Abor- Code Spec Description

Transcription

1 Physician Assistant Fee Schedule Effective January 1, 2013 ***See Physician Injectable Fee Schedule for J Code pricing 0-20 Max 21+ Max Incision And Drainage Of Abscess (Eg, Carbuncle,Suppurative Hidradenitis, Incision And Drainage Of Abscess (Eg, Carbuncle, Suppurative Hidradenitis, Incision And Removal Of Foreign Body, Subcutaneous Tissues; Simple Incision And Drainage Of Hematoma, Seroma Or Fluid Collection Puncture Aspiration Of Abscess, Hematoma, Bulla, Or Cyst Debridement Of Skin, Subcutaneous Tissue, Muscle And Fascia For Necrotizing AS Debridement; Skin, And Subcutaneous Tissue Deb Subq Tissue Add-On Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus); Two Paring Or Cutting Of Benign Hyperkeratotic Lesion (Eg, Corn Or Callus); Mor Biopsy Of Skin, Subcutaneous Tissue And/Or Mucous Membrane (Including Simpl Biopsy Of Skin, Subcutaneous Tissue And/Or Mucous Membrane (Including Simpl Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed E Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed E Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed E Excision, Benign Lesion Including Margins, Except Skin Tag (Unless Listed E Avulsion Of Nail Plate, Partial Or Complete, Simple; Single Evacuation Of Subungual Hematoma Wedge Excision Of Skin Of Nail Fold (Eg, For Ingrown Toenail) R Tattooing, Intradermal Introduction Of Insoluble Opaque Pigments To Correct R Tattooing, Intradermal Introduction Of Insoluble Opaque Pigments To Correct Removal, Implantable Contraceptive Capsules Insertion, Non-Biodegradable Drug Delivery Implant Removal, Non-Biodegradable Drug Delivery Implant Removal With Reinsertion, Non-Biodegradable Drug Delivery Implant Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Geni Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Geni _01_01 Phys Assistant to MCD PUBL v1.2.xls 1/111

2 12004 Simple Repair Of Superficial Wounds Of Scalp, Neck, Axillae, External Geni Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And Simple Repair Of Superficial Wounds Of Face, Ears, Eyelids, Nose, Lips And/ AS Layer Closure Of Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Exclu Layer Closure Of Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Exclu Layer Closure Of Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Exclud Layer Closure Of Wounds Of Scalp, Axillae, Trunk And/Or Extremities (Exclud Layer Closure Of Wounds Of Neck, Hands, Feet And/Or External Genitalia; Ove AS Layer Closure Of Wounds Of Face, Ears, Eyelids, Nose, Lips And/Or Mucous Me AS Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Woun AS Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Woun AS Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Woun AS Surgical Preparation Or Creation Of Recipient Site By Excision Of Open Woun AS Allograft Skin For Temporary Wound Closure, Trunk, Arms, Legs; First 100 Sq Cm Or Less, Or 1% Of Body Area Of Infants And Children Application Of Skin Substitute Graft To Trunk, Arms, Legs, Total Wound Surface Area Up To Sq Cm; Each Additional 25 Sq Cm Wound Surface Area, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) Application Of Skin Substitute Graft To Trunk, Arms, Legs, Total Wound Surface Area Greater Than Or Equal To 100 Sq Cm; First 100 Sq Cm Wound Surface Area, Or 1% Of Body Area Of Infants And Children Application Of Skin Substitute Graft To Trunk, Arms, Legs, Total Wound Surface Area Greater Than Or Equal To 100 Sq Cm; Each Additional 100 Sq Cm Wound Surface Area, Or Part Thereof, Or Each Additional 1% Of Body Area Of Infants And Children, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) Application Of Skin Substitute Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, And/Or Multiple Digits, Total Wound Surface Area Up To 100 Sq Cm; First 25 Sq Cm Or Less Wound Surface Area _01_01 Phys Assistant to MCD PUBL v1.2.xls 2/111

3 15276 Application Of Skin Substitute Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, And/Or Multiple Digits, Total Wound Surface Area Up To 100 Sq Cm; Each Additional 25 Sq Cm Wound Surface Area, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) Application Of Skin Substitute Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, And/Or Multiple Digits, Total Wound Surface Area Greater Than Or Equal To 100 Sq Cm; First 100 Sq Cm Wound Surface Area, Or 1% Of Body Area Of Infants And Children 0-20 Max 21+ Max Hysterectomy Sterilization Abortion Application Of Skin Substitute Graft To Face, Scalp, Eyelids, Mouth, Neck, Ears, Orbits, Genitalia, Hands, Feet, And/Or Multiple Digits, Total Wound Surface Area Greater Than Or Equal To 100 Sq Cm; Each Additional 100 Sq Cm Wound Surface Area, Or Part Thereof, Or Each Additional 1% Of Body Area Of Infants And Children, Or Part Thereof (List Separately In Addition To Code For Primary Procedure) Forehead Flap With Preservation Of Vascular Pedicle (Eg, Axial Pattern Flap AS Muscle, Myocutaneous, Or Fasciocutaneous Flap; Head And Neck (Eg, Temporali AS Muscle, Myocutaneous, Or Fasciocutaneous Flap; Trunk AS Muscle, Myocutaneous, Or Fasciocutaneous Flap; Lower Extremity AS Flap; Neurovascular Pedicle AS Free Muscle Or Myocutaneous Flap With Microvascular Anastomosis AS Free Skin Flap With Microvascular Anastomosis AS Free Fascial Flap With Microvascular Anastomosis AS Graft; Derma-Fat-Fascia AS Implantation Of Biologic Implant (Eg, Acellular Dermal Matrix) For Soft Tissue Reinforcement (Eg, Breast, Trunk) (List Separately In Addition To Code For Primary Procedure) Excision, Excessive Skin And Subcutaneous Tissue (Includes Lipectomy); Abdo Y AS Graft For Facial Nerve Paralysis; Free Muscle Graft (Including Obtaining Gr AS Graft For Facial Nerve Paralysis; Free Muscle Flap By Microsurgical Techniq AS Graft For Facial Nerve Paralysis; Regional Muscle Transfer AS Excision, Excessive Skin And Subcutaneous Tissue (Includes Lipectomy), Abdo Y AS Excision, Coccygeal Pressure Ulcer, With Coccygectomy; With Flap Closure AS Excision, Sacral Pressure Ulcer, With Skin Flap Closure; With Ostectomy AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 3/111

4 15937 Excision, Sacral Pressure Ulcer, With Muscle Or Myocutaneous Flap Closure; AS Excision, Ischial Pressure Ulcer, With Ostectomy, In Preparation For Muscle AS Excision, Trochanteric Pressure Ulcer, With Skin Flap Closure; AS Excision, Trochanteric Pressure Ulcer, With Muscle Or Myocutaneous Flap Clo AS Dressings And/Or Debridement Of Partial-Thickness Burns, Initial Or Subsequ Destruction (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery, Destruction By Any Method, Including Laser, With Or Without Surgical Curett Destruction (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery, Destruction (Eg, Laser Surgery, Electrosurgery, Cryosurgery, Chemosurgery, Destruction By Any Method Of Flat Warts, Molluscum Contagiosum, Or Milia; Chemical Cauterization Of Granulation Tissue (Proud Flesh,Sinus Or Fistul Destruction, Malignant Lesion (Eg, Laser Surgery, Electrosurgery, Cryosurge Destruction, Malignant Lesion, Any Method, Trunk, Arms Or Legs; Lesion Diam Destruction, Malignant Lesion, Any Method, Trunk, Arms Or Legs; Lesion Diam Destruction, Malignant Lesion, Any Method, Trunk, Arms Or Legs; Lesion Diam Mohs Micrographic Technique, Including Removal Of All Gross Tumor, Surgical AS Mohs Micrographic Technique, Including Removal Of All Gross Tumor, Surgical AS Mohs Micrographic Technique, Including Removal Of All Gross Tumor, Surgical AS Mohs Micrographic Technique, Including Removal Of All Gross Tumor, Surgical AS Mohs Micrographic Technique, Including Removal Of All Gross Tumor, Surgical AS Excision Of Chest Wall Tumor Including Ribs AS Excision Of Chest Wall Tumor Involving Ribs, With Plastic Reconstruction; W AS Excision Of Chest Wall Tumor Involving Ribs, With Plastic Reconstruction; W AS Mastectomy For Gynecomastia AS Mastectomy, Partial (Eg, Lumpectomy, Tylectomy, Quadrantectomy, Segmentecto Mastectomy, Partial (Eg, Lumpectomy, Tylectomy, Quadrantectomy, Segmentecto AS Mastectomy, Simple, Complete AS Mastectomy, Subcutaneous AS Mastectomy, Radical, Including Pectoral Muscles, Axillary Lymph Nodes AS Mastectomy, Radical, Including Pectoral Muscles, Axillary And Internal Mamm AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 4/111

5 19307 Mastectomy, Modified Radical, Including Axillary Lymph Nodes, With Or Witho AS R Mastopexy AS Reduction Mammaplasty Y AS Mammaplasty, Augmentation; With Prosthetic Implant Y AS R Breast Reconstruction, Immediate Or Delayed, With Tissue Expander, Includin AS R Breast Reconstruction With Latissimus Dorsi Flap, Without Prosthetic Implan AS R Breast Reconstruction With Free Flap AS R Breast Reconstruction With Other Technique AS R Breast Reconstruction With Transverse Rectus Abdominis Myocutaneous Flap (T AS R Breast Reconstruction With Transverse Rectus Abdominis Myocutaneous Flap (T AS R Breast Reconstruction With Transverse Rectus Abdominis Myocutaneous Flap (T AS Exploration Of Penetrating Wound (Separate Procedure); Neck AS Exploration Of Penetrating Wound (Separate Procedure); Abdomen/Flank/Back AS Excision Of Epiphyseal Bar, With Or Without Autogenous Soft Tissue Graft Ob AS Biopsy, Vertebral Body, Open; Lumbar Or Cervical AS Injection, Therapeutic (Eg, Local Anesthetic, Corticosteroid), Carpal Tunnel Injection, Enzyme (Eg, Collagenase), Palmar Fascial Cord (Ie, Dupuytren'S Contracture) Injection(S); Single Tendon Origin/Insertion Injection(S); Single Or Multiple Trigger Point(S), One Or Two Muscle(S) Injection(S); Single Or Multiple Trigger Point(S), Three Or More Muscle(S) Arthrocentesis, Aspiration And/Or Injection; Small Joint Or Bursa (Eg, Fing Arthrocentesis, Aspiration And/Or Injection; Intermediate Joint Or Bursa (E Arthrocentesis, Aspiration And/Or Injection; Major Joint Or Bursa (Eg, Sho Insertion Of Wire Or Pin With Application Of Skeletal Traction, Including Removal Application Of A Multiplane (Pins Or Wires In More Than One Plane), Unilate AS Replantation, Arm (Includes Surgical Neck Of Humerus Through Elbow Joint); AS Replantation, Forearm (Includes Radius And Ulna To Radial Carpal Joint); Co AS Replantation, Hand (Includes Hand Through Metacarpophalangeal Joints); Comp AS Replantation, Digit, Excluding Thumb (Includes Metacarpophalangeal Joint To AS Replantation, Digit, Excluding Thumb (Includes Distal Tip To Sublimis Tendo AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 5/111

6 20824 Replantation, Thumb (Includes Carpometacarpal Joint To Mp Joint); Complete AS Replantation, Thumb (Includes Distal Tip To Mp Joint); Complete Amputation AS Replantation, Foot; Complete Amputation AS Bone Graft, Any Donor Area; Minor Or Small (Eg, Dowel Or Button) AS Bone Graft, Any Donor Area; Major Or Large AS Fascia Lata Graft; By Incision And Area Exposure, Complex Or Sheet AS Tendon Graft, From A Distance (Eg, Palmaris, Toe Extensor, Plantaris) AS Autograft For Spine Surgery Only (Includes Harvesting The Graft); Morselize AS Autograft For Spine Surgery Only (Includes Harvesting The Graft); Structura AS Bone Graft With Microvascular Anastomosis; Fibula AS Bone Graft With Microvascular Anastomosis; Iliac Crest AS Bone Graft With Microvascular Anastomosis; Metatarsal AS R Bone Graft With Microvascular Anastomosis; Other Than Fibula, Iliac Crest, AS Free Osteocutaneous Flap With Microvascular Anastomosis; Other Than Iliac C AS Free Osteocutaneous Flap With Microvascular Anastomosis; Iliac Crest AS Free Osteocutaneous Flap With Microvascular Anastomosis; Metatarsal AS Free Osteocutaneous Flap With Microvascular Anastomosis; Great Toe With Web AS Electrical Stimulation To Aid Bone Healing; Invasive (Operative) AS Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; Less Than 2 Cm AS Excision, Tumor, Soft Tissue Of Face Or Scalp, Subcutaneous; 2 Cm Or Greater AS Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial (Eg, Subgaleal, AS Excision, Tumor, Soft Tissue Of Face And Scalp, Subfascial (Eg, Subgaleal, AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Face Or AS Excision Of Malignant Tumor Of Maxilla Or Zygoma AS Excision Of Malignant Tumor Of Mandible; AS Excision Of Malignant Tumor Of Mandible; Radical Resection AS Excision Of Benign Tumor Or Cyst Of Mandible; Requiring Intra-Oral Osteotom AS Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Intra-Oral Osteotomy AS Excision Of Benign Tumor Or Cyst Of Maxilla; Requiring Extra-Oral Osteotomy AS Meniscectomy, Partial Or Complete, Temporomandibular Joint (Separate Proced AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 6/111

7 21121 R Genioplasty; Sliding Osteotomy, Single Piece AS Augmentation, Mandibular Body Or Angle; Prosthetic Material AS Augmentation, Mandibular Body Or Angle; With Bone Graft, Onlay Or Interposi AS Reconstruction Midface, Lefort I; Single Piece, Segment Movement In Any Dir AS Reconstruction Midface, Lefort I; Two Pieces, Segment Movement In Any Direc AS Reconstruction Midface, Lefort I; Three Or More Pieces, Segment Movement In AS Reconstruction Midface, Lefort I; Single Piece, Segment Movement In Any Dir AS Reconstruction Midface, Lefort I; Two Pieces, Segment Movement In Any Direc AS Reconstruction Midface, Lefort I; Three Or More Pieces, Segment Movement In AS Reconstruction Midface, Lefort Ii; Anterior Intrusion (Eg, Treacher-Collins AS Reconstruction Midface, Lefort Ii; Any Direction, Requiring Bone Grafts (In AS Reconstruction Midface, Lefort Iii (Extracranial), Any Type, Requiring Bone AS Reconstruction Midface, Lefort Iii (Extracranial), Any Type, Requiring Bone AS Reconstruction Midface, Lefort Iii (Extra And Intracranial) With Forehead A AS Reconstruction Midface, Lefort Iii (Extra And Intracranial) With Forehead A AS Reconstruction, Bifrontal, Superior-Lateral Orbital Rims And Lower Forehead AS Reconstruction, Entire Or Majority Of Forehead And/Or Supraorbital Rims; Wi AS Reconstruction, Entire Or Majority Of Forehead And/Or Supraorbital Rims; Wi AS Reconstruction Of Orbital Walls, Rims, Forehead, Nasoethmoid Complex Follow AS Reconstruction Of Orbital Walls, Rims, Forehead, Nasoethmoid Complex Follow AS Reconstruction Of Orbital Walls, Rims, Forehead, Nasoethmoid Complex Follow AS Reconstruction Midface, Osteotomies (Other Than Lefort Type) And Bone Graft AS Reconstruction Of Mandibular Rami, Horizontal, Vertical, ''C'', Or ''L'' Os AS Reconstruction Of Mandibular Ramus, Horizontal, Vertical, ''C'', Or ''L'' O AS Reconstruction Of Mandibular Rami And/Or Body, Sagittal Split; Without Inte AS Reconstruction Of Mandibular Rami, Sagittal Split; With Internal Rigid Fix AS Osteotomy, Mandible, Segmental AS Osteotomy, Mandible, Segmental; With Genioglossus Advancement AS Osteotomy, Maxilla, Segmental (Eg, Wassmund Or Schuchard) AS Arthroplasty, Temporomandibular Joint, With Or Without Autograft (Includes AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 7/111

8 21242 Arthroplasty, Temporomandibular Joint, With Allograft AS Arthroplasty, Temporomandibular Joint, With Prosthetic Joint Replacement AS Reconstruction Of Mandible, Extraoral, With Transosteal Bone Plate (Eg, Man AS Reconstruction Of Mandible Or Maxilla, Subperiosteal Implant; Partial AS Reconstruction Of Mandible Or Maxilla, Subperiosteal Implant; Complete AS Reconstruction Of Mandibular Condyle With Bone And Cartilage Autografts (In AS Reconstruction Of Zygomatic Arch And Glenoid Fossa With Bone And Cartilage AS Reconstruction Of Orbit With Osteotomies (Extracranial) And With Bone Graft AS Periorbital Osteotomies For Orbital Hypertelorism, With Bone Grafts; Extrac AS Periorbital Osteotomies For Orbital Hypertelorism, With Bone Grafts; Combin AS Periorbital Osteotomies For Orbital Hypertelorism, With Bone Grafts; With F AS Orbital Repositioning, Periorbital Osteotomies, Unilateral, With Bone Graft AS Orbital Repositioning, Periorbital Osteotomies, Unilateral, With Bone Graft AS Malar Augmentation, Prosthetic Material AS Secondary Revision Of Orbitocraniofacial Reconstruction AS Open Treatment Of Nasoethmoid Fracture; With External Fixation AS Open Treatment Of Depressed Frontal Sinus Fracture AS Open Treatment Of Complicated (Eg, Comminuted Or Involving Posterior Wall) AS Open Treatment Of Nasomaxillary Complex Fracture (Lefort Ii Type); Requirin AS Open Treatment Of Depressed Malar Fracture, Including Zygomatic Arch And Ma AS Open Treatment Of Complicated (Eg, Comminuted Or Involving Cranial Nerve Fo AS Open Treatment Of Complicated (Eg, Comminuted Or Involving Cranial Nerve Fo AS Open Treatment Of Orbital Floor ''Blowout'' Fracture; Transantral Approach AS Open Treatment Of Orbital Floor ''Blowout'' Fracture; Periorbital Approach AS Open Treatment Of Orbital Floor ''Blowout'' Fracture; Combined Approach AS Open Treatment Of Orbital Floor ''Blowout'' Fracture; Periorbital Approach, AS Open Treatment Of Orbital Floor ''Blowout'' Fracture; Periorbital Approach AS Closed Treatment Of Fracture Of Orbit, Except ''Blowout''; With Manipulatio AS Open Treatment Of Fracture Of Orbit, Except ''Blowout''; Without Implant AS Open Treatment Of Fracture Of Orbit, Except ''Blowout''; With Implant AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 8/111

9 21408 Open Treatment Of Fracture Of Orbit, Except ''Blowout''; With Bone Grafting AS Open Treatment Of Palatal Or Maxillary Fracture (Lefort I Type); AS Open Treatment Of Palatal Or Maxillary Fracture (Lefort I Type); Complicate AS Closed Treatment Of Craniofacial Separation (Lefort Iii Type) Using Interde AS Open Treatment Of Craniofacial Separation (Lefort Iii Type); With Wiring An AS Open Treatment Of Craniofacial Separation (Lefort Iii Type); Complicated (E AS Open Treatment Of Craniofacial Separation (Lefort Iii Type); Complicated, U AS Open Treatment Of Craniofacial Separation (Lefort Iii Type); Complicated, M AS Open Treatment Of Mandibular Or Maxillary Alveolar Ridge Fracture (Separate AS Open Treatment Of Mandibular Fracture; Without Interdental Fixation AS Open Treatment Of Mandibular Fracture; With Interdental Fixation AS Open Treatment Of Mandibular Condylar Fracture AS Open Treatment Of Complicated Mandibular Fracture By Multiple Surgical Appr AS Open Treatment Of Temporomandibular Dislocation AS Open Treatment Of Hyoid Fracture AS Incision And Drainage, Deep Abscess Or Hematoma, Soft Tissues Of Neck Or Th AS Biopsy, Soft Tissue Of Neck Or Thorax 3 Cm Or Greater AS Biopsy, Soft Tissue Of Neck Or Thorax 5 Cm Or Greater AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Neck Or AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Neck Or AS Excision Of Rib, Partial AS Costotransversectomy (Separate Procedure) AS Excision First And/Or Cervical Rib; AS Excision First And/Or Cervical Rib For Outlet Compression Syndrome Or Other AS Ostectomy Of Sternum, Partial AS Sternal Debridement AS Radical Resection Of Sternum; AS Radical Resection Of Sternum; With Mediastinal Lymphadenectomy AS Hyoid Myotomy And Suspension AS Division Of Scalenus Anticus; Without Resection Of Cervical Rib AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 9/111

10 21705 Division Of Scalenus Anticus; With Resection Of Cervical Rib AS Division Of Sternocleidomastoid For Torticollis, Open Operation; Without Ca AS Division Of Sternocleidomastoid For Torticollis, Open Operation; With Cast AS Reconstructive Repair Of Pectus Excavatum Or Carinatum; Open AS Reconstructive Repair Of Pectus Excavatum Or Carinatum; Minimally Invasive AS Reconstructive Repair Of Pectus Excavatum Or Carinatum; Minimally Invasive AS Closure Of Median Sternotomy Separation With Or Without Debridement (Separa AS Closed Treatment Of Rib Fracture, Uncomplicated, Each Treatment Of Rib Fracture Requiring External Fixation (''Flail Chest'') AS Open Treatment Of Sternum Fracture With Or Without Skeletal Fixation AS Excision, Tumor, Soft Tissue Of Back Or Flank, Subcutaneous; 3 Cm Or Greater AS Excision, Tumor, Soft Tissue Of Back Or Flank, Subfascial AS Excision, Tumor, Soft Tissue Of Back Or Flank, Subfascial (Eg, Intramuscular) AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Back Or AS Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lam AS Partial Resection Of Vertebral Component, Spinous Processes; Thoracic AS Partial Resection Of Vertebral Component, Spinous Processes; Lumbar AS Partial Excision Of Posterior Vertebral Component (Eg, Spinous Process, Lam AS Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Deco AS Partial Excision Of Vertebrae (Eg, For Osteomyelitis); Thoracic AS Partial Excision Of Vertebrae (Eg, For Osteomyelitis); Lumbar AS Partial Excision Of Vertebral Body, For Intrinsic Bony Lesion, Without Deco AS Osteotomy Of Spine For Correction Fixed Deformity, AS Osteotomy Of Spine For Correction Fixed Deformity, AS Osteotomy Of Spine, Posterior Or Posterolateral Approach, Three Columns, On AS Osteotomy Of Spine, Posterior Or Posterolateral Approach, One Vertebral Seg AS Osteotomy Of Spine, Posterior Approach, For Correction Of Deformity, Single AS Osteotomy Of Spine, Posterior Approach, For Correction Of Deformity, Single AS Osteotomy Of Spine, Posterior Or Posterolateral Approach, One Vertebral Seg AS Osteotomy Of Spine, Including Diskectomy, Anterior Approach, Single Vertebr AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 10/111

11 22224 Osteotomy Of Spine, Anterior Approach, For Correction Of Deformity, Single AS Osteotomy Of Spine, Including Diskectomy, Anterior Approach, Single Vertebr AS Open Treatment And/Or Reduction Of Odontoid Fracture(S) And Or Dislocation( AS Open Treatment And/Or Reduction Of Odontoid Fracture(S) And Or Dislocation( AS Open Treatment And/Or Reduction Of Vertebral Fracture(S) And/ Or Dislocatio AS Open Treatment And/Or Reduction Of Vertebral Fracture(S) And/ Or Dislocatio AS Open Treatment And/Or Reduction Of Vertebral Fracture(S) And/ Or Dislocatio AS Open Treatment And/Or Reduction Of Vertebral Fracture(S) And/Or Dislocation AS Arthrodesis, Lateral Extracavitary Technique, Including Minimal Diskectomy AS Arthrodesis, Lateral Extracavitary Technique, Including Minimal Diskectomy AS Arthrodesis, Lateral Extracavitary Technique, Including Minimal Diskectomy AS Arthrodesis, Anterior Transoral Or Extraoral Technique, Clivus-C1-C2 (Atlas AS Neck Spine Fuse & Remove Addl AS Addl Neck Spine Fusion AS Arthrodesis, Anterior Interbody Technique, Including Minimal Diskectomy To AS Arthrodesis, Anterior Interbody Technique, Including Minimal Diskectomy To AS Arthrodesis, Anterior Interbody Technique, Including Minimal Diskectomy To AS Arthrodesis, Anterior Interbody Technique, Including Minimal Diskectomy To AS Fusion of spine bones with removal of disc at lower spinal column with posterior instrumentation AS and image guidance Arthrodesis, Posterior Technique, Craniocervical (Occiput-C2) AS Arthrodesis, Posterior Technique, Atlas-Axis (C1-C2) AS Arthrodesis, Posterior Or Posterolateral Technique, Single Level; Cervical AS Arthrodesis, Posterior Or Posterolateral Technique, Single Level; Thoracic AS Arthrodesis, Posterior Or Posterolateral Technique, Single Level; Lumbar (W AS Arthrodesis, Posterior Or Posterolateral Technique, Single Level; Each Addi AS Arthrodesis, Posterior Interbody Technique, Including Laminectomy And/Or AS Arthrodesis, Posterior Interbody Technique, Single Interspace; Each Additio AS Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Technique Including Laminectomy And/ Or Discectomy Sufficient To Prepare Interspace (Other Than For Decompression), Single Interspace And Segment; Lumbar AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 11/111

12 22634 Arthrodesis, Combined Posterior Or Posterolateral Technique With Posterior Interbody Technique Including Laminectomy And/ Or Discectomy Sufficient To Prepare Interspace (Other Than For Decompression), Single Interspace And Segment; Each Additional Interspace And Segment (List Separately In Addition To Code For Primary Procedure) 0-20 Max 21+ Max AS Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; Up To AS Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 7 To AS Arthrodesis, Posterior, For Spinal Deformity, With Or Without Cast; 13 Or M AS Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 2 To 3 V AS Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 4 To 7 V AS Arthrodesis, Anterior, For Spinal Deformity, With Or Without Cast; 8 Or Mor AS R Kyphectomy, Circumferential Exposure Of Spine And Resection Of Vertebral Se AS R Kyphectomy, Circumferential Exposure Of Spine And Resection Of Vertebral Se AS Exploration Of Spinal Fusion AS Posterior Non-Segmental Instrumentation (Eg, Harrington Rod Technique), Ped AS Posterior Segmental Instrumentation (Eg, Pedicle Fixation, Dual Rods With M AS Posterior Segmental Instrumentation (Eg, Pedicle Fixation, Dual Rods With M AS Posterior Segmental Instrumentation (Eg, Pedicle Fixation, Dual Rods With M AS Anterior Instrumentation; 2 To 3 Vertebral Segments AS Anterior Instrumentation; 4 To 7 Vertebral Segments AS Anterior Instrumentation; 8 Or More Vertebral Segments AS Pelvic Fixation (Attachment Of Caudal End Of Instrumentation To Pelvic Bony AS Reinsertion Of Spinal Fixation Device AS Removal Of Posterior Nonsegmental Instrumentation (Eg, Harrington Rod) AS Application Of Intervertebral Biomechanical Device(S) (Eg, Synthetic Cage(S AS Removal Of Posterior Segmental Instrumentation AS Removal Of Anterior Instrumentation AS R Unlisted Procedure, Spine 90 1 AS Excision, Abdominal Wall Tumor, Subfascial (Eg, Desmoid) AS Excision, Tumor, Soft Tissue Of Abdominal Wall, Subfascial (Eg, Intramuscular); AS Excision, Tumor, Soft Tissue Of Abdominal Wall, Subcutaneous; Less Than 3 Cm AS Excision, Tumor, Soft Tissue Of Abdominal Wall, Subcutaneous; 3 Cm Or Greater AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 12/111

13 22904 Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of AS Removal Of Subdeltoid Calcareous Deposits, Open AS Capsular Contracture Release (Eg, Sever Type Procedure) AS Incision, Bone Cortex (Eg, Osteomyelitis Or Bone Abscess), Shoulder Area AS Arthrotomy, Glenohumeral Joint, Including Exploration, Drainage, Or Removal AS Biopsy, Soft Tissue Of Shoulder Area; 3 Cm Or Greater AS Biopsy, Soft Tissue Of Shoulder Area; 5 Cm Or Greater AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Shoulde AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), AS Arthrotomy, Glenohumeral Joint, Including Biopsy AS Arthrotomy; Glenohumeral Joint, With Synovectomy, With Or Without Biopsy AS Arthrotomy, Glenohumeral Joint, With Joint Exploration, With Or Without Rem AS Claviculectomy; Partial AS Claviculectomy; Total AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Clavicle Or Scapula; AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Proximal Humerus; AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Proximal Humerus; Wit AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Proximal Humerus; Wit AS Sequestrectomy (Eg, For Osteomyelitis Or Bone Abscess), Scapula AS Sequestrectomy (Eg, For Osteomyelitis Or Bone Abscess), Humeral Head To Sur AS Partial Excision (Craterization, Saucerization, Or Diaphysectomy) Bone (Eg, AS Partial Excision (Craterization, Saucerization, Or Diaphysectomy) Bone (Eg, AS Ostectomy Of Scapula, Partial (Eg, Superior Medial Angle) AS Resection Humeral Head AS Radical Resection For Tumor; Clavicle AS Radical Resection For Tumor; Scapula AS Radical Resection Of Bone Tumor, Proximal Humerus; AS Removal Of Foreign Body, Shoulder; Complicated (Eg, Total Shoulder) AS Muscle Transfer, Any Type, Shoulder Or Upper Arm; Single AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 13/111

14 23397 Muscle Transfer, Any Type For Paralysis Of Shoulder Or Upper Arm; Multiple AS Scapulopexy (Eg, Sprengel'S Deformity Or For Paralysis) AS Tenotomy, Shoulder Area; Single Tendon AS Tenotomy, Shoulder Area; Multiple Tendons Through Same Incision AS Repair Of Ruptured Musculotendinous Cuff (Eg, Rotator Cuff) Open; Acute AS Repair Of Ruptured Supraspinatus Tendon (Rotator Cuff) Or Musculotendinous AS Reconstruction Of Complete Shoulder (Rotator) Cuff Avulsion, Chronic (Inclu AS Tenodesis Of Long Tendon Of Biceps AS Resection Or Transplantation Of Long Tendon Of Biceps AS Capsulorrhaphy, Anterior; Putti-Platt Procedure Or Magnuson Type Operation AS Capsulorrhaphy, Anterior; With Labral Repair (Eg, Bankart Procedure) AS Capsulorrhaphy, Anterior, Any Type; With Bone Block AS Capsulorrhaphy For Recurrent Dislocation, Anterior, Any Type; With Coracoid AS Capsulorrhaphy, Glenohumeral Joint, Posterior, With Or Without Bone Block AS Capsulorrhaphy, Glenohumeral Joint, Any Type Multi-Directional Instability AS Arthroplasty, Glenohumeral Joint; Hemiarthroplasty AS Arthroplasty, Glenohumeral Joint; Total Shoulder (Glenoid And Proximal Hume AS Repair of shoulder AS Repair of shoulder AS Osteotomy, Clavicle, With Or Without Internal Fixation; With Bone Graft For AS Prophylactic Treatment (Nailing, Pinning, Plating Or Wiring) With Or Withou AS Prophylactic Treatment (Nailing, Pinning, Plating Or Wiring) With Or Withou AS Closed Treatment Of Clavicular Fracture; Without Manipulation Open Treatment Of Clavicular Fracture, With Or Without Internal Or External AS Open Treatment Of Sternoclavicular Dislocation, Acute Or Chronic; AS Open Treatment Of Sternoclavicular Dislocation, Acute Or Chronic; With Fasc AS Open Treatment Of Acromioclavicular Dislocation, Acute Or Chronic; AS Open Treatment Of Acromioclavicular Dislocation, Acute Or Chronic; With Fas AS Closed Treatment Of Scapular Fracture; Without Manipulation Open Treatment Of Scapular Fracture (Body, Glenoid Or Acromion) With Or Wit AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 14/111

15 23600 Closed Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture Open Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture, AS Open Treatment Of Proximal Humeral (Surgical Or Anatomical Neck) Fracture, AS Closed Treatment Of Greater Humeral Tuberosity Fracture; Without Manipulati Open Treatment Of Greater Humeral Tuberosity Fracture, Includes Internal Fi AS Open Treatment Of Acute Shoulder Dislocation AS Open Treatment Of Shoulder Dislocation, With Fracture Of Greater Humeral Tu AS Open Treatment Of Shoulder Dislocation, With Surgical Or Anatomical Neck Fr AS Arthrodesis, Glenohumeral Joint; AS Arthrodesis, Glenohumeral Joint; With Autogenous Graft (Includes Obtaining AS Interthoracoscapular Amputation (Forequarter) AS Disarticulation Of Shoulder; AS R Unlisted Procedure, Shoulder 90 1 AS Arthrotomy Of The Elbow, With Capsular Excision For Capsular Release (Separ AS Biopsy, Soft Tissue Of Upper Arm Or Elbow Area; 3 Cm Or Greater AS Biopsy, Soft Tissue Of Upper Arm Or Elbow Area; 5 Cm Or Greater AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Upper A AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Upper A AS Arthrotomy, Elbow; With Synovial Biopsy Only AS Arthrotomy, Elbow; With Joint Exploration, With Or Without Biopsy, With Or AS Arthrotomy, Elbow; With Synovectomy AS Excision Or Curettage Of Bone Cyst Or Benign Tumor, Humerus; With Autograft AS Excision Or Curettage Of Bone Cyst Or Benign Tumor, Humerus; With Allograft AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Head Or Neck Of Radiu AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Head Or Neck Of Radiu AS Sequestrectomy (Eg, For Osteomyelitis Or Bone Abscess), Shaft Or Distal Hum AS Sequestrectomy (Eg, For Osteomyelitis Or Bone Abscess), Olecranon Process AS Partial Excision (Craterization, Saucerization, Or Diaphysectomy) Bone (Eg, AS Radical Resection Of Capsule, Soft Tissue, And Heterotopic Bone, Elbow, Wit AS Radical Resection For Tumor, Shaft Or Distal Humerus; AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 15/111

16 24152 Radical Resection For Tumor, Radial Head Or Neck; AS Resection Of Elbow Joint (Arthrectomy) AS Muscle Or Tendon Transfer, Any Type, Upper Arm Or Elbow, Single (Excluding AS Tenoplasty, With Muscle Transfer, With Or Without Free Graft, Elbow To Shou AS Flexor-Plasty, Elbow (Eg, Steindler Type Advancement); AS Flexor-Plasty, Elbow (Eg, Steindler Type Advancement); With Extensor Advanc AS Tenodesis Of Biceps Tendon At Elbow (Separate Procedure) AS Repair, Tendon Or Muscle, Upper Arm Or Elbow, Each Tendon Or Muscle, Primar AS Reinsertion Of Ruptured Biceps Or Triceps Tendon, Distal, With Or Without T AS Repair Lateral Collateral Ligament, Elbow, With Local Tissue AS Reconstruction Lateral Collateral Ligament, Elbow, With Tendon Graft (Inclu AS Repair Medial Collateral Ligament, Elbow, With Local Tissue AS Reconstruction Medial Collateral Ligament, Elbow, With Tendon Graft (Includ AS Tenotomy, Elbow, Lateral Or Medial (Eg, Epicondylitis, Tennis Elbow, Golfer AS Arthroplasty, Elbow; With Membrane (Eg, Fascial) AS Arthroplasty, Elbow; With Distal Humeral Prosthetic Replacement AS Arthroplasty, Elbow; With Implant And Fascia Lata Ligament Reconstruction AS Arthroplasty, Elbow; With Distal Humerus And Proximal Ulnar Prosthetic Repl AS Arthroplasty, Radial Head; AS Arthroplasty, Radial Head; With Implant AS Revision of total elbow repair AS Revision of total elbow repair AS Osteotomy, Humerus, With Or Without Internal Fixation AS Multiple Osteotomies With Realignment On Intramedullary Rod, Humeral Shaft AS Osteoplasty, Humerus (Eg, Shortening Or Lengthening) (Excluding 64876) AS Repair Of Nonunion Or Malunion, Humerus; Without Graft (Eg, Compression Tec AS Repair Of Nonunion Or Malunion, Humerus; With Iliac Or Other Autograft (Inc AS Hemiepiphyseal Arrest (Eg, Cubitus Varus Or Valgus, Distal Humerus) AS Prophylactic Treatment (Nailing, Pinning, Plating Or Wiring), With Or Witho AS Closed Treatment Of Humeral Shaft Fracture; Without Manipulation _01_01 Phys Assistant to MCD PUBL v1.2.xls 16/111

17 24515 Open Treatment Of Humeral Shaft Fracture With Plate/Screws, With Or Without AS Treatment Of Humeral Shaft Fracture, With Insertion Of Intramedullary Impla AS Closed Treatment Of Supracondylar Or Transcondylar Humeral Fracture, With O Open Treatment Of Humeral Supracondylar Or Transcondylar Fracture, With Or AS Open Treatment Of Humeral Supracondylar Or Transcondylar Fracture, With Or AS Closed Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral; Withou Open Treatment Of Humeral Epicondylar Fracture, Medial Or Lateral, With Or AS Open Treatment Of Humeral Condylar Fracture, Medial Or Lateral, With Or Wit AS Open Treatment Of Periarticular Fracture And/Or Dislocation Of The Elbow (F AS Open Treatment Of Periarticular Fracture And/Or Dislocation Of The Elbow (F AS Open Treatment Of Acute Or Chronic Elbow Dislocation AS Open Treatment Of Monteggia Type Of Fracture Dislocation At Elbow (Fracture AS Closed Treatment Of Radial Head Subluxation In Child, Nursemaid Elbow, With Manipulation Closed Treatment Of Radial Head Or Neck Fracture; Without Manipulation Open Treatment Of Radial Head Or Neck Fracture, With Or Without Internal Fi AS Open Treatment Of Radial Head Or Neck Fracture, With Or Without Internal Fi AS Closed Treatment Of Ulnar Fracture, Proximal End (Eg, Olecranon Or Coronoid Open Treatment Of Ulnar Fracture Proximal End (Olecranon Process), With Or AS Arthrodesis, Elbow Joint; Local AS Arthrodesis, Elbow Joint; With Autogenous Graft (Includes Obtaining Graft) AS Amputation, Arm Through Humerus; With Primary Closure AS Amputation, Arm Through Humerus; Open, Circular (Guillotine) AS Amputation, Arm Through Humerus; Secondary Closure Or Scar Revision AS Amputation, Arm Through Humerus; Re-Amputation AS Amputation, Arm Through Humerus; With Implant AS Cineplasty, Upper Extremity, Complete Procedure AS Biopsy, Soft Tissue Of Forearm And/Or Wrist; 3 Cm Or Greater AS Biopsy, Soft Tissue Of Forearm And/Or Wrist; 3 Cm Or Greater AS Radical Resection Of Tumor (Eg, Malignant Neoplasm), Soft Tissue Of Fore AS Capsulotomy, Wrist (Eg, Contracture) AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 17/111

18 25107 Arthrotomy, Distal Radioulnar Joint Including Repair Of Triangular Cartilag AS Excision Of Tendon, Forearm And/Or Wrist, Flexor Or Extensor, Each AS Synovectomy, Extensor Tendon Sheath, Wrist, Single Compartment; With Resect AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Radius Or Ulna (Exclu AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Carpal Bones; With Au AS Excision Or Curettage Of Bone Cyst Or Benign Tumor Of Carpal Bones; With Al AS Sequestrectomy (Eg, For Osteomyelitis Or Bone Abscess), Forearm And/Or Wris AS Partial Excision (Craterization, Saucerization Or Diaphysectomy) Of Bone (E AS Radical Resection For Tumor, Radius Or Ulna AS Carpectomy; All Bones Of Proximal Row AS Removal Of Wrist Prosthesis; (Separate Procedure) AS Removal Of Wrist Prosthesis; Complicated, Including ''Total Wrist'' AS Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Secondary, Single, AS Repair, Tendon Or Muscle, Flexor, Forearm And/Or Wrist; Secondary, With Fre AS Tenodesis At Wrist; Flexors Of Fingers AS Tenodesis At Wrist; Extensors Of Fingers AS Tendon Transplantation Or Transfer, Flexor Or Extensor, Forearm And/Or Wris AS Tendon Transplantation Or Transfer, Flexor Or Extensor, Forearm And/Or Wris AS Flexor Origin Slide (Eg, For Cerebral Palsy, Volkmann Contracture), Forearm AS Flexor Origin Slide For Cerebral Palsy, Forearm And/Or Wrist; With Tendon(S AS Capsulorrhaphy Or Reconstruction, Wrist, Open (Eg, Capsulodesis, Ligament R AS Arthroplasty, Wrist, With Or Without Interposition, With Or Without Externa AS Centralization Of Wrist On Ulna (Eg, Radial Club Hand) AS Osteotomy, Radius; Distal Third AS Osteotomy, Radius; Middle Or Proximal Third AS Osteotomy; Ulna AS Osteotomy; Radius And Ulna AS Multiple Osteotomies, With Realignment On Intramedullary Rod (Sofield Type AS Multiple Osteotomies, With Realignment On Intramedullary Rod (Sofield Type AS Osteoplasty, Radius Or Ulna; Shortening AS 2013_01_01 Phys Assistant to MCD PUBL v1.2.xls 18/111