H99RPHPA NHIC, CORP. PAGE 1 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER AI 01/01/2010 PRINCIPAL PHYSICIAN OF RECORD J4 01/01/2010 DMEPOS ITEM SUBJECT TO DMEPOS COMPETITIVE BIDDING PROGRAM THAT IS FURNISHED BY A HOSPITAL UPON DISCHARGE PA 07/01/2009 SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG BODY PART PB 07/01/2009 SURGICAL OR OTHER INVASIVE PROCEDURE ON WRONG PATIENT PC 07/01/2009 WRONG SURGERY OR OTHER INVASIVE PROCEDURE ON PATIENT PI 07/01/2009 POSITRON EMISSION TOMOGRAPHY (PET) OR PET/COMPUTED TOMOGRAPHY (CT) TO INFORM THE INITIAL TREATMENT STRATEGY OF TUMORS THAT ARE BIOPSY PROVEN OR STRONGLY SUSPECTED OF BEING CANCEROUS BASED ON OTHER DIAGNOSTIC TESTING PS 07/01/2009 POSITRON EMISSION TOMOGRAPHY (PET) OR PET/COMPUTED TOMOGRAPHY (CT) TO INFORM THE SUBSEQUENT TREATMENT STRATEGY OF CANCEROUS TUMORS WHEN THE BENEFICIARY'S TREATING PHYSICIAN DETERMINES THAT THE PET STUDY IS NEEDED TO INFORM SUBSEQUENT ANTI-TUMOR STRATEGY V5 01/01/2010 VASCULAR CATHETER V6 01/01/2010 ARTERIOVENOUS GRAFT V7 01/01/2010 ARTERIOVENOUS FISTULA V8 01/01/2010 INFECTION PRESENT V9 01/01/2010 NO INFECTION PRESENT A4264 9 9 01/01/2010 PERMANENT IMPLANTABLE CONTRACEPTIVE INTRATUBAL OCCLUSION DEVICE(S) AND DELIVERY SYSTEM A4336 P 9 01/01/2010 INCONTINENCE SUPPLY, URETHRAL INSERT, ANY TYPE, EACH A4360 9 9 01/01/2010 DISPOSABLE EXTERNAL URETHRAL CLAMP OR COMPRESSION DEVICE, WITH PAD AND/OR POUCH, EACH A4456 P 9 01/01/2010 ADHESIVE REMOVER, WIPES, ANY TYPE, EACH A4466 9 9 01/01/2010 GARMENT, BELT, SLEEVE OR OTHER COVERING, ELASTIC OR SIMILAR STRETCHABLE MATERIAL, ANY TYPE, EACH A9581 1P 19 01/01/2010 INJECTION, GADOXETATE DISODIUM, 1 ML A9582 4 4 01/01/2010 IODINE I-123 IOBENGUANE, DIAGNOSTIC, PER STUDY DOSE, UP TO 15 MILLICURIES A9583 4 4 01/01/2010 INJECTION, GADOFOSVESET TRISODIUM, 1 ML A9604 6 6 01/01/2010 SAMARIUM SM-153 LEXIDRONAM, THERAPEUTIC, PER TREATMENT DOSE, UP TO 150 MILLICURIES C9250 9 9F 07/01/2009 HUMAN PLASMA FIBRIN SEALANT, VAPOR-HEATED, SOLVENT-DETERGENT (ARTISS), 2ML NOT FOUND C9254 9 9F 01/01/2010 INJECTION, LACOSAMIDE, 1 MG NOT FOUND C9255 9 9F 01/01/2010 INJECTION, PALIPERIDONE PALMITATE, 1 MG NOT FOUND C9256 9 9F 01/01/2010 INJECTION, DEXAMETHASONE INTRAVITREAL IMPLANT, 0.1 MG NOT FOUND C9257 9 9F 01/01/2010 INJECTION, BEVACIZUMAB, 0.25 MG NOT FOUND C9360 9 9F 07/01/2009 DERMAL SUBSTITUTE, NATIVE, NON-DENATURED COLLAGEN, NEONATAL BOVINE ORIGIN NOT FOUND (SURGIMEND COLLAGEN MATRIX), PER 0.5 SQUARE CENTIMETERS C9361 9 9F 07/01/2009 COLLAGEN MATRIX NERVE WRAP (NEUROMEND COLLAGEN NERVE WRAP), PER 0.5 CENTIMETER NOT FOUND LENGTH C9362 9 9F 07/01/2009 POROUS PURIFIED COLLAGEN MATRIX BONE VOID FILLER (INTEGRA MOZAIK NOT FOUND OSTEOCONDUCTIVE SCAFFOLD STRIP), PER 0.5 CC C9363 9 9F 07/01/2009 SKIN SUBSTITUTE, INTEGRA MESHED BILAYER WOUND MATRIX, PER SQUARE CENTIMETER NOT FOUND C9364 9 9F 07/01/2009 PORCINE IMPLANT, PERMACOL, PER SQUARE CENTIMETER NOT FOUND E0433 APR 9 01/01/2010 PORTABLE LIQUID OXYGEN SYSTEM, RENTAL; HOME LIQUEFIER USED TO FILL PORTABLE NOT FOUND LIQUID OXYGEN CONTAINERS, INCLUDES PORTABLE CONTAINERS, REGULATOR, FLOWMETER, HUMIDIFIER, CANNULA OR MASK AND TUBING, WITH OR WITHOUT SUPPLY RESERVOIR AND CONTENTS GAUGE E1036 R 9 01/01/2010 MULTI-POSITIONAL PATIENT TRANSFER SYSTEM, EXTRA-WIDE, WITH INTEGRATED SEAT, NOT FOUND OPERATED BY CAREGIVER, PATIENT WEIGHT CAPACITY GREATER THAN 300 LBS G0420 1 1 01/01/2010 FACE-TO-FACE EDUCATIONAL SERVICES RELATED TO THE CARE OF CHRONIC KIDNEY DISEASE; INDIVIDUAL, PER SESSION, PER ONE HOUR G0421 1 1 01/01/2010 FACE-TO-FACE EDUCATIONAL SERVICES RELATED TO THE CARE OF CHRONIC KIDNEY DISEASE; GROUP, PER SESSION, PER ONE HOUR G0422 1 1 01/01/2010 INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING H99RPHPA NHIC, CORP. PAGE 2 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER WITH EXERCISE, PER SESSION G0423 1 1 01/01/2010 INTENSIVE CARDIAC REHABILITATION; WITH OR WITHOUT CONTINUOUS ECG MONITORING; WITHOUT EXERCISE, PER SESSION G0424 1 1 01/01/2010 PULMONARY REHABILITATION, INCLUDING EXERCISE (INCLUDES MONITORING), ONE HOUR, PER SESSION, UP TO TWO SESSIONS PER DAY G0425 3 3 01/01/2010 INITIAL INPATIENT TELEHEALTH CONSULTATION, TYPICALLY 30 MINUTES COMMUNICATING WITH THE PATIENT VIA TELEHEALTH G0426 3 3 01/01/2010 INITIAL INPATIENT TELEHEALTH CONSULTATION, TYPICALLY 50 MINUTES COMMUNICATING WITH THE PATIENT VIA TELEHEALTH G0427 3 3 01/01/2010 INITIAL INPATIENT TELEHEALTH CONSULTATION, TYPICALLY 70 MINUTES OR MORE COMMUNICATING WITH THE PATIENT VIA TELEHEALTH G0430 5 5 01/01/2010 DRUG SCREEN, QUALITATIVE; MULTIPLE DRUG CLASSES OTHER THAN CHROMATOGRAPHIC METHOD, EACH PROCEDURE G0431 5 5 01/01/2010 DRUG SCREEN, QUALITATIVE; SINGLE DRUG CLASS METHOD (E.G., IMMUNOASSAY, ENZYME ASSAY), EACH DRUG CLASS G8545 1 1 01/01/2010 I INTEND TO REPORT THE HEPATITIS C MEASURES GROUP G8546 1 1 01/01/2010 I INTEND TO REPORT THE COMMUNITY-ACQUIRED PNEUMONIA (CAP) MEASURES GROUP G8547 1 1 01/01/2010 I INTEND TO REPORT THE ISCHEMIC VASCULAR DISEASE (IVD) MEASURES GROUP G8548 1 1 01/01/2010 I INTEND TO REPORT THE HEART FAILURE (HF) MEASURES GROUP G8549 1 1 01/01/2010 ALL QUALITY ACTIONS FOR THE APPLICABLE MEASURES IN THE HEPATITIS C MEASURES GROUP HAVE BEEN PERFORMED FOR THIS PATIENT G8550 1 1 01/01/2010 ALL QUALITY ACTIONS FOR THE APPLICABLE MEASURES IN THE COMMUNITY-ACQUIRED PNEUMONIA (CAP) MEASURES GROUP HAVE BEEN PERFORMED FOR THIS PATIENT G8551 1 1 01/01/2010 ALL QUALITY ACTIONS FOR THE APPLICABLE MEASURES IN THE HEART FAILURE (HF) MEASURES GROUP HAVE BEEN PERFORMED FOR THIS PATIENT G8552 1 1 01/01/2010 ALL QUALITY ACTIONS FOR THE APPLICABLE MEASURES IN THE ISCHEMIC VASCULAR DISEASE (IVD) MEASURES GROUP HAVE BEEN PERFORMED FOR THIS PATIENT G8553 1 1 01/01/2010 AT LEAST ONE PRESCRIPTION CREATED DURING THE ENCOUNTER WAS GENERATED AND TRANSMITTED ELECTRONICALLY USING A QUALIFIED ERX SYSTEM G8556 1 1 01/01/2010 REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION G8557 1 1 01/01/2010 PATIENT IS NOT ELIGIBLE FOR THE REFERRAL FOR OTOLOGIC EVALUATION MEASURE G8558 1 1 01/01/2010 NOT REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION, REASON NOT SPECIFIED G8559 1 1 01/01/2010 PATIENT REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION G8560 1 1 01/01/2010 PATIENT HAS A HISTORY OF ACTIVE DRAINAGE FROM THE EAR WITHIN THE PREVIOUS 90 DAYS G8561 1 1 01/01/2010 PATIENT IS NOT ELIGIBLE FOR THE REFERRAL FOR OTOLOGIC EVALUATION FOR PATIENTS WITH A HISTORY OF ACTIVE DRAINAGE MEASURE G8562 1 1 01/01/2010 PATIENT DOES NOT HAVE A HISTORY OF ACTIVE DRAINAGE FROM THE EAR WITHIN THE PREVIOUS 90 DAYS G8563 1 1 01/01/2010 PATIENT NOT REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION, REASON NOT SPECIFIED G8564 1 1 01/01/2010 PATIENT WAS REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION, REASON NOT SPECIFIED) G8565 1 1 01/01/2010 VERIFICATION AND DOCUMENTATION OF SUDDEN OR RAPIDLY PROGRESSIVE HEARING LOSS G8566 1 1 01/01/2010 PATIENT IS NOT ELIGIBLE FOR THE "REFERRAL FOR OTOLOGIC EVALUATION FOR SUDDEN OR RAPIDLY PROGRESSIVE HEARING LOSS" MEASURE G8567 1 1 01/01/2010 PATIENT DOES NOT HAVE VERIFICATION AND DOCUMENTATION OF SUDDEN OR RAPIDLY PROGRESSIVE HEARING LOSS G8568 1 1 01/01/2010 PATIENT WAS NOT REFERRED TO A PHYSICIAN (PREFERABLY A PHYSICIAN WITH TRAINING IN DISORDERS OF THE EAR) FOR AN OTOLOGIC EVALUATION, REASON NOT SPECIFIED) G8569 1 1 01/01/2010 PROLONGED INTUBATION (>24 HRS) REQUIRED G8570 1 1 01/01/2010 PROLONGED INTUBATION (>24 HRS) NOT REQUIRED H99RPHPA NHIC, CORP. PAGE 3 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER G8571 1 1 01/01/2010 DEVELOPMENT OF DEEP STERNAL WOUND INFECTION WITHIN 30 DAYS POSTOPERATIVELY G8572 1 1 01/01/2010 NO DEEP STERNAL WOUND INFECTION G8573 1 1 01/01/2010 STROKE/CBA FOLLOWING ISOLATED CABG SURGERY G8574 1 1 01/01/2010 NO STROKE/CVA FOLLOWING ISOLATED CABG SURGERY G8575 1 1 01/01/2010 DEVELOPED POSTOPERATIVE RENAL INSUFFICIENCY OR REQUIRED DIALYSIS G8576 1 1 01/01/2010 NO POSTOPERATIVE RENAL INSUFFICIENCY/DIALYSIS NOT REQUIRED G8577 1 1 01/01/2010 REOPERATION REQUIRED DUE TO BLEEDING/TAMPONADE, GRAFT OCCLUSION OR OTHER CARDIAC REASON G8578 1 1 01/01/2010 REOPERATION NOT REQUIRED DUE TO BLEEDING/TAMPONADE, GRAFT OCCLUSION OR OTHER CARDIAC REASON G8579 1 1 01/01/2010 ANTIPLATELET MEDICATION AT DISCHARGE G8580 1 1 01/01/2010 ANTIPLATELET MEDICATION CONTRAINDICATED/NOT INDICATED G8581 1 1 01/01/2010 NO ANTIPLATELET MEDICATION AT DISCHARGE G8582 1 1 01/01/2010 BETA-BLOCKER AT DISCHARGE G8583 1 1 01/01/2010 BETA-BLOCKER CONTRAINDICATED/NOT INDICATED G8584 1 1 01/01/2010 NO BETA-BLOCKER AT DISCHARGE G8585 1 1 01/01/2010 ANTI-LIPID TREATMENT AT DISCHARGE G8586 1 1 01/01/2010 ANTI-LIPID TREATMENT CONTRAINDICATED/NOT INDICATED G8587 1 1 01/01/2010 NO ANTI-LIPID TREATMENT AT DISCHARGE G8588 1 1 01/01/2010 MOST RECENT SYSTOLIC BLOOD PRESSURE < 140 MMHG G8589 1 1 01/01/2010 MOST RECENT SYSTOLIC BLOOD PRESSURE >= 140 MMHG G8590 1 1 01/01/2010 MOST RECENT DIASTOLIC BLOOD PRESSURE < 90 MMHG G8591 1 1 01/01/2010 MOST RECENT DIASTOLIC BLOOD PRESSURE >= 90 MMHG G8592 1 1 01/01/2010 NO DOCUMENTATION OF BLOOD PRESSURE MEASUREMENT G8593 1 1 01/01/2010 LIPID PROFILE RESULTS DOCUMENTED AND REVIEWED (MUST INCLUDE TOTAL CHOLESTEROL, HDL-C, TRIGLYCERIDES AND CALCULATED LDL-C) G8594 1 1 01/01/2010 LIPID PROFILE NOT PERFORMED, REASON NOT OTHERWISE SPECIFIED G8595 1 1 01/01/2010 MOST RECENT LDL-C < 100 MG/DL G8596 1 1 01/01/2010 LDL-C WAS NOT PERFORMED G8597 1 1 01/01/2010 MOST RECENT LDL-C >= 100 MG/DL G8598 1 1 01/01/2010 ASPIRIN OR ANOTHER ANTITHROMBOTIC THERAPY USED G8599 1 1 01/01/2010 ASPIRIN OR ANOTHER ANTITHROMBOTIC THERAPY NOT USED, REASON NOT OTHERWISE SPECIFIED G8600 1 1 01/01/2010 IV T-PA INITIATED WITHIN THREE HOURS (<= 180 MINUTES) OF TIME LAST KNOWN WELL G8601 1 1 01/01/2010 IV T-PA NOT INITIATED WITHIN THREE HOURS (<= 180 MINUTES) OF TIME LAST KNOWN WELL FOR REASONS DOCUMENTED BY CLINICIAN G8602 1 1 01/01/2010 IV T-PA NOT INITIATED WITHIN THREE HOURS (<= 180 MINUTES) OF TIME LAST KNOWN WELL, REASON NOT SPECIFIED G8603 1 1 01/01/2010 SCORE ON THE SPOKEN LANGUAGE COMPREHENSION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8604 1 1 01/01/2010 SCORE ON THE SPOKEN LANGUAGE COMPREHENSION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8605 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE SPOKEN LANGUAGE COMPREHENSION FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8606 1 1 01/01/2010 SCORE ON THE ATTENTION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8607 1 1 01/01/2010 SCORE ON THE ATTENTION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8608 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE ATTENTION FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8609 1 1 01/01/2010 SCORE ON THE MEMORY FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8610 1 1 01/01/2010 SCORE ON THE MEMORY FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8611 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE MEMORY FUNCTIONAL COMMUNICATION MEASURE AT EITHER H99RPHPA NHIC, CORP. PAGE 4 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER ADMISSION OR AT DISCHARGE G8612 1 1 01/01/2010 SCORE ON THE MOTOR SPEECH FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8613 1 1 01/01/2010 SCORE ON THE MOTOR SPEECH FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8614 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE MOTOR SPEECH FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8615 1 1 01/01/2010 SCORE ON THE READING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8616 1 1 01/01/2010 SCORE ON THE READING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8617 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE READING FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8618 1 1 01/01/2010 SCORE ON THE SPOKEN LANGUAGE EXPRESSION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8619 1 1 01/01/2010 SCORE ON THE SPOKEN LANGUAGE EXPRESSION FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8620 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE SPOKEN LANGUAGE EXPRESSION FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8621 1 1 01/01/2010 SCORE ON THE WRITING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8622 1 1 01/01/2010 SCORE ON THE WRITING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8623 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE WRITING FUNCTIONAL COMMUNICATION MEASURE EITHER AT ADMISSION OR AT DISCHARGE G8624 1 1 01/01/2010 SCORE ON THE SWALLOWING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS HIGHER THAN AT ADMISSION G8625 1 1 01/01/2010 SCORE ON THE SWALLOWING FUNCTIONAL COMMUNICATION MEASURE AT DISCHARGE WAS NOT HIGHER THAN AT ADMISSION, REASON NOT SPECIFIED G8626 1 1 01/01/2010 PATIENT WAS NOT SCORED ON THE SWALLOWING FUNCTIONAL COMMUNICATION MEASURE AT ADMISSION OR AT DISCHARGE G8627 1 1 01/01/2010 SURGICAL PROCEDURE PERFORMED WITHIN 30 DAYS FOLLOWING CATARACT SURGERY FOR MAJOR COMPLICATIONS (E.G. RETAINED NUCLEAR FRAGMENTS, ENDOPHTHALMITIS, DISLOCATED OR WRONG POWER IOL, RETINAL DETACHMENT, OR WOUND DEHISCENCE) G8628 1 1 01/01/2010 SURGICAL PROCEDURE NOT PERFORMED WITHIN 30 DAYS FOLLOWING CATARACT SURGERY FOR MAJOR COMPLICATIONS (E.G. RETAINED NUCLEAR FRAGMENTS, ENDOPHTHALMITIS, DISLOCATED OR WRONG POWER IOL, RETINAL DETACHMENT, OR WOUND DEHISCENCE) G9141 1 1 09/01/2009 INFLUENZA A (H1N1) IMMUNIZATION ADMINISTRATION (INCLUDES THE PHYSICIAN COUNSELING THE PATIENT/FAMILY) G9142 1 1 09/01/2009 INFLUENZA A (H1N1) VACCINE, ANY ROUTE OF ADMINISTRATION G9143 1 1 08/03/2009 WARFARIN RESPONSIVENESS TESTING BY GENETIC TECHNIQUE USING ANY METHOD, ANY NUMBER OF SPECIMEN(S) J0461 1P 1F 01/01/2010 INJECTION, ATROPINE SULFATE, 0.01 MG J0559 1P 1F 01/01/2010 INJECTION, PENICILLIN G BENZATHINE AND PENICILLIN G PROCAINE, 2500 UNITS J0586 1P 1F 01/01/2010 INJECTION, ABOBOTULINUMTOXINA, 5 UNITS J0598 1P 1F 01/01/2010 INJECTION, C1 ESTERASE INHIBITOR (HUMAN), 10 UNITS J0718 1P 1F 01/01/2010 INJECTION, CERTOLIZUMAB PEGOL, 1 MG J0833 1P 1F 01/01/2010 INJECTION, COSYNTROPIN, NOT OTHERWISE SPECIFIED, 0.25 MG J0834 1P 1F 01/01/2010 INJECTION, COSYNTROPIN (CORTROSYN), 0.25 MG J1680 1P 1F 01/01/2010 INJECTION, HUMAN FIBRINOGEN CONCENTRATE, 100 MG J2562 1P 1F 01/01/2010 INJECTION, PLERIXAFOR, 1 MG J2793 1P 1F 01/01/2010 INJECTION, RILONACEPT, 1 MG J2796 1P 1F 01/01/2010 INJECTION, ROMIPLOSTIM, 10 MICROGRAMS J7185 1P 1F 01/01/2010 INJECTION, FACTOR VIII (ANTIHEMOPHILIC FACTOR, RECOMBINANT) (XYNTHA), PER I.U. J7325 1P 1F 01/01/2010 HYALURONAN OR DERIVATIVE, SYNVISC OR SYNVISC-ONE, FOR INTRA-ARTICULAR H99RPHPA NHIC, CORP. PAGE 5 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER INJECTION, 1 MG J9155 1P 1F 01/01/2010 INJECTION, DEGARELIX, 1 MG J9171 1P 1F 01/01/2010 INJECTION, DOCETAXEL, 1 MG J9328 1P 1F 01/01/2010 INJECTION, TEMOZOLOMIDE, 1 MG K0739 9 9 04/01/2009 REPAIR OR NONROUTINE SERVICE FOR DURABLE MEDICAL EQUIPMENT OTHER THAN OXYGEN NOT FOUND EQUIPMENT REQUIRING THE SKILL OF A TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES K0740 9 9 04/01/2009 REPAIR OR NONROUTINE SERVICE FOR OXYGEN EQUIPMENT REQUIRING THE SKILL OF A NOT FOUND TECHNICIAN, LABOR COMPONENT, PER 15 MINUTES L2861 P 9 01/01/2010 ADDITION TO LOWER EXTREMITY JOINT, KNEE OR ANKLE, CONCENTRIC ADJUSTABLE TORSION NOT FOUND STYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH L3891 P 9 01/01/2010 ADDITION TO UPPER EXTREMITY JOINT, WRIST OR ELBOW, CONCENTRIC ADJUSTABLE NOT FOUND TORSION STYLE MECHANISM FOR CUSTOM FABRICATED ORTHOTICS ONLY, EACH L5973 P 9 01/01/2010 ENDOSKELETAL ANKLE FOOT SYSTEM, MICROPROCESSOR CONTROLLED FEATURE, DORSIFLEXION NOT FOUND AND/OR PLANTAR FLEXION CONTROL, INCLUDES POWER SOURCE L8031 P 9 01/01/2010 BREAST PROSTHESIS, SILICONE OR EQUAL, WITH INTEGRAL ADHESIVE NOT FOUND L8032 P 9 01/01/2010 NIPPLE PROSTHESIS, REUSABLE, ANY TYPE, EACH NOT FOUND L8627 P 9 01/01/2010 COCHLEAR IMPLANT, EXTERNAL SPEECH PROCESSOR, COMPONENT, REPLACEMENT NOT FOUND L8628 P 9 01/01/2010 COCHLEAR IMPLANT, EXTERNAL CONTROLLER COMPONENT, REPLACEMENT NOT FOUND L8629 P 9 01/01/2010 TRANSMITTING COIL AND CABLE, INTEGRATED, FOR USE WITH COCHLEAR IMPLANT DEVICE, NOT FOUND REPLACEMENT L8692 P 9 01/01/2010 AUDITORY OSSEOINTEGRATED DEVICE, EXTERNAL SOUND PROCESSOR, USED WITHOUT NOT FOUND OSSEOINTEGRATION, BODY WORN, INCLUDES HEADBAND OR OTHER MEANS OF EXTERNAL ATTACHMENT Q0138 1P 19F 01/01/2010 INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (NON-ESRD USE) Q0139 1P 19 01/01/2010 INJECTION, FERUMOXYTOL, FOR TREATMENT OF IRON DEFICIENCY ANEMIA, 1 MG (FOR ESRD ON DIALYSIS) Q0506 P 9 01/01/2010 BATTERY, LITHIUM-ION, FOR USE WITH ELECTRIC OR ELECTRIC/PNEUMATIC VENTRICULAR ASSIST DEVICE, REPLACEMENT ONLY Q4074 1P 19 01/01/2010 ILOPROST, INHALATION SOLUTION, FDA-APPROVED FINAL PRODUCT, NON-COMPOUNDED, ADMINISTERED THROUGH DME, UNIT DOSE FORM, UP TO 20 MICROGRAMS Q4115 1 1F 07/01/2009 SKIN SUBSTITUTE, ALLOSKIN, PER SQUARE CENTIMETER Q4116 1 1F 07/01/2009 SKIN SUBSTITUTE, ALLODERM, PER SQUARE CENTIMETER Q9968 4 4F 01/01/2010 INJECTION, NON-RADIOACTIVE, NON-CONTRAST, VISUALIZATION ADJUNCT (E.G., METHYLENE BLUE, ISOSULFAN BLUE), 1 MG S0280 9 9 01/01/2010 MEDICAL HOME PROGRAM, COMPREHENSIVE CARE COORDINATION AND PLANNING, INITIAL PLAN S0281 9 9 01/01/2010 MEDICAL HOME PROGRAM, COMPREHENSIVE CARE COORDINATION AND PLANNING, MAINTENANCE OF PLAN S3713 9 9 10/01/2009 KRAS MUTATION ANALYSIS TESTING S3865 9 9 04/01/2009 COMPREHENSIVE GENE SEQUENCE ANALYSIS FOR HYPERTROPHIC CARDIOMYOPATHY S3866 9 9 04/01/2009 GENETIC ANALYSIS FOR A SPECIFIC GENE MUTATION FOR HYPERTROPHIC CARDIOMYOPATHY (HCM) IN AN INDIVIDUAL WITH A KNOWN HCM MUTATION IN THE FAMILY S3870 9 9 04/01/2009 COMPARATIVE GENOMIC HYBRIZATION (CGH) MICROARRAY TESTING FOR DEVELOPMENTAL DELAY, AUTISM SPECTRUM DISORDER AND/OR MENTAL RETARDATION 0199T 1 1 01/01/2010 PHYSIOLOGIC RECORDING OF TREMOR USING ACCELEROMETER(S) AND/OR GYROSCOPE(S) (INCLUDING FREQUENCY AND AMPLITUDE), INCLUDING INTERPRETATION AND REPORT 0200T 2 2F8 01/01/2010 PERCUTANEOUS SACRAL AUGMENTATION (SACROPLASTY), UNILATERAL INJECTION(S), INCLUDING THE USE OF A BALLOON OR MECHANICAL DEVICE, WHEN USED, 1 OR MORE NEEDLES 0201T 2 2F8 01/01/2010 PERCUTANEOUS SACRAL AUGMENTATION (SACROPLASTY), BILATERAL INJECTIONS, INCLUDING THE USE OF A BALLOON OR MECHANICAL DEVICE, WHEN USED, 2 OR MORE NEEDLES 0202T 2 28 01/01/2010 POSTERIOR VERTEBRAL JOINT(S) ARTHROPLASTY (EG, FACET JOINT?S¨ REPLACEMENT), INCLUDING FACETECTOMY, LAMINECTOMY, FORAMINOTOMY, AND VERTEBRAL COLUMN FIXATION, INJECTION OF BONE CEMENT, WHEN PERFORMED, INCLUDING FLUOROSCOPY, SINGLE LEVEL, LUMBAR SPINE H99RPHPA NHIC, CORP. PAGE 6 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER 0203T 1 1 01/01/2010 SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; HEART RATE, OXYGEN SATURATION, TC 26 RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE) AND SLEEP TIME 0204T 1 1 01/01/2010 SLEEP STUDY, UNATTENDED, SIMULTANEOUS RECORDING; MINIMUM OF HEART RATE, OXYGEN TC 26 SATURATION, AND RESPIRATORY ANALYSIS (EG, BY AIRFLOW OR PERIPHERAL ARTERIAL TONE) 0205T 1 1 01/01/2010 INTRAVASCULAR CATHETER-BASED CORONARY VESSEL OR GRAFT SPECTROSCOPY (EG, INFRARED) DURING DIAGNOSTIC EVALUATION AND/OR THERAPEUTIC INTERVENTION INCLUDING IMAGING SUPERVISION, INTERPRETATION, AND REPORT, EACH VESSEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0206T 1 1 01/01/2010 ALGORITHMIC ANALYSIS, REMOTE, OF ELECTROCARDIOGRAPHIC-DERIVED DATA WITH COMPUTER PROBABILITY ASSESSMENT, INCLUDING REPORT 0207T 1 1 01/01/2010 EVACUATION OF MEIBOMIAN GLANDS, AUTOMATED, USING HEAT AND 0208T 9 9 01/01/2010 PURE TONE AUDIOMETRY (THRESHOLD), AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); AIR ONLY 0209T 9 9 01/01/2010 PURE TONE AUDIOMETRY (THRESHOLD), AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); AIR AND BONE 0210T 9 9 01/01/2010 SPEECH AUDIOMETRY THRESHOLD, AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE) 0211T 9 9 01/01/2010 SPEECH AUDIOMETRY THRESHOLD, AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE); WITH SPEECH RECOGNITION 0212T 9 9 01/01/2010 COMPREHENSIVE AUDIOMETRY THRESHOLD EVALUATION AND SPEECH RECOGNITION, AUTOMATED (INCLUDES USE OF COMPUTER-ASSISTED DEVICE) 0213T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; SINGLE LEVEL 0214T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0215T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0216T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; SINGLE LEVEL 0217T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0218T 9 9F 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH ULTRASOUND GUIDANCE, LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0219T 9 9 01/01/2010 PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; CERVICAL 0220T 9 9 01/01/2010 PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; THORACIC 0221T 9 9 01/01/2010 PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE LEVEL; LUMBAR 0222T 9 9 01/01/2010 PLACEMENT OF POSTERIOR INTRAFACET IMPLANT(S), UNILATERAL OR BILATERAL, INCLUDING IMAGING AND PLACEMENT OF BONE GRAFT(S) OR SYNTHETIC DEVICE(S), SINGLE H99RPHPA NHIC, CORP. PAGE 7 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER LEVEL; EACH ADDITIONAL VERTEBRAL SEGMENT (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 0545F 1 1 01/01/2010 PLAN FOR FOLLOW-UP CARE FOR MAJOR DEPRESSIVE DISORDER, DOCUMENTED (MDD ADOL) 1200F 1 1 01/01/2010 SEIZURE TYPE(S) AND CURRENT SEIZURE FREQUENCY(IES) DOCUMENTED (EPI) 1205F 1 1 01/01/2010 ETIOLOGY OF EPILEPSY OR EPILEPSY SYNDROME(S) REVIEWED AND DOCUMENTED (EPI) 14301 2 2F8 01/01/2010 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; DEFECT 30.1 SQ CM TO 60.0 SQ CM 14302 2 2F8 01/01/2010 ADJACENT TISSUE TRANSFER OR REARRANGEMENT, ANY AREA; EACH ADDITIONAL 30.0 SQ CM, OR PART THEREOF (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 2060F 1 1 01/01/2010 PATIENT INTERVIEWED DIRECTLY BY EVALUATING CLINICIAN ON OR BEFORE DATE OF DIAGNOSIS OF MAJOR DEPRESSIVE DISORDER (MDD ADOL) 21011 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; LESS THAN 2 CM 21012 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF FACE OR SCALP, SUBCUTANEOUS; 2 CM OR GREATER 21013 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); LESS THAN 2 CM 21014 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF FACE AND SCALP, SUBFASCIAL (EG, SUBGALEAL, INTRAMUSCULAR); 2 CM OR GREATER 21016 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FACE OR SCALP; 2 CM OR GREATER 21552 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF NECK OR THORAX 3 CM OR GREATER 21554 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF NECK OR THORAX 5 CM OR GREATER 21558 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF NECK OR ANTERIOR THORAX; 5 CM OR GREATER 21931 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBCUTANEOUS; 3 CM OR GREATER 21932 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); LESS THAN 5 CM 21933 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF BACK OR FLANK, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER 21936 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF BACK OR FLANK; 5 CM OR GREATER 22901 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBFASCIAL (EG, INTRAMUSCULAR); 5 CM OR GREATER 22902 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; LESS THAN 3 CM 22903 2 2F8 01/01/2010 EXCISION, TUMOR, SOFT TISSUE OF ABDOMINAL WALL, SUBCUTANEOUS; 3 CM OR GREATER 22904 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF ABDOMINAL WALL; LESS THAN 5 CM 22905 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF ABDOMINAL WALL; 5 CM OR GREATER 23071 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF SHOULDER AREA; 3 CM OR GREATER 23073 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF SHOULDER AREA; 5 CM OR GREATER 23078 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF SHOULDER AREA; 5 CM OR GREATER 24071 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 3 CM OR GREATER 24073 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER 24079 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF UPPER ARM OR ELBOW AREA; 5 CM OR GREATER 25071 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; 3 CM OR GREATER 25073 F 01/01/2010 BIOPSY, SOFT TISSUE OF FOREARM AND/OR WRIST; 3 CM OR GREATER 25078 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOREARM AND/OR WRIST AREA; 3 CM OR GREATER 26111 2 2F8 01/01/2010 ARTHROTOMY WITH BIOPSY; 1.5 CM OR GREATER 26113 2 2F8 01/01/2010 ARTHROTOMY WITH BIOPSY; 1.5 CM OR GREATER 26118 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF HAND OR FINGER; 3 CM OR GREATER 27043 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; 3 CM OR GREATER H99RPHPA NHIC, CORP. PAGE 8 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER 27045 2 2F8 01/01/2010 BIOPSY, SOFT TISSUE OF PELVIS AND HIP AREA; 5 CM OR GREATER 27059 2 2F8 01/01/2010 DECOMPRESSION FASCIOTOMY(IES), PELVIC (BUTTOCK) COMPARTMENT(S) (EG, GLUTEUS MEDIUS-MINIMUS, GLUTEUS MAXIMUS, ILIOPSOAS, AND/ OR TENSOR FASCIA LATA MUSCLE) WITH DEBRIDEMENT OF NONVIABLE MUSCLE, UNILATERAL 5 CM OR GREATER 27337 2 2F8 01/01/2010 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; 3 CM OR GREATER 27339 2 2F8 01/01/2010 ARTHROTOMY, WITH SYNOVECTOMY, KNEE; 5 CM OR GREATER 27364 2 2F8 01/01/2010 PARTIAL EXCISION (CRATERIZATION, SAUCERIZATION, OR DIAPHYSECTOMY) BONE, FEMUR, PROXIMAL TIBIA AND/OR FIBULA (EG, OSTEOMYELITIS OR BONE ABSCESS) 5 CM OR GREATER 27616 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF LEG OR ANKLE AREA; 5 CM OR GREATER 27632 2 2F8 01/01/2010 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE 3 CM OR GREATER 27634 2 2F8 01/01/2010 EXCISION OF LESION OF TENDON SHEATH OR CAPSULE (EG, CYST OR GANGLION), LEG AND/OR ANKLE 5 CM OR GREATER 28039 2 2F8 01/01/2010 1.5 CM OR GREATER 28041 2 2F8 01/01/2010 ** LONG DESCRIPTION NOT AVAILABLE ** 28047 2 2F8 01/01/2010 RADICAL RESECTION OF TUMOR (EG, MALIGNANT NEOPLASM), SOFT TISSUE OF FOOT OR TOE; 3 CM OR GREATER 29581 1 1F 01/01/2010 APPLICATION OF MULTI-LAYER VENOUS WOUND COMPRESSION SYSTEM, BELOW KNEE 3008F 1 1 01/01/2010 BODY MASS INDEX (BMI), DOCUMENTED (PV) 3015F 1 1 01/01/2010 CERVICAL CANCER SCREENING RESULTS DOCUMENTED AND REVIEWED (PV) 3038F 1 1 01/01/2010 PULMONARY FUNCTION TEST PERFORMED WITHIN TWELVE MONTHS PRIOR TO SURGERY (LUNG/ESOP CX) 31626 2 2F8 01/01/2010 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH PLACEMENT OF FIDUCIAL MARKERS, SINGLE OR MULTIPLE 31627 2 28 01/01/2010 BRONCHOSCOPY, RIGID OR FLEXIBLE, INCLUDING FLUOROSCOPIC GUIDANCE, WHEN PERFORMED; WITH COMPUTER-ASSISTED, IMAGE-GUIDED NAVIGATION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE?S¨) 32552 2 2F8 01/01/2010 REMOVAL OF INDWELLING TUNNELED PLEURAL CATHETER WITH CUFF 32553 6 6F 01/01/2010 PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA- THORACIC, SINGLE OR MULTIPLE 32561 2 28 01/01/2010 INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); INITIAL DAY 32562 2 28 01/01/2010 INSTILLATION(S), VIA CHEST TUBE/CATHETER, AGENT FOR FIBRINOLYSIS (EG, FIBRINOLYTIC AGENT FOR BREAK UP OF MULTILOCULATED EFFUSION); SUBSEQUENT DAY 3293F 1 1 01/01/2010 ABO AND RH BLOOD TYPING DOCUMENTED AS PERFORMED (PRE-CR) 3294F 1 1 01/01/2010 GROUP B STREPTOCOCCUS (GBS) SCREENING DOCUMENTED AS PERFORMED DURING WEEK 35-37 GESTATION (PRE-CR) 3323F 1 1 01/01/2010 CLINICAL TUMOR, NODE AND METASTASES (TNM) STAGING DOCUMENTED AND REVIEWED PRIOR TO SURGERY (LUNG/ESOP CX) 3324F 1 1 01/01/2010 MRI OR CT SCAN ORDERED, REVIEWED OR REQUESTED (EPI) 3328F 1 1 01/01/2010 PERFORMANCE STATUS DOCUMENTED AND REVIEWED WITHIN TWO WEEKS PRIOR TO SURGERY (LUNG/ESOP CX) 33782 2 28 01/01/2010 AORTIC ROOT TRANSLOCATION WITH VENTRICULAR SEPTAL DEFECT AND PULMONARY STENOSIS REPAIR (IE, NIKAIDOH PROCEDURE); WITHOUT CORONARY OSTIUM REIMPLANTATION 33783 2 28 01/01/2010 AORTIC ROOT TRANSLOCATION WITH VENTRICULAR SEPTAL DEFECT AND PULMONARY STENOSIS REPAIR (IE, NIKAIDOH PROCEDURE); WITH REIMPLANTATION OF 1 OR BOTH CORONARY OSTIA 33981 2 28 01/01/2010 REPLACEMENT OF EXTRACORPOREAL VENTRICULAR ASSIST DEVICE, SINGLE OR BIVENTRICULAR, PUMP(S), SINGLE OR EACH PUMP 33982 2 28 01/01/2010 REPLACEMENT OF VENTRICULAR ASSIST DEVICE PUMP(S); IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE, WITHOUT CARDIOPULMONARY BYPASS 33983 2 28 01/01/2010 REPLACEMENT OF VENTRICULAR ASSIST DEVICE PUMP(S); IMPLANTABLE INTRACORPOREAL, SINGLE VENTRICLE, WITH CARDIOPULMONARY BYPASS 36147 2 2F8 01/01/2010 INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); INITIAL ACCESS WITH COMPLETE RADIOLOGICAL EVALUATION H99RPHPA NHIC, CORP. PAGE 9 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER OF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT (INCLUDES ACCESS OF SHUNT, INJECTION?S¨ OF CONTRAST, AND ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA) 36148 2 28 01/01/2010 INTRODUCTION OF NEEDLE AND/OR CATHETER, ARTERIOVENOUS SHUNT CREATED FOR DIALYSIS (GRAFT/FISTULA); ADDITIONAL ACCESS FOR THERAPEUTIC INTERVENTION (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 3650F 1 1 01/01/2010 ELECTROENCEPHALOGRAM (EEG) ORDERED, REVIEWED OR REQUESTED (EPI) 37761 2 2F8 01/01/2010 LIGATION OF PERFORATOR VEIN(S), SUBFASCIAL, OPEN, INCLUDING ULTRASOUND GUIDANCE, WHEN PERFORMED, 1 LEG 4004F 1 1 01/01/2010 PATIENT SCREENED FOR TOBACCO USE AND RECEIVED TOBACCO CESSATION COUNSELING, IF IDENTIFIED AS A TOBACCO USER (PV) 4063F 1 1 01/01/2010 ANTIDEPRESSANT PHARMACOTHERAPY CONSIDERED AND NOT PRESCRIBED (MDD ADOL) 4255F 1 1 01/01/2010 DURATION OF GENERAL OR NEURAXIAL ANESTHESIA 60 MINUTES OR LONGER, AS DOCUMENTED IN THE ANESTHESIA RECORD 4256F 1 1 01/01/2010 DURATION OF GENERAL OR NEURAXIAL ANESTHESIA LESS THAN 60 MINUTES, AS DOCUMENTED IN THE ANESTHESIA RECORD 43281 2 28 01/01/2010 LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITHOUT IMPLANTATION OF MESH 43282 2 28 01/01/2010 LAPAROSCOPY, SURGICAL, REPAIR OF PARAESOPHAGEAL HERNIA, INCLUDES FUNDOPLASTY, WHEN PERFORMED; WITH IMPLANTATION OF MESH 4330F 1 1 01/01/2010 COUNSELING ABOUT EPILEPSY SPECIFIC SAFETY ISSUES PROVIDED TO PATIENT (OR CAREGIVER(S)) (EPI) 4340F 1 1 01/01/2010 COUNSELING FOR WOMEN OF CHILDBEARING POTENTIAL WITH EPILEPSY (EPI) 43775 2 28 01/01/2010 LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; LONGITUDINAL GASTRECTOMY (IE, SLEEVE GASTRECTOMY) 45171 2 2F8 01/01/2010 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; NOT INCLUDING MUSCULARIS PROPRIA (IE, PARTIAL THICKNESS) 45172 2 2F8 01/01/2010 EXCISION OF RECTAL TUMOR, TRANSANAL APPROACH; INCLUDING MUSCULARIS PROPRIA (IE, FULL THICKNESS) 46707 2 2F8 01/01/2010 REPAIR OF ANORECTAL FISTULA WITH PLUG (EG, PORCINE SMALL INTESTINE SUBMUCOSA ?SIS¨) 49411 6 6F 01/01/2010 PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), PERCUTANEOUS, INTRA-ABDOMINAL, INTRA-PELVIC (EXCEPT PROSTATE), AND/OR RETROPERITONEUM, SINGLE OR MULTIPLE 51727 2 2F8 01/01/2010 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH URETHRAL TC 26 PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE 51728 2 2F8 01/01/2010 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING TC 26 PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE), ANY TECHNIQUE 51729 2 2F8 01/01/2010 COMPLEX CYSTOMETROGRAM (IE, CALIBRATED ELECTRONIC EQUIPMENT); WITH VOIDING TC 26 PRESSURE STUDIES (IE, BLADDER VOIDING PRESSURE) AND URETHRAL PRESSURE PROFILE STUDIES (IE, URETHRAL CLOSURE PRESSURE PROFILE), ANY TECHNIQUE 5200F 1 1 01/01/2010 CONSIDERATION OF REFERRAL FOR A NEUROLOGICAL EVALUATION OF APPROPRIATENESS FOR SURGICAL THERAPY FOR INTRACTABLE EPILEPSY WITHIN THE PAST 3 YEARS (EPI) 53855 1 1F 01/01/2010 INSERTION OF A TEMPORARY PROSTATIC URETHRAL STENT, INCLUDING URETHRAL MEASUREMENT 57426 2 2F8 01/01/2010 REVISION (INCLUDING REMOVAL) OF PROSTHETIC VAGINAL GRAFT, LAPAROSCOPIC APPROACH 6070F 1 1 01/01/2010 PATIENT QUERIED AND COUNSELED ABOUT ANTI-EPILEPTIC DRUG (AED) SIDE EFFECTS (EPI) 63661 2 2F8 01/01/2010 REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED 63662 2 2F8 01/01/2010 REMOVAL OF SPINAL NEUROSTIMULATOR ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED 63663 2 2F8 01/01/2010 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR ELECTRODE PERCUTANEOUS ARRAY(S), INCLUDING FLUOROSCOPY, WHEN PERFORMED 63664 2 2F8 01/01/2010 REVISION INCLUDING REPLACEMENT, WHEN PERFORMED, OF SPINAL NEUROSTIMULATOR H99RPHPA NHIC, CORP. PAGE 10 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER ELECTRODE PLATE/PADDLE(S) PLACED VIA LAMINOTOMY OR LAMINECTOMY, INCLUDING FLUOROSCOPY, WHEN PERFORMED 64490 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SINGLE LEVEL 64491 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64492 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), CERVICAL OR THORACIC; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64493 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SINGLE LEVEL 64494 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; SECOND LEVEL (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 64495 2 2F8 01/01/2010 INJECTION(S), DIAGNOSTIC OR THERAPEUTIC AGENT, PARAVERTEBRAL FACET (ZYGAPOPHYSEAL) JOINT (OR NERVES INNERVATING THAT JOINT) WITH IMAGE GUIDANCE (FLUOROSCOPY OR CT), LUMBAR OR SACRAL; THIRD AND ANY ADDITIONAL LEVEL(S) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 74261 4 4F 01/01/2010 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE TC 26 POSTPROCESSING; WITHOUT CONTRAST MATERIAL 74262 4 4F 01/01/2010 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE TC 26 POSTPROCESSING; WITH CONTRAST MATERIAL(S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED 74263 4 4 01/01/2010 COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE TC 26 POSTPROCESSING 75565 4 4 01/01/2010 CARDIAC MAGNETIC RESONANCE IMAGING FOR VELOCITY FLOW MAPPING (LIST SEPARATELY TC 26 IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 75571 4 4F 01/01/2010 COMPUTED TOMOGRAPHY, HEART, WITHOUT CONTRAST MATERIAL, WITH QUANTITATIVE TC 26 EVALUATION OF CORONARY CALCIUM 75572 4 4F 01/01/2010 COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC TC 26 STRUCTURE AND MORPHOLOGY (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) 75573 4 4F 01/01/2010 COMPUTED TOMOGRAPHY, HEART, WITH CONTRAST MATERIAL, FOR EVALUATION OF CARDIAC TC 26 STRUCTURE AND MORPHOLOGY IN THE SETTING OF CONGENITAL HEART DISEASE (INCLUDING 3D IMAGE POSTPROCESSING, ASSESSMENT OF LV CARDIAC FUNCTION, RV STRUCTURE AND FUNCTION AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) 75574 4 4F 01/01/2010 COMPUTED TOMOGRAPHIC ANGIOGRAPHY, HEART, CORONARY ARTERIES AND BYPASS GRAFTS TC 26 (WHEN PRESENT), WITH CONTRAST MATERIAL, INCLUDING 3D IMAGE POSTPROCESSING (INCLUDING EVALUATION OF CARDIAC STRUCTURE AND MORPHOLOGY, ASSESSMENT OF CARDIAC FUNCTION, AND EVALUATION OF VENOUS STRUCTURES, IF PERFORMED) 75791 4 4 01/01/2010 ANGIOGRAPHY, ARTERIOVENOUS SHUNT (EG, DIALYSIS PATIENT FISTULA/GRAFT), COMPLETE TC 26 EVALUATION OF DIALYSIS ACCESS, INCLUDING FLUOROSCOPY, IMAGE DOCUMENTATION AND REPORT (INCLUDES INJECTIONS OF CONTRAST AND ALL NECESSARY IMAGING FROM THE ARTERIAL ANASTOMOSIS AND ADJACENT ARTERY THROUGH ENTIRE VENOUS OUTFLOW INCLUDING THE INFERIOR OR SUPERIOR VENA CAVA), RADIOLOGICAL SUPERVISION AND INTERPRETATION 77338 6 6F 01/01/2010 MULTI-LEAF COLLIMATOR (MLC) DEVICE(S) FOR INTENSITY MODULATED RADIATION THERAPY TC 26 (IMRT), DESIGN AND CONSTRUCTION PER IMRT PLAN 78451 4 4F 01/01/2010 MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION TC 26 H99RPHPA NHIC, CORP. PAGE 11 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC) 78452 4 4F 01/01/2010 MYOCARDIAL PERFUSION IMAGING, TOMOGRAPHIC (SPECT) (INCLUDING ATTENUATION TC 26 CORRECTION, QUALITATIVE OR QUANTITATIVE WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION 78453 4 4F 01/01/2010 MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE TC 26 WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); SINGLE STUDY, AT REST OR STRESS (EXERCISE OR PHARMACOLOGIC) 78454 4 4F 01/01/2010 MYOCARDIAL PERFUSION IMAGING, PLANAR (INCLUDING QUALITATIVE OR QUANTITATIVE TC 26 WALL MOTION, EJECTION FRACTION BY FIRST PASS OR GATED TECHNIQUE, ADDITIONAL QUANTIFICATION, WHEN PERFORMED); MULTIPLE STUDIES, AT REST AND/OR STRESS (EXERCISE OR PHARMACOLOGIC) AND/OR REDISTRIBUTION AND/OR REST REINJECTION 83987 5 5 01/01/2010 PH; EXHALED BREATH CONDENSATE 84145 5 5 01/01/2010 PROCALCITONIN (PCT) 84431 5 5 01/01/2010 THROMBOXANE METABOLITE(S), INCLUDING THROMBOXANE IF PERFORMED, URINE 86305 5 5 01/01/2010 HUMAN EPIDIDYMIS PROTEIN 4 (HE4) 86352 5 5 01/01/2010 CELLULAR FUNCTION ASSAY INVOLVING STIMULATION (EG, MITOGEN OR ANTIGEN) AND DETECTION OF BIOMARKER (EG, ATP) 86780 5 5 01/01/2010 ANTIBODY; TREPONEMA PALLIDUM 86825 5 5 01/01/2010 HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); FIRST SERUM SAMPLE OR DILUTION 86826 5 5 01/01/2010 HUMAN LEUKOCYTE ANTIGEN (HLA) CROSSMATCH, NON-CYTOTOXIC (EG, USING FLOW CYTOMETRY); EACH ADDITIONAL SERUM SAMPLE OR SAMPLE DILUTION (LIST SEPARATELY IN ADDITION TO PRIMARY PROCEDURE) 87150 5 5 01/01/2010 CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID (DNA OR RNA) PROBE, AMPLIFIED PROBE TECHNIQUE, PER CULTURE OR ISOLATE, EACH ORGANISM PROBED 87153 5 5 01/01/2010 CULTURE, TYPING; IDENTIFICATION BY NUCLEIC ACID SEQUENCING METHOD, EACH ISOLATE (EG, SEQUENCING OF THE 16S RRNA GENE) 87493 5 5 01/01/2010 INFECTIOUS AGENT DETECTION BY NUCLEIC ACID (DNA OR RNA); CLOSTRIDIUM DIFFICILE, TOXIN GENE(S), AMPLIFIED PROBE TECHNIQUE 88387 5 5 01/01/2010 MACROSCOPIC EXAMINATION, DISSECTION, AND PREPARATION OF TISSUE FOR TC 26 NON-MICROSCOPIC ANALYTICAL STUDIES (EG, NUCLEIC ACID-BASED MOLECULAR STUDIES); EACH TISSUE PREPARATION (EG, A SINGLE LYMPH NODE) 88388 5 5 01/01/2010 MACROSCOPIC EXAMINATION, DISSECTION, AND PREPARATION OF TISSUE FOR TC 26 NON-MICROSCOPIC ANALYTICAL STUDIES (EG, NUCLEIC ACID-BASED MOLECULAR STUDIES); IN CONJUNCTION WITH A TOUCH IMPRINT, INTRAOPERATIVE CONSULTATION, OR FROZEN SECTION, EACH TISSUE PREPARATION (EG, A SINGLE LYMPH NODE) (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE) 88738 5 5 01/01/2010 HEMOGLOBIN (HGB), QUANTITATIVE, TRANSCUTANEOUS 89398 5 5 01/01/2010 UNLISTED REPRODUCTIVE MEDICINE LABORATORY PROCEDURE 90470 9 9 09/28/2009 H1N1 IMMUNIZATION ADMINISTRATION (INTRAMUSCULAR, INTRANASAL), INCLUDING COUNSELING WHEN PERFORMED) 90644 9 9 01/01/2010 MENINGOCOCCAL CONJUGATE VACCINE, SEROGROUPS C & Y AND HEMOPHILUS INFLUENZA B VACCINE, TETANUS TOXOID CONJUGATE (HIB-MENCY-TT), 4-DOSE SCHEDULE, WHEN ADMINISTERED TO CHILDREN 2-15 MONTHS OF AGE, FOR INTRAMUSCULAR USE 90670 1 1 07/01/2009 PNEUMOCOCCAL CONJUGATE VACCINE, 13 VALENT, FOR INTRAMUSCULAR USE 92540 1 1 01/01/2010 BASIC VESTIBULAR EVALUATION, INCLUDES SPONTANEOUS NYSTAGMUS TEST WITH ECCENTRIC TC 26 GAZE FIXATION NYSTAGMUS, WITH RECORDING, POSITIONAL NYSTAGMUS TEST, MINIMUM OF 4 POSITIONS, WITH RECORDING, OPTOKINETIC NYSTAGMUS TEST, BIDIRECTIONAL FOVEAL AND PERIPHERAL STIMULATION, WITH RECORDING, AND OSCILLATING TRACKING TEST, WITH RECORDING H99RPHPA NHIC, CORP. PAGE 12 11/18/2009 HCPCS ADDS PROC CMS PROC CODE TOS TOS DATE DESCRIPTION EXCL MFSDB MODIFIER 92550 1 1 01/01/2010 TYMPANOMETRY AND REFLEX THRESHOLD MEASUREMENTS 92570 1 1 01/01/2010 ACOUSTIC IMMITTANCE TESTING, INCLUDES TYMPANOMETRY (IMPEDANCE TESTING), ACOUSTIC REFLEX THRESHOLD TESTING, AND ACOUSTIC REFLEX DECAY TESTING 93750 1 1 01/01/2010 INTERROGATION OF VENTRICULAR ASSIST DEVICE (VAD), IN PERSON, WITH PHYSICIAN ANALYSIS OF DEVICE PARAMETERS (EG, DRIVELINES, ALARMS, POWER SURGES), REVIEW OF DEVICE FUNCTION (EG, FLOW AND VOLUME STATUS, SEPTUM STATUS, RECOVERY), WITH PROGRAMMING, IF PERFORMED, AND REPORT 94011 1 1 01/01/2010 MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWS IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE 94012 1 1 01/01/2010 MEASUREMENT OF SPIROMETRIC FORCED EXPIRATORY FLOWS, BEFORE AND AFTER BRONCHODILATOR, IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE 94013 1 1 01/01/2010 MEASUREMENT OF LUNG VOLUMES (IE, FUNCTIONAL RESIDUAL CAPACITY ?FRC¨, FORCED VITAL CAPACITY ?FVC¨, AND EXPIRATORY RESERVE VOLUME ?ERV¨) IN AN INFANT OR CHILD THROUGH 2 YEARS OF AGE 95905 1 1 01/01/2010 MOTOR AND/OR SENSORY NERVE CONDUCTION, USING PRECONFIGURED ELECTRODE ARRAY(S), TC 26 AMPLITUDE AND LATENCY/VELOCITY STUDY, EACH LIMB, INCLUDES F-WAVE STUDY WHEN PERFORMED, WITH INTERPRETATION AND REPORT