CPT® Modifiers

Modifier Description
22 Increased Procedural Services
23 Unusual Anesthesia
24 Unrelated Evaluation and Management Service by the Same Physician or Other Qualified Health Care Professional During a
Postoperative Period
25 Significant, Separately Identifiable Evaluation and Management Service by the Same Physician or Other Qualified Health Care
Professional on the Same Day of the Procedure or Other Service
26 Professional Component
27 Multiple Outpatient Hospital E/M Encounters on the Same Date
32 Mandated Services
33 Preventive Services
47 Anesthesia by Surgeon
50 Bilateral Procedure
51 Multiple Procedures
52 Reduced Services
53 Discontinued Procedure
54 Surgical Care Only
55 Postoperative Management Only
56 Preoperative Management Only
57 Decision for Surgery
58 Staged or Related Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative
Period
59 Distinct Procedural Service
62 Two Surgeons
63 Procedure Performed on Infants less than 4 kg
66 Surgical Team
73 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure Prior to the Administration of Anesthesia
74 Discontinued Out-Patient Hospital/Ambulatory Surgery Center (ASC) Procedure After Administration of Anesthesia
76 Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional
77 Repeat Procedure by Another Physician or Other Qualified Health Care Professional
78 Unplanned Return to the Operating/Procedure Room by the Same Physician or Other Qualified Health Care Professional Following
Initial Procedure for a Related Procedure During the Postoperative Period
79 Unrelated Procedure or Service by the Same Physician or Other Qualified Health Care Professional During the Postoperative Period
80 Assistant Surgeon
81 Minimum Assistant Surgeon
82 Assistant Surgeon (when qualified resident surgeon not available)
90 Reference (Outside) Laboratory
91 Repeat Clinical Diagnostic Laboratory Test
92 Alternative Laboratory Platform Testing
95 Synchronous Telemedicine Service Rendered Via a Real-Time Interactive Audio and Video Telecommunications System
96 Habilitative Services
97 Rehabilitative Services
99 Multiple Modifiers

Category II Modifiers
Modifier Description
1P Performance Measure Exclusion Modifier due to Medical Reasons
2P Performance Measure Exclusion Modifier due to Patient Reasons
3P Performance Measure Exclusion Modifier due to System Reasons
8P Performance Measure Reporting Modifier - Action Not Performed, Reason Not Otherwise Specified

HCPCS Modifiers
Modifier Description Modifier Description Modifier Description
A1 Dressing for one wound AE Registered dietician AQ Physician providing a service in an
A2 Dressing for two wounds AF Specialty physician unlisted health professional shortage
A3 Dressing for three wounds AG Primary physician area (HPSA)
A4 Dressing for four wounds AH Clinical psychologist AR Physician provider services in a
physician scarcity area
A5 Dressing for five wounds AI Principal physician of record
AS Physician assistant, nurse
A6 Dressing for six wounds AJ Clinical social worker practitioner, or clinical nurse
A7 Dressing for seven wounds AK Non participating physician specialist services for assistant at
A8 Dressing for eight wounds AM Physician, team member service surgery
A9 Dressing for nine or more wounds AO Alternate payment method declined AT Acute treatment (this modifier should
AA Anesthesia services performed by provider of service be used when reporting service
personally by anesthesiologist AP Determination of refractive state 98940, 98941, 98942)
AD Medical supervision by a physician: was not performed in the course AU Item furnished in conjunction with a
more than four concurrent anesthesia of diagnostic ophthalmological urological, ostomy, or tracheostomy
procedures examination supply

00_2022_PCE_Fold_Out_Cover.indd 1 07/09/21 4:26 PM

 Table of Contents
Introduction y Medicine Services and Procedures..........1015

y Features, Symbols, and Conventions............3 y Category II Codes.................................... 1111

Instructions for Using This Code Book...... 4 y Category III Codes...................................1133

y Multianalyte Assays..................................1165
Anatomical Illustrations............................... 5
Appendices
Index............................................................ 41
y Appendix A: New, Revised, and Deleted
Code Chapters.......................................... 307 Codes and Advice for 2022......................1167
y Evaluation and Management Services.......307 y Appendix B: Crosswalks for
Deleted Codes.........................................1215
y Anesthesia.................................................339
y Appendix C: Inpatient-Only
y Surgery Procedure Codes.....................................1217
§ Surgery/General.....................................357 y Appendix D: CPT® Modifiers,
§ Surgery/Integumentary System..............359 Definitions, and Tips.................................1223
§ Surgery/Musculoskeletal System...........399 y Appendix E: CPT® Category II
§ Surgery/Respiratory System..................537 Modifiers...................................................1235
§ Surgery/Cardiovascular System.............561 y Appendix F: HCPCS Level II
Modifiers, Definitions, and Tips................1237
§ Surgery/Hemic and Lymphatic
Systems..................................................625 y Appendix G: Resequenced
§ Surgery/Mediastinum and Diaphragm....631 CPT® Codes.............................................1331
§ Surgery/Digestive System......................633 y Appendix H: Vascular Families for
Interventional Radiology Coding..............1333
§ Surgery/Urinary System.........................697
§ Surgery/Male Genital System.................723 y Appendix I: Modifier 51 Exempt,
Modifier 63 Exempt, and Add-On Codes....1339
§ Surgery/Reproductive System................735
y Appendix J: Brand-Name and Generic
§ Surgery/Intersex Surgery.......................737
Vaccinations Associated With
§ Surgery/Female Genital System............739 CPT® Codes.............................................1341
§ Surgery/Maternity Care and Delivery.....757 y Appendix K: Place of Service/
§ Surgery/Endocrine System.....................763 Type of Service........................................1343
§ Surgery/Nervous System.......................767 y Appendix L: Drug Class List.....................1347
§ Surgery/Eye and Ocular Adnexa............809 y Appendix M: APC Status Indicators.........1365
§ Surgery/Auditory System........................833 y Appendix N: ASC Payment Indicators......1367
§ Surgery/Operating Microscope...............841
y Appendix O: 2021 E/M Office or
y Radiology Procedures................................843 Other Outpatient (99202-99215)
Audit Worksheet.......................................1369
y Pathology and Laboratory Procedures.......893

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 Anatomical Illustrations

Anatomical Illustrations

Title: Circulatory System Labels Biology Diagram, License: CC0 Creative Commons (Free for commercial use No attribution required), URL link: https://pixabay.com/en/
circulatory-system-labels-biology-41523/

  5

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 Anatomical Illustrations
Anatomical Illustrations

36  

PCE_book.indb 36 27/10/21 7:00 PM

 Index

A (Vitamin A) — Abdomen or Abdominal, X-ray

A
Peripancreatic 48000 Incision Procedures, See Also Laparotomy
Skin and Subcutaneous Tissue 10060, Drainage 49020, 49040, 49060, 49062
10061 Exploration 49000, 49010
A (Vitamin A) 84590 Ectopic Pregnancy, Surgical Treatment Paracentesis 49082, 49083
A-II (Angiotensin II) 82163 59130 Peritoneal Lavage 49084
Excision/Destruction Reopening, Recent 49002
Ab Externo Trabeculectomy (AET) 65850 Cyst With or Without Omentectomy 58960
Ab Interno Trabeculostomy 0621T, 0622T 5 cm Diameter or Less 49203 Injection, Air or Contrast Material 49400
5.1-10.0 cm Diameter 49204 Intraperitoneal
Abbe-Estlander Reconstruction Greater Than 10.0 cm Diameter 49205 Tunneled Catheter
Procedure Endometrioma 49203, 49204, 49205 Exit Site 49436
Lip Excision 40527 Tumor Insertion 49418, 49419, 49421, 49435
Plastic Repair With Sectioning and Intraabdominal Removal 49422
Inserting Pedicle 40761 5 cm or Less 49203 Revision 49325
Abdomen or Abdominal 5.1-10.0 cm Diameter 49204 Venous Shunt
Greater Than 10.0 cm 49205 Insertion 49425
Abscess Incision and Drainage
Radical Resection Ligation 49428
Peritoneal 49020
5 cm and Greater 22905 Removal 49429
Retroperitoneal 49060
Less Than 5 cm 22904 Revision 49426
Subphrenic 49040
Anesthesia, See Anesthesia, Abdomen Subcutaneous (Abdominal Wall) Laparoscopy
Angiography 3 cm and Greater 22903 Surgical 49321, 49322, 49323, 49324,
CT With Contrast Material 74174, 74175, Less Than 3 cm 22902 49325, 49326, 49327
75635 Subfascial (Abdominal Wall) Unlisted Procedure 49329
Magnetic Resonance (MRA) 74185 5 cm and Greater 22901 Without Treatment 49320
Aorta Less Than 5 cm 22900 Laparotomy, See Also Exploratory
Angiography 75635 Exploration Laparotomy, Abdomen
Aortography 75625, 75630 Post-operative Hemorrhage 35840 Reopening, Recent 49002
Endovascular Repair 33894, 33895 Preperitoneal Pelvic Packing 49013, Staging 58960
Thromboendarterectomy 35331 49014 Ligation, Artery 37617
Aortic Aneurysm Reopening of Recent Laparotomy 49010 Lymphangiogram/Lymphangiography
Endovascular 34701-34708 Staging/Restaging 58960 75805, 75807
Device Placement 34808 With or Without Biopsy 49000 Injection 38790
Open Repair 34832, 34841-34848, Fascia Reinforcement With Nonbiologic or Magnetic Resonance Imaging (MRI)
35081-35103 Synthetic Implant 0437T With Contrast Material 74182
Prosthesis or Graft 34813, 34820, Hernia Repair Without Contrast Material 74181
34709-34711 Epigastric 49570, 49572 Followed With Contrast Material 74183
Exposure 34812 Inguinal Needle Biopsy (Percutaneous) 49180
Infrarenal Repair 34830, 34831, 34832 5 Years or Older 49505, 49507, 49520, Nonbiologic or Synthetic Implant 0437T
Open Exposure 34833, 34834 49521, 49525 Panniculectomy, Infraumbilical 15830
Screening Ultrasound 76706 Laparoscopic 49650, 49651 Paracentesis
Biopsy During Exploratory Laparotomy 6 Months to Less Than 5 Years 49500, With Imaging Guidance 49083
49000 49501 Without Imaging Guidance 49082
Blood Vessel Repair Less Than 6 Months of Age 49491, Pelvic Exenteration (Radical Resection)
Direct 35221 49492, 49495, 49496 51597
With Graft 35281 Omphalocele 49600, 49605, 49606, Peritoneal Venous Shunt Revision 49426
With Vein Graft 35251 49610, 49611 Radiation Therapy Guidance Device
Bypass Graft Removal (Infected) 35907 Spigelian 49590 Placement 49411, 49412
Catheter (Tunneled) Removal 49422 Umbilical Radiography/Imaging
Celiotomy, See Laparotomy 5 Years or Older 49585, 49587 CT 74150-74178
Cesarean Section Delivery Less Than 5 Years 49580, 49582 MRI 74181, 74182, 74183, 74185
Delivery Only 59514, 59620 Ventral or Incisional 49560, 49561, Peritoneogram 74190
Delivery With Postpartum Care 59515, 49565, 49566 Ultrasound 76700, 76705
59622 With Mesh Implantation 49568 X-ray 74018-74022
Routine Obstetric Care 59510, 59618 Hysterectomy (With or Without Salpingo- Removal, Mesh/Prosthetic Material 11008
With Hysterectomy 59525 oophorectomy) Suture, Secondary 49900
With Tubal Ligation 58611 Radical 58210 Ultrasound
CT Scan Supracervical 58180 Complete 76700
With Contrast 74160, 74174, 74175, 74177, Total (TAH) 58150 Limited 76705
75635 Colpourethrocystopexy 58152 Unlisted Procedure 49999
Without Contrast 74150, 74170, 74176,
Omentectomy 58956 Wall Debridement for Infection 11005,
74178
Partial Vaginectomy 58200 11006
Drainage
With Resection of Ovarian Malignancy Wound (Penetrating) Exploration 20102
Paracentesis
58951, 58953, 58954, 58956 X-ray, Radiologic Exam 74018-74022
With Imaging Guidance 49083
INDEX

Without Imaging Guidance 49082

  41

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 INDEX
Very-Long Chain Acyl-CoA Dehydrogenase Vitamin, Other, Unspecified
Decompression 61597 Basic Evaluation 92540 Agent Detection 87534, 87535, 87536,
Very-Long Chain Acyl-CoA Dehydrogenase — Vitamin, Other, Unspecified

Thromboendarterectomy 35301 Caloric 92533, 92537, 92538 87537, 87538, 87539

Body Nystagmus Antibody 86701, 86702, 86703
Biopsy Optokinetic 92534, 92540, 92544 Antigen 87389, 87390, 87391
Open Positional 92532, 92540, 92542 Confirmation Test (Western Blot) 86689
Cervical/Lumbar 20251 Spontaneous 92531, 92540, 92541 Influenza
Thoracic 20250 Peripheral Stimulation 92540 Antibody 86710
Percutaneous (Skin) Posturography, Dynamic 92548, 92549 Antigen Detection 87804
Cervicothoracic 22510, 22512 Sinusoidal Vertical Axis Rotational Testing Vaccine 90653-90668, 90685, 90686,
Lumbosacral 22511, 22512 (Torsion Swing Test) 92546 90687, 90688, 90689
Excision Tracking Test, Oscillating 92540, 92545 Respiratory Syncytial
Decompression of Spinal Cord 63081- Vestibular Evoked Myogenic Potential Antibody 86756
63103 (VEMP) 92517, 92518, 92519 Antigen Detection 87280, 87420, 87807,
Intraspinal Lesion 63300-63308 Nerve Section Approach 87634
With Skull Base Surgery 61597 Transcranial 69950 Recombinant 90378
Fracture/Dislocation, Closed 22310 Translabyrinthine 69915 Salivary Gland, Cytomegalovirus (CMV)
CT Analysis 0691T Antibody 86644
Vestibule of Mouth
Kyphectomy IgM 86645
Biopsy 40808
1 or 2 Segments 22818 Antigen Detection 87271, 87332, 87495,
Destruction, Lesion 40808
3 or More 22819 87495, 87497
Excision
Repair With Injection 22510, 22511, 22512
Lesion 40810, 40812, 40814, 40816 Virus Identification via
Tethering 0656T, 0657T
Mucosa For Graft 40818 Immunofluorescence 87254
Corpectomy 63081-63103, 63300-63308
Disc, See Intervertebral Disc Vestibuloplasty Virus Isolation 87250, 87252, 87253,
Fracture Anterior 40840 87254, 87255
Closed Treatment 22310, 22315 Complex 40845 Visceral Larval Migrans 86280
Open Treatment 22325, 22326, 22327, Entire Arch 40844
22328 Posterior 40842, 40843 Viscosity Test 85810
Joint Replacement, Lumbar Spine 0202T Vibration Perception Threshold 0107T Visible Light Hyperspectral Imaging
Process Fracture 22310 (VLHI) 0631T
Vidal Procedure (Excision of Varicocele)
Very-Long Chain Acyl-CoA
55530, 55535, 55540 Visit, Home 99341-99350
Dehydrogenase (VLCAD) Enzyme
Activity 0257U Video/Videoradiography Visual
Esophagus (Swallowing Function) 74230 Acuity Screen
Very Low Density Lipoprotein (VLDL)
Pharynx/Pharyngeal Evaluations 70371, Automated 99172, 99173
83719
74230 Evoked Potentials 0333T
Vesication Site Unspecified (Cineradiography) 76120, Axis Identification, Intraop, Pt Fixation
Lung, Resection/Plication 32141, 32655 76125 0514T
Puncture Aspiration 10160 Speech and Pharyngeal Evaluation 70371 Field
Assessment 0378T, 0379T
Vesicle, Seminal Video-assisted Thoracoscopic Surgery,
Exam 92081, 92082, 92083
Excision, Mullerian Duct Cyst 55680 See Thoracoscopy
Function Screen 1055F, 99172
Incision (Vesiculotomy) 55600, 55605 VII, Coagulation Factor 85230 Reinforcement Audiometry (VRA) 92579
Vesiculography 74440
VII, Cranial Nerve, See Facial, Nerve Vita Risk®, Arctic 0205U
Vesicopsoas Hitch 50785
VIII, Coagulation Factor (Proconvertin) Vital Capacity Measurement (VCM),
Vesicostomy 51980
85240 Total 94150
Vesicourethropexy (MMK, Burch)
Villus, Chorionic, Sampling/Biopsy Vitamin
Complicated 51841 59015 A 84590
Simple 51840
B Complex, See B Vitamins
Villusectomy, See Synovectomy
Vesicovaginal Fistula Closure B-1 (Thiamine) 84425
Abdominal Approach 51900 VIP (Vasoactive Intestinal Peptide) B-2 (Riboflavin) 84252
Rectovaginal Approach 57300 84586 B-6 (Pyridoxal Phosphate) 84207
Vaginal Approach 57320 B-12 (Cyanocobalamin) 82607, 82608
Viracor TRAC™ dd-cfDNA 0118U
C (Ascorbic Acid) 82180
Vesiculectomy 55650
Viral Antibodies 86280 D
Vesiculogram, See Vesiculography Blood Serum Level
Viral Warts, Destruction
1, 25 Dihydroxy 82652
Vesiculography 55300, 74440 15 or More Lesions 17111
25 Hydroxy 82306
Up to 14 Lesions 17110
Vesiculotomy 55600 25 Hydroxy D2 and D3, 0038U
Complicated 55605 Virus Counselling 4019F
AIDS 87390 E (Tocopherol Alpha) 84446
Vessel, Blood, See Blood, Vessels
Burkitt Lymphoma K 84597
Vessels Transposition, See Antibody K Dependent Bone Protein (Osteocalcin)
Transposition, Great Arteries Early Antigen 86663 83937
Nuclear Antigen 86664 K Dependent Protein S 85305, 85306
Vestibular
INDEX

Viral Capsid 86665 Other, Unspecified 84591

Function Tests
Human Immunodeficiency
Additional Vertical Electrodes 92547

300   CPT® is a registered trademark of the American Medical Association. All rights reserved.

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 Surgery/Integumentary System

10030 - 10080
Surgical Procedures on the Integumentary 10060 Incision and drainage of abscess (eg, carbuncle,
suppurative hidradenitis, cutaneous or subcutaneous
System (10030-19499) abscess, cyst, furuncle, or paronychia); simple or single 
FRVU 3.01   NFRVU 3.62   GLOBAL 010   MUE 1
Surgical Procedures on the Skin,
MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AG, AQ,
Subcutaneous and Accessory Structures AR, E1, E2, E3, E4, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC,
(10030-11646) GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, SA, T1, T2, T3, T4, T5, T6, T7,
T8, T9, TA, XE, XP, XS, XU
Introduction and Removal Procedures on the Skin,
ASC PI: P3  ASC Sep. Pay: Yes  APC SI: T  APC: 5051
Subcutaneous and Accessory Structures
CPT® Asst: SEP 2012; Vol 22: Issue 9, APR 2010; Vol 20: Issue 4,
(10030-10036) DEC 2006; Vol 16: Issue 12
10030 Image-guided fluid collection drainage by catheter (eg,
abscess, hematoma, seroma, lymphocele, cyst), soft tissue
Incision and Drainage of Abscess
(eg, extremity, abdominal wall, neck), percutaneous 
FRVU 3.95   NFRVU 19.53   GLOBAL 000   MUE 2
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81,
82, 99, AF, AG, AQ, AR, AS, GA, GC, GZ, KX, PD, Q5, Q6, QJ, XE,
XP, XS, XU
ASC PI: G2  ASC Sep. Pay: Yes  APC SI: T  APC: 5071
CPT® Asst: APR 2019; Vol 29: Issue 4, AUG 2017; Vol 27: Issue 8,
MAY 2014; Vol 24: Issue 5, MAY 2014; Vol 24: Issue 5, NOV 2013; Vol
23: Issue 11
10035 Placement of soft tissue localization device(s) (eg,
clip, metallic pellet, wire/needle, radioactive seeds),
percutaneous, including imaging guidance; first lesion 
FRVU 2.46   NFRVU 12.57   GLOBAL 000   MUE 1
MOD 22, 47, 50, 51, 52, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81,
82, 99, AF, AG, AS, CT, GA, GC, GY, GZ, KX, LT, Q5, Q6, QJ, RT, XE,
XP, XS, XU
ASC PI: N1  ASC Sep. Pay: Yes  APC SI: T  APC: 5071
CPT® Asst: JUN 2016; Vol 26: Issue 6
10036 Placement of soft tissue localization device(s) (eg,
clip, metallic pellet, wire/needle, radioactive seeds),
percutaneous, including imaging guidance; each additional
lesion (List separately in addition to code for primary
procedure) 
FRVU 1.25   NFRVU 10.77   GLOBAL ZZZ   MUE 2
MOD 22, 47, 52, 54, 55, 56, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99,
AF, AG, AS, CT, GA, GC, GY, GZ, KX, LT, Q5, Q6, QJ, RT, XE, XP, 10061 Incision and drainage of abscess (eg, carbuncle,
XS, XU suppurative hidradenitis, cutaneous or subcutaneous
ASC PI: N1  ASC Sep. Pay: No  abscess, cyst, furuncle, or paronychia); complicated or
CPT® Asst: JUN 2016; Vol 26: Issue 6 multiple 
FRVU 5.33   NFRVU 6.21   GLOBAL 010   MUE 1

Surgery/Integumentary System
Incision and Drainage Procedures on the Skin, MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AG, AQ,
Subcutaneous and Accessory Structures AR, E1, E2, E3, E4, F1, F2, F3, F4, F5, F6, F7, F8, F9, FA, GA, GC,
(10040-10180) GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, SA, T1, T2, T3, T4, T5, T6, T7,
T8, T9, TA, XE, XP, XS, XU
10040 Acne surgery (eg, marsupialization, opening or removal of
ASC PI: P3  ASC Sep. Pay: Yes  APC SI: T  APC: 5052
multiple milia, comedones, cysts, pustules) 
CPT® Asst: SEP 2012; Vol 22: Issue 9, DEC 2006; Vol 16: Issue 12
FRVU 1.52   NFRVU 3.42   GLOBAL 010   MUE 1
MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ, AR, 10080 Incision and drainage of pilonidal cyst; simple 
GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU FRVU 3.06   NFRVU 7.24   GLOBAL 010   MUE 1
ASC PI: N1  ASC Sep. Pay: No  APC SI: T  APC: 5051 MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AG, AQ,
CPT® Asst: FEB 2008; Vol 18: Issue 2 AR, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, SA, XE, XP, XS, XU
ASC PI: P3  ASC Sep. Pay: Yes  APC SI: T  APC: 5071
CPT® Asst: MAY 2007; Vol 17: Issue 5, DEC 2006; Vol 16: Issue 12

GLOBAL Global Days  MUE Medically Unlikely Edit  MOD Modifier Crosswalk  APC APC Value  ASC PI ASC Payment Indicator 
APC SI APC Status Indicator  ASC Sep. Pay ASC Separate Payment  CPT Asst CPT® Assistant Article Reference 
HCPCS CODE DOSAGE Dosage Amount for Drug  PAYMENT LIMIT Maximum Reimbursement Amount
CPT® is a registered trademark of the American Medical Association. All rights reserved.   359

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 21087 - 21125 Surgery/Musculoskeletal System
21110 Application of interdental fixation device for conditions
21087 - 21125

other than fracture or dislocation, includes removal 

FRVU 21.32   NFRVU 25.71   GLOBAL 090   MUE 2
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99,
AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS,
Defect
XU
area
ASC PI: P2  ASC Sep. Pay: No  APC SI: J1  APC: 5163
CPT® Asst: SEP 2018; Vol 28: Issue 9, DEC 2013; Vol 23: Issue 12
21116 Injection procedure for temporomandibular joint
arthrography 
FRVU 1.34   NFRVU 6.41   GLOBAL 000   MUE 1
MOD 22, 47, 50, 51, 52, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR,
CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, Q6, QJ, RT, XE, XP, XS, XU
Impression of the ear is ASC PI: N1  ASC Sep. Pay: No 
taken for creation of CPT® Asst: SEP 2018; Vol 28: Issue 9, MAY 2017; Vol 27: Issue 5,
auricular prosthesis MAY 2016; Vol 26: Issue 5, AUG 2015; Vol 25: Issue 8

Repair, Revision, and/or Reconstruction Procedures

on the Head (21120-21296)
Auricular prosthesis 21120 Genioplasty; augmentation (autograft, allograft, prosthetic
material) 
FRVU 15.47   NFRVU 20.24   GLOBAL 090   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
99, AQ, AR, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP,
21087 Impression and custom preparation; nasal prosthesis 
XS, XU
FRVU 38.00   NFRVU 46.49   GLOBAL 090   MUE 1
ASC PI: G2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5165
MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81,
82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, CPT® Asst: SEP 2018; Vol 28: Issue 9
XE, XP, XS, XU 21121 Genioplasty; sliding osteotomy, single piece 
ASC PI: P3  ASC Sep. Pay: Yes  APC SI: J1  APC: 5165 FRVU 16.06   NFRVU 19.28   GLOBAL 090   MUE 1
CPT® Asst: SEP 2018; Vol 28: Issue 9, SEP 2006; Vol 16: Issue 9, DEC
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
2006; Vol 16: Issue 12
81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6,
21088 Impression and custom preparation; facial prosthesis  QJ, XE, XP, XS, XU
FRVU 0.00   NFRVU 0.00   GLOBAL 090   MUE 1 ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5164
MOD 22, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, CPT® Asst: SEP 2018; Vol 28: Issue 9
99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6,
QJ, XE, XP, XS, XU 21122 Genioplasty; sliding osteotomies, 2 or more osteotomies
ASC PI: R2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5164 (eg, wedge excision or bone wedge reversal for
CPT® Asst: SEP 2018; Vol 28: Issue 9, SEP 2006; Vol 16: Issue 9, DEC asymmetrical chin) 
2006; Vol 16: Issue 12 FRVU 22.66   NFRVU 22.66   GLOBAL 090   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
Other Maxillofacial Prosthetic Procedures 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6,
(21089) QJ, XE, XP, XS, XU
21089 Unlisted maxillofacial prosthetic procedure  ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5165
FRVU 0.00   NFRVU 0.00   GLOBAL YYY   MUE 1 CPT® Asst: SEP 2018; Vol 28: Issue 9
MOD 52, 53, 59, 62, 66, 78, 79, AR, GC, GY, GZ, KX, LT, Q6, RT, 21123 Genioplasty; sliding, augmentation with interpositional
Surgery/Musculoskeletal System

XE, XP, XS, XU bone grafts (includes obtaining autografts) 

APC SI: T  APC: 5161 FRVU 25.63   NFRVU 25.63   GLOBAL 090   MUE 1
CPT® Asst: SEP 2018; Vol 28: Issue 9, SEP 2006; Vol 16: Issue 9, DEC MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
2006; Vol 16: Issue 12 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
Q6, QJ, XE, XP, XS, XU
Introduction Procedures on the Head (21100-21116)
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5164
21100 Application of halo type appliance for maxillofacial fixation,
CPT® Asst: SEP 2018; Vol 28: Issue 9
includes removal (separate procedure) 
FRVU 10.44   NFRVU 19.03   GLOBAL 090   MUE 1 21125 Augmentation, mandibular body or angle; prosthetic
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
material 
81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, FRVU 19.84   NFRVU 83.38   GLOBAL 090   MUE 2
Q6, QJ, RT, XE, XP, XS, XU MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5165 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6,
QJ, XE, XP, XS, XU
CPT® Asst: SEP 2018; Vol 28: Issue 9

New Code  Revised Code  Add-On Code  # Resequenced Code  FDA Approval Pending  Modifier 51 Exempt  Modifier 63 Exempt 
Female-only Procedure  Male-only Procedure  Maternity  Merit-based Incentive Payment System Code 
Telemedicine Code  FRVU Facility Total RVU  NFRVU Non-facility Total RVU 
410   CPT® is a registered trademark of the American Medical Association. All rights reserved.

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 Surgery/Cardiovascular System

33016 - 33050
Surgical Procedures on the Cardiovascular 33030 Pericardiectomy, subtotal or complete; without
cardiopulmonary bypass 
System (33016-37799) FRVU 58.44   NFRVU 58.44   GLOBAL 090   MUE 1
Surgical Procedures on the Heart and MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
Pericardium (33016-33999) Q6, QJ, XE, XP, XS, XU
Surgical Procedures on the Pericardium
(33016-33050)
33016 Pericardiocentesis, including imaging guidance, when
performed 
FRVU 6.89   NFRVU 6.89   GLOBAL 000   MUE 1
MOD 22, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CG,
CR, ET, GA, GC, GJ, GR, GZ, KX, PD, Q5, Q6, QJ, SC, XE, XP, XS,
XU
ASC PI: G2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5182
CPT® Asst: JAN 2020; Vol 30: Issue 1
33017 Pericardial drainage with insertion of indwelling catheter,
percutaneous, including fluoroscopy and/or ultrasound
guidance, when performed; 6 years and older without
congenital cardiac anomaly 
FRVU 7.14   NFRVU 7.14   GLOBAL 000   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ,
AR, CG, CR, ET, GA, GC, GJ, GR, GZ, KX, PD, Q5, Q6, QJ, SC, XE,
XP, XS, XU
CPT® Asst: JAN 2020; Vol 30: Issue 1, MAR 2020; Vol 30: Issue 3
33018 Pericardial drainage with insertion of indwelling catheter,
percutaneous, including fluoroscopy and/or ultrasound
guidance, when performed; birth through 5 years of age or
any age with congenital cardiac anomaly 
FRVU 8.11   NFRVU 8.11   GLOBAL 000   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ,
AR, CG, CR, ET, GA, GC, GJ, GR, GZ, KX, PD, Q5, Q6, QJ, SC, XE,
XP, XS, XU
CPT® Asst: JAN 2020; Vol 30: Issue 1, MAR 2020; Vol 30: Issue 3
33019 Pericardial drainage with insertion of indwelling catheter,
percutaneous, including CT guidance 
FRVU 6.60   NFRVU 6.60   GLOBAL 000   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 76, 77, 78, 79, 99, AQ,
AR, CG, CR, ET, GA, GC, GJ, GR, GZ, KX, PD, Q5, Q6, QJ, SC, XE,
XP, XS, XU
CPT® Asst: JAN 2020; Vol 30: Issue 1 33031 Pericardiectomy, subtotal or complete; with

Surgery/Cardiovascular System
cardiopulmonary bypass 
33020 Pericardiotomy for removal of clot or foreign body (primary
procedure)  FRVU 72.36   NFRVU 72.36   GLOBAL 090   MUE 1
FRVU 24.19   NFRVU 24.19   GLOBAL 090   MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80,
Q6, QJ, XE, XP, XS, XU
81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6,
QJ, XE, XP, XS, XU CPT® Asst: DEC 2017; Vol 27: Issue 12

33025 Creation of pericardial window or partial resection for 33050 Resection of pericardial cyst or tumor 
drainage  FRVU 29.43   NFRVU 29.43   GLOBAL 090   MUE 1
FRVU 22.51   NFRVU 22.51   GLOBAL 090   MUE 1 MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
Q6, QJ, XE, XP, XS, XU
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
Q6, QJ, XE, XP, XS, XU

GLOBAL Global Days  MUE Medically Unlikely Edit  MOD Modifier Crosswalk  APC APC Value  ASC PI ASC Payment Indicator 
APC SI APC Status Indicator  ASC Sep. Pay ASC Separate Payment  CPT Asst CPT® Assistant Article Reference 
HCPCS CODE DOSAGE Dosage Amount for Drug  PAYMENT LIMIT Maximum Reimbursement Amount
CPT® is a registered trademark of the American Medical Association. All rights reserved.   561

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 38530 - 38700 Surgery/Hemic and Lymphatic Systems
38530 Biopsy or excision of lymph node(s); open, internal Laparoscopic Procedures on the Lymph Nodes and
38530 - 38700

mammary node(s)  Lymphatic Channels (38570-38589)

FRVU 16.61   NFRVU 16.61   GLOBAL 090   MUE 1 38570 Laparoscopy, surgical; with retroperitoneal lymph node
MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, sampling (biopsy), single or multiple 
79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT,
FRVU 15.11   NFRVU 15.11   GLOBAL 010   MUE 1
PD, Q5, Q6, QJ, RT, XE, XP, XS, XU
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5091 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
CPT® Asst: FEB 2019; Vol 29: Issue 2, APR 2014; Vol 24: Issue 4,
Q6, QJ, XE, XP, XS, XU
AUG 2010; Vol 20: Issue 8 ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5361
38531 Biopsy or excision of lymph node(s); open, inguinofemoral CPT® Asst: FEB 2019; Vol 29: Issue 2, NOV 2007; Vol 17: Issue 11,
node(s)  MAR 2000; Vol 10: Issue 3
FRVU 13.11   NFRVU 13.11   GLOBAL 090   MUE 1 38571 Laparoscopy, surgical; with bilateral total pelvic
MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, lymphadenectomy 
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, FRVU 19.36   NFRVU 19.36   GLOBAL 010   MUE 1
Q5, Q6, QJ, RT, SC, XE, XP, XS, XU
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
APC SI: J1  APC: 5091 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
CPT® Asst: FEB 2019; Vol 29: Issue 2 Q6, QJ, XE, XP, XS, XU
38542 Dissection, deep jugular node(s)  ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5362
FRVU 15.15   NFRVU 15.15   GLOBAL 090   MUE 1 CPT® Asst: FEB 2019; Vol 29: Issue 2, NOV 2007; Vol 17: Issue 11,
MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, MAR 2000; Vol 10: Issue 3
79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, 38572 Laparoscopy, surgical; with bilateral total pelvic
PD, Q5, Q6, QJ, RT, XE, XP, XS, XU lymphadenectomy and peri-aortic lymph node sampling
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5361 (biopsy), single or multiple 
CPT® Asst: FEB 2019; Vol 29: Issue 2, AUG 2010; Vol 20: Issue 8 FRVU 26.65   NFRVU 26.65   GLOBAL 010   MUE 1
38550 Excision of cystic hygroma, axillary or cervical; without MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
deep neurovascular dissection  80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5,
Q6, QJ, XE, XP, XS, XU
FRVU 15.38   NFRVU 15.38   GLOBAL 090   MUE 1
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5362
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, Q5, CPT® Asst: FEB 2019; Vol 29: Issue 2, JAN 2015; Vol 25: Issue 1, NOV
Q6, QJ, RT, XE, XP, XS, XU 2007; Vol 17: Issue 11, MAR 2000; Vol 10: Issue 3
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5091 38573 Laparoscopy, surgical; with bilateral total pelvic
38555 Excision of cystic hygroma, axillary or cervical; with deep lymphadenectomy and peri-aortic lymph node sampling,
neurovascular dissection  peritoneal washings, peritoneal biopsy(ies), omentectomy,
FRVU 30.26   NFRVU 30.26   GLOBAL 090   MUE 1
and diaphragmatic washings, including diaphragmatic and
other serosal biopsy(ies), when performed 
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT, PD, FRVU 34.20   NFRVU 34.20   GLOBAL 010   MUE 1
Q5, Q6, QJ, RT, XE, XP, XS, XU MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79,
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5092 80, 81, 82, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6,
QJ, SC, XE, XP, XS, XU
Limited Lymphadenectomy for Staging Procedures ASC PI: G2  ASC Sep. Pay: Yes  APC SI: J1  APC: 5362
(38562-38564) CPT® Asst: MAR 2019; Vol 29: Issue 3, APR 2018; Vol 28: Issue 4
38562 Limited lymphadenectomy for staging (separate 38589 Unlisted laparoscopy procedure, lymphatic system 
Surgery/Hemic and Lymphatic Systems

procedure); pelvic and para-aortic  FRVU 0.00   NFRVU 0.00   GLOBAL YYY   MUE 1
FRVU 20.75   NFRVU 20.75   GLOBAL 090   MUE 1 MOD 47, 50, 51, 52, 53, 59, 62, 66, 78, 79, 80, 81, 82, AR, AS, GY,
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, GZ, KX, LT, Q6, RT, XE, XP, XS, XU
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, APC SI: J1  APC: 5361
QJ, XE, XP, XS, XU CPT® Asst: APR 2018; Vol 28: Issue 4, MAR 2000; Vol 10: Issue 3
CPT® Asst: FEB 2019; Vol 29: Issue 2, MAR 2001; Vol 11: Issue 3
38564 Limited lymphadenectomy for staging (separate Radical Lymphadenectomy (Radical Resection of
procedure); retroperitoneal (aortic and/or splenic)  Lymph Nodes) (38700-38780)
FRVU 20.82   NFRVU 20.82   GLOBAL 090   MUE 1 38700 Suprahyoid lymphadenectomy 
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, FRVU 23.41   NFRVU 23.41   GLOBAL 090   MUE 1
80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, MOD 22, 47, 50, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78,
QJ, XE, XP, XS, XU 79, 80, 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, LT,
CPT® Asst: FEB 2019; Vol 29: Issue 2 PD, Q5, Q6, QJ, RT, XE, XP, XS, XU

New Code  Revised Code  Add-On Code  # Resequenced Code  FDA Approval Pending  Modifier 51 Exempt  Modifier 63 Exempt 
Female-only Procedure  Male-only Procedure  Maternity  Merit-based Incentive Payment System Code 
Telemedicine Code  FRVU Facility Total RVU  NFRVU Non-facility Total RVU 
628   CPT® is a registered trademark of the American Medical Association. All rights reserved.

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 Surgery/Nervous System

61000 - 61151
Surgical Procedures on the Nervous ASC PI: A2  ASC Sep. Pay: Yes  APC SI: T  APC: 5441
CPT® Asst: OCT 2020; Vol 30: Issue 10, MAY 2017; Vol 27: Issue 5,
System (61000-64999) SEP 2014; Vol 24: Issue 9
Surgical Procedures on the Skull, Meninges, 61070 Puncture of shunt tubing or reservoir for aspiration or
and Brain (61000-62258) injection procedure
FRVU 1.64   NFRVU 1.64   GLOBAL 000   MUE 2
Injection, Drainage, or Aspiration Procedures on the MOD 22, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR,
Skull, Meninges, and Brain (61000-61070) CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
61000 Subdural tap through fontanelle, or suture, infant, unilateral ASC PI: A2  ASC Sep. Pay: Yes  APC SI: T  APC: 5442
or bilateral; initial CPT® Asst: OCT 2020; Vol 30: Issue 10, MAY 2017; Vol 27: Issue 5,
FRVU 3.33   NFRVU 3.33   GLOBAL 000   MUE 1 JUL 2008; Vol 18: Issue 7, AUG 2008; Vol 18: Issue 8, SEP 2008;
MOD 22, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, CR, Vol 18: Issue 9
ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
Twist Drill, Burr Hole(s), or Trephine Procedures on
ASC PI: R2  ASC Sep. Pay: Yes  APC SI: T  APC: 5442
the Skull, Meninges, and Brain (61105-61253)
CPT® Asst: MAY 2017; Vol 27: Issue 5
61105 Twist drill hole for subdural or ventricular puncture
61001 Subdural tap through fontanelle, or suture, infant, unilateral FRVU 13.67   NFRVU 13.67   GLOBAL 090   MUE 1
or bilateral; subsequent taps MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
FRVU 3.14   NFRVU 3.14   GLOBAL 000   MUE 1 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ,
MOD 22, 47, 51, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, CR, XE, XP, XS, XU
ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU 61107 Twist drill hole(s) for subdural, intracerebral, or ventricular
ASC PI: R2  ASC Sep. Pay: Yes  APC SI: T  APC: 5442 puncture; for implanting ventricular catheter, pressure
CPT® Asst: MAY 2017; Vol 27: Issue 5 recording device, or other intracerebral monitoring
61020 Ventricular puncture through previous burr hole, fontanelle, device
suture, or implanted ventricular catheter/reservoir; without FRVU 9.19   NFRVU 9.19   GLOBAL 000   MUE 1
injection MOD 22, 47, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR,
FRVU 3.07   NFRVU 3.07   GLOBAL 000   MUE 2 ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ, XE, XP, XS, XU
MOD 22, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, 61108 Twist drill hole(s) for subdural, intracerebral, or ventricular
CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU puncture; for evacuation and/or drainage of subdural
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: T  APC: 5443 hematoma
CPT® Asst: MAY 2017; Vol 27: Issue 5 FRVU 26.63   NFRVU 26.63   GLOBAL 090   MUE 1
MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99,
61026 Ventricular puncture through previous burr hole, fontanelle,
AQ, AR, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ, XE, XP, XS, XU
suture, or implanted ventricular catheter/reservoir; with
injection of medication or other substance for diagnosis or 61120 Burr hole(s) for ventricular puncture (including injection of
treatment gas, contrast media, dye, or radioactive material)
FRVU 3.10   NFRVU 3.10   GLOBAL 000   MUE 2 FRVU 22.16   NFRVU 22.16   GLOBAL 090   MUE 1
MOD 22, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ,
XE, XP, XS, XU
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: T  APC: 5442
61140 Burr hole(s) or trephine; with biopsy of brain or intracranial
CPT® Asst: MAY 2017; Vol 27: Issue 5
lesion
61050 Cisternal or lateral cervical (C1-C2) puncture; without FRVU 37.54   NFRVU 37.54   GLOBAL 090   MUE 1
injection (separate procedure) MOD 22, 47, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80,
FRVU 2.40   NFRVU 2.40   GLOBAL 000   MUE 1 81, 82, 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ,
MOD 22, 47, 51, 52, 53, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, XE, XP, XS, XU
AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, 61150 Burr hole(s) or trephine; with drainage of brain abscess or
Surgery/Nervous System

XS, XU
cyst
ASC PI: A2  ASC Sep. Pay: Yes  APC SI: T  APC: 5441
FRVU 39.87   NFRVU 39.87   GLOBAL 090   MUE 1
CPT® Asst: MAY 2017; Vol 27: Issue 5
MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 99,
61055 Cisternal or lateral cervical (C1-C2) puncture; with AQ, AR, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ, XE, XP, XS, XU
injection of medication or other substance for diagnosis or 61151 Burr hole(s) or trephine; with subsequent tapping
treatment (aspiration) of intracranial abscess or cyst
FRVU 3.50   NFRVU 3.50   GLOBAL 000   MUE 1 FRVU 29.35   NFRVU 29.35   GLOBAL 090   MUE 1
MOD 22, 47, 52, 53, 58, 59, 63, 76, 77, 78, 79, 99, AQ, AR, CR, MOD 22, 51, 52, 53, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 99, AQ,
ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU AR, CR, ET, GA, GC, GJ, GR, KX, Q5, Q6, QJ, XE, XP, XS, XU

GLOBAL Global Days  MUE Medically Unlikely Edit  MOD Modifier Crosswalk  APC APC Value  ASC PI ASC Payment Indicator 
APC SI APC Status Indicator  ASC Sep. Pay ASC Separate Payment  CPT Asst CPT® Assistant Article Reference 
HCPCS CODE DOSAGE Dosage Amount for Drug  PAYMENT LIMIT Maximum Reimbursement Amount
CPT® is a registered trademark of the American Medical Association. All rights reserved.   767

PCE_book.indb 767 27/10/21 7:03 PM

 78816 - 79999 Radiology Procedures
78816 Positron emission tomography (PET) with concurrently 79403 Radiopharmaceutical therapy, radiolabeled monoclonal
78816 - 79999

acquired computed tomography (CT) for attenuation antibody by intravenous infusion

correction and anatomical localization imaging; whole body FRVU 5.43   NFRVU 5.43   GLOBAL XXX   MUE 1
G Code Crosswalk G0219 MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, CR, ET,
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1 GA, GC, GR, KX, PD, Q5, Q6, TC, XE, XP, XS, XU
MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, CT, GC, ASC PI: Z3  APC SI: S  APC: 5661
GR, GY, GZ, KX, MA, MB, MC, MD, ME, MF, MG, MH, PD, PI, PS, CPT® Asst: SEP 2005; Vol 15: Issue 9
Q6, QQ, TC, XE, XP, XS, XU
79440 Radiopharmaceutical therapy, by intra-articular
ASC PI: Z2  APC SI: S  APC: 5594
administration
CPT® Asst: SEP 2020; Vol 30: Issue 9, FEB 2013; Vol 23: Issue 2, FEB
FRVU 3.55   NFRVU 3.55   GLOBAL XXX   MUE 1
2005; Vol 15: Issue 2
MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, CR, ET,
78830 Code is out of numerical sequence. See 78804-78808. GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XU
78831 Code is out of numerical sequence. See 78804-78808. ASC PI: Z3  APC SI: S  APC: 5661
CPT® Asst: SEP 2005; Vol 15: Issue 9
78832 Code is out of numerical sequence. See 78804-78808.
78835 Code is out of numerical sequence. See 78804-78808. 79445 Radiopharmaceutical therapy, by intra-arterial particulate
administration
78999 Unlisted miscellaneous procedure, diagnostic nuclear FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
medicine
MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, GC, GR,
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1 GY, GZ, KX, PD, Q6, TC, XE, XP, XS, XU
MOD 26, 52, 59, 79, 80, 81, 82, AS, GY, GZ, KX, MA, MB, MC, MD, ASC PI: Z2  APC SI: S  APC: 5661
ME, MF, MG, MH, PD, QQ, TC, XE, XP, XS, XU
CPT® Asst: DEC 2006; Vol 16: Issue 12, SEP 2005; Vol 15: Issue 9
ASC PI: Z2  APC SI: S  APC: 5591
CPT® Asst: DEC 2016; Vol 26: Issue 12, DEC 2016; Vol 26: Issue 12, 79999 Radiopharmaceutical therapy, unlisted procedure
OCT 2015; Vol 25: Issue 10 FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
MOD 26, 52, 59, 79, 80, 81, 82, AS, GC, GY, GZ, KX, PD, TC, XE,
Therapeutic Nuclear Medicine Procedures XP, XS, XU
(79005-79999) ASC PI: Z2  APC SI: S  APC: 5661
79005 Radiopharmaceutical therapy, by oral administration CPT® Asst: FEB 2012; Vol 22: Issue 2, JAN 2007; Vol 17: Issue 1,
FRVU 3.98   NFRVU 3.98   GLOBAL XXX   MUE 1 MAR 2005; Vol 15: Issue 3, SEP 2005; Vol 15: Issue 9
MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, GC, GR,
KX, PD, Q6, TC, XE, XP, XS, XU
ASC PI: Z3  APC SI: S  APC: 5661
CPT® Asst: FEB 2012; Vol 22: Issue 2, SEP 2005; Vol 15: Issue 9
79101 Radiopharmaceutical therapy, by intravenous
administration
FRVU 4.32   NFRVU 4.32   GLOBAL XXX   MUE 1
MOD 22, 26, 52, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, GC, GR,
KX, PD, Q6, TC, XE, XP, XS, XU
ASC PI: Z3  APC SI: S  APC: 5661
CPT® Asst: FEB 2012; Vol 22: Issue 2, SEP 2005; Vol 15: Issue 9
79200 Radiopharmaceutical therapy, by intracavitary
administration
FRVU 3.95   NFRVU 3.95   GLOBAL XXX   MUE 1
MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, CR, ET,
GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XU
ASC PI: Z3  APC SI: S  APC: 5661
CPT® Asst: SEP 2005; Vol 15: Issue 9
79300 Radiopharmaceutical therapy, by interstitial radioactive
colloid administration
Radiology Procedures

FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1

MOD 22, 26, 52, 53, 59, 76, 77, 79, 80, 81, 82, 99, AQ, AS, CR, ET,
GA, GC, GJ, GR, GY, GZ, KX, PD, Q5, Q6, QJ, TC, XE, XP, XS, XU
ASC PI: Z2  APC SI: S  APC: 5661
CPT® Asst: SEP 2005; Vol 15: Issue 9

New Code  Revised Code  Add-On Code  # Resequenced Code  FDA Approval Pending  Modifier 51 Exempt  Modifier 63 Exempt 
Female-only Procedure  Male-only Procedure  Maternity  Merit-based Incentive Payment System Code 
Telemedicine Code  FRVU Facility Total RVU  NFRVU Non-facility Total RVU 
892   CPT® is a registered trademark of the American Medical Association. All rights reserved.

PCE_book.indb 892 27/10/21 7:04 PM

 Medicine Services and Procedures 92953 - 92997
92961 Cardioversion, elective, electrical conversion of arrhythmia;

92953 - 92997
Open airway by lifting
neck and tilting head back internal (separate procedure)
FRVU 7.20   NFRVU 7.20   GLOBAL 000   MUE 1
MOD 22, 52, 58, 59, 76, 77, 78, 79, 99, AQ, AR, CR, ET, GA, GC,
GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
APC SI: S  APC: 5781
CPT® Asst: FEB 2015; Vol 25: Issue 2, JUN 2000; Vol 10: Issue 6, JUL
2000; Vol 10: Issue 7, NOV 2000; Vol 10: Issue 11
92970 Cardioassist-method of circulatory assist; internal
FRVU 5.50   NFRVU 5.50   GLOBAL 000   MUE 1
MOD 22, 52, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS,
CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
92971 Cardioassist-method of circulatory assist; external
FRVU 2.93   NFRVU 2.93   GLOBAL 000   MUE 1
Mouth to mouth MOD 22, 52, 58, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS,
resuscitation CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
92973 Code is out of numerical sequence. See 92998-93000.
92974 Code is out of numerical sequence. See 92998-93000.
92975 Code is out of numerical sequence. See 92998-93000.
92977 Code is out of numerical sequence. See 92998-93000.
92978 Code is out of numerical sequence. See 92998-93000.
92979 Code is out of numerical sequence. See 92998-93000.
92986 Percutaneous balloon valvuloplasty; aortic valve
FRVU 38.47   NFRVU 38.47   GLOBAL 090   MUE 1
MOD 22, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82,
99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE,
XP, XS, XU
APC SI: J1  APC: 5192
CPT® Asst: FEB 2015; Vol 25: Issue 2, JAN 2013; Vol 23: Issue 1
92987 Percutaneous balloon valvuloplasty; mitral valve
FRVU 39.76   NFRVU 39.76   GLOBAL 090   MUE 1
MOD 22, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82,
99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE,
XP, XS, XU
APC SI: J1  APC: 5193
CPT® Asst: FEB 2015; Vol 25: Issue 2
Artificial breathing by
pressing on chest 92990 Percutaneous balloon valvuloplasty; pulmonary valve
FRVU 31.73   NFRVU 31.73   GLOBAL 090   MUE 1
MOD 22, 51, 52, 54, 55, 56, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82,
92953 Temporary transcutaneous pacing 99, AQ, AR, AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE,
FRVU 0.03   NFRVU 0.03   GLOBAL 000   MUE 2 XP, XS, XU
MOD 22, 52, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,

Medicine Services and Procedures

APC SI: J1  APC: 5193
AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU CPT® Asst: FEB 2015; Vol 25: Issue 2, JUL 2015; Vol 25: Issue 7
APC SI: S  APC: 5781
92997 Percutaneous transluminal pulmonary artery balloon
CPT® Asst: AUG 2019; Vol 29: Issue 8, MAY 2014; Vol 24: Issue 5,
angioplasty; single vessel
FEB 2007; Vol 17: Issue 2, JUL 2007; Vol 17: Issue 7, AUG 2000;
Vol 10: Issue 8 FRVU 18.50   NFRVU 18.50   GLOBAL 000   MUE 1
MOD 22, 51, 52, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,
92960 Cardioversion, elective, electrical conversion of arrhythmia; AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
external
APC SI: J1  APC: 5193
FRVU 3.16   NFRVU 4.64   GLOBAL 000   MUE 2
CPT® Asst: MAY 2017; Vol 27: Issue 5, JUL 2017; Vol 27: Issue 7,
MOD 22, 52, 58, 59, 63, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, MAR 2016; Vol 26: Issue 3, FEB 2015; Vol 25: Issue 2
AS, CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, XE, XP, XS, XU
APC SI: S  APC: 5781
CPT® Asst: JAN 2012; Vol 22: Issue 1, JUL 2001; Vol 11: Issue 7, JUN
2000; Vol 10: Issue 6, NOV 2000; Vol 10: Issue 11

GLOBAL Global Days  MUE Medically Unlikely Edit  MOD Modifier Crosswalk  APC APC Value  ASC PI ASC Payment Indicator 
APC SI APC Status Indicator  ASC Sep. Pay ASC Separate Payment  CPT Asst CPT® Assistant Article Reference 
HCPCS CODE DOSAGE Dosage Amount for Drug  PAYMENT LIMIT Maximum Reimbursement Amount
CPT® is a registered trademark of the American Medical Association. All rights reserved.   1047

PCE_book.indb 1047 27/10/21 7:04 PM

 0632T - 0648T Category III Codes

Transcatheter Ultrasound Nerve Ablation CSF Shunt Analysis (0639T)

0632T - 0648T

Procedure (0632T) 0639T Wireless skin sensor thermal anisotropy measurement(s)

0632T Percutaneous transcatheter ultrasound ablation of nerves and assessment of flow in cerebrospinal fluid shunt,
innervating the pulmonary arteries, including right heart including ultrasound guidance, when performed
catheterization, pulmonary artery angiography, and all FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
imaging guidance MOD 22, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS,
FRVU 0.00   NFRVU 0.00   GLOBAL YYY   MUE 1 CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, SC, XE, XP, XS, XU
MOD 22, 51, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, AS,
CR, ET, GA, GC, GJ, GR, KX, PD, Q5, Q6, QJ, SC, XE, XP, XS, XU Spectroscopy Studies of Flap or Wound
ASC PI: J8  ASC Sep. Pay: Yes  APC SI: J1  APC: 5194 (0640T-0642T)
0640T Code is out of numerical sequence. See 0493T-0494T.
CT Breast (With/Without Contrast) 0641T Code is out of numerical sequence. See 0493T-0494T.
(0633T-0638T)
0642T Code is out of numerical sequence. See 0493T-0494T.
0633T Computed tomography, breast, including 3D rendering,
when performed, unilateral; without contrast material Transcatheter Implantation and Removal
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
Procedures (0643T-0646T)
MOD 22, 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5, 0643T Code is out of numerical sequence. See 0545T-0546T.
Q6, QQ, RT, SC, TC, XE, XP, XS, XU 0644T Transcatheter removal or debulking of intracardiac
ASC PI: Z2  APC SI: S  APC: 5522 mass (eg, vegetations, thrombus) via suction (eg,
0634T Computed tomography, breast, including 3D rendering, vacuum, aspiration) device, percutaneous approach, with
when performed, unilateral; with contrast material(s) intraoperative reinfusion of aspirated blood, including
imaging guidance, when performed
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
FRVU 0.00   NFRVU 0.00   GLOBAL YYY  
MOD 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5, MOD 22, 23, 52, 53, 58, 59, 76, 77, 78, 79, 99, CC, ET, EY, GA, GC,
Q6, QQ, RT, SC, TC, XE, XP, XS, XU KX, Q5, Q6, SC, XE, XP, XS, XU
ASC PI: Z2  APC SI: S  APC: 5571 ASC PI: J8  ASC Sep. Pay: Yes  APC SI: J1  APC: 5192

0635T Computed tomography, breast, including 3D rendering, 0645T Transcatheter implantation of coronary sinus reduction
when performed, unilateral; without contrast, followed by device including vascular access and closure, right heart
contrast material(s) catheterization, venous angiography, coronary sinus
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1 angiography, imaging guidance, and supervision and
interpretation, when performed
MOD 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5, FRVU 0.00   NFRVU 0.00   GLOBAL YYY  
Q6, QQ, RT, SC, TC, XE, XP, XS, XU MOD 23, 52, 53, 58, 59, 76, 77, 78, 79, 99, CC, ET, EY, GA, GC,
ASC PI: Z2  APC SI: S  APC: 5571 KX, Q5, Q6, SC, XE, XP, XS, XU

0636T Computed tomography, breast, including 3D rendering, 0646T Code is out of numerical sequence. See 0570T-0571T.
when performed, bilateral; without contrast material(s)
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
Magnetic Gastropexy With Gastrostomy Tube
MOD 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, Insertion Procedure (0647T)
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5, 0647T Insertion of gastrostomy tube, percutaneous, with
Q6, QQ, RT, SC, TC, XE, XP, XS, XU magnetic gastropexy, under ultrasound guidance, image
ASC PI: Z2  APC SI: S  APC: 5523 documentation and report
FRVU 0.00   NFRVU 0.00   GLOBAL YYY  
0637T Computed tomography, breast, including 3D rendering,
when performed, bilateral; with contrast material(s) MOD 22, 47, 52, 53, 58, 59, 76, 77, 78, 79, 99, AQ, AR, CR, ET,
GA, GC, GJ, GR, KX, Q5, Q6, QJ, SC, XE, XP, XS, XU
FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
ASC PI: J8  ASC Sep. Pay: Yes  APC SI: J1  APC: 5302
MOD 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR,
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5,
Q6, QQ, RT, SC, TC, XE, XP, XS, XU Quantitative Magnetic Resonance Tissue
ASC PI: Z2  APC SI: S  APC: 5572 Composition Analysis (0648T-0649T)
0648T Quantitative magnetic resonance for analysis of tissue
0638T Computed tomography, breast, including 3D rendering,
composition (eg, fat, iron, water content), including
when performed, bilateral; without contrast, followed by
multiparametric data acquisition, data preparation and
contrast material(s)
Category III Codes

transmission, interpretation and report, obtained without

FRVU 0.00   NFRVU 0.00   GLOBAL XXX   MUE 1
diagnostic MRI examination of the same anatomy (eg,
MOD 26, 50, 52, 53, 59, 76, 77, 78, 79, 80, 81, 82, 99, AQ, AR, organ, gland, tissue, target structure) during the same
AS, GA, GG, KX, LT, MA, MB, MC, MD, ME, MF, MG, MH, PD, Q5,
session; single organ
Q6, QQ, RT, SC, TC, XE, XP, XS, XU
FRVU 0.00   NFRVU 0.00   GLOBAL XXX  
ASC PI: Z2  APC SI: S  APC: 5572

New Code  Revised Code  Add-On Code  # Resequenced Code  FDA Approval Pending  Modifier 51 Exempt  Modifier 63 Exempt 
Female-only Procedure  Male-only Procedure  Maternity  Merit-based Incentive Payment System Code 
Telemedicine Code  FRVU Facility Total RVU  NFRVU Non-facility Total RVU 
1158   CPT® is a registered trademark of the American Medical Association. All rights reserved.

PCE_book.indb 1158 27/10/21 7:05 PM

 Appendix C

00176 - 31780
Inpatient-Only Procedure Codes
The data in this Appendix is based on the OPPS/ASC Proposed Rule for CY 2022. Please check the CMS website at www.cms.gov for final updates.
Codes appearing in this Appendix may contain a placeholder “X.” According to the AMA, the codes with placeholder “X” are used to provide the proposed
placement of where the codes may fall in the code set once the code set is finalized. CMS used the placeholder “X” codes for the proposed changes
because the final code changes were not released before the proposed changes were implemented. Please check the CMS website at www.cms.gov for
the Final Rule for OPPS/ASC CY 2022 to ensure that you use only codes that are complete codes and do not contain the placeholder “X.”

CPT® Code CPT® Code CPT® Code CPT® Code CPT® Code CPT® Code CPT® Code CPT® Code CPT® Code

00176 01274 20955 21433 22328 23200 27122 27280 27592

00192 01404 20956 21435 22532 23210 27125 27282 27596
00211 01442 20957 21436 22533 23220 27132 27284 27598
00214 01444 20962 21510 22534 23335 27134 27286 27645
00215 01486 20969 21602 22548 23472 27137 27290 27646
00474 01502 20970 21603 22556 23474 27138 27295 27702
00524 01634 21045 21615 22558 23900 27140 27303 27703
00540 01636 21141 21616 22586 23920 27146 27365 27712
00542 01638 21142 21620 22590 24900 27147 27445 27715
00546 01652 21143 21627 22595 24920 27151 27448 27724
00560 01654 21145 21630 22600 24930 27156 27450 27725
00561 01656 21146 21632 22610 24931 27158 27454 27727
00562 01756 21147 21705 22630 24940 27161 27455 27880
00567 01990 21151 21740 22632 25900 27165 27457 27881
00580 11004 21154 21750 22800 25905 27170 27465 27882
00604 11005 21155 21825 22802 25915 27175 27466 27886
00632 11006 21159 22010 22804 25920 27176 27468 27888
00792 11008 21160 22015 22808 25924 27177 27470 28800
00794 15756 21179 22110 22810 25927 27178 27472 31225
00796 15757 21180 22112 22812 26551 27181 27486 31230
00844 15758 21182 22114 22818 26553 27185 27487 31290
00846 16036 21183 22116 22819 26554 27187 27488 31291

Appendix C  Inpatient-Only Procedure Codes

00848 19305 21184 22206 22830 26556 27222 27495 31360
00864 19306 21188 22207 22841 26992 27226 27506 31365
00866 19361 21194 22208 22843 27005 27227 27507 31367
00868 19364 21196 22210 22844 27025 27228 27511 31368
00882 19367 21247 22212 22846 27030 27232 27513 31370
00904 19368 21255 22214 22847 27036 27236 27514 31375
00908 19369 21268 22216 22848 27054 27240 27519 31380
00932 20661 21343 22220 22849 27070 27244 27535 31382
00934 20664 21344 22222 22850 27071 27245 27536 31390
00936 20802 21347 22224 22852 27075 27248 27540 31395
01140 20805 21348 22226 22855 27076 27253 27556 31725
01150 20808 21366 22318 22857 27077 27254 27557 31760
01212 20816 21422 22319 22861 27078 27258 27558 31766
01232 20824 21423 22325 22862 27090 27259 27580 31770
01234 20827 21431 22326 22864 27091 27268 27590 31775
01272 20838 21432 22327 22865 27120 27269 27591 31780

  1217

PCE_book.indb 1217 27/10/21 7:05 PM

 Appendix H  Vascular Families for Interventional Radiology Coding 

Arterial Vascular Family

First Order Second Order Third Order Beyond Third Order
Left Vidian
Left Caroticotympanic
Left Meningohypophyseal
Trunk
Left Inferolateral Trunk
Left Inferior Hypophyseal
Left Internal Carotid Left Ophthalmic
Left Superior Hypophyseal
Left Anterior Choroidal
Left Posterior
Communicating
Left Common Carotid
Left Middle Cerebral
Left Anterior Cerebral
Left Superior Thyroid
Left Ascending
Pharyngeal
Left Lingual
Left External Carotid Left Facial
Left Occipital
Left Posterior Auricular
Left Superficial Temporal
Appendix H  Vascular Families for Interventional Radiology Coding 

Left Internal Maxillary Left Middle Meningeal

Thoracic Basilar and Branches
Left Vertebral
Aorta – Posterior Cerebral
(Cont.)
Left Internal Thoracic
Left Superior Epigastric
(Internal Mammary)
Left Inferior Thyroid
Left Subclavian Left Ascending Cervical
Left Thyrocervical Trunk
Left Transverse Cervical

(Considered one vessel Left Suprascapular

for coding purposes)
Left Deep Cervical
Left Costocervical Trunk
Left Supreme Intercostal
Left Superior Thoracic
Left Thoracoacromial
Left Lateral Thoracic
Left Anterior and Posterior
Circumflex Humeral
Left Circumflex Subscapular
Left Subscapular
Left Thoracodorsal
Left Axillary
Left Profunda Brachii
Left Ulnar
Left Common Interosseous
Left Brachial Left Deep Palmar Arch
Left Radial Left Superficial Palmar Arch
Left Metacarpal(s)
Left Digital(s)

1334  

PCE_book.indb 1334 27/10/21 7:05 PM

 27/10/21 7:05 PM
Appendix O  2021 E/M Office or Other Outpatient (99202-99215) Audit Worksheet

  1371
2021 E/M Office or Other Outpatient (99202-99215) Audit Worksheet
Per CPT®, symptoms may cluster around a specific diagnosis and each symptom is not necessarily a unique condition. Comorbidities/underlying diseases, in and of
themselves, are not considered in selecting a level of E/M service unless they are addressed and their presence increases the amount and/or complexity of data to be
MDM Definitions reviewed and analyzed or the risk of complications and/or morbidity or mortality of patient management. The final diagnosis for a condition does not in itself determine
the complexity or risk, as extensive evaluation may be required to reach the conclusion that the signs or symptoms do not represent a highly morbid condition. Multiple
problems of a lower severity may, in aggregate, create higher risk due to interaction.
A problem is a disease, condition, illness, injury, symptom, sign, finding, complaint, and/or other matter addressed at the visit, with or without a diagnosis being
Problem
established at the time of the visit.
A problem is addressed or managed when it is evaluated or treated at the visit by the provider reporting the service. This includes consideration for further testing or
treatment that may not be elected by reason of risk/benefit analysis or patient/parent/guardian/surrogate choice. Notation in the patient’s medical record that another
Problem Addressed professional is managing the problem without additional assessment or coordination of care documented does not qualify as being “addressed” or managed by the
provider reporting the service. Referring a patient to another provider without evaluation (by history, exam, or diagnostic study[ies]) or consideration of treatment does
Appendix O  2021 E/M Office or Other Outpatient (99202-99215) Audit Worksheet

not qualify as being addressed or managed by the provider reporting the service.
Minimal Problem A problem that may not require the presence of the provider, but the service is provided under the provider’s supervision.
Self-limited or Minor
A problem that runs a definite and prescribed course, is temporary in nature, and is not likely to permanently affect the patient’s health status.
Problem
A problem with an expected duration of at least one (1) year or until the death of the patient. For the purpose of defining chronicity, conditions are treated as
chronic whether or not the stage or the severity changes (e.g., uncontrolled diabetes and controlled diabetes are a single chronic condition). Stable for the purposes of
calculating medical decision making is defined by the specific treatment goal(s) for an individual patient. A patient that is not at their treatment goal is not stable, even
Stable, Chronic Illness
if the condition has not changed and there is no short-term threat to life or bodily function. For example, a patient with persistently poorly controlled blood pressure for
whom better control is a goal is not stable, even if the pressures are not changing and the patient is asymptomatic. The risk of morbidity without treatment is significant.

CPT® is a registered trademark of the American Medical Association. All rights reserved.
Examples may include well-controlled hypertension, non-insulin dependent diabetes, cataract, or benign prostatic hyperplasia.
A recent or new short-term problem with low risk of morbidity for which a treatment is considered. There is little to no risk of mortality with treatment, and full recovery
Acute, Uncomplicated
without functional deterioration is expected. A problem that is normally self-limited or minor, but is not resolving consistent with a definite and prescribed course is an
Illness or Injury
acute, uncomplicated illness. Examples may include cystitis, allergic rhinitis, or a simple sprain.
Chronic Illness with
A chronic illness that is acutely worsening, poorly controlled, uncontrolled, or progressing with an intent of controlling progression and requiring additional
Exacerbation, Progression,
supportive care or requiring attention to treatment for side effects, but that does not require consideration of hospital level of care.
or Side Effects of Treatment
Undiagnosed New Problem A problem in the differential diagnosis that represents a condition likely to result in a high risk of morbidity without medical intervention. An example may be a lump
with Uncertain Prognosis in the breast.
An illness that causes systemic symptoms (symptoms affecting one or more organ systems) and has a high risk of morbidity without medical intervention. For
Acute Illness with Systemic systemic general symptoms such as fever, body aches, or fatigue in a minor illness that may be treated to alleviate symptoms, shorten the course of illness, or to
Symptoms prevent complications, see the definitions for “self-limited or minor” or “acute, uncomplicated.” Systemic symptoms may not be general, but may be single system.
Examples may include pyelonephritis, pneumonitis, or colitis.
An injury which requires medical intervention that includes evaluation of other body systems that are not directly related to the injured organ, the injury is extensive,
Acute, Complicated Injury or the treatment options are multiple and/or associated with risk of morbidity. An example may be a head injury with brief loss of consciousness, multiple fractures,
multiple injuries, etc.
Chronic Illness with Severe
Exacerbation, Progression, The severe exacerbation or progression of a chronic illness or severe side effects of treatment that have significant risk of morbidity and may require hospitalization.
or Side Effects of Treatment

PCE_book.indb 1371
 Anesthesia Modifiers
Modifier Description Modifier Description Modifier Description
P1 A normal healthy patient AA Anesthesia services performed QK Medical direction of two, three,
P2 A patient with mild systemic personally by the anesthesiologist or four concurrent anesthesia
disease AD Medical supervision by a procedures involving qualified
physician: more than four individuals
P3 A patient with severe systemic
concurrent anesthesia procedures
disease
G8 Monitored anesthesia care (MAC) QS Monitored anesthesia care service
P4 A patient with severe systemic for deep complex, complicated,
disease that is a constant threat QX CRNA service: with medical
or markedly invasive surgical
to life direction by a physician
procedure
P5 A moribund patient who is not
expected to survive without the
operation
G9 Monitored anesthesia care for
patient who has history of severe
cardio-pulmonary condition
QY Medical direction of one certified
registered nurse anesthetist
(CRNA) by an anesthesiologist
Thank You for Your
P6 A declared brain-dead patient
whose organs are being removed
for donor purposes
GC This service has been performed
in part by a resident under the
direction of a teaching physician
QZ CRNA service: without medical
direction by a physician
Contribution to the
Hardship Fund
Ambulatory Modifiers
Supporting your fellow
Modifier Description Modifier Description Modifier Description
CPT® Modifiers LEVEL II (HCPCS/National) Modifiers T1 Left foot, second digit
AAPC members in need
25 Significant, Separately Identifiable E1 Upper left, eyelid T2 Left foot, third digit
Evaluation and Management E2 Lower left, eyelid T3 Left foot, fourth digit
Service by the Same Physician
or Other Qualified Health Care E3 Upper right, eyelid T4 Left foot, fifth digit
Professional on the Same Day of E4 Lower right, eyelid T5 Right foot, great toe
the Procedure or Other Service
F1 Left hand, second digit T6 Right foot, second digit
Thanks to your book purchase, AAPC will be able to help even more members who face
27 Multiple Outpatient Hospital E/M
F2 Left hand, third digit T7 Right foot, third digit financial difficulty through the Hardship Fund.
Encounters on the Same Date
F3 Left hand, fourth digit T8 Right foot, fourth digit
33 Preventive Services
50 Bilateral Procedure F4 Left hand, fifth digit T9 Right foot, fifth digit The Hardship Fund is a financial aid program created to assist our members with:
52 Reduced Services F5 Right hand, thumb TA Left foot, great toe
58 Staged or Related Procedure or F6 Right hand, second digit
Service by the Same Physician Maintaining their membership and certification through
F7 Right hand, third digit
or Other Qualified Health membership renewal dues, exam prep tools and more
Care Professional During the F8 Right hand, fourth digit
Postoperative Period F9 Right hand, fifth digit
59 Distinct Procedural Service
Registration for national or regional conferences
FA Left hand, thumb
73 Discontinued Out-Patient
Hospital/Ambulatory Surgery
GG Performance and payment of Certain local chapter events
a screening mammogram and
Center (ASC) Procedure Prior to
diagnostic mammogram on the
the Administration of Anesthesia
same patient, same day
74 Discontinued Out-Patient
Hospital/Ambulatory Surgery GH Diagnostic mammogram All awards are based on the availability of funds and the applicant's ability to
converted from screening
Center (ASC) Procedure After
mammogram on same day demonstrate reasonable hardship. A portion of each book sale goes to helping more
Administration of Anesthesia
76 Repeat Procedure or Service LC Left circumflex coronary artery applicants through their time of need. We appreciate your contribution and your
by Same Physician or Other LD Left anterior descending coronary support for your fellow AAPC members.
Qualified Health Care Professional artery
77 Repeat Procedure by Another LM Left main coronary artery
Physician or Other Qualified
Health Care Professional LT Left side (used to identify To learn more about the Hardship Fund and its efforts or apply
procedures performed on the left
78 Unplanned Return to the
Operating/Procedure Room by
side of the body) for financial assistance, visit aapc.com.
the Same Physician or Other QM Ambulance service provided
Qualified Health Care Professional under arrangement by a provider
Following Initial Procedure for of services
a Related Procedure During the QN Ambulance service furnished
Postoperative Period directly by a provider of services
79 Unrelated Procedure or Service RC Right coronary artery Procedural Coding Expert 2022
by the Same Physician or Other
Qualified Health Care Professional RI Ramus intermedius coronary artery
During the Postoperative Period RT Right side (used to identify
91 Repeat Clinical Diagnostic procedures performed on the 9 781646 312160
Laboratory Test right side of the body)
ISBN: 978-1-646312-160
E-Book ISBN: 978-1-646312-283

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