Listed below is an explanation of the types of service found on this schedule.

Transcription

1 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: LEGEND Listed below are some aids we hope will help you understand this fee schedule. If, after reading the information below, you need further clarification of an item, please call Molina Provider Relations at COLUMN 1. TS (Type Service): Definition: Files on which codes are loaded and from which claims are paid. The file to which a claim goes for pricing is determined by, among other things, the type of provider who is billing and by the modifier appended to the procedure code. Listed below is an explanation of the types of service found on this schedule Ambulatory Surgical Centers (non-hospital) are paid from this file. COLUMNS 2, 3 and 4. CODE, DESCRIPTION and FEE. COLUMN 5. AGE MIN and MAX: Codes with minimum or maximum age restrictions. If the recipient's age on the date of service is outside the minimum or maximum age, claims will deny. COLUMN 6. MED REV (Medical Review): Claims with some codes pend to Medical Review for review of the attachments, manual pricing, or to confirm Prior Authorization by the surgeon. COLUMN 7. PA (Prior Authorization): Some services must be prior authorized before they are rendered. If a PA request is approved, a PA number will be issued for inclusion on the claim. If a PA request is not approved, no payment for the service will be made. COLUMN 8. SEX (Restriction): Some procedure codes are indicated for only one sex. COLUMN 9. PSR (Provider Specialty Restriction): If a code has a provider specialty restriction, reimbursement for its performance will not be made to other specialties. COLUMN 10. SL (Service Limitation): Codes with frequency limitations. COLUMN 11. X-OVERS (Only): These codes are payable for Medicare/Medicaid recipients only. COLUMN 12. UVS>001: An 'X' in this column means more than one unit of service per day may be billed.

2 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: 1 08 G0105 COLORECTAL SCRN, HI RISK. IND G0121 COLON CA SCRN; NOT HIGH RISK IND G0260 INJ FOR SACROILIAC JT ANESTH V2785 CORNEAL TISSUE PROCESSING 1, ANES;INTRAORAL,INC BIOPSY, NOS DRAIN SKIN ABSCESS COMPLICATED SIMPLE REMOVAL FOREIGN BODY COMPLICATED REMOVAL FOREIGN BODY INCISE/DRAIN COMPLEX POSTOP WOUND DEBRIDE SKIN, FX DEBRIDE SKIN/MUSCLE, FX DEBRIDEMT;SKIN,SQ,MUSC.FASCIA,MUSC&B DEBRIDE SKIN, SUBCUTANEOUS TISSUE DEBRIDE;SKIN,SUBCU TISSUE AND MUSCLE DEBRIDE;SKIN,SUBC TISS,MUSCL & BONE BIOPSY OF SINGLE LESION DEBRIDE SKIN/MUSCLE, FX EXCISE BENIGN LESION TO 0.5 CM EXCISE BENIGN LESION 0.6 TO 1CM EXCISE BENIGN LESION 1.1 TO 2CM EXCISE BENIGN LESION 2.1 TO 3CM EXCISE BENIGN LESION 3.1 TO 4CM EXCISE BENIGN LESION OVER 4CM EXCISE BENIGN LESION TO 0.5CM EXCISE BENIGN LESION 0.6 TO 1CM EXCISE BENIGN LESION 3.1 TO 4CM EXCISE BENIGN LESION OVER 4.0CM EXCISE BENIGN LESION TO 0.5CM EXCISE BENIGN LESION 0.6 TO 1CM EXCISE BENIGN LESION 1.1 TO 2CM EXCISE BENIGN LESION 2.1 TO 3CM EXCISE BENIGN LESION 3.1 TO 4CM EXCISE BENIGN LESION OVER 4.0CM EXCISE/HIDRADENITIS/PRIMARY SUTURE EXCISE/HIDRADENITIS/W/OTHER CLOSURE EXCISE/HIDRADENITIS/PRIMARY SUTURE EXCISE/HIDRADENITS/OTHER CLOSURE EXCISE/HIDRADENITIS/PRIMARY SUTURE EXCISE/HIDRADENITIS/OTHER CLOSURE EXCISE MALIGNANCY TO 0.5CM EXCISE MALIGNANCY 0.6 TO 1CM EXCISE MALIGNANCY 1.1 TO 2CM EXCISE MALIGNANCY 2.1 TO 3CM EXCISE MALIGNANCY 3.1 TO 4CM EXCISE MALIGNANCY OVER 4CM

3 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: EXCISE MALIGNANCY TO 0.5CM EXCISE MALIGNANCY 0.6 TO 1CM EXCISE MALIGNANCY 1.1 TO 2CM EXCISE MALIGNANCY 2.1 TO 3CM EXCISE MALIGNANCY 3.1 TO 4CM EXCISE MALIGNANCY OVER 4CM EXCISE MALIGNANCY TO 0.5CM EXCISE MALIGNANCY 0.6 TO 1CM EXCISE MALIGNANCY 1.1 TO 2CM EXCISE MALIGNANCY 2.1 TO 3CM EXCISE MALIGNANCY 3.1 TO 4CM EXCISE MALIGNANCY OVER 4CM SIMPLE REMOVAL OF NAIL PLATE REMOVE ADDITIONAL NAIL PLATES EVACUATE HEMATOMA UNDER NAIL EXCISION NAIL AND NAIL MATRIX SIMPLE RECONSTRUCTION NAIL BED NAIL RECONSTRUCTION COMPLICATED SIMPLE EXCISION PILONIDAL CYST EXCISE PILONIDAL CYST;EXTENSIVE TATOOING; 6 SQ CM OR LESS X TATOOING; 6.1 TO 20 SQ CM X INSERTION OF TISSUE EXPANDER REPLACEMENT OF TISSUE EXPANDER WITH X REMOVE TISS EXP-NO PROSTHETIC INSERT X SIMPLE WOUND REPAIR 12.6 TO 20 CM SIMPLE WOUND REPAIR 20.1 TO 30 CM SIMPLE WOUND REPAIR OVER 30 CM SIMPLE WOUND RPAIR 12.6 TO 20 CM SIMPLE WOUND REPAIR 20.1 TO 30CM SIMPLE WOUND REPAIR OVER 30CM TREAT SUPER DEHISCENCE; SIMPLE CLOSE TREAT SUPER DEHISCENCE; W/PACKING REPAIR OF WOUND (7.6 TO 12.5 CENTIME REPAIR OF WOUND (12.6 TO 20.0 CENTIM REPAIR OF WOUND (20.1 TO 30.0 CENTIM REPAIR OF WOUND (OVER 30.0 CENTIMETE LAYER CLOSURE 7.6 TO 12.5 CM LAYER CLOSURE 12.6 TO 20 CM LAYER CLOSURE 20.1 TO 30 CM LAYERCLOSURE WOUND OVER 30 CM LAYER CLOSURE 7.6 TO 12.5 CM LAYER CLOSURE 12.6 TO 20 CM LAYER CLOSURE 20.1 TI 30 CM LAYER CLOSURE WOUND OVER 30 CM

4 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: COMPLEX REPAIR 1.1 TO 2.5 CM REPAIR WOUND/LESION ADD-ON COMPLEX REPAIR 1.1 TO 2.5 CM REPAIR WOUND/LESION ADD-ON COMPLEX REPAIR 1.1 TO 2.5 CM REPAIR WOUND/LESION ADD-ON REPAIR WOUND/LESION ADD-ON EXT/COMP SECONDARY CLOSE /DEHISCENCE SKIN TISSUE REARRANGEMENT TISSUE TRANSFER; TO 10 SQ CM WOUND PREP, TRK/ARM/LEG SURGICAL PREPARATION OR CREATION WOUND PREP, F/N/HF/G SURGICAL PREPARATION OR CREATION HARVEST CULTURED SKIN GRAFT PINCH GRAFT;DEFECT UP TO 2CM SPLIT GRAFT; UP TO 100 SQ CM EPIDRM AUTOGRPT TRNK/ARM/LEG EPIDRM AUTOGRFT T/A/L ADD-ON E ODR, A-GRFT FACE/NCK/HF/G EPIDRM A-GRFT F/N/HF/G ADDL SPLIT GRAFT; UP TO 100 SQ CM DERM AUTOGRAFT,TRNK/ARM/LEG DERM AUTOGRAFT T/A/L ADD-ON DERM AUTPGRAFT FACE/NCK/HF/G DERM AUTOGRAFT, F/N/HF/G TISSUE CULTURED SKIN AUTOGRAFT, TRUN TISSUE CULTURED SKIN AUTOGRAFT, TRUN TISSUE CULTURED SKIN AUTOGRAFT, TRUN TISSUE CULTURED SKIN AUTOGRAFT, FACE TISSUE CULTURED SKIN AUTOGRAFT, FACE TISSUE CULTURED SKIN AUTOGRAFT, FACE FULL THICK GRAFT EACH ADD 20 SQ CM FULL THICK GRAFT TO 20 SQ CM SKIN FULL GRAFT ADD - ON FULL THICK GRAFT TO 20 SQ CM FULL THICK GRAFT EACH ADD 20 SQ CM INTERM DELAY FLAP CHIN/NECK/FEET BLEPHAROPLASTY, UPPER; EXCESSIVE FOREHEAD FLAP WITH PRESERVATION OF V ISLAND PEDICULE FLAP GRAFT NEUROVASCULAR PEDICLE GRAFT COMPOSITE SKIN GRAFT REVISION OF UPPER EYELID X EXCISION, EXCESSIVE SKIN AND SUBCUTA

5 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: EXCISE EXCESS SKIN THIGHS EXCISE EXCESS SKIN THIGHS EXCISE EXCESS SKIN THIGHS EXCISE EXCESS SKIN THIGHS GRAFT FACIAL NERVE PARALYSIS FACIAL NERVE PALSY MUSCLE GRAFT REANIMATION MUSCLE TRANS FACE EXCISION, EXCESSIVE SKIN AND SUBCUT SUCTION ASST LIPECTOMY HEAD & NECK SUCTION ASSISTED LIPECTOMY TRUNK SUCTION ASST LIPECOMY UPPER EXTREM SUCTION ASST LIPECTOMY LOWER EXTREM COCCYGECTOMY PRIMARY SUTURE COCCYGECTOMY FLAP CLOSURE EXCISE SACRAL PRESSURE ULCER REMOVAL OF PRESSURE SORE EXCISE,WITH SKIN FLAP CLOSURE ESC SAC ULCER/FLAP/OSTECTOMY IXCISE ULCER W/OTHER FLAP CLO EXC SAC ULCER/FLAP/OSTECTOMY EXC ISCHIAL ULCER DIRECT SUTURE EXC ISCHIAL ULCER OSTECTOMY EXC ISCHIAL ULC/SKIN FLAP CLOS IXC ISCHIAL ULC/OSTECTOMY/FLAP EXC ISCHIAL ULC/OSTECTOMY/FLAP EXC TROCHANTERIC ULCER DIR SUTUR EXC TROCHAN ULCER OSTECTOMY EXC TROCHAN ULCER SKIN FLAP CLOS EXC TROCH ULC SKIN FL CLO/OSTECT EXC TROCH/ULC FLAP CLOSURE TROCH ULC/EXC-FLAP-OSTECTOMYURE ULCE DRESS/DEBRID BURN MED,NO ANESTH DRESS/DEBRID BURN LG, NO ANESTH PUNCTURE ASPIRATION BREAST CYSTS MASTOTOMY/DRAIN ABSCESS DEEP INJEC FOR MAMM DUCTOG OR GALACTOGRAM BREAST BIOPSY NEEDLE BREAST BIOPSY INCISIONAL NIPPLE EXPLORATION EXCISION OF LACTIFEROUS DUCT FISTULA EXCISE BREAST LESIONS,1 OR MORE EXCISION OF BREAST LESION IDENTIFIED EXCISION OF BREAST LESION IDENTIFIED PLACE BREAST CATH FOR RAD MASTECTOMY FOR GYNECOMASTIA M

6 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: MASTOPEXY X F REDUCTION MAMMAPLASTY X MAMMAPLASTY, AUGMENTATION;W/O PROSTH X F X MAMMAPLASTY WITH PROSTHETIC X F REMOVE INTACT MAMMARY IMPLANT REMOVE IMPLANT MATERIAL IMMEDIATE INSERTION OF BREAST PROSTH X F EDLAYED INSERTION OF BREAST PROSTH X NIPPLE/AREOLA RECONSTRUCTION X BREAST RECONSTRUCTION,IMMEDIATE OR X RECONSTRUCTION BREAST-OTHER X PERIPROSTHETIC CAPSULECTOMY, BREAST X REVISION OF RECONSTRUCTED BREAST X INCISION OF ABSCESS;DEEP BIOPSY,MUSCLE,SUPERFICIAL BIOPSY,MUSCLE,DEEP BIOPSY,MUSCLE,PERCUTANEOUS NEEDLE BIOPSY, BONE, SUPERFICIAL, NEEDLE BIOPSY,BONE;DEEP;TROCAR/NEEDLE BIOPSY, EXCISIONAL, SUPERFICAL BIOPSY,EXCISIONAL,BONE,DEEP BIOPSY,OPEN,VERTEBRAL BODY BIOPSY,OPEN,VERTEBRAL BODY REMOVE FOREIGN BODY; SIMPLE REMOVE FOREIGN BODY; COMPLICATED BIOPSY FOREMAN SOFT TISSUES; DEEP SKELETAL TRACTION; WIRE OR PIN REMOVE IMPLANT, SUPERFICIAL REMOVE IMPLANT; DEEP APPLY ESTERNAL FIXATION SYS,STND CON APPLICAT MULT UNILAT EXTERN FIX SYST ADJ/REVIS EXTERN FIX SYST W/ANESTHES REMOVAL UNDER ANESTH EXT FIX SYSTEM BONE GRAFT; ANY DONOR AREA, SMALL BONE GRAFT, ANY DONOR AREA; LARGE CARTILAGE GRAFT; COSTOCHONDRAL CARTILAGE GRAFT;NASAL SEPTUM FASCIA LATA GRAFT;BY STRIPPER FASCIA LATA GRAFT;BY INCISION TENDON GRAFT; DISTANT TISSUE GRAFTS; OTHER BONES INVASIVE (OPERATIVE) ARTHROTOMY, JAW,UNILATERAL REMOVAL OF (LESS THAN 2 CENTIMETERS) EXCISE BONE;MANDIBLE

7 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: EXCISE BONE (S); FACIAL REMOV BY CONTOUR BENIGN TUM FAC BONE EXCISE MALIGNANCY OF FACIAL BONE EXCISE BENIGN CYST;MANDIBLE EXCISE MALIGNANT TUMOR; MANDIBLE REMOVE MANDIBLE CYST COMPLEX EXCISE LWR JAW CYST W/REPAIR TEMPRORMANDIBULAR ARTHRECTOMY TEMPOROMANDIBULAR MENISCECTOMY CORONOIDECTOMY; UNILATERAL MAXILLOFACIAL FIXATION GENIOPLASTY;SLIDING OSTEOTOMY,SINGLE GENIOPLASTY; SLIDING OSTEOTOMIES, GENIOPLASTY;SLIDING,AUGMENT W/BONE AUGMENTATION,LOWER JAW BONE REMOVAL/CONTOUR BENIGN TUMOR/CRANIAL OSTEOPLASTY; MAXILLA, SEGMENTAL OSTEOPLASTY; FACIAL, AUGMENTATION OSTEOPLASTY; FACIAL BONES, REDUCTION BONE GRAFT; NASAL, MAXILLARY, OR MAL BONE GRAFT; MANDIBLE RIB CARTILAGE GRAFT; AUTOGENOUS EAR CARTILAGE GRAFT; AUTOGENOUS TEMPOROMANDIBULAR ARTHROPLASTY ARTHOPLASTY TEMPORMANDIBULAR JOINT ARTHPLASTY,TEMPOROMAND,PROSTH REP RECONSTRUCT MANDIBLE, EXTRAORAL RECON.MAND/MAX,SUBPERI IMPLANT;PARTI RECON MAND/MAX,SUBPERI IMPLANT;COMPL RECON MAND/MAX,ENDO IMPLANT;PARTIAL RECON MAND/MAX,ENDO IMPLANT;COMPLETE REPOSITION ORBIT/ EXTRACRANIAL RECONSTRUCT ORBITOLFACIAL BONES ORBITOCRANIOFACIAL RECONSTRUCTION TREATMENT OF NASAL FRACTURE DIGITAL MANIPULATION OF NASAL FX MANIPULATE NASAL FX; INSTRUMENTAL OPEN TREATMENT NASAL FX; SIMPLE TREATMENT NASAL FX; COMPLICATED TREATMENT OF NOSE FRACTURE OPEN TREATMENT OF NASAL SEPTAL FRACT CLOSED TREATMENT FX NASAL SEPTUM OPEN TREATMENT NASOETHMOID FRACTURE OPEN TREATMENT NASOETHMOID FX,EX FIX TREAT NASOETHMOID COMPLEX FX

8 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: TREAT NOSE/JAW FRACTURE TREAT CHEEK BONE FRACTURE OPEN TREATMENT OF DEPRESSED ZY GOMAT TREAT DEPRESSED MALAR FRACTURE TREAT FX OF ORBIT W/O MANIPULATION TREAT EYE SOCKET FRACTURE TREAT PALATAL/ALVEOLAR RIDGE FX TREAT DENTAL RIDGE FRACTURE OPEN TREATMENT ALVEOLAR RIDGE FX TREAT LOWER JAW FRACTURE CLOSED REDUCTION MANDIBULAR FRACTURE TREAT OPEN MANIBULAT FX W/O MANIPUL TREAT LOWER JAW FRACTURE OPEN TS CLOSED/OPEN MAND FX/EXT FIX TREAT MANDIBULAR FX W/O FIXATION TREAT MANDIBULAR FX WITH FIXATION OPEN TREAT.MANDIBULAR CONDYLAR FX TX TEMPOROMANDIBULAR DISLOCATION TEMPORMANDIBULAR MANIPULATION REPAIR DISLOCATED JAW INTERDENTAL WIRING OTHER THAB FRACTU I & D DEEP ABSCESS OR HEMATOMA I & D WITH PARTIAL RIB REMOVAL EXCISE BENIGN TUMOR; SUBCUTANEOUS EXCISE BENIGN TUMOR; DEEP EXCSION OF RIB; PARTIAL PARTIAL REMOVAL OF RIB DIVISION OF SCALENUS ANTIGICUS REVISION OF NECK MUSCLE REVISION OF NECK MUSCLE TREAT STERNUM FRACTURE; CLOSED BX, SFT TIS-BACK/FLANK;DEEP EXCISE TUMOR,SOFT TISS-BACK OR FLANK REMOVAL (LESS THAN 5 CENTIMETERS) TI TREAT SPINE FRACTURE CLOSED TREATMENT OF BROKEN AND/OR DI MANIPULATION SPINE W/ANESTHESIA INSERTION OF INTERLAMINAR/INTERSPINO INSERTION OF INTERLAMINAR/INTERSPINO EXC TUMOR ABDOMEN WALL SUBFASCIAL REMOVE SUBDELTOID CAL DEPOSITS EXC BENIGN SHOULDER TUMOR SUBCU RELEASE SHOULDER MUSCLE I & D SHOULDER DEEP ABSC HEMATOMA DRAIN SHOULDER BURSA

9 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: DRAIN SHOULDER BONE LESION EXPLORATORY SHOULDER SURGERY ARTHROTOMY DRAIN/REMOVE FOREIGN BODY BIOPSY OF SHOULDER DEEP REMOVAL OF SHOULDER LESION EXC BENIGN SHOULD TUMOR DEEP REMOVAL (LESS THAN 5 CENTIMETERS) TI BIOPSY SHOULDER JOINT SHOULDER JOINT SURGERY ARTHROTOMY;GLENOHUMERAL JOINT ARTHROTOMY;STERNOCLAVICULAR JT ARTHROTOMY,GLENOHUMERAL,W/ EXPLORA CLAVICULECTOMY PARTIAL CLAVICULECTOMY TOTAL ACROMIONECTOMY PARTIAL/TOTAL EXCISION CYST/TUMOR CLAVICLE/SCAPULA EXC CLAVICLE/SCAPULA GRAFR PRI EXCSION TUMOR CLAVICLE/SCAPULA GRAF EXCISION TUMOR PROXIMAL HUMEROUS EXCISION TUMOR PROX HUMEROUS AUTOGEN EXCSION TUMOR PROX HUMEROUS HOMOGEN SEQUESTRECTOMY CLAVICLE SEQUESTRECTOMY SCAPULA SEQUESTRECTOMY PARTIAL EXCISION CLAVICLE FOR OSTEOM PARTIAL EXCISION SCAPULA FOR OSTEOMY PARTIAL EXCISION PROXIMAL HUMERUS OSTECTOMY OF SCAPULA PATTIAL RESECTION HUMERAL HEAD REMOVE SHOULDER FOREIGN BODY MUSCLE TRANSFER, SHOULDER/ARM MUSCLE TRANFERS FIXATION OF SHOULDER BLADE INCISION OF TENDON & MUSCLE INCISE TENDON (S) & MUSCLES (S) REPIR OF TENDON (S) REPAIR OF TENDON(S) CORACOACROMIAL LIGAMENT RELEAS REPAIR OF SHOULDER REPAIR BICEPS TENDON RUPTURE REMOVAL/TRANSPLANT TENDON CAPSULORRAPHY, ANTERIOR REPAIR SHOULDER CAPSULE REPAIR SHOULDER CAPSULE WITH BONE BL REPAIR SHOULDER CAPSULE CORACOID PRO

10 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REPAIR SHOUDER CAPSULE CAPSULORRHAPHY/RECURRENT DISLOCATION REVISION OF TOTAL SHOULDER ARTHROPLA X REVISION OF TOTAL SHOULDER ARTHROPLA X OSTEOTOMY CLAVICLE W/WO INTERNAL FIX OSTEOTOMY CLAVICLE; BONES GRAFT NONU REINFORCE CLAVICLE REINFORCE SHOULDER BONES TREAT CLOSED CLAVICULAR FRACTURE W/O TREAT CLAVILCE FRACTURE TREAT CLSD STERNOCLAVICLAR DISLOC TREAT CLSD STERNOCLAVICULAR DISLOC W TREAT CLAIVICLE DISLOCATION OPEN TREAT CLSD/OPEN CLAVICLE DISLOC TREAT CLAVICLE DISLOCATION TREAT CLAVICLE DISLOCATION TREAT CLAIVICLE DISLOCATION OPEN TREAT CLSD/OPEN ACROMIOCLAVICUL TREAT CLSD SCAP FX W/O MANIPULATION TREAT SHOULDER BLADE FX TREAT SCAPULA FRACTURE TREAT CLSD HUMERAL FRAC W/O MANIPULA TREAT CLSD HUMERAL FRAC WITH MANIPUL OPEN TREAT CLSD/OPEN HUMERAL FRAC W/ OPEN TREATMENT OF PROXIMAL HUMERAL ( TRT CLSD GRTR TUBEROS FX W/MANIPULAT OPEN TRMT CLSD/OPEN GRTR TUBEROS. FX TRT CLSD SHLD DISLOC W/MANIP-NO ANES TRT CLSD SHLD DISLOC W/ MANIP,W/ANES TREAT SHOULDER DISLOCATION TREAT SHOULDER DISLOC FRAC W/MANIPUL TREAT DISLOCATION/FRACTURE TREAT CLSD SHOULDER DISLOC/SURG/ANAT TREAT DISLOCATION/FRACTURE FIXATION OF SHOULDER ARTHRODESIS SHOULDER JOINT W/WO LOCA ARTHRODESIS SHOULDER JOINT W/PRIMARY AMPUTATION FOLLOW-UP SURGERY DRAINAGE OF ARM LESION DRAINAGE OF ARM BURSA DRAIN ARM/ELBOW BONE LESION EXPLORATORY ELBOW SURGERY ARTHROTOMY OF THE ELBOW, WITH CAPSUL BIOPSY ARM/ELBOW SOFT TISSUE;DEEP REMOVE ARM/ELBOW LESION

11 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REMOVE ARM/ELBOW LESION; DEEP SUBFAS REMOVAL (LESS THAN 5 CENTIMETERS) TI ARTHROTOMY, ELBOW; FOR SYNOVIAL BIOP EXPLORE/TREAT ELBOW JOINT REMOVE ELBOW JOINT LINING REMOVAL OF ELBOW BURSA REMOVE HUMERUS LESION REMOVE/GRAFT BONE LESION REMOVE/GRAFT BONE LESION REMOVE ELBOW LESION REMOVE/GRAFT BONE LESION REMOVE/GRAFT BONE LESION REMOVAL OF HEAD OF RADIUS REMOVE BONE LESION,SHAFT OR DIST.HUM REMOVEAL LESION/RADIAL HEAD OR NECK X REMOVE BONE LESION/OLECRANON PROCESS PARTIAL REMOVAL OF ARM BONE PARTIAL REMOVAL OF RADIUS PART EXCIS BONE, OLECRANON PROCESS REMOVAL OF ELBOW JOINT REMOVAL OF ELBOW JOINT HARDWARE REMOVAL OF HARDWARE OF FOREARM BONE REMOVAL OF ARM FOREIGN BODY DEEP MUSCLE/TENDON TRANSFER LENGTHEN TENDON,UPPER ARM/ELBOW,EACH REVISION OF ARM TENDON REPAIR OF ARM TENDON REVISION OF ARM MUSCLES REVISION OF ARM MUSCLES REPAIR OF BICEPS TENDON REPAIR ARM TENDON/MUSCLE REPAIR OF RUPTURED TENDON REPR ELBW LIGMT W/TISS ARTHROPLASTY ELBOW WITH MEMBRANE ARTHROPLASTY W/DIST AL HUMERAL PROST ARTHROPLASTY,ELBOW/IMPLANT,LIG RECON ARTHROPLASTY W/DISTAL HUMERUS/PROXIM ARTHROPLASTY RADIAL HEAD ARTHROPLASTY RADIAL HEAD WITH IMPLAN REVISION OF TOTAL ELBOW ARTHROPLASTY X REVISION OF TOTAL ELBOW ARTHROPLASTY X OSTEOTOMY HUMERUS W/WO INTERNAL FIXA MULT OSTEOTOMIES W/REALIGN ON INTRAM REVISION OF HUMEROUS REPAIR HUMERUS W/ILIAC OR OTHER AUTO

12 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REVISION OF ELBOW JOINT DECOMPRESSION FASCIOTOMY FOREARM W/B REINFORCE HUMERUS TREAT CLSD HUMERAL SHAFT W/MANI TREAT CLSD HUMERAL SHAFT FRAC W/O MA OPEN TREAT CLSD/OPEN HUMERAL SHAFT F OPEN TREATMENT OF HUMERAL SHAFT FRAC TRT CLSD HUM SUPRA/TRANS FX,W/O MANI TRT CLSD HUM SUPRA/TRANS FX,W/MANIP TREAT SUPRA/TRANS CONDYLAR FRAC/PERC OPEN TREAT SUPRA/TRANSCONDYLAR FRAC/ OPEN TREATMENT OF HUMERAL TREAT CLSD EPICON FX, W/O MANIP TREAT CLSD EPICONDYLAR FRAC, MEDIAL/ PERCUTANEOUS SKELETAL FIXATION OF HU TREAT HUMERUS FRACTURE TRT CLSD CONDYLAR FX W/O MANIPULATIO TRT CLSD CONDYLAR FX W/MANIPULATION TREAT HUMERUS FRACTURE PERCUTANEOUS SKELETAL FIXATION OF HU OPEN TREATMENT OF BROKEN AND/OR DISL OPEN TREATMENT OF BROKEN AND/OR DISL TREAT CLSD/ELBOW DISLOCATION W/O ANE TREAT CLSD ELBOW DISLOCATION REQUIRI TREAT ELBOW DISLOCATION TREAT CLSD MONTEGGIA TYPE FRAC DISLO X TREAT ELBOW FRACTURE OPEN TREAT CLSD/OPEN RADIAL HEAD/NEC OPEN TREAT RADIAL HEAD/NECK FRAC WIT TRT ULNAR FX,PROX END W/O MANIPULAT TREAT ULNAR FRAC,PROXIMAL END W/MANI TREAT ULNAR FACTURE FUSION OF ELBOW JOINT FUNSION/GRAFT OF ELBOW JOINT AMPUTATION FOLLOW-UP SURGERY TENDON SHEATH INCISION AT RADIAL DECOMPRESSION FASCIOTOMY FLEXOR/EXTE DECOMPRESSION FASCIOTOMY FOREARM W/D DECOMPRESS FOREARM 1 SPACE DECOMPRESS FOREARM 2 SPACES INCISION/DRAINAGE;DEEP ABSCESS/HEMAT INCISION/DRAINAGE INFECTED BURSA; FO INCISION;DEEP W/OPENING OF CORTEX/AB EXPLORE/TREAT WRIST JOINT BIOPSY FOREARM SOFT TISSUE

13 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: EXCISE SUBCUTANEOUS REMOVE FOREARM LESION DEEP REMOVAL (LESS THAN 3 CENTIMETERS) TI INCISION OF WRIST CAPSULE BIOPSY OF WRIST JOINT EXPLORE/TREAT WRIST JOINT REMOVE WRIST JOINT LINING REMOVE WRIST JOINT CARTILAGE EXCISION,LESION OF TENDON SHEATH EXCISION GANGLION;WRIST,PRIMARY EXCISION GANGLION;WRIST,RECURRENT RADICAL EXCISE BURSA,WRIST/FOREARM T RADICAL EXCISE BURSA,WRIST/FOREARM T SYNOVECTOMY TENDON,WRIST,SINGLE COMP PARTIAL REMOVAL OF ULNA REMOVAL OF FOREARM LESION REMOVE/GRAFT FOREARM LESION REMOVE/GRAFT FOREARM LESION REMOVAL OF WRIST LESION REMOVE & GRAFT WRIST LESION REMOVE & GRAFT WRIST LESION SEQESTRECTOMY FORE ARM BONE ABSCESS PARTIAL REMOVAL,RADIUD/ULNA W/SUCTIO PARTIAL REMOVAL OF RADIUS REMOVAL OF WRIST BONE CARPECTOMY; ALL BONES OR PROXIMAL RO RADIAL STYLOIDECTOMY EXCISION DISTAL ULNA REMOVE FOREARM FOREIGN BODY X REMOVAL OF WRIST PROSTHESIS REMOV WRIST PROSTH, COMPLICATED REP,TEND/MUSC;PRIM,SING;EACH TEN/MUS REP,TEND/MUSC;SECOND,SING;EA TEN/MUS REPAIR FOREARM TENDON/MUSCLE REP TEN/MUS,EXTEN,FOREARM,WRIST,PRIM REP TEN/MUS,EXTEN,FOREARM,WRIST,SECO REP TEN/MUS,EXTEN,SECON,W/GRAFT,EACH REPAIR FOREARM TENDON SHEATH LENGTHEN/SHORTEN FLEX,SING..EACH TEN TENOTOMY,OPEN,FLEX,EXTEN;SING,EA TEN RELEASE WRIST/FOREARM TENDON FUSION OF TENDONS AT WRIST FUSION OF TENDONS AT WRIST TEND TRANSPLAT...SING.;EACH TENDON TENDON TRANSPLANT,W/GRFT..EACH TEND

14 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REVISE PALSY HAND TENDON (S) REVISE PALSY HAND TENDON W/TENDONS REPAIR/REVISE/RECONSTRUCT WRIST JOIN ARTHROPLASTY WRIST;W/INTERNAL FIXATI CENTRALIZATION-WRIST ON ULNA RECONSTRUCT ULNA/RADIOULNAR REVISION OF RADIUS;DISTAL THIRD REVISION OF RADIUS;MIDDLE OR P REVISION OF ULNA REVISE RADIUS & ULNA REVSION,MULTIPLE,RADIUS OR ULNA X REVISION,MULTIPLE,RADIUS AND ULNA SHORTEN RADIUS/ULNA LENGTHENING RADIUS/ULNA W/AUTOGENOUS SHORTEN RADIUS & ULNA LENGTHENING RADIUS & ULNA 2/AUTOGENO REPAIR RADIUS OR ULNA REPAIR/GRAFT RADIUS OR ULNA REPAIR RADIUS & ULNA REPAIR/GRAFT RADIUS & ULNA REPAIR OF DEFECT W/GRAFT;RADIUS OR U REPAIR OF DEFECT W/GRAFT; RADIUS AND REPAIR/GRAFT WRIST BONE RECONSTRUCT WRIST JOINT;DISTAL RADI RECONSTRUCT WRIST JOINT;DISTAL ULNA RECONSTRUCT WRIST JOINT;SCAPHOID RECONSTRUCT WRIST JOINT;LUNATE RECONSTRUCT WRIST JOINT TRAPEZ RECONSTRUCT WRIST JOINT; DISTAL RADI REVISE ARTHROPLASTY,REVDVE EPIPHYSEAL ARREST; DISTAL RADIUS OR EPIPHYSEAL ARREST; DISTAL RADIUS AND PROPHYLACIC TREATMENT/RADIUS PROPHYLACTIC TREATMENT; ULNA PROHPYLACTIC TREATMENT;RADIUS & ULNA TREAT FRACTURE OF RADIUS W/MANIPULAT OPEN TREAT CLSD/OPEN RADIAL SHAFT FR CLOSED TREATMENT OF BROKEN FOREARM A OPEN TREATMENT OF RADIAL SHAFT FRACT TREAT FRACTURE OF RADIUS TREA CLOSED ULNAR SHAFT W/MANI OPEN TREAT CLSD/OPEN ULNAR FRAC W/WO TREAT CLSD RADIAL & ULNAR SHAFT FRAC OPEN TREATMENT OF RADIAL AND ULNAR S OPEN TREAT CLSD/OPEN RADIAL & ULNAR

15 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: TREAT CLOSED DISTAL RADISL FRAC W/MA PERCUTANEOUS SKELETAL FIXATION OF DI OPEN TREATMENT OF DISTAL RADIAL EXTR OPEN TREATMENT OF DISTAL RADIAL INTR OPEN TREATMENT OF DISTAL RADIAL INTR TREAT CLOSED CARPAL SCAPHOID FRAC W/ OPEN TREAT CLSD/OPEN CARPAL SCAPHOID TREAT WRIST BONE FRACTURE OPEN TX, CLSD/OPEN FX... EACH BONE TREAT CLOSED RADIO/INTERCARPAL DISLO OPEN TREAT CLSD/OPEN RADIO/INTERCARP PIN RADIOULNAR DISLOCATION TREAT CLOSED DISTAL RADIOULNAR DISLO OPEN TREAT CLSD/OPEN DISTAL RADIOULN TREAT CLSD TRANS-SCAPHOPERILUNAR FRA OPEN TREAT CLSD/OPEN TRANS/SCRAPHOPE TREAT LUNATE DISLOCATION W/MANIPULAT OPEN TREATMENT LUNATE DISLOCATION FUSION OF WRIST JOINT FUSION WRIST JOINT; W/SLIDING GRAFT FUSION/GRAFT OF WRIST JOINT INTERCARPAL FUSION;W/OUT BONE GRAFT INTERCARPAL FUSION;W/BONEGRAFT FUSION DADIOULNAR JNT/ULNA AMPUTATION, FOREARM, SECONDARY CLOSU DISARTICULATION WRIST; SECOND CLOSUR TRANSMETACARPAL AMPUTATION; SECONDAR DRAINAGE OF FINGER ABSCESS DRAINAGE OF FINGER ABSCESS DRAIN HAND TENDON SHEATH DRAINAGE OF PALM BURSA DRAINAGE OF PALM BURSA MULTIPLE/COMP TREAT HAND BONE LESION RELEASE OF TISSUES OF PALM, ACCESSED PARTIAL RELEASE OF TISSUES OF PALM, INCISE FINGER TENDON SHEATH INCISION FINGER TENDON EXPLORE/TREAT HAND JOINT EXPLORE/TREAT METACARPOPHALANGEAL JO ARTHROTOMY, INTERPHALANGEAL,EACH JNT BIOPSY HAND JOINT LINING BIOPSY METACARPOPHALANGEAL JOINT LIN ARTHROTOMY,INTERPHALANGEAL, EACH JOI EXCISION BENIGN TUMOR,HAND SUBCUTANE EXCISION BENIGN TUMOR, HAND; DEEP

16 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REMOVAL (LESS THAN 3 CENTIMETERS) TI FASCIECTOMY,PALMAR,WOW Z-PLASTY,OTHE FASCIECTOMY,PALMAR,WOW Z-PLASTY,OTHE FASCIECTOMY,PALMAR,WOW Z-PLASTY,OTHE REMOVE WRIST JOINT LINING REVISE FINGER JOINT EACH DIGIT REVISE FINGER JOINT EACH INTER TENDON EXCISION PALM,FINGER REMOVE TENDON SHEATH LESION EXCISION OF TENDON PALM,FLEXOR EXCISION OF TENDON, FIINGER, FLEXOR REMOVE FINGER BONE REMOVE BONE CYST/BENING TUMOR OF HAN REMOVE BONE CYST/BENIGN TUMOR HAND W REMOVE BONE CYST PROXIMAL MIDDLE/DIS REMOVE BONE CYST PROXIMAL W/AUTOGENO PARTIAL REMOVAL OF HAND BONE PARTIAL REMOVAL PROXIMAL/MIDDLE PHAL PARTIAL REMOVAL DISTAL PHALANX(FLING RADICAL RESECTION FOR TUMOR, HAND RADICAL RESECT FOR TUMOR,PROXIMAL/MI RADICAL RESECTION FOR RUMOR,DISTAL P REMOVAL OF IMPLANT FROM FINGER OR HA REPAIR OF FINGER TENDON REPAIR OF FINGER TENDON WITH GRAFT REPAIR OF FINGER TENDON REPAIR OF FINGER TENDON REPAIR OF FINGER TENDON WITH GRAFT PROFUNDUS TENDON REPAIR W/INTACT SUB PROFUNDUS TENDON REPAIR;SECONDARY W/ PROFUNDUS TENDON REPAIR;SECONDARY W/ FLEXOR TENDON EXCISE IMPLANT P REMOVAL ROD AND INSERTION OF TENDON X EXTENSOR TENDON REPAIR,DORSUM EXT TEND REP,SING.;W/GRAFT,EACH TEND EXCISE EXTENSOR TENDON,IMPLANT TUBE REMOVE TUB/ROD,INSERT GRAFT EXTENSOR TENDON REPAIR,DORSUM F EXTENSOR TENDON REPAIR,DORSUM EXTENSOR TENDON,CENTRAL SLIP R EXTENSOR TENDON,CENTRAL SLIP R TENDON REPAIR,DISTAL INSERT CLOSED TENDON REPAIR,OPEN,PRIMARY/SEC TENDON REPAIR,OPEN,PRIMARY/SECONDARY REALIGN EXTENSOR TENDON-FOR ARTHRITI

17 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: TENOLYSIS,SIMPLE,FLEXOR,TENDON P TENOLYSIS,SIMP...;PALM&FLING EACH TE TENOLYSIS,EXT TEND...;EACH TENDON TENOLSIS,COMPLEX TENDON,HAND,F TENOTOMY,FLEXOR,SINGLE,PALM,OPEN TENOTOMY,FLEXOR,SINGLE,FINGER TENOTOMY,EXTENSOR,HAND OR FINGER TENODESIS;FOR PROXIMAL FINGER J TENODESIS,FOR DISTAL JOINT STA TEND LENGTHEN, EXT SINGLE, EACH TEND SHORTEN, EXT...SINGLE, EACH TENDON LENGTHENING,FLEXOE,HAND/FINGE SHORTEN FLEXOR,HAND/FINGER-EACH TRANSPLANT HAND TENDON TRANSPLANT/GRAFT HAND TENDON TEND TRANS/PLNT, EA TEND; W/GRAFT X TRANSPLANT/GRAFT HAND TENDON REVISE THUMB TENDON TENDON TRANSFER/MUSCLE TRANSFER HAND TENDON/MUSCLE TRANSFER REVISE THUMB TENDON FINGER TENDON TRANSFER SUBLIMIS TRANSFER TO CORRECT CLAW FI REVISION OF FINGER HAND TENDON RECONSTRUCTION; W/LOCAL HAND TENDON RECONSTRUCTION; W/GRAFT RELEASE THUMB CONTRACTURE THUMB TENDON TRANSFER FUSION OF KNUCKLE JOINT FUSION OF KNUCKLE JOINTS FUSION OF KNUCKLE JOINTS RELEASE KNUCKLE CONTRACTURE RELEASE FINGER CONTRACTURE REVISE KNUCKLE JOINT REVISE KNUCKLE WITH IMPLANT REVISE FINGER JOINT REVISE/IMPLANT FINGER JOINT REPAIR COLLATERAL LIGAMENT PRIM.REP.COLLATERAL LIGAMENT/LOC TIS RECONSTRUCT FINGER JOINT W/GRAFT REPAIR NON-UNION HAND REPAIR/RECON,FINGER,INTERPHAL JOINT CONSTRUCT THUMB REPLACEMENT SITIONAL CHANGE OF FINGER X REPAIR WEB FINGER; WITH SKIN FLAPS

18 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REPAIR OF WEB FINGER REPAIR WEB FINGER,COMPLEX,INVOLVING CORRECT METACARPAL FLAW CORRECT FINGER DEFORMITY LENTHEN METACARPAL/FINGER REPAIR HAND DEFORMITY REPAIR SUPERNUMERARY DIGIT REPAIR FINGER DEFORMITY;MACRODACTYLI REPAIR MUSCLES OF HAND RELEASE MUSCLES OF HAND EXCISE CONSTRICTING RING,Z-PLASTIES TREAT CLSD FX; W/MANIP,EACH BONE TREAT CLSD FX.,W/MANIP & FIX,EACH BO PERCUTANEOUS SKELETAL FIXATION OF ME OPEN TX,CLSD/OPEN FX...EACH BONE TREAT CLSD THUMB FRAC DISLOCATION W/ TREAT CLSD THUMB FRAC DISLOCATION W/ OPEN TREAT CLSD/OPEN THUMB FRAC DISL TREAT HAND DISLOCATION W/ANESTHESIA PERC. PINNING,CLOSED CARPOMETACARPAL TREAT HAND DISLOCATION TREAT HAND DISLOCATION TREAT KNUCKLE DISLOCATION W/ANETHES PERC PINNING,CLOSED METACARPOPHALANG OPEN TREAT CLSD/OPEN KNUCKLE DISLOCA TREAT FX,MANIP,TRACT/FIX,EACH OPEN TREAT...W/W/O FIX, EACH TREAT CLSD ART FX..W/MANIP, EACH OPEN TX, CLSD/OPEN FX...EACH TREAT CLSD FX...;W/PERC PIN,EACH OPEN TX,CLSD/OPEN FX..;EACH PERC PINNING, CLOSED INTERPHALANGEAL OPEN TRMT OF CLOS OR OPEN INTERPHA J THUMB FUSION WITH GRAFT ARTHRODESIS, THUMB W/ OR W/O INTERNA ARTHRODESIS OF THUMB W/ GRAFT FUSION/GRAFT OF HAND JOINT ARTHRODESIS KNUCKLE W/ OR W/O INT FI ARTHRODESIS KNUCKLE W/ GRAFT ARTHRODESIS FINGER JOINT W/WO INTERN EACH ADDITIONAL JOINT FUSION/GRAFT OF FINGER JOINT FUSE/GRAFT ADDED JOINT AMPUTATE METACARPAL BONE AMPUTATION OF FINGER/THUMB

19 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: WITH LOCAL ADVANCEMENT FLAPS DRAINAGE OF PELVIS LESION DRAINAGE OF PELVIS BURSA TENPTPMY, SUBCUTANEOUS, CLOSED-HIP O INCISION OF HIP TENDON INCISION OF HIP TENDON EXPLORATION OF HIP JOINT DENERVATION OF HIP JOINT SUPERFICIAL BIOPSY OF SOFT TISSUES DEEP BIOPSY OF SOFT TISSUES EXCISION SUBCUTANEOUS TUMOR, HIP-PEL REMOVE HIP/PELVIS LESION REMOVAL OF (LESS THAN 5 CENTIMETERS) BIOPSY OF SACROILIAC JOINT BIOPSY OF HIP JOINT REMOVAL OF ISCHIAL BURSA EXCISION TROCHANTERIC BURSA EXC CYST OR TUMOR SUPERFICIAL DEEP W OR W/O BONE GRAFT W/BONE REQUIRING SEPARATE INC COCCYGECTOMY SUPERFICIAL BIOPSY OF SOFT TISSUES REMOVE HIP FOREIGN BODY REVISION OF HIP TENDON TRAN EXTERNAL OBLIQUE MUSCLE TO GREA TRANSFER PARASPINAL MUSCLE TO HIP TRANSFER ILIOPSOAS MUSCLE TO GREATER TO FEMORAL NECK S MUSCLE CLOSED TREATMENT OF POSTERIOR PELVIC CLOSED TREATMENT OF POSTERIOR PELVIC OPEN TRMT OF CLOSED OR OPEN COCCYGEA TRMT OF CLOSED FEMORAL FX TRMT CLOSED INTERTRO-PETROCHANTERIC TRMT PF CLOSED GREATER TROCHANTERIC TREAT HIP DISLOCATION REQUIRING ANES TREAT HIP DISOLOCATION TX A TRAUMA TIC DISLOCATI; NO ANESTH SEE 27265;REQUIRING GEN ANESTHESIA MANIPULATION OF HIP JOINT I&D DEEP ABSCESS,INFECTED BURSA FASCIOTOMY INCISION OF THIGH TENDON INCISION OF THIGH TENDONS ARTHROTOMY, KNEE JOINT

20 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: BIOPSY THIGH SOFT TISSUES BIOPSY THIGH SOFT TISSUES NEURECTOMY,HAMSTRING MUSCLE NEURECTOMY,POPLITEAL (GASTROCNEMIUS) REMOVAL OF THIGH LESION REMOVAL OF THIGH LESION REMOVAL (LESS THAN 5 CENTIMETERS) TI BIOPSY KNEE JOINT LINING EXPLORE/TREAT KNEE JOINT REMOVAL OF KNEE CARTILAGE REMOVAL OF KNEE CARTILAGE REMOVE KNEE JOINT LINING REMOVE KNEE JOINT LINING REMOVAL OF KNEECAP BURSA REMOVAL OF CYST OF MEMBRANE COVERING REMOVE KNEE CYST REMOVAL OF KNEECAP REMOVE FEMUR LESION REMOVE FEMUR LESION/GRAFT REMOVE FEMUR LESION/GRAFT REMOVE FEMUR LESION/FIXATION PARTIAL REMOVAL LEG BONE(S) REMOVAL OF FOREIGN BODY REPAIR OF KNEECAP TENDON REPAIR/GRAFT KNEECAP TENDON REPAIR OF THIGH MUSCLE INCISION OF THIGH TENDON INCISION OF THIGH TENDONS INCISION OF THIGH TENDONS LENGTHENING OF THIGH TENDON LENGTHENING OF THIGH TENDONS LENGTHENING OF THIGH TENDONS TRANSPLANTS OF THIGH TENDON TRANSPLANTS OF THIGH TENDON TRANSFER OF TENDON OR MUSCLE IN HAMS ARTHROTOMY WITH OPEN MENISCUS REPAIR REPAIR OF KNEE LIGAMENT REPAIR OF KNEE LIGAMENT REPAIR OF KNEE LIGAMENTS REPAIR OF DEGENERATED KNEECAP REVSION/REMOVAL OF KNEECAP REVISION OF UNSTABLE KNEECAP RECONSTRUCTION, KNEE LATERAL RETINACULAR RELEASE ANY METH RECONSTRUCT(AUGMENT)KNEE;INTRA-ARTIC

21 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: RECONSTRUCT KNEE;INTRA&EXTRA-ARTIC REVISION OF THIGH MUSCLES INCISION OF KNEE JOINT ARTHROPLASTY,PATELLA; W/O PROSTHESIS REVISE KNEECAP WITH IMPLANT REVISION OF KNEE JOINT REVISION OF KNEE JOINT REVISIOSN OF KNEE JOINT DECOMPRESSION FASCIOTOMY, THIGH AND/ DECOMPTESSION OF THIGH/KNEE DECOMPRESSION OF THIGH/KNEE TREATMENT OF FEMUR FRACTURE CLOSED TREATMENT OF SUPRACONDYLAR OR TREATMENT OF FEMUR FRACTURE TREATMENT OF THIGH FRACTURE TREATMENT OF FEMUR FRACTURE TREATMENT OF THIGH FRACTURE TREATMENT OF FEMUR FRACTURE TREATMENT OF FEMUR EPIPHYSIS TREATMENT OF FEMUR EPIPHYSIS TREAT KNEE FRACTURE TREATMENT OF KNEE FRACTURE TREAT KNEE FRACTURE (S) X TREAT KNEE DISLOCATION TREAT KNEE DISLOCATION TREAT KNEECAP DISLOCATION TREAT KNEECAP DISLOCATION REPAIR KNEECAP DISLOCATION FIXATION OF KNEE JOINT AMPUTATION FOLLOW-UP SURGERY DECOMPRESSION OF LOWER LEG DECOMPRESSION OF LOWER LEG DECOMPRESSION OF LOWER LEG DRAIN LOWER LEG LESION DRAIN LOWER LEG BURSA INCISION OF ACHILLES TENDON INCISION OF ACHILLES TENDON TREAT LOWER LEG BONE LESION EXPLORE/TREAT ANKLE JOINT EXPLORATION OF ANKLE JOINT BIOPSY LOWER LEG SOFT TISSUE DEEP REMOVAL (LESS THAN 5 CENTIMETERS) TI REMOVE LOWER LEGLES ION REMOVE LOWER LEG LESION BIOPSY OF ANKLE JOINT

22 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: REMOVE ANKLE JOINT LINING REMOVE ANKLE JOINT LINING REMOVAL OF TENDON LESION REMOVE LOWER LEG BONE LESION REMOVE/GRAFT LEG BONE LESION REMOVE/GRAFT LEG BONE LESION PARTIAL REMOVAL OF TIBIA PARTIAL REMOVAL OF FIBULA EXTENSIVE ANKLE/HEEL SURGERY REPAIR ACHILLES TENDON REPAIR/GRAFT ACHILLES TENDON REPAIR OF ACHILLES TENDON REPAIR FASCIAL DEFECT OF LEG\ REP/SUT LEG TENDON, W/O GRAFT, EACH REP/SUT TEND,LEG...W/W/O GRAFT EACH REP/SUT EXT TEND,PRIM,W/O GRAFT EACH REP/SUT TEND.;SECON.W/W/O GRAFT-EACH REPAIR LOWER LEG TENSIONS REPAIR LOWER LEG TENDONS RELEASE OF LOWER LEG TENDON TENOLYSIS...MULTIPLE, EACHS REVISION OF LOWER LEG TENDON LENGTHEN/SHORTEN TEND;MULTIPLE, EACH REVISION OF CALF TENDON REVISE LOWER LEG TENDON REVISE LOWER LEG TENDON EACH ADDITIONAL TENDON REPAIR OF ANKLE LIGAMENT REPAIR OF ANKLE LIGAMENTS REPAIR OF ANKLE LIGAMENT REVISION OF ANKLE JOINT REMOVAL OF ANKLE IMPLANT INCISION OF TIBIA INCISION OF FIBULA INCISION OF TIBIA & FIBULA REPAIR OF TIBIA EPIPHYSIS REPAIR OF FIBULA EPIPHYSIS REPAIR LOWER LEG EPIPHYSES REPAIR OF LEG EPIPHYSES REPAIR OF LEG EPIPHYSES TREATMENT OF TIBIA FRACTURE TREATMENT OF TIBIA FRACTURE REPAIR OF TIBIA FRACTURE REPAIR OF TIBIA FRACTURE OPEN TREATMENT OF TIBIAL SHAFT FRACT

23 RUN: 12/29/17 07:13:13 DEPARTMENT OF HEALTH AND HOSPITALS - BUREAU OF HEALTH SERVICES - FINANCING PAGE: CLTX MEDIAL ANKLE FX CLTX MED ANKLE FX W/MNPJ REPAIR OF ANKLE FRACTURE TREATMENT OF FIBULA FRACTURE TREATMENT OF FIBULA FRACTURE REPAIR OF FIBULA FRACTURE TREATMENT OF ANKLE FRACTURE TREATMENT OF ANKLE FRACTURE REPAIR OF ANKLE FRACTURE TREATMENT OF ANKLE FRACTURE TREATMENT OF ANKLE FRACTURE REPAIR OF ANKLE FRACTURE TREATMENT OF ANKLE FRACTURE TREATMENT OF ANKLE FRACTURE REPAIR OF ANKLE FRACTURE REPAIR OF ANKLE FRACTURE CLOSED TREATMENT OF FRACTURE CLOSED TREATMENT OF FRACTURE OF WEIG OPEN TREATMENT OF FRACTURE OF LOWER OPEN TREATMENT OF FRACTURE OF LOWER OPEN TREATMENT OF FRACTURE OF LOWER OPEN TREATMENT OF DISTAL TIBIOFIBULA TREAT LOWER LEG DISLOCATION TREAT LOWER LEG DISLOCATION REPAIR LOWER LEG DISLOCATION TREAT ANKLE DISLOCATION TREAT ANKLE DISLOCATION REPAIR ANKLE DISLOCATION REPAIR ANKLE DISLOCATION FIXATION OF ANKLE JOINT FUSION OF ANKLE JOINT FUSION OF TIBIOFIBULAR JOINT AMPUTATION FOLLOW-UP SURGERY AMPUTATION OF FOOT AT ANKLE DECOMPRESSION FASCIOTOMY, LEG; DECOMPRESSION FASCIOTOMY, LEG; DECOMPRESSION FASCIOTOMY, LEG; DRAINAGE OF BURSA OF FOOT TREATMENT OF FOOT INFECTION TREATMENT OF FOOT INFECTION TREAT FOOT BONE LESION INCISION OF FOOT FASCIA INCISION OF TOE TENDONS EXPLORATION OF A FOOT JOINT EXPLORATION OF A FOOT JOINT