1 Appendectomy - Outpatient 2 Asthma 3 Back Pain - Lumbar Diskectomy 4 Back Pain - Lumbar Fusion 5 Back Pain - Lumbar Laminectomy 6 Birth Control - Cut and Tie Tubes 7 Bladder Exam - Cystoscopy 8 Bunion Surgery 9 Cardiac Catheterization - Diagnostic 10 Carpal Tunnel Surgery 11 Cataract Removal with Lens Implant 12 Childbirth - Cesarean Delivery and Newborn Care 13 Childbirth - Vaginal Delivery and Newborn Care 14 Colonoscopy - Preventive Screening 15 Colonoscopy with Polyp Removal 16 COPD - Chronic Obstructive Pulmonary Disease 17 Coronary Angioplasty 18 Coronary Angioplasty with Drug-Eluting Stent 19 Coronary Angioplasty with Non-Drug-Eluting Stent 20 Coronary Artery Disease - Heart Disease 21 Diabetes 22 Ear Infection - Chronic - Ear Tubes 23 Endometriosis - Inpatient 24 Endometriosis - Outpatient 25 Enlarged Prostate Surgery - TURP 26 ERCP 27 Gallbladder Removal - Laparoscopic 28 Hemorrhoid Surgery 29 Hernia Repair in Groin - Incision 30 Hernia Repair in Groin - Laparoscopic 31 Hip Replacement 32 Hysterectomy - Abdominal 33 Hysterectomy - Vaginal 34 Knee Arthroscopy With ACL Surgery 35 Knee Arthroscopy With Meniscus Surgery 36 Knee Replacement 37 Neck Pain - Cervical Spine Fusion 38 Ovary and Fallopian Tube Removal 39 Shoulder Arthroscopy with Labrum Repair 40 Shoulder Arthroscopy with Rotator Cuff Repair 41 Sinus Endoscopy with Biopsy 42 Tonsil and Adenoid Removal 43 Tonsil Removal 44 Upper Endoscopy 45 Upper Endoscopy With Biopsy 1
46 Upper Endoscopy With Dilation 47 Upper Intestine Removal - Laparoscopic 48 Uterine Fibroid Removal 49 Vasectomy - Male Sterilization 50 Weight Loss Surgery - Gastric Bypass 51 Weight Loss Surgery - Laparoscopic Band 52 Abnormal Uterine Bleeding - Endometrial Ablation 53 Abnormal Uterine Bleeding - Office Visit 54 Acne 55 Acupuncture 56 Allergic Rash 57 Allergy and Immunology - Specialist Visit 58 Allergy Injections 59 Allergy Symptoms 60 Allergy Testing 61 Ankle Pain 62 Athletes Foot 63 Back Pain - Chiropractor Visit - Six Visits 64 Back Pain - Doctor Visit 65 Back Pain - Epidural Steroid Injection 66 Back Pain - Physical Therapy 67 Bacterial Culture - Other Source Test 68 Bacterial Culture - Urine Test 69 Basic Metabolic Panel Test 70 Biopsy - Bladder 71 Biopsy - Breast 72 Biopsy - Cervix 73 Biopsy - Colon 74 Biopsy - Esophagus 75 Biopsy - Kidney 76 Biopsy - Neck 77 Biopsy - Prostate 78 Biopsy - Skin 79 Biopsy - Testicles 80 Biopsy - Thyroid 81 Birth Control - Intrauterine Device 82 Blood Draw 83 Blood in Stool Test 84 Bone Density Study - Hips, Pelvis, and Spine 85 Bronchitis - Acute 86 Cardiology - Specialist Visit 87 Chickenpox 88 Chiropractic Manipulation 89 Chlamydia Test 90 Cholesterol Test 2
91 Cold Sore 92 Common Cold 93 Complete Blood Count - CBC Test 94 Comprehensive Metabolic Panel Test 95 C-Reactive Protein - CRP Test 96 Creatine Kinase Test 97 Creatinine Test 98 CT Scan Angiography Without Dye Followed by With Dye - Chest 99 CT Scan With Dye - Abdomen 100 CT Scan With Dye - Abdomen and Pelvis 101 CT Scan With Dye - Chest 102 CT Scan With Dye - Pelvis 103 CT Scan Without Dye - Abdomen 104 CT Scan Without Dye - Head or Brain 105 CT Scan Without Dye - Maxillofacial - Face 106 CT Scan Without Dye - Pelvis 107 CT Scan Without Dye Followed by With Dye - Abdomen 108 D and C - Miscarriage 109 Dermatology - Specialist Visit 110 Ear Infection - Acute 111 Ear Nose, and Throat - Specialist Visit 112 Eczema 113 Electrocardiogram - EKG 114 Electroencephalogram - EEG 115 Electromyogram - EMG 116 Enlarged Prostate - BPH 117 Family Medicine - Specialist Visit 118 Fasting Blood Glucose Test 119 Flu - Influenza 120 Gastroenterology - Specialist Visit 121 General Health Panel Test 122 Glaucoma - Eye Shunt 123 Gonorrhea Test 124 Head Lice 125 Hearing Loss - Adult 126 Heart SPECT Imaging Studies 127 Heart Stress Test With Heart Ultrasound 128 Heart Ultrasound for Birth Defects 129 Heart Ultrasound With Blood Flow Study 130 Heartburn 131 Hematocrit Test 132 Hemoglobin A1c Test 133 Hemoglobin Test 134 HIDA Scan 135 High Blood Pressure - Hypertension 3
136 High Cholesterol 137 Hives 138 Human Papillomavirus - HPV Test 139 Influenza Test 140 Internal Medicine - Specialist Visit 141 Kidney Stone 142 Kidney Stone Disintegration - Lithotripsy 143 Knee Injection 144 Knee Pain - Minor 145 Lactate Dehydrogenase - LDH Test 146 Laryngitis 147 Laryngoscopy 148 Liver Enzyme Study - GGT Test 149 Liver Panel Test 150 Low Testosterone - Office Visit 151 Low Thyroid 152 Mammogram - Diagnostic - Digital 153 Mammogram - Diagnostic - Film 154 Mammogram - Preventive Screening - Digital 155 Mammogram - Preventive Screening - Film 156 Medical Oncology - Specialist Visit 157 Migraine Headache 158 Mole Removal 159 Mononucleosis 160 Mononucleosis Test 161 MRI Scan With and Without Dye - Abdomen 162 MRI Scan With and Without Dye - Brain 163 MRI Scan Without and With Dye - Lumbar Spine 164 MRI Scan Without Dye - Brain 165 MRI Scan Without Dye - Cervical Spine 166 MRI Scan Without Dye - Knee 167 MRI Scan Without Dye - Lumbar Spine 168 MRI Scan Without Dye - Upper Extremity - Arm 169 Neck Pain - Primary Care Physician 170 Nerve Conduction Studies 171 Neurology - Specialist Visit 172 Nutritionist - Specialist Visit 173 Obstetrics and Gynecology - Specialist Visit 174 Office Visit - Primary Doctor - Established Patient - High Complexity 175 Office Visit - Primary Doctor - Established Patient - Low Complexity 176 Office Visit - Primary Doctor - Established Patient - Minimal Complexity 177 Office Visit - Primary Doctor - Established Patient - Moderate Complexity 178 Office Visit - Primary Doctor - Established Patient - Moderate to High Complexity 179 Office Visit - Primary Doctor - New Patient - High Complexity 180 Office Visit - Primary Doctor - New Patient - Low Complexity 4
181 Office Visit - Primary Doctor - New Patient - Minimal Complexity 182 Office Visit - Primary Doctor - New Patient - Moderate Complexity 183 Office Visit - Primary Doctor - New Patient - Moderate to High Complexity 184 Office Visit - Specialist - High Complexity 185 Office Visit - Specialist - Low Complexity 186 Office Visit - Specialist - Minimal Complexity 187 Office Visit - Specialist - Moderate Complexity 188 Office Visit - Specialist - Moderate to High Complexity 189 Orthopedic Surgery - Specialist Visit 190 Pap Smear Test 191 PET Scan with CT Scan 192 Physical Medicine and Rehabilitation - Specialist Visit 193 Physical Therapy - Exercises 194 Physical Therapy - Functional Activities 195 Physical Therapy - Massage and Traction 196 Physical Therapy - Nerve and Muscle Retraining 197 Pink Eye 198 Podiatrist - Specialist Visit 199 Prostate-Specific Antigen - PSA Test 200 Psoriasis 201 PT Blood Test 202 Radiation Treatment Delivery - Low Intensity 203 Radiation Treatment Delivery - Medium Intensity 204 Radiation Treatment Delivery - Varied Intensity 205 Retinal Detachment Repair 206 Rheumatoid Arthritis 207 Ringworm 208 Scabies 209 Screening Culture Test 210 Sed Rate - ESR Test 211 Shingles 212 Shoulder Pain 213 Sinusitis - Acute 214 Sleep Apnea 215 Sleep Study 216 Sleep Study at Home 217 Sleep Study With CPAP 218 Sore Throat 219 Strep Throat Test 220 Stuffy Nose 221 Swimmers Ear 222 Swimmers Itch 223 Thyroid Hormone Test - Thyroxine - T4 224 Thyroid Hormone Test - Triiodothyronine - T3 225 Thyroid-Stimulating Hormone Test - TSH 5
226 Tuberculosis - TB Test 227 Ultrasound - Abdomen 228 Ultrasound - Breasts 229 Ultrasound - Pelvic - via Abdominal Wall 230 Ultrasound - Pelvic - via Vagina 231 Ultrasound - Pregnancy 232 Ultrasound - Rear of Abdomen 233 Uric Acid Test 234 Urinalysis - Automated Urine Test 235 Urinalysis - Manual Urine Test 236 Urinary Tract - Bladder Infection 237 Urine Microalbumin Test 238 Urine Pregnancy Test 239 Urology - Specialist Visit 240 Uterus Exam - Hysterosalpingography 241 Uterus Exam with Biopsy 242 Vaccine - Chickenpox 243 Vaccine - Diphtheria, Tetanus, Pertussis - DTaP 244 Vaccine - Flu - Adult 245 Vaccine - Flu - Child 246 Vaccine - Hepatitis A - Adult 247 Vaccine - Hepatitis A - Child 248 Vaccine - Hepatitis B - Adult 249 Vaccine - Hepatitis B - Child 250 Vaccine - Hib 251 Vaccine - Human Papillomavirus - HPV 252 Vaccine - Measles, Mumps, Rubella - MMR 253 Vaccine - Meningitis 254 Vaccine - Pneumonia 255 Vaccine - Polio 256 Vaccine - Rotavirus 257 Vaccine - Shingles 258 Vaccine - Tetanus - Td 259 Vaccine - Tetanus, Diphtheria, Pertussis - TdaP 260 Vitamin D Test 261 Wellness Visit - Established Female Patient - Age 12-17 262 Wellness Visit - Established Female Patient - Age 18-39 263 Wellness Visit - Established Female Patient - Age 40-64 264 Wellness Visit - Established Male Patient - Age 12-17 265 Wellness Visit - Established Male Patient - Age 18-39 266 Wellness Visit - Established Male Patient - Age 40-64 267 Wellness Visit - Established Patient - Age 1-4 268 Wellness Visit - Established Patient - Age 5-11 269 Wellness Visit - Established Patient - Age Less Than 1 270 Wellness Visit - Established Patient - Female Age 65 and Over 6
271 Wellness Visit - Established Patient - Male Age 65 and Over 272 Wellness Visit - New Female Patient - Age 12-17 273 Wellness Visit - New Female Patient - Age 18-39 274 Wellness Visit - New Female Patient - Age 40-64 275 Wellness Visit - New Male Patient - Age 12-17 276 Wellness Visit - New Male Patient - Age 18-39 277 Wellness Visit - New Male Patient - Age 40-64 278 Wellness Visit - New Patient - Age 1-4 279 Wellness Visit - New Patient - Age 5-11 280 Wellness Visit - New Patient - Age Less Than 1 281 Wellness Visit - New Patient - Female Age 65 and Over 282 Wellness Visit - New Patient - Male Age 65 and Over 283 X-ray Abdomen 284 X-ray Ankle - 3 Views 285 X-ray Cervical Spine 286 X-ray Chest - 2 Views 287 X-ray Chest - Single View 288 X-ray Fingers - 2 Views 289 X-ray Foot - 3 Views 290 X-ray Hand - 3 Views 291 X-ray Hip - 2 Views 292 X-ray Knee 293 X-ray Lumbar Spine 294 X-ray Shoulder - 2 Views 295 X-ray Wrist - 3 Views 7