BIOPSY 19103L-MR MV MR Guided Breast Biopsy, Vac Assist - LT 19103, 77021, 10022, 19295, 90772, A4550, 99000 19103L-ST MV Stereotactic Breast Biopsy, Vac Assist - LT 19103, 77031, 10022, 19295, 90772, A4550, 99000, 76098 19103L-US MV US Guided Breast Biopsy, Vac Assist - LT 19103, 76942, 10022, 19295, 90772, A4550, 99000, 76645 21550 US Guided Face and Neck Biopsy (FNA) 21550, 76536, 76942, 90772, A4550, 99000 60100 US Guided Thyroid Biopsy 60100, 60001, 76536, 76942, 90772, A4550, 99000 19102L-MR MV MR Guided Breast Biopsy - LT, Non-Vac Assist ***TRADITIONAL*** 19102, 77021, 10022, 19295, 90772, A4550, 99000 19102L-ST MV Stereotactic Breast Biopsy - LT, Non-Vac Assist ***TRADITIONAL** 19102, 77031, 10022, 19295, 90772, A4550, 99000, 76098 19102L-US MV US Guided Breast Biopsy - LT, Non-Vac Assist ***TRADITIONAL*** 19102, 76942, 10022, 19295, 90772, A4550, 99000, 76645 ASPIRATION 10022L-MV RF guided Hip Injection Aspiration - LT 10022, 77002, 27095, Q9949, 90772, A4550, 99000 19000L-US US Guided Cyst Aspiration, Breast; and Fine Needle Asp - LT 19000, 10022, 76645, 76942, 90772, A4550, 99000 19001 Puncture Aspiration of cyst of breast; each Additional Cyst 60001 US Guided Fine Needle Aspiration (Biopsy) of Thyroid 60001, 76536, 76942, 90772, A4550, 99000 ARTHROGRAM 73202LA-LR Shldr CT Arthrogram of Shoulder w/wo con - LT, CT Guided 73202, 23350, Q9949, 90772, A4550, 77012 73223LA-LR Elbow MR Arthrogram of Elbow w/wo con - LT, CT Guided 73223, 24220, Q9949, 90772, A4550, 77012 73223LA-LR Shldr MR Arthrogram of Shoulder w/wo con - LT, CT Guided 73223, 23350, Q9949, Q9952, 90772, A4550, 77012 73223LA-LR Wrist MR Arthrogram of Wrist w/wo con - LT, CT Guided 73223, 25246, Q9949, Q9952, 90772, A4550, 77012 73723LA-LR Ankle MR Arthrogram of Ankle w/wo con, Unilat, CT Guided 73723, 27648, Q9949, Q9952, 90772, A4550, 77012 73723LA-LR Hip MR Arthrogram of Hip w/wo con, Unilat, CT Guided 73723, 27095, Q9949, Q9952, 90772, A4550, 77012 73723LA-LR Knee MR Arthrogram of Knee w/wo con, Unilat, CT Guided 73723, 27370, Q9949, Q9952, 90772, A4550, 77012 73202LA-MV Shldr CT Arthrogram of Shoulder w/wo con - LT, RF Guided 73202, 23350, Q9949, 90772, A4550, 77012 73223LA-MV Elbow MR Arthrogram of Elbow w/wo con, Unilat RF Guided 73223, 24220, Q9949, Q9952, 90772, A4550, 77002 73223LA-MV Shldr MR Arthrogram of Shoulder w/wo con - LT, RF Guided 73223, 23350, Q9952, Q9949, 90772, A4550, 77002 73223LA-MV Wrist MR Arthrogram of Wrist w/wo con - LT, RF Guided 73223, 25246, Q9949, Q9952, 90772, A4550, 77002 73542LA-MV RF Arthrogram of Sacroiliac Iliac Joint - LT (eg Pain Mgmt) 73542, 27096, Q9949, 90772, A4550, 77002 73723LA-MV Ankle MR Arthrogram of Ankle w/wo con, Unilat, RF Guided 73723, 27648, Q9949, Q9952, 90772, A4550, 77002 73723LA-MV Hip MR Arthrogram of Hip w/wo con, Unilat, RF Guided 73723, 27095, Q9949, Q9952, 90772, A4550, 77002 73723LA-MV Knee MR Arthrogram of Knee w/wo con, Unilat, RF Guided 73723, 27370, Q9949, Q9952, 90772, A4550, 77002 73040LA-MV RF Arthrogram of Shoulder - LT ***TRADITIONAL*** 73040, 23350, Q9949, 90772, A4550, 77002 73085LA-MV RF Arthrogram of Elbow - LT ***TRADITIONAL*** 73085, 24220, Q9949, 90772, A4550, 77002 73115LA-MV RF Arthrogram of Wrist -LT (1..3 Inj 25246) ***TRADITIONAL*** 73115, 25246, Q9949, 90772, A4550, 77002 73525LA-MV RF Arthrogram of Hip - LT ***TRADITIONAL*** 73525, 27095, Q9949, 90772, A4550, 77002 73580LA-MV RF Arthrogram of Knee - LT ***TRADITIONAL*** 73580, 27370, Q9949, 90772, A4550, 77002 73615LA-MV RF Arthrogram of Ankle - LT ***TRADITIONAL*** 73615, 27648, Q9949, 90772, A4550, 77002 MYELOGRAM 72126-LR Myelogr CT Myelogram C-Spine, CT Guidance, Lumbar Puncture 72126, 62284, Q9949, 90772, A4550, 77012, 76376 72129-LR Myelogr CT Myelogram T-Spine, CT Guidance, Lumbar Puncture 72129, 62284, Q9949, 90772, A4550, 77012, 76376 72132-LR Myelogr CT Myelogram L-Spine, CT Guidance, Lumbar Puncture 72132, 62284, Q9949, 90772, A4550, 77012, 76376 72126-MV Myelogr CT Myelogram C-Spine, RF Guidance, Lumbar Puncture 72126, 62284, Q9949, 90772, A4550, 77002, 72240, 76376 72129-MV Myelogr CT Myelogram T-Spine, RF Guidance, Lumbar Puncture 72129, 62284, Q9949, 90772, A4550, 77002, 72255, 76376 72132-MV Myelogr CT Myelogram L-Spine, RF Guidance, Lumbar Puncture 72132, 62284, Q9949, 90772, A4550, 77002, 72265, 76376 72240-MV RF Myelogram C-Spine, Lumbar Puncture ***Traditional*** 72240, 62284, Q9949, 90772, A4550 72255-MV RF Myelogram T-Spine, Lumbar Puncture ***Traditional*** 72255, 62284, Q9949, 90772, A4550 72265-MV RF Myelogram L-Spine, Lumbar Puncture ***Traditional*** 72265, 62284, Q9949, 90772, A4550 72270-MV RF Myelogram Complete Spine, Lumbar Puncture ***Traditional*** 72270, 62284, Q9949, 90772, A4550 EXAMS_2007-08-01 Page 1/5 SORTED - NUMERIC
CT 62273 CT guided epidural inj, blood or clot patch 62273, 62270, 77012, 36410, 62273, A4550 70460 CT Head w/ con 70460, Q9949, 36000, A4550 70470 CT Head w/wo con 70470, Q9949, 36000, A4550 70480O CT Orbits, Sella or posterior fosa 70480, 76376 70480T CT Temp Bones 70480, 76376 70481O CT Orbits, sella or posterior fossa w/ con 70481, 76376, Q9949, 36000, A4550 70481T CT Temp Bones w/ con 70481, 76376, Q9949, 36000, A4550 70482O CT Orbits, sella or posterior fossa w/wo con 70482, 76376, Q9949, 36000, A4550 70482T CT Temp Bones w/wo con 70482, 76376, Q9949, 36000, A4550 70486F CT Maxillofacial (maxilla, mandible) 70486, 76376 70486S CT Sinus 70486, 76376 70487F CT Maxillofacial (maxilla, mandible) w/ con 70487, 76376, Q9949, 36000, A4550 70487S CT Sinus w/ con 70487, 76376, Q9949, 36000, A4550 70488F CT Maxillofacial (maxilla, mandible) w/wo con 70488, 76376, Q9949, 36000, A4550 70488S CT Sinus w/wo con 70488, 76376, Q9949, 36000, A4550 70490 CT Neck 70490, 76376 70491 CT Neck w/ con 70491, 76376, Q9949, 36000, A4550 70492 CT Neck w/wo con 70492, 76376, Q9949, 36000, A4550 70496 CT Angio Head w/wo con 70496, Q9949, 76376, 36000, A4550 70498 CT Angio Neck w/wo con 70498, Q9949, 76376, 36000, A4550 71250 CT Chest 71250, 76376 71260C CT Chest w/ con 71260, Q9949, 76376, 36000, A4550 71260CAP CT Chest/Abd/Pel w/ con 71260, 74160, 72193, Q9949, 76376, 36000, A4550 71270 CT Chest w/wo con 71270, Q9949, 76376, 36000, A4550 71270CAP CT Chest Abd & Pelvis w/wo con 71270, 74170, 72194, Q9949, 76376, 36000, A4550 71275 CT Angio Chest w/wo con 71275, Q9949, 76376, 36000, A4550 72125 CT Cervical Spine 72125, 76376 72126 CT C-Spine w/ con (Cervical Spine) 72126, Q9949, 76376, 36000, A4550 72127 CT Cervical Spine w/wo con 72127, Q9949, 76376, 36000, A4550 72128 CT Thoracic Spine 72128, 76376 72129 CT Thoracic Spine w/ con 72129, Q9949, 76376, 36000, A4550 72130 CT Thoracic Spine w/wo con 72130, Q9949, 76376, 36000, A4550 72131 CT Lumbar Spine 72131, 76376 72132 CT Lumbar Spine w/ con 72132, Q9949, 76376, 36000, A4550 72133 CT Lumbar Spine w/wo con 72133, Q9949, 76376, 36000, A4550 72191 CT Angio Pelvis w/wo con 72191, Q9949, 76376, 36000, A4550 72192 CT Pelvis 72192, 76376 72193 CT Pelvis w/ con 72193, 76376, Q9949, 36000, A4550 72194 CT Pelvis w/wo con 72194, 76376, Q9949, 36000, A4550 73200L-Elbow CT Elbow - LT 73200, 76376 73200L-Finger CT Finger - LT 73200, 76376 73200L-ForArm CT Forearm (Radius / Ulna) - LT 73200, 76376 73200L-Hand CT Hand - LT 73200, 76376 73200L-Shldr CT Shoulder - LT 73200, 76376 73200L-UprArm CT Upper Arm (Humerus) - LT 73200, 76376 73200L-Wrist CT Wrist CT Upper Arm (Humerus) - LT 73200, 76376 EXAMS_2007-08-01 Page 2/5 SORTED - NUMERIC
CT - Cont'd 73201L-Elbow CT Elbow w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-Finger CT Finger w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-ForArm CT Forearm (Radius / Ulna) w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-Hand CT Hand w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-Shldr CT Shoulder w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-UprArm CT Upper Arm (Humerus) w/ con - LT 73201, 76376, Q9949, 36000, A4550 73201L-Wrist CT Wrist w/ con - LT 73201, 76376, Q9949, 36000, A4550 73202L-Elbow CT Elbow w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-Finger CT Finger w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-ForArm CT Forearm (Radius/Ulna) w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-Hand CT Hand w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-Shldr CT Shoulder w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-UprArm CT Upper Arm (Humerus) w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73202L-Wrist CT Wrist w/wo con - LT 73202, 76376, Q9949, 36000, A4550 73206 CT Upr Extremity w/ con, Angio 73206, Q9949, 76376, 36000, A4550 73700L-Ankle CT Ankle - LT 73700, 76376 73700L-Foot CT Forefoot - LT 73700, 76376 73700L-Hip CT Hip - LT 73700, 76376 73700L-Knee CT Knee - LT 73700, 76376 73700L-LwrLg CT Lower Leg - LT 73700, 76376 73700L-Thigh CT Thigh - LT 73700, 76376 73701L-Ankle CT Ankle w/ con - LT 73701, 76376, Q9949, 36000, A4550 73701L-Foot CT Forefoot w/ con - LT 73701, 76376, Q9949, 36000, A4550 73701L-Hip CT Hip w/ con - LT 73701, 76376, Q9949, 36000, A4550 73701L-Knee CT Knee w/ con - LT 73701, 76376, Q9949, 36000, A4550 73701L-LwrLg CT Lower Leg w/ con - LT 73701, 76376, Q9949, 36000, A4550 73701L-Thigh CT Thigh w/ con - LT 73701, 76376, Q9949, 36000, A4550 73702L-Ankle CT Ankle w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73702L-Foot CT Forefoot w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73702L-Hip CT Hip w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73702L-Knee CT Knee w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73702L-LwrLg CT Lower Leg w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73702L-Tight CT Tight w/wo con - LT 73702, 76376, Q9949, 36000, A4550 73706 CT Lower Ext w/ con, Angio 73706, Q9949, 76376, 36000, A4550 74150 CT Abdomen 74150, 76376 74150P CT Abdomen/Pelvis 74150, 72192, 76376 74160 CT Abdomen w/ con 74160, Q9949, 76376, 36000, A4550 74160P CT Abdomen/Pelvis w/ con 74160, Q9949, 72193, 76376, 36000, A4550 74170 CT Abdomen w/wo con 74170, Q9949, 76376, 36000, A4550 74170P CT Abdomen w/wo con, Pelvis w/ con ONLY 74170, Q9949, 72193, 76376, 36000, A4550 74170PP CT Abdomen/Pelvis w/wo con 74170, Q9949, 72194, 76376, 36000, A4550 74170U CT UROGRAM, Axial abdomen w/wo con 74170, 72194, 76376, Q9949, 36000, A4550 74175 CT Abdomen w/wo con, Angio 74175, Q9949, 76376, 36000, A4550 75635 CT Angio Aorta with Runoff 75635, Q9949, 76376, 36000, A4550 EXAMS_2007-08-01 Page 3/5 SORTED - NUMERIC
MR 70542 MR Orbit / Face / Neck w/ con 70542, Q9952, 36000, A4550 70543 MR Orbit / Face / Neck w/wo con 70543, Q9952, 36000, A4550 70545A MR Angiography, COW w/ con 70545, Q9952, 36000, A4550 70545V MR Venography, Head, w/ con 70545, Q9952, 36000, A4550 70546A MR Angiography, COW, w/wo con 70546, Q9952, 36000, A4550 70546V MR Venography, Head; w/wo con 70546, Q9952, 36000, A4550 70552 MR Brain w/ con 70552, Q9952, 36000, A4550 70553 MR Brain w/wo con 70553, Q9952, 36000, A4550 70553-MV IAC MR IAC`s w/wo con 70553, Q9952, 36000, A4550 70553-MV Pituit MR Pituitary w/wo con 70553, Q9952, 36000, A4550 71551 MR Chest w/ con 71551, Q9952, 36000, A4550 71552 MR Chest w/wo con 71552, Q9952, 36000, A4550 71552BP MR BRACHIAL PLEXUS 71552, Q9952, 36000, A4550 72142 MR Cervical Spine w/ con 72142, Q9952, 36000, A4550 72146 MR Thoracic Spine 72146, 76376 72147 MR Thoracic Spine w/ con 72147, Q9952, 76376, 36000, A4550 72148 MR Lumbar Spine 72148, 76376 72149 MR Lumbar Spine w/ con 72149, 76376, Q9952, 36000, A4550 72156 MR Cervical Spine w/wo con 72156, Q9952, 36000, A4550 72157 MR Thoracic Spine w/wo con 72157, Q9952, 76376, 36000, A4550 72158 MR Lumbar Spine w/wo con 72158, 76376, Q9952, 36000, A4550 72196 MR Pelvis w/ con 72196, Q9952, 36000, A4550 72197 MR Pelvis w/wo con 72197, Q9952, 36000, A4550 73219L-ForArm MR Forearm (Radius / Ulna) w/ con - LT 73219, Q9952, 36000, A4550 73219L-Hand MR Hand w/ con - LT 73219, Q9952, 36000, A4550 73219L-UprArm MR Upper Arm (Humerus) w/ con - LT 73219, Q9952, 36000, A4550 73220L-ForArm MR Forearm (Radius/Ulna) w/wo con - LT 73220, Q9952, 36000, A4550 73220L-Hand MR Hand w/wo con - LT 73220, Q9952, 36000, A4550 73220L-UprArm MR Upper Arm (Humerus) w/wo con - LT 73220, Q9952, 36000, A4550 73222L-Elbow MR Elbow w/ con - LT 73222, Q9952, 36000, A4550 73222L-Finger MR Finger w/ con - LT 73222, Q9952, 36000, A4550 73222L-Shldr MR Shoulder w/ con - LT 73222, Q9952, 36000, A4550 73222L-Wrist MR Wrist w/ con - LT 73222, Q9952, 36000, A4550 73223L-Elbow MR Elbow w/wo con - LT 73223, Q9952, 36000, A4550 73223L-Finger MR Finger w/wo con - LT 73223, Q9952, 36000, A4550 73223L-Shldr MR Shoulder w/wo con - LT 73223, Q9952, 36000, A4550 73223L-Wrist MR Wrist w/wo con - LT 73223, Q9952, 36000, A4550 73719L-Foot MR Forefoot w/ con - LT 73719, Q9952, 36000, A4550 73719L-LwrLg MR Lower Leg (Tibia / Fibula) w/ con - LT 73719, Q9952, 36000, A4550 73719L-Thigh MR Femur (Thigh) w/ con - LT 73719, Q9952, 36000, A4550 73720L-Foot MR Forefoot w/wo con - LT 73720, Q9952, 36000, A4550 73720L-LwrLg MR Lower Leg (Tibia / Fibula) w/wo con - LT 73720, Q9952, 36000, A4550 73720L-Thigh MR Femur (Thigh) w/wo con - LT 73720, Q9952, 36000, A4550 73722L-Ankle MR Ankle (Hindfoot) w/ con - LT 73722, Q9952, 36000, A4550 73722L-Hip MR Hip w/ con - LT 73722, Q9952, 36000, A4550 73722L-Knee MR Knee w/ con - LT 73722, Q9952, 36000, A4550 EXAMS_2007-08-01 Page 4/5 SORTED - NUMERIC
MR - Cont'd 73723L-Ankle MR Ankle (Hindfoot) w/wo con - LT 73723, Q9952, 36000, A4550 73723L-Hip MR Hip w/wo con - LT 73723, Q9952, 36000, A4550 73723L-Knee MR Knee w/wo con - LT 73723, Q9952, 36000, A4550 74182 MR Abdomen w/ con 74182, Q9952, 36000, A4550 74183 MR Abdomen w/wo con 74183, Q9952, 36000, A4550 77058L-MV MR Breast Unilateral w/wo con - LT 77058, Q9952, 36000, A4550, 76350, 76376 77059C-MV MR Breast/Chest Bilateral; w/wo con 77059, Q9952, 76376, 76350, 71552, 36000, A4550 77059-MV MR Breast Bilateral, w/wo con 77059, Q9952, 76376, 76350, 36000, A4550 77059N-MV MR Breast Bilateral w/o con 77059, 76376 70547 MRA Neck (Carotids) 70547, 76350, 76376 70548 MRA Neck (Carotids) w/ con 70548, 76350, 76376, Q9952, 36000, A4550 70549 MRA Neck (Carotids) w/wo con 70549, 76350, 76376, Q9952, 36000, A4550 71555 MRA Chest w/wo con 71555, Q9952, 76350, 36000, A4550 72198-MV MRA Pelvis w/wo con 72198, Q9952, 76350, 36000, A4550 73225 MRA Upr Ext, w/wo con 73225, 76350 73725 MRA Low Ext w/wo con 73725, Q9952, 76350, 36000, A4550 74185 MRA Abdomen w/wo con 74185, Q9952, 76350, 36000, A4550 U/S 93925 US Duplex Scan Lower Ext Arteries (Complete Bilateral) 93925, 93922 93926L US Duplex Scan Lowwr Ext Arteries - LT 93926, 93922 93930 US Duplex Scan Upper Ext Arteries (Bilateral) 93930, 93922 93931L US Duplex Scan Upper Ext Arteries - LT 93931, 93922 76831 US HysteroSonogram / SonohySterography (SIS) 76831, 58340, A4550 HESTERO 74740-MV RF Hysterosalopingogram 74740, Q9949, 58340, 36000, A4550 MISC 77053 Ductogram or Galactogram, Breast, Bilateral 19030, 77053, G0204, 36000, A4550 77053L Ductogram or Galactogram, Breast - LT 19030, 77053, G0206, 36000, A4550 77055L MG Diagnostic Mammo - LT ***Monarch CalOptima ONLY*** 77055, 77051 77056 MG Diagnostic Mammo; Bilateral ***Monarch CalOptima ONLY*** 77051, 77056 77057 MG Screening mammo, Bilateral ***Monarch CalOptima ONLY*** 77052, 77057 62273-MV RF guided epidural inj, blood or clot patch 62273, 62270, 77002, 36410, 62273, A4550 72285-MV RF Cervical / Thoracic Diskogram, each level 72285, 62291 72295-MV RF LUMBAR Diskogram, each level 72295, 62290 74415-MV RF IVP, drip and/or bolus techniques 74415, Q9949, 36000, A4550 74430-MV RF Cystogram 74430, 58340, Q9949, 36000, A4550 74450-MV RF Retro Cystourethrogram 74450, 58340, Q9949, 36000, A4550 74455-MV RF VCUG 74455, 58340, Q9949, 36000, A4550 76125-MV Cervic RF Spine Cineradiography/Videofluoroscopy; CERVICAL Complement 76125, 72052 76125-MV Lumbar RF Spine Cineradiography/Videofluoroscopy; LUMBAR Compl Flex/Ext 76125, 72114 76775 US Abdomen, Retroperitoneal (eg, renal, aorta, nodes) 76775, 76857 76801 US OB 1st trimester (14 wks), Fetal & Mat Eval 76801, 76830 76856T US Pelvic (Complete) Trans-Vaginal & Trans-Abdominal 76856, 76830 EXAMS_2007-08-01 Page 5/5 SORTED - NUMERIC