CT CT Myelogram MRI Abdomen without 74150 Cervical 62302 Abdomen / MRCP 74181 Abdomen with 74160 Thoracic 62303 Abdomen / MRCP with & without 74183 Abdomen with & without 74170 Lumbar 62304 Abdomen / Pelvis without 74176 2 or more MRA Abdomen 74185 62305 Abdomen / Pelvis with 74177 Regions MRA Brain 70544 Abdomen / Pelvis with & without 74178 MRA Carotid / Neck 70547 Abdomen with & without Pelvis with 74178 MRI Arthrogram MRA Chest 71555 (joint contrast) 73725x2 MRA Pelvis Runoff (to ankle) CTA Abdomen with & without 74175 73722 72198 CTA Abdomen Runoff (to toes) 75635 Ankle 73615 MRA Pelvis Without 72198 CTA Abdomen / Pelvis 74174 27648 CTA Cardiac 75574 73722 Brain without 70551 CTA Chest with & without 71275 Hip 73525 Brain with & without 70553 CTA Coronary 75574 27093 70553 Brain & Orbits with & without CTA Head with & without 70496 73722 70543 CTA Neck with & without 70498 Knee 73580 Breast Bilateral 77059 CTA Pelvis with & without 72191 27370 without or with & without. 73222 DX=cander add 0159T Cervical without 72125 Shoulder 73040 Thoracic without 72128 23350 Cardiac 75557 Lumbar without 72131 73219 Thumb 77002 Cervical without 72141 Chest without 71250 20600 Cervical with & without 72156 Chest with 71260 73222 Thoracic without 72146 Wrist (1 Chest with & without 71270 73115 Thoracic with & without 72157 compartment) Chest PE Protocol 71275 25246 Lumbar without 72148 Facial Bones without 70486 73222 Lumbar with & without 72158 Wrist (3 73115 compartment) 25246x Hip 73721 Head without 70450 Head with 70460 Dexascan Lower Extremity - Joint Head with & without 70470 Axial Skeleton 77080 Specify: Hip, Knee, Ankle 73721 Plus Vertebral Lower Extremity without 73700 Fracture ONLY Vertebral Orbits without 70480 Fracture 77086 Orbits without 70540 Orbits with 70481 Orbits with & without 70482 Pelvis without 72195 Pelvis with & without 72197 Pelvis without 72192 Pelvis with 72193 S.T. Neck without 70540 Pelvis with & without 72194 S.T. Neck with & without 70543 77085 Lower Extremity - Not a Joint Specify: Femur, TibFib, Foot 2018 CPT CODES MR/CT S.T. Neck without 70490 TMJ 70336 S.T. Neck with 70491 S.T. Neck with & without Sinus without 70492 70486 Upper Extremity - Joint Upper Extremity - Not a Joint Specify: Shoulder, Elbow, Wrist Specify: Humerus, Forearm, Hand 73221 73218 Temp Bones / IAC's without 70480 Breast Biopsy 19085 Upper Extremity without 73200 Additional Lesion 19086 Urogram 74178 73718 Page 1 of 5 Updated 01/08/2018
NM/Fluoro/Mammo/US Nuclear Medicine Bone Scan Whole Body A9503 78306 Bone Scan Limited A9503 Specify: Body Part 78300 Bone Scan 3 Phase A9503 Specify: Body Part 78315 Bone Spect A9503 78320 Gastric Emptying A9541 78264 Heart Treadmill 78452 J1245 Heart Pharmacologic 78452 J1245 Hida with CCK 78227 Hida without CCK A9537 78226 I-131 Whole Body Scan A9528 I-131 Whole Body Scan with Therapy I-131 Therapy All I-131 Addt'l Info on Pg 4 Liver Spect Scan A9541 78205 Liver Spleen 78215 A9567 Lung VQ A9540 78598 71020 Muga Scan A9560 78472 Parathyroid Scan A9500 78070 Renal Mag 3 Renal Lasix Renal Captopril Renal Scan-DMSA A9551 78710 Thyroid Uptake and Scan 78014 WBC Whole Body A9521 78806 WBC Limited A9521 78805 Fluoroscopy Ultrasound Barium Swallow 74220 Abdominal Complete 76700 Modified Barium Swallow Abdominal Limited 76705 74230 (must have speech pathologist) Aorta Iliac IVC for Aneurysm 76705 Barium Enema 74270 Breast (Bilateral x2) 76641 Barium Enema with Air 74280 Carotid 93880 Hysterosalpingogram (HSG) Lumbar Puncture 74740 77003 Chest Doppler, Arterial Unilateral Lower 76604 93926 58340 62270 Doppler, Arterial Bilateral Lower Doppler, Arterial Bilateral Upper 93925 93930 20610 Doppler, Arterial Unilateral Upper 93931 Pain Mgmt - Hip Injection 77002 Doppler Aorta Iliac 93978 Pain Mgmt - Sm Joint 77002 IVC for Transplant Specify: Toes, Fingers 20600 Doppler, Mesenteric 93976 Pain Mgmt - Int Joint 77002 Doppler Renal Artery 93975 Specify: Ankle, Wrist, Elbow 20605 Doppler, Portal Vein 93976 Pain Mgmt - Lg Joint 77002 Doppler, Venous Bilateral 93970 Specify: Hip Right or Left 20610 Doppler, Venous Unilateral 93971 Small Bowel Follow Through 74250 Extremity 76880 74247 Specify: Body Part Upper G.I. Barium Swallow 74220 Fetal Hips 76885 Upper G.I. with KUB 74247 Head / Soft Tissue Neck 76536 Upper G.I. with 76831 74249 Small Bowel Series HSG 58340 VCUG 74455 51600 Digital Mammography OB Single >14wks 76805 OB Multiple 76810 OB 1st Trimester < 14 wks 76801 OB T-Vag 76817 Screening Bilateral 77067 Screening Unilateral Pain Mgmt - Sm Joint 77067-52 Specify: Toes, Fingers 20604 Diagnostic Bilateral Pain Mgmt - Int Joint 77066 Specify: Ankle, Wrist, Elbow 20606 Diagnostic Unilateral 77065 U/S Pain Mgmt - Lg Joint Specify: Hip Right or Left 20611 Mag / Spot Bilateral 77065-52 Paracentesis 49083 Pelvis 76856 Mag / Spot Unilateral 77066-52 76856 Pelvis with T-Vag Stereotactic Breast Biopsy 19081 76830 Additional Lesion 19082 Renal 76770 Ultrasound Guided Procedures Renal Post Transplant 76776 19083 Scrotal (Testicular) 76870 Breast Biopsy G0206 Thoracentesis 32555 77051 Thyroid 76536 A4550 Transrectal (Prostate) 76872 Additional Lesion 19084 Transvaginal 76830 Breast Cyst Aspiration 76942 Specify: Side, Nodule 19000 76942 Thyroid Biopsy Specify: Side, Nodule 10022 Soft Tissue Neck Biopsy Specify: Side, Nodule 20206 76942 Page 2 of 5 Updated 01/08/2018
Additional Guide for Nuclear Medicine THYROID UPTAKE SINGLE DETERMINATION * Probe only with one return (2, 4, 6, OR 24HOURS) THYROID IMAGING, WITH UPTAKE-SINGLE DETERMINATION * Return with probe plus one image of the thyroid gland acquired at 6 hours after dose THYROID IMAGING WITH UPTAKE-MULTIPLE DETERMINATIONS * Return with probe and Includes the above with two returns for determination I131 WHOLE BODY SCAN-NO THYROGEN NO HIGH DOSE *TSH >30 *SDMI Dose *SDMI Whole Body Scan THYROGEN I131 WHOLE BODY SCAN NO HIGH DOSE *Thyrogen given by doctor s office Monday and Tuesday *SDMI Dose Wednesday *SDMI Whole Body Scan Friday- I131 WHOLE BODY SCAN WITH HIGH DOSE (29.9 MCI-200MCI) *TSH>30 Pregnancy test Required within 7 days unless Hysterectomy/Tubal Ligation *SDMI High Dose *SDMI Whole Body Scan 1 week after High Dose THYROGEN I131 WHOLE BODY SCAN WITH HIGH DOSE (29.9 MCI-200MCI) *Pregnancy test Required within 7 days unless Hysterectomy/Tubal Ligation *Thyroid labs within 3 months *Thyrogen given by doctor s office Monday and Tuesday *SDMI High Dose Wednesday *SDMI Whole Body Scan 1 week after High Dose 78012 78014 78014 Page 3 of 5 Updated 01/08/2018
Interventional Radiology Angiography and Venography Abdomen Angio (Aortagram) w/ Bilateral Lower Ext Arteriogram (Bilateral Runoff) 36200 75625 75716 A45550,1 36226x2 Carotid w/cerebral w/vertebral Arterties 4 Vessel 36223x2 Cerebral Vertebral Angio Carotid Angio Bilateral w/unilateral Vertebral 36222x2 (selective cath placement) 36226 36223x2 Bilateral Common Carotid Angio (w/head & neck) Bilateral Common Carotid Angio (w/neck only) 36222x2 Renal Angio Bilateral (aortagram) 36252 Renal Angio Unilateral (aortagram) 36251 Upper Extremity Angio Bilateral Upper Extremity Angio Unilateral Extremity (Arm or Leg) Venogram Bilateral Extremity (Arm or Leg) Venogram Unilateral Varicocele Embolization (VA Ins Only) 75716 36215 36216 36215 75710 75822 36005x2 75820 36005 37241 36012 36011 75833 Venous Access Procedures Chest Port - Insertion Chest Port - Exchange/Replace Arm Port - Insertion Arm Port - Exchange/Replace Port Removal (Arm or Chest) Port Repair (Arm or Chest) Not Replaced Tunneled Catheter Placement Tunneled Catheter Exchange Tunneled Catheter Removal IVC Filter Insertion IVC Filter Removal 36561 36582 36571 A4450,1 36585 36590 36576 36558 36581 36589 37191 37193 Other Special Procedures Vertobroplasty 1 Level Thoracic Vertebroplasty 1 Level Lumbar Additional Level Thoracic or Lumbar 22520 22521 22522 Kyphoplasty Consultation (New Patient) 99204 Kyphoplasty Consultation (Established Patient) 99214 22523 Kyphoplasty 1 Level Thoracic 22524 Kyphoplasty 1 Level Lumbar 22525 Kyphoplasty Additional Level Thoracic or Lumbar Post Op Care 99212,2 Page 4 of 5 Updated 01/08/2018
Interventional Radiology Nephrostogram (*Unilateral) Tube Insertion Tube Check Tube Change Tube Removal Urological Special Procedures *If Bilateral is needed, x2 Nephrostogram w/ Ureteral Stent Insertion (Ureteral Blockage) 50390 74475 50392 50394 50398 75984 50389 50393 74480 50398 50394 75984 Retroperitoneal or Peritoneal Percutaneous Drain Cavity Space 49406 Soft Tissue / Muscle 10030 A4450,1 Organ 49405 A4649 Peritoneal Cath Insertion 49418 Renal Cyst Aspiration or Pelvis Inj 50390 Cholangiogram thru Cath (T-Tube Check) 47505 74305 Lung Biopsy Mediastinum Liver Biopsy (hep c or random) Pleural Biopsy Abdomen / Retroperitoneal Biopsy Lymph Node Biopsy Bone Biopsy Trocar or Neddle;Superficial Bone Biopsy Needle; Deep Bone Marrow Biopsy Pancreas Biopsy CT Guided Special Procedures Renal or Adrenal Biopsy (patient must have a urologist or urology consult) Soft Tissue / Muscle Biopsy 32405(core) 71035x2 47000(core) 32400(core) 71035x2 49180(core) 1002(FNA) 38505(core) 20220 77002 20225 38221 48102(core) 50200(core) 20206(core) PET Scan and PET/CT Fusion codes call 515-8425 For additional Special Procedure contact Specials at 732-6019 Page 5 of 5 Updated 01/08/2018