ULTRASOUND CPT Description US ECHOENCEPHALOGRAPHY US SOFT TISSUE HEAD AND NECK US CHEST REAL TIME WITH IMAGE DOCUMENTATION 76641

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ULTRASOUND CPT CPT Description 76506 US ECHOENCEPHALOGRAPHY 76536 US SOFT TISSUE HEAD AND NECK 76604 US CHEST REAL TIME WITH IMAGE DOCUMENTATION 7664 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited 76700 ULTRASOUND ABDOMINAL REAL TIME WITH IMAGE DOCUMENTATION 76705 U/S SINGLE ORGAN 76770 ULTRASOUND,RETROPEROTONRAL,REAL TIME WITH IMAGE DOCUMENTATION;COMPLETE 76775 US ECHO LIMITED 76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation 76800 US ECHO SPINAL CANAL 76830 U/S TRANSVAGINAL 7683 HYSTEROSONOGRAPHY W OR W/O COL 76856 ULTRASOUND PELCIC REAL TIME WITH IMAGE DOCUMENTATION;COMPLETE 76857 US PEL LIM OR F/U 76870 US ECHO SCROTUM 76872 U/S TRANSRECTAL 7688 Ultrasound, extremity, non-vascular, real time with image documentation; complete 76882 Ultrasound, extremity, non-vascular, real time with image documentation; limited, anatomic specific 76885 US ECHO, INFANT HIPS REALTIME 76886 US,Infant Hips,Real Time;Limited, Static 76970 US STUDY FOLLOW UP 76975 Ultrasound Gastrointestinal, Endoscopic 76999 Echo examination procedure 93880 DUPLEX SCAN EXTRACRANIAL ARTER 93882 DUPLEX SCAN EXTRACRANIAL ARTER 93886 TRANSCRANIAL DOPPLER STUDY INT 93888 TRANSCRANIAL DOPPLER STUDY INT 93890 Transcranial Doppler vasoreactivity study 93892 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection 93893 Transcranial Doppler study of the intracranial arteries; emboli detection with intravenous microbubble injection 93922 NON-INVASIVE PHYSIOLOGIC STUDI 93923 NON-INVASIVE PHYSIOLOGIC STUDI 93924 NON-INVASIVE PHYSIOLOGIC STUDI 93925 DUPLEX SCAN LOW EXT. ART. OR A 93926 DUPLEX SCAN LOW EXT. ART. OR A 93930 DUPLEX SCAN UP EXT. ART. OR AR 9393 DUPLEX SCAN UP EXT. ART. OR AR Provider Procedure Codes Last Updated: JAN 208 PAGE

93965 NON-INVASIVE PHYSIOLOGIC STUDI 93970 DUPLEX SCAN EXT. VEINS, COMPLE 9397 DUPLEX SCAN EXT. VEINS, UNILAT 93975 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; complete study 93976 Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal organs; limited study 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study 93979 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; cunilateral or limited study 93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study 9398 Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study 93990 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) 93998 UNLISTED NONINVASIVE VASCULAR DIAGNOSTIC STUDY G0389 Ultrasound B-Scan And/Or Real Time With Image Documentation; For Abdominal Aortic Aneurysm (Aaa) Screening 7680 Ultrasound Obstetrical Pelvis, Pregnant Uterus, First Trimester less than 4 Weeks Single Or First Gestation 76802 Ultrasound Obstetrical Pelvis, Pregnant Uterus, First Trimester less than 4 Weeks Each Additional Gestation 76805 Ultrasound Obstetrical Pelvis, Pregnant Uterus, B-Scan 7680 Ultrasound Obstetrical Pelvis Complete, Multiple Gestation After st Trimester 768 Ultrasound Pregnant Uterus Fetal & Maternal Evaluation Plus Fetal Anatomic Evaluation Transabdominal Single Or First Gestation 7682 Ultrasound Pregnant Uterus Fetal & Maternal Evaluation Plus Fetal Anatomic Evaluation Transabdominal Each Additional Gestation 7683 Ultrasound, pregnant uterus, real time with image documentation 7684 Ultrasound, pregnant uterus, real time with image documentation 7685 Ultrasound Obstetrical Pelvis Limited (Gestational Age, Heart Beat, Emergency) 7686 Ultrasound Obstetrical Pelvis Follow Up Or Repeat 7687 Ultrasound Pregnant Uterus Transvaginal 7688 Fetal Biophysical Profile 7689 Fetal Biophysical Profile Without Stress Non Stress 76820 DOPPLER VELOCIMETRY, FETAL; UMBILICAL ARTERY 7682 DOPPLER VELOCIMETRY, FETAL; MIDDLE CEREBRAL ARTERY 76825 Ultrasound Obstetrical Echocardiography, Fetal, Cardiovascular System 76826 Follow Up Or Repeat Study 76827 Doppler Echocardiography Fetal Complete 76828 Follow Up Or Repeat Study RT Code Description 7704 Computed tomography guidance for placement of radiation therapy fields 7737 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of session; multi-source Cobalt 60 based Provider Procedure Codes Last Updated: JAN 208 PAGE 2

77372 Radiation treatment delivery, stereotactic radiosurgery (SRS), complete course of treatment of cranial lesion(s) consisting of session; linear accelerator based 77373 Stereotactic body radiation therapy, treatment delivery, per fraction to or more lesions, including image guidance, entire course not to exceed 5 fractions 77385 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; simple 77386 Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking, when performed; complex 77387 Guidance for localization of target volume for delivery of radiation treatment delivery, includes intrafraction tracking, when performed 7740 Radiation treatment delivery, superficial and/or ortho voltage, per day 77402 Radiation treatment delivery, > MeV; simple 77407 Radiation treatment delivery, > MeV; intermediate 7742 Radiation treatment delivery, > MeV; complex 77422 High energy neutron radiation treatment delivery; single treatment area using a single port or parallelopposed ports with no blocks or simple blocking 77423 High energy neutron radiation treatment delivery; or more isocenter(s) with coplanar or noncoplanar geometry with blocking and/or wedge, and/or compensator(s) 77424 Intraoperative radiation treatment delivery, x-ray, single treatment session 77425 Intraoperative radiation treatment delivery, electrons, single treatment session 77520 Proton treatment delivery; simple, without compensation 77522 Proton treatment delivery; simple, with compensation 77523 Proton treatment delivery; intermediate 77525 Proton treatment delivery; complex 77600 Hyperthermia, externally generated; superficial (ie, heating to a depth of 4 cm or less) 77605 Hyperthermia, externally generated; deep (ie, heating to depths greater than 4 cm) 7760 Hyperthermia generated by interstitial probe(s); 5 or fewer interstitial applicators 7765 Hyperthermia generated by interstitial probe(s); more than 5 interstitial applicators 77620 Hyperthermia generated by intracavitary probe(s) 77750 Infusion or instillation of radioelement solution (includes 3-month follow-up care) 7776 Intracavitary radiation source application; simple 77762 Intracavitary radiation source application; intermediate 77763 Intracavitary radiation source application; complex 77767 HDR radionuclide skin surface brachytherapy; lesion diameter up to 2.0 cm or channel 77768 HDR radionuclide skin surface brachytherapy; lesion diameter over 2.0 cm and 2 or more channels, or multiple lesions 77770 HDR radionuclide interstitial or intracavitary brachytherapy; channel 7777 HDR radionuclide rate interstitial or intracavitary brachytherapy; 2 to 2 channels 77772 HDR radionuclide interstitial or intracavitary brachytherapy; over 2 channels 77778 Interstitial radiation source application, complex, includes supervision, handling, loading of radiation source when performed 79403 Radiopharmaceutical therapy, radiolabeled monoclonal antibody by intravenous infusion 0394T HDR electronic brachytherapy, skin surface application, per fraction 0395T HDR electronic brachytherapy, interstitial or intracavitary treatment, per fraction A9543 Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries Provider Procedure Codes Last Updated: JAN 208 PAGE 3

A9606 G0339 G0340 G600 G6002 G6003 G6004 G6005 G6006 G6007 G6008 G6009 G600 G60 G602 G603 G604 G605 G606 Radiopharmaceutical, therapeutic, not otherwise classified Image guided robotic linear accelerator-based stereotactic radiosurgery, complete course of therapy in one session or first session of fractionated treatment Image guided robotic linear accelerator-based stereotactic radiosurgery, delivery including collimator changes and custom plugging, fractionated treatment, all lesions, per session, second through fifth sessions, maximum 5 sessions per course of treatment Ultrasonic guidance for placement of radiation therapy fields Stereoscopic x-ray guidance for localization of target volume for the delivery of radiation therapy Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: up to 5mev Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 6-0mev Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: -9mev Radiation treatment delivery, single treatment area,single port or parallel opposed ports, simple blocks or no blocks: 20mev or greater Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: up to 5mev Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 6-0mev Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: -9mev Radiation treatment delivery, 2 separate treatment areas, 3 or more ports on a single treatment area, use of multiple blocks: 20 mev or greater Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; up to 5mev Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 6-0mev Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; -9mev Radiation treatment delivery,3 or more separate treatment areas, custom blocking, tangential ports, wedges, rotational beam, compensators, electron beam; 20mev or greater Intensity modulated treatment delivery, single or multiple fields/arcs,via narrow spatially and temporally modulated beams, binary, dynamic mlc, per treatment session Compensator-based beam modulation treatment delivery of inverse planned treatment using 3 or more high resolution (milled or cast) compensator, convergent beam modulated fields, per treatment session CRID CPT CPT Description 33206 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial 33207 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); ventricular 33208 Insertion of new or replacement of permanent pacemaker with transvenous electrode(s); atrial and ventricular 3322 Insertion of pacemaker pulse generator only; with existing single lead Provider Procedure Codes Last Updated: JAN 208 PAGE 4

3323 Insertion of pacemaker pulse generator only; with existing dual leads Upgrade of implanted pacemaker system, conversion of single chamber system to dual chamber 3324 system (includes removal of previously placed pulse generator, testing of existing lead, insertion of new lead, insertion of new generator) 3322 Insertion of pacemaker pulse generator only; with existing multiple leads Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, with attachment to 33224 previously placed pacemaker or pacing cardioverter-defibrillator pulse generator (including revision of pocket, removal, insertion, and/or replacement of existing generator) Insertion of pacing electrode, cardiac venous system, for left ventricular pacing, at time of insertion of 33225 pacing cardioverter-defibrillator or pacemaker pulse generator (including upgrade to dual chamber system and pocket revision) (list separately in addition to code for primary procedure) 33227 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; single lead system 33228 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; dual lead system 33229 Removal of permanent pacemaker pulse generator with replacement of pacemaker pulse generator; multiple lead system 33230 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing dual leads 3323 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing multiple leads 33240 Insertion of pacing cardioverter-defibrillator pulse generator only; with existing single lead 33249 Insertion or replacement of permanent pacing cardioverter-defibrillator system with transvenous lead(s), single or dual chamber 33262 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverterdefibrillator pulse generator; single lead system 33263 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverterdefibrillator pulse generator; dual lead system 33264 Removal of pacing cardioverter-defibrillator pulse generator with replacement of pacing cardioverterdefibrillator pulse generator; multiple lead system 039T Insertion or replacement of subcutaneous implantable defibrillator system with subcutaneous electrode 0387T Implantation or replacement of permanent ventricular pacemaker 0388T Removal of permanent ventricular pacemaker 33477 Implantation of heart valve (pulmonary) to lungs, accessed through the skin SLEEP Code 95782 95783 95800 9580 Description POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, ATTENDED BY A TECHNOLOGIST POLYSOMNOGRAPHY; YOUNGER THAN 6 YEARS, SLEEP STAGING WITH 4 OR MORE ADDITIONAL PARAMETERS OF SLEEP, WITH INITIATION OF CONTINUOUS POSITIVE AIRWAY PRESSURE THERAPY OR BI-LEVEL VENTILATION, ATTENDED BY A TECHNOLOGIST Sleep study, unattended, simultaneous recording; heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time Sleep study, unattended, simultaneous recording; minimum of heart rate, oxygen saturation, respiratory analysis (e.g., by airflow or peripheral arterial tone), and sleep time Provider Procedure Codes Last Updated: JAN 208 PAGE 5

95805 Multiple Sleep Latency Test or Maintenance of Wakefulness Test 95806 Sleep study, unattended, simultaneous recording of, heart rate, oxygen saturation, respiratory airflow, and respiratory effort (e.g. Thoracoabdominal movement) 95807 Sleep study, simultaneous recording of ventilation, respiratory effort, ECG or heart rate, and oxygen saturation, attended by a technologist 95808 Polysomnography, Sleep staging with -3 Additional Parameters of Sleep, Attended by a Technologist 9580 Polysomnography, Sleep staging with 4 or more Additional Parameters of Sleep, Attended by a Technologist Polysomnography, Sleep staging with 4 or more additional Parameters of Sleep for PAP titration, with 958 initiation of continuous positive airway pressure therapy or bilevel ventilation, Attended by a Technologist HOME SLEEP STUDY TEST (HST) WITH TYPE II PORTABLE MONITOR, UNATTENDED; MINIMUM OF 7 G0398 CHANNELS including: EEG, EOG, EMG, RESPIRATORY MOVEMENT, AIRFLOW, ECG/HEART RATE AND OXYGEN SATURATION G0399 HOME SLEEP STUDY TEST (HST) WITH TYPE III PORTABLE MONITOR, UNATTENDED; MINIMUM OF 4 CHANNELS: 2 RESPIRATORY MOVEMENT/AIRFLOW, ECG/HEART RATE AND OXYGEN SATURATION G0400 HOME SLEEP STUDY TEST (HST) WITH TYPE IV PORTABLE MONITOR, UNATTENDED; MINIMUM OF 3 CHANNELS A4604 TUBING WITH INTEGRATED HEATING ELEMENT FOR USE WITH POSITIVE AIRWAY PRESSURE DEVICE A7027 COMBINATION ORAL/NASAL MASK, USED WITH CONTINUOUS POSITIVE AIRWAY PRESSURE DEVICE, EACH A7028 ORAL CUSHION FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, EACH A7029 NASAL PILLOWS FOR COMBINATION ORAL/NASAL MASK, REPLACEMENT ONLY, PAIR A7030 FULL FACE MASK USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH A703 FACE MASK INTERFACE, REPLACEMENT FOR FULL FACE MASK, EACH A7032 CUSHION FOR USE ON NASAL MASK INTERFACE, REPLACEMENT ONLY, EACH A7033 PILLOW FOR USE ON NASAL CANNULA TYPE INTERFACE, REPLACEMENT ONLY, PAIR A7034 NASAL INTERFACE (MASK OR CANNULA TYPE) USED WITH POSITIVE AIRWAY PRESSURE A7035 HEADGEAR USED WITH POSITIVE AIRWAY PRESSURE DEVICE A7036 CHINSTRAP USED WITH POSITIVE AIRWAY PRESSURE DEVICE A7037 TUBING USED WITH POSITIVE AIRWAY PRESSURE DEVICE A7038 FILTER, DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE A7039 FILTER, NON DISPOSABLE, USED WITH POSITIVE AIRWAY PRESSURE DEVICE A7044 ORAL INTERFACE USED WITH POSITIVE AIRWAY PRESSURE DEVICE, EACH A7045 EXHALATION PORT WITH OR WITHOUT SWIVEL USED WITH ACCESSORIES FOR POSITIVE A7046 WATER CHAMBER FOR HUMIDIFIER, USED WITH POSITIVE AIRWAY PRESSURE DEVICE, E0470 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITHOUT BACKUP RATE E047 RESPIRATORY ASSIST DEVICE, BI-LEVEL PRESSURE CAPABILITY, WITH BACK-UP RATE E060 CONTINUOUS AIRWAY PRESSURE (CPAP) DEVICE E056 HUMIDIFIER, NON-HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE E0562 HUMIDIFIER, HEATED, USED WITH POSITIVE AIRWAY PRESSURE DEVICE 94660 CONTINUOUS POSITIVE AIRWAY PRESSURE VENTILATION (CPAP), INITIATION AND MANAGEMENT PT/OT Code AMA Long Description Provider Procedure Codes Last Updated: JAN 208 PAGE 6

420 PHYSICAL THERAPY 42 PHYSICAL THERAPY: VISIT CHARGE 422 PHYSICAL THERAPY: HOURLY CHARGE 423 PHYSICAL THERAPY: GROUP RATE 424 PHYSICAL THERAPY: EVALUATION/RE-EVALUATION 429 PHYSICAL THERAPY: OTHER PHYSICAL THERAPY 430 OT General 43 OT Visit Code 432 OCCUPATIONAL THERAPY: HOURLY CHARGE 433 OCCUPATIONAL THERAPY: GROUP RATE 434 OCCUPATIONAL THERAPY: EVALUATION/RE-EVALUATION 439 OCCUPATIONAL THERAPY: OTHER OCCUPATIONAL THERAPY 28520 Strapping, hip 2905 Application of long arm splint(shoulder to hand) 2925 Application of short arm splint (forearm to hand), static 2926 Application of short arm splint (forearm to hand), dynamic 2930 Application of finger splint, static 293 Application of finger splint, dynamic 29200 Strapping; thorax 29220 Strapping, thorax 29240 Strapping; shoulder (eg, Velpeau) 29260 Strapping; elbow or wrist 29280 Strapping; hand or finger 29520 Strapping; hip 29530 Strapping; knee 29540 Strapping; ankle and/or foot 29550 Strapping; toes 909 Biofeedback training, perineal muscles, anorectal or urethral sphincter, including EMG and/or manometry 9583 Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk 95832 Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side 95833 Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands 95834 Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands 9585 Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine) 95852 Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side 9700 Physical therapy evaluation 97002 Physical therapy re-evaluation 97003 Occupational therapy evaluation 97004 Occupational therapy re-evaluation 9700 Application of a modality to or more areas; hot or cold packs 9702 Application of a modality to or more areas; traction, mechanical 9704 Application of a modality to or more areas; electrical stimulation (unattended) 9706 Application of a modality to or more areas; vasopneumatic devices Provider Procedure Codes Last Updated: JAN 208 PAGE 7

9708 Application of a modality to or more areas; paraffin bath 97020 Microwave 97022 Application of a modality to or more areas; whirlpool 97024 Application of a modality to or more areas; diathermy (eg, microwave) 97026 Application of a modality to or more areas; infrared 97028 Application of a modality to or more areas; ultraviolet 97032 Application of a modality to or more areas; electrical stimulation (manual), each 5 minutes 97033 Application of a modality to or more areas; iontophoresis, each 5 minutes 97034 Application of a modality to or more areas; contrast baths, each 5 minutes 97035 Application of a modality to or more areas; ultrasound, each 5 minutes 97036 Application of a modality to or more areas; Hubbard tank, each 5 minutes 97039 Unlisted modality (specify type and time if constant attendance) 970 Therapeutic procedure, or more areas, each 5 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 972 Therapeutic procedure, or more areas, each 5 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 973 Therapeutic procedure, or more areas, each 5 minutes; aquatic therapy with therapeutic exercises 976 Therapeutic procedure, or more areas, each 5 minutes; gait training (includes stair climbing) 9724 Therapeutic procedure, or more areas, each 5 minutes; massage, including effleurage, petrissage and/or tapotement (stroking, compression, percussion) 9739 Unlisted therapeutic procedure (specify) 9740 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), or more regions, each 5 minutes 9750 Therapeutic procedure(s), group (2 or more individuals) 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 5 minutes 97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 5 minutes 97533 Sensory integrative techniques to enhance sensory processing and promote adaptive responses to environmental demands, direct (one-on-one) patient contact, each 5 minutes Self-care/home management training (eg, activities of daily living (ADL) and compensatory training, meal 97535 preparation, safety procedures, and instructions in use of assistive technology devices/adaptive equipment) direct one-on-one contact, each 5 minutes Community/work reintegration training (eg, shopping, transportation, money management, avocational 97537 activities and/or work environment/modification analysis, work task analysis, use of assistive technology device/adaptive equipment), direct one-on-one contact, each 5 minutes 97542 Wheelchair management (eg, assessment, fitting, training), each 5 minutes 97545 Work hardening /conditioning; initial 2 hours 97546 Work hardening /conditioning; each additional hour (list separately in addition to code for primary procedure) 97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 5 minutes Assistive technology assessment (eg, to restore, augment or compensate for existing function, optimize 97755 functional tasks and/or maximize environmental accessibility), direct one-on-one contact, with written report, each 5 minutes 97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper Provider Procedure Codes Last Updated: JAN 208 PAGE 8

extremity(s), lower extremity(s) and/or trunk, each 5 minutes 9776 Prosthetic training, upper and/or lower extremity(s), each 5 minutes 97762 Checkout for orthotic/prosthetic use, established patient, each 5 minutes 97799 Unlisted physical medicine/rehabilitation service or procedure G05 Services of physical therapist in home health setting, each 5 minutes G052 Services of occupational therapist in home health setting, each 5 minutes G057 Services performed by a qualified physical therapist assistant in the home health or hospice setting, each 5 minutes G058 Services performed by a qualified occupational therapist assistant in the home health or hospice setting, each 5 minutes G059 Services performed by a qualified physical therapist, in the home health setting, in the establishment or delivery of a safe and effective physical therapy maintenance program, each 5 minutes G060 Services performed by a qualified occupational therapist, in the home health setting, in the establishment or delivery of a safe and effective occupational therapy maintenance program, each 5 minutes G028 Electrical stimulation, (unattended), to one or more areas, for chronic stage iii and stage iv pressure ulcers, etc. G0282 Electrical stimulation, (unattended), to one or more areas, for wound care other than described in G028 G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care ST Code AMA Long Description 440 SPEECH-LANGUAGE PATHOLOGY 44 SPEECH-LANGUAGE PATHOLOGY: VISIT CHARGE 442 SPEECH-LANGUAGE PATHOLOGY: HOURLY CHARGE 443 SPEECH-LANGUAGE PATHOLOGY: GROUP RATE 444 SPEECH-LANGUAGE PATHOLOGY: EVALUATION/ RE-EVALUATION 3575 Laryngoscopy, flexible fiberoptic; diagnostic 3579 Laryngoscopy, flexible or rigid fiberoptic, with stroboscopy 92507 Treatment of speech, language, voice, communication, and/or auditory processing disorder; individual 92508 Treatment of speech, language, voice, communication, and/or auditory processing disorder; group, 2 or more individuals 925 Nasopharyngoscopy with endoscope (separate procedure) 92520 Laryngeal function studies (ie, aerodynamic testing and acoustic testing) 9252 Evaluation of speech fluency (eg, stuttering, cluttering) 92522 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); 92523 Evaluation of speech sound production (eg, articulation, phonological process, apraxia, dysarthria); with evaluation of language comprehension and expression (eg, receptive and expressive language) 92524 Behavioral and qualitative analysis of voice and resonance 92526 Treatment of swallowing dysfunction and/or oral function for feeding 92597 Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech 92605 Evaluation for prescription of non-speech-generating augmentative and alternative communication device, face-to-face with the patient; first hour 92606 Therapeutic service(s) for the use of non-speech-generating device, including programming and modification 92607 Evaluation for prescription for speech-generating augmentative and alternative communication device, faceto-face with the patient; first hour Provider Procedure Codes Last Updated: JAN 208 PAGE 9

92608 Evaluation for prescription for speech-generating augmentative and alternative communication device, faceto-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure) 92609 Therapeutic services for the use of speech-generating device, including programming and modification 9260 Evaluation of oral and pharyngeal swallowing function 926 Motion fluoroscopic evaluation of swallowing function by cine or video recording 9262 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; 9263 Flexible fiberoptic endoscopic evaluation of swallowing by cine or video recording; interpretation and report only 9264 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; 9265 Flexible fiberoptic endoscopic evaluation, laryngeal sensory testing by cine or video recording; interpretation and report only 9266 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; 9267 Flexible fiberoptic endoscopic evaluation of swallowing and laryngeal sensory testing by cine or video recording; interpretation and report only Evaluation for prescription of non-speech-generating augmentative and alternative communication device, 9268 face-to-face with the patient; each additional 30 minutes (List separately in addition to code for primary procedure) Assessment of aphasia (includes assessment of expressive and receptive speech and language function, 9605 language comprehension, speech production ability, reading, spelling, writing, eg, by Boston Diagnostic Aphasia Examination) with interpretation and report, per hour 960 Developmental screening (eg, developmental milestone survey, speech and language delay screen), with scoring and documentation, per standardized instrument 96 Developmental testing, (includes assessment of motor, language, social, adaptive, and/or cognitive functioning by standardized developmental instruments) with interpretation and report Standardized cognitive performance testing (eg, Ross Information Processing Assessment) per hour of a 9625 qualified health care professional's time, both face-to-face time administering tests to the patient and time interpreting these test results and preparing the report 97532 Development of cognitive skills to improve attention, memory, problem solving (includes compensatory training), direct (one-on-one) patient contact, each 5 minutes CHIRO Code AMA Long Description 9583 Muscle testing, manual (separate procedure) with report; extremity (excluding hand) or trunk 95832 Muscle testing, manual (separate procedure) with report; hand, with or without comparison with normal side 95833 Muscle testing, manual (separate procedure) with report; total evaluation of body, excluding hands 95834 Muscle testing, manual (separate procedure) with report; total evaluation of body, including hands 9585 Range of motion measurements and report (separate procedure); each extremity (excluding hand) or each trunk section (spine) 95852 Range of motion measurements and report (separate procedure); hand, with or without comparison with normal side 9700 Physical therapy evaluation Provider Procedure Codes Last Updated: JAN 208 PAGE 0

PAIN 97002 Physical therapy re-evaluation 97003 Occupational therapy evaluation 97004 Occupational therapy re-evaluation 9700 Application of a modality to or more areas; hot or cold packs 9702 Application of a modality to or more areas; traction, mechanical 9704 Application of a modality to or more areas; electrical stimulation (unattended) 9706 Application of a modality to or more areas; vasopneumatic devices 9708 Application of a modality to or more areas; paraffin bath 97020 Microwave 97022 Application of a modality to or more areas; whirlpool 97024 Application of a modality to or more areas; diathermy (eg, microwave) 97026 Application of a modality to or more areas; infrared 97028 Application of a modality to or more areas; ultraviolet 97032 Application of a modality to or more areas; electrical stimulation (manual), each 5 minutes 97033 Application of a modality to or more areas; iontophoresis, each 5 minutes 97034 Application of a modality to or more areas; contrast baths, each 5 minutes 97035 Application of a modality to or more areas; ultrasound, each 5 minutes 97036 Application of a modality to or more areas; Hubbard tank, each 5 minutes 97039 Unlisted modality (specify type and time if constant attendance) 970 Therapeutic procedure, or more areas, each 5 minutes; therapeutic exercises to develop strength and endurance, range of motion and flexibility 972 Therapeutic procedure, or more areas, each 5 minutes; neuromuscular reeducation of movement, balance, coordination, kinesthetic sense, posture, and/or proprioception for sitting and/or standing activities 976 Therapeutic procedure, or more areas, each 5 minutes; gait training (includes stair climbing) 9740 Manual therapy techniques (eg, mobilization/ manipulation, manual lymphatic drainage, manual traction), or more regions, each 5 minutes 97530 Therapeutic activities, direct (one-on-one) patient contact (use of dynamic activities to improve functional performance), each 5 minutes 97760 Orthotic(s) management and training (including assessment and fitting when not otherwise reported), upper extremity(s), lower extremity(s) and/or trunk, each 5 minutes 9776 Prosthetic training, upper and/or lower extremity(s), each 5 minutes 97762 Checkout for orthotic/prosthetic use, established patient, each 5 minutes 98942 Chiropractic manipulative treatment (CMT); spinal, 5 regions 98943 Chiropractic manipulative treatment (CMT); extraspinal, or more regions 97750 Physical performance test or measurement (eg, musculoskeletal, functional capacity), with written report, each 5 minutes 98940 Chiropractic manipulative treatment (CMT); spinal, -2 regions 9894 Chiropractic manipulative treatment (CMT); spinal, 3-4 regions G0283 Electrical stimulation (unattended), to one or more areas for indication(s) other than wound care, as part of a therapy plan of care Code AMA Long Description 27096 Injection procedure for sacroiliac joint, anesthetic/steroid, with image guidance (fluoroscopy or CT) including Provider Procedure Codes Last Updated: JAN 208 PAGE

arthrography when performed 62280 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; subarachnoid 6228 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, cervical or thoracic 62282 Injection/infusion of neurolytic substance (eg, alcohol, phenol, iced saline solutions), with or without other therapeutic substance; epidural, lumbar, sacral (caudal) Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, 6230 other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic Injection(s), of diagnostic or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, 623 other solution), not including neurolytic substances, including needle or catheter placement, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal) Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic 6238 or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; cervical or thoracic Injection(s), including indwelling catheter placement, continuous infusion or intermittent bolus, of diagnostic 6239 or therapeutic substance(s) (including anesthetic, antispasmodic, opioid, steroid, other solution), not including neurolytic substances, includes contrast for localization when performed, epidural or subarachnoid; lumbar or sacral (caudal) 62350 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; without laminectomy 6235 Implantation, revision or repositioning of tunneled intrathecal or epidural catheter, for long-term medication administration via an external pump or implantable reservoir/infusion pump; with laminectomy 62355 Removal of previously implanted intrathecal or epidural catheter 62360 Implantation or replacement of device for intrathecal or epidural drug infusion; subcutaneous reservoir 6236 Implantation or replacement of device for intrathecal or epidural drug infusion; nonprogrammable pump 62362 Implantation or replacement of device for intrathecal or epidural drug infusion; programmable pump, including preparation of pump, with or without programming 62365 Removal of subcutaneous reservoir or pump, previously implanted for intrathecal or epidural infusion 63650 Percutaneous implantation of neurostimulator electrode array, epidural 63655 Laminectomy for implantation of neurostimulator electrodes, plate/paddle, epidural 63663 Revision including replacement, when performed, of spinal neurostimulator electrode percutaneous array(s), including fluoroscopy, when performed 63664 Revision including replacement, when performed, of spinal neurostimulator electrode plate/paddle(s) placed via laminotomy or laminectomy, including fluoroscopy, when performed 63685 Insertion or replacement of spinal neurostimulator pulse generator or receiver, direct or inductive coupling 63688 Revision or removal of implanted spinal neurostimulator pulse generator or receiver 64479 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, single level 64480 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); cervical or thoracic, each additional level (List separately in addition to code for primary procedure) 64483 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level 64484 Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or Provider Procedure Codes Last Updated: JAN 208 PAGE 2

CT); lumbar or sacral, each additional level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 64490 that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 6449 that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; second level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 64492 that joint) with image guidance (fluoroscopy or CT), cervical or thoracic; third and any additional level(s) (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 64493 that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; single level Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 64494 that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; second level (List separately in addition to code for primary procedure) Injection(s), diagnostic or therapeutic agent, paravertebral facet (zygapophyseal) joint (or nerves innervating 64495 that joint) with image guidance (fluoroscopy or CT), lumbar or sacral; third and any additional level(s) (List separately in addition to code for primary procedure) 6450 Injection, anesthetic agent; stellate ganglion (cervical sympathetic) 64520 Injection, anesthetic agent; lumbar or thoracic (paravertebral sympathetic) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); 64633 cervical or thoracic, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); 64634 lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); 64635 lumbar or sacral, single facet joint Destruction by neurolytic agent, paravertebral facet joint nerve(s), with imaging guidance (fluoroscopy or CT); 64636 lumbar or sacral, each additional facet joint (List separately in addition to code for primary procedure) SPINE Code AMA Long Description 20930 Allograft, morselized, or placement of osteopromotive material, for spine surgery only (List separately in addition to code for primary procedure) 2093 Allograft, structural, for spine surgery only (List separately in addition to code for primary procedure) 22206 Osteotomy of spine, posterior or posterolateral approach, 3 columns, vertebral segment (eg, pedicle/vertebral body subtraction); thoracic 22207 Osteotomy of spine, posterior or posterolateral approach, 3 columns, vertebral segment (eg, pedicle/vertebral body subtraction); lumbar Osteotomy of spine, posterior or posterolateral approach, 3 columns, vertebral segment (eg, 22208 pedicle/vertebral body subtraction); each additional vertebral segment (List separately in addition to code for primary procedure) Provider Procedure Codes Last Updated: JAN 208 PAGE 3

2220 Osteotomy of spine, posterior or posterolateral approach, vertebral segment; cervical 2222 Osteotomy of spine, posterior or posterolateral approach, vertebral segment; thoracic 2224 Osteotomy of spine, posterior or posterolateral approach, vertebral segment; lumbar 2226 Osteotomy of spine, posterior or posterolateral approach, vertebral segment; each additional vertebral segment (List separately in addition to primary procedure) 22220 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical 22222 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; thoracic 22224 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; lumbar 22226 Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; each additional vertebral segment (List separately in addition to code for primary procedure) 22505 Manipulation of spine requiring anesthesia, any region 2250 Percutaneous vertebroplasty (bone biopsy included when performed), vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; cervicothoracic 225 Percutaneous vertebroplasty (bone biopsy included when performed), vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral Percutaneous vertebroplasty (bone biopsy included when performed), vertebral body, unilateral or bilateral 2252 injection, inclusive of all imaging guidance; each additional cervicothoracic or lumbosacral vertebral body (List separately in addition to code for primary procedure) 2253 Injection of bone cement into body of middle spine bone accessed through the skin using imaging guidance 2254 Injection of bone cement into body of lower spine bone accessed through the skin using imaging guidance 2255 Injection of bone cement into body of middle or lower spine bone accessed through the skin using imaging guidance 22526 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; single level 22527 Percutaneous intradiscal electrothermal annuloplasty, unilateral or bilateral including fluoroscopic guidance; or more additional levels (List separately in addition to code for primary procedure) 22532 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic 22533 Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar Arthrodesis, lateral extracavitary technique, including minimal discectomy to prepare interspace (other than 22534 for decompression); thoracic or lumbar, each additional vertebral segment (List separately in addition to code for primary procedure) 22548 Arthrodesis, anterior transoral or extraoral technique, clivus-c-c2 (atlas-axis), with or without excision of odontoid process 2255 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2 Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and 22552 decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace (List separately in addition to code for separate procedure) 22554 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); cervical below C2 22556 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); thoracic 22558 Arthrodesis, anterior interbody technique, including minimal discectomy to prepare interspace (other than for decompression); lumbar Provider Procedure Codes Last Updated: JAN 208 PAGE 4

22586 Arthrodesis, pre-sacral interbody technique, including disc space preparation, discectomy, with posterior instrumentation, with image guidance, includes bone graft when performed, L5-S interspace 22590 Arthrodesis, posterior technique, craniocervical (occiput-c2) 22595 Arthrodesis, posterior technique, atlas-axis (C-C2) 22600 Arthrodesis, posterior or posterolateral technique, single level; cervical below C2 segment 2260 Arthrodesis, posterior or posterolateral technique, single level; thoracic (with lateral transverse technique, when performed) 2262 Arthrodesis, posterior or posterolateral technique, single level; lumbar (with lateral transverse technique, when performed) 2264 Arthrodesis, posterior or posterolateral technique, single level; each additional vertebral segment (List separately in addition to code for primary procedure) 22630 Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace (other than for decompression), single interspace; lumbar Arthrodesis, posterior interbody technique, including laminectomy and/or discectomy to prepare interspace 22632 (other than for decompression), single interspace; each additional interspace (List separately in addition to code for primary procedure) Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including 22633 laminectomy and/or discectomy sufficient to prepare interspace (other than for decompression), single interspace and segment; lumbar Arthrodesis, combined posterior or posterolateral technique with posterior interbody technique including 22634 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) 22800 Arthrodesis, posterior, for spinal deformity, with or without cast; up to 6 vertebral segments 22802 Arthrodesis, posterior, for spinal deformity, with or without cast; 7 to 2 vertebral segments 22804 Arthrodesis, posterior, for spinal deformity, with or without cast; 3 or more vertebral segments 22808 Arthrodesis, anterior, for spinal deformity, with or without cast; 2 to 3 vertebral segments 2280 Arthrodesis, anterior, for spinal deformity, with or without cast; 4 to 7 vertebral segments 2282 Arthrodesis, anterior, for spinal deformity, with or without cast; 8 or more vertebral segments 2288 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); single or 2 segments 2289 Kyphectomy, circumferential exposure of spine and resection of vertebral segment(s) (including body and posterior elements); 3 or more segments 22830 Exploration of spinal fusion Posterior non-segmental instrumentation (eg, Harrington rod technique, pedicle fixation across interspace, 22840 atlantoaxial transarticular screw fixation, sublaminar wiring at C, facet screw fixation) (List separately in addition to code for primary procedure) 2284 Internal spinal fixation by wiring of spinous processes (List separately in addition to code for primary procedure) 22842 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 to 6 vertebral segments (List separately in addition to code for primary procedure) 22843 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 7 to 2 vertebral segments (List separately in addition to code for primary procedure) 22844 Posterior segmental instrumentation (eg, pedicle fixation, dual rods with multiple hooks and sublaminar wires); 3 or more vertebral segments (List separately in addition to code for primary procedure) 22845 Anterior instrumentation; 2 to 3 vertebral segments (List separately in addition to code for primary procedure) Provider Procedure Codes Last Updated: JAN 208 PAGE 5

22846 Anterior instrumentation; 4 to 7 vertebral segments (List separately in addition to code for primary procedure) 22847 Anterior instrumentation; 8 or more vertebral segments (List separately in addition to code for primary procedure) 22848 Pelvic fixation (attachment of caudal end of instrumentation to pelvic bony structures) other than sacrum (List separately in addition to code for primary procedure) 22849 Reinsertion of spinal fixation device 2285 Application of intervertebral biomechanical device(s) (eg, synthetic cage(s), methylmethacrylate) to vertebral defect or interspace (List separately in addition to code for primary procedure) Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation 22856 (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); single interspace, cervical 22857 Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar Total disc arthroplasty (artificial disc), anterior approach, including discectomy with end plate preparation 22858 (includes osteophytectomy for nerve root or spinal cord decompression and microdissection); second level, cervical (List separately in addition to code for primary procedure) 2286 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical 22862 Revision including replacement of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar 22864 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; cervical 22865 Removal of total disc arthroplasty (artificial disc), anterior approach, single interspace; lumbar Decompression procedure, percutaneous, of nucleus pulposus of intervertebral disc, any method utilizing 62287 needle based technique to remove disc material under fluoroscopic imaging or other form of indirect visualization, with the use of an endoscope, with discography and/or epidural injection(s) at the treated level(s), when performed, single or multiple levels, lumbar 62292 Injection procedure for chemonucleolysis, including discography, intervertebral disc, single or multiple levels, lumbar 6300 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), or 2 vertebral segments; cervical 63003 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), or 2 vertebral segments; thoracic Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without 63005 facetectomy, foraminotomy or discectomy (eg, spinal stenosis), or 2 vertebral segments; lumbar, except for spondylolisthesis 630 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), or 2 vertebral segments; sacral 6302 Laminectomy with removal of abnormal facets and/or pars inter-articularis with decompression of cauda equina and nerve roots for spondylolisthesis, lumbar (Gill type procedure) 6305 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; cervical 6306 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; thoracic 6307 Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), more than 2 vertebral segments; lumbar 63020 Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, Provider Procedure Codes Last Updated: JAN 208 PAGE 6