EAPG Listing (version 3.11) Effective October 1, 2016

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Violet Warner
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1 DC EAPGs: EAPG Relative Photochemotherapy Superficial needle biopsy & aspiration Level I skin incision & drainage Level II skin incision & drainage Nail procedures Level I skin debridement & destruction Level II skin debridement & destruction Level III skin debridement & destruction Level I excision & biopsy of skin & soft tissue Level II excision & biopsy of skin & soft tissue Level III excision & biopsy of skin & soft tissue Level I skin repair Level II skin repair Level III skin repair Level IV skin repair Level I breast procedures Level II breast procedures Level III breast procedures Level I musculoskeletal procedures excluding hand & foot Level II musculoskeletal procedures excluding hand & foot Level III musculoskeletal procedures excluding hand & foot Level I hand procedures Level II hand procedures Level I foot procedures Level II foot procedures Level I arthroscopy Level II arthroscopy Replacement of cast Splint, strapping & cast removal Closed treatment fx & dislocation of finger, toe & trunk Closed treatment fx & dislocation exc finger, toe & trunk Open or percutaneous treatment of fractures Bone or joint manipulation under anesthesia Bunion procedures Level I arthroplasty Level II arthroplasty Hand & foot tenotomy Arthrocentesis & ligament or tendon injection Pulmonary tests Needle & catheter biopsy, aspiration, lavage & intubation Level I endoscopy of the upper airway Level II endoscopy of the upper airway Endoscopy of the lower airway Respiratory therapy Pulmonary rehabilitation Ventilation assistance & management Exercise tolerance tests Echocardiography Cardiac electrophysiologic tests & monitoring Placement of transvenous catheters Diagnostic cardiac catheterization Peripheral transcatheter & revascularization procedures Pacemaker insertion & replacement Removal & revision of pacemaker & vascular device Level I cardiothoracic procedures Level II cardiothoracic procedures Secondary varicose veins & vascular injection Vascular ligation & reconstruction Resuscitation Cardioversion Cardiac rehabilitation Thrombolysis Atrial & ventricular recording & pacing Aicd implant Coronary angioplasty Pharmacotherapy by extended infusion Pharmacotherapy except by extended infusion Phlebotomy Copyright 3M Health Information Systems, 2016 Page 1 of 9

2 DC EAPGs: EAPG Relative Level I blood & blood product exchange Level II blood & blood product exchange Deep lymph structure & thyroid procedures Allergy tests Home infusion Nutrition therapy Alimentary tests & simple tube placement Esophageal dilation without endoscopy Anoscopy with biopsy & diagnostic proctosigmoidoscopy Proctosigmoidoscopy with excision or biopsy Diagnostic upper gi endoscopy or intubation Therapeutic upper gi endoscopy or intubation Diagnostic lower gastrointestinal endoscopy Therapeutic colonoscopy Ercp & miscellaneous gi endoscopy procedures Level I hernia repair Level II hernia repair Level I anal & rectal procedures Level II anal & rectal procedures Level I gastrointestinal procedures Level II gastrointestinal procedures Level I laparoscopy Level II laparoscopy Level III laparoscopy Level IV laparoscopy Screening colorectal services Extracorporeal shock wave lithotripsy Urinary studies & procedures Urinary dilatation Level I bladder & kidney procedures Level II bladder & kidney procedures Level III bladder & kidney procedures Level I urethra & prostate procedures Level II urethra & prostate procedures Hemodialysis Peritoneal dialysis Testicular & epididymal procedures Circumcision Insertion of penile prosthesis Other penile procedures Destruction or resection of prostate Prostate needle & punch biopsy Artificial fertilization Level I fetal procedures Level II fetal procedures Treatment of incomplete abortion Therapeutic abortion Vaginal delivery Level I female reproductive procedures Level II female reproductive procedures Level III female reproductive procedures Dilation & curettage Hysteroscopy Colposcopy Extended eeg studies Electroencephalogram Electroconvulsive therapy Nerve & muscle tests Level I nervous system injections, stimulations or cranial tap Level I revision or removal of neurological device Level II revision or removal of neurological device Level I nerve procedures Level II nerve procedures Spinal tap Level II nervous system injections, stimulations or cranial tap Laminotomy & laminectomy Sleep studies Level III nerve procedures Level IV nerve procedures Copyright 3M Health Information Systems, 2016 Page 2 of 9

3 DC EAPGs: EAPG Relative Minor ophthalmological tests & procedures Fitting of contact lenses Laser eye procedures Cataract procedures Level I anterior segment eye procedures Level II anterior segment eye procedures Level III anterior segment eye procedures Level I posterior segment eye procedures Level II posterior segment eye procedures Strabismus & muscle eye procedures Level I repair & plastic procedures of eye Level II repair & plastic procedures of eye Cochlear device implantation Otorhinolaryngologic function tests Level I facial & ent procedures Level II facial & ent procedures Level III facial & ent procedures Level IV facial & ent procedures Tonsil & adenoid procedures Audiometry Occupational therapy Physical therapy Speech therapy & evaluation Manipulation therapy Occupational/physical therapy, group Speech therapy & evaluation, group Vascular radiology except venography of extremity Magnetic resonance angiography - head and/or neck Magnetic resonance angiography - chest Magnetic resonance angiography - other sites Myelography Miscellaneous radiological procedures with contrast Mammography & other related procedures Digestive radiology Diagnostic ultrasound except obstetrical & vascular of lower extremities Vascular diagnostic ultrasound of lower extremities Pet scans Bone densitometry Mri- abdomen Mri- joints Mri- back Mri- chest Mri- other Mri brain & magnetoencephalography Cat scan back Cat scan - brain Cat scan - abdomen Cat scan - other Angiography, other Angiography, cerebral Developmental & neuropsychological testing Full day partial hospitalization for substance abuse Full day partial hospitalization for mental illness Half day partial hospitalization for substance abuse Half day partial hospitalization for mental illness Counselling or individual brief psychotherapy Individual comprehensive psychotherapy Family psychotherapy Group psychotherapy Activity therapy Case management & treatment plan development - mental health or substance abuse Crisis intervention Medication administration & observation Mental hygiene assessment Mental health screening & brief assessment Intensive outpatient treatment Day treatment - half day Day treatment - full day Level I diagnostic nuclear medicine Copyright 3M Health Information Systems, 2016 Page 3 of 9

4 DC EAPGs: EAPG Relative Level II diagnostic nuclear medicine Level III diagnostic nuclear medicine Therapeutic nuclear medicine Radiation therapy & hyperthermia Afterloading brachytherapy Radiation treatment delivery Instillation of radioelement solutions Hyperthermic therapies Radiosurgery High energy neutron radiation treatment delivery Proton treatment delivery Level II afterloading brachytherapy Level I adjunctive general dental services Level II adjunctive general dental services Level I periodontics Level I prosthodontics, fixed Level II prosthodontics, fixed Level III prosthodontics, fixed Level I prosthodontics, removable Level II prosthodontics, removable Level III prosthodontics, removable Level I maxillofacial prosthetics Level II maxillofacial prosthetics Level I dental restorations Level II dental restorations Level III dental restoration Level I endodontics Level II endodontics Level III endodontics Level I oral & maxillofacial surgery Level II oral & maxillofacial surgery Level III oral & maxillofacial surgery Level IV oral & maxillofacial surgery Level I orthodontics Sealant Level I dental film Level II dental film Dental anesthesia Diagnostic dental procedures Preventive dental procedures Level II periodontics Level II orthodontics Anesthesia Level I dental implants Level II dental implants Level I molecular pathology & genetic tests Level II molecular pathology & genetic tests Level III molecular pathology & genetic tests Level I pathology Level II pathology Pap smears Blood & tissue typing Level I immunology tests Level II immunology tests Level I microbiology tests Level II microbiology tests Level I endocrinology tests Level II endocrinology tests Level I chemistry tests Level II chemistry tests Basic chemistry tests Organ or disease oriented panels Toxicology tests Therapeutic drug monitoring Level I clotting tests Level II clotting tests Level I hematology tests Level II hematology tests Urinalysis Copyright 3M Health Information Systems, 2016 Page 4 of 9

5 DC EAPGs: EAPG Relative Blood & urine dipstick tests Simple pulmonary function tests Cardiogram Level I immunization Level II immunization Level III immunization Minor reproductive procedures Minor cardiac & vascular tests Minor ophthalmological injection, scraping & tests Pacemaker & other electronic analysis Tube change Provision of vision aids Introduction of needle & catheter Dressings & other minor procedures Level I other miscellaneous ancillary procedures Psychotropic medication management Biofeedback & other training Patient education, individual Patient education, group Class I chemotherapy drugs Class II chemotherapy drugs Class III chemotherapy drugs Class IV chemotherapy drugs Class V chemotherapy drugs Class I pharmacotherapy Class II pharmacotherapy Class III pharmacotherapy Class IV pharmacotherapy Class V pharmacotherapy Class VI pharmacotherapy Class VI chemotherapy drugs Class VII chemotherapy Class vii pharmacotherapy Expanded hours access Additional undifferentiated medical visit/services Observation Smoking cessation treatment Diabetes supplies Motorized wheelchair Tpn formulae Implanted tissue of any type Motorized wheelchair accessories Venipuncture Allergy therapy Vaccine administration Class VIII - combined chemotherapy & pharmacotherapy Class IX combined chemotherapy & pharmacotherapy Class X combined chemotherapy & pharmacotherapy Class XI combined chemotherapy & pharmacotherapy Class XII combined chemotherapy & pharmacotherapy Class XIII combined chemotherapy & pharmocotherapy Obstetrical ultrasound Plain film Ultrasound guidance Ct guidance Radiological guidance for therapeutic or diagnostic procedures Mri guidance Level I therapeutic radiation treatment preparation Level II therapeutic radiation treatment preparation Medical radiation physics Treatment device design & construction Teletherapy/brachytherapy calculation Therapeutic radiology simulation field setting Radioelement application Radiation therapy management Therapeutic radiology treatment planning Corneal tissue processing Basic blood typing Minor cardiac monitoring Copyright 3M Health Information Systems, 2016 Page 5 of 9

6 DC EAPGs: EAPG Relative Minor device evaluation & electronic analysis Level II other miscellaneous ancillary procedures Incidental to medical visit or significant procedure Medical visit indicator Admission for observation indicator Minor chemotherapy drugs Minor pharmacotherapy Telehealth facilitation Pen formulae Direct admission for observation - obstetrical Direct admission for observation - other diagnoses Direct referral for observation - behavioral health Major signs, symptoms & findings Spinal diagnoses & injuries Nervous system malignancy Degenerative nervous system diagnoses exc mult sclerosis Multiple sclerosis & other demyelinating diseases Level I cns diagnoses Level II cns diagnoses Transient ischemia Peripheral nerve diagnoses Nontraumatic stupor & coma Seizure Headaches other than migraine Migraine Head trauma Aftereffects of cerebrovascular accident Nonspecific cva & precerebral occlusion w/o infarc Cva & precerebral occlusion w infarct Cerebral palsy Acute major eye infections Cataracts Glaucoma Level I other ophthalmic diagnoses Level II other ophthalmic diagnoses Conjunctivitis Ear, nose, mouth, throat, cranial/facial malignancies Vertiginous diagnoses except for benign vertigo Infections of upper respiratory tract & otitis media Dental & oral diagnoses & injuries Level I other ear, nose, mouth,throat & cranial/facial diagnoses Level II other ear, nose, mouth,throat & cranial/facial diagnoses Cystic fibrosis - pulmonary disease Respiratory malignancy Bronchiolitis & rsv pneumonia Community acquired pnuemonia Chronic obstructive pulmonary disease Asthma Level I other respiratory diagnoses Level II other respiratory diagnoses Pneumonia except for community acquired pneumonia Status asthmaticus Acute myocardial infarction Level I cardiovascular diagnoses Level II cardiovascular diagnoses Heart failure Cardiac arrest or other causes of mortality Peripheral & other vascular diagnoses Phlebitis Angina pectoris & coronary atherosclerosis Hypertension Cardiac structural & valvular diagnoses Level I cardiac arrhythmia & conduction diagnoses Atrial fibrillation Level II cardiac arrhythmia & conduction diagnoses Chest pain Syncope & collapse Digestive malignancy Peptic ulcer & gastritis Copyright 3M Health Information Systems, 2016 Page 6 of 9

7 DC EAPGs: EAPG Relative Esophagitis Level I gastrointestinal diagnoses Level II gastrointestinal diagnoses Inflammatory bowel disease Non-bacterial gastroenteritis, nausea & vomiting Abdominal pain Malfunction, reaction & complication of gi device or procedure Constipation Hernia Irritable bowel syndrome Alcoholic liver disease Malignancy of hepatobiliary system & pancreas Pancreas diagnoses except malignancy Hepatitis without coma Gallbladder & biliary tract diagnoses Cholecystitis Level I hepatobiliary diagnoses Level II hepatobiliary diagnoses Fracture of femur Fracture of pelvis or dislocation of hip Fractures & dislocations except femur, pelvis & back Musculoskeletal malignancy & pathological fractures Osteomyelitis, septic arthritis & other musculoskeletal infections Connective tissue diagnoses Back & neck diagnoses except lumbar disc diagnoses Lumbar disc diagnoses Lumbar disc diagnoses with sciatica Malfunction, reaction, complic of orthopedic device or procedure Level I other musculoskeletal system & connective tissue diagnoses Level II other musculoskeletal system & connective tissue diagnoses Osteoporosis Pain Skin ulcers Major skin diagnoses Malignant breast diagnoses Cellulitis & other bacterial skin infections Contusion, open wound & other trauma to skin & subcutaneous tissue Other skin, subcutaneous tissue & breast diagnoses Decubitus ulcer Malnutrition, failure to thrive & other nutritional diagnoses Inborn errors of metabolism Level I endocrine diagnoses Level II endocrine diagnoses Electrolyte disorders Obesity Diabetes with ophthalmic manifestations Diabetes with other manifestations & complications Diabetes with neurologic manifestations Diabetes without complications Diabetes with renal manifestations Renal failure Kidney & urinary tract malignancy Nephritis & nephrosis Kidney & chronic urinary tract infections Urinary stones & acquired upper urinary tract obstruction Malfunction, reaction, complic of genitourinary device or proc Other kidney & urinary tract diagnoses, signs & symptoms Acute lower urinary tract infections Malignancy, male reproductive system Male reproductive system diagnoses except malignancy Neoplasms of the male reproductive system Prostatitis Male reproductive infections Female reproductive system malignancy Female reproductive system infections Level I menstrual & other female diagnoses Level II menstrual & other female diagnoses Vaginal delivery Postpartum & post abortion diagnoses w/o procedure Copyright 3M Health Information Systems, 2016 Page 7 of 9

8 DC EAPGs: EAPG Relative Threatened abortion Abortion w/o d&c, aspiration curettage or hysterotomy False labor Other antepartum diagnoses Routine prenatal care Normal neonate Level I neonatal diagnoses Level II neonatal diagnoses Other hematological diagnoses Coagulation & platelet diagnoses Congenital factor deficiencies Sickle cell anemia crisis Sickle cell anemia Anemia except for iron deficiency anemia & sickle cell anemia Iron deficiency anemia Acute leukemia Lymphoma, myeloma & non-acute leukemia Radiotherapy Chemotherapy Lymphatic & other malignancies & neoplasms of uncertain behavior Septicemia & disseminated infections Post-operative, post-traumatic, other device infections Fever Viral illness Other infectious & parasitic diseases H. pylori infection Schizophrenia Major depressive diagnoses & other/unspecified psychoses Personality & impulse control diagnoses Bipolar disorders Depression except major depressive diagnoses Adjustment disorders & neuroses except depressive diagnoses Acute anxiety & delirium states Organic mental health disturbances Mental retardation Childhood behavioral diagnoses Eating disorders Other mental health diagnoses Opioid abuse & dependence Cocaine abuse & dependence Alcohol abuse & dependence Other drug abuse & dependence Allergic reactions Poisoning of medicinal agents Other complications of treatment Other injury, poisoning & toxic effect diagnoses Toxic effects of non-medicinal substances Extensive 3rd degree or full thickness burns w/o skin graft Partial thickness burns w or w/o skin graft Rehabilitation Signs, symptoms & other factors influencing health status Other aftercare & convalescence Neonatal aftercare Joint replacement Contraceptive management Adult preventive medicine Child preventive medicine Gynecological preventive medicine Preventive or screening encounters Hiv infection Aids Genetic counseling Inpatient only procedures User customizable inpatient procedures Unassigned Durable medical equipment & supplies - level Durable medical equipment & supplies - level Durable medical equipment & supplies - level Durable medical equipment - level Copyright 3M Health Information Systems, 2016 Page 8 of 9

9 DC EAPGs: EAPG Relative Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level Durable medical equipment - level User customizable 340b drugs Note: 1. 3M Health Information Systems, Definitions Manual, Version (January 2016). 2. The EAPG grouper is proprietary computer software created, owned and licensed by the 3M Company. All copyrights in and to the 3MTM Software are owned by 3M. All rights reserved. Copyright 3M Health Information Systems, 2016 Page 9 of 9

EAPG Listing (version 3.13) Effective October 1, 2018

EAPG Listing (version 3.13) Effective October 1, 2018 DC EAPGs: FY19 Relative 1 Photochemotherapy 0.179385 2 Superficial needle biopsy & aspiration 1.099801 3 Level I skin incision & drainage 0.543275 4 Level II skin incision & drainage 1.894953 5 Nail procs