HEALTHFIRST 2011 RADIOLOGY PROGRAM CODE LIST

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1 HEALTHFIRST 2011 RADIOLOGY PROGRAM CODE LIST Outpatient Radiology utilization call Carecore at Modality CPT CODE Description CT SCANS CT HEAD/BRAIN W/O CONTRAST CT SCANS CT HEAD/BRAIN W/ CONTRAST CT SCANS CT HEAD/BRAIN W/O & W/ CONTRAST CT SCANS CT ORBIT W/O CONTRAST CT SCANS CT ORBIT W/ CONTRAST CT SCANS CT ORBIT W/O & W/ CONTRAST CT SCANS CT MAXLLFCL W/O CONTRAST CT SCANS CT MAXLLFCL W/ CONTRAST CT SCANS CT MAXLLFCL W/O & W/ CONTRAST CT SCANS CT SOFT TISSUE NECK W/O CONTRAST CT SCANS CT SOFT TISSUE NECK W/ CONTRAST CT SCANS CT SOFT TISSUE NECK W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY HEAD CT SCANS CT ANGIOGRAPHY NECK CT SCANS CT THORAX W/O CONTRAST CT SCANS CT THORAX W/ CONTRAST CT SCANS CT THORAX W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY CHEST, NON-CORONARY CT SCANS CT C SPINE W/O CONTRAST CT SCANS CT C SPINE W/ CONTRAST CT SCANS CT C SPINE W/O & W/ CONTRAST CT SCANS CT T SPINE W/O CONTRAST CT SCANS CT T SPINE W/ CONTRAST CT SCANS CT T SPINE W/O & W/ CONTRAST CT SCANS CT L SPINE W/O CONTRAST CT SCANS CT L SPINE W/ CONTRAST CT SCANS CT L SPINE W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY PELVIS CT SCANS CT PELVIS W/O CONTRAST CT SCANS CT PELVIS W/ CONTRAST CT SCANS CT PELVIS W/O & W/ CONTRAST CT SCANS CT UPPER EXTREMITY W/O CONTRAST 1 Carecorenational

2 CT SCANS CT UPPER EXTREMITY W/ CONTRAST CT SCANS CT UPPER EXTREMITY W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY UPPER EXTREMITY CT SCANS CT LOWER EXTREMITY W/O CONTRAST CT SCANS CT LOWER EXTREMITY W/ CONTRAST CT SCANS CT LOWER EXTREMITY W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY LOWER EXTREMITY CT SCANS CT ABDOMEN W/O CONTRAST CT SCANS CT ABDOMEN W/ CONTRAST CT SCANS CT ABDOMEN W/O & W/ CONTRAST CT SCANS CT ANGIOGRAPHY ABDOMEN CT SCANS COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL CT SCANS COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITH CONTRAST MATERIAL(S) CT SCANS CT SCAN CT SCAN COMPUTED TOMOGRAPHY, ABDOMEN AND PELVIS; WITHOUT CONTRAST MATERIAL IN ONE OR BOTH BODY REGIONS, FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SECTIONS IN ONE OR BOTH BODY REGIONS COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITHOUT CONTRAST MATERIAL COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, DIAGNOSTIC, INCLUDING IMAGE POSTPROCESSING; WITH CONTRAST MATERIAL (S) INCLUDING NON-CONTRAST IMAGES, IF PERFORMED CT SCAN COMPUTED TOMOGRAPHIC (CT) COLONOGRAPHY, SCREENING, INCLUDING IMAGE POSTPROCESSING CT SCANS Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium CT SCANS CARDIAC CT FOR MORPHOLOGY CT SCANS CARDIAC CT FOR CONGENITAL HD CT SCANS CORONARY CTA CT SCANS CT ANGIOGRAPHY ABDOMINAL AORTA CT SCANS 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; NOT REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION CT SCANS 3D RENDERING WITH INTERPRETATION AND REPORTING OF COMPUTED TOMOGRAPHY, MAGNETIC RESONANCE IMAGING, ULTRASOUND, OR OTHER TOMOGRAPHIC MODALITY; REQUIRING IMAGE POSTPROCESSING ON AN INDEPENDENT WORKSTATION CT SCANS CT LIMITED OR LOCALIZED FOLLOW-UP STUDY MRA MRA HEAD W/O CONTRAST MRA MRA HEAD W/ CONTRAST MRA MRA HEAD W & W/O CONTRAST MRA MRA NECK W/O CONTRAST MRA MRA NECK W CONTRAST MRA MRA NECK W & W/O CONTRAST 2 Carecorenational

3 MRA MRA CHEST (EXC MYOCARDIUM) W/ OR W/O CONTRAST MRA MRA SPINAL CANAL W/ OR W/O CONTRAST MRA MRA PELVIS W/ OR W/O CONTRAST MRA MRA UPPER EXTREMITY W/ OR W/O CONTRAST MRA MRA LOWER EXTREMITY W/ OR W/O CONTRAST MRA MRA ABDOMEN W/ OR W/O CONTRAST TMJ FACE, ORBIT, NECK W/O CONTRAST FACE, ORBIT, NECK W/ CONTRAST FACE, ORBIT, NECK W & W/O CONTRAST HEAD W/O CONTRAST HEAD W/ CONTRAST HEAD W/ & W/O CONTRAST, brain, functional ; including test selection and administration of repetitive body part movement and/or visual stimulation, not requiring physician or psychologist administration 70555, brain, functional ; requiring physician or psychologist administration of entire neurofunctional testing CHEST W/O CONTRAST CHEST W CONTRAST CHEST W & W/O CONTRAST CERVICAL SPINE W/O CONTRAST CERVICAL SPINE W/ CONTRAST THORACIC SPINE W/O CONTRAST THORACIC SPINE W/ CONTRAST LUMBAR SPINE W/O CONTRAST LUMBAR SPINE W/ CONTRAST C SPINE W/ & W/O CONTRAST T SPINE W/ & W/O CONTRAST L SPINE W/ & W/O CONTRAST PELVIS W/O CONTRAST PELVIS W CONTRAST PELVIS W & W/O CONTRAST UPPER EXTREMITY W/O CONTRAST UPPER EXTREMITY W CONTRAST UPPER EXTREMITY W & W/O CONTRAST UPPER EXTREMITY JOINT W/O CONTRAST UPPER EXTREMITY JOINT W CONTRAST UPPER EXTREMITY JOINT W & W/O CONTRAST 3 Carecorenational

4 73718 LOWER EXTREMITY W/O CONTRAST LOWER EXTREMITY W CONTRAST LOWER EXTREMITY W & W/O CONTRAST LOWER EXTREMITY JOINT W/O CONTRAST LOWER EXTREMITY JOINT W CONTRAST LOWER EXTREMITY JOINT W & W/O CONTRAST ABDOMEN W/O CONTRAST ABDOMEN W CONTRAST ABDOMEN W & W/O CONTRAST CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL; WITH STRESS IMAGING CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES CARDIAC MAGNETIC RESONANCE IMAGING FOR MORPHOLOGY AND FUNCTION WITHOUT CONTRAST MATERIAL(S), FOLLOWED BY CONTRAST MATERIAL(S) AND FURTHER SEQUENCES; WITH STRESS IMAGING SPECTROSCOPY GUIDANCE FOR NEEDLE PLACEMENT BREAST W/ AND/OR W/O CONTRAST; UNILATERAL BREAST BILATERAL BONE MARROW BLOOD SUPPLY NUCLEAR MED THYROID RAI UPTAKE NUCLEAR MED THYROID MULTIPLE UPTAKE NUCLEAR MED THYROID SUPPRESS OR STIMULATION NUCLEAR MED THYROID UPTAKE AND SCAN NUCLEAR MED THYROID IMAGE, MULTIPLE UPTAKES NUCLEAR MED THYROID SCAN ONLY NUCLEAR MED THYROID IMAGING W FLOW NUCLEAR MED THYROID MET IMAGING NUCLEAR MED THYROID MET IMAGING WITH ADDITIONAL STUDIES NUCLEAR MED THYROID SCAN WHOLE BODY NUCLEAR MED THYROID CARCINOMA METASTASES UPTAKE (add on code - use w/ code only) NUCLEAR MED PARATHYROID NUCLEAR IMAGING NUCLEAR MED ADRENAL NUCLEAR IMAGING NUCLEAR MED BONE MARROW IMAGING, LIMITED NUCLEAR MED BONE MARROW IMAGING, MULTIPLE NUCLEAR MED BONE MARROW IMAGING, WHOLE BODY 4 Carecorenational

5 NUCLEAR MED SPLEEN IMAGING W/WO VASCULAR FLOW NUCLEAR MED LYMPH SYSTEM IMAGING NUCLEAR MED LIVER IMAGING NUCLEAR MED LIVER IMAGING W FLOW NUCLEAR MED LIVER IMAGING SPECT NUCLEAR MED LIVER IMAGING SPECT W VASCULAR FLOW NUCLEAR MED LIVER AND SPLEEN IMAGING NUCLEAR MED LIVER AND SPLEEN IMAGING W FLOW NUCLEAR MED LIVER FUNCTION STUDY NUCLEAR MED HIDA SCAN NUCLEAR MED SALIVARY GLAND IMAGING NUCLEAR MED SERIAL SALIVARY GLAND NUCLEAR MED SALIVARY GLAND FUNCTION TEST NUCLEAR MED ESOPHAGUS MOTILITY STUDY NUCLEAR MED GASTRIC MUCOSA IMAGING NUCLEAR MED GASTROESOPHAGAEL REFLUX EXAM NUCLEAR MED GASTRIC EMPTYING STUDY NUCLEAR MED GI BLEEDER SCAN NUCLEAR MED GI PROTEIN LOSS EXAM NUCLEAR MED MECKEL'S DIVERTICULUM IMAGING NUCLEAR MED LEVEEN SHUNT PATENCY EXAM NUCLEAR MED BONE OR JOINT IMAGING LTD NUCLEAR MED BONE OR JOINT IMAGING MULTIPLE NUCLEAR MED BONE SCAN WHOLE BODY NUCLEAR MED BONE AND/OR JOINT IMAGING; 3 PHASE STUDY NUCLEAR MED BONE JOINT IMAGING TOMO TEST SPECT NUCLEAR MED NON-IMAGING HEART FUNCTION NUCLEAR MED CARDIAC SHUNT IMAGING NUCLEAR MED RADIONUCLIDE VENOGRAM NON-CARDIAC NUCLEAR MED MPI, SPECT, SINGLE REST OR STRESS NUCLEAR MED MPI, SPECT, MULTIPLE, REST OR STRESS NUCLEAR MED MPI, PLANAR, SINGLE REST OR STRESS NUCLEAR MED MPI, PLANAR, MULTIPLE, REST OR STRESS NUCLEAR MED ACUTE VENOUS THROMBOSIS IMAGING NUCLEAR MED VENOUS THROMBOSIS IMAGING UNILATERAL NUCLEAR MED VENOUS THROMBOSIS IMAGING BILATERAL 5 Carecorenational

6 NUCLEAR MED MYOCARDIAL INFARCTION SCAN NUCLEAR MED HEART INFARCT IMAGE EF NUCLEAR MED HEART INFARCT IMAGE SPECT NUCLEAR MED GATED HEART, REST OR STRESS NUCLEAR MED CARDIAC BLOOD POOL MUGA SCAN NUCLEAR MED HEART FIRST PASS SINGLE NUCLEAR MED CARDIAC BLOOD POOL IMAGING, MULTI NUCLEAR MED CARDIAC BLOOD POOL IMAGING, SPECT NUCLEAR MED CARDIAC BLOOD POOL IMAGING, SINGLE AT REST (Use with 78472) NUCLEAR MED PULMONARY PERFUSION IMAGING NUCLEAR MED PULMONARY PERFUSION WITH VENT SINGLE BREATH NUCLEAR MED PULMONARY PERFUSION W/WASHOUT OR W/O SINGLE BREATH NUCLEAR MED PULMONARY VENTILATION IMAGING NUCLEAR MED PULMONARY VENTILATION MULTI NUCLEAR MED PULMONARY PERFUSION IMAGING, PARTICULATE, WITH VENTILATION IMAGING, AEROSOL, 1 OR MULTIPLE PROJECTIONS NUCLEAR MED VENT IMAGE 1 BREATH, 1 PROJECTION NUCLEAR MED VENT IMAGE 1 PROJECTION, GAS NUCLEAR MED VENT IMAGE MULTI PROJECTION, GAS NUCLEAR MED LUNG DIFFERENTIAL FUNCTION NUCLEAR MED BRAIN IMAGING LTD STATIC NUCLEAR MED BRAIN LTD IMAGING AND FLOW NUCLEAR MED BRAIN IMAGING COMPLETE NUCLEAR MED BRAIN IMAGING COMPLETE W FLOW NUCLEAR MED BRAIN IMAGING SPECT NUCLEAR MED BRAIN FLOW IMAGING ONLY NUCLEAR MED CISTERNOGRAM (Cerebrospinal Fluid Flow) NUCLEAR MED CEREBROSPINAL VENTRICULOGRAPHY NUCLEAR MED CSF SHUNT EVALUATION NUCLEAR MED CEREBROSPINAL FLUID SCAN SPECT NUCLEAR MED CSF LEAKAGE DETECTION AND LOCALIZATION NUCLEAR MED RADIOPHARMACEUTICAL DACRYOCYSTORGRAPHY NUCLEAR MED KIDNEY IMAGING MORPHOLOGY NUCLEAR MED KIDNEY IMAGING MORPHOLOGY W VASCULAR FLOW NUCLEAR MED KIDNEY IMAGING MORPHOLOGY W VASCULAR FLOW AND FUNCTION STUDY NUCLEAR MED KIDNEY IMAGING MORPHOLOGY W VASCULAR FLOW AND FUNCTION, SINGLE W PHARM INTERVENTION NUCLEAR MED KIDNEY IMAGING MORPHOLOGY W VASCULAR FLOW, MULTI, W/O AND W PHARM INTERVENTION 6 Carecorenational

7 NUCLEAR MED KIDNEY IMAGING, SPECT NUCLEAR MED KIDNEY FUNCTION STUDY, NON-IMAGE RADIOISOTROPIC NUCLEAR MED URINARY BLADDER RESIDUAL STUDY NUCLEAR MED URETERAL REFLUX STUDY NUCLEAR MED TESTICULAR IMAGING W VASCULAR FLOW NUCLEAR MED RADIOPHARM LOCALIZATION OF TUMOR, LIMITED AREA NUCLEAR MED RADIOPHARM LOCALIZATION OF TUMOR, MULTI AREAS NUCLEAR MED RADIOPHARM LOCALIZATION OF TUMOR, WHOLE BODY NUCLEAR MED RADIOPHARM LOCALIZATION OF TUMOR, SPECT NUCLEAR MED RADIOPHARMACEUTICAL LOCALIZATION OF TUMOR OR DISTRIBUTION OF RADIOPHARMACEUTICAL AGENT(S); WHOLE BODY, REQUIRING 2 OR MORE DAYS IMAGING NUCLEAR MED RADIOPHARM LOCALIZATION OF ABSCESS, LIMITED AREA NUCLEAR MED RADIOPHARM LOCALIZATION OF ABSCESS, WHOLE BODY NUCLEAR MED RADIOPHARM LOCALIZATION OF ABSCESS, SPECT MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET) METABOLIC EVAL MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; SINGLE STUDY AT REST OR STRESS MYOCARDIAL IMAGING, POSITRON EMISSION TOMOGRAPHY (PET), PERFUSION; MULTIPLE STUDIES AT REST OR STRESS Brain Imaging, Positron Emission Tomography (Pet) Metabolic Evaluation Brain Imaging, Positron Emission Tomography (Pet) Metabolic Evaluation, Perfusion Evaluation POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; LIMITED AREA (EG, CHEST, HEAD/NECK) POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; SKULL BASE TO MID-THIGH POSITRON EMISSION TOMOGRAPHY (PET) IMAGING; WHOLE BODY POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; LIMITED AREA (EG CHEST, HEAD/NECK) POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; SKULL BASE TO MID-THIGH POSITRON EMISSION TOMOGRAPHY (PET) WITH CONCURRENTLY ACQUIRED COMPUTER TOMOGRAPHY (CT) FOR ATTENUATION CORRECTION AND ANATOMICAL LOCALIZATION IMAGING; WHOLE BODY ULTRASOUND U/S GASTROINTESTINAL, ENDOSCOPIC S-CODES S8037 MAGNETIC RESONANCE CHOLANGIOPANCREATOGRAPHY (MRCP) CROSSWALK TO S-CODES S8042 MAGNETIC RESONANCE IMAGING (), LOW-FIELD (Crosswalk to any CPT code.) S-CODES S8092 ELECTRON BEAM COMPUTED TOMOGRAPHY (ALSO KNOWN AS ULTRAFAST CT, CINET) G-CODES G0219 PET IMAGING WHOLE BODY; MELANOMA FOR NON-COVERED INDICATIONS G-CODES G0235 PET IMAGING, ANY SITE, NOT OTHERWISE SPECIFIED G-CODES G0252 PET IMAGING, FULL AND PARTIAL-RING PET SCANNERS ONLY FOR INITIAL DIAGNOSIS OF BREAST CANCER AND/OR SURGICAL PLANNING FOR BREAST CANCER 7 Carecorenational

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