02Z6ZZ, F02Z8YZ, F02Z8ZZ, F02ZBEZ, F02ZBFZ, F02ZBUZ, F02ZBYZ, F02ZBZZ, F02ZCEZ, F02ZCFZ, F02ZCUZ, F02ZCYZ, F02ZCZZ, F02ZFYZ, F02ZFZZ, F02ZHEZ, F02ZHFZ, F02ZHGZ, F02ZHUZ, F02ZHYZ, F02ZHZZ |
| PXX08213 | Physical therapy exercises, manipulation, and other procedures – 213 | 0JN0XZZ, 0JN1XZZ, 0JN6XZZ, 0JN7XZZ, 0JN8XZZ, 0JN9XZZ, 0JNBXZZ, 0JNCXZZ, 0JNLXZZ, 0JNMXZZ, 0JNNXZZ, 0JNPXZZ, 0KN1XZZ, 0KNFXZZ, 0KNGXZZ, 0KNKXZZ, 0KNLXZZ, 0KNMXZZ, 0KNNXZZ, 0KNPXZZ, 0KNQXZZ, 0KNRXZZ, 0KNSXZZ, 0KNTXZZ, 0LN9XZZ, 0LNBXZZ, 0LNFXZZ, 0LNGXZZ, 0LNHXZZ, 0LNJXZZ, 0LNKXZZ, 0LNLXZZ, 0LNMXZZ, 0LNNXZZ, 0LNPXZZ, 0RNEXZZ, 0RNFXZZ, 0RNGXZZ, 0RNHXZZ, 0RNLXZZ, 0RNMXZZ, 0RNQXZZ, 0RNRXZZ, 0SN0XZZ, 0SN2XZZ, 0SN3XZZ, 0SN4XZZ, 0SN5XZZ, 0SN6XZZ, 0SN7XZZ, 0SN8XZZ, 0SN9XZZ, 0SNBXZZ, 0SNHXZZ, 0SNJXZZ, 2W61XZZ, 2W63XZZ, 2W64XZZ, 2W65X0Z, 6A3Z0ZZ, 6A3Z1ZZ, 8E0KX1Z, 8E0ZXY4, 9WB3XBZ, 9WB3XCZ, 9WB3XDZ, 9WB3XFZ, 9WB3XGZ, 9WB3XHZ, 9WB3XJZ, 9WB3XKZ, 9WB3XLZ, 9WB4XBZ, 9WB4XCZ, 9WB4XDZ, 9WB4XFZ, 9WB4XGZ, 9WB4XHZ, 9WB4XJZ, 9WB4XKZ, 9WB4XLZ, 9WB5XBZ, 9WB5XCZ, 9WB5XDZ, 9WB5XFZ, 9WB5XGZ, 9WB5XHZ, 9WB5XJZ, 9WB5XKZ, 9WB5XLZ, 9WB6XBZ, 9WB6XCZ, 9WB6XDZ, 9WB6XFZ, 9WB6XGZ, 9WB6XHZ, 9WB6XJZ, 9WB6XKZ, 9WB6XLZ, 9WB7XBZ, 9WB7XCZ, 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F0736FZ, F0736GZ, F0736HZ, F0736UZ, F0736YZ, F0736ZZ, F0737ZZ, F0756BZ, F0756CZ, F0756DZ, F0756EZ, F0756FZ, F0756GZ, F0756HZ, F0756UZ, F0756YZ, F0756ZZ, F0766BZ, F0766CZ, F0766DZ, F0766EZ, F0766FZ, F0766GZ, F0766HZ, F0766UZ, F0766YZ, F0766ZZ, F0776BZ, F0776CZ, F0776DZ, F0776EZ, F0776FZ, F0776GZ, F0776HZ, F0776UZ, F0776YZ, F0776ZZ, F0796BZ, F0796CZ, F0796DZ, F0796EZ, F0796FZ, F0796GZ, F0796HZ, F0796UZ, F0796YZ, F0796ZZ, F07B6BZ, F07B6CZ, F07B6DZ, F07B6EZ, F07B6FZ, F07B6GZ, F07B6HZ, F07B6UZ, F07B6YZ, F07B6ZZ, F07C6BZ, F07C6CZ, F07C6DZ, F07C6EZ, F07C6FZ, F07C6GZ, F07C6HZ, F07C6UZ, F07C6YZ, F07C6ZZ, F07D0EZ, F07D0FZ, F07D0UZ, F07D0YZ, F07D0ZZ, F07D1EZ, F07D1FZ, F07D1UZ, F07D1YZ, F07D1ZZ, F07D2EZ, F07D2FZ, F07D2UZ, F07D2YZ, F07D2ZZ, F07D3EZ, F07D3FZ, F07D3UZ, F07D3YZ, F07D3ZZ, F07D6BZ, F07D6CZ, F07D6DZ, F07D6EZ, F07D6FZ, F07D6GZ, F07D6HZ, F07D6UZ, F07D6YZ, F07D6ZZ, F07D7ZZ, F07F0EZ, F07F0FZ, F07F0UZ, F07F0YZ, F07F0ZZ, F07F1EZ, F07F1FZ, F07F1UZ, F07F1YZ, F07F1ZZ, F07F2EZ, F07F2FZ, F07F2UZ, F07F2YZ, F07F2ZZ, F07F3EZ, F07F3FZ, F07F3UZ, F07F3YZ, F07F3ZZ, F07F6BZ, F07F6CZ, F07F6DZ, F07F6EZ, F07F6FZ, F07F6GZ, F07F6HZ, F07F6UZ, F07F6YZ, F07F6ZZ, F07F7ZZ, F07G0EZ, F07G0FZ, F07G0UZ, F07G0YZ, F07G0ZZ, F07G1EZ, F07G1FZ, F07G1UZ, F07G1YZ, F07G1ZZ, F07G2EZ, F07G2FZ, F07G2UZ, F07G2YZ, F07G2ZZ, F07G3EZ, F07G3FZ, F07G3UZ, F07G3YZ, F07G3ZZ, F07G6BZ, F07G6CZ, F07G6DZ, F07G6EZ, F07G6FZ, F07G6GZ, F07G6HZ, F07G6UZ, F07G6YZ, F07G6ZZ, F07G7ZZ, F07H0EZ, F07H0FZ, F07H0UZ, F07H0YZ, F07H0ZZ, F07H1EZ, F07H1FZ, F07H1UZ, F07H1YZ, F07H1ZZ, F07H2EZ, F07H2FZ, F07H2UZ, F07H2YZ, F07H2ZZ, F07H3EZ, F07H3FZ, F07H3UZ, F07H3YZ, F07H3ZZ, F07H6BZ, F07H6CZ, F07H6DZ, F07H6EZ, F07H6FZ, F07H6GZ, F07H6HZ, F07H6UZ, F07H6YZ, F07H7ZZ, F07J0EZ, F07J0FZ, F07J0UZ, F07J0YZ, F07J0ZZ, F07J1EZ, F07J1FZ, F07J1UZ, F07J1YZ, F07J1ZZ, F07J2EZ, F07J2FZ, F07J2UZ, F07J2YZ, F07J2ZZ, F07J3EZ, F07J3FZ, F07J3UZ, F07J3YZ, F07J3ZZ, F07J6BZ, F07J6CZ, F07J6DZ, F07J6EZ, F07J6FZ, F07J6GZ, F07J6HZ, F07J6UZ, F07J6YZ, F07J7ZZ, F07K0EZ, F07K0FZ, F07K0UZ, F07K0YZ, F07K0ZZ, F07K1EZ, F07K1FZ, F07K1UZ, F07K1YZ, F07K1ZZ, F07K2EZ, F07K2FZ, F07K2UZ, F07K2YZ, F07K2ZZ, F07K3EZ, F07K3FZ, F07K3UZ, F07K3YZ, F07K3ZZ, F07K6BZ, F07K6CZ, F07K6DZ, F07K6EZ, F07K6FZ, F07K6GZ, F07K6HZ, F07K6UZ, F07K6YZ, F07K7ZZ, F07L0EZ, F07L0FZ, F07L0UZ, F07L0YZ, F07L0ZZ, F07L1EZ, F07L1FZ, F07L1UZ, F07L1YZ, F07L1ZZ, F07L2EZ, F07L2FZ, F07L2UZ, F07L2YZ, F07L2ZZ, F07L3EZ, F07L3FZ, F07L3UZ, F07L3YZ, F07L3ZZ, F07L6BZ, F07L6CZ, F07L6DZ, F07L6EZ, F07L6FZ, F07L6GZ, F07L6HZ, F07L6UZ, F07L6YZ, F07L7ZZ, F07M0EZ, F07M0FZ, F07M0UZ, F07M0YZ, F07M0ZZ, F07M1EZ, F07M1FZ, F07M1UZ, F07M1YZ, F07M1ZZ, F07M2EZ, F07M2FZ, F07M2UZ, F07M2YZ, F07M2ZZ, F07M3EZ, F07M3FZ, F07M3UZ, F07M3YZ, F07M3ZZ, F07M6BZ, F07M6CZ, F07M6DZ, F07M6EZ, F07M6FZ, F07M6GZ, F07M6HZ, F07M6UZ, F07M6YZ, F07M7ZZ, F07N1EZ, F07N1FZ, F07N1UZ, F07N1YZ, F07N1ZZ, F07N6BZ, F07N6CZ, F07N6DZ, F07N6EZ, F07N6FZ, F07N6GZ, F07N6HZ, F07N6UZ, F07N6YZ, F07N6ZZ, F07Z8CZ, F07Z8DZ, F07Z8EZ, F07Z8FZ, F07Z8UZ, F07Z8YZ, F07Z8ZZ, F07Z9CZ, F07Z9DZ, F07Z9EZ, F07Z9FZ, F07Z9GZ, F07Z9UZ, F07Z9YZ, F07Z9ZZ, F08D5BZ, F08D5CZ, F08D5DZ, F08D5EZ, F08D5FZ, F08D5UZ, F08D5YZ, F08D5ZZ, F08F5BZ, F08F5CZ, F08F5DZ, F08F5EZ, F08F5FZ, F08F5UZ, F08F5YZ, F08F5ZZ, F08G5BZ, F08G5CZ, F08G5DZ, F08G5EZ, F08G5FZ, F08G5UZ, F08G5YZ, F08G5ZZ, F08H5BZ, F08H5CZ, F08H5DZ, F08H5EZ, F08H5FZ, F08H5UZ, F08H5YZ, F08H5ZZ, F08J5BZ, F08J5CZ, F08J5DZ, F08J5EZ, F08J5FZ, F08J5UZ, F08J5YZ, F08J5ZZ, F08K5BZ, F08K5CZ, F08K5DZ, F08K5EZ, F08K5FZ, F08K5UZ, F08K5YZ, F08K5ZZ, F08L5BZ, F08L5CZ, F08L5DZ, F08L5EZ, F08L5FZ, F08L5UZ, F08L5YZ, F08L5ZZ, F08M5BZ, F08M5CZ, F08M5DZ, F08M5EZ, F08M5FZ, F08M5UZ, F08M5YZ, F08M5ZZ, F0C33EZ, F0C33FZ, F0C33UZ, F0C33YZ, F0C33ZZ, F0CH3EZ, F0CH3FZ, F0CH3UZ, F0CH3YZ, F0CH3ZZ, F0CM3EZ, F0CM3FZ, F0CM3UZ, F0CM3YZ, F0CM3ZZ, F0DZ6EZ, F0DZ6FZ, F0DZ6UZ, F0DZ6ZZ, F0DZ7EZ, F0DZ7FZ, F0DZ7UZ, F0DZ7ZZ, F0FZDEZ, F0FZDFZ, F0FZDUZ, F0FZDZZ, F0FZFEZ, F0FZFFZ, F0FZFUZ, F0FZFZZ, F0FZGEZ, F0FZGFZ, F0FZGUZ, F0FZGZZ |
| PXX08214 | Traction, splints, and other wound care – 214 | 0NH005Z, 0NH035Z, 0NH045Z, 2W12X6Z, 2W12X7Z, 2W13X6Z, 2W13X7Z, 2W14X6Z, 2W14X7Z, 2W15X6Z, 2W15X7Z, 2W16X6Z, 2W16X7Z, 2W17X6Z, 2W17X7Z, 2W18X6Z, 2W18X7Z, 2W19X6Z, 2W19X7Z, 2W1LX6Z, 2W1LX7Z, 2W1MX6Z, 2W1MX7Z, 2W1NX6Z, 2W1NX7Z, 2W1PX6Z, 2W1PX7Z, 2W1QX6Z, 2W1QX7Z, 2W1RX6Z, 2W1RX7Z, 2W26X4Z, 2W27X4Z, 2W28X4Z, 2W29X4Z, 2W2LX4Z, 2W2MX4Z, 2W2NX4Z, 2W2PX4Z, 2W2QX4Z, 2W2RX4Z, 2W32X2Z, 2W32X3Z, 2W32XYZ, 2W35X1Z, 2W35X2Z, 2W35X3Z, 2W35XYZ, 2W3LX1Z, 2W3LX2Z, 2W3LX3Z, 2W3LXYZ, 2W3MX1Z, 2W3MX2Z, 2W3MX3Z, 2W3MXYZ, 2W45X5Z, 2W6LX0Z, 2W6LXZZ, 2W6MX0Z, 2W6MXZZ, 2W6NXZZ, 2W6PXZZ, 2W6QXZZ, 2W6RXZZ, 2Y45X5Z, 5A02115, 5A02215 |
| PXX08217 | Biologic Infusions | 3E0U0GB, 3E0U3GB, 3E0V0GB, 3E0V3GB |
| PXX08227 | Spinal Instrumentation / Stabilization | 0RH108Z, 0RH138Z, 0RH148Z, 0RH408Z, 0RH438Z, 0RH448Z, 0RH608Z, 0RH638Z, 0RH648Z, 0RHA08Z, 0RHA38Z, 0RHA48Z, 0RHC08Z, 0RHC38Z, 0RHC48Z, 0RHD08Z, 0RHD38Z, 0RHD48Z, 0RHE08Z, 0RHE38Z, 0RHE48Z, 0RHF08Z, 0RHF38Z, 0RHF48Z, 0RHG08Z, 0RHG38Z, 0RHG48Z, 0RHH08Z, 0RHH38Z, 0RHH48Z, 0RHJ08Z, 0RHJ38Z, 0RHJ48Z, 0RHK08Z, 0RHK38Z, 0RHK48Z, 0RHL08Z, 0RHL38Z, 0RHL48Z, 0RHM08Z, 0RHM38Z, 0RHM48Z, 0RHQ08Z, 0RHQ38Z, 0RHQ48Z, 0RHR08Z, 0RHR38Z, 0RHR48Z, 0SH008Z, 0SH038Z, 0SH048Z, 0SH208Z, 0SH238Z, 0SH248Z, 0SH308Z, 0SH338Z, 0SH348Z, 0SH408Z, 0SH438Z, 0SH448Z, 0SH508Z, 0SH538Z, 0SH548Z, 0SH608Z, 0SH638Z, 0SH648Z, 0SH708Z, 0SH738Z, 0SH748Z, 0SH808Z, 0SH838Z, 0SH848Z, 0SH908Z, 0SH938Z, 0SH948Z, 0SHB08Z, 0SHB38Z, 0SHB48Z, 0SHH08Z, 0SHH38Z, 0SHH48Z, 0SHJ08Z, 0SHJ38Z, 0SHJ48Z, 3E0V3GC |
| PXX09168 | Incision and drainage, skin and subcutaneous tissue – 168 | 0H90XZZ, 0H96X0Z, 0H96XZZ, 0H98X0Z, 0H98XZZ, 0J9700Z, 0J9900Z, 0J9B00Z, 0J9C00Z, 0W9K00Z, 0W9K0ZZ, 0W9K30Z, 0W9K40Z, 0W9K4ZZ, 0W9L00Z, 0W9L0ZZ, 0W9L30Z, 0W9L40Z, 0W9L4ZZ, 0Y9000Z, 0Y900ZZ, 0Y9030Z, 0Y903ZZ, 0Y9040Z, 0Y904ZZ, 0Y9100Z, 0Y910ZZ, 0Y9130Z, 0Y913ZZ, 0Y9140Z, 0Y914ZZ |
| PXX09171 | Suture of skin and subcutaneous tissue – 171 | 0HQ0XZZ, 0HQ8XZZ, 0HQAXZZ, 0HQTXZZ, 0HQUXZZ, 0HQVXZZ |
| PXX11180 | Other CT scan – 180 | 8E09XBG, 8E0XXBG, 8E0YXBG, B22100Z, B2210ZZ, B22110Z, B2211ZZ, B221Y0Z, B221YZZ, B221ZZZ, B22300Z, B2230ZZ, B22310Z, B2231ZZ, B223Y0Z, B223YZZ, B223ZZZ, B3250ZZ, B3251ZZ, B325YZZ, B325ZZZ, B3280ZZ, B3281ZZ, B328YZZ, B328ZZZ, B32G0ZZ, B32G1ZZ, B32GYZZ, B32GZZZ, B4200ZZ, B4201ZZ, B420YZZ, B420ZZZ, B4210ZZ, B4211ZZ, B421YZZ, B421ZZZ, B4240ZZ, B4241ZZ, B424YZZ, B424ZZZ, B4280ZZ, B4281ZZ, B428YZZ, B428ZZZ, B42C0ZZ, B42C1ZZ, B42CYZZ, B42CZZZ, B42F0ZZ, B42F1ZZ, B42FYZZ, B42FZZZ, B42G0ZZ, B42G1ZZ, B42GYZZ, B42GZZZ, B42H0ZZ, B42H1ZZ, B42HYZZ, B42HZZZ, B42M0ZZ, B42M1ZZ, B42MYZZ, B42MZZZ, B52200Z, B5220ZZ, B52210Z, B5221ZZ, B522Y0Z, B522YZZ, B522ZZZ, B52800Z, B5280ZZ, B52810Z, B5281ZZ, B528Y0Z, B528YZZ, B528ZZZ, B52900Z, B5290ZZ, B52910Z, B5291ZZ, B529Y0Z, B529YZZ, B529ZZZ, B52J00Z, B52J0ZZ, B52J10Z, B52J1ZZ, B52JY0Z, B52JYZZ, B52JZZZ, B52K00Z, B52K0ZZ, B52K10Z, B52K1ZZ, B52KY0Z, B52KYZZ, B52KZZZ, B52L00Z, B52L0ZZ, B52L10Z, B52L1ZZ, B52LY0Z, B52LYZZ, B52LZZZ, B52Q00Z, B52Q0ZZ, B52Q10Z, B52Q1ZZ, B52QY0Z, B52QYZZ, B52QZZZ, B52R00Z, B52R0ZZ, B52R10Z, B52R1ZZ, B52RY0Z, B52RYZZ, B52RZZZ, B52S00Z, B52S0ZZ, B52S10Z, B52S1ZZ, B52SY0Z, B52SYZZ, B52SZZZ, B52T00Z, B52T0ZZ, B52T10Z, B52T1ZZ, B52TY0Z, B52TYZZ, B52TZZZ, B92F00Z, B92F0ZZ, B92F10Z, B92F1ZZ, B92FY0Z, B92FYZZ, B92J00Z, B92J0ZZ, B92J10Z, B92J1ZZ, B92JY0Z, B92JYZZ, BB2700Z, BB270ZZ, BB2710Z, BB271ZZ, BB27Y0Z, BB27YZZ, BB27ZZZ, BB2800Z, BB280ZZ, BB2810Z, BB281ZZ, BB28Y0Z, BB28YZZ, BB28ZZZ, BB2900Z, BB290ZZ, BB2910Z, BB291ZZ, BB29Y0Z, BB29YZZ, BB29ZZZ, BB2F00Z, BB2F0ZZ, BB2F10Z, BB2F1ZZ, BB2FY0Z, BB2FYZZ, BB2FZZZ, BG2200Z, BG220ZZ, BG2210Z, BG221ZZ, BG22Y0Z, BG22YZZ, BG22ZZZ, BG2300Z, BG230ZZ, BG2310Z, BG231ZZ, BG23Y0Z, BG23YZZ, BG23ZZZ, BG2400Z, BG240ZZ, BG2410Z, BG241ZZ, BG24Y0Z, BG24YZZ, BG24ZZZ, BP200ZZ, BP201ZZ, BP20YZZ, BP210ZZ, BP211ZZ, BP21YZZ, BP220ZZ, BP221ZZ, BP22YZZ, BP22ZZZ, BP230ZZ, BP231ZZ, BP23YZZ, BP23ZZZ, BP240ZZ, BP241ZZ, BP24YZZ, BP24ZZZ, BP250ZZ, BP251ZZ, BP25YZZ, BP25ZZZ, BP280ZZ, BP281ZZ, BP28YZZ, BP28ZZZ, BP290ZZ, BP291ZZ, BP29YZZ, BP29ZZZ, BP2A0ZZ, BP2A1ZZ, BP2AYZZ, BP2AZZZ, BP2B0ZZ, BP2B1ZZ, BP2BYZZ, BP2BZZZ, BP2G0ZZ, BP2G1ZZ, BP2GYZZ, BP2GZZZ, BP2H0ZZ, BP2H1ZZ, BP2HYZZ, BP2HZZZ, BP2T0ZZ, BP2T1ZZ, BP2TYZZ, BP2TZZZ, BP2U0ZZ, BP2U1ZZ, BP2UYZZ, BP2UZZZ, BP2V0ZZ, BP2V1ZZ, BP2VYZZ, BP2VZZZ, BP2X0ZZ, BP2X1ZZ, BP2XYZZ, BP2XZZZ, BP2Y0ZZ, BP2Y1ZZ, BP2YYZZ, BP2YZZZ, BQ200ZZ, BQ201ZZ, BQ20YZZ, BQ20ZZZ, BQ210ZZ, BQ211ZZ, BQ21YZZ, BQ21ZZZ, BQ230ZZ, BQ231ZZ, BQ23YZZ, BQ23ZZZ, BQ240ZZ, BQ241ZZ, BQ24YZZ, BQ24ZZZ, BQ2B1ZZ, BQ2BYZZ, BQ2C0ZZ, BQ2C1ZZ, BQ2CYZZ, BQ2D0ZZ, BQ2D1ZZ, BQ2DYZZ, BQ2DZZZ, BQ2F0ZZ, BQ2F1ZZ, BQ2FYZZ, BQ2FZZZ, BQ2R0ZZ, BQ2R1ZZ, BQ2RYZZ, BQ2RZZZ, BQ2S0ZZ, BQ2S1ZZ, BQ2SYZZ, BQ2SZZZ, BQ2V0ZZ, BQ2V1ZZ, BQ2VYZZ, BQ2VZZZ, BQ2W0ZZ, BQ2W1ZZ, BQ2WYZZ, BQ2WZZZ, BR200ZZ, BR201ZZ, BR20YZZ, BR290ZZ, BR291ZZ, BR29YZZ, BR29ZZZ, BR2C0ZZ, BR2C1ZZ, BR2CYZZ, BR2CZZZ, BR2D0ZZ, BR2D1ZZ, BR2DYZZ, BR2DZZZ, BR2F0ZZ, BR2F1ZZ, BR2FYZZ, BR2FZZZ, BW2100Z, BW210ZZ, BW2110Z, BW211ZZ, BW21Y0Z, BW21YZZ, BW21ZZZ, BW2500Z, BW250ZZ, BW2510Z, BW251ZZ, BW25Y0Z, BW25YZZ, BW25ZZZ |
| PXX17225 | CHEMOTHERAPY | 3E00X0M, 3E0130M, 3E0230M, 3E0300M, 3E0330M, 3E0400M, 3E0430M, 3E0500M, 3E0530M, 3E0600M, 3E0630M, 3E0A30M, 3E0K30M, 3E0K70M, 3E0K80M, 3E0L30M, 3E0L70M, 3E0M30M, 3E0M70M, 3E0P30M, 3E0P70M, 3E0P80M, 3E0Q00M, 3E0Q30M, 3E0Q70M, 3E0W30M, 3E0Y30M, 3E0Y70M |
Table 5: Relevant Procedure Codes CPT/HCPCS
| Group ID | Group Name | Code Value |
| CT0007 | X-Ray Thoracolumbar Spine / Pelvis | 72010, 72020, 72069, 72080, 72090, 72100, 72110, 72114, 72120, 72200, 72202, 72220 |
| CT0025 | Preventive Medicine, Care Coordination | 2000F, 2001F, 4000F, 4001F, 4004F, 93790, 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, 99398, 99399, 99400, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99441, 99442, 99443, 99446, 99447, 99448, 99449, 99499, G0175, G0245, G0246, G0247, G0402, G0406, G0407, G0408, G0425, G0426, G0427, G8402, G8686, G8688, G8690, G8692, H0034, H0039, H0040, S0220, S0221, S0315, S0316, S0317, S0320 |
| CT0026 | Anesthesia and pain meds | J0571, J0572, J0573, J0574, J0575 |
| CT0028 | Depression Screening | 1220F, 3085F, 3351F, 3352F, 3353F, 3354F, 3725F, 96127, G0444, G8431, G8432, G8433, G8510, G8511, G8940 |
| CT0078 | Prosthetic Implant | L8699 |
| CT0079 | Toxicology Screening | G0480, G0481, G0482, G0483 |
| CT0080 | Imaging Abdomen | 76705, 76999 |
| CT0082 | Medicines for pain | 96372, H0033 |
| CT0089 | Metabolic Renal Hepatic Chemistry Panel | 80010, 80047, 80048, 80049, 80050, 80051, 80052, 80053, 80069, 80076, 82040, 82374, 82435, 82565, 82947, 84132, 84155, 84295, 84520 |
| CT0090 | Physical Therapy / Rehab | 4018F, 97001, 97002, 97003, 97004, 97005, 97006, 97010, 97012, 97014, 97016, 97018, 97022, 97024, 97026, 97028, 97032, 97033, 97034, 97035, 97036, 97039, 97110, 97112, 97113, 97116, 97124, 97139, 97140, 97150, 97530, 97545, 97546, 97750, 97755, 97760, 97761, 97762, 97799, G0129, G0160, G8990, G8991, G8992, G8993, G8994, G8995, S9129, S9131 |
| CT0091 | Physician Services – Outpatient | 99050, 99051, 99053, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, 99271, 99272, 99273, 99274, 99275, 99354, 99355, 99381, 99391, T1015 |
| CT0092 | Physician Services – Inpatient | 99221, 99222, 99223, 99238, 99239, 99252, 99253, 99254, 99255 |
| CT0111 | Procedure – spinal neurostimulator | 63650, 63660, 63661, 63662, 63663, 63664, 63685, 63688 |
| CT0112 | Procedure – spinal canal – injection into spinal canal | 62310, 62311, 62318, 62319 |
| CT0113 | Procedure – spinal canal – other | 62263, 62264, 62280, 62281, 62282, 62350, 62355, 63600, 63610 |
| CT0118 | Procedure – peripheral nerve – decompression – other | 64708, 64712 |
| CT0119 | Procedure – block – nerve | 64412, 64425, 64430, 64445, 64446, 64447, 64448, 64449, 64450, 64455, 64475, 64476, 64483, 64484, 64520 |
| CT0120 | Procedure – destruction – nerve | 95873, 95874 |
| CT0124 | Procedure – other or rx – peripheral neurostimulator procedures | 64550, 64553, 64555, 64560, 64561, 64565, 64575, 64577, 64580, 64581, 64585, A4290 |
| CT0125 | Procedure – neuro – other or rx | 27003, 27035, 62360, 62361, 62362, 62365, 62367, 62368 |
| CT0126 | Procedure – neuro – other non – or rx | 62273 |
| CT0131 | Procedure – anesthesia | 01991, 01992 |
| CT01392 | Other diagnostic nervous system procedures | 95907, 95908, 95909, 95910, 95911, 95912, 95913 |
| CT01394 | Medications (Injections, infusions and other forms) | J7328 |
| CT01395 | DME and supplies | A4466, A9273, E1012, E1036, E2622, E2623, E2624, E2625, K0740, K0743, K0744, K0745, K0746, L4631, L5961, Q4161, Q4162, Q4163, Q4164, Q4165, Q9950 |
| CT0158 | Imaging – other imaging – epidurography | 72275 |
| CT0161 | Tests – neuro – muscle testing | 95831, 95832, 95833, 95834, 95851, 95852, 95857 |
| CT0162 | Tests – neuro – ncv / emg | 95860, 95861, 95863, 95864, 95865, 95866, 95867, 95868, 95872, 95875, 95900, 95903, 95904, 95905, G0255, S3900 |
| CT0163 | Tests – neuro – evoked potentials | 95925, 95926, 95927, 95928, 95929, 95930, 95933, 95934, 95936, 95937 |
| CT0165 | Tests – neuro – other | 95920, 95921, 95922, 95923, 95965, 95966, 95967, 95970, 95971, 95972, 95973, 95974, 95975, 95978, 95979, 95980, 95981, 95982, 95990, 95999, 96000, 96001, 96002, 96003, 96004, S8040, S9015 |
| CT02387 | Pathology | 81490 |
| CT03396 | Other OR therapeutic procedures on nose, mouth and pharynx | 4240F, 4242F, 4248F |
| CT0442 | Other care – respiratory – equipment / supplies | E1399, K0195, S8186 |
| CT0444 | Other care – prevention – smoking cessation | S9453 |
| CT0446 | Imaging – cta – chest | 71275 |
| CT0453 | Tests – pulmonary – peak flow | S8110 |
| CT05141 | Procedure – graft | L8670 |
| CT05171 | Procedure – central venous catheter – insertion | S5522, S5523 |
| CT05176 | Procedure – peripheral venous catheter | 36000 |
| CT05184 | Procedure – vascular access – port / pump – insertion | E0782, E0783, E0786 |
| CT05191 | Procedure – related supplies – other | C1819 |
| CT05202 | Rx – diuretics, loop diuretics | S9361 |
| CT05210 | Other care – other – pvd – compressor | E0675 |
| CT05257 | Tests – vascular – arterial – extremity | 93925, 93926 |
| CT05258 | Tests – vascular – venous | 93965, 93970, 93971 |
| CT0692 | Therapy – neurostimulator – nausea / vomiting | E0765 |
| CT0694 | Rx – gi – antiemetics | S9351, S9370 |
| CT0697 | Rx – gi – ppis | C9113 |
| CT0743 | Other diagnostic radiology and related techniques | 72081, 72082, 72083, 72084 |
| CT0809 | Procedure – other spine – rx / dx – injection | 27096, 64490, 64491, 64492, 64493, 64494, 64495, G0260 |
| CT08111 | Imaging – other imaging – bone density – dexa | 77080, 77081, 77082 |
| CT08113 | DME – heat/cold application | E0215, E0217, E0218, E0221, E0225, E0231, E0232, E0235, E0236, E0239 |
| CT08114 | DME – traction | E0830, E0870, E0880, E0890, E0900 |
| CT08115 | DME – trapeze / other orthopedic device | E0910, E0911, E0912, E0920, E0930, E0940, E0941, E0944, E0945, E0946, E0947, E0948 |
| CT08118 | Prosthetics – lower extremity | L5000, L5010, L5020, L5050, L5060, L5100, L5105, L5150, L5200, L5210, L5220, L5230, L5250, L5270, L5280, L5301, L5311, L5321, L5331, L5341, L5400, L5410, L5420, L5430, L5450, L5460, L5500, L5505, L5510, L5520, L5530, L5535, L5540, L5560, L5570, L5580, L5585, L5590, L5595, L5600, L5610, L5611, L5613, L5614, L5616, L5617, L5618, L5620, L5622, L5624, L5626, L5628, L5629, L5630, L5631, L5632, L5634, L5636, L5637, L5638, L5639, L5640, L5642, L5643, L5644, L5645, L5646, L5647, L5648, L5649, L5650, L5651, L5652, L5653, L5654, L5655, L5656, L5658, L5661, L5665, L5666, L5668, L5670, L5671, L5672, L5673, L5676, L5677, L5678, L5679, L5680, L5681, L5682, L5683, L5684, L5685, L5686, L5688, L5690, L5692, L5694, L5695, L5696, L5697, L5698, L5699, L5700, L5701, L5702, L5703, L5704, L5705, L5706, L5707, L5710, L5711, L5712, L5714, L5716, L5718, L5722, L5724, L5726, L5728, L5780, L5781, L5782, L5785, L5790, L5795, L5810, L5811, L5812, L5814, L5816, L5818, L5822, L5824, L5826, L5828, L5830, L5840, L5845, L5848, L5850, L5855, L5856, L5857, L5858, L5910, L5920, L5925, L5930, L5940, L5950, L5960, L5962, L5964, L5966, L5968, L5970, L5971, L5972, L5973, L5974, L5975, L5976, L5978, L5979, L5980, L5981, L5982, L5984, L5985, L5986, L5987, L5988, L5990, L5999 |
| CT08120 | Prosthetics – external power | L7009, L7040, L7266, L7272 |
| CT08121 | Orthotics – spine | L0130, L0140, L0150, L0160, L0170, L0172, L0174, L0180, L0190, L0200, L0220, L0430, L0450, L0452, L0454, L0456, L0458, L0460, L0462, L0464, L0466, L0468, L0470, L0472, L0480, L0482, L0484, L0486, L0488, L0490, L0491, L0492, L0621, L0622, L0623, L0624, L0625, L0626, L0627, L0628, L0629, L0630, L0631, L0632, L0633, L0634, L0635, L0636, L0637, L0638, L0639, L0640, L0700, L0710, L0970, L0972, L0974, L0976, L0999, L1000, L1001, L1005, L1010, L1020, L1025, L1030, L1040, L1050, L1060, L1070, L1080, L1085, L1090, L1100, L1110, L1120, L1200, L1210, L1220, L1230, L1240, L1250, L1260, L1270, L1280, L1290, L1300, L1310, L1499, L1500, L1510, L1520 |
| CT08122 | Orthotics – other | L4000, L4002, L4010, L4020, L4030, L4040, L4045, L4050, L4055, L4060, L4070, L4080, L4090, L4100, L4110, L4130, L4205, L4210, L4350, L4360, L4370, L4380, L4386, L4392, L4394, L4396, L4398 |
| CT08123 | Orthotics – lower extremity | L1600, L1610, L1620, L1630, L1640, L1650, L1652, L1660, L1680, L1685, L1686, L1690, L1700, L1710, L1720, L1730, L1755, L1810, L1820, L1830, L1831, L1832, L1834, L1836, L1840, L1843, L1844, L1845, L1846, L1847, L1850, L1860, L1900, L1902, L1904, L1906, L1907, L1910, L1920, L1930, L1932, L1940, L1945, L1950, L1951, L1960, L1970, L1971, L1980, L1990, L2000, L2005, L2010, L2020, L2030, L2034, L2035, L2036, L2037, L2038, L2040, L2050, L2060, L2070, L2080, L2090, L2106, L2108, L2112, L2114, L2116, L2126, L2128, L2132, L2134, L2136, L2180, L2182, L2184, L2186, L2188, L2190, L2192, L2200, L2210, L2220, L2230, L2232, L2240, L2250, L2260, L2265, L2270, L2275, L2280, L2300, L2310, L2320, L2330, L2335, L2340, L2350, L2360, L2370, L2375, L2380, L2385, L2387, L2390, L2395, L2397, L2405, L2415, L2425, L2430, L2492, L2500, L2510, L2520, L2525, L2526, L2530, L2540, L2550, L2570, L2580, L2600, L2610, L2620, L2622, L2624, L2627, L2628, L2630, L2640, L2650, L2660, L2670, L2680, L2750, L2755, L2760, L2768, L2780, L2785, L2795, L2800, L2810, L2820, L2830, L2840, L2850, L2999 |
| CT08124 | Orthotics – orthopedic shoes | L3000, L3001, L3002, L3003, L3010, L3020, L3030, L3031, L3040, L3050, L3060, L3070, L3080, L3090, L3100, L3140, L3150, L3160, L3170, L3201, L3202, L3203, L3204, L3206, L3207, L3208, L3209, L3211, L3212, L3213, L3214, L3215, L3216, L3217, L3219, L3221, L3222, L3224, L3225, L3230, L3250, L3251, L3252, L3253, L3254, L3255, L3257, L3260, L3265, L3300, L3310, L3320, L3330, L3332, L3334, L3340, L3350, L3360, L3370, L3380, L3390, L3400, L3410, L3420, L3430, L3440, L3450, L3455, L3460, L3465, L3470, L3480, L3485, L3500, L3510, L3520, L3530, L3540, L3550, L3560, L3570, L3580, L3590, L3595, L3600, L3610, L3620, L3630, L3640, L3649 |
| CT08125 | Orthotics – other | L0980, L0982, L0984, S0395 |
| CT0831 | Procedure – removal of pins or fixation | 20665, 20670, 20680, 20694 |
| CT0833 | Procedure – casting / splinting – application | 20663, 29000, 29010, 29020, 29035, 29040, 29044, 29046, 29049, 29220, 29305, 29325, 29345, 29355, 29358, 29365, 29405, 29425, 29435, 29440, 29445, 29450, 29505, 29515, 29520, 29530, 29540, 29550, 29580, 29581, 29590, 29720, 29730, 29740, 29750, 29799 |
| CT0834 | Procedure – casting / splinting – supplies | A4570, A4580, A4590, Q4025, Q4026, Q4027, Q4028, Q4029, Q4030, Q4031, Q4032, Q4033, Q4034, Q4035, Q4036, Q4037, Q4038, Q4039, Q4040, Q4041, Q4042, Q4043, Q4044, Q4045, Q4046, Q4047, Q4048, Q4050, Q4051, S8450, S8451 |
| CT0835 | Procedure – injection – tendons / joints / etc. | 20500, 20550, 20551, 20552, 20553, 20612 |
| CT0840 | Procedure – other dx on musculoskeletal system | 20200, 20205, 20206, 20220, 20225, 20240, 20245, 20250, 20251, 20950, 27040, 27041, 27323, 27324 |
| CT0841 | Procedure – other rx on muscles and tendons | 25000, 27000, 27001, 27005, 27006, 27025, 27057, 27060, 27062, 27087, 27097, 27098, 27100, 27105, 27110, 27111, 27301, 27305, 27306, 27307, 27325, 27326, 27328, 27329, 27372, 27385, 27386, 27390, 27391, 27392, 27393, 27394, 27395, 27396, 27397, 27400, 27496, 27497, 27498, 27499, 27600, 27601, 27602, 27619, 27892, 27893, 27894 |
| CT0849 | Procedure – anesthesia | 00630, 00632, 00634, 00635, 00640, 00670, 01130, 01905 |
| CT0851 | Therapy – chiropractic / osteopathic manipulation | 98925, 98926, 98927, 98928, 98929, 98940, 98941, 98942, 98943 |
| CT0855 | Therapy – neurostimulator – muscle training | E0764, E0770 |
| CT0857 | Rx – muscle relaxants – muscle relax, skeletal central | S9363 |
| CT0860 | Imaging – ct – abdomen – pelvis | 72192, 72193, 72194 |
| CT0863 | Imaging – ct – lumbar spine | 72131, 72132, 72133 |
| CT0866 | Imaging – ct – study | 77078, 77079 |
| CT0867 | Imaging – mri – pelvis | 72195, 72196, 72197 |
| CT0870 | Imaging – mri – lumbar spine | 72148, 72149, 72158 |
| CT0873 | Imaging – mra – spinal canal | 72159 |
| CT0874 | Imaging – mra – pelvis | 72198 |
| CT0878 | Imaging – nuclear – other musculoskeletal | 78399 |
| CT0887 | Imaging – x-ray – si joints – arthrogram | 73542, G0259 |
| CT0889 | Imaging – x-ray – discography | 62290, 72285, 72295 |
| CT0890 | Imaging – x-ray – myelogram | 62284, 70010, 72265, 72270 |
| CT0920 | Procedure – injection of skin lesion | 11900, 11901 |
| CT0929 | Procedure – excision – skin – shave skin lesion | 1121F, 1125F, 1126F, 1127F, 1128F, 1130F, 1134F, 1135F, 1136F, 1137F, 1150F, 1151F, 1152F, 1153F, 1159F, 1160F |
| CT0969 | Other care – chronic edema – surgical stockings | A4490, A4495, A4500, A4510 |
| CT0970 | Other care – chronic edema – appliance – limb compression | A4600 |
| CT0971 | Other care – chronic edema – appliance – non – segmental | E0666 |
| CT0972 | Other care – chronic edema – appliance – segmental | E0656, E0660, E0667, E0669, E0671, E0673 |
| CT0973 | Other care – chronic edema – compression stocking | A6530, A6531, A6532, A6533, A6534, A6535, A6536, A6537, A6538, A6539, A6540, A6541, A6544, A6545, A6549 |
| CT0974 | Other care – chronic edema – compressor – non – segmental | E0650 |
| CT0975 | Other care – chronic edema – compressor – segmental | E0651, E0652 |
| CT0976 | Other care – chronic edema – compressor | E0676 |
| CT0977 | Other care – chronic edema – sleeve | S8422, S8423, S8424 |
| CT0979 | Other care – chronic edema – gauntlet | S8428 |
| CT0980 | Other care – chronic edema – exterior wrap | S8429 |
| CT0981 | Other care – chronic edema – complex therapy | S8950 |
| CT0991 | Tests – skin | Q3031 |
| CT1021 | Rx – vitamins – multivit prep | A9152, A9153 |
| CT1026 | Other care – diabetes care – glucose monitoring – lancet | A4259 |
| CT10295 | Thyroid Function Tests | 84432, 84436, 84439, 84442, 84443, 84480 |
| CT10296 | Low dose steroids | S9490 |
| CT1036 | Other care – nutrition – assessment | 97802, 97803, G0270, G0271 |
| CT1044 | Other care – nutrition – parenteral – pump | 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 |
| CT14389 | Other Laboratory | 0030T, 0058T, 0059T, 0194T |
| CT1620 | Therapy – phlebotomy | 99195 |
| CT16296 | Lipid Level Monitoring | 80061, 82465, 83695, 83698, 83700, 83701, 83704, 83718, 83719, 83721, 84478 |
| CT16297 | Blood Count | 85004, 85007, 85008, 85009, 85013, 85014, 85018, 85025, 85027, 85032, 85041, 85044, 85045, 85046, 85048, 85049, 85060, G0306, G0307 |
| CT16299 | Bleeding Status | 85002, 85345, 85347, 85348, 85610, 85611, 85670, 85675, 85705, 85730, 85732, 99363, 99364, G0248, G0250, S9401 |
| 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, 96521, 96522, 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 |
| 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, G0249 |
| CT1647 | Lab – hematology – blood count | 85055 |
| CT18300 | Microscopic examination (bacterial smear, culture, toxicology) | 0041T |
| CT1901 | Therapy – behavior – evaluation and therapy | 96150, 96151, 96152, 96153, 96154, 96155 |
| CT1903 | Therapy – behavior – medication management | M0064 |
| CT1905 | Therapy – behavior – partial hospitalization | S0201 |
| CT1907 | Tests – neuro – sleep studies | 95803, G0398, G0399, G0400 |
| CT19303 | Psychiatry Evaluations | 90785, 90791, 90792, 90801, 90802, 96118, 96119, 96120, 96125, T1023 |
| CT19304 | Psychiatry Services | 97532, 97535, H0004, H0031, H2010, H2015, S3005, S9454, S9482, T2034 |
| CT19378 | Laboratory – Chemistry and Hematology | 0026T, 0103T, 0111T, 83987 |
| CT19381 | Smoking / Tobacco Cessation | 99406, 99407 |
| CT19382 | High Risk Behavior Screening | 4293F |
| CT19383 | Sexual Behavior Counseling | G0445 |
| CT19384 | Peer Services | H0038 |
| CT2009 | Alcohol / Drug Use Screening | 3016F, 4158F, 4290F, 4320F, 80100, 80101, 80102, 80103, 80300, 80301, 80302, 80303, 80304, 80320, 80321, 80322, 80375, 80376, 80377, 82009, 82010, 82075, 99408, 99409, G0430, G0431, G0442, G0443, G9621, G9622, H0001, H0003, H0049, T1006 |
| CT20376 | Other Laboratory | G9143 |
| CT2302 | Therapy – behavior – other | G0177, H2000, T2036, T2037 |
| CT2304 | Therapy – pt – exercises / activities | 93668, 97533, 97537, 97542, S8990 |
| CT2305 | Therapy – pt – modalities | G0283, S8948 |
| CT2308 | Therapy – biofeedback | 90901, 90911, E0746 |
| CT2309 | Therapy – activity therapy | G0176 |
| CT2325 | Other care – ostomy – supplies | A4361, A4362, A4364, A4369, A4371, A4372, A4373, A4375, A4376, A4377, A4378, A4379, A4380, A4381, A4382, A4383, A4388, A4389, A4390, A4391, A4392, A4393 |
| 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, 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 |
| CT2331 | Other care – observation | G0379 |
| CT2332 | Other care – child care – foster care | S5140, S5141, S5145, S5146 |
| CT23398 | Ancillary Services | 0115T, 0116T, 0117T, 0130T, 99415, 99416, G9474, G9475, G9476, G9477, G9478, G9479 |
| CT2341 | Other care – other – exercise classes | S9451 |
| CT2352 | DME – mobility aids | A4635, A4636, A4637, E0100, E0105, E0110, E0111, E0112, E0113, E0114, E0116, E0117, E0118, E0130, E0135, E0140, E0141, E0143, E0144, E0147, E0148, E0149, E0153, E0154, E0155, E0156, E0157, E0158, E0159, E0950, E0951, E0952, E0955, E0956, E0957, E0958, E0959, E0960, E0961, E0966, E0967, E0968, E0969, E0970, E0971, E0973, E0974, E0978, E0980, E0981, E0982, E0983, E0984, E0985, E0986, E0990, E0992, E0994, E0995, E1002, E1003, E1004, E1005, E1006, E1007, E1008, E1009, E1010, E1011, E1014, E1015, E1016, E1017, E1018, E1020, E1028, E1029, E1030, E1031, E1035, E1037, E1038, E1039, E1050, E1060, E1070, E1083, E1084, E1085, E1086, E1087, E1088, E1089, E1090, E1092, E1093, E1100, E1110, E1130, E1140, E1150, E1160, E1161, E1170, E1171, E1172, E1180, E1190, E1195, E1200, E1220, E1221, E1222, E1223, E1224, E1225, E1226, E1227, E1228, E1229, E1230, E1231, E1232, E1233, E1234, E1235, E1236, E1237, E1238, E1239, E1240, E1250, E1260, E1270, E1280, E1285, E1290, E1295, E1296, E1297, E1298, E2201, E2202, E2203, E2204, E2205, E2206, E2207, E2208, E2209, E2210, E2211, E2212, E2213, E2214, E2215, E2216, E2217, E2218, E2219, E2220, E2221, E2222, E2224, E2225, E2226, E2227, E2228, E2230, E2231, E2291, E2292, E2293, E2294, E2295, E2300, E2301, E2310, E2311, E2312, E2313, E2321, E2322, E2323, E2324, E2325, E2326, E2327, E2328, E2329, E2330, E2331, E2340, E2341, E2342, E2343, E2351, E2360, E2361, E2362, E2363, E2364, E2365, E2366, E2367, E2368, E2369, E2370, E2371, E2372, E2373, E2374, E2375, E2376, E2377, E2381, E2382, E2383, E2384, E2385, E2386, E2387, E2388, E2389, E2390, E2391, E2392, E2394, E2395, E2396, E2397, E2601, E2602, E2603, E2604, E2605, E2606, E2607, E2608, E2609, E2610, E2611, E2612, E2613, E2614, E2615, E2616, E2617, E2619, E2620, E2621, E8000, E8001, E8002, K0001, K0002, K0003, K0004, K0005, K0006, K0007, K0009, K0010, K0011, K0012, K0014, K0015, K0017, K0018, K0019, K0020, K0037, K0038, K0039, K0040, K0041, K0042, K0043, K0044, K0045, K0046, K0047, K0050, K0051, K0052, K0053, K0056, K0065, K0069, K0070, K0071, K0072, K0073, K0077, K0098, K0105, K0108, K0669, K0733, K0800, K0801, K0802, K0806, K0807, K0808, K0812, K0813, K0814, K0815, K0816, K0820, K0821, K0822, K0823, K0824, K0825, K0826, K0827, K0828, K0829, K0830, K0831, K0835, K0836, K0837, K0838, K0839, K0840, K0841, K0842, K0843, K0848, K0849, K0850, K0851, K0852, K0853, K0854, K0855, K0856, K0857, K0858, K0859, K0860, K0861, K0862, K0863, K0864, K0868, K0869, K0870, K0871, K0877, K0878, K0879, K0880, K0884, K0885, K0886, K0890, K0891, K0898, K0899, L0978 |
| 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, 99295, 99296, 99298, 99471, 99472, 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, S0265 |
| CT9909 | Procedure – maintenance – cns / spinal pump / port | 95991 |
| CT9910 | Procedure – anesthesia | 01996, 01999, 99100, 99116, 99135, 99140 |
| CT99101 | Other care – other – lead assessment | T1029 |
| CT99102 | Other care – other | 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 | 77011, 77012, 77013, 77014 |
| CT99106 | Imaging – cta – other | 72191 |
| CT99107 | Imaging – mri – other | 76498, S8035, S8042 |
| CT99108 | Imaging – mri – guidance | 77021, 77022 |
| 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 | 76998 |
| CT99115 | Imaging – us – other | 76970, 76977 |
| CT99116 | Imaging – nuclear – bone scan | 78300, 78305, 78306, 78315, 78320 |
| CT99125 | Imaging – nuclear – localization of inflammation | 78805, 78806, 78807 |
| CT99133 | Imaging – other imaging – fluoroscopy | 76496 |
| CT99134 | Imaging – other imaging – fluoroscopy – guidance | 77002, 77003 |
| CT99136 | Imaging – other imaging | 76101, 76102, 76120, 76125, 76140, 76150, 76350, 76376, 76377, 76390, 76499, Q0092, R0075 |
| CT99139 | Imaging – supplies – contrast agent – low osmolar | Q9965, Q9966, Q9967 |
| CT99140 | Imaging – supplies – contrast agent – high osmolar | Q9958, Q9959, Q9960, Q9961, Q9962, Q9963, Q9964 |
| CT99142 | Lab – pathology consultation | 80500, 80502 |
| CT99143 | Lab – chemistry | 82540 |
| CT99148 | Lab – surgical pathology | 88325 |
| CT9915 | Procedure – microsurgery | 69990 |
| CT99169 | Lab – specimen collection – blood – venous – venipuncture | 36415, S9529 |
| CT9917 | Procedure – related supplies – access catheter | A4301 |
| CT99171 | Lab – specimen collection – blood – venous – venous port | 36540 |
| CT99172 | Lab – specimen collection – blood – arterial – arterial puncture | 36600 |
| CT99173 | Lab – specimen collection – specimen handling | 99000 |
| CT99176 | Lab – stat request | S3600, S3601 |
| CT9918 | Procedure – related supplies – ablation – catheter | Q4116 |
| CT99182 | Transportation – paramedic | S0207, S0208 |
| CT99183 | Transportation – other transportation | A0080, A0090, A0100, A0110, A0120, A0130, A0140, A0160, A0170, A0180, A0190, A0200, A0210, 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, S9975, S9992, T2001, T2002, T2003, T2004, T2005, T2007, T2049 |
| CT99184 | DME – other | A9281, A9283, A9300, A9900, A9901, A9999, S8185, S8270, S9381, T1999, T2029, T2039, T5001, T5999 |
| CT99185 | DME – bath / toilet aids | E0160, E0161, E0162, E0163, E0165, E0167, E0168, E0170, E0171, E0172, E0175, E0240, E0241, E0242, E0243, E0244, E0245, E0246, E0247, E0248, E0249 |
| CT99186 | DME – beds / accessories | E0250, E0251, E0255, E0256, E0260, E0261, E0265, E0266, E0270, E0271, E0272, E0273, E0274, E0275, E0276, E0277, E0280, E0290, E0291, E0292, E0293, E0294, E0295, E0296, E0297, E0300, E0301, E0302, E0303, E0304, E0305, E0310, E0315, E0316, E0325, E0326, E0328, E0329, E0350, E0352, E0370, E0371, E0372, E0373, E0462 |
| CT99187 | DME – safety equipment | E0700, E0705 |
| CT99188 | DME – restraints | E0710 |
| CT99189 | DME – whirlpool – equipment | E1300, E1310 |
| CT99190 | DME – repair / maintenance | K0739 |
| CT99191 | Supplies | A4206, A4207, A4208, A4209, A4210, A4211, A4212, A4213, A4215, A4216, A4217, A4218, A4244, A4245, A4246, A4247, A4248, A4265, A4270, A4280, A4450, A4452, A4455, A4456, A4458, A4461, A4463, A4465, A4470, A4480, A4550, A4561, A4562, A4601, A4649, A4651, A4652, 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, A6501, A6502, A6503, A6504, A6507, A6508, A6509, A6510, A6511, A6512, A6513, A6550, A7000, A7001, A7002, A9155, A9282, C1751, C1769, C1883, C1894, C9898, J1642, S8415, S8430, S8431, T2028 |
| CT99192 | Prosthetics – implant | L8680, L8681, L8682, L8683, L8684, L8685, L8686, L8687, L8688, L8689, L8690, L8691, L8695, L9900 |
| CT99195 | Prosthetics – other | K0672, L8041, L8042, L8043, L8044, L8045, L8047, L8400, L8410, L8415, L8417, L8420, L8430, L8435, L8440, L8460, L8465, L8470, L8480, L8485, L8499 |
| CT99196 | Prosthetics – repair | L7500, L7510, L7520 |
| CT99197 | Other – non – covered | A9270, G0293, G0294, S9986 |
| CT99198 | PQRI | G8493, G8502 |
| CT9927 | Procedure – related supplies – other | A4648, C1713, C1727, C1765, C1879, C9250, C9359, C9360, C9361, C9363, C9364, Q9968 |
| CT9928 | Therapy – acupuncture | 97810, 97811, 97813, 97814 |
| CT9930 | Therapy – habilitation | T2013, T2014, T2015, T2016, T2017, T2018, T2019, T2020, T2021 |
| CT99309 | Physician Services | 99251 |
| CT99316 | Physician Services – Inpatient | 99356, 99357 |
| CT9935 | Therapy – hyperbaric oxygen | 99183 |
| CT9936 | Therapy – neurostimulator – tens – device | E0720, E0730, E0731 |
| CT9937 | Therapy – neurostimulator – tens – leads | A4595 |
| CT9938 | Therapy – neurostimulator – tens – supplies | A4558 |
| CT99392 | Other diagnostic procedures (interview, evaluation, consultation) | 0074T, 0089T, 0146T, 0147T, 0148T, 0150T, 0185T, 0188T, 0189T, 0203T, 0204T, G0436, G0437, G0438, G0439, G0447, G0454, G9156, Q5010, S9110 |
| CT9940 | Therapy – other | 36299, 99024, 99185, 99186, E0761, E0762, M0076 |
| CT99400 | Advance care planning | 1123F, 1124F, 1157F, 1158F, 99497, 99498, S0255 |
| CT99401 | Bundled Payment / Medical Home | S0280, S0281 |
| CT99402 | Care Plan Oversight | 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380 |
| CT99403 | Case Management Services | G0162, G0463, S0250, T1001, T1016, T1017, T2022, T2023, T2024 |
| CT99404 | Case Management Services – Behavioral | 96116, G0503, G0507, H0023, H1011 |
| CT99405 | Case Management Services – Educational | T1018 |
| CT99407 | Case Management Services – Oncology | S0353, S0354 |
| CT99408 | Chronic Care Management | 99487, 99489, 99490, G0506 |
| CT99409 | Home Health / Hospice | G0179, G0180, G0181, G0182 |
| 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 |
| CT99414 | Physical therapy / Rehab | 97164, 97168, 97172 |
| CT99415 | Physician Services – Outpatient | 99358, 99359 |
| CT99416 | Procedures and Reporting | 99080, 99090, 99091 |
| CT99418 | Transitional Care Management | 99495, 99496 |
| CT99419 | Wellness Assessment | S5190 |
| CT9947 | Rx – analg/antipy/nsaids – narcotics | J1170 |
| CT9950 | Rx – electrolytic, caloric, water – potassium supp | S5012 |
| CT9951 | Rx – electrolytic, caloric, water – multi-mineral prep | S5014 |
| CT9955 | Rx – electrolytic, caloric, water – caloric rx dextrose / rel | S5010, S5011, S5013 |
| CT9956 | Rx – electrolytic, caloric, water – hydration – unspecfied | 90760, 90761, Q0081, S9373, S9374, S9375, S9376, S9377 |
| CT9957 | Rx – miscellaneous rx | A9150, C9399, Q4074 |
| CT9958 | Rx – miscellaneous rx – enzymes | S9357 |
| CT9960 | Rx – miscellaneous rx – anesthetics, local | J2001 |
| CT9961 | Rx – diagnostic rx – roentgenography | Q9957 |
| CT9962 | Rx – other | S9346 |
| CT9963 | Rx – pharmacy fee | 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 |
| CT9971 | Other care – home care – rehabilitation – occupational therapy | G0152 |
| CT9972 | Other care – home care – rehabilitation – speech therapy | G0153, 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 |
| CT9993 | Other care – other – therapeutic riding | S8940 |
| CT9994 | Other care – other – back care | S9090, S9117 |
| 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 | 0004M, 0054T, 0055T, 0056T, 0101T, 0216T, 0217T, 0218T, 0230T, 0231T, 0347T, 0348T, 1000F, 1100F, 1101F, 2040F, 2044F, 22510, 22511, 22512, 22513, 22514, 22515, 27279, 33952, 33954, 33958, 33962, 33966, 33984, 37191, 37192, 37193, 37619, 4019F, 6030F, 62304, 62305, 64634, 64635, 64636, 7010F, 76881, 76882, 77085, 77086, 80329, 80330, 80331, 80361, 80362, 80363, 80364, 80365, 80366, 80367, 80368, 80369, 80370, 80373, 90769, 90770, 90771, 90776, 95885, 95886, 95887, 96360, 99052, 99054, 99151, C9443, C9444, C9446, C9801, C9802, G0276, G0299, G0300, G0344, G0449, G0459, G0466, G0467, G0468, G0469, G0470, G0472, G0473, G6035, G6038, G6039, G6045, G6046, G8051, G8052, G8053, G8155, G8156, G8157, G8214, G8217, G8219, G8220, G8221, G8696, G8697, G8698, G8790, G8791, G8792, G8793, G8794, G8795, G8967, G8968, G8969, G8970, G8971, G8972, G9199, G9200, G9201, G9467, G9468, G9469, G9470, G9471, G9472, G9539, G9541, G9542, G9543, G9544, G9561, G9562, G9563, G9577, G9578, G9579, G9583, G9584, G9585, G9637, G9638, G9669, G9670, L0455, L0457, L0467, L0469, L0641, L0642, L0643, L0648, L0649, L0650, L0651, S9901 |
Table 6: Relevant Typical Drug Groups
| Group ID | Group Name |
| RX001 | contrast media |
| RX002 | diagnostic agents |
| RX017 | hypnotics and sedatives |
| RX018 | other nervous system drugs |
| RX0543 | peripheral vasodilators |
| RX0546 | Antiplatelet agents, thrombin inhibitors |
| RX0645 | antacids |
| 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 |
| RX0855 | Glucosamine |
| RX0856 | antigout preparations |
| RX0857 | antiinflammatory and antirheumatic products |
| RX0858 | antipsoriatics for systemic use |
| RX0859 | antipsoriatics for topical use |
| RX0860 | muscle relaxants |
| RX0861 | opioids |
| RX0862 | other analgesics and antipyretics |
| RX0863 | other drugs for disorders of the musculo-skeletal system |
| RX0864 | topical products for joint and muscular pain |
| RX0968 | antibiotics and chemotherapeutics for dermatological use |
| RX0969 | antifungals for dermatological use |
| RX0970 | antipruritics incl. antihistamines anesthetics etc. |
| RX0971 | antiseptics and disinfectants |
| RX0973 | corticosteroids dermatological preparations |
| RX0974 | ectoparasiticides incl. scabicides insecticides and repellents |
| RX0976 | irrigating solutions |
| RX0977 | medicated dressings |
| RX0978 | other dermatological preparations |
| RX0979 | preparations for treatment of wounds and ulcers |
| RX0980 | Moisturizers and skin protective agents |
| RX1082 | antiobesity preparations excl. diet products |
| RX1086 | corticosteroids for systemic use |
| RX16106 | iron preparations |
| RX16109 | vitamin b12 and folic acid |
| RX18121 | antimycobacterials |
| RX19123 | antidepressants |
| RX19125 | anxiolytics |
| RX23130 | immunosuppressants |
| RX23131 | mineral supplements |
| RX23133 | other nutrients |
| RX23135 | vitamins |
| RX99137 | anesthetics local |