CT HEAD OR BRAIN WITHOUT AND WITH CONTRAST Computerized Tomography Advanced

Transcription

1 321 ANGIOCARDIOGRAPHY Angiography/Interventional 323 ARTERIOGRAPHY Angiography/Interventional 0144T CT heart wo dye; qual calc Computerized Tomography 0145T CT heart w/wo dye funct Computerized Tomography 0146T CCTA w/wo dye Computerized Tomography 0147T CCTA w/wo, quan calcium Computerized Tomography 0148T CCTA w/wo, strxr Computerized Tomography 0149T CCTA w/wo, strxr quan calc Computerized Tomography 0150T CCTA w/wo, disease strxr Computerized Tomography 350 CT SCAN, GENERAL Computerized Tomography 351 CT SCAN, HEAD Computerized Tomography 352 CT SCAN, BODY Computerized Tomography 359 CT SCAN, OTHER Computerized Tomography CT BRAIN, HEAD Computerized Tomography CT HEAD OR BRAIN WITH CONTRAST Computerized Tomography CT HEAD OR BRAIN WITHOUT AND WITH CONTRAST Computerized Tomography CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR ETC. Computerized Tomography CT ORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA, EAR WIT Computerized Tomography CTORBIT,EYE SOCKET, SELLA TURCICA, POSTERIOR FOSSA,EAR,W/WO Computerized Tomography CT SINUS, FACE,JAW,MANDIBLE,MAXILLOFACIAL NO CONTRAST Computerized Tomography CT FACE, JAW OR MANDIBLE, MAXILLOFACIAL, WITH CONTRAST Computerized Tomography CT FACE, JAW OR MANDIBLE, MAXILLOFACIAL,WITHOUT/WITH CONTRAS Computerized Tomography CT NECK SOFT TISSUES,LARNYX,THYROID ETC. NO CONTRAST Computerized Tomography CT NECK SOFT TISSUES,LARYNX,THYROID,ETC.WITH CONTRAST Computerized Tomography CT NECK SOFT TISSUES, LARYNX,THYROID,ETC.WITHOUT/WITH CONTRA Computerized Tomography Ct angiography, head Computerized Tomography Ct angiography, neck Computerized Tomography CT CHEST, THORAX Computerized Tomography CT CHEST, THORAX WITH CONTRAST Computerized Tomography CT CHEST, THORAX WITHOUT AND WITH CONTRAST Computerized Tomography Ct angiography, chest Computerized Tomography CT CERVICAL SPINE, NECK SPINE NO CONTRAST Computerized Tomography CT CERVICAL SPINE, NECK SPINE WITH CONTRAST Computerized Tomography CT CERVICAL SPINE, NECK SPINE WITHOUT AND WITH CONTRAST Computerized Tomography

2 CT THORACIC SPINE, UPPER BACK NO CONTRAST Computerized Tomography CT THORACIC SPINE, UPPER BACK WITH CONTRAST Computerized Tomography CT THORACIC SPINE, UPPER BACK WITHOUT AND WITH CONTRAST Computerized Tomography CT LUMBAR SPINE, LOW BACK Computerized Tomography CT LUMBAR SPINE, LOW BACK WITH CONTRAST Computerized Tomography CT LUMBAR SPINE, LOW BACK WITHOUT AND WITH CONTRAST Computerized Tomography Ct angiograph pelv w/o&w dye Computerized Tomography CT PELVIS NO CONTRAST Computerized Tomography CT PELVIS WITH CONTRAST Computerized Tomography CT PELVIS WITHOUT/WITH CONTRAST Computerized Tomography CT ARM OR UPPER EXTREMITY Computerized Tomography CT ARM OR UPPER EXTREMITY WITH CONTRAST Computerized Tomography CT ARM OR UPPER EXTREMITY WITHOUT AND WITH CONTRAST Computerized Tomography Ct angio upr extrm w/o&w dye Computerized Tomography CT LEG OR LOWER EXTREMITY Computerized Tomography CT LEG OR LOWER EXTREMITY WITH CONTRAST Computerized Tomography CT LEG OR LOWER EXTREMITY WITHOUT/WITH CONTRAST Computerized Tomography Ct angio lwr extr w/o&w dye Computerized Tomography CT ABDOMEN WITHOUT CONTRAST Computerized Tomography CT ABDOMEN WITH CONTRAST Computerized Tomography CT ABDOMEN WITHOUT AND WITH CONTRAST Computerized Tomography Ct angio abdom w/o&w dye Computerized Tomography Ct angio abdominal arteries Computerized Tomography CT SCAN FOR STEREOTACTIC LOCALIZATION Computerized Tomography CT MULTIPLANAR RECONSTRUCTIONS Computerized Tomography CT SCAN FOR LOCALIZATION Computerized Tomography CT SCAN FOR NEEDLE BIOPSY Computerized Tomography CT GUIDE FOR TISSUE ABLATION Computerized Tomography CT SCAN FOR THERAPY GUIDE Computerized Tomography G0131 CT scan, bone density study Computerized Tomography G0132 CT scan, bone density study Computerized Tomography S8092 Electron beam computed tomog Computerized Tomography S8093 CT angiography coronary Computerized Tomography 340 NUCLEAR MEDICINE, GENERAL 341 NUCLEAR MEDICINE, DIAGNOSTIC 349 NUCLEAR MEDICINE, OTHER 615 MRA, HEAD AND NECK Magnetic Resonance 616 MRA, LOWER EXTREMITIES Magnetic Resonance 618 MRA, OTHER Magnetic Resonance

3 MRA, MRI ANGIOGRAPHY HEAD AND/OR Magnetic Resonance NECK WITH OR WITHOUT CONTRA Angiography MR angiography head w/o dye Magnetic Resonance MR angiography head w/dye Magnetic Resonance MR angiograph head w/o&w dye Magnetic Resonance MR angiography neck w/o dye Magnetic Resonance MR angiography neck w/dye Magnetic Resonance MR angiograph neck w/o&w dye Magnetic Resonance MRA, MRI ANGIOGRAPHY CHEST[NOT MYOCARDIUM] WITH/WITHOUT CONT Magnetic Resonance Angiography MRA, MRI ANGIOGRAPHY SPINAL CANAL & Magnetic Resonance CONTENTS WITH / WITHOUT Angiography MRA, MRI PELVIS ANGIOGRAPHY WITH/WITHOUT CONTRAST Magnetic Resonance Angiography MRA, MRI ANGIOGRAPHY UPPER EXTREMITY WITH/WITHOUT CONTRAST Magnetic Resonance Angiography MRA, MRI ANGIOGRAPHY LOWER EXTREMITY WITH/WITHOUT CONTRAST Magnetic Resonance Angiography MRA, MRI ANGIOGRAPHY ABDOMEN WITH/WITHOUT CONTRAST Magnetic Resonance Angiography S8037 MRcp Magnetic Resonance 610 MRI, GENERAL Magnetic Resonance Imaging 611 MRI, BRAIN & BRAINSTEM Magnetic Resonance Imaging 612 MRI, SPINE & SPINAL CORD Magnetic Resonance Imaging 614 MRI, OTHER Magnetic Resonance Imaging 619 OTHER MR TECHNOLOGY Magnetic Resonance Imaging MRI TEMPROMANDIBULAR JOINT,TMJ,JAW JOINT Magnetic Resonance Imaging MRI FACE, NECK, ORBIT Magnetic Resonance Imaging MRI orbit/face/neck w/dye Magnetic Resonance Imaging MRI orbt/fac/nck w/o&w dye Magnetic Resonance Imaging MRI BRAIN HEAD BRAINSTEM WITHOUT CONTRAST Magnetic Resonance Imaging MRI HEAD, BRAIN, BRAINSTEM WITH CONTRAST Magnetic Resonance Imaging MRI HEAD,BRAIN,BRAINSTEM WITHOUT /WITH CONTRAST Magnetic Resonance Imaging FMRI BRAIN BY TECH Magnetic Resonance Imaging FMRI BRAIN BY PHYS/PSYCH Magnetic Resonance Imaging MRI brain w/o dye Magnetic Resonance Imaging MRI brain w/ dye Magnetic Resonance Imaging MRI brain w/o & w/ dye Magnetic Resonance Imaging MRI CHEST Magnetic Resonance Imaging MRI chest w/dye Magnetic Resonance Imaging MRI chest w/o&w dye Magnetic Resonance Imaging MRI CERVICAL SPINE OR NECK SPINE WITHOUT CONTRAST Magnetic Resonance Imaging MRI CERVICAL SPINE OR NECK SPINE WITH CONTRAST Magnetic Resonance Imaging MRI THORACIC SPINE CHEST SPINE UPPER BACK WITHOUT CONTRAST Magnetic Resonance Imaging

4 MRI THORACIC SPINE OR CHEST SPINE OR UPPER BACK WITH CONTRAS Magnetic Resonance Imaging MRI LUMBAR SPINE OR LOW BACK WITHOUT CONTRAST Magnetic Resonance Imaging MRI LUMBAR SPINE OR LOW BACK WITH CONTRAST Magnetic Resonance Imaging MRI CERVICAL SPINE NECK SPINE WITHOUT/WITH CONTRAST Magnetic Resonance Imaging MRI THORACIC SPINE OR CHEST SPINE WITHOUT/WITH CONTRAST Magnetic Resonance Imaging MRI LUMBAR SPINE OR LOW BACK WITHOUT/ WITH CONTRAST Magnetic Resonance Imaging MRI pelvis w/o dye Magnetic Resonance Imaging MRI PELVIS Magnetic Resonance Imaging MRI pelvis w/o & w dye Magnetic Resonance Imaging MRI upper extremity w/o dye Magnetic Resonance Imaging MRI upper extremity w/dye Magnetic Resonance Imaging MRI UPPER EXTREMITY, ENTIRE EXTREMITY, NOT A JOINT Magnetic Resonance Imaging MRI JOINT OF UPPER EXTREMITY Magnetic Resonance Imaging MRI joint upr extrem w/ dye Magnetic Resonance Imaging MRI joint upr extr w/o&w dye Magnetic Resonance Imaging MRI lower extremity w/o dye Magnetic Resonance Imaging MRI lower extremity w/dye Magnetic Resonance Imaging MRI LEG OR LOWER EXTREMITY, OTHER THAN JOINT Magnetic Resonance Imaging MRI JOINT OF LOWER EXTREMITY, HIP OR KNEE OR ANKLE OR FOOT J Magnetic Resonance Imaging MRI joint of lwr extr w/dye Magnetic Resonance Imaging MRI joint lwr extr w/o&w dye Magnetic Resonance Imaging MRI ABDOMEN Magnetic Resonance Imaging MRI abdomen w/dye Magnetic Resonance Imaging MRI abdomen w/o&w dye Magnetic Resonance Imaging MRI CARDIAC HEART Magnetic Resonance Imaging Magnetic image, myocardium Magnetic Resonance Imaging CARDIAC MRI FOR FUNCTION COMPLETE STUDY Magnetic Resonance Imaging Cardiac MRI/limited study Magnetic Resonance Imaging Cardiac MRI/flow mapping Magnetic Resonance Imaging MAGNETIC RESONANCE IMAGING, BREAST, WITHOUT AND/OR WITH CONT Magnetic Resonance Imaging MRI BREAST BILATERAL Magnetic Resonance Imaging MR spectroscopy Magnetic Resonance Imaging MRI BONE MARROW BLOOD SUPPLY Magnetic Resonance Imaging MR GUIDANCE FOR NEEDLE PLACE Magnetic Resonance Imaging MRI FOR TISSUE ABLATION Magnetic Resonance Imaging MRI, ONE BREAST Magnetic Resonance Imaging MRI, BOTH BREASTS Magnetic Resonance Imaging MAGNETIC IMAGE, BONE MARROW Magnetic Resonance Imaging S8035 Magnetic source imaging Magnetic Resonance Imaging S8040 Topographic brain mapping Magnetic Resonance Imaging

5 MYOCARDIAL OR HEART MUSCLE PERFUSION; MULTIPLE STUDIES Nuclear Cardiology MYOCARDIAL OR HEART MUSCLE SPECT; SINGLE Nuclear Cardiology THALLIUM* SPECT;MYOCARDIAL/HEART Nuclear Cardiology TOMOGRAPHIC SPECT WITH OR WITHOUT QUANTITATION. Nuclear Cardiology CARDIAC OR HEART BLOOD POOL IMAGING Nuclear Cardiology MUGA HEART SCAN Nuclear Cardiology HEART WALL MOTION (ADD-ON) Nuclear Cardiology HEART FUNCTION (ADD-ON) Nuclear Cardiology HEART FIRST PASS SINGLE Nuclear Cardiology HEART FIRST PASS MULTIPLE Nuclear Cardiology Heart image, spect Nuclear Cardiology Heart first pass add-on Nuclear Cardiology CARDIOVASCULAR NUCLEAR EXAM Nuclear Cardiology 409 OTHER IMAGING SERVICES, OTHER Other Ct procedure Other MRI procedure Other UNLISTED PROCEDURE Other 921 Other Diagnostic Peripheral Vascular Lab Other 972 Professional Fees Diagnostic Radiology Other 974 Professional Fees Nuclear Medicine Other 404 POSITRON EMISSION TOMOGRAPHY (PET) Positron Emission Myocardial imaging, PET Positron Emission Heart image (pet) single Positron Emission Heart image (pet) multiple Positron Emission BRAIN PET [POSITRON EMISSION TOMOGRAPHY] Positron Emission Tomography BRAIN PET [POSITRON EMISSION TOMOGRAPHY] PERFUSION Positron Emission Tomography Tumor imaging, whole body Positron Emission TUMOR IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), METABOLIC Positron Emission Tomography Tumor imaging (pet), limited Positron Emission Tumor image (pet)/skul-thigh Positron Emission Tumor image (pet) full body Positron Emission Tumor image pet/ct, limited Positron Emission Tumorimage pet/ct skul-thigh Positron Emission Tumor image pet/ct full body Positron Emission G0030 PET imaging prev PET single Positron Emission G0031 PET imaging prev PET multple Positron Emission G0032 PET follow SPECT singl Positron Emission G0033 PET follow SPECT mult Positron Emission G0034 PET follow SPECT singl Positron Emission G0035 PET follow SPECT mult Positron Emission G0036 PET follow cornry angio sing Positron Emission G0037 PET follow cornry angio mult Positron Emission G0038 PET follow myocard perf sing Positron Emission G0039 PET follow myocard perf mult Positron Emission

6 G0040 PET follow stress echo singl Positron Emission G0041 PET follow stress echo mult Positron Emission G0042 PET follow ventriculogm sing Positron Emission G0043 PET follow ventriculogm mult Positron Emission G0044 PET following rest ECG singl Positron Emission G0045 PET following rest ECG mult Positron Emission G0046 PET follow stress ECG singl Positron Emission G0047 PET follow stress ECG mult Positron Emission G0125 PET image pulmonary nodule Positron Emission G0163 Pet for rec of colorectal ca Positron Emission G0164 Pet for lymphoma staging Positron Emission G0165 Pet,rec of melanoma/met ca Positron Emission G0210 PET img wholebody dxlung Positron Emission G0211 PET img wholbody init lung Positron Emission G0212 PET img wholebod restag lung Positron Emission G0213 PET img wholbody dx Positron Emission G0214 PET img wholebod init Positron Emission G0215 PETimg wholebod restag Positron Emission G0216 PET img wholebod dx melanoma Positron Emission G0217 PET img wholebod init melan Positron Emission G0218 PET img wholebod restag mela Positron Emission G0219 PET img wholbod melano nonco Positron Emission G0220 PET img wholebod dx lymphoma Positron Emission G0221 PET imag wholbod init lympho Positron Emission G0222 PET imag wholbod resta lymph Positron Emission G0223 PET imag wholbod reg dx head Positron Emission G0224 PET imag wholbod reg ini hea Positron Emission G0225 PET whol restag headneckonly Positron Emission G0226 PET img wholbody dx esophagl Positron Emission G0227 PET img wholbod ini esophage Positron Emission G0228 PET img WhBD ring restg esop Positron Emission G0229 PET img metaboloc brain pres Positron Emission G0230 PET myocard viability post Positron Emission G0231 PET WhBD colorec; gamma cam Positron Emission G0232 PET WhBD lymphoma; gamma cam Positron Emission G0233 PET WhBD melanoma; gamma cam Positron Emission G0234 PET WhBD pulm nod; gamma cam Positron Emission G0235 PET not otherwise specified Positron Emission G0252 PET imaging initial dx Positron Emission G0253 PET image brst dection recur Positron Emission G0254 PET image brst eval to tx Positron Emission G0296 PET imge restag thyrod cance Positron Emission G0336 PET imaging brain alzheimers Positron Emission ULTRASOUND UNLISTED Ultrasound General MYELOGRAM Angiography/ Interventional CISTERNOGRAPHY Angiography/ Interventional DACROCYSTOGRAPHY,TEAR DUCT Angiography/ Interventional

7 TMJ,TEMPROMANDIBULAR JOINT,JAW JOINT, ARTHROGRAPHY Angiography/ Interventional SIALOGRAPHY, CONTRAST EXAM SALIVARY DUCT Angiography/ Interventional BRONCHOGRAPHY UNILATERAL Angiography/ Interventional BRONCHOGRAPHY BILATERAL Angiography/ Interventional CERVICAL MYELOGRAM Angiography/ Interventional THORACIC MYELOGRAM Angiography/ Interventional LUMBAR MYELOGRAM Angiography/ Interventional MYELOGRAM FULL SPINE Angiography/ Interventional Epidurography Angiography/ Interventional CERVICAL DISCOGRAPHY Angiography/ Interventional LUMBAR DISCOGRAPHY Angiography/ Interventional SHOULDER ARTHROGRAM, CONTRAST EXAM OF SHOULDER Angiography/ Interventional ELBOW,ARTHROGRAM, X-RAY WITH CONTRAST Angiography/ Interventional WRIST ARTHROGRAM, CONTRAST EXAM OF WRIST Angiography/ Interventional HIP ARTHROGRAM, CONTRAST X-RAY OF HIP Angiography/ Interventional KNEE ARTHROGRAM, CONTRAST EXAMINATION OF KNEE Angiography/ Interventional ANKLE ARTHROGRAM, ARTHROGRAPHY, CONTRAST STUDY Angiography/ Interventional PERITONEOGRAM Angiography/ Interventional SMALL BOWEL SERIES, SMALL BOWEL VIA TUBE Angiography/ Interventional CHOLANGIOGRAM PERCUTANEOUS Angiography/ Interventional X-RAY FOR BILE DUCT ENDOSCOPY Angiography/ Interventional X-RAY FOR PANCREAS ENDOSCOPY Angiography/ Interventional X-RAY, BILE/PANCREAS ENDOSCOPY Angiography/ Interventional UROGRAM, RETROGRADE [RETROGRADE PYELOGRAM] Angiography/ Interventional UROGRAM ANTEGRADE Angiography/ Interventional

8 VASOGRAPHY, VESICULOGRAPHY,EPIDIDYMOGRAPHY Angiography/ Interventional PENIS,CORPORA CAVERNOSOGRAPHY Angiography/ Interventional URETHROCYSTOGRAM RETROGRADE, CONTRAST EXAM URETHRA & BLADDER Angiography/ Interventional URETHROCYSTOGRAM VOIDING,CONTRAST EXAM URETHRA & BLADDER Angiography/ Interventional RENAL CYST X-RAY Angiography/ Interventional HYSTEROSALPINGOGRAM, CONTRAST STUDY UTERUS AND TUBES, FERTIL Angiography/ Interventional X-ray fallopian tube Angiography/ Interventional VAGINOGRAM Angiography/ Interventional CONTRAST X-RAY EXAM OF AORTA Angiography/ Interventional CONTRAST X-RAY EXAM OF AORTA Angiography/ Interventional CONTRAST X-RAY EXAM OF AORTA Angiography/ Interventional X-RAY AORTA, LEG ARTERIES Angiography/ Interventional ARTERY X-RAYS, HEAD & NECK Angiography/ Interventional X-RAY EXAM OF ARM ARTERIES Angiography/ Interventional ARTERY X-RAYS, HEAD & NECK Angiography/ Interventional ARTERY X-RAYS, HEAD & NECK Angiography/ Interventional ARTERY X-RAYS, HEAD & NECK Angiography/ Interventional ARTERY X-RAYS, HEAD & NECK Angiography/ Interventional ARTERY X-RAYS, NECK Angiography/ Interventional ARTERY X-RAYS, NECK Angiography/ Interventional ARTERY X-RAYS, SPINE Angiography/ Interventional ARTERY X-RAYS, SPINE Angiography/ Interventional ARTERY X-RAYS, ARM/LEG Angiography/ Interventional ARTERY X-RAYS, ARM/LEG Angiography/ Interventional ARTERY X-RAYS, KIDNEY Angiography/ Interventional

9 75724 ARTERY X-RAYS, KIDNEYS Angiography/ Interventional ARTERY X-RAYS, ABDOMEN Angiography/ Interventional ARTERY X-RAYS, ADRENAL GLAND Angiography/ Interventional ARTERY X-RAYS, ADRENAL GLANDS Angiography/ Interventional ARTERY X-RAYS, PELVIS Angiography/ Interventional ARTERY X-RAYS, LUNG Angiography/ Interventional ARTERY X-RAYS, LUNGS Angiography/ Interventional ARTERY X-RAYS, LUNG Angiography/ Interventional ARTERY X-RAYS, CHEST Angiography/ Interventional ARTERY X-RAY, EACH VESSEL Angiography/ Interventional VISUALIZE A-V SHUNT Angiography/ Interventional LYMPH VESSEL, ARM/LEG UNILATERAL Angiography/ Interventional LYMPH VESSEL, ARMS/LEGS BILATERAL Angiography/ Interventional LYMPH VESSEL, TRUNK UNILATERAL Angiography/ Interventional LYMPH VESSEL, TRUNK BILATERAL Angiography/ Interventional SHUNTOGRAM FOR INVESTIGATION OF PREVIOUSLY PLACED INDWELLING Angiography/ Interventional SPLENOPORTAGRAM Angiography/ Interventional VENOGRAM, CONTRAST EXAM OF VEIN, ANY EXTREMITY UNILAT. Angiography/ Interventional VENOGRAM, CONTRAST EXAM OF VEIN, ANY EXTREMITY BILAT. Angiography/ Interventional INFERIOR VENA CAVOGRAM Angiography/ Interventional SUPERIOR VENA CAVOGRAM Angiography/ Interventional VEIN X-RAY, KIDNEY Angiography/ Interventional VEIN X-RAY, KIDNEYS Angiography/ Interventional VEIN X-RAY, ADRENAL GLAND Angiography/ Interventional VEIN X-RAY, ADRENAL GLANDS Angiography/ Interventional

10 75860 VEIN X-RAY, NECK Angiography/ Interventional VEIN X-RAY, SKULL Angiography/ Interventional VEIN X-RAY, SKULL Angiography/ Interventional VEIN X-RAY, EYE SOCKET Angiography/ Interventional VEIN X-RAY, LIVER Angiography/ Interventional VEIN X-RAY, LIVER Angiography/ Interventional VEIN X-RAY, LIVER Angiography/ Interventional VEIN X-RAY, LIVER Angiography/ Interventional Atherectomy, x-ray exam Angiography/ Interventional Atherectomy, x-ray exam Angiography/ Interventional Atherectomy, x-ray exam Angiography/ Interventional Atherectomy, x-ray exam Angiography/ Interventional Atherectomy, x-ray exam Angiography/ Interventional FISTULA X-RAY,SINUS TRACT X-RAY, SINOGRAM Angiography/ Interventional MAMMARY DUCTOGRAM OR GALACTOGRAM, SINGLE DUCT Angiography/ Interventional MAMMARY DUCTOGRAM OR GALACTOGRAM, MULTIPLE DUCTS Angiography/ Interventional Dual energy x-ray study Bone Density Dxa bone density/v-fracture Bone Density BONE MINERAL, SINGLE PHOTON Bone Density BONE DENSITY DUAL PHOTON,OSTEOPOROSIS STUDY Bone Density 0151T CT heart funct add-on Computerized Tomography 0152T Computer chest add-on Computerized Tomography CT FOLLOW-UP OR LIMITED STUDY ANY AREA Computerized Tomography X-RAY OF MAMMARY DUCT Diagnostic mammography X-RAY OF MAMMARY DUCTS Diagnostic mammography

11 77055 MAMMOGRAM, ONE BREAST Diagnostic mammography MAMMOGRAM, BOTH BREASTS Diagnostic mammography Us bone density measure THYROID UPTAKE; SINGLE DETERMINATION THYROID UPTAKE; MULTIPLE DETERMINATIONS STIMULATION, SUPPRESSION OR DISCHARGE (NOT INCLUDING INTAKE THYROID IMAGING WITH UPTAKE; SINGLE DETERMINATION THYROID IMAGING* WITH UPTAKE: MULTIPLE DETERMINATIONS THYROID IMAGING OR SCAN ONLY THYROID IMAGING OR SCAN WITH VASCULAR FLOW THYROID CARCINOMA /NEOPLASM IMAGING; NECK AND CHEST THYROID NEOPLASM IMAGING; WITH ADDITIONAL STUDIES THYROID NEOPLASM IMAGING; MULTIPLE AREAS THYROID NEOPLASM IMAGING; WHOLE BODY Thyroid met uptake PARATHYROID SCAN ADRENAL SCAN OR ISOTOPE IMAGING ENDOCRINE NUCLEAR PROCEDURE BONE MARROW; LIMITED AREA BONE MARROW : MULTIPLE AREAS BONE MARROW WHOLE BODY PLASMA VOLUME NUCLEAR EXAM, PLASMA VOLUME RBC OR RED BLOOD CELL MASS OR VOLUME OR SURVIVAL STUDY RED CELL VOLUME DETERMINATION, MULTIPLE SAMPLINGS

12 WHOLE BLOOD VOLUME OR PLASMA/ RBC OR RED BLOOD CELL VOLUME RED CELL SURVIVAL EXAM DIFFERENTIAL ORGAN/TISSUE KINETICS (EG, SPLENIC AND/OR HEPAT RBC OR RED BLOOD CELL SEQUESTRATION STUDY PLASMA RADIOIRON DISSAPEARANCE (TURNOVER) RATE IRON OR RADIOIRON ORAL ABSORPTION IRON OR RADIORION ORAL ABSORPTION RED CELL UTILIZATION TOTAL BODY IRON OR CHEALATABLE IRON SPLEEN IMAGING ONLY WITH OR WITHOUT VASCULAR FLOW KINETICS, STUDY OF PLATELET SURVIVAL, WITH OR WITHOUT DIFFER PLATELET SURVIVAL STUDY LYMPHATICS AND LYMPH GLANDS OR LYMPH OR LYMPHATIC SYSTEM Blood/lymph nuclear exam HEPATIC OR LIVER SCAN; STATIC ONLY HEPATIC OR LIVER SCAN; WITH VASCULAR FLOW HEPATIC OR LIVER SCAN; SPECT Liver image (3-d) w/flow HEPATIC OR LIVER AND SPLEEN IMAGING OR SCAN; STATIC ONLY HEPATIC OR LIVER AND SPLEEN IMAGING* OR SCAN; WITH VASCULAR LIVER FUNCTION WITH HEPATOBILIARY AGENTS HEPATOBILIARY,TC HIDA SCAN /BILIARY TRACT,GALL BLADDER SALIVARY GLAND IMAGING SALIVARY GLAND IMAGING WITH MULTIPLE IMAGES SALIVARY GLAND FUNCTION STUDY ESOPHAGEAL MOTILITY OR ESOPHAGEAL SCAN

13 STOMACH OR GASTRIC MUCOSA OR LINING STUDY GASTROESOPHAGEAL REFLUX STUDY STOMACH OR GASTRIC EMPTYING STUDY VITAMIN B-12 ABSORPTION STUDY OR SCHILLING TEST; NO INTRINSI VITAMIN B-12 ABSORPTION STUDY/SCHILLING TEST; WITH INTRINSIC VITAMIN B-12 ABSORPTION STUDY OR SCHILLING TEST; COMBINED WI NUCLEAR SCAN, GI BLOOD LOSS G.I. PROTEIN LOSS EXAM NUCLEAR SCAN OF BOWEL TEST VENOUS DRAIN, ABDOMEN GI nuclear procedure BONE SCAN AND/ OR JOINT LIMITED AREA BONE SCAN AND/ OR JOINT MULTIPLE AREAS BONE OR SKELETON SCAN, WHOLE BODY NUCLEAR SCAN OF BONE BONE AND/OR JOINT MULTIPLE AREAS, TOMOGRAHIC OR SPECT Musculoskeletal nuclear exam VASCULAR FLOW IMAGING OR ISOTOPE ANGIOGRAPHY OR ISOTOPE VENO NUCLEAR SCAN OF VEIN CLOT VENOUS THROMBOSIS OR BLOOD CLOT IMAGING; UNILATERAL VENOUS THROMBOSIS OR BLOOD CLOT IMAGING; BILATERAL LUNG LUNG PEFUSION LUNG PERFUSION IMAGING, REBREATHING AND WASHOUT, W/WO SINGLE LUNG

14 78587 LUNG Perfusion lung image LUNG LUNG VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASH LUNG VENTILATION IMAGING, GASEOUS, WITH REBREATHING AND WASH LUNG SCAN* DIFFERENTIAL FUNCTION (VENTILATION/PERFUSION) STU UNLISTED RESPIRATORY PROCEDURE NERVOUS SYSTEM, BRAIN NERVOUS SYSTEM, BRAIN NERVOUS SYSTEM, BRAIN BRAIN SCAN OR IMAGING, WITH VASCULAR FLOW BRAIN SCAN OR IMAGING SPECT OR TOMOGRAPHIC BRAIN BRAIN CEREBRAL BLOOD FLOW CEREBROSPINAL FLUID CEREBROSPINAL FLUID CEREBROSPINAL FLUID CEREBROSPINAL FLUID CSF LEAKAGE DETECTION AND LOCALIZATION TEAR FLOW, 1 NOT Nervous system nuclear exam RENAL OR KIDNEY IMAGING; STATIC RENAL OR KIDNEY IMAGING; WITH VASCULAR FLOW RENAL* OR KIDNEY IMAGING; WITH FUNCTION STUDY/ IMAGING RENOG RENAL OR KIDNEY IMAGING; WITH VASCULAR FLOW AND FUNCTION STU

15 78708 Kidney flow & function image Kidney flow & function image RENAL OR KIDNEY IMAGING; SPECT NUCLEAR EXAM OF KIDNEY KIDNEY NO PHARMACEUTICALS KIDNEY WITH PHARMACEUTICALS RENAL OR KIDNEY TRANSPLANT EVALUATION URINARY BLADDER RESIDUAL STUDY URETERAL REFLUX STUDY TESTICULAR IMAGING OR ISOTOPE SCAN SCAN OF TESTES/BLOOD FLOW GENITOURINARY NUCLEAR EXAM NUCLEAR TUMOR LOCALIZATION, LTD NUCLEAR TUMOR LOCALIZATION, MULTIPLE NUCLEAR TUMOR LOCALIZATION,WHOLE BODY TOMOGRAPHIC (SPECT) ABSCESS LOCALIZATION OR GALLIUM SCAN; LIMITED AREA ABSCESS LOCALIZATION OR GALLIUM SCAN ; WHOLE BODY TOMOGRAPHIC (SPECT) NUCLEAR UNLISTED EXAM G0062 peripheral bone densitometry G0063 central bone densitometry 483 ECHOCARDIOLOGY Echocardiography Echo transthoracic Echocardiography Echo transthoracic Echocardiography

16 93307 Echo exam of heart Echocardiography Echo exam of heart Echocardiography Echo transesophageal Echocardiography Echo transesophageal Echocardiography Echo transesophageal Echocardiography Echo transesophageal Echocardiography Echo transesophageal Echocardiography Echo transesophageal Echocardiography Echo transesophageal intraop Echocardiography Doppler echo exam, heart Echocardiography Doppler echo exam, heart Echocardiography Doppler color flow add-on Echocardiography Echo transthoracic Echocardiography THROAT OR, PHARYNX OR, LARYNX X- RAY INCL. FLUOROSCOPY Fluoroscopy LARYNGOGRAM,LARNYNGOGRAPHY Fluoroscopy CERVICAL ESOPHAGRAM, PHARYNGOGRAM, CERVICAL ESOPHAGUS Fluoroscopy BARIUM SWALLOW,ESOPHAGRAM, ESOPHAGUS X-RAY WITH CONTRAST, Fluoroscopy CINE OR VIDEO ESOPHAGRAM, SWALLOWING FUNCTION, PHARYNX Fluoroscopy UGI,* UPPER GI SERIES, UPPER GASTROINTESTINAL TRACT,WITHOUT Fluoroscopy UGI, UPPER GI SERIES, UPPER GASTROINTESTINAL TRACT, WITH KU Fluoroscopy UGI, UPPER GI SERIES,WITH SMALL BOWEL SERIES OR FOLLOW-THRU Fluoroscopy UGI, UPPER GI SERIES,AIR OR DOUBLE CONTRAST WITHOUT KUB Fluoroscopy UGI, UPPER GI SERIES,AIR OR DOUBLE CONTRAST WITH KUB Fluoroscopy UGI UPPER GI SERIES AIR OR DOUBLE CONTRAST&SMALL BOWEL SERIE Fluoroscopy SMALL BOWEL SERIES, SMALL BOWEL FOLLOW-THROUGH Fluoroscopy

17 74260 DUODENOGRAPHY HYPOTONIC Fluoroscopy BARIUM ENEMA*, COLON, SINGLE CONTRAST COLON OR BARIUM ENEMA, Fluoroscopy BARIUM ENEMA COLON DOUBLE CONTRAST, Fluoroscopy CYSTOGRAM, CYSTOGRAPHY, CONTRAST EXAM URINARY BLADDER Fluoroscopy FLUOROSCOPY ANY BODY PART Fluoroscopy Cinematic x-rays Fluoroscopy G0120 Colon ca scrn; barium enema Fluoroscopy G0121 Colon ca scrn; barium enema Fluoroscopy G0122 Colon ca scrn; barium enema Fluoroscopy ULTRASOUND BREAST ECHO SONOGRAM UNILAT/BILAT Gynecological Ultrasound ULTRASOUND PELVIC NON OBSTETRIC COMPLETE Gynecological Ultrasound ULTRASOUND PELVIC, LIMITED OR FOLLOW-UP,NON OBSTETRIC Gynecological Ultrasound NUCLEAR EXAM OF HEART FLOW Nuclear Cardiology NUCLEAR EXAM, HEART SHUNT Nuclear Cardiology MYOCARDIAL OR HEART THALLIUM PERFUSION; SINGLE STUDY Nuclear Cardiology MYOCARDIAL OR HEART MUSCLE IMAGING INFARCT Nuclear Cardiology MYOCARDIAL OR HEART MUSCLE EJECTION FRACTION Nuclear Cardiology ULTRASOUND ENDOVAGINAL TRANSVAGINAL,TV OB Ultrasound 0126T Chd risk imt study Other 329 DIAGNOSTIC OTHER RADIOLOGY Other Ct bone density, peripheral Other Photodensitometry Other X-ray exam, dry process Other Fluoroscopic procedure Other X-RAYS FOR BONE AGE Other

18 77079 CT BONE DENSITY, PERIPHERAL other DXA BONE DENSITY/PERIPHERAL other DXA BONE DENSITY, VERT FX other RADIOGRAPHIC ABSORPTIOMETRY other Acute venous thrombus image Other Extracranial study Other Intracranial study Other Extremity study Other Extremity study Other Extremity study Other Extremity study Other Penile vascular study Other Penile vascular study Other Doppler flow testing Other G0106 Colon CA screen;barium enema Other G0389 ULTRASOUND EXAM AAA SCREEN other 320 RADIOLOGY, DIAGNOSTIC GENERAL 322 ARTHROGRAPHY 324 CHEST X-RAY 400 OTHER IMAGING SERVICES, GENERAL EYE FOREIGN BODY MANDIBLE OR JAW, LIMITED, LESS THAN 4 VIEWS MANDIBLE* OR JAW,COMPLETE, MINIMUM 4 VIEWS MASTOIDS LIMITED, LESS THAN 3 VIEWS PER SIDE MASTOIDS* COMPLETE, COMPLETE MINIMUM 3 VIEWS PER SIDE

19 INTERNAL AUDITORY CANALS OR MEATI,MIDDLE EAR FACIAL BONES LIMITED, LESS THAN 3 VIEWS FACIAL BONES* COMPLETE, 3 OR MORE VIEWS NASAL BONES OR NOSE, COMPLETE MINIMUM 3 VIEWS OPTIC FORAMINA ORBITS, EYE SOCKETS, COMPLETE MINIMUM 4 VIEWS SINUSES, PARANASAL SINUSES, WATER'S VIEW, LIMITED, 2 VIEW SINUSES*, PARANASAL SINUSES, SINUS CAVITIES, COMPLETE SELLA TURCICA, PITUITARY GLAND SKULL OR CRANIUM OR HEAD, LIMITED LESS THAN 4 VIEWS SKULL OR CRANIUM OR HEAD, COMPLETE MINIMUM 4 VIEWS TEETH, PARTIAL TEETH, MULTIPLE TEETH, FULL MOUTH TMJ, TEMPROMANDIBULAR JOINT, JAW JOINT, OPEN/CLOSED MOUTH UN TMJ, TEMPROMANDIBULAR JOINT, JAW JOINT, OPEN/CLOSED MOUTH BI CEPHALOGRAM, ORTHODONTIC PANORAMIC X-RAY OF JAWS NECK,SOFT TISSUES, AIRWAY, NECK SOFT TISSUES THROAT, PHARYNX, LARYNX, DYNAMIC SPEECH EVALUATION SALIVARY GLAND FOR CALCULUS CHEST, ANY SINGLE VIEW CHEST, PA CHEST, CHEST STEREO CHEST* PA AND LAT 2 VIEW, AP AND LATERAL CHEST 2 VIEWS WITH APICAL LORDOTIC,

20 CHEST TWO VIEWS OR PA AND LAT WITH OBLIQUES CHEST PA AND LAT OR TWO VIEWS WITH FLUOROSCOPY CHEST WITH OBLIQUES 4 VIEWS CHEST COMPLETE 4 VIEWS WITH FLUOROSCOPY CHEST WITH SPECIAL VIEWS, BUCKY, LAT DECUBITUS VIEWS, RIBS UNILATERAL, 2 VIEWS RIBS UNILAT AND PA CHEST, 3 VIEWS RIBS* BILATERAL 3 VIEWS RIBS BILATERAL AND PA CHEST STERNUM, BREASTBONE, MINIMUM 2 VIEWS STERNOCLAVICULAR JOINT OR JOINTS MINIMUM 3 VIEWS SPINE ENTIRE FULL AP AND LAT, SPINE SURVEY SPINE SINGLE VIEW ANY LEVEL CERVICAL SPINE LIMITED OR AP AND LATERAL, 2 VIEW CERVICAL SP C-SPINE COMPLETE WITH FLEXION AND EXTENSION VIEWS, THORACO-LUMBAR SPINE, ERECT SCOLIOSIS T-SPINE THORACIC SPINE, 3 VIEW, AP AND LAT AND SWIMMERS VIEW THORACIC SPINE, UPPER BACK,4 VIEW WITH OBLIQUES THORACOLUMBAR JUNCTION, T-L SPINE SPINE SCOLOSIS STUDY, SUPINE AND ERECT AP VIEWS LUMBAR SPINE LUMBOSACRAL SPINE LIMITED AP AND LAT L-SPINE LUMBAR SPINE LUMBOSACRAL SPINE COMPLETE WITH BENDING VIEWS

21 LUMBAR SPINE LUMBOSACRAL SPINE 72120,BENDING VIEWS ONLY PELVIS* AP, PELVIS PA, PELVIS 1 VIEW PELVIS COMPLETE MINIMUM 3 VIEWS SI JOINTS, SACROILIAC JOINTS, LESS THAN 3 VIEWS, LIMITED SI JONTS*, SACROILIAC JOINTS, COMPLETE 3 OR MORE VIEWS SACRUM AND COCCYX, TAILBONE [ MINIMUM 2 VIEWS] CLAVICLE OR, COLLARBONE COMPLETE SCAPULA, SHOULDER BLADE COMPLETE SHOULDER, 1 VIEW OR LIMITED SHOULDER*, COMPLETE MINIMUM 2 VIEWS ACROMIOCLAVICULAR JTS, A-C JOINTS, BILATERAL WITH OR WITHOUT HUMERUS, ARM, UPPER ARM ELBOW LIMITED, AP AND LAT ELBOW, 2 VIEW ELBOW ELBOW*,COMPLETE MINIMUM 3 VIEWS FOREARM, RADIUS AND ULNA, RADIUS, UPPER EXTREMITY OF CHILD WRIST, LIMITED OR AP AND LAT WRIST*, COMPLETE MINIMUM 3 VIEWS HAND, LIMITED HAND AP & LAT, 2 VIEW HAND *AP &LAT & OBLIQUE VIEWS, MINIMUM 3 VIEWS, FINGER OR FINGERS HIP UNILATERAL 1 VIEW, LIMITED HIP UNILATERAL HIP* UNILATERAL MINIMUM 2 VIEWS OR COMPLETE HIPS, BILATERAL HIPS, HIPS AND AP OR 1 VIEW PELVIS DURING OPERATION HIP X-RAY

22 PELVIS AND HIPS INFANT OR CHILD, VIEWS AP AND FROG LEG X-ray exam, sacroiliac joint FEMUR, THIGH, UPPER LEG, KNEE AP&LAT LIMITED KNEE, 2 VIEW KNEE KNEE AP LAT OBLIQUE MINIMUM 3 VIEW, KNEE* COMPLETE OBLIQUES TUNNEL VIEWS PATELLAR /STANDING VIEW KNEES STANDING AP VIEW LOWER LEG, TIBIA AND FIBULA, SHIN INFANT LEG INCLUDES UPPER AND LOWER ANKLE 2 VIEW, AP AND LATERAL ANKLE, LIMITED ANKLE ANKLE,* 3 VIEW, AP AND OBLIQUE AND LATERAL FOOT AP AND LATERAL OR 2 VIEW FOOT OR LIMITED FOOT FOOT*,COMPLETE, 3 VIEW FOOT, AP LAT AND OBLIQUE VIEWS, HEEL, OS CALCIS, CALCANEUS MINIMUM 2 VIEWS TOE OR TOES KUB ABDOMEN 1 VIEW ABDOMEN AP & ADDITIONAL VIEW*, 2 VIEW, SUPINE&ERECT,UPRIGHT ABDOMINAL 4 VIEW SERIES COMPLETE, ERECT SUPINE& DECUBITUS ABDOMINAL SERIES COMPLETE AND UPRIGHT PA CHEST GALL BLADDER X-RAY,ORAL CHOLECYSTOGRAM, SINGLE DOSE GALL BLADDER X-RAY,ORAL CHOLECYSTOGRAM,, DOUBLE DOSE OR REPE IVP*, INTRAVENOUS PYLOGRAM, EXCRETORY UROGRAM, KIDNEY X-RAY, IVP OR, INTRAVENOUS PYLOGRAM OR,WITH HYPERTENSIVE SEQUENCE IVP OR, INTRAVENOUS PYLOGRAM OR WITH INFUSION TECHNIQUE IVP OR, INTRAVENOUS PYLOGRAM WITH TOMOGRAMS/NEPHROTOMOGRAMS.

23 74710 PELVIMETRY, OBSTETRICAL X-ray stress view CHILD CHEST AND ABDOMEN AP NOSE TO RECTUM, SINGLE VIEW BONE AGE STUDY, HAND AND WRIST FOR BONE AGE BONE LENGTH STUDY, SCANOGRAM, LEG LENGTH STUDY LIMITED METASTATIC BONE SURVEY, METASTATIC BONE SURVEY BONE SURVEY INFANT, JOINT SURVEY, SINGLE VIEW ONE OR MORE JOINTS TOMOGRAPHY OR PLANOGRAPHY ANY BODY PART RADIOLOGICAL EXAMINATION, SURGICAL SPECIMEN POLY-TOMOGRAPHY, COMPLEX MOTION TOMOGRAPHY ANY BODY PART CINDERADIOGRAPHY, EXCEPT WHERE SPECIFICALLY INCLUDED X-RAY STRESS VIEW plain films X-RAYS BONE LENGTH STUDIES plain films X-RAYS BONE SURVEY, LIMITED plain films X-RAYS BONE SURVEY COMPLETE plain films X-RAYS BONE SURVEY, INFANT plain films JOINT SURVEY, SINGLE VIEW plain films D0350 Oral/facial images G0188 Xray lwr extrmty-full lngth US EXAM K TRANSPLANT W/DOPPLER Ultrasound OB US NUCHAL MEAS, 1 GEST Ultrasound OB US NUCHAL MEAS, ADD-ON Ultrasound 402 ULTRASOUND Ultrasound General

24 HEAD BRAIN UTLRASOUND, ECHO, SONOGRAM Ultrasound General Ophth us, b & quant a Ultrasound General OPTHALMIC, EYE ULTRASOUND,ECHO,SONOGRAM A-SCAN Ultrasound General OPTHALMIC,EYE, ULTRASOUND,ECHO, SONOGRAM B-SCAN Ultrasound General Echo exam of eye, water bath Ultrasound General Echo exam of eye, thickness Ultrasound General Echo exam of eye Ultrasound General Echo exam of eye Ultrasound General Echo exam of eye Ultrasound General ULTRASOUND THYROID NECK ECHO SONOGRAM Ultrasound General CHEST ULTRASOUND,ECHO,SONOGRAM Ultrasound General ULTRASOUND ABDOMINAL* ECHO SONOGRAM COMPLETE Ultrasound General ULTRASOUND ABDOMINAL LIMITED LIVER, GALL BLADDER, PANCREAS Ultrasound General ULTRASOUND AORTIC RENAL RETROPERITONEAL NODES COMPLETE Ultrasound General RETROPERITONEAL OR BACK WALL LIMITED ULTRASOUND Ultrasound General ULTRASOUND RENAL OR KIDNEY TRANSPLANT Ultrasound General SPINAL CANAL ULTRASOUND Ultrasound General Echo exam, uterus Ultrasound General ULTRASOUND SCROTAL TESTICULAR ECHO SONOGRAM Ultrasound General ULTRASOUND PROSTATE TRANSRECTAL Ultrasound General Echograp trans r, pros study Ultrasound General EXTREMITY ULTRASOUND, NON VASCULAR Ultrasound General Echo exam, infant hips Ultrasound General Echo exam, infant hips Ultrasound General ULTRASOUND OR ECHO FOLLOW-UP STUDY ANY AREA Ultrasound General

25 93880 ULTRASOUND CAROTID ARTERY Ultrasound General Extracranial study Ultrasound General Intracranial study Ultrasound General Lower extremity study Ultrasound General Lower extremity study Ultrasound General Upper extremity study Ultrasound General Upper extremity study Ultrasound General ULTRASOUND VENOUS DOPPLER EXTREMETRIES Ultrasound General Extremity study Ultrasound General Vascular study Ultrasound General Vascular study Ultrasound General Vascular study Ultrasound General Vascular study Ultrasound General G0050 Residual urine by ultrasound Ultrasound General 0005T Perc Cath stent/brain cv art Angiography/ Interventional Exempt 0006T Perc Cath stent/brain cv art Angiography/ Interventional Exempt 0007T Perc Cath stent/brain cv art Angiography/ Interventional Exempt INJECTION SONOGRAM Angiography/ Interventional Exempt INJECTION SHOULDER Angiography/ Interventional Exempt INJECTION ELBOW Angiography/ Interventional Exempt INJECTION WRIST Angiography/ Interventional Exempt INJECTION HIP Angiography/ Interventional Exempt INJECTION KNEE Angiography/ Interventional Exempt Endovasc abdo repair w/tube Angiography/ Interventional Exempt Endovasc abdo repr w/device Angiography/ Interventional Exempt Endovasc abdo repr w/device Angiography/ Interventional Exempt Endovasc abdo occlud device Angiography/ Interventional Exempt Endovasc extend prosth, init Angiography/ Interventional Exempt Endovasc exten prosth, addl Angiography/ Interventional Exempt Reposition veexemptus Catheter Angiography/ Interventional Exempt TransCatheter retrieval Angiography/ Interventional Exempt TransCatheter occlusion Angiography/ Interventional Exempt TransCatheter stent Angiography/ Interventional Exempt TransCatheter stent add-on Angiography/ Interventional Exempt TransCatheter stent Angiography/ Interventional Exempt TransCatheter stent add-on Angiography/ Interventional Exempt INJECTION SIALOGRAM Angiography/ Interventional Exempt

26 50394 INJECTION KIDNEY Angiography/ Interventional Exempt INJECTION URETER Angiography/ Interventional Exempt INJECTION LEAL CONDUIT Angiography/ Interventional Exempt INJECTION BLADDER Angiography/ Interventional Exempt INJECTION HYSTERO Angiography/ Interventional Exempt Endovasc tempory vessel occl Angiography/ Interventional Exempt CHEST FILMS AND FLUROSCOPY GUIDANCE NEEDLE BIOPSY Angiography/ Interventional Exempt PACEMAKER INSERTION Angiography/ Interventional Exempt REMOVE ESOPHAGEAL FOREIGN BODY Angiography/ Interventional Exempt CHOLANGIOGRAM IN SURGERY Angiography/ Interventional Exempt CHOLANGIOGRAM, POST-OPERATIVE Angiography/ Interventional Exempt X-RAY FOR BILE STONE REMOVAL Angiography/ Interventional Exempt X-RAY GUIDE FOR GI TUBE Angiography/ Interventional Exempt X-RAY GUIDE, STOMACH TUBE Angiography/ Interventional Exempt X-RAY GUIDE, INTESTINAL TUBE Angiography/ Interventional Exempt X-RAY GUIDE, GI DILATION Angiography/ Interventional Exempt X-RAY, BILE DUCT DILATATION Angiography/ Interventional Exempt X-RAY CONTROL Catheter INSERT Angiography/ Interventional Exempt VENOUS SAMPLING BY Catheter Angiography/ Interventional Exempt STEREOTACTIC BREAST BIOPSY/ FINE OR CORE NEEDLE Angiography/ Interventional Exempt BREAST NEEDLE LOCALIZATION Angiography/ Interventional Exempt Percut vertebroplasty, CT Computerized Tomography Exempt CT GUIDANCE FOR NEEDLE BIOPSY Computerized Tomography Exempt CT scan for tissue ablation Computerized Tomography Exempt CT GUIDANCE FOR CYST ASPIRATION Computerized Tomography Exempt CT GUIDANCE FOR RADIATION FIELDS Computerized Tomography Exempt CT BONE DENSITY, AXIAL DEXA Exempt DXA BONE DENSITY, AXIAL DEXA Exempt GENERATION OF AUTOMATED DATA; INTERACTIVE PROCESS INVOLVING Exempt COMPLEX MANIPULATIONS AND INTERPRETATION, EXCEEDING 30 MINUT Exempt ECHO EXAM, FETAL HEART; FOLLOW UP OR REPEAT Echocardiography Exempt ECHO EXAM, FETAL HEART; DOPPLER, PULSED WAVE A/O CONTIN. WAV Echocardiography Exempt ECHO EXAM, FETAL HEART; FOLLOW UP OR REPEAT Echocardiography Exempt Bx breast percut w/image Fluoroscopy Exempt Bx breast percut w/device Fluoroscopy Exempt CHEST FLUROSCOPY FOR TRANSBRONCHIAL BRUSH/BIOPSY Fluoroscopy Exempt BARIUM ENEMA THERAPEUTIC FOR INTUSSECPTION Fluoroscopy Exempt Xray control Catheter insert Fluoroscopy Exempt X-ray guide, GU dilation Fluoroscopy Exempt Fluoroguide for vein device Fluoroscopy Exempt FLUOROSCOPY, PHYSICIAN TIME MORE THAN ONE HOUR, ASSISTING A Fluoroscopy Exempt

27 FLUOROSCOPIC LOCALIZATION FOR NEEDLE BIOPSY OR FINE NEEDLE A Fluoroscopy Exempt Fluoroguide for spine inject Fluoroscopy Exempt Percut vertebroplasty fluor Fluoroscopy Exempt MR guidance for needle place Magnetic Resonance Imaging Exempt MRI for tissue ablation Magnetic Resonance Imaging Exempt COMPUTER DX MAMMOGRAM ADD-ON Mammography Exempt COMP SCREEN MAMMOGRAM ADD-ON Mammography Exempt MAMMOGRAM, SCREENING Mammography Exempt PROVIDE RADIOISOTOPE(S) Nuclear Cardiology Exempt Cardiovascular stress test Nuclear Cardiology Exempt Cardiovascular stress test Nuclear Cardiology Exempt Cardiovascular stress test Nuclear Cardiology Exempt Cardiovascular stress test Nuclear Cardiology Exempt Ob us < 14 wks, single fetus OB Ultrasound Exempt Ob us < 14 wks, addl fetus OB Ultrasound Exempt ULTRASOUND OBSTETRICAL * PREGNANT UTERUS COMPLETE OB Ultrasound Exempt ULTRASOUND OBSTETRIC PREGNANT UTERUS,TWINS OB Ultrasound Exempt Ob us, detailed, sngl fetus OB Ultrasound Exempt Ob us, detailed, addl fetus OB Ultrasound Exempt ULTRASOUND OBSTETRICAL LIMITED, AGE, HEART BEAT,PLACENTA, P OB Ultrasound Exempt ULTRASOUND OBSTETRICAL OB ULTRASOUND OR ECHO, FOLLOW-UP /REP OB Ultrasound Exempt Transvaginal us, obstetric OB Ultrasound Exempt ULTRASOUND OBSTETRICAL ECHO PREGNANT UTERUS BIOPHYSICAL PRO OB Ultrasound Exempt Fetl biophys profil w/o strs OB Ultrasound Exempt FETAL ECHOCARDIOGRAM OB Ultrasound Exempt CHORIONIC VILLUS SAMPLING OB Ultrasound Exempt ULTRASOUND GUIDANCE FOR AMNIOCENTESIS OB Ultrasound Exempt 0082T Stereotactic rad delivery Other Exempt 0083T Stereotactic rad tx mngmt Other Exempt 0174T CAD CXR WITH INTERP Other Exempt 0175T CAD CXR REMOTE other Exempt Fna w/image Other Exempt PHARMACY, DRUGS INCIDENT TO RADIOLOGY Other Exempt Therapeutic Radiology General Other Exempt 331 Therapeutic Radiology Chemotherapy Inject Other Exempt 332 Therapeutic Radiology Oral Chemo Other Exempt 333 Therapeutic Radiology Radiation Therapy Other Exempt 335 Therapeutic Radiology IV Chemo Other Exempt 339 Therapeutic Radiology Other Other Exempt 342 Nuclear Medicine Therapeutic Other Exempt Place needle in vein Other Exempt Injection, venography Other Exempt

28 36010 Place Catheter in vein Other Exempt Place Catheter in vein Other Exempt Place Catheter in vein Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Establish access to artery Other Exempt Establish access to artery Other Exempt Establish access to artery Other Exempt Artery to vein shunt Other Exempt Establish access to aorta Other Exempt Place Catheter in aorta Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt Place Catheter in artery Other Exempt 371 ANESTHESIA, INCIDENT TO RADIOLOGY Other Exempt Intravascular us Other Exempt Intravascular us Other Exempt Laparoscopy w/cholangio Other Exempt Laparo w/cholangio/biopsy Other Exempt 621 Med/Surg Supplies Incident. to Radiology Other Exempt Injection for myelogram Other Exempt Inject for spine disk x-ray Other Exempt Inject for spine disk x-ray Other Exempt Injection for tear sac x-ray Other Exempt PERQ VERTEBROPLASTY, FLUOR Other Exempt PERQ VERTEBROPLASTY, CT Other Exempt Xray, endovasc thor ao repr Other Exempt Xray, endovasc thor ao repr Other Exempt Xray, place prox ext thor ao Other Exempt Xray, place dist ext thor ao Other Exempt d render w/o postprocess Other Exempt d rendering w/postprocess Other Exempt US GUIDE, INTRAOP Other Exempt FLUOROGUIDE FOR VEIN DEVICE Other Exempt NEEDLE LOCALIZATION BY X-RAY Other Exempt FLUOROGUIDE FOR SPINE INJECT Other Exempt STEREOTACT GUIDE FOR BRST BX Other Exempt GUIDANCE FOR NEEDLE, BREAST Other Exempt Radiation therapy planning Other Exempt Radiation therapy planning Other Exempt Radiation therapy planning Other Exempt Set radiation therapy field Other Exempt Set radiation therapy field Other Exempt Set radiation therapy field Other Exempt Set radiation therapy field Other Exempt

29 77299 Radiation therapy planning Other Exempt Radiation therapy dose plan Other Exempt Radioltherapy dos plan, imrt Other Exempt Radiation therapy dose plan Other Exempt Radiation therapy dose plan Other Exempt Radiation therapy dose plan Other Exempt Radiation therapy port plan Other Exempt Radiation therapy dose plan Other Exempt Radiation therapy dose plan Other Exempt Radiation therapy dose plan Other Exempt Special radiation dosimetry Other Exempt Radiation treatment aid(s) Other Exempt Radiation treatment aid(s) Other Exempt Radiation treatment aid(s) Other Exempt Radiation physics consu Other Exempt Radiation physics consult Other Exempt Proton beam delivery Other Exempt Proton beam treatment Other Exempt External radiation dosimetry Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiation treatment delivery Other Exempt Radiology port film(s) Other Exempt Radiation tx delivery, imrt Other Exempt Weekly radiation therapy Other Exempt Weekly radiation therapy Other Exempt Stereoscopic x-ray guidance Other Exempt Neutron beam tx, simple Other Exempt Neutron beam tx, complex Other Exempt Weekly radiation therapy Other Exempt Radiation tx management, x5 Other Exempt Weekly radiation therapy Other Exempt Radiation therapy management Other Exempt Stereotactic radiation trmt Other Exempt Special radiation treatment Other Exempt Radiation therapy management Other Exempt Proton trmt, simple w/o comp Other Exempt Proton trmt, simple w/comp Other Exempt Proton trmt, intermediate Other Exempt Proton treatment, complex Other Exempt Hyperthermia treatment Other Exempt

30 77605 Hyperthermia treatment Other Exempt Hyperthermia treatment Other Exempt Hyperthermia treatment Other Exempt Hyperthermia treatment Other Exempt Infuse radioactive materials Other Exempt Radioelement application Other Exempt Radioelement application Other Exempt Radioelement application Other Exempt Radioelement application Other Exempt Radioelement application Other Exempt Radioelement application Other Exempt High intensity brachytherapy Other Exempt High intensity brachytherapy Other Exempt High intensity brachytherapy Other Exempt High intensity brachytherapy Other Exempt Radioelement application Other Exempt Radioelement handling Other Exempt Radium/radioisotope therapy Other Exempt Breath tst attain/anal c-14 Other Exempt Breath test analysis, c-14 Other Exempt Radiofrequency energy to anus to create thermal lesions Other Exempt C9716 C9725 Place endorectal app Other Exempt G0338 Linear accelerator stero pln Other Exempt G0339 Robot lin-radsurg com, first Other Exempt G0340 Robt lin-radsurg fractx 2-5 Other Exempt R0070 Transport portable x-ray Other Exempt R0075 Transport port x-ray multipl Other Exempt S8060 Supply of contrast material Other Exempt Injection for breast x-ray Exempt ADDITIONAL X-RAYS AT SURGERY Exempt Us for tissue ablation Ultrasound General Exempt Umbilical artery echo Ultrasound General Exempt Middle cerebral artery echo Ultrasound General Exempt ULTRASOUND GUIDANCE FOR MYOCARDIAL BIOPSY Ultrasound General Exempt ULTRASOUND GUIDANCE THORACENTESIS Ultrasound General Exempt Us guide, vascular access Ultrasound General Exempt ULTRASOUND GUIDANCE FOR NEEDLE BIOPSY Ultrasound General Exempt ULTRASOUND GUIDANCE FOR ASPIRATION OF OVA Ultrasound General Exempt GASTROINTESTINAL ENDOSCOPIC ULTRASOUND Ultrasound General Exempt ULTRASOUND AT SURGERY Ultrasound General Exempt G0161 Echo guide for cryo probes Ultrasound General Exempt