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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 Prostatectomy, sometimes abbreviated PRSCMY, is a procedural episode. The Prostatectomy episode includes services related to the procedure such as a facility stay, anesthesia services, as well as services within the 30-day pre- and 90-day post-operative care time window, such as diagnostic services, (imaging, labs etc.), office visits, physical therapy and ancillary services.
Episode Components
| Triggers | A Prostatectomy episode trigger includes an inpatient facility claim with a procedure trigger code in the principal position and a qualifying diagnosis code in the principal position (Table 1). This episode is also triggered by an outpatient facility or professional claim with a procedure trigger code (in any position) and a qualifying diagnosis code (in any position) on the same claim line. |
| 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: Prostate CancerProcedure – LymphadenectomyProcedure – Orchiectomy, Perineal Prostatectomy, Suprapubic Prostatectomy |
Code Tables
Table 1: Trigger Codes
| Trigger Type | Code Value |
| CPT / HCPCS Triggers | 55801, 55810, 55812, 55815, 55821, 55831, 55840, 55842, 55845, 55866, 55873 |
| ICD-10-CM (DX) Qualifying Diagnosis | C61, C775, C7982, D075, D400, D4959, N4230, N4231, N4232, N4239, R972, R9720, R9721, Z1503, Z8546 |
| ICD-10-PCS (PX) Triggers | 0VT00ZZ, 0VT04ZZ, 0VT07ZZ, 0VT08ZZ |
Table 2: ICD-10 Typical Diagnosis
| Group ID | Group Name | Code Value |
| DXX05345 | Orthostatic Hypotension / Dizziness | I951, R42 |
| DXX06267 | Nausea, vomiting | R110, R1110, R1111, R1112, R112 |
| DXX11104 | GU – urethral discharge | R360, R369 |
| DXX11110 | GU – hemoglobinuria | R823 |
| DXX11112 | GU – abnrml urinalysis | R8299 |
| DXX11113 | GU – abnrml GU imaging | R934, R9341, R93421, R93422, R93429, R9349 |
| DXX11115 | GU – s / p cystostomy | Z9350 |
| DXX11116 | GU – urinary tract – nec | N398, Z87448 |
| DXX11117 | GU – urinary tract – nos | N369, N399 |
| DXX11152 | Urinary Frequency & other symptoms | R301, R350, R3911, R3913, R3916, R3919, R39191, R39192, R39198, R392, R3982, R3989, R399 |
| DXX11153 | Urinary Incontinence | R3981 |
| DXX11157 | Urinary Obstruction | N139 |
| DXX11158 | Hematuria | R310, R311, R312, R3121, R3129, R319 |
| DXX1118 | Neoplsm – neoplsm uncertn behvr – upper urinary tract – nos | D4959 |
| DXX1184 | GU – hx of uti | Z87440 |
| DXX1214 | Neoplsm – malignant neoplsm – personal hx – prostate | Z8546 |
| DXX1231 | Neoplsm – abnrml findings – prostate | R972, R9720, R9721 |
| DXX1232 | Neoplsm – screening – prostate | Z125 |
| DXX1268 | Prostate Cancer | C61 |
| DXX1269 | Prostatic Hypertrophy w Obstruction | N401, N403 |
| DXX1272 | Other disease of prostate | N414, N418, N420, N423, N4230, N4231, N4232, N4239, N4281, N4282, N4283, N4289, N429 |
| DXX1273 | Prostatic Hypertrophy | N400, N402 |
| DXX1274 | Prostate Cancer-in-situ | D075 |
| DXX1275 | Prostate Cancer, uncertain behavior | D400 |
| DXX16295 | Acute post-hemorrhagic anemia | D62 |
| DXX1768 | Secondary malignancies | C775, C7982 |
| DXX1963 | Anxiety Disorders | F064 |
| DXX2104 | NS – acute pain – post op | G8918 |
| DXX2337 | Prvn – routine medical exam | Z0001 |
| DXX2352 | Othr – other | Z1503, Z8042 |
| DXX2370 | Fever & Chills | R5081, R509, R6883 |
| DXX2379 | Observation/Examination | Z0000 |
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 |
| DXX01392 | Delirium, Encephalopathy | I674 |
| DXX04130 | Aspiration Pneumonia | J690, J691, 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 | J182, 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 |
| DXX05274 | Transfusion, Infusion related complications | D6951, E8771, R5084, T8029XA, T8030XA, T80310A, T80311A, T80319A, T8039XA, T8040XA, T80410A, T80411A, T80419A, T8049XA, T8051XA, T8059XA, T8061XA, T8069XA, T80818A, T8089XA, T8090XA, T80910A, T80911A, T80919A, T8092XA, T80A0XA, T80A10A, T80A11A, T80A19A, T80A9XA, Y620, Y621, Y623, Y630, Y631, Y640, Y650, Y651 |
| 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, I825Y1, I825Y2, I825Y3, I825Z1, I825Z2, I825Z3, I825Z9, 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 |
| DXX05303 | Acute CHF / pulm edema | I5021, I5023, I5031, I5033, I5041, I5043, J810, J811, R0601 |
| DXX05308 | Pulmonary Embolism | I2690, I2692, I2699 |
| DXX05309 | IVC & other intra-abd venous thrombosis | I81, I820, I82220, I82221, I823 |
| DXX05311 | Other Phlebitis, Lymphangitis, varices | I808, I82601, I82602, I82603, I82609, I82611, I82612, I82613, I82619, I82621, I82622, I82623, I82629, I82A11, I82A12, I82A13, I82A19 |
| DXX05320 | Atrial Flutter / Fibrillation | I480, I481, I482, I483, I484, I4891, I4892 |
| DXX05340 | Other cardiac arrhythmias | R000 |
| DXX05342 | Acute cor pulmonale | I2601, I2602, I2609 |
| DXX05367 | Hypertensive Urgency | I160, I161, I169 |
| DXX05372 | Shock during or following cardiac surgery | I97120, I97121, I97710, I97790 |
| DXX05373 | Shock during or post-procedure | I97711, I97791, I9788, T8110XA, T8111XA, T8112XA, T8119XA |
| DXX05375 | Dehydration | E860, E861, E869 |
| DXX06160 | Gastroenteritis | A080, A0811, A0819, A082, A0831, A0832, A0839, A084, A088, A09, K5289, K529 |
| DXX06276 | Anal and rectal conditions | K594, R151, R152, R159 |
| DXX06305 | C-Difficile Infection | A047 |
| DXX06306 | GI Bleed | K2901, K2931, K2971, K2991, K625 |
| DXX06307 | Intestinal Obstruction | K315, K560, K5660, K5669, K567 |
| DXX06335 | Retroperitoneal Abscess | K6812, K6819, K689 |
| DXX09187 | Wound Infections | K6811, T814XXA, T8183XA |
| 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 |
| DXX10102 | diabetes mellitus with ophthalmic manifestations | E11311 |
| DXX1030 | Diabetes, poor control | E0811, E08641, E08649, E0865, E0911, E09641, E0965, E1011, E10641, E1065, E11641, E1165, E1311, E13641, E160, E161, E162 |
| 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 |
| DXX11145 | Urinary Complications | N99520, N99521, N99522, N99523, N99524, N99528, N99530, N99531, N99532, N99533, N99534, N99538, N9981, N9989 |
| DXX11147 | Complication of genitourinary device | T83011A, T83011D, T83021A, T83021D, T83031A, T83031D, T83091A, T83091D, T83510A, T83510D, T83511A, T83511D, T83512A, T83512D, T83518A, T83518D, T8351XA, T8351XD, T83590A, T83590D, T83591A, T83591D, T83592A, T83592D, T83593A, T83593D, T83598A, T83598D, T8359XA, T8359XD, T8361XA, T8362XA, T8369XA, T8369XD, T8381XA, T8381XD, T8382XA, T8382XD, T8383XA, T8383XD, T8384XA, T8384XD, T8385XA, T8385XD, T8386XA, T8386XD, T8389XA, T8389XD, T839XXA, T839XXD |
| DXX11149 | Urethral Stricture | N358, N359, N99110, N99111, N99112, N99113, N99114, N99115, N9912 |
| DXX11150 | Bladder Dysfunction, hemorrhage | N312, N318, N319 |
| DXX11152 | Urinary Frequency & other symptoms | R300 |
| DXX11167 | Acute Kidney Failure | N170, N171, N172, N178, N179, N19, N990 |
| DXX1265 | Male infertility, impotence | N46021, N46022, N46023, N46024, N4611, N46121, N46122, N46123, N46124, N46125, N46129, N469, N522, N5231, N5232, N5233, N5234, N5235, N5236, N5237, N5239, N528, N529, N5319 |
| DXX1267 | Prostatitis, abscess, hemorrhage of prostate | N410, N412, N413, N421 |
| DXX1392 | Urogenital fistula | N322, N360 |
| DXX16296 | Hemorrhage | R58, R710 |
| DXX1846 | Opportunistic Infections | B3781, 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, B007, B377 |
| DXX1852 | Severe Sepsis | A483, R6511, R6520, R6521 |
| DXX1853 | Bacteremia, SIRS, no organ dysfunction | R6510, R7881 |
| DXX1860 | Other Sexually Transmitted Diseases | A5601 |
| DXX2161 | Complications from Central Line | T80211A, T80212A, T80218A, T80219A, T8022XA |
| 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, 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 |
| DXX2360 | Complication of Implanted device, graft | T836XXA, T85613A, T85623A, T8579XA |
| 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, G9731, G9732, G9748, G9749, G9751, G9752, G9761, G9762, G9763, G9764, 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, K9161, K9162, K9171, K9172, K91840, K91841, 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, 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 |
| 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 |
| DXX9914 | HAC 09: Manifestations of Poor Glycemic Control | E0800, E0801, E0810, E0900, E0901, E0910, E1010, E1100, E1101, E1300, E1301, E1310, E15 |
Table 4: ICD-10 Relevant Procedure Codes
| Group ID | Group Name | Code Value |
| PXX01177 | Computerized axial tomography (CT) scan head – 177 | B92FZZZ, B92JZZZ |
| PXX01210 | Other radioisotope scan – 210 | CF161ZZ, CF16YZZ, CH1YYZZ, CH2YYZZ, CT1H1ZZ, CT1HYZZ, CT1YYZZ, CT2YYZZ, CV191ZZ, CV19YZZ, CV1YYZZ, CW101ZZ, CW10DZZ, CW10FZZ, CW10GZZ, CW10LZZ, CW10SZZ, CW10YZZ, CW111ZZ, CW11DZZ, CW11FZZ, CW11GZZ, CW11LZZ, CW11SZZ, CW11YZZ, CW131ZZ, CW13DZZ, CW13FZZ, CW13GZZ, CW13KZZ, CW13LZZ, CW13SZZ, CW13YZZ, CW141ZZ, CW14DZZ, CW14FZZ, CW14GZZ, CW14LZZ, CW14SZZ, CW14YZZ, CW161ZZ, CW16DZZ, CW16FZZ, CW16GZZ, CW16LZZ, CW16SZZ, CW16YZZ, CW1B1ZZ, CW1BDZZ, CW1BFZZ, CW1BGZZ, CW1BLZZ, CW1BSZZ, CW1BYZZ, CW1J1ZZ, CW1JDZZ, CW1JFZZ, CW1JGZZ, CW1JLZZ, CW1JSZZ, CW1JYZZ, CW1YYZZ, CW1ZZZZ, CW201ZZ, CW20DZZ, CW20FZZ, CW20GZZ, CW20KZZ, CW20LZZ, CW20SZZ, CW20YZZ, CW211ZZ, CW21DZZ, CW21FZZ, CW21GZZ, CW21KZZ, CW21LZZ, CW21SZZ, CW21YZZ, CW231ZZ, CW23DZZ, CW23FZZ, CW23GZZ, CW23KZZ, CW23LZZ, CW23SZZ, CW23YZZ, CW241ZZ, CW24DZZ, CW24FZZ, CW24GZZ, CW24KZZ, CW24LZZ, CW24SZZ, CW24YZZ, CW261ZZ, CW26DZZ, CW26FZZ, CW26GZZ, CW26KZZ, CW26LZZ, CW26SZZ, CW26YZZ, CW2B1ZZ, CW2BDZZ, CW2BFZZ, CW2BGZZ, CW2BKZZ, CW2BLZZ, CW2BSZZ, CW2BYZZ, CW2J1ZZ, CW2JDZZ, CW2JFZZ, CW2JGZZ, CW2JKZZ, CW2JLZZ, CW2JSZZ, CW2JYZZ, CW2YYZZ |
| PXX03231 | Other therapeutic procedures – 231 | 3E013GC, 3E0303Z, 3E030FZ, 3E030HZ, 3E030KZ, 3E030RZ, 3E030WK, 3E0333Z, 3E033FZ, 3E033HZ, 3E033KZ, 3E033RZ, 3E033WK, 3E0403Z, 3E040FZ, 3E040HZ, 3E040KZ, 3E040RZ, 3E040WK, 3E0433Z, 3E043FZ, 3E043HZ, 3E043KZ, 3E043RZ, 3E043WK, 3E0503Z, 3E050FZ, 3E050HZ, 3E050KZ, 3E050RZ, 3E050TZ, 3E050WK, 3E0533Z, 3E053FZ, 3E053HZ, 3E053KZ, 3E053RZ, 3E053TZ, 3E053WK, 3E0603Z, 3E060FZ, 3E060HZ, 3E060RZ, 3E060TZ, 3E060WK, 3E0633Z, 3E063FZ, 3E063HZ, 3E063RZ, 3E063TZ, 3E063WK, 3E09329, 3E0933Z, 3E0934Z, 3E093BZ, 3E093GC, 3E093HZ, 3E093KZ, 3E093TZ, 3E09729, 3E0973Z, 3E0974Z, 3E097BZ, 3E097GC, 3E097HZ, 3E097KZ, 3E097TZ, 3E09X29, 3E09X3Z, 3E09X4Z, 3E09XBZ, 3E09XHZ, 3E09XKZ, 3E09XTZ, 3E0D329, 3E0D33Z, 3E0D34Z, 3E0D36Z, 3E0D37Z, 3E0D3BZ, 3E0D3GC, 3E0D3HZ, 3E0D3KZ, 3E0D3RZ, 3E0D3TZ, 3E0D729, 3E0D73Z, 3E0D74Z, 3E0D76Z, 3E0D77Z, 3E0D7BZ, 3E0D7GC, 3E0D7HZ, 3E0D7KZ, 3E0D7RZ, 3E0D7TZ, 3E0DX29, 3E0DX3Z, 3E0DX4Z, 3E0DX6Z, 3E0DX7Z, 3E0DXBZ, 3E0DXHZ, 3E0DXKZ, 3E0DXRZ, 3E0DXTZ, 3E0F3SF, 3E0F7SF, 3E0F8SF, 3E0G3BZ, 3E0G3HZ, 3E0G3KZ, 3E0G3SF, 3E0G3TZ, 3E0G7BZ, 3E0G7HZ, 3E0G7KZ, 3E0G7SF, 3E0G7TZ, 3E0G8BZ, 3E0G8HZ, 3E0G8KZ, 3E0G8SF, 3E0G8TZ, 3E0H3BZ, 3E0H3GC, 3E0H3HZ, 3E0H3KZ, 3E0H3SF, 3E0H3TZ, 3E0H7BZ, 3E0H7HZ, 3E0H7KZ, 3E0H7SF, 3E0H7TZ, 3E0H8BZ, 3E0H8HZ, 3E0H8KZ, 3E0H8SF, 3E0H8TZ, 3E0J3SF, 3E0J7SF, 3E0J8SF, 3E0K3BZ, 3E0K3HZ, 3E0K3KZ, 3E0K3SF, 3E0K3TZ, 3E0K7BZ, 3E0K7GC, 3E0K7HZ, 3E0K7KZ, 3E0K7SF, 3E0K7TZ, 3E0K8BZ, 3E0K8GC, 3E0K8HZ, 3E0K8KZ, 3E0K8SF, 3E0K8TZ, 3E0N73Z, 3E0N76Z, 3E0N77Z, 3E0N7BZ, 3E0N7GC, 3E0N7HZ, 3E0N7KZ, 3E0N7SF, 3E0N7TZ, 3E0N83Z, 3E0N86Z, 3E0N87Z, 3E0N8BZ, 3E0N8GC, 3E0N8HZ, 3E0N8KZ, 3E0N8SF, 3E0N8TZ, 3E0P3GC, 3E0P3SF, 3E0P7SF, 3E0P8SF, 3E0W33Z, 3E0W36Z, 3E0W37Z, 3E0W3BZ, 3E0W3GC, 3E0W3HZ, 3E0W3KZ, 3E0W3TZ, XW03331, XW03372, XW04331, XW04372 |
| PXX04178 | CT scan chest – 178 | BW2400Z, BW240ZZ, BW2410Z, BW241ZZ, BW24Y0Z, BW24YZZ, BW24ZZZ |
| 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, BH48ZZZ, BH49ZZZ, BL41ZZZ, BL43ZZZ, BQ40ZZZ, BQ41ZZZ, BQ42ZZZ, BR49ZZZ, BR4FZZZ, BV44ZZZ, BV49ZZZ, BV4BZZZ, BW41ZZZ, BW4GZZZ |
| PXX05226 | Other diagnostic radiology and related techniques – 226 | B300ZZZ, B30MZZZ, B30PZZZ, B410ZZZ, B412ZZZ, B413ZZZ, B414ZZZ, B415ZZZ, B416ZZZ, B417ZZZ, B418ZZZ, B419ZZZ, B41BZZZ, B41CZZZ, B41DZZZ, B41FZZZ, B41GZZZ, B41JZZZ, B510ZZA, B510ZZZ, B511ZZA, B511ZZZ, B519ZZZ, B51BZZA, B51BZZZ, B51CZZA, B51CZZZ, B51DZZA, B51DZZZ, B51FZZA, B51FZZZ, B51GZZA, B51GZZZ, B51HZZA, B51HZZZ, B51JZZA, B51JZZZ, B51KZZA, B51KZZZ, B51LZZA, B51LZZZ, B51TZZA, B51TZZZ, B51VZZA, B51VZZZ, BW00ZZZ, BW01ZZZ, BW0KZZZ, BW0LZZZ, BW11ZZZ |
| 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, BF2500Z, BF250ZZ, BF2510Z, BF251ZZ, BF25Y0Z, BF25YZZ, BF25ZZZ, BF2600Z, BF260ZZ, BF2610Z, BF261ZZ, BF26Y0Z, BF26YZZ, BF26ZZZ, BF2C00Z, BF2C0ZZ, BF2C10Z, BF2C1ZZ, BF2CY0Z, BF2CYZZ, BF2CZZZ, BW2000Z, BW200ZZ, BW2010Z, BW201ZZ, BW20Y0Z, BW20YZZ, BW20ZZZ, BW2G00Z, BW2G0ZZ, BW2G10Z, BW2G1ZZ, BW2GY0Z, BW2GYZZ, BW2GZZZ |
| PXX11112 | Other OR therapeutic procedures of urinary tract – 112 | 0VT30ZZ, 0VT34ZZ |
| PXX11180 | Other CT scan – 180 | 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, 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, BG2200Z, BG220ZZ, BG2210Z, BG221ZZ, BG22Y0Z, BG22YZZ, BG22ZZZ, BQ200ZZ, BQ201ZZ, BQ20YZZ, BQ20ZZZ, BQ210ZZ, BQ211ZZ, BQ21YZZ, BQ21ZZZ, BQ230ZZ, BQ231ZZ, BQ23YZZ, BQ23ZZZ, BQ240ZZ, BQ241ZZ, BQ24YZZ, BQ24ZZZ, BR290ZZ, BR291ZZ, BR29YZZ, BR29ZZZ, BR2C0ZZ, BR2C1ZZ, BR2CYZZ, BR2CZZZ, BR2D0ZZ, BR2D1ZZ, BR2DYZZ, BR2DZZZ, BR2F0ZZ, BR2F1ZZ, BR2FYZZ, BR2FZZZ, BT2000Z, BT200ZZ, BT2010Z, BT201ZZ, BT20Y0Z, BT20YZZ, BT20ZZZ, BV2300Z, BV230ZZ, BV2310Z, BV231ZZ, BV23Y0Z, BV23YZZ, BV23ZZZ, BW2100Z, BW210ZZ, BW2110Z, BW211ZZ, BW21Y0Z, BW21YZZ, BW21ZZZ, BW2500Z, BW250ZZ, BW2510Z, BW251ZZ, BW25Y0Z, BW25YZZ, BW25ZZZ |
| PXX12113 | Transurethral resection of prostate (TURP) – 113 | 0VT07ZZ, 0VT08ZZ |
| PXX12114 | Open prostatectomy – 114 | 0VB00ZZ, 0VB03ZZ, 0VB04ZZ, 0VT00ZZ |
| PXX12117 | Other non-OR therapeutic procedures, male genital – 117 | 0VTN0ZZ, 0VTP0ZZ, 0VTQ0ZZ |
| PXX12118 | Other OR therapeutic procedures, male genital – 118 | 0VT10ZZ, 0VT20ZZ |
| PXX12120 | Laparoscopic Prostatectomy | 0VT04ZZ |
| PXX1667 | Other therapeutic procedures, hemic and lymphatic system – 067 | 07BC0ZX, 07TC0ZZ |
| PXX17225 | CHEMOTHERAPY | 3E00X05, 3E01305, 3E02305, 3E03002, 3E03005, 3E03302, 3E03305, 3E04002, 3E04005, 3E04302, 3E04305, 3E05002, 3E05005, 3E05302, 3E05305, 3E06002, 3E06005, 3E06302, 3E06305, 3E0G305, 3E0G705, 3E0G805, 3E0K305, 3E0K705, 3E0K805, 3E0N305, 3E0N705, 3E0N805, 3E0Q005, 3E0Q305, 3E0Q705, 3E0R302, 3E0R305, 3E0S302, 3E0S305, 3E0V305, 3E0W305, 3E0Y705, XW03351, XW04351 |
| PXX17226 | RADIATION THERAPY | CW70NZZ, CW70YZZ, CW7N8ZZ, CW7NGZZ, CW7NNZZ, CW7NPZZ, CW7NYZZ, CW7YYZZ, D0003ZZ, D0013ZZ, D0063ZZ, D0073ZZ, D0Y0FZZ, D0Y1FZZ, D0Y6FZZ, D0Y7FZZ, D7003ZZ, D7013ZZ, D7023ZZ, D7063ZZ, D7073ZZ, D7083ZZ, D7Y0FZZ, D7Y1FZZ, D7Y2FZZ, D7Y6FZZ, D7Y7FZZ, D7Y8FZZ, DDY7CZZ, DDY7FZZ, DF003ZZ, DFY0CZZ, DFY0FZZ, DH073ZZ, DH083ZZ, DH093ZZ, DHY7FZZ, DHY8FZZ, DHY9FZZ, DHYBFZZ, DP003ZZ, DPY0FZZ, DT003ZZ, DT013ZZ, DT023ZZ, DT033ZZ, DTY0CZZ, DTY0FZZ, DTY1CZZ, DTY1FZZ, DTY2CZZ, DTY2FZZ, DTY3CZZ, DTY3FZZ, DV003ZZ, DV013ZZ, DVY0CZZ, DVY0FZZ, DVY1FZZ, DW013ZZ, DW033ZZ, DW043ZZ, DW053ZZ, DW063ZZ, DWY1FZZ, DWY3FZZ, DWY4FZZ, DWY5FZZ, DWY5GDZ, DWY5GFZ, DWY5GGZ, DWY5GHZ, DWY5GYZ, DWY6FZZ |
Table 5: Relevant Procedure Codes CPT/HCPCS
| Group ID | Group Name | Code Value |
| CT0017 | Perineal Prostatectomy | 55801, 55810, 55812, 55815 |
| CT0018 | Retropubic Prostatectomy | 55831, 55840, 55842, 55845 |
| CT0019 | Suprapubic Prostatectomy | 55821 |
| CT0020 | Laparoscopic Prostatectomy | 55866 |
| CT0021 | Cryosurgical Ablation of Prostate | 55873 |
| CT0025 | Preventive Medicine, Care Coordination | 98960, 98961, 98962, 98966, 98967, 98968, 99078, 99361, 99362, 99366, 99367, 99368, 99371, 99372, 99373, 99383, 99384, 99385, 99386, 99387, 99393, 99394, 99395, 99396, 99397, 99398, 99399, 99400, 99401, 99402, 99403, 99404, 99411, 99412, 99429, 99441, 99442, 99443, 99446, 99447, 99448, 99449, 99499, G0175, G0406, G0407, G0408, G0425, G0426, G0427, H0034, S0220, S0221, S0315, S0316, S0317, S0320 |
| CT0026 | Anesthesia and pain meds | J0780, J1960, J2270, J2310, J3010, J3070, S0012, S0092, S0093 |
| CT0080 | Imaging Abdomen | 74000, 74010, 74020, 74022, 74150, 74160, 74170, 74177, 74181, 74182, 74183, 74185, 76700, 76705, 76999, C8900, C8901 |
| CT0082 | Pain medicines | 96372, H0033, J0592, J1230, J2315 |
| CT0083 | Blood Type, Coomb’s test | 86077, 86900, 86901 |
| CT0089 | Metabolic Renal Hepatic Chemistry Panel | 80010, 80047, 80048, 80049, 80050, 80051, 80052, 80053, 80069, 80074, 80076, 82040, 82247, 82248, 82310, 82330, 82435, 82565, 82947, 84132, 84155, 84295, 84450, 84460, 84520, 84550 |
| 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, T1015 |
| CT0092 | Physician Services – Inpatient | 99221, 99222, 99223, 99238, 99239, 99252, 99253, 99254, 99255 |
| CT0096 | Subsequent Physician Services Inpatient | 99462 |
| CT0119 | Procedure – block – nerve | 64472 |
| CT01394 | Medications (Injections, infusions and other forms) | C9276, C9279, C9282, C9283, C9285, J0171, J0558, J0561, J0695, J0714, J0875, J1443, J3095, J7121, J7312, J7328, Q2042, Q2044, S0148 |
| CT01395 | DME and supplies | A9584, E1012, E1036, E2622, E2623, E2625, K0743, K0745, K0746, Q4161, Q4162, Q4163, Q4164, Q4165, Q9950 |
| CT0140 | Rx – central nervous system – barbiturates | J2515, J2560 |
| CT0141 | Rx – central nervous system – benzodiazepines | J2060, J2250, J3360 |
| CT0144 | Imaging – ct – head / brain | 70450, 70460, 70470 |
| CT0149 | Imaging – mri – brain | 70551, 70552, 70553 |
| CT02387 | Pathology | 81540 |
| CT04282 | Chest X-Ray | 71010, 71015, 71020, 71021, 71022, 71023, 71030, 71034, 71035 |
| CT0442 | Other care – respiratory – equipment / supplies | E1399, K0195 |
| CT0445 | Imaging – ct – chest | 71250, 71260, 71270 |
| CT0447 | Imaging – mri – chest | 71550, 71551, 71552 |
| CT0448 | Imaging – mra – chest | C8909, C8910, C8911 |
| CT0449 | Imaging – nuclear – lung scan | 78596, A9536, A9558 |
| CT05171 | Procedure – central venous catheter – insertion | 36556, 36558, 36561, 36563, 36565, 36566, 36569, 36571, S5522, S5523 |
| CT05172 | Procedure – central venous catheter – fluoroscopy – guidance | 77001 |
| CT05173 | Procedure – central venous catheter – replacement | 36578, 36580, 36581, 36582, 36583, 36584, 36585 |
| CT05174 | Procedure – central venous catheter – repair / maintenance | 36575, 36576, 36595, 36596, 36597, 36598 |
| CT05175 | Procedure – central venous catheter – removal | 36589, 36590 |
| CT05176 | Procedure – peripheral venous catheter | 36000 |
| CT05179 | Procedure – catheter – arterial – arterial line for monitoring | 36620, 36625 |
| CT05183 | Procedure – catheter – arterial – other | 36640 |
| CT05184 | Procedure – vascular access – port / pump – insertion | 36260, C1772, C2626, E0782, E0786 |
| CT05185 | Procedure – vascular access – port / pump – revision | 36261 |
| CT05186 | Procedure – vascular access – port / pump – removal | 36262 |
| CT05187 | Procedure – vascular access – port / pump – maintenance | 36593 |
| CT05190 | Procedure – anesthesia | 00532, 01916, 01924 |
| CT05199 | Rx – cardiovascular system – vasodilating rx | K0455 |
| CT05210 | Other care – other – pvd – compressor | E0675 |
| CT05217 | Imaging – nuclear – venous thrombosis – scan | 78456, 78457, 78458 |
| CT05218 | Imaging – nuclear – venous thrombosis – radiopharmaceutical | A9504 |
| CT05230 | Tests – cardiac stress tests – cardiac stress tests – other | 78491, 78492 |
| CT05233 | Tests – cardiac – ecg – ecg – 12 lead | R0076 |
| CT05307 | Electrocardiogram – EKG monitoring | 93000, 93005, 93010 |
| CT05308 | Cardiac Stress Test | 78451, 78452, 78453, 78454, 78460, 78461, 78464, 78465, 78472, 78473, 78481, 78483, 93015, 93016, 93017, 93018 |
| CT05385 | Other diagnostic cardiovascular procedures | 93050 |
| CT06109 | Imaging – x-ray – abdomen | 74190 |
| CT0691 | Therapy – nasogastric tube | 43752 |
| CT0692 | Therapy – neurostimulator – nausea / vomiting | E0765 |
| CT0693 | Rx – gi – antichol/antispasmodics | J7635, J7636 |
| CT0694 | Rx – gi – antiemetics | J1240, J1260, J1626, J2405, J2469, J2550, J2765, J3250, J3280, J8498, J8501, J8597, Q0164, Q0165, Q0166, Q0167, Q0168, Q0173, Q0174, Q0179, Q0180, Q0181, S0091, S0174, S0181, S0183, S9351, S9370 |
| CT0695 | Rx – gi – h2 antagonists | J2780, S0023, S0028 |
| CT0697 | Rx – gi – ppis | C9113, S0164 |
| CT0711 | Procedure – biopsy – liver – needle biopsy of liver | 47000, 47001 |
| CT0712 | Procedure – biopsy – liver – wedge biopsy of liver | 47100 |
| CT0730 | Imaging – nuclear – liver | 78201, 78202, 78205, 78206 |
| CT0743 | Other diagnostic radiology and related techniques | 50430, 50431 |
| CT08106 | Imaging – x-ray – other – joint survey | R0070 |
| CT0959 | Procedure – other non – or rx – other non – or skin procedures | 96999, 97602 |
| CT0965 | Other care – wound care | 97597, 97598, 97605, 97606, E0181, E0182, E0184, E0185, E0186, E0187, E0188, E0189, E0190, E0191, E0193, E0194, E0196, E0197, E0198, E0199, E0769, G0281, G0282 |
| CT0969 | Other care – chronic edema – surgical stockings | A4490, A4495, A4500, A4510 |
| CT0971 | Other care – chronic edema – appliance – non – segmental | E0655, E0665, E0666 |
| CT0972 | Other care – chronic edema – appliance – segmental | E0656, E0657, E0660, E0667, E0668, E0669, E0671, E0672, E0673 |
| CT0974 | Other care – chronic edema – compressor – non – segmental | E0650 |
| CT0975 | Other care – chronic edema – compressor – segmental | E0651, E0652 |
| CT0993 | DME – wound therapy | E2402 |
| CT1011 | Rx – antidiabetic rx – insulins | J1815, J1817 |
| CT1012 | Rx – antidiabetic rx, misc | J1610 |
| CT1016 | Rx – corticosteroids | J7622, J7624, J7626, J7627, J7633, J7634, J7637, J7638, J7641, J7683, J7684 |
| 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 | B9998 |
| CT1043 | Other care – nutrition – parenteral | B9999 |
| CT1044 | Other care – nutrition – parenteral – pump | B9006 |
| CT1045 | Other care – nutrition – parenteral – all – inclusive | S9364, S9365, S9366, S9367, S9368 |
| CT1046 | Other care – nutrition – education | S9452 |
| CT1101 | Procedure – cystoscopy – dx | 52000 |
| CT1108 | Procedure – cystoscopy – w / stent insertion | 53855 |
| CT1110 | Procedure – cystoscopy – rx – other | 52606, 52640 |
| CT1117 | Procedure – indwelling catheter | 51701, 51702, 51703 |
| CT11290 | Ureteral catheterization | 50693, 50694, 50695 |
| CT11291 | Nephrotomy and nephrostomy | 50432, 50433, 50434, 50435 |
| CT1137 | Procedure – anesthesia | 00865, 00904 |
| CT1146 | Therapy – dialysis – supplies | A4932 |
| CT1155 | Imaging – x-ray – urinary tract – cystography / voiding cystourethrogram | 51600, 74430 |
| CT1159 | Tests – gu – post void residual / bladder capacity | 51798 |
| CT1164 | Tests – gu – urodynamics – voiding pressure | 51795 |
| CT1166 | Lab – urinalysis | 81007, 81015, 81020, 81050, 81099 |
| CT1167 | Lab – specimen collection – urine | P9612, P9615 |
| CT1201 | Procedure – vein – pelvis – other | 37790 |
| CT1204 | Procedure – biopsy – prostate | 55700, 55705, 55706 |
| CT1207 | Procedure – destruction – penile lesion | 54050, 54055, 54056, 54057, 54060, 54065, 54110, 54111, 54112, 54115, 54200, 54205, 54220 |
| CT1208 | Procedure – penile prosthesis – implant | 54400, 54401, 54405 |
| CT1209 | Procedure – penile prosthesis – revise / remove | 54406, 54408, 54410, 54411, 54415, 54416, 54417 |
| CT1210 | Procedure – penile prosthesis – prosthesis | C1813, C2622 |
| CT1211 | Procedure – other dx – male genital | 54100, 54105, 54231, 54235, 54240, 54250, 54500, 54505, 54699, 54800, 55110 |
| CT1212 | Procedure – other non – or rx; male genital | 54000, 54001, 54450, 55000, 55100, 55120, 55200, 55450 |
| CT1214 | Procedure – orchiectomy | 54520, 54522, 54530, 54535, 54690 |
| CT1215 | Procedure – orchiopexy | 54620, 54640, 54650, 54692 |
| CT1216 | Procedure – excision of hydrocele | 55040, 55041, 55060 |
| CT1217 | Procedure – other or rx; male genital | 54015, 54120, 54125, 54130, 54135, 54162, 54164, 54300, 54304, 54360, 54380, 54385, 54390, 54420, 54430, 54435, 54440, 54512, 54550, 54560, 54600, 54660, 54670, 54680, 54700, 54830, 54840, 54860, 54861, 54865, 54900, 54901, 55150, 55175, 55180, 55400, 55500, 55520, 55530, 55535, 55550, 55559, 55600, 55605, 55650, 55680, 55720, 55725, 55860, 55862, 55865, 55899 |
| CT1218 | Procedure – anesthesia | 00908, 00920, 00921, 00922, 00924, 00926, 00928, 00930, 00932, 00934, 00936, 00938 |
| CT1219 | Rx – reproductive system – impotence rx | J0270, J0275, S0090 |
| CT1221 | Imaging – us – scrotum | 76870 |
| CT1222 | Imaging – us – transrectal | 76872, 76873 |
| CT1223 | Imaging – nuclear – testes | 78761 |
| CT1224 | Imaging – x-ray – male genital | 74440, 74445 |
| CT1225 | Lab – cancer antigen – psa – screening | G0103 |
| CT12389 | Transurethral resection of prostate (TURP) | 0421T |
| CT1326 | Rx – reproductive system – androgens / comb | J0900, J1060, J1070, J1080, J2320, J3120, J3130, J3140, J3150, S0189 |
| CT1327 | Rx – reproductive system – estrogens / comb | J1000, J1380, J1410, J1435, J9165 |
| CT1328 | Rx – reproductive system – gonadotropins | J0725, J1620, J3355, S0122, S0126, S0128 |
| CT1329 | Rx – reproductive system – progestins | J1051, J2675 |
| CT1330 | Rx – reproductive system – gonadotropin rel horm agnsts | J1675, J9225, J9226, S0132 |
| CT1602 | Procedure – lymphadenectomy | 38571 |
| CT1615 | Therapy – transfusion – administration | 36430 |
| 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 |
| CT1626 | Rx – blood derivatives | P9041, P9045, P9046, P9047 |
| CT16296 | Lipid Level Monitoring | 80061, 84478 |
| CT16297 | Blood Count | 82728, 83540, 83550, 85004, 85007, 85008, 85009, 85013, 85014, 85018, 85025, 85027, 85032, 85041, 85044, 85045, 85046, 85048, 85049, G0306, G0307 |
| CT16298 | Finger stick – Blood Tests | 36416, 82948, 88720 |
| CT16299 | Bleeding Status | 85002, 85345, 85347, 85348, 85610, 85611, 85670, 85675, 85705, 85730, 85732, 99363, 99364, G0248, G0250 |
| CT1630 | Rx – coagulation system – anticoagulants | S9336, S9372 |
| CT16316 | Blood transfusion | P9070, P9071, P9072 |
| CT1634 | Rx – coagulation system – antiplatelet rx | J0130, J1245, J1327, J3246 |
| 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, 96523, 99601, 99602, A4220, A4221, A4222, A4223, A4305, A4306, C8957, E0776, E0779, E0780, E0781, K0552, K0601, K0602, K0603, K0604, K0605, S1015, S5035, S5036, S5497, S5498, S5501, S5502, S5517, S5518, S5520, S5521, S9379, S9542, S9810 |
| CT1646 | Lab – hematology – coagulation | 85170, 85175, G0249 |
| CT1647 | Lab – hematology – blood count | 85055 |
| CT1651 | Lab – immunology | 86078, 86079, 86300, 86301, 86304, 86316, 86320, 86332 |
| CT1652 | Lab – transfusion medicine | 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 |
| CT17101 | IMMUNOTHERAPY | S9338 |
| CT17104 | RADIATION TREATMENTS | C9728 |
| CT17107 | Hormone Therapy | J1950, J3315, J9155, J9202, J9217, J9218, J9219, S0175, S9560 |
| CT1775 | Therapy – chemorx – administration – cns | 96450, 96542 |
| CT1776 | Therapy – chemorx – administration – iv | 96409, 96411, 96413, 96415, 96416, 96417, Q0084, Q0085, S9329, S9330, S9331 |
| CT1778 | Therapy – chemorx – administration – other | 96401, 96402, 96405, 96406, 96549, Q0083 |
| CT1794 | Imaging – pet – tumor imaging | 78811, 78812, 78813, 78814, 78815, 78816 |
| CT1799 | CHEMOTHERAPY | 96420, 96422, 96423, 96425, J0207, J0640, J0641, J8530, J8565, J8610, J9000, J9001, J9035, J9055, J9070, J9171, J9178, J9190, J9201, J9207, J9208, J9209, J9250, J9260, J9264, J9265, J9280, J9293, J9340, J9355, J9360, J9390, J9395, S0156, S0170, S0187 |
| CT1805 | Rx – antibiotics / antivirals / antifungals – infusion | S9494, S9497, S9500, S9501, S9502, S9503, S9504 |
| CT1806 | Rx – antibiotics – aminoglycosides | J0278, J1580, J1840, J1850, J3000, J3260, J7682, J7685 |
| CT1807 | Rx – antibiotics – cephalosporins | J0690, J0692, J0694, J0696, J0697, J0698, J0710, J0713, J0715, J1890 |
| CT1808 | Rx – b-lactam antibiotics | J0743, J1335, J2185, S0073 |
| 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 | J2545, J3305, J7676, S0030, S0080, S9061 |
| CT1824 | Lab – microbiology – other | 87015, 87176 |
| 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 |
| CT1828 | Lab – microbiology | P7001 |
| CT18302 | CHLAMYDIA SCREENING | 87110 |
| CT19303 | Psychiatry Evaluations | T1023 |
| CT19304 | Psychiatry Services | H0031, H2015, H2016, S3005, S9482 |
| CT19381 | Smoking / Tobacco Cessation | 99406, 99407 |
| CT2006 | Alcohol / Drug Use Management | H0045 |
| CT2009 | Alcohol / Drug Use Screening | 99408, 99409 |
| CT2101 | Lab – therapeutic drug assay | 80170, 80200, 80202, 80299 |
| CT2302 | Therapy – behavior – other | G0177 |
| CT2325 | Other care – ostomy – supplies | A4366 |
| CT2326 | Other care – bladder / bowel care – other supplies | A4310, A4320, A4321, A4322, A4331, A4332, A4333, A4334, A4335, A4354, A5113, A5114 |
| CT2327 | Other care – bladder / bowel care – catheter | A4311, A4312, A4313, A4314, A4315, A4316, A4338, A4340, A4344, A4346, 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, A5200 |
| CT23309 | Markers for Inflammation | 85651, 85652, 86140, 86141 |
| CT2331 | Other care – observation | G0379 |
| CT2338 | Other care – other – education | S9445, S9446 |
| CT23398 | Ancillary Services | 99415, 99416, G9473, G9474, G9475, G9476, G9477, G9478, G9479 |
| 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, 99299, 99300, 99466, 99475, 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, 99170, 99288, 99289, 99290, 99360, 99450, 99455, 99456, 99485, 99486, 99488, S0260, S0265 |
| CT9910 | Procedure – anesthesia | 300 |
| CT99102 | Other care – other | H0043, H0044, S9900, S9970, S9988, S9990, S9991, T2025, T2035, T2038 |
| CT99103 | Imaging – ct – follow – up | 76380 |
| CT99104 | Imaging – ct – other | 76497 |
| CT99105 | Imaging – ct – guidance | 77012, 77013, 77014 |
| CT99107 | Imaging – mri – other | 75559, 75563, 76498, C1770, 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 |
| CT99116 | Imaging – nuclear – bone scan | 78306 |
| CT99117 | Imaging – nuclear – bone scan – radiopharmaceutical | A9503, A9561 |
| CT99120 | Imaging – nuclear – lymphatics | 78195 |
| CT99121 | Imaging – nuclear – brain – radiopharmaceutical | A9557 |
| CT99124 | Imaging – nuclear – tumor localization | 78800, 78801, 78802, 78803, 78804 |
| CT99125 | Imaging – nuclear – localization of inflammation | 78805, 78806, 78807 |
| CT99127 | Imaging – nuclear – other – automated data add – on | 78890, 78891 |
| CT99128 | Imaging – nuclear – other | 78799, 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, 76496 |
| CT99134 | Imaging – other imaging – fluoroscopy – guidance | 77002 |
| CT99136 | Imaging – other imaging | 75900, 76080, 76101, 76102, 76120, 76125, 76140, 76150, 76350, 76376, 76377, 76390, 76499, Q0092, R0075 |
| CT99137 | Imaging – therapeutic procedure – abscess drainage | 75989 |
| CT99138 | Imaging – therapeutic procedure – other therapeutic procedure | 75984 |
| 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 | 82045, 82150, 82306, 82307, 82308, 82331, 82340, 82436, 82486, 82487, 82488, 82489, 82491, 82492, 82528, 82530, 82533, 82541, 82542, 82543, 82544, 82570, 82626, 82627, 82633, 82634, 82651, 82652, 82668, 82670, 82671, 82672, 82677, 82679, 82742, 82746, 82950, 82951, 82952, 83051, 83069, 83491, 83497, 83498, 83499, 83735, 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, 84066, 84075, 84078, 84080, 84133, 84143, 84144, 84146, 84152, 84153, 84154, 84156, 84157, 84160, 84165, 84166, 84181, 84182, 84233, 84234, 84235, 84238, 84300, 84402, 84403, 84466, 84525, 84540, 84545, 84560, 84702, 84703, 84704, 84999 |
| CT99146 | Lab – cytology | 88104, 88106, 88107, 88108, 88112, 88125, 88160, 88161, 88162, 88172, 88173, 88182, 88184, 88185, 88187, 88188, 88189, 88199 |
| CT99147 | Lab – cytogenetics | 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, 88304, 88305, 88307, 88309, 88312, 88313, 88314, 88318, 88319, 88321, 88323, 88325, 88329, 88331, 88332, 88333, 88334, 88342, 88348, 88349, 88358, 88365, 88367, 88368, 88371, 88372, 88380, 88381, 88384, 88385, 88386, 88387, 88388, 88399 |
| CT99149 | Lab – other clinical lab | 88400 |
| CT99169 | Lab – specimen collection – blood – venous – venipuncture | 36410, 36415, S9529 |
| CT9917 | Procedure – related supplies – access catheter | A4300, A4301 |
| CT99171 | Lab – specimen collection – blood – venous – venous port | 36591, 36592 |
| CT99172 | Lab – specimen collection – blood – arterial – arterial puncture | 36600 |
| CT99173 | Lab – specimen collection – specimen handling | 99000 |
| 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 |
| CT99184 | DME – other | A4639, A4640, A9281, A9283, A9300, A9900, A9901, A9999, S9381, T1999, T2029, 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, E0301, E0302, E0303, E0304, E0305, E0310, E0315, E0325, E0350, E0352, E0370, E0371, E0372, E0373, E0462 |
| CT99187 | DME – safety equipment | E0700, E0705 |
| CT99188 | DME – restraints | E0710 |
| CT99189 | DME – whirlpool – equipment | E1300, E1310 |
| 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, A6550, A7000, A7001, A7002, A9155, C1751, C1769, C9898, J1642, S8430, S8431, T2028 |
| CT99195 | Prosthetics – other | K0462 |
| CT99198 | PQRI | G8427, G8428, G8430, G8440, G8441, G8442, G8447, G8448, G8464, G8465, G9019, G9020, G9033, G9035, G9036, G9050, G9051, G9052, G9053, G9055, G9056, G9057, G9058, G9059, G9060, G9061, G9062, G9140 |
| CT9922 | Procedure – related supplies – drainage | C1729 |
| CT99309 | Physician Services | 99251 |
| CT99311 | Urine Protein | 81000, 81001, 81002, 81003, 81005, 82042, 82043, 82044 |
| CT99312 | HbA1C | 83036 |
| CT99314 | Robotic Surgery | S2900 |
| CT99316 | Physician Services – Inpatient | 99356, 99357 |
| CT99392 | Other diagnostic procedures (interview, evaluation, consultation) | G0438, G0439, Q5010 |
| CT99400 | Advance care planning | 1123F, 1124F, 1157F, 1158F, 4553F, 99497, 99498, S0255, S0257, S0311 |
| CT99401 | Bundled Payment / Medical Home | G9187, S0280, S0281 |
| CT99402 | Care Plan Oversight | 94005, 99339, 99340, 99374, 99375, 99377, 99378, 99379, 99380 |
| CT99403 | Case Management Services | 0518F, 0521F, 5050F, G0162, G0463, G9012, S0250, T1001, T1016, T1017, T2022, T2023, T2024 |
| CT99404 | Case Management Services – Behavioral | 96116, G0503, G0507, H0023, H1011 |
| CT99407 | Case Management Services – Oncology | G9054, S0353, S0354 |
| CT99408 | Chronic Care Management | 99487, 99489 |
| CT99409 | Home Health / Hospice | G0179, G0180, G0181, G0182 |
| CT9941 | Rx – allergy – antihistamines / comb | J0945, J1200, Q0163, Q0169, Q0170 |
| 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 |
| CT99417 | Risk Assessment | G9316 |
| CT99418 | Transitional Care Management | 99495, 99496 |
| CT99419 | Wellness Assessment | S5190 |
| CT9942 | Rx – gi – antichol/antispasmodics | J0461 |
| CT9944 | Rx – autonomic rx – sympathomimetic rx | J0170, J1250, J1265 |
| 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 |
| 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 |
| 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 | T1502 |
| CT9960 | Rx – miscellaneous rx – anesthetics, local | J0670, J2001, J2400, J2795, S0020 |
| CT9961 | Rx – diagnostic rx – roentgenography | Q9957 |
| CT9962 | Rx – other | T1503 |
| CT9963 | Rx – pharmacy fee | Q0513, Q0514 |
| 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 |
| CT9973 | Other care – home care – social worker | G0155, S9127 |
| CT9974 | Other care – home care – home health aide | G0156, S9122, T1021 |
| 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 |
| 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 |
| 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 | 0010M, 3268F, 3269F, 3270F, 3271F, 3272F, 3273F, 3274F, 33952, 33954, 33958, 33962, 33966, 33984, 37191, 37192, 37193, 37619, 4163F, 4164F, 52441, 52442, 6030F, 7010F, 81313, 81504, 86902, 90769, 90770, 90771, 90776, 96360, 96446, 97610, C9443, C9444, C9446, C9722, C9739, C9740, G0299, G0300, G0344, G0472, G0473, G6045, G6046, G8060, G8061, G8062, G8152, G8153, G8154, G8155, G8156, G8157, G8193, G8196, G8204, G8209, G8214, G8217, G8219, G8220, G8221, G8373, G8374, G8378, G8379, G8383, G8437, G8439, G8696, G8697, G8698, G8702, G8703, G8704, G8705, G8706, G8707, G8916, G8917, G8918, G8961, G8962, G8967, G8968, G8969, G8970, G8971, G8972, G9199, G9200, G9201, G9298, G9299, G9307, G9308, G9309, G9310, G9311, G9312, G9362, G9363, G9497, G9500, G9501, G9503, G9539, G9540, G9541, G9542, G9543, G9544, G9558, G9559, G9560, G9637, G9638, G9642, G9643, G9644, G9645, G9654, G9655, G9656, G9657, G9658, J2274, J2704, J9267, 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 |
| RX0425 | antihistamines for systemic use |
| RX0426 | Bronchodilators: adrenergics for systemic use |
| RX0427 | drugs for obstructive airway diseases – inhalants |
| RX0429 | other systemic drugs for obstructive airway diseases |
| RX0530 | agents acting on the renin-angiotensin system |
| RX0534 | Other Anticoagulants |
| RX0535 | beta blocking agents |
| RX0536 | calcium channel blockers |
| RX0538 | diuretics |
| RX0539 | i.v. solutions & additives |
| RX0540 | Nitrates and other antianginals |
| RX0541 | other antihypertensives |
| RX0543 | peripheral vasodilators |
| RX0546 | Antiplatelet agents, thrombin inhibitors |
| RX0547 | Heparin group |
| RX0645 | antacids |
| RX0646 | antidiarrheals intestinal adsorbents |
| RX0647 | antiemetics and antinauseants |
| RX0648 | digestives incl. enzymes |
| RX0649 | drugs for constipation |
| RX0651 | drugs for peptic ulcer and gerd |
| RX0652 | intestinal antiinfectives |
| RX0654 | stomatological preparations |
| RX0857 | antiinflammatory and antirheumatic products |
| RX0860 | muscle relaxants |
| RX0861 | opioids |
| RX0862 | other analgesics and antipyretics |
| RX0864 | topical products for joint and muscular pain |
| RX0965 | agents for treatment of hemorrhoids and anal fissures for topical use |
| 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 |
| RX1086 | corticosteroids for systemic use |
| RX1089 | drugs used in diabetes |
| RX1090 | endocrine therapy |
| RX1091 | drugs to treat hypoglycemia |
| RX1093 | insulin |
| RX1194 | urinary antiinfectives and antiseptics |
| RX1197 | Genitourinary tract agents |
| RX1296 | androgens |
| RX1297 | drugs used in benign prostatic hypertrophy |
| RX13102 | progestogens |
| RX13103 | sex hormones and modulators of the genital system |
| RX1399 | gonadotropins and other ovulation stimulants |
| RX16106 | iron preparations |
| RX16108 | other hematological agents |
| RX16109 | vitamin b12 and folic acid |
| RX16110 | vitamin k and other hemostatics |
| RX16111 | Agents to stop bleeding |
| RX16112 | Blood stimulating agents Erythropoietin |
| RX17112 | Chemoprotective agents in Cancer Treatment |
| RX18117 | antibacterials for systemic use |
| RX18118 | antifungals for systemic use |
| RX18119 | antiinfectives |
| RX18122 | antivirals for systemic use |
| RX19123 | antidepressants |
| RX19125 | anxiolytics |
| 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 |